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Home My WebLink AboutEAGLE CREST #1 TR B LT 17 F~!~N, ~' t'~% MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~t~--~ PHONE J~NEW MAILING ADDRESS LEGALDESCRiPTIO~~- ~ X /OS % ~( ~ LOCATION NO. OF BEDROOMS m ~ ~,~.c~o: "~"w/./Y/pm ~..,,,.. .~..,~.o. ~ We, ~ Foundati~ Nearest t ),n~ ~ ~ ~ ~ TOp of tile ,o finish grade Mg~r~, ~n,~h4le i.ches =~ Ty. of cr,b Crib diame~/~ Crib depth Total ef f~ti~ a~orption area m DISTANCE TO: ~ Class ~ ~ ~ '~Depth ~ Driller D~stence to lot line PERMIT ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(si OTHER REMARKS T 72-01~(~ 1/78) ~ PERMIT I"11_11'~ T C 1- PAL I T'~r' OF R/-ICHCtRRGE DEPARTMENT ~HEALTH AND ENVIRONMENTAL ~'XOTECTION 825 'L STREET, ANCHORRGE, 264-4720 Ot~--SITE 5EI4ER PERr~IT RPPLICRNT LOCRTION LEGRL RICHRRD W. LRRSON CRESTVIEW LiT TR B EAGLE CREST PO BOX ~0~2 E.R. LOT SIZE ~4-24~ 17820 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MA.~IMUM NUMBER OF BEDROOMS SOIL RRTING (SQ FT?BR>= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 4 LEt,IGTH= .~6 GRFI%,'EL DEPTH= THE LENGTH DIMEt~$ION IS THE LENGTH (IN FEET> OF THE TREHCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET>. THE TAFt-ICH I~IIDTH I5 5. e00 FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCRVATION (IN FEET>. REQU I RED SEPT 1- I~: TR[~II~-. --~ 1- .~E= '1000 GRLLOI'-,I_C; PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE ItISTALLATION IWSPECTIONS OF A~IY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T&-IO ( 2 ~' I I'-.ISPECT I 0~15 RRE RE~.U I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE HELL OR 450 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM R PRIVATE WELL TO 8 PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY APPLY. SPECIFICRTIONS AND CONSTRUCTION DIRGRRMS RRE AVAILABLE TO INSURE PROPER INSTALLATION. PEAr'11 T E×P I RES DECEMBER .?~-~ 1-c~*$1 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM I~l RCCORDRNCE WITH THE CODES. ~: I UNDERSTAND THRT THE ON-SITE 5EWER SYSTEM MAY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. FE. PJ'I [ T HO. ~r~F.~lr ,~ IF~_TH rt~lo EHYIR0~r~tmL P~.0TEcrIoN ( ~i0470 ) LO~ r ! ON 1_8~ll. LOt TYPE OF SOIL Ri~o~Prlo~l g~r~l~ [.s: oP~t[rF[8.o iI~$rrll_~riox KH'.=~EcrIoh~ ~c RNV I~lal_~ ~J~r Fo ~4l~ P~r',, ~) ~1~ -I t,lJJ~.~ ,~' P~:'SID[]'~ rl-~r ti+: ~I~L liEU_ ~ .I .HILL £t~'~TI=IU_ ~E ~r~r~ IN ~-P~ ti[~ T~ ~. ~,.~=_~~~~ .................. ~i~r/ ~i,~ tt i~o~ ...... ......... ~] ......... LEGAL DE~C~,PT,ON~ /--- l ? 1 2 3 4 5 0 7 g 10 11 12 13 14 15- 16 17, 18- 19- 20- SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 i-1 PERCOLATION TEST SOILS LOG - PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? ,F VES. ATW.AT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE m nutes/nch) PERMIT NO. r. iU~l v C I PAL I T¥ OF 8NCHOF<8GE DEPARTHENT /'~HEALTH AND ENVIRONHENTRL~='~OTECTION 025 2~4-4720 WELL PERI~ I T 800262 > APPLICANT LOCATION LEGAL RICHARD LARSON CRESTVIEW BOX 1072 EAGLE RIVER LOT SIZE 694-2466 22000 SQURRE FEET MINIHUH DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR R PRIVATE WELL OR i50 TO 200 FEET FROH R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINiMUI'I DISTRHCE FROH 8 PRIVATE WELL TO B PRIVATE SEWER LINE IS 25 FEET AND TO 8 COHHUNITY SEWER LINE IS 75 FEET. blELL LOGS ARE REQUIRED ~ND I'IUST be RETURNED TO THE DEPRRTHENT WITHIN 30 DAYS 0f THE WELL COHPLETION. OTHER REQUIREHENTS I'I~Y RPPL~. ~PECIFICRTION~ AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERI~I I t E~:P I RES DEC:EI~BER 3:::~ :L~80 I CERTIFY THAT .t: I RM FRHILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE I. IUNICIPRLITY OF ANCHORAGE. 2: I WILL IN_~TALL THE SYSTEM IN~CCORDRNCE WITH THE CODES. , : ....... · RPPLIC~NT RIC/~RD ~SON - V4. 0 ill', i '¥~.cHuGIAK~ ACASKA ,,' , .o ,!':.~ 688.3199 4b~[~";RILLING CO. WE SERVE ALL ALASKA POST OFFICE BOX 42 - CHUGIAK, ALASKA 99567 DAW- ' ESDED ....... Z..-.......Z ..-..,~ ~..'. ................................. KIND OF FORMATION: " FR M ................................................................................ ,,'--ruou'.'~ .......... : ........ '' FROM ...................... ~ . ' FROM '...'.;..~ .............. , -' FROM'. ......... ';; [FROM, ;;; .... FT. TO ...................... I'T ................................... FToTO ...................... FT .................................... FToTO ...................... FT .................................... FToTO ...................... Fl' .................................... FT. TO ...................... FT .................................... · MISCL, INFORMATION: KODIAK; ALASKA 486-4826 DEPTll OF WELL .............. ~,..d.7..~..7~... ..................................................... STATIC LEVEL OF WATER FT ....... /...5.~..T~.'.~......./.'.dL..4L~,: 1./.,~,~..'. ...... DRAW DOWN FT ...... ?.(?...2~ ................................................................. GALS. PER'IIR.....,.?...¢2. ,0......./.~,, '~.~..' .~.:. .................................................. ' '~- qr' .¢.....¢. KIND OF CASING .....~...L.t'. ........... .~....,,.~ ........................................... FROM ....................... FT. TO ....................... FT .................................. FROM ....................... FT. TO ........................ FT ................................. FRO.',! ...................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ...................... FT. TO ........................ FT ................................. FROM ..................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ........................ FT ................................. FROM ....................... FT. TO ....................... FT ......... FROM ....................... FT. TO ........................ FT ................................. DRILLER'S NA IE ....., ............... f..J ............. c..£:.{...~. ...... ';. ............................................ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH A'UTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION ":' (a) Legal Description (include lot, block, subdivision, section, townshil~, rangei Z/7 '7-/Ep.c"r- ~ ER&LE C~eE"c' .S[O. (b) Locatiop,,,~address or directions) , , App,,can H meP, Te,ephonelHoma Bus,ness Applicant Ad.dress ' ~ (c) {d) Lending Instilution (e) Real Estate Company and Agent Address ' ' Applicant is (check one):~.er~ding Institution I-I; Owner/builder/1~'; Buyer r'l; Other ri (explain); Telephone ' Telephone (f) ~ the HAA to the Iollowing address: s & s £r,a~em~g SRB 196x TYPE OF RESIDENCE $ing;e-Family~l~ Multi-Family [] Number of Bedrooms v~ Other WATER SUPPLY Individual Well[] Community[] Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~' Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (tll84) EtlGINEERING FIRM PROVIDI'"'~INSPECTIONS, TESTS, FILE SEARCH, D'""% J~ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigatic~n and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm $ 3,'S~nglnear~ Telephone Address SRB 196x Eagle Q, Iv~", iJed~l '~' Date .,.~_ ..~",.....,~O I~ 6. DHEP APPROVAL Approved for -,F/.,,,,~r.. bedrooms by ~ ' .,Date Approved Disapproved Conditional Terms ol Conditional Approval CAUTION ~. The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska, The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA/ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST o FEBRUARY 1984 264-4720 I~/NICIPALIT'i' OF JbEPT. OF Hr~L'tH &, ENVII~NI~NTAL P~OTECTION IAAR 0 7 lgSJJ Legal Description: Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Cased to Depth o] Grouting Pump Set At A/j~anitary Seal on Casing (Y/N) i..~[;)~pression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 8"~-'~'/ Standpipes (~.1~ Air-tight Caps~") Depression over Tank ~1~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /J'~- Size /'OO O No. of Compartments Foundation Cleanout ,..//2re Last Pumped '"~/~'r~ ; for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well ~Z-/~__.. To Property Line /~ ~ b"' To Water Main/Service Line /~ I/''' Course To Building Foundation ,e--~' J To Stream, Pond, Lake, or Major Drainage Comments ~ ~--- Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata · · * Date Ir~siall;ed.' ~" ~'"~ / Width of Field Square Feet of Absorption Area Depression over Field ~ Results of Last Adequacy Test ~'~ Separation Distance from Absorption Field: To Water-Supply Well ~ ~[,-4~ L [ ~.- TO Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field ~ Depth of Field Gravel Bed Thickness Standpipes Present (~)/J~. Date of Last Adequacy Test To Property Line /0 r I- To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions /Manhole/Acc~ss (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed Io all MOA and HAA guidelines in effect on the date of this inspection. Signed Company Eagle Receipt No. Date of Payment Amount: $ Date "~ "-~'""~ MOA No. Page 2 of 2 '~ DATE RECEIVED INSPECTION APPOINTMENTS DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAG~tuN ~/~ DEPARTMENT OF HEALTH&ENVIRONMENTAL PROLCON OF~ 825 L Strut - Anchora~, Ala~a ~,,~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER~ER FACILITIES "~ ~c/VED I I 5. LECtAL DESCRIPTION r~.~ 1'7 . ]oh~k 1~ £~h_ ~-r~-I- ~1~. STREET LOCATION ' "F'h ,'." ,L 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS r-1 One [] Four ~- r-I Two [] Five SINGLE FAMILY [] MULTIPLE FAMILY ~ Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL· COMMUNITY [] PUBLIC UTI LITY I~1 Other · ATTACH WELL LOG, A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) SEWAGE DISPOSAL SYSTEM ~ ,ND,V,DUA'/ON-S,TE" Iq yl [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72.010 (Rev. 6/79) . ' , THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] '13,VO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []FUBUCUTlUTY Connection Verified INSTALLER []SepticTank or I--IHolding Tank Size:~ I f Tank is homemade SOIt. S RATING give dimensions: TYPE OF TANK MANUFACTURER~ TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding~ ~ Tank Absorptiont//~d ~Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS -- B DROOMS [] APPROVED FOR r-I CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/?9)