HomeMy WebLinkAboutVALLEY VIEW ESTATES #1 BLK 1 LT 14oGRE/,
,iR ANCHORAGE AREA BOR~.JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska gg503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LEGAL DESCRIPTION
PHONE
SEPTIC TANK:
DISTANCE /~,)~)
FROM WELL
INSIDE LENGTH -- "
MANUFACTURER ~/-~-~'b~CJ /"~¢r~TERIAL )/-~,--~"~'~'~-~-~ COMPARTMENTS '
INSIDE WIDTH LIQUID DEPTH LIQUID CAPACIT _ _ ALLONS.
NEAREST LOT OF LINES
NUMBER OF LINES / DISTANCE BETWEEN LINES ~ TRENCH WIDTH~I'N. TOTAL EFFECTIVE
ABSORPTION AREA~ ~/O~'_/¢ SQ. FT. LENGTH OF EACH LINE - '
DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_ IN. ABOVE TILE IN.
WELL: .
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION LOT LINE SEWER LINE__ : TANK__ SYSTEM
CESSPOOL . OTHER SOU RCES
APPROVED_ DISAPPROVED REMARKS
DISTANCE FROM:
°,STANCES: 4~: ?'7 :
INSTALLED BY:
SEWER LINE DEPTH:
LOT SLOPE:
REMARKS:
Form EQ-032
DIAGRAM OF SYSTEM
DATE
'I:'I:-.IE: L.l:il:t'-,!l::!i'l'l:-I I:::, :[ I,'i[CF,i~.-:;:[ ON ]: '~; THE: I...ti:~F,II::iTH ,:: :l: I",l F:'EE:T ) OF:' 't'HI:E "i-I:~t[I::NCFI Of~: [::,l::~:l:l:[ NF' ]: Ei:L E:,.
-I'I-IE: I:)I:EF:"]'H I:31::: I:::[ 'T'F~:I%:I'.,II::::H 1:31:::: F']:T :[~; TH:liE D]::~;TI'-:INC:E: [3E:THE:E:!",! THEI: :iE;I...II:,]:F-F:IC:I:I:: O1:: THE:
J:iil:,~:OIJi~-~[:) Fff-,l[::, "t~HE:: I:~[CIT'T'C[i"i OF' -I"PIE: [~,'-'-:',Cla',,,'F:IT]:CJiq ,::]:N F'F:I:~':-I:'::,.
TFtE:F:[I:: ]::i~; NO :5[:::']' [,,I ]: !)'I"FI FI:)F~:
'I'HI:~: 12i[;~:l::l',,,'E:[~ I)E:i::'TI-] ]::~i; THE H ZI'.J,:[HI:~iH [:)E:I::'-FH OF' GI:;~:I::I',,.'I:I::I.. 13E:'T'I,.IEEI",I '['HI:~. OUTFf::tl..L F:']:F'E:
FINE:) THF.:' E~I:::FI:'T(:IH OF' THE: FZ,'.'.::C:FI'.,.'F:IT ]: OH
· . O fi' E GEOT~CHNICAL fi` DEVELC--?MENT
' ' ~ ,~/~'Box 90, Davis St., Eagle River, Alaaka 99577
"' , ' ' ~ 6~-2~4 or ~-22~
~-2~ 0~ LOG
Soils ~ Foundations
HatHng Address= ~ ~- ~* ~
Depth (feet).
CO.
Earl Ellis
68~-2280
Land Development
Tel. No. S~'-~?~
5ol] ~haractertstlc$
0
2
5
6
7
8
9
10
11
12
14
15
16
Ground Water Encountered: Yes
No / If yes, what depth
Proposed Installation:.
Comments:
Seepage Pit
Drain Fte~d
Performed by: Date:
./
M-W DRILLING, INC.
DRILLING LOG
Well Owner Jerry Watkins Use of We1! Domestic,
Location (address of: Township, Range, Section, if known; or distance main road' Lot 14 Block 1 Valley View Estates
Size of casing 6" Depth of Hole 225 feet Cased to 38.8 feet
Static water level 50 ft.. (~ (below) land surface. Finish of well (check one)
Screen ( ); Perforated ( ).
Describe screen or perforation N/A
open end (xx );
Well pumping test at 2~ gallons per (I~Y~[) (minute) for 1 hours with 1007o
of drawdown from static level.
Date of completion 5 / 30 / 77
Depth in feet from
ground surface
WELL LOG
Give details of formations penetrated, size of material, color and hardness
ft.
0 TO 2
2 TO 6
6 TO 8
8 _TO 36
36 .TQ 60
60 _TO 99
99 _TO, 130
130 .TQ 195
· 195 .TO 225
.TO.
.TO.
.TO.
__.TO
___TO
Casing stickup
Organics
RFCEIVFD
NOV 2 ooo
Sitty gravel, cobbly
Bedrock, gray
Bedrock, white~
Bedrock, gray >
Bedrock,
Bedrock, gray, water seaps in sporatic
Dept. Health & Human S~rviP..~e8
fractures through(
1--CUSTOMER
PERf'II T NI.).
r.)EI:'I::d;.'.]"hlE;'.,FF OF i.-IEF:ILTH FINE) ENVIF~'.Obg41:ZN]-FIL PFd]-I,'ECT~ON
825 '" L.
)
FII::'PI'_ i CRNT
I._CiC:FIT I ;]]iN
L E I,:iiFIL.
.:rE:]::~:i,:~'.'.? P.!FITI< I
1:3ERR'.¢ H ! I_.LC
I,..:L4 [3:1_ ',,,'FILL. I:::]'¢ ',,,'IEI.,.I E':-:;T
LOT SIZE
t269X:E; L:.,I,;!URRE FEE']''
t',l :[ iq :[ l',ilJl'd I}I:E;TFINI,:::E E:ETI.,IEEN R HELL FINI,) l::llq'T' ON-SITE 2;EI-qFIGE [):[SF'OS;r:II,.. S'-?STEH IS
:LI;:)EI FEET FOr.;'. I::1 PRI',,,'I::I']-E 141EL. L OR ;?.~F:il;~l I::'EE'T' I,-"OFR Fl PI._IBL. IC HELL..
HEI,LL LOI,-:i:::-:; FIRE REQI,..IlRE[:, FINE:, MU'!:;T E:E I;.:E]qJRNED ]"O 'THE [)EPFIRTMENT I4I"I.'HII'4 ]:C~ [.',FI'CS
OF THE 1.4ELL COHPLE'].'ICtIq.
:E;F'ECIFICFITION'.:_; FINL':, CONSTRUCTION DZRI,:~R, FIM'LC, FIRE R',,,'RIL. FIE[I,..E TO ZN~-;URE PROPER
I NS T RL.I.J::I'].' I
]: CL:I,RTIF:"T' THFIT
:1.: Z I::11"1 FFIHII,_IRR
FORTH E:"r' TH
;2': I HIL. I
THE
THE REQUIREMENT'-'~; POR ON-SITE :::';EI.,.IERS FIND HELL..S Ft~E;
3F' FINCHORRGE.
El'"l IN FII.]COF.'[:,FINCE I,,IITI4 "FHE CODES.
T '::;':%1 II[I) E:'T'. I:I-I'E .........
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF ~EALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Day phone
Address
/
Day phone
Day phone
o
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
· TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-O25 (Re¥ 1191) Fronl ~A ~21 ;
5. STATEMENT OF INSPECTION BY ENGINEER
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 application 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 investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes.
Phone
ordinances, and regulations in effect on the date of this inspection.
Name of Firm d:~ ~/----~'- ,,~'/~,'~//¢',¢,¢',"~,~'~
Address
Engineer's signature ~ .
DHHS SIGNATURE
~ Approved for
Disapproved.
bedrooms.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
? /
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DH HS does th is as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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 engineer's work.
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Z~' lZ// ~/~// //~/I¢~Y'//¢/~w ~'~ -~''~'' Parcel I.D.
A. WELL DATA
Well type /2,~, r./4-'7~ If A, B, 3r C, attach ADEC letter.,--~ ,z_ADEC w~ter system number /V',/~,
Log present (Y/N) /V / Date completed .?~ ~/{'j'i 7 Driller
Total depth ~.3..~"- ~ Cased to -~<~' ~' Casing height .2,¢
Sanitary seal (Y/N) ?' Wires properly protected (Y/N) ~'
FROM WELL LOG AT INSPECTION
Date of test ' ~/~¢//'7 ? /°/t7/?~.--
Static water level ;~'~ //¢ ~ ~/
Well flow .3--//¢~ g.p.m. J&/~ dU
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Public sewer service line /kJ~ /~ ,
WATER SAMPLE RESULTS:
Coliform ~) Nitrate
Date of sample: I~./'"G/~'
B. SEPTIC/HOLDING TANK DATA
Date installed 7-/~ - ~ ~ Tank size
Cleanouts (Y/N)
High water alarm (Y/N) /V
Date of pumping /~//¢//'~"/ ~-~
/ /
g.p.m.
Collected by:
; On adjacent lots
; On adjacent lots ,;7. ~
.
Pubhc sewer manhole/cleanout /~'
Other bacteria
/ 2-5-0
Compartments
Depression (Y/N) '/V/
Foundation cleanout (Y/N)
Surface water/drainage
Alarm tested (Y/N) /Y/
SEPARATION DISTANCES FROM ,~E15TIC/HOLDiNG TANK TO:
Well(s) on lot / ~/~) '~'~ nadjacentlots ~g?~" Foundation ,/~2~P ---~
To property line oO-~A ¢- Absorption field ~ / Water main/service line /E:)(p ._/L
72-026 (Re','. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Manufacturer
Size in gallons
Manhole/Access (Y/N)
Vent (Y/N)
"Pump on" level at
"Pump off" level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length /"//~ Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
J
Soil rating
Gravel thickness 7
Cleanouts present (Y/N)
Date of adequacy test
for
System type
Total depth
if yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ,//
To building foundation
On adjacent lots
Surface water ~/./~
Curtain drain
On adjacent lots ~O¢ ¢'- Property line
. To existing or abandoned system on lot
Cutbank /2- Water main/service line
Driveway, parMng/vehicle storage area
/¢)¢ y-
,5
bedrooms
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
ignature
Engineer's Name
Date
HAA Fee $ /7
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA
Waiver Fee: $
Date of Payment
Receipt Number
'~-~--~ '~J ~ '~'-'~'"11~ ~' I~l'e Ii
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH &
825 L Street - Anchorage,~Alaska 99501 I=i~ViRONMENTAL pROTECTION
ENVIRONMENTAL ENGINEERING DIVISION OCT 2 5 1978
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
MAILING ADDRESS
PROPERTY RESIDENT (If different from above)
PHONE
PHONE
PHONE
2. BUYER
MAILING ADDRESS
3. LENDING INSTITUTION
MAILING ADDRESS
4. REALTOR/AGENT
PHONE
PHONE
MAILING ADDRESS
9. LEGAL DESCRIPTION
STR E E~I~OCAT~N~
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four [] Other
~ SINGLE FAMILY ~[L Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY
~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled
[] COMMUNITY since June 1975. For wells drilled prior to that date, give well
[] PUBLIC UTI LITY depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTI LITY
If individual/on-site, give installation date
If system is over two (2) years old an adequacy test is required
by this Department.
72-010(3/78)
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
~ i '. THI~ SIDE FOR OFFICIAL USE ONLY
DATE RBCEIVED
INSPECTION APPOINTMENTS
TiME TIME TIME
CATE CATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
. [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMrLY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
c PU UC UT.,TY '] --7 ]
Connection Verified. INSTALLER
[]Septic]T.~n~F...~r ~]Holding Tank
Size: / ,~.~ ~' If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURE~ ~ ,.~,.,j._
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELL TO: Septic/Holding Tah~ Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
~ APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title) /~' )
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
LOT \PLATFORM
~m ..' '.. ~...
. : ..~ ,~ ¢, ..
-
0 0
EXCLUSI~ NOTE:
~reon ~ used F~ consLruc~t~ ~ F~ esE~ bo~ or Fence ~s.
ASBU[LT CERTIFICATE:
~'~ SecL~on Township: Ron~e:
SAMPLE DATA SHEET
PROJECT:
LOCATION OF WELL (Le~'l Description):
continuation sheet for Class A &. B)
WELL DEPTH: ~P-~:~FT. CASING:
?
DATE DRI~L,,~ CO.P,E?:, ~/~/~7
STATIC WATER LEVEL (~p of C~sing): /~-~ FT DATE':
3f~, ~F' FT SCREEN:
Elapsed Time Since
Clock PumPing Started/ epth to Drawdown/ Pumping Remarks
· Time Stopped, Min.' i'ater, ft. Recovery Rate, GPM
.RECOVER~
t 0 t' ]~ 0 t/t'
5
15
20
Comments: ~ ·"
SAMPLE DATA SHEET
PROJECT:
LOCATION OF WELL (Legal Description): L/q
WELL DEPTH: ! FT. CASING:
DATE DRILLING COMPLETrD:
STATIC WATER LEVEL (T~p of Casing):~
(use continuation sheet for Class A &.B)
X
~T~,~y' :~'--~"~/~-~,~ ~.-7'-//~/5 DATE OF TEST:
FT SCREEN:,
DRILLER:
Elapsed Time Since _'-;
Clock Pumping Started/ J)epth to Drawdown/ Pumping Remarks
.Time Stopped, Min. Water, ft. Recovery Rate, GPM
~ ~:: ( swl ) 0 0 Start
[20 (2 hours)
180 (3 hours)
240 (4 hours)
FT DATE:
ADEQUAOY TES~
DATE TEST COMPLETE
CLIENT'S NAt~E, '~"-,¢/uc;/
ADDRESS
PRoPERTy LEGAL DESORIPTION~ ~
SHEET / OF.//
STEVEN E. FLODIN,P.E.
TEST DATA
TIME GPM ACCUM TOTAl
/' ~ALLONS
o
31 ·
[dATER HT WATER HT COMMENTS
IN. TANK PIT/FLD
, ~ ~,'10
TEST PERFORNED BY: