HomeMy WebLinkAboutPREUSS #2 BLK 2 LT 11 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
JPHONE I ~_~N EW
MAILING ADDRESS / '
LEGAL DESCRIPTION
I Well I Absorption area f Dwelling _/ PERMIT NO.
~ ~ DISTANCE TO:I
/
~Z Manufacturer .~ Mater~~ · No. ofcompartmen~
Liq. capacity in galYons Inside length Width~ Liquid depth
/ DO~ IF HOME.DE:
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ DISTANCE TO: Well l~ ~ Foundation Nearest Io~i~e/.~__ PERMIT NO.
~ ~llO~ ~
Length of each line Total length of lines Trench width Distance bet e ' es
~ ~ ~ Top of tile to finish grade Material beneath tile Total eff~tive absorption~re=
Length Width Depth PERMIT NO,
~ h Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance Io lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(si
OTHER
PIPE MATERIALS
SOl L TEST RATING
REMARKS
[ ,/ .
APPROVED / DATE LEGAL
(Rev. 3/78) (
SULLIVAN WATER WELLS
P. O. BOX 272. CHUGIAK. ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND !/'~'
ADDRESS 70'~
LEGAL DESCRIFTION ¥ ~ 7' / /
DATE-Started
P£RMn NUMSER
Ended
DEPTH OF WELL / o /
STATIC LEVEL OF WATER FT.
DRAW DOWN FT. .~"
GALS. PER'HR ~ o O
~'~o
KIN'D OF CASING ~' v
KIND OF FORMATION:
From /
From
From / t Ft.
From : ':? Ft.
From ~:' ~"Ft.
From / '~ Ft.
From Mr c~' Ft.
From Ft.
From '-'.'~ Ft.
From Ft.
From Ft.
From Ft.
to '.' ':? Ft.
to ~-~-' Ft.
to /-:~' Ft.
to -7 ~ Ft.
to ~:" ~ ' Ft.
to Ft.
to /'.'~ ['Ft.
to "Ft.
From Ft. to__
to .... Ft.' ' ~ ' : * From Ft. to
From Ft. to ' Ft.
From ' Ft. to
From Ft. to Ft
From Ft. to,__Ft. '
· From Ft. to
From Ft.'to
From~Ft. to
· From~Ft. to
From Ft. to Ft.
From ~Ft. to Ft
Ft.
Ft.
Ft.
Ft,
Ft.
Ft.
Ft.
Ft..
Ft.
Ft
Ft.
Ft
Ft.
Ft.
Ft
M1SCL. INFORMATION:
- ~ -~C ~
DRILLER'S NAME "'~ ........
PERMIT NO.
I'.ILII'-.! I C I~""RL I TY OF R I"..IL-:-I-""~mF:R F~E
DEPRRTMENT u.-- HERLTH RND ENVIRONMENTRL!r'ROTECTION
B25 'L" STREET., RNCHORRGE, RK. 9_o..50i
264-4728
14ELL_ RI"WD Ob~--S I TE SEL-.IER
( 8±10_?.5 )
RPPLI CR[.~T 14RYr-E COUSINERU
LOCRTION DRVID ST
LEGRL L'll B2 PRUESS
PO BOX 76~ E.R.
LOT SIZE
F'ERr-1 ! T
694-~'140
TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH
MRMIMUM ['lUMBER OF BEDROOMS
SOIL RRTING (SD FT/BR>= 135
THE REOUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
DEPTH= 7' LEbl~3TH= 5-1 GRR',/EI DEPTH= 4
THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BET[,EEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE E~.,CRVRTION (IN FEET).
THERE IS NO SET ;4IDTH FOR TRENCHES.
THE GRR","EL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETI,.IEEN THE OUTFRLL PIPE
R[..ID THE BOTTOM OF THE EXCRVRTION (IN FEET).
REQLI I RE[.-" SEPT I C TR[,;~,,. S I ZF-- ~ E~E~O GRLLO~4S
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEF'RRTMENT DURING THE
INSTRLLATION INSPECTIONS OF R,~'~Y 14ELLS ADJACENT TO THIS PROPERTY AND. THE
NUMBER OF RESIDENCES THRT THE I,IELL WILL SERVE.
TI.I,D < 2 > I ~4SPE,~_.T I C, F45 RRE F:E~!.L! I RED
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT HILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETI,IEEN A I,IELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS
'100 FEET FOR R PRIVRTE WELL OR J. SC_.~ TO 2£~0 FEET FROM R PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC I,IELL.
MIr.~Ir,lur,1 DISTRNCE FROM R PRIVRTE I,IELL TO R PRIVRTE SEI,ER LINE IS 25 FEET RND
TO R COMMUNITY SEI,IER LINE IS 75 FEET.
I,IELL LOGS RRE REQUIRED RND MUST BE F.'.ETURNED TO THE DEPRRTMENT [,IITHIN _?.0 DRYS
OF THE I,IELL COMPLETION.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTION'--'; RND CONSTR. UCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
PERt4 I T E:~(P I RES C. FC:FI'.IBEF:
I CERTIFY THRT
l: I RM FRMILIRR I,IITH THE REQUIREMENTS FOR ON-SITE SEWERS RND ;4ELLS RS SET
FORTH BY THE r,IUNICIPRLITY OF RNCHORRGE
2: I ~,IILL INSTRLL THE SYSTEM IN RCCORDRNCE HITH THE CODES.
3: I UNDERSTRN[:, THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE Et.~LRRGEMENT IF THE
RESIDENCE IS REMODELE[;, TO INCLUDE MORE THRN .~ BEDROOMS.
V4. 0
8__
9~
10~
11__
12~
O & E ENG,NEERING & DEVELOI-MENT CO.
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Ru~ell Oytter
694-2774
Performed for:
Legal Description: Z/_4~-- //~ ~/._z~..~-- ~
Earl Ellis
SOIL LOG 688-22s0
Name: ./)/),g', ~.4 ~/~,)c--('~f~,,~'c--~ mel. No ~/-Z/~
Depth (feet)
Soil Cheraclerlstlc$
PLOT PLAN
13 __ ~t,/
14~
PERC. TEST
15__
16
Ground Water Encountered: Yes ~ No
Proposed Installation: Seepage Pit ,,.--*
Comments:
If yes, what depth
Drain Field.~
Performed by: '~~'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMEIITAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
1. GENERAL INFORMATION
Application Date August
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lbt":ll, Block 2 Pr~ess Subdv. T14N R1W Section 8
1986
Location (address or directions)
(b) Applicant Name Mike Legler Telephone: Home Business
AppIicantAddress '20610 David Ave. EaKle River, AK 99577
(c) Applicant is (check one): Lending Institution []; Owner/builder I~; Buyer []; Other [] (explain);
(d) Lending Institution Alaska StatebaBk Telephone
Address P,O, BOX 100240 Anchorage, AK 99510
(e) Real Estate Company and Agent N/A
Address
277-5661
Telephone
(f) Mail the HAA to the following address:
_~J~ineer
TYPE OF RESIDENCE
SingIe-Familyl'~ Multi-Family[]
Number of Bedrooms '~
Other
WATER SUPPLY
Individual Well E-"] Community [] Public []
Noto: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite I~1 Public [] Community []
Holding Tank []
Note: If community well system, must have written.confirmation from the State Department of Environmental Conservation
attesting to tho legality and status.
Page I of 2 72.o25 0~/84)
ENGINEERING FIRM PROVIDh,G INSPECTIONS, TESTS, FILE SEARCH, L,r, fA AND 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 tho 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, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm EAGLE RIVI:R FNC, I~JFFRI~R .(;FRVIP. I:R Telephone
Address EAGLE RIVER, AK 99577
....
6o
Approved A Disapproved Condition~J./
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health arid 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 engineer's work.
Page 2 of 2
72-025 (11/84)