HomeMy WebLinkAboutT15N R1W SEC 8 LT 65B
~IAI LING ADDR ESS
MU N(I)Cl PA LI TY OF'ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage;, Alaska 99501 Telephone ;264-4720
ON-SITE SEWAGE DISPOSAl. SYSTEIVl AND/QR WELL INSPECTION REPORT
DISTANCE TO:
UWell/O~ I Absorptio~'are~.~,' t. Dwell ing
Inside length
IF HOMEMADE:
NO. OF BEDROOMS
Liquid d.~epth~...~-
DISTANCE
Dwelling
NO.
DISTANCE TO: Well
No, of lines / Lengl
Top of tile to finish grade
Foundatior~O .//. Nearest lot lin,
Total Trench wid
Material beneath
Length
Type of crib
)th
Crib depth
Total effectiv .¢~sC~t~ area
PERMIT NO,
Total effective absorption area
Well Building foundation ;t lot line
DISTANCE TO:
Distance to lot line
Building Sewer line Septic tank
OTHER
PIPE MATERIALS p(~ ~\ ¢~
SO,'TE T.A ,N ¢
INSTALLER
72-O~(R~ev, 3/78)
DATE
LEGAL
I)E:f:'FIf;:THENT Cfi- ~IEFILTH FIND EN'v'
FIPF::'J..IC:FINT RENFI .Al
LX)CFI'T' I ON NORTH Et I FRCHI.,K:'3D I,.OOF:'
I..E~3Ffl._ "~ ........ :'
L :,... [, '"""'
.... :":'-;':" '- ':' ' ....... ' '- "
...... , · :,:",
THE REQLIIF;?,Eb SIZE Of THE SOIL. RF3SORPTION S'¥'S'FEH
THE: l. Eh,lC:i'l"f.I D:[ HENS I ON I :/..; THEE: LE!:I'.,16TH ,:: I N F'EiET), OF' -I"HE: I'Fa'.Ei:NC:H OF'. f)f:~:F:l I I'.,IF':[ EL.P.
THE: E:,[::PTH OF I::1 "FRENC:H OR r:'IT IS THE E:,ISTFINCE E:ET!.,JEEN "FHI:: SL.If;~tFFIC:I!:: 01'r TIdE
GI?CiLII'.,t[::, FIN[) THE BOTTOH OF THE: E:',:-:',C:FI'v'F:ITION
'f'HE{f7:E I:5 NO SET blIl';,-Fbl FOR
THE: lYjlq'.i::'lYi(:~[.. [::,E:PTH IS THE HI i",IIPILIbl OEPTH OF' 13f,iff-T,,,'EL. E:E"I'.t,.IEfEN TI'II!:: OUTFFIL.L. /:'IF'E:
FINE:, THE: E:OTTC$1 OF Tlq['~ I:FJi:':',['J:FI'v'FITI r:d',,I
PEF:.'H I T FIPF'L I CFINT HFtS Tf IE RESPCINS I [2: I L I T"t TO I NF:'CIFe. PI TH I S BEF:'FIRI'f"I[~:I",I"I' I'::,L.IR I NC:i "FI IlS
:[I"~STFILLFFF :t: ON I blFJ;F'a:C:I"I ON:E; OF FIN'-? I.'.IELI..S laD,:I'FiCENT TO -['1"11 S P[?.OI::'ERT"~' FIN[)
NIJI'diF.3ER Of::' I~'.[~SID['SNC:E:S "FHFIT 'I'FII~Z I.,~ELI_. P.IIL,L S[.::R',/F£.
I~:I:~CKF::':[LLIt',II3 OF' RN'~' S't'STEH b. IITHOUT FINFIL., INSF'EC'I'ION FIN[)
f.:'I£F:'IqRTPIENT HiL.L. D[S SIjli~:.JEC':T TO P[ROSECUTION.
I::1 f ::' F:' F:: 0 'v' FII.. D"J"
PI I N I HUN I:.', I :!TT'FINCE E:ET FIEEN FI I.,.IELL. FIN[:) f:lN't' ON.-.S :1: TF): SEI.,.IFIGE
:LO0 F'LZET' FOR R PRI',,,'FtTE I.,~ELI_..~
::L~50 -FCI 200 FEET FRCII'4 Ft F:'UDI..~C HEI..L DEPEI",I[)IIqG I.JF'CIN THE: TY'F:'E
I.,IEL..I_ LOGS I::IR[Z REQI..IZ[F~:EI) FIND MUST EJE R[~JTI...I~tNFZI) TCi THE: DEJf::'FI~'.THI~JNT b.l:['f'["l:(l"~ :.:tO I)f. WS
OF:' THE P.IEI..I... COMF:'L.I~:T]OI"L
OTI'Ii~R I:;i~[~7(;!IJZREHE:NTS HFI't' I::IF'F:'I..'*'. :SF'EC:IFIC:IaTXOblS I::lf',l[:, C:OI"~STI;i:I.JCTIOI'-,I
RVlaILFIDL. E TO INSORE: PROPER INfJTf:II...IJaTZON.
I CERT:IJF'~' 'THFIT
::L: ]: RFI I::'f:IHILIFIF.'.' I.,tI'FH THE I:?.EQLIIREHE:NTS; F:'OR ON-<SITE SEi:P.IETF;i:S FIN[) P,IEL. L.S I:::IS
F'OF(TH EP~¢ THE HLINIC:IF'f:ILIT'.r' OF I::INCHOF,'FIGE.
2: I I.,.III_L INSTFtl..L THE: S"r'S'FIZPI ZI',I FIC:C:O[4:C, FII",If.::L:.' I.,.IITH THE:
:!~: I L.INE:,EF;.:'.E;TFIND 'I'HFfT THE OI'.,I-..ff, ITE '.};EHE:R S'.d'.'S'FFEH P'lFl"r' F':'.[EiJ:!L..III;:E: IEbILFIF~:GE:M[i~NT
RE':SI[)[CNC:E ]:::~ R[£PIOI.':'EI_.E[.':' TO I I",ICI.LI[::,E: PIOF~:[/ THFIIq :'~.:
S I ONED:
FIF'F'I.. l Cf:INT RENFI
............ ? -7
.l=,.,I.J[:.[ [3'r ................................................. [':,FITF' - ' ":' ":'
PER. MIT N(~ (
TCPE O~ ~OIL ~D~ORBTION ~TEH L~;:
NRNIMLIH NUHBER OF BEDROO/fS = '~
THE REQUIRED SIZE OF THE ~OZL RB~;ORPTZON S%'STEH
MI_IN I C."" - F'I-":IL I T"-r' L--~F' FII'-,IF' ~t~.IF;~..RL~.~E I,): ~ ~
DEPRRT['IEN. OF HERLTH RND EN~IF:_NMEN,,n " .,... PROTECTION
82.5' "L" STREET., RNCHORR.~E,-' RK. 99501
,~64 4,' ,. a
WEL_L I:::l'r-,.ID, Cfl"-.I--_"=% I TEE: SEEt, JER F'ISD:f,11 T
SOIL RFIT I NF~
LOT SIZF -z//c/ 0 SQ,_ RE FEI--T.
(:,Q FT,'"BR) =
r:,EF'"rH:: / /
Ii'~ F~-: F-I "...' E I_ E) [E F' T I-.4 = 7
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIEI'D.
THE DEPTH OF R TRENCH, OR PIT I`S THE DISTRNE:E BETNEEN THE SIJRFFIC:E OF THE
GROUND RND THE BOTTOM, OF THE EXCFIVRTION <IN FEET).
THERE IS NO SET HIDTH, FOR TRENCHES.
THE CiRRVEL DEPTH IS THE MINIHUM DEPTH OF GRRVEL BETb.!EEN THE OUTFFILL PIF'E
RND ]'HE BOTTOr,1 OF THE EXCRVRTION (IN FEET).
F;i'.Em2LI I RED _~.EF:'T I mi: 'FRI'-JF--': ~ I ~...~--'= /~9~
F'ER,I,1IT FIF'F'LICFff.~T HRS THF RE;SF'Or.4SlBILIT'¢ TO INl=ORrf THIS DEPflRTMENT DURING THE
INSTFtLLFITION INSPECTION`S OF RNY HELLS RE)JRCENT TO THIS F'ROF'ERT'¢ FIND THE
NIJP1BER OF RESIDENCES THRT THE HELL HILL SERVE.
TI.,.I~3 < 2 > 'I I'-,I~.;PECT I FII'-4'::; FIRE F-:E (...-!LI I F-:: EIC.,
BRCKFILLINF~ OF RN¥ SYSTEM HITHOUT FINRL IN_,FEI..TION FiND RPPRO',/RL B%' THIS
DEPRRTHENT HILL BE SUB.TECT TO PRO`SECUTION.
,I'IlNIMUr,1 DISTFiNCE IBETHEEN Fi HELL RND RNY ON-SI'FE SENRGE [.',ISF'O`SRL SYSTEH IS
:1.08 FEET FOR FI PRIVRTE NELL; OR
::L50 TO 200 FEET FROM R PUBLIC NELL DEPENDING UF'ON THE T'.r'PE OF PUBLIC HELL.
HELL LOGS fiRE REQUIRFD RND MU`ST BE RETLIRNED TEl THE DEF'RRTHENT HITHIN ZO DF¥'r'S
OF THE HELL COHPLETION,
OTHER REQUIREMENTS [fiRM RF'PL'.¢, SF'ECIFICRTIONS Ri',,ID CONSTRUCTION DIRGF::RDI`S RRE
RVRILFIBLE TO INSURE PROPER INSTSLLRTION.
F"[E Rr,11 T E._- ,"v, p T F,'[='_._~ [.'-,EC E--.I'"IE:E F-: ~-':1 .. 197'-4-- '_=.
I
:!.:
FORTH BY THE MUNICIPRLIT~r' OF RNCHORFIGE
2: I HILL IN.STRLL THE SYSTEM IN RCCORDFINC:E klITH ]'HE CODES.
-<: I UNDERSTFfi",4D THRT THE ON-SITE `SENER SYSTEi'fl HR"r' REQUIRE
RESIDENCE IS REMODELED TO Ii",IC~,LIDE HORE 'THFIN :3 E:EDRO01'I`S,
S i GN El, :'?/~7)'/¢t-~ ,~2 g..,,
CERT IF'Y' THRT
I FII'I FFII'IlLIFIR HITH THE REQUIREMENTS FOR ON--SITE '::'-,EHER:,
Applicant
ISSUED B%'~
ENLRRGEMENT IF THE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT O,:: HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATION
TEST
Pouch 6-650, Anchorage, Alaska 99602 '2.76-2221
SC)ILS LOG - PERCOLATION TEST
10
11
12
13
14
15
16
17
18
19-
WAS GROUND WATER
ENCOUNTERED?
DEPTH?
Reading
Net
Depth to
Water
Net
Drop
20-
PERCOLATION RATE
(minutes/inch)
· TE T RUN BETWEEN -- FT AND FT
72 008 [7/7G)
~'1'7z7'?C ZPv;ZL; ~[., t:7
MUNICIPAI_ITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF: INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b)
Property owner
Mailing Address
(c) Lending Institution
Telephone: (home)
Telephone
Business
Mailing Address
(d)
Real Estate Company and Agent
Address.
Telephone
(e) Mail the HAA to the following address: (or check here)~if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 _~[~51,~J~2 .r~.
Eagle River, Alaska 995,77
2. TYPE OF RESIDENCE
Single-Famil'~,~, Number of bedrooms
3. WATER SUPPLY
Individual Well~-~' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-.sit~ 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.
72-025 (Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 end 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 Jn compliance with ail Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
Telephone ~G;2,¢'¢ Z~¢'
S & S ENGINEERING
17034 Eagle River Loop Road No. 204
EagJe R|¥er~ AlasKa
Name of Firm
Address
Date
Approved for ,.~ ._bedrooms by . . _ Date ~.,~ .-_':~'~, .,"~'~,~/.'.'.~/
Approved ~ Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DH HS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS does this 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.
72-025 (Rev. 7/88) Back Page 2 of 2
A. WELL DATA
MUNICIPALI'FY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description: ~,-,~r¢' [c~--~'f~,
Well Classification ~ ~..k,
Well Log Present ¢¢~:~N) _'~ _ Date Completed \'¢~, '~ '::'l
Total E)epth ~ ~'"~ ~ Cased to _1¢~'¢¢~ Depth of Grouting
Static Water Level
Casing Height Above Ground _ \'7~''~ -'~
Electrical Wiring in Conduit~-)xl) _
SEPAFIATION DISTANCES FROM WELL:
To Septic/FIolding Tank oil Lot \ ,~--~-~
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
1'o Nearest Sewer Service Line on Lot
IfA, B, C, D.E.C. Approved (Y/N) N/A-
Yield __\ ~ ~--~ ~'t'"~ -~
Pump Set At
Sanitary Seal on Casing (d~/N) ~
Depression Around Wellhead (Y/.~ ~
; On Adjoining Lots '\ ~:~
; On Adjoining Lots _
To Nearest Public Sewer Cleanout/Manhole _
Water Sample Collected by
Water Sample Test Results
B. SI=PTIC/HOLDING TANK DATA
Date Installed ~c> -l~"7°LSize \. ~::;~:~>
Standpipes(:~N) '~ Air-tight Caps <{3~/N) _
Depression over Tank (Y/~
Pumping/Maintenance Contact on File (Y/N)~\~.
Holding Tank High-Water Alarm (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING 'YANK:
To Water-Supply Well ~
To Property Line ~='
To Water Main/Service Line \-~"~'--
To Stream, Pond, Lake or Major Drainage Course
Comments ~"~¢~ ~7.¢~ ~, g~
No. of Compartments
Foundation Cleanout(](5~/N)
Last Pumped ~ --,¢-¢fF'~
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
Y
72-026 IRev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /~'~ \~ - "'7~
Width of Field
Square Feet of Absortion Area
Depression over Field
Results of Last Adequacy Test
Type of System Design
Length of Field "Z~'~' I
Depth of Field \~
Gravel Bed Thickness "~ ~
'3~"7 ~ "¢;' Statndpipes Presentd~N)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Founda{..~o~
Lot
To Property Line ~,~::~ ~ .4-
~ L.% To Existing or Abandoned System on
; On Adjoining Lots ~ ~J¢
To Water Main/Service Line
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Cutbac[~(if present)
D. LIFT STATION
Date Installed
"Pump On" Lev~el-6L
High Water Alarm Level at~
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
~ Pumping Cycles during Adequacy Test.
**Check Permitted Bedroom Rating Against HAA Request** ~..
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this
inspection.
S & S I-2NGINEEEING
Signed ......... ,
Company ~aale Rival, Alaska ~577
Date ~ -~//~ 7/~;~ ~' eal
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
ANAL¥SfS REPORT BY SAMPLE for Work O~de£ $ 13441
Date Report Printed: MAY 24 89 @ 10:27
Client Sample ID:L65B SEC B ~lSD
Collected MAY 18 89 @ 14:00 hrg.
ReceiYed MAY 19 B9 @ 15:30 hrs.
Pre~orved with :
Client Dome
Client Acct
P.O.# VERBAL
Req #
Ordered By
SDREDGP
UA
Analy~l~ Completed :MAY 22 89
Laboratory Suporvi~o~ :RTEPHEH C, EDR
Released By
Send Reporta to:
I)D & S EN(;R
~)
Special
Inlltruct:
Chemlab Ref #: 5366 Lab Dmpl ID: I Matrix: WATER
Allewable
Parameter To,ted Result/Units Method Limits
NITRATE-D 3,4 mg/1 EPA 353.2 10
Sample
1 Testg Performed ' Soo Special Instrmctions Above DA~Unavailable
ND- Done Detected *" See Oample Remarks Above
NA- Not Analyzed LT~Lee~ Than, GT-Greater Than
INSPECTION APPOINTMENTS
TIME
DATE DATE
INSPECTOR
~'/~ T E RECEIVED
TIME
DATE
~JSPECTOR INSPECTOR
..... ~.iFAL~i,~:
MUNICIPALITY OF ANCHORAGE g./~l/?og~'' OF
825 L Street - Anchorage, Alaska 99501 '
ENVIRONMENTAL SANITATION DIVISION JUL
REQUEST FOR APPROVAL OF INDIVIDUAL VVATER AND SEWER F
DIRECTIONS: Complete all t)arts on page 1, Incomplete requests will not be processed. Please allow ten 110) days for processing,
1. PROPERTY OWN R ~. PHONE
PROPERTY RESIDENT (If different from above] PHONE
2. BUYER PHONE
MAILING ADDRESS
3. LEN DING INSTITUTION(_.jL~~ ~ ~ .~.//7
MAILINC ADDRESS -/
PHONE
~'. REALTOR/AGENT
MAILING ADDRESS
6. TYPE OF RL"SIDENCE NUMBER OF~BEDROOMS
E~] One E] Four
~ SINGLE FAMILY
[] Two ~] Five
~ MULTIPLE FAMILY [] Three ~] Six
~' WATER SUPPLY
, INDIVIDUAL* ~ ' /L ' * ATTACH WELL LOG. A well log is required for all wells drilled
COMMUNITY '-~~ since June 1975. For wells drilled orlor to that date, gwe we~
~ PUBLIC UTI LITY depth (attach log if available.)
E~] Dther
8. SEWAGE DISPOSAL SYBTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
t ~ 7~,' YEAR ON-SITE SYSTEM WAS INBTALLED.
NOTE: THE INSF',E~CC,T~IO.~=~LE-EFJY[~A__CCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1, TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] 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
[~] PUBLIC UTILITY
Connection Verified INSTALLER
E~]Septl/~,,T~k or [] Holding Tank
Size: / ~" If Tank is homemade SOILS RATING
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[~"~APPROV ED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)
APPI 'ANT FILLS OUT UPPEFI H, F ONLY _
Address ¥~'?~, , ¥'~,× ~.~:~'~1
Street Looatl~ ~ ~m, *~h
Type of R~sl~nce I
Single Family
~ Mulllple Family No. of Bedroo~ ~'~
~ Other
Phone
Phone
Phone
Water Supply '~
~' Individual ' ATTACH WELL LOG. A well Icg Is required for all wells drilled since June 19751
Community For wells drilled prior to that date, give well depth (attach Icg if available).
Sewer Disposal
[~ Holaing Tank
Year Individual Installed:~'"~
When Connecied to Public Utdily:
NOTE: THE INSPECTION PEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN SE INITIATED.
Time
Insp~otor
Field Notes:
Time
Inspeclor
Date
Inspector
._(. ~;~"~R'~VED BEDROOMS ) DISAPPROVED
) CONDITIONAL APPROVAL*
s',,:
'CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well TO Absorption Area
Well to Tank
Well Log Received
Septic Tank Size