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HomeMy WebLinkAboutSCHROEDER LT 3415c,Froeder Q y oeso O51 3q 0()C M2 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 ❑NEW ,� C,k-k uo-I<, L)() � �PH�ONE lJ7t /old% 7 J UPGRADE MAILING ADDRESS �12-I� 1`1 lnK i=�ea�_,z I<tv��r _ i�c qGi S 7 LEGAL DESCRIPTION I_o-r LI 6.p A SC,4_kRCtz. S/d� LOCATION NO. OF BEDROOMS 1 �l k4 F �2 Vt/ // 7 v DISTANCE TO: Well � Absorption area 5-� Dwelling 7' PERMIT NO. O F- Z wFa- Manufacturer �7SL Material J7 -F No, of compartments _ ffle ---El- w Liq, rapacity in gallons IF HOMEMADE: Inside length e Width _ Liquid depth �!S U ®� o�z DISTANCE TO: Well Dwelling PERMIT NO. O Z I ­_Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well il f Foundation e Nearest lot line PERMIT NO. 6 x �0' to 1 U No. of lines Length of each line Total length of lines i Trench width Distance between lines / inches I.- Top of tile to finish grade Material beneath tile �� inches Total effective absorption ra Length Width Depth PERMIT NO. w Q I_ wa Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line Class F- Depth Driller Distance to lot linePER MIT NO. r S 15-Frn (a DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER PIPE MATERIALS SOI L TEST RATI NG T -� INSTALLER l'J P—A i� L-4 f ) M -s . " REMARKS 4_e OF Al //''ffLL" ''`` s •1 r /Vvra V 10 Rtimut A. bAekir w e •O4 Vr'AV �++ wv - APPROVED, DATE LEGAL ^ ^ ��PA I C �, :1 F::" W -N L_:1 C.1, V, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: 840538 UPGRADE DATE ISSUED.- 07/03/84 APPLICANT: CHUCK 8ARR ADDR�SS: S&S ENGINEERING, SRB I96X EAGLE RIVER., AK 99577 CONTACT PHONE: 694-2979 LE-3AL DESCRIP: SUBDIVISION: SCHROEDER LOT: 34 BLOCK: NA SECTION: 2 TOWNSHIP: 141\1 RANGE.: 2W LOT SIZ�: 133�8 (SQ^FT" OR ACRES) I certify that: 1" I am familiar with the requirements for an -site sewers and wells set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2" I will install the system in accordance with all 11O8 and regulations and in compliance with the design criteria of thivi permit" 3° I will adhere to all MOA and �tate o� Alaska requirements �or the set back distances from any existing wello Wastewater, disposal system or public s�werage system on this or any adjacent or nearby lot" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODEG� THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED;(2) AG-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTIQN REPORT; AND <3) THE ELECTRICI'AL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED DATE: APPLICANT RR� ISSUED BY DATE: V�������_._� - �� ��a au�� L k9q�»�' OAK ^ SOILS LOG MUNICIPALITY OF ANCHORAGE u DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION IJ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ( /£_ L 2 LEGAL DESCRIPTION: � f�E PLTH r_ZFU 1 2 3 4 5 6 8 9 10 11 12. ,--13 14 15 16 17 18 19 20 COMMENTS PERF=ORMED 72-008 (6/79) :5,/ L. C / J f.J SLOPE r. DATE PERFORMED:_ ., �sberf A. fteq%r, No. 115'1.. •''.:.Q Reading Date Gross Time Net -rime Depth to Water WAS GROUND WATER ENCOUNTERED? /L/C/ L O P E IF YES, AT WHAT DEPTH? ., �sberf A. fteq%r, No. 115'1.. •''.:.Q Reading Date Gross Time Net -rime Depth to Water Net Drop /y PT— PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) —_e FT MUNICIPALITY OF ANCHORAGE D O DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 C� Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions') Z5 I (b) Property Owner A, ze er r v L2 Telephone: Home Business Mailing Address (c) Lending Institution F:T2E M CAIS �vuh oizT��v� Telephone Mailing Address (d) Real Estate Company and Agent Zop I 2-E—P,L-ry /30 L_ Address / 3 C/ 5- �. J A,icN. 4X Telephone 2--1 — Z op (e) Mail the HAA to the followino address: or: Check hereof hold for pick up. List contact person and day phone number below. S & S ENGINEERING 17034 Eagle River Loop R*ael No. 204 ge River, Alaska 99jj/ 2. TYPE OF RESIDENCE Single -Family 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 the legality and status. 4. 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 Mev e'eei Front 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 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, ordinances, and regulations in effect on the date of this inspection. S & S ENGINEERING Name of Firm 17034 Eagle_ Telephone ZS 49 Address Eagle River, Alaska 99577 Date C.S��2ovl /-C"rf1JS f7v2 io �vg�7� S�w62. CL)jQAJtS:C:J)oi= E,c/5,WC, �ousc �cJAIL A- N N T I t. S u VA tM iv ✓L 8 4j t� c�-F ��Ya-.-,� Mcv/r.� £� �iSSoCsri¢•r$J !-:'G- -�Z GonlO ("r 1 0 .V /,Q1 L_- 6. 6. DHHS APPROVAL Approved for Approved 5 FES bedrooms by - �'`"� P' �'�^ Date Disapproved Conditional L'� Terms of Conditional Approval cGe�< -7c"--VOCs M1�=WGA„ C•0/�INGG(- %LU /Q�•81i tlrtQ 4� CAUTION r, P, H �_ C_ 7- 7'� P "- b 6'c- /.97 � ,'c- /.s� /?&F. 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 DHHS does this as a courtesyto 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. Page 2 of 2 72-025 rape 8/861 Back FES bedrooms by - �'`"� P' �'�^ Date Disapproved Conditional L'� Terms of Conditional Approval cGe�< -7c"--VOCs M1�=WGA„ C•0/�INGG(- %LU /Q�•81i tlrtQ 4� CAUTION r, P, H �_ C_ 7- 7'� P "- b 6'c- /.97 � ,'c- /.s� /?&F. 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 DHHS does this as a courtesyto 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. Page 2 of 2 72-025 rape 8/861 Back C -�- MUNICIPALI,TY,pf ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST -FEBRUARY 1994 c `" / 264-4744 j Legal Description: A. WELL DATA Well Classification A • If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Total Depth Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Depth of Grouting — Pump Set At Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) no (./- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot oo r ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Z -S'4- Water Sample Test Results Comments —.ate M L&t� B. SEPTIC/HOLDING TANK DATA Date Date Installed Size No. of Compartments 2 Standpipes (f� I) Airtight Caps (17N) Foundation Cleanout &N) Depression over Tank (Y4!!j Date Last Pumped -3 Pumping/Maintenance Contract on File (Y/N) 1`j% n ; for Holding Tank High -Water Alarm (Y/N) " fl_� Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank To Water -Supply Well Zoe/f To Building Foundation i97-/ To Property Line /oI To Disposal Field 5/ I To Water Main/Service Line / C) i- To Stream, Pond, Lake, or Major Drainage Course 1k4A \ Comments �sup�� 1�[�t��- 7-0 Page 1 of 2 72-026 fRnv 8'86) Font C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata g 5 Type of System Design / 2-6—�� Date Installed 3 - 3N Length of Field _ 30' Width of Field _ u''D" Depth of Field __ / Gravel Bed Thickness La Square Feet of Absorption Area - ZLQ C, ` Standpipes Present ('Q/N) Depression over Field (Y/O Date of Last Adequacy Test C Results of Last Adequacy Test S �1 S Fft�-ser Separation Distance from Absorption Field: To Water -Supply Well __ ? Fc)o r 4 To Property Line _ i o / To Building Foundation __ 1,5' To Existing or Abandoned System on Lot �?y / ; On Adjoining Lots To Water Main/Service Line _ /014 To Cutbank (if present) Aj/,,� To Stream/Pond/Lake/or Major Drainage Course �"IA To Driveway, Parking Area, or Vehicle Storage Area & S / Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at _ High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments I — Dimensions Manhole/Access (Y/N) — 'Pump Off' Level at _ Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** 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 ENGINEERING Signed 170a4-Eal; Wer -I* 0"*ad-No.128ER —401 Compan}agle River, Alaska 99577 MOA No. Z% Uo 3 Receipt No. .2 C) (5 / U C)._2 -J 3,��� � � `M d, Date of Payment e Amount: $ Page 2 of 2 72-026 (Rev 8`86% Back 4 I MUNICIPALITY 01' ANCHORAGE DIVISION OF ENVIRO .NMT NTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTlAN APPLICATION FOR HEALTH AUTHORITY ARPROVAL CERTIFICATE Application Date !s(/'�v. P1� �� 1. General Information (a) Legal. Description (i. lot, block, subdivisign, section, township, range) Location (address or directions) (b) ApplicantsNameT�1.;ij�� � C .?f.`�}:'�k% Tel�hone� HonxeT Bus-iness—T� Applicants Address (c) Applicant is (check one) Lending Institution . � , Other (explain); Owier/builder Buyer (d) Lending Institution. Address (e) Real Estate Co. & Agent Address '.Telephone (f) Mail the IiAA to the following address: 2. Type of Residence filugle—Family Multi—Family Other: (_describe Number of Bedrooms_ 3. WateE�y- Individual. Well. Community F-1 Public F_-1 Teleohone Note: If community well, system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal OnsiteT. 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 21 5 6.. 0 4 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 onsite 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 aw investigation and inspection, the on --site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address Date (ENGINEER DHEP Approval Approved for _-j� bedrooms By Approved Disapproved Terms of Ifin Itional Approval CAUTION B Telephone IN e t.+ /V �R.`��a f4 on F.�ua rs°n rrG.' ANA 4 A0 A11 -UQ Conditional THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF. HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY_ UPON THE REPRESENT-- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL, ENGINEER REGISTERED IN THE STATE OI' ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR FENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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. (DHEP SEAL) RR4/e.j/D18 (Page 2 of 21 1 7--19-84 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 f-JUL 2 7 1984 A. WELL DATA RECEIVED Well Classification If A, B, or C, D.E.C. Approved(Y/N) Well Log Present (Y19)'2 Date Completed IL9-2 �_ Yield i Total Depth _ Cased to Depth of Grouting Static Water LevelPump Set At l3 Casing Height Above Ground 130 Sanitary Seal on Casing )� Electrical Wiring in Conduit(E) _ Depression Around 4%bllhead (Y Separation Distances from We11: To Septic/Iield2ng- Tank on Lot ` �� �; On Adjoining Lots To Nearest Edge of Absorption Field o Lot—, / On Adjoining Lots__',�6?NJ To Nearest Public Sewer Lin /� To Nearest Public. Sewer Cleanout/Manhole_ 4 x To Nearest Sever �Se vice Line on Lot, ZY Water Sample Collected By S S �,� - Date Water Sample Test Results J1SR G�1j✓L B. SEPTIC/-1ft fNG TANK DATA Date Installed r �c S' Size 1_. ' No. of CompartmentsStandpipes N) _ Air -tight Caps <� Foundation Cleanout ) Depression over Tank (Y— Date Last P d Pumping/Maintenance Contract on File (Y/N ; for Holding Tank High -Water Alarm (Y ) 7 Temporary Holding Tank Permit (Y/N)____� Separation Distances from Septic/110,Xda�ng Tank: To Water -Supply Wb11 Ile)- To Building Foundation_ � To Property Line �� J To Disposal Field / To Water Main/S vice Line s To Stream, Pond, Lake, or Major Drainage Course Comments [Page 1 of 21 2-15--84 C. ABSORPTION FIELD DATA Soils Forting in Absoz'gtion/Strata �i Type of System Design Date Installed �- Length of Field — eta —_ Width of Field _ �6 r Depth of Field _ 3 —_ J Gravel Bed Thickness Square Feet of Absorption Area 1��6� Standpipes PresentN) Depression over Field (YOV Date of Last Adequacy Test -- Results of Last Adequacy Zest !� /- Separation Distance from Absorption Field: To Water -Supply Well 0 / To Property LineTo Building Foundation 1,1 f To Existing or Abandoned System on r Lot On Adj 'Hing Lots 3"7, �=-- -- To Water Main/Service Line P//.F To Cutbank('f resent) 4" To Stream/Pond/1ake/or Major Drainage Course / To Driveway, Parking Area, or Vehicle Storage Area -j -- Comments I). LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Comments Dimensions e/Access (Y M) — —� off" Level at Vent (Y/N) —� during Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request ** :I certify that I have checked, verified, or conformed to on the date of this inspection. Signed h NE31�IE":":plNt Date 1-2.' Company an t1VER;j�t.'Aat4d$ES%T MOA No KBl /d5/s (Page 2 of 21 Guidelires 1h effect A r. s•• Rj�6i•Jr t.. �i �' ]�>57•& ''rte �` r� 2-15-84 January 31, 1977 7 k13 tai?x ?i, ?t"? 1 .1i i�it4t L 11vi rtSlti�kE�ntal, Protection Lot 34 5chroodar Subdivisai0a of pecyple .Crb t.1em- t,Lwaj .jatz� will tie tate 3arnu an aowz '' ao e a xwat. Yak Havl r mp t era �.r; �'kanc t�.nt��,ng ea€tequat4al Y: Lt,l t ho CIA-:roat nanjilar of peCipLo in film: resoiCtenfco. Upon Y'F*Sanl pfiV Sewer uynte m Will be tc-Stc t.t mid up,,ir&ts.xad. iA tt=. c-a—resuArY. xf tliore aro gray farther r. icueeSations3, ple aucu Vorittl(It thifs u5'jvra �?L '(79.2511, extunniolt 224. )-,iwt/l j I I k�E , 6;,=(- es J� January 31, 1977 � 14 r. otf ^ To: Health and Environmental Protection From:/,/-V/e z:), 13k-101 OW Subject: Lot 34 Schroeder Subdivision I plan to add another bedroom to my existing dwelling. I am aware that upon resale the sewer system must be upgraded if necessary to be adequate for a four (4) bedroom home.