HomeMy WebLinkAboutCHANDELLE ACRES LT 12 ,,- ~ -~.. MUNICIPALITY OF ANCHORAGE
/z DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
I~ ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME 1PHONE I ~i~I NEW
MAI LING ADDR ES~
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
Well Absorption area Dwelling PERMIT NO.
DISTANCE TO:
Manufacturer
Material No, of compartments
Liq. capacity in gallons Inside length Width Liquid depth
~ ~ ~ Manufacturer Material Liquid capacity in gallons
Q Well Foundation ~ Nearest lot line PERMIT NO.
~ DISTANCE TO:
~ ~ ~ No. of lines / Length of each line Total length of lines Trench width Distance be~7~nes
~' ~ ~ ' ~ inches
~ ~ ~ Top of tile to finish grade --t Material beneath tile Total effective'absorption area
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 to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PiPE MATERIALS
SOIL TEST RATING
INSTALLER
RE~RKS
APPROVE DATE LEGAL
72o013 (Rev. 3/78)
by
DOC {2o.
SULLIVAN WATER WELLS
P. o. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND ,:.
ADDRESS :.
LEGAL DESCRIPTION
DATE - Started '~. /
PERMIT NUMBER
Ended
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
~<eT~DRAW DOWN FT. ) -~
GALS. PER HR ,~ ~,~ ~,
?
KIND OF CASING . ,'
KIND OF FORMATION:
From
From
From ~
From
From~
From
From__
From
From__
From.__
From__
From ~
From__
From
From~
From
From
Ft. to ? Ft. '
Ft. to ~ '" Ft. C
Ft. to Ft.
Ft. to i,'~ Ft. .~H ~O ,~ (~,4~e~'~. From
Ft. to /_ Ft. ..~ ~' .~ ~ From
Ft. to ).,~Ft CiA T ~ tZz ~ ~ ~ From~
Ft. to Ft. '~
Ft. to d~d; Ft.
Ft. to Ft. "f~,., ( c ,~.~/ / .~'~ ~Z 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.
Ft. to__Ft
Ft. to Ft
Ft. to__.Ft
Ft. to Fl
Ft. to Ft
Ft. to Ft
Ft. to Ft.
Ft. to__Ft.
Ft. to__Ft
Ft. to Ft.
Ft. to.__Ft
Ft. to__Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft
MISCL. INFORMATION:
DRILLER'S NAME
SULLIVAN WATER WELLS
P.O. BOX 2?2, CHUGIAK, ALASK~7 a TELEPHONE 688.2759
OATE.Slaned ~,//~ .... Ended ~'~ ..... GA~.PERHR ~
PERMIT NUMBER ........................... KIND OF CASING
KIND OF FORMATION:
From .... Fl, to .... Ft .....
Fmm~Ft. to. '
Fmm~Fl, to ..... Ft.
From..,
From ,
From ,.
From_
From _
Front__~ FI, to__
Front .... FI. lo ....
-Fl, lo ..... Ft ....
· FI. to ..... FI .......................
· . FI, lo ..... Ft._
Fl, to ..... FI.
FI. lo ..... Ft.
_ Fl.
Ft.
Frmn ....... FI, to- -FI.
From ......... Ft. to .... Ft.
From .... Ft. Io ......... Ft.
From ...... Ft. to ...... FI.
From ...... Fl. to ....... Ft .....
Frum ..... Ft. lo ..........Fl,
From ..... Fl, h)
Front ..........Ft. to ........ Ft.
From ......... Fl. h)
From ...... Fl. lo
From ....... Fl. to
From ..... Ft. lo ......
From ....... FI. lo___ _ Ft
From ........ Fi. to .... Fl
From ..... l:t. lo ..... Ft.
From ...... FI. to .... Fl.
From Ft. to ....... Fl-
MISCL, INFORMATION:
I)RI LLI!R'S NAME
PERMIT NO.
APPLICANT
LOCATION
LEGAL
DEPARTMENT HEALTH AND ENVIRONMENTAL .OTECTION
825 'L" STREET, ANCHORAGE., AK. 99501
264-4720
L-JELL AND, ,]~[-~--'._--~I ~'i SE I.-JER F'EF:P1 IT
810526 )
MILE BARBARIC
L12 CHRNDELLE ACRES
SR BOX 7149 CHUGIAK
688-~0t0
LOT SIZE 46000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS = 2: SOIL RATING (SQ FT/BR)=
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
[:,EPTH=
28]:
:1. ~-S~ L EI'~Im]TH = :-----}~5 C~ R R'...' E L [:,EF'TH=
THE LENGTH [:, I MENS I ON IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF R TRENCH OR PIT IS; THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRR'.,,'EL BETWEEN THE OUTFRLL PIPE
AND THE BOTTOM OF THE E)<CFIVRTION (IN FEET).
F-: E,_---!LI I F~:E£:, '_---.EF'T I C: TRr-~t:-'. '_--] I ZE= -1 £-, ~.'r-~L:-~ ~_3RLLE, f-~5
PERMIT RPPLICRNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
T~-.IO ( 2 > I I'-.ISF'E~]:T I AN_~- RF-:E RE,;!L~ I F-:E[:.
BACKFILLING OF AN'T' 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 WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM R PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO ~ COMMUNITY SEWER LINE IS 75 FEET.
1.4ELL LOGS ARE REQUIRED AN[) MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DRYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS M8'¢ RPPL'¢. SPEC:IFICBTIONS AND CONSTRUCTION DIAGR8MS 8RE
RVRIL8BLE TO INSURE PROPER INSTRLLATION.
F'EF.:r-11 T E:=-::F' I RES [:.EE:Er-IE:EE: ----<±--
I CERTIF'¢ THAT
I: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET
FORTH BY THE MUNICIPRLIT'¢ OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SS'STEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ]: BEDROOMS.
S I G N E D: -
APPL I CFINT MILE BARE:RRI C
I'-";SUE[:, BY__ TE ....
V4. 0
[] SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 I.. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
_//2
SLOPE
PERCOLATION
TEST
SITE PLAN
~10
11
12
13
14
15
16
17
18
19
20
COMMENTS
Robert A.
I~.
WAS GROUND WATER ~j/~.~ I~.
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
~/ /I
PERCOLATION RATE {minutes/inch)
TESTRUN BETWEEN ,,'~'~' FTAND ~ FT
z
PERFORMED BY:
72-008 (6/79)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date "~,/~/~ '~
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
LIp_ c [-I ~V O 6 L ~ £ /)-C~ ~ ~,T h[ ~Ill
Location (address or directions)
ff£ YEfl ~ C~EE~'/ N, oH~GLEN~ fl'~ ) L~pl off Ccou6Ze~F ~ O/ N.~ cofi~ERo~
(b) Applicant Name ,56~0~ ~, ~b~lCl~Telephone:Home d~P-3~O Business
Applicant Address ~J~;~ ~,~; ~: ~ ;7-- ~~, ...... ZZll ~ ~YY:57[.
(c) Applicant is (check one): Lending Institution ~ ' Owner/builder ~'; Buyer ~ · Other D (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family I~' Multi-Family []
Number of Bedrooms ~
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.
72-025 (11/8,4)
Page I of 2
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.
Name of Firm t~ ELe~--5 / ./~'~', Telephone ._~-~//"ff'~) ~'~
Address /~OO ~, .~~ ~E, ~'~/~ ~ ~C~. ~ff Y~~
Date ¢//~
Approved for ~,/r/~,~/. ~ bedrooms by/:~
Approved . Disapproved
K Conditional
Terms of 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 engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE (MO~l
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &HEALTH AUTHORITY APPROVAL (HAA)
ENVIRONMENTAL PROTECTION CHECKLIST- FEBRUARY 1984
264-4720
? L.
WELL DATA
RECEIVED
Legal Description:
Well Classification I~ ~)1 Fl DU
Well Log Present t~N) / Date Completed
Total Depth ~ ? Cased to
Depth of Grouting
Static Water Level ~-
Casing Height Above Ground Z, ',.~,~
Electrical Wiring in Conduit
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
Pump Set At
Sanitary Seal on Casing (~N)
Depression Around Wellhead (Y~
I f,J~ ~' 'On Adjoining Lots
l 0~-/7/-- 'On Adjoining Lots ./~)O
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments ;~ P~'~
To Nearest Public Sewer
~/'~f To Nearest Sewer Service Line on Lol~ /V//°/'
FAcza¢ , Y-
B. SEPTIC/HOLDING TANK DATA
Date Installed
t ' I
Standpipes ~N)
Depression over Tank (Y/~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
TO Water-Supply Well ll-~
To Property Line J~
To Water Main/Service Line ,.~V',/¢~
Course / O0/'~-
Size [00 0 NO. of Compartments
Air-tight Caps(~N) Foundation Cleanout ~_N)
Date Last Pumped ~,,/?/~
/~/,4- ;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~'-//~0 /
Width of Field /~..~--
//
Square Feet of Absorption Area
Depression over Field (Y(~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well I ~)_ 0 /'
To Building Foundation ~ f f
To Water Main/Service Line fY'/
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field ;~--~' ?
Depth of Field /~) /'
Gravel Bed Thickness O~ £
(~) ZO Standpipes Present ~)N)
Date of Last Adequacy Test
To Property Line ~/-...~ /
To Existing or Abandoned System on
· On Adjoining Lots [00
To Cutbank (if present)
/ od
Comments
D. LIFT STATION
Date Installed Dimensions
Size in Gallons / Manhole/Access (Y/N)
/
"Pump On" Level at /j~, "Pump Off" Le~¢~_
/ ltl ..~ent(Y/N)
High Water Alarm Level at I~t / ~.~.~......~P
Tested for umping Cycles during Adequacy Test. Meets MOA
Electrical Codes (Y/N)
Comments
** Check Permitted DeC'eom Rating Against HAA Request **
I certify that I hatvl~ c.~ecke¢, )~erificld, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed _ Date ~'//Z
Company MOA No.
Receipt No. .~'~ ~-(~O~
Date of Payment
Amount: $ ~
Page 2 of 2
72-026 (11/84)
E-Lc LOG
ALASKA P,,idlROFImEFITAL CONTROL SEI uICE$, IrlC.
JOHN M BARBARICK
2211 W 46TH
ANCHORAGE ALASKA
99517
SELLER-JOHN M BARBARICK
05/12/86
JOHN M BARBAi{ICK
2211W 46TH
ANCHORAGE ALASKA 99517
60214
LEGAL:CHANDELLE ACRES BLOCK 0 LOT 12
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE-05/07/86
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 1020 SQFT.
THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 691 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A
3 BEDROOM HOME.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 05/08/86 .
FLOW TEST ON WELL
WELL FLOW DATE-05/07/86
A FLOW TEST WAS PERFORMED ON THE WELL. 691 GALLONS OF WATER WAS
PUMPED AT A RATE OF 6.91 GPM OVER A DURATION OF 1.65 HOURS.
THE DRAWDOWN WAS 9.2 ' WITH A RECOVERY TIME OF 10 MINUTES
AND THE STATIC WATER LEVEL WAS 202.5 FEET.
THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME.
1200 Dies! 33rd Aocnue. 5uii¢ [~, Anchoroqe, Alosko 99503.(907) 561-50/~0
ALASKA ENVIRONMENTAL
CONTROL SERVIC-~, INC.
1200 West 33rd Aven,.¢, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SH£ET NO.
'T ~ K
5'0 "'
2(~,6'
21.5
Wo
WEt~.
i
~ D~.~ ~ RECEIVED
I NSP ECTI ON APPOI NTM E NTS K;~ z/~%~--~--~' "-7/::~
TiME TIME TIM'~
DATE DATE DATE
INSPECTOR INSPECTOR I NSP ECTOR _ ~
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~NMENTAL P~OTECTION
825 L Street - Anchorage, Alaska 99501
ENVIRONMENTAL SANITATION DIVISION JUL 2 2 199i
Telephone 264~720 ~g~ ~
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE
DIRECTIONS: Complete all parts on page 1. Incomplete reques~ will not be proce~ed, Please allow ten (10) days for processing.
1, PROPERTY OWNER ~ PHONE
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
2. BUYER PHONE
MAILING ADDRESS
3, LENDING INSTITUTION PHONE
MAILING ADDRESS
4. REALTOR/AGENT PHONE
MAI LING ADDRESS
5. LEGAL DESCRIPTION
STREET LOCATION
6. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] One [] Four
~ SINGLE FAMILY [] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY
[] PUBLIC UTILITY
* 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.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY 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
[] INDIVI DUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
...... ,~ .~ i/-'~ (~ ~
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~
[]INDIVIDUAL/ON -SITE DATE INSTALLED f, . ,
[]PUBLIC UTILITY '~_~ .... ~,.
Connection Verified INSTALLER
[]Septic Tank or []Holding Tank
Size: i ~ ~ ,~ If Tank is homemade SOILS RATING
give dimensions:
TYPE
OF
TANK
MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
Absorption Area to nearest Lot Line
5, COMMENTS
[] APPROVED FOR BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
E]~]~"-DISAPPROVED
DATE BY
72-010 (Rev. 6/79)
Aunicipality
of
Anchorage
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
(.;L()i~C;E M. SUt LIVAN,
DEP.A~ 1%1[ N l' <)F HFCAL TH AN[:) ENVIP, OFJF~.IEN7 AL PP, OTECTION
July 29, 1981
Biathlon Construction
Star Route 7149
Chugiak, Alaska 99567
Subject: Lot 12 Block 1 Chandelle Acres Subdivision
Approval for the individual sewer and water facilities
cannot be granted until the following items have been
completed:
(1)
The water analysis report needs to be submitted to
this office from the Chem Lab, 5633 B Street, for
our review.
(2)
Exposed electrical wires to the well head are in
violation of the Municipality of Anchorage codes and
must be encased in conduit.
Please notify this office for a reinspection when the noted
descrepancy has been corrected. If there are any further
questions, please call this office at 264-4720.
Sincerely,
Robert C. Pratt, R.S.
Associate Specialist
RCP/ljw
cc: Alaska Bank of Commerce
3230 C Street 99503