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HomeMy WebLinkAboutCHUGIAK GARDENS LT 4 NAME 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 MAILING A D DR ESp~ LEGAL DESCRIPTION LOCATION PHONE ~NEW I']UPGRADE A/ell . _ , I AbsorPtion area Dwelling ~ ~ ,~ DISTANCE TO: I .~ ~r ~---~0 - I I I I Manufacturer i~ Mate~ ~~ ~ w.,, Liq. capacity in gallons ~ ............. I Inside length DISTANCE TO' Well __ ~weHing ~ M~ ~ ~ ~ ~] M.ter~, ~ / We Foundation _ , ~Nearestlotline/~ , DISTANCE TO: I /~O I ~ ~ / No. of hnes ~ I L~gth of ~gh hdc , ~ Total length o~inp~ , / Trench width ~ ~ ~ Top of t, le to f,n,sh ~rado ~ Mater,al Boneath tilo ~ ~inches I Length Width I Depth Type of crib~ Cri~iameter ~ Crib dep~ ~~, Depth II Driller Distance to lot line ' L DISTANCE TO: Building foundation ~ Sewer line Septic tank / NO. OF BEqRO,OMS' PERMIT NO. No. of ~partments Liquid depth Liquid capacity in gallons PERMIT NO. Dista?e~t~een lines Total effec.~e(~s~.~ion area PERMIT NO. ~al effecti~orption ar~,/-.~ A N e~l~i n e ~ ~ PERMIT NO. Absorption area(s) OTHER PIP~ MAT~IALS SOIL TEST RATING INSTALLER REMARKS , APPROVED ~ DATE LEGAL ' Department -f Health and Environmenta3 ~rotection 825 Street, Anchorage, AK. ~501 ~ .~-._ ~-~7~o ~' Permit ~ '~L~i~:~q ON-SITE SEWER PERMIT ~,O,~X '77o'73~' Location: Phone Nu~er: ~g~ ~scr~t~on: r~ ~~.,,~ ~~'~ ~ot s~z~: TYpe of Soil ~sorption System Is: Trench: ~ Drainfield: Seepage Bed: HOlding T~nk: ~.~m~m ~r o~ ~rooms: ~ ~ So~ ~a/~(sq.~t/br) The Requireu~f 1-~sorptlon System Is: D~PTU 9 ' LENSTH 6RAVEL DEPTH 3 ~ ~ WIDTH The length dimension ist~-{ength(in feet) of the trench or drainfield. The depth of a 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 minim~ depth of gravel between t~e outfall p~pe and the bottom of the excavation(in feet). ~ ...... * * RE~UZRED SEPTZC(~S) TANK SZZE = ~~SALLONS Permit applicant has the responsibility to inform this C~artment during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. ~ ~ * TWO(2) INSPECTIONS ARE REQUIRED ~ * ~ Backfilling of any 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. Minim~ distance from a private well to a private sewer line is. 25 feet and to a co,unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion,, Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * ~ ~ PERMIT EXPIRES DECEMBER 51~ 1 9 8 3 ~ ~ I:certify that: (1) I ~ f~iliar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site if thex~sid~nceis remodeled to S igne~: ~~L~?' ~'~t 7 sewer SYstem may re~uire enlargement include more t~ ~/,bedro~:~~ . Issued by: ~//~)~//~/~-~A , SWP/024(1/81) MUNICIPALITY OF ANCHORAGE f Health and Environmenta Sign eR: SWP/024 (1/81) the residence is remodeled to include more that ~¢ bedrooms. Date: 5-' 1 ?- F~ Department Protection 825 ~ Street, Anchorage, AK. 99501 264-4720 ,/,, * * * HANDWRITTEN PERMIT * * * Permit.~ ~ ON-SITE SEWER PERMIT Applicant: ~~O // ~ "~"~~_~~ailing Address: ~/ / Location: Phone Number: Legal Description: ~7-- ~ ~~ ~/~f~g~ Lot Size: Type of Soil. Absorption System Is: Trench: ~' Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: S Rating(sq.ft/br) The Required S f ~ " t oi~ Absorption System Is: DEPTH ~IiI L~NGTH Ii ' GRAVEL ~EPTH 3'..__ i W~DTH The length dimension is the~e~ngth(in feet) of the trench or drainfield. The depth of a trench or pit is the distance be~n the surface of the ground and the bottom of the excavation(in feet). ~ere ~s no set width for trenches. The gravel depth is the minimum depth of g~ave~ between the outfall Pipe and the bottom of the excavation(in feet). ~\~/ · * REQUIRED SEPTIC(I-'tebD~G) TANK%,~SIZ~%- ~ GALLONS * * Permit applicant has the responsibi~city to'~nform this department during the installation inspections of any wel~s adjace~ht t© this property and the number of residences that the well will ser~e. ~\ . . ' · * * TWO(2)'LINSP~CTIdNS ARE REQUIRED * * * Backfilling of any system witho~ fink~nspectionand~ approval by this department will be subject to prosecution. '", -- Minimum distance between a ~% a~ any on-Site sewage disposal system is 100 feet for a private well or 150 to fO~ f~et frOm a public well depending upon the type of public well. Minimum dista~roma private well to a private sewer line is 25 feet and to a community sewer line,,is 75 feet. Well logs are required and must be returned to this department/within 30 days of the well completion. Other requirements may apply. Spe~fmgatlons and construction diagrams are available to insure proper install~tic/n. · * * PERMIT EXPIRES DECEMBER 31, 1 9 8 ] * * * I certify that: (!) I am familiar with the requirements for' on-site sewers and wells as set forth by the Municipality' of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG [] PERCOLATION TEST PERFORMED FOR: . LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SLOPE DATE PERFORMED: '~--'~'~'" SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT DATE:,. 72-008 (6/79) Loca~ioa Sketch: '' Was Ground Water Encoun'~e:ad? if ¥~s~ At What Dspth .- ow .,: <._..,, 'Instal~Seapage Pit Drain Field Dep:~h Of lnla~ .... ~apth To Botto~ Of Pit Or T~enc~ .......... ' : COHHENTS: ..... ~" ' _ _ .LOCATION;OF,:. WELL~ '.::'- ::~- [ PIIall :'~=mplll~;~itht~iai~"tb~,e~.l~;:/',~ ~;.3~';,~9~? ~f~,?~.~ ~:~.~;:;N~,~: . '~ . .... :. . .... :.:~,,~.,~, ;..-.,-:~,,~-~:...~ ,,.,,,~.~}.v,.-- ~,,-~,~-,~,.,~.:~.~ .~,,~FIet. r~IIow ~';~,~,. ~ ..... .. . . ,.:, .. r.:_ .. :. , , ,~, ./f,e.Z-,. 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Aut ,..', ,: . . - , Form O~-WWR (11/81) Copy 'Dislribution: ' WHITE'State DG~St PJNK-:DrJJJlr~ CANARY-Customer ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALT_H AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) Application Date Legal Description (include tot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~~~~ Telephone: Home I,~ ~-t~...~"7 Business Applicant Address (c) Applicant is (check one): Lending Institution [] ' Owner/builder~L~ Buyer []; Other [] (explain); (d) Lendingl'nstitution .~~lt,,L.. b~/,,,,..l~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ¢ Multi-Family~ Number of Bedrooms / Other WATER SUPPLY Well ~ Community [] Public Individual [] 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. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN~ iNSPECTIONS, TESTS, FILE SEARCH, DA ~,~ 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 inspe~l~nS ENGINEERING Name of Firm ~,~D i96X Address ~GLE ""'"' A~ ~577 Date Telephone AF, proveclfor ~'~L~-~--~ bedroomsby~~ ~ ~rn~V~conditio~n, i Approva~iSapprov~l// ' ' Conditional 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 (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION t986' WELL DATA Well Classification S,~''~ Well Log Present Total Depth L']~-~L~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sam p le Test Results If A, B, C, D.E.C. Approved (Y/N) Date Completed ~-~ -~'~:) '~ ~'~ Yield Depth of Grouting Pump Set At ~ Sanitary Seal on Casing~l~ Depression Around Wellhead,(-Y~) · On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ,-~ ~ ~'/'-/&-"~'-'~'~"~'~--~' · Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed /0.'~,-'~ 3' Size Standpipes~)J~. Air-tight Caps ~N-~ Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~) To Property bne /~ ' To Water Ma:m/Service Line .~: No. of Compartments Foundation Cleanout~,N')" Course ~,.~Date Last Pumped for Temporary Holding Tank Permit (Y/N) "--- To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026t11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~ "' ~ '" Width of Field Type of System Design Length of Field Depth of Field Square Feet of Absorption Area Depression over Field,~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot / .Gr. avel Bed Thickness Standpipes Presen~N~F' Date of Last Adequacy Test ~7'.. ~'-_,~ ~, To Water Mc.J~,/Service Line ,~O ' ~- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on · On Adjoining Lots To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions nhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check _PeJ:mJtted Bedroom Rating Against HAA Request ** $ & S ENGINEERING I certify th~;~ I~v{j ~,ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~r~.Gi.F' .iYr-~,, Al( r~r~$~-'7 Date .,~///~,./~t~.,~,~/'~ ~-"/ Company MOA No. ,~'-"-- C~'D ~ Receipt No. r~. ~ ~_,=~.1~, Date of Payment *~ ~ ~[ q ~ ~ Amount: $ ~:~ '~ ~ Page 2 of 2 72-026 (11/84) APPLIC. . IT FILLS OUT UPPER HAL ONLY Property Ow.er Phone r- -- . ?~':,L-4A~. Buyer ,- . ./_, ~ Zip Code Lending Institution Phone Address Zip Code Realty Co. & A~nt Phone Address Zip Code Legal Description ~0~ d /~ ~ X Type of Resi~nce ~Single Family ' ?Z ~ Multiple Family No. of Bedroo~ ~ _. ~ Other Water Supply  Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~ ~? ~ ~ Individual Year Indiridual Installed: ~ ~ubli~ Utility When Connected 1o PuBlic Ulilily: ~ Holding Tank NOTE: THE INSPECTION FEE MUST A~O~ANY EACH RE~EST BEFORE ~O~ESSING CAN ~E INITIATED. Time Time Time ~ ---- ~ Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ~,..T'~,., ( {,..J=~ '{~ '~ J,~ C.o. MUNICIPALITY OF ANCHORAGE ~- ,,... r,-~,.' .-.,~ENVIRON,,AZNTAL PROTECTION ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area f ~'"~ ' Welt Log Received g ~'"'-' l Or C,,.o --~) ..~ Well to Tank / ~" ¢-.~ Septic Tank Size 72-023 (3182) CHEMICAL & GEOLOGICAL LABORATORIES ~0~ ALASIC,4, INC.. TELEPRONE (907) 562-2343 5633 B Street ! Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] PUBLIC WATER SYSTEM I.D.# [] ;PRIVATE WATER SYSTEM Name S & S ENGINEERING Sla_B !96X Ma,..g ^Udr,,s~, EAGLE RIVER. AK 99577 Phone No. City State · Day Year SAMPLE TYPE: .4~--Routine [] Check Sample (for with lab ref. no. [] Special Purpose routine sample 8AMPLE NO. LOCATION 31 4 I Zip Code [] Treated Water I~-JJntreated Water Time Collected Collected Date Received Time. Received Analytical Method: TO B~COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: S~tlsfactory [] U~atisfactory [] S~ple too long In transit; sample should nOt be over 30 hours old at examination to ihdicate reliable results. Please send new sample via special delivery mail· * No.'of colonies/100 mi. Lab ~Ref. No. I I I I Result* Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFOPE Membrane Filter: Direct Count Verification: LTB .... ~..:,': :.~n~ Reported By ..... :~ _ , TNTC = Too Numberous To Count OB = Other Bacteria Coilformll00ml BGB ............ Co,Ifc"-".'"'' .... Date Time: / ,,~ a.m. p.m. CHEMICAL & GEolOGICAL LABORATORIES C,.. ALASKA, INC.~ ..... TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER /~~ 274-3364 5633 B St reet ~ Drinking Water Analysis Report for Total Coliform Bacteria TO .BE COMPLETED BY WATER SUPPLIER I.D. NO. Phone No. WATER SYSTEM: Water System Name TO-BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination Mailing Address City State Zip Code Mo. "'Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab raf. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO, 1 2 3 4 5 LOCATION Time Collected Collected By I J I I to indicate reliable results. new sample. Date Received Time Received Analytical Method: [] Fermentation Tube E] Membrane Filter Please send Lab Ref. No. Result* Analyst r'~' ?< -~.;i~; I-Cl' I CT-I I I I-I-1 *No of colomes/100 mi. or No. of Positive c~ort;ons READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collect m:l Source Date Received Time Received .p,m, Lab, No. Presumptive 10mi 10mi Z0ml Z0ml /0mi 1,0mi 0.1mi 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB Broth 24 hours: Broth 48 hours: Multiple Tube Report: 10mi Tubas PositiVe/Total 10mi Portions Membrane Filter: Direct Count Collform/100ml Verification: LTB BGB Final Membrane Filter ReSults ?~ Collform/lOOml Reported By ' : ~:' :~' ~ Data Time: ~' a.m. p.m.