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Home My WebLink AboutBLOOM COUNTY LT 2Io (.o 0 _." 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 PHONE J~NEW )/,,,~),2'~'d-E ~J WJTR~/~ ~ ~-3o~ ) ~UPGRADE MAILING ADDRESS LEGAL DESCRIPTION ~t ~ ~ L ~ LOCATION / NO. OF BEDROOMS ' lWell IAbsorPtionare~ Dwelling PERMITNO. DISTANCE TO: ~OO ' , / ~ Material _~ / No. of ~ ~ Manufacturer ~e~. ~ compartments Liq. capacity in gallons inside length Width Liquid depth /~O IF HOMEMADE: ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ~ Manufacturer Material Liquid capacity in gallons ~ Welt Foundation Nearest lot line PERMIT NO. ~ DISTANCETO: +~00 / i ~ / +/0' ~ ~ ~ No. of lines Length ~ ~ ~ Total 1~gt',~ of :',~: ~ ~ width ~¢ ~ Distance between lines ~ Q~ Top of tile to finish grade~ I~J~/~ ~ ~ / ~. ~ Material beneath tile ~ inches Total effect,i~o~ion area Length Width Depth PERMIT NO. ~ ~ 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. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ' PIPE MATERIALS ~0 SOIL TEST RATING I ., REMARKS I ",-"' z I I I ~ ' ~e' ~ ~;,~ ,(',t, -%'~; _) ~, '.:'~. ,,.,' ," ,t- : ' ,; .': .., ??' ' , · ¢ ":' APPROV~~~- DATE LEGAL 72-013 (Rev. 3/78) DEF'AR'T'MEN]' OF HEALTH AND ENVIR[)NMENTAL F'R[]TECTIOI9 825 L. STIREET.~ ANCHORAGE, AK 9950 1 1264.-4720 F::'ERM I '1" NO ." DAI'E ISSUED: 850684 10/21/85 APPL. t CANT: ADDRESS: CONTACT F:'HONE: VANCE CINSTRUCTION P.O. BOX 771543 EAGLE RIVER, AK 99577 688-3001 L. EGAI.. DESCR I P: I...OT ,SIZE: MAX BEDROOMS: SUBDIVISION: BL. OOM COUNTY S--8~62 SECTION: 3 TOWNSHIP: 15N 24000 (SQ. FT. OR ACRES) 3 LOT: 6,:3B BLOCK: NA RANGE: IW Lis'Led below are the op't. ions available to you in designir'!g your septic: system. Choose the option t, hat.. best Fits your site. DE:P'T'FI TO PIPE B('ITTOM (F;::'I".) GRAVE. I .... DEF'"r'H (f.:'T.) T[]TAL. DEF'TH (FT.) GI::;:AVEI_ WID'T'H (F'T.) GF:b:~VEL LENGTF'I (FT.) GRAVEL, VOL. LJME (CLi. YDS. ) TANI< SIZE (GALS) SOIL J:~ATING (SQ. FT. /BR) 4.0 4.0 4.0 6. () 0.5 3.5 10.0 4.5 7.5 ~. 5 14.0 5.0 ;~. 0 28.0 28.0 13.3 14.6 20.8 00().0 *.~ 1,000.0 ** 1,()00.0.** 85 85 85 · ~'~ TANI< MUST HAVE AT L.E"'AS] .... I"WO ("',OMF'AR'TMENTS I c:er't.:i.~y that: 1.. I am t'amilzar ~ith the r'equiremer~ts for' on-site sewers and wells as set. t'orth by the Municipality of' Anchorage (MOA) and the St. ate oF. Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o¢ th'zs permit. 3. I will adhere to all MOA and State of' Alaska requirements ~c)r the set bacl.:: distances ~rom any existing well, wastewater disposal system or public sewerage system on this or any adjac:ent or near'by lot. Zl,. I understarid that t. his permit is valid ~c)r' a maximum of' 3 bedrooms and any enlargement will requi~e an additional permit. IF A LIFT STA'¥ION IS INSTALLED IN AN AREA'COVERED BY MOA BUlL. DING CODES,. THEN (1) AN E',L,E:C'I"RICAL F',:'ERMT, T AND INSPECTION MUSH" BE: OB"I-AIIqED; (2.) AS.-BLJIL. I"S WILl,., NOT BE AF:'PROVED WI'I"HOU~ AN EI_ECTRICAL INSPECTION REPORT; AND (3) "l"lqE EI..ECTRiCAL WORK MUS]" BE D(]NE BY A LICENSED EELEC]"RI[,;I'Alxl. o 1 bNI:.D DATE: APPL. I CANT: W~I[~C I~TRUCT I ON ISSUED BY MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PhUTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~Tune a,, 19~P4~_ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2 Bloom County T15N R1W Section _R (formerly Location (address or directions) Monastery Rd lot (b) Applicant Name Gregory Vance Telephone: Home 698-3OO1 BusinessRgg-3OOl Applicant Address P.O- P, ox 7715/43 F, ag'le River, A'la,~ka 9957.7 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution C~ty Address 100 Swanson St. Was±lla: (e) Real Estate Company and Agent N/A Address Telephone Alaska Telephone (f) Mail the HAA to the folloWing address: Pickup by applicant TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] C'I a.qs "A" 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 [] C.ommunity [] 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 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDI! ,NSPECTIONS, TESTS, FILE SEARCH, Do . 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 EAGLE RIVER ENGINEERING SERVICES Telephone EAGLE RIVER, AK 99577 Address ,D. n rmv., Date ~"'*/~///~-~ 694-5195 Engineer's Seal DHEP APPRO. V~L~ Approved f~~_-~ ~*~/~-'~bedrooms by ~ Disapproved Approved . Terms of Conditional Approval 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) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~j HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 JUN 0 Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) 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 Sample Test Results Comments If A, B, c, D,E,C. Approved (Y/N) / Date Completed ~ Yield Depth of Grouting Pu m p Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ~'~'/ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) /?//'//.,4- Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line "/~ / To Water Main/Service Line /O Course Size /~'~...5'~/' No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped /t./~..~,.~ '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 /'~//,~" Width of Field //7/" Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~,~ / To Building Foundation L o t /z///~,~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~,~',~"~ Type of System Design Length of Field 0~. ~c ! Depth of Field ~7x · Gravel Bed Thickness ~ // Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ~'/¢ / To Existing or Abandoned System on · On Adjoining Lots ~3~ / 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 Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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. Signed ...~.~.~~ Date Company ~/~' z-~ J- MOA No. Receipt NO. "~1 (~_ ~0 ~ ~ Date of Payment ~ - q' ~ Amount: $ ~~~ Page 2 of 2 72-026 (11/84) Engineer's Seal BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 Telephone: (907) Address: 274-~5334.._- DATE: June 4, 1986 PWS I.D.# 214691 To Whom it May Concern: According to records on file in this office the SUBDIVISION Water Regulations BLOOM COUNTY Water System is in compliance with the State Drinking Sincerely, S?eve. Eng, ~..~ District ~-~ineer