HomeMy WebLinkAboutSUNNY VALLEY LT 22A
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
[] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMS
DISTANCE TO: IWell
~ ~ Manufacturer
Ma i I ~ No. of co~rtments
IF HOME.DE:
Liq. ca~ ~gallons Inside length Width Liquid depth
fi Z D:ISTANCE TO: Well Bwelling PERMIT NO.
O ~ ~ Manufacturer Material Liquid capacity i~ gallons
¢~ Q DISTANCE TO: Well
~ No. of linesI La.otb of each l,,e Total lan,th ,f lines Trenc~h Distance b~A. lines
~ Top of tile to finlsh¢~de ¢O Material ¢&ath tile S+ inches Total e ffect ive. absorption a,e,
m Well Building foundation ~arest lot line
~ DISTANCE TO:
D ill
~ DISTANCE TO: Building foupde~ion Sewer line ~eptic tank ~ Absorptio. area(s)
I
OTHER
REMARKS
72-013 (Rev. 3/781
HUN I C I PI-3L I?¢ OF Fff'JC:HORFIGE
[,EPRRTHEWd "F HEF~LTH RN[:, EN'./'IRCff-g'IENTR' '='EOTECTIObl
264-4720
F'EF. iH 11~ NO:
[.,RTE I S'SUED:
'FIPF'L I CFtF.FT'; HRHMRN COH~T
E.E. RE ..... BL ,-, ~-,, ¢.
ERGLE RIVER., AK 99577
L. ONTI~_.T F'HONE: 6'_-¢.4-~¢' ,..e_.
- i ' LOT:z,='-':'
LEGFIL DESCRIF': SUE:E.;I;,,,'ISION: :,L~JH¢ VRLLE't'
SE~.T I ON: 16 TOHNSH I P: ±4N RFINGE:
LOT _,i~E: iR ,.'SQ. FT. OR RCF:ES:~
I'IH;:':; BEE.,ROOHS:
LISTED E:ELC, H RRE ]'HE C,F'TIC, HS R'¢RILRE:LE TO 'T':II.t IN E:,ESIG,NING
_~_~E~I. L-:HOC, SE THE: OPTION THAT
BEST FiTS '¢_-,I_IR' SITE.
BLOCK: NFl
'-fOUR SE:PTIC
· - T F: E f-,i ~_1: H E; E [:. 1.,1_ [:.
DEPTH TO PiPE BOTTOH (FT.) 4. E~ 4. 0 4.
GRRVEL DEF'TH (FT.) 8. 0 ~b. 5 _-.',.
TOTFIL DEF'TH <FT. ) 12. 0 4. 5 7.
GRFf,,"EL NIDTH (:FT.). 2. 5 t7. 0 5.
GRRVEL LENGTH (FT. > 26. 0 3.4. 0 44.
..GRRVEL VOLUHE (CU. "r'[.,S. ) 28. 4 21. 4 36.
TRNK SIZE (GRLS) t., 000. 0 *:+: 1., 000. 0 *:+, t, 000.
SOil_ RRTING ,::SQ. FT. /BR) 13:7 125 t25
,+::+: TRNK ,HUST HRVE FIT LER_,T TNO C:OI,1PFIRTNEN'fS
I CERTIFY .THRT:
i. I RI'I FRHILIRR NITH .,THE RE¢~_IREI'tENTS FLF LN---,I~E :,EHER=, RND NELL., ~,
FORTH B'¢ THE I'IUNIC. IPRLITY OF RNCHOR8GE (HOR> RN[' THE _THTE OF
2. I HILL INSTRLL THE _,TpTEtl IN R]E:ARDRNC:E HITH RLL HOR ]:DE:'E~ RNE:, R'EGULRTtONS,
RND tN COHF'LIRNCE NITH THE DESIGN CRITE~:IR OF THIS PERHIT.
~.. I NILL R[:,HERE TO RLL MOFI RND STRTE OF HLH_F.R REQLIIREHENTS F3F' THE _,ET E,H..K
DISTR(.~CES FROM RN'¢ E;:.,:ISTING NELL, NRSTEHRTER DISPOSRL :,~..,TEfl OR PUE, LIC:
SEHERRGE =.¢:,TEII ON THIS OF: RN;T' R[.,J'AC:ENT OR NERRE:'t' LOT.
4. t UHE.,ERSTRNE:, THFIT THIS' PERMIT IS VRLZ[:, FOR R IdH,.,lflLll OF ~ E:EDRO01,1S
,Et.L RE 8N R[:,[:,ITIONRL F'ERMIT.
RN't' ENLRRGEMENT NILL ~' ~ I '
~F R LIFT STRT~ON ~S ~NSTRLLED ~N RN ~RER COVERED DY MOR BUiLD]H6 CZDE'5,
THEN (Z) RN ELE..TRZE~L PERMIT RNE:, INSPECTION MUST BE OE,~NZfIE[L. t:.z) H=,-E, UZLT-
N~LL NOT BE ~PPROVED NZTHOLIT ~N ELECTRZE:RL ~N=,FEL. TZuN RE~ORT; RN[:, (~%~THE
ELECTRICRL HZRK FILIST BE,DONE E:~' R LICENSED ELEC:TRIC:IRN. ¢
.........
P O ~b'-~,'~ 6-650
ANCHORAGE, ALASKA 99502-0650
(907) 264-411 I
TONY I(NOWL£S
MA YOR
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Permit #:
840384
January 31, 1985
TO: Permit Applicant
SUBJECT: Lot 22 Sunny Valley Subdivision
A permit issued by this Department for an individual well
and/or on-site sewer system has expired as of December 31,
1984.
Permits are issued on a calendar year basis by authority
of Municipal Ordinance. A new permit must be obtained from
this Department for any well and/or on-site sewer system not
installed by the expiration date.
If you have drilled the well, a well log needs to be sent
to this Department for documentation of the installation
and to close the permit.
If a private engineer inspected the installation of the
on-site sewer system, the original as-built inspection report
and the yellow copy must be sent to this office for review
and approval, and for documentation.
If there are any further questions, please call this office
at 264-4720.
Sincerely,
Keith E. Bandt, Supervisor
Environmental Engineering Program
KEB/ljw
enc: Copy of Permit
SWP/057
MUNICIPALITY OF 8NC~ RAGE
DEPARTMENT 0 i~EALTH.AND ENVIROHMENT~L I )TECTION
~ 825 L~STREET, ANCHORAGE, AK 995~
264-4?20
O~--$~TE
PERMIT NO: 840~84
DATE ISSUED: 05/'24/~84
F'ERr'I IT
LOT: 22
RANGE: ~W
APPLICANT:
ADDRESS:
CQNTRCT PHONE:
HRMMAN CONST.
BOX 672
EAGLE RIVER,
694-2776
RK 99577
LEGAL DESCRIP: SUBDIVISION: SUNNY VALLEY
SECTION: i6 TOWNSHIP:
LOT SIZE: iR (SQ FT. OR ACRES)
MAX BEDROOMS.: ~
t4N
BLOCK
LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC
SYSTEM. CHOOSE THE OPTION THAt BEST FITS YOUR SITE.
TRE~-~E:H BEC. ~t_ C~RRIN
DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 · 0
GRAVEL DEPTH (FT.) 8 0 0.5 ~. 0
TOTAL DEPTH (FT.) 120 4. 5 7, 0
GRRVEL WIDTH (FT.) 2.5 t?.0 5. 0
GRAVEL LENGTH (FT.) 26. 0 ~4. 0 44. 0
GRAVEL VOLUME (CU. YDS, ) 20 4 21, 4 26.2
TANK SIZE (GALS) 1,000.0 ** t~000. 0 *m 1~000. 0 *m
SOIL RATING (SQ. FT.?AR) ~? t25 125
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
I-CERTIFY THAT:
i. I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA.
I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS~
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
2. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY E~ISTING WELL, WASTEWATER DISPOSRL SYSTEM OR PUBLIC
SEWERRGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR 8 MAXIMUM OF 2 BEDROOMS AND
RNY ENLARGEMENT WILL REQUIRE RN ADDITIONAL PERMIT.
IF R LIFT STATION IS INSTALLED IN RN RRER COVERED BY MOA BUILDING CODES,
THEN (1) RN ELECTRICRL PERMIT RND INSPECTION MUST BE OBTRINED~ (2) RS-BUILTS
WILL NOT BE RPPROVED WITHOUT RN ELECTRICAL INSPECTION REPORT.; AND (_~) THE
ELECTRICAL WORK MUST' BE DONE BY ~ LICENSED ELECTRIC!RN.
l
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82B L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
3-
4-
5-
6-
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
SLOPE w SITE PLAN
II11'%11111
I I I ~.,l'~q I I
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
J -~ ~- - 15-~
P E4~C-4~cA-T-I~ N RATE
TEST RUN BETWEEN FT AND -- FT
PERFORMED BY:
72-008 (6/79)
DATE:
by
DOC Co. dba
SULLIVAN WATER WELLS
P. o. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND /.,~ ?z,,;'~ :~,; ,.,,,' ~, : kc/' DEPTH OF WELL / ~/,.J
ADDRESS LC ~.,,¢ ,'?'~'~[ fi' ~ STATIC LEVEL OF WATER FT.
LEGAL DESCRI~ION '~'" / ' ;~' ~ ' ,~3 ~ ,~,.~ .~ ,~'f ~ ~,?;~ DRAW DOWN FT.
DATE - Sta~ed ,A / ~ 7 Ended ~:~k~' GA~. PER HR ~
PE~IT NUMBER/ '~ ~[&~ ) ~
KIND OF CASING
KIND OF FORMATION:
From () Ft. to / Ft. :~ ,)~z~ /,L~.._,/9~- ,) From-- Ft. to Ft.
From 70, Ft. to "~' .5',, Ft. -~ []/" '}[? ~g'~ ~'Jt ' : r ~]; { ~ 7r From Ft. to Ft
From Ft. to Ft. ?% ~/~ From Ft. to__ Ft.
From %,3 Ft. to ~ ~ ;" Ft. ,, ~. ~ -!- ;' z, ,~,5'~, '~ From Ft. to__.Ft,
~ "'-' / ,f /:d/r'*7<7 ~%-~ ,~ Ft.
From > ~ Ft. to Ft. From Ft. to
' '~ .... From Ft. to Ft
From '? , Ft. to/.~ ~ Ft/ /~;/.(c~,'.'~' ~ ~,,'~, .
Ft._ C~,,-4 7' d , ~.;'.-l~d,::'z, From Ft. to .Ft.
.. Ft.
Ft,
__.Ft.
Ft._
Ft
Ft.
From ! -- ! Ft. to / ,;'o
From /~ , Ft. to l¢l
From Ft. to
From Ft. to
From Ft. to
From -- Ft. to.
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to
From Ft. to Ft
From___Ft. to Ft.
From~ Ft. to Ft
From___Ft. to Ft
MISCL. INFORMATION:
DRILLEWS NAME ·
flT
by
iiiiER'W'ELLS
-
SULLIVAN
P.O. BOX 272• CHUGIAK, ALASKA 99587 • TELEPHONE 888.2759
OWNER OF LAND DEPTH OF WELL y:7 ' :5' /
ADDRESS - d<r .74= % <'. I.
STATIC LEVEL OF WATER FT.��
LEGAL DESCRIPTION4.Lt' /A..:.$ �Y Vj{Lt :. .
DRAW DOWN FT.
DATE • Started X-lrf Ended ,^ GALS. PER NR
PERMIT NUMBER RL�h1 I KIND OF CASING
KIND OF FORMATION:
From Ft. to Ft.
FromFt. to ' _ll' Jt.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft. 1 4A From Ft. to Ft.
From Ft. tohl-L-Ft. r'. �' i �. rK✓•�G .From Ft. to
Fl
From 61_ Ft.to_�Ft.- ' tV-416Ci%1-
J ,
From_UrL_Ft. to : , P Ft: °
Fromr:t FLtol.!, Ft. G' r•.' 1 r
From/? 1 Ft. to /2 t FL S %?•+%A %. �> 1 �: a
From Ft. to '_Ft zkJ.'L'!=.:
From Ft. to Ft.
From
Ft. to Ft.
Ft. 0 -
From
Ft. to
Ft.
Ft. to
Ft. to
Ft. to
From
Ft. to
Ft. '
From
Ft. to
Ft.
From
Ft. to
Ft.
From Ft.
From Ft. to . Ft
From Ft. to Ft.
Frim Ft. to Ft.
From
Ft. to
Ft. 0 -
From From
From
FL to 1104P 1 oy o
t Two
Ft. to VASO\ ntt►�
.From
From
From
Ft. to
Ft. to
Ft. to
-Ft.
Ft.����,,`�
Ft. �"'
F90111 -Ft. toFt.
Front Ft.
From Ft.
to-Ft.From-Ft.
MISCL. INFORMATION:
From Ft. to Ft
DRILLER'S NAME "• �.�'
PERMIT NO:
DATE ISSUED:
HU~4 I C I ~-~L~ I -IFY ~f:.=
DEF'ARTMENT OF HEALTH AND ENVIRONIdENTAL PROTECTION
8~¢5 L STREET, ANCHORAGE, Ab,:: 99501
8407 t8
08/24/84
APPLICANT:
ADDRESS:
CONTACT PNONE:
WILLIAM GLAFKE
PO BOX '770344
EAGLE RIVER, AK
694-93;~3
99577
LEGAL DESCRIP:
LO]' SIZE:
SUBDIVISION: SUNNY' VALLEY LOT: ~*°
SECTION: 16 TOWNSHIP: ~4N RANGE: 1W
1.25A (.~Q. FT. OR ACRE,:})
BLOCK: N/A
I certify that:
1. I am i'amiliar with the requirements for' on-site sewers and v~ells as set.
forth by the Municipality o£ Anchorage (MOA) and the State o£ Alaska~
2. I will install the system in accorclance ~ith all MOA codes and .regulations,
and .~.n compliance ~ith the design criteria o¢ this permit.
3. I ~ill adhere to all MOA and State o£ Alaska requirements Cop the set back
distances £rom any existing _well, waste~a't, er disposal system or public
sewerage syste,~l o~ this or any adjacent or nearby
MUNICIPALITY OF ANCHORAGE
~th and Environmental Prot! tion
~J Fourth Floor West k~
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
REPORT ON-51TE SEWAGE DISPOSAL SYSTEM
SEPTIC TAN K~ ~;~2
DISTANCE ///} ~-/_~.~.~J NUMBER OF
FROM WELL_~Fv MANUFACTURER ~/~'~¢~¢-'~ MA'rERIAL. _~___.(~7¢ _ ~ _ __COMPARTMENTS
INSIDE LENGTH ~ ~ __INSIDE WIDTH LIQUID DEPTN' LIQUID CAPACITY GALLONS.
I',L[ .....
' __ ........... ~j,% / TOTAL LENGTH~
DISTA"CE FROM WELL ]Z~ FOUNDATION ~'S'--f NEAREST LOT L "E _~_ ___OF LINE
~___DISTANCE BETWEEN LINES X~4 TRENCH WIDTH~ iN. TOTAL EFFECTIVE
ABSORPTION AREA_~¢~ SQ. FT. LENGTH OF EACH LINE ~ /
DEPTII OF FILTER
DEPTI4: TOP OF TILE TO FINISH GRACE ~ ~MATERIAL BENEATH TILE ~ IN. ABOVE TILE
SEEPAGE PIT:
DIAMETER --
OR WIDTH LENGTH BEPTH ¢
Log Crib ~-Rings/CRIB SIZE: DIAMETER___DEPTH_ DISTANCE FROM: WELL
TOTAL EFFECTIVE
BUILDING FOUNDATION /~,t NEAREST LO/ LINE ,.~c'9/' . ABSORPTION AREA (WALL AREA)
Well
Class: Depth:
Well Distance To: Lot Line
Bldg: Sewe~ Line:
Pipe Materials:
# of Bedrooms:
Installer: ,/~/F:[/4-Yc7~,~
Remarks:
'Fg'PIE (}F SO '!; i. t:::liii:':R:l!;~'.l~','i" ]i ON '.i:!;"?:~TEPi I ::S: 'i"FNENCH
HI::!H]U"ilti',! It..~ ~I.!:R 01::: I'"1.. r, t-.', :=: X']: ';.-dill i:;'Fq' :.'i !i "'::~'. .... F:T,-'"E:I:E:)~:::
THE i:,Ni:(:!!i:[!;i:l:!I) S];;-;I~ OF' Y!'iiE SON. FtE:SO~?.!:::'"i'I{'}t'-,! S'-dg;'i'!'N"! ]]5:
THiE !..!!:l-,~i!i't"F.i D :!; HENS 1!10i'-,I ]: S 'FI.fl:i: i..Eli,i(::i'l"H ,:: iii N F::EiEli' ::' OF:' 't'l-'-Itii: 'i'F;'.Ei!",IE:H IlXiF;: i11:,t:;i:1::1111 t'-,IF:' ltl ELD.
'1't-.fl-ii; i3,1:;F'TH OF: F:! TRF(NI31.t Ilii:;~: F:q't' ~£:~; THE:; [:, ]: :?];TF!I'-,!Ct!i: [E:!'{T!.,.II:::Ii::N "i'HIE :iRJF~J:::'i::i(3E[ ()F THE
E:ii:{{)l...Ii'.,t[:, FIN[)'FHI!: I~:O'I"TOH OF: '!"11t! I!~HCF:I'v'Ft'FION (:[t",! I:::'!:E:T).
'T'HI!:I:~NR :i:9; F,!O ::i;iE"!' i4):t::,"i'H i:::(::ff~: Tt:~:Ei",ICHES.
'i"HE: GNF:t'v'IiEI. [:,IEI:::'TI4 IS THE: I'i):t'-,!:[1'"11. ti"i DEPTH OF: GI:;~'.I::I',,,'E::I.. FP, IETF!EE:i",I
F:INii:, 'f'HIE E!:O'I'TOH Ot:: 'i"Hi!ii: E:::.::CFt',,,'f::f?']:OI'..I ,:::IN F:!Et-~::T).
................................................... Il::::~ [F:::lt I(i':: l!":::i: :~::i! {iii Eib. i: E::::~ ii._ I!=:%1 ~'"',,~ ~'~"' i{i'tl IF::::': ?" ]!X i(i} ~"dl .............................................................
i:::i F'FICkiI:::IGEi F't.l:::ll",!l- l"lf::t~'d E:I:: N',!:~:iTFtI..!...i!~D R'i' I-HEi I'::'E:FN'"I)iTTEiEE'"'-"ii; (lJF']'iiRXd",! SI..!ER}'E:C'F 'FO 'T'HEi
FOLt_..OF.! ]l NE!i
::i. E:i:~[i..Ii.i:F:: F:I ti:!_I::lSEi; 'J: IifR :!::!' NSF' F:tPF'F.~'.O'v'E:D F:'i. Fii',IT i'1Fl'.d ieee':: :!:Ng;TFttA.ED.
Fi CON"t' :i: I'.,!110!.J::E; I"!1::! ]: NT!::it'.,II:::iNCi:~: FIGI:;N!!i:EHE:H'f' i '.E!; Ii:IE{:!t..I :i: i:;N:::t3,. ): F Fi i,iFt ]: NTENFINCEE
FIEiii:~:~EE:I"I!ii:N'i" :!:S NOT i<E:F:'T CI..It:;~fI:;N::NT '.r'lilLI i'll::'f'? tE~E I:;i:ii!:6!LI:[FN~{[)TO E:Nt...I::I!:;:.(:iiE TH!E SO:N_
t::iF:'::;FIF;?I:::'T !: iN :iE;'-d:-;lEl"l h~l.,, Lt... ~.dl'-_ ['11::t'?' E~t:' t::! E: "i:ii:i'F Till F;'I:']":~:''~
................. "'If'- iNJJ {:1:)~ ,,;E ;E:i1: X:,,:lEi ii"..,,ii E:E; N> EEl Eli:: 'T" lie i{i} ii'...,!i _?i;; ii,:::;::~ ii::;~E:: E~: F;;:: ~Eil: G:~ lt.j! I1 E,:i~:: IIRi El:, ......................
FE~F~CK!::.':i:M :!:HG O1:-' Fi!",!"r' S;"~":'--.,TI}i:H ki:t:"!'HO!.l"i' F:']:i",IFII.. N",ISF'IF:(X:T}:ON FINIi:, t::IF'F'NO'v'FII._. E:'t' "I'H:[S
t)E~F'!::IFUt'HE:N'i' !4!'1.1. !iE~lii: {R.tllik:riii:C"!' TO F:'!:;~:O%ECI..I't':t:Ot'-,I.
i','i]:NN,it. IH [:,:t:S'FFii',ICE: ii~:i:Tt,.!Ei-EI'.,I F:t !.,.IIEI...L. t:::11'.,16 t::li',l"r' (:ff,i-S:['l"l!::: 5E3,.iI::iEii!E: f) ]i Si::'O:E;F:tL :!~;"~":5'I"E!'"t
fiL:!t8 i:::E:!:'t" I:::'IX}i:;~: t:;:t i::'i:;N!:VF:t"t'i:: HI':Ei...I.. Oi-;;t 2i;:i{;!i FEE'i" j:.'lilt:;i: F:I t::'LIEff..IC [,.!~2:1..I
O'i"HEI:;: !:;~'.E6!IJ ill l:;~:i!!:f'iE:i'.,!"t":i.i; i'lFl"r' FtPF:'I..'-rL 'SF:'Eiil: i F :11 CI':IT :t: i:}i~',iE;
FI'v'FIN..i~!Fifi..E: '10 :t:NfE;I.!E:E: PI';i'.OF:'EI:;~: :[i',!:E;TI:::tl..LFTt"~ON
]1 ii:!EF4Tii'F'~'r~ THI::IT
:l.: 1i: I:;lt,'l I:::'1::1i"I:i:I..]:1:::t1:;i: 141!:I-H THiE I:E:Ei{:!IJ]it:;.'Ei:t'tI!ENYii~ FOI:~'. (:)I',i""'E;iTE: ~E;EiiI4E:t::~::: FIND 141'~:!...t...~:i: l::i'-"!i; SEN'
FOFN'i"! E','r' 'FI'IE HIIi",I!C]:F:'f:~t.]YI"-r' (:IF
2: :[ !.,.! :~ ! t.. ]: N'.ii;"t'FIi.t.. q"H!~: '.i:","S"t't:!:H :[ N FI(X:OI:E:Di::IN{:::E: H :[ TH 'i"HiiE COE:,ES.
3: :[ i..It".IDE:F~'.S"I'f:::tHI:::' THF!T TH!:: OI'+'~':E;:i:TE!: E:E].,.IEFi: S'v'S'FE{i'i i"!(:l"d F:flE(N.J:[i:~Ni::: E:Ni..FtI:;i:(:iE:Ht!{I',!T :i:t:::' TI'iF::
R'ESI[:'ENCE :I:S i~:ti(HO!)!!:I..E:i::, TO :!:t",!CI I..i[:'E t'IOR'.E: ]l-iF~i~',l ::i:
F:IPt::'! :[ C!::iN'i'//HI I..[.. Y FIH ~!',, Iiii..l:",t:::i<E:
PERFORMED FOR:
LEGAL DESCRIPTION:
I
2
3
4
§
6
7
8
.,~9
10
,41
12
13
14
15.-
16-
17-
18-
19-
20-
COMMENTS
PERFORMED BY:
72-008 (7/?6)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch 6,650, Anchorage, Alaska 99502 276-2221'
SOILS LOG - PERCOLATION TEST
I SLOI~E
SOILS LOG
[] PERCOLATION
TEST
~'~tlV~S GROUND WATER
ENCOUNTERED?
DEPTR? IF YES. AT WHAT
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE (nqnutes/inch)
TF~T F~N BETWEEN ~ FT ,~ND ~FT J ~
L' le. -t/o P,-(=e
g C ERTIFIEDBY: ~ ~~ATE: ~/7 r
.-. ,,"T~'~,~ . MUNICIPALITYOF ANCHORAGE -~.,h:~'~.~ ~%;...'-1~--~., .
....... - .... ~.-- ,P.O. Box 196650 ~Anchorage Alaska 90519 6650 ,..:
CERTIFICATfi OF HEA'LTH AUTHORI~
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. ~ ~- ~
1. GENERAL INFORMATION
Complete legal description ~ ~/~
HAA # -\~, (-~c[o~(~) ,q3('~](~
Location (sit~.e. address or directions)
"' ,d,;,x,,,-"
..Rropebty ow,er '~./I½.. ~ ~//~Z//~"~- Day phone
Lending agency ~ ~ Day phone
Maflin. g address ." '
Agent.,; ''~ ':
Address
Day phone
Unless otherwise requested. HAA will be held for pickup.
NUMBER OF BEDROOMS: ~- ~
TYPE OF WATER SUPPLY:
Individual well ~
' ~" "' Community well
Public water
NOTE:
If community well system, provide written confirmation from State ADEC attest-
i~g to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
Iddividual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025(Rev. 1/91) Front MOA~21
STATEMEN'r. ~? INSPECTION BY~ ENGINEER ..'. i '
· . ';,::, .' · .... *,h ,'~'h'~!Ji; : ' .
As cerhfled by my seal affixed hereto and as of the val~dahon date shown be ow vet fy that my
investigation of trOiS Health Authority Approval application 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 systen~ il in compliance with all Municipal and State codes
ordinances, anO regulations in effect on the date of this inspection.
Name of Firm .... KND Engineering Phone ~ ~,~-~ J//
20441 Ptarmlgan Blvd,
A ddresSEngineer's signature Ea'cl~~
Date
DHHS SIGNATURE
,~ A_p. proved for
bedrooms.
Disapproved·
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
The Municipality of An(~l~orage 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 cou. rtesy 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. .
SEP I' /998
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744
Health Authority Approval Checklist
LegalDescription: ~/~/~/~/~/ ~o/~Z,/~ Parcell. D.:
A. WELL DATA
Well type /~/~4
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date compleied
Cased to Casing height (above ground)
Y
Wires properly protected (Y/N)
Date of test
Static water level
FROM WELL LOG AT INSPECTION
Well production
g.p.m.
WATER SAMPLE RESULTS:
Coliform ~
Date of sample: r ~/~//~,
B. SEPTIC/HOLDING TANK DATA
Nitrate
~' O. l 0 ~,~//I Other bacteria
Collected by: .,~/f/',~/,~-~-v~?../-//~ ~,~
Tank size ?~_~_._, ~Number of Compartments 2- Cleanouts (Y/N)
Depression (Y/N) /4?/ High water alarm (Y/N)
Pumper
Date installed
Foundation cleanout (Y/N) y
Date °f pd~Ping' ~ ~'/~
C. ABSORPTION FI'EED DATA :,, '"'.
Dat~ ih~talled ~<~////~fc/' 't; Soil rating (g.p.d./~ orffe/bdrm)
Length ~' ~ Width [" ~-
Effective,absorption are~ ::. z./F~ Z~
Date of adequacy test
Fluid dapth in absorption field before test (in.); /~ '
Fluid depth B~ (ins) Minutes later:
Peroxide treatment (past 12 months) (y/N)
Gravel thickness below pipe
Monitoring Tube present (y/N)
Results (Pass/Fail)
Systemtype ,~/~ ~r"~__~.
7 ~ Total depth /~ /
· Depression over field (y/N) /V/
For ~-- bedrooms
Immediately affer//~gal, water added (in.): ~ 75/. ~''
Absorption rate = '~ L) ~ g.p.d.
If yes, give date ,~
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N)
High water alarm level at*
Cycles tested
E. SEPARATION DISTANCES
/
,/
,/ Size in gallons __
"Pump on" level at* / "Pump off" level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot /~)~) -/~
Absorption field on lot /L~)~,.~
Public sewer main
Sewer/septic service line
On adjacent lots
On adjacent lots /~:~)~) /
Public sewer manhole/cleanout
Lift station ,/v/,~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation /~) e Property line.. /~ -~ Absorption field. /D
Water main/service line ,~ ,,c Surface water/drainage /~)(~ -7c Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Proper'by line //.) ~ Building foundation /~ -A Water main/service line ,~- ~' J-
Surface water /g}('~ t-~L Driveway, parking/vehicle storage area ~.~' /4-
Curtain drain /~)0 'P Wells on adjacent lots /~9 F_D -)
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review o
in conformance with MOA HAA guidelines in effect on this date.
Signature ~---¢/~.-~.
Engineer's N-~me,
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (Rev. 3/96)*
KND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
(907)696-6111/FAX (907)696-8111
September 16, 1998
Municipality of Anchorage
Dept. of Health & Human Services
On-Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Sunny Valley Subdivision Lot 22, Inspection report and HAA request
Gentlemen:
On August 20, 1998, we received a request to provide services in conjunction with a septic
adequacy and well flow test for requesting a municipal HAA. While performing a record
search on the existing system we found that permits were issued but the inspection report
was not on file. We contacted the owners and they researched their records and found the
original inspection report signed by the engineer. We are attaching the original inspection
report along with our HAA packet. Our field inspection and adequacy test correlate with
the original inspection information.
The residence had sat vacant for several weeks prior to our field inspection, therefore to
insure an accurate test we introduced over 1000 gallons of water into the system without
maximizing the capacity of the drain field. While the system is working in the mid range
of its capacity, it more than handled the extreme stress we used to reach the actual
operating level of the system.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
~) Engineering
attachments: On-Site Sewage Disposal System Inspection Report
Health Authority Approval Checklist
Certificate of Health Authority Approval
Water Sample Test Results
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
~'GREATER ANCHORAGE AREA BOROUGH~)q '
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-456i
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
3. Legal Description:
4. Location:
Phone:
Phone:
5. Type of facility to be inspected
6. Well Data:
A. Type ~,'i'i'i.,?,~
No. of bedrooms
B. Depth ";'~,,
D. Bacterial Analysis
B. Ins.taller :4;::
Size i.:~ : 2. Manufacturer
1. Absorption Area ~ P : 2. Material
Total length of lines
Bo
C. Construction
Sewage Disposal System:
A Installed ....
C. Septic Tank: 1.
D. Seepage Pit:
E. Disposal Field:
Distances:
A. Well to: Septic tank ~'!~
Nearest lot line
Foundation to septic tank
, Absorption area
, Other contamination
, Absorption area
C. Absorption area to nearest lot line
Sewer Lines
EQ-03~ (1/74)
Page 1 of two
t Page 2 of two pages - R~ st for Approval of Individual er & Water Facilities
Legal Description Lot 22 Su)')ny Valley SuLdivi.~io~
Comments
Approved
1Disapproved/x~ 2~.~ Y~.~. Datel/13/75
Approval Va id for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this reouest for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)
October 25, 1973
Alaska State Bank
442 West Fifth Avenue
Anchorage, Alaska 99501
SUBJECT: Request for Department of Environmental Ouality Approval for
Stanley Anderson, Lot 22, Sunny Yatley Sub,division.
Dear Sir:
A request for .Separtment of Environmental Ouality .)p(~rowl of tile water and
sewer syst~s on the abov~ Froperty was received 6.v this office o~ October
23, 1973. ~
ll)e se:~or syst~) is existing, l(o~,',~ever, b(:cause of lack of information con-
cerning the details of the system, it is impossiblo for this offic() to ~val-
uate the adequacy to determine compliance with minimum requirements.
An cvaluat(on form used by ti)ts department is enclosed. If this form can be
completed, signed, and returned to 'C~(is officer with ti~e necessary information,
an ~valuation can be made.
If ti)is office can be of any assistance, please do not hesitate to call .694-
2116.
Thank you in advance for your cooperation.
John R. Lee, R. S.
Eagle River District Sanitarian
sr
Enclosure