Loading...
HomeMy WebLinkAboutGEORGE SEHM LT 14, 15 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 [] NEW L~v ~.~ ~ /--~o~ b ~;~'UPGRADE MAILING A D D~..7 LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer Liq. capacity in gallons DISTANCE TO: Well DISTANCE TO: No. of lines Length of each line' Top of tile to finish grade Length ~.z~ ¢~) / Width Type of crib Crib diameter __ We ! DISTANCE TO: Class Depth Well~,~ / Absorption area Well HOMEMADE Inside length Dwelling Material ,% Width Trench width ~. Cz., ~ R/c, NO. OF BEDROOMS PERMIT NO. ~,~, No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons DISTANCE TO: Foundation PERMIT NO, length of lines Distance between lines inches aterial beneath tile Total effective absorption area inches PERMIT NO. ~ ~ ~ ~rib depth ....... Total ption area ,~ t~) ~ B uildi n~ f,~ ~)d~tion iller Nearest lot line Distance to lot line Septic tank OTHER PIPE MATERIALS INSTALLER REMARKS LEGAL PERMIT NO. Absorpt on area(s) 72-d~'3/~Rev. 3/78) Department ~-Health and Environments~ Protection 825 k~ Street, Anchorage, AK. "~9501 264-4720 * * ~ HANDWRITTEN PERMIT * * ~ Permit ~ 2~AND/OR ON_S i TE SEWER PERMiT Z Mailing Address: ~ ~ ~. Applicant: ~ ~ ~ ~ l~,~7~ Location: Phone Number: /..~_~_ ~ Legal Description: Z~,~ ~/~ ~~ ~ ' Lot Size: Type of Soil ~sorption System Is:~ ~~ ~/O~ Trench: Drainfield: Seepage Bed: v ~ . Holding Tank Maxim~ N~ber of Bedrooms: ~ Soil Rating(sq. ft/br) The Required Size of the Soil ~sorption System Is: ' DEPTH ~' Y~" LENGTH ~O~ GRAVEL DEPTH ~ WIDTH The length dimension is the length(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 minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(~) TANK SIZE = /~00 GALLONS ~ ~ Permit applicant 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. * * * 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. Minimum distance from a private well to a private sewer line is 25 feet and to a conu~unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completipn. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31~ 1 9 8 3 * * * I certify that: (1) 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 the residence is remodeled to include more that 3 bedroo~s~ ~ Signe~: pp~i~an//~/~ Issued by :~~ Date: ~"-'--/O ~ SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVI RONMENTA/PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST '~. SOILS LOG [] PERCOLATION TEST F 'Top ~;0t ~. 1 2 3 5 6 gRoql~f5 ~ ~'T~ 8 9 10 11 12 13 14 15 16 17 18 19 20- COMMENTS WAS GROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Bo× 196650 Anchorage, Alaska 99519-6650 343-4744 . :..* .. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL iNFORMATION Complete legal description Location (site address or directions) 23131Tu. ndJ~Ro6~ Oha~iak, Alask~ 99567 Property 'owner Mailing address Lending agency H~nry Hit~ P.~, Box ~71129 Cl~u~RZ~k, AK 99567 Day phone 271-6454 Day phone Mailing address Agent Ccu[og,/.n~ S,tA~z[no / ~)0N MeJ~ENZIE REAL ESTATE Day phone 694-9055 Address 13155 O,~L G~_~.nn H,~9~Tu~: ~u.~'~. ~O:~z_~£~.~/f. A~' 00577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water y_v_v. If community well system, provide written confirmation from State ADEC attest° lng to the legality and status of system. 47,'~. TYPE OF WASTEWATER DISPOSAL: Ind!vidual on-site -- ....=...~o'H~n'~'~anE'' . -, Community on-site P DIi-U'%'C sewer .... ' NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fronl MOA#21 'XJOM spseui6ue isuoissajoJd eq), u! suolsslbuo Jo sJoJJe Jol elq)suodseJ ),ou s! e6eJoq~uv ~o /q!led!o!un~ eqm 'penss! s! eleoU)l~eo e eJo~eq e),ep eZ~lSUe Jo suol~oedsu! ),onpuoo ),ou op SHHO jo sae/,Old,,,3 's),ue~ueJ!nbeJ a),e),s pus isJepeI u!elJeo/gs!),es o)JepJo u! suo!lni)tsu! 6ulpuel Jieq), pue seuuoq,~o sJaseqoJnd o), ~sepnoo e se siq), saop SHHO aqJ. 'm~sslV jo e),m,S eq), u! peJe)s!§elJ jaau !6ua isuo!ssejoJd ),uepuedepu! ue iq eAoqs g qdeJ6sJed u! ue^!6 suo!)m, ueseJdeJ eq), uodn ~lUO pes~q se~oiJ!lJeO /qpoq),nv q),lSeH senss! (SHHO) seoi/ues ue,,,nH pu~ qileeH ,m ),UeLU)J~de(3 e6sJoqouv ~o/q!l~d!o!unlAI eqJ.. s),uetuuuoo I~UOp,)pp¥ :suo.lelnd!ls 6u!~OllOJ eqi ql!~ 'SLUOOJpeq 'SLUOmpeq .--?.,)~-~?- '7.,\ eleO euoqd G:.':-.?.: ~"~:.'~.. ~..~ ,. ~ Joj le^oJdde leUOp,!puoo 'peAoJddes!O 7/ JOJ pe^oJdd¥ /)( ~II:II'I.,LYNIgI$ SHHa eJn)euDls s~eeu!6uEI sseJppv uJJ!..-I ~o e~ueN · uo!loedsu! slq), jo elep eq~, uo ~,oejJ, e u! suolleln6eJ pue 'seoueu!pJo 'sepoo e)elS pus led!o!unl/~ lie ql!M eoUe!ldLUOO u! s! L~m, SlS lesods!p Jm, e~elSeM Jo/pue ilddns JeleM el!s-uo eq) 'uo!loedsu! puc uo!le6!lse^u! tLU LUOJJ pUS SelU e6eJoqouv jo/q!led!o!unlAl LUOJJ peu!elqo UOp, eLUJOJU! eq~, uo peseq )eq) ~pe^ JeqlJnJ I 'u!eJeq peleo!pu! eJn)onJls jo edil pus SLUOOJpaq JO JeqLunu eq) JoJ e)enbepe pue leUO!lounj 'ejes s! Luelsis leSOdS!p je~eMe~SeM Jo/pus ilddns Je~,eM el!s-uo eq~, leql sMoqs uo!leo!ldde te^oJddv i~,poqlnV q)leeH s!ql jo uo!le6p, se^u! . i~u leq), tjpe^ I 'Moleq uMoqs elep UO!lep!leA aql Jo ss puc oleJeq Idq~lNION~l kla NOIJ.OqclSNI .*10 .LN=IINqJ.Y.L$ "9 'S  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAl. CHECKLIST Legal Description: ~'~¢ \'~t ~ \~' ~ ¢~¢.~¢ ~--t~:~ Parcel I.D. A. WELL DATA Well.type ~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Cased to FROM WELL LOG Date completed Driller Casing height Wires properly protected (Y/N) ~ AT INS C~~TION Static water level Well flow Pump level o SEPARATION DISTANCES FROM W.,EEL TO.' Septic/holding tank on lot J/~"Q ~ ~' Absorption field on lot / 'Z'~c'~> ~ ~ / ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ,.~te of sample: B, SEPTIC/HOLDING TANK DATA Date installed ~-" ~'~ Cleanouts~N) ',~ High water alarm (Y~ Collected by: Tank size \ ~.~ C:~ Foundation cleanout~'N.) Date of pumping Other bacteria Compartments Depression (Y~ Alarm tested (Y/N) Pumper .._7-/~. ~--~'$_~/~o o Well(s) on lot To property line \ ~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: "'/'~' ~ ~' On adjacent lots Absorption field Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) Manufacturer "Pump on" level at High water alarm level Meets MOA electrical codes (Y~ SEP~ROM LIFT STATION TO: Wel'Fon lot On adjacent lots Manhole/Access (Y/N) ~ested Surface water D. ABSORPTION FIELD DATA Date installed Length ~z~o~ Width \ T6tal absorption area '-~ ~::~ Depression over field (Y~j~ Results,~:~fail) cd.Peroxide treatment (past 12 months) (YN~_~ ~..~..o,..~C. ~_~, ~,.(.,...k. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '7,.-~ ok ¥ On adjacent lots .~.J Soil rating \o c~'¥/~:'~ System type Gravel thickness ~/0 Total depth Cleanouts present ~/N) Date of adequacy test ~ - If yes, give date To building foundation On adjacent lots ~ Surface water Curtain drain Cutbank Property line To existing or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect ~ date of this inspection. Signature Engineer's Name Date S & $ ENGINEERING 17034 Eagle River Loop Road No. r HAAFee$ / 7~)' Date of Payment / 2 Receipt Number 72-026 (Rev, 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number '~ "~'~"~" ~ z t ~J : D,~_j_~ RECEIVED ~ ' . INSPECTION APPOINTMENTS TIME TIME TIME INSPECTOR INSPECTOR I NSPECTOF[/ / '' MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE Deborah Beckett Out of State MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE Lots 14 & 15 Geora~ .q~h~ AdS nE ~h~ Allhr~%z ,qtl]~ 2. BUYER PHONE Stephen Wrenn & Latzra Luden 276-8242 MAI LIN~.SSThunderbird Place Anchorage Alaska 99504 3. LENDING INSTITUTION PHONE First Alaskan Mortgage & Escrow Inc 694-4533 MAILING ADDRESS Eagle River Loop Road Eagle River Alaska 4, REALTOR/AGENT PHONE Laurie Long -- -~ora/vt ~e~V 694-9494 MA~L~N~.~.DP~E 911 Eagle River~Alaska ! §. LEGAL DESCRIPTION Lots 14 & 15 Georqe Sehm Add of Robert Aubrey Sub ;TREET LOCATION Ramsey :Road 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ One [] Four [] Other__ ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 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 Unk~ow~ 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 [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []HoldingTank Size:. If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTA~NCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [] APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter m~Jst accompany certificate) Deborah 2eckeht e/o Laurie Long Totem Realty P.O. Box 911 Eagle River, Alaska 99577 Subject: Lots 14 & 15 George Sehm Add of Robert Aubre¥ Sub. Approval for the individual sewer aD~d wa'~er facilJ/tie~ be granted until the following items have been o The top of the well casing sealed with a sanitary seal so that it is water tight. Exposed electrical wires to the well head are in violation of the Municipality of Anchorage codes and must he encased in conduit. o The water anaiysis report ~eeds to be ~submitted to %his office from tile Chem Lab,~ 5,533 ~ Street, for our review. The ~eptic tank pumped with a receipt submitted department. ° Expose the septic tank manhole to verify J.t.~ e~d. stence~ Locate and expose ~,71]e standpipe to t%~e seep. ag~ pit-: /er cur inspection. ~9'~i~ is to insure the minimum gi~tance ° A four (4) inc'h cas~: iron clean©ut T~e<~.ds the septic ta~k 'and/or leaching area. An adequacy test nee,'!s to be performed on t'he adequate according i:o National Standards. A l_istinc needs to be submitted to this office for our EXCAVATION ROBERT A. SHAFER WORK December 26, 1982 CIVILENGINEER 694-2979 Laurie Long Totem Realty P.O. Box 911 Eagle River, Alaska 99577 Dear Ms. Long, Reference: Lot 14 and 15; George Sam Addition; Robert Aubrey Subdivision This letter reports the findings and determinations of an inspectibn of the individual on-site well and waste water disposal system serving the small log structure located on the referenced property. This inspection involved the checking of the horizontal separation between the existing wells on the referenced property and on adjoining properties with respect to what appears to be the location of a tess pool serving this structure. At the same time the well was checked to determine the grade around the casing and wiring from the casing was in compli'ance with existing codes.. The water system consists'of a six inch steel cased well drilled to an unknown depth. The well wires are adequately protected by conduit and a sanitary seal has b$en installed on the top of the casing. The grade around the casing is adequately sloped to prevent water from draining toward the well. The wa'ste water disposal system appears to be a cess pool located to the rear of the house approximately from 70 to 80 feet from the existing well. I regret to inform you that due to the horizontal distance to the well, permsnent continued use of this system is not recommended. to be adec area sufficient distance from EXCAVATION ROBERT A, SHAFER WORK December 26, 1982 CIVIL ENGINEER 694-2979 Laurie Long Totem Realty P.O. Box 911 Eagle River, Alaska 99577 Dear Ms. Long, Reference: Lot 14 and 15; George Sam Addition; Robert Aubrey Subdivision This letter reports the findings and determinations of an inspectibn of the individual on-site well and ;mste water disposal system serving the small log structure located on the referenced property. This inspection involved the checking of the horizontal separation between the e×isting wells on the referenced property and on adjoining properties with respect to what appears to be the location of a cess pool serving this structure. At the same time the well was checked to determine the grade around the casing and wiring from the casing was in complfance with existing codes.. The water system consists of a six inch steel cased well drilled to an unknown depth. The well wires are adequately protected by conduit and a sanitary seal has b&en installed on the top of the casing. The grade around the casing is adequately sloped to prevent water from draining toward the well. The wa'ate water disposal system appears to be a cess pool located to the rear of the house approximately from 70 to 80 feet from the existing well. I regret to inform you that due to the horizontal distance to the well, permsnent continued use of this system is not recommended. There does appear to be adequate area sufficient distance from surrounding wells to allow installation of an approved septic system. The exact specifications and costs of such a system will have to be determined after a soil test has bee~ performed. If we may be of further service, please do not hesitate to callo ~nicipality of Anchorage Department of Health and ~viro~entsl Protection SRB 196X EAGLE RIVER, ALASKA PObCH 6 65O (907) MA YOH DEPARTIVIENT OF HEALTH AND EN\/I~ROf~MENTAL PROTECTION January 25, 1983 Deborah Beckett % Laurie Long Totem Realty Post Office Box 911 Eagle River, Alaska 99577 Subject: Lots 14 and 15 George Sehm Addition of Robert Aubrey Subdivision The engineer's report submitted to this department indicates the on-site sewer system consists of a cesspool and is approximately 70 - 80' from the well. It should also be noted that a septic tank was not in place. Therefore, prior to approval from this department, the following needs to be completed: 1) Have a soils test performed by an engineer~ See the enclosed listing. 2) Obtain a permit for the installation of a new on-site sewer system. 3) Have the old cesspool pumped and caved in. A more current water sample will need to be obtained from this department.. The results must be satisfactory. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Acting Program Manager RCP/ljw