HomeMy WebLinkAboutSUN VALLEY HEIGHTS BLK 3 LT 25un Valley
Hight
Block
Lot 2
#0Z7-062-38
Permit Number:
Name:
STEVE VOVES
Address: ~
13231 MOUNTAIN PL.
Phone:
(907) 261-9244
Municipality of Anchorage
Development Services Department
Building safety Division
On-Site Water & Wastewater Program, 4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak,us (907) 343-7904
On-Site Wastewater Disposal System and/or Well Inspection Report
SW020464 PID Number: 01 7-062-58
Wastewater System: [] New
No. of Bedrooms:
4
Page 1 of 3
· Upgrade
ABSORPTION FIELD ~
r'l Deep Trench n Shallow Trench ri Bed riMound ./,//~Other
Block: Lot: Subdi is'on: Depth to pipe ~ttom from oHglnal ~mde: Gr~el~pth beneo~ pipe:
5 2 SUN VALL~ HEIGHTS F~
Ft.
Township: Range: Section: ~11 edded ob~ oHglnal grade: ~ G~ I~th:
~~ ~ ~tt}Number of lin~: I Bines:
WELL: U New ~ Upgrad ~., .idth: Number of lin.: Distence bet .... n.
C
Pump S~'t At: Co$1ng Height Above Ground:
GPM
Ft.
SEPARATION DISTANCES
T~"~T° Septic Absorption Lift Holding Public/Private
Tank Field Station Tank Sewer lines
Well 100'+ ....
Surface Water 100'+ ....
Lot Line 5'+ ....
Foundation 5'+ ....
Curtain Drain ·
Remarks:
EXISTING SEPTIC
TANKS
NONE KNOWN
I
COMPLETLY ABANDONED
Pipe material:
SQ.
Dote installed:
TANK
· Septic ri Holding ri S.T.E.P. [3 Other
Manufacturer: Capacity in gallons:
ANCHORAGE TANK 1250
Material: Number of comlxlrtments:
STEEL 2
LIFT STATION ~
ot High water Qlarm at:
Pump Make~¢.-~l: Electrlaol Inspections performed by:
BENCH MARK
Location and Des~riptlon:
THRESHOLD OF SLIDING GLASS
DOOR IN BASEMENT
Inspections performed by: AKWWC, INC. Dates: 1st 11/19/o2
2nd 11/19/02
3rd 12/05/o2
Development Services Department Approval
Reviewed(R,¥. f2/ot) and approved by:_~'/--~~''' Date: J//h, sc'
'PE~' NU~eER:
SW020464
100' WELL RADIUS
\
EXISTING
4 BEDROOM
HOUSE
,/
/
/
/
/
/
/
/
LOCATION OF'
EXISTING DRAINFIELD
PARCEL ID NUMBER:
017-062-.38
I A B C
DBL1 12.2 45.9
DBL.2 12.9 46.4
ST1 22.6 ,55.4 [ 65.4
ST2 25.5 75.4
DBL,5 25.1 55.1 74.4
DBL4 54.0 74.4
B 53.4 68.9
A ~ 57.4
',tRW 1250
SEPTIC TANK
PREPARED FOR: PHONE NUMBE~,b
ST/V/ VOV/S 261-9244/,345-2504
LEGAL DESCRIPTION:
LOT 2, BLOCK ,3; SUN VALLEY HEIGHTS SUBDIVISION
TYPE OF WORK:
AS-BUILT OF SEPTIC TANK UPGRADE
PERMIT NUMBER:
SW0204.64
AS-BUILT
DRAWING
PARCEL I0 NUMBER:
017-062-,58
TOP OF TANK AT INLET = 98.15~
INVERT OF BUNG AT INLET = 97.59/
FINAL
NEW 1250
SEPTIC TANK
GRADE = 102,55
;'r~ oP OF TANK AT OUTLET. = 98.18
GALLON ~
INVERT OF BUNG AT OUTLET = 97.3,8
ALASKA WATER & WASTEWATER
~-~;= ........ ~ '~ CONSULTANTS, lNG. ~*'~;~ ..... ~m~*~,: ....
6901 D~BARR ROAD, SUITE Z8 * ANCHORAGE, AK 9950& * PHONE (g07)357-6179 * F~K (907)558-~&0
PREPARED FOR: PHONE NUMBER:
STEVE VOVES (907) 261-9244/345-2304
LEGAL DESCRIPTION:
LOT 2, BLOCK ,5; SUN VALLEY HEIGHTS SUBDIVISION
TYPE OF WORK:
DATE:
12/09/02
DRAWN BY:
B.S.G.
SCALE:
N.T.S.
PAGE NUMBER:
3OF3
PROFILE AS-BUILT DRAWING OF SEPTIC TANK UPGRADE
MUNICIPA£1TY OF ANCHORAGE
Development Sen/ices Department
On-Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519~6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Date Issued: Nov 19, 2002
Expiration Date: Nov 19, 2003
Permit Number: SW020464
Legal Description: SUN VALLEY HEIGHTS BLK 3 LT 2
Design Engineer: 0041 AK Water & Wastewater Consultan'
Owner Name: STEVE VOVES
Owner Address: PO BOX 112811 Total Bedrooms: 4
ANCHORAGE, AK 99511-2811
Parcel ID: 017-062-38
Site Address: 013221 MOUNTAIN PL
Lot Size: 47762 SQ. FT.
Permit Bedrooms: 4
This permit is for the construction of:
~ Disposal Field [] Septic Tank [] Holding Tank ~ Privy
Private Well ~ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
'(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By:
Date:
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
on-Site Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage,ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
017-062-38
Permit Number
Property owner(s)
Mailing address (1)
MailiNg address (2)
STEVE VOVES
13231 MOUNTAIN PLACE * ANCHORAGE. AK
Day phone 261-9244/345-2304
Legal description (Lot, Block & Sub'd.)
Legal description (Section, Township & Range)
Lot Size Z~ 7/7~' Z
THIS APPLICATION IS FOR:
Sewer Only
Sewer and Well
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
Swimming Pool
Therapy Pool
Acres/~
Zip Code 99516
SUN VALLEY HEIGHTS SUBDIVISION: LOT 2. BLOCK 3,
N/A
Number of Bedrooms 4
[] Well Only []
[] Water Storage []
[] Jacuzzi []
[] Water Softening Unit []
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
ALASKA WATER & WASTEWATER CONSULTANTS, INC.
(Signaturc of propcrty owncr or euthorizcd agcnt)
Permit Fees: '~"4~)0 ° *'----
Date of Payment:
Receipt Number:
Waiver Fees:
Date of Payment:
Receipt Number:
ALASKA WATER & ' VASTEWATER
September 18, 2002
Municipality of Anchorage
Development Service Department
Building Safety Division
On-Site Water & Wastewater Program
4700 South Bragraw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Septic Tank Upgrade for Lot 2 Block 3, Sun Valley Heights Subdivision
To whom it may concern:
The existing 4 bedroom house is currently served by an on-site well and septic system. The
conventional septic system contains a 1000 gallon septic tank and a 500 gallon septic tank. The
existing septic tank has collapsed and needs to be upgraded. We are proposing that the existing
1000 gallon and 500 gallon septic tanks be replaced with a 1250 gallon septic tank. Them are no
surface waters within 100 feet of the proposed upgrade.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
sys!ems. If yo)l~have any questions, please contact us at 337-6179. Thank you for your
assistance. , ~ I
/S er _y :[/
.5
NOTE: Attached is a site plan drawing, a design drawing,, and a 5 page construction
specification letter which are all part of the design package for this septic system.
6901 Debarr Road, Suite 2B * Anchorage, AK 99504
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com
I / C~S EPTiC'"\
/ ~ AREA-')\
/ SUN VALLEY HEIGHTS S/;O~"-' \
~\ LOT 3, BLOCK 2, \
SERVED BY
'~ COMMUNITY WATER
SUN VALLEY HEIGHTS S/D;
LOT 2, BLOCK 2,
/
1
C~'~SEPTIC
\
100' WELL RADIUS
OPOSED SEPTIC TANK UPGRADE t
\ //
t/ [ I SUN VALLEY HEIGHTS S/D;
t/ / / LOT 1, BLOCK 3,,
\ /I
/
~f \ \ ', COMMUNn'Y WATER
~ ", \', Bp..v,~_ H~.~_m S/O:
LOT ~. BLOCK B. '\ \ \
DATE:
1 ~/~ s/2oo2
DRAWN BY:
A!.ASKA WATER & WASTEWATER J.L.U.
~-~ CONSULTANTS, ING. SCALE:
1"
PREPARED FOR PHONE NUMBER: PAGE NUMBER:
STEVE VOVES 261-9244/545-2;504 1 OF 2
LEGAL DESCRIPTION:
LOT 2, BLOCK 5; SUN VALLEY HEIGHTS SUBDIVISION
TYPE OF WORK:
SITE PLAN FOR SEPTIC TANK UPGRADE
SUN VALLEY HEIGHTS S/D'
SERVED BY
COMMUNITY WATER
~S[PTIC
SUN VALLEY HEIGHTS S/D;
LOT 3, BLOCK 3,
SERVED
BY
(-~EPTIC
COMMUNrTY WATER
4 BEDROOM
HOUSE
--.EXISTING SEPTIC
SYSTEM
SUN VALLEY HEIGHTS S/D;
LOT 1, BLOCK 4,
SERVED BY
COMMUNITY WATER
C-SEPTic /
INSTALL DOUBLE
100' WELL RADIUS
o
EXIST1NG
4 BEDROOM
HOUSE
1000 GALLON
SEPTIC TANK TO BE
RI.LED WffH CONCRETE
AND COMPLETELY
ABANDONED~CRUSH AND
FILL THE SO0 GALLON
TANK.
PROPOSED 1250 GALLON
SEPTIC TANK --
INSTALL DOUBLE
CLEANOUTS
ALASKA WATER & WASTEWATER
,~ CONSULTANTS, lNG. ~~ ....
690[ DEBARR ROA~, SUITE EB * ANCHORAGE, AK 9950/~" PHONE (907)~57-617g * FAX (907)538-SZ~b
PREPPED FOR: PHONE NUMBER:
STEVE VOVES 261-9244/545-2504
~L D~CRI~ION:
LOT 2, BLOCK 5; SUN VALLEY HEIGHTS SUBDIVISION
~E OF WORK:
DESIGN OF SEPTIC TANK UPGRADE
DATE:
11/18/2002
DRAWN BY:
C,J.G.
SCALE:
1" = 40'
PAGE NUMBER:
20F2
EXISTING DRAINFF:LDS TO BE
REMAIN IN USE
Municipality of Anchorage, Alaska Page Iot
~Anchorage
ii/lg~~Parcel Viewer
Tax Parcel 01706238-000 Detail
(~ Click here to view this parcel on the map,
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card,
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Owner Information
VOVES STEVEN R & DEBORAH K
PO BOX 11281'1
ANCHORAGE , AK 99511-2811
Parcel Address
13221 MOUNTAIN PL
Parcel Details
Parcel ID:
Deed Year:
Deed Book:
Deed Page:
Plat:
Legal Description:
Tax District:
Area:
01706238-000
1989-07-20 00:00:00
1925
0000519
000000
SUN VALLEY HEIGHTS, BLK 3 LT 2,
O37
47,762ft2
Parcel Values
Land Value: $ 54,700
improvements Value: $187,200
m GIS Mah] Page [ contact us ]
weather ] l about
Current Cursor Function: Identify
http://gisweb.ci.anchorage.ak.us/website/anchorage/application/map.htm 1/I0/2003
MUNICIPALITY OF ANCHORAGE
DEPAR'rMENT OF HEALTH & ENVIRONMENTAl_ PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchora§e, Alaska 99B01 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl_ INSPECTION REPORT
NAME
LEGAL DESCRIPTION
LOCATION
DISTANOE TO:
~ ~ Manumit'er -- .........
~ ~ ~ No. of lin~ Length of e~¢l, line TotaT~s
~ Length Width Depth
~ ~ Tyl)~f' ~ Crib diameter- Crib depth
~ D~;' Well -' ~ding fo undad(;
~ CE T~ Buildi~,g foun~at~o% Sewer line
' PNONE
NO. OF BEDROOMS
PERMIT NO,
Dwelling
Material
th
Material
Nearest lot lin~
'r re n c~wiO tt~ t
No. of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Total effective absorption area
PERMIT NO.
Total effective absorption area
Nearest lot line
Dis~.~ ~-e / PERMIT NO.
~~k
1
OTHER
PIPE MATERIALS
SOiL TEST RATING
INSTALLER
REMARNS
APPROVED
DATE LEGAL
72-013 (Rex,. 3/78)
FIPF'L. I C:FINT
LOC:RT I ON
I_EGRL
14 POIJGLFt'.::; MORRI:SON SRFI BE)',:':', 3:O2-H
MIL. E 2. 5 DEFIRMOI"~E:,
LOT 2 BLF..' 2;~ '.:.';UN VRLLE'¢ Frrs.
LOT SIZE
T"r'F'E OF SOIL RBSORPTION S'YS]"EM I5.;: TRENCH
,:$4~]41211Zi SI;!IjtR[:,.E I'":'EE'T
MR:~-',[MI..,IM NIJME,'ER OF BEDROOMS ,.~ 4- SOIL RFI'f'Ii'.,IG ,:.'SQ FT,-"BR)=
THE RE);!UIRIS[)SIZE OF THE SOZt.. RBSORPTION S"r'STEM
24.6
]'HE [.ENGTH DIMENSION IS; THE LENGTH '.'.'IN FEET) OF' THE TRENCt4 OF:,: DRFIIi",IFZELD.
]'HE B'EP'f'Ft OF FI TRENCH OR PIT IS THE [:,ISTRNCE BETI4EEN THE SURFRE:E OF THE
GROUN[) RI",IC, TFIE BCITTOM OF' THE E;:':;CFI',,,'RTION '.':IN FEET).
THERE IS 1"40 '.'SE:T I.,.II[:,TH FOR TRENE:HE2;.
THE GRR',,,'EL D['!:F'TH IS THE MINIMUM [:'EF'TH OF' GRR',,,'EL. BETWEEN THE OUTFFILL PIP[.::
Bi'qB, THE BOTTOi"I OF TFIE EXE:FI',,"RTION ( IN FEEl').
[:'ERi'fltT F'IPF"L.]:C:FINT FIRS ]'HIE RESF'ON~;I¢ILI]"¥ TO INFORM THIS I}EF, FIRTMEI'4'F [:,URING THE
INSTF:ILLFITICIN INSPECTIONS OF" RN'.r' I.,.IELLS FIDJRCENT ]"O THIS PROF'ERT¥ F/NE:, THE
NUMBER OF RESIDENCES THF'IT THE P.IELL !.4ILL SERVE.
............... "T'II.,.IIC) ,::: >'_:~ ::, Z ['-,t~'S;Pl[~: c:"r z C,~',qlS F[F.i:i[E: F-.:IE~:i:.:.~L.II If: [;:E:IIZ:, .............
E:FICKF]:LL. IIqG OF FIN¥ S'¢S]'EH 14ITHOUT FINFIL INSPECTION FINE) FIPPF;.'.O',/FtL BY THIS
D.F3::'FIRTMI?:NT 14ILL E[E S.;UBJECT Ti:3 F'ROSECUTZON.
MINIMLIM [:,IS;TFIF,IC:E E:E'I'!.,IEEN FI 1.4EL.L.. RN[:, FIN'¢ ON--StTE SE!.,.IRGE [:'ISPOSRI_ S'¢S]'EM IS
1.¢F~ FEET FOR R PRIVRTE HELl.. OF: ±50 TO 200 FEET FROM FI PUBLIC WELL DEPENDING
UF:'OI'.,! TFIIE T"?F'E OF' PIJBLIC HEI..L.
M:L'NIMI...IM [)ISTRNCE FROM R I:'I;~IVR'I'E NELL 'TO R PRI',,,'RTE SEP.IER LINE IS 25 FEE;']" FIND
'TO I::1 COMMUNtT'¢ ~2;E!.4E:R L. INE ILS 7.'3 FEET.
OTFIER REI;!UIREI"IENTS MF:I'-r' FIF'PL'¢. SPECIFIC:FI]"IONS FIND C:OI'.I':T, TRUC'r'ION [:,IF:iGRFIMS I::IRE
RVRILFIBI_E TO INSURE F'ROF'ER INSTFILLFITIOI'.,L
I CERTIF:"r' THFIT
1: I RP'I FFfftlLIFff~r 14ITH THE REQUIREMENTS FOR ON-SITE SENEI;.'.'S RND 14ELLS FIS ':.:.ET
FORTH B'¢ THE MUNICIPFILIT"r' OF FINCHORFIGE.
2:: I WILL INSTFILL TFIE S'¢STEM IN RCE:ORDFINCE HITFt "rFIE
g: I UN[:,ERS'FFIN[:, TFIFFI" THE ON-~,ITE SEWER S"r'2]TEM MFP? REQUIRE ENL. FIRGEI'dENT IF 'THE
RESIL":,ENCE IS:'; REMODEL. ED ]"0 INCLLIDL:: MORE THFIN 4 BEDROOM':];.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
525 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~'SOILS LOG
~'¢PERCOLATION
TEST
PERFORMED FOR;
LEGAL DESCRIPTION:
SLOPE
SITE PLAN
10
11
12
13
14
15
16
17
18
19
WAS GROUND WATER ~ O SL
ENCOUNTERED7
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ '5 -,, ~ :3i3 1 o 2' IYh/ , Ii
0~',
CoAAB 140- I
G, ' iR ANCHORAGE AREA BOROt
-,,,,..,AflTMENT OF ENVIfl0NMENTAL
3§00 TUDOR t~OAD ANCHORAGF., ALASKA ggE07 27g-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
~ ' & '-~Z~* ..... MAILING
NAME~ ~/~ ~ ~/~ ...... ADDRESS~
LOCATION. ~--~::~ ~-J~ LEGAL DESCRIPTION~L~:"~,
SEPTIC TANK:
DISTANCE FROM WELL
LIQUID CAPACITY /~2~j~
NUMBER OF
7~ MATERIA[ ~''7'~-~-~-- COMPARTMENTS
LIQUID
GALLONS. INSIDE LENGTH ,.----'~-- INSIDE WIDTH ~--- DEPTH
SEEPAGE SYSTEM: SEEPAGE
NUMBER OF PITS // OUTSIDE DIAMETER
LI NIN G~ E~['~RI/~L ....
DiSTA~IDTH
, LENGTH_ DEPTH
NEAREST LOT LINE .......
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA]
SQ, FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
UMBER OE
ABSORPT'ON AREA__
. FOUNDATION /~ z , NEAREST LOT LINE
DISTANCE BETWEEN LINES '---- TRENCH WIDTH
SQ. FT. LENGTH OF EACH tINE /~-~-~"~ / /~-?
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
, OP LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE ? '~'~)/~/~ ~ IN. ABOVE TILE~' z/
TYPE~--~_~/~-~_ _, DEPTH_ -~r'~~, __,BUILDING FOUNDATION. _~7~, _SAMPLE ~/~ , NEAREST
OTHER
NEAREST ~ SEPTIC SEEPAGE / ~/~ SO URC ES-~
LOT LINE /~ ~ , SEWER LINE ~ , TANK ~D ~ , SYSIEM /~ CESSPOOL
DISTANCES:
DIAGRAM OE SYSTEM
DATE
GREA"FER ANCHORAGE: AREA E3OROUGH
SEWAGE DISPOSAL SYS"rEM -- APPLICATION AND PERMIT
,.STALLAT,O. LOCAT,O. /2 T:. -' ' "
LEGAl DESOR,PT,ON_ } O /~' ':Z- Z%~ '/~ .¢'~ ? (. ,N ~/' ///-/":,i¢ IV '* / eL i/~ ::;'
SOil TEST RESULTS /'~:': '') ''~ %f:-)' /'~ /~FA~ /:; ~, )~ ~;/~ NOTE~ THIS PERMIT 15 NOT VALID WITHOUT 8Oil TEST
COMPLETION DATE ANTICIPATED J~ ~' '7 ,~ '~ ;~ ~
FINAL INSPECTION= 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJEC'~' TO PROSECUTION.
/
~:1~1' ~-~
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TA~NK __ /'~
FOUNDATION TO SEEPAGE PIT r',,~* ~2 DRAIN F[ELD ''~' lc')
SEPTIC TANK TO S~EPAGE Pit WALL ~
GRAVEL BACKFILL
CONFORM TO BOROUgh BEGULAT[ONS REGARDING INSTALLATION.
· H E~LTh THO
LICENSED DESIGNER
DIAGRAM OF SYSTEM
] CERTIFY THAT I AM FAMILIAR wJ'rH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN_ACCORDANCE WITH SAID CODE.
/ ' ~ ~ ~":~ APPLICANT'S SIGNATURE '
?eol: goi i CLAP:. ·
~ ; with alternating sand seams
4 ~i ] and lenses
10
t~et Dr,op
def',~;, Of a ~ ~ , ,-, 'TZ"":'~''''
('0:, uF U?'k ·
~gg9.,~9~. ~.ioda~ area is ~eguired per bedroom
By: . ·
Ies~ Peri:o~med ~ ~{rl~sle
Data Certified Sy:.~,N,,gt.~ignal Tes'in '
Date:
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HFALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
,.,1..
Location (address.or direS!i0ns) "
(b)
Property owner ' '",,~&~,~ ,l~'J~,'~ ~' ' ',~'
*~* --'"~ %'"' ~' ' "" ~
Mailing AdCres;".,,:'/~'~ ," ,.,c/ . ~L.zf~.~r-:
Telephone: (home)
Business
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here [~, if hold for pick up.)
List contact person and day phone number below:
2, TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms
3. WATER SUPPLY
Individual Well/~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site ~' Public [] Community [] Holding Tank []
Nole~ If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72-025 (Rev. 7/88) Page 1 of 2
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A. WELL DATA
We,,
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
Legal Description:
Well Log Present (~YO _Date Completed _~;'~&'~
Total Depth ~.~¢'O ¢Cased to ~/'¢/~' Depth of Grouting
Static Water Level //¢¢' Pump Set At __
If A, B, C, D.E.C, Approved (Y/N)
Yield
Sanitary Seal on Casing~'Y~N)
Depression Around Wellhead (Y(~
Casing Height Above Ground
Electrical Wiring in Conduit eND
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ~/~
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
Comments A,/~'~' ~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
'~' "~' ;Date _ ~-/~ ~'¢¢~
B. SEPTIC/HOLDING TANK DATA
uate Installed ?-,z.8'~/ Size
Standpipes
Depression over Tank (Y~_.))
Pumping/Mair~tenance Contact on File (Y/N)
/
Holding Tank High-Water Alarm (Y/N) _
SFPARAT. ION DISTANCES FROM SEPTIC/HOLDING TANK:
To Wa!~r-Supply Well ' /¢'¢
To Pr(~)erty kine, , r ~ /~
To W&ier Main/Service Line ,~
,., ~ ~ ~ ', ~,,:~, /
To Str~ar~, Pond?b.akdor Major Drainage Course /crc
Comments '
.~¢z~ ___ No. of Compartments
Air-tight Caps Y~)
Foundation Cleanout (Y~)
[:)ate Last Pumped 6,-/-/~¢*'~ /)"/'/.~4~/
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88} Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~-~'~-~/
Width of Field
Square Feet of Absortion Area / O.~(~
Depression over Field
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot gc wf/z'c~f
To Water Main/Service Line
Type of System Design
Length of Field 76[/
Depth of Field /? /
Gravel Bed Thickness ~ /
Statndpipes Present ~YN)
Date of Last Adequacy Test
To Stream, Pond, Lake, or Maior Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots ~
tO ¢' To Cutback (if present)
Comments
D. LIFT STATION
Dimensions
-- Manhole/Access (Y/N)
"Pump On" Level at '"'"~"~_ "Pump Off" Level at
High Water Alarm Level at -'""~'"'~ Vent (Y/N) _
Tested for '"~'~_ Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N)
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
Company
Date .~/?
MOA No. 0~-¢
Receipt No,
Waiver Fee: $
Receipt No
Date of Payment
Amount: $
72-026 (Rev 7/88) Back
Date of Payment
Page 2 of 2
GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633BSTFIEET ANCHORAGE, ALASKA99518 TELEPHONE(907) 562-2343
FEDERAL TAX ID # 92-0040440
ANAl, ISIS 8EPOR~ BY SAMPLE for Work Order { 12117
Date Report Printed: ){AR i4 89 0 i0:39
Client 8amplo ID:L2, BN, SUN VALLEY
?WSID :OA
Collected MA8 lO 89 ~ IS:SS hrs.
Received }~AR 10 89 @ 16:00 Are.
Preserved with :NONE
Client Name : A E C S
Client Acct: ANECSR?
P.O.{ NONE 8EC'D
Req #
O~dered By :
Analyais Completed :}{AN 13 89 8end Reports to:
Laboratory Suporvispr,:STEPHEN C. EDE IJA E C N
Special
Instruct:
Chemlab Ref #: 4496 Lab Smpl ID: I Matrix: W6TER
Allowable
NITEATE-N 0.63 mE/1 EPA 353.2 10
Sample ROUTINE SA}4PLE.
8emarks: SA~?LE COLLECTED BY 8P.
Testa Performed Soo Special Instructions Above OA-Onavailable
Rone Detected "' See Sample Remarks Above
Not Analyzed LT-Loss Than, GT-Greater Than
' ALASKA I1UI[ O m [1TAL CONTROL IrIC.
· ~ ~n(lin~erinq ~, ~nuironm~nt~l Studies
DOUG MORRESON
13231 MT PARK DR
ANCH AK 99516
SELLER-SAME
DOUG MORRESON
13231 MT PARK DR
ANCH AK 99516
3-17-89
90034
LEGAL:SUN VALLEY HTS BLOCK 3 LOT 2
FLOW TEST ON WELL
WELL FLOW DATE-3-10-89
A FLOW TEST WAS PERFORMED ON THE WELL. 1269
PUMPED AT A RATE OF 5.3 GPM OVER A DURATION OF
THE DRAWDOWN WAS 5 ' WITH A RECOVERY TIME OF 2
AND THE STATIC WATER LEVEL WAS 199 FEET.
~{E WELL IS ADEQUATE FOR ~IS 4 BEDROOM HOME.
GALLONS OF WATER WAS
4 HOURS.
MINUTES
141 ~ W6SL 33gc5 ~,.V6l]U6 · c~nchol~&(~6, AD,$k,~ 99503 · (907) 279-5553