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Home My WebLink AboutIVERSON LT 1v rson S/D 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 ADDRESS LEGAL DESCRIPTION lOCATION DISTANCE TO: Liq. ty in gallons Absorption area inside length IF HOMEMADE: No. of compar.~ernts Liquid depth Well Dwelling PERMIT NO, DISTANCE TO: urer Liquid capacity in gallons Mat~ idth Material INearest lot line.~ Trench width ..~ ~_r~ inches Foundation Total len§th of lines Material beneath tile DISTANCE TO: Well /~.~)/,2 I / Length of each line~,.~ Top of tile to finish grade~ ) PERMIT N O,. O~.1,/~..,//~.~ Distance between line~//~ Total effective absorption area PERMIT NO. ~ ~ 4.¢, Length ~e of crib DISTANCE TO: Class ~ ~_~/ DISTANCE TO: Width :rib diameter Depth Crib depth Building foundation Total effective absorption area Nearest lot line Depth Driller Distance to lot line PERMIT NO, Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RATING INSTALLER REMARKS APPROVEp / / DATE LEGAL PERMIT NO. RPPLiCRNT LOCATION LEGAL ERICKSON"S BA(}'KI.4OE CHUG IRK [EFHE'FME~..T,_,.:,~ I HEFILTH FIND EN',,,'IR'NMEMTRL_ _ c .... "'b ,"STREET., FIH]FIOF'RGE, FIK. T±SN RiW SEC 9 LOT i]:0 LOT SIZE 60000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MRNtMLIM NUMBER OF BEDROOMS SOIL RRTING (SQ FT?BR)= ±]:0 THE REQUIRED SIZE OF' THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH ,.'.'IN FEET.'." OF THE TRENCH OR DRA!NFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROLIND AND THE.BOTTOM OF THE E:,.-','CA',,,'RTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRFI',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETWEEN THE OLtTFRLL PIPE RN[." THE BOTTOM OF THE E~WCAYATION (IN FEET). PERMIT RPF'LICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLATION INSPECTIONS OF RN'¢ WELLS RDJRCENT TO THIS PROPERTY AND THE NUMBER OF' RESIDENCES THAT THE ~4ELL WILL SER'¢E. BRCKFILLING OF ANY SYSTEM WITHOUT FINRL INSPECTION AND APPRO',,,'RL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AN[:, RN"r' ON-SITE SEWAGE DISPOSAL. S'T'STEM IS ±00 FEET FOR R PRI'¢ATE WELL OR 'tSR TO 2A0 FEET FROM A PUBLIC WELL DEPENDING LIPON THE TgPE OF PUBLIC WELL. MINIMUM DISTFINCE FROM A PRIVATE WELL TO R PRI',,,'RTE SEWER LINE IS 25 FEET RND TO A COMMUNIT',? SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MFW APPLY. SPECIFICATIONS AND CONSTRUCTION D!AGRRMS RRE R',,,'RILFIBLE TO INSURE PROPER INSTALLRTION. I CERTIFY THRT i: I AM FAMILIAR WITH 'THE REQUIREMENTS FOR ON-SITE :-_-;EWER'=; AND 14ELLS AS SET FORTH B"r' THE MUNICIF'RLITY OF RNCHORFIGE.- 2: I WILL INSTAL[.. TFIE '=;"?STEM IN ACCORDANCE WITH THE CODES. 2:: I UNDERSTAND THRT THE ON-SITE SEFIER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 2: BEDROOMS. SIGNED: .................................................... APPLICRNT ERICKSON¢S BACKHOE I_-,.:, _lEI,-'""1 ' Bi-" ' ................................... D M FE_L~.._O..._.,QJ ,~' - ........... V4. 0 Location: ], ~JNICIPALITY OF ANCHORAGE~ ~ Department ~ Health and EnvironmentaI~rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT .. ,~_. ~ ~)~ ?t ~ Mailing Address :~]/~ Phone Number: ~<~ Type of Soil Absorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~. Soil Rating(sq.ft/br) / ~ ~3 The Required Size of the Soil Absorption System Is: 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). /~ GALLONS * * · * REQUIRED SEPTIC(HOLDING) TANK SIZE = 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 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. Specifications and construction diagrams are available to insure proper installation. · * * PERMIT EXPIRES DECEMBER 1 9 8 1 * * * 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 t~ ~sidens~is remodeled to include more that 3 bedrooms. SWP/024(1/81) PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE SITE PLAN 1 2 ~3 ~ 7 8 9; 11 12 /4/,4- r,~P ? WAS GROUND WATER ENCOUNTERED? 13- 14- 16- 17 18 19- Robert A, Sh No, 145~ 20- SOILS LOG [] PERCOLATION TEST IF YES, AT WHAT // / E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS TEST RUN BETWEEN FT AND -- FT PERFORMED BY: ~S~& S Engineerln~ 72-008 (6/79) DATE: SUBJECT: Water well easement from Lot 130B to Lot 130A, S\'t~ ~ Section 9, T15N, RlW, SM, AK. (Iverson Subdivision) This document describes a water easement from a public deep well located on Lot 130B and running west northwest to the res- idential dwelling located on Lot 130A. The easement width is sev- en and one half feet on each side of a direct line from the well on Lot 130B to the southeast corner of the dwelling on ~.ot 13On. The subject- ~ ~ ea~emen~ shall run with the land and continue so long as there is no potable water source on Lot 130Ao The owner/s of Lot 13_OB__shall provide water.~o_.Lo~t~.~.~30A on demand, at a monthly r~te not to exceed ten (10)~d011ars. ~he drawing below~ depicts-~the easement pictorially. This document was drawn by Albert L.' and Lauralea Iverson, husband 'and wife, and present owners of the [' Iverson subdivision, and their signatures are afixed below° The subject of this document shall continue and apply to any future owner/s of the above described property. State of Alaska, Third District: LOT 130A- ..... ~c~:-.,;~6~ '- This is to certi£.v ~that on: yoz, oe~ore me, t~e unde~-/~ si~ned Notary Public in aRd 2or the State off Ala~;ka~ personally appeard Albert L. ? ~ . and Luaralea Ivprson, known : ~ In wztness whereof, I have set ' - ~ my han,d and seal ~he day and / ar irst er ' aT ' :?' ,';' .... ~'.:'.'9 ', ~ : ..: (.~ / , .) : , L.~, STATE OF ALASKA x_~' DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE Jot PUBLIC WATER SYSTEMS APPROVAL TO CONSTRUCT Plans for the construction or modification of ~/-~o~7 /5 0 A /&d--d ~ public water system located Alaska, submitted in accordance with 18 AAC 80.100 have been reviewed and are i~___approved' [] conditionally approved (see attached conditions). BY TITLE DATE · If construction has not started within two years of the approval date, this certificate is void and new. plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Date APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construdtion of the L-,JT~ J ~ /7 'J"- I ~'~/~ ~J uJ water system was completed on ~'.) ! '7 "~ ~ granted interim approval to operate for 90 days following the completion date. publ,c (date). The system is hereby BY TITLE DATE As-built Plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to 0 p. rat e. ,/~,~.%/~_/~ ~, - .... o ¥ BY TITLE DATE 18-0407 (Rev. 11183) DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEER/MUNI-BOROUGH (Complete Section C) 4. GOLDENROD - MUNI-BOROUGH (Complete Section A} . - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~,~/8'-.~ GENERAL INFORMATION (a) Legal Desc~ption (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name _//~:~/~2¢¢¢ra- ~ -- TeTphone: Home .~~c. Business one): Lending Institution []; Owner/builder []; Buyer []; Other/E3, (explain); (c) Applicant is (c_.heck (d) Lending Institution · //~'-'~,-¢-/--~¢-¢ .~-~A.~ _~¢.~¢~-i-elophone Address Estate Company and Agent~L~ ~/~'~ ('~~' (e)AddressReal ~--~'~:/ (~'¢~-/, ~ Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family J~ Multi-Family [] Number of Bedrooms k.:¢ Other WATER SUPPLY Individual Well [] Community'~ P~ 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 [] 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 ¢1/84) ~"~'~ :--' --mING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION, As certified b m seal aff xed hereto and as of the validation date shown be ow verify that my investigation of th s 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 , o ~',~¢~"~4~ Telephone .~//f'~. . /~, ~ ' / / Address --, *~,,,.,~ ~¢ ¢,~ ....... / Date Approved for (./~¢~ms by -,~,. //~f~ Approved ~ Disapprovec(/ Conditional Terms of Conditional Approval Date 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAAi CHECKLIST - FEBRUARY 1984 W]~,r .L [i~TA Well classification ~ Well Log" P=esent ~Y.~ Total DePth ' /-~/~ ~' Cased to Static Water Level /0 ~ Pump' Set At Casing Height Above Grcund / ~ ElectriCal Wiring in Conduit Y~) Separation Distances f~cm Well: To Septic/H~ Tank on Lot /j-Lo ¢~ To Nearest Edge of Absorption Field on Lot/~D % To Nearest Public Sewer Line /~J ///4 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENt[AL PROTECTIO?I I985' zJ .f0EIVED If A, B, O~ C, D.E.C. Approved~/~U Dat$ Completed /~7~~' Yield S//~/~v 9/0 /- Depth of G~outing .. Sanitary Seal on Casing &Y~N) Depression Around Wellhead (Y~_~ ; On Adjoining 'Lots /~'-cQ ; 0~. Adjoining Lots /~--O To Nearest Public Sewer Cleancut/Manhole ~ ~ ~ To Nearest Sewe= Service Line on Lot Water Sample Collected By~ ~r~ ~¢¢/~,/~;~ Date . Water Sample Test l~esults _~-z-/j-~¢ ~-~ ~-~/ / C~-nts '~ ~ ~ ~ B. SEPTIC~ TANK DATA Date Installed dc¢ (~ ~ ~ / Size / OPm No. of Ccmpartments ~ Standpipes ~) Ai=-tight ~ps ~) Foundation Cleanout (Y~ ~ession o~= Ta~ (Y~ rote ~st ~ - / ? - ¢~. P~ing~intenan~ ~n~a~ ~ File (Y~) ; for ~ Holding Ta~ High-Wate~ ~a~ (Y~) P~ ~=a~f Holdi~ Tank ~t (Y~) ~ Separation Distances f~cm Septic/F_~ Tap~k: To Water-Supply Well /~19 ~- To P~operty Line /O ~ To ~ter ~i~vi~ Lir~ O~m /~ Co~ ~ To Building Foundatic~_ /69 To Disposal Field ~' To Stream, Pond, Lake, o~ Major D~ainage CoKments Receipt ~ Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD [XATA Soils Rating in AbsorPtion Strata Date .Installed Width of Field Square Feet of Absorption A~ea Depression over Field (Y~ Results of Last Adequacy Test /'.~D ~//~. Type of System Design'S./4 Length of Field Depth of Field Gravel Bed Thickness ~ Standpipes P~esent Date of Last Adequacy Test Separation Distance f~cm Absorption Field: To Watez,-Supply Well /~ To Building Foun~tion Lot ~ ; To Wate~ Main/~vi~ Line To St~e~ond~ke/~ ~jo~ ~aina~ C~se , TO ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea Conmgnts D. LIFT STATION Date Installed Size in Gallons "PLu~ C~" r~.vel at High Water Alarm Level at Tested for Electrical Codes (Y/N) Din~nsions ~nhole/Access (y/N____J) Off" Level at Vent (Y/N) ~n~cles during Adequacy Test. M~ets MOA Comments ** Check Permitted Bedroc~ Rating Against HAA Request ** I certify that I have checked, verified, ~ confoc,~ed to all MOA on the date of this inspection. KB1/d5/s Date ~/~S~ [Page 2 of 2] HAA~C~.es in effect 2-15-84 HEMICAL & GEOLOGICA LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I,D. NO, Water System Name (*) See h on back " Phone No. Mailing ,~ddress State City MO. Day Year Zip Code SAMPLE TYPE: ~ Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water i~.,dU nt reated Water SAMPLE NO. LOCATION ~ . ILL,,- / f~-~o,,~ ~J~ I I I Time Collected Collected ._~ TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: 'Satisfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received Analytical Method: [] Fermentation Tube ~ Membrane Filter Lab Ref. No. Result* Analyst I ~ I ~-~ ~NO. of colonies/ID0 mi or NO of Positive portions READ INSTRUCTIONS BEFORE COLLECTING SAMPLE O6.1220 Rev. 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter:. Direct Count, Verification: LTB Final Membrane F,~.,-Resu/t~s/ , /: ? Time: TNTC= Too Numerous To Count BGB Coilformll00ml Coilform/100ml .5'".--.-/ /. (~'")' ~) a.m. Date Date Date Inspector Inspector Inspector Comments Conditional Approval Date Sewer Installed -"~""'"'""'=="~-- =Pl~l'nit No. Septic Tank Size /6 -- ~/ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~/~O L~~ ~/~/~ Phone Lending Institution Realty CO. & Agent ~(/ ~t~ - ~', ~J ¢~C Phone Legal Description ~ s,re.t.oo t,o. LOT Typ~f Residence ~Single Family ~'Multiple Family No. of Bedrooms D Other Water Supply D Individual A~ACH WELL LOG. A well log is required for all wells drilled since June Community 1975. For wells drilled prior to that date, give well depth (attach log if Public Utility available.) Sewage Disposal ~ Individual Year Individual Installed: D Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, January 14~ !.982 A,L. Iverson 3!00 Sheldon Jackson Anchorage, AK 99504 Subject~ T15N, RtW, Section 9, Lot 130A, Dear Mr, Iverson: Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: ° 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 be encased in conduit. ° The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. ° The sewer system servin~ the dwelling directly to the east of you will need to be iocated so that we may determine %he distance between the sewer and community well. Please notify this department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincere!y~ Robert C. Pratt Associate Environmental Specialist ._ CHEMICAi.& 'G~_~,OGICAL-LABORATORIES ~.. ALASKA, INC. ~' ~ TELEPHONE (907)-279-4014 ANCHORAGE INDUSTRIAL CENTER /~_~ ' · 274-3364 5633 B Street /..."J-~,;,.;--.~Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTE M: Water System Name Phone No. Mailing Address State City Mo. Day Year Zfp Code · SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION I 7'/::~" 2 I / .¥ I , I Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: [] Satisfactory [] Unsatisfactory --I Sample too long in transit: sample should not De over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received ; · '., , Analytical Method: [] Fermentation Tube E:YMembrane Filter Lab Ref. No. Result* Analyst I ICI I I READ INSTRUCTIONS BEFORE COLLECTING SAM PLE 06-1220 {b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source L-~b. NO. · resumptlve 1Omi 1Omi ZOml 1Omi lOml Z.Oml 0.1mi 24 Hours 48 Hours gonflrrnatory 24 Hours 48 Hours EMB Broth 24 hours: Broth 48 hours: Multiple Tube Report: Z0ml Tubes Positive/Total AOml Portions Membrane Filter: Direct Count Collform]],OOml Verification: LTB BOB Final Membrane Filter Results - ,, ':; Collform/lO0ml _ ~', ~ . : ~ ~.':'. Reported By ·: Date