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Home My WebLink AboutREED LT 1%O (~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE~,TION 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 ~ ~ NO, OF BEDROOMS Wellf ~ Absorption ~r~a ' Dwelling PERMIT NO, ~,s~,c~ ~o: /o/~, i~ / ~ ~Manufacturer Liq, capacity in gallons Inside length Width Liquid depth ~ ~:~ (~ IF HOMEMADE: ~ DISTANCE TO: ~ ~ ~ Manufacturer--~ Material Liquid capacity in gallons ~ Ho. of lines ~ Lengthofe~h~ne$~ - Total length~loflines Trench.. /~w~$ inches Distancebetwe~li~s~ ~ Top of tile to finish grade ~ $ ~ Materialbei~eath tile Total effecdve.bsorption area Length Width Depth PERMIT NO. ~-<~ Typeofcrib Crib diameter Cribdepth ~ Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Classr~'~~i~'."., Depth~'~'~' D~er .. 2) .... DistancetolotJine~, PERMITN~. Building fpundatioo, Sewer line~ Septic tany¢/r Absorption area(s)~/ ~ DISTANCE TO: ~ ~/~, ~ OTHER .,~ L~ ~ PIPE MATERIALS INSTALLER~ %57 f- [ -" .-' - AP"~/ . ~/ DATE LEGAL '-' ~ 13 (Rev. 3/7 ~' :1. 5 :3 0 5 0 zl.'?0 :L7 5 10 0 :I:1:::' AI...]:I:::'T EFT'A'I']:E)I'..I IS :I:NSTAI..I..E:D :l:lxl AN AI:RE:A [::)(]VI!!:I:RI!Ei:)::) )3Y I"IE)~:~ BU:I:I...i'}II".IE~ CE)[)IiLS~, 'I'I'II~N ( :L ) ~:~lq I!ii:l...l!ii:CYTl::;: :t: E) ('::fl... l::'l)::':Fd'd :1: '1' f.~tq}.:) :t: N[i:;t::'l:i!:C;'l' :i: ON F'ILEiiFI' !i:E!i: (]Erl (.~ :i: NE:I:) ~ C:?. ) F~Eb"E~L.~ I L.."I'E~ [.~.J I I.t. t',lCi'f ~.':ll:ii: Fq::'I:::'F;:Ci\;Ei::O [4 :i: TI...IOL.FI" (.~bl [i!:l..E:[;:l'i::~ :[ [:~':q.... :1: I',.I!F;t:::'ti::[:TI" :1: DN I::~:E:I::'C)F:;:T ii (!~lXl!.') (:::.!;) TH[ii: IEI. li::[::;'T'l:.;: :!: I::',(~l.. WI]I::~:i'.:: I"IIJE~'T' }:~I!: i:)(:]Nl!i: Ii~¥ (.'~ 1.. I (]l!i:IxlEEi:.O lii:L.I:!i:C::TI::;~ :1: (:; :t: f"~l'q ,, LEGAL DESCRIPTION: 1 2 3 4 5 7 8 9 lO 11 12 13 14 15 16 17 18 19 2o Municipalil¥ o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENG~AL) Township, Range, Section: "7'~5'"W ,~'/J ~5~-'~.- ,/~" SLOPE SITE PLAN 'PT L./z-o5 d WAS GROUND WATER \/,.~...- ENCOUNTERED? . S IF YES, AT WHAT ! L DEPTH? 7 0 P I~epthlo Water Alter Z / t/Ioni~oring? ~ , _1~'...%_._~- ,' Reading Date Gross Net Depth to Net Time Time Water Drop Io '~--~ /,o z-¢ IO51 PERCOLATION RATE ~,~Z~ (mmutes/~nch) PERC HOLE DIAMETER TEST RU~J BETWEEN ./.".5~*' FTAND 7~ FT PERFORMED BY: ~¢~% '- A~ ';/¢~' , X~( /~ -- CERTIFY THAT ~HIS TEST WAS PERFORMED I. ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECTON THIS DATE. DATE: 72-008 (Rev. 4/85) ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. [200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 56~,-5040 SHEET NO CHECKEO BY DATE W~,ILH Wt:LL RECOI(I; SLATE OF ALASKA DEPAR1MEN/' OF NATURAL RESOURES [)~vmion o[ Geolo0icul & Geophysicol Surv,uys LOCATION OF WELL (Pleo~e complote ~Jlhor Ia, lb oF to.) ANCH I REED MS 'rANCE ANO DIRECTION FROM ~OAO INTERSECTIONS WELL LOG Malorlal Type LOAM FINIS CONST.CO PO BOX 67'-1087 CIlUC, IAK, ALASKA ....... 2 (I 5 ,, I I~EC -:1.2_, .]_98 5 .... ~-~-6 .... ]'~- ' [7] '":"" .... [~ ..~,,,,rg. ]-2:~._~&:t._ tL] ~.,, ,,,.,, E] o,, ]35 148 "~ .....6 -~" ,o 205 ~' r)..., w.i¢,, ]7 ' ..... " 152 16b ~. F,.JS,, OF ].65 j.~Q ~v~ ..DPE~ HOLE SANDY LOAM GRAVEL SANDY GRAVEL BC.rUCD~iS GlO?liVE% FINE SAND WASH ROCK GRAVEL SAND SAND GRAVE[, WATER DAMP GRAVEL BLUE CLAY BLUE CLAY GRAVEL 178 1.88 1~%~7E--~ s'AixTD ................... I88 ~L92 SILT STONE 192 19,1 ~ ...................... BLACK BASALT ]94 198 GRAVEL WATER 198 205 xx ~,'.'"'o': f 1""',' c ......... , [Z! A-'-] 5478 ---BA-RT--BULIL~OCI<S---WE]hG--DRII'.I_ iNG iNC PO BS~ 8-/-,J272 WF:S.I:LLA,Ai',ASKA ~"J"'":_ ...... d%.)_::.~il.,<: z~//L ~: ,d' ..... ""'":.- m;:,:'., :1 ~ ~ 085 ..... e MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~z~! /~2 /2- HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Reed Subdivision, Lot 1 T15Nr R1W, Sec.9 Location (address or directions) 23140 Four Wheel Dirve Peters Creek, Alaska (b) Property owner H.U.D. Mailing Address 605 W. (c) Lending Institution Mailing Address 4th Ave. Telephone:(home) Business Suite 086 Anchorage, AK 99501 Telephone (d) Real Estate Company and Agent The Address 8040 Opal C~rc]e Telephone 243-1022 (e) Mail the HAA to the following address: (or check here rq, if hold for pick up.) List contact person and day phone number below: P~c.k-up by Rngin~r Realty Store Anchorage: AK 99502 2. TYPE OF RESIDENCE Single-Family [] Number of bedrooms 3 3~ WATER SUPPLY Individual Well rq Community Fq Public [D Connect #864124 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 E~ 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 SerVTelephone 694-5195 Address P.O.B. 773294 Eagle River, AK 99577 Date /,///6/? ~' 6. DHHS APPROVAL Approved for -~ Approved /~, Disapproved Conditional Terms of Conditional Approval The MunicipalityofAnchorage Department of Health and Human Services(DHHS) issues HealthAuthorityApproval cerificated 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 courtesy 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. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) , i CHEOKLIST ~ FEBRUARY 1984 A. WELL DATA 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 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments · 343,4744 ::. Legal Description: Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed /~'~,G' Size Standpipes (Y/N) ~/ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: /d0¢$¢ / No. of Compartments Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) _/V /t2 Date Last Pumped ]D-,/C'R '~/~,,4 ;for '~,/~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field L/ TO Water-Supply Well To Property Line ~'la To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. ;'/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /¢ ¢¢-¢-' Width of Field /o¢ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~3'- Depth of Field ~ / Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well '~"//,'¢ To Property Line -J'- / .~,¢e ,,~¢,¢-~'~- /5'¢¢ ~/~,~,~. To Building Foundation ..2g / To Existing or Abandoned System on Lot '~'~ ; On Adioining Lots To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutback (if present) D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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 J~ Company Eagle Rivor Engineering Services P, O. Box 773294 Date /.2-,).~.o/,p,c Eagle River, Al( 99577 694-5195 MOA No. ,P,¢"-~ ~- Receipt No. ~_5~'~-0~)~ Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 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 i,~") '" ~'1'~.'/-'' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 't-~ :L,~.-~ %,,/.,?'~ "~ /~, ~ ,7 .,- (b) (c) Location (address or direct.io?) , Applicant is (check one): Lending Institution F.~; Owner/builder ~Buyer ~; Other ~ (explain); _ Address (e) Real Estate Company and Agent Address Telephone (1) Mail the FtAA to the following addres~s: Single-Family [£,F Multi-Family [] Number of Bedrooms .... ,-.~ Other WATER SUPPLY / Individual Well .~/ Community [] Public EJ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Onsi[e [¢~' Public ['J Community ["J Holding Tank [] Note: If community well system, faust 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 PROVIDING INSPECTIONS, YESTS, FILE SEARCH, DATA AND INFORMATION As certified by rnyscai ~dfixed hereto arid 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 wastowater 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 ~nspection, 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. Date ..... ~ ~_:~_Z~ .... ,-~ Engineer's Seal DHEP APPROVAL Approved for -'"'"'~""' ~ bedrooms by ~__ ¢. Approved /-- ~- . .... ~isapproved Generational Terms of Conditional Approval 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 DI-IEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DPIEP 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 (HAA) MUNICIPALITY OF ANCHOI[AGE CHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTIOn' i]EC 2 1985 WELL DATA P,E C EI, Well Glassification' Well Log Present (Y/N) _ Legal Description: If A, B, C, D.E.C.. Approved (Y/N) Date Completed / ~ .///'g'/~f'~ -~' Yield /2/,4 Total Depth ,~3'._~ i Cased to .~/'P.~ / Static Water Level Casing Height Above Ground /~ /t Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot //~:~2 / / Depth of Grouting Pump Set At / ~(~"-~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot / / / ; On Adjoining Lots To Nearest Public Sewer Line ,/,fj ,~.~,'~ To Nearest Public Sewer Cleanout/Manhole . . To Nearest Sewer Service Line on Lot Water Sample Collected by ~/~,/~/.'~ ~/'JC(-~ ~'6"¢"P1 ;Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed //Z/"~.~,* Size ¢ Z;"~'~_~2 Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ /~/'///~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line H To Water Main/Service Line Course Comments No. of Compartments ~'/ Foundation Cleanout (Y/N) Date Last Pumped ; for ///,,4- Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field /'~'*~ ! 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 Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course //-~'2.-~'t~,/~Z'//')Y), Type of System Design Length of Field ~'~'-~ Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line '~.~' To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) LIFT STATION ~i:teeilnn~i~llll:dns . ManhDiolrr~:ic°ensSs (Y/N) "Pump On" Level at /}/h "Pump O,," Level at .~ High Water Alarm Level at I -// / ' ~.._-~__--__ %~r~cfa~rcodes (y/N) ~ Pumping Cycles during Adequacy Test, Meets M?A I certify t h a~)lf¢,ve,~_ heck, Cd'~Cerified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed W/,,~//~/~¢'/~ Receipt No. ,%~'-~ Date of Payment Amou.t: * Page 2 of 2 72-026 (11184) HEMICAL & GEG~,OGICAL L~gi-IY~T~RIES 0~' ALASKA, INC, TELEPHONE (907) 562.2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: (9 See h on back I,D, NO, Water System Name CiW State Mo, Day Yeer Phone No. SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab reft no, [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 3 I , I Time Collected Collected B~ ~:~,,~/x/ .-~.~ 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 hoursoid at examination to indicate reliable results. Please send new sample via special delivery mail. Date Rece,ved Time Received Analytical Method: [] Fermentation Tube ,~, ' Membrane Filler Lab Reft No. Result* Analyst I I [-'r'q J F-l'q I [Z]Z) o6.122o (b) Rev. 1963 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count Verification: LTB BGB. Final Membrane Filter R~ts / ~'~ ~ Time: TNTC = Too Numerous To Count Collform/100ml Collformll00ml D,Ill,