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HomeMy WebLinkAboutSHERWOOD HEIGHTS LT 6it 1 on MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION J/ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT - PHONE JEW NAME GS �'�" �� 9 gel ❑UPGRADE MAI LING ADDRESS _ - a LEGAL DESCRIPTION IIII.rr�O LOCATION` S. Gi N0. OF BEDROOMS V - Well 1— A sorption area/ Dwelling F3o� DISTANCE TO: '0IC>T- PERMIT O. C7 _ Uy N• z Manufacturer �,�.. 1 Material No, of compartments a. Q 1 '1 71" ui - `n Liq, rapacity in gallons IF HOMEMADE: Insidelength Width Liquid depth � Well Dwelling PERMIT NO. O DISTANCE TO: C7 zh Material Liquid capacity in gallons 02< Manufacturer p Well 1 ©d Foundation r Nearest lot line 00 '," PER IT Y �� jj 50 DISTANCE TO: l ,� w� w U No. of Ines Length of ch Ii e r Total length of lines Trench width �+ 42E: s inches Dista nyce t�etw Ij.nes Z I" Q u — -► Top of the to finis grade f Material beneathl�ile `L C r^� R� inches Total effective abs rption area / e2ii.. 60 6 © Length Width Depth c%•` PERMIT NO. u (7 Q F- Type of crib rib diameter Crib depth Total of a sort 'on area w° well wilding fou ndatio Nearest lot line _ �n DISTANCE 'O: Class Depth Driller _ Distance to lot line PERMLT.,N� J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING INSTALLS 7 7 e REMARKS _ C oo cot ��,.yy Ci_-67;3 �J z LEGALTS APPROVED -', DATE a� - - ---►� 72-013 (Rev. 3/78) YILL LOG Iate Drilledt�- Static 'nater Level___4 Feet Draw Down '; _ A feet T Material Drilled: Gallons Per Minute Total Feet of Casingg� 0 feet to i -�•�bi-r a t0 to f� to m to Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 17 :11 it i 1E DEPARTMENT O� HEALTH AND ENVIRONMENTAL PoOTECTION 825 3TREE[� 0NCHORAGE, AK 'PY ^ ealf ' ' 264-4720 rZAV J�~y ����� � ���� ��WW��� �� ����K~� �THIM� 1 � PERMIT �O: 850180 ENGINEERED DESIGN DATE ISSUED: O5/13/85 APPLICANT: FEJES 8EVELOPMENT ADDRESS: 11600 CANGE ROAD ANCHORAGE, AK 99516 CONTACT PHONE: 34�9~8011 LBAL DESCRIP' SUBDIVISIN: SHERWOOD HEIG�TS LOT: /. BLOCK: NA - SECTION: �Z TOWNSHIP: 11N RAMSE: 3W LOT SIZE: 65061 (SQ.FT, OR ACRES) I cert��y that: the cup on~site sowers and wells as set 1 I am {amiliar ^ forth by with the Municipality requiremonts of Anchoragn SMA) and the State o� Alaska. the in accordance with all MOA codes and regulations� 2^ I will install system and in compliance with UP design criteria o[ this perf", MOA and StaLe OF Alaska roquirements [or An set back 3, I will adhere to all distances from any ex115ting well, wastewater disposal system or �ublic sewerage system on this or any adjacent or nearby lot. -� �I (t � i STf-� 4 C fal or-rx. �at�� 1 1� STt�ti� �aF 1 t �k _ t` (s��e4ate 51 .1' ILI r� 5� 1 I ga o W pv,i -i; - f a . S Vl N� Y CM14.j�E.- �P VI OF A/ p ,....,, ,9 @ z ��f,a,t (`'' �flfeSit.tC t>s a 1C�fi' fGEe a. 2p ^��;r�� ,>. ® �� - E �, •�. ,. � .r . _ ; �r � "{� c_t�-c.G" t� rf �. i • i��. � . d ! � , , .'F'� �ia R ' .ice U �Z., 1.,.,' _ ��� tl T� t h3 � M '�....�i � 1 \?.l .� � � [`1 A.a i C.,Y --'Ill i R3_... THOM A. F13CHER A C -E . 6793 �?s-t" t-L..��. �. C •, / �A )( ✓� x . ; " = GcWiL Hca E- Lm F oa •%.� so I L- "_i, ;.:y 'NYr-•�� e 1 1i,: 1;'� `t ' �' I iWrr`c v1' j ri I: E Jtwfi i ,r-- I Vis, � `•, �g 0 0 I Y, SOILS PERFORMED FOR:_ LEGAL DESCRIPTION: WAS GROUND WATER e 5 S ENCOUNTERED? L 0 P IF YES, AT WHAT • , I I Irl 2 i I L. ' v 3 �5 r I I lVT 7 � 4 r , r 8 I 1f 9 ,r r ' 10- 11 12 13 14- 15 16 17 18- 81920 19- 20- SOILS LOG MUNICIPALITY OF ANCHORAGE / -:C— l�( DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST :F__S � .� antiuY �Ue1 l DD��Dr�� l-WL�l l�.S fl'�Q�n2rwn� DATE PERFORMED: �S�PI� SITE PLAN ReadingDate WAS GROUND WATER e 5 S ENCOUNTERED? L 0 P IF YES, AT WHAT E DEPTH?-�� ReadingDate Gross Time Net Time Depth to Water Net Drop L PERCOLATION RATE ////q A/` TI�RUN�ETWEEjV COMMENTS SGtY/ L f1 d (//1C//1 f/?21 11zew 3 '710 y PERFORMED BY: l MA 72-008 (6/79) CERTIFIED BY: (minutes/inch) FT AND _e..e FT _3 DATE: 4 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 7 } Application Date A/ • �— _ f. t.7t NY.I;AL INFORMATION Description (/include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Telephone: Home Business Applicant Address — c -.7 2- G (c) Applicant is (check one): Lending Institution 0 ; Owner/builder-;Buyer El, Other E7 (explain); (d) Lending Institution Address —___-- — --- -- — (e) Beal Estate Company and Agent— Address --.--- ---- - Telephone ------ --------- -- (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family) Multi -Family ❑ Other 1 Number of Bedrooms 3. WATER SUPPLY Individual Wel -"T) Community (-1 Public 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 Onsitoirp Public ❑ Community E7 Holding Tank Note: If community well system, must have written confirmation frorn the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 12-02b 01 8111 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 Heald, 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 FirmLZJrtL_ Telephone Address CAtt)(rZ– Date Engineer's Seal n �r)r�� L ✓ % - y L1e o O n or p �° °7tro;;t A. nscr;E' 7 G _ h193 /7 G. DHEP APPROVAL Approved for bedrooms b Y /J Date¢" Approved _ �_ Disapproved _ �na PP —Conditional Terms of Conditional Approval 0_0 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 (HAA) CHECKLIST - FEBRUARY 1964 264-4720 MUNICIpALfry of afvc ENVIRONME F HEALTH &ORAGB NTAL PROTECTION UL 39,6, Legal Description: S�'-��--a-- -_S'" A. WELL DATA Well Classification YAI V- If A, B, C-, D�.E..C..Ap/proved (Y/N) Well Log Present (Y/N) Date Completed _� �� [ ?— Yield C, Gi�� M Total Depth ?sem 4- Cased to y Depth of Grouting Static Water Level _\4- e Pump Set At - Casing Height Above Ground — �✓© I, Sanitary Seal on Casing (Y/N) J Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) VQ Separation Distances from Well: To Septic/Holding Tank on Lot — ; On Adjoining Lots (op To Nearest Edge of Absorption Field on Lot ) C. -)%Z)! ; On Adjoining Lots — ( C=zh To Nearest Public Sewer Line —W -1 -Ar To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ��' Nnin, Date 7� F-- Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 1� f9Siz e No. of Compartments Z Standpipes (Y/N) YOS Air -tight Caps (Y/N) _ Foundation Cleanout (Y/N) Depression over Tank (Y/N) M4O Date Last Pumped' Pumping/Maintenance Contract on File (Y/N) for— Holding Tank High -Water Alarm (Y/N) I Ar— Temporary Holding Tank Permit (Y/N) t -I I'& Separation Distances from Septic/Holding Tank: To Water -Supply Well t� --To Building Foundation Sbr To Property Line To Disposal Field 5 To Water Main/Service Line �Qb I �"' To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Abs rpt' o Strata t Type of System Design c� Date Installed Length of Field — Width of Field Z,t�� Depth of Field C,,.,) fzq_ n Gravel Bed Thickness Square Feet of Absorption Area `GD 0------ Standpipes Present (Y/N) Yt� Depression over Field (Y/N) 0 d Date of Last Adequacy Test N /4 Results of Last Adequacy Test Separation Distance from Absorption Field: 1� To Water -Supply Well 0c) 4— To Property Line To Building Foundation IZ)b i To Existing or Abandoned System on Lot — ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course —tz VtA---- ,i To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at _— High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions hole/Access (Y/N) Pump Off' Level at Vent (Y/N) — Pumping Cycl ring Adequacy Test. Meets MOA Check Permitted Bedroo Rating Against HAA Request *" I certify that I have c ck , verified, or c nformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. �( Date of Payment .�°,°••°°°°°° r `°atS®� Engineer's Seal Amount: $ _moo S a� C�, : ° ;`.'_" '• " P 6' �`r ; r,I T' f ` PW Pa e 2 of 2 90 Tt1o% Fl. F18CHER aAf g t1 f Cl- - 6793 4 )7 72-026 (11/84) ,lal 7 i As -built Certificate: Seo 90~•f<J ��/ ,S-