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HomeMy WebLinkAboutMONTGOMERY LT 205t i i'..., 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 ~ ~DP~RA~E MAILING ADDRESS . LEGAL DESCRIPTION Well Absorption ar~ Dwelling P~RMIT NO. DISTANCE TO: ~, Manufact,,r Mat~ _i No. of components Liq, capacity in gallons _ Inside length Width Liquid depth /¢O~ Ih HOMEMADE:  ~ Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest lot line PERMIT NO, ~ ~ DISTANCE TO: /¢~ ~ No. of lines/ Length of each line Total length of lines TrencV~)h Distance between lines ~ -- Top of tile to finish grade ~ / Material beneath tile Total effective absorption area Length Width Depth PERMIT NO~ < ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ¢ DISTANCE TO: ¢ Class Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TEST RATING REMARKS = APPROVED DATE LEGAL 72-013 (Rev. 3/78) F'ERi',! :I: T Pt 1; F::I.-i f:tF'! l~'O f',F'I'4' T ,m..-. r,'i:£ ;-2~Z~ :t.-";2 OL[:, GLEN.'.. L2 t,IC I',tT :~ 'Z MER? S T .... l:,:,p"7~ !'l;,F'r. ,z"r'F,[:' [."tF THE ....................· ....,. ~., ........... THE L. ENGTH DiMENSZON IE; THE L.E;I',."GTFI ,::ih! FEET) (DF THE TRENCH OR DF4::R.~;iXlF'IELrZ:,. THE DEP"r'H (:il:.: FI 'T'P'.'.Ei'.,!CH OR F'iT Z% THE E:,:¢ST!~NCE E;ETklEEN 'THE SURi::'RCE OF THE GROUND RI'.4D THE POTTOM OF' THE EXE:.~:t',..,'R'TZ.':.'!hl ,::li--~ FEET'). THERE iS NO SEq" kI'.I;DTH FOR TRENC'HES. THE GRFI'v'EL DEPTH ZS THE: M_Tiq:r.?iLff,1 DEPTH OF: GRF!VEL. E:E'T'I.qEEN THE OUTFI::!LL F:'ZPE: RND THE BOTTOM Of:' THE EXCAVATION (if'.,! FEET). BRCKF ~ LL. 1 r'4(~i OF' R?',?'? S?S'TEM 1.4 DEP~RTMEt",!T I.,.!ZL.L BE E;UEk~ECT 'T'O F'ROSECUTZEd'-t MZNZrdUf'I DZST'F~h!CE BETHEEN R I.,.iELL. :~6E~ FEET FOR Fi F'RI'¢KYTE !4E:LL_ OR :!.56 TO 2~;~i8 FEET FROM R PLiE:LiC NELL C'EF'END!F,iG UPON THE TUF'E OF PUBLZC i.,.!EL..L. MZN:[f'!UN DZSTRNCE FROM R PF;:;EVR'TE P.IEL. L TO TO R COrdMLtNZT'¢ E;E!.,.!EF~: LINE ~E; ?'5 FEET. OTHER REC~UIREMENTS fdR~? RPF'L"d. SPECZF'ICRT~:ONS R!'4D CONST'RUCT;~ON DZR(SRFiP!S; F:WR!LBBLE TO INSURE PROPER !NSTRL. LRT .f. CERTZF'"r' Ti'-!FIT :i.: I RH FRMi~LII:IR P.!ITI--I 'THE REiC!U;[REME:NTS F'OR ON--.S]:TE SEk!ERS Ri'.,!['., k!ELLS RS SET FORTH B'?' THE MUNIE:IPFIL;.rT'¢ OF RNC:HC~RFiEiE. 2: t kIILL INST,qL.L THE S?STEM ;~h! RCC.:O?.[::,RNC:E !4ZTH THE CODES. Z-'l: ~ I.!?.~DERSTFI!',ii:) THR'I- THE OF.r-.SITE SEP.!EI:;.: S'-r'STE?I i'"IR? RECi!..iZRE ENLRRC:iEFiENT IF THE RES ~ DENCE RPF'L ;[ E;Rt",iT M ;i: E;HRE% RODERi CI<: ;[ '-;;':; I !I:;T:, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 7 8 ----.~0 10 ~2 14 '17, 18- 20- ~ATE PERFORMED: ,/L/~'7 ,5/I? ~:P SLOPE SITE PLAN P RFORMED WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT CERTIFIED BY:~ ~ DATE: 72-008 (6/79) PHONE 694-2583 Sam Cotten Drillint~ Co. P. O. BOX 296 EAGLE RIVER. ALASKA 99577 SAM OOTTEN, OWNER a e// ,~'~ >,roduck~o~ of ~or~ i?zan 2~ gaL. per ~e k~/' MUNICIPALITY OF ANCHORAGE '~ ~/ DIVISION OF ENVIRONmeNTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date /~OC ~ ~c/ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~.'loe~,4iz[ i?~oc(~iTr~c/z Telej~hone - Home Business Applicants Address (c) Applicant is' (check one) Lending Institution Buyer~--~'; Other~--~ (explain); (d) Lending Institution. ~. Telephone Address .' (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. T~e of Residence Single-Family~ Number of Bedrooms 3. Wate____r Suppl_~ Individual Well.~x' Multi-Family F--~ Community Other (describe) 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 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] 5. Engineering Firm Providing Inspections, Testsz File Search, Data and Information tions in effect on the date of this inspection° Name of Firm Address }'l © 0 ',~ D ate / 0,// 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 ~th all Municipal and State codes, ordinances, and regula- bedrooms Disapproved Approval DHEP Approval Approved for S Appr°Vedcon~it Terms of ional (ENGINEER SEAL) Conditional Telephone CA~fION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTtt AND ENVIRONMENTAL PROTECTIO~ (DHEP) ISSUES HF~LTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- b~NTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. j/D18 [Page 2 of 2] (DHEP SEAL) 7-19-84 ae ;-- MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA)' DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (~JI_A)~-NVIRONMENTAL PROTECTIOF~ C C :LZS - F .B UN Y it]CT il_ ? 1984 Legal Well Classification ~ %/,0 ~ Well Log P~esent ~//N) Total Depth 7z-~ ~ ' Cased to~- ~ ~ Static Water Level 'Ti ,g' Casing Height Above Ground f, Electrical ~i~{'ng in Conduit ~/N) Separation Distances frcm Well: To Septic/Holding Tank on Lotj~g¢ If A, B, or C, D.E.C. Approved(Y/N) Date Completed ~- / ~ /~f~ P ; Yield Lj, 3l Depth of Grouting Pump Set At Sanitary seal on Casing~(~/N)~ Depression Around Wellhead ; On AJjoining Lots~Z~c To Nearest Edge of Absorption Field on Lot4~- 71 q,O ; On Adjoining Lots To Nearest Public sewer Line A~4- To Nearest Public sewer Cleanout/Manhole ~ To Nearest sewer Service Line on Lot Water Sample Collected By ~. (+~'o~.~J ; Date Water Sample Test Results ---- '~ ~ --~,4]/g~ip/..~'~q· CO~nts ~ ~,,vv.... %,uc~LJ ~co~ ~ ~c~,p-- ~ ~-uv,--,. %'~ ,W, Jl~;F9~~ Be SEPTIC/HOLDING TANK DATA Date Installed~- C - ~ I - ~ ~ Size / ~} O o ~_~/ No. of Compartn~nts Standpi~s~) ~ Ai~-tight Caps ~) qP5 Foundation Cleanout ~)~ ~pression o~ Ta~ (Y~ D~ Date ~st P~d'~g- g ~ ~ ~ ~ P~ing~intenan~ ~n~act ~ File (Y~)t~ ; for Holding Ta~ High-Water Ala~ (Y~) ~.~ ~ra~y Holding Tank Petit (Y~) Sep~ation Distance ~ ~ptic~olding Tank: To Water-Supply ~11~ / g~ ' ~ ~)0.9 . To ~ilding Foundation~ qq ' To Property Line *(/0 ~ ti II,5 To Water Main/Service Line Course ~ To Disposal Field ~ ~ To Stream, Pond, Lake, or Major Drainage Receipt 9 Date Paid: Amount: [Page 1 of 2] 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed~ Width of Field Square Feet of Absorption Area Depression over Field kJ ~[]c/~_ Type of System Design Length of Field A~ ~ (~ / Depth of Field ~ ~ ~ Gravel Bed Thickness ~-~ u Standpipes Present (~) Date of Last Ad~quacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~z~/Oo~ ~_~To Property Line ~ /~j To Building Foundation .~-~z, ~' To Existing or Abandoned System on Lot ~7~ ; On Adjoining Lots ~ 3 f o o To Water Main/Service Line ;u~ To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course ~r]-! o o To Driveway, Pa~king Area, or Vehicle Storage Area $'/~7~ ' D. ~IFT STATION Date~~In !led Size_ in Ga~ "Pump On" Level at ~ High Water Alarm Level at Tested for Electrical Codes(Y/N) Conments Dimsnsions Manhole/Access (Y/N) e" Level at ~ing Ade~ets .MOA ** Check Permitted Bedroom Rating Against [{~Jt Request ** certify that I have checked, verified, or cDnforrmd to all MOA on t h~Ofd~f ~hi~J i~t i~'~ ~ KB1/d5/s [Page 2 of 2] ~ ~ % Leroy 2-15-84 ALASKA UIROFImI FITAL COIqTROL $1 'R'OlCI $, IF1C. OCT 17 1984 HIKE ROOERI-CK BOX 97 CHUGZ,qK AK 99567 SELLER - OEE HAYES BUYER - 5UBDIVIS. ZON- NONTGOMER Y BLOCK - 0 LOT - 2 ADEQUACY TEST FOR 5EWER SYSTEH THE TYPE OF ABSORPTION SYSTEH IS A TRENCH WITH AN AREA OF 260 5I~FT. THE SYSTEH IS CAPABLE OF ACCEPTr_NG 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEH Z5 6.I8 GALLONS. BASED UPON THE TEST DATA THE 5YSTEN .TS ACCEPTABLE FOR A 5 BEDROOH HOHE. THE SEPTIC TANK WA5 PUHPED ON OCT 4 1984 . FLOW TEST ON WELL THE WELL FLOW RATE WAS 4.255 GPH FOR .~ HOURS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUHE OF i000 I5 ADEQUATE FOR THIS ~ BEDROOH HOUSE, 1200 LUcsl 33rcl Auenue, Suite ~ · Anchorage, AIo,I , 99503 ',,(907) 561-5040