HomeMy WebLinkAboutHYLEN CREST #1 BLK 2 LT 7D
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MUNICIPALITY OF ANCHORAGE
~'i · 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
[] UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
'~ We~ ~ ~--~ Abs°rpti°2 ~ea / Dwellin~ O
~ ~ Manufactur~¢ Ma~r~l/
~ ~ No, of compartments
Liq.~acity...~allons/ ~ ,~ . IF HOMEMADE: Inside ,.ngth~=.. Width~ /* Liquid depth~/~
Well
~ ~ DISTANCE TO: D~elling PERMIT NO.
-~Z ~ I' //~
O ~ < Manufacturer /~ / ~'~
~: --~ Material ~ Liquid capacity in gallons
~ Well Foundation Nearest lot line PERMIT NO,
~ ~ DISTANCE TO: ~o~1
=1~ ~ No. of lines Length ofeachlioe / T gthoflines Trench width inches Distance between lines
~ ~ ~ Top of tile to finish grade M~(erial beneath tile Total effective absorption area
~ inches
f
~ Type of crib Crib diameter Crib d~pth . Total effective ~~~
_~ ~ D,STANCE TO: , W"'2 ¢, ,_fL """2~ou¢~t'on ~..,~,t ,ot,i.,/O ,/_
~ ~ Class ~ Depth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING ~ /~' / k l
R EMAR KS Qo
............ ,._,. -
~ .._ DATE / LEGAL ,
PERMIT NO;
[:,RTE ISSUED:
I'"ILtl%I :[ ~-: I F"FII_ 1'
DEPARTMENT OF HEALTH AN[.', ENVIRONMENTAL F'~'OTECTION
825 . STREET, RNCHORRGE., AK
264-4?20
8402:98
05,/2:a. / 34
FtF F L. I ...PINT.
RDDRE_]S:
CONTRCT PHONE:
C,/O S & S ENG¢G.
SRB t96X
EAGLE RI'¢ER., RK
694-2979
SC:HMIDT E,F..J=, E,.,_.Hv
'_='.9577
LEGAL. DESCRIP: SUBDIVISION: HYLEN CREST LOT: 7 BLOCK: 2
SECTION: 8 TGWNSHIP: 2L4N RANGE: "IN
LOT SIZE: 2072]< (SQ. FT. OR AC:RES)
MR>:: BEDROOMS: '""
LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC
.=,'r=,TEfl. L. HOO;=,E THE ~]F'TIF~N THRT E,E_,T FITS '¢OLIF.: SITE.
DEPTH TO PIPE BOTTOM (FT.)
GRAVEL. DEPTH (FT.)
TOTAL DEPTH (FT.)
GRAVEL ~IDTH (FT.)
GRBVEL LENGTH ,(FT. )
GRRVEL VOLUME (CU. VDS. )
TANK SIZE <GALS)
SOIL RATING (SQ. FT./BR)
T R F' I'-,i ~::.: H BEE-', 1.,.I.[:'AR
4.0 4.0 4.0
'";:.0 0.5 ]-'.0
7. 0 4. 5 < 7.
2, 5 28. 0' ~>~' 5,
22.~. 0 ~:¢ 54. 0 '156.
72. 2 56. 0 iCi.
000. 0 ~,~. l., 000. 0 ~:+:(~"~ :1.., 000.
445 3 Z.'.O 445
m'4-: GRRVEL LENGTH > ,'75 FT. F.'E:.ILIRE~ MULTIPLE RUN=-, (NOT E,..,CEE[:,IN~J ,~ FT.
~::+: TRNK blLIST HRVE RT LEAST TNO P..OMFRRTMEN' ' "'-r~
EACH )
I CERTIFY THRT:
1. I RM FAMILIAR NITH 'THE REQUIREMENTS FOR ON-SITE SEWERS AND NELLS RS SET
FORTH E:Y THE MUNICIPALITY OF RNCHORFIGE (MOA) ~ND THE STATE OF RLBSKR.
2. I WILL INSTALL THE SY'=]TEM IN RCCORDRNCE WITH ALL MOR CODES AND REGULATIONS.,
RN[." IN CGHPLIRNCE NITH THE DESIGN CRITERIA OF THIS PERMIT.
3:. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET E:FICK
DISTANCES FROM ANY ENISTING WELL, NRSTEWRTER DISF'OSRL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NERRBY LOT.
4. I UNDERSTAND TH8T THIS PERMIT IS VALID FOR F~ MRk.',IMUI"] OF 3, BEDROOMS AND
ANY ENL8RGEMENT NILI_ REQUIRE RN ADDITIONAL PERMIT.
IF R LIFT STATION IS INSTRLLED IN RN RRER CO'¢ERED BY MCR BLIILDING ~:O[:,ES,
THEN (&) RN ELECTE~%;RL~F'ERMIT AND INSPECTION MUST BE OBTIRINE[:,.; (2) RS-BLIILTS
WILL NOT BE R~P~O~TED W~THOUT RN ELECTRIORL INSPECTION REF'ORT~ AND (Z;) THE
SIGNEDELECTR I CRL
'-' ,
I.:,z, UEB BY DATE:
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,-.
PERFORMED FOR:
LEGAL DESCRIPTION:
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2O
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
COMMENTS ~/'~ ~
SLOPE ~ SITE PLAN
ENCOUNTERED?
[- o
P
E
IF YES, AT WHAT
DEPTH?..
Gross Net Depth to Net
ReadingDate
Time Time Water Drop
/ Is-/~-w¢ I/,'~/, .------ i ~-¢ ____.
/I ~
PERCOLATION RATE ~0 tminutes/inch)
TEST RUN BETWEEN '~ FT AND (~ ~ FT
PERFORMED BY:
72-008 (6/79)
CERTIFIED BY: DATE:
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRON~IE~I'AL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
AJPPLICATION FOR I~J~IoTH AUTHORITY APPROVAL CERTIFICATE
1o General Information
Application Date
(a) Lega% Description (include lot~ block, subdivision~ section~ towaship, range)
Location (address or dire¢~io'ns)
Applicants Address
(d) Lending Institution
Telephone
Address
(e) Real Esta~;e Co. & Agent
Address
(f)
Telephone
~SgSf ~lm H.&A to the follo~rlng address:
T~ of Residence
Single~Family~
Number of Bedrooms
Individual Well~
Multi-Family
Other (describe)
Community ~ Public F~
Note: If community well system~ must have %r~itten confirmation from the State
Department of Environmental Conservation attesting to the legality and status~
4. S~e~age~ Dis. po~sa~l
Onsite ~: Public ~: Community ~---2[ Holding Tank ~
Note: If community we].l system~ must have ,~itten co~imation from the State
Department of Enviro~ental Conse~ation attesting to the legality and status.
[Page 1 of 2]
E-~ineerin~F~FirmProvidin~ections_z_Tests, File Search_m_~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 t~at the on-site
water supply and/or w~stewater 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 ob2ain~! from the Pkmicipa!iny of Anchorage files and from my
investigatioa and inspection, the on--site ~mter supply and/or w~stewa~er disposal
system is in compliance ~rlth all Municipal and State codes~ ordinances, and regula~
riots in effect on the date of this inspection.
Approved for ~__~J.~ bedrooms
/
Approved,~. Disapproved
Terms of Condleional Approval
__Telephone
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEP;dtTMENT OF HEALTH ~,ID E~VIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOI~LY UPON T~IE. REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIOYAL ENGIk~ER REGISTERED
IN I~IE STATE OF ALASKA~ THE DHEP DOES THIS AS A COURTESY TO PURC}I&SERS OF HOMES AND
T~iEIR IgNDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERA~ AND STATE REQUIRE-~
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT ]~SPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN gS~ PROFESSIONAL ENGINEER'S WORK°
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7'=19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
AUG S 0 1984t
Cased to
Date C~.~leted
Hylen Crest Subdivision
If A, B, c~ C, D.E.C. Approved(Y/N)
Yield
Depth of G~outing.
Well Classification
Well Log P~esent (Y/N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in 'Conduit (Y/N)
Separation Distances f~om Well.'
Pump Set At
Sanitary Seal on Casing (_Y/N)
Depression A~ound Wellhead (Y/N)
To SePtic/Holding Tank on Lg.t ~-~3'O ,/~ ; On Adjoining Lots
.To Nearest. Edge of A~sorption Field on Lot ~5~) ,/ ; On Adjoining Lots
To Nearest Public, Sewer Line
C le~cUt/M~nh(5I~
Water Sample Collected By
Water Sample Test Results
Cc~nts
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
B. SEPTIC/HOLDING TANK DATA
Standpipes:Y~) / ~% Air-tight Cap (~ Foundation Cleanout~Y~)
Depressionk~/over Tank (Y~) Date Last P,urr~ed ~/~ ~Y5~
P~ing~intenan~ ~n~a~ ~ File (Y~)~ ; fo~ ~//~
'
Holding Ta~ High-Wate~ Alarm (Y~) % ~a~y Holdi~ Tank ~r~t (Y~)
~p~ation Distan~s ~ ~ptic~olding Ta~:
To Water-Supply Well ~)~5~
To P~operty Line r/LD
To Water ~/Service Line
Course
Co~nents
To Building Foundation
To Disposal Field /~ i
To Stream, Pond, Lake, c~ Majo~ D~ainage
;..3 /
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorptio/n Strata
Date Installed
Width of Field
Square Feet of Absorption~A~ ea
Depression over Field (~/N3/
v
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Wall
3-: C7 Type of System Design
Length of Field ~ ~ /
Depth of Field
~a~l ~d Thick,ss
./~g7 ~ Stan~i~s ~esent ~)
~te of ~st A~a~ ~st ~ ~ ~'~
/~ ~
To Building Foundation ~ ~ /~ To Existing or Abandoned SYstem cn
Lot /aJ //~ ; On Adjoining Lots /{/,//~>~-
To Water ~4~%~-~,/Service Line ~-~ ~f~ To Cutbank(if presg..nt) /CT,/~-
To Stream/Pond/take/or Major Drainage Course /'~ //~
To D/riveway, Parking Area, or Vehicle Storage Area ~ ~ /
Cohue~ts
D. LIFT' STATION
Date Installed
Size in Gallons
"i~ On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Ma~ole/access (Y/N)
"~f"-- Vent Level at ~)
Pumping Cycles during Adequacy Test.
Meets .~DA
Comments
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on the date of this
Sig~ed ' :-%~¥~'" Date ~/.7~/~/ .
Company ~ ' ~ .............. . MOA No
KB1/d5/s
[Page 2 of 2]
19E~. OW E~TVIRONMENT/h,B~ CONS]~?,RV.~TflON
SOUTHCENTRAL REGIONAL OFF ICE
437 "E" STREET, SUITE 200
ANCHORAGE, ALASKA 99501
BILL SHEFFIELD, GO¥£IINOR
Telephone: (907)
Address:
274-2533
To Whom It May Concern:
Ac~cording to Pecords on fi, lc in this office the
~t.~=__=~'l~_~_jj]).~[___ Water System is ,n compliance with the State Drinking
Water Regulations.
Si ncerely,