HomeMy WebLinkAboutHYLEN CREST #1 BLK 2 LT 12
,/~__~ 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
lP~°-NE I[]NEW
MAILING ADDRESS
~EGAL DESCRIPTION
J WeH orption area Dwelling PERMIT NO.
~ ~ Manufacturer
~ ~ Material / / No. of compartments
Eiq, capacity ~e ~aHo~s Inside length Width Eiq~id depth
/~ ~
~ ~ DISTANCE TO: ~ell Dwelling PERMIT
0 Z ~ Manufacturer
:E - ~ Material Liquid capacity in 9allons
. DISTANCE TO: CO~ ~ ~ '--
L~.~ NO. of lines .~ Length~of each line/'~ Total length of lines/~ ~ Trench width~ ~ inches 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 ~ /--~ ,Drille~ . 1)~, Distance to lot line PERMIT NO.
~ Building foundati~V~ Sewe~ii~e ~
~ DISTANCE TO: ~ Septic tank Absorption area(s)
OTHER
~IPEMATERIALS -- , ~ ¢ ~.
c t
SOIL TEST RATING . .
i,~~ '~
APPROVED DATE LEGAE
72-013 (Ray, 3/78)
DEF:'ARTMENT DF HEALTH AND ENVIRONMEI~ITAI_ PROTECTION
825 L STREET, ANC, HORAGE., AK 99501
264-4720
I:'ERM I T NO:
DATE, ISSUED:
84()5'74
C 7/16/84
APPI_ I CANT:
ADDRESS:
CONTACT F'HONE:
NEWTON EX(]AVATING
5237 E 22ND
ANCHORAGE, Al-.'.'.' 99504
335-756:5
L. EGAI_ DESCRIF'
LOT SIZE::
LOT LOCATION."
MAX BEDROOMS:
,SIJBDIVISION: HYI_EN CREST
SECTION: 8 TOWNSHIP: 14N
20049 (SQ. FF. (:IR ACRES)
SILVERTIP CIRCLE
3
L. CIT: 12
RANGE: 1W
BI...OCK:
L,,isted below are the Ol:.)ti(]r~sll avai.l, able 'Lo y(:]Lt in clesignf, ng yot.lr septic:
system. Choose the option that b~st fits your site.
DEPTH TO PIF:'E BOTTOM (FT.) 3.0 '~'~' 4. () 4,.0
GRAVEL DEPTH (FT.) 6.0 0.5 3.5
T[ITAI_ DEF'TH . (FT.) 9.0 4.5 7,, 5
GRAVEl... WIDTH ~FT. ) 2.5 :1.8.,0 5.0
GRAVEL LENGTH (FT.) 35,,0 35.0 45, 0
GRAVEL VOL[JIdE (CU. YDS,, ) 21.0 25.3 :53. :.5
TANK SIZE (BAL. S) 1,000.0 .~.~. 1,000.0 .~.~. 1,000,0 .~.¢,
SOIL RATING (SQ,FT. /BR) :[38 :1.38 :[38
DEF']?'I TO F'IPE BOTTOM < 3.5 FT. REQIJIRES IIqSLII_AT:I:(]N
DEF:'TH TO PIPEBOTTDM < 4.0 FT. MAY REQUIRE A LIFT STATION
TANI< MLJST HAVE AT I...EAST TWO COMPARTMENTS
I c:ertify that:
:1.. I am f'amiliar wi'l.h the I"r,.~qt.~:i. relnerlt~.il {'cji" on-~it.e sewE~rs and Ne:l:ls as set
forth by the Municipality oF Anchorage (MOA) aFtd the State o[ Alaska.
2,, I will install the system in accordance w:i. th all MOA codes and r'egula't:.:i, ons,.
and in tempi, lance with the design criteria oF th:i.s permit.
3. I ~i].]. adhere 'L(:] all M[IA and State of' Alaska requirements for the set back
distances from any existing well, ~as'Lewater disposal system or pLd):LJ.c:
sewerage system on this or a~ny adjacent or nearby lot.
4,, ~ unders'Land tha'L 'Lhis permit, is valid f'o~ a maximum of' 3 bedr'oomsl and
any enlargement will requir'~ an additional permit.
IF A LIFrT STATION IS INSTALI...ED IN AN AREA COVERED BY MOA BLJILDING CODE:.c~.~
TI4EN' (1) AN EL. ECTIRICAL. PERMIT AND INS~' 'E.L,] 1ON"" ' ' IdUST BE OBTAINED; (2) A~'""[LIJII_.I~q '"=
WILL NOT BE AF'F'ROVED WI"f'HOLJT AN ELECTRICAL INSF'ECTIDIq FdEF'ORT; AND (3) TI'"II~[
EI...E(..,TR.t. CAI_ WORK IdUST BE DONE BY A LICENSED ELECTR]:[]IAN.
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 (~'1 '~
4
5
6
7
8
9
SLOPE
-t
SITE PLAN
10
11
12
13
14
15
16
17
18
19
2o
COMMENTS
PERFORMED BY: ~)o~'w/
72-008 (6/79)
WAS GROUND WATER S
L
ENCOUNTERED? ' ('"~ P O
FYES AT WHAT I
E
Reading Date Gross Net Depth to Net
Time Time Water Drop
~.~ ~ .~ ,
PERCOLATION RATE
TEST RUN BETWEEN
/3-'
(minutes/inch)
~' lf'2~ FT AND ~ FT
CERTIFIED BY: DATE:
MUNICIPALITY OF ANCHORAGE ,~
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directionS);"
(b) Property owner
Mailing Address
(c) Lending Institution
Mailing Address
Telephone: (home)
Telephone
Business
(d) Real Estate Company and Agent
Address ~'¢~ /'/° /../&/CC'p" ~.
Telephone ~¢E'
Mail the HAA to the following address: (or check here~ if hold for pick up.)
List contact person and day phone number below:
(e)
2. TYPE OF RESIDENCE
Single-Family',~ Number of bedrooms
3. WATER SUPPLY
Individual Well [] Community'S-- Public []
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~r-- 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
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Health Authority ApproYal (HAA)
: I.-~I~I~CHECKLIST- FEBRUARY 1984
343-4744
A. WELL DATA
Well Classification
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
~,%//cf, 'If A, B, C, D,E.C, ApprovedON)
'"¥V.~g Present (Y/N) Date Completed Yield
Tott I D~.....~-- -- Cased to ___ Depth of Grouting __
Static Water Le~.~ ..... Pump Set At __
Casing Height Above G~ ____ . Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)'%..____ Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM ~
To Septic/Holding Tank on Lot __ -%. ; On Adjoining Lots
~ ; On Adjoining Lots
TO Nea res"'~t u~Clean o u t/M an hole
; Date ''%-,
B. SEPTIC/HOLDING TANK DATA
Date Installed 3-/?-~'4 Size
Standpipes~)/N)
Depression over Tank (Y~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank ~'ig.h,W, at~r Alarm (Y/N)
sEpARATION DI'ST'~I~'O~,S FROM SEPTIC/HOLDING TANK:
TO water-SupPly wel!, i!~:'~
To Property Line '-/~
T~) Water. Main/serviCe'Line ,~'
To Stream, P~nd L. ak6 o~". M'ajor Drainage Course
Comments:-T~//4 ¢'/¢;f ~'~.~ i/)'r~/~/./iTE',g"/"
/~'5'~O No. of Compartments
Air-tight Caps CN)
Foundation Cleanout~N)
Date Last Pumped //¢/~
;for ,,~//4-
Temporary Holding Tank Perrnit (Y/N)
To Building Foundation
To Disposal Field
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area
Depression over Field
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Statndpipes Present(~N)
Date of Last Adequacy Test
To Water-Supply Well
To Building Foundation
Lot ~/~
!
To Water Main/Service Line /~ ¢'
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ¢/e'~_.,,/c# ,~'//¢,8~/,f /,V'¢~'~/~/'Y~---J~' ~7~
To Property Line ¢~ /
To Existing or Abandoned System on
; On Adjoining Lots ¢~¢/'~
To Cutback (if present) ?~
D~TATION
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 effe(
inspection.
Signed
Company
Date
MOA No.
Receipt No.
Date of Payment
Amount: $
Receipt No.
72-026 (Rev. 7/88) Back
!ffe~c,~ the date of this
~ * 7~~ngln~'~Seal
· .. ..' L4,¢/
..... , %¢-
Waiver Fee: $
Date of Payment
Page 2 of 2
DEPT. OF ENVIRONMENTAL CONSERV/kTiON
/
STEVE COWPER, GOVERNOR
ANCHORAGE/WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 1334
ANCHORAGE, ALASKA 99503
563-6775
DATE: 11-08-88
PWSID: 215289
To Whom It May Concern:
According to the records on file in this office, the HYL~N
CR~ST SUBDIVISION Water System is in compliance with
State of Alaska Drinking Water Regulations.
the
MPL:pkk
Sincerely,
Michael P. Lewis, PE
Environmental Engineer
C,�
ALASKA STATEW{DE TERRAL!FT
The evrahemv Soho= Sr Pmbkm sofa 1
NOTICE OF TERRALIFT TREx
FOk
MOA ON-SITE WATER AND WASTEWATER t DEPT OP HEAD TH ANo HUMAN $ERtl m
CIM a HEARD ABOUT US iiOW? � � yi
ot: -BwcK: ue= L '��
LEACH ARF ► MARKED BY: jW ! 4 TYPE OF LEACH FFA
CRIB Ef
LoCATEs: YEs 0 NoA BED ❑
TRENCH
SF�nc TANK PUMPED 8Y:
M oNIroR TUBE PRESENT: YEs Y NO ❑ TERRAuFf OPERATOR: 0'0-k
E6W LEVEt.s
Byq% JoB AF"TeR CoMPLEnoN 30 DAY Fou.ow UP
DAA_: tq j 9,0 L` ' 4
CLEAN OUT:
MONMOR Tune: _
COMMENTS:
4212 He= St., Ea& Resor, Alaska M77 ($07)4W7163
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