HomeMy WebLinkAboutDENALI VIEW BLK 3 LT 7 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/!~II WELL INSPECTION REPORT
NAME
iMAILING ADDRESS-
LEGAL bb~RIPT~6~'
I LOCATioN ' . __
Well
DISTANCE TO:
IPHONE I EW
Manufacturer
Liq. ]pacity in gallons Inside length Width
oO
NO. OF BEDROOMS
PERMITNO. ~2'10¢//?
No, of compart~._..~ts
Liquid depth
TO: Well
lufacturer
DISTANCE TO:
No. of lines
Top of tile to
we"Il,ri ¢t"
Length-of'eac line
Length
Width
DISTANCE TO:
Dwelling . ~
,,,,,,,,~ater iai
Fo ~t~.n /~I
To~:al I e~.h¢ f[ _ .~ ~/c~lin Tren ~ ~th
Materia beneathtile
Class
DISTANCE TO:
Crib diameter~ Crib depth
Well~Depth ~ r~illl~g f°undati°nj
Building foundation Sewer ine
OTHER
PERMIT NO. /
yin gallons
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
inches Distancebe FJines
~ Total ef fect~?~.~ r% ~
T/ PERMIT NO. ~.//
ption area
.~]earest lot line
Distance to lot line
Septic tank
PERM'T NO' ¢/O,//'-/
Absorption area(s)WO¢~ CF __
APPROVED
DATE LEGAL
72-013 (Rev. 3/78)
PERMI]" NO.
AF'PLICRNT JO ANN HAGNER SR~ ,:':~ ~754
LOCRTION LIPPER HUFFHRN-SLILTANA
LEGRL L? B2: ~=~* L)mtO ~,LC'T SIZE
1 *FE OF SOIL NB-,ORF1 ION S'¢5~'EM I5' TRENCH
M~,",IMUM NUMBER OF BEDROOMS = 2c SOIL RHTINm (50 FT,."'BR::,=
TH~ R~OLIIRED SIZE OF THE :,OIL -"-F ", -
'-- HBz, JRFTIuN ~-, ,,:
-'*-,TEM Is,:
3:49 '="-' '"'-
494±9 SOU~RE FEET
~"-~L.ir-.~ I L~... I F::'F~L I T'-~-' C,F.:-- ~-..~C:~_~C,~:~2;~E:
DEPBRTMENT OF HEALTH AND ENVIRI]NMENTBL FRJTEL:TION
'=' '-' ~ '" ' " 'l- -
.... ~.-, L'" STREET., ANCHORAGE.
,264-47~0
c ~.~ ,.. )
THE LENGTH DIMENSION IS THE LENGTH (IN FEET'.', L'IF THE TRENCH OR DRFIINFIEL. D.
THE DEPTH OF' FI T' - ·
RENF;H OR PIT I'--; THE [:'I'=;TFINCE E:ETHEEN THE ':' :, '"
I3~.'OUND FiND THE 6JTTUM OF THE E;:~;C:R'v'RTION <IN FEET).
· "'1- '
-,LIRFHCE OF THE
THERE IS NO SET HIDTH FOR TRENCHES.
THE GRR'v'EL DEPTH .IS THE MINIMIIM DEPTH F~F GRR'v'EL
- - DETHEEN THE OIlTFFiLL PIPE
RNF.:, THE BOTTOM OF THE E>:;CR',,,'RTION (.IN FEET::,. -
PERMIT ' , , ~ ~ ......
HPFLICRNT HR::':. THE RESPONSIBILIT,¢ TO ~NFORM THIL=; DEPFtRTHENT DURING THE
INSTRLLRTION INSPECTIONS OF RN'¢ HELLS RDJRL':ENT TO THIS PROPEF.?T,¢ RND T'HE
NUME,'EF.: OF RESIDENCEN-., THRT THE HELL HILL '- , ·
= EF.: ,, E.
BRCk:'FILLING OF FtN'¢ ,--,,,- ·
· -,T:,TEH I.,.IITHi_]LIT FINRL INSPECTION RN[:, RPF'F. IO'v'RL B~' THIN';
F.:'EF'RRTMENT HILL DE SUBJECT TO PRL]SEC:UTION.
MINIMUM £:'ISTFiNCE BETHEEN Fi HELL FIND RN~r, ON-SITE SEP.IRGE £',I'--~,p-~, ,=,,~..
]~00 FEET' FOR R PF.:I","RTE HELL OF.: 1~0 TO 20~-'~ FEET FROM R PUBLIC HELL F-:'EPENDING
· - .... --,,-,L.-'=-'~EM
UPON THE T"r'PE OF' PLIBLIC HELL.
MINIMUM DI-,TRNL. E FF..'JM R F'RZ'v'RTE HELL TO R PF.:I',,,'RTE '"]EHER LINE Z.=, 2._'"; FEET' RND
TO R COMMUNIT'.r' SEHER LINE I""] 7",..~ FEET. '-
HELL. LOGS RRE R'.E~L~IF. rED AND MUST DE F'.'ETURNED TO THE DEPARTMENT HI'THIN
OF' THE HELL
OTHER -.OMPLET I ON.
· ' REOLIIREMENTS MR"r' RPPL'T'. SPECIFICATIONS RND CONSTRUCTION [:'IROF.:RMS ARE
R'v'RILRBLE TO IN..':,JRE PROF'ER INSTRLLRTION.
F'~_:F,~.].~'.l I T E:-' ::-:: F. I F-m-.'E=':-.-_~ E::.."E~:C:~_2I'.IE~:E~:~: -~::.1_ ::..'L.',~--=-..
I CERTIF:"¢ THRT
L' I RM F~MILIRR HITH THE REOUIF.;EMENT,.-': FOR ON-SITE ...... -.: ~ND HELLS ~:, '--';ET'
:'ORTH E:'T' THE MUNICIPFtLIT,T, OF FfNCHORRGE. '=,Elm"r=,,- .,_
i;: I HIL. L IN-STFILL TFIE '-'
.:,'r-,TEM IN BCC:OR[:,BNCE HITH THE C:OF.:'ES.
~' I LIN[:'ERSTFtND THBT THE ON-!~ITE '-,
,-,-. . - :,EHER S'¢'";TEM MR"," REOUIRE
E-,IDENL:E I'm REMu£:'ELED TO INCLUDE MORE THFiN 3:BEDROOM,2 ENLRRGEMENT IF THE
I,::,:,NT .,0
// ..... ....... ' .......................... / i ,*
SOILS LCG
MUNICIPALITY OF ANCH~ALff¥ OF ANCHORAGE
E
DEPARTMENT OF HEALTH AND ENVI
SOILS LOG - PERCOLATION TES~;'' ,,:~ 1981
PERCOLATION
TEST
PERFORMED FOR:
~]E FF%~"/
4
5
7
8
9
3
VAN Ag, EL
SLOPE SITE PLAN
10
11
12
13
14
15
16
18
19
20
COMMENTS
WASGROUN. WATER
ENCOUNTERED? Nc)
O
P
E
IF YES, ATWHAT
DEPTH?
Reading ' Date Gross Net Depth to I Net
Time Time Water Drop
9~0 0-~-~1 -'- '"' I~~
' I~,
~ oF
,..x~... ..... .~,.. ~
;;*:'
: ..~; I'ffo. 2225-E ,'
' ,,,~a-~: ....... .:.;~o,? -'
"~ -/O~/,,~ ~.~,'~, TEST RUN BETWEEN ---~ FT AND '7 ET
PERFORMED BY:
CERTIFIED BY: ~'~' ~ DATE:
72-008 (6/79)
Box 1~69, ~TAR I{OUTE A ANCHORAGE, ALASKA 9950~
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF
DRILLED AT THE RATE OF
PROPERTY OWNER
,;~2.1o 00 PEr FOOT. MUNiCIPALiTY OF ANCHORAGE
['"~T C~ I'-':-'! ~-
",. ! ,O :: 4
].br~ ~J a. g n. eZ 2d3-7597 :NVI~, r., ,',
LOCATION OF WELL SITE
DRILLER
RECEIVED
WELL LOG:
1.6 Fcz..~ ,,2.e,'~ .ho.f-: 416 9cd~
Co4.:t: o.fi. ]),t.4.UJ.r,.q.: ,?.21.00 pe~ .if..oo4. X 300
Co4~t o.fi !Oe.,L¢ $~d.: ?/20.00
;'6300. O0
fZo Ctc~c/.c ~.o¢ ,oct, u.p cc, t..
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
,~63 ~Oo 00
WRITE CHECK PAYABLE TO RaMPArT DRILLINg WORKS FOr THE SUM OF
THANK YOU VERY MUCH.
DATE
BERNIE CLAUS OF RAMPART DRILLING WORKS
SERVICE CHARGEOF lY2% PER MONTH WILL BE ASSESSED ON PA TS.
MuNICIpALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND EN¥iRONMENTAL pROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF iNSPECTION FOR HEALTH AuTHORiTY APPROVAL
OF oN-SITE SEWER AND wATER FACILITY
264-4720
Apptication Date
. RAL iNFORMATION - .~-dWision, section, townshiP' range/
GENE · '-'de tot, block, ~u,, ~/ .... ~ ~:~
' CIU '
(al Legal Description tin .. //¢c~-
' //- '' --" ' r ; Buyer
Applicant Address . _ .~,.,, institution E]; owner/buflde'/~
Applicant is {check one/: Lenu,-~
Telephone
Lending institution
Address
Real Estate company and Agent
AddreSs
Telephone . ddress:
· ' the HAA to the tol~owmg a
Mah
TYPE OF RESIDENCE
Single-FamilY J~ MultFFamilY [~ Other
'5
Number ct Bedrooms
R suPPLY Environmental conservatio
WATE .. [~ public
umtY
..... 'eli ~ Corem -onfirmation from the State Department o!
individual TM _
Note'. ti community watt system, ,,u
attesting to the legality and statuS.
Note: it community well 72-025 ('
attesting to the ~egalitY and status.
Page 1 ct 2
, ENGINEERING FIRM PROVIDIN~ 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 i_ns_9_ection.,~--'-
Name of Firm
Address
Date
Telephone
DHEP APPROVAL~--~
Approved ,o[,_.,~-~'~ bedrooms by,/~.'~~'~'
Approved~"~x .. Disapprove~"' '
Terms of Condition~Approval
~--~-. ~.-.-<~-~ Date
ConditiO~aL
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
72-025 (11/84)
WELL DATA
Well Classification
Well Log Present~/N)
Total Depth
MUNICIPALITY OF ANCHORAGE (MO~
HEALTH AUTHORITY APPROVAL (HAA)
J~UNICIPALiTy O= .. CHECKLIST- FEBRUARY 1984
DEPT. oF ~.-~CHORAGL~ 264-4720
~=NVIRONIHEN; .~, C~L TH
'"~' ~ROT~CTiON Legal Description:
APR
RECEIVED
~V~r~ If A, B, C, D.E.C. Approved (Y/N)
Date Completed ~ l./ I~ Yield
Cased to ~:;~O Depth of Grouting -'"
Static Water Level ~'OI
Casing Height Above Ground ~.
Electrical Wiring in Conduit~_..~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line '-'
Pump Set At '-
Sanitary Seal on Casing~N)
Depression Around Wellhead (YO
; On Adjoining Lots
· On Adjoining Lots
To Nearest Public Sewer
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments ~'~'~"'~-
~ To Nearest Sewer Service Line on Lot '-
,~.,E,M/~/y I~/{J~;~AAJJ~, ;Date .~,/.~//
B. SEPTIC/4~II~I~!i TANK DATA
Air-tight Caps ~N)
Date Installed Size
Standpipes ~N)
Depression over Tank (Ye
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
To Water Main/Service Line
Course
No. of Compartments
Foundation Cleanout~}/N)
Date Last Pumped l ~/~ ~./~'
, for "--
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed c~//-~/~/
Width of Field ~/,~
Square Feet of Absorption Area
Depression over Field (Y~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
-~I~Q
~__ Type of System Design
Length of Field ~'~,/ '¢' ~'~ ~ ----'
Depth of Field ~I
Gravel Bed Thickness ~' /
Standpipes Present ~N)
Date of Last Adequacy Test
To Water-Supply Well
To Building Foundation
Lot
To Water Main/Service Line -~' ~,5 I
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~ /~l~..J~ ON ~'~T~"
!
To Property,,Line "f'/~
To Existing or Abandoned System on
; On Adjoining Lots
TO Cutbank (if present)
Do
LIFT STATION /~/A
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that J~ave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed (J~r-J~ ~,/L Date
Company MOA No.
Date of Payment ~ L~ ~ ~[~
P g. 2 of 2
72-026 (11/84)
BF. SSE~ EPP$ & PO'~2-g
222O EJ~ 88 AV'~NUE
,~IQI~O~.GE, AK 99507
( 907 ) 349-6451
WATER ~ELr. TEST
Client's Name:
Ack]tess:
Init/al Reading on Meter:
0~;00
- OOOO
· ~/7 /.7 ~ ~ ~
4; 45 I. 6 ~7 ~ ozso
Pr~]~,~:t]on Rn~e: ~.O GP~ 2.1-Hour CapocityZ~ C~llc~u
Time ' / Time .....
Date _ '- ' ' Date ,' ...... Date' · ...... ~ ·
Inspect'or ' ~ ' :lnspeot(~r ' r ..... Inspeoto~
Comments ' (~.~ ' - ' .... ~tlonat Approval '
~ate~ewerln~tatl~ ~ ~ ~ P~;mltNo.' ~ '. SeptloTan~Size' ~ 0 '
~ _~[ . Holdl.g Tank SIZe
- Well to Tank ~" .
......... APPelANT F~LSOUT LOWER HALF.~O'NLY '
, ,. .
BUye~ .... ~ .... . .
~endlnglnetltut o ~'- ~~ ~
Address -. · -. ~
Re~v Oo..[A~nt ~ ~ .... __ Phone
Legal Description ~-~ ~ ~'~'~ -'~~ ~~ '~ '" '
Street Location ~1~~ d}~~-
- ~lngte Family
-~ Multiple Family -- No-of B~moms - ,r -
= DOther ~ .- - ~', . ,_ ~,~ , . , '~ ,
wat~?~rdu, l ' ' - - A~AC, WELLLOG.-AWe, ~g ,, ~qul~ for atl wells drlll~ ,ln~ June
D C~mmunlty . . 197[ F~ ~elis-drilled Prior to fiat:date, give wel depth (attac~ Icg If
~. D Public Utility . . ~ .... - '
-' Sew~Dtspoeal , --- ---
, ~ Individual - ~ , ~rl~ivldual Ineta!l~: ': ~-'
D Public Uti ty ' When Connected to Publtc Utility:
C ~91~lng Tank .... _ ~ ....... ~ ....
N~E: THE INSpECTI~ FEE MUST ACC~A~-~REQU~BEF~ PROCE~I~ CAN-BE INITIATED.