The URL can be used to link to this page

Home My WebLink AboutCOTTONWOOD HEIGHTS BLK 1 LT 12 ,IUNICIPALITY 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 [] UPGRADE MAILING ADDRESS LEGAL DESG~IPTIO~. ~ NO, OF BEDROOMS DISTANCE TO: Well. I AbsorptiT~re~ Dwelli~o ' PERMISN~ ~ Z Manufacturer ~~/' Mat~ ~/ No. of compartments Liq. c~p~city in gallons ............. Inside length Width Liquid depth ~ ~ ~ mSTANC~ TO: W.U ~.~n. .ERM~T NO. ~ -- ~ Manufacturer Material Liquid capacity in gallons Well Foundation Nearest lot line PERMIT NO. ~.~ DISTANCE TO: ~ ~ O ~r>~~ [~ Ne. of lines ~ Lengt f~chline Totallengthoflines T idth inches Distancebetweenlines Total effective absorption area Top of tile to finish grade ~ ~ Material beneath tile .~1-~ inches ~ Length Width Depth PERMIT NO. < W Type of crib Crib diameter Crib depth Total effective absorption area m 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 SOIL TEST RATING ~.~,~;/ B~ INSTALLER~ ~ REMARKS 1~] APPROVED DATE LEGAL ~ .... ' ~ 72-013 (Rev. 3/78) oo "t MuNzcZpRLzT¥ OF ANCHORAGE D£PARTMENT ~ '~ALTH AND ENVIRONMENTAL 825 '~" ~(REET., ANCHORAGE, AK. 91..~0~ ' ~ 264-4728 ~ELL RND Ot~--S I TE 5EHE~ PERt~ PERMIT NO. ( 780404 ) APPLICANT LOCATION LEGAL GORDY FERGUSON P.O. BOX i29 KABOB STREET Li2 Bi COTTONWOOD HEIGHTS SUBD LOT SIZE 64000 SQUARE FEET TYPE OF SOIL 8BSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT?BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= Ii LENGTH= 29 GRR',/EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQLI I REE. SEPT I [: TAr~K S I ZE: :L250 C, iAL. L_OF4S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY 8ND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO (; 2 ) I F~SPECT IONS ARE REQLI I REE~ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELb OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL.. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERr~ I T EXP I RES DECEMBER 31, l__q. 7'8 I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 2: i UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. APPLICANT GORDY FERGUSON ISSUED BY DATE___~C~ V3. 2 / SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-660, Anchorage, Alaska 99602 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: [] PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS / SLOPE ENCOUNTERED? IF YES, AT WHAT DEPTH? SITE PLAN ~t-- ~t~ ~ .... ~--,-[11 S ,; .... 1 O Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND ~ FT 72-008 (7/76) 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 10t, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address /'~- ~' (c) Lending Institution ,~-'~'~ ~/5'0.1 _ Telephone' (home) /~ 77~/~ ~~ i~/~/ ~1~ / Mailing Address (d) Real Estate Company and Agent Address / (~ ~' ~O ~'~,/,~ -/-~.~..~ c/~, Telephone (e) Mail the HAA to the following address: (or check here i~,if hold for pick up.) List contact person and day phone number below: TYPE OF RESIDENCE Single-Family~ Number of bedrooms ~'~ WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site,[~ 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 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 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 inspection. Address Date Telephone 6. DHHS APPROVAL Approved ¢or --'~' llbedrooms by Approved ~////~L Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025 (ReVl 7/88) Back Page 2 of 2 Well Classification '~ Well Log Present (Y/N) Y Total Depth Z~/ Cased to Static Water Level //5- Casing Height Above Ground Electrical Wiring in Conduit (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: If A, B, C, D.E.C. Approved (Y/N) __ Date Completed ~-/~ - 7~ /..,~'7 Depth of Grouting ~ Pump Set At Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer'Line ~ /~O To Nearest Sewer Service Line on Lot Water Sample Collected by O-' Water Sample Test Results d2J~ Comments ; On Adjoining Lots -/./,O¢ ~/00 ~ ; On Adjoining LOts -/'/OO ~ To Nearest Public Sewer Cleanout/Manhole ~/OO ~ ~5-0' ; Date ~, - II- ?0 B. SEPTIC/HOLDING TANK DATA Date Installed ~' -Z-~/' Size Standpipe~ (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~J//'~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well .-/-/~0 ~ To Property Line "/' To Water Main/Service Line .,~ b'"~::2 / To Stream, Pond, Lake or Major Drainage Course Comments /z~/"*'~'l? t~' ~g" ¢¢'/0~/ No. of Compartments )"' Foundation Cleanout (Y/N) ,Y" Date Last Pumped /~ -/~- ; for Temporary Holding Tank Permit (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 ~, - 7_- - 7 ~ Width of Field ~) ~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ~ 'Z. / Depth of Field ! j Gravel Bed Thickness ~ Statndpipel Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well J' To Building Foundation Lot A.///''z}' To Water Main/Service Line -/- To Stream, Pond, Lake, or Major Drai.nage Course -F/O~ / To Driveway, Parking Area, or Vehicle Storage Area '/ /~"" Comments ' /'-//C~x.x,,/'<. TO Property Line 7/-/'~- / To Existing or Abandoned System on ; On Adjoining Lots ¢- ~,~'-~ To Cutback (if present) Y' /~::~ ' D. ~N Date I nstalled'"'"~ Dimensions Meets MOA Electrical Codes Commen.~....~.~~' Size in Gallons ~ Manhole/Access "Pump On" Level at ~ "Pum~evel at High Water Alarm 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 inspection .... Signed Company ~c"4~'b/' ~mq~ F,.~ ,_~--~c..~ Date ~, ~...~., ~' 0 MOA No. ReceiptNo. C~/~~ C~'~/~ Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHF, MI~AL & OLOGI~AL LABORATORIF, S OF ALASKA, IN~. ~ 5633 B STREET ANCHORAGE, ALASKA 99510 · TELEPHONE (~0~)562-2343 FEDERAL TAX I.D. #92-0040440 ~.eq ! .... O:dezed ~y .: Ar~lysts Completed =JUg'13 90 ' Send RepOzte to: Released By: .~-(~_ ~ 2) ' ' " Special ......... t lrdtruct: '.' - Chemlab RoE I: 901834 Lab Lmpl ID: ! Jhtzlx: #ATE~ ~I?~AT[-~ 1.5 ag/1 EPA ~55.2 10 Sample ~OUTI~E SAMPLe.' Romar'ks: SAMPLE COLLECTED BI ~D2. Tests ~ezfozmed * See Spoof. al Irdtzuct~ord Aboye . UA-Unavailable ~one Detected ** See Sample ~er~a~ks Above Mot Analyzed LT-Lese Than, OT-O~eate~ Than