HomeMy WebLinkAboutFOX HILL BLK 2 LT 8
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
NAME
MAI LI N~XbR ESS
LEGAL P ESCRIPTIO~
]PHON E
[]UPGRADE
LOCATION
I I Well . . /d I Absorption axe ~ ~)welling
~ D,STANOETO: L l/Z) '~'I /O-
F- ~ Material
~ ~ i~/Liq, ca a 'tV~ aligns IF HOMEMADE: I Inside length ~ Width
DISTANCE ~: Well ~ Dwelling
Manufacturer /~ Material
NO, OF BEDROOMS~,~
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
Nearest lot line PERMIT NO,
,Total length of lines Trench width Distance between lines
inches
Material beneath tile Total effective absorption area
inches
Well
DISTANCE TO:
No, of lines Length of each line
Top of tile to finish grade
~en~thSo ~ W,d,h /q/ /
Type of crib Crib diameter Crib depth
DISTANCE TO: "2~ /~+ lilding foundation
Driller
DISTANCE TO:
Nearest lot line /b / '~""
Distance to lot line
Sewer line Septic tank
PERMIT NO.
Absorption area(s)
OTHER
SOIL TEST RATING . z~!
IN __~LER
R EMAR KS
APPRovED
,~.,,, . ,~,:, - DATE
I/-~ ((_..,J [
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{"ll..I'.'ST H]:::I',,,'E F:IT L.EI::IS;T TPJO COI'qF'F:IRTFIEI",IT:S
E:L'!fi;:'F :1: l:::'"r' "FHI:q'T':
:'_L: 31 I:::11'"! F:'I:qI'qltlL. IF'II:~'. P.t31'T'Iq THE I:;i%Ii;!UitlF;i:EHE]NTS; FOR OI",I-ES 31TIE S;E]I.,.tER!~; FIN[> HELL'S; FI~ SET
FCII~i'.TH E~"i'~ THE hlL.li",l 3] C][ F::'I~:IL. i~ '1""~'~ Ol:::' I:::tI",ICHO~;i'.I::IGE < HEIFI i:' I:::II",ID THE S'T'I:qTE O1:::'
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t:::lH"r' E;NI...I:::!RC'iiEI'llEht'I' H;I;L.I.... R1E(;!I...I't.'RE I:::IN F:!I:>i):I:T:I:Cd",IFIL.
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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
SLOPE
/ WA~ GROuND WATER
ENCOUNTERED?
SOILS LOG
PERCOLATION
TEST
DATE PERFORMED:
SITE PLAN
DEPTH?
S
L
o
p ~.f,~,
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE (minutes/inch)
/W/,~/ TEST R, UN BETWEEN F TAND F T
PERFORMED BY::
72-008 (6/79)
SUSHV
DOC Co. dDa
P. O, BOX 2'/2, CHUGIAK, ALASKA 99,567 o TELEPHONE 688-2759
OWNER OF LAND ,:;.~ / :?.--' · / / c -t /,.,~,, t I)EPTII OF WELl, _...,:
ADDRESS __d] ,4~ ~7 -~ .... STATIC LEVEl, OE WA'I'ER F'T.
LF~A[, D~2qCRIP rl~_~_,_ ?C ~ -~;~,v272~&~/, ..... DRAW DOWN FT ................................
DATE. Started __,~/_~.~2_ ......... Ended ..... ~ ......... GALS. PER IHt ( d,
PERMll NUMBER. ............................................. KINI) OF CAMN( ...... _ =-
KIND OF FORMATION: -
Erom ..... Et, to
From ...... Ft. to
[:rom ....... Ft. to ...... Fi ................
F't n .... Irt. [o
From Ft, h>
to ; = _Ft._ ~' ' ,-- .- ~ , ~', From _ __Et. to .... I"1 ....
From
From
From .....
Ft to ..... Ft ...........................
From ........... Ft. to ...... Ft,
Prom _Et. lo . . J:t ...........
From ....... Ft. to
From ...... Fi to
From ..... l"t. to
Fromm_ ~_Ft. 1:o I"t .........
Frmn ...... Irt. to ......... Itt ............................. __~_ _
Fmm ..... _.._.:Ft, to~ __Ft
F~om FL to Ft,
From Ft. ~o_ .
Fromm_ ....... Ft. to,
From ........ Ft. to ....... Fi .........
From ...... Ft. to
From ..... Ft. to
Frmn ...... Et. to ...... Ft
From .......... Ft. to
MISCL. INFORMATION:
DRILLI'~R'S NAME _ __£.:'~:_~',~' ;;. ~_2k=m: ......
t~' ~:.-'~ Pescription (include lot, block,
MUNICIPALITY OF ANCHORAQI~
I'fU~T_C]]]PA. LTTY OI~ ~[0~ DEPT. OF HEALTH &
~VISION OF E~/IRO~E~AL ]~T~VIRONMENTAL PROTECTION
:CATION FOR [~;ALTH AUTHORITY ~PROVAL CERT~ 1984
subdivision, section, to~.mship, range)
£ocatIon (address or directions)
Business
Applicants Address
(c) Applicant is (check one) Lending Institution
Buyer ~ ; Other LZ: (explain);
~-~ ; Owner/builder~;
(d) Lending Institution
Tel e_l!ho ne
Address
(e) Rea]. Estate Coo & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. T~pe of Residence
Single-Fami.ly ~:
Number of Bedrooms
Multi-Family
Other (describe)
3. ~3_r_. su~.!l-
Individual ?fei].J~ Community ~ Public ~
Note: If community well systems must have written confi~nation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Di~osal
Ons ite .~i Public .~__~: Community :~.~-I Holding
Note: If community well system, must have written corLfirmation from the State
Department of Eavironmental Conservation attesting to the legality and status.
[Page 1 of 2]
Engineering Firm Providing Ins~ections, Testsz File Search, Data and Information
As certificd 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 Mu. nicipality ef Anchorage files and from my
investigation and inspection, the on-site water supp].y and/or ~stewater disposal
system is in compliance ~.~th ~1 Municipal and State codes, ordinances, and regula~'
tions in effect on the,da~,,.~f~:~:~¥~:~J, nspection.
Name of Firm ... ~'~: ~U?~q ........ Telephone
Address
Date
DHEP Ap.?roval
Approved for ~]5
Approved ~:h
bed rooms
Disapproved
Terms of Conditional Approval
CADTION
THE MUNICIPALITY OF ANCttORAGE DEPARTMENT OF ItEALTtt AMD E~IRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESE~f-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN TIlE STATE OF ALASKA. TIlE DHEP DOES Tills AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR I~NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. FaMPLOYEES 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
Be
WELL DATA
Well Classification
Well Log P~esent ~/N)
Total Depth /~ I~ ~ Cased to
/
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduitf~/N)
Sepa=ation Distances f~.cm Well'.
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH ALTi~ORITY APPROVAL (HAA)
CHECKLIST - FI~RUARY 1984
Legal Description: L~c! ~ /.~c~/J~
If A, B, o~ C, D.E.C~ Approved(Y/N)
Date Completed '.~/~ Yield ZO
/~b /~ ~ Depth of GroutinG
Pump Set At ~i.~,/~'.
SanitarY Seal on Casing 6~_/N)
Depression Around Wellhead (_Y~
To Septic/H~;~6~i~3 Tank on Lot .'i //O' !
. ..~. ; On ~joining Lots /O~ /~'
To Nea=est Edge of Abso=ption Fieid,~ Lot /~-' ; On Adjoining Lots /OO
To Nearest Public Sewer L%ne '... ~ ~/~///~ ' ' To Nearest Public Sewer
Cleanout/Manhole. ik//~ " To Nearest Sewer Service Line on Lot
Water Sar~ple Collected By ~ ~¢~-t~//;/<~c~/~c-; Date ~,//.~//~ ~
Water Sample Test P~sults Y~T//
SEPTIC/~ TANK DATA
Date Installed' ~/~/~ Size /~OD No, of Cc~,~a~tm~.nts ~
Standpipes~/N) Air-tight Caps ~) Foundation Cleanout ~N)
Depression over. Tank (Y~ Date Last
Pumping/MaintenanCe Contract on File (Y/N) ; for ~---~
Holding Tank High-Wate~ Alarm (Y/N) /,vz~ Tempo=ary Holding Tank Permit (Y/N)
Separation Distances f=om Septic/~{olding Tank:
To Water-Supply Well _.
To P~operty Line
To Water Main/Se~v. ice Line
Course
To Building Foundation ?>~'~) /~
To Disposal Field. ~(% /
To Stream, Pond, Lake, or Majo~ D~ainage
Comments
[Page 1 of 2] 2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption A~ea
Depression ove~ Field (Y~
Results of Last Adequacy Test
Separation Distance f~om Absorption Field:
To P~ope~ty Line
Type of System Design
Length of Field 20 ?
Depth of Field ~t ~-;
Gravel Bed Thickness /
~W Standpipes Present ~/~N)
Date of Last Adequacy Test
To Water-Supply Well /~-- /
To Building FouDdation ~ /~
Lot ~/~ ; On adjpining
To Water Mai~/Service Line /vr//~-.
TO Stream/Pond/Lake/or Major D~ainage Course... /~///~
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Existing or Abandoned System cn
Lots ~ '/7~
To Cutbank~if present)
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Con~ents
Dimensions
Sanh~le/A~cess !Y/N)
/"Pu~D Off" Level at
.//~//" /~ ,Tent (Y/N)
Meets 5DA
** Check Permitted Bed~oomRatingAgainst HAARequest
I certify that I have checked, verified, or conformed to all MOA HAA
on the date of this inspection.
[Page 2 of 2]
Guidelines in effect