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HomeMy WebLinkAboutALPINE WOODS BLK 4 LT 3  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 IPHON~ I J~NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ]Well I Absorption area , Dwelling PERMIT NO. DISTANCE TO: ~ ~ Manufacturer Mat~dal No. of eom~m~nts Liq. capacity in gallons Inside length Width Liquid depth J,~EO IF HOMEMADE: ~ ~ Well Dwelling PERMIT NO. ~Z DISTANCE TO: O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation , Nearest lot line PER~T~ ~ DISTANCE TO: ~,~ I') ~ No. ofline, Length of each'line. Totalleng,h of line, Trench width . Distancebe~ne, ~ ~ ~ Top of tile to finish grade Material beneath tile ~ Total eff~tive-~absorpU~n~rea Length Width Depth PERMIT NO. ~ W Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING ~ , .~1~ t~ ~.6.~ '~,APPROVED' DATE LEGAL 72-013 (Rev. 3/78) C E:'H':'M::'T' F':..!7)HE: L. E::,": ~::: L. D. :::::".:: CFt ]: F' :: ."[:: X 'Fd:::' E:, I:' r'~ C: :r-I F; :: SOl LS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street. Anchorage, Alaska 99501 264~720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST SLOPE SITE PLAN lO 11 12 13 14 15 16 17 18 19 20 COMMENTS ENCOUNTERED7 O P ~ E IF YES, AT WHAT DE.T.? I'q5 , Gross Net Depth to Net Reading Date Time Time Water Drop ~X..'"'7,",,...~. ~,.,,~  ~ ~','~: . .,:,-- TEST RUN BETWE.E~ I · FT AND CERTIFIED BY: PER~OR',"EO B": (~ ~nF(~ ~'DATE~ 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Nam~ ' .Jo~,~ f'-/'~?x~,~- Telephone: Home Business Applicant Address ~.xoY' Cie .... 1~¢~ I~ z_o. i (c) Applicant is (check one): Lending Institutio~ r"i; Owner ; Buyer []; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the fol~w/~g address: TYPE OF RESIDENCE i~' Multi-Family Single-Family Number of Bedrooms Other WATER SUPPLY Individual Well [] Commun Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~/' Public [] Community [] Holding Tank [] Note: If'~community welt system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DAi A 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. Name of Firm ,dE4 £' Telephone Address i ~0~ c.~ -~ ) ~c~--~ ~ //~ ~"~ ~ Date Approved ~"'~' Conditional Terms of Conditional Approval 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) HI~ICIPALITY OF ANCHORAGE DMSION OF ENVIRONMEI~kL HEALTH DEPAR~iENT OF HEALTH AND ENVIROI~E~ PROTECTION APPLIC~TION FOK ~ALTH AUTHORITY APPROVAL CERTIFICATE 1. ~eneral Information Application Date /~ 7 (a) Legal Description iinclude lot, block, subdi,vision, sect,ion, to~nship, range) Location (address or directions) (c)Applicant~is (check one) Lending Institution ~ ; OWner/builder ~ ; Buyer ~--~ ; Ocher ~--~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) ~ the HAA to the following address: 2. Type of Residence $ingle-Famtly~ Nmaber of Bedrooms Multi-Family ~--~ ¥ Other (describe) Water supp!~' 'rndividual Well ~--~ Community ~ Public [----[ Note: If community well system, must have written confirmatiou from the State Department of Emvironmental Conservation attesting to the legality and status. 4. Sewage Disposal 0nsite ./~]. Public .~ Community ~ Holding Tank ~--~ Note: If community well system, must have written confirmation from the State ~Department~ of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5- En$ineerin$ Firm Provtdtn~ Inspections~ Tests~ Pile 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 amd/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, amd regula- tions in effect on the date of this inspection. Same of /W(L Date / ' 7- g.9'" DHEP Approval Approved for ~ ,, Approved (ENGINEER SEAL) Disapproved Conditional Telephone ~/' Sd ~ CAUTION TH~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~r~ALTH AND E~IRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TH~ REPRESENT- ATIONS GIVEN IN PAiLAGRAi~ 5 ABOVE BY AN INDEPENDENT PROFESSIO~NAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE ~HEP DOES THIS AS A COURTESY TO PTJRCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OP DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS LN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) KR.4/eJ/D18 [Page 2 of 2] 7-19-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH A/3THORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Log Present (Y/N) Total Depth /3/~ Cased to Static Water Level /~ Casing Height Above Grcund Electrical Wiring in Conduit (Y/N) Separation Distances frcm Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~/~ Cle ancu t/Ma nho le Water Sample Collected By Water Sample Test Results C~{~ nts Legal Description: If A, B, cr C, D.E.C. Approved(Y/N) Date Completed Pump Set At Depth of Grouting Sanitary Seal on Casing (Y/N)&/~ Depression Around Wellhead (Y/N)~/~ To Nearest Public Sewer To Nearest Sewer Service Line on LOt ; Date £)/~ ; On Adjoining Lots /-~ ; On Adjoining Lots Be SEPTIC/HOLDING TANK DATA Date Installed /e ~-3/- Size /7~.~ ¢' ~Z. No. of Ccmpartments Standpipes ~/N) Air-tight Caps ~N) Foundation Cieanout ~-~ ) Depres~sion over Tank (Y~ Date Last P ~umped Pumping/Maintenance Contract on File (Y/N) /9//} ; for ~//~ Holding Tank High-Water Alarm (Y/N) /~[/;~ Temporary Holdin~ Tank Permit (Y/N) ~//~. Separation Distances frcm Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course ~//~ To Building Foundaticn To Disposal Field To S~e~, Pond, Lake, c~r Major Drainage Receipt ~ Date Paid: I Amount: [Page 1 of 2] 2-15-84 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / 0 -~/- ~t Width of Field 3 / Square Feet of Absorption Area Depression over Field .(Y~ Results of Last Adequacy Test /~'~ ~ Type of System Design ~-~J ~/ Length of Field ~. ~' / ~p~ of Field /d,~/ Gravel ~d ~i~ss ~,~ / ~.~ ~ Stan~ims ~e~nt~) ~te of ~st A~a~ ~st Separation Distance from A~scrption Field: / Z~T -~ TO P~operty Line To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/c= Major Drainage Ccurse To Driveway, Parking Area, c~ Vehicle Storage .area f~ w To Existing or Abandoned System cn / ; On Adjoining Lots To Cutbank( if present) ~//~ LIFT SqlITION Date I P.-~ talled Size in Gallons "Pump. On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Corm~nts Dim~nsicns Manhole/Access (Y/N) Level (Y/N) during Adequa~ Test. ~eets MOA ** Check Permitted Bedrocm Rating .~]ainst HAA Request ** I certify that I have checked, %~rified, cr confc~m~d to all MOA HAA Guidelines in effect on the date of th~s i~nspect~c~. KB1/d5/s MOA No. [Page 2 of 2] DEPT. OFENVIRONMENTAL CONSERVATION 437 "E" STREET, SUITE 3fl3 ANCHORAGE, ALASKA q9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-?533 To Whom it May Concern: Accordin§ to records on file in this office the ~/~ Water System is in compliance'with the State Drinking Ware. Regulations Sincerely,