HomeMy WebLinkAboutALYESKA BASIN #7 BLK 25 LT 35
-~-~" 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
IP'°NE
MAILING ADDRESS
LEGAL DESCRIPTION ~ ' I
LOCATION I NO. OF BEDROOMS
F
I~ell I Absorption area Dwelling PERMIT NO.
~ DISTANCE IP I;'C '
P Z Manufacturer Material~ No. of compartments
Liq. capacity in gallons Inside length Width Liquid depth
~ ~ IF HOMEMADE:
~ ~ Well Dwelling PERMIT NO.
~ ~ Z DISTANCE TO:
~_~O ~ ~ M~nufacturer Material Liquid capacity in gallons
~ DISTANCE TO: Well Foundation Nearest lot line PERMIT NO.
~ ~ No. of lines Length of each line Total length of lines Trench width Distance between lines
inches
~~ ~ Top of tile to finish grade Material beneath tile Total effective absorption area
O inches
Length Width ~ Depth PERMIT N~
~ Type of crib~ Crib diameter~ Crib depth ~[~ Total effective absorption area
m DISTANCE TO: W~jl~ ~ Build~ foundatio9 Nearest lot line
; Clas~ ~ ~
~ ~ll~ ~,~' pth Driller Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS ~ .~OJl~ ~O~,
SOIL TEST RATING
INSTALLER
REMARKS
~z~ ,~ ~ ~ ........ ~:~-~'
APPROVE D ': DATE LEGAL
(Rev. 3/78)
RF'F'L ]: E:RIqT '
la[:,[':,F:EZ E; '
C:ONTFIC?' F:'HOI'.,IE '
I:..', FI ',,,' E HE 1' ER
,:¥:[.;21 TFtH '3E
RI",ICHOF'.F~GE., Ftk:
2 4 3: - 1 Fj ::: ',F
L. EGFIL.. DEIE;CFI I F' ·
L 0 T 2; .T 2:E:. '
SECT I Ol'..i
~ ..... ::t~J:l. (':: ::, F'T OF.'. FtF:RES.; ::,
.l CEF.'.'T I F "¢ THRT:
W'
PERMIT NO'
DATE I :,--,LIED'
~I_I~l ICI F 1LITe' OF A~4CH[ ~AI]E
DEPARTMENT OF .tEALTH AND ENVIRONMENTAL P,.~TECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
C~4----,¢ I TE _C.E[qER
840460 HAND WRITTEN'~
05,-.'14/84
AF'F'L I CANT'
ADDRESS:
CONTACT PHONE'
DAVE HEIER
4121 TAHOE DR.
ANCHORAGE, AK
243-1088
LEGAL DESCRIP-
LOT SIZE~
SUBDIVISION: i~I~~.~%N-#?
SECTION' 16 TOWNSHIP' iON
15001 *~'
~:.~.FT. OR ACRES)
RANGE- 2E
I CERTIFY *THAT:
1, I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA.
2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS~
AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
~. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
WORK MUST BE DONE. BY A
AF'PLICANT' DAVE HEIER
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN <l) AN ELECTRICAL PERMIT 8ND INSPECTION MUST BE OBTAINED~ (2) AS-BUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT~ AND '::~) THE
ELECTRICAL L I CENSE[> ELECTR I C I AN.
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAl. PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
DATE PERFORMED:
SRE P~N
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
X
O
P
E
Gross Net Depth to Net
Read ing Date Ti me Ti me Water Drop
PERCOEATION RATE ~ --~ (minutes~)
C2~ ~'~) ~/'~"~/~)~;t/')')TEST RUN BETWEEN
COMMENTS
PERFORMED BY: ~---~'~ ,~j/~.~~//~
72-008 (6/79)
3 FT AND 3 /~ FT
CERTIFIED BY~
.2/ X'
'L
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)
(b)
(c)
Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
Applicant Name ~Cb )~e~
Applicant Address ~ 1% ~ ~~
Applicant is (check one): Lending Institution ~; Owner/~u~d~ ~; Buyer ~; Other ~ (explain);
Telephone:Home ~H.~ - Io'3' '~' Business
P ~ ~uct-lo&~r,.c" ~tr.. ~q~'/J~
(d) Lending Institution Telephone
Address
(e) Real Estate Company and Agent
Address
(f)
Telephone
Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family [~ Multi-Family
Number of Bedrooms
Other
WATER SUPPLY
Individual Well [] Community [] Public I~.
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 well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
E'NGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFO
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my invest~
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functh
for the number of bedrooms and type of structure indicated herein. I further verify that based on the infer
from the Municipality of Anchorage files and from my investigation and inspection, the on-site Water su
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations
the date of this inspection.
Telephone ~"~ I -~'o ~/. 0
Name of Firm
Address
Approved for 'J"~, ~ bedroom~ hu ~
~ Date
Approved ~ Disappro~ ~on~
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
m UCZPA Z OF CHOmSE
PROVA
Well ClasSification ~1
Well Log PTesent (Y/N) ~; ~.
Total Depth ~. Cased to
Static Water Level ,,
Casing Height Above Ground
Elect=ical Wiring in Conduit (Y/N)
Sepa=ation Distancss f~cm Wall'.
To Septic/Holding Tank on Lot ,
To Nearest Edge of Absc~tion Field on Lot
MUNICIPALITY OF ANCHORAQE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
APR 5
CHECKLIST - FEBRUARY 1984
Legal Description:
If A, B, Cz' C, D.E.C. AL~rove _c~'yN)
Date Completed , ,e,/,,1 Yield
Depth of G~outinG
Pump Set At ~,~ ....
To Nearest Public Sew~= Line
Cleanout/Manhole ~-
Ware= Sample Collected By
Wate~ Sample Test Results
Comments
Sanitaz.y Seal on Casing (Y/N)~.~
Da~ession A=ound Wellhead (Y/N)~.
; On Adjoining Lots ~
; On Adjoining Lots ,.~,d...,
To Nearest Public Se~sr
To Nea=est Sewer Service Line on Lot
; Date ~ ,,
SEPTIC/HOLDING TANK ~1%TA
Standpipes ~N) g~ Ai=-tight Caps ~ Foundation Cleanout ~N, )~
Dep=ession ove= Ta~k (Y~D~o Date Last Pumped ~3 4
Pumping/Maintenance Contract on File (Y/N)~9,4~ ; fo= , ~.
Holding Tank High-Ware= Alarm (Y/N! ~ Tempo=az-y Holding Tank Permit (Y/N)
Separation Distances fzcm Septic/Holding Tank:
To Water-Supply Well q~. , To Building Foundation, ~ ~ ~
To PToperty Line IQ'+ . . To Disposal Field ~ q' .
To Water Main/Se=vice Line ~ ~o' To St=earn, Pond, Lake, c~ Major D=ainage
Course C~T(Ou'
Date Paid: ~-~-~ g--
Amount: ~.~. Ob
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption St=ata
Date .Installed (~ - 34%- .3 ~/
Width of Field . .?_~'
Squa=e Feet of Abscrption A~ea
DeP=ession over Field (Y~
ReSults of Last Adequacy Test
a 16,,- Type of System Design
iength of Field ~ ~
Depth of Field . . 0' %-'
Gravel Bed Thickness
Standpipes P=esent (yd..
Dete of Last Adequacy Test
Separation Distance fTcm A~sCrption Field:
To Water-Supply Wall ~uoc To ~o~ty Li~ ~Tto
To ~ildiD~ F~n~tion ~T ~'. To Existing ~' ~ndo~d System
Lot ~ ; ~ ~joining ~ ~r ~o '
To ~te= ~in/~rvi~ Line~ Bo' To ~t~(if ~e~nt~ ~
To S~e~ond~ke/~ ~jo~ ~ai~ ~ ~F~u' ,
TO ~i~y, P~ki~ ~ea, ~ Vehicle St~a~ ~ea ~' .
g6:O
DateInstar~
Size in Gallons
Dimensions
Manhole/Access (Y/N)
"Pump On" Level at
High Water Alarm Level at
Tested fo=
Electzical Codes (Y/N)
Cc~ments
~j,} "Pump Off" Level at ,
,
Pumging Cycles du=ing A'~ts MOA
**
** Check Permitted Bedro(zn Rating Against HAA Request
I ce=tify that I have checked, verified, c~. confczmed to all MOA HAA Guidelines in effect
on the date of this
Cc~3any
KB1/d5/s
[Page 2 of 2]"
2-15-84
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, sUITE 303
ANCHORAGE, ALASKA g9501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-P_533
To Whom it May Concern:
According. to records on file in this office the _~~~
Water System is in compliance with the state Drinking
Water Regulations
Sincerely,