HomeMy WebLinkAboutASPEN RIDGE BLK 1 LT 3
MUNICIPALITY OF ANCHORAGE
DE, ;TMENT OF HEALTH AND HUMAN SER~ -:S
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SiTE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name
Address
Phone(s)3 ~ ~ ~-~'-~{~:~"~ 1 Permit~O~...,~rNO' ~/'~ INo. of Bedrooms~
LEGAL DESCRIPTION
Township, Range, Section
.¢¢¢ 3 $~/ /' t"Z rf / P; 3
TANKS
DISTANCES
WELL
SEPTIC
TANK
ABSORPTION
FIELD
WELL
LOT LINE i 0 '~ 10 l 0
FOUNDATION l~, ~0 '"'~ '~¢--) ~
AS-BUILT DIAGRAM (Show location of well, septic ,erty hnes, loundahon,
dnveway, water bodies, etc.)
[] SEPTIC [] HOLDING
Manufacturer Capacdy m gallons
Materiak ,~ et No. of Com~rtments
TYPE OF SYSTEM
~ TRENCH [] BED [] W. DRAIN [] OTHER
Depth to p~pe bottom from Total depth from original grade
or,ginal grade ql ~-) FT ?~ <::~ FI
Fill added above original grade Gravel depth beneath p~pe
0 FT ~-0 FT
Gravel length (]ravel w~dth
~ 3 FT 3, ~g' FT
Total absorption area
~'~.~:~ Sg FT
Number of hnes J Soil rating
Installer
Distance between lines
N,/~. F1
P~pe material
Cc,ri- J- !-" ~915~
Date Installed
WELLS
PRIVATE
~(A,B,C)
[] OTHER (Identifv)
Total Depth J Cased to
I
FT
Date Installed:
Installe~
REMARKS:
FT
~ A~ ~ ~t~ "1'' ~caie:. ns~ dot '' ' "I' ,,'ENGINEER'88EAL
, ¢~ ¢~ cedily thai Ibis inspecti0n was ,edormed acc0rding ,o all '
Municipal and Slale gu,dehnes m effect on Ihis dale: ~/~/~ L Sg %[H~ODO~ ~. ~OOR~,,- , g
72-013 (3/85)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geologicol ~ Geophysicol Surveys
Drilling Permit No. 860140
LOCATION OF WELL (Placid complete either Io, lb or lc.) A.D.L. Ne.
Anch. 3 1 _o,_o,_of_ sO wE
ic.IIDISTANCE ANO DIRECTION FROm ROAD INTERS£CTIONS $. OWNER OF WELL:
Flying Arrow Const.
Address:
Anchorage. AK
Street Address and Area of Well Lo~'aflon
,. WELL LOG F.., B.,ow ,. S. DATE OF MPL,T,O,
Surface .
· M alerlal Type Top Bottom
Light brown clay & rocks 0 47 6. ~C.bl. feel
Gray clay & rocks 47 73 ~.~ ~.,,.~ ~o~.~ ~o,~.~
Brown clay & Erav el 73 81 ~.usz: ~o~.,~
Fracted r~ck 81 220 ~ ,.,~.,,~. ~ ,.,.~. ~ c~...~,~,' .
Water coming from cracks ,~, ~ ~..,w.,,
in rock ~. c~s,,~, ~w.~.~
~lem. I.. le~ff. Depth $11cku$~ff.
~ ~--~, 9. FI~ISM OF WELL:
' ,~_ ''~ ~ ~ Slot/Math 81~e= Length:
NOtI* ,~ .... Backfilling Gravel peek
~".~ad ~lh I~NO~IA~= I0. STATIC WATER LEVEL: B8 ft. ,
'~'"~" ~ Above
-..,~ ~ Below land lurface Dote
Equipment u,ed:
II. PUMPIN~ LEVEL below I~nd ~urf~=e end YIELD
~OO ff utter 4 hrl pumping ~ g.p.m.
~ff. ofler ~hrs. pumping.~g.~.m.
~ . . ' ~ Moterlel: ~ Negf Cement ~ Olher:
13. PUMP; · (If available) HP
Length of Drop Pipe ff. cope~lly g.p.m.
14. REMARKS:
· .16. WATER WELg 'CONTRACTOR'S CERTIFICATION: 15. Wat.r Temperoture 'o ~ F ~ C
~ii w. II w~l drilled under my jurisdiction end this report Is true to the baal of my knowledge end belief;
?: '~-- Regi~tered ~usiness Name.. Conlract License Number
:"~,"~': 1 1 1 40 ~o.]:.~'~'D'~.tve , A~cho~ e , ./~I:~ 9951 6
o.,,: ·
AuthoH~e'~"~epresenlutlve '~ 67 ,',':T~.Z ·
FOrm ' ....
O[~WWR
Copy Distribution: WHITE-State DGGS~ PINK-Drtller~ CANARY-Cu~t~mlr
DEPARTME[NT OF HIEAL. T'H AND ENVIROtqMENT'AL. PROTECT ]; OI~I
825 L.. STREET's, ANCHORAGE, AK 99501
264-4720
I:::'FZRM I '1" NO:
DAT'E ISSUED:
860140
05/23/86
AF:'PI.... I [;ANT:
A D D R E S S:
CON"['ACT PHONE:
DANMAR CONSTRUCT I ON
28:30 IE 88'TH AVE:I'4UE
ANCHORAGIE, AR; 99507
· "."!;49-2386
L..EGAI... DE:SCR I P:
I....OT S I Z El::
MAX BEDF~OOMS:
SUBDIVISION: ASPEN RID6E
SEC'T' I ON: ::.";5 'T'OWNSH I P:
50909 (SQ. FT. OR ACRES)
4
LOT: 3 BL..OCK: 1
12N RANGE: 3W
L. isted below are the options available t.o you in designing your sept:i,c
systern, Choose the option thaT., best £its your site.
DEPTH 'T'C) PIF"I!F;; BOT'T'C)M (FT.)
GRAVEl .... DEF'TN (FT.)
TCITAL. DEF::'TH (F"T'.)
GRAVE] .... W]:DI"H (FT.)
bF',AVt::.L L..E~.t"4GTH (F"'"t'.)
GRAVIEL, VOL..LIME (CU, YDS. )
TANI< SIZE (GALS)
SOIL.. RAT]:NE~ ('SQ.F:'T,, /BR)
4.0 4.0 4.0
4 ,, 2 (). 5 3.5
8.2 4.5 7.5
2.5 25. () 5 ,, ()
93.0 *~ 4.7.0 84.0 *.~.
40.5 43.6 62., :.'$
250,() ** 1,250.0 *~ 1,25().() **
194 :[ 93 194
· x-.~. [':'}F:d::~VEI .... L..IENGTH > 75 F"T. RE;QU I RES MUL. T I PI_E RtJNS (NO'I" Er XCEI.'.ED I NG '75 t:::"1" ,, EACH)
· * T'AI\IK MUST' HAVE AT L..E~S'I .... I"WO C";[~IdF'AF~TMENTS
:[ c e r' 'f., :i. f' y t h a t:
1,. I am Cami].iar. w:L't'..l'"~ the requirements Cot on-site sewers and wells as set
Forth by the Mun:[c::[l:)ality oF Anchorage (MOA) and the State oF Alaska,
2,, I w:i. ll install 't:he system in accordance with all MOA codes ancI regu].at:Lor~s,
and J. ri compliance with the des:i, gn cr'i'f, eria of' th:i.s permit.
:3,, I w:Lll adhere to all MOA and State of Alaska nequiremertts For' the set back
d:Lstarlces From any exist:Lng well, wastewater disposal, system or public
sewerage system on 't'..his or any adjacent or nearby lot.
zl... I understand '[.hat this'permit :Ls valid for a maximum o¢ 4 bedPooms and
any enlargement will reqLtire an additional pel-fi~i'(..
IF::' A L. IF"T' S'TATION IS INS'I"AL..I....ED I!'4 AN AREA C[]VERED BY MOA BUIL...DING C*,ODES,
THEt".I (1) AN ELECTF:~ICAI_. PERMI'T' AND INSPECTIOIq MI.JST BE OB'T'AII'4ED; (2.) AS-BUIL. TS
W-1;L.L.. IxlO'T' BE API::'F~OVED WITHOUT AN L:.:]....EC]'RICAL INSF'IECTIC'.Uq REPORT; AND (:3) THE
tEL. EC;TF::4ICAI .... W[]RK MUS'T' BE DONE BY A LICENSED li~:L. IEC;TRICIAN.
AF:'F'L... I CANT': DAI',IMAF:;:/ [].OI'4~TF:;:UC'T' I ON
FIatt0-~ Technica! Services
14530 Echo Street
Anchorage, Alaska 99518
6
3
8
J ~u~om~ po~vo...C
LOT J SLI< i ASPEN
· I /
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION [] PERCOLATION
TEST
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: C)(~[/'~ ~;~r~ / ~)<:~ /~(4.¢' ~::~.~'~'rf.z(_/"~'~..3 DATE PERFORMED: ~//3/~'
1
3
4
5
9
SITE PLAN
10
11
12
13
14
15
16
17
18
19
20
THEODORE F. MOORE
CE 3589
WAS GROUND WATER S
ENCOUNTERED? V L
O
P
//~-~-~1F YES, AT WHAT
E
DEPTH? J31 ~' I
Depth to Net
Gross Net ,~tr ) Water Drop
Reading Date Time Time (
CRff-~/)k' ~//3 ~,'r..,o Pt'/ .-
~ I ,.5-//y ~o: ~-' Ar~ ~y~"
i ~: 3~ ~ ~ ~/~
PERCOLATION RATE J ,,.~""' (minutes/inch)
TEST RUN BETWEEN ~'~ FT AND ~'~ , FT
C,,T . ED DAT :
72-O08 (6/79)
4
F
t
//
SURVEY of LOT 3, BLOCK 1, ASPEN RIDGE SUBDIVISION
I~ hereby certify that I have survey, ed the above de~cri~b~j property., Anchorage Recordin
Pi.'stricl, Alaska, (Plat 82-198) ann dmt the improvement° situateqJ thereon are wi~.n
the property iines and do not encroach on the adjacent protmrty and that there are no
roadvays, transmission lines or other visable easenmnts except as M~o~ hereon.
It is the respq, nsibilitv of the owner or builder to verify proposed grades relative
tofinished, grades .and utility hookupp, and to determine the existance of any ~easements
or covenanns or other restrictions Which do not appear on tJ~e recorded subdiv, plat.
PLOT PLAN X Date: ff///b~ Drawn by: ~.Z.~. Scale: 1"=50'
FOUNDATION AS-B'UILT__Da~e: By: GRID 3039
FINAL AS-BUILT Date: By:
2
TEMPLIN LAND SURVEYING
SRB Box 74.57 Ph. 745-]49
PALMER, Al<. 9964"5
Note: This copy VOII) ~,i. thout, u')
or i g i na.l sc;: 1 a~ x:l .s i f4] ~a tu rc
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
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name Btt¢ 8c~cO,~ Telephone: Home 3 ¥5"-O,Y~.. Business
Applicant Address /'~O/' 64/. ~/~¢.~. c~/~ ~ H ./ /~,'tc..~to¢'c~'
(c) Applicant is (check one): Lending Institution []; Owner/builder [~'; Buyer []; Other [] (explain);
(d) Lending Institution /4(~-.~-.~ P't~,4~! ~.~.~-, Telephone
Address
(e) Real Estate Company and Agent ~o~ ~ (~ -
Address ~O.
Telephone
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~ Multi-Family []
Number of Bedrooms ~'~
Other
WATER SUPPLY
Individual Well I~ Community [] 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 well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/84)
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.
Nameof Firm F(~/~ ~'~¢~'~¢a/ ,.~,.~ru'~¢,.~ Telephone '~,.~'- I~
Address
~-~ Date
Approved for f~ bedrooms by . ~
Approved ,~ Disapprove~ / ~ Conditiona~
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)
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
264-4720
l.~gC~'~ g~ Leg~a,,~.,~,,~ Description: ~'~'
A, WELL DA
Well Classification
Well Log Present (Y/N) Y
Total De pth ~ ~. O ' Cased to
Static Water Level ~°
Casing Height Above Ground
Ejectrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot {I q '
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments
If A. B, C, D.E.C. Approved (Y/N)
Date Completed ~ / 7/~'~ Yield
'~ ( ' Depth of Grouting N,/J.
Pump Set At ~-~'4 ~'
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
· On Adjoining Lots ~ too °
;.On Adjoining Lots
N
~, ~,. To Nearest Public Sewer
N. ~. To Nearest Sewer Service Line on Lot
'r~',~ ; Date 7
B. SEPTIC/HOLDING TANK DATA
Date Installed ~'/l~ {~e~ Size
Standpipes (Y/N) ~ Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well I Iq '
To Property Line '~' ,~'~ ~
To Water Main/Service Line N,.~.
Course ~, I0o '
No. of Compartments
Foundation Cleanout (Y/N)
Date Last Pumped R/, A.
, for f~
Temporary Holding Tank Permit (Y/N)
To Building Foundation 11 t
To Disposal Field 9 ~
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 ~ ~'/'~/~d~
Width of Field ~'. ~'°
Square Feet of Absorption Area 9~'O
Depression over Field (Y/N) N
Results of Last Adequacy Test ~, ~,
Separation Distance from Absorption Field:
Type of System Design
Length of Field
Depth of Field ~-~
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
li, A.
To Water-Supply Well
To Building Foundation
Lot J~, ~.
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line (O '
To Existing or Abandoned System on
; On Adjoining Lots ~, ~O ~
To Cutbank (if present) N,/J,
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access. (Y/N)
· · .,PumP Off" Level a~t
, ..,, Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
EleCtrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~T"~ ~. ~ Date ~ ,//./~'~''
Company ~'~z~? /~F.~..~ .~u'~' MOA No. ~,.~' "~$ ~-
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
