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HomeMy WebLinkAboutT12N R3W SEC 15 LT 390 l.g'-- MUNICIPALITY OF ANCHORAGE DE ITMENT OF HEALTH AND HUMAN SER £S Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTFM AND/OR WELL INSPECTIC)N REPORT LEGAL DESCRIPTION TANKS SEPTIC HOLDING TYPE OF SYSTEM '~TRENCN [] BED [] W. DRAIN [] OTHER Fl 8)- FT '~-' ~'"z~I := ' ~, ~ FI DISTANCES SEPTIc ABSORPTION TANK FIELD WELL WELL I 0 (.~1 ~- tO~:' ~ LOT LINE FOUNDATION WELLS PRIVATE [] OTHER Ildentifv'l RE~IARJ(S: Municipal and Slala guidelines iii effect on Ihis Irlspecbons Pedofmod by: ....... t this JllSpOCliol) was pedomled according lo all EN( SEAL C~.5283 72-013 (3/85) Municipality oi Anchor:age DEPARTMENT OF HEALTH & HUMAN SERVICES 025 "L' Street, Anchora§e, Alaska 99502-0650 SOILS LOG -- PERCOLATION 'I"EST 1 2 3 4 6- 7 8 9 10 ENCOUNTERED? -- 12 13 14 t5 ~6 18 ~9 20 S IF YES, AT WHAT O DEPTH? Depth to Waler AFter /~0nil0rin0? Dale: I ILO [) I',1 !S :1: T' IE !3 E kl Ei: F;~ I:::' E I::;~ PI :1: '1" I:::'e:~ r' In :i. t. Numb ~ r' D,".-:d:.(::.) I: ~i![i~.l~.!l::l AI..,L,. ]: A~NC.'I,E B Alql::: 440 E:A~iD' :S&'I"H AVEIXIUIE F:',~l~ c:(~.~) ]. I d :~ ko'L L:i :i. z ]: NFI]RM D · II ,, Ir~ ,, [!~ ~ I:::'1::~: :[ C}l:t T() 1 ~VI ~ 21x!D I N!i31>[CG'I' I ON~i~ BY ENI31NIEIS. F~ ~, ]: F' [~F-I"E:F¢ OI:::I:::'ICIE HC}LII:;~E} [:::l~[...I.. ::f~;43-'zl. 6E}l AND L..IEAVH f~ MIEEH~IA[")IE TH i [~[I I:::'I~:I::~N I I' V~q.. Z D F:OI::~ ~ ~3 ]: Iql:':)l~lE I:::'~ :l: I...Y I:~E:E~ I DIEN[;IE ONLY I~::NI31NIEI]~IR kl ]: L..I. ,] LIEKI' ]: FY I NISTAL..I.~Y'[' I CIN ElF: 'TIRE:NCH t:~[EC~ILI:I:I::~E:I~IE:N'TSi ht..I..El~ ~1' I'HE: "I':[NIS: Cfi:' C;EI::CI t I:::'Y I"HfY'[ ~ :3. i ~J:i.],] a(::lh(~?l'~:) 'Lo all PICIJ~ arid Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 7 8 10 11 14 15 10 17 18 19- COMMENTS ~_,//~/'Y/~ ~-~4>Z~ (~ X'O Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? ~/~ S IF YES, AT WHAT ~) DEPTH? p E '~- / ~"- 7-/?-4/ SITE PLAN PERCOLATION RATE /2!! -~(m~nuLes/mch) PERC HOLE DIAMETER __ TEST RUN BETWEEN (~'" FT AND '~> FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DAT"~:_ ~/"~/i'l~ ?~-008 (Rev. 4/85) [) I',1 ,:1 I 1' E,:~ E W E IR I: IR I"1 I T l)ay I:::i"x:)rl~. ~ :: 45...q-44(J 1:5'. NO'f']:I:::Y '0HHS ~')EI:rCTdE 1S'T 8x ?.N~:) ]:IxlgF'E[T[']:[IIqS,, TH]:S f'or"Lh by t.l'le)) Iqur'lJ. cJ. palJ.'Ly of ~nchor, ag~) (IvlD(q) and ('3 ~.' )~ ~GINEER'S SEAL) PERFORMED FOR:~ I lC L o~- LEGAL DESCRIPTION: 'T/Z ©L 1 2 3 4 5 6 7 8 9 10- 11 13- 14- 15- 16- 17- 18- 19- 20- Municipality o! Anchorage DFPARTMENT OF HEALTH & HUMAN SERVIC 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST h/to WAS GROUND WATER ENCOUNTERED? Township, Range, Section: SLOPE ~', 1-,' [, SITE PLAN S L IF YES, AT WHAT O DEPTH? p E D~]pth to Waler ~, I[r ,/ / ' Reading Date Gross Net Depth to Net Time Time Water Drop 4 el/& /o.'d~ Io ...... 04' PERCOLATION RATE~7~, ~ / (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ ~ FTAND /~ ~ FT PERFORMED IN ~ I SEWER SYSTEM LOCATION PLAN '~ ~ ~-- ~ ~, ::. 5~0, *,~ *ccu.*~ or ~oc*~,o. or ~/, ~ ~~ ¢¢~ '~. ~' ' . ............~ D/TERMINEO BYU~E OF CLOTH TAPI~ AND '{UNICIPALITY OF ANCHORAGE Hca . and Environmental Protec Fourth Floor West 825 L Street Anchorage, Alaska 99501. 264-4720 ' ~ -IH.{,Pi{cr!oN P, EPOP,'f ON-SITE SEWAGE DISPOS,.? SEPTIC i-AN K: [ IQUIi} [3F/']iI I IOUID CI\PACITY/'~__~_ GALLONS. SEEP,\QE PIT: Log Crib . .Rings_ Crib Size: 131 ,M~_ t[ ~t iii Pill Dt%]ANCU FF!OM: WEI.L ;fell Distance To: Lot Line Bldg: Sewer Line: ............. it.ii 1 l)ep~ 'merit of Health ;md Envi~onmentn' 2518 1~. Tudor Road Anchorag'c, Alaska 99507 276-2221 ~oteetion ThIs fOr[Il report.;: Soil.; lo9 ......... ~ ....... Percolal;im~ Lest Feet 7- 14- Nas qrou? walcr encountered? /~/d) 1F yus, at wi~a[ de~[l~? ' 5~.:L. _ L ~:~t,, g: <;~-,,~ ri,,,~ -I ~.~ :i,,,~ t~ ~"L ~ I .e/aL ..l ...... e'...~ .... ~ .............. . .................. : ...................... ..... ~..~8 ........ 1'. .......... ~_.:/~ ............................................. [ J I - .~ .............. o,,~_7 .... /~.~L ........... Percolation ra[c /~ -Proposed i~sb~llaC~on: Seepage PiL .......... twain I icld Well Owner. DRILLING, INC. DRILLING LOG _Use of Well : Location (address of: Township, Range, Section, if known; or distance main road Size of casing : f .Depth of Hole Static water level ":' ft. (ab'o(~fi) Screen ( ); Perforated ( Describe screen or perforation Well pumping test at ~ ,' gallons per of drawdown fi'om static level. Date of completion 'r / ' ~- ~ I / / ' ' ~:; feet Cased to ' ' __feet (below) land surface. Finish of well (check one) open end ( ). (minute) for_~ hours with WELl. LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness :); ft. .TO. TO. TO .TO. .TO. _TO _TO. _TO _TO. .TO. .TO .TO 2 -- STATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SI:!RVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORI'f'Y APPROVAL OF ON-SITE SEWFR AND WATER FACILITY 264-4744 Application Date GENERAL INFORM/~I(~N (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a Le~lal Descriptio'f'i'(include lot, block, subdivision, section, township, range) LOCation taeeress or dlrec~ on ~)~ , , I.,~ ~J (b)~Propedy Owner ~ ]L~ ~'~,~ ~/~ Telephone: Home ~ Mailing Address ~ ~ ~ ~ ~¢{~ ~ ~ ~ ~O (c) Lendidg Institution ~, (, ~, ~ ¥~¢H, Telephone Mailing Address_ J~O0 ~ ~/~ r4~ ' ~,~ O ~ (d) Real Estate Company and Agent ~ -~ Address I~/~ Telephone ~ '/ (e) Mail the HAA to the foliowin~ address: or: Check here ~old for pick up. List co~tact person and day phone number below. 2. TYPE OF RESI~D.~ Single-Family ~ Number of Bedrooms Individual Well [JJ/ Community [] Public [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality/and status. Onsite LL¢ Public J~ Community [] Holding Tank Lq 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 IRev 8'¢61 Front 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 a. nd/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. (~'~-L''7*f''v~q\'l ? i/~''~'(2~'. [f-'U~' ,' Telephgne ~' Z-~ ~ (.-~ l t Engineer's Seat Approved for ,/~,, bedrooms by _ te Approved ,_/",~. Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates 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. Page 2 of 2 72 [~75 fRcv ~/861 Back i,,AtjNiCipAUTY 01~ ^NCHO~IAOE DEPT. OF HEALTH E&CTIo~4UNiCiPALiTY OF ANCHORAGE (MOA) L pP, OT Et4Vt~ON~ENI^ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 J~. ~ ~ ~gRR 264-4744 WELL DATA Well Log Present (Y/N,_ "¢----Date Completed °7/~'L/~-~ --' Yield ~ Total Depth ~ _~a Cased to _ I '~,O Depth of Grouting ~'~/~'' Pump Set At "~'"~ Sanitary Seal on Casing (Y/N) -- Depression Around Wellhead (Y/N) Static Water Level Casing Height Above Ground --- Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot _ To Nearest Edge of Absorption Field on Lot I_¢..~,¥'~~ ; On Adjoining Lots To Nearest Public Sewer Line ~-- 1~'~),) ~,----------------~ 1-o Nearest Public Sewer Cleanout/Manhole -- 1%...~? ~ 1-o Nearest Sewer Service Line ~n L, ot Water Sample Collected by ~2~~_~:..4¢~--; D at e Water Sample Test Results __ ~'- SEPTIC/HOLDING TANK DATA Date Installed ~ ~ Size _ I 7~,~ O NO. of Compartments Standpipes (Y/N) .----~- Air-tight Caps (Y/N) __(F Foundation Cleanout (Y/N) Depression over Tank (Y/N) _ -- /k,~ [)ate t.ast Pumped Pumping/Maintenance Contract on File (Y/N) _ t~,--,~/~ ;for _ Holding Tank High-Water Alarm (Y/N) ---- I~/.~ Temporary Holding Tank Permit (Y/N) Separation Distances lrom Septic/Holding Tank: To Water-Supply Well __,~-.~ To Property Line ~)~ '~' To Water Main/Service Line Course - Comments To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 el 2 72 026 fReV £~'861 Fronl C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date,nsta,ed '-7/ Width of Field '7.--- Square Feet of Absorption Area ~_ ( Depression over Field (Y/N) Ix*..) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Length of Field _ Depth of Field _ Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Type of System Design To Property Line · To~or Abandoned System on Lot '~('--) ! -- , On Adjoining Lots To Water Main/Service Line ~ ~,.I .~_/_ To Cutbank (if present) ~J/~c'"- To Stream/Pond/Lake/or Major Drainage Course ~ ~//f/~ To Driveway, Parking Area, or Vehicle Storage Area / ~) Comments D. LIFT STATION Date Installed Dimensions ~ Size in Gallons Man~hole/~ "Pump On" Level at '~.~~..~..~ Off" Level at High Water Alarm Lever at Vent (Y/N) Tested for ~. Pumping Cycles during Adequacy Test· Meets MOA Electrical Codes (Y/N~ ** Check Per~ed BedrooC/Rating Against HAA Request ** I ce r ti fy t h at,~ 17~v~e/~iYec "~d, °r c~onformed to all MO/~..and HAA guidelines in effect on the date of this inspection Signed ~///////'~ ~ ~ate '7~~ ' Compan/~ ~MOA No. ~ -~/~ Receipt No. ~ ~:¢ Date of Payment ~ ~'//-~'~; Amount: $ ,/~' ¢'¢ Engineer's Seal ~ { MUNfCIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Page 2 of 2 JUL z i 1988 RECEIVED MUNICIPALITY OF ANCHORAGE ~/-'~, ENVIRONMENTAL ENGINEERING DIVISION T~laphon~ 264-4720 REOUEST FOR APPROVAL OF INDIVIDUAL WATER AN~ SEWER FACILITIES DIRECTIONS: Comolete all parts on page 1, Incor, plete requests wig ftot be proces=md, Please allow ten (10) (.lays for processing. 1. PROPERTY OWNER PHDNE James Fuller 349-3031 MAILING ADDRESS 4240 Abbott: Ro~td PROPERTY RESIDENT (~f different from above) PHONE same PHONE 2, BUYER Same MAI LING ADDR ESS LENDING' IN§TtTUTION Alaska Statebattk PHONE 279-7637 MAILING ADDRESS 310 E. Nort:hern Lights 99503 4. REALTOR/A(~ENT None PHONE MAILIk G ADDRESS ~EGAL DESCRIPTION I~ Lot 39~ Section ~f~, Township 12 North, Range 3 West, STREET LOCATION 4240 Abbott Road S. TYPE OF RESIDENCE ~'~ oING[.E FAMILY [~ MULq' PLE FAMILY 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY L SEWAGE DISPOSAl. SYS-EM r~ [NDIVIDU,~ L/ON-SITL [~ 3UBLIC UTI LITY NUMBER OF BEDROOMS [] One [~ Four [] Two [] Five [] Thrge [] Six [] Other _ ATTACH V~ ELL LOG, A well log is rer~dired fol' all wells drilled s, ~ee June 1975, For wells drilled prior to that (late, give well ~depth (attach ]o~ if availgble.) If individual/on-sita, give installation datG~'%'-------- If system is over two (2) veers old an adequac'"~-test is r~eu--~re--~---~ oy this Department, NOTE: THE INSPECTION FEE MUST ACCOIVIPANY EACH REQUEST BE FORI-'- PROCESSING CAN BE INITIA'rED. 72.010~3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS; 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2, WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTA'[~ C ES Septic/Holding'Tank WELL TO: Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [~;~'~PPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) D,SAPPROV LEGAL DESCRIPTION 72-010 (Rev, 3/78)