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HomeMy WebLinkAboutT12N R3W SEC 15 LT 112II'Z.. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL FNGINEERING DIVISION 825 L Street - Anchorafle, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WFLL iNSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION / PHONE J~NEW LOCATION ~ DISTANCE TO: IWell~ ~ X DISTANCE TO: I ~ ~,STA~CE T~-- ~uilding foundation JAbsorption area Inside length~ l~ Dwelling Foundation Total length of li,~ IDwelling Width M at ~.~i~- ............ Nearest lot line .... Trench widtl~ __ ~'~ L~_ inches Material beneath tile tt .~ \ ~ inches Depth Crib depth OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER ~ ¢~t~ ~- Building foundation NO. OF BEDROOMS PERMIT NO. Liquid depth PERMIT NO, Liquid capacity in gallons PERMIT NO, ~ ~)O ~ q Total effective absorption area PERMIT NO, Total effective absorption area Nearest lot line Driller Distance to lot line Sewer line Septic tank PERMIT NO. __~ DATE LEGAL 72-013 (Rev. 3/78) J::'l:i:l:~i'.!"l ]: I::ff::'F:'i :[ i::l:::l?',t't' I II::l~:; Il'Iii: ti:! ::ii,l:'J:::Jt',l'!i; :1: Iii: :i: I. :i: l"r' 'i'l? ]: I",tl:: OF[:l"i I!'J :1: :!; [::'1 :l:'l:::ll~: J FiE::iqT [::'L.It:i: :!: ?-,!l::i ):!"!:!i;'ll:::il I I::!l ]:OF,I tl"!:!:i;F:'[i:C:q ]:0i",1% I:~11::: I::11",1"? t'IE:I.I :; I::[I:::,.:II::IC:ICI'qT 'ICI '!I'IZ:!: J::'!::i:Ol'::'lli:l:i:l"~' I::lhli::, I",RI!'tl:i~l ? OI::: Ii?.li::ii;]:l:'[i:i',lC:[?iil 'iHt:::ll I'l'llii: ~,tlii:LI I'1]:1.1 BORING NUMBER i Date Completed:9/6/?8 ?~ SOIL DESCRIPTION -:., SILTY SAND (SM) -- ~ brown --1.5' -- ~',.]! SAND W/SOME GRAVEL (SM) ~ gray, fine--medium sand · -r- ....... 3.5' -- [ ?", SAND '%aS'~. ~ ~ 1 -- :,.. Gray, Fine, with lenses .'.? of med. sand w/some -- )'~': gravel -- -"'..(,~.~,-~.' SANDY '~RA'---VE'~ FGW-') --13.0' .... gray 14.0' TI No Groundwater encountered LOCATION SKETCH No Scale Test Pit 1 Approx. excavation for house NOTE: DISTANCES SHOWN ARE APPROXIMATE AND HAVE NOT BEEN MEASUREO RY SURVEYING METHODS. EXPLANATION ORGANIC MATERIAL Little (~Ss,72, 5Z I%, 85.9 pcf BEDROCK TYPICAL SOILS LOG ~ iSAMPLER TYPE SYMBOLS I -SO L SYMBOLS I DATE. CALE. Lot 112 Section 15, T12N, R3W, S.M. Alaska TRIO. ROd. NO. 85114 [DWG. NO. a-01 J 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 i')ctc etr~er" .~".~ lqcG6 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) U o_t- If'a, 'r"/Z N ., Location (address or directions) (b) Applicant Name ~6~¢,1, Applicant Address Business (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer ~]; Other E" (explain); (e) Lending Institution ,~;,,,at~ ~n z~,,.~,~ f ~ TeTep~one Address ~_ :~¢~1 e~,, ~.~ Real Estate Company and Agent Address Telephone (f) Mail the HAA to tile following address: TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms __ i,~ Other WATER SUPPI.Y Individnal Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to tile legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well systom, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 ol 2 72.025(11 8.1) 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 wastewafer disposal system is safe, functional and adeguafe 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 d~spos~l system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address J~(~ Date D~ Telephone _ Engineer's Seal DHEP APPROVAL Approved for ."/'~e.~¢~ bedrooms by Approved /~"~'¢'~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Depa~lment of Health and Epvironmenta[ Protection (DHEP) issues Health Authority Approval certificates based .olely upon the representations given in paragreph 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 DHI-:P 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: . ~-~.~ ~ ( ~ '~ ,, WELL DATA Well Classification Well Log Present (Y/N) Y If A, B, C. D,E.C. Approved (Y/N) 2' Date Completed ~'/ 13 I 'I ~ Yield Total Depth '~ ~ ~, ' Cased to Static Water Level . Casing Height Above Ground I~. Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N~/'~. Cleanout/Manhole ~(,/t. Water Sample Collected by _ Water Sample Test Results _ Comments Depth of Grouting _ I",l, tI , Pump Set At -~' '~ 7,-~'~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) i t6- ' ; On Adjoining Lots I~ ~, ~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date B. SEPTIC/HOLI)ING TANK DATA Date Installed Standpipes (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 _ To Property Line To Water Main/Service Line _ ~b/~, Course :~ '~ / E. O/ 7,5' Size/0~¢~¢~ _ No. of Compartments ~' Air-tight Caps (Y/N) t'" _ Foundation Cleanout (Y/N) Date Last Pumped iq, Fi · ; for N, A. kt, II. Temporary Holding Tank Permit (Y/N) To Building Foundation I~ * To Disposal Field '¢¢ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(1U84) MUNICIPALITY OF ANCHOR?,GE DEPT. OF HEALTH & ENVIRONMENTAl. PROTECTION 5 1988 RECEIVED C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed )/~ &' / ? Z,' Width of Field '30" To Water-Supply Well To Building Foundation Lot To Water Main/Service Line Type of System Design Length of Field cfI ~ Depth of Field IO ~ Gravel Bed Thickness ff t Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Ares, or Vehicle Storage Area Comments ~W~c ~'{~; 'T~v-¢ t~ C 4 Standpipes Present (Y/N) Date of Last Adequacy Test _ I~/~/cCC" To Property Line '~ To Existing or Abandoned System on ; On Adjoining Lots ".-"~ ;¢ O To Cutbank (if present) 7;' 100 * D. LIFT STATION fV,/J, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA 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 .,~,/~¢~i~¢_ ,~, ~-¢.¢.~ Date i'~/~ Company i--I¢/-A,/ 'T'cc~,..d ~¢~rMOA No. Receipt No. ~¢~/ Date of Payment Amount: $ _~- '~ ~%5~' ~ %55*' Engineer's Seal Page 2 of 2 d It/IL LABORAT RIES, lNG, UBU~TORY I.D. I _6Z4~' 7127 OLD SEWARD "IGH~,?,¥ __ ANCHORAGE, ALASKA 99518 (907)344-8551 ~C~RIOLOGICAL WATER ANALYSIS DATE COLLECTED MONTH DAY YEAR I.D. NO, IPUBLIC SYSTEMS) L_._.L~] ~ I _1_ I TO BE COMPLETED BY WATER SUPPLIER TIME COLLECTED I TYPE,DF SYSTEM ~ ~ p~ [~] PUBLIC[~INDIVIDUAL ~IRCLE CLASS : A B C Residential O~Y~T TELEPHONENUMBER NAME EM ~O~cl~n c~ 3 ~-I ~ 7~ SYSTEM ADDRESS ' CITY ~A, STAT~i~ ZIP CODE LOCATION WHERE SAMPLE WAS COLLECTED 'C0[LECTED BY:(SIGNA~EL TYPE OF SAMPLE (CHECK ONLY ONE THIS COLUMN) [] DRINKING WATER ~CHECK TREATMENT ~ RAW SOURCE WATER ~ NEW CONSTRUCTION OR REPAIRS [] OTHER(Specify) []CHLORINATED []]FILTERED [~]UNTREATEO OR OTIIER FOR LAB USE ONLY RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE Sample too long in transit, Sample should not be over 30 hours. Sample received too late in week Not in proper container Leaked out Insufficient information provided, Please read instructions on form. Other (Specify) IS THIS SAMPLE A CilECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE? YES J2~NO PREVIOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) SEND REPORT TO:(PRINT FULL NAME,ADDRESS AND ZIP CODE NAME ~A~,M 7-'~i~[ ~Or~,C'~ ADDRESS J~-~m ~c/-~ ..~ CITY /~hcA ~ STATE ,,~F~ ZlP __'c~"'7oc-'/( RECEIVED FROM RECEIVED BY AN~:Y?L METHOD: 12d'MEMBRANE FILTER [] FERMENTATION TUBE Date & Time Completed !2-2z~'/o LABORATORY RESULTS Analyst-- ~ F}( '/ c [] Other Bacteria [~ Test unsuitable because: [] Confluent Growth [] TNTC ~--~UN SATISFACTORY I SATISFACTORY BACTERIOLOGICAL WATER ANALYSES RECORD FOR LAB USE ONLY TOTAL COLIFORMS FECAL COLIFORMS OTHER READ SAMPLE COLLECTION Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results, Reported By__ . INSTRUCTIONS ON BACK OF FORM ~9 Coliform/lOOml BGB _ Col i form/lOOml Da te Time A.M, P.M. MUNICIPALITY 0F ANCHORAGE DIVISION OF ENVIRONMEIf~AL HEALTH DEPAR'I/dENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAl, CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, Location (address or directions) range) (b) Applicants Name Applicants Address Telephone - Home .,~usiness (c) Applicant is (cheek one) Lending %nstitution [~ ; 0wner/builder~--~ ; Buyer [---~ ; Other C~ (explain); (d) Lending Institution Ad<~Pk~ss .......... Telephone (e) Real Estate Co. & Agent Address Telephone (f) Mall the }bkA to the following address?/ / 2. ~¥pe of Residence Number of Bedrooms___~_ -- 3. Water Supply Note: If community well system, must have written confirmation from the State Department of Enviromnental Conservation attesting to the legality and status. 4. Sewage Disposa~ Onsite~ Publlc~--] Community~ Holding Tank[~ Note: If community well system, must have written confirmation from the State Department of Enviromnental Conservation attesting to the legality and status. [Page 1 of 2] As certified by my seal affixed ~re~o a~d as of thc validation date sho~ below, I verify t~t ~ investigation of this Health ~thority Approval sho~ that the on-site water supply a~/or ~stewater disposal system is sere, f~ction~ a~ ~eq~Ue for ~he n~ber of bedrooms a~l ~pe of structure indicat~ herein.. I further verify that, based om the i,~o~'=ion obtain~ frsm the ~nlcipality of ~chorage files a~ from my 'investigation ~d i~pectio~, the on-site ~ter supply a~/or ~stewater dtspos~ system ts im compliance ~.th ~1 ~nicipal and State codes, ordfnances~ cioz~s in effect: om the date of this inspection, e Address S~t~ R~'¢; ~o~ 73~0-~e Date ll/~9 /~f . , DHEP Approva_.l Approved for__a__bedrooms Approved ~ Disapproved (ENGINEER SEAL) Condition~ -- Telephone ..... ......... ..' . Terms of Conditiom~ Approval CAUl'ION THE MUNICIPALITY OF ANCHORAGE DF. PARTMENT OF EEALTN AND ENVIRON24ENT3~L PROTECTION (DHEP) ISSUES HF~kLTH AUTHORII~f ~?PROV~J~ 6q~RTIFICATES BASED SOI3~LY UPON THE REPRESF. NT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN ]2%DEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DNEP DOES TI{IS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDF. R TO SATISFY CERTAIN FEDERAL AND STATE REQU~RE- NENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICAT~ IS ISSUED. THE MLrNICIPALIT~f OF ANCHORAGE IS NOT RESPONSIBLE FOR EP~ORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7 -19 -84 Casir~g "'" Seum~ai:i.on Dial:anita fJ~(,~ TO SeptJ,c/[~old:Lr~g Tank on ~:t ~ / /' ; C)c~ AdjcttHng :,~:)t::~ ......... To [$:~arest: l?ub:LJ, c Se~:: ]:,J.r:a ,.=.J~ffr ..................................... '?o Neauest: Public ..................................... ,¢4. x/¢c.. [.,i. rle on Lot: ['//t:- Date Inst:a.LLed ,_.?..L.~,~,._/..Z¢~ v' ~ i' ""~ ": ' ~' " ' ' o t.c;l~,]p ].p~.: ...;~ ............. . . PU=Q i. ng/HainLenan~ ' -(' , Se pacation l:,istan(~s TO, ~¢!~ter"-Soj;,ply l{b To P:cope:t::, Lire _:~:..i}:~,: ....................................... "['o Wat:~r Hai n/~ntvi:~ &i ne ,~/'. 'I~o St:~eara, Pond, '[~e, at' ~ajo:c I)rainaga Co. ABSORi~ION FIELD DATA Soils ~ting in ~])so~ption St~:~ata .__L_~-_~__~.I~ ........ Type of System ~mLgn ~i~L Square I)%et of Abs(~ption A]zea ___ ~(~Z .............. Standpi~s P~,esent .{.~.,~_ ........ ' l~)sults of last A~quacy 'l~)st ...~;. ~)ps~e~tJ.on Distant) f~on Absorption Field: To EKlildi~ Foundation _.~J ................. To Existing or ~ndc)~d Sy;~tem _2.=L~ ...................................... TO [~i~way, Pa~ki~ ~ea, ~ Vehicle Stora~D .~ea .~ ,g'~/ ~ ........... C~mmnt.~ ...................................................................................... D. LI£,~' STATION Dat~) Ink, tailed Di~.u~sions Si~) in Gallons .............................. M~ole/Access "P~ ~%" Le~,l at "l~.u~p Off" ]~vel at High ~ter ~,1 T~v6~i at .................................. %~nt .~ .................. 2,k ....... ~ .... Tested fo~ ........................... ~m~:Lng Cyc. les du~ing ~equacy Electrical ~(~s (Y~q) 's Co~nt.. ................................................................................................. ** (he{~ tbrmitted I~ck,~m Rating Agai~t ~. [~quest i ~z~tif. y that I have checked, w, rifi~d, (~' ~nfo~]d to all ~A ~A ~i(~l].r~s in effect ~n~/~/~ ~-~'.' ~L- '.v~m ~..~;'~%.,*.--~'L~;~'*,~I,,,,,*'' -~*,~ I ' f 2 ~ ~ TH '~'"~ ....... ~ ...... ~'"' [Pa~. 2 o ] ~. ,, ~o~o~ ~. ~oo,~ · ~ "~%,,--%~- ...'~ September 6, 1978 R&MNo. 851145 Mr. Glenn Caley SRABox 1432 Anchorage, Alaska 99502 Subject: Soil Investigation for Sanitary Sewer System, Lot 112, Section 15, T12N,'R3W, S.M., Alaska Dear Mr. Caley: At your request of September 5, 1978, we conducted a subsurface soils inves- tigation at the proposed location of the sanitary sewer system on the subject lot. The investigation complied with those procedures required by the Municipality of Anchorage Department of Health and Envirorm]ental Protection. ! This investigation, which was accomplished on September 6, 1978, consisted of a test hole excavated to a depth of 14 feet below the existing ground sur- face. The test hole was sited by you and its location is shown in attached Drawing A-O1. Excavation was accomplished by hand. The topography at the excavation site is generally gently-sloping to the north. At the time of the investigation the site had been stripped. The top of the test hole was located at original ground surface. The-soils encountered in the excavation are shown in the test hole log in Drawing A-O1. This log displays specific conditions encountered at the test location. However, subsurface conditions may vary in other parts of the lot without any apparent surficial evidence of the change. Groundwater was not encountered. Bedrock was not encountered. At the time the hole was exca- vated seasonal frost was not present and permafrost was not encountered. Based on the visual classification of the soil and the requirements set forth by the Muncipality of Anchorage, a percolation test was not necessary within the test hole on the subject lot. September 6, 1978 Mr. Glenn Caley Page -2- We appreciated this opportunity to be of service to you. Please contact us if you have any questions concerning this letter or if we can be of addi- tional service. Very truly yours, iSULTANTS, INC. GS:/kah/12-V