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Home My WebLink AboutT13N R3W SEC 26 Lot S2-10 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 MAILING ADDRESS -t- LOCATION ~' i L,q. cap~ gallons~,¢ IF HOME,DE: Inside length Width ~ -- ~ ~ ~ Manufacturer ~ Material Foundation / Nearest lot li~e ~ ~ Top of tile to finish 9rad~ / ~ tf % Materi I eneath til ~ LenDth Width ~ ~ Type of crib Crib diameter Crib depth ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class~~ Depth ~ p Orille~~ ~ ~ DISTAN~E~: Building foundation Sewer li~e NO. OF BEDROOMS PERMIT NO. ompartments Liquid~depth~ PERMIT NO. Liquid capacity in gallons PERM[ NO Distance between lines absorption area Total effective PERMIT NO. Total effective absorption area Nearest lot lin ~ Septic tank Absorption area(s) Distance to lot line PERMIT NO. OTHER PIPE MATERIALS sTALLE ..... RE~ARKS LEGAL 72-013 (Rev. 3/78) ~ WATER WELL RECORD STATE OF ALASKA OEPARTMENT OF NATURAL RESOURES Division of GeoIogicDI ~ Geophysical Surveys (Please complete either la, ib or lc.) Feet Below Sur face Bottom Top ¢0 5.~LTE OF COMPLETION D A.0., ~ d~+t,d E3 Bo,,d UI or,.,: 10. STATIC WATER LEVEL: ~O ft. ?_~/~,~/~ Dote [] Above or ~ Below load surface PUMPING LEVEL below land aurfuce and YIELD IB.GROUTING Well Grouled: []Yes [] No Material: []Neet Cement [~ Other: IS. PUMP: (it available) HP Length of Drop Pipe ft. capacity g.p.m. 14. REMARKS: This .~.~.11 was drilled under my juti~sdlc!ion end this reporl is true to the best of my knowledge and belief; Water Temperature ____o [] F [] C PO b,~,tt 6-650 ANCHORAGE, ALASKA 99502 0650 (907) 264-4111 TONY KNOWLES MA YO,q DEPARTMENT OF HEALTH AND ENVIRONNiENTAL PROTECTION Permit ~: 840356 January 31, 1985 TO: Permit Applicant SUBJECT: T13N R3W Section 26 Lot S½ of 10 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by autho=ity of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, rKeith E. Bandt, SupeYviso Environmental Engineering Program KEB/ljw eric: Copy of Permit SWP/057 ~1Lir-~ i BS I PI:IL I T~' OF I:I~-~C:HORF'IGE DEPRRTMENT OF HERLTH RND ENVlRONMENTRL PROTECTION .-.~5 L STREET.. RNCHORRGE, RK 99501 264-4720 B31'4--S ITE SEIC--IER ._';~:lC-JELL PERi'"1 I T PERMIT NO: 840_~56 DRTE ISSUED: 05718,,"B4 RF'PLIC~NT: LRRRY & J~CKIE SMITH R[:,DRESS: . C/O ~i~- LINDEN DRIVE CONTRCT PHONE: ~4=.c', ?_,=,_,04 =~ LEGBE [E¢CRIP.~ c · , " 5UB[:'I',/I~ION: N8 LOT si,,'2'le BLOCK: N8 SECTION: 26 TOWNSHIP: ~N RBNGt ~W LOT SIZE: ~6~28 ._M. FT. OR 8CRES) L_T LECRTION. OFF CMMFE, ELL BIRSTRIP EOMD ~ 5IST~D BEEOW RRE THE oPTIoNS R',~BLE TO '¢OL~5IN [:',SIMNING SEPTIC DEPTH TO PIPE BOTTOM EFT..¢' 6. 8 ~ 6. 0 6. 8 TOTRL DEPTH (FT.). ~. lt. 0 ~ ~ 5 8, 0 GBRVEL WIDTH '(FT.., ~ %~ _~. ~ ~ ~2. 0 ~. 0 GRRVEL LENGTH (FT.) ~ 60. e ~ ~. O 84. e GRRVEL VOLUME (CU. YDS. ) ~ :8. 5 ~ =.~. 4 _8. 8 TRNK SIZE (6RLS) 0 :*'*: ~m i, 250. 0 OIL RR Nu ,.~M FT. /BR) ;0 i50 i50 ~ . e:m GR8 L. ~ENGTH FT. RUN_, (NOT EXCEEDING 75 FT. ERCH) e,~ TRN~U~T HRVE TWO ................... i CERTIF'~ T~T: i. I RM FR~IILIRR WITH THE FOR ON-SITE SEWERS RND WELLS 8S SET FORTH B~ THE MLINICIF~LI~' '~ OF '::MO~) RND THE STRTE OF RLRSKR. 8ND IN CO[~PLIRNCE WITH ~ [:' [GN uRITERIR OF THIS PERMIT. ]-. I WILL R[>H~RE TO RLL MOR tN~ STRTE OF RLRSK8 RE~UIREMENTS FOR THE ~ET BRCK DISTRNCESF~OM 8NY E>(tSTI I~ WELL, WRSTEW8TER DISPOS L SYSTEM OR PUBLIC SEWERRGE S'¢5~EM ON TH~S 0 f RNY RDJRCENT oR NERR~Y LOT. · 4. I UN~ERSTRNC* ~HRT THI=, PE ~MI IS VRLtB FOR 8 MRXIMUM OF 4 BEBROOM~ %/ THEN El::, 8N ELECTRICRL PERMIT 8NB INSPECTION MUST BE OBTRINED.~ (2) R~ BUILTS WILL NOT BE RPPRO',,,'ED WITHOUT RN ELECTRICRL INSPECTION REPORT~ RNO (5:) THE ELECTRICAL WOrK MUST BE BONE B'¢ R~ICENSEB ELECTRICIRN. RPPLICRNT: LRRR~ & JRCKIE SMIT8 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST 10 - WAS GROUND WATER 11 ENCOUNTERED? 13- 14- 15~ 16- 17- 18- 19- 20- IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE minutes/inch) TEST RU .BETWEEN . FTAND ~" ~-- 5' CERTIFIED BY: -- FT 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-S~TE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ' Applicant Name ~'~LNJ~- Applicant Address Lending Institution []~ []; Buyer []; Other [] (explain); Applicant is (check one): (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family~ Multi-Family [] Other Number of Bedrooms ~ WATER SUPPLY individual Well~ 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 we system, must have written/confir:,mation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 {11/84) 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/~)r 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 (..5 Cj% ~,._=v,.aCr-~-~.~ ~---]~"~ ,qE_ ~elephone ~-'-- ~/~ Address )~ ~~ '~ ,~~ ~ ~ Date ~/~ /~ -~'~,~ ~/i~/~- / Engineer's Seal DHEP APPROVAL Approv=c~::t for ~ b~drooms by Approved ~'~N. Disapproved ~ Terms of Conditional Approval · CAUTION' The Muncipality of Anchorage Department of Health and Environmental Protection (DHEPI 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 lendil~g institutions in order to satisfy certain federal and state requireme(tts. Employees of DHEF analyze data before a certificate is issued. The Municipality;of Anchorage is not responsible for errors I professional engineer's work. Page 2 of 2 - NIUNi~IPALITY OF ANCHORAGE HEAL~[I, A. WELL DATA We C assificabor~-~~4',fcrr~iE'; ':. ' :-~' If~A, B, C, D..E.C App{gved 'Wel Log PreS",t:(~/~)~ ~ ~-DateCompleted'- · ~- -'Stat c Water Level ,~O -T -T2 :, ..~ .... PumpSet&t · .' ..¢ - ":'*' ~' ;Z;;¢ "~',b* :.. CaCng Height Above Ground ~%~' ? ';--SanitarySeal on Casmg,~(N)¢ Electri~l Wiring in Conduit (Y/N), ~ ~. ~:;~ .Depress~onAround Wellhead TO Septic/Holding Tank on Lot : I O~:' ; ';;; O~Adjqining Lots To Nearest Edge of Absorption Field on Lot , ~--; On Adjoining Lots_ ~ ~o Nearest Public Sewer Line ~I ~ : To Near~st P~blic-~ew~ Cleanou~Manhole ~/~ To Near~t Sewer Sel~ice Line Water Sample Test Results % ~S ~~_ SEPTIC/HOLDING TANK DATA Date Installed 5'/~__~/~',~ Size f'~-"L'~ No. of Compartments Foundation Cleanout (Y/N) ~:~ -- - Standolpes (Y/N) 'T'~L% Air-tight Caps_(Y/N) ~ Depress,on over Tank (Y/N) _~ Y~ ~ ~*& ~ ) Date Last Pumped Pure ~,ng/Maintenance Contract on File (Y/N) ~ ~ ,; for - Holding 7~nk High-Water Alarm (YIN) ~/~ Temporaw Holding Tank Permit (WN) ~' Separation D~stances from Septic/Holding 'rank: To Water-Supply Well ~ TO Building Foundation To PropeAy Line ~ To Disposal Field __~ / To Water Main/Sewice Line ~ ~ ~ To Stream, Pond, Lake, or Ma~or Drainage co.,s _ ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ;~'-//';~ ~7//'~'..~-~- Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well I ~ / To Building Foundation ~-~ Lot ~ I ¢~ TO Water Main/Service Line .~,~'- Type of System Design Length of' Field Depth of Fie;Id --H ~'/~-'7 ~" Gravel Bed Thickness ¢ ~ ~ ' ~') Standpipes Present (Y/N) Date of Last Ac,quacy Test. To Property Line To Existing or ,~bandoned System on ; On Adjoining Lots To Cutbank (if present) _ I~') ~. TO Stream/Pond/Lake/or Major Drainage Course .-~ for To Driveway, Parking Area, or Vehicle Storage Area -~.~ ~ Comments LIFT STATION Date Installed ~ Dimensions N Size in Gallons /' ---- ~-- Manhole/Access ,Y/ ) j "Pump On" Level at /~ _ "Pump Off" Levei at / High Water Alarm Level ay_ ~ __Vent(Y/N) Tea.ed for / Ad uaey Electrical Codes (Y/~ _ ** Check Permitted Bedroom Rat ng Aga nst HAA Request *~ I certify that I have checked. ~. or conformed to all MOA and HAA 9 uidelines in effect o~ the date of this inspection. Signed ~ ~ ~ Date~ ~/~ ~~ Company 6.~'r~'f~,~&~_ E,~ MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 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 Name -~'-~¢ 'i~E~-I~,-~, Telephone: Home ~_~-'~ -- ~,c--,n~-~'Business Applicant Address _.~_'~/' ~--~~ ~i t~-'~.~..~ ~) ~ I/~n~r~c~4..~ ~.z~-- , /~ , . (c) Applicant is (check one): Lending Institution []; Own Buyer []; Other [] (explain); (d) Lending Institution -~..,z-,~/s'/'t-,/~ Address (e) Real Estate Company and Agent Address Telephone Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Other Number of Bedrooms ~' _ WATER SUPPLY Individual WellcJ~ Community [] Public [] Note: If corn m4''unity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsit~ Public [] Community [] Holding Tank [] Not~:/If community well system, must have written confirmation from the State Department of Environmental Conservabon attesting to the legality and status. Page I of 2 ;~ o~5 II~ 84! 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 disposat system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm '?~phl~c, cA~cz- (~4Erl~- C~:~r-4_~'F¢_ Telephone Address J] ~ C~(~ ¢~ ,' ~-~ ~' 6. DHEP APPROVAL , .: (' · . , ': .... Approved for ,~4'z 44 bedrooms by Approved Disapproved Conditional Terms of Conditional Apprc~r~ ~-/'~}:~5 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~% I MUNICIPALITY OF ANCHORAGe' DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR 2 1985 WELL DATA Well Classification ~:::;~.~t~¢11'~ If A. B, C, E~.E.C. Approved (Y/N) Well Log Present (Y/N)"-~ ~'"~ Date Completed '~'/~ ~/~:~'¢, - Yield Total Depth ~) ~* Cased to ~::~O f Depth of Grouting Static Water Level f,~O / Pump Set At '~"~ / Casing Height Above Ground ~/''-' '~' fl Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y~'~ ~ Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot I (~'~.- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot \ ¥~,¢" , On Adjoining Lots To Nearest Public Sewer Line ~ / ~ To Nearest Public Sewer Cleanout/Manhole ~,/~r To Nearest Sewer Service Line on Lbt water Sample Collected by ~w-~ ~"~ Ort~'l~- ;Date Water Sample Test Results Commems ~ ~p~,¢, o1= -. B. SEPTIC/HOLDING TANK DATA Date Installed --~---------------~'/ZT/~- Size Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) ~ ~'1~--"~'~" ( ~- ¢' ~ Date Last Pu~ed Pumping/Maintenance Contract on File (Y/N) ?~ ./?~'. ;for Holding Tank High-Water Alarm (Y/N) ~/.¢~, Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To WaterLSupply Well ~ 0 Z,./ To Property Line To Water Main/Service Line ~ ~' '~- Course Comments '~ No. of Compartments Foundation Cleanout (Y/N) To Building Foundation '"'/ ~'/"r~ To'Disposal Field ~ To Stream, Pond, Lake, or Major Drainage 72-026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed -~-/g 7/~-~,~- Width of Field ~'~' Square Feet of Absorption Area ~-~ Depression over Field (Y/N) Results of Last Adequacy Test __~ Separation Distance from Absorption Field: / To Water-Supply Well i To Building Foundation Lot ~ I ~ To Water Main/Service Line ~....~ '"t-- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field (~z~ / Depth of Field /'J / q 'f ~' ¢' ) Gravel Bed Thickness "7 z' (¢.~¢ ,,) Standpipes Present (Y/N) Date of Last Adequacy Test ~' [45r (~[..=:I~) To Property Line .,~ / To Existing or Abandoned System on ; On Adjoining Lots ~)~'"~ To Cutbank (if present) t..3 ./¢~ Comments LIFT STATION Date Installed Size in Gall, ohs "Pump On' Level at High Water Alarm Level ~V Tested for Electrical Codes (Y/7 Comments Dimensions Manhole/Access (Y/N) / "Pump Off" Level at _ Vent (Y/N) Pumping Cyc~,/iuring Adequacy Test. Meets MOA / ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, ~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~ ~-~".~/L Date Company 6...~%1'~.~. ~ MOA No. Receipt No. Date of Payment ~ - '~'~ ""~/~ ~ Amount: $ L~¢~/~' Seal Page 2 of 2