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HomeMy WebLinkAboutKNIK HEIGHTS BLK F LT 12 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/OF{ WELL INSPECTION REPORT NAME .. UPGRADE LEGAL DESCRIPTION -- LOCATION NO, OF BEDROOMS ] Well . r:~ ...... I A~-sorption area Dwelling Man~ fac~ur~ ...... Liq. capacity in gallons ~ IF ROMEMADE ~ Inside length ~ Width PERMIT NO. No. of compartments Liqu. id d e p,..~t b Liquid capacity in gallons DISTANCE TO: No. of lines I Length of each line Top of tile.~to finish grade ~ _. Length Width Type of crib Crib diame~r~ ~ ~ ~ell DISTANCe: Class Depth Building foundation DISTANCE TO: Foundation/ ]Nearest lot line Total length of lines I Trencl~,widtb '~,~-~ L 7, Matel~i:t~L~neath tile , ! '-- Depth Crib depth inchs$ Building foundation Driller Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS PERMIT NO. Dista nc~n Ih, es Total effective absorp, tion area PERMIT NO. / Total effective absorption area Distance to lot line PERMIT NO. Septic tank ' Absorption area(s) DATE LEGAL F'E:i::?.H ]: "i' I',!0 :: '- ,. ~.. : "'' ,::::,f ' .... ~ ......... .ll~..) , .;'::Hii..~ .,,..:'ii.['.~::.:! · ,..~ ,, [ v' '.:.,"~!.:.: i'.'l:~i~:i.,:::::i.l::~.:i;~.J .~...? ~ ......... !", "~ '.'~ ":~,...' .~:':'u:ti '~ ~;::.~...:...: . mr, F "n.? :[ 0'['. ,, · . ~ ~ ~'~ '~' r'~..':'~.'[. ' ?~ '~ -:::~ ' ~ ;I ~. ' ........ z~ ): ...... ~,..,.' i ';::: ,..:: ...... , ..... /~ SOILS LOG I 1600 CANG£ RD. ANCttOR.,4G£ , At(. (907) 3~,¢,5 --?'O~ [] PERCOLATION TEST SOILS LOG - PERCOLA'rlON 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 IOo DATE PERFORMED: SLOPE ,~.~. / /~,~,¢~ E NCOU NTE R ED? SITE PLAN - IF YES, AT WHAT /j -- --- _ __ DEPTH? ~ _L_.i.. J Gross Net [ Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE__ TEST RUN BETWEEN ~ FT AND (minutes/inch) .... FT COMMENTS / ~ DATE: PERFORMED BY:' ('~[""~,'~ ~1¢~C1~C~..'~.__ CERTIFIED BY: -- - Date D=illed: Static Water Level_ Draw Down 7-22-85 73 feet feet WELL LOG_. Gallons Per Minute Total Feet Qf ~ksing ?yoe Material Drilled: 0 feet 95 feet to 95 Silty Sand to 100 Gravel w/water to to to to Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 MUNICIPALITY OF ANCHORAGE / DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4'/'44 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Z_ -7 /z.. /< Location (address or directions) (b) PropedyOwner ~L ~b~/ Telephone: Home 3~¢-3¢~ Business Mailing Address (c) Lending Institution Al Mailing Address (d) Real Estate Company and Agent Address ~ (e) Telephone Z-.-'~ 2- PS"~r-/ Mail the HAA to the followina address: or: Check here ,[~ hold for pick up. J List contact person and day phone number below. S & S ENGINEEI~II~G 17034 Eagle River Loop Road No. 204 ~a~lle I~iver, Alaska ~9577 TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER SUPPLY Individual Well E~'""Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite E~ 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 IRev 8/861 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 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 S & S ENGINEERING 17034 Eagle River Loop Road Address Date Telephone ¢?.? Approved for _~,,/..,,z',' ('..~'.) bedrooms by ,. 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 72-025 trey a/861 Back f~ /~.:C\4'-~'"i~;t~I'JlCIPAL ~'Y OF ANCHORAGE (MOA) ,m~q\C',/~',61' ~. ,, ,..~2.i u'~I/~I~TH AUTHOF TY APPROVAL (HAA) ~' ~,~J~"~ ..... CHECKLIST - FEBRUARY 1984 ?~: :;~ '~. ~, ,~;~ 264-4744 WELL DATA Well Classification Well Log Present ~N) Total Depth / Static Water Level Cased to Casing Height Above Ground Electrical Wiring in Conduit ~N) Separation Distances from Well: 7'o Septic/Holding Tank on Lot . To Nearest Edge of Absorption Field on Lot Legal Description: /._-,~'T' /Z-- ~z..,,~ .'~ 1</4 11< If A, B, C, D.E.C. Approved (Y/N) Date Completed r' c~,~ / Depth of Grouting Pump Set At C,,(. /(_. Sanitary Seal on CasingS/N) Depression Around Wellhead ; On Adjoining Lots ; On Adjoining Lots .,/_ To Nearest Public Sewer Line ._~ ,r,.,/,~.~ To Nearest Public Sewer Cleanout/Manhole I"'~/'ct 2L ~ /-/; To Nearest Sewer Service Line cfi Lot Water Sample Collected by ~ 5 ~/~1~ ;Date. //~'] ~' Water Sample Test Results ¢~, ~~ ~ ~/~5 ~ ~~/~ Comments ~LL_ ~/~./% ~¢~G/% ~--~--~ ~- ~/~ B. SEPTIC/HOLDING TANK DATA Date Installed ~"~ -/~ Standpipes (~N) Air-tight Caps Depression over Tank (Y/~}.~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /'~'/-.~ Separation Distances from Septic/Holding Tank: 'Fo Water-Supply Well //l¢ / To Property Line /0 To Water Main/Service Line Course Size / ~:~ No. of Compartments Foundation Cleanout Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) /'J//)' To Building Foundation /.,4 ! To Disposal Field / ~' / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72 026 IRev 8 861 Fronl ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~*"- / ~ Width of Field ~ ~ Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test _ ..~ Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot 'to Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ,~,¢-/ Depth of Field /°b/ Gravel Bed Thickness ~ Standpipes Present Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots , ~'r~//' To Cutbank (if present) /~'/,,4 ! Comments D. LIFT STATION 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 (luring Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MO/A arid HAA guidelines in effect on the date of this inspection. Si~,n~ S ENGINEERING u 17034 Eagle Ri~er I.~ Road No. ~ate_ Com~ ~er¢.!a~ 9~511 MOA Ne, / Date of Payment ~ ~/~ ~ Amount: $ ~ Page 2 of 2 72 026 (Rev R,86~ Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEAL-FH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~-{~),/ i. GENERAL INFORtViATION (a) Legal Description (include lot, block, subdivision, se,ction, township, range) Location (address or directions) (b) Applicant Name //t--,A-"tE:h-¢~,~ / ~'~ (_- Telephone: Home [~4-%"- ¢c¢ I~usiness Applicant Address ~ Oo ~bd~ . (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer E]; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE ? Smgle-Family~ Multi-Family [] Number of Bedrooms "~ Other WATER SUPPLY Individual Wel~) Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsl ~, -Eq~=I Public [] Community [] Holding Tank [] Note: I1 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 ENGINEERING FIRM PROVIDING INSPECTIONS, I'ESTS, FILE SEARCN, 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 Healtt~ 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 ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspec~t!on. · -~ ~-[~-- Telephone Date Approved fo,' ~-,L._~_, bedrooms b~,/_~¢ '%'/ Disapprov~'d Conditionalu Approved Terms of Conditional Approval Engineer's Seal rJ 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 DI-IEP 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 Descrip.tion: ~,* ~-"' ..... rm/~,LIJ-I & RECEIVED WELL DATA Well Classification _ ~ ,,r~.\ k/"~ If A, B, C, E~.E.C. Approved (Y/N) Well Log Present (Y/N) 3'¢m-¢"~ Date Completed -'~/~'~7//~.~:~-z~~ Yield Total Depth _ ~r ~ ~ -- Cased to ~ ~O/ Depth of Grouting Static Water Level _ ~,~ Casing Height Above Ground ~_~ ~ I Electrical Wiring in Conduit (Y/N) _ Separation Distances from Well: Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot. To Nearest Public Sewer Line Cleanout/Manhole ~ Water Sample Collected by "~!~T4~v~ Water Sample Test Results _ ~_'~ _/"¥~r~ Comments ; On Adjoining Lots ! ~"~'~:, / ; On Adjoining Lots I To Nearest Public Sewer ,, _ To Nearest Sewer Service Line on Lot ~.,5 ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~_~'/i t-~/~--:¢:'~' Size. i ~.~ CA..~-.-~ ('4~'¥~'No' of Compartments "~ Standpipes (Y/N) ~~ Air-tight Caps (Y/N) '~ Foundation Cleanout (Y/N) V~, Depression over Tank (Y/N) __ ~}'O Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ' ; for Holding Tank High-Water Alarm (Y/N) _~__/ Separation Distances from Septic/Holding Tank: To Water-Supply Well ~_~/~ / To Property Line _ ',~.)~_~ To Water Mai¢~rvi~e Temporary Holding Tank Permit (Y/N) To Building Foundation TO Disposal Field ~ ~ · To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption~trata/ Date Installed _ ..~//I~//._~,~_.~__.~ )/ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: TO Water-Supply Well / "(~ ~) ~'~'%~- Type of System Design Length of Field ~::> cz..)-- / Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Building Foundation ~,~' / To Existing or Abandoned System on Lot ~ ~//¥ '-"--~" ;On Adjoining Lots To Water Main~ce L~? '~_"~-- ,"~"-- To Cutbank (if present) _ I,~/~'--~ To Stream/Pond/Lake/or Major Drainage Course · / To Driveway, Parking Area, or Vehicle Storage Area _ (~-:~'~ Comments D. LIFT STATION ~? Date Installed / . ~/ Dimensions Size in Gallons / /Manhole/Access(Y/N) "Pump On" Level at.,7,/ ~ "Pump Off" Level at High Water Ala~evel at ~ Vent(Y/N) ~_ Tested for/ ~ Pumping ~uri~ Ad~u~y T~ M~ MOA Electri~od~ (Y/N) _/ ents ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have chec~eri~;~r conformed to all MOA and HAA guidelines in effect on the date of this inspection.