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HomeMy WebLinkAboutMCKINLEY HEIGHTS #2 BLK 2 LT 9 GR'~' TEA ANCHORAGE AREA BOROU~ q Db,~RTMENT OF ENVIRONMENTAL QUALI, 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL· SYSTEM ",i: ~ ' ' ~ ADDRESS P~ONE SEPTIC TANK: DISTANCE FROM WELL___ l(?'2'[ LIQUID CAPACITY ....... ~ LZ~)L~ ..... ' · · · (~fi (L'. COMPARTMENTS MATERIAL LIQUID INSIDE LENGTH_ INSIDE WIDTH DEPTH.__ SEEPAGE SYSTEM: NUMBER OF PITS_~ LINING MATERIAL SEEPAGE PIT: OUTSIDE DIAMETER i - ! ~- ORWID1H l~) ,LENGTH i~1 ................ DEPTH DISTANCE FROM WELL____ /(~ ,~t BUILDING FOUNDATION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) i.~7 ~.- SQ. FT. TII_E DRAIN FIELD: DISTANCE FROM WELL_ ~'~_~-~'~--. ~ -- FOUNDATION . NEARES~~ NUMBER OF LINES ........ DISTANCE BETWEEN TRENCH WIDTH _ ABSORPTION AREA ...... _~ ~. FT. LENGTH OF EACH LINE ~.. '-~F TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL B. NEATH TIL ~.-~'"'~ TA L LENGTH OF LINES~ IN. TOTAL EFFECTIVE WELL: TYPE ~;&~L DEPTH '7(~r) ' DISTANCE FROM £~)! WATER ...... BUILDING FOUNDATION./~)~f-~i:'y' ') ~' _SAMPLE /,~---, SEWER LINE .,TANK,ilp',,x I¢~o' s~,,o~ I()Z' LOT LINE ~y t i NEAREST SEPTIC , , SYSTEM , CESSPOOL DISTANCES: DIAGRAM OF SYSTEM , NEAREST OTHER , SOURCES__ APPROVE~ ~. (,/ DATE G.A.A.B. 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 GENERAL INFORMATION (a) Application Date November 19, 1986 LegalDescription(includelot, block, subdivision, section, township, range) Lot 9, Block 2 McKinley ~ei~hts #2 T15N R1W Sec. 20 Location(addressordirections) Chugiak (b) Applicant Name Ron Owen Telephone: Home 688-1797 Business N/A Applicant Address P.O. Box 167 Chugiak~ Alaska 99567 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution _F--iJ2~q.3~. Nation~l__ Address P.O. Box 770548 (e) Real Estate Company and Agent N/A Address N~_A_ Telephone _ N/A~_ (f) __Telephone __694-2 Eagle River~ Alaska 99577 Mail the HAA to the following address: pic kup~by__engine er TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 3 Other 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. 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 (~1/84) 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 disposal systern is in compliance with aH Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address E.~-E- R I V E R- E N G INEJi~.gVi-CES Date EAGLE RIVER, AK 99577 ?.O. BOX 773294 694-5195 DHEP APPROVAL Approved for 3 Approved 2~ __ Disapproved __ Conditional Date /2-2-g~ 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 DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION 2 6 1986 RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MO~I HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: Well Classification Well Log Present (Y/N) Y Date Completed ?//'¢/'7 / Yield Total Depth /~;~-- Cased to 13 '~.,/,~ £~'~'~'ff: ' Depth of Grouting /-~"~ Static Water Level 3 I /;>¢r._/.~.~ ;'~'~) U~ .'~, Pump Set At /f:Y// Sanitary Seal on Casing (Y/N) ¢~' Depression Around Wellhead (Y/N) Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) _ /~//~Z To Septic/Holding Tank on Lot /[20 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ,./::,.,r~A Water Sample Test Results ; On Adjoining Lots /¢'~'S'" / ; On Adjoining Lots ;7~''~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot E-~3;,-~-'¢-e-, ,-,'~ ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed 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 ¢'~'¢¢ ~' To Property Line ¢'/¢~ / To Water Main/Service Line ¢/0" Course /' /'~'.~ ~ No. of Compartments / /V Foundation Cleanout (Y/N) _ Date Last Pumped Z;~- Y"/ /~'d. ; for ,,-~¢ 8 Temporary Holding Tank Permit (Y/N) To Building Foundation .7 '~ 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 Strata Date Installed ?~ ?'~- Width of Field /1'5-/ 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 /~ ;' Depth of Field ~, z/ / Gravel Bed Thickness ~ / Standpipes Present (Y/N) Date of Last Adequacy Test To Building Foundation Lot _ To Water Main/Service Line 't To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbank (if present) To Property Line ~'/¢::~ ¢* To Existing or Abandoned System on On Adjoining Lots ? ~''~' ~ /~y'~ 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 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. ~-¢~-~.~.~:L~-* Date Company z~/x ~-~ MOA No. ReceiptNo. _~ © / O ~-~ Date of Payment ///~ ~1~--~ - Amount: $ ~5 ~' Page 2 of 2 72 026 (11/84) Eagle River Engineering Services P. 0. Box 773294 Eagle River, AK 99577 694-5195 rVl-~J' DRILLING, Inc. P. O. Box 4-1728 · 2811 Dawson A C 907-279-1741 ANCHORAGE, ALASKA 99509 Well Owner DRILLING LOG Use of Well Dom Location (address of: Township, Range, Section, if known; or distance main road Size of casing Static water level Screen ( ); Describe screen or perforation Well pumping test at, ,~ gallons per of drawdown from static level. Date of completion 11~ ~:e~ 1 o7! Depth of Hole ft. (~bbVe) Perforated ( ~ feet Cased to ~ ' feet (below) land surface· Finish of well (check one) ). I~ on e open end ( x ); (minute) for 1 hours with ],09~ ft. WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness .TO ;' .TO (:J" TO .TO .TO. .TO .TO .TO .TO .TO TO .TO __.TO TO TO 03A!333 t NOIJ.O]lO;~d 1VIN~WNO}IIANI~ ~ ~ HIIVNH dO 'Id:lO 20VaOHDNV -I0 M. IqVdlDtNrlW 3 -- Contractor