The URL can be used to link to this page

Home My WebLink AboutHOMESTEAD HILLS #1 BLK 3 LT 10~ ~ I LIO E 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 PHONE [~NEW [] UPGRADE NAME MAILING ADDRESS LEGAL DESCRIPTION ~ ) LOCATION ' I NO. OF BEDROOMs ~eH PE~T NO. ~STA~C~ TO, //b ~+ ~ ~ 7 ~anufactu~er No. o~ compartments L~q, capac~W ~n gallons ~F HO~E~A~E: ~ns~de ~ength t ~dth ~ L~qu~d depth D~GTAN~E TO: ~eH D~e~h~g ~ PE~T NO~ ~anu~acturer ~amfia~ ~ L~qu~d cap.tv m gallons / O / Distance bet~lines No. of lines~ Length~of each~l~e Total length~w% ~°f lines Trench width l Top of tile to finish ~ Material beneath tile / Total effecti ~ i~s Length Depth NO. Type of crib ~ Crib diameter Crib depth Totel effective absorption area Well Building foundation ~earest lot line DISTANCE TO: DISTANCE TO: Building foundation Sewer line ~ Septic tank ~ Absorption area(s) OTHER PIPE MATERIALS REMARKS APPROVED - ' DATE LEGAL ,-',N--IS, ~l TE SEI...IEP.. .~:: I-JELL PEP-.I'-I T T PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: SHARON DALE 4}08 GARFIELD ANCHORAGE, AK LEGAL [:'ESCRIP: LOT _I~E. MAX BEDROOMS: SUBDIVISION: HOMESTEAD HILLS SECTION: 22 TOWNSHIP: i2N 41000 (SQ. FT. OR ACRES) 4 LOT: ~O RANGE: ~W BLubk.. ~ LISTED BELOW ARE THE UFTIUN--. AVAILABLE TO YOLI IN DESIGNING YOUR ~,EFTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS YOLIR SITE. TR.F.~ICi~I DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 GRAVEL DEPTH (FT.) G.O 0. 5 TOTAL DEPTH (FT.) 10.0 4.5 GRAVEL WIDTH (FT.) 2.5 25.0 GRAVEL LENGTH (FT.) G5. 0 47.0 GRAVEL VOLUME (CU. YDS. ) ~.1 4~.5 TANK SIZE (GALS) 1,250.0 ** 1,250.0 SOIL RATING <SQ. FT./BR) i~4 4.0 7.5 5.0 84. 0 i.. 250. 0 .~-~ GRAVEL LENGTH } 75 FT. REQUIRES MULTIPLE RUN.~ (NOT EXCEE[.,IN~ 75 FT. EACH) TANK MUST HAVE 8T LEAST TWO COMPARTMENTS ~ I CERTIFY THAT: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT~ ~. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM 8NY E~ISTING WELL~ WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. I UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 4 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF R LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES.. THEN (i) AN ELECTRICAL PERMIT 8ND INSPECTION MUST BE OBTAINED~ (2) 8S-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRIL:AL INSPECTION REPORT.~ AND~,~.~'~' THE ELECTRICAL 'WORK MUST BE DONE BY ~ LICENSED ELECTRICIAN, RPPLICRNT: - HAR0~DRLE ISSUED ~ ~ 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 PERFORMED FOR: LEGAL DESCRIPTION: J-- o'/- Io -- ~ PT3 4 6 8 9 10 11 12 13 14 15 16 17 18- 19- 20- COMMENTS PERFORMED BY: ,~O~zf'~ (q~(l.r- SLOPE DATE PERFORMED: ~-~. SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ ~ (minutes/inch) TEST RUN BETWEEN '~ FT AND .~, ,5' FT (~ERTIFI ED BY: WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of SeOlOgiCDI 8~ Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either ia, lb or lc.) A.D.L. No. la.lISorough ~}Subdivisi°n'~' / Lot Block Ib.ll '/4qtre. Section No. TownehiPNj'--] Range EF--~ Meridian / U ~ --of--at__of-- sE] w~ lc. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5. OWNER OF WELL: 2. WELL LO~ Feet Bel~ 4. W~LL DEPTH: (fln~l~ ~, ~ATE OF COMP~TION Surface ~:: : ~ -- ~:"~ die.. ~ in. tO,,:~~ ~'7+~2~f. Depfh /~, ?~< ~ ~ ~ Weight /":::;' Ibs./ft. ~:~,~ ..~ /:~ diem. in. fo ff. Depth Sfickup ft. ~t~: ' "?'~' -~ x'~~ ~-~..') ~. ~.,s. o~ W~L~: ,.;~ ....... ~.~,~ ,~¥, ~ ~'~' ~ ,~., ~ ...... v~ ~ SI0t/M~h Size: Length: ~:~,~ .~ ~>~.~ ~?~, ~" ~'~ ~:~ / Set between ft. and ft. ' ~x~ '~" Backfilling Gravel pack ,.... ,,..; . .............. ' ~,,~ I0. STATIC WATER LEVEL: · ~IkII~IDAII~ ~F ~N~O~ __ff. offer ~hrs. pumping g,p,m. ENVI~ONMLP i~L r~ ,~,~ Meteri.l: ~ Neet Cement ~ Other: D C '~ I~!~ ~ ~ ,ub.: ~ de, ~ Centrifical ~ Other 14. REMARKS: 15. W~fer Temperu~ure ~o ~ F ~ C [~E2?istered Business Nero.:h , Contract Licen,e : ~ AuthoriZed ~:presentotive . ~- MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE , 1. General Information Application Date (a) Legal Descriptio~ (includ.e. lot, bl~ck, subdivision, section, tcwmship, range) ./-~7~ /o 5~.5 /~,~/~.'7~ /~?~4 .... -~,~ £~,,0 Location (address or directio~s) (c) Applic~ is (check on~) Lending Institution ~; ~er/b~lder~; Buyer ~; Other ~ (~plain); ~us ines s 5-LZ ' 3~Zf/ Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the NAA to the following address: age Type of Residence Single-Fam~ly~ Number of Bedrooms Multi-Family Other (describe) Water Supply Individual Well~ Community Public~ Note: If commumity well system, must have written ¢onfimation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal Note: If community well system, must have wri%',~ coufirmation from the State Depar~men~ of Environmental Conserv~a~?.~l~f~t?.~'iog to ~he legality and status. i of 2] ~ 5. ~n$ineering Firm Providing Inspections~ Tasts~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, verify that my investigation of this Health Authority Approval shows that the water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and ~ype of structure indicated herein°- I further verify based On the information obtained from the Municipality of Anchorage files amd from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Munioipal and State codas, ordinances, and regula- tions in effect on the date of this inspection. Date Telephone (ENGINEER SEAL) Approved for ~ bedrooms Approved i Disapproved ..~ ~ Tarns of Conditional Approval >nditional CAUTION THE bPJNICIPALITY OF ANCHORAGE DEPARTMENT OF ~rEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGIMEER 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 A_ND STATE REQULRE- MENTS. ~MPLOYEES OF DHEP DO NOT CO~IDUCT 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. RR4/aJ/DI8 [Page 2 of 2] (DtlEP.. SEAL ) 7-19-84 WELL E~TA Well Classification OF ( OA) - 198 Legal Description: If A, B, c~ C, D.E.C. Approved(Y/N) Well Log Present Total Depth F~ 7 ' Cased to Static Water Level Casing Height Above Grcund Electrical Wiring in Conduit~N) Separation Distances f-rcm Wall: To Septic/Holding Tank on Lot ~7' Depth of G~outing ~/~ Pump Set At Sanita=y Seal on CasingS) Depression Around Wellhead / I10 .ff- ; On Adjoining Lots To Nearest Edge of Absczption Field on Lot //0 t~_ ; On Adjoining Lots To Nearest Public Sewer Line ~/~ To Nearest Public Sewer Cleanout/Manhole ~/~ To Nearest Sewer service Line on LOt W/~ Water Sample Collected By ~5 /~. &~//f~ ; Date Water Sample Test P~sults SEPTIC/HOLDING TANK DATA Date Installed ~-~/'~ Size /~5'd ~ No. of Cc~partmsnts Standpipes ~) Air-tight Caps ~) Foundation Cleanout Depression over Tank (Y~ Date Last P .ugt~ed W//~ Pumping/Maintenance Contract on File (Y/N)/J~ ;for Holding Tank High-Water Alarum (Y/N) ~/~ Temporary Holding Tank Per_~t (Y/N) ~/~ Separation Distances frcm Septic/Holding Tank: ! To Water-Supply Well /;0 ~ To Building Foundation ~ /3 / / TO Property Line /0 To Water Main/.Service Lir~ Course To Disposal Field ~ ~ / To Stream, Pond, Lake, or Major D~ainage Receipt $ Date Paid: ~ount: ~I [Page 1 of 2] .' 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption St=ara__ Date .Installed ~- ~/' ~ Width of Field ~-, 5' / Square Feet of Abso£-~tion A~ea Depression ove= Field (Y_~) Results of Last Adequacy Test Separation Distance from A~scrption Field: To Water-Supply Well //d / ~ Type of System Design Length of Field / Depth of Field Gravel Bed Thickness ~ Standpipes Present Date of Last Adequacy Test . To PrOpe=ty Line ~ /0 To Existing or' Abandoned System cn --p' TO Cutbank(if present) , ~,/~ TO Building Foundation -~7-/ Lot ~,/~ ; On Adjgining To Wate= Main/Se=vice Line ~,/~ To Stream/Pond/Lake/or Majo= D=aina~e Course ~,/~ To Dmiveway, Pa=king Area, Or Vehicle Storage Area D. LIFT STATION Date Installed Size in Gallons "Pu~p On" Level at High Water Alarm Level at Tested fo~ Electrical Codes(Y/N) Cc~ments Din~nsions , Manhole/Access (Y/N) , ~ ~ "~ff" Level at ~ s du~ing Adequacy Test. Meets MOA ** Check Permitted Bedrccm Rating AGainst HAA Request I certify that I have checked, verified, c= confc~n~ed to all MOA HAA Guidelines in effect on the date of this inspection. KB1/d5/s ,/Page 2 of 2]