HomeMy WebLinkAboutSKY RANCH ESTATES #2 BLK 2 LT 13E STA'I' S
Lo%
MUNICIPALITY OF ANCHORAGE
DE tTMEN'r OF HEALTH AND HUMAN SER -ZS
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION REPORT
Namo
Address
LEGAL DESCRIPTION
TANKS
SEPTIC ~ HOLDING
TYPE OF SYSTEM
~4TRENCH [] BED [] W. DRAIN [] OTHER
'~ ~ FT
SQ FT
_'5 9Z
FT
FT
c~) T~3o3q
Date Installed
WFLLS
[] PRIVATE 'L~ OTHER (Iderdifv)
Total Dcp[h Cased to
FT
Dale Iiistalied
DISTANCES
--~ SEPTIC ABSORPTION
- TANK FIELD WELL
WELL Z d_~o.--e ,~. oo '+
LOT LINE 2~q /~ Zoo '~
FOUNDATION ! 3 ,~,,;L. ~_oo d-
ET
REMARKS:
Scale: ~/~l
Crt '~ &Jc~fi~ Inspections Pedormed by:
Municipal and Stale §uilJulines in ellect 0n ,l~M~st,: -- ~ ~- ''Y' () -8 '~
/
72 013 (3/85)
ENGINEEfl'$ SEAl.
FRAMING -- -- []
INSULATION '__ __ []
SHEETROCK --~ []
STRUCT. FINAL ~ []
OTHER .... []
[~ NO NONCOMPLIANCE OBSERVED --
INSPECTION REPORT FA,, ~.--'r~ C,~E
MUNIClF'ALIT¥ OF ANCHORAGE, BUILDING SAFETY DIVISION
INSPECTIONS {907) 563-346,~ 401 W. INTERNATIONAL RD.
ADMINtSTRATJON (907) 786-57~
FOUNDATION -~ ~ ELEC. SERVICe' --- ~
~L~G ~OUaH ~ ~
BOND BEAM . ~ ~ ELEC. ROUGH ~ ~ GAS TEMP.. ~ ~
ELEC. FINAL ~ GAS ~
OTHER ~ MECHANICAL _. ~
MECH. FINAL ~ ~
FIRE FINAL ~ ~ PLBG. FINAL ~ ~
ZONING ~ ~ OTHER . __ ~
COMMEN'
CORRECTIONS ESSENTIAL AS
EXPLAINED BELOW
~PECTED
DATE
WHEN CORRECTIONS ARE MADE, PLEASE CALL FOR INSPECTION
, ~-oo~l.~ 2,~51 DO NOT REMOVE TI'IlS NOTICE
~ FFL.] _.t*;'.,I I JIH HOI-ILHFIN
L..OCFIT :[ ON
I...EGFIL I..EF[ ::L:~: E,,Lt .... _-.,[-,.~RHi'~I_.H E_,T.
X.:,4-5 - 2"?'~*;q.
LOT .:,],,:.E 9'99';79:~ S6!UFIF:E F'E.ET
'TYPE OF ::5,0IL. IIE_,uF..I II_hi ;:T::,IE. II :I:S: E:';~;~:FIIF,tF'IE[..[::'
I' 4 U i I E., E R (J F - B E E:' R 1511:)H :5 :, U I L F h 1
i'IFIX ~ HUi'I ': :' ':" ' ........ "' ;' '~ -
THE RE6:¢JZRED sZZE OF THE :,uZL HE,...uRFFZ,.i,I ..... TEll
THE LENGTH Dii'IENS;]:ON IS ]'PIE LENGTH (Ii",] FEET:) OF THE TRENCH OR E:,RFI :[ NF :I: ELD.
THE [.'EP]"H OF R TI:;.:IENCH OR PIT IE, THE [:,I:STlaNCE. BET!.,.IEEN THE SURFFICE OF THE
GI;.:OUN£:' FIi",I[:' THE BOTTOH OF' THE E?-':CFI',,,'Rq'ION ,::IN FEET::'.
THE GRR"/EL. E:,EPTH Z'..:; THE I'I:[N:iI¢IUI't DEPTH OF' GF..'FI',/EL E:ETI.4EEN THE OUTFR[...L PIPE
RI",ID THE BOTTOI'I OF TFiE E',:':',CFIVRT T (:iN ':: Z ['4 FEET ::'.
PErrd',l :(. T f IF F L :[ L,I- Ii',1 F Piti2; THE RE2;F'F$,I:5,~ E: Z L :[ T"r' TO Z I' IF URI' I TH Z .:,'- E:'EPFIF::Tt'IENT [:'UR ~ I',lEi THE
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±E~.9 FEET FOR FI PF..'I',/FITE NELL OF: :LSE~ TO 2E, E~ FEET FRF$1 FI PUBL.:[C NELl_ DEF'EN[:':[NG
UF'ON THE T'¢PE OF PUBL. IC
t'I:[N:[I'ILIH E.'i2';TRNCE FROH FI PF..']:',,,'RTE 1.4ELL TO
TO R COI'II'ILINIT"r' SEI.qER LIi",IE ]::F., 7'5 FEET.
OTHER R[.{6!UIREHENT2; I-IR're' FIPF'L."r'. 5PECZF:[C:FITION::'5 RNE:' C:ONL=;]"RUCTZON D'rRGRRH:5 FiRE
FIVR]:L.RBLE "1'O INSLIF,'E F'ROF'ER INSTFILL. RTION.
I
:£:
FORTH E?¢ THE HUN:[CIPRI...ZT"," OF RNCHORRF. iE.
;.:: .[ !4ILL IN:--.,TRLL TIr-lE E?¢STEH :[N RCCOF:'.[:,Fti'.,IOE I-,.I.T. Tt-I THE
Z: I LiNL':,EF.:':i;TI:d",IE;' THRT THE ON-'.:.;ITE SE!.4EF: S"r'5TEH HR"r' F.'.ELqUII:,:E ENL. RI:~:GEHENT
F:'.E2:";I[.,ENCE IS REHODELEE:' 'f'O INCL. UE:,E HORE THRN 5 BEBF.:O011:5,.
..E~TII- r THFIT
. ~l ....... E]
I RH FFIHILIRI~: NITH THE RE6!IJIREHENTE', F'F' L~I-._,I FE ._,EP.IE~ .... RNE:, HELL_,
;: .[ aNE[ ..........
IF THE
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 284-4720
SOILS LOG - PERCOLATION ]'EST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL D E SC R I PTIO N :.~ {::~"~
15
16
17
18
19
2O
COMMENTS
8,5
SLOPE SITE PLAN
15o ~F~S~m WAS GROUND WATER I'60
ENCOONTERED? _
IF YES, AT WHAT
~,~LT' -' ~..~4~:3 DEPTH?
Reading Date Gross Net Depth to Net
Time Time Water Drop
.~i~:.'
~.,,.
~ ~ '' ........ ''_~ ~LATION RATE JmJnutes/inchJ
~, ? , ~ 'rEST RUN BE~EEN FT AND ---- FT
PERFO""EO S", O'"'
CERTIFIED BY:
DATE: 7~ J,//~'~
72.008 (6/79)
QGRL
ANCHORAGE AREA BO[ 'SH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPI:CTION REPORT ON-SITE SEWAGE DISPOSAl. SYSTEM
NAME
LOCATION_
MAILING ADDRESS ~')/~ ~'~)O,,~ ~,2~/ PHONE
LEGAL DESCRIPTION /J2T I~ ~} 2~ ~,1~ ~--~F~7('I ~1~ ,2
SEPTIC TANK:
DISTANCE ~ /~
FROM WELL ' -~,~-I~- MANUFACTURER ,(~
MATE R IAL'~J- -~l~"(ld @/
NUMBER OF
COMPARTMENTS
INSIDE LENGTH _ INSIDE WIDTN ~
LIQUID DEPTH
LIQUID CAPACITY /000
_GALLONS.
SF-EPAGE PIT:
NUMBER OF PITS / DIAMETER '~' OR WIDTH ,/~t , LENGTH'3~, DEPTH /~ /
LINING MATERIAL ~ CRIB SIZE: DIAMETER'S_DEPTH ~7 DISTANCE FROM:
BUILDING FOUNDATION ~'~lt., NEAREST LOT LINE ~,~0
TOTAL
EFFECTIVE
ABSORPTION AREA (WALL AREA) '~',~, .SQ. FT.
ADDITIONAL ABSORPTION
TYPE. ~)/44 ,¢~L,/~7~ CONSTRUCTION
I
BUILDING NEAREST
FOUNDATION LOT LINE
CESSPOOL OTHER SOURCES
APPROVED / DISAPPROVED
DEPTH DISTANCE FROM:
NEAREST SEPTIC SEEPAGE
SEWER LINE TANK SYSTEM
REMARKS
DISTANCES:
INSTALLED BY:
PIPE MATERIAL:
LOT SL,OPE:
REMARKS: ",~)~ ¢Q2.5"-2,$'1~
DIAGRAM OF SYSTEM
DATE ~//.-~ ~'~/'
APPROVEO ~ O, ~,~:,~{;W,~F-
G.A.A.B.
Form No, EQ-031
GREATER ANCHORAGE: AREA BOROUGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
SFWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
PERMIT NO,
NAME OF APPLICANT ~
MAILING ADDRESS
F[NANCED THROUOH TO BE INSTALLED BY -
PHONE
OTHER
NOTE~ THIS PERMIT IS NOT VALID WITHOUT SOIL TE~'
FOUNDATION TO SEPTIC TANK --
FOUNDATION TO SEEPAGE PIT __--~/-~
SEPTIC TANK TO SEEPAGE PiT WALl- /~' /
/O' ,SEEP^ EP'T. /g) '
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
GRAVEL BAGt(FI LL,
CONFORM 'ro BOROUGH REGULATIONS REGARDING INSTALLATION,
, CERTIFY THAT I AM FAMILIAR wrrNAPPLiCANT,sTHE REQUIREMENTSsiGNATuREOF
DESCRIBED SYSTEM 15 'N ACCORDANCE WITH SA'D CODE,
Performed
Leoal
This
"One ~s~ is word~ a d~ousam~ o~inim~s" ~ "' ' ~
For Glaoie~ Excavating Date Performed~ 6-15-7~,,,. .....
Oescrintion: Lot~Block~__Subdivision g~=anoA 8~b
Form Renorts Soils Loq. ~o8 Percolation Test
Oeoth
Feet
Soil Characteristics
~ Seepage Pit Entrance
Siity Sand SM 2~0
Total Depth of Pit -16 ft.
Ground Water [ncountered?~
Was
Yes, At what Depth?
~0
Readinq Date
Percolation Rate
Proposed
Den, th of Inlet
Cn~!~ENTS: 250 sc~ ft.
No bedroc~
Gross' Time
!i'inute
Installation: Seeoaoe
Net Time
Depth to H20
Net Oron
Pit yes Drain Field
Depth 'Fo Bottom Of Pit Or Trench
drainage area Fg~uired per bedroom
or water table ~ ft. below seepa~_~
Test Performed By. Zim ~ack Data Certifiednat:o:~_?~BY: Oonst. Test Lab
MUNICIPALITY OF ANCHORAGE
DEPARIMENI' OF HEAl. Itt AND ENVIRON MEN'I'AL PRO']ECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERIIFICAIE OF INSPECIION FOR ltEAL1H AU FHORllY APPROVAL
OF ON-Sll E SEWER AND WA FER FACILll Y
264-4120
Application Date '
i. (;ENE,qAL INFOliMAIION
(a) t_e{ al DescHptKm (include Icl block, subdivision, seclion, township, range)
__L..L%. l-
Location (add~oss of direc~iol~s)
_. .............. ?
(b) Applicam Name ..._:~o ~:~ ........ 'ielephone: Home :4.S- ~ ~Z Business ......
Applicant Address ~ ~ C ...........................
(c~ Applicant is (check one): Lendin~ Institulion ~ ~ OwneWbuilder~; Buyer ~; Other ~ (explain):
(d) Lendm~ h~sti~ution ....... ~/~ ................... Telephone
Address ...................
(e) ~eal Estale Company a~d A~ent ~'~:~ .....................
Address
] elephone .........................................
Mail the HAA Io the following address:
'I'YPE OF RESIDENCI5
Single-Family [~ Multi-Family []
Number el Bedrooms
Other
WATER StJPPLY
h~dividuat Well [] Colnmunity,.~ Public []
Mole: fl community well sys[om, must have written corfli~ ma/ion frmn the State Department of Environmental Conservation
atlesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite ~ Public [] Community I-I Holding Tank []
Note: II community well system, must bave wlitten confirmation from the State Department el Envilonmental Conservation
attesting to the legality and status.
Page 1 of 2 72 025 111'84}
;-HUiPI~ IU]IHG FIId~ I'flOVIDING INSPEC'I'IOt',IS, TES1 $, bILE ~EARCH, DATA AND INFORMATION
2,,~ co, U liod by n ~y seni al fixed hereto and as of the validaUon date sbown below, I verify lha[ my investigation of this HealUq
At~tt~o~ily ~g ,~ovai slx)ws that the on-site water suppiy and/or wastewater disposal system is safe, functional and adequate
[ol Hie mm~U?~ of b~d~(.,Ol~)S af~d type of stlucture indicated herein. I further verify that based on the information obtained
ho~u ~ho Municip;dity of Ancherage files and Irom my investigation and inspection, the on-site water supply and/or
u¢astt,waU}~ di:;j)osal systern is in compliance with all Municipal and State codes, ordinances, and regulatioes in effect on
,,uu,,::: 'V t,:( 0__ 3 ti
:' ; ~.i. ;n,~:: ~ii~ Hea~.~h-A,]lhority .¢l)proval~n~ion n~rely
,, ~;~; ~h,i the s'dL]¢~t waber ~,¢~j-!/produc~d 150 gal]~s per
i 'r ~ ~:',: d~,v and' that cert~J6d labora~d'ry tests/~how~d/x6o
d~,-~'P ,~ ~,~li,o~'m bacteria ~l~Xa sample o~hat water/No wa~ntee
~r/dertifica~J~n is expre~e~ or impli~Xconcern~g' the lodg term
~dequacy ~ safety of ~h~-'~ater supply~/
ON-SIIE SEWAGE DISPOSAL SYSTEM NOTE: [his Ilealth Authority Approval
inspection merel~ certifies Ulat the subject on-site sewage disposal
system accepted at least 150 gallons of water per bedroom per day
as de~mmfined by methods approved by the Municipality of Anchorage
Depr;r tmeet of Uealth aed Iluman Services. No warantee or
certification is expressed or implied concerning the long term
adeq~(mv of Bhe on-site sewage disposal system. Construction data
reported on buried system components is from f4OA files and was
not verified ducing this inspection.
~elephone 3 Y,;-~.- ~%7/J
Date
CAUTION
The Mencipality of Ancborage Department of Health and Environn~ental 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, ~he Municipality of Anchorage is not responsible lor errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL [I"IAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
2
Well Classification ~,,~,,,'¢'~1//~' '- /'~ If A [3, C. D.E.C. Approved (Y/N)
Well Log Present (Y/N) ~¢"*,~' Date Completed ~/~,'~ Yield
Total Depth .~/,~ /Cased ,o ~/~ Depth of Grouting
Static Water Level
Casing Height Above Ground
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 _
Cleanout/Manhole
Water Sample Collected by /~!/A~
Water Sample Test Results
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N) ~,~/,,~
~' ~' : On Adjoining Lots ~¢' · ~'
~z~¢ ' ''" : On Ac.oining Lots ,~O~) ' ~'
-a Nearest Public Sewer
To Nearest Sewer Service Line on Lot 2~,Z';," '"'
Date
Comments
B. SEPTIC/HOLDING 'rANK 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 ,Zl ~'
To Water Main/Service Line _.,~"¢¢
Course
Air-tight Caps (Y/N)
No of Compartments
Foundation Cleanout (Y/N) _ J/~:~'
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field ;~"
To Stream Pond. Lake. or Major Drainage
Commenls /~.S ~(.~; l'1L
k
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /¢~$
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 ¢,~2d~3
To Building Foundation ~- ¢
Lot /'~' '~'
TO Water Main/Service Line
,~.,,/~..~,~¢/¢/v/ Type of System Design
Length of Field &~-c--~ / /NCO"
Depth of Field
Gravel Bed Thickness ~ ¢
Standpipes Present (Y/N) Y~,~
Date of Last Adequacy Test
To Property Line /¢ · ~'
To Existing or Abandoned System on
; On Adjoining Lots /~¢~) * ~
To Cutbank (if present) ,4,/,/G¢
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons ~"¢'//
"Pump On" Level at
High Water Alarm Level
Tested for /~
Electrical Codes (Y/N)
Comments
Manhole/Access (Y/N) '/¢~
"Pump Off" Level at /~./z
Vent (Y/N) ,~,)/~
Pumping Cycles during Adequacy Test. Meets MOA
,J
** Check Permitted Bedroom Rating Against HAA Request
I certify that,. , e/poo , v~_formed to_~all MOA and HAA guidelines in effect on the date of this inspection,
Signed /~"~,. /4tCz~,,~P'C_/t-~-~-'~,- )Date ~ ~ 7 ~
Company ~ ~/~ A,F~ e ~7~OA NO.
Receipt NO. ~2 ~ ff 7~
Date of Payment ~--a ~ ~ ¢, :~?~
Amount: $ ~ ~,¢ O Seaf~ ".,.
Page 2 of 2
72-026 (11/84)
BILL SHEFFIELD, GOVERNOI~
DEPT. OF ~NVI]~ONMENTA~L CONSERV/~T]~ON
Telephone: (907)
Address:
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
274-~533
To Whom it May Concern:
L'/~'~.~
' ' '~ Water System is in compliance with the State Drinking
Water Regulations
Sincerely,
Michael P. Lewis
Environmental Engineer