HomeMy WebLinkAboutROLLING HILLS ESTATES BLK B LT 3
,'-~ MUNICIPALITY OF ANCHORAGE ~'~'-~
~ DE. RTMENT OF HEALTH AND HUMAN SER .,ES
" .~ Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name DISTANCES
/~ o)z L. ~ ~ [ ~ ~ T0 SEPTIC ABSORPTION
WELL
A~FROM ~ TANK FIELD
Phone(s) I Permit No No of Bedrooms NELL I ~ ~ J I ~
Township, Range, Section AS-BUILT DIAGRAM (Show location of well, sep~ic system, property IlnOs, loundatlon,
TANKS
~ SEPTIC ~ HOLDING
Manulacturer Capacity in gallons
Material No. of Compa~m~nts
TYPE OF SYSTEM ~s~tN~) ~e u~
~TRENCH ~ BED ~ W. DRAIN ~ OTHER
Total ab~orphon area Distance between lines ~ O~ 0 ~ ~
Number of lines Sod rating Pipe m~tedal ~ ~ ~
,nstaHer ~on bate'nsta"ed ~J ~¢ ~O X'
Classification (A.B.C) Total Depth FT Cased to J ~ J ~g. ~.
Installe~ Date Installed:
REMARKS:
ENGIN ER'S SEAL
J ~~-~ ~ ce~ily that this inspection was pedormed accor,ing to ai'
A · TNEODOi~E F. MOORE
Municipal and State guidelines in effect on this date: d (30/~ ~ '~'~'% CE- 3589
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:
2
3
4
7
8
DATE PERFORMED: ~' /.~'C:~ //8 7
Rothf.¢ I~ l&
5EOPE
SITE PLAN
10
11
12
13-
14-
15-
16-
17-
18
19
2O
THEODORE F. MOORE
CE - 3589
WAS GROUND WATER
ENCOUNTERED? Jk/ I~
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time (~l't),,) Water Drop ~..Z:'~)
COMMENTS ~'~ ¢~t. t~ ,~s~ ,ff'~o '~ by
t~
PERCOLATION RATE ] ~ (minutes/inch)
TEST RUN BETWEEN ~' ~' . FT AND 1~'~ FT
PERFORMED BY: ~'[~t/"']~.~ '"r'(c~,~ .~"~¢-o,';¢~ CERTIFIED BY: ~ ~ ~ DATE:
L.. E: G;::fi...,
2o0, oo EA%%
/80. oo
/o' 7TL~Oh4h'I.
Y
0
responsibility t9 de~mlne the
~. restfl~ong which ~ not appear
~ the recorded sul~Mdon plst. U~der
SURVEY CERTIFICATION: I.hereby ceEtJfy that I have surveyed the property shown and described hereon and that the
~ · :~ impr~vem~ntss~t~ate~there~nareWithinthepr~perty~inesa~dn~en~r~hmentsex[st~thertha~n~ted~
NOTE: It is the contractor's responsibility to check top of foundation in relation to finish grade and building setbacks in
~ I relation to lot lines and easements.
LEGAL DESCRIPTION: LEGEND:
ENGINEERS ~s ~/~ r o~., . ~/~.~.s~. ~.....:
0 ~/8 REBAR FOUN~
SURVEYORS ~o~ ~ ~9C~ ~ ~ EXISTING ELEVS.
DATUM ASSUMED GRID:
A,C,ORAOE. A,AS,A ~0~
PHONE (907)972-"2B~ DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~.j ~-~ - ~.~c:/~.
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date O'-~(,y' ~/ If~,~ 7
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Looation (address or direotions)
7 3 I~ Vtole~
(b) Property Owner
Mailing Address
(c) Lending Institution
Telephone: Home ~ ¥.~ ' ~'~/e"R Business
Telephone
Mailing Address
(d)
Real Estate Company and Agent
Address ~0 / ~. ~o
Telephone
(e)
Mail the HAA to the followin~ address: or; Check here [~, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single-Family []
Number of Bedrooms
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environ mental 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 I of 2 72-025 IRev 8/861 Front
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.cxV~.\-¢ ~.%xi\Cg%~UNICIPALITY OF ANCHORAGE (MOA)
~'~ ~ ~, HEALTH AUTHORITY APPROVAL (HAA)
-~0~ ~n~ CHECKLIST - FEBRUARY 1984
~C~X~ ~ Legal Description: Lo~ ~
WELL DATA
Ro lt,;,,~' H,tls
Well Classification
Well Log Present (Y/N)
Total Depth 8?'
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot 1 O$'
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line '
C eanout/Manhole
Water Sample Collected by 'T"~
I~r~"~ (-4 If A, B, C, D.E.C. Approved (Y/N) At, A-.
N D'atecompleted C(,~k ~c~ I~.--) Yield>"/,~'~,~ ~$d'//8/,E7
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
Y
; On Adjoining Lots
I t ~ ' ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
;Date _._~//~'/~' 7
Cased to ~ ~ ? '
WaterSampleTest Results 5~/~'~'~'¢/~',Y' -- 0 ~(t~r~ /roo~ ~ O. / ~/~ ..N,~/~ - N
Comments ~t( ~,o~ ~Ac~ ~ ~" ~e~ c~ ~ef ~f~ ~i~ /Ee' ~[o~
SEPTIC/HOLDING TANK DATA
Date Installed d~'/3 o//~ 7' Size
Standpipes (Y/N) F
Depression over Tank (Y/N) N
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
I Z3-O
Air-tight Caps (Y/N)
No. of Compartments
Y' Foundation Cleanout (Y/N)
Date Last Pumped
N.A. ; for
Temporary Holding Tank Permit (Y/N)
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course ~. too ~
los~
To Building Foundation ~0 '
To Disposal Field 3'"
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2
72~026 fRev 8/86~ Front
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~O,~' ~3 ~ / ,Gc~,-,~ Type of System Design
Datelnstalled I%~'-c~4&',~ 7-re~,c4- ~-t~, -cay Length of Field -'Ftc^c4 -
Width of Field ~(, k' Depth of Field
Square Feet of Absorption Area
Depression over Field (Y/N)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test 7///~'~
To Water-Supply Well /¢~.' cC*on,, /,'t c.¢, To Property Line
To Building Foundation "/¢ ~ To Existing or Abandoned System on
Lot _ N, ~. ; On Adjoining Lots ~ ~o,
To Water Main/Se~ice Line N, A, To Cutbank (if present) ~, ~
To Stream/Pond/Lake/or Major Drainage Course ~ ~ ~ o ~
To Driveway, Parking Area, or Vehicle Storage Area 3~ ' ~ ~ ~
Comments S~ ~~ i~ e~o ~l ~(~ /~/ o/ ~,'b.A~ /~.
LIFT STATION g ~
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 ~'",/L~ ~, ~ Date
Company ~'[o./-~-~/~ 7"~cb ~"u.c.r MOA No.
ReceiptNo. ~ ~O/ O~ /~
Date of Payment ~ ~ ~ ~ ~
Amount: $ /~ ~
Page 2 of 2
72-026 (Rev 8/86/ Back
Engineer's Seal
LABORATORIES OF A LASKA
CHEMICAL & GEOLOGICAL , INC.
/~..--,~.'o~,~Q~',.~,...~ FEDERAL TAX ID # 92-0040440
· APPLIC ' IT FILLS OUT UPPER HAL ONLY
PrOperty Owner ~.,,7~__~.)4~/,/ ,.~ ~/.~,~,~....,~... Phone
Mailing Addre~ ~ ~ ~_/~ ~ ~/~:~..~ Zip Code
Buyer
Address Zip Code
Phone
Lending Institution ~ ~ ~
Address ~/~ ~ ~ /.~ ~/~ ~ ~,/~ ZiP Code .~
Realty Co. & A~nt
Address Zip Code
Legal Description ~ ~ ~/ /~. ~/ ~~ ~
Street Locati~ .~.~ .~_~.~ .~
Type of Resi~nce
~ingle Family
~ Multiple Family No, of Bedroo~
~ Other
Water Supply
~ndividu~l A~ACH WELL LOG. A w¢l Icg is required for all wells drilled since June 1975.
~ Community For wells drilled prior to that date, give well depth (attach Icg if available).
~ Public Utility
Sewer Disposal
~ndividual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Da~ Date
Inspector Inspector inspector I n s peet °~/~'*' .~ ~L~
Field Notes:
MUNICIPALITY OF ANCHORAGE
DEPT. OF H:/,LTi{
ENViRONMENtAL pROTECtION
DEC g 0
.RECEIVED
(~) APPROVED BEDROOMS ~ *CONDITION, S OF APPROVAL
( ) DISAPPROVED ~"~ ~'~'""~" ' "
Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received
Well to Tank Septic Tank Size
CONSULTING ENGINEER
203 W. 15th AVE 'C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
Roy L. Gamble
7315 Violet Drive
Anchorage, Alaska 99502
~.N'./%P.Om ...... October 25,
SANITARY SEWER AND WATER ADEQUACY TEST
1983
LEGAL:
LOCATION:
OWNER:
RESIDENCE:
Lot 3, BlockB, Rolling Hills Estate
7315 Violet Drive
Roy L. Gamble
Single Family Three Bedrooms
WATER SYSTEM:On Site Well. Tested Satisfactory. Distances to
Septic System OK. Well Casing and Conduit OK.
SEWER SYSTEM From Municipal Records. NO RECORDS
Tank Espinoza 1000 gal.
Absorption System. Crib with trench added on.
Absorption Area Unknown
Soil Rating: Unknown
Installation Date 1965
DATE OF TEST:Oct. 4, 1983
TEST PROCEDURE:
System was inspected and pumped on Sept. 22,1983.
Liquid level in tank was 34 inches, liquid removed
approximately 800 gal. Total depth of tank 11'-8".
~.~}~, Liquid level in crib was 40 inches. Total depth 14 fee~.
~ O~ A~%%~. Water was added to the crib at a steady rate of 5 gal.
~. & - .'.~per min. At a liquid depth of 54 inches water was
~.' ~ ~.~F~eard backflowing into the tank. Approximately 200
~*~49~ ~%*'~al had been added when this happened.
~-.~.-.~'~%%??'.~,~= ~n Oct. 4th. water was again added to the system.
~]~Ez2~~ ~.¢~[ this time the tank was full. The liquid
level
%[~'~~.~mn~,~,~..,~__ the tank stayed at 34 inches while the level
~ ........ ~?_~' in the crib rose to 54 inches and stayed at that
'%~ONA~_~ level 600 ~al was added to the system in the course
of two hours. No signs of backup or distress were
observed.
TEST RESULTS THIS SYSTEM MEET THE MUNICIPAL REQUREMENTS.
;/Jo LF_.T OR.
LoT ~ '!~ ~ c~ ~
~o LL|ItG HILL.