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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 '~JO/~ S3SSu!6us leUO!SSSJoJd sql u! SUO!SS!LUO JO $,loJJ8 JOJ. slq!suodseJ leu s! S6eJOLIOU¥ )O 41!led!o!unv~ @qJ. 'psnss! s! SleO!J!HO9 e sJoJsq elsp SZ~lSUe do suo!loedsu! lonpuoo leu op SHHQ jo see~oldLuq 'slusuueJ?bsJ elelS pue leJepej u!eHeo ,~ts!les el Jep~o u! suop, nl!lsu! 5u!pusl 4sq~ pue seuJoq jo s~sseq3md el ~seHnoo e se s!ql ssop SH HQ sqJ_ 'e~sel¥ jo slel$ eql u! psJelS!SsJ ~seu!Sue leUO!SsejoJd luspusdepu! ue/~q s^oqe ~ qde~ee~ed u! ue^!6 suohlelUSseJdeJ eq~ uodn ~lUO peseq seleo!j!~Jeo le^mddv ,~lpoq~nv qlleeH s@nss! ($HHQ) seo!^Js$ UeLUnH pue qlleSH jo ~ueuJHedsQ eSeJoqouv to ~l!led!o!unl~ sql NOI.LnVO leAOJdd¥ leUO!l!puoo jo SLUJOl leUO!]!puoo peAoJddes!o j/ pe^oJddv uo losBo u! suo!lelnBeJ pue 'seoueu!pJo 'sopoo sielS pue led!o!unlAl lie ql!~ s,oUe!ldbuoo u! s! LUOlS,~S lesods!p JOle~SlSe~ ~o/pue ~lddns ~ele~ slfs-uo eql 'uo!losdsu! pue uoflee!lss^u! ALU uJoJJ pue Sel!l s§eJoqou¥ jo ,~l!ied!s!unv'~ sql uJoJj peu!elqo uo!leLuJoJu! sql uo peseq elenbepe pue leuo!~ount 's~es s! uJels,~s lesodsfp Jslet~else~ Jo/pue ~lddns Js~e~ slis-uo @q~ leql st~oqs le^mdd¥ ,q!Joqlnv q]leShl s!q~ jo uo!le6jlss^u! ~uJ NOIJ.Vl/~BOJNI (3NV VJ. VO 'HOIdV3$ 3'11d 'SJ. S3.L '$NOI.LOidSNI DNIC]IAOI:id I/¥1dlg DNIEI33NION:! .cxV~.\-¢ ~.%xi\Cg%~UNICIPALITY OF ANCHORAGE (MOA) ~'~ ~ ~, HEALTH AUTHORITY APPROVAL (HAA) -~0~ ~n~ CHECKLIST - FEBRUARY 1984 ~C~X~ ~ Legal Description: Lo~ ~ WELL DATA Ro lt,;,,~' H,tls Well Classification Well Log Present (Y/N) Total Depth 8?' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 1 O$' 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.