HomeMy WebLinkAboutROBIN HILL #1 BLK 3 LT 2A
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
NAME APPLICANT: MC GEE INDUSTRIES
_?~ .m~ xx xxt~xz~.. _~_ ~.~
EGAL DESCRIPTION
LOCATION
_ JAbsorption area~
TO=
Manufacturor
Liq. capacit IF HOMEMADE: length
I Dwelling
Materia%l-~-,~.~,
Width
PHONE
NO. OF BEDROOMS.
PERM,T O Om
No. of comp~ment~
Liquid depth
DISTANCE TO:
Manufacturer
Well Dwelling
Well
D]STANCE TO: I ~J~/'.~'
NO. of linesI I L-ength of~ch~./e ,, - Total length of,]
I Material benead tile
TOPLengthOf tile to finish grad~width ~
Type of crib
DISTANCE TO:
Class
DISTANCE TO: Building foundatil
OTHER
RIALS
Building foundation
SOIL TEST RATING
INSTALLER
REMARKS
PERMIT NO.
Material Liquid capaci lions
Nearest lot l i.~ ~- ~10?~
Distance between lines
inches
Total effectiva absorption area
PERMIT NO.
Total effective absorption area
Nearest lot line
]nce to lot line PERMIT NO.
Septic tank Absorption area(s)
~UNICIPALI~ OF ANCHO~GE
~/ ~¢ ~44~ DEPT. OF HEALTH &
~ ~NVIKUNMbNIAL PROTECTION
APPROVED DATE
LEGAL
F'ERMiT NO.
AF'PL i CANT
LOCflT t ON
LEGAL
DEPFtRTMENT i_,,- HEFlLTH AN£:, ENVIRONMENTAL r-F:OTECTZON
8'25 '" L'" STREET, FlNC:HORRGE, ilK. g'95F4± IJro
264-472F~
MCGEE INDiJSTRIES
L2RE;3. ROBIN HILLS
:~.RR b,L,', 566 RN]:HORRGE 9'~..~R7 .~:'45-E~F~-<2
': .~' '9'9~.99~. S6!URRE FEET
LOT _, I,=E
T'¢F'E OF SOIL RBSOF.:PTION S'¢STEM IS [:,RFtlNF!EL[:,
i"IFIXIHLtM NLiMBER OF E:E[.',RO¢IHS = -'i-
SOIL F. tRTING ,::S6! FT,..'BR)= 2t2 f~ ~ ~ S~'7/_~
THE RE6!LIIF.:ED SiZE OF THE SOIL RBSORF'TION _-~:TEH IS:
TFIE LENGTH DIMENSION IS THE LENGTH (IN FEET.'.', OF THE TRENCH OR DRAINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE [:,ISTFINCE BETWEEN THE SURFFtCE OF THE
GROUND AND THE BOTTOM OF THE Ek-:CRVBTION ,::IN FEET::,.
THE GRR',,,'EL DEPTH IS THE MINIMUM DEPTH OF GRFIVEL BETNEEN ]"HE OUTFRLL PIPE
AN[:, THE BOTTOH OF THE E'XCRVRTiON ,::IN FEET::,.
- I-I "'" ~ ~ -
PEF.:HtT FIF'F'Li_-:FINT HI:IS THE F.:E'-,F'_N_-,IBILIT~ TO INFORM THIS DEPARTMENT DIIF.'.INF~ THE
It',tSTFILLRTION INSF'EF:TIONS OF AN'¢ WELLS ADJACENT TO THIS FF. LFEFT~ RNr:, THE
NUHBEF: OF RESZ£:,ENC:ES THAT THE WELL WILL SER',,,'E.
BACKFILLING OF
_-~_-.b~ t.4tTHOUT FINAL INSPECTION FIND HFFF._,HL THIS
E:,EF'RRTMENT WILL E',E SUBJECT TO PF.'FSE]~TION.
MINIMUM DISTANCE BETWEEN Fl NELL AND RN'¢ ON-'~;ITE SEWAGE DISPOSAL S'¢STEM IS
:t. 00 FEE'/' FOR A PRI',,,'RTE WELL OR '150 TO 200 FEET FROH Ft PUBLIC NELL DEPENDING
UPON THE T'¢PE OF PUBLIC WELL
MINIMUM DISTANCE FROM FI PRIVATE NELL TO Fl PRI',,,'FiTE SEWER LINE IS 25 FEET FIND
TO Fl COMMUNiT'¢ SEWER LINE ~.S 75 FEET.
NELL LOGS FIRE RE~]!UIRED FIN[:, MUST BE RETURNED TO THE DEPFlRTMENT I.,.IITHIN 2:0
OF THE klELL COMPLETION.
OTHER REL-]UIREh'IENTS MFi'¢ FiPPL'¢. SPECIFICFiTIONS FIND CONSTRUCTION [:,IFtGRFIMS FIRE
RVFIILABLE TO INSURE PROPER INSTALLFITION.
i CERTiF'~' THFIT
i: i FlM FAMILIFlR WITH THE REt;!UiREMENT$ FOR ON-SITE SEWERS AN[.', f.4ELLS AS SET
FORTH B'¢ THE MUNIE:IPRLiT'¢ OF FINCHORFIGE.
2: I WILL INSTALL THE S'¢STEM iN ACCORDANCE WITH THE CODES.
2: I UNDERSTAND TFIFIT THE ON-SITE SEWER S'¢STEM I¥1R'¢ RE6!UIRE ENLFlRGEMENT IF THE
RESIE:,ENCE IS REMODELE[:, TO INCLLI[:,E MORE THAN 4 EE[,F.'DDHS.
ll~lUbt NUItE:~'EF: OF BE[;,ROOH$ ~ 4 $O]L RA3'INB (SC..~
.)
~E~U]~:~P ~]~-l~ OF IH~ SO~L RE;SORPTION E.Y_~TEFi
iPTH= ~-; L E~i~T H~ ~l ~ Ri~ ~-'E L_ [:'EF'-I~ H=
{HE [~F'IH OF A ~F~NE.N OF~ F'I~ ]g THE [)]5~8N~:E D~1'HEEN THE SURFRC:E OF THE
~tE G~:RVEL DEPTH ]5 T~ I,IIN]I~LII,1 DEPTH ~ GRfiVEL DETNEEN ~NE OUTFflLL PIPE
i~L~TION ]N~,F'E[:~]ONS OF 8NY N~LLS ~DJ~CENT TO t'H~. PF~OF'ERTY
~::ILLJNG OF ANY S.V~.TEI'i NITHOUT FiN~L ]NS, PEC:TJC~ AND ApPrOVAL E;Y THIS
{COMI~LINJTY ~,ENE~ LI-N~ IS 75 FEET.
~ {~LL COl,iF'LET ~ ON, ;': :::
~E~LE TO ]NgUF~ P~OF'E~: ~N53RLLRTION,
~T ~FY THFtT
~I'I F~I,1]LIFt~ N]lH ~H~ F~UIREHENT5 FO~ C~¢~SITE 5EI,JE~5 fiND H~LLS
i BY lP~ HLIN]C]P~LIIY C~
I
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION
825 L. Street, Anchorage, A!aska 99501 264-4720
SOILS LOG-- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR: P¢~I
LEGAL DESCRIPTION:
2
3
4 h~%
5
6
7
8
9
10
11
12
13
.14
15
16
17
18
19
20
SLOPE
COMMENTS SO,' I £~¢~
DATE PERFORMED:
SITE PLAN
WAS GROUND WATER S
ENCOUNTERED? ¥'-~ L
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
i i i~ [o ' q 7-. , 3,0
~ -zo6 lo · 6o , I~
PERCOLATION RATE /'~ (minutes/inch}
TEST RUN BETWEEN "~ FT AND ~ ~/'~. FT
).-o3 ~l'/ ~d,'-~ i,,-.4-~ee,, '/z ,,.,.,& /o
PERFORMED BY: ~_.o.~t~or') C)/lal ~'i ~:~VC,.~ ~
DATE:
p n Rn',z' q_zlnl~ · Ai,,,I~I-I(hI~A~I: Al A.QK'A · .q.q.RQ1
,~1',. ]i F~Oi",!i'li!::",i'i"fii,
~, .:. ~. ,,;~ ~,~.' 'r.-~F'~
hh::~,??.,;i;xh~-. DUE; ~i'0 i..r;h~?,:U"~':" '~ i",lt':~ ~;~:~h:H..!~[ ~;~::" :::h',"P:::_ 'FH~:~; F'~:~',FJOi...IT
.... ,: i: ~
~-~:~.,. ~" "i"HE
... h .: f;""l 'fS:; % '~: '"' '"' '~- ,r~.~ ..........
G:;Ld..!~"4~:, Hr',iL, i';~[: Ea::i'FEwi OF "~ ....... ' ......... , .........
......... ,
::iF<;;',?'M.. L.,L~ IH i:: 'FF~E HT?.I];HLii"! l':,:F"rl.i (iF: I~i~,::H',,,~;~ ........
Ti.i: E'.crTTEd,i i"F T~.::: E;:.:;(;;l::fv'¢:T;i;(;d'.i ,.; ):N F:':Z~:U.''
.......... ! LI ...... ~ ~ ¢_':' "...,;' FiH~./ ':"_, .... :':" '*"~ ~, .... ~.,.~' 'Z T'FiOU'T F :i;hh':iL. ...... T ,.~c: p :::' "'f;i; ;i'.; ~.:ff.4D ,,~'~" ,, .,.-,. ,r ,..:?./ 'i";..}.' 5;
..... F','r':lT:i~..h":;:: E',E"i"P.itZE:N i::i i.4EL. L I::'ff-,l[:, ,,,,~ ""':: ........
iff ¢i, ,, Fb,i.--.:':;.. ii.. :E;J:lP. II:i(}~I:;~
i'i.i.i;.~'..'. D;!;:5;T~::iHCi: F:i;;:(;d"i i:i F'ii::',,,~l;'ff'~ i4E!..f i'O i:i ' ::'-:' SiZ!4iEi:;?.
C:HI'i.H.'-:"¢ :;b;Hi:i:;: i.ZI.i?:' ;rS; ?%;
,.,~i.:'~ i i Ftf'i::; .¢"i'- .... i;;:[::;I];~i.i;i i:;U;E., i:q~'..hT) i,I1.1:5 i' Ed:5; i:;5::TU¢;i',iED TO THiE DE:PFIf~:TI"Ii:~ii",IT
; i: : '~: ........... i"iW¥' "~ '* -" :F:'~:: ;: [ -
· , ............ I,, :i ~ - I t:1 !,, ~ i::';( :!':I'(T ~'f"!':: l:'~i",!i::, .....
;:~V:l};;...i:iE',i..E: :':' J; -, ::;..,',;.E; i:':O.)i::'t~i:; ;ii",iS~;'!'Eli.LFfF)ON
..... . ,., .,...,...,.,...~ .,.. ...... Oi",!'"'~5 :[ TIE :,
':~ ~ .!; i",i:~i;~'iii..L "fi"F: ...... i'""'-
................ :;, .,, :'t ~i'~,i i:: ..... ;F':'Fff',It;:F. H:[TH THE
' ~" ;'" '~¢' ' ~' ' :',"~ _':, !E:. 'l i'!t';f'r' F:i:!;;0..f:i;
~....t .. t "Fi'it:iT i'Hi'E ~;:~"ir'--:?~' ] ii: :;~;EN[:iq: ":" ....... '." '
~;'f'..',..',.~ ::;' :(:5 i?h'Hl"ii>F'i I:t.~ T'-'...;i I'.,lr::l_.t..!i:;,i:~; I,tt:i¢;~:E Ti-IRi'.,i '~, E;:h.L,I'.: .... '~::,.
: , ..... : ............... : ....... /' ' ' · , -
n.?i':i.. TPi:-:i'." 'f'"" ':' /
'"'~ ,. , ....... ~ '. ~/'% O~"
;/
.7
Nc{lee Ind ust'~- ies
Slia ;.!ox 566
Ancho,rage, ~ ~].,k 99507
The enginee~-'s as-buJ, l. ts, which have been submitted t:o this
office, a!:e not within the pa1;ameteus of the on-site
tion permit issued by this department~ The ,Jisck'ep~ncit~s will
need to be corrected oefo~'e this Gepat~t~,~ent can accept the sub-
m-Ltted ent3ineet' as-bui..ts. %~ectonics, inc. t is not on the
appl2ov~d list o~l authorized engiueeuing fJ. rm~s for on-site
instaliatiotls.
if you ha~e any further questions please contact youu engi-
[~dwa ~'d Piack
P. O. ~3ox 4-2265
Anchora-je, AK 99509
Cory .;.Jil lis,
Acting
Prog ram Manager
~1 WATER WELL RECORD STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological ~ GeophysicolSurveys
Drilling Permit No.
LOCATION OF WELL (Pleole comptete either la, lb or lc.) A.D.L. No.
,o.llBorougn SuPdivili ~ Lot "'°¢~ ' .ll I/4qtr'' Section NO. TownlhiPN[:::] Range Er~ Mlridion
Anch. Robin Hill 2A 3 --of--of--of-- sE] wa
Ic.JJDISTANCE ANO DIRECTION FROM ROAD INTER~ECTIONS 3, OWNER OF WELL:
Address:MT, Tom McGee
2. WELL LOG Feet Balo~ 4. WELL DEPTH: (fi,al) 5. DATE OF COMPLETION
Brown Gravelly Till 111 12~ ~ T,,fW.II
9. FINISH OF WELL:
~ AbOVe or ~ Below land surface Date
Equipment usld:~T~ Valve ~a$1eT
i 3 ~ ft. after 4 hrs. bumping 4
12.GROUTING Well Orouted: ~ Yea ~ No
Moteri~l: ~Neof Cement ~ Other:
Length of Drop Pipe ~35 n. copocify ~ g.p.m.
.5 ~PM Flow restrictor install
d i~ house
15. W~fer Temperefure ~ ~ F ~ C
Dotten Drilling Co. AA0512
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
264-472O
Application Date -~,~/"~' /7.~ /?c~(-
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name ~o~
Applicant Address J ~ / F[o~ /
(c)
Telephone: Home 3 ~/,5"-/-~-¢--,~ Business 3
Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain);
(d) Lending Institution
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single-Family [] Multi-Family [] Other
Number of Bedrooms ~ :~-
Cc' ~ ','
3. WATER SUPPLY
Individual Well [] Community [] Public []
Note: If corn munity welt system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL ~
Onsite [] Public [] Community [] Holding Tan~ []
Note: If community well system, must have Written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
ENGINEERING FIRM PROVIDIN~ 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 system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm .F[¢z ["~,p 7'~ c h n ~ C Cxl' .~ ~ r'~, ~ c ~,- Telephone
Address / ~5-3 0 ~ ~ ~ c~r~ ~/~
Date _ ~¢~ I~
THEODORE F. MOORE
*'. CE- 3589 ,*'
Engineer's Seal
Approved for_ {¢~g)' ~/~'bedrooms by
Approved ~/'/-- Disapprove/' Conditional(~.
Terms of Conditional Approval
Date
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representation~ gi~,en in Paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does ~his 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
MUNIGIP^LII¥ Ur ^NL:HUI~(JI~
DEPT. OF HEALTH &
~"~ ih~tJRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
SEP 1 8'1986,
REC:ElVEI)
WELL DATA
Well Classification
Well Log Present (Y/N)
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N) Y
Separation Distances from Well:
To Septic/Holding Tank on Lot I1~'
~°'¢xr/e If A, B, C, D.E.C. Approved (Y/N)
Y' Date Completed '3/81 / ~t./ Yield
· Cased to 15-~' Depth of Grouting
{~J~' Pump Set At -;~ i,-/7'
Sanitary Seal on Casing (Y/N)
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by 'T'~'~
Water Sample Test Results
Comments
Depression Around Wellhead (Y/N)
ti
; On Adjoining Lots ';~ fca ' ·
I-t'¢' ' ; On Adjoining Lots > fcc'
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot /~,,6.
;Date
B. SEPTIC/HOLDING TANK DATA
Date Installed ~/' I?(~B
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
To Water Main/Service Line
Course ;~ fca '
Size 1 ~..¢0 ~,~t No. of Compartments
Air-tight Caps (Y/N) Y' Foundation Cleanout (Y/N)
Date Last Pumped ~/17
H,A. ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field 17 ·
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C, ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ,~/,'g /
Width of Field 8 ¥"
Square Feet of Absorption Area ~'
Depression over Field (Y/N) N
Results of Last Adequacy Test ,A ¢t¢c/~cr~
Separation Distance from Absorption Field:
/'~3c4~-m Type of System Design
Length of Field
Depth of Field 1 2.5' '
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
Y
To Water-Supply Well
To Building Foundation
Lot N. ,~.
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
To Property Line t¢~
To Existing or Abandoned System on
; On Adjoining Lots ~. ~o ~
To Cutbank (if present) N.A.
D. LIFT STATION N,A,
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.
Date
MOA No.
Signed ¢'~"~ ~.
Company ~/~ ~'/~/~
Receipt No....~
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
Engineer's Seal
'~'"',IVO I C E
"~ ~ ~ CLEANING SERVIC[-
P.O, BOX 112688 PHONE 345-2513 ANCHORAGE, ALASKA 995: ~ 25
Job Add~ess
ROTOR ROOTER SERVICE CALL I-fRS
STEAM THAWING FIRS
T_RIP C H A~R ~._E-
OVERTIME CHARGE HRS.
ADDITIONAL LABOR CHARGE HRS.
PUMP NG SERV CE .. ~(~.AL)
HYDRO-JET SERVICE HRS
PLEASE PAY FRf. M.IHIS INV..Ct_ICE
TOTALFOOIAGE CIEANEDORTHAWED . BLADESUSED
[] JOB NC) GUARAN1EEDFOR,FpLL®i'FING REASON ~'\ -- ~
WORK ACCEPTED B", _ ...... ! \_~_k:.,.~_~l ..................
MUNICIPALITY OF ANCHORAGE
DMSION OF ENVIRONMENTAJ~ HEAL~
DEPARTMENT OF HEALTH AND EN~v-IRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal Description (include lot, block, subdivisioo,~ section, township, range)
Lot 2A Blcok 3 Robin Hills Subdivision ~l~l
Location (add~ess or directions)
12801 Floral Lane Anchoraqe, Alaska 995~6
(b) Applicants Nam~ Tom Mc Gee
Telephone
Applicants Address 12801 Floral Lane Anchorage, Alaska 99516
(c) Appliqant is (check one) Lending Institution ~-]; Owner/builder~;
Buyer ~; Other ~ (explain);
(d) Lending' Institution Telephone
Address
(e) ~al Estate Co. & Agent
Address
Te le phone
2. Type of Rmsidence
Single-Family
Number of Bed~conm
3. W__ater SuDply
o
M~lt i-Family ~--~
four
Othe~ (describe)
Individual Well ~ C~m~nity ~ Public ~_~
Note: If ccnmunity well system, must have w~itten confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Is the well adequate for the number of kedrocr~ specified in this HAA (Y/N)
Sewage Disposal
Onsite ~ I%]blic ~ Cora~unity ~ Holding Tank ~
Is the wastewater disposal system adequate for the number of bedrocras (Y/N)
[Page 1 of 2]
2-15-84
5o En~ineerin~ Firm Providing Inspsction~sr. Tests.,___~ta and Information
I e~tify that I have ch~ckedr verified, c~ conformed to all MOA HAA Guidelir~s in
effect on the date of this inspection.
Signed
Nan~ of Firm
Address
Signed by
Date
Date
Telephone
This Department has received
written confirmation from
the engineer(A.E.C.S.) tha't
conditions on the conditional
approval of March 28, 1984
have been met and this property
is in compliance with MOA
ordinances and codes.
( ENGINEER SEAL)
6. DHEP Approval
Approved for four bedrocks
Approved ~ Disapproved ~
Terms of Conditional Approval
Conditional
Date 6-22-84
The Municipality of Anchorage Department of Health and Environn~ntal P~otection dces
not guarantee the continued satisfactory performance of the water supply and/or the
wastewater disposal system. This approval indicates thatv as of the validation date
shown above~ based on the data and information furnished by an engineer registered in
the State of Alaska, the w~ter supply and vrastewater disposal system is safe and func-
tional for the number of bed~ocms 8nd type of structure indicated.
(DHEP SEAL)
7. Mail the HAA to the following address:
KB2/d5/s
[Page 2 of 2]
2-15-84
MUNICIPALITY OF ANCHORAGE
DMSION OF ENVlRONMENTkL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information A%~plication Date
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (add~ess o~ directions)
(b) Applicants Nan~ ~t~ /~ '~ Telephor~
Applicants Address i~%[~%[ ~'~.-C~-~x~t~x._~lX\'-h~-, ~h~'A~5{h~.~_/
(c)Applicant is (check one) Lending Institution ~; Owner/builder
Buyer ~ .~ O~her ~ (explain)~
(d) Lending Znstituticn Telephor~
Address
(e) Real Estate Co. & Agent
Address
Te le phone
2. _Type of Residence
Single-Family ~
Numbe~ of Bedroo,~6
3. Wate~ Sup~
ti-Family ~
O~e~ (des~i~)
Individual Well .~,. C~unity ~ Public L~,
Note: If c~nity w~ll system, must ha~g w~itten confirmation frcra the State
Department of EnviroP-~ental Conservation attesting to the legality and status.
Is the w~ll adequate fo~ the number of bedrocms sp~cified in this ~_g (Y/N)
Sewage Dispcsal
Onsite~ Public ~ Community ~-~ Holding Tank ~-~
Is the wastewater disposal system adequate fc~ the numbe~ of bedrcx]ns (Y/N)
[Page 1 of 2]
2-15-84
~ 5. E_ngineering Firm Providing Inspections, Tests, Data and Information
I certify that I have checked, verified, or conforn~d to all YOA HAA Guidelines in
effect on the date of this inspection.
Signed ~ ~6-~w~-.
Date
Telephone
6. DHEP Approval
Approved ~ . Disapproved ~-~ Conditional
Te~cf Conditjona~l Approval ~ ~x~ a.-,~-~o,L~x)3t~
The Municipality of Anchorage Department of Health and Envirom~ntal Protection does
not guarantee the continued satisf&ctory performance of the water supply aF.d/or the
wastewateF disposal system. This approval indicates that, as of the validation date
shown above, based on the data and information furnished by an. engineer registered in
the State of Alaska, the water supply and wastewater disposal system is safe and func-
tional for the rnmber of bedrccras and type of struct~l~e indicated.
( D~EP SEAL)
~.,~ ;~.--~l'__e HAA to the lng address:
7.
[Page 2 of 2]
2-15-84
A o WELL DATA
UNIcIPAUTY OF ANCHOPkA~(3~/
MUNICZPALTTY OF ANCHORAGE (MO~) DEPT. OF HEALT~H~j?~
ENVH~ONMENTAL pRC.~e~.-~ ~
HEALT~ aU~OR~TY APPROVAL (~)
C~CKLI~ ~ FEBRU~Y 1984 ~A~ ~ '[ ~L.,~.
zo. RECEIVED
Well Classification
Well Log ~esent (Y~) Y
Total ~p~ /~/, ~d to
Static Wate~ ~1 /~
Casing ~ight ~ G~nd. /, 7
Elee~ical Wiring in C~nduit (Y~)
If A, B, c~ C, D.EoC. Approved(Y/N) NI~
Date Completed /2-d5'~ ~ Yield
/>~ m'~. ~pth of 'G~outing ~o-/~xou./~
Sanit~ ~al on Casing
Separation Distances f~om Well:
To Septic/Holding Tank on Lot //.~ ~/, ~ On Adjoining Lots im/O
Tcy Nea~est Edge of Absorption Field on Lot /j~7~, ; On Adjoining Lots ~
To .Nearest Public Sewe~ Line ~//~ To Nearest Public Sewer
Cleancut/MapJ%ole ~//~ To Nearest Sewe~ Service Lir~ on Lot
Wate~ Sample Collected By /~.~),~ ; Date 3.-~/-~;~ ~
Wate~ Sample Test .Results ~ \. -~-~,~,~x:Cs%~
~t,~ ~$~ ~o,,d~.',L ~',~d ~?,,,~ h~,,7,',3 c~,W.-.'~...l ~.'~'
B. SEPTIC/HOLDING TANY, DATA
Date Installed ~C~-Iq-f~ Size I'ggO _~llg~ No. of Cc~pa~tm~nts
Standpi~s (Y~) ~ Air-tight Caps (Y~ ~ Foun~tion Clean~t (Y~)
~pression ove~ Ta~ (Y~) ~ ~te ~st P~d ~l~ <~e~
P~ing~intenan~ ~n~a~ on File (Y/~) NJ~_~ for~l~
Holding Ta~ High-Wate~ ~a~ (Y~) ~ J~ _ ~ra~y· Holdirg Tank Pe~t (Y~)~ _
~p~ation Distan~s ~ptic~olding Ta~:
To Water-Supply ~11~ jig ~-~, To ~ildi~g F~ndation
To ~o~rty Li~ ~O ~. TO Dis~sal Field
To ~ter Main/~rvi~ Li~ ~__ To S~e~ Pond~ ~e, ~ ~jor ~aina~
Comments
[Page 1 of 2] 2=15-84
Ce
De
ABSORPTION FIELD DATA
Soils Pating in Absorption Strata
Date Installed ~'-- 18
Width of Field ~
Type of System Design
Length of Field ~7/ ~/,
Depth of Field /_/_~ ~ ,
~--~,. ~-, --~, ~ ~"Z4'~ ~,'~
G~avel Bed Thickness ~m'C~
Square Feet of Absorption A~ea ~'?~' .~C-,/z Standpipes P~esent (Y/N)
Depression ove~ Field ¢~/N) ~/ ~te of ~st ~aw ~st 4//4
Results of hast Adequa~ Test /~_//~
Separation Distance f~om Absorption Field:
To h%te]z-Supply Well /.~ 7~-~, .T° P~ope~ty Line /~
To Building Foundation 2 ~C.], /gcx ;,~/~"~' Existing or Abandoned System an
~,ot. /V/~ ~ m ~joining ~,ots >/~
To Wate~ ~ain/Be=vi~ Uine 4//M To mtb.~(if p~e~nt)
To St=e~/~ond/~ke/o~ ~ajo~ mainage Course W/~
TO ~iveway, Pa~ki~ ~ea, ~ Vehicle Stora~ ~ea ~%:~
'' f ' , ~ 7
Date Installed
Dimensions
Size in Gallons
"PL~ On" Level at
High Wate~ Alarm Level at
Tested fo~
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pun~ing Cycles du~ingAdequacy Test.
Meets MOA
Electrical Codes(Y/N)
Cc~anents
** Check Permitted BeckroomRating Against HAA Request **
I certify that I have checked, verified, c~ conformed to all MOA HAA Guidelines in effect
on the date of this inspectic~n.
Signed , ~ .~-~,,~ Date 3 '- 2 ~"~'~
[Page 2 of 2]
ALASKA e lUlI OFlmeF/TAL COI1TI OL Sel dICe$, 119C.
I~nqi'~¢¢r'in§ F., [r, Jironmcr~1al $1ucJics
June 19, 1984
Depar~nent of Health and
Environmental Protection
825 L Street
Anchorage, Alaska 99501
NOILD]]IO~J.:J 'IVIN3"~'4ONIAN:~
x~ HLqV~H JO 'J.d::.Cl
~OV~IOHDNV ;~O .k. LIqVdlDIMR~N
Subject: Robin Hill, Lot 2A, Block 3
This office made a re-check on the subject property on June 18, 1984.
The driveway (asphalt) was >10' frc~n the system. No depression was
observed over the system. At the time of the recheck, the electrical
wires had been buried. The well had been provided with sufficient
conduit on the wiring; furthermore, Mr. McGee intends to provide further
'fill' around the well casing.
This office requests that the 'conditionals' be removed from the health
authority on this property. If this office can be of further assistance,
please contact us at 561-5040.
Sincerely,
Larry Montgomery
Engineering Technician
/caj
1200 Wcsl 33r'cJ Aug'nut. $ui1¢ J~,.Anchoreq¢. Alasku 99503..(907) 561-50/40