HomeMy WebLinkAboutROLLING HILLS VIEW ESTATES BLK 3 LT 6
'i' MUNICIPALITY OF ANCHORAGE ~
· DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE [] UPGRADE
LEGAL DESCRIPTION
LOCATION
DISTANCE TO: We2/O /,./it
Manufacturer
Lic, capacity in gallons IF HOMEMADE:
DISTANCE TO:
DISTANCE TO:
No. of lines /'
!
Top of tile to finish grade
Length
Type of crib Crib diameter
Well
DISTANCE TO:
Class
DISTANCE TO:
Absorption area ! Dwelling ~- !
Inside le~ngth __ Width ,. ·
Foundation .~) ~
Total
leath tile
NO. OF BEDROOMS
PERMIT NO,
No. of compartments
Liquid depth
Dwelling PERMIT NO.
Material Liquid capacity in gallons
Nearest ct I ne
Trench w~
7~ inches
inches
Distance between lines
PERMIT NO.
depth Total effective absorption area
Building foundation Nearest lot line
Driller Distance to lot line
Sewer line Septic tank
PERMIT NO.
Absorpt on area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING T
INSTALLER
REMARKS
DATE LEGAL
Applicant:
Location:
Legal Description: l~r~' ~/~
Type of Soil Absorption System Is:
Trench: Drainfield:
Maximum Number of Bedrooms:
~UNICIPALITY OF ANCHORAGEf,
Department~ '~ Health and Environmenta/ ~'grotection
825 ~ Street, Anchorage, AK. ~9501 .~ ~
264-4720 ~
* * * HANDWRITTEN PERMIT * * *
WELL AND/a0N-SITE SEWER PERMIT
~//~/~J.~ Mailing Address: ~1~/~F.-~~ ~, ~
Phone Number:
~/~/~/~//~ $/~t Size:
Seepage Bed: __Holding Tank:
Soil Rating(sq.ft/br)
The Required Size of the Soil Absorption System Is:'
DEPTH ?l ;
LENGTH -~-?'
GRAVEL DEPTH ~' WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(~) TANK SIZE = /~0 GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the r~esidence is remodeled,-~o include more tha~ 3 bedro
Issuedby:
Signe~:Applicant~/~F~/~/u~- ~'~'~/' Date: 3~% -/~ /~ ~
SWP/024 (1/81)
SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
2
4
8
10
12
14
17
20
COMMENTS
MUNICIPALITY OF ANCNII~R~rY OF ANCHOP, A(~
__. ., OE HF_ALTJ:L.&_.DEPT L
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION 1~ 1 8 1~
[] PERCOLATION
TEST
SLOPE
RECEIVED
DATE PERFORMED:
SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross
Reading Date Time
Net Depth to
Time Water
Net
Drop
ERCO LATION RATE
TEST RUN BETWEEN
$ & S ENG;NEE~,;NG-
PERFORMED 8Y$.~. il I. gA_.Y'
EAGLE RIVER, AK 99577
CERTIFIED BY:
DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Ataska 99501 264-4720
SOILS LOG- PERCOLATION TEST
SOILS LOG "
PERCOLATION
TEST
PERFORMED FOR: ~
LEGAL DESCRIPTION:
DATE PERFORMED: ["~ - /'~~ -~"7~
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
2O
OL
COMMENTS l~,_~~ L~' /[~ O ~-~
~.:.k~W R,I,.kNA ['~.~'~LO~ 'X'~-~"~ A~.~A
PERFORMED BY: d'_o,~/x/r~ ,r~ /~ ~- b'~'~5
SLOPE
WAS GROUND WATER S
ENCOUNTERED? ~O L
0
P
E
IF YES, AT WHAT
DEPTH?
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time A/..~N Water ~T' Drop
.~_~_ _~ I :~ i 0 ~. 6~ ., i/~ ,,.
PERCOLATION RATE
TEST RUN BETWEEN ~ FT AND
CERTIFIED BY: ~
DATE:
OWNER OF LAND / , ·,;
ADDRESS ...... :- / ·
LEGAL DESCRIPTION ~"
DATE-Started
PERMIT NUMBER
DOC Co. obi
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688.2759
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
KIND OF CASING ,,-' _
KiND OF FORMATION:
Fmm , , Ft. to Ft.,
From Ft. to ,, Ft.
From_ Ft. to Ft.
From Ft. to , Ft. ,
tt
MISCt, INFORMATION:
Ft. to Fl
Ft. to Ft.
. Ft. to_ Ft.
Ft. to
Ft. to Ft
Ft. to Ft.
Ft. to__.Ft.
Ft. to Ft.
__.Ft. to Ft.
Ft. to Ft.
, Ft. to Ft.
From . Ft. to Ft
From .... Ft. to ... Ft
From ... Ft. to.. . Ft.
From Fl. to . Ft.
From Ft. to Ft.
From_ Ft. to Fl,
DRILLER'S NAME ..
by
DOC Co. dba
SULLIVAN WATER WELLS
P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759
OWNER OF LAND
ADDRESS
LEGAL DESCRIPTION
DATE - Started
:,, , ~ Ended
PERMIT NUMBER
DEPTH OF WELL
STATIC LEVEL OF WATER FT.
DRAW DOWN FT.
GALS. PER HR
KIND OF CASING
KIND OF FORMATION:
From Ft. to Ft
From Ft. to Ft.
From__Ft. to Ft
From Ft. to Ft.
From__Ft. to Ft.
From Ft. to : :, , Ft.
From___Ft. to Ft.
From Ft. to Ft.
From · . Ft. to -- · Ft.
From Ft. to :? 'Ft
From Ft. to Ft.
From ~ r / ( Ft. to 7"~>~> Ft.
From Ft. to Ft.
From__Ft. to Ft
From__Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft..
From
From
From
From
From
From
From
From
From __
From,
From
From
From
From
From
From
Ft. to Ft.
Ft. to_ Ft
Ft. to.__ Ft
Ft. to Ft
Ft. to
__ Ft. to. Ft
Ft. to Ft
__ Ft. to Ft.
Ft. to Ft.
_Ft. to. Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
Ft. to Ft.
___Ft. to. Ft.
Ft. to Ft.
Ft. to Ft.
MISCL. INFORMATION:
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
264-4720
Application Date October 27, 1986
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
lot 6; Block ~ Rollin_~ Hills view Estates
Location (address or directions)
~.~l ga R~v~r
T14N R1W Sec. 6
(b) Applicant Name Ann KJnca~d Telephone: Home 694-62B0 Business
Applicant Address 19208 Upper McC:~ary EAgle River, Alaska 99577
(c) Applicant is (check one): Lending Institution []; Owner/builder I~; Buyer []; Other [] (explain);
(d) Lending Institution A-I a~ka Mutual Telephone 694-9571
Address P.O. box 771068 Eagle River, Alaska 99577
(e) Real Estate Company and Agent N/A
Address
(f)
Telephone N/A
Mail the HAA to the following address:
plckup by enAlneer
2. TYPE OF RESIDENCE
Single-Family [] Multi~a/~ily [] Other
Number of Bedrooms ~ "~.'~
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. 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 (11/84)
ENGINEERING FIRM PROVIDh~,G INSPECTIONS, TESTS, FILE SEARCH, D~ I'A AND INFORMATIOn'
As certified by my seal affixed hereto and as 0f 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
Address
Date
the date of this inspection.
Name of Firm __
EAGLE RIVER ENGINEERING sERVICES
EAGLE RIVER, AK 99577
P. 0. BOX 773294
694-5195
Telephone
DHEPAPPROVAL ~ ~ .~ // / ~ ~ , p
Approv.~~gr ,--7~./-4~--~"--~ bedrooms~:~'/'~'~ ~j Con;,~a~.Date
Appr0vea y Disappro ed ;: :.:. , '*
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental 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 Lssued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
.. ' ~";~"~' _~ ~UNICIPALITY OF ANCHC.
DEPT. OF HEALTH &
ENVIRON/V~NTAL PROTECTION
Nov
.RECEIVED
MUNICIPALITY OF ANCHORAGE (MO~/
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720 /--~ 7~ ¢'
Legal Description: ~
A. WELL DATA
Well Classification ,~ 1 c/,,~l 7-/~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) Y Date Completed /'./d/~'~'/ Yield
Total Depth 54:~c~" Cased to ~-//" Depth of Grouting
Static Water Level ~"-~ ~ /'~//~'~' ~/'~ ~ ~-~ ,2..$ Pump Set At
Casing Height Above Ground /_Z ~ Sanitary Seal on Casing (Y/N)
,/t,.' Depression Around Wellhead (Y/N)
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 .,V,./~
Cleanout/Manhole -/~-"/~,~
Water Sample Collected by
Water Sample Test Results
; On Adjoining Lots ~-?¢0 '
/i~5-/ ; On Adjoining Lots 'f'/'~'~"
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
~"~r/,¢-- ,'¢~'~ ~'~¢¢'"'*"~'~"'"'¢ ;Date
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed
Standpipes (Y/N) ? Air-tight Caps (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Size /~¢~ ~'~ ! No. of Compartments ~
Foundation Cleanout (Y/N) ~
Date Last Pumped ¢~Y, /~'P~'
;for /"%~//4
Temporary Holding Tank Permit (Y/N) "/~'/'~
Separation Distances from Septic/Holding Tank:
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
To Building Foundation J'~ /
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
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
To Building Foundation /4~ /
Lot
To Water Main/Service Line ~/"~"
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments ~ ~"re ....,c- A
z'~//""~'/C ' Type of System Design
Length of Field ~:/'~ /
Depth of Field // /
Gravel Bed Thickness ~'"
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line t?~ /
To Existing or Abandoned System on
; On Adjoining Lots ~- --~ /
To Cutbank (if present) /~//~
D. LIFT STATION
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 c.~7,~ed, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed j/~r~~ Date
Company ~"/'~' ~'--~ ' MOA No.
Date of Payment //--/~ --~ "~
Amount: $ ~ ~ ~ Seal
Page 2 of 2
72-026 (11/84)
APPLIC~iT FILLS OUT UPPER HAL?"~ONLY
Property Owner '~/~ ~ ~/~ [/~//~/~ ,~//~'~,~ ~'~ ~ ~ Phone
Majiing Ad~e~ ~t/ [ ~ ~ (.) l?L~ ~/ ~ ~ ~.j~ i-{, ~ ,~ Zip Code '7 '7'~
Buyer
Address Zip Code
Phone
Lending Institution ,//g~:;~:' ~' ~ ~/ ~]d~' '~.> 4 L. ~) ~ ~/~
Address ~:/[~('//r ~ K Zip Code
Realty Co, & A~nt Phone
Address Zip Code
S~,.e~ ~oc~.~ ~/~ ~/~/p'
Type of Resi~nce
~Single Family
~ Multiple Family No. of Bedrooms _~
~ Other
Water Supply
~dividual A~ACH WELL LOG. A wall 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
~lndividual 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 Date Date
Inspector Inspector Inspector Inspector
Field Notes: ,,~ ~ ~2..~~ ~ ~,..~ ~-.,~o ~L~ ~) ' '"'~:~ L.~ ~ ' ~ ~"~" '"-~'
~, I ~ MUNICIPALITY OF ANCHO~GE
(By:~ONDITIONAL~ ~ t ~ ~APPROVAL* ~ ~ ~
~-- 2--~ WelltoTank /~& /~ Septic T~k Size /~ ~ ~'
(,O¢'
Il"'