The URL can be used to link to this page

Home My WebLink AboutSUE TAWN ESTATE #2 BLK 2 TR B ~a MUNICIPALITY OF ANCHORAGE ~, I , ~' 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 LO~ATIO~ (.C¢1~ ~ ~O. OF BEBROOM~ I Well [ Absorption area Dwelling PERMIT NO. DISTANCE TO: / ~ ~ IF HOME.DE: Well Dwelling PERMIT NO, Manufacturer - ~ Material Liquid capacity in gallons DISTANCE TO: Well~ oundation Nearest lot line PERMIT NO, No. of lines Length of each line Total length of line, [, ~ Trench wi th Distance between lines Top of tile to finish flrad0~~ ~ Material beneath tile ~ ~t inches Total effectivo absorption area Type of crib Crib diameter Crib depth Total effective absorption area We]] Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(si ~13 (Rev, 3/78) DEF'RRTMENT ',.~,~' HEFtLI'H RND ENVIRONMENTR_ ~h(:O'FECTION 825 '"L" S'FREET, RNCHORRGE., FIK. 9950i F'ERMIT NO. F 810072 ) KLEIN CONSTR.iTIDN CREEF:-. RD' FETER_ L.F,.EEK. SIJE TFIWN 82 TRRCT B IF P_ l L. HNT LOC:FF¥ I ON LEGRL E,C,-.,~_~,. PRLMER RK LOT ..... E 100000 SQURRE FEET ,=- "-' '" FI -~' '"= ' IS: TYPE I_'IF _,LltL FIE,=,uRF FI..N _,Y_,TEM [:,RRINFIELF:, MR::~,IMIJM NI_IMBER OF BEDROOMS = ,1. SOIL F. HTIN= ~,.:-,~:.! FT, E,R.- THE REQLIRED _,I¢.E OF THE =,OIL FIBSnF.'PTIEN 9'¢STEM IS: 85 [) E-iF" TU~ = e; LE~-tGTH= 4:~. GRF~N-"EL [)EF' TI-i:: 2 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTBNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCBVRTION (IN FEET). THE ]-R~Z[-~"Z:PI l~gl [)l-Ia IS 5. Clr3~Zl F-EET. THE GR~VEL DEPTH IS THE MINIMUM DEPTH OF GR~VEL BETWEEN THE OUTFALL PIPE ~ND THE BOTTOM OF THE EXCaVaTION (IM FEET). RE[:, __.Ef T I C: PERMIT RPFLI_.HNI HRS THE RE_,FON=,IE, ILI r, TO INFORM THIS DEPFIRTMEN'F DLIRING THE INSTRLLRTION IN_~FEL.] IUN_, OF FINY WELLS RDJRCENT TO THIS PROPERT'¢ FINE) THE NLtMBER OF RESIDENCES THBT THE WELL WILL SERVE. ~T[.--~03 ¢~2 > Z i'4SF'EI]:T I Cif-~S RD:: ~.':E,~q.l_l ]~ F:E[: ....... BRCKFILLING OF RN~ SYSTEM WITHOUT FINRL INSPECTION RHD RPPREIVRL BY THIS DEPRRTMENT WILL BE =,UB..E_.T TO PROSEC_TII3N. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS ±00 FEET FOR R PRIVRTE WELL OR i50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTFINCE FROM R PRIVRTE 14ELL TO R PRIVRTE SEWER LINE IS 25 FEET FIND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED HND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 2:0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICFITIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTFtLLRTION. I CERTIFY I'HRT !: I RM FRMILIRR WITH ]'HE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MUNICIPFtLITY OF RNCHORBGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 2:: I UNDERSTBND THRT THE ON-SITE SEWER SYSTEM MR'¢ REQUIRE ENLRRGEMENT IF THE RESIDENCE I~~:LI_I[:,E MORE THBN 4 BEDROOMS. FIF'F'L~',~ CONSTRUCT I ON , ; ? SOILS LOG MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 82E L. Street, Anchorage, Alaska 99B01 264-4720 SOILS LOG - PERCOLATION TEST SLOPE .A'rE FEREORME.:ZX FE PLAN WAS GROUND WATER 11 - ENCOUNTERED? IF YES, AT WHAT DEPTH? 13 14 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: 72-008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN FT AND -- FT CERTI FI ED B~ ~'~~'~ (minutes/inch) b 0 0 0 0 0 0 0 0 0 0 0 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 GENERAL INFORMATION (a) (b) (c) Application Date Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ' Applicant Namec-~'--~f.-~.'~' ~¢"~.~Z2/~'¢ Telephone: Home ~ ~/o'.~,~.~ Business Applicant Address ~_0. ~/bd?e ? Applicant is (check one): Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain); Lendin Institution ~¢~oJ~,~'~¢( .~c/)~.=~:- Telephone (e) Real Estate Company and Agent Address Telephone TYPE OF RESIDENCE Single-FamilyK Multi-Family [] Number of Bedrooms ¢ Other 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:"~lf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDI~;~'GJINSPECTIONS, TESTS, FILE SEARCH, D~lb/A 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 regula,tions in effect on the date of this inspection. Telephone Ca-7 ApprovedDHEP APPROVALfor ~¢~"~ ~ ~ ~ bedrooms by Date '~/ Approved l?~% Disapproved Conditional 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 issued. The Municipality of Anchorage is not r:esponsible for errors or omissions in the professional engineer's work. Page 2 of 2 72 025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: "~-~ MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED WELL DATA Well Classification Well Log Presentd~/N) Total Depth '¢1~ Static Water Level ' Cased to Casing Height Above Ground Electrical Wiring in Conduitd~N) Separation Distances from Well: To Septic/14o!,~!'~9 Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completes /~-Z..A' - ~ I Yield ~ ~' ' Depth of Grouting ~-- Pump Set At ~/,1~, ~r¢~-~'~ Sanitary Seal on Casingd[::~/N) Depression Around Wellhead To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by' ~ Water Sample Test Results Comments ~ ~.,,...)¢:~.. ~/~& -r~ /,,,~ ~,~-~s ~ ; On Adjoining Lots t ,,~;'c:¢-'F ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ¢' 's~ 1.~ ; Date B. SEPTIC/H-~EDING TANK DATA Date Installed "~- ~ ¢ E~ I Standpipes (~/N) Air-tight Caps ~'N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/l~ Tank: To Water-Supply Well [, ~ ~ J¢ To Property Line lc, To Water Main/Service Line ~ Course' } Size ['~-~;'~ No. of Compartments Foundation Cleanout (~N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~' To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~ ~'~, -~E, t Width of Field ~- I Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation t ~' ~- Lot ~':'~l~/b~ Type of System Design Length of Field ~L,. / Depth of Field Gravel Bed Thickness Standpipes Presentd~O/N) Date of Last Adequacy Test To Water Main/Service Line (. ~ t'~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line [ To Existing or Abandoned System on ; On Adjoining Lots '~¢ To Cutbank (if present) 1. C;,z~ t +' Comments 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 Perm/~Bedroom Rating Against HAA Request ** I certify t ha,t,'f h av~p~e~ verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~-'~/' Date __<//2 Receipt No. ~ ~ ~ I q % Date of Payment J g ¢ ~ ' ~% ~,~ 'i~eer's' Sea[' '~ ~, :: ~,' Amount: $ 72-026 (11/84) ~ ~ ~.-~' DA~ .E<R ECEiVED ~ , INSPECTION APPOINTMENTS ~ME TIME TIME DATE DATE DATE INSPECTOR . . ~ iNSPECTOR INSPECTOR MUNiCiPAU~v ,~F A~C~ORAGE ~NV~ON~N~L P~O~,C~ON MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 ~Street-Anchorage, A~askag9501 JUL 2 0 1981 ~ ENVIRONMENTAL SANITATION DIVISION ~C~I~ D Telephone 264-4720 ~. _ · ~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be preceded. Please allow ten (10) days for processing. PHONE MAIEIN~ DRESS PROPERT~ESIDENT (If different from above) ~ PHONE PHONE MAILING ~SDRESy¢ { 3. LEND}~ I~STFUTIO~" PHONE 4. REALTOR/AGENT - ~ , PHONE NUMBER OF~BEDROO,MS E~] One ./~ Four [] Two~'~ [] Five [] Other .,PT, B. LEGAL DESC STREET LOCATION ~ 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY [] Three [] Six 7. WAT =/~UPPLY I NDIVI DUAL* * ATTACH WELL LOG. A well log is ~equired for all wells drilled '[] COMMUNITY since June 1975, For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~. INDIVIDUAL/ON-SITE** .)97~;/,/ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY I. TYPE OF RESIDENCE NUMBER OF BEDROOMS ,., '. [] SINGLE FAMILY [] ONE [] THREE [~) FIVE [] OTHER, [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~Septic Tank or [~ Holding Tank Size: I.~.~-C~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL /~ 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line ] Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS [] CONDITIONAL APPROVAL (letter must acco,~pan~/certificate) // [] DISAPPROVED ~ 72-010 (Rev. 6/79) Pack bottle ~:~'e-a~lly i~'~ r,-miling tube wi'ih lab fo~m. DTI001853