HomeMy WebLinkAboutSKYLINE VIEW #1 BLK 4 LT 2LOT'
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIV]ENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
'~AME
PHONE ,, ,~N EW
MAILING ADDRESS
DESCRIPTION
Well z Absorction Cea/ D~lling
~ ~ Manufacturer Material No, of compartments
Liq. ~apact~ in gallons i Inside length Width Liquid depth
/'¢~712 IF HOMEMADE: .~
~ ~ DISTANCE TO: Well ~ Dwelling PERMIT NO.
Well Foundation Nearest lot lin~
'~"~'t~ ® ~ No. of lines / Length o,~e ,. Total len~in,s.o .- Trench wi~¢~ inches TotaIDistanoe betwe~¢~effec,v,
~ Top of tile to finish grade ,~ , Material beneath tile
inches
~ Length Width Depth / I PERMITNO.
~P Type of crib Crib diameter Crib d Total effective absorption area
¢ ~ DISTANCE TO: Well Building/o~a~tion Nearest lot line
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
INSTALLER
DEPRARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. STREET, RANCHORRAGE., RAK
264-4720
F'ERblIT NO
PRATE ISSUED:
840~78
0572]~78,4.
RAPPLICANT:
RAI)DRESS:
CONTACT PHONE:
LEONFIRD R NELSON
862:3 E :1.0TH AVENUE
ANCHORRACiE., BBl',:: 99504
552-263:3
LEGRAL DESCR IF':
LOT SIZE:
LOT LOCRTION:
MRAX BEg, ROOMS:
SUBDIVISION: SK'¢LINE VlEII4 ~t
SECTION: i6 TOWNSHIP: ±5N
92??4 (SQ. FT. OR RACRES)
El_DER DRIVE OFF DOGWOOD
4
LOT: 2 BLOCK: 4
RRANGE: ±W
LISTED BELOW FIRE
SYSTEM. CHOOSE THE OPTION THAT BEST FITS "fOUR SITE.
T F-': E f-.i C H E~ E [:, t..*.!.
THE OPTIONS RAVRAILRABLE TO '..r'OLI IN I]'ESIGI':,IING YOUR SEPTIC:
[:,EF'TH TO PIPE BOTTOM (FT. ', 4. 0 4.
GRRVEL [:,EPTFI '::FT." 4. 0 ~L~/ !.'-1.
TOTRL DEPTH ,::FT. ) 8. 0 4.
GRA',,,'EL !,.IIDTH (FT. ', 2. 5 ~¢> 20.
GRAVEL L. EI'4GTH ,:: FT. :.', 6_.:. 0 ~_=:
GRFI'v'EL VOLUHE ,::CU. YDS. ) 26. 2 28.
TANK SIZE (GALS) ~., 250. 0 ,~m 2L., 250.
SOIL RATING (S~. FT. ,."AR) 225 ±25
[:,~:l.=, I ~.-41
4.0
Z.':. 5
'7.5
5.0
54. 0
40. 0
:1.., 250. 0 ¢,-,m
~,~, TANK MUST HRAVE RT LERAST TWO COMPRARTMENTS
I CERTIF'"'¢ THAT:
I. I AM FAMILIAR WITH THE REC..!UIREMENTS FOR ON-SITE SEWERS RAND WELLS RAS SET
FORTH BY THE MLINICIPRALIT'¢ OF RNCHORRAGE (MOB:.', AN[:, THE STRATE OF RAILRASI.,::R.
I WILL INSTRALL. THE S'.:r'STEM IN ACCORDANCE 1.4ITH RALL MORA CODES FIND F..'.EGULFITIONS,
RAN[:, IN COMPLIANCE WITH THE DESIGN CRITERIRA OF THIS PERMIT.
]:. I WILL RDHERE TO RAI...L MORA RAND STRATE OF RALRASKRA REQUIREMENTS FOR THE SET BRACK
DI':~TANCES FROM RANY EXISTING WELL., I.,.IRASTE!-,.IRTER [:,ISPO':.']RAL SYSTEM OR PUBLIC:
SEI.,.IERRAGE S'T'STEM ON THIS OR RN'¢ RA[:,JRACENT OR NEARB'-," LOT.
4. I LIN[:,ERSTRAND THRAT ]HI-', F'ERMIT I=, VRLID FJF. R IIlRA,=.:,IMUIll OF 4 BE[.,F..UUM=, RAND
RAW¢ ENLFtRGEMENT I.,.II/.L REC!UIRE RAN ADDITIONAL PERMIT.
IF El LIFT STATION IS INSTALLED IN FIN RARERA COVERED BY MOA BUILDING CODES.,
THEN (:;k) Ri'.,t ELECTRICRAL PERMIT RAN[:, INSPECTION MUST BE OBTRII'.,IED.~ (2:) RS-BUILTS
WILl.. NOT BE RAPPROVED, WITHOUT RN ELECTRICRAL INSPECTION REPORT.; AND (~) THE
ELEC:TRICRAL !.,.IORK MUST BE [:,ONE B'.r' R_LICENSE[:, ELECTRICIAN.
RPPLICFINT: LEONRARD R NELSON
IS2;LIE[:' B"r' ~,~.z.~.~.-~_..~o~.-¢c~¢ ........... [:'RTE;~//~,~Tr~ b ~
MUNICIPALITY OF ANCHORAGE
e,~,~.,"~*~',, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
,!',~.'~,~,~!: 825 L. Street, Anchorage,
Alaska
99501
264-4720
~'N"=~=~'~' SOILS LOG - PERCOLATION TEST
f SLOPE
SOILS LOG
PERCOLATION
TEST
:-?>,.: :h >:
BITE PLA~
_ ,,z:?_(O ,~ :
10
11
12
13
14
15
16
I7
18
19
2O
COMMENTS
'T-~',-O/'j''~ 0~7 IF YES, AT WHAT
DEPTH?
/-to ~-. e'
WAS GROUND WATER //~ SL
ENCOUNTERED?
O
P
E
Reading
¢:, '/. ~
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN AND FT
Gross Net Depth to Net
Reading Date Timo 'rime Water Drop
,, LI /,,~. _
7
//
CERTIFIED
PERFORMED BY:t/~
72-008 (6/79)
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Oivision of Geological A Geophysicol Surveys
Drilling Pormll No.
LOCATION OF WELL (Pleose complele either Io~ lb or lc.) A.D.L. No.
Anch ~kyl.ine 2 4 _of_of__of -- sl-I wO
~'clJDISTANCE AND DIRECTION PROM ROAD INTERSECTIONS 5. OWNER OF WELL:
Mr,
Leo~.ard
Nel~on
Address: 8633 E. lOtli
Stroll Address and Argo of Well LoooHon Anchorage, Ak, 99504
WELL LOS Feet Bslow 4. WELL DEPTH: (fJ.ol) 5. DATE OF COMPLETION
su,f~. 247 ,,. 9 2 -
Gravel, sand, soil 0 2"';:> 6. ~Ceble ,oo, ?:~Rolory ~OrJven ~Dug
' ¢ ~ .... ~ ' ~Jetted
Orcekstone wi'Dh st:t'eqlcs o:~ ~.i,n 31 '-
8. CASING: ~ Threaded ~ Welded
o '4 v ]. 7
dlem.~ln, to__. fL Dspfh Weight
9. FINISH OF W[LL:
Type: Dlomoter:
Sot between ft. end ff.
. = Bock filling Grovel pock
~ft. otter hfs. pumping g.p.m.
12~GROUTiNG Well Grouted: ~ Yes ~ No
Materiel: ~ Neff Cement ~ Olher:
13. PUMP: (if oveileble) HP
Length of Drop Pipe fl. copocify g.p.m.
16. WATER WELL CONTRACTOR'S CERTIFICATION:
15. Wofer Temperelure ~o ~ F ~ C
Authorized' Represent'~live ,/"
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONM]~NTAL PROTECTION
APPLICATION FOR HF~ALTH AUTHORITY APPROVAL CERTIFICATE
1, General Information Application Date ./~~'l~ _
(a) Legal De~scription (include lot~, block, subdivision, section, township, range)
Locat~o/n (address~or directions)
(b) Applicants Name ~/~Or j ~e ~Ot/ Telephone Home 3~us~e'7,q <.
Applicants
(c) Applicant is (check one) 'Lending Institution ~ ; O~er/builder ~ ;
Buyer Other
(d) I~ending Institution ~ ~-~ /'-2L~' Telephone
Address
(e) Real Estate Co. & Agent
Address
(~)
Telephone
~%~e ~i~A to the following address:
2. T~j~e of Residence
Single-Family~
Number of Bedrooms
Multi-Family
Other (describe)
3. Water Supply
Individual Weli~ Community ~ Public ~-~
Note: If community well system, must have ~,~itten confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
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 regula-
tions in effect on the date of this inspection.
Name of FirmL~)~' ~J~CC~ Telephone
Address___ .5-& /
DItEP Approval
Approved for - ~ bedrooms
Approved ..~ Disapproved.__
(ENGINEER SEAL)
Terms of Conditional Approval
CAUTION
THE bFONICIPALITY OF ANCHORAGE DEPARTMENT OF I~ALTH AND ENVIRO~NTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON T}~ REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN TI~ STATE OF ALASKA. TI~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR I~ENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAoL AND STATE REQUIRE-
MENTS. 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Well Classification
Well Log Ihtesent .~)
Total Depth 2 ~"7 / Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit~.~)
Separation Distances f~cm We~i
Legal Description: ~_~ ~
< (
If A, B, C~ C, D.ErC. Approved(Y/N) ~ ~ ~
,~ , ~ ~ dF
~t~ ~leted ~/~3 ~ Y~eld ~'-~
~ ' ~pth of ~outing /'
~ ~t At ~
~' Sanit~y ~al on Casing~
~ession ~ound ~l~ead (~
~ ~-~-~
TO Septic~ Tank on Lot /~¢~- / ; On Adjoining Lots
To Nea~st Edge of Absorption Field on Lot /O~ / ; On Adjoining Lots
To Nearest Public Sewer Line /J /~ To Nearest Public Sewe~
Cleancut/Mar~ole /~J //'9 To Nearest Sewer Service Line on Lot
Water Sample Collected By~. I'~D ~.'/~'//}~/~ ; Date ///~. ~./%~ =f
Wate~ Sample Test Results ~.~/'4-F/~' ;~'~c'
Ccm~e nts .-~ ~
SEPTIC/~T~ DATA
Standpipes (~Y/~ Air-tight Caps,0 Foundation
Depression over Tank (~f~l)~_~ Date Last ?~ped ~
Pumping/Maintenance Contract on File~(Y/N~4//~--, for '
High-Wate~ Alarm .(.Y/N)/~//~- Temporary Holding Tank Permit (Y/N~z~
Holding
Tank
Separation Distances frc~ Septic/Holding Tank:
!
To Water-Supply' W~ll To Building Foundation.. /~ "~
TO P~operty Line /~ ('-/~ To Disposal Field /O
To ~ter ~Service Line ~--O ' To Stream, Pond, Lake, or Major D~ainage
Course /t) o ~ ~
Coranents
Receipt #
Date Paid:
Amount: c~ %-,o(b
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed 7/~ ~
Width of Field. / ~O ~
Square Feet of Absorption A~ea
Depression over Field ~T~I)
Results of Last Adequacy Test
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes P~esent
Date of Last Adequacy Test
Separation Distance fr(ml A~sc~ption Field:
To Water-Supply Well ~/~O f.~ To P~operty Line
To Building Foundation ~_~O ~.~L To Existing or Abandoned System on
Lot FtJ 0 '¥~3~ ; On Adjoining Lots /~ ~
To Water ~k~Service Line ~_~-~ !F- To Cutbank(if p~esent)
To Stream/Pond/Lake/c~ Major D~ainage Ccurse /~2 ~
To D~iveway, Parking A~ea, c~ Vehicle Storage A~ea ~7~
D. LIFT STATION
Date Installed
Size in Gallons
"P~u~¥ On" Level at
High ~ater Alarm Level at
Tested for
Electrical Codes(Y/N)
Dir~nsions
~ / /"~Lmp Off" Level at~
Vent
Meets MOA
** Check Permitted Bedrcom Rating Against HAA Request
I certify th~t3I have checked, verified, or conformed to all MOA HAA Guidelines in effect
°n the datzeZ°~nis iD'~Pe cti°n'~/z//~//~ ,~. ---~z/~/ D ///,//~ /F ~;~ ..:-~r~' ~ .~.~ :w:~ ~
Signe ate ~.~e ~ '%%
KB1/dL/s ?
[Page 2 of 2] '~z' '~'"~.- o.,~,O~.~,~,,v,t~. '~t~%*~'~,,~'~