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Home My WebLink AboutORTH LT 6 NAME ¢IUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONIVtENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE MAILING AD,~ ESS LEGAL DESCRIPTION Absorption area Dwelling I ~th , I w~;' -- Lic :jty in gallons IF HOMEMADE: ~ DISTANCE TO: Well ~/~ Dwelling Foundation grade / ( Material beneath tile Width Depth NO. OF BEDROOMS No, of compaftmar~ts Liquid depth ~ERMIT NO. Liquid capacity in gallons Distance between/igas . Total effective ab~s~)rCtioa, area PERMIT NO. TyF Crib diameter Crib depth Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Septic tank Well Building foundation DISTANCE TO: DIS'rANCETO: Buildingfounclation ewer line '~ O (~) Absorption areals) '[ ~ C~ (~ -.~ OTFIER PIPE MATERIALS . ]'~.)~,~__~,-.:~ ~/. -~OI L TEST RATING . / I~TALLER ~ ;r, (" DATE LEGAL PERMIT NO. ( 780~69 ) PPLICBNT EVERET'f HONEGGER .OCRTION BIRCH RD _EGRL L60RTFI SUAD LOT SIZE TYPE OF SOIL. RBSORBTION SYSTEM IS;: 'FRENCH MAXIMUM NUMBER OF BEDROOMS -- 4 SOIL RATING (SQ FT/BR)= 45650 SQUARE FEE'T' THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E:, E F' ']F ~-,-~ =--- :.1._ i:Z~ t_ EE p.~ t.-~ "lF' ~-t == 4 4 ~C-.~ F-: F:~ "-.-' EEL. ET. E-Si ~=:' 'l- ~-,,-~ == ~ THE LENGTH DIMENSION IS THE LENGTM (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF FI TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFFICE OF THE GROUND AND THE BOTTOM 01= THE E?.',CAYATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. ]'HE GRRVEL DEPTH IS THE MINIMUM DEPTH OF' GRFIVEL BETWEEN THE OLITFRL. L. PIPE FIND THE BOTTOM OF THE EXCFIYRTION (IN FEET). PERMIT APPLICANT HAS THE RIESPONSIBILITY TO INFORM THIS DEPF~RTMENT DURING THE INSTALL.FtTION INSPECTIONS O1= ANY WELLS f4DJF-tIZ:ENT TO THIS PROPERTY FIND THE I",ItJMEcER OF F,'ESIDENCES THAT THE 14ELl.. WII_L SEI;..'VE. E~ACI'(FILLING OF: ANY SYSTEM WITHOUT FINAL IHSPECTION AND FIPPROVRL 8Y THIS pEPRRTMENT 14ILl_ BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL FIN[) ANY ON-SITE SEWAGE DISF'OSFiL. SYSTEM IS i00 FEET FOR R PRIVATE WELI_~ OR 150 TO 200 FEET FROM Ft PUBLIC WELL DEPENDING /JPON THE TYPE OF PUBLIC WELL,. C'THER REQUIREMENTS MAY FIPPLY. SPECIFICFI'i'IONS F;IND CONSTRUCTION I)IFIGRFIMS AVRILFIBLE TO INSURE PROPER II",ISTRLI~RTION. I CERTIFY THFIT :1.: I AF'l FAMILIAR WITH THE REQUIREMENTS FOR ON-si'rE SEWERS FIND WELL. S RS SET FORTH BY THE MUI',tlCIPFILITY OF ANCHORRGE. 2: I WILL INSTALL THE SYSTEM IN FICCOR[:,ANCE WITH I'HE CODES. ]!:: I UNDERSTAND THFIT THE ON-SITE SEWER SYSTEM MAY REQIJIRE ENLFIRGEMENT RESIDENCE IS REMO~.LIDE'C' MORE THAN 4 BEDROOMS. - ,¢ "¢ THE f53'/.(JO JN S J B D ; V DE O H a mill e r ':' Remarks DESCRIPTION Frool WOONV.!APD,,LI.~I~P(;I![lt'f ,~, ASSoCIA'I'I~i WELL CONSTRUCTION LOG Well ideation: (,ddress & legal desorip~,) Oepth of weil~/ _,t. Casin,: depth ~/ Static w~ter I~ve[ ft. ~, below) land surface. Date~ Finish af .ell: (~screen, perforated, open-ho,e, other). describe intervals and size: Well yield tested by (pumping, bailing, air) at for / hours with .~ _It. of drowdown from static level. USDS no. Date well completed gal/min. DRILLER'S MATERIAL LOG Depth below land Give description of strata penetrated surface in leot (size of ~]aterial, color, hardness of drilliug, and water corrtent) .~tO _~.tO .... 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 ___~ / 18~/85 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lo~ 60rth Subdivision S14, T12N~ R3W Location (address or directions) Off B~rch - Sout:h Anchorage (b) Applicant Name (Jh_~.~att Telephone: Home 346-2259 Business 561-1123 Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder L~; Buyer E]; Other [~ (explain); .... (d) I_ending Institution .... Rainier Bank Address U'~ j:F~._r_ ~L~; ~ Branch (e) Real L--state Company and Agent Address Telephone Telephone (f) Mail tile FIAA to the following address: TYPE OF RESIDENCE: Single-Family ~] Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well [~ Commtmity [] 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 L-J Cornmunity [] Holding -rank I~ Note: I1 community well system, must have written confirmation from the State Department of Environmental Conservation altesting to the legality and status. Page 1 of 2 72-025(11.84) ENGINEERING FIRM PROVI1)ING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed Ilereto 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 flies and from my investigation and inspection, the o~-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and reguJadons in effect on the date of this i~spection. Name of Firm _~,J~ ~//~e~-~.t~ Telephone 7~ Date --~ f~ ~,] _ DHEP APPROVAL Approved forx V bed r ° o m s bY ~ q~U/c't~-/'-~--~/~,~--~ -~,~Date Approved /.~' _ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protectien (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 responsible for errors or omissions ~n the professional engineer's work, pRr~r~ ? ,-~f P MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: Lot 6, Orth Subd. S14, T12N, R3W WELL DATA Well Classification ~ ~l'""l' If A, 13, C, D,E,C. Approved (Y/N) Well Log Present (Y/N) ¥ Date Completed 7-8-77 Yield Total Depth 81 ' Cased to 81' Static Water Level 67 ' 24" Casing Height Above Ground Electrical Wiring in Conduit (Y/N) ¥ Separation Distances from Well: To Septic/Holding 'Tank on Lot 200 '+ Y 6 gpm Depth of Grouting Not shown on Log Pump Set At _Not Shown on Log Sanitary Seal on Casing (Y/N) Y Depression Around Wellhead (Y/N) N To Nearest Edge of Absorption Field on Lot 200,' To Nearest Public Sewer Line None :tn Area To Nearest Public Sewer Cleanout/Manhole None in Area To Nearest Sewer Service Line on Lot Water Sample Collected by QUADRA-McFadden ; Date 2/14/85 Water Sample Test Results Passed ; On Adjoining Lots ,. i00'+ ; On Adjoining Lots i00'4~ 200'-F Comments Well passed 4 hfs, of p~lmping @ 3 and 5 gpm with l:ittle draw down. B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Y Air-tight Caps (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) Holding Tank High-.Water Alarm (Y/N) __ N/A SeparatiOn Distances from Septic/Holding Tank: To Water-Supply Well . 200 '+ To Property Line 44' To Water Main/Service Line 80 ' Course None in Area. Comments 1978 Size 1250 gal. No. of Compartments 2 Y Foundation Cleanout (Y/N) Date Last Pumped ; for _ Temporary Holding Tank Permit (Y/N) N/A To Building Foundation 18' To Disposal Field 13 ~ To Stream, Pond, Lake, or Major Drainage Absorption field passed with only a 2.5" rise for 1,020 Gallons. Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ].978 Width of Field 3' Square Feet of Absorption Area Depression over Field (Y/N) N Results of Last Adequacy Test 18 ' Separation Distance from Absorption Field: To Water-Supply Well 200 ~+ 18' To Building Foundation Lot N/A To Water Main/Service Line 175 Type of System Design Length of Field 48' Depth of Field 100" Gravel Bed Thickness 76" Standpipes Present (Y/N) Date of Last Adequacy Test To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course None in area. To Driveway, Parking Area, or Vehicle Storage Area 10 ' Comments Absorption field passed - 2/14/85 Trench Y 2/14/85 To Property Line 43' To Existing or Abandoned System on ;On Adjoining Lots 200'+ Not 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 checke_~ verified, or conformed to all~ O,~ and HAA guidelines in effect on the date of this inspection. Signed ?¢,C~(t/,.,L~ ~-'~yl~4~%,,,'~ate ~//~/~ Receipt No. ,~ Date of Payment ~ ~" ~s,a~tn~(;~ Sea~% ¢~ .;.'- Amou nt: $ Page 2 of 2 MUNICIPALITY OF ANCHORAGE O~:PT, O~: -?Li:' ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECI'IOI~INVIRONME'N]'' ~ CTION 825 L Street- Anchorage, Alaska 99501 F~ B ~ 6 i~/~'i ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 R E C ~ 1 V ~ D REOUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DI FIECTIONS: Complete all Darts on page 1. Incomplete requests will not be processed. Please allow ten (1 0) days for processing, 1, PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT ~lf different from above) 2, BUYER MAI LI NG~DR ESS PRONE PRONE 3. LENDING INSTITUTION MAt LI N~'AODF~ESS PHONE 4, REALTOR/AGENT MAI LING ADDRESS PHONE 5. LEGAL DESCRIPTION STREET LOCATION 6, TYPE OF RESIDENCE [~--Er~G LE FAMILY [] VIU LTl PLF_ FA ~41LY 7. WATER SUP.~1~ NUMBER OF BEDROOMS [] One I-~OU r [] Other [] Two [] Five [] Three I-- Six ~ INDIVIDUAL* ~ COMMUNITY ~ PUBLIC U~TJ~-t TY , E, SEWAGE DISPOS~cL""~YSTEM [~DIVIDUAL/ON-SITE~ [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY 72-010(3/78) * ATTACH WELL LOG. Awell log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) **If individual/on-site, give installation date If s/stem is over two (2) years old an adequacy test is required by ~is Department. ,ACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR ]NSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY E~ ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER [~Septic Tan~or []Holding Tank "~L~..~ Size: ~ :~;'~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS I [~'~"APPROV ED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) ///) LEGAL DESCRIPTION 72-010 (Rev. 3/78) Pebruary 21~ 1979 )~vere%% ~{on~ggor Star l?~ute ~o× g2-~I AnchoraGe: Alaska 99502 Subjeot. Lot 60rth Subdivision A!?¥~r(.~val for your in~lividual so~.,?a~r an~, water facilit&ss will uo.h be granted until %he follo?~ing itc. ms ])aw~ been E×pose the well for our inspection to <let:ermine proper construction,, also,, to ins%ufo the mini~u~'~l distance requirements are met between your well an~'I s~wmr system~ (x) Dc~liver the water analysis repot% to this office for our revie'~Vo P~o~,.ify this depart, men% :for a re inspectS, on ~qh~,n ~'tescr~pancies have b¢~(',n correche¢~o If there are any further questions, please (~on~:.~a~t this o~fice at Sincerely~ Robert C. Prat%~ R,S, Associate S:pecialist ]~eop].es Bank anal Trust Mertgage Loan ~partment Pouch 7,,~007 99510