HomeMy WebLinkAboutOUR MOUNTAIN BLK 2 LT 8NAME MUNICIPALITY OF ANCHORAGE ~,~/o DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION /,,¢.~/0~.¢._/ ENVIRONMENTAL ENGINEERING DIVISION ¢.~7.~/.//~.Ct/ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT MAI LING ADDRESS LEGAL D ES~R-I PTION LOCAT,OZN~ ~o 7/_ Manufacturer ILiq. capacity in gallons IF HOMEMADE Well DISTANCE TO: Manufacturer Well DISTANCE TO: No. of lines ! Length of each line / Top of tile to finish grade Length Type of crib Crib diameter Absorptioo area Dwelling gth Width Dwelling BONE k NO, OFBEDROOMS3 PERMIT NO. No, of compartments Liqoid depth PERMIT NO. Material Liquid capacity in gallons Foundation /NearesTTot line PERMIT NO. (' Total lengt~ o~ine~ ],Trench width ~<, ] Distance between lines / ~ *-J ~ C ~// inchesm M~terial beneath tile ii J Total effective,~bsoFPtion Depth / PERMIT NO. Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Driller Distance to lot line PERMIT NO. DISTANCE TO: Sewer line Building foundation Septic tank Absorption area(s) PIPE MATERIALS SOIL TEST RATING INSTALLER / / REMARKS / / APPROVED ~'~ ~_' .... _., ~ ' DATE 12-813 (Rev. 3/78) , ;' MUNICIPALITY OF ANCHORAGE Department ~ Health and Environmenta] ~rotection '~-q~/L~--- 825 ~ Street, Anchorage, AK. _3501 ~ ~ ~?~ 264-4720 * Permit ~ ~$©%%q, WELL AND~ ON-SITE SEWER PERMIT Applicant: Location: Mailing Address: Phone Number: Legal Description: ~ ~> /~ ~ ~5~d__.ff_ ~z.~-L.~. Lot Size: Type of Soil Absorption System Is: Trench: ~/~ Drainfie'ld: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~' DEPTH The Required Size of the Soil Absorption System Is: LENGTH ~'7 .. GRAVEL DEPTH c/ WIDTH The length dimension is the length(in feet) of the trench or drainfieldo 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(HQt-D~-Na) TANK SIZE = /~C© 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 departmen~ will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee~ 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. W.ell 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 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 residence is remodeled to include more that 3 bedrooms. SWP/024(1/81) ; MUNiC[PAL~IW OF ANCHORA(E Oepa~tm~nt Of [{~alth a~d ~iro~e~ta~ ~rot~otion /~;~w.,~{-,.-g' ' 825 L ~t~ee~ Ancho~aga~ ~g, 99501 ~ ~ ~ HAnDWRITTeN P~RM[T ~ N ~ ~,~mi~ ~ ........ NELL AND~ ON~S[T~ 8EWER PERMIT i Applicant: 'A , .. ... ~'6- Mailing Ad~e~ ~ ~' ~: Type of Soil ~o~ptJ. o~ Sy~te~ . ~. ' /,3,.-'5' .. '.Phs R(~i%re4 ~za of the Sol1 Absorption Sy~ta~ The ].onp~h ~tmen~ion ia the lenqtt~(in fa~) o~ the tcew~l~ or drain~/e~ The gravel ~epth is ~ m~imum depth of gravel bat, ween ~ha outfial~ Lhe ~tto~ of the ~x~avaLion (i~ fe~t) , ~ ~ REGUIRED $EP~C(HO~) TANK $1Z~ = ~.0 GALLONS e ~a~mit applicant t~as thG ~aaDonsibilit. Y to ~ll~O~ ~hia daDarbraent dur~aq ~h~ ' ~ ~ TWO(2) INSpEcTIONS Afl~ fl~aU[R~O ~ ~ * ~ackfillin~ of any ~ysb~ w~.ahaub f~ma~ ~n~speCb).on and aDprova~ by ~h~ ~ill ba aubje~L tO pt:o~ecu, t~o~, ~. ~{~ distance betwaon a well and any on-site s~waqe di~l?O~a! ~ystem is 106 '- for a private wa],l or t50 to 200 feet from a pubhx: wel[ d~pend~ng upol% t]l~ t, o~~ public well, MLI%~ dist~ca, from, ~a priva~ well to ~t private sewer, ,l&~"~,. ~ 2~ feet and to ~ Oo~ty s~w~r lzn~ i~ 75 ~eat, Wall logs are Other ra~i~emsnt~ may apply, Specifications ~d constr~ctton dkagr~ i certify that: ~et forth by th(~ Mtu~i~ipa].J. ty of Anchorage. ' rsmmd >/% q., ,Permit ~ ~ : 82070:: January 31, 1983 TO: Permit Applicant Subject: Lot 8 Block 2 Our Mountaki~ A permit issued by this department for an individual we]A and/er en-site sewer system has expired as of December 1982. Permits are issued on a calendar -/ear basis, as shaae'! the permit, by authority of Municipal Ordinance. if you have drilled the well., a we] ! leg needs to he sent to this department for documentation of the instal.'at~on- date and te clese the permit° If a private engineer inspected the insta]_lahie~.~ e[ tho on-site sewer system, please have them send us ~R'.e [er cur files and decumentatien. If there are any further questiens, please cal! this effice al: 264-4720. Sincerely. Rebert C. Pratt, R.S. Acting Pregram Manager Sewer and Water Pregram RCP/ljw eno: Copy of Permit SWP/057 'Tp i 009 993M '@ dLund loS :]310ANI 9NllllUQ NO~qlM ~ SUOlieD 6umnpoJd si IIOM s!qi I¥1UNIClPALITY 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 S~.p~¢jw~c'h ¢~ Iq,~6 _ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lo~'~lock 2; ~ Moa~ain Subdd~io~_ Location (address or directions) (b) Applicant Name ~. -(;;~6J~.~.!~, ___ Telephone: I--Iorne ~.~ ___ Business Applicant Address __ 4~0_1 Ar~bZ¢~ ¢!.ir~.&~~ A~a.sJza___~9_504 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer ~; Other ~ (explain); (d) Lending Institution Address AT_TJ:.ALT~0~_ (e) Real Estate Company and Agent no~e Address Telephone Telephone (f) ~l~he HAA to the following address: S & S Engineering SRB 196X Eagle River Road Eagle River, Alaska 99577 'rYPE OF RESIDENCF Single-Family [] Multi-Family[] Number of Bedrooms Other WATER SUPPLY Individual Well ~ Community E] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public F~ 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 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA,i~, 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 fudher 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 regCations in effect on the date of this inspection. Name of Firm ~ & $ ENGINEERING Telephone __~/> ~ ~ ~ SE B 196X Address Date ~GLE RIVF~R, Al( 99577 DHEP APPROVAL L~,~) ~.4, Approved for T~___beOroomsb ~ ~.~ c~ Dato Approved ~" Disapproved Conditioffal 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 i*egistered 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 DHFP do not conduct inspections.or analyze data before a cedificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the p~'ofessional engineer's work, Page 2 of 2 72-025 (11/04) MUNICIPALITY OF ANCHORAGE (MO~I HEALTH AUTHORITY APPROVAL (HAA) /,.,~C~O ~,G~~,'" '_~ CHECKLIST264.4720" FEBRUARY 1984 Well A, B, C, D.E,C. Approved (Y/N) Total Depth I t .% Cased to //.~ Static Water Level Casing Height Above Ground ,._~, / r Electrical Wiring in Conduit ~N) Separation Distances from Well: To Septic/Holding Tank on Lot / (~' Depth of Grouting ~' Pump Set At Sanitary Seal on Casing ~N) Depression Around Wellheadg,(~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole water Sample Collected by _,~ Water Sample Test Besults Comments \ ~.//.~' L-5- \/1~'¢.4~ ; On Adjoining Lots /¢~/'¢' ; On Adjoining Lots ~(.2¢2 r -~- To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date ~/ ~'/O Date Installed / /'~-'-'-'~/~Y Size /~O7~ (~'/~¢,.- No. of Compartments Standpipes Y~N) __ Air-tight Caps ~"4) Foundation Cleanout ,~N) Depression over Tank (Y,~ Date Last pUmped Pumping/Maintenance Contract on Fide (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: · for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line ' To Water Main/Service Line Course b//A To Building Foundation ~" To Disposal Field /~' ¢~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ,-~ Lot Type of System Design i/~d~)L~"¢ Length of Field ~'¢'! Depth of Field Gravel Bed Thickness ~! Standpipes Rre~ent (~1) Date of Last Adequacy Test 7/',~'/~ (¢' .s PCrc o y pcP-. $ To Water Main/Service Line ?C~' ''~ 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) 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 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. // Signed $&$ENGINEERING Date Company~R B '~6X MOA No. EAGLE,RIVER, AK 995 [, Receipt No. /---~.Q CD I - Date of Payment ~ ~'~ '/':?' Amount: $ U/'~...~r~' O~ Page 2 of 2 72-026 (11/84} APPLIC. FILLS OUT UPPER HAL ONLY Mailing Address /-" '.~'~ Buyer Address Zip Code Phone Lending Institution Address ~:- :. __ -,;,.,,~, Realty Co. & Agent Address Zip Code Zip Code Phone Phone Street Locatio~ -'~: '~ ") (~ ,/',. '\ ,. :-7'-7::: .~""· _(.'% Type of Residence  Single Family ._? Multiple Family No. of Bedrooms _ -~ [] Other Water Sepply ~ individual ATTACH WELL LOG· A well Icg is required for all wells drilled since Juno 1975. [] Community For wells drilled prior to that date, give well depth (attach Icg if available)· [] Public Utility Sewer Disposal ' ~ Individual ' Year Individual Installed: //_ 'i? ~' ~L [] Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE iNSPECtioN FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Date Inspeclor Field Notes: Time Date Inspector Date Inspector Time Date Inspector ~ ) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDFrlONAL APPROVAL' DATE L' '-~ ~ '~;: '/'' *CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Welt To Absorption Area Well to Tank I .(.', ~' Well Log Received Septic Tank Size 72-023 Scotk i,/o.'l, fo o /\ well lo,3 subu, lJ. ttecl to this ol'~{ice toy eu? f~.l.~ss an(i a~-builts o~J t~b} installation in this o~ffico. en<.~ineor inspectec~ the syst:e~0, pi. ease send not(wi discl?cpancJes hav+~ been cx}Frected. ].f t~ero aye any' fuF'ther que~tions, [YLo~e call this~ ot;t'[CO at 26~-4'72U~ sinc<;rety, Cory Willis, acting t',o. wo~-