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Home My WebLink AboutPARTNER PARCELS TR AOnsite File Partner Parcels Tract A PID# 050-751-38 Formerly T14n RIE Sec 33 SE4 SE4 ~' -~ '1 ' MUNICIPALITY OF ANCHORAGE 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 NAME~ MAIL,NG ADDRESS LOCATION Well Absor tion I D'STA=TO, j ~ ~t~c~) IF HOMEMADE: DISTANCE TO: Well Dwelling Manufacturer Well . / ~ F~nd~ DISTANCE TO: ~ /~ ~ I j No. of line¥ j Leng~ch ¢~ J Total~ oCb~ I Top of ti'e to*4s*r'¢ ~.,// IMateri.' ben.arb ti'e Width Liqu d depth PERMIT NO. Material Neare~t~e/~ Trench ' th inches Liquid capacity in gallons Total effective absorption area Nearest lot line Septic tank Distance to lot line QTHER PIPE MATERIALS REMARKS 3 (Rev. 3/78) PERHIT NO. DE'PFIRTP'IENT HEP~[..TH !::iND EN',/iRONHENTIaL ROTECT][ON 825 '"L" STREET., RNCHORRGE., RK. 99501 2e;4-472C~ RPPL i CRNT LEGBL RONRLD KF~RF'ENKO TLI.4NR1E S. 3:2: 'TRR SE4SE4 SRB tg~F:; ER E.R. 99577 L 0"1" SIZE 694-2L:)7S! 999D~9 ~.;(;:¢JF[RE FEET T'¢F'E OF SOIL RBSORPT!ON SUSTEH IS: DR[~INFIELD HFI;:.::II','ILIH NLiHBER OF' BEDROOMS :E;OIL. RRTING <Sg[ FT,,"BF'.)= 150 THE REQUIRED SIZE OF' THE SOiL FIF_.~SORF'TION '_::'¢S]"EM iS: 'THE LENGTH DIMENS_T. ON IS THE LENGTH ,::IN FEET) OF' THE TRENCH, OR [:,RFiIP,IF:[EL.D. THE DEF'TH OF FI TRENCH OR PIT IS THE D]:STFtNCE BETWEEN THE SURF'F. IC:E OF THE Cff~:OUN[:, PIN[:` THE BOTTOM OF THE EXCF¢,,.-'FCrlON (If-,! FEET). THE GRR',,,'EL DEPTH IS THE MINIMUH DEPTH ElF GRF. P,,'EL EfETt-qEEN "FHE OUTFRLL F':[F'E RF,ID THE BOTTOM OF THE EXCRVR'TLrON ,::ZN FEET::,. PERMIT RPPLICFiNT HI:iS ']"FIE: REBPO.NSIBZLZT¥ "FO IIqFORM THIS DEF'RRTMENT DURING THE iNSTRLLFFFiON INSPECTIONS 01:: Ri'.,lU,' I,.!ELL2; RD.TRCENT 'TO THIS PROPERT'¢ RND THE NUHBER OF RES![.',ENCErE; THRT THE HELL HILL SER',,,'E. E:RCKFILLING OF F:!!",!Y ':'.;"r'STEI'4, H!THOUT F'ZNF~L. INSPEC:T!ON RNI} FIPF'RO',,,'RL 8"? THIS DE'PFIR-FHEF,iT I,.!ZLL 8E SUE:JECT TO PROSECLITION. MiI',!IMUM [:,ISTRNC:E BETHEEN Fi HELL FIND F.!N'¢ ON-SITE SEHFIGE DiSPOSR[... SYSTEM ZS :~.8~ FEET FOR R PRZ'¢F~TE !,JELL OR ::[50 TO 2¢E~ FEET FROM R PLIBLZC HELL DEPEN[:,ZNG UPON THE T'.?PE OF PUBLIC HEL.L. H:~N!i',ILII','] DZSTRNCE FROId Fi PRZ~,,'~'!'E 14ELL TO R PRZVRTE SENER LINE IS 25 FEET TO R C:OHh'iUNZTY SEHER LiNE IS 75 FEET. OTHER RE6!UZF:EMEN-FS MW'r' RPPL'?'. SPECZFZCFITZONS FIND CONSTRUCTZON E:,ZF~GR~M2; RF'.E t:]VRIL. REC_E ]'0 INSURE F'ROPEER iNSTlaLI._FITZCd'4. I CERTIF'¢ "f'FIR'T t: I F!i"'! FI::fi"IiLIF:iF,: HITH THE REQUIREMENTS [:"OR ON-SiTE SEHERS RND HELLS FIS SET FORTH B'.¢ THE HUN!E::[PRLIT'¢ OF RNCHORRGE. 2: i i.4ZLL_ INS'FRLL THE S'¢S]"EM IN RC:CORC, RNCE 1.4ITH THE CODES: 3: I UNDERS'FFiND 'I'HFIT THE ON-SITE SEHER SYSTEM F"IR'T' RE*]:~UiRE ENLRRGEMENT ZF THE RESIDENCE :[S REh'iODELEB, 1"0 INCI...UD, E h'!ORE THRN 3 BEDROOMS. flF F'L ! CfiNT ROF,!~:, KF!RF'ENKO MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 4 5 6 7 8 9- 10- 11 13- 14- 15- 16- 17- 18- 20- COMMENTS DATE PERFORMED: SLOPE SITE PLAN WAS GROUND WATER ~' SE ENCOUNTERED? o P DEPTH?IFYES'ATWHAT / t 1~ 1, E' Gross Net Depth to Net Reading Date Time Time Water Drop / PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) I FT MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~..~'~K~ '- ~--//--r~ I~AA # ~/~ ~,- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Location (address or directions) (b) Property owner '~vlJ ~¢~.~-.,,t~J~o Telephone: (home) ~t~0~'Business Mailing Address '~ ~ ~2~!~ ~,~-~,,~.- ~ ~(~.,. ~-- 0"~'/ (c) Lending Institution .. Telephone Mailing Address ~d N ~'~. ~,[1~. (d) Real Estate Company and Agent J~ 0~ Address Telephone (e) Mail the HAA to the following address: (or check hereJ;~if hold for pick up.) List contact person and day phone number below: TYPE OF RESIDENCE Single-Family~it~, Number of bedrooms WATER SUPPLY Individual Well ~ Community [] Public [] Note: If communityf" well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site'[~/ 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. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of thevalidation date shown below, Iverifythatmyinvestigationo'rt~is 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 the date of this inspection. '~ ~ Telephone ~J'~'~ ~ -- ~ //0 Name of Firm Address ~~O ~ (~ /~ Date /7/ Seal 6. DHHS APPROVAL Approved for '-~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 7/88)Back Page 2 of 2 A. WELL DATA Well Classification Well Log Pres.ent IY/N)~ ~) ~Date Completed Total Depth~_/~a~ed to '8~,,~ ~epth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) y SEPARATION DISTANCES FROM WELL: ' To Septic/I-.~NFm~Tank on Lot /,~. ¢ ~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewe? Line '/"/'//,~r To Nearest Sewer Service Line on Lot Water Sample Collected by ~-~ Water Sample Test Results ,~ ~' ~ Comments ./_~/),~. '~/~I~.~/ /'~-~ MUNICIPALITY OF ANCHORAGE (MOA) ,'('~'~,~1 ~%Health Authority Approval (HAA) .~ ~/ ~" C~CKLIST- FEBRUARY 1984 ~;~ . ~ 343-4744 ' " ( ~ Legal Description: ~ E ' If A, B~ C, D.E.C. Approved (Y/N) ~/~ Yield /7/, ~d',~L- ~-' '// 5'6 Pump Set At ....... i - Sanitary Seal on Casing (Y/N): '~// Depression Around Wellhead (Y/N) ~',~. ; On Adjoining Lots / ~ ~- ~-~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole B. SEPTIC/HOLDING TANK DATA Date Installed ~/(~,~- Size l¢.~ot::~ No. of Compartments Standpipes (Y/N) 'T'~/C) Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) Foundation Clean, ut (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well [~' ~ ~ To Property Line ~ IO To Water Main/Service Line ~ ! ~ To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/~ ~ Width of Field ~O~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field '70 Depth of Field '7' Gravel Bed Thickness ,.~, Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: / ~';~ ~ To Property Line To Water-Supply Well To Building Foundation /~/,~ ~ L o t To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) Comments D. LIFT STATION No H~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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 Company MOA No. Receipt No. Date of Payment Amount: 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Engineer's Seal UNSUBDII/IDI£D / ~EAGLE / / DT1001278 ~ x PARTNER PARCELS 1978-1662