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HomeMy WebLinkAboutROCKHILL BLK 3 LT 3 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONIVIEN'rAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONI MAILING ADDRESS LEGAL DESCRIPTION LOCATION Absorption area Dwelling Ma Inside length Width Well DISTANCE TO: I /~-)~ r Manufacturer ~... ILiq. caBacity ngallons IF HOMEMADE DISTANCE TO: We I Dwelling Manufacturer DISTANCE TO: Well l/~.~O I / Length of eac~li.~e Top of tile to finish grade 7~' Length Width Type of crib ;rib diameter DISTANCE TO: Yell DISTANCE TO: Depth Building foundation Foundation Total length of lines ~/-~ Material beneath tile Depth Crib depth Building foundation Driller Sewer line Material ~ Nearest lot line Trench w~t~___~, inches NO. OF BEDROOMS ~ERMIT NO. '~-I0 Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO,¢~./~.~ .~ ~__ , Distance bet wee,~/~//~ Total effective,.~so~)on area PERMIT NO. ITotal effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING APPROVED DATE LEGAL '~' PERMIT NO. PIF F L I _.HNT LOCRT I ON R- LE.~HL L. HELE_,uN L.i:JN.-,TF..UL.T 101',I MRIN TREE DRI',,,'E L.~, TM B -~ RUCKHILL ~..,,."D [:,EPRRTMENT O, HERLTH FiND ENVIRONMENTRL P~,{TECTION 9'25 'l_" .STREET, RNCHORRGE., RK. '9~"='0:t ~.~_~'~./~" 'fS~ 264-4728 ' PO mFI .... ' " ~ ~95&~ ~ ' ~"' '" LOT =,IZE ~c,o~= SQURRE FEEl' TYPE OF SOIL RBSORF'TION =,'r_-,TEM IS: TRENCH :,OIL. RRTING ("',Iq FT/BR)= MR::..',IMLIM NUMBER OF BEDROOMS = 4 _,I~E OF THE SOIL RBqORPTION =~r_TEM : 'THE RE".;!UIRED c ~ _.. ~ ,c, IS [:,EF'TH= '---~- [_ EI%~,STH = 4-----=: ,3 R R'-.-' E L [)EF'TH= THE LENGTH DIMENSION IS THE LENG'rH (IN FEET) OF THE TRENCH OR DRRINFIEL[:,.-- THE DEPTH OF R TREN_,H OR PIT IS THE DISTRNCE E:ETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRR',,,'EL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E>(CRVRTION (IN FEET). F:E,;~L~ I IqE[:. SEPT I F'ERMIT RPPLICRNT HRS THE RESPONSIBILIT?~ TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RN'¢ WELLS R[:,JRCENT TO THIS PROPERTY RND THE · , ' ' '~ · I-' - '~ NUMBER. OF RE_,IDEN_.E_ THRT THE WELL WILL SERVE. T I...~3 (=':' .') I [~SPE"]T I - BRI_.KFILLIH~ OF RNY :~:TEH NITHOUT FINRL INSPECTION RND RF'PROVRL B'T' THIS ' '- ~ R PROSECUTION. DEPRRTHENI' WILL BE :,UE, JE-.T TO MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SE[,.IRGE DISPOSRL :,~-,TEM t0~ FEET F]E R PRI',,,'RTE WELL OR i50 TO 2F~F~ FEET FROM R PUBLIC NELL DEPENDING ' F: UPON THE TN'PE OF FUBLI.. NELL. MINIMUM DISTRNC:E FROM R PRIVRTE NELL TO R PRIVRTE SEWER LINE IS 25 FEET RN[:' TO R COMMUNITY SENER LINE IS 75 FEET. WELL LOrn:, 8RE REQUIRED FiND MUST BE RETURNED TO THE DEF'~RTMENT WITHIN OF THE WELL UOMFLETIUH. OTHER RE~UIRENENI-,": M~Y ~PPL'¢. '-:,FEC. IFIbHTIUN-,C ~ND' CONSTRUCTION DI~GRFtMS ~RE ~'¢~IL~BLE TO INSltRE FR_FER INST~LL~TION. F'ERr'I I T E.--.P I RE--. [:,EC:F~-r-IBER ._--::L.. "-1- 3~c: :-IL I CERTIF~¢ THRT ,- . . .,_,=. ,=. J.: I RM FRMILIRR WITH THE REL.-~.LIIREMENTS FOR ON-SITE =,EWER=, RN[:, WELLS 8S _,ET FORTH BY THE MUNIE:IPRLIT"r' OF RNCHORRGE. 2: I NILL INSTRLL THE --,'r_,TEfl IN RCCORDRNF-:E WITH THE CF~E:,E'-';. 2:: I UNDERSTRN[:' THRT THE ON-SITE --,EHER S"r'STEM MR"r' F.:EI,.UIF..E ENLRRGEMENT IF ]'HE ' '-- " -' I S RE_I[.ENLE . REMODELED TO INCLUDE MORE THFtN 4 8E[:,ROOMS. _, I _~HE[.: RPF'L I CRNT C:RRLESON CQNSTRIJC:T I ON I S'-]UED B'T' [ HTE U~J~L LOT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST DATE PERFORM LEGAL DESCRIPTION: ,L 1 2 4 5 7 9 SLOPE (~SOI LS LOG [] PERCOLATION TEST _AN 10 11 12 13 14 16 17 18- 19 2O COMMENTS NO. 1732-E June 22, 1968 PERFORMED WAS ~ROU"D WATER ~o ~ ENCOUNTERED? _ O P E iF YES, AT WHAT DEPTH? Gross Net , , Depth to Net Reading Date Time Time Water O Opr , PERCOLATION RATE minutes/inch) TEST RUN BETWEEN , FT AND , FT Z' u c . Well Log For ................ :. .................... ~ ....... . .,-'.'. ;., .......................................................................... L o cation ..... ~ ~.~ ..... ~.~ ....... (~ ~. .... ~;~ ......... ~75::~ ~ ....... (fL(.:~..-. ..... ~ ~. ~. ?.. :'. ..................... Date completed. ......................................... : ............................ '~u~o~u~"~'~'o~ · Depth of well ................ : .......................................................................................... . Size of casing ........................................................................................................... Distance to water.. .~u & ............. : .......................... Dist~ce to water while pumping ........................................................ at rate of ................ '.~ ............................. gallons per hour. Formation from to '-~ / '7¥.' Driller DELTA DRILLING COMPANY SRA BOX 394 B ANCHOraGE. ALASKA 99507 Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~) \ Z'~ I~ ~ ,'~-(~\ HAA # GENERAL INFORMATION Complete legal description Rockhill Lot 3,' Block 3 Location (site address or directions) 9600 Hain Tree Drive. Anchoraqe Property owner Mailing address Lending agency Mailing address Wayne & Betty Brown 9600 Hai~ N/~ Anchorage: AK Day phone 346-2746 Day phone Agent Bonnie Maynor/Jack White Address 3201 c K~r~, An~h~raq~, AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 "4 TYPE OF WATER SUPPLY: NOTE: Day phone 762-3110 ndividual well x Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site x Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA#21 s),uewwoo leUO!~!PPV :suo!jelnd!ls §U!MOIIOJ eql ql!M 'SUUOOJpeq JoJ leAoJdde leUO!lipuoo 'peAoJddes!Q 'SwooJpeq __~ G6Z§ ~69 euoq8 .~oJ. peAoJddV ~' =IEIrI.L~fN~IS SHHO LLG66 ~ ' .z~A~E L L~xo~ ei~i~uD!s s'Jeeu!bu=lssej p PV · uol3oedsu! slq3 jo e~ep eq~ uo 3oejje u! suo!~elnOe~ pue 'seoueu!pJo 'sepoo e~e~S pue led!olunlAI lie q~!t~ eoue!ldLUoo u! s! LUe3S~S lesOdS!p je~eMels~ Jo/pue/qddns ~ele~ e3!s-uo eq~, 'uol~oedsu! pue uo!~e§!~se^u! ~LU LUO~J pue sel!J e§e~oqouv jo ,~!led!oiunlAI eq~ LUO~J peu!m, qo UOI3eLUJOJU! eq~ uo peseq ~eq~ ~Jpe^ Jeqpnj I 'u!e~eq pe~eo!pu! e~n~on~s jo ed~ pue SLUOO~peq ,tO jequJnu eq3 ~o~ e~enbepe pue leUO!~ounj 'e~es s! LUe~S~S leSOdS!p ~e~e~e~s~ Jo/pue ~lddns ~e3e~ ei!s-uo eq~ 3eq3 s~oqs uop, eo!ldde le^o~ddv ~poq3nv q~leeH s!q~ ~o ~LU ~,el.J:~/~JlJeA I 'MOleq UMOqS elep UOp, ep!leA eq~, ,to se pue o:~eJeq pex!jJe leas/~uJ Xq pe!J!lJeo s¥ '9 I:I=I=INION=1 Ag NOI.LO=IdSNI 40 .I.N=IIN=I.LVJ.S 'S Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) ,/'~-'-'/*',~'/-c If A, B, or C, attach ADEC letter. 21/ Date completed ADEC water system number Driller Cased to ~d' / Casing height Wires properly protected (Y/N) /// Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ~'/.~ P~bl~c sewer service line g.p.m. ; On adjacent lots //~° ' ; On adjacent lots ~'/,~ Public sewer manhole/cleanout Petroleum tank '"~'"~ WATER SAMPLE RESULTS: Coliform Date of sample: Collected by: Other bacteria B, SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) water alarm (~.. High Date of pumping Tank size /,o~.-~ Compartments ~ Foundation cleanout (Y/N) .// Depression (Y/N) Alarm tested ('(~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /'~' 5'/ To property line ~"~ Surface water/drainage On adjacent lots 2'~/'~ / Foundation -'~' / Absorption field /e-' Water main/service line ~-/o 72-026 (Rev. 3/91 Front MOA21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length .~ / Total absorption area Width Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) Soil rating ,=~5- System type Gravelthickness_ z~,' _Total depth ~" Cleanouts present (Y/N) Date of adequacy test ~/"~.,/~ for '""',/,,¢- If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation Onadjacentlots ~'~ / Surface water Curtain drain On adjacent lots ?'"~'~ ' Property line ?/ 5-~" To existing or abandoned system on lot Cutbank -"//~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number A Eagle River Engineering Services 11940 Business Blvd. Suite #205 P.O. Box 775294 Eagle River, Ak. 99577 694-5195 Fax 694-5297 J Legah /ff,~o/~/n~t, LOT' TS., ~ae~ $ Owner: k,',4/,~ ~' 8'~:~'~'~' -7~ ~-,,~./ Date: JType of test: /l~Well Flow Test [] Septic Test Only [] Well & Septic Test [] Other: Meter Monitor Well Tank GPM PSI Remarks Time Reading Level Level Level /,y ; 2zt In, 5 ~2, '2 /" 55 CHEMICAL & GEOLOGICAL LABORATORY Cllont Client bm ! Oral.od ~0 ! NOJi {ICIIVSD 2) Allowable ....... ~ ..................................... 2.4 WI I~l 3S3.Z lO Ml~Tl-N Above UA.~rdveihble APPLI ' '\NT FILLS OUT UPPER HA ONLY P~gP~grtyC~vner .~'~>L4- C'~. 7' Phone ~-' ~ ~ ~ Zip Code Buyer /..~ /~}',/~-i ,~., Z,p._20 64,3 H /~ ,~/~- ~/lrt ~- Zip Code . Lendinglnstitution /~'r/~:~7~ ~/~'t~2. ~r'~ /'?f'~'b''4-~l~ ,none Address /L. '7///~ ~..i~ //~/~/'Tb Street Location O0 +~1~ I ~'- Type of Residence  Single Family Multiple Family No. of Bedrooms [] Other Water Supply ,~ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [] Community For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal ~ Indi¥idual Year IndMdual Installed: f / -'" ! [] PuBlic Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector JV1 JNICIPALITY OF ANCHORAGE Field Notes: DF~T C ENVIR D; ~;, :r,:,'~ ..... O, ~-'.~[ION RECEIVED { ) DmAPPROVED ( ) CONDITIONAL APPROVAL* Soils Rating Date Sewer installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size ALASKA " ,IUIROFIIlleFITAL COFITROL SE!I dlC S, IF1C. ~nqineeHn§ $ I~nuironmentul Studies February 10, 1983 Municipality of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority On February 9, 1983 our company collected a water sample from the house located on Lot 3 Block 3 Rock Hill Subdivision. The property owner is Bowman. The water analysis was satisfactory. The well has a seal and the casing stands approximately 1 feet above the ground. The electrial wires are completely enclosed in conduit. Ail standpipes are capped. A copy of the report is attached. Sincerely, 1200 LUest 33rcJ Auenu¢, Suite J~ · Anchoreq¢, Alaska 99503 · [907) 276-1361 ,,, DATE RECEIVED " INSPECTION APPOINTMENTS 'rIME TIME __ A~-~ TIME DATE DATE DATE (~ -- INSPECTOR INSPECTOR INSPECTO .~ R~ MUNICIPALITY OF ANCHORAGU MUNICIPALITY OF ANCHORAGE DEPT. OF 1ff2/,.LTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO~ENTAL [:,[~OTECTION  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION O:P~ Telephone 264-4720 R E C E I V E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES )IRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.  PHONE MAILING ADDRESS PROPERTY RESIDENT {If different from above)- PHONE MAILiN~ADDRESS 4. REALTOR/AGENT ] PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS~= ~ One ~ Four ~ SINGLE ~ Two ~ Five FAMILY ~ MULTIPLE FAMILY ~ Three ~ Six [] Other 7. WATER SUPPLY ~.~ INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** /¢5/ [~] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79} )~,/ ] THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS I'~ ONE [] THREE [] FIVE [] OTHER SINGLE FAMILY [] 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 Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Sept[c/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~'~'APPROV ED FOR z~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY