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HomeMy WebLinkAboutRAYMOND TEDROW BLK 4 LT 1 'UNICIPALITY OF ANCHORAGE Heal and Environmental Protect n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 SEPTIC T/U',~K: DISTANCP[ FROM \,V ~ L_ L NUMBER OF COMPARTMENTS '~'~- INSIDE LEt;C-'.¥tt .... II',ISI[2, E "¢lDl'tfl_ I_IQUID DEPTH LIOUID CAPACITY I(-.~-2 GALLONS. TILE [DRAIN r:IELD;~'~(X ,, ~. [ I TOTAL LENGTH [j l DISrANCE FROM W{~LL ~_FOJNDATION__~© _NEAREST LQI' LINE ~ ~ OF LINE ~ AF)SORI'TIOFI ,.XREA ..~_~ ____ SQ. FT. [ ENG'FH OF EACtl LINE DEPTIt OF FILTER OFPlll: lOP O!' ~lt_[ ~O FIr,ilSII GRA[)E ~'~ MAil-RIAL BENEATH TILE ~_~-~_ N, ABOVE TIlE ~ IN. SEEPAGE PI'Y: DIAMETER __ OR WIDTH ..... EEI'iGTH____, DEPTH Log Crib Rings [3UILDIN(; FOUNDA !ION __. Crib Size: DIAMETER .... DEPI-14___ DISTANCE FROM: WELL q OTAI._ EFFECTIVE NEAREST LOT LINE____ ABSORPTION AREA (WALL AREA) SQ. FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~ of Bedrooms: Installer: Remarks: __r:~'~ APPROVED L}EPIqRTI',IENT OF '-IEI::tLTH R .,Il} ~.,il,,, I RONHEIq'I_~L , RPPL I CF:tN'T' ~',l:ll"t COTTON 80~',,';'c ..... ~ EF~GLE R I ',/ER IBK ~:~5",::'E' -./r:-,q,....,.. ~_~_. ~."~.o=:',_,._~ t...OCFIT i ON I}I':~NN E:'T~fEE~'~~ LIE. GFII .... I...:1. B4 TEE:,B?.ON '~ ..E~I:':' I....OT._,'ZIZE EiF~FIFI ...... S"~. RE'~.,... FEET 'r'YF:'E C)F S;O~L. FIErZ'J'RETIZH SYSTEM IS: 'T'RENCH I'"Ii::I:~.~',IMIJH NUHSER OF EED~']TI¥1'.E = 't'lql~E: I:~:EQIJI. REI)'.E:IE'E OF THE r~OIL. ~E~SORPTION ~ I E.H I.S: THE I._ENGTH [:,iMENSIOI'.~ ~E; THE I...ENGTH ,'IN FEET', OF THE I~EN..H L'F~' I}RRINFIELJ}. THE DEPTH OF A TRENCH OR F'J'I" IS THE [:,LE;TRNCE E,E. IHLEN THE c RFFI-E OF THE GI~:OIJNI]:, FIN[:, THE E~OTTOM OF THE E',,~',]:R',,,'R'I'ION ,' J Iq FEE'I"', '- ...... l ~.EN 'THERE ~S NO z,EI 14JDTH FOR ..... ' ...... THE ..... ;'"'"',,"'"" .~.P, EL BETWEEN THE OI...ITFFll. J.. PIPE ~r.m,~ DEPTH IR; THE I"iINJHI. JM [:,EPTH ~l"~[:, THE 80T'T'C~M ()F THE E~'~',CA',,,'RTION ( IN FEET). FI PFI[;K~(]iE PLI::)NT MR"r' IBE INSTFIL. LE[:' FIT THE PERMITTEE'"S OPTION '.51...18.YEC"F TO "FFIE FOLI..JDN I NG COND 11" ~ ONS: :1.. EITHER Ft C:LRSS ~ OR ~ N~E;F RPPROVED PLRNT MRY BE ]NSTRI....L. ED, I::I [~]]N'I"]NUI]IIJ:~ I"iFtI NTENFINCE FIGREEMEN'F IS REI~IIJ J RED. IF Ft I"IRI NTENFINCE. I~GREEI'dENT IS NOT KEF'I" CURRENT YOU t'iRY BE REQLI~RE[:' ]"0 EI",ILRRGE THE SOIL. [r~E:E:ORF'TIIZIN ~YE;TEM RN[::,,..'OR YOI.J H~Y E:E SUE:JECT TO F'RO'.E:EC:IJ"I'ION. MI I'.,IIMIJM I:)IiB]"FINC:E E;E'I'I,.IEEN FI !4EI~.L. FIN[::, ANY ON-iE;.'["FE SEP.IAG[:' D ISPOSFIL. SYSTEM :I.E~CI F'EET FOR F"~ F'RI',,,'RTE NELl... OR ~i'.¢."lEl FEET FOF.'. FI PLIBL. IC NELL. (]THEIR RE[.:!U I REMENTS I'"IFI'~-' FIPFi.2¥'. SPEC: I F Z CRT I ONE; FIND L-:ON'.':..";TRIJCT' I ON [:, i FIGRFIM'..:i; laRE A'v'FI I L.FIBI...E TO I 1'.4E;I...IRE F'F:'.OPE:R I NSTFtI~..LFITI ON. :[ CIL:]:~:T]:F'Y TI-fl:IT :L: I FIM FFIM:[I....IFtR NI'T'H 'T'HE REQUIREMENTS'; FOR ON--L-lITE SEWER'-:..'; RN[:' I.,.IEL. LS FIS SET F'OF;.'FH-I [:J"r' THE i'"ILII",I I C I F'FIL I "l""r' OF FINC:HC~RFtGE. 2: I NIL. L. IN':STFII...I._ THE :F.,Y'.::qTEH Ihl FICCORDF:INCE W.'[TH THE CODES. ii:: I IJi'.,I[:,ERS;'TFIN[:' '['HRT THE OI",I~S]:TE SEI.,-!ER S"r'STEH HFIY F,'E[:~UIRE Ei"~LFIRGEHENT IF TFIE RESII)ENCE ]:S REMO[)EI..E[) ]"O INCI..;I...I[:,E MORE "['HFIN ]: E:E[:,ROOMS. FIPF'I.... I CF:INT F:;FIM COTTON O 8- E GEOI' Russell Oyster 694-2774 Soils Et Foundations Performed for: Name: .~:~//x~y Mailing Address: Legal Description.'.}-O-~ '-'-~_~ Depth (feet) CHNICAL 8- DEVELC Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOZL____LO~G IVIE NT CO. Earl EII/s 688-2280 Land Development Tel, No, ~/' ~':/'- ~Y~-~ Soil Characteristic~ 2 14 15 ~6 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No /~'"' If yes, what depth Drain Field~ Performed by: .... '~ ~'i !~ Date:_ MUNICIPALtYV OF ANCHORAGE DEPAR'I~MEI'4T OF HEALTH AND ENVIRON~i',tNYAL DIVISION OF ENVIFIONi'~EN~i'AL I-IEAL'i'H CERTIF~CA'¢[ L OF INSPECTION FOR HEAl_TH AUTHORITY APPROVAL OF ON-.Si"I'E S~ilWER AND WATER FACILI'i'Y Application Da~e GENEI:~f,.tL INFOI~MA¥1ON (b) (c) t,r,;~ al ,Oo'~¢rtptioh 0ncludo lot, block, s~Jbdivisio~,~.,se~ction, to~w~ship, r'ango) -,--- / . ~1 .... .., , ./ . ,~.- .. , , ,.' f ., . ..... ~.,../.- .f ..... ¢"d' ~,~¢¢i . /_ .... ??. '(~_ ~" ;.::'-'~:.. ~Z__._.-A ..... ~ ~ ¢ ~.A~-~--..:~'" %~%-/:---~:~%~-::-~::L~-:-~: ~L'~:~::~-~'¢'-:.~-c'~'~'*' Location (~(Idro~ or d~recbons) _ ', - ~ ~ ~.2: .....~-~:):-" c~ .- .................................................. , .. K AOp, ic~nt ...... hame- ", ': . .,.- ....... ' ( .4_.,=~.:_.__ :_. Telephone: Horne Ek~siness App)ic~nt Addr~¢L:b ........................................ Apphcant is (check one): Lending Institut~on F~; Ownor/builde~0 Buyer [~; Other ~ (explain); (d) I.,orldmg institution .................................... Telephone ........................ Address ................................................................. (e) Real Estate Company and Agent Address (f) Telephone _ !~i~i'~:~ HAA tO the following address: 'tYPE OF RESIDENCE Single-Famify'~'Z~, Multi-Family D Other Number of Bedrooms ~ __~ ......... WATER SUPPLY h'ldividual Well [] Cornmunity E.~ Public ~4~ Note: If community well system, ~nust have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~/~. Public [] Community ~ Holding 'lank [] Note: If comrnunity well system, rnust Iqave written confirmation from tt~o State Department of Environmental Conservation attesting to the legality and status Page 1 of 2 ~z-025 ¢~ 841 ENGINEERING FIRM PROVIDING ~qSPEC'i'IONS, r~'ESTS, FILE '-~ -- ' ' , - · AS cedifled by rny seal a~fJxod hereto and as of tl~e validation date shown below. I Authority Approval shows that the on-sito water supply and/or wastewater disposal %,atm,~ : for tho Rur~ber of bedrooms and type of structure indicated herein. I fL~rth6r verity fi'om the Municipality of Anchorage files and from my investigatioe and iuspcctien, wastewaler disposal systern is in compliance with all Municipal and State codes, ordin~ the date of fi'tis inspection. Name of Firm , , ,, .,~p,,~,,,,,:,,.,,~,l~:~ 'Telephone Address ........ ~.-7;-4~F4{: .bd~:kA~'.~5~ / Approved for ~_~:~_--:.~'?::._¢bedrooms by ~ Date 2. .............. Conditional,-.--, Approved ....... ~_~ ...... Disapproved Terms el Cor;d~lion.,I Approval CAUTION Tile Munc~paht'/ of Ancl~orage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval cr:rtif,ca'~es based solely upon the representations given in paragraph 5 above by an indepeudont professional engineer registered in tho State of Aiaska. The 13HEP does this as a courtesy to purchasers of homes and their lending instituhons :; order to satisfy certain federal and state requirements. Employees of DI-IEP do not conduct ~nspections or analyze data hsfore a certi[icate is issued. Tho Municipality of Anchorage is not responsible for onors or omissions in the professional er~gmeer s work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) .._ HEALTH AUTHORITY APPROVAL (HAA) ~NVIRo~, CHECKLIST- FEBRUARY 1984 .... Legal Description: L., o'"~- WELL DATA A Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments _ If A, B, C,' D.E.C. Approved4~N) Date Completed Yield  _ D~/pth of Grouting /, Pump Set At /, Sanitary Seal on Casing (Y/N) /'~ Depression Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/I,~EEHN6~ TANK DATA Date Installed q- Standpipes(~I/N) Depression over Tank (Y/J~ Pumping/Maintenance Contract on File Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic~le~li~g-,Tank: To Water-Supply Well To Property Line t To Water Main/Service Line _ Course _ Size ! ~L~ NO. of Compartments ~--.-, Air-tight Caps~N) Foundation Cleanout~J~N) Date Last Pumped ~[ - ~ t //~, ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(lW84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - ~ Lc ~ "7 ~ Width of Field "~' "' Square Feet of Absorption Area Depression over Field (Yd~P Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness "~ '~. Standpipes Present Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot '~ //~ f To Water Main/Service Line (. c:~ 4- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~.c~ t d= To Existing or Abandoned System on ; On Adjoining Lots ~ 14' Zo/~utbank (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. .~-~t r:t ~ Date Signed Company Receipt No. Date of Payment Amount: $ MOA No. Page 2 of 2 72-026 (11/84)