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Home My WebLink AboutHIGHLAND HILLS #2 BLK 2 LT 8B05o I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SF. WAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT -NAME~ t//'- /PHON~ ~EW ~'~ LEGAL DESCRIPTION LOCATION NO, OF BEDROOMS Well Absorption area/ Dwelling PERMIT NO. DISTANCE TO: ~ ~ Manufacturer ~ ~ Liq. capacity in gallons Inside length Width Liquid depth / [)~Z) IF HOMEMADE: Well 'Dwelling PERMIT NO. ~(2~ DISTANCE TO: Well F~unda.tion /,~ Neares~ lot line/ PERM~ [-] = DISTANCE TO: ¢O'F I ~ M.gl[i~ No. oflines/ Lengt~'~lzline T°tal ler}gt~l_~ ?nes Trench wi~h Distance between.% ~ ~ Type of crib ~ib diameter rib depth ~tal effective absorption aree m Well Building foundation Nearest lot line ¢ DISTANCE TO; .j Class ~/) ~ 2~//~ ~~ .J ~[)~f D~pt er I Distance to lot line PERMIT NO. '~ DISTANCE TO: OTHER PIPE MATERIALS SO~LTESTRATING · I INSTALLER ~ ~ ~ ~ )~-L- REMARKS ~.~- L~O~ ...,~.,::,,'..-~ ,, , ~ APPROVED~i;~ 4: ~: ]t;~ ~:~:i-d~ DATE JEGAL PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17, 18- 19- 20- COMMENTS PERFORMED BY: 72-008 [6/79) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST SLOPE DATE PERFORMED: Z~-~Z ~..~' ~"' SITE PLAN No. 1457.E WAS GROUND WATER ENCOUNTERED? O p- E IF YES, ATWHAT DEPTH? Reading Date Gross Net Depth to Net Time -rime Water Drop (minutes/inch) ATE TEST RUN BETWEEN FT AND FT DATE: (~/C,,~'~'~ PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8-- 9 10 11 12 13 14 15- 16-- 17 18 19 2o COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~ SOILS LOG PERCOLATION TEST SLOPE SITE PLAN WAS DROUND WATER IF YES, ATWHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop ~'ERCBL.-C,,T4ON RATE / .~'o ¢ / - '~' /~¢~flh~utes/ineh)_ TEST RUN BETWEEN FT AND FT PERFORMED BY: /~ ~¢/~c-~-"~'~ , CERTIFIED BY: 72-008 (6/79) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicol ~ Geophysical Surveys Orllling Permit LOCATION OF WELL (Please complele either Io, lb or lc.} A.D.L. No. ~o~.~'~rrough SubdPv~sion / Lot Block ~1 I/4qtr'' Section No. Townsh[PNO Range E~ Meridian WELL LOG Feet Below ~. WELL DEPTH: (find) 5, OATE OF COMPLETIO~-~ Moterlol Type Top Boflom Sial/Me sh Size: Lenglh: Set between ft. and fl. Backfilling Gr~vel pack ~ ~) II PUMPING LEVEL beloVond surface and YIELD %~j Material: ~ Nee? Cemenl ~ Ofhor: ~ 13. PUMP: Longlh of Drop Pipe ft. co'city 9.p.m. 15. Waist Temperature ~o ~ F ~ C Th~s~~~weH w~s drill~un~ my(~//~.~/~,~juHsdl~llpn ond, lhis/~pporl is true lo the b~of my/knowledge~ ~'~/and belief; ' Re~istere~BusJness Name ~ Conlroct License Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEAL TH AUTI-IORITY APPROVAL ~2 --/~ ~S OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date __/,2,./,2.. ?/-..~ ¢. GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) 2.~ ~- 2 ~ I z¢1/4' ~ >/L~'4/~,-,~x //,'/h -~ ,:¢. T/+,,,~ ,,-~/~, Location (address or directions) Applicant Name ./¢'~/~,..v ,'~'~,-/~. Telephone:Home ~.¢4.,'_-_~.~'"/o Business Applicant Address --~'.f~ ~ ¢5"' ~'., ,¢~q~ /~- /~,~"~ ./ ~///'f Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution __ Telephone Address (e) Real ~state Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [-I Number of Bedrooms ~ Other ' " WATER SUPPLY Individual Well ~ Community [] Public [] : Note: If community well system, must have written confirmation from the State Department oi Environmental Conservation attesting to the legality and status, SEWAGE DISPOSAL Onsite [] 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. Page 1 of 2 72-025 (11,84) ENGINEERING FIRMPROVIL wGINSPECTIONS, TESTS, FILE SEARCH, ~,.~TA 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 further verify that based on the information obtained from the Municipality of Anchorage fifes 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. Name of Firm E;~,GLE~RiV~,!( L:~)3~ ~ Telephone Address P. O_ BOX 7737~4 Date I.)..~.2z_~'/'~EC 694-5195 Engineer's Seal Appr°ve~f~r ~'¢'~ bed rooms bY ate ~,-.~. ¢.~ ,,.~'~¢¢'¢.¢~ Approved ~ _ Disapproved Conditional 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 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 in the professional engineer's work. Page 2 of 2 72-025 (11/841 MUNICIPALITY OF ,~.,,JHONI, IDNIClPALITY OF ANCHORAGE (MO~) DEPT. OF HEAL'FH & .............. ~NVIEONMENTAL P~OTEC~L~m ~u~mu~ · APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 Legal Description: RE{EiVED WELL DATA Well Classification /¢:~-~ / M,A-'TI~. If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) /V Date Completed ~%-///;~/'~"~- Yield Total Depth /~' "" Cased to /'~-¢,',,/xDepth of Grouting /~./'~ Static Water Level _ ?/¢ / ~.'/~'"' ~' ~"¢ c~'~'"4'r Pump Set At /,.2._,¢ / Casing Height Above Ground ~ ¢'- "' ~' Sanitary Seal on Casing {Y/N) .Y Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ? Depression Around Wellhead (Y/N) /v To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _ Cleanout/Manhole Water Sample Collected by /-~'.r Water Sample Test Results ; On Adjoining Lots '/ /~" ; On Adjoining Lots To Nearest Public Sewer To Nearest SeWer Service Line on Lot Comments B. SEPTIC/HOLDING 'TANK DATA Date Installed /~¢~0~--/~,~.~, Size Standpipes (Y/N) ?' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '¢'/~" To Property Line '~¢ / To Water Main/Service Line "/~ "' Course No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation /o('; / To Disposal Field /~'" / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line ~'/¢ / To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area '~/o / To Property Line *'¢'¢" To Existing or Abandoned System on ; On Adjoining Lots /"-3~ /' Comments 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 ~-~:~~ Company ZLR~./~,J-. MOA No. ,.5 / Receipt No. 2 ~) C) / ~'~ ~¢:~ ,x~ Date of Payment /~/~ ~~ Amoun,:$ ~ ~ '' Page 2 of 2 72-026 (11/84) EAGLE RIVER EAGLE RIVER, Al( 9957~ P, 0. BOX 773294 694-5195 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~'4 ~'' / -'~*'~'~ :'~'-// Telephone: Flome 4¢'~'¢/~ ~¢' -~ ? Business ,6".~../ ,- Applicant Address --~'~ ~) ~ 5'- ?_.~j.,~-.~. .,¢~,.u-'¢.') ..,,z¢,/,,-- (c) Applicant is (check one): Lending Institution []; Owner/builder,,[~'; Buyer []; Other [] (explain); (d) Lending Institution /~','"~ Address Telephone (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well,~" Community I-] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to tho Iogality and status. 4. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department ol Environmental Conservation attesting to Ihe legality and status. Page 1 of 2 72-025(1~ 84i ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 suppJy 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. Name of Firm J~.GJ.E RIVER ENGIN_E~ERIN6t SERVICES Telephone EAGLE RIVER, AK 99577 Address __ 694-5195 Engineer's Seal Approved for ~--*__&~__~ bedrooms b Date _ Approved -- ~ Disapproved Conditional 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 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 stale 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 in the professional engineer's work. Page 2 of 2 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORrrY APPROVAL ~H/~ICIPALITY OF ANCHORAGE ""-" DEPT, OF HEALTH & CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL PROTECTION 264-4720 Legal Description: Well Classification ,~ z Well Log Present (Y/N) _ Total Depth ] '~ 3 / Cased to Static Water Level ,'~'~2 · ' 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 If A, B, C, D.E.C. Approved (Y/N) Date Completed ~-//.2/,~' ..¢' Yield / "~" Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N). Depression AroUnd Wellhead (Y/N) Comments ; On Adjoining Lots /¢o ¢' ; On Adjoining Lots /~ ''~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~ ~- /' B, SEPTIC/HOLDING TANK DATA Date Installed /¢,',~.5- /¢,'¢f,.k'Size /~¢ ¢~ / No. of Compartments Standpipes (Y/N) _ /J/ Air-tight Caps (Y/N) f~' Foundation Cleanout (Y/N) Depression over Tank (Y/N) / Date Last Pumped Pumping/Maintenance Contract on File (Y/N) '/'/'/~ ; for Holding Tank High-Water Alarm (Y/N) /~'/,'~ Separation Distances from Septic/Holding Tank: To Water-Supply Well /E~9 '/'- To Property Line /~ ~ To Water Main/Service Line /~ + Course '~'/¢"~ ~ Temporary Holding Tank Permit (Y/N) · To Building Foundation To Disposal Field /'3~' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field .~o "" Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~"~ To Building Foundation -+-..¢"-¢--) Lot To Water Main/Service Line / ¢ ¢' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field ~.~L~ / Depth of Field //'/ Gravel Bed Thickness 7 / Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ,,~.2~.~.~_ ~ ~';~z~',~ '3'o" 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. Signedj~~ Date Company ~'.-...~Z,~ ,,E~¢4 ~'~"',~,~'¢';,"~'*-~MOA No. ~' ~ ~ ~ J'' Receipt No. Date of Payment {V ~?~' ~' : '" 7 %%'"~' ~'~ Engineer's Seal Amount: $ Page 2 of 2