HomeMy WebLinkAboutHIGHLAND TERRACE #3 LT 20L 2.0
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRQNMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
PHONE
UPGRADE
MAILING ADDRESS
LEGAL DESCRIPTION
~z~z
Manufacturer ..¢) /'
_ ,E ROMEMADE:
DISTANCE TO Well . .
Manufacturer I ~/L~.
DISTANCE TO: ],~
Ne. of lines /
Top of tile to fil~,~ gr~dE
Length
Type of crib
DISTANCE TO:
Width
De~th
/?U,
Class
/vow-
DISTANCE TO:
IAbsorptio ~ area/,./.,
Inside length
OTHER
Dwelling
:F77
OweHing..~ /..~
Widt ~
I Material
Foundati~.~.. /g- I Nearest lot line . /.~
~/o
Total le. ngth oJ lin~'S I T~en~ width
Depth
NO. OF BEDROOMS
PERMJ.T NO. ,
No. of compa'rtments ~
Licluid depth
PERMIT NO.
Liquid capacity in gallons
D i s t a n c e~_.~lwe e~n lines
Total effecti~(sorption area
PERMIT NO.
Crib depth Total effective absorption area
Building foundation
Driller
Nearest lot line
Distance to lot line
Building foundation Sewer line Septic tank
PERMIT NO.
Absorption area(s)
PIPE MATERIALS
INSTALLER
[REMARKS
APPRO ~ ~
DATE LEGAL
F'EF;:I"II T NO.
FIF'F'L :Il CFINI'
L O 12 Fl l' ~ 0 N
LEGFI! ....
HERBEI;i:T HRNCEu2K
CEIF4:F4: I E £:,R I ',,,'E
L. 2;) H:[GH[..EQND TERF.:FICE
76-E LmFIh:iE E:IL':,GE ~1SI5'??
L131" S I ;:~ E
FEET
T"tPE OF=' SOIL. FtE'E'ZF~'F'"FZ.'iN :T::TEi'I I'-'":.;: TF.:ENCH
I"IFI::':iiHLIH F,IL.II"IE:EF?. OFr E',EE:,F4'.E~E~f,IS =
SO.'[L. RFITII'.,tl3 '::5;! FmT,.m'E~Fi:)= .L ....
THEE REi;!Ij I RED S I ZE "Jif: THE :E:;O 3: L. RBE;ORF'T I ON z, r z, I Ell I'.'~;:
'THE L..ENG"I"H [::,IP'II.~:NSION IS THE L.E:NGTH ,::IN F'EET) OF THE ]"RENCH OR [>RF4INF']:E:L.D.
THE DEF'TH Eft:' FI I'F:ENCFI Of;i: F'IT IL.E; THE DISTRNE:E E',ETHEEN THE SURF'RCE OF THE:
GE:L-~IJND FIND THE BOTTOH OF' THE E',:.,:E:FI',,,'RT.T. ON ,::I[.,I FEEl'::,.
'I"HEF4:E I."5 NO SEll' H:EDTH F'OF~: TRENE:H[.ZS.
THE GRFf,/EI... DEPTH I:5 TFIE HINIHLIH DEPTFI OF GE:FI',,,'EL. DEff'I.,.IEE:i'.,I THE C)UTFFIL.L F'IF'E
FIND THE E~OTT'OH OF' THE E;*:E:FI',/FCFZON ,:::IN FEET::,.
F'EF:H! T F)F'F'L,I E:FINT HF:IS THE F4:EE:E;F'ONS]:BI L I T¥ TO I NFOF:H TH:IS DEF'FtFi:THIEN1~ [:d...IF,i:I NG THE:
:[ N:~iTFIL.L.FtT :[ ON ): NL~;PECT .T. F'ff-,IS qF F:IN'¢ I,.IELI_:~; FIE:,J'FtCE'N'F TO l"H :[ E; PFiffL'ff::'EFYf"¢ FINE:, THE;
I'..HE:ER OF F:'E~I[:,ENEE'5 TFIFll" THE' klEL. L 14]:LL. SERVE.
H I I'.,I t HLIH El, :1: SI"IaNCE DETHE:E:N R HEL. L FIND R[m,I'T' OF,I--.S I TE SEI.,.tRGE D I '.T:;F'OSFIL S'¢S1%1'1 I S
:t. Eu.3 f:'EET FOR Ft F:'f~:I',,,'FI'I"E I.,.IELL OR :[.rSe~ TO ;3E~O FEET F'ROH R PUBL.]:C: NELL. E:,EF'ENDING
UPON l"HE 'I"'¢F'E: OF F'UE',LZC klELI ....
1"I:[t'.4ZHUH D:[STFff,ICE FF:OH R F'F?Z',,,'RTE ktELL TO FI f:'R :[ ',,,'RTE SE:NER L. INE IS 25 FEET RI'-,tE:,
"1'0 R CCff'IHUF,tZT'¢ SEklER LZt.,IE Il:E; 7~5 FEET.
EFI'HE:R REQIJ ]7 F.'.[r'.:HENTS HFI? RF'PL'T'. :E;F'[."321F I CRT I ON:E; RN[:, CON!.::;TRUCT ]: L')I',I El, I FIGE:FIHS RR:IE
R',,,'FI]:LRBL. E TO ZNSIJRE Pf~'.OF'EE: ~NSTFILLRTZON.
I C:ERTIF"¢ THFIT
J..: I FIH FFIHILIFIR !,.II'TH I'HE I:;i:E6!UIF:EHEt"~I'S F'Of~: EII'.4-mS.~TE SEI4EF4:S FIND I.,.)EL...L..:i~; I::1:!~ SE'T
Fi:iF:TH B'¢ THE HUN I E: I F'FIL I T'¢ OF FINCHOF:tRE-iE.
;i'.: t I.,.!II_L II",I:STFILL THE S'¢STEH IN FICCOF.:E:,FINCE kI:[TH THE COE:,ES.
2:: I UN[:,ERSTFtND THFIT THE EU'..I-SITE: SE:'I41ZFi: S'¢'.'SI'EH I"IFl"r' Fi:E6!U:!:RE F-"I",IL. FtRGEHFXNT :f:F' THE
RES :[ L'."ENCE I S F.:EHOri:,ELE[:, TO ]: NCL. U[:,E HCJRE THFIN Z BEDF,::OOHS.
S ]1 GNE:E:, .
FIF'F'L. I CFINI' I-IE~ ...,~:R I 'r-IF~NCC)C:F::
'v',:l.. I;3
MUNICIPALITY OF ANCHORAGE
Department f Health and Environmenta ~rotection
825 L Street, Anchorage, AK. 99501
264-4720
* * * HANDWRITTEN PERMIT * *
~~ ON-SITE SEWER PERMIT
Location: ~0~/~ ~/ Phone Number:. ~ -2
Legal Description: /~ ~ /~J 'T~F~}'O~__ LOt Size:
Type of Soil Absorption System Is:
Trench: ~ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: _,.~ Soil Rating(sq.ft/br) /
The Required Size of the Soil Absorption System Is:
/
DEPTH--~/ LENGTH L3 . GRAVEL DEPTH ~-~ WIDTH
The length dimension is the length(in feet) of the trench or drainfield. 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(HOLDING) 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 department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
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. Well 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 31~ 1 9 ~ 1 * * *
I certify that:
(1) I am f~niliar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will instal], the system in accordance with codes.
(3),~erstand that the on-site sewer system may require enlargement if
~ the~esidenc? is remodeled to include more that 3 bedrooms. .
cant Date [~/p~
SWP/024(1/81)
SOILS LOG
/
LEGA~ OESCRIPTION:
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
[] PERCOLATION
TEST
SLOPE
,/
SITE PLAN
WAS ~ROUND WATER /O/O ~
ENCOUNTERED?
0
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND ---- FT
PERFORMED BY:
72-008 (6/79)
either or
2. WELL LOG
TOp Bottom
STATE OF ALASICA
DEPARTHEltT OF HATURAL RESOURCES
H/sj E/~
3, OWNER OF ¥1ELL:
4. WELL DEPTH:
6, USE: [~Dom~st?c []]]Public Slopply
~[~j I r r igat ion ~ Recharge
~Test ~/elt ~Other:
7, CASING: ~ ]hreaded ~elded
8. FINISH OF ~ELL
~A~ve ~Oelo~ land surface
Type: ~Suumersib}e ~Reciprocatin~
[5 Jet ~ Or, ....
.... I Completioln
Elevatlon Date of
]]Dug
[~]lndus~ry
FL.
WATER WELL CONTRACTOR'S CERTIFICATIO~I:
This well was ~rilled under- my jurisdiction and th~s report :s True to the best of rny knowledge and bet:eF:
g .p.ra
H I hl :[ MLIM [)I STFINI]:E IL"-:ET!,JL::EI'.,I FI I.,.IEI....L 191",1['., Fll",l"r' OI",t-S I TE SEP.tFtGE E:' I SF'O':2;I:"iL S;"r%TEi"I I S;
::1..0~2~ I~::'EET F'OR FI F'RI',,,'F1TF.': I.,.IELL OR :1.5121 TO ;.7:00 FEET FROM I:1 PLIDI...IC HELL [:'EF'EN[:'II",IG
UF'ON THE TYPE OF F"IJE',L. I C HELl....
M]:NIMIJH [)I'..:.,TI::INCE F'ROI'"I FI PRI',,,'FtTE HELL TO I:1 PRI',,,'FITE S]EI.,.hSJ;: L. INE .IS; ;.:::!5 FEET FINE:'
TO I:l CCd"IHLIN I T"r' SEI.,]E'~R L :!: i",~E I :S ?5 FEET.
HEI_.L.L. OGS; FIF::E RE:QU:I:RE[:, FIND i"ILIST BE RETURNED TO 'THE: [:,EPFIRTMENT HITHIi'.,I
OF "I"HE HELL. C:OMI::'I...ET I ON.
OTHER [;~IEQLI I REh'IENT'.iF, MFt"~.' FIPPL'T'. L:;F'EC: I F I CFI]"t ONS FII'.,II} L-:OI'.,IS]"RIJCT ]: 01'.,I [:, I I::IGRFIHS; I:::II:;LE
I::i',,,'I:::11 I..F:IE:LE TO I I'.,I:~:";t..I.F..IE P~:;I(]PER Z NL:;TFILLFIT I ON.
I CERT I f::'¥ 'FI'"IFI'F
::L: I FIM FFIMILIf::IF-.' I.,.II]"H THE F::EQI..II'Fi:EME:I",tT!~; [:'OR OI",I-:.:.:,ITE :.:.i;EP-!ERS F:INB' [,.!EL.L'.iE; FIS; E.:,E"I"
FOR]"H Ei?~" THE HLII",I I C I Pt:Il._ I "F'~' OF FII",PT.:HC~F::FIL:iE.
2: I HtL. L. iI",IS.';TFILL THE SYS]"EM IN F~CCORE:,FINCE HITFI THE CO[:'ES.
!:]; I GNE[:,: ...............................................................................................................
FIPPL I CFINT HERD ,?.: I"IFIRG I E H~:II'.,!E:OI]:K
i ::,iS I...tli~: [:, D"r'...
94. ~
MUNICIPALITY OF ANCHORAGE(~'~'~-~O
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMFNTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date '~'.~
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot block subdivision, section, township, range)
Locabon (a~dress or directions)
(be, ~6'r~pedy 'Owner_ . ,,~,.¢.,..... ~¢..~c.,. ~ Telephone: Home
~},, Mailing Address
Business
(c) ~ b, er~ding InstitUtion';" ,"
-Mailing 4ddress
(d) Re~l Estate Companyand Agent
Address
Telephone
Telephone
(e)
Mail the HAA to the followina address: or: Check herexl~, if hold for pick up.
List contact p~o~Ta/n2¢ daypJao~e, nuJ;pber below.
TYPE OF RESIDENCE
Single-Family.~
Number of Bedrooms
WATER SUPPLY
Individual Well.~' Community [] Public []
Note: If community well system, must have written confirmation from the State Department of 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 trey 8/861 Front
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 supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. [ 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
Address /~c~
DHHS APPROVAL
Approved for ~'~,~/~-"~ ('~.~bedrooms by
Approved X Disapproved
Terms of Conditional Approval
Conditional
CAUTION
The Municipality of Anchorage Department of Health and Human Services /DHHS) issues Health Authority Approval
certificates 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 acourtesyto purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS 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-o25 (Rev 8'861 Back
.MUNICIPALITY OF ANCHORAGE (MOA)
v~ ~;~" ....~: HE,:AI" 1~1 AUTHORITY APPROVAL (HAA)
~,~,~-ii'l~.¢~¢.~ ~'~' '" CHECKLIST- FEBRUARY 1984
~x~ \?.0~' ~ ~,vl 264-4720
Legal Description:
WELL
DATA
Well Classification ~r/~.l V/~'~' ~ If A. B. C. D.E.C. Approved (Y/N) ,4//.~_
Well Log Present f~N) Da!e_ Cor~pI.L.e~. d ¢¢ -- ? ~' "7 ~'''/ Yield ~'/-, (~'
?¢' /
Total Depth ~'~ _,~) .~__ Cased to (~'~/Vl~'A/~%~thC~oufCi'n~"'(~
Static Water Level ~'~ ~ / Pump Set At ___J,,/L A//'CA,'0/,,/'A/
Casing Height Above Ground / Z~ /
~ Sanitary Seal on Casing (Y~-'~
Electrical Wiring in Conduit ~;N) Depression Around Wellhead
Separation Distances from Well: LL. ', .~,j,, 1
TO Septic/Holding Tank on Lot (.~ ,'I )/jcc.w ~ ;On Adjoining Lots
To Nearest Edge of Absorption Field or~"L~st" -./~)'~-~ _; On Adjoining Lots /0¢
To Nearest Public Sewer Line /t-//fA To Nearest Public Sewer
Cl'eanout/Manhole /L//./r To Nearest Sewer Service Line on Lot
Water Sample Collected by /-_ , ~e~ d¢¢' ; Date
Water Sample Test Results ~..4--~-7 5.
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed '''~ ~ A U~' ~/ Size [6)~(_.),/z~ No. of Compartments '~
Standpipes ~N) Air-tight Caps C/N) Foundation Cleanout (Y/¢~.
Depression over Tank (Y/¢
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~'
mo~a[ep. Mal~pe L~ne
~. , .:,¢ .. . $~
~&ge 1 0f 2
Date Last Pumped
;for
Temporary Holding Tank Permit
To Building Foundation '~ /
To Disposal Field .~g2 /
To Stream, Pond, Lake, or Major Drainage
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ~"3
Width of Field 60 '
Square Feet of Absorption Area
Depression over Field (Y,~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation '-~-
Lot
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
t ~ ~' /D //~2/),/{ Type of System Design
Length of Field /¢
Depth of Field "~ /
Gravel Bed Thickness
~ '7 ~' (,//' Standpipes Present ~'~?N)
Date of Last Adequacy Test
; On Adjoining Lots
To Cutbank (if present)
To Property Line ¢q'C)/Tt-
To Existing or Abandoned System on
I0/4-
D. LIFT STATION
Date Installed ~ Dimensions
Size in Gallons -'"'""~"'"-~-~ Manhole/Acce~..~.N). ~'
"Pump On" Level at ~ 'P~,~f~ff" Level at __
THiegsledW~r Alarm Level at _ J ~/N)..~ P~~ Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to ail MOA and HAA guidelines in effect on the date of this inspection.
Signed Date
Company /~<~ ~ -~'~.. MOANo.~,~'7
Receipt No. c,~- 0 0 /--0 :) //
Date of Payment ~ -F7
Amount:$ / 0 0 ~ ~¢ ¢
Page 2 of 2
72-026 (11/84)
unicipa..ty,
Anchorage
P.O, BC 96650
ANCHORAGE, ALASKA 99519-6650
(907) 345-4200
TONY KNOWLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
August 11, 1987
Leroy Reid, P.E., PhD
Alaska Environmental Control Services
1200 West 33rd Avenue, Suite B
Anchorage, Alaska 99503
Subject: Lot 20 Highland Terrace Subdivision #3
Waiver Request WR87-045
Dear Dr. Reid:
Your request for a waiver of the 100 foot separation required
between the septic tank and well on the subject lot has been
granted.. This distance has been waived to 89 feet.
The topography in the area is such that contamination of the
well from the septic tank is extremely unlikely.
This waiver is valid for the existing septic tank only. Future
upgrades must meet all applicable setback requirements.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
cc Gus Andress, P.E.
Manager, On-site and Water Quality Programs
ALASKA t~I1UIROPImE~I"ITAL COFITROL $~RUIC~$, Irlc.
En~lineerin~I 6 ~nuironmenld $ludies
Request fox' w:tive~' Well ,'-iept i.n Tanl~
1200 ~Jesl 33rd /~uenu¢. SuiI¢ ~ · Anchor~e, J~l~ska 99503e[907l 561-50z10
~ 20. HI§blond To,race Subdivision, Addition NO. 3.
bin l~e ~,,af~.r~, ~,~e~ ams On not m, edrt~, ~ er,cr~rsch on the
PLOT' PLAN',
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
5633 B STREET ANCFIORAGE, ALASKX~95i8 ~ELEPHONE (9~77562-2343
~~:t~,,~ FEDERAL TAX ID # 92-0040440
Time Time .4e
Date
Inspector
Date
Inspector
Date
Inspector
Comments
Conditional Approval
Date Sewer Installed
Soils Rating
!
Permit No.
Well To Absorption Area
Well to Tank
Septic Tank Size
Holding Tank Size
Well Log Received
APPLICANT FILLS OUT LOWER HALF ONLY
Property Owner z/¢/,¢~¢_,~,/~.~'
Mailing Address ~
Buyer ~(//~.~/~'-<~ -- ¢ ~:'~,
Address
Lending Institution
Realty Co. & Agent
Address
Legal Description
Street Location
Phone
Phone
~gle Family .'
[] Multiple Family
[] Other
Wate, r.,,Su pply : [] Individual
[] Community
[] Public Utilit,
No, of Bedrooms
ATTACH WELL LOG. A wel log is requirec~\for all wells drilled since June
1975. For wells drilled prior to that date, give well depth (attach log if
available,l
}osal
Individual
[] Public Utility
[] Holdln¢ Tank
Year Individual nstalled:
When Connected to Public Utility:.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCI=SSING CAN BE INITIATEB.