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Home My WebLink AboutHIGHLAND TERRACE #5 TR 1-A/~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAI..TH & 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 PHONE~ ~'NEW MAILING ADDRESS LEGAL DESCRIPTION · /' NO. OF BEDROOMS Well ; Absorption area~ ~wellin~ ' PERMIT NO. ~ ~)~_. Material~,~/~. No, of compartments Z ~ ~ Liq. capacit~ in gallons Inside le~ Width Liquid depth / ~.~ ~) IF HOMEMADE: - . ~ DISTANCE TO: Well 7~ / Dwelling " PERMIT NO, ~ Manufacturer' /~ Material -~ Liquid ca~acity in gallons ~ Well / Foundation Nearest lot lin~ J-' DISTANCE TO: /~5- ~0~ I ~ r No. of lines/ Length o~::~ l,~e Total ,vg_¢ ofHinWs 'd'~ ~' ~: T~of tile to finish grad~:l.,-~7 ~- Material beneath til0[ ~ '~'~ ~"~- inches Total effective~absor~orl area Length Width ~ Depth ~u ~j~ PERMIT NO. ~ ~ Type of crib Crib diameter/ ~ /~ Crib depth Total effective absorption area ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Class Deptb Driller Distance to ~ot line PERMIT NO. ~ DISTANCE TO: Building f~undation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING REMARKS ........ :;:,~ i ~. ~ ~...4 ~:.:;) ]. ]! ;iA';i!; :: .:... '~' ~'i;:! '/ """ ":' '" ~" "" F ' i'c:)r, .... 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I ILh.., t ~t~1 I::'F::"TTi::'"I...F.~d ....... t..~1'1:::.....1 .,.l.J,', .. ~":: ' ' ' , ~ ............. igN)::) ~. ) 't'I"I1~: :::' ~:: ...... :i' ...... . i"It J?." ~'" "~' ..... I... ]; -~-->-'"'~:'~ ~" MUNICIPALITY OFANCFIORAGE i e-~,~.~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~:' 825 L. Street, Anchorage, Alaska 99501 264-4720 ~ SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: Li;GA L DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 /7 D O f'~ 5-- ,q /.,'1 C SLOPE _ / WAS GROUND WATER ~ S ENCOUNTERED? L O P E IF YES, ATWHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Dr op PERCOLATION RATE (minutes/inch) '~1~ TEST RUN BETWEEN FT AN?~/ COMMENTS 72-008 (6/79) FT SOILS LOG MJNICIPALITY OF ANCHORAGE ., PERCOLATION DEPAFITMENT C)F HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST 0 5 r 9 ENCOUP4TEHED~ ~ IF YES, Al' WtlA'T ~ t./ t)EP-FH7 i3 [ES'r RUN BETWEEN'~,~:F_ ..... ~ ~ FI COMMEN YS 12 008 SOILS LOG PEF~COLATION 'rES]' MUNICIPALll'Y OF ANCHORAGE DEPAR'rMENI'OF HEAL'TH AND ENVIRONMENTAL PROTECTION 825 -. Stroe. t, Anchorage, Alaska ~)9501 264-4720 oOILa LO(] -- PERCOLATION TES I- WAS GROUND WATEFt ENCOUNTERED? IF YES I\TWHAT ./: .,'N.'% ~.~,.,.,,~ ............. ~ ...... F~ ..... Tim~, .~:., ..' ,,',, ~ ~ ~ ~' I ..~.~ ,~ ' "~'~ ~7 ........ tT~'>~' rEST ~UN BETWEEN FT AND FT Net O~Ol) 4 6 7 8 9 ~2 ]3 ~4 ~5 ~6 19 20 COMMENTS 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 1. GENERAL INFORMATION Legal Description (include lot, block subdivision, section township range) Location (address or directions)" ., (b) Applicant Name '~O-"?,~'L ~ Telephone: Home ~,~'" ~-'~,-~'~bo°'~ Business Applicant Address .~'/~ ~:> ,.~"..~./~ ~-~:z.~_~__~..2~ ,/-~~ (c) Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain); (d) Lending Institution ~"¢~ ~.~,'//. Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: SRD 196x t~, ~ oiver, alaska TYPE OF RESIDENCE Single-Family,J~ Multi-Family [] Number of Bedrooms ¢ Other WATER SUPPLY Individual Wellx Community [] Public [] Note: If community well system, must have written conlirmation lrom the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite,.l~' 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. Paae 1 of 2 72-025 {11/84) E;NGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, t 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 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 Date SRB l'?6x ,Eagle l~.ivert AJa.*ka Telephone Approved for ¢¢~-~-""" bedrooms by~/~ ~-'¢--'~ · ,'/ .,- ~...~ -- Approved ,,~ Disapprove~_ 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. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) ~NICIPAI. IfY OF ANCHORAGE DI~PT, OF H~AL~{ & HEALTH AUTHORITY APPROVAL (HAA) ~NVIRONME~AL PROT~ION 264-4720 F [~ ] ~ Well Classification _ ~l~t VArT~'__ If A, B, C, D.E.C. Approved (Y/N) Well Log Present CN~ Date Completed ,J. -' ~'-- Yield Cased to ~ ~ IO H / /g /DO / Total Depth 5°0 ~ Static Water Level _ Casing Height Above Ground Electrical Wiring in Conduit ~/,N~ Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer [_ine Cleanout/Manhole /"///~' Water Sample Collected by Water Sample 'rest Results Comments Depth of Grouting //~',~' Pump Set At Sanitary Seal on Casing Depression Around Wellhead ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot _ ; Date B. SEPTIC/HOLDING 'rANK DATA Date installed Standpipes f~,CN) __ Air-tight Caps Depression over Tank ¢rC'Lt~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well Jb(.~ 1 t~ To Property Line _ ~<2 1 1~ To Water-Mc.[~/Service Line '-~ Course /'//~" Size J~'.~ No. of Compartments Foundation Cl~a~ nout ~,.~ (W,~_.~ate Last Pumped /VZ~r- ~,/%/ ; for /'~'~,...~ Temporary Holding Tank Permit (Y/N) To Building Foundation ./¢/~' To Disposal Field ~ I To Stream, Pond, Lake, or Major Drainage 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 ¢¢7~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ,~'o ~ +'- Lot To Water;,Msh~/Service Line ~ / ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~,~ Standpipes Prese nt~/,N)' D~/?~.of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~,,O To Cutbank (if present) 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. Signed Company Receipt No. Date of Payment Amount: $ MOA No. ,¢~(~rO ,.~ Page 2 of 2 72-026 (11/84)