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Home My WebLink AboutLEVAR LT 6S/D (~. MUNICIPALITY OF ANCHORAGE .~.=.~__.,~, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PRONE NAME ~ ~. /~ ~ ~ ~,_~ ~ ~,~-5~O~ ~UPG,ADE MAILING ADDRE~ ' ~ LEGAL DESCRIPT~-O~ ~ ~ ' ~ - ' LOCATION ~ / ~ / NO. OF BEDROOMS (~ DISTANCE TO: J~~~ I Absorption area , Dwelling , PERMIT NO. ~ Liq capacity n ~a ~n~ ' Inside length Width~ - Liquid dept~ IF HOMEMADE' .~Z~ ' DISTANCETO: Well ZJ~, Dwelling PERMIT "O. O z ~ Manufacturer Material Liquid capacity in gallons -~ ~ ~s~c~ ~o: ~,~, .oun~t /~'"""r"st ~ot .n. ~ -~' 7~ ~ ~ Z No. of lines ~ Leng~ of each line Total ler~h of lines Trench width ~t~ between lines ~ p. ti t)~is grade 'Il / Material beneath tile ' Iotal'effectiveabsorption area ,U 'Length Width ~ . Depth ' / PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective abs~ption area ~u Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth ~. ~. Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) PIPE MArtIALS ~ ~' ~ ,, ~ . .~¢ ___ SOILTEST'RATIN~ ' ~ ~ INSTALLER / ' / ~ _ REMARKS ~ ~ ~ ~ ~- ~ MUNICIPALITY OF A 4C~I ,~ [ -~ ~ - ~ ~ ~ ~NVIRONM~NTAL Pi0 [E ;TIC:4 72-013 (Rev. 3~78) F'E RI'"I I T N O. FIF'PL I CFII'.,~]" LOC:FFt" I ON LEGFIL I.]:,EPf]RTMEi'.,IT OF HEE~::IL.'f't."I FINE:, EI'.,I',/IF.:ONHENTFIL F'RCITECI'ION 825 '*L.'" STREET., FINCHORFIGE., FIK. 9950'1_ Cl lt"-,~ ...... 2; .'E -IF E: :'~; EE t..-.i IFE tF~: F" E ~.: IPl :E ,:: ',:;:]:0578 ) jI]HN P.IFIGNER L..~ ',,.'F~R '.SBC,',,,'. LOT ~.; S E.]I]: :i.::~: - T J_ ]:N - R Z.':[4 370R SPI:;.:INGEF.:Cc2L F:INC:H. FII<. 9950 56i:-]:0i:7 LOT SIZE 9999'99 :F.;QUFIRE FEET' 'T"T'F'E OF SOIl_. RE::'};ORF'TZON SYSTEM Ii-.';: TRENCH i'"IFI::.:;II"IUI'"I NUHBE:'R OF DEDI;.'.OOHS = 5 SOIL RRTINI3 ,::SC! FT,.."E:R)= i50 TFIE REQIJlRE[:, SIZE: OF THE SOIL FIBSORPTIOI'.,I S"r':STEM IS: THE L..IENGTI-I DIMENSION IS THE LENGTH '::II",l FEET) OF THE I"F:.'ENCH OR [:'RRII",tFIELD. THE DEPTH OF' FI 'T'RENRH OR F'IT IS THE DiSTFINCE BET[4EEN THE .SURFRC:E OF THE GROUND RND 'THE E',OTTOH Eft:: THE E',qCR',,,'FITION (l'N FEET). THEF.:E IS NO SET 14I[:,TFI FOR TI:~:ENCHE2';. 'THE GF.:R',,,'EL. [:,EF'TI'-I IS THE I"IZi'.,III"ILII"'I [:,EP"I'H OF GRR',,"EL BETNEEI'-,I THE OUTFFI[d.. F'IPE fiN[:, THE BOT'TOH OF THE E',:qCFI',,,'RTTON '::IN FEET). PERHI T I:IF'F'L I CFII",IT IqFIS THE RESF'ONS I E:iL I T'¢ TO Ii",tFORH THI:5 B'EF'FtRTI'IEI"4T [:'UR ING THE tt',12;TRL. LRTION IN':;PECT'IONS OF FIIq'T' WELLS FI[:'JRCENT TO TH:E:5 F'ROF'ER'T'¢ FINE:, THE i",IUMBER OF RESI[:'ENCE:."".~; THFIT THE WELl_ WILL. SER',,,'E. ................... ""IF ~--.!1 C) ,:.: ;Z .':), I If'q] :E; F" EC C: T' t: ~Z~ lt'...t :.~!; F:~ IF;-: E:Z F: [C (;:~ L~ ][ F: [£ I[]:: E~RCKFIL.L..ING OF FIN'T' S'-r'STEH WITHOUT FINRL II"4SPECTION FIND FIF'PF.'.CWRL B"r' THIS [:'EPRRTHENT W):I_L BE :E;UBJECT TO F'ROSECUTIOIq. I"IIt",IIHIJH [."ISTFII',ICE BETWEEN R WELL laNE::' FIi",I'¢ ON-SI]'E SEP.IFll]iE [:'I:SF'O:'];FIL S'T'STEr,1 IS :1.00 FEET FOR FI F'F.'.I',,,'FITE I.,JELI_ OR ±50 TO 200 FEET F:ROt'I FI F'UBI.IC I.,JELL. [:,EPEi'-,IDII'.,IG IJF'OI'.,I THE T'T'F'E OF F'UE:LIC WELL. t"lIt'-,lIi"ll_li"l I}I. STFff.,ICE FROM FI PF.:I',,,'FITE I.,.IELL TO FI PRI',,,'FITE SEWER LINE IS ;2:5 FEET Ri'.~l[:, TO FI COMHUi",II]""r' SEI.,JER LINE IS '75 FrEET. OTHER REC!I._IIREHENTS I"IFI'T' FIF'F'L."r'. SPEC:IFICRTIONS FIND' C.':ONS]'T4::UC:TIOI'-,I DIFIGRFII"IS FIRE FI","FI I LFIBLE TO I I'.,12;IJRE PROPEF..: I N~;TRL. LR]"1654. :i: CER'TIF"r' TFIFIT :L: I FIM F'FIHIL..IRR NITH THE I:;;:EQUIREI'"IENTS FOR CIIq-SITE SEWERS Ir:ff',l[:' WEL. I..S FI:S SET FORTH B'¢ THE MUNICIPFILIT"r' OF RNCHORFIGE. ;lit: I WILL II",ISTFILL. THE '.:-]'¢STIEI'"I IN FICCOR[:,RNCE I.,IITH THE CODES. .]ii:: I I...IN[:,ERSTRND TI'IRT TIqE ON-SITE ::SEI.4ER S'T'STEM MR"r' F,:E(.':!UiRE ENL_FIRGEHEI"4T IF' THE RE::.:; I [:'EI"4CE I I.E;.,,REI~..C:'~LE[:, TO I NCLU[:'E MORE THFIN 5 E',EI}ROOMS. t:IF'F'L~ ..TI.-.ll-.l[q ~: . i::-;SL, ...... ...... ,:'.', ~ .~;01L$ LOG 71£5 Old Seward Hwy. Anchorage, Alaska 99502 349- 6561 PERCOLA1 ION TEST SOILS LOG- PEFICOLATION TEST ~ B)edroor~._5 ORGA-Htc S't~,T aL SLOPE.>.- SITE PLAN [ C-r'-[ 'i -! ,~'- -F - ~ --;~ ENCOUN'FFRL EP l ~ ~ ~ ~ _ .~ .... ~ ~ .... ~ ...... MUNICIPALITY OF ANCHOPJIGE DIVISION CF ElgVIRONMENTAL HEAL'iTt DEPA~E~ OF ~2~ ~D ~MENT~L P~ECTI~N A,~PLIC~L[~ [~R ~TH ~ORI~ ~PRO~ CE~IFIC~TE 1, ~ral Infection ~plication Date ~C%{ e (a) ~gal ~s~ipticn (inclu~ lot, bl~k~ subdivision, ~ion, tG{nship, range) Lo~tion (ad.ess ~r directions) (c) AoDlicant is {check one) l~nding Institution ~; ~er~3uil~r B{:~r ~Zt; Other ll~ (explain); (d) ~nding Institution irt'f% t F~d~~~ r)~ [~T~.~gP~n*~P~I (e) ~al Estate Co. & Agent ~/, ~ .... Address Te le phone 2. of ____ si_dence Number of Beclroo~s 3. Water SUpO~y- Othe (d scribe) ....... Individual Well ~-__~ Community ~ Public ~ Note: If corgunity ~11 system, must have ~itten confirmation frGn the State Departa~nt of Environmental Conservation attesting to the. legality and status. Is the ¥~11 adequate for the n~m~r of bedrocks specified in this HAA 4. Sewag_e~l Is the wastewater disposal system adequate far the plm~ber of kedro~n~ (Y/N) [Page. 1 of 2] 2-15-84 5. _En_q~]~e_ri.ng Firm Providl,~g I~s~pe~_ ctic~_ns__z Tests, E~ta and Information I certify that I have checked, verified, or conforn~,d to all MOA HAA C~ide!ir~s in effect on the date cf t_his inspection. (ENGINEER S~) 6. DHEP Approval Approved for Approved ~ Disapproved F--~ Conditional Ter, Ts of Conditional Approval %he Municipality of Anchorage D~partn~nt of Health and Environgenta]. Protection dc~s not guarantee 'the continued satisfactory pe, rfo~rmanc9 of the wate~, supply and/or waste, water disposal system° This approval indicates that, a,~ of the validation shown above, based on the data and info~raation furnished ky an engir~3er registered in the State of Alaska, the water supply and 9rastewater disposal system is safe and func- tional for the numbe~, of bedr. cc~ns and, type of structt[re indicated. 7, Mail the HAA to the following address: KB2/d5/s !Page 2 of 2] MUNICIPALITY OF ANCHORAGE (MOA) HEALTH A33THORITY APPROVAL (HAA) CHECKLIST - FEBRU~-RY 1984 Well Classification jx~,/A- f,~z[ ~,~,,_ Well ~ ~esent (Y~) Total ~p~ Card to Static Water Casing ~ight ~ Gr~nd Elec~ical Wiring in ~nduit (y~) sep~ation Distan~s ~ ~11: To ~ptic/Holding Ta~ ~ ~t To ~a~st ~ge of ~so~ption Field on Lot To Nearest bablic ~= Line C lean,t/Manhole Wate~ S~le Colle~ed By Wats= S~le Test ~sults If A, B, c~ C, D.E.C. A~. YA$)~nYaolNn~ Date Completed Yield Depth of G~outing. Pump Set At Sanitary Seal on Casing (~./'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/HOLDING TANK DATA Date Installed lO-2-'~-e~'.~]k si~ /300 6~A~ No. of C~,_~a~tments Standpipes (Y/N) ~ Air-tight Caps (Y/%]) Y~5 Foundation Cleanout ~~_ Depression ove~ Tank (_~Y/N). N6~ Date Last Pumped ~A -- Pumping~intenance Cont/ract c~ File _(y/N) ~.~; for Holding Tank High-Wate~ Alarm (Y/N) /VO Temporary Holding Tank Permit (Y/N) ~//~ 'Separation Distano~s f~(~u Septic/Holding Tank: To Building Foundation I I, ~) ' To Disposal Field . ~ z To Stream, Pond, Lake, or Major D~ainage To Water-Supply ~1]. TO Property Line To'Water Main/Service Line Course __ ~,//~ C oum~ nt s___~, t~e m{ c.r [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /o/~7 Width of Field ~,~r .~o ~, _/. Square Feet of Absorption A~ea 7~O ~ Depression over Field (Y/N) ~D Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~)'[~hl(~ To P~operty Line ;O,C~~ To Building Foundation ~ I, O ' To Existing or Abandoned System cn / Lot ~ ~2, O ; On Adjoining Lots '~ 3O, ~ r To Water Main/Service Line _~-/ ' To Cutbank(if present) / To Stream/Pond/Lake/o~ Majo~ D~ainage Course ~- ? To Dl~iveway, Parking A~ea, c~ Vehicle Storage A~ea ~ ~ (~ .~//~/~ Ty~e of System Design Length of Field '~, O ~ ~p~ of Field ~ O' Grail ~d ~ick~ss ~, ~' Stan~i~s ~esent (Y~) De LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) A?'PLI c A Din~nsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Con~ents ** Check Permitted Bedrocm Rating Against HAA Pequest I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspectioq. Signed Date ~.:~.:.°o 2248-5 o° ::- .' [Page 2 of 2] 2-15-84