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Home My WebLink AboutLILAC PARK BLK 2 LT 5 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LOCATION Manufacturor ~, in ~allons DISTANCE TO: Manufacturer IF HOMEMADE: Well Well DISTANCE TO: I Length acl line No, of linesi Top of tile to finish grade Length Width Type of crib Crib diameter DISTANCE TO: DISTANCE TO: Well HONE NO, OF BEDROOMS. I Absorption~re~ Inside length Dwelling Foundation Material beneath tile Depth Dwelling Material Widtf~-~------~ Material Nearest lot I1~ ¢ Trench width !, inches inches PERMIT NO, No. of companion? Liquid depth PERMIT NO. Liquid capacity in gallons [~"N EW [] UPGRADE Crib depth Building foundation Distance between lines otal effective absorptio~ area//¢ -- PERMIT NO. Total effective absorption area Nearest lot line Sewer lin~ ~. ~.¢ Depth Driller Distance to lot line PERMIT NO. Building foundation Absorption area(s) OTHER Septi~ tank ~ PIPE MATERIALS SOIL TEST RATING INSTALLER /UEcI.zJTO,~)' EX ~z~.- II G REMARKS APPROVED / DATE 72-013 (Rev. 3/78) LEGAL ALASKA BllUIRO[lmE DTAL COF1TROL Sel dlCeS, IFIC. I~n§in¢¢~'in§ 8 ~nuJronmcnl(tl Slu~lics August 3, 1984 Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Subject Property - L/lac Park Subdivision, Block 5, Lot 2 Dear Mr. Bantz: MUNIcIPALiTy Op DEPT 0r '~ r"/CHORA~ E · r HEALTH & NVIRoNIviENTAL PROTECTION AUG 2,1984 RECEIVED. The system on the subject lot was installed per Munici.pali~. of Anchorage permit. The portion "toP of the 'tile to fin/sh grade" refle(,~ts an additional 0.5' of fill placed over the system for total of 4 feet of cover. If you have any f~rther questions please feel ~r. ee to call Sincerely, John W. Gates Engineer Tectu~ician 1200 L~¢sl 33r¢I Aucnu¢. $ui1¢ [~ .~nchoro§¢. A]esko 99503,(907) 551-50z10 C: I FIL ~I T'T" Ii.]F [;-I['-,,~C~- E:,EF'RRTMEI'.EF OF HEALTH AND ENVIRCNMENTRL PRETEE:TION 825 L STREET., ANCHORAGE, ~K 99501 Z~4-4, Jl'-,~ _. I TE SE~--IEF-". -~-. bl[U_l_ F:"ERh"I I -F. F'ERMIT NO: [:,RTE I _~=,IJE[,: · ,. ~ k4,4,. ,=,4 FIF'PL. I CANT: HD[:'RE .... : _:UNTHL. T PHONE ROD CARLESON P 0 BOX ~0-905 ANCHORAGE, AK 246-2787 99511 LEGAL DESCRIP LOT S I ZE: LOT LGCATION: MFIX BEDR ] 31'1S: SUBDIVISION: LILAC PARK SECTION: 22 TOHNSHIP: 56?60 <SQ. FT. OR ACRES) LILAC CIRCLE/LILAC DRIVE 4. LOT: 5 BLOCK RANbE: LI=,TE[ E, EL3H RF.:E TFIE OF'I'IONS AVAILABLE TG YOIJ IN [:,ESIGNING YOUR cI=F'TTg SYSTEM. CHOO'--qE THE OF'TIGN THFtT BEST FIT'..-.-., YOUF.: =,ITL. 'T' R i ~'q E: i E: E [:. L-.#. [_]:, F." F~ 1E [4 [.'EF'TH TO PIPE BOTTOM (FT..':' ~:. 5 ** 4. 5 GRAVEL DEPTH <FT. ) ' 6.. 0 0. 5 TOTAL DEPTH (FT.) 9. 5 ~, 0 'GRAVEL NIDTH (FT.) 2. 5 22. 0 GRAVEL LENGTH (FT.) 52L. 0 ' 42. 0 GRAVEL VOLUME (CU. YDS. ) 20. 6 ~4, 2 I'ANK SIZE (GALS) :L, 250. 0 *:+: ±, 250. 0 :+::+, SOIL. RATING (SQ. FT. /BR) t52 .'252 4. 0 g. 5 7.5 .5.0 66. 0 48. 8 'J... 250. 0 i52 ** DEF'TH TO PIPE BOTTO'M :::2 4. 0 FT. MAY REGUIF.:E a LIFT STATION *:+: TANK MUST HAVE FIT LEAzT ThIO ]:]MPFtRTMENTS I CERTIFY THAT: J.. I tim F'AMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND HELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALFtSKA, 2. I HILl_ INSTALL THE SYSTEM IN 8CCORDRNCE WITH ALL MOFt CO[:,ES AND REGULFfTIONS., AND IN COrlPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3:. I WILL 8DHERE TO ALL 1',108 AND STFtTE OF FtLRSKfl REGUIREMIENTS FOR THE SET BACK :DISTANCES FROM ANY EXISTING WELL., WAS'TEWATER [:,ISPOSAL SYSTEM OR PUBLIC: SEWERAGE SYSTEM ON THIS OR ANY RD..TRCEI'qT OR NEARBY LOT. 4. ,I UNDERSTAND THAT THIS' PERMIT IS VALID FOR R MRXIIdUM OF 4 BEDROOMS AND RN,Y ENLFtRGEMENT WILL I;.'.EC.~UIRE AN FIDDITIONRL PERMIT. IF A LIFT STATION IS INSTALLED IN AN.AREA C:CIVERED BY MOA BUILDING CODES, ]'HEN <i) FIN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTRINEE:u (;~:) AS-BI_lILTS WILL NOT BE APPROVED HITHOUT AN ELEE:TRICRL INSPECTION REPORT.~ AND (.3) THE ELECTRICAL HORK MUST BE DONE BY R LICENSED ELECTRICIFtN. APPLICANT: ROD E:RR'LESON I=,=,LIED BY DATE: 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 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SLOPE SITE PLAN 10 11 12 13 14 15 16 17.- 18- 19 2O WAS GROUND WATER SL C-'3¼ ENCOUNTERED? P .~,\~,',~""'~ ~-~51~,~'~'~ IF YES, AT WHAT / E ~~ DEPTH? ~/~. ) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE__ ~ ,'"'T (minutes/inch) TEST RUN BETWEEN ~:>' . FT AND FT ~ . WATER WELL RECORD STATE OF ALASKA DEPARTMENT Of NATURAL RESOURE~ Division of Geologicol 8 GeophysicolSurveys- . LOCATION OF WELL (Pleole complete either Ia, Ih or lc.) ~ A.D.E. No. lc. DISTANCE AND DIRECT[ON FROM RO~D [~ITERSECTIONS 5. OWNER OF WELL: Street Add?se. ~n~ Areo of Well Locotlon 2. WELL LOG Feel Below Surfoce 4. WELL DEPTH; (flnol) 5. SATE OF coMpLETI~ 9. FINISH OF WELL.: ~ - ......... ~'"" 12.GROUTING Well Grouted: ~ Ye~ ~'No Molerlol: ~ Ne~f Cement ~ Other: 13. PUMP; (if avoiloble) HP ~ Length of Drop Pipe fl. capac[ly g.p.m. IG. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperolure ~___o ~ F ~ C ~ Registered. Business NO~ Co~lroct License, Number Authorized ~resontotive Form O~-WWR (11/81) Copy Distribution: WHiTE-Stole DGGS, PiNK-Driller, CANARY-Cuslomer MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL }~ALTH DEPARTMENT OF ~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Description (include lot, block, subdivision, Application Date ~/Ob~ tI (~'1 ~( section, township, range) Location (address or directions) (b) Applicants Name I-~e.~le7 .~-~e~o~w ~- Telephone~- Home Business Applicants Addres - (c) Applicant is (check o~) Lending Institution ~ ; ~er/builder ~ ; (d) Lending Institution (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. T~ of Residence Single-Family~ Number of Bedrooms 3. Water.Supply~ Individual Well~I Multi-Family Other (describe) Community~ Public~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. ~ewase Disp~s.al Onsits ~ Public ~--~ Community ~] Holding Tank E~ 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] 5. E__n$ineering Firm Providing Ins_j~ections, 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° I further verify that, based on the information obtained from the ~lunicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or 9rastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm /~,~ ~-~'~7~¢K5 Telephone , ~'' .' :,:~. ~ ._- .> ~'b Z~:~.fit' l~.'~-'q~ .... . ..~7~ ,.~ Approved for ,4q/z ('/-) bedrooms By ~.~ g~L~,'~Z-'"'::~?D~a' / Approved ~ Disapproved Condition~ Terms of Conditional Approval CAUTION THE bf0NICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT= ATIONS 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 REQUIRE- MENTS. ~MPLOYEES 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. (DHEP SEAL) RR4/ej/Di8 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AiFI'HORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification Well Lcg P~esent (Y/N) y Total Depth /~'5' Static Water Level Casing Height Above Ground Cased to MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTFI & ~NVIRONMENTAL Pi~.L FECTION NOV i 1984 Legal Description- R~og[-~V/.~ pT__ LI a/lc ' If A, B, o~ C, D.E.C. App~oved(.Y/N) Date C~t~leted Pump Set At Electrical Wiring in Conduit (Y/N) / Separation Distances f~om Well: To Septic/Holding Tank on Lot Td Nearest Edge of Absorption Field on Lot To Nearest "Public Sewer Line AY ; On Adjoining Lots ~ ; On Adjoining Lots To t~arest Public Sower C leancut/Manhole Water Sample Collected By ~o~ ~c) ~c~, Date Water Sample Test Results 5'2,~-, 5-~_ ~ '~o~.~/ AJo~¢ ~m ~¢~- To Nearest Sewer Service Line on LOt-~ /~ 0 b.,,/ ,.dr a P / B. SEPTIC/HOLDING TANK DATA Date Installed ~- ?-7- ~V Size /~-~0~ Standpipes {Y/N) ? Air-tight Caps (Y/N),~ Depression oveF Tank (Y/N) AJ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) AJ ; for Holding Tank High-Water Alarm (Y/N) A//~ Temporary Holding Tank Pern~it (Y/N) Separation Distance's f~cm Septic/~ Tank: To Water-Supply Well To P~operty Line To Wa*~/Service Line Course ~! No. of Ccnva~tmsnts Foundation Cleanout (Y/N) To ~ilding Foundation I ~,~ To Disposal Field g ' To Stream, Pond, Lake, o~ Major Drainage [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - %?- ~ ~ Length of Field Width of Field -~J ~o" Depth of Field' ~ /O~ Gravel Bed Thickness Square Feet of Absc~ption A~ea Depression over Field (Y/N) Results of last Adequacy Test Separation Distanc~ frc~ Absorption Field: To Water-Supply Well I?-J- 'To Building Foundation 2_ ~-' To Existing or Abandoned System Lot A~ /9 ; On Adjoining Lots To Water ~/Service Line ~r3' To Cutbank(if present) To Stream/Pond/Lake/c~, Major Drainage Course TO D~iveway, Parking Area, c~ Vehicle Storage Area '~O ' D. LIFT STATION Date Installed Size in Gallons "Primp O~" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dilrensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Coi~(~lTts ** Check Permitted Bedroom Rating Against HAA Request ** ~ ~/_~/~_ I certify that I have checked, verified, o~ conformed to all MO~:~H~ on the date of this inspection. S i.Q~,ed Date //- / - ~ ~/ Company ~ ~-~ ~V~ ~>~ c'~ MOA NO. c~y-~2 KB]./dS/s n effect [Page 2 of 2] 2-15-84