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HomeMy WebLinkAboutBIRCH HILLS TERRACE #2 BLK 1 LT 2ac 0o0  MUNICIPALITY OF ANCHORAGE DEPARTMI=NT OF HEALTH & ENVIRONMENTAL PROT=~;TION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT l L~AL D~SCRIPTION L~CATION ' NO. O F~ROOMS ( '~ DISTANCE TO: ]~e~/~ t~ I Abs°r~re~ Dwelling/ , ~ PE~M~.~ NZ Manufacturer ~ ~.i Mat~lY[ 5 No. o* com~mants Liq.~a~itV~lons Inside lenoth Widtht Liquid depth / ~ ~ /) IF HOMEMADE: w., ~ ~ Z~'/_ / ~' Material Liquid capacity in O ~ ~ Manufacturer =--~ Well/2 Four, on~ ~ Near~ line~ PER M~ gallons ~ DISTANCE TO:. ~ '~ t~n-- ~ ~ ~ Lenflth ~o. of lines~ ~s ~ Tr ~ista lines ~ :~ Top of tile to h~a¢ °~in9 Totalling ~;~h '"i ches  M~ iai~eat~ e~ . / ~ -- ~ --Z ~ r/ 7Z inches Total eff,ctive absorption area Length Width Depth ' PERMIT NO. ~[q ~ Type of crib Crib dia ~rib depth Total effective absorption area ~ Building foundation Nearest lot line ~ DISTANCE TO: ~ Class S ~ ~~/~ ~. Driller Distance to lot line PERMITNO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ' ~ ~lPfi MATfi~IALS SOILTESTR~IN~ ~ z~// , 1 ~ ;'"/~Rr~ .-,.,,-,07'~ ,~ / ~ ~-;~E RIVER, ALASK& S9577 i ~ ~'~'- ~ . . ~ 3 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE Department ~f Health and Environmental Protection 825 Street, Anchorage, AK. 3501~ 264-4720 ~ * * * HANDWRITTEN PERMIT * * * Permit ~ ~,~.... ~ ON-SITE SEWER PERMIT Location: Phone Number: Legal Description: IO'~ ~/~l ~R~,~ ~l// TRJ7~ 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 }C~ LENGTH .~' /~ 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(HeE~4-NG) TANK SIZE = /~5C) 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 ~rosecution. 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 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to inClude more that~b~rooms/.//q Applicant ' ' Date: ~ ~' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 SLOPE DATE PERFORMED: d~l~_Jt Hilt '7?,rrr, c ~, ~ ,~. SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED BY: 72-008 (6/79) Robert A. 1'4o, WAS GROUND WATER ^/ S ENCOUNTERED? /Y~ , 0~ IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop · ! PERCOLATION RATE TEST RUN BETWEEN CF (minutes/inch) FT AND ~ FT DATE:~~i~ 0 rn 0 © 0 0 0 0 © © 0 0 0 0 0 © 0 0 © 0 0 0 © 0 0 0 0 0 0 0 © 0 © © 0 0 0 ~.~  © ,,..C. 3 © 0 0 0 0 0 0 0 0 0 0 0 MUNIClP.~LITY 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) Lot 2 Block I Birch Hills Terrace #2 5-22-86 Location (address or directions) Lacy Dr. (b) Applicant Name Tom W,~son Telephone: Home 694-2831 Business Applicant Address 2528 Lacy Dr. Eagle River, Ak. 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder,~; Buyer []; Other [] (explain); (d) Ledding Institution Ak. USA FCU Telephone Address Eagle River (e) Real Estate Company and Agent None : Address Telephone (f) Mail the HAA to the following address: S & S ENGINEERING, SRB 196X EAGLE RIVER~ AK 99577 TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms 4 Other WATER SUPPLY Individual Well I~ 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 (11/84) ENGINEERING FIRM PROVID , INSPECTIONS, TESTS, FILE SEARCH, [ A 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 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 S & $ ENGINEERING Telephone ~" y ~/"' '~'"'~;;~'.~' SRB ~96X Address ~,~Av ,'~ ~ ,,.,,,,., EAGLE RIVER, AK 99577 ,,,m~ ~ ~ I~0 Date DHEP APPROVAL Approved for ~'~' bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional 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 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MOLl HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: L~T Well Classification Well Log Presentd~N) Total Depth ~'Z,- ~ Static Water Level Casing. Height Above Ground Electrical Wiring in Conduit (~'N) Separation Distances from Well: To Septic/.l~ Tank on Lot MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JUN 0 41986 RECEIVED If A, B, C, D.E.C. Approved (Y/N) Date Completed '~- 'Z.-'7..- .-- ~,'~ Yield ! Cased to ~-" To Nearest Edge of Absorption Field on,Lot To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by Water Sample Test Results Comments Depth of Grouting '-'--- Pump Set At ~J ~'--' Sanitary Seal on Casing Depression Around Wellhead (Y,~ ~ ~'7..~ · On Adjoining Lots ~ 'Z..?./ ; On Adjoining Lots To Nearest Public Sewer I~ Jj~ To Nearest Sewer Service Line on Lot ~--~ ~. ~-~ '~(.a[~. 'Date B. SEPTIC/.H-OEDtNG-TANK DATA Date Installed Standpipes ~N) Air-tight Capsd~N) Depression over Tank (Y/~[~ Pumping/Maintenance Contract on File (Y/N) / Holding Tank High-Water Alarm (Y/N) ~/~ Separation Distances from Septic/HofdiTTCj Tank: To Water-Supply Well I/'Z. To Property Line /o '.¢.- To Water Main/Service Line Course ~.~- ~- ~;5 Size j~.c~:~ No. of Compartments Foundation Cleanout (~)N) Date Last Pumped ~' ; for Temporary Holding lank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I[~, ..-- dc - Width of Field 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 /~rL.__ Type of System Design Length of Field Depth of Field ~c~ Gravel Bed Thickness Standpipes Presentc~N) Date of Last Adequacy Test / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line I C;:~ ~Jr- To Existing or Abandoned System on · On Adjoining Lots ~ I .{__ To Cytbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) 4 "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** t certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ & $ ENGINEERING Signed Date lulAV '~ Q ~no~ SRB 196X C°mpan~,Gi.E kiVr-R, AK 99577 MOA No. Receipt No. ~ Date of Payment Amount: $ i-inl L ~' i~/f, jU MAY 2 9 IgR6 Page 2 of 2 72-026 (11/84)