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HomeMy WebLinkAboutSOUTH HILLS BLK 5 LT 10011 o,1/' LoT- NAME 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 MAILING ADDRESS LEGAL DESCRIPTION NO, OPBEDROOMS We ¢~ ~,~j-c'~Absorptio_n~area Dwelling PERMIT NO. DISTANcETO: )~0~' ! '~ Width ~ '~ ~ '-/0 '~ ~ Manufacturer ~ ~ ~ Material ~ No. of pompartments ~ capacity)~¢ IF HOMEMADE: Inside length Liquid depth DISTANCE TO: ~Well Dwelling PERMIT NO. L~quM capacity in gallons Foundation ~ ~ PERMI~ -~S~ DISTANCE TO: Welli¢~ .¢. ¢'0~.~ No. of Hnes ~- Leng~h~.~) of~z~i .~.~ea h line Top of tile to finish grade Length Width rib diameter Well Material beneath tile Depth Crib depth Type of crib Building foundation Material Nearest lot Iine~o ~F Trench width ~ "7~.~ inches DISTANCE TO: Class Depth Driller DISTANCE TO: Building foundation Sewer line OTHER PIPE MATERIALS SOl L TEST RATING Distance between lines Total effectiv a sorption area PERMIT N , Total effective absorption area Nearest lot line Septic tank Distance to lot line REMARKS APPROVED 72-013 (Rev. 3/78) DATE LEGAL [: LOC:IE: t5 SEF'T :[ C CEi:;;:T :[ FY 'T'I'I!::tT: :.i...Z i::li'i F:'F:II'!:[!..:[f::Ii:;: I,.!:i:TH TI'liE i:;UE(;:!t..I:[F;:EHE[',iT:!ii; I:::'O1::,: ON-":E;:['T!E :!~;tEI,.IEI::;::E; FIN[:' HELLS f::lS SET FOi::;:TI'[ !;~ff 'T'I'IE~: H!,..!t'.,! ]Z (::: :tZ F:'i::il..,. :[ 'T'T' (:ZlF' t:::l~.,ll]::i..li:]li:;i:t::!i:]il~: ( HOFI ) I:::tND "I'HIE S"['F:t'TE: OF I::IL.I::t:~;t(R, 2. :[ i,.!ZL.[, :I:i'-,fSTI::Ii....i.. TI'fIE :~!;"¢:~;;TEPi :i:hi t:::tC.E:CIt:;;:t:)t:::ff',iCE F.I:[TH I:::IL.L f'lOt::f CODES FIND I~'.iEGtJI...;FI"FiONS., Fit'-4D Z i'q COl'fiFd.... Z R!q(:;:E: i4 :t: 'i'!l THE: t:)ES i EiN ~::::f;: :[ I"tER :[ Ft OF 'T'H :[ S t::'iERH :[ T. :Z. Z gi;i:LL FiDt'"IEF;:E 'T() I:::E_.L. ['IOF:t FIND S'TF:iTE OF [:tL.[:t~:~;[:::I:::I REQU:I:F4:Et'IENTS FOR THE SET BRCk:: D Z :E;"i'f::Ii",!C.E~::~5 Ff;~:OH t::li",lY E',,':: ]: ST :I: NG i,.iELi ..... F.iFi~;TEHF!TE~:F: D :t: SPC~:SFII-. S'¢STEFI OR PLJBL. Z C: SEHEF:F!E~E: SY:E;FEH (:)i",i Tt"iZ:5 (:)R FIl",J"r' RE:,,Ft:aCENT OF;'. NEFtREW LOT. ,;L i UNDEFE~;T!:::ff',ID TI"!WT' 'TH:iS F'EF:H:[T :IS VFIL. ZD FOF', R t,lia',,.,',:[t'"ll.jl"l OF 3: BEE:,I:;~'.OOf't:E; FIND F:ii',I? IENL. F:Ii:;'::GEbiE!",i'T' FI :i: t..I_. F;'.IEt]:¢J:i:I:~:E FI!"4 F!DD:[TZ()NFIL. F'EF;'.FI:[T. Date Drilledl Static Water Level Draw Down NELL, LOG feet feet lot ~0 Blk, 5 South Hills S,t>d. Gallons Per Minute Total Feet of Castn~ 3~ Type ,Material Drilledl 0 feet to ,~ fe~ tO 3a fc~t tO tO to tO Hefty Drilling S.R.A. Box 1553 H Anchorage,Alaska 99507 IIF'PL I CRNT L. OC:IIT I ON LEGBL ±405 W ±5TN lIVE 99501 CFllIRLES ROSS L&OB5 SOUTH HILLS LOT SIZE 999999 SQUliRE FEET T9PE OF SOIL RBSORPTION SYSTEM IS: TRENCH MliXIMUM NLIMBER OF BEDROOMS = _.5'-': SOIL RRTING (SQ FT,/BR)= 3t5 ]"HE REQUIRED SIZE OF' THE SOIL IIBSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH '.'.'IN FEET) OF THE "FRENCH OR DRliINFIELD. ]'HE [:'EPTH OF lI ]REN-.H ]R PIT IS THE [.I=THNt...E E, ETHEEN TNE ':;ItRFRRE OF THE GROUND lIng, THE BOTTOM OF THE E',:.:',CIIVRTION (tN FEET;). THERE IS NO SET WIDTH FOR TRENCHES. TBE GRliVEL DEPTH IS THE MINIMUM DEPTH OF GRII'¢EL BETWEEN THE OUTFliLL PIPE lIN[:, THE BOTTOM OF' THE E',:.:;CIIVIITION (IN FEET). PERMIT IIPPLICIIN'T' HFIC; THE RESPONSIBILITY TO INFORM THIS DEPlIRTMENT DLIRING THE INS'I"IILLIITION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY lIND THE NUMBER OF R. ESIf}ENCEL:; THlIT ;'HE WELL HILL SERVE. ........... T ~.--lCH ,:: 2 ::, I ~"~'----..F' E,:Z: T ][ C~f"~'~-~'. F]F-:[-] [;-: E L]." L[ Z F:':EE[:, BliCKFILLING OF liNY SYSTEM WITHOUT FINRL INSPECTIOI'.4 RND IIPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTliNCE BETHEEN li NELL liND liNY ON-SITE SEWRGE DISPOSIIL SYSTEM IS ±00 FEET FOR FI PRIVlITE HELL OR ±50 TO 200 FEET FROM R PUBLIC I.,.IELL DEPENDING UPON THE T'¢PE OF PUBLIC WELL. MINIf'IUM DISTlINCE FR. OM R PRI'¢lITE HELL TO lI PRIVlITE SEWER LINE IS 25 FEET lIND TO R COMMUNITY SEWER LINE IS 75 FEET. i.4ELL LOGS RRE REL-]LIIRED RND MUST BE RETURNED TO THE [:,EPIIRTMENT NITHIN 3:0 DliYS OF THE WELL COMPLETION. OTNER REQUIREItENTS MR'¢ lIPPL.'¢. SPECIFICFITIONS liND CONSTRUCTION DIlIGRliMS liRE IIVRILIIBLE TO INSURE PROPER INSTliL..LRTION. F"E F:~"'li % "T E::-:;F-" ][. F-:E':--=; [)EC:E~"IE:EF: 2-': :::L., 1%=;'~:3]'': I CERTIFY THlIT ±: t RFI FRI'IlLIIIR HITH THE REQUIREMENTS FOR ON-SITE SEWERS AND 14EL..L.S lis SET FORTH B"," THE MUNICIPlILIT'¢ OF IINCNORIIGE. 2: I WILL INSTIILL THE S'¢STEM IN RE:CORDANCE 14ITH THE CODES. 3:: I LINDERSTFIND THRT THE ON-SITE SEWER S"r'STEM MAY REQUIRE ENL. lIRGEMENT IF THE RE_,.!.EENLE IS F.'.EMODEL. E[:, TO INCLUE:'E MCIRE TNRN 3: BEDF:.uuM ..... PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 204-47Z0 SOILS LOG -- PERCOLATION TEST DATE PERFORMED:.__ SOILS LOG PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- ve.r~I d~ns e. SLOPE TE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Time Time Water Drop ~ /!:q7 to O,q3 ,03 m ,-/'/ -¢:~__._.__ _.~. ?_~ t Z :,~'~-l~ _ ~ O. PERCOLATION RATE ',.~.~-'~.,) (minutes/inch) TEST RUN BETWEEN ~ o~ ) FT AND CERTIFIED BY: 72-008 (6/79) P()UGI I 6-650 (90~) 2(~4 4111 January 4, 1982 Charles B. Ross 4451 Edinburg Anchorage, Alaska 99502 Permit ~ 810686 Subject: Lot 10 Block 5 SouGh Hills Subdivision A permit issued by this department for a well and/or system has expired as of December 31, 1981. sewer Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Sewer and Water Program Enclosure: Copy of Permit F:iF'F:'L. I C f:!i'-4 T ~]:HF:~RL. ES L. OCFF'I- I ON :]. ]i:;~:"!"l'"l !::IVE. LEGRL "' '" .:,[.U FHHILL_ L. OT ~..E~ E, LK 5 ....... = '- " T"¢F'E OF :'SOIL. RSSORPTION ':2;YS]'E!"I IS: TRENCH MF!::.::~MUH h...h'IBER OF BE[:,ROOMS = S:IL RRT.[Nt] THE REI]:~U:[REE:, :qZ;;:E': CIE' TFtE '::"'~1 ~IE,~..~5 ].[LIN - ~, ~;~.~,:,TEI1 I.:,. .y" E::. E: F" 'T ~"""~ .......... :~ L.. E; ~"-.~ C}i -F ~'~ ......... z~: ~~' C~ F: ff:~ %¢ E: ~.-- E::" E: F" 'T ~'~ == 4- "FHE LENGTH DIMENSZON t% 'THE LENGTH '::IN FEET) OF THE TRENC:H OR E:'RF!INFIEL[:'. THE DEPTH OF Fl TRENCH OR F'tT t~ THE [)ZE;TFINCE BETNEEN THE SL.IRFFICE OF THE GROUI'qD !::~N[:~ THE BOTTOM OF' THE E',~',CF~VFI]"ICff4 (IN F:'E:ET). THERE ZS; NO SET WIDTH FOR TRENCHES;. THE ~ H El.. [:'EPTH I:, THE MINIMUM [EF FH OF' P~"'""'¢~'~ EETI4FEN T'-IE OUTF'::JLL PIPE .1N FEET). RN[:, THE E:KTT]M f"F THE E::.0]:RVFITION "" F:: E: tl];:'~ L.,.~ % ~::;;~: E?: E:. ',:E; E: P' "T' SE C: -T" ~::~ ~'"~ ~-::::: :~ % :;~ ESE ........ F'ERM):T Fff::'PL. ZCFINT HRS THE F'.ESPONSZBZL~T'¢ TO ~NFORM THIS I}EPRRTHENT I}URING "f'HE INS"rRLLRT]ON INSPECTIONS; OF RN'¢ HEL. LS R[)SFICENT TO THZS PROPERT'¢ FIND THE NUHE:ER OF RESZDENE:E5; 'T'HFFf' THE I,.tEL. L 1.4ILL SERVE. E:RCKFIL. LZNG OF' RN"¢ S~¢%TEM HITHOIJT FINRL INSPECTION RND RPf:'ROMRL IE¢¢ THIS DEF'Fff~:TMENT I'.!IL.L BE :SUBJECT ]"0 F'ROSECUTION. MIF,!IHUM D!STF:INCE BE'I"HEEN R I.,.IELL FIND ¢~f',l'T' ON-SITE SEHRGE [)ISF'OSFIL SYS'T'E:M :t.E~i;~) FEET' FOR FI PRI'v'RTE HELL OR 1. SEt ]"0 ;2~DEI FEET FROM FI PUEIL. IC I.qELL.. DEPENDING UPOI",I THE "I'~'?F'E OF PLtE~LtC I,.tEL. L. MZP,ItMUM DISTFINCE FROPt F! PRIVFITE WELL TO R PRIVFF'f'E SEHER LINE :[5; 25 FEET RND TO ~ COMhlUNtT'¢ '.~;EHER LINE ItS 75 FEET. HELL L. OGS; FiRE REQUIRED RND MUST 8E RETURNED TO THE [:,EPFIRTMENT t.,.IITHIN OF THE HELL. COMPLETION. OTHER REg!LIIREMENTS PtRM F:iF'PL.'¢. SPECIFZCI:~TtONS FIND C:ONSTRUCTION DIFIGI;~:FIM:~3 F~RE t::WFIILFiBLE TO INSLIRE F'ROPER INSTFtL. LFIT ION. I ...JIF. t .[. T 'TFIFI'T I,.II=L.t .......... :I.: ]: F:ff"l FFIMIL):FIR 14ITl4 THE REQU]RE:f,1EN"F'i~; FOR :iN-SITE '=.Et,.![:.F:b RN[:, '"' ,= =c ,:= .. F'ORTH L"¢ 'THE M..HZ ...P I.]t~ OF F:iNCHORFtGE. ,..: I P.I!L.L..Iii... I~ LL THE ..,~.-] Ell IN RCCORPFINC:E t,.IITH THE ..... r.., lEft I'"tF!"F REI])I..ftRE ENLI::IRGE:MENT IF' THE 3: ! UN[)ERSTf~N[:' THFIT THE ON-SZTE S;EP~ER ':"": ..... RE:~;];[::,ENCE IS F:EHODELE[:' TO ZNC:L.U[::'E MORE THRN ]: BE[:,ROOMS. S I G NE [:, ~ ................... ; c:'. .... ............... MUNICIPALITY OF ANCHORAGE DEPARTME, NT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~RCOLATION TEST PERFORMED LEGAL DESCRIPTION: 4 5 6 7 SLOPE DAT~ PERFORMED: ~ n'~ SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: ENCOUNTERED? 0 DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop 3 ,, I:~& 15- $.1(~ PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: (minutes/inch) 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST TEST LEGAL DESCRIPTION: ~-~L¢~)'-~' tO ~.~ SLOPE DATE PERFORMED: ~_'~- ~.'~J © '-' ~'-( SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ,// . ,~) / TEST RUN BETWEEN ~/~-- FT AND (i~ · FT PErFOrMED BY: ~ ,. /~ jJ[/~/' CERTIFIED B : ~V : 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DIVISION OF E~'IRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY ~PPROVAL CERTIFICATE 1o General Information Application Date (a) Legal Desc,{iption~(include lot, block, subdivision, section, township, range) Location (addres~ or directions) (b) Applicants Name_~/C/~ ~c,% ~ Telephone - Home Business (c) (d) Applicants Address Applicant .is (check one) Lending Institution ~; C~ner/builder~; Buyer[--l; o her[2l] < plai ; Lending InstitutiOn Telephone _ Address (e) Real Estate Co. & Agent Address T~lepnoaa (f) Mail the HAA to the following address: 2. T~of Residence Single-Family~ Number of Bedrooms 3o Water S~p_ll Individual Well~. Mnlti~Family~ Other (describe) Community: Pub].ic: Note: If community well system~ must have ~Titten confirmation from the State DepartmenC of Environmental Conservation attesting to the legality and status. Sewage D___i~s~o_~ a~l 0nsite ~ Public ~ Community ~ Holding Tank ~ Note: If community well system, must have written confirmagion from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] Firm Providin Ins actions Tests File Search~ Da_re end 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 ~astewater 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 .~y investigation and inspection~ the on-site water supply and/or ~astewater disposal system is in compliance ~rith all Municipal and State cedes~ ordinances~ and regula~. ~ions in effect on the date of ~his inspection. (ENGINEER SEAL) DHEP Apj~roval ~k/~ Approved ~ Disapproved Conditional Terms of Conditional Approva~-~ CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENViRONMENTA-L PROTECTION (DttEP) ISSUES HF~iLTH ALVftIORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN LN 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 ST~iTE REQUIRE- MENTSo ~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/D18 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) PP OWn c c n sr - Well Classification Well Log Present 8) Total Depth 2~-~?' Cased to Static Water Level Casing Height Above Ground Electridal Wiring in Conduit Separation Distances f~c~ W~ll: To Septic/Holding Tank on Lot /~/ To Nearest Edge of Absc~ption Field on Lo To Nearest Public Sewer Line Legal Description: If A, B, c= C, D.E.C. Approved(Y/N) /~ , Date ,~Completed 7-.~'~'~/ Yield /,~ 3~ Depth of Grouting A//~ Sanita=y Seal on Casing Depression Around Wellhead (Y~ ; On Adjoining Lots /~0 ; On Adjoining Lots /dO To Nearest Public Sewer Cleanout/Manhole ~,~ To Nearest Sewer Service Line on Lot Water Sample Collected By /~f~$ 2~. /~/~J ~ Date Water Sample Test Results ~ ~- ~'~L?~ ~2~3L ~~ Be SEPTIC/HOLDING TANK DATA Date Installed ~/~/~/_ t Size StandpiDes .~/N) Air-tight Caps No. of Compartments Foundation Cleanout Dap~ession over Tank (Y_~ Date Last Pumped ~/~ Pump!ng/Maintenance Contract on File (Y/N)J/~ ; for ' ~/~ Holding Tank High-Water Alarm (Y/N) ~/~ 'Teapota~y Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: To Building Foundation ~/ To Disposal Field ~ /'~ z To Stream, Pond, Lake, ctr Majo~ Drainage To Water-Supply Well /~/ TO Property Line /0 / '~'" To Water Maip~Service Line Course Receipt ~ Date Paid: Amount: ~o_d~_ [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD E~TA Soils Rating in Absorption Stnzata Date .Installed Width of Field Square Feet of Absc~ptionA~ea Depression ove~ Field (Y~ Results of Last Adequacy Test Type of System Design Length of Field Depth of Field ~ ~ -- 7 Gravel Bed Thickness [3ate of Last Adequacy Test To Water-Supply W~ll To Building Foundation Lot To Wate~ Main/Service Line To Stream/Pond/Lake/c~ Majo~ D~ainage Ccuarse To D~.iveway, Pa~king A~ea, o~ Vehicle StoraQg. A~ea Separation Distance f~omAbsc~ption Field: /&3w' To P~operty Line ~' To Existing ~ndomd System ; ~ ~joining ~ts ~' '~ TO ~t~(if p~e~t) ~/~ D. LIFT STATION ~ talled Size~ "PumDOn" Level at ~ High Water Alarm Level at Tested for Electrical Codes(Y/N) Ccm~nts Dimens}ons ~ ~ ~ent (Y/N) PumginyCyc~S~~ Test. M~ets MOA ** Ched~ Pe~Litted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the ~ate of is ~/.ction. Signed ~~Y- Date KB1/d5/s [Page 2 of 2] 2-15-84