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Home My WebLink AboutSOUTHPARK #2 BLK 3 LT 15 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 NAME · PHONE EW MAI L I N G ESS LEGAL DESCRIPTION z J I LOCATION NO. OF BEDR~S ~' DISTA"CETO: ]Well ¢/~ IAbsorptiona~/ Dwelling ~¢ .ERMITNO. ~ Z Manufacturer Meterial No. of co rtments , ~ Well Dwelling PERMIT NO. Q Well Foundation ~ / Nearest lot lin) / -~ PERMIT ~ DISTANCE TO: ~ /~ I ~ Trench ~'dt (~ Total effective absor ~ion area · ~ 'o, of tile to fini h .tad, ~2~al b Length Width Depth ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line m DISTANCE TO: ~ Class ~ Depth Driller ..... Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer llne Septic tan~ Abso¢ption area(si OTHER PIPE ATERIALS 72-013 (Rev, 3~78) MLINICIF'FP._I'T¥ OF FINCHORPIGE DEPPIRTHENT OF' HEFILTH PIND ENVIRONi'dENTFIL PROTECT'ION 825 L STREET, ~NCHORFIGE, PIK 9750::L 264-4720 PERI'alIT NO: [:,RTE iSSUED: 8,40172 04/::L2,.."B4 FIPF'L I CRN'T: PIF;,DRESS: CONTFICT PHONE: L.EGFIL DESE:R I P': LOT S i ZF£: i-,tFIX BEDROOi'dS: L. PIN[)I'IPIRK-',/EN TURE LTD F' 0 BO::',; ±±:t654 PII'.,ICH OR:FIChE., Fil< 9 '_--.~ 51 ± 3:45-4807 SLIBDIS,'ISION: SOUTH PFIRK Ii=2 SEC:]"ION: 72: TOI4NSHIP: i:.I.N 2]L?'60 C-7,Q. FT. OR. RCRES) ]: LOT 15 BLOCK: RRNGE: ~H LISTED BEI...OH RRE TFIE OPTIONS R',,,'FIILRBLE TO ¥OLI 11'.4 DESIGNING ¥OLIR SEPTIC S'¢STEf, I. CFIOO~E THE: OPTION THR-F BEST FITS '-fOUR SITE. 4.0 4.5 4.0 8.0 0.5 5:.5 ±2.0 5.0 7.5 ~ 22:.0 5.0 ~0 44. 0 77 0 :~-::'~: 3:5. 4 3:7. 4 57. 0 ::L., 00El. 0 :+",~: ±:, 000. 0 :+:* t, 000. 0 25:7 220 227 DEF'TH TO PIPE BCKF'FOI"I '::FT. ) GRRVEL DEPTH (FT.) TOTRL DEPTN (F"I". ::, GR. RVEL WIDTH (FT.) GR. PI',/EL CLENGTH (F-F. GRFI'v'EL. 'v'OLUME (CU. '.~'E:,':-';. ::, TFINK SIZE (GPILS) SOIL R.F]TING (SQ. FT. ,,"E=R) :+:$ GRFI',,,'EL LE1`',IGTH }. 75 FT. REQUIRES MULTIPLE RUNS (NOT E',:':;CEEDING 75 FT. ERCH) :+::+: ]'RNK MUST HR',.-,'E Fl]" LEPIST THO COi"IPRRTi"IE1`',ITS I CERTIF'-? THFIT: '1.. I FiN F'RHII._IBR WITH THE REQUIREMENTS FOR ON-SITE SEI.4ERS RND' HELLS RS SET FORTH B'Y THE MUNICiPPIL. IT'¢ OF PINCHORRGE (HOFt) Ri".,ID TFIE STFITE OF FILRSKFL 2. i HILL INSTRLL THE :.:..;'T'STEH IN FICCORDFINCE HITH FILL HOFI CODES RND REGULFITIONS., FIND IN CO[,'iPLIRNE:E HITH THE [:,ESIGN CRIT'ERIR OF THIS PERMIT. 3:. I HII_L F:IDNE. RE TO FILL NOR RN[:.., S'f'RTE OF FtLRSKR REQUIREHENTS FOR THE SET BRCK DISTRNCES FROH RN'¢ E',:.:,'ISTING HELL., 1.4PISTEHRTER DISF'OSRL S'¢STEH OFt PUBLIC SEWERRGE S'¢STEH ON THIS OR PINY RDJRCENT OR NERRB"r' LOT. 4. I LJNDERSTRND THFIT THIS PERMIT IS VRLID FOR Fi HR',:':;INUffl OF ]: BEDROOM'::; PINE." PIN'¢ ENLRRGEMENT WILL REQLIIR. E PIN PIDDITIO1`',IPIL. PERMIT. iF FI LIFT' '.:~',TFITION IS iNS'!"PILLED IN RN FIREPI COVERED B"r' MOB BUlL. DING CODES, THEN (:1..) FIN EL. ECTRICPIL F'ERHIT i:IND INSPECTION MUST BE OBTPIINE[.".~ (2) PIS-BLiIL. T'--'; HILL NO'F E!E PIPPROVE[." HITHOUT RN ELECTRICRL INSPECTION REPORT.; 13ND (c..:) THE ~LECTRICFIL I,.IOF.~( HUST BE DONE B'¢ FI LICENSE[:' ELECTRICIPIN. , I , ~'"-% ~ '-'/¢ ['MTE .... ............ FtPPL;IiCPINT :( I.~IND!;1PIRK-VEI'.ITURE LTD ' ISSUED PERFORMED I~OR: LEGAL DESCRIPTION: 1 2 6 ,8 9- 10- 11 12-' 13- 14- 15 16 17 18 ~ JNIC!PALITY OF ANCHORAGE DEPARTMEr,~T OF HEALTH AND ENVIRONMENTAL PROTECTION SOILS LOG -- PERCOLATION TEST - SLOPE WAS GROUND WATER ENCOUNTERED? C.. Re[d, Jr. IF YES, AT WHAT DEPTH? SITE PLAN PERFORMED BY: Gross Net D~pth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST R'UN BETWEEN CERTIFIED BY: 72-008 (6/79) .' I MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HBALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1o General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~.o~'CA~f~W_~'~~%-~%bl~Teleph°ne - Home Buoiness Applicants Address '~ O, ~,~>~ _ ~ t /&'~-~ / ~.~(J-I; ~-- '~-~t -- (c) Applicant is (check one) Lending Institution ~ ; Owner/builder.S; Buyer ~ ; Other ~ (explain); ,. .__~__ . . .... (d) Lending Lnstitntion. Telephone ...... ~i'~' __ Address (e) Real Estate Co. & Agent_ Address Telephone -' (f) Mail the ~ to th~ following address: . T__ype___.of Residence Single-Family., Number of Bedrooms Multi-Family Other (describe) Nater Supply Individual Well~ 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 0nsite Pu lic CommunityCU Holding Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the lagality and status. [Page 1 of 2] e Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by m~ 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-mite 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 Anchorag~~Yiles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance v~th all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection° Name of Firm Address Date (ENGINEER SEAL) DHEP Approval Approved for~Lx3-~c~bedrooms Approved Disapproved By Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH ~ND ENVIRONmeNTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGIlfEER REGISTERED IN THE STATE OF ALASKA~ THE DREP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. ~MPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA BEFORE A CERTIFICATE IS ISSUED. T}~ 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® MUNICIPALITY OF kNCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification A Well Log P~esent Total Depth Cased Static Water Level Set At Casing Height Above G~ound Electrical Wiring in Conduit (Y/N) Separation Distances 'f~om Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field To Nearest Public Sewe~ Line C leancut/Manhole To Nearest Water Sample Collected By ; Water Sample Test MUNICIPALITY OF ANCHORAG2 DEPT. OF HEALT'..I & ~NVIRONMENTAL pE.S TECTiO,Xl RECEIVED Legal Description: ~C~- t~ ~ ~ If A, B, ~ C, D.E.C. ~p~o~d(Y~) ~ ~te ~leted ~pth of G~out Seal on Casing (Y/N) A~ound Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots Nearest Public Se~r Service Line on Lot Date CQ,~t'~nts B. SEPTIC/HOLDING TANK: DATA Dat~ Installed ~'"'i, AU~I' %~Size I~_~--~O ~ No. of Ccrapa~tm~nts ~ Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression ove~ Tank (~[/N)r~-~ Date Last Pumped ~/~ Pumping/Maintenance Cont~zact on File (Y/N)~/~ ; fo~ - Holding Tank High-Water Ala~m (Y/N) ~A/~ Temporary Holding Tank Permit (Y/N) .Separation Distances f~om Septic/Holding Tank: To Water-Supply Well ~ ~..C)'-~ · To P~operty Line ~ To Water Main/Service Line co.se TO Building Foundation I'~ 4 TO Disposal Field '7" To' Stream, Pond, Lake, c~r Major Dcainage Counts [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 23'7 Date Installed '~%a~-( ~ ~ ~ngth of Field Width of Field ~6~" ~p~ of Field Grail ~d ~ick~ss Squ~e Feet of ~sorption ~ea '7~O ~p~ession ove~ Field (Y~) Results of ~st A~a~ ~st Sep~ation Distan~ f~ ~sorption Field: To Building Foundation ~ ~ ' To Existing or ~ndo~d System Lot ~4/~ __ __; ~ Adjoining ~ts To Water Main/~vi~ Line ~,~ ~'~ To ~t~(if pre~nt) To Stre~ond~ke/~ Majo= ~aina~ ~se To ~i~way, Parki~ ~ea, ~ Vehicle Stora~ ~ea Comrents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at Tested for / Pumping Cycles du~in~Adequacy Test. Electrics]. Codes (Y/~ Co~n~nts ** Check Permitted Bedroom Rating Against HAA Raquest ** I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of s~-P~ion. Signed . Date ~/~c~'-- Company ~-~L q~o%~ %C~ MOA No. KB1/d5/s [Page 2 of 2] 15-84 SHEFFIELD, GOVEI~NOR 7~lephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 'ANCHORAGE, ALASKA q9501 274-2533 PWS I oD.# /-~ e.~, To Whom it May Concern: According to records on file in this office the Water Regulations Water System is in compliance-with the State Drinking Sincerely,