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HomeMy WebLinkAboutSTEWART #1 BLK 2 LT 4 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 LOCATION NO. OF BEDROOMS 2~ DISTANCE TO: , ~8~ /O ~,~ Manufacturer~ Materia~'~/~. N°'°fc°mpartments ~ ~ Liq. capacity in gallons Inside length Width Liquid depth / () ¢~ IF HOMEMADE: ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Cla~n~r ~ Depth Driller Distance t0 lot line PERMIT NO. ~ / Building foundation Sewer llne Septic tank Absorption area(s) ~ DISTANCE TO: OTH E R SOl L TEST RATING REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) DOC Co, dba P. o. BOX.272, CHUGIAK, .~ _ASKA 99567 a TELEPHONE 688-2759 OWNER OF LAND ADDRESS LEGAL DESCRIPTION DAtE-Started ~?/?./p' ,Z PERMIT NUMBER DEPTH OF WELL / '~ / STATIC LEVEL OF WATER FT. / / DRAW DOWN FT GALS. PER HR KIND OF CASING KIND OF FORMATION: From__ From From_,5 From From --~ From / From~ ? From / From /~') From _~ From Ft. to Ft._ From__.Ft. to Ft. From Ft. to Ft. From__fit. to Ft, : From Ft. to Ft. From Ft. to__Ft. From Ft to Ft From Ft. to Ft. From Ft. to Ft From Ft. to F[ From Ft. to Ft From Ft. to__Ft From Ft. to Ft From__.Ft. to Ft From Ft. to Ft. From Ft. to. Ft. From Ft. to FL From _ Ft. to __Ft. From Ft. to Ft. From .Ft. to Ft. From Ft. to _Ft. From Ft. to _Ft. MISCL. INFORMATION: DRILLER'S NAME PERMIT NO. ( 82C~E~4D ) FIF'PL. ~ CRNT p T C ~-I~ F.':'£ P. HRI",IK I NS L. OCFIT ~ON LOLRNE;, RVE. LEGF:IL LOT 4 BLK 2 STEWFII'-Z.:"I~', SUB ......... h..,!lr:,,,! t , ILt-I._. !11 I'11',,[. Ei"~VII,;d3!'qMENTE:iL . .:OTECTION 825 "L ¢ S'I."REE'-I'¢ RI"i!C;HORREiE., RK. S~¢5021. .2S4-4720 ~_.11~.-~---..=. '~" -." ." F'. O. ~=:f]::.:: JjR~ ERGL. E RIVER ~;.['4'I"2257J_~ LOT SIZE 24758 SE~URRE FEET TYF'E OF SOEL AE:SOI.--::PTZON ::.!;?STEM IS: TRENCH MRE,:!MLIM NUMBER OF BEDROOMS SO.EL I'~'.FFf'ENC~ '::SQ FT,?BR)= :L]:8 THE REGCJIRED S:[ZE OF THE SOIL RBSORPTZON S'¢STEM IS: T'HE LENGTH DIMENSION IS THE L. ENGTF! EIN FEET) OF' THE 'TRENCH OR DRRiNI=!ELD. 'THE DEF'TI.-! OF R TRENCH Of,;?. PIT iS THE DiSTFiNCE 8ETt-qEEN THE SURFRE:E OF THE GROUN[:, RN[:, THE E~OTTOM OF' 'THE EXCRVRTtON (IN FEET). THERE ZS NO SET NIl}TH FOR TRENE:I.qES. TNE GRRVEL DEPTH IS THE M!NIMUI',I [>EI.:'TFI Of:' GRRVEL. BETI.,.IEEN TNE OUTI,:'FtLL PiPE RND THE E~OTTOM OF THE EXCFIVRT!ON (!F,t FEET). F'ERHIT I'!h'F'LIL:HNF HRS 'il-lc. F..E_FL.,L, IE,.[LE ? "FO INFZffE'M THIS DEPRRTMENT [:,LIRING ]"HE: INSTFiL. LR-I.'ION !NSI,:'ECTEONS OF RN"? I,.!ELLS RDJRCEI",IT 'TO THIS PROPER]-"? FINE:, THE .?.qur'IE~ER OF RESIDENCES ]'HR]' THE NELL NII_L SERVE. BROKFE. LLZNG 0l,:' RNb' S'.FS'I.'EM klITHOUT F'ENRL INSPECTION DEPlaRT!"!ENT NELL BE: SUBJE[ST TO PROSECUTIOi'-,I. FIPPROVFI!. B"¢ THIS MINIMUM DISTRNCE BETNEEN R !qEL. L_ FIND RN? Oi'.[-SITE SENRGE DISF:'OSRL S'¢STEi"I IS; !00 FEE'T FOR Fi PRI'¢I~TE I.,.!EL.L OR ::[.5C~ TO 2EE3 FEET FIE:OM R PL.IBLIC .14ELL DEPEND'_[NG UP[]N 'TNE T"r'PE OF F'LIE~LIC !.qELL. MINZMLtM DISTRMCE FRO!"1 R PRZVRTE NELL TO R F'RI',,¢R'I"E SEIqER LII'.,!E IS 25 FEET RN[:, '1"0 R COMMUNIT? SEWER LINE IS '75 FEET. NELL LOGS RRE R. EOUiF~:E[:, FIND MUST BE RETURNED TO THE DEPRRTMEN"I- k!ITHEN ]:,C~ DRVS OF' THE [qELL COMPLETION. OTNER REG!I.JEREMENTS MFIh.' RPF'L'~'. SF'EC:IFICFI. TIONS RND COh!:FSTRUCTION DIRGRRMS P, RE RVFIILIaE:LE TO IN.E]UI,4:I,E F'ROF'ER INSTFILLRTION. I CERTIF? TNFIT ::[.: ! FiM FRMtLIRR kI!TP, TFIE REQLI!fE:EMENTS FOR ON-SiTE SEk~EF?.S ¢]ND 14ELLS RS SET FORTH E:~r' THE MUNiCIF'F!L!T? OF RNCH(}RRGE. 2: Z IqILL i!'qSTRM_ THE S'¢STEid ZN RCCORD¢aNCE NZTH ["HE CODES. ]:: I UNDERSTRND TFIRT THE OF.l-SITE SEklER S"r'STEM MR'¢ REE:fUIRE ENLFIRGEMEN'T IF THE RESIDENCE ES REMODELED 1"0 !NC:LUE:,E MORE "FNRN 3: E:EDROOMS. S i GNED: R~NT F: l CHFIRD P. HFffNK I N'---; E PERFORMED FOR: [~EGAL DESCRIPTION: 1 2 3 4 5 6 ~ 13- ~'-"~ 14- COMMENTS SOILS LOG [] PERCOLATION TEST MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 /~ . ~SOILSLOG- PERCOLATION TEST SLOPE "1 W ASOROD"DW"TER ENCOUNTERED? /U"© O ~_, e .a,~,.g_~_/~C~..ff~:. Time Time Water Drop . ,,,.~ ~ .... ~ / [~ PERCOLATION RATE ~[/[ ~ (minutes/inch) TEST RUN BETWEEN , FT AND , FT ./->/ x// 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) Ia) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Properly Owner (c) Lending Institution G ~" '' ""~lbphone Mailing Address ¢~O ~: 7~ ~'~ v-, ; .:.':.:: .. 5~ ~ (d) Real Estate Company and Agent '.. ~ ~¢'~¢ .'?~ F~ Telephone ~-~/~5 "' *'" (e) Mail the HAA to the followine address: or: Check here~, if hold for pick up. List contact person and day phone number below. Business TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER 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 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 fRev 8/861 Front ')~JOM S,J88U!eUe leUO!SSejoJd CHI u! SUO!SS!LUO JO SJOJJe ]OJ elq!suodse~ ~,ou s! eeeJoqeu¥ jo/q!ledlo!un~ aqJ. 'panes! si e~ee!J!lJeo e eJojeq ejep eZ~leUe Jo suop, eedsu! )onpuoo leu op SHHQ jo see/,oldUJ:l 'slueLueJ!nbe~ ejm. spue leJepe,t u!epao ,~Js!les o3 ~ep~o u! suo!lm.!jsu! 8u!puel ~!@q~ pue seuJoq jo s~eseqeJnd el ~$apnoo e se s!ql seep SH HQ eq± 'e;ISelV jo a~el$ aql u! peJa~,s!ee~ ~eeu]6ue leUO!SSejO]d luepuadepu! ue ,~q e^oqe g qdeJeeJed u! ua^lB suo!le:!ueseJdeJ eq~ uodn /~lUO peseq se~eo!j!)pe,') le^oJddv ~lpoqlnv qlleeH senss! (SHHQ) see!^JaS ueuJnH pue q~leeH Jo ~UeLUpedeQ e6eJoqouv jo ~j!led!e!unw eq.L NOIJ. rP¢O ie^oJddv leUO!ilpuoc) jo suJJe/ leUO!l!puoo peAo~ddes[Q /,X. Pe^°Jddv IVAOI:iddV SHHI3 '9 lees s,Jeeu!Ou3 } · eleC] o&-. -,? ///.Z_ ~ ~' euoqdeleJ.~,~¢¢~ .O.,h,?~L?zT¢'~&~,~¢ ,,('¥y?l,~tc.,1' ~./~.?/7u/ LUJ!q JO euJeN 'uo!loedsu! S!LN jo elep eLll UO loei~e u! suo!lejn~ieJ pue 'seoueu!pJo 'sepoo elelS pue led!o!unR lie L~I!M 8OUBIIdLUo0 UI S! LUelS/~S leSOdS!p JeleMelBeM Jo/pue Xlddns JeleM elIS-UO eql 'uo!lo@dsu! pue uo!le8!leeAU! ~LU LUOJJ pue Sel!J eaeJoqouv jo Xl!led!o!unW eql LuoJj peu!elqo UO!II~LUJOJU! aLII UO peseq IBLJl ~J!JeA JeLJlJnJ I 'uleJeq peleo!pu! eJnlonJ~,s jo edXl pu~ suJooJpeq ]o JequJnu aLIi JoJ elenbepB pue leUO!lgunl 'eJee s! uJelS~S lesods!p Je]leMeleeM Jo/pue ,~lddns Jele~A el!s-uo eLll lei-il SMOL4 S leAoJddv ,~i!JOLllnv qlleeH s!ql jo uo!le6!lSeAU! ,~w leqj/~J!JeA I 'MOleq UMOqS elep UO!lep!leA @ql IO Se pue Ole]eq paxNJe leas ,~LU Xq pau!peo sV NOI.L*CBEIOJNI tiNY ¥J.¥C] 'HOI~'V:IS :1-114 'S.LS:I I '$NOI.LO=IdSNI ~)Nlal^Obld INEIIJ 9NIU=EINI-~)N:I .§ MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION MUNICIPALITY OF ANCHORAGE (MOA) /~, JG !1990 HEALTH AUTHORITY APPROVAL (HAA) ' CHECKLIST - FEBRUARY 1984 284-4,.4 R E C E I V E D Legal Description: ~.'OT ~ L~,~oc:~'z~ 2L .:~-~'~f/~- .5~.'b~/- /,./.. Y A. WELL DATA Well Classification ~'~-'~ r~ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y Date Completed ~'- -=j '* ~ ~' Yield Total Depth / ~ ! Cased to ,~'~4 L)c'l/~Depth of Grouting Static Water Level Casing Height Above Ground ~ / Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /05' To Nearest Edge of Absorption Field on Lot Pump Set At ,/4:7 / Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) t~''/ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments [t/'/"~4 To Nearest Public Sewer ^//~ To Nearest Sewer Service Line on Lot J~- H' ; Date ?-Z~-' ¢0 B. SEPTIC/HOLDING TANK DATA Standpipes (Y/N) ~" Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /O ~ To Property L!n9 ' -, ~0 / To Water Main/ServiCe Line /~'~ Course /t,~O ~J ~'~ Size lO&~ No. of Compadments 2~ Air-tight Caps (Y/N) '~ Foundation Cleanout (Y/N) Date Last Pumped '~ ~ ~0 ~'k~/.~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ~' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 fRev 81861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /.~"~cr"~ Type of System Design Date Installed ~..,J~/~'z.- Length of Field / /-'-;. ~ ~-,~ Width of Field '~¢ ~' Depth of Field e~-~.~¢ ~¢ /./L (¢ Gravel Bed Thickness(~.~~ ,~//~ -' Square Feet of Absorption Ar _ -/ Standpipes Present (Y/N) Depression over Field (Y/N) /L/ / Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /! ~ To Building Foundation ~'~'// Lot /~ To Water Main/Service Line 1'70 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~,~"¢ To Existing or Abandoned System on ; On Adjoining Lots ~-% To Cutbank (if present) ~: ' Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions ./' Man~Y/N) .-~Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha~l'ha--~v checke~ver~fied.O~conformed to all MOA and Signed ~-.¢~2 ~ Date ~'/~ ~ Company ~' ~- ~ MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72 026 fRev 81861 Back HAA guidelines in effect on the date of this inspection. ,,' .' ,~' CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-23zl3 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SA~LP~S for Work Order E 258S9 Date Report Printed: JUL 30 90 ~ 19:56 Client Sample ID:2132~ LO.AND, HOM~ PWSID :UA Collected JUL 26 90 ~ 14:30 hrs. Received JUL 26 90 ~ 15:50 hrs. Presez?ed wi~h :AS REQUIRED Client Namo: HANHINS, RICHARD Client Aect : HANKRC P,O~ NONE RECEIVED Req ~ Ordered By : RICHARD HANKINg Anaiysl~ Completed :JUL 27 90 Send Repo~g8 to: Laboratory Supervisor :STEPHEN C, EDE 1)HANKIN$, RICHARD 8pecl*l CALL ~0~ PIC[~ AT 69~-2371 Che~ab Ref ~: 9026?9 Lab Smpl ID: i Matrix: WATER Allowable Param~te~ Teste~ Result Ultra Method Limit~ NITDATE-H 3.5 mR/1 EPA 355.2 10 Sample ROUTINE SAMPLE. SA~LE COLLECTZD BY JW. Tests Performed ' See Special Instructions Abow HA~Unavailable Not Analyzed LT~Lo*s Than, GT~O~eater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AU;I'HORITY APPROVAL: OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date' ////~/~' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range), /oF ,¢ Z. / Locat on (address or. directions) (b) Applicant Name 1~¢/ Applicant Address (c) Applicant is (check one): Lending Institution{~; Owner/builder ~?~uyer []; Otb'er [] (explain); (d) Lending Institution ',~//~'~i~a!? ~'"~'x'cJ~¢~'C', ~O Telephone (e) Real Estate Company and Agent /~///~ Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi2Famiiy Number of Bedrooms ",J'~ Other WATER 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. 4. 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 ¢u84) ENGINEERING FIRM PROVIDING INSPECTIONS, 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 suppty and/or wastewater disposal system is safe, functional and adequa!e 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 in, c~ctio~, NameofFirm 'i~',/'~//~'''/4 ~'~/~'C~7,'~E~:"?/'~? Telephone Approved ,.~, Disapproved Conditional Terms of Conditional Approval 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) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~o~'- JW ~ ~z~c~ 7__ WELL DATA Well Classification Well Log Present (Y/N) /,~-/ Cased to ~ ~eepth~(~f~;outin9 Total Depthstatic Water Level // ~, ' Sanitary Seal on Casing (Y/N) Y ~ Depression Around Wellhead (Y/N) Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If'A, B, C, D.E.C. Approved (Y/N) Date Completed J:~/'~/'~ ~'- Yield To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ~-~' Water Sample Test Results ; On Adjoining Lots ~_.oo ¢ ; On Adjoining Lots /-'~' To Nearest Public Sewer To Nearest Sewer Service Line on Lot ..~//A- ;Date /'~Z2 ? B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) "/' Air-tight Caps (Y/N) Depression over Tank (Y/N) /¥/ Pumping/Maintenance Contract on Fi~e (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line /~",~' Course /v~o Size ,/~,o0 No. of Compartments 2- Foundation Cleanout (Y/N) Date Last Pumped /¢/~1/ ; for Temporary Holding Tank 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) Soils Rating in Absorption Strata Date Installed Width of Field .~" Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Z. Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line --'~ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Date Installe;d~, Dimensions . ¢ S~ze in Gallons.,-~._ _~Manhole/Access (Y/N) ~- ~- _ _ _ · , p'ng Cycles during Adequacy Test. Meets MOA ** Check Pe?mttte. d Bedroom Rating Against HAA Request ** I certify that ~,~ave dhecked~er~ied/¢ conformed to all MO~ and HAA guidelines in effect on the date of this inspection. Signed ~ ~ Date Amount: $ ~. O O ~¢~ %~r's Seal Page 2 of 2 · APPLIC"~NT FILLS OUT UPPER HAl~-'~' ONLY Buyer Address ~ Zip Code Phone Realty Co. & A~nt Zip Code~ ~ Other Water Supply ~ Public Utility Sewer Disposal ~ Holding Tank Time Time Time Date Date Date inspector Inspector Inspector Inspect °r (~C)AA~.% Field Notes: MUNICIPALITY OF ANCHORAGE ¢¢~/'~ ~ DEPT, OF HEALTH ~.._. ~ ,:?,~. i~J ENVIRONMENTAL PROTECTION ~ a:.~,~ ~of .__---- MAR ~/¢.¢~./..=. R E C E i V E D ( ~)~_APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ~ ) CO.D~T,ONAL APP.OVAL' DATE 3 Soils Rating Date Sewer Installed weg To Absorption Area Well Log Received / ,~ ~ ~ - ~- F' %~¢ Well to Tank Septic Tank Size