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HomeMy WebLinkAboutTANAINA HILLS LT 16  MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PRO'FECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LOCATION NO, OF BEDROOMS '.w' Manufacture,' ~ P'~- (~ (%~0 Materi~l~/ No. of co~rtmonts Liq' c?~ xl'°ns IF HOMEMADE: Inside lengthx~ WMth ~ Liquid depth ~4 , ~ Wall Dwelling PERMIT NO. ~ DISTANCE TO: O ~ ~ Manufacturer ..... Material Liquid capacity in gallons ~ DISTANCE TO: Well Foundation / Nearest lot line PERMITNO. ~ Ne. of lines Length of each li~]e ~ Potalle of lines Trench width Distance between lines ~ Top of tile to fh~ish grade Material beneath tile Total effective absorption m'ea ~ LenCh ~¢ ¢ ..~ Width t . .~ D0pth , PERMIT NO. ~ Type of crib~ Orib dismayS_ Crib d.p~ ~,al effective absorptio, area,,~ ~ j Class Depth I Driller / Distance to lot line PERMITNO. m ........... Building foundation Pine Septic tank Absorption area(si PIPE MATERIALS Date Drilled ~ Static Water Level_ Dr~w Down 6-25"85 100 feet feet Gallons Per Minute Total Feet of Ca. sl~.q 3O 160 Tyoe Material Dril!edl 0 feet to 120 f~et to 125 feet to ]54 feet to to to Hefty Drilling S.R.A. Box 1553 H ^nchor~ge,Alaska 99507 120 Silty Sand 125 Sandy Gravel 154 Clay 160 Gravel w/water DEPARTME]"TT' [ IqEALTH AND IE. NVIRONMENTAI... OTECTION 82,5 L ~"I'RI~i',E'71'~ ANCHORAE}I.E ~, Al< 99,50 F'ERM IT I'qO.~ 850298 DATE ISSUE:D: 061].5185 APPI_ I CANT '.' R · I='. i NG ADDRESS~ I:::',,[]. BOX 110492 ANCHDRABE, Al< 99511 CONTACT F'HONE: 546- 153~2 L. EDAL DESCRIF:': SUBDIVISION." TANAINA HILLS LO'T." 16 SECTION." 35 I'OWNSHIF:': 12N RANBE~ 4W LOT !iI:[ZE,", 53784 (SQ.I:::'T. OR ACRES) MAX BIEDROOMS: :5 BLOCK.* NA Liste. d below are 'Lhe options available to you in designing ¥ouP septic sy~.~t, em. Ch~o.s~., the option 'Lhat b~.s'L ¢i'ks your' DEPTH TO P IF'E liID'T'TOI~I (I=T.) :';.0 .~..~. GRAVEl.. DEPTH (F:'F.) O. 5 R. 0 '[OTAL DEP'f'H (I='T'.) :'.;,,5 4.0 GRAVEl. WID]'I"I (F'T.) 25.0 ~L, C) [:3RAVEL LENGTH (Fl".) 4.7.0 1~79. () ~-~ E.IRAVEL VOI...UME (CLJ. YDS. ) 43,, 6 59,, 8 TANK S I ZE (GALS) 1,000.0 ,Y.,~ 1,000,, 0 .~..}~, SOIL RATING (SQ.FT'./BR) 260 . 30~ '~ DEPTH TO PIF'Ii': BO'FTOM < :}';,,5 FT. REQLJIF~ES :[NSUL. ATIOIq ~l. DEPTH '1'0 PIPE BO'T'T'OI~t < 4.0 I=T. MAY t::dEQLIIRIE A LIFT' ~]'ATION ,~,.1~ GRAVEL I.,,,EIqGTI-t > 75 F'T. F~EQI..IIRES MUI..TIF'LE RUNS (NOT EXCEEDING 75 FT. EACH) '~"~ TANK MUST HAVE A'T LEAST TWO COMF'AF(I'MEi~ITS cer'k:i, fy that." :1.. I am familiar' with the pequir'ements for' orr...si'La, ,sewer's ar'Id wells as; set forth by 'khe Murlicipality of Anchor, age (MOA) and 'Lhe Sta'Le of A'.l. aska. I ~il.:l. install the .~y~,tx,,.m in a:c:opdance .i't.h all HDA code~ and regulat:i, ons~ and i~'l qomp],'iance ~it.h the clc~s:i, gn c:l'iter'ia or th:i.s per're:it,, 5. I wi!l adhere to all 19DA and State of Alaska requil'em~n'L~ for 'Lhe scyL bac:l~ d:J.s'[.aFIc:~HF~ fPOl~ al'ly ~])~J. L1til]g well~ wastewa'l:er' d:L~q:)osal s~ys'kem of pLIblic sewer'age !~¢yst.~gqJl OIq t[')i~ OP any adjacent op near'by lot. 4. I under's'Lar'lcJ 'khat {his pepmit i~ valid fop a ma).~imLIm of ::$ bedEooms and any enlar, gelnent ~J.].l Paquita an addit, ianal p~Pmit. IF: A 'I"I-~EEIq W]:LL EI.,.EDTRI(]AL W(]RI< I~tJS'l" BE DONE S~ I GNED LIFT STA'T'ION IS IIxlS'I"ALLEI) IN AN AREA COVERED BY MOA BUILDING CDDES!, (:1.) AN ELEC]'F?ICAL F:'ERMIT AND INSPE(]TIOIq MUST BE OBTAINED; (R) AE]-'BUILTE; NI]T BE APF'F~OVE'D WITHOIJ]' AN [<L.ECTRICAL. INSPECTION REPORT; AND (:];) THE AF:'F'L I CANT ISSI..IED BY ~ ~" SOILS LOG MUNICIPAI.ITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST LEGAL OESCR,PT,ON: Tmq n,,q c~. ~ \/s 2 8 9 10 11 14 15 16 17 18 19 20 ©L [LOPE SITE PLAN WAS GROUND WATER - S ENCOUNTERED? NO ,& pY~l~,? AT WH AT ,-- E / ~/ , ~-- ' Gross Net Depth to Reading Date Time Time Wafer Drop PERCOLATION RATE ,~-~ 0 (minules/inch) TEST RUN BETWEEN FT AND~ , FT ALASKA e[,.iRO[I[Ile[1TAL CO~ITROL SeRv,C~$, IllC. ~ncli~¢ri~~ ~, ~nvi~onmcnlol PERCOLATION TEST DATA SHEET ADDRESS PO. ~.? "~ zip COOE LEaL LO~ATIO, TOIAL DEPTH OF HOLE ZONE TESTED ft TO ft. READING // CLOCK TIME NET TIME DEPT~ TO NET DROP RATE (min/in) DATUM -~ .a. s~',, -, ~. pa ,05% I00~ · ,;H~O ~ ~o..,~ /am,'. ~..~ ,0~. FINAL PERCOLATION RATE ~-~'~ PERFORMED BY _(/~Z~/.~C)~_ _(mtn/in) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH A,UTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date -'~ GENERAL INFORMATION (a) Leg~ription~ (include lot, bloc~,~rbdivision, section, township, range) Location (address or directions) ~ ' (b) Applicant N~'~--, Applicant Address (c) Applicant is (check one): Lending Institution ~; Owner/builde~ Buyer ~; Other (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address'.' 2. TYPE OF RESIDENCE Single-Family)~ Multi-Family [] Other Number of B/edrooms 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. f 4. SEWAGE DISPOSAL Onsite"~;~ Public [] Community [] Holding'rank [] ,./ Note; If community well system, must have written confirmation from the State Department of Environmental Conservation h attesting to the legality and status. Page 1 of 2 72-025 (t1~84) 5, 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 supply and/or wastewater disposal system is sate, functional and adequate for the number of bedrooms and type of structure indicated lrerein. I further verify that based on tire 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 t~bis-i~spe~tion.~'~'""-"~ Name of Firm ~-'/~-'-~--::~'¢'~ ~'~'~-) ,-<' - ' ~ Telephone Address .~¢,~ Date ~"~.-¢ ~'//~/r'.--¢ ~%~-~ /¢'./..¢-~/,~,:,,~¢' - ..¢~ c~ ~-~ ¢; Approved for ~.~'~...4..¢_.~¢.~ bedrooms by--Date Approved ~,.'~ Disapproved Conditional Terms of Conditionbl 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 DFIEP 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 MUNICIPAL{TY OF AN£HO~AGE DEPT, OF HEALTH & ENVIRONMENTAl. PROTECTION Well Log Presen?~) Total Depth //'¢ Cased to Statio Water Level ./~L.~ Casing Height Above Ground Electrical Wiring in Conduit~¢'~.~) Separation Distances from Well: To Septic/Holding Tank on Lot MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: '~ / ? If A, B, C, D,E.C. Approved (Y/N) Date Completed ~' - ~,~, ~.~ .2 __ Yield ~ Depth of Grouting Pump Set At __ /'-%".¢ / Sanitary Seal on Casin~_?~) Depression Around Wellhead (Y~_~ ~1~. ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line. Cleanout/Manhole _ Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING'rANK DATA Date Installed. ? .-//-,~.5~ Size Standpipes~'¢4) __ Air-tight Cap .~xl) Depression over Tank (Y~ Pumping/Maintenance Contract on File (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 ~-~"~ /7'~ Course Comments No. of Compartments '~- Foundation Clean ouk'~"N) Date Last Pumped . ,.¢~'~/ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~.~ / To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7 Width of Field Square Feet of Absorption Area -/"~*~',,"~'¢//Type of System Design Length of Field ~¢~'~'¢* / Depth of Field Gravel Bed Thickness -~' · ~, Standpipes Presen4~) Depression over Field (Y,~'~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation? -/ Lot .4/¢*//~,:' ~ 1~:~ To Water Main/Service Line ¥o S~reamlPondlLa~e/or ~aio~ Drainage Course To Driveway~ Parking Ares~ or ~ehi¢le Storage Area Comments ~;/'-~'~ / LIFT STATION ' Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Date of Last Adequacy Test / To Property Line /d: To Existing or Abandoned System on ; On Adjoining Lots /'~¢o', / TO Cutbank (if present) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Electrical Codes (Y/N) Comments Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ,have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed~'~'~' /"~'~¢'~¢'/4¢~'-~7¥( Date C--~-:-'2) - -~¢'-~ Compan'~-~-~¢-~¢'~'~ ? -/~'% MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) BF~SSE, EPPS & PC~TS 2220 F2~T 88 AVENUE ANCHOflAGE, AK 99507 (907) 349-6451 WATER %~KLL TEST Location: DI~PT. OF HEALTH i:~,l v i kC,,; .4; ,',,%NT AL p,~OTeC] Initial Reading on Meter: Rate: ~__GPM 24-Hour Capaci~____ Cal/ons