HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3 BLK 4 LT 18LoT' ~ [ ~ 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 I Well I AbsorPtion area Dwelling PERMIT NO. ~, ~ Manufacturer ~ Materia~ No. of compartments ~ Liq. capacity in gallons Inside length Width Liquid depth ~ 000 ~ ]F HOMEMADE: . ~ Well Dwelling PERMIT NO. ~ ~ ~ No. of lines4 Length of each~e t Total length of line~ Trench width~ Distance between~ ~ ~ Top of tile to finish grade Material beneath tile Total ~ffectiv~ ab o priori Length Wi6th Depth PERMIT NO. ~ ~ Tyge of crib Crib diameter Crib depth Total effective absorgtion area ~ ;la~ ~J~'~/~. ( Depth Driller Distance to lot line PERMIT NO. m Building foundatio~ Sewer llne Septic tank Absorption area(s) ~ DISTANCE TO: OTHER SOl L TEST RATING INSTALLER REMARKS APPR D DATE LEGAL 72-013 (Rev. 3/78) F,F p~'4 'r '~" I".!0. FiF'PL_ ! CRNT UOCFIT ~ LEGRL ~:I..E: ?,. '£:ON'~T TH J['¢£:,EF'E~ I RD kITS L±8 B4. THLINE:,ERE:ZF:D HTE; E:OX ~::.....,..~:.,.$ F'F!LHE:F: I F'T .::,IL.: ;:::::U;3;: ;Z E;(;!UF!RE FEET qq' FIES'JF~'F'TE -N :,~ .:. t[--I1 __: T'?'F'E ElF .. ,.. I L. -' '";'"-' ', i' q TF:ENCH HF:I::'::IP!Uf'! i'.,]LIHBEF~: OF EEE,F'E"PI"C, = :21: ..,utL RFITING ,:::..:.,IS! F'[-bR.. iR;: Ik!~ F:EE:!LII F,:EZ':, _,I,;..E OF THE SOILHE,.z, IJRF-'"'-- ' '-I luff- ~ rz, Tb.l-!-'"- --' 'Z:,:'- 'T'FIE LENGTH DZHENStON IS THE LENGTH <IN FEET> OF THE TRE:NCH OR 'THE .C)EF'TH OF-' FI TRENCH OR PiT ZS THE DISTRNCE BETHEEN THE SURFRCE OF THE GROUND RND THE BOTTOH OF 'THE ENCRVR]"ION (IN FEET). THERE IS NO SET I,.IIDTH FOR TRE:NCHES. TFIE GRRVEL DEPTH ES THE HINIHUH DEPTH OF GRRVEL BE]q.,.IEEN THE OI. JTFRLI_ PIPE: RND THE BOTTOH OF THE EXCRVRTZON <Zf.,! FEET>. '"':-'" '-'-' " I.]Z::, DEF'FIRTHENT E:,UFJ::[NG 'f'HE F:'ER!'IZT FIPF'LZC:Fff',IT HRS THE RE_,F,_N.:,IE, ZLZT~ TO [NFCRH "'F ._. T '- ' -' -[ "~'" INSTRLLRT!E~N INSPE'C'T'I:~'S r'~F RNV HELLS RE:,.:RCENT TC TH_:, FR_F.:,~F~ Fff.,lg, THE NUHE:EF: OF RE:S I [:,ENC:ES 'THFtT 'THE HELl_ l.,.!I LL. 'SER'/E. FFI"I-:'FZ ....... l'l'-J~ cir:' F!N"r' .:,~-'"~']"F'~:: . _ ~ HITHOLIT ....... F'INFtL "N'::-:F'F"TT-N FINIs, F:IF'P~:OVRL E,'r E:,EF'FIRTHENT HILL~ E:E SUEt.ZEIi:T TO Fr,.UzEL. UTtUM HZI'-,JlP!UH DtL:;.,TFINCE BETHEEN R HELL RN[> t60 FEET FOR R F'RI'v'RTE 1.4EL. t_ OR tDE~ 'FO 2OC~ FEET FROH R PUBLIC HELL DEPENDING UPON THE TYPE OF PLIBLZC HEL. L. HINIPIUH D!STRNCE FROH FI PRZ',,,'R"rE NELL TO R PRI'v'RTE SE!4ER LIF,IE IS 25 FEE'T RND 'TO R COHHUNZTV SEHEF'. LZNE iS '75 FEET. OTHER REg!UIREh~ENTS h!R'¢ RPPLV. SF'ECIFICRTZONS RND CONSTRtJCTtON D:I:RGRRHS FIRE R',,,'RiLRE:L.E TO _TN.SUi~:E PF..'C~F'ER ZNSTRLLRTiON. ! C:ER"FIF"r' THR'T :1.: I RM FRHILIRR NIT]"I THE REQUIREMENTS FOR ON-SITE SEI.,IERS RND HELLS FIS SET FORTH 8'¢ THE h'IUNZCIPF!LZTY OF RNCHORRGE. 2: :[ HILL INSTlaLL THE S"r'STEH IN F/CC:ORDFINE:E H!TH THE CODES. 2:: ]: UNE:'E~'.SI?IND "f'HFIT THE :~-'SiTE SEHE~: S'¢%TEP1 HF!'¢ F:EE:¢..iZRE ENLf:IRGEHENT IF THE S t GNED: ............. ~ i.5;~;UEE:, E:S'_ ...... ~......_E:,F~TE ........... ~ .... ~,'a.. e~ LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST .SOI LS LOG [] PERCOLATION TEST DATE PERFORMED: 2 3 7 13- 15- 16- 17- 18- 19 - J~.t.,t A, 20- COMMENTS 72-008 (6/79) SLOPE SITE PLAN WASGROUNDWATER /~O ~ ENCOUNTERED? pO E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop , / PERCOLATION RATE hi. ~ (minutes/inch) TEST RUN BETWEEN FT AND -- FT ///- ~ MUNICIPALITY 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 DateMay 7, 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 18, Block 4~ Thunderbird Heights T16N R1W Sec.25 Location (address or directions) Thunderbird Drive (b) Applicant Name Archie Walker Telephone: Home 688-2838 Business N/A Applicant Address SR2-Box :t31, Chugiak, AK 99567 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Ci~.y Mortgage Telephone 694-3503 Address centerfield Drive, Eagle River, AK 99577 (e) Real Estate Company. and Agent N/A Address Telephone (f) Mail the HAA to the following address: pickup TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY Individual Well [] Community [] Public [] '. Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 ( t 1/84) Page 1 of 2 EN, GINEERING FIRM PROVIDING ,NSPECTIONS, 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 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 EAGLE RIVER ENGINEEHINL~ bERViOE$ Telephone Address c~n~ ~ rolled ~14 qq~77 Date ,~'/,7/°c4r p. 0, BOX 773294 694-5195 DHEP APPROVAL ,'- ~'~ "" Approved ,~ Disapproved Cond't'o Terms of Condit~n~l 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) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 09501 RILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: To Whom it May Concern: , According to records on file in this office the ~q~2~ ~ 6~c~)~z~ Water System is in compliance with the State Drinking Water Regulations Sincerely, Michael P. Lewis Environmental Engineer ,T-~ · ~'/~TE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME j~ DATE DATE DATE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF ii'AL'Iii &  825 L Street - Anchorage, Alaska 99501 EN¥[*~ONMENTJ\L Pi~©TECTION ~ ENVIRONMENTAL SANITATION DIVISION 0C'~" ~ 6 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWA ~[j~ D DIRECTIONS: Complete all parts on psge 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing. PROPERTY RESIDENT (If different from above) PHONE ~AILING ADDRESS ' 3. LE"DING INSTITUTI~ · PH O~ E ~--~/ MAILING ADDRESS 4. REA~TOR~A~T~ ~ ~ -- ~ ~-~--7/PHONE 5. LEGAL DESCRIPTION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS  ~ One ~ Four SINGLE FAMILY ~. Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) [] Other 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY [] PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM [] PUBLIC UTILITY l~)-~- ~1 ( NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN RE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ~E~'~APPROVED FOR ~ . BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY /y 72-010 (Rev. 6/79} MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION ¢,AY 0 8 lg8 WELL DATA Well Classification ~"~'~'~'~;~ /.~.~ ,, I(A, B, C, D.E.C. Approved (Y/N) Y Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line. Cleanout/Manhole Water Sample Collected by Water Sample Test Results Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed /~E' / Size /~,~,~, ¢.4/NO. of Compartments Standpipes (Y/N) -)/ Air-tight Caps (Y/N) .~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) '/J"//'~ ; for 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 Temporary Holding Tank Permit (Y/N) To Building Foundation ,z~- / TO Disposal Field ~-- ¢%~.-.. r-~¢¢--~ To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA r ~'' I Soils Rating in Absorption Strata Date Installed /'~' ~ ! Width of Field ~ / Square Feet of Absorption Area ~,(~oo z~ Depression over Field (Y/N) Results of Last Adequacy Test ,~'/~-'(~--~ ~ ,-, ~ Separation Distance from Absorption Field: To Water-Supply Well "="~¢~ To Building Foundation ~o / Lot /S/J/I To Water Main/Service Line /-/~" To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~w" Comments Type of System Design Length of Field ~ ,D. / / Depth of Field // Gravel Bed Thickness 7 / Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line "?~' / To Existing or Abandoned System on ; On Adjoining Lots ¢~ / To Cutbenk (if present) LIFT STATION /¢,,///~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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. Date MOA No, Signed ~~ Company ,"¢~'~ Receipt No, '~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84)