HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3 BLK 6 LT 10
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
PNONE °NEW
[] UPGRADE
LEGAL DESCRIPTION
LOCATION NO. OF BEDROOMSL~
DISTANCE TO: , '
l- Z Manufacturer (~] Material No. of compartments
Liq. c~p.~y_~ gallons IF HOMEMADE: Inside length Width Liquid depth
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
O Z ~ Manufacturer Material Liquid capacity in gallons
ID Well /1 Foundation Nearest lot line PERMIT NO.
No, of lines Length of each line Total length of lines Trench width Distance between lines
F- -- Top of tile to finish grade--,, ~ Material beneath tile ~, Total effec tion area
ID ~) ~.~ inches
Length Width Depth PERMIT NO.
<~ ~- Type of crib Crib diameter Crib depth Total effective absorption area
u~ Well Building foundation Nearest lot line
u~ DISTANCE TO:
.~ Class Depth Driller Distance to lot line PERMIT NO.
LU Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOl L TEST RATING
INSTALLER
REMARKS
72-013 (Rev. 3/78)
, DEPFhRTHEN'I- ( iiqE!RLTH HND EN'v'IRONMENTF!! .... 01-ECTION
, 825 '"L"' S]"REE"f'., RNCHORRGE., FIK.
~......~ ~.~ _.... c; T T E c~ ~= ~._~ EE: ~;~
PERMIT NO. ,:: 8:1.!E~44 ) /
FiPF'[ ZF:RNT KL. EZN CONST B(]/s 2524 F'FILMER
LOCFITION THUN[:,EREIIRD HTS k ~ ~t~'~ ~'
L EGRt LtF~ R~ TN~tND~-F'8~Rr', HT':; lOT '~]'.-'E 2:L00~ S6~URRE FEET
/I
bH,-,I !LI1 NIIhlFIFK' OF EIEDR. EIEIMS :;/ 4 /~ SOIL RFITING
THE REQUIR. EE:' SIZE: OF' THE SOIL. RE:SORPTION S'¢E;TEM IS:
(SQ FT/SR)= 85
THE LENGTH DIMENSION iS THE LENGTH (IN FEET) OF TNE TRENCH OR DRF!INF!ELD.
TFtE DEPTH OF R ]"RENCFI OR PIT IS Tt4E DIS'TF!NCE BETNEEN THE SURFRC:E OF THE
GROUND FIND ']"HE DOTI"Ot~I OF THE EXC:FI',,,'RTION ,::Il'.,! FEET).
THERE IS NO SET HID'TN FOR. TRENCHES.
THE GRFIVEL DEPTH IS; I"HE l,t:[NIf,IUi',l DEPTH OF GRFIVEL BETI.4EEN THE OUTI:--RLL PiPE
RND "FHE BOTTOM OF TNE E;:.-':CFtVRTION ,::IN FEET).
F'ERMIT F/PPLICRNT HFIS TPIE RESPONSIBILIT'T' TO INFORM THIS DEPRRTMENT DURING THE
INS.;TRLLRTION INSPECTIONS OF RNL,.' !.,.!ELLS RDJRCEt'.,IT TO THIS PROPERTV FIN[) THE:
NUMBER OF RESIDENCES THRT THE: .~4ELL MILL SERVE.
E~RE:KFILLING OF BNV S'¢STEM P~I'rHOUT FINAL INSPECTION RND FtPPROVRL B'~' THIS
DEPF~RTMENT HILl... BE SUBJECT TO PR. OSECUTION.
MINIMLIM [. I:,TH",IL.E" BETP~EEN R HELL. ~ND RNY'ON=Si]"E SEI4RGE DISPOSAL S'T'STEM _f': ....
:tE~O FEET FOR B PR:[YRTE P.IEL.L OR ZSE~ ]"0 ~08 FEET FROM R PUBLIC NELL DEPENDING
UF'ON TNE T~.'F'E OF F'UBL!C P.IELL
MINIMUM [:,IS.;TRNCE FROM R PRIVRTE HELL TO a F'RIYR'T'E SEI,.tER LINE IS 25 FEET FIND
1-0 R COMMUNtTV SEI.,.tER LINE IS 75 FEEl'.
O-FNER REg~U!REMENTS bl~gT' BF'PL.~'. SPECIFtC:BTIONS RND CONSTRUCTION DI~GRRMS BRE
RVRIL~BLE TO INSUR. E PROPER INSi'~LL.FI'FION.
I CERTIF"r' TI-IRT
i: I FIM F'RMILIRR. P.I!TH 'THE RE(?~U!REMEI",.ITS FOR ON-SITE SENE:F-.':S RND NELLS RS SET
FORTH BV THE MUNICIPRLIT'T' OF FINCHORRGE.
2: i NILL INSTRLL THE S"r'S'FEM IN RCCORDRNC.'E !4I'FH THE CODES.;.
3: I UN[:,ERSTRND TPIFFf' T~.,~i: ON-SiTE SE!4ER S'¢STEM r'R'=' REC.-!UIRE ENLFtRGEMENT IF THE
RESIDENCE IS REP!O['ELE'' '_.' ' 0 INCL. U[:'E MORE THFIN 4 E, EE:'ROOMS.¢
-~:IPPL~qT r(LE I i",t COI',.ST
SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
SLOPE
SITE PLAN
ENCOUNTERED?
0
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
r~
!
PERCOLATION RATE / J f--/ (minutes/inch)
TEST RUN BETWEEN F~-AND FT
COMMENTS
72-008 (6/79)
CERTIFIED
MUNICIPALITY 0f ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
1. GENERAL INFORMATION
Complete legal description
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~,,~'/- .~"~-'~ ~'7~ :~ HAA# ~'~c~[O[5
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
~,~,~_~-~ ~
Day phone
Day phone.
Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system,.
4. TYPE OFWASTEWATER DISPOSAL:
NOTE:
Individual on-site ~
Holding tank
Community on-site
.'- Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA#21
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Municipality of Anchorage /'~
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Desodption: /'~/6) ~4r.: ~
A, Well Data
Well type /"~'q~'cl~- If A, B, or C, attach ADEC letter. ADEO water system number
Log present (Y/N) Date completed Driller
Total depth Cased to Casing height
Sanitary seal (Y/N) Wires properly protected (Y/N)
Parcel I.D.
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well flow
Pump level1
MUNICIPALITY OF ANCHORAGI~
t:NVI£ONMENTAL SERVICES DIVISION
OCT 0 5 199,
g.p.m.
RECEIVED
SEPARATION DISTANCES FROM WELL TO:/~/,Z~
Septic/holding tank on lot ~ ''~
Absorption field on lot
Public sewer main
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Sewer service line
Petroleum tank
WATER SAMPLE RESULTS:
Coliform Nitrate
Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed j
/
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size /Z .~'Z~) Compartments
Foundation cleanout (Y/N) /~ Depression (Y/N)
/~'//~ Alarm tested (Y/N)
7/7~'&-'/~' ~ Pumper' '-~ J~-'-5 ~c~/v~>'~'/
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ~-'/,,8- On adjacent lots /~'///- Foundation ~
To property line ~'.~ Absorption field ~ Water main/service line I O '~'
Surface water/drainage ! o 0t-
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed
Length -~ Width
Total absorption area ~'ZF~ Cleanout present (Y/N)
Date of adequacy test I~)¢:/-' / t ¢'~ Results (pass/fail)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft
~- ' ~ Gravel thickness
.System type -71Z ~,u <,d--
Total depth // '
Depression over field (Y/N)
for ~- Bedrooms
After test
.If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
,"."//zt~ On adjacent lots ,,'t'//~L Property line
I 7_~ To existing or abandoned system on lot /,.~o,,~ '~'
Cutbank ~J/l'}- Water main/service line
Driveway, parking/vehicle storage area ~.5
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
David E. Dayton P.E.
Signature 20210 Donalar St.
Ch iak, Alaska
Engineer's Name ,,~1 . /2..¢ ,// ,. //
Date /0/~¢. ~
HAA Fee $ ~00
Date of Payment /¢._
Receipt Number ~.~,.~o~, ~...) -
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
D. R. DAYTON, P.E., R.L.S.
~n~x~~ Chugiak, Alaska 99567
20210 Donalar
(so7
696-2417
October 2, 1993
ADEQUACY TEST.
Legal Description: Lot 10, Blk 6, Thunderbird Heights #3
Date of Test: October 1, 1993
Septic Tank: 1250 gallon, 2 compartment, steel tank
Absorption System: 37' x 5.5' effective depth trench
Soils Rating: 85 sq. ft. per bedroom
Requirements: 4 BR - 600 gallons per day
Test:
The system was tested by pumping water into the trench while
measuring volume and water level rise at timed intervals.
After pumping was stopped, the water level drop was measured
at timed intervals.
Results:
The absorption system accepted 627 gallons with a 0.55{ rise
in the water level. After pumpin was atopped, the water level
dropped to the original level within 10 minutes.
The system is currently functioning adequately for a 4 bedroom home.
DATE DESCRIPTION CHARGES CREDITS BALANCE
J~'s PUl flPING
Ea~le Ri ~er, Alaska i)
(~07) 694 ,~
PAY LAST AMOUNT IN BALANCE COLUM~
8S87~:/8P874 PC'L~'PAK rS0 SETS)
CARBONLESS SPEEDISET
( ~ D; ~RECEIVED
iNSPECTIOn. APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
,NBPEDTOR ,NSPEOTOR ,NSPECTOR¢
MUNICIPALITY OF ANCHORAGE MHNICI~ALITY OF ANCHORAGE
Telephone 2fl4-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests wiII not be processed. Please allow ten (10) days for processing.
PROPERTY RESIDENT (l~ifferent from above) PHONE
MAILING ADDRESS
STREET LO6~TION
6, TYPE OF ~ESIDENCE
NUMBER OF BEDROOMS
[] One ~ Four [] Other
SINGLE FAMILY [] Two [] Five I --
MULTIPLE FAMILY [] Three [] Six '
WATER SUPPLY
[] INDIVIDUAL* * ATTACH WELL LOG. A well Icg is required for all wells drilled
~ COMMUNITY since June 1975. For wells driiled prior to that date, give well
[] PUBLIC UTI LITY depth (attach Io§ if available.)
8. SEWAGE DISPOSAL SYSTEM
~ INDIVIDUAL/ON-SITE** //9(~/ YEAR ON-SITE SYSTEM WAS INSTALLED,
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-O10 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
3, 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 UTI LITY
Co~nection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[~31NDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY
Coonection, Verified. INSTALLER
[]SePtic Tank or ~]Holding Tank
Siz~e: If Tank is homemade BOLLS RATING
give dimensions:
TYPE OF TANK MANUFACTURER , ~ ·
TOTAL ABSORPTION AREA MATERIAL , , ,
4. DISTANCESwELL TO: Septic/Nolding Tank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line , ,
0MMENTS
5 PPROVED FOR E ROOMS
[] CONDITIONAk APPROVAL {letter must accompany certificatel
[] DISAPPROVED
DATE