HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS #3A BLK 4 LT 13LoT
,~., MUNICIPALITY OF ANCHORAGE
DE[ ~TMENT OF HEALTH AND HUMAN SER~
, ~ Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Name <-/ .5 ~-- % DISTANCES
~'~ TANK FIELD
Phone(s) ~ Pe~,~ No ol Be~r)oms WELL
AS-BUILT DIAGRAM (Show location of w¢l, septic system, property hnes, ~oundegom
~EPTIC ~ HOLDING do ~ ~ ~ ~
Material No. of Compa~ments ~ 0 I ~FOt ~
Depd, lO pipe bO m from Tola, depth lro~¢e
Numbe¢ of~lnes oil rahng Pipe maleri81 .1~
~n Date Installed
~ PRIVATE ~THER {Identify) ~I.,~X
REMARKS:
S & S ENGINEEEIN~ ~
72-013 (3/85)
CE)F-t't ACT F:'I 'K:)NEi: ~ 69'./--2c77'~?
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~E!:U; :2~ ,¢ I :I. &hl ,! F;,' J. t,'.,I
I..(Ji E~ :i: Z,.::.. .',c c~c,,-
1'4f:~X. t".IUI"i~}E~I:~: Eft: ..I .) , JlA (~ .
E~EI:[I.. fIE:E;'i .. _r I-,, O F:"I
FICi ],,¢~:'~'1'I:[::1:;;~ F; ...... II :[FI I'E,WI' ,.tt,.~l ........
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NAME
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
PHONE
8 ' 8,ql []UPG.ADE
NO. OF BEDROOMS
DISTANCE TO:
Manufacturer
Liq. capacity in gallons '
/000 IF HOMEMADE:
D STANCE TO: Well
DISTANCE TO:
I Absorpt~n/area
Inside length
Dwelling -
Material
Nearest lot line
No. of lines each line f lines Trench width
Top of tile to finish gradfi~ ! Material beneath tile
Length ' Width
Type of crib Crib diameter
Depth
Crib depth Total effective absorption area
Well : Building foundation
Nearest lot line
DISTANCE TO:
Depth Driller Distance to lot line
t/
DISTANCE TO:
PERM T NO.
No. of compart~.~ts
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance betwee lines
inches
Total effective ab~s~r~/tion area
PERMIT NO.
BuildingTfoundation Sewer line
· ~ ~0 0 0
Septic tank
PERMIT NO.
Absorption area(s)
OTHER
PIPE MATERIALS
b3 3d
SOl L TEST RATING
INSTALLER
REMARKS I I
APPR VED ~tT~__~
~2-0~ 3~R er. ~'~78) ' ~"7'
DATE LEGAL
E:,EPFIRTHEN-f' OF HERL.-FH FIND EN',/IRONME},rTF-!L. F'F?OTEC:T_TON
825 "'L-" STREET., FINCHORF!GE., F:IK.
2 6 4 ,.~ 4 7' 2 0
~i) ?..~ --.- 92:; ~ ~- ~ ~;;, [~i" L...i ~:E: F~: ~::~ ~E ~-,c-_' ~',,! :E-- "~-
( :E, 20ZO± )
L...C.r 1 ! ..~,t
_ CGFIL
'S.'TE VEl'.4 i ....Si.( R(liG S
L:t3r:,=4,. TI--II !I'-IF:F,eB T F'F;,. ........... Id-f':E;
.F'O ,c'- ~..,,_ ,-, D CHUGIFIK
LOT ::, ~T ,.b.
el 8 8 - ;2 8 i: :1..
TYPE: C!F'
I' I: ........ F. ~ .... ~ '::;',-":;TF,1 IS: TRENCH
i"iFIXIMUM r',!Ll"tl:'xfa¢, OF BEDRE"DI"!S = 3
THE LENG]"F! DZPiENSION IS THE L. EN,':i~TH ,{IN FEET) OF' THE TRENCFi OR DRR!NFIELD.
THE DEPTH OF' R T'RENCH OR PIT !2; THE C, ISTRHCE BETHEEN THE SURFRCE OF THE
GROLIND FIN[:, THE 80TTOH OF' THE EXCRVR"rION (iN FEET).
THERE ~S NO SET NZDTH FOR TRENCHES.
THE GRFfYEL DEPTH IS THE HINIMUH DEPTH OF GRRYEL E:ETWEEN THE OUTFRLL. F'IF'E
RND THE E~Cfi"TOI'd OF THE EXE:FI',,,'FITZON ():N FEET).
PEF:M! T FIPP 1' - Ri', T HF!S 'THE c,,--,: :,-,, ,= .rF, 1' 'r ""y .
....... h~.._l ............... TO INFORPI THIS [:,EPRRT'MENT C...F::TH'!i THE
ZI'-,EC, TF~I ........ L~RT'[ iN TN':PFF:TInN':;. ..... OF RNY I,.iFL[.S RD.:fFICENT TO THZS -'""-"'-'--"'-r~ ~-~ ~T .F¢'I£'.. THE
NUi"IE',ER OF .... ~'Ec Zr',~:'N'"E':. ............ THFIT THE .WELL !.,.IZLL :-"': ' ¢~:',_R ,,-.
?!iNiHLtM DISTFINE:E E:ETNEEN R WELL RhlD RN? ON-...SITE SEHP, GE DISPOS,q.L SYSTEi"f IS
i00 FEET FO[--:'. R PRI',/RTE NELL OR ;1_50 'TO 2k.30 FEET F'Ii'.OM R F'UE~I...IC: i.,.IEI_L DEPENDING
UPON THE TYPE OF PUBLIC I,.IELL.
MIHIMI...IFI DIS]"RNCE FROM F! PR!'¢FITE NELL TO Fi PRZ',,,'R'T'E SEWER LINE IS 25 FEET RND
'TO Fi COHMUi'qlTY '_~,EIi~ER'. LiNE IS 75 FEET.
OTHER REQUIREMENTS MAY F~,F'PLY. SF'EC~F!E:RTZONS FINE;, 130NSTRIJCTiON DN~GRI::IMS FIRIE
RVR~L. RBLE TO iNSURE PROF'E,~;: ZNSTRLLFIT!OF.I.
~ CERT~F"r' THRT
t: ! FIM FF!H!LIFIR !,.IITH THE L~,,:.t..,~,. ........ N,_, FOR ON-'SZTE
FOR]"H_:,.P'/ THE .hll_..~ ~ _..,I~.IT-'1'[],,:d,,~ T"r',..,.,, OF F!F,!C:HORFIGEL
l: Z UN[i:'ERS~}~ND THRT THE ON-SITE SEi'-!ER SYSTEM HRY REQUIRE ENL. RRGEMENT
F. ES Z [:'ENCE ~:~ E E MOE:'E ~J~{:' TO Z NC:LUC'E !',lr][~'P' 'THI~kl ":~: E:EF:,[i'r'.-~PtS.
? ¢?:, ............................
Russell Oyster
694-2774
Performed for:
O & E ENG.NEERING & DEVELO, ,WENT CO.
Name:
Box 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Legal Description:
SOIL LOG
Earl Ellis
688-2280
Depth (feet)
7__
8__
9
10__
11__
~--d 2 __
13
14__
Soil Characteristics
PLOT PLAN
~
PERC. TEST
Ground Water Encountered: Yes
Proposed Installation: Seepage Pit
Comments:
No--./~--- If yes, what depth
Drain Field
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)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 13; Block 4; Thunderbird H~iqhts Addition #3A
J~ 15~ 1987
Location (address or directions)
(b) Property Owner Darr~ ~ Patricia We~lephone: Home
Mailing Address
(c) Lending Institution Northway Mortgage Telephone
Mailing Address
(d)
Business
RealEstate Company and Agent TARGET REALTY/Dick Brown
Address P.O. Box 774627~ Eagle River~ Alaska 99577
Telephone 694-2388
(e)
Mail the HAA to the followin(~ address: or; Check here [~, if hold for pick up.
List contact person and day phone number below.
S & S ENGINEERING/694-2979
17034 Ea~le River Loop Road, Suite 204
Eagle River, Alaska 99577
TYPE OF RESIDENCE
Single-Family [~
Number of Bedrooms
ordered by Dick Brown
4
WATER SUPPLY
Individual Well [] Community [] Public []
Note: If corn munity 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
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 safe, functionai 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 ...... ,'-,,.,~,~,~- Telephone ~, ~'z/.~ ~--?"~ ~'
Address 17034 Eagle River Lcx~p Road No. 204
'Date
Eagle River, Alaska 99577
DHHS APPROVAL
Approved for -r°--~C~)bedroems by ~ ~' ~/'~ Dete
Approved ~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Depadment of Health and Human Services (DHHS) issues Health Authority Approval
certificates based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The D H HS does this as a courtesy to purchasers of homes and their lending institutions in
order to satisfy certain federal and state requirements. Employees of DHHS 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 (Rev 8/86) 8ack
DEPT.
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA g9501
STEVE COWPER, GOVERNOR
Telephone: (907)
Address:
274-2533
DATE:
To Whom it May Concern:
According to records on file in this office the LC'~/~t./~,,.,
.~L~: ', ~ Cz.
Water Regulations
Water System is in compliance with the State Drinking
Sincerely,
'Time ' Time ,~e
Date Date Date
Inspector Inspector Inspector
Comments Conditional Approval
. ,, .~ . ~ ,~d~OOill8
( ' .~al /',pprowl .,,9
Date Sewer Installed Permit No. Septic Tank Size
~ ~ Holding Tank Size
Soils Rating Wel[ To Absorption Area Well Log Received
Well to Tank
APPLICANT FILLS OUT LOWER HALF ONLY
Prope~y Owner Phone
Mailing Address ~oz 252~ ~a[~e~ AK 99645 745-273~
Buyer
Address
Lending Institution Phone
Address [0[ ~, ~e~so~ ~[v~, ~acho~e~ ~[ 99503 276-3[[0
Realty Co. & Agent Phone
Address " 724 ~. [5~h Aveaue~ Aacho~a~e, A[ 9950~ 272-057[
Legal Description
Street Location ~e~[ ~oo~ ~o~d
Type of Residence
~ Single Family
~ Multiple Family No. of Bedrooms 3
~ Other
Water Supply
~ individual A~ACH WELL LOG. A well Icg is required for a~l wells drilled since June
~ Community 1975. For wells drilled prior to that dste, give well depth (attach Icg if
Public Utility available.)
Sewage Disposal
~ Individual Year Individual Installed: [~ ~2
Public Utility When Connected to PubJic Utility:.
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
MUNICIPALITY OF ANCHORAGE (MOA)
MUNICIPALITY OF ANCHOR,I~I~.LTH AUTHORITY APPROVAL (HAA)
ENVIRONMENTAL SERVICES DIVI$1Oi'~HECKLIST - FEBRUARY 1984
264-4744
AUG ! 0 1987 Legal Description: / ,,7-
WELL DAT^ RECEIVED
Well Classification 4
Well Log Present (Y/N)
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
Comments ~ ~,,~F ~ ~'(~
If A, B, C, D.E.C. Approved~'4)
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
~_~O/'-¢ ; On Adjoining Lots
.~OO t~z ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
=Ch Z_//I ~"~
B. SEPTIC/HOLDING TANK DATA
2__
Date Installed ~' '~' '~ ~ Size /Z-¢"o No. of Compartments
Standpipes~/N) Air-tight Caps ~N) Foundation Cleanou~/(Y/l~
,.,,,
Date Last Pumped ,~
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
Course
for
Temporary Holding Tank Permit (Y/N)
To Building FoL~ndation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72 026 fRev 81861 F¢onl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~:)'~/'/'/'~- Type of System Design
Date Installed ~/'- ~ "~'~- Length of Field ~-~
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~0~
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
Depth of Field /~(-~.
Gravel Bed Thickness
Standpipes Present (~N)
Date of Last Adequacy Test
To Property Line ~-./ /
To Existing or Abandoned System on
; On Adjoining Lots 3¢/¥
To Cutbank (if present) '~f/"~
Comments
D. 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 ar,.d HAA guidelines in effect on the date of this inspection.
__ __Da._
Si n & S ENGINEERING tR
17034 Eagle Rl~er Loop Road No, 204 -
Coml~¥e I~vec~Alas~577 MOA No,
Receipt No. /~ ('J / O O /O
Date of Payment
Amount: $
Page 2 of 2
72 026 fRev 8/861 Back