HomeMy WebLinkAboutTIMBERLUX #3 BLK F LT 15
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONIVIENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LOCATION NO. OF BEDROOMS
~ ~ ~ Z Manufacturer ~or~ Material ~ No, of compartme~
Liq. capacity in gallons Inside length Width Liquid depth
j,~ ~ IF HOMEMADE:
~ ~ DISTANCE TO: Well Dwelling PERMIT NO,
O z ~ Manufacturer Material Liquid capacity in gallons
O Weft Foundation [ O Nearest lot line PERMIT NO.
Le th of each line ~ i ~ jncfies
~ N, of lines ~]~ ZTj~ Total length of lines Trench ~2b Distance between lines
~ Top of tile to finish grade 4 _5 Material beneath tile Total effective absorption area
~ ~ inches /~ CO
Length Width Depth PERMIT NO.
< ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
APPROVED DATE LEGAL ~
72:013 (Rev. 3/78)
DEPARTMEN'T OF HEAI...TH AND EhlVtRONMEN f'AL PROTECTION
825 _ STREET, ~NCHGRAGE, AK 99501
264-4720
IEI~ Ih,4 -- ~E~ ]E -if" E:~,~ Ell', EEC ~,~,,~ EE:: F;~: ~Z.,!: B,,,,t EE: E_.- E-- F" EE [E: ~'"'~ Z q,~
PERMI'I NO: 850225
DATE J SS .lEI); 05/24/85
APPLICANf': 50NN J CALLANAN
ADDRESS: :}';I4:[ W 71ST
ANCHORAGE, AK 99502
C. ONf ACT PHONE: 2.43- 1987
LEG~L. DESCRIP: SUBDIVISION: TIMBERLUX ADDN ~3 [..eT: 15
SECTION: ;]!;4 'TOWNSHIP: 1.21\ RANGE: 3W
LO'F RIZE: ]..95A (S6~.F'T. OR ACRES)
LOT LOCATION: TIMBERI. UX CIRCLE
MAX BEDROOMS: 4
BI....GCK: F
Listed below are the optioris ava].iable to yclu i.n d6¢sign).ng your
system,. Choose the op~:.ion that bes~ ¢its youp site.
sE~pt :[ c
DEP'I"H I'0 P]:I::'E BOTTOM (FT,, .' 4.0 4.0 4.0
GRAVEL DEP'FH ~Ft.) 4.0 0.5 3,,5
]'eTA[ D~:J:'TH (Fl.) 8.(-) 4.5 7.5
GRAVEL WIDTH (FT,,) 2.5 30,,0
GRAVEl- LENGTH (FT.) :l. BI.O ~' 58.0 1.56.0 '~'~'
GRAVEL VOLUME (CU.YDS.) '75,,5 64.5
TANK SIZE (GALS) 1.250.0 ~'~ 1.,250.0 ~'~ ].~250.0 ~"~
SOIL RATING (Se. FI /BR) 362 290
,,x-~'~ ORAVEL ..ENGTH
¢.--~ TANK MLJS'[ HAVE
) 75 I::T,, REQUIRES MULTIF'LE RUNS (NO'] EXCEEDING '75 ,=T. EACN)
A"f LEAST fWO COMPARTMENTS
I cer'til, y t:hat:
forth by'the Municipality e¢ Anchopage (MOA) and the State o~ Al.aska.
~ will ~nstall ~he ~ystem in a(::co~*dance witb all MOA code~i and regulati~3ns,,
and in comp].iance with the design cnitepia o¢ {his per'mit.
:3. ~ will adh6, pe to all MSA and S~:ate of Alaska' requirements Cop the se'( back
distar'lces Crem any existing well, wastewater' disposal system ep public
~ewerage eystem on ~:.his cu- ar:y 'adjacen'~ of nearby lc~t~
4. [ t~nder's'Land that this i;)epmiT, is valid Cop a max:i, mum o~ 4 bed¢ooms and
an~ enlargement wiI1 require a~ adcl:i, tional permit~
IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,
THEN (1) AN ELECTRICAL PIERMIT AND INSF'ECTION MUST BE E}BTAINED~ (2) AS-BLJILTS
WILL NOT BE APPROVED WITH(]GT AN IELECTRICAL I~PECTION REF'ORT; AND (3) THE
ELE(;TRICAL WGRK 'lUST BE DONE BY A I_ICENSED ELECTRICIAN.
SIGNED DATE:
I SSt Jr D BY ~_._.. ..... DATE:
L. EYT S :[ ZE::
LC)T L.C)[Z]¢.;T Z (Z)N:
HK~,X [3 E: :C)F;,' [:1)(:)!'1 ~!i
LC~T
I
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
PEREORMED FOR:
LEGAL DESCRIPTION:
3
4
5
6
7
8
9
10
11-
12
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS ~Co" J '~ '~ '/5.~ / ~
WAS GROUND WATER
ENCOUN ,ERED?
IF Y T WHAT
DEP
O~lter
~/torm~
(ENGINEE~
SEAL)
DATE PERFORMED:
Township, Range, Section: ~ $~(
SLOPE SITE PLAN
$
L
0
E
Gross Net Depth to Net
Reading Date
Time Time Water Drop
I
PERCOLATION RATE ~ Z, (minutes/inch) PERC HOLE DIAMETER __
[" ' CERTIFY THAT THIS TEST WAS PERFORMED IN
-i/~ PERFORMEDSY: ,~tEC$ ~110~ ~.T~g-o'~c
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ ~ 2, dP - (~ ~'
72-008 (Rev. 4/85)
I
i:) ENGINEERING GEb 'OGY
Consulting7 and Services, Arctic-Subarctic
P.O. Box 110186, Anchorage, Alaska 99511
[9o. 7] .¢49-494z
JAMES B. ROB~RTII, i.......,~.S ~ SOILS LOG
360 West Benmon I~lvd. #207
Anchorage, AK ~03 ~RCOLATION
~ ~/~ ~ TEST
SOILS LOG - PERCOLATION TEST
~I~N, ~,3.~,;
SLOPE SITE PLAN
0/- 1
6
10-
WAS GROUND WATER
11 ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
O,
ai-i~16
'13-
14-
15
16
17
18
19~
20
COMMENTS
PERFORMED BY:
L
o
P
E
/ / /
PERCOLATION RATE ¢ (minutes/inch)
TEST RUN BETWEEN ~ , FT ANO ZT~('~ FT
!
' Cons'ul~ and Serv4ces, Arctic-Subarctic
~.'~. Box 110186, Anchorage, AIo~ka 99511'
[9q7] ~g9-494z
[] SOILS LOG
JAMES B. ROBERTS, PE, RL~'?
360 West Benson Blvd., #207
Anchorage, AK 99503 ERCOLATION
~ ~ ...j~. ~ TEST
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
2
3
7
14
17
18~
20-
COMMENTS
/ / SLOPE SITE PLAN
,:,m-.?
Reading Date Time Time Water Drop
I ~'l/a/.~/~.'o~, o, ('~
2 " /,:',;~ / Zg" Ih"
~ /n,'o~ ~ ~ ~' /h"
4 " ,~,'/~ ~ V~" /"
~EST RUN ~EN /~ ' FT qO /~' FT
/~ '.
PERFORMED BY:
CERTIFIE~
I
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
0/~-~..7/--- ~! HAA# ~P-~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
. _. Lqcation (adCress or directions)
(b) Property owner ~'-/~/~/") L; ~//~/~4'/?Telephone:
(c) Lending Institution z/~/1/~ Telephone
Mailing Address
(d) Real Estate Company and Agent
Address
Telephone -/~/~./~
(e) Mail the HAA to the following address: (or check here/~, if hold for pick up.) '*"
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family/~ Number of bedrooms '~
3. WATER SUPPLY
Individual Well'~ Community [] Public []
Note: If community well system¢ must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site.~ '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.
72~25 (Rev. 7/88) Page 1 of 2
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 safe,
functional ,and adequate for the number of bedrodms 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 regular, ions in effect on the date of this inspection.
Engineer's Seal
6. DHHS APPROVALS,,
Approved for ~,Z// bedrooms by,
Approved .~'~______~'Disapp roved
Terms of Conditional Approval
Conditional
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer
registered in the State of Alaska. The DHHS 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.
72-025 (Rev. 7/88) Back Page 2 of 2
¢~r~ M~1~,~,,~'ITY OF ANCHORAGE (MOA) ~ c~ ~'~.~i~'~l~h Authority Approval (HAA)
~st~q~ CHECKLIST - FEBRUARY 1984
~ ~ 343-4744
~ .~ _ ~ Legal Description:
Well Classification /~~. If A, B, C, D.E.C. Approved (Y/N) ~
Well Log Present (Y/~) ~ Date c0mple;~d' /~ Yield ~ ~/~ ~
Total Depth /~? Cased to ~/Depth of Grouting ~
Static Water Level ~ / Pump Set At
Casing Height Above Gmuod ~// ~
Electrical Wiring in Conduit (Y/N) ~
I
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL: / r /
TO Septic/Holding Tank on Lot J-~'~ ; On Adjoining Lots ~/~'~'~
/
To Nearest Edge of Absorption Field on Lot /,~ '~ i ; On Adjoining Lots ~/~
To Nearest Public Sewer Line ,/r""~/'-,'z~ To Nearest Public Sewer Cleanout/Manhole '~,7,'z~-
To Nearest Sewer Service Line on Lot '7 /~)~:~ /
Water Sample Collected by ~, ('~'~ ; Date ~'h~,/<~ ~. ~
Water Sample Test Results
Comments -.
B. SEPTIC/HOLDING TANK DATA
Date Installed/~.//2~../.~,~' Size
Standpipes (Y/N)~ /~
Depression over Tank (Y/N)
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N) .,..~.~/Z~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
//,~ -~C) No. of Compartments
Air-tight Caps (Y/N)
To water-Supply Well //~ ~ !
To Property Line ~ '~ /
To Water Main/Service Line ~ ~ /
Foundation Cleanout (Y/N)
Date Last Pumped ~/~-~-,~' ~. '
;for ~
.
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field ~-~ /
To Stream, Pond. Lake or Major Drainage Course
Comments
72~026 (Rev. 7/88) Front Page 1 of 2
Square Feet of Absortion Area
Depression over Field (Y/N)
Results of Last Adequacy Test
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field ~ .~ ~ / ~/~/~
~ Gravel Bed Thickness
/~ ~ Statndpipes Present (Y/N)
Date of Last Adequacy Test
/
Type of System Design /L~'~"~/
Length of Field 7,~-' /
Depth of Field ~ '¢-. -'~ /
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well /~.~ ~7 /
To Building Foundation -.~,/~) /
Lot '/c'V/Z¢- ;On Adjoining Lots _
To Water Main/Service Line ~'/',/.~ / To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Sterile Area ~ ~ ~ /
Comments ,.~ /¢'/O,z~- ~c:'~r-~(.£ y~'¢'~'. ~/~
To Property Line /'~ /
To Existing or Abandoned System on
D. LIFT STATION
Date Installed
Size in Gallons
Dimensions
Manhole/Aoces8 !Y~//N) _~z~
"Pu~¢p-O'ff" Level at
"Pump On" Level at / / ~ ~/' Vent (Y/N)
High Water Alarm Level at
Tested for
Meets MOA Electrical CodCs-(-Y~N)
Comments __
Pumping Cycles during Adequacy Test.
**Check Perr~1~ted Bedroom/Rating Against HAA Request**
I certify tha~/l~y/e~check~e~ ~'erified, or conformed to all MOA and
ins pection.////////////
MOA No. ~" .'~ ~- / .~
ReceiptNo. c~07// '~'~¢~)~--) ReceiptNo.
Date of Payment _ ,//_2 -- ~7Z ~,,P" / Waiver Fee: $
Amount: $ /~ o ~
. . Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
the date of this
Engineer's Seal