HomeMy WebLinkAboutTIMBERLUX #2 BLK I LT 1LoT .~ DEPARTNIENT 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 ' NO. OF ~Z Manufacturer Material~;~ ~o. of compartment~ ~ Liq.~a~ gal,~ ~{ ~ 5 M E ~ D E; h]~id~ ,a.gth ~idth Liquid d~pth ~ DISTANCE TO: Well Dw~lli.g PER~IT NO. ~--~ ~ Manu~aaturer Material Liquid capacity in gallons , Nearest I°t 'i~¢ ~ DISTANCE TO: We?~ ,~ ~ 'FounOatio~ , No. of lines ~ Le~ ~r~n~ Total lengt~pgin~ Trench~g inches Distance batwee~F21ines Total efa tire absorption area DISTANCE TO: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER TEST RATING RfiMARKS ,, I DATE LEGAL 72-013 (Rev, 3/78J ~ F'ERHI T NO. ( 7~ L4 dL',,=: " HF PLI _.HNT LOCRT I ON LEGFIL. [:,E,F'FIF;:TMENT Oi~? HEFtL. TH FIhlD ENV I RuNMEi",I'f HL F f~.:u i' E.L T I _ N _, FREET., HNL. HI-IRtlbL. AK. 264-4720 JOHN HRIN HILLRNE:, DALE ER ,"'~::t [:HI=II:, =,T .--'":44 ........ Li E, LF.. I FltlEERL.-F', - .. LOT _,I,-E .~.¢¢400 SL=.!LtRRE FEET TYF'E OF :,[_ILL HE ...... REIII-IN :,T_,TEfl I'=';: TREN_.H HRXIf,'ILIM NUt,'IE:ER OF EEE. F:.E ~i'1_. = 4 z,_IL. RRT];N3 ,z- ";'.- , ...... ~ FT,. EJ ......250 THE RE'.:.,_IRED SIZE C[F THE .._liE.. ttE,=,uRF1 .[_N _,T_,TEfl I=,. THE LENGTH DIHENSION IS THE LENGTFI (IN FEET> OF THE TRENCH OR DRR:[NFIEL. D. THE DEPTH OF' Fi TRENCFt OR PIT IE; THE DISTFINCE BETHEEN THE SL.IRFRCE OF THE GROLIND AND I'FIE 80TTOH OF THE EXCFIYFITION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRFIVEL DEPTH 1"5 'FtiE HINIHUH DEPTH OF GRFI'v'EL. BETHEEN 'i"HE OUTFFII_.L PIPE: AND THE E:OTTOft OF THE EXCR',/ATION <IN FEET.'.". FEF. fllF HPFLI_.HNF HH_ THE RE=,FUN=,IBILIT¢ INFORH TH]::..=;' [>EF'RRTHENT DURING 'l'FiE INSTFtLLFITION IN.=,FEL. TILN_, uF FINY HELLS RE:,JRE:EN'T' TEl TI-tIE; FF FEET'T RNE:, "FHE N_HBE~ OF F,.E_,I[,EN~,E-, THFIT THE HELL HILL BRCKF'ILLING OF ANY SYSTEH HITHOUT FINFIL INS;PEE:'FION AND RF'PROVFIL B"r' THIS DEPRRTftENT HILL BE SUBJECT TO PROSECUTION. ftZNZt'tUH D~jDTRNCE BETHEEN R HELL. AND ANY ON-'SITE SEHRGE D~SF'OSRL SYSTEH t00 FEET FOR R PRZVRTE HELL.¢ OR 150 TG 208 FEET FROH FI PLIBLZC WELL DEPENDING OPON THE TYPE OF PUE:L. ZC WEL.L.. HELL LOGS ARE REQUZRED AND MUST BE RETURNED TO THE DEPRRTHENT H~THZN 2:¢ DFIYS OF THE WELL COHPLETZON. OTHER R. EQUIREIdENTS HAY RPPL"r'. SPECIFICATIONS RNE:, CONSTRLIE:TIOIq DIFIGRRHS ARE AVAILABLE TO INSURE PROPER INSTALLATION. CERTIFY THFI'F ]C AH FRMILIFIR HITH THE R. EQUIREHENTS FqR ON _ITE _,EHEF._., RNE:, WELt .... =,L.f I i: FORTH B"r' THE HUNICIPFILITY OF FINCHORRGE. 2: I HILL INSTRL. L TEIE SYSTEH IN FICCOR[:'FINCE WITH THE CODES. Z4: I UNDERSTFtN[:, THAT THE ON-SITE E;EWER SYS"FEF1 HFIY REQUIRE: ENLRF.'.'GEMENT IF THE RESIE:,EN~I.EHODF:.LE[.)~TO INC:L_IJ[:,E t'lORE THFIN 4 E:EDROOFIS. . E; I GNE[; :~- ~'~-I'f-_";FINT ............................... ..TOHN HIfllNF'":"] ............................................ I'-:: 'SI_lED n T ..... v~_*~ ................. [:,A FE ....... ,,/x: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~, PERCOLATION TEST Pouch 6-650, Anchorage, Alaska 99502 276-222'~ SOILS LOG - PERCOLATION TEST SLOPE 7 8 SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 Gross Net Depth to Net Reading Date Time Time Water Drop I '~/7-o /¢:4I- 0 5~~ , 5 ~/~o Ig, l~' ~ ,, 3~'' 2/," PERCOLATION RATE "~ 0 (minutes/inch) TEST RUN BETWEEN ~ FT AND ~:~ FT 72-008 (7/76) WELL WATER WELL LOG FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 IV'l ~ ~ DSE OF WEL~ /~ ~ SIZE OP CA~ING &" DEPTH OF HOLE//~ ~To CASED TO / / STATIC WATER LEVEL_~FT. YIELD_tGAL.PER.MIN. WITH FEET OF DRAWDOWN. REMARKS COMPLETED ~-~- ~ ~ PUMP TO BE SET AT DATE FTc Oto '7 AI.V/vl 7 to~¢ ~o,¢.? Al.. V/v1 ,fl,'/tolo/ Al., /_~3 o.Z~ /3~.~ ~ __.~o to__. to ~0__ to ,, tO__ to__ .__,_t 0~__ to to__ to 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 Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) ApplicantName~¢H¢ ~ ~P& ~1~ Telephone:Home ~¢~/~/ Business Applicant Address ~93G ~lLL~¢~L~ ~9~ ~D&HOR~&., (c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); (d) Lending Institution db1'1 9, ~,q~/Ik)G-5 ~ .LOP, r.) Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-FamiLy [] Number of Bedrooms "~o¢-. Other WATER SUPPLY Individual Well.J~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality Cn:d.¢.status. 4. SEWAGE DISPOSAL Onsite l~. 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 nl/84) ENGINEERING FIRM PROVIDIN , , 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' Muaicipality 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 e;)~l~clP.. ~ ~,~,¢_,W'['e..<, Telephone Address t~ ~ ~ Date ~ ~ Engineerls Seal 6. DHEP APPROVAL Approv;O for ?~'_/,.~,,~_.,~./)bedrooms by /?~-~'7~-~.//~/ .,~,.~--,'~/C Date Approved /~ Disapproved Conditional Terms of Conditional 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 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: J~IJNICIPALII~ OF ANCHC)~A~ DEPT. OF HEALTH ENVIRONMENTAL PROTECTI©bt ,J U N O ~ WELL DATA Well Classification Well Log Present (Y/N) It A, B, C, D.E.C. Approved (Y/N) Date Complete~ ~;~ - ~'"~J Yield Total Depth % I ~ Cased to I I Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot t Depth of Grouting "-' Pump Set At ~ v~tv~x-u~. Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots t ~"b-I'" ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ; Date Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date installed ~.-~,'~"l~J Size ~ No. of Compartments Standpipes (Y/N) "¢ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from SeptiP/Holding Tank: 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 ~1 To Stream, Pond, Lake, or Major Drainage Course "'---' Comments ~ Page 1 of 2 72-026( 11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well I To Building Foundation Lot '--"--- Type of System Design '~_~c~ Length of Field ~(L~ ~ Depth of Field I ~, 'J~ Gravel Bed Thickness ~ Standpipes Present (Y/N) Y Date of Last Adequacy Test To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ~-~ '~ To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutbank (if present) ~ 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 choked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~ Date (~-~ Company' ~ ~.~.e,~.i'~=~MOA No. Receipt No. _~ ~'~4~¢--0 ~'~'J-,.~'"~.. Date of Payment ~-- & ~ Amount: $ & ,~-'~-- Engineer's Seal Page 2 of 2 72-026 nli84) i hereby certify that a ,trey Subdivisi~ was madeon ~U~ and that the improvemen~ situated thereon are wi~in the pro~y lines and do not overlap or encroa~ on the pro~y lying adjacent thereto, lhat no improvements on property lying adjacent thereto en~oa~ on the premises in ~uestion and that there are no roadways, transmission hnes or other visible easements on said pro~y except as indicted O~e~ at Anchorage. Alaska. this 7 day Of J lC;~TING ENGINEERS, INC. $RA Box 60, Anchorage. Alatka 99507 ~4 -0817 ZT~'° 5-g.~ - iO · U'~.:~ ' ' ~U U..T t-.c?....- F~ DATE RECEIVED _/,~ INSPECTION APPOINTMENTS TIME /1^ / TIME !TIME q DATE( ~"~'~ ~ ~ ~ DATE DATE INSP~ ~ ~ / INSPECTOR INSPECTOR ~UNIClPALITY OF ANCHO~Ag~ DEPT. OF HEALTH & DEPAffiTM~NT OF H~ALTH & ~NVI ~ONMENTAL P~OTEOTI~vlRONMENTAL PROTE~ION  825 L Street-Anchorage, Alaska 99501 OCT 3 0 1979 ENVIRONMENTAL SANITATION DIVISION RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES ~DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (10) days for processing, 1, PROPERTY WNER ~ PHONE MAI LING~SS e~ PROPERTY RESI DENT (If different from above) PHONE PHONE MAILING ADDBESS 3, LENDING I~STITUTION MAILING ADDRESS MAILING ADDR~ 5, LEGAL DESCRIPTION ~TREET LOCATION TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [~L Four IZq. SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY [~ INDIVI DUAL* ; * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) [~ INDIVIDUAL/ON-SITE** {'¢77 YEAR ON-SITE SYSTEM WAS INSTALLED. [~] PUBLIC UTI LITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY I. 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 E~PUBLIC UTILITY Connection Verified INSTALLER [~Septic Tank or [] Holding Tank Size: i-~,~'O If Tank is homemade SOILS RATING give dimensions: TOTAL ABSORPTION AR EA MATERIAL 4, DISTANCESwELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS I~- APPROVED FOR ~' BEDROOMS [] CONDITIONAL. APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev, 6/79)