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HomeMy WebLinkAboutTANAINA VALLEY LT 4 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Lot Towflshlp, Range, Section TANK,.~ ~/ SEPTIC [] HOLDING . TYPE OF SYSTEM '~'rRENCH ~ BED [] W. DRAIN [~ OTHER grade ~ FT ~"~ FT ~/ FT L WELLS Dale hlstalfed [] PRIVATE ~ OTHER (Identify) '1 oral Depth Date Inslalled: Cased to FT DISTANCES ~ WELL WELL LOT LINE FOUfiDATION SEPTIC ABSO~PTIO~ TANK FIELD /2' /~ ' ~' /0' REMARKS: hlspections Performed by: 72-013 (3185) NEER'S SEAL.) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST m OAT LEGAL DESCRiPTiON: ~/H 3 4 5- 6- g. 11 12 13 15 16 17- : ANCHORAGE DEPT. OF HEALTH & IRONMENTAL PROTECTION 49- !AUG 91988 2o- 'RECEIVED Township, Range, Section: .~ z~ 7-/Z A~ ,~..'./~/ SLOPE SITE PLAN f WAS GRQUND WATER ,'.'NCCU.TERED7 · //~ IF YES, AT WHAT DEPTH? Reading Date Gro~ Net Depth to Net Time Tlme Water Drop PERCOLATION RATE __ (m~nute~incl~) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT ANn ----Ff' PERFORMED aY: .~ ~)~[/ I ~/Cl~ ~ ~PC~J(~ CERTIFY THAT THIS TEST WAS PERFORMED IN M LJ IXl I (::: ii: F:' A I. ]: "1' Y E) F' I"'~ N C H E) R A E) ii: 0 N - S ~ 'T Iii: S I!: IAI E R F:' E R M :[ 'f' F:'e:~ruYl:i.'L Nl.~mbel'~ 88(:)053 :Oate Issued: 0512::',";/88 IEng:i.r~el~r, De~;igned O~ne~' Name: DEEE;IE~IxlE~ IN WOOD Day F'horle~ E)wrlE~f' A(::h::Ip~,.?!~H~, '7021 DI::(II::?TWOOD L.ANE ::~;49.,,',8():t. 4 P a p I:: e ]. I d ~: 0:1 ]. ," () 51' ."79 Li:rL L6.)ga].: ,'3ubd:i. visiorl~ TANA.T. NA VAL.J_,IEY I_~_)'t.~: 4. B:Lock: - Sect J. on;: 4 TownshJ. l:):: ].2N Range: 4W L..(z)t E~ :i. z E~ :]~;;]~;92'7 ( ~(:l. f t. o P a [: P ~ ) Max ;.)c~dpcx3ms~ 'l"hi~ F'el"m~.~:,~ 4 'f'crLc~l Capacity: 4 ~/~6~ ~/~ ~/P~C~ SEI::'TIC 'I"ANI:::: M:i.r'limum 'La'Lal septic rani< i::apacd, ty: :l.,~:?:~t~O ga].lons. E:ach sel:)t:i,c r~:.~:~l'~l':: I~lU~it HavE~ at least ~t c~:~mpar"Lment~. Oep'Lb 'Lo top oF sep'L:Lc t. arlk(s) < 4.0 I:NFq]I::~M ]:).H.II.E~. F'RJ:C)R 'l"l::] :I. ST &. 21xll) INSPLECTIOI\IS BY ENGII'4E:IER, AI::TIEI:?~ I'IOURS [:ALL 34::!;"-'4,5E1:1. AND I....Iii:AVIE A MISSSAGE CUI~g:.T'I'RLJCT PER 1EIxI[:]~NE]ERS A"I"f'~[;HL::D API::'ROVI~D DIESII:!)N I F :1: C;E]':I'I" :1: F:'Y 'T'H(,../I: :[,, ]: ¢3ffi fi:]¢Tl:i, lia]" w:i.'Lh 'Lhe r',t~)qLt:i.l'emer'lt!~, {'(:)p (:;)rl...q~J. t6) ~i~e~l'~i i;tf](:l wells as fopt. l'~ by the I"lunic:i. paJ.:i, ty of Anchopage (IdI;:IA) and 'f. h6~ St.a'ke oF Alaska. 2. I ~;i. ll :i. ns'La:l. 1 the syst. em in ac:c:cn*danc:r.0 ~i'Lh 811 NOA cod~.:'.~s 8tt{;:I pegu].at:i.o~s, arld :i,l'l c:cmlpJ. J. arl(:ae w~.t'.h 't',.l"l(~ design cr'J.'t, el-ia c:H' 'Lhis pepm:i.'k. 3. I wi:l. 1 adhoPe 'Lt:t all MOA and EM'.,a't'.,e c)f Alasl<a neqt.~J.p~:?mt:,~rl't:.s for' the set back distances Ct, c:)m any e>(:i.s'Lin~.] t,,~.~;I.:l., ~as'L~;.wat~r' c:Iispc)sal system op publJ, c: fii}~gl~(.}U'F:U.:]J~?.) SyWSt(gifl or'l th:Ls (21" any iM::J.j¢~i]E2f'it {:)P I"lE¢~'ill'J:)y 1c)t. 4,, :t: under'stand that {his peP~l:['[. J,~B valid {rI2P a ffla>CiflH..iflI Elf 4 bednoom*iE;,, I al?sc:, urld,~)r's't, ar, d 'Lhat '~:l',e c~paci'Ly. ~ of the tcrLa:l: sys'Lem is 4 bedi',c,c, ms and , .. , ~ , r'e~ adcli'Lil:)nal piJfmi'E. -- z ._. .............................. ...... ([:]~ner'.) DESIGNS )Jxl Wi]f'II) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED DATE PERFORMED: LEGAL. DESCRIPTION: ~(~- /7/ r°wnship, Range, Section: L~-~(~'Z'-,'-/ 77¢? /Z/./ /.-' ~///fg SLOPE SITE PLAN 14 17 s~ ~o 18 19 WAS GROUND WATER E.COUNTERSD? -- ./V'¢ _ IF YES, AT WHAT DEPTH? OeCh to Wa~ ~er Gross Net Def~th to Net Reading Date Time Time Water Drol~ 20- PERCOLATION RATE .~" L/ (m~nutes/inch) PERC HOLE DIAMETER (~ ' TEST RUN OETWEEN .---~,~ FTAND .-...~' ~'-- FT PERFORMED BY: ),UA t;h)¢ ~)¢ t::~]~/~I _ I ~~~RTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATB ~¢~ 72-008 (Rev. 4/85) $1~711 ol 5 ? 15 8 14 I I' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL. SERVICES CERTIFrCATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ~-/5-"--8~ GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner ¢;~E<;/d',tl$ ixl I,V/)DIb Telephone: Home . Mailing Address '70Zl ,~2~I~-'FV.{O~I~ /-.Id. ,,Al, JO. ~q~/~ (c) Lending Institution _-~',,,'~/.,"Z /'-.--//J ~ A/~/,u ~ Telephone Business Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followinci address: or: Check here ,[~'~if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family ~J. Number of Bedrooms' WATER SUPPLY Individual Well [] Community ~ Public ["l Note: If community 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. Page1 of 2 72-025 IRev 8/861 Fronl 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 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, NameofFirm ,,~.~/)E'r~50~j ~-7'J~H~E'~,f.~ Telephone ~7'~(,'1 Address ~0. ~ ZVo 77~ ~'(~t~ ) ~IL ~&~' .,Engineer's Seal Approved for '¢' bedrooms by _ . Date Approved .~ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department 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 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. Page 2 of 2 72-025 iRev 8/861 Back WELL DATA t* PALIT¥ or A.CHORAG IMOA) .,~cc~EALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 Legal Description: ~/~ Well Classification Well Log Present (Y/N) Total r)epth 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 Cleanoul/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B; C, D.E.C. Approved (Y/N) Date Completed Yield 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 B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) .&J Pumping/Maintenance Contract On File (Y/N) Holding Tank High-Waler Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ Size /ZG~,'D No. of Compartments 2~. Air-tight Caps (Y/N) ,.V Foundation Cleanout (Y/N) Date Last Pumped ~l,d '~' ; for _ ~ Temporary Holding Tank Permit (Y/N) To Property Line To Water Main/Service Line Course N o ,tfE~ /~ Co m ments -'7'~'~,. Y __ To Building Foundation ~" __ To Disposal Field .~' / To Stream, Pond, Lake, or Major Drainage 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 .-¢ To Building Foundation Lot /¢/0 t4E. OT~E'~.5 TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~EI4J C.o[i 7.~T,C_UOT-IOI,J /_Z ~ Type of System Design Length of Field ;2',¢ ' Depth of Field 8 ' Gravel Bed Thickness ':/' .~' Standpipes Present (Y/N) A/ Date of Last Adequacy Test Y To Property Line _ / To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (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 [ have check,~d,.verified, or conformed to all MOA 8nd HAA guidelines in effect on the date of this inspection, Signed ~,~4,Lc~- ~/~¢4.~f~..~ Date /ff/~/~ ~ Company 4A/~C4~lJO Receipt No. ~~ Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE .q601 C STREET. SUITE i334 aNCHORAP~E, ALASKA 99503 STEVE COWPF. R, GOVERNOR 563-A775 DATE: ~3-- t~_~-S~ PwsI O ~: __~_~_AzZZ~_-_, ......... To Uhom It May Concern: accordinq to the records on File in this office, the _~eoo~<~___ ~..~..6_b~¢5~_~x~.~.~aUater System is in compliance wLth the 'qtate o? alaska Orinkinq Water Requlations, RSK:sa Sincerely, Environmental Field Ofrice~