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Home My WebLink AboutTANAINA VALLEY LT 10 MUNICIPALITY OF ANCHORAGE EPARTMENT OF HE^,T. HUMAN SERWC, S Environmental Health Division ~,~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTE~ AND/OR WELL INSPECTION REPORT ..~, DISTANCES /)~ 5/~.~ /~ /~ ~ Tn SEPTIC ABSORPTION A"d~FROM ~" TANK FIELD WELL 70z/ ~IFTWoo~ PL, Phonets) Permit No. No el Bedrooms WELL 3Y~' ~0/¢ 8&O I~Z. LOT LINE ---- LEGAL DESCRIPTION Lot I Block ~ Subdivision /0 -~ ~i~A VA~v FOUNDATION Township, Range, Section I A~-BUJLT DIAGRAM tShow location o~ well, septic system, property lines, ~oundation, TANKS -- U ~ SEPTIC ~ HOLDINO Manulacturer Cap~city in Malerial No. el Compadments TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER / Depth to pipe bottom Irom Total depth lrom original grade Fi~I added above original grade Gravel depth beneath pipe Gravel length Gr~vel width &5 FT ~ FT Total absorption ~rea Distance between lines Number or lines Soil ra~ing Pipe m~tedal / /~- S~FT ~/4~F~ ~/)¢~ WELLS IZ-~-~ ~ [~ ~ PRIVATE ~ OTHER fldentifvl REMARKS: o~, ,~O~ZO~ ~ Inspections Pedormed by: 72-013 (3/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: 1 4- 5' $- 7 8 9 10 11 12 13 14. 16- 17- 18- lg- 20- ~ ~LT~.I <.5 AklO NICIPALIT¥ OF ANCHORAGE DEPT. OF HEALTH & q RON/vlENTAL PROTECTION Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? ~',.I C) IF YES, AT WHAT DEPTH? Reading Date Gro$1 Net Depth to Net ','~me Time Water Drop DEO 0 1988 [ ECEIVED PERCOLATION HATE -- (m~nutea~nch) PERC HOLE DIAMETER TEST RUN BETWEEN _ . FT' AN[:) _, _ FT /~/ .~?~-~.~ Of~' ,/~4~5:,¢>~ 6~r'l o/~/ 72-008 {Rev. 4/~5) T F:'f.:s,r' it'd. 'L I\h,.unbe~r': El!frO ],62 Owrler N,t~me~ DE:NAI,.I E~UF:'PL.Y ;IN[:;. / [)LES:[r31qS :IN WI]I:]D (~NCHDF:~A(3E: !, ~-~1.( 995:1, E~ ];IxlS'l'~lJ.,.,~ I:::'li}:F~ EI',JBIIqEE:i::~S DE. SIIf~N!, 6'.:~' OF' 5' HIDE DR~]:NI::'IE].,D M]:'l'H :;ii;~ 01:::' GR~:V¢EI ..... "I'O'T'~L. i)E]::'TII 7' ].,?.Sk:) BF.1[ .... EilE:I='T:[C I'~NI<:. '11. t;[!}; I::'ISI:;WI~I ]:!S :[flSUEED f::OFl f.~ E~]:NGLEE Fr~PI];I..Y RES',[DIENC;E; IJI\IL..Y ¢-~ND IE X F:' :1: I~IEES :1, 2/:;~; :1/EH!I. I::>HI::/NEi: ]:)1,11,.1!!!~ I::,'r~ :1: tlr 'Ii:;! ~-~[..L. ]: I\ISI=I!i!:I:; F ]: 13NS. CEI::!T ]: F::'Y 'Ti'k:~ 'f' ,~ ]: ~Yi].], :i.I'S~iiFLm].I 'l:.he !;iyi~FLem :i. rl a(::(::121'(:larlc::(~, m:i.'Lh a].]. IdC)~.~ c::c~c:le~i arid and i.n c:omp12, anl:::e ~:['Lh 'Lhe des~:i, EIn (:r'J.'LF~r':i.~,~ of 'Lh:i.~ I:]epm:i.'L,, 'LY :II\lC. / DEE~ ~EiI\IS ]:l\l 'WOOD Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TFST PERFORMED FOR:. LEGAL DEBCRIPTION:,.~./~'- /(;3 f,2/~/,~//,(A //~,Z_~,~/ 1 2 4 5 6 7 8 9- 10- 11 13 14 15 16 17 18 19 20 Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT ~ DEPTH? pO E II 4,'4~ LT.'/o PERCOLATION RATE --...L_ (m~num~,mcl~) PERC HOLE DIAMETER __...~-~ TEST RUN BETWEEN _ ~ .FTAND _'7 FT Municipality of Anchorage DEPAFITMENT OF HEALTH & HIJMANSERVICES 825 "L" Street, Anchorage, Alaska 99502q3650 SOILS LOG -- PERCOLATION TEST 4 5 6 7 8 9 10 11 12 13- 14- 15- 16- 17- 18- 19- 20- ~ [~_/ S.'Sq 5; 'Io Township, Range, Section: ~'~'/ ~'/~41 SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? . ~/,'~ IF YES, AT WHAT DEPTH? S T}me T~me Water Drol3 P~RCO~TION RATE ~ ~ (mmul~mcll) P~RC HOL~ DIAMETER ~" ~' T~T nUN BETWEEN ~ ~ AND ~ ~ PERFORMED IN T L LEGEND LOT CORNER ~':~DRA,.ao~ AR.OW S.OT ~LEVAT~O. IT SHALL aE THE RESPONalSILITY OF THE LOCAL ZONIN~ CODES ANO ORDINANCES, ALL LOT PLO~,,, PLAN J~(~ ............ ~ ~[ CR I~y[ ~ II~IM, I LOT [O , BLOCK / ,.,,.- ~...;571 ~~ ~,~ ~'~ ~ ~ SCALE I" = 4.0' ' I RASPBERRY ROAD $?,26 ~0 5 7 6 3~41 aJ. 15 18 16 8 9 14 I0 Parcel I.D. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AN ::) WATER FACILITY FOR SINGLE FAMILY DWELLING HAA # ~_\O~_ C~(.~(~,~j~ 1'. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) /_. c, /,v~'ZZ ~ (b) Property owner .D~-~/~,,~'~ //v /,~,ooz~ Telephone: (home) Mailing Address (c) 'Lending Institution Telephone Business 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 Number of bedrooms Single-Family [~ 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 stetus. 4. SEWAGE DISPOSAL On-site ~ Public I"1 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. 72-025 (Rev. 7/88) Page 1 of 2 leUO!~!puoo pe^oJddes!(] /~q SLUOOJpeq leAoJdd¥ leuo!l!puoo lo swJeJ. /~ p@AoJddv ~ Jot peAoJddv lYAOIJdd¥ SHHa '9 /,.'i(/~, ML~N ClPALI'TY d'F ~NCHORAGE (MOA) !;~!!/~,(;~;%~ ~' i i"H~¢ijl~h Authority Approval (HAA) ' ~ ..... ~ ~'~KI. IST - FEBRUARY 1984 ~' ' 343-4744 Legal Description: A. WELL DATA Well Classification Well Log Present (Y/N) Date Completed Total Depth Cased to __ Depth of Grouting 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 To Nearest Sewer Service Line on Lot WaterSample Collected by WaterSample Test Results Comments _~)EC- If A, B, C, D.E.C. Approved (Y/N) _,[,/ Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B, SEPTIC/HOLDING TANK DATA Date Installed I?---~"~¢ Size Standpipes (Y/N) y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) _ No. of Compartments )/ Foundation Cleanout (Y/N) ~V Date Last Pumped M~u~ N El~/ ; for %/)rOFl~r~ 6)C ~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well -~ ~ ~ ' To Property Line ~-(¢~ To Water Main/Service Line _ ~ 5/¢ To Stream, Pond, Lake or,Major Drainage Course Comments To Building Foundation To Disposal Field ^lO~dF.E_ ~Al 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area ,5'(,,4) Depression over Field (Y/N) N Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot ~4~E ~ Lo'r To Water Main/Service Line Type of System Design Length of Field & 5'' Depth of Field 7 ' Gravel Bed Thickness .~ ' Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line 4~¢ ~ To Existing or Abandoned System on ; On Adjoining Lots -/5" To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course I, loIdE /If A~A To Driveway, Parking Area, or Vehicle Storage Area Comments AB,Sc,~pT'~o~ F'IF,./..I~ 15 "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) -'"'""'""--~ Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** .:.:::: . I certify that I have checked, verified, or conformed to all MOA a'n-d H inspection. Company /~0'~'TLSOD ~Jd,~cJ~..~-~tf~& Date /'&'/~-'?/8 ~ MOA No, fect on the date of this Engineer's Seal Receipt NO, O.~--~-O ~"7 Date of Payment Amount: $ ~2-026 (Rev. 7188) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORA6E/WESTERN OISTRICT OFFICE 3601 C STREET. SUITE 133~ aNCHORAGE, AL_ASEA 99503 STEVE COWPER, GOVERNOR 563-6775 To Whom It May Concern: Accordinq to the records on File in this oFFice, the _Ca~O~{~ ...... ~c.,\.~_~%;c~¢5¢.%~,~,~.t~tDDatep System is in compliance with the qtafe o¢ Alaska Oninkinq Waten Requlations. PSK:sa Sincerely, Environmental Field OFf'icer