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HomeMy WebLinkAboutTANAINA VALLEY LT 21 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Heallh Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address TANKS '~ SEPTIC [] HOLDING DISTANCES WELL SEPTIC ABSORPTION TANK FIELD WELL --LOT LINE ........ FOUNDATION ....... TYPE OF SYSTEM ~J 'tRENCH E] BED ~ W. DRAIN [] OTHER /~O FT lolal depth Irom original grade ~', % FT ~ FT /0 WELLS PRIVATE ~, OTHER (Idenlifv) REMARKS: I - ~1 ~¢A ~, ~ ~ ~ J~&'O~ ~ertily flint this igspeclJml was pedormed ~6~ordJng ~o all Michcm) E.~ ~ndcrson 72 013 (3~85) O N ..... ~iJ I 'T' E S Iii!: W E R P Iii: R M I T F'ef'm:i'L NumberJ~ 8130~16 l)ate Issulm:.l: 07/07 Eng,.neet, Designed Owner' Name~ I:)E~II:~I~S IN WI]OD O~,~ner' Al::ldr'e!ss~ '7c)2:L DRIFT'WE)OD LANE ANC]I-K)I~A[']E, Al< 995:1,8 Day ;:!;49 '"" JiJ () SI::P'f':[C', 'l'AIxlK.~ Min:lmum 'Le~tal sep'Lic tank (~apaci't.y: :1.,~.~5() ga:l. lcJr'Js. tank mu~it J'l~sv(:? ~'il'J:. ].::h'i~:i'~.. ~:~ ~::c)fliJ;)L:P'~.fil(:~r'lt.~:. Dep'Lh 'Lo 'Lc:p oI' se:?pti~ tarll..'. (!~) < 4,,0 ]:NI::I::)RM D,,H,,H,,S. F:'RJ:OR TO li~'T' & 2ND INSF:'E£:;TION,~3 BI:..'. ENGINEER!, AF:]'I:!.:R OFF:'I[;Ei: I..IOLIRS, CAI....L ::4:3-468:1. AND I..EAVE A ME!38AGE,, [',ONSTF~LICT F:'EF:/ I!:NI:~]:I',IEER!3 A'rTAI:.'Hlii:D APPRI:)VED 'T'H :l: ~iJ PI:~:F. IM I T E XI:::' I RE~3 :1. ,'2./:S 1/813 f'H ]:8 I:::'EFIM I'T VAL. I D FOR A S IlxlE)L.E FAM ]:L..Y RE81DEN[',IE ONLY. CIEI:~"I' I FY T'HAT ~ :[ am t'am:L].iar, w:i.'Lh 'Lhe r'equir'enl(}~ntl:: fop c)n.-.si'Le sewer's and wells ~or'{h by l:l"t~.::, ~'JLu'l~lSipa],J,'Ly c:)(' ~rlcshlDpa:ge (MOA) arid 'Lhl.:, ~'Lal'..e of' A].asJ<a. :1: wi].:l. :Li]sta].]. the system :i.n ac::ccmdar~ce wi'Ll"~ a:L1 MOA c:ode::: and ~3r'ic.J J.r'l cc)mj:i:J.J.~twic:(.:~ wi'Lb thJ.:e d(~.~J, gri {sPJ. ter':La or this pepmit,, I Lu'ld~:~l'~'L,':~nd that 'Lh:i,s per'mi'L is w:~l~d {'Ol- a max:i, rm,.Ul/ oF 4 bedPc, e~ms,, also und~'~tand that the c~:~::L'l',.y of the total sys't, em ~s 4 bedr, oonls and PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: 1 2 3 4 LT/.'/ / / /~ 7 8 9- 10- 11 Township, Range, Section: SITE PLAN SLOPE WAS GROUND WATER ENCOUNTERED? ,d/~ 13- 15- 16- 17- 18- 19- 20- IF YES, AT WHAT DEPTH? 0eplh 10 Waler ADer Moniloring? fie ¢~/H~/~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop _ / ~,-ZT- ~8 0 o 17~,oo" o _ f/ ,' ,'~'-', /o //, Z ,~-" . ~- ,~ ~ //, oo" , z ~' ~ $~ ~ ¥o. ?S'" , PERCOLATION RATE -~"~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND <~2 FT COMMENTS ~ [95.00~ ." 31~711 6 7 MichaeJ E, Andorson 4381 .E 14 13 MUNICIPALITY 0,:: ANCHORAGF Deparh'nent of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHGRITY APPROVAL OF ON-SITE SEWER AND WATER FACILII"Y FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) LoT' ~.1 TA/4,4/^IA t]ALL~ Sul~J, Sq TIZ~J ~J Location (address or directions) (b) Property owner Mailing Address Telephone: (home) .. Business (c) Lending Institution ALtlA~JdE:_ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ,[~hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community ~ Public [] Nole: If community well System, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SE!WAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ~ jo ~ ebed · ~Jo~ s.J@@u[Bu@ leUOlSS@loJd @q~ u! suo!ss!uuo Jo sJoJJe JoJ elq!$uodsaJ ]ou s! ~beJoqou¥ jo ,~[led!o!u nl~N eq/'penes! e! eleo!J!~Jeo ~ eJoj@q e]ep ez,~le ue Jo suo!]oedsu! ~onpuoo iou op SH HQ jo s@e,~old LUa 'e~ueLuaJ!nb@J @Ieee pue leJepej u!e~Jeo ,~J$!ies o~ JepJo u! euoRn]!]eu! 6u!puel J!eq] pue s@uJoq ,~o sJeseqoJnd o] Ase~Jnoo e se s]q] eeop SHHQ eqJ. 'e)lSel¥ ~o e]e~$ eq] u! peJa~ell~eJ ~eeu!bue leUO!SsejoJd ]uepuedepu! ue,~q e^oq~ S qde~l~e~d u! ue^!8 suo!~e~uaeeJdeJ eq~ uodn/~lUO peeeq pe]eo!j!Jeo le^oJdd¥/q!Joqlnv q],leeH sense! (8HHQ) eao!^Jes ueuJnH pue q~leeH ~o ]ueLu],J~dec] ebeJoqouv ~o/q!led!o!u nv, l le^oJddv leUO!]!puoo ~o euuJe/ leUO[].!puoo pe^oJddes!O '// ~WooJpeq ~- peAoJddv _~ .~o~. peAo.~ddv 'l~/AOt:tddV SHHC] '9 lees sjeeu!euJ A. WELL DATA Well Classification 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 'Fo Nearest Sewer Service Line on Lot WaterSample Collected by WaterSample Test Results Comments .5'~-_-E A'F'FAO~ICZ;Z MUNIQ[~,~bli~¥~OF ANCHORAGE (MOA) Cl~,~,t/~'I ~-~l~.~/~lfii~y Approval (HAA) ~¢,~- ~'~CKI. ST- FEBRUARY 1984 ~}.'f~ ~. () ~ 343-4744 " Legal Description: ~d~ ~/ _ Date Completed Depth of Grouting Pump Set At Sanitary Seal on Casin9 (Y/N) Depression Around Wellhead (Y/N) If Al B, C, D.E.C. Approved (Y/N) Yield Y ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ¢-Z&-g~' Size Standpipes (Y/N) y _Air-tight Caps (Y/N) ,I/ Depression over Tank (Y/N) _ Pumping/Maintenance Contact on File (Y/N) No. of Compartments -~ Foundation Cleanout (Y/N) Date Last Pumped MgW 42~/45T;, ; for ~¢-~v ~o/~: Y Holding Tank High-Water Alarm (Y/N) _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well 12~00 To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Temporary Holding Tank Permit (Y/N) Comments 7~-026 (Rev. 7/88) F¢ont Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ,5' ' To Water-Supply Well To Building Foundation Lot &!o/4E oM LoT To Water Main/Service Line Square Feet of Absortion Area /ZoO Depression over Field (Y/N) Results of Last Adequacy Test 4/£¢/ SEPARATION DISTANCE FROM ABSORPTION FIELD: ; On Adjoining Lots To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course klo~IE /~ A~¢A To Driveway, Parking Area, or Vehicle Storage Area ~f 5' Comments Ar~5~pT-/~~ ~?srgt4 rs Type of System Design Length of Field /8~' Depth of Field ~. Gravel Bed Thickness ~' ' Statndpipes Present (Y/N) Y Date of Last Adequacy Test W~-~' To Property Line To Existing or Abandoned System on D. LIFT STATION Date Installed Size in Gallons "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 and HA'A guide_'~r~_'~s~i~ ~t~on the date of this inspection. -- (~G~~ ,~,~ OF ~/~ Signed ~~ Company ~ a~ ,J ~. ~*~ ~aT~;Z~ ~ ~. ¢~ ~ Michael E. Anderson ] MOA No. ¢~ ~'% 438~ -~ Receipt No. ~0 ~ ~/ Receipt No, Date of Payment ¢~¢~¢/~- Waiver Fee: $ Amount: $ / 7~.~ Date of Payment 7~ o~6 (n~. 7/8e) e.o~ Page 2 of 2 ~NCHORA~E, ALASKA 99503 STEVE COWPER, GOVERNOR 563-~77S To ~hom It May Concern: accordinq to the records on File in this office, the _Co,.~,'5_~£~_ ...... ~-~--,~ b~q-~5~ x_~,,v, ~A~tJater System is in compliance tJith the 'qtafe oF Alaska Orinkinq Water Requlations, ~SK:sa Sincerely, Environmental Field Officer