HomeMy WebLinkAboutTUSTAMENA TERRACE #1 LT 10'/7
'/~' MUNICIPALITY OF ANCHORAGE
DEPARTMENT 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
NAME Koro CO + O f" P"O"E *"EW
LEGAL DESCRIPT ON
~ DISTANCE TO: Iw*'' /OO' I t~' Dwelling N~~ tt~ PERMITNO~Z
~< ~¢C~c Matorial~ ~I NO. of compartments ~
Liq. capacity in gallons Inside length Width Liquid depth
j OOO IF HOMEMADE:
' ~ Well Dwelling PERMIT NO.
~ ~ ~ DISTANCE TO:
O ~ ~ Manufacturer Material Liquid capacity in gallons
O Well Foundation Nearest lot line ~, PERMIT NO,
~ No. oflines 3 Lengthofeachline.~, TotalJeng$4f~n~t Trench width~ inches Distancebotwoenllnes
~ N Top of tile to finish grade ~ I Material beneath tile Total effective absorption area
~ G inches
Length Width Depth PERMIT NO,
~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer llne Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
REMARKS
APPROVED DATE LEGAL
2-013 (Rev. 3/78)
F'EF::HiT t'-lZ:
I,)FFt"E ]' ':J '7 E:'E,:
DEF'FIRTMEiq"f' OF HERLI'H F:II'-.ID E~It""II:~._I'.!i',IEI'4TWL.'- -. - PF:OTECTION ,:,¢:._, .t ...... ] F..EET., F:INC:HOF.:F]GE., Fhq::
F" E F-: ~'"1 :E -F
F - I'- 'FF. 7. T F'HONE:
!'(ORF' I CONSTRFtBT I NG
J..:]!:;;t50 RIDGE!4OOD CIR.
FINCFll']I:~:R G E., RK
]i:45'"'OS'20
:SLIBI) i",,'IE;IE~i",I: TUSTEMEh!R TERRRCE LOT: '10
SE Z"" ]' "H ' '- ~
,z,.' TOklI'.4SHIF:': ::L2N F;?.RNGE: 3:t.,.I
i. ;25B ,::SQ. FT. L-t~' F:ICF::ES)
ELOCK': NR
L. iS'I'ED BE:LOkl FIRE: THE OF:']'IONS R'v'F::IIL. RBLE 'TO 't'OU iN DESIGNING '[OUR SEPTIC
S'¢'.-]TEM. CHOOSE THE OPTIOi'4 TI-..IRT BEST FiTS '.r'OUF..' SITE.
DEP'TH TO PIPE -BOTTOM° (F'T..':,
ORRVEL DEPTH (F'T. ::, O. 5
TOTFIL DEF'TH EFT. ::, 72:. 0
GRFI'v'EL.. !.,.IIDTH (F"T. ::, 1'?. 0
G~:FI',,,'EL LEIqGTH (FT.) ' ]:4. 0
L')F..'I::I',/EL '¢OL. LIFIE: (CI...I. ¥[)S,
TRNI.( SIZIE ,(GF!L.:E;;, :]... EiOCt 0 :~.::~.:
SOIl... F:.'.'F:ITING (S;O. FT. ,,"B,l,~9 t25
:+::+: [:'E:PTH TCI I::'IPE. Eu..3] TCd"I .C ..3:: 5 FT. ~'E-:. - ]'F?c'':~.,-- INSt_ILRTIOi",I
~.:m DEPTH TO F:'IF'E BOI"TEH -::: 4. 0 F'T. i"lFl'-r' F~:E6!UIRE FI LIFT STFtTILgI"~
n.::+: TRi",II'( i"ILIST I.-IF:t',/E FI"F LEF. S'I' TP.iO COI.'!F'Rf:;:THE:hlTL=;
i CERTIF'¢ TFIR]":
i. I Ri"l FRi"IIL. IRR HI'TH THE REQUIREHENTS FoR ON-SII'E SEHERS AND HELLS RS SET
FORTH B'¢ THE iqUNiC!PFtL~]:T'f OF' F:INCHORRGE (HOB) RND THE STRTE OF:' RLRSKR;
2. i [,.iIL. L iNSTF~LL THE S'¢STEH IN F:ICCORDRNCE !.4ITH RLL MOR CODES RND REGULFITIONS.,
RND IN COHF'LIRhfCiE 1.4iTH THE DESIGN C:RITERIFI OF' 1'HIS PERi"IiT.
_3:. ! klIL..L Ft[)t-IERE TO FILJ.... !',IOF~ RND STR'TE' OF:' RL. RSI-(R REL--&IIREHENTS F'C)F..' THE SET BRCK'
DISTFiNCES PF'.OH RN"r' EXISTING 1.4EL;L., 14FISTEHRTER DISPOSFIL S'?STEM OR PUBLIC
SE!4EF..'BGE S'¢STEH Oi",t THIS OR RN'¢ RDJ'RCENT OF.'.' NEFtRB'¢ LOT.
4. 'i I_.iNDERSTRND THF:IT T,LI!S PER'MIT IS VI::ILTD FOR IR i"IRXIPtUM OF' ~: BEDF?.OOHS FIND
FIN"r' Ei',II...RF;tGE:I'"IE:i'.,I'I' D]I[...L REQLIIF:'.E FIN RDDiTiONRL PERi"IIT.
iF R
'['FIEN
I-,.t.~L.L. ?',lOT E,t:. ,, kR_,EE., I,Jl.'THFtlIT RN ELECTF'i~:FIL I?LFEL. TIuN REF JF.T., FIND ,"~', THE
..... - - - ' ":"~ B"? '" L ! C:ENSEEJ ....... ' .....
E b..iRIL. I~IL. I-,J'F.'I-:' lllj_,l E:F( [:,Ol'.&r.Z Pi EL~.:_.IRIL. IHf~.
I_IFT STFITi-H IS !i",I:STFiLLED II",t F!!",! I::iF:.:EFI C':O'v'EF4:ED B'T' MOFI BLIILE. INO CiE'ES
,::::L) Flhl ELEFTF'IZFIL PERMIT FIND INSF:'ECTION i'10:¥' '-' BE OETRII"~E[, "2':' -'---' '-
' - H_, E,I~I I LT:,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
13-
14-
15-
16-
17-
18-
19-
2O
COMMENTS
PERFORMED BY:
72-008 (6/79)
o-t lb
DATE PERFORMED;
SLOPE
SITE PLAN
WAS GROUND WATER SL
ENCOUNTERED? /~O pO
E
IF YES, AT WHAT
DEPTH?
Reading Date Gross Net Depth to Net
' Time Time Water Drop
4;z8 ,'?q-
4: 33' o.'73-
4~o 3 4;4r [m,'~ o,F~ 0,17
lfl~o + 4:50 ~;'~ o,~q
PERCOLATION RATE
TEST RUN BETWEEN
~ '2~ (minutes/inch)
~'O FT AND ~O FT
CERTIFIED BY:'
DATE;
// / ,
~ WATER WEI, L RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RE$OURE$
Division o! Geologicel & GRoph¥sICOI Surveyl
/'~].IDISTANCE ~'1~ ~IRE~N F~OM ROAD
S~t 8~d ~aTel 90 ~0~
Gray rock 1~ 2~ e. FINISH OF WELL:
~ock w~ter incl 275 287
Bail tested at 1 G~
Ma~uson Drillin6 AA
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRON~NTAL HEALTH
DEPARTMEN~ OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HF~TH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date
(a) L~al D~escriptlon (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants Name
(c)
Telephone - Home Business
Applicants Address /.~_~*~j ,~/~)~=/zZTZ2~7,O
Applicant is (check one) Lending Institution ~ ; ~__~builder~;
Buyer ~ ; Other ~ (explain);
(d) Lending Institution
Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the H~ to the following address:
2. T~pe of Residence
Single-Family~
Number of Bedrooms
3. Water Supply-
Individual Well~'~
Multt-Family~
other (describe)
Community ~ Public ~ ·
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. 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.
[Page 1 of 2]
5o Engineering Firm Providin8, 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 regula-
tions in effect on the date of this inspection°
Address /dj, .~
Date //~l/~,~'/- ~. /'~l[~ ~/
DHEP Approval
Approved for
Approved ~
bedrooms
Disapproved
(ENGINEER SEAL)
By t.-~. -~ :~'~' a t e
Conditional~/
y C. Reid, :;:
2251 .E
Terms of Conditional Approval
CAUTION
2HE MUNICIPALITY OF ANCHORAGE DEPARTME~£ OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS 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 REQUIRE-
MENTS% 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.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
~HEMICAL & GI~OLOGICAL L.4BOR~4~ORIES or
_ ~,~. -. TELEPH
Drinking W~
TO BE COMPLETED
~'~; - ,.~-
WATE. S~STEM: I
)NE (907) 552-2343 ANCHORAGE INDUSTRIAL CEI
5633 B Str~eet
ter Analysis Report for Total Colifor
Y WATER SUPPLIER
I I I I I ~*~Sse"o"bee'
I.D, NO.
Phone No.
SAMPLE DATE: ~
Mo.
SAMPLE TYPE: .
~ooutlne - . - L- -~
'[]'Check Sample (for routine sam
with lab ref. no.
[] Special Purpose
State Zip Code
/4LASK.4, INC.
ITER
Bacteria
TO BE!COMPLETED BY LABORATORY
.,, ,., ~i~,,,~ ~ ,.. ,~ ........ ?.~ .
Ana~'~'~ shows this Wate~ SAMPLE to be:
~l~l'Un~atisfactory
; [] Sar~ple too long in transit; sample should
notre over 30 hours old at examination to
' indicate reliable results. Please send new
via special delivery mail.
ical Method:
Fermentation Tube
Membrane Filter
SAMPLE
NO.
1
., I
, 1
I
LOCATION
No. Result' ~ Analyst
jr-~
READINSTRUCTIONS
BEFORE
COLLECTING SAMPLE
t~embrane Filter;. Direct Count
ler]flcatlon: LTB '
[hal Membrane Filter Results ~'~
~'NTC= Too Numerous To Count
BACTERIOLOGICAL WATER ANALYSIS RECORD
BGB_
Co[Iformll00ml
Co]lformll00ml
Time: i a.m.
~, p.m.
A®
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAL)
CHECKLIST - FEBRUARY 1984
WELL raTA
Well Classification/~/D/Y/Z)~,q8 If A, B, C~ C, DoE.C. Approved(Y/N) /~/.~
Well Log P~esent ~/N) '~ Date Completed ~/~/~"ff Yield/~~ ~
Total Depth ~7z '~ Cased to /~O~j ~ ' Depth of (~outing
Static Water Level ~O~ ~ ~ Pump Set At
Casin~ Height Above G~ound ~,~ Sanita3ey Se(a~l on Casin~ ~N)
Electrical Wi~ing in Conduit ~/N) Depression A~ound Wellhead (Y~ _
Separation Distances f~cm Well:
To Septic/Holdin~ Tank on Lot /~)~ ~ ~ ; On Adjoinin~ Lots /~
To Nearest Edge of Abso~tion Field on Lot/~~9 ; On Adjoining Lots /~'~(~
Public Sewe~ Line . /~//d~ To Nea~es.t Public Sew~
To
Cleanest/MaD_hole ~/~-- To Nearest Sewe~ Service Lir~ on LOt ~/~
Nearest
-! _ . . /
Wate~ Sample Collected By ~/~27~, Date /~/~ ./. /~_~/
Wate~ Sampl. e Test P~sults
C~nts ~ ~-// /~ -- ~/~0/~F ;/~(~ /~'~'/F
B. SEPTIC/HOLDING T~/qK DATA
Date Installed ~//~./~f/9 SiZe /~0~ 0 NO. of C~t~ ~ ®
Standpipe ~) Ai~-tight ~ps ~) Foun~tion Cleanout ~)
~p~ession 0~ Ta~ (Y~ Date ~st P~d ~ ~
P~in~intenan~ Con~a~ ~ File (Y~)~ ; fo~ ~/~
Holdin~ Ta~ High-Wate~ Ala~ (Y~) ~/~ ~a~y Holdi~ Tan~ ~t (Y~)
Sep~ation Distance ~ ~ptic~olding Tank:
To Building Foundation ~)
To Disposal Field /~/ ~
_ To Stream, Pond, Lake, c~ Majo~ D~ainage
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /~- ~ ~) Type of System Design
Date Installed . ~//~/~3 Length of Field ~- <2)
Width of Field /~ ' ~ Depth of Field ~, O~-
Gravel Bed Thickness ~
Squaze Feet of Absorption A~ea ~2~ ~ Standpipes P~esent ~/N)
Depression over Field (Y~ Date of Last Adequacy Test
Results of Last Adequacy Test ~/~
Separation Distance from Absorption Field:
To ~ate~Supply Well /Z. ~'~ To P~ope~ty Line ~F~
To Building ~oundation ~ ~ To Existing or ~k~ndoned System cn
Lot ~///~ ; On Adjoining Lots .~//~
To Wate~ Main/Service Line ~//~ To Cutbank(lf present)
To St~eam/Pond/Lake/c~ Major Drainage Course /~ ~ ~ ~
To Driveway, Parking A~ea, o~ Veh Storage A~ea
':D~ D~-~, /
/
D. LIFT STATION ~ /~/
Date Installed /'
Size in Gallons
"Pump On" Level at
High Wate~ Alazm Level at
Tested fo~
Dimensions ~
Manhole/Access (Y/N) ~
-'-' "Pump Off" Level at ~
'- ~ Vent (Y/N) '~--
Pumping Cycles du~ing Adequa~z Test.
Electrical Codes(Y/N)
Comments
Meets MOA
** Check Permitted Bed~ocm Rating Against [{AA Request
I certify that I have checked, verified, or confo~mad to all MOA HAA C~idelines in effect
on the date of this inspection.
Company .~._~.,~'/ .'..~.-, e',
KB1/d5/s
[Page 2 of 2]
.''
~a'm~ V No. 2251-~
2-15-84