The URL can be used to link to this page

Home My WebLink AboutT15N R1W SEC 18 LT 187 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 MAILING ADDRESS LEGAL DESCRIPTION LOCATION Well I Absorption area DISTANCE TO: t~::~ "~ I ~'! Manufacturer Li~ . capacity in gallons Inside lenqtlz, IF HOMEMADE: -- DISTANCE TO: Well ~ J. Dwelling Manufacturer Well Foundation DISTANCE TO: Length of ~J No. of lines each Total length of lines Top of tile to finish grade //-' I Mater~a] beneath tile DISTANCE TO: Well[ ~ t ~ ~tion Driller DISTANCE TO: OTHER PIPE MATERIALS INSTALLER REMARKS PHONE ~UPGRADE NO, OF BEDROOMS Materlal NearestlotHne Trench width PERMIT NO. No. of com~ments Liquid dep,th PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines inches Total effective absorption area inches Nearest lot line I Distance to lot line PERMIT NO. Septic tank Absorption area(s) DEPARTMEN'T 01::: HE, ALTH AND ENVIRONMEN"FAL F'ROTECTION G25 L STREET, ANCHORAGE, Al< 99501 264-4720 PERM/IT NO: G50417 Il)ATE ISSIJED'-' 0'7/:[7/G5 AP F;I... I CANT: ADDRESS: CONTACT F'HONE: % G&S ENGINEERING AMERICAN EXCAVATION SRB 196-X EAGLE RIVER~ AK 99577 694-2!979 LEGAL DESCR II=': I_OT SIZE: MAX BEDROOMS: SUBDIVISION: N/A LOT': IG7 SECTION: 18 'TOWNSHIP: 15N RANGE: 1W 5A (SQ. I:::1", [IR ACRES) BLOC, K: N/A [.,,~;s'Led below ape the options available to you in clesigning youe septic: s, ystem. Choose the option that best. fi'Ls your site. DEP'TN 'T'O PIPIE BO'TTON (FT. > 4,,0 4.0 4.0 GI:~AVE'I.., BEPTH (IZ'T.) 6.0 0.5 5.5 TOTAL DEPTH (F"T',,) 1(),, 0 4.5 7.5 GRAVEl,., WII)TI4 (FT.) 2.5 14.0 5.0 GRAVEL LENGTH (FT'.) 22.0 28.0 28,,0 GRAVEL VOL. LJME ([',U. YI)S. ) 15.5 14.6 20.8 I"ANI< SIZE ([~AL..S) 1,000.0 *~ 1~000.0 *'t' ~,000,,0 '~'~' SO]',L RATING (SGh, t:::"T. /BR) 85 85 G5 ~";~ "rANK MLIS]" HAVE A'T' L, EAST TWO C(]MPARTME~ITS centify that: 1.. I am famill, ar with 'Lhe pequirement, s for 2. on-site i~ewers and wel:[:~ as set for'th by 'Lhe Municipality of Anchopage (NOA) and the State of Alaska. I will install the system in accordance with all MOA codes and r'egulat:i, ons, and in compliance with the design cr'iter'ia of thzs pem~it. I will adhere to all MOA and ${ate of Alaska requii-ements for the set back CJist. arl~:es fr'om any existing well, wastewaten disposal system of pL~blic sewenage system on this on any adjacent op neanby.l~t.; I under'stand that th~.s permit, is valid eom- a maximum of ;~; bedr'ooms and any enlangement will r'equine an additional pePmit. IF A LIEf' S'¥ATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN EL. EI.]I'r~I~b~,. PERMIT AND I~SPE,C.,'TION MUS)~ BE OBTAINED~ (~':D ~?-BUtI.,.TS WILl..; N(]'~ BE AP?,~ITHDUT AN ELEC'mZ?L ZNBF'ECTION REF'ORT~'AND ('.::;)THE EI...EE[,"rRI[,AI_ N~ M~~NE B YA L,,ICENSED EI..,,EC'I"RICIAN. ....... % ......................................................... . ..... ............. APF'I... I CAIq'I" :~/~J<S ENG I NEBEIR I NB AMER I CAN E X CAVA"r I ON -- BY. A'rE, 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: J~ [L~q[~L~I ~ LEGALDSSCR,PT,ON: . 1 2 3 4 5 6 7 8 9 10- 11 13- 15- 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: 72-008 (6/79) ~_,Y~_~ ~'"~*~ ~ DATE PERFORMED: ~ SL6PE ~ SITE PLAN WAS GROUND WATER ~/~ pO E ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ /~ (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED B~~~ / ~IUNICIPALITY 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 /~' -'//j-'* 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~7/~)~,P V~,~-~/VI¢-... Telephone: Home ~'~' ~(¢,~7~.'~ Business Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/l:~,.~er [~; Buyer []; Other [] (explain); (d) Lend/nglnstitution--/'2'~'~'',~ ~-~-- Tet.ephone .___ (e) Real Estate Company and Agent Address Telephone (f) ..~'the HAA to the following address' TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of Bedrooms ~' Other WATER SUPPLY Individual Well ~L Community [] Public [] 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 [] i~el.~) ['t'~'yI'~';F'IC');~''~ 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 ¢2 025 (11/84) ENGINEERING FIRM PROVIDINg, ,,'~SPECTIONS, TESTS, FILE SEARCH, DA'~.. 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 disposer 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 disposat system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ ~-~: ~X~Ji~I~i~HiE[~' Telephone Address,, ,¢ 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 ~s not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72 025 (11/84) MUNICIPALITY OF ANCHORAG~ MUNICIPALITY OF ANCHORAGE (MOA) DEPT, OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) EHVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264-4720 L198§ Legal Description: 7--/.,.--,¢/ KI-L.i:I V WELL DATA Well Classification ?¢' )I/4,1 T''(~ if A. B, C, D.E.C. Approvea (Y/N) '-'----- Well Log Present (4¢/~')~ Date Completed -,¢~'~ / ¢~'~,~"~ Yield ~'~ · { -- I /- - ------- Total Depth ~ k.~ Cased to '~ ¢' Depth of Grouting _ Static Water Level ~'~/ Pump Set At -- Casing Height Above Ground Electrical Wiring in Conduit ~)N) Separation Distances from Well: To Septic/N, eNt~,~j Tank on Lot Sanitary Seal on Casing (~N) Depression Around Wellhead (Y/~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer L~ne Cleanout/Manhole Water Sample Collected by Water Sample Test Results ,//-J(:~ IV"' : On Adjo~mng Lots ~/¢¢ / ~ . On Adjolmng Lots /E)~ 1"~' To Nearest Public Sewer -"'" To Nearest Sewer Service Line on Lot Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (~N) Air-tight Caps .(~N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm [Y/N) -- Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line /~,.) To Water Main/Service Line 7~- Course ./~ ~ ~"' ~ Comments .~J_F~ / NO, of Comoar~mems Foundation Cleanout (Y/4~ Date Last Pumped ~ for Temporary Holding Tank Permit (Y/N) To Building Foundatior To Disposal Field To Stream. Pond. Lake, or Major Drainage Page 1 of 2 72-026(11/84) /D:Sb ~UNlalPALITY OF AN~_~_, TEOTI-" D[PT, OF H[ALTH & ~ J ~ OF H~LTH · ~NVI~ON~NTAL PRO ~VIRONMENTAL PROTE~ION I g ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW Please Tomplete all parts Dp page 1. Incomplete requests ten ~10) days for processing. 4ONE DDRESS J IDIRECTIONBi 2. SUYER MAILING LENDIN~ tAILING ~AILING ~ENCE ~' SINGLE FAMILY -] MULTIPLE FAMILY SUPPLY ~ iNDIVIDUAL* COMMUNITY PUBLIC UTILITY :IE DISPOSAL SYSTEM [~ iNDIVIDUAL/ON-SITE** [] PUBLIC UTILITY [] One [] Four [] Other .._ [] Two [] Five ...~'~' Three [] Six * ATTACH WELL LOG, A well log is required for all wells drilled since June 1975,.For wells drilled prior to that date, give well depth (attach log if available,) **If individual/on-site, give installation date If system is over two (2) years Did an adequacy test is required by this Department, : THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. E. LEGAL' STREET L~ NOI 72-o~0 THIS SIDE FOR OFFICIAL USE ONL~ INSPECTION APPOINTMENTS 1. TYPE OFrRi=SIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY qDIVIDUAL ~ COMMUNITY [] PUBLIC UTILITY Connection Verifie SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified _ []Septic Tank or [] Holding Tank Size:__ If Tank is homemade give dimensions: __ TYPE OF TANK kL ABSORPTION AREA ~ ONE [] THREE [] TWO [] FOUR DATE DRILLED LOG RECEIVED PERMIT NUMBE MANUFACTURER MATERIAL DROOM8 [] FIVE F- SiX [] OTHER WELL TO: 6. COMMENTS ~:~'~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter_must aCC~any certificate) ENGINEERING FIRM PROVlDIN~ ,,~SPECTIONS, TESTS. FILE SEARCH, DA'i,. 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. Name of Firm ~ ~-~.; EX~ii~I~i~HiE[~ Telephone Address ,, Date ,~. ~7~ re D" PA""RO V, b Appr°vedf°r ~¢t~'bedr°°msby-~'~"' ~ ~ Approved ,,~f Disapproved Conditional Terms of Conditional Approval Date /~///':~ _'~/ 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 ~s not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72 025 (11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date installed '7- ~-) --~ Width of Field // Square Feet of Absorpuon Area Depression over Field (Y~ Results of Last Adequacy Test Separation Distance from Absorpuon Field: To Water-Supply Well /(-) ~;) //-- TO Building Foundation ,')~'~ ! Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area Length of Field Depth of Field ,,/~:~ Gravel Bed Thickness Standpipes Present (~N) Date of Last Adequacy Test To Property une To Existing or Abandoned System on : On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed S ze in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Aceess IY/NI "Pume Off" Level at Vent (Y/N) Pumping Cycles aunng Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M CA and HAA guidelines in effect on the date of this inspection. Signed :8 ~, ~ ENGINEERINg- Date ~/0 ~ / ~- ~p- Com~ RIVE~ A~8~ '~7 MOA No. ~- ~ ~ Receipt NO;~'~¢~ Date of Pay mere /¢ ~/~ ~,%-- Amount: $ ~,~ Page 2 of 2 72-026 ll 1/84) ~TNV7. IVO$}V30, ~