HomeMy WebLinkAboutVALHALLA BLK 4 LT 5
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
Name DISTANCES
Address % TANK FIELD WELL
~ ~ ~-- ~ ,r,veway, water bodies, etc)
TANKS N
~ SEPTIC ~ HOLDING
n
TYPE OF ~YaTE~
~TRENCH g BED g W. DRAIN ~ OTHER
original grade ~ FT
~ FI
WELLS ......
~PRIVATE ~ OTHER (Identify)
FT
installer Date I~s*alled:
REMARKS:
, .miry ,,,, this inspection was pedormed accordi.g to all
municipal ~nd Stat, guidelines in effect en thin daJ6~ ,~ /a
72-013 (3185)
<:i
PERFORMED FOR:
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99592-0650
SOILS LOG -- PERCOLATION TEST
D^TE PEI~r~
LEGALDESCRiPTiON:Z'¢"/'_~~ ,~jZ~'-",/ ~//~L,4//LZk'¢ Township, Range, Section: '7~Z.~ ,~'~J -¢~,- ~b.
COMMENTS
.~
PERFORMED BY:
ACCORDANCE WITH ALL STATE AND MUNICIPAL
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT O
DEPTH?
P
E
Oeplh la Water Alter
Monilorin8? ,,~ Date: ~Z~'-~
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE ~'~'~ '~ (m~nutes/mch) PERC HOLE DIAMETER
TEST RUN BETWEEN ~,¢ FTAND ~'/ FT
, ¢'¢~ ~W/¢' CERTIFY THAT THIS TEST WAS PERFORMED '"
GUIDELINES IN EFFECT ON THIS DATE. DATE: ~¢~¢
72-008 {Rev. 4/85)
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG -- PERCOLATION TEST
(ENGINEER'S SEAL)
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
PERFORMED BY:
DATE PEREORMED:
Township, Range, Section: '~'~,~)
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth Io Water Alter
Monitoring? Dale:
Gross Net Depth to Net
Reading Date
Time Time Water Drop
PERCOLATION RATE /'~1o ¢ (mlnutes/mchl PERC HOLE DIAMETER __
TEST RUN BETWEEN ~' ~', FT AND ,/~ FT
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE.
CERTIFY T'AT THIS TEST WAS PERFORMED IN
DATE: ¢'-'/'¢/'~'~
72 008 (Rev. 4/85)
CONTROL SERVICES, INC,
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO OF
CHECKED BY DATE
SCALE
ALASKA I~FIUIROiflm~FITAL COFITROL SI~RUIC~S, IFIC.
~nqineerinq 0 ~naironmental Studies
[f th( [m~;talle~tJon is liar ]llspeclte(i by am AF. CS en,,~,i!!ae:', A!~fi
1200 I.Uasl a3rd Aucnue, Suil¢ ~ · Ancharoqe, Alaska 99503 · (907) 276-1361
.2
SCALE:
I~
I
I ca
~-~E:PA RE[ D FORt
AS- BUILT
! ,Z
I hereby certify that on accurate sur
described property=
/_or 5' ~3zoc/( .~
was made on /~PCY' /.~"' J~ and that Ihe
improvements situated thereon are within the property lines
and do not overlapor encroach on lhe property lying ad-
jacent therefor that no improvemente on the property lyk~
bd acent thereto encroach on the premises in question and
Ih~l there are no roadways, lransmissloa lines or olher
visible easements on s~id property oxcept as indicaled
CONTROL SERVICES, INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO ~
OF--
DATE
CHECKED BY
i./
I]
0
.]
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0
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0 0 0 00
GP~ATER ANCHORAGE AREA BOROI~GH
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
ADD RESS~.~'
?
SEPTIC TANK:
DISTANCE FROM WELL__~t/
LIQUID CAPACITY
__MATERIAl )/ ~7~:: NUMBER OF
COMPARTMENTS
GALLONS. INSIDE LENGT' INSIDE WIDTH
LIQUID
DEPTH __
SEEPAGE SYSTEM: SEEPAGE P~t:
NUMBER OF PITS _ /~ _ OUTSIDE DIAMETER ~- or WIDTH./~
NEAREST LOT I. INE~[)
/ /
/~___, LENGTH "~' , DEPTH
BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
TILE DRAIN FIELD:
TOTAL LENGTH
DISTANCE FROM WELt .... FOUNDATION. , NEAREST LOT LINE , OF LINES
NUMBE~OF LINES WEEN L · TRENCH WIDTH / _ ~IN,:~[Of~L EFFECTIVE
ABSOR ,-AIWA SQ. FT. OF ACH LINE__
DEPTH: TOP OF TILE TO FINISH GRADE
__DEPTH OF FILTER MATERIAL BENEATH TILE
IN, ABOVE TILE__
~ DISTANCE FROM ' / WATER
WELL: TYP~E'_-Z'~:~/~'~.) , DEPTH - .BUILDING FOUNDATION.~~ ~/' SAMPLE__ ,NEAREST
~ Z NEAREST /~ SEPTIC ~c~. / SEEPAGE ~,~ / OTHER
LOT LINE ) , SEWER LINE '~' ~,TANK ., SYSTEM ~ CESSPOOL ~, SOURCES
DISTANCES:
'/';
DIAGRAM OF SYSTEM
GAAB-HD-2
GREATEr'
327 Eagle St.
ANCHORAGE AREA
ItEALTH DEPARTMENT
Anchorage, Alaska 99501
'OROUGH
279-2511
Case No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
:3 .2 . ,/7
RESIDENCE ADDRESS~5;~( ;/}~:~]fl~E ~ iL LOCATION OF INSTALLATIO"
APPLICATION TO INSTALL: SEPTIGTANK ~ , SEEPAGE PIT_ / ,DRAIN FIELD ,OTHER
TOSERVETHE FOLLOWING FACILITY ::~ /:~/:&O/~f ~¢:-
~ER~~ST RESULTS ANTICIPATED DATE OF COMPLETION
BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT
THIS IS TO SERVE AS , '--~//f~;r:~,'~)L?',;~-<. , PERMIT TO INSTALL A
_AS DESCRIBED BELOW, SiZE OF UNIT TO DESERVED -
., SEPTIC TANK SIZE ~/~ ~ ?>o TYPE SEEPAGE AREA
DIAGRAM OE SYSTEM
cAS.
GREATER ANCHORAGE AREA BOROUG}
IlEAl,TH DEPAR'FHENT
327 EAGLE STREET
ANCHORAGE, ALASKA 99501
Depth
Feet Soll Charac t¢:ristlcs
if Yes, At What Depth
Reading Date
Gross Time
Net Time
Location Sketch
Depth To H20
Net Drop
Proposed Instal~Seepage Pi~ /~- Drain Field
T~st Performed BS"~&~. = ~ , , ..... _ ,-.-~
Data Certified By
I'~t R IV~LL DRILLD{S LOG I' DO NOT FILL IN
f ~ ( / ~ :~f, ////~, .- usc~ so. .
Drilling Co.
, Driller
Lacat~on (aaa~e~s
, ,,, ~ ~ .... ,,, , . ....
,
8tat~c ~ater level ~:: fee~ (above) (be l~d s~face, Finish o~ well
(check one) Open end ( ~ Screen ~ ): Perforated ( ).
'? :~[': ~ --bepth in feet from
~ .... ,"-'- ground surface
Describe screen or perforations:
l'~ell pumping test at gallons per (hr) (min) for hours
feet of drawdown from static level~
Remarks.. j! ,,/?, ';, ..:. , , ,_,, .. .
~ ~.i ~ "/';.:., '. - / ' ,
Give details o~ formations penetrated, size of material,
color, and hardness.
tO
tO
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to
to
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. 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
Mailing A~Jdre~s -
Telephone: (home)
B usi ness ~ "/-~"'-
(c) Lendi0g Institution
Mailing Address
Telephone
(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
Single-Family"~ Number of bedrooms
3. WATER SUPPLY
Individual Wel Ir'j~
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE 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 legailty and status.
z~-02~ IR6v. Z/e81 Page I of 2
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,MUNICIPALITY OF ANCHORAGE (MOA)
NIQPALIf'Helatth~4t~.tbeJl!ty Approval (HAA)
ONM~NTAI,Gt4ECI~I~/~io~EBRUARY 1984
343-4744
Legal Description:
RECEIVED
A. WELL DATA
Well Classification if A. B, C, D.E.C. Approved (Y/N)
Well bog Present~N) Date Completed '~.~7 Yield ,¢4-- -~,(¢
Total Depth~'O' Cased to /_5'0 t
___ Depth of Grouting /.J//I
Static Water Level --Ye- //_5'
Casing Height Above Ground
Electrical Wiring in Conduit (~N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot _
To Nearest Public Sewer Line . /,,//~4
To Nearest Sewer Service Line on Lot
Water Sample Collected by /'¢-~'-c~'
Water Sample Test Results .~/¢'~'_ "7-- ~--~
Comments '-~ /x~/.:¢- /¢-~-~-J
Pump Set At
Sanitary Seal on Casing N)
Depression Around Wellhead (Y~)
; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
B. SEPTIC/HOLDING TANK DATA
Date Installed /~"~-?~ Size
standp pes N/ _ Air-tight Caps
Depression over Tank (Y,~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
No. of Compartments
Foundation Cleanout (Y~)
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
SEPARATION'DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Sul~pl~/,Well;: ~¢ ,~ /F~//_/ To Building Foundation
To Property Line ' ' /~ ''P To Disposal Field
To Water Main/Servic~ Line /o ¢-
'To Stream, Pond; La~e or Major Drainage Course
Commenis. ' ·
72-026 (Rev 7/88) Fronl Page 1 of 2
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APPLI ~NT FILLS OUT UPPER HA ; ONLY
Address Zip Code
Lending Institution
Realty Co. & Agent /~/)~3 ~ ~ Phone
Address Zip Code
Type of Residence
[~ Multiple Family NO. of Bedrooms~--,~
[] Other
Water Supply
t~ Community For wells drilled prior to that date, give well depth (attach log if available).
[] Public Utility
Sewer Disposal
'~ Individual Year Individual Installed:
[] Public Utility When Connected to Public Utility:
[] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time
Date Date Date
Inspector Insp6ctor Insp6clor
Field Notes:
Time ,
Date
RECEIVED
( _~ ) APPROVED BEDROOMS
) DISAPPROVED
) CONDITIONAL APPROVAL'
DATE
BY:
*CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed
Well To Absorption Area
Well to Tank .7/~/
Well Log Received
Septic Tank Size ~/~) (~J~