HomeMy WebLinkAboutWOODRIDGE BLK 2 LT 12
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF FIEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
DISTANCE TO: Dwelling
Manu facturBr
Liq. capacity in gallons IF HOMEMADE: Inside length / Width
DISTANCE TO: )we ng /
Manufacturer Materia]
DISTANCE TO:
No. of lines j Length of~ llne :hoflines
Top of tile to finish grade .,~ ~
Length Width Depth
Nearest lot
PHONE
[] UPGRADE
NO. OF BE~.ROOMS
No. of compartments
Liquid depth ~
PERMIT NO.
L~dU i~c a~n gallons
PERMIT NO
~MIT NO.
Type of crib Crib diamete
Crib depth
Building fo~atiol~
Total effective absorptior
Nearest lot line
DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARNS
Distance to Io ,line
APPROVED DATE
72--~013 (Rev. 3/78) ~;) ~
LEGAL
DEPRRTMENT OF HERLTH RND EN'¢IRONMENTFIL PROTECTION
8;25 L STREET., I~NCFIORFIGE., FIt.'..' 9950:;L
264-4',.*'2E1
F'ERM I T NO; ~,4u~4,
DFITE I =,.=,I..IED. 06,.."0:1.,,~ 84
ENb I NEEF..E[¢ DESIGN
FIPF L I L, FIN r,
AP.. ['RE,=,=,.
CONTFIL-:T F'HONE:
MRRK R, NILLER
3800 PFITRICIR LN.
RNCHORRGE, RK 99584
26~-4276
LEGFIL ""': .........
[,E_uRIF. SUBDIVISION: N]CDRIDQE LOT: 22 E, LOCk.:
_,EcTIuN. m TJNNSHIF: ~d.N RRNGE: 2:1.,.I
LOT SIZE: %.;34R ,:;S6!. FT. OR RCRES>
'CERTIF'¢ THRT:
I BM FFIMIL;IFIR NITH THE REQUIREMENTS FOR ON-SITE ?.,EWERS FIND NELLS FIS SET
FORTH D'¢ THE MUNICIPRLIT'¢ OF RNCHORRGE (MOFI) FIND THE STFITE OF FILRSKFI,
I NILL INSTFILL THE S~r'BTEf"I IN FICCORDFINCE NITH FILL MOFI CODES FINE.." REGUI. FITION5;,,
FIN[:' IN COFIPLIFINCE NITH THE; DESIGN CRITE'.'RIFI OF THIS PERHIT.
I NILL RDFIERE TO FILL MOFI FIND.STFITE OF RLFISI<:FI REC..!UIREMENT$ FOR THE SET BFICK
DISTRNr.::ES FROM RNY ENIS.]TING NELL, WFISTENFITER DISPOSRL S'¢STEM OR PUBL. IC
SENERRQE S'¢STEM ON THIS OR RN'¢ R[:,JFICENT OR NERRB'¢ LOT.
IF R
THEN
NILL
ELECTRICI-qL NORK MUST DE DONE B~r' FI LICENE;ED ELECTRICIFIN,
:~, I GNED DRTE:
FIF'PLICFINT: MFIF'.K ¢_ MILLER ~
LIFT _,TRTION I_-, INSTRLLE[:, IN RN RREFI IZ:O',/ERED B'¢ MOR BUILDING C:O[:,ES;.,
,' ~ '~.' , '- dE, TFtlNE[~., (2] H-, E, UILT.,
..I. RN ELECTF'IC:FIL F[~F..MIT FIND INSPECTION flU..~T E:E ~- ' . -c_. ,::
NOT E:E FIPPROVED NITHOLIT FIN ELE_.TRIL. HL IN_FEL. TIuN REFuRT., FIN[:, (-~) THE
SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~o 7/ IZ
~ o~
,C/cZ
DATE PERFORMED:
SLOPE ~,/
[] PERCOLATION
TEST
E PLAN
10
11
12
13-
14-
15-
16-
17-
18-
19-
20
Robert D, Bush
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
RUN BETWEEN FT AND FT
COMMENTS ~'~;~ (~") ~,, 7:° o~, ~..~-,.
PERFORMED BY: '~¢~Z~ CERTIFIED BY:__~ DATE:~¢
72-008 (6/79)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
PERCOLATION
TEST
8
9
10
11
12
SLOPE
SITE PLAN
13-
14-----
15-
16-
17-
18-
19-
20-
DEPTH?
CE - 5333
Gross Net Depth to Net
Reading Date 'Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND FT
COMMENTS
72-008 (6/79)
MUNICIPALITY OF ANCFIORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, ,~treet, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
SOILS LOG
PERCOLATION
LEGAL DESCRIPTION: L~/~ ["~' {'-'~[~¢'~"
1
6
7
DATE PERFORMED:~'~--//Z--~::~ I
10
11
12
13
14
15
16
17
18
19
20
WAS GROUND WATER
ENCOUNTERED?
"IICYES'ATWHATDEPTH?
O
P
E
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE
(minutes/inch)
TEST RUN BETWEEN FT AND -- FT
__ CERTIFIED BY: L.
72-008 (6/79)
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG-- PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
3
4-
5-
6-
7
8
9
10
11
12
13
14'
15
16
17
18
19-
,sD
DATE PERFORMED:
SLO~
SITE PLAN
WAS GROUND WATER iX.///O I~
ENCOUNTERED?
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time 'rime Water Orop
COMMENTS
PERCOLATION RATE (minutes/inch)
, ~, ..,4 ~/
TEST RUN BET EEN ~L/_.zzi)/z~-~'- ET AND FT
4/4-
72-008 (6/79)
I~ is the responslbHity of the owner lo
mine die ex~sto"~-'e of any easements, ,~ovenants o;
restriction5 ;,-h:ch do Ril cppear on ':~ .~cordee
for esta~dishlng bounda~ er fence lines.
LO-l-
s ooo ~4' 32"
~t0.84
/
/
/
/
~o~u-0 //
/
/
/
/
/
/
/
/
/
/
0,0
~ooD~O6~' 50~D I'v',
To uo,,-,'rr'.~ ¢t~.,_%,./,s .,5~./0~o //
~.~o ¢,,,- o,,.d /o. ,$,d,-oo. k
~PL. IC^NT: MARK ~. MILLE~
ANCHOrAGe, aK 99S04
CONTACT PHO~E:
L£iGAL OESCRIP: SUi~OI~
· LOI-.SIZE~ J.Z4A
ISICN: ~OCD~IDGE LOT: 12 ~LOCK:
N: ~ TCWNSNIP: 11N ~qAI, GE:
(S~.FT. 6~? ACRES)
CERTIFY THAT:
1, I AM FAMILIAR WITH TH~ R£.QUIP, I~M~k%~ ~OR ON'~SITF SEWERS ~NO W~LLS AS SET
FORTH ~Y THE MUNICIPALITY OF ANCHO~AOE (~0~) qNO THE ST~TE O~ ALASKA.
2. I ~ILL I~STALL THE S~ST~ IH ACCORDAhCE ~ITH ALL MCA CODES ~NO REGUL~TIO~,S~
ANO IN CCMPt,~AN¢2 ~ITH I~ PESIG~ CRI'FE~:IA OF THIS PERMII.
3. i ~ILL A~HERE TO ALL ,~6A ~ND STATE O~ ALASKA ~EQUIREF;ZNTS FO~ THE SET
5ISTANCE$ fROM ANY EX~STING ~LL, NAST~WATER DISPOS,~L sYST~'~ OR PUE~LIC
SEWE~AG~ SYS~&M C-N-~Hi.S C~ ANY. A~J~C~N~ CP-NEA~{~Y
IF A LIFT SIA't ICN IS INST~L. LEI; IN AN AREA COVEPED !!y MOA r~UILDING CODES,
TH~N (1) AN ELECTRICAL F.~JRMIT .ANO Z$~SPECTION (~UST ¢~ 03~A!N~<D; (2) ASm~!U~LTS
wILL NOT ;!E A~PROVE~ ~ZTHCUT AN ~LECTRICAL INSPECTION R;PORT; AND (3) THE
~{L~CTRtCAL ~OF~K ~T 8E DCN~ '2Y A LI, C~NS~.C ~L[CTRICIAN.
ISSUED 8Y
\o,G.
O, 6,
::L::I.i'.,I
L]:STE!][:, 13EL,OH FIR:I( Tl-.ll:i] Of::"l']:E~i'.,IS F:I'v'I:::IIL. FIE:L[~: TCI '~.'(:)lJ I1'.,I [)E:.E;ICii'.,III',IG Y]])LII:;~'. SEPTIC
S~'S"i"Ei','I. CI"IOCI:E;1;!i: ]"HI5: CIF:'T]:CIIq TI.IFIT 13EST
'-'ii" 1[:;7: [iK tbql C]:: It, ,.11 Il]C?,: lEE: IL):,, 11..4 ,.
DEF'TI.I TO F:' :[I:::'E t'31::YT"I'OH ,:: F'T. ::, 7'. ~i~
Scotch' 7664 "Posl*il' Roullng,Requesl Pads
ROUTING .- REQUEST
GF'.Fi'v'EL Dr~:I':'-FII (F"I". ::,
I"(}TF~I.., D[~:F'TH ,::F"t".
[:~ITF:I',,,'EI.. I.,.I]: D'I"II ':: F::"T'. ::'
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'"~ ..... .. , E.:. '*
14 ,I [ ","-I . PiE (C:LI. '""' ~ ~
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.... ,::S(/L ":' '"
'~::"' ]'1 RFFr ] I,I ~ F::'T. HANDLE
:.m+: ~R[I IJ I...[:!:I'.,!GTH .'::' ,."k', and
:-I-::.{.: 'I'FINI'( }'II...IS'T I-II::l~,,,'l.i! I:rlT I~
FOHWARD
[] RE*UR. /ti
C:E!]';;[T Z I::"-/ 'FHFIT:
:1. 3: I:::IH F:FIr,'I]iL..~I:::I[;;: I.,.1:I:'1'1.1
FOFi:TI.I I.. TIdE i',ll...llq ]: C:
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Dale __ From
..... F::li'.,l[:, :l: Iq E:OHF'L. T ]:::It'.,IC [:2~-~ .::~-- (~-¢--'~(
::~:.
,
I.qEL.LS F:I'.i~; SI5['T
ELF:' I:::II...R SI.( I:'-I.
FIND
TEl FI ........................ . ........................... ~...~ ~..~'.:~-,.~.r,.~.,:.~r.~:. rOF:: T'HE S[C'I" BF"I'C:k~
F:llq"r' 15111:'", 1:5i;'[ ~[ ~'.1[i) HELL, ['.ff3ST[51HI:::ITDi[~: D i[ 55PO:~:FIL ~hJ~i!:"['E~''] (3[;~'. F'L.IEtL.
~iJ;"r'~!;"l'l~:l'"l O1",1 TI'I:[S (317 F::II",I'T' FID.:rFIC:[!7.,IT CIF~'. I',IERI:~:E','~J I,..O"1~,
"f-IIF:IT TI.1:1: :5; I:::'11!!:[;:1"1 ]: T Z :Fi; 'v'F:IL Z l) FO[;;: FI I','11:::1',:.,',:1: i',llJl',l ]::iF:' ,q. E~IEE)F;:OOI"I:;::; FIND
EHLFIR'.(.:iI!'~HEI'.,IT I,.I:[L.L, [;~',I!5:L:]I...I]:F~:E: I::11'.,I ]:;:IDE:,]:T]:OI'.,IFIL F'EF;'.H:[T.
]: F' F::I ' L :( F:'T ~!!;TF:)"I" :[ Ol'.J :t: ~; ]: I'.,ISTF!L.I....[15[:, ]:1'.,I FII'.,I F::IR:EFI CCI',,,'EF~'.E[) B'.r' hlOl:':l E:LI I L.I) I f.,ll} CODES.,
'T'HEI'.,t (::L) FIN E:L.I~i:C:"I'F;'.:[CF:IL. F'IiS:I:;U,'I:[T FII'.,I£:, ZIqSl::'liS:C:l":[CIl',J I',ILIi~;'T 131-2: OI3TFI:[IqED.~ ,::;;~'.) I::'IS--,I-31...I]:L'I"S
!.,.I '_I:M.. I'.,ILTI' BE F:IF::'Pr,;'.O',,,'I~i:I) H ]: T,LIEII...IT FIN EL[5C:TF['.:[ E:F:IL. :[ NSI::'[i::C:T' :[ ON 1:;~'.[5:P()F'::T.= FII'.,ID ,::::!i:) THE
F~I..EE:'T'I4:],'E:F]L. I.,.ICIFi'.I.::: I',IU:i;;T 1'3[~: [.':,O1',,11!~: 13'~.' F:I L. ZC:[£1'.,I:~:;I!5:I.)
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMEb~fAL H~i~LTH
DEPARTMENT OF HEALTH AND F, NVIRONMENTAL PROTECTION
AP. PLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
General Information Application Date
L.
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicants ~ame~_.~2~._~.Je~
Applicants ~dress
(c) Applicant i~ (check one) Lending institution
Telepbone- Home
Busilless
(d) Lending Institution ~/a~
(e) Real Estate Co. & Agent
Address
(f)
Telephone ......
Mail the HAA to the following address:
2..,,TY~_,e of __Residence
Single-Family~_~
Number of Bedrooms
3. Water Su~.
Individual Weil~[~.
Multi-Family~
.__~
Other (describel
Community [~ Public
Note: If community well system, must have writ. ten confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewa~is_~sal
Ousite ~ Public L~-~_ Community C-~- Holding Tank ~
Note: If community ~ll system, must have written comfirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page i of 2]
.~i~ Firm Providing, In_~s~e~ctions~ T~s_~taj_~F~:le Search_z._Data and Informa
As certified by my sea]. affixed hereto and as of the validation dat~ shoWn'b~t'ow' ]. "~
verify that my investigation of this Health Authority Approval showl that the ou-7.,~i~e
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, a~d regula-
tions in effect on the date of this inspection.
Name of Firm BIJSH ENGINEERIN(~ _~~ Telephone
P. O. BOX ~2964
....
(~NGI~ER SEAL)
Approved~ Disapproved ~ Co~ition~
Te~s of Conditional Approval
CAUTION
TH~ bflJNICIPALITY OF ANCHORAGE DEPARTMENT OF H~u~LTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES ~ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON T}~ REPRESEN~I'-
ATIONS GIVEN IN PARAGI~H 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. 3~, DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITLYI'IONS IN ORDER TO SATISFY CERTAIN i~DERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICA%~ IS ISSUED. %~[E, MLrNICIPALITY OF ANCHORAGE IS NOT RESPONSIBI~J FOR ERRORS
OR OMISSIONS IN THE PKOFESSION~L ENGINEER'S WORK.
(DMEP SEAL)
RR4/e]/DI8
[Paga 2 of 2]
A. WELL DATA
Be
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AL~HORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
Legal Description:
b~UNICIPALIT¥ OF ANCHOr,AG:
OEPL OF HEA/~;I &
£NVIRONMENTAL P[~C} LTC ~1oi, i
NOV 1 1984
Well Classification ..-f'~,'d,~/~/_ If A, B, OE C, D.E.C. Approved(Y/N) /L//,,~
Total ~p~ ~q~ Card to ~/ ~ ~p~ of ~outing
Static Water ~1 Z~ / ~ ~t At
Casing ~ight ~ Ground /~ '/ Sanit~y ~al on Casing
Elec~ical Wiring in ~nduit ~Y~) ~ ~ession ~ound ~l~ead
Sep~,ation Distan~s ~ ~t1:
To ~ptic~olding Ta~ ~ ~ /~ ~ ; ~ ~joining Lots
To ~a~st Edge of ~s~ption Field on ~t /~/ ' ; ~ Adjoining ~ts /~O
To Newest Public ~r Line _ ~/~ To ~est ~blic ~r
Clean~t/Ma~olt ~/~ To ~est ~ ~rvi~ Li~, on ~t
Wate~ S~le Test ~sults . ~ /~9~
~te Installed _~_ Si~ / 2 ~0 NO. of Cot9~nts
Stan(~i~s (Y~) y Aid--tight Caps (Y~) ,~ Foun~tion Cleanout (Y~).
~ession o~ Ta~ (~) ~ -- ~te ~st P~d
P~ing~intenan~ ~n~a~ on File (Y~) ~/~ fo~__.~ /~
Holding Ta~ High-Wate~ ~a~ (Y~) ~/~ ~a~y $oldi~ Tank Permit
~p~ation Distan~s ~ ~ptic~olding Ta~:
To Water-Supply Well_ /3~)
To Property Line _ 2/0 r.p
To Water Main/Service Line
COUnts
To Building Foundation ~
To Disposal Field ~ ~'A/'
TO Stream, Pond, Lake, c~ Major D~ainage
[Page 1 of 2] 2-15--8~
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed ~ - Z - ~
Width of Field
Square Feet of Absorption A~ea
Depression over Field (Y/N)
Results of Last Adequacy Test
~c~ Type of System Design
Length of Field ~_~<~ ~ ~
Depth of Field ~ ~
Gravel ~d Thick,ss ~ ~
~ Stan~i~s ~esent (Y~)
~ of ~st A~a~ ~st
Separation Distance frcm Absorp~tion Field:
To ~ater-Supply W~ll /~./ To P~operty Line /8 '~
To Building Foundation /Q + To Existing or Abandoned System cn
Lot ~J//~ ; On Adjoining Lots /~--(3 ~-
To Water Main/Service Line ~J/~ To Cutbank(if p~esent) ~) ~
To St~eam/Pond/Lake/c~ Major Drainage Course AY //~
To Driveway, Parkin(3 Area, c~ Vehicle Storage Area /~ ~-/
Cor~rents
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electn~ical Codes(Y/N)
Comments
Dimensions
Manhole/Access JY/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
~ets MOA
** Check Permitted Bedrocm Rating AGainst HAA Request **
I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect
on the date o~is inspection./
Signed /~'/~//~/~/~,~~ Date ///~//~
C~any ~ MOA No. J~g-O~ ~.~.~.~..~.~
KB1/dS/s _ ~. ~ ~ ~ I~ · ~o~r, o.
I
2-15-84