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Home My WebLink AboutGILBERT LT 58A ilb rf' D L58A 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 DESORIFIO~- LOCATION We, / I D,STANCETO: I-ZOO Manufacturer L?. ,E D STANCE TO: Well , I I WeU. _ I DISTANCE TO: ~ /~]~ I No of lines I I Length of~ Top of tile ~n,sfi ~rade ~ I ~en~th ~idth ]Type of crib Crib dia~r Well DISTANCE TO: Class ~, z, ~ ~eptb Building foundation DISTANCE TO: OTHER PIPE MATERIALS SOiL TEST RATiNGPU REMARKS Abs~.o~ o n/re~...a/_. Inside length Dwelling Founde _ /____/_ Material N eares_~<~i n e ../Z' T"aneh D inahes ~//~riaJ benea, t~a tiJe :)epth NO. OF BEDROOMS~.~ DATE LEGAL P E~ITJ~IO. _/ . No. of coml~artme~ Liquid depth PERMIT NO. Liquid capacity in gallons Distance b et w~eJ~ y~,~ Total effective absorption area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) 72-0 3/78) ............ PERM i T ,c:2.~ ' STREET., RNCHI-JRRGE., RK. S /;! " 264-4720 -- ' ~-..H,ELL. RtPqtlE:. ,-",tP4-- S ] TE SE~-.J]EF-." F"ERtP]t ] -IF" ,' ,:,-.k~t4,=, ) F'PE I _.HNT L OC:FIT t ON LEGRL RRN[:,RLL OR RICHRF:D GILB 2:28 BONIFRCE 24.92.": 9'9504 2:2:8-5722: SE4NE4 T'lSNR2W S .... L._o LOT SIZE :_:;60F~0 SQURF.:E FEET TYF'E ElF SFIIL RBSBF.:F'TtFJN' :,t=,TEM IS: [:,RRINFIELD MRXIMUH NUMBER OF BEDROOMS = 3 SOiL RRTING THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: £:,EF'TH= ¢--% LEFHGTH= 59 ,SF:F~%."EL [:.EF"TH= 2 THE LENGTH DIMENSION I~ THE LENGTH IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R'TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SLIRFRE:E OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THE TREP-~C:H I~IC"'TH IS 5_ ~Zl~%~E~ FEET. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OLITFRLL PIPE AND THE BOTTOM OF THE EXCRVRTION (IN FEET). PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY NELLS RD~RCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE NELL WILL SERVE. T t-~ C, .:'..:..'-~- _':, ]: ~'-.~ S F" E ,-: T Z ,:~ ~'-~ S RF-:E FiE L-'::-~ Lll ~ F=: E [:. BRCKFiLLII'4G FJF RNY :,t_-TEi'l WITHOLIT FINRL INSPECTION RND RF'PROVRL E"Y THIS DEF'RRTMENT N ILL E:E SUB.TEr:T TO PRFr_=,ECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSAL SYSTEM IS ±00 FEET FOR R PRIYRTE WELL OR ±SF1 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN S':0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS RND CONSTRUCTION DIFIGRRMS RRE RVRILRBLE TO iNSURE PROPER INSTRLLRTION. F"EF:I--1Z T E::--::F" Z F-: E'_-~ E:.EC:E["IE-"EF~: 2::.1 t _.ERTIF~ THRT ±' i RI"I FRI"'IILIRR WITH THE REL-]LIIREMENTS FOR ON-SITE SEWEF.:S AN[:, WELLS RS SET FOR. TH BY THE MLINICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCOR[:,RNCE 1.4ITH THE CODES. q:' T UNDERSTRN[:, ~R~ THE ON-SITE SEN~R SYSTEM MRY REQLIIRE ENLRRGEMENT IF THE ~'.'S~[:,ENC~ ~~C:LL'[:'E M,ZIRE THRN 2: BEDRBOMS. ~~:R[~,~. OR RICHRRD GILBbN/ · /.d/Ur~.~.,.o~.~,,,-.,,,,,.~.v,.o.,,,~.,-,,.,.,o,-~,-,o, [] r.~o.,,,-,o. v~..~~ SOILS LOG PERCOLATION TEST lEGaL DESCRIPTION: SI SITE PLAN 2 3 4 5 6 7 8 9 12 13 14 15 16 17 18 2O WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop I! PERCOLATION RATE {minutes/inch) TEST RUN BETWEEN ,. FTAND ~T COMMENTS ' ~ ~/ PERFORMED BYI~I~ ~ ~-~::, cERTIFiED 72-008 (G/79) 1 2 4 5 6 ,7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION' [] PERCOLATION TEST. 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST / DATE PERFO[RMED: SLOPE SITE P~-.~N ........ / WAS GROUND WATE~ S ENCOUNTERED? _ J ~ p E 'IF YES, AT WHAT DEPTH? ~[ · ~ ' Gross Net Depth to Net Reading Date Time Time Water Drop PERCOEATION RATE (minutes/inch} TEST RUN BETWEEN FT AND CERTIFIED BY: APR 04 1983 Z53.5 ~ 255D 255.0 ,'" 255.5 255.5 E::I 2890 i255.0 259.5 , 257.5 z57.5 ,~/ / 2630 .a65DCL ' 0 d • O O O O O , d y ; . . . . . . . . . . . . • . . . . . Oil III . . . . . . ; . . • . . . • y y y y y 0 d O O O O O , d y ; . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . ; . . • . . . • y 0 d , d y ; . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . ; . . • . . . • y O O . . . . . . . . . . . . O . . . . • . . O : . . . . O . . . . . . O . . . . . . O . . : . . O . : . . O . . . . : O . . . . : O O . • . • . • . . : . • . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . • . . . : y y . . . . . . . . . . . . . . . y . . . . . . . . y . . . . . . . . y . . . . . . . . y . . . . . . . . y . . . . . . . . y . . . . . . . . y . . . . . . . . y . . . . . . y `•� . . • . . . . . . . . : . • 0 d d y Z r 0 d y : 0 MUNICIPALITY 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 A2R[G Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 58A, GILBERT SUBDIVISION, T15N, R2W, SEC. 25 Location (address or directions) CARLISLE DR. (b) Applicant Name H.U.D. Telephone: Home n/a Business 563-3333 Applicant Address C/O ASSOCIATED BROKERS 640 W. 36th AVE. #1 ANCHORAGE, AK 99503-5807 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer ~]; Other [] (explain); H.U.D. - SELLER 263-3486 (d) Lending Institution GOLDOME-RAINIER Telephone Address P.O. BOX 101200 ANCHORAGE, AK 99510 (e) Real Estate Company and Agent TARGET, INC. ATTN: IRIS BORING Address P.O. BOX 774627 EAGLE RIVER, AK 99577 Telephone 694-2388 (f) Mail the HAA to the following address: PICK UP BY ENGINEER TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 3 Other WATER SUPPLY ....... Individual Well ~'1 Community [] Public [] Note: If community welt 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 co6firmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 NOlJ. l'l~fO le^oJdd¥ leUO!l[puoo jo suJJej_ leUO!~!puoo pe^oJddes!C] '~,~ pe^oJdd~' lees s,JeeU!bUq a~eQ LLg66 ~ ';~2LA. I~ .q~/D'C;J ~76E£LL X.O~ 'O'& ssaJppv ~6I~-~69/L06 au°qdalel 'SDAS DNI~IDN2 ~AI~ 2~DV2 ~J!J ~o e~eN 'uo!loadsu! uo loelle u! suo!~eln6a~ pue 'seoueu~pJo 'sepoo a~elS pue led!o!unR lie q1!~ eoue!ld~oo u! ~o/pue Alddns ]ale~ e~is-uo eql 'uo!~oedsu! pue uo!~eB!1seAu! A~ ~o~ pue sely aeeJoqouv ~o ~l!led!o!unw eql ~o~t peu~e~qo uo!~e~JOjU! eq~ uo peseq ~eq~ ~jpeA Jaqunj I 'u!eJeq pe~eo!pu! eJnlonJls ~o ed~l pue s~oo~peq ~o Jeq~nu eql JO~ a~enbepe pue l~uo!~ounl 'aCes s! ~8~s~9 lesods!p Jele~e~se~ Jo/puc ~lddns Ja~e~ el!s-uo eq~ ~eq~ s~oq9 leAoiddv ~!ioqlnv qlleeH s!q~ ¢o uo!ieb!lseAu! X~ ~eql ~jpeA j 'MOlaq UMOqS e~ep UO!~ep!leA eq~ 1o se pue o~eJaq pax!Jle lees X~ Xq pa!JiMeo sV " NOILY~MOJNI aNY wva 'HOMYBS 311J 'S&S3~ 'SNOI~O3dSNI 9NIOIAOMd ~MIJ 9NIM~NION~ WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF AN~°~iST FEBRUARY 1984 ENVIRONMENTAL SERVICES PlVl$1Oi~d4.4720 ; PR 8 ]988 RECEIVED 651 z, If A, B, C, D.E.C. Approved (Y/N) ¢/~ ,y Well Log Present (Y/N) Total Depth ,¢,2 77.~- / Cased to wZ/'¢2 / Casing Height Above Ground /'~// Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /25' To Nearest Edge of Absorption Field on Lot Date Completed '~.//~'-'~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots /~'~¢ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Public Sewer To Nearest Sewer Service Line on Lot ;Date Comments sEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) /.b' Air-tight Caps (Y/N) Depression over Tank (Y/N) /b/ Pumping/Maintenance Contract on File (Y/N) ./~/~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Welt /,~3- / To Property Line ~ ? / To Water Main/Service Line /'/~ / Size /~¢:2 _?,¢,/ No. of Compartments ~ Foundation Cleanout (Y/N) Date Last Pumped -~¢/¢.~/~' ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ._z~ / To Stream, Pond, Lake, or Major Drainage Course Comments Page i of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /¢~' Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //':¢ To Building Foundation ,~ o Lot To Water Main/Service Line /--/o To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field ~" ¢' / Depth of Field /-/, J- Gravel Bed Thickness ~ / Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ,,~.~- / To Existing or Abandoned System on ; On Adjoining Lots .¢~3~ / To Cutbank (if present) ?/.~ LIFT STATION ~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~' -' Date Company Z~',,;¢/~ 5" , MOA No. Receipt No. (~ Date of Payment ,/---/"'-o Amount: $ /2 Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR H~a~LTH AUTHORITY APPROVAL CERTIFICATE ~ / ~ ~p~7~A~ ~ 1 ica tio n 1. General Information ~o7~ ~>~ ~_~t~_zo~.~ ~/?~ Date (a) Lega~ Description (include l~t, block, subdivision, sec~tion, township, range) Location (address or direction~) .Z I - ~ome Business Applicants Address (c)Applicant _is (check o_~ne) Lending Institution Buyer ~ ; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. Typ~ of Residence Single-Family~ Number of ~Bedrooms 3. Water Supply- Individual Well ~~' Multi-Family ~--~ Other (describe) Com~unity~-~ 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 0nsite ~ Public ~--~ Community ~q 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] e Engineering Firm Providing Inspections~ Tests~ File Search~..p3ta 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 Mnnicipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or ~stewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm DHEP Approval Approved for Approved ~ bed rooms Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH A~D ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY ~N 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 MIINICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. RR4/ej/DI8 [Page 2 of 2] (DHEP SEAL) 7-19-84 ae Be ¼~.:'MUNICIPALITY OF ANCI-IORAQ~. DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION ~Z~LT~ AUT~O~ZTY APPROVAL (~)Al J6 ~! ,-~ I984 CHECKLIST - FEBRUARY 1984 RECEIVED If A, B, O~ C, D.E.C~. ApToved(Y/N) "-'-----" Well Classification .-~' Well Log ~esent~) ~te ~l~ted ~ _ / tO ~ ~ ~pth of~ ~outin~ Total ~p~ ~ ~ ~d / Static Water ~1 Casing ~ight ~ G~nd ,'~ Sanit~y ~al on ~sing~) Elec~ical Wi~ing in ~nduit~) ~p~ession ~ound ~l~ead (Y~ ~p~ation Distance f~ ~11: To ~ptic~ Ta~ on ~t To ~a~est ~of '~so~tion Field on ~t . To Newest ~blic ~ Lin9 Clean~t/Ma~ole . Wate~ S~le Colleete~ B~ Wate~ S~le Test ~s~ SEPTIC~ TANK DATA Date Installed V/~'~/~' Size /~-')~gZ~ NO. of C~,Eua~tmsnts ~- Stan~i~s~) Ai~-tight ~ps~) Foundatio~ Cleanout~N) ~p~ession o~ Ta~ (~ Date ~stP d ~/~/~ P~ing~intenan~ ~n~a~ ~ File (Y~) ~; fo~ "- Holding Ta~ High-Wate~ ~a~ (Y~)~ ~a~y Holdi~ Tank Pe~t (Y~) ~ ~p~ation Distance ~ ~ptic~ Ta~: To Water-Supply ~11 /~ ~ To ~ilding F~ndati~ ~ 7~ To ~o~rty ni~ /D /~. TO Dis~sal Field ,~ / TO ~ter Mai~vi~ Li~, ~/~ To S~e~, Pond, ~e, ~ ~jor ~aina~ Co~ ~/~ Con~nents [Page 1 of 2] 2~15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorp~i~on Sprata Date Installed ~.//~./~ Width of Field Square Feet of Absorption A~ea ~/L Type of System Design 'Length of Field ~--~ Depth of Field ~ f .Gravel Bed Thickness ~ ~ z~ ~ Standpipes P~esent ~ Depression over Field (Y~ Results of Last Adequacy Test /~of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /d~P~) / To P~operty Line To Building Foundation c~ ! -~ To Existing or ~ndo~d System Lot ~/~ ; ~ ~joining ~ts _~ /~ To Wate~ Main/~vi~ Line ~/~ To ~t~(if ,pre~nt) To St~e~ond~ke/~ Majo~ ~aina~ C~ To ~iveway, Pa~king ~ea, ~ Vehicle Stora~ ~ea ~ Con~nts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Ala_~m Level at Tested for Electrical Codes(Y/N) C~nts Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Cycles du~ing Adequacy Test. Meets MOA ** Cheek Permitted Bedroc~ Rating Against HAA R~quest certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect or~ the ~dat%~f~,~;~.~9~tion. i . - ~:H. '~"~' .... / Company ............. KB1/d5/s [Page 2 of 2] MOA No. 2-15-84 APPLIr \NT FILLS OUT UPPER HA "oNLY PropertyO~er f~'/.Jq/'/ Of :'~:~-r(/ q//,~.~c ~ Phone Zip Code Address :~: d ~-~ ~ Phone Lending Institution /.~j~, Address ~)/p ~; ./~: ~ip Code Phone Realty Co, & A~nt Address //~ Zip Code Legal Description ~ Type ~ Resi~nce ~Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply A~ACH WELL LOG. A well log is required for all wells drilled since June 1975. ~ndividual For wells drilled prior to that date, give well depth (attach log if svaHable). ~ Community ~ Public Utility Sewer Oisposal Year Individual Installed: ~lndividual When Connected to Public Utility: ~ ~ PublicUtility ' ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Date Date Da,e D.te ?/,, Inspector Insp~tor Insp~tor Insp~tor ~' ~ ~ -- ~ :~() "~ ~ / *CONdiTIONS OF~AP7 ( ) APPROVED BEDROOMS OVAL ( ) CONDITIONAL APPROVAL* Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received Well to Tank Septic T~k Size