HomeMy WebLinkAboutGLEN EAGLE BLK 2 LT 3
NAME
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
/[~ UPGRADE
LEGAL DESCRIPTION
NO, OF BEDROOMS
Dwelling ~¢ !~/. PERMIT NO.
M a ,;~a~.,~¢~ ~' No, of compartments ~.
Liquid depth
PERMIT NO,
ILiq capacty ]ga o~s --./~/t1[ Insidelength --- Width
I No. of lines / [ Length of each hne/~_~ Total leng~ ~ Ijne~
Top of the to finish grade ~] ( ~ I M~erial beneath~il~
~ngth Width Depth
~] Type of crib Crib diameter~/~//~ Crib depth
DISTANCE TO: ~el~--~ Budding foundat~o
ICl~s Depth Driller
Material
Nearest lot line¢~,~/ /Z
Liquid capacity in gallons
PERMIT NO.
TrencJ~ width/(,;~ (-2 inches Distance betwee~q~2~,~
Total effective absorption area
PERMIT NO.
Total effective absorption area
Septic tank
Nearest lot line
Distance to lot line L~ERMIT NO,
[ Abs~n area (s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
I NSTA~,LER
REMARKS
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I:::IF'F'L '1' ]" I:::llqT I:!', ]1] I..I.. 1'"l(3(')(i}l",ll<;f_:~]"r~
DEPA~Tr'IENT OF HEALTH RHD EN¢IROHMEHTAL PROTEC:TION
.... 5 "L STREET.. ANCHO~::iGE, FiE. 99501
2G4-47;~0
NELL RtqE:. Cf[-~---S I TE
PERMIT NO. <
LOCAT ! Ol'.l ~5' cx-,,,o,n,¢,,~/¢~
TYPE CIF SOIL AELc, ORBTION SY"-:TEM IS:
SEL.JEF.' F'EF-:I-.1 I T
LOT SIZE .~,/000 S,;!LIRRE FEET
HR::<]r. IUM NUt.IBER: OF BE[)RCIOMS = z.~ qnIL RFITIN,-i
THE R'.EQUIREE) SIZE OF THE SOIL flE:SOR'.PTICir4 ?T'STEH
[)EiZ'TI4= L E ['4~3 TiY=
THE LENGTH E)IMENSII/IN IS THE LENGTFI (IH FEET::, OF THE TF:ENC:FI IDA C'RRINFIECD.
THE DEPTH OF R TRENCH I)R PIT IS THE DISTRHC:E E',ETHEEN THE %IIF'FRF:E I)F THE
GRF~IIHD AND THE E:CITTOM OF THE E,.,-.H,RTII3t. I ,"IN FEE'F).
THERE IS NO SET HIDTFI FOR TRENCHES.
THE GRAVEL DEF"FH I$ THE hlINtMUhl DEPTH OF GP.R',,EL PE'rHEEN THE OUTFFtLL PIPE
AND THE BOTTOM OF THE EXCRN,'RTION (IN FEET).
F'ERHIT AF'F'LIF:ANT FtRS THE F-tESF'L-ff.iSIE:ILIT'¢ TF~ INFORH THIS [:'EF'ARTHEt.IT C, LIRII,.iG THE
IhlS'rRLLflTIOH INSF'EC:TICiI'.IS OF RN'-r' HELLS FID..TRI-:ENT -ro 'rklIS F'R'.OF'EF.:T'f AND THE
HUHE:ER OF RESIDENCES THAT THE NELL HILL SERVE.
T 1-..1CI ':: ';,..--: ', Z l'-4:5 P E b--: 1- I F-, b.I '__-_--.. Fi F-: I~ I";-: Fi ~..! LI ! F; E L-':,
E:flF:F.:FILLII,.IG OF ANY SYSTEM NITHOUT FINAL IHSF'EL-:TION fiND RF'PR:n',/flL E:'T' THIS
DEPRRTHENT NILL E',E SLIB,TEC:T TO PROL:;ECUTIOi",f.
HINIhlUt'I DISTFti"tCE E;ETHEEN A HELL AND ANY ON-SITE SEHflOE [:'ISF'OSRL SYSTEM IS
±E~O FEET FOR R F'R:IVATE HELL.~
15E~ TO 2E~E~ FEE'F FROt'I IR F'LIEtLIC: HELL DEF'ENE:,II'.~G LIF'OI,.~ THE: TYF'E OF PLIE:LIC: HELL.
HELL LOGS ARE R:EQLIIRED AND MLIST E',E RETUR:NE[:, TO THE [:'EF'ARTMEHT Hi'THIN
OF THE HELL COhIF'LETICff. I. -'
OTHER: REQLIIR:EhlENTS i"lR'¢ RF'F'LY. SPEC:IFtC:RTICINS FINE:, C:I-~NS'FR:UCTICiN DIFIGRRMS RF. tE
R',,.'RILRE:LE TO INSLIR:E PR:OF'ER: Ii"ISTRLLRTION.
F' E F-: I-.1 :l -1- E .-4 F' I E: E 25 [:, E 13 E r.1 E: E F-: Z]: :'1_ . :_1_ '~., 7
T ,::ERTIFY THFFr
1: ! Ar,1 FIqr'IlL]:RF.: HITH THE REE.!LIIREMENTS Ff]R OI,.I-SZ-I-E SE~.qE:::S FlriD HELLS RS, SET
FFIF,'TH E','T' THE MLINTC~F'RLITY OF HN_.HUF.:HUE.
2: I HI'LL :rNSTALL THE SYSTEM IH RF:L-:FIRDRNF:E HITH THE L-:OC, ES.
Z<: I UNDERSTAI'.ID THAT THE ON-SITE 5EHEE: SY:STEhl MR"r' RELT!U]'R:E EI"ILRRGEi"IENT IF THE
RE'E,I[:,EI,',ICE IS REhlODELED TO II'-ICLLIDE MOR:E THAN E'. E:EDR:L-U-~f'IS.
App].icant ~ / -
i[SSLIE[:, _R'T' [:,FtTE...__..,~. . ","? 2'
"~ SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
Pouch ~-650, Anchorage, Alaska 99B02 276-2221'
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION:
[] PERCOLATION
TEST
1
2
3
8
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
'T-OlO .D c,~ ~
SLOPE SITE PLAN
S
L
O
P
E
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date
Time Time Water Drop
/
PERCOLATION RATE
(minutes/inch)
FT AND
TEST RUN BETWEEN
/
PERFORMED BY:
FT
72 008 (7/761
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
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, rang.e)
Location (address or directio, ns)
?
(b) Applicant Name/~ II
Plo Telephone: Home
Applicant Address /z¢),O /'~ D ~,- ?"~ ¢
(c) Applicant is (check one): Lending Institution []; Owner/builder,~; Buyer []; Other [] (explain);
Business
(d) Lending Institution/~___¢ ./r~'~-~r" ~..,~-(/f2/&[~f_z~ _Telephone
Address _~"'_~¢~__¢2/ ~. /~.¢~,..¢'¢~..J /~/'¢/ ~ff/ ·
(e) Real Estate Company and Agent
Address
Telephone
(f)
Mail the HAA to the k)lLowiua address:
~&5 ENGINEERING
SRB-19O'g(
EAGLERIYEI~AK 99,577
TYPE OF RESIDENCE
Single-Family¢ Mulli-Family
Number of Bedrooms
Other
WATER SUPPLY
Individual WellJ~ 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 []
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 72-025 (11/84)
ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'IA 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 olstructure 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 comjpliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection. S& $ ENGINEERIN6
$&
$ El,~,. SE B ] 96X
Name of Firm Telephone
,SE B ] 96X · -
EAGL~ RIVER~ AK 99577 :'
Address
APR 2 6 1986
Date
Approved for ~"-F (2~ bedrooms b'y 'l.f~.~[. ~(.~L-_~_~ate
Approved _~ Disapproved - Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Deparlment 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 (~6es this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state .~,~uirements.'~' Employees of DHEP do not conduct
inspections
or
analyze data before a certificate is issued. The Municip~'h'ty of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 ol 2
MUNICIPALITY OF ANCHORAGE
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
~IRONMENTAL. PROTECTION
ECEIVED
Casing Height Above Ground
Electrical Wiring in Conduit
Separation Distances from Well:
WELL DATA
Well Classification "--/~ I LIC¢'C~ r~J,J
If A, B, C, [).E.G., Approved (Y/N)
Presen (¢~N)
Well
Log __ __ Date Completed ,..~/_..i~./"///~;:~' Yield/
Total Depth _~ .~:¢~' Cased to Depth of Grouting
Static Water Level ~--~¢:) Pump Set At ~ ~
· Sanitary Seal on Casing
Depression Around Wellhead
To Septic/Holding Tank on Lot J('),-.%i ~' ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot J ~:~o I b _; On Adjoining Lots
To Nearest Public Sewer Line ""J'J/~ To Nearest Public Sewer
Cleanout/Manhole ~ To Nearest Sewer Service Line on
Water Sample Collected by ~ % ~"'-f~' ~,-~r~,¢. ~.4~(,- ; Date
Water Sample Test Results -~¢¢'Ch~, tc,,~c-~r'o,'r-~V'
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ~'"-' ~SE~
Standpipes
Depression over Tanl~
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.McJ~,/Service Line
Course
Size /~,~,~--o No. of Compartments ~
Air-tight Caps~'/N-)' Foundation Cleanout~)
Date Last Pumped Y~ /,~'~
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation .~'~ /
~,,~,./.- · : ;., ~,
: To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026t11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ,~-.,~O -- '~¢
Width of Field "'~ ~
Square Feet of Absorption Area
Depression over Field
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well J~ ~ t .,----
To Building Foundation
Lot
Depth of Field
Gravel Bed Thickness
Standpipes Present~
Date of Last Adequacy Test
To Water'M"'Ei~/Service Line ,~'o '~ ~
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design '~.,~-/C.. ~-/
Length of Field
'7'
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
Comments
D. 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~ have checked, verified~,or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
& S ENGINEEEING '~ -'
Signed ~1(~-- 'IY6X Date
Company ..................... MOA
Receipt No. .~ ~ ;~L~
Date of Payment q- ~%-~6
Amount: $ &~
Page 2 of 2
72-026 (11/84}
