HomeMy WebLinkAboutGOLDEN VIEW HEIGHTS LT 4ALqA
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 '['elephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [~,N EW
MAILING ADDRESS
LEGAL DESCRIPTION
DISTANCE TO: Wel~ ~O~ Absorption,~area~ / Dwelling PERMITNO,
F- Z Manufacturer Material No. of compartments
Liq. capacity in gallons Inside leng~ Width Liquid depth
I J, O~'~O IF HOMEMADE: ~
I
~ ~ ~ DISTANCE TO: Well ,- Dwelling ~ PERMIT~NO.
O ~ ~ Manufacturer ~ Material Liquid capacity in gallons
Well ~)~ ~- Foundation Nearest lot line t PERM]% NO.
DISTANCE
TO:
~ength of~ach~ine ; Total length of lin~s Trench width / Distance between lines
Total effectiv[ absorption area
~ ~ Top of tile to finish grade ~ l Material beneath tile ~a I
~ ~ inches
Length Width Depth ..~ PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total ef~ive absorption area
Lu Well Building foundation Nearest lot line
~ DISTANCE TO: ~
~ Building foundati~ Sewer line Septic tank Absorption area(s)
~ DISTANCE TO: ~ ,~
OTHER ~ ~,~, ~_n~'~
PIPE MATERIALS ~
SOIL TEST RATING ~
INSTALLER
R EMAR KS
APPROVED DATE LEGAL
MUNIC:IPRLIT'¢ OF FINCHORBGE
DEPFtRTMENT C HFFILTH BND ENVIRONMENTRL )TEC:TION
825 L STREET.. FINCHORRGE., RK 995~,_11
264-4721.'9
C)~-4---S ITE SEI-,IEF.~ .~= PIELL PEF~I'-I I 'l
ERHIT NO: 840~80
~FITE ISSUED,: 05224.284
FIF'PL I CFINT:
FtDDRESS:
CONTRCT PHONE:
LEGFIL DESCRIP:
~-~ '=_~F¢.. T I UN
LOT
MRN BEDROOMS:
FEJES DEVELOPMENT
P.O. BOX tt-2009
RNCHORRGE., RK 99511
~49-80it
SI_IBDIVISION: GOLDEN VlEH HTS. LOT: 4R
: ]:4 TOHNSHIP: i;-2N RRNGE: _-.-':FI
,:'.SI_.]. FT. OR RCRES)
BLOCK: NR
LISTED BELOW RF,'E ]'HE OPTION:.-'; RVRILRBLE TO '.¢OU IN DESIGNING YOUR SEPTIC:
SVSTEIS. CHOOSE THE OPTION 'T'HRT BEST FITS VOUR SITE.
T I~.' E: i'-,i C: H B E
DEPTH TO PIPE BOTTOM (FT.) 4. 0 4, 0
GRRVEL: DEPTH (FT.) 2. 0 8. 5
TOTRL. DEPTH (.FT,) 6. 0 4. 5
GRRVEL HIDTH (FT.) 2. 5 :1.4. 0
GRRVE:L LENGTH (FT.) 64, 0 28. 0
GRRVEL VOLUME (CU. 'v'[:,S. ) ~.4. 8 14. 5
TRNK SITE (GRLS) '.L,.000, 0 :+::+: 2., 000. 0
SOIL RFITING (SD... F'T. /E:R) 85 85
** TRNK MUST HRVE RT LERST TWO COMPRRTMENTS
i CERTIFY THRT:
±, I AM FRHILIRR WITH THE REQLIIF.:Et,IENTS FOR ON-S]:TE SEWERS RND HELL=,, ~ '- R=,~ SET
FORTH BV THE IdUNICIPRLITV OF RNCHORRGE (MOM) RND THE STRTE OF RLRSKR.
2. I NILL INSTRLL, THE SVSTEM IN RCCORDRNCE HITH RLL. MOR CODES RND REGULRTIONS.,
RND IN COMPLIRNCE HITH THE DESIGN CRITERIR OF THIS PERMIT.
S'.. I NILL RDHERE TO RLL MOM FIND STRTE OF RLRSKR REQUIREMENTS FOR 9'HE SET BRCI<
DISTRNCES FROM RNY E~;ISTING HELL, WRSTENRTEF.'. DISPOSRL S'¢S'rEM OF.: PUBLIC
SENERRGE SVSTEM ON THIS OF.: RN'T' RDJRCENT OR NERRB'¢ LOT.
4. I UNDERSTRND THRT THIS PERMIT IS 'v'RLID FOF.', Ft MFI;-~IMUM OF .S: BEDROOMS. RND
RN'T' ENLRRGEMENT WILL RE.qUIRE RN RDDITIONRL F'ERMIT,
IF R LIFT STRTION IS INSTRLLED IN RN RRER COVERED Db' f'IOR BUILDING COPES,
THEN (:t) RN ELECTRICRL PERMIT RND INSPECTION MUST BE OBTRINED.~ (2) RS-BUILTS
HILL NOT E:E RPPROVED.WITHOUT RN ELECTRICRL INSF'ECTION REPORT.~ RND (3:) 'THE
ELECTRICRL WORK MLIST BE [:'ONE B'¢ R LICENSED ELECTRICIFtN.
S I GNED
9F'PL I CRNT:
SSUED BV
DFITE
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.-
20-
C) SL E
SITE P LAI'~
ENCOUNTERED? '-
0
P
IF YES, AT WHAT I E
DEPTH? /
'/ ~-/ Gross Net Depth to Net
Reading Date
Time 'Fime Water Drop
PERCOLATION RATE
(minutes/inch)
/ ~TEST RL~N
72-008 (6/79)
~.~ soil
~ The sol. 1 is fairly con~.
sistant with some efta1
~ --- boulders and sand to
silt layers. The soil
is loosely compacted
with a moderate moistu~
content.
~a~ Gz~and }Ia~:eP E~count~red? No
If Ye~, At Wha~ Depth .
Readln8
Locat ~o~ Ske:ch
Depth To
WATER WELL RECORD
STATE OF ALASKA
DEPARTMENT OF NATURAL RESOURES
Division of Geological .& Geophysical Surveys
Drilling Permit No.
LOCATION OF WELL (Please complete either la, Ib or Ic.) A.D.L. No.
I'dBorough Subdivision LotBlock Ib. I/4 gtrs. Section No. Township NE] Range EO Meridian
—ot_of_af SO WO
Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS
1 O I�'(✓ .Y..tJ.-�.) % v C1f rJ:
Street Address and Area of Well Location
3. OWNER OF WELL: ,
�-- _ •. is _
Address: {.•
2. WELL LOG Feet Below
Surface
M aierial Type Top Bottom
4. WELL DEPTH: (final)
ft.
5. DATE OF COMPLETION
— —
,, n .'
6• 0 Cable tool Rotary Driven Dug
Jetted E] Bored Other:
;vAuger
t ?
7. USE: Ej Domestic Public Supply Industry
Irrigation ❑ Recharge Commerical
E] Test Well ❑ Other:
(�
8. CASING: E] Threaded .] Welded
diam. in. to ft. Depth Weight Ibs./ft.
diam. in. to ft. Depth Stickup it.
9. FINISH OF WELL:
Type: - Diameter:
CSE Slot/Mesh Size: Length:
Set between ft. and ft.
Backfilling Gravel pack
F HEALTH 8,
EISVIRONMENTNL PROTEaUR
=
10. STATIC WATER LEVEL: ft.
Above or Ej Below land surface Date
Equipment used:
I I . PUMPING LEVEL below land surface and YIELD _
ft.after hrs. pumping g. p. m.
ft. after hrs. pumping g.p.m.
12.GROUTING Well Grouted: E] Yes Q No
Material: Neat Cement Other:
13. PUMP: (if available) HP r: '•^
Length of Drop Pipe -- ft. capacity g.p.m.
O-Subm. ❑ Jet Centrifical ❑ Other
14. REMARKS:
16. WATER WELL CONTRACTORS CERTIFICATION:
This well was dri!led under my jurisdiction and this report is true to the best
.Registered Business Name Contract
(
15. Water Temperature ° � F � C
of my knowledge and belief;
License Number
Signed: - Date: - -
Authorized Representative
Form 02-WWR (11/81) Copy Distribution: WHITE-Stote DGGS, PINK -Driller, CANARY -Customer
C
C
U.
r
0
z
0
MUNICIPf~LITY 0F ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPA/{TMEN~f OF HEAl,TH AND ENVIRONMENT~L PROTECTION
.~AJPPLICATION FOR 'REALTH ALri'NORITY APPROVAL CERTIFICATE
1o General Information
(a)
Application Dat~ ~j~ Z ~ ~ if=Cj~
Legal Description (include lot, block, subdivisiou, section, to~mship~ range)
Locagion (addrese~ or directions)
(b) Applicants Name ~ffL-~ 7,~'i{~ i'~6'O~(,t~9~,-~W Telephone ~ Home ~- Business
Applicants Address ~o ~O)~ ~2oo~ ~c~!,'~.~E ~0~ ~75~/~.
Buyer ~ ~ Other ~ ~ a_xplain)~
(d) Lending Institution Telephone
Ad~co s
Address
Telephone
(f) Mail the tLAA to the followin$ address:
2o T~e of Residence
Single-Family ~-~.~ Multi-Family I~
Number of Bedrooms ..... 2t
Water
Individual
Conunu~i ty ~
Note: If community well sys~:em, mus~ have written confim'aation from the
Department of Environmental Conservation attest~no to the legality .... [
4. S~Fj~g~ D~~_
Note: If community wel.l system, must have v~itten confi~ation from thc
Department of Environmental Conse~atlon attesting to t:he legality ariel status.
[Page 1 of 2]
o
As certified by my seat affixed hereto and as of the validation date shown below~ I
verify ~hat my investigation of this He~.th ~thori~y Approval shows that the on~i~e
water ~upply and/or ~stewater disposal system is safe, f~ction~l and adequate for
the number of bedrooms and type of structure indicated herein~- I further verify that~
based on the i~or~ation obtain~ from the Municipality of ~chorage files and from my
investigation ~d inspection~ the one. site ~ter supply and/or ~,mstewater disposal
sys~:em is in compliance v~.th mll Municipal and S'gate codes~ ordinances~ and regula=
tions in effect: on the da~:e of this inspection.
Name of Firm ~-~J~ Telephone ~'~?/~-~OVO
DHEP Ap~proval
Approved for
Approved
Terms of Conditional Approval
(ENGINEER SEAL)
bedrooms
Conditional '~'f; ....
Disapproved .....
CAUTION
T~ ~f0~-~ICIPALITY OF ~;CHORAGE DEPART~b~f OF I-~EALTH A>]D EbBflP~0~R~ENTAL PROTECT%ON
(DHEP) ISSUES MEAI,,TH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TILE. REPRESENT,~
ATIONS GIVEN IN PARAGI~DPH 5 ABOVE BY AN INDEPEblDENT PROFESSION&L ENGINEER REGISTEP~
IN THai STATE OF ALRSKAo %/IE DHEP DOF, S THIS AS A COUR~SY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN OR_DER TO SATISFY CERTAIN FEDERAL ~D STATE REQUIRE~
MENTSo EMPLOYEES OF DHEP DO NOT CONDUCT ]iNSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MbrNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN ~ PROFESSIONAL ENGINEER'S WORK°
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
A. WELL DATA
Well Classification
Well Log Present (Y/N)
Total DepthS-/
Static Water Level
Casing Height Above Ground
Electrical Wiring in ConduitS/N)
Separation Distances f~cm Well:
To Septic/Holding Tank c~ Lot
Cased to
Legal Description:
If A, B,
Date ~leted ~J//
~pth of ~outing
Pump Set: At
Sanitm.~/ Seal on Casing ~N)
Depression Around Wellhead ~ ~
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot/~{,$-~O ; On Adjoining Lots
To Newest ~blic ~ Line ~(~ TO ~est Public
Clean~t/Ma~ole ~(~ To ~est ~ ~vi~ Li~ on
Wate~ S~le ~olle~ed By . ~ _; ~te ~[I ~ [~
B. S.EPTIC/HOLDING TANK DATA
Date Installed ~D{g'~g Size ~<90 No. of Ca,%~artnmnts
Standpipes ~N) Air-tight Caps _~)N) Foundation Cleanout
Depression over Tank ,(.Y/~: Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ~g~J-; fo=
Holding Tank High-Water Alarm (Y/N) W(~_ Temporary Holding Tank Pe~£~-~t (y/N)~7/~t
Separation Distances f~cm Septic/Holding Tank:
To Water-Supply W~ll
To Property Line
TO Water Main/se=vice Line
con=se
Con~ents
To Building Foundation ~%'~(~w
To Disposal Field .. ~.,~ %'
To Stream, Pond, Lake, c= Major D~ainage
Receipt %
Date Paid:
Amount:
[Pa(.~ 1 of 2] 2-15-84
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date .Installed ~/~c) f~
Width of Field ,~ ~
Square Feet of Absorption A~ea ~ 78 a
~,.~-~ TFpe of System Design
Length of Field ~"
Depth of Field ~t
Gravel Bed Thickness . ~"
Standpipes P~esent ~/N)
Depression over Field (Y~ Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distanc~ f~cm A~sorption Field:
To Water-Supply Well [~.~' ¢J~ TO P~operty Line
To Building Foundation ~.~ i To Existing o~' Abandoned System cn
Lot ~/~- ; On Adjoining Lots ~:~c~~
To Water Main/Service Line A3[~ To Cutbank(if p~esent)
To St~eam/Pond/Lake/c~ Majo~ Drainage Course /OI A-
To Driveway, Parking A~ea, c~ Vehicle Storage A~ea
D. LIFT STATION
Date Installed
Size in Gallons
"Ptm~ On" Level at
High Water Alarm Lavel at
Tested for
Electrical Codes(Y/N)
Dimnsions
Manhole/Access {.Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Coii~nts
Meets MOA
** Check Permitted Bedroom Rating Ac3ainst HAA Request **
certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect
on the date of this inspection.
KB1/d5/s
[Page 2 of 2]
2-15-84