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Home My WebLink AboutCAMPBELL HEIGHTS BLK 2 LT 1B ~ MUNICIPALITY OF ANCHORAGE e DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON~qlTE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME IPHONE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~k~ ~''% lAbsorptlonerea D~lling PERMITNO. ~ Manuf~turer ~.~ Material No. of compartments Liq. capacity in gallons Inside length Width ~ IF HOME.DE: ~ Liquid depth ~O~ Well Dwelling PERMIT NO. O Z < Manufacturer Material . Liquid ca.city in ~2 Wail , ~. ,~ Foundatio.~[ ~ Nearest lot line PE"MIT NO. ~ = DISTANCE TO: ~ ~ ~ ~ ~ ~ ~, ~ T~ of tile to finish grade / ~ Materiel beneath tile ~ OTHER APPROVED DATE LEGAL 72-013 {Rev. 3/78) MUNICIPALITY OF ANCHORAGE Departmen~f Health and Environment~,Protection 825 ~ Street, ~-nchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit 9 WELL AND/~R ON-SITE SEWER PERMIT Location: , . Phone Nu~Dr: ~/~ Type of Soil ~sorption System Is: Trench: __ Drainfield: ' Seepage Bed: ~Holding Tank: Max~ N~ber of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Size of the Soil ~sorption System Is: DEPTH ~ ' LENGTH ~ / GRAVEL DEPTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravet depth is the minimura depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE : /~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departmer will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fe~ for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a co.unity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days Of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that:' (1) I am familiar with the requirements for on-site sewers and wells as (2) (3) SigneR: set forth by the Municipality of Anchorage. I will install the system in accordance with codes. I understand that the on-site sewer system may ~require enlargement if the residence is remodeled to include more th~ bedrooms. /'~,~.~.~. ~. ~ ~ Issued by.'~~ Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264~4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: 1 ~ 2 3 4 5 ~ 6 7 8 9 10 11 12 13 14- 15- 16- 17 18 19 - 20- COMMENTS WAS GROUND WATER ENCOUNTERED7 Y~ ~ SL IFYES, ATWHAT ~0/'7-- 6' POE DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop Ft~.O te-~Z~ 'Z: ~1 C) ,!_ PERCOLATION RATE [ ~;> (minutes/inch) TEST RUN BETWEEN } '~' FT AND '~ *~ FT PERFORMED BY: C¢.~. L<;nn~; G,~4,. ~ 72-008 (6/79) CERTIFIED BY: DATE:~ ALASKA E HIF OFim£PITAL COFITF OL InC. LOT TH A 1 2 3 4- '7 8 g 10 ll 12 13- 14 15 16. 17 - 18 19 20. Supplemental Soils Information. LOT LOT TH TH OL I 8 15 16, 17. 18- 19 2 3 4- 6 7 B 9- 10- 11 12 13 14 15. 16- LOT TH 1 2 3 4 5 6- 7- 8 10 17 /- WATER CONNECTION - Lo~ltion Record ACCT..O. , NAME ADDRESS L~ ~ BLOCK ~ ADDITION ~ ~~ LOCATION: ALLEY ~REET~ TYPE OF MAIN ~ CURB STOP C TO C KEARNY WIRE CONNECTOR W. CURE STOP C TO I OTHER: CONN. CORP CONNECTOR INSP. COUPLING C TO I PERMIT X ERASS BUSHING TOTAL. X GALVANIZED BUSHING · COMMENTS: BROKEN MAIN, EXT. CONNECTION, EXTRA PIPE 2 PART UNION CASING. DELAYS, ETC. FT. O 3 PART UNION PICA SERVICE CLAMP X [] PAID PREV. ~/' COPPER P~PE ~ " [] W.M. = .~ I 1/4" KEY BOX ~ PAID CASH 2' KEY BOX i-~ SUE AGREEMENT ,~ ] I THAWWIRE DISCONNECTS -- ALT. ~ 'OCAT,ON ~.J' ~ ~ EXCAVATOR .?~A_ . ./~.~ r/.r~ [],MP.D,ST. APPOINTMENT TIME: ~ 7 TIME READY: [] EXT. AGREEMENT H.L~ON 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 GENERAL INFORMATION (al (b) (c) (d) Legal Description (include Io~ .blo,..CJS_subdiyiAi.q~ secti?no~t~,wnship, range) Location (address or dire~ions) ~ Applicant Address ~ ~ ~~ ~ Applicant is (check one): Lending Institution ~; Owner/builder~; Buyer ~; Other ~ (explain); [en~in~ Institutio le~ephono (el Real Estate Company and Agent Address Telephone (fl Mail the HAA to the following address: Other TYPE OF RESIDENCE Single-Family, S" Multi-,.~ily D Number of Bedrooms WATER SUPPLY Individual Well I["1 Community I"1 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[] CommunityD Holding Tank [] Note: If corem unity well system, must have written confirmation from the State Deparlment of Environmental Conservation attesting to the legality and status. Page I of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown betow. I venfi ir.a! m¥~.m~.~.,~c'~ ~ '..~ ~s He~'t~ Authority Approval shows that the on-site water supply and/or westewater c~sposat sys'.e m. ;s ~.~'e. f_c,=o",e.' a."~ C ac.equ~e for the number of bedrooms and type of structure indicated herein· I further ver,f7 fha: basic., cc. ~e ~ fc,~-... ~' oc. c.~ta~ned from the Municipality of Anchorage files and from my investigation and mspect~c~. :.',e cc,~".e 'e,~e~' ~.~p'~.~y ancO'or wastewater disposal system is in compliance with all Municipal and State codes, orc~,na,"~es, a.'~3 r~'~ J.z~o-$ in eff,,ect on the date of this insp..ection. Date ~ ,' Approved for?~ ~ be~.?t ~ Date ' Approve~ ~ ~' Disappr onal ~ ; Terms'of ~onditi~alApproval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protec/Jon IDHEFt m F~e_'*u~ Au~ Approval ce~ficates based ~olely upon the representations given in paragral~ 5 abo~e by engineer registered in the State of Alaska. The DHEP does this as a courtesy to purct'.a~e~'s cf. ~ ~ ~ lendir~ institutions In order to satisfy certain federal and state requirements. Employees of DHEP ~3 nc~ ~_~,~: ~.~ec'~ons o~ · analyze data before a certificate is issued. The Municipality of Anchorage is not res~n.s~.."~e ~'c~ ~ c~' c¢'t'~s~or~ in the professional engineer's work. Page 2 of 2 WELL DATA Well Classification' Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot __ To Nearest Edge of Absorption Field To Nearest Public Sewer Line Cleanout/Manhole Water Sam Water Sam suits MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHO.ITY ^PP.OVAL C,ECKUST- FEa. UAnY ~J, JK~:~ALIW OF ANCHORAOJ DEPT. C~ HEALTH & J~/IIIONt~NTAL PI~OTECTION L4../~'/'~'JC~ If A, B, C, D.E.C. Approved (Y/N) Date Completed Depth of Grouting Pump Set g (Y/N) Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING TANK DATA Date Installed //~ ~--oD~ S ze ~ No. of Compartments Standpipes~l) Air-tight Caps Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) __,/lJ~'- Holding Tank High-Water Alarm (Y/N) .J~/.~"_ Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ ~) To Property Line ,,~-{~ To Water Main/Service 12ine ~ / Course ,"1' ~0{) ' Foundation Cleanouti~N) Date Last Pumped ~ ; 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 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed W dlh of Fie d Square Feet of Absorption Area Depression over Field (Y~). Results of Lest Adequacy Test Depth of Field L Gravel Bed Thickness yo ' S~an~pi~ Cate of L~t Ad~uacy Separalion Distance from Absorption Field: To Waler-Supply Well ~ ~,~....~ /5' To Building Foundalion Lot J To Water Main/Service Line ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line "~,~"/-' To Existing or Abandoned System on ; On Adjoining Lois ~V~ To Cutbank (if present) ~ Comments D. LIFT STATION Date Installed Size in ( "Pump On" Level al High Waler Alarm Level at Tested for Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) g Adequacy Test. Meets MOA °° Check Permitted Bedroom Raling Against HAA Request ** I certify that I J~e~e checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~'~'~, Dale Company A~~''~ ~ MOA NO. Engineer's Seal