HomeMy WebLinkAboutTHUNDERBIRD HEIGHTS BLK 2 LT 4
~"~ MUNICIPALITY OF ANCHORAGE
'//'m"~, ~,~'~ 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 ~HONE NEW
MAILING ADDRESS
LEGAL DESCRIPTION '
LOCATION NO. OF BEDROOMS
~ Manufacturer ¢~C~ Material ~'~ e
Liq. capacity in gallons inside length Width Liquid depth
~ O ~ DISTANCE TO: Well ~ ~Dwelling PERMIT NO.
Q Well , J Foundation Nearestlothne :PERMITNO.
~ x DISTANCE TO:
~ ~ ~ No. of lines Length of ~ch Ii rotal length of lines Trench width Distance ~t~en lines
~ inch~
~t~0 TY" O~ crib. Crib di.mzt.r Crib depth Total .ff~,i. a~orption ,rea~O 0 ~
~ Class Depth Distance to lot line PERMIT NO.
~ DISTANCE TO: Building foundation Se~r line Septic tank Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING~ / r .....
INSTALLER J J
72-0 3 (Rev. 3~78)
MUNICIPALITY OF ANCHORAGE . .
. ~- Department ~Health and Environmental.~,.otectzo~---~O
Permit ~~_.,''~- W~u=-AN~/6R ON-SITE SEWER PERMIT
Applicant:
Location: P~oneN~mber:
Type of Soil Absorption System Is:
Trench: Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br)
The Required Size o~ the~Soi% Absorption System,s:.'
DEPTH LENGTH WIDTH
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 gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~OO 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 department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
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 community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
i 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
set forth by the Municipality of A~chorage.
(2) I wil~.~nstall the/system ~n accordance with codes. 3 .
(3) I ~nd~nd that/the on-sLte ~ewer system may require enlargement if
· . theJ r~c~/~/remodeled to znclude more that 3 bedrooms.
PERFORMED FOR: . ..~ft/,~'
MUNICIPAI. ITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG -- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
SLOPE SITE PLAN
/
/
/
/
10
WAS GROUND WATER
11 ENCOUNTERED? /,~-'~ I~
IF YES, AT WHAT I pO
DEPTH?
13-
Gross Net Depth to Net
Reading Date Time Time Water Drop
14-
15-
16-
17-
18-
19-
PERCOLATION RATE ~/' ~"J~ (minutes/inch)
TEST RUN BETWEEN FT AND Fy'
COMMENTS
.)
o/
ApPLI,"' ,NT FILLS OUT UPPER HA'-':, ONLY ,,-
· Phone
Property Owner '~,~],[ I~lCe
Mailing Address ~ Zip Code 694-4414 '
Buyer David R., & Cynthia K. Darling
Address ERA Box 15640~ Anchorage,
Alaska
Z~p Code
99507
Le.diogt.stimUo. Peoples Bank and Trust (Janet Greenh~lgh) Phone
Address Puch 7007, 8th and G Street, Anchorages~A~code 99501 ~63-3239
Rea,,yco.&Agen, RE/HAX of eagle river, Inc. Pho.a
Add,e. PO Box 848, Ea~lo River, AK z,pcode 99577 $94-4200
LegalOescrlpt~n Lot 4, Block 2, Thunderbird [[eights
S,~,Locat~ N~ Th~nderbird Drive
Type oi Residence
· :~ Single'Family
(~ Mulllple F~mlly....~...~..No. of Bedrooms _'~
r-I Other ";
Water Supply
[] Individual '* ATTACH W~LL LOG. A wail log la required for all wells drlled since June 1975.
~ community For wells drilled prior to that date. give well depth (attach log 11 available).
[] Public Utility
Sewer Disposer
~ Individual Year Indlv~uel Installed: ~ ~ ~,3
[] Public UtJlity When connected Io Public Utility:
~] Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
D.,. D.,e D.,e D.,.
Inspector Insp~tor Iflsp~tor
( ~PPROVED ~DROOMS~ *CONDITIONSOF APPROVAL
{ ' ) DISAPmOVED
BY: ~
~lls Rating Date ~wer Installed Wetl To ~sorptiofl Area Wed Log Recelv~
APPLIC~,-~NT FILLS OUT UPPER HAM:,,ONLY
,,op,rt, O,,,e, /~Y'T~--~ ~O,~A~**~V~-~.7*'/~'''u'/
Street
~bltc Fo~ wells ~ilted prior to th~ date, give well depth (attach I~ If available).
U~l~ty
~P~
~OTE: THE ~NS.ECT~ON ~E ~US~ ~CCOM~NY ~C~BE~O~ ~OCESS~Ne C~N BE ~T~ED.
Time Time Time ~ Time
Fletd Notes: ~~
~C,~t. r ~' ....
( ) APPROVED ~DROOMS 'CONDITIONS OF APPROVA[
( ) DISAP~OVED
( ) CONDIT~NAL APPROVAl'
DATE
BY:
Well to Tank ~ ~ptlc T~k Size
MUNICIPALITY OF ANCHORAGE ,,~
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot. block, subdivision, section, township, range)
Location (address or directions) ,
(b) Property owner~.~".,~,~- Telephone: (home)
(c) Lending Institution ____,/' Telephone
Mailing Address
(d) Real Estate Company and Agent
Addresa
(e) Mail the HAA to the following address: (or check here r-i, if hold for pick up.)
List contac~rson and day phone'number below: .
/
2. TYPE OF RESIDENCE
Single-Family EL Number of bedrooms
-/
3. WATER SUPPLY :
Individual
Well
y]~'
Public
Communit__... .
Nole: If community well system, must have written c onfirmatlo ~ from the State Depa~ment of Envlronmental;i ~,~
Conse~at onattest ngtoth ega ~andstatus ·
4. SEWAGE DISPOSAL ~ - ] · ,'-; ~: ';;~ .~,*; '.,' .;~.~ % ;~,~~
. .,.. r'
~ot~: I~ community wolt ~V~tom, mu*t
~on~o~ation ~tte~tin~ to tho le~allt~ ~nd ,tatu~.-:.v
.
n~sl,..z~) Page 1 of 2 ;. I · ,,~. ;;:~:~. r '
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE ,SEARCH, DATA AND INFORMATION
As certified by mysealaff xed hereto and as of the vahdation date shown be ow, I verify that my nvestigatio~ of thls
Health Authority Approval shows that the on'-site water supply end/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 ell Municipal and
State codes ordinances, and regulations n effect on the date of this inspection
Name0f Firzfg"~..~..~..P/F .~_~oe-~'.ar',~---_o~ Telephone ~ --'~0
Address ~ ~'~ ~~~ ~
6. DHHS APPROVAL
Approved for S
Approved ~'~- '
Disapproved Conditional
Terms of Conditional Approval /f~/~)/o.g~
Engineer's Seal
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated based only upon the representations given In paragraph 5 above by an independent professional engineer
registered In the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending
Institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections
or analyze data befores certificate is Issued. The Municipality of Anchorage Is not responsible for errors or omissions
In the professional engineer's work.
Page ~ of 2 { . . ;~:~ .'~
3601 C STREET, SUITE 316
ANCHORAGE, ALASKA 99503
DATE: February 10, 1989
PWSID: ~%1156
To Whom It May Concern:
According to the records on file in this office, the
EKLUTNA THUNDERBIRDS HEIGHTS S/D Water System is in
compliance with the State of Alaska Drinking Water
Regulations.
Sincerely,
VERA E. CRAIG
Environmental Field Officer
A. WELL DATA
·
Well Log Present (Y/I~ ~f//~ Date Completed
TotalDepth/~//~'~ ~sedto',4/",/~ Depth of Grouting
Static Water Level /~J2.,'~
Casing Height Above Ground /~,~
Electrical Wiring in Conduit (Y/N). ~-~ .~
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
343-4744
' Legal Des~ptiOn: '~'2'''-'
If A, B, C, D.E.C. Approve(~N)
Pump Set At
Sanitary Seal on Casing (Y/N) %'~
Depression Around Wellhead (Y/N) ~/~.~
; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /f"/'~x~' ; On Adjoining Lots
To Nearest Public Sewer Line /~'.J~ To Nearest Public Sewer Cleanout/Manhole ~.p,.x~-.
To Nearest Sewer Service Line on Lot '
water Sample Collected by
Water Sample Test ReT . /f'~,~x'/
Comments .,L/~-~..~, ~'~' ~
B. SEPTIC/HOLDING TANK~t~ATA . ~ ' ~
Date , nstalled .,""-.z'/- ~'---~S ize /'~ ~:~ No. of Compartments ~
Standpipes~J) )~-~ Air-tightqap~)~ Foundationcleanou~)~
Depression over Tank (~Y ~ G . Date Lest Pumped
Pumping/Maintenance Contact on File (Y/N) ~ ~ ' : ;for
Holding Tank Hig~-Water Alarm (TM) ~ Tempora~ H01ding Tank Permit (
SEPARATION DISTANCES FROM. SEPTIC/HOLDING TANK:
To Water-Supply Well ~ ' To Building Foundation ~
To Prope~y Line /~ /~ To Disposal Field /~
TO Water Main/Service [.ine '"~/ ~
To Stream, Pond, Lake or Major Drainage Course
Comments
Page I of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absortion Area ~'~',~
..c~..
Depression over Field (Y~.~ .~o
Results of Last Adequacy Test
Type. of System Design .~.,~--~.~'-~
Length of Field
Depth of Field ~;~,~'~
Gravel Bed Thickness
Statndpipes Preser~)
.--. Date of Last Adequacy Test
Date Installed
Size in Gallons
D. LIFT STATION
Dimensions
"Pump On" Level at
High Water Alarm Level at
Tested for ~ Pumping Cycles during Adequacy Test.
~oeemtSmeM~Ot; Electrical C~
Manhole/Access (~ J
"~.~3ff~vel at
Vent (Y/N)
I certify that/'Ji, mave check'~d, v6rified, or conformed to all MOA and HAA~-<.:.~u~_~e~in effect (in the date of this
Date of Payment ~--/~ O/ Waiver Fee* $
Amount: $ /~- ~ ~ Date of Payment
~ ~... ~) S~ck .Page 2 of 2
SEPARATION DISTANCE FROM~OM2AxBS.ORPTION FIELD:
To Water-Supply Well xt?'~?~r' To Property Line
To Building Fquhdation J ./_~ /
To Existing or Abandoned System on
Lot -'/~'~= ~""-*~--~" 7"~On Adjoining'Lots .--~-~
· To Water Main/Service LIne ' ""',~'~ /'/ TgCutback (if present)
To Stream, Pond, Lake, or Major Drainage Course /~,/~.~.~. r~.~,~.~::._,**~._l
,/
To Driveway, Parking Area, or Vehicle Storage Area '~.5"'~ --/--'
Comments ~ ~, ~ j//~_~.~.,~ ~ ;> (~/~/w
