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Home My WebLink AboutT15N R1W SEC 8 LT 29yrisio Rio Sa Lot 2scA NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION DEPARTMENT ENVlF 825 L Street - ON-SITE SEWAGE DISPO qUNICIPALITY OF ANCHORAGE )F HEALTH & ENVIRONMENTAL PROTECTION ONI~ENI'AL ENGINEERING DIVISION Anchorage, Alaska 99501 Telephone 264-4720 3AL, SYSTEM AND/OR WELL INSPECTION REPORT PHONE [] NEW G~ -' t'~'~7 Q DUI'GRADE NO, OF BEDROOMS ,3 PERMIT NO. J D ISTANCE TO: J Well ~ JLiq. capacity in gallons IF H~OMEMADE: DISTANCE TO: Well J ~ Well DISTANCE TO: No, of lines Length of each line Top of tile to finish grade DISTANCE TO: Length '~ 0 / Width Type of crib /~f/~/~ Crib diameter~.~[ Well DISTANCE TO: OTH E R PIPE MATERIALS ~STA~ I ~-EMAR KS Dwelling Material Foundation Nearest Iot,~Jine Total length of lines ~ Material beneath tile Deptb jCrib depth /j,////~ Trench width Total effective absorption area Suilding foundation~ .~ ~' SepticNearesttankl°t linc Driller Distance to lot line I I '1 j Sewer line Liquid depth PERMIT Liquid ca~pacity in gallons PERMIT NO. Distance between lines inches Total effective absorption area inches : PER IT NO. APPROVED ,~ / ~2-0f 3 {Rev. LEGAL [ DEPARTMiEI' OF NEALI'H ~lqD ,EN~Ir~Oi,IMENT F:'ROI'[ CT;[I,I ~ b.:::5 IL STREET, ANCHORAI:iE~ AK '¢9501 264.-4720 H:.F',I'~.( r 19(:3." DATE c,~:, :". I .¢,AJI_].). 840645 LJPI : 7/31./84 AF'PL I CAIql'.' ROBER'T' EiE:I"{AI ADDREESS: P.O,, BOX 671 C]14Ura ~ AK.~ AK C(:)NTAC'T PHC]IqE ~ 688-2779 LEGAL DESCR ]:F:': SUBDIVZS]:ON: SECTION: 8 LOT SI ZIE~ 2', ,, 5A I certify 'Lhat: 1. I mm t'amiliaP with 'Lhe t'ar"Lh by 'Lhe I%tnicil]a].: 2. Z ~:i. 11 il'ls'La:t 1 the sys~ and in comp].:i, ance ~Lt.h 3,, I wi].], adhere 'Lo all HI distances fpc)m any exJ.~ sewerage system (m-~ 'LhJ.~ IFr ~ LI'FT STATION IS INSTALL THEIq (t) AN EL. EC;TF~ICAL. PERM] WIL.L.. NOT BE AFPROVI.D WITHOUT' LL..E:E, II.~I(.,AI.~ WORK MUST BE DOIqE ][ ']F'IEE: '= .' ....... " =" '";" ~ ._~ IE~. IL 4[ E:::.. IF.,, IF. It _ Ik', ~ II % KADI :. !F?EF4 :1,08 99567 NA I_OT~ 2!9 t.L.O[,I'..:'] "' ' ' NA TI]WNSHIF'~ :LSN RANGE: :LW 'T. OF~ AC, RE~) {y cJf AnchcJpage (IdOA) and 'Lhe State oF Alaska. e~l ~rl ac:ccH~claxnc:e with a'.L]. M[IA cc3des arid the des~gr'l cr'itePia al' tlqis p~Pmit,, 'A and S'Lat~ o{' A].asJ<a r'caqL&:Ll~eilie~rrlL~;' ~cJP th(.~ set back on any ad.jac:er'tL (~p near'by lo'L. EI) tN AN AREA COVERED BY MOA BUILDIIq(,3 CODE:S. AND IIqSPE[',TION PIUST BEE OBTAINED; (2) AS-BUILTS Ahl EL..ECI'F¢I[]AL INSPE{CTION REF'C)F(I'; (.~ND (3) l'fllE BY A LICIZNSED ELECTRI[',IAN. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 82.5 L. ~treet, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG 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 DATE PERFORMED: SLOPE SITE PLAN ENCOUNTERED? O P IF YES, AT WHAT -/ DEPTH? (;ross Net Depth to Reading Date Time Time Water PERCOLATION RATE (minUtes/inch) TEST RUN BETWEEN FT AND FT COMMENTS. PERFORMED BY:_ 72-008 (6/79) MUNICIPALITY OF ANCIIORAGE D~VISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF IU~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ~tBAI,TH AUTtlORITY APPROVAL CERTIFICATE 1. General Information Application Date _~/' / / (a) Legal Description (include lot, block, su,bdivision, section, township, raege) Location (addr~5,ss or~ d~rections) (b) Applicants Name.__~'~j~i2, ,{.~':~_~.~./~//~ ~-//.~ Telej~!?,]~_e- florae Busineas / __ ~. ..... '-77~ (c) Applicant (d) Lending Institution Telephone Adaress .............. (e) Real. Estate Co. & Agent Telephone ~.~.. 77¢ (f) Mall tile NAA to the following address: T_j[~e of Residence Single-Family~-'-~_ Number of Bedrooms Other (describe) Water S ~!~_~Z Individual Well ~ Community ~ Public Note: If community well sys~tem~ must have ~'itten confirmation from the State Department of Envi~onmental~ Conservation attesting to the legality and status. [Page 1 of 2] Sewage Disposal Onsi.~,7~N--~ Public F ~ Community 2 ] Ho].ding Tank [ ~ Note: If community ~¢ell sys!tem, must have written cosfirmation from the State Department of Environmentali Conservation attesting to the legality and status. Engineering, Firm Providing. I~spections, Tests, File Search~ Data and Information As certified by my seal affixed hereto and as of the validation data 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 o~tained from the Mm~ic~pality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance wi~h ell Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm (ENGINEER DHEP Approval Approved for ' ~') bedrooms hpprove{~?x' D~sapproved Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCIIORAGE DEIARfbIENI' ~ · ' '~ OF HEALTH AND ENVIRONbiENTAL PROTECTION (])LIEP) ISSUES REALTH AUTHORITY APPROVe,CERilI' .... ~ICAIE.~' ~ BASED SOIJJ. Y~ ~' UPON TIlE REPRESENT- ATIONS GIVEN IN PARAG~PH 5 ABOVE BY ~q INDEPENDEN%' ~ ' ' PROFES~:~N--~]~ ENGINEER REGISTFRED IN THE STATE OF ~AS~. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES THEIR ~NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~D STATE REQUIRE"' MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR .~ALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OP ~CHORAGE IS NOT RESPONSIBLE IgOR ERROES OR OMISSIONS IN T}H{ PROFESS~O~L ENGINEER'S WORK. (DHEP SE~) RR4/ej/D18 [Page 2 of 2] 7-19-84 Well Classification ~;t)e~f. _ Zf A, B, c~ C, Well Log. P~esent (__Y~ Date C~,pleted Total [k,~pth. ~v, ~d ~ ~b~ - Static Wate~ ~1 /~, ~3 ~ ~t A% //, Casing }~ight A~ G~(mnd ~ ~,~/ Elee~ical Wi~ing in ~)nduit ~) ~ ~p~ation Distan~s ~ ~11: To ~ptic~oldinG Ta~ ~ ~t ~/~ ~/~3-; To ~a~est ~ of ~so~ption Fie]~d on ~t >/~O ~ Legal Descr To Water-Supply We:L1 _ 7~/~ To Property Lir~ _ ~ ~O To ~ter ~in/~vi~ Li~ +/Ox ...... Co~nts [Pa{$ 1 of 2] To Buildin~ Foundation To Disposai Field_ "-/q5'-/ TO Stream, Pond, Lake, c~ Major D~ainage // No. of C~a~tm~nts ~m~7~ . F°Undgtign Cleanout (Y~) -- y Holding Tank I%~rmit (Y/N) Date Installed Standpipe s. ~/N) Depression ove~ Tar~k' (~Y~ _Air-tight Caps [~te Last Pumped Pumping/Maintenance Contract on File (Y/N) Holding Tank HigR-Wate~ Alal~m (Y/N) Temtx)ral Separation Distances ~.c~ Septic/Y{olding Tank: 2-15-84 B. SEP]?IC~OLDING TANK DATA To Nearest Public Sewe~: Line ~7//~ io Nearest Public Sewer Cleanaut/Manhole ,t)//~ To Nearest Sgwer Service Line an Lot Wate~ S~nple Collected By. ~O~.~u Water Sample Test Results .,e/~/~,~. / / ', In h~joining Lots >/oo .; On Adjaining Lots -~pth of Groutincjr~,/J~.~./ __ Sanitary Seal on Casing ~N) y~ession A~ound Wellhead (Y/~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata. Date Installed Width of Field /.~ Square Feet of Absorption A~ea ~LD~ Type of System Design Length of Field ~D ~ Depth of Field ~'~ Gravel Bed Thickness O,~~/ Standpipes P~esent ~/N) Depression over Field (Y~ Date of Lest Adequacy Test Results of Last Adequac~ Test ~3//~ ~ Separation Distance frcm Absorption Field: To Water-Supply Well I~ To P~operty Line To Building Foundation , ~-~ ~ To Existing o~ Abandoned System c~ Lot ~o/ ; On Adjoining Lots ~.~'/ To Water Main/Service Line ~t///~ To Cutbank(if present) To Stream/Pond/Lake/c~ Major D~ainage Course ;~1~/~ /~, ~ To D~iveway, Parking A~ea, o~ Vehicle Sto~age A~ea/~.~/~'~x"-:~ ,~ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Ala~mLevel at Tested fo~ /~)/~ Electrical Codes(Y/N) /~ Cc~Nn~nts Pumping Cycles du~ing Adequacy Test. Dimensions ~/~ Manhole/Access (Y/N) ~//~ "Pump Off" Level at /~3/.~ Vent (Y/N) ~tJ/~ Meets MOA ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, c~ confc~r~d to all MOA HAA Guidelines in effect on the date of this inspection. Company KB1/d5/s [Pa~e 2 of 2] 2~15-84 ALASKA e UI,ROIqmeiqTAL cOrlTROL ~n§in¢~rinq $ ~l~uironm~nlo[ $1udks inc. August 24, 1984 Department of iHealth and Environmental Protection 825 L Street : Anchorage, Alaska 99501 Attn: Keith ~andt Legal: Lot 29 T12N R1W Section 8 Well ~low Test on Single Family Residence [)ear Keith: A flow test w~s performed on the well at the above property on August 24, 19814. The static water level was at -.14.98' Over 450 gallons ofi water was pumped at a rate of 4.5 gpm with a drawdown of 13i.49'. The recovery time was 120 minutes. I consider thiis well adequate for domestic useage in this 3 bedroom house. Please contact me if you have any questions. Approved: Sincerely, 'en Turner v~ronmental Scientist 1200 UJ~sl 33rJ J~ucnu¢. S~il~ B, J~nchora~. /~l~sb g~503 .(907) 561-50~10 GRE Depar' 3330 "C" Stree 4. 5. 6. ~['0/~- INDIVII Approval requested by:, Mailing Address: Property Owner: Mailing Address: Legal Description: Location: · .TER ANCHORAGE AREA BOROUGH ~ ;merit of Environmental Quality Anchorage, AlaSka 99503 274-4561 Date Received Time of Inspection Date o¢ Inspection :E UE T APr,OVAL ~UAL, SEWER & WATER FACILITIES FOR Type of facility to be insp~cted Well Data: A. Type ~-'~) C. Construction Sewage Disposal System: A. Installed C. Septic Tank: 1. Size D. Seepage Pit: 1. Absor E. Disposal Field: Total 1 Distances: A. Well to: Septic tank Nearest 'lot line C~O~ B. ¢~undation to septic t~n C. Absorption area to near( EQ-034 (1/74) o/j ~E p 'J~ t Cl, No. of bedrooms B. Depth D. Bacterial Analysis B. Installer /~(~L~9~,~ / 2. Manufacturer ~tion Area ~-d~__~ 2. Material ~ngth of lines r~ Absorption area ~'~ ,, ~wer Lines ~oo,' Other contamination ~/'/A~ _ , Absor~_ion~t area r~,~/_~,~,, C, '-~)'~V' age 1 of two pages