Loading...
HomeMy WebLinkAboutFORELAND VIEW BLK 1 LT 2Foreland View Block 1 Lot 2 #017-401-41 MUNICIPALITY OF ANCHORAGE D*TMENT OF HEALTH AND HUMAN SEROES E Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name Ro OC/'I Lor /Cf4h- DISTANCES FRDM TD SEPTIC TANK ABSORPTION FIELD WELL Address Po Dov Ito yns AncSb% c AK 9ssiy WELL — 7777 „Ly k x Phoneis) 3 Y 6 2 7-3? Permit No. oxo } Y'4 No. of Bedrooms LOT LINE LEGAL DESCRIPTION Lot - a Block % Subdivision d vrfa.> FOUNDATION — — - Township, Range, Section rr i ! L {U RJ 1,r-dva 3 AS -BUILT DIAGRAM (Show location of well, septic system, property Innes, foundation, driveway, water bodies, etc.) TANKS XStEPTIC ❑ HOLDING Manufacturer Capacity in gallons Material S TQ e l No. of Compartments 2 TYPE OF SYSTEM OARENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade /r, FT Total depth from original grade +� FT i Fill added above original grade d ria. FT Gravel depth beneath pipe 6 {'a FT 3� Gravel length FT Gravel width 3 FT Total absorption area 1235 SQ FT Distance between lines NA FT Number of hoes t Boil rating _ i fit SQ FT Pipe material C / F 0 Installer - Date Installed WELLS ❑ PRIVATE ❑ OTHER fidentity) Classification (A,B,CI Total Depth FT Cased to FT Installer Date Installed: REMARKS: L Scale: Inspections Performed by: ENGINEER'S SEAL Date certify that this inspection was performed according to all Municipal and Stale guidelines in effect on this date: _ 16 Health Department Approval: rk Date:—W, 7 (3/85) " Izz"p1 -, yy,-ery x-5 x . •' Y @'moi y'��^3 y�' a� rs N HL LTH,=A �+T t #( MEiyTAL Pf p ON l3�6 L STREKT e- ANCHC RARE* AK 9950l 264 4744 h:fa T NGS: tta4� - CANT: ROBERT CARLESON R8z P.O.:BOX 110905 ANCHORAGE, AIG 99511 7-T PHONE: 346-2787 _ DESCRIP: IZSa 46000 (SQ.FT. OR ACRES) $,below are the options available to you in designing your Z*PtiC n. Choose the.aption that, best Fits your site. - - --- _ _ _ _ -v rfMC-_H - � �o T el : TO PIPE BOTTOM (FT.) . 1. r 04 4.0 1.5 ibJ� DEPTH (FT.) 6.5 0.3 3.v r _DEPTH:(FT.) 8.0• 4.5 5.0. ..,WIDTH (FT.) 2.5 27.0 5.4 " LENGTH (FT. } 85.0 ** 54.0 w yt31.GME (rU. YDS..) 55.1 54.0 Bile, 1,256.0 1,2610.0 10250.4 3(It NO (06.FT. /BR)" 275 242_ 27�, )EPTHfTO PIPE BOTTOM < 2.0 FT. REQUIRES ADDITIONAL GROUND COVER AWTH TO PIPE BOTTOM < 3.5 FTP REQUIRES INSULATION )CPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION AVEL LtNGTH ? 75 FT. REQUIRES MULTIPLE RUNS. NOT EXCEEDING 75 FTS* t= ' '*K MUST 14AVE AT LEAST TWO COMPARTMENTS `i f y that a familiar,with the requirements for on-site sewers andw@31s rrtli by the Municipality of Anchorage (MOA) and the State- of A1asf#q uail� install the system in accordance with .all'MOA codes and reit id in 'compliance with the design criteria of this permit. r `; g w,fq 1. adhere to al.i MOA and State of Alaska requirements ior,tho i # from any .existing well, wastewater dispos44 .eaystaam «werag system on this or any adjacent or nearby lot. uh+i r,stand that this.permit,is.valid for a ma;(imuM of 4 btpd rp�f T3 ^ to r emitn't will require an .,additi-canal. permit. _ t 7 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: /'''fes' C— L -A,1 L �' KC'F`l-LAiZJPSbY"� DATE PERFORMED: LEGAL DESCRIPTION: F^ Com; 0Y1 JaU1elj X'�)Q Township Range Section:'T�ZAj 93 QEPT / .. SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS ✓)Y • �CIY: 4 &j)W V\ Z/ WAS GROUND WATER ENCOUNTERED? 11 IF YES, AT WHAT DEPTH? _ Depth to Water After Monitoring? Date: Reading Date Gross Time Net Time Depth to Water Net Drop zU 2-2S 23S f' 3 76o� + Zo 2 S o2 NS- zo ass oaf c PERCOLATION RATE L.L! (minutes/inch) PERC HOLE DIAMETER FEST RUffTWEEN �- FT AND �'� FT T�v PERFORMED BY: l VCA A1Y V I 7CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) U SOILS LOG ❑ PERCOLATION TEST SOILS LOG — PERCOLATION TEST Ron Clark' - 8-16-81 PERFORMED FOR: DATE PERFORMED: - LEGAL DESCRIPTION: Lot 2 Blk 1 ^ rUl-rre Ic-"pp - Ui BLJ -Slp TH #6 - DEPTH SLOPE SITE PLAN (FEET) 1 ORGANIC MAT. , S 2 3- 4- 4 TO 10 SILTY GRAVELS 5 6 i GM 8 ,9 10 - 11 - WAS GROUND WATER No -S - ENCOUNTERED? LTO IO SAMPLE OBTAINED p 12 E IF VES, AT WHAT 13 DEPTH? 14 Reading Date Gross Net .-`Depth to Net , Time Time Water Drop 15 1 8-16-81 12:10 0 77" --- 16 `.` �`,*® Of Qc i0 2 8-16-81 12:31 21m 8411 7" 17 rc..•. .. .. •• e •'•�, 3 8-16-81 8:3 8hr 20m 12'Dry 144." 2 �4 18 T 19 •• •• M ; J •ee•e• •.ecce• ••C' HN T. LOVEtt 20� sJ,•. No. 3512- 512-•: ��_® i 9 d� '•.OFESe..• ........ PROfES$�ONo4 8min/inch PERCOLATION RATE - (minutes/inch) 77tt 14411 TEST RUN BETWEEN FT AND FT For safety factor use 210 sq. ft. bedroom - COMMENTS - PERFORMED BY: John Lovett CERTIFIED BV: DATE: 8-16-81 t7 nnn f6nn7 - Ni �. i c "-Z -�I / s Lo V�44/0 1 / /� Z O o -- / tv J / q/ n J d1 :0 CIO c'r_ �•G� / / ty. %c�C ��cn lG XIC� ti — a• .' ��! / ,moi / / / , � I r 0 0 MUNICIPALITY OF ANCHORAGE • DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date _ S (a) Legal (. Z (b) Applicants includlot, block, subdi (. yN )kj � V r E w -S-2 dtKW 0V" ?ONVf- ay. w Applicants Address ?'o' abX ( l D qOS A" ctq14 )e�l q ?'5y (c) Applicant is (check'one) Lending Institution ; Owner/builder ; Buyer ; Other (explain); I (d) Lending Institution Telephone Ad _ws (e) Real Estate Co. & Ageni Address Telephone (f) Mail the HAA to the following address: E N 6) r2 W I L-(- -D I C K. 0 I 2. Type of Residence Single—Family Multi—Family Number of Bedrooms 3. Water Supply Individual Welly Community Other (describe) Public = Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. 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] 35V6 Z78T 5. `Engineering Firm Providing Inspections, Tests, File Search, Data 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 om-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 obtained from the Municipality of Anchorage files and from my investigation and inspection, the onsite water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Address 1 6 0 ) _I� UJ J mc�, V �lvl2er'S 11 C_ ;;; lune ss, W66 6. DHEP Approval y�.c.,,.a ` Approved for Toe.i bedrooms Approved �- Disapproved —�- Conditional Terms of Conditional Approval Telephone -5q6 ZBUfl fAAk- q4.q r L CAUTION j r' THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH ANA ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL.CERTIFICATES BASER.'SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFLSSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 A. WELL DATA Well Classification 0 0 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: T-o2EL1ArAJF) IJl C MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR G 61986 (_-JUaCEIVED S -Z, S_ T/Z.rJ 23,0 If A, B, or C, D.E.C. Approved(Y/N) Well Log Present (Y/N) Date Cotpleted '?-Ik-?E- Yield 1jn Total Depth 130, Cased to 7/ dDepth of Grouting Static Water Level f 7 Pump Set At Casing Height Above Ground Sanitary Seal on Casing MIN) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) /J Separation Distances from Well: To Septic/Holding Tank on Lot f /0p On Adjoining Lots To Nearest Edge of Absorption Field on Lot t/00 ; On Adjoining Lots To Rarest Public Sewer Line NA To Nearest Public Sewer i Cleancut/Manhole N fi To Nearest Sewer Service Line on Lot '(- 9O Water Sample Collected By Date Water Sample Test Results 7 -7 -?q E� Coments B. SEPTIC/HOLDING TANK DATA Date Installed ('-27-X-5 Size /ZSo No. of Compartments 2 - Standpipes (Y/N) Y Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) /J Date Last Pumped /(J Pumping/Maintenance Contract on File (Y/N) NA ; for Holding Tank High -Water Alarm (Y/N) &)A Temporary Holding Tank Permit (Y/N)A-� Separation Distances from Septic/Holding Tank: To Water -Supply Well +-/�' To Building Foundation To Property Line 60 r To Disposal Field �� r To Water Main/Service Line 4- VC To Stream, Pond, Lake, or Major Drainage Course %/00' Comments Receipt # �j-?3179'3 Date Paid: Amount: (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATAO Soils Rating in Absorption Strata �7 S � Type of System Design ✓e�lc Date Installed F-2-7 -$5 Length of Field C1 Width of Field 3%" Depth of Field /015 Gravel Bed Thickness (o El Square Feet of Absorption Area /7-3sr Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test N �� Results of Last Adequacy T9st P Separation Distance frau Absorption Field: To Water -Supply Wall f SOD To Property Line 60 To Building Foundation 7-5-1, To Existing or Abandoned System cn Lot 41, A f On Adjoining Lots -/- /00 � To Water Main/Service Line fi 5� To Cutbank(if present) To Stream/Pond/Lake% Major Drainage Course -or- /00 ` To Driveway, Parking Area, cr Vehicle Storage Area 14 �0 Um ents D. LIFT STATION — /J/14 Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Tested for Electrical Ccdes(Y/N) Consents Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroan Rating Against HAA Request ** I certify that I have checked, verified, or confcrned to all MOA HAA 1;Rt effect on the d6a�tY�e V�inspec�tion. Signed Date 3-54-61A:01 CaCd�� �any EIV X25 -,rP�r5 MOA No. O 6 -O Z3 r KBl/d5/s [Page 2 of 21 jsir'nL .. 2-15-84