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