HomeMy WebLinkAboutTIMBERLANE PARK #1 BLK 4 LT 9 MUNICIPALITY OF ANCHORAGE '~--I~ ~=;~.~=~ 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 LEGAL DESCRIPTION LOCATION I F HOME'DE: I nside~ngth Width Liquid depth O~ Manufacturer ~ ~ .Ct ~ ~ Material Liquid capacity in gallons ~ DISTANCE TO: Wel~ Od'd' Foundatlonl30,~'¢" -- Nearest ,~, PERMIT NO. ~¢~i~ No. of lines r Length oke~h;ine Total ,e~h~f~ines Trenc.~ width,, inches Distance betwe~ lines / ~f Total effec ire absorption are Topoftiletofinishgrade ~ Materialbeneathtile er_ ~ inches ~Z'[ Length Width Depth PERMIT ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ DISTANCE [O: Well Building foundation Nearest lot line ~ Class Depth Driller Distance to lot line PERMIT NO. a Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER REMARKS / ~J ~ ~ ] 72-013 (Rev, 3/78) PERMI f' NO: DA]~E ISSUED: ~'¢'] LJt II"ql ][ CE ~ P ¢,~-~ L. ]] T' '"¢' ~l If=- ~ Ih,4~ IF_~ lb-ll ED IF.E." ~'~ ED IEEE DEPARTMENT OF HEALTH Afl:E) ENVIRONtdENTAI_ F'F:OTEECTION L~:._) L GTREET~ ANCNORAGE, Al:;: ~-~'' 264-4720 840824 (. 9/,=...,/8 I. APPI_ICANT: CONIFER CONSTRUCTION ADDRESS: P 0 BOX 110712 ANCHORAGE, AK 9951] CONTAC]" PHONE: 346-2574 _EGAL OESCRIP: SUBDIVIGION: TIMBERLANE PARK LOT: 9 SECTION: 24 TOWNSHIP: :L2KI RANGE:: 3W _OT SIZE:: 2.~2A (SQ. FT. OR ACRES) L_OT _OCATION: HILLTOP DRIVE MAX BEDROOMG: 3 BLOCK: 4 Lis'Led below are the options available to you ~.n designing yOLH' septic system. Choose the optio~ tha'L bes~: ¢i'Ls you~ site. DEPTH ~0 PIPE BOT'[OM (FT.) 5.0 5.0 5.0 GRAVEL DEPTH (FT.) 4.5 0.5 3,,0 TOTAL DEPTH (FT.) 9,,5 5,,5 8.0 GRAVEl_ WIDTH (FT.) 2.5 :t7.0 5.0 GRAVEL L. EINIGTI-t (FT.) 42.0 :];4.0 44.0 GRAVEl_ VOLUME (CU.YDS.) 19.5 21.5 28.6 ]-ANI< SIZE (GAF_S) 1~000.0 ~¢, 1~000.0 '~'~' ' ][~000.0 SOIL RATING (SQ.F:T. /BR) 125 I25 ~25 TANK MUST NAVE AT LEAS]' TWO COMPARI"MENTS I c:en'Lify that: ]., I am Familiar, with 'Lhe requirements Fer on-site sewers and wells a~ set £enth by {he Municipality o¢ Anchorage (MOA) and,the State or Alaska. 2. t wiI1 install, the system in acc(3rdance with all MOA c~des and negulations, and in compliance wi{h the design c~itepia o¢ this pepmit. 3. I ~il]. adher'e 'l:.o all MOA and State cH' Alaska requiPements for the se'L back distances Fpom any existing well, waste~ater disposal system or' public sewenage system on thie or any adjacent en neapby let~ 4. I understand that {his penmit is valid fop a maximum of 3 bedr, ooms and any enlargement will require an additJ, enal permit. IF A'L. IFT STATtOI'-! IS II,ISTALLED I1',1 AN ARE:A COVE:RED BY MOA E[J].L,~IlIE¢ THEN ('1.) AN EL~.:.I,]hlL, AL F:'ERMI'T' AND INSPECTION MUST BE OBTAINED; (2) A.~ El. Il-1,, (.:,, THE WILL NOT E,E APF'ROVED WI'¥HOUT AN EL.ECTRICAL. INSPECTION I',,.:.FO~:,, AND EL,_L,,RI{¢AL WORK {¥1US'T BE ]DOI\IE BY A LICEI",ISED ELEL, FP, I(.].AI,I. APF'L T [,ANT: ~ I F':E F~.'X) N S T RU CT I ~ PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 4 7 8 10- 11 14- 15 16 17 18 19 ~-~)~7'"?~¢~'//~'/S~ ~/~ ~ ~ ~ SLOPE SITE PLAN [~ SOILS LOG [] ' PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TESTRUN BETWEEN 72-008 (6/79) Iminutes/inch) , FT AND , FT MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL t{EALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~ !- ~ O ~'~ ~ (a) Legal Description (include lot, bloc~,~ subdivision, section, township, range) Location (address or directions) (b) Applicants Name~o~ ~o~ ~e~yoF Telephone - Rome Business Applicants AddressC/o ~D~ //~7/Z (c) Applicant is (check one) Lending Institution ~-~ ; Ow~er/builder~ ; Buyer ~--~ ; 0ther~ (explain); (d) Lending Institution ~m t ~C~ ~AV/~ Telephone Address ~- ~ ~ ~, (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family~--~ Number of Bedrooms 3. Water Supply Individual Well[--"~ ,, Multi-Family Other (describe) Note: If community well system, must have written confirmation from the State Department Of Environmental Conservation attesting to the legality and status. Sewase Disposal 0nsite~ 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] 5. Engineering Firm Providin~ 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 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 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 all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm DHEP Approval Approved for~L,~Q bedrooms Approved ~ Disapproved __ Conditional Terms of Conditional Approval CAUTION THE MTINICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL 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 ~OR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 .[Page 2 of 2] 7-19-84 MUNICIPALI~ OF ANCHORAGE (MOA) HEALTH ALFlI4ORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Cla6~ification 4 Well Log P~esent (Y/N) Total Depth Cased to Static Water Level Casing Height Above Grcund Electrical Wiring in Conduit (Y/N) Separation Distances f~crn Well.. To Septic/t{olding Tank on Lot Jo Near. st Edge of Absu~p~ion Field on Lot To Nearest<Public Se~r Line (]leancut/Manhole Water Sample Collected By Water Sample' Test Results Cc~,t~nts S ~'~ L/~ ~- t 86; 0 £ Pump Set At b ,/ Sanitary Seal on,Casing (Y/N) Depression A~ound WeTlhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public.Sewer To Nearest Sewer Service Line on LOt ; Date B. SEPTIC/H~G TANK DATA · Date Installed ,IO- ~- ~? Size /ZEcU Standpipes (Y/N) Y Air-tight Caps (Y/N) / Depression over Tank (Y/N) Afl Date Last Pumped No. of C~tva~tments '7--~ Foundation Cleanout (Y/N) ~ Pumping/Maintenance Contract on File (Y/N) Ax/ ; fo~ Holding Tank }~igh-Water Alarm (Y/N) 4//~ Temporary Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holdin~.q~. ~Ta-nk:~bk To Water-Supply Well ,~/OO ~/~-e//~t~0~Building Foundation /~ (~ ~' ~*¢ ~ ,~j /oh._.,) i - To P~operty Line/~ + To uisposa~ Field I O' TO Water Main/Service Line +/0' To Stream, Pond, Lake, c~ Mai(Dr D~ainage co se Corm~nts [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /.o - ~- ~ Width of Field ~ ~f~ Square Feet of Absorption A~ea Dep~ession over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: . To Building Foundation /367' To Existir~ or Abandoned System cn Lot /b//~ ; (k~ A~joining Lots ~- ~-O ~ To W~ter Main/Service Line fi-7--O~ To Cutbank(if present) To Stream/Pond/Lake/or Major D~ainage Course /~/~ To D~iveway, Parking A~ea, or Vehicle Storage A~ea /-~__ Type of System Design Length of Field ~ ' Depth of Field ~, S~ Gravel Bed Thickness Standpipes' Present (Y/N) Date of Last Adequacy Test Date Installed Size in Gallons "Pump On" L~vel at High Water Alarm Level at Tested for Electrical Codes(Y/N) Din~nsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) PumpinG Cycles ck~in~ Adequacy Test. Meets MOA Cu.,~ents Check Permitted Bedroc~ Rating A~ainst HAA Request I certify that I have checked, verified, c~ conforned to all MOA HAA _G~<'l~]~/mj~ 1n effect on tb~ date of this inspection.. [Page 2 of 2] 2-15-84