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