HomeMy WebLinkAboutCOHOE LT 8
MUNICIPALITY OF ANCHORAGE
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~.~ ~ ~ t NO. OF BEDBOOMS~
~11 ]1 ~ Absorption 0 / PERMIT
DISTANCE TO: r¢ou~: ~¢e~ are~/ Dwelling'
~ Manufacturor ~¢~ Material--¢~ / ~o. ofoomoa,tmonts~
~ Liq. capac~ ~,ons IF HOME.ADE: Inside length Width -- Liquid depth
~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO.
~ -- ~ Manufacturer Material Liquid capacity in gallons
~ W~I l/ ' Foundation /~ / Nearest iot line ~ / PEBMITNO.
~ ~ Z No. of lines¢~ Length of each li~ ¢ / Total length of I1%~ ~ Trench widt~/.W inches Distance between~.lines
~ ~'¢ 9~ ?] Material beneath tile ~inches Iota{ effe¢ive.a~sorpticn ,rea
Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
~ Well Building foundation Nearest tot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
SOIL TEST RATINO _ t /
iNSTAELER - .r.~
REMARKS
APPROVED DATE LEGAL
72-013 (Rev. 3/78)
PERM I T
DEPFtR'I"MENT OF: HE:FILTH FIN[:, ENVIRCLNHEh,Fr'F4L. F'RCF!"EE:T!ON
825 "L. '"
2E.4.-472E~
C) ~..,,~ ..... ~: ::E 'T E::
RPPL I CFtNT
LOC:RT I ON
LEGRL
KEVIN R BROt.4N
SFIME
L. 8 (::OH()[": S/E:,
9 ::.": 4 i S T F.: U T Z R',,,' E
I_O]" SIZE
:1.65t9(~ SC!URF.:E FEET
T"r'PE OF' SOIL FIBE;OF.:P'TION S'¢'S"t"EM :['"5: PIT
hlt::tXlMI...l!',l NI...IME~EF.: OF E:EDROOMS = 5
SOIL_ RRTING ,::.SCI F'T/BR)=:
THE REQU I RE[:, S I ZE ~F:' THE SO I L. F4E:SORF'T I ON S~r':.T.,TEM L' :F., ·
THE L. ENGTH DIMENSION IS THE LENGTH '::Ih,I F:EET) OF ERE:FI SIDE FOR R SEIEPFtGE F'IT.
THE DEPTH OF R TRENCH OF.: F'I]: IS THE E:'ZSTF~NCE 8E:'['P.IEEN THE SURFFICE OF THE
GROLIh,I[:, RN[:, THE BCq"TC~M OF THE EXCRVR'T ]' ON ,:.' IN FEET).
THE GF.:FtVEL. [:'EPTH ZS "FHE M!NIMtJH [:'EPTH OF' GRR",,'EL. BE:TI.4EEh~ THE OL.rT'FRL. L. PIPE
FIN[:) THE BOTTOH OF= THE EXCFtVRTION (IN FEET.':,.
F'EF.:MI"F RF'F'LICRNT HFIS T'HE REBPONS IBIL IT"r' 'TO INFORM 'T'HIS DEPRR'T'HENT DUF.:I NG THE
INSTFtLLRTION INSF'ECTtOh,tS OF' FIN'.¢ I.,.!E!_LS RE:,JRCENT TO ]"HI'.'5 PROPERTY RND THE
NUhtE~ER OF' RESI[:,ENCES ]"HRT THE NEL. L !,.~ILL. SERVE.
-T tI..,-~ (D <.': :2 :::, :][: ~'-,,!t 5.=T, F' E] C: '"f- ::[ C, Pql ET.,, IR F,'. E..7. IF.;,.'. E C::::, ILJ Z f;;.'. E:E [),
BRCKF ILL t h,lG OF' F!N"r' S"r'STEM H I THOLIT FI NB[.. I NSPEC:'T I (.'iN RNE) FtF'PRO'v'FtL B'¢ 'T'H I. S
DEF'F:IRTHENT I.,.IIt...L BE: SUBJECT 'TO PRC)SE:C::UTION.
MINIMUM DISTFtNCE BETf,.tEEN .FI WELL RN[:, FIN? ON-5;I'FE SENRGE DISPOSAL
:l. t3g:l FEET FOR l::I PRIVFI"f'E NELL OR ±5t,'3 T'O 2.C~.E~ FEET F'ROM FI PUE:LIC: NELL DEF'Eh,IE:,ING
UPOh,I THE T'¢PE OF PUBLIC: NELL.
MINIMLIH DISTFINC:E F'RCd"I R PRIVFtTE P~EL.L TO Ft PRI'v'FITE SENER LINE: :f.S 25 FEET F~ND
TO R COMMUNIT'T' SEI.,.IER LINE IS '75 FEET.
OTHER REQUtREMEh,ITS MF¢'r' FIF'F'L'?'. SF'E:CIFICR'I'IONS FINE:, CONSTRIJCTION DIRGRFIMS
R'v'FIILFIBLE: ]"0 Ih,!SURE PROPER th,ISTFtLLRT!ON.
! CERTIF'T' THFIT
::L: I FtM FFIMILIFIR 1,4ITH THE REQUIREHEh,tTS FOR ON-'.:.:;ITE 5ENERS Rh,ID 14FLLS FIS SET
FORTH 8'¢ THE HUNICIPFILIT"T' OF RNCHORRGE.
2: I I.'.IILL. INST'FIL. L THE S'¢STEM IN FICCOR[:,FINCE NITH ']"HE: CODE:'.:.;.
]:: I Uh,IDE:RSTRh,f[:, T'HFIT THE ON-SITE SEP.tER S'¢STEM Mt:%' REQUIRE .ENt_F~RGE:MEh,!'T' IF THE
RES If':,Eh,!CE I'.S REMC~DE,~'O I.NC:L. UI}E MORE THRN 5 8EDROOhtS.
.-- .
---- -,~' z,/FtP F'L I R F~' F?. 01.,.! h4 ~
, ./..,. C:
,. t.)_. ,
- /..,,u~ .~ ' ' I ~U / - ' I .......
SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVI RONI~i~i'~;LI~OcTFE~i~'~P. AGE
825 L. Street, Anchorage, Alaska 99501 2~htr41~2~r- HF'"LTH ~,
PERCOLATI~wk~':ON'TEST!I;:^' [.:<o ~'-~
SOILS
LOG
PERFORMED FOR:
~/-0
SLOPE
LEGAL DESCRIPTION: ~_~ ~ ~ ~
1
10
13
16
17
18
20
COMMENTS
PERFORMED BY:
WAS GRO~ND WATER /~kJ S
ENCOUN'~ERED? . . ~ O~
P
E
IF YES, AT WHAT
DEPTH?
[] PERCOLATION
TEST
SITE PLAN
Gross Net Depth to Net
Reading Date Time Time Water Drop
~ ~.'01 I0 o.?,~ r),oLt-
.o ~..'z~ ~ O, 51o
PERCOLATION RATE '~ (minutes/inch)
TEST RUN BETWEEN 3, .~' FT AND I'~r 0 FT
!
72-008 (6/79)
GP"~.TER ANCHORAGE AREA BOROI'~-H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511
N.o 82
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME /~:.'/ ~-~*/z.J ~,~9. ~-'"~ ~i'''~-~'- ADDRESS
LOCATION LEGAL DESCmPT ON
SEPTIC TANK:
~' NUMBER OF
DISTANCE FROM WELl /~--~ ~ MATERIAL C ~..//~'C,~_.~_~'?~ COMPARTMENTS
LIQUID CAPACITY /~' (-2,,'~~ GALLONS. - INSIDE LENGTH "~INSIDE WIDTH /
LIQUID
DEPTH ~
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS. / OUTSIDE DIAMETER. ~ OR WIDTH /(/t~ /, LENGTH ~ ? w , DEPTH
LINING MATERIAL
NEAREST LOT LINE
DISTANCE FROM WELl /-~'5'~9 /
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)
BUILDING FOUNDATION.''''j2 ~';'
SQ. FT.
TILE DRAIN FIELD: /J//,,~
NEAREST LOT LINE
DEPTH OF FILTER MATERIAL BENEATH TILE
TOTAL LENGTH
OF LINES
IN. TOTAL EFF,~.LVE
IN. ABOVE TILE
WELL:
LOT LINE
TYPE PJ~-:~--~'~'~'-~ , DEPTH ~-~/~ ~'
/ NEAREST ~ SEPTIC
SEWER LINE , TANK
DISTANCE FROM x ~- WATER
, BUILDING FOUNDATION. /~'¢--~ ~-~ SAMPLE
/_~-C) ~ SEEPAGE '
SYSTEM //'-~ ';~, CESSPOOL
NEAREST
OTHER
SOURCES__
DISTANCES:
/~-Z~
DIAGRAM OF SYSTEM
HEALTH AUTHORITY
GAAB-HD-2
GREATEF
327 Eagle St.
~NCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
')ROUGH Case No. //~/~-
SEWAGE DISPOSAL SYSTEM APPLICATION & PERMIT
APPLIC~TIO~TO I~ST~LL: SEPTIC TANK ~,,SEE~AGEPIT ~ ,DR~I~ FIELD ,OTHER.
FI~CEDTHROUGH ~~ I/ , TO ~EINSTALLED 8Y
BEL~TO B~ FILLED OUT BY HEALTH OEPARTMENT~
~- /~EPTI C TAN "
D TANCES:,
[U..L¥/' '
¢.o /
I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the
ab°ve describedTstem is in acc°rdance with said c°de'W /~,)/ ~~,~'-~ ~
DATE APPLICANTS SIGNATU RE,,, ~/~' ,.
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES.
Division of Environmental Services
On-Site Services Section
P.O. Box196650 Anchorage,'Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ol5- O~1- P-O
HAA #
GENERAL INFORMATION
Complete legal description
Location (site address or directions) ~ "5~ I S,T r~oq'7_. ~ ~,'~
Property owner
Mailing address
Lending agency
Mailing address
Day phone
Day phone
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: --~ ,~
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev, 1/91) Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
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 application 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 regulations in effect on the date of this inspection.
Name of Firm / ~ ~' ~- ' ~ ~ '~ ¢ t~.~, ~ ~. ~ Phone
Address ~¢% ~ /~ ~ ~ ~ ~
~~~ Date
EngineeCs signature
Sa
DHHS SIGNATURE
,~r Approved for
// '~ Disapproved,
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
l
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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.
72-025(Rev, 1/91) Back MOA#21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
Parcel I.D. 0/.5- O:~- Z CZ:)
A. Well Data
Well type /~-
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot ~> 7_ c) o
Absorption field on lot ~ ~. 4) C~
Public sewer main
Sewer service line
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed Ig"7O ~_~lcl~ Tanksize l~)ec) -'h.'~ O Compartments ~ -I- I
Cleanouts (Y/N) './ Foundation cleanout (Y/N) ~1 Depression (Y/N) J'"!
High water alarm (Y/N) J~J/,,~- Alarm tested (Y/N)
Date of pumping /L~,~ ~,~.~ ~ ~: ~/~ Pumper "~ ~ ~ m,~-~-~v~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots /~,//',x--~ Foundation ~'~
Absorption field _.~ Water main/service line ~
72-026 (3/93). Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ! q g ~--
Length 7 ~:'
Total absorption ama
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF)
Width ~ Gravel thickness
[ ~L~ ~ Cleanout present (Y/N) "7
"~/2-. 7//c/'-/ Results (pass/fail) ~
System type
Total depth ~. [
Depression over field (Y/N)
for ~
After test ~ c~
Bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1'~/
To building foundation
On adjacent lots
Surface water /'"t/~
Curtain drain
On adjacent lots /"F'//,,~ Property line
To existing or abandoned system on lot
Cutbank /'k.l ,~ ~/~. Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effecY~n the. date-Of.this inspection.
Engineers Name
Date --7/~
HM Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3/93)* Back
' INSPECTION APPOINTMENTS
TIME ' TIME TIME ~.
DATE DATE DATE
MUNICIPALITY OF ANCHORAGE~,,,,~,..,,'z DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTI~ui~JJ~I~~MENTAL Pi~OTECTION
825 L Street-Anchorage, Alaska 99S01 AU G 6 1980
ENVIRONMENTAL SANITATION DIVISION
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce.ed, Please allow ten (10) days for processing.
1. PROPERTYOWN,R , PHONE__
7¢
MAILING ADDRESS
PROISERTY R ESI DENT (If different from above) - PHONE
2. BUYER PHONE
MAILING ~DDRESS~
,,,-Fa+ .aro r 5-'
3, LENDING INSTITUTION ' PHONE
MAI L FN~G AIbDR~'SS ~ ~:-'
MAILING ADDRESS
5. LEGAL DESCRIPTION
-"-' '
STREETLOCAT, ON y ~
~ SINGLE FAMILY .~ ~ Two ~ Five
~ MULTIPLE FAMILY ~ ~ Three ~ Six
-/
7. WATER SUPPLY
/
[] INDIVIDUAL* /
~ COMMUNITY //
[] PUBLIC UTILITY
[] Other
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1976. For wells drilled prior to that date, give well
depth (attach log if available.)
8, SEWAGE DISPOSAL SYSTEM
'[~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING
\
CAN BE INITIATED.
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
[] SINGLE.FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] INDIVIDUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
r--~Sept[c..Ta~tk~or [] Holding Tank
Size: /~'~(~) If Tank is homemade
give dimensions:
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE
[] TWO [] FOUR [] SlX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
PERMIT NUMBER
DATE INSTALLED
iNSTALLER
SOl LS RATING
TYPE OF TANK MANUFACTURER
TOTAL ABsoRpTION AREA MATERIAL
Septic/Holding Tank
4. DISTANCES
WELL TO:
Absorption Area ISewer Line
~'[~ OTHER
INearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
DATE
[~PPROVED FOR ._~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVEDIBY(~ ~
72-010 (Rev. 6/79)
ALASKA ENVIRONMENTAL
THINKING OF THE FUTURE
SRA BOX 1584fl · ANCHORAGE, ALASKA 99507
DEPT. (3F i!
ENVIRON,/~EN I,qL ,,. ~ LCTION
RECEIVED
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES ~9~m ~
FOR
Mailing Address:
2. Property Owner:
Mailing Address:
3. Legal Description:
4. Location:
5. Type of facility to be inspected
6. Well Data: ~__~:~),~xL/~y-}rk
A. Type ~~
C. Construction
7. Sewage Disposal System:
No. of bedrooms
B. Depth~
D. Bacterial Analysis
A. Installed B. Installer
C. Septic Tank: 1. Size /~0~2. Manufacturer
D. Seepage Pit: 1. Absorption Area ~-~ 2. Material
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank
, Absorption area
, Sewer Lines ,
Nearest lot line , Other contamination
/
B. Foundation to septic tank //~ , Absorption area
C. Absorption area to nearest lot line
LQ-034 (1/74) Page 1 of two pages
Page 2 of two pages - Req
Legal Description ~/~~Tx' <~/
ar Approval of Individual S~
Water Facilities
Comments
Approved
~~~~ ~isapproved Date ~~~
Approval Valid for one year from date signed /
Greater AnChorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
I certify that the information contained in this request for approval o be a true and
accurate representation of~he½ubject sewer and water facilities and these facilities
are operating...
SIGNED ~7~~~~//~~ Date
EQ-034 (1/74)
~HH~)~ GREATER ANCHORAGE AREA BOROUGH..
Department of Environmental Quality
3330 "C" St., Anchorage, Alaska 99503 - 274-4561
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
Type of Inspection: CMRO
VA FHA
CONV X
Property Owner: Richard and Carrie Strutz
Box 364
Maiq ing Address: Petersbur6, Alaska 99833
Day Phone
Name of Buyer:
William E Wfmmer
Mailing Address: ~fntlchtk, Alaska 99639
Day Phone
Name of Lending Institution: Alaska National Bank of North
ntverstty Bganch
~90~ Seward.~wy ..... Center
Mailing Address: ancnora~e, AK ~uj Phone 279-4585
Name. of Realtor or Agent: Advance Realty Att: Jess Holliday
601 E. Northern Lights Blvd
Mai I i ng Address: Anchorage, Alaska 99503 Phone 274-1680
Legal Description: Lot 8, Cohoe Subdivision
t o c a t i o n: 9341 S trutz Ave Anchorage
7. Type of Facility to be inspected:
8. Water S~upply
C~mmuntty Water
Type of Supply: Public Utility
3 No. Bdrms.
Individual
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System' Public Utility
If Individual, date of installation
Individual (on-site)
1972
X
EQ-037 (]/74)