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Home My WebLink AboutHILLSIDE PARK PUD LT 23 r 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 NAME , PHONE ~'~EW MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~O. OF BEDROOMS ~Z Manufacturer 4~~ Mater~ C ND. of compartments ~ iLiq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ( Manufacturer Material Liquid capacity in gallons No. of lines ] Length of ~h~ine Total length of lines Trench width Distance between lines --~. ~ ~ ~ inches ~ ~ Top of tile to finish grade Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ ~ Class~ ~ Depth Driller Distance to lot line PERMIT NO, ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS ~ SQl L TEST RATING Id REMARKS APP~ED DATE LEGAL APPL ! CANT L.OCRT I ON LEGAL WINTER WI=,E INCE EAST TREE L22: HILLSIDE PARK DERARTMENT ~Z,~HERLTH AND ENVIRONMENTAL p'~'~TECTION 825 "'L ~STREET., ANCHORAGE., AK. 264-4728 7488 E. 28TH LOT SIZE ~4, ~::t -,L4UHF, E FEET T'¢PE OF SOIL,c'c"-rl:'C"~'tl]~.~,,_,=,_,...=, .~ .,,, '-::,N.=,TE'"~ 'M IS : TRENCH MAXIMUM NLIMBER OF E, EE.F..UOM_-, = 3: =,UIL RATING ,,::,u.. F"F..."BR::,= ::L42 'T'HE REQLIIRED SIZE JIF THE '-,UIL AB=_F..PTION SYSTEM 'THE LENGTH DIMENSION IS THE LENGTH (IN FEE7') OF THE TRENCH OR DRRINFIEL. D. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS 7'HE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND 'THE BOTTOM OF THE EXCRVRTION (IN FEET). F:E,;.,L~ I F-:ED :.Et:- T ][ C: TR~'-,il'::=.'-- ]: ¢_E ....... t E"i~Zt~:3 ,_3F~L_[_O~'-.I?~; F..:.RMIT APPLICANT FIRS THE RE_,PON_,IE, ILITY TO INFEF. M THIS DEPRRTMENT DUF..INU THE INz, THLLH1 ION IN'-]PECTIuNN, OF ANY WELLS AD,IACENT TFI THIS F'ROPERT"r' AND THE N_ME, EF. OF RE=,ICENE. E.=, THAT THE WELL WILL SERVE. U, I'-~ =. R E ~;-~ L~ ][ F: E [:. -F~.J~O ,:' ;-"- ':, I [-~=.PE _-T I - '-- RF:E E, RUkFILLINb OF ANY =N=,TEH WITHOUT FINAL INSPECTION AND HFPRE,HL BM' 1HI=, DEF'ARTMENT WILL BE SUBJECT TO F'ROSE6_TION. MINIMUM DISTANCE BETWEEN R WELL AND RNY ON-SITE SEWRGE DISPOSAL SYSTEM IS ±00 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAN' APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE RVAILRBLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT t: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE NITH THE CODES. ~: I UNDERSTAND THRT THE ON-SITE SENER SYSTEM MAY REQUIRE ENLARGEMENT IF' THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN g BEDROOMS. S I GNED ' ..................................................... APPLICANT WINTER WI"'"iE INCE !_-,.=,L E[ B [:,RTE ....... -~ / V4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 3 § 8 10- 11 12 13 14 15 16 17 18 19 20 SLOPE Illll SITE PLAN WAS GROUND WATER S ENCOUNTERED7 /¥O ~ P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTEGTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date Le~at Description (include lot, block, subdivision, section, toWnship, range) (a) Location (address or directions) - ; (b) Applicants Name ~f/'--I~l~O ~'~C'J1'I~-I-'~l~l~L Telephone Hom~ - Bus tries s .... ~'-~' Applicants Address '--/O ~ I ~l~ ~ ~Z.~ (c) Applicant_is (check one) Lending Institution'~ ; ~er/builderJ~[.?~;~'~ Buyer ~ ; Other ~ I (explain); (d) Lending I~stitution Telephone Address (e) Real Estate Co. & Agent Address me Be e Telephone (f) Mail the HAA to the following address: Type of Residence Single-Family~ Number of Bedrooms Multi-Family~--~ Other (describe) Water Supply Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal., Onsit~t 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] e 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 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 A~chorage 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 om the date of this inspection. Name of Firm ~DHEP. Approval Approved fo edrooms Approved /~k. Disapproved Terms of Conditional Approval~ CAUT ION THE M~INICIPALITY OF ANCHORAGE DEPARTMENT OF HEA~LTH 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 ~D 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 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTHA.U~HORITY APPROVAL (HAA) ivtUi~IIC~PALITY OF ANCHU~^~c DEPT. OF HEA~~IF~'cKLIST ' FEBRUARY 1984 ENVIP. ON~ENTAL PROTECTION 264-4720 i,,~!Av,, 0 8 'I§1~ Lega~ Description: ~"'"~ WELL_,ATA RECEIVED Well Classification (~-~c°~.~t'a'~l~t' / If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Total Depth Cased to Static Water Level, Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Date Completed · Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results Comments SEPTIC/HOLDING TANK DATA Date Installed ~/-~/(~ J Size ~ (.~(~C-.~ No. of Compartments Standpipes/Y/N/ t'~, A~r-tight Caps IY/N/ ¥8 Foundation C~eano~~--~, Pumping/Maintenance Contract on File (Y/N) ~":,~/t~ ;for Holding Tank High-Water Alarm (Y/N) ~ Jl¢~ . Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank,~, '~ 'O / To Water-Supply Well ~..~C¢) .t'-~T-~.t,. k.. To Building Foundation To Property Line J ~ i,.~_. To Disposal Field ~" To Water Main/Service Line iOr~ ~ ~,,4 ¢¢'l.?Z..- ¢~/~i~ To Stream, Pond, Lake. or Major Drainage Comments Page I of 2 ABSORPTION FIELD DATA Soils Rating in Absorption S~a~ta ~4~. / ~//~¢¢,, Type of System~..~Desigfn Date Installed ~/.'..~/~ I ' Length of Field Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ t ~ To Building Foundation Lot To Water Main/Service Line Depth of Field I '~' Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Z, ff-:, To Property Line i ~ / r~ TO Existing or Abandoned System on ; On Adjoining Lots ~.~2, t.+~, To Cutbank (if present) ~-~' / To Stream/Pond/Lake/or Major Drainage Course I ~rO laC.- To Driveway. Parking Area, or Vehicle Storage Area Comments LIFT STATION Date Installed Dimensions Size in Galtons ~hole/Access (Y/N) ~- "Pump On" Level at /'Pump O,' Level at High water Alarm Level at / / Vent (Y/N) Tested for / / Pumping~6ffes during Adequacy Test. Meets MOA Electrical Codes (Y/N) / ( Comments [ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I havcChecked, ve~i'ied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,~ ~ ~ "' '~'~ate ~/7,/~ Company v"~i'~q.~l=-'~-~l&"¢--- ~ MO~'~No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) .~"?%Y?' A '",¢¢~ Engineer's Seal ~ _. THOM'A. FISC rER · ¥~o".. CE- 6793 .?.~ ~ A'~'Home .Services 15900 Francesca Drive Anchorage, Alaska 99516 345-1890 * ~ DATL DESCRIPTION PREVIOUS BALANCE CHARGES CRI~DITS BALANCE DUE [~ BALANCE if [h/s statement does not agree with your records p/ease not/fy us at once, S TA TEMEN T Time Time ~ ~.:ne Date Date Date Inspector Inspector Inspector Comments Conditional Approval :' ( . ,:,;';":~nal Approval Date Sewer Installed Permit No. Septic Tank Size ~__~¢ Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~ ~ ~'~ ~ . (' ~ ~('5 ~¢~/~m~ ) Phone Mailing Address 7~00 Buyer /~ O c A~/~ Lending Institution ~0 le*/~ (~ ~rJ*~ ~} e ~. ~ ,c~. Phone Address ~0~ .~, T~o~ S~,' ~,. ~0-/ ~ ;7-?-7Stl Realty Co. & Agent ~c - ~¢~¢fi~, , ~W~" ~*. Phone Address ~ ~ 0 I ~ ~ . Legal Description Street Locati6n~ ~ Typ~f Residence ~Single Family ~ Multiple Family No. of Bedrooms Q Other Water Supply ~ Individual ~tl'/[.~ ~'~ ~ A~ACH WELL LOG. A well tog is required for all wells drilled since June Community 1975. For wells drilled prior to that date, give well depth (attach log if ~ Public Utility available.) Se~e Disposal ~ Individual Year Individual Installed: ,, ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,