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Home My WebLink AboutTANAINA HILLS LT 24NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION 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 PHONE [ E]NEW :DROOMS PERMIT NO, No. of com~p.~tments Liquid depth PERMIT NO. Liquid capacity DISTANCE TO: Absorption'area~ ~ Dwelling "7 ;ity in gallons DISTANCE TO: IF HOMEMADE: Material DISTANCE TO: Welll ~"~ ~ '~:~'~.~Z~ ___ No. of lines Length of e_ach line ~ to finish grade Length W~dth Type of crib Crib diameter Well DISTANCE TO: DISTANCE TO: Building foundation OTHER PIPE MATERIALS Eoundation Jine Total length of lines Trench wi~,th Material benoath tile Crib depth Building foundation Drill r Sewer line Total effective absorption area Nearest lot line Distance to lot line Septic tank bsRo~e a (s) INSTALt_ER REMARKS APPROVED 72.013 (Rev, 3/78) CE-6 "M-W DRILLING, Inc. ;56-207 P.O. Box 110378 · 10330 Ord Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 33511 ."i '. . ' DRILLING LOG : .. : Well Owner Ann DOyle ,, Location (address of: 'Township, Range, f~ection, ff known; or distance main road T.g/~o Ill, Tanaina tlills Subdivis.ion .,~l../f Size of casing_ '6" Depth of Hole_~l' ~eet Casedto ?fl1 ' feet fltatlc water leve~_/t. (~ ~- low) land surface. Finish of well (eheek one) Use 6fWe]l Domestic open end · . . ~creen ( ); Perforated ~( ~ ~ )~.. : Describe screen or perforation,,, ,~ I/~/,/~ Well pumping test at__.2~_ga~!~isi'~ ~ (minute) of drawdown /rom static {~li: !!~ i ~ J for,, ] hours with iOOZ 9ate ofcompletio~ Au2. 21,'ii~ ~9~ ': ~ ~:~? ? :~' ' WELL "~:i :,' .... LOG ~: ~':., G~ detatl~ of formations penetrated, size of material,~ol~d~r~. avel ~ ~ . x ); ft. ~)epth in feet from ground surface 0 TO 2 2 _TO 4 4 _TO 55 ~1 .TO. 137 _137 _TO 155 i~55 _TO 162 _162 _TO 191 . 191 .TO. 201 Water gravel .... TO -- ,TO.____ ' ~TO.. 11600 CAN6E RD. ~NCHORAGE~ A~ ~16 ~ SOILS LOG PERCOLATION TEST LEGAL DESCRIPTION: 2 SLOPE 10 12 15~ 20- THOM A. FISC CE-6793 .'" WAS GROUND WATER , ,~, ENCOUN'DERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop DEPT, PERCOLATION RATE .................................. (minutes/inch) ON TEST RUN BETWEEN FT AND COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~r~/~" ~'~/ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name '~¢r"~' Applicant Address (b) Telephone: Home Z~-bT:~?~ BusinessZT~ (c) Applicant is (check one): Lending Institution []; Owner/builder,~, Buyer []; Other E] (explain); (d) Lending Institution Yd J ,~ Telephone Address ~'~ I f~- (e) Real Estate Company and Agent . ~ /~.- Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family",L~ Multi-Family [] Number of Bedrooms '~"~ Other WATER SUPPLY Individual Well,~ Community [] 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 [-1 Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 72-025 (~1 Page 1 of 2 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 Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipai and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ I'J~~ (~:N.~{/'i-~--. ~..~[3"i~- Telephone Date. Engineer's Seal DHEP APPROVAL Approved ior ~-~ bedrooms by Approved ~ Disapproved Terms of Con,dit cna Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 requirements. 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. Page 2 of 2 72-025 (H/841 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Lega[ Description' ~"~-- Well Classification. "~JJ~,'T,'T,'T,'T,'T,'T,~ IA, B, C D.,E.C. Approved (Y/N) ~/~'~ Well Log Present (Y/N) _ ~(~S Date Completed _ ~/~' J / I ? ~:~ Yielc TotaIDepth~L- Casedto '_~.OJ '~ Depth ol Grouting _ ~J/ Static Water Level ~ ,~)~(~)" Pump 8et At X~,"'.~ Casing Height Above Ground ~'7 ii Sanitary Sea on Casing (Y/N) Electrical Wiring in Conduit (Y/N) '~(~-'~'~.~ Separation Distances fi'om Well: To Septic/Holding Tank on Lot ~ ~')~) t ~ : Orl ADjoining Lots To Nearest Edge of Absorption Field on Lot ~ I~'~ !.~-- : On Adjoining Lots To Nearest PubliC Sewer Line ~/l~r To Nearest Public Sewer Cleanout/Manhole _ ~"-~/J~r To Nearest Sewer Service Line on Lot J ~'"~') ~ ''''~''' Water San, pie Collected by .-'~,r~¥~, A' ~ '"~- :Date __ '/-~-/ Water Sample Test Results Comments Depression Arouno Wellhead (Y/N) ~"'~ ~-~ SEPTIC/HOLDING TANK DAI'A Date Installed ~ ~ _ ze No. of Com*artmems ~-- Stan0pipes (Y/N) '~.~ Air-tight Caps (Y/NI "~'~--~> Foundation Cleanout IY/NI Depression over Tank (Y/N) ~,,,J O Date Last Pumpea ~[""/I Pumping/Maintenance Contract on File (Y/N) _ ~/~"~ : for ~ Holding 'rank High-Water Alarm (Y/N) . ~l /_tO~·- Temeorary Holding Tank Permit [Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well _ To Property Line ~,~ i.~,. TO Water Mair~_~.r~j.c.~e~jn~ Course ~ ~_..)~j I._~._ ! To Building Foundation '/~ To Disposal Field ' ~ To Stream. Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(1 US'I) C. ABSORPTION FIELD DATA Soils Rating ia Absorption Strata Date Installed ~--/J ~/~_~'~ Width of Field '.._~-'~-~'_~ ~ / Square Feet of Absorption Area ~-~-ff') Type of System Length of Field Depth of Field ,~vel Bed Thickness ~'~ Standpipes Present (Y/N) Design Depression over Field (Y/N) ~ ~ Date o/f--L.)ast Adequacy Test Results of Last Adequacy Test ~¢~ --~i~_....~ ~[~--~l,~ / Separation Distance from Absorption Reid: To Water-Supply Well I ~ I '_'1~ To Property Line .~ ¢~;,~ To Building Foundation ! ~) / Lot To Water Main/Service Line To Existing or Abandoned System on ; On Adjoining Lots _~, To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course _~ ~-.~;.1 ~f-¢/-"' To Driveway, Parking Area, or Vehicle Storage Area -'~ / Comments D. LIFT STATION Date Installed Dimensions ~ Size in Gallons ~,,~ Manhole/Access (Y/N) ~' "Pump On" Level at y) /- "Pump Off" Lev~"~ High Water Alarm Level at / / ~.,~ /~.~¢~Y/N)__ ~ i!i~!c:a! 't :odes (Y~ LyPumping Cycles during Adequacy Test' Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that l havre checked,~', ~)~cd~,~formed to all M~OA a,~ HAA g/~idelines in effect on the date of this inspection, Signed .'~,z~,~ '¢~1~~ Date Receipt No. /~0 Date of Payment Amount: $ /¢~ ~ ~ ~Z" n ~TR r~ ~'~ Engineer's Seal Page 2 of 2 72 026 (11/84) HOMF~ SF. FIVICE$ 15900 Francesca Drive Anchora~,e, Alaska 99516 345-1890 or 345-2444 INVOICE # CUSTOMER Block DATE DESCRIPTION TOTAL AMOUNT