HomeMy WebLinkAboutHOFFBECK LT 2 & T12N R3W SEC 35 W2SE4NE4 PTNOnsite File
HOFFBECK LT 2 &
T12N R3W SEC 35
W2SE4NE4 PTN
PID# 017-091-94
Hoffbeck Lt 2 was formerly Prator Blk 3
Municipality of Anchorage
Community Development Department Page ( of
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: to,6 P 11 1 030 PID Number. Of 'rtt — 04 ! — 9N ❑ New .Upgrade
p
Name: �Toe_ g Lr �r
ABSORPTION FIELD
N e $
r_-7[ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
`
(I'M'70 bnawa �t,r
I El Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
4 GPD/SF
G, 0 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
1.0 Ft.
Gravel depth beneath pipe
$• Ft.
Subdivision L Block Lot
d 7�
Fill added above original grade
7-11--( — _�, 0 Ft.
Gravel length
/0f7 Ft.
Township Range Section
Gravel width
Z• 0 Ft.
Beds: Number of Lines
/
Distance between lines
e�_ Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
1
From
Tank
Field
Tank
Line
10210 Ftz
9 Ft.
Well
�� p
+ vv! f/
A
/h
_So f/
TANK kSeptic ❑ S.T.E.P. ❑ Holding ❑ Other
ManCapacity
1 Capacity
/Tht ^n/) i 2- S0 Gal.
Surface Water
rVQ
(VOr1
Material
�! �—we
Number of compartments
2i
%
Lot Line
Z.0 f
•ZBff
NA
FoundationZ
Z�f
LIFT STATION
Manufacturer
Capacity
Curtain Drain
rr
G h W
h fK/ vt
Gal.
Remarks 1 /
Pu M � O �� 1.Pq FfJ '!i'i. L r
Pump on level at
Pump off level a
in.
High water alarm at
in.
L dyn5 L eirl r
Pump make a del
Electrical Inspections performed by
Installer
PIPE MATERIAL Housetotank c�l/ Tankto
—4031 drainfeld
r-/(I • iYyl Cl tY 4 f: yf
Drainfield iM jy CO/MT z �3
Inspector rof�.� nJvY4Y rz
BENCHMARK (Assumed elevation) 1&0 It
Inspectionf„ /
��—Z�
dates: i
Location and description
wrA
3b 4m
fG
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
_`ne>�nq&%,1�amp
OFA'
Conditional Approval: Date
e
A'4
:49TH �p
.. .............
..................
A • MICHAEL N. ANDERSON : c
' /
E asy
�j���
Approved • Datec
inspection Repon_r - zooc
Permit No. OSP111030 Page 2 of 2
• Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: HOFFBECK LOT2
MARK
A
B
GRND.
ELEV.
PIP
ELE .
CO
30
21
101
01
55
56
99.7
TC01
66
63
99.7
TCO2
75
65
99.7
CO3
79
65
99
J944.
C04
80
65
99
MT
136
102
97.8
C05
160'
121
97.6
PID No.: 017-091-94
100' WELL RADIUS
BENCH, GARAGE SLAB
Col
TCO1 r? CO2
�C95—
T _
I 1 1\\ 1
I o, I 11
I \ \
/Y \
/ IMT\
I 0 I
1 11 1
\\ J C05 1 1
Y A BUILT
SCALE: I"=40'
SEPTIC SECTION
N.T.S.
MIGINAL ..�1 11- / -4
..
ILL •''''••
R i ry%/bJ(4 /99 THH)//�y�///J
:M0 •,. .. ... N..... .f..F .
MICHAEL N. ANDERSONS
No. C/E%469
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP111030
Tax Code Number: 01709194000
Work Type: Septic Upgrade
Permit Effective Dates: March 24, 2011 to March 23, 2012
Design Engineer: ANDERSON CONSTRUCTION & ENG'G
Subdivision: HOFFBECK
Site Legal Address: HOFFBECK LT 2 & T12N R3W SEC 35 W2SE4NE4 PTN G:3039
Owner/Address: HOFFBECK JOSEPH D & SHARON
PO BOX 111763 ANCHORAGE AK 995111763
Site Mailing Address: 14470 CHAWA CIR, Anchorage Lot Size in Sq Ft:
Total Bedrooms:
This permit is for the construction of:
159407
4
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Issued By: f:
Date:
Date: Ji/�
MUNICIPALITY OF ANCHORAGE
;w
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Aater & Wastewater Program
Mayor Dan Sullivan
* ON-SITE SEWER/WELL PERMIT APPLICATION
v� FOR A SINGLE FAMILY DWELLING
R h!�
Parcel I.D. 6 (? 0 q( 9 q
Property owner(s) J, Y Okl �beCk Day phone 3yS ,
Mailing address P 1) ° u 11 / % � 3 " CkO!�, P (? 1.5 14
Site address 14 N 7 n C�_& wQ C r c t''/1 ,,P 1
Legal description (Sub'd., Block & Lot) f}` &K D2 c � 5 (Abd • Lo
Legal description (Township, Range & Section)
Lot Size 3 . � G Sq. Ft. Number of Bedrooms
THIS APPLICATION IS FOR:
THIS APPLICATION IS AN:
(N all that apply)
Waiver Fees: _
Initial ElAbsorption
Field
Date of Payment:
Septic Tank
,� �r>
Upgrade �
Tank
El
Renewal F1Holding
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Fa mil Dwelling and is in a dance with applicable Municipal Codes.
G:�
(Signature of property owner or authorized agent)
Perm' ush ees:
,
Waiver Fees: _
Date of Payment:
Date of Payment:
Receipt Number:�-�
,� �r>
VNIM
Receipt Number:
Permit No.
0041c)
Waiver No.
GABuilding\On Site\Forms\Client Forms\Permit App_01 041 1.doc (Rev. 1/11)
Michael N. Anderson, P.E.
Civil/Structural Engineering & Construction
4661 Natrona Avenue
Anchorage, Alaska 99516
Phone 345-3377
Fax 345-1391
Jan. 14, 2011
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
Re: Hoffbeck Subd. Lot 2
To Whom it may concern:
This is a request for a new 4 bedroom septic permit on the above referenced lot. The test hole excavation
consisted of silty gravel for the full excavation depth of 12 feet. The perc rate was 22 minutes at elevation
5 feet. The existing system is close to the bedrock and will be abandoned. The slopes are all gentle at about
10 to 15 percent running towards the southwest side of the lot. Due to the lot size, this upgrade will not
impact any of the other neighboring lots as the site plan shows. No slopes greater than 25 percent are with
200 feet of the proposed new system.
Please call me if you have any questions.
Since
Michael N. Anderson, P.E.
DESIGN CRITERIA:
4 BDRM X 150 = 600 GPD
SOILS = 600/0.6 = 1,000 GPD
1000 GPD/10 = 100-
(1) TRENCH
6.0'
DEEP
5.0'
EFFECTIVE
2.0'
WIDE
100'
LONG
/ EXISTING WELL
100' RADIUS. TYP —
O
IV
V
i v �
m TH#2�_
Qr I `
dop
TH 1/
(TI -111)
0.5
12
(TH#2)
MOUND OVER
b GRADE
FILTER FABRIC
& INSULATION
4°0 PIPE
—6.0
SEWER ROCK
\ SEPTIC
WELL
PTOWERTY LINE
I I
(EXISTING HOUSE
/ � I
WELL \ 4�
PROPOSED JNE 6 ��— ✓ i \ \\
DRAINFIELD TEST HOLE RADIUS I r
I
VACANT LOT
ISEPTIC
I
I
WELL
o
Septic Design Prepared for
JOE & SHARON HOFFBECK
HOFFBECK SUBD. LOT 2
Anchorage, Alaska
Michael N. Anderson, P.E. DATE:
4661 NATRONA AVE. DRAWN:
ANCHORAGE, ALASKA 99516
PH 345-3377 / FAX: 345-1391 SCALE:
I
I
i
i
DRIVEWAY
i
/
/
OF
#�
i 49 !H-
...
HL��DERSON-'
.........0 .. ....I
3/22/2011MICH E Ai
•�1� °
No C 9 9 i
ORG 0.5
ORG
—1.0
GM
GM
2.0'
Li
BEDROCK 12
LJ
BEDROCK
\ SEPTIC
WELL
PTOWERTY LINE
I I
(EXISTING HOUSE
/ � I
WELL \ 4�
PROPOSED JNE 6 ��— ✓ i \ \\
DRAINFIELD TEST HOLE RADIUS I r
I
VACANT LOT
ISEPTIC
I
I
WELL
o
Septic Design Prepared for
JOE & SHARON HOFFBECK
HOFFBECK SUBD. LOT 2
Anchorage, Alaska
Michael N. Anderson, P.E. DATE:
4661 NATRONA AVE. DRAWN:
ANCHORAGE, ALASKA 99516
PH 345-3377 / FAX: 345-1391 SCALE:
I
I
i
i
DRIVEWAY
i
/
/
OF
#�
i 49 !H-
...
HL��DERSON-'
.........0 .. ....I
3/22/2011MICH E Ai
•�1� °
No C 9 9 i
EXISTING DRAIN PIPE IS INSULATED
UNDER THE DRIVEWAY
NEW 1250 TjK, OLD
TANK TO BE 1PUMPED,
CRUSHED AND FILLED PER
CODE
DRIVEWAY
PROPERTY UNE
Septic Design Prepared for
JOE & SHARON HOFFBECK
HOFFBECK SUBD. LOT 2
Anchorage, Alaska
Michael N. Anderson, P.E. DATE:
4661 NATRONA AVE. DRAWN:
ANCHORAGE, ALASKA 99516
PH 345-3377 / FAX: 345-1391 SCALE:
NO SLOPES
GREATER THAN
25% WITHIN 50'
OF THE SYSTEM
3/22/2011
DJR
1 "=40'
i
I
I
I
� I
I
I
I
I
POWER POLE I
EASEMENT
I
0
9
M
R
M
*A&"OF matt�I
c;•
`
•••y
.'
..49TH ...
/�( ............................: i
MIff
CHAEL N. ANDERSON '
1♦��;'o�� No. C, 99 �AV
`
CO CO
---
/�;/ 0
THI 1
1
01
'i 10 \\
A UNE, AX SLOPE
� � � \\ \ \\
\ \
—142
i
i
DRIVEWAY
PROPERTY UNE
Septic Design Prepared for
JOE & SHARON HOFFBECK
HOFFBECK SUBD. LOT 2
Anchorage, Alaska
Michael N. Anderson, P.E. DATE:
4661 NATRONA AVE. DRAWN:
ANCHORAGE, ALASKA 99516
PH 345-3377 / FAX: 345-1391 SCALE:
NO SLOPES
GREATER THAN
25% WITHIN 50'
OF THE SYSTEM
3/22/2011
DJR
1 "=40'
i
I
I
I
� I
I
I
I
I
POWER POLE I
EASEMENT
I
0
9
M
R
M
*A&"OF matt�I
c;•
`
•••y
.'
..49TH ...
/�( ............................: i
MIff
CHAEL N. ANDERSON '
1♦��;'o�� No. C, 99 �AV
EXISTING
LEACH FIELD
PROPOSED
LEACH FIELD
EXISTING
LEACH FIELD
PROPOSED
LEACH FIELD
SEPTIC TANK
Septic Design Prepared for
JOE & SHARON HOFFBECK
HOFFBECK SUBD. LOT 2
Anchorage, Alaska
Michael N. Anderson, P.E. DATE:
4661 NATRONA AVE. DRAWN:
ANCHORAGE, ALASKA 99516
PH 345-3377 / FAX: 345-1391 SCALE:
3/22/2011
DJ R
1 "=40'
EXISTING SLOPE
25% SLOPE
EXISTING SLOPE
25% SLOPE
EXISTING SLOPE
25% SLOPE
OF -74
.•••
• 49TH •��
... ........................ : .
�MICHAEL N. ANDERSON.'
�� •' No. C 94 •� �
Municipality of Anchorage
Date
``(2NGINEEI SEAQ•"a
"W4 :"
Development Services Department
Building Safety Division
Depth to Water
,= m
w N
- �' V
%im
On -Site Water and Wastewater Program
• a••• o e mo 0 0• w ®m
4700 Elmore Road
" m • ..�' A7• ...... • . m m n •>
P.O. Box 196650 Anchorage, AK 99507
n P'�UCHAEL N.
www.ci.anchorage.ak.us
Cc - S4uq
(907) 343-7904
Soils Log Percolation Test
�
-
Performed For: cry — -e z 4(_ , Date Performed
Legal Description: my i4'7,tz k Goo Z Township, Range, Section:
C=r I Slope
_�
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
COMMENTS
t
16, Ur�ph�zg
WAS GROUND WATER
ENCOUNTERED? tA0
s
IF YES, AT WHAT DEPTH? L
Depth to Water After P
P
Monitoring? unC—, E
Date:
C
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
re
to
/lam
�
1 Sib
PERCOLATION RATE Z Z-- (minutes/inch) PERC HOLE DIAMETER i0
TEST RUN BETWEEN L( FT AND S FT
PERFORMED BY: ! 11 k'--'4-""4✓.1 1 CERTIFY THAT THIS TEST WA
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: I /,{
90
- Y''-"- �•�J 7A
Municipality of Anchorage (EN s 4L F �►
Development Services Department ' 49 •��
Building Safety Division • s . s .. • • .. • • .... s e o . d
On -Site Water and Wastewater Program
4700 Elmore Road� ��'.:�...... ..... .
�• MICHAEL IN. ANDERSON y's
P.O. Box 196650 Anchorage, AK 99507 �•• CE 9409 • „
www.ci.anchoraae.ak.us
(907) 343-7904 ��rr • •„� y�
Soils Log - Percolation Test
Performed For: -TO— ILL, Date Performed:
Legal Description: L u {- 2 [ted � � a t k, Township, Range, Section:
1_t-? � AaC-741.
Depth a✓y uvtit r S
(Feet)
1
2
7
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
COMMENTS
C ffl
S!' �1 ” ."'_ l
WAS GROUND WATER
ENCOUNTERED? V
S
IF YES, AT WHAT DEPTH? L
Depth to Water After P
F
Q Monitoring? „c__ E
Date: 3 /2 /I
Site Plan
ID._ _/. ,L-,
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
3d
3 Z
3b
�
34t/s
3b
lifer
HERGULA I [ON RATE Z.'j _ (minutes/inch) PERC HOLE DIAMETER (p
TEST RUN BETWEEN_FT AND 4:�_ FT
PERFORMED BY: ('-I1 k C_� , I CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 3//y(11
) k.-/ 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 I []NEW
MAILING ADDRESS
LOCATION NO. OF BEDROOMS
~ M DISTANCE TO: Well lO& t Absorptio~a[ea Dwelling~/ PERMIT~_~NO.
~<~z Manufacturer ~ Ma~(~-~ N°'°fc°mpartments
~ N Liq. capacity in gallons Inside length Width Liquid depth
~O IF HOME~DE:
~ M DISTANCE TO: Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ Well/fl/ / Foundation ~ Nearest lot li9~ PERMIT ~O.
¢ ~ DISTANCE TO: -~ ~O ¥ ~O ~ ~
~Z~. No. ofline, / ".ngthofeachlinee¢. Total length of Unes~¢ . Trench~d~_ i~ .istancebe~?~lines
~ ~ ~ Top of tile to finish grade Material beneath tile [ Total effective a~sprptfon area
Length Width Depth PERMIT NO.
~ p Type of crib Crib diameter Crib depth I Total effective absorption area
~ Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Cla~ I~¢ Depth Driller Distance to lot line PERMIT NO,
Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST R~TING
INSTALLER/
REMARKS "~/ ~'-
~7~¢ DATE LEGAL
PERMIT NO:
DATE' ISSUED:
DEI='ARTMli~]qT Fi..._/HEALTH AND ENVIRONMENTAL i~,~TECTION
· 8R5 L ol.F~EE.] , ANCHORAGE, AK 9950i
C]~ ~',~ ,~ ~B' YE '"F [~] ~ IEE [,,,~ E] F~:'. F" EC r~ ~"~"~ ]r '"'~ ....
APF'L I C..AN T
ADDRESS
COI'q'I'AC'T' PI-lONE:
JOE HOFFBECK
BOX 11'1765
ANCNORAGE, Al':::
345- 12.27.
99511
I..EGAL DESCR I
L. OT SIZE:
MAX BEDROOMS:
SUBDIVISION: PRATOR
SECTION: 35 TOWi'qSHIF'." 12Iq
4.8A (SQ.F'T. OR ACRES)
'3
LOT: N/A
RANGE,:" 3W
BLOCK:.~.,"~
Lis{ed below are ±.he options avail, able ~:~;,]~-~in designing yl~Lll: septic
Choose ~ thE, ~' t h a'l' '
system, option .. bes~s~'o~u".. . s..it~.... _
DEPTH "1"0 F'IPE BO'I"]'OI'd (F"r.) '4.s
GRAVEL. DEF']H (F T. ) / ~,,-~.,~ z~ O. 5 3.0
TOTAL DEPTH (F'T.) -/ 7.0~ z 5.0 7.0
GRAVEL WIDTH (I::T.) / ~,,
5.0
(Fr.) /
GRAVEL VOt_UME (CU. YDS.) j 33~4 34.3 47.4
TANK SIZE (GALS) 1. 1.00().0 ** 00C).0 .~.~ 1,000.0 .x..
S(]IL ~AFING (SQ.FT,,/BR) ( '206 ...../ 201 , 2.0,6
~ GRAVEl,.. I,_ENGTH > 75 FT. I:~EQUIRES MULTIF'L~RUNS (NOT EXCEEDING 75 FT. EACH)
Forth by the Municipa].ity oF Anchopage (MOA) and the ~tate of Alaska.
2. t w'ill in~tall ~he ~y~tem in accordance with all MO~ c:~de~ and peguIations~
and in ~ompliance w~,~:l"i the design cri{eria of this permit,,
3. I ~i].l adhere 'L~ all MOA and Sta{e oF Alaska requirements FoP the set back
· distarH:es ['ro~ any existing ~e].l~ wastewatep
sewerage system on this oP any adjacent or neaPEy ].or,,
4. I understa{nd thaC this permit is w~lid [or a maximum ~[ 3 bedrooms and
any enlargement will p[~quire ali additional permi{.
IF A LIFT STATION IS INSTAL. LED IN AN AREA COVERED BY MOR BUILDINB CODES,
THEN (1) AN ELECTRICAL. F'ERMIT AND IIqSF'ECTION MUST BE OBTAINED; (2) AS-BUII....TS
EI_.EC'I'RICAL W~RK MLJST B~t DON~. BY A I._IC[:INISED ELECTRICIAIq. '
............
E~SSOI LS LOG"
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[~PERCO LATION
TEST
4
5
6
~7
8
9
10
11
12
13
14
15
16
17
18
19.
2O
SLOPE
DEPTH
1
COMMENTS /fl'7 ~'/aK
SITE PLAN
WAS GROUND WATER ,~0 SL
ENCOUNTERED? , O
P
IF YES, AT WHAT E
DEPTHS,//
Gross Net Depth to Net
Reading Date
Time Time Water Drop
~&o , jo
PERCOLATION RATE 7 , 5..(:' ' j~)
(minutes'/ii~ch)
'/ ,,'cz_
TEST RUN BETWEEN FT AND FT
72-008 (6/79)
CERTIFIED BY:
~L~r~ ~W~U~"-,~
CONTROL SERVICL~ INC.
1200 West 33rd Avenue, Suite B
ANCHORAGE, ALASKA 99503
(907) 561-5040
SHEET NO OF
CALCULATED BY /~ ' "~J)~'~/ DATE
CHECKED BY DATE~
1:30
SCALE
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL ~R. ALTH
DEPARTMENT OF NEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR ~ALTH AUTHORITY APPROVAL CERTIFICATE
1o General Information
(a) Legal De~scription (include lot, block,
.. ~:. Location (address or directions)
· : '(b) Applicants Name ~'~FF~
Application Date. q-~L~f
subdivision, section, townships range)
Telephone- Home Business
Buyer ~; Other ~.'.(.explain);
il (d) Lending Institution Telephone
Address
- (e) Real Estate.Co~'& Agent
Address
(f)
Telephone
Mail the FAA to the following address:
'2. TYpe of Residence
. Single-Family~
· Number of Bedrooms
3. water supply.-
Multi-Family~--~
Other (describe)
Individual Well~ Comnmnity~-~ Public~--~
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Disposa~
Onsite~. 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]
En~ineerin~ Firm Providin~ Inspecti. ons~ 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 M~nicipality of Anchorage files and from my
investigation and inspection, the on-si~e 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.
~ ~ /~/(~. Telephone ~/'~
'DHEP Approval
' 'A~proved for ~bedrooms
Disapproved
Approved _~,,,_
Terms of Conditional Approval
CAUTION
THE MUNiCIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
:: " (DHEP) ISSUES ~ALTH AUTHORITY A~PROVAL 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 BEFOR~ 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)
N~UHK::IPALITY OF ANCHOP, A~,~ALTH AUTHORITY APPROVAL (HAA)
D~PT. OF HEALTH & CHECKLIST - FEBRUARY 1984
J~NVIRONMENTA~ PROTECTION~
,SEP ~ 5 1985
WELL D,T, RECEIV F..i
Well Classification ~kJ~
264-4720
Legal Description:
If A, 13, C, D.E.C. Approved (Y/N)
Well Log Present ~¢)/N)
Total Depth / ~-' '~ /
Static Water Level ~
Casing Height Abov¢~rbund
Electrical Wiring in Condui (t~N)
Separation Distances from Well:
To Septic/Holding Tank on Lot
Cased to 'Z /
Date Completed //'- ~0 - '7(~) Yield
Depth of Grouting W'//'~''
Pump Set At W///¢
Sanitary Seal on Casing(~N)
Depression Around Wellhead (Y(~)
/o'-//
; On Adjoining Lots
' On Adjoining Lots
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line
Cleanout/Manhple
Water Sample Collected by
Water Sample Test Results
/, 5-'7
f
///.///
///./~',-^ TO Nearest Public Sewer
~f///¢' ~u Nearest Sewer Service Line on Lot
,/~--5 ~_ ;Date
~ ~/~ F~ c '~ ~ y
~?x//
B. SEPTIC/HOLDING TANK DATA
Date Installed ~-/
Standpipes CN) Air-tight CapstaN)
Depression over Tank (Y(~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well _ ,/'~
To Property Line ~
//.,
To Water Main/Service Line
Course
Size /'~'~ ~'/¢'¢~ NO. of Com. partments
Foundation Cleanout (Y(~
Date Last Pumped
;for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page I of 2'
72-026(1~/84) /
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
· ~ "'"'/,~'~'¢ Type of System Design
Length of Field ~?'~ "'
Depth of Field
~'Z<-~ ~ Gravel Bed Thickness
..-%
Depression over Field (Y~'N~)
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ?/z//''
To Building Foundation ~¢.~" "7~
Lot ~
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Standpipes Present(~)
Date of Last Adequacy Test
To Property Line
To Existing or Abandoned System on
;On Adjoining Lots 4~)..~
To Cutbank (if present)
Comments
LIFT STATION
-D~size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
· Cycles during Adequacy Test, Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify t.l~l h?v~e.,.c¥/c~ed, ~'~rified, or conformedDate to
SigneZ..~////cC_~g(f_.~/~./,/,~., ..,.¢~.,.¢ all MOA apd HAA guidelines in effect on the date
Company ,/¢'~ ~'-~~'4.. ~~~A No. ~'~
Receipt No. ~O~ .~ ~.~ '~ ~ """~'~'
Date of Payment <:~ ~
Amount: $ J-4,~
Page 2 of 2
72-026 (11/84)
of this inspection·