HomeMy WebLinkAboutILIAMNA ACRES TR 9 S2
NAME
MUNICIPALITY O1-: ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
IPHONE~'-fs--Ict36 [
[] NEW
[~UPGFIADE
LEGAL DESCRIPTION
LOCAT ON
I DISTANCE TO:
~' Z I Manufacturer
-- ' IF
~I~ ~ ....
r4~l U~STANCE TO:
fi' ~ /T°P of tile to finish grade
4: ~- / Type of crib Crib diameter
5'ftc- '3c/ T'lz-/V ~.3uU
u)_~! DISTANCE TO:
Dwelling
Poundation
IMaterial ~
/ Trench width
J -- inches
'l'otaI length of lines
NO, OF BEDROOMS
PERMIT NO,
'~ q O gZ 4¢
N?~Lof com~_artments._
Liquid depth
PERMIT NO.
Liquid capacity in .qallons
Distance between lines
Material beneath tile Total effective absorption area
~- inches
C~ib depth I Total effective absorption area
Well Building foundation Nearest lot line
Depth Driller Distance to lot line
Sewer line
Septic tank
Building foundation
LAbsorptio~ area(s)
PIPE MATERIALS
OTHER
SOl L TEST RATING
INSTALLER
REMARKS
APPROVED
72 013 (Rev, 3/78)
DATE LEGAL
'J. Ct '?//,~4__4ctze-_s' __ fi cl ¢;Lt,
D E !:::' A R T M E N 't" 0 F F'IE A L.'I'['"I A N D E I',l V I R C) N M E I',IT A L. I:::'R r.3'l' E C'T' I {.')l',l ("'"~"~"~/~"
825 L S'I"REET ~, AI',IC]HCtFd.~GE ~, ~1.::: fi)95() :L
264 .-. 47 ,'..:~ 0
F:'E I::;~J"t ]: T I',10:
DA"FI!!~.
A F'I:::'I.,. I C~NT:
A D D R E S S ~:
CONTAC, T I::','HOI~,lf~': ~
LO'I' SIZE~
84'C)8R6 L.!I:::'G R ADIE '
09/[:77/84
I....li!:N t S I.-II~!:l-Hql.... :l: N
SI:~A 3:.? 4'-'"F~
A N C H 0 R A G E, ~ I<
345 .-.. :1.936
99502
SUBD I V I S I ON: S 112'1"R9 I I..L. ]: AMI',IA AC ,, L..E)'T': I',IA
SEC'I" I [)1',!: 3Zl- "I"[:)WI",ISt,.I I P:121',! F~AI',.IGI~i:~ :3W
2A (SQ,, FT,, CIR ACI:II~S)
BLOCK :: l",1~:/
]: c e r' '1:., :i. f' y i'. h a t:
'Fori:.h I::ly 't'..he l".'tuF~:i.c:i, pa].:i.i:.y o£ AFichc)rag(;.z, (MC]A)
~'.',, :1: w:i.].:l,ins'La].], the sys:t..em :i.n ac(::ordaFH:::[:! w:i.'t:.h a].].
arid in comp].:i, anc:e ;/,~:i.'t:.l'l the (::h-:~s:i. gn c:riter'i,~!t c:),~' th:i.-i~!~ pc.:.'-r'm:i.'t:.,,
3,, I w:i.].], adher'(...".) i:.o a].]. MOA ar'~(::l ,r'.~H'..ai:.,~.) o'[' Alaska
s(.,'.:,,,,.~er'age s',,/st(.:~?m on 'l:.h:i.s (:)p F..~. ['l ',,/ aC'Jj~':~t[:EH"lt OP I'l(:.~al'~J::)y ].c)t,,
IF: A I.:.IF:T ,r:B'I"Aml"ION .1:S ]:NSTAI..J..J!i!D IN AI".t ARENA (:,[)VE!:RED BY M[)A BUILDING CODEi:S~,
'T'Hl!ii:lxl (1) AN 11!:'I._I!!i:[TT'R:I:CAL. l::"l!i:l:Rl'd]:"l" AI',ID :I: N',".~ff::'ECT ]: ON MLIST BE OBTA:I:NIi~:.D; (2) AS'"'BU:[L.T!i~
WILL NOT BE AF:'F'F([)VED WI'T'I'I'~)UT AN ELECTFRICAL IN!!:-",F:'E:CT:I:ON REI:::'OFFI"i[ AND (3) THE
EI..I~CTT'F/ICAI... WC:IRI< MUST BI!!!: DONE BY A L]:Cli!i:NSED EL. ECTRIC:t:AI',I,,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION
ENVIRONMENTALENGINEEHINGDIVISIQN
825 I. Street- Anchorage, Alaska 99501 Tolephone 264-4720
QN-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELl_ INSPECFION REPORT
NAME
MAILING ADDRESS
-LEGAL DESCRIPTION
7-/_, c),
LOCATION
Well /
DISTANCE TO:
Manufacturer
~ Well / -
~-I Length of each line
T~ ¢ ti~ fi~ g~¢d.
Width
~1 Type of crib
Absorption,,~.._/area Dwe,~.~ g~._ _ /
Materia. I
Inside length___ Widt~~/~
PHONE [~
q~ ~'{~- /'~' :~/-~ / [] UPGRADE
NO. OF BEDROOMS
PERMI-F NO.
No. of compartments
Liquid depth
Dwelling PERMIT NO.
Liquid capacity in gallons
Material
Foundation / Nearest lot line
,5-S' /
Total length of lines /Trench widtl~_ /
OTHER
PiPE MATERIALS
tb 3o,-)¢
Material beneath tile
Depth
PERMIT NO. _
~ ~o 9¢ S'~
Distance between lines
Total effective absorption area
PERMIT NO.
Crib depth Total effective absorption area
Building foundation Nearest lot line
Distance to lot line
Driller
Sewer line
SOIL TEST RATING
INSTALLER
REMARKS
Septic tank ~ ~'
PER MIT. N.__O.
IAbsorption area(s)
APPROVED DATE LEGAL
72-013 (Rev. 3~78) f- 'J'
PERMIT N0. ( E:2E'~ )
RPPL. ICFINT
LOCFITION
LEGFIL
DEPRRTMENT OF HEFtLTH FIND ENVIRONMENTFll.. PROTECTION
825 "L'" STREET., RNCHORFIGE., FIK. 9950:1.
264-'472(']
S;E.*,~ER F'E:'R ~-'1 I 'T
LENIS HEFINLI N
S:1.,."2 TR. 9 ILLIFIMNFI FICRES
SRFI BO>~ 324-R 99507
LOT SIZE 999999 SQUBRE FEET
TYPE OF SOIL. RBSORPTION SYSTEM IS: DRRINFIELD
MRXIMUM NUMBER OF BEDROOMS = ~
SOIL RRTING (SQ FT?BR)= 200
'rHE REQUIRED SIZE OF THE SOIL RBSORF'TION SYSTEM IS:
[) E F' ]- t-i = .~_--';.. -":2; L. F_T I'-.I t~ T I-! -- ;=-: ,~!- G R R %,' E L_ [:, E F" T H = ;2
THE LENGTH DIMENSION IS THE LENGTH (IN FEE]'') OF THE TI:;?.ENCH OR DRRINFIEI..D.
THE DEPTH OF R TRENC. H OR PIT IS THE DISTFINC:E BETNEEN THE SURFRCE OF' THE
GROLIIqD RND Tt-IE BOTTOM OF TFIE E,':<CR',,,'RTION (IN FEET).
]-HE'"] ]'F'ENr_?.H IL-JI I [)TH I S 5. ~E.~]'~O F-E~.ET_
THE GRRVFL DEPTH IS 'THE MINIMUM DEPTH OF GRFIVEL BETNEEN TFIE: OUTF'RL.L PIPE
FIND '['FIE BOTTOM OF THE E,"4CRVRTION (IN FEET).
I~E~;!IJ ][ IRED. :SEF'T ][ L--:.. T FII'-,II<: S :I ZE= ::1_ ~_-t£-~ L:-~ CiFIIL L C~i'-,IS;
PERMIT FIF'PI..ICFINT HRS THE RESPONSIBILIT'¢ TO INFORM THIS DEPI::IRTMENT [:,LIF.'.ING THE
INSTRLLFITION INSPECTIONS OF-"' Rl",h-~ NELLS FIDJRCENT TO THIS F'ROPERT¥ RND THE
NUMBER OF' RESIDENCES THFIT 'rilE 14ELL NILL SERVE.
TIL,,IC~ ,:: ;~.: ::, :E I'-,ISF"EE:T I C~ I'-,I'..--S_.; F-IRE RE I..~!LII I F.':E D,
BFICKFILLING OF FINV SVSTEM WITHOUT FINFIL INSPEC:TION RN[:, RPPF.'.O',,,'RL BV TI-lIS
DEPFIRTMENT I,-IILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTFINCE BETNEEN FI NELL RND FINV ON-SITE SENRGE DISF:'OSRL. SVSTEM IS
:t00 FEET FOR R PRI'v'FITE NELL OF."..'1.50 TO 200 FEET FROM I.".1 PI..IBL!C I.,.IELL DEPEN[:,ING
LIPON THE TYPE OF PUBLIC I.,.IELL
i','IINIMUM [.',ISTFINCE FROM R PRIVFITE NELL TO R F'RIVFITE SEWER LINE IS 25 FEET FIND
TO R COMMUNITY SENER LINE IS ?5 FEET.
OTHER REQUIREMENTS MFI¥ RF'PL"r'. SPECIFICFITIONS FIN[''' C:ONSTRUC:'rION [:,IFIGRFIMS RRE
t-]',,,'RILFIBLE TO INSURE PROPER INSTFILLFITION.
I CERTIFY 'T'FIFIT
:l.: I FIM FRI"'IILIFIR WITFI THE REC-.!UIREMENTS [-"OR ON--SITE SEI.,.IERS RN[:, NEL. L.S RS SET
FORTH BY THE MUNICIPRLITV OF RNCHORRGE.
2: I NII_L INSTRLI_ TFIE SYSTIEM IN RCCORDFINCE NITH ]'HE CODES.
Si:: I UNDERSTRND THFIT THE ON-SITE SENER SYSTEH MFtY REC,!UIRE IENLRRGE. MENT IF THE
RESI[:,ENCE IS REMODELE[:, TO INCLUDE MORE THRN 3: BEDF.'.OOMS.
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:
DATE PERFORMED: ~- Z''~-~(~
LEGAL DESCRIPTION:
2
3
4
7
8
[-~ II
SLOPE
{
SITE PLAN
10
11
12
13
14
15
16
17
18
2O
COMMENTS
PERFORMED BY:
72-008 (6/79)
WAS GROUND WATER S
ENCOUNTERED? ~/¢-.LS OL
P
E
IF YES, AT WHAT !
DEPTH? { '~
Gross Net Depth to Net
Reading Date Time Time (l~;r~,;[¢i Water Drop
PERCOLATION RATE / 7 (minutes/inch)
TEST RUN BET~/EEN ~ FT AN/~ ~-- FT
CERTIFIED BY: DATE:.
~nqin,!mm) 8 ~nulror, mcnl!l! $1urJirs
READIHG tt CLOCK TIME NEY IIM~: Dl!Pi'H tq liE'[ DROP /P, ATE (minIin)
~ ~ /,~7 l~,~ ,~/ ~ ,o~ 1 ....
FIL'AL PERCOLA'FION RATE ~---------"%Z~ ,- .(mln/in)
I DRILLING CO.
P.O, Box 42
CHUGIAK, ALASKA 99567
PHONE 688-3199
DATE ,,"
NAME
ADDRESS
CITY
f
LEGAL OWNERS
BANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEED OF TRUST
HOME PHONE
WORK PHONE
DESCRIPTION OF WORK
WELL NUMBER
/
DEPT
/
* / HP SETTING
SERIALNUMBER //" ' it i
MATERIALS
QTY.
All charges shall be paid in full within
ten days unless other arrangements
are made prior to work. The customer
shall pay interest at the rate of two (2)
percent per month on any amount not
paid within ten days. Failure to pay
may result in a lien against the
property.
THIS IS A RIGN T TO LIEN SAID
PROPERTY DESCRIBED ABOVE
I UNIT! , ! AM(~U~T"'
WORKMAN DATE
CUSTOMER SIGNATURE
COMMENTS
MATERIALS AMOUNT
UNIT
PRICE
LABOR HO~RS I RATE
MATERIALS (FROM ABOVE)
OTHER CHARGES
PAY THIS AMOUNT
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL H~iALTII
DEPARt}lENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTIIORITY APPROVAl., CERTIFICATE
1. General Information Application Date ~-Y:_9~ 8¢/ __
(a) Legal Description (include lot, block, subdivision, section, townsh].p, range)
Location (address or directions)
(b) Applicants Name A~z~oCt; I,~a~,~L~'~ ..... T~e!iphone ~- Ilonm~q~ /?{~usiness
Applicants Address ~fl~. ~o~ '~gq ~g~ ~,~c~-~/~(~..c=- a~_
(c) Applicant is (check one)Lending i~Sg~Ut~O~ [~[ ; Owner/buS&de~ ;
~uye= L~5 ; Other 7"~ (explain);
(d) Lending Institution
'r e i e ?il o r~...'.. ...............
Address
(e) Real Estate Co. & Agent
(f)
Address
Telephone
Mail the ItAA to the following address:
~.y~e of Residence
Single-Falaily '~.~ biulti-Family [~'2~[ Other (describe)
Number of Bedrooms
Water
Individual Well ~ Community LTl
Note: If community well system, must have ~itten confJ_~ation from the State
Department of Enviro~ental Conserw~tion attesting to the legality and status.
4. Sew__~a.ge P~_ osal
Onsite ~_~ Public F-~ Community ~i~. fielding Tank F-~
Department of Enviro,mental Couse~/a¢ion attesting to the .(esa.l..i. uy md t;Fatus,
[Page 1 of 2]
5. E_~:Jneering Firm Providing~n~s_p~ion~sz__Tests, Fi_~l_e_S_ear~cJ)!~_.JJata and Information
As certified by my seal affixed hereto and as of the wtlidation 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° ! 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_~_~.~
Telephone
Date~
k~.~NEER SEAL) ~ $, (, /, / ~ ·
Approved _~_ Disapproved __ Condition~. __
Terms of Conditional Approval
CArrION
THE MtINICIPALITY OF ANCIIORAGE DEPARTblENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DIIEP) ISSUES ~AI, TH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON TILE REPRESENT-
ATIONS GIVEN IN PAtLAG[LAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DIIEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTSo ~24PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. I"dJg 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
A. WELL DATA
MUNICIPALITY OF ANCHORAGI~
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MOA)ENVIRONMENTAL PROTECTION
HmZTH PROVAL
OCT >3
CHECKLIST - FEBRUARY 1984
Legal DescriptJ. on :R~~,.~,~,~
Well Classification %~40r~ If A, B, or C, D.E.C. ApproVed(Y/N)
Well Log P~esent (YZ~j) ~JO Date,~ ~d~ ~- . Yie~
,O~,~Aal ,~.~ U_~-~-- / ,/-~' Card t~'c'~ ~P' ~pth of Grouting ~~
Casing ~Lgh~ ~ G~ound I, ~ ~ SanL~a~y ~aZ on CasLng
Eleat~ieal Wi~ing in ~nduit ~) ~: ~P~es~ion ~ound ~llhead
Sep~ation Distan~s fr~ ~11: ~:, ~1:
To ~ptie/~in~ ~ on ~t ~-~- /~,~-~ ~ Adjoining Lots
To ~a~est Edge of ~so~tion Field on Lot~ ~OO ; ~ Adjoining LotsF¢
To Nearest PuDlie ~ Line ~ To Newest Public
Clean. t/Manhole ~ To ~est ~ ~rvi~ Line on
Wate~ S~ple Collected By ~ ~S~ ; ~te ,~Z g~
Water S~le Test ~sults 3'~'V~s~
Be
SEPTIC/HOLDING TANK DATA ,,Uf.J3.-~,. r'~
%'c/
Date Installed /O-Z~-[Z- '/Size ./'60?~ ~r No. of Cc~,~artments ~__
.Standpipes _~/N) ~ Air-tight Caps ~N)" c/e) Foundation Cleanout ~_~N)
Depression over Tank(Y~ /%~O Date Last Pumped x~/~ y /C~/ ,/.~:/ ,L~
Pumping/Maintenance Contract on File (Y/N) ~j~. ; for
Holding Tank High-Water Alarm (Y/N) ~4~ Temporary Holding Tank Permit !Y/N)
Separation Distances f~om Septic ./~..01ding Ta0k:
To Water-Supply Well d~ -~c~{ ~O,>~1 ~o Building Foundation ;~ %~ !
To Property Line ~-- ~ ' To Disposal Field ~ ~ !
To Water Main/Service Line Az+ To Stream, Pond, Lake, or Major Drainage
Date Paid: %o-'
Amount:
[Page 1 of 2] 2-15-84
C. ABSORPTION FIELD DATA
~--
Soils Rating in Absorption St~at~ ~OO
Date Installed ~--/O
Width of Field
0g/~_ Type of system
length of Field .... ~ ~'7
Depth of Field ~ ~
Gravel Bed Thickness ~-~-
Square Feet of Absorption Area
Depression over Field (Y~)~ ~O Date of Last Adequacy Test
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~-
To Building Foundation
Lot AJ~-
To Water Main/Service Line
Standpipes Present4~y~ ~o
~ f0 01 To P~operty Line ~- /~
~-~ To Existing or Abandor~d System on
; On Adjoining Lots ~-~ /4~ -
To Cutbank(if present)
!
To Stream/Pond/Lake/or Major Drainage Course ~--T fO ~
To Driveway, Parking Area, or Vehicle Storage Area ~5 ,~ !
Comrents {- F~ ~_ ~,*l~~
...D. LIFT STATION
Dato~
Size in Gallon~--.~
"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)
Pumping~Oycles during Adequacy Test.
Meets MOA
Check Permitted Bedrcc~ Rating Against HAA Request
I certify that I have checked, verified, o~ conformed to all MOA
on the date of._~this .inspection.
Company ~ C~
KB1/d5/s
Date
MOA,
[Page 2 of 2]
2-15-84