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Home My WebLink AboutFYFE BLK H LT 1�� i' Y ��=:.:�� = �.aa "s a � y, , c a � M� s �� ;�v � �� x � ��fi �u GAAB-HD,I e� G774TER ANCHORAGE AREA BOROU ,,H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON -SITE SEWAGE DISPOSAL SYSTEM NAME ' O� 4iV /� �i 40 4T! MAILING ADDRESS �� Lo6AA0 PHON 'y LOCATION �?�f ✓ '�� LEGAL DESCRIPTION taf � / T`1 F 5 06 SEPTIC TANK: DISTANCE FROM WELL CAI 1 MATERIAI LIQUID CAPACITY C GALLONS. INSIDE LENGTH NUMBER OF j COMPARTMENTS I �4 INSIDE WIDTH � LIQUID DEPTH- Z-r SEEPAGE SYSTEM: SEEPAGE PIT: L�INlG S i f NUMBER OF SITS OUTSIDE DIAMETER OR WIDTH LENGTH , DEPTH, LINING MATERIALDISTANCE FROM WELL / �T BUILDING FOUNDATION NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ICI 0 SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION AREA FOUNDATION , NEAREST LOT ISTANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE TRENCH WIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE, IN. ABOVE TILE WELL: ► DISTANCE FROM WATER TYPE DEPTH BUILDING FOUNDATION. SAMPLE NEAREST NEAREST SEPTIC SEEPAGE OTHER LOT LINE SEWER LINE , TANK SYSTEM CESSPOOL , SOURCES DISTANCES: f 4-6- 3 6-D = I �; GD i ' F-=1P1 T ,D-- l 94 r C - la,+' DIAGRAM OF SYSTEM DATE APPROVED HEALTH AUTHORITY GAAB- GREA 11 L. 1, AHCHURI AGE, AREA _ 3RO UlGH Case No. HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 NAME OF APP L k` p RESIDENCE AD Dl SEWAGE DISPOSAL SYSTEM - APPUCATMH & PERAMT LEGAL DESCRIPTION MAILING ADDRESS/ P/H0NErN0.27�'-->�� LOCATION OF INSTALLATION RIA /J APPLICATION TO INSTALL: SEPTIC TANK X , SEEPAGE PIT TO SERVE THE FOLLOWING FACILITY , DRAIN FIELD , OTHER FINANCED THROUGH TO BE INSTALLED BY PERCOLATION TEST RESULTS 12A_ 13V ANTICIPATED DATE OF COMPLETION r BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT G THIS IS TO SERVE AS 'Yl,r,. %�/arcLLT PERMIT TO INSTALL A � "'"`� s r�"�� AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .SEPTIC TANK SIZE 1<-00 TYPE 5fe� SEEPAGE AREA 600L7 DIAGRAM OF SYSTEMS DISTANCES: 7-A7,,,K = &G r 0rSTilcxoc r ,,�'✓_ c L-`v w ,r pr (U Health Authority ■■■■■�E■■■■■■■■■N■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■ME■■■■■■■■■ ■■M■■■■■■■■■■■■■■ ■ ■' ■■■■■■■N■UM■■■■NE■■E■■ ■■■■■■■■■\■■■■E■■■� ■■' ■■■■■■■■■■■■■■■ �. MEN N■■■■E■■O■M■■■■. ■■■ ■■■■■■■■■■■■■■■ .M ��. M■R■■■ I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE �/' A APPLICANTS SIGNATURE J GREATER ANCHORAGE AREA BOROUGT—` ! HEALTH DEPARTMENT CASE i# 327 EAGLE STREET ANCHORAGE, ALASKA 99501 Performed For �11, 1' %%j,�s S�; � 7 Date Performed_Z Legal Description: Lot / Block y-j. Subdia.sion j e This Form Reports a: Soi� is Loge - ercolat onTest Depth Feet Sail Characteristics Location Sketch t/ e seo/,,we, 71s Lvl'rE 3i ne /vUse/ COh7 ac �c �v�'i/a c� f ma>s�crrt' cdrite��t s _ m ed• L Samid i "ars 7� sand lenses 8 rr /D rr 'S, Was Ground 'dater Encountered? �� oo� If Yes, At ,?at Depth Proposed Instal17t� ion Seepage Pit f/ Drain Field Depth Of Inle* UhDepth Te Bottom Of Pit Or 'Trench""" COMMENTS : 7! o a . r » >; �r Test Performed By: ,cn Data Certified Date: l�-� � y f - i+ � 1t� �� ,t 11 \\�\ ill! \�\z� 1� rir //�'✓ �. r - i� _K ` i FOr D *y. - 1'g,; Location Lc�� fit. �1ac�. 1 ��►�a Sl,�bd � vi.s.l�'�2 ;,�� -_' ! i ,, -- r r/1 I SI/�. L Date Completed , cT1I� �g ./ �� ;'r. t �� i yt } p De.itllof`weil\�:la,'��;FeE:�, ` Size of yr. � Y ` ..! / �I :h // ✓ /+cam p { -. Distance•to water �� .�'�E:� x . •al f;. /rA t /'r .r i //� � `�' -• {� :� � }J c n � /� S! / �� j- Sri/� ��/r i� K�)t� Distancto 3�a%r while pumping 147ie�>z+ /.+ �i atate�/� 3Fz k� F gallons` per }YJ r. <_c... 1` i 1._--. ��__ �:�� = Y -r ''a. .t ic. .d , /S ., _ �. �_' -'�i/ �,y cam' �•� ��. ��`= Description of Fo ina'tionj , r* :- #rom U P( �c ter" _� v rtj 7•�ZfiS'ii F :�• s ` 10 v ram- /J ` r 011s- A� fif , f N certify the above true and correct. z. Yam'. •�-y.• ,71 ,.�,�. .� /J:'. ir,•" %i � � `:-:-,��1C."�.� F l�:l.._ �• _ � �-.� //% °lY�' i%/ �� [ �.� ` ``r i 'S••f (er rel P. Toss : BA \` S �7}ST II,r77.ti. _ ~ ` �t\ ' ' � • .� + ANCHOHACE - PHONE 2792849 �; We advise you to attach thLs certificate to your deed _ 0: f.. •�Z iC-y � :t1 / nr<. :�- i� i � .,� . :,rq•* P �.-./F `£.r ew i ,;'�.�� r �.s � ~ '- - -i e^.c. �i'.l MUNICIPALITY OF ANCHORAGE ® Department of Health & Human Services 4 DIVISION OF ENVIRONMENTAL SERVICES] 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON -SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcell.D.# 009-273-40 HAA# HA890510 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Block H Fyfe-Subdivision Location (address or directions) 1865 East 57th Avenue (b) Property owner A. H . F . C. Telephone: (home) Business 562-1222 Mailing Address o Heritage Real Estate 3230 C Street, Anchorage 99503 (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Eve Thompson o Heritage Real Estate Address 3230 C Street, Anchorage, Alaska 99503 Telephone 562-1222 (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Ox Number of bedrooms four 4 ) 3. WATER SUPPLY Individual Well �X Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On -site ❑ Public a Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. E14GINEERING 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Flattop Technical Services Telephone 345-1355 Address 14530 Echo -Street, Anchorage, Alaska 99516 Date December 16 1989 Engineer's Seal 6. DHHS APPROVAL APPki,Y&Y,rXXXXXXdrooms by ��' ate July 9, 1990 A0pbiXXXXXXXXxXX xxxxx Conditional Terms of Conditional Approval This property is disapproved: the Conditional Approval of December 26, 1989 has not been completed. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE ® Department of Health & Human Services DIVISION! OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON -SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # _ �_ % HAA # hW d �IQZVO 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) oaf �3tocl, Hf /=y,i2e S'/b Location (address or directions) (b) Property owner A H F C Telephone: (home) Business S6 2- I'?- 2? Mailing Address `lo ller, C Reat �//e 3Z30 vC"S f�ncGrar.� �99So3 (c) Lending Institution INA. Telephone Mailing Address (d) Real Estate Company and Agent 14er, Jcxq e R ect /':r 1-e — C vex TAOy'p10 Address 3 Z30 ,4!-r `!"� 5 0 3 Telephone _Ed 12 2 2 (e) Mail the HAA to the following address: (or check here 2, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family ($ 3. WATER SUPPLY Individual Well 9 Number of bedrooms N Community ❑ Public ❑ Ted /'To orb Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On -site ❑ Public N 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. 72-025 (Rev. 7/88) Page 1 of 2 5. 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 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm F(ab,,y TecA17 i cat fervcce Telephone 3 `f.S-- I:r Address A, Sri. All C 6 cr'� -I" 4 1-C Date !�E'C2rn!a�r / 19F9 4) A/ �vyi'3 •'R "Tw •°. �ac�c_ Engineer's Seal . TncGDG<'.- F. Pti00RE ; Q ." CE-3589 c:s f • tl no c7 1tJ' Preyes,v,�a� 6. DHHS APPROVAL , Approved for bedrooms by , ' ate 12 r 2(!— 0 f Approved _ Disapproved Conditional Terms of Conditional Approval V E D F 1 C A 71OAl T_ H,4 r Ll o ce .TF &,9 S aFE AJ CPAIVER.rE0 TO 5fA161. E i9 A41.L Y. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 oranalyze 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. 7/88) Back Page 2 of 2 r0" 'UV A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) A Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: /-0f S I.D Well Classification Pr veak6 If A, B, C, D.E.C. Approved (Y/N) NA Well Log Present (Y/N) Y Date Completed - / 29 / G9 Yield 14" Zoem rh eceJ l z/ ll 169 Total Depth 10 7 Cased to 10 7 Depth of Grouting 1,4r4. Static Water Level 3 7' Pump Set At Casing Height Above Ground 2 y � Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) _ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Nr A. ; On Adjoining Lots N. '4. To Nearest Edge of Absorption Field on Lot N. ; On Adjoining Lots N• A To Nearest Public Sewer Line 6' Y I To Nearest Public Sewer Cleanout/Manhole 6ti ' To Nearest Sewer Service Line on Lot >, 2d ' Water Sample Collected by Flu >4 fop 7-e-C6 n (ca 1 Su cl ; Date 12 1111(5,9 Water Sample Test Results Sseka:6ac r-�z - O ca/r-10, r7 //00 naA -dcfe c4il'le ni{-frl`e1 Comments Sen0-raf10 otrs{ecn re-r 6uer'e 1c4a1 6r7t 7/ ene ceretl '1-s'ewer' W ere 1 n s {mot (l P s o Th;r aCu�ec I,,,�, %s cur -en f/r /as (�i Coe ct a cel{x h u f (fFC ;s i n ;�Ae ro c-&Cr o,f_ cow vcrf(n B. SEPTIC/HOLDING TANK DATA N,A• (f becC k,- Y6 cLS(nq le �ur4(ty Date Installed Size No. of Compartments V Standpipes (Y/N) Depression over Tank (Y/N) Air -tight Caps (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High -Water Alarm (Y/N) Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Property Line To Water Main/Service Line To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments Ver;fl:e X non/Ircf-rvn )1v f}({/GUr.0 Sece_•ev- 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA M, 4. Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Property Line ; On Adjoining Lots To Stream, Pond, Lake, or Major Drainage Course To Existing or Abandoned System on To Cutback (if present) To Driveway, Parking Area, or Vehicle Storage Area Comments f/'Grt Aed co41? ec fro"r) 216 / -C/wGC -5 eu" -e - D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) ""Check Permitted Bedroom Rating Against HAA Request"* "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidee4r j�n effect on the date of this inspection. 0 A� Signed .F.Y Company Flecf!�,4 %ccA n ted SSeru r c Date De-c•eni h -er t 6 19 9 9 s e �• ° .-........... �3 Engineer's Seal MOA No. 89 —Q.7 2 c!• e o oaoeaaef� it a•rH 000K� ,:, MOORE �0°e.aaaa°°°° . �%, / ClT Receipt No. Receipt No. Date of Payment Waiver Fee: $ Amount: $ f % - 06 Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 APPLI�T NT FILLS OUT UPPER HAI- ONLY Property Owner ),� `) �-� 7D tJ ,, Phone Mailing Address b b ( 7 --- 4rld % Zip Code 7 / rG vO 1 Buyer IQ�IYI r'IC�E`SC7n Address WJ 1 I,-/ 7 � —� L'-� �-v1C�1 � r I /�- � Zip Code 9 � 6 e-2 — Lending Institution 1 US D C, hog Phone Address Zip Code Realty Co. & Agent Phone % Address / Zip Code L Legal Description�.� ( % }} _ �i� t7 Street Location 13,65 G C . i ;; Q T l� � /l/its kc- Type of Residence eSingle Family Multiple Family No. of Bedrooms ❑ Other Water upply Rr Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal r ❑ Individual Public Utility Year Individual Installed: -1 When Connected to Public Utility: ) � 7 ❑ Holding Tank ,S w m,- 3-1( --73 ' W-6� NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST 14EFORE PROCESSING CAN BE INITIATED. Yam" Time Time Time Time Date Date Date Date ) Inspector Inspector Inspector Inspector Cf/(if c7 Field Notes: ( PPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( )CONDITIONAL APPRO, L' DATE BY. tr Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72-023 (3/82)