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Home My WebLink AboutEKLUTNA WEST LT 13NAME 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 [] NEW PHONE ~UPGRADE ~)~e{~ ~-;~ ~:~ OF BEDROOMS 3 Well Absorption area Dwelling PERMIT NO, DISTANCE TO: Material Manufacturer ~ Liq. capacity in gallons IF HOMEMADE: DISTANCE TO: DISTANCE TO: No. of lines t Well Length of each Iir~e~ ' Dwelling PERMIT NO. Material Foundation Nearest lot line Total length of lines~..~ Trench~w Material beneath tile ,.~ {~) ~1 Top of tile to finish grade Length Width Depth Type of crib Crib diameter Crib depth Well DISTANCE TO: Building foundation Driller Sewer line luid capacity in gallons Distance between lines inches Tota effective absorpt?~..~r~ inches IPERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Absorption area(s) Septic tank Depth DISTANCE TO: Building foundation OTHER MATERIALS SOIL TEST RATING INSTALLER REMARKS 72-0~r3~ R~. 3/~8) DATE LEGAL ON--S I TE PERMIT NO. APPLICANT LOCATION LEGAL ~MUNICI~ ~LIT~' OF 8NC:|'|~. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 ~L ~ STREET~ ANCHORAGB AK. _g~501 264-472((~ JOE BLAIR PIONEER STREET L13 EKLUTN8 WEST LIPORP, DF P~Rrq I T SR BOX 14~0 CHUGIAK LOT SIZE 688 9102 20000 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ~ SOIL RATING (SQ FT?BR>= THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:~EPTH= {:; LEI~i]TH= 25 GRFIVEL DEPTH---- 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) Of THE TRENCH OR DRRINFIELD. 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 THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET>. REQU I RED SEPT I C tRt~K S I ZE= 500 GALLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. T~O (2) INSPECTIONS PRE RE~UIREE' BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION 8ND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELb OR i50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. OTHER REQUIREMENTS M8¥ APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS PRE AVAILABLE TO INSURE PROPER INSTALLATION. PERMIT EXPIRES DECEMBFR I CERTIFY THAT i: 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 WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE =AMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Lot 13; Eklutn~ W¢~ Subdivision Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Pau~ Godwin 21537 Tina Street Peters Creek~ 21537 Tina Stre~ NORWEST MORTSA$~ 16635 Centerfi~ld Drive, Dick Brown TARGET REALTY Chuglak: Address 17034 N. Eagle River Loop Road Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: individual well Community well NOTE: AK Day phone 696-2867 AK 99~7 Day phone ~q4-1144 101 E~gle River AK 99577 Day phone 694-2388 River ~ AK Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: X×X individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev, I/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER 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 application 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 ............. ,-- -~'"'""~ ,) Phone Address 17o34 Eagle River ~yd Ne. ~ ~ngineer's signature ~ ~ ~ ~ate ; ~/' ..,/ . , '%-. ~.~., · ' DHHS SIGNATURE ,~- Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date '7' '; 'JIl[flJ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to 8atis~ certain federal and 8tare requirements. Employees of DHH$ 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. 1/91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~ \-z~ ~..~_~_~_~.~,, ~--<~/=, Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height FROM WELL LOG A. Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line Wires properly protected (Y/N) g.p.m. On adjacent lots adjacent lots AT INSPECTION Public sewer manho e/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~-- ~. ~t '7.~ Tank size Cleanouts ~N) ,,// Foundation cleanout (Y/~i~) High water alarm (Y~ Date of pumping (.,,~ :~ - 3' ~ Pumper -Cc~/~c,-- Compartments Depression (~'~ Alarm tested (Y/N) '~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ~ t~- On adjacent lots ,~ [~v To property line /C) ~' Absorption field ~-~ [ ~ Surface water/drainage ~- ~o ~ Foundation Water main/service line 72-026 (~93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPAI~~ON TO: Wetf-ol~o~n adjacent lots Sudace water Soil rating (GPD/Ft2) D. ABSORPTION FIELD DATA Date installed ~ [ ~1 '7 ~ Length '~, / ~ Width Total absorption area ~'~ f/ Date of adequacy test ~-~ ~' o ~' Y' Results~/fail) Water level in absorption field before test ...i~eroxide treatment (past 12 months) (y~ EPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain ~ ~ Gravel thickness Cleanout present (~/N) / for After test If yes, give date On adjacent lots Cutbank Total depth Depression over field (Y~) Driveway, parking/vehicle storage area Property line To existing or abandoned system on lot Water main/service line Bedrooms E. ENGINEER'S CERTIFICATION I cerUfy that I have checked, verified, or con~ to all MOA and HAA guidelines in effect on th~ date of this inspect/on. ,':'~ ,:.: · , $ & S.~ENGIN/EERI~,T~ uae HAA Fee $ ,~ ~ ,~ Waiver Fee $ Date of Payment '-~/~ ~'?~' Date of Payment Receipt Number {~ ~ ('/*;5-/_./C)~'-? Receipt Number 72-026 (3/93)* Back · ~ Telephbne-26~4~: , REQUEST FoR APPROVAL OF INDIVIDUAL W~TER AND~ ~1 LI~?' DI REOTIONS= Complete all parts o~ page 1, Inoomplete re~ Will not'be proc~e,~--~ ~- '~AILING ADDRES~ PROPERTY RE~E~ (If diff~ren{ trom above) · ONE" 3, [~OlNG INSTITUTION PHONE MAILING ADDRESS f ' ~ ' 5, LEGAL DESCRIPTION ~ STREET LOCATION ~ 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY [] INDIVIDUAL* COMMUNITY PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM '~ INDIViDUAL/ON-SITE** NUMBER OF BEDROOMS [] One r'-I Four I-~ Other [] Two [] Five ,~ Three [] Six * ATTACH WELL LOG. A well log is required for all Wells drilled -. - since June 1975. For wells drilled prior to that date, give well depth (attach 'log if avail~able.) - - .. **1 f individual/on-site, give instal lation data ~ If system is over two (2) years old an adequacy test is required [] PUBLIC UTILITY NO T E: TH EIN8 PECTI ON FEE MUST ACCOMPAN~ EACH REQu ES TBE FORE. PR~)cESS i NO cAN B ~qNl~l~ATE D. 72-010(3/78) '- ' ' '- - I, -TYPE-OF RESIDENCE ~ MULTIPLE FAMILY ~' COMMUNITY '~- ~.UBLIC UTILITY . , · - .~ -~=-~:~,~ - ~- ~ ~.- . - .... --~ -~ i PERM Y ~UMBER -~ ~,~ ~;;~'Se~i;Tan~ or ~ ~ Holding Tank · · Size: If Tank is homemade ~SOILS RATING ' give dimensions: TYPE OF TANK MANUFACTURER 5. 'COMMENTS . . / ~ CO~D T LEGAL 72~010 (Rev. 3/78) File Lot 13 Eklutna West Subdivision FROM IB3ECT See above DATE MEggAOE The above fee was refuned to ~ir. Blair, since the subdivision has a community water system and is on a monitoring basis, the system is only one(l) year o~ from being upgraded and enlarge~, the fee is waived by department policy. We ,have returned Hr. Blair's check to him and the property stands approved at this time. SIGNED Laura J. Ward ~'~<~'~ '~ ~ ~ewer an~ ~er ~e¢~on Redi~rmo 4S 471 Poly Pek (50 sets) 4P471 SIGNED n~T/,CH ~l~r') FIIF F(')R FOLLOW-UP DATE