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Home My WebLink AboutHULSE LT 7 QGREANCHORAGE AREA BO Department3330°f EnvironmentaIc Street Quality Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER ~g//~//~ ~-'~ .. MATERIAL ~¢~COMPARTMENTsNUMBER OF ~ INSIDE WIDTH .LIQUID DEPTH LIQUID CAPACITY /OOO GALLONS. SEEPAGE PIT: NUMBER OF PITS I . DIAMETER -- LINING MATERIALCO~r'~ ~2~RIB SIZE: DIAMETER ~ ,DEPTH DISTANCE FROM: WELL BUILDING FOUNDATION NEAREST LOT LINE__ ADDITIONAL ABSORPTION TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~/~ SQ. FT. WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION -- LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM DISTANCES: REMARKS: DATE DIAGRAM OF SYSTEM 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 Parcel I.D.# 050-521-06 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENE. RAL INFORMATION Complete legal description Hulse Lot 7 Location (site address or directions) 25245 C~ystal Creek, Eagle River Property owner John Bodde Mailing address 11155 Ashley Park, Eagle River, AK Lending agency NRA/~' Maili'ngaddress P-'(~'; ..Bo~ 6127, Anchorage, AK 99519 Agent ..- ...... .- · N/A ....... Ad dress UnleSs otherwise requested,. HAA will be held for pickup. Day phone 258-7777 msg 99577 Day phone 776-11q? Day phone Public Wat~'~:'~:: . ' NOTE: if communi~/~:weil system, provide written confirmation from State AD~attes~ , lng to the legality and status of system. ~ .~ ' 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ,~-'' ?' ~ Holding.tank !~'~.~',~.,~-:~, - - , , :;._~_ _~.-:,..,:communityon.site - - ; Public sewer ';~":':: -" NOTE: X If community wastewater system, provide written confirmation attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #2~ STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that m~, 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 furtherverify 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. Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, AK Engineer's signature ~ 99577 Date DHHS SIGNATURE . ,,~ Approvedfor Disapproved. conditional approval for bedrooms. bedrooms, with the following stipulations: ', \ u, Additional Comments , B~: Date 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 DHHS does this as a courtesy to pumhasers 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. 1/91) Back MOA ~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type /~A~///,q7/~ Log present (Y/N) Total depth ~- Smfitary seal (Y/N) Date of test Static water level Well production Health Authority Approval Checklist Parcel I.D.: ,Atto Date completed /q ? 3 e ~- ~. Cased to P q o t Casing height (above ground) Wires properly protected (Y/N) }//~ FROM WELL LOG AT INSPECTION WATER SAMPLE RESULTS: Coliform -~ Date of sample: Nitrate 69, ff~/47 ~,//~ Other bacteria Collected by: ~/Z ~ B. SEPTIC/ttttI2..,~ TANK DATA Date installed 0 ~/~5 Tank size /dDO Number of Compartments / Cleanouts (Y/N) Foundation cleanout (Y/N) ~/~ /?/g/b~ Depression fi/Iq) /&/0 High water alarm (y/N) /V DateofPumpmg ff?/~5'//q( Pumper C. ABSORPTION FIELD DATA Date installed 0 ~/~ Length ~,~0' Width Effective absorption area Date of adequacy test IY~//~/?5 Fluid depth in absorption field before test (in.); Fluid depth ~2a Minutes later: Peroxide treatment (past 12 months) (Y/N) Soil rating (g.p.d./ft2 or ft2/bdrm) Ii~o f ,ti .... JSystem type t Gravel thickness below pipe ~ t Total depth // Monitoring Tube present(Y/N) V~Depression over field (y/N) Results (Pass/Fail) /P/~$ For ~ bedrooms g, $' Immediately after ~! gal. water added (in.):. II (in.) Absorption rate = '727 ~q g.p.d. If yes, give date D. LIFT STATION /V//'C- Date installed Manhole/Access (YfN) High water alum Cy~j Fo ,..~"Pump on" level at* *Datum "Pump off' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Lift station 't/00 ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation /_/~) ~ t Property liue /'/0 Absorption field Water main/service line -P/0' Surface water/drainage/X//,4 Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain Water maird~ervice line 7c Driveway, parking/vehicle storage area Wells on adjacent lots //00 ENGINEER'S CERTIFICATION I certify that I have determined thrufield inspections and review of Municipal ~' ,~t~~lems are in conformance with MOA H~ guidelines tn q~ect on this date. Signature Engineer's Name LO~/5 ~f~ Date ~- ~ 2 - e~ {~%~ .,... ,... ,,~ ..... HAA Fee $ Y Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number INSPECTION APPOINTM ENTS DATE DA TE DATE~/- M~[OPAL ~ OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF I:~ALTI'I & DEPARTMENT OF HEALTH & ENVIRONMENTAL P~OTECT~iRONMEN~AL ~:;~,OTECTION 825 L Street - Anchorage, Alaska 99501 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE~~t~"I~ DI~fiCTIOffiS: Complote all parts on pa~e 1. Ineompl~t~ roqu~st~ ~ill not bo pro*o~d. Please allo~ ton {10) dags for procossin~. 1. PROPERTYO~NER I PHONE MAI LIN~DDRESS PHONE pROPERTY RESIDENT (If different from above) ~ /~ PHONE 2, BUYER MAILING ADDRESS 4, REALTOR/AGEnT I ~HONE MAILI~B 6. TYPE OF RESIDENCE .~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four J~ Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * 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 available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPA. I~EAC" REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. ~7~, ~) ~' ~ ~~,2 THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size:~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area ~ewer Line I Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS J~-'"'APPROV ED FOR · '~ BEDROOMS [] CONDITIONAL APPROVAL (letter must a~om~any certificate) [~]--'~ISAPPROVED DAVID A. SLENKAMP ROBERT A. SHAFER MECHANICAL ENGINEER 694-9055 ~pril 9, 1980 CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE DEPT. OF ;; :/J,i;l & ENVIRONME.,h ,u; ,.., .~CTION Mary Bodde P.O. Box 984 Eagle River, Alaska 99577 APR 1 0 1980 RECEIVED Dear Ms Bodde, Reference: Lot 7; Hulse Subdivision A sewer system adequacy test was performed on the system located on the referenced property per your request. The test was performed on April 7 and 8, 1980. The septic tank was pumped and verified to have a capacity of approxi- mately 1000 gallons. The seepage pit was charged with 1000 gallons of water and after a 24 hour period approximately 582 gallons had percolated from the crib. It can be concluded from this test that the system is functioning adequately at this time for your three bedroom home. If we can be of further assistance, plea se do not hesitate to call. Municipality of Anchorage Department of Health and Enviornmental Protection First National Bank of Anchorage SRB 196X EAGLE RIVER, ALASKA