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Home My WebLink AboutEAGLE RIVER HEIGHTS BLK 8 LT 9 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 MAI L~'~G ADDRESS LEGAL DESCRIPTION LOCATION ~ ~Z ~ Manufacturer ~ ~ ~ ~ ~..~ D STANCE TO' Well ~ ~ ~ Manufacturer Q I Well ~ INo. ofmines / l Length o( each Hn~ ~ m Length ~)dth ~ M m Type of crib Crib dismeter DISTANCE TO: ~ m c)ass Depth ~ DiSTAnCE TO Building foundstion IAbsorption area Inside lengt~, D~elling Foundation Total length of lines Material beneath tile Depth Crib depth Building foundation Driller Sewer line PHONE ~ UPGRADE W dth ~ I Material Nearestlotline ~ Trench width '~_.~ inches NO. OF BEDROOMS PERMIT NO. No. of comp>rtments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Dista.~.~,t~ween lines Total e~ect~ive absorptjon/~a /' Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Sept c tank Absorpt on area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS Fr~/,4' cA~ ~3~ ~-~ p~. n' LEGAL 72-013 (Rev. 3~78) DIi[F:'ART!¥JE]',It" OF:: I'"i!EAI...'TI'"I AND iENV!R[]NI'IEiiNTAI- F:'RO]"E]CT ION (!i~25 L. S'T'RE]ZT. ANCHC)F':AE)E. AK 99."'50! 2 :S 4- z! 720 f~' ~"~ 1'h F::'t::r ~-~ c~. CONTACT' I ..... t ....... P:' 'z ,"~l ¥')j:'c "' :', T ~4,. IIAz, ~. ,....,..,, .......... ~::/' q .: q, 1' ",,'ER', AK '~r"~'?. 1585 SLIBD I V ! S ]: C)N: EAGLE!: F;: I VE:F:: H'TS ,, SECTIC)N~ 12 'I'OW!',ISHIF': !4N 1,, IA (SQ.F'T,, OR ACRE:S) I_ist.,:~d I::',e!c;w apc.-~ t.l'-~e~ c)ptions available 'Lo '/,:~L~ zn ,'.J6'...:.tg,,tl,sj ...- ~- ...... '~ ..... "'~ .............. Lh.~:e ,-~r:tic~r~ that best fits your' site, DE;I:::'TH TC) F:'IF:'E BOTT(2,1¥! (FT.) GRAVE:-.L. T)EF:'TH (F:T,, TDTAL. DEF:'TH (FT.) GRAVEL. I~.J[D'T~,'~ (F:'T. LSF;tAVEEL LE:NGTH (1::"1",,) GF;,'AVEL. VOLUM, IE (CU. YDS. ) T'ANK SIZIE (GALS) SC)ZL 'F.'.ATZNi3 (SQ,, F::'I'. /BF:;'.) f' or' *..'-, ~ o' v.. t he Mun :Lc: ip a.l.' ity c.,f ~.-,n d'~ ..... ..or'age .::. I ~wi 1 inst. all t. ln6~ ?/stem :i.r} ac:cc~Pdar~c:e v~:i.t.["~~.,~... , ,_, ~¢, ....... ,,... lat. ::d.c, in (::oi'np].iarl(::¢za wit. Ii 'LN,~ c:16as:i.c~r~ c:r,i'b:~Pia ~,, Z t.,,~J. ]. ]. adhei'(a t.o a].]. MOA and State of Alaska. r'equir~:ement, s 'fc, p th';.'s ........ d i ~:.+ ............. E&I']CE~S ¢ P (D¢1] a~.l]V C{'X J ¢:s+ :LKto~ t,',~62]. ]., ~/.;as'L~ewa'b~:r' ,.. ' ........... ~" IcrL SE~'V,~E{'i" a(~(~? '~;'y'~E;t.E:~I~'~ C:)I'] '~ h i~'E]~ (])1" f~tl-i~..' adD .S~C:E.}F)% C]P ~ t~z:.z.::h ~.¢ y' ,. ' ,.r. : "· .......... ]..$ *EC'. ....... , ,. '.. 4~ , - ' 4 '¢., c:,T,.-~l .............. ::,TF.,._L. Iz.D IN AN AREA ..... ~,, (1) AN ......... L.t ........ t..,--,l.... I,...I,M.,. AND ~.1,,...¢1 ....... I.J, MIJST x~n'" AF:'F:'RC)VED WIT'HOUT AN =LF:"TT'r~'T'qA .,.I ....... I...~ ....... ~,,-4 ::,~'~:,n~:."r',, ~-'~ .... Fl..Cz ~. 'r, ~ ,.,,,1 BE ¥, ,: ,: , ::' m "r 'r m , .......... AND., _,~ .,- .......... ~ ......... .,L. b~IUST BE )Df~EW' A L.ICENSk:.D E:L~:CIF:IL;.LAN S: I S N E D PERFORMED FOR: LEGAL DESCRIPTION: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 /. Street, Anchorage, Alaska 99501 264~.720 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST 1 /~, 2 3 4 6 7 8 12 14 ' : ~ 1-4 .*~ ,~ N COMMENTS SLOPE SITE PLAN WASGROUNDWATER ~) S ENCOUNTERED? L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Data Time Time Water Drop TEST RUN BETWEEN FT AND -- FT PERFORMED BY: ~'/,~ ~ '11 _[ DATE: CERTIFIED BY: f....~ - 72-008 (6/79) Parcel I.D.# 1. 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 FAMILY DWEL,LING 050-281-11 NAA# GENERAL INFORMATION Complete legal description Eagle River Heights, Lot 9, Block 8 T14N R2W Sectionl2 Location (site address or directions) 10212 Lee Street, Eagle River Property owner Mailing address Richard & Lira Beck Dayphone 265-3066 P.O. Box 670604, Chugiak, AK 99567 Lending agency N/A Mailing address Day phone Agent Address N/A Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ~ TYPE OF WATER SUPPLY: Individual well X Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: x If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. NameofFirm Eagle River Engineering Services Phone 694-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature DHHS SIGNATURE Approved for 4 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional comments Date 2 -~--¢~- q;l'l I The Municipality of Anchorage D~partment 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 purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,4&~4 ~'/V¢.~ /H..7~W'TS~ Lpz-~, ~'L.Z' ~' Parcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level O~O ~ 5?/ - i/ If A, B, or C, attach ADEC letter. ADEC water system number ,~./Q Date completed /,JW/L/VDJu~/ Driller /~0 ' Cased to ~/~) ~ + Casing height FROM WELL L~/,~ Wires properly protected (Y/N) AT INSPECTION g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot //00 + Absorption field on lot //.;)0 ' ~ Public sewer main -/~//~ Sewer service line ~ ~ lO/ ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank lOO/ A WATER SAMPLE RESULTS: Coliform ff~' Nitrate Date of sample: O~/~ ~-/~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed /~ ~/-J Tank size ~ /~C~ Compartments Oleanouts (Y/N) )/g_5 Foundation cleanout (Y/N) Yg-~ Depression (Y/N) High water alarm (Y/N) /v/O Alarm tested (Y/N) /"//"~ Date of pumping /0/01/~1 Pumper ,_~/~'~ ' S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ,/~(~ To property line /~ ~0 ~ Surface water/drainage On adjacent lots Absorption field Foundation 30' Water main/service line 6/0 ' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical ~__ SEPARATION DI~/././././././~NCE FROM LIFT STATION TO: Well o~ On adjacent lots Manufacturer ~ M~Y/N) "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed / ~/~'~/ Length 50' Width ,~" Total absorption area ~DD v-- Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) ~///'/ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot F-/~ ' On adjacent lots To building foundation On adjacent lots ¢ ~,~ Surface water Curtain drain Soil rating //.~) ~ Gravel thickness ~ / Cleanouts present'(Y/N) Date of adequacy test for '/-/ If yes, give date System type Total depth bedrooms Property line Y /~ To existing or abandoned system on lot ,~ ~) / Cutbank AJ.//'4 Water main/service line A//.4 Driveway, parking/vehicle storage area /V'O//~ .,'~ ,~,P.~ ,~Z~.//~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effecl~ Signature ~' Engineer's Name '~-~' ' ~ ,~='~-~"'~'- Date //~ 7/~ .)-- ~ this inspection. HAA Fee $ / '~'~)'~ Date of Payment Z-- Receipt Number ~. ~ ~ ~7{',~ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number Eagle River Engineering Services A 11940 Business Blvd, Suite ~205 P.O. Box 775294 694-5195 Eagle River, Ak. 99577 Fax 694-5297 Owner: ~ Date: Type of test: . ' D Well Flow Test ~ Septic Test Only ~ Well & Septic Test ~ O[~er: Meter Monitor Well Tank GPM PSI "Remarks "ime Reading Level Level Level ;. JAH 24 'gE 09: B~ I'tORTHERH TESTIHG, AItG:HORAGE Zagle River Engineering Box 773294 ~agle Riv~-r AK 99577 Attn; Louie Bu~era P.3'4 NORTHERN TESTING LABORATORIES, INC, FAIRBANKS, ALASKA 96701 ANCHORAGE. ALASKA 9~503 3330 INDUSTRIAL AVENUE ($07)45~3116-FAX4~-3~25 Re~o~C DaCe: 01/24/92i Date Arrived: 0~/22/92[ Date Sampled: 0~/22/921 Time sampled: 0900 Collected By: LH Our Lab #~ : Location/Pro~ect~ You= sample ID: Sample Matrix: Commentu: Al16061 Eagle River ~tS 9/8 Water MDL ~ Method Limit Flag Definitions B - Below Regulatory H ~ Above Regulatory E ~ ~elow Detection Li~it E~tima~ed Value Method Parameter Un/=~ Remul~ Flag NDL !Analyzed EWA ~53.3 ,Nltrate-N mg/l 1.2 0.1 101/22/92 '. Microbiology ':Suporv&sor MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL m~ALTH DEPARTMENT OF ~A. LTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date /~ (a) Legal Description .(include lot, b~ck, subd%v>sion, section, township, range) (b) -~'. Telephone - Home~2 71~ Business /.~'~-~- (c) Applicant is (check one) Lending Institution ~ ; Owner/builder ~--~; Buyer ~ ; Other ~ (~plain); (d) Lending Institution ~/~, ~~ ~) Telephone Address (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms Water Supply Multi-Family ~--~ Other (describe) J Individual Well~ Community~--~ Public ~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Sewage Disposal 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] 5. En~iueerin~ Firm Providin~ 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 wsstewater 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 a~d 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 ~d'~.- ~..~,4'/~/ F~'/_~, Telephone 07~- ~m~/6~ Address (ENGINEER SEAL) DHEP Approval Approved fo r ~'~r/ edrooms Approved ~ Disapproved~ Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~&LTH AUTHORITY APPROVAL 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 BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIgNAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Desc~rip tion: t,. OV 5 ECE!VED If A, B, (mt C, D.E.C. Approved(Y/N) ~a~--~ Yield Depth of Groutinq ~-~ }4 Pump Set At /~ ~ Sanitary Seal on Casing (Y/N) .,F' Depression Around Wellhead (Y/N) Well Classification Well Log P~esent (Y/N) Total Depth / ~-o Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Sepa=ation Distances frcm Well: TO Septic/Holding Tank on Lot Date C~pleted ; On Adjoining Lots To Nearest Edge of Absc~ption Field on LOt To Nearest Public Sewer Line /~/~ To Nearest Public Sewer Cleanout/Manhole ~/~-- To Nearest Se~r Service Line on Lot /p~ ~- ; On Adjoining Lots Water Sample Collected By ~3 ' ~ ~ ~ ~ ?te Wate~ Sample Test l~esults .~ t, J ~-~ ~ M~ ~ B. SEPTIC/HOLDING TANK DATA Date Installed /~ ~ Standpipes (Y/N) .y Dap~tession ove= Tank (Y/N) Size /~--o0 /-6~/. No. cf Oa,~artments / Air-tight Caps (Y/N) // Foundation Cleanout (Y/N) /L/ Date Last Pumped 1~/~ ~, Pun~ping/Maintenance Contract on File (Y/N) ~J~ ; for - Holding Tank High-Water Alarm (Y/N) ~J/~ Temporary Holding Tank Permit (Y/N) Separation Distances frcm Septic/Holding Tank: To Wat~-Supply Well /~m 7~ To Property Line ~-~ + To Water Main/Service Line lm ~ Course /~ ~_ ~o Building Foundation 5- ! To Disposal Field ~ w To Stream, Pond, Lake, c~ Major Drainage [Page 1 of 2] 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /~,/~ ~ Width of Field ~o" Type of System Design L~ngth of Field ~--~ / Depth of Field /-~ / Gravel Bed Thickness ~ / Square Feet of Absc~ption A~ea ~O ~ Standpipes P~esent (Y/N) Depression over Field (Y/N) /L/ Bate of 5ast A~quacy ~est Rmsults of Last ~e. quacy Test Separation Distance f~cm Absc~ption Field: To Water-Supply Well /~ To Building Foundation ~ ~ W To Existing or Abandoned System cn Lot ~3 / To Wate~ Main/Se=vice Line To St~eam/Pond/Lake/c~ Majo~ Drainage Course To Driveway, Pa~king A~ea, c~ Vehicle Stc~age A~ea De Date Installed Size in Gallons "Ptm~ On" Level at High Wate~ Alarm level at Tested fo~ Electrical Codas(Y/N) Di~nsions Manhole/A ess (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles ck~ing Adequacy Test. Ccm~ents ** Check Permitted Bed~oc~ Rating Against HAA Requeet I certify that I have ~hecked, verified, c~ confcz~m~d to all MOA HAA Guidelines in effect on the date of this inspection. Signed [Page 2 of 2] Bate ,',~', ·A ·- "1' ~, .... ,- ~__ · ~ ~ · {; "'. ~JNE 224 071 ..'~.~, i :'. ...... ', 2-15-84