HomeMy WebLinkAboutEKLUND BLK 1 LT 1
EqUN~CIPALITY OF ANCHORAGE
DEPARTI~IENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIV~S~ON OF ENVaRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date _%_~--~
GENERAL INFOR~'IATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
(b) Applicant Name _~( ~_~_~ ~ ~-~ ~-.- Telephone: Home~ ~ "~q~'/q Business ,~¢'¢Z- / ¢o u
(c) Applicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); .......
(d) Lending Inslitution ~'"~'~*x [,,~v~_:¢ ~.¢~-~ Telephone
Address ....... _~ _~¢~¢' .d- ~
(e) Real Estate Company and Agent ..........
(f)
Address
Telephone .6"-'~.-~,'~' ~dDO
~"~n:~ HAA to the following address:
TYPE OF RESIDENCE
Single-Family ~-~ Multi-Family
[',lumber of Bedrooms ---~
Other
WATER SUPPLY
Individual Well ~- Community BI Public ~'J
Note: If community well system, must have written confirmation from the State Department of Enwronrne ta~ Conservation
attesting to the legality and status.
4, SEWAGE D~SPOSAL
Onsitc¢~ Public ~] Community [7.J Holding Tank [-J
Note: If community well systere, must have written confirmation from the State Department of Environmental C, oesetvation
attesting to the legality and status.
Page 1 of 2
ENGINEERING FIRIVI 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
Al]thority 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 ail Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Narne of Firm
Date
Telephone
DHEP APPROVAL
Approved for'"¢~?~' ~'¢~..__ bedrooms by
Approved Disapproved
Terms of Conditional Approval
Conditional
Date
CAUTION"
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a cour[esy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. Tile Municipality o'i Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: /c~.¢~ /
MUNICIPALITY OF ANCHORAGE
DEPZ. OF HEAVfH &
[NViEONMENTAL PROTECTION
I',.';; 0'; 985
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit~/.N%'
WELL DATA
Well Classificatio'~'-~¢-(, ",~ ¢~'*rF -~-~ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present.EYe) ¢'¢~/~:~ Date Completed ~'6¢z~C Yield
,/'~z~" Cased to ~ ~ '¢~ Depth of Grouting
Pump Set At ~/.//'
/c~ ~ ~/~ Sanitary Seal on Casing ~/-N~
Depression Around Wellhead ~
Separation Distances from Well:
To Septic/Holding Tank on Lot ~' ~'
-I-o Nearest Edge of Absorption Field on Lot ~/¢~
To Nearest Public Sewer Line
Cleanout/Manhole /~//~-
Water Sample Collected by
Water Sample Test Results
Comments (.~ ¢4,.- ~
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
B. SEPTIC/HOLDING TANK DATA
Date installed
Standpipes ~/,N)~- Air-tight Caps ~/N')"-_
Depression over Tank.¢¢~
Pumping/Maintenance Contract on File (Y/N)
/
Holding Tank High-Water Alarm (Y/N)
Separation Distances fro~ Septic/Holding Tank:
To Water-Supply Well '~_'~' ~
To Property Line /~
To Water Main/Service Line
Course
Size /(~O ~) No. of Compartments ~/c
Foundation Cleanout (-Y~_
Date Last Pumped ~//~¢2-
M/c'/'~t~' ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation '~" ~ ~'
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Depression over Fiel~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot /'"¢-/_,z
To Water Main/Service Line ,,..~-o
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Depth of Field
Gravel Bed Thickness
Standpipes Present
Date of Last Adequacy Test
Type of System Design
Length of Field __
To Property Line
'To Existing or Abandoned System on
; On Adjoining Lots /'-~/'///--
To Cutbank (if present)
Corrlrnents
D. LIFT STATION
Date Installed
Size in Gallons
"F'ump On" Level at
i-ligh Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
/~/'/,Z~ Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
~* Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, veriI~d, or conformed to all MOA and H~A guidelines in effect on the date of this inspection
Sign(,d ___ ~RB 198}( Date O / ¢ / ~3
,,3L~ RIVER, A~S~& ~957~ ~ ,/
Company PR- 69~2979 ~ MOA No.~,~- ¢0 ~
Date of Payment ~-'/- S¢¢ ___~
Page 2 of 2
72 026 (tl/84)
,~ MUNICIPALITY OF ANCHORAGE
'% Telephone 264-4720
[ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~ '"
825 L Street - Anchorage, Alaska 99B01
ENVIRONMENTAL ENGINEERING DIVISION
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ten (~0) days ~or processing.
I. PROPERTY OWNER ~ PHONE
M~NG ADDRESS
PROPERTY RESIDENT (If ~ifferent [rom ~bove) PHON~
2. BUYER ~ PHONE
MAI~IN~ADDRESS
3, LENDING iNSTITUTION ~ C/~ I PHONE
4. REALTOR/AGENT ' ' '
M~ ADDRESS
5, LEGAL DESCRIPTION,
;TREET LOCATION
t-z /o
6. TYPE OF RESIDENCE
'
SINGLE FAMILY
[] MULTIPLE FAMILY
NUMBER OF BEDROOMS
[] One [] Four
[] 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
**tf individual/on-site, give installation date ! ?L~"
If system is over two (2) years old an adequacy test is required
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010(3/78)
THIS SIDE FOR OFFICIAL USE ONL\
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
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 E~ 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 Sewer Line I Nearest Lot Line
1
WELL TO: __
Absorption Area to nearest Lot Line
5. COMMENTS
~'"'~APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE BY (T~,~
72-010 (Rev. 3/78)
September 12, 1979
Area Realty
Parkgate Professional Building
Eagle River, Alaska
Attention: A1 Romaszewski
Re: Adequacy Test on Existing Sanitary Sewer System; Lot 1, Block 1, Eklund
Subdivision, Eagle River, Alaska
Gentlemen:
Per your request of August 31~ 1979, we conducted a test of the sanitary
sewer system on the above described property.
The septic tank was pumped prior to the performance of the test on the
seepage pit. During the test the liquid level in the seepage pit was
measured before and after the addition of 950 gallons of water. All liquid
levels were measured below the top of the standpipe and are shown in the
following table:
Initial Water Second Water Third 24 hour Total
Reading Added Reading Added Reading Reading Drop
(gallons) (gallons)
74" 500 54" 450 57" 96" 40"
The water level rose 20 inches with the addition of 500 gallons of water,
indicating a capacity of 25°0 gallons per inch. Twenty-four hours later the
liquid level was again measured and found to be 96 inches. It had dropped 40
inches° This indicates an average effluent acceptance rate of 1,000 gallons
per day for the surrounding soils. If the three bedroom residence on the
property is to house six people, the average load on the system can be
expected to be 450 gallons per day. We can therefore conclude that the
system is disposing of effluent at an adequate rate for a three bedroom
residence.
We appreciate this opportunity to be of service to you. Please contact us if
you have any questions regarding this letter or if we can be of additional
service to you.
Very truly yours
Gary ~. Smith
_:ro.j ~t Manager
GS/rm/AT&SI~B
September 7, 1979
l/f(I)
David/Beverley Sadoski
Post Office Box 259
Eagle River, Alaska 99577
Subject: Lot i Block 1 Eklund Subdivision
Approval for your individual sewer and water facilities
can not be granted until the following items have been
c?mpleted:
The water analysis report be delivered to this office
from Chem Lab, 5633 B Street, for our review.
(3)
(4)
The septic tank pumped with a receipt submitted to
this office. Be sure to have the pumper state the
number of gallons pumped. This office needs verification
of size of the tank.
Locate the seepage area and expose 'the standpipes sc) that
measurements to the well can be made to insure proper
distance requirements from well to 'the sewer system~
A percolation test be performed on the existing leaching
area° This test will determine if the system is adequate
according to National Standards. A listing of private
firms performing the test is enclosed°
Please notify this department of a re-inspection when 'the
no'ted descrepancies have been corrected. If there are any
further questions, please contact this office at 264-4720.
Sincerely'~}~R'
Robert C. .
Associate Specialist
RCP/ljw
cc: Alaska Mutual Savings Bank
Post Office Box 1068 99577
Conventional
.. =,' .... uv~: requestea by: Coast Mortgage Co.
..... ~ ...... P.O. Box 1200 Anchorage
~, ^, ,. ,Jerry Kendall
Phoila:
3, _oga] 8escPip'tion: Lot 1~ BLock 1 ~kl~nd Subdivision
4,
::J. -'~:J: u,: 'facility to be inspected
A. 7yoe Drilled
C '" '~ ........... ~ , Standard
Single
[{0. o'f DedPoo;F,S
...... ~ 130 '
Disposal System:
~ ~ led 1972
£c!~'a'i c Tank: !.
~,~:c ....... c,'~ Pit:
Size
3
E. 51sposa! Fie'Id:
!. Absorption Area 16x16x6
Total length of lines
Saris factorx ,
Stack STeel
Cement Block
,..=;, ~u: Septic tank
}(earest lot line
66' 95'
, Absor2t~ori area
C o',fi'ha2i i T~d'6
Other "~' ~
s. roJnaa'?.on S~;Oo;C taflk
, ,~,~.,b~D~on aFea to neaFest lo~ :':~
',c:-?: 2 of ~wo pages - Remuest for Aooroval of Individual Sewer & Water Facilities
Lot 1, Block 1 Eklund Subdivision
Legal ~escriotion
Comments _
Date 6-10-7S
AoDroval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
eer": fy that ~:he -' nformati on containeo in this rer~uest for aDoroval to be a true and
,~v,c m~u~on of ~m~ suoject sewer an~ water facilities and these
are eve'rating satisfactorily.
1. Approval requested by:
Mailing Address:
2. Property Owner:
Mailing Address:
Legal Description:
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received 7/lg~ZZ~L
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
NatioJ[~l Ban[( ~la~lca
JerRy Kendal le
St Rt 217 D Eagle f~iver ~
3. Lot l ~ J~Ll_o_ck 1 Eklu~td__Sub_divi~
4. Location: Mile l~Old Eagle~ad
5. Type of facility to be inspected ~
6. Well Data:
A. Type Prilled M-W
C. Construction Standard
7. Sewage Disposal System:
i972 B. Installer__ ~elf
1. Size lO00 ga]__
1. Absorption Area
Field: Total length of lines
A. Installed
C. Septic Tank:
D. Seepage Pit:
E. Disposal
Distances:
A. Well to:
2:00pm
7/1(¥74
Phone:
Phone: 6g&-2211
No. of bedrooms 3
B. Depth _ 1BO'
D. Bacterial Analysis Satisfantn~v
2. Manufacturer__$1ack S'~ee!
16×1~6' 2. Material Cement Block
Septic tank 66' , Absorption area
Nearest lot line , Other contamination
B. Foundation to septic tank
C. Absorption area to nearest lot line
95' , Sewer Lines
, Absorption area
EQ-034 (1/74) Page I of two pages
~Page 2 of two pages - Re~_.~st for Approval of Individual
Legal Description
~er & Water Facilities
Comments
Disapproved
Date
Approval Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
certify that the information contained in this request for approval to be a true and
accurate representation of the subject sewer and water facilities and these facilities
are operating satisfactorily.
SIGNED
Date
EQ-034 (1/74)