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Home My WebLink AboutEKLUTNA HEIGHTS BLK 2 LT 6A1 GAAB-HD- I GR~P~'ER ANCHORAGE AREA BOROU~I~, HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY ~ GALLONS. ' OF i MATER AL k. -~:,,-~/~./I ' ARTME~fS. INSIDE LENGTH ~ INSIDE WIDTH DEPTH.~ SEEPAGE SYSTEM: NUMBER OF PITS LINING MATERIAl NEAREST LOT LINE SEEPAGE PIT: OUTSIDE DIAMETER DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) l ., LENGTH ~]& ,DEPTH d f BUILDING FOUNDATION~) '~, SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER ~ DEPTH: TOP DE TILE TO FINISH GRADE FOUNDATION SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: LOT LINE fY~'E_~J~//--£~.~) , DEPTH NEAREST SEWER LINE. / D~! DISTANCE FROM ,BUILDING FOUNDATION. SEPT,C ~ ' SEEPAGE ., TANK O , SYSTEM WATER SAMPLE /'~ 0 / CESSPOOt , NEAREST OTHER , SOURCES DISTANCES: DIAGRAM OF SYSTEM -( DATE APPROVED - HEALTH AUTHORIIY GAAB-H'D-2 ~ GREATEE .NCHORAGE AREA f? ROUGH iCaseN* H EA LTH DEpARTMENT ~~-~ a~7 Eagle St. ~ Anchorage, Ala~ 99501 SEWAOE DISPOSAL-SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT~a t)l~ l~ C~ [0 CC MAILINa AB,RESS ~0~ Z/VD '~. PHONE RESIDENCE ADDRESS ~: ~LIJT~ ~ LOCATION OF INSTALLATION LEGAL DESCRIPTION ~ ~ ~2 ~'~ APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWIN~ F~'CILITY SEEPAGE PIT. DRAIN FIELD .,OTHER FINANCED TtlRouGH ~:)~.~ ~-' /,, TO BE INSTALLED BY PERCOLATION TEST RESULTS /c'~O ~ '/~-/~ ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT · LI JO/~. , PERMIT TO INSTALL A THIS IS TO SERVE AS /~/]/~, 1 c'~/ AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED · SEPTIC TANK SIZE /C'~L~'~ TYPE ~~EPAGE AREA DISTANCES: TYPE DIAGRAM OF SYSTEM I 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 Z~/&/~L~ APPLICANTS SIGNAl- l':~ ' ~ <~ ~l MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY H87-0103 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6Al Block 2 Eklutna Heights Subdivision - T15N R1W Section 3 Location (address or directions) Pioneer Street (b) (c) (d) Property Owner Richard Godwin Telephone: Home 688-2674 Business 278-1611 Mailing Address PO Box 770614, EaRle River, Alaska 99577 Lending Institution Alaska Mutual Bank Telephone 694-9571 Mailing Address PO Box 771068, Eagle River, Alaska 99577 Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here I-'[, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family []x Number of Bedrooms three (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 the legality and status. SEWAGE DISPOSAL Onsite [~x 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 I of 2 72-025 ~Rev 8/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'iA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this HeaRh 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 EaRle River En~ineerin~ Services Telephone 694-5195 Address PO Box 773294 EaEle River, Alaska 99577 Date Engineer's Seal Amended Certificate DHHSAPPROVAL Approved for three(3) bedrooms by Approved xxxxxxxxxx Disapproved Terms of Conditional Approval Conditional Date February 24, 1987 CAUTION 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 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. Page 2 of 2 72-025 (Rev 8/86) Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION (a) (b) (c) Application Date Febru~:_? 17; 1987 Legal Description (include lot, block, subdivision, section, township, range) l,c~t 6A1~ Rl~ck 2; ~,klutna Heights Ti~N; R1W: Sec. 2 Location (address or directions) Pinnear Street; O, hu~iak Applicant Name Rioh~-r,d O_,~win Telephone: Home 6R~-P67~ Applicant Address P.O. Box 77061LI: Eagle R~ver: AK 99577 Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); Business 27R-1611 (d) Lending Institution Alaska Mutual Bane Address p.O. Box 771068, Eagle River, Alaska (e) Real Estate Company and Agent N/A Address N,/A Telephone Iq/A (f) Mail the HAA to the following address: Eagle River gngineering Serv~¢¢~ P'.0. Box 77~294 Eagle River, Alaska 99577 'Telephone 69zf-9571 99577 TYPE OF RESIDENCE Single-Family~ Multi-Family I-"1 Number of Bedrooms 3 Other WATER SUPPLY 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 Environ mental Conservation attesting to the legality and status. Page I of 2 , 72-025 (11/84) ENGINEERING FIRM PROVIDIN~ ,NSPECTIONS, .TESTS, FILE SEARCH, DA,_, 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 compliahce with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Ea~'le R~ver ~n~ineer'in~ Serv-ice_~ Telephone 694-5195 Address P.O. Bo~ 773294: ~,~g']e R-ive,~: A'lm,qkm 99577 Date ,Tan~]ary 17: 1987 Approved for ~ bedrooms by , _ _ Approved ,-..~ Disapproved Conditional Terms of Conditional Approval 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 courtesy 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. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 72-025 (11/84) WELL DATA MUNICIPALITY OF ANCHORAGE (MO~) PROTEC'~,~CKLIST ' FEBRUARY 1984 264-4720 1987 Legal Description: ~/~.*.~ RECEIVED Well Classification ~;x v ~ ~'i~. Well Log Present (Y/N) /17 Total Depth /..~.5 ,;.,_,~,A,,TCased to ,~ l Static Water Level &'(" Casing Height Above Ground ~ ~ Electrical Wiring in Conduit (Y/N) '~' Separation Distances from Well: To Septic/Holding Tank on Lot ,5'-?/ To Nearest Edge of Absorption Field on Lot /3-5'-/ If~A, B, C, D.E.C. Approved (Y/N) Date Completed /'~ ,?,~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results To Nearest Public Sewer Nearest Sewer Service Line on Lot ; Date ~//,'/~//~ 7 Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /,/4 Separation Distances from Septic/Holding Tank: To Water-Supply Well 'X~'"~ / To Property Line -,~/--// To Water Main/Service Line Course ~-,/Oo Size /gP~2~?~/ Nc. of Compartments / Air-tight Caps (Y/N) ¥ Foundation Cleanout (Y/N) Date Last Pumped 2'///~,/ ~A ; for Temporary Holding Tank Permit (Y/N) To Building Foundation //''/~' To Disposal Field 7 2 E '~ To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) ABSORPTION FIELD DATA SOils Rating in Absorption Strata ~$ ~.~/~/~ /~'~ ~,/~ Type 0f System Design Date Installed /~ ~_2 ~-- '~/'~ n~-v~'-f- Length of Field Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ._~'~ Separation Distance from Absorption Field: Depth of Field Gravel Bed Thickness /-4~'! '~ Standpipes Present (Y/N) Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot 4 I~ ' To Water Main/Service Line To Property Line "! ~ ~' To Existing or Abandoned System on ; On Adjoining Lots L~e / To Cutbank (if present) ~ J-~ ' To Stream/Pond/Lake/or Major Drainage Course To Drive,in/, Parking Area, or Vehicle Storage Area Commen,~F'~,~.)z// = ~',~ ) Z?Z?//?.5'''' ~_ LIFT STATION ~/~ Date Installe~ "~ Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Electrical Codes (Y/N) Comments ~ ~'""'""~ ~ Vent (Y/N) ~'"""'~.......~Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify th~ecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~~"~::~--"~ Date 'J/"~'~./A~ 2 $/-- ~..o..~d~ Company ~'~J" MOA No, ReceiptNo, ~1~)~/ ~'"~' ~' Date of Payment ,=~ ,- .~O .~ ~. ~C~ ~ Amount: $ Page 2 of 2 72-026 (11/84) Engineer's .Seal · ' i 87 F~bruary 20~- 9 : ' AS-BUILT I hereby certify that I have surveyed the following described ,t.?,' . , ' /' ~ - ,, . ~chorase ~cor~g Precinct, Alaska, and that the ~nts situated ther~n a~ within the prope~y fines and do not . overlap or encroach on the p~Ee~y lying adjacent thereto, that no improvements 0n propeay ly~g adj~ent the~to en~ach on the p~m~es ~ question and that ~e are no roadways ~ammissiofi lin~ or other visib e ea~ments on ~aid proPe~y except as indicated hereon. Dated a~ Eagle ~ver, Al~ka · - ~ ' ~x ~-~56~ Eagle River, Alaska ~5~ ' - Phone (~7) 69~3 ~"~ '~D~PARTUE( ,)0~ ~EALTH ANDOENVZRONH~N] ) PROTECTION /; ~ ~ 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224 or 225 ~ Date Received: June 8, 1977 #I: Time 1~?~ /.m. #2: Time ;~ ~ #3: Time Date 6-1~ 77 Friday Date ~ ~7~5~ ~sp PrJ Insp ~f~ ~. REQUEST FOR APPROVAL OF INDIVIDUAL~EWER Date Insp AND WATER FACILITIES /.. Lending Institution Request: Mailing Address: 535 D Street 99501 Home Federal Bank - Bill C~ker 272-1451 Phone: 2. Property Owner: . R°bert-/R°~Din Chlupach Phone: ~ ''' 9"a:~:n- Address: Star Route Box 50 99567 688-3233 3. Legal Description: Lot 6A Block 2 E~lutna Heights Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: Well System: Permit # Construction Individual well (x) Community/Public System ( ) Depth of Well 125' Well Log on File ( ) Bacterial Analysis o Sewage Disposal System: Permit # Septic Tank Size Absorption Area On-site System (x) Public Utility ( ) Installed Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Department of Health and Environmental Protection Request for Approval of' Individual Sewer and Water Facilities Legal Description: Comments: Lot 6A Block 2 Eklutna Heights Subdivision Affadavit Attached: Approved: Disapproved Department Worksheet: ( ) [ ) Letter Attached: ( ) Date: / '~UNICIPALITY OF ANCHORAGE "l Department of Health and Environmental Protecti~Nl~A[lr,'o~ 825 L Street, ~c~orage, Alaska 279-2511, ext. 224, 225 ~equest for Approval of Individual Sewer and Water acil iF Name of Buyer: ~// Mailing Address: Phone: Lending Institution: Mailing Address: ~0/ Phone: ZTZ - /~/ Realtor/Agent: Mailing Address: Legal Description: Street Location: Single Family Residence: (~/ Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: *Individual Well (~ Public/Community System If Individual Well, well depth /Z~f~ If Community System, name of system ( ) Sewage Disposal System: On-site System If On-site System, date of installation: Public System ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received 2/27/YS Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conventional 2/2g/'7: 1. Approval 'requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: Davi~ Taylor Box SO Pioneer St Phone: Sane Phone: Lot 6A, Bloc]< 2 Ek]utna IIeights STOL) Pioneer Street Chugiak 5. Type of facility to be inspected 6. Well Data: A. Type Drilled SJ~}gte No. of bedrooms B. Depth 135 C. Construction Sewage Disposal System: A. Installed 1970 C. Septic Tank: 1. D. Seepage Pit: 1. Standard D. Bacterial Analysis B. Instal 1 er ~'lim~inghs,~ Size 1000 gals 2. Manufacturer Wallace Absorption Area 4~0 sq/£t 2. Material E. Disposal Field: Total length of lines I Distances: A. Well to: Septic tank 10' Nearest lot line 60~ , Absorption area , Other contamination B. Foundation to septic tank 120' Sewer Lines , Absorption area 20~ C. Absorption area to nearest lot line 20' EQ-034 {i/74) Page I of t',,,'3 %1':; Legal Description Lot 6A~ Block 2 Eklutna Heights Subdivision Comments Approve~',~~ 4. Disapproved Date 2/28/75,. 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 areOperating satisfactorily. SIGNED Date EQ-034 (1/74) ~. Numb~- of .b~drooms in hous 5. ~;ate~ Analysis: a, Bac%erial b. Detemgen~ 6, Well data: a. Typ~. . d. Distance fr. om well to closest existing om proposed: 3. Seepage Ar,ea ~_ ~2~ . 6. Other sources of possible contamination, i.e., cPeeks~ lakes, houses~ baPn~ drainage ditch, e~c. ~, .... Sewage disposal system· a. Age of syste~ ..~ . b. Septic tank capacity in gali~ns_. /~ ~.. . c. Name of septic ~ank manufactux,~~ 1. If "home made" show dlaFPam on mevePse ~zde of this fomm. Percolatio~ Test '~esults f, Percolation Test performed by "~ Use the reverse .side of this form to show diagram. Diagram should include .... ~the foilowing h~formation: p!,operty lines;.well location, house location, m~ptic tank location, disposal area location, location of percolation test, a~ direction of ground slope. 9. The hr~o-~mt~on .on this form is true and correct to the best of my knowledge. $zfnature of Applican~ Oa?'e Szgned ~0 ~E FILLED OUT BY HEALTH DEPART~.~ENT PERSONNEL above described sanitary facilities are hereby approved, subject to the [~'l!owin~ con~,i~fons: ' Conditions: The above described sanitary facilities are disapproved for the following reasons| Approval is valid for one year following the date of approval. CPJ: cw