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Home My WebLink AboutEKLUTNA HEIGHTS BLK 2 LT 8C NAMEI J 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 [~]UPGRADE MAI LING AD D~I~SS ~) & O LEGAL DESCRIPTION r Dwelling Material~. Width Liq. ca Inside length IF HOMEMADE: Well Dwelling PERMIT NO. DISTANCE TO: Manufacturer Material Trench2~zidth ~ Foundation ~ (, Nearest lot line ('~_. ~'~_¢~ inches Total leng li~es Mater iai ~e~nne°a~t h tile ~ (.~¢ inches Depth DISTANCE TO: Well~/2~ No. o,,,nas! I Leng,h o,~;,,.~ g of tile to finish grade Widt Liquid depth Liquid capacity in gallons NO. 7 Total effective,~iS~orp_tion area .E M,T No. of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER SOILTESTRATING A~ (~~ J APP,~ DATE LEGAL I:::']:'F :l::!i!; THE: I:::, ]: ::!?['F:tNE:E E:!!i!:'r'!.rrE:li!!:F,! 'I"HE :!!!;L.il:;i:t'::l::i(:::[i:: Ol::' 'THE: THE !',t :!7 F,! :t: !',1i..11','1 E ::.:%: I:::! 'v' F:i 'T' :[ Cfi'.,! 0 ~ E GEC?-"SHNICAL 8- DEVEL~- MENT CO. Russell OySter 694-2774 ,Soils [:t Foundations Performed for: Box go, Davis St., Eagle River, Alaska 99577 694-2774 or688-2280 SOZL LOG Ead Ellis 688-2280 Land Development Tel. No. 4 ~'~?-?£3o Legal Description: Dql~th (feet) 0 2 3 i , lO 11 12 15, 16 Ground Water Encountered: Proposed Installation: Seepage Pit Comments: ~Jz4 No Drain Field 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. # 051-~r'3(~ - ~-'~ CERTIFICATE OF HEALTH AU'I'HORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# GENERAL INFORMATION Complete legal description Eklutna Heights Lot 8C, Blk 2 Location (site address or directions) 24507 Chugiak Drive, Chugiak Property owner George & Susa~ Zadolnny -:_Mailing'address,",P.O.:'?Bo× 672302, Chuq±ak, AK ~' ..... city- Morgage/Hau~ine '..Lending agency 99567 Day phone 688-1142 Day phone 2??-0?00 Mailing address P.O;' Box 92810, A~chorage, AK 99509 Agent A~ctic T_~on [:~'oo./Katherine Herf~y phone 243-4~1n .~. ':' NUMBER OF BEDROOMS: ' 3- .~ . . ~ 3.'* ~PE OFWATER SUPPLY: '~ ..... ';' :..' '~ . .~ ,. Public water.. .... . x ....... NOTE: If community well sy, tom, provide written confirmation ~rom Sm~o lng to the legality an~ status of system. .. 4. TYPE OF WASTEWATER DISPOSAL: ndividual on-s te ............. . , x ~ ;'~.. Holding tank Gommunity on-~ito ' ::':~' ~ .........- Public sewer ' -~;~' . .; ~: . ...~- ~i{,,,~,. ~:~' ~* , . -'~' ~:'~ ..... ' ~ 1~:~- ' NOTE: ':' If Community. wa~tewater system, provide written confirmation from. .State- ADEC.. ,,'??. ~ . a~esting to the legali~ and status of system.' "* "' :~ ':*'*' ~" 5. STATEMENT OF INSPECTION BY ENGINEER , L , 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 structu re indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves.t~ation 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, Ea.qle River, AK 99577 Engineer's signature Date ;7- , ¥- ?.~- 6. *DHHS SIGNATURE ~--:":?Approved' for .... Disapprovtd. Conditional approval for '~"bedrooms, 'with the followi6g StiP0'ia~i6ns: ::'' -' A~lditi~3nal comments ' ~ '" "'" '~' ...... ' ........ Date (~- 2 - ¢'..vx'''' '. ~:,~'~e k~u~ic¢~ality of,.~h,~)rage Department of Health and Human Services (DHHS)issues Health Authority "-~ ~pl~'roval C,~rtifica~e.~:ba~ed only upon the representations given in paragraph 5 above by an independent "pro~,ssi~p. al'e6~i~ r(~gistered in the State of Alaska. The DH HS does this as a courtesy to purchasers of homes ' "~ ~ ~' Inf eraland tat r ir m n Em a~dth,e.i[~(~ndingins{itutionsinordertosatiSfYcerta' ed s e equ'e e ts. Ployees of DHHS do not ¢ondu~t~In~ctlons or analyze data before~a certificate is issued. The Municipality of Anchorage is not responsible fo¢ errors or omissions in the professional engineer's work. 72-025 (Rev. 1/~1) Back MOAi~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Wall Data Well type Log present (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Total depth Cased to Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 t 't 'o "ns Absorption field on lot / Pul~lic sewer main / Sewer service lino~ WATER~MPLE RESULTS: CoI!~ Nitrate D~e of sample: FROM WELL LOG Wires properly pro~~ ,~SPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/N~EBING TANK DATA Date installed D~/2 9 Cleanouts (Y/N) ~/~ High water alarm (Y/N) Date of pumping Tank size //.){) D Compartments Foundation cleanout (Y/N) ~ Depression (Y/N) b//~ Alarm tested (Y/N) /~///~ ~"///~/~/~ Pumper SEPARATION DISTANCES FROM SEPTIC~G TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field / Foundation Water mai~/service line CONTINUED ON BACK PAGE 72-026 (3/93)* Front C..,FT ST^T,O, Date installed Size in gallons Vent (Y/N) High water alarm level Manufacturer Manhole/Access (Y/N) ~ "Pump on" level at '.~P'~ump off" Level at ~ ..... ~- ~;ycles tested Meets MOA electrical codes (Y/N) .. SEPARATION DIS!ANCE'~RoM LIFT STATION TO: W~eJPOlffTot On adjacent lots D. ABSORPTION FIELD DATA Width / Date of adequacy test {.) ?/7/~..~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft Gravel thickness Cleanout present (Y/N) Results (pass/fail) /8',5" /',/./.4 Date installed Length '~(-~ ' Total absorption area Surface water ~;~//_~'/~, System type / Total depth / / Depression over field (Y/N) for After test / If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water '/- Curtain drain /V On adjacent lots -/ 2~00 ' Properly line ~ ]- Y To existing or abandoned system on lot Cutbank ~ ~ / Water main/service line Driveway, parking/vehicle storage area :~/~ ' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineees Name Date HAA Fee $ Date of Payment Receipt Number :~::;:~ ~. I~ ~ Louis A. Bulera Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back 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. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lo.z: 8C; Block 2; Ekl~tna He. Lghts Subdivision Location (site address or directions) 24507 Chugiak Drive Property owner Mailing address Lending agency Mailing address Harold powell 24507 Chu~iak Driv2.~ Day phone 277;1741 Ch~.qiak~ Ak. 99567 Day phone Agent ~by ~e~r~e~' ~REATLAND REALTY Day phone 694-9125 Address 11411 01d Glenn High,Jay Eagle River, Ak. 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: XX Public water 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 NOTE: ×X Public sewer 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, 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 a~l Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature Date DHHS SIGNATURE Approved for Disapproved. ~"~,¢¢~t:~.~ :3/) b e d r o o m s, Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~ ~)~_~.-c __ 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 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 engineeCs work. 72-025 (Rev, 1/91) Back MOA ~21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C, attach ADEC letter. Legal Description: A. WELL DATA Well type ~ Parcel I.D. ADEC water system number ~ ~ ~'~ "~ I Log present(Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~ Absorption field on lot "~ '~ g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer main Public sewer manhole/cleanout Public seweFservice line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: S. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~)/N) High water alarm (Y~ Date of pumping Tank size I o~::>o Compartments '2.- Foundation cleanout t~N) XI Depression (Y~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ?.-Oo ~' To property line I c> Surface water/drainage On adjacent lots Absorption field loC) Foundation Water main/service line 72-0~6 (Rev. 3/91) Front MOA 21 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 et~ S~ DISTANCE FROM LIFT STATION TO: V~ell on lot On adjacent lots Manufacturer Manhole/Access (Y/N) -----'-~ "Pump off" level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~-1 ~ Length 'TL~' Width '~5{.~ Total absorption area IC)~q Depression over field (Y~ /',/ Results/{]~/fail) Peroxide treatment (past 12 months) Soil rating 7~~o b/IDy-'- Gravel thickness "~ ' Cleanouts present (~/N) Total depth Date of adequacy test '~ - ~ ~ I for -r"/.J~E.~_.- if yes, give date System type bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ?.-o ~) To building foundation On adjacent lots Surface water Curtain drain On adjacent lots /Jl~- Property line To existing or abandoned system on lot Cutbank ~'~ ' Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on [~ ~of this inspection. Date HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 July 2, 1991 WALTER J. HICKEL, GOVERNOR 563-6775 FOR: S & S Engineering PWSID 211431 My review of the records on file in this office reveals that the Dawn Water Company Class A Public Water System, is in compliance with the provisions of 18 AAC 80.060, State of Alaska Drinking Water Regulations. Sincerely, Keven K. Kleweno Lead Engineer 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 Application Date December 10~ 1986 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 8C, Block 2 Eklutna Heights T15N (b) R%W Sec,3 Location (address or directions) P,h~gi m.k; A1 a,~ka Applicant Name ~.,ita GanYerano Telephone: Home Applicant Address P.'O. Box 100720 Anchorage~Alaska Business 995~0 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending lnstitution First National Bank Telephone Address P.O. Box 100720 Anchorage, Alaska 99510 (e) Real Estate Company ~nd Agent Address N/A (f) Telephone N/A Mail the HAA to the following address: Pickup by Engineer TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms 3] Other ''tl 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. 4. SEWAGE DISPOSAL Onsite [] Public [] Communityl-'l Holding Tank [] Note: If community well system, must have written confirmat on from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM 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 Healt~' 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 Telephone Address FA~i F RIVFR EI~IG1NEERI~G SERVICES Date }2Is ,/~,~ EAGLE RIVER, AK 99577 P. 0. BOX ~i3294 694-5195 Engineer's Seal DHEP APPROVAL Approved, fori 2,, ~ Approved X."/' Disapproved Terms of Conditional Approval bedrooms by ~--/~~-'~' ~ 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 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 2 72-025 (11/84) WELL DATA ~p*~-I. ~I~,[H'~L~:~I~ITY APPROVAL (HAA) ENVIRONMENT~R~C]~- FEBRUARY 1984 264-4720 1986 Legal Description: ~.r~ ECEIVED Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wir_ing in, Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results 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 To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~/'7¢/ Size ~goo ,~1, No. of Compartments Standpipes (Y/N) '1" Air-tight Caps (Y/N) 'T' Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~J A ; for Holding Tank High-Water Alarm (Y/N) /dA Temporary Holding Tank Permit (Y/N) Separation Distances fro~ Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line '~ 10 / To Building Foundation .~2. ,.~'/ To Disposal Field To Stream, Pond, Lake, or Major Drainage Course '* J oo / Comments Page 1 of 2 72-026(11/84) C, ABSORPTION FIELD DATA Soils. Rating in Absorption Strata Date Installed '~'- '7? Width of Field ~-~(~ ~'"~/"~,~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field 76' ' Depth of Field '// Gravel Bed Thickness '7 /0 6 ¥ Standpipes Present (Y/N) /~ Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ,.~2 / Lot ~',"~ To Water Main/Service Line '/'/o / To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area To Property Line '+/o / To Existing or Abandoned System on ; On Adjoining Lots ~o ' To Cutbank (if present) ~" '/- /0o/ Comments D. LIFT STATION ~ j/,J/3, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** Date Company ]_:~. ,~ ,g.5'. MOA No. Receipt No. ~:)Od-~ J ~ 0(~ 0 ? - Date of Payment /Z - //~'~ '- ~"~,~ Amount: $ _~ _~'~'-~: O4~..; Page 2 of 2 72-026 (11/84) Eagle~lver Engineering Services P; 0. Box 773294 Eagle River, AK 99577 694-5195 MUNICIPALITY OF ANCHORAGE En ~l~l~r~l~l~i~.LTH & ENVIRONMENTAL PROTECTION RECEIVED DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the Water Regulations Water System is in compliance with the State Drinking Sincerely,