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Home My WebLink AboutEKLUTNA HEIGHTS #1 BLK 3 LT 5L5 Ht:s. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF ~r~,AI,TH AND ENVIRON~NTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE General Information (a) Legal Description (include lot bloc~ .subdivision, Location (address or directions) (b) Applicants Name_~_/~/~/'-3~3z0 ~/~ . Applicants ~dress ~5~~ Z ~o ~ f~ 6 ~ ~ (c) Applicant is (chec~one) Lending ~ns~i~utioa (d) Lending Institution A,d~ss section, township, range) - Home B~s iness Te___lephone (e) Real Estate Co. & Agent Address (f) Telephone ~i-1 the tiaa to the following address~ 2. T_~pe of Residence Single-Family~ Number of Bedrooms 3~ Water Supply Individual Well~--~ Multi-Family Community Other (describe) Public~ Note: If community w~ll system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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] E_~ineerin~ Firm Providi__n~on_~s,~ests~ File Searc~h~pata and Infomnation" 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, f~%ctional amd adequate for the number of bedrooms and tTpe 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 wmstewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inapection. Name of Fiz~ Address Da~e DHEP A~p_~p v~a~ l_ ~ Approved for ~::~ bedrooms By Approved.7~__ Disapproved Terms of Conditional Approval Conditional Telephone CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF R~ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH A~fHORITY APPROVA3~ CERTIFICATES BASED SOLELY UPON THE REPRESEN~I'- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA~ THE ~HEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQULRE- MENTSo k~PLOYEES 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 ~ ~tE PROFESSIONAL ENGINEER'S WORE. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. ~ELL DATA Well Classification Well Log P~esent (Y/N) Total Depth Static Water Level Casing Height Above Ground MUNICIPALITY OF ANCHORAGE (MOA) H~ALTH AOm~TY APPROVAL (~A~) CHECKLIST - FEBRUARY 1984 R E f E I V E D Legal Description: If A, B, c~ C, D.E.C. Approved(Y/N) Date C~leted Yield Cased to Depth of G~outing Pum~ Set At MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &' ,,.~ ENVIRONMENTAL PROTEGt'JOJ~ .. _* Electzical Wiring in Conduit (Y/N) Separation Distances f~cml Well: To Septic/Holding Tank cn Lot ~. ~ .... ; On Adjoining Lots 2~ To Nearest Edge of Abscml~tion Field on Lot~X30 ~ ; On Adjoining Lots Sanita=y Seal on Casing (Y/N) Deu~ession Amound Wellhead (Y/N) To Nea=est Public Se~r To Nearest Sewer Service Line on LOt Date ; To Nearest Public Sewer Line C leancut/Manhole Water Sample Collected By Water Sample Test Besults B. SEPTIC/%~ TANK DATA Date Installed ~( ~-f Size /69d~O No. of CQ,~a=tments Standpipes~) Air-tight Caps~) ,, Foundation Cleanout (~i'~'~ DePression over Tank (~) Date Last Pumped ~ - Pumping/Maintenance Contract on File (Y~/~. ; fo~ Holding Tank High-Water Alaz~n (y/N~/~- Temporaz-y Holding Tank Permit (Y~///$ Separation Distances f=cm Septic/Holding Tank: To Water-Supply Well 2Do ~ To Building Foundation ~ ~ I To ProDerty Line TO Water Main/Service Line Course C~ents ' TO Disposal Field ~- '~- To Stresml, Pond, Lake, c~ Majo= D=ainage Receipt ~ ~9~(%~ Date Paid: ~,.~-~%- . Amount: c{~. (DC> [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Abscmption Strata {~ ~ Type of System Design -g~~-~~'~ Width of Field ~ ~ ~p~ of Field ~ ' S~e ~et of ~s~tion ~ea ~ ~ Stan~i~s ~e~nt ~ ~p~ation Distan~ ~ ~s=pti~ Field: To Buildi~ F~n~tion ~ '~ To Existing ~ ~ndo~d System ~ To ~i~way, P~ki~ ~ea, ~ Vehicle St~a~ ~a ~ ~ LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions · Mgnhol /A ss ** ** Check Permitted Bedrocm Rating Against HAA Request I csrtify that I have checked, verified, c~ ~onfo~,=d to all MOA HAA Guidelines in effect on the date of this inspection. Signed Ccm~any KB1/d5/s [Page 2 of 2] 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVAT]ON ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 BILL SH,EFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: ~.~ According to records.on file in this office the ~ Water System is in compliance-with the State Drinking Water Regulations Sincerely, -. APPLIr?ANT FILLS OUT UPPER HA'-" ONLY ,~roPerty ~wner /,,~-/'~y~F',.~ ~.~.)~--~ Z ~~ Phone ~ailingAddre~ ~D~ ~',,/~7~ ~ ZipCode <~ ~'~/~--~ ~ Lending Institution ~ 4 //~ ~¢~ O/CZ Phone Address ;"/~¢Z/~/ ~ ~,/.~ ~/.J~ D E'~ ¢~ Zip Code 4~(~_2~4.3~ ~'~2 Realty Co. & A~nt ~ ~ ~ ~l~7 S ~¢ Y~ L ~y ~'¢ ~ ~y ~2~. ~ ~1 ~ Phone Ty~ of Resi~nce Single Family D Multiple Family No. of Bedroo~ ~ ~ Other Water Supply ~ Individual A~AOH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OOESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ~ C.(..,~ ~ "-~ ~.~'~'~ ~UNICIPALITYOF ANCHO.AGE DFPT C': ~'::'1.1;! o, ( ) APPROVE *OONDITIONS OF APPROVAL (~DISAP~OVED Soils Rating Date ~wer Installed ~ell To Absorption Area Well Log Received Well to Tank Septic T~k Size 72-023 (31~2) EXCAVATION ROBERT A. SHAFER WORK February 15, 1983 CIVIL ENGINEER 694-2979 Finis Realty ATTENTION: Jerry Braman Mile 20, Old Glenn Highway Chugiak, Alaska 99567 Dear Jerry, Reference: Lot 5: Block 3: Eklutna Subdivision MUNICIPALITY OF ANCHORAGE DF~T Cr ;'~'L'i ' ?. ENVIR.D~ ,IL.' :t,: ,'~ .... ~) LL rIGN RECEIMED A sewer system adequacy test was performed on the system located on the referenced property, as you requested. The septic tank was pumped and verified to have a capacity of 1000 gallons. The seepage was tested by first removing approximately 500 gallons of water from the crib and then adding 500 gallons of fresh water back into the crib to completely fill it. After a period of 74 hours the water level in'the crib was measured to determine an approximate amount of water that had percolated out of the crib. As a result of this test approximately 408 gallons of water had percolated out over a period of 24 hours. It can be concluded from this test that the waste water disposal system serving the two bedroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failures. If we may be of fur>her service, please do not hesitate to call. ~s/ss cc: Municipality of gnchorawe De'~artment of Health and Enviionmental protection Safeco Title Company AT'PE~?'TON: Pam MUNICIPALITY OF ANCHORAGE ENVIR'.);4L :1', A.: .<3. RECEIVED SRB 196X EAGLE RIVER, ALASKA January 27, 1983 Betty and Herschel Bryant Box Chugiak, AK 99567 Subject: Lot 5 Block 3 Eklutna Heights Sub. Add. #1 Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The septic tank pumped with a receipt submitted to this department. The total number of gallons pumped needs to be on the receipt and verified by a registered engineer as to the actual number of gallons pumped. This is to verify the size of the septic tank. A four (4) inch cleanout neods to be installed to the sep- tic tank. four (4) inch cleanout needs to be installed to the leaching area. An adequacy test needs to 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. This report needs to be submitted to this office for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, RP91p/EH Enclosure Robert C. Pratt Associate Environmental Specialist