HomeMy WebLinkAboutCOLONIAL PARK BLK 4 LT 10A-1L..
N A M E0.,~_~.~v,,'~_ ,,
LOCATION
GREA.:R ANCHORAGE AREA BORL ..,GH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska gg§03
REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE ./N
FROM WELL ~.
INSIDE LENGTH
INSIDE WIDTH
LIQUID DEPTH
NUMBER OF
,'--"~..___.
COMPARTMENTS
LIQUID CAPACITY/~'c~ GALLONS.
TILE DRAIN FIELD:
DISTANCE FROM WELL
FOUNDATION
NEAREST LOT LINE
TOTAL LENGTH
OF LINES
NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH__ IN. TOTAL EFFECTIVE
ABSORPTION AREA 3~-~ SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER (~. /'
DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE~ IN. ABOVE TILE IN.
WELL:
TYPE _(~ CONSTRUCTION .DEPTH
BUILDING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION__ LOT LINE__ SEWER LINE , TANK SYSTEM
CESSPOOL OTHER SOURCES
APPROVED DISAPPROVED REMARKS __
DISTANCE FROM:
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY: ~
SEWER LINE DEPTH:
PIPE MATERI
LOT SLOPE:
REMARKS:
%
G.A.A.B.
Form EQ-032
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"One test is
2204 Cleveland Anchorage, Alaska 99503'
Performed For Foremost Construction Date Performed 4/21,/76 -
Legal Oescrinti0n: k0t 10.__~ASl0ck 4 Subdivision Colonial Park Subd. EaqLe River
This ~orm Reports Soils Loq Percolation Test
0eoth '
.~Feet Topsoil S0il Characteristics
"- "~z'~t¥ ~i,i~ ..... " T
Sandy Gravel
6~ ,. (GP-GW)
14 ~,
16
18
20 ,
Brown Sandy
(SP-SW)
Bottom of test hole
No ground water or bedrock
encountered
Was Ground Water Encountered?
I¢ Yes, A% what Depth?
Readinq
Date
Grnss Time
.?
Net Time
Depth to H20
Net Drop
Percolation Rate ~linute
Prnposed Inst~'llat'iO~: Seenaoe Pit Drain Field
DeQth of Inlet~ DepthS'° Bottom Of Pit Or Trench
C~!~ENTS: 105_q_~_~are feet draina e 'area re uiredp_er bedroom
,T~,t eerformed Z), ~/~--- .... Data Certified )3~/:CONSTRUCTION TEST
i-amY's u. -~lacK Date: 4/23/76
MUNICIPALITY OF ~NCHORAGE
DIVISION OF ENVIROk~MENTAL ~EALTH
DEPARtmENT ,OF HEALTH AND ENVIRObIMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
General Information Application Date
(a) Legal Description (include lot, block, subdivision, s~tion, tow~hV, ra. nge)
[j..~..~.~.~, .~..~g:~i_.~, ~o j~..~
Location (address or directions) O-"' J/ ' '~/" dv~c~.~J
(b) Applicants Name ~-..~_'~. ~.~,~ Telephone- Home Business
(¢) Applicant is (check one) Lending Institution ~--~ ; Owner/builder ~
.yer f--q; Other <.plain); ' '
(d) Lending Institution ..~.~,_.~,~-~<-~_~ b~,.,-z~ Telephone
(e) Real Estate Co. & Agent
Address
Telephone
(f) .~a-~t the HAA to the following address:
Single-Family.~_,
Number of Bedrooms
Multi-Family ~--~
Other (describe)
3. 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. Sewa$e Disposal
Note: If co.unity well system, mu~ ~y~)~'~en cogitation from the S~a~e
Department of Enviro~ental Conse~ation ,a,ttesting to the legality a~ status.
,'1:~
[Page 1 of 2]
En~ineerin~ Firm Providing. Inspections~ Tests~ File Search~ Data and Infor~?a~tiou
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 amd 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 regula-
tions in effect on the date of this inspection.
Name of Firm
Telephone
Date~'Ah~
CADTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF h'E~ALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES m~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. TH~ 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 COLrDUCT 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.
RR4/ej/D18
[Page 2 of 2]
7-19-84
A. ~I~LL [I~TA
Well Classification .
Well Log Present (Y/N)
Total Dspth Cased to
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
Separation Distances f=cm Well--
,~UNiCt-~AL,, f Or
MUNICIPALITY OF ANC~)~%GE (MOA)' DEP'I OP HEAL-I'it A
0 7 1985
Legal Description~¢~~D F
If A, B, ~ C, D.E.C. ~o~d(~.)
~te ~le~d Yield
~pth of ~ting
~ ~t At
To Septic/Holding Tank cn Lot ~ ¢-0 .¢ v ; On Adjoining Lots 2~o
To Nearest Edge of Absoz~tion Field on Lot 2oo ~' ; On Adjoining Lots
To Nearest Public Sew= Line
Cleanout/Manhole
Water Sample Collected By
Water Sample Test Besults
. Sanitary Seal on Casing (Y/N)
D~u=ession A~ound Wellhead (Y/N)
TO Nearest Public Sewsr
To Nearest Se~r Se=vice Line on LOt
,SEPTIC/HOLDING TANK DATA
Date Installed ~,/7'7 Size /'O~ L~JNo. of CcmDartments
standpipes ~1~ Air-tight Caps ~.fY~, Foundation Cleanout ..~.~ )
Deu~ession over Tank ~ Date Last, t~m~ed 2-- 2 ¢--B~"-~-
Pumping/Maintenance ContraS/ct On File (Y~/~ ; for
Holding Tank High-Water Alan1 (Y~/~ Tempo=azst Holding Tank Permit
Separation Distances f~cm Septic~ Tank:
To Water-Supply Well ~ ~ To Building Foundation Z~
To PToperty Line .... /~ ~z// To Disposal Field
To Water Main/se=vice Line
Course
Com~snts
/'~) "~' TO Stzeam, Pond,
Lake, or Major Drainage
Receipt # ~.%Q-~%.
Date Paid: %.-)_ ~%--
Amount: ct~ .oQ3
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption St=ara
Date .Installed
Width of Field
Square Feet of Absorption Area
Depression over Field (~ ..... Date of Last Adequacy Test
Results of Last Adequacy Test 7~ 3'~,~ c ~ ~
Separation Distance f~cm A~sC=ption Field:
To Water-Supply Well 2(.~ /~ To Property Line /~
Length of Field
Depth of Field ' '/
Gravel Bed Thickness
~- ~--~' Standpipes Present
To Building Foundation ~ ~ ' To Existing or' Abandoned System cn
Lot /~ ~ ~ ~ ; On Adjoining Lots ~ t'~
TO Water Main/Service Line /~ ~ To Cutbank(if present)
To St=earn/Pond/Lake/or Major Drainage Course /t/m
To Driveway, Parking Area, or Vehicle Storage Area ~ ~;z ..
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Cc~m~nts
Dimensions
Manhole/access (Y/N)
"Pu~9 ~f" Level at . .
Pumping Cyc~,s '~nlng Adequacy ~st.
Meets MOA
**
** Check Permitted Bedroom Rating A~ainst HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines
on the date of this inspection.
Signed
Company
KB1/d5/s
[Page 2 of 2]
in effect
BILL SHEFFIELD, GOVERNOR
DEPT. OF ENVIRON MENTAl, CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
Telephone: (907)
Address:
274-2_533
To Whom it May Concern:
According to records on file in this
.... /~ Water System is
Water Regulations
in compliance-with the State Drinking
Sincerely,
REQUEST FORAPPROVAL OF INDIVIDUAL WATER AND S. EWER FACILITIES
-' , , . ! ' . . ,
DIRECTIONS: Complete ell parts on page 1. Innomplete reques~ Will not be processed, Please allowten (10) days for processing..
1. PROPERT~Y OWNER '""'?-~ ' ' ' ' ' PHONE
MAILI~8 ADDRE88 ' ~ - ' " -"
PRbPERTY RESIDENT ~f'different from above) .... . ' ' ' PHONE'
.2~ ~E~ ' . / . - ' - ' , PHONE ~
MAILING ADDRESS ' ¢ / ' ' ' , :, ....
3. L~D~NG INSTITUTION ' ,_ ' ' ' '
MAILIN6 A~BRE88 / ' ~ ~ ' '
x ¢ .,, , .
S." LEbA~r DESCRii~TION ............. ' ..... "
-6. TYPE OF RESIDENCE ' '
~ SINGLE FAMILY ~ One ~ Four ~ Other
~ Two ~ FiVe
- ~ MULTIPLE FAMILY ~ Three ~ Six
7. WATER SUPPLY ....
~ IEDIVIDUAL* * A~ACH WELL LOG. A well log is required for all Wells drilled
_ ~ COMMUNITY since June 1975. For wells drilled prior to that date, give well
~ PUBLIC UTI LITY ?pt~ (attach log if available.)
8, SEWAGE DISPOSAL SYE+EM ' ' ' "
~ INDIVI DUAL/ON~ITE** **If individual/on-site, give installation date. ~ -
'.. ,~. If system is over two (2) years o d an adequacy test is required
PUBLIC UTILITY . by this Department. -
NOTE: THE
INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROC~SJNG CAN BE INITIATED.
~2~10(3/78)
THIS SIDE FOR OFFICIAL USE ONLY
DA RECEIVED
' INSPECTION APPOINTMENTS " '
TIME I TiME TIM
E
DATE DATE DATE r
INSPECTOR' ' INSPECTOR INSPECTOR ,
DIRECTIONS:
1. 'TYPE OF RESIDENCE r NUMBER OF BEDROOMS , ,,
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [~] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
2. WATER SUPPLY PERMIT NUMBER ~
[] INDIVIDUAL DEPTH OF WELL
[] . COMMUNITY DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE~ISPOSAL SYSTEM PERMIT NUMBER
[] I NDIVI DUAL/ON -SITE DATE INSTALLED -
[]PUBLIC UTILITY ~--"~
Connection Verified , INSTALLER
[]Septic Tank Or [] Holding Tank
Size: If Tank is homemade ,SOILS RATING
give dimensions: ., ' ... /
TYPE OF TANK MANUFACTURfiR
TOTAL ABSORPTION AREA MATERIAL
Absorption Area tO nearest Lot Line
5. COMMdNTsrl ,
I
[~'~APPROV ED FOR __~ BEDROOMS
[] CONDITIONAL APPROVAE (letter must accompany certificate)
[] DISAPPROVED
DATE BY (Title) ~ '
LEGAL DESCRIPTION
72-010 (Rev. 3/78)
DAVID A, SLENKAMP
MECHANICAL ENGINEER
694-9055
Ar~ril ?3, 1981
ClVIL,ENGtNE~.R
MUNICIPALITY OF ANCHORAGE
DEPT, OF HEALTH
ENVIRONMENTAL PP, OTECTION
David Km,~alski
c/o Cmeat &~nd Real~y
P.O.
ATTE[{T!O~,~: ~loris
Deor
~eference: Lo. Block 45 Colonnial Park ~ivision
A ~ewer system ade~cy test ~.ms ~erfo~ed on the system located
on the referene~ oroperty, ~t the tempest of Great ~nd ~lity.
The se~tic t~nk ~ms p~p~d ~nd varified to have s cspscitJ~ of
JO00 ~llons. '~e absorbtion trench ~s tested ~ a conti~ous
f'low of w,:~ter ever ~ period of 24 bour~. '.~e flow e~ce~ed that
req~red for ~ J bedroom residence. ~erefor, it i~ concluded
that the absorbtion trench is c~rently functioning ~dequately
~or the three bedroom residence located on this oroperty.
APR 2 4 1981;
RECEIVED
:f ~ m~y be cf further s.arvice, please rio not hesitste to contact
· //,,, ,'/,
' A. Shafer~ ,'P.E,
,.;c. :-'eoples ]~nk & Trust Comoany
]innicipaJ ;.ty o.f Anchorage
$r;8 196x EA( LE RIVER, ALASKA
MUNICIPALITY OF ANCHORAGE
DEPARTME[ OF HEALTH AND ENVIRONMENi
825' L Street, Anchorage, Alask~
D%b%SO~t' 279-2511, ext. 224 or 225
Date Received: July 25,,...1~77
PROTECTION 99501
#1: Time %2: Time #3: Time
Date Date Date
Insp Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request:
Mailing Address: Pouch 7-007
Peoples Bank and Trust
99510 Phone: 279-7511
2. Property Owner: James E. Davis Phone: 276-7777
Mailing Address:
2810 C Street 99504
3. Legal Description: Lot 10A Block 4 Colonial Park Subdivision
4: Single Family Residence: (~
Multiple Family Residence: ( )
Number of Bedrooms: Four
Number of Bedrooms:
Se
Well System:
Permit #
Construction
Individual Well ( ) Community/Public System (~
Depth of Well Well Log on File ( )
Bacterial Analysis
Sewage Disposal System:
Permit #
Septic Tank Size
Absorption Area
On-site System k~ Public Utility ( )
Installed Installer
Manufacturer
Soils Rate Material
Distances: Well to Septic Tank
to Sewer Line Nearest Lot line
to Nearest Lot Line
to Absorption Area
Absorption Area
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L Street, Anchorage, Alaska 99501
279-2511, ext. 224, 225
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
VA FHA
2. Property Owner: James E. Davis
Mailing Address: C/O Executiv~ Realty
2810 "C" St. Anch., Ak.
Name of Buyer: David K. and Patricia A.
99504
Kowalski
__ Day Phone: 2Z_6-777__Z_
Mailing Address: Box 1400 Eagle River Road Day Phone: ...... 6--94-9803
Eagle River, Ak. 99577
Name of Lending Institution: PEOPLES BANK & TRUST CO.
Mailing Address: Pouch 7-007, Anch. Ak. 99510 ._Phone:
279-7511
5. Name of Realtor or Agent: Robert P. Yerger-Gold Rush Realty
Mailing Address: P.O. Box 893, Eagle River, Ak. Phone:. 694-2287
Legal Description:
Location'
Lot 10-A, Blk. 4, Colonial Park Subdivision
Corner Hillcrest and First Streets
7. Type of Facility to be Inspected: Single Family Residence
8. Water Supply
Type of Supply: Public Utility.
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility__
If Individual, date of installation
No. Bdrms., 4
Individual Community
Individual (on-site)__
72-003(3/76)
Page TWo
.' Department of
Request for Approval
Health and Environmental Protection
of Individual Sewer and Water Facilities
Legal Description:
Co~nents:
Lot 10A Block 4 Colonial Park Subdivision
Affadavit Attached: ( )
Letter Attached: ( )
Approved: Date:
Disapproved:
Date:
Department Worksheet: