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Home My WebLink AboutF & R BLK 1 LT 3 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 NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION WeN O~: DISTANCE TO:I z ly .r ~- ~ I Manufacturer ~.~ ¢~ , ~ Liq c7~¢~n gallons IF HOMEMADE: ~-- ~ DISTANCE TO: JWell ~ I Manufacturer ~ % I DISTANCE TO: I ~Z ~ No, of lines ~ ~ Length of each line Top of tile to finish grade m J Length Width ~ ~ J Type of crib Crib diam~ J ~ DISTANCE TO: Well j JClass . Depth ~ DISTANCE TO: Building foundation Absorption ~rea JInsidelength Dwelling Foundation Total length of I~nes Material beneath tile Depth Crib depth Building foundation PHONE I Material Nearest lot line/5 ~ Trench width / ~:~¢--J inches inches NO. OF BEDROOMS~._~ PERMIT NO'sz/¢ZB No, of compartments Liquid depth PERMIT NO. Liquid capacitv in gallons PERMIT NO.~z O ista nce b~lines Total effectiCe abs~tion area PERMIT NO. Total effective absorption area Nearest lot line Driller Distance to lot line PERMIT NO. Sewer Pine Septic tank Absorpt on area(s) .J~ NEW [] UPGRADE OTHER PIPE MATERIALS SOI LTESTRATING INSTALLER REMARKS DATE LE ALAS~g~ PERMIT NO. ~ILI~J IC:I F-~LIT~' IDF I=lr-JCH f~FIGE DEPARTMENT O. HEALTH AND ENVIRONMENTAL P.OTECTION 825 'L' STREET., ANCHORAGE, AK. 99501 264-4720 ~4ELL R[4E~ O[4--SITE SibliF~ PERI4 IT 82i028 ) APPLICANT JOHN & CYNTHI~EHIMMEL _?.500 KFtCHEMAK PL 99502 LOCATION ~+~__, C "'~ LEGAL I~ /D ~_~l~_o~ ~a~ ~ LOT =,I~E T'¢PE OF SOIL 8B~ORF'TION S~'STEM IS: TRENCH ¢~ %~ ~ 2.:44-0786 999999 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT?BR)= i05 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [)EPTH= 121_ LEI'-k3TH= 2~ GRR',,-'EL [:,EPTH= 7 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). SEPT I C: TRI'4k'. S I ZE= -1 00E~ IS;-;LLm]f4S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO <2> I f-ISPECTIIDf4S lIRE ~EG~LIIRE[) BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIMATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PEF-:f.1 I T E><p I F.:FS C. EC:Ef. IBER _--<'J_.. I CERTIF'¢ THAT t: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH 8Y THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~-.: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE/I~ REMODELE.[) TO INCLUDE MORE THAN ]: BEDROOMS. RPPLIE:ANT~--~JOHN & CYNTHI=. HIMMEL I=:_ED E:Y_ ..... DATE .... /2-~---~ V4. 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF REALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2221 SOILS LOG -- PERCOLATION TEST SOILS LOG F-] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 5 6 7 ~o 12 13 14 15 16 17 18 20 COMMENTS SLOPE SITE PLAN ~,~ r~,-''h-~i -,~l !, , ~ ; \ '"WAS G R O.U N? ENCOUNTERED? IF YES, AT WHAT DEPTH? S Gross Net DeDth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT 72-008 (7/76) 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 - .~' ~ l ~0~' HAA# ¥'~ GENERAL INFORMATION Complete legal description Lot 3; 'F & R Subdivision; Location (site address or directions) Hiland Road Property owner Mailing address Lending agency Mailing addres~;00 Agent Address Richard L. Pom~ray/ Day phone 271-3379 - Hm#696-2747 SR 2 Box 9201 Eagl~ River, Ak. 99577 PACIFIC ALASKA MORTGAGE Day phone 258-7534 Attn: Carla D~a£~ ~. #204 An.o. hn~a?_~ A£a~a 99503 Day phone., Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS:~ 3 '/ 3. TYPE OF WATER SUPPLY: NOTE: Individual well ×X Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XX Individual on-site Holding ta~nk Community on-site 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 5. STATEMENT OF INSPECTION BY ENGINEER Se 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature S & S ENGINEERING 17034 Eagle River Loop Road NO. ~_~ Eagle River, Alaska 99577 Phone Date DHHS SIGNATURE ~ Approved for _;7~"-,-~_~1 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 engineer's work. 72-025 (Rev. 1/91) Back MOA #21 (~ Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: LoT '~'~/ ~'~" g//~ ~l~,~+~u'~o'") Parcel I.D. ~0 I~ AhB, or A. WELL DATA Well type Log present (Y/{~) Total depth Sanitary seal ~N) C, attach ADEC letter. Date completed (.~ Y-.- Driller # ~O 4-. ~ Casing height Wires properly protected ~N) Cased to 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 Public sewer main ~J/~ Sewer service line g.p.m. ADEC water system number AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (~ Nitrate Date of sample: I / ~ Ic~ ~ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~0/~, / ~%. ~'~ Tank size ~000 Cleanouts (~N) Ye_.% Foundation cleanout (~) High water alarm (Y/~) /~O Date of pumping ~/ OC...'~ ~I, t ~"Pr ~. '~Cqmpartments ~/~--:St'-~L''~ 7Depression (Y/I~) Alarm tested (Y/N) Pumper ~', 1~, '& SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field 100¢ ~ Foundation L/O¢ .t~ t Watermain/serviceline <~O 4- 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~ ~)//~r Manufacturer J Size in gallons~ Manhole/Access ~ Vent (Y/N) "~at J "Pump off" level at High water alarm level "~"-~'~Cycles tested Meets MOA electrical codes (Y/N) ~ ~ SEPARATION D ~,~'~'OM LIFT STATION TO: Well on lot ~ On adjacent lots D. ABSORPTION FIELD DATA Date installed Length ~q,~ ' Total absorption area /O/(~/S2- Soil rating /0.~ Width ~ ~ ' Gravel thickness Depression over field (Y/I~ Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) ~o-r Cleanout~ present (~N) Date of adequacy test for -'~ ~oc~j~.3 If yes, give date System type T~x~c~ l/~-- Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I00 To building foundation On adjacent lots Surface water Curtain drain On adjacent lots } O0 ¢ Property line v-'~O' ~' To existing or abandoned system on lot I~O '~- Cutbank /[Jd~F_ Water main/service line /00~ ~- 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 Engineer's Name Date S & S ENGINEERING 17034 Eagle River Loop Road Eagle River, Alaska 99577 HAA Fee $ Date of Payment c-~q ~ ?¢'~ Receipt Number ~'~L~,_~,-o~. (- 6~%¢'(~ ) 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ANALYSIS RESULTS for INVOICE t 50696 Chemlab Raf.t 92.0349 Sample ~ I ~atrix: WATER FAX: (907) 561-5301 Client Sample ID PWSID Collected Received Preserved with DRINKING WATER L3 F & R S/D HIGHLAND RD UA JAN 28 92 @ 17:00 h~s. JAN 29 92 ~ 15:40 hrs. AS REQUIRED Client Name :S & S ENGINEERING Client Aoot :SNSENGP BPO~ : Req! : Ordered By :R. SHIFER POW :NONE RECEIVED Analysis Completed : JAN 31 92 Laboratory Supeutts.or_~. STEPHEN C. EDE Send Reports to: l)S & S ENGINEERING 2) Parameter Results Units ~ethod Allowable Li~ts NITRAIE-N 1.8/'"'mE/1 EPA 353.2 10 Sample ROUTINE SA~LE COLLECTED BY: J.W. Remarks: I Tests Performed ' See Special Instructions Above UA-Unavailable ND- None Detected ** See Sample Remarks Above NA- Not Anal!ned Lt-Less Than, GT-greatar Than ~r~_~ Member of the SGS Group (Soci~t~ G(~n(~rale de Surveillance) APPLF .... NT FILLS oUT UPPER HA: ONLY Propr'ctY,,~wner ~"'O~'¢C~ :~=- ~" C\t¥'~-~"\\~')' ('~ ~a~ Phone Ma'l'ng Addre~ ~ ,~,~f~ ~ [~ ~ ('[~'~ ~ ~: Buyer '~ Address Zip Code Realty Co. & Agent ~ ~ ' ~ ......... Phone ~ 0 []~ Zip Code Address Type of Resi~nce ~Single Family ~Multiple Family No. of Bedrooms ~ Other Water Supply ~lndividual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: . ~ Public Utility When Connected to Publio Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Date Inspector Time Date Inspector Time ------ Time · '-,,,,~/ Date Date (") L ¢2 ~- · Insp~tor Insp~tor "Municipality of Anchorage" "Dept. of Health & EnVil'onmen.ta/ Protec~or¢' (~1~) APPROVED BEDROOMS ) DISAPPROVED > CONDITIONAL APPROVAL' DATE ~"~ ~'--~ 2_ BY: ~ ~ ~"~ *CONDITIONS OF APPROVAL Soils Rating 72-023 (3182) Date Se, yer Installed Well To Absorption Area Well to Tank tWell Log Received Septic Tank Size