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Home My WebLink AboutSUE TAWN ESTATE #2 BLK 1 LT 6 MUNICIPALITY OF ANCHORAGE( ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~(I ENVIRON[VIENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ! I~EW MAILING ADDRESS LEGAL DESGRIPTION LOCATION NO, OF BEDROOMS DISTANCE TO:I ~ O~' , ~ ~ ~ ~] ~ I P al Dwelling I PERMIT NO. ~ Z Manufactu r ~ < ~ ~ Material ~ ~ ~~ No, of compartments Li~acity~.-~in gallons IF HOMEMADE; Inside length Width ..... Liquid depth ~ ~ DISTANCE TO: 'Well ~ / Dwelling PERMITNO, O z ~ Manufacturer~ Material Liquid capacity in gallons Well I Foundation ~ Nearest lot Ii e PERMIT NO. ~m DISTANCE TO: ~ OC) ~ ~ ~ ~ ~C)~) ":l ~~:~ NO. of ,,nes i Length of~a~, ,,,.e Tota, ,en~.~th o~ Ih, es Trench w,d~.~ inches Distance --/~ lines ~ Total effec ive 2bsor ~ Top of tile to finish grade ~, Materialbeneath tile (~ ,) q¢inches ~ ~ ~ Length Width ~ Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Tota~ effective absorption area ~ Well Building foundation Nearest lot Hne ~ DISTANC~ TO: ~ 0~ass ~ Depth Driller Distance to lot llne PERMIT NO. ~ ~ DISTANCE TO: Building ~oundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING ~ INSTALLEfl REMARKS ', ' '"" ' APPROVED ~l-i~ -J ~&)~ DAT LEGAL 72-013 (Rev. 3/78) L)iClTir "c'c, ~: 85()0 ?"7 ') 3!; i ~;i'. 9 ! 85 Ai::'F:'!_..IC,.':~Iq]":: GF:ORGI!:-.NE I"!OLD['IVAN ANiX) ADDRESS~ I" 0 BOX G ]'Ri)I>I£IOD :, ql':; 9c75.-E~7 CJI NI'I-AC]" F:'H[)IqI:' :'. 78::~;-2885 c~::'~'r' rF ' xc .... ~:'' '[~,~N c,/'h" '. '~.j ..... C, :I:ON: :I.S: ._[, I,c~,'n .... t~l:: ........· LO]' SI?~:.: ' MAX BEDR'00.'*S ~ I ~'~ ~[:J I:)e].c)~ ~t~"(.'~, the ..... ' ..... ava:i. system. ~1 i]o=.e i:.h~ q]tion ths.'~ ,.)!_.. I TO I-' .t.!- ,. BOI-'I"OM (I:'T GRAVEl DEF:'TH (F'!"-) :~ ,- M -:~ ~'-' .... ., , - ) :[: C), ':'~ ,'~ TO'T'AL D= iF. ~::'r C. % .... 1Al ]: DT!~ (F:'T. L,,~,..,VJ._ L .. xtO ! ~::'" I-~NI';:: SZZE (GAl 3) ..5 e)p t :i. c: -;.,'-x, -Ai,!K MUS'I' lAVE: AT LEAS'"' 'TN(3 C[]MPAI::;:FMENTS Z (::~}}n'{'.:i. Fy i:.ha'L~ J...I am i',_.u.[ilJ. Zia[- ~,}:i.i:.h 'Lt"ie r,{~:}clLi:i, peme:ant Fc)r'Lh by 'khe Hun:i.c~pa].i%y of' AnckH::}r'ag¢~ (MOA) and Ci'i~ State oF ~!m. sl::a,, 2~ ! ~A*J. I 1 :Lnsi:.al I Ll']e sys'l:.em in ' ccc "dan:-(..~ "':" ~- a'l ~ '.~u-w~ , ,, ,_ · ..... I t*~J.].], ai;:!l"lizH'ue} 'Lc} .al ] MOA ', c~......., .. . , se~JePage system or'i {.his of any adj,::~c,;~.~rlt 4:: I LU-ICJEaPS'I:.aFicJ fha'I:. 'Lhis pe~-mi'L :i.s raj. id f~]r' a maximum c:)F 5 bs;dpeoms a. nd any (~l-Ilal"Cj~}ifl(al"it will PeHqL~ir's:, an ifF: A ~ '::"r ~: '~""'r' .... ! .... IA II~B, IS IIxSTA.LED ;lin AN AI:~IEA COVEF!ED BY MnA (I) AN F:I =-T~'I"]Af I ~J,,t., AND ].!.!._~, [...~.,] ].d,., h~.,,:~, BE AND (3) TI-I 6,., AI='F'Fd_')VI!:D l,:l]"T'Hr' j]- ~...,! ..... N...I,A_ WOI::;~K MUST BE T~r~h"=' BY A L.!.i.,._.t ....... [ ..... L,....b,ld._,].,..-,.!= GIECh:iGEf',!,:C I',O,_.DOvAN AND ~uPJ:'/IEFi tq[IN[:'GA,q ............................................................ ...... MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street. Anchorage, Alaska 99§01 264-4720 SOILS LOG - PERCOLATION TEST ~-,~ SOIL~LOG~--0 0 '~ PERCOLATION TEST PERFORMED FOR: C~.(.~'~'~--~. "'~)~-(~ ((~(,~,/~,~-~T'~ DATE PERFORMED: 4 5 6 7 ~0 SLOPE PL~LA N 13 14 15 16 17. 19- 20- WAS GROUND WATER ~/'~) [~ ENCOUNTERED? i pO IF YES, AT WHAT ~///~ E DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) COMMENTS PERFORMED ~]Y: 72-008 (6/79) PiqIFILIMINARY plODettT.. '%.~ .............(_5_ _ [ ............. It> ,f ......................... 19:,_' % L$ON WELL DRJLLMG 1305 W. 45TH STREET '., ANCHORAGE. aLASKA 99503 PHONE 272-9343 Well Size of casing ~' q ~ ~l ' Depth' of Hole J O .S' feet Cased to ~ /(? feet lC)' S~ '-r~' ,~L~...~, ~_~ Static water level ~ ~ ft. (above) ~ land surface. ~inish of well check one)', open end h ~ DRILLING LOG Owner ~- ~-''(L-M 'F I.L~. 4 % ~,~- Use of Wel~~-~ ' Location (address of: Township, Range, Section,_ if ~own; or dfstanee maim road ~ Itfklf~ hours wi.th Screen.. ( ); Perforated ( '~ ). *I t~b.~.~/?~:t:' ~" Describe-screen or perforation ~1" ,:; H ' Well pumpin~ test at '~ gallons per (hour) ~t~) for of drawdown from static level. Date of completion ~. '~ ~;~'~ ' Iq ); WELL LOG ground surface TO. TO ' ' 'I"TY Oi: ~,t,.iC~O~,~'~t ' " ' ' TO. o Give details of formations penetrated, size of material, color and hardness '.- TO__ TO_ 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 C"~_Z~ ~ - LI'~ ~ - ,--~. 9-, HAA# GENERAL INFORMATION Complete legal description Lot 6;%Block 1; Sue Tawn Estates #2 Location (site address or directions) 23443 HickZin9 CirCe Property owner Walt Mono.qan & Georqene Moldovan Day phone Mailing address C/0 JACK WHITE CO. EAGLE RIVER AK 99577 Lending agency Mailing address Day phone Agent Barb Cr~6nden/JACK WHITE CO. Day phone Address 11823 Old Glenn Hwy Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 5 TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: 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 Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. 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 inves_ti_gation 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 thi~'ns,~)ection. Name of Firm i/J/// Phone ~'~.¢Z_ ~'¢¢, Address s & $ ENGINEERING / / / ] 7034 Eagle River Loop R~ac Engineer's signature Ea.qlaRiver, Alasl(ag~)~/ ~ Date '~-/~/¢' t DHHS SIGNATURE /~ Approved for ~'/c/~' ~(//'~1 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ~ (~--¢--c.¢~-,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 DH HS 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type ~-~ .~C6~- Log present ~N) I Total depth \ o~' ( Sanitary seal ¢~Tr:/N) %/ If A, B, or C, attach ADEC letter. ADEC water system number Date completed \~ "?-~ ~"/~ Driller Cased to '~O) t ~ '~ Casing height ~,~z- Wires properly protected (~N) y Date of test Static water level Well flow Pump level1 FROM WELL LOG g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line 7~" AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate B. SEPTIC/HOLDING TANK DATA Collected by: Other bacteria Date installed 1~ ~ ¢ Tank size / S'-z '~ Compartments Cleanouts (~N) ~f Foundation cleanout ~/N) ,V' Depression {Y,~ High water alarm (Y/~ t'(/''~ Alarm tested (Y/N) Date of pumping /2. - /~' ~ ~ Pumper .3"-.~. (..¢-.¢¢' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot '.] oo To property line . / Surface water/drainage On adjacent lots / ,~o t ~ Foundation Absorption field ~ f Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level .~--'""~'~ Cycles tested Meets MOA ele~~ S~N'DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manhole/Access (Y/N) .,~-~ ~ at Surface water D, ABSORPTION FIELD DATA Date installed / Length ~ f Width Total absorption area Date of adequacy test /2--- ~'- ¢ ?'5 Water level in absorption field before test Peroxide treatment (past 12 months) (Y/~ Soil rating (GPD/Ft2) ~& /'/~ System type ~ Gravel thickness ~ 1 Total depth / Cleanout present ~'N) / .Depression over field (Y/~ /J Results (l~fail) /¢-¢<---------------~ for ~ Bedrooms After test ~" /J"¢ 'J'~' ~"5'"/~ ~"'/"~/ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /c) ~ t-p- On adjacent lots To building foundation 2.~z~ / On adjacent lots '~ o ! °~ Cutbank Surface water /o o / c- Curtain drain ~ /a z~ / '~ Property line To e~x~ting or abandoned system on lot Water main/service line Driveway, parking/vehicle storage area // E. ENGINEER'S CERTIFICATION ~cert~fythat~havechecked~Ve~f~rc~nf~rmedt~a~M~AandHAAguide~inesine~ect~nthedat`e~fthisinspecti~n~~ '' "~¢;i~;' ~ HAA Fee $ Date of Payment Receipt Number Waiver Fee Date of Payment Receipt Number 72-026 (3/93)* 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 Application Date 9/12/85 GENERAL INFORMATION (a) Legal Description (include lot, bl0ck, subdivision, section, township, range) Lot 6 Block 1, Suetawn Estates #1 T15N R1W S¢c.15 Location (address or directions) Chu~iak (b) Applicant NameMoldovan/Mon'e~an Telephone: Home 688-~748 Busings __ Applic,ant Address PO Bo~: ~949 ~ Girdwood ~,.Alaska 99587 (c) Applicant is (check one): Len~ling I~stituti0n'[]; Owr~er/b~'!lder~-~; Buyer []; Other [] (explain); (d) Lending Institution N/A Address (e) Telephone Real Estate Company and Ager~/A. Address Telephone MailtheHAAtothefollowingaddress: Pickuo by Engineer TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conse~val~n .' attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: if community wellsystem must have written confirmation fromtheState Departmentof EnvironmentalConse~vafio~ attesting to the legality and status. Page 1 of 2 5. ENGINEERfNG FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto a nd as of the validation date shown below, I verify that my invest£;adon ol this i4ea[th Authority Approval shows that the on-site water supply an d/or wastewater disposal system is safe. funcrro~a] arid adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the [nfo~rmat~oo o~;tamed from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply arid'or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regc[a~ons in effect oN the date of this inspection. Name of Firm Address Date ~.~ {/'~3~ EAGI_E RIVER ~NRINFFRINR ~FRVINFR EAGLE RIVER, AK 99577 P.e.~UX ~73294 '694-5195 Telephone Engineer's Approved for ,5 +iO - bedroo . -- ~ Disapprov--~ed ~ '"' Approved Terms of Conditional Approval ~ itional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) isst~es I-lea~ih Authc~ Approval certificates based solely upon the representations given in paragraph 5 above by an ir~de~t l~ofess~,~al . , engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes ams ttt~r ~efi~ir~g institutions in order to satisfy certain federal and state requirements. Em ployees of DHEP do not co~dfcct inspectors or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors o¢ omissions in the professional engineer's work. ~ Page 2 of 2 72-025 (11/84) ' ~ WELL DATA Well Classification MUNIcIPALiTY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPAl. ITC OF ANCHoR~CKLIST - FEBRUARY 1984 DFPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION SEP 1 2 1985 RECEIVED Legal Description: ~o7'- ~ 7-/.~-/~' .,~ z ~ J'~'~ / If A, B, C, D.E.C. Approved (Y/N) ' ~-~ Well Log Present (Y/N) Total Depth ' ?~'~- Cased to Static Water Level ~- Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: T~ Septic/Holc~ing Tank on Lot Date Completed /4~/.)~/~ ,2 Yield Depth of Grouting - ~ Pump Set At ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Neares~ Edge of Absorption Field on Lot ?~¢' / To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by ; On Adjoining Lots ; On Adjoining Lots /~¢ /z,-',*-~¢.- To Nearest Public Sewer /'~'~"'¢-- To Nearest Sewer Service Line on Lot ~ ~ ~-~'g ;Date Water Sample Test Results 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) Separation Distances from Septic/Holding Tank: To Water-Supply Well /'0'~ ' To Property Line /~' ¢- Size /~5-o~ ~' No. of Compartments Z~ ~" ' Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) .Y Date Last Pumped .~-¢./~¢c~, ~.~:~ /L////,~¢' ;for /Z'// Temporary Holding Tank Permit (Y/N) . To Water Main/Service Line To Building Foundation To Disposal Field Course To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. , ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field -~" Square Feet of Absorption Area Depression over Field (Y/N) /!// Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /¢~ / '"~"- To Building Foundation ~,~c) Lot ~ ~,~'~_ -'~' ¢¢ J~ Type of System Design Length of Field ~?~'/ '~' Depth of Field / Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line /~ -/- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 2" To Property Line /,o To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION 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 MQA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~...~".~-7¢%~ Date Company Receipt No. Date of Payment Amount: $ MOA No. Page 2 of 2 72-026 (11/84) Engineer's Seal