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Home My WebLink AboutSKYLINE VIEW BLK 2 LT 5 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING _DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2,64-4720 ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPECTION REPORT MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~NO. OF BEDROOMS .... m Wemm [Absorption area , ~e~ ., ~ m PERMIT NO.. ~ Z m Manufacturer / ...... n m Material m No. of compartments ~ Lq capacity nga ons[ ....... [ nsdelength [Width [ Liquid depth ' ~'~ ~3 I IF .ulwEIwAD:' I / ~ I ] - ~ .... ' ,~- -- -- _% < ~ 1Type of crib Crib diameter ~i~de/h, ; Total e ective abso'pt)o, area ~ ~ Well .... ~~ion Nearest~ ~ DISTANCE TO: ~ ~ IClass Dept~ _ Driller ~~ I~ERMIT NO. ~ ~ Building fot(~~ -~wer ~ ~ '"7 'Se~i~ ~ ]Abso,'ption area(si OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS · THE ~.u:Z)TT!::)I'i OF "FH~X E;:':;(::Fl',,,'Fi"? :!: Oi',l (:IN DEPTH :[ S THE Iq ]: N ]: ~'~l.jl'"l [::'!~:F"I'~I (:)F' ~:L:iJ:,~:l:::i',,,'~;~:!... E?,E~:'T'HEEN THE OUTF=FILL. P ~',OT"FOI'! OF "rH[FZ ~:;.;;(:::FI',/Fi"i":[(]:iI'.] ,::Z[iq i.iI='0i',! "!'HI:_:!: "i"'./f::'i~!: C$:' F'I...I~i'L. :L C: .b!EL.! ?'i Z N ]: PILl?! i'.) TO FI CCll','!i'ql...Ih! ]' T".,.' !.,11:~;I... L L.O(3S OF 'i"HIF.:; !,.!!!];!._L. (:l T I. li!i~l:;i~ I;;i: ~;!X;:! I...I F! 'v' I:::I ]; L. F!E',L.~!i; 'T'C! SOILS LOG PFRFORMED FOR: LEGAL DESCRIPTION: 2 3 7 8 9 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST [] PERCOLATION TEST ' SITE P[~AN ...... 10 11 12 13 14, 15 16 17 18 19 20 ENCOUNTERED? O P E IF YES, ATWHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop / PERCOLATION RATE (minutes/inch) COMMENTS PERFORMED 72-008 (6/79) TEST RUN BETWEEN FT AND FT CERTIEIED 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 GENERAL INFORMATION Complete legal description Lot 5; Location (site address or directions) 19311 Dogwood Chugiak, AK Property owner Carl Ko~nig&r Mailing address P.O. Box 671430 Ch~giak, Day phone AK 99567 688-2124 561-1750 Lending agency Mailing address Day phone Agent Address Kathi F6rnand6z/VISTA REAL ESTATE Day phone AK 99503 3000 "C" Str6~t, S~it~ 101 Anchorage, 562-6464 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: XXX Individual well Community well 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: XXX Public sewer If commuhity 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 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 ty..pe 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 S&S ENGINEERING ~ ./ Add ress 17o:~4 Ea,4e River Lodo Road/NO. 204 Engineer's signatureE~gl° River, Date DHHS SIGNATURE .X' Approved for /~-~ ~--~ ~/ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. Municipality of Anchorage Department of Health and Human Services HEAl. TH AUTHORITY APPROVAL CHECKLIST Legal Description: ~'¢~ ~"~.¢/-~ ~-- 4'~[~.~¢-~f4~ftrcel I.D. A. Well Data Well type Log present (~N) Total depth \ Sanitary seal (~/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed 9 -~ 'E, '?-~ Driller Cased to ~,~' ~¢z.¢.-r'- '~-z. -¢~'Casing height Wires properly protected ~N) "~ FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ c~ Absorption field on lot \ ~ ~ Public sewer main ~ I Ar Sewer service line ~ ~ 4- ; On adjacent lots ; On adjacent tots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~:~ Date of sample: (~ B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts~/N) High water alarm (Y~ Date of pumping Nitrate ¢--. ~ ~ Other bacteria Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle Ri*cer, Alaska 99577 Tank size \ -¢..~"0, Compartments Foundation cleanout ~}'N) '-/ Depression (Y~) ~ Alarm tested (Y/N) ~ (z~ (,_¢ --- "~\ ~ ~ "~ Pumper ~_'~. ~¢-~ ¢oo~'- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~, co To property line \ o ~ ~ ~-~ ~ ~ Surface water/drainage 72-026 (3/93)' Front On adjacent lots Absorption field Foundation Water main/service line 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 electrical codes (Y/N)j~ SEPARATION J~S-'TA'~E FROM LIFT STATION TO: We11"oon lot On adjacent lots Manufacturer Manhole/Access (Y/N) /~~eve. at ....-----"'~ycles tested Sudaoe water D. ABSORPTION FIELD DATA Length -x-~ Width Total absorption area z'~-/-~ ~ S0il rating (GPD/Ft "~ ~* Gravel thickness Cleanout present.N) System type '~i?~r....~ Total depth ~ CP~ Depression over field (Y/~,)~ ~ Date of adequacy test [~ /(~ ~ '~ ~ Results~fail) Water level in absorption field before test '~ Peroxide treatment (past 12 months) (Y~.) I-~ \Z--~o.,~ ~ for After test If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTIQN FIELD TO: Well on lot \ ~c> \-V To building foundation On adjacent lots '~ ~ '~ Surface water \ ~c~ Curtain drain lA On adjacent lots ~, ¢ ~ \ '~ Property line \ o~ ~- To existing or abandoned system on lot ,~/,~ Cutbank ~ / j~ Water main/service line \ Driveway, parking/vehicle storage area ~---'-~ E. ENGINEER'S CERTIFICATION I certify that I have ch ~'fied, or_.~nformedto all MOA and FI,4A guidefines in effect on th~;..cl~t~ of this inspection, Engineer's Name Date HAAFee$ ./7 Date of Payment Reoeipt Numbe,~q[~gzZ 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number COMMERCIAL TESTING & ENGINEERING CO. .......... REPORT of ANALYSIS Chemlab Ref.~ :93.2812-1 Client Sample ID :L5 B2 SKYLINE VIEW Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :S & S ENGINEERING Ordered By :R.J.S. Project Name : Project~ : PWSID :UA WORK Order :67250 Report Completed :06/21/93 Collected :06/15/93 @ 14:45 hfs. Received :06/16/93 @ 15:00 hrs. Technical Director~STE~H~E~/C. EDE Released By . /'('~__~- -~. Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nltrate-N 2.66 mg/L EPA 353.2/300°0 10 06/18 LLH * See Special Instructions Above UA = Unavail~le *'~ See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = [,ess Than D = Secondary dilution. GT = Greater Than ~SGS Member of the SGS Group (Sooi~t~ Gbn~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA Time , 'Jrne Date Date Inspector Inspector Comments Dale Inspector 0"~E~ ~-~-~. MUNICIPALFW OF ANCHORAGE Permit No. Well To Absorption Area Well to Tank ENVh, .I,~. ~.,/,. f .O f: , RECE.I_VED Date Sewer Installed Soils Rating Conditional Approva! Septic Tank Size Holding Tank Size Well Log Received APPLICANT FILLS OUT LOWER HALF ONLY Property Ownerd-~(~- ~- -S L-, Mailing Address~, 0, ~ Buyer ['A¢~ ~ CLA¢/-~ Lending Institution Address GNG -'He~lty 0o. & Agent ~ ~ Address Legal Desarlption LOT Phone Phone Phone Type,,,e f Residence /t~ Single Family L.J [] Multiple Family No. of Bedrooms [] Other wat~l~ Supply C] Individual [] Community [] Public Utility ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date. give well depth (attach Icg if available.) ' Sewage Disposal /~ Individual Year Individual Installed: [] Public Utility When Connected to Public Utility: J [] Holding Tank L NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROOF. SS~NG CAN BE INI'fiATEI),