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HomeMy WebLinkAboutHIDEAWAY LAKE BLK 2 LT 3"t52- 0/5-  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTFCTION ENVIRONMENI'AL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELt. INSPECTION REPORT NAME pHONE 7"(¢ .UEW MAILING ADDRESS LEGAL DESCRIPTION ~CATION ~ NO. OF BEDROOMS Well ~bsorption aroa DwelHng / PERMIT NO. }- ~ Manufacturer Material No. of compartments i Liq. capacity in gallons Inside length Width Liqeid depth / ~ ~ IF HOMEMADE:  Well Dwelling PERMIT NO. DISTANCE TO: ~ ~ ~ Manufacturer ~ Material Liquid capacity in ~allons ~ DISTANCE TO: Well // ~ , Foundation~ 2, ~ ~ ~ No. of lines / Length~of each~ ~ line Total~lengtht of lines /'Trench~o width inches Distance between lines ~ Top~ finish grade ~O ~¢~]0~ ¢¢ Material beneath tile Total effective absorption area Lengtl~ Width Depth .... PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area Ju Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Dis(ance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER SOIL TEST RATING REMARKS APPROVED DATE LEGAL I:;:11::'1:::' L i!i (3 I:::1 t",l "1" H iii I)!:i:;i::t!,ll:':!"/ I...1( Dt:~i i.ii:::: !::',;ii' H lll)I '/:ll,lf::!"r' !.!'( '5,-'"!) r,1 ii] I'.,I ]] HI..II','I [) ;!] s'rl'.ll'-,l(?liL I_'ii~E:i-i"l,!i~]!::i]i,..i !:::! I.,IU;!..I. t:::iI'.,!D FiI'.!'.r' (]II,,I-..S ][ !Ti :;l.!~n]il F tlii[!Yl" FOl.;i: I:::1 I:::'I;;ii)]VI:::fTIi:; ~,.!~iit..I..; ;!.':!i~ii:l 'i'0 ;;;ilI;.!nl;i!n I::T~I_~!i'I' !;.:l:;i~Ot'q I::1 F'I..I!i!',I ](I]i: I,.lI!]l t. ll)lH::'i:ii]!'.,!D]]i',!(]i I. I1::'Oi'..! iH!!:] i'"r'Pl!! O1:' !::'t. 11]!',1...](3 l.,.l!:i]!.! !4!!]i! 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E] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~ PERCOLATION Pouch ~-650, AncJlora~e, Alaska 99502 ~76-~:Z~ TEST ~;~- SOILS LOG -- PERCOLATION TEST ~oo, r~o, -7~7:~ PERFORMED FOR: LEGAL OESCRIPTION: SLOPE DATE PERFORMED: ' SITE PLAN 11 12 13 14 15 16 17 18 19 2O NO. 1823,E WAS GROUND WATER IF YES, AT WHAT · ,zt-' I'1" PERCOLATION RATE TEST RUN BETWEEN FT AND Iminut es/inchl '~, COMMENTS PERFORMED BY: ~__~/,..'1..~ ~--~/~..~v:-'~.,~...~ ..- CERTIFIED BY: DATE: ,.t10¢ Oi ~ L'% oD[ O[ O~ © DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 H 8 7- 0 1 0 6 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3 Block 2 Hideaway Lake Subdivision Location (address or directions) 11001 Hideaway Lake Circle (b) Property Owner Mr. Sharpe Telephone: Home 346-3446 Mailing Address 11001 Hideaway.Lake Circle, Anchorage (c) Lending Institution Key Pacific Mortgage Telephone Mailing Address 101 Benson, Anchorage Business 99516 (d) Real Estate Company and Agent Bob Baer/Totem Realty Address 724 East 15 Avenue, Anchorage 99501 Telephone 272-0571 Mail the HAA to the followine address: or: Check here [], if hold for pick up. List contact person and day phone number below. S & S Engineering 17034 Eagle River Loop Road ~204 Eagle River, Alaska 99577 (e) TYPE OF RESIDENCE Single-Family I~X Number of Bedrooms three (3) 3. WATER SUPPLY individual Well [2kx 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. 'SEWAGE DISPOSAL Onsite [~X Public [] Community [] Holding Tank [] 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 72-025 fRev 8/861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As cedified 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 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 S &S Enqineerinq Telephone 694-2979 17034 Eagle River Loop Road ~204 Address Date Eagle River,Alaska 99577 Engineer'sSeal This department has received written confirmation from the engineer regarding the Conditional Approval of February 26, 1987. The corrections have been accomplished and an inspection has been completed by the engineer. The subject property meets with Municipal standards and is now approved. DHHS APPROVAL Approved for three (3)bedrooms by Approved .,~_ Disapproved Terms of Conditional Approval Conditional June 26, 1987 Date CAUTION 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. Page 2 of 2 72-025 fRev 8/861 Back ROBERTA. SHAFER HEALTH AUTHORITY APPROVALS June 25, 1987 CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Municipality of Anchorage R E C E [ V E D Department of Health and Human Services 825 L Street SEWER&WA~ERMA,NEX~NS,ONS Anchorage, Alaska 99501 Lot 3; Block 2; Hideaway Lake Subdivision A condiZional Health Authority Approval was issued on the referenced SEWER & WATER ,NSPECT,ON property in February, 1987. The terms and condition of this HAA have been satisfied and verified during our inspection of June 32, 1987. ENGINEERING STUDIES ANDREPORTS IRequest yo~i~.~.)ue a final HAA at this time. ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN SRB 196X EAGLE RIVER, ALASKA 99577 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3; Block 2; Hideaway Lake Subdivision February 19, 1987 Location (address or directions) 11001 Hideaway Lake Circle (b) Applicant Name Mr. Sharpe Telephone: Home 346-3446 Business Applicant Address 11001 Hideaf~y Lake Circ.~e, Anchorage, Alaska 99516 (c) Applicant is (check one): Lending Institution []; Owner/builder ¢]; Buyer [] Other [] (explain); (d) Lending Institution Key Pa~fic Mort.qage Telephone Address 101 BeypSo/4.~ Ancho&A~et AlAskA ,,, ~: .; (e) Real Estate Company and Agent Totem RecJ. t~//Bob B~c& %: ;~ ,~; :.~. Address 724 ~t ~Sth, Anchorag6, Alaska 99501 ~. Telephone 272-0571 ' ;:" (f) ~the HAA to the following address: S ~ S ENGINEERING 17034 Eagle River Loop Road, Suite 204 Eagl~ River, Alaska 99577 Ordered by Realty Other Public [] TYPE OF RESIDENCE Single-FamilyY~ Multi-Family [] Number of Bedrooms 3 WATER SUPPLY Individual Well []( Community [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,~ Public [] Community [] Holding Tank [] 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 72-025 ¢1/84) ENGINEERING FIRM PROVIDING INSPECTIONS. TESTS, FILE SEARCH, DATA AND INFORMATION 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 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, tile 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 $ & .~ .c:HG!NFI:"ING Telephone ~ ~'~Z'-'2~ ~ ~ ~ Address 17034 Eagle RJ~er L~ R~d No. 2~ Eagle Rive~ Alaska ~ Date ~~ ~ '~ I) Repair w~ll cap and conduit 2) Replace portion of monitoring tube above gravel depth with solid pipe. Work to be done not later than ~7 ~, ~: ;~ ~I~ Approved for /~2bedroomsby __ . Date ~pr~ ~is~ppro~ Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval cedificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees 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 in the professional engineer's work. Page 2 of 2 y~C,'~.:~'5 MUNICIPALITY OF ANCHORAGE (MOA) O~ ,,~\G HEALTH AUTHORITY APPROVAL (HAA) _~5~ ~ CHECKLIST-FEBRUARY 1984 WELL DATA ~ Well Classification Well Log Present~/N) ,-~* ~' If A, B, C, D.E.C. Approved (Y/N) Date Completed ;~//~/:)? Yield ,,--~. ~' ,'~Pz,.4 --/'- Cased to ') ~---f ~-'¢' Depth of Grouting Pump Set At ~.. ~t Sanitary Seal on Casing (Y/~) I:)epression Around Wellhead (Y/~) Total Depth Static Water Level ~ Casing Height Above Ground Electrical Wiring in Conduit (~N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot /oO ~-~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Besults ; On Adjoining Lots / ; On Adjoining Lots /'J//~- To Nearest Public Sewer ~/~ To Nearest Sewer Service Line on Lot ~/~ ~ d-.~ ~_?~/~1~ ;Date Comments SEPTIC/HOLDING TANK DATA Date Installed Standpipes Depression over Tank (Y~/ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /L)/,,,~ Separation Distances from Septic/Holding Tank: Size /ooO No. of Compartments __ ~., Air-tight Caps ~N) Foundation Cleanout~/N) Date Last Pumped ~_../~.c,/~ ;for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation ~.~ z To Disposal Field ~ f 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 Width of Field ~ 5'~/ -- .-/ '~.?.~_Type of System Design Length of Field Depth of Field ,._.h~4Gravel Bed Thickness ,,~t Square Feet of Absorption Area (~) .L/:¢' _O~ Depression over Field (Y~(~} Results of Last Adequacy Test 50-. T-t % Separation Distance from Absorption Field: To Water-Supply Well /OO L_¢ To Building Foundation Lot To Water Main/Service Line /'O ¥o Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ' Standpipes Present (I~N) Date of Last Adequacy Test To Property Line /O To Existing or Abandoned System on ; On Adjoining Lots 30 To Cutbank (if present) Date Installed ~, / Size in Gallons //-F "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 MOA 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. Signe~ &q~'f~'INEERING Date 2 Comp~]~34 Eagle Ri:vet Loop Roac{ NO. 2~[~OA No. Eagle River, Alaska 99577 Receipt No. ./(.) 4:~ / ~ E) ,'~ ~ Date of Payment ~ -~ Amount: $ /'() /3 Page 2 of 2 72-026 {11/84) ACHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER [] ~?,Llo W*TER SYSTEM I,~., I I I I I I I [~RIVATE WATER SYSTEM Name /?~,>,~/ I~ ,~ ~,~ H3c~c¢/ Phone NO. Mailing Address City f SAMPLE DATE: State Mo. Day Year Zip Code SAMPLE TYPE: LLT"Routlne L] Check Sample (tot routine sample with lab ref. no, [] Special Purpose ) [] Treated Water [] Untreated Water SAMPLE NO. LOCATION 21 I 3 I I 4 I J Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: ¢ Sad;factory [] Unsatisfactory [] Sampletoo long in transit; sample should not De over 30 hours old at examination to indicate reliable results. Please send ne~ sample via special delivery mail. ? Date Received Time Received Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. Result* J Analyst BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUC~r'IONS BEFORE COLLECTING SAMPLE TNTC OB Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Resu[t/s __ Reported By = Too Numberous To Count = Other Bacteria Coilform/100ml BGB ,- Coilform/lOOml [)ate Time: /5~0 a.m. , ~ D Al'"~ RECEIVED INSPECTION APPel NTMfNTS I NSP ECTOR INSPECTOR I NSF ECTO~R-, MUNICIPALITY OF ANCHORAGE DEPT, OF H;'ALTII &  DEPARTMENT OF HEALTH & ENVIRONMENTAL pRoTECTI~VJRONMENI'AL I:;~Oi'ECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION JUL ~ Telephone 264-4720 RECEIVED REQUEST' FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing, 1. PROPERTY OWNER PHONE MAILING ADDRESS ~'- PROPERTY RESIDENT (if different from above) PHONE 2, BUYER ~ PHONE MAILING ADDRESS ' '- H - 3. L~NDING INSTITUTION PHONE MAI LING ADDRESS 4,~/~REALTOR/AGENT __PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION L_o'~-:~, STREET LOCATION I-\~O, eo.~o~t_,~ I.~.e.. O.xY'~\e~ ~Y~o ,o;l'~ ~tO L~pp~.v o~abl~_.q Rd 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS · ~r o,~"~T~'NGLE FAMILY [] One E] Four [] Other___ [~ ......Two [] Five [] MULTIPLE FAMILY ~ Three I~1 Six 7, WATER SUPPLY ~NDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A Well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~DIVIDUAL/ON-SITE~ [] PUBLIC UTILITY ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH FIEQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6179) ~ ,¢"~. ~b ~(~ 2¢D7' _ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [~ ONE [] THREE [] FIVE O OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: /c_~0 If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: Absorpt on Area to nearest Lot Line 5, COMMENTS I~'/APPROVED FOR ~-~ BEDROOMS [] CONDITIONAL APPROVAL (letter must acc/orfi'~y certificate) [] DISAPPROVED DATE BY