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HomeMy WebLinkAboutHERITAGE HEIGHTS LT 4 QGRE, __ I:K ANLrlUKAt I: RKrR Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~,\k~', ~ ~ ¥~ ~::~g'~ MAILING ADDRESS <~(}~0 ~"~L~f~.,Ig¥,~,YYA PHONE~I~-~'-~'-q' - LOCATION I M~.~ .t''3 S~ ~3~'F ~N.g~'~ LEGAL DESCR PT oNL(S~ L~ SEPTIC TANK: DISTANCE -- _ NUMBER OF FROM WELl. MANUFACTURER '~ ~_~(.O~,J MATERIAL<~(]~,~C¥~'LJ[~. COMPARTMENTS -- - LIQUID CAPACITY I~.~¢'~ GALLONS. INSIDE LENGTH ~ INSIDE WIDTH LIQUID DEPTH SEEPAGE PIT: NUMBER OF PITS ~ DIAMETER OR WIDTH LINING MATERIAL-~ ~-ONq'~t~q:- CRIB SIZE: DIAMETER/~ BUILDING FOUNDATION ~ , NEAREST LOT LINE ~ ~1 LENGTH I~s,DEPTH \r~I DEPTH ~ I . DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) bq SQ. FT. ADDITIONAL ABSORPTION WELL~--~ ..... ~-~--- TYPE BUILDING FOUNDATION -- CESSPOOL APPROVED C O~~.UCTION NEAREST LOT LINE OTHER 50U RC[S~ DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC S~ SEWER LINE ~~,~YSTEM REMARKS ) 7(2 DISTANCES: ~; .~,0~ DIAGRAM OF SYSTEM INSTALLED BY: N~ ~N.\~..X5 F~,~I.~\,,~¥5 PIPE MATERIAL: LOT SLOPE: Form No. EQ-031 SHEET NO. -~ OF CALCULATED BY ~3V~ CONTROL SERVICIr INC. 1200 West 33rd Avenu'~.r-$uite B ANCHORAGE, ALASKA 99503 (907) 561-5040 hT~c~r~E~'T ~2 CHECKED SY SCAL~ 1'/---3o' DATE DATE ~$.E PT~C ........ GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT pERMIT NO. NAME OF ^ppL,CANT I.STALLAT'ON LOCAT'ON ,"~.'~'~,'~'.~7'--- INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO SE SERVED FINANCED THROUGH MA,LING ADBRESS ~o~/o ,/--~..-.~'/~,,,~, P.ONE ~ DRAIN FIELD OTHER . SEEPAGE PIT TO SE INSTALLED BY ~lOTE: THl~ PERMIT i~ NOT VALID WITHOUT FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. i~ACKFILLING Of ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPT'C tANK SI~E J~3O TYPE MINIMUM DI,~TANCE~, REQUIREMENT~ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE P~T- SEPTIC TANK TO SEEPAGE Pit WALL 3" SEPTIC TANK -- SEEPAGE PIT TO NEAREST LOT LINE. ~VeLL TO SEPTIC TANK / ~)~) / DRAIN FIELD WATER mAIN TO SEPtiC TANK - SEPTIC TANK, SEEPAGE AREA SIZE TYPE SEEPAGE PIT //~0 / ALSO CONSIDER AREA WELLS. SEEPAGE F~T /~ '/ , SEEPAGE PI~// ~~) / DRAIN FIELD - TO RIVER, LAKE STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION- [.ICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 2S-68 AND THAT THE ABOVE DAte "¥" //-- )~ ApF',CANT'S ~IGNAT~RE GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAl QUALITY 3330 "C" Street ANCltORAGE, ALASKA 99503 ¥,11.v g,~...k~ Performed For ~1 H ru~>~ Legal Description: Lot ~ Block This Form Reports Soils Log ~ Case # Dated Performed Subdivision Percolation TeCt Depth Feet Soil Test Must Be Logged To 4' Below Proposed Seepage System - Soil Characteristics Top-o; I L_,L_LLL_ I I i Was Ground Water Encountered? Nc:) If Yes, At What Depth? L_L_L__L_J t t t I Reading Date Gross Time Net Time Depth to H20 Percolation Rate Minute Proposed Installation: Seepage Pit~ Drain Field Depth of Inlet ................. _~]~ Depth to Bottom of Pit Or Trench" ~ COM~ENTS: ~cJ~.~..~___o~ ~'.,_~ lar~'~,_._u~,'~.- ~r~ _ ~ ~,~ Net Drop Date: 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# ~)/~' -?;~P~''"'~ ~1. GENERAL INFORMATION Complete legal description I-oT L-{ I HAA# Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent C_q y-o 1 ~-'"~ ~_~-t.~ Jr ~'~. ~-~o~...~' Address ~-/~ r~ ~o ,,' ~.~o ~' =, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~ Day phone Day phone Day phone 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 4. TYPE OF WASTEWATER DISPOSAL: NOTE: If community well system, provide written confirmation from state, A'DEC attest- ing to the legality and status of system. '~( ?:'/(-'I' :','~'" / Individual on-site tank' . , _ : ::.... Holdin~ 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 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 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. Engineer's signature %0~''' ~;~~ D~ SIGNATURE ~.~ Approved for Disapproved Conditional approval for bedrooms, bedrooms, with the following stipulations: , '. Additional Comments ,;/,,,,, By: 'f: ,*llPJi 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.·', ,: ,:i ,ii'~, . :~,~: ~ :, :;:~ !: :':i : 72-025(Rev. 1/91) Back MOA#ZI :':.':';:"-; i:; :'' ' Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type '/~'~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~ ~.'~ Absorption field on lot Public sewer main Sewer service line AT INSPECTION .g.p.m. g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) x / / High water alarm (Y/N) ~///~- Date of pumping g'/~ll- ~ Tank size / ~- ~,L~ Foundation cleanout (Y/N) Compartments y Depression (Y/N) Alarm tested (Y/N) Pumper A~ cL~c~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1~ On adjacent lots To property line /0 ~ Surface water/drainage Foundation Water main/service line Absorption field CONTINUED ON BACK PAGE 72-026 (3/93)* Front 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) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed ~' ~- 7~ Length P-O Width Soil rating (GPD/Ft Gravel thickness Total absorption area ('¢, ~ ~ Cleanout present (Y/N) Date of adequacy test ¢2~3/p V Results (pass/fail) Water level in absorption field before test~, ~ Peroxide treatment (past 12 months) (Y/N) ~ System type ~ /~ I/~ Total depth I LC / Depression over field (Y/N) for After test Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain If yes, give date E. ENGINEER'S CERTIFICATION On adjacent lots ~///-A- Property line To existing or abandoned system on lot Cutbank I""~o ~4 ~ Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to ali MOA and HAA guidelines in e~tO~tfie date of this inspection. Signature ~ 5~~~ Engineer's Name '~¢ ~- ~'- Date '¢'"/31 [R L/ HAA Fee $ dL~ ¢~ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number 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 GENERAL INFORMATION (a) (b) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ,5?70 Telephone: Home -~-z;'~-',---~2--~¢~' - Business '-~Y~;'.~° -~'i¢°~2/' Applicant is (check one): Lending Institution []; Owner/builder,~.~'; Buyer E]; Other ~ (explain); _ Lendin(~ Institution (e) '~ neat Es{ate Company'ahd'Agent ¢) TYPE OF RESIDENCE Single-Family.~ Multi-Family [] Number of Bedrooms ~2) Other WATER SUPPLY Individual Well [] CommiJnEy [~' Public [] '. Note: If community well system, must have written confirmation from the State Department of Enviromnentai Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite}'S~ Public [] Community [] Holding Tank [-! No[e: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. ' - Page I of 2 72-025 (I U84) ~? ENGINEERING FIRM PROVIDING t~-~PECTIONS; TESTS, FILE SEARCH, DATA-.-,,4/D INFORMATION '- As certified by my seal affixed hereto ant as of the validation date shown Delow, 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 cbtained 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 Munici pal anc State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ~ E C-~, //ACrct Address Date. Telephone "-~-~//' v ~-0 C/O · DHEPAPPROVAL ~.~ ~'~,(D ~ ~. d;~ Approvedfor-~"~.~' ~2, bedrooms by//~'~l"2-~d:~/~Date Approved ~'~ Disapprov~J~:¢ Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates 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 72-025 {11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) ,U,'Ji;iCIPALITY OF ANCHORAG~:HECKLIST - FEBRUARY 1984 D,~PT, OF I[~/,LTH & J:N'¢i R©NMENT/.,L P~OTECTION 264-4720 Legal Description: '/'-/aa/ WELL DATA ?~ E C E i.~/~ ED Well Classification Well Log Present (Y/N) Date Completed Total Depth Cased to' Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot __ To Nearest Edge of Absorption Field on To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Resu comments If A, B, C, D.E.C. Approved ~)N) /,GCC Yield Depth of Grouting Pump Set At Sanitary Seal ( (Y/N) Depressi Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed .~/~/7~'""~ Standpipes ~N) Air-tight Caps ON) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) /~/,~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To ProperTy Line To Water Main/Service Line Course ("GO ! Size _.~ii~)-J I~'/~No. of Compartments Foundation Cleanout (~N) Date Last Pumped Temporary Holding Tank Permit (Y/N) /1¢//-/ To Building Foundation c~~) / To Disposal Field / ~ / 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/I~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~-OO /~ TO Building Foundation ~.-O / ~ Lot ¢¢/A To Water blain/Service Line /~' /~/-- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area . 170 ~/~l-ype of System Design Length of Field /~,' / Depth of Field Gravel Bed Thickness ~' / Standpipes Present (Y/N) Date of Last Adequacy Test Comments To Property Line I ~ / To Existing or Abandoned System on ; On Adjoining Lots ~. ,.,.5-- "'"~ To Cutbank (if present) /~//~ I O0/'-/- 2.0 '-/'" D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at / /~ "Pump Off':,l,~ High Water Alarm Level at ~/~ Tested for ~/ / ~,~'"~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (.Y/N) Comments __ ** Check Permit ed-t~Bedroom Rating Against HAA Request ** Signed~certify~h1~ha~/~d~?dj`~c~nf~rmedt~a~M~/~a~guide~inesineffect~nthedate~fthisinspecti~n.~%~/~.~F%~Z~,~ Date ////c~' -- Company ~ P~¢~--~-.-~. /,/~ MOA No..,¢¢,.~0~ ~ Receipt No. Z °( '£ ~ 'b~ ~)""~) Date of Payment Amount: $ ~ Page 2 of 2 72-026 (1 lz84} ALASKA e"rljlROFlmerITAL COFITROL Sel rCeS, II'lC. ~§i~¢ri~§ 8 Enuiro~m¢~lel Studies ED HRUBES 5970 YUKON ROAD ANCHORAGE ALASKA 99515 SELLER-ED HRUBES ED HRUBES 5970 YUKON ROAD ANCHORAGE ALASKA 99515 07/15/86 60290 LEGAL:HERITAGE HEIGHTS LOT 4 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-06~16~86 THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN AR~ OF 648 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 677 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE~ THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 05/30/86 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. 1200 ~esl 33r~ /~ucnue, ~uil¢ ~ * Anchoro§¢, Alasb 99503 *[907) 561-50/40 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: June 11, 1986 PWS I.D.# 210087 To Whom it May Concern: According to records on file in this office the Service Hanshew Water Regulations MOA Heritage Heights Water System is in comPliance with the State Drinking Sincerely, Michael P. Lewis Environmental Engineer