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Home My WebLink AboutHERITAGE HEIGHTS LT 12 ~ 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 MA,L,NG ^DDREaS LEGAL DESCRIPTION LOCAT~O~ Manufacturer Manufacturer I No, of lines . I Length of eac~ li~ ~rad~ Length Width , T~pe of crib ' Crib diameter Well DISTANCE TO: DISTA~Cfi TO: Buildin~ foundation Absorption area Inside len9th Dwelling Foundatio?o Total length of I~/nes Material beneath tile Depth Crib depth Building foundation Driller Sewer line OTHER PI PE MATER 1~?~,1~ 77 ~%- sol L TEST .ATI NG INSTALLER REMARKS Dwelling Material W dth Material Nearest lot line~ Trench wid t t.L, ~ z~' inches- Total effective absorption Nearest lot line Distance to lot line Septic tank PHONE [] NEW [~'"t33~--R A D E NO. OF BEDROOMSff PERMIT NO. No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons Distance between line,~//~,~., Total effective absorption area PERMIT NO. area PERMIT NO. Absorpt on area(s} 72-013 (Rev. 3/78) DATE LEGAL F'ERMIT NO. " E:. ""' RF'F'L I CRNT JOHN KFI'v'RNRGH SRR E,U,,., I,..1-11_-:FIT I I_'IN 5~E.'lJ. CH L)~'J'"Hff..' I P]~F'~ I Ltl- H~HL I H HI"~L.' ~r',l',," I i%UP,It'l~.i",~ I I'lL. I"''"''' ] I I=.L. I 1 UPI 82~ '"L,,., STREET., RNBHOF.':RGE., FIK. D95, ( 2. E;4-472EI TYPE OF SOIL RESORPTION '_-??STEM IS: TF:ENCFI " It I '_:;OIL. RFITIN3 ,::SQ FT,.."BR)= HH.>,Ii"I~M NLME, EF.. OF 8E[:,ROOMS = 4 ': T "~ -' - "-A ' I-i '-~ "- THE REQUIRED ..... E. I-IF THE SOIL HE,:,_F..FTI_I'~ :,T:,TEM THE LENGTH DIMENSION IS THE LENGTH ,::IN FEET'., OF THE TFEN_.H OR DRR.J, NFIEL[:,. "' P IS THE [:,EPTFI OF R TF, EN_.H !3R PIT THE C, ISTFINCE E:ETWEEN THE S_RFREE 'OF THE GF.:OUND RN[:, THE 80TT, CiM OF! THE Ek.','CR',/RTION ,'IN FEET', THERE IS NO SET HIDTFI FOR TF. ENL. HE_,. ~.. " THE GF.':RVEL DEPTH IE;':THE MINIMUM DEPTH OF GRFI',,,'EL E, ETHEEN THE OUTFFILI_ P RN[) THE BOTTOM OF :THE EXr:RVRTION ,'IN FEET[:,. · PERMIT RPPLIC:RNT HFI=q THE RESPONSIBILIT'T' TO INFORM THIS DEF'RRTMENT DURI.N~3 THE INSTRL. LRTION INSPECTIONS OF RN~r' WELLS ,RDJRr:ENT TO TI-tIS FF.'LFE..T~ RND THE RE=,I[EN~Ez~ THRT THE NELL WILL z, ERYE. NUMBER ElF ........ "' ¢- "' · ~'- ' F' - ' 'P~ ,~- t3°¢ EF!.CKFIL. LING OF RN'¢-q'¢~TEH' i4~T~HOUT.- ~ FINFIL IN=,FE_,TIL]N RN[:'~ HFF ..~HL THIS '- F' -' ' '-'- " T-I- " DEPRF.:TMENT WILL E,E :,l..l_,JE_.'f TL] ' F~..U:,EbI_IT. L N. _ '- 'P' D q '-~ IS MINIM I1',1 DISTFtNC:E E:ETHEE:N R WELL RN[:, FINY ON-SITE :,E[IH.~E I...FL:,RL S'¢STEM ...... . /.~,~ TO '2C~0 FEET FF'ZI"I R PUE:LIC NEI.L. DEF'EIqB, ING :tRO FEEl' F']F.' FI F'RI',/FITE WELL r~, '~" PFN '['HE T'¢F'E OF FUE, LI_. WELL' '¢' MINIMUM ..:,ISTFINCE FROM R PRI',/RTE WELL TO Fl PRIVFITE SEWER LINE IS '::,.25 FEET Rt'4D TO FI COMMUN!T'¢ =,EWER LINE IS """F~ FEET. OTHEF.'. REC~ IF.'EMENTS MR"r' HFFL.~. :,FEL. IFI_.RT!ONS RN[:, CONSTF~UC:TIOf"i [:,IRGRFIMS RRE RVRILRE:LE TO iN:-.-..UF.:E F'R3F'ER INSTRLLRTIZN F"EF-:~"-"~ .l -l- E::<:F" :I. F-: ELE; [:.EC:Ei'-IE.'EF~: g:J_., tLa~31 I CERTtFY THRT .'. 1: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FDRTH E:'¢ I'HE MLINICIF'RLIT'¢ OF RNCHORRGE. ,~' ~;-: '2: I WILL INSTRLL THE :,Y:,T_M IN RC::ORDRNCE WITH HE CO[:,ES. 2;: I UNDERSTRN[:, THRT THE ON-SITE SEWER S'¢STEM MRy REQUIRE: ENERRGEMENT IF 'rHE RESIDENCE IS RErg3[:,ELE[:, TO INE:~)E MORE THRN 4 BEDROOMS. S 1 GNE[:: --~ ::= ............................... ~-~-~ ' ~ ~'LICRNI' ..!OHN E:. KRV~NRGFI / ' I S~LIED __ :~ ..... ~ 'v'4. 0 Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME /~-~2/2~/ /¢~r2.¢~ MAILING ADDRESS //~-~ ~/]/~/'/-~-/~/~/~'] PHONE LOCATION //~/~gg'/T' /t~/,¢-~F-I-¢ LEGAL DESCRIPTION ,~ 7- 1S~- /"-'/~---/2-1Z'-,,~-'C~E SEPTIC TANK: DISTANCE FROM WELl INSIDE LENGTH MANUFACTURER INSIDE WIDTH ~/¢ ~- NUMBER OF LIQUID DEPTH LIQUID CAPACITY. /~--¢) GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER __ LINING MATERIAL~~/~''¢ CRIB SIZE: BUILDING FOUNDATION ~ It NEAREST LOT LINE__ OR WIDTH LENGTH DEPTH DIAMETER DEPTH ~ /DISTANCE FROM: WELL ~/.,~- TOTAL EFFECTIVE .. ABSORPTION AREA (WALL AREA) SQ. FT, ADDITIONAL ABSORPTION WELL: CONSTRUCTION BUILDING NEAREST FOUNDATION- LOT LINE C'ESSPOO[ OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM DISTANCES: INSTALLED BY: LOT SLOPE: REMARKS: Form NO. EQ-031 DIAGRAM OF SYSTEM DATE ~ ~'~'~'~--------------~--- 7~'~ APPROVED f G.A.A.B. GREATER ANCHORAGE ArEa Borough PERMIT NO. DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C' STREET ANCHORAGE, ALASKA 99503 s,w^G, ,,,s,.os^,. sm', - ^,.,.,.,C^T,O. ,.BTAL'AT,ON LOCATION C?~ ~Z~, .. ~ ~- ~~ INSTALLATION OF: SEPTIC TANK SEEPAGE PIT , DRAIN ~IELD COMPLETION DATE ANTICIPATED OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL 're;st FINAL INSPECTION: 24 HOUR NOTICE RE(~UIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS fOUNDATION TO SEPTIC TANK ! , DRAIN FIELD , DRAIN FIELD SEEPAGE Pit ALSO CONSIDER AREA WELLS. , SEEPAGE PIT. FOUNDATION TO SEEPAGE PIT . SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK , SEEPAGE PIT TO NEARESTIOTLINE~ ~ ~~ WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, ., SEEPAGE PIT , DRAIN FIELD TO RIVER, LAKE STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION § FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON BIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit PITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH ~:~:EGULA~ONS REGARDING INSTALLATION. [ CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE ENGTNEERING & GEOLOGIC , L CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907--279--0483 TELEX 090--35419 Geologists Land Surveyors JAMES W. ROONEY, P. E. MALCOLM A. MENZIE$. P.E., L.S. JAMES H. WELLMAN. P.E. RALPH R. MIGLIACClO Engineering Geologist June 13, 1974 R & M No. 462038 Mr. Harry Foosnes 1436 Matterhorn Anchorage, Alaska Re: Test Hole and Soil Log Report for Sanitary System Lo, Heritage Heights Subdivision Dear Mr. Foosnes: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of June 11, 1974, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 11 area for the pur- pose of defining general subsurface soil conditions for the proposed sanitary system. ExcavatiOn was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 12.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-O1. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS, INC. JWR:kd xc: GAAB ANCHORAGE FAIRBANKS JUNEAU TH-1 6-12-74 .?'.i;.".': ORGANICS 0.0' 0.5' SILTY SAND (SM) .2.0' SANbY GRAVEL (GW) 10.0' SAND, TRACE GRAVEL (SP) NO WATER TABLE 11.5' T.D. Note: Test Hole Excavated With Tractor-Mounted Backhoe. F~ Engineering ~ Geological Consultants Inc. ~V~ ANCHORAGE FAIRBANKS ALASKA JUNEAU HARRY FOOSNES PROPERTY LOG OF TEST HOLE ANCHORAGE ALASKA June 13,7~s~.c~,.'~ 1"-2.0' lewN eY WED ICHK~ BY WED P,O,~.NO. 4620 OWe NO. A-01 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 1. GENERAL INFORMATION Complete legal description LoT 12, Location (site address or directions) ANCHoeA~ Property owner Mailing address ,~ol Lending agency Mailing address t~l w. ~¢~e~ A~ ~,~ Agent ~eH~ Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well 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 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 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!i_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 this inspection. Name of Firm FLA't-roP Address Iq 5'5o ECHo Engineer's signature DHHS SIGNATURE i!i/x~,IApprovod for ~ .: DisapprOved. Conditional approval for Phone Date % THEODO¢~E F MOO~F ,~ f~ bedrooms. bedrooms, with the following stipulations: Additional Comments By: ..~ot-~q ¢~z4~ lq~ Date 3'/~/~' ~/- 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 and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L CT 1 2 Parcel I.D. A. Well Data If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires propedy protected (Y/N) AT INSPECTION Well type A v~ ~/~ Log present (Y/N) Total depth Sanitary seal (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 ~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 ~o Cleanouts (Y/N) High water alarm (Y/N) N Date of pumping Tank size I 2 5o Foundation cleanout (Y/N) G ~l L Compartments Y Depression (Y/N) Alarm tested (Y/N) ~,/~, Pumper --~'_~ ~<~ ~/' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N To property line Sudace water/drainage On adjacent lots N ,A. Absorption field 15 ' ~T~'~ Foundation °1 F~eo~ C,o, C.o.'~ Water main/service line ..~/oo 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ff / ~ ~ Soil rating (GPO/Fl2) I. ~ Ler'~jth 35-' Width fi' Gravelthickness Totalabso~tion area ~ ~ Cleanout present (Y/N) Date of adequacy test u/1~/% Results (pas~fail) Water level in abso~tion field before test ~ ~ After test Peroxide treatment (past 12 months) (Y/N) ~o~ ~ ~o~¢ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N.A, On adjacent lots ~ 3o Properly line To building foundation l~' F~0~ C,o, To existing or abandoned system on lot U On adjace~ lots >~o' Cutbank N,A. Watermai~se~ice line Suffacewater ~ lDO' Driveway, parking/vehicle storage area 2o ,5%5/ System type ! Total depth It). 5 Depression over field (Y/N) for 38.5'" Bedrooms Curtain drain t~tb~q E o~evE~ 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 F~ HAA Fee $ ~¢,~ o__~_~ Date of Payment Receipt Number .,~::5~':,' ", ' ? "i ,, :' % Ci~ .. 3~;:;'2 ." ,¢ ·: Waiver Fee $ Date of Payment Receipt Number ~'-"~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 C~/'~"~ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~E~[ ~H Telephone:Home Applicant Address Business (c) Applicant is (check one): Lending Institution [] Owner/builder []; Buyer []; Other,~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family~ Number of Bedrooms Other WATER SUPPLY Individual We~' Community~ Public~ /~[.,~/~1~/ ~.~ 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 (11/84) ENGINEERING FIRM PROVIDING~_~$pECTIONS, TESTS, FILE SEARCH, DAT~ND 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, 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 i~_~ction. Name of Firm Telephone Address DHEP APPROVAL Approved for ~(~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional 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 enginee~ registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending ~nstitutions 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 dot responsible for errors or omissions in the professional engineer's work. Page 2 of 2 WELL DATA ~, MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 SEJ~ 2 4 ~ 264-4720 Lege/I Description: /_ ~O'~,/.2t~ ~~ . t,' · '~l~ ' / i ,~- ~ J '' Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~r~"~O To Nearest Edge of Absorption Field on Lot C~(~'7 To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results d If A, B, C, D.E.C. Approved (Y/N) X Date Completed Yield Cased to Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed /~/7,~ Size Standpipes(Y/N) /'~ (11) Air-tight Caps (Y/N) Depression over Tank (Y/N) /~/ Pumping/Maintenance Contract on File (Y/N) /~///'~., Holding Tank High-Water Alarm (Y/N)..,.v,,,,~/,Z~ / Separation Distances from Septic/Holding Tank: To Water-Supply Well ~'_~7')?'-- To Property Line '~'~ To Water Main/Service Line Course ,,~/~/~ Comments ~' t No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ~::~/~/~;~- ~'~" ;for lemporary ~olOin~ Tank ~e~m~t (Y/~) To Buildin~ Foundation 1o Disposal Fiold To Stream, ~ond, kake~ or Major ~raina~e 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 /.~" Lot To Water Main/Service Line /(~ '/"' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments / / ..... LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Type of System Design_ ~/~A/'~/-/- Length of Field Depth of Field /(:~', Gravel Bed Thickness ~5 Standpipes Present (Y/N) Y (~.) Date of Last Adequacy Test ~/)~ / TO Property Line To Existing or Abandoned System on ; On Adjoining Lots ,,..~'~ To Cutbank (if present) / ! O . ,,,,v Dimensions :>_,>.U Manhole/Access (Y/I~ "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MQA Comments Page 2 of 2 72-026 (11/84) ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav~..,)c:c.k:.d~verifie~or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~,'~ Date Company MOA No. ReceiptNo. ~tS~l ~: ~,~0. .... 2:,." Amount: $ (~ ,~(~' , ~ ~"'~~' E~gineer's Seal ~,, . JUNL MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL NEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~O~ ~-~V~gqo~H Telephone - Home Business Applicants Address ~0 I C-~'t~%~l"g~, (c) Applicant is (check one) Lending Institution ~ ; Owner/builder~; Buyer~ ; Other~ (explain>; (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address ~)'~ ~- Telephone ~ ~ ~ I (f) Mail the ~ to the following ~dress: 2. Type of Residence Single-Family..~-~. Number of Bedrooms 3. Water Supply Individtml Well~--~ Multi-Family Other (describe) Community ~ Public~--~ Note: If community well system, must have written confirmation from the State Department of E~vironmental Conservation attesting to the legality and status. 4. 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] 5. Engtneerin~ Firm Providing Ins~ections~ 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, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm -~~ Cpu ~ Telephone (ENGINEER SEAL) DHEP Annroval /q Approved for ~C~t~ bedrooms By .- Approved ~ Disapproved '~ Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF WEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES WEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) m{4/ej/D18 [Page 2 of 2] 7-19-84 A® { MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (~JtA) CHECKLIST - FEBRUARY 1984 Well Classification /~ 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: To Septic/Holding Tank on Lot ~d~-O ~ MUNICIPALITY OF ANCI~ORAC'~ DEPT. OF HEALTH & [bJyJRONMENTAL PROTECTION ,!'.; 1 '7 1985' Legal Description: If A, B, o~ C, D.~..C. Approved(Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression A~ound Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~¢-(D + ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cle ancut/Manhole Water Sample Collected By Water Sample Test Results Cott~'~nts To Nearest Sewer Service Line on I~t ; Date Be SEPTIC/HOLDING TANK DATA \ £ 'q Date Installed ~ 1~ Size Standpipes (Y/N) O/~ Air-tight Caps (Y/N) Depression over Tank (Y/N) N Date Last Pumped No. of Cott3a~tments Foundation Cleanout (Y/N) Pumping/Maintenance Contract on File (Y/N)Ff/~ ; for ~/~ Holding Tank High-Wate~ Alarm (Y/N) ~//~ Temporary Holding Tank Per_mit (Y/N) }¢/~ Separation Distances f~c~ Septic/Holding Tank: To Water-Supply Well ~ To Property Line To Water Main/Service Line Course IX,/o TO Building Foundation To Disposal Field To Stream, Pond, Lake, c~ Major Drainage Co~t~t~nts Receipt 9 Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 85 Date Installed ~//~/ ~[ (..~.!'~r.~((~ Width of Field ~/~" SquaEe Feet of Absorption AEea Depression over Field (Y/N) ~ Type of System Design TC.t NcH Length of Field 'Depth of Field __. /~, Gravel Bed Thickness Standpipes PEesent (Y/N) Date of Last Adequacy Test ~/7/g~ Results of Last Adequacy Test ~.~ Separation Distance from Absorption Field: To Water-Supply Well ~O~D 4- To PEoperty Line ~O + To Building Foundation /~ To Existing or Abandoned System on Lot ~ ON ~' ; On Adjoining Lots ~[D + To Water Main/Service Line IO e To Cutbank(if present) To Stream/Pond/Lake/or Majo~ Drainage Course ~ O ~; ~- To DEiveway, Parking A~ea, or Vehicle Storage A~ea ~O Cor~rents Not,.I F-. D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimens ions Manhole/Access (Y/N) "Pump Off" Level at Vent (y/N) Pumping Cycles during Adequacy Test. Meets MOA C~nts ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or conformed to all ~OA HAA Guidelines in effect on the date of this inspection. Date %, (.,% JUN[ £~,197~ .~ ~ KB1/d5/s [Page 2 of 2] 2-15-84 CONSULTING ENGINEER '-..,..203 W. 15th AVE 'C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: DATE OF PUMPING: DATE OF TEST: TEST PROCEDURE: TEST RESULT: ~ ~;~,' ,7' '.v.~3 LOT 12, HERITAGE HEIGHTS 5901 CHISANA JOHN KAVANOGH SINGLE FAMILY, FOUR BEDROOMS COMMUNITY WELL FROM MUNICIPAL RECORDS: TANK: 1250 GAL. STACK STEEL, TWO COMPARTMENTS ABSORPTION SYSTEM: TRENCH ABSORPTION AREA: 385 SOIL RATING: 85 INSTALLATION DATE: TANK 1974, TRENCH UPGRADE 1981 JUNE 7, 1985 JUNE 7, 1985 WATER WAS ADDED TO THE TRENCH AT A STEADY RATE OF 7 GALLONS PER MINUTE. THE WATER LEVEL IN THE SUMP WAS MONITORED. AT THE BEGINNING OF THE TEST THE WATER DEPTH WAS 43 INCHES, AFTER ADDING 500 GALLONS THE DEPTH WAS 46 INCHES. AFTER 16 HOURS THE DEPTH WAS 39 INCHES. THE WATER LEVEL IN THE TANK WAS UNCHANGED THROUGHOUT THE TEST. THIS SYSTEM MEETS THE REQUIREMENTS OF THE MUNICIPAL CODE. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the operational requirements of the Municipality and State. MUNICIPALITY OF ANCHORAGE · OF 825 L Street - Anchorage, Alaska 99501 J~NVIRONMENTAL P~C:q ECTION ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 'J U L 9 I980 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERj~-~'r, l[~_EQ RECTIONS; Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten.(10)- days )~or processing. PROPERTY OWNER ~ ~' ?/~ / / PHONE i MAiLTNG ~ADDP~SS- - I, ~ -- PROPERTY RESIDENT. ~lf different from above) 2, BUYER ~ k I / PHONE .I,d~, ~. ¢ ~J__0~. /U,~ [ ~47-475~ M~,I LING AD DR ESS 3, LENDIJ~.G INSTITUTION PHONE MAILING ADDRESS / 0 4. ,EA,TO,,AGENT , ._ ~.~ .~z~,~// MAILING ADDRESS -- ! ~ ?~"~'~-~ 5. LEGAL DESCRIPTION Z~/2. ~TR E ET LOCATI ON 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY y NUMBER OF BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* [] COMMUNITY PUBLIC UTILITY * ATTACH WELL LOG. Awell 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 ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX ---' P~RMIT NUMBER ....... 2. WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED [~] PUBLIC UTI LITY ('.~, Connection Verified INSTALLER (~ []Septic Tank or ~ Holding Tank Size: /~3~~'b If Tank is homemade SOILS RATING give dimensions: TYPE QF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DIsT/~.~'(~ESwELL TO: Septic/Holding Tank Absorption Area Sawer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ~ APPROVED FOR ~' BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED ~,,~ DATE BY LEGAL DESCRIPTION 72-010 (Rev. 3/78) Tobben ;purkland P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 Dale Hopkins Dymamic Realty 501W Northern ~ights Blvdo Anchor~ge~ Alaska. 99503 ADEQUACY TEST July 14, 1980 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTit & ENVIRONIv'~ENTAL P,:,OTECT[ON Legal: Residence: Water: Sewer: Date of Test Test Procedure: JUL 1 5 1980 RECEIVED Lot 12, Heritage Heiths $/D Four Bedroom, two storey Community System From Municipal Records: Soil Rating: 85 Tank Steel, Two Compartment, 1250 gal. Concrete rin~ crib. 6 feet deep, 4 feet diameter Absorption Area, Unknown Constructed: June 1974 July 14, 1980 System inspected on July7. Tank full, 48 inches of water in crib. Tank pumped July 8 and crib filled to overflow. Water depth in crib prior to filling 45 inches Add 300 gal, more ce less 71~ inches Water levels on July 9 Tank 16 Crib 34 Crib was refilled at a rate of 6 gpm. and the following depths recorded. Volume 0 6O 120 180 Depth 34 41 45 54 Crib takes 108 gal. per foot. System was rechecked on July 14. Water level in crib was 53 inches. Tank was full. The residents of the dwelling were requested not to use any water. The crib was again fileed at a rate of 7,5 gpm. Volume Depth o 53 75 62 150 67 225 ?l~ Tobben Spurkland P.E. Dale Hopkins Lot 12, Heritage Heigths The absorptin was monitored as follows: Time 10.OO 11.OO 12o 15 12.3o 12.45 O1.OO o~.15 Total absorption time° 3.25 hours Total absorption 112 gal Absorption Rate: 827gal per 24 hour. Depth 71~ 70 66~4 65~/¢ 64 64 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ~_~.x~./~.~ Date Received Time of Inspection Date of Inspection 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 4. 5. 6. REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Phone: Phone: Legal Description: Location: Type of facility to be inspected Well Data: A. Type B. Depth No. of bedrooms C. Construction A. Installed~.-~.~d~ C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: D. Bacterial Analysis Sewage Disposal System: ~'7~ B. Installer ~ ..~.i Size / -~' <' > 2. Manufacturer Absorption Area ,'~ .',.,.~ ~i 2. Material Total length of lines 8, Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages ~a~e ,2 of two pages - Rs ~t for Approval of Individual ~ · & Water Facilities Legal Description Comments Approve Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 ~"EPTI.. ~ tiEALhi ~, ~'"l;¢ IR O Nl~,qE N l-A L PROTECTION .... ;,¢ i ? 1985 _RECEIVED To Whom it May Concern: According to records on file in this office the /~--~S~.,,~' S~/"~']..9,,,/~0~ Water System is in compliance with the sta~e Drinking Water Regulations Sincerely,