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Home My WebLink AboutHERITAGE HEIGHTS LT 17 Municipality of Anchorage Page ¢ of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~'b~./~ ~0o 7 ~ PID Number: Name: Doc~q/~zj' ~ ~o ~ ~Q~ ~ Wastewater System: D New ~ Upgrade Address:~ ~00 ~;~n~ ~ ~* ~tt ~ ABSORPTION FIELD Phone: ~-~ No. of B~drooms: O Deep ~ Shallow Trench ~Bed ~~Other ~oil Rating: ~ Total D~m original grade: LEGAL DESCRIPTION GP~q. Ft. Lot: Block: Subdiv~ion: Depth to pipe boffom from original grad~ ~el depth beneath pipe Township: Range: Section: Fill added above origi~ Grave~ Ft Ft. WELL: Aw ~ New ~ Upgrade Gravel wid~ Number of lines:~ce between Ft. I ~ Ft. Classification (Private, A,B,C): TotalDepth: Ft. CasedTo: Ft. ~rptionarea: SQ. Ft Pipemateriah Driller: Date Drilled: Static Water Level: ,nst~e~ ~ ~ O~ IZ Date installed: Yield: Pump Set at: Casing Height Above Ground: TAN K GPM Ft Ft, SEPARATION DISTANCES ~ Septic ~ Holding D S.T.E.P. To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity in gallons: Tank Field Station Tank Sewer Lines ~ C~ ~ ~ From Material: Number of Compa~ments: Sudace Water ~/~0' >too _ _ - STATION LIFT Lot ~ ~ Size in gallons: Manufacturer; Foundation J ~ ~ ~' ~ .... "Pump on" level at: "Pump off" level at: High water alarm at: Cu~ainDrain -- -- _ _ - Pump Make & Model Electrical Inspections pedormed by: Remarks: Or~l 3~'C ~n~ ~o~ BENCH MARK Location and Description: I Assumed Elevation~ ~ ENGINEER'S SEAL Department of Hea.,~ and Human Se~ices approval :~' ~ Reviewed ~nd 72-013 (Rev. 9/91) MOA 25 PERMIT NO: SW980078 PID NO: 01536143 SWING TIES: FROM: COR. "A" COR. "C" TO: FDN C.C. "D" 55.5' 45.5' S.T.C.C. "E" 67' 54' S.T.C.C. "F" 69.5' 62' DBL. C.C. "G" 70' 64' CHISANAWAY PAGE 2 OF 2 .. - - , .~.11.:>~,~ ~/~ -~/.x / / / 3 BEDROOM HOUSE "F" NEW 1250 GALLON SEPTIC TANK EXISTING SEEPAGE PIT PLAN VIEW SCALE: 1" = 30' 94.0 GROUND ELEV. 99.1 1250 GALLON SEPTIC TANK PROFILE VIEW SCALE: 1" = 5' ~L_INV. 94.2 LOT 17, HERITAGE HEIGHTS S/D SEPTIC TANK REPLACEMENT AS-BUILT INSPECTION REPORT FLATTOP TECHNICA~ SERVICES SCALE: AS NOTED 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 MAY, 1998 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW980078 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:KNOCK DOUGLAS G & JODETTE M OWNER ADDRESS:5900 CHISANA WAY DATE ISSUED: 4/27/98 EXPIRATION DATE: 4/27/99 PARCEL ID:01536143 LEGAL DESCRIPTION: HERITAGE HEIGHTS LT 17 LOT SIZE: 19078 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK SYSTEM ALL cONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DATE: / NOTE: ALL HOMES IN THIS SUBDIVISION ARE SERVED BY AWVVU,~/ ~ PUBLIC WATER SYSTEM - NO WELLS WITHIN 200 FEET ~) HSE ,.,.DO..X ST ,e SEPTIC ~ ~ ~ SEPTIC TANK EXISTING INSTALL DOUBLE C O SEEPAGE PIT ' ' SEPTIC SYSTEM O O O ~~ HOUSE ' ~ L. 17 H~RITAGE HTS. S/D ~ ~ ~n ~. ~:~ ~ & SEPTIC TANK UPG~DE ~ ~* ~-- ~ '~ SITEP~N ~ ~ [ ~.~o~o~ r. ~ooa~ . ~ ~ FLA~OP TEC~ICAL 8ER~CES ~ I~GH = 30 '**~1 ~ CE- 3589 ,Z,~ 14530 ECHO 8T~ET DRAWN BYTFM ~?e ""'" X~ ~CHO~OE,~AS~99516 APRIL, 1998 ~o fe sS ~ NOTE: THIS IS NOT A SURVEYED P~T. ~~ ALL LOCATIONS SHOWN ARE APPROXIMATE. '~K ANLUUKAbI: AKI:A I:$UP' IL~Iq Department of Environmental Quality 3330 C Street Anchorage, Alaska 99.50.3 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE (~4 ~/~ FROM WELL INSIDE LENGTH MANUFACTU RER~/~'~/ Pl~' ~ MATERIAL INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/~O~ GALLONS. SEEPAGE PIT: BUILDING FOUNDATION ~ , NEAREST LOT LINE zc~)< zotca, o ;< I1 .DE PTH ((~ DISTANCE FROM: TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .SQ. FT. ADDITIONAL ABSORPTION TYPE I TION BUILDING NEAREST FOUNDATION __ LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK __ SYSTEM REMARKS DISTANCES: PIPE MATERIAl · LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM Form No. EQ~031 GreATEr ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 33:)0 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 27t3-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT I- ' FINAL INSPECTION: 24 HOUR NOTiCe REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMEnt O~ ENVIRONMENTAL QUALITY AUTHORITY Will BE SUBJECT TO PROSECUTION. FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE Pit SEPTIC TANK TO SEEPAGE PIT WALL ! WATER MAIN TO SEPTIC TANK /' L~ , SEEPAGE PIT / / / / SEPTIC TANKi ~D~ SEEPAGE Pit GRAVel BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. La(: ENS2"D~R : AN~)R~GE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM iS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE / GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAl QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For ~1~ D¥~p.. Dated Performed ~-~o-7~ Legal Description: Lot I~ Block__ Subdivision~ This Form Reports Soils Log~ _ ___ Percolation Test Soil Test Must Be Logged To 4' Below Proposed Seepage System ~ Soil Characteris.~*'c~ 9~ 10-- 11~ 12-- Was Ground Water Encountered?__N(~) 13-- 14-- If Yes, At What Depth? .... T J J JI '-1'~- __L_L_!. It __iti I/ -J. i 1_. ill , i I ~ i l l i I I I I I ~LL_I_d_ 1 I L_LI t_1 t I I I /i.i I L I i i ~ Reading Date Gross Time Net Time Depth to H2fl Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom o~--Pit Or Trench ' COM~ENTS: IF_~-J L,~v..~'_ ;~ ~~ ~ ~ss~/~ ~ ,~' Test Performed BY ....... Date Certified BY: Date: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN.SERV!CES__ 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. # L ~\_'7~ - ~(c_~\ - L~,~ HAA ~ 1. GENERAL INFORMATION Complete legal description Lot 17; Heritage H~i~ts L.ocati~on(site address or directions) 5900 Chisana Way Anchorage Property owner Mailing address Lending agency Mailing address William & Annelise Moss 5900 Chisana Wa~ Anchorage~, Day phone 346-3273 AK 99516 Day phone Agent Ray Dahl/ Dynastic Properties Address Day phone 261-7636 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. XXX TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: 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 flies and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & $ ENGINEERING Name of Firm 17034 E_~-_ ~!v-_r L_-~_.-_ ~,,~a ,,~ 9~ Phone . (~ Eagle River~ Alaska 99577 Address . . Engineer's signature -~/~.~/7. ~.,,'----~ Date DHHS SIGNATURE · iX' Approved for 3 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificate~ 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 & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4[,w~,e~i~ Health Authority Approval Checklist ' Legal Description: ,~¢~' / F,/ ,//~¢",4'~ ,7'/¢¢~-~' /'/~'-Z'~/¢'/~-¢ Parcel I.D.: Well type ~ ~ ~ If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~resent (Y/N) Total de Cased to Casing height AU6 19 1996 Sanitary seal Wires (Y/N) LOG Date of test Static water level Well production ' WATER SAMPLE RESUL g.p.m, g.p.m. Coliform Nitrate Other ~le: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '~'~2~?~/'Tanksize~¢'~¢£ Number of Compartments / Cleanou/t~)/N),Y'~'-~' Foundation c eanout (Y~. -"z-/~ Depression (YECj;~ ,¢4/'~ High water alarm (Y/~ /E? Pumper ~'~--'-¢'~/~' ~_5' Date of PUmping C. ABSORpTIoN FIELD DATA''~ Date installbd ~'~'~ -7~/' Soil rating (g.p.d./fF ~/~-~ System type Length ~/~ ~ widthS;,7 ~,~O ' Gravel thickness below pipe ¢~' / Total depth Effective absorption area . ~¢'~'0/' Monitoring Tube present,N) Y~'~ Depression over field (Y~ ~ ~ ' Date of adequacy test ~,¢ -/~' ' ~ ~' Results ~Fail) ,~/¢--~--~ For '~ bedrooms Fluid depth in absorption field before test (in.); ~7, ,/ Immediately after3*-2Z gal. water added (in.): Fluid depth ~-/?/ ' (ins) Minutes later: ~"~ -~ Absorption rate = /4,,,.~:~ ~ .g.p.d. Peroxide treatment (past 12 months) (Y~¢~' /¢~,-/~' ~/'-,,¢~'~,,~ If yes. give date 72-026 (Rev. 3/96)* ,4/./. Manhole/Access (Y/N) ~evel at* -- "Pump off" level at* High water alarm leve~ *Datum E. SEPARATION DISTANCES ~N_ DISTANCES FROM WELL ON LOT TO: //V/- ///' On adjacent lots Septic/holdini~ ~ Absorption field on lot Public sewer main ~ Public sewer manho~ Se~_w. er--CeeC~s-'~rvice line Lift station SEPARATION DISTANCES FROM(SEP~T1C'/~OLDING TANK ON LOTTO: Foundation ~ / Property line ~/;~ Absorption field Water main/service line J~ /¢' Surface water/drainage /'¢¢ /'¢'' Wells on adjacent lots ./¢~/' ''''¢ - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ,,"/~:~ /~''- Surface water Curtain drain Building foundation /'"~::¢ '~- Water main/service line Driveway, parking/vehicle storage area "~'"¢~/'z'/ Wells on adjacent lots .,"~'/~' ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal records,¢ ~,?¢~uev4~,'~ ~,~s are in conformance with MO~ HAA gu~lelines in effect on this date. ~,. ~ Engineer's U.me ~O&~-/L~ L Lo ~-~ HAA Fee $, Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~)t~-~LC~\ ~ ~ HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 17; Heritage Heights Subdivision Location (address Or directions) 5900 Chisana Way (b) Property owner Mailing Address (c) Lending Institution Mailing Address Charles H. Rosenthal 5900 Chisana Way Telephone: (home) Business Telephone (d) Real Estate Company and Agent Address 3000 A Stre~.t 'Telephone 562-7653 FORTUNE PROPERTIES~ INC. ATTN: N~il Thomas Suite 101 Anchorace, Alaska 99503 ....: (e) Mail the HAA to the following address: (or check here [~(if hold for pick up.) _. List contact person and day phone number below: S & S ENGINEERING Eagle River, Alaska 995~ TYPE oF RESIDENCE Single-Famil~ Number of bedrooms WATER SUPPLY Individual Well [] Community r~ . Public/~ Note: If community well;system, must have written confirmation from the State Department of Environmental Conservation a~tb~ting toth legality and status. SEWAGE DISPOSAL On-site [~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. 72-025(Rev. 7/88) Page 1 of 2 5. 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, Iverifythat 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. 5 & 5 ~ .......... INE 17034 Eagle River Loop Road No. 204 - ,- ,.; .... ^f~.~ 99577 Telephone Name of Firm Address Date 6. DHHS APPROVAL Approved for '~? Approved / bedrooms ~y .... -~ ~ Date Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health AuthorityApproval cerificated based only upon the representations given in paragraph S 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 satisfycertain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data beforeacertificateis issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88)aack Page 2 of 2 A. WELL DATA 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 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Be~ults Comments F I~'~Lif¥ MUNICIPALITY OF ANCHORAGE (MOA) _ Health Authority Approval (HAA) ~NTAI. ~=A~IST ' FEBRUARY 1984 $E'~VIC£S DIVISION 343-4744 ~[~)R ~ 2 ~9~0 Legal Des ription' ~ RECEIVED Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~,//~z¢¢ Size I ~ No. of Compartments ~ Standpipes CC?N) ' 7 Air-tight Caps ¢~) y Foundation Cleanout~(YN) "~ Depression over Tank (Y/~ ¢'J D~tte Last Pumped ,¢i¢_ ~ \_ ¢~O I"~/~- ;for Pumping/Maintenance Contact on File (Y/N) / Holding Tank High-Water Aiarm (Y/N) r-~/.~ Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line "~(~F' To Building Foundation ~. ~=.t.~ To Disposal Field To Stream, Pond, Lake or Major Drainage Course \ C)c:) Comments ~- ~L~-~ ~cC.~:~ 72-026 (Rev. 7/88) Front Page 1 of 2 / C. ABSORPTION FIELD DATA /~%/~ ~'0 Soils Rating in Absorption Strata Date Installed '~ ~ ,~-2~_ Width of Field ~'~:~,~" t Square Feet of Absortion Area Depression over Field (Y/~ Results of Last Adequacy Test Type of System Design Length of Field 'q---~ ~ Depth of Field I [ ~ Gravel Bed Thickness ~ Statndpipes Present ~g:~N) Date 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 To Property Line /~1 ~ To Existing or Abandoned System on Adjoining Lots -' To Cutbac.k (if present) Comments D. LIFT STATION Date~ Size in Gallon~s'---~ "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ~"~--~--. Vent (Y/N) ~~ycles during Adequacy Test. **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 Company Date MOA No. S & § ENGINEERING 17034. ~,qgJe Ricer Loup Road No. 204 ~,1~ River, A ~ka 9957~ Receipt No. ~)1 Date of Payment Amount: $ 72-026 IRev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~(~D- I~'~ CO OF ON-SiTE SEWER AND WATER FACILITY 264-4720 GENERAL INFORMATION '. (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ,- , (b) Applicant Name C~'-~' ~;;~Ti~ne'Homo "~4'~' ~ · Business Applicant Address ~-c,~ ~;;~O (~ ~"Jl~ l~11~'~ / (c) Applicant is (check one): Lending Institution []: Owner/builder,,~; Buyer []; Other [] (explain); (d) Lending Institution Address Telephone (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 Well [] Community [] Public,,~ Note: If community well system, must have written confir~m~e, tion fr, qm ihe State Department of Environmental 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 a~ttesting to the legality and status. Page 1 of 2 72-025 (11/84) 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, 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 [/',~')-[~I':~'~'''3~'~ ~-t,~L~'~.-_ ~:~.?,,'_"F~. -Telephone ~ ~~ ~ , . .' Address ~00 C~~ ~ ~,0~ j ._ Date [[ J~ [~ ' Engineer's Seal Approved for (.~(_/r_~2-~ bedrooms b ,,~ Disapproved Co d" na Approved Terms of Conditional Approval Date The Muncipality of Anchorage Department of ,I-lea~lth'and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the re'pres,egtations 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 MUNICIPALITY OF ANCHo~,~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED WELL DATA 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 To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 If A, B, C, D.E.C. Approved (Y/N) ~ Date Completed Yield 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 B. SEPTIC/HOLDING TANK DATA Datelnstalled ~_~"-/~-~/"~4¢'Size t O¢-~O O~No. of Compartments Standpipes (Y/N) ~'~ Air-tight Caps (Y/N) ~'~ Foundation cleanout..(Y/N) Depression over Tank (Y/N) ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) I~/¢~r ;for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service/~[ine Course ~'~ / ~'~ Temporary Holding Tank Permit (Y/N) ~"~/"~ TO Building Foundation .~;;;~ z'''~ ~ ,~¢-41~ ' ~ - ~i"~'~:~.. To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(~/841 ABSORPTION FIELD DATA Soils Rating in Absorption Strata '~ ~"" ' Type of System Design Date Installed ,'-~/'~- ~_~/"J~- Length of Field Width of Field = ~ '~ I ~ Depth of Field _ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ravel Bed Thickness ~'~ [ (~ Standpipes Present (Y/N) ~ Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well--~--r~'--~'~/''~-'' To Building Foundation Lot ~ 1~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area / To Property Line "~ O To Existing or Abandoned System on ; On Adjoining Lots '._-4~(~ I.~.. · To Cutbank (if present) ~ ,l ~ Comments D. LIFT STATION Date Installed ~ Dimensions Size in Gallons //- M/nhole/Access (Y/N) . "Pump On" Level at ~/"Pump Off" Level at High Water Alarm Levey / Vent(Y/N) ~ Tested for / . / Pumping Cy~during Adequacy Test. Electrical ~rE (y/N) ' / Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha~ checke&verified, ~.r~onformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed'~-~'r"'l-~ v~-=-, v~- V'~ ;'"~' ,~¢¢,~c.~'~-~~ Date Company~~ ~ MOANo. ¢/?¢ 71 ........ Date of Payment . ~~~ Amount: $ ~: ~ · "' ...... ,-- . Engineer's Seal P ge of 72-026 (1 t/84) ~' DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR IMUNICIPALITY OF ANCR(3DA~I: DEPT. OF tt,L-ALTH & MUNICIPALITY OF ANCHORAGE [NVIRONM~NTAL PROTECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street- Anchorage, Alaska 99501 J U ENVIRONMENTAL SANITATION DIVlSlONTelephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIREOTIONS: Complete ~11 parts on p~ge 1, Incomplete requests will not be processed. Please ~llow ten (10) days for processing, 1. PROPERTYOWN~ . . PHONE PROPERTY RESIDENT (If different from above) ' ' PHONE 3. LENDINGINSTITUTIO~ - / / - ' I PHONE PHONE 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS ~ One ~ Four ~ SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Three ~ Six Other 7. WATER SUPPLY [] 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.) 8. SEWAGE DISPOSAL SYSTEM ~' INDIVIDUAL/ON-SITE** /~7,~/. YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [~] ONE [] THREE E~] FIVE [~] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT 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 UTILITY Connection Verified. INSTALLER [~]Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSQRPTIQN AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line ] Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5; COMMENTS ~_~--APPROV ED FOR : BEDROOMS [] CONDITIONAL APPROVAL (letter must acco~ny~ertificate) []DISAPPROVED 72-010 (Rev, 6/79) Tobben Spurl land P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 Marlene Poor SRABox 62 K Anchorage, A~aska 99507 June 26,1980 ADEQUACY TEST Legal: Street Address Residence Wa~er Sewer Date of This Test Test Procedure Lot 17, Heritage Height 5900 Chisana 3 Bedroom, 2 Storey CAU From Municipal Records: Septic Tank. l(~Ogal., one compartement, steel Absorptionn. Log crib, 616 sq. ft. absorpt~n area. Constructed in 1974 June 25,26 1980 SMstem was inspected on June 23. The 4 inch CI pipe to the tank was found disconnected at the tank. Tank bottom is 9 ft. below ground Crib bottom is 10.5 ft. below ground. 7~2 inches of water in crib° Tank was pumped on June 23. Water was introduced into the crib on 6/25 and the following readings of the water depth taken: Beginning of test Add 500 gallons Add 500 gallons 3~ inches 12 16~ On 6/26 Dry Level in septic tank 24 inches The 4 inch pipe to the tank should be reconnected. The pipe to the crib is not plux, b but it should not be adusted With the above item corrected this system will meet the municipal requirements. ' , · ~~. :. : ~ N~UNICIPAL!,;IY O? ANUHUIgAbI' .,[..[J.?,~'~}'. '~' · 895. A~shreet, .... Anchorage, Alaska 99501 ~ ~~. .-~ ~ ~.~& Oa~e Received: March 17, 1~77 ' 1st T ~'~ec~ion: Time 9: 2nd Inspection: Time Date 3-1~riday Date ~L}-~7 ~L~5 . Inspector J K~ ~dy Inspector /~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER A~D WATER FACILITIES 1. Lending Institution Request: First National Bank of Anchorage Ma:L~Llng Address: Post Office Box 720 99510 Phone: 276-6300 Property Owner: Mailing Address; Legal Description: Albert C. Condo Star Route A Box 62-K 99507 Lot 17 Heritage Heights Phone: 344-4405 Single Family Residence: (x) ~,~-~'~ Family' Residence: ( % Number of Bedrooms: Number of Bedrooms: We].l Data: Type Community Construction Depth Bacterial Analysis Well Log Filed Sewage Disposal System:. Permit % Septic Tank Size Absouption Area On-site system Installed' 1974 Installer Manufacturer Soils Rate (.x) Public Utility ( ) Material o Distances: Well to Septic Tank to Sewer Lines Nearest Lot Line Absorption Area to Nearest Lot Line to Absorption Area ~. : [~i~/1 '/ 8 ~ lS L Str'ee~, Anchorage, Alaska 99S~[q'I~6iy;\,:P[,'i.)'I'~CT!ON '" -~/-~, uest ~or A royal o~ Individual Sewer ~d Water P~e'~Lt~s ¸. Name of Buyer: Mailing Address: Phone: Lending Institution~' /,~I~,~ ~ ~ ~' Mailing Address: ~ ~ ~ ~ ~ Phone: Mailing Address: ~/ J Legal Description: Street Location: Single Family Residence: (/Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: L Individual Well ( ) Public/Community System If Individual Well, well depth If Community System, name of system o Sewage Disposal System: On-site System. (/ Public System date of installation: ~~ /~/~ If On-site System, ( ) *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 , o Dep'arLment of Health:and Environmen~ 1 Protection Reques~ 'for Approval of Individual Sewer and Water Facilities Legal Description: Lot !7 Heritage Heights Subdivision Comments: Affadavit Attached: (') Letter Attached: ( ) Approve %~ ~_ L ~--'~D Date: Disapproved: ~epartment Worksheet: