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Home My WebLink AboutHERITAGE PARK BLK 1 LT 9r'T:d MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT .ame DISTANCES Address ~ " TANK ~ELD WELL Phone(s) Per~it No. ' Township, Range, Section AS-BUILT DIAGRAM (Show location of well septic system, prope~y lines, foundation, ~SEPTIC ~ HOLDING Capacity in gallons Depth to pipe bottom from Total depth from original grade FT 4 FT .~ ' / ,istance between lines Number of I[ s Soil rating Pipe material Cmsiflcation (A,B,C) Total Depth Cased to / '--~ / ~,~ Inst~/ier /" Date Ins~alled: 17034' Eadle'~Riv~ Loo~ ~a~ Health Depadment Approval' / 72-013 (3/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES PO BOX 196650 ANCHORAGE, ALASKA 99519 343-4744 HAND WRITTEN PERMIT Permit Number: SW90(~%~k~- Date Issued: Engineer: Design Owner Name: ~ Owner Address: Permit Expiration Date: Day Phone: Parcel ID: O~O~//~Y~ Lot Legal: Subdivision: /~F~,'~q~/~F~ Lot: ~ Block: 1 Section: ~ Township: ;~// Range: /~ Lot Size:~f3 (sq.ft. ~r acrcs~ Max Bedrooms: This Permit: ~ Total Capacity: ~ SEPTIC TANK: Minimum septic tank capacity:~ gallons. Each septic tank~must have at least 2 compartments, insulation is required if depth to top of septic tank(s) is less than 4.0'. Lift stations require an appropriate electrical inspection. WELL LOG: A copy of the well log must be sent to DHHS within 30 days of the well's completion. I CERTIFY THAT: 1. I will install the on-site sewer system and/or well in accordance with all codes and regulations of the Municipality of Anchorage (MO~) and State of Alaska , and in compliance with the design criteria of this permit. 2. I will adhere to all MOA and State of Alaska requirements for separation distances from any existing well, septic system, or surface water on this or any adjacent or nearby lot. 3. I understand that this permit is valid for a single family dwelling with a maximum of ~ bedrooms. I also understand that any enlargement will require an additional permit. · ~. I understand this permit is issued for the calendar year and expires on December 31 of the year issued. 5. I will notify DHH$ prior to all inspections by the engineer or well driller. db/ll5 l /_ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST I ~ ~I~I~,N~I~I~'S~L) PERFORMI DATE E~~ LEGAL DESCRIPTION: 10 11 12 13 14 15 16 17 18 19 2O Township, Range, Section: WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water Afl.~. / Monitoring? v?'-""~'f~ Date: ~ Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE -- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN -- FT AND __ FT COMMENTS ./~? "Eagle Rive~, Alaska ~9~77 ...... ~ ~ ~/~/~ ACCORDANCE WITHALL STATE AND MUNICIPAL GUIDELIN~ EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED IN 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. # 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLINg, - ~C). \ \ - .%-'~ NAA# Lot 9; Block I; Heritage Park S~bdivision~ .: Location_(site address °r,d rections)_ 19731 Ivy'Hom6 cir~l~ Property owner Mailing address Lending agency Mailing address 'Beatti~ J. Smith Day phone 694-5823 P. O. Box 773961' Ea¢l& Riv~r~ Alaska 99577-3961 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, ¢ rovide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: ×X Individual on-site Holding tank Community on-site . Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality ano 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 sl~own 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. Name of Firm S & S ENGINEERING Address 17034 E,agle Ri,ve~' Loop Eagle River, Alaska 9952'7 Engineer's signature Phone DHHS SIGNATURE __7~____ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date Ill 'J';q,'lil;'lJ 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 It21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-z>--r ~ '~;~,,,~- ~ ~-~¢,¢--~¢_.,~ ~'~¢¢.,¢--Parcel I.D. A. WELL DATA Well type A Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to Date of test Static water level FROM WELL LOG Well flow Pump level SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main // Sewer'se~v~ WAT~MPkE RESULTS: Ca~tl 'e orfrnsa m~.le: Nitrate ADEC water system number Driller Casing height Wires properly protected (Y/N) ~ AT INS T~~ION MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION ; On adjacent lots ; On adjacent lots SEP 2 6 1991 g.p.m. RECEIVED Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed /~ - "L. - c~ o Cleanouts ~YN) V High water alarm (Y~) Date of pumping ~-~ - 9/ Tank size ~ OC::X;~ Compartments Foundation cleanout ,(__~)/N) ¥ . DePression (Y/4~ Alarm tested (Y/N) ,J Pumper Well(s) on lot To property line ~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: 'Z,O~ ~ ~ On adjacent lots ~/Ar AbSorption f/eld i;~ J Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Manufacturer Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N~~ SEPAR~NCE FROM LIFT STATION TO: ~ lot On adjacent lots -~~Cyc es tested Surface water D. ABSORPTION FIELD DATA Date installed /.~ * '7..- Length '~¢' Width Z Total absorption area '"¢~ ~' Depression over field (Y/~) Results (pass/fait) ~J//~ Peroxide treatment (past 12 months) (Y~I,) Soil rating /~O~/'~¢- System type 'q~¢-¢- ~ Gravel thickness ~' J Total depth ~ J Cleanouts p resent~(YN) ~' Date of adequacy test /'-/~ vJ for '~,/~ /~/,/~ ~,J'a/ If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot "7~- To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ,J/,~- Property line To existing or abandoned system on lot Cutbank /a{/~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION HAA Fee $ Date of Payment Receipt Number I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature S A S ENGINEERING 17034 'Eagle River k~p Road No, 2~ Engineer's NameEagle River, Alaska g"S~ Date ~ 2~ ~/' Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 17 �'•� �'.> 'nom. � �� a b 2 49th Deep oso bs seo oo %o ae9 ao Robert C. John son NO 880-5 4 a t AS -BUILT IL F_ I hereby certify that I have purveyed the following described property: l-90 CeA - ` ,Su les+ -7— G!/ Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this�day of A -U4 1 19 ` ROBERT C. JOHNSON'-�, SCALE: Registered Land Surveyor No. 880 -LS 1" _ Q Box 77-0456, Eagle River, Alaska 99577 Phone (907) 694-2543