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HomeMy WebLinkAboutHERITAGE PARK BLK 1 LT 16 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 NA~IE 5 PHONE MAILING ADDRESS LEGAL DESCRIPTION ~ ' - LOCATION DISTANCETO: J Well Manufacturer ~/A *T~ ~ L q. capacity IF HOMEMAD E: DISTANCE TO: ;nufacturer DISTANCE TO: Well <' Wdth STeel Inside length Dwelling Foundation ,/¢ .~. Material Nearest lot line/~j.,.~t' Trench widj~/)/, inches Ne. of .nes/ Length Top of tile to finish grade. ~' Length ~idth' Total len~th~f~ lieF, Material beneath tile Depth NO. OF BEDROOMS3 (~NEW [] UPGRADE PERMIT NO. No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO, Distance between lines Total effective absorption ~rea,~ P_-. 7z9 ~r~ PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line DISTANCE TO: Depth Driller Distance to lot line Building foundation Sewer line Septic tank DISTANCE TO: PERMIT NO. Absorpt on area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER RE~RKS APPROVED DATE LEGAL Z, F 16 BtK fle. i'#a5 e lc, 72-0'J3 (Rev. 3/78) Departmen% W~R&Ki%~'&A~ ~vi~~Protection 825 ~j Street, Anchorage, AK. ' 99501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND/OR ON-SITE SEWER PERMIT ~D~, Mailing Address: permit ~ Applicant Seepage Bed: Holding Tank: Soil Rating(sq.ft/br) ~ LOcation: ~k%,, · ~D~t~ ('~ / __ Phone Number: Legal Description: 7~ / ~ ~ I ~ d~~°'~ Size: TYpe of Soil Absorption System Is: Trench: ~ Drainfield: Maximum Number of Bedrooms: ~ The Required Size of the Soil Absorption System Is:' The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~©0 GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of/residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type ore public well. Minimum distance from a private well to a private sewer line is~ 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I und~rstand that the on-site sewer system may require enlargement if the /e/~idence is re~/~eled to include more that 3 b~rooms. Signe~: ._ Issued by: ~w'~o~%, ,//~357 Appl~ant Date: '? --i _~ ~-~ SWP/024(1/81) PERFORMED FOR: LEGAL DESCRIPTION: DEPTH 2 3' 4 8 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST '~J~i~' SOILS LOG [] PERCOLATION TEST SLOPE SITE PLAN 10- 11 12 13 14 15 16 17 18 19 2O COMMENTS ~-~-¥~ ~-~ ~- ~ [ I S WAS GROUND WATER ~ ~ ~ ENCOUNTERED7 P E IF YES, AT WHAT DEPTH7 Gross Net Depth to Net Time Water Drop Reading Date . T. ime. / . _ .. ~ ~ ~ OF · ' ' .... (minutes/inch) PERCOLATION RATE TEST RUN BETWEEN FT AND ~ FT / 72-008 (6/79) 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 GENERAL INFORMATION Complete legal description Lot 16; Block 1: 'H'erit'~ge Park Location (site address or directions) 19724 Ivy' Home Circle Eagle River, AK 99577 Property owner Mailing address ,.,L. ending agency Mailing address Agent Address Vickie Herman Day phone 19724 Ivy Home Circle Eagle River, 694-6252 AK 99577 Day phone Day phone e Unless otherwise requested, HAA will be held'for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water XXX 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 XXX 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 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 furtb.er..~erify that based on the information obtained from the Municipality of Anchorage files and fr°m/C~y investigation and inspection, the on-site water supply and/or wastewater disposal/¢ystem/is' in compliance with all Municipal and State codes, ordinances, and regulations in eff/ect/ / on ti~e date of this inspection. / ~ / Name of Firm ,/'' >._ ..//:-"/' "- /-'~-~-~" Phone ? ~aaress .___~. _--'., ~7.~__, _Z .... .~ ~., ~ 6. DHHS SIGNATURE :. Approved 'for -~ Disapproved. bedrooms. Condition'al approval for bedrooms, with the following stipulations: Additional Comments By: Date 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 th is 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:~--'l"\~, ~'2,...¢..\ '~LS--~-c"~..~L_ ~/~rcel I.D. A. Well Data Well type ~ 1~/~ Log present (WN) Total depth Sanitary seal (Y/N) Date of test If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller ~ Cased to ~ Wires prop~d (Y/N) ~ FROM AT INSPECTION ~ ..~~ ~ Static water lev~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ; On adjacent lots gp.m Absorption field on lot q~-~,o' ; On adjacent lots ~~ Public sewer main Public sewer man~ Sewer service line Petrol~ WATER SAMPLE RE~ Coliform Nitrate Other bacteria ~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '~ - '?..~'--~, '5 Cleanouts ~'N) High water alarm (Y~) Date of pumping Tank size ~, c~==, ~ Compartments Foundation cleanout (~1) ~/ Depression ~ Alarm tested (Y/N) _c~ ~ 'PUmPer: '-~__-. To property line ~ c> ~ Jr Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ,-/,.-~, z> On adjacent lots Absorption field ~ ~ Foundation Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93)* Front C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off'~ High water alarm leve~ Meets MOA electrical codes (Y/N) SEPARATION DISTAN~M LIFT STATION TO: W~'~ot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~ ~ Total absorption area Date of adequacy test r.~Water level in absorption field before test Peroxide treatment (past 12 months) (Y~8) ~'~ ~ '~ Soil rating (GPD/Ft2) ~;~¢'~ Width 2~j Gravel thickness ~ ~ Cleanout present/N) ~ ~ Z ~ ~ Results~fail) System type Total depth "/ Depression over field (Y/~ ,~' ~'A~' .¢' for After test / If yes, give date Bedrooms Well on lot To building foundation On adjacent lots Surface water Curtain drain SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots Property line !/_/L. / To existing or abandoned system on lot Cutbank ~J~/,~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to ali MOA and HAA guidelines in effect on the date of this insp~c(/on 17034 Eagle River Lo~R~ NO. 204 Engineer's Name ,. ............. / Date ~/2~ $':~.~ ?/ HAAFee$ /'70 Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number ~.~l MUNICIPALITY OF ANCHORAGE ~ DEPARTIVIENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRON['dlENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-472O Application Date J'7~- Ibc ~ GENERAL INFORfdATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ¢2¢,¢¢E~ ~E:2'L.¢~.~,-~...5 Telephone: Home _[z:~¢¢"'- f¢'~'~')~' Business (c) Applicant is.(check One): Lending Institution []; Owner/builder/~; Buyer []; Other [] (explain); (d) Lending Institution -~r~=a'"3.~'~'r'~ ~k.~c~'~'~/~¢~ Telephone Address (e) Real Estate Company and Agent Address Telephone (f) McCf'the HAA to the following address: TYPE OF RESIDENCE Single-Family,J~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] 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 J~ Public i'-1 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 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDIN~rC~NSPECTIONS, TESTS, FILE SEARCH, DA--~A 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 d~sposal system is the date of this inspection. Name of Firm ~f'~ 2~ ¢,' ~;'~J "'~:'~1'~ Telephone Date Approved for ¢¥_~.~._~z_' bedrooms by ~ '-;/ ~'~.4_.,t.~.4~-~'__~;.) Approved. /' Disapproved __ -- Conditional Date 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) WELL DATA ',...~./ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) · CHECKLIST- FEBRUARY 1984 ' 264-4720 Legal Descr, iption: L"-~--'T' (, 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 ~ 1~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~::::::~, ~._~, ~ ~, I~:~, '~ ~ If A, B, C, D.E.C. Approved~..~'N) Date Completed Yield Cased to . Depth~of Grouting I'"-' . Pump Set At Aitary 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/HOED'lNG TANK DATA Date Installed Standpipes~,/N) Air-tight Caps~/N) Depression over Tank (Y/~) Pumping/Maintenance Contract on File.(Y/N) ~/. '/~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Hcldi?,g Tank: To Water-Supply Well "7.~.~ 1,4r- To Property Line ~.~:::, ~A*- To Water Main/Service Line, ~ ~ Course ~'~/~ Size ¢L ~;~:~:;~ No. of Compartments Foundation Cleanout /Date Last Pumped ; for Temporary Holding Tank Permit To Building Foundation 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 'Z~ Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present<C...~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 I Z JO! To Existing or Abandoned System on ; On Adjoining Lots ~ ~ ~ To ~utbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "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. Signed '~ '¢ :.;:?'~ .:'~h~'::;~!i~h'~ Date \?._ ,--- t,~ ~ ~' Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Mailing Ad(~ress Zip Code 7/+,5-2553 Buyer Frederick D., & Vic!ti L. !~'erman Address Zip Code Lending Institution A~.8.~S. T~ . . ~ Phone ~aczfmc t~ortgage Company Address 101 W. Benson Blvd, PO Box 420, Anchorag$ipcode 99510 276-31!O Phone RealtyCo. aA~nt RE/~4AX o~ sagle river~ Inc. (~im Addr~ ~OX S~g~e ~iveTg, A~[ ZipCode 99577 69~-Z. 200 Legal Description Lot 16, Block 1, Heritage Park Subdivision Street Locati~ T~T ~?' ~.,tM ivv Home Circle Type of Res~.ce ~ S~.u~e FamUy ~ MoR~p~e Family No. of 8edmo~ ~ Other -'~ Water Supply ~ Individualt~ A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~ ~ ~ ~ For wells drilled pr[or to that date, give well depth (attach Icg if available). Community ~ Public Utility Sewer Disposal ~ Individua~ Year Individual Installed: ~ Public Utility When Connected to Public Ut~t~u~ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector MUNICIPALIIY OF ANCHORAOE H~ALTH RECEIVED APPflOVAL OF G~ P-z>~% WelltoTank $epticT~kSize / O0 0 DEPT. OF ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-5533 To Whom it May Concern: ~b.~Water System is in compliance with the State Drinking Water Regulations Sincerely, Septembez. 28~ ~.~8~ TO, Cory '~illis, R.S. M~nieipality of Anchorage Department of Health and Envi~omental Prote~tion Put,eh 6-650 Anchorage~ AlaSka 99502-0650 From I James L. Thode P.E. JI,T Engineering 1,546 Eagle River Rd. Eagle River, Alaska 99577 Subject, Lot 16 Blk 1 Heritage Park S/D As~ouzlts In answer to your letter of September 22, ~,.983 the Iollov~L..~g information is provided~ The distanc~e from the perforated drain pipe to the origin, al gro'~md Surface is 3 feet. O~e foot of added fiI1 was placed over the drainfield trench whioh adds up to 4 feet to the finished grade as indicated on the as-b~.~ilt,. ~.e 'total depth of the tre~'~eh from the original grade is 8 feet as indicated on the installation permit, Please call me at 694.~3713 '~ ~' _ _ _z you have any qt~estions. $incere ly, James L. Thode P~E. RE/MAX of Eagle Rive?, Inc. J[im Mor~tague P.Oo Box 848 Eagle River, Alaska 9957~ ~.pt. ember 22, 1983 mort ..ag ua P. O. Box 84~ Eagle River, AK 99577 Subject:- Lei-. 16, '3].oc~-' 1, Heritage Park :{ubdivision Property owner -.-~,~.K Construction Approva]. for the .individual sewer and water ~Jacilities cannot be ~jrante(i until the fo].~o%~iD~ items have been cof.aptete<~_~ The engineer's as-builts, which have been submitted to this office, are not within the paran~eters o~ thc., on-site installation permit ~s~.~ued by this <~epart~aent. The discrepancies will need to be corrected before this ~' department c{¥/accept the submitted engineer as-bull, ts. Please notify this Department ~or a r~..L~,~ct~on when the noted discrepancies have been corrected. If there are any further que~t, ions, please call this office at26~-,~"740'~. c~43/ej/~2 Cc: Jim Ti]ode, JL~l' ~.fl',-g ineerin9 1546 Ea~jle River EaSj.i.e River, Al{ 99577 RE/~.~AX of Eagle l~iver, Inc. Jim Montag ue P. O. Box Eagle R. iver, AK -99577 Subject~ LOt 16, Block 1, Heritage Park Subdivision Property owner ~SK Construction Approval for the individual sewer and water f~acilities ~anDot be granted until the ~ollo~;ing items ~ave been o The en~ineer's as-builts, which have been submitted to this o~ice, are not within th~ parameters of the on-site ins~allatlon permit issue~ by this d~)artl~ent. d~s,,r~)a~]c~es ~]1 n~d to be corrected before this Please notify th~.s Department for a reinspect~on %~hen the noted discrepancies hsve been corr~cted~ ~f there are any fur~her questions, pteas~ call this o~fice at 264-472~. lo~e, P.E. g ineer~.n9 1546 Eagle F. lver .... ;:~.: / Ea~le River, Ak ~99577 R. S. ARK Meadow Canyon O Ion Cr ter Dr. 0 War Rd. St. 1St. St RIVERLa°aha CI'. ~ CAMPGROI Chekof Neumann CI ~ 9 1. St Lawrence Cl. 6. Shumagin Cl. 2. Attu Cl. Z Little Diomede CI IO MTA TELEPHONE EAGLE RIVER e FIRE STATION ~ MEAELECTRICITY ~ LIBRARY ~ STATE TROOPERS I~ ALASKA GAS C ,tr~ l~J~/'~ ~ [/~'/'~ ~" '~ ~'"'~/'~' ~// POST OFFICE COMPILED AND PUBLISHED BY I~~ t~ ~7V ~/~ ALASKA MAP SERVICE, INC. MAP PUBLISHERS SINCE 1958 ANCHORAGE, ALASKA USA COPYRIGHTED ALASKA MAP SERVICE, INC. THIS MAP IS COPYRIGHTED · IT IS UNLAWFUL TO REPRODUCE ANY PART THEREOF, WHETHER FOR PERSONAL USE OR RESALE, WITHOUT PERMISSION