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Home My WebLink AboutHERITAGE PARK BLK 1 LT 18NAME 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 PHONE ~NEW [] UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO'Well ~ ~ ' 7,/.. ~ Manufacturer ~ ILiq. capacity in gallons = u~c~. 7.,, I ~_~ ~a..~t~.~r ~ I I Well ~= I D~STANCETO: ~ ~ ~ I No. of lines ~ Length of each line ~ [ ~ength Width ~ ~ [ Type of crib Crib diameter ~ Well ~ DISTANCE TO: ~ Class Depth ~ DISTANCE TO: Buildi~on Absor~Stion area Inside length Dwelling Foundation Total length of lines Material baneath tile Dapth ~"~t h Building foundation Sewer line Dwelling ..~ Material w dth______ Material Nearestlotline Trench width inches inches NO, OF BEDROOMS PERMIT NO. No. of co~artments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines Total effective absorption area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line PERMIT NO. Sept c tank Absorpt on area(s) OTHER PIPE MATERIALS L TEST RATING INSTALLER REMARKS *., JOHN E. APPROVED DATE 72-013 (Rev. 3/781 LE At ECEI ED PERMIT NO. DEPARTMENT L.' HEALTH RND ENVIRONMENTAL'x~ROTECTION 825 'L' STREET, ANCHORAGE, AK. 9950~ 264-4728 C, D4--SITE SEIMEF: PEF:~I IT ( 82t05t ) t, ro AF F L I _.ANT LOCATION LEGAL JC FOSTER BiLtB HERITAGE PRRK S, ,FIu. ~ ..... G Rfl B.¢, t,'~.J... HNCHOE. R.~E 99507 ~44.-7E:84 LOT SIZE '-gg~q~ --. ~ ....... SE, IARE FEET ,-, c ' IS TYPE OF SOIL flBSOR. PTION --.¢_.,TEft : TRENCH SOIL RATING (SI-T;, FT?BR)=.-'~'--'.~ I',lflXIMUi'4 NUMBER OF BEDROOMS THE RE~..!LIIRED SIZE OF THE SOIL flBSORF'TION _-,Y'=,TEM IS: [:,EPTH= -: LFI'4G T,' ;= 2.: c.-: G F-: l:t"-.-" E L [:',E P T H = 4 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF fl TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCRVATION (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). REL::!IJ I RE[:, SEPT I C TR~'4K: S I ZE= ::LOEiE"i ,3RLL~][qS PERMIT flPF'LICANT HAS THE RE=,FUN_-,IBILIT~ TO INFLRM THIS DEPARTMENT D_IRING THE INSTALLATION INSPEC:TION", OF ANY WELLS A[:,..TRE:ENT TO THIS rr,:.._rr-~.~Y I--IND THE NU[1E, ER OF RESIDENCES THAT THE WELL WILL SERVE TI40 < 2 ) I t'4SF'F-F':T I CIl'-,tS RF.'E RE6!.IJ I RE[:. BACKFILLING OF ANY SYSTEM WITHOUT FINAL IN~FEC. TILN AND APPROVAL BY THIS ' -¢ I": DEPARTMENT ~4ILL BE SUB.TECT TO FRu_,E.UTtON. MINIMUM DISTANCE BETWEEN fl WELL AND tiNY ON-SITE SEWRGE DISPOSAL SYSTEM IS t00 FEET FOR A PRIVATE HELL OR t50 TO 200 FEET FROM fl PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNIT~ SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICRTIONS RND CONSTRUCTION DIAGRAMS ARE RVAILABLE TO INSURE PROPER INSTRLLRTION. F'EI~:I'-I I T ED<F' I E."ES [)ECEDIBEFC _git, - qF:'-~ I CERTIFY THRT i: I tim 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 THE CODES. ~: I UNDERST8ND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. HFFLI..RNT JC FOSTER ~ & ~NGINEERS, INC. -S ~ ' 7125' OLD SEWARD HWY. ANCHORAGE, ALASKA 99503 349 -6561 ,~.,~ - ' i ~ ''SCqLS EOG '' ~'" ........... ~ t~"~pER CO LATiON TEST SOILS LOG -PERCOLATION TEST 5 6 7 9 l0 ll 12 ~4 15 16 ~7 18 ]9 20 DAI'ff PERFOHMED:_ /0'/ ~I'~ SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTIO Gross Net Depth to Net i Date Time Time ~/ater Drop 183~E ..' .~i~ -- PERCOLATION RATE TEST RUN BETWEEN ~'~ , ET AND 7 ~T COMMENTS PERFORMED BY: 12-OOB (G/79) Parcel I.D. # 1. GENERAL INFORMATION Complete legal description MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services :. : On-Site Services Section P.O. Box 196650 Anchorage,Alaska 99519-6650 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lo,~ 18; Block I; Heritage Park Subdivision Location (site address or directions) Property owner Mailing address 10427 Tradition Ea.~l~ River, AK 99577 M~lin & Claudia Ballcnsky Day phone 10427 Tradition Eagle River, AK 99577 694-3561 Lending agency ' Agent REAL ESTATE SUPPORT SERVICE Address 8200 H~mboldt Ave. S. Day phone A.~ttn: Ross Day phone 800-829-7377 .. . Tomoson S~e 204 Minneapolis~ MN 55431 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Individual well Community well Public water ×XX '/ . If community well system, provide written confirmation from State _ ~in~ to the leaalitv~ _ and status of system. NOTE: 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 verifythat 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 /~=~r.~~. .......... Phone ~ ~/'/' - ~' '~ -7 7 ~ ~ -.., ....... , ~.Dp ~oa~ N~..204 Engineer's signature ' Date ~'~ ~/,/4,~ DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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 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(Rsv. 1/91) Back MOA~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type ~-,'~o/~r Log present (Y/N) Total depth If A, B, or C, attach ADEC letter. ADEC water system number Date completed ............ Driller Cased to Casing height Sanitary seal (Y/N) Well flow Pump level1 FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Wires properly protected (Y/N) AT INSPECTION g.p.m. Public sewer main Sewer service line g.p.m. Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~1 · Tank size ~ ,~ c~c~ Compartments Cleanouts (~1) ~ ~"P Foundation cleanout~;~l) ~ ~' Depressio{~ (Y~ High water alarm (Y/{~ ~ Alarm tested (Y/N) ~ ~- Date of pumping ~ ~ ~ ~ ~' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t-4.~- ~ On adjacent lots ~ ~ Foundation To property line ~, t2 ~,~L- Absorption field Sudace water/drainage ~ ~ Water main/service line 72-026 (3/93)* Fro~t CONTINUED ON BACK PAGE 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) ~ LIFT STATION TO: Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump Surface water D. ABSORPTION FIELD DATA Date installed ~c~V. Length '~ '7~? /' Width Total absorption area ~ 9, ~ Date of adequacy test ~' ~ / ;5 Water level in absorption field before test Peroxide treatment (past 12 months) (Y~_ ~"~ Soil rating (GPD/FF) ~<~ ~- System type '~-~/--~ /Jo ) (' Gravel thickness ~ ~ '/' Total depth Cleanout present (~N) / Depression over field (Y/.~ ,,,J' Result~fail) /~z'r5''-~ for ,_~ /t- Bedrooms ~/,J,¢_.~ ,¢~,./0 >/,Jr If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot h,~ ~, To building foundation On adjacent lots Surface water Curtain drain On adjacent lots *-'~l ~ Property line / ¢" To existing or abandoned system on lot ~{ .,~ Cutbank ~/ ~-- Water main/service line \ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect o~LZbE,.date of this inspection. S~ignature ~-ngineer's Name ~0/3¢~'~ · ('~ ~.t.,,4-f¢ ~ ~~*~'*'~=~~ / Date H~ Fee $ ~¢~¢P ' ~ ¢ Waiver Fee $ Date of Payme~ ¢¢¢/~ ¢~ Date of Payment Receipt Numar ,.~, %~ ~ 5~ Receipt Numar 72-026 (3/93)° Back APPL/' ,NT FILLS OUT UPPER HA ' ONLY Phone Property Owner J, Cl Foster ~ 344-7884 Mai~ing Addre~ C/) 2203 C Street, Anchorage, Ak. zip Code 99503 Buyer Merlin l~,nne and Claudie Joan Ballensky Address Zip Code Phone Lending institution AI~ Bank of O.~erce/Eagle River Branch 694-2021 Address Zip Code ~ Phone Realty Co. & Agent.. H.earthside, INC., Gallery ~ [-~_~'-~ · - Tc~ Ward' ' .... ' '- · I; 563-3655 Address 603 W. Todor Rd, Anchorage.. Ak. Zip Code 99503 Legal Description ~I~t 18, B 1, Heri~.ge Pork Sub. Street Locaticn ~l~tion ta~l Type of Residence (~ Single Family [] Multiple Family No. of Bedrooms 3 [] Other Water Supply [] Individual / ~ ATTACH WELL LOG. A wcfll log is required for all wells drilled since June 1975. [2~ Community -:~;.~ ~::-~- ~ For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility Sewer Disposal [] Individual Year Individual Installed: ].983 [] Public Utility When Connected to Public Utility: /,~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time ~ -~7~,· Inspector Date Inspector Date Inspector Field Notes: Inspector 1983 "Municipality cf Artch0rage" "Dept, of Health & Environmental Protection" *CONDITIONS OF APPROVAL Soils Rating 72-023 (3182) Well To Absorption Area Well to Tank Well Log Received Septic Tank Size