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Home My WebLink AboutHERITAGE PARK BLK 2 LT 1 ~ "~.~/ 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 LEGAL ~ESCRIPTIO~ I W~II e .. ~ [ Absorption area / PE ~ ~Z Manufacturer /--/~ ~ ~'M~//- No. of compartments ~ N Liq. cgpag~y ir~gallo~s F HOMEMADE Inside length Width Liquid depth / ~ ~ , : . .~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ·O~ ~ Manufacturer ~ /~ Material ~iquidcapaciWin~allons ~ G~'~ DISTANCE TO: ~ell '~' ~ .~ Found~ti~z ~ ' Nearest lot ,i~o;-- ' / h~ Distance j ~ .o. of lines Length ~a~ I~e Total le~h~ ,in~ Trenc "inches , Tota fg tire abs , N Top of tile to finish grade ~ ( Material beneath tile ~ itinches ZY Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter de Total effective absorption area m Well Build g foundation Nearest lot line ~ DISTANCE TO: ~ Class ~ Depth Driller Distance to lot line ~ PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS / .. ~ ~/~//./~;~ ..... ,~ .* -~eNVI~ONMEN Al PR( )TEC' ION APPROVED 72-0 3 (Rev. PERMIT NO: DATE I SStJED: AF:'PL I CANT': ADDRESS: CONTACT PHONE: LEGAL DESCF~ I F': :OEF AR TIIE::.t.IT OF HEAL. TH ANf.) ENVIRONMENTAL F"F;:O]'ECTIOtq 8::'.'.~9 I._ STREET, ~I',ICHORAGE~ AK ?95} 1 0 x 840749 DIEVCON-~40B HAINES % ....... ~ ENGINEERING EAGLE RIVER, AK 99577 694-2979 LOT SIZE: MAX BEDROOMS: SLIBDIVISION: HERI]"AGE PARK SECTION: 7 TOWNSHIF': 14N ,=:~,48 (E( .FT, OR ACRES) 3 LOT: I RANGE: :LW ~,e.:=ignJ. ng yaur sep't::ic Listed belc:)w are the c~ptions available 'Lo yOL~ in ~./st~m, Chaos~ the c]p'~J.c]I] ,.J,(:.~. b~sC ?its yc)ur DEPTH 'TO P]:F'E BO]'TOM (F'I".) 4.,0 4,.0 4~0 GRAVEL.. DEP'I'H (I::'T.) 6.0 O. 5 3.5 TOTAL. DEPTH (FT,,) lO~ 0 4,, 5 '7,, 5 GRAVEL I;JIDTH (FT,) 2.5 14.0 5~0 GRAVEL. -LENGTH (FT'.) 28.0 28.0 41~0 GRAVEl_ VOI..UME (CLJ. YDS. ) 16.9 14,, 6 30,, 4 TANF':.' S I Z E (GAL:S) 1,000.0 ~-.~ ]., 0()0.0 .~':~ :i., 000.0 SOIL RATING (SQ,,FT. /BR) 112 85 12.'.5 ~. TANI< MLJST HAVE AT LEAST TWO COMF'ARTMFNTS I certify that: 1. I am ~'amiliar with {he pequirements Far on-site set4eps and we].ls as sec Fopth by the Municipality oF Anchor'age (MOA) and the State o~' Alaska. 2,, I will install the system ~n accordance v,;ith a].l MOA cades and regu].at:i, ons, and in comp].iance with the) design cf'J. Cepia DF this pepmit. 3. I wi.Il adhere to all M[]A and State o~ Alaska r. equirements fop the set back dis'Ear'ices ¢pom any existing well, wastewater disposal system or public sewepage system (~n this (Ir' any adjacent or near'by IcJt. 4. I undenstand that this permit is valid fop a maximum c)¢ 3 bedi-ooms arid any enlargement' will require an additional per'mit, IF A I.,,:IF:']" STATIOtq IS INSTAL. LED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND ]:NSPECTION MUST BE OB]"AINED; (2) AS-BUILTS WILL NOT BE APPROVED WITFIOLIT ~lxl ELECTRICAL INSPECTION REPOR'T; AND (3) THE IEL. ECTR:I:CAL WOFd< MUST BE DONE BY .A LICENSED ELEC]"RICIAN.. PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 5- 7 8 ~0 11 12 13 14 17 18 20 COMMENTS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST WASGROUNDWATER ~ ~ ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) TEST RUN BETWEEN FT AND ~ FT MUNICIPALITY OF ANC:-IOii&GE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alask~ 99519-6650 343-4744 C-.'. -:~j,t;~: JFHEAuTt"~-, ;~,--, · APPRO'../'-.L FOR .~:, SINGLE FAMILY DWELLING Parcel I.D. # 0 ~'O -,~.)1 ~'7¢i t. GENERAL INFORMATION Complete legal description Loc~,tion (site address or directions) P r~'~:;~h'(y owner Mailin~ 'address "Lending agency Mailing addrees Day phone Day phone Add tess Unless otherwise'requested, HAA will be held for pickup. NUMBER OF BEDROOMS: · Day phone TYPE OF WATER SUPPLY: Individual well NOTE: community well Public water ~-~ 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 .)/~ .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 ?f,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 17C34 -"---~= ~!.:.~r L~ ~'-~ N~ ~n4 _ Phone 6 ~f N. ~/-7 ~ Eagle River, Alaska 99577 Address ~~~ ~ EngineeFssignaturo ,_. _ '~-------- Date ¥ X~ /R 7 DHHS SIGNATURE . '.~'. Approved for -~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municil~ality of,.,Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations g yen n paragraph 5 above by an independent professional engi~'~er registered in the State of Alaska. The DH HS 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 Legal Description: Municipality of Anchorage /.=.~. ~ DEPARTMENT OF HEALTH & HUMAN SERVJI~P^UT¥ OFANCHo~.A~ Environmental Services Division ENVIRONMENTAL SERViCES DIVt$I~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 APR 1 0 1997 Health Authority Approval Checklist A. WELL DATA Well type' A (~o~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production t/p~e of sample: . B. SEPTIC/HOLDING TANK DATA Date installed ~ 'Jf~';:~ Tank size Foundation cleanout ~N) Date of Pumping q-L~ .c/~ If A, B, or C, attac~ ADEc .~tter. ADEc water syslem number ;~1 __~ Date completed __--~ · _ Cased to __ Casing h~ove ground) __ __ ~rly protected (Y/N) __ FROM WELL LOG ~ AT INSPECTION _ J g.p.m. ' g.p.m. Nitrate Collected by: C. ABSORPTION FIELD DATA Date installed q 'l~O '~4' Length o~' Width Other bacteria Number of Compartments Depress,on (Y(~ /tiC) High water alarm (Y(~ Pumper ~',~- bedrooms Soil rating (g.p.d./fF or ft~dr'-~ ~2~¢ System type Gravel thickness below pipe ~ ' Total depth Effective absorption area ~ .~(o ¢¢ Monitoring Tube present {~N). ~c.s Depression over field (Y,~ ii Jo Date of adequacy test q '~ '~ Results (~Fail) PA~.5 For Fluid depth in absorption field before test (in.); ~" Immediately after ~Ogal. water added (in.): O" Fluid depth (ins) Minutes later: O Absorption rate = .g.p.d. Peroxide treatment (past 12 months) (Y/HI /¢/~¢ ~,f.~u),tJ If yes, give date 72-026 (Rev. 3/96)* LIFT STATION .~ Date installed Size ~~'"~ · Manhole/Access (Y/N) ± ~' level at* "Pump off" level at* High water alarm level at*~- *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot O~~ Absorption field on lot ~On adjacent lots Public sewer main ~ Public sewer manhole/cleanout ~e~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation JO'~ Property line I~) "~ Absorption field Water main/service line JO~ 1- Surface water/drainage iCC~-~' Wells on adjacent lots ~O~ "~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation ~ ' .1: Water main/service line J~ "~ Driveway, parking/vehicle storage area ~5 ' ~- 4,'0,.,),0 Wells on adjacent lots ~'+' ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review Of Municipal recor~Ce~."~C..t~ems are in conformance withMOA ~A guidelines in effec~ on this date~ --,, ,., ...,.. Signature ~ . Engineer's Name ~b~'~/t r C. ~OwO~ Date ' ~//°/ ~7 ' ~'~;~ :cEi880i /~ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 t'7~ _/-~'~ -; ..~, \ \ - ~..¢~ ' HAA# GENERAL INFORMATION Complete legal description Lot Ii Block 2~ Heritage Park Subdivision... Location (site address or directions) 10724 Tradition Avcn~¢ Property owner Mailing address Larry & Jane Hyatt Day phone Lending agency, Day phone Mailing address Agent Lori C~.~wd~r JACK WHITE COMPANY Day phone Address 10928 Eagle River Road Eagle River, Alaska 99577 694-5500 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: $ "~ TYPE OF WATER 'SUPPLY: Individual well Community well Public water XX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and statu~'~"system. TYPE OF WASTEWATER DISPOSAr-'~ i ',.:~¢~i¢~i. , ?':- Indlwdual on-s~te Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and~st, atus of syste~. . -' , 'h , ~..t!,,.'~'!?l' 4[' '.' ,'.- /'~'t' :"' '('" (~,,/~,,~.',~.,: '"'-?f'. -,,! .-¢ ;{:,,.: : ,; [;'*\t¢ . 72-025(Rev. 1/91) Fron MOA#~l:i,:i ~" "''"' ~' ' ' ¢~ " '' '' ' f":'U;:, ~'~ . ,. ,.. ),,.. r' q,.-I ~., :~ F!i']" .... ;, ,.. u., ":;'"'":; :~" ' .... i', ti _'. . ; . '" ,.' I f ' " ~i I A I P-MI:N I UP IN~iPI:[; I IUN I:IY ~..N~ilNb. I:.H 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/orwastewaterdisposalsystem 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 waiter 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 ENGiNEERiNG 17034 Eagle Ri,vet Loop Road No. 204 Eagle River, Alaska 9'~577 Name of Firm Address Engineer's signature DHHS SIGNATLtRE Approved for Disapproved. bedrooms. Conditional approval for Phone bedrooms, with the following stipulations: Additional Comments Date _?/'~ ~4/ III The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based oniy 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 purcl~asers 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 Mur',.icipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ( Municipality of Anchorage · Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~.,-o'1' { ~:>t.,~- '~ ~-.~-~.~ Parcel I.D. A. WELL DATA Well type ~' ~l~O~,"~ Log present (Y/N) If A, B, or C, attach ADEC letter. Date completed ADEC water system nUmber Driller Total depth Cased to Casing height seal (Y/N) Wires properly protected (Y/N~)~~' Sanitary FROM WELL LOG ~/INSPECTION ', .... ; On adjacent lots Absorption field on lot / Public sewe~ m~in / ' Sewer se~ WAT/~AM PLE RESULTS: ~,~/lffo r_m _.~ Nitrate Date of sample: Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~- ~L~ - ~'~ Cleanouts ~)'N) X~ High water alarm (Y/~ Tank size \oOo Compartments "Z.- Foundation cleanout {~/N) ~ Depression (Y,~ Alarm tested (y/N) ~/A Date of pumping' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 'Z. o e, ~.r On adjacent lots To property line ~ c> ~ '~' AbsorPtion field Surface water/drainage ~ O~ ~ ~ Foundation \O~J¢ Water main/service line ~(-~ ~ + 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electri~ SEPAR~9.N"Efi~TANCE FROM LIFT STATION TO: ~ on lot On adjacent lots Manufacturer Manhole/Access (Y/N) ~ "Pump on" level at ~f" level at Cycles tested Surface water D, ABSORPTION FIELD DATA Date installed c~_ ilo -~'¢i Length 'Z-'k, ~ Width Soil rating 11"~~/F~¢-. System type Gravel thickness Total depth Total absorption area '~'~ Depression over field (Y/~[:) R es u Its&"fi~/fail) Peroxide treatment (past 12 months) (YN~ Cleanouts present(~CN) Date of adequacy test for ¢-~Jo vJ,J If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '?--oO '"' To building foundation On adjacent lots -z~=, Surface water \o~ Curtain drain ~'~ IA- On adjacent lots ~1~- Propertyline To existing or abandoned system on lot Cutbank ,-4 I ~- 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 S & S ENGINEERING Signature Ea~le ~iver, Alaska 99577 ' Engineer's Name HAA Fee $ //~¢ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 ~ection. Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONE~IENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WA~i~'R~I~ACILITY 264-4720 Application Date GENERAL INFORMATION {a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name _ r~/~V'C~A.~2 Telephone: i-lom'~'e Applicant Address ~_ j, .,~,,~/.~-,/~/: ~'-,~z// (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution ¢~¢~,' ~ Telephone Address (e) (f) Real Estate Company and Agent _ Address ~elephone M-ei.l-the HAA to the following address: TYPE OF RESIDENCE Single-Family~,~, Multi-Family [] Number of Bedrooms '~ Other WATER SUPPLY Individual Well [] Community [] Publi,,¢~ Note: If community welt system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 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. 72.025 ('7~:¢¢)/~ ENGINEERING FIRM PROVI ~IG 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 Address Date Telephone Approved for Approved '/ ~7 ~7tcOndit'Onal Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Nealth 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 (11184) WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (NAA) CHECKLIST ' FEBRUARY 1984 Legal Desc~ption: Well Classification A If A, B, C, D.E.C. Approve~) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting /L~/ Pump Set At Static Water Level Casing Height Above Ground '¢//~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) / ,/ '~Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~7 ?'ye ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~L~ '¢' ; On Adjoining Lots To Nearest Public Sewer Line ' To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/14G~=DING, TANK DATA Date Installed Standpipes ~-~N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/l~Tank: To Water-Supply Well ~;~-') To Property Line //~ To Water Main/Service Line Course Size /~) No. of Compartments Air-tight Caps~-~N) Foundation Cleanout~-~N) ¥ Date Last Pumped /~¢J~/' ; for Temporary Holding Tank Permit (Y/N) 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 Square Feet of Absorption Area Depression over Field (Y/E¢;I~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well '~-,,o c-~ To Building Foundation Lot To Water Main/Service Line Z~/,,,,~ /:t, U/~, Type of System Design Length of Field ~ Depth of Field //D Gravel Bed Thickness '~Z. Standpipes Present Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area. or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots '?~ ~ /¢" To Cutbank (if present) ~'J/~4 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 a/pal HAA ~,uidelines .... '" "~ ~':" L?'~GII~K'I~i'~II~":;' Date 2- ~/~ ~ ~ Company ..... ,~ ¢,.R, ,-~l.~to~-~ cr,:pl~ MOA No. ~ ~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) in effect on the date of this inspection. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: Address: 274-2533 DATE: ~//~/~)~/ Pws I.D.~ 2/ m ~%/ To Whom it May Concern: According to records on file in this office the /~ '~~Water System is in compliance wi th the S~e Drinking Water Regulations Sincerely,