HomeMy WebLinkAboutHERITAGE PARK BLK 2 LT 8A
NAME
t.~ 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
lOCATION ~ NO. OF BEDROO~
I s
~ ~ Manufacture~ ~la~j~ ~ ~ No. of c~tments
[Liq.~apacity in gallons I IF HOME.DE [ Inside lengthW[dt~ Liquid depth
. .i/~.,~-~ I.~., = J.~,,i~." 2' ~ ...~,~o~ '
3~ D,STANCETO: I I d /--
~ ~ ~ Manufacturer /' { ~ Material Liquid capacity in gallons
~ ] IWell ~! Foundation ~ _ INearestlotline~ PE~IT~ ~
: ~ ~ ] ~ I ~ /~7 ~ ~ , I ~o i~h~s
~ ~ Top of tile tot~fi is ~ grade ~ ~e~.'al b~e~t h~,~tiLe ~' ~' ~inches
~ [ Length ~ Width .. Oepth ~
~ Type of crib Crib diameter Crib de~/ ~/~ Total effective absorpt,on area
m Well Building fou~at¢on Nearest ]or line
DISTANCE TO:
~ Class ~ Depth Driller Distance to lot line PERMIT NO.
~ DIS~A~E TO: Building foundation Sewer line Septic tank Absorption area(s)
PERMIT NO.
OTHER
PIPE MATERIALS
I NS.T-~L LER - -
R EMAR KS
DATE
· DEPARTMENT OF I"'IEAL]]"~ ' AND ENVIRONM?'ENTAL, F'F~'.OTE6]T IO1',1
8;25 L. STFUEIET, AIqCHO!:;?.AGE, AK 9950.t
;26,:[...--472 ()
P E R M ! T N 0:
DATE ISSLIIED~[
AF'F'L I CAN]":
A:ODFU:_'SS:
CONTAC]" F:'HONE;:
LEGAL DESCRIF':
1010S/84
JOHN KI,,.:,~ ..... . _~..,-~'"
~,,:x;, FZI'.tG t NEIER I NG
EAGL..E RIV.iER, AK 99577
6942979
L., 0]/ SI ZIE:
Z:-L.D ~r.. [Jl .....
MAX ~,: r.,..-,,c,,
SUBDIVI!3ION: HERITAGE I::'ARK
SECTtON~ 7 TOt/-;NSHIF:': 1,.'¢N
20000 (SQ,,F"f'~ OR ACRES)
svs'Lem.. Choose t. he op'L:i, on ..,,a~ ,~ ~==... [ :~. ~..=
DEF'TH 'f'E) F-'IF'E BOT'TOM (F'T,)
~Fi,/..'.?v'El_ DEF:'TH (F'T.)
T'OT~L DEF'TH (FV'f'. )
GRAVEL. WIDTH (F:"I'.)
GIRAVEL. LEIxlGTH (I::'T.)
GRAVEL VOLUME (CU.YDS.)
TANK SIZE: (GAL. S)
SOIl_ RATING (SQ.I::]',~ /BR)
4 ,, 0 4.0 4.0
5 ,. 0 '0.5 3.5
9.0 4 ,, 5 7 ,, 5
2 ,, 5 2 6 ,, 0 5.0
· 90 ,, () '~+'~' 5(). 0 97.0 .~'-~-
45.9 48.2 71.9
250.0 -~"~' i, 250.0 -~"~' 1,250 ,, 0 -x..~.
225 2:1.3 225
...... 1 .,.1 L ......... ~, ....................... 75
GRAVEL. I,E]xI(}]TH > '75 F:]". RFZ,'.].!U]:F~ES *t ' "*'::' ~r :~,.. lin::', .. (H-ri" Fz,x+*~::i:cf~-rr, u:,. ..... ,c'"r,. ,..... ,':'¢'¢"'*'~.., ..
'TAIxlI< MUST HAVE AT I...I::.,..~F 'T'WO ~,,c,~,c,-,,
t. ify t. hat.=
forth 'by the Municipa].it.y c:)f Anchorage ' (MOA) and the Stat. e of Aia-ska..
I wi].l install the ~sy~Fl:.a.)xfl ill acc:or'danc:e with a:l. 1 MOA cod(:~s anti re:.:x~u].ations,
and in complianc{:~ wiCh th~, dE. sign cpJ. teP:i..:;:~ of this p~.:~rmi'L,,
I ~%~i].I adh(;.H"e t.o all MOA al"Id E;t.a'L~b (3'[' Aiasl.,:a rs~quirement, s for the .s~eC back
distar'Ices f'r'om any ex:i. st. ing v,~e]:i,' ~A~astewater' d:i. sposal syst.(am
se[,x.z.n"age ?~y~Ht. efit Ol] this cH" any adj.ac:ex~t ar' nearby
I L.Un(:Je~r'st. aF~d 'Lha'L 'Lhis permit is valid fc)r a maximum of 4 b(~dr'oc)ms and
any 'er'i].ar'gemer'tt will. require afl addit, ior'~al
IF A [...lF'l" S"FA'TION IS INS]'mALLED' IN AN AREA COVERED BY MOA BLJILBtNG
THEN (I) AN 'EL. ECTF~IC, AL. !::-'I-ZRfdIT AND INSF:'ECTION MUST BE OBTAiN[:_'"D; (2 AS..':.BU!L."F'.']!~
WILL.. NO:" BE AF:I::'F(OVED WI]"HOUT AN EL. EE:TRICAL ).:NSF:'EC]'ION F,'.F:PORT; AND (3) THE
IELECTRICAL. WORK MUST BE )DONE BY A t_IC'.ENSED ELIECT'F~]:C'.IAN.
I R-,I., :=, ] ~ - PROTECT 1i: ON
Dl::-"~,~,l]'ii:::.N1 0t::: HEAI....'TH AND ENV ,nx~-~.
PERMIT NO:
DATE ISSUED:
AF'PL I SANT:
Cr.]NTAC]" PHONE:
JOHN I< I NSIEI_L..A
% S8,.S [':NG I NEER ING
EAGt_E RIVER, AK 99577
6942979
LEGAL D ....... I,.t. 1 ,.
L.CiT SI ZtE:
J:. ,....LI ~[JOt 1
MA X 'q~' '~ :"" ~' c:~ ~
,:~U...L i ~- ].,~.t. Otq, , ,EI~..] qE .... F'ARK
~.,I...C, IOH. 7 ,0~1~,t ,Il . :I. 4N
,~.(..,~_) ..... (,.~. , ]. (]Fi ACI::(ES)
List. ed belc)w are the clpt. ior~s availab]..'..~ to you in design:i.r~g your' sept:Lc
system. Choo~e 'Lh~ option Chat bes'L fits yoLu- site,,
'~. ' '~" 4.0 4.0 zt 0
:[.,:F ,I-I TC) PIF'IK BOTTOM (ET'.) '",-
GRAVEl_ DEPTH (F'T.) ~. 0 (). ~ 3.5
TOTAL DEF'TH (FT.) o.. 0 4.5_ -v.. ,, '.'5
GRAVEl_ WIDTH (F:'T.) ~.'~ 5 ',::~:'~.. 0 .:'::~,, C;
GRAVEl- I_ENGTH (F:'T.) 68., 0 4-4,, 0 73,, 0
GRAVEL VOI_UME (CU. YDS. ) 34,, '7
· ~ c . . . J. ~ 0
TANK .~ I ZE (GA~ !_.: ) 1 ~ 000.0 '.~':' 1 ~ 000.0 ':'~ . 0()0... '~":~'
SOIl.- IRA]"ING (SQ,FT. IBR) ~-~:.,-'~'~" 213 ~o,--.
L,,~ffl, AR 1 ,d,...N F.;
~',-¢+ TANI< MUST HAVE AT I_EAST TWO ~r~. o _,.-~ ~:' -~
I c:e:l~tify that:
1. I am familiaP ~,~J.'Lh Che r'e)quJ. Pements f'cm on-.site :s(a~,,,:~r-:~ and t,.x:~:l.:l.s as set
IF A
T JF"d
WIL.L.
E:I_E:C;TF~:I:CAL WORK IqUS'I' BE :00NE BY A l ...... N~,I_: EL,_.L,]I,.£.,,..I,,
£c.)pth by the Murlic:ipality of AnchoPage (MOA) an'd the State of Alaska~
I will. ins'Lall t. he system in ac:c(opdanc:e ,z~:i.t.h al! M(]A c:od~s .and r'egulat:i, ons,'
and in compliance with the design criteria oF tln:i.s per'mit.,
I will..adhe:-e 'Lo a].l MOA al":d State o.F Alaska p(,2qL{iPE~fiBBI'IC~ ~'OP' the sc.fL batik
dist. arlces Fl"om any existing well, t,,Jaskewa'!:.eP disposal, symt. em oJ" public
se~.,¢ePage ::WI:ri. em on t. his op ~l"~y' ad.lac:eriC of near'by Imt.
I undei"sCand that this per'mit J.~ valid fc:,r ama. ximum of 3 b~cJr'ooms and
any er'~].ar:geme)rYL ~,~J.].]. PequiPe an ad(:[itic)r~a! pePmi'L~
LI:FT STATION .IS INSTALLED Ilxl AN ARE:A COVERED BY MOA BUIL..:OING CODES~
(1) AN ELECTF~ICAL. F'ERMZT AND INSF'EC]:ION MUST' BE OBTAINED; (2) AS--BU!LTS
NDT BE AF'PROVED WITFIOLJT AN ELECTRICAL. INSF'ECTIOIq REPORT; AND (3) THE
DATE
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG-- PERCOLATION TEST
2
6
[] 'SOILS LOG
PERCOLATION
TEST
10
WAS GROUND WATER
11 ENCOUNTERED? O
P
12 IF YES, AT WHAT
~ DEPTH?
i5'
14-
15-
18
19
20
COMMENTS
Gross Net Depth to Net
Reading Date ~Tijme' Time Water Drop
TEST RUN BETWEEN ~ , FT AND ~ , FT
Parcel I.D. #
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
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
HAA #
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Day phone
Day phone
Day phone
w
Unless otherwise requested, HAA will be h. e/d for pickup.
NUMBER OF BEDROOMS: ~- %/
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
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
Holding tank
Community on-site
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~421
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 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.
David I~. Dayton P.E.
20210 Donalar St.
Name of Firm
Address
Engineer's signature
bedrooms.
DHHS SIGNATURE
._~ Approved for / -,~
Disapproved.
Phone
Conditional approval for
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 p?ofessional engineer's work.
72-O25(Rev, 1/91) Back MOA#21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
LegalDescription: /--c~O~',~ /~'Z_..~ /-~
Parcel I.D. J~ff"~ ',~'?/?- ?~.
A. Well Data
Well type
Log present (Y/N)
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 Casing height
Wires properly protected (Y/N)
AT INSPECTION
FROM WELL LOG
Static water level
Well flow
. g.p.m.
.g.p.m.
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed /ff~v /9 ~'~
Cleanouts (Y/N) ~/
High water alarm (Y/N) /'~,~-
Date of pumping ~'/7~///~'?
Tank size /~ ~ Compartments
Foundation cleanout (Y/N) y Depression (Y/N)
Alarm tested (Y/N)
Pumper .~-p'5'
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
?
On adjacent lots /~.,/~'~ Foundation
Absorption field .~' Water main/service line ~ ~,~-
72-026 (3~J3)* Fro~t CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
Surface water
D. ABSORPTION FIELD DATA
Date installed ~'-' ¢' /~"F/
Length :5~~- Width
Total absorption area ?~/2 cvs
Date cf adequacy test ,/'~',~/j~,¢
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/Ft2) ~- ~
~'z ' Gravel thickness
Cleanout present (Y/N)
Results (pass/fail) ,~¢~;
System type
.~? 'Total depth /~'
)/ Depression over field (Y/N)
for ~ _Bedrooms
After test
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Sudace water
Curtain drain
/~/~¢ On adjacent lots 't~',,~,d;z .. Properly line
/
2. z.- To existing or abandoned system on lot
~'-'/~ Cutbank _z;?_~ ~ Water main/service line 'z ~-,---
,/~ ~ ;/- Driveway, parking/vehicle storage area ~: ~'~
E. ENGINEER'S CERTIFICATION
Signature
Engineer's Name
Date
I cerb'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on t~e date of this inspection.
David R, Dayton P.E.
20210 Donalar St.
· ¢??'.i:'::,, ¢~:×:? · !~::" ~::h ::"d:i:~::
ChuCak, Alaska 99567 ........ '"' "*:' ......
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
72-026 (3~93)' Back
PARCEL: 050-211-~000-95 CARD: g± OY UI HSS±u~l~'l'±~h bill.m". PP~h~
~ RENUMBERED TO/FROM: .... 1
HAYES ROBERT J & SAUNDRA M ~~TAGE~ ~
10618 TRADITION AVENUE 0
EAGLE RIVER AK 99577 8412 SITE 10618 TRADITION AVE
LOT SIZE: 40,000 ---DATE CHANGED---
ZONE · R1ASL OWNER : 01/06/94
TAX DIST: 010 ADDRESS: / /
GRID : HRA ~ :
NOTES : REF 050-211-72,73 (93-165)
.................................. ASSESSMENT HISTORY ......
---LAND .... BUILDING .... TOTAL ....
.... DEED CHANGED---
BOOK : 0000 PAGE:
DATE : 12/30/93
PLAT : 930165
FINAL VALUE 1992: 0 0 0
FINAL VALUE 1993: 0 0 0
FINAL VALUE 1994: 50,200 174,900 225,100
EXEMPT VALUE 1994: 0 0 0
0000
--EXEMPTION---
..... TYPE .....
STATE EXEMPT t994: 0
/'
FINAL VALUE 1994: ~ , 225,10'0
-COMM COUNCIL-
EAGLE RIVER VAL
!2
SURVEYOR'S CERTIFICATE
I, ~illiam D. Ftem%ng, p~ofesslon~l land ~rveyo~ do hereby cert~f~
ACCEPTANCE OF DEDICATION
The Municipahty of Anchorage hereby accepts for pubt¢c uses
OWNER:
ROBERT J. HAYES
10616 Tradition
Eagle River. Alaska 99577
SAUNDRA M, HAYES
NOTARY AKNOWLEDGEMENT:
BENEFICIARY:
KEY BANK OF ALASKA
Sue M. Schlect, Vice President
P.O. Box 100420
~uchora~e, ~!aska 99510
NOTARY AKNOWLEDGEMENT:
VICINITY MAP SCALE.
LOT gA, BLOCK 2,
HERITAGE PARK SUBDIVISION
DTI002761