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Home My WebLink AboutHERITAGE PARK BLK 2 LT 17 ~ -/ 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 NAME ~ PHONE Dwelling~ PERM~ NO. ~ ~ Li~iuIl°ns 'IF Inside length Width Liquid d~th HOME,DE: .OZ~ ' DISTANCE TO: Well Dwelling i~/~~ PERMIT ,O. O Z ~ Manufacturer aterial Liquid capacity in gallons Foundat on~z / Near. st otlne-- i ~ linas g Le~o~¢~ Total I~f ~nes Distance ~e,ween lines ~i ~ No. of t Trenc~d~ r, ~ ~ inches ~ Top of tile to finish grade / Material beneath tile ~ // Total effective ab~tio~ area Length Width ' Depth PERMIT NO. ~ Type of crib Crib diameter Cr~epth ~ --~ Total effective absorption area ~ Well Building~undation Nearest lot line ~ DISTANCE TO: ~ Class~ ~ ~Depth ~- Driller Distance to lot line PERMIT NO. ~f t ~ Building foundation Sewer line Septic tank Absorption area(s) g DISTANCE TO: OTHER ~ ~ PIPE MATERIALS ~. ~ .... ~,~ 72-013 (Rev. 3/78) DEPARTMENT GF HEAL.TH AND ENVIRQIqMENTAL. G25 I._ S"I"REET~ ~,,-IC,t 3 ,Ab~..~ AK ¢9501 F:'ERM I T NC:): DATE I,_..~UED. 09 / 17/S4 AF'PL I CANT: ADDIRESS: CONTACT PHONE: DEVCON INC. % S&S ENGINEERING EAGLE RIVER, Al<:: 99577 694-2979 LEGAL DESCRIF': SLIBDIVISION: HERITAGE PARK SECTION: '7 TOWNSHIP: 14N LOT SIZE: 55654 (SQ.FT. OR ACRES) MAX BEDROOMS: 3 LC)T: 17 RANGE: iW BL(]CK:¢:'"' / Listed below ace. the opt. ions available 'l.c)'you in designing youF- septic system,, Choose t. he option tha'L best. ~its yOLU' DEF'TH. TO P 3:F'E BO]-TOM (FT,,) 4,, 0 4,, 0 zI.. 0 GRAVEL DEPTH (FT.) 8~0 0,,5 3,,5 TGTAL DE:F'TH (FI".) GRAVEl_ WIDTH (~]',) ~..5 ..... E.¢R~.,VEL. LENGTH (FT.) .............. GRAVEL VOLUME (CLJ.YDS.) 63.0 5z[, 0 I ~'{.5 TANK SIZE (GAl_S) SOIl_ RA, lNG (SQ,,FT,, /BR) 424 ::~:)0 424 GRAVEl.. LENGTH > 75 FI". R~.E..UII.~.S MUL. T'IF:'LE RUNS (,~J~T E'XCFEDII'qG '"/5 F'T. TANK MUST HAVE AT I_:IEAST 'TWO COMF'ARTMENTS I cepti£y that: 1. I am Cami3. iaP with t. he. r'equi~*ements ¢¢ar' on-site sewers and we:Lls a~ set f'o~th by the Municipality of Anchorage (MOA) and the State .oF Alaska, 2. I will :i. nsta].l' the system in acco~-dance wit. h ali MOA codes and pegu].ations, and Jn compliance wit. h t. he design cr, itepia o¢ this permit., 3,, I ~i13. adhePe t.o all MOA and St.a'Le c){' Alaska r, equi~ements ~'<2J* th(~ set bacl<: dis'Lances Fr'om any existing we].].~ wastewater' disposal system oc public sewerage syst. em on this of any adjacent o~- near'by lot, 4. I under*stand that. {his permit is valid ¢(:m a maximum o~' 3 I:~ed'pooms and any enlargement will r, equine an additional pet-mit. IF A LIFT STATION IS INSTALLED IN AN AREA Cd.,:.,:ED MOA BUlL. DING THEN (1) AN ELEC]"RICAL F'ERM]:T AND INSPECTION MUST BE OBT'AINED; (2) AS-BUILTS NIL_ :O] BE ~F'F'R~k~ NlTl-.lC3LJ3 ~hl ELED3R. IUAL ~N~.,FEC, T1U,,i F.,_I Ql,7, ~lq ....... E_EETIRICAL WOR.~:~MLJS"~ BE DONE BY A t_ICENSED' ELEC]"F(]:CIAN,, AF'F'LICANI-~~ I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: C O~ '- LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 P 10 11 12 13 14 15 16 17- 18 19 20 El SOILS LOG PERCO LATION TEST WAS GROUND WATER ~[J~/,) I~ ENCOUNTERED? O P E IF YES, AT WHAT Gross Net Depth to Net Reading Date Time Time Water Drop ~ FT AND TEST RUN BETWEEN . COMMENTS /....//' "'"~/~ PERFORMED BY: .:~,i~ ~ E~'~ilNIE~iN~ CERTIFIED BY? ~ -- 72-008 (6~79) ~ FT DATE: :~~/ 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 0~"o NAA# . ~("~0~°~ k'~ ,..,.~C~"-'[ 1. GENERALINFORMATION Complete legal description Lot 17, Block 2, He~-itage Park Location (site address or directions) 19437 Caura Cee ¢irc!e Property owner Mailing address Rick & Janice McCurdy Day phone 19437 Laura Lee Circle, Eagle River, Ak 99577 696-2741 Lending agency Mailing address Day phone Agent' Remax/Kathi Olmstead Day phone Address16600 Centerfield Dr., Suite 201, Eagle River, AK 99577 694-4200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ¥ TYPE OF WATER SUPPLY: Individual well Community well Public water xxx NOTE: 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 NOTE: XXX 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 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. Name of Firm Address En~'ineer's signature S & S ENGINEERING i~034 Eagle Rivur Luol., ~oad N.,,. 204 Eagle Rivet', Alaska 99577 Phone Date DHHS SIGNATURE ^pproved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 'f;lmllPli The Municipality of Anchorage Department of Health and Human Services (DHH8) 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 DHH$ 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-O25 (Rev. 1/91) Back MOA ~1 JUN 1 8 1999 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERV~E~J"^u~ Environmental Services Division eNVIRONMENTAl-SERVICES 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist LegalDescription: L67-t7 /jce¢~ 3.. ///Z~/~'/J-(*C-/J'C44'ParcelI.D.: 05~0- bi~-0'..~ A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production · Dar o~fsample: If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to Ca~bove ground) Wir,es"properly protected (Y/N) FROM WELL LOG ~ AT INSPECTION ~ g.p.m. Nitrate Other bacteria Collected by: SEPTIC/HOLDING TANK DATA Date installed 6~/~(,/¢ ~ Tank size / e ~) ~ Number of Compartments __ Foundation cleanout ~/N) ~Y~J' Depression (Y,~ Date of Pumping (, / ~1 ~ Pumper ~-'/~ ~' ABSORPTION FIELD DATA Date installed ~ / ~ (* j ~' V / Length -) ~ Width Effective absorption area'~)/~ cO Date of adequacy test ~/I ~ g.p.m. ~- Cleanoutsd~/N) ¥¢~ ~'~ High water alarm (Y/~ ,v O Soil rating (g.p.d./fF or ft2/bdrm). ~-oS"(~/)vc.,) System type 'T ~ 8,v c/4 3 Gravel thickness below pipe 5'- Total depth ! ~- Monitoring Tube present(l~N) Y/Lj' Depression over field (Y~-~ /v d Results~)Fail) ~ ~ $_,r For -~ bedrooms Fluid depth in absorption field before test (in.); ~' /~ Immediately afters 1 7) gal. water added (in.): Fluid depth ~- -Yz (ins) Minutes later: I ~ Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) ~ o,, 4- ~ ~'~ ~ ~ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on'~j~~'~ High water alarm level at* ~'"'"-~ *Datum Cycl~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot On adjacent lots Absorption field on lot On ad~''''--~'-' Public sewer manhole/cteanout Public sewer main .~----- Se~ce line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~- ¢'~ Property line ~ '/- Absorption field Water main/service line /0 4- Surface water/drainage/o ~ '~ Wells on adjacent lots "Pump off" level at* SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / 0 ~- , . Building foundation ! o ['~ Water main/service line Surface water ] 0 o Driveway, parking/vehicle storage area 6 Curtain drain ,~ ~ ~ ~ ~ ~ 8 ~v ,rO Wells on adjacent lots ~v {4 / ?O4, ENGINEER'S CERTIFIC.KTION .,.,t..",,~'~ ,, I certify that I have determined thru field tnspecbons and review of Mumc/pal records~lf~r~.~[/e 'v'~j~l~ are in conformance wi~ MOA~H~A guidelines in effect on this date. ~:~'- ~ ~ Date G /J ~ / ~ ~ '~, ¢~,? .... .;:~,?~ HAA Fee $ ~--~ 4~ ~' '~-- Date of Payment Receipt Number 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 1. GENERAL INFORMATION /7 Complete legal description Location (site address or directions) Property owner Mailing address Lending agency d Day phone Mailing address. Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well /~ Public water If community well system, provide written confirmation from State ADEC attest- ing to the !egality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site 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 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. Name of Firm KND Engineering Phone ~ ~¢ ~ ~'/// - 20441 Ptarmigan Bvd. Address _ Ea91 ~ ,~ Date Eng'neer s signature ~ -- 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 eng'neer s work. 72~25 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: Los /7 -~ll( ¢ t4~r;26,a~.~ {Do~/~ Parcel I.D.: A. WELL DATA ' Well type ~ If A, B, or C. attach ADEC letter. ADEC water sy~ Log present (Y/N) .....--'Date completed ~ Total depth ased to height (above ground) Sanit.f Wires properly protecte FROM WELL LOG AT INSPECTION Date of test / / Well production .~ g.p.m. / g.p.m. WATER SAMPLE RESULTS: Coliform ~ Nitrate .~/ Date of~ ~/~Collected by: Other bacteria - / Fluid depth in absorption field before test (in.); Fluid depth ,~//f-Minutcs later: t~ / Peroxide treatment (past 12 months) (Y/N) Immediately after~'~'~al, water added (in.): (in.) Absorption rate = /~/~t~ g.p.d. If yes, give date B. SEPTIC/HOLDING TANK DATA Date installed ¢~/e:~/~Tanksize/~t57Zg~-· Number of Compartments ~ Cleanouts(Y/N) / Foundation cleanout (Y/N) / Depression (Y/N) /~/ High water alarm (Y/N) /4// Date of Pumping ~7,/~/~D~ Pumper x f/~7 / / /~/ C. ABSORPTION FIELD DATA Date installed ~/~ A/ Soil rating (g.p.d./fl2 or ft2podrm)Al/. ~d)~'System type / Length .~/¢~ Width ~' Gravel thickness below pipe ~'' Totaldepth Effective absorption area ~'~ff,~ ~7 ~Monitoring Tube present(Y/N) / Depression over field (Y/N) Date of adequacy test ~//~/~:~5-' Results (Pass/Fail) /~S'S For ~.~ bedrooms MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date Location~ (address o~ diregt, tons) (b) Telephone- Home3-~/~ Business (c) Applicant is (check one) Lending Institution ~; Owner/builder~ ; Buyer ~; Other{ [ (explain); (d) Lending Institution ~.d~/~ ~c~--dz~ ~/~ Telephone~_~7~ (e) Keel Estate Co. & Agent / Address Telephone (f) ~the HAA to the following address: Type of Residence Single-Family~ Number of Bedrooms Other (describe) 3. 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 0nsite~' 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. ~[pa~e 1 of 2] Engineering Firm Providing Inspectf°ns~ Tests~ File Search~ Data and Information AS ~erttfied b7 my seal affixed hereto and as of the validation date show~ 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 regula- tions in effect on the date of this inspection. Address Date Telephone (ENGINEER SEAL) Approved for __ bedrooms By Approved ~ Disapproved Terms of Conditional Approval Dat, Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES h-~.ALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. IRR4/eJ/D18 2 of 2] (DHEP SEAL) 7L19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - F~BRUARY 1984 Well Classification well Log P~esent (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances f~cm Well: To Septic/Holding Tank on Lot ~ MUNICIPALITY OF ANCHORAGE DI:PT. OF HEALTH & ENVIRONMENTAL PROTECTION t EC ,'5. Date Completed Pump Set At Yield Depth of G~outing Sanitary Seal on Casing (Y/N) Dap~ession A~ound Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot~-- ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewe~ Service Line on LOt Water S~ple Collected By ; ~ Date Water Sample Test Results C~t~Lo-nts B~.. SEPTIC/HOLDING TANK DATA Date Install~d Size /D~-~. NO. of Cc~,~a~tlrents Stan~i~s ~Y~)// ' ~ Ai~-tiGht Caps ~ Foun~tion Cleanout~) ~ession o~ Ta~ (T~ ~te ~st P~d P~ing~intenan~ ~n~a~ ~ File (Y~/~; for Holding Ta~ High-Wate~ ~a~ (Y~)~/~ ~r~ Holdi~ Ta~ ~t (Y~) Sep~ation Distan~s ~ ~ptic~olding Ta~: To Water-Supply ~11 ~ ~ To ~ilding F~ndation /(~ / To ~o~rty Li~ /~ ~- To Dis~sal Field ~ / To ~ter ~i~vi~ Line ~ ~ To S~e~, ~nd~ ~e~ ~ ~jor ~aina~ Commnts Receipt Date Paid: Amount: [Page 1 of 2] 2-15-84 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed ?~,/~t~ Width of Field r~ / Length of Field '~ Depth of Field Gravel Bed Thickness Square Feet of Absorption/~ea ~ O Standpipes P~esent/~) Depression over Field (~f~7 ~r/ ~ of ~st B~a~ Test~ ~ Results of ~st ~a~ ~st ~/~ Sep~ation Distan~ ~ ~s~ption Field: To ~te~-Supply ~11 ~ ~ To ~o~rt~ Li~ /~ ~ To Building Foun~tion ~ '~ ~ To Existing or ~ndo~d System Lot ~P ~ ; ~ ~joining ~ts ~ ~ ~. To Wate~ M~vi~ Line ~ ~ To ~t~(if pre~nt) ~ TO Stre~ond~ke/~ ~jo~ ~aina~ ~se ~0 ~ ~ TO ~i~way, Parki~ ~ea, ~ Vehicle St~a~ ~ea ~ ~ Counts ~ ~';~ D. LIFT STATION Date Installed Size in Gallons "Pt~np On" Level at High Water Alarm Level at Tested for Electn~ical Codes (Y/N) · [ Dimensions , / ~anhole/Access (Y/N) ~ /~ Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Co~L~%~nts ** Check Permitted Bedroom Rating Against HAA Request I oertify th/a~ ~ave checked, verified, o~ conferee to all MOA HAA Guidelines in effect on the da~e~/of ~J~¢$/inspection. '~'~"~" [Page 2 of 2] 2-15-84