HomeMy WebLinkAboutHERITAGE PARK BLK 2 LT 18
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
~AME
FWell / . [ Absorption area (~
Manufacturer ~
Liq, capacity in ~allons I . .......... ~. I Inside length
DISTANCE TO' IWell
Dwelling
Manufacturer
N°'Oflines i ILength°feachline~I T°tallength°fline~zl'
Topoftileto~inishgrade ~ I ~ Materialbeneathtile
Length Width Depth
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
DISTANCE TO:
IClass Depth Driller Distance to lot line PERMIT NO,
Building foundation ;ewer line Sept c tank Absorption area(s)
DISTANCE
TO:
NO. OFBEDROOMS
Dwelling JO I
Material ,~ ~ e(~ j
Width
PERMIT NO.
Material
Nearest lot line ~r)t
Trench widthv] ~
~ ~)inches
No. of com~.a, rtments
Liquid depth
Liquid capacity in gallons
PERI~T~r~NO.~ --.,
Distance between lines ~l~/i~
Total effective absorp, tion ~rea
PERM T NO.
OTHER
SOl L TEST RATING
INSTALLER
ENV
APPROVED
DATE LEGAL
72-013 (Rev. 3/78)
PERMIT NO.
[:,EF'RRTMENT i,.__/HERLTH RND ENV!RONMENTRL ,..~./.OTEC:TION
825 "L" STREET., RNCHORRGE., RK. 995E'tL
264-4720
0 ~-...~--'.'_~. Ir TE SEI~4EF-." F'EF~-."IPli .-E T
( 83:O284 )
RPPLICRNT
LOCRTION
LEGRL
DEVCON ENT. INC. 541t OLD SEL,.IRRD HHY.
LOT t:=: BLF':.: ~ HEFITH.,E F'RRK SUB LOT SIZE
56t-t882
9999 SQURRE FEET
TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH
MRXIMUM NUblBER OF BEDROOMS = Z-:
SOIL RFITING (SQ FT/BR)= 85
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFtELD.
THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
F.: EL--:., El :[ F-:E[:,, :.SF'F'T ]: C: TR~'-.~-::; '_:. Z ZE= ::~... £-,,:-]IE'~ ,_3RLL
PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO INFORM THIS DEPRRTMENT DURING THE
INSTRLLRTION INSPECTIONS OF RNa' WELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE HELL WILL SERVE.
T~-~,], ,::: 2 ) ][ 1~'-.~2---_.F'E,]:T ][ Eit'-.t'_.-] F~F-: f--- F-:F L--:!L" I: F-:E[:,
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRF.'.TMENT WILL BE SUBJECT TO PROSECUTION.
MiNIf'IlII'I_' DISTRNCE BE:TWEEN R WELL RND RNY ON-SITE SEWRGE [:,__FU=.HLT'-] '"-- S"¢STEM IS
t~-""~E'~ FEET FOR R PRIVRTE HELL OR t58 TO 2F-'~E'~ FEET FROM R PUBLIC HELL DEPENDING
UPON THE TYPE OF PUBLIC HELL
MINIMUM [:,ISTRNE:E FROM R F'F.'.IVRTE HELL TO R F'RI',/RTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MR"," RPPL"r'. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INSTRLLRTION.
I CERTIFY' THRT
t: i RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND HELLS RS SET
FORTH BY THE MUNICIPRLIT'¢ OF RNCHORRGE.
2: i HILL I~STRLL THE S'¢STEM IN RCCOR[:,RNE:E WITH THE CODES.
~'. I UNDER~RN[:, THRT THE ON-SITE SEWER SYSTEM MR¥ REQUIRE ENLRRGEMENT IF THE
R. ES iDE~.~ REMO[:,E~~NE:LUDE MORE THRN 3: BEDROE, MS.
I 'q'~UE[:' ~ TE d 3 '~,'~[. o
SOILS LOG
· MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
[] PERCOLATION
TEST
PERFORMED FOR: '~ ~__ N,/~.O ¥~
LEGAL DESCRIPTION: L
Ov¢~' bucci en
1
2
3
5
6
7
8
9
12
13
o
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
SLOPE
'~ tO' 15~
SITE PLAN
14
15
16
17
18
19
2O
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE
TEST RUN BETWEEN
FT AND
(minutes/inch)
__ FT
COMMENTS
PERFORMED BY: /'~_ O
72-008 (6/79~
5. STATEMENT r~OF INSPECTION BY ENGINEER ~ '"' '~ "
As certified by my Seal affixed hereto and as of the validation date sh~)'Wn I~elow, 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 Anch~)'rag~ files' and frsm '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 n effect on the date of this inspect on ..,.~..
_ conditional aPprogal fOr'' ..............................
t ~ ".~,'- ' "' ' ' ....... "' ' ''? '"' : ' ' ' ":' '
?' ~ ~ ., ':2~ - ~ ~'. , . . , . . ',~. - : - -
s,~he Mum6~pah~,ot'~nChorage ~pa~ment of Hea th ~nd HumPh Sew c~s (DHHS) ~Oes Health Auth0n
~Approw .Ce~ifia.~s bas~ only upon the representations given in paragraph 5 above by an independent '
', ,/b ~,- I" ~' ,
profe~iOnal engin~r registered in the State of Alaska. The DHHS does this as a cou~esy to puroha8em of homes '
...and their le~ding inst tutions i~,0[~ef~ ~t n~ ce~aio, f~e(a.I a~d state requirements. Employ~ of DHH8 do not '
conduct inspections or anal~e data before a ce~ificate is i~ued. The Municipali~ of Anchorage is not
responsible for errors or omi~ions in th~'P~fe~ional engin~¢~ woik~ ...... ':
Municipality of Anchorage
Departmeqt of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~ z~' ,~'~--' .,~ ~--/~.~/~.~'~' ~--_-~-- Parcel I.D.
A. Well Data
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed _ . ~}rgller-~_
Total depth ~ __ ~ Casing height
Sal3i~g~l~) Wires properly protected (Y/N)~
FROM WELL LOG AT INSPECTION
Date of test
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
S~e
; On adjacent lots
; O~adjacent lots
.~-~-P~lic~ew e r manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Data-of sump .la-:
Nitrate Other bacteria -Co/l~cted by:
B. SEPTIC/HOLDING TANK DATA
Date installed .../~,.~ ~ / ~'~'.~ Tank size /z~ c~ ~ ~'.~ ~ Compartments
Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N)
High water alarm, (Y/N) ' ,,c)//~ A arm test?d'(Y./N)
Date of pumping ,' ~7¢~,~_ ,/ ,?, /~'~4-- ,, Pur~per ',r '' ~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot
To property line
Surface water/drainage
On adjacent lots
Absorption field
Foundation
Water main/service line
72-026 (3/93)° Front 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)
SEPAR~TI~FI' STATION TO:
Wel~ '"~¢~'~z~~' On adjacent lots
Manufacturer
Manhole/Access (Y/N)
"Pump off~
Sudace water
D. ABSORPTION FIELD DATA
Date installed ,--/~,,,,~'~' ?
Length ~ ~z"..~',~ Width
Total absorption area ~"?~,~"',/® Cleanout present (Y/N)
Date of adequacy test ,_~-,'~/ /~' /~,~.~r- Results (pass/fail)
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF)
Gravel thickness
System type
Total depth
~ Depression over field (Y/N)
,,~'.~'~ for ..~
After test /~ ~/'~//.'/~
If yes, g~e date
Bedrooms
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ On adjacent lots
To building foundation ~ ~' '"-~ ~"
On adjacent lots ,~ "'~:~//
Surface water ~
Curtain drain ""~//,,¢
Property line
To existing or abandoned system on lot
Cutbank / .d"~ 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
Engineer's Name
Date
inspection.
HAA Fee $
Date of Payment
Receipt Number
72-026 (3/93)' Back
Waiver Fee $
Date of Payment
Receipt Number
HUSTON.XLS
Douglas T. Kenley
Civil Engineer
State of Alaska C.E. 8176
SEPTIC SYSTEM ADEQUACY TEST
Legal Description
Applicant
Date of Test
SYSTEM DATA
Tank Volume
Number of Bedrooms
Absorption system
Number of Bedrooms
Absorption required (1.5 daily flow)
TEST DATA
TIME FLOW VOL. TANK LEVEI.z.,~:.¢.~.'.~ TUBE LEVEL z,~.,'~', COMMENTS
(gpm) (gals)
System Passed ~ Sysytem Failed
Comments
Page 1
I1
~ '~ APPLI(.,,NT FILLS OUT UPPER HA~ ' ONLY
Property Owner ]}evcon Enterprises~' Inc. , ' Phone
5411 Old Seward Highway
Mamng Address Anchorage, Alaska zip Code 99502 561-1082
Buyer Robert & Julie Howe
13201 Brant Way
Address Anchorage, Alaska zip Code 99502
Lending Institution ~edl~atonal Bank of Anchorage Phone
36th & C Streets
Address Anchorage, Alaska zip Code 99503 265--3813
Realty Co. &Agent Century 21 Heritage Homes & Investments, Inc. Phone
Tom & Carolyn Szymanski
Address 207 E. Northern Lights Anchorage, Alaska zip Coda 99503 363--2406
Legal Description Log 18 Block 2 Heritage Park
Eagle River, Alaska 99~77
Stree% Locatio~ ~ Laura Lee Circle , ~agle River', Alaska 99577
Type of Residence
~ Single Family ~
[] Multiple Family No. of Bedrooms 3
[] Other
Water Supply
[] Individual A~I'ACH WELL LOG. A well Icg is required for all wells drilied since June 197,5.
~] Community For wells drilled prior to that date, give well depth (attach Icg if available).
[] Public Utility
Sewer Disposal
~) Individual· Year Individual Installed: ]-~83
[] Public Utility '-~ When Connected to Public Utility:
[] Holding Tank "'"-,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQOEST BEFORE PROCESSING CAN BE INITIATED.
Time Time Time Time
Date Date Date
Date
Inspector Inspector Inspector Inspector
F,e,d Notes: C- 0.-- c.
MUNICIPALITY OF ANCHO~GE
ENVIRONM[NTAL PROTECTION
~b - ~ "-'
RECEIVED
(~) APPROVED BEDROOM8 *GOND[TION8 OF APPROVAL
( ) DISAPPROVED
( )OONDITIONAL APPROVAL*
~ ~ --~ WeH,oTank / SopticT~kSize
December 15, 1983
Devcon Enterprises, Inc.
5411 Old Seward Higt%way
Anchorage, AK 99502
Subject: Lot 18, Block 2, Herita~3e Park
Approval for the individual sewer and water facilities cannot
be granted until the followin(3 ite.l~s have been completed:
0 The standpipe to the sewer system need caps on them.
l~lease notify this Department for a reinspection when the
noted discrepancies have been corrected. If there are any
further questions, please call this office at 264-4720°
Sincerely,
C~75/ej/Zl
Cory Willis,
Acting S~wer & water '-
Program Manager