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Home My WebLink AboutHERITAGE PARK BLK 2 LT 25 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 __ LEGAL DESCRIPTION LOCATION DISTANCE TO: Manufacturer Liq. IF HOMEMADE: DISTANCE TO: urer DISTANCE TO:wa'll,,J/A No. of [inesj Length of ~ach line~? Top of tile to Absorptio~r~a Dwelling ~.~ Materi ~ Inside length Width PHONE .~NEW I -lOg Z u UPGRADE NO. OF BEDROOMS PERMIT NO. No. of ,~partments Liquid depth Dwelling PERMIT NO. Material Liquid capacity in gallons Foundation ~(,~1 lNearast :~i~, PE~T~) 5 7~ Total length of line~zil Trench widt~nches Dis~ce be~nes Length }e of crib DISTANCE TO: Class DISTANCE TO: finish grade ~ Width Material beneath tile Depth Total effective absorption area inches PERM T NO. - :rib diameter Nell Total effective absorption area Crib depth Building foundation Driller Sewer ne Nearest lot line Depth Distance to lot line PERMIT NO. Building foundation Septic tank Absorption area(s) OTHER APPROVED DATE 72-013 {Rev, 3/78) F'ERHIT NO. DEP~RTI',IENT ~,'~' HEALTH ~i'4D EN',,,'IRONMENT~L~?CITECTtON 825 "L'" STREET., ~NCHOR~GE., FIK. 2950~ 264-4720 ,:: 8~:0575 ) BF'F'L I CRI'4T LOCBT I ON LEGFtL ..TRI"IES RBRRMS 4TH R',,,'E L 25 BK 2 HERRiTRGE PRRK OLD SEWRF.:[:, LOT SIZE T'¢F'E OF SOIL FIB2';ORF"FION _-.~-_-TEI'i iS' TRENCH i"IFI;qtMUM NLIMBEF.: iF BEDROQMS = 4 56±-44.90 20000 SQI_fFtRE FEET SOIL RRTING ,:.'SI_'..! FT,.."E:R)=,_,._':'~ THE REg!UiRED SIZE OF THE SFtIL FIBSORF'TION ':;YSTEM IS: g. E F" T H = 13:: L E i'-.l ,_3 T H = 2 ;~-:: ,_3 F: Fi %-" E L [:. F F" T H ~ :---': THE LENGTH DIMENSION IS THE LENGTH (tN FEET) OF THE TRENCH OR DRFtINFIELD. THE DEF'TH OF FI TRENE:H OR PIT IS THE DISTFINCE BETNEEN THE SURFFICE OF THE GROUND FIND THE BOTTOM OF THE E:-"-',CFI',,,'RTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRR',,,'EL DEPTH IS THE MINIMLIM DEPTH OF GRRVEL BETNEEN THE OUTFFILL PIPE FIND THE BOTTOM OF' THE E',:.:;CFI',..,'FITION (IN FEET). PEF.:MIT FIF'PLIf':FINT HFIS ]'HE RESF'ONSIBILITY TO INFORM THIS [:,EF'RRTMENT [:,LtF..:INF~ THE iNSTRLLFITION INSF'ECTIONS OF' FINY NELLS FIE:,JFIf':ENT TO THIS PROF'EF.:T'¢ FIND THE NUMBER F~F RESIDENCES THF4T THE NELL NILL 'g ..... F T[--lC~ ,,:] 2 ::, ][_ ~'-~'_-]F'EC: T Z C~ft-~'_-] RF-:F F-:E~]:~J Z BRCKFiLLING OF FINY SYSTEM WITHOUT FINFIL INSPEC:T!ON RN[:, RF'F'F.'.ID',,,'RL B'.,.' THIS F:,EF'RF.:TMENT WiLL BE SLIBJEL:T TO PROSEF:UTION. MINIMUM DISTFINC:E BETWEEN FI NELL FIND FINY ON-SITE SENFIGE DISPOSFIL SYSTEId IS i00 FEET FOR FI PRIVFITE WELL OR ±50 TO 200 FEET FROM FI PUBLIC WELL DEPENDING UPON THE TYPE OF F'UBLIC WELL. HININUM DISTFINCE FROM FI PRIVFITE NELL TO FI PRIVRTE SENER LINE IS 25 FEET FIND TO FI COMMUNITY SEWER LINE iS 75 FEET. OTHER REQUIREMENTS MFIY FIPPLY. SPECIFICRTIONS FIND CONSTRUCTION DIFIGRFIMS FIRE FIVRILFIBLE TO INSURE PROPER INSTFILLFITION. I CERTIFY THFIT ±: I FIM FFIMILIFIR WiTH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS FIS SET FORTH BY THE MUNICIPFILITY OF FINCHORFIGE. 2: I WILL !NSTFILL THE SYSTEM IN FICCORDFINCE NITH THE CODES. ~: I UNDERSTRND THFIT THE ON-SITE SEWER SYSTEM MFIY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROOMS. //I-~F'F'L I E:FIN T ..TFIMES FIE, F..RMS PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- COMMENTS PERFORMED BY: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 g Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST 3895 SLOPE "'J SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH7 Gross Net Depth to Net Reading Date Time Time Water Drop E~CO LATION RATE RUN BET~NEEN CERTIFIED BY: GENERAL INFORMATION (a) ~.~,, MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Legal Description (include lot, block; subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~"/~-- ,~ ,~,~/¢'-r,~Telephone: Home ~'~'~"-6' ..'2. ~,/ Business Applicant Address ~,4:~, ~.~. '~ '~,~ ~) ~.! ,,z~ ~ i'~,~ ~'3'- ~ (c) Applicant is (check one): Lending institution []; Owner/builder~; Buyer []; Other [] (explain); (d) Lending Institution "~'~¢ '~' -~"~/;'~")-~ ~ Telephone Address ~-.~ '~ z) ¢ 5" ~". (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Number of Bedrooms -~ Other WATER SUPPLY Individual Well [] Community [] Public, J~ Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsiteJ~'~ Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-o25 (11/84) EI~IGINEERING FIRM PROVIDING 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 E~.~-~E R!VE~ ENG!NEE~!N~ ~;:RVICI:~ Telephone ~GLE RIVER, AK 99577 Address Date 5- ~9~-5! 95 Engineer's Seal Approved for ~7~¢;~¢'~ bedrooms by ~ ~¢~'~"/~ Date Approved ~--~'~'-Disappro~ ~--~~COnd}tiOnal Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health 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 WELL DATA '~/ MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: / = ¢' MUNICIPALI'F'/OF ANOrlOP. AGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION] 7MAi 0 U RECEIVED Well Classification P~& 1' ~ /~,o,.,4 · If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed J7~''~ Size /¢o ~, ( No. of Compar[ments Standpipes (Y/N) Y Air-tight Caps (Y/N) /~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /~//,4' ; for Holding Tank High-Water Alarm (Y/N) Separa!ion Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Temporary Holding Tank Permit (Y/N) ./4//~ To Building Foundation To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / ~ $' ~ Width of Field ~ / Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ,..~ Separation Distance from Absorption Field: To Water-Supply Well ~ To Building Foundation ~-'-~0 Lot TO Water Main/Service Line '¢/"~z9 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field ¢'~ ¢ / Depth of Field ,'~¢ Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line /,¢ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ._,~:~ ~r~ Date ~'¢"/,~ ~'/'P$- Company ~%~ ~'¢~ ~¢"'~'~MOANo. ~-~ ~- Receipt No. ~L/ / ~ q ~ -<,.-.. -...~,:~ '~ ¢ --~%-- ~ .~,. ~0 Engineer's Seal Page 2 of 2 ¢~ % Cc.6/~o , r~.,~¢ APPLIG,,..NT FILLS OUT UPPER HAL _, ONLY P'~(~pert~' ~wner I)evcon Enterprises, Inc. Phone Mailing Addre~ 541] 01~ geward HtEhway AnchoraMm. AM Zip Code 9950~ Buye{' C. Alan & Patti Jackson Address ~{N Fm~r~h Avmn. e ~Elp R{vmr: AM Zip Code fl9577 Lending Institution ~aska Bank of Co~erce Phone Realty Co, & A~nt ~O~ & Carol~ Sz~anski, Centu=y 2t Meritage Homos & Invest~/~~ , ~Ph°ne Address 2fl7 ~- M~m~n T,{¢h~ Rn,~3~z~m~R- AW~n~m~ A~zipc°de 99~nh 263-21:06 Legal Description ~O~ 25 Block 2 HeCitage Park Subdivision Type of Resi~nce ~ Single Family ~ Multiple Family No. of Bedroo~ 3 ~ Other Water Supply ~ Individual ~ ~p ~0~ ~ A~ACH ~LL LOG. A w~l Icg is required for all wells drilled since June 1975. ~ Community ~ ~ For wells drilled prior to that date, give well depth (attach Icg if available), ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: ] qg3 ~ Public Utility When Connected to Public Utility: ~/A ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED, Time Time Time t Date Date Date Da ~ Inspector Inspector Inspector Inspector ~t[~.~' C..~, ~ ~UNICIPALITY OF AN~O~GE RECE! E (~ ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE ~ Soils Rating Date ~wer Installed Well To AbsorptiOn Area Well Log Received ~ G~3~;~3 Welt to Tank Septic T~k Size September 16, 1983 DevGo~I }3nterprlses 5411 Old Seward Anchorage, AK 99502 Subject; Lot 25, Block 2, i[eritage Park Subdivision Approval for the individnal sewer and water faGilities cannot be granted until the [ollowin9 items have been Gompleted~ o n'~_ne * depression ove~ the sewe~ system will need to be filled so that surface water drains away [rom the sewer system. o 'i'he com~lunity ~ate~tt~il ~"~ be approved by Mr. Mike Matt. news o~_ the ot~t?~gf~-a~ka Department of Envirorn,lental Conservation (274-~ Please notify this Department for a reinspection t~hen the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, CW37/ej/E2 Cory