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Home My WebLink AboutHIDEAWAY HILLS BLK 1 LT 3A G£~,~rER ANCHORAGE AREA BORO~.~?t DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ,~,~-//,,~/,.-_...~/~,~,~ ,//~/¢/~/~..f PHONE NAME ~'~ "~-'" ~-'~'""~?~ '~"~ ~/~)"/~J~ ~'/-)' ADDRESS _ LOCATION SEPTIC TANK: LEGAL DESCRIPTION ~'~'-~"'_-~ NUMBER OF ~ DISTANCE FROM WELL ~',,..,,,.~2. ,~. ,,..~_~2-./) MATERIAL ~'~.~'~" COMPARTMENTS LIQUID CAPACITY /'~?~--) GALLONS. INSIDE LENGTH ~ INSIDE WIDTH. ~ DEPTH __ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS // OUTSIDE DIAMETER LINING MATERIAL ,"'~-/'~/~ NEAREST LOT LINE ~:~'~) /--~-~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~ OR WIDTH , LENGTH , DEPTH DISTANCE FROM WELL ~'~'~ ~ , BUILDING FOUNDATION SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION , NEAREST LOT LINE TOTAL LENGTH . OF LINES NUMBER OF LINES ~BETWEEN LINES ~ - TRENCH WIDTH ABSORPTION ARE~ SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TiLE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH'TILE IN. TOTAL EFFECTIVE IN. ABOVE TILE WELL: ~:~.~;7~ .~..~. DISTANCE FROM ~ WATER TYPE ~'~-~'~'4~'~ , DEPTH ~ , BUILDING FOUNDATION. SAMPLE ~ , NEAREST SEEPAGE ~ OTHER NEAREST / SEPTIC / ~ CESSPOOL SOURCES LOT LINE ~ SEWER LINE TANK SYSTEM DISTANCES: DATE DIAGRAM OF SYSTEM G'"~,A .A.B. GREATER ANCHORAGE AREA BOR~O-~UGH DEPARTMENT OF ENVIRONMENTAl. QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE. ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT PERMIT NO. LEgaL INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS '~/ ~ !'~ y//~////~ COMPLETION DATE ANTICIPATED SEEPAGE PIT ., DRAIN FIELD , OTHER TO BE INSTALLED BY 02 FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. / TYPE SEEPAGE AREA SI~E TYPE MINIMUM DISTANCES, REQUIREMENTS fOUNDATION TO SEPTIC TANK SEPTIC TANK TO SEEPAGE Pit WALL SEPTIC TANK , SEEPAge Pit , DRAIN P~ELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK ~: ~' L/, SEEPAge Pit DRAIN FIELD ALSO CONSIDER AREA WELLS. , SEEPAGE PIT WATER MAIN TO SEPTIC TANK . J~/~ · DRAIN FIELD SEPTIC TANK, ~ ~' j , SEEPAGE PIT /~" TO RIVER, LAKE, STREAM. DRAIN FIELD DIAGRAM OF SYSTEM CAST NON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSINGGAP Ex~avaTI~Oj%LS-fEE%INTO I~NDISTURbE_D_ SOIL. 4 INCH DiaMETer CaST IRON SIPHON PIPES ON SEPTIC TANK AND SEePage PIt f~TTE d WiTH 21 rTIG R~ R~M~)VAB LE_caPs. ~RAVEI-_ ~_ACKFILL CONFORM TO BOROUGH REGULATIONS REgARD[Ng INSTALLATION. HEALTH oRTHORITY LICEN~ESIgNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS DP GREATER ANCHORAge AREA BOROUgh ORDINANCE NO. 28-68 AND THAT THE ABOVE D^TE " ~' · / ''/ APRL'OANT'S S,~NATURE ~ // / ///'~'~- ~ -e ~..j~ 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 /3 GENERAL INFORMATION (a) Legal. Description (incluqle Iqt, bloc.k, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~-¢-Jl,~ 4~¢¢.LP-~ Telephone: Home Applicant Address 2646 (c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); (d) Lending Institution The First National Bank of Arqt&ephone Address 425 O Street, Anchorage, Alaska mailing P.O. (e) Real Estate Company and Agent N/A 265-3063 Box 720, Anchorage, Alaska 99510 Address Telephone (f) Maitthe HAAtothefollowingaddress: 425 G Street 5th fllor closing Attn. Tina Martin TYPE OF RESIDENCE Single-Family [~Muiti-Family Number of Bedrooms Other 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 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 (11 ~84) Page 1 of 2 Gk~SPECTIONS, TESTS, ENGINEERIN'G FIRM PROVlDIN FILE SEARCH, DAYA AND INFORMATIO,N ~:-. - 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 in.c, pectior~. ; ,,~ . · NameofFirm (~/)/"/,c~q ¢ff~t~/~--~' Tele,~hone ~"-~P/'~/~-/ Address Z//7~0 ~4.,A~.dLE~5'I P~Z¢'.,~' ~/0~ ~'~' Engineer's Seal Approved for /~'~94,//~ bedrooms by ~(~_q J)~A Approved ,~ Disapproved Condition(~l Terms of Conditional Approval Date 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 Jn 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 Anchprage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (! ~/84J MUNICIPALITY OF ANCHORAGE (MOX~ HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Classification Well Log Present (Y/N) Total Depth 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 Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Cased to Depth of Grouting Sanitary Seal on Casing (Y/N) Depression Around Wellhead ('~/..~) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date M~JN~CIPALITY OF ANCHORAGE DEPT, OF HEALTH & ~NVIRONMENTAL PROTECTION MAY (3 REEEIYJ D B. SEPTIC/HOLDING TANK DATA NO. of Compartments ~ ~ ¢.5 Foundation Cleanout (Y/N) /~(~ Date Last Pumped ~/~9:-~ , for ~ Temporary Holding Tank Permit (Y/N) )k~/~ To Building Foundation To Disposal Field /-~ To Stream, Pond, Lake, or Major Drainage Date Installed _'~4¢1i.. ~J¢'17 Size Standpipes (Y/N) y'¢--~ Air-tight Caps (Y/N) Depression over Tank (Y/N) 40 Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Sep. tic/Holding Tank: To Water Main/Service Line Course '~P/~O / Comments * Fr, m Page I of 2 ' 72-026111/84) ABsoRPTION FIELD DATA Soils Rating in Absorption Strata z,~,~'""~'E,) · / /~I Type of System Design Date Installed '~ Al~C //(~?'~ I u , Length of Field Width of Field 8" ''''¢' Depth of Field Gravel Bed Thickness Square Feet of Absorption Area ~/.~--. Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test ~('~.?[.~(,2.¢-¢. ~/fD1/' :04A4'" Separation Distance from Abs,orption Field: To Water-_Supply Well /~/~ To Building Foundation .,=~ ~ ' Lot To Water Main/Service Line ~7..~' t To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ';~'f-O¢¢~, ~r~'[.~ To Property Line To Existing or Abandoned System on ; On Adjoining Lots .~"O 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 ali MOA and HAA guidelines in effect on the date of this inspection. Signed /~t4.0¢'~ ("~0- ~" Date Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84)