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Home My WebLink AboutSOUTHPARK #2 BLK 1 LT 15 ~)~ MUNICIPALITY OF ANCHORAGE - DEPARTMENT OF HEAL'rH & 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 ~N EW l~~' ~ ~ ~ ~"~L_~ ;~c,,~-~' ,/~q ?~ ~ UPGRADE ~AILING ADDRESS LEGAL DESCRIPT]ON LOCATION NO. OF BEDROOMS ~ ~ Manufacturer Material No. of compartments Liq. capacity in gallo~s ~ Inside length Width Liquid depth ~ Z-.~ IF HOMEMADE: ~ ~ DISTANCE TO: Well ~/, Dwelling PERMITNO. O ~ ~ Manufacturer/~ Material Liquid capacity in gallons Well Foundation Nearest Jot ~ine PERMIT NO. Distance between lines ~[ ~ No. of lines ~ Length o~ ea~ line~/"~ f Total len~h~ ~nes Trench wi~_ inches Total effective absor 'on area ~ ~ Top of tile to finish grade ~l Material beneath tile inches Length Width ~epth PERMIT NO. ? / ~ ;la~/ ~' ~~¢~ ~ ~l~Ddl'er Distance to lot IJ ne PER M ITN ~ DISTANCE TO: Building foundation S~wer line Septic tank AbsorptiOn ~rea(s): OTHER ~,~ APPR V D~ 7 ~ ~X ; "; . DATE LEGAL ).-)i!!~]:::'ARTMi!!~N]' OF' ?[E!:AL'i]I AND E]'~IVZROixih'.iE/NTAL. [~;:~D I.~. ~!~YTR[~:E~'~i'~ i':'fiqCl IC!RAGi!~: ~ F:fi::: 99::50 1 [].'CiI?FA C:T 7..'-.' 6 3- 4 GRAVEL )::)l:ii:l::~'",:["l (F:T ~ ) TOTAl.... )::)1~:!:::'"!"iI (!::'"!":~) ~ GF;.:(:~VI':~:L W]:DT','i (i:::'T,.) C)F;:AVE~L. L.E!:NGTH (F'T.) GRAVEL VOLUME[ (CU,, YE)S., ',' ]"ANK SIZE (GALS) SOIL RAT):N~} (S(:;% F:]". /BR) F:IERPI I T I'40: DATE:: A F:'F:'L. i CANT AD,":)RESS: CONTACT L..Li I ,E~]: i ..[]T OCAT' ]: ON MA× BEDROOI" '-h 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 5 ¢ '' SCOPE DATE PERFORMED: ~-~ ~/~'- ~ ~'~ SITE PLAN 10 11 12 13 14 15 16 17- 18- 19- 20 ' COMMENTS WAS GROUND WATER S ENCOUNTERED? ~ ~ L O P E IF YES, AT WHAT DEPTH? ~ ~/~E_ ~lt2f,~ Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~-f~ ~:~? !0 o.9'~ o,/o ~ 2:~ /0 ~,~ +O~O ms? !0 0,~ PERCOLATION RATE "~' ~ (minutes/inch) TEST RUN BETWEEN Z?/. ~- FT AND %~--'~,. FT CERTIFIED BY: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST 1 2 3- 4- 5- 6 7 8 9 10 11 12 13 14- 15- 16- 17~ 19 COMMENTS :OI/: SLOPE SITE PLAN ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ) ~ ~ J 7:oF ~.~ /. ~f , ~ PERFORMED BY: CERTIFIED BY: 72*008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) pr. opert~ Owne~' ./~".~. "~P*'/E' Z.OR~Telephone: Home (c) Mailing Address ";' - 'Lending Institdtio'n · Telephone ~Mailing Address Business (d) Real Estate cpm'pany ahd Agent '. · Address Telephone (e) Mail the HAA to the followina address: or: Check here rQ if hold for pick up. List contact person and day phone number below· S & SENc'INI~ERING 17034 Eagle R[¥e~ Lo~ Road No. 204 Eagle River, Alaska TYPE OF RESIDENCE Single-Family/~ Number of Bedrooms WATER SUPPLY individual Well [] Community [] PublJc/~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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. Page 1 of 2 72-025 IRev 8/861 Front ENGINEERING 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 flies 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 S & $ EN~INEERING 17034 Eagle Ri:vet Lu~p F, ua~ ~io. :~u~. Address Eagle River, Alaska 995~7 Date Telephone DHHS APPROVAL Approved for Approved Terms of Conditional Approval bedrooms by _ . . Date Disapproved Conditional. CAUTION 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 DH HS 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 engineer's work. Page 2 of 2 72-025 fRev 8/861 Back /~t,tc~O?,ACI~_U,_I~ICIPALITY..., ,,,. OF ANCHORAGE (MOA) 'I~'LTH AUTHORITY APP OVAL (HAA) CHECKLIST - FEBRUARY 1984 WELL DATA Legal Descr~[p,t, ion: ..-, ~' '/~/.~-~ /~ / 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 ~ 0 '7L To Nearest Edge of Absorption Field on Lot~X-~c~ r.¢ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments y~¢-~'/ ''~ / If A, B, C, D.E.C. Approved[,~ ,,],) Date Completed Yield Cased to Depth of Grouting 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 ; Date B. SEPTIC/HOLDING TANK DATA Date Installed '~iD'~'- Size //~5':'L~ No. of Compartments ~ Standpipes~N) Air-tight CapsC/~) Foundation CleanouGN) Depression over Tank (Y__~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~"/h ;for Holding Tank High-Water Alarm (Y/N) ~//,.~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply ~ ~O f -~- To Property Line' To W~ter Main/Service Like Course Comments / To Building Foundation '-~'- ./ To Disposal Field r' ~- : To Stream; Pondl Lake, or Major Di'ainage Page 1 of 2 72 026 fRev 81861 Front ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,~ '~ ~///'~/'~ Type of System Design Width of Field ."~r'~/'' Depth of Field Gravel Bed Thickness /~,~ ~"¢~' - Standpipes Present{~N) _ . Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply ,~¢~"' To Building Foundation Lot To Water Main/Service Line //(-~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line ; On Adjoining Lots To Existing or Abandoned System on To Cutbank (if present) Comments D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for /~- Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M CA and HAA guidelines in effect on the date of this inspection. /_ Signed$ & $ F.,%t6tf~-"-"',".~,%L,~ Date ,"~"'- .,/~ /~'¢¢' ,,:,, ,.~' Compaq034 Eagle River Loop Read Eagle River, Aleske Receipt NO. Date of Payment A ou.t: / Page 2 of 2 72-026 fRev 8/861 Back DEPT. OF ENVIRONMENTAL CONSERVATION STEVE COWPER, GOVERNOR ANCHORAGE/WESTERN DISTRICT OFFICE 3601 "C" STREET. SUITE 1334 ANCHORAGE. ALASKA 99503 _~563-6775 DATE: PWSiO #: 29 April 1988 213475 To Whom It May Concern: Accordin~ to the records on tile in this ot?iceo the SOUTH PARK TERRACE SUBDIVISION'' ........................... Water System is in compliance uith the State o? Alaska Drinking Water Regulations. Sincerely. Eonald S. Klein .Environmental Field O??icer MUNICIPALITY OF ANCHORAOI: ENVIRONMENTAL SERVICES DIVISION ..... ~ 2 9 1988 · RECEIVED- DEPARTMENT 0F'HEALTH AND ENv~RONMENTAL PROTECTIOI~ DIVISION OF ENVIRON MENTAL HEALTH CERTIFICATE C F INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AN D WATER FACILITY 264-472C Application Date GENERAL INFORMATION · '.; (a) Legal D/~scriphon (include lot. block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~J~ 4~z~,~' Telephone: Home _~¢/.5~-,_5'-~/,¢ Business Appl,cant Address /~'--,~00 ~-~/~-~ ¢/~,~,¢¢M ,-¢~/~?--~ ~'~ (c) Applicant is (check one}: Lending Institution []; Owner/builder/l~"; Buyer []; Other [] (explain); (d) Len~inglnstitution .,~_,-"~?~-~ .~-~"~? ~/~_~/..2 Telephone Address ~ -~ ~'~'~-~ (e) Real Estate Compagy and Agent ~.~ Address Telephone (f) ¢:-~'h~ HAA to the following address: 2, TYPE OF RESIDENCE Single-Family..[~ Multi-Family [] Number of Bedrooms ZT/ Other 3. WATER SUPPLY Individual Well [] Community [] Public,J~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, 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 tl ~/84) Page 1 of 2 5~ ENGNEERNGFRMPROVDNG SPECTONS TESTS FLESEARCH DA'I' ND NFO~MATON." ?: As certified by my sea[ 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 ts safe funcbonaJ and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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, qrd[nances, and regulations in effect on the date of this inspection. ' Name of Firm $ & 5 ENGINEERING Telephone SE B 196X Address EAGLE RIVER, AK 99577 JUL I ~. 1986 Date 6. DHEP APPROVAL Approved for Approved Disapproved Terms of Conditional Approva~ CAUTION The Muncipality of Anchorage Department o! 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 ?2-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: AIUNIcIPAUT¥ OF ANCHORAQTz D~PT, OF HEALTH & ENViRONMeNTAL PROTECTION WELL DATA 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 ' Cased to ifA, B, C, D.E.C. Approved(~N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around 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 Sewer Service Line on Lot Water Sample Collected by ; Date Water Samp. l~ Test Results Comments . :.. B. SEPTIC~TANK DATA Date Installed Standpipes (~TN) Air-tight Caps~/N) Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) ¢i Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/HoMi,,u Tank: Size 1'7--'¢~O No. of Compartments ~ Foundation Cleanou¢~YN) Date Last Pumped ~ I~'~'"~ '~ ' ~]~' ;for Temporary Holding Tank Permit (Y/N) ~J~/' -- To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation To Disposal Field ( ~ I.~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~- L Width of Field Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot "~ [/% To Water Main/Service Line · Type of System Design Length of Field ~ '~, Depth of Field Gravel Bed Thickness Standpipes Present. N) Date of Last Adequacy Test '"'2.-~, l.-p- To Property Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots '"'~ To Cut .l~k (if present) Comments D. LIFT STATION 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. Sig~ed S & S ENGINEERING Date JUL I 4 1986 SRB 196X Compan MOA No ~GLE RIVER, AK 99577- ' Receipt No, "'~!. Date of Payment Amount: $ ~ Page 2 of 2 72-026 (11184) DEPT. OF ENVIRONMEN~T/~L CONSERV/~T~ON ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the c>~..,¢ _~ /~. _"~-~/'~/~/~cly Water System is in compliance with the State Drinking Water Regulations Sincerely,