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Home My WebLink AboutSOUTHPARK #2 BLK 1 LT 27 ,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na.,e DISTANCES "7"'~/~--~'/~v:~--' ~'"~---~ '~"~'~ ~ SEPTIC ABSO"PTION WELL ~d~ .... TANK FIELB Phon~(s) ' ' - rP~,.~Jt No. ~/ 'N~ el Bed ...... WELL ~Z--~/ LE LL C~C~P~O~ ~ L0T LINE Township, Range, Section AS-BUILT DIAGRAM (Show Iocabon of well, septic system, property hnes. foundation, %/j~ ~ ~ ~. ~ Om, eway, water bodies, Utc) ' TANKS Manu,ac,u,er Capac,ty,ngaJlons /' A--F;= ';:b' I No. el Compa~mems , TYPE OF SYSTEM ~TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth to p~pe bottom from ~o[aJ depth Jrom original grade Tota, absorp, ...... . Distance between lines L WELLS~ ~ ~ PRIVATE ~ OTHER (1~ REMARKS: -- --. t -- Scale: ~'~ ~ ~ ~0'~ ~, [~ In~tionsPedo~b~-- % .... ~ ~;~':~ ~;~ENGIN~ER'SSEAL ~u.icipal and Stale guidelines in elJect on this d~te:. {,O/BO /~ 72-013 13/851 'i'l.i}::i; .':2Y::;;TEi"i l'.itJS'i FiE: :i:h.!ST'AI...L.E:L~ (~,S (i~Hi:)WN [:]lq 'l"hllE EI'~I[iJ:[NE:EF:;:'~;~ DEE;:I:E~N .(:)A!i:~:) ,:::~ .,,:,/i /o,' I RENCI4 MUST NOT ..... · ,:,..:,. ..... ~ HOI4EVER TI'-IE T0'I'AL ~EPTH 8F THE ..... ~.X[~[:,I:D c?.O F'EE~i",, Iqf)'T :l'i:'Y.. [)i iI'i~ ~..,~:,1 ' "':"" "'"'""'~"br,.r:: ~"'L..!... -.t N,r~r' r::.b t~"""'"" ].6 hc:,'c~ EX~REMZ TY'~ 01':r TRENCH ~t[IS"I" NOT EiE CLOSE["~ THAN 50 FT; F:'I::~OM SIEVE~RE SLOPE i::4ABE~i[T CREEl:::,, [li:[~J:.: [::';Zi:dd.[T ]:~ F::E)F: Pi z[. E{E:DF;;Et(:)FI E;ZNGL.k~ FANZI-Y (:;ff:?::}:i))!:I,[[:;iZ (]N[.Y'~ ¢.~hl~:) I:'.XF'IF([~:~3 C)N :~.;::'./J;:l. 275 270 274 ~)~ 276 281 Potter Area Reference Map--P15 .. . = :'~ 1~Z. ~.6~ / T ,~ t~u' ~- ~ / '" / /TM ~0~: ~11 Dimensions ~nd ~ocations ~ust Be ~ield Verified Prior go Gonstruction · SEWER. SYSTEM 'LOOATION PLAN DEPARTMENT OF HEALTH & HUMAN SOILS LOG -- pEFIGOLATION~,TES7 6- 7- .8- 9- 10 11 I3- 15- 18 19 } '<- -.~ . ~ / WAS GROUND WATER I I I DEt~ARTM~NT OF I-tEAI~TH & HU 825 "L" StCeeL Anchorage, Alask~ SOILS LOG -- PERCOLATION TE 2 3 4 5 6 8- 9- / ~' / I1'11 II t0 12- 13- :IPALITY OF ANCHOP, ACE DEPT. OF HEALTH & PROTE42TION NOV 6 1993 I I MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be compl'eted prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (address or directions) (~) ~ropertv ownor /g~~ lei,phone: (home) ~ Business Mailing Address (c) Lending Institution /("/~//*'~ Telephone Mailing Address (d) Real Estate Company and Agent /~.A Address Telephone Mail the HAA to the following address: (or check here , il~f hold for pick up.) List contact person and day phone number below: (e) 2. TYPE OF RESIDENCE Single-Family~ Number of bedrooms. ~ 3. WATER SUPPLY Individual Well [] Communityx Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site)~ 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 (Re,. 7/88) Page 1 of 2 5. 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 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. NameofFirm _//~¢-~/~/;~(~¢'/~/¢'~,/~//'~,)¢O-'r~-~ ~,'4~'/''~ Telephone Address _~r ~ ~ ; ~~ ~ ~~. Engineer's Seal DFIHS APPROVAL Approved for_ Approved ~'~'.~. bedrooms by_ ./~ :~ ,~, ~ ,£ ate Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of H~alth and Human Services (DHHS) issues Health Authority Approval cerificated 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 engineer's work. 72-025 {ROY 7/88)B~ck Page 2 of 2 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Date Complete/ (~, C, D.E.C. Approved (Y/N) ~ Yield SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on ; On Adjoining Lots To Nearest Public Sewer Line .~' To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer S~on Lot Water Sample Collect,e~y __ .; Date/'/ Water Sample T/e~esults ~-"~--¢~,~~.-'~ ~ ~ Comments Depth of Grouting ~/ Pump Set At ~- Sanitary Seal on Ca~ (Y/N) Depression Aro. J,~ellhead ~oining Lots B. SEPTiC/HOLDING TANK DATA Datelnstalled ~/~/.~////~Size ~'~7.--~O No. of Compartments ~ Standpipes (Y/N) ~ Air-tight Caps (Y/N) ,~' Foundation Cleanout (Y/N) Depression over Tank (y/N) /[-/ Date Last Pumped ~ pumping/MaintenanceContac~ on File (Y/N) /(~/'~-- ;for ~ Holding Tank High-Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ~ ~ ~ To Property Line ~- ! To Water Main/Service Line ~'//O / To Stream, Pond, Lake or Major Drainage Course To Building Foundation ,,/~" / TO Disposal Field /~' / Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA ~o~ls Rating in Absorption Strata __ [)ate Installed Width of Field __~ Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Type of System Design Length of Field ,~.~ Depth of Field ~' '" Gravel Bed Thickness ~ ~:;~ ~-' .~' Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation ,or To Water Main/Service Line /O / 'To Stream, Pond, Lake, or Major Drainage Course '1'o Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ;On Adjoining Lots ~/00 / To Cutback (if present) >/.o / D. LIFT STATION [)ate Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes Dimensions Manhole/Ac( Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitt, I certify that inspection. Signed Com Date MOA No. Rat ainst HAA Request** or conformed to all MOA and HAA ( ;ffect onthe date of this Engineer's Seal Date of Payment Amount: $ 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 .~. ?5bM ~o~ · £oF Z7 PLOT PLAN .-- AS BUILT. %< SCALE {~-O~ GRID ZOB ~o 5o-I~1 I Iieraby certify that I have surveyed the followin~ described property: ~at thiri are no roadways, transmission lines or othlr visibl~ Dated ~i~ th~ %~eODa7 of ~o~ r ~9 ~0.. or ri~trictio~ which do not appear on the recorded subdivision plat. 1731 George Bell Circle (gO?) S45-6476 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 October 19, 1990 STEVE COWPER, GOVERNOR 563-6775 FOR: Corwin & Associates Attn: Bruce Corwin PWSID: ~213475 According to the records on file in this office, the South Park Subdivision Lot 3. Block ~1 Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, VERA E. CRAIG ' ' t Environmental Speclalls VEC:pf