HomeMy WebLinkAboutSPRING BROOK VISTA #1 BLK 1 LT 2
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 Ri:PORT
UPGRADE
MAILING ADDRESS ~'
LEGAL DESCRIPTION
Well Absorption area PERMIT¢O~'
b. Z Manufacturer
~ ~ ~j~;~ M~O No, o2~ompartments
Liq, capacity in gallons Inside length Width - ' Liqui~ ~epth
LO~ IF HOMEMADE:
~~ O ~ DISTANCE TO: Well ~welling PERMIT NO,
Oz
~ - ~ Manufacturer Material Liquid capacity in gallons
~ Well Foundation ~.t Nearest lot Iwe ~ I ' P~MIT ~O, ' ....
w~w
tengt~of each line Total length of lines Trench widt~ s~ Distanc een lines
~ ~ ~ ~ Top of tile to finish grade ~¢ Material beneath tile Total effective
~ 11---- 72 inches
b~ Length Width Depth PER~T ~
< ~ Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundation Nearest lot line
m DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO,
~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s)
OTHER
SOIL TE~T RATING ~ ~
INSTALLER O
:.~ --~~ DEPT, OF HEALTH
........ ,~,~,~,~j~ PROT~CTi~)I' ~ 0
'' ~ ~ I~O.D .......
APPROVED REC. E [ LEGAL
72-013 (Rev, 3/78)
Permit ~
Applicant: '~2~b~ ~-~ ~,
Legal Description: ~ m 'E F [
Type of Soil ~sorption System Is:
Trench: ~ Drainfield:
Maximum N~ber of Bedrooms:
DEPTH
MUNICIPALITY, OF ANCHORAGE
Department ~ Health and Environmental 'rotection
825 ~ Street, Anchorage, AK. ~3501
264-4720
* * * HANDWRITTEN PERMIT.* * *
WELL AND/OR ON-SITE SEWER PERMIT
Mailing Address: ~Z~a
Phone Number: '~ (/Q'"~-
size:
Seepage Bed~ Holding Tank:
Soil Rating(sq. ft/br)
The Required Size of the Soil Absorption System Is:
LENGTH 3/~,,~ GRAVEL DEPTH ~/~ '
. _ · WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
REQUIRED SEPTIC(HOLDING) TANK SIZE = /~3~_ GALLONS
*
*
*
*
Permit applicant has the responsibilJ, ty to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site sewer system may require enlargement if
the. residence is remodeled to include more that 3 ~drooms.
Applicant
SWP/024(1/81)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L, Street, Anchora0e, Alaska 99501 264-4720
SOILS LOG - PERCOLATION 'rEST
[] SOl LS LOG
PERCOLATION
TEST
DATE PERFORMED: ~ ~ t~ '-~'3~3
LEGAL DESCRIPTION:
2
5
7
8
SLOPE
v~ 5TF)
SITE PLAN
10
11
12
13
14
15
16
17
18
19
2O
COMMENTS
trio U. ~,
O
P
E
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
'2.. '1! }5'?,~, _'~c> ~,~ ~ __9'J¢ ~' .z "
(minutes/inch)
DEPT. OF ENVIRONMENTAL CONSERVATION
May 18, 1983
RILL SHEFFIELD, GOVERNOR
~phone;~O~ 274-2533
Addre~: 437 "E" Street
Suite 200
Anchorage, AK
99501
To Whom It May Concern:
Recent chemical analyses and records for the Springbrook Vista Water
Supply indicate the system to be in compliance with State Drinking
Water Regulations.
Sincerely,
James F. Hayden
Environmental Field Officer
JFH/msm
cc: Keith Carlson
4030 Lore Rd, #9
~chorage, AK 99507
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH &HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
~ ~ - ~"~ NAA #
1. GENERALINFORMA'rlON
Complete legal description 5ot 2: Bl'ock 1; Spring
Brook Vista '~
Location (site address or directions)
12322 E. Prince of Peace
Eaqle River, AK 99577
Property owner
Mailing address
Lending agency
Mailing address
Agent
Address
Dennis Morgan
12322 E. Prince of Peace
Day phone 696-0874
Eagle River, AK 99577
Day phone
Day phone
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
TYPE OF WASTEWA'rER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE:
3 N
x xx /~o~F//4wwj J'
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system,
xxx
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system,
72-025 (Rev. 1/91} Front MOA 1~2t
STATEMENT OF INSPECTION BY ENGINEER
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 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 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.
Phone ,~'~' z/z_ ~ ~ ~ ?~
Name of Firm
Address
Engineer's signature
Approved for -~
Disapproved.
Conditional approval for
17034 Eagle RJver, LO~o"p Roa/~ N ,")ma
bedrooms.
DHHS SIGNATURE
Date '~/~-/~'~'
bedrooms, with the following stipulations:
.%
Additional Comments
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 DHHS does th is 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 (Rev. 1/91) Back MOA ¢121
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:~.--~'¢''Z'' f~L-~- ~ ~-~¢¢.-!~L~ ?-'~o¢---Parcel I.D.
A. Well Data
Well type ~'-"~'~ (%
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to C..asicr~eig ht
Wi res~~d (Y/N)
FROM~ AT INSPECTION
Static water le~
g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
; On adjacent lots
; On adjacent lots
Public sewer main P~anhofffFc~anout
Sewer service line .~etroleum tank
WATER SAMPLE RESULTS.;~~
Coliform ~ Nitrate Other bacteria
D~te of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed /r~
Cleanouts ~/N)
High water alarm (¥~)
Date of pumping
Tank size \~ ~ Compartments
Foundation cleanout~/i) W Depression (Y/~j
Alarm tested (Y/N) ~'-
-' '7~-/-I: ~ °t ~ Pumper ~--~-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot --7~,-~ ~ On adjacent lots
To property line / o ! ~ Absorption field
Surface water/drainage / D o
Foundation
Water main/service line
72-026 (3/93)* Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Manufacturer
Manhole/Access (Y/N)
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N) ~
SEPARATION DISTA..b~-E'CR~M LIFT STATION TO:
W~o~~'~ On adjacent lots
¢.yeteCt~t e d
Surface water
Water level in absorption field before test
Peroxide treatment (past 12 months) ~
D. ABSORPTION FIELD DATA
Date installed \ ~
Length / \ z~ ,~- \ Width
Total absorption area
Date of adequacy test
Soil rating (GPD/Ft2) ~.~ ~2~ I b~ System type
z~. ~ Gravel thickness Lc I Total depth
Cleanout present (~/N) ",-/ Depression over field (Y~
ResultS/fail) ~' f"~<; % for ~ Bedrooms
After test S'"~ '~'
/Z-/J'~ ~//J' If yes, give date
Well on lot 7..-,c, ~
To building foundation
On adjacent lots ~
Surface water
Curtain drain
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
On adjacent lots '~/-'~ Property line
/-~-/ To existing or abandoned system on lot
Cutbank '~/,/¢ Water main/service line
r ¢-- Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA c
Signature .. ~/~r ~~
Engineer's Name 17Q34~ ~gl.e'Eiver Loop~.~ Ne. e~.
,/ Ea~J~ ¢~r, Alaska g9577 ~
Date ~/%~/¢}
HAA Fee $ / '~D c C~
Date of Payment ~ ~ Z. ~'--'---~/ ~
Receipt Number ,2_.~¢,~,Z '2- C'/~'g'/_~,~
72-026 (3/93)* Back
Waiver Fee $
Date of Payment
Receipt Number
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 June 9~ 1988
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
f,c~t- 2, Bloc. k 1 SPRINGBROOK VISTA, Sec. 1, T1AN, R2W
Location (address or directions)
12.322 P~"ince of Peace Dr. Eagle River
(b) Applicant Name H.[kD. Telephone: Home n/a Business 563-3333
Applicant Address c/o Associated Brokers 640 W. 36th Ave. ~I1 Anchoraqe, AK 99503-580?
Attn: Eric Dy~u_ d _
(c) Applicant is (check one): Lending Institution LJ; Owner/builder Eg; Buyer []; Other [] (explain);
(d) Lending Institution N,/A Telephone
Address
(e) Real Estate Company and Agent N/A
Address
Telephone
(f)
Mail the HAA to the following address:
Pick up by Enqineer
TYPE OF RESIDENCE
Single-Family [] Multi~Fa~m11~
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 (~ 1/84)
Page 1 of 2
ENGINEERING FIRM PROVIDINL ,SPECTIONS, TESTS, FILE SEARCH, DA. 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, functionaJ 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 ~.,~l~ Riv~'r- ~ngin~.ring ,~-r'vi(~.~ Telephone 907/694-5195
Address P.O. Box 773294 Eaqle River, AK 99577
Date
DHEP APPROVAL ~'~
Approved for '~4¢,'~'~t/-d'~ bedrooms by
Approved _,~.. Disapproved Conditional
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
72-025 (11/84)
~UNt~,I~AIJT¥ OI~ ANCHOI~AG
[N~I~N~E~NTAL ~EI~V~CF.S DiVISiON
,ECEIVED
WELL DATA ~
Well Classification
Well Log Present (Y/N)
MUNICIPALITY OF ANCHORAGE (MO~j
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description:
~~ B, C, D.E.C. Approved (Y/N)
Date Completed Yield
Total Depth Cased to
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
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
Y
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed Size
Standpipes (Y/N)
Depression over Tank (Y/N)
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ¢-D.~,¢ ·
To Property Line ¢'/O /
To Water Main/Service Line
Course
Air-tight Caps (Y/N)
No. of Compartments ~.
Y Foundation Cleanout (Y/N) ~
Date Last Pumped '3"-~'""~' /~"¢'~'
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation ,~ '"- 7 ~
To Disposal Field ~""
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026¢1/84)
C. 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 /
Lot
To Water Main/Service Line Y'"/¢ ¢
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Type of System Design
Length of Field //..7 ,¢'- /
Depth of Field /~ /
Gravel Bed Thickness ~" /
Standpipes Present (Y/N)
Date of Last Adequacy Test
,y
To Property Line /.2 ,~5- /
To Existing or Abandoned System on
; On Adjoining Lots ¢-~ /
To Cutbank (if present)
Comments
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 · j
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have che__cke_.~d verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed~'~'"~----~,'~ Date
Company I=.,(, niv,, ~.,,.~.o..~.,. ~..,~... MOA No. g ~' - .2_~' 5--
Receipt No. Eafll~ River. AK 99577 /O~0
694-5195
/ 7
Page 2 of 2
72-026 (11/84)
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHOPAGE/WESTERN DISTRICT OFFICE /
3~01 C STREET, SUITE 133~
/
ANCHORAGE, ALASKA 99503
STEVE COWPER, GOVERNOR
563-6775
DATE
PWSID #:
To Wl-,om It May Concern:
Accor'dinq to the records on File in this o¢¢ice, the /NO~
~1,,'~ C~-M Water System is in compliance with the
Alaska Drtnkinq Water Requlations.
Sincerely.
Ronald S. Klein
Environmental Field O??icer
APPLIC UT FILLS OUT UPPER HAl ONLY
Mailing Address
Buyer
Address
Phone
Zip Code
Lending Institution
Address
Legal Description ~.... % ~"
Type of Residence -~ Single Family
~ Multiple Family
~ Other
Water Supply
~ Individual
~ Public Utility
Zip Code
Phone
Phone
;,'F~*H ~ELL LQG, A wellilo; i;/ ;e;pi;e/f~ for all wells drilled since June 1975.
Fo}'well~,~rilied oJior to treat d~e~ i~f~'~'~w_ell depth (attach log if available).
Sewer Disposal \~"o~(~' '.¢¢, -~r"' /-., ,~'/_D , ////..~,~}-- ' ~-
il. Individual - YeaFIndividua nstalled:
[] Public Utility ¢:.i ~.~."~.~t¢'~'~O\L\[¢3 Wl:~en Connected [o Public Utility:
[] Holding Tank :
NOTE: THE INSPECTION FI~E' MOST ACcoMPANY EACH REC)UEST BEFORE PROCESSING CAN BE INITIATED.
Time
Date
Inspector
Time
Date
Inspector
Time
Date
Inspector
Time
Date '~ ~
Inspector
Field Notes:
MUNICIPALITY OF ANCHORAGE
DEPT. OF HZ/,LTi] L*:
ENViRONMZNI'AL P&O'fFCTJON
(~) APPROVED BEBROOMS
) DISAPPROVED
) CONDITIONAL ¢~RQ~'AL*
DATE_ ,.,
'CONDITIONS OF APPROVAL
Soils Rating
Date Sewer Installed I
Well To Absorptioe Area
Well to Tank
tWell Log Received
Septic Tank Size