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Home My WebLink AboutSPRING BROOK VISTA #1 BLK 2 LT 7 ( 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 NAM E P~-~--- I' [] U ~/~ MAILING ADDRESS LEGAL DESCRIPTION LOCATION ' ~ - / N~OF BEDROOMS ''Absorption ar~" . .... PERMIT NO. N~ DISTANCE TO: - ~ Manufacturer · ~ ~~ Ma~~ No, o~compartments Liq, capacity in gallons ~ Inside length Width Liquid depth /~ IF HOMEMADE: ~ ~ ~ DISTANCE TO: Well Dwelling ...... PERMIT NO~ O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Well Fou~i~h ~ No,DISTANCETO:of,ines ~ LengthCe~llline. Totalle~W,lines Trencl~k,h ~ Distance betweon lines N ~ ~ Top of tile to finish grade / Material beneath tile t Total ef~octive absorption area ~ength W~d~h De~lh ~R~IT NO. ~ ~ TVDe of chh CHb d~ameter CHh da~th Total ef[ec~vs absorption area m Well Building foundation Nearest lot Ih~e ~ D[STANC~ TO: ~ Class Oepth Ddller ' b~stance to ~o~ Has ~RM~ ~. 8u~[din~ fouadat~oa Sewer Hna Septic tank Absorption area(s) ~ OlSTANCE TO: OTHER ~l~ MATeRIAlS SOIl T~ST ~ATING REMARKS APPROVED DATE LEGAL 72-013 (Rev. 3/78) I"lFI;,.:l];.i'ql..JH NUMBER F~F BEDROOHS = 4 SOIL F.:FITING ·" ' " [:'R:R 7[ NF ): ELD. 'TI4E I...EN6JTH DIIdENS]:C(N 15 THE I_ENGTH ,'IN FEET> OF THE ~fr~.E'NCH OF,:: 'rl4E DIEPTH OF' R TF.:ENCH (:)[~ PIT IS 'I'HE [:,ISTRNC:E BETb. IEEN THE 'f'HERE IS NO z, ET kIDTH FOR -FENE:t4ES FHI: f3P, HV[zL DEPTH ,[':.', THE H,[NIf'IUH DEP1H UP JF. HVEL I~N[> THE.' BOT'I"OH OF THE E>-',Cf:IVflTION (I1'4 FEET), PERHIT RF'PL. ICflNT HAS TI4E RESPONSIBILITY TCI I NFORH THIS DEPFIRTHENT [:,UR II',IG 'THE fNSTFILLRT¥ON ZNSPECTIONS OF' RNY WELLS:; fl[x.:rRCENT TO THIS PROPER"rY RND 'file t"~I..IHBEF.". OF [,..E._,iI)ENCE=, THflT THE bIELL b.I:[LL. SER',/E. 8flCKF'ILLING OF tiNY SYSTEM 1.4ITHOUT FINflL. INSPECTION FIND RF"F'RO',/RI_ E:Y THIS [:,EF'tal;?.TMENT 14II...L BE SUBJECT TO PROSECUTION. MINIMUH DISTRNCE E~ETf4EEN R WELl... FIN[:, tiNY ON-SITE SEWREiE DISF'OSRL SYSTEH iOO F'EET FOR R PRIVFFrE I, IELL.; OF..'. :'C50 TO 200 FEET FROH R PUBLIC WELL [:,EPEN[:,IN6 UPON THE TYPE OF F'UE:LIC OTHEF.: F.:E"(;'~.UIREf,'IENTS I'"lfl'.r' RPPLY. SPECIFIC:flTIONS RI'lQ CONSTRUCTION DlflEiF.'.RHS Rg'RII_FIIBLE TO INSURE PROPER INSTflL. LFIT:[.ON. I C:Ele. T I FY THflT :.1.: I I=IM FFtI"IIL. IFflr.'. bIITH THE REL~UIF..EMENI_ FOR ON-S~.TIE =,ILq-,IER:::, Fllq[:' WELl.S; RS SIET FORTH E:Y THE MUNICIPRL, ITV OF RNC':HOF.'.FIBFL. ~:: I kIILL INSTFILL THE SYSTEM IN RCCORDFII"ICE I.,l'rTt'-I THE CODES. E:: I UNDERSTFIND THRT THE ON-SITE SEI4ER SYSTEM MFtY REC.-IL.lIRE IENLRRGEMENT IF: THE F.'.ESII>ENCE IS RIEMO[:'ELFLI)T¢.CL INC:LII.~,E HORE~ THflN 4 _ ;l: _fiLl AF'F'I_ I CFII',tT CHFtRLES LERVI TT ,,-;-,-,.,, ..._,. --, .: ,, .... // I --~, . .: ,1. .;. ' ' W ' , /,. t,,/i :'.,: ':'/" .'/,~;,L~ ~, .,..(,,- m-'~(' "' erformed For eoal Oescrintion: Lot 7 BlocL 2 his Form Re~orts Soils Loq Yes 2204 Cleveland .Anchorage, A)aska 99503' Charles ~ea~ Date Performed 8-8-78 __Subd~ vi ~ i ~n_ Sr~g Brook Vi~tn Percolation Test NO" ~eoth Feet Soil Characteristics e,~t &--Re Bro~ Sandy Gravel Thin layer of Silt Water Seepage at 7' Brown Gravelly Silt . -- (wet) Wet Brown Sand 8 0-- Was ~round Water Encountered? .¥e~ 1¢ Yes, At what Depth? Seepage at 7' Readinq Date Gross Time Percolation Rate !linute Proposed Installation: Seenaoe Devth of Inlet Net Time Depth to H20 Pit Drain Field Depth To Bottom Of Pit Or Trench Sn~,pENIS: 150 Sq. Ft. dr~ainaa~e___area requi~red_j_per ]~frmr~minu~go__5'. Water seepage at 7' in Net Drop ~est Performed By David ?a~l Da ta Certi fi ed Date: 8-8-78 GRE: ANCHORAGE AREA EOF' IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS_ PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH SEEPAGE PIT: NUMBER OF PITS LINING MATERIAL ~i034 BUILDING FOUNDATION .~ NUMBER OF MANUFACTURER W~/--U/~_(-~ MATERIAL /.~O1~1C Y'e.'F~ ._ CO~p~ARTM~_.~NTS~~1 CRIB SIZE: DIAMETER_ DEPTH DISTANCE FROM: WELU TOTAL EFFECTIVE NEAREST LOT LINE~ ABSORPTION AREA (WALL AREA) ~ SQ. FT. ADDITIONAL ABSORPTION WELL: i~ TYPE 6 ~ ~1~ ,~/ __ BUILDING FOUNDATION CESSPOOL . APPROVED __ CONSTRUCTION_ NEAREST NEAREST LOT LINE SEWER LINE OTHER SOURCES__ __ DISAPPROVED REMARKS __ DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: PIPE MATERIAl · LOT SLOPE: REMARKS: Form No, LQ-031 DIAGRAM OF SYSTEM I /;"~ % ' GREATER ANCHORAGE AREA BOROI' · ' ~, ~ ,, .$ ,.~.x 3330 "C" Street ~ '~', %qt-" ~;~b~~ Anchorage, Alaska 99503 80H~S lOG - PEROI,ATION TgST Performed for ~:~ike Co~crete Date Performed Legal Descri~n: -~'~~gc~ 2~"~m~ 5~oo1~ ~tA Th~s 'Form repor~s:--~ls 1o9. ~ ....... Percolation ~es~ Depth Feet Gray Silty gravelly sand 250 S.P./B.R. Slight water seepage 8- Gray silty gravelly sand l l - 12.- 13-- 16~ bottom o£ test hole Was ground water encountered? Yes If yes, at what depth? 5-6' Reading Date Gross Time Net Time Depth to Water Net Drop Preposed installation: Seepa(.le Pit Yes Drain Field :X:pth of inlet ................ · Dept~"-:t-O"li-g~'~D~{'}J'f--pit or trench COI,1MENTS: _._No_._bedr_ocl~_ encoun.tered~ 'i~{.-f-OT~,¢e~]- i~':~-~ ~ ~'m"7~- ~[~i~ ............. ~ ~J."rt:i'fi~d ' ByC..c~n~._t.r_u.¢..tLo_n .............. pale: EQ.'040 (6/74) Test Lab Ready-Mix Concrete- Sand &'Gravel Excavating - Road Building - Trucking Klondike Alaska Inc. Mile 19, Old Glenn Highway P.O. Box 588A - Chuglak, Alaska 99567 Phone 688-2161 TIL WALLACE, Pres. Serving Anchorage, Eagle River, Palmer & Wasilla August ~ I978 TO WttOM IT MAY CONCEh~N: I(] oudi!.qe ATlask.;., l'nc. Jm';ta] ].ed at ]250 gallon ,sewor ko Mun'kcfpaliLy r.;tat~dards ol'~ I,oi: ? ]31o(~k 2 oJ~ SprS. ns BPook VJsN~ in the :~ttrnr~'~et- of 197~.. TIL 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 NAA # ~-'~OAc~ ~q ~ Q~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) / Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution Mailing Address (d) (e) Real Estate Company and Agent Address 'l'elephone Telephone: (home) Telephone /~YA Business Mail the HAA to the following address: (or check here d for pick up.) List contact person and day phone number below: z I/ 2. TYPE OF RESIDENCE~' Single-Family [[;F' Number of bedrooms J 3. WATER SUPPLY ~ Individual Well [] Community [] Public Note: If community well system, must have written confirm.ation from the State Department of Environmental Conservation attesting to th legality and status. " 4. SEWAGE DI~AL On-site lip'/ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 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, Iverifythat 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. Address /~ ~ ~//~j~' ~//~ ~/'~ 2~ Engineer's Seal 6. DHHS APPROVAL Approved for ¢ Approved ~ bedrooms by Disapproved Conditional Terms of Conditional Approval T /-l /.r t y ,4 The Municipality of Anchorage Department of Health 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 DHHSdonotconductinspections 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. 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 FOR: CORWIN & ASSOCIATES ATTN: JERRY November 16, 1989 PWSID: ~211431 According to the records on file in this office, Dawn Water Co. Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, ra E. Cra'ig ~ Environmental Field Officer VEC:bas 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 completed prior to submittal) (a) Legal Description (include lot, block, subdivision, sectiOn, township, range) (b) / Location (address or directions) Property owner Mailing Address (c) Lending Institution Mailing Address ¢' I (d) Real Estate Company and Agent Address Telephone W//'/~'' (e) Mail the HAA to the following address: (or check here ~ld for pick up.) List contact person and day phone number below: Single-Family [~' Number of bedrooms 3. WATER SUPPLY . ~ Individual Well [] Community [] 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 DI~L On-site lB/ 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 (Rev. 7/88) Page 1 of 2 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, lverifythat my investigation of th is 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 reg~ulations in effect on the date of this inspection. Name of Firm Address eal 6. DHHS APPROVAL Approved for ,,~ Approved .~Z% bedrooms by _/~~ ~ ~ Disapproved Conditional Terms of ~onditional Approval The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph S 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 DHHSdo 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. 7/88) Back Page 2 of 2 - MUNICIPALITY OF ANCHORAGE (MOA) Health Aulhority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Well Log Present (Y/N) Date Completed Total Depth Cased to __ Depth of Grouting Legal Description: Static Water Level Pump Set At / Casing Height Above Ground Sanitary Seal on~ng (Y/N) /- To Nearest Edge of Absorption Field on Lot _/]~ ; On Adioining Lots To Nearest Public Sewer kine ~~ To Ne~Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on~ot __ Water Sample Collected by __/ __; Date __ Water Sample Test Results ~/ /'~'.~-... I~ ]' ._ To Water-Supply Well To Property Line To Water Main/Service Line B. SEPTIC/HOLDI~N~ TANK DATA Date lnstalled(~C:/~'/*~.~ Size /'¢¢~'~) No. of Compartments ~/--~2 Standpipes (Y/N)__ ~ __Air-tight Caps (Y/N) F Foundation Cleanout (Y/N) Depression over Tank (Y/N) /t.,,'/ Date Last Pumped .,~zp~, 29. Pumping/Maintenance Contact 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 Building Foundation ,~*~/'"~ £ TO Disposal Field ~¢~ / To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata,, Date Installed Width of Field ~ / //¢'¢ ~Y¢~_/~ Type of System Design Length of Field Gravel Bed Thickness Square Feet of Absordon Area ~O~ Statndpipes Present (Y/N) Depression over Field (Y/N) ' '~ ,~ Date of Last Adequacy Test .esu,ts of ~a,t Ad~qu~c~ ~st ~~'~~ Lot ~/~ ; On Adjoining~Lots To Water Main/Service Line /CO / To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutback (if present) /u//'4- /0/ /2/4- Date Installed 7~¢'' Dimensions ' Size in Gallons ..~=¢~"'~;)O ,~)'~_¢'~,/~,,,P Manhole/Access (Y/N) · / ~ . - / ~ . "Pump On" Level at _ ~ '~ ¢O~z _"Pump Off" Level at High Water Alarm Level at ~ / '~ ~¢~, Vent (Y/N) Tested for ~~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments. '~ ~/:~ ~'~ ~¢~ ~~ .~ · *Check Permi~ Bedroom ~ating Against HAA Request** ~ certify that I~e 6hecke¢ ~ed, or conformed to all MOA and HA n effect on the date of this ¢ MOA NO. ~ Receipt NOd2~ Date of Payment Amount:¢ / 72-026 (Rev. 7~88) Back Recall: Waiver Fee: $ Date of Payment Page 2 of 2 iii. i :ilD6partment of] Envi r~nmen~'al., Qu~'l,i ~Y ~C ':St - ~,- ~ ree~!Anahorage,-~Alaska:::'~!99503 ~,:: 274~45 ''Ir ~' .";i!?ii D~ t~,:.:RE~ ~ ved ,i:' · . peCtion· pection:! ~' '14~75 :REQUEST;,FOR :ApP INDIVIDUAL SEWER.i& WATER.FACI[ITIE Pa~e 2 of two pages, P ~ Legal Description Approval i. Valid¥°r?one~year fromdate~s'igned ..... ~. ~ar.tment~ DIAGRAM !I: certify that the information contained in 'this request for approval:to'be a, true ~e~representation of the~subj~ct, sewen. 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