HomeMy WebLinkAboutSUNSET HILLS WEST BLK 1 LT 14Municipality of Anchorage •`S'n
ter.
U p.rctment
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.org/Onsite
Development Services Division
On -Site Water and Wastewater Program
* * * * VARIANCE/WAIVER REVIEW * * * *
Waiver#: OSV221002 COSA#: Permit#:OSP211374
PID#: 018-203-13
Legal Description: SUNSET HILLS WEST BILK 1 LT 13
Engineer: Pannone Engineering Services
Your request for amending the existing waiver of the required 100 feet horizontal separation from
the septic tank on Blk 1 Lt 13 to the neighboring private wells have been approved. The approved
separation distance are:
91 feet from the well on Blk 4 Lt 6
86 feet from the well on Blk 1 Lt 14
• 93 feet from the well on Blk 1 Lt 13
In addition, the tank is approved to be 3 feet from the northern field.
This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department. Per the 1998 waiver for the well on Blk 4 Lt 6 is approved to be 70 feet from the
field on Lt 13.
............................................... IN ............................. IN 1
Waiver is Granted: X Waiver is not Granted:
Date: 119 ZZ Approved by:
Name of Revi er
..................................................... IN IN 0 .................... 1
**** VARIAN C E/WAIVER REVIEW ****
WATER WELL LOG
FOSS DRILLING
1336 Ingra Street
Anchorage, Alaska 99501
DEpL Ol: ilEAl,IH &
ENVIRONMENfAI. I,~ C ~-)N
USE OF WELL
SIZE OF CARINGS" DEPTH OF HOLE/~T. CASED TO_ /
~E~ o~ O~AWOOW~.
FT.
REMAP~S__
,L
ANCHORAGE AREA BOR,..JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE
FROM WELL
MANUFACTURER __ MATERIAL _
INSIDE LENGTH
INSIDE WIDTH ..... LIQUID DEPTH
NUMBER OF
COMPARTMENTS
LIQUID CAPACITY__ GALLONS,
TILE ~DRAIN FIELD:
~__ ~l~r~J '
DISTANCE FROM WELL FOUNDATION. 20 _NEAREST LOT LINE / _____OF LINES ~¢_
ABSORPTION AREA4. ~~SQ. FT. LENGTH OF EACH LINE
DEPTH OF FILTER
TYPE .... CONSTRUCTION
.DEPTH DISTANCE FROM:
BLJILDING NEAREST NEAREST
FOUNDATION__ LO7' LINE SEWER LINE
SEPTIC SEEPAGE
TANK .... SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED DISAPPROVED __REMARKS
DISTANCES:
DIAGRAM OF SYSTEM
OCUl4
INSTALLED BY: ~ ~ F-
Form E6~-032
/-(4/u coc./c
~.A.A.B. /
F'ERM I T i,1...
FII::'F'L I CFINT
LJ:]CFIT I ON
L. EGFIL.
i"ll:::l:,.,:II'"lUi','l I'~IJi'II...E.K r3F DE::[:,ROOHS = ]';
THE RIEQI.JII~'.EI} ...,.I.,=E OF' ]'HE c ... II.. PI[ ..... F..F I .I..r. ll .... r-, I E.I1 l:.,:
[Ii::, IE.-'.'i IF" -II" ~-I] ::=: ._:~.. L..~=.ll-.!l _ail IHt .... ;'2Z'::JL.:JL. llll~:~ill:~."[l'"Zl]~..,,"lE~l] ..... ~._.. IE .il~ I] Il ~1 .......
THE I_EI"IG]"H I} I MENS I ON I .?T.'; THE L. ENGTH ( I N FEET ::' O1::: THE 'T'REI",ICH OR [:,RF1:1: NF:' :t: E[..I:).
'rile [:,EF'TH OF R TRENCH OF,;: F'IT IS THE [:, ]: :E;'f'FIf.,tCE E',E"f'P.IIEEN ]"I4E !ii;I..II;:[::f::iC[E: OF 'THE
I."¢ROUIq[) FIND THE IBo"rTOM OF THE E',:.,:CRVFFr'ION ,:I1'.,I F'EEI').
THE "rl:qEIqCH I.,.tI[:,TH I=OR DRFIINFIEL.[)S I:E; :~: I-:EET.
THE GRFIVEL DEPTH I'F; ']"FIE: i',H:N]:MU[',I DEPTI4 OF GRFIVEL. [.-]ET!.4EE:N THE OUI'F'FiI..I.. PIPE
[:IN[.':, TIlE BOTTOM O1:::' ]'HE ENCF:IVFITION (]]'.,I FEET).
........ .I.:~ RE6!I...II[;i:IiE[:,. IF FI MFIIN"f'ENI:rff.,ICI:E
F:I ...Ci',ll I. hllJ...IJ.:, MFIII'.,IT'ENFIN[::E F:IGREEMENT "'~:'
FIGREEMEI'.,Fr ' ':' ' ...... :':
.[_, i'.,IcFr kEF [ CIJRREi'4T ~.'OIJ i"lFl'.r' L,L RE]::!IJ ]: RE[:, ]"O [L]",II.J:IFi'J]E THE .:,Jl.I
IIE_UF..FflL. PI r...,l[_ll FINE:,,.'"Of;,' '-r'Ol..I I'"t[:l'~,~ EE .::,I.J[.,...IE_L.I T']
1"III"4IMUH [)ISTRNCE E:E'rWEEN R HELL. FIND i::11'49 ON-tSI]'E SE:!.qI::IGE DISF,'OSFfl.. S'~.".E;"I"I~::i','I
iOO FEET FOE: I::1 F:'RI'v'FITE ].,.lli~]_L. OR ;;i.':OC~ [:'EET FOR [:1 F'IJI~I..IC kIEl.L.
:E;PEC:IFICFYf'IONS i::lf.,ll]:, CON':~;TRLICTIC~iq [:,IF]GRFIPI'.2; FIRE F:IVF:iILFIE:LE TO IN:!~I..IRE PROPI!i:R
t NSTFILLFIT I ON.
I CERT:[I:"¢ THF:IT
:1.: I I::IM F'l::llqll_II::lf~'. I,.I]:'1"1--I THE RE6!IJlREME'I",I]':E; f:'OR OI",I-SITE
FORTH 8~r' THE MUi",I I E: I PFIL I T"r' OF' RI",ICHORFIGE::.
;:?: :[ klILL. II",ISTFIL. I~ THE S'¢S'TIEM II",l FICCORDFIhlCE NI'FH 'rile CODES.
]:: I UNDEIE::BTFIND ]'I.-IFYI" THE OI'.&~~SZTE SE!.4ER S"r'S'['EM I'qR"r' REQUIRE IENI...I::IRGIEMEI",F]' IF' THE
RESII}IEI",IC[£ :[:E; REZMO[:,EI.JiE:[:' TO IIqCL.I...IDE I"I(]F:~:IE THFII",I 3: BE[:,I:;~tOOMS.
S t GNIE[:':
FF'LIL. I' 1',11 E;FIN[:'"r' z,FE. lhlE, E:F.C:~
ORE. ,ER ANCHORAGE: AREA BO,..)UGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 IlCll STREET ANCHORAGE, ALASKA 99509
T E L EPHO N E ,~-Y~r:~=~'
SEWAGE DISPOSAL SYSTEM ~ APPLICATION AND PERMIT
INSTALLATION OF: SEPTIC TANK
TYPE AND SIZE OF FAC][.ITY TO BE SERVED
FJNANCED THROUGh .
__ SEEPAGE PIT ., DRAIN FIELD ~-
TO BE INSTALLED BY f
SOIL 'TEST .ESUL'rS __ ~ / ~ .OTIS, THl~ pE..IT ,~ NOT VALIB WITHOUT ~OIL TE~.
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE .... TYPE SEEPAGE AREA SIZE --~--0- ~r/~/ ?/~ '~ ~;/~/
MINIMUM DISTANCES. REQUIREMENTS
FOUNDATION TO SEPTIC TANK --
FOUNDATION TO SEEPAGE
SEPTIC TA~K TO SEEPAGE PIT WALL
SEPTIC TANK ,SEEPAGE PIT
TO NEAREST LOT LINE.
WELL TO SEPTIC TAN~;
DRAIN FIELD
WATER MAIN TO SEPTIC TANK
DRAIN FIELD - ,
SEPTIC TANK, ., SEEPAGE PIT
TO RIVER, LAKE, STREAM.
DRAIN FIELD
., DRAIN FIELD
, SEEPAGE PIT
ALSO CONSIDER AREA WELLS.
, SEEPAGE PIT .
, DRAIN FIELD
TYPE
i
CAST IRON IN'rO AND OUT OF SEPTIC TANK AND INTO CRII3 CROSSING GAP OF
EXCAVATION 5 FEET ]NTO UNDISTURBED SOIL.
4 }NCH DIAMETER CAST IRON SIP~ION PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE' / / __/~- /F,,~/~ ~.:
EQ-01B(3-751 r~
[] SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
PERCOLATION
TEST
Pouch 6-650. Anchorage, Alaska 99502 276-222'[ /~Ct.'l O. $ )~
SOILS LOG - PERCOLATION TEST %'o,'/.~
~J
SLOPE
PERFORMED FOR:
LEGAL~ESCRiPT,ON: LO~ 14
O,r'~o.,,-,,:os -/Li'U¥~,,-' (?T
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19-
20-
q'~ q
DATE PERFORMED: ~y'~\~' I0)
PLAN
COMMENTS
PERFORMED BY:
72-008 (7/76)
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
~. z~.10 2,0 ~;'-t IO ~;~ ~,5 ,50
,,
PERCOLATION RATE ' ~ (~ (minutes/inch)
TEST RUN BETWEEN ~'' :2'~; ~*. ~- AND 4' -- .T
~-- -~.~ MUNICIPALITY OF ANCHORAGE
e ·'~. D£PARTMENT OF HEALTlt AND ENVI I1ONMENTAL PROTECTION [] PEI~COL/~TION
6
7
10-
11
12
14-
16-
17-
20-
SLOPE SITE Pt_AN
3
4~
~ '0! O
--.]
DEPTH? ............. . .
Gross Net Depth to Net
PERCOLATION FIAT~ ............................ (minutes/inch)
TEST RUN BETWEEN ........ FT AND FT
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)
Location (addreSs br d'irections)
Mailing AdSress
Telephone: (home) Business
(c) Lending institL~fion
Mailing Address
Telephone
(d)'Real Estate Company and Agent
Address
Telephone
(e) Mail the HAA to the following address: (or check here ~I:~ if hold for pick up.)
List contact person and day phone number below:
2. TYPE OF RESIDENCE
Single-Family'J~i~, Number of bedrooms
3. WATER SUPPLY
Individual Well ~l~L
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 DISPOSAL
On-site'l~f, 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.
72q)25 (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, 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.
Name of Firm
Address
Date
6. DHHS APPROVAL
Approved fo~'~.-~,t ~,-)bedrooms by
Approved .~ Disapproved __
Terms of Conditional Approval
Conditional
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 r)HHS 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 erro rs or omissions
in the professional engineer's work.
MUNICIPALITY OF ANCHORAGE (MOA) ~
Health Authority Approval (HAA)
CHI:CKLIST - FEBRUARY 1984
343-4744
/-~7"- 14/ ~.~ / 5u~/$£7~/-/¢z~.$ ~),
Legal
Desqription:
Well Log Present (~)N)
Total Depth /O& Cased to
Static Water Level ~ '~
Date Completed
/o& Depth of Grouting
Casing Height Above Ground
Electrical Wiring in Conduit (~N)
SEPARATION DISTANCES FROM WELL:
To Septic/Flolding Tank oil Lot
If A. B, C. D.E.C. Approved (Y/N) '~,/~
Yield (~ 6,~--- ¢z*¢)~
Pump Set At
Sanitary Seal on Casing ~N)
Depression Around Wellhead (Y~)
;On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ¢Ot ~¢4¢¢'e,~ ¢~¢) ,~.¢; On Adjoining Lots
To Nearest Public Sewer Line /J//} To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot ~'5"/¢c
Water Sample Collected by ~¢'~-¢ ,'~" ~)/~""'4/ ; Date //
Water Sample Test Results /~¢'¢ "7~ '""~-' ,,,d/~',~,~
B. SEPTIC/HOLDING TANK DATA
Date Installed ~//./.3~77 Size
Standpipes ~)N) _ Air-tight Caps ~,~N)
Depression over Tank (YQ~
Pumping/Maintenance Contact on File (Y/N)
Holding Tank High-W,~t.er Alarm (Y/N) _ ,,~/~4-
SFPARA+'ION DIS'~:/~',Cc~.E.',.~:.Fk_R_OM SEPTIO/HOLDING TANK:
TO Wato;-Supply We, II '. "-~',~?,'~ ! TO Building Foundation
· .. ': ':.;:' '~ '? .,: t ~
To.Property, Line:- :,.~ %v/d 'Fo Disposal Field
To ~ater Main/Serviae~Line-~u', /~ /
To Stream, Pond, Lake Orr'Major Drainage Course /~'~
Comments .
No. of Compartments ~ - ,..~'e~7¢ A~/~/ .,d/~",
Foundation ~?~9~)
Date Last Pumpe~?/"~¢'~ /~'Y "'~/'"/
Temporary Holding Tank Permit (Y/N)
/o
72-026 (Rev 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata ~.-/O Type of System Design
Date Installed ~/~/~ - ') ~ Length of Field
Width of Field ~' ' Depth of Field ~ '
o~n,..,o.~,¢- ~ v - Gravel Bed Thickness
Square Feet of Absort Area ~ ~¢'8 Statndpipes Present gN)
Depression over Field (Yb Date of Last Adequacy Test
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ¢0 ~ ¢,//~/I/'¢4~ ¢~//¢I/~' To Property Line /(2
To Building Foundation /¢
To Existing or Abandoned System on
Lot /J//fi' ; On Adjoining Lots /o ' ,-/--
To Water Main/Service Line /o ¢ To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course /~"0
To Driveway, Parking Area, or Vehicle Storage Area ~,4/877//t-z')/ ~,,,J~E)~ ~£/v'zt?,g,4Y
D. LIFT STATION
"Pump On" Leve""~'~" ..... L?/ , '"
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test.
**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
Signed
Company
Date
MOA No.
Receipt
Date of Payment
Amount: $
72-026 (Rev. 7188) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
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 .~'¢7~V~¢'~''~
GENERAL INFORMATION
(a)
Legal Description (include lot, block, sub.division, section, townsbip, range)
1-o%/'[ I oL: 'r '7?z.,J
L o c a [i.o~q~( 8~(:ff:Jl~ ~6 .~¢ r .directions)
(c~t~ce~ j~ (~b~c~,one~: Le~dmg Institution ~; Owner/builder [] · Buyer ~ ' Other~, (explain);
(d} ~n~¢~'lns~itutioh ~'~.,? /J~ Telephone
(e) Real Estate Company and Agent
Address .... ~,/wcz.~
Telephone ~-7~ '-
Telephone: Home '~J4' ~45~? Business Z-:7(',. '-
(f) Mail the HAA to the following address:
TYPE OF RESIDENCE
Single-Family'~ Multi-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, .:
SEWAGE DISPOSAL
Onsite"~ Public [] Community r-) Holding Tank [] . '.
attestingN°te: If communitYto the legalityWell andSystem'status.must have written confirmation from the. ~:"S, tat e. ~ Department.... of, Environmental Conservation
Page 1 of 2 72-025(11/84)
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. ~ 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. ~, /.-~;~i--,//o
Name of Firm __ '//~7~'~;~ ~ Telephone
Address /~./~ ,-~
Date
D HEP APPROVA¢~¢~'~'~ bed rooms by~2~
Approved for ~
, Approved ,~.,,--~ Disapproved
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
ALASKA ,,JIROFImeFiTAL COBI'ROL S I, IC S, IFIC.
Department of Health &
Human Services
825 L. Street
Anchorage, Alaska 99501
Attn: John Kennedy
Aagast 12, 1986
MUNICIPALITY OF AlqCHORAr~
DEPT, OF HEALTH &
ENVIRONMENTAL PROTECTION
SEP 51986
RECEIVED
Re: Lot 14, Block 1, Sunset Hills West
On July 29, 1986, we installed a monitor tube near the absorption area
elf the above referenced lot to see if there was ground water present.
The tulle was installed to 9 feet total depth. The drainfield is
approximately 5 feet deep. On August 5, 1986, ~he monitor 'Lube was
checked and found ts be dry,
During the excavation to install the new standpipe, we found that the
distribution line was sloping dowll from where the line from the tank
connects to the distribution line. It is unknown how much of the
distribution line is sloped. The spo~ where the standpipe was installed
may be a dip in the line from settling.' The system has been functioning
properly with no backup into the house.
We feel that ~he existing disposal system is corrently performing
adequately, and reqaest that you graut final approval of ttle Health
Certificate.
If you have any questioas please feel free te call.
Sincerely,
Alan WJ en
Engineering Techaician
Approved by:
ALASKA B, LIIROFIITleiqTAL COFITROL SehdlCE!$, IFIL
~nqineerJnq 6 ~nuironmenlol Studies
Municipality of Anchorage
Department of Health &
Haman Services
825 L. Street
Anchorage, Alaska 99501
Attn: Steve Morris
July 22, 1986
^ ' c??°'v
Re: Lot 14, Block 1, Sunset Hills West
The above referenced lot has a conditional on its HAA for the standpipe
in the absorption area to be located and extended. Apparently none
existed, so on June 10, 1986 a new standpipe was installed to clear the
conditional. When this standpipe was being installed, we found the
absorption area to be quite full of fluid. We have been monitoring the
level in the trench since. We are presently Installing a monitor tube
near 'the trench to raonltor ground water, if any exists. The deadlln6
for the conditional has passed aad we are requesting that you extend the
date until our investigation is completed.
If you have any questions, please call.
Approved by:
Sincerely,
EAnl~n~tere~ng Tec, h~ ~ :
1200 [[lest 33r~ r%enue. Suite [~,Anchoro§e. Aloska 99503,(907) 561-5040
MUNICIPALITY OF ANCHORAGE
DIVISION Of' ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONbiENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
(a)
Legal Dascription (iq~lot, bl.ock, subdivision, section, township, range)
Loc~tion (address or directions)
(c) Applicant is (check one) Lending institution ~ ; Owner/builder ·
Buyer ~--~; Other ~ (explain), ~t.~ ~Z~--~/~'~ ~--~'
(d) Lending Institution Telephone
Address
Telephone
(f) Mail the HAA to the following address:
2. ~ype of Residence
Singie-Family,~
Number of Bedrooms
3. Water SU~X
Mult'i-Family~--~
Other (describe)
]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.
.S ew~ge pi,s~po.s a~
Onsite /~ Public ~-~ Community ~...~ Holding Tank
Note: If community well system, m~st have written confirmation from the State
Department of Environmental Conservation attesting to the legality and stat~s.
[Page 1 of 2]
5. Engineering Firm Providing Inspe93ions~ 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 Y~anicipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
ordinances, and regula-
system is in compliance with all Municipal and State codes,
tions in effect on the date of this inspection.
Date
_ Telephone
(ENGINEER
" ?>' C, ~,cid, 3r..':,' /"~.
DHEP Approval ~?] ~-~ ', '". "~,.,," '
for~. . J ~ ~ _
Approved __ Disapproved ~ Condition~
Terms of Condigional Cpproval_~~ ~~O ~--
T~ M~ICIPALITY OF ~CHORAGE DEPARtmENT OF ~ALTH ~D E~IRON~ PROTECTION
(DHEP) ISSUES ~LTH AUTHORITY ~PROV~ CERTIFICATES BASED SO~LY UPON THE REPRESENT-
ATIONS GIVEN IN PA~G~PH 5 ABOVE BY ~N INDEPENDENT PROFESSIO~L ENGINEER ~GISTERED
IN T~ STATE OF ~S~. T~ DHEP DOES ~IS AS A CO~TESY TO P~C~SERS OF HOMES ~ND
THEIR ~NDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDE~ ~ND STATE REQUIRE-
MENTS. ~PLO~ES OF DHEP DO NOT CONDUCT INSPECTIONS 0R kNALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. T~ M~ICIPALITY OF ~NCHORAGE IS NOT
RESPONSIBLE FOR ERRORS
OR OMISSIONS IN T~ PROFESSIO~L ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
MUNICIPALITY OF ANC,
DI:PT. OF HI!ALTH &
~N¥1RONMENTAL PRO'£ECT Q~[~gICIPALITY OF ~C[~GE (M~)
C~CKLI~ - FEBRU~Y 1984
RECEIV[D
Well Classification
Well Lcg P~esent 8)
Total Depth ./~..~ _
Static Water Level
/ Cased to
Casing Height Above Grcund _. /~//
Electrical Wiring in (k~nduit~N)
SepaJzation Distances f~cm Well:
To Septic/~{olding Tank on Lot ~O/
To Nearest Edge of Absorption Field on Lot__~)'
To Nearest Public Sewe~ Line A/~-
Sanita~.y Seal on Casing
Depression A~ound Wellhead (Y~
.__; On Adjoining Lots-- ~
; On Adjoining Lots_~/~O
To Nearest Public Sewer
Cleancut/Manhole /~Z//f~ To Nea~,e~t Sewer Service Line ob Lot
' ~7/-~ ~d2-~d~ dR, - /,/
, ~ ~ /_' ....
[ , ; z
SEPTIC/HOLDING TANK DATA
Standpipes ~) Ai~-tight Caps ~) Foundatio~ Cleanout
Depression o%~ Tank .(Y~) Date Last Pumped ~//~/~ -~/r~x~]2
Pumping/Maintenance Contract on File (Y/N) /~,~ .; fo~ ' ' / /
Holding Tank High-Water Alarm (Y__~/N_) ~d I,~-~ Temporary Holding Tank Permit (Y/N)
Separation Distances fl~cm Septic/Holding Tank:
To Water-Supply Well ~9/ To E~Jilding Foundation /~ /
TO P~ope~ty Line . .~ 1~>/94- To Disposal. Field /D/
To Wate~ Main/Service Line _lO/ To Stream, Pond, Lake, c~ ~jo~ D~ainage
[Page 1 of 2] 2-15~84
C. ABSORPTION FIELD DATA
De
Soils Rating in Absorptio~ Strata
Date Installed ~/~
Width of Field 5'
Square Feet of Absorption A~ea
Depression over Field (Y~)j)
Results of Last Adequacy Test
Separation Distance from Absorption Fi~d:
~/~ ~ Type of System Design Length of Field
Depth of Field ~,~ '
Gravel Bed Thickness ~ '
Standpipes P~esent ~N) ~
Date of Last Adequacy Test~-'/~/~//~.~/ ~--,'
. TO P~o_Derty Line /O /
~0~ ~TZ~ To Existing or Abandoned
; On Adjoining Lots ~c ~q~ /
,t~LT~ To Cutbank(if present.
To Water-Supply Well
To Buildin9 Foundation
Lot ~ tf~-
To Water Main/Service Line
To Stream/Pond/Lake/o~ Major D~ainage Course
System cn
To D~iveway, Parking A~ea, c~ Vehicle Storage A~ea
LI~ STATION
Date ~ Dim~ions
"~ ~" ~1 at ~ ~ ~1 at.
High Water ~ ~1 at ~[ Vent (Y~)
Tested fo~ ~ing Cycl~dequa~ ~st. ~ets ~A
Electrical Co~s (Y~)
Co~nents
** Check Permitted Bedroom Rating Against HAA l~equest
I certify that I have checked, verified, ~ confo~msd to all MOA HAA Guidelines in effect
o? the dare,of this inspection.
S~gned
KB1/d5/s (~ c
[Page 2 of 2]
Date
NOA No.
"-gR
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all part~ on page 1. Incomplete requests will not he processed. Plaase a IOW ten (10) days for pro~esslng.
PROPERTY OWNER ) ~ - PHONE
MAILINGADDRES~ ~ ,~ ~ ~ /~ ~ ~
PHONE
YER~ - PHONE
2. BU ,
~AILING ADDRESS
, , ' ' PHONE
MARLING ADDRESS
4. REALTOR/AGENT · / PHONE
S. LEGAL DESCRIPTION
I ,
STREET LOJ3~ATI ON ! ,
S. TYPE OF RESIDENCE ~ SINGLE FAMILY
~1 MULTIPLE FAMILY
7, WATER SUPPLY
~INDIVIDUAL~
[] COMMUNITY
PUBLIC UTI LITY
~IUMBER OF BEDROOMS
[] One [] Four [] Other
[] Two [] Five
];~L-~ Three [] Six
ATTACH WE LL LOG. A well log i.~ required for all we Is drilled
since June 1975. For wells drilled prior to that date, .qive well
aepth (attack log if available,)
Jation date I777
~ INDIVIDUAL/ON-SITE** "11 individual/on-site, give insta ,
If system is over two (2) years old an adequacy test is required
~] PUBLIC UTI LITY by this Department,
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED,
72-010(3178;
THIS SIDE FOR OFFICIAL USE ONLY "
DATE RECEIVED
INSPECTION APPOINTMENTS
TIME TIME TiME
DATE CATE DATE
INSPECTOR INSPECTOR INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
[] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] .SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILtTY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
[]INDIVIDUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTILITY /..~_.,"~ ~
Connection Verified
INSTALLER
[~]Septic Tank or []Holding Tank
Size: If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MAN U FAE,~
TOTAL ABSORPTION AREA MATERIAL,~ t~~
4. DISTANCESwELL TO: Septic/HoldingTank Absorption Area Sewer Line Nearest Lot Line
Absorption Area to nearest Lot Line
5, COMMENTS
[~'~APPROVED FOR ~'~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)
[] DISAPPROVED
DATE ~~. /,~
72-010 (Rev, 3/78)
~ - "UNICIPALITY OF ANCHORAGE
~,~ DEPARTMEN1 =l: HEALTH AND ENVIRONMENTAL
Date Received:
~ROTECT I
99501
October 26, 1977
#].: Time 2:00 p.m. . ~2: Time ~3: Time
Date 1~-27-77 Thursday Date Date
Insp Pratt Insp Insp
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
Lending Institution Request: Secu:rJ.ty National Bank
Mailing Address: Pouch 7-777 99510 Phone: 278-6800/42
2. Property Owner: Sander/Caryn Steinberq, . Phone: 274-3685
Mailing Address: Star Route A Box 1475D 99502
3. Legal Description: Lot 14 Block 1 .Sunset Hills Subdivision
4: Single Family Residence: (x) Number of Bedrooms:
Multiple Family Residence: ( ) Number of Bedrooms:
Three
Well System:
Permit =
Construction
Individual Well
Depth of
(x) Con, unity/Public System ( )
Well Well Log on File
Bacterial Analysis
(x)
Sewage Disposal System: On-site System (x) Public utility
Permit ~ Installed 1977 Installer ~--- ~--'
Septic Tank Size 2~( ' Manufacturer
Absorption Area .~o Soils Rate ~]~ Material ~Du~q~/
7. Distances: Well to Septic Tank to Absorption Area
%o Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
Page Two
Department of Health and Environmental Protection
Request for Approval of Individual Sewer and Water Facilities
Legal Description:
Lo% 14 Block 1 Sunset Hills Subdivision
Comments:
AffadavJ. t Attached: ~--~
Disapproved:
Letter Attached: ( )
Date:
Departmen~ Worksheet:
THIS IS FOR WELL APPROVAL ONLY REQUEST FOR APPROVAL OF
SEPTIC HAS BEEN APPROVE[).
COPY A~TACHED INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection:
2. Property Owner:
Mailing Address:
3. Name of Buyer:
Mailing Address:
CMRO VA
SANDER S_~_IN~ETiG and CARY~ ST~_.IN~. _ERG
SPA Box 1475D Anch.. AK 99502
FHA 'l [ CONV X
Day Phone 274-3685
__ Day Phone
Phone 276-6800 X42
4l Name of Lending Institution: _ SECURITY NATIONAL BANK
Mailing Address: pot]eh 7-777~ Anchorag~r Alaska 99510
5 I Name of ~× T~an e]r~r~r Mari~ Jones
Mailing Address: Phone
Legal Description: _ t ~l ~nnrl-¢pn (]/I)~ B]nr~k One (1); gr~lgF~ r]TTiT,q ~.qm
Location: 14185 Hancock Drive
(Oceanview Area)
7. Type of Facility to be inspected:
8. Water Supply
Type of Supply:
Single F~nily Residence
No. Bdrms. 3
Public Utility
Individual X
If Individual, number of dwellings presently served
If Individual, depth of well
Sewage Disposal System
Type of System:
If Individual, date of installation
ONE,
Public Utility
Approved 4/13./77
Individual (on-site) . ×
EQ-037 (1/74)