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Home My WebLink AboutT15N R1W SEC 9 LT 52 MUNICIPALITY OF ANCHORAGE DE RTMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Na,,. ,, DISTANCES ~ ~J~,f~J ~/~_~ C~ ~ ~ '~ ~ ABSO"PTION/ Addr ~ TANK ~ FIELD / WELL Township. Range, Section % AS-BUILTDIAGRAM~S~ow ocahono we sop csysom ~ropery es, o oaten, , ; t ~ ~ Orlveway, water bodies, otc} / TANKS Manut~ctt er Capac,ty ,n gallons TYPE OF SYSTEM ~ ~N / ~ ~ WELLS _~_PmV~ ATE ~ OTHER ndentUv) / REMARKS: I 1~ Eaele_ ~,~,,,, ~oa~ ~o. ~G~ ceHily tkal Ihis ins~ectm was peH~rmed amrding Health Oepadmont Approval:~~ ~' ~~ Date: ~--/~ 72-013 (3/85) ...... Lb.,,ltIl~i!i::L..ll ....... IF::"(I!E::IF:i~:~LI""ql Z' "1t J.. :t: am i am ;i. ;I, i. a r' ~,~ :i, t. h 'Lb e~ i" ,>,~ C:l&.( :i. i' ~rr, er"rL~i t' c:)t" C)l'l '"bikini ~i r~' ® ~Ih~:~ t'I::)r't, kl I::ly Lht::'! 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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 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Ti5N RiW Section 9 Lot 52 Location (address or directions) North Birchwood Loop area (b) Property Owner Joyce Andrus Telephone: Home 694-5252 Business 688-2985 Mailing Address PO Box 670638, Chugiak, Alaska 99567 (c) Lending Institution Federal Alaska Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the followinr~ address: or: Check here ~4; if hold for pick up. List contact person and day phone number below. S & S Engineering TYPE OF RESIDENCE Single-Family r~x Number of Bedrooms Three (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 the legality and status. SEWAGE DISPOSAL Onsite [~x 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 8/86/ 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 & S Engineering Telephone 694-2979 Address Date Engineer's Seal This department has received written confirmation from the engineer, S & S Engineering, regarding the Conditional Approval of December 11, 1986. The corrections have been accomplished and an inspection has been completed by the engineer. This department has reviewed the documents and the subject property meets with Municipal codes and is not approved. DHHSAPPROVAL Approvedfor three(3) Approved XXXXXXXXXX bedrooms by ~ ~' ~~ Disapproved Conditional Terms of Conditional Approval Date March 13, 1987 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 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, Page 2 of 2 72-025 tRev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALIT~ OF ANCHOP, A~ALTH AUTHORITY APPROVAL (HAA) DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MAR 0 1987 WELL DATA RECEIVED CHECKLIST- FEBRUARY 1984 264-4720 Well Classification Well Log Presen_~. ) Total Depth '::~ Static Water Level Casing Height Above Ground Electrical Wiring in Condui((Y~N) Separation Distances from Well: Cased to If A, B, C, D.E.C. Approved (Y/N) Date Completed ~- --5 '--~:~/-) Yield Depth of Grouting f'"'~"'~ Pump Set At g'~ K / Sanitary Seal on Casin~'(Y)'N) Depression Around Wellhead (Y,~ To ,Sel~Holding Tank on Lot ,,~) r ; On Adjoining Lots /(-~'~ "' '/'" TO Nearest Edge of Absorption Field o.n ~o, "~/~- ;On Adjoining Lots /~ To Nearest Public Sewer Line ~/~ ' To Nearest Public Sewer Cleanout/Manhole Id/~ To Nearest~wer Service Line on Lot Water 8ample Collected by ~l~ ~' ~~ ; Date ~ ~ Water 8ample Test Results ~ ~' t '~ ~ ~:~ 7 comm~ ~ D ~/~ ~~ ~ ~- ~ · ~I~/HOLDING TANK DATA Datelnstalled ~'/~'~/~'? Size '~O~) No. ofCompartm~:ndat,onClea~nou '~N StandpipeS/N) ' ~ . Air-tight Cap~N) ' ~) Separation Distances from.li~t~Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course Comments/~' ;~ To Building Foundation TO Disposal Field To Stream, Pond, Lake, or Major Drainage /0 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Stand~eSe~'~'(Y/N) Depression over Field (Y/N) j Dat~ef~ast Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field:~/// To Water-Supply Well To Property Line '" To Existing or Abandoned System on ¥ To Building Foundation Lot ,?'" ; On Adjoining Lots To Wate[..M~i'n'~Service Line To Cutbank (if present) T.p.~t'~:eam/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 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 I A ~-' Vent (Y/N) . Pumping Cycles during Adequacy Test. Moots MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t ~a~l ~ ~'l~ctl~l~lN~ r i f i e d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 17034 Eaele Rlvm' L'~['. ~ -'~-~ H- CompanEyagle RIver' Alaska 99577 MOA No~ Receipt No. Date of Payment Amount: $ 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 / 2..//~//,~ ~ GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, btock, subdivision, section, township, range) Location (address or directions) Applicant Name J~vce ,~/,JO~,~. ,<;' Telephone: Home6~'~-,~'2-~"~-- / Applicant Address / Applicant is (check one): Lending Institution []; Owner/builder~; Buyer r't; Other [] (explain); Business (d) Lending Institution ~o. ,,~-~q~ ~; Address Telephone (e) Real Estate Company and Agent /'J O ~ ~= Address Telephone (f) Mail the HAA to the following address: S & S ENGINEERING SRB 196X P-.AISLE RIVER, AK 99577 TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well~ Community[] Public [] r, 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 Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA ~ A AND INFORMATION As cedified 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 pf 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 in~p~i~iGiNEERiNG Name of Firm ~ ~ j~{~, Telephone Address ~.~.G~.~ ~iVEE, AK ~577 Date ~E E~/~/~ C~S ~o~ ~o .-- ¢,z/_ ¢ ¢,,~ ¢.. Approved for ~ bedrooms by ~ - - . Date Approved Disapproved Conditional ms ct Conditional App:oval ~ ~ ~ ~d _l d/?87 - CAUTION The Muncipaiity 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) MUNICIPALITY OF ANCHORAGE (MO~.,) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: NJUNICIPALITY O1: ANCHORAGE DEPT. OF HEAL~'H & ENVIRONMENTAL pROTECTION WELL DATA Well Classification ..~:~J U~-- ~ If A. B, C, D.E,C. Approved (Y/N) Well Log Present (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 Go.~ments /'~./~/~--~/// Date Installed Standpipes (Y/N) Depression over Tank (Y/N) 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 Size No, of Compartments Air-tight Caps (Y/N) Foundation Cleanout (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) / / T~j ,pra.r,~Holding Tank Permit (Y/N) Separati°n Distances fr°m Septic/Holding Tank/A// // l,/~ To Water-Supply Well ~ ~ I/'~°/ fdin.~ Foundation To Property Line ~,~ Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course · 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 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~'~e ~.~'J"' - /~"~4:;, ~ C--, ~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) /~/~/ate of Last Adequacy Test ~,~, T~o Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manh?e/Access (Y/N) /"P,~mp Off" Level at (Y/N) ~.,/ /~JmPing 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 arid HAA guidelines $ Signed & S ENGINEERING Date SRB 196X ' c~d'~/~.~_ Corn pai~GLE RIVER, AK ~T/ MO^No. Receipt No. ~Ob I ' ~ Date of Payment Amount: $ ~ I~ Page 2 of 2 72-026 (11/84) in effect on the date of this inspection. HEALTH AUTHORITY APPROVALS SEWER E WATER MAiN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTtON & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT A. SHAFER March 8, 1987 CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAO~E DEPT. OF HEAl. TH & ENVIRONMENTAL p~O,rEC HOht Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 RECEIVED REFERENCE: Lot 52; Section 9; TI5N~ RIW A conditional Health Authority Approval #H86-1334 and an on-site sewer and we~l p~rmit #87006 was issued for the referenced property. AK the work required to be performed to satisfy the conditions of both the HAA and the permit has been completed. Attached is a copy of the w~ll log and coliform bacteria analysis for the new well. Also a copy of the inspection report for the inst~ation of the holding tank and maintenance contract is provided. A new check list is also provided for your records. RequeSt you issue a final Health Authority Approval for this property. If you~,,~h~any additional questions, please contact me. Sineer~y, / SRB 196X EAGLE RIVER, ALASKA 99577 Drive AK 9957