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Home My WebLink AboutEAGLE CREST #1 TR B LT 46Eagl Lot 46 #050-291-03 Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCAT,ON SEPTIC TANK= DISTANCE FROM WELL INSIDE LENGTH MAILING ADDRESS PHONE INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS. I IQUID CAPACITY 10OD GALLONS. SEEPAGE PIT: NUMBER OF PITS I DIAMETER ..(L~OR WIDTH I~'l, LENGTH {~1, DEPTH I~-' LINING MATERIAL ~ CRIB SIZE: DIAMETER DEPTH DISTANCE FROM: ~ t TOTAL EFFECTIVE BUILDING FOUNDATION ~ NEAREST LOT LINE ABSORPTION AREA (WALL AREA} WELL ADDITIONAL ABSORPTION WELL: TYPE ~ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION ~-~/i~P~ NEAREST NEAREST LOT LINE SEWER LINE OTHER SOURCES DISAPPROVED DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK -- SYSTEM REMARKS DIAGRAM OF SYSTEM t. c,~. ,eh ~;. DISTANCES= INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: Form No, LQ-D31 APPROVED G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUAt. ITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Performed For ~/~/~.,.F ,'~ Legal Description: Lot This Form Reports Soils Log ~ Soil Test Must Be Logged To 4' Depth Feet Soil Characteristics Case # 4-- 10-- 11-- 12~ 13-- 14-- ~j//~$~/Jc~' Dated Performed /~/,'/~,.~ ~7~,4~~ ,Subdivision ~"m,o/~ 0~/~ PerColation Test Below Proposed Seepage System - Was Ground Water Encountered?. So ~^ If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet .Depth to Bottom of Pit Or Trench COMMENTS: Test Performed BY /~_ ~ ~.x~,~.~ Date Certified BY: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewatcr Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELDNG Parcel I.D. Expiration Date: 1. GENERAL INFORMATION Complete legal description LoT q I~ ~ Location (site address or directions) Current Property owner(s) ~ '~.x~,~ Day phone Mailing address I~ 0 ~4'~ ~' ~l'{ Lending agency Mailing address Real Estate Agent Mailing Address Day phone Un/ess otherwise requested, HAA wi//be held by DSD for plckup. NUMBER OF BEDROOMS: .~ , 3. TYPE OF WATER SUPPLY: Individual WeII Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Deve!opment Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificatas of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of Ihe validation date shown below, I vedty that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedty 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. . NameofFirm ~ ,l~bz, ~p~vJ/,.l~,t/,( ~' Phone Address ~ ~ ~ I,~.'.'~/--~t Engineer's Printed Name '~"~'~ _~ovlZled~-~ Date ~/'~d/t~[ · .. £r.;(O.-, ","/.':' .,'t' '~ ' ,";"[' ,', · ,'/' ';~, ENGINEERS 5. DSD SIGNATURE L.',' ',:' ~, C:*':,,: .. ~ ," p'"" Approved for ~ bedrooms. . ,.:- ,,~ Disapproved. "~"~" ' ' ' d3%'.,] ne ,//.. Conditiona approva Jor bedrooms. ,,,ith the owing stipu a . g[ ..... . ~' WATER AND .~ · PROGRAM .. .~ c.~,-.. .. r ,6,.' ~ Additional Comments tN'ore: The ~vell for this property meets existing State and Municipal Codes. There are nitrates Current nitrate concentration is 5.06 mg/i. EPA maximum concentration is 10.0 m~/I. More information ou nitrates is avmmb~e Irom tile On-Site Sen'ices Program, at 343-7904. Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Dlvisian On-SEe Water & Westewater Program 4700 Sou~h Bragaw St. P.O. Box 196650 Anchorage, AK 9951g.6650 www.ci.anchomge.ak.us (gO7) 343-7~O4 Legal Description: WELL DATA Date completed To~ d,n,th ~ Date of test Static water level Wall production HEALTH AUTHORITY APPROVAL CHECKLIST E~_,I.~ ~ _ ~t _ g.p.m. wal~ L~ (Y/N) Wires pmpedy protected (Y/N) Casing height (above ground) AT INSPECTION "7 g.p.m. "~O in. WATER SAMPLE RESULTS: Coliform ~) colonies/100 mi. Date of sample: b/~,JP I Other bacteria ~t~ colonies/100 mi. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size gal. Foundation cteanout (Y/N) Date of pumping Number of~partments ~ession over tank (Y/N) ../ Pumper Data installed Cleanouta (Y/N) High water atarm (Y/N) C. ABSORPTION FIELD DATA Date installed Soil rating (~p.d./ff2 or ft=/bdrm) System type Length ~ ft. ~ldth ~ ft. Gravel below pipe ft. Total depth _ ft. Eft. absorpt~6n area ~ Monitoring tube __ Depression over field _ Date of adequacy test / Results (Pess/Fai~) For bedrooms Fluid depth in absorption field be/Ib~e test in. Water added gal. New depth in. Elapsed Time: min. / Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (y/N & type) If yes, give date UFT STATION Data installed 'Pump on' level at in. Datum E. SEPARATION DISTANCES / S~ze in gallons / ~ levei.,~// in. Cydes tes~ Manhole/Access {Y/N) High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot f,t//.~ Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank ~ //-¥- SEPARATION DISTANCES FROM SEPTIC/HOLDING T?K ON LOT TO: Building foundation --. -- Property line ~ Absorption field. . Watar main ~ Water ser~ce~e ~ __ Sudace watar _ Wells on adjacent lots --. -- / SEPARATION DISTANCE FROM ABSORPTIO/~VFIELD ON LOT TO: Property line Building fou~:taflon _ Water main __ Water Service line Surface ?tar D~veway, paddng/vehide storage Curtain drain Wells 1adjacent lots COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have detannined through field inapecffons and review of Municipal records that the above systems are in conformance wfth MOA HAA guidelines in effect on this data. Engineer's Printed Name *'~ ~.~ ~4 I ata '1 1o, HAA Fee $ Date of Payment 0/3.~/~, / Receipt Number ~,1 s~ '7 (Rev. 1~) Waiver Fee $ Date of Payment Receipt Number T-095 ?.05/Og F-BS~ Project Namc,'~ lC. ,' 5 ~f, 0 5:N~' mt~/L EPA 3~'~0 0 ri :o!/1OO,ad, $.MI8 9222B APPLI T FILLS'OUT UPPER HAI." ONLY Phone Multiple Family NO. Of Other Public Utllily ~, ~ Holding When ~ected to Public Utility; . ,, NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ( ~ APPROVED ~DROOMS ~ 'CONDITIONS OF APPROVAL ( ) DISAP~OVED ( ) CONDIT~N~ ~P~ OATE ~lls Rating Date ~wer Instalt~ Wetl To ~sorption Area Well L~ R~eiv~ Well to Tank Septic T~k Size Tt=.a Time .~_~,...~ Date Date D~ate Insp~tor Insp~tor Ins~tor ~mments ~nditlonal Approval Date Sewer Install~ Pe~it No. ~ptlc Tank Size //__Q ~ Holding Tank Size ~lls Rating Well To Absorption Area Wed L~ R~elved Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Legal Description ~ ~ ~' ~ ~ ~ , ~aC~ ~ Typ~ Residence D Single Family D Multiple Family No, of Bedr~ms ~Other ~, ~.~ . ~ ~ ; Individual A~ACH WELL LOG. A well log Is mqulr~ for all wells drlllN since June D ~mmunity 1975. For wells drilled prior to that date, give well depth (attach ~g If ~ Public Utilit~ available.) Sew~ Disposal ' Year Individual Installed: ~-~Oc;'~- FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATE~ NOTE: THE INSPECTION I~ATE RECEIVED ~'~ ~" ~ INSPECTION APPOINTMENTS TIME TIME TIME CATE CATE CATE o MUNICIPALITY OF ANCHORAGE (~'~ ,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ~ 825 L Strut - Anchor~, Al~a ~1 ENVIRONMENTAL SANITATION DIVISION Tele~e ~47~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts o, page 1. Incomplete ~u~ ~11 ~ot ~ pr~. ~ease ?low ten 110) days for pr~sing. 1. PROPERTY OWNER , PHONE ..Fran~ ~C_rv3~ml ~an~a/'' ~qq-3~3b PROPERTY RESIDENT (If different from ebon) 4 PHONE , PHONE UAILING ADD~S 5 - 5n MAILING ADDRESS ~- ' 4. REALTOR/AGENT PHONE MAILINQ AD'ESS 5. LEGAL DESCRIPTI. I~LM · STREET LOCATION -- % ~, Q - 6. ~Y~E OF RESIDENCE NUMBER OF~BEDROOMS ~ One ~ Four . D Other ~ SINGLE FAMILY Two ' Five ~ MULTIPLE FAMILY ~ Three ~ Six ~ INDIVIDUAL' ' A~ACH WELL LOG. A well log is required for all wells drilled · ~ COMMUNITY since ,June 1975. For wells drilled prior to that date, give well ~ PUBLIC UTI LITY depth (attach I~ if available.) SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY .YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72.010 (Rev. 6/79) ~ THIS SIDE FOR OFFICIAL USE ONLY -' 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR I'-I SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL . [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER r--IINDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []SepticTank or [--iHoldingTank Size: If Tank is homemade SOILS RATING · give dimensions: .. TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL WELL TO: .... . . . Absorption Area to nearest Lot Line .... 5. COMMENTS ' [] APPROVED FOR BEDROOMS [] CONDITIONAl APPROVAL (letter must accompany certificate) I-'1 DISAPPROVED DATE BY 72-010 (Rev. 6/79) GREATER ANCHOP~AGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received 5/9/74 Time of Inspection lO:O0 Date of Inspection ~/15/74 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: e 4. 5. 6. e Be VA Smi le.v's Realty A1 Zimmerman Phone: Phone: Legal Description: Lot 46. Tract B Eagle Cre~t ~uhdJv~p~nn Location: Nile 2 Eagle River RQ~d Type of facility to be inspected Well Data: A. Type Drilled C. ConstructtonStandard Sewage Disposal System: A. Installed 1972 SiDgle Fnm41y No. of bedrooms 3 B. Depth D. Bacterial Analysis B. Installer R.B, Wood & Son C. Septic Tank: 1. Size 1000 9als D. Seepage Pit: 1. Absorption Area 12'xlg'xl2' 2. E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank llO' Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line 2. Manufacturer St, ck ~+~1 Material ~nn~m+m , Absorption area 14~, Other contamination , Absorption area , Sewer Lines EQ-034 (1/74) Page 1 of two pages -' Pa~e 2 of two pages - Re~..~st for Approval of Individual ...~er & Water Facilities Legal~D~scriptton ,~7"~,~ -/',~',,~'.~ /~'-,~/~,,/~ Comments Approved~ Disapproved Date _~~/ Approval Valid for one year from date signed Greater Anchorage Ar~a Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) 17, lg74 Veterans Administration 429 O. Street Anchorage AK 09501 S~BJ~CT: Lot 45, Tract B, Eagle Crest Subdivision, Sir: The subject lot ts not kYatlable to public sewer, end tt is not economically feasible to serve the lot with public se~r at this tla~. The sewer system, if installed to local specifications, should provtde adequat~ su~age disposal until such tt~ as public se~er is availaulc. ~e water supply, ~htch must be an Individually drilled ~ell placed at least 100 feet fro~ the se~er system, s~muld proviO~ a potable supply of ~ter if Installed to stale a~ld local specifications, Sincerely, John R. Lee, R.S. Eaole River Otstrict Sanitarian sr / i