HomeMy WebLinkAboutBEVERLY HEIGHTS LT 2Bevcr y Heights
Lot
#051-232-d9
MAILING AD DR ESS~-..~
LEGAL DESCRIPTION
LOCATION
l' 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
PH, ONE
Inside length
Dwelling
Foundation
Total length of lines
Material beneath tiJe~,.
Depth
Crib depth
Building foundation
Driller
Sewer line
DISTANCE
TO:
ua Length of each llne
< t.- Type of crib Crib diameter
[u Well
~ DISTANCE TO:
ua Building foundation
~: DISTANCE TO:
NO. OF BEDROOMS
PERMIT NO,
OTHER
PIPE MATERIALS
SOILTESTRATING
INSTALLER
REMARKS
I[] NEW
[Z]JJPG RADE
Material No. of compartments
Width Liquid depth
PERMIT NO.
Material Liquid capacity in gallons
Nearest lot line PERMIT NO.
Trench width
inches
inches
PERMIT NO.
Nearest lot line
D~stance to lot line PERMIT NO.
Septic tank Absorption area(s)
APPROVED
72~)13 'fRev. 3/78) '
DATE LEGAL
MUNICIPALITY OF ANCHORAGE
Department~. Health and
Environmenta?'?rotectio
825 - Street, Anchorage, AK. .9501
264-4720
'" ~'P ' ' # HANDWRITTEN PERMIT ' ~ '
Permit #~'~' 'WELL AND/OR ON-SITE SEWER PERMIT
Phone Nu~er:
Lot Size:
Seepage Beds Holding Tank:
Soil Rating(sq.ft/br) ~.~'
Location:
Legal Description:
Type of Soil Absorption System Is:
Trench: ~ Drainfield:
Maximum Nund~er of Bedrooms:
The Required Size of
DEPTH ID' LENGTH
the Soil Absorption System Is:'
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('HetD'h'~) TANK SIZE =~/~/V& GALLONS ' '
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
o~ residences that the well will serve;
' ' "TWO(2) INSPECTIONS ARE REQUIRED e # .
Backfilling of any system without final inspection .and approval by this depart~en
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 fee
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.
# . e 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
(2)
(3)
SigneR:
set forth by the Municipality of Anchorage.
I will install the system in accordance with codes.
I understand that the on-site sewer system may require enlargement if
the residence is remodeled to include more that 3 bedrooms.
Ap~t Date: ~/~/~1 ~/ °
SWP/024 (l/S1)
MUNICIPALITY OF ANCHORAGE
nEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. St~et, Anchorage, Alaska 99501 2644720
SOILS LOG -- PERCOLATION TEST
SOILS LOG
PERCOLATION
TEST
SLOPE SITE PLAN
WAS GROUND WATER z/ S
ENCOUNTERED? /~b L
O
P
E
IF YES, AT WHAT .//~
DEPTH?
14 ~ ~' ~' T' f~rroH o F//~eF Gross ~.~'_~''~. Depthto Net
Reading Date Time ~T~ 4t ~&~ater Drop
20-
PERCOLATION RATE (minutes/inch)
TEST RUN BETWEEN FT AND FT
PERFORMED BY: ¢,'~ ~,~.~r.~.r/¢~}/~f~ CERTIFIED BY: Z ~Z~'~"~ DATE:
72-008 (6/79)
WE SERVE ALL ALASKA
POST OFFICE BOX 42 - CHUGIAK, ALASKA 99~7
~Dl~cc ~ L~'~ ~ ~' ~. ~' ~ '~ 'd ' ~ ' '." -' /;'"
..... ~ , ~- %. ~ '~- ,. ~ , .__ , ~-/ ~
DATE ' ~ ' ' " ' -- '
- STAR~ED .~ ...... ~...~;= ................................................................
DA~E - ENDED ...,~:~.=....~...~.~..:::....,~.:...::.' .........................................
KODIAK, ALASKA
4864826
/ / ' "~ '7 ~-..~ --,--
DEPTH OF ~,¥ELL ........ ..~.....~....{. ............ .-'......./..,. ..................................
STATIC LEVEL OF %¥ATER FT.-.~......; .............. ,......., ........ ,~'.,./....~.....~-.~:. ~
,O 'N ,,' d:
GALS. PER IIR ...........................................................................................
KIND OF CASING ,..;..-.d..,.~..,.....~. :...~.. ................ :; ............................
KIND OF FOIL',IATION: I
' ,")~" ,,-t ":/~-'':- : ~;' :;' /":' / ,;'
FROM ......t .......... :..... FT. TO .................. FT.-., ............................. ;.:-
FROM ..:,~;..-:;':-.-~Z.... Fr. TO ..-:~...J..~...... FT. :.'....:..L:'"..~.f.-...,.::J:.'.'.~
FROM ...,-,~..;.....~..:.... FT. TO-~.:..'.'../: ...... " ' ''
FRO.'., ..~:':.'.:~.../...... FT. TO ..:.~....'.:;..i:~... FF. :' ...:....:.."..~;:....;.:.;.:..:.:
':~ ~ 't' "-' ~ " '
FROM ........ a...~..... Fr. TO~,7~ ........ ~ .....FT. d..'~,:..,.~.Jt...'- .-T.....:-.,:.
FRO~I .,,~..t.../.;;;~. FT. TO "r'"'":"-'"t ...... FT,.'....,',
FROM ...................... FT. TO ...................... Fr ....................................
FROM ....................... Fr. 'fO ....................... FT ..................................
FROM ....................... FT. TO ........................ Fi" .................................
FROM ....................... FI. '1'O ........................ FF .................................
FROM ....................... FT. TO ........................ FT .................................
FROM ....................... FT. l'O ........................ FT .................................
FROM ....................... FT. TO ........................ FT .................................
FROM ...................... FF. TO .........! .............. FI .................................
FRO.',I ......... :....: ........ FT. TO ........................ FI .................................
FROM ....................... FI'. lrO ........................ FT .................................
FROM ...................... Fr. TO ...................... Fl' ....................................
FRO,',I ...................... Fl'. TO ...................... Fi' ....................................
FROM ....................... FT. ]'O ........................ FI .................................
FRO.',{ ....................... FI. TO ....................... FT ..................................
FROM ...................... Fr. TO ...................... FI ....................................
FROM ....................... FF. 10 ........................ FI .................................
MISCL INF OIL'dATION:
- ..;. ,- , i \
GREATER ANCHORAGE AREA BOROU'CA~&T~b
~30 Tudor R~d -- Pouch 6~65~
' ' I~E~J~N REPOR? ON-~IT[ SEWAGE 61SPOSAL SYSTEM
SEPTIC TANK:
D,STANCE FROM wm ~/
SEEPAGE SYS~E~: SEEPAGE pl~:~/~
N?- 932
COMPARTMENTS
GALLONS. INSIDE LENGTH // ' INSIDE WIDTH OEPIH
NEAREST LOT LINE ..' .' .' .'~"~ /
~ DRAIN FIELD:
DISTA~
NUMBER OF P,TS ! OUTS.OEO.AMETER -- ORW,DT. // ' LENGTH
MATER,AL /-~'~ C/~/,~ . D,sT~.cE ~,o~ ~m ~Z-/~
, BUILDING FOUNDATION
. TOTAL EFFEC*IVE ABSORPTION AREA ~ALL AREA)
NUMBER OF LINES
ABSORPTION AREA
, FOUNDATION . NEAREST LOT LINE
DISTANCE BETWEEN LINES~ TRENCH WIDTH
SQ. FT. LENGTH OF EACH LINE ~
DEPTH: TOP OF TILE TO FINISH GRADE
WELL: 'h'PE J)'/?-'J~ /~/.Z/D~P~ //4~''
LOT LINE /~ /?.z... NEAREST SEPTIC
SEWER LINE /~/~z.
TOTAL LENGTH
· OF LINES
IN. TOTAL EFFECTIVE
DEPTH OF FILTER MATERIAL BENEATH TILE
DISTANCE FROM ,~'/ WATER
,BUILDING FOUNDATION. 7 SAMPLE ~ , NEAREST
. SYST~ . CESSPOOL ~ , SOURCE~/~
DIAGR~ OF
~{~t -_ ~ GREATP_I. ANCHORAGE AREA BOROv.
DEPARTMENT OF I'NVIRONMENTAL QUALITY
i:~ ' SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
.AMEO. ARPLC....T/~r~ · £m/~.< ,',A,L,.G ADD.. /?''~' ~-""
,_;; ,NS'"AL~T,O. LOCA"'O. ~.~'wly 4Z'~. ,,'? .~
i~,'T.A.O,,.O.,AC,L,TTTO.'"-.RVS. ..~,~,,.1= ~,.-,,//.. ~,,.,/I,,~'~, ~ f~,~,.~.
OTHER
, SEI~rlC TANK SIZE
SEPTIC TANK, ~Z'~ SEEPAGE PIT //~(~ DRAIN FIELD
TO RIVER, LAKS. STREAM.
FITTED WITH AIRTIGHT REMOVABLE CARS.
G~'r~,TER
ANCHORAGE AREA BORr"~-~H
HEALTH DEPARTMENT
327 EAGLE ST. ANCHORAGE. ALASKA 99S01 279-2511
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
/
MATERIAL
DISTANCE FROM WELL ,,.~
uOU~D CAPAaTV /,~ ,S-'~
GALLONS· INSIDE LENGTH
SEEPAGE SYSTEM:
NUMBER OF PITS
LINING MATERIAL
NEAREST LOT LINE
TILE DRAIN FIELD:
SEEPAGE PIT:
OUTSIDE DIAMETER
ADDRESS ~"~"~,~-~' PHONE.
INSIDE WIDTH ~'~:'-~ / LIQUID
DEPTH ,,-~
OR WIDTH ! ~L . LENGTH /4- , DEPT. G
· DISTANCE FROM WELL /'~-- / ~' 1,
. BU~LD~NG FOUNDAUON ~ ?
· IOIAL EFFECIIVE ABSORPIION AREA (WALL AREA, ~'~3 ~:) SQ. FI.
DISTANCE FROM WELL
IOTAL LENGTH
· FOUNDATION . NEAREST LOT LINE . OF LINES
NUMBER OF tINES
DISTANCE BEIWEEN LINES
TRENCH WIDTH
IN. TOTAL EFFECTIVE
ABSORPTION AREA
SQ. FT. LENGTH OF EACH LINE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE IILE
LOT LINE ~ . SEWER LINE ~ ~ TANK ~ ~- , ~YSTEM /~ . CESSPOO~ ~ , SOURCES
!!: ·
0' to i5! ....... gravel
15' to 21' ....... Hard pan
21' to 26' ...... san~'~nd c~ay
26' to 29'6" --- grave!
29t6" to 40t --- olay end gravel
40' to 60' ..... clay ~d sand
60' to 73' ..... . Eard pan
73' to ?~'6" --- sand with little water
73'6" to 98' --- Hard pan
98' ........... Little seep
98' to 106~ .... Hard clay and sand
106' to 1D8' --- Olay and shale
138' to 178t --- Sandstone
178~ to 182~ --- Hard ~an
182' to 187' --- Sandstone'
187' to 190' --- Olay
190' ........... WATER
~ gal ~er ~lnute. 150' rise. Well
to !~0' .
Parcel I.D. fi
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Sewlces
On-Site ,Sewices Sec~on ·
P.O. Box 196650 Anchorage. AJaska 99519-6650
(9o7) 343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING
;I. Gi='~ERAL'IN FoRMAT10 N
'. Compl~t& legal description - [=~[VEF~LY HEIGHTS SUB. DMSlON: LOT, 2. " '
Location' [site address or directions) "~ 8~3{ BEVERLY ~,VE'NOE CHUGIAK'. AK 99567
· Pro' .pe.rty own. er ROGER BLANKENSHIP ........ Day phone (907) 688-6~07'
'" Mailing addmss 18931 BEVFRYLY AVENUE CHU(JiAK.'AK '9'9567"
Lending age~ncy Day phone
Mailing address
Agent Day phone
Address
Un/ess otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
In'di~,Idual well - '
Community well .....
" ' Public water'-
NOTE: If community well system, provide wrftten confirmation from Staie ADEC e~est-
lng to the legalib/ and status of systero. . .
4. TYPE OF WASTEWATER DISPOSAL: --.
Individual on-site xxx
Holding Tank ..
Community on-site
Public Sewer
NOTE: If community wastewater system, provide written confirmab'on from State ADEC
lng to the legality and status of system.
72-025 (Rev. 1/91) Front MOA #21 Coml3utsr Vertlon
6. DHHS SIGNATURE
X.: ~ Appi:oved for ' 3
Disapproved -
Conditional approval fo~: -
I Note; A/.aska. Water. and Waste. water Consultants, Inc. shall be paid $400.00 at,
or pnor to, Closing for the engtneedng services provided. - '
5. 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
wastewatar disposal system Is sa[e, functional and a_d~lbate for the number of bedrooms'and type of
structure indicated he _rei['~..I.fudher. v.~rffy~at.bes~l ~n ~e in _ .fc~r~_ ?tion_obtained from the Municipality of
)~,nchorage files and from~my'lnve.~tlgation ah~J Insl~e~tlon;the'0ff:site water'supply and/or Wastewater .
disposal system'is In compliance with all Munld ~al and State codes, ordinances, and regulations In effect
. Name of Firm ALASKA WAT/ER~ V~,S.~ tAT~R CONSULTANTS, INC. Phone (907} 337-6179
system In aoco~ance wfth'ADEC and MOA DHH~ Guidelines & Regulations. ,The. mperted results described the
ped..(~'n.-ance ¢~f the syst._em under .the. .c(~nd. it(~_, encoun, tered at .the time of ~ tes~ and separation distances'
the eyaluaJor of the s~tem. Satisfactory test results do not guarantee future pedorrnarice',' -.
Aw~C~ ~nc` can the~ef~e n(x ~m4de any w~r~n~y f~r future est~t~ &f h~ ~t~ ~eThe c~ntent ~f th~s rep~it ~s.f~ the s~e bene~t ~f the ~ ~sted ab~. Any . ' ~.~.,
system ~11 continue to meet the operational requirements of the ADEC or MOA DHHS ..............
relian~e'up~i or'iJ.~ of this'~o~rt by any other peFsoti -or parly ls hot authorized ............
bedro0msl V~i~h t~e followin? stipulati~h~:,,
Additional comments
The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority
Approval Certificates based only upon the repmsantations given In paragraph 5 above by an Independent
professional engineer registered In the State of Aleska. 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'ceH, ificata Is Issued. The Municipality of
Anchorage is not responsible for errors or oml~ions in the professional engineer's work.
72025 (Rev. 1/91) Bac~ MOA #21 Comput~ Version
A. WEU. DATA
Well Type PRIVATE
Log present (Y/N)
Toms deplh
unlcipa.ty o! Anchorage
DEPARTMENT OF HEALTH & HUMAN
~ntel 6endcea DIv~lon
~.5 "L" $1met. Rm 602 Anchorage, AMsk~ g9501
MUNIClP~JI'y OF ANGHORAC~
Health Au~hority APproval Cheokli$1~lv~AL ~cE~ o~ox
BEVERLY HEIGHTS S/D; LOT 2 Parcel I.D.: 051-2,,32-49
If A. B, or C, attach ADEC letter. ADEC water system number N/A
Date completed
Cased to 180'
5/10/72
Casing height (above ground) 18"+
Wires properly protected (Y/N) YES
*1go' PE~ WID. L LOG. WELL HAS BEEN Dt..LPENED PER HOMF. OI~ER. IT IS NOT KNOWN WHEN WELL WAS
Date of test
$latio water level
Well pnxluction
WATER SAMPLE RESULTS:
Coliform 0
FROMWEI. L LOG ATINSPECTION
5/72 9/21/00
UNKNOWN 208'
4 g.~m. 0.40
Nitrate /~.~; ~_5/L- Other bacteria
Date of ~ample: 11/6/2000
B. 8EPTIC~IOLDING TANK DATA
Date Instelled 5/10/1972 Tank size
Foundation cteanout (Y/N) *'~YES
Date Of Pumping 9/19/2000
C. ABSORPTION FIELD DATA
Date Installed 6/198,3
Length 26' ~
Effective abeorption area
Fluid (lepffi in abeOfption field before test (In.);
Fluid dep~ o' (Ins) Minutes latec
Peroxide ~eatmant (past 12 months) (Y/N)
;~o2a O~v. ~M)' oxr~w vmim
g.p.m.
A.W.W.C.. INC.
*HOMEMADE CONCRbI~. TANK
**INSIDE CRAWLSPACE
2,37.5 Number Of Compedmants 1 Claanoute (Y/N) YEs
Copresslon (Y/N) NO Hlgh water alarm (Y/N) N/A
Pumper JR'S PUMPING
Soil rating (g.p.dJlt2 ~ 85
U.K. Gravel thickness below pipe
*MEASURED IN FIELD.
system type TRENCH
~' Total depth .7.5'+/-
260 SQ.FT. MonltedngTubepmsent(Y/N) YES Depre~slanoverfleld(Y/N) NO
9/lg/2000 Results (Pass/Fall) PASSED For 3 Bedrooms
Q' Immndlatelyafter 488 gal. water added (in.): _
0 Absorption rate = 4,50+
N/A ff yea, ONe date -
D. UFT STATION
Date Installed
Manho!e/A,~ _~s (Y/N)
High water alarm level ate
Size in gallons
"Pump on" lev~ at'
*Datum
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Sept]c/holding tank on lot .56'+
Absorption field on lot .125'+/_
Public sewer main N/A
SewelYceptio ~ewlce line 25'+
"Pump off" level at'
Property line
Surface water
Curtain drain
"MEASURED FROM
On adjacent lots 1 oo'+
On adjacent lots 10o'+
Public ~wer manhole/cloaneut N/A
U~ ata~Orl N/A
EDOEJTO EDGE OF PIPES.
Waiver Fee $
Date of Payment
Receipt Number
F. ENGINEER'8 CERTIFI,~.aJ~IO~
of Munlclpal /ecord.~ t ~/th[~ af~/ve systems ere In conformance
with MOA I-[/RA gulce4~/(//~ ~,?ejfffL"t'oa ~hls date.
Eng . .,emaI, . , NES$
Oata ~l/q I~
Water maln/cendce line 1 o'+
D~amy, parking/vehicle storage area 1 o'+
Wells on adjacent lots 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+
Water maln/cewlce line 10'+ Surface water/drainage 10o'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
10'+ Building foundation 10'+
lOO'+
NONE KNOWN
Absorption field 5'+
Wells on adjacent lots 100'+
MUNICIPALITY OF ANCHORAGE
MEMORANDUM
WATER WELL ADVISORY
AUT,,OR T APPROWL NO.
During a recent Health Authority Approval on-site inspection
and test of t]~e potable water supply well on Lot ~
Block -- of ~F l~ ~,~f Subdivision, the well's
productivity was determined to be ~ gallons per minute.
The minimum well productivity required by this Department
(AMC 15.55) for a ~ bedroom residence is O,~ gallons
per minute. Although the subject well currently exceeds this
minimum requirement, all parties concerned are advised that the
production capacity of the well may fluctuate. Restriction
of non-critical water uses such as washing cars and watering
lawns and gardens may be required.
This advisory must be attached to all copies ~f the subject
Health Authority Approval.
~ MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY ~PPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date I.'JP.~RU~RY ~.q, 108'/
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
BEVERLY HEIGHTS, LOT 2 T15N, RIW, Sec 18,
(b)
(c)
(d)
(e)
(f)
Location (address or directions)
BEVis-']:~Y DRIVe, CHUGIAK. /g_,ASKA
Applicant Name I',1~7 W./~ Telephone: Home J'i/A Business
Applicant Address R'~./~.X OP 1F'A. GT,1F. RTVk'3~, PO ROX 7778LIq, T:'A~T,E RTV'~R, ATA.C;gA qq~77
Applicant is (check one): Lending Institution ri; Owner/builder ri; Buyer I-I; Other~ (explain); R'PAI',T'c~T'AT~
Lending Institution NClR'I'HT,ANI3 Iq,qRqYl~R'F Telephone 69h-TR77 ATTN.' Katie
Address 1~00 W. TUDOR, ANCHOP~AGV., AT,ASKA
Real Estate Company and Agent RI~LY OP V~!,F.. R'r~FR, I',Im,~, WA!
Address P.O. Po~ 77PR4q, FAC, T,F R~nmR, AI,AS!~A q9577
Telephone (907)
Mail the HAA to the following address: PICK-UP ~ ~GIN~,J-:i-U:NG SEiTv'ICE '
'FAC, T.!:' RT%~:I~, AT.A~I~A 99577
TYPE OF RESIDENCE
Single-Family J~( Multi-Family f-I
Number of Bedrooms
Other
. .I
WATER SUPPLY ' ' ' ,
IndividuaIWellJ~ Community[] Public[] '
Note: Il community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting to the legality and status· '
SEWAGE DISPOSAL
Onsite J~ Publicr'l 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 ~,2.~:z5 (..e4)
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 ~ealth
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adeq u.., t e
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 o! Firm EAGLE Rlrl~ER ~GIhrlEERING SERVICES Telephone (°07) 6qq-5195
Address PO ]~OX 77329q. E./1..G[.,IZ R~v'1ZR, A.~SY-,A 99577
Date FFBRUAR¥ ).9, 1957
DHEP APPROVAL
Approved for ~bedrooms by
Approved ~_~ Disapproved
Terms of Conditional Approval
~onditional
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.
Page2of2 ' ",
MUNICIPALITY OF ANCHORAGE (MOAi
HEALTH AUTHORITY. APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984
264-4720
Legal Description:
Well Classification
Well Log Present (Y/N) Y
Total Depth ~f 7o" Cased to
Static Water Level ~;?
Casing Height Above Ground 2"
Electrical Wiring in Conduit (Y/N) Y
Separation Distances from Well:
To Septic/Holding Tank on Lot '~'~.'-E"
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line + ! o
Cleanout/Manhole ~ lo'
Water Sample Collected by
If A, B, C, D.E.C. Approved (Y/N)
Date Completed /o/'r~, W Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
,'oo ; On Adjoining Lots "
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date 2 - ~' - $ 7 c..'"
B. SEPTIC/HOLDINGTANK DATA
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 Wetl ~'~"
To Property Line * lo'
TO Water Main/Service Line
Course 4 io~ '
Comments"
Size I 2 30 ~)..~. No. of Compartments
Air-tight Caps (Y/N) ~' Foundation Cleanout (Y/N)
~ Date Last Pumped /'~'
~"~ ; for
~v~ Temporary Holding Tank Permit (Y/N) /VA
To Building Foundation ,d ?
To Disposal Field ~'J""
To Stream, Pond, Lake. or Major Drainage
Page I of 2
72q326(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed ' ~/~" !
Width of Field 3 '
Square Feet of Absorption Area ;2GO ~ U,.'
Depression over Field (Y/N) ~J
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well I =, o
To Building Foundation I ~ o '
Lot
To Water Main/Service Line ~ to,
To Stream/Pond/Lake/or Major Drainage Course
To Driveway. Parking Area, or Vehicle Storage Area
Comments
Type of System Design
Length of Field 2 4' ' ~.~
Depth of Field I o ' : . .
Gravel Bed Thickness ,.5' '
Standpipes Present (Y/N) "r'
Date of Last Adequacy Test 2. -'~ -,~ 7- ~"
To Property Line '~ lc, '
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present) ~ .C(. '
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
*° Check Permitted Bedroom Rating Against HAA Request
I certify that I ha~v~hecked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed
Date
Company ~,~ E.t MOA No.
ReceiptNo. /~'~)/" (~)~.) 2-./"
Date of Payment ~--/_~.0/~
Amount: $ //~) ~:)~
,ST''o Z
Page 2 o'f 2
Property C'wner
?. Tom and Terry Fatherree
MailingAddrsss P.O. Box 689, EaRle River, Ak 99577
Suyf~ichael & .Whitnt Funsin
.~d~,ess 1545 N View Dr. Anchorage, Ak 99504
t,,dlng~ns,m,on Spokane Mtg.
Addrass 3201 "C. St. Suite 250, Anchorage, Ak
Really CO. & A~ent RE/MAX of Eagle River
Legat Description
Type of ReslCtence
~E] Other
W~ter Supply ~ Individual
~ Community
Public Utility
Sewe~rPUisposal
APPLIC~"~IT FILLS OUT UPPER HAI/"ONLY
Add,.. P.O. *BOX 848, Eagle River, Ak 99577
Zip Code
Zip Code
99503 z,p c~e
Joyce Porte or Virginia
Zip Code '
Lot 2 Beverly Hts.
NHN Beverly. Driver(map attached)
No. of Bedroom~ 3
Pt~°ne688-297 5
277-0543
Phone
694-4200
ATTACH WELL LOG. A well log la required for all wells drliled since June 1975.
For wails ~rilled~ prior to that date, give well depth (attach log if available).
Year Individual Installed: "1971
When Cor.lected to Public Utility:
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE P~OCESSING CAN BE INITIATED.
Time Time
Date Date
Inspecto¢ Inspe~:tor
Field Notes:~_~ iC_. %~
) APPROVED BEDROOMS
) DISAPPROVED
) CONDITIONAL APPROVAL'
DATE
BY:
Time Time
°CONDITIONS OF APPROVAL
Soils Rating I Date Sewer Installed
Iwatl To Absorption Area
Well to Tank
EXCAVATION
WORK
May 30,
1983
ROBERT A. SHAFER
CIVIL ENGINEER
694-2979
Re/Max Realty e/f
ATTENTION: Joyce Port
P.O. Box 848
Eagle River, Alaska 99577
Doar Ms. Porte,
Reference: Lot 2; Beverly Heights Subdivision
A sewer system adequacy test was performed on the system located on
the referenced property as you requested. The septic tank was pumped
and verified to have a capacity of 1000 gallons. The seepage
pit was tested by charging the system with approximately 150 gallons
of fresh water prior to the water coming out of the ground on the
side hill adjacent to the crib.
It can be concluded from ~his test t~at the septic tank is adequate
for the three bedroom residence. HoWever, the seepage pit appea~s
..... to have failed. The crib was completely full of water at the
beginning of the test and when additional water was added to the crib
'water was observed pouring out in a steady stream along the side
hill adjacent to the crib. It will be necessary for the absorption
area to be upgraded before it can be considered ~deqb~te for the
three bedroom residence located on this property,
If we may be of further service,
US.
(~R~BERT A. ~I[hyETC~, P.E.
.' mks/ss
cc: Municipality of Anchorage
Department of Health and Environmental Protection
please do not hesitate to contact
SRB 196X EAGLE RIVER, ALASKA
GREATER ANCHORAGE AREA BOROUGH' '
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686 DATE RECEIVED:'~'-/~--'7'z-'
INSPECT:
TIME:
1. APPROVAL
ADDRESS:
PHONE:.
2. PROPERTY OWNER:
3. LEGAL DESCRIPTION:
4. TYPE FACILITY TO BE
NUMBER OF BEDROOMS:
~EQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
REQUE~STEO BY: :~ ~, ~, 'r~ ~ ~' ~ m
.-~/~ PHONE:
·
INSPECTED:
5. WELL DATA:
A.
B.
C.
O.
E.
6. SEWAGE
DEPTH ! Y? ~7 '
SIZE ~ ~'/
CONSTRUCTION
·
BACTERIAL ANALYSIS
DISPOSAL SYSTEM:
Ae
SEPTIC TANK {IF HOMEMADE,
1. SIZE / ~- ~
2. AGE / ~ ~
SHOW
3. 'MANUFACTURER
DIAGRAM
ON BACK)
4. INSTALLER
-- ~ APPROVAL
· P/LGE TWO
REQUEST
SEWER & WATER
FACILITIES
B. SEEPAGE PIT
1. SIZE /~7
2. LINING
C. DISPOSAL FIELD
1. NUMBE~INES
2. TOTAL LENGI~
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK.
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE "-----'-
D. WELL TO PROPERTY LINE /~--~
E. WELL TO OTHER POSSIBLE CONTAMINATION
F. FOUNDATION TO SEPTIC TANK ~--J'/
G. FOUNDATION TO SEEPAGE PIT
H. SEEPAGE PIT TO PROPERTY LINE
8. COMMENTS:
DATE: ~ //~f'~ ~
APPROVAL VALID FOR ONE YEAR
GREATER ANCHORAGE AREA
DISAPPROVED:
DATE:
FROM DATE SIGNED·
BOROUGH DEPARTMENT OF
ENVIRONMENTAL QUALITY
Raymond £mmons
Post Office Box 8~
Chuglak, Alaska
Subject: Lot 2, Beverly Subdivision
Dear Hr. £mmons:
The construction of the well servtng the subject properly
~s epproved and the proper distances from the ~ell to
the sewer system have nov been ~et. The se~er system
ts an approved syste~.
%f you have any questions concerning the above, please
do not hesitate to contact this office.
Sincerely.
Lynn Coed
Environmental Specialist
cc: VA Administration
bb
Deer Str$:
wis only ZO feet from the septtc tln~ en~ 8~ fete
~c Itlen, thc well ~tste~ces of ~C feet fro~ the
septic tsn~ ln~ 10~ feet from the seepage rlt nec~ to be
o~tatne~.
~ot ~esttate to cent&ct this office.
Sincerely,
Lynn $. Coed
£nvtronmentel Specialist
st
cc: Reymond 3. £mmons
VA Ad~tntItritton
,DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99507
279-8686
DATE RECEIVED:
INSPECT:
TIME:
II - I~ '71
:'7 .'.?0
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER AND WATER FACILITIES
FOR
1. APPROVAL REQUESTED BY:
NUMBER OF BEDROOMS:
WELL DATA:
A. TYPE .I
B. DEPTH
C. SIZE
//
D. CO,STRUCTION
E. BACIERIAL ANALYSIS
6. SEWAGE DISPOSAL SYSTEM:
2.
3.
4.
SEPTIC TANK (IF HOMEMADE. SHOW DIAGRAM ON BACK)
SIZE / '~. ~-c:>
AGE
MANUFACTURER
INSTALLER
APPROVAL REQUEST FOR SEWER & WATER FACILITIES
PAGE TWO
e
Be
SEEPAGE PIT
~. SiZE //-/X 7~ ~:7~ .~'~,c,,;~
2. LINING
C. DISPQ~ FIELD
1~ NUM~F LINES
2. TOTAL LE)~
REQUIRED MEASUREMENTS
A. WELL TO SEPTIC TANK
B. WELL TO SEEPAGE PIT
C. WELL TO SEWER LINE
D. WELL TO PROPERTY LINE /~"'~"
E. WELL TO OTHER POSSIBLE CONTAMINATION
F. FOUNDATION TO SEPTIC TANK /~
G. FOUNDATION TO SEEPAGE PIT ~7I
M. SEEPAGE PIT TO PROPERTY LINE ~f-~)/
8. COMMENTS:'
APPROVED:
DATE:
DATE: //-/'~-
APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED.
GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY