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Home My WebLink AboutTANAINA HILLS LT 3Tanaina Hills Lot 011-051 -04 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT qame DISTANCES L t)t~ -~ (_l.. 'F ~ l o i, Yi,4 _~ SEPTIC ABSORPTION Address TANK FIELD Phone(si No ol S,~ooms WELL 'T LOT LINI: Township, Range, Seclion · gq -I-IZ/d TANKS SEPTIC [] HOLDING /Z~O NO. of Comparimenls TYPE OF SYSTEM 0~'TRENCH W. DRAIN [] OTHER BED Total depth Irom original grade Depth to pipe bottom Irom original grade ~/ FT FiU added above original grade ~,_, C~- FI Gravel depth beneath p~pe Gravel lenCh Gravel width Distance between lines Pipe material WELLS [~RIVATE [] OTHER (Identifv) ClassiScation (A,B,C) Total Depth Installer (~ ~0~ Dale Inslalled: REMARKS: WELL 24', ' //' FOUNDATION AS-BUILT DIAGRAM (Show location ol well, septic system, property lines, Ioundalion, driveway, water bodies, /'~/~/WA I,."-/. ~."" A/~//)/-:"7~£0 eJ cerlily thai this inspe~tlon was perfornled according to all IMunicipal and State 9ulDelihes ih ellsct 0n ihl./~dat~ , //~5"/¢0 ) Hesllh Depadmen, Approval: g~~~// Date:. 72-013 (3/85) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geologicot ~ Geophysicot Surveys lc. OtSTANCE ANDDIRECTIO FROM ROAO INTER~ECTIO#g 4. WE ~ [ TH:(IInQI) t~. T[OF ~TI ~ ~_ ' ~ ~ ? ~ 0 ,-,-,,- 0 ..-... 0 c....,,.~ I0. STATIC WATER LEVE~l~ft, '-- [qulpmeflt Mild: IZ.GRO~TING Well G~oulid: ~ Yel ~ NO I~. PUMP: (If ovallabie) 0 ~.b.. O 16. WATER WELL COHTRACTOR'3 C[RTIFICATION: IS.W~llr T.mp.r~tur. , c I ,.C~II,'~ E:L!.... i' (:' c.) ~: r c:,? c:ic.c :i r ~::) ~[* J. I'i !i;!c :!. a ~'. ii. (:Icl o ',/(,..! I" IL a I1 I.:; ( !ill ) ~: ]:l"fl::[)!::d¥1 Z;h,l"h,l'l,,fi;,, I:::'F',':[C)F,: t'[::) :l:l',lSF:'li:l:71']:l:ll"t':~ I:t¥ IEIql3;l:N[ii:t:[d:~, :i:F CC)N!ii'] I::dJC; I' !::"EF;: El".t(:a ]: Ixl[:.:li~:l::;: ' :}~ f-*/l' !'~E;I'IIE[) S:/l!i!ii~ :1: E)I;I ,, I I'1:1 ~/i F:'t:!!:I::~M :[ '1 IE X F' :I; I::~l~:!i!i :1. ;:':~ /:/!; :t./*?O Pd"4]:) V/~I... Z[ ~.) Ii:Ell:ii: PI ~:il ]: Iq('~L.t!: I::;hl¥[ :t: I.Y HC)I¥1E:. LEGENO 0 LOT CORNERS FOUNDATION MMlael ~, Anderson ~ ~ - DRAINAGE ARROWS 4381 - E NOTES~ BESSE, EPPS 8~ POTTS ?.220 E. 881h. AVE. $49-64§2 ANCHORAGE, ALASKA 99507 349-64§4 DRAWN aY, ~)~-- DA?E' (~ - -1 - ('~ {..,.) FLD. BK. ' Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN.SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:. DATE PERFORM6 LEGAL DE: 1 2 3 4' 5- 6- 7 8 9 10 11 12 13- 14--- 15- 16 17 lO 20 CRIPTION: · .~ Township, Range. Section: SLOPE SITE PLAN ~ 53 7~gA/~A ~I,LLS WAS GROUNO WATER ENCOUNTERED? IF YES, AT WHAT PERCOLATION RATE TEST RUN BETWEEN /Bo PERFORMED BY: /'/]t,/~':)e /~,),,~o,,~ q/J~ I jv~l UI~CL- ~', /'~'J.~l:"/,lJJ,~CERTti:Y THAT THIS TE~T WAS pERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GLIIOE/.JN~:S IN EFFECT ON THIS DATE. OATE- 72-~O8 [Re~. 4~85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I,D. # ~[/- D~' t -- (~c[ HAA# 1. GENERAL INFORMATION ' : Complete legal description ~o~ Location (site address or directions) Property owner hike Gearhart Mailing address ~6910 Tanaina Drive Lending agency '. Mailing address 6910 Tanaina Drive Anchorage, AK Anchoraqe, Day phone AK 99502 Day phone 248-0826 Agent Addres~ Day phone Unless otherwtse requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4__ TYPE OF WATER SUPPLY: Individual well Community well Public water xxx NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. ~ 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ' attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 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 ali Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING 170'~, ~-agie Riwr gu~p ;~u.~: ~. 2'*',,4 Phone ~ c~/../- :gL c~ '~ ~ Address Eagle Rlver~ Alaska 99577 Engineer's signatu re '/~'-,/~- ~'-"7~-- Date / ~'/(; /c'/( Disapproved. Conditional approval for bedrooms. be,drooms, with the following stipulations: Additional Comments Date 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. MUNtCWALI'PI OF ANC;HORA~b ~Nv~RONMEN'rAL SERV CE8 DI¥1$1ON Municipality of Anchorage DEC O&, 199~' ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division .... iVED 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 34)~g E Lcgul Descriptiou: A. WELL DATA Well lype VC4k/.~ IfA, B, or C, attach ADEC letter. ADEC ;vater system namber Health Authority Approval Checklist LO§ present ~i~) k( Date completed ~ ,Z~-?~ Total depth ¢9 ~ J ' Cased to ~ ~ I ' Casing height (above grmmd) J%'~ Saaitaw seul ~) %[ Wires properly protected ~) ~ FROM WELL LOG AT 1NSPEC~ON Static wuter level ] I 5 ~ /I 3 ' Well production ~ O g.p.m. ~ ~ ti ~ g.p.m. WATER SAMPLE RESULTS: Coliform ' d Nitrate Dateofsample: i~-~D-~, -- q~ tg, I00 Other bacteria C-'r ollectedby: S B. SEPTIC/HOLDING TANK DATA Date installed 7~.~¢--.~b Ta,~ksize /~_ff"-43 Number of Compartn,.ents Z-- Cleanoats~) ~ Fm/ndatiol, cleaaout ~) ~ Depression (Y~ ,J High water alarm (Y~) '/& DateofPampmg 1/--~/.-5~ Pumper ~W '-~'~ C. ABSORIrI'ION FIELD DATA Date installed '7 *X4 ~c)° Ceagth .~ / Width ..~ t Effective absorption urea /-.¢'t7/D / Date of adequacy test /c~ - ~t? Gravel thickness below pipe Monitoring Tube present~O;N)7 Re,alls ail) Soil rating (g.p.d./ftz or ft2/bdrm) /-.~<'-q)CT~ystem type 4 ' Total depth Depression over field (Y~ For ~ bcdromns Fhfid del)th in absm'ption field before test (ill.); ~-) ¢ hmnediately ~fftcr~/Ca gal. water added (ia.): Fhfid depth ~) ~' (las.) Minutes later: "'""~ Absorption rate = ~,,'~d) ../x- g.p.d. Peroxide treatment (past l2 months) (Y~.~ [~/c(~l./a.' lfyes, givedate ¢J///~ D. LIlT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump oa" level at* High water alarm level itt* ~ted-'~~ ~_~Pmnp-off~-i~at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorptiou field on lot Public sewer main Sewer/septic service line ,~..~, t~' ?tO ~9 ~ 4' : Ou adjaceut lots ; On adjacent lots Public sewer mauhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~r~ ff_~/D, Property liue Fo t-Jo Absorption field 3-- l Water maio]scrvice line /0 t 4' Surface ~vater/drainage ],96 t .t~ Wells on adjacent lots ./D o t .4. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Wells on adjaccut lots I coo Water main/service line /} 0 !-1.~ Driveway, parkiug/vehicle storage area ~. ~ t-l- Property line IO I .-~ F. ENGINEER'S CERTIFICATION : I. certt~,V that I have determined thru field_ in*~ections_ and revtew o~ Mumctp al record~ ~,~¢~t~s'~ .......... ~ ~ ~ are m coq/o,'mance with MOA ll~bi guidelines in effect on this date. ~ A "...~ I~ HAAFce $ ~:~d~O Date of maynlent /~///d~-~ Receipt Number ,~ S--,'~ ~ ./ Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Paymeut Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Z$ Z",4,V,~W.'.4 /-///./~ ~'~.',~zZ ~y' ~IZ~ ~ ~ ~ Location (address or directions) (b) Property owner ~ ~ ~EZ& %~0¢~$ Telephone: (home) Mailing Address CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SiTE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here ,~ hold for pick up.) List contact person and day phone number below: ' 2. TYPE OF RESIDENCE 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 ~I~OSAL On-site I~' 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 5. 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 A/'J j) ~--~-~O/'~ ~'"~'~J &, ,J ~-[~"~ ~J O Telephone Address PP. Z,'*o'77 Date / I// ,5'"/ d~0 6. DHHS APPROVAL Approved for ?'/ bedrooms by Approved ./~,.... Disapproved Terms of Condltional Approval Conditional The Municipality of Anchorage Department of H~alth 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 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. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WELL DATA Well Classification /'~/Z////¢ ,~'z~ Well Log Present (Y/N) y Date Completed Total Depth ,2'-~ !' Cased to Z~/' Depth of Grouting MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Static Water Level ~'//' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A, B, C, DiE.C. Approved (Y/N) Yield .~ 74 SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line .i~/L~.$ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results ~'~¢TI Comments U°ELL 15 Pump Set At MOT _F')E. TEI~I,~iq~c_I Sanitary Seal on Casing (Y/N) y ~" Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date //,,/~/¢0 B. SEPTIC/HOLDING TANK DATA Date Installed 7./2¢/¢~ Size Standpipes (Y/N) ~ ~-' Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well /,_~ t To Property Line /-//¢ / To Water Main/Service Line ~---.~- / To Stream, Pond, Lake or Major Drainage Course Comments / No. of Compartments )/ '~ Foundation Cleanout (Y/N) Date Last Pumped .z/E.~ f./E VJ ;for ~ ~ ~/.~'F~ t]CT/o ~ Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field IS 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Square Feet of Absortion Area EcC::)O Depression over Field (Y/N) h.I Results of Last Adequacy Test ./'~-'¢~-¢~¢-¢ ~- SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /¢...~ ' To Building Foundation Lot To Water Main/Service Line Gravel Bed Thickness /7/ / Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) ,,'¢'¢,4/~: /:~/'~'~5'~,,¢/2- To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /~ ~.¢O,'~. ~-T' I O Xl N "Pump On" Level at 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 inspection. Signed Company ~ Date /l/15~ /¢/0 MOA No. Receipt No. ~c~3 ~/,"~ Date of Payment Amount: $ ,t~.,. o~.. ~ ¢ ~.~.,-, Receipt No. k%'~,~..~¢d~;~ *~ Waiver Fee: $ Engineer's Seal Date of Payment 72-02§ (Rev 7/88)Back Page 2 of 2