HomeMy WebLinkAboutHERITAGE HEIGHTS LT 8GREAi,._ . ANCHO RAGE AREA
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
NAME ,~'~V~ FCX~ ~(,~ MAILING ADDRESS ~--~ L~) /grcaL'~ ¢ PHONE ~-7~ -_¢5b'Z~4
SEPTIC TANK:
DISTANCE
FROM WELL '~
INSIDE LENGTH
MANUFACTURER
INSIDE WIDTH
MATERIAL COm-cv'¢'~e
NUMBER OF
COMPARTMENTS J
LIQUID DEPTH
LIQUID CAPACITY~-O00 GALLONS.
"~ FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE ~"'~
TOTAL LENGTH
FOUNDATION ~)~II NEAREST LOT LINE P'31 OF LINES '~'~k~
DISTANCE BETWEEN LINES ~'~[~ TRENCH WIDTH~O IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE ¢~bI
DEPTH OF FILTER
MATERIAL BENEATH TILE ~ I IN. ABOVE TILE ~9 IN.
WELL: (~ (/~-u. ~ c~'4r~: v~'
FOUNDATION , LOT ~bl~ LIl~b~--
_
CESSPOOL ~~~R ~U~ ~
APPROVE~ DISAPPROVED REMARKS
DISTANCE FROM:
DISTANCES:
DIAGRAM OF SYSTEM
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
REMARKS:
APPROVED
G.A.A.B.'~ ('~
Form LQ-032
GreaTEr ANCHOrAgE ArEa Borough
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
TELEPHONE 274-4561
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
SEEPAGE PIT , DRAIN FIELD
TO BE INSTALLED BY
PERMIT NO.
INSTALLATION OF: SEPTIC TANK//~/f~
TYPE AND SIZE OF FACILITY TO BE SERVED ~-~
FINANCED THROUGH
COMPLETION DATE ANTICIPATED
· OTHER
NOTE: THIS PERMIT iS NOT VALID WITHOUT SOIL TEST
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.
TYPE
i
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK SI
/
FOUNDATION TO SEEPAGE PIT L~) , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL /~ ~
, SEEPAGE PIT jO (
SEPTIC TANK ~
TO NEAREST LOT LINE.
DRAIN fielD
t
WELL TO SEPTIC TANK / ~ ~ , SEEPAGE Pit ~O ~
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK /O~f , SEEPAGE PIT /
DRAIN FIELD
SEPTIC TANK,
SEEPAGE PIT (O¢~ , DRAIN FIELD
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKPILL
CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDIN/~NCE NO. 28-68 AND THAT THE ABOVE
This form reports: SoilslO~21og~
Depth
Feet
2-
3-
4-
5-
6-
7-
8-
9-
lO-
ll -
12-
13-
14-
~,~-~-dREATER ANCIIORAGE ARiA BOROUG'h
Department of Environmental Quality
3330 "C" Street
Anchorage, Alaska 99503
SOILS i,O(; -- PEROI,ATION TEST
//~ Percolation test
_. Perform~d ~ /~ ~/~-
Was ground water encountered?
If yes, at wila~ depth?
Reading Date Gross Time Net Time
Percolation rate minute.
-Proposed installa'~T~n: Seepage Pit Drain Field
Depth of Inlet ................. · Depth t-d'-~bT~n-~:¢--pit or trench
COMMENTS:
EQ-040 (6174)
Depth to Water Net Urop
Date:
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. #
1. GENERAL INFORMATION
Complete legal description
HAA #
Lot 8; Heritaqe Heiqhts
Location (site address or directions)
6060 Yukon Road
Property owner
Mailing address
JaniFa-~ks ~ (~ · ~
1200 N. Nash Street ~228
Day phone
Arlington, VA
279-7611
22209
Lending ag?,nCy
Mailing address
Day phone
Agent
Address
Day phone
o
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
Public water xxx
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
NOTE:
XXX
Public sewer
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 inves~tigation 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.
Phone
Name of Firm
Address
Engineer's signature __
Date
D..s s.o..TU.*
X . Approved for 7'~do (,~1..~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
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.
72-025(Rev. 1/91) Back MOA ~21
Municipality of Anchorage /~
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: L.~,?- ~ /~/~r~rr, er_~E [--/ETGRT-~ ~'//~ Parcel I.D.
A. Well Data
Well type /C'O~/--/C.
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Date completed
Cased to
Driller
Casing height
Wires properly protected (Y/N)
AT INSPECTION~
/ MUNICiPALiTY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
SEP 1 2; 199;~
FROM WELL LOG
Well flow .g.p.m.
Pump level1 . -L T~
SEPARATION DISTANCES FROM WEL
Septic/holding tank on lot ,// ; On adjacent lots
AbsorptiOnpublic sewerfieldmain°n lot // ; On adjacent lots
Sewer service line /
C~h~~P~ESRESULTS:
D~e of sample:
Public sewer manhole/cleanout
Petroleum tank
Nitrate
Collected by:
g.p.m.
RECEIVED
Other bacteria
B. SEPTIC/i'I~'~3H~rTANK DATA
Date installed
Cleanouts(~)/N) y~.~
High water alarm (Y/~
Tank size
Foundation cleanout Y~)
Date of pumping ~//~_ J/? ~ Pumper.
SEPARATION DISTANCES FROM SEPTICA=I~L=~IiI~G-TANK TO:
Well(s) on lot /..~E ?~E/-~2'- On adjacent lots
To property line /C) r.~___ Absorption field ~-
Surface water/drainage /(_.gO ~
~A(- Compartments /
~'"~ Depression (Y(~ ~
Alarm tested (Y/N) ?.,//~
Foundation ,~' 7'--
Water main/service line /'(~ ~-
72-026 (3/93). Front CONTIN U E D ON BACK PAGE
C, LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
"Pump on" level at
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM. J_IF:F--ST~TION TO:
Well on I.~t-.----~'~~ On adjacent lots
D, ABSORPTION FIELD DATA
Date installed
Length ~'~' /
Total absorption area
Date of adequacy test
Water level in absorption field before test
Width
'~ ~ ~ ~;~ Cleanout present~N)
F/z' / ¢; Results~ail)
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at~
.Cycles tested ~
Surface water
Soil rating (GPD/FF) /.~0-///c3/'¢-~
Gravelthickness ~' ~
Peroxide treatment (past 12 months) (Y/N)
System type
Total depth /,~ /
Depression over field (Y~:~)
for ~--~¢~ ~'~-~?) _Bedrooms
After test ~::>"~ ~'¢-/'
If yes. give date ,,t///~-
Well on lot
To building foundation
On adjacent lots
Sudace water /¢')E?
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
On adjacent lots / c-~ ~/-- Property line
To existing or abandoned system on lot /
Cutbank/J~,'Jd [>4/~.~- f'JT-- Water main/service line
Driveway, parking/vehicle storage area ~:~ /
Curtain drain /'~o/~'~ /~'/kJ ~ ~/'J
E, ENGINEER'S CERTIFICATION
I cerb'fy that I have checked, verified, or conformed to all MOA and HAA
Signature
I7034 E~gle Ri r Loop Road
Englneegs Name ~r Lo .
/ Baole Riv~lasEa ~77
,:' ,:b'.,:'
HAA Fee $ ~-~*0 O,
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
-- '7 DATE RECEIVED
" INSPECTION APPOINTMENTS
TME TIME TIME
DAT.E . / DATE DATE
, N S p E C./T~O R .j../ ' NSPECTOR ' NSPECTOR
:: MUNICIPALITY OF ANCHORAGEI=Niv DEPT. OF HEALTH &
· fl ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTrONIRONMENTAL
PROTECTION
825 L Street - Anchorage, Alaska 99501
( ) 'IOV 9 1979
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES (
\
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days fgr ~;ocess~
PHONE
1. PROPER~.~WNER
MAILING ADDRESS
PROPERTY RESIDENT (If different from above) PHONE
MA,L,N ADDRESS
3. LENDING INSTITUTION PHONE
MAILING ADDRESS
PHONE
4 REALTOR/AGENT
MAI LING ADDRESS
STREET LOCATION
6. TYPE OF RESIDENC~/ NUMBER-'OF~BEDROOMS
~ ,~ One [~] Four
SINGLE
FAMILY
[] Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY [] INDIVIDUAL*
[] COMMUNITY
PUBLIC UTILITY
*ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEW/~GE DISPOSAL SYSTEM
/~ INDIVIDUAL/ON'SITE** /¢7¢2~''~ YEAR ON-SITE SYSTEM WAS INSTALLED.
[] PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REO. UEST 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 [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
~ COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
'~ I NDIVI DUAL/ON -SITE DATE INSTALLED
[]PUBLIC UTI LITY ~.~- ~,~ - ---~ ~,
Connection Verified
INSTALLER
'[~Septic Tank or [~] Holding Tank
Size: \l~)l:~L---~ If Tank is homemade ' SOl LS RATING
give dimensions: ~ ~. L----')
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
I
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
/ APPROVED FOR ~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany c_eEtificate)
[] DISAPPROVED
DATE BY
72 010 (Rev. 6/79)
MATERIALS TESTING · QUALITY CONTROL
SOILS ENGINEERING
2204 Cleveland Ave.
RO. Box 10-1126
Anchorage,AK. g95ll
277-0251
710 Third Ave.
P.O. Box 254.0
Fairbanks, AK. 99707
452-1267- zi56-5155
SF_.PT C
ADEQUACY
SYSTEM
REPORT
JOB NO. CTL 79-267
DATE OF REPORT 11/7/79
DATE OF TEST 11/5/79
LEGAL DESCRIPTION '
LOT 8 BLOCK
OR SECTION
Her±~aqe He±qhts SUBDIVISION
, T N, R W, S.M. , ALASKA
PERFORMED FOR:
Western Enterprises
4101 Arctic Boulevard
Anchorage, Alaska 99503
PHONE NO.
REQUESTED BY:
Phil Powelson
PHONE NO.
TYPE OF SYSTEM '
NUMBER OF BEDROOMS
SEPTIC TANK WAS PUMPED r~yEs [] NO
ABSORPTION RATE: AVERAGE 24 HOURS 600
SURGE RATE: 500 GALLONS IN 20
SEPTIC TANK - SIZE
[] CRIB OR SEEPAGE PIT
LEACH FIELD
GALLONS.
MI NUTES.
1250
GALLONS
NOTES & OBSERVATIONS'
, APPROVED BY:
TEST PERFORMED BY: D.P, REPORT PREPARED BY: D.P.