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Home My WebLink AboutFRIDERICK H HAHN HOMESTEAD TR Bm 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 .~,.e DISTANCES A~dr~$S TANK FIELD WELL Lot j (~ock I Sub~w,s,qn ~ ~' ~ ~-/ TANKS ~SEPTIC ~ HOLDING TYPE OF SYSTEM TRENCH ~ BED ~ W. DRAIN ~~ ~ FI ~.~ ~, FT .~ Iota' a~so~ D'stance ~,ween ,,ne~ WELLS ~PRIVATE ~ ota,~THER 'Identify) I 17074 E'=I- Pi--r [~ Re:E [;~. ~ cealy that this inspeaion WaS pedormed amrdin~ to all' ~ ~ A. ~ ]~ '. .unici~al and ~*~fl ~~ """ ""' 72-013 (3/85) MUNICIPALITY OF ANCHORAGE · !e 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 NAME PHONE o_Le UP RADE NO. OF BEDROOMS ~ Z Manufacturer . ~ ~ ~ Materia~, ~ [ No. of ~c°mpartments Liq. capacit% in gallons Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwellin9 PERMIT NO. ~ Menufacture~ ~ ~ ~ ~ ~a~i~, ~-' Liquidcapacityl.~llons = Well Foundation , Nearest lot line PERMIT NO. ~ DISTANCE TO: ~ ~00 ~ ~ ~ ~ ~ NO. of lines Length of each line Total length of lines Trench width Distance bet~en lines ~ ~ ~ TOp of tile to finish grade , Material beneath tile ~ Total effective abso~.~rea Length Width ~epth PERMIT NO. <~ Type of crib ~rib d~; Crib dept~ ~ ./ Well- Building fou~o~ Nearest lot line ~ DISTANCE TO: ~ ~~ Depth Driller Distance to lotline~ 0 ' PERMITNO. ~ DISTANCE TO: Building~un~,io~, Sewer line~ ~ Septic tank~/oO Absorption~_/OOarea(sl OTHER PIPE ~ERIALS I SmLTESTRATINa ~ ~ ~'~1~5-~-~~P <~. ~ ,' INSTALLER ~_ ~j ~ 72-013 { Rev./3/78) PERMIT r.lO. RPPLICR['IT CURT DRHL P. O. BOX 351, ERGLE RIVER LOCRTION PTRRMIGRN BLVD. LEGRL _?RR. 12~ TR. B, HRHN HOMESTERD S?D LOT SIZE 41E, O0 TYPE OF SOIL RBSOF,:PTION S~rSTEbl IS: TRENCH rlUN Z C I P_nL T T"r' OF DEPF~RTMENT ~ HEFILTH RI.ID EI',IYIROr.lrtENTF~L"--~,OTE~TION E .... STREET, R['ICHORRGE, RK. l-IEEE RI'-4D C)I'-.I--S I TE SEI,.IER PERt.1T T 694-2~ MRXir,lUr,l NUMBER OF BEDROOMS SOIL RRTING (SQ FT?BR)= 100 THE REQUIRED SIZE OF THE SOIL RBSORPTIOf.I SYSTEM IS: [)EPTH= :;[ ~t_ LEI'4GTH= 25 GRR%'EL [:,EPTH-- 6 THE LENGTH DIfIENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRf-ICE BETI4EEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE E×CRVRTION <IN FEET>. THERE IS NO SET HIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFRLL PIPE RND THE BOTTObl OF THE E×CRVRTION (IN FEET>. F-:EGI-.LI I F:ED SEPT I C TRI'-41< S I 7'-E= ~LOOO 6RLLEII'4S PERMIT RPF'LICRNT HRS THE RESPONSIBILITY TO INFORrl THIS DEPRRTMENT DURING THE INSTRLLRTION INSPECTIONS OF RNY HELLS RDJRCENT TO THIS PROPERTY RND THE r-lUMBER OF RESIDENCES THRT THE HELL HILL SERVE. TiqCm ( 2 ) I r-,ISPECT I Of-IS RRE R Eri~ U I RED BRCKFILLING OF RNY SYSTEM I,IITHOUT FINRL INSPECTION RND RPF'ROVRL BY THIS DEPRRTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETHEEN R HELL RND RNY ON-SITE SEI,IRGE DISPOSRL SYSTEM IS iE~O FEET FOR R PRIVRTE HELL OR i50 TO 208 FEET FROM R PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC HELL MINIMUM DISTRNCE FROM R PRIVRTE HELL TO R PRIVRTE SEHER LINE IS 25 FEET RND TO R COMMUr4ITV SEHER LINE IS 75 FEET. HELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT HITHIN ~0 DRYS OF THE HELL COMPLETIOf-~. OTHER REQUIREMENTS blRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE R',,,'RILRBLE TO INSURE PROPER IN-~TRLLRTION. PERt.11 T E~<P I F-:ES DEC:ErlBF'F.' 2:---1 .. -1 98:2 I CERTIPr' THRT i: I RM FRrqILIRR I4ITH THE REQUIREMENTS FOR ON-SITE SEHERS RND FELLS RS SET FORTH BY THE MUNICIPRLITY OF RNCHORRGE. 2: I HILL INSTRLL THE SYSTEM IN RCCORDRNCE HITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEHER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO Ir. ICLUDE f,IORE THRN ~ BEDROOMS. SIGNED: RPPLICRNT CURT DRHL V4. 0 COMMENTS SLOPE ' · .. - - ..'. WA~ QROUND WATER ;' NO. !~32-E" .June 2.:2. .' PERC~kTION RATE '., , TEET ~UN B~EEN "' PERFORMED BY: 72-008 (6/79) FT AND , SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99667 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS ~;?' LEGAL DESCRIPTION DATE - Started PERMIT NUMBER DEPTH OF WELL ,~'/ STATIC LEVEL OF WATER FT. GALS. PER HR . KIND OF CASING KIND OF FORMATION: From /) Ft. to "~ Ft. From "~ Ft. to ~ F~. Fromm. Ft. to Ft. From ..... Ft. to '~/ Ft. From Ft. to Ft. From .... Ft. to .:? ~ .Ft. From ) ~ Ft. to ,?~' Ft. From -~ ~: Ft. to ~' ~ Ft. From '~? Ft. to Fromm. Ft. to Ft. From Ft. to Ft. From Ft. to Ft, From Ft. to Ft, From Ft. to ,, Ft. From .... Ft. to Ft. From __ Ft. to Ft. From Ft. to . Ft From From From From From From From,~ From From , From From ?From" From From From From From Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft Ft. to . Ft. Ft. to Ft. Ft. to . Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft, Ft. to'- · · .Ft.' Ft. to Ft. Ft. to .... Ft. Ft. to . Ft. Ft. to.. Ft. Ft. to Ft M1SCL. INFORMATION: DRILLER'S NAME 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING · ~.~'~) - .~.,¢ -~7 HAA# ~ ~L.'~,i r. ~,.,~ c~ ~.~ GENERAL INFORMATION " Complete legal description ,,~,,,~=~=,=~A.~'~_.~.~=~.~ .g .,~ ,,~,.,.~_J ~.-/~,-,,~'.,--~'~'-~, Location (site address or directions) ~.,,~ ,¢~.~.~,...,,, ~',,,¢,,,..J ,E'..~-..~.~ .~,..,,~=~..,, Property owner Mail.lng address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: '~ '~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 IRev. 1/91) Fron! MOA i21 o 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 all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Engineer's signature '~'/~': '"'~'. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. Date -7- 1' bedrooms, with the following stipulations: Additional Comments Date ?-23 - ' 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 engineec 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. Municipality of Anchorage DEPARTMENT OF H~LTH & HU~N SERVICES ~vlmnmentai Se.i~s Oivbion 825'L" Street, Room 502 · Anchorage, Alas~ 99501e (90~ 34~7~ Health Authority Approval Checklist l,~,alDescription: .~,~-,~,~,~,,~ .,,~,~j ~,~--. ~, Parmll.D.: A. W~.I.I. DATA Well t~e LoS pr~scat T~ ~ Date cfi'test Static water Well produclion Y ff A. B. or C. attach AD£C letter. AD£C water system number Dat~ completed ~7,.e ,~ ~ to ,~'P" Caslns I~ight (abow gmuad) ~-~ q,~ 2 vro ly Nitrate WATER SAMPLE RBSULTS: Coliform ~- B. SEPTIC/HOLD~G TANKDATA AT INSPECTION .,ti./" Date in~!lcd /.z~ ~'/~'~ Tank size ~'~ Foundation cl~out (Y/N) ~' Depression (Y/N) ~ Number of Coml~u~m~nts High wator C. ABSORFrlON F~I~I.I~ DATA . Deprmsion over field (Y/lq) ,4/ For .4 bedmoms Fluid ~ in absorption field before test (in.); .4'/~lt,, lmm~lialcly ~ .~ v~ ~al. water n4tled (in.): Fluiddcptb .~.ff~ (ins.)Minutcs later. .~ Absorptionratc - ,,'e'J"W g.p.d. Peroxide treatment (past 12 months) (Y/N) ~.,,/~. If yes, give dal~ "-- LI~T STATION Date il~'talJed Size in ?lions M~nholdAco~s (Y/N) "[~mp on" lcvel at* ~ SEPARATION DISTANCES SEPARATION DISTANCES FROM W~-ON LOT TO: Septic/holding ~n~ on lot / Absorption field on lot / Public sewer rn~in Sewer/septic service linc ; On adjacent lots ; On adjacent lots Public sewer mnnholc/cle~nnut Lift station SEPARATION DISTANCES FROM SEFIIC/HOLDINO TANK ON LOT TO: Building foundation ~ '",~'~z Properly linc ..~"~ ~',~-~ Absorption field Wafer mnin/sCrViCO iillO ~'d '~,~',~ Stllfaco water/d~inng¢ ,~A/~" Wells On adja~ilt lots SEPARATION DISTANCE FROM ABSORPTION Fn~ n ON LOT TO: Building foundation ,~, Cut--in draill F. ENGINEER'S CERTIFICATION Property Line .,~i~.,'z Water m~in/sctvicc linc ~'.0'" Dry, parkin.g/vchicl¢ storage mca ,~ ~,,z"*~ Wells on adjacent lots ;;~ ~ ~''~''',~ .wn.~.'~,N.%,.. ms are 1 certify that I have determined thru field inspections and review of Municipal records in conformance with .MOA I'I/M intideline~ in effect on this date. ~'~. .4 Signature /.~ ,,~ ~'_ ~'. ,~ ,.~ .~, w Date of Paymcm ,~ Da~ of Payment Receipt N.mhcr ;~/r ~'~-'~) Receipt Number Rev. 8/95 OSS: han.wk.doc MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~ HAA# ~O~_ ~L[ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block,.subdivision, section, township, r,3nge) .__ Location (address or directions) Telephone: (home) Mailing Address ~:~ / (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent ('//'~./'(/' ~/~/~'t/~'~" Address //0 72 ~ ~'~/~ Telephone (e) Mail the HAA to the following address: (or check here~lZ,~if hold for pick up.) List contact person and day phone number below: ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle Riverr Alaska 99577 2. TYPE OF RESIDENCE Single-Family,S' Number of bedrooms "~ 3. WATER suPPLY J 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 DISPOSAL On-site,S. Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of. Env ronmental Conservation attesting to the legailty and status. Page I of 2 __1~{~ _,~J~[CIPALITY OF ANCHORAGE (MOA) ~/~'~C~Y~'~' [.S Ur~" -.~/.~ . . Health AuthorltyApproval (NAA) ' C,ECKUST- .U*.Y 84* Legal ~scription: ~~ We~l d~aSsificati'eh ~.~i~'~ ' ',' ' ~f A, ~, C, D.E.C. ApproVed ' W,~I L'og P~Sen{ ~~ D~t~ com'pl;te~ ' ~/W'/ Total Depth ~O.. C.a~ 's~,o~' Depth of Gro;ti/ng' ' ~ ~' ' Y Static Water Level ~' / Pump Set At ' f'~ ~' Casing Height Above Ground ~*~) $¢ Sanitary Seal on Casin N) / Sle~:trical Wiring in Conduit{~) . ' y · Depression A'r~und Wellhead (Y~.,,V. SEPARATION DISTANCES FROM WELL:" .. ' ' ' ' . .' ' To Septic/~otdfrrg'Tank on Lot /~0 ./~- · , On Adjoining Lots /O~) TO Ne~re'st Edge Of Absorptior~'Field on lot ~o t~. ":'~ on Adjoining Lots To Nearest Public Sewer Line /~Z:) t.~. To Nearest Public Sewer Cleanout/Manhole ~'~ ~'- To Nearest Sewer Service Line on Lot ,_5""~) t Water Sample Collected by,-~ ? ~' ~'~/,'/~'J/~'~'~//~ ,t Date · /.., ~ - / ' Water Sample Test Results,_~ -'/'/ 5-~=~4.~,~.o~'/~ ~ z~--r'. , /~./~,7-~,~.--,~-/.~ ..[" Comments ~...~ ~ ~'~/~/~' ~ B. SEPTIC/f'I~L=Bfl~ TANK DATA · Date Installed /~'~/ "Size/~ No. of Compartments ~' Standpipes~) .~ Air-tight Caps~l)y FoUndation Cleanout~) DePressiOn OverTan~(Y~ ~ ' ~ Date Last P~mped · pu.mping/Maintenance Contact o,n File (Y/N) v4,,}/~ ;for Ii''W 'er'Aam ~,Ni" n/~"' ' ' Holding l:'ank Hig at I r (Y Temporary Holding Tank Permit SEPARATION DISTANCES FROM SEPTIC/i~ETRRT~TANK:,.,.. ,, ,..., · TO Water'Su, pPiy Well /"4~'<:~ t-/z- To Building Foun~ti'on" ,To Property Line' /0 ¢ 1/-- To Disposal Field ~!~'~:~'. /'. , T~ Water Main/Servi~:e Line ~.;,',',',',',',',','~ /'-~-- ' ' ' 'TO Stream, Pond, Lake or Major Drainage Course ,~-,'~/,-J' .~" comments ~ · 72-026 (Rev. 7/6,8) Fro~t page '~ of 2. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION" As certified by my seal affixed hereto and as of the validation data shown below, I verify that my investigati6n of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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, 17034 Eagle Rivm' Leep R~ad No. 204 Data 6. DHHS APPROVAL Approved for .~ Approved ~ Terms of Conditional Approval Disapproved Conditional -. T~h e~ality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval /cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer · J 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) Bacl~ Page 2 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /'~;;~ ,~' / Wi'dth of ~ield" ' "" .~ ,'.-~'" Square Feet of Absortlon ~rea Dep, ression over Field ('~ Resu?ts of Last Adequacy T~sf' A~"t/~''~-~/~ ., .~. . . SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot / ' ~ To Water Main/Semice Line Type of System Design Length of Field ~-- ~- (/ Depth of Field ,/~ "Gravel Bed Thickness Statndpipes Present ~) Date of Last Adequacy Tes~ ' To Property, Line ' /~ To Existing or Abandoned System on ; On Adjoining Lots' - ~ ~ To Cutback (if pre~nt) To Stream, Pond, Lake, or Major Drainage Course To Drivewa~,,_Parking .Area, or Vehicle Storage Area D. LIFT STATION. Date Installed Size InGall'ons""" ' ' < ' ' "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments " Di~nension~ ' ' '" ' '"? ~Manh~le)Acc~s (Y/N);.' ~ //. "PumpOff"Levelatr/IA //t,~' I/IL.t--- Vent (Y/N) ' ~/ J"J Pumping Cycles during Adequacy Yest. **Check Permitted Bed~'o(~m Rating Against HAA Request** I certify that I have ~hecked, verified, or conformed to'ail MOA and HAA gmdehnes ,n effect or~a~t~ 1 ~thjs inspection.. , . . .. .... Signed S & S ENGINEERING . Date .... . . .... R , .'Receipt No, Date of Payment ' "-' Waiver Fee: $ Amount: $ ,/~"2t~.)- 'O D Date of Payment 72-026 in.. 7/883 Back Page 2 of 2 DATE RECEIVED t ~' iNspEcTiON APPOINTMENTS 'TI1UIE~. TIME TIME ~ ~'~ INSPECTOR INSPECTO~ MUNICIPALITY OF ANCHORAGE MUNICIPALIfY ~HO~GE ~ ~,,.,...,.,~ o~ .~,. "~'~" ~,_..~.o,.. ' ~.v,.o..,.~.~ ,~,..~, 01~10~: ~omp~e~e a~l pa~s o. ~age 1. I~s~s ~ ~iU ee~ ~ ~. ~lea~e aHo~ ~en ~0> days ~o~ MAILING ADDRESS PROPERTY RESIDENT {If different from above) PHONE 2. ~UYER PHONE MAILING ADDRESS 3. L~NOI~8 INS J PHONE MAILING ADDRESS 4, REALTOR/AGENT ~ PHONE ~AILIN~ ADDRESS 6. TYPE OF RESIDENCE z SINGLE FAMILY I'-1 MULTIPLE FAMILY 7. WATER SUPPLY ' INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY NUMBER OF~BEDROOMS One ' ~ Four Two Five Three [] Six [] Other 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 Jattach log if available.) 8. 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 FOP. OFFIGIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE I'-I 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 []INDIVIDUAL/ON -SITE DATE INSTALLED •PUBLIC UTILITY ~ Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: ~/'~c~ If Tank is homemade SOILS RATING ; give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line 5. COMMENTS J~APPROVED FOR ,~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79)