HomeMy WebLinkAboutPETERS CREEK BLK 3 LT 6Peters Creek Block 3 Lot 6 #051-115-06 r r — MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 26411720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ��s-j� PHONE �EW GV J —Z��j ❑UPGRADE MAI LIDiG ODR SS- C.� c- S LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS O Y DISTANCE T0: Well Abs rpbon a/ Dwelling �3 PERMIT NO. � 7 NQ Manufacturer _ Material No. of compartments Z_ WF Liq, 25itty in gallons CCJJ IF HOMEMADE: Inside lend Width Liquid depth d Y DISTANCE TO: Well 1 Dwelling PERMIT NO. -10Z _ IQ- Manufacturer Material Liquid capacity in gallons O = DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. W Y. = No, of lines Length of each Ii Total length of lines Trench width Distance between lines f2W IOCheT H Top of the to finish grade Material beneath tile Total effective absorption area C3 Inches W Length 7 Width [� /o ,P Depth 4 K.UG `[ PERMIT P �dT /t 6 W Type of crib Crib diameter Crib tl ten n Total effective abtorpt V ep •,/� W 'T t"Well w I DISTANCE TO: Buildingion Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J Building foundation DISTANCE TO: Sewer line Septic tank Absorption areafs) OTHER PIPE MATERIALS P ✓G SOIL TEST RATING a5- BA INSTALLER""T; REMARKS / f L .•• ..4 • as f1ae.A A. Mrlaf me g;'. ►�.. 1u7� � it APPROVED DATE LEG L S P:: EaGt�EEn1PlG SRO tr_ALAS mAtr S ,., KA 72-0131Rev.3/781 / 1 , r � o c c 0 u .. Oak u � w � 0 0 L6 §Z .j 0. . :o)¥. _j C6 J 0 z rd 0 0 0 0 > 0 0 s w X 0 9$4 Lni U: :S.: U rz u 0; 0: 0 1 , r � � c= o c c 0 u .. §S|§# u � LL4 }� � 0 0 L6 §Z 0. . :o)¥. kam., C6 J 0 z rd � c= o c c 0 u .. m u � LL4 }� � 0 0 0 0. . :o)¥. 0 0 w 0 cl: 0 0 0 0 0 0 0 s 9$4 Lni U: :S.: U rz u 0; 0: a 0 0 4J: u W. -0: d uj '0� 'd ra � 0 G r.: zLLa w w CZ j LLI w rd: (0: CQ t" � c= o c c 0 u .. m u � LL4 }� � 0 0 0 0. . 0 Cd 0 0 w 0 cl: 0 0 0 0 0 0 0 9$4 U: :S.: U CO u .. m u � LL4 }� � 0 0 0 0. . 0 Cd 0 0 w 0 cl: 0 u .. m u u 0. . C: > : (a: 0 14 9$4 U: :S.: U rz u 0; 0: a 0 0 4J: u W. -0: d '0� 'd ra � ai G r.: ¥at w Mi w Cq rd: (0: CQ t" :rz -MUNICIPALITY OF ANCHO,..,GE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHOP.AGE, AK 99501 264-4720 O N —SITE S E W E R PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE 'LEGAL DESCRIP ,LOT SIZE: ',MAX BEDROOMS: 840447 06/12/84 -& WELL— P E R M I T C/O S & S ENG'G. IRA KRUGEWR SRB 19'6X EAGLE RIVER, AK 99577 694-2979 SUBDIVISION: PETERS CREEK SECTION: 10 TOWNSHIP: ION 10500 <SQ. FT. OR ACRES) 3 po LOT: BLOCK: 3 RANGE: 1W LISTED BELOW ARE THE OPTIONS AVAILABLE TO YOU IN DESIGNING YOUR. SEPTIC SYSTEM. CHOOSE THE OPTION THAT BEST FITS - - - - - - - - - - YOUR. SITE. - - - - - - - - - - - BEO - - - - - - - - - - - - - - - - - - - W. E>RFi I N DEPTH TO PIPE BOTTOM (FT. > 4.0 3.5 ** GRAVEL DEPTH (FT.) 0.5 2.0 TOTAL DEPTH (FT.) 4.5 5.5 GRAVEL WIDTH (FT.) 14.0 5.0 GRAVEL LENGTH (FT.) 28.0 36.0 GRAVEL VOLUME CCU. YDS. > 14.5 :16.6 TANK SIZE (GALS) 1, 000. 0 ** 1, 000. 0 ** SOIL RATING (SQ. FT. /BR) 85 85 * DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION ** TANK. MUST HAVE AT LEAST - - - - - - - - - - - - - - TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - - - I CERTIFY THAT: 1. I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF ALASKA. 2. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS, AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. 3. I WILL ADHERE TO ALL MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. 4. 1 UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 3 BEDROOMS AND ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOR BUILDING CODES, THEN (1) AN ELECTP. AL PERMIT AND INSPECTION MUST BE OBTAINED: (2) AS-BUILTS' WILL NOT BE APPA WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORVMVSrJ6 JOONE BY A LICENSED ELECTRICIAN. SIGNEDDRTE: ----- � APPLICANT: S & S ENG'G. IRA KRUGEWR !o ISSUED BYE------ DATE: ------------------------------- - �/ MUNICIPALITY OF ANCHORAGE • \\ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION il;.. 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED LEGAL DESCR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMM W ATr1Z L WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? C�9-- SOI)_cS jLOG O ❑ PERCOLATION TEST DATE PERFORMED: S—Zt—&L ■■■■■■■■■■ ■■MEZE■■■■ ■■■NOMMEN■ ■■■NEEM■■■ Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE ry (minutes/inch) TEST RUN BETWEEN F A D FT PERFORMED 72-008 (6/79) - Municipality of Anchorage ��t� • Development Services Department Building Safety Division On -Site Water S Wastewater Program 4700 South Bragaw SL 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 DWELLING Parcel I.D. HAA# 65b5g7 1. GENERAL INFORMATION Expiration Date: i I — R — O G Complete legal description PETERS CREEK SUBDIVISION: LOT 6. BLOCK 3. Location (site address or directions) 23243 TUNDRA ROSE AVENUE • CHUGIAK. AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address Day phone 688-2340 Day phone CINDY WILSON w/REMAX Day phone 696-0214 16600 CENTERFIELD DRIVE * EAGLE RIVER. AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System Public Sewer ❑ The Municipality of Anchorage Development 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. Certificates 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 engineers work. 4. 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, 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 verify that based on the informatidn obtained from the Municipality of Anchorage riles 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date tt OS Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ✓ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineers Report Well Flow Advisory Other By: (/rf/_,./ �. Original Certificate Date: (Rw. 11)01) ......... CE/r79953 tiUtuhll; ON-SITE WASTEWATER : Municipality of Anchorage Development Services Department Building Safety Division Onsite Water b Wastewater Program 4700 South Brapaw St. P.O. Box 198850 Anchorage, AK 995198850 www.al.anchorage.ak.us (907) 9437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: PETERS CREEK SUBDIVISION: LOT 6. BLOCK 3 Parcel ID: O 51- 115 -D(o A. WELL DATA Well type Date completed PUBLIC WATER SYSTEM If A, B, or C provide PWSID# _ Cased to ft. FROM WELL LOG Date of test Static water level ft. ,WOV9uction 9— p.m.- WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate Collected by: B. SEPTIC/HOLDING TANK DATA Well property protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. n n r Tank Type/Material STEEL Date installed 8/13/1984 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 11/8/2005 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA ri,v Date installed 8/13/1984 Soil rating (g.p.d./ft'or® 85 System type BED Length 22 ft. Width 18 ft. Gravel below pipe 6. ft. Total depth 4.8 ft. Eff. absorption area396 ft' Monitoring tube YES Depression over field NO Date of adequacy test 11/g/2005 Results (Pasa/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 639 gal. New depth DRY in. Elapsed Time: D min. Final fluid depth DRY In. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date — D. uFT STATION Date installed Size in gallons "Pump on" level at _in. E. SEPARATION DISTANCES High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfllfi station on lot Absorption field on lot Public sewer main line PUBLIC WATER On adjacent lots On Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10,+ Building foundation 10'+ Water main 10'+ Water service line 1G'+ Surface water 100'+ Driveway, parkingivehide storage 50'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Munidpal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. ...:. ..... mese, .. Engineer's Printed Name JEFFREY A GARNESS 379/S3 Data I r�9 05 ,ed ••H74/p d�c` �oreesW� 4 HAA Fee E Date of Payment Receipt Number 7LS \fim (Rev. 12m) Waiver Fee $ Date of Payment Receipt Number I I LOT 12 I LOT 13 I LOT 14 I i — — — — — I N 90'00'00'E 70.00' \� — -`POWER POLE — — — — —— — — — — N 90-00-00-W 70.00 S 0 TUNDRA ROSE AVENUE -----— — — — — — — — — — ---- T— I I I I PLOT PLAN — AS BUILT -X_ SCALE 1' - 30' GRID t 136OProject No. 05-256 Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone Registered Land Surveyors (907) 522-4625 rax kglangls*aloska.net / 1clangle0alasko.net � ,.•••••••.�qsa 1 hereby certify that 1 have surveyed the followingP described property: •' LOT 6, BLOCK 3, PETERS CREEK SUBDIVISION (PLAT P-373) moi-' 49B 5 Anchorage Recording District, Alaska, and that the Improvements situated thereon are Ar within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed t7 .......... v.' promises and that there are no roadways, transmission Ones or other visible "' sosements an said property except as Indicated hereon. 0/l '•• KENNETH .LAN 15-5202 Dated this the�`t'� Day of NDVva4bY?4- , ?=S at Anchorage, Alaska `lJ ''•1;�9�u5,.•• N Is the responsibility of the owner to determine the existence of any easements, Q4� sIONA- covenants, or restrictions which do not appear an the recorded subdivision plat. 10' POWER EASEN SEPTIC CLEANOUTS �o �o CANVAS STORAGE SHED 9.8' (TEMPORARY STRUCTURE) o 8 8 LOT 7 23.2 24.3' W W • io LOT 5 o g o bo u is ONE STORY 12.4'i� S • WOOD FRAME co ci z ,••'�'� RESIDENCE b? In n ' 23.7' 12.4' 7.7' n DECK o:z u . s LOT 6 10,500 s.f. WELL -`POWER POLE — — — — —— — — — — N 90-00-00-W 70.00 S 0 TUNDRA ROSE AVENUE -----— — — — — — — — — — ---- T— I I I I PLOT PLAN — AS BUILT -X_ SCALE 1' - 30' GRID t 136OProject No. 05-256 Lang & Associates, Inc. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 (907) 522-6476 Phone Registered Land Surveyors (907) 522-4625 rax kglangls*aloska.net / 1clangle0alasko.net � ,.•••••••.�qsa 1 hereby certify that 1 have surveyed the followingP described property: •' LOT 6, BLOCK 3, PETERS CREEK SUBDIVISION (PLAT P-373) moi-' 49B 5 Anchorage Recording District, Alaska, and that the Improvements situated thereon are Ar within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed t7 .......... v.' promises and that there are no roadways, transmission Ones or other visible "' sosements an said property except as Indicated hereon. 0/l '•• KENNETH .LAN 15-5202 Dated this the�`t'� Day of NDVva4bY?4- , ?=S at Anchorage, Alaska `lJ ''•1;�9�u5,.•• N Is the responsibility of the owner to determine the existence of any easements, Q4� sIONA- covenants, or restrictions which do not appear an the recorded subdivision plat. Municipality of Anchorage vS • Development Services Department Building Safety Division Onsite Water 6 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ost -u Parcel I.D. --34- HggO 1. GENERAL INFORMATION Expiration Date: %— 1 A — O ;L Complete legal description PETERS CREEK SUBDIVISION; LOT 6. BLOCK 3. Location (site address or directions) 23243 TUNDRA ROSE AVENUE • CHUGIAK. AK 99567 Current Property owners) TOM AND KIM LEGAY Day phone 688-6357 Maling address 20640 CHAPEL DRIVE • CHUGIAK. AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, HAA will be held by DSD lorplckup. 2. NUMBER OF BEDROOMS: •2 *SEPTIC SYSTEM SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System N Public Sewer ❑ The Municipality of Anchorage Development 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. Certificates 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 the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health AuthorityApproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system islarel 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 ofAnchorage files and from my lmrestigation and inspection, the on-site water supply and/or wastewater disposal system islare) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. Name of Finn ALASKA WATER do WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B ' ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date ko, Engineers Comments: In conducting this evaluation, AWKV, ina attempted to provide a thorough, consdentious engineering analysts of the system In accordance with ADEC and MOA DSD Guldelines 6 Regulations. The reported resub described the performance of the system under the conditions encountered at the time of the test and separation distances measured to readily ldentiffable fee hirm The operational ft of all wells and septic systems depend on the total soils conditlat, gramdwetar levels Chet may fluctusta during the year, and the water usage of the family being served by the system. These conditions are outside the combo/ of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden detects or enaoachments. AMW, Inc. can therefore not provide any warranty or future estimate of how long the system w01 continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner fisted above. Any reflance upon or use of this report by any other person or party Is not aufhodzed, nor will It confer any legal tight whatsoever. 5. DSD SIGNATURE ✓ Approved for ;2— bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineers Reort Other cQP , •c G�.• ,yG ON-SITE WATER AND .; • WASTEWATER PROGRAM 2 •: A By. 1� _ / V, t Original Certificate Date: __% " 12 aw izvot Municipality of Anchorage Development Services Department J Budding Safely DIASW OnSne Water & Wastewater Program 4700 South Bragaw SL P.O. Box 198650 Anchorage, AK M1ti M wwmclAnchorage.stus (807)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: PETERS CREEK SUBDIVISION: LOT 6. BLOCK 3 Parcel ID: O S/ - 115- - 0 G —" 14M71JQ Well type Date completed PUBLIC WATER SYSTEM If A, B, or C provide PWSID# _ Cased to R FROM WELL LOG Date of test Static water level IL production 9— p.m- WATER SAMPLE RESULTS: Conform colordesH00 m1. Nitrate S. SE PTIWHOLDING TANK DATA Wen properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. nn. mi. TankTyp&Uaterlai STEEL Date Installed 8/13/1984 Tank size 1000 gal. Number of Compartments 2 Cleanouta (YIN) YES Foundation cleanout (YM) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 14 A Ave I Pumper JR'S PUMPING C. ABSORPTION FIELD DATA 'SEPTIC SYSTEM SIZED FOR 3 BEDROOMS Date trmstaned 8/13/1984 Son rating (g.p d.IR'oKt§�R085 System type BED Length 22 ft. Width. 18 R Gravel below pipe 6- ft. Total depth 4•a fL Etf. absorption area 396 ft' Monitoring tube YES Depression over field NO Date of adequacy teat 7/2/2001 Results (Pass/Fal) PASS For'2 bedrooms Fluid depth In absorption field before test 2 in. Water added 402 gal. New depth 8 in. Elapsed Time: 5 min. Final Auld depth 2 In. Absorption rate >z 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 6 type) NONE KNOWN N yes, give data ___=_ D. LIFT STATION Data Installed 'Pump on' level at _in. E. SEPARATION DISTANCES Stee in gallons High water alarm level at in. Cycles tested Meets alarm 6 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfil t station on lot Absorption field on lot Public sewer main One PUBLIC WATER On adjacent 1.7 Public sewer manhoieldeanout Holding tank SEPARATION DISTANCES FROM SEPTIC(HOLDING TANK ON LOT TO. Building foundation 5'+ Property One 5'+ Absorption field 5'+ Water main 10'+ Water service Ono --L0!+— Surface water, 1 oo'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO. Property One 109+ BulldbV foundation 10'+ Water main 10'+ Water service One 10'+ Surface water 1001+ Driveway, parkingNetdde storage 50'+ Curtain drain NONE KNOWN Web on adjacent lots 100'+ F. COMMENTS 0. ENGINEER'S CERTIFICATION I cer* that / have determined through field klspectlons and fnlml review of M~records that the above systems are In..... cordbrmance with MOA HAA guldetlnes In eBed on this date........ Engineer's Printed Na O JEFFREY A. GARNESS Vq tCg71 4 V �,�''•..... Date ---fir HAA Fees CO • fo Waiver Fee $ Date of Payment 4 /0/ Recelpt Number e-2-50 (Rw. IND) Date of Payment Receipt Number JUL-00-01 11:26AY FMADVARTA2 BJRTGAGE r sr . • Ib• /iwgl , h.rR • A/eM 11 AicMr� M HeetMb l E �OOi2T6SllT T-211 P.02/02 f-111 30 C) Q sertllf IMI 1 I i*vwd ohs IsBalsl 4 two • a. J1E�mt , PA-rtAV CX/YK tJYO. I IINge111e It q• At"", e.e"MY�N111�IA1 q ti1rM1y1N Is 1111 ►.Io.NPoI If of IM epw Is dd.6idlw MN sd1140a $I my spswlep. IO/r ("Itleibes winch h list III - an IM PNr111 1011140 Owl. Wow M e4p111g40e11 sired 40y eels M1ev1 a Old IN ONA"Ok" 1r IN e111el1 w" !«Mowry M IN • floss. i "%I „or d+*..+ RICHARD P.•HANKINS I o.le► tea. sccltTOO PssruWauw 1.a1O 1111v:te11 grs111 TI v" % P.0.0011 Mall -9"U MWA.JL.130 �•y.s• ass r11. Q44371 �feT7 . YI.11 i • 1.: ....... n. ' TOTfiL Pn.02 MUNICIPALITY OF ANCHORAGE Auk • DEPARTMENT OF HEALTH & HUMAN SERVICES am Division of Environmental Services On -Site Services Section WAQPALITY OF ANCHORAGL P.O. BOX 196650 Anchorage, Alaska 99519-6650ENVIRONMENTALSERVICES DIVISION 343-4744 NOV 15 1996 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING R E C E I V E D Parcel I.D. # O S`/ — I I S —o L 1. GENERAL INFORMATION HAA # VACS ,0!�Z2(11 Complete legal description Lot 6; Block 3; Peters Creek Subdivision Location (site address or directions) 23243 Tundra Rose Chugiak, AK 99567 Property owner Rocky DiDoel Day phone Mailing address 3401 Eureka Apt. 2A Anchorage, AF,,, Lending agency Norwest Mortgage/ Don Pressar Day phone Mailing address Eagle River, AK Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 xxx Day phone 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 XXX 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. 77-025(Aw.1/91) From L40An1 S. 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. Name of Firm 5& 5 ENGINEERING Phone 6 q y —;- 9-7 e1 age R iver oop Roa Nc. 004 Address Eagle River, Alaska 99577 Engineer's signature qq A Date i! /r S `� C2r �...' .......... !P,i ROBERT C. COWAN C 6. DHHS SIGNATURE �� CE -8801 1L titl Approved for bedrooms. Disapproved. Conditional approval for 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 courtesyto 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. rams (P • u+) ank s10A m Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: "l' b F -4-y- 3 1�E �S lfykalmeI I. D.: 0S'1 - / /3'- 0 L A. WELL DATA Well type R-) U L- If A, B, or C, attach ADEC letter. ADEC water system Log present (YM) Total depth Sanitary seal (YM) Date of test Static water level Well production WATER SAMPL Colifo to of sample: _ Date completed Cased to FROM WELL LOG B. SEPTIWHOLOING TANK DATA Nitrate g.p.m. Collected by: MUNICIPALITY OF 15 1996 C=heig"t)�e (Y/N) E D AT INSPECTION Other bacteria 9— p.m—Data installed ` - 13''e4 Tank size 100 o Number of Compartments Z Cleanouts f%)N)_4_ Foundation cleanouti9N) T— Depression (Ya—A— High water alarm (Y& W Date of Pumping 11- Lo -4 Lo Pumper a�P- . PJ M F 1,,, � C. ABSORPTION FIELD DATA Date installed S -1'3 Soil rating (g.p.d./ft' or ftR/bdrm) 9JI61- System type Length ZZ Width .f /Yr Gravel thickness below pipe Ci �r Total depth S Effective absorption area 3 1 LT Monitoring Tube present llRd) ,�_ Depression over field (Y r( Date of adequacy tesi/ /-10 - 9 Resulfs4j!jj0ail) _ AVS For 3 $4-. bedrooms 4 Fluid depth in absorption field before test (in.); Immediately after 10 gal, water added (in.): Fluid depth (ins) Minutes later: Absorption rate = w o a.p.d. Peroodde treatment (past 12 months) r� a If yes, give date 72-028 (Rev. 3198)' I 2`1 -`j le M:T. DA,, Fiorn� i5 Dc c��F, i�c� — floc � A FST _I D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at' E. SEPARATION DISTANCES Size in gallons 'Pump on" level at' 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main line On adjacent lots On adjacent lots Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: level at" Foundation 23 1 Property line 7-11 Absorption field & t Water main/servioe line folk Surface wateddrainage _1,2C!� %V Wells on adjacent lots loo 1 k SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: PmnnAv lion :S r At ilrllnn etu mdntinn COS- Wafer main/sorrier lion /01 d Surface water 1 �o l � Driveway, parking/vehicle storage area r t Curtain drain °� �a Wells on adjacent lots /,0 p 1 I F. ENGINEER'S CERTIFICATION I certW that I have determined trim field inspections and review of Municipal records fl�ipB�bovbls are in conformance with MQA HAA guideljnes in effect on this date. Signaturej(/L\%/G Engineer's NameuAr�%Z✓".� ar Data I/ //S- /474 \' r UWF c oowrw CE - 8801tr HAA Fee S Date of Payment g Receipt Number. s 72-026 (Rev. 3/g8)' Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH i£ HUMAN SERVICES - m. 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. # 0 S 1 — I' ,s-_ QiS HAA # 1-1 A 9 40& a,3 1. GENERAL INFORMATION Complete legal description Lot 6; Btoch 3; Petena Cteek SubcUv.iaion Location (site address or directions) 23243 Tundrta Roee Chugiak, AK 99567 Property owner Canace Stnob[e C/0 RAL Inspeetiona Day phone 800-766-2366 Mailing address 801 Conaaebe<ona.0 8Cvd. Canmet, IN 46032 Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: _3_ 3. TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water XXX Day phone Day phone _ If community well system, provide written confirmation from State ADEC attest- ` ` ing to the legality and status of system. _ \, �,, ; } IM I 4. TYPE OF WASTEWATER DISPOSAL Individual on-site XXX - Holding tank " Community on-site :- L; Public sewer:.! .;�,'•^:r�p •;';.......i .,.f �/IJ: ..f:.....-:.....7_�.__�.2.. 7j`.r .s—: ': `: ,ilC.,',�,,,1���';: NOTE:: If community wastewater system, provide written confirmation froi; State ADEC attesting to the legality and status of system Haas m.+. uv,j r.e Mw m a• . ? ._ 5. STATEMENT OF INSPECTION BY ENGINEER a. 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 furtherverify 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 S d S ENGINEERING Phone 17034 Engle River Loop Road No. 204 Address Eagle River AlpskjAw Engineers signature Date 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for RCEERT G COWAN j 'CE -8801 r �•��+ .. Additional Comments <<� Date f/- 2 9 9¢ L' e F . The t�unicipaliry of Anchorage Department of Health and Human Services (DHHS) Issues Health Authorfiry _ ;%Appproval Cem cad" based only upon the representations given In paragraph 6 above by an independent 'profess�o alen�IiieerregisteredintheStateofAlaska TheDHHSdoesthisasacourtesytopurchasersofhomes andthev endinginstitutionsinordertosatisfycertaintederalandstaterequlrements.EmployeesofDHHSdonot , :conduct inspections or analyze data before a certlficRite is issued. The Municipality of Anchorage is not Pons for enors or omissions in the professional engineefs work, ; ^+ + ; , �. 72M OVM W)'ftY MOAszI. :... i��A :•S 3`: ).; :. ® Municipality of Anchorage Department of Health and Human Services ffil HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo &,t_ -z, "rcel I.D. D sl - 1157 — D b A. Well Data Well type If A. B. or C, attach ADEC letter. ADEC water system number Log present (YM) Date completed Driller Total depth Cased to Casing height Sanitary seal (YM) Wires property protected FROM WELL LOG Date of test Static water level Well flow Pump levell SEPARATION DISTANCES FROM SeptMJhoiding tank on lot Absorption field on lot Public sewer main AT On adjacent lots On adjacent lots sewer manhole/cleanout Sewer service ling/ Petroleum tank WATER SA4PLE RESULTS: g.p.m. Colijo Nitrate Other bacteria Date of sample: Collected by: B. SEPTIClHOUNN&TANK DATA Date Installed Tank size /oo ^ Compartments Z Cleanouts LVIN) Foundation cleanout C9N) ;i4 Depress (Y� .� High water alarm (Y& Alarm tested (Y/N) .r Date of pumping It -111 —95/ Pumper o SEPARATION DISTANCES FROM SEPTICTANK TO: Well(s) on lot 4/.+ On adjacent lots IJ Foundation 23 ' To property line 2/ ' Absorption field $ ' Water main/service line /o Surface water/drainage /,7o 1 4- 72-M 72-M t&S)•Fom CONTINUED ON BACK PAGE z in O o rn-n -� A T c� 10 C7 g�C _N C O ^ z Date Installed Tank size /oo ^ Compartments Z Cleanouts LVIN) Foundation cleanout C9N) ;i4 Depress (Y� .� High water alarm (Y& Alarm tested (Y/N) .r Date of pumping It -111 —95/ Pumper o SEPARATION DISTANCES FROM SEPTICTANK TO: Well(s) on lot 4/.+ On adjacent lots IJ Foundation 23 ' To property line 2/ ' Absorption field $ ' Water main/service line /o Surface water/drainage /,7o 1 4- 72-M 72-M t&S)•Fom CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (YRS Vent (Y/N) High water alarm level 'Pump on" level at Meets MOA electrical codes (YM) SEPARATION LIFT STATION TO: tested at on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 3 -13- 9 4( Soil rating (GPD/F12) BS 00 System type BE D Length ?2Width /b Gravel thickness G'' Total depth S� Total absorption area -3g ` Cleanout presenta �Depression over field (Ya Date of adequacy test // - /o - 9'! Results as tail) /RAS for 3 Bedrooms Water level in absorption field before test 4 After test •,Peroxide treatment (past 12 months) (1(fgl '"a✓ / If yes, give date 11e •i+'' OJ"Y 42 4-SJ4 k ZL,e, /F//seat SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot -fl On adjacent lots —Property line 2s' To building foundation ' To existing or abandoned system on lot 114 On adjacent lots 30 1 Cutbank ^il Water maindservice line /a Surface water /04,' i Driveway, parkingNehicle storage area /o Curtain drain /ao 14 E. ENGINEER'S CERTIFICATION I cen7fy that I have checked, verified or conformed to all MOA and HAA guidelines in effect on the date of this inspection. N ���•�". �'•S� tQ ,A, C;0 � ( ;' Signature 1.: k fid & Engineer's Name /l"J6f.eT C• CowA� Jj, z—( Date !/ /1 i/�y { aoccaT c. co'NAN HAA Fee $ '560. tN Date of Payment '&ZZ1/ '?/ Receip(Number Y� / (e�9r) 72-028 (393)- Back Waiver Fee $ Date of Payment Receipt Number, MUNICIPALITY ANCHORAGE O DEPARTMENT OF HEEALTHTH& 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. If ()-2) 1 - 1 I �- Ill 1. GENERAL INFORMATION HAA# a�Pq JOLlLlq Complete legal description Peters Creek, Lot 6, Block 3 T15N R1W Sec.10 Location (site address or directions) Property owner Mailing address 23243 Tundra Rose Avenue AHFC Day phone 561-1900 520 E. 34th Avenue, Anchorage, AK 99503 Lending agency N/A Day phone Mailing address Agent Roelph Milton/Heritage Real Estate Day phone 694-4994 Address 18550 Eagle River Road, Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water X 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 X v 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(a".119i) From UOA.n 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 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 Engle River Engineering Services Phone -694-5195 Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature- Date 6. DHHS SIGNATURE Approved for Disapproved. 0 Conditional approval for Additional Comments bedrooms. bedrooms, with the following stipulations: • 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 lendi ng 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. 72025(Ra.1/91) Bao1 MOAR21 Municipality of Anchorage Ak Department of Health & Human Services mom HEALTH AUTHORITY APPROVAL CHECKLIST VEMP Legal Description: PMex5 119= L076 31k? Parcel I.D. 7js14 Relw SEc./o A. WELL DATA Well type PNB! -f f - If A, B, or C, attach ADEC letter. ADEC water system numberT� Fb - A/1/ Log presept(Y/N) Total Sanitary seal (Y/N) Date of test Static water level Well flow Pump level — Date completed Casedto FROM WELT. LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot — Absorption field on lot Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Driller Casing height Wires properly protected (Y/N) EW1RONtvtENr ANt}t0PAGE AT INSPECTION AL SERVICESDIVIsloN g.p.m. ..o ie On adjacent is On adjacent lots Public sewer manhole/cleanout Petroleum tank Other bacteria _ Collected by: Date.instailed 09 13.1,944 Tank size - 1,040 Compartments SEP 2 7 1991 RECEIVED 9.p -m. Clea nouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) AVO Alarm tested (Y/N) -- NSA Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: i Well(s) on lot N ZA On adjacent lots 61.4 Foundation %3 Topropertyline of Absorption field SE!e -1 Water main/service line fro' Surface water/drainage 724M(Ra."1)Fm MOA 21 CONTINUED ON BACK PAGE C. LIFT STATI Date Installed Size in gallons Vent(Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer nhole/Access(Y/N) "Pump off" level at Cycles SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 0 ��/ s�Y4 Soil rating 75 9!_1e— System type SCb 1. Length Z2 Width IF, Gravel thickness 65 otal depth 5 (1''V';t; 356 Total absorption area Cleanouts present (Y/N) Depression over field (Y/N) A) Date of adequacy test 8/s/yi Results (pass/fail) ©'IT for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot LY A On adjacent lots AIA Property line To building foundation -27' To existing or abandoned system on lot 4L_ On adjacent lots ?oma Cutbank 4y� Water main/service line �'• ' Surface water ^V/a Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on lh@date, pf this inspection. Ar T s ' •. l Signature *� w^y_ a L'�i ;• .� Engineer's Na e __ �oi. ^� •; ,7e d f Date/ /` ; A. Eulcra LouisJ'•'• C:-6795 r lB P�OFES$10�`�+ HAA Fee $ ��� Waiver Fee: $ Date of Payment r �'— Date of Payment Receipt Number S Receipt Number 72-M (Rw. W)13mk MOA 21 I Eagle River Engineering Services A- 11940 Business Blvd, Suite #205 P.O. Box 773294 694-5195 Eagle River, Ak. 99577 Fax 694-3297 Legal: n> & SLZCX S PE7re5 eeEck 5 Owner: fHrr Date: Type of test:;:Ys: O Well Flow Test Septic Test Only E3 Well do Septic Test U Other: i , I Time Meter Monitor Level Well Level lank Level GPM PSI ;:! RemarksReading IV5 3,09 *• hol jeep 39„ � SGPId pry 11 7I/ 30: Ito I T2911&7 Aty • Z r l 4+5o0 ,Zi Z 99S'0 _ IXY 91 T3 0 0 ' 113 i.i i....... ,r 7;4 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DIVISION OF ENVIROITHENTAL HEALTH ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH AND ENVIROh1KENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFI"U 2 6 X184 1. General Information Application Df kihe (a) Legal Description (include lo;, block, subdisision, section, township, range) Location (address ordirections) (b) Applicants Name ,�/�I� `'l eZft{eTelephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer Q ; Other Q (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. 6 Agent 1W LF LC44je 1— - Address iPal . .653 j5�? TelephoneY (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Number of Bedrooms 3. Water Supply - Individual Well D�l Community Other (describe) Public M Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Y \ I Public Community Holding Tank El 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 21 C (00". go 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 regula- tions in effect on the date of this inspection. Name of Firm Telephone Addres aF a1 >> :rf A. shofar 6. DHEP Approval G : •.. 1437e ye5�E a. Approved for bedrooms Byfl� .5t', Approved Disapproved V Conditional �J ' Terms of C nditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIROMNTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. E`1PLOYEES 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 284-4720 rr /� Legal Description: L 6 B 3 pe-t�! S Coe A. WELL DATA Well Classification If A. B,//C, O.E.C. Approved (Y/N) -/ Well Log Present (Y/ ) Date Completed J� /S >9 4e -Yield llLL 3� !i r 4 �— Total Depth — Cased to / 'E Depth of Grouting u WStatic Water Level 3�D Pump Set At r -C it Casing Height Above Ground Sanitary Seal on Casing ©Y PI) _ Electrical Wiring in Conduit(Y N) Depression Around Wellhead (Ya Separation Distances from Well: To SepticA laid n+g Tank on Lot 103 ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot 1! -7 f ; On Adjoining Lots �V'o To Nearest Public Sewer Line !!2To Nearest Public Sewer r Cleanout/ Manhote N To Nearest Sewer Service Line on Lot ZS .c Water Sample Collected byS S 7�y� Z ; Date Water Sample Test Results znofe-smell Comments B. SEPTICfHOLIMI , TANK DATA Date Installed ® 3 Size No. of Compartments 2 Standpipes &N) Air -tight Caps (Y ) Foundation Cleanou6N) Depression over Tank (YQ Date Last Pumped yG C✓ Pumping/Maintenance Contract on File (Y/N) Li'' ; for Al �H'- Holding Tank High -Water Alarm (Y/N) � Temporary Holding Tank Permit (Y/N') &?2 Separation Distances from Septic/l'aid wg Tank: To Water -Supply Well /O '? To Building Foundation 23 r r To Property Line /O '{ To Disposal Field B To Water Main/Service Line �� % To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) Ar v u /=- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata f$ S'J d'n Type of System Design BE Dale Installed 81 1A Length of Field ?2 r Width of Field A8r Depth of Field S .1 .. Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field 6 Gravel Bed Thickness Standpipes Present GY)N) Date of Last Adequacy Test IAI AJ -e G..) To Water -Supply Well 1/7 r To Property Line �� r r To Building Foundation 3S To Existing or Abandoned System on N0 nJ B 2-0 r Lot ; On Adjoining Lots r To Water Main/Service Line !` /d To Cutbank (if present) /v a ^r/? To Stream/Pond/Lake/or Major Drainage Course o ^J rr To Driveway, Parking Area, or Vehicle Storage Area f 01 - Comments Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments •' Check Permitted Bedroom Rating Against HAA Request •• 1certify thiP ec�ed,verified,orconformedtoallMOAandHAAguidelinesineffectonthedateofthisinspection. Signed SRO ng ng DateJ7 4Z--f3ef F"'e'iv_ . Company AIasi,, 2g!= MOA No. 257 S —v o 9 Receipt No. I Date of Payment 'a co t Amount: $ Page 2 of 2 72026 (11,84) .. D t1.1�.�r •�� SA�1r ' .'� b S• N. 1447.(