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HOMESTEAD HILLS BLK 1 LT 4
Homestead Hills Lot 4 Block 1 #015-173-12 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street • Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW �Qyii—���-de�� 3— .fLt ❑UPGRADE �" MAILIN DDDREASS _ P OAC 1100 73 LEGAL DESCRIPTION L Jio�1� a� ead Ff:�l LOCATION dine !�/ NO. OF BEDRQOMS 1�ctp O DISTANCE TO: Wells e • v Absorption area �� `JC Dwelling PERMIT NO. _y d Manufacturer Mater No. of compartments Q W F rn Liu, cipacitJly Rgallons (J IF HOMEMADE: Inside length Width Liquid depth y DISTANCE TO: Well Dwelling PERMIT NO. _z< f Manufacturer Material Liquid capacity in gallons O W FoundationNearest lot ine P HMIT NO. W = DISTANCE TO: � y .3 / - a10 -`WZ f,? W No. of lines Lengt R ch line �l Total lenn h f lines Trench wi th inches Distance between lines Top f ti a to finish jade Material beneath file Total tivn n ~ 9 g eff ab. r area O inches Lengt6 Witl r Depth PFfiMli NU. w (7 i H Type of crib Crib diameter Crib depth Total affective absorption area W d H DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line 77 RMIT NO. J W DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIA S P f SOIL TEST RATINQGr j O J INSTALLER Hkbb Cs{--A,%G1►oc szy' REMARKS 90 z s r e 271 3. IZ 74/9' J APPHOVEW U DATE LEGAL 7/cf/e/ Lot y Block 1 Har+&L+ead Hits 72013 (Rev. 3/78) MUNI C I P A L I T Y O F ArJ (-_ H O R A L E DEPARTMENT ( HEALTH AND ENVIRONMENTAL POOTECTION .. 825 K STREET, ANCHORAGE, AK. 95 1 • - 264-4720 OrJ—SITE SEWER PERM I T PERMIT'NO. C 810322 ) APPLICANT WAYNE ANDERSON PO BOX 10-273 243-4100 LOCATION TRAPLINE LEGAL L4 61 HOMESTEAD HILLS LOT SIZE 19729 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSQ FTtBR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 7' L_ErJGTH= 34 GRF NAKL_ ©EPTH= THE LENGTH DIMENSION IS THE LENGTH CIM 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 CIN 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 CIN FEET). REG?U I REF? SEPTIC TF NK SIZE= 1250 GALL.OrJS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER. OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO C z, > I rJSPECT I coven ARE REOU I REQ --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY OM -SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET 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. OTHER. REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER. INSTALLATION. PERMIT EXP I RES MECEME3ER 31, 15+87. I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED APPLICANT ISSUED BY 47A'iNE AFJ/D;EP.SOPJ T�'P£ Cr SOIL P,850RPTIOM S•l;TEM IS: TRENCH N111:It/R/ trRIVER OF 8£ofMY MS = 4 SOIL RATING <SQ FT/W)r 8-5 THE REWIRED 512E OF THE 'SOIL W-51IRPTION Sf5TEl1 IS: pt_T?Tt- 7 L-a74l3Ti-t= Z4 rRfi'��EL DEf�TNa 5 THE LEWjTH Ott0t3tON IS THE LENGTH CIN FEET) OF TW- T`RO :N OR ORAIWIF-LD. THE DEPTH OF A TR'EibN OR PIT IS THE DISTANC` MtWEEN THE 19"ACE OF THE GF"" AMID THE BOTTOM OF THE Emi"TION <[N F££r). THERE IS fit) SET WIDTH FOR TRCN:' . THE rjRLYEL. DEPTH tS THE MINI?lJM DEPTH OF GRAVEL. SETTICEH THE OUTFALL PIPE ANO THF' SOTTOH OF THE t0:"3VATION (IN FEEr). Rt=�tJ Z REU SEP T I (r Tt�tJK S I �E= 1.7_S9 �ALL_1a?V� . ! PEPl1IT APPLtCANr Hws THE RE�i'LWSI8ILITY TO twaRt THIS D£PA><Tt1ENr oll ma THE I; msrALLArrom IN5PECTr(Ni OF nNY 11-Lus ADJt cor To Tits PROPERTY AND THE tU-18ER OF RESIDEENDES THAT THE I4ELL. WILL SERyr- Twr t xT4t F"Sc-r r s=ir4s tv2Et2EQu I REO — a1 3TILLIt1G OF Air! S►`STE1 Wtn+)sjr FINAL inspECrroN AND Fwvj YIaL 8Y THIS I DME-IRTMENT WILL BE VJDJECT To P1d3.3£curtON- fil4ltaJM DLSTA"M BETWEEN A WELL FM ANY ONlSITE SEHFM DISPO'-DIL SYST01 t5--- 18+3 Fcer roR A PRIVATE WELL OR iRa TO 298 FEET FROM A PUBLIC WELL o£PEWIt1G 10" THE TYPE OF PUBLIC WELL. tgrNttlJM DISrANCE FROM A PR[YAT£ I -JELL TO A PRIVATE SEWEP LIRE 15 25 FEET ANP TO A OOMJN [ rV 'SE WG -R LINE IS 73 FEET. + Or". REW IREMEN T5 Wl APPLY. SPEC tF iCA TI ONs Am CONSTRUCTION o IAMIMS ARE AVAILA6l£ To INSURE PROPER Itt;TALLATION. I ccRrIFY TMT L, t AM FAMILIAR W [ TH THE $ZEQ1J IRE p*NTS FOR ON-SITE 5EwER5 AND WBLLS AS SEr FORTH $Y rFf_ rFJN IC IPAL I rY OF AIM: 2: I 14ILL IK -TALL THE S`STE1 IN AC7 INCE WITH THE CODES. 3. I 1R)DEF'5TANO THFIT THE ON SITE Sa-ER S?.STEM tDiY REQUIRE ENLFR<3Fl*NT IF THE Rt=S IDEN nE IS RgIOD£L£D TO INa-Lo ftE Tl*Vl 4 BEDROOM - U - - r 1 t�'1c�FStSGM `--- Ss ITD GY---J- ----------- ------ -- J r111ir'L� pl_LTY Iii` FitJCi-�#Rt�C3E .4 DTMFIIT UF. MAI -T" � EWER%"EMTAL PROTECTION �, • 825 'L' 'STREET, ft -0 st:+©E AY. ?3501 a: PERMIT ti]. C 819322 ) 'cra APPLICANr Lb%w At7DEz"s PO BOX 19-273 243-4iOQ- a LJorlInTION TRAPLINE LErjnL. L4 8i t-*VC5TEA0 HILLS LOT SIZE i9t29 SOJARE FEET,:: T�'P£ Cr SOIL P,850RPTIOM S•l;TEM IS: TRENCH N111:It/R/ trRIVER OF 8£ofMY MS = 4 SOIL RATING <SQ FT/W)r 8-5 THE REWIRED 512E OF THE 'SOIL W-51IRPTION Sf5TEl1 IS: pt_T?Tt- 7 L-a74l3Ti-t= Z4 rRfi'��EL DEf�TNa 5 THE LEWjTH Ott0t3tON IS THE LENGTH CIN FEET) OF TW- T`RO :N OR ORAIWIF-LD. THE DEPTH OF A TR'EibN OR PIT IS THE DISTANC` MtWEEN THE 19"ACE OF THE GF"" AMID THE BOTTOM OF THE Emi"TION <[N F££r). THERE IS fit) SET WIDTH FOR TRCN:' . THE rjRLYEL. DEPTH tS THE MINI?lJM DEPTH OF GRAVEL. SETTICEH THE OUTFALL PIPE ANO THF' SOTTOH OF THE t0:"3VATION (IN FEEr). Rt=�tJ Z REU SEP T I (r Tt�tJK S I �E= 1.7_S9 �ALL_1a?V� . ! PEPl1IT APPLtCANr Hws THE RE�i'LWSI8ILITY TO twaRt THIS D£PA><Tt1ENr oll ma THE I; msrALLArrom IN5PECTr(Ni OF nNY 11-Lus ADJt cor To Tits PROPERTY AND THE tU-18ER OF RESIDEENDES THAT THE I4ELL. WILL SERyr- Twr t xT4t F"Sc-r r s=ir4s tv2Et2EQu I REO — a1 3TILLIt1G OF Air! S►`STE1 Wtn+)sjr FINAL inspECrroN AND Fwvj YIaL 8Y THIS I DME-IRTMENT WILL BE VJDJECT To P1d3.3£curtON- fil4ltaJM DLSTA"M BETWEEN A WELL FM ANY ONlSITE SEHFM DISPO'-DIL SYST01 t5--- 18+3 Fcer roR A PRIVATE WELL OR iRa TO 298 FEET FROM A PUBLIC WELL o£PEWIt1G 10" THE TYPE OF PUBLIC WELL. tgrNttlJM DISrANCE FROM A PR[YAT£ I -JELL TO A PRIVATE SEWEP LIRE 15 25 FEET ANP TO A OOMJN [ rV 'SE WG -R LINE IS 73 FEET. + Or". REW IREMEN T5 Wl APPLY. SPEC tF iCA TI ONs Am CONSTRUCTION o IAMIMS ARE AVAILA6l£ To INSURE PROPER Itt;TALLATION. I ccRrIFY TMT L, t AM FAMILIAR W [ TH THE $ZEQ1J IRE p*NTS FOR ON-SITE 5EwER5 AND WBLLS AS SEr FORTH $Y rFf_ rFJN IC IPAL I rY OF AIM: 2: I 14ILL IK -TALL THE S`STE1 IN AC7 INCE WITH THE CODES. 3. I 1R)DEF'5TANO THFIT THE ON SITE Sa-ER S?.STEM tDiY REQUIRE ENLFR<3Fl*NT IF THE Rt=S IDEN nE IS RgIOD£L£D TO INa-Lo ftE Tl*Vl 4 BEDROOM - U - - r 1 t�'1c�FStSGM `--- Ss ITD GY---J- ----------- ------ -- J PERFORMED } 'SOILS LOG MUNICIPALITY OF ANCHORAGE PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: 40 / 91k i'r)!S/�•�C DEPTH SLOPE SITE PLAN FEET?�� F—T—F= 1' 2- 3- 4- 51 •3-4•5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 X62lu PERFORMED 72.008 (6/79) (G/o) l..7e//9r>4-el l7r,re/- WAS GROUND WATER &e) ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWE N FT AND FT CERTIFIED DATE: Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-173-12 Expiration Date: d 1. GENERAL INFORMATION Complete legal description HOMESTEAD HILLS S/D; BLOCK 1, LOT 4 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 4361 TRAPLINE DRIVE, ANCHORAGE, AK, 99516 JACK & VERLYNN HERRING Day phone 4361 TRAPLINE DRIVE. ANCHORAGE. AK JUDY ROSENBERG W/ PRUDENTIAL Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: 248-7301 229-1097 TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well ® Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ `t Y 6 , CU Date of Payment ' LO1i4113 Receipt Number 06�('o @6 COSA # QSelal q7 0� Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems 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 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(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, Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, 1.0. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 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 sale benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or parry is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Phone 337-6179 Date i2o 13 Conditional approval for bedrooms, with the following stipulations: ON—SITE WATER AND W AS-rEWATER ..a Original Certificate Date: I - -�; 0 -1 The ality or,4nehorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: / COSA Checklist L / Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 11105) If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: HOMESTEAD HILLS S/D; BLOCK — / 4 L-�% Parcel ID: 015-173-12 A. WELL DATA Well type COMMUNITY Date completed Total depth ft. Date of test Static water level Well production WATER SAMPLE Coliform If A, B, or C provide PWSID# 211669 _ Sanitary seal (Y/N) Cased to ft. FROM WELL LOG IN= Well Log (Y/N)— Wires properly protected (Y/N Casing height (aboround; F -M colonies/100 ml. Nitrate mg./L. Collected by: ft. Now in. Arge-n'ic ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 7/8/1981 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N)NE High water alarm (Y/N) N/A Date of pumping 8/18/2013 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA Date installed 7/8/1981 Soil rating (g.p.d./ftor /bdrm 85 System type TRENCH Length 39 ft. Width 4 ft. Gravel below pipe 5 ft. Total depth *7.3 ft. Eff. absorption area 370 ft' Monitoring tube *YES Depression over field NO Date of adequacy test 9/20/2013 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 32 in. Water added 705 gal. New depth *47 in. Elapsed Time: 125 min. Final fluid depth 40 in. Absorption rate >= 600+ g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — *NOTE: SUMP ONLY EXTENDS 33" BELOW INVERT OF LATERAL PIPE. TOTAL DEPTH AND LIQUID LEVELS ARE CALCULATED BASED UPON LATERAL LINE ELEVATION. **13" BELOW INVERT. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off' level E. SEPARATION DISTANCES level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on Public sewer main Sewer /septic service On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas 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 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS *UNSPECIFIED ON ORIGINAL INSPECTION REPORT. ASSUMED BASED UPON FIELD MEASUREMENTS. G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date �20�l3 (Rev. 11105) Municipality of Anchorage Development Services Department Building Safety Division ,. . On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 1 www.muni.orglonsite r (907)343-7904 v CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING r Parcel I.D. 015.1' 3-1 �_ COSA# bl( 0101_13 1. GENERAL INFORMATION Expiration Date: / D - 2 15�- () 7 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HOMESTEAD HILLS: LOT 4. BLOCK 1 4361 TRAPLINE DRIVE ' ANCHORAGE. AK 99516 ROY & JOAN TRrrr Day phone 337-2408 4361 TRAPLINE DRIVE • ANCHORAGE. AK 99516 Day phone DEBBIE GOETZE w/PRUDENTIAL Day phone 441-2408 3801 CENTERPOINT DRIVE J200 • ANCHORAGE. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class "A" Well 0 Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 samples. (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 Certificate of On -Site Systems 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 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(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 I O Ie/of. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lest, 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 lluduate 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 benett 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 f bedrooms. Disapproved. Conditional approval for bedrooms, with the Illowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory L/ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other ......... f isn— o 10 F AV f6-,'% :AQP• yo''� •• ON•SITE•••••�G+� WATER AND WASTEWATER PROGRAM By: Original Certificate Date: Municipality of Anchorage e • Development Servvice�sy Department ButlAing Safety D,Y,Dbn A (1 On.Ske Water 3 Wastewater Program 47W Bragew Street P.O. Boor 196650 Anchorage, AK 99519.6650 wwwrnuni.orglonsite (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HOMESTEAD HILLS: LOT 4. BLOCK 1 Parcel ID: O Q6'— 1 -73-12- A. 3-12 A. WELL DATA Well type CLASS •�• Data completed _ Total d� Date of test Static water level Well production If A, B, or C provide PWSIDN 211669 Well Log Sanitary seal (Y/NL_.�W re�roperty protected (YM) to ft. FROM WELL LOG WATER SAMPLE RESULTS: Coliform colonies/100 ml. Arsenic: B. SEPTICIHOLDING TANK DATA ft. g.p.m. Nitrate Casing height (above ground) in. AT INSPECTION of sample: Collected by: ft. g.p.m. colonies/100 mi. Tank Type/Material SEPTIC/STEEL Date installed 7/6/1961 Tank size 1250 gai. Number of Compartments 2 Cteanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 10/5/2006 Pumper McDONALDS PUMPING C. ABSORPTION FIELD DATA 16SELOW EX N MOWTORIN6 TUBE ONLY DaDW 35' e8J0N THE *NM Date krsta6ed 7/8/1981 Soil rating (g.p.d./ft'or4jS� 85 System type DEEP TRENCH Length 39 ft. Width 4. -) ft. Gravel below pipe 5 ft. Total depth `5.6 ft. Eff. absorption area 370 ft' Monitoring tube "'YES Depression over field NO Date of adequacy test 10/5/2006 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before lest 0 in. Water added 900 gal. New depth25 in. Elapsed Time: 129 min. Final fluid depth 12 In. Absorption rate r= 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YIN 3 type) NONE KNOWN If yes, give date — D. UFT STATION Date installed "Pump on" level at _in. Size in gallons Manhole/Acoess (YIN) "Pump otr leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots is sewer manhole/deanout Sewer /septic seance line Holding tank An ment areas Manure/animal excrete storage areas 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 200'+ PUBLIC/100'+ PVT SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parkinghrehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacentkits 200'+ PUBLIC/100'+ PVT F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in confomrance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date IQ h 9 % COSA Fee S L� • (X-) Waiver Fee E Date of Payment i �1 10 / U � Date of Payment Receipt Number % 32 1 NDIt— Receipt Number (Rev. 11/05) N6 MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Ml Division of Environmental Services Onsite Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILL,Y/DWELLING Parcel l.D.# 015-173-12 HAA#A17(�,��`� 1. GENERAL INFORMATION Location (site address or directions) 4361 TRARI INE QR ANCHORAGE AK 99516 Property owner `TAT WARD Day phone (1107)5564-5545 Mailing address 4361 TRAPLINE DR. ANCHORAGE AK 99516 Lending agency Mailing address Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 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 xx Holding Tank Community on-site Public sewer NOTE: If community, wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shag be paid $1,100.00 at, or prior to, closing for the engineering 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 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. V Name of Firm Phone_ (9071337-6179 Engineer's Signature I /f! 1 / Date S In conducting this evaluation, AWWC, I C1 a pted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and OA HS Guidelines & Regulations. The reported results described the performance of the system under the conditidlis encountered at the time of the test, and separation distances measured to readily fdentiriable features. The operational lite of all wells and septic systems depend on the focal soils condition, ground water levels that may fluctuate during the year, and the water o�oO,i 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. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. 0 ° - c �� , '• The content of this report is for the sole benefit of the owner listed above. An Q ( I ...'................ Any ., reliance upon or use of this report by any other person or party Is not authorized, �.. r... ... . nor will it confer any legal tight whatsoever. r ir. efFey A. rnessr 6. DHHS SIGNATURE Approved for 4- bedrooms Disapproved Conditional approval for Additional Comments M ICE-7953...�c�vo Prof as siono\ o bedrooms, with the following stipulations: Date 51 -SI -0 O 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 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH S HUMAN SERVICES Environmental Services Division 825 V Street. Rm 602 Anchorage, Alaska 99501 (907) 343-4744 Health Authority Approval Checklist Legal Description: HOMESTEAD HILLS S/D: LOT 4. BLOCK 1 Parcel I.D.: 015-173-12 A. WELL DATA Well Type "A' If A, 8, or C, attach ADEC letter. ADEC water system number Log present (YIN) Date completed Total depth FROM WELL LOG Casing height (above ground) Wires property protected (YIN) AT INSPECTION Data of lest Static water level Well production O.P.M. 9 -p -m - WATER SAMPLE RESULTS: •1, :.,A B. 8EPTICIHOLDING TANK DATA Data installed 7/8/81 Tank size 1250 Number of Compartments—Cleanouts (Y/N) YES Foundation deanout (VM) YES Depression (YIN) NO High water alar (YIN) N/A C. ABSORPTION FIELD DATA Data Installed 7/8/81 Soll rating (g.p dJfl2 or f12/bdr) 85 System type TRENCH Length 39' Width 4' Gravel thickness below pipe 5' Total depth 8' Effective absorption area 370 SO FT Monitoring Tube present (YM) YES Depression over field (YM) NO Date of adequacy teat 8/30/2000 Results (Pass/Fall) PASS For 4 Bedrooms Fluid depth In absorption field before test (In.y D' Immedlateiy after759 gal. water added (ln.� 27. Fluid depth 18.5' (Ina) Minutes later. 280 Absorption rate - 600 + GPD Peroxide treatment (past 12 months) (YM) haze OW, a!aat' Comvaur Wrnbn B yea. give dais 6/28/2000 do 7/28/2000 D. LIFT STATION Date Installed Size Manhole/Access High water alarm level ar 'Pump off level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Seplic(holding tank on lot On Public sewer main adjacent lots sewer manhole/deanout line Lift station SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Foundation 5'+ Property One 5'+ Absorption field 5'+ Water mainiseMce line 10'+ Surface water/drainage 100'+ Wells on adjacent kits 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property One 10'+ Building foundation 10'+ Water maintservice One 10'+ Surface water 100'+ Driveway, parldnghrehide storage area 10'+ Curtain F. ENGINEER'S I cef & that I i of Munidpal ryry W0 MOA WAG Engineer's HAA Fee Date of Payment Wells on e field Inspedfons and review systems are in conformance on this date. Waiver Fee Date of Payment Receipt Number Receipt Number 72-M lwv. Mr Cwp" VwWm lut MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Envkonmerdal Services On -Site Services Section P.O. Box 198850 An&mrape, Alaska 99519 -WW MM 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLYDDWELLING Parcel I.D.# 015-173-12 HAA# 'K14CC��O 3�L5 1. GENERAL INFORMATION Property owner STEVE WARD Day phone (9Q7) 564-5545 Mailing address 4361 TRAPLINE DR ANCHORAGE AK 99516 Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise Iaquested, MAA Will be held forpickup. APPLYING FOR CONDITIONAL HEALin AUThJRITY APPROVAL 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 NOTE: tf 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 xx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmaticn from State ADEC Ing to the legality and status of system. 72-0251Rev. 1191) Fran MM 921 COM PAW Venin Note: Alaska Water and Wastewater Consultants, Ina shall be pald $700.00 at, or prior to, dosing for the engineering 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 wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. l further verity that based on the information obtained from the Municipality of Anchorage flies and from my investigation and inapgcdion, the on-site water supply and/or wastewater disposal system Is in compliance with all Muni iphla nd State codes, ordinances, and regulations in effect 1 on the date of this inspection. . / Name of Finn Phone (9307) 337-6179 Engineer's Signature "I v Date F / iii'/aa In condix ft rids evaluation. AJWKC, ! pted to provide a thorough, conscientious englneer/ng anwry of the system In accorrtanoe with ADE C and S Gulderinee d Regulations. fie reported results described the performance of the system under the Gond barls encountered at the time of the test and separation dlstences mae&sad to nwWy lderrBAable lash m The operadona/We of all wells and septic systems depend on the local soles condition, ground water levels Chet may 8uchrate dudng the year, and the water 00000pp� usage of the lamly being served by the system. These conditions are outside the control of o OF A the evaluator of rine system. Satisfactory test results do riot guarantee lulure performance o `� ,....... of the system, nor do they guarantee that there are no hidden defects or encroachments. v AVVWC, inc. can therelore not protide any wemnty for future estimate of how long the app system will continue to meet the operational requirements of the ADEC or MOA DHHS. 0 ...:.... . The content of thia report is for the sole benefit of rine owner Wed above. AV 0 rellance upon or use of this report by any other person or party is not authorized, p.. nor willltconfer any legal tight whatsoever. [711 e re A. Gan —7953 6. 6. DHHS SIGNATURE Approved for bedrooms Disapproved ...1:.:'. xx CondlUonal approval for 4 bedrooms, with the following stipulations: Money to be put in escrow fcr a replacement septic system if nepaprl plus $500 for a s nand ePprjr ndpqgr r St In h- be released until this office hag ioon final npprnmil Additional Comments CM Date -2 - IS - O o The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate Is issued. The Municipality of Anchorage is not respcnsible for errors or cmissicns in the professional engineers work. 72-C25 (Rev. 1191) sack MCA #21 Com"r Vembn Municipa ft of Anchorage E I V E D DEPARTMENT OF HEALTH & HUMAN SER Env ronmentel SeMcea DMebn 825 OV Street Rm 802 Anchorage. Alaska t;=1(n 343NM 152000 MUNKIPALITY OF ANCWMGE HOSM Authority Approval jS fII *AEWALSMICES DWI' Legal D orc HOMESTEAD HILLS S/D: LOT 4. BLOCK 1 Peroell.D.: 015-173-12 A. WELL DATA Wen Type PUBLIC B A. 8, or C, attach AMC letter. ADEC water system number Logo AMR nt (Y" Data completed Total depth Casing hWt (above Votind) gardtan "at _wlm properly Dnp (Y" FROM WELL LOO AT INSPECTION Dais of lest Staticwater wral Wen production g.pm. 9_pjrL WATER SAMPLE RESULTS: W_ iL sEpiICM "ING TANK DATA Data tromned 7/8/81 Tank alta 1250 Number of COMPIVI MOMs2-Ck WOM (YIM YES— FOIaldatlOn CbanOUt (Y/N) TES Depression (YIN) NO High weler alarm (YIN) N/A c. ABSORPTION FELD DATA Date fined 7/8/81 Sun rating (g.p dJn2 or ft2Ibdm%) 85 System bPe TRENCH 39' Wkltlh 4' GMNW t dckno$s below pipe 5' Total depth 8' Etfecit a absorption arae 370 SO FT Monitortrp Tube present (00 YES_ Depression overtleld (YIMNO— Dete of edequecy test 8/9/2000 Raehdta (paaalW PASS For 4 Bedrooms FkW depth in absorption told betoro test pn.k n" Immediately ager 1109 get. water added M}` _36 Fk/d depth 21.5" (ins) Misrms later. 976 Absorption rate GPD perp ide treabmenl (past 12 months) (00 Y Kyes, on dam 6/28/2000 alt 7/28/2000 MW 3"rcMvu rv6vM Srrp;ic LS&e 0. LIFT STATION Dais trutalled ManholalAwess (00— High watxalaml Im J%cksted E SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 'Pump dr level ar aom t bb SEPARATION DISTANCES FROM SEPTICHOLDING TANK ON LOT TO: Foundation 51+ Property Qne 5'+ Abompllon lbid 5'+ Waw nm4Vaetvbe Ine 10'+ Surfeco100'+ Wob on adJaoe d bb 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property ane l o'+ Bdit tundagon 10'+ Wabr mainbwvke *m 10'+ Surface water 1000+ Dry, ChM - I M 00 a SM 10'+ Curtain drain. F. ENGINEER'S wth MOA 9 Slgeaturo— Engineers Ne MAA Fee: 3 by 6y Date of payment $ J,( 5/ ev Reoalpt Number cm WaIM RM Date or Payment Receipt Number ro!?UT/G. ESM 7. er 1 i htxaps Record"Preclncl, Alaska JT SURVEY CERTIFICATION LEGEND eebycarli/y Mat l Its" Surveyed lheproperly shown and described (b a Braes carpe I,ad that the Inprov"Wrds tlluafed thereon are wahln fhe prop- o aim pope and net and dorof overlop ortncrooch an adjacent property and that no o • 2 a2 hub d t %'~$On adjauwd Pf"ly over lop or encroach on the premises o eyg"t 3p'rt -' •stlon and that the* are roroodwoys,unnfy arras or other vblblt vanla an cold property eeeepf at Ldlealed hereon. LOT 5 DATE-0—P.L4 E / . O dR/ Date05-0/—U/ . Prepared by: R. L. BUTTON RepluemdLand Swmatrr (.vn%1P%9-E.^CO 3/9u�FrMMvly+ n��ti.•.... na.r..n.....• MUNICIPALITY OF ANCHORA Department of Health & Human SeGErvlces DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # d�s��7.� HAA # t IRR- oLI R'1 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) l of I3 fuc cc .y Ho ,S kVAoe lkar s /f7 Location (address or directions) y?6/ 'Tr+zltee Drrc.e (b) Property owner 710 Fe en eV Telephone: (home)3W 3637 Business Mailing Address '136/ Tnarnhn.G Dr«e 4ncloc7; 991—(4' (c) Lending Institution Ude/!e Telephone S6 Z- 218/ Mailing Address H6O W T"/or lid hmcAc,22;qe /k 99S103 (d) Real Estate Company and Agent Reflowx p�9yy — POf"t" ffernol� Address 2600 Cor'd6vex SIC ty; 9-9 T-0-7 Telephone 2 7e 2761 (e) Mail the HAA to the following address: (or check here B, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family 9 3. WATER SUPPLY Individual Well ❑ Ted "Core- - 3yS-/Ssr Number of bedrooms_rL Community IN 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 IR 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. 72M5 (R". 7/") 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. NameofFirm F'(ctH G Tchn%c"t Sefvccri Telephone Sys= i34; Address Date Navem &Pep- I IP%M ••••••••C Engineer's Seal A d . THECDO.AZ F. MCC@@ �Q.,'.•••C-c-3549 ^',tt.� 6. DHHS APPROVAL Approved forbedrooms by Date'40,14-, ApprovedPL Disapproved Conditional Terms of Conditional Approval The Municipality 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 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 oranalyzedata before a certificate is issued.The Municipalityof Anchorage Isnot responsible for errors oromissions in the professional engineer's work. n425 (A". T/BBI BKk Page 2 of 2 N,UNICIPAUTY OF AP:CHO�AGE MUNICIPALITY OF ANCHORAGE (MOA) 10^IM[NTAt SEs �IC�' C'�I ICN • Health Authority Approval (HAA) O CHECKLIST - FEBRUARY 1984 O 21936 343-4744 n Legal Description: LOP A. WELL DATA (tom Well Classification If A. B. C, D.E.C. Approved (YIN)G— Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ' ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments DF!' %m Hza yJker IeH-er af�nrl.�f_ Pnrta t�u!�a�r. c 0~141 OrovFT,�/, {_ +-o�ZrAr F oyoeraiy/' B. SEPTIC/HOLDING TANK DATA Date Installed ZIZZ / Size J2-,M�FsLNo. ofCompartments Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped y 2— % Role Rooftl Pumping/Maintenance Contact on File (Y/N) Iv,A. ; for ft A. Holding Tank High -Water Alarm (Y/N) N.A. Temporary Holding Tank Permit (Y/N) lu•R. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well Z:t POO To Building Foundation /2 r To Property Line > i0 r To Disposal Field To Water Main/Service Line > '257' To Stream, Pond, Lake or Major Drainage Course > Ioar Comments 72-M (Rw. 7/68)Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 93 a `I L?6&T Type of System Design-rreAC4 Date Installed 7/9/B1 Length of Field 3-9 Width of Field y6', Depth of Field 6 Gravel Bed Thickness Square Feet of Absortion Area 370 Stalndpipes Present (Y/N) Y o Depression over Field (Y/N) N Date of Last Adequacy Test rG / 12-/ 66 Results of Last Adequacy Test fi dGnuu% for y btct roa.nr SEPARATION DISTANCE FROM ABSORPTION FIELD: I t'rnc.l Fro. c.o. k /V, P,y, t„t To Water -Supply Well Pool To Property Line Jef”' To Building Foundation To Existing or Abandoned System on Lot 1Y, A. ; On Adjoining Lots -7 30I To Water Main/Service Line > 75- To Cutback (if present) /v1 A. To Stream, Pond, Lake, or Major Drainage Course too' To Driveway, Parking Area, or Vehicle Storage Area �> So' Comments Adnauaev nkrf o^ lolmlag cAowerf D. LIFT STATION N,h- Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (YIN) Comments Dimensions Manhole/Access (Y/N) —"Pump Off' Level at Vent(Y/N) "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and Inspection. Pumping Cycles during Adequacy Test. HAA guidelines in effect on the date of this Signed I.<.� 5C 04 ` OF A4q oe Company E-kt8V r�oiepwl Se^,e r- a'� Ir I "* '•49TH�•�,t 0 Engineer's Seal Date / Ila; A:........�......0 MOA No. _ B8-os2 ............. Receipt No. -0S - Di% (o 3-7 Date of Payment //-?- S/P Amount: $ 70.6 ?) d . THEODORE F. MoopE O CE -3569 opt e Q �l� '•. ...... a�.on Receipt No4��esstcn�a..�rr ,.. Qek Waiver Fee: $ Date of Payment 72-M (Rev. 7/98) Back Page 2 of 2 • HE 0C� a�da��a STEVE COtYPER, GOVERNOR IIEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 563-6775 3501 C STREET. SUITE 1334 ANCHORAGE. ALASKA 99503 DATE: November 2. 1988 PWSID: 211669 To Whom It May Concern: According to the records on file in this office, the HOMESTEAD HILL. SUBDIVISION Water System is in compliance uith the State of Alaska Drinking Water Regulations. Sincerely. Vera E. Craig ((JJ • Environmental Field Officer VEC:pkk 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE ^ ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY INSPECTOR INSPECTOR INSPECTOR COMMUNITY since PUBLIC UTILITY ....,• DEPT. OF I'.''.%LI;1 C. MUNICIPALITY OF ANCHORAGE nen;,;: ;:"LTiCTION eo DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ' \1 825 L Street • Anchorage, Alaska 99601 8. SEWAGE DISPOSAL SYSTEM ENVIRONMENTAL SANITATION DIVISION Telephone 264-1720 RECEIVED FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES REQUEST DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. PHONE 1. PROPS TY OWNER M IL GAD ESS '5' PROPERTY flESIDE (lf tlifLferentrom above) PHONE f PHONE 2. BU ER MAILIN ODRESS PHONE 3. LENDING INSTITUTION L 41:fgei'r S MAILING ADDRESS 47N A 7—s PHONE 4. REALTOR/AGENT MAILING ADDRESS 5. LEGAL DESCRIPTION 1141nEl LOCA ION 6. TYPE OF RE DENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ' ATTACH WELL LOG. A well log is required for all wells drilled INDIVIDUAL' June 1975. For wells drilled prior to that date, give well COMMUNITY since PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM /YEAR ON-SITE SYSTEM WAS INSTALLED. INDIVIDUAL/ON-SITE" ❑ PUBLICUTILITY ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. NOTE: THE INSPECTION FEE MUST 72010 (Rev. 6/79) 72010 (Re, 6/79) THIS SIDE FOR OFFICIAL USE ONLY SIDENCE NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER E FAMILY PLE FAMILY ❑ TWO ❑ FOUR ❑ SIX LY F:1INDIV71DUAL PERMIT NUMBERDUAL DEPTH OF WELLNITYDATE UTILITYonnection DRILLED Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY DATEINSTALLED Connection Verified ❑SepticTankor ❑Holding Tank Size: If Tank is homemade give dimensions: INSTALLER SOILS RATING - - - TYPEOFTANK -AREA MANUFACTURER - TOTAL ABSORPTION � MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line 7pearest Lot Line Absorption Area to nearest Lot Line S. COMMENTS V�'APPROVED FOR 44- BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72010 (Re, 6/79)