No preview available
HomeMy WebLinkAboutHILLSIDE PARK PUD LT 7Hillside Park Lot 7 #015-122-44 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211320 PID Number: 015-122-44 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New®❑ Upgrade Name Shane Wallace ORPTION FIELD reO De Trench El Wide Trench El Bed El Mound Site Address 7281 Tree Top Circle, Anchorage, AK 99507 Other Phone Number of Bedrooms Soil RatingJTotal depth from original grade 4 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from originalg e Gravel depth beneath pipe F . Ft. Subdivision Block Lot Hillside Park PUD - 7 Fill added above original gradeGr I length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista a between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between tr ches From Tank Field Tank Tank Line Ft2 Well >100' N/A N/A N/A >25 TANK ❑Q Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water > 100' N/A N/A NIA Material Plastic Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >1 o' N/A N/A N/A LIFT STATIOk Manufacturer Capacity Remarks Gal. Alarm location E cal installed by PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Installer A+ Home Services Drainfield D3034 CO/MTD3034 Inspector J.Millette BENCHMARK (Assumed elevation) 100 ft Inspection 1. 9/17/21 9/17/21 Location and description dates: 2nd Bottom of Siding 3rd 4m ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ��� Conditional Approval: Date • .cS� 49 Septic SystemBenjarrr Schiller Approved Date 10+�`�%s�'•.,C013/21 E 12592� ,.•*&f'A' F�F�P - ... - �0 ki ROFESO Note: this approval does not include well permit requirements. tKev uoiuzri u/ DECKFENCE Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEER1"=50' EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE 1250-GAL SEPTIC TANK W/20" MANWAY CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP211320 PID # 015-122-44 HILLSIDE PARK PUD SUB, LOT 7 A B MH1 15.9 SV1 20.1 2CO 21.9 A B 24.8 23.5 21.9 FEET 0 50 100 TREE T O P CI R C L E 4-BDRM HOME 10/13/21 PUBLIC WATER SERVICE LINE (ASSUMED LOCATION PER 1992 AS-BUILT) 2COMH1 SV1 PLAN AS-BUILT PROFILE AS-BUILT (NO SCALE) 89.5 84.3 90.0 96.7FCOMH1 SV11250 GAL SEPTIC TANK 2CO89.3 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEER10/13/21 PERMIT # OSP211320 PID # 015-122-44 HILLSIDE PARK PUD SUB, LOT 7 Lot 3 Lot 8 10'x10' CEA EASEMENTS r S 89'59'00"E 225.79' A N 15'x40' CEA-411' EA m EASEMENT A 24.7'x20.2' DECK 10' CEA WOODEN FENCE 8.5'x15.2' BALCONY EASEMENTS z.o'xt s.4' CANT 53.4' f 2.0'x8.0' STORY 2.0'x8.4' CANT Lot 7 CANT C- 2 32,206 s.f. 28.4' 3.0' RESIDENCE N o Z CANT8.4 O O > m 12.4e- N p PORCH C. A 244. Lot N 6 MANHOLE—/ T 1p N SEPTICy PIPES b� Q Lot 8 10'x10' CEA EASEMENTS NOTE: THE LOT IS SERVED BY A PUBLIC WATER SYSTEM. Lot 18A PLOT PLAN ___ AS BUILT _X_ SCALE _1_=_40__ GRID _ SW 2539__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone oo0��p4� (907) 522-4625 Fax oo �F q Professional Land Surveyors kenOiangsurvey.com o .. . ,. 9 jonothanOlangsurvey.com �d�,.• ..S pp. I hereby certify that I have surveyed the following described property: LOT 7, HILLSIDE PARK P.U.D. SUBDIVISION (PLAT No. 79-168) Anchorage Recording District, Alaska, and that the improvements situated thereon are 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 premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. l Dated this the __VL— Day of OLIIQ Loii -_, _`��-� `I_7_, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH ................. r.............. KENNETH G.rLANC�: o to [Lit c � .LS -5202. oy�0 ���OFESSIONAI- �o AECC963 0 0 A N 15'x40' CEA-411' EA m EASEMENT A NOTE: THE LOT IS SERVED BY A PUBLIC WATER SYSTEM. Lot 18A PLOT PLAN ___ AS BUILT _X_ SCALE _1_=_40__ GRID _ SW 2539__ Project No. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone oo0��p4� (907) 522-4625 Fax oo �F q Professional Land Surveyors kenOiangsurvey.com o .. . ,. 9 jonothanOlangsurvey.com �d�,.• ..S pp. I hereby certify that I have surveyed the following described property: LOT 7, HILLSIDE PARK P.U.D. SUBDIVISION (PLAT No. 79-168) Anchorage Recording District, Alaska, and that the improvements situated thereon are 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 premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. l Dated this the __VL— Day of OLIIQ Loii -_, _`��-� `I_7_, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 49TH ................. r.............. KENNETH G.rLANC�: o to [Lit c � .LS -5202. oy�0 ���OFESSIONAI- �o AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211320 Work Type: SepticTank Upgrade Tax Code Number: 01512244000 Site Legal Address: HILLSIDE PARK PUD LT 7 G:2539 Site Mailing Address: 7281 TREE TOP CIR, Anchorage Owner: WALLACE SHANE F Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft Total Bedrooms: l„Cllj DCI)aI- tIIIellt 8/4/2021 - 8/4/2022 32206 Disposal Field Q Septic Tank Holding Tank Privy Private Well Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Q Date: C/2 N ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-122-44 Property owner(s) Shane Wallace Day phone Mailing address 7821 Tree Top Circle, Anchorage, AK 99507 Site address 7821 Tree Top Circle Legal description (Sub'd., Block & Lot) Hillside Park PUD, Lot 7 Legal description (Township, Range & Section) Lot Size 32,206 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank 0 Upgrade ❑x Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: !� 2 2 5 _ Waiver Fees: Date of Payment: V -Z Z02 Date of Payment: Receipt Number: 04015 `% 1� Receipt Number: Permit No. OSP 2 119 2.o Waiver No. Permit App_:- :' .. c July 27, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 7/27/21 Subject: Hillside Park PUD Lot 7- 7821 Tree Top Cir. Septic Tank Replacement Dear On-Site Services Engineer: The owner of the above lot has a septic tank that is nearing its end of useful life, we are submitting this permit application for its replacement. The attached site plan identifies the location of the home, existing septic system, as well as the public water service line. No conflicts exist between this proposed system and any other wells , water service lines, or septic systems, whether on this lot or adjacent lots. The new septic tank will be a minimum of 10 0’ from all wells and surface water, more than 10’ away from the water service line and foundation, and more than 5’ from the existing absorption trench. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211320, Deb Wockenfuss, 08/04/21 DECKFENCE Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE 1250-GAL SEPTIC TANK W/20" MANWAY MAINTAIN 10' SEPARATION FROM FOUNDATION CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND HILLSIDE PARK PUD SUB, LOT 7 FEET 0 50 100 NOTE: NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM PROPERTIES ARE ON A PUBLIC WATER SYSTEM ALL WELLS ON SURROUNDING LOTS ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. TREE T O P CI R C L E 4-BDRM HOME July 27, 2021 REMOVE EXISTING TANK PER UPC PUBLIC WATER SERVICE LINE (ASSUMED LOCATION PER 1992 AS-BUILT) 2CO Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211320, Deb Wockenfuss, 08/04/21 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: PID Number: Name: GaXz>?G-a]T oW Wastewater System: ❑ New ❑ Upgrade Addres-n-eB _ Avk�� ftlo ABSORPTION FIELD Phone: 2l 03-4 csL No. of B Dome: Deep Trench O Shallow Trench ❑ Bed O Mound O Other �. LEGAL DESCRIPTION Soil Rating: Total Depth from original gra de: VK, Lot: �J Block: Subdivisio ' Depth to pipe bottom from original grade- U Gravel depth beneath pipe �F ! 1 K Ft. Fi 1 Ft. Township: Range: Section: Fill id( above original grade: A' Gravel length: �1�s Ft yam. ! + ` - Ft. WELL: ❑ New 11 Upgrade Gravel as•ptM- a , Jt-l� Ci FI Number of lines: t Distance between lines: ,�. Ft Classification (Private, A,B ) Total Depth: Cased To: Total absorptioneras: PI material: FL Ft. t20Z 50 Ft. u L Ur. Orllle[ 21 f Date Drilled: Statio Water Level: Insta ler. LSrJ�wN Date initialled. a Ft. r�>l�o� Yield: I Pump Set at: Casing Height Above Ground: TAN K GPM Ft. Ft. SEPARATION DISTANCES Septi E3 Holding 0S.T.E.P. To Septic Absorption Lia Holding blic/Prlveie Manufacturer:Capacity n ellOns: From Tana Field Station Tana Sewer Lulea r% Well I L �T II / / t � Material: Nr of Co�vparlm�nla: umbe f/ Water LIFT STATION Irak tack LotSize in gallon. nufacturer: Line Foundation i iJ /_1k / "Pump on" level at: "Pump oM'levela: Highweteralarm at: Vt Curtain Pump Make 6 Model Electrical Inspections performed by: Drain p Remarks: is BE CH MARK Location and Description: ! 1� t� 1 ( Assumed Elevation: kkQM2 E'f}1Q RL .'tt�i�E•eACgs�e� Aw Joe Inspections performed by: Dates: 1st 2nd le `eN •• e ROGER J SHAFER ,o sew NO. 215 .0 \ice Department of Health and Hum a ervices approval i�\,r l�0~e••e.e eeeee•f Reviewed and approved by: Date: Z��O,aFEsq-'e'�d 72-013 (1/91) MOA 25 / Permit No. Page 2- of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report I-t 1L... , _„.. 72-019 A J211) MOA 25 ARCO RK EXPL. ID:907-265-1393 µiu wiie. „ Nse �• cR� ( -3- /o' 4. IL FEF 26'92 10:01 P70.001 F,01 I S. 79 I a' A IL %6Or 1- L9 m 10 i. RJ. HAFER No.8215 •=�w� c pROFE5510Np� 2 "Z��GI2 �_� �y7 N10 Lo./ .recv.—o tyjf'kc��a✓a.r ��,� Vii. • � *.,��,L ��► ILr"!. jars" earl It is the responsibility of the owner to determine +ws- ,,j.r� pre- strictions ,�• the existence of any easements, covenants, or re- n•A- ..;` �,��Mn%; strictions which do not appear on'the recorded sub - division plat. Under no circumstances should any data hereon be used for construction or for estab-S -NOTE Ts OFREC040,OTHER THAN THc lishinu boundary or fence lines. The surveyor taker SHOWN ON THE RECORDED PLAT, ARE , responsibility for the initial transaction only. SHOWN HFREON. _Lro[NO LOT"7... ►•� ', . . --•'�+ • � DRA[t CACAPMONUMENT SROM A/[ I S/O� %�A K CLIC% f PLAY NO. ) • MAR PROECOR./RO ANCHORAGE RECORDING DISTRICT a Hu/ • TACK REPAMC ' BY: MM4 Mr A d3S0CIdTFS SKA 9 /... n ••. IBT: Iww MUNI G I Fz*nL I TY QF= nN(-,HQFZFiGE DEPAP.TMENT Y-� HEALTH AND ENVIRONMENTAL/"%OTECTION 825 STREET, ANCHORAGE, AK. 9w.,31 l ; 2E4-4720 r 4', ITE EaEWEFZ PEFSM I T PERMIT NO. C 800294 ) APPLICANT GREAT ALASKA CONSTRUCTI 2520 E. TUDOR #2 279-7813 LOCATION TREE TOP CIRCLE LEGAL "L7'HILLSIDE PARK LOT SIZE 22000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING CSQ FT/BR)= 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 12 LENGTH= 43 GRFiYEiL ©EF�>TH= r THE LENGTH DIMENSION IS THE LENGTH CIN 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). F:Ec�'U I FRED SEF='T I C -rn"K SIZE= 12SG (3nL_LQNS3 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER, OF RESIDENCES THAT THE WELL !JILL SERVE. --- TWQ _<2> I t-ISF}ECT I Qthl'S RF2E REQU I F2ED --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT !JILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-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. F"EF?MIT EXF=� I FRGS DECEMFR-'ER 31r 1<54QE3 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: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: ---------------------------------------- APPLICANT GREAT ALASKA CONSTRUCTION ISSUED 64'x'___-- �7/C �- V4.0 ---------- L/ ---DATE--- --- o CTL Aa e '1800:. _ .V4 . 8 . THLAVE. STF,: 'C' :ANCHORAGE; ALASKA' "99503 248-1333 PERFORMED FOR, L $ H Construction -_)/1Q/80 DATE'PERFORMED: .:.._ LEGAL -.DESCRIPTION: Lot 6 --.Block _r --Subdivision. '.Hillside .Park THIS FORM, REPORTS: 10 Visual, Solis Examination '- ^. D Percolation Test - � ACTL -..80-13a5 A' DEPTH- SOIL :NflTES r j FEET = KDESCRIPTION •4" TOPSOIL 1' =. Oran a sandv silt ■A u■ec■■NONEq■■w 2' Tan sandy silt' tan -gravel, coarse sand �I ■ fraction, relatively :dry, CP -100 SF/BR 16� SUN R■■C■■■■■■■■i■■!9■■■■■W ■A u■ec■■NONEq■■w amr..\i■�aii■ii■� �I ■ ■ SUN 0 WOMENN ■V,■■■�^7■■�\■w■ W■■ ■i■w■M iaiii ■■ ■d INS EMISSION v • iNu■■En! ■ulw■■sa■■ mm ■o�vv ■■■■■ ■■u■VB �EWOi■■�ii�i� ■■■0NO ■■■■.ON, w w■i�v■■ w �■■°wiw■■■iii■aii■■�r�I � ■:iia=■=i■i■■i■mm■=uitwtn■ aw■ aaww t® atm■aaa■■■■aawta■ aw■a■■■■o■ aw■■a■■aai■a■■ ■■■■■aw MINIMUM aw■■aaaw■ww■■ a■ wa ■ R■■C■■■■■■■■i■■!9■■■■■W u■ec■■NONEq■■w amr..\i■�aii■ii■� SUN 0 WOMENN ■V,■■■�^7■■�\■w■ W■■ ■i■w■M iaiii ■■ INS EMISSION •i • iNu■■En! ■ulw■■sa■■ mm ■o�vv ■■■■■ ■■u■VB �EWOi■■�ii�i� ■■■0NO ■■■■.ON, w w■i�v■■ �■ �■■°wiw■■■iii■aii■■�r�I � ■:iia=■=i■i■■i■mm■=uitwtn■ aw■ aaww ■wc\■ atm■aaa■■■■aawta■ aw■a■■■■o■ aw■■a■■aai■a■■ ■■■■■aw MINIMUM aw■■aaaw■ww■■ BOTTOM OF HOLE WAS�GROUND WATER _ENCQUNTERED No - i '� ' : °t" IF YES,=•WHAT DEPTH c ' LEGEND 0 _ Perc lone ® S – Sample taken ■ - .Frozen zone"�GENL'ftAC SITE •awrc a ♦—'Water.lable READING :,'.DATE "GROSS -TIME ' •• NET•'TJMEP.4DEPTH TO H2O'=• NET`DRAINIAGE ,a • i PERCOLATION RATE:DRAINAGE REQUIREMENTS: '1b0•SF/Bedroom! PROPOSED INSTALLATION: D SEEPAGE PIT B -DRAWN 'FIELD D OTHER' w COMMENTS : 1. TEST PERFORMED BY: Bob Peters DATA CERTIFIED BY:_ DATE: 3mes R. Rin s 7 11 80 CO:NST F J CT I ON =1800 w 48Th SAVE STE. AN CHORAGE;`,ALASKA' 99503 TEST LAB 248 `1333 k , PERFORMED FOR: ..GREAT ALASKA ,CONSTRUCTION DATE PERFORMED: 7/10:/80•,;{ LEGAL DESCRIPTION: Lot 7 Block Subdivision 'Hilside Park THIS' FORM -REPORTS: ® Visual Solls Examination ->' O Percolation_ -•Test ACTL 801390 DEPTH -SOIL FFFT ' . "•. DESCRIPTION NOTES — ' s� Brown silty sand with some gravel occassional"organics roots _ - — Tan silty gravelly sand with `occassional'cobbles — slightly moist N�Y�Ot�VCAOEI - SP -150 SF/BR MttO�l �OEEMiiiiai��iMEMEiiiiniO tit�hl��at� a�00=0�MORE - Tan "sandy"gravel, with iiiiw — cobbles, relatively dry • GP -100 SF/BR m� =mmrA% BOTTOM OF HOLE WAS GROUND. WATER ENCOUNTERED NO = IF YES, WHAT DEPTH LEGEND ^tr... m — Perc:=zone , m S -Sample -token a-1'rozerYzone %PrNrt%AL.DI1t )LVrL ' V Water table READ1 G DATE '.•'GROSS .TIME NET. -• TIM E `r.-DEPTH•TO•H204' NET.'DRAINAGE,. w. PERCOLATION RATE: - r' DRAINAGE' REQUIRl MENTS:. SEE. ABS �t* % Or PROPOSED: INSTALLATION :" .D SEEPAGE -'PIT • •XW DRAIN': FIELD';' O OTHER / • M44 ••• - •""" COMMENTS: %'�• I WOMEN �mu�musummu� �Y Y N�Y�Ot�VCAOEI MttO�l �OEEMiiiiai��iMEMEiiiiniO tit�hl��at� a�00=0�MORE �ilA W iiiiw ii�ir ii iiiiME no ENEEMEW m auaoui m� =mmrA% nat� Rome �w���►6w�UP momm uA oI'le-P—= �. r7 �n ■moi �iiiiiw 106 E_ ■it �UNr.m muut o dom RL � ammuums ..I .................MMMMMMMMMI ..MEMO. mm o u�ipiiEMaEM MNEME MMEEMMEEMMEEEEEME TEST?'PERFORMED BY:.' B . P. `DATA CERTIFIED BY. amP c it _ �I�CCf.t'�Q(�SL��M DATE: 711/804/ , !S� 7) NJbr� i 7) NJbr� Development Services DepartmentPhone- 907-343-7904 On -Site Water & W614k_astewater SectionFax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-122-44 Expiration Date: juiq 1. GENERAL INFORMATION Complete legal description Hillside Park PUD Lot 7 Location (site address) 7a 81 Tree Top Circle, Anchorage, AK 99507 Current property owner(s) Shane Wallace Day phone Mailing address Real estate agent 7a81 Tree Top Circle, Anchorage, AK 99507 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic R Water Storage ❑ Holding Tank ❑ Community Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 155r) Date of Payment Receipt Number of UqD D COSA # 0_`5CZ_ l 16 ZO Date: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, PE Date 10/14/21 `o TM 6. DSD SIGNATURE .... System #1 Approved for bedrooms ' • � ►. '1�. ' ' ' • ' . ' ' Benjam(rySchiller % System #2 Approved for bedrooms �� �<`��'., CE 125927/97/91 •'�e� Disapproved 1pROFESS1�Np�-�A*� Conditional approval for bedrooms, with the following stipulations: WASTE -PATER ? J� rrvUUKAM -1 /J��IicNT SFRVIG�S ���` By: Original Certificate Date: The Municipality of Anchorage Development 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet LT COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test?Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample Comments __________________________________________________________________________________ B. TANK DATA Age of tank(s) years Tank type/material Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA ______________________ Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: Hillside Park PUD Sub, Lot 7 015-122-44 11 1 PWSID # 212461 <1 Septic/Plastic New ■ <1 Year Old Deep Trench 1980 7/12/21 ■4 14.5 23 N/A* 812 27 ■ ■ 1440 *Unknown 21 >600 No * Septic system does not include a cleanout for the absorption field. Depth of MT matches IR ✔ COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to:(Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’Yes if No ft Absorption Field on Lot > 100’Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’Yes if No ft Holding Tank > 100’Yes if No ft Animal Containment > 50’Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’Yes if No ft Property Line > 5’Yes if No ft Absorption Field > 5’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to:(Please enter distances if less than required) Building Foundation > 10’Yes if No ft Property Line > 10’Yes if No ft Water Main > 10’Yes if No ft Water Service Line > 10’Yes if No ft Surface Water > 100’Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’Yes if No ft Community Wells > 200’Yes if No ft F. ENGINEER’S 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 conformance with MOA COSA guidelines in effect on this date. 10/14/21 n/a n/a ✔ n/a n/a n/a n/a n/a n/a n/a n/a ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ _gi1v ✓ Municipality of Anchorage p �4 BG, Development Services Department o Building Safety Division � - �� On -Site Water and Wastewater Program 4700 Elmore Road s A t E,; P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-122-44 COSA# i3se(a �a�5 Expiration Date: 1. GENERAL INFORMATION Complete legal description HILLSIDE PARK PUD LOT 7 Location (site address) 7281 TREE TOP CIRCLE, ANCHORAGE, AK 99507 Current Property owner(s) STEPHEN & SUSAN LEWIS Day phone Mailing address 7281 TREE TOP CIRCLE, ANCHORAGE, AK 99507 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding Tank Community Class A Well ® Community On-site Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site 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 sample results. (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. 1 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 ARCTERRA CONSULTING INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 06/06/2012 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future 4111,. occupants or can ArcTerra guarantee that no unseen —� encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE V Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory WASTEWATER Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: %'/ Original Certificate Date: & (Rev. 11/05) /j , Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HILLSIDE PARK PUD LOT 7 Parcel ID: 015-122-44 A. WELL DATA Well type A If A, B, or C provide PWSID # 212461 Well Log (Y/N) Date completed Sanitary seal (YIN) Wires properly protected (Y/N) Total depth _ft. Cased to _ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform _colonies/100mL Nitrate mg/L Arsenic: mg/1 Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Unknown Date installed Unknown (1980 est.) Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (YM) N Date of pumping 6/6/12 Pumper A+ C. ABSORPTION FIELD DATA Date installed 1980 Soil rating (g.p.d./ft2 or ft2/bdrm)150 System type Deep Trench Length 43 ft. Width 2.5 ft. Gravel below pipe 7 ft. Total depth 13.2 ft. (Measured 6/6/12) Eff. absorption area 602" ft Monitoring tube Y Depression over field N Date of adequacy test 616/12 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 2.4 in. Water added 850 gal. New depth 10.8 in. Elapsed Time: 30 min. Final fluid depth 2.4 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFTSTATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _in. Pump off' level at _in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 51+ Water main 101+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 2001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main 101+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 501+ (None Known) Wells on adjacent lots 2001+ F. COMMENTS *Bawd on assumed septic field dimensions (43'L x 2 x TED = 602 SF) per MOA record documents G. ENGINEER'S CERTIFICATION I 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 KENNETH M. DUFFUS Date 616112 COSA Fee $490.00 Date of Payment Receipt Number tnJys� (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage .� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING (, Parcel I.D. 1_--44 COSA Expiration Date:_LL 1 ' O 1 Q 1. GENERAL INFORMATION Complete legal description I-iil\aiAe Par P.LLD Location (site address) ,, -fZ61 tree lop Circe_ Current Property ownet(s) M;cLNc-r,\ Z-rwi.. Day phone 346- 4712. Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 72$1 Trcc 7fop -rirc.`e t Av�c , A k 91 Fi l to Unless otherwise requested, COSA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well Public Water System ❑ Day phone Day phone 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 On -Site 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 sample results. (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. NameofFirm )Razklanc, rnsiAf-e-Nug Phone Zli-3UG Address zo; W, 151+. _4h. zoz. A"c1.o, asc AI'. 11 5b/ Engineer's Printed Name LarDate 11110/06 OF/,, / ui. e.�.7-T • �i • l .01 00 5. DSD SIGNATUREjlo I /o Approved for bedrooms. ilk`\ \``= Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By 2 Original Certificate Date: if (R.v, IIMS) \ Municipality of Anchorage (• �`1 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: N\q t pw1L VAJ) lo{ } A. WELL DATA Well type Date completed = Total depth - ft. Date of test Static water level Well production Parcel ID:61-1521 A 2- L" If A, B, or C provide PWSID # 2129 tot Well Log (YIN) Sanitary seal (Y/N)= Wires properly protected (Y/N) Cased to - ft. Casing height (above ground) - in. FROM WELL LOG WATER SAMPLE RESULTS: AT INSPECTION fi. ft. g.p.m. g.p.m. Coliform __M—colonies/1 00 mL Nitrate '- Arsenic: = ug/L date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Unkwu.jn* mg/L Other bacteria Collected by: colonies/100 mL Date installed l.Un{C "' * (480, Tank size 1250 gal. Number of Compartments 2: Cleanouts (Y/N) y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 100 Pumper A+ 1ioMrc �� ,np C. ABSORPTION FIELD DATA* � SEE Ac6a�(tr Sys}�,. Dxa 40�` aFt, T. s441i<.iio.� Date installed 1480 Soil rating (g.p.d./ft2 o ft2/b rm 1150 System type 06r p lrencVN Length ft. Width 2115 ft. Gravel below pipe _ T ft. Total depth 11,5 ft. Eff. absorption area _ft= Monitoring tubei'--100 Depression over field _ Date of adequacy test o oFS Results (Pass/Fail) P4i5 For 41bedrooms Fluid depth in absorption field before test 2L in. Water added_= gal. New depth Zyin. Elapsed Time: 20 ' min. Final fluid depth 20 in. Absorption rate >= COO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ��e���� If yes, give date i D. LIFT STATION Dat>installed Size in gallons Manhole/Access (Y/N) "Puat in. 'Pump ofP level at in. High water alarm le at in. DatCycles to Meets ala 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 Sewer /septic service line Animal containment areas cclmm. ^ Fy W CCL On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas — SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 r+ Property line 51+ Absorption field S t+ r � Water main to * Water service line 10 + Surface water W. O Wells on adjacent lots *2001 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 r 1, Property line 10+ Building foundation ID •+ Water main 10 + Water Service line 10 1+ Surface water N-0- Driveway, parking/vehicle storage 5 r+ r Curtain drain /V-0. Wells on adjacent lots ZOO + F. COMMENTS G. ENGINEER'S CERTIFICATION �(r. ' ` ••; +;t I certify that I have determined through field inspections and 40TH<1'y review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 'r . 4,r4?, .. . Engineer's Printed Name Lew$ Date COSA Fee $ �%D Waiver Fee $ Date of Payment I I h ab S Date of Payment Receipt Number 2-11 9 Receipt Number (Rev. 11105) .s? ee, of A(gh,8 4 �• t14 4',?� Fred Wutnm}p J a �f s % NO. 32355 `'- 14 °Aos�sioa►L �� ,.... EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON UE RECORDED PLAT ARE NOT SHOWN HEREON. Dow/;n9 f 15 /S /K AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the followif 7 ng described property: Lb de Park P. V. D. Su6a- Anchorage 'Recording, Precinct, Alaska, and that the Improvements situated thereon are within The property lines and do not overlap or encroach on the property tying adjacent thereto, that po improvementson property lying adjacent thereto encroach on the premises In question and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated at Anchorage, Alaska qq�� this L4fh day of NOVembeY 197A FRED WALATKA & ASSOCIATES (907) 248.1666 Engineers and Surveyors MUNICIPALANCHORAGE • '� DEPARTMENT OF HEALTHEALTH8 HUMAN SERVICES Division of Environmental Services low On-Site Services Section QLIIU P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O t5 122 ys V HAA # It -1 nS9 0 X11 GENERAL INFORMATION Complete legal descriptionL &f 6 Allftdo Pork P• u• r) Location (site address or directions) 72Y' T��s fep ttrr/� Property owner ldcsrLe< 111/1c/peter- ere rc.dg Day phone 316 -332 r Day phone- 229-v6i, Mailing address - 72'f l Tr•e& LaX ClrcleyAnAef!y; . hP- 99S /6' Af cA AK 99sa3 Lending agency Mailing ad Day phone Agent GeL-L"pso.+_ DXARw ;r P-*Ae.A41 Day phone- 229-v6i, Address 3111 c" sf. Ct ,Ae /ao Af cA AK 99sa3 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 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 'l� 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. mns (e«. i/9n R0 l MOA 41 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 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 F/aHaP T,cAn;eai f Phone 3 ys - /355— Address I V13o Ecti, Sf.. 4�etio�gge hlk 99s-/,( Engineer's signature Z� Date 14' 199E ................. 6. DHHS SIGNATURE Approved for d V If bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: �� ,,/ �a-- Date • The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Acproval 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(RWAM) Back M0AW21 Municipality of Anchorage �Fp 0 fig& DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ,,.,,r,1(iVALI I Y lir A:...H-AAGt 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)'3434744` r)!"Icl Health Authority Approval Checklist Legal Description: I-of6' 14,11ride Park F.a. D. Parcell.D.: Oir /Z2 HS A. WELL DATA Well type C /a.rs :4' If A, B, or C, attach ADEC letter. ADEC water system number of 2, YC/ Log present (Y/N) _ Total depth Sanitary seal (YM) _ Date of test Static water level Well production Date completed Cased to FROM WELL LOG WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Casing height (above ground) Wires properly protected (YM) g.p.m. Collected by: AT INSPECTION Other bacteria g.p.m. B. SEPTICIHOLDING TANK DATA rf'^ Date installed '7/0/6o Tank size12� Number of Compartments 2 Cieanouts (Y/N) Y Foundation cleanout (YM) Y Y Depression (YM) —P High water alarm (Y/N) N. A Date of Pumping 6/120,9 Pumper No�A)Cr^c•a• e,sialle..t 6n '2 ea eC hl*7 or Sieh t /un A'J Cl"e-Z [ovf C. ABSORPTION FIELD DATA O 30MA -rIV XCA`op4l �e.0 r/u%.oe OP2'gs Date installed 7//t/ &o Soil rating (g.p.dJftz or ft=/bdrm) loo a' System type Tee^c< YRn Length 2S' Width 3Gravel thickness below pipe &' Total depth Effective absorption area Yoo a Monitoring Tube present (YM) Y Depression over field (Y/N) N Date of adequacy test 91Y/98 Results (Pass/Fail) rase For v bedrooms Fluid depth in absorption field before test (in.); rl Immediately after8� gal. water added (in.): _ . eFrJu Fluid depth 60-S* (ins) Minutes later. 66 Absorption rate = > 600 g.p.d. Peroxide treatment (past 12 months) (YM) 72-026 (Rev. 3196)', If yes, give date Al• A D. LIFT STATION Date Installed Size in gallons Manhole/Access (Y/N) `Pump on" level at' 'Pump off" level at* High water alarm level at' *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: M,4. Septic/holding tank on lot Absorption field on lot Public sewer main Sewer /septic service line _ On adjacent lots On adjacent lots - Public sewer manhole/cleanout - Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation t6' Property line 70, Absorption field ro Water main/service line > ra' Surface water/drainage roo' Wells on adjacent lots 2w SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 30' Building foundation 20' Water main/service line > to Surface water > rcAe,' Driveway. parking/vehicle storage area M. Curtain drain Nonop s oem Wells on adjacent lots > 2o0' F. ENGINEER'S CERTIFICATION I certify that I have determined thru Geld inspections and review of Municipal recgrdsthat the above systems are in conformance with MOA HAA guidelines in effect on this date. ,/- Signature ...: Engineer's Name Date Son�t�r lit / lO /99f T - HAA Fee $ 300 = Date of Payment Cf /l O Receipt Number _ _Qq 0-5/ 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number , MUNICIPALITY OF ANCHORAGE • ~• DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services &PALITY OF ANCHORAGE On -Site Services Section E MENTAL SERVICES DIVISICN P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 AUG 13 1997 CERTIFICATE OF HEALTH AUTHORITY RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # O f S f 2 2 VI/ HAA # 1. GENERAL INFORMATION Complete legal description t_c4 7, HIllsrcre, Par k P. Location (site address or directions) 7 2.6 / Tic v (f) rcfe Property owner Dorano f Tean me2mGr Dayphone 3Y6-1y9Y Mailing address P.O. Cox 113311/1 14-.,ctir-!�4P Aic 99S/1 Lending agency Nor cuerl- mc" -f E aqp Day phone 2 7G- Y ZS'O Mailing address 2S5 -O (itnerli, Surft IYO6�4n�. 4k 99S03 Agent �4 �^ �u✓nsI naln Ecco Day phone -5- -s966 Address 7600 /'ring $f,. AAchOra4e, f1k 9-2S/S Unless otherwise requested, NAA will be held for pickup. 2. NUMBER OF BEDROOMS: ` N 3. TYPE OF WATER SUPPLY: Individual well Community well _ ✓ Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ✓ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72d251Rar.1101) Ffp l MOA921 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 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. NameofFirm rt rf-fop Tedi,,;cu/ Stvef Phone 3"T-2SE Address 1115 6) ECyo Sf. /4,, 90 Ak 99s 1K Engineers signature 9n� , Date 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments M bedrooms. • bedrooms, with the following stipulations: Date ��S_" �'' ?'J 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 DH HS does this as a courtesy to purchasers of homes and thei r 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. 72425(A.1/91) •.�. Mai 721 MUNICIPALITY OF ANCHOR Municipality of Anchorage ENVIRONMENTALSERVICES DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division AUG 13 1997 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist RECEIVED Legal Description: 4o -7s- Park Na.O_ parcell.D.: orS-'/22- HH A. WELL DATA Well type eta1S ,f " If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (YM) Date of test Static water level Date completed Cased to FROM WELL LOG Well production g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Casing height (above ground) Wires properly protected (YM) Date of sample: Collected by: B. SEPTIC/HOLDINGTANK DATA )4 K AT INSPECTION Other bacteria g.p.m. Date installed 19 go Tank size /'Number of Compartments 2 Cieanouts (Y/N) 'r Foundation cleanout (YM) Y Depression (Y/N) IV High water alarm (Y/N) N A Date of Pumping t f /y 19 G Pumper Rolo Roo le f - C. ABSORPTION FIELD DATA -A A Date installed 1980 Soil rating (g.p.dJftz or ft2/bdrm) fSYI a' System type Tren[j) Cd I� Length H3' Width an I- Gravel thickness below pipe 7Y_e« N Total depth /y' (IMI Effective absorption area O 2 0' Monitoring Tube present (YM) Y Depression over field (YM) _P Pee per l Date of adequacy test 8/ r --/ 9 7 Results (Pass/Fail) P'cry For 5r bedrooms Fluid depth in absorption field before test (in.); SImmediately after��gal. water added "(in.): /y Fluid depth _S (ins) Minutes later: /6 Absorption rate = > > 6'00 a.p.d. Peroxide treatment (past 12 months) (YM) None know. If yes, give date 72-026 (Rev. 3/96)' * J Slslvn oroccrmen %ro( erf 4e-- NtrAr.//srfid„ D. LIFT STATION N. 6 Date installed Manhole/Access (Y/N) High water alarm level at' _ Cycles tested E. SEPARATION DISTANCES Size in gallons `Pump on" level at* 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: 9.14. Septictholding tank on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots "Pump off" level at* Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation is Property line 3S r Absorption field , lam' Water maintservice line ID' Surface water/drainage > 100' Wells on adjacent lots > 200'/ trio' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line IS Building foundation Is-' Water main/service line!o' Surface water �> r oo' Driveway, parking/vehicle storage area Is" ' Curtain drain _ None SA*�;,) Wells on adjacent lots > 200, F. ENGINEER'S CERTIFICATION I certify that I have determined thru field Inspections and review of Municipal recor&.,lj heabovB syste s are in conformance with MOA HAA guidelines in effect on this date. Signature ir�•••♦ •••••...u•••• ',q Engineer's Name 77-ieo olo,-e l= r` taa—r Mr :D'Eo^� Date A -u a,/f /3 /997 (r :�.'••....., ri; ;;t HAA Fee $ Date of Payment Receipt Number. 72-026 (Rev. 3196)' Waiver Fee S Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH b 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 l.D.# Off IZI µy HAA# WA94.OL4 1. GENERAL INFORMATION Complete legal description Lot 7; H.cLl de Pa)tk Subdivcaion Location (site address or directions) 7281 T4ee Top Citcte Anchortage, AK Property owner J. m Sa,Llee Day phone Mailing address C/0 REAL ESTATE SUPPORT SVC 8200 Humbot t Ave. S. M•inneaaotie, MN 55431 Lending agency Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Day phone Individual well:. - Community well XXX `�"• Public waterILI NOTE: If community well system, provide written confirmation from State ADEC attgstl ing to the legality and status of system. �c,'•, 4. TYPE OF WASTEWATER DISPOSAL: t'/,�i,+.�C,�.• 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.: n-= (Rwv. us» Fm Mw m 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 furtherverity 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 b S ENGINEERING Phone 6qy —Xp 79_ 17034 Eagle River Loop Road No. 404 Address EagleltlnU Engineer's signature nate. ROBERT C. COWAN f r 6. DHHS SIGNATURE`"c CE-seol 1� s Approved for bedrooms. 11t>`18„'a-,�t`���41► Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments i 1' • By: i e 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 orderto 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 engineee.s work:,.;,. rk=M.••IM) eaa, MOA OZ Municipality of Anchorage AL .fliti1, Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Loi % hfl(..LSOE A42K —SbParcet I.D. o/s-y A. Well Data Well type 6of4MU,01TY If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Sanitary seal (YM) Date of test Static water level FROM WELL LOG to Casing height Wires properly Well flow/ g.p.m. level l SEPARATION DISTANCES FROM WELL TO: Septiclholding tank on lot ZO(rA -� AT INSPECTION Absorption field on lot Zoo 11 ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: NA Coliform Nitrate Date of sample: -Collected by: bacteria B. SEPTIC/119tDtM6TANK DATA j Date installed l y �d ' Tank size /2S0 CAC_ Compartments Z / Cleanouts QN) Yy�ECS 29 Y(:::� Depression (Y(014./O High water alarm (Y/N)\ N� Alarm tested (Y/N) D I"17 /� I rI 5 ✓ Pumper Ant ffz>m r, SciecliceS g.p.m. Pnr1 ry N T T C M � A o On adjacent lots b �` Absorption field on lot Zoo 11 ; On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: NA Coliform Nitrate Date of sample: -Collected by: bacteria B. SEPTIC/119tDtM6TANK DATA j Date installed l y �d ' Tank size /2S0 CAC_ Compartments Z / Cleanouts QN) Yy�ECS � Foundation cleanout mN) Y(:::� Depression (Y(014./O High water alarm (Y/N)\ N� Alarm tested (Y/N) Date of pumping SI /� I rI 5 ✓ Pumper Ant ffz>m r, SciecliceS SEPARATION DISTANCES FROM SEPTIC/HGLDINGGTANK TO: Well(s) on lot n)oPf 60#?, i On adjacent lots ZCX0 14 Foundation 5'1 - To r1" To property line )0 r.�_ Absorption field 51-f- Water main/service line Surface water/drainage1� tf n-0zs(aea)'Fmt CONTINUED ON BACK PAGE C. LIFT STATION XPJO Cr el/ 63(L_PT_ Date Installed Size in gallons Manhole/Access Vent(Y/N) High water alarm level 'Pump on' level Meets MOA electrical codes (YM) SEPARATION D. ABSORPTION FIELD DATA tested LIFT STATION TO: off' Level at adjacent lots Surface water Date Installed 15 Soii rating (GPD/Ft) S-0 `/C4 System type 1ttZt QC_ H Length 43 r Width uK Gravel thickness % �Aa &Cvo Total depth I I r Total absorption area �=,r Cleanout present (`�J) Depression over field (YA Date of adequacy test /I IIS /19— Resultsa ail) "` SJ for �� Bedrooms Water le vel in absorption field before test g After test `I Peroxide treatment (past 12 months) (YM) Nc)ti cr K( svr/ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot tioNtr P tt7c'A rF On adjacent lots 200 r'f Property line r To building foundation /O * To existing or abandoned system on lot _ On adjacent lots 30 r"' Cutbank SO )'f Water main/service line Surface water /bJ4- Driveway, parking/vehicle storage area /o'A Curtain drain 106V6r K lJowN A' 5`(J42)cr—L ¢c ,RZ AFTM /A.+Slhuyli/.,j. gcrex pa /i-kVkm ,i tKE)a.cr /N A4cA FKES, E. ENGINEER'S CERTIFICATION X-rD/SCo✓&t&5 Aw EAgxiaQi Lluf CLCYJ/ L- r AF7Z�,t 1»"K--WAAS I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Signature Engineers Name k0/36/IT- C. Caw AN Date / / // n / R 4 v �— HAA Fee $ Date of Payment 91-11 Receipt Number 5� 72-026 ("3)' Back Waiver Fee $ Date of Payment Receipt Number, F ROBERT C. COWAN CE -8801 of this inspection. MUNICIPALITY ANCHORAGE • ~� DEPARTMENT OF HEALTH 8 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 Parcell.D.# r1�-1`�`�-yi� 1. GENERAL INFORMATION Complete legal description HAA If "R3 21 CI -31 Hillside Park Subdivision Location (site address or directions) 7281 Treetop Circle, Anchorage, Alaska Property owner Tim Ra11PP Day phone 346-1383 hm Mailing address 7281 Treetop Circle, Anchorage, Alaska 99516 263-4902 wk-- Lending k, Lending agency Mailing address 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 4 V Day phone 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. 72-025 (Rw.1/21( Front MOA D21 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 typeof 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. S & S ENGINEERING Name of Firm 17034Eagle-Rire. Loop Roa}No= Phone Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE .jK__' Approved for Disapproved. Conditional approval for Additional Comments M bedrooms. Date 1-02-97 OF Q,e'a rr�,1 d �.; 0- m ' V� ER JI SHAFER No. 8215 . 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 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. 7225(Pp w1) 6� MOAnt Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: t!_l2:, r4,_HIf,i105 ARxYy Parcell.D. A. WELL DATA Well type t QMmuN17Z If Log present (Y/N) ti Total depth ti Sanitary seal (Y/N) Date of test Static water level Well flow Pump level ?WS x,1). :aa►2y6 B, or C, attach ADEC letter. ADEC water system number Date completed �/A Driller Casedto IVA Casingheight Wires properly protected (Y/N) AI/A FROM WE L LOG N 9 - p.m - SEPARATION DISTANCES FROM WELL TO: r Septic/holding tank on lot 2� "L ; On adjacent lots Absorption field on lot 'G' ; On adjacent lots _ Public sewer main Sewer service line WATER SAMPLE RESULTS: f_/A Coliform Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Public sewer manhole/cleanout Petroleum tank Collected by: Other bacteria Date installed ICIS J Tank size 12.50 6`tt Compartments a Cleanouts (ON) YES Foundation cleanout &N) I Depression (Y/@ High water alarm (Y/N) ro/R Alarm tested (Y/N) Date of pumping /V o 2 Pumper 4 +- 1-6ties_ SERurcrtr SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot NZR' On adjacent lots / a.00+ Foundation } To property line 16'+ Absorptionfield 5 + Water main/service line �� = Surface water/drainage /Va1Vp— 72026 (Rev. 7/91) FrW1 CONTINUED ON BACK PAGE z MQ Q RI w A O Date installed ICIS J Tank size 12.50 6`tt Compartments a Cleanouts (ON) YES Foundation cleanout &N) I Depression (Y/@ High water alarm (Y/N) ro/R Alarm tested (Y/N) Date of pumping /V o 2 Pumper 4 +- 1-6ties_ SERurcrtr SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot NZR' On adjacent lots / a.00+ Foundation } To property line 16'+ Absorptionfield 5 + Water main/service line �� = Surface water/drainage /Va1Vp— 72026 (Rev. 7/91) FrW1 CONTINUED ON BACK PAGE C. LIFT STATION .- Date Installed 'V Manufacturer Size in Vent(Y/N) High water alarm level Meets MOA electrical codes (Y/N) on" level at Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO:" Well on lot On adjacent lots ace water D. ABSORPTION FIELD DATA Date Installed 1160 Soil rating 150 S� System type TRErvc.H 43 Pe4 FJW -5o,45 l.o Length Z, Width (,IA,rAb-- Gravel thickness�{,U"k• Totaldepth Ay'S'�r4 PBA Prw J Total absorption area 401 Sr,, PF -k Pr&w-r Cleanouts present 19/N) Depression over field (Y/O No Date of adequacy test Results (Os/fail) PASS for bedrooms Peroxide treatment (Past 12 months) (Y/6 ma nt-owIf yes, give date . 'DE?TW of 'Merrr-m r4p SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot N�%t On adjacent lots x`200 r Property line " /0 r r To building foundation 10 To existing or abandoned system on lot M14 r On adjacent lots 30 r- Cutbank NOAry., Water main/service line /0= r Surface water (Od 4- DrIXeway, parking/vehicle storage area 10'4- Curtain Or* Curtain drain Nhri5'_ Kwot-•, tdo %f-Oc- -F!Yia.r &,I F'IL<,• "SAC7.4 E. ENGINEER'S CERTIFICATION tom`( 1it.-�r —,-9 /Ac•F5. 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines In•'e=®,tqq the date of this inspection. OF A�%Ili • . S & S ENGINEERING � •.,6'�i0�o rcr Signature 17034 Eagle Rirer Loop Road No. •iO4 ry c S d Eag a River,Alaska 99577 b •ems '�••• Engineer's Name t- A / I A Z /J o...>.«.. .n.... Date v� ���— 12' Jr`, Rr`c_RJ•F,;X ER 215 E HAA Fee $ Date of Payment Receipt Number 72-M (R". 191) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE 2 �¢ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES 1� CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date Ju t; f0 /967 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) hof?jhf(l/ fe Park P.Gl.D Location (address or directions) 728f Treetey Cercfe (b) Property Owner K- 1c Yoan n.n Telephone: Home '3y6- 13r Business Mailing Address 725/ Tree /p Cc r� 1 e (c) Lending InstitutionMe�rn c A Telephone Mailing Address (d) Real Estate Company and Agent F1eri&Je. #omw — PeFer larrw7 Address 207 E. NorAern L.yF/yy 4ACACr!. M "s-03 Telephone S76-- 13 3 3 (e) Mail the HAA to the followina address: or, Check here E9, if hold for pick up. List contact person and day phone number below. Zn!g( Moore — F(aLW 7ec4 'Servrfd 3 yS- 13SSS 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms y 3. WATER SUPPLY Individual Well O Community® Public 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 ® Public 0 Community ❑ Holding Tank 0 Note: If communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 iRw 8.881 Front n rml, S. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 11 As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _F la {{e, Tedi n i ca l Sem c./ Telephone 3 `IS - 13sS Address JHS 30 G�Dlccyf Date ZMA fy !o /967 `PSE OF•A 4 ����49T" '•'* t •..L� -.. ....¢........o Engineer's Seal I. THEODORE F. MOORE ;AF (1sQ CE -3589 ^�v� DHHS APPROVAL - Approved for 00 bedrooms by Approvedy� Disapproved Conditional _ Terms of Conditional Approval CAUTION Date 72—/L_g T2 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. Page 2 of 2 Tx-o?s IR" W86) en k MUNICIPALITY Of ANM)dNJq[PALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVIC% Et F,tt,UTHORITY APPROVAL (HAA) CHECCKLIST- FEBRUARY 1984 J U L 1 264-4744 01987 RECEIVED A. WELL DATA r, Legal Description: __ Lot 7. lftlls7de Park P•U.A t' Y Well Classification ' A If A. B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Total Depth Static Water Level Cased to Casing Height Above Ground _ Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot _ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Depth of Grouting — Pump Set At Yield Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots ; On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments 1). r_- _C CerftAcale af%CAeo( B. SEPTIC/HOLDING TANK DATA Date Installed 1980 Size 125 'i"f No. of Compartments —Un kneaon — Prlrjcava6 2 Standpipes (Y/N) i (t) Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped H /H / ZS'/C57 Av 3-laocr Pumping/Maintenance Contract on File (Y/N) N.A. ; for N- A. Holding Tank High -Water Alarm (Y/N) N• k- Temporary Holding Tank Permit (Y/N) N.A. Separation Distances from Septic/Holding Tank: To Water -Supply Well > 200' To. Building Foundation 9 fron C. 0. To Property Line > 10, To Disposal Field UA k To Water Main/Service Line G! _pretww P0_y > ro' To Stream, Pond, Lake, or Major Drainage Course t'oo' Comments No as - bdtlf elrate*lna an �tle of D#H-S SePlic lank- rtie rs e<r /Oe mlt, crzna 19BY adtQuacy 7zcrF refOe/!` Page 1 of 2 714)76 (Ft" P 861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata -I.so Q'18o1rm Type of System Design 'rreecb Date Installed Un k,er�rrr�v 1960 Length o1 Field N3 der Ioee,-'G Width of Field Depth of Field 1 2 Per per'^' 1 Gravel Bed Thickness 7' per per,n,i Square Feet of Absorption Area 60 2 ljd�fl p-111" Standpipes Present (Y/N) Y Depression over Field (Y/N) Ig Date of Last Adequacy Test 7 121.67 Results of Last Adequacy Test Adeoaa%e fer y bedroom Separation Distance from Absorption Field: To Water -Supply Well > Boo ' To Property Line to To Building Foundation Un Ir. > roTo Existing or Abandoned System on Lot N. A. ; On Adjoining Lots > 30 ' To Water Main/Service Line U^ k j2"Juma6 tv > lo' To Cutbank (if present) N.A. To Stream/Pond/Lake/or Major Drainage Course ' loo ' To Driveway, Parking Area. or Vehicle Storage Area Un k _-� ro' Comments No as- 5.%111 pe ret W*,ng CPA �,1e erf DNfIl, /1r part or 44t/ iE4(.#"iael iar.rl' no 7/4/67 N"aerf ~Ar/vi 41"bo war .nrirl_ml &, je4 sus kr7 apPre�,«a 1t 614,n o/ fAe+9rctve1 16' eolA of Ae ead c -o. 7-o{al_oeyaAli , D. LIFT STATION No Nz0 u+or eAco,,&Perece c..r1i,tc oer,�J 0A.( )'/e 11 execepkd 109 Y a/lonr Nzo .,o -v 2 !Ir /7e -o oC w,iAoaf Date Installed b"i dy of N:O /r"e1a in fAe CoA-tjlo- 4-c.4e Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at — Tested for Electrical Codes (YIN) Comments ' Manhole/Access (Y/N) "Pump Off" Level at •• Check Permitted Bedroom Rating Against HAA Request •• _ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed T c 7Na+•< Date 7/ Company rktb%e Tech Sau MOA No. 87-QS2. Receipt No. o5:7, _ O d 1c—O Date of Payment lo6 7 Amount: $ /00 1 o Page 2 of 2 72-026 IRP" 8'881 Back Aw .*''•49THV :•kik 0 �.:HEODORE F. MORE; T# V,, •• CE - 3589 fie} A Engineer's Seal RUN BILL SHEFFIELD, GOVERNOR DEPT. OFFENVIRONMENT ALL CO NCONSERVATION r l pn�a: (907) Addmn: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: G lZG 4`7 cws I.O.k 2/2 q G / To Whom it May Concern: According to records on file in this office the ��Y.' /✓Y.L�- /:.^/ f11-) Water System is in compliance with the State Drinking Water Regulations Sincerely, APPLIC NT FILLS OUT UPPER HAL�ONLY Time Pro,�rty Owner 5arrel and Diand Bose Phone 201 Tree Top Circle Mailing Address8j!A BOX 2013 Anchorage Alaska zip Code 99307 344-1134 Byer Gary and Celia Youngren � r- o Woodcrest Date Address Richardson Texas zip Code 70080 Date Lending InstltutiLromas and 'Nettleton Phone 1,'300 B Street, Suite 103 Attention: Address ArTchora7e Alaska Cathy Chase ZIPCode 99503 503-3542 Realty Co.✓t Agent 'C-21 Heritage IIones and Investment Phone 207 E, Northern Lights Blvd Inspector Address Anchorage Alaska Atten: Y. IIellstto?mcode 99503 nG3-2415 Legal Description Lot -.7 IIillside Fart- Subdivision Street Location 7381 Tree Ton Circle Type of Residence ' ' MUNICIPALITY OF ANCHORAGE 1'Single Family 04 DEPT. Of li'.ALTH t. ' Multiple Family No. of Bedrooms - ENVIRONM:NTAL PROTECTION 0 Other Water Supply Individual�/ 'Community ��� �t.., ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. For wells trilled prior to that date. give well depth (attach log If available). Public Utility J'�• ( � APPROVED BEDROOMS *CONDITIONS OF APPROVAL Sewer Disposal RrIndividual Year Individual Installed: l 9R n 'Public "` Utility When Connected to Public Utility: C Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Date Sewer Installed Time Time Time Tlme � r- o Dale Date Date Date is Inspector Inspector Inspector Ins�p`}oor Field Notes: /' _ MUNICIPALITY OF ANCHORAGE _ tt11 A5(SKILA f%� DEPT. Of li'.ALTH t. ' ENVIRONM:NTAL PROTECTION RECEIVER f ( � APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( 1 CONDITION AL APPROVAL' DATE �— B {[y� Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received — / tG;'t; I Well to Tank Septic Tank Site 12 Q3IWI ALASKA RUIROf1 nTAL COnTROL ONUS, InC. Engineerinq E Enuironmental Studies FEBRUARY 3 1984 NANCY HELLSTROM 207 E NORTHERN LIGHTS BLVD ANCHORAGE AK 99503 SELLER — BOSE BUYER — BOSE SUBDIVISION — HILLSIDE PARK BLOCK — LOT — 7 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 900 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON FEBRUARY 3 1984 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. Ye I eroy C. Reid, Jr. •%rte ,I No. 22,51-E..... rte,✓1_L_--I I t YL .1' HERITAGE HOMES 6 INVESTMENTS, INC. p�0..... b� 1 FESSl0��o' Anchorage. Northern 99 03 Boulevard Business (9071 263-2415/276-1333 Residence (907) 3454781 NANCY E. HELLSTROM Sales Associate Eoch OH;w is led n.d.nrly O.e.d 0 d OP -'&.d 1200 West 33rd Avenue, Suite B 9 Anchorage, Alaska 99503 • (907) 276-1361 5. LEGALDESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE �Yd p� SINGLE FAMILY ❑ One .R Four ❑ Other -a/,-R­�) (� INSPECTOR INSPECTOR INSPECTgRI _�_tI(,JA 7. WATER SUPPLY ❑ INDIVIDUAL' MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF 11=ALTH & �\\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT2"RONMENTAL FLOTECTION 825 L Street - Anchorage, Alaska 99501 • NOV 2 5 1980 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RR EE CC TF I� REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND MAN- DIRECTIONS:Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. MAILING ADDHE� 7q9 oe O PROPERTY REST DANT (If tlifferentjrom above) PHONE 1111f C/dV 2. BUYER PHONE MAI LING ADDRESS 3. LENDING iNSTITU_TJQN PHONE MAILING ADDRESS - REALTOR/AGENT PHONE MAILIN ADDRESS 5. LEGALDESCRIPTION STREET LOCATION TYPE OFR SIDENCE NUMBER OF,BEDROOMS p� SINGLE FAMILY ❑ One .R Four ❑ Other t ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled IN. COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM 4� INDIVIDUAL/ON-SITE" YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. 72010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY Cl INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Hold-rig Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR / BEDROOMS ❑ CONDITIONAL APPROVAL Iletter must accompany certificate) ❑ DISAPPROVED DATE BY 72010 (Rev. 6/79)