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Home My WebLink AboutLAKE O THE HILLS BLK 1 LT 8 GRE/~-'~R ANCHORAGE AREA BOP'~GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION MAILING ADDRESS -~'P/ i~/:; LEGAL DESCRIPTION PHONE SEPTIC TANK: DISTANCE INSIDE LENGTH .MANUFACTURER INSIDE WIDTH MATERIAL LIQUID DEPTH __ NUMBER OF COMPARTMENTS .LIQUID CAPACITY / '~ ~O GALLONS, SEEPAGE PIT: NUMBER OF PITS / DIAMETER OR WIDTH / ~ LENGTH~/ DEPTH / ~' LINING MATERIAL - CRIB SIZE: DIAMETER__DEPTH ? DISTANCE FROM: WELL/ O~ . TOTAL EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE__ ABSORPTION AREA (WALL AREA) '~) ~' SQ. FT. WELL: TYPE ./:)~ i Vd~CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM DISTANCES: DIAGRAM OF SYSTEM PIPE MATERIAL: LO - SLOPE: GREATER ANCHORAGE AREA BoROuGh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO.. INSTALLATION LOCATION MAILING ADDRESS PHONe INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SEEPAGE Pit ~ . DRAIN FIELD ., OTHER / 1~, . TO BB,NSTALLED. NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK 3-- / FOUNDATION TO SEEPAGE PIT ~ 0 ! SEPTIC TANK TO SEEPAGE Pit WALL / ~/ SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD ., SEEPAGE PIT WATER MAIN TO SEPTIC TANK DRAIN FIELD DRAIN FIELD / , DRAIN FIELD ALSO CONSIDER AREA WELLS. SEEPAGE PIT SEPTIC TANK, :~ ~/~? , SEEPAGE PIt /:: ~ DRAIN FIBLD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRib CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFOR~I TO BOROUGH REGULATIONS REGARDING INSTALLATION. LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ~?HORAGE ArBA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE ~4ay 2, 1974 Mr. or Mrs. Ted DaFoe P.O. Box 2326 Anchorage, Alaska 99510 Dear Hr. or Mrs. DaFoe, We are under construction on a home situated on~/~o~t_~_~ c~Block_l, Lake O' The ~ills Subdivision. It anpears' that your septic tank and seepage pit are both located on this lot. Two separate lot surveys have been done on Lot 8, Block 1~ by Lake O' The Hills Joint Venture from whom the lot was purchased. We would like to proceed with construction on Lot 8~ Block 1o Thereforer we request that you, as the owner of record of the disposal system serving your Dro~erty, make arrangements within 10 days of the above date to remove this system from Lot 8~ Block 1, Lake O' The Hills Sub- division. Yours very truly, Ed Dinsberg dba Dinsberg Construction Municipality of Anchorage DeveloPment Services Department ' Building Safety Division On-Site Water and Wastewater Program ' 4700 South Bragaw St. P.O. Box 196650 AnchOrage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILy DWELLING Parcel I.D. 015-331-13 HAA#' OL'~ Expiration Date: 1. GENERAL INFORMATION Complete legal description Lake O' the Hills S/D, Block 1, Lot 8 Location (site address or directions) 11531 Re~,le~je-~ G - 0 Current Prol~erty owner(s) Sandra & James Singleton Mailing address 11531 Rockridge, Anchorage, AK 99516 Day phone 346-2206 Lending agency Mailing address Real Estate Agent. Mailing Address · Day phone · Mary Tutterow, c/o Dynamic Properties Day phone 261-7682 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: 6 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well [] [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site I-'1' Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority · Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer-registered-tn-the-State-of-Ataska.-C-ertifmates-of-Health-Authodty -Approval-are-required -for-the-transfer-of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Cedificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be relssued 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 Municlpality 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 vedfy that my investigation, based on procedures outlined 'in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure Indicated hereln. I further redly that based on the Information obtained from the Municipality of Anchorage files and from my investigation and ihspection, 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 Watkins Engineering, Inc. phone-349-1851 Address P.O. Box'110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis Date 318104 DSD SIGNATURE ,1,,'''~ Approved for ~ Disapproved; - Conditional approval for bedrooms. bedrooms, withthe following stipdl~t]'b'~2 · Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 01/02) - A. WELL DATA ~.~~ ! :M icipality Of Anchorage · De~/elopment SerVices Department ~:~ :.Building safety Division : "'~ :; on-site Water & Wastewater Program ~ ,:" ' · , ' '~: 4700South BragawSt.' .' Box 96650 Anchorage. AK 99519-6650 , .. :': ! .~ ::., ~. www.muni.org/onsite HEAL H A HORITYAPPROVAL,CHECKLIST:'=,!i lake'O' the Hills. Block 1, tot 6 .~arc~l I : 015-$31-13 Well type Pdvate : t' ii ~lf'A, B, or.C pro~,lde PwsID # Well Lbg (Y/,N) .Yes I' . ~ ' iii' ' :; ' Date completed 1974 ,, ' . ! Samtary seal (Y/N) ,Yes Wires properly pfotei~ted (Y/N) Yes TC~t~aidepth 1'65· ft.i , Case'd to140+ ff. ·· Casing helght (above ground) >12 in. of test. unKnown i · '! ·, ~ i. ~ ~' ' ' · 11 . :: · ., Ii , ~ '~ ~ ';' ' Static water level NA: '~ "" .i'.. ~,.~i~ it. ~.90~ !. i:: ., :~ .ft.. Well production NA ': ,,1g.p.m.i.~ -. =: i6.0 -' = ' ~Ig.p.m. q,. AMPI:.~ R sUL'I:'S;: :; '"" ' W ERS E · : ~ . i ...... ~ Cohform' 0 :, colonies/100 mi. , .Nitrate !,0 : mg./l. ~, , Otherbactefi~ 0 I :colonies/100 mi. '1,' ~ .i',':. ~ ~ ": '~amp ArSenic:: NA : mgl/I.' I :i: i~I Date'l~f I'~i :3p./04 : Collected : C Ellis ' ' ' : ' · ;~ "::- · " ' : ' ' ' ' ~ · ~ - .' ' D A ....... " '~' , SEPTICIHOL lNG TANKDAT ~ . · : , ,, '; . , : ~ . ~ "[[ ,I ' . , . ~ : ' . , TankType/Materlal Steel ,,t,, ~ -~= ,~ ~ , [, I:. ~,, Date Installed 5/22/1974. I ,: ( i~ r ~ 1 i' Clean0ut (Y/N). es Foundation Cleanout~lN)'.'Y6~;' !; Delhi' , ~'li 0~,er ~a~i.~(Y/N) :N° !'i . High water ~l~'rm'~'Y/N)~ No _ Dateof um in .10/20/2003' ' , 'YPum er ~ A+ Home Semces .... p p g ............ p .............................. . _ ABSORPTION FIELD DATA ~ ...... ~ ~, : , ,. , .......... ,, ....... Da!einstall~d 5/22/1974 i])iSsilrating:(g.p;d.lft-0rft'/bdrm)':11b~ , ii Syst,em.type!® ' ._ . Lenoth'21~ : .. 't:ft ',t~:I :.:: :' Width ;1181~-t:'l~,, ',, ' ': ft.', .: ! Gravelbelowppe'9' . ft. ,, .. , ,: ,. - ; ,1'. I , ,. ~,1 ....... 1 .... /,I~ ~'~ ' ' ' '" "Yes ..... No Total depth 12,., ft. ~ ,,. Eff.'absorpt on area~ 702 ~ ft, ~ Monitonng tube', · t Depression overfield :'! ' ' ' ' ' ': ...... ' ' ' ' " Date of adequacy test ,11/18/2003 , =l',: ·.1 f:~esul!s(Pass/Fall) Pass .. : :. : i' ,~,:.For 6 . bedrooms 83 25 1254 I ~ 102 5 F u d dePth'in abSorptionfield before·t~',~t · i~i: ~ ,t Watei' added gal. ,. ' ~. ;{ New depth · 'in.' E a~sed Time" ~120 m~ in'.', ' ,,; Final fluid ePth 97.75 in.: ,~ , :i,-Absorpton!rate >ff. 900 . . g.p.d. Any rejuvenation treatment (past ti2 mo.) q &'ti e) N_one Known..L_ ': ' . ..~ f YeS,: g~ve,date . . ' : , ~ ' ! I , ' '= ' - I~i,.' '~. , -~ , ~ , . :~ , : ~lt: . ' ':: !:-" ~ : (~i~:· '~i !·'-': ; i . LIFT STATION "Pump on" level at in. Datum Size in gallons ",Pump off" level at Cycles tested Manhole/Access (Y/N) in. Ee SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot '.100 Absorption field on lot 109 Public sewer main .>200 On adjacent lots 100+ On adjacent lots lO0+ Public sewer manhole/cleanout >200 Sewer/septic service line 55 Holding tank >100 sEpARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 50 ' Water main >100 Property line 20 water service line 98 · . Absorption field 27 Surface water 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: .... Property line 20 Water ServiCe line ¥109 Curtain drain None known Building foundation. 71 Surface water 100+ Wells on adjacent lots 100+ Water main >100 Driveway, parking/vehicle storage ;28 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify tha't I have determined through field inspections and-; .,~ review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. · Engineer's Printed Name Cindy Ellis Date 3/8/2004 ':' Date of Payment ~/ ~ Receipt Number /-~ ~ 'd.c~. ;,-,' T"'"' (Rev. 12/01) Waiver Fee. $ Date of Payment Receipt Number -o ~OCj 'cjcj "~.00,00o0 / I / I / / / I ~ L c~'~L~- '~,.00,00o0 ~ / / / / / / / Z uJ / / / / / / / ~ .~ ~_,o.ClO N O0 02' -~5" W 42.'74 RI3 GKR,...J ~D G F-- - DRIVE 3-- ~--04; 2:35PM; ;907 561~301 ~ 2/ 3 'S Ref,# 1041032001 ent Name Watkins Engineering oject Name/# Lake o' the Hills ent Sample ID Blk l, Lot 8 d~ix Drinking Water / t$1D 0 All Dates/Times are Alaska Standard Time Printed Date/Time 03/05/2004 Collected Date/Time 03/02/2004 I 0:00 Received Date/Time 03/02/2004 10:32 Technical Directorf Stephen C. Ede · Released By% npleRemarks: Allowable Prep Anal),sis amctcr Re~ults PQL Units Method ContainetD Limits Datc Date Init .rets Depar=ment Nitrate-N 0.100 U 0.100 mg/L EPA 300.0 B (<=10) 03/02/04 JIB crob:l, ology Laboratory Total Coli form 0 col/100mL SMI8 9222B A (<=1) 03/02104 DKC = E--04; 2:35PM; ;907 561E301 ~ 3/ 3 200 W. Potter Drive aking ater Analysis Report for Total Coliform Bacteria - Tel: (907) 562-2343 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (9071 561-5301 MUST BE COMPLETED BY WATER SUPPLIER .Z PUBLIC WATER SYSTEM I.D. # PRIVATE WATER SYSTEM }-ax r~um0er ~ ll~,lin~ Addr r~s CI Send Resnlts Ill Send Invoice City SAMPLE DATE: Month SAMPLE TYPE: :) Routine O Repeat Sample (for routine sample with lab ref. no. ) CI Special Purpose SAMPLE LOCATION Day Time Collected Year Treated XVater Untreated Water CoUected By TO BE COMPL~.TfiD BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory Unsag~factow Sample over 30 hou~ old, resul~ may be unrcllable ~ Sample too long in ~n~t; sample should not be ov~ou~ old at examina~on ' ' ~o' indicate rcliab!t rcsuP~. PIe~e s~d new aample via ~cial deliv~'mail. Date Receiv~ ~ ' ~ ~ O~ Time Received Analysis Began Analytical Method: ~ ]Vl'enlbrane Filter ~ MMO-MUG * N,,mh~-nfcnlnnies/lO0 ml. '.esult* Analyst 1 041 032-/4 Fbks JMiI Date: Time: ;Client notified ofunsatlsfactory results: Phened Spoke with o Date: Time: [] Faxed Faxed ~mments: BACTERIOL0. GICAL WATER ANALYSI .S...R~.. CORD MMO-MUG Result: Total Coliform 'E. Colt Membrane Filter:. Direct Count O __ Colonlesli00 mi Verification: LTB BGB COLIFIRM Fecal Coliform Confirmation Final Membrane Filter Results Reported By '~2' ~JL~"'~ TJVTC- Too Igumere.s re Colmt OB - Other Bocferto CT&E Envi~mm~ental Services Inc. 1200 West Potter Drive. Ancherage. A[ 99511Li 605 t (907) 5~-2343 ! (907) 561-5301 www. sgsenviranmentaLmm Municipality of , oA r chorage Mark Beglch, 3lay . Development Services Department P.O. Box 196650 · 4700 Bragaw Street Anchorage, Alaska 99519-6650 (907) 343-8101 Office (907) 343-8125 Fax http://www.muni.org DEPARTMENT March 19, 2004 James K. & Sandra Singleton 11531 Rockridge Drive Anchorage, AK 99516 Dear Mr. and Mrs. James Singleton: RE: Septic System Encroachment, Lot 8, Block 1, Lake O' The Hills Subdivision, Grid 2639 MOA Right of Way Division has reviewed a request from Mr. and Mrs. Singleton for a letter of non-objection to an existing septic system which encroaches nine (9') feet into twenty (20') feet Walkway Easement located on the south side of the referenced lot. On the as-built survey dated 3/3/04, submitted with the request, the petitioners have shown the existing septic system. Right of Way Section issues this letter of non-objection with stipulations, and by using it the~.. petitioner is agreeing to the following: · 1. Municipality of Anchorage (MOA) will be held harmless, now and forever, for any damages or injury to any person as a result of the encroachments. 2. All applicable codes and regulations will be observed and maintained .within the easement. 3. This letter of non-objection will in no way preclude MOA from full use and enjoyment of its rights within any portion of the easement. 4. Additional and extraordinary costs incurred during any future required construction, repair or reconstruction of MOA improvements to accommodate any or all of the encroachments shall be paid by the property owner. All letters of non-objection should be retained in your permanent files. Should you have any questions, please call me at 343-8033. Sincerely, Jack L. Frost, Jr. Right of Way Supervisor Concur, ,"/ . /I .. ] Lake O' Thc Hills, Lot 8, Blk l, Singleton Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650. www.ci.anchorage.ak.us (907).343-7904 ON-SITE SEWEPJVVELL SUBMITTAL COMMENT SHEET To: Cindy Ellis Legal description: Lake O' the Hills Block 1, Lot 8 The a{tached paperwork has been reviewed and is being returned for the following reasons: [-1 Original signature or stamp missing on J-'J Calculation error in design. . J--1 Additional soils information needed. [-1 Water monitoring results inadequate. J--J Discrepancy in information submitted. J-'l Topographic information missing or inadequate. J~ Incomplete; missing Letter of Non-Objection from Right of Way for' system in 20' Walkway Easement. ['-i' Incomplete; missing . ['-] Additional adequacy test information needed. I--I Water sample unacceptable. [--I Measured/proposed distances/dimensions missing. I--] Locations of all soils, percolation and water monitoring tests not shown. [--I Proposed system too deep for soils information submitted. r-] Well log required. r-'l omission in narrative. I--] Insufficient fill over tank or field. [-'1 Other. portion of Name of reviewer: 3'eft Date: 3-11-04 Please supply the necessary information and re-submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK septic, Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 · 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING .~.?h\-\..-,~ ~ ~- . NAA# ~-~-"Q~(~,~5;~ 1. GENERAL INFORMATION Complete legal description Lot 8; Block I; Lake o! the Hills Subdivision Location (site address Or directions) Property owner Mailing address James and Sandra Singleton Day phone 346-2206 11531RoeE Ridge Drive, Anchorage, Alaska 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: NOTE: Individual well XXX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: XXX Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 s~uewwoc) leUOpJppv :suop, elnd!~s 6U!MOIIOJ eLt~ q~!M 'SLUOOJpeq 'SLUOOJpeq JoJ leAoJdde IBUOp,!puoc) 'peAoJddes!C] Jo, peAoJddv ~ :IEInlYNDIS SHHO eJn~eu6!s s,Jeeu!Bu3 sseJpp¥ LUJ!-I J.O eLUBN '9 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/~T~,,. ~U:, ~! ~q~ OF: 'ri-hE /'tlLZ.~ g/D Parcel I.D. A. WELL DATA Well type Log present (Y/(~ Total depth sanitary seal Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number h-//,/]- Date completed (,~E./ I~E:R~z~ 3.]~ Driller Cased to L'/0 '¢' Casing height [~' Wires properly protected (~N) FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/h,.L:;;hg tank on lot Absorption field on lot Public sewer main g.p.m. Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout /L)~- Petro eumtank WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: Other bacteria B, SEPTIC/H~I~ING TANK DATA Date installed Cleanouts ~1) High water alarm (Y/N) Date of pumping Tank size /"C/-.~ ~-/~r'L. Compartments 'Foundation cleanout {~) Y~$ Depression (Y/~) Alarm tested (Y/~j~ SEPARATION DISTANCES FROM SEPTIC/~G TANK TO: Well(s) on lot /O(J' TO property line /0 1~ Surface water/drainage On adjacent lots Absorption field I00 /00 ' ~ Foundation /0' water main/serviCe lin 72-026 (Rev. 7/91) Front cONTINUED ON BACK PAGE C. LIFT STATION Manufacturer Size in gallons Vent (Y/N) Manhole~_ ~zz..Le_v e~ Cycles tested at ~.--~ "Pump off" level at High water alarm level Meets MOA electrical~ ~ .~¢y.~a~n lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed ~-~--'~'~ Soil rating /I Length ~l~ Width l~' Gravel thickness Total absorption area '~(.~¢'~- %F Cleanouts present (~/'N) Depression over field (Y/¢ ~ Date of adequacy test Results (pass/fail) for Peroxide treatment (past 12 months) (Y/I~)) HOT ~r',~ If yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent tots /00 ~- Property line ~--o0 "/- To existing or abandoned system on lot Cutbank /0(~ re. Water main/service line Driveway, parking/vehicle storage area /6 ¢- &o ?- E. ENGINEER'S CERTIFICATION Signature Engineer's Name Date I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec $ & $ ENGINEERING ~7034 Eagle River Loop Rood NO, 204 HAA Fee $ Date of Payment '~ ~/~, ~ ~ ~-~ Receipt Number Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL I~iBORATtgRY A D~¥1$1ON OF COMMErlCIAL TESTING & ENGINEt~RJN~ CO, 6633 ANCHORAGE, ALASKA 9951 TELEPHONE (907) 562.2543 FAX: (907) 5~1-5301 ,,le,netl By; ~ (~ ~.__~__ CHEMICAL & GEOLOGICAl4 LABORATORY A DI~q$10N OF COMMERCIAL TESTI~i(, & £?~OlNEERING CO~ TO BE COMPLETED BY WA'F~R SUPPLIER r-'l El PUBLIC WATER ~¥$TEM i,O. jI~..pRIVATE WATER SYSTEM c~y Drmk'ng Water Analysis Report for Tota~ Corform Bacteria TO BE OOMPLETED BY LABORATORY SAMPLE g~--Routlri~ [] Check 8ample (for with lab tel ~ Sp~e]a~ Puroo~ SAMPLE 1 this W~ter SAMPLE to be: [] S~mp!e ;oo lea9 in transit; ~nmple should nm L-,e over 30 ho~Jr~ o:d at examination amy S~mp~e via 8F¢clal deliv~ mail, · No, cf ~;,2kx~ie&,'lO0 mi, READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC - Too Numerous To Count OB : Other Bacteria Final ~embtane Filter Bo~ulle _ ~. ~/ .................... CalIIor~100 mt ...... .,2 ..... PART ONE OF TWO REMAINDER TO FOLLOW Application Date GENERAL IhlFOR f~ATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 (b) Applicant Name _~pt.~; &'~[o~-Or',, Telephone: Home 31"/L/"~'qO~' Business :z?q-8(oll Applicant Address ~ ~X ~5 ~m~[0~ ~/~ (c) Appli~¢nt is (check one): Lending Institution ~; Owner/builder ~Buyer ~; Other ~ (explain); (d) Lending Institution F~rst Nati.&onal Bank of i~.ch. Telephone "' 265-3809 P O. Box 92090 Address 201 W. 36th St. ' Ancnorage, AK 99509 ... (e) Real Estate Company and Agent Address Telephone (f) MailtheFIAAtothefollowingaddress: ~ Please phone 265-3809 when ready for pick-up - Lauree Gallion TYPE OF RESIDENCE Single-Family [~FC'M ulti-Family Number of Bedrooms Other WATER SUPPLY Individual Well ~]~"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 [] 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. 72-025 (11/84) Page 1 of 2 5. ,"EHGI~':tEERI~'~G FIRIVl 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 i~_ectio?, Name of Firm _~f_~,~(,~. ¢ 0,-¢,¢~¢J~6Lf~ Telephone. Engineer's Seal CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct insPections or analyze data before a cedificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ~-.~ ~ N!.uNiCIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MO~,, DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST- FEBRUARY 1984 . MAR ~ '[' ~l~ Legal DescriRtio_n: WELL DATA Well Classification t'~'I ~' I~"£/LcCJ~/ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~(~ Date Completed IS4/~/¢I¢4z,~/Iq Yield 8 ~p/~ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots Total Depth 8~ Static Water Level 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 //O; ; On Adjoining Lots '¢'~O~ f To Nearest Public Sewer Line. dO~r J~,bD, To Nearest Public Sewer Cleanout/Manhole /~/~. To Nearest Sewer Service Line on Lot Water Sample Collected by ~b,',4'~:~ k/~Eb(- ; Date Water Sample Test.esults 5~.-~ Comments B. SEPTIC/HOLDING TANK DATA ' '~ /75'o 9~z/. ~' Date Installed ;,~ /V~o~u '~/ Size No. of Compartments ! Standpipes (Y/N) ~,¢__5 Air-tight Caps (Y/N) c/~G Foundation Cleanout (Y/N) I Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Welt To Property Line ~el To Water Main/Service Line /O Course Da(e Last Pumpe'd /~//~ :for-----" Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~- Width of Field Type of System Design Length of Field ~/' Depth of Field _ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness ~ Standpipes Present (Y/N) Date of Last Adequacy Test To Prope~y Line ~¢ f To Existing or Abandoned System on ; On Adjoining Lots ~ ~ To Cutbank (if ~resent) Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed [.~'~ OO,f~t''- Date /(~ Company ~¢~'(~i~ ~ (~6f'(zt/¢'~" MOA No. Receipt No. ~ 7"~ (:~'~ / Date of Payment ~.-6:~ ? ~ Amount: $ ~ .~--o.j.~/_ Engineer's Seal Page 2 of 2 72-026 (11/84) INVOICE ® 013494 ~~~¢ ~SEWER AND DRAIN ..,~¢~,~ ~ ~ CLEANING SERVICE P.O. BOX 4-2841 PHONE 345-2513 ANCHORAGE, ALASKA 99509 Job Address ROTOR ROOTER SERVICE CALL HRS. STEAM THAWING HRS. TRIP CHARGE HRS. OVERTIME CHARGE HRS. ADDITIONAL LABOR CHARGE HRS, PUMPING SERVICE ~O(GAL) PLUMBING REPAIR CHARGE HRS HRS PLEASE PAY FROM THIS INVOICE -- _TO M ER ORDER TOTAL TOTAL FOOTAGE CLEANED OR THAWED _BLADES uSeD ~ PROBABLE CAUSE OF STO~AGE -- WORK ACCEPTED BY GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received ~=~C~ Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF ~~'~ I DIVIDUA, SEWERF RWATER FACI, T ES Approval 'requested Mailing Address: Property Owner: Mailing Address: Legal Description: Phone: ~.~l%- ,~\~/~ \ Phone: Location: A. Type _L~O~,O~ ~c~. B. Depth "i¢' C. Construction /r~o~2~w,~, D. Bacterial/$~.~.~ ./~Analysis 7. Sewage Disposal System: ~])L]~L~C~ ~[ ~ ~ ~-~ A. Installed B. Installer Type of facility to be inspected J~,~]o~o~r~ NO. of bedrooms Well Data: ~ C. Septic Tank: 1. Size /~-0 2. Manufacturer D. Seepage Pit: 1. Absorption Area ~~d~, 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line F~-NR4 (1/74/ Paan 1 nf twn nanp~ 1. Type of Inspection: 2. Property Owner: Mailing Address: 3. Name of Buyer: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'C" Street, Anchorage, Alaska 99503 -- 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES ,MUi'~L.i, ,::,I.!'IY O~: ANCHO,,AG~ Df[s.'~.i~t'ML'~'!T OF HEALTH & .EN¥ i i~Oi'q M'-q ~ I-,',L pl~Ol ECTION !976 CMRO VA FHA James K. Singleton and wife, Sandra C. Singleton CONV ×X SRA Box 24S, Anchorage, Ak same (refinance) Day Phone 344 5706 - home 274 8611 x 553 (Mr.) Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: Mailing Address: Day Phone The First National Bank of Anchorage P. O. Box 720, Anchorage Phone none Alaska 99510 279-4481 Phone 6. Legal Description: Locat ion: Lot 8, Block iv Lake O' the Hills Subdivision See attached reference Map 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation single familv residence No. Bdrms. 6 Individual we11 1 Individual (on-site) EQ-037 (1/74) 'Page 2 of two pages - Re, 'Legal ,Description ~ st for Approval of Individual _~r & water Facilities Comments Approved .... ~ _~ ~ Disapproved Date,~-!~- ~,,~ ~-i~'~?a~ ApprOval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)