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Home My WebLink AboutNORTH WOODS PHASE 2 BLK 1 LT 6North Woods Block 1 Lot 6 #051-741-25 't\MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SHITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME a7-( PHONE q �t (jC.� o(CJ� K NEW ❑ UPGRADE ADDRESS MAILING ADDRESS e? 01 LEGAL DESCRIPTION Cd C �Y LO TION NO. OF BEDROOMS U Y DISTANCE TO: Well (C,' Absorptj� lea // Dwelling 41 PERMIT NO _ Ww2Q � Manufacture N `eye c-e,� No. of co artments ur llons IF HOMEMADE: Liq. cap7AM Inside length Width Liquid depth Y JU`2 DISTANCE TO: Well Dwelling PERMIT NO. 0 Z F Manufacturer Material Liquid capacity in gallons O UJ y DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. J LL Z P2 w No. of lines Length of each line Total length of lines Trench width inches Distance between lines ¢ E C1 Top of tile to finish grade Material beneath tile nchas Total effective absorption area Lu C7 Length ` Width Depth / /7 PERM! N . /0-1 ©( a" Type of crib Cribdiameter Crib depth Total effective absorp Cn DISTANCE TO: Well 06hnqBuilding fou at' / Nearest lot line C �_ J J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER P E TERIALS I L TEST RATING I NSTA k REMARKS AP) DATE LEGAL 72-013..¢Rev.3/78) / v MUNI C_- IFzlFll I -r `r'F= t=l N Z� H , F=1 DEPARTMENT k- HEALTH AND ENVIRONMENTAL tr0TECTION 825 'L' STREET, ANCHORAGE., AK. 9950:1 264-4720 03t-.1 T -r F= !E5 F= t4 FEE FZ F="F= F?CSI I "Ir PERMIT NO. ( 821058 APPLICANT STEVEN L SKAOSS CONST LOCATION LEGAL L681 NORTHWOODS II PO BOX D CHUG IAK 99567 I M (s CY-) AD -ac - 688-2831 J� LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 2 SOIL RATING (SQ FT/BR)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 0"E=F=l'-r"— 1S I E-=" .3-r" q Cis oFZF:jVE:l E> [-= F=" -r " = 71: THE LENGTH DIMENSION IS THE LENGTH IN 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 (IN FEET). r " FE -r FR FE P-41:2.* " L4 I 0m -r H I -"F- 15. C-511DO F=F=F=-r- THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FR F= G -x 11 1 FR> FE C_- !S F= F" -r I I::. -r F:l r-4 K :F. I 7_7E= A RDI DE C-3 f-3 Fl I 9_0t-4 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 WILL SERVE. --- -rWID < f:N > 19 E; F=4 FE ms -r I ID " S: 1=1 F;: E= F;;'.* F= 0 U I F;?_ FE Ca -- — BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL 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 15 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;` E="F-_ M I -r F= X F" I Fe F="-<; 0m EF ,_ EM F= FR q , -1 :F-4 I-so;2 I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APDL I ISSUED BY STEVEN L SKAb,�,fC_0_N_S_T --- DATE - V4. 0 .r O & E ENC..�NEERING & DEVELOrMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name: '5TEye1J Z, �K466 60"57"• //►►Tel. No. ZZIF � Mailing Address: ®P 8.0 Legal Description: LUT' 6., 13zocK /o Alolz!/,e woop -�50« . Poul '.P Depth (feet) Soil Characteristics 0 1 1194 51i --r '-7e)/> 5x14- 2 4 �!f'i, 5 f� S /d9 PO c KQTS 4- ZE-ktS6Fx 3a! 5 D Sim 5,q"v 6 PAC, < :%%cid 2S� 8 °2 50�8� 2 . 9 PLOT PLAN 10 4� T;o SALE 11 12 13 PERC. TEST 14 15 16 Ground Water Encountered: Yes k' No If yes, what depth �d Proposed Installation: SeepagePit Drain Field Comments: 14�-k1��6 ") 'iEarl P. Ellis : W. Performed by: • Date: �� .may Si M eem6 `og��.�p.. .. 0660... .......... •a.A : . 'iEarl P. Ellis : W. Performed by: • Date: �� -7, -e 31 Municipality of Anchorage j Development Services Department Building Safety Division On -Site Water and Wastewater Program s r 4700 Bragaw 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 Parcell.D. COSA# ollb l - Expiration Date: 3 -- 6 ~ O g 1. GENERAL INFORMATION Complete legal description 4,,;"e4 .B/ock'l, W -1 - Location (site address) i72 .G3iro A /fir. el7e.9 !.o ,- ,4e Current Property owner(s)Pe-pry%A Ile -"51 Day phone Mailing address pl;4,6 9// -/?//o 57asi.oPSs/gwd.'YG, .EA9/e .P,✓c,,/Y< gs77 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: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System © 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 Onsite 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 Onsite 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. Name of Firm Dou /ras 7` /(en lcy Phone ��U7� 9,-"'7073 Address Z_ A/oryhSfisi Oma•, ��/mer Xle 99G,s-y Engineer's Printed Name 90u 7`.' 11'e";7 Date ) T. to S. DSD SIGNATURE Approved for o2-_ bedrooms. Disapproved. 0 Conditional approval for bedrooms, with the following stipulations: ,)ttttttrr�rr/�,,,� Additional Comments AN1yQ,7FR " � c PROGRAM t A, IMNI 1)!p))1111 Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other. By; Original Certificate Date: r (Rw. t V05) Municipality of Anchorage .• • Development Services Department ° Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsde (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Zo7 e, 1614" /c' /, yp L-11 sy0006r 'Oti Parcel ID: A. WELL DATA Well type Date completed Total depth ft. Date of test Static water levet If A. B, or C provide PWSID # Sanitary seal (Y/N) Cased to ft. FROM WELL LOG Well Log (Y/N) _ Wires properly protected Casing height (a rc AT IN TION ft. in. Well production g.p.m. g.p.m. WATER SAMPLE RES C oliform colonies/100 ml Nitrate mg/L Other bacteria colonies/100 mL ic: mg/l Date of sample: _ Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material : a %,'Vs lc e l Date installed Tank size /"'o gal. Number of Compartments Cleanouts (Y/N) y Foundation cleanout (Y/N)AfY_ Depression over tank (Y/N) High water alarm (Y/N) A�ld Date of pumping _ l kle 7 Pumper _fes At/- 70 f ^ 9 C. ABSORPTION FIELD DATA Date installed %0 S -X Soil rating (g.p.d./fe or! /bd )��-116 System type /.ge- 4! Length yC ft. Width J ;- ft. Gravel below pipe • y ft. Total depth _Z ft. Eff. absorption area L110 ftp Monitoring tube Y Depression over field Date of adequacy test -2//,/07 Results (Pass/Fail) J ,.s_ss For i bedrooms Fluid depth in absorption field before test -& in. Water added J-17 gal. New depth -E'- in. Elapsed Time: 30 min. Final fluid depth �' in. Absorption rate >= /!Sy g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /// If yes, give date D. LIFT STATION Data installed 'Pump on' level at _ in. Size in gallons 'Pump off" Cycles tested 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 containment areas %✓ter t Manhole/Access (Y/N) alarm level at Masts alarm & circuit requirements? On adjacent lots On adjacent tots manhole/cleanout ffin Holding tank Manure/animal excrete storage areas /e'0 r r SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation t fe Property line art trf Absorption field /O ''t Water main y t /', Water service line �D fr Surface water / n 0 ' Wells on adjacent lots a? 00 t Ff SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �n j �% Building foundation 3o i Water main t t Water Service line y0 >CT Surface water i eel +' Driveway, parkingfvehiele storage ,yene /.(nervi) 00 �' Or Curtain drain fo ex;o7' Wells on adjacent lots a F. COMMENTS ' •� N �r tr s .a GING .v saC,e!e f�.G yrs P.£au*� G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and 6ff+� • • TM review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. �r. • :� 4• .. ° e' Engineer's Printed Name Dnua /,q3 f n le.,� (;E 8175 t). Date ^-9-07 �� •' �•D COSA Fee 1$ 4430 Date of Payment 3 Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number -NO .ex'a n 0 � I : n lyy/sloF.p/il/�Bj�y r's`: oo F T THIS DATE. CERTIFY THAT I HAVE SURVEYED THE SCALE, WING DESCRIBED PROPERTY: 1"=50' Woods Subd.,Phase II,Lot 6,Blk. 1 AT NO ENCRQ4CHMENTS EXIST DATE EXCEPT AS TED. IT IS THE RESPONSIBILITY OF THE 3-29-92 TO DETERMINE'THE EXISTENCE OF ANY LDATABY ENTS, COVENANTS, OR RESTRICTIONS DO NOT APPEAR ON THE RECORDED GRID= NW 1559 SUBDI- PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' TA HEREON BE USED FOR CONSTRUCTION 27-24 OF FENCE NES.INES' OR FOR ESTABLISHING BOUND- DRAW DMS iSY Ts -l« � rl. 0 � I : n lyy/sloF.p/il/�Bj�y r's`: oo F T THIS DATE. CERTIFY THAT I HAVE SURVEYED THE SCALE, WING DESCRIBED PROPERTY: 1"=50' Woods Subd.,Phase II,Lot 6,Blk. 1 AT NO ENCRQ4CHMENTS EXIST DATE EXCEPT AS TED. IT IS THE RESPONSIBILITY OF THE 3-29-92 TO DETERMINE'THE EXISTENCE OF ANY LDATABY ENTS, COVENANTS, OR RESTRICTIONS DO NOT APPEAR ON THE RECORDED GRID= NW 1559 SUBDI- PLAT. UNDER NO CIRCUMSTANCES SHOULD FB' TA HEREON BE USED FOR CONSTRUCTION 27-24 OF FENCE NES.INES' OR FOR ESTABLISHING BOUND- DRAW DMS PTH 04 •� ... ..... s • ......* Dvm. Ma. 34 nd Q I� IS - 9 p MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 14 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.# ��iii1" - HAA# FAQSao 1. GENERAL INFORMATION Complete legal description Lot 6; Block 1; North Woods Subdivision Phase II Location (site address or directions) 22246 Whispering Birch, Chugiak, Alaska Property owner Bruce and Robin Hopper Day phone 6287668-24245 wk 99567 Mailing address HC 80 203 Whispering Birch, Chugiak, Alaska 032 Lending agency Day phone Mailing address Agent Audrey Mason - RE/MAX OF EAGLE RIVER Day phone 694-4200 Address 16600 Centerfield Drive, Suite 201, Eagle River, Alaska 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 2 XXX 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(Rev.1/91) Front MOA#21 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone S & S ENGINEERING Address 17034 Eagle River Loon Rear] Np 204 Eagle River, Alaska 99577 Engineer's signature Date nMon?�� j �r Lci nn4;; r�J(C�eadaw. iA u E(i u. ;. X17' •'{ 6. DHHS SIGNATURE Approved for bedrooms. 0 Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments UITIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services. HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I a'r' U b ma�'� k TA �+a o o s S 6 Parcel I.D. - A. WELL DATA A Well type Log present(Y/N)_ Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) - FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: AT INSPECTION Septic/holding tank on lot ZOD t� ;'On adjacent lots - Absorption field on lot 110' ,� ; On adjacent lots — Public sewer main Public sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed 10" 62- Cleanoutso/N) High water alarm (Y® Date of pumping. 3 - 2 L Nitrate Collected by: - Other bacteria Tank size 1000 Crrct.- Compartments -2. -- Foundation Foundation cleanout (Y& Depression (Ya '� (✓� Alarm tested (Y/N) �A- .`t Z Pumper -:17- (4,2 s P a a t., SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 2 "' On adjacent lots 'S �- Foundation 8 To property line 10 t � Absorption field 1 `j J Water main/service line 1 n , + Surface water/drainage t 'o 0 � CONTINUED ON BACK 72-026 (Rev. 7/91) Front 4 - Zm �r G _ O Z m D n Z r M O g p ..,,J m z ca rI N M 2 ® O viG) O m z Tank size 1000 Crrct.- Compartments -2. -- Foundation Foundation cleanout (Y& Depression (Ya '� (✓� Alarm tested (Y/N) �A- .`t Z Pumper -:17- (4,2 s P a a t., SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 2 "' On adjacent lots 'S �- Foundation 8 To property line 10 t � Absorption field 1 `j J Water main/service line 1 n , + Surface water/drainage t 'o 0 � CONTINUED ON BACK 72-026 (Rev. 7/91) Front 4 - C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes Manufacturer Manhole/Access (Y/N) SEPARATION-OfSTANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots ==-"Fump off' level at Cycles tested Surface water _ Date installed o- 00 Soil rating 2`50 `a Arg- System type V�rc--.J Length _ '4(0' Width 37- Gravel thickness o, S / Total depth to Total absorption area V/tl?_ Cleanouts present (ZYN) 4 Depression over field (YAM r i Date of adequacy test 3 "Z t, .c, 2 Results pass il) PA -SS for 'r►1g4,rv. 3)bedrooms Zroxide treatment (past 12 months) (YoV.�c,ai� ILr�io�.l If yes, give date 01'11 x O r� 4 N Ac ILO -0., SEPARATION DISTANCE FROM ABSORPTION FIELD TO: 1 Well on lot �r- � On adjacent lots ~ 4,Property line 10 k. - To building foundation On adjacent lots Surface water Curtain drain "3a \t" Z7 Cutbank To existing or abandoned system on lot t�,A Water mai n/serviceline. '� kk- Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in S & S ENGINEERING Signature 17034 Eagle River Loon Read{ NO ip@4 1111091a River, Alaska 99577 Engineer's Name Date Z'1-9 Z- HAA Fee $ — T20 `! Waiver Fee: $ Date of Payment 3 % Date of Payment Receipt Number Ci y♦� ! n Receipt Number 72-026 (Rev. 3/91) Back MOA 21 rI `r,,r 5,1 date of this inspection. p,!mt �yt'pM1'.ry FiTf.� .5 t tVo. DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 FOR: S & S Engineering February 19, 1992 PWSID # 213001 WALTER J. HICKEL, GOVERNOR (907) 349.7755 My review of the records on file in this office reveals that the Northwood Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria sampling requirements listed in Table C, and with the inorganic sampling requirements listed in Table B of 18 AAC 80.200. Sincerely, 4yg- Byron O Roys Environmental Engineer BR/cf MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ah _311q (a) Legal Dcrintion (inc ` de lot, block, subdivision, section, township, range) L [3 r IX A'zo J'v F Location (address or directions) (b) Applicants Applicants Address `Z,• (c), Applicant is (check one) Lending I Buyer E::l ; Other EEJ, (explain); - Home Business ; Owner/builder =1 ; (d) Lending Institution /V Telephone Address (e) Real Estate Co. & Agent Address r/e Tel phone t_�9 (f) 1 the HAA to the following address: 84 rSilo ?dQIWEBr�l�SC .� RIVE . p 7� 2. Type of Residence Single -Family � Multi -Family Other (describe) Number of Bedrooms 43 3. Water Supply '� a/•-- to la- Address Q Individual Well M Community M 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. [Page l of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information 6. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Address F Date / DHEP ADDroval Approved for%N2EE 3 bedrooms Approved X (ENGINEER SEAL) Disapproved Conditional Terms of Conditional Approval CAUTION Telephone THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2� 4111( Type of System Design Date Installed /O/r z ngth of Field Width of Field 3 L Depth of Field Gravel Bed Thickness �'-�- Square Feet of Absorption Area Standpipes Present (Y ) Depression over Field O? Date of Last Adequacy Test Leng- Results of Last Adequacy Test /J Ila- Separation Distance from Absorption Field: r To Water -Supply Well 2 U.� To Property Line %0 To Building Foundation Z% To Existing or doped System cn or Lot A.,-On1Y? On Adjoining Lots To Water-Ma4WService Line o ® -/— I To Cutbank(' esent) +Jiff To Stream/Pond/Lake/ar Major Drainage Course /U •'J �'—" To Driveway ,,r%Parking Arrear cr Vehicle Storage/ /� 2,.� nnrrwebnFm D. LIFT STATION Date Installed Dimensions Size in Gallons Manho /Access (YIN) "Pump On" Level at " f" Level at High Water Alarm Level at ent (YM) Tested for Pumping Cyc s during Adequacy Test. Meets WA Electrical Codes(Y ) Coartnents ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. ` Signed - Date b lcf Company & 0 eNalfigeni MOA No. RIVER, _ ALM*A :195TH 1'H, 594-ZU0 KBl/d5/s [Page 2 of 21 ,�s 00 """' 2-15-84 APPLICANT FILLS OUT UPPER HAI 'ONLY Property Owner1 Q,�� r�.v.i._,� �1 lC Phone Apdress Zip Code lkMailing Auyer Address Zip Code P Lending Institution (',y. _- i V \ L1� Phone Address Zip Code = (; tS (Sig Realty Co. & Agent �c) U(� t �c) CL !/ `� vm ,� Phone Address im` Zip Code X�.. Date -...y Legal Description 1 Street Location Type of Residence �ngle Family y ❑ Multiple Family No. of Bedrooms— edrooms❑ EIOther Water Supply ❑ Individual - ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. (TI-i8ofmunity For wells drilled prior to that date, give well depth (attach log if available). ff Public Utility Sewer Disposal { 4 QL�nd-ividual Year Individual Installed: t t ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. I1C tT 4 rz', f. \ ".. ( Time Time Time Time (-til.9 Date Date Date Date -...y Inspector Inspector Inspector Inspector P(( - A— Field Notes: OF ANCHORAGE 1 MUNICIPALITY DFPT. Or I '!TH CCTION Cl v RECEIVED ( `)}-APPROVED. BEDROOMS 'CONDITIONS OF APPROVAL ( I DISAPPROVED ( ) CONDITIONAL APPROVAL' d"f DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72-02313/821