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Home My WebLink AboutHOLLY HILL BLK 1 LT 10 Municipality of Anchorage Page I 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 Name: ~O~ ~ ~oC;CY~ ~UU~ Wastewater System: D N~W' ~Upgrade ~": ABSORPTION FIELD Phone: ~_~ ~No. of B~rooms: ~DeepTrench ~ Shallow Trench OBed ~Mound ~Other LEGAL DESCRIPTION so,, Rating; Total Depth from original ~?de: Lot: Block: Subdiv~ion: ~epth to pipe boffom from original grade: Gravel depth beneath pipe Township: I Range: ITM Fill add~ above originat grade: Gravel length: WELL: ~VtSTi~New D Upgrade Gravelwidt.: I Num~r of lines: IDis~nlin.: t~a Pipe materiah Cl~ifi~tion (Private, A,B,C): Total Depth: ~To: Total absorp :~ / /~ Driller: ~ ~Date Drilled: 8atic Water Level: Installers= Date installed: ' Yield:~ ~~GPM ~[ Pump Set at: Ft..] ~ing Height A~ve Ground:Ft. ~N ~ ~EPARATION DI~TANcE~ ~ Septic ~ Holding ~s.T.E.P. TO ~eptic A~tion Li~ Holding Publi~/Private ManufaCturer: Capaci~ in gallons: From Tank Field Station Tank ~wer Lines A~ ~ T~ ~ J ~ ~O Numar of Compartments: s u dace Water }~1+ /~+ 1~+ ~ -- LIFT STATION Lot ~1 Size in gallons: Manufacturer: Foundation ~ ~ i ~ J O I~ i~l~ ~ ~ ~'Pump on"~ulevel at: "Pump ~ I°~' level at: High ~ter~ealarm at: ~Pump Make & Model El~trical Inactions pedo~by: BENCH MARK Location and Description: Ft 2ndI~ Depa~ment of Health and Human Se~ices approval - ~;~;'... .~ Reviewed and approved by: C ~ Date: I~' q-~ Iq~O'FES~ / · / / HOUSE .~ ~ , ~Z~ MT1 47.8 57.7 NgW 1250 5~bON ~PE OF WOR~: AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE~~[, ............3¢. fre: A. G~rness~ ~OCELYN JUUL 349-1969 12/3/98 A.C,O. 1 A B :PTCO 52.8 21.0 S1 32.7 23.0 S2 28.1 24o~ MH 26.8 25.4 C01 24.7 27.2 MT1 47.8 37.7 MT2 40.2 58.3 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 30, 1998 Expiration Date: Oct 30, 1999 Permit Number: SW980424 Legal Description: HOLLY HILL BLK 1 LT 10 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Robert & Jocelyn Juul Owner Address: 7140 Henderson Loop Anchorage, AK 99507-2543 Parcel ID: 014-081-25 Site Address: 007140 HENDERSON LP Lot Size: 8427 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field r~ SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must 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 engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services $25 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us December 4, 1998 Jeffrey Garness, P.E. Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road Anchorage, AK 99504 Subject: Waiver Request for Holly Hills, Lot 10, Block 1 Waiver Request #WR980085- Parcel ID #014 081 25 Permit #SW980424, Health Authority #HA980478 Dear Mr. Garness: Your request for a waiver of the required 10 feet horizontal separation from the on-site wastewater disposal system to propertyline has been approved. The approved separation distance is 1.0 foot. Additionally, the separation distance between the absorption fields has been approved to 7 feet. This waiver approval applies to the existing on-site wastewater disposal system only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Mears Civil Engineer On-Site Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WRY{ ~ ~(~0\~(~_~ PID# 014-081-25 HA# Date Received: October 9, 1998 Legal Description: Lot 10 Block 1 Holly Hill Subdivision Engineer: Jeff ~arness, P.E., Alaska Water & Wastewater Consultants, Inc. Permit ~ SW980424 7320 East Chester Heights Circle, Anchorage, Alaska 99504 Applicant: Robert Juul Waiver Requested: Lot line waiver of 1 foot from the south property line to the proposed trench. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec %: ([3i~\[o~PDS/'~t%t~ Amount: $ I~\~-~-~'-, Date Paid: Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle ~ Anchorage - Alaska 99504 (907) 337-6179 N Fax (907) 338-3246 Consulting Engineers October 7, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Upgrade Design for Lot 10, Block 1, Holly Hill Subdivision. To whom it may concern: The existing 3 bedroom house is served by a private septic system and by a private well. The existing trench will not pass an adequacy test and must be upgraded prior to the sale of the house. One test hole was excavated to the west of the existing septic system. We propose to install a new trench parallel to the utility easement along the west property line. As can be seen on the attached design, there are several issues that need to be resolved. First, there is a class "C" well on the neighboring lot (Lot 11, Block 1, Holly Hill S/D) which encroaches the existing and proposed septic systems. Waivers are being obtained from A.D.E.C. concurrent with this permit application. Second, due to the limited area where a new trench can be placed, we propose to encroach the existing trench. We request you waive the separation distance of 12 feet between the north end of the proposed trench and the existing trench down to 7 feet. Third, we request you issue a 1 foot lot line waiver fi'om the south property line to the proposed trench. It is our opinion that the proposed upgrade will improve the existing conditions and is the only viable option short of an innovative septic system. Comments regarding the proposed upgrade design are summarized as follows: 1. SOILS: Attached is a log which shows the soil profile, and the percolation test result. Below the organics/fill, the soil is a SM material with some ML to a depth of 15.0 feet (bottom of test hole). No groundwater was encountered during the excavation of the test hole. One percolation test was performed at 5.5 to 6.0 feet which perked out at a rate of 6.7 minute/inch. 2. TRENCH DESIGN: a. Percolation Rate: 6.7 minutes/inch b. Allowable Application Rate: 0.8 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 563 fi2 f. Effective Depth: 6 feet g. Reduction Factor = N/A h. Width: 1 feet (use frost bucket) i. Minimum Length: 47 feet j. Effective absorption area = 564 ft2 k. Maximum depth = 9 feet 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The lot is generally flat; however, approximately 20 feet to the west of the proposed trench, the topography transitions to roughly a 50% slope. The septic systems on Lots 10, 11, & 12 are adjacent to this slope. The concerns regarding the separation distance to this slope were addressed in a 1987 evaluation done by S&S Engineers (John Swanson, P.E.). Cdven the fact that the existing systems have functioned adequately, it is reasonable to assume that the proposed trench, although about 10 feet closer to the cutbank, should function adequately. It is our recommendation that the subject waiver be approved. Denial of the waiver would dictate that an innovative system be installed, and that it would be installed to the east of the existing trench, closer to the class "C" well. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. /~ ~ ~/,s~s~,~Sincerely, Presiqdefft C) -t PROPOSED SEPTIC (SEE DESIGN, PAGE :2 OF SEPTIC SYSTEM I I ~- H~-i~E'RSO N LOOP / \ / x/ NG 3 BDRM HOUSE I ~ / \ / EAST 72nd AV ALASKA WATER. AND WASTEWATEI{ CONSULTANTS, INC. 7,]20 E. CHESTER HEIGHT~ CIRCLE, ANCHORAGE, AK gg504 PHONE: (907) 357-617g/FAX: (907) 53~t-324-6 LEGAL DESCRIPTION: HOLLY HILL SUBDIVISION, LOT 10, BLOCK 1, TYPE OF WORK: SITE PLAN PREPARED FOR: PHONE NUMBER: ROBERT AND JOCELYN JUUL 549-1969 DATE:lO/6/98 IDRAWN BY:J.L,M. IscALE: I = 100'PAGE: 1 OF2 -7955 ~ I { I I t 00' WE ~,A I I 8 t < , / ,.~.. ,..~-' "~ '-'- '"~' '"~'- ,..., , ~ ~ '1.~ I b I / /~ USED AS AN ALTERNA EXA~E 9 FE~ BEEP MAXIMUM X WIDE (USE A FROST BUCK~). ~O/M~ · X I O ADD 6 FE~ OF CL~N. W~HED S~ER DRAINROCK. .............. ~ ~. WELL EXISTIN~ 1250 ALLON S.T.E.P. S~TEM. TO BE EX~VA~D TO ~RI~ iNTE~RI~. APPRO~D IF OF POOR INTEGRI~, THE T~K I IS TO aB PUMPED, CRUSHED, AND 100' WELL RADIUS c~¢~ c" A~NDONED COMPL~ELY; AND [ ~--- HOLLY HILL SUBDIVISION; LOT 10, BLOCK 1 .............. ~ ............ : .... ~PE OF WORK: PREPARED mR: PHONE NUMBER: JOCELYN JUUL 34g-1969 ,O.E~T AND ~;%'.... ..... &,~ J.L.M. 1 = 30' 2 OF 2 ALASKA WATER & WASTEWATER ?.~2o [. CH~'ST~. ,TS. C~RCL~ · ^NCHOr~[, ^~<. ~0~ ~.. ........ ....~ ~y-' [SOIL LOG - PERCOLATION TEST[ ,~/ LEGAL DESCRIPTION: HOLLY HILL SUBDIVISION, LOT 10, BLOCK PERFORMED FOR: ROBERT AND JOCELYN JUUC ~,/'~JAMES P. WlLLIAMS~ DATE PERFORMED: 9/24/98 TaST HOLa ~ ' ' .... ' -- DEPTH ~ 2~ SOIL C~SSIFICATIONS W/ SOME ML i S~ OH ........ J --; 6 SC I - GROUNDWATER I Ira /x x ~ x / DATE READING CLOCK NET TIHE WATER LEVEL NET DROP TINE (HINUTES) READING (INCHES) B.O.H ..... 6 ...... ~.L!L PERCO~TION ~TE 6,7 (NIN,/INCH) PERC. HOLE DIA, 6 (INCHES) 20 ~ TEST RUN BETWEEN 5.5 FT, AND 6,0 FT, PERFOMED BY A~S~A WATER · WASTEWATER I, ~ X~ (,., ~ . CERTI~ THAT THIS WAS PERFORMED~IN ACCORDANCE WITH ALL ~ AND MUNICIPAL ~UIDE~NES IN EFFECT ON THIS DATE. DATE: ~ ~ / DEPTH TO DATE GROUNDWATER ........ D~_R? ......... / / I .\ \ / C ~ I~ING TRENCH TO BE I ~ ~ ~ /~ USED AS AN ALTERNATE EITE EXA~E ~ FEET DEEP MAXIMUM WIDE (USE A FROST BUCK~). ADD 6 FE~ OF CL~N, ............... ~ / ~ ~ ~ EX~STING I S.T,E,P, S~TEM. TO BE EX~VAmD TO VERI~ INTEGRIW. ~ ] ~ ~ APPROV~B] IF OF POOR INTEGRI~, THE T~K IS A~NDONEDTO BE PUMPED,~OMPL~ELy;CRUSHED,ANDAND I I 100' WELL RADIUS ~LL C REP~CE WITH A NEW 1250 I ~' ~ON S.T.E.P. S~STE~ ....... ~ ............................................ Af. AS~ WA~.~ A~ WAS~WA~ CONS~T~S, ~C. 7520 E. CHEER HEIG~ cm,c~. ANCHO~GE. ~ 9958¢ ~PE OF WORK: ~ ~r~ PREPARED FOR: PHONE NUMBER: ~¢~1 ..... " DATE: 1 0/6/98 ORAWN BY: S~: PAGE: J.L.M. 1 = 50' 2 OF 2 DEPT. OF ENVIRONMENTAL CONSERVATION TONY KNOWLES, GOVERNOR DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER and WASTEWATER PROGRAM 555 CORDOVA STREET ANCHORAGE, AK 99501 http://www.state.ak.us/dec/home/htm Telephone: (907) 269-7521 Fax: (907) 269-7650 October 29, 1998 Jeffrey A. Garness, P.E. Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle Anchorage, Alaska 99504 Subject: Lot 10, Block 1, Holly Hills Subdivision; Anchorage, Alaska; ADEC Project Number 389, Separation Distance Waiver Request Dear Mr. Garness: This letter is in response to your submittal received in this office on October 22. 1998 requesting separation distance waivers between the existing Class C Public Water System Source Well located on Lot 11, Block 1, Holly Hills Subdivision; and the existing septic tank/lift station and proposed trench upgrade on Lot 10, Block 1, Holly Hills Subdivision. You have requested the Department waive the separation distance between (1) the referenced Class C Source Well and the existing septic tank/lift station from 150 feet to 115 feet and (2) the referenced Class C Source Well and the proposed trench upgrades from 150 feet to 127 feet. The Department also understands that the current trench will not be abandoned and thus, will require the Department to waive the separation distance between the referenced Class C Source Well and the current trench from 150 feet to 123 feet. Please notify the owner/operator of the Class C Source Well on Lot 11, Block 1, Holly Hills Subdivision, that the above separation distance waivers have been requested from this Department. Based on your submitted design information, available subsurface soil and groundwater table information, recent analytical test results from wells on both Lot 10 and Lot 11, and State Drinking Water and Wastewater Disposal Regulations, it appears that the current, and proposed, Lot i0 septic system will not impact the above referenced Class C well. Therefore, in accordance with the provisions of 18 AAC 80.030, the following separation distances are granted: Jeffrey A. Garness, P.E. 2 October 29, 1998 Between the existing Class C well on Lot 1 I' and the existing septic tank/lift station on Lot I0 from 150 feet to 115 feet. Between the existing Class C well on Lot 11 and the proposed trench upgrade on Lot 10 from 150 feet to 127 feet. Between the existing Class C well on Lot 11 and the existing trench on Lot 10 from 150 feet to 123 feet. These approvals do not imply the granting of additional authorizations, nor obligate any federal, state, or local regulatory body to grant required authorizations. Thank you for your cooperation with this Department. If you have any questions, please contact me. Sincerely, Steven A. Pettis Env. Eng. Asst. II MUNICIPALITY OF ANCHORAGE EPART""E.T Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Address ~ 2 ~ ~ ~ ~ ~ ~ ~ / TANK FIELD /~ / ~//~ ~.Z- FOUNDATION Township, Range, Section [ ' ~S-BUILT DIAGRAM (Show location of well, septic system, prbpe~y lines, foundation, '7/~ ~ ~ S *~ ~/ driveway, water ~o~m., .,c.) TANKS N I ~anu~acturer Capacity in gallons Material No. of Compadments TYPE OF SYSTEM ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER D~pth tO pipe bottom lrom ~ Tolal depth from original grade / original grade FT / FT Fill added above original grade Gr~h P*Pe FT FI Gravel length ~ ~ravei width FT / Total absorption area / Distance between lines ~ SQ FT FT Numb~es J Soil rating Pipe material WELLS _ / f / ~ PRIVATE ~ O~ ~ ~'2~ ~ -~0 Classification (A,B,C) ~ Cased to Scale: ~[~'. ENG NEER'S~SEAL Inspections Pedormed by: : Date: /, I State guidelines in .llect 0n~date: ~/~? cedii, that this ,nspe.ion was ped0rmed acc0rding t0 all .unicipaland . ~.;1 ~ 1'1,,.,)_t~= .L 1 tb F::' I NP, NC. Iii. CCtI::~F:'Fi:O~,~'FI' I C)N Owne:,r' A,:::iclpo:~si: 23E"i E!'/4S't ....... ::~ IH F:' IE I:R M I T F:'a r, c: e 1 I ct: 0,1. 4..-OB I....,.2,5 Lot, Legal: ii!h,d;:ld:i.v;i.~:,:J.c~r'i= I--IOL.I_? t-..IIt_I_S SitJE~i}, L, ot,: 10 Se~ct.:i,c:,n~ ,4. 'Fc::,~.,~r~!sl"~:i.p~ lli?,N I::tangr~?~ 3W B~<~d r. c, omsl = T'h i si Per' m i t. ~ 3 't"c)t.o. I Capac i t, y: 3 f~ 1 oc: i<: I M:.t.~. I 1 r" r 'THAT i~ :t,, I i.-.'~m f,!'~m'/il:i, ap w;i,'t'..l"i 'L'.l-'~e; r'e?qLtir'e:.;mer-rt.s; fop c~r'v-s~:i.t.e~ ~set,,~<.)~r'sl ai"ld for',t.l"l t:iV t.t"te~ I"h,,uaic" "' '' ~ ......... . .l,l..~a.t.,t,~,,/ of F,~nchor'age~ (I"ICiA) arid t, he~ 2. I w:i. ll :i. nsrLall t.l"le;, ~sysrbe?m ;i.n ac:c:or'dar'ic:e;, t, oit. h all 1¥10{,~ ~;. i will actt"u.:.:.~r'e t,o all I¥10~t and St.a'Le c){ /,~;l,a~skill r'e~quirg!m~:.:~nt~i f'or' 't',,h'e slle'l'., back ~n y e:.n 1 ~?i r' cj {{~/l'iii~l"! t. It~ ;J. ], ]. I') t;:i, qLt i P (~) ii'ti"t ~i/[:l I;;I i t, J, Or'l YB. ;I. t3 Ell, "til J, 'il. Municipality Anchorage , Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 9, 1989 Alaska Housing Finance Corp 235 East 8th Avenue Anchorage, Alaska 99507-2543 Subject: Lot 10 Block 1 Holly Hill Subdivision Permit ~880264, P.I.D. ~014-081-25 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1988. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, .the orginal as-built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. When applying for a new permit, the fees are: $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincerely, Daniel J. Roth Acting Program Manager On-site Services Section DJR/ljw enc: Copy of Permit C) N .... S :l: I' I,:.i: E~ Ei: F:' "I' :[ C T fq N K F' E: I::;,' N :1: ']' i?..i.' :.-~i;N::;E!:T F'L,,AE~'T'];C TANK CAV]ZN!:':'~ :IN (.,,'dqD WI:El... BIZ I::~:Ei:Fq...¢.~C..I::ZD BY NE:W E)l:i!:l::' i 1C 'f'At'qt<: ~ U i n :i, ¢i'~(.,t¢~'~ 'L.(::~'L,:~',' ], sep'L :i, c: 't,,ank c:apa(::: :i. ty :~ ~., 000 ga ]. ]. (-~r~[i. E:ac:ln !,'.'~ept. i(:: ALASKA ENVIRONMENTAL Jo. /-*-/O ~/ CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B SHEET NO, ANCHORAGE, ALASKA 99503 CALCULAT"DSY (907) 561'5040 DATE CHECKED S¥ DATE SCALE South Fork Construction P.O. Box 770567 · Eagle River, Alaska 99577 · 907-694-435! MARCH ~7~ ~ 989 DUANE E. WERT INSPECTED 17{E ELECTRICAL WIRING AND TERMINATIONS OF THE ADD ON LIFT STATIONS FOR THE UPGRADE OF THE SEPTIC SYSTEM ON LOT ].0 BLOCK ! HOLLY HILLS SUBDIVISION ALL WIRING MEETS ELECTRICAL CODE~ SOUTH F/ORK DUANE E. ~ERT ST. OF AK. ADMINISTRATIVE LICENSE 4~D778658 CERTIFICATE OF FITNESS ~880S /~-~UNICIPALITY OF ANCHORAGE ~ Heal .~'and Environmental Protec ~n Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON'SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DI STANCE FROM ~VELL. INSIDE LENGTH____ MAN U FACTU R E R __ MATE RIAL -- [CLg.~ .. COMPARTMENTS INSIDE WIDTH ~ LIQUID DEPTH --~ - .LIQUID CAPACITY /OO(~GALLON$. T'LE DRA~N Fi ELD: I I TOTAL LENGTH 1 (,,4 NEAREST LOT L,NE_ o g DISTANCE FROM WELL ' _~FOUNDATION I ~ O f Lines I DISTANCE BETWEEN LINES ~/~ .TRENCH WIDTH~IN. TOTAL EFFECTIVE ABSORPTION AREA ~ ~ SQ. FT. LENGTH OF EACH LINE ' DEPTH OF FILTER q ~ DEPTlt: TOP OF TILE TO FINISH GRADE ~ MATERIAL BENEATH TILE IN. ABOVE TILE ~ IN. SEEPAGE PIT: Log Crib. Rings__ BUILDING FOUNDATION_ DIAMETER -- OR WIDTH___, LENGTH DEPTH Crib Size:I DIAMETER .DEPTt4 DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE.__ ABSORPTION AREA (WALL AREA) SQ. FT. Well ~~ Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: ~ ~ of Bedrooms: ~ ~ -g ' Installer: ~m~, , Remarks: ~1 =0 I~ ~ F:! Fq:::n::::J.:::F:!l':!iJ!ii: J:::'I...I::!N"J' I'"IF:!'T* E:liii: ]:N:!!i;"iF:tL..i..iiii:J:) t:::I'T' 'T'F'II!!i: !::'li!!:l:;irh'J :J: T"J"l!!:!i!i: '" :!i:; OP'T':I:ON :iil;I...iti3..:l'tiii:C"!" TO THE!: i::: E~i .. 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MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99B02 276-222t' SOILS LOG- PERCOLATION TEST [] SOILS LOG [] PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: ~"'~/V 8 9 10 11 WAS GROUND WATER ENCOUNTERED? 12 13 14 15 16- 17- 18 19 20 /'"-/,~Z-L V Z/// ...~ ,-"~u~l VI c~ ~/./ SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND FT October 6, 1977 MOENING-GREY & ASSOCIATES, INC. GEOLOGISTS AND ENGINEERS 715 I STREET, SUITE 8 ANCHORAGE, ALASKA 9950! TELEPHONE 274.2314 Department. of Health & Environmental Protection Environmental Health Division 825 L Street Anchorage, Alaska 99501 Attention: Robert Pratt Re: Soils Test for Block 1, Lot 10, Holly Hills Subdivision - Owner Benson. Gentlemen: The owner of Lot 10 placed a daylight basement structure on the property and in order to obtain sufficient fall for a sewer system, installed the seepage trench at a depth close to the bottom of our test pit excavation. Accordingly, a question has arisen with respect to the water table eleva- tion in this area. The property is situated on a small hill which probably represents a kame terrace deposit. The terrace materials consist primarily of sand and sandy gravels. The deposits are exposed along a steep cutbank immediately south of the property. This exposure shows a cross section of some 25 to 30 feet. Inspection of the bank during our original June 6th test and immediately following notification of the deeper system installation on October 5th shows the deposits to be relatively dry and free of any seepages or other indications of a high water table. Accordingly, we see no problem with the installation and would conclude that the water table is substan- tially deeper than the 4 feet required from the bottom of the seepage trench. Please advise if you haVe any questions concerning the foregoing. Yours truly, M0 E N I N G- G R E Y-~&~-C~-~'~F E S, INC. HJG/lv PERMIT NO. [:,EF'AR'f'MENT HERLTH AN[:, ENV I RONMENTAL ~:0TEC:T I 0N 825 '"L"' STREET, RNC~DRRGE., AK. 9950± 264-4720 I,-~E~ IL_ F'EF:[".I I 1- ,:: 8Z-::O42L~ ) PFFL. I~.HNT LOCRTION LEGAL PATRICK R I"iRITLRND L10 E:± HOLLY HILL '7t40 HEI'.&'.,ERSOI"t LOOF:'._~.,..4.._,r:.~.-,-=-~,.. 3:49-6967 LOT _-.!~E q."a'~9'~.g SQUARE FEET MINIMUM DISTANCE BETb. IEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR A PRIVATE WELL OR Z50 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE HELL. TO A PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS PRE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 50 DFI9S OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F"EF-:i'""t I:. T E:=-::F' I F-:ES [:,EE:ElPllE:EF: 7~=:1.. ' "- ~ .... I CERTIFY THAT 2: I RM FRMIL. IAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH B"r' THE MUNICtPALtT'¢ OF FtNCHORRGE. 2: I WILL INSTALL THE SYSTEM IN RCCOR[:'RNCE WITH THE CODES. ........ RPPL I CFINT F'RTR I CK R. blR I TLRND ~ SSI_lEI:, ~ ~ ............................... L HIb .......... V4. 0 WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Seologicol ~ Geophysical Surveys Drilling Permit No, LOCATION OF WELL (Please complete either la, lb or lc.) A.D.L. No. I~.llBorough Subdivision Lot I Block ,b.ll I/4qtrs. Section No. Township N{~ Range Er--] Meridian ~c.JIDIsTANCE AND DIRECTION FROM ROAD INTERSECTIONS 5. OWNER OF WELL: Address: Street Address and Area of Well Location 2. WELL LOG Feet Below 4. WELL DEPTH: (final) 5. DATE OF COMPLETION Surface 8 i:~ Moteriel Type Top Bottom ~,~. ft. -- ' ~ "~' ..... ~'Threaded :~ Welded dlom. ~; In. to~ ft. Depth Weight '~'/ Ibs./ft 9. FINISH OF WELL: Sial/Mesh Size: Length; Set between ft. and ft. O~te ~ Above or ~ Below land surfoce II. PUMPING LEVEL below land surfoee end YIELD ft. offer hrs. pumping~g.p.m. ff. offer hrs. pumping ~g.p.m. 12.GROUTING Well Grouted: ~ Yes ~ NO Material: ~ Neat Cement ~ Other: 15. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. 16. WATER WELL CONTRACTOR'S CERTIFICATION= 15. Wafer Temperature o ~ Authorfzed Representative Form 02-WWR (H/81) Cooy Distribution; WHITE-Stale D~GS. PINK-Driller, CANARY-Customer 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 Parcel I.D.# 014-081-25 1. GENERAL INFORMATION Complete legal description Lot 10; Block 1; Holly Hill~ Subdivision Location(siteaddresso~directions) 7140 Henderson Loop Anchorage, AK Property owner Robert Juul Day phone 345-2386 Mailing address C/O ~rud. ential Vista ?,eal ~state Anchorage,, AK Lending agency Mailing address Day phone Agent Brian Broderick/Prudential Vista R.E. Day ph0ne. 273-7261 Address 4241 "B" Street Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 -v 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. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XX 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 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my :investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations ineffect, on the dat~?f this inspection. Name of Firm F4,/';~]~ Phone -'* Engineer's signature ~ Date /' 2/-)/~Ou, ALASKA WATER & WASTEWATER CONSULTANTS, INC IS TO BE PAID $3628.75 AT CLOSING FOR ENGINEERING SERVICES PERFORMED. 6. DHHS SIGNATURE %/' Approved for '~'~J bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a 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. 72~25 (Rev. 1/91) Back MOA #21 RECEIVED Municipality of Anchorage DEC 0 3 1098 DEPARTMENT OF HEALTH & HUMAN SERVI~.~i~^uTy o~ ^Nc,o~~ Environmental Services Division aI,~iI~ON~eNT^LSE~VlCES DI~I~) 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: A. WELL DATA Well type ~)~,t,J~,~ Log present (WN) Total depth If A, B, or C, attach ADEC letter. ADEC water system number '~-~.~ Date completed ~/P~ .~ Cased to ~ ~ / Casing height (above ground) Sanitary seal ~/~) Wires properly protected(~l') Y'E~ Date of test Static water level FROM WELL LOG AT INSPECTION / Well production g.p.m. WATER SAMPLE R..~ULTS: Coliform ~ ". Date of sample: ///~o/~' ~ TANK DATA Date installed ~ Tank size Foundation cleanout ~ ~'~. Nitrate °'~J~ ~ Other bacteria .~ : Collected by: ~, .ud. u:j. L. 1 7_5;(..3 Number of Compartments 7_- Cleanouts ({~hN) ¥~.5 Depression ~1~) ~o High water alarm (~1~ Y'~ Date of Pumping t,J P__U,J Pumper ABSORPTION FIELD DATA Date installed 1,/Z ~/q~ Soil rating g~.p.d.~ or ftS~edm~) (~. ~ I Length ~./t Width ~- Effective absorption area _.~ (o~ ~;' Date of adequacy test ~'~ ~ ~J System type Gravel thickness below pipe ~ Total depth Monitoring Tube present([~l) 'Y'E-.~ Depress on over field Results (Pass/Fail) ..... For Fluid depth in absorption field before test (in.); Fluid depth --'--- (ins) Minutes later: --"" Peroxide treatment (past 12 months) (Y/N) Immediately after ~ gal. water added (in.): Absorption rate = ~ ~ g.p.d. If yes, give date bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed ~ ~ /'Z-8'//~§ Manhole/Access (~)'N) High water alarm level at* Cycles tested ~ P--~'~ Size in gallons II ~o "Pump on" level at* *Datum f~o~-.ro,~,. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/he~i~g tank on lot Absorption field on lot Public sewer main Sewer/septic service line ~.G ~-f- On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 1%~ ~ Property line '-7 ~ ~ Absorpt on field Water main/service line I o I* Surface water/drainage Ioo~-t- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ Building foundation 1~'-t' Water main/service line Sudace wat~ [oo~ ~ Driveway, parkin~vehicle storage area Cu~ain drain ~ ~ ~o~ Wells on adjacent lots ENGINEER'S CERTIFICATIO~ ~ I ce~i~ that ~de~i~d~ie~ insp~tions and review c Engineer'sN mJ '0 Date l Z/~/~ ~ HAA Fee $ Date of Payment /~ /~ /'~ ~ Receipt Number ~z.~//__~'z.~ dT~-.~7 ~) Waiver Fee $ '/ Date of Payment Receipt Number 72-026 (Rev, 3/96)* 9075615~01 P.01/01 CT&E Ref,# Client Name Project Name/// Cliff Sample ID Matrix Ordered By PW$ID S~nple R~m~ks~ 985912001 AK Water & Wa,stewater Consultants Inc. Holly Hills Lol 10 Bk I Holly Hills Lo! 10 Bk 1 Drinking Water Client PO# Printed Date/Time 12/0~'/98 00:21 Collected D~te/Tlme 11/30/98 12;00 Received Date/T/me 11/30/98 13:30 Technic~d Director: Stepher~ C, Ede CoLiform Nitrate. N 0,1~0 U 0.100 mg/L EPA 300.0 11130/98 max 11/$0/98 ll/~O/g~ SCL RECEIVED DEC 5 1991 Municipality ct Anchorage DepL Health & Human Services TOTAL P. 01 MUNICIPALITY OF ANCHORAGE Department of Health & Human ServiCes DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING C}iL/.~'~(::~ \- ..'7~.~ NAA# ~-1 -c:~c~ (~\~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location ,(-aqdz ss (b) (c) (d) Telephone: (home) Business Pronertv~wn%r,~- ¢~.'r~t~ v,~ ;s~,,/~J Mailing AddreSS.' _"~',~ ~A'"' ~O/d~ Lending Institution" ' ~ "' Telephone Mailing Address Real Estate Company apd Agent Address Z-C 'r/ Telephone Z~ ¢~¢¢~ Mail the HAA to the following address: (or check here'~[~ if hold for pick up.) List contact person and day phone number below: (e) 2. TYPE OF RESIDENCE Number of bedrooms ~-~ Single-Family,S' 3. WATER SUPPLY Individual Well~' Community [] Public [] Note: If,community well system, must have written confirmation from the State Department of Environmental ConserVation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site'~ 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 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of th is 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~'~' Telephone Address / ~/~ ,t... bJ' ~¢~ ~/'~"/ ~ Date 6. DHHS APPROVAL Approved for .~ Approved ~" bedrooms b y/~/~/ / ~Date Disapproved Conditional Terms of Conditional Approval ,z; ,m.li III The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their k;nding 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. 7/88) Back Page 2 of 2 ~ MUNICIPALITY OF ANCHORAGE (MOA) (~-~,1 Health Authority Approval (HAA) MUNICIPALITY~ORAGE CHECKLIST - FEBRUARY 1984 " ~ - 343-4744 ENVIRONMENTAL SERVICES DIVISION Lega 1989 A. WELL DATAR E C E I V E D Well Classification Well Log Present (~/N) __ Date Completed · Total Depth ~'/ Cased to Static Water Level Depth of Grouting Casing Height Above Ground Electrical Wiring in Conduit ~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot / To Nearest Public Sewer Line If A, B, C, D.E.c. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (~)'N) Depression Around Wellhead (Y(~ ; On Adjoining Lots ,/~J /0 ~ ; On Adjoining Lots /~-~ ''/' / To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~'"/'Z'~'~/? Size StandPiPes~N) Depression over Tank (Y(~ pumping/Maintenance Contact on File (Y/N) /~.5'"o No. of Compartments Air-tight CapsON) Foundation Cleanout ~'N) Date Last Pumped ;for ,~'//'~ Temporary Holding Tank Permit (Y/N) /~' Holding Tank High-Water Alarm (Y/N) SEPARATIQI~;.~'~,~§_,~,f~M SEPTIC/HOLDING TANK: To Wat e.~'~~.i::"" ~f To Building Foundation TO Pro~ine "~~ ~ To Disposal Field To Wa~a~ervice Line ~0 72~026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /0 Width of Field Square Feet of Absortion Area Depression over Field (Ye Results of Last Adequacy Test Type of System Design Length of Field Depth of Field ~'~ Gravel Bed Thickness ~ · Statndpipes Present CN) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Property Line To Water-Supply Well / To Building Foundation L.ot ,,'~/~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Existing or Abandoned System on ; On Adjoining Lots /'~/'~ To Cutback (if present) ~u ~'r_) / Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level Tested for ---"- Meets MOA Electrical Codes~)/N) Comments Dimensions /'~/· ~'"! X $I '! Man hole/Access CN) "'Pump Off" Level at --~ ~/ Vent~N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** or conformed to all MOA and HAA guidelines in effect on the date of this I certify that I have checked, lverified, inspection. Signed Company Date MOA No. ~2~¢ Receipt No. Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment 721026 (REV. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT BY SAMPLE £or Work Order ~ 12186 Date Report Printed: MAR 17 89 @ 14:21 Client Sample ID:LIO, B1, HOLLY HILLS PWSID :UA Collected MAR 15 89 @ 16:00 hrs. Received MAR 15 89 @ 16:10 hrs. Client Name : A E C S Client Acct: AKECSRP P.O.% NONE REC'D Req ~ Ordered By : A. WEIN Analysis Completed :MAR 17 89 Send Reports to: Laboratory Supervisor :S~EP~ENC~ EDE 1)A E C S Released By : ~'~-',~ 2) Special Instruct: Chemlab Ref #: 4548 Lab Smpl ID: i Matrix: WATER Allowable Parameter Tested Result/Units Method Limits NITRATE-N 0.24 mg/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY A. WEIN. 1 Tests Performed * See Special Instructions Above UA=Unavailable ND~ None Detected *' See Sample Remarks Above NA~ Not Analyzed LT~Less Than, GT~Greater Than . APPLF'- NT FILLS OUT UPPER ONLY Property Ow,ner p/5~ ~/~ / ~'[~ ]~, /~ /.~/~/~ ~ Phone Address Zip Code Lending ~nstitution Phone , /~ 7/ , Zip Code Address /~//~ r ~d/A./~ / ~' (j).~ /'~/~/d /~// ~ ~ Realty Co. & A~nt Phone Address ~/D /~//m Zip Code Street Locati~ "il z /~ /~m ,,1~ /) ~ ~, .,, J .Z.~2 .~?~, /:J lq/, ~ ~ Type of Resi~nce ~ing!e Family ~ Multiple Family No. of Bedroo~ ~ ~ Other Wateru IndividualSUpply ~o)/,t~ ~, 4~i ~ /]/:'t'~tZ ~ /~5tg{~ A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal Individual Year Individual Installed: /~// ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Inspector Inspector Inspector Inspect~ i MUNiCip,^,L!T ~ AN~HOJ~I~ Field Notes: DEPT. OF HEAgTH /~ ENVIRONMENTAL PROTECTION. RECEIVED ( ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ~ONDITIONAL APPROVAL* DATE ~ ~ ~ ~ ~ Soils Rating Date ~wer Installed Well To Absorption Ar~ Well Log R~ceived Well to Tank Septic T~k Size ^L^$K^ iUIROIlmenTAL COI1TROL irE. MAY 27 1983 i'~UNi'... ..... DEPT. OF ~JVIRONMENTAL PRO I'i:'CTION PATRICK MAITLAND 7140 HENDERSON LOOP ANCHORAGE AK 99507 SELLER - PATRICK MAITLAND BUYER-MICHELLE FINK SUBDIVISION-HOLLY HILL BLOCK-1 LOT-10 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 456 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 675 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF THIS 3 BEDROOM HOUSE. 1000 IS ADEQUATE FOR 1200 LUcsl 33r{I Au6nu¢, Suite ~ · An¢llordq¢, Al~skd 99503 · (907) 276q361 , DAT~'RECEIVED I NSP ECTI ON APPOI NTM ENTS~~' ~ ~/_.~ TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSPECTO~R~ MUNICIPALITY OF ANCHORAG~ ~UNIOIPALITY OF ANOHORAGE DEPT. OF DEPARTMENT OF HEALTH E ENVIRONMENTAL PROTE~NMENI'AL L ~)'[ECTION 825 L Street - Anchorage, Alaska 99501 ENVI RON~ENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplet~ requesg will ~ot be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER ~ ~ j~ PHONE MAILING ADDRESS ~'~ ~OPER~Y R~Sl~NT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS - · 4. R~ALTOR/AGENT~ J PHONE I MAILING ADDRE~ 5. LEGAL DESCRIPTION STREET LOCATI ON 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF~B EEfROOMS [] One [] Four [] [] Two [] Five [] Three [] Six 0ther~ 7. WATER SUPPLY & & J~'AT J~ INDIVIDUAL*' Iff~[' TACH WELL LOG. A well Icg is required for all wells drilled [] COMMUNITY since June 1975. For wells drilted prior to that date, give well [] PUBLIC UTI LITY depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [~ I N DIVI DUAL/ON-SITE** [] PUBLIC UTILITY YEAR oN-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ., THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or I--1Holding Tank Size: j~)~)O If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORF~TION AREA MATERIAL 4. DISTANCES Septic/Holding Tank JAbsorption Area Sewer 'ine I Nearest Lot Line I I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) " "SAPPROVED DATE BY Anchor e 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4t 11 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 29, 1980 Patrick/Dorothy Maitland 7140 Henderson Loop Anchorage, Alaska 99507 Subject: Lot 10 Block 1 Holly Hills Subdivision The semi-public well, which serves your dwelling, has not been approved by this department. The well is on Lot 11 and does not meet the minimum distance requirements between neighboring sewer systems. Therefore, before approval can be granted, the neighboring sewer system will need to be relocated 120 feet from the well or drill a separate well to serve your residence. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specfalist RCP/tjw cc: National Bank of Alaska Pouch 7-025 99510 Ralph W. Stewart % Heritage Homes 207 East Northern Lights Boulevard 99503