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Home My WebLink AboutFINLEY LT 1Onsite File Finley Lot 1 #015-112-44 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181314 PID Number: 015-112-44 Dwelling: ®❑ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑ Upgrade Name: Rodger & Darlene Lee ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 10400 Finley Circle, Anchorage AK 99507 ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 830-8723 4 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Finley 1 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft, SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well >100' N/A NIA NSA >25' TANK ®❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 11,250 Gal. Surface Water >100' N/A N/A N/A Material Steel Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >10, N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Installer A+ Home Services Drainfield Exist. CO/MT Inspector J. Williams BENCH MARK (Assumed elevation) 100 ft Inspection151 2/26/19 �d Location and description dates: 2 3'd 41t1 Bottom of siding. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp F Conditional Approval: Date • �� a e49th � mm................. ............... MICHAEL E. ANDERSON ! `� NO. CE-4381 .1 �� Cep°'•., 1/29/20 °°�o •. ...`��Q� Approved ' �Lis Date 3�� 0 pR 1�� Inspection Report-9-1-12.doc ..\..\..\..\Desktop\Forge logo.jpg 100500 FEET 1"=50'4-BDRM HOMECO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE CONTOUR INTERVAL - 5' LEGEND PERMIT # OSP181314 PID # 015-112-44 FINLEY, LOT 1 A B ..\..\Admin\Schiller seal\Signed seal.jpg 104th AVE FINLEY CIRCLE3' ROAD RESERVE EXISTING ABSORPTION BED EXISTING WELL EXISTING WELL 1,250 GALLON SEPTIC TANK 1/29/20 SV1SV22CO 355 350 10' T&E EASEMENT PLAN AS-BUILT A B SV1 60.2 SV2 67.7 2CO 70.1 72.5 79.8 82.3 PROFILE AS-BUILT (NO SCALE) 90.2 85.7 90.5FCOSV1 SV22CO1250 GAL SEPTIC TANK 90.1 PERMIT # OSP181314 PID # 015-112-44 FINLEY, LOT 1 94.6 1/29/20 E. 104th AVENUE 3' ROAD RESERVE _r r IF,_0' T&E EASEMENT Lot 1 11 w ut Lot 16A o COVERED CONCRETE STORAGE PADS 7.7'x12.2' SHED w/ RAMP N—rvcLc I WEST 299.86' 05 o` 72.2'x76.2' SHED \IA ` �� `(SEE NOTE) / (SEE NOTE) J .�� NOTES: ��° 1) THE GRAVEL PARKING w000EN FENCE Lot 2 Quo ENCROACHES ONTO LOT 2. 10' T&E EASEMENTS ^ob 2) THE SHED & WOODEN FENCE \ \ ENCROACH ONTO LOT 1. CHAIN-LINK FENCE. 1 40,413 S.F. v CHAIN-LINK FENCE-\/\ 6.0'x12.0' DECK / 2.1'x2.3' CANT < ;� -SEPTIC PIPES—\ ry 2,p. �p 0 _ 1, � �N f.?. JAL=31.37' R=20.00' CANT STORAGE CANT 2.8'x3.9' WOODEN PAD \ 1-1 PLOT PLAN ___ AS BUILT _X_ SCALE _1= 50__ GRID _ SW 2536Project No. 11500 Daryl Avenue, Anchorage, Lang & Associates, inc. (907) 522-6476 Phone Alaska 99515-3049 (907) 522-4625 Fax Professional Land Surveyors kenOlongsurvey.com y 0000�Op�O /� Q o �F ry•�9��0 S 4�0AA Jonathan®langsurvey.com ooP 0��.' -9 I hereby certify that I have surveyed the following described property: LOT 1, FINLEY SUBDIVISION (PLAT No. 83-298) TH V 0 49. .". Anchorage Recording District, Alaska, and that the improvements situated thereon are • • • • • .. . .' • � within the property lines and do not encroach onto the property adjacent thereto, that improvements the lying thereto the "p' •: •or no on property adjacent encroach on surveyed ; KEIJNETFI NG premises and that there are no roadways, transmission lines or other visible easements Indicated hereon. �c, o QO s'.4 i2$I�.�2e on said property except as ..�'V 0 '•.LS—�5j202. ' SJp� 4'4%, ___=1i - Dated this theID Day of _________, _� _'_�--- at Anchorage, Alaska "R? ESSIONA� � I It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 „„”°""'Y MUNICIPALITY OF ANCHORAGE �+` On-Site Water&Wastewater Program `S PO Box 196650 4700 Elmore Road , I g' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,,y ;,, httpa/www.muni.org/onsite 1. . / ;i1 . \N _ / I)cpartnicnt AhCNOPPE On-Site Wastewater Disposal System Permit Permit Number: OSP181314 Effective Date: 9/10/2018 Work Type: SepticTank Upgrade Expiration Date: 9/10/2019 Tax Code Number: 01511244000 Site Legal Address: FINLEY LT 1 G:2536 Site Mailing Address: 10400 FINLEY CIR, Anchorage Owner: LEE RODGER A& DARLENE E Lot Size in Sq Ft: 40413 Design Engineer: FORGE ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: �,CA 4 l Date: Issued By: �f{ Date: D ef MUNICIPALITY OF ANCHORAGE vc, 67 8 9 70 411111 , Community Development Department Phon= ••07S414'3-013401d Development Services Division Fa •'7-343-7997 On-Site Water & Wastewater Program A ON-SITE SEWER/WELL PERMIT APPLICATION Ol 5 8 L 9 � Parcel l.D. 015-112-44 Property owner(s) Rodger & Darlene Lee Day phone 830-8723 Mailing address 10400 Finley Circle, Anchorage AK 99507 Site address Same Legal description (Sub'd., Block & Lot) Finley, Lot 1 Legal description (Township, Range & Section) Lot Size 40,413 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (EI all that apply) Absorption Field ( i Initial Single Family (SF) I XI (w/wo ADU) Septic Tank Upgrade X Duplex (D) Holding Tank n Renewal Multiple Dwellings n Privy n (SF and/or D) Private Well Water Storage THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: ogi6 Waiver Fees: Date of Payment: 90116 Date of Payment: Receipt Number: Q 5q b Receipt Number: Permit No. 05P/7/3I Ll Waiver No. Permit App_.-:• law *� GE ENGINEERING PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) September 6, 2018 Municipality of Anchorage Development Services Dept- On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Finley, Lot 1 - 10400 Finley Circle Septic System Design and Permit Application Dear On-Site Services Engineer: The septic tank on the subject lot is leaking and must be replaced prior to the issuance of a COSA for the property. The attached site plan identifies the location of the home and the existing well and septic system. No conflicts exist between this proposed system and any other well or septic system,whether on this lot or adjacent lots. The new septic tank will be placed a minimum of 5' from all deck or stairway foundation supports and all lot lines. The existing septic tank will decommissioned in accordance with Municipal Code. The existing well on the lot is shown. The placement of the new septic tank will not encroach into surrounding protective well radii. Please refer to the attached plan sheet for the septic design. If this design is followed,there will be no adverse impacts to adjacent properties. Sincerely, ""- OF At t :S.• • `1� Michael E. Anderson, PE 1*.. 49• TH •.*,94 Michael E.Anderson • 43f is%11••. 9/6/18 •• ,1-E � i �1 44:0°ROFESS10��ir FINLEY, LOT 1 _ L_T\1\ _ ..c ' S'_. — 104th A N 3'ROAD RESERVE ` \ , / \ � — ._ — _ - -� r / EXISTING WELL OEXISTING ABSORPTICJN BED f / 10'T&F EASEMENT , LOT 1 ..., EXISTING 1,250 11 • 0 GALLON SEPTIC TANK 4-kRM HOME \ } \ 3IE 2C•SZCO \ \ i =�\\ u- �' / LOT 16A / \ r\___ _________7—.3s5-V PLACE NEW 1,250 ____/- i \ GALLO EPTIC T�NK — — — — �\ / / \ I \ LOT 2 I NOTE: I I DECOMMISSION EXISTING SEPTIC TANK IN 1 ACCORDANCE WITH MUNICIPAL CODE. \ \ EXISTING WELL \ \ \ \ / illikt GE _ ENGINEERING \\ - / NOTE: '.-\ --,......... ••,��F alit�� NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND "\�. ••• q4-q •• PROPOSED SEPTIC SYSTEM 47,"\ ••. •• CO-CLEANOUT arc-,.....* ti • a2C0-DOUBLE CLEANOUT 49th * \4 ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS FCO-FOUNDATION CLEANOUT r PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC r 7✓L' C ..-r FS-FLOW SPLITTER VALVE �. :................ •�: SYSTEMS. •73�,;MICHAEL E. ANDERSON �� MT-MONITORING TUBE •• -,-,�•., No. CE-4381 •.•�_` 0 50 100 SV-SEPTIC VENT •••'F�i••• ......... I fR0FESS\0Pi MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES t~ / '~ I/ Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES '~,C~,~./~ /.:E",~'~ ~ SEPTIC ABSORPTION ~ ' TANK FIELD / WELL .o......,.,o. FOUNDATION Township, Range, S~tion ~'/~')~--''] ~,~ ../ *S-.UILT DIAGRAM (Show local,on of well, septic syste., property ,,ne,, foundation, /> driveway, waler bodies, elc.) ~ - TANKS Manufacturer Capac,y in gallons TYPE OF ~Y~TEM ~' / ~' ' ~,' , ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER Depth ,O pipe bottom from Total depth , ..... igina, grade / °riginalgrade ¢.~.~ FT /--~,.~ Fi / ' ' nstaller Date Installed / WELLS ~ PRIVATE ~ OTHER (Identlfv) / ~ // Classification (A,B,C) Total Depth ] Cased tO / Installer Date Installe~: ~ ~ale: ~ ENGINEER'S SEAL' I ~'/JP ce.il, thai Iht, inspe.ion was ped0rmed acc0rding t0 all Municipal and Stale guidelines Iff effect on this date:. ~ ] / Health Depadment Approval: . . Date; 72-013 {3/85) Atunicipa, itYof Anchorage P.O. BE,,, 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 ~X~X~, Tom Fink, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 8, 1988 Rodger/Darlene Lee 2609 West 32 Avenue Anchorage, Alaska 99517 Subject: Lot 1 Finley Subdivision Permit #870139, On-site Sewer/Well Permit A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. 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 original as-built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re-applying for a new permit, the new 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, Robert W. Robinson Program Manager On-site Services RWR/ljw enc: Copy of Permit d_~,b / I~cl~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMEO FOR: LEGAL DESCRIPTION: 4 5 6 7 8 9 10 11 12 13- 14~ 15- 16- 17- 18- 19- IVL) Township, Range, Section: ~J ~M .~ /~ MUNICIPALITY OF ANCHOIM~-I3E DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION JAN 2 RECEIVED SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED7 S L IF YES, AT WHAT O DEPTH? p E Deplh Io Water Alter Monitoring? Date: Gross Net Depth to Net Reading Date Time Time Water Drop 20 - PERCOLATION RATE ~/' ~ {minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN //' ~'' FT AND ~ FT COMMENTS ~'0 ] ~,,' PER ORMEDB'; ,4. I CERT,. THAT TH,S .EST WAS PERFORMED ,N ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; ~ ''/' '~ 7 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: z~ ~''/~r'~ LEGAL DESCRIPTION: ~.-0~'" // ..SM 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- WAS GROUND WATER ENCOUNTERED7 Township, Range, Section: "~,~ ,~.3/,,J .~'~.. ,/.~"' SLOPE SITE PLAN IF YES, AT WHAT DEPTH) Depth to Water After Monitoring? Dale: _ Gross Net Depth to Net Reading Date Time Time Water Drop - ,07 PERCOLATION RATE ,/'~° ~' (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN '~ FT AND ''~' ~'' FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE, DATE: 72-008 (Rev. 4185) , SURVEY TYP~ DRAINAGE ~ ' ~ ~ ~ A~UMED E~V W~O DECK ~ ~ = ~ CHAIN LINK FENCE r-! LOT SURVEY [] RE;CERTIFICATION AS-BUILT- NO CORNERS SET ,ponsibihty ctthe builder or owner~ prior to construction, to verify proposed buildin9 grade relotlvi to finished grade and utility connections end to determine the existence of any easements, covenants Or restrictions which do not appear on the recorded subdivision plot. : Lot Survey Certificoti~ NOTE: Fences ore shown in their approxirnot~ locations only. LEGEND hub 6 tack-found [3 set II iron rebor -found 0 set · iron pipe -found ® set brass cop -found (~) set alum. cap -found (~ set ,-, Prep. ar. ed by t £NCH /V/A/RK /NC. Professional Land Surveyors t Drown by= Scale: 1" = .50' DGM Dote Surveyed C~ecked by, · ' 4-~-R7 . · Dote Drawn: I Grid; 4-~-R7 · 2536 Legal Description-' LOT 1 FINLEY SUBDIVISION I hereby Certify that I hove. su~eyed the properly shown hereo~, o~d the improvements situated thereo~ are within the property linee and do not overlap or encroach on odjocen~ property, excep~ as indicated hereon. Easemenle of record, other than those shown on the recorded plaf~ ore not shown hereon. w'o'87_026 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: /~ ~ ~"~ ~"~-~"~" LEGAL DESCRIPTION: Township, Range, Section: 5 6 7 8 9 10 11 12 13 14- 15- 16 17 18 19 2O SLOPE WAS GROUND WATER ~,/,...,,,, ENCOUNTERED? __ S IF YES, AT WHAT / OE DEPTH? /~-- p Depth to Water AIter '?''~, "'--' '~'~'~'? E Monitoring? ~,~ .'~. 5'"'" SITE PLAN IIIII Illlll I t II Illl Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /'~,~" tm~nute~'inch) PERC HOLE DIAMETER ~' ~/ 'TEST RUN BETWEEN ~"~' FTAND ~ FT / PER.O~ED ~ ~ ~' ~/~ ~ C~R~,~ ~H*~ ~,~S TEST W*S P~R.O.~E~ ~U ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~--~ 72-008 (Rev. 4/85) WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological ~ Geophysical Surveys OrllHng Permit No. LOCATION OF WELL (Plecss complete either lc, lb or lc.) A.D.L. No. Townehip NC~ Range Er--] Meridian Ic.JrDISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3, OWNER OF WELL: Address: i 2. WELL LOG Feet Below Surface 4. WEI,~, DEPTH: (final) 5. ~ATE OF CO,MPLETION Material Type Top Bottom ~ ~ ~ J [ :~' :():~ ~ Irrigation ~ Recharge ~ Commerlco~ I0. STATIC WATER LEVEL: '' ' ft. / / ~ Above or ~Below land surface MUNICIPALI~ O~ A~ E ~, PUMPING LEVEL below land surface and YIELD DE~. OF H ALTH & q'; ft, after ]. hrs. pumping g.p.m, Material; ~ Ne~f Cement ~ Other: 15. Wafer Temperature ~o ~ F ~ C MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, townsh'ip, range) Location (address or directions) (b) Property Owner ,,'~ '/"'~"~" Mailing Address ~.O, ~oX /]2..'~...~ (c) Lending Institution ~ z~ ~~ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone: Home ~¢~'--~"":~"! Business Telephone Mail the HAA to the followina address: or: Check here"J~, if hold for pick up. List contact person and day phone number below. (e) TYPE OF RESIDENCE Single-Family~ Number of Bedrooms z./.. 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. 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 1 of 2 72-025 ~Rev 8/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,/~'-~ Telephone Address /Z4'ro ~O .~'~,~/ ~/~/?"~' ~ ,~v/~/ ,,/~7~ Date D HHS APPROVAL,~)~ [/-~ ~/~~~Da Approved ?X'~_ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 IRev 8/86) Back MU.,CtPAUTV OF A.C.ORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES s .v,c s CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROV~ OF ON-SITE SEWER AND WATER FACILITY Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include or, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner Mailin~ Address (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address _/ Telephone (e) Mail the HAA to the followinQ address: or: Check here I-'], if hold for pick up List contact person and day phone number below. TYPE OF RESIDENCE Single-Family"~ Number of Bedrooms WATER SUPPLY Individual Well'l~[. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite'~ Public [] Community [] Holding Tank [] Note: tf community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRpv 8'861 Fronf ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. / Name of Firm f Telephone .~, Address /~ ~'~/ .~F''~rL /~: $~;/T~" ~ /¢Md,~¢ Date /- Z.~"- ~' DHHS APPROVAL Approved for /~/'~,"' ~/"/) bedrooms by Date ~,pprcvc~ D~:cpprcvc~ Conditional Terms of Conditional Approval ~ ~ ~J/~/~ /'~ CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRcv 8:861 Back WELL DATA MUNICIPAUTY OF ANOrI~J:~CIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH ~.IEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL pP, OTECTIONCHECKLIST- FEBRUARY 1984 264-4744 · FEB ,. ,~ . Legal Description: ~' / RECEIVED Well Classification Well Log PresenCY~N) Total Depth ,.,~ q Sr Static Water Level Casing Height Above Ground ' 'j / Electrical Wiring in Conduit (Y/L!~ Separation Distances from Well: To Septic/Holding Tank on Lot / To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole '~"x/~ Water Sample Collected by /, Water Sample Test Results )'X~? Comments 5-~o~.~ p?cK o~-~,- ,~-'/u ~ ~'( If A, B, C, D.E.C. Approved (Y/N) Date Completed ~/~- ~/~'~ Yield Cased to ~ ?Z- Depth of Grouting / ~'-~ / Pump Set At Sanitary Seal on Casing ~r~N) Depression Around Wellhead (Y/~)~ / / ; On Adjoining Lots /~'O -/ /~),-~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot .4 Dat~,//// B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes c('~N) Depression over Tank (Y~) ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /ar'Z' To Property Line '~ ~-(-~ / To Water Main/service Line Course Size / Z J'~ No. of Compartments Air-tight Caps~;~N) Foundation Cleanout(C~N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) / To Building Foundation ~' To Disposal Field / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 . 72 026 fRcv 81861 ~Oni C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Type of System Design Length of Field ~'f~,, '¢~ Depth of Field / - Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test 1 ~/~ ,,~ . Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~ ~; / Lot To Water Main/Service Line ~ i$~ / To Stream/Pond/Lake/or Major Drainage Course / To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ ~'~?" To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area /c- ~, .¢ / Comments D. LIFT STATION Date Installed Dimensions ~-~ Size in Gallons Ma~/N) "Pump On" Level at ~-'"~"Pump Off" Level at High Water Alarm Level at /~//~--"'"'""~ Vent (Y/N) Tested for ~ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have £hecb, ed, v~rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~/UI.~ -- Date ~ ~T":~'~g'~ Company /~'~'~ J' MOA No. ~¢-~ Z'~' ReceiptNo. ~ ~')O/ ~Ol ? Dateof Payment ~ /D] /¢'~ Amount:, ~-k~:~ Page 2 of 2 72-026 fRev 81861 Back