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Home My WebLink AboutFOREST VIEW HEIGHTS LT 18 MUNICIPALITY OF ANCHORAGE DEPARTIwcNT OF HEALTH & ENVIRONMENTAL PRO/ECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPF-CTION REPORT NAME LEGAL DESCRIPTION LOCATION Well DISTANCE TO: ] IManufacturer __-) ~Liq capac ty ~ ga OhS / F HOMEMADE I Manufacturer Well ~STANC~ TO: I No. of lines I Length of each line I Top o[ tile to finish ~rade ~ Width Type of crib Crib diameter ~ Well ICl~ Depth ~~ Building foundation Absorption area D?, alii n/g I Material t W,dthTU Inside length rP,HON E NO. OFBEDROOMS PERMIT NO. No. of compartments / Liquid depth Dwelling PERMIT NO. Material Liquid capacity in gallons Nearest lot line ~NEW [~'0'PGRADE Foundation Total length of lines Trench width PERMIT NO. Distance between lines Material beneath tile Total effective absorption area inches Depth PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank PERMIT NO. IAbsorpt on area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL MUNICIPALITY OF ANCHORAGE Department ~f Health and Environmenta~ Protection 825 Street, Anchorage, AK. 9501 264-4720 * ~ ~ HANDWRITTEN PERMIT ~ ~ ~ ~erm~it ~ ~>:~ ~ A~ ON-SITE SEWER PERMIT Applicant: ~Tim ~ /~ ~Op~/~ Mailing Address: ~ Location: Phone Nu~er: .Legal Description: ~/S ~~[$~ ~& Lot Size: Type of Soil ~sorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank Maximum N~ber of Bedrooms: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH .LENGTH GRAVEL DEPTH WIDTH 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). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = t'5'~O GALLONS * * 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. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * 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 is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the re~idence is remodeled to include more that 3 bedrooms. kpp l~c ant-~ 1 Date: ////_~ /~ SWP/024 (1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2_64-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~ ~ PRONE LEGAL.DESCRiPTION// Absorption area Dwelling IMaterial lWidth NO. O F ~B~ROOMS PERMIT NO. No. of compartments Inside length Liquid depth Dwelling PERMIT NO. F°undati°~l TotalA~ng~l~O[ Ii nes "LOCATION / , | DISTANOE TO: I,- 2~ I Manufacturer ~ ILiq. capacity in gallons L IF HOMEMADE ~,-~ I DISTANCETO' I ~ ~ ~ I No. of lines / Let;geller ~h~¢ne ~ ~ width < P I Type of crib OTHER PIPE MATERIALSL~(~[ ~'"~- SOIL TEST RATING REMARKS Material beneath tile Material Nearest I Trerlch~ inches ~ inches Depth l[] NEW [~ADE Liquid capacity in gallons Distance ~?/~es Tota.,[.effective absorption area PERMIT ND. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) '!"HEi LE;NEi'I"H !;:, ]i I'"IEN'iiii ]i ON '.[ S THE L!~i!'.,JGT,~.! 'F!"lfE !;)E;!:::'TH ........... (~!1::' FI 'T'I:?[::'F,!r":I.~ f'll:;' l::'r'T'.. T';::; ']"b"[:,. ..... , ~;;~ ~ ~'..~:, :: '..! ::, ""H ~: :%r'r"-or.'~ or:~ THE 'r'HEI:RE :I;S NO :SET !,., ;f: B 'TH F'O,~: 'T'F~.Ei'.,,CH,.;:E;. ~ ,- ..... !"HE (;~iI:;;:FI'v'EL. [)t~;P"!"H ]: :E; THE: hl ;[ t",1 ;[ t','!l...ll',l DEPTH OF GF4:I::I ,,,'~;t.... E',ETHIEEN 'THE; OI.J'TF:;'~::I~Z¢.:'~:~;/~'I'~ ~ / .,1 ,,~;;~..: ,~: ,:::;::,, ,.., ",r' ,:;;;~,, ,F.::" ,r"::,, ..~::~: ,::::::" ,r~:::" '"',"-," ,r'"': .... i::'iE!:(:H];T F::I!:::'F'I.. ;I:CF::II'.4T Hl:::l:i~; q'14E I;:ESPEd'.,Ei;;[E~;[i...;[T'¢ TO ZNFORr'! TH;I:S !;:,E;PF;IRTF1ENT [:,LIt;;'. ;[ NG THE; ];I"4STF:ILI.!:~T];(;)N ];NSPECT"I;O!'.,!~; OF !:~N'.r' I.,.IE:L. LS FID.~I'!::tCEN'T 'T'EI TH):S I:::'l:;%ff:'E~;;fT'V FIND 'T'HE t'-:!LIi'IE:E:¢;: OF' ~:E:rf~; :I: [)IENCE:5 "FI.-!FIT 'THE: t,!EL.L !,.! ~ !....I... SER'v'E. t"1];N]'!"1U!'l D]:S"f'F:INE:E I:;~qE'!"HE:Ei'.,! I:::1 I.,.!E:!....t.~ FIN[:, F!!",t"r' (1) J";! -" :~[ ]i T ~i :!ii;E;I.,.l!::l(!iE :~.(!11;~1 I:;:-Eil;E'I' J:;:'l'.iil~;i'. l::'l ~;:'[;;:;[',,,'f::l"l'lJ!![ I.,.IEL.!.... O~:;['. :£(:i9 TO ;:.'..".' E~ Et FEET !:::'F;rOf'"l I:::I UPON "I"H!;~:; 'T"¢F"E OF f::'UB[.:[C NE;M... i"! :[ i",! ;[ r'l!...ll~"l [:, :[ STF!NE:IE F:'F;'.OI',I F! PI:;i'. ;[ ',,,'RTE I,.!tEL. L. TO !:::I F>~; ;[ ',,,'!::tT!!ii; S!EI,.I!fE.¢: L TO f4 COi',II',ILq'.,I;i;T'T' '_'!i;El.,.Lf.;!;i;;: L:£1'.,IE ;I:S 7'T, I::'EET'. OTH!ii:l:;;: ~;i:E(;:!LI ;!; F::E:FIEi',!T'.iii; I',1R'.¢ FIP!:::'L."r'. :~E;F't~i;E: ;[ F ~[ E:I::IT ;I. Ol",l~i]; !:::!!",ft;) E:Eff,Ei;'TRLIC T ]; O1",! D ;!; !:;:!GRF::!I"!:~!; l:::lf:~:E F:,..",,,'F:I];L.!qE',L. Ei 'r'O ]:I'.,!'J.~;I...t!:;;:E: I::'!:;;ii;)FCE~;~: ;t; E: E F;;:'T' ]: F'"~" T l'-I!::l T " :;!. ' ;l; FII"! I:::'1::11"1 ;[ L. :[ I::11:;;: I,! ;[ "I-'H THE I:~'l:{f:)l I'j' I~'1:!'1'"11:.:~'1'.,1"."':::; F:'()~: EIN'....;i!; ;I; TIE !:::'Ot:;;:'!"H ,..'? 'THE l"1 ...lt'.,I ;I; E: :I; F'I::iI.... ]; 'T"¢ ElF ;2 ' ;1; !,! i!; I....!.... :1; l",lti:i;"l'F:!l...!._ 'T'H!E :."--';'¢STEt"t .' i'.,I R(;]:[;;:O~;ii[:,I::!t",!E:I!!:; I.,] ][ TI"! "1'1-.'1!!~; ;;i!: ' ;[ LI!",E:,ERS'I"F:!I",![) THF!-!" T!"'!li!i; ON-S ;1: TE SEt.,.!E;i:~: ,:.~,~.,,:'T ::'~-. i'"!!::I'.~.' i;;:E([;!l...! t:;;:IES ;[ E:,IENE:Ii[ ;[ S i:;;li'];l"lE [)El... I:{t':, T ;"~ ;I; t",I(];:L.i...I[)E[ I'"tOF~:E 'T'HF!N ;]: f':'! I;::f F' P !.. ;[ tZ: I::1 N-" !'(1:~ "t" (].'II-:'O L. 'E; ~::[ ;[ ,3-[ //*.: SEND PARTS I AND 3 WITH CARBON INTACT PART 3 WILL BE RETURNED WITH REPLY. II II III Gross Net Depth to Net Reading Date Time Time Water Drop (minutes/inch) PERCOLATION RATE PERFORMED BY: 72-008 (6179) Jan~amy 5~ Mr. i,iiahaal Bond 1008 g. J. 2'th Avenue A~mt~ovaga, Alaska 99501 SUBJECT; Permit and Appliaation fey Sewage Disposal Sys'tam, Lot lJ, Fov~es~ Haigh'~s Subdivision Bond; June 25, 1970, you obtained a pcrmi-t from this Department fey tile inst,~lla'gion of a sewage disposal system, tls of ~his da-~c, Please ~dvise 'this Depa~,tment if you have installed~ or inDnd -to install~ a sewer syst~.nn on ~iie sui~j~ct pvopevty and wish you~ p~mi'~ k¢~p-g pending in ou~ fii~s. Sincerely, C.S. HcKechnie Envi~onman%al tiealth Aida 9ROUGH Case No. GREATL 327 Eagle St. ANCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM ~ APPLICATION & PERMIT NAME OF APPLICANT /~7¢~/ RE.$1DENCE ADDRESS .~> LEGAL DESCRIPTION, APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ///'/~ - /,~---~/,/'~, PERCOLATION TEST RESULTS _ MAILING ADDRESS./~Z'3'~ LOCATION OF INSTALLATION. , SEEPAGE PIT ~ , DRAIN FIELD PHONE NO???~ ~'/~' , OTHER ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY ttEALTH DEPARTMENT DISTANCES: , ~'~ '~,~z- ,PERMITTO INSTALLA THIS IS TO SERVE AS AS DESCRIBED BELOW. SIZE OF UNITTO RESERVED . SEPTIC TANK SIZE /~0 ~TYPE ~~,SEEPAGE AREA TYPE~~ DIAGRAM OF I certify that I am ~amiliar with the requirements o~ Greater Anchorage Area Borough Ordnance No. 28-68 and that the above described system is in accordance ;vith said code. -~r.'~ ¢7t,/~? b~¢'~&j[ L~'~'' ~"~'( ~ ~]/ /¢Y;/ APPklCANTSSIGNATURE DATE f / iP '/_o? I 7 ~ A E B. No. Prope,dd/of: I~UNICIPAUTY OF ANC~ DEFr, OF HEALTH & ENVIRONMENTAL PP, OTEC'rlON RECE!YED Subject: To: FOLD '~'' ~"J" /J SRB 196X, EAGLE RIVER, ALASKA 99577 Lot 18, Forest View Heights Health Authority Approval Susan Oswalt M.O.A.- D.H.H.S. ROBERT A. SHAFER, P.E. 694-2979 HEALTH AUTHORITY APPROVALS EXCAVATING / CIVIL ENGINEERING WORK ARRANG ED I ADEQUACY TESTS I SOIL TESTS WATER & SEWER LINES & MAIN EXT. ON SITE INSPECTIONS DATE OF MESSAGE ROUTING SYMBOL ~ May 9, 190 ____ TITLE OF ORIGINATOR Civil Engineer FOLD MESSAGE The original well on the subject property has been abandoned below grade subsequent to drilling the new well on April 9, 1990. REPLY MUNICIPAUPf OF ANCHoP-.A~ DEPT, OF HEALTH & ENVIRONMENTAL PROI~ECi-iON MAY 1 01990 RECEIVED From: DATE OF REPLY ROUTING SYMBOL SIGNATURE OF REPLIER ITITLE OF REPLIER RETAINED BY ADDRESSEE o ]] 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ~ 0 0 0 0 0 0 0 0 0 0 0 0 Z ? , .. ~.. .... . .. .~ ,~.~;,~ ....,On.SteSe~cesSecton~ ....... ~ , ~ -=,, -:,~ P.O Box 196650~ Anchorage, ,' - : "~.:;: ~ ';CER~IF CATE OF H~LTH,AUTHORI~'~ '., , :,~:' ,'.,: ~" '~ :~l?~ ~=n~;~n~,A n' ~,"~..' -~.~...~h,,-,,~i. ' ~-t{-~ ~ ~t~l~'i ............ , .... ~1~--I~1.~ ......... , ...... . . .,~..-. . .,., . _~,. :,. ~ ....... ,,:,...~?,, Comp ete ega descr pt on' L~ W /~" '.:]W~ Property owner/~/'} ~/~/~- ./~0 L/f70~'/~'~C~'~/~' Day phone "~, ~ ~z · ,~. ~ ~ i :-~ '~ ;': ~' '.' ' h '. ~. Lending a~e~o~ Mailing address : ' ' '" '':~ ' ..... .,],:,..,,,r,.::- ~ ~ ..... -...,. : Address ' ....... ~" '~ ........... ; .... , . ,.. Unless otberwlso~ requested,;HA~ ~ BEDROOMS. "2. NUMBER OF " 3, TYPE OF WATER SUPPLY .... Individual well Co,~:munitY?ell Pub lc water : ., ..... .... , ........ 1.:... ', , ~ ..... L. '":'" ']1 ~ ..... "~'" NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and statu~'of s ".i.' '"":"' ' 4. TYPE OFWASTEWATER DISPOSAL: · i' .... .' ':: ,~oldin. g t,a. nk ...... ~ . .~ ,.~,. , , ~ ..Co , ,Publcsewer "' ? NOTE:' IfCb~munity W~te~ ·attesting to · :;.. ;- 72~25 (R~. 1/91) ' Front MOA ~21 STATEME..NT,, OF INSPECTION BY~ ENGINEER As certified by,my seal affi ,,xed he, mt0 ar investigation Of this Health AuthorityApl and/or wastewater disposal s~ and type of structure indicated herein. I fur the Municipality of Anchorage ~files and from supply and/or wastewater dis ordinances, and regulations In Name idation date shg..wn below, I verify that my dication shows~ that~the o n-site water supply ~nd adequate for.the number of bedrooms:, ~ihat based on the nformation obtained'from 3 and inspection the on-site water. h all MUnicipal anc State codes, this :;i~:":~ ' "' "~'.Phone '~':'I~;E--'~::~/'.--~7 2_ . Address Engineer's si :', Date ... , ,: : 7,,'. , . '~. ~.: ,. ~ ',~ .* ~.~:.~ ...... ......... q ..................... ~.~ . ~ 1517~ ~ ' .... {'~ ~ . , e ,~.. ' A :' bedrooms,::~.,..:...:~, ?,, '.~ ,~2:?~.; ~k(~ ~ss~e~- ' t ..~. '.7 ..... · ~:.,'.,' ',' ', :¢'r ;' ,',,, ; ~':~" "~,~,~ :. ,' ' .. ' Dlsappro"ed.~ :' "~"~':"'" ........ '";':"':";' .......... : ..... ~'~ ": ......... :' ' '" ' Oonditional approval tar ':~':?~::~' '~' b~droom~ ~with the follow ng sbpulabons:., ~'.' '~ ~ ~ - ;',~ ~./; ;;2.. . -r '. '~ , -' The Munlctpalit~ of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Cartificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does th s as a ecu rtesy to purchasers of I~omes and their lending Institutions In crder to satisfy certain federal and state requirements. Em ployees of DHHS do not r ana ze data beforea certificate s ssued .T,h,,? Municipality of Anchorage is not conduct nspections o y ...,, ,, resnons b e for errors or om~ss ons ~n the professiona ,gng!,q,eer's.~,or~k, ~.. 72-025 [Rev. 1/91) B,sck MOA ~1 -- 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. # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) -' "' Prol~'rty owner .]V~ C~/I/J ~ .~ '":'Mailing~ddm~ '~~ [ ~//% .~/~ ,,'. ~ Lending agency Da~/phone '.:~. Mailing address . : :'; .. ','~'..Agent. ' 'r -:.:..?:_;. ' '-C -Add'r%S ""' ...... '" ' ' '' ' , :-- ' ....... .... - .. :'- :.,:": Unless othe~/se requested, H~ will be held.fdr ¢icku~ - -'. ':: ~'.: ' ~ :-', .:-,"-, .' .... . k~ L 'h -" ' ':'"'-' '~ .'~'~%':.~."./~'.,~ ,!:'. .:..,:-.-..:. ......... ~ :. - · ~. /[ . , '- . .: . ' ~" ;.. .: '- _ , ,"' ~--~'F ~ ~' - Pub owater - NOTE: If commum~ well system, prowde wri~en confirmation from Statff~EO , , ... mg to the legah~ and status of system ' ...... 4, ~PE OF WASTEWATER DISPOSAL: "- ":-' C.';;: -: Individua on-site . . Holding tank . .. _ : Communi~ on-site" Public sewer -,. ,. " community'w r'sYstO~ P~O o w °n NOTE: If astewate , vid ri~en confirmati attesting to the legality and status of system. 72-025 (Re~. 1/91) Front MOA#21 ' ' ':'~' ' -' verify that my As certified' by my seal affixed h~'reto and as of the validation date shown below, I~ : ..... 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 inves.ti_gation 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 ~ Engineer, s signatu/e.~,.'..~_+Lh'~ '~..~.~<~f~ Date -/~--~..~~ 5. STATEMENT. OF INspEcTiON BY ENGINEER DHHS SIGNATURE .;-.~:: ...... . ........... . bc~:lrooms, 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 ~ot . .~ ...... .. :.'?' responsible for errors or omissions in the professional eng needs work. 72-025 (R~v. 1/91 } Beck MOA Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descr pt on/--. ~-/- / ~/ /~'r/?.~,Jr- 0[C~'//6-7]~.~l~arcel I.D. A. Well Data '0~; Well type ,/ t b o/7' 7_ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) ~/" Date completed ~---~--~ ariller~/~Y Totaldepth /, _//~ / ~;-'~. Casedto /() ] Casing height Sanitary seal (Y/N) y FROM WELL LOG Static water level We,, f,ow Pump level1 SEPARATION DISTANCES FROM WELL TO: / Septic/holding tank on lot / L/? '7 Absorption field on lot_ / ~' ~? / (~-/' i Public sewermain /~/~ / (7& ~ Sewer service line ~7¢'¢;-¢ / ('¢") Wires properly protected (Y/N) AT INSPECTION g.p.m. ~ ;On adjacent lots ; On adjacent lots Petrole, m tan WATER SAMPLE RESULTS: Coliform ~/'~ Nitrate Date of sample. 7~'~'~h ~ )~_~ Collected by: ..-~ .~ Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ///~2-" / :} (' Tank size Cleanouts (Y/N) ~ Foundation cleanout (Y/N) High water alarm (Y/N) ~ / Alarm tested (Y/N) Date of pumping _j._~o ~?? ¢"~, / ~'~ -~' ,~-_~. 7 ?~Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / Well(s) on lot /¢_2 / To property line Sudace water/drainage On adjacent lots Absorption field Compartments Depression (Y/N) Foundation .- Water main/service line ~/~ 72-026 (3/g3)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm levo~"~ Meets MOA electrical codes (~Y)--~-_~ SEPARATION ~E-FROM LIFT STATION TO: Well on !9,t.j On adjacent lots Manufacturer Manhole/Access (Y/N) ....... Pump off" Level at Cycles tested Sudace water D. ABSORPTION FIELD DATA Date installed /(~ '--'7~--~(~'" - ~/ Soilrating (GPD/FF) / '.~_~, Systemtype ~ ~ ' // Totaldepth Length ~'p, ~ Width ',~('~ Gravel thickness ~_-"?-~ ?---~ / Total absorption area ._- / (, / Cleanout present (Y/N) Date of adequacy test'~-~:~:~ ~' ) F,.__~ Results (pass/fail) { Water level in absorption field before test ~, - ~.~ Peroxide treatment (past 12 months) (Y/N) ,~) qU/'/ _~- Depression over field (Y/N) for . ~ After test ~--' ~ / If yes, give date Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /' ~}~ / ('~), On adjacent lots / ~'~? / ~'-/~ ~ Property line To building foundation --'~ ~'~'//~-/: ! To existing or abandoned system on lot On adjacent lots ~(~'? L~ ) Sudace water !!~/~ ~!/,? ~% Curtain drain /~/' (~J/ ~ Cutbank ~ ~',://~ Water main/service line Driveway. parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. :~*~:~:...:~ , ~ :. H~ Fee $ ~¢L). ¢/U Waiver Fee $ Date of Payme~ P - Date of Payment Receipt Num~r ~,~ ~ ~ ~/ ) Receipt Number I?ick Mystlom. Mayor Mtuficipality of Anchor ¢ Department of Health and Human Services 825 "L" Slreet P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 February 22,1995 Mr. James Sizemore James Sizemore & Associates 6410 Switzerland Drive Anchorage, AK 99516 Subject: Waiver Request for: Lot 18, Forest View Heights Waiver Approval: # WR950007 Dear Mr. Spurkland: Your request for waiver(s) of the required 10 foot horizontal separation of a septic system to a lot line has been approved. The approved separation distance(s) are: Absorption Field to Property Line 5 feet This waiver approval applies to the absorption field to property line separation only. Any future upgrades to either will require all separation distances be met or another approval be obtained from this department. Sincerely, Robert W. Robinson Civil Engineer On-Site Services kb WR~ WR950007 Date Received: Legal Description: Engineer: MUNICIPALITY OF ANCHORAG~ Department of Health and Human Services On-site Services Section Waiver Review Worksheet PID# 014-141-25 HA% HA9500~5 Permit 2-22-95 Lot 18, Forest View Heights James Sizemore & Assoc. 6410 Switzerland Drive Anchorage, AK 99516 Applicant: Waiver Requested: Mr. Kounovsky 5' to south lot line Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: None 2. Special Conditions: - N/A 3. Other: Waiver is Granted: X Waiver is NOT Granted: List Conditions or Reasons for above: The lot line encroachment will have no detrimental effect on the on-site disposal or well sites or the adjoining lot. Date: 2/22/95 By: ~me of Revib, wer Rec #: 00781 Amount: $ 115.00 Date Paid: 2/22/95 James Sizemore & Associates Civil Engineers & Surveyors 6410 Switzerland Drive (907) 345-1572 Anchorage, AK 995116 Feb. 21, 1995 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section Lot Line Separation Distance Waiver Request Dear Mr. Robinson I am requesting a waivor of the required lot line separation distance of 10 ft. for and existing deep trench absorption field located on Lot 18, Forest View Heights Subdivision. Evidently when the existing trench, which was a replacement or upgrade of the original system constructed on the lot, was constructed in 1981, the end of the trench encroached on the 10 ft. lot line separation. I failedto pick this up when reviewing the micro-fisch files. Enclosed are prints of photo's taken on Feb. 21, 1995 showing a view of the property immediately South of the end of the trench. The childrens swings indicate no adverse impacts due to the encroachment. Since the system is operatin9 satisfactorily, and since the current owners bought the home with the system in place in 1990 andmade no modification to the system, I feel that a waiver of this separation distance is justified. Sincerely yours. James F. Sizemore P.E. CT&E Ref.~ Client Sample ID Matrix CT&E Environmental Services Inc. Laboratory Division ~`~`~`~j~`~`~`~`~j~f~jf~jjjj~fJ~~ 95.0510-1 L18 FOREST VIEW HEi~orator¥ Analysis Reporl: WATER Client Name JA~4ES SIZEMORE & ASSOCIATES WORK Order 12484 Ordered By Printed Date 02/09/95 ~ 16:28 hrs. Project Name Collected Date 02/06/95 ~ hrs. Project~ Received Date 02/06/95 ~ 14:30 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: SAMPLE COLLECTED BY: UA. QC Allowable Ext. .Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 300.0 iON 1.0 02/07/95 MCE See Special Instructions A~bove UA = Unavailable See Sample Remarks Above NA = Not ~-nalyzed Undetected, Reported value is the practical ~uantification limit. LT = Less Than Secondary dilution. GT Greater Than 200 W. ~0~e~ D~ive, Ancho~8§e, AK 9961 8-1 605 -- Iel~ (907) 562-2343 g@×: (907) 561-5301 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. fi: CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOE:: SINGLE FAMILY DWELLING / ¢ -- /5/-/-,.~...9"' HAA # /~/¢ ~0 ¢' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 18; Forest View Heights Location (address or directions) 7229 Lewis Place Anchorage, Ak. 99517 (b) Property owner Kevin Ramsdell Mailing Address Telephone '(home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here,i;~X if hold for pick up.) List contact person and day phone number below: $ & .5 ENGINEERING 17034 g-.u~i,¥~, Lc, vp R~.d N~. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family~D( Number of bedrooms 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 ID( 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 8 ~o ~ e6ed ')po~ s,Jaeu!bua leUO!SSe~OJd eq] u! suo!ss] u JO JO sJoJJe JO~ elq !suodsaJ ~ou s] eSeJoqouv ~o/q!led!o! unF~ eqJ_ 'penss! s! aleoy!lJao e eJo~eq e]ep eZXleUe Jo suoRoadsu!~onpuoo~ou oPSHHQ ~osaeAoldLu:a's~UeLUeJ!nbaJ e~e~spueleJep@~ u!e]J@oX~s!~solJepJou!suoRn~Rsu[ bu!pua[ J!aq] pue s@uJoq ~o sJeseqoJnd o~ Asa]Jnoo e se s!q~ saop SHHQ aql 'e)tSelV Io ale,S eq~ u! paJe~s!baJ ~eeu!bue leUO!SSe~oJd ~uapuadapu! ue Xq e^oqe ~ qde~BeJed u! ua^j6 suoRe~ueseJdeJ ~q] uodn AlUO peseq le^oJddv ,~]!Joq~nv q~leaH sanss! (SHN(]) seo!^JaS ueuJnH pue q~leaH ~o ]uetu~Jeda(] a~eJoqouv lo X]!led!o!unlAI eqJ_ leUO!]!puoo le^oJddv leUO!~lpuoo ;o SLUJa± pe^o]ddeslC] ~, pe^o]ddv Xq SLUOOJpa!~JO; pe^oJddv 'lYAOUdd¥ SHHO '9 LLE66 ~alSel¥ '~^!~1 el6e~l e]eC] euoqdale± i~'I,~ 'oN peon{ doo1 .m,.,ja ~lt}~] 9NIa~t~NIgN~t S ~' $ sseJppv w~!d,to eweN 'uoRoedsu! s!ql jo elep eql uo loe;;e u! suo!lelneeJ pue 'seoueu!p~o 'sepoo elel$ pue led!oiunlAl lie q~!/~ eoUe!ldUJoo u! s! uJe~s,~s lesods!p ~ele~e~se~ Jo/pue,~lddns Je~e~ el!s-uo eq~ 'uoRoedsu! pue uo!leBi~se^u! XuJ LUO~; pue salY eSeJoqouv ~o /q!ledio!unF,~ eq~ LUOJI peu!e~qo UOReLUJO~U! eq~ uo peseq ~eq~,~jpe^ ~aq),Jn~ I 'u!eJeq pe~eo!pu! eJnionJis ~o edX~, pue swoo~peq lo ~eqLunu eq~ ~o; e~enbepe pueleuo!~ounj 'e~es s! LUe~SXS lesods!p ~ele~eise~ ~o/pue Xlddns ~e~e~ e~!s-uo eq~ ~eq~ s~oqs le^oJddv X~!Joq~nv q~leeH s!q~ jo uoRe6p, se^u! Xbu leql/~lpe^ I '~oleq u~oqs e~ep uoRep!le^ eq~ ~o se pue oleJeq pax!~je leas ,~w/,q pew~Jeo sV NOI.L¥1NI:tO:INI aNY V.LVa 'HOI:I¥~S B'll:l 'S.LS].L 'SNOI.I.O~ldSNI DNIQIAOUd INUt-I !DNII:I]~NIIDN':I '§ MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) NIciPALHY 6~H~,J~ ISClr~- FEB R UAR Y 1984 ENVI ONMENTAL SERVICES DIV~4,~'~4744 Legal Description: Z-~ .'~ A. WELL DATA Well Classification _ Well Lo9 Present (Y/N) _ 4~ Total Depth /01 Cased to /el Static Water Level Z-it ~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Date Completed /m/ Depth of Grouting RECEIVED ..~ ,' ,J~, !~. .~'~'4. Mt /~i If A, B, C, D.E.C. Approved (Y/N) /k) h Yield ~, ~ Pump Set At C~/'~' Sanitary Seal on Oasing (Y/N) Depression Around Wellhead (Y/N) A.) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot [ OrO *'/- To Nearest Edge of Absorption Field on Lot [ (20'"F ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Line ./~ ~- To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~ ~ "~ Water Sample Collected by ,~ ~' ~ ~__~4',J~ i~r~dfi;Date Water Sample Test Results .~/~1 t ' --,~ '/~"~ Comments B, SEPTIC/HOLDING TANK DATA Date Installed i//~z; -?! Size Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: / '~ %'-0 bTc,~Jo, of Compartments t1 Foundation Cleanout (Y/N) Date Last Pumped ~'-'-~ ;for Temporary Holding Tank Permit (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line To Building Foundation ..~ ~ -~ 'Fo Disposal Field ~' To Stream, Pond, Lake or Major Drainage Course Comments ~ ~9 .~.t'r' P~9/~A. ?~r~ b~ 72*026 (Rev 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ! 6) - ,2_ ~ Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ¢/C~/~ Type of System Design ! Length of Field ~ -~ Depth of Field / ~', Gravel Bed Thickness ,~ Statndpipes Present (Y/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ! OO JF To Building Foundation ,._~O Lot To Water Main/Service Line / O / fi-- To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area / To Property Line / (P To Existing or Abandoned System on ; On Adjoining Lots ~ O ~ To Cutback (if present) /,~//'or Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at ~'~ ~/'~%~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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 Company Date MOA No. Eagle ~iver, ~la~a 99577 Receipt No. Date of Payment Amount: $ 72-026 (Rev 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 BSTREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order ~ 21374 Date Report Printed: M~Y 1 90 @ 11:45 Client Sample ID:L18, FORREST VIEW HEIGHTS PWSID :UA Collected APR 26 90 ~ 15:00 [us, Received APR 27 90 @ 15:30 lus. Preserved with :AS REQUIRED Analysis Completed :APR 30 90 Laboratory Supe~v~or_~EPHEN C. EDE ReleasedRy : ~~ ~.~-~ Client Name : S & S ENGR Client Aect : SNSENGP P.O.~ HONE RECEIVED Req ~ Ordered By : R. SHAFER Send gepozts to: l)S & S ENGR 2) Special Instruct: Chemlab gel ~: 901113 Lab Smpl ID: I Matrix: WATER Allowable Parameter Tested Result Units Method Limits NITRATE-N 0.33 mg/1 EPA 353.2 i0 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY RDJ, i Tests Performed ' See Special Instructions Above UA=Unavailable ND= None Detected "Sss Sample Remarks Above NA~ Not Analyzed LT-tess Than, GT=Groator Than APPLIC NT FILLS OUT UPPER HA[ ONLY Property Owner k~'~/'..~c~¢../~/ 2~,~()'/.)~.~/~ /' Phone Address Zip Code 7 Lending Institution .,.:. _. _... ,_ ? ........ ~..,/ Realty Co. & Agent Legal Description /-/>Z' /~ '?~)/"wC?::-~ Type of Besl~nce ~lngle Family ~ Multiple Family No. of Bedrooms ~ Other Phone Phone Water Supply .~ndividual ATTACH WELL LOG, A well Icg is required for all wells drilled since June 1975, [] Community For wells drilled prior to that date, give well depth (attach Icg if available). [] Public Utility Sew~er~isposal .~' ..~'~lndlvidual Year Individual Inslalled: [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Date Inspector Time Date Inspector Field Notes: Time Date inspector Time Date Inspector ~AUNICIPALITY OF ANCHORAC~b C~ i!~ iTTM ,~, .. :', 0 "~ RECEIVLD )APPROVED BEDROOMS DISAPPROVED ) CONDITIOi~AL AP/ff~OVAL' *CONDITIONS OF APPROVAL Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 72 023 ALASKA 8DUIBOFIm~FITAL COFITROL $~RUIC~$, IFIC. ~' MUNICIPALITY OF Ah.ICHORAGE D~ )' ( .... , T : ~ FNVI,R ), 4,' i, ,' ; ]'-lION R~C~V~O 1220 Wesl 25th ~ucnue '. ~nchoro§¢, J~lask(J 99503 ,~ (907) 276-1361 Time Date MUNICIPALITY OF ANCHORAGE DEPARTMP OF HEALTH AND ENVIRONMEN'~ *ROTECTION 82~5- L Street, Anchorage, Alas .... 99501 279-2511, ex, t,. 224 or 225 ~2. Time ~~'~ [ ~%~:~, Time REQUEST FOR APPROVAL OF INDIVIDUAL SEWER ~D WATER FACILITIES Lending Institution Request: Alaska Statebank Mailing Address: 310 East Northern Lights Blve. Phone: 279-3361 2. Property Owner: M.W. Bond Mailing Address: 7231 Lewis Road 99507 Phone: 272-0571/realty 3. Legal Description: Lot 18 Forest View }{eights Subdivision 4: Single Family Residence: ~ ) Number of Bedrooms: 3 Multipie Family Residence: ( ) Number of Bedrooms: Well System: Permit ~ Construction Individual well (~ Co_.mmunlty/Publ~c Syskem ( ) Depth of Well Well Log on File ( ) Bacterial Analysis System: On-site System (x) Public Utility ( ) Septic Tank Size ~~ ~ Manufacturer ~'b'~/~J~$~' Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES I,,',UNICIPALITY OF ANCP''~, '.(~L: I)EPI', O!: i iS/\:.fH ,: 1. Type of Inspection: CMRO VA_ FHA CONV ~( 2. Property Owner: ]vJw Bond Mailing Address: 7231 Lewis Road Anch. Day Phone:_212-(~571 (Rea.1 ~¥) 3. Name of Buyer:J_im K. TopolskJ Mailing Address:_232 Nc~,~.h T~.? n~ Day Phone:_272-b.b,/~.! z 49 4. Name of Lending Institution:Alaska Mailing Address:_.PO Box 2/+0 Aneh. Ak. Phone: 279-76~7 5. Name of Realtor or Agent:_Kurt: H. Knecht (Tot~.m Realty) Mailing Address: 72/+ E. 15th Ave. 99501 Phone:_2??.-3361 6. Legal Description: Lot 18 Forest View HeJ.~hts s/d Location: Forest View H~iEhts 7. Type of Facility to be Inspected; Residenoe 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 No.~drms. 3 Individual. 1 Individual (on-site)_~_ 72-003(3/76) Page Two Department of Health and Environmental Protection Request for Approval of Indivi_dual Stawer and Water_' Legal Description: Lot 18 Forest View Heights Subdivision Comments: Affadavit Attached: ) Disapprove~: Da~e: Letter Attached Department Worksheet: ,I~EATEIt gNO. iORgGE N~g 3OP, OUGI4 ,~: ~CHORAGE, ALASKA 99501 INDIVIDUAL SEWAGE ~qD WATER FACILITIES Approval Requested By Address Phone . 1// :-; tl 2. Property Owner ,~X:? /T,'/:l({, Phone 4, Typ~ of Facility L-"' 2 / '- Number of B~drooms Well Data: B. Depth C. Size D. Construction Sewage Disposal System: Septic '£ank (If homemade, show diagram on back) 3. Manufacturer 4. Installer Approval Request for S ~ ~ Water Facilities Page Two B, Seepage Pit 1. Size C. _Disposal Field 1. Number o£ Lines : 2. Total Length 7. Required Measure~ents A, Well to Septic Tank B.. Well to Seepage Pit C. Well to Se~er Line D. Well to Property Line E. l'1ell to Other Possible Conta.tination F. Foundation to Septic Tank G. Foundation to Seepage Pit H. Seepage Pit to Property Line 8. CO~MENTS: DISAPPROVED: DATE: APPROVAL VALID FOIl ONE YEAR FRO~I DATE SIGNED, GREATER ANCHORAGE AREA BOROUGH HEALTH DEPAR'INENT EDll70 FHA Form 2573 Form Approved Rev. July ~95B FEDERAL HOUSING ADMINISTRATION Budge~ Bureau No. 63-R296.8 HEALTH AUTHORITY APPROVAL IND"VIDUAL ~A/ATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFFICE MORTGAGEE SERIAL NO. ~ _ [ Alaska ~tuaZ savings ~nk GhOUl MORTGAGOR OR SPONSOR PROPERTY ADDRESS Michael Bond [ 720~ Lm~is Place SUBDIVISION NAME Forest View Heights Subdivision OCK NO. LOT ~). TOTAL NUMBERI LIVING UNITS BEDROOMS BATHS 2% BASEMENT ~Yes E]No ] New installatioo WATER SUPPLY BY: Community system Can a/tlc or other area be mode Into additional bedrooms? (If Yes, how rnony~) SYSTiM DESIGNED FOR ~o. o~ ~D~S~ o^,~xo~ D,S,OS^~ Individual [~] Public system SEWAGE DISPOSAL BY: I [E~] Yes [X~ No [] Public system [] Community system X~I [ndMdual I ~ PART II.---TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [] County ~ Local Department of Health that this individual water-supply system ['~ is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [--'] County tern with proper maintenance: [~--] Can be expected to function satisfactorily, and is not likely to create an insaoitary condition [] Local Department of Health that this individual selvage-disposal sys- []Cannot be expected to function satisfactorily NOTE: The health aufl~orlty should complete the appropriate opinion statement above end affix date, signature and title in the spaces provided. Use of the above grid for Health Department Inspector's sketch os well as use of the back of tbls form is at the option of the health authority. PART III.~FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER; I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the Individual water-supply system be considered [] Acceptable E~ Not Acceptable Sewa/ke disposal be considered [] Acceptable [--] Not Acceptable, DATE '~SIGNATURE HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM [---I CHIEF ARCHITECT [] DEPUTY. FOR CHIEF A~RCHITE~C[.~ FHA Form 2573 R~v. July 1958