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HomeMy WebLinkAboutHIGHLAND HILLS #4 BLK 2 LT 20A MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl_TH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 LStreet-Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl_ INSPECTION REPORT NAME -MAILING ADDRESS Bo'x LEGAL DESCRIPTION PHONE 1--"~ N i:.W ~WC~ -bqli UPP~RADE A-hcI4 c:i'O l o LOCATION I Wgl{ _ iL [ Ab~brPtio,~ are~ ~Liq. capacity in gallons I ........... Inside length -- Manufacturer Manufacturer Well DISTANCE TO: ............ I N NO of lines Eength of each line Total length of lines 6 -- Well ~ ~u,l~d,nfl foundat~o~ [ Dwellinl 0 wTd~T{ tMaterial Trench width _ _"~ (~.) inches NO. OF BEDROOMS PERMFF NO. No, of compartments LiquiO depth PERMIT NO. Liquid capacity in gallons Nearest lot line Total effective absolption area OTHER PIPE MATERIALS ~AST SOIL TEST RATING INSTALLER REMARKS PERMIT NO. Total effective absorption alea Nearest lot line Distance to lot line rPERMIT NO. Septic tank .ZAbsorptJo~ aaiea(s) APPROVED DATE LEGAL O&E ~INEERING & DEVE! OPIViENT CO Box 90, Davis St., Eagle River, Alaska 9u577 694-2774 or 688-2280 'lu~sell Oyster 694-2774 Performed for: Legal Description: Depth (feet) Earl Ellis SOIL LOG 688-2280 ~: ,4¢~. ¢:~¢~ ./_-.~,~ T~..~0._~-~ Mailing Address:~-----~7./~- ~7~.¢-Y ~ ZL-N}.~.L/¢.r.~ZI~._-~ b/~. ~'?~?.¢/O f Soil Characteristics 5 6 8__ r, Grg.und Water~ Encountere¢:r ,.Yes, PLOT PLAN PERC. TEST .: ~' No_v' ,:If-ye.s, what depth PmDosed InsJallation: SaeCage Pit - Drain Field~ '~ Co,.~.ments: .... WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological G GeophysicoiSurveys LOCATION OF WELL {Please complete either la, lb or lc,) I Street Address and Arco of Well Location / Feet Below . WELL. LOG f Surface Material Type Top Bottom Drilling PerlrHt No. A,D.L. NO. Town~hip NE) Re,go EE][ s [] w E][ 7. USE: ~.~J Domestic [] Public Supply EJ Industry [~] Irrigatlon ~ Rech<]rgo [] Commerlcol [] T.,t Wort [~ OIhor: 8. CASING~ [] Threaded L~ Welded j:~jNiCIP ALl'fY OF IrS. WATER ?,'ELL CONTRACTOR'S ~ERTIFtCATION; 9. FINIStt OF WELL: Backfilling _ _ .¢___ Grovel pock I0. STATIC WATER LEVEL: ft. L~ Above or ~ Below lend surfaco Date lt. PUMPING LEVEL below land surface end YIELD ~; ,/"'~._ft. after .j~z~hrs. pumpings: ~. g.p.m. ~. fl ofler hfs pumping ..... g.p m. I~.GROUTIN6 Well Grouted: [] Yes [] No Material: L~J Neat Comonl E~ Other: .......... 13. PUMP: (if available) HP ........ Length of Drop Pipe ft. capocily g p.m. 14. REMARKS: 15. Walor Temperalure __._o ~_~ F [] C This well was drilled unds( my jurisdJclior, and this report is lrue 1o the best of [ny knowledge and belief; Registered Business Name Conlracl License Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICE"S. Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage,'Alaska 99519-6650 343-4744 Parcel I.D. # O ~'"0 -- ~'?_ -- ~"4' 1, GENERAL INFORMATION · Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~: ;..; V,;.. : . . LOt 20A; Blo~ 2; Highland Hills Location (site address or directions) NHN W2~.d M~un~x'.n D~iv~. Anchorag6, AK Property owner Ron~i Ritt6r Mailing address P.O. Box 210246 Anehoragz, Lending agency Mailing address_ ; '" Agent Gre.q Erkins/ Gr6,q Erkins R~alty 3$4O'A~ctic Blvd. Suite 102= Anchorage, Ad dress Day phone AK 99521 694-6080 Day phone Day phone 562-3382 AK 99503 Unless otherwise ~'equested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well community Well Public water NOTE: If community well system, provide written confirmation fi'om 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: 72~025 (Rev, 1/91) Front MOA~21 XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system..' ; .'..~:: - ., .. ,:'..?--..: STATEMENT iOF INSPECTION BY ENGINEER ~ '~:' As certified by my seal affixed hereto and as of the validation date shown below, I verify that mY investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of AnchOrage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. , . S & S ENGINEERING Name of Firm ~ 7034 f;a_~le River Loop RolI~ NO, 204 Eagle River, Maska 995~ . Address ~ /~ / DHHS SIGNATURE / Approved.,,,, for Disapproved. Conditional approval for bedrooms. 9edrooms, with the following stipulations: Additional Comments The Municipality of AnChorage Department of Health and Human Services (DHHS)!esues 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.~atisfy certain federal and state requirements. EmplOyoee of DHHS do not conduct inspections or analyze data before'a certificate is issued. The Municipality of AnChOrage is not~ .' respOnsible for errOrs o~ Omissions in the prOfessional engineer's work. ::~ · .,. : .: : ,: , '~, · , ., . ..;;,--~: . : ,-.: ,, : , Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~¢ ?,~>/k A, Well Data .Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed -'] -~].-cl ~ '7.. Driller Cased to \ o ~ ~ Casing height Wires properly protected ~/~;~N) Well type Log present (~N) Total depth '?.~\ o ' Sanitary seal (~) '--/ I. FROM WELL LOG Date of test Static water level Well flow Pump level1 g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot \ Absorption field on lot i Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform E2) Nitrate Date of sample: ~ -~5- ¢cl ~ d_b, \o Other bacteria Collected by: %'--~ <-~ ~---/--kOr¢~, B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts {~1) High water alarm Tank size / ~-~ c:~ o Compartments '~- Foundation cleanout~N) V Depression/Y/{~) Alarm tested (Y/N) ,_L(.~ Date of pumping ot .~ \ ~ ~ ~ z.(. Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ ¢ c, To property line \C:) Surface water/drainage On adjacent lots Absorption field \¢~. L .F- Foundation Water main/service line J c:) 72-026 (,'~:,:J3)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SEPARATION DIST,~GE'F'~M LIFT STATION TO: ~ On adjacent lots Manufacturer Manhole/Access (Y/N) Surface water D. ABSORPTION FIELD DATA Date installed G ~ ~ ~ Length "7~-L,, ~ Width Total absorption area '~---L~© J~ Date of adequacy test ~ % l ~ -~>L.~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y~_~. Soil rating (GPD/Ft2) ~ ~-'~/¢ ~ System type %¢ Gravel thickness ~'- ' Total depth Cleanout present '(~) ',-/ Depression over field (Y,~ Results (~,fail) ~',~'~--~ ~ for ~ Bedrooms \ © After test 1 ~ o,,~,% ~-~Lo ~ ~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ ~ ~'~ To building foundation On adjacent lots Sudace water Curtain drain On adjacent lots \ o c~ Property line To existing or abandoned system on lot Cutbank ~1 ~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this insgection. ,/) .... Engineer's Name HAA Fee $ ~ ~O , ~'3/.~ Waiver Fee $ Date of Payment ~-~ ? ~ ? ~ Date of Payment Receipt Number *¢('2 ~" d~ ~/' ~ ) Receipt Number c'l'&E lief.// Client 8am?D ID Matrix Cllem N,ame Ordered B)' Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services ~-~-,~'~j~,~j~-~,~r~ff~~~~ LABORATORY ANALYSIS REPORT 94 4756-3 I.OT 20.4. BLK 2- I ]I(~I-II.A N'D }lULLS . WATER S & S ENOINTERJN(; WORK Order 82338 R SHAFER , Printed Dale 09/20/94 (?-~ 09:30 krs, Collected D~tc 09/15/94 ~09:00 hrs. ll.eeeived Date 09/16/9,:1 (0~ 10:00 hrs. UA Technical £)ireetor STEPHEN C. EDE --~an'-li';Tg~,~,U,~,uTs-:" '~.BBY'~'i;'~'~T~lTB;gZ:~_~-r.-L-~T~b-~-i5 ~';.;7 ............................................................. QC Allowable Ext. Anal .Paratllater V,e,qul~s Qual Units -Method Limits Dale Dalc [rd( --Pit--~a-C~ .............................. --6'5 ~5 .....'iF .... ;~ ~--~-~ ..... X~XBS']i/}~ 2~- ..... ~ ............ ~ ~ ~7i'- ~}- - * Sec Speci~d Insln~tions Above ....... UA = Lhd¢¢ail~le ** See Smnple Kenmrks Above ~ = Not ~t~l)'ze<l U = Un~t~te<~ R~o~ed vaB~ is tke pi*cti cai q~mtification limb, L'f= ~os 'Ihat D = Seco n ~ry ~ luria,. (;1'= C~'eatet 'lhall 5833 B Street. Anchorage, AK 99518-1500 --Tel: (907) 562-2343 Fax: (907) 561,5301 ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO, FLORIDA. ILLINOl!i MARYLAND Ivl=~a/ 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 20A; Block 2; Highland Hills Subdivision Location (site address or directions) Wild Mountain Drive Property owner Mailing address Lending agency Mailing address Agent Address Ronni Ritter P.O. Box 210246, Anchorge. Alaska Day phone 99521 694-6080 hm 277-5522 w~ Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 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: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOAI¢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 typeofstructureindicated herein. I furtherverifythatbased 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 Address Engineer's signature HS SIGNATURE Approved for Disapproved. Conditional 17034 Eagle River Loop Road No. 204 Phone Date ~ bedrooms. approval for bedrooms, with the following stipulations: Additional Comments By: Date 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 1/9~] Back MOA¢I21 Legal Description: A. WELL DATA Municipality of Anchorage //"~'~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ~-~\ t~C~V-/,~-~,~ Parcel I.D. If A, B, or C, attach ADEC letter. Well type ¢(Z.t-,.O,¢¢~. Log present (~N) _ ~ Total depth ¢-~.o ~ Sanitary seal'N) ADEC water system number Date completed "~ - L~ - Cased to ~O b, ~ Casing height Wires properly protected~'N) FROM WELL LOG Date of test Static water level Well flow Pump level '~-'~ O ' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot g.p.m. Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform _(~ Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed Cleanouts ,'""~ / N ) High water alarm (Y~ Date of pumping Nitrate Collected by:_ Other bacteria _ $ & $ ENGINE~[RING :FTO~14_F. agleJ~JLv_er Loop Road No. ~04 Eagle Rlver, Alaska 99577 Tank size ~ oc.~ Compartments ~- Foundation cleanout ~TN) _ V Depression (Y~::¢) ~(' . Alarm tested (Y/N) ~/.'~ ¢~ Pumper -.~,~',_ ~$~Poo ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot IC, c~ ~4- On adjacent lots ~OO ~ To property line \-c> ~ Absorption field ~, c~ ~ Surface water/drainage I c> o Foundation Water main/service line_. 72-026 (Rev. 7/9~) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Manufacturer Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/.~N~'~ SEPA~OM LIFT STATION TO: Weft'tin lot On adjacent lots .-~¢~ off" level at .~~Cy0 ~e8 tested Surface water D. ABSORPTION FIELD DATA Date installed ~ ' ~' ~' Length .~-L¢ ~ Width Total absorption area Depression over field (Y~ Results~/fail) Peroxide treatment (past 12 months) (Y~ /~'~' Soil rating ~' ~(~'¢~/ Gravel thickness ~ ~ Cleanouts present ¢~'N) Date of adequacy test ¢~0 ~/~ If yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellon lot ~,~ To building foundation On adjacent lots Surface water \ Curtain drain On adjacent lots ~"¢ Propertyline To existing or abandoned system on lot Cutbank ~31~- Water main/service line Driveway, parking/vehicle storage area E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature 17034 E:,gle River Loop Roa~ Engineer's Name Date ~ '~ '~ '~ ~-:'~ HAAFee$ /7~' ~ Date of Payment ~'-- / ~-~ ~ ? *, Receipt Number ,:~ ~ '~/--'/~ ~- ~/~ ~'-~--) Waiver Fee: $ Date of Payment Receipt Number CtIEM1CAL & GEOLOGICAL [ 4BO.,R. ATORY A DIVIgION OF COMMERCIAL TE~TING & ENGINEERING CO, 5633 ¢ StREeT Ar~C~O~AGE ALASI<A 995~8 IEL~PI-ION~ F~07', ~-~34~ FAX: ~.~L~IS ~:~q,~8 ~[ I~VOIC~ I 56774 Cbe~.l.b ~.I ~2 39?7 3a~plo ~ ~ ~: ~&~ P~ID AU~ S 92 ~ 1~50 ~UG 6 9~ ~ 13:30 BPO! ; OYdered 57 :ROGER HITRA~Z--~ ~)(O.lO) ~j/) BPA 353.2 10 i Te~ ~{orr~d ' 3.. Sp~<dal ln~r~,:~to~ Abo. g~ NA,, No~ An&lyz~d tT-5~ Tlma, ~-Oreet~r Th~n ~IUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAl. TH AND ENVIRONMENrI'AL PROTECTION DIVISION Of: ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTFIORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORI~IATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 20A Block 2 HiF~hland Hills //~1 Location (address or directions) Wild Mountain Drive Sec, 28 (b) Applicant NameJOe Fellerman Telephone: Home N_~__A. Business 2~4-3~61 Applicant Address 601 W. 5th Ave. Ancl~orage? Ak. 9~01 (c) Applicant is (check one): Lending Institution D; Owner/builder E_']; Buyer []; Other [] (explain); (d) Lending Institution _~A~]~bt~_~a ~Jtual Balnk 'lelephone .. Address __ 6~, W, 5~b._Ave (e) Real Estate Company and Agent ~_~ Address qO1 g,q5th Telephone ...... 561-13_33 (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family ~ Multi-Family [~] Number of Bedrooms __ 3 Other WATER SUPPLY Individual Well [.%~ Community [.--] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~:] Public [] Community E] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of F-nvironmental Conservation attesting to the legality and status. Page I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, I.¢ATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this IRealth 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 verily 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 /~ ¢-/',E~-____~. _ ~_ EAGLE R IVER~ Date P, 0, BOX 773294 694-5195 A roved for ~~ %be/droor~z6,J;~/ =~__~-~.~,'--~t, ~/;'~"~-¢'¢~]-,-I ky' Date ~.. '~. ~:~. ~' Co~i~di¢onal Approved ~ .... Disapprove/ '~i~_ Terms of Conditional Approval -!1 " CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP). issues Flealth Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independont professional engineer registered in the State of Alaska. The DFIEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a 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 (~ 1/84) MUNICIPALITY OF ANCftORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 -. ?, 264-4720 Legal Description: ~ o ~ DEP~ Of: HE'-- '~""~"'~ · ~urH, & RECEIVED WELL DATA Date Completed _'~/..~.5//.E.-~ ~' Yield Depth of Grouting _"'~" Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Well Classification Well Log Present (Y/N) Total Depth 'J'~/¢"" Cased to Static Water Level ~/ ' /~,6, Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding 'Yank on Lot '/'/Oo ", To Nearest Edge of Absorption Field on Lot ~/~u r,- To Nearest Public Sewer Line If A, B, C, D.E.C. Approved (Y/N) /~ I'~ "~, I (,-f*¢,.~ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ,,"~"~'~-- To Nearest Sewer Service Line on Lot ~'¢'-~ Water Sample Collected by . ~'~3 ~ ,,,3,,~-~,-, '~¥'S'~'~ ~" "'"~' ; Date ~f~'/~;" --- Water Sample Test Results '~'~ 1'~ ~ ~ '-/~',,~ --~ Comments B. SEPT-IC/HOLDI.NG TANK DATA Date Installed Standpipes (Y/N) _ Depression over Tank (Y/N) Size /~,~o Air-tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '¢',)o¢ To Property Line To Water Main/Service Line ~'/~ / ! Course ~ No. of Compartments ~/- Foundation Cleanout (Y/N) ~" Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation lo / To Disposal Field /~' / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 C. ABSORPTION FIELD DATA Soils.Rating'in Absorption Strata Date Installed Width of Field ~'¢ // Type of System Design Length of Field ~2 ~' / Depth of Field /0 / Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line ¢-/O / To Stream/Pond/Lake/or Major Drainage Course Gravel Bed Thickness '-¢- ! Standpipes Present (Y/N) Date of Last Adequacy Test ~ ,d' ¢'~ / o/,',-, ~-/¢-~,- .... To Property Line .~/~' To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Driveway. Parking Area. or Vehicle Storage Area 90" Comments Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed J~"~¢~--~ Date Company ~/8,6'; J', MOA No. ~ '7'- ~-¢ .I- Receipt No. Date of Payment / (~ Amount: $ ~:3 Page 2 of 2 72-026 (11/84) APPLI( NT I'-ILLS OU'[' UPPER HAl ONLY Property Owner Steven M. Matlin Mailing Addres'~O. gc~x 2760 Buyer Address Zip Code Zip Code Lending Institution Address Realty Co. & Agent Zip Code Zip Code "/'// /"/ Pbone Phone Legal Description Lot 20A, Blk. 2-hlgJ. and Hills #4 Street Loca_t_lon 7 ]~j ] d MOunta~ n ]]r{¥¢./_ OFF Type of Resl~nce ~;. Single Family ~- ~ Multiple F~ily No. of Bedrooms / ~ Other Water Supply ~,lndividual : 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 Ut!!lty: Bewer Disposal : , .~ilndividual Year Individual Installed: / '" [] Public Utility = , " ~ '= When Connected to P6blic Ulility: ~ " [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time -rime Time Date Date Date Date Inspector Inspector Inspector Inspector ) DISAPPROVED ) CONDITIONAL APPROVAL' 198 I;:;...- ,;:;;~:];,j Profecliorl" *CONDITIONS OF APPROVAl. Date Sewer Installed Well ro Absorption Area Well to Tank Well Log Received~/~, SeplicTankSize~ /~ /~ ~'~ 72.023 (3182) POUCH 6 650 ANC~IORAGE. ALASKA 99502-0E, 5~} (907) 264 41tl DEPARTMEN ," OF HEALTH AND ENVIRONMENTALPHOTEC]'ION September 9, 1983 Steven M. Matlin P.O. Box 2760 Anchorage, AK 99510 Subject: Lot 20A, Block 2 Highland Hills Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: o The application shows the number of bedrooms exceeds the number the on-site sewer system was originally designed for. An upgrade will be required. Prior to any upgrade, a permit needs to be issued from this department. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Sincerely, ' Jim Roberts Associate Environmental Specialist JRS0/p/E1 MUNICIPALITY OF A'4CHORAGE DEP'L OF HEAL,ii & ENVIRONMENTAL Pti ~ 1 ECT SEP RECEIVED September 14, 1983 Municipality of Anchorage Pouch 6-650 Anchorage, Alaska 99502-0650 Attention: Jim Roberts Dear Jim; The realtor who is selling my house, completed the application and submitted it. The house was built according to the original plans and specifications which called for three (3) bedrooms, two (2) full bathrooms, and a den which the realtor mistakenly called a bedroom. Please change the application accordingly. Sincerely, · n M. Marlin MUNIcIP/',,LiTy OF ANCHORAG~,z DEPT. OF HEALTil & ENVIRONMEN' T'Z~L PR'~ TECTIoi,,~ RECEIVED APPLIC FILLS OUT UPPER HAl. ONLY P~operty Owner ~F~?(~ /~) /J~ //~/~'Y////J Phone Lending Institution JJOi~ f--~~jd~'''~ j Phone ~ddress ~ ~O ~ ~ C ~ ZiP Code _ Realty Co. & A~nt Phone Address Zip Code ~treet Locati~ Type of ~i~nce ~gle Family ~ Multiple Family No. of Bedroo~ ~ Other Wa!e~upply ~ Individual ~/~ ATTACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~ PublicC°mmunitYutility ~3 ~:> ~ ~ For wells drilled prior to that date, give well depth (attach log if available). Se~er~isposal Year ~nd~vidual Installed' ~ndividual ~ Public Utility ~ - ~ When Connected to Public UtiHiy~ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector [; (;" i z, IgS~. (?)) APPROVED BEDROOMS *CONDITIONS OF APPROVAL I I D~SAPPROVED ( ) CONDITIONAL APPROVAL' DATE il- ~ Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size [ ~')~)~