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HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE BLK 4 LT 3 MUNICIPALITY OF ANCHORAGE DEPARTMEN-F OF HEALTH & ENVIF~ONMENTAL PRO'FECTION ENVIRONMENTAl. ENGINEERING DIVISION 825 L Street - Anchorafle, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEiVI AND/()R WEi_L INSPECTION REPORT w~"'~'=~T'ell ,i~-~ )'T Ahsorptio ~ area DISTANCE TO' I M~ufacturer ~. / ~b~ I - : : ]" Dwelling ¢.__ ~ ~" / DISTANCE TO: O ~ ~/ Manufacturer Width Well Dwelling - - T Material Iiquid depth P[ZRMIT NO. Liquid capacity in gallons Material beneath tile Total ef{~ive~ion area 74) ~ .... Length Type of crib DISTANCE TO: Class DISTANCE 1-O: Depth PERMIT NO. Crib depth Total effective absorption a~ea Building foundation Nearest lot line Depth Driller Distance to lot line [PERMIT NO, t Building foundation Sewer line Septic tanl< /Absorption area(s) D,STANCE TO: No. of lines( Top of Iile to finish grade Width O-FHER SOIL TEST RATING 72-013 (Rev. 8) DATE LEGAL 0 0 0 © 0 0 0 0 0 0 0 ,:,~:: .... L :.E;'f'F,i'.EE'T'., FIIW:HORFiGE., F:IK. 995,:..,J. '-~ FIF:'F'L.. i CF:IF,IT F:IN'f'C~ I N[Z"i'I"E: NIE I SEN 5~:4C~ EFIE;T 4.:1. Ir~',,,'E. 995Ei4. ' .... L..OCF:Fr' I Obi MTS I [:,E ',,,' I LLF:IGE: E:,R Z VE ~: L..!EGI':IL. L 3: E', 4. HT:SZD, E: ',/':[L..L..Ffl3E S,.."D LOT SIZE 6:l. 7'Z:d. SQL)F:IF~:[~: FLEET 'r'h-'F'[E OF:: ............... S 'TF~:ENCH /z ~:~;O I L HI:::~SU[,::f..' I .[ UN :, 'r .:, 1 El"1 I ' -- ~'~1 '~':'""I'I"IUH NUHE, E:R 'iF E[:T'F'"'-H~: ...... :1. SC iL. RFIT]:NG '::~%:!. THE: F:E(~!U I RE[:' tE;Z 2'.E: OF THE SO:I:L. FIDS 3F'F::'T ! ON S'¢STEM ~ S: E::~ E: F:" T' !!'-~ ..... ',',~E~ L, ~5E ~",,~ C~ -'F ~'-~ ....... :21 ".~.. Z~: E3 t~: F:~ %,~" E~E 1 ........ ~:" E: F~ 'T Tl"fl~: I...IENCiTH D I ME:NS ]: ON ~ :E; THE LENCCFH C ~ ~',1 FEET ::' OF::' THE TRE:NC:H OR. DI";~tF:I I NF' I EL.I:'. I"HE DEF'TH OF' FI TRENCH OR F'~T IS THE D Z?FFINCE DETI.'.IEE:N THE SUIRF'FICE OF' TFIE GF;i:OI...IN[:, I::ff',l[:' THE E:O'T"f'OM OF' THE I.~:MCFI","FI"I' :[ 01",1 ( Z I",1 F'EE:T). "I'T'IEt:Z'.E ~ S NO SET P.! I [:'"FFI FOI? THE: GRr:i',,,'E:L. [:,EF'TH ]:S THE HII'-,I~MI...IM DEF'TH OF GRRVEL. BETI.,.IEEI'.,! THE OUTF'FILI.... F::'I Flhl[:, THE E',O'TTE~M OF 'TI...II~ E:XCFi',,,'FIT~OI'.,I ,:: IN FEET). F:'tEF:HIT F::ff;:'F::'LICF:IN'T' !-..ll::l~i; "!."f-IE!:J F;~%SF'i3NSIE:]:LIT'T' 'TF II'.,IF'OF~-:H THI::.:.:, [:,EF'FIF.'WI"IEi'.4T [:,l. Jl:.~ilt'.,If..'.i 'T'HI::Z I t",ISTF:IL.L.F:IT i [)tq T N'.:~ F'E .7 "1" I Oi'-,IL:~; OF:' F:Ii'.,I'-? FtEI..L'S F:ll)...TF:tCENT TO 'TH Z :5 PF:OF'EF:.':T"r' FIN[:, THE: H. I"IE [:.:'F;: OF:' Fi:E:~:.:; I [:,Ei",ICE:~; THF:IT T'HE I.'.IEIJ.... H :[ L..L. SERVE. :::::::::::::::::::::: L.L.. I I'.,IG OF F:ll".t"r' Sh"STEM ,~,.~ I T,~"IOUT F I I'.,IFIL. ]7 NSf:'ECT I O1'.,I FIN[::, :'IF'F F.: Z ','I:~L. Bh.' TH :[ :'~; I:::,EF'FIF:TME:i'.,FF M :1: LL.. BE ':2 L [:: .:rE :: T "r'E~ F'[~'OL:;E i' _ T I qN M I I'.J I HI...IH [:, :1: :STFIi'.,IC:E.'i E',E:"I"H[EEt'.I FI HELL.. Fltq[:, FIN'.r' ::I.C~C~ I:::IEET F:'Ot;: FI F'I';;:I',/'FITE I.,.t[;LL OF.' ::LSE~ "to 2t:-3c~ FEET F:Fi:L3i',t R F:'IJBL. IC kIEL.I.... [:,EF'EI'.,I[)II'.,IG IJF::'[:II'.,I THE 'I"h.'F'[E OF F::'IJE;L.. I E: I.,.IEL[ .... I'"I]:t'.,I!MLff"! [.',IS;'TFIi'.,ICE I::'t';;:OH t::1 PF:I',,,'FITE: I.,~E]...L TO F:I F'RI',,,'F:I"t"E: £SEI.,.IER L..INE I:E; 25 FEET FIi'.,I[:, 'TO F:I [::OMHUN I 'Fh.' :~:i;E].,.IE:Jf:~: L I hll:Z I E; 75 F'[EET. HIEL..L. LOG'!i; Fhq:E F:~:Ei:~::!I.I:t:F:E:I.'::, FIN[::, MU?I' DIE F.:.':ETUF..'I'.,IEI) TO 'r'HE L'.':,EF'FtRTMENT H!¥HIN ElF' THEJ I-,.IE0..L CEIHF'L. ETI 01'.,I. OTHEi]:;'. I::;:E(;!Lt :1:REHIEi'.,FF:5 MFI"r' F:IF:'PL.Y'. SF'E]31F:' Z CFIT I Oiq?, FII",I[:, COi",ISTF.:UCT I O1",1 E:, :I: FIGF;i:FIHS FIF:E r.::l',,,'FI I Lf::iE:LE 'T'O I i'.,I:.];LII;;:E; PROF'EF: I t'.,I'JSTFILLFIT :[ O1'-,t. I CEFi:'I"! F:'"r' "r'Hl:::l"l" :t.: I FIH F:'f::iMILIFIr;: HITH THE: RE6!LItF;~:EHEI',,FI"L:i F'OF..: Ii)I'.J-S:[TIZ :E;I.SI,.IEF;i:E; i:::ll'.,l[:, I.,.IELI...S A.?.'; SE"r' F::OFi:TH E',h.' THE: HLII'.JIC:IF'F:II.,..IT'¢ OF' FINCHOF.'.FIGE:, ;.T,.:: :I: H :!: L,..L., ]:I'.,I:!.~;TFiLL THE :~,;"r'STEH I I",1 FICCOFi',E'.,FII'.JCEi: 1.41 TH THE CODES. ::,:,::: .'1: Ui'.,t[:,[!.[F:S.;'T'F:II'.,Ir::, THFIT THE OI'.J-'E,I'TE ::_:;EI.,.IEF~'. :E;',r'L:;TEM HFI"r' REf.::!IJ:[F:E ENL. F31;:.'GEHI!:"JI"~T IF THE F:..:[ii::Fi; I [:, E N C E I S F:: E M 0 [:, E L E [:, T O I N C L U [:, E H O R E "r FI FII'.J 4. B E [:, R O 0 H S. FIF'F:'L I E:FII'.,IT FIl'-,l"f'O I F,IETTE: t'.,IE:: I '.YEN FIF:'F:'L I C:F:tNT RNTO I NETTE NE I SEN LOCFFI"ION HTSIDE VZI~.LIRGE E:,F.".IS,'E L. EGFIL ._,~.4H ERST 4. t STREET 99504 L3T q: £:LC:CK 4 HT=,I[E"" ) YILLFtGE LOT SIZE ~:,i, ::.q." "'~' ' cl.311FiF.'.E FEET "f"¢F'E FII::." 'qF'IIL FIE:'qqF-'F'TION .z ~ z rE. fl IS: TRENCH HFIXZP'IUH NUP1E:ER OF EE'E,I:('-'zHE = 4 SOTL F..PT]f,l~ ,C'_=;uq F'F,.."BF::::,= .... THE F:EQUZREE:, SIZE OF TFIE SOIL FIBSOF.:F'TION SYSTEH IS: THE LENGTH DIMEI'.,ISIOI',I iS THE LENGTH (IN FEET.':, OF TFIE TRENCH OF..: [:,F.:FIINFIEL. D. THE DEF'TH OF FI TF'.ENCH OR PI']" IS ']"FIE DI.STRNCE EfETNEEI'.,I THE SUF.'.FRCE OF TFIE: E:iF.'J3UNE:, FINE:, THE BOT'T'OH OF THE.' EXCRVFITION ,:.'zr.,I FEET;,. THERE IS NO SET NIDTH FOR TF:tENC:HEq. ']"FIE GF?.RVEL. E:,EPTH I2'; "FHE r,III'.,tIHUH DEPTH OF' GRFI',,,'EI~ BETklEEN THE OUTFRLL. PIPE FIND TFIE F30"I"TOH OF' THE. EXCFI',,,'FIT I ON ,:: I N FEET ;.,. F:'EEF4:I"I 11" RF'F'L I CFINT HR'.-:; THE: RE:,F _ N'_", I E, I L. I ¥-r TFI I NI'--'ORH TH I S DEF'RF.:TI"IENT E:,IJ~: I NG THE ..... I~' ...... ~F ' "" ~ II'.~STF~LLR"r'ION ]:I',I:,FE_.'IIONS OF FINY I.,.IELL':7 HE. JHL. ENT TO THI':'_, FL._FEF. r~ RI'.,IE:., THE [IU~IE,E[. OF f;.:ESIE:,ENCE':i; THFIT THE HELL HTLL :~,E:F.:',,,'E. H:[hlII"IUH E:,ISTRNC:E BETHEEN FI NELL FIND RNY ON-SITE SE[,.IRGE DISPOSAl_ SYSTEM IS &O0 FEET FOR lq PRZ',,¢FI"I"E HEL. L OR 250 TO 200 FEET FROH R F'UBLZC HELL DEF'END~NG LIF'ON THE TYPE ElF' Pt. IE:L~C: NELL HZNZHUH [:,ZSTFIHC:E FF:Ohl FI F'RZVFITE HELL TO R PR~VRTE 5EHER L. ZNE ~S 25 FEET FIND TO F'I E:OHHUI'4ZTY SEI,.IER LINE ZS '75 FEET. HEL. L LOGS RRE REQUIRED FINE:, hlUST DE RETURNED TO THE DEPRRTHENT I,I~TH~N ~:0 DRYS OF THE I,.IELL COr,IPLETZON. ¢~---~'~.% .... ; '"' "' '"'-' "'' ......... ~ AND ,::,:,NSTRU':~OI', ~Rr,1 ..qlfE:l'. RE. WIJIF:.EI1EI'41z f'lR'¢ FIF'F'L'¢. =,FE...].FIC. P1 ILF,Iz, S la~E~ ~., I CE:RTIF'Y' 'THFIT ::L: I Rh'l FFIF'IILIHF.: HITFI THE REQUIREHENTS FOR ON-SITE SENEF.:S RND 14ELLS FIS SET FORTFI BY THE HUNICIF:'RL. ITY OF." RNCHORF~GE. 2: I HILL INE;TFILL. THE SYS'T'EH IN RC:COF..'£,FtNCE NZ"FH THE CODES. 2~:: ]: UNE:,EF:STFIND THFIT THE: ON-SITE SEI.,.tEF?. S"r'STEH HR"r' RE:C!IJIF'.E ENLRRGEHENT IF' THE F:'.ES, I[:,ENCE IS F,'EHODFLED TO INCLU[:,E HORE 'r'FIRN 4 E:E[:,ROL')HS. S I GNEI::,: ..................................................................... HFFLI..PUI RNTOINE:TTE NEISEN ..,, , ...... ) ~ ) ~ DEPRF,:TP1EN '~F HERL. I'H AND EHVIF"3HMENTF ¢'E:OTEC:TION " 1- I E: L. L_ ~ ~ 4 ~:. ~Z, ~-~ ..... :~ Z "T~ ~ff~ :~ E 1.. I ~FZ l~ F' ~Z E~: I'd Z -F TYF'E OF qr'TL FiE',SORFTIFIN ~ '- --, 1,1F~;-:/IP1UH NUHE:ER OF E',EDR:C,~IflS = ~ ~OIL RF~rlNG THE F:EOI.JIF:ffC' SI:[~E CiF THE SOIl_ .FiE:SOF'F'TION S'¢SI"EM IS: THE LEHGTH DIMENSION ]:S THE LENG,I'H ,:IH FEET) OF THE TREHC:H OR DRR~HF]ELD. THE DEF'IH OK FI TRENCH OR P~T [~:; THE 0.?STFINCE E:EI'FIEEH THE SURFRC:E OF THE G~:OI..ND ~ND THE DOTTOM OF THE EXC:RV~T]ON (IN FEET). THEF:E ~c_, HO :,ET HIE:,TH FOR TRENCHE:S THE GRR'zEL DEF"rH ]S THE Id~NIMIjH C, EPTH OF GRFtVffL E:ETHEEN THE OLITFF~LL F'[F'E RHO THE EtOTTOP1 qF THE E,.-,L.H~FTJ'"~N (IN FEET) F'E~:MIT flF'F'LICFINT HFt~: THF_ RESPOi'P:;IBILIT'¢ T(:I II.,IF()RH THI~ [.E. FHF4TMEH'[ [:,I..If.;'IHCJ FHE I J:,THI_LFI IOH Ib!_J:EL.] IOHS OF F~I'-,Fr' !.,IELL.-'S, flC,.JflCENT TCI THIS PF..._I' EFT~- I'-iLIFIE:EF4 OF RES II)EHCE-q, THFIT TttE HELL HILL SEi;5/E. ........... '-I?1 '.1 IZI C~: :~: .':-, ~[ i"1 :_m-:.. p E: f---~- 'T' ]: t_q I'-.I :~:~ Fi I';i: E~ t:;.:: [!E (;:! LI _f. [:~: Ir_'--.: Elf:llZ:~'::F'I EL. I ~".~CJ [:IF' Ftf'l'T' ._, T _-, I Er1 H I THOIJT F' I HFiL ]: N':.-',PEC:T [ OJ',~ FI~",!.[) RPF'F'tOVFIL E','¢ TH ! S: [:,EF'f:IF: FMEH'F l,lI LL BE '51.1[?,.)' E C: T TO PE%hC-:ECLIT I ON. PIINIMLIM [)I:STf'it-iCE DETHEEi"I tq HEL. L Ri'.,I[;', NH'9 ON-SITE SEHRGE DISF'OSFIL S'.r'$TEr'l IS :1_00 FEET FOB: R F'F;:Ib'RTE HELL CffR 150 TO 2:00 FEET FK:OM FI F'IJE',LIC I,IEt._I_ [:,EPEI"tE:,II'a3 Lli:'Oi',I THE TYPE OF F'LIDL. IC' FIEt L. [,IINIMUH [',IL:,TFINC:E F:ROH FI F:'RI',,,'F~TE HELL TO a F:'FtlVRTF_' %EHEF: TO la COM/'ILINIT"r' 5EHE[;: LiNE I:5 75 FEET. HELL LOGS RF.:F.. F:EOLiIRE[:' Rf',!E:' HIJST E~E F.:E'TLIF,'NED TO 1-HE E:,EPF~RTMEt',IT HI-FHIH OF THE PIELL C:OMF'LETIOt',L F:EC:If.III;:EP1ENTS MFI"r' RF'PLV. 'SF'EC:IFICRTIOt'IS FIN[:' C:ONS'FR%IC:TICi/.~I,C, IF~GF.;:FIr'I~z.-FiF:E_~_~..~._.~ Cl T~tE ~7'' F' [hZ [;:-: I'-1 I "f" E-- ~-:". F' Z ['q-': E_:: :-_-4 E:, fiE:-: ~77: E.Z' I'"1 f_E: ITL-'; [4;: 7.5: I CEF:TIF"¢ THF?T ! I tiM FFIMILIFIR I,JITH THE REQLIIF.:Ei"IENT5 FOR OH-'%ITff :¢EHERS fBNC, I,IEt_LS f:IS SET FOF:TH ~',"r' THE MLINIC:IF'RLIT'r' 2' I HILL IiqSTflLL THE ?','STEM It'.! FICE:OrRC'FtNCE [,l'.fl"H THE CODES. Z I LIt4£"EF'STFIi"'J[:' THF~T TI'iff ON-SITE SE!.4EF:: S',r'STEr'I MF~h-' F:EQIJII~:E ENLF4RGEMEtIT IF THE I';:E:5[[:,E:-N([:E [% F:tEI'IOE:,ELED CONSTRUCTION TEST LRB "One Test is worth a Thousand Opinions" 2204 Cleveland Anchorage, Alaska 99503 277--0231 Performed for Legal Description: This Fomn reports: Dan Rogers Lot 3 Block 4 SOILS TEST yes Date Performed 11/9/79 Subdivision Mt. Side Village PERCOLATION TEST yes Depth Feet Soil Characteristics 10" Peat & Reddish Silt Brown Sandy Silty Gravel ,(GM) Bottom of Test Hole Bedrock ~as Ground Water Encountered No f YES, What depth? ~ading.,[ Date I Gross T~ne .I Net TLme [ Depth to H20 Net Drainage I 11/9/79_ 24 Hours i Saturation P~r~od' ' 11/10/79 I 0 Hours 4" " " " I 3.0 Hours 7" 3" I ~ ' ..... i 3.5 Hours 7 1/2" 1/2" " " " I 4.0 Hours ! 8.0" 1/2" ercolation Rate 1/2" / 30 Minute Proposed Installation: SEEPAGE PIT D~AIN FIELD Depth of Inlet Depth to Bottom~f )~C4ENTS: Bedroc~ e~countered-at ~, level']~~2'5 Pit or Trench Square feet d~a~nage area~ ~ ~requ~,.~er bedroom. ~ ~!~pa~/~ Data Certified By: Construction Test Lab ~St Performed Date : November 13, 1979 Tt~A CT A '/PE Y,'/TW i~5//° r-i~gNU, v.,/E>., 7- S Ol°£O'OL)/'yv, P00. Q~/ 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.# 6; :fz c; - I-7,). - O 1. GENERAL INFORMATION Complete legal description Lot 3; Block 4: Mountainside Villaqe Subdivision Location (site address or directions) 17741 Mountainside Village Drive Anchorage, AK Property owner Mailing address Lending agency Mailing address Warren & Toni Niesen 17741 Mountainside Village Day phone Anchoraqe, AK Day phone 345-6722 99516 Agent Jack Vandenberg / Jack White Co. Day phone 762-3113 Address 3201 "C" Street Suite 100 Anchorage, AK 99503 NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Unless otherwise requested, HAA will be held for pickup. 4 ~ NOTE: XXX Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature $ & S ENGINEERING Eagle River, Alaska 99577 DHHS SIGNATURE X Approved for ~! Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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 profess onal engineer's work. 72-025 (Rev. 1/91) Back MOA Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Health Authority Approval Checklist LegalDcscril)tion: LOT- 3 B~. ~ Parcel I.D.: A. WELL DATA Well type pR ~ v ,q r ,Z Log present ((~N) ¥~' J Total depth ]ff O If A. B. or C. attach ADEC letter. ADEC water systeln number Date contpleted G J t (~ / g' [ Cased to B~o,~o,, @ ~g Casing height (above ground) Sanitary seal (I~/N) "t' £ ,c Wires properly protected (fi)N) Date of test Static water level ~ O Well production I. 3- FROM WELl. LOG g.p.m. AT INSPECTION ! g. /o co g.p.m. WATER SAMPLE RESULTS: Coliforln 0 Date of sample: B.~tOLDING TANK DATA Date installed Foundation cleanom Date of Punlping q / '7 / q 6" C. ABSORPTION FIELD DATA Date installed 6 / ~r I / Length I/ ~ __ Width Nitrate ], (~ Other bacteria O Collected by: $ & S ENGINEERING 17034 I~aglt River Loop Road No. 204 ,.aBle River, Alaska 99577 Tank size } g. ,,c- ra Number of Conlpartmeuts ¥~ 5 Depression (Y/~) ~,-' o High water alarm (Y~ Pumper ~ q' 14~,~ ge~ Soil rating (g:p.d,/ft2or~ ~-3~'~ Systemtype D~-~ ! r' / 3 Gravel thicknesS below pipe cd __ Total del)th / Effective absorptiml area q 00 ~- Monitoring Tobe present((~J/N) 'itt .~ Depression over field (Y,(~ Dateofadequacytest ~l /19 / q $' Results ~ail) /0 4-*'.Y For ~ bedrooms Fhfid depth in absorPtion field before test (in.): ~ B hnlnediately after'~66 gal. water added (ill.): Fluid depth ,0 / ri. .(illS.) MinUtes later: ~"/~ Absorption rate = Peroxide treatment (past 12 nlonths) (Y/N) i,J ~,v 4. & ,o ~,.,,¢ If yes, give date ~- Jg~,,O~ II~$'t°[-r-T,~ I[.' ~ 7~6 ,q 'r- -- (~,~ Leo ~'J T ~ ~ 1~1'4,),,~.,1 D. LIFF STATION Date installed Size ill gallons Manhole/Access (Y/N) ~ High water alarm level at* ~ *Datum E. SEPARATION DISTANCES ?ump ofF' level at* SEPARATION DISTANCES FROM WELL ON LOT TO: loldingtank lot 7 0 0 4- on Absorption field on lot Public sewer main Sewer/septic service line /0o ~nc On adjacent lots Oil adjacent lots Public sewer manhole/clcanout Lift statioa ~v /4 SEPARATION DISTANCES FRO~HOLDING TANK ON LOT TO: Building foundation ~ ,,h. ~ .C Property line '¢~ Absorption field Water main/service liue C 0 t+ Surface water/drainage /0 o L/_ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~ t Water main/service line Surface water Curtain drain Driveway. parking/vehicle storage area / Wells on adjacent lots ] 00 / q- Property. line F. ENGINEER'S CERTIFICATION / certify that / have determined thru field inspections and review oJ'Municipal records th.~t~e~_u ~ ~,s, are in conformance with,MOA IbM guide~nes in e~kct on this date. ~-~ ~ffd ...... '~ 2}~, Engineer's Name ,, o,3 &4 F t. ~ 0 ~ ,q ~ ~~~~ ;~, ~ ~,.bt,:~,,~;.,7,,,..,., ............... ~ i, ~ ~ nOBERT C COWAN ],~ Date~ ~j~ CE-8801 ,~' ~' ' ,, ¢/... ..,..~? ~ .............................................................................................................. .... HAAFee $ ~ ~ ' ~ Waiver FeeS ' DateofPaymellt ///~7/~: Date of Paymellt Receipt Number Receipt Number Rev. 8/95 OSS: haa.wk.doc CT&E Enviro~men~el Sec'vice,, Inc. WATER L] BI,Ii~ MOUNTAINSIDE VILLAGE :;±an/ Name ~ & ~ ENGINI~ERING ;>cdered By R. C0WA~ ;~rojac5 Name UA WORK Orde~ 19704 Pr~n~ed Date 11/~2/95 ~ 17:3~ hrs. Reueived Date 11/25/9~ ~ 15:00 hfs Technical Director STEPHEN C, EDE :;ample Remarks= slaM,LB COLLECTED BY: BOB C. QC Allowable EXt. Anal 1.60 mg/L EPA '200.0 ION l0 11/21/95 se~ special I~t~u/d~lo~ AboVe %~A - ~lavail&ble See Sample R¢~arks Abov~ NA - Not ~l&lyzed ~; ~ Undetected, Reported value ~ E~a practical q~ant~flcat~on limit. I,T - Les~ TA~i~ ~ .- ~econdary dilution. GT - Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL C)F ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, sectio, n, township, range) Location (address or directions) (b) Applicant Name Applicant Address '~/~'L~'~"v/ Telephone: Home Business (c) Applicant is (check one): Lending Institution []; Owner/builder,~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms __~7~ Other WATER SUPPLY Individual Well')~2' Community [] Public [] Note: If community well system, nnust have written confirmation from the State Department of Environmental Conservation attestin9 to the legality and status, SEWAGE DISPOSAL Onsite..l~ Public [] Community [..} Holding Tank [] Note: If community well system, must have written confirmation from the State Dopartment of Environmental Conservation attesting to the regality and status. Page ] of 2 /2-025 (H¢84) ENGINEERING FIRMPROVIDINL ~SPECTIONS, TESTS, FILE SEARCH, DA', AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that rny 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 ~' ~//~' ~" Address Date Approved for ~O¢~ bedrooms b 'c/(~'.1..~¢¢~_ Date Approved ,/~'~ Disapproved Cond~h~ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state 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 (11,84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 WELL DATA Well Classification *~2/~t/'¢7-'~" Well Log Present ON) Total Depth _ ,/~0 / _ Cased to Static Water Level ~_/~ Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield /~¢'¢ ? Depth of Grouting A//dJ Pump Set At ~'~'/ Y~N Sanitary Seal on Casing ) Depression Around Wellhead (YIN)/ ;On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~/07~ ; On Adjoining Lots To Nearest Public Sewer Line ,¢'//¢ . To Nearest Public Sewer Cleanout/Manhole _ ~//,/¢ _ To Nearest Sewer Service Line on Lot . Water Sample Collected by /]-~'-4"~ 2¢, A//&-~ ; Date Water SampLe 'Test Results ~r~'7'~J~d~,¢~/~,~ ~/ Comments ~ ¢~/£,7~. ,,¢z~-d '7~-~'~' /O- B. SEPTIC/HOLDING TANK DATA Date Installed ~ Standpipes (Y~N) Air-tight Capst~l'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 /~ / To Property Line To Water Main/Service Line _ Course Size ¢7''[~' No. of Compartments Foundation Cleanout(~N) Date Last Pumped /0 A///¢' ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field _ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(1~/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ - C- Width of Field -3 / Type of System Design Length of Field //~ z / Depth of Field /~' / Gravel Bed Thickness ,~ Standpipes Present¢/N) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (Y& Results of Last Adequacy Test Separation Distance from Absorption Field: / // To Water-Supply Well To Building Foundation Lot To Water Main/Service Line '~'/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~"-~ To Cutbank (if present) Comments LIFT STATION / Size in Gallons ~ "Pump On" Level at ~ High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~ping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I hav.,e,C~ec~ed, v.~rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~(~ .,~/z~ --. Date //D Company ,/'~'4¢ 5' MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 ALASKA g[ILIIROFIm F/TAL COFITROL S RUIC S, IRE. ~ngj.eerin§ $ ~nuironm¢~tal $1u~Jcs /'~UNICiPAi~;'f OF DEPT. WARREN NEILSON SELLER-WARREN NEILSON 17741 MOUNTAIN SIDE VILLAGE DRIVE ANCHORAGE ALASKA 99516 WARREN NEILSON 17741 MOUNTAIN SIDE VILLAGE DRIVE ANCHORAGE ALASKA 99516 50674 LEGAL:MOUNTAINSIDE VILLAGE BLOCK 4 LOT 3 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-10/9/85 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 1856 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1000 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 10/9/85 . FLOW TEST ON WELL WELL FLOW DATE-10/9/85 A FLOW TEST WAS PERFORMED ON THE WELL. 252 PUMPED AT A RATE OF 1.4 GPM OVER A DURATION OF THE DRAWDOWN WAS 23.9 ~ WITH A RECOVERY TIME OF AND THE STATIC WATER LEVEL WAS 92.3 FEET. THE WELL IS ADEQUATE FOR TItlS 4 BEDROOM HOME. % ;.'¢F'Rnr~c e~O''-~' ~, GALLONS OF WATER WAS 4 HOURS. 90 MINUTES 1200 LO6sl 33rd /~u6nu¢, $ui1¢ [~, Anchoroqe, Alosko 99503 ,,(907) 561-5040 ALASKA ENVIRC)NI~CNTAL CONTROL SERVIC, INC, 1200 West 33rd Avenue, 'Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO CALCULATED BY CHECKED BY.. S C A LL~i~~_ -- OF DATE. DATE INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECT,&R , MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVlRONMIENTAL PROTECTION DEPT. OF HEALTH &  825 L Street - Anchora0a, Alaska 99501 ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE~I. DIRECTIONS: Complete all parts ou page 1. Incomplete requests will not be pracessed. Please allow ten (10) days for processing, . PHONE MAI LING ADDRESS PROPERTY RESIDENT (If different from above) PHONE MA~-LI N G ADDRESS 3,' LENDING INSTITUTION . I PHONE ' MAILING ADORESS 4. REALTOR/AGENT / PHONE J MAILING ADDRESS ~- LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] One I~ Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY [i~ INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [~' INDIVIDUAL/ON-SITE** _ I~/~' J YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] I'NDI VI DUAL/ON -SITE [~ PUBLIC UTILITY Connection Verified []Septic Tank or []Holding Tank Size: If Tank is homemade give dimensions: PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line Septic/Holding Tank Absorption Area Sewer Line INearest Lot Line §.COMMENTS Conditional approval if monies are escrowed to drill a new well if necessary, pending a satisfactory water sample analysis and an approved well log. This inspection is set for Monday, December 7, 1981 DATE ~-'~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED for a four(4) bedroom (12-1-81 per RCP over radio) ljw