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Home My WebLink AboutHILLSIDE PARK PUD LT 14 /~'~' MUNICIPALITY OF ANCHORAGE //~-'"~"~'~.j,,.~'~ ' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I[~,~.~ ~/} ENVIRONMEN'rAL ENGINEERING DIVISION : ~'~/11~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE D~SPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME I ~'~ -- ~ [,/ IPHONI~ MAILING ADDRESS LEGAL DESCRIPTION ,/ /~T /d LOC%TibN - ' / ~ I Manufacturer ~ / ~ ~ ~ ~o. of lines~ I Length ~ / ~ I ~o~/ ~ ~ Top of tile to finish~ gradeWidt~ '" ~ I Tgoe of crib I TALC[ TO: ~ell ~ [CI~ De~th ~ I ~ TO: Buildino foundation Absorptio~l~rea I nside length Dwelling Foundation Total I e n~,~e~ Dwelling g (~* Materil¢,...~_ Width Material Nearest Le~t line j Trench widt~ Material beneath tile ~:~4~ inches Depth [] UPGRADE NO. OF BZOOMS No. of c,~r~a~rtments Liquid c~'p t ~ PERMIT NO. Liquid capacity in gallons PERM'T NO~/0 ~(¢ DJ st a n c e ~_.~e~i n es Total ef~,~.~a~rption area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line Sewer line Septic tan k PERMIT NO, Absorpt on area(s) OTHER PI PB ATER'? : F REMARKS DATE LEGAL PERMIT NEI. DEPARTMENT ~ HEFIL]"H 8NJ:, EN',/IRONMENTBL ~--~:OTEC:TION 825 "L' STREET, ~NCHOR~GE., FIK. DD50i 264-4720 C,~-~--S I T'E SE~4EF;: PERf"~ I T 8102:66 ) HF PL I L. FINT LOCAT I ON LEGAL JRK CONST CROOKED TREE L14 HILLSIDE PARK ~._,ti CHILKRT C:T LOT =,I ~..E TYPE OF SOIL AE, z, ORF FION =,T-,TEM I TRENCH MAXIMUM NLIMBER OF BEDRUOM_, = -'-. SOIL RATING ,::S]! FT/E:R)= 6_q. 4-3:i8t 3:1000 _,QLIRRE FEEl" '-- ~ -"-n'' '-'"= ' IS: /',~O THE REQUIRED _,I~E OF THE SOIL HB=,LRFTION _-,~_,TEH LENGTH .IN FEET) I]F THE TR. ENCH THE LENGTH DIMENSION I$ THE R THE DEPTH OF ~ TREN.,H 'R PIT IS THE DISTffiNCE BETWEEN THE SLIRFffiCE OF THE GROUND ~ND THE BOTTOM OF THE E::<CffiVffiTII]N (IN FEET). q FOR TRENCHES. THERE IS NO _ET WIDTH THE GRAVEL DEF"TN IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE E,NcR~,,RTIoN <IN FEET). F~:Ei~L, I F-:'E[:, _.FZP 1 I t3 TF~II'4t<.' $ I ZET=: ~L~Zl~-Zt£1 F'ERMIT RFFLI..~NT HR=, THE RE=,FUN-",IE, ILIT~r TEl INFORM THIS DEPARTMENT DURING THE INSTALLATION INDPEL. TILN=, OF ANN' HELLS ADJACENT TO THIS PROPERTY AN[:, THE; NUMBER OF R.E_,IDENCES THAT THE WELL WILL '-~'~,'~ BRCKFILLING OF RNY ~'"A ' ',,, 'n- BY ...~'_TEM WITHOUT FINRL INSPECTION AND RFPRO,HL THIS DEPRRTMENT WILL BE :,UBJEL. T TO FRUz, ECUTImJN. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS t00 FEET FOR R PRIVATE WELL OR 150 TO 280 FEET FROM R 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 R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT .:. 1: I AM FAMILIAR W~TH 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 THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. '¢4. 0 ~_~O01<ED TF,~E L{4 H{LLCS[D[ ~ ~75. :LJL CH{I F. Rr CT LOt S[~ : OBP TH: tl-3 LEN~i TH = ~:2. 13i~A%-'EL DEP TH ~' ~'~ PERFORMED FOR: LEGAL DESCRIPTION: 1 3 6- 7- 8 9 10 13- 14 15 16 17 18- 19 2O COMMENTS PERFORMED BY: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99S01 264~472~ SOILS LOG - PERCOLATION TEST SLOPE ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFOE Reading Date ~ross NO; 1732.E June 2~, ~S~68 RU~ BE-P/NEEN PERFORMED FOR:. LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13- 14 15 16- 17- 18- 19 2O COMMENTS ~VIUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Ar, cho~age, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST SOl LS LOG PERCOLATIO TE~T DATE PE.FO.mD: /t//47'~,/o, 7, SLOPE SITE PLAN w^s G.OU.D W^TE. ENCOUNTERED? OEPTH? Gros~ Net Depth to Net Reading Date Time Time Wltlf . PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT 1240, 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: Z3 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the foil #AECC884 ,�y OF AAAC y ON-SITE TER AND z= in� sti t� t ATEl o PROGRAM f VT M SE»h��Xl� Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.doc Legal Description: Hillside Park PUD; Lot 14 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA Class A well PWSID 212461 ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above groun�`d) Date of flow test for C00 Static water le beginning of test ft. B. TANK DATA Age of tank(s) 11 years Tank type/material 'flll ste6 Parcel ID: 015-312-23 Structure served by this system Well production at time of test gp Water storage tank volume gallons Well disinfected for orm test? ER Yes ❑ No ❑ Coli acteria is Negative (trate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by _ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Measured operating fluid level in septic tank 50" Lift station material OR Standpipes/foundation cleanout per record drawing Comments - Date of pumping S dSTr "G Double c/o's before tank instead of FCO D. ABSORPTION FIELD DATA Which system tested (date installed) 2008 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.4 ft (max) Measured depth to pipe invert from grade 3.6+ ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 5.8' ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced - gallons Comments/Deficiencies: COSA Checklist yellow sheet Adequacy test date 5/21/19 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 1241 gal New depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) no If yes, enter date I- E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or it community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No *5+ Community Sewer Manhole/Cleanout >� Surface Water > 100' ❑ Yes if No ft es If No ft Neighboring Tank > 100' ❑ Yes if No ft Private Se ptic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft olding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' ft Community Wells > 200' Animal Containment > 50' ❑ Yes if No ft es if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Communi er Main > 75' ❑ Yes if No ft ] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water > 100' QQ Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' El Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Yes if No ft Wells on Adjacent Lots: Water Main > 10' [] Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water> 100' [] Yes if No ft F. ENGINEER'S COMMENTS *met code at time of installation. G. ENGINEER'S CERTIFICATION o � OF 1 certify that 1 have determined through rield inspections and review O Q of Municipal records that the above systems are in conformance with * • ' 4*j MOA COSA guidelines in effect on this date. • , , , , , , , • , , , , , , , , , • , , , �do r y�A\Gorn s•= 0 9 CE— 9 c G COSA Checklist yellow sheet `i a Quo f essioo°Q� #AECC884 Parcel I.D. # 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3, TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: ing to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- TYPE OF WASTEWATER DISPOSAL: Individual on-site NOTE: 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 -' '' ' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, Phone ~-7~ - ~ ~/l J~ ordinances, and regulations in effect on the date of this inspection. NameofFirm I:l'b~ ~v-~.~_~.(g ~-'~- Address ,,d.,.o ~ u~ /~- &--~ ~ ~_o ~ Engineer's signature '(- ~?~~. / bedrooms. DHHS SIGNATURE Y Approved for Date. Disapproved· Conditional approval for bedrooms, with the following stipulations: Additional Comments Date Z2 - 2 E~- ?~- r' \,:The MuniciPa ty of. Anchorage Department of Health and Human Services (DHHS) issues Health Authority ",.':Approval ~.,ertifiq~t~ based only upon the representations given in paragraph 5 above by an independent "pr?feSsie?alW' 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. 72~5(Rev. 1~l) Back MOA~I Municipality of Anchorage Department of Health and HUman Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L~-~ / L~ [.]r;[,t % \(::~e__. ~'~ Parcel I.D. A. Well Data Well type l~A t/ If A, B, or C, attach ADEC letter. ADEC water system number ,~! ~--~/~ / Log present (Y/N) Date completed Driller Total depth Sanitary seal (Y/N) Cased to FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Casing height Wires properly protected (Y/N) AT INSPECTION g.p.m. Septic/holding tank on lot Absorption field on lot 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: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~'A/~/ Cleanouts (Y/N) High water alarm (Y/N) Date of pumping Tank size 1 ~ Compartments Foundation cleanout (Y/N) 7 Depression (Y/N) ~//~, Alarm tested (Y/N) Pumper A~/~- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot l'~[~/~ On adjacent lots /"~'//~ Foundation TO property line ZT~) Absorption field ~ Water main/service line Surface water/drainage 1'~ I~) 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION /'"~//~ Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ~) ~ Width t Soil rating (GPD/Ft Gravel thickness System type ~--~,E~ Total depth Total absorption area Date of adequacy test Water level in absorption field before test Cleanout present (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Depression over field (Y/N) \%\ for '~ Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water On adjacent lots ~ ,/,X~ Property line To existing or abandoned system on lot Cutbank ~'"~ c, vt ~__ Water main/service line Curtain drain 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 '~'~ ~ Engineer's Name [ O~g6~ ~,,~--------I~ t ~ HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Rick Mystrom, Mayor MuniCipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 5, 1995 Mr. Tobben Spurkland 203 W. 15th Avenue, Suite 203 Anchorage, AK 99501 Subject: Waiver Request for: Lot 14, Hillside Park Subdivision Waiver Approval: # WR940070 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 4 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, Daniel J. Roth Givil ~n~ineer On-Sit~ Services kb MUNICIPALITY OF ANCHORAG~ Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR940070 PID~ 015-312-23 HA~ HA940681 Permit Date Received: 12-28-94 Legal Description: Lot 14, Hillside Park Engineer: Tobben Spurkland 203 W. 15th Avenue, Suite 203 Anchorage, AK 99501 Applicant: James Porter Waiver Requested: Absorption Field to Property Line - 4 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: X Waiver is NOT Granted: List Conditions or Reasons for above: ~/~LD £~1¥/~ Date: /-~- ~- By: Rec ~: 00551 (#641733) Amount: $115.00 Name of Reviewer Date Paid: 12-28-94 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: HAA 940681 Lot 14 Hillside Park Atto: Dan Roth Per your comments dated 12/22/94 we are submitting an application for a lot line waiver. With this additional information I hope that the HAA will be issued. Yours Tobben Spurkland P.E. December28,1994 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Lot Line Waiver Lot 14, Hillside Park December 28, 1994 Gentlemen; We request the granting of a 4 foot lot line waiver for the drainfield that was installed on this property in August 1981. The adjoining property is an undeveloped tract. The installation was inspected and approved by a Municipal Inspector in 1981 with a note "Not Recorded" where the distance to lot line should have been noted. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIWSION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 9/'! Z//~' GENERAL INFORMATION (a) Legat Description (include lot, block, subdivision, section, township, range) Lo~t I~1,~ ~{1l~I¢ ?¢tt't~ P 44 0 Location (address or directions) 71¥t (b) Applicant Name Dtc~.,~l,o Fir~ Telephone: Home 3'¢~'-,~'7/ Business P¥,,~" Applicant Address 71 ~1 ~Oo ~-v~e 7'~ /~-,,~cbor~ [-~ ¢29,5"1 ~ (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution' J~r.~' ~-~u"~-et~ (e) (f) Address Real Estate Company and Agent Address Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Familyl~l Multi-Familyl-I Number of Bedrooms '~' Other WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written con, ftrmat~on from, the State Department of Environmental Conservation attesting to the legality and status. '-" SEWAGE DISPOSAL i ~ Onsite ~ Public D Community D 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 (11/84) 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~'l~J"J'oj~ 7"~¢~n'~¢r,,[ .~e~"~-¢,~/' Telephone Address 1~30 ~cA~ ~ ~ ~cAor~ ~ ~1~ Date ~ $~ 1~ Seal Approved for './.~.~-.~::~ bedrooms b ate Approved ~ .~ ' Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Heaitl~ '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. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPAUIY OF ANCHOR~i~IECKLIST- FEBRUARY 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SEP Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) 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 Water Sample Collected by Water Sample Test Results RECEIVED 264-4720 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Y* Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) P~D ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ,~/~'/~ I Size Standpipes (Y/N) Depression over Tank (Y/N) 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 To Property Line To Water Main/Service Line 74) Course Air-tight Caps (Y/N) No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation N" 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 ~i' / ?/,~t Width of Field :~,, u Square Feet of Absorption Area Depression over Field (Y/N) N Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well N,/~. To Building Foundation I '7 ' Lot ¢~'/~(~'~ Type of System Design Length of Field 5''~ ~ Depth of Field ! o ~ Gravel Bed Thickness $ ' StandpiPes Present (y/N) Date of Last Adequacy Test To Water Main/Service Line ?o ' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments · P/ o/ab" To Property Line ~ icj To Existing or Abandoned System on ; On Adjoining Lots '~' ~'~ To Cutbank (if present) leo~ D. LIFT STATION 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. Date 9 MOA No. Signed ~'"'~ Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: Sept. 8, 212461 PWS I.D.# 1986 To Whom it May Concern: According to records on file in this office the HILLSIDE PARK S/D Water System is in compliance with the State Drinking Water Regulations Sincerely, rvisor MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 14 Hillside Park Subdivision Location (address or directions) 7141 Crooked Tree Drive Applicant Name Homequit¥ ' Telephone: Home Business Applicant Address San Mateo, California (b) (c) Applicant is (check one): Lending Institution Eli; Owner/builder []; Buyer []; Other I~explain); Sel.,ler (d) Lending Institution Westland MortgaRe Address Telephone (e) Real Estate Company and Agent Heritage Homes .r'.._Helan Address Telephone ~76-1333 (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~x Multi-Family [] Number of Bedrooms three (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 [~x 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 72-0~5 0~,84) 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 Date Engineer's Seal This office has received written confirmation from the engineer(Tobben Spurkland) regarding the conditional approval of May 15, 1985. The conditions have been corrected and the property now meets MOA requirements and is now fully approved. 'Approved for . three (33 bedrooms by Approved ×××× _ Disapproved Conditional Terms of Conditional Approval Date May 17~ 1985 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. MUNICIPALIT~ OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~ALTH DEPARTMENT OF h'EALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR h-EALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block.,~ subdivision, section,~township, Location (add.res~ or directions) (c) Appliqant .is (check one) Lending .Institution ~-~ ; Owner/builder ~--~; (d) Lending Institution Address range) Telephone (e) Real Estate Co. & Agent Telephone ~ 7~ f ~ (f) Mail the HAA to the ~ollowing address: 2. Type of Residence Single-Family~--~ Number of Bedrooms 3. Water Supply~ Individual Well[~ Multi-Family~ Other (describe) 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] 5. En~ineerin§ Firm Providin~ Inspecttons~ 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 regula- tions in effect on the date of this inspection. Name of Firm ~/~u/~,~/Co~//~/~e~'~ Telephone ~'~-5~.~ Dar e ~~_.-~ "~ 08, (ENGINEER SZ ) 6. DHEP Approval -~.c. .~',- '1:~ A~p~o. ~&- for/~{_d./ bedrooms By ~ ~ Dat'~' Approved __- Disapproved __ Conditional Te=s of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRON~NTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 AAND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. E~[PLOY~ES OF DHEF 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 264-4720r i A 1985 'T WELL DATA Well Classification C--C~/'n. iYt [ll/~' ,~ IfA, B, C, D.E.C. APproved (~N) Well Log Present (Y/N) ~. ~.~. Date Completed ~, . ~[~. Yield Total Depth ,~.~ J~. Cased to .~! ~r Depth of G routing ~'~ ~ ~' Static Water Level ~..~. Pump Set At ,~..~' Casing Height Above Ground ~, ~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ' ~J~ Depression Around Wellhead (Y/N) ~')~ Separation Distances from Well: To Septic)Holding Tank on Lot .¢.~20~ / ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot -~- 2.0~ . ; On Adjoining Lots To Nearest Public Sewer Line ~/T~'~earest P~" .~. Cleanout/Manhole __-- j~l~~::e Line on Lot_ Water Sample Collected by ~~.¢~-~ ; Date - Water Sample Test Results Comments ~_~ ' SEPTIC/HOLDING TANK DATA Date Installed ~--'~--C¢~[ Size ,~/"~¢) NO. of Compartments ~ Standpipes~N) Air-tight Caps'?N) Foundation Cleanout(~';N) Depression over Tank (Y~ Date Last Pumped :~'~7-~" Pumping/Maintenance Contract on File (Y/N) ~,~ ; for Holding Tank High-Water Alarm (Yi~ Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Hold, lng Tank: To Water-Supply Well C~l/v~'~ Ct\L/\-~ O~'~ ~' To Buitding Foundation To Property Line It~ 4- To Disposal Field ~ / To Water Main/Service Line "~"-/- To Stream, Pond, Lake, or Major Drainage Course Comments Page I of 2 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 ?'~_ _.~Jt-~ Separation Distance from Absorption Field: To Water-Supply Well ~.'brv~vvt, ,w,"'~.~ To Building Fo. undation i ~ ''/' Type of System Design Length of Field ~"~ Depth of Field / ~ ~ Gravel Bed Thickness ~"-/ Standpipes Present (Y(~ Date 0f Last Adequacy Test Lot ~' ' ;On Adjoining Lots ~_~- t'~'~+ To Water Main/Service Line ~"~-~"'+- To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course / O O~ To Driveway, Parking Area, or Vehicle Storcge Area ~ ~ / ~ To Property Line To Existing or Abandoned System on D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions J Manhole/Access (Y/N)~~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I havq cJ~eCked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 0~)__/']//__~¢Y'~ Date ,~'"--"~/(~)~__~ Company J~'F~('~ ~ MOA No. Receipt No. ~ ~ Date of Payment ~---/~_~ Amount: $ ~ . Page 2 of 2 ~ w~ 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: Addre.~s: 274-2533 pws I.D.~ ~/~ ~/~/ To Whom it May Concern: According to records on file in this office the /~u Y~ ~/~.~_z~ Water System is in compliance with the sta~e Drinking Water Regulations Sincerely, 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 MUNICIPALITY OF ANCHOEAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION MAY 17, 1985 RE: LOT 14, HILLSIDE PARK. GENTLEMEN: On May 16, 1985, Smart Excavating exposed and extended the monitoring tubes for the septic system installed on subject lot. This system prsently meets all the requirements of the Municipal Code. Yours DATE RECEIVED " INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF H~AL~'il DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~IVIRONMENTAL PROfECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION OCT 1 5 1981 Telephone 264-4720 D FI:i\/FI REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWEII~ ~A~;~tTYE~'1~ DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER i PHONE MAI L'l NG :ADDRESS PROPERTY RESIDENT (If different from ~bove) 2. BUYER PHONE MA"rr_l N G AD [~R E'~dS 3, LENDING INSTITUTION I PHONE MAI I'1 N-G'A D D R ESS 4. REALTOR/AGENT I PHONE MAILING ADDRESS STREET LOC~ATION I 6. TYPE OF RESIDENCE "' NUMBER OF~BEDROOMS [] One [] Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ~ COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~],, INDIVIDUAL/ON-SITE** /F~'/ YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTILITY (~*q- ~ 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 NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/HolOin§ Tank IAbsorption Area [Sewer Line I Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~"/APPROV ED FOR '~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) DATE BY