Loading...
HomeMy WebLinkAboutHILLSIDE PARK PUD LT 19Hill ide par'k Lot t9 #015-312-28 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONiVIENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT IPHONE [] LIPGRADE MAILING ADDRESS L©CAT~©N Well D STANCE TO: ~ ~ I Manufacturer m ILiq. capacity in gallons I ~ DISTANCE TO: Iwell ~ ~ ¢ Manufacturer ~ % DISTANCE TO: ~ I~o of lines Iken~thofeach [ ~ngth Width ~ ~ ~ Crib diamete~-- m ] DISTANCE TO: ~ ICI~ Depth Absorption area Inside length Dwelling Dwelling W dth !Material Foundation I Nearest lot line Total length of li,pes t [Trench widt~_~ ~/-~-,~, ?'__ inches Material beneath tile Depth Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank NO, OF BEDROOMS PERMIT NO. No~ of ¢o~perr~ent$ Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance between lines Total effective absorption area PERMIT NO. PERMIT NO. Absorpt on area(s) OTHER PIPE MATERIALS SOIL TEST RATING / INSTALLER REMARKS APPROVED DATE LEGAL , DEPARTMEN! ~F HEALTH AND ENVIRONMENTA/~ROTECTION~]dh -~-~ - ,, 825 'L' STREET, ANCHORAGE, AK. 'b~501 .~,~,,,(.j PERMIT NO. ( 800297 ) ~o~A ~.:~/~ //~' ' ~ ~ "~ ~Z~ APPLICANT .TOM STEWART 8420 WILLIWAW ~]~ ~'~-~ ' ~8684~ LEGAL ~;;~ :19~';:~ ~i~]~R]~'~ ~LOT SIZE'~ ~0000 SGUARE P]EET Type o~ soil absorption system is: TRENCH ~_~b[;-~O Max&mum number o~ bedPooms 4 So~1 Paring (S~ FT/BR)= 145 ~¢~ "rhe required size of ±he soil absorption system is: Depth= 18 I,.ength= 48 Gravel Depth= 7 The length dimension is the length (in feet) of the trench or drainfield. The depth of a ±rench or' pit is the distance between the surface of the ground and the bottom of the excavation (ir, feet). Ther-e 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). F~equi red Septi c -ra~k Si z e= 1 ::;=SO Gal 1 Permit applicant has the responsibility to inform ±his department during the installation inspections of any wells adjacent to this property and the number, of residences thmt the well will serve. "TW£1 (8) I ~SF~E(iTIONS ARE REGtLIIRED 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 1S0 to 800 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 2S feet and to a community sewer line is 7S feet. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. Permit expires December !iI1 ~ 1980 I certify that 1: t am familiar' with ±he requirements for on-site sewers and wells as set forth by the Municipality o¢ Anchorage. 2: I will install the system in accordance with ±he codes. B: I understand that the on-site sewer sys±em may require enlargement i~ the residence._ is remqCeled to include more than 4 bedrooms. i.ONSTRUCT~ON TEST LAB "One Test is worth'a Thousand Opinions" 2204 Cleveland ~Anchorage, Alaska 99503 277-0231 ~rfor~ned for Tom Stewart ~gal Description: Lot 19 ]is Fomn reports: SOILS TEST__ 'Block Date Performed 6/20/80 Subdivision HILLSIDE PARK PERCOLATION TEST YES Depth Feet Soil Characteristics TAN SANDY GRAVEL TO TAN GRAVELLY SAND ~.,-Perc zone 8-10 feet rating: 145 CF/BR. 13~brown clay l~'~gravelly silty sand _----BOTTO~f6' ~s Ground Water Encountered ; YES, What depth? NO ' i, ~/19/80 saturation per~od ~/20/80 11 A.M. ~--~ f 0 5.5 0 11:15 A.M. 6/20/80 15 7 1.5 16/20/80 _~Jll:30 A.M. I 30 9 2 · 5 '4inute s · · Dep~9~~?~ Depth tO Bott~ of ~t or Trench .~,~pwmc~i~~ z ~erc rate for zone from 8-10 feet: 145 SF/BR. -- '---~ -- --~ dames st Perf~2,~v L~a~'~ Data Certi_ied By: . "~3~ Date : June 23,- 19 Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 1. GENERAL INFORMATION Complete legal description Hillside Park Lot ~q COSA # (DSC_. \\\ %'~ ~ Expiration Date: Location (site address) a. os4a-Treeline Ct., Anchorage, AK 995o7 Current Property owner(s) Debora & Vincent McClain Day phone 382-2477 Mailing address Lending agency 1OgZ~l Treeline Ct., Anchorage, AK 9q~;o7 Day phone Mailing address Real Estate Agent Keira Lestina ¢) Great Land Realty Day phone 529-/+660 Mailing Address Unlbss otherwise' requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: z+ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _A Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site ['-I [] Public Sewer E~ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Pannone Engineering Services, LLC Phone 272-8218 Address P.O. Box loo217, Anchorage, AK 9951o Engineer's Printed Name Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water ~vels that ,.maY fluctuate during the year, and the water usage of the family being served bv the svstem .~.-~ ?..~... lnese conmtions are outside the con ' - ~ - ~ %r-. .............. ,~ _ .. ...... trol of the evaluator oftNs system. All systems eventually fail and ,.~c9 -"' a .s, austactory test results ac not guarantee future performance of the system, nor do they m,arante- tho~ ~ ~'" ~ '"..× ~ mere are no hidden defects or encroachments PES ~o- *~-o-~ ............ ~ °7 ~ ~.~ .... E ."' 49~ ~ ~.~ .......... :.. .. _ ~. , · ....... .~.~ nm p~uvme any warranty tor Imure ~,,...¥,~~,,,.,,~,,,,,~ v ........... ~..~ ,,u~ g~ve any esumate o~now ~ong the system will continue to meet the operational ~,~~~.,d ;;?v~;e,~}t~e~ifatnhceeMu~OonA oDrSuDs~ oT~hlontent .o,f tNs rep?rt ~s for the sole benefit of the owner listed confe~an--le air/ "P'' nts report oy any other person or party is not authorized nor will it ~9~:t No CE 8149 _ _:~_ g grit whatsoever. '4;~2'. ' ~. DSD SIGNATURE ' ,,,?~'L" ................ ;~ ~ Approved for J"f' bedrooms Disapproved. Conditional approval for bedrooms, with the following stipulations: ,>',Ow,. ...... . -.. %. 0N-S T[ ~: '~ATERAND ~m:~ ~ ' PROGraM "":5 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date:.,,/O - /7- // Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS, APPROVAL CHECKLIST Legal Description: Hillside Park Lot ~9 Parcel ID: A. WELL DATA Well type A If A, B, or C provide PWSID # ,==24.6z Well Log (Y/N)  pleted Sanitary seal (Y/N) properly protected (Y/N) Total dept~.,, ft. Cased to ft. J Casing height (above ground) Date of test ~ ~ Static water level ~ ft. ft. Well production _J '""'""~.P.m. gpm WATER SAMPL~LTS: ~ Coliform,,,,-- colonies/100 mL Nitrate mg/L~ Ar,~c.' ug/I Date of sample: - ~d by' B. SEPTIC/HOLDING TANK DATA Tank Type/Material .. Greer Steel Date installed 81/J~98o in, Tank size .. ~2~o gal. Foundation cleanout (Y/N) Y Date of pumping C. ABSORPTION .FIELD DATA Number of Compartments Depression over tank (Y/N) N Pumper Cleanouts (Y/N) Y High water alarm (Y/N) N , Date installed Length ~8 ft. Width Total depth 9.5. ft. Eft. absorption area 672 ft2 Date of adequacy test ',o1',',12o',=. Results (Pass/Fail) Fluid depth in absorption field before test _o in. Elapsed Time: =..~o min. Final fluid depth _o in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N Soil rating (g.p.d./.ft2 or ft2/bdrm) zzr5 ft. Monitoring tube Y Pass System type Dee_~ Trench Gravel below pipe. 7 Depression over field N For _~ bedrooms Water added6oo gal. Absorption rate >= 600+ New depth_8 in. g.p.d. If yes, give date D. LI~TATION Date inst~lfte,d m size in gallons Manhole/Access (Y/N) / "PumP on'' le~ "Pump off" level at in. High water ~ Datum "'-~cles tested ~ __ Me~& circuit requirements? Septic tank/lift station on lot On adjacent lots Absorption field on lot / Public sewer main// Sewe~ice line A~m~containment areas in. '~acent lots _pub!ic-~.~ole/Holding tank .....~cleanout Manure/animal excrete ~as SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line, ',o+ Building foundation Water service line ~o+ Water main [o+ Wells on adjacent lots 200+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~o+ Surface water ~oo+ Wells on adjacent lots 200+ AbsorPtion field Surface water Property line zo+ Water Service line zo+ Curtain drain None Known COMMENTS Water main zo+ Driveway, parking/vehicle storage ~o+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R, Pannone, P.E. Date COSA Fee $. Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Pa~ent Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program ~,~/ 4700 Bragaw Street P.O. Box 196650 ~ Anchorage. AK 99519-6650 www.muni.org/onsite (907) 343-7904 ~/~JU CERTIFICATE OF ON-SITE SYSTEFIS . PPROVAL FOR A SINGLE FAHILY DWELLING Parcel I.D. ~ I ~'- D Id 1. GENERAL INFORMATION COSA# b~..O Expiration Date: ,_~. '~_ Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency . Mailing address · Real Estate Agent Mailing address HILLSIDE; PARK PUD SUBDMSION~ LOT 19 10541 TREE;LINE COURT * ANCHORAGE~ AK 99507 PATRICIA MEYER Day phone 10541 TREE;LINE COURT * ANCHORAGEf AK 99507 Day phone 346-8212 JULI£ £RICKSON w/ PRUDENT~L JACK wHrr~ Day phone 563-5500 3801 CENTE;RPOINT DR. t~200 · ANCHORAGE~ AK 99505 Unless othe~vise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval ara valid for 90 days from the date of issue for properties served by a pdvate or Class C well and may be reissued with new water samples. (Certificates may be reissued for a pedod of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 alt applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. o NameofFirm GARNESS ENGINEERING GROUP. Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide e thorough, conscientious engineering analysis of the system in accordance with ADEC end MOA DSD Guidelines & Regulations. The repealed results described the perfon'nance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate dudng the year, and the water usage of the family being sen/ed by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future peffo~nance of the system, nor do they guarantee that there ere no hidden defects or encroachments. GEG, LTD. can therefore not proWde any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content cf this report is for the solo benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not autho#zed, nor will it confer any legal dght whatsoever. DSD SIGNATURE ~ Approved for ~' . bedrooms. Disapproved. Conditional approval for .~ bedrooms, with the fllowing stipulations: Phone 337-6179 Date Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department Bulldlng Safety Division On-61te Water & Wastewater Program 4700 Bragaw Street P.O. Box 196850 Anchorage, AK 99519-6650 (9O7) 343-~g04 CERTIFICATE OF 0N-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HILLSIDE PARK PUD SUBDNISION~ LOT 19 A, WELL DATA Welltype ~lr~SS A IfA, B, orCprovidePWSID~ 212461~ ~ Date completed Sanitary saal Y~~ms properly protected (Y/N) ~ ft. Casing height (above ground) in. F OM WELL ^T NSPECT ON Dete of te, t ..-'" Static Water ~l ~ ft. / // ft. Well production g.p.m. ,,,- g.p,m. WATER SAMPLE RESULTS: Coliform coionies/lO0 mL Nlt~ mg.~. c~ onies/lO0 mi. · · . Date of sample: ~ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Tanksize 12,50 gal. Number of Comperlmente 2 Foundation clianout (Y/N) YES Depression over link (Y/N) NO Date of pumping 4/11/2007 Pumper Date inatelled 8/4./1 gS0 Cleanoute (Y/N) YES High water alarm (Y/N) N/A MCOONALDS PUMPING C. ABSORPTION FIELD DATA ~,egcow EXISTING GRADE e SUUPI Date inslilled e/4/lg8O Soil rating (g.p.dJ~o~ 145 System type Length 48 fl. Width 3 fl. Gravel below pipe ToliI depth *9.75 ff. Eft. absorption area 672 fi2 Monitoring tube**YES Date of adequacy test 4/11/2007 Results (Pass/Fall) PASS, Fluid depth in absorption field before test DRY in. Water added 706 gal. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (YiN & type) NONE KNOWN **SUMP EXTENDS ONLY 4.6 FEET INTO THE DRNNROCK TRENCH 7 ,ft. Depression over field NO For 4 bedrooms New depth DRY in. 600+ g.p.d. If yes, give date - D. UFT STATION Date installed Size in gallons Manhol~ ~ 'Pump on' level at in. "Pump off' ~~-----~Hlgh water alarm level at in. ~ ~ Meets & circuit requirements?. Cydee tested, alarm E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ~ Absorption field on lot Public sewer main Sewer/sepfi~ ~ Holding tank .:~lnment areas Manure/animal excrete storage areas On adjacent lots On adjacent lots e/cieanout Absorption field 5'+ Surface water, 100'+ Water main. 10'+ Driveway. parking/vehicle storage 10'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main 10'+ Water service line 10'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation. 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS O. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 1~' /' 7-. /~ ~' COSA Fee ~ x'7/~ 0 Date of Payment 5 - I - 0 '7 Receipt Number~Cp O '7~~) (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 03 TREELINE COURT ? .- ~_--~- .m. ;- .... ~ ~ N00°04'45"W 52,56 I ,'n :3: '~ ,,~ ~ ,- o~ ~ ° ~" -.i~g "~'~. N00"04'45'W 140.00 LOT 11B LAKEWOOD I LOT 12A HILLS SUBD. ~ ' MUNI~IPALITY OF ANCHORAGE ' ~ (,~.,~11_*~',1 .~.. Department of Health & Human Services ...... . i~//~,~ ~ DIVISION OF ENVIRONMENTAL SERVICES ,CERTIFICATE OF INSPECTION',FOR HEALTH AUTHORITY APPROVAE OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~ ~ "~~ '" HAA~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Descr pt on ( nc ude 10t block subdivision section, township, range) Mailing Address. ,, (c) Lending nstitut~on - - Telephone Telephone: (home),'~_Cf~/~_~ Business Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or checkher~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family.~ Number of bedrooms 3. WATER SUPPLY ndividual Well [] Community [] Public ~ ,,~,,.Note: f commun ty we ~system~ must gave w.r ~ten confirmat on from .the State, Department .of Environmental . Conservabon attesbng to th legahty and status. ' ' "' 4. SEWAGE DISPOSAL ' On-site~t;~ Public [] Cum ,munity [] Holding Tank [] Note: If community well system, must have writ{eh confirmation from the State Department of Environmental Conservation attesting to the legailty and status, 72-025 Rev. 7/88) Page 1 of 2 '~JOM s,Jeeu!§ue ~uo!s~eloJd eLtl U! SUOIsmLU0 ]O ~JOJJe JOJ el'q!su0dseJ lou m. e§e]oqou¥ ~o ,~1 .led. o ..... un~ eq_L 'pensm m el~oljqJeo e eJo~eq ~J~p e~z/~.., ~u~..., JO suoiio~d~d!lonpuoo lou op SHHC] ~o ~ee,~ol dLU~ '~ueuJe.qnbeJ e~m~ ou~ I~Jepe; u!~peo,~s!;~ ol JepJo u! suo!lm!l~u! Jeeu!Bue muo!s~e;oJd iuepuedepu! u~,~q e^oq~ ~ ~d~jB~.md u! ue^!§ ~uop, m, ue~eJdeJ eqj uodn ~lUO peseq i~Ao:~ddV X~!Joqlnv qll~eH sense! (sHHa) seo!^Je$ u~uJnH pue qll~eH ~o ;UeLUp~dea eB~Joqouv ~o/~l!l~d!o!unlN eq.L MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) U N i¢1PALI~ 'G,~I~'~'A..C.~ E B R U A RY 1984 I:NVIRONMENTAL SERVICES d,~i~44 Legal Description: /,/~- AUG 1 7 1990 A. WE" DATAR E C E IV E D Well Log Present (Y/N) Date Completed /Yield Total Depth Cased to. Depth of Grouting Static Water Level ____ __ Pump SetAt/// Casing Height Above Ground . - San itary~p~ °n Ca~ir~J (Y/N) ..... SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot // ; On Adjoining Lots To Nearest Edge of Absorption Field on L/ ; 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 ; Date If~B, C, D.E.C. ApproVed~l) ' Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~//y/Y'O Size Standpipes~N) Depression over Tank (Y~ /Z3'~ No. of Compartments ~'" Air-tight Caps i~) _ Foundation Cleanout~'/N) Date Last Pumped Pumping/Maintenance Contact on File (Y/N) /~.'/',,';~- for Holding Ta~gt~ H ~,Water Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) SEPA~:~I~A~ES F.OM SEPTIC/HOLDING TANK: ~""~%~L~ '"' ' z ~ .. . · ~r~,,y ~i'~.:...' '> ~-~' To Di,po,~ ,ie~ T~a[er Mai~/$e~vice Line ~ Comments' 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed <g~/?/~'g) Width of Field .2/ Square Feet of Absortion Area Depression over Field (Y~t~ Results of Last Adequacy Test Type of System Design Length of Field ~7/ Depth of Field /~ ~ Gravel Bed Thickness :2 / Statndpipes PresenL~.)N) Date 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 Comments [~ ~ ~ I.,,'~l{ To Property Line /~' To Existing or Abandoned System on ; On Adjoining Lots ..~ 2'-¢ / To Cutback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On~' Level at High Water Alarm Level at Tested for Dimensions ~ M a n h o I e/.Ac~..ess~ N"'~ ....~.~-~P~'~np Off" Level at Vent (Y/N) Meets MOA EI~/N) Comments Pumping Cycles during Adequacy Test. inspection. ~.,.. //f Signed ~ Company Date **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 MOA No. Cg~- Receipt No. Waiver Fee: $ Receipt No. Date of Payment Amount: $ Date of Payment 72-026 (Rev. 7/88} Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 August 3, 1990 STEVE COWPER, GOVERNOR 563-6775 FOR= AECS Attn: Lee Reid PWSID: %21246~ According to the records on file in this office, the Hillside Park Subdivision Lot 19 water system is in compliance with the State of Alaska Drinking Water Regulations. SinCerely, VERA E. CRAIG Environmental Field Officer VEC:pf -~ ~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME , TIME DATE DATE DATE ~r~__ _ INSPECTOR INSPECTOR ~ INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALI~ OF ANCHORAGE DEPT. OF HEALTH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT~RONMENTAL P~OTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISIONSEP 2 3 1980 Telephone 264-4720 n rPr/~ ir~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER ~ ~ PHONE PHONE PROPERTY RESIDENT (If different from above) PHONE 3. LENDING INSTITUTION .4 ~ PHONE MAILING ADD~ESS STREET LOCATION 6. TYPE OF RESIDENCE [~I~IG LE FAMILY [] MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [~0ur [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* IZ~--~ OMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. Awell log 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 [~'DIVI DUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. 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 SOILSRATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank IAbsorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS [~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY