HomeMy WebLinkAboutHILLSIDE PARK PUD LT 30r
OTHER
P,P.V.C
1 5u
AbZe ~Xe~Va~ ~n~ ...........
and .~e~l or excoodl ali
r~ul~o~n~-o~ the
Ihkll ~ i-GAL
Kinney R. Baxtuc 11/12/80
PERMIT NO.
DEPARTMENT Q~EALTH 8ND ENVIRONMENTBL 8~,~TECTION
825 'L STREET, RNCHORRGE, 8K.
264-4728
,Dr-~ ....... SITE SEI4E~: F'ERf. I I
( 800655 )
RPPLICRNT
LOCRTION
L. EGRL
GRERT RLRSKR CONSTRUCTI
CROOKED TREE
2510 E.
TUDOR RD
LOT SIZE
279-78it
28000 SQURRE FEET
TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH
MRXIMUM NUMBER OF BEDROOMS = 5
SOIL RRTING (SQ FT?BR)= 150
THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS:
-[:,. EP TH = H;--)~ I,, EI'-~ GTH= 47 (]iR R %.' F---- [_ DEPTH= 8
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD.
THE DEPTH OF 8 TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE
GROUND RND 'THE BOTTOM OF THE E~CRV8TION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRRVEL DEPTH I_ THE MINIMUM DEPTH OF GR8VEL BETWEEN THE OUTFRLL PIPE
RND THE BOTTOM OF THE EXCRVRTION (IN FEET).
RE,;.~L~ I F~:E[:. SEPT I ~5.- T,]t'-.~--: S I ~E= :;1_50~-Z~ -' Fl - .=
F'ERMIT RPPLICRNT HRS THE RE_-,P]N=IBILITY TO INFLRM THIS DEPRRTMENT DURING THE
INSTI-qL. LRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE
NUMBER OF RESIDENCES THRT THE WELL WILL SERVE.
Tt40 (2) I ~-~SPE,]TIE, r-~S R~:E ~:EC4LlIREC.
BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS
DEPRRTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTRNCE BETWEEN R WELL RND ANY ON-SITE SEWRGE DISPOSRL SYSTEM IS
· 00 FEET FOR 8 PRIVRTE WELL OR ~50 TO 200 FEET FROM ~ PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND
TO R COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE
RVRILRBLE TO INSURE PROPER INST8LL8TION.
F'EF-:I'4 ][ T E:~-=:P I RES I::.ECEt"IB~F-"
I CERTIFY THRT
±: I RM FRMILIRR WITH THE REQL IREMENTS FUR ON-_ ITE _EWER~ RND WELL:, Hz, SET
FORTH BY THE MUNICIPRLITY OF RNCHORRGE.
2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES.
3: I UNDERSTRN[:' TFIRT THE ON-=,ITE ~EWER =bzTEft MRY REQUIRE ENLRRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THRN 5 BEDROOMS.
S I GNED:
T GRERT RLRSKR CONSTRI_ICTION
ISSUEB, ~-~- _-~-_Z~~----DRTE~-~-~--~--~--
V4, 0
PE]R~RMED ~ Great Alaska Construgtion (Jim Bender)
LEGAL~E~SCRIPTJON: ~" ~ ~-.'~'~30,.~: .....
~IS ~RM R~O~S:~,~- ~V~ ~s :Exam~fim ~-~
Subdivision Hills£d~ Park · .'_'
DEFFI'H - .SOIL .... ~ .N,OTES.
. ': ':- ~/~.'
4 ~ TOPSOIL
?]..~'~ Brown-orange SILT ~, ' .' ~/.~
]3.0'-- ' BM~n~.~ with cobbles'
~:: ./' ; cobbles' ;'-; ..... I~0-'S~/~R
-- ~'~" ..... - ;. ~? 1,27 '..
"7 %~ OT TOM OF.~HOEE
,WA_~'.'.~I:A~I~I~;?WATER~''~,....____ -- LENCOUI~ERED ~' ' EO "- -
e)
DRAINAGE REQUIREMENTS: See above
;1~ ~AfN FIELD O O-THEI~"-
DATA CERTIFIED BY: Kihney R. Baxter, P.E.
~&~E:10/27/80
PERCOLATION '-RATE:
p R 0 p~sED-~-~IS-TAL~ A'¢I~ ? O 'SEEPAGE ,PIT ~
COM'?' ENTS:
Peters
~TATEMENT OF II
BY ENGINEER
Engineer's signature
and type of structure indicated heml n. furthervenfythat based on the nformat on obta ned from.,
~ and f'r0m pe, ction, the on~S!te water;.
raft Municipal and Stai~codes~:i~'
' ' Date
o['~b¢~ S~'u)klc~nd
CE-2225
Approved for -~r~, ~ ,/(; .~ bedrOoms'.
DisapP'r0~e~::,
Conditional approval
bedrooms, with the following stipulations:
Comments
The Municipality of Anchorage Department of Health and Humai~ Services (DHHS)issues Health AuthOrity
APproval Certificates based only'upon the representations given In paragraph 5 above by an independent
Back MOA #21
Municipality of Anchorage
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: /-eT 5¢~ kt~L~.~lbl,~ 'F'A-~.~3<:- Parcel I.D.
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
FROM WELL LOG
A. Well Data
Well type
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
Date of test
Static water level
Well flow
Pump level1
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer service line
Wires properly protected (Y/N)
AT INSPECTION
g.p.m.
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Date of sample:
Nitrate Other bacteria
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 11 Ii ~. I~C) Tank size i~ ~ Compartments ~
Cleanouts (Y/N) ~7~ Foundation cleanout (Y/N) ?' Depression (Y/N)
High water alarm (Y/N)
Date of pumping
Alarm tested (Y/N)
Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot On adjacent lots
To property line '> Z./_~ Absorption field
Surface water/drainage ~ .l O
Foundation --~
Water main/service line
72-026 (3/93)° Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Manufacturer
Manhole/Access
"Pu
Cycles tested _
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
On adjacent lots
D. ABSORPTION FIELD DATA
Date inStalled t~ I1 ~ } ~ ~
Length ~
Total absorption area
Date of adequacy test
Water level in absorption field before test
Peroxide treatment (past 12 months) (Y/N)
Soil rating (GPD/FF) I '~0 System type ~
Width -.~ Gravel thickness (~ Total depth I
~-~¢_.2 Cleanout present (Y/N) ~ Depression over field (Y/N)
/'1/~ 1 ] ~ ? Results (pass/fail) --~ for /-/ Bedrooms
7/4-
-- After test '~ / '*
"'7 If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots /'"////-~- Property line
To existing or abandoned system on lot
Cutbank ~,~ ~ ~. Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspect'on.
Signature ~ ~
Engineer's Name '"~'~ ~'~¢~d--L~x-~-~?
Date ]-'~),,4t. ).-0~ ~.~ ~/
HAA Fee $
Date of Payment
Receipt Number
Waiver Fee $
Date of Payment
Receipt Number
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
HAA#
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
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: ¢ N
Day phone
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: 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 ail Municipal and State codes,
Phone ~-7~'--~ ? I
ordinances, and regulations in effect on the date of this inspection.
Nameof Firm
Address ~_o '~,
Engiheer's Signature
6. DHHS SIGNATURE
Approved for
DisapprOved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Additional Comments
By: .~ O~41'4 ~' t'q I'T"~ Date "7/~/c~ %
/ /
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. 1191) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description:
Parcel I.D.
A. WELL DATA
Well type /~
Log present (Y/N)
Total depth
Sanitary seal (Y/N)
If A, B, or C, attach ADEC letter. ADEC water system number
Date completed Driller
Cased to Casing height
Wires properly protected (Y/N)
FROM WELL LOG
AT INSPECTION
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
g.p.m.
Septic/holding tank on lot
; On adjacent lots
Absorption field on lot
Public sewer main
Sewer service line
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Nitrate
Other bacteria
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed II1 t-z--I 8O Tank size t 5C~..J Compartments
Cleanouts (Y/N) Y Foundation cleanout (Y/N) /V' Depression (Y/N)
High water alarm (Y/N) ~"//.'~, Alarm tested (Y)N)
Date of pumping ~/l~/~ &.- Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ]~'~/~--
TO property line ~
Surface water/drainage
On adjacent lots J~/,,z:~ Foundation
Absorption field ~ Water main/service line
72-026 (Rev. 7t91) Front ~ CONTINUED ON BACK PAGE
C. LIFT STATION ['~X
//-~
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 J[ I 12-I ~O Soil rating
Length ~ C~ Width
Total absorption area ~O-~
Depression over field (Y/N)
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
Gravel thickness ~?~ Total depth
Cleanouts present (Y/N) /
Date of adequacy test
for --~
bedrooms
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot
To building foundation
On adjacent lots
Surface water
Curtain drain
On adjacent lots I'¢/~_~ Property Ii ne
To existing or abandoned system on lot
Cutbank ['~,~ ~-¢- Water main/service line
Driveway, parking/vehicle storage area
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
~,~,' %.:: :'!%~
Engineer's Name
Date
HAAFee$ /7E) c Cr~
Date of Payment ~ %~,-~'-~.. ~.
Receipt Number ~ .~7 ~) ~,~)
Waiver Fee: $
Date of Payment
Receipt Number
20S WEST 15YH, AVENUE SUITE 206
ANCHORAGE, ALASKA 99502-3904
(907) 279-3916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL
L. ot 30 Hillside Park
LOCAT I ON:
710() Crocked Tree
F:'F:OWNER:
RESIDENCE: S:i, ngle Fam:i. ly~ 4 Bedreorns
WELL:
Cornmunity System PWSID 212461
SEPTIC SYSTEM:
FR[]M MUNICIF'AL.. RECORDS: 5 Bedroem System
'T'ANK: Greer Steel 1500 Gal. Two Comparts.
ABSORPT 101~ SYS'T'EM: Trench
ABSORI::'TION AREA: 8()0 Sq. F:'t.
SO I L.. RA]"I NG: 150
I NST'AL..L. AT I ON DA]"E: 11 / :l. 2/8C)
DATE OF LAST PUMPING: Anch.. []ess Peol June 18, 1992
DATE OF TEST:
June 17~ :L992
TEST PROCEDURE: System was inspected and measured. Tank was
,Found with 8 feet of cever and with a l:[cluid level o-F 48.5 inch .....
es,, Trench clean out was 8.5 deep and w:i. tl") 5" o.F l:i. quid. Trench
ha~F, nc) ~noni'~]cH'" . Cleanout i~:tt ({.H'ld C)f '~]rEen(::h i!;~ plugged.
lz).':~C (~)a].l(::)l']s (::)'F (:::].ear') watel'" ~,.Jas added to the tr'enc:h wh:i. le mi:the
water leve].s J.n the tank was mor')itored,, ]"he war. er ],eve1 rose 3
inc:hes w:i, th the first 200 gal:l, ons and di(::l net rise any ~urther.
TEST RESULT: Tl"):i.s system meets 'l::he cc)de r'equirements ef
the I-.lealth and Social Services Depart ....
" ,. .:d.)...(.,)~ I..) ...I. (...~
men'[: c,.{: the Mun:i.c:i. pality e.i-
v,~ei.'"e fflea~ul'"ed, but based oki tht~.) soJ. 1 l'"epcil'"t and the .~a(:::'l::. that the
system received :t. 2()C) ga].l OhS wi'!:hout, bacl.:::i, ng up ~ 'l::he sys'l:em is
jud g ed sat :i. s~c ac t or y ,,
.:..~,.IJ Ll tl.. ~' ~ s"t ems depends on the
NOTE "f'he opera'l: :i. onal i :i. f e (::).F al i ,': '.'~ ....... ' '"
!ocal so:i.], c:ond:[tions~ grc)unctwater levels that may ,{:luctuate
during the 'ye:,ar,~ and the water usage o.[: the fam:i, ly being servect
by t:he ~vs":~,m~ These C:OF~C:I~t:[oF~S are
eva].ua'Eor o"f 'Ellis sept:it: system. Ne [::ar't therefc~r'e net g:i.w~? any
estimate e,F how long th:i.s system w~11 .Funct:i. en satis.{:a(::tc)ry .~:er
C:LU'"F'eBt OF' ~LV[:LIKe OC:CLIpaI']ts.
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE DISTRICT OFFICE
800 E. DiMOND BLVD., SUITE 3-470
ANCHORAGE, AK 99503
WALTER J. HICKEL, GOVERNOR
June 22, 1992
FOR: Tobben Spurkland
PWSID # 212481
My review of the records on file in this office reveals that the Hillside Park S/D Class "A"
Public Water System ia in compliance with the routine coliform bacteria sampling
requirements listed in Table C, and with the Inorganic sampling (nitrate (as nitrogen) only)
listed in Table B of 18 AAC 80.200,
Re/cf
Sincerely,
Rachel Clark
College Intern
RECEIVED
JUN 2 4 t992
Mur~icipality of Anchorage
Dept, Health g, Human Services
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 30~ Hillside Park P.U.D.
Location (address or directions)
7100 Crooked Tree Drive
(b) Property owner Waqne & Marile'n Sundqu~st
Mailing Address 7100 Crooked Tree Drive,
(c) Lending Institution
Telephone:(home)
Anchorage, Ak.
Telephone
346-1879 Business
Mailing Address
(d) Real Estate Company and Agent Better Homes & Gardens Relocation ATTN: Shirley Tomblinson
Address Assoc. Brokers 640 West 36th Avenue #1, Anchorage. AR. 99503
Telephone 563-3335
(e) Mail the HAA to the following address: (or check here I;~,~if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
Eagle River, Alaska 99577
2. TYPE OF RESIDENCE
Single-Family BiX Number of bedrooms z¢
3. WATER SUPPLY
Individual Well [] CommunityJ~( Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting toth legality and status.
4. SEWAGE DISPOSAL
On-site []X Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2 , ,
5. 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 th is
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
17034 EagJe Ri~er Loop Road No. 2~
Eagle River, Alaska ~
Telephone
6. DHHS APPROVAL
Approved for
Approved
_ Disapproved Conditional
Terms of Conditional Approval
The Municipality of Anchorage Department of Health and Human Services (DH HS) issues Health Authority Approval
cerificated 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.
72-025 (Rev. 7/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority APproval (HAA)
MuII~I~r~i:K'U~'P,I~R~ARY 1984
~.NVtRONMENTAL SE~I~I~'~,IStO N
MAY 8 ]99begalDescripti°n: .ZJ~?~-'~O~'
A. WELL DATA
Well Classification
/ ECEIVED
Well Log Present (Y/N) ___~ Date Completed
Total Depth Cased to Xx Depth of Grouting
Static Water I~evel Pump Set At
Casing Height Above Ground ~ N,~t Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)%~ Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 700 'f' ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 2. O0 + ; On Adjoining Lots
To Nearest Public Sewer Line %N To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot ~ .r~
Water Sample Collected by
~, ; Date
Water Sample Test Results
Comments _~P_
If A. B. C, D.E.C. Approved (Y/N) ~
Yield
Standpipes (Y/N) t., Air-tight Caps (Y/N)
t
Depression over Tank (Y/N) hJ
Pumping/Maintenance Contact on File (Y/N)
B. SEPTIC/HOLDING TANK DATA
Date Installed ! ! -'1 ~-P, OSize ,~ ~;'4Z> No. of Compartments
Cj Foundation Cleanout (Y/N) ~)
Date Last Pumped
/,,3/~ for
Holding Tank High-Water Alarm (Y/N) ~bJ//A Temporary Holding Tank Permit (Y/N) ~//,Pr!
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well ~.
To Property Line .20 '~'
To Water Main/Service Line
To Stream, Pond, Lake or Major Drainage Course
72-026 (Rev. 7/88) Front
TO Building Foundation
TO Disposal Field
!
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed /I -- /'~- --
Width of Field ¢:~
I .z'~_--O 'f"/~, Type of System Design
Length of Field
Depth of Field I
Square Feet of Absortion Area ~ ~Gravel Bed Thickness
Statndpipes Present (Y/N)
Depression over Field (Y/N) /~). Date of Last Ad?~acy Test
Results of Last Adequacy Test ~ ~ fi .~ ,~.~ C..'~ (' ~ -- "'~1 ¢ e-- (~')
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well
To Building Foundation
Lot I~O~JC.
To Water Main/Service Line (O 'Y
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line ,2. O JF
To Existing or Abandoned System on
; On Adjoining Lots _~O ~'+
To Cutback (if present) /~ O/~) ~
Comments
D. LIFT STATION
Date Installed "~ Dimensions
Size in Gallons ~'~ Manhole/Access (Y/N)
"Pump On" Level at ~ "Pump Off" Level at
High Water Alarm Level at . I~ i'[_.~ Vent (Y/N)
Tested for IV ~ Pumping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N)
Comments
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in
inspection.
Signed
Company
Date _
MOA No.
$ & S ENGINEERING
17034 Eagle River Loop Road No. 204
~_~g!e ~;,,~_r: Alaska 99577
this
Receipt No.
Date of Payment
Amount: $
72-026 {Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE WESTERN DISTRICT OFFICE
3601 C STREET, SUITE 322
ANCHORAGE, ALASKA 99503
April 27, 1990
S~'EVE COWPER, GOVERNOR
563-6775
S & S Engineering
17034 Eagle River Loop, Suite 204
Eagle River, Alaska 99577
PWSID: #212461
According to the records on file in this office, the II'ils'de P rk
Subdivision Water System is in compliance with the State of Alaska
Drinking Water Regulations.
Sincerely, ~/~-~
s.
Environmental FielN3~'Officer
VEC:bas
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
DIVISION OF ENVIRONMENTAL SERVICES
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4744
Application Date
GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL)
(a) Legal Description (include lot, block, subdivision, section, township, range)
L~ ~ 14~, I .~ ~_ ?~.~_/~/'t/~ E C
Location (address or directions)
~ ~[~ Telephone:Home ~'~ Business
(b)
Properly Owner
Mailing Address ~ 1 ~
(c) Lending Institution ~L L~ · Telephone
Mailing Address Cio H ~"~ '~ '
(d) Real Estate Company and Agent ~~ ~'-'~ ~ [~¢~'~
Address ~o~ ~. ~ L~ ~
Telephone ~7~ ~]~ ~
(e) Mail the HAA to the fotlowin~ address: or: Check here~, if hold for pick up.
List contact person and day phone number below.
TYPE OF RESIDENCE
Single:Family ~]
Number of Bedrooms
WATER SUPPLY
Individual Well [] Community ~'
Public
[]
Note: If community well system, mustf' have written confirmation from the State Department of Enwronmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite~ Public [] Community [] Holding Tank []
Note:/$'rf 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 fRev 81861 Front
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 ~¢-~7q
Address / ~,~3~ I,~/-
~ ~. r~. ~:~:~: *'Engineer's Seal
~, ,", JUNE ~5, Lgit .. ' ¢
DHHS APPROVAL
Approved for "/4~x-~ ~'4¢./~ bedrooms by ~'~ ~' "'"~¢'~'~- -~-~
Approved ~ Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Autharity 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.
Page 2 of 2 72-025 fRev 8/86) Back
A. WELL~B)~I~TA ~
Well Cl~L~i~'n L~ ~ ,g, S
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
Legal Description: L. OT ~O~
If A, B, C, D.E.C. Approved (Y/N) Y
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
Date Completed Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)
Depression Around Wellhead (Y/N)
; On Adjoining Lots
; On Adjoining Lots
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
; Date
Comments
B. SEPTIC/HOLDING TANK DATA
!
Date Installed l'~,~ ~O
Standpipes (Y/N) 1' u~O Air-tight Caps (Y/N)
Depression over Tank (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 ~' ~- ~
To Property Line ~
To Water Main/Service Line ~ ~ o
Course t',.t
Size I~¢:~0 No. of Compartments
Foundation Cleanout (Y/N) Y
Date Last Pumped
;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
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed t,,,}O ~/
Width of Field ~
1q8o
I
Square Feet of Absorption Area ~ O1~
Depression over Field (Y/N)
Results of Last Adequacy Test "~ ~.~
Separation Distance from Absorption Field:
To Water-Supply Well
To Building Foundation
Lot I'~ o
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
Type of System Design "T ~,g:= N~,I~
Length of Field ,,,~{~}"
Depth of Field ! ~;~1
Gravel Bed Thickness
Standpipes Present (Y/N)
Date of Last Adequacy Test
To Property Line · Z
To Existing or Abandoned System on
; On Adjoining Lots ,.~3
To Cutbank (if present)
D. LIFT STATION r~ o i%/'/.~
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 have checked, verified, os-conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed ~ ~k'~-''-~'-~~ Date ~'1,1~'7
Company MOA No.
Receipt NO. /~:)(~ / ct~ O//
Date of Payment "~-' ~"'". ~ ~'-
Amount: $ ,~"¢-,~~'~ ~
Page 2 of 2
72-026 (11/84)
Engineer's Seal
CONSULTING ENGINEER
203 W. 15th AVE -C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O.BOX 6-6650
ANCHORAGE, ALASKA 99502-0650
Subject:
Health Authority Approval
Lot 30, Hillside Park p~
JULY 9, 1987
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
1987
RECEIVED
Gentlemen,
During an Health Authority Inspection on subject property is was
discovered that the infiltration trench was installed four feet
deeper than the permit allowed. Total depth of trench was 16 feet
and total depth of testhole was also 16 feet. On July 9, 1987, an
attempt was made to install a monitor tube to check for
groundwater, but the auger hit large boulders at 5 and 10 feet.
Three attempts were made.
The soillogs for Lots 30, 31, and 36 all shows gravelly material
with cobbles. None of the testholes are deeper than 16 feet, but
show no change in materials within that depth. I consider it
unlikely that groundwater is present within 20 feet of the
surface of lot 30, and request that a certificate be issued for
this property.
The only way to possitively verify my assessment will be to
utilize a backhoe to excavate a pit. The resulting pit would be
large, due to the required depth and the sluffing of the pits
sidewalls, and most likely would destroy the present land-scaping.
Yours ~
Tobbfen Spurklan~d P.E.
cc Peter Jarrat
CONSULTING ENGINEER
203 W. 15th AVE "C" SUITE 203
ANCHORAGE, ALASKA 99501
TELEPHONE: (907) 279-3916
SEPTIC SYSTEM ADEQUACY TEST
LEGAL: LOT 30, HILLSIDE PARK P~
LOCATION: 7100 CROOKED TREE
OWNER: JAMES EASTLACK
RESIDENCE: SINGLE FAMILY, FOUR BEDROOMS
WELL: CLASS A COMMUNITY SYSTEM
SEPTIC SYSTEM: FROM MUNICIPAL RECORDS:
TANK: GREER STEEL, TWO COMP. 1500 GAL.
ABSORPTION SYSTEM: TRENCH
ABSORPTION AREA: 800 SQ.FT.
SOIL RATING: 150
INSTALLATION DATE: 11/12/80
DATE OF PUMPING: JUNE 2, 1987, ANCHORAGE CESSPOOL PUMPING
DATE OF TEST: JUNE 1, 1987
TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND
WITH 8 FEET OF COVER AND A LIQUID DEPTH OF 51
INCHES. TRENCH HAS CLEAN-OUTS AT BOTH ENDS, NO MONITOR TUBES.
BOTH CLEAN-OUTS WERE 8.5 DEEP AND DRY. 1000 GALLONS OF WATER
WERE ADDED TO THE CLEAN-OUTS AT A CONSTANT RATE OF 7 GPM WITHOUT
ANY SIGNS OF BACKUP.
TEST RESULT: THIS SYSTEM MEETS THE CODE REQUIREMENTS OF
THE MUNICIPALITY OF ANCHORAGE FOR A FOUR BEDROOM RESIDENCE.
The operational life of all septic systems depends on the local
soil conditions, groundwater levels that may fluctuate during the
year, and the water usage of the family being served by the
system. These conditions are outside the control of the evaluator
of this septic system. We can therefore not give any estimate of
how long the system will continue to meet the operational requi-
rements of the Municipality and State.
o. 2225-E
JUNE 25. 1971
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 9950!
5TEVE COWPER~ GOVERNOI~
Telephone: (907)
Address:
274-2533
DATE: July 9, 1987
PWS I.D.~ 212461
To Whom it May Concern:
According to records on file in this office the
S/D
Water Regulations
HILLSIDE ?ARK
Water System is in compliance with the State Drinking
Sincerely,
Ronald S. KleS_n
EnvS_ronmental F±eld Of£icer