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HomeMy WebLinkAboutHIGH HOPES LT 1High Ho #015-082-15  Municipality of Anchorage Development Services Department ,_.-'_-: _ _ _ Building Safety Division On-Site Water & Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ~.~' www.ci.anchorage.ak.us (907) 343-7904 Page 1 of On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 0SP101035 PID Number: 015-082-15 Name: BRIAN MULDER Wastewater System: [] New · Upgrade Address: 6800 E. 99TH AVE, ANCHORAGE, AK, 99516 ABSORPTION FIELD No. of Bedrooms:4 Deep /FI Ph°ne:(,907)' ' .~51 --446.~ [3 Trench [] Shallow Trench [] Bed [] Mound.-'/' Other LEGAL DESCRIPTION so,, Rating: Total Depth fr.~J~"'odginal grade: GPD/Sq. Ft. / Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: ~ depth beneath pipe: - 1 HIGH HOPES /,/ Ft. Township: _ Range: _ Section: _ Fill added above original grade.~.~ Gravel length: .x Dist .... Ft. Gravel width Number of lines: between lines: WELL: [] New [] Upgrade Ft. Ft. Classification (Private, A,B,C): Total Dept~ Cased Tm(BEDROCK) Total ab~oomtion area: Pipe matedah Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. D&T EXCAVATING 6/9/2010 J Pump Set At: Casing Height Above Ground: GPMJ ~t. ~t. TANK SEPARATION DISTANCES · Septic [] Holding [] S.T.E.P. [] Other* Tc.~.......~To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: Tank Field Station Tank Sewer Unes GREER 1250 Material: Number of compartments: Well 100'+ -- -- -- 25'+ STEEL 2 Su~oce Water 100'+ .... LIFT STATION Size in gallons: J Manufacturer: / Lot Line 5'+ ....J Foundation 5'+ .... "Pump on" level ~t: ~at: High water alarm at: Curtain Drain = NONE KNOWN . Pump~ Electrical Inspections per~ormed by: I I Remarks: BENCH MARK Location and Description: OLD SEPTIC TANK WAS ABANDONED IN PLACE PER UPC BOq-rOM OF TRIM, N.E. CORNER OF HOUSE Assumed Elevation: 100.00 Ft. ENGINEER'S SEAL Inspections performed by: GEG, Ltd. Dates: 1st 6/9/2010 Development Services Department Approval ~ ::':'!'.,iJj Conditional approval: Date: ~¢¢~/. '~ '~J / CEr-7953 -" ~h~',~ -V...i I ~': / ~ .-" .,,o~ /// ///' .,/ q~_~, '~/..]LlS.', ~,~,~:~ Reviewed and approved by: ~/.,.~/~/,1.,', ~'-<~-,~/(D~t:e:/),-.2. 7-/O '~,"~¢~ ..... ~'~: AS BUILT DRAWING ~^~°~"~ ~' OSP1 O1035 - O15-082-15 ' '; .j:".;TJ 5.; , /""": :.;~ :i:~::::....~, ..;...,..,..... ~... ~ EXISTING SEPTIC ,~v . ~.., .2.'~-- .. ~.~ s~ ~~:/ A B C ST1 2~.39 17.57 26.74 ST2 33.27 25.1~ 33.48 DBL1 39.36 31.15 37.73 DBL2 40.05 31.67 37.98 SCALE: I I 1" = 40' P.gP~.eD fOR: IPHON[ UUU~[.: I p~[ .uu~[.: BRIAN MULDE. I 907-351-446~ I 2 Of S u ?~ '- , -' -~. H gH HOP[S S/D; LOT ~ A J . . . ~PE Of WORK: DATE: AS-BUILT DRAWING Or NEW SEPTIO TANK 8/~0/20~0 A B C ST1 28.39 17.57 26.74 ST2 33.27 25.18 33.48 DBL1 39.36 31.15 37.73 DBL2 40,05 31,67 37,98 (Rev. 01/05) AS BUILT DRAWING OSP1 01 035 - 015-082-1 5 ST1 TOP OF TANK --X ?l AT INLET = 90.56 ~/~lI AT INLET = 90.10 /! GALLON TANK FINAL GRADE = 95.29-95.94 ST2 r~ /- TOP OF TANK TLET = 90.51 I I '-INVERT OF BUNG l/ AT OUTLET = 89.74 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 * PHONE (907).3,37-6179 * FAX (907)338-3246 * WF..BSIIE: wwa,t.game~engineering.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BRIAN MULDER 907-551-446,3 LEGAL DESCRIPTION: HIGH HOPES S/D; LOT 1 'POPE Of WORK: PROFILE AS-BUILT DRAWING OF NEW SEPTIC TANK (Rev. 01/05) 3OF3 IDRAWN BY: A.J.G. DATEk/~ 0/20~o Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSP101035 01508215000 Septic MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Upgrade Permit Effective Dates: May26, 2010 to May26, 2011 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: HIGH HOPES Site LegalAddress: HIGH HOPES LT 1 G:2439 Owner/Address: Mulder Bdan 6800 E. 99th Ave. Anchorage AK 99516 Site Mailing Address: 6800 E 99TH AVE, Anchorage Lot Size In Sq Ft: 65907 Total Bedrooms: 4 This permit Is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Pdvy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18MC72) and Ddnking Water Regulations (18MC80). 3. The wastewater code requires inspections dudng the installation. The engineer must notify the Development Sentices Department at least 2 hours pdor to each inspection. Provide notification by caIling (907) 343-7904 (24 hours). 4. From October 15 to Apd115, a subsurface soil absorption system under construction during freezing weather must either:. A~ Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERHIT ,5,PPLICATION FOR ,b, SINGLE FAMILY DWELLING Parcel I.D. Properly owner(s) Mailing address Site address OI~-O~Z-lO BRIAN MULDER §~00 E. ggTH AVE * ANCHORAGE. AK Day phone 351-4463 Zip Code 99516 Legal description (Sub'd, Block & Lot) HIGH HOPES S/D: LOT 1 Legal description (Township, Section & Range) N/^ Lot Size Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR ( ~;~all that apply): Absorption Field [~ Septic Tank [] Holding Tank ~E] Privy Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP~ Ltd. Permit/Rush Fees: Date of Payment: Receipt Number: (-~J (Rw. 11/05) Waiver Fees: Date of Payment: Receipt Number: GARNESS ENGINEERING GROUP, Ltd. = ........ :. CONSULTANTS & GENERAL CONTRACTORS ...... ' May 14, 1010 Municipality of Anchorage Dcvelopmcnt Service Department On-Site Water & Wastewater Program 4700 Ehnore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Upgrade for lligh Ilopes Subdivision; Lot 1, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The existing septic tank (installed 6r21/1984) is collapsing and must be replaced. We are proposing to install a new 1250 gallon septic tank at the location shown on the attached drawing. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any qu~tions, please contact us at 337-6179. Thank you for your assistance. NOTt'¥A ~d is a site p~an drawb~g and a d¢sign drawing, which are al~ part ~f the design pacl~age f~r this septic sj (Contact G.E.G. Ltd. for 7 page construction speciJ"tcation letter.) 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com I I z' II ', S/D; LOT 4 ] \\ I / _ I ~'~c ~ / ' I / ~ I ~ ~ / ~ I s-s-~. S/~; k ~ I ~ I eL~K 1, LOT 2 ~ I I I ......... ~ I I -- k / N / N /// / / ~ I t~' ~ ~1~~, j HIGHs/D; HOPESLOT 2 ~ FOUe-WAY S/O; //,~ PROP , BLCOK 1. LOT 4 1250 S[~C / / /7" " / / / ',', / '%, COMMUN~ WE~ / COMMUN~ WE~I COMMUN~ WE~ J COMMUN~ WE~ ] COMMUN~ WILL ~ ~ ~ JNJ // ...... CONSULTANTS & GENESAL CONtRACtORS ......................... ~ ~ PREPPED FOR: PHON~ NUMBER: PAGE HUMBER: X~ BRIAN UULDER g07-~51-446~ 1 OF 2 k'~d~ ~(mes~.- HIGH HOPES S/D; LOT 1 A.J.G. ~::~Jl.~.JI SITE P~N 5/14/2010 ~[G, Ltd. HAS A 7 PACe SPeCIFiCATiON Lr'TIER THAT PERTNNS TO 'FHIS DESIGN. TO O~TNN A COPY OF THE LFTTER CONTACT GEO. BY PROCEEDING FOEW~D ~TrH THIS INSTALLATION, THE ENGINEER. ' WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE RE~D THESE SPECIFICATIONS AND AGREE TO AGCIF[cvT THE 'I[RMS AND CONDmONS OUTUNED. NOTE: SCOPE OF WORK IS LIMITED TO REMOVAL OF OLD SEPTIC TANK AND INSTALLATION OF NEW 1250 GALLON STEEL SEPT C TANK. EXIb-~NG 1250 C,N. LON SEPTIC TANK TO Br. PUMPED, CRUSHED, AND COMPL-~LY AI~IDONED PER MPC. / / / / / / / / / GARNE. SS ENGINEERING Ol{..O?.~P_:..L_.td~; f~l'~h,~l~ '"'.?.~Op~\ DESIGN OF PROPOSED SEPTmC UPG"ADE ~%~<~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI LING ADDRESS EGAL DESCRIPTION LOCATION Well DISTANCE TO: Manufacturer C~E~ Liq. IF HOMEMADE: Well Dwelling I6, E Materiel Inside length Width PHONE [~N EW ~F.~g.~... '~O ~ ! E~] UPGRADE NO. OF BEDROOMS No. of Liquid depth Material Foundation ~ Total ,en~.~gf~Jines Trencl? w~.~,~'-' --' ' laches DISTANCE TO: Dwelling ! PERMIT NO, Manufacturer Liquid capacity in gallons DISTANCE TO: inches We, I I/+. ! No. of lines [ Length of~N.~..each I~ne Top of tile to finish grade Material benea'th tile Length Width Deptl~ Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Distance b~7 ~f~es Total effective a~sgrptio~,rCa PERMIT NO. DISTANCE TO: Well Building foundation Nearest lot line Oeptl~ Driller Distance to lot line PERMIT NO. Building foun.~dation Absorption area(s) OTHER Sewer lille I PIPE MATERIALS SOIL TEST RATING Septic INSTALLER REMARKS APPROVED ~/ DATE LEGAL C:~:)I",I T FIC: "F F:'HCINE: ' C:EiFi:T]:F'"r' 'TI'It:::Ii" ::1.. I I::11'"1 F:'F:Ih'I:[L..II::II:~: [.,t:i:"1"t"i "!'[11!: Fi:I:!:(;]IjI!:;i:E:I'tlZI",!'I":ii!i i::'0i:;~: C i",i"'":E:[T.~ :Ei!ZI.,.IEF~:':3 F:II",IE:' I.,.ll:..~L..l..~:i~ F:l:i.~: I::'O[~:TH [i',"r' "THIZ I"ILII",[IC:I. d. ]1'~ !:::it:::' F:!I",IC:HCIP~FIC!iI~: (i-"1Ot:::1::' l::li",l!:::' "I'H[E :~i',Tl:::l'!"li~: OF:' f":'lLFl:~i;l':::l:::l. :ili:.]: ['.tI!....l... ]:t",I:iE:TI:::II...I.... 'TH[!!: ?'/:!!:T'li!iff"i :i:hl I:::IC:::C[;~:[:'F:IHF'[:' IqI'T'H I:::IL.L ["lCIl:::l C:O[::'[!i:~!i I::ff',l[::' F:II",ID :[ IqC:OI'ff::'L. '_i: l:::li"~ll::::!iii: ~'.I :[ TH THE::: E:dZ:ii!: :[ GI",I C:I~: :[ 'I"E:F~:: :[ ]::1 OF:' TH ]: :!i!: F'EFff'1:1: 'T'. ::i:::. T !,.!I!..I.. I::lf::d"li!!i:F~:E!: "1'O I::i[...L.. I'I()FI I:::11",I!3' :.E.'["l'l':l"l"liC Of I:::lL..l:::l:!iiit':::l::l Fi'.E:::l:i:!lJ:[l:;i:[i~l"'ll!!~l",!']':ii!: F:'OI:;i: THE [::' I '.'ETTI::Ih,II::::Ei::ii!i !::'I:;i:OH I:::ll",ltr' Iii:::':: I :E!:'T' I hlCii I.'.I[EI...I ..... [.'.11:::1:!!!', I"[~!:I.'.II:::IT[EI:;~: I::' t '.Eiil::'O:iii~f::ll_ .:, ~ .:: ILI I O1:~[: F:'U[3f.... '.EF,[~,b.I[~:.:I:~-iF:ICiiE!: ?,"r':ii!7!'.~i:H O1",I 'f'H:[:i~: O1::~: I:::ll",!"/ I::I[::,..:rI:::IC:E.::I'.,I'I" 131:;i: NEFIF~:t3h.' I.r:T'. ,::!..I I..ll'.,l[::d!~:I:',i'.:!~2Fl::ff.,l[::* 'T'I..II:::tT' "1'I-I ;!: i!!; I:::'[!!:l:;i:l,'l :[ T I ii~: ',/!:::IL.. I [::' F:'OI:~: I:::1 I','IF:I[:.:: I I','IL.II','I Cfi::' ,::1. I!i[[EI3, Fi:C,:)I~"I:~:.~i t'::II'.,I'T' l!!!:hll..Fll:;i:(!il!.~l','l!!!!:l'.,IT I.,.! :1: L!... I:~'.E!:l:i:!l.J :i: I:~:!:~: F:IN t:::l[)d-::, I T I Cfl'.,iFIL. F:'lZl';i:hl :[ T. MUNICIPALITY Ob ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 1_. Slroet, Anchora!lo, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION I EST t+ SLOPE SITE PLAN WAS (';ROUND WA1 ER ENCO JNTERED~ NO IF Y[T;, Al'WHAT DEPTH? Date Pi ~:1('~1 ATION RATE 1 Depth to Net / I Ir";[ HUN BFTWEEN FT AND FT COMMENTS ', C : (6179) ~~ ' .: , ..... ' rATER ~ = -- ~,r ~ ': = ~ '13=; 't, '" Oiv S on Of Georogicol & 'Geophys cai.Surveys ":: LOCATION OF' WELL (Pleole compl,te either Io~ lb Or I¢.J ...... ...~ , · ' ~/~'~ :! 'l,. ~ , , . . . ~- '~ D STANCE ~ND ~IRECT~ FROM R~O' NT~R~ECTION8 ' ~ OWHER OF~EL~' / ., ~._ ~,~ ~ ,~ f/~ ~ · + ~ - . ....... _ . , .~ ~ ,~ · ~-- . . . , -~ ' ' / ~ ' ' ' ' '~:?', '. ~ Z~ : e C'A~ING~ :~Threaded ~ Welded , -; . · ~ · -~ L / ~- ; '.~ ~.,;. -; ¢~,~ .~-:~. ~.t.. .~.r~.~ ., ~ . · · . ~ .'r'. -- r ' " : ..... Length, · , .... a~ · · ~ ....... · ~ , z~. :~ .t/"~'~ s ~ ....... · ~:. -~ . - ' ~: ',..~ ...... ... ~ .~c tO~~ , ~ ..... E HEA . .... . , ~: - ." .-. I~'~ ~tt , '' ' ~ .... · '" ' ' 'd ~ ~ ~'- ' ' H uHer : ~T% ."'.' ','r · .~ .. . . ~, ,'.', . ' , ,, ., ..~-- , ' , 2": :,:,:~ '".'' .: .,: ,: ~,.., ,., .: . ,.~ :: .., ,.,, , ,-, ,,:.~ ' , =~¢' '. ':.: ' . "' , ". ~:~R~S~ ': ' ' WATER WELL CONTRACTOR'S GERT F'CATION ' 5~ W~i~r Temper. ute : % '1~. . , .' ' ' . ' ' ' Con re6 Llc~ N ~ . ' , ' : .' " '._ , Authorized Rt~sental lyer ' DATE: TO: FROM: SUBJECT: July 23, 1984 Laura Crow MEMORANDUM Environmental Health Division Request for Refunds - Account ~ 2460 Please make arrangements for the following refunds. Two(2) were MOA inspeCtions and changed to engineer inspection. One(l) the well permit was paid for twice. One(l) the permit was revoked. Daryl Eo Kollander 2911_0 West 80th Avenue Anchorage, Alaska 99502 Receipt It 278742 Amount $15.00 Account I~ 2460 Tract 1-B Peter Gate Subdivision Permit It 840035 - Well Permit (Purchased Sewer and Well Permit on Permit #840547) Bernie Willis 10008 Marmot Circle Anchorage, Alaska 99502 Receipt II 279032 Amount $].45.00 Account {I 2460 Lot I High Hopes Subdiv{sion Permit # 840156 - Sewer/Well Permit (Purchased MOA inspection changed[ to engineer inspection.) premiere Construction 4155 Tudor Road #206 Anchorage, Alaska 99503 Receipt ~I 279608 Amount $145.00 Account !t 2460 Lot 9 Block 2 Spring Itills Estates Subdivision Permit It840521 (Purchased MOA inspection changed to engineer inspection.) R.D. Neilson Star Route A Box 7380W Anchorage, Alaska 99516 Receipt tl 288398 Amount $20.00 Account I~2460 Lot 8 Block 2 Spendlove View Heights Subdivision Permit I1840514 (Permit has been revoked by this Division) Laura J. Ward Office Associate cc; File attachements 91-010(4/76) Depth Feet 3- 4- 5- 6- 8- 9- 10 - I1 - -- 12 .. 13 - Pout'- 6-650, 99502.' - 2518~. Tudor R~'d Anchorage, Alaska Performed for KARL B. HOLFELD & ASSOC., INC. Date performed 5/25/76 Legal Description: ~I~.q_~'~~_.SE1/4x__,~i/4, ~_fe__cL, !4Jj T~, R 3W 'This fom reports: ~olls log .... x Percolation test ~/A Hole K At toe of · anic Mater~al ;ilty Sand S.M. 250 S. to N. S1.)pe of 13© -!--+- --1 .... Sand S.W. 125 Gravel to 3" G.S. 85 14- 15 - 16 - ]obbly Gravel water encountered? No Sandy Gravel 125 If yes, at what depth? Tota Reading Depth = 16' 'Date Percolation r~,te .... Proposed installation: %/epth of Inlet COHbIEtITS: GroSs Time Net Time Depth to tt20 minute Seepage Pit ' Drain Field Depth to bottom of pit or' trench Net Drop Perforrned By: __~ ~= -Certified By: ~ Date: - 5/25/76 Pouc~' 6-650, 9950Z' -'2518 E. Tudor R-rtd Anchorage, Alaska Performed for KARL B. HOLFELD & ASSOC., INC. Date performed . 5J25/76 Legal Description: _Lot 2~.~ SE]/~ SW1/~, NEi_~_4, Se~. %~, ~%.~N, R 3W 7'his fom reports: Soils log _ __z ' ' ' ~ercolAtion test N/A Hole B Organic Silty Gravel G.M. 225 Coarse cobbly gravel G.W. 85 Depth Fect 2- 3- 4- 6- 7- 8- l0 - ll - 13 - On a ridge sloping 15° to N. Sandy Gravel to Gravelly Sand S.W. 125 14- 15 - 16 - Coarse Gravel .G.W..~ 85 waser encoun~erea~ __. No --Total Depth = 16' If yes, at what depth? Reading Percolation r~ Proposed installation: ~epth of Inlet CO~IMENTS: Date GroSs Time I INet Time Depth to H20 minute, Seepage Pit ' ~ ' Drain Field Depth tO bottom of pit or trench Net Drop Performed By: /~2,~_~ ([~_~,~<~~ Certified By: ,~ Date~. F/m~/7~ __ I)I']I'AICI'J\rIJ'~N'I' UI' ll~AL'I'Jl ALNI~ ~INV IItU.~B'IISN l/~b I'liL~I,U,L,I Pou 6-650, 99502,,' - 2518B. Tudor F -,d Anchorage, Alaska Performed for ~AP~L__ttO~D & ASSOC., INC ........ Date performed Legal Descript'ion: _not 3~4~__S~i/~N~__~_~.~_4~_Sec. 14,_T12N~ R 3W 'Ibis form reports: Soils log x Percolation test ~/A Depth Feet 2 3 6 7 5/2~/76 Hole C Organic __Silty-Gravel 225 G.W. 85 Clean Gravel to 3" g lO-- 11 - 12-. 13- 14- ~ravelly Sand S.W. 125 to 3" G.W. ~ 15 ---- encounterea~ and S.W. 125 16 -- -- ~vel to 3" G.W. 85 If yes, at what depth? R ,. Total Depthp~t~6' ead~ng GroSs Time Net Time Depth to H20 Net Drop Percolation r~ Proposed installation; /~pth of Inlet CO>iMEN'[S: ____ minute, Seepage Pit Drain Field Depth to bottom of pit or trench Perforl~md By: ~ Certified By: __o_~--~. _ Date: _ 5?25/?6 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 DWELDING 1. GENERAL INFORMATION Complete legal description Lot 1; ~k--~4-High Hopes Subdivision Location (site address or directions) 6800 East 99th Avenue, Anchorage, Alaska Property owner Berpie w411 ~ ~ Day phone 346-3004 Mailing address 6800 East 99th Avenue, Anchorage, Alaska 99516 Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well xxx 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. XXX 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 ofstructure indicated herein. Ifurtherverifythat 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 ~ & 5 -~.HG!M 17034 Eagle River Loop Road No. 204 Eagl~ ~[v~r, Alaska 99-~7? Phone Date DHHS SIGNATURE ~ Approved for/~'~ ~ (/"v¢//~f) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) 8ack MOA ~21  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/~OT/I ~b/(: [,, /'¢16-/4~ fio!')¢.~ % Parcel I.D. C~/'..~'-~ A1 WELL DATA Well type Log present Total depth Sanitary seal If A, B, or C, attach ADEC letter. Date completed Cased to / ~' ADEC water system number Casing height_ Wires properly protected (~q) FROM WELL LOG Date of test (b- "¢ - 8'-/ Static water level c:~ / Well flow Pump level g.p.m. AT INSPECTION - MUNiCIPALHY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION JUN 1 g.p,m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/.L~ tank on lot Absorption field on lot Public sewer main Sewer service line (0o '+ ;On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform C~ Nitrate Date of sample: ~,,'"~. m[r/~ Other bacteria O Collected by:. B. SFPTIC/HOLDING TANK DATA Date installed ~ - c~.'~c -. ~ L~ Cleanouts ~xi) ~F~.g Tank size /~(~::,O G~(_ Compartments ~ ,. Foundation cleanout Y~N) ~l~S Depression (Y/~_J~ /k~o ~/~ __ Alarm tested (Y/~ ~/~ ~-'I 0 -~ ~ Pumper ~ /¢0~ ~/~ High water alarm (Y/~.'.~ . Date of pumping SEPARATION DISTANCES FROM SEPTIC/~4~j~N'G- TANK TO: Well(s)on lot (00 ~ On adjacentlots I00 rff_ To property line ~O'+ Absorption field (~ + Surface water/drainage I. O0 "{-' Foundation Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE Size in gallons '""'"~,, Man~ Vent (Y/N) ~at ~ "Pump off" level at High water alarm level ~ Cycles tested Meets MO~ ~ S~ION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed ~)-c'3'-'bc-~?>O( Soil rating Length /-~' Width Total absorption area Depression over field (Y/~)) Results (pass/fail) Peroxide treatment (past 12 months) (Y/~__~ Gravel thickness ~> Cleanouts present ~N) Date of adequacy test for 4~- ~--¢o~,~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: System type Total depth ,/ bedrooms Well on lot To building foundation On adjacent lots__ Surface water Curtain drain On adjacent lots /00 ~ Property line To existing or abandoned system on lot ___ _Cutbank /b'///~ _Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature Engineer's Name Date $ & $ ENGINEERING 17t~4 Eagle Eiver Loop Road No. 20~ Eagle River, Alaska 99577 HAA Fee $ /~) ~ Date of Payment Receipt Number .~ ¢¢ ~"? ~"~ ~ ,- . .. .; ~ Waiver Fee: $ Date of Payment Receipt Number CtlEMICAL & GEOLOGICAL LABORAIORY A DIVISION OF COMM£RC~A[. TESTIN(.I & ENOINEERING CO. 0033 B STREET ANCHORAGE, ALASKA 99518 T/L[F'H~NE (907) FAX: (907) 501-530t JU~ tO 92 { 16~00 hx~. ~t ~ JUN i2 92 POt :XOIt~ MCIlVID 2,7 ~/1 ~PA $5~,2 10 NA- Hot Anmlyssd CT,~**m Ih~n, Gt-O~,ate~ Thmn ~g~"~ membor of the 805 Group (~oc[Ot~ GGnOrafe de Survellhmce) 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 1 High Hopes Subdivision (T12N R4W SEction 18) Location (address or directions) 6800 East 99th Avenue, Anchorage, Alaska 99516 (b) Applicant Name B. Willis Telephone: Home 346-3004 Business 6800 East 99th AVenue, Anchorage, Alaska 99516 Applicant Address (c) Applicant is (check one): Lending Institution []; Owner/builder'Z~; 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 Ek Multi-Family [] Number of Bedrooms four (4) Other WATER SUPPLY Individual Well ~ Community [] Public [] Note: II community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 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. 72-025 (~1/84} ENGINEERING FIRM PROVIDI INSPECTIONS, TESTS, FILE SEARCH, C ~, 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 ir~spection, 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 This department has received written confirmation from the engineer (AECS, INC.) regarding the conditional approval of Januaty 16, 1985. This property now meets with the MOA regulations and ordinances and is therefore approved. Engineer's Seal DHEP APPROVAL Approved for four(4) bedrooms by ~ ~' ~' ' . ~ Date April 10, 1986 Approved xxx Disapproved Conditional 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 ia 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) ALASKA ,,uIr oI m iqTAL (}OiqTBOL IH(}. ~nqJncerinq $ ~nuJronmcnlol $1udics April 7) 1986 Manicipality of Anchorage Department of Health & Hurmn Services 825 L Street Anchorage, Alaska 99501 Attn: Steve Morris Subject= Conditional Health Authority Approval Applied 1/10/85~ Lot l, Block 0, High Hopes Subdivision Dear Steve; A site visit 4/7/86 confirmed the conditions on the 3anuary 1985 Health Authority Approval have been met. Standpipes for septic tank and trench are now present. If you have questions, please call. Sincerely, cc: Bernie Willis Dennis Roe Field Engineer MUNICIPAI. ITY OF ANCHOP, AG,.: DEPT, OF HEALTH & ENVIRONMENTAL PRO F~CTION RECEIVED 1200 ~Jtsl 33rd Aucnu¢. $tlJl¢ [3' ~nchoroqe glosk~ 9¢5o3o(~o7) 561-50/40 MYNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONME, IffAL HEALTH DEPARTMENT OF 5iEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1o C~eneral Information Application Date (a) Legal Description (include lot~ block~ subdivision, section, to,reship, rar~e) Location (address or directions) . ' (b) Applicants Name ~ . ~///g Tel e~pljo ne_~- R~0me ZBusiness (c) Applicant is (check one) Lending Institution (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone Mail the lika to the following address: 2o T~pe of Residence Single-Family~ Number of Bedrooms Multi-Family Other (describe) Individual Well ~/~: Community ~ Public ~ / Note: If community well system, must have written confirmation from the S~ate Department of Lnvtrorm~enta~ Conservation attesting to the legality and status° 0nsite Public Community ' IIolding Tank ~ Note: If community well system, must have written confirmation from the State ~4~Department of Environmental Conservation attesting to the legality and status° [Page 1 of 2] g_~.ineerin~ Pis Providin. I~ections Tests~File ~_e_9__rg_h_~_Data and Infor~ation As certified by my se~ affixed hereto and as of the validation date sho~ below~ verify that my investigation of this Health Authority Approval shows ~:hat the on-sl wager supply and/or was~ewater disposal systsm is safe, function~ and ~equate for the n~ber of bedroom~ and ~ype of structure indicated herein~ 1 further verify that, based on ~he i~o~ation obtain~ from the ~nicipa].ity of ~choraga files and from my invemtigation ~d inspection, the on-site ~ter supply and/or ~mstawater disposal system is in compliance ~.~th ~1 ~nicipal and Stage codes~ ordinances, a~ reg~a= tions in effec~ on ~he date of ghis inspection. Name of Fi~~~~ Talephon~f~Z~/~,~-~)~) .... Approved for bedrooms By A rev .... ~ - ( PP ~ ~z,,approved Te~8 of, Condition~ A rovai'[~ -, ,. PP ........ __. . ........ __ .~ . CAUTION THE MUNICIPAI, ITY OF ANCHORAGE DEPARTMENT OF ~F~kLTH AND ENVIRONM]ZNTAL PROTECTION (DHEP) ISSUES HE~SfL~H AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT~-. ATIONS GIVEN IN PARAGRA~PH 5 ABOVE BY AN I~DEPENDENT PROFESSIONAl, ENGINEER REGISTER~.~ IN ~.CRE STATE OF .4Z~S'K&. 'I'd~ DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDI~]'G INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDEtL~, AND STATE REQUIRE~ MENTS. EMPLOYF, ES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICA%~E IS ISSUED. ?RE MUNICZPAI,I%"f 0]? ANCHORA~E IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TI'U~ PROFESSIONAL ENGINEER'S WORK° (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19-84 Well Classification,~.. Well Log P~esent ~Y~.~N) Total DSpth t~ / ~d to Static Water ~1 Casing ~ight ~ Gr~nd Elee~ical Wi~ing in ~nduit~) ~p~ation Distan~s ~ ~11: To ~ptic~olding Ta~ ~ ~t MUNICIPALYW OF ANCHORAC ! DSPT. 0[: I-IiEAL'HI & ENVI~ONMEN'EAL P~'~' ~ ~[10 I OF (MOA) C~C~I~ - F~RU~Y 1984 ~te ~leted . ~/~/~C/ ~iel~ ~Q. ~ / Sanitary ~al on Casing ~ession ~nd ~l~ead /~// c~ ; ~ ~joining ~ts ~'/~/~ To ~a~st ~ge of ~s~tion Field on ~t /~ fW'/.; ~ Adjoining ~ts To ~est ~blic ~ Line ~/~ To ~est ~blic Clean~t~a~ole .~ To ~est ~ ~vi~e L/~n ~t Wate~ S~le Colle~ed By ~'~~ _; ~te /./~ /~ Wate~ S~le Test ~sults ! ~>~.~/-G ~'/~f ~ ~ . [Page 1 of 2] SEPTIC/HOLDING TANK DATA Date Install~ ~/~/~ Size l'~-~ No. of Cc~%~a~hrents Standpi~es~) ~1 Aid-tight Caps ~) Foundation Cleanout~N) Pumping/Maintenanc~ Contract on File (Y/N) /P/~-; for_ ~/~ Holding Tank High-water Alarm (Y/N) ~/~C~' Ten, popery Holding Tank Permit (Y/N~//~~/ Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well iD~/'-k~ To Building Fc~mdation /~ / To P~ope~ty Line ~! To Disposal Field To W~ter Main/Service Line + l~/ To Stream, Pond, Lake, c~ Major D~ainage course .t--I DP/. . J , L) Receipt ~ Date Paid: lxl(~ Amount: ~/'~' ~- 2-15-84 C. ABSORPTION FIELD DATA Soils ~ating in Absorption St~a. ta /~ ~/ Type of System Design Date .Installed ~/~ ~-/~/ ' ~ng~ of Field ~' / Width of Field ~/ ~p~ of Field /~ ~ Square Feet of Absorption A~ea Depression over Field (Y~.)) Results of Last Adequacy Test Gravel Bed Thickness ~>~ Standpipes P~esent Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line / / O / ~' To P~operty Line ~ ~-O [5 [ / To Existing or' Abandoned System cn ; On Adjoining Lots 'Y-~'d / ,~/ ~ To Cutbank(if present) . To Stream/Pond/Lake/or Major D~aina~e Course ./-/ZPD / To D~iveway, Parking A~ea~ or Vehicle Storage A~ea g/~) / I D. LIf~f STATION Date Installed /Dimensions /~/ ~'~ Size in Gallons r~ho.le/~~ (Y/N) "P~2 On" Level at ~/ [l>Pu~-~f" Level at____ High Water Ala_~m level at .. /~ ~ Vent (Y/N) Tested for ~ing Cycles du~ing Adequacy Test. Meets MOA Electrical Codes(Y/N) Coa~ents ** Check Permitted Bedroom Rating Against HAA }~quest I certify that I have checked, verified, or conformsd to all MOA HAA ~idelines in effect on the date of_this inspection. Signed Date