The URL can be used to link to this page

Home My WebLink AboutHERITAGE HEIGHTS LT 9 ;~"' MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENGINEERING DIVISION ENVIRONMENTAL 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE [] NEW MAI LING ADDRESS LEGAL DESCRIPTION LOCATION , . NO. OF B~R~ Well ~A~ Absorpti~ area ~ Manufacturer Mat~i~[ ~0. of co~rt~onts Liq. capacity in galloons Inside length Width Liquid depth t g~O / IF HOMEMADE: ~ DISTANCE TO: PERMIT NO. Well Dwelling O ~ ~ Manufacturer ~ --~ Material . Liquid capacity in gallons ~ Well~,~, ~(~ I~ Foundation Nearestlotline PERMTNO. ~ ~ ~ No, of lines Length of eac~ line~ Total length of lines Trench width Distance between lines Top of tile to finish~ ~grade~ : Material beneath tile Total effective absorption area Eength Width Depth PERMIT NO. ~ D Type of crib Orib diameter Crib depth Total effective absorption area ~ m DISTANCE TO: Well Building foundation Nearest lot line ~ Class ~c~ HmO Depth Driller ' Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s} OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS ~.~ '.. APPROVED PERMIT hi6) DA]'E ISSUED CX]N] A ]..' r F'HOIqE: DtEI::,~f~FIII:.I,t~ OF: HEALTH AND ENVIF:CP*IMEN"I"AL. PROrTEC"FIOI,,I ~~ Fi,,: .... L S'I"REET, IMqUHURglaE., AK 995()1 " 91'7.¢5/85 DAVE HAF~BOUR 4101 UNIVERSITY DR, ANCHORAGE, AK 99508 I_EG,..~L DESCI::( i F' L. OT MAX BEDROOMS: SUBDIVISION: HIERTIAGE HTS, SEC]"ION~ 4 TONNSHZF': ~2N 22'.'645 (SQ. I::"T'. OR ACRES) 4. Iz.O T: 9 RANGE: 3W LOCI....: NA Listed below ar.e t. he opt.:i, ons available to you in designing your' septic ,.~y~uer¢,. Choose t.l"ie c, pt. iccn that be. st fits yc, ut- sit. e,, DFF:'TH 'TO F:'IPE BOTT'OM GRAVEL DEP I"H ]'O"t'AI_ DEF:'I-H (FT,, GRAVEL.. WID]"H (F'T,, GRAVEL I_IENGTH (1::=t''. ) ' GRAVEL VOLUME TANK SIZE (GALS) SOIL RATIIqG (SQ.F:T. /BR 4. ,, 0 5.0 ' 4 ,, 0 ~ B ,, 0 0..'5 3 ,, 5 ~/ 2. '5 .1. o ,, ~..) 5.0 / .... ', '~'o O .:;7,, 0 17.4 19.0 ;77. ~5 250 ,, 0 ~.~ i, :250.0 .~. 1,250 ,, 0 .>s.~ .85 85 85 *"~' ]"Alql< I"ILIST HAVE A'Tr LEAS'T' TWO C[]I"IF'ARTMF::NTS I c:er't, ify that: 1. I am f'ami:l, ial- with the requirements for on-sit;e sewet;s anti well.s as set for'th by the MunLcil:3ality of' Anchorage (MOA) and the State or AZaska. 2. I will insta].~ the system in accor'dance wit. h all MOA c:odes and regulations, and in coml:)liance wit. h ti'am, des:i, gn c:r'iter'ia caf i:.his permit. 3. I will adher'e t.c, all IdOA and State of Alaska PeqLtipement. s fop the s~:~t back dist. ances f'r'om any existing welZ~, wastewat, eP d:i. sposal systE, m or' public sewerage system on t. hJ.!~i o1" iar]y adjac:ent of ne)ar'by, lot., 4. I undePstand tlna'L 'Lhis l~enmi'l:, is va].id Fop a maximum o¢ 4 bedrooms and any enlargement will r'equSr, e an additional perm:it.. IF A LIE]' STATION IS INS]'Y4LL. ED IN ~-IN AREA COVIERED BY MOA BUILDING CODE:S, ]"HEN (1) AN ELECTRICAL F:'ERMIT AND IIqSF'EC]"ION MUST BE OB]"AINED; (2) AS-'BUILTS WILL. NOT BE APF'FZOVED WITHOU]" AN EL.EC]"F~ICAL. INSPEC]"ION REF:'OR]"; AND (3) THE EL~C]'RICAL WORK PIUS]" BE DONE BY A LICENSED EL. EC]"RICIAN. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: D ~0¢(~ t'/'-a.r bO~-,~f' DATE PERFORMED: LEGAL DESCRIPTION: l. at' 2 3 ~-t'l Si'l~-)~ ~-~1 4 5 6 8 SLOPE SITE PLAN 10 11 12 13 14 15 ~7 2O COMMENTS WAS GROUND WATER S ENCOUNTERED? ~1~O L O P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT 72-008 (6/79) ANCHURAfJI: ARI:A UU ' Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~¢//) ~¢- ~ ¢/ LOCATION SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH NUMBER OF MANUFACTURER ~,~'7'2¢¢J~ ~'/~'~-E~-- MATERIAL~4'L~ /~"~/'~/ COMPARTMENTS 2..- INSIDE WIDTH LIQUID DEPTH __ .LIQUID CAPACITY /2&~ GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER OR WIDTH__ LINING MATERIAL ~/k/~j CRIB SIZE: DIAMETER__ BUILDING FOUNDATION ~Z)/'/" NEAREST LOT LINE ~ /'/ ADDITIONAL ABSORPTION LENGTH DEPTH ,¢ C /! / DEPTH ~! DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) /'~,¢2~:~.. SQ. FT. WELL: TYPE ~g~/~ - /~¢¢~/../~L CONSTRUCTION BU I LDI NG N EA REST N EAR EST FOUNDATION__ LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED / DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK __ SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: ~-'~ o__,~, PIPE MATE RIAL~ LOT SLOPE: REMARKS: Form No, EQ~031 I01 ~ G.A.A.B. GREATER ANChORAgE Area Borough PERMIT NO. DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMI~~ INSTALLATION OF: SEPTIC TANK . SEEPAGE PIT , DRAIN FIE . OTHER SOIL TEST RESULTS _ . ~ ~ FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY Will BE SUBJECT TO PROSECUTION. ~;~ ' DiAGR}~/ OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS / FOUNDATION TO SEPTIC TANK ~ CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF [ SEPTIC TANK , SEEPAGE PIT '~ ~'ff , DRAIN FIELD DRAIN FIELD . SEPTIC TANK, , SEEPAGE PIT ,DRAIN FIELD TO RIVER, LAKE, STREAM. EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. LICENSED DESIGNER [ CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28°68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN A~OORDANCE WITH SAID CODE, ~~ R&M Civil Engineers ENG r EERING & GEOLOGIC _,L CONSULTANTS 229 EAST51st. AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA ggs03 TELEPHONE 907--279--0483 TELEX 090--35419 Geologists Land Surveyor~ JAMES W. ROONEY, P. E. MALCC LM A. MENZ ES, P.E., L.S. JAMES H. WELLMAN, P.E. June 13, 1974 ...... ,~ RALPH R. MIGLIACCIO U Engineering Geologist JUN 1. '7 1974 R & M No. 462037 Mr. Harry Foosnes 1436 Matterhorn Anchorage, Alaska Re: Test Hole and Soil Log Report for Sanitary System Lot 9 Heritage Heights Subdivision Dear Mr. Foosnes: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of June 11, 1974, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 9 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe and the test hole was extended to a total depth of 13.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS, INC. JWR:kd xc: GAAB ANCHORAGE FAIRBANKS JUNEAU TH-1 6-12-74 ORGANICS SILT, TRACE SAND (ML) SILTY SAND (SM) GRAVELLY SAND TRACE SILT (SP) 0.0~ 0.5' 1.0' 2.5' 4.0' SANDY GRAVEL TRACE SILT (GW) NO WATER TABLE 13.0" T.D. Note: Test Hole Excavated with Tractor-Mounted Backhoe. Engineering ~, Geological Consultants Inc. ANCHORAGE FAIRBANKS ALASKA JUNEAU Harry Foosnes Property Log of Test Hole Anchorage Alaska MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01~-- 1. GENERAL INFORMATION Complete'legal description Lot~t,9~ Her±rage Beights Location (site address or directions) ~rbperty owner . <UPChurch :. Mail ng address ' '~ ;- 6081 Yukon Road Day phone · Lending agency ........ Mailing address .? ' Day phone Agent Larry_ Mauiden/Jack White Day phone 762-3106 Address 3201 C Street., Suite 200, Anchorage, AK99503 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 ~ 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 seat affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. $ & S ENGINEERING Name of Firm lYU34 Eagle River Loop Road No. 204[ Address Eagle Rive, r, Alaska 99577 . Engineer's signature ~ Phone ~R~/'-~'~ '2~ Date DHHS SIGNATURE ~ Approved for ~L-0 L/',~. Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments 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) Back MOA~21 Municipality of Anchorage [~ ~ C ~_ I V E D Environmental Services Division ~J~A ~__~-~-..~9 ~)~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (90..~=~-~-~ ~unicipality of Anchorage Health Authority Approval Check~t' Health & Human Services A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production o~o[ sample: If A, B, or C, attach ADEC letter. ADEC water system number ~ Date completed Cased to _ ~ Cas~t~(~bove ground) _ ~~ ~-~roPe rl~p_r°tected (Y/N) - FROM WELL LOG ~ AT INSPECTION ~ g.p.m, g.p.m. Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed (~/~-~'~/?~ Tanksize ~,,~O Number of Compartments ~' Cleanouts(~/N). ~--~ Foundation cleanout(~/N) Date of Pu~mPing' ~¥/~'~ / ABSORPTION FIELD DATA Date i~stalled~ '~ / ~[/~ 5--. ~. Soil rating (g.p.d./ff' o~ Length ' ~ ~ ~ Width ,'~- Effective absorption a~ea Date of adequacy test Depression (Y~ ~O High water alarm (y~ N~ Fluid depth in absorption field before test (in.); Fluid depth ~ Ix (ins) Minutes later:. ~'5'~ System type 7~.'~'¢." Gravel thickness below pipe ~ '/'~- /Total depth Monitoring Tube present {~i~/N). V'~¢ Depression over field Results (Pass/Fail) /~ ~ -~ For ~ ~ / cl" Immediately after ~'93-gal. water added (in.): I o Absorption rate = ~ C) ~) -/'- g.p.d. bedrooms Peroxide treatment (past 12 months) (Y/N) ~,0,v,~- ~<,vo~,,, If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* _~~pump off" level at* High water alarm level at* _-----~~um SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sew~e Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~' 'p Property line ~ -/r Absorption field Water main/service line /o ~- Surfacewater/drainage /o~ 4~ Wells on adjacent lots On adjacent lots On a_a.¢jaeentlS'~s Public sewer manhole/cleanout SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation / ¢ ¢- Water main/service line Driveway, parking/vehicle storage area ~'- w ,¢ Wells on adjacent lots ) ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recgCf21~?~e ~/~ms are in confo~ance with MOA H~ guidelines in effect on this date. S gnatu e · ~ EngneersName IC8~,4, ~, C~ Date q~? / W ¢ . HAAFee $. ~ ~ ' ~ Date of Payment __ Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 1. GENERAL INFORMATION Complete legal description Location (site address or directions) 4, c~l too V.¢~ ~:~t u e. Property owner ("~,~.¥,~ Mailing address Lending agency Mailing address Day phone A/¢ 01~-o¢.~,~, /~14, ~ ~-/~ Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Ir~divid~al well.- Community well NOTE: Public water ,~" If community well system, provide written confirmation from State ADEC attest- ing to the legalityand status of system.- - ' ~ TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER - As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm-'~r,~u,cr~,~,~_ ~. ~vc Address ~,~,~o~ /q~ ~ A~c~ Engineer's signature_ ~ ~ Approved for '~,'./-- Disapproved. Conditional approval for DHHS SIGNATURE Phone bedrooms. bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91 ) Back MOA ¢21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE~ Environmental ServicesDivision -- E C E IV E D 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 OCT 4 1996 Health Authority Approval Checklist Municipality ut Anclq,,orage Oept, Health & Human Services Legal Description: A. WELL DATA Parcel I.D.: C~I...~- '3~,~- Z ~ Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (YFN) Date completed Total depth ~ Casing height (above ground) Wires properly protected (Y/N) Date of test Static water level FROM WELL LOG .~-~"7 g.p.m' AT INSPECTION .......~-"---'~ Well production WATER SAMPLE RES~ Nitrate Other bacteria /Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping q [z¢l°)t~ Tank size / ~ Number of Compartments ~ Depression (Y/N) ?'[ High water alarm (Y/N) Pumper C. ABSORPTION FI]ELD DATA Date installed Length ~Drt L~') Width Soil rating (g.p.d./ft2 o~ ~5~S System type T~ COq-0,5 Gravel thickness below pipe /4 2 ~ Total depth Effective absorption area Date of adequacy test ~rl~lq Fluid depth in absorptioo field before test (in.); / O'" Fluid depth /qqo ~ Minutes later: / q ~' Peroxide treatment (past 12 months) (Y/N) ~c~ Monitoring Tube present(Y/N) "~ Depression over field (Y/N) /'4 Results (Pass/Fail) qg:>~.S~ For ~t' bedrooms Immediately after~,eogal, water added (in.): Absorption rate = d-~'o '0- .g.p.d. If yes, give date ~ ~ D. LIFT STATION Date installed Manhole/Access (Y/N) ~-'"'"~ High water alarm~'~'-'-~ A *Dmum Size in gallons -----' _.___..._~-~---'-'- "Pump off" lcvcl at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ; Oo adjacent lots Absorptiou field on lot ......--------"-'~l adjacent lots Public sewer main Public sewer manhole/cleanout ~icc line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5~t Property line .5'l Absorption field Water main/service line z..g' + Surface water/drainage / m ~ + Wells on adjacent lots ! oO 4- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~t Water main/service line Surface water / e:,C~ ~- Cmtain draio /o~ 4- Wells on adjacent lots l oo '~ Drivexvay, parking/velficle storage area '~---B Property line F. ENGINEEWS CERTIFICATION I certiJ) that I have determined thrufield inspections and review c in conJbrmance ,,ith MOA HAA guidelines in effect on this date. Signatur._e ..._..~.~"~ Engineer's Name Date Date of Payment Receipt Number Rev. 8/95 OSS: baa, wk,doc Waiver Fee $ Date of Payment Receipt Number 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) Location (address or directions) (b) Property Owner Der'~o.r~(. Mailing Address (c) Lending Institution Mailing Address ~ 05- (d) Real Estate Company and Agent Telephone: Home ;~ ~/'~'- '~'¢ YO Business ~or~¢ Telephone ~¢ ~ - ~ 70~ Address Telephone (e) Mail the HAA to the followina 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, 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 72-025 fRev 8/861 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. 1 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. NameofFirm ~/~/"'/'ot~ '7"ec~[c~/ _~'~'~'~c.~_~ Telephone Address I ~30 ~o ~.~ ~ c~ ~ ~ ~ ~/~ Date ~ 7~ /~7 OF Aft.',,,. ........ 0 ORE F MOORE Seal DHHS APPROVAL Approved for ~ bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional CAUTION 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. Page 2 of 2 72-025 IRev 8/861 Back WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) MUNiCiPALITY OiEii~I'~i~JTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICF~i~'~e,~I~_~ST . FEBRUARY 1984 264-4744 AUG 7 1987 Legal Description: /- o ~ RECEIVED Well Classification ,N,,4. 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 ¢'~6 he /.1-,__o if A, B, C, D.E.C. Approved (Y/N) 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 To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~' / gS'/7 '~ Size Standpipes (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 N.A, (.p~!, I~¢ bl~o) To Property Line ~ To Water Main/Service Line ~, ~o' Course :;> ~oo Air-tight Caps (Y/N) No. of Compartments ~ Foundation Cleanout (Y/N) Date Last Pumped p / ? / ,¢ 2' N, 4.. ;for N, ,~-- ~,. Temporary Holding Tank Permit (Y/N) N, ,4. :To Building Foundation 16- ~ To Disposal Field .. To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 fRev 8/86~ Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well N, A. ( ~'~ To Building Foundation ¢ ~ ' Lot ~ 3d' ,,'Ecf,-'¢ Type of System Design Length of Field ~ 7 ~ Depth of Field 7.5' ' Gravel Bed Thickness ~ 8" Standpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line ~ to' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line ~ ye To Existing or Abandoned System on ; On Adjoining Lots ~ ~d,' To Cutbank (if present) ~,,4. ~ IOo' 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 Signed ~.~~-~, ""~'~.-~ Date Company F'1~/¢,¢t¢ 1-~c6 %'vX~ MOA No. ReceiptNo. / ~ ~/~ ~ 0 /~ Date of Payment ~/~ Amount: $ /~ ~ ** 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. Page 2 of 2 72 026 fRev 81861 Rack Engineer's Seal 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) Location (address or directions) _ 6'o0! bo (b) Applicant Name 0~ ~bo~ Telephone: Home ~'~P~ Business (c) Applicant is (check one): Lending Institution []; Owner/builder ~; Buyer []; Other [] (explain); ? (d) Lending institution Address ' Telsphone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms ~t 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 I~ 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 72-025 (11/84) 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 F'((,(~i~ l~c&~l'(c~,/ ,.~,~"~c~/' Telephone Address ~ ~¢ ~ ~0~ ~ Date ~/~ ........ ...... THEODORE F. MOORE ass, ..' Engineer's Seal DHEP APPROVAL Approved for~'~OO~--(¢)bedrooms by Approved Disapproved Terms of Conditional Approval Conditional Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION 1985 Well Classification Well Log Present (Y/N) Total Depth 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 If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Cased to _ Depth of Grouting Pump Set At Sanitary Seat on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date SEPTIC/HOLDING TANK DATA Date Installed 6'~v'~'~'f ?y ~ Standpipes (Y/N) ~' 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 ~ ~-OO~ ~ of Compartments Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation I~- ~ To Disposal Field ~" ¢ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 8,-.¢ ~ f/~¢-.¢~"~ Type of System Design Date Installed P/~ /~" t'(IDC'ht"c~'¢~ Length of Field Width of Field ~'O ~ )~4~!~' '--~ ~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Depth of Field ~ ~ Gravel Bed Thickness ~ ~' Standpipes Present (Y/N) 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 Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line 8¥ To Existing or Abandoned System on ; On Adjoining Lots ~ $~' · To Cutbank (if present) 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 ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ,9/3'o Signed ~_~'~,II~.~ ,~. ~ Date Company I¢'~'¢'~¢'¢~,~ 1",~.,~ ,.~¢-~ MOA No. Receipt No. ~- ~ % (¢ O "/ Date of Payment ~ -~-¢'~ o ..... ~ ~'-- Amount: $ ~]~ ~0 Page 2 of 2 72-026 (11/84) Engineer's Seal .Lot 9 Hermt_a~e ~_3~k- 4~lus ~qest Subdivision Laura J. Harrison Sewer and Water SeCtiOn DATE The attached paperwork is for application of refUnds.· These were done by the engi~.eers during the strike. Please make application for the money to be refunded. Thank you. SIGNED DATE SEND PARTS 1 AND 3 WITH CARBON INTACT - ~x¥ .^~ (~o s~s) ~ ~7, Redi~onn® 4S 471 PART 3 WILL BE RETURNED WITH REPLY. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER __ PHONE Bill Allen~ 276-2010 MAI LING ADDRESS Fairbanks PHONE PROPERTY RESIDENT (If different from above) Dane Harbour X[ / ,~ ~ 265-6520 MAILING ADDRESS ARCO BOX 360 99510 3. LENDING INSTITUTION"~ ~ _ ~/ / ~ v \~ ~ J PHONE Alaska Mutua~ S~ving~ and L~'n / ~--.~/~ 601 West 5th~Aven~e 9~5Ql't~ / ~, (~\~ 4 REALTOR/AGENT ~\ \ ~ ~. ) / I\ , ~'% ~' PHONE Pat Newton, Centur~ 21-~e~zta~e Homes (~k~ ~ ~ 276-1333 5. LEGAL DESCRIPTION ~ Lot 9 Heritage Height% Subdivision STREET LOCATION ~ 6 0 81 Yukon 6. TYPE OF RESIDENCE SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [] Other 7. WATER SUPPLY [] INDIVIDUAL* ~ COMMUNITY [] PUBLIC UTI LITY *ATTACH WELL LOG. A well 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 [~ INDIVIDUAL/ON-SITE*~ [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL. USE ONLY INSPECTION APPOINTMENTS -IME DATE INSPECTOFI TIME DATE DATE RECEIVED TIME DATE INSPECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE E~ SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAl_. [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3, SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -.SITE [~ PUBLIC UTILITY Connection Verified L~Septic Tank or E~Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELl. TO: NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING MANUFACTURER MATERIAL Septic/Holding Tank Absorption Area Sewer Line [] OTHER Nearest Lot Line Absorption Area to neare!;t Lot Lille 5, COMMENTS [] APPROVED FOR BEDROOMS [~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/78) ', '~ .O '~",/ ] Department~£ Health and Env±ronmental Protect±on ' '~ ~_ # 0.,¢~ ",~l ~2~ ~ S~reet, ~chorage,.Alaska 99001 ~ 279-2511, ext. 224, 225 ~ ""~' ' " . , ~.~' . . ,, . .... ,. Property Owner:~ Mailing Address: Phone: Name of Buyer: ~T/~-"J~/-- '~- -~-~. __ _l~--J-- Mailing Address: _~ ~W ~_~Z~-~--'~; Phone: · Instit~hiO~Phone: Lending : Mailing Address: __ Realt°r/Agent:7_~~-'~.__.~6~? ~-/ ~r_ -~_ z = _-~;~ .- Mailing Address: ~ Phone: ~ Legal Description: ~ ' Street Location: ~ Single Family Residence: (~ Number of Bedrooms: ~ Multiple Family Residence: ( ) Number of Bedrooms: o Water Supply: If Individual Well, well depth If Community System, name of system *Individual Well ( ) Public/Community System 8. Sewage Disposal System: On-site System (~ Public System ( If On-site System, date of installation: *NOTE: A well log is required on'ALL wells drilled since 6/75.. 3/77