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Home My WebLink AboutHERITAGE HILLS BLK 3 LT 7 '~ Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5~k,) ~)~..~ ~:~ PID Number: 015 -~l Name: ~5 ~ ~ n ~ ~ Wastewater System: . _New ~Upgrade / No. of Bedrooms: ~D~p Trench ~ Shallow Trench D Bed ~ Mound ~ Other : Total Depth from original grade: LEGAL DESCRIPTION ~oilRating: ' ~ GPD/Sq. Ft. E'~'-- LOt: ~ Bloc~ ~r'"~: ~//J~ Depth to pipe bo.om from ori~nal g~de: Gravel depth ben.th pipe Range:~t~n ;Fill added above original grade: Township: , ~-- /* 0 ~ Ft. Ft. WELL: ~New D Upgrade ~rave~width: ~ / Numbe~ of Unes: Ft. ~ Ft. Cla~ification~ }~ ;~(Private' A,B,C): T~ta~th: Ft.Cased2~To: Ft. Total absorption~5~,area: SQ. Ft. PipeA~material: ~5~-- Date installed: Yield~ J Pump ~at: / ~ing HeightA~ve Ground: SEPARATION DISTANCES ~s,pt~c ~ Holding ~ S.T.E.P. .0 ~ptic A,so.t'0. L,ff Holding .ublic/Private Ma n u,~ From Tank Field ~tion Tank Sewer Lin~ J I I Material: Numar o~mpa~men~: Water 100~ 100+ ~/~ _ LIFT STATION Foundation ~ I ~ ~ ~ -- -- -- "Pump on" level at: at: Cu~ain Pump ectd~l Ins~ions pedo~ Remarks: ~/~ ~// ~?/E~ EOm~/~ BENCH MARK . Location and Descdp~: ~ ~ , Depadment of Health and Human Se~ices approval '~'~":~""'~;:, "~t..' %-.....":,-~'" Reviewed and approved by: ~~/~ ~Date:/0 I~'~ ~ .t~...,,~.~bo 72-013 (Rev. 9/91) MOA 25 PERMIT NtJ~EER: AS BUILT DI~WING PARCEL ID NUMBER: SW980589 " 015-221 - 25 ..... 1D' UTILITY EASEMENT ,-.~:~'""~ ~ ~" ALTERNATE SITE~ /// ~ / / j WILL REQUIRE LOT N TH.1i /// C01 ~ IFC02/ / LINE WAIVER ~ ~ ~ // C02~ ~ ~ FC01 FC02 19.9' 11.6' ITN#2 GO1 1 ~ .~' 55,4' -~~/~_ ~-~ [ GO2 ~2,0' 55,1' NEW WELL MT1 13.5' 51.8 .... / / (LOCATION PER MT2 54.8' 56.4' / [ AB-~U~LTpERFORMEDSURV~By 100' WELL RADIUS SURV~ORS) ¢~,¢0 , ~S~ WA~ A~ WAS~WA~ CONS~TA~S, ~C. ~ -~ -- ;~A~ PHONE: (BO7) ~37-6179/F~: (eOT) 338-~248 _EOAL DESCRIPTION: ~PE OF WORK: PREPARED FOR: PHONE NUMBER: 0E~953 COX 345- 2372/265-264e BOB AND JAN ~$~ ".. ~ ...." DATE:] 0/15/98 ID~WN BY: SCALE: PAGE: = 2 2 *- ,STATE OF ALASKA DEPARTMENT OF NATURAL RE$OUROE8 DIVISION OF MINING & WATER MGMT LOCATION OF WELb~S¢~ ? ~0'/~ ~ ,,' WATER WELL RECORD BOROUOH , .,I ~ ,~..~.V I $IO~H LOT BLOOK 6EOTIOhl O'rRa. . Gs ~w LOCATION/~K~CH= WELL OWNER,, DEPTH8 M~$URED FROM~ca~lng to0 ~ ~roun~ - Depth of h~ie:~ft DATE OF COMPL~ION BOREHO[~ DATA: Depth Depth of caslng:~ft Material Type and Color From To ...... ___ ~ WELL INTAKE OP~NING TYPE;~open end ~ screened '~ -- ~ ~ ~ SCREEN GRAVEL PACK TYPE', ,. Volumo used: D~ t~ to~: D~ELOPMENT M~HOD:Q~~ hCT 1 g !998 __. ,.puration: D M?ficipality of A~c~or PUMPING L~L AND YIELD~ PUMP INTAEE DEPTHt ~. fl Horsepower; WELL DISlNFE~ED UPON =IACTOR INFORMATION: REMARKS: _~'~.._~/t/'~ ~.~~' PLEASE MAIL WHITE COPY OF LOG TO: o~gna'~ute of 'Autllorized Re~pre~ntatiVe' '~ DN~IDIVISI~ O~ MINING & WATER MGMT 3601 C St, ~lte 800 ANCHORAGE AK 99503-5936 Phone (9071269.8639,F~ (907)662.13~ ;.. ¢ MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Upgrade Date Issued: Oct 01, 1998 Expiration Date: Oct 01, 1999 Permit Number: SW980389 Legal Description: HERITAGE HILLS BLK 3 LT 7 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: BOB & JAN COX Owner Address: 12201 HERITAGE RD ANCHORAGE , AK 99516-2345 Parcel ID: 015-221-23 Site Address: 012201 HERITAGE RD Lot Size: 16500 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field ~ SepticTank [] Holding Tank [] Privy [] Private Well [] 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 ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE EXISTING WATER WELL SHALL BE PERMANENTLY DECOMMISSIONED IN ACCORDANCE WITH 15.55 PRIOR TO ANY CONSTRUCTION OF THE WASTEWATER DISPOSAL SYSTEM. Received By: Issued By: Date: Alaska Water & Wastewater Consultants, Inc. 7320 East Chester Heights Circle ~ Anchorage N Alaska 99504 (907) 337-6179 N Fax (907) 338-3246 Consulting Engineers September 30, 1998 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref.' Well Relocation and Septic Upgrade Design for Lot 7, Block 3, Heritage Hills Subdivision To whom it may concern: The existing 3 bedroom house is served by a private septic system and a private well. The existing septic system, which consists of a septic tank and a seepage pit, will not pass an adequacy test. Due to the current well location, it is impossible to upgrade the existing septic system outside the protective well radii (wells that serve the referenced property and the adjacent lot to the east), so we are proposing to relocate the well. The existing septic tank and seepage pit is to be abandoned completely. The existing well is to be permanently abandoned per M.O.A. requkements and a new well is proposed to be drilled in the southeast corner of this property. We request a permit to drill a new well and to install a deep trench with a 1000 gallon septic tank (see attached design). Comments regarding the proposed upgrade design are summarized as follows: 1. SOILS: Attached are the soils logs which shows the soil profile, and the percolation tests result. The soils below the organics in test hole #1 are a ML material with some SM pockets to a depth of 17 feet (bottom of test hole). The soils below the organics in test hole #2 are a ML/SM material to a depth of 16.5 feet (bottom of test hole). No groundwater was encountered during the excavation of the test holes. Two soil percolation tests were performed in each test hole(see attached soil logs). Soils visually appear to be less pei-meable than the percolation tests indicate, so a higher application rate is to be used. 2. TRENCH DESIGN: a. Percolation Rate: 6.8, 2.7, 9.2, & 8.8 minutes/inch b. Allowable Application Rate: 0.6 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day_ e. Minimum Absorption Area: 750 ft2 f. Total Depth: 10.5 feet (max.) g. Effective Depth: 7.5 feet ofdrainrock h. Width: 2,5 feet i. Minimum Length: 50 feet j. Effective absorption area = 750 ft2 k. Entire system is to be insulated. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPItY: As can be seen on the attached topography site plan, there are no slope concerllS. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179. Thank you for your assistance. incerely, ~ JamesP. W' 'am, . · Civil Engineer ~E PHYSICALLY VERIFIED PRIOFI T~L-D~LLING, ~ ~ ( .......... ~ F%¢~' / u~ ~-~' , ]520 E:~H~R "~IG~S CIRCLE, ANOHO~¢E, ~ / HE~TAGE HILLS)UB~ISlON LOT 7, BLOCK~ ~=~ARED FOR' ' k ~ P~ONE NUMBER: .... J~BOB AN'D JAN COX .~ ~5--2372/265--2649pAGE D~TE' D~WN ~: ~ ~ ~ 5C~: ~ : NOTE: THE SEPARATION DISTANCES FROM THE NEW WELL TO ALL NEIGHBORING SEPTIC SYSTEMS SHALL BE PHYSICALLY VERIFIED PRIOR TO DRILLING OF WELL, THE NEW WELL LOCATION SHALl_ BE VERIFIED PRIOR 'FO INSTALLATION OF THE NEW SEPTIC SYSTEM. TRACT D NO WELLS OR. SEPTICS ARE WITHIN 100'+ OF' THE PROPOSED SEPTIC UPGRADE. PROPOSED SEPTIC ~ SYSTEM (SEE ~ES!GN,~ \-- ~ E. 13tst AVENUE , ¢~ . ¢/~ , ¢¢~¢ E. 131s~ AVE, A~S~ WA~R A~ WAS~WA~R CONS~TANTS, ~C. HERITAGE HILLS SUBDIVISION, LOT 7, BLOCK 3 ~PE OF WORK: SITE P~N 345-2372/265-2649 COX t -PROPOSED DEEP TRENCH 50' LONG BY 2,5' WIDE BY 10,5: DEEP MA×IMUM WITH /--PROPOSED 1DO0 gALLON 7,5 OF CLEAN, WASHED / SEPTIC TANK SEWER DRAINROCK, / / ~EXISI'INO SEPTIC TANK TO / / ~E ABANDONED COMPLL~ ' / / ~ EXISfINO SEPTIC CRIB TO --DOUBLE / / / BE ABANDONED COMPL~ WiLL REQU RE LOT X /~/ ~ ~ ~ ~ ~ / ', ~///~ ~ FbUNbAT~N~ ~/ I ] ' J / / ~ ~~~&5i" ..... >~ L ..... PEB M,O.A, WELL O~INANCE. I I ' ~ i I I100' wELL RADIUS 'N~-TES: ..... PROPOSED WELL-~ t) SEPARATION DM'FANCES FROM THE N~V WELL 70 ALL NEIGHBORING SEPTIC ~STEMS SRALL BE PHYSICALLY I VERIFIED PRIOR TO DRILLING OF IHE WELL THE NEW WELL ] TH~ N~W S~PT,C ~ST~M. ~ 2) THE CON]RACTOR SHALL HAVE ALL PROPERTY LINES ;AND THE NB~ WELL ~OIUS F~GGED BY A REGISTEREO ~ ~ND SURV~OR PRIOR TO CONSTRUCTION, 3) THE PLUMB~N~ SHALL BE RE-ROUTED WITHIN THE C~WL SPACE TO COME OUT OF TRE FOUNDATION AT ~ A DEPTH OF 2.0' BEN.TH GRADE, THE CONTRACTOR SHALL VERI~ THE F~SARILI~ OF THIS PRIOR TO ~ J CONSTRUCTION. ~ m HERITAGE HILLS SUBDIVISION, LOT 7, BLOCK 3 DESIGN OF SEPTIC SYSTEM UPGRADE )~'~ PREPARED FOR: PHONE NUMBER: BOB AND JAN COX DATE:9/$O/98 IORAWN BY: ISCALE: IPAGE: A.C.G. 1 = 30' 2 OF 2 AI.ASKA WATER & wASTEWATER 7320 E. CHESTER HTS. CIRCLE * ANCHORAGE, AK. 99504 · ' PHONE (907) 537-6179 * F~ (907) 338-3246 ~'." m somL LOG PERCO~TION TESTI - ~f~" 49~ LEGAL DESCRIPTION: HERITAGE HILLS, LOT 7, BLOCK 3 ~ '[ ....... : ..... ~ .... PERFORMED FOR: BOB AND JAN COX DATE PERFORMED: 9/19/98 ~,"... c.E....'".~ ORG TEST HOLE '~r o f e s DEPTH ~ 1 ~ PA~E 1 OF 2 SOIL C~SSIFICATIONS ?:::;? GW ~ ORG :~:%:- ' .- Gp ~ML ~GC OL ME DENSE SILT TO ~ SP CH .... SOME SM. NO ~ SN OH DEPTH TO DATE GROUNDWATER ~ ¢ ~ ] I ~&~ .' DATE RE. lNG CLOCK NET TINE WATER LEVEL NET DROP TINE (HINUTES) RE.lNG (INCHES) 9/21/98 1 6:06 13~]J[JJ] 3 6:36 6" 4 7:06 30 2 5/8' 3 3/8" Hill J 14~j]j~j, 5 7:06 PERC~TION ~TE 8.8 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20~ TEST RUN BETWEEN 4.0 ~.~D COMMENTS: PERCO~TION DATA ON THIS PAGE FOR UP~ ER BENCH F~C.~OL~ ~ ;LY. PERFOMED BY A~SKA WATER ~ WAST~ATER ',//~r~A~ 11'lb THIS WAS PERFORMS9 IN ACCORDANCE WITH ALLJS~AT~-A~D MLNICI~C G~DEEINES IN EFFECT ON THIS DATE. DAm ~O~I~S DEPTH TO DATE GROUNDWATER DRY 9/19/98 DI~' ,__9/28/9B A I.ASKA WATER & WASTEWATER .~0F' z~/~, 7320 E. CHEER HTS. CIRC~ * ANCHO~GE, AK. 99504 ~'"' PHONE (907) ~57-617g * FAX [907) ~58-5246 ~ ~" '"~0 PERFORMED FOR: BOB AND JAN COX ~JAMES P. WlLLIAM~'~ '" DATE PERFORMED: g/19/9B ~ ".. NO. g60B .." ~'TEST HOLE ~ 1 / ~".... C.E. ,..." DEPTH 1- PAGE 2 OF 2 2-- SOIL C~SSIFICATIONS ! ~;/.?;;', GW ~ ORG I ML ~ ~ ~M~ CL ~ ,~ ~ SW MH ~ sP CH SM OH ~-- SC SEE PAGE 1 OF 2 7-- ~ DEPTH TO ~ GROUNDWATER DATE lO-- 11-- ~ DATE READING CLOCK NET TIME WATER LEVEL NET DROP ~ TIME (HINUTES) READING (INCHES) 12 -- 9/21/98 I 6:08 13 -- 3 6:38 6" 14 -- 5 7:08 6" .... 6-- ~ 7:38 30 2 3/4" 3 1 17-- 1B-- 19--' PERCO~TION ~TE 9.2 (MIN,/INCH) PERC. HOLE DIA, 6 (INCHES) 20 I TEST RUN BETWEEN 7.0 FT, AND 7.5 FT, COMMENTS: PERCO~TION DATA ON THIS PAGE FOR L(~WER BENCH ~RC HOLE qLY. r THIS WAS PERFORME~ IN ACCORDANCE WITH AL~ STATE AND ~UNICIF 'L ~UmDELmNES mN EFFECT ON THIS DATE. BATE, ~r'[l/~ ~/. DEPTH TO DATE GROUNDWATER ..... b~ _'7... ',ALASKA WATER & WASTEWATER 7320 E. CHESTER HTS. CIRCIF * ANCHORAGE. AK. 99504 PHONE ("07) 337-8179 * F~ (g07) 33B-3246 ~..' [SOIL LOG - PERCO~TION TEST] 49 PERFORMED FOR: BOB AND JAN COX--~[~/~~[~.~....~][[j~./...~. DATE PERFORMED: 9/19/98 / ~,'". c ~ .'".~ DEPTH ~(f~O, ORG ~IESI ~OkE ~2 PA~E 1 OF 2 SOIL C~SSIFICATIONS U~,~:~'"'' Gp ~ ML ¢~¢~,, spSW cHMH ~ ~ ~ ~ /~ J' . ~'x, ~SM OH / sc /. DEPTH TO DATE / ~ , ', GROUNDWATER i ~ X~ ~'~t~v , ~ , D~ 9/28/98 ~ATE RE. lNG CLOCK NET TINE WATER LEVEL NET DROP TINE (NINUTES) READING (INCHES) 2 6:31 10 4 6:41 10 2" 5 6:41 6 6:51 ~0 2 1/8' 3 7/8" 7 ~:51 6" ~ 7:0~ ~0 2 ~/~' 3 3/~" B.O.H. 9 7:0~ s" 10 7:11 10 2 11 7:11 ~2 ~;21 '-~-- 2 :/a" 3 3/~" ~RCO~TION ~TE 2.7 (NIN./INCH) PERC. HOLE DIA. ~ (INCHES) TEST rUN aEtweEn 4.0 ~. AND ~.5 PERCO~TION DATA ON THIS PAOE FOR UF ~ER BENCH ~RC. IOL~ (?h .Y. COHNENTS: USE 0.6 GPD/SF SOIL RATING B~ED UPON VISU~ ASSESSMEN'/tOF S(JI~J PERFOMED BY A~SKA WATER ~ WASTEWATER I,; ~ ~/{jb~ , CERTI' THAT DATE. DATE: t/0[[ Iq ~, DEPTH TO DATE GROUNDWATER DRY 9/~ 9/98 DRY 9/28/98 .ALASKA WATER & WASTEWATER 7320 E. CHESTER HTS. CIRCLE * ANCHORAOE, AK. 99504 ' [SOIL LOG - PERCO~TION TESTI ,~ ~ 49~U ~ / '~ LEGAL DESCRIPTION: HERITAGE HILLS, LOT 7, BLOCK 3 PERFORMED TEST UOLE .... 1- PAGE 2 OF 2 2-- SOIL C~SSIFICATIONS ~ GM CL ~- ~//~c )~',i~ OL ~ ~, SW '~Tm~' ~ ~HH ~ sP ~ CH ~ SH F~ OH ~- ~ sc SEE PAGE 1 OF 2 7-- ~ DEPTH TO DATE m ~ GROUNDWATER lO-- ~ 11-- ~ DATE RE.lNG CLOCK NET TINE WATER LEVEL NET DROP ~ TIHE (HINUTES) READING (INCHES) 2 6:24 30 1 5/8" ~ 3/8" 13 ~ 3 6:25 6" ~ 6:55 30 1 5/8" ~ 3/8" 14 ~ '~ - 5 6:55 6" ~ 6 7:25 30 1 5/8" 4 3/8" 15~ 17~ 18~ 19-- PERCO~TION ~TE 6.8 (NIN,/INCH) PERC. HOLE DIA. 6 (INCHES) 20-- ~ TEST RUN BE~EEN ~ 7.0 FT. ANB 7.5 FT. COHHENTS: PERCO~TION DATA ON ~IS PAGE FOR LOVrER BENCH ~RC. BOLE ?~ LY. PERFOMED BY A~SKA WATE~ · WASTEWATE~ I, ~ ~ ~ , CE~TI~ THAT THIS WAS PERFO~D IN ACCORDANCE WITH ALL ,TE A~O ~UNICIP;[L GUIDELINES IN EFFECT ON THIS .AT . DEPTH TO DATE GROUNDWATER GL ,TER ANCHORAGE AREA _ tOUGH Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~/O¢?~/'~ ~'~'(~2/~¢,dP/~/~] MAILING ADDRESS /~O/Y ~A2~~/~ ~-/~/~- ~"~'- PHONE LOCATION [-/g.-~'i7~¢¢ ~/ ~£ F~'~'/F'~f'}/v LEGAL DESCRIPTION ~- ? gZ~ ,~ /7/Z~/?i77~ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH. MANUFACTURER NUMBER OF cOMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~O GALLONS. SEEPAGE PIT: NUMBER OF PITS / . DIAMETER ___ OR WIDTH 2~-~, LENGTH~? ~7, DEPTH TOTAL EFFECTIVE BUILDING FouND/~TION ~'~7/ /, NEAREST LOT LINE t~P ABSORPTION AREA (WALL AREA) ~o~ SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE ~)r/)OS~-i) I htbld. BUILDING FOUNDATION -- CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE F ROil1: SEPTIC ~rj~/_//~ SEEPAGE TANK ~2~' , SYSTEM ~ //)r:) ' DISTANCES:. PIPE MATERIAL: LOT SLOPE: Form DIAGRAM Of SYSTEM DATE G.A.A.B. GREAT,ER AN¢3HOF~AGE AREA BOROUGH SEWAGE D~SPOSAL SYSTE~ ~ APPUCAT~ON AND / FINAl.- IH~PE~TION~ 24 HOUR NOTI~ REQUIRED. BACKFIEEING OF ANY SYSTEM ~ITHOUT FINER IN~PE~TIO~ ~ THE HEALTH DEPARTMENT AUTHORI~ ~IILE BE SUBJE~T TO p~O~ECUTIOH. SEPTIC TANK SIZE TYPE~ ] ~CT~SEEPAGE AREA. SI[E -- TYPE MINIMUM DISTANCES, ~EOUIREMENT~ DIAGRAM Of POUNDATION TO S~EPASE Pit 20 ~. DRAIN FIELD -- ~0 ~;O S;.~:[e LIt;E- 10 ~ ~r~de: 2',per IOO' J ~ZATER ANCHQRAGE AREA BORO[J~.~/ DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 CASE # Performed For ~ ~ ~ojL This Form Reports Soils Log Date Performed Subdivision Percolation Test Depth Feet Soil Characteristics 3 5 6 7 8 9 l0 Was Ground Water Encountered? If Yes, At what Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Hinute Proposed Installation: Seepage Pit Drain Field Deoth of Inlet De~th To Bottom Of Pit Or Trench CnM?ENTS: ~,%-- ~ / Test Performed B,y ~~ ~ Data Certified By: Date: 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. # 01.5-221 '~'~ TM 1. GENERAL INFORMATION Complete legal description Lot 7; Block 3; Heritage Hills Location (site address or directions) 12201 Heritage Rd. Anchorage, AK Property owner Mailing address Lending agency Mailin_g address Agent Carol Address Rob ~ ,Tan CoX Dayphone 273-8227 12931 Mission Circle Anchorage, AK 99516 Day phone Douthit/Rema~ Properties Day phone 273-8227 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water xx 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~O25 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER ordinances, and regulations in effecton the date of t~j/s Name of Firm Address 73~J0 EngineeCs A%AS~A NA~gR & ~AS~A~ CO~SU%~A~S, ZS ~O B~ PAZD $2390.00 A~ C~OSZNG ~O~ 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 corn )iiance with all Municipal and State codes, DHHS SIGNATURE ~ Approved for bedrooms. inspection. Phone Date /o//5' Disapproved. Conditional approval for 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 ~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICE~ Environmental Se~ices Division 825 L Street, Room 502 · Anchorage, Alaska 99501 Legal Description: A. WELL DATA Welltype Pr} L/~--~ Log present~N) Total depth ~--~-- ~:~ Sanitary seal(~N) Health Authority Approval Checklist ,ger:¢t: Parcel I.D.: Date of test Static water level Well production If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to .~_.,2- ~z:~ / g.p.m. Casing height (above ground) Wires properly protected (~) AT INSPECTION FROM WELL LOG WATER SAMPLE RESULTS: Coliform "~ Nitrate /' ,-~cQ rrt~//_. Other bacteria Collected by: Date of sample: Tanksize /~Off)~l Number of Compartments c:~ Cleanout (~N) ._ y~-~ Depression (Y~ /~ High water alarm (Y~') /¢~ Pumper B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout(~N) Date of Pumping C. ABSORPTION FIELD DATA Date installed / ~//4::~//~'_/¢ Soil rating (g.p.d./fF or fF/bdrm) Length ~_~) / Width c:~ / / ' ' Gravel thickness below pipe 7, ~ Total depth q*~ ' /¢*/-'/ Effective absorption area Date of adequacy test ' Results (Pass/Fail) .... For bedrooms Fluid del~th.j in absorption field before te~~. . _ 72-026 (Rev. 3/96)* LIFT STATION Date installed /~//~ Size in Manhole/Access (Y/N) ~./..~P~umF-6"n~el at* "Pump off" level at* High water alarm level at~..~¢~ *Datum Cycles~ete"~// E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /'~ '/- / Absorption field on lot /~)~) '/ Public sewer main /M'/,~ ! Sewer/septic service line : c~ ~ "/- O. ~.adjacent lots ,/<¢O '/- On adjacent lots Public sewer manhole/cleanout /4/'//~ Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 5 / Property line --~ ~ Absorption field /~_ Water main/service line tO(4'' Surface water/drainage l_('~'¢-- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIEED ON LOTTO: Property line IO[j¢' Building foundation } O / Water main/service line Surface water Curtain drain ENGINEER'S CERTIFICATION I certify that I h~ve'~te ections and review of Municipal recgr~ ,n conforman~o with~7~/~/~g~~ec, on this date. Date Driveway, parking/vehicle storage area Wells on adjacent lots I O0/~ HAAFee $ L~g"~¢/~" ~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~F~ ~:~ ~-~-'~ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 12-8-86 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7 Block 3 Heritaqe Hills Location (address or directions) 12201 Heritaqe Road (b) Applicant Name Janis Mumford Telephone: Home 345-2503 Business Applicant Address 3515 Spinnaker Anchoraqe, AK. 99516 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); (d) Lending Institution Renier Financial Services Address Telephone (e) Real Estate Company and Agent None Address Telephone (f) the HAA to the following address: ~GLE RI~ER~ AK 995~ TYPE OF RESIDENCE Single-FamilyK'l Multi-Family [] Number of Bedrooms 3 Other /, '// I ' 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 Onsiie [~ Public r"l 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 I of 2 72-025 (11/84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA~'r'/~ AND INFORMATION , As certified by my seal affixed hereto and as of the validation date shown below, t 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 FirmS & S EI~IGINEERING Telephone ~'~;'~ ~ ~ ~ ~' Address SR B 196X Date EAGLE RIVER, AK 99577 DHEP APPROVAL Approved · . Disapproved Conditional Terms of Conditional ~ppr0val 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 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MO~) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCHOI~AGF~HECKLiST . FEBRUARY 1984 D~PT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION Legal Description: Lot 7 Block 3 Heritage Hills 'OF_(; 1 5 1986 ~ELL DATA R E C E!V E D Well Classification Private If A, B, C, D.E.C. Approved (Y/N) N/A Well Log Present ('~ No Date Completed 1972 Yield .5 G.P.M.+ Total Depth Approx. 230~ased to 40'+ Depth of Grouting UK Static Water Level 192' Pump Set At UK Casing Height Above Ground 12"+ Sanitary Seal on Casing (~N) Yes Electrical Wiring in Conduit Y~) Yes Depression Around Wellhead (Y/~ No Separation Distances from Welh ~~;~ ~;~ TO Septic/Holding Tank on Lot ~/ ;On Adjoining Lots ~OO' + To Nearest Edge of Absorption Fiel~on Lot ~ O0~+ ; On Adjoining Lots ~ To Nearest PuSiic Sewer Line N/A To Nearest Public Sewer Cleanout/Manhole ~/A To Nearest Sewer Service Line on Lot Water Sample Collected by S&S Bn¢&nee~n~ ; Date ]2-9-86 Water Sample Test Results Comments ~d ~//~ , - ,// / B. SEPTIC/HOLDING TANK DATA Date Installed 11-7-72 Standpipes ON) ~es Depression over Tank ('~ No Pumping/Maintenance Contract on File (Y/N) N/A Holding Tank High-Water Alarm (Y/N) N/A Separation Distances from Septic/Holding Tank: To Water-Supply Well R2' To Property Line 10'+ To Win, el-M-mn/Service Line 30' + Course N/A Size !000 No. of Compartments _2 Air-tight Caps¢/N) Yes Foundation Cleanout (Y,~ No Date Last Pumped 1 2-1 ] -R6 ; for Temporary Holding Tank Permit (Y/N) N/A To Building Foundation 7' To Disposal Field 36' To Stream, Pond, Lake, or Major Drainage - Comments Page I of 2 72-026¢1/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 11-7-72 Width of Field 22' Square Feet of Absorption Area Depression over Field (Y/¢ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Su pply Well 100 ' + To Building Foundation 31 ' Lot N/A To Water-Mill/Service Line 30 ' + To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 225 sq=ft_/Br. Type of System Design Length of Field 27' Depth of Field 11'+ Gravel Bed Thickness 7' 686 Standpipes PreSent ~)/N) No Date of Last Adequacy Test Satisfactory for 3 bedrooms Yes 12-12-86 To Property Line 10'+ To Existing or Abandoned System on ; On Adjoining Lots 30'+ To Cutbank (if present) N/A N/A 50'+ 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 t~a~ have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. $ ENGINEE.ING Date /~-',~,~-~ Signed $~ 'J~6X MOANo. ComparwA~, .............. Receipt No. Date of Payment Amount: $ _ Page 2 of 2 72-026 (I 1/84) ~UNICIPALITY OF ..... ~ A~'~ . ,,,,-,,.~. DEPT, OF HEAL, ,., FNV RONMENTAL ~.: ~,, r pr, CE,, ,51986 ECEIVEb ~'~ ML%~ICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL ~F. ALTH DEPARTmeNT OF HEA/,TH AND ENVIRONMENTAL PROTECTION A]PPLICATION FOR R~g. ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date /////~/ (a) Legal Description (include lot, block, subdivision, section, township, range) Location (a.ddress ox directions) (b) Applicants Name ~v~, ~: ~// Telephone - Home ~O~ Business Applicants Address (¢) Applicant is (check one) Lending Institution ~-'--'-[ ; O~ner/bullder ~I ; (d) Lending Institution '~eC~[J/',"~ ~L~/'~K?~/ ~o~Telephone Address _ C/Or ¢" " (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. T~pe of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Well[-"-"~ Multi-Family~_J Other (describe) Community~ Public~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ Public ~-~ Community ~ Holding Tank ~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providin~ Inspections~ Tests~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm ~(~'~/~ ~c~/ 73 8o -f~ , Date /O,/Z7 /8~ Approved for .~ bedrooms By~ Approved '~ Disapproved Condition~ Te~s of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF I-IEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. 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° (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7--19-8~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ; ~ / 7 ! ? a Width of Field ~ ~ Square Feet of Absorption A~ea ~8~' Length of Field ~ 7 Depth of Field 7 Gravel Bed Thickness ~N~ Standpipes P~esent (Y/N) Type of System Design Depression over Field (Y/N) Sf~b~ Date of Last Adequacy Test Results of Last Adequacy Test · ~ ~/~ ~? Separation Distance f~om Absorpticn Field: To Wate=-Supply Well f~' To P~o~erty Line ~' To Building Foundation 3;' To Existing or Abandoned System cn Lot N.,4. ; On Adjoining Lots ~ 30 ' TO Water Main/Service Line N'~' To Cutbark(if present) To Stream/Pond/Lake/o~ Majo= D~aina~e Course I',1. /4. To D~iveway, Pa~kin~ Area, o~ Vehiole Sto~age Area ~ ~-~' Contents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo~ Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequa~ Test. Meets MOA Co~ents - -- ** Check Permitted Bed~ocm Rating A~ainst HAA Request I certify that I have checked, verified, o~ conforf~-~d to all MOA HAA Guidelines in eff~ct on the date of this inspection. _~~9~ Signed ~ ~. ~ Date iI/Z?/~ ~"%-~' ........ ff,~..' A ~ ; THEODORE F. ~OORE ..... [Page 2 of 2] 'q~;.' '~,~,""-.~,- ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Ix OV. 1 984 Well Classification $t*/~4.~ F/~I~,&~ Well Log P~esent (Y/N) P~ Total Depth ~3~; ' ~ o~r Cased to Static Water Level ~ 1~o' ~3. Casing Height Above Ground ~ '/~ F~ Electrical Wi~ing in Conduit (Y/N) ¥ Separation Distances f~om Well: To Septic/Holding Tank on Lot ~g ~ ' To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~/} Date Completed ~N~ Legal Description: ~O~ 7 .. If A, B, c~ C, D.E.C. Approved(Y/N) ~ ~ ? ~_ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression A~ound Wellhead (Y/N) ; On Adjoining Lots ~ ; On Adjoining Lots 7 To Nearest Public Sewer Cleancut/Manhole N t% To Nearest Sewe~ Service Lir~ on Lot .... ..N/t Wate~ Sample Collected By ~-~ ; Date Water Sample Test Results B.. SEPTIC/HOLDING TANK DATA Date Installed It / 7 /7 ~ Size I000~,~1 NO. of C~a~tments ~ Standpipes (Y/N) ~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Depression ove~ Tank (Y/N) ~ Date Last Pumped ~, O'-~,~ ~ 1~8~ Pumping/Maintenance Contract on File (Y/N) N.~. ; for Holding Tank High-Wate~Ala~m (Y/N) N.~. Temporary Holdi~gTank Permit (.Y/N) Separation Distances f~om Septic/Holding Tank: To Water-Supply Well ~8' To P~operty Line 16' To Water Main/service Line Course 7 ~o0' To Building Foundation 7 ' To Disposal Field ~6'' ^I,A. To Stream, Pond, Lake, c~ Major D~ainage Counts [Page 1 of 2] 2-15-84 ' , -' ~ I[ 5 RECEIVED iNSPECTi~)i,,: APPOI NTM ENTS TIM[~ TIME TIME DATE DATE DATE . MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC[~oNM[NT~L PAOTECTIOH 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION /~'~(~ ~ ~ i~ Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER PHONE ~AILIN~ ADDreSS PROP~T~ RESIDENT (If different from above) PHONE ~AI LI NGADDR ESS MAILING A~RESS ~C[~I~ RC~'~ ~ ' 5. LEGAL DESCRIPTION LoT TREET LOCATION 6. TYPE OF RESIDENCE [I~"~ING L E FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [~] One [] Four [] Two [] Five E~ree [] Six Other 7. WATER SUPPLY [~'~DIVI DUAL* [] COMMUNITY [] PUBLIC UTILITY * 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 D//./~SAL SYSTEM ,ND,V,DUAL,ON-S,TE-- Iff '7'3 YEA, ON-S,TE SYSTEM WAS ,NSTALLED. [~] PUBLIC UTILITY /¢,,/~ ?- 7 ~-~ ¢':"L~ /~ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS E~SINGLE FAMI LY [] ONE [~;~TH R E E [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL ~ COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PI~RMIT NUMBER [~]INDIVIDUAI_/ON -SITE DATE INSTALLED [Z3 PUBLIC UTI I. ITY Connection Verified INSTALLER b~]Septic Tank or L~] Holding Tanl< / /,~.~/- Size: /¢zF-r -o _ If Tank is homemade SOl LS RATING give dimensions: TYPE OF TANK ~;L MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Lin~' I WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~ APPROVED FOB __ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~ DISAPPROVED ALASKA i nuiRonml nTAL COrlTROL $1 RUICI $, ~nclin~rin§ F~ ~n~ironmenlal $1udJcs IF1C. 10/16/81 1',4UNICIPALITY OF ANCHORAGE DEPT. OF HEALTii & ENVIRONMENTAL PROTECTION RECEIVED GARY LYNCH SRA BOX 1597-B ANCHORAGE AK 99507 SRf,T,ER - GARY LYNCH BUYER- SUBDIVISION-HERITAGE HILLS BLOCK-3 LOT-7 ADEQUACY TEST FOR SEWER SYSTSM THE TYPE OF ABSORPTION SYST~4 IS A PIT WITH AN AREA OF 686 SQFT. THE SYST~4 IS CAPAfAT,~. OF ACCEPTING 450 GAT,TONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYST~4 IS 485 GAT,TONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 B~DROOM HOME. THE SEPTIC TANK WAS PUMPED ON 10-16-81 . SEPTIC TANK ADEQUACY T~IE EXISTING SEPTIC TANK VOLUME O~ 1000 IS ADEQUATE FOR 1220 UJest 25th Aucnue · Anchor,§e, Alaska 99503 · (907) 276-1361 825 "L" STREET ANCHOFiAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SU[ I. IVAN, MAYO[{ I)EPARI'IvlEN'r OF IAEA[ TI I ANO I2NVIRONMF['..,'I AL PROTECTION October 6, 1981 Garry T. Lynch Star Route A Box 1597-B Anchorage, Alaska 99507 Subject: LOt 7 Block 3 Heritage Hills Subdivision (2) Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: The water analysis report needs to be submitted to from the Chem Lab, 5633 B Street, for this office our ev ew. A well log submitted to this office for our files and review. (3) The septic tank pumped with a receipt submitted to this office. (4) An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. If there are any further questions, please call this office at 264-4720. Sincerely, James S. Roberts Associate Environmental Specialist JSR/ljw cc: Spokane Mortgage 3201 C Street, Suite 250 99503 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received January 31, 1977 Time of Inspection Date of Inspection ~~. REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. Approval requested by: Home Federal Savings.and Loan Mailing Address: 535 D Street Phone: 272-1451 2. Property Owner: Roger/Venita Morris Phone: 344-4035 Mailing Address: Star Route A Box 1597-B 99507 3. Legal Description: Lot 7 Block 3 Heritage Hills 4. Location: ~.~0 5. Type of facility to be inspected Single Family No. of bedrooms 6. Well Data: A. TyPe Individual C. Construction // Sewage Disposal System: On-site system B. Depth D. Bacterial Analysis A. Installed 1973 B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A, Well to: Septic tank Nearest lot line , Absorption area , Other contamination , Sewer Lines __ B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages ~.~ ~,) ',~.~/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES MUNICIPALITY OF DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION' g E C.E.LV_E D. CONV. 1. Type of Inspection: CMRO VA FHA 2. Property Owner: -~-~:~"~ ~ ~'/~/V/?/¢ ~~/~ Mailing Address: ~ ~X /~;-~. ~'Day~'~ ~Phone: Mailing Address: ~0' ~oX q Day Phone; 4. Name of Lending Institution: ~/~6 ~ ~¢-4 / ~,//-;' / Mailing Address: ~ ~ ~. ~'~ Phone: 5. Name of 'Realtor or Agent: /~ ¢ ~/* ~'--~ 6. Legal Description: Type of Facility to be Inspected: ~¢ z ~ ,z c ~, No. Water Supply Type of Supply: Public Utility. ,Individual. If Individual, number of dwellings presently served If Individual, depth of well ~:t k~ o ~3 ~ Sewage Disposal System Type of System: Public Utility. If Individual, date of installation Individual (on-site) ¢- ' 72-003(3/76) Page 2 of two pages - Re( ~t for Approval of Individual $ ~r & Water Facilities L~egal Description Lot 7 Block 3 Heritage Hills Comments Approved Disapproved Date ~- ~/~ Appr~ Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) GREATER ANCHOEAGB AR£A BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279~8686 Date Received Time of Inspecfion Date of Insooction~' REQUEST FOR AP?ROVAL OF INDIVIDUAL SEt~ER & ~;~A/q~R FACILITIES FO~ 3. Legal Descrip~ion:~% ~ ~ ~) Number of Bed(~ . _, Well Data: ~ ~' Sewage Dtsoosal ys%e ~ ~ ~ Septic Tank: 1. Size~OOO 2, ~anufacturer~ Seepage P~t~ 1. Size~ ~ ' Disposal Field: To%al Length of Lines Distances: A. Well To: Sep%tc Tank_~_.~, Absorption Area~/~ , Nearest Lo% Line ~ / Othe~ Contamination Absorption Area to Nearest Lot Line_____~_~ ! , Sewer Lines Re~q~_e~st for Approval c individual Sewer & Water Facili° 'es Two ~--~ ~' Date~ /~ Approval Valid {or One Year Fa.eom Date Signed Anchorage Area Borough, DeFarkment o{ Environ=.ental Qua!~y DIA~RAM OF o.STEM [ and accurate representation of the subject' .~ewer and water faci!itfes located