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HERITAGE PARK BLK 2 LT 2
H ritage Park Estates Block 2 Lot 2 #050- 2 ! 1-78 ,_, Municipality of Anchorage Pag.e 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: ~Wqq02~2 PID Number: Name: Wastewater System: [] New /~Upgrade /dTo~ ~D,~o~ ~v~. ABSORPTION FIELD ~ ~/V~ ~ ~E77 Ne. otB oo~s: ~ Deep Trench D Shallow Trench ~Bed DMound DOther LEGAL DESCRI PTI O N Soil Rating: Total Depth from original grade:~, ~. ~ GPD/Sq~ Ft. Lot: Block: Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe ~ ~ ~1~ ~ ~,~ Ft. ~.~Ft. Township: ~ Range: Section: Fill added above original grade: Gravel length: ~ / Ft. ~9 Ft. I WELL: ~ New ~ Upgrade Gravel width: Number of lines: Distance baleen lin~; ~ Ft. / ' Ft. Clessification (Private, A,B,C): ~/~ Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilted: i Static Water Level: Installer: Date installed: Ft. ~ ~~TIO~ ~-~-~ vi,~u: ,,ms,, a~: C~,in, ,,i,~*~ov~ ~rou,~: TAN K GPM Ft. Ft. SEPARATION DISTANCES ~septic ~ Ho~ding ~ S.T.~.P. From Tank Field Station Tank Sewer Lines ~WC~ ] ~ ~ Material: Number of Compa~ments: Surface '~ '+ LIFT STATION Water /00 /~ Lot ~ufacturer: Line ~' ~ ~ - ~ Foundation /0~ ~' ~ ~ ,,,Pump on,, level at: ~~ at: i High water alarm at:~__~,,,_._, I _ . ~¢~ ~ ~ =umpMake&Model IElectricallnspectionspedorm~o~ Cu~ain Drain Remarks: BENCH MARK Location and Description: Assumed ¢¢¢'~ ~1 Elevation: ENGINEER'S SEAL S & S ENGINEERING ¢ ~./~/~? Inspections performed by: E..~..i~.,. ~b.~.,~s~ Dates: 1st 7 -z7-9~ ,, ~ ~~-~-~.~ Department of Heal nd Hu 8e~iGes appro~a 72~13 (Rev. 9/91) MOA 25 · Per~it No.Sw940252 Page 2 of 2 Municipality of Anchorage 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 Legal Descriptio~ERITAGE PARK SUBD., BLOCK 2, LOT 2 PIDNo.: 05021178 SCALE CO1 C02 i000 GAL SEPTIC TANK -EXISTING SYSTEM BE USEO IN THE FUTURE NEW FINAL lOpO GAL. SEPTIC iTANK 93.1' C04 PCO'~6:ST0:0 CO1 22.0 1~.0 C02 25.0 19.0 DV 31.0 27.0 C03 33.5 46.5 C04 42.0 68.0 MT1 34.5 6~.0 82.8 ................... ~.~...~ NO WATER F0.b~.l~]) ........... LOT 2 DRIVE PROPERTY SERVED BY (~OMMUNITY WATER SYSTEM. NO V'/.[LLS WITHIN 200' 017 SEPTIC SYSTEM. No. 1457.~ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PER_MIT PERMIT UMBER:SW940252 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:COX BRUCE A & LOIS D OWNER ADDRESS:10708 TRADITION AVE EAGLE RIVER, AK 99577-8412 DATE ISSUED: 7/21/94 EXPIRATION DATE: 7/21/95 PARCEL ID:05021178 LEGAL DESCRIPTION: HERITAGE PARK BLK 2 LT 2 LOT SIZE: 25800 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS RECEIVED BY: . DATE: DATE: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. July 12, 1994 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGiNEERiNG STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD CESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Heritage Park Subdivision; Block 2; Lot 2 Request you issue a permit to upgrade the septic system serving the three bed~o~mhouseonthe referenced property- An adequacy test was performed on the existing system and the absorption capacity of the system was found to be inadequate. A test hole was excavated and a percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the test hole has been checked and found to be dry. Attached is the proposed upgrade design. This property is served by a Public Water System. There are no protective well radii which encroach upon the property. We do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic system. If you have any questions, or require additional information for your review, please contact us. /E~/LSU/jk 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 w Z 3 (]¥~Od,9 ,og = Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE P[ Township, Range, Section: 1 2 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN I WAS GROUND WATER ~.~ . ENCOUNTERED? IF YES, AT WHAT DEPTH? ~ ..,~....~ Gross Net Depth to Net Reading Date Time Time Water Drop I q -. 1 PERCOLATION RATE __ TEST RUN BETWEEN __ l ~'~(minutes/inch) PERC HOLE DIAMETER ,~'~ FTAND ~'"~ FT $ & $ ENGINEERING PERFORMED BY: ~ 7034 i=agie Kiver Loop Road, No. ~04 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ,~_a,.~/A~E'~I~ilI~(~UIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ON-SITE WAS'£~.WATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES MATERIAL SPECIFICATIONS Heritage Park Subdivision; Block 2; Lot 2 1. The scope of this project includes the installation of a leachfield trench to serve the three bedroom residence located on the referenced property and excavation of the existing septic tank to verify its integrity. If the integrity of the existing septic tank is poor the existing septic tank is to be excavated, pumped, crushed, and abandoned. The existing leachfield is to be abandoned in such a way that is may be used in the future. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANKINST~r~.ATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Heritage Park Subdivision; Block 2; Lot 2 July 12, 1994 Septic tanks installed with less than 4' of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10' from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENC~/DRAINFIELDINSTALLATI(]N: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution 'pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter and installed approximately in the locations shown on the design. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 1. M~/.~aIALSP~IFICATIONS: Any septic tank proposed for installation must be constructed Municipally approved septic tank manufacturer. by a Page Three Heritage Park Subdivision; Block 2; Lot 2 July 12, 1994 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTMD3034 (P¥C) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. Ail leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements. Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. Se The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Page Four Heritage Park Subdivision; Block 2; Lot 2 July 12, 1994 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER MAILING ADDRESS LEGAL DESCRIPTION LOCATION t. /' 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 P,ONE Absorption area /0 / I nside length Dwelling Width NO. OF BEDROOMS ,? PERMIT NO. No. of compartment:~_ Liquid depth Dwelling PERMIT NO. Liquid capacity in gallons Well I I DISTANCE TO: I "~ ~ ~L I- 2 Manufacturer / I ~ DISTANCE TO: [Well 0 ~<~ IManufacturer o I Well ./ ~:z:: IDISTANcE TO: I ; ~ I No. of lines / I Length °f each line~ ,, I ~l-Z~:l / I < ~. I Top of tile to finish grade ., ) ILength Width ,~ I- I Type of crib Crib diameter ~ I DISTANCE TO: .~ IClas~-~ ~ Depth ~ I ~'~.A/~-~ ' ~ ~ISTANCE TO: Building foundation Material Nearest Trench wd~inches Foundgtion Total length of~n~,~ Material beneath tile Depth PERMIT NO. Distance bet w~.~ Total effective~s~p~n area PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s} OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS DATE LEGAL PERMIT N] 8'":.--'5 "'b- / STREET., RNCHORRGE., BK. 264-4720 ( 8-'-':0288 RPPLICRNT LOCRTION LEGRL DEVCON ENT. INC. 54ii OLD SEWRRD HWb'. LOT 2 BLK 2 HERITRGE PRRK SUB LOT SIZE TYPE OF SOIL RBSORPTION S'¢STEM IS: TRENCH MRXIMUM NUMBER OF BEDROOMS 56i-i082 9999 SQURRE FEET SOIL RRTING (SQ FTZBR)= 85 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: [:.EF'TH= 2L ~.-]~ L E ~'-~ ~'~.J T H-- 22 ,3F:R %.'EL [:.EF"TH= ~:::_; THE LENGTH DIMENSION IS THE LENGTH (IN FEET;, OF THE TRENCH OR DRRiNFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCR9RTION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH iS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE E~CRVRTION (IN FEET). F'ERMIT RF'F'LIC:RNT HRS THE F-:ESF'ONS!BIL!T"r' TO INFORM THIS [:'EF'RRTMENT [~IJRING THE INSTRLLRTION INSPECTIONS OF RN"r' WELL'"] RDJRCENT TO THIS PROPERT"r' RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. TI~--~O ,:.' 2 ::. ~1 ~-.~5F'EC:]- Z C,~-~-~-; RF-:E F-: E L-T.." L~ z BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RN[:, RPPROVRL BY THIS [:,EPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMLIM DISTRNCE BETWEEN R WELL RND RN~ ON-SITE SEWRGE DISPOSRL SYSTEM IS ±00 FEET FOR R PRIVRTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE T~PE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRI9RTE SEWER LINE IS 25 FEET RND TO R COMMLINIT~ SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. I CERTIFY THRT 1: I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH B'¢ THE MUNICIPRLIT'¢ OF RNCHORRGE. 2: i 14ILL INSTRLL THE S'¢STEM IN RCCOR[:,RNCE WITH THE CODES. Z.': I UN[:,ERSTRND THRT 'THE ON-SITE SEWER SYSTEM MR'¢ REQUIRE ENLRRGEMENT iF THE s IGRESN~~.f~~IDENCE/~ S REMO[:,ELED ,TO.-I_~ NCLUDE MORE THRN_~_~_~__3-: BEDROOMS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST 5 6 7 8 9 ,..~.~10 11 12 PERFORMED FOR: LEGAL DESCRIPTION: SLOPE PLAN CUT 13- 14 15- 16 17, 18- 19- 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net '-.. Reading Date Time Time Water Drop "'":,i:.i!i:l,~2t 4-1'b0 0 I',(~0 PERCOLATION RATE ~ Z (minutes/inch) TEST RUN BETWEEN ~ FT AND G FT COMMENTS 72-008 (6/79) L-I g I hereby certify the following described property, LOT 2 , BLK 2 HERITAGE PARK Anchorage Recording Precinct, Alaska, has been surveyed by me. or at ,my direction, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adja. cent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines, or other visible easements on said property, except as indicated hereon, It is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finished grade and utility con- nections and to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. ENGINEERS '/ ~ SERVICE~ P.,O. BOX 104053 ANC~ AK 99510 Date: 7 - 15-85 !Scale: 1"=40' Grid: NW 055 MUNICIPALITY OF ANCHORAGE Development Services Department} Phone: 907-343-7904 On -Site Water & Wastewater Section ter' Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-211-78 1. GENERAL INFORMATION Expiration Date: 9?^ 1!? - 2 ©Z3 Complete legal description HERITAGE PARK BILK 2 LT 2 Location (site address) 10708 Tradition Avenue Eagle River AK 99577 Current property owner(s) VANDEGRIFF KEVIN & CONNY Day phone Mailing address 10708 Tradition Avenue Eagle River Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone AK 99577 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic El Water Storage ❑ Holding Tank ❑ Community Well El Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Dista Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5 Waiver Fee $ Date of Payment $ °Z6 2 Date of Payment Receipt Number. o Receipt Number COSA # 0_'5C_2_1 1516 Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE 6. DSD SIGNATURE System #1 Approved for 2 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Phone 907.406.1058 Date 2 ®. .... ............... uttsL. LS .� .o'• Date . No. C 11904 PRS F ESS bedrooms, with the following stipulations: \PALI TY p QAt O qTF� ATF yo Z5 M J o 7" , m liq&l z1, �-4—iOriginal Certificate Date: CY —I '2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other S-V-ee ( Via^ Legal Description: HERITAGE PARK BLK 2 LT 2 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COS Sta=ments water _v6'at beginning of test ft. Community well B. TANK DATA Age of tank(s) 27 years Tank type/material septic Measured operating fluid level in septic tank ❑® Standpipes/foundation cleanout per record drawing Date of pumping June 7, 2021 D. ABSORPTION FIELD DATA Parcel ID: 050-211-78 Structure served by this system Well production at time of test apr-r'' Water storage tank volons Well disinfected oliform test? �E] Yes ❑ No MC om!' m bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance Age of lift station N Lift station material Comments Which system tested (date installed) 1994 Adequacy test date 81181202' ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 9.6 ft (max) Fluid depth prior to test 33 in Measured depth to pipe invert from grade 4.1 ft (min) Water added 641 gal ❑ N/A — pressurized field New depth 45 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective FMCode-requiredsoil cover over field Final fluid depth 33 in FE System presoaked Absorption rate '450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sew -Manhole/Cleanou ❑ Yes if No ft ❑ Y Neighboring Tank > 100' F-1Yesif No ft rivate Sewer/Septic Line > 25' F -1Y Absorption Field on Lot > 100' F-1Yesif ft Holding Tank > 100' ElY Neighboring Absorption Fields > Animal Containment > 50' EJY ❑ Yes if No ft Manure/Animal Excreta Storage > 10 Commu ' ewer Main > 75' Yes if No ft ❑ From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes t > 100' ft Surface Water > 100' ❑✓ Yes if No ft Yes if No ft Yes if No ft Yes if No ft Absorption Field > 5' 0 Yes Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' Yes if No ft if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No 0' If septic tank is under driveway comment below Yes if No ft Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots: ✓❑ Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Service Line > 10' F/� Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. _ COSA Checklist yellow sheet * "4 TH Cu s L. TOwnse d • • • ` . t Q� Date 2 20 y �ipNo. C 11 AV �����PROFESSVO��V` �- �GiN;ER° MUNICIPALITY DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 AN On -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic 'Tank advisory Certificate of On -Site Systems Approval #OSC211516 Subdivision: Heritage Park Blk 2 Lot 2 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 27 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. 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(50 -211-78 1. GENERAL INFORMATION HAA# !-I tot Expiration Date: Complete legal description Lot 2, Block 2, Heritaqe Park Estates Subdivision Location (site address or directions) 10708 Tradition Avenue Current Property owner(s) John and Beth Brewer Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Un/ess otherwise requested, HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: Three {3) 'Day phone 696-0917 10708 Tradition Avenue Eagle River, AK 99577 Day phone Day phone ~;"' T~'PE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _A Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority - Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for propedies served by a pdvate or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION'BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchoraqe, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE ~ Approved for ~ Disapproved. Conditional approval for bedrooms. Phone 522-7773 Date 5/6/2003 bedrooms, with the following stipulations: ~.~': ON-SITE ; ~: WATER AND ~' ;. WASTEWAII::I~: ~ .. p~nP~!RAM ... ... ... l/l J)))) Additional Comments Attachments: HA,& Checklist Septic System Advisory Well Flow Advisory IRev', Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: .-~'' /~" 0 ..~ Legal Description: A, WELL DATA We~ type A Date completed ~ Total depth. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK '99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Lot 2. BIo(;k 2, Herttane p~rk SubdiYision IfA, B, or C provide PWSID # 212291 Sanitary seal (Y/N)__ Cased to ft. FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform colonies/lO0 mL Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size t.001) gal. Foundation cleanout (Y/N) _Y Date of pumping 5~/200~ C. ABSORPTION FIELD DATA Date installed 7/29f1994 Length 54 Total depth 10 ff. Nitrate mg./1. Collected by: Number of Compartments ~ Depression over tank (Y/N) N Pumper JR's Ppmpinq Parcel ID: 050-211-78 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION ft. g.p.m. in. Other bacteria colonies/100 mi. Date installed 7~1111994 Cleanouts (Y/N) ¥ High water alarm (Y/N) N Soil rating (g.p.d./fl= or ft=/bdrm) .8 GPD/SF System type Deep Trgnch ff. Width ~!. ft. Gravel below pipe Eft. absorption area 594 fl= Monitoring tube Y Depression over field N Date of adequacy test 4/28/200~ Results (Pass/Fail) Pass Fluid depth in absorption field before test 47,5 in. Elapsed Time: 15 min. Final fluid depth 48 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N For ~. bedrooms Water added497 gal. New depth51 in. Absorption rate >= 450 g.p.d. If yes, give date D. LIFT STATION Date installed · "Pump on" level at Datum E. in. SEPARATION DISTANCES Size in gallons 'Pump off' level at in. Cycles tested Fo SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot NIA' Absorption field on lot NIA Public sewer main NIA Sewer/septic service line NIA Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots >20~ On adjacent lots >200' Public sewer manhole/cleanout NIA Holding tank NIA RFPARATICLN DISTANCES FROM ,.~EPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Water main ~ )/~) / Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >5' Water service line Building foundation >10' Surface water >100' Wells on adjacent lots >200' Absorption field >5' Surface water >100' Water main >10' Driveway, parking/vehide sto~age >25' Properb/line >10' Water Service line >t0' Curtain drain None Noted COMMENTS in. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 5/612003 Waiver Fee $ Date of Payment Receipt Number --: L-I '1 herebycertify the following described property. LoT ~_L_. BLK , 2 _HERITAGE PARK Anchorage Recording Precinct. Alaska. has been surveyed by me. or at .my direction, and that the Improvements sltualed thereon are within the property lines and do hal overlap Or encroach on the property lying ad[a. cent thereto, that no Improvements on property lying adjacent thereto encroach on the premises in Question and that there are no roadways. Irsnsmiesion lines, or olher visible easements on said property, except as Indicated hereon. Ir Is the responsibility of the owner or builder, prior to construction, to verify proposed building grade relative to finished grade and utility con- nections and to data,nine the existence of any easements, covenants. or restrictions which do ?et appear on the recorded subdivision plot. '~ ' SERViC~ P.O. BOX 104053 ANCI AK 99510 Date: 7- 15-83 Scale: 1'%40' Grid: NW055 °°°°°°°g> m ooo ~P> oooiooooo~ °°°°°°°°° zz °m P 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 Lot 2; 'Bl~' 2; Heritage Park Location (site address or directions) Property owner Mailing address Lending agency Bruce and Lois Cox 10708 Tradition Eagle River, AK 10708 Tradition Ea~le River, Day phone 696-4082 (h) 564-6350 (w) AK 99577 Day phone Mailing address Agent PHH/HOMEOUITY Attn: Ed Vau,qhn Day phone (708) 57 I-$295 Address 2221 Camden Court Oakbrook, Illinois 60521 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water XXX If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: xxx 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 it21 STATEMEI~I'~ OF INSPE~CTION 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 su. pply 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 ~ Phone · S & S ENGIN.~I~ING / Address 170.14 Eaole'/l~er L~" Rc~ed No. Eagle P~las~.~'577 ~ ' Engineer's signatu~?~' ~ Date Sm DHHS SIGNATURE Approved for ~ 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 D H HS 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..O25(Rev, 1/91) Bsck MOA~I Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:/-/£~IT//GE' ~,12.Jc. I~-0¢/:-. 2_., ~-o~- 2_ Parcel I.D. A. Well Data Well type ~,~,,~;~z~'? If~,)B, or C, aEach ADEC le~er. ADEC water system number Log pr~ ~ Date ~mpleted .~ Total depth ~~ Casing height Sanita~ seal (Y/N) ~ Wires properly protected (Y/N) Static water level Well flow p~~~ · SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~o~ ' ~- Absorption field on lot :zoo ' ~ Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /J./,~ WATER SAMPLE RESULTS: Coliform Date of sample._~~ ~ B. SEPTIC/~ TANK DATA Date installed '7 -~ -,~¥ Cleanouts (~N) ~/~$ High water alarm (Yin) __ Nitrate O~ Collocted y: Tank size /¢oo d-,~c, Compartments Foundation cleanout (~N) V=~ Depression /J, Alarm tested (Y~) Date of pumping '~--~., 7-;~,*J~-._ Pumper SEPARATION DISTANCES FROM SEPTIC/I~tE~Et~ TANK TO: Well(s) on lot f'/.~ On adjacent lots To property line /yS'~ Absorption field z~' ' Surface water/drainage /,~d ~- Foundation Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C, LIFT STATION Date ~'~ts~._~ Manufacturer Size in gallons ~ Manhole/Access (Y/N) Vent (Y/N) _~ _ ~ ~bc~f ~Jacent lots Surface water D. ABSORPTION FIELD DATA Date installed 7 - ~ c/_ R '-/ Soil rating (GPD/FF) 42, ? System type .R~,2~-?~-/c,d Length ~'~ ' Width ~' Gravel thickness ~ .~' ' Total depth Total absorption area ..~c)~/ 4z~ Cleanout present (~N) y~-_r Depression over field (Y~) Date of adequacy test /U~v~ ~'ys~-e~,, Results (pass/fail) /.-2./74-. for o-~ _~-~--~'-Bedrooms ~aier le~on t~eld beTore'test ~-----~ After test Peroxide trea_~~nths) (Y/N) If yes, give SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Sudace water Curtain drain On adjacent lots 2©o ' ~ Property line 2~,' To existing or abandoned system on lot ~'o ' + Cutbank ~'o ' + Water main/service line /dO t ~ Driveway, parking/vehicle storage area ~ E. ENGINEER'S CERTIFICATION I cerb'fy thatl have checked,~ed to all MOA Signature Engineer"s Nall~:~. ~.~.~ ~ ~.6 i~, 2-u4 ¢ and HAA guidelines in HAA Fee $ Date of Payment Receipt Number Vr' Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)° Back MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 2; Block 2; Heritage Park Subdivision Location (address or directions) 10708 Tradition, Eagle River, Alaska (b) Property owner Gerald and Elizabeth Stevenson Mailing Address (c) Lending Institution Mailing Address Telephone: (home) Business Telephone (d) Real Estate Company and Agent RE/MAX OF EAGLE Address 16600 Centerfield Driue~ Suite 201, Telephone 694-4200 - Audrey Ma~on Ea~le River, Alaska 99577."' (e) Mail the HAA to the following address: (or check here P~, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road. Suite 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community~- Public,~ Note: If community well. system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site r~ 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~)25 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat 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. ~ further verify that based on the information obtained from the Municipality of Anchorage flies 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 S & S ENGINEERING Address ,-,,,o.~ c~,,i,= plve_r Loop Roe~ ILl,-, on,, Eagle River, Alaska 99577 Date Telephone 6. DHHS APPROVAL Approved for ~ bedrooms by Approved c//~%...~ Disapproved Terms of Conditional Approval Conditional TheMunicipalityofAnchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHSdo not conduct inspections or analyze data before a certificate is issued. TheMunicipalityofAnchorageisnot responsible for errors or omissions in the professional engineer's work. Page 2 of 2 Well ClasSification J~ Well LOg Present (Y/N) Total Depth Cased to Static Water Level. Casing Height Above Ground E ectricalWiring 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 To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~. b~,-~- MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: Date Completed Depth of Grouting If A, B, C, D.E.C. ApProved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) "f' ; On Adjoining Lots ~_. OO ~'Jr ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed -'~- Ib-~.~ Size ( StandPipes (Y/N) L~ Air-tight Caps (Y/N) Depression over Tank (Y/N) No. of Compartments 2~ Foundation Cleanout (Y/N) Date Last Pumped ~ - / - ;for Pumping/Ma!ntenance Contact 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 [ 0 To Stream, Pond, Lake or Major Drainage Course Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field 72-026 (Re~;. 7/88) Front page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed _~'-- /~ Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test Length of Field ·, Depth of Field ~Gravel Bed Thickness -~ ~ /o Statndpipes Present (Y/N) AJ ~ . Date of Last Adequacy Test To Water-Supply Well To Building Foundation Lot /kJ/¢l To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ~' ¢/~[:;~ Type of System Design SEPARATION DISTANCE FROM ABSORPTION FIELD: ~. ¢:t~""f To Property Line ~.O/~ To Existing or Abandoned System on ; On Adjoining Lots ~, O / "~ ! / O 'h To Cutback (if present) Comments D. LIFT STATION Date installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **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 thi.~.~ inspection. Signed $ & ~GINEERING 17034 Eagle.River. . Loo?,.?oad~,,, No. 204. Company Eagle Rivet*, t~asKu Receipt No. Date of Payment Amount: $ Receipt No. Waiver Fee: $ 72-026 (Rev. 7/88) Back Date of Payment Page 2 of 2 I~/, 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, townsJ:~p, range) Location directions) or ~_;~. _ / '(address A~plicantName~.~.~ ,~--¢,/¢~'.~-~, Telephone:Home ~--~'¢'/-'=~'?'/ Business ~-~V~ (C) Applicant is (check one): Lending Institution =; Owner/~der =;Buyer =; Other~(explain); ~~ TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms '~ Other WATER SUPPLY Individual Well [] Community E] 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. 72-025 (11/84) Page 1 of 2 ENG~iNEERiNG FIRM PROVIDIN~=~SPECTIONS, TESTS, FILE SEARCH, DA'~-,~-~AND INFORMATION - , As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Hearth 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 flies a~d from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ali Municipal and State codes, ordinances, and regulations in effect on -the date of this inspection. ' · Name of Firm Address ,,., PH, ~94-2979 Date Telephone DHEP APPRO..~i~ ._.. ~ Approved for ~ bedrooms bY/~ -' Y'u~"l ~-~-~~ %Date Approved ,~.~ . Disapprov'e'd Conditional 0 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 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 (~ 1/84) MUNICIPALITY OF ANCHORAGE (MO'~}~ ENVIRONMENTAL PP'OTEcTION .EALT. AUT.ORITY APPROVAL C.ECKUST- FEBRUARY 4984 264-4720 escd ,,o.' WELL DATA Well Classification 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: IfA, B, C, D.E.C. Approved ~)N) Date Completed Yield Depth of Grouting ~ / Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/l-~ Tank on Lot ~=:=,¢ t A- ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ~; On Adjoining Lots To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ~:~- ~' ~'~' To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTICZI=H~'-DtI~G TANK DATA Date Installed ~'-~,L¢~ ~ Standpipesd~N) Air-tight Caps~N) Depression over Tank (Y/,.~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/.H~ldm~ Tank: To Water-Supply Well ~ ~ ~ To Property Line ~. '~' I,.~.. To Water Main/Service Line Course Size ~ ~ No. of Compartments 7,- Foundation Cleanout ~:~N) Date Last Pumped ~=1 -- t q, -~ ~ /~A ; for "-- Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~' ¢ ~ ~ Width of Field "~'* Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well "~ ~ To Building Foundation ~--c~ Lot =/¢='}i~''q-.~ Type of System Design Length of Field ~--/"/ Depth of Field ~ L Gravel Bed Thickness '¢:~z'~ Standpipes Present Date of Last Adequacy Test ~'[ --~ ct - ~- To Water Main/Service Line ~. c=, ~--~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line I To Existing or Abandoned System on ; On Adjoining Lots To Cutbar~k (if present) Comments 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 ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'*:.~ ~ ~'~',,~,-~-~-**,,,,"~ Date ¢ _ Company ~., ¥. ~,.,~,, .... .,-,, .¢.~,i~ ..,~,-,,~.** MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11184) DEPT. O!~ E~VIRONMENT~[~ ~@~SERVATt~ON / ANCHORAGE/WESTERN DISTRICY OFF ICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SI'~£FFIELD., GOVERNOR Telephone: (907) Address: 274-2533 To Whom it May Concern: According to records on file in this office the ~~o:.:, .~,~Y/v/Jt'O/'? Water System is in compliance with the state Drinking Water Regulations Sincerely, -, . APPLIC : IT FILLS OUT UPPER HAL .ONLY Phone Property OWner ~)evcon Enterprises, Inc. 5411 Old Seward Highway Zip Code 'q(~9 561--tf~R9 Mailing Address Anahor~g~ ~ A1 ~m Buyer James L. & Gtmger Y. Ribelin 3910 Northwood Drive #2 Zip Code 99~9 Address ~hn~: A] Lending Institution First ~ederal S~fn~s & L~an Phone 813 West Northern LiEhts Boulevard Address ~choraKe, Alaska zip Code 9q503 274-~665 Realty Co. & A~nt~e~t~ry 21 HeritaKe Homes/Tom & Carol~ Sz~ns~i , Phoge 207 E. NOrthern Lights Boulevard ~' ~ Address ~chorage, Alaska mpCode 99503 ~76-~ Legal Description Lot 2 Block 2 Heritage Park Eagle River, Alaska street Locati~ N~ Tradition. Avenue ~ ~ · ~a~le River. ~aska Type of Resi~nce ~ Multiple Family No. of Bedroo~ ~ ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l log is required for all wetls drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach ~og if available). ~ Public Utility Sewer Disposal 1983 ~ Individual Year Individual Installed: Public Utility When Connected to Public Utility: D/~ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time / Time Time Time Inspector Inspector Inspector Inspector Field Notes: MUNICIPALI~ OF ANCHO~GE ENVIRONM~Ni'AL PROTeCtION RECEIVED ) *CONDITIONS OF APPROVAL APPROVED BEDROOMS ( ) DISAPPROVED ( ) CO DmO *L Date ~wer installed Well To Absorption Area~o~ ~ Well Log Received Soils Rating 72-023 (3182)