HomeMy WebLinkAboutLAKE O THE HILLS EAST BLK 2 LT 7 MUNICIPALITY OF ANCHORAGE ' ~ "--".~ ~ T ~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ., ~ Environmental Heallh Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nar.e DISTANCES ^~d.~r~s//J~)/,/t"J¢ ~J:::' Z,/¢'/,&'C',,A¢'IC"'/~' /~. ,.~//'./~,K ~ SEPTIC ABSORPTION TANK FIELD WELL Phone(s Permit N~O ~' INofof Bedrooms WELL LEGAL DESCRIP'flON Township, Range, Seclion AS-BUILT DIAGRAM tShow location of well, septic system, properly hnes, foundation, Manufacturer Capac,ty ,n gallons ¢"~¢ ,~3~-..~ Material No. of Compadmen~ ~_.-¢ N, TYPE 0 F SYSTEM ~//~ .c'¢~'~/')¢ ,~F [~f-,( ~': [] TRENCH J~ BED [] W. DRAIN [] OTHER t:;:~ '.=., onginaIDepth to p,pe bottom frOmgrade ~'v fff FT Total depth from original grade3 FT / ~(A,~ /©i ~ ~ ~ _ .... Gravel length Gravel width FT /2 / FT .~ / Total absorphon area Distance b~een lines ~& ¢, s~ FT ~ ' ~T "~ / /~'~ ~ OTHER (I ' ) ~ PRIVATE ~ ~ / Classffmahon (A,B,C) ~~ Cased to FT r~ FT ~ :.~ REMARKS: / ..,.., ~~ %/¢ ~4 ~O ~-/L ~ ~0~ Scale: "- ..... le Ri e k Gad No. ~ ,5) DepaPt. ment c~f' Heal+.h & Humar~ Set'vices (~5 L.. S'Lr'ee'L, Anc::hc.~rage, A:l.a!~t..'.a 9950i 34.:':.;-47::~0 0 Ixl .... S I T E S E W E R 'P E R M I T F'ePmi'L NumbeP: 88()()85 Date Issued: 06/15/88 UpgPade Engineer' Designed Owne~" Name: EMPII:~E 01::' AMERICA FEDERAL.. SAVINGS Clwner' Addr. ess." :3() WARDER SPRINGIZIELD, OH 45504 Day Phene: 694-~?.979 Papc:el Id: 0 J. 5-.];33-C)7 L. ot I...egal: SubdivisJ. Dn: LAKE 0 THE HILLS E. Lc~}..: 7 Section: 2:3 Townsh:Lp~ I~N Range: 3W I_et [;J. ze R50()0 (sq, f't., Dp a(zpes) Max Bedr'oems: This Pe~mit~ 3 Total Capacity: SEPTIC TANK: Minimum 'L~tal septic: tank .'::apacity: J.~000 gallons. Each septic tank mus'L have at .1. east :-? compat'tmen'Ls~ Depth to top oF septic tank(s) < 4.0 feet r'equiPes :i. nsulatic)n oveP tank (s), INSTAL..L I:':'ER ENGINEERS DESIGN; BED WI:TH SAND FILTER '.' :[:2'.' X 4'7', MAXIMUM DEF:'TI.~-OF" SAND FriLTER = 5'. MAXIMUM DEF']"I..~ OF: BED = 3',, I~!O'T'IFY DHHS BEFOFq~[ :[S'T AND ~:'.ND INSPECTIONS, THIS PERMI]" EXPIRES 1~?./~]./88. I CERTIF:'Y THAT~ 1,, :[ am f'amiliap wit. h {he pequipemen'Ls f'c)p on-site sewers and t.,~e].ls as set for"Lh by the Municipality of' AnchoPage (MOA) and the State of Alaska. 2'.. ! will install the system in accoedance with all MOA codes and Peculations, and in coml~liance wi'l:.h the design cnit. ePia of 'Lhis pePmi'L. :2;. ]: will adhepe t.c) all MIDA and State of Alaska pequipements fop the set. back distances fpom any existinD well, wastewatep disposal system cm public sewepage sys'Lem~(:n 'Lh:bz¢ op any ad.jac:ent op near'by lot, 4, I undepstand tha~pepmit is valid Fo~~ a max:i, mum of' :3 bedpooms,, I also unde~"s'La~+~at~he capacity of' the total system is 3 I:'.)edPooms and any en].aP~ wil~ r'equ:[ee an additional pe['mi'L,, (O~n~[· ..... ) E~~OF' AME~RICAC~ FEDER~FEDERAL .... ~AV'I'NG ~ t SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST /'/~UTownship, Range, Section: SIT'PLAN / SLOPE 10 11 12 13 14 15 16 17 18, 19- 20- WAS GROUND WATER ENCOUNTERED? S / L IF YES, AT WHAT ~ O DEPTH? / p E / Oeplh to Water Afler,,,~ ' MonitarinD? /' Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER __ ACCORDANCE Wlt,&,~~'~ GUIDELIN~~HIS DATE. DATE: 72-008 (Rev. 4/85) NAME ,¥,~,,,, 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 PHONE ~NEW [] UPGRADE EGAL DESCRIPTION LOCATION NO, OF BEDROOM8 , ,, Well ~ , .~ PERMIT NO.~.~'~ ~ ~ No. of compa~nts ~ ~ L q. ce IF HOME,DE: Inside length Width ' Liquid depth Dwelling DISTANCE TO: PERMIT NO. Material Liquid capacity in gallons Manufacturer Well ~ , /~ Nearest lot line DISTANCE TO: /~(',/_z/, No. of lines I Length of eacl Trench wic inches Top of tile to finish grade ~,// inches Length Type of crib NO. Depth PERMIT NO. ~en lines Well DISTANCE TO: Class Building foundation DISTANCE TO: Crib depth Total effective absorption area Building foundation Nearest lot line Driller PERMIT NO. Distance to lot line Septic tank Sewer line Absorption area(s) PIPE MATERIALS OTHER 72-013 1834-E MUNICIPALITY OF DEPT. ENVIRONMENTAL Au[ RECE " Department Y~R&RiAH-&Aa ~nvironmenta~ %rotect%on~ j ~ 825 ~,~ street, Anchorage, ~ 264-4720 ~ ~ ~ HANDWRITTEN PERMIT Permit ~ ~7~ WELL AND/OR ON-SITE SEWER PERMIT. Phone Number: Location: , Legal escription: Type of Soil ~sorption System Is: Trench: ~Dralnfleld: Seepage Bed: H01dlng Tank: Maxlmum N~ber of Bedrooms: ~ ,,. Soil Ratlng(sq.ft/br) /~ The Required Size of the Soil ~sorption System Is: ' LEN6TH 6RAVEL DEPTH WIDTH The length dimension ls the length(in feet) of the trench or dralnfleld. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There ls no set wldth for trenches. The gravel depth is the minlm~ depth of gravel between the outfall pipe and the bottom of the excavation(in feet). ~ ~ REQUZRED SEPTZC(HOLDIN6) TANK SZZE = /~ 6ALLONS Pe~it applicant has the responsibility to inform this department durlng the installation inspections of any wells adjacent to thls property and the number of residences that the well will serve. TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without flnal inspection and approval by thls department will be subject to prosecution. Min~ distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minlm~ distance from a private well to a private sewer line is 25 feet and to a co--unity sewer line is 75 fee~. Well logs are required and must be returned to thls department wlthin 30 days of the well completion. Other requirements may apply.' Specifications and construction diagrams are available to lnsure proper installation. ~ ~ ~ PERMIT EXPIRES DECEMBER ~1~ I certify that: (1) I ~ f~lllar with the requirements for on-slte sewers and wells as set forth by the Municipality of ~chorage. (2) I wlll lnstall the system in accordance wlth codes. (3) I understand that the on-site sewer system may require enlargemen~ if 'th~~:. ~is remodeled to includeissued by:~~m°re<~3'bedr°°ms' SWP/024(1/81) [:,EF'RRTMENT OF HEFtLTH RN[:, ENV!RONMENTRL F'ROTECTION 8.':_"'5 "'L'" STF.:EET., FINCHORRGE., RK 9D50± 264-472F1 : RNCHOF.'.RGE E;94-2±.-_'.:± : EFIGLE RIVEF.'. F" E F4-'.' ~'.1 :E 'T PERMIT NO. 0000~0 RPPLICRN'F: 0 BOWEN CONST. CO RDDRESS: ~:~05 RRC]'IC ~±57± RNCHORRGE, 9~ ~50~ LRKE 0 THE HILL,,.,, ERS RRNGE: 0 SECTION: LEGRL DESCRiF'TiON - =,_E,[I',ISION: TOWNSHIF': 0 PHONE ' BLOC:K 5E;2-2:2Ft8 MRX'fMI_IM NUHBER OF E:EE:,ROOMS = 2: SOIL RRTING = LISTED BELFIW RRE THE OF'TIONS RVRILRBLE TO YL]Lt IN DES! SYSTEM. CHOOSE THE rIF'TtON THRT E:EST FITS Y]UF.' SITE. ,-"BR ) SEF'T t C WIDTH = LENGTH = 2:7.0 FT. TOTRL DEPTH = 8.0 FT. GRRVEL DEPTH = ~.5 FT. GRRVEL VOLUHE = ±~.7 CU. YDS TRNK SiZE = ±.,000.0 WIDTH = T"T'F' lr ,::AL 2.5 FT. 0 FT. LENGTH = '-24. 0 FT. TOTRL DEPTH = 5. Fi FT. GRRVEL DEPTH = 0. 5 FT. GRR'v'EL VOLUME = ±0. 6 CU. "r' TRNK SIZE = ±:, 000. 0 GRLL Wi[:,TH = 0' FT. LEi',IGTH = FT. ,/ TOTRL DEPTH = 7. GRRVEL DEPTH = 2. 5 GRRVEL VOLUHE = 18. 2: TRNK SIZE = ':1, 000. 0 GRL I _.Eft ~ IF~, THR'T: [:" E '--=; ':.' TI.4i: THENT T R N K ::' TWO COMF'FIRTMENT TRNK). ': ~L. i RH FRMtLIRR WI/I~H· THE REQUIREHENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH BY THE MLINIC.I,¢'RL. ITY OF RNCHORRGE RND THE STRTE OF RLRSKR. 2. I WiLL INSTRL,t// THE S"r'STEM IN RCCORDRNCE WITH ]"HE CODES RND HAVE REC:Et'¥'ED R COPY OF THE CO?"E SUMMRRY RND [:'IRGRRM RTTRCHMENTS WHICH IS PRRT OF THIS PERM I T. / 3:. I UNDERSTFIt~[:, THFIT THE ON-SITE SEWER SYSTEM MF¢'r' REQUIRE ENLRRGEMENT IF THE. RESIDENCE IS R~MODELED TO INCLUDE MORE THRN 3: BEDROOMS. F'ERMIT HF'FL~~:HN] HHb, THE RESF'ONSIE:ILITY TO INFOR.hl PERSONNEL DLIRING THE iNSTRLLRTISN iNSPEC:TIGNS IF RNY WELLS R[:'JRC:ENT TO THIS FR_FEF. T¢RN[:' THE NUMBER-OF ,RESIDENCES THRT THE WELL' P~ILL SERVE. SI GNE[:": RPPLICRNT: 0 BOWEN CONST. CO ISSUE[:, B"r': / ,~ (. [:'RTE: F'iT,.."14,.."R]: S E-NGI] EERS INC 7125 Old Seward Hwy. Anchorage, Alaska 99502 349-6561! SOILS LOG - PERCOLATION TEST [,~'~O ILS LOG [~"~PPER CO LATIO N TEST JOHN E. SWAHSON~ 1834-E ! 2 3 r-----~ 4 5 ~',K'- 7' u 7 8 9 12 13 14 17 18 20 -I WAS GROUND WATER /) SL ENCOUNTERED? ~'~ 0 E IF YES, AT WHAT DEPTH? . r Gross Net Depth to Net Reading Date Time Time Water Drop :OLATION RATE ¢,:% '.~ ~:~. I ~P (minu,eslinch) COMMENTS PERFORMEDBY:. ~ ~--~ CERTIFIED BY: DATE: P~O~EClr [~ke O' The Hills TEST HOLE ~O. 6 S~EET r',F ~ H.T. Newton 07t6 ELEV. 'TOP OF HOL~ 832 ~ ~_ , eL., uary 7, ,~981 ._O.z~q. j_C !~ateri al Moist, Brown, Sandy Gravel, GW Moist,o~-~wn, Gravelly. Sand, SW Water Table Bottom of Hole Water Table at 13~0 Percualtion Rate 7.5 min/~nch Time De,~th to Water 12:25 12:35 12:45 12:55 1:05 1:15 1:25 LrL 4'11" 5'2¼" 5'4" 5'5¼" 5'6-3/4" 5'8" 1 O~K~ LAKE O' THE HILLS EAST SUBD. - 'TE.~T F~OLP_ Lod-~'Tic::t--J P:1-6~ ~_~ ~.,N~,,W~.IN SCHEBEN.KORYNTA 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 C~)~?-~ -. ~-¢-)~:) ,~ - CJ-'~ NAA# 1. GENERAL INFORMATION Complete legal description Lot 7; Block 2; Lake o~ the Hills East Subdivision Location (site address or directions) 7201 Mountain r_ake Circ!e¢ Anchorage¢ Alaska Property owner r.~sh~_r and HyEna Robinsort Mailing address Day phone 346-8204 Lending agency Day phone Mailing address Agent Day phoq'e Address Un/ess otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: .3 TYPE OF WATER SUPPLY: Individual well Community well xxx Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. XXX 72-025 (Rev. 1/91) Frorlt MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 17034 ~aele River Loop Road Eagle River, Alaska 99577 Engineer's signature Phone Date DHHS SIGNATURE 7-. 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 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 engideer's work. 72-025 {Rev, 1/91) Back MOAlY21 ( Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORIT~ APPROVAL CHECKLIST .~ ,e,~'~ ' Legal Description: L~, ~::~3..f ~ OF Tile l~1~.~ /O Parcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) letter. If.~ B, or C, attach ADEC Date completed Cased to ADEC water system number Driller Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULT~/~r Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK~ATA Date installed <~' I~'-~/ Cleanouts (~/N) High water alarm (Y,~ Date of pumping . Tank size 10OO ~ Compartments Foundation cleanout (~/N) ~'~---~ Depression (Y/(~) Alarm tested (Y/N) //,~-.(~ / ~ '-)j Pumper /4,4- 't'~?V'F¢~_ SEPARATION DISTANCES FROM SEPTIC/~ TO: Well(s) on tot c~ OO To Property line (0 Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (Rev. 7/91).Front CONTINUED ON BACK PAGE C. LIFT STATION Size in gallons ~...~..,~ Manhole/Access (Y/N) Vent (Y/N)~ "Pump o~ ~ "P~..p-off High water alarm level '~-~.~_ .~sted.~ __~_ Meets MOA electrical codes (Y/N)~..-/'¢~' Well on lot D. ABSORPTION FIELD DATA Date installed Length /'~'"7 ' Total absorption area Depression over field (Y/~ Results p~s/fail) ":-~//~/S~' Soil rating /0~'~ ~"~/~'¢ System type Width . / ~ t Gravel thickness /~'~/ '- ¢~r"& .Totaldepth ~ ~'¢ Cleanouts present ~N) ~' ~o Date of adequacy test for ~¢~ (~b~ If yes, give date Peroxide treatment (past 12 months) bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 2001 + To building foundation On adjacent lots ~0O ~-~- Surface water ]00 t.¢_ Curtain drain On adjacent lots ,..-q. O6 ~- Property line To existing or abandoned system on lot Cutbank j'k~Ocd¢_ Water main/service line Driveway, parking/vehicle storage area /o I6/4- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date $ & S ENGINEERING 17034 Eagle River Loop Roa~ No, ~_0~J~ Eagle River, Alaska 99572' HAA Fee $ Date of Payment [~ ~.~_c~,~.~ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number %;, ', i;l h",?'ER ~ DEPT. OF ENVIRONMENTAL CONSERVATION WALTER J. HICKEL, GOVERNOR ANCHORAGE DISTRICT OFFICE 3601 "C" STREET, SUITE 322 ANCHORAGE, ALASKA 99503 563-6775 Januaw 21,1992 FOR: S & S Engineering PWSlD 213603 My review of the records on file in this office reveals that the Lake O the Hills East Subdivision Class "A" Public Water System, is in compliance with the routine coliform bacteria samples requirements listed in Table C, and with the inorganic sampling listed in Table B of 18 AAC 80.200. Sincerely, Keven K. Kleweno Lead Engineer Hodson F~oropp & LevJ~ne U~iFORi~ RESIDENTIAL APPRAISAl_ REPORT ~.~, ~m. 3891K 2,054.63 Seattle t~?cqaaqe ~]choraqq, Alaska '~U ILT lip 75 Not like~ ?-': ~CUP~OY PR,CE AGE - 7201 MCuntain fake Circle __~,,~T,0¢ 28.01 LOt ?~..Bl~k 2, ~e O The ~lls ~st __ ~blns0n F~'~ly .............................. u.,~,~ 015-~333-07 1991 ,o~ s,uo. 66.67 __ i Co~mlnbm t~IJD,VA) ;0..~.~s ~i8 i~ ~ est~lish~ residential neiq~zb_~..a~q~?¢~.~Y 8 t~le8 souCh~st of d~to~ ............ b~hc,r~m¢ Sch~Le- sho~rt~ and ~lo~tent_.._ (.e[%e~8 c~e ~thzn a !0 15 ~te ~lve. buildZu~ is pr~ri!y single fsf~lv of averaq~.~9_ c~¢.~!~_~al~. ~r lot cover ~d ell',fi~ I~lar To~ra~y At street ~ade srte ~ee 25~~e feet c,,,~¢ Lot Yes ~o.r~ c,~ ~, S~q%~- ~-~ Res. z~,~ ~¢.,~ ~s~ ~h.~ I~l~ ~. , X: o.~,~,., None ~] ~ ~,~,,,. ~halt w,~ ~ C~ln Well ' s~-~ None ~ I--~ **~.~.~ ~, .... ~ ~ical utilit~__ s,o~ ~r ~ '-- *~7 None .... ~ ~ ~M*' M.~ 20005~0360-B Or ~sclos~ encr~c~ent~. The site is well i~dsca~ and has a ~! ~t~n ~ive ~ ar~s. ~e~s 1 -- ~,.~r WW~ C~ ~0 ~'~r,8 No ~':,!e~n ~0 Er~r~ E~ Ilem~; F ..........:::::::::::::::: S::: · ~.,,~,t,.~.; ~n{ties~]clude a f~e~lace sk 14 his vac~ ¢~.s(~J~ he&-~ fl~ing¢ accents built-in ~l~tor. et ch~ o] ass ac(-ents¢ ltd.t"ror accents/ vanlt~ ceiling, sauna ~'~ ~bs- whO'll! ~th. ~d:rd sh(~-er~ h~idif~er, air c]_a~e~] ~e st~le to Jz~ all s~f¢o~_..9~h~_~"'~p¢~_~ .%~n~ a~2.~sts~en~_~.¢__.~5.~onsider~ ap~o~iate .............. ~f u~.]_xl.z.l.~q the ~s% recent for ~e s~ject pro~. St~le valuc:s ~'e k~st ref!ea%~ .... ~_~..~.. s~l~ s¢les aV~l~le ~ .~iCqt~nq the ~]~d to u~% value ,/ 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 .Ma~ 27, 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7; Block 2; Lake ~ the. Hil~s East Location (address or directions) 7201 Mountain Lake. Circle, Anchoraq~, Alaska (b) Property.Owner Empire of Am~.ri~a Telephone: Home Mailing Address F~.deral Savinqs Bank (c) Lending I~s~i.t?!i0n GMAC ... Telephon(~' -- Mailing Address .... Bu¢~.r/Dauid 05ol~iB~z (d) Real Estate Company'and Agent HERITAGE REAL ESTATE/Nancy P~erSon Address 18550 Eaqlc River Road, Eagle R~ve~, Alaska Telephone 694-4994 Business (e) Mail the HAA to the followino address: or: Check here ~, if hold for pick up. List contact person and day phone number below. S ~ S ENGINEERING/694-2979 17034 Eagl~ River Loop Road, Suite 204 Eagl~ River, Alaska 99577 TYPE OF RESIDENCE Single-FamilyxE~ Number of Bedrooms ordered by Nancy P~erson 3. WATER SUPPLY Individual Well [] Community [] Public.~ ,.; , Note: If community well system, must have written confirmation from the State Department of Enviro'nmental 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 I of 2 72-025 IRev 8/86~ Front (99/9 ^aM) 980-~L 'H~o/~ s,Jaau!aue leUO!SSejo~d eq~ u! SUO!SS!LUO ~O s]o~e ]oJ alq!suodse~ hou s! aOe~oqau¥ jo AHled!o!un~ sql 'penss! s! eheo!J!pao e~ep aZ/,leUe Jo suoiloadsu! hanpuoo ~ou ap SHHC] jo Se@XOIdLU::I 'shueLuaJ!nbaJ e]e~s pus le]apet u!eHeo Ajsp, es oh ]@p~o u! suo!~m,!lsu! ISu!pu@l J!eqh pus seuJoq jo sJaseqo~nd oh Xsapnoa e se s!qh saop SHHC] aq/'eHSel¥ jo e~ehS ~eeu!6ua leUO!SSajO~d huapuadapu! ue Aq 8^oqe S qde~8e~ed u! u8^!8 suo!he~ueseJd@] aqh uodn /quo peseq le^oJddv AHJoqhn¥ qHeeH sanss! (SHHQ) sao!^~aS UeLUnH pus qhleaH Jo ],uau4pedac] @8eJoqou¥ jo Ah!led!o!unv~ NOI.L~YO 88- leAoJdd¥ leUO!Hpuoo jo sLu~e/ leUO!l!puoo paAo~ddes!C] ~X" peAoJdd¥ auoqdela± ua lo^Ha u! suo!lelnaeJ pus 'saoueu!pJo '$epoo slats pus led[olun~ lie qi!~ eoueildUJoa u! 4a/pus Alddns ~aIeM al!s-ua alit 'uo!loadsu! pus uo!~ealhsa^u! ,~LU LUOJJ pus Salff aae~oqauv jo XHled!o!un!AI aql Luo~j pau!elqo uo!~eLu~oju! aql ua paseq leqh AJHa^ ]eqpnl I 'ula]aq peleo!pu! aJn],onJis a~enbape pus leUOi~aunl 'alee s! LUelsXs lesods!p ]ehe~alse~ ~o/pue Xlddns NOII~INUO:INI C]N~ ¥J.¥(~ 'HO~IY:IS :1'I1_-I 'S.LS:IL 'SNOIJ. C):IdSNI 9NI~IAOI:Id INI:II-I ~DNII~:I:INI~DN=I · ~ALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264 4744 LegalQe. scription: ~ ///t/x' 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: To Septic/Holding Tank on Lot ,~ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Clea'nout/Manhole Water Sample Collected by If A, B, C, D.E.C. Approve~ (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 ~ r~ ; On Adjoining Lots ';~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipe'~N)t J.,n~ Air-tight Caps Y~N) Depression over Tank (YN~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/l"f~m~Tank: To Water-Supply Well ~2..~.~ To Property Line /~ To Water Main/Secviee-Line /~ I._~ Course' , ~ /R ~ ~ /~:;~ ~:;~,o¢-/~ ,.~ Size .~:~ ~ ~ No. of Compartments Foundation Cleanou. t/~'l) Date Last Pumped Z/f"~/~.~ F/~- '1~ /?~/'/~/~ 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 fRev 8/86~ Fron~' ? ~ C. ABSORPTION FIELD DATA Soils Rating in Absorptk2n Strata Date Installed 7,/~ ~/'/~ 0-'6 ¢¢ Length of Field ¢ "~ ~'' '/' //2. r Width of Eield / Depth of Field Gravel Bed Thickness Standpipes Presen (~) Date of Last Adequacy Test Square Feet of Absorption Area Depression over Field (~ Results of Last Adequacy Test W/ Separation Distance from Absorption Field: To Water-Supply Well ¢~-~.,90 /~L To Property Line ./~:::2 To Building Foundation ~/~ To Existing or Abandoned System on Lot '~ ~ ! ~ ; On Adjoining Lots ,/~:¢~ ~ To Water Main/Service Line / ~ ! ~' To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ~/g:2~ ~?/- To Driveway, Parking Area, or Vehicle Storage Area ~,~d::) ! Comments .,':~/~-- ,-,~ 7-/~'~¢t/~-2 ('¢ ,/"~Z¢,'~ ¢'~:2 d:%"N-/- /,&-~ 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) £ "P/Omp Off" Level at / / ///;'~Vent (Y/N) v/ /~//Pumping Cycles during Adequacy Test. Meets MOA C(~mm~nts ' ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MO~ and,MAA guidelines in effect on the date of this inspection. P E~illl~ ....... - .... Receipt No, ,:,ate of, a,,men, Amount: $/ Page 2 of 2 72-026 (Re',, 81861 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN OISTRICT OFFICE / 3601 C STREET. SUITE 133a / ANCHORAGE° ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 To Whom It May Concern: Accordinq to the records on File in this o~ice, the __~_~__/~ ...... ~_~)/Watee System is in compliance with the ~ ~ ............... State of At~sk~ Ocinking Wm~eP Regulations. RSK:sa Sincerely. ein Envir-onmental Field O~[cer' MUNICIPALITY OF ANCHOP~\GE DMSION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE t, General Information App!i~tion Date 3-7-84 (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 7~.._BLOCK 2f LAKE OF THE HILLS EAST Location (adck~ess or directions) (b) Applicants Name Bowen Quality Construction Telephon~ 562-3208 Applicants Add~.ess 3605 Arctic Blvd. #1571 Anchorage, AK 99503 (c) Applicant is (check one) Lending Institution ~; O~ner/ouilder ~ ; Buyer ~-~; Other ~ (explain); (d) ~Lending Institution Alaska M~tual Bank Telephone 958-7890 Address Minn-Benson (e) Real Estate Co. & Agent Address Te !ephor~ 2. Type of Pesidence Single-Family ~-~ Nmmber of Bedrooms 3. Water Supply Multi-Family Ot~er describe) Individual Well~-~ C~,~nity~ Public~--] Note: If c~m~nity well system, must have written confirmation f~cm the State Department of E~vironmental Conservation attesting to the legality and status. Is the well adequate fo~ the number of bedrocms specified in this HAA (Y/N) yes 4. S?wage Disposal Qnsite ~-~ Public ~-~ C~,~nity i t Holding Ta~ ~--~ Is the w~astewater disposal system adequate for the number of b~drocras (Y/N) yes [Page 1 of 2] 2-15-84 5. Engineering Firm P~ovidlng Inspections, Tests, Data and Information I certify that I have checked, verified, or conformed to all MOA FAA Guidelir~s in effect on the date of this inspection. (ENGINEER SEAL) f%~ ~ %.]~ £ ~)~; .~A~ 6. DHEP Approval · Approve d for -'~ kedrccms Approved ~ Dis.app~°"~d i I Te~ of ~nditional App~ovat Date C~nditional ~ The Municipality of Anchorage Department of Health and Enviror~=Te. ntal Fr~otection does not guarantee t~ ~ntinued satisfactory perfo~nance of the wate~ supply and/or the wastewater disposal system. This approval indicates that~ as of t~ validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska~ the water supply a~d wastewater disposal system is safe and func- tional fo~ the number of bedrccr~ and t~ of structure indicated° (D~EP SEAL) 7. Mail the HAA to the following address: KB2/d5/s [Page 2 °f 2] 2-15-84 Well Classification ~'~;/¢U/O J '~/ Well Log P~esent (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances f~cm Well: To Septic/Holding Tank c~n Lot To Nearest Edge of Absorption Field on Lot ' To Nearest Public Sewe~ Line · c, App=o (/N) Date Ccmpleted Yield__ Depth of Grouting Pump Set At Sanitary Seal on Cas{ng (Y.__~) Depression Around Wellhead ( Y__~)~ ; On A~joini~g L°~s ; On Adjoining Lots TO Nearest Public Sewer Cieancut/Manhole To Nearest Se~r Service Line on Lot __ Wate~ Sample Collected By ~l ~,D,/¢A/I~7-&'7~ .; Date ~/ ~/~ ~ Wate~ Sample Test Results Ccm~e nts~a-~ SEPTIC/HOLDING TANK DATA Date Installed 7-~=~3 Standpipes (Y/N) ~ Eepression over Tank (Y/N) /4~ Date Last Pumped A//~ --/¢eg~ ~{J/--t%/~; Pumping/Maintenance Contract on File (Y/N) /J~9 ; for Holding Tank High-Water Alarm (Y/N) J//~ Tempora=~; Holding Tank Permit (Y/N) Separation Distances ~om Septic/Holding Tank: Size _LL)OZ> g,4/-, No. of Cc~art~ents ~ Air-tight Caps ~ Foundation Cleanout (Y/N) ~-~ To Building Foundation I I ~ To Disposal Field 2_¢D' To Stream; Pond, Lake~ c~ Major D~ainage To Water-Supply Well To P_~operty Line To Water Main/Service Line Course Comments /Tz~/%U~/ ?TF~q/ /0~7~/~ / 7- /=~ ~ [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ?{ - ~zb - ~5 Width of Field z%~,~ S~e Feet of ~sorption ~ea ---~-~'-~ .~, ~?-/K~.Ty'pe of System Design Length of Field 'll (~ / Depth of Field ~ / Gravel Bed Thickness 3, ~ / Standpipes P~esent (Y/N) Depression ove~ Field (y/N) Results of Last Adequacy Test Date of Last Adequacy Test ^//~ J/fZ7 S~/3rgT~ Separation Distance from Absorption Field: To Water-SupplyWell To Building Foundation Lot /~',/~ TO Wate~ Main/Service Line To Stream/Pond/Lake/o~ Major D~ainage Course To D~iveway, Parking Area, o~Vehicle Sto~age Area To P~operty Line ~/ [~! ' To Existing or Abandoned System cn ; On Adjoining Lots /V./~ To Cutbank(if present) LIFT STATION ~(3~ ~/~.~'T Date Installed Size in Gallons "Pump On" level at High Water Alarm Level at Tested fop Electrical Codes (Y/N) Dir~ ns ions Manhole/Access (Y/N) I'Pu~p Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Co~{~nts ** Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of this inspection.. KSl/d5/s Date MOA No. [Page 2 of 2] 2-15-84