HomeMy WebLinkAboutLAKE O THE HILLS EAST BLK 3 LT 5
MUNICIPALITY OF ANCHORAGE
-\,\ On-Site Water&Wastewater Program
rr>` PO Box 196650 4700 Elmore Road :` 1• .
' Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http://www.muni.org/onsite
l)t luirtni(•nt
On-Site Wastewater Disposal System Permit
Permit Number: OSP191107 Effective Date: 4/16/2019
Work Type: SepticTank Upgrade Expiration Date: 4/15/2020
Tax Code Number: 01533317000
Site Legal Address: LAKE 0 THE HILLS EAST BLK 3 LT 5 G:2639
Site Mailing Address: 7051 LAKE 0' THE HILLS CIR, Anchorage
Owner: LOUGHREY JEFFREY L & Lot Size in Sq Ft: 26985
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4
This permit is for the construction of:
❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage
All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: Date: f v /0*
Issued By: •' ' Date: 47,.
MUNICIPALITY OF ANCHORAGE Rusit
-• ,vfc.)
Development Services Department `. . Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-333-17
Property owner(s) JEFFREY LOUGHREY Day phone
Mailing address 7051 LAKE 0 THE HILLS CIR
Site address 7051 LAKE 0 THE HILLS CIR
Legal description (Sub'd.. Block & Lot) LAKE 0 THE HILLS EAST BLK 3 LT 5
Legal description (Township. Range & Section)
Lot Size 26,985 Sq. Ft. Number of Bedrooms 4
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(Z all that apply)
Absorption Field [ Initial ❑ Single Family (SF) 1.
(w/wo ADU)
Septic Tank 0 Upgrade 0 Duplex (D) n
Holding Tank ❑ Renewal ❑
c 9V1 ttip -o swellings .J
Privy [ ') S - or D)
FtPrivate Well n a
Water Storage f1 APR 1 2019 . a
THIS APPLICATION INCLUDES A WAIVER REQUEST ev, ti
o` 6 8 L Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
///1"(
(Signature of property owner or authorized agent)
Permit/Rush Fees: Waiver Fees:
Date of Payment: W/57/9 Date of Payment:
Receipt Number: Receipt Number:
Permit No. OS CI 7 /JO?* Waiver No.
G\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
•
•
• •
April 15,2019
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage,Alaska 99519-6650
Fax 249-7847
Re: New Septic tank permit
Legal: 7051 LAKE 0'THE HILLS CIR
To Whom it may concern:
This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact
any of the neighbors or encroach on any wells,septic or open water issues. The lot has a community water
system therefore no wells to be concerned about.
Sincerely IA_
Michael N. Anderson, P.E.
4661 Natrona
Anch, Ak 99516
Ph 727-8864
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PLAT, Al NOT SHOWN tii:.i� Or1-. I: t S
L.a k,-t, 0 1-#c_ gilt t s ,E0�f 3 1--t,*1- g
As Built No Cornors ret This Date Book No. Page No.
..,.... PILE
I hereby Certify that I hays surveyed the following devxit,od proparty, Lot Clock ' w'�• C. Q ��f y
L A"r O' Tn.'. /r C C,.:' .1:'n":•'. Anehortaa recording Proe,nct, Alaska, and thrt r�i. es....a'AA••oii, rlo A
the improvements situated t!+•r.•.•► «+ within t►.r f r:;,erty lints and do not Ovari:p or tp C�.1. 1,;:s7
tial t wt
•rwaiern on the property lying adjacent thereto. that no impro�vments on proporty b'�y�efrolet.. Si �iA r
lying adjacent thereto encroach on the premises in quer:ion and that there are no roodweys, Cr ; J✓dJ It L�
transmission lines or other visible easements on said �o or f ••••at•••••a•••••••ao••••.•e•••/�
p p ty except as indicated hereon. ✓ ' 4 /• j
0 N.•NU)••.•.••..M•NN•:•N el
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Anchorage, Alaska Z' rt -. /7.;r Q4)is•., No. 7303-5•f l.O"j
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~ k , MUNICIPALITY OF ANCHORAGE
{,2 F.J)) ENV,RONU[N~'AL ENG,NEERING D,VlSION
~ ~ ~1~// 825LStreet-Anchorage, Alaska 99501 Telephone264-4720
~--~"~~, ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME J9 ) ~ ' ~"O~ ~ '~
LEGAL D~CRIPTIO~ o . ~
iLOCATiON NO, OF BEDROOMS
DISTANGE TO: ]~ Absorption area ~ Dwe,Hng/~ (
~V' V~ No. of c~rt~ents
~ ~ Inside length Width Liquid ~th
L iq. ca pa~.~i~__ ns I FH O ME MADE:
Well Dwelling PERMIT NO.
~ ~ ~ Manufacturer Material Liquid capacity in gallons
~ We'~ F°undati~o ' Nearest ~t~'
~ = DISTANCE TO: ~ Distance ~1~ lines'
--.m~'~ No. oflines/ Length~q~ine T°talle~tT~es Trencher0 inches
Material beneath tile Total effeof~bso~tion area
k~ Top of tile to finish graOe ~ 7& inches
~ Length Width Depth PERMIT NO.
~ ~ Type of crib Crib diameter Crib depth Total effective absorption area
m Well Building foundation Nearest lot line
~ DISTANCE TO:
~ Class Depth Driller Distance to lot line PERMIT NO.
~ Building foundation Sewer line Septic tank Absorption area(s)
~ DISTANCE TO:
OTHER
DATE LEGAL
72-0'L ~.v. 3/78}
}J: 4, !3 - 2. G 5 '7
:50 Z L R FI T 'i l".I G ,:: :5 Q F:'"I" :."' E: R :: :2 -:3 El
"r:..~:: L. ENGTH F~''h'FFJ':::Tr/t''l TO: 'Tt...jE:~ .... ir'iTel T?..I }::'F'I:!/T", F'iF 'T'kIt' '!"~'::'F!F:H "i[~'
.... "r' ~ ....... L:h:: F' .... ~"~F: .... ~4~]:'
~,,~:.', r- FIF .... ~ .... [;'F'., '"'.4 i"'~E:. .... PTT TC::~.,... THE i)T'-Tq~''~'''r::' ~{~F:'i"h.iFFFJ ~ ~-.,~: .-..,¢ ..... I.,.
THE: ..... i"'
':~'"'t ~' '" Fff':iE:' Ti,.F F'"T"F"hi f']F' THE F::.::F:F:¢v'FiT~]N '::~FJ FEET).
-f'HERE Z~; ?',E) c;i:::T I TF'FTN FOR T
?E!" ~ r', 'T'PlF MTFJTI'4I th1 ",~ZF'TF'I FIN- F~z.F~ ,ti ::F:-T'i.,.!FEj'., .... m"
....... ~.! .... ~.: .............................. '
THE ...... ~s ...... ,.=, ~ .,.,'.. Ih,c.
Fit. l[:, THE E',.]L"]"("~'"; F~F:' 'I"FiI:::' E::.::C!:::i',,,'I~T ]: ON ,:' 'r~.:~ F '~'T",
i"! i l',l ! h!lJH [:, :[ S'TFLNCE BETHEIEN F:I HELL FIND Ffi'4':." Oiq-~; l TE ~:E!,.!iaGE [:, Z SF'O:E;F~L,. ~;'T':~;'T'EH
:i.g~Ei F'EET F'OR R F'R]:VRTE t,~EL.L OF: 15E~ 'TO ;2E~9 I::E:E:'!" F:ROM F:I PUBLIC HELL [:,EPEh!DZF,IEi
UPOJ'.~ 'THE "F"/PE: OF PUE~:LZC HEL. L.
.... T~i'i ........ rC'TZt!'-lr'"P' F';:'"'" : F'~']"'qTF p.m: 'T7 R F'F!',,,'I:TFE BE.,.!ER LINE IE; 25 FEET
] .... ~ r":F/i'4i','it?.,ITT'.,.' ':::Fb.!EF: L. ZNE Z~5 '75 F:EET.
L2, ~ _"',:;.:;-,',..,-,,....~u.~ ~ .... ~ ..., cm:c~, ,:':,~'r".TL- ...... RT~Fr.4':; CN ..... Fq""F' '"] ...... 'J
~:., ~2:' E;;> ~'~"~ ,F ~ ]P- F"::' ~-'"' '~" ~R? iF:m' .=:; ~::)~ ~:. L2 E::. F~'~ ~::::~ ~::.. ?'~ ...... =.....~.... .............. ..._,.,
T F:FF':T~F'T' THRT
7 ? "' c'"¢'~t .......r~[" T""N Tp? ~'F':' " F:' Cc '" F '- "F':: F'"[' '" F -':: 'r TE ~]E,E[;S; ::'-,E: .... E~L23 ::5
FORTH B'./ THE HUF,I:[C:[F'FtLZT'T' OF FINCHOF~:FI(:iE.
;2: I HZL. L ]:F,!:~;TFtLL THE S?STEH Zi'-,! F~C:CORDFiF4CE i.,~ZTH THE C:ODES.
]:: Z UNDER'.~;TF~['.,ID THFFT' THE O!",hm:E;ZTE ~;EF!ER SYSTEM !"ffTT' I~;'.E(;]UZRE ENLFff~:GEHENT' Z F:'
.:~:E:~ T '2, Ei'.~CE ! ~; F:EH ] i::,EL..E :, TO I F,!CLU[:,E ."'ff3RE' ]'HRN 4. E EC,F;'.OEii"iS
:E'; Z G?4E[:, ' ...............................................................................................................................
PROJECT L' ~ O' The Hills
CLIENT H.T. Newton
W.O. 0716
TEST H°
. . ~'~._ ~i
ELEV. TOP OF HOLE 820
DATE February 9, 1981
0rqanic Material
Moist, Brown~ Silty Sandy Gravel, GM
Cobbles
Grab Sample
Bottom of Hole
No Water Table '~
Perculation Rat 17.1 min/inch ~/'
Time D~Pth to Wat~j~
10:27 7'2½"
10:37 7'4"
10:47 7'5"
t0:57 7'6"
11:07 7'6½"
11:17 7'7"
t1:27 7'7-3/4"
UNWIN m S~HI~Si:N m KOI:IY~ITA ~ HU~TTL
~515 A STI:I~ET --
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IV UH ~1 J ITAR:t.E.
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LAKE O' THE HILLS EAST SUBD.
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. # ~ '~ \ ~-1--
1. GENERAL INFORMATION
Complete legal description
HAA#
Lot 5; Block 3; Lake o the H~s East
Location (site address or directions) 7051 La~.¢ of the. H~t.~s Circle
Property owner
Mailing address
Lending agency
Mailing address
Frank Thompson
C/O OAMPS S.W. thc
340 East palm Lanet Suite 300
Day phone (602) 253-6477
Phoenix., AZ 85004
Day phone
Agent Jeff Bergland / JACK WHITE C0.
Address
Day phone
762-3111
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS: 4 %
TYPE OF WATER SUPPLY:
Individual well
Community well
NOTE:
NOTE:
XX×~
Public water
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
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91} Front MOA #21
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm
Address
Engineer's signature
DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
$ ~. ~ FNC, INF. ERING
17034 Eagle River Loop Eoac{ No. 204
Phone
bedrooms.
Date
bedrooms, with the following stipulations:
Additional Comments
Date
I
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 .,dependent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purahasers 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, 1191) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: LoT :~ ~L~ £,~K~ O'T~,E I~Ig.L~ Parcel I.D.
A. WELL DATA
Well type Co,,~mu/~/T~'(~Jf A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth Cased to
Sanitary seal (Y/N)
FROM WELL LOG
Casing height
Wires properly protected (Y/N)
AT INSPECTION
Date of test
Static water level
Well flow
Pomp level
g.p.m, g.p.m.
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main (J¢"%'~,-'~J~
Sewer service line ~.~o
WATER SAMPLE RESULTS:
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Petroleum tank
Coliform Nitrate
Date of sample:
Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed IO /
Cleanouts(~)
High water alarm (Yl~
Date of pumping
Tank size / ~ ..c(b Compartments '~-
Foundation cleanout t(~)'N) ~ Depression (Y/(~
Alarm tested (Y/N) ./L~
Pumper /~-'l' [~o.,v~' '-~"tUlC
SEPARATION DISTANCES FROM SEPTIC/~TANK TO:
Well(s) on lot /I.,/Lg~/~ ~/'?..~d&r?J?
To property line JO 'Y- Absorption field
Water main/service line
Surface water/drainage L^~'
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION /UO ,,c,~
D at'~Tne ~ -stalled._
Size in gallons
Vent (Y/N) "Pump on" level at -
High water alarm level
Manufacturer
Meets MOA electrical codes (Y/N) __ ~
SEPARATION D~JST~CE FROM LIFT STATION TO:
W~ On adjacent lots
Manhole/Access (Y/N)._
'---- ,~-~- "Pump off" level at
Surface water ~"-'"~.
Soil rating ~'C:)C.b °emSystem type ~"'~'E~"-~E/-/
Total depth //0 /
bedrooms
D. ABSORPTION FIELD DATA
Date installed /0/~/d¢~
Length ~ Width ~'~,¢~ ~':¢,u r4 ~=~G~ r~V']el thickness ~
Total absorption area ~z~" L~IJplc~T'E$ (¢ooz~ _j Cleanouts present ,~'~'4)
Depression over field (Y~) ,/'(,~O Date of adequacy test
Result~fail) //:)/~ ._C_~- for z~
Peroxide treatment (past 12 months} (Y/N) ./C)ox.,'~- /(/L/dUd,L/ If yes, give date
SEPARATION DIS,TANCE FROM ABSORPTION FIELD TO:
Wellonlot(.c:o,,t444~.,,,..)iT"7~ /,JELL) Onadjacentlots ~-oZq~,--C, JFr-'-r' Propertyline ~
To building foundation /...E-/.f~ To existing or abandoned system on lot ,./_.y,~..u ~'7
On adjacent lots
Surface water
Curtain drain
Cutbank /L/5~E /¢/~E~E/d~-Water main/service line ~.3- r~
Driveway, parking/vehicle storage area ~ /
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
,~ & $ ENGINEERING
'17034 Eagle: Rivet' Loop Ro~,d No. 204
HAA Fee $ /
Date of Payment
-,!)
Receipt Number ~12~ ~ /
Waiver Fee: $
Date of Payment
Receipt Number
DEPT. OF ENVIRONMENTAL.CONSERVATION
WALTER J. HICKEL, GOVERNOR
ANCHORAGE DISTRICT OFFICE
800 E. DIMOND BLVD., SUITE 3-470
ANCHORAGE, ALASKA 99515
(907) 349-7755
March 4, 1993
Mr. Scott Swenor
S & S Engineering
SUBJECT: Lake O'The Hills Subdivision
Class "A" Public Water System, PWSID 213603
Dear Mr. Swenor:
I have completed a review of this office's files concerning the monitoring status of the
above-referenced Class "A" Public Water System and found the following:
The last satisfactory Total Coliform Bacteria Sample results was submitted
to this Department on December 11, 1992. This does meet the provisions
of 18 AAC 80.200(a), of the State Drinking Water Regulations.
The last inorganic Chemical Contaminants Sample results were submitted
to this Department on June 12, 1991. This does meet the provisions of 18
AAC 80.200(a), of the State Drinking Water Regulations.
The last Radioactive Contaminants Sample results were submitted to the
Department on December 11, 1992. This does meet the provisions of 18
AAC 80.200(a), State Drinking Water Regulations.
The last Organic Chemical Contaminants/Volatile Organic Chemical (VOC)
were submitted to this Department on July 7, 1992. Based on analysis of
the previous VOC samples results have been satisfactory. This does meet
the provisions of 18 AAC 80.200(a), State Drinking Water Regulations.
Issuance of this letter does not imply that the above-referenced Class "A" Public Water
System is in compliance with other provisions of the State Drinking Regulations.
If you have any questions on the above information, please do not hesitate to contact this
office at 349-7755.
Sincerely,
Michael Lu
Environmental Eng. Asst. II
Tom Fink,
Mayor
uni pality of Anchorage
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
March 17, 1993
Roger Shafer, P. E.
S & S Engineering
17034 Eagle River Loop Road
Suite 204
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 5 Block 3 Lake o' the Hills East
Waiver Request ~WR930012, PID #015-333-17, HA930111
Dear Mr. Shafer:
Your request for waiver of the required 10 foot separation
between a septic system and a lot line has been approved. The
waived distance is 2 feet from the leachfield to the southwest
property line.
This approval applies to the existing septic system lot line
separation only. Any future upgrade to the septic system will
require all separations be met or another approval from this
department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
DJR/ljm
HEALTH AUTHORITY
APPROVALS
SEWER & WATER
MAIN EXTENSIONS
SEWER & WATER
INSPECTION
ENGINEERING STUDIES
AND REPORTS
WELL INSPECTION
& FLOW TEST
SITE PLANS
ROAD DESIGN
SOIL TEST
PERCOLATION
TEST
STRUCTURAL &
MECHANICAL
INSPECTIONS
ON SITE
WASTE WATER
DISPOSAL SYSTEM
ROBERT SHAFER1 P E
ROGER SHAFER. P E
March 12, 1993
CIVIL ENGINEERS
(907) 694-2979
FAX 694-1211
MUt,!IC,%&'.I'i'Y C'F ANCHORAGE
ENVILCNME'%f/'L St'R\ IC~S PiVISlON
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. Box 196650
Anchorage, Alaska 99519-6650
Re: Lot 5 Block 3 Lake O' The Hills East S/D.
RECEIVED
Request you issue a waiver for the separation distance
between the leachfield trench serving the referenced
property and the southwest property line at approximately
two feet. We feel the waiver should be granted for the
following reasons.
1) An adequacy test performed on the septic system on
3/5/93 indicates the leachfield trench is performing
very well. The trench absorbed in excess of 1000
gallons over 24 hours.
2) The trench does not impinge upon any protective well
radii. Since the referenced property and surrounding
properties are served by a community well, it is
unlikely a well will be placed on the adjacent
property.
3) The trench is more than 30 feet from the septic system
on the adjacent property. No influence of the septic
systems on one another is expected.
If any further information is needed to complete your
review, please contact us at 694-2979.
Sincerely,
SCOTT W. ~WENOR
Environmental Engineer
ROC-ER J. S~AFER~. p·'R..
17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577
I~UJNICIPALITY OF ANCHOF~.GE
DIVISION OF E~UfIRORR~EN~AL HEALTH
DEPARTMENT OF HEALTH A~qD ENVIRONMENTAL PROTECTION
APPLICATION FOR [{EALTH AUTHORITY APPROVAL CERTIFICATE
General Info z~nation
Legal Description (include l~ot, block,, subdivision, section, township, range)
: ~1 ~:- o, .... ~' ~ ~.,~¢.~_ ,~4'-{-~%z 44; lis ~' ~~ ~ ~
Location (address or directions)
Applicants Address~M_ O~d~ ........
Xppiicant is (check one) Lending i~stitution ~ ; ~er/builder ~ ;
Buyer ~ ; Other ~ (explain);
Lending Institution Telephone
(a)
(b)
(c)
(d)
Address
(e) Real Estate CO, & Agent ~fj~~ ......
Address
Telephone
(f) Mail the H3~ to the following address:
2. ~T~pe of Residence
o
Single-Family
Number of Bedrooms
Multi-Family
Other (describe)
Individmnl Well ~-~ Community ~ Public ~-~
Note: If ~ommunity well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
Sewage Disposal
Onsite :z~: 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]
e
E_~ineering Firm Providing 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 b~nicipality of Anchorage 'files and from my
investigation and inspection, the on-sike %mter 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°
~ame of Firm~~ ~/'~D~/7~F~'/~_~~- ~~ Telephone
Address
Date
(ENGINEER SEAL)
DHEP Approval
Approved for ~'g~/~" bedrooms
Approved .,,~ Disapproved
Terms of Conditional Approval
CA~ION
THE [~ONICIPALITY OF ~NCHORAGE DEPARTMENT OF ItEALTH AND ENVIRONmeNTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESEnt-
ATIONS GIVEN IN PARAGRAPH 5_ABOVE BY AN INDEPENDEb~ PROFESSIOb~L ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURC~kSERS OF HOMES
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CER%kIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~%MALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ~CHORAGE IS NOT RESPONSIB.LE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S ~RK.
(DHEP SEAL)
RR4/ej/DI8
[Page 2 of 2]
7 -19-84
~MUNICIPALITY OF ANCHOP, AGE!
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION~
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (H/LA)
CHECKLIST - FEBRUARY 1984
Well Classification
Well Log P~esent (Y/N)
Total Depth /%;f~ Cased to
Static Water Level
Casing He ight Above Ground
Elec~ical Wiring in Conduit (Y/N)
Separation Distances f~om Well:
FEB 2 lg8[;
RECEIVED
Legal Description: "r/~/g/~'~,f.,o
¢f; l(s
If A, B, c~ C, D.E.C. Approved(Y/N)
A~//F- Yield
Depth of Grouting
Pump Set At
Sanitary Seal on Casing (Y/N)~J~
yg;/~ Depression Around Wellhead (Y/N)ft2/,4
Date Completed
To Septic/Holding Tank on Lot ~>~oc} / ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~9d/ ">; On Adjoining Lots
To Nearest Public Sewer Line
Cle ancut/Manhole
Water Sample Collected By
Water Sample Test l~esults
B. SEPTIC/HOLDING TANK DATA
Date Installed- IO/~D/~ z. Size iD__~-0 . No. of Co~%)a~ments
Standpi~s ~) Ai~-tight Caps ~) Foun~tion Cleanout
~p~ession ove~ Ta~ (Y~ Date ~st P~d /~ j J - ~ .- ~ ~ ~; '
P~ing~aintenan~ ~n~act ~ File (Y~) ~ ; fo~ -~
Holding Ta~ High-Wate~ Ala~ (Y~) ~ Te~r~ ~ldi~ T~n~ Pe~t ~Y~) ~/~
~p~ation Distan~s ~ ~ptic~olding Tagk:
To Water-Supply ~11 ~O / To ~ilding F~ndatio6' /~,~ / I.)
To P~operty Line /0 ~¢""
TO Water Main/Service ?b.,i._.n~. /3,.,c'
TO .Disposal *Field ~-'
To Stream, Pond, Lake, o~ Major D~ainage
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD ~TA
Soils Rating in Absorption Strata
Date Installed /' °/~o ~
Width of Field .~ ~
Square Feet of Absorption A~ea ~2~ $'~
~Od)~ Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness ~ '
Standpipes Present
Separation Distance f~om Absorption Field:
To Water-Supply Well ~3o/ ~'~ To Property Line /O
To Building Foundation To Existing o~ Abandoned System cn
Lot /o~/% ; On Adjoining Lots ~o /
To Wate~ Main/Service Line ~, ~'>~.3 To Cutbank(if present) ~/~
To Stream/Pond/Lake/c~ Majo= D~ainage Ccu~se /DO
To D~iveway, Parking A~ea, c~ Vehicle Stc~age A~ea
Date Installed
Size in Gallons
"P~p On" Level at
High Water Alarm Level at
Tested for
Electrical Codes(Y/N)
Counts
Dimensions A)//~
Manhole/access (.Y/N)
"Pump Off" Level at
~3~ Vent (Y/N)
Pumping Cycles du~ing Adequacy Test.
Meets MOA
** Check Pe=mitted Bedroc~ Rating Against HAA Request
certify that I have checked, verified, or confoFa~d to all MOA HAA Guidelines in effect
on the date of this inspection.
KB1/d5/s
[Page 2 of 2]
DEPT. OF ENVIRONMENTAL CONSERVATION
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA q9501
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-~533
To Whom it May Concern:
According to records on file in this office the ~ /~ /?~ ~
,~/.~_~,/-.~ Water System is in compliance-with the State Drinking
Water Regulations
ALASKA rFLIIRODmeFITAL COFITROL SI I iCI S, IDC.
~V 9 198#
CIZRDON~TZEL
7051 LAKE CF THE HILL CIRCLE
~ AK 99516
SELLER - ~kX~ETZEL BUYER -
SUBDIVISION - LAKE(DF TIIE HILLS F/MST BIJUC~ - 3 LOT - 5
ADEQJ3CY TEST FCR SEWER SYSTEM
THE TYPE CF gBSORPTION SYSTEM IS A TRENCI-I WITH AN ,aREA CF 828 SQFT.
THE SYSTEM IS CAPABLE CF AGCEPTING 600 GALLONS CF WATER PER DAY.
THE SURGE CAPACITY CF TIIE SYSTEM IS 616 C_ALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS 3EF__EPTABLE FCR A
# BEDRCCM I-IClVE. ~-
THE SEPTIC TANK WAS PU~/PED ON N:3~8 1984 .
SEPTIC TANK ADEQIJACY
THE EXISTING SEPTIC TAI~N VOL~ CF 1250 IS ADEQ3ATE FOR
THIS # BEDROOM HOUSE.
1200 [Uesl 33rtl Auenue. Suite [3, ~nchora§e, Alaska 09503 o(907) 561-50/40
· ,, %. MUNICIPALITY OF ANCHORAGE
DI~PT, OF HEALTH &
CONSTRUCTION AND OPERATION CERTIFICJ~gt~NMmr~ PROTECTIOI~
ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APR 2 tgS,4
PUBLIC 1NATER SYSTEM
RECE! ED
APPROVAL TO CONSTRUCT
Plans for the construction of L/x~' i(~--~ (~
H I L.L--C E'O.g T
public water system located
by 6/~K .fl-
, Alaska, submitted in accordance with 18 AAC 80.100
have been reviewed and are
~;~ approved.
.,/E] conditionally approved,~ (see attached conditions).
If construction has not started within two years of the approval date, this certificate is void and new
plans and specifications must be submitted for review and approval before construction.
APPROVED CHANGE ORDERS
Change (contract order no, Approved by Date
or descriptive reference)
The "APPROVAL TO OPERATE" section must be completed before any water is made available to
thepublic. )-~,~,.~/tc Pb/~Ct~,:~¢' ~'~/~¢v~ ¢(['~¢ ~iff (,*()¢
APPROVAL TO OPERATE
The construction of the ~/~d,E: ~l~ T-~Lj E ('~'l LL~ 6:4¢T' '~ (~ ~'.¢' ,~ / public
water system was completed on (p~-- ~,¢( ~"// (date). The system is hereby
granted interim approval to operate for 90 days following the completion date.
BV TITLE DATE
As-built plans submitted during the interim approval period, or an inspection by the Department has
confirmed the system was constructed according to the approved plans. The system is hereby granted
fina/l~approval to opera!~e. ~
TITLE DATE
APPLIC. JT FILL 5 UUI UI-'H,-K
Buyer
Address Zip Code
~ ~ Phone
Realty Co, & Agent
Address Zip Code
Type of Resi~nce
~ Single Family
~ Multiple Family No. of Bedroo~
~ Other
Water Supply
n A~ACH WELL LOG. A wall log iS required for all wells drilled since June 1975.
~Community~iVidual For wells drilled prior to that date, give well depth (attach log if available).
~ Public Utility
Sewer Disposal
~dividual Year Individual Installed:
~ Public Utility When Connected to Public Utility:
~ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED.
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Inspector
~_~_ 0._, O~ 5 ~ MUNIClPALI~ OF ANCHO~eE
~(( ~C~'~ ~ DEPT. OF HEALTH
~ ~o~o~c'~ d~o~x ~ ~ ~(% ~ ~ ~'- ~ ENVIRONMENTAL PROTECflON
JUN
gECEI EB
~ APPROVED BEDrOOm8 *GONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) OONDITIONAL APPROVAL'
wemm Log Received
Soils Rating Date ~wer Installed Well To Absorption A~
~O0 /O- ZO '9 ~ WelltoTank -- ' Septic T~k Size
72-023 (3182)
June 21, 1983
il & P Investment, Inc.
Po O. i3ox i0-90.
Anchorage, AK 99511
Subject: Lot 5, Block 3~ Lake o'the Hills, East
Approval for the individual sewer and water facilities cannot
be granted until the following items have been completed:
o The depression over the sewe'~' system will need to be filled
so that surface water drains away from the sewer system°
Please notify this Department for a reinspection when the
noted discrepancies have been corrected° if there are any
further questions~ please call this office at 264-4720.
oincerely~
CNIO/ej/~{2
Cory Willis
