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Home My WebLink AboutBOREALIS #1 LT 14 MUNICIPALITY OF ANCHORAGE -~ DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT .ame/~ // ~' DISTANCES ~0, ~X /010~ ~ ~ ~/0 ~ SEPTIC ABSORPTION ~re.~ ~ TANK FIELD WELL , / / n~~ / ~ FOUNDATION Township, Range, Section ~t~ ~ ~ ~t AS-BUILT DIAGRAM (Show Iocabon of well, septic system, .rope.y lines, foundation, driveway, water bodies, etc.) TANKS ~/~ ~ ~/a~ N ~ SE.T~C ~/F~ D HOLmNG ~'~ Manufacturer ~ Material ~ No. of Compadments TYPE OF SYSTEM ~r~ ~ ~, ~ ~ TRENCH ~ BED ~ W. DRAIN ~ OTHER ~ Depth to pipe bottom from Total depth from original grade ~ originalgrade O ~ / FT ~ -~/~ FT ~ ~ Fill added above original grade Gravel depth beneaJh pipe ~ ~ ~ ~ Gravel length Gravel width ~ .' Distance between lines XZ~ Total absorption are. ~SOFT ~ FT ' ~ WELLS ~ . . . ~ PRIVATE ~OTHER fldentifv) Classification (A,B~ Total Depth J.~d~ J ,n...,,e.z "T ' ~/~* ~Z ~ ~ ~~* ~.le:~ ENGINEER'S SEAL Inspections Pedor~ed by2 I~ cedil, that this inspe.ion was pedormed according to all ~~ . : Municipal and State guidelines in effect on~ale: 7 72-013 (3/85) M U N I C I P A L.. :1: 'T' Y 0 Ir':' A ht C', H 0 R A G DeF.)e. rtmer'~t, of' Health & l...luman Ser'vic:es 8~:.7.5 I .... Str'eet.~ Arlchorage, Alaska 99501 0 N - .S I T E S Ii!i: W E IR F:' E R M I T Permit Ixlumber Dat. e Issued ,. ,-:. '~ 188 Owner Name: AI....ASI<A HOIJS ING I::'INAN[]:E ~ORP[IRAT :[ ON O~ner' Addr~ess," I;::', 0, BOX 10 10;2.0 ANCHOF~,~(3E .. AK 9951 ()- 10~.:?.() Day Phone: 56:1...... 5 () 4 () Pa r c e ]. I d: 015.-..:20:2.'.;....,~20 L. ot I...egal: SuL~d:i. visior~: BOREALI8 ~ gU~D. L~t~ ~4 Sec:tion: ~?,1 Townsh:i.p: l~2N Range: 3W I_ot. S:i. ze 16()00 (sq. ft. or ac:~es) Max Bedr'ooms: This Permit: 2 Total Capacity: 2 Block: 1 SEP'I"IC; TANK: Minimum 'Lotal sept. J.c: tank capacity: 1,000 gallons, Eac. h sept:i.,:::: t. ar)k must. have a'L ].east 2. compartments, Depth 'Lo top of Sel:)tic tank(s) < 4.,,0 feet requiPes insulation oveP tarsi.:: (:.".4). IIqF:'ORt'q D.H.H.S. F:'RIC)R TO :LST & 2ND INSPEC'TIONS BY ENGINEER., IF:: AF'TEF:~ OIr. rI:::;ZCE I-..IOl.ll::~[l, CAL. L. .345.",-4681 AND I_EAVE A MES,SAGE, CONSTRL~CT I:::'ER EIqGINEEF~S ATTACI..~ED APPROVIrT::D DES'~GN, PERM I 'T' EXF' I RES 1J:'./:3 .1./88 ,, PERMIT VAL.~D FOR A SIIqGLE FANII....Y RESIDENCE ONI....Y, I CERTIF'Y THA'I": 1, I am famJ. liar with the requirements for on-site sewers ancl welis as set forth by the Municipality c:)f Anchorage (MOA) and the State of Alaska. ;:?.,,I will install the system in accordar, c:e with all MOA c:ocles and regular:ions, and in com[)liance wi'Lb the design cr'.i'Ler, ia :]!',,, I w:i. ll adhere to a].l MOA and Stat. e of Alaska pequipe[nents for the set bac:k dist. ances from any existing well~, wastewater' disposal system or' public sewer'age system on this oP any adjac:ent or neaPby lot.., 4,, I undepstand ti]at this permit is walid for' a maximum oF :2 bedrooms,, I also Lu']depstand t. hat the cal::)a(:::~.t.y of the total system is ~':'. bedrooms and re0u:i, pe arq addit, ional per'mit. any enlarqtement will/ . / (Owner) AI..~<A HOUSIIxlG FINAIqC',E CORPORATION 1 =..:~t..u~d By ~ DATE ~ .~.. unicipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 August 1, 1988 Lee Reid, P.E. Alaska Environmental Control Services, Inc. 1412 West 33 Avenue Anchorage, Alaska 99503 Subject: Waiver Request for Lot 14 Borealis Subdivision Waiver Request ~WR88-042, Permit ~880142 Dear Mr. Reid: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. waived distance is 5 feet. The 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 Serivces DJR/ljw~7 ~ay 2.3 ~ooo Municipality of Anchorage Department of He.a]th & Human Services 825 L Street Anchorage, AK. 9950] Attn: Dan Roth Re: Lot ]4, Block ], Boreal. is The subjec, t lot sewer system needs to be upgraded due t.o a high water table. The only suitable area is in the south east corner of the .lot as shown on the diagram. It will be necessary to instal] the upgrade. 5 feel from the east lot line which borders ].ct 18. The proposed upgrade does not encroach on any other wells, sewer systems or upgrade areas. Attached is a letter to HI;D, who currently owns lot 13, requesting a statement of non-objection for the lot line waJ vei-. As this loL has no other eptions for upgrade area, we request that you grant a lot line waiver of 5 feet. If you have any questions, please call. Sincerely, Approved by: Alan C. WJen Engineering Technician 1200 UJest 33rd Auenu¢. $ui~¢ (~ · Anchoroqe, Alaska 99503 .(907] 561-50z10 PERFORMED FOR: LEGAL DESCRIPTION: -' O ~'.~'. !~~INEER'S SEAL) Municipality of Anchorage 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: '7'2'~/' ~J ~'-d-- ~/ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Deplh lo Waler Aller Monil0ring? Date: SLOPE SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~" (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN COMMENTS PERFORMED BY: /~-~ )~-' ~')/~/' I ~t~~ ~~CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev, 4/85) PERFORMED FOR: LEGAL DESCRIPTION: ~'~/4 ~'~ / Municipality of Anchorage no ora e, SOILS LOG -- PERCOLATION TEST COMMENTS WAS GROUND WATER / E.COU.TERED? .~, 3 IF YES. AT WHAT ~-~ ~ ! (~ DEPTH? p SLOPE SITE PLAN E Depth to Water Afte~,... ~ ! MonitorinD? Date: F-- Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE Z % (minutes/inch) PERC HOLE DIAMETER ~"'' ~ FT AND -~ FT TEST R. UN BETWEEN ,47' /~o ~/~z,9. P ERFORMEDBY: /l~I~'~ ~ ~J/~'~t/' I ~ ~~ C ERTIFYTHATTHISTESTWASPERFORMEDIN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) .s 8 C~. 90 ~-$ rI' F,~AME NOOJE oo ' ALASKA ENVIRONMENTAL JOB CONTROL SERVICES, INC. 12OO West 33rd Avenue, Suite B SHEETNO. OF ANCHORAGE, ALASKA 99503 CALCULATED BY ~. ~."~ ~ ~--t~ ~'~ (907) 561-5040 CHECKED BY DATE ....... ~ "~ ........... t ............ ~ ................... ~ }~ ~ ~ ............. ~ ~' ~ ~ ' ~ }~~ ~ ~ : :, ~ ~ ~ ~ . ~ ........................... .~ ............... ~. ~ , .~...~ ................... , ......... ~ ............. ~.~...~ ~ ................. ~ ........................ ~ .......... ~ ........ ~... .... ~ ....... :...~ + ~ ........... ......... ....... :....v.~ .... ,.~ ~ ...... ....... ~-~ ...................... ~..~[ ........ ~ ~- .......... ........ ~...'!'~" ~ ; ~ ~: : I t~ ~ ~ ...... ~ ............ ~ ........ ~. ~ ....... ~ ............. ~ ....................... ' ~ =~ ~ ~ ' L I ~1] ............................. ~ ~ ........ ; ............. ; ............... .~ .......... ;~ ............ ~ ............................. ...~ ........ ~ ............. ~ ......... ~ ......... ¥,~..., ,,~.....¥....,...; ................ ~ , . ~ : ~ ~ ' / I1_t; ~ ~ .. ~ ~ ~ ~ .............................. . ~ ~ ~ E-:: ~ ~<~ :~ ~ ~ ~/~ ~ ~ ; ....................... L ........... ~ .......... ~ ........ .... E ....~ ......:~,: E'"::'~ . ~'~ ~. ~ ;~ ~ ......:. ................ ; ~ ~ ....... ; .... ~ ..... : ....................... DEPT. OF ENVIRONMENTAL CONSERVATION BILL ~HEFFIELD, ~RNOR ~ephone:~90~ 274-2533 437 B. Street Sulte 200 Anchorage, AK 99501 April 16, 1984 Alaska Environmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchroage, Alaska 99503 Dear Sir: Subject: Borealts S/D, Lot 14, Block 1, horizontal separation waiver between Omega I4ater System lqell and 0n-lot ~aste Disposal System The Department has reviewed the subject waiver request and hereby waives the well to septic separation for the subject property to 120 £t provided that the following conditions are met: 1. The house on the subject lot must not hav~ more than two bedrooms. 2. The O~ega ~ater system (PI~S i~210786) cannot expand beyond its present 10 lots served. Sincerely, Environmental Engineer BEE/msm ALASKA enulRonrn nTAL CONTROL s RU'IC S, IFIc. ~in¢~ri~j ~ ~,uironmentol $1uclics Nay 18, 1988 To: Boustng & Urban Development Federal Center c/o Mr. Ed Tolley 'Marston Pl~opert¥ Management Co. Subject: Request for approval of 5' distance from lot line on Lot 13-14, Block 1, Borea]is Subdivision The sewer system on lot 14, block 1, Borealls Subdivision needs to be upgraded before Alaska State Housing can release the property to the new buyer. Because of the high water table, the system must be moved to higher ground tow/rd the south east corner of the lot. See the attached sketch. We need to place the system within 5 feet of the east lot line. The MOA code requires 10 foot separatin. They will grant a waiver of the distance providing the adjacent property owner signs a statement of non-objection. You now own lot 13. There is a shed on your lot which is $ feet in from the lot line. The driveway for the garage ts 37 feet east of the lot line. The existing sewer system is 75 feet from the lot line. The system proposed to be installed ts not anywhere near the existing system or near where it would interfere with the upgrade for this lot's system, were it necessary.. We therefore request that you make a statement on non-objection to the fact that the sewer system for lot 14, block 1, Borealls Subdivision will be place within 5 feet of the lot line. Thank you for your cooperation. Sincerely, Leroy Reld Jr., , PE Preside. ~t 1200 [Uest 35d ~uem~e. ~il, ~,e~nchoroqe. ~los~a 99505,,,,tg071 5~-5~ ' ' ' ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 ~o~ L/q SHEET NO, CALCULATED BY CHECKED BY DATE DATE ' ( I 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 NAME IPHON'E [ []NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF ] Well I Absorption area D~elling PERMIT NO, DISTANCE TO: I ~ ~ Manufacturer ~X;)'~ ~ ~C~ Material No. of compartments ~ ~ Liq. capacity in gallons ! IF HOMEMADE: Inside length Width Liquid depth ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. ~ -- ~ Manufacturer Material Liquid capacity in gallons , Nearest lot line PER~I~ NO. ~~-~ Nc. of ,in~ Length of each lin~ Total ,en~ofZn~s Trench wi~ Dist~7~ween lines ~ ~ ~ Top of tile to finish~grade Material beneath tile II Total elective absorEtion area Length Width Depth PERMIT NO, ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line m DISTANCE TO: ~ CJass Depth Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ~ ;~ PIPE MATERIALS - REMARKS ~ J I-~ = ') , .. EI)L APPROVED DATE LEGAL 72-013 (Rev. 3/78) FILII",I I C: :[ F'FIL. I "F°'r' OF I:::It",tCFIC)RI::IGE I::,EF'FII:;.:"r'r,IEI'q"F ElF FIEFILTH FIND EI",t',,,' I RONHE1",tTFtL F'F.".OTE:CT 1 ON S25 L STREET, FI1'4CHOI:;.:FIGE., FII.-':.: '_.9. '.'¢ 5 0 "1 264-4?20 F'EF..:H ]; T 1'.,IO · E:,FITE .'[ ':~ ':~;I...IE F., · HFFL. I .h1'4T' Fi D E:, I.T,: E ::.-..; L--;. C:OI'.~'T'FICT F'HONE ' [...E:GFII.._ B,E'.2;CI-T:: I F' · I...O T ',~, I Z E ' LOT' :24- BLOf'::I<' :2 F. HN JE · _-<l.,J CERT I F"," THFIT: :.1_.I Fll'd F'"FIl'd.l.' [_ I FIR 1.4 ]: TFI THE: REC!LI I REMEN'I"S FOR O1'-,I-S I TE SEI.,.IERS FIND 14ELL.'_-7, AS SET I'--ORTH B",.' THE P1U1'qlCII::'FII_IT"r' OF' RI",tC:HORFIGE ,::I"IOFt> FIND 'I"HE STFITE CIF ;2. ;l: I.,.IILL t1'.,fSTFILL. THE :-.E-';"r'STEt"I I1'-,I FIC:CORE:,FII",ICE P.II"f'H FILL PIOFI CODES FIN[.':' REGULFtTIO1",I$, I:":IN[> I1"4 I.']:I]II~'II::'L..IFI1'4CE !.,.IITH THE DESIGN CRITERIFI OF THIS F'ERHIT. 2.. Z i.,.Iil...L FIE:,HEEI:;.:EE TO FILL HOFI FINE:' STFI"FE OF RLFISI'::.'FI R:EC-.!UIREHENTS FOR THE '5, ET E:RCI'-':: [.,IS;TRI",iC:.ES FF.:OM FIN'¢ E;:"-:I:i~,TII",tCi 1.4ELL, 14FiSTEI.4FITER DI:.E;POSFIL S'T'STEt'"I OF.'. PUBLIC :"T',EI.,.IERFIGE S'¢2;]'EH O1'4 THI'::; OF.". FIN"r' FFIE:,...TFICENT 017 I",IEFIRE,'"r' L. OT. I F F:I L I FT ?.,'f'FtT I ON I S I NSTI::II...LE[:' I I",t FIN FIF.':EFI E: Fi ',,,' E F.: E [:, B'¢ HOFI BU I L.E:, I NG I_-:OE:,E?,., THEI",i "':L', I":ll",t EI_EC:TF:: I E:FIL F'E;F.':H I T FINE:, 11",ISF'ECT 1 ON I"lt_IST E:E OE:TR I NE[':'.~ ,'2"' I"'I.=,-E,_ I LTL=; !.,.I I L .... I",IO"F E:E F:IF'F'F/:O',,,'ED t.,.t 7[ THI3UT FII',I' ELECTF.': t ~:FIL. I NSF'ECT I O1",1 F.:EF'OF.:T., FIND ':: :~: ::' THE :~ I C:iI",tI:'E[:: ~~ ....... [: FITE: . MUNICIPALITY OF ANCHORAGE Department Health and Environments? rotection 825 ~. Street, Anchorage, AK. ;9501 264-4720 7., * * * HANDWRITTEN PERMIT * * * Permit ~ ' ~/'f¢ ~ O~ITE SEWER PERMIT'-~u"'6~c% 1 Location: Phone Number: Legal Description: ~-/~ /~ ~ ~J/~/~l'~ ~O~ Size: Type of Soil Absorption System Is: Trench: ~.--Drainfield: Seepage Bed: Holding Tank Maximum Number of Bedrooms: ~. Soil Rating(sq.ft/br) ./.~..~.. DEPTH ~ ( The Required Size of the Soil Absorption System Is: LENGTH . GRAVEL DEPTH ~.~b WIDTH The length dimension is the length(in feet) of the trench or drainfield. 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 is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfa!l Pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = .... GALLONS Permit applicant has the responsibility to inform this/~epartment during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum 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. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth ,b'~tne Municipality (2) I will install the system in ~) ........... I understand/ that the on-site .... ~e/residen('Je[is remodeled to ant x of Anchorage. accordance with codes. sewer system may require enlargement if include more ~~b~o~ Issued by: Date: U~/'/'~//~/ ~ SWP/024 (1/81) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [] PERCOLATION TEST SITE PLAN DEPTH '~, ~,T (I:E T) 4- 10- 11- 5 1L'T~ 13- .,~ 14 ~ 16- '~L) 17. 18-- 20- ENCOUNTERED? O P, IF YES, AT WHAT lq '5 E DEPTH? ~" h~/~_ Reading Date Gross Net Depth to Net Time 'rime Water Drop :~: /D , ~y , 72-008 (6/79) PERCOLATION RATE (minutes/inch) TEST TIETWEEN FT AND : · ANCHORAGE AREA Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~*~q ~L_~ YT~ MAILING ADDRESS ~,'7'¢~ LOCATION ~ fY/~-~, ~ ~t .~-O.../.~ ~ LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL /~'~ INSIDE LENGTH MANUFACTURER INSIDE WIDTH MATERIAL. ~' 7'~-~.._ NUMBER OF COMPARTMENTS LIQUID DEPTH __ -/'// .LIQUID CAPACITY GALLONS. SEEPAGE PIT: I NUMBER OF PITS __ DIAMETER __ LINING MATERIALI:~--'~-/~/~/~{~'C~::~IB SIZE: BUILDING FOUNDATION ~'0_~I, .OR WIDTH /~ / DIAMETER__ NEAREST LOT LINE ADDITIONAL ABSORPTION LENGTH / ~ IDEPTH ! '~ / .DEPTH DISTANCE FROM: WELL / 2.2. TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) .,~,~ t./ SQ. FT. WELL: TYPE ~E~/I- Ppt~L-I ~- CONSTRUCTION BUILDING NEAREST FOUNDATION __, LOT LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED NEAREST , SEWER LINE DEPTH DISTANCE FROM: SEPTIC /.¢_ SEEPAGE , TANK /~J) SYSTEM / ~'~-' - REMARKS DISTANCES: INSTALLED BY: LOT SLOPE: REMARKS: Form No. LQ-031 DIAGRAM OF SYSTEM G.A.A.B. GREATEr ANCHORAGe Area BOrOUgH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SEEPAGE PIT TO BE INSTALLED BY SOil TEST RESULTS ,~.~'"C~ '~ COMPLETION DATE ANTICIPATED DRAIN FIELD OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK $IZE /¢00/~/~l~/ TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK ,, SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC Tank DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, /~C~ , SEEPAGE PiT TO RIVER, LAKE, STREAM. DRAIN FIELD , DRAIN FIELD , SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE PIt /~ , DRAIN FIELD . CAST~JJ~ON IN_-ro AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCA~.~:r-J~I~--~EET INTO UNDISTURbed SOIL, r~ ~ TYPE DIAGRAM OF SYSTEM 4 INCH DI~:M~"Z'~R~.C;A_~T IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT PITTED WITH AI~_RTIGH__T..~EMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DATE ' APPL:CANT":: S:GNATURE ; ~ ~'~'X GF ANCHORAGE AREA BOROUGH Depar'cme~,c of Environmental Quality 3330 "C" Street Anchorage, Ala:~ka 99503 Performed for ~o~m~\;3 ~1-~ Legal Description: /,~-~] J.,i. ~< ~ This form reports: ~Soils~ log _,~ .... Depth Feet Date performed Percolation test 2- 3- 4- 5- 0 - 8- 9- Was ground water encountered? If yes, at what depth? Reading Percolation rate Proposed installation: ~)e,~ ~.~ of Inlet COXMEN'FS: Date Gross Time Net Time minute~ See~afle Pit ..... Drain Field Depth to bottom oF pit or trench Depth to H20 Net Drop, 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 Parcell.D.# 0/~",-~O3"~,,O HAA# I'~~._~ 1. GENERAL INFORMATION Complete legal description Boreal±s #1 Lot 14 LoCation (site address or directions) 4850 Omega Circle, Anchorage Property owner Ray 9eme~ & La~a Meyer Day phone Mailing:address ~,R~n c~,~-? c_i~-~.]~_.. An~hnt-~De, AT( qqS].6 Le',nding agency City Noir:gage/Jack Green Day phone Mailing address P.O. Box 92810, Anchoraqe, A_K 99509-2810 Agent Fortune P~opez~ies/Debbie Clark Day phone Address 2525 C street, Suite 205, Anchorage, AK 99503 345-1569 277-0700 562-7653 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 2 3. TYPE OF WATER SUPPLY: Individual well Community well Public water x NOTE: -If community .... "-' '- '~- ..... '-' ..... ;°* ..... "'--" °'~- '"' - °' ~' ~ ADEC cftc, st " 4.~TYPE.. . ,OF WASTEWATER DISPOSAL: ~ ~ Individual on-site x :?:~-.,,' ...... :'~"-,.' Holding tank ' - ,. -~ ............ . Community on-site ,,~.~, Public sewer '~,7 ,.,., NOTE: If community wastewater system, provide written confirmation from State ADEC '~ · attesting to the legah~ and status of syste 7E~2S (Rev. 1t91) Front MOA~I STATEMENT OF INSPECTION BY ENGINEER r ' ~ ' As certified by my seal affixed beret°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 ,,Eagle River Enqineerinq Services Address p.n_ ~w 773?94; ~._~03e P~.~er. _a_w_ Engineer's signature ~ 99577 Phone 694-5195 Date DHHS SIGNATURE /-"'/Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date . . and their lendi.ng institutions in orde[·to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is iss.u,~e~%~he U~ni~!pal!~ ?.~:~,..nchorage is not responsible for errors or OmissiOns in the professional ~g[~eps~orl~ %' '¥"" ':"'?'/. ~ ,"::~' :'~'~:' ~','.'~":'!'",~:~,-'? ::: /i' ,' ". Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data Well type 4 If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller ,.../' Total depth Cased to Casin~l~'ght Sanitary seal (Y/N) Wires properly protecte/~/N) FROM WELL LOG AT I/N~PECTION Date of test __ Static water level Well flow ~/~~rn. g.p.m. Pump level1 SEPARATION DISTANCES FROM~T~: Septic/holding tank on lot ; On adjacent lots Absorption field on lot // ; On adjacent lots Public sewer main Sewer service line///// WATER 8~E RESULTS: D~'te of sample: Public sewer manhole/cleanout Petroleum tank Nitrate Other bacteria Collected by: B. SEPTIC/~ TANK DATA Date installed ~ 2//5/?~ Cleanouts (Y/N) Y ~ L/'/) High water alarm (Y/N) Date of pumping Tank size /¢~)D Compartments Foundation cleanout (Y/N) /~ Depression (Y/N) i~I//T- Alarm tested (Y/N) ~/"//~ ~'/(] ~ Pumper /~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation -¢~ ~ / ,/2_¢C0~J) Water main/service line /'¢ '~ / 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) \/~ High water alarm level Manufacturer .AJ/4- - ~NT'~I~TO~- Manhole/Access (Y/N) )/,~ .~ ~ /'"Pump off" Level at // z./ ~, Cycles tested 7z',/~0 Meets MOA electrical codes (WN) ~U/~I~ ~I,/"[ EL ~O.-T~2/~,v/L //VSPEC~770,/,/ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /./J/~ On adjacent lots -/' Z-~(~ / Surface water -/",/~ ~ D. ABSORPTION FIELD DATA Date installed Length '~ 5 / Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width Soil rating (GPD/FF) /50 Z/~ //~ ~ System type ~/~ D / ~ / Gravel thickness ~. z~ / Total depth ~-~ ~ ~. ~ j Cleanout present (Y/N) yc~.~ Depression over field (Y/N) ,/~/(~ Results (pass/fail) P/)- ,~,.% for ~- Bedrooms After test /~//~ If yes, give date ~'//~/ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ,/V//~t On adjacent lots 7~ 7.-DO / Property line To building foundation ~- -~ / To existing or abandoned system on lot On adjacent lots 7~ ~ O ' Cutbank Z'//,4 Water main/service line 3 Surface water /-///I Driveway, parking/vehicle storage area ~/~ j Curtain drain 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. ~),E.I~I I,/,4L /NS'T.,4LLYtl'IOh./ Signature Engineer's Name Date p__ {.po ~ Y. HAA Fee $ Date of Payment 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 lot, block, subdivision, section, township, range) 7"-/,-/ 1 kocation~d~~~ · Telephone'(home) (b) Property o,~ner (c) Lending In~t:bti~n'"'~ '~. f~..-~. '" Telephone Mailing Address Business (d) Real Estate Company and Agent Telephone (e) Mail the HAA to the following address: (or check here"~i~ if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Number of bedrooms Single-Family'ji~ 3. WATER SUPPLY Individual Well [] Community,S. 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-site1~i~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ~ ~o ~ @bed ~oel3 (88//. ^~) S~O-~' '>tJON~ s,jeeu!bue leUO!SSejoJd eql u! SUO!SS!LUO JO SJOJJ@ JOJ elq!suodseJ lou s! ebeJoqou¥ jo ~l!led!o!unv~ eq.L 'penss! s! eleo!j!~Jeo e @Jojeq e~ep eZ~leUe Jo suo!lo@dsu! lonpuoo lou op SHHQ ~o se@~oldLU3 's3UeLUaJ!nbeJ elels pue leJepej u!e~Jeo ~s!~ss ol JepJo u! suo!lnl!TSU! bu!puel J!eql pu~ SetUOLI JO sJeseqoJnd o~ ~se3Jnoo ~ se S!ql seop SHHQ eq.L 'e>lssIV jo el8lS @q~, u! peJels!beJ Jeeu~bue ieuo!sseioJd luepuedepu! ue ~q e^oqe S qdeJSeJed u! ue^!b suo!l~lueseJdeJ eq3 uodn XlUO peseq pel~o!J!Jeo IE^oJddv/,l!Joqlnv qlleeH senss! (SHHQ) s@o!^JeS ueLunH pue qlleeH ~o ~,ueLulJedeQ e~eJoqou¥ jo ~l!led!o!unl/N eq.L I~^oJddv leUO!l!puoo ,to SLUJeJ. leUO!l!puoo p@^oJdd~siQ ,/~ pe^oJddv .~ JO,[ p@^oJdd¥ "IVAOI:IddV SHHO '9 ,,~ M.U~IZ(~IPALITY OF ANCHORAGE (MOA) ANCH MuN'q~ ~.~th Authority Approval (HAA) RVICES u ~ RON~__~ 'ulvc~EOKLIST- FEBRUARY 1984 _NVt ~ 343-4744 Legal Description: /---/'/' -~/ RECEIVED -77~ A. WELL DATA Well Classification ~"gt/'/~ If A, B, C, D.E.C. Approved~N) '~~ Present (Y/N) Date Completed Yield Total De'~,,,~ Cased to __ _ Depth of Grouting __ Static Water Lev'~,,~,~ Pump Set At __ Casing Height Above Gr~,~ __ __ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/~,,,~ Depression Around Wellhead (Y/N) SEpARATI ON DISTANCES FROM To Septic/Holding Tank on Lot ~ ; On Adjoining Lots __ To Nearest Edge of Absorption Field on Lot ~ ; On Adjoining Lots To Nearest Public_Sewer_Line _____ __ To Nearest P'~wer Cleanout/Manhole _ 'Fo Neare_st Sewer Service Line on Lot _W_ .ater S_amp e _Colle_cted by ;Date ~ ~/oat;rm~sPle Test Results '"~,,~~~ B. SEPTIC/HOLDING TANK DATA Date Installed ~°/~/~'~?~Size /,~v~ No. of Compartments Standpipes ~N)~ Air-tight Caps~_,~N) Depression over Tank (Y~_.) Date Last Pumped .I. Pumping/Maint~,~~ct on File (Y/N) . ~/A 'for , Holding T a__~:~/N) Temporary Holding Tank Permit (Y/N) S..A .... ~*~: .~.~.5)~' ' wat~0~H~ · - ;*"/~'~ To Building Foundation To To Pro~~'"~ To Disposal Field ~ / To Stream, ~/~kee~,~brDrainage Course Comments Foundation Cleanout ('Y~) 72-026 (Rev. 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(~) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well /~.~ To Building Foundation Lot /~ C- To Water Main/Service Line /o -/-- To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design ~'~ Length of Field .~' / Depth of Field ~- - 2.5' ! Gravel Bed Thickness ~3, ~' Statndpipes Present CN) ./ Date of Last Adequacy Test TO Property Line L To Ex~ ; On Adjoining Lots /~ 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 ~)'N) Comments Dimensions ~/' f b/A Manhole/Access (~N) // "Pump Off" Level at ~ Vent (Y~ 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 gui, inspection. Signed Company Date MOA No. the date of this Seal Receipt No. (~ Date of Payment Amount: $ Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION 3601 C STREET, SUITE 322 / ANCHORAGE, AK 99503 STEVE COWPER, GOVERNOR 563-6775 FOR: ALAN/AECS DATE: PWSID: April 13, 1989 210786 To Whom It May Concern: According to the records on file in this office, the Borealis Omega S/D Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Vera E. Craig Environmental Field Officer VEC:kk 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 Daie 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) Legal Description (include lot, block, subdivision, section, township, range) Telephone: Home (c) , Len~l ng ~!Dst~tut~ .,, ~.~/'~ Telephone (d) Real Estate~o~any and Agent Business (e) Mail the HAA to the followina address: or: Check here ,[~hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~r Number of Bedrooms WATER SUPPLY Individual Well [] Community~ Public [] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Front ~oea 19~z~ ^~u~ ~0-~z ~ Jo ~ e6.ed 'NJOM s,Jeeu!Sue I~UO!SSejoJd eqi. u! SUO!SS!LUO JO sJOJJe Jo,t elq!suodseJ .l. ou s! eS~Joq:)u¥ jo ~.l.!l.ed!o!un~ eq.l. 'penss! s! el.ea!j!:pea ~ eJoj. eq e.l. ep @z~leu~ Jo suop,::)edsu! ionpuoo lou op CjHHQ ,to see~oldUJ=1 'siueLueJ!nbeJ ella~,s pu~ I.eJepej u!m. Jeo .~J.s!.l. es Ol. Jap Jo u! suo!.lm.!~su! 5u!puel .qeq~, pue seLuoq jo sJas~qa.,nd o),. ,~selJnoa .e s.e s!q~. seop SHHQ eq.L '.e:~S~lV ,,.o e:l..elS eq~, u! peJe:l.s!SeJ Jeeu!Sue leuo!ssejoJd ~.uepuedepu! uB ~q e^oqe ~; qde~Se~ed u! ue^!5 suo!:l..e.l, ueseJdeJ eq~, uodn .~lUO pes'eq se.I..eo!j!.peo I~^oJddv ~,!Joq~nV q~l~eH sanss! ($HHQ) seo!^Jas u.euunH pu~ qll~eH ~o ~u@uu~a.ed@Q e[~.eJoqauv jo ~!l~d!o!unlAl eqm NOI.LrIYO le^oJdd¥ I.eUO!l!puoo ,to SLuJe.L leuo!~.!puoo pe^oJdd.es!a "~/' pe^oJddv ,¢~ _~ _,,~ elea ~2~ / ,~~.~ ,~q SLUOO.Ipeq "~'l'^OHddY .,IO,t pe^o..Idd¥ '1414(] '9 ~"..~".....~...,C ..-.~/.."~ euoqdele.L ,,,¢.~ WJH ,tO ew.eN · uo!:~::)edsu! s!ql ,to el. ep eql uo loe~.,te u! suo!leln§e., pu.e 'seoueu!pJo 'sepo:) el'e~s pu.e ledF:)!unR lie t.ii.!~ eou'e!ldwoo u! s! wel. s/~s lesods!p Jel.e~els.e/v, Jo/pue ~lddns .,el. eM el!s-uo eql 'UO!l. oedsu! pu.e uo!l. e6!~se^u! ~w woJ,t pu.e sel!,t eS.eJoqou¥ ,to ~l.!l.ed!o!unl,,N eql. woJ,t peu!.elqo UO!l..ewJo,tu! eql uo pes~q l..eql .~,tfJe^ .,eqlJn,t I 'u!eJeq pel.eo!pu! eJnl. on.qs ~.o ed~l pu.e swoo~peq ,to ~eqwnu eql. Jo,t elenbep.e pu.e I.eUO!loun~ 'e,tes s! we~s/~s I.esods!p JeleMelSeM Jo/pu.e ,~lddns Jel.eM el!s-uo eql leql SMOqS I.eAoJddv ~l!Joq~,nv qll.eeH s!q~,,to uo!~.e6p, se^u! ~LU leql ~,t!JeA I 'MOleq UMOqS m,.ep UOp,.ep!l.e^ eql ,to se pu.e oleJeq pexg~e I.ees ~LU ~q pe!~!peo s¥ NOI.LYINI:IO4NI aNY vJ. Va 'HOllY:IS :1'I1_-I 'SIS:I/'SNOIJ. O=IdSNI ONIQIAOEId INl:lld ONII:I=I=INION=1 'g MUNICIPALITY OF A 11~ .~...~.~.~ITY OF ANCHORAGE (MOA) ENTAL SERV ~IRON~ ~ XUTHORiTY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 AUG 2 6 1988 RECEIVED Legal Description:~ ~ WELL DATA Well Classification ~---a~ If A, B, C, D.E.C. Approved ON) 1~' Present (Y/N) Date Completed Yield Total De-'~,,,,,,~ Cased to. Depth of Grouting Static Water Le~,~ Pump Set At Casing Height Above Gr~:~__ __ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N)~,,,,,~ Depression Around Wellhead (Y/N) Separation Distances from Well:. To Septic/Holding Tank on Lot ;On Adjoining Lots To Nearest Edge o~ Ab~orption;'Field on Lot __ ,~'~Adjoining Lots '_ To Nearest Public SeWer` Line To Nearest P~ewer Cleanout/Manhole To Nearest Sewer Serv~on Lot _ Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA No. of Compartments / Foundation Cleanout (Y~) Date Last Pumped f"a~,-~ ,,,~J/~l ;for Temporary Holding Tank Permit (Y/N) ~/~ Date Installed StandpipesCN) 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/Holding Tank: To Water-Supply Well To Property Line ~ f''~ To Water Main/Service Line Course /0'0/,.~ To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 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 ~'~' ! Lot /~ 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 Length of Field -~" / · Depth of Field ~' ""~'~' Gravel Bed Thickness ~' ~' · Standpipes Present ~)N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on · On Adjoining Lots /~/'~"' To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes~N) Comments Dimensions Manhole/Access ~lN) "Pump Off" Level at Vent (Ye Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that~W~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date ~"~"~ -~'~'' Company ,"'~'"~' MOA No. Receipt No. ,~;~¢ ~--~ Date of Payment Amount: $ //7~)' ~ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: August 25,, 1988 PWSID: 210786 To Whom It May Concern: According to the records on file in this OMEGA Water System is in compliance with Drinking Water Regulations. o??ice, the BOREALIS the State o? Alaska Please note that departmental records indicate that the public water system was installed prior to the 1978 implementation o? the Alaska Drinking Water Plan Review regulations. No as-built plans have been reviewed or approved by the department, nor are any necessary. Since the system has submitted acceptable water samples on a regular basis and received a satis?actory sanitary survey evaluation by the department, the system is acceptable under the standards in e¢¢ect at the time o¢ installation. An o¢¢icial "Certi¢icate to Operate" may be issued upon receiving a complete set o¢ as-built plans. Any expansion o¢ the water system aCter 1978 will require plan review and the issuance o¢ a "Certi¢icate o¢ Operation" permit. I? you have any questions, please Western District o?¢ice. contact me at the Anchorage/- MPL:pkk Sincerely, Michael P. Lewis, RE Environmental Engineer MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF H~ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ~IEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date ~:. ~ /~ (a) ~gal Des§ription (inc, lude lot, block, subdivision, section, township, range) / Iq/. i Lo~ati~on (ad.dress or dir~¢tion~) (b) Applicants Name ~/ J~J,'~ vNf913~)~. Telephone- Home Business Applicants Address ~ ~ <C>Appltcant~s (check__one)Lending Institution Buyer ~ ; Other [[ (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent__ /_p~t~,~ Address <f) Mail the HAA to the following address: 2. Type of Residence Single-Family ~ Number o~ Bedrooms 3. Water Supply Individual Well,~-~. Multi-Family Other (describe) Communi tYT~' 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 Onsitez~ Public ~ Community ~ Holding Tank ~--~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. En~ineerin~ Firm Providing ~gspections, Tests~ File Search, Data~ and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of .Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm ~ ~_ (~':,~,~ Telephone . ' ::'- :"' ," .. " DHEP Approval Approved for~Z~bedrooms Approved ~ Disapproved __ Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMiENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO ~-SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/Di8 [Page 2 of 2] 7-19-84 ~INICIPALITY OF ANCHOR4G3 DIfPT. OF HEALT:~ c,~ [.N¥tRONMENTAL PRO't'£CFION C~I~ - F~R~Y 1984 ~ . R f C EJ V E D ~o~d~) ~11 ~ ~e~nt (Y~ ~1 ~te ~le~d Static ~ate~ ~1 ~0 ~ ~ Casing ~ight ~ G~nd ~ ~r)~ Sanit~ ~al on ~stng ~9~ation Distan~s ~ ~11= To ~a~st ~ of ~tion Field on ~t To ~est ~bli= ~= Line ~/~ To B, SEPTIC/HOLDING TANK DATA Date Installed ~-/3- 7 4 Size lO00 NO. of Ccmpa=tments Standpipes (Y/N).. y Ai~-tight Caps (Y/N) y Foundation Cleanout Dep=ession ove~ Tank (Y/N) N Date Last Pumped S-/~ ~ ~ Pumping/Maintenance Contract on File (Y/~,) ~/~} ; fo= -~//~4, Holding Tank High-Ware= Alama (Y/N) A///~ Tempo=a~ Holding. Tank Permit Separation Distances f=cm Septic/Holding Tank: To Water-Supply W~ll /&~) ~-~, To Building Foundation / To'P=ope~ty Line . ~i~-~, To Disposal Field ~ '~, To Stream, Pond, Lake, o= Majo~ D=ainage Counts [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption St=ata Type of-System Design Date Installed ~/a~/~ q Length of Field <~-&, & ' Width of Field .~- ' Depth of Field /~ '~ + Gravel Bed Thickness ~ ' Square Feet of Absc~ption A~ea ~(~ Standpipes P=esent ~N) Depression over Field (Y~ Date of Last Adequacy Test ~ //,5-/~ Results of Last Adequacy Test ~dt; I~d-~p(~/~/~D% ~'~- Separation Distance f~cm Absc~ption Field: To Water-Supply Well 1~1' To P=operty Line 10 / To Building Foundation _~ , ~' To Existing or Abandoned System cn Lot ~ ~ ' ; On Adjoining Lots ~ To Water Main/Service Line A//6 'To Cutba~(if pre,sent) To St=eam/Pond/Lake/c~ Majo= D~ainage Course ~/~ To D~iveway, Pa=king A~ea, c~ Vehicle arc. age A=ea D. LIFT Date Size in ,d "Pump On" Level at High Water Alarm Level Tested for Electrical Codes Cc~nents Dimensions Manhole/access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. M~ets MOA ** Check Pemmitted Bedrocm Rating Against I certify that I have checked, verified, c~ on the date of this inspection. Signed Date Company ~'~ I ~/~ ~ 4D, MOA No. KB1/d5/s . [Pa~e 2 of ,quest ,d to all MOA HAA in effect 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION / SOUTHCENT~AL REGIONAL OFFICE 4'37 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 9950! BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: To Whom It May Concern: Water System i s i n comp I i ance w i th th-~-~ ~-~-~n.k-T-~--- Water Regu ations. Sincerely, DEPT. OF ENVIRONMENTAL CONSERVATION / ~11l ~.IEFFIELD, GOVERNC~ r~o~:(~o~ 274-2533 ~' 437 ~. Street Suite 200' Anchorase, 99501 Alaska Envizon~ental Control Services, Inc. 1200 ~. 33rd Avenue, Suite B ~nchroage, ~tas~a 99503 · pril 16, 1984 MUNICIPALITY OF ANCHORAO~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIOI',¢' SEP 8 1984 RECEIVED Dear Sir: Subject: Rorealis S/D, Lot 14, Block 1, horizontal separation ~aiver between Omega Water Systea Well and On-lot Raste Disposal Syste~ ~he Department has reviewed the subject ~aiver zequest and hereby waives the veil to septic separation for the subject property to 120 ft provided that the follo~rlng conditions are ~t: 1. The house on ~he subject lot ~,st not hav~ ~ore than ~o bedrooms. e The 0~ega rater system (I~S #210786) cannot expand beyond its present 10 lots served. Sincerely, Environmental Engineer GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested Mailing Address: Phone: 2. Property Owner: Phone: Mailing Address: 3. Legal Description: 4. Location: ~_,~.~ 5. Type of facility to be inspected No. of bedrooms 6. Well Data: A. Type C. Construction Sewage Disposal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: 1. B. Depth D. Bacterial Analysis B. Installer ~, ~/ Size "~'~' ~.,.~ (~ 2. Manufacturer Absorption Area b-¢¢'~ ~ 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank ~I/ , Absorption area ., Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - R~ ~ for Approval of Individual r r & Water Facilities Legal Description Comments Approved/d~-~,~-~~-~Disapproved Date / ~-/~/-,~ Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) Department of Environmental Quality Water and Sewer Questionnaire Date ,.5' ~/~..-/-~, Time Subdivision .ot Owner's Name: Block , Questions: 1. How many bedrooms are now in your house? t 2. How many bedrooms were in the house at the time of purchase?~ 3. Were the basement bedroom walls "roughed in" at the time of purchase? /~//~ 4. Was the basement bathroom plumbing "roughed in" at the time of purchase? ~//~' e Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom? If on a public water supply, do you always have an adequate supply of water? ~/~ 7. Is the pressure always adequate? OTHER COMMENTS: