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HomeMy WebLinkAboutSPRING HILLS ESTATES BLK 1 LT 14 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 E~UPGRADE MAI LING ADDRESS LEGAL DESCRIPTION LOCATION ~ NO. OF BEDROOMS DISTANCE TO: Well / Absorption area Dwelling PER~I~ NQ, ~' <~ Manufacturer Mate~l. ~/~%'~ No, o(~_compartments ~ /~G ~ons Inside length Width Liquid depth /~ &~ IF HOMEMADE: NO. Well Foun~d,ation Nearest lot line PERMIT NO, DISTANCE TO: /~ o~ ¢ Length of each line Total length of lines Trench wi~hf~ inches ~tween lines No. of lines / ~ /~/~'~ / Top of tile to fiqish grade I Material beneath tile Total effective, absorption area .~..~¢ //~'~ inches C,~ ~'~ ~ Length Width epth PERMIT NO, Total effective absorF DISTANCE TO: Class foundation lot line DISTANCE TO: Depth Driller Distance to lot line Building foundation OTHER PIPE MCTERIALS / (-'//8'F- / ~ '~ ~ l~'~ SOIL TEST RATING INSTALLER REMARKS Sewer line Septic tank Absorption area(s) APPROVED DATE LEGAL 72-013 (Rev. 3/78) I'I~NIL. IFHLI FT OF FINCH( GE BEFHF..'IIIENT OF' HERLTH FIND ENVIF.'FNI'"IENTRL F'ROTECTION c,,~.._, L _,TF..EET., FINCHCIRFtGE., RK '995C'k:L 264-4720 F'ERMIT NO: [:,RTE I.=,.=,UE[:: HF F L I _.HNT [ DF..E_,~,: CONTRCT PHONE MT: ',,,'IEW CONST. 2L205 W. 79TH. RNCVHORRGE, RK ~44-7667 99502 LEGRL DESCRIF': LF~T S;IZE: '"' E, EB RL Ufl.., Il't,.'-, ' ., , - -. ,. ,.."r · SUBDIVISION: SPRING HILLS SECTION: .15 TOMNSHIF': ':L2N 49L~.50 (S6~. FT. OR RCRES) .~: LOT: '14 F. RN.~E. ~ I.,.I E, LUL. F .... '1 LI_,TE[. BELOW FIRE THE OPTION'S RVRILRBLE TCI 'T'GIJ IN [.E_t~'iNINU VOI.IR _,EFTIU S"¢STEM. r:Hf]rv=;,E THE OF'TION THRT E,'EST FITS '.fOUR _,ITE. ....................... ..... .... DEF"I"H TO PIPE 81_]TTCIM ,::FT. ) 4. 0 4. 0 / GRRVEL DEPTH (FT.) 'f'OTRL DEPTH ,::Fl'. ) GRRVEb WI-£:,TH (FT.) GRRVEL LENGTH. (FT.) GRFIVEL VOLUME (CU. '¢DS. ) TRNK SIZE SOIL RRTING (56!. FT. ,-"DR) 4.0 - 6. C4 .,, C't 5 / F~:..5 '-' ~i . ~ 0 / / ~,. 0 I 28. 0 % ooe. e ** eeo. e ** .1., ee z. e ,+::+: TRNK I'"IU~ST HR',,,'E RT L[-"'FiST TP.IO COMPRRTMENTS I CERTIF"r' THRT: ±. I RM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE ~E~,IERS RN[:' WELLS RS SET ' FORTH B'¢ THE MLINICIPRL.ITV OF RNCHORRGE (MOR) RND THE STRTE OF RLRSKR. 2. I WILL INSTRLL THE S'¢STEM IN RCCORDRNCE WITH RLL. MOR CODES RWD REGULRTIONS., FtND IN COMPLIRNCE WITH THE DESIGN CRITERIR OF THIS PERMIT. ~. I WI/.L RDHERE TO RLL MOR RND STRTE OF RLRSKR REL.]UIREMENTS FOR THE SET BRCK I},I~TRNCES FROM RNV EXISTING WELL., WRSTE~4RTER DISPOSRL SVSTEM OR F'UE:LIC '.SEWERRGE SVSTEM ON THI'=; OR RN'¢ RI.':'JRCENT OR NERRB'¢ LOT. 4. I UN[."ERSTRND THRT THIS PERMIT I'~] VRLI[:' FOR R MRXIMLIM OF 3.'. BEDROOMS RND RN'¢ ENL.RRGEMENT WILl. REtT~.UIRE RN R[:'DITIONRL PERMIT. iF R LIFT S'T'RTION IS INSTRLLED IN RN RRER COVERED BY f"IOR BUILDING CODES, ]"HEN ('1.'.', RN ELECTRICRL PE:RMIT RND INSPECTION MUST BE OBTRINE[:,.; (2) RS-BUILTS ;,.tILL NOT BE RPPF.'.OVED WITHOUT RN ELECTRICRL INSPECTION REPOR'f'.;' RND (]'::) THE ELECTRIC:RL WORK MUST BE [:,ONE B"r' R LICENSED ELECTRICIRN. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ,~ SOILS LOG [] PERCOLATION TEST PERFORMED FOR: ~'~ '~ LEGAL DESCRIPTION: 2 3 4 7 8 10 12 ~3 18 20- SLOPE COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? OATEPERFORMEO:J C-- /729' IF YES, AT WHAT DEPTH? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT C rv~-W DRILLING, Inc. P.O. Box 10-378 · 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 Well Owner DRILLING LOG Location (address of: Township, Range, Section, if known; or distance mmn Use of WellD°"~es'tic road Size of casing_ Static water level 203 Screen ( ); Describe screen or perforation Hone Well pumping test at_l0 gallons per o£ drawdown from static level. Date of completion Jul:y ;~9~ Depth of Hole 29[ feet Cased to ..... feet ft. ~'~b%'9~) (below) land surface. Finish of well (check one) open end ( 7, Perforated ( ). ri' (minute) for 1 hours with lOOp WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 .TO. 2 CmsinK, ,si;ic:k~p .TO_ !7 .TO. .TO. TO i.58 .TO. 20k .TO_ .TO .TO. .TO. .TO_ __.TO. .TO_ .TO. ); ik)uldeP MUNiCIPALITy OF ANCHO~GE D~PT. Off H~ALTH & kcEIVED %il'w' (,;:~' c,a~ t., 'ban NWWA fi. cz ...... Ccntraet~ Corl:i~iea.te No's. 81~ & .9,73 3-- CONTRACTOR 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~\ ~ - E'-,~.~\ .- ~ ~':,~ NAA# 1. GENERAL INFORMATION Complete legal description Lot 14; Block I; Spring Hills Estates Location (site address or directions) 9821 Spring Hill Drive Property owner Mailing address Lending agency Mailing address Tad & Sue Bydlon 9821 Sp~n,q Hill Drive~ Day phone Anchorage, A~. Day phone Agent Eler~ta Gut~Zius PHH/HOMEQUITY 1855 Gateway Boulevard Address P. 0. B~. 4039_ Concord, California 94524-4039 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: Day phone 51-0246-6524 XX Individual well Community well 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 NOTE: 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 typeofstructureindicatedherein. I furtherverifythat 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm. S & S ENGINEERING Address 17034 ~.~~,4 ~v,., e~:~ Eagle River, Alaska 99577 Engineer's signature THIS CERTIFICATE IS TO CHANGE THE APPROVED BEDROOM CAPACITY FROM 2 BEDROOM TO 4 BEDROOM. NO CHANGES HAVE BEEN ~MADE TO THE PROPERTY. Phone Date .'~- L,~ - ~'~. DHHS SIGNATURE _~_ Approved for Disapproved. Conditional approval for /Z~_..¢._ ~_) bedrooms. bedrooms, with the following stipulations: Additional Comments By: ? ,.¢ / Date. _ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 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 DESIGN ROBERT SHAFER, P.E. ROGER SHAFER. P.E. January 7, 1992 CIVIL ENGINEERS (907) 694 2979 FAX 694-121 I RECEIVED Elenita Gut~ius PHH/HOMEQUITY 1855 Gateway Boulevard P. O. Box 4039 Concord, California 94524~4039 lvlunic~pality of Anchorage Dept. Health & Human Services REFERENCE: Lot 14; Block I; Spring Hills Estates 9321 Spring Hill Drive, Anchorage HOMEQUITY NO: 1385-31314 (Bydlon) D~ar Ms. Gutelius, At~ached is a well and septic approval certificate, well flow test data sheet, and invoice for the referenced property. Please note the approval certificate is for a 2 bedroom residence as requested. However, we have been informed by the Real Estate age~ Jack Blair, there actually exists 4 bedrooms within the home. The size of the septic system installed on the referenced property is adequate for a 4 bedroom residence, however, according to Dan Bolles of the Municipal Health Department, since the septic system wa~ o~y permitted and subsequently approved for a 3 bedroom house, a 4 bedroom approval cannot be obtained at this time. Prior to obtaining a 4 bedroom approval we must designate a location on the property for an alternate 4 bedroom septic system for a possible future upgrade. This is done by excavating a test hole, performing a percolation test, and designing an alternate septic system. The costs associated with this work are as fallows~ I. EXCAVATE TEST HOLE 500.00 2. PERCOLATION TEST 150.00 3. SEPTIC DESIGN 300.00 TOTAL = $950.00 If we may be of further service, please con~act us. Sincerely, RJS/gm 17034 EAGLE RIVER LOOP. SUITE 204, EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE BEPARTMENT 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 o/'~/,,~''~ ~,5'"/--. ~__2 NAA # /.~'//'/ 1, GENERAL INFORMATION Complete.legal description Lot 14; Block 1; Spring H~ Estates Location (site address or directions) 9821 Spring Hilt Drive Property owner Mailing address Lending agency Mailing address ]'had & Sue Bydlon Day phone. 9821 Spring Hil2~~ Drive, Anchorage, Alaska Day phOne Agent Elenit~ GuteLius PHH/HOMEQUITY Day phone_..~lO-246-6524 1855 Gateway Boulevard Address P. O. Box 4039 Ak. Ag~ Jack B~_-_~r ~257-.~¢59 Concord, California 94524--4039 Unless otherwise requested, HAA willbe held forpickup. . NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well XX Community well 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: ×X 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 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/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 Ad dress Engineer's signature DH.S v/'~k~ Approved for Disapproved. Conditional approval for S & S ENGINEERING 17034 Eagle River Loop Road No. 2_.0~__ Eagle River, Alaska 99577 Phone 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 engineer's work. 72~725 (Rev. 1t91) Back MOA ~1 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type Log present~/N) Total depth Sanitary seal (~/N) If A, B, or C, attach ADEC letter. Date of test Static water level Well flow Pump level FROM WELL LOG %o"5' Ul4, SEPARATION DISTANCES FROM WELL TO: ADEC water system number "J'~, _ Date completed "/-~ct-~'4' Driller ~ Cased to ~--~ -~' Casing height_ ~z-'~' Wires properly protected ~/N) 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 RESULTS: Coliform ~ c'°'"~/t ~o~-. Nitrate Date of sample: \'7.. ~ \Lo . ~'~,1 B, SEPTIC/HOLDING TANK DATA Date installed O, - 1.1 ~. ~,~ Cleanouts ~5/N) '~ Collected by: Tank size ~ '/..~" o ~:.:.~,~ ~ Foundation cleanout (~/N) 'y' High water alarm (Y~:) Date of pumping Other bacteria S & S ENGINEERING ' 4 .......... ~_ ~: .... ~ n~n l~oad No. ~0 Ea~31e River, Alaska 99S77 Compartments Depression (Y~I) Alarm tested (Y/N) Pumper /~,4- t'~bFl¢. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \ ~b ~..k To Property line \ O Surface water/drainage On adjacent lots ~oo Absorption field Lc ,~' ~ Foundation Water main/service line 72-026 (Rev. 7/91) Fronl CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes~ ROM LIFT STATION TO: "Well on lot On adjacent lots Manufacturer Manhole/Access (Y/N) .----- ''Pump on" level at ..;--'~'~ump off" level at .~"~Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed Soil rating Length '~' Width Total absorption area "'5 c~ ~ ,¢ Depression over field (Y,~) ..~Resu Its <~/fail) Ip'A~ for peroxidb treatment (past 12 months) (Y,G~) ~',~,.,/,~ 'SbPARATI0~ DISTANC~E ~:ROM ABSORPTION FIELD TO: Well on lot \ c~o ~ ~ To building foundation On adjacent lots "¢ o Surface water I c, Curtain drain ~/A,- System type [;::>¢-.~,t~¢~¢.;~4> Gravel thickness 7,~ ' Total depth '7 ~ Cleanouts present ¢~/N) ~/ Date of adequacy test /~' I~11 "/"'/'~- ¢ ~' ~",,) 'i~ bedrooms If yes, give date /'~/,'~ On adjacent lots ~ ~'~ PropertY line To existing or abandoned system on lot Cutbank /~/,~ Water main/service line 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 effe, 5, & $ ENGINEERING Signature 17034 Eagle River Loop Road No, 204 _Eagle River, Alaska 99577 Engineer's Name Date \~-~'~- / ¢:~ ~ ~ \ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number f this inspection. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES D.v,s,o. or ENV,RONMEN~AL SERV, CES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL or ON-SITE SEWER AND WATER FAO,UTY 264-4744 Application Date _.~- c2.5~'- ,¢ 7 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Properly Owner ~, 1~ ~"~elephone: Home Mailing Address " (c) Lending InstitUtion ='_~E'. Telephone Mailing Address "' (d) Real Estate Coppage'and A~e.t ~-¢¢[F ~' ~'~ Address ~l_~ ~. /5~' ,~ ~, Telephone ~¢ ?.~ ~ ~'~¢~( . (e) Mail the HAA to the followino address: or: Check here hold for pick up. List contact person ~d day phone number~elow. ,, uus~ness . ?_ ? Z ._.~r3.._~ TYPE OF RESIDENCE Single- Fa mily/~l 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 fray 8/861 From ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm '~-'¢-~.-'~ ~.--~,/'¢'~'¢"/"-"/'~..// Telephone Address ~,~ ././~' ~',-5""~ ~d/¢¢*~ ~/~ ~'~"¢-// DHHS APPROVAL Approved for ~* (.'~) bedrooms by ~ ~' ~~ Approved Disapproved Conditional Terms of Conditional Approval CAUTION 'rhe Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 77-025 fRev 8/861 Back '~'¢Ic~.~. ' MUNICIPALITY OF ANCHORAGE (MOA) /~3i~ o D/ViS/ON HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 LeGal Desc~tion: WELL DATA Well Classification //~"~ ~ Well Log Present (Y/N) / Total Depth ~'~L~/ Cased to '~--~/ Depth of Grouting /v'.~ Static Water Level ~/'~-~- ¢ ,,'~,"'~-'-* ¢', ~, Pump Set At Casing Height Above Ground ,,/"¢~ '/ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y' Depression Around Wellhead (Y/N) Separation Distances from Well: 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 '~J,,'~ To Nearest Public Sewer Cleanout/Manhole '~ To Nearest Sewer Service Line on Lot Water Sample Collected by/,~,~¢~ ~,/¢n¢~-~ ; Date "~- ,¢-~' Water Sample Test Results ?~/¢-¢ If A, B, C. D.E.C. Approved (Y/N) Date Completed ;~'~/,~--¢¢'~ Yield Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) t~'/ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Flolding Tank: To Water-Supply Well . ~ ''~ To Property Line /~ ~ To Water Main/Service Line Course Size /~'~'"~ No, of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) Date Last Pumped Z¢- ,~,¢C /v//~ ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ,/'-~ To Disposal Field 4~¢,, To Stream, Pond. Lake, or Major Drainage comments Page 1 of 2 72-026 IRe¥ ~/8~YFronl ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ¢,~" 2~'~- ¢¢'¢¢' Width of Field ~ o / Square Feet of Absorption Area Depression over Field (Y/N) 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 ._~..,..f~ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ~ ~ To Existing or Abandoned System on ; On Adjoining Lots .,,,~ To Cutbank (if present) Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test, Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t ha~/~v~.~c..~J, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed .'~'~¢'~¢"~~ Date Co m pa ~'.¢-,2¢- -~-~¢,/'- MOA No. Receipt No. /0 O/cO Date of Payment Amount: $ ¢O0 O0-~ Page 2 of 2 72-026 fRev 8/861 Back BEVAN ENGINEERING Approved Well & Septic Engineers P.O. Box 112852 Anchorage, At< 99511 (907) 522-13~ (907) 258-0584 Marl::i'~ 5, '1.987 Re :: Bcfl:::, Ba~'.:.!r, Heal th Au'l::hcn'":i.t.y Appr"c:lva]. (HAA) Apl::,l :i. cat:i. I....ot. 14 B1 !.:: 1 Sl::H'":i. ng H:i.].:L Estates (3[.~::,nt ]. (.:.:.xnen :~ Dur:i. ng the per:i, od .Fr"c;m F:'ebruar,/ 26 '1':.(::~ Marc:h 3, 1987 we per'FcH'"mecl r"esearc:h~, :i. nve!~d:: :i. (;.:lat. :i. ohs, wc~,l 1 .F ]. [::)[.~, t(~:,s'b ing and abs,::]rp'l: i cn"~ -F :i. el d te:~s'l:: :i. ng I::)ur-~-:uan'l:'. '1':(::~ t.'h.::.)al'l':h Au'l::hcn'":i.'[:y Apprl:lw~':l ~::~r'~ the al:x::~w.~? re.Fer"en"~c6)d We per.For'reed a ~,,..x~))]. ]. .F 1 c)w 'l:(c~s'b and ..Fc)und 'l::he well. 1 I::)rc:,duc:t:i. on to) J::~(~:.: 4. iZ; ga]. ]. 'l::cx:::,l.:: a. v,x:':d:(./~r '~aml::):l.e .f:c)r" []c)].J..fc~l'"rg akFh'::l.]l.y!~!~:i.!~, a:~.l']CI the [-(~.:i,!!![L.i].'l':.~.!~ ~.~1.~1'"(~.:~ I.,,1(:)~ I::)er.f,::H'"m(~ed an ax::le.,quac:y test (:in tl](.:¢? Sel],'l:::i.c: sy~,'l::ern and determ:i.n(,.:.:d tha'~:. :i.+:. .:::d::l!~-;c:,r"be~x::l at a rat(!.:~ c:,.F ,1':~zl.[~!~-.I. ij;p:~,.].].ons per day (gl::)d) ,, Th:i.s exc:e.?:~,ds thc~ 61[~i]~ gpd I'"(~?C:IL.I:i.r,~'.:~cl '~:,:::H'' a'~ 4 I:)e~c:h'"OcHil I"IcHw:.}:~. ]"h(.z.) sc.:.~pt:i.c: '(':.~H"II.:: ~l.~::~!~ii pl.lil'lp(.:.:.)cJ ar'icl '[.'.h~..:~ w.::er :i..f :L e:~¢:l .I:..(::~ b,':~:, 125({:~ g..v.]. ]. ohs ,, "l"~::~ c:~ur I.::n(:l,/~].,:!.'~dge ail. o.F the :i.n.fc~r"mat:i.c)n requested (::x'~ 1:.'.he HAA Chec:l.::l:i.s'l::. and Applica'l'.'.:i.c)n has been assc.:4M::~led,, I,',.ll~:~ are sul::~m:i.'l:'I:'.:i.r'~g '[':in:i.s data 'l.:c~ 'Tc]u .For your re,v':i. ~-:.))~,,,~ ,, 1:::'1 ea'..~(.'..~ (:::oi"Yl:'.ac:'[:: L.H~i :i~ .-f: t.q(.::) (:::ar] I::H~(:)¥:i. ct(.:.:~ al']y ach::l:i, t:L clnal :i. n.f.,::H'"mat :i. (::)n, cc B(::)!::~ Baer, '!'crl::~.:~m Rea].ty MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HJ~ALTH DE]?ARI]~ENT OF IIF~LTtt AND ENVIRONMENTAL PROTECTION APPLICATION FOR [{EALTH AUTHORITY APPROVAL CERTIFICATE 1o General Information Application Date L - I~ ~-" ,- (a) Legal De.scr, iption (include lo, t, block, subdivision, section~ towns~!ip~ range) Location (address or directions) (b) (c) Applicants Name [~ /~% Telephone - Home Applicants Address Applicant is (check one)Lending Institution ~[ ; Owner/builder [TH Other (e plain); (d) Lending Institution Telephone Address (e) Real Estate Coo & Agent Address (f) Telephone Mail the HAA to the following address: 2. T~ of Residence Single-Family I~[~ Number of Bedrooms 3. Wa_ tear. Su_.~pp_~l~y' Individual Well E~[ Multi-Famil y _~__~,. Other (describe) Note: If community well system~ must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status~ ~e_!~,ia g e p__i s_jp o s al Onsite ~---~ Pnblic ~--~ Community ~--~] Holding Tank ~2~ Note: If community well system, must have ~r£itten co~tfirmation from the State Department of Environmental Conservation attesting to the legality and status° [Page 1 of 2] 5o Engineering Firm Providing.. Inspectio.n~Tes~a._File..~ . _ _. Searchz Data and Information As certified by my sea]. 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 i"urther 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. Approved for ~. 5~_.__ bedrooms ! Approved ~.~. Disapproved Te~ms o~ Conditional Approval CAUTION T~', M~'~ICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND EbNIRO!~IENTAL PROTECTION (DHEP) ISSUES 'HEALTH AUTHORITY APPROVAl, CERTIFICATES BASED SOLELY UPON THE. REPRESEb~- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAl, ENGIN-EER REGISTERED IN THE STATE OF ~ASKA. THE DHEP DOES ~IIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING. INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- ~ENTS~ F~IPLOYEES OF ~{EP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN ~{E PROFESSIONAl, ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. ~LL [I~TA .,~UNICiPALITY OF ANCHORAC~E MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH ALVI~ORITY APPROVAL ( ~IAA~NVIRONMENTAL PROTECIIoN CHECKLIST- FEBRUARY 1984 Legal Descriptior~ Well Classification -~ ~ (t) ,'~- l Well Log P~esent (Y/N) Total D~pth :L L I ' Cased to Static Water Level 7_ O ~5 ' Casing Height Above Ground Electrical Wiring in (bnduit !.Y/N) Separation Distances f~om Well: I TO Septic/Holding Tank on Lot If A, B, c~ C, D.E.C. Appzroved(Y/N) Date Completed ~ - ! ~ -. 'Z/Al ' Depth of G~outing. Pump S~t At Sanitary Seal on Casing (Y/N) \/ Depression Around Wellhead (Y/N) AJ ~ On Adjoining Lots {- I© To Near~st Edge of Absorption Field on Lot '~' (OO~ ; On Adjoining Lots '+ To Nearest Public Se~r Line ~3o~J63 i~J ~.~-~ To Nearest Public Sewer Cleanout/Manhole TO Nearest Sewe~ Service Line on Lot Water Sa~-uple Collected By i~ oO ; Date '~- - -/-- ~ ~ Water Sample Test Results 3./~'7~t 5 (~t~ C--~O/'L / ~ (j(~-(~ (~ /~ cor mnts i oc-7, Date Installed ~-'L'~ ~q Size l?-~-O% Standpipes (Y/N) ~ Air-tight Caps (Y/N) / Depression ove~ Tank (Y/N) ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~/ ; for Holding Tank High-Water Alarm (Y/N) AJ /~ Temporary Holdin~ Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: , To Water-Supply Well To P=operty Line ~ To Water Main/Service Course ~k I 0 O NO. of C~,~a~tmsnts '-~-- Foundation Cleanout (Y/N) To Building Foundation ~t_O '% To Disposal Field Lo, ~' I TO Stream, Pond, Lake, c~z Majo~ Deainage Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed ~ - 7_~ '7 -- ~ ~/ Width of Field ,~ O i, Square Feet of Absorption A~ea ~ Depression over Field (Y/N) ~) Results of Last Adequacy Test Separation Distance f~om Absorption Field: To Water-Supply Well -~ /Oo' To P~operty Line Type of System Design Length of Field ~ ~ ' Depth of Field ~'At! Gravel Bed Thickness LF Standpipes P~esent (Y/N) Dete of Last Adequacy Test I To Building Foundation '+ 'ZO~ TO Existing or Abandoned System Lot AJ ;~ ; On Adjoining Lots + ! O O ~ To Water Main/Service Line -~ ~O' To Cutbank(if present) To Stream/Pond/Lake/c~ Majo~ .D~ainage Course TO D~iveway, Pa~king Area, c~ Vehicle Storage Area ~- ~-0 ' Comments -~- /~) 3 ~- ~' q-/ O ~j /~ ~ /~ ~/~, -7- /~ Date Installed Size in Gallons "Pump Oa" Lavel at High Water Alarm .,[~vel at Tested for Electrical Codes (Y/N) Pumping Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Cycles c~ing Adequacy Test. Meets ~DA Comments ** ** Check Permitted Bedroc~ Rating AGainst HAA Request I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. "' Signed Date Z-- / 'Z- --~ / ~'"~ KB1/dS/s [Pa_~e 2 of 2] 2-15-84