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HomeMy WebLinkAboutSUNSET HILLS BLK A LT 6 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: '~-"~ t.~ (~ it. Co PID Number:O~ ~-- ~ ,~m~: % ~ ~T~-~ ~L~I ~ Wastewater System: D New ~Upgrade Address: ~lCO SON¢1~ '~ ABSORPTION FIELD NO of e rooms: ~Shallow Trench ~ Bed ~ Mound ~ Other Phone: ~¢¢~ ¢O~ '~ ~ Deep Trench LEGAL DESCRIPTION SoilRsting: /,~ GPD/Sq. Ft TotaiOepthfromo~algrade: Lot ~ ~ck:~ ~ ~'~Subdivisi°n:~b~ ~ ~epth to pipe botlom from original, grade: Ft. Gravel depth beneath pipe ~ Ft. Fill 8deed above originsI ~rade; Gravel length: Number of lines: ~ Oisl~nce behYesn lines' WELL: ~ New ~ Upgrade Oravalwidth: ~ Ft / ' ' ' Classibcation (Private. A.B.C): Total Depth: C~sed TO: Total ~bsorption ares: .~ Pipe material: Driller: Date Drilled: galic Water Level:Ft. Installer:/~ / ~ Date in~{~/led:~ Yield:GPM [ PumpSetat: Ft ICasing HeightAb°veGmund:Ft. TANK SEPARATION DISTANCES u Septic ~ Holding ~S.T.E.P. To Septic Absorption Lift Holding ~ublic/Pdv~te Menu , ~ From Tank Field Stalion Tank Sewer Lines Surface Water NO~6 lq0~¢ lqo~¢ LIFT STATION LineL°t i~ ~ I ~ Size in gallons: [Manufacturer: Foundation ,~ .~ ~ ] "Pump on" lece~at: ] ,,~,.~ o,,,, ,e~.¢~,: CurtainDrain ~lO~ ~¢,~ ]%~¢~ PumpMake&M°del Remarks: BENCH MARK Location and Description: Assumed Elevation: ~ . ~ ~NG'i~E~'~'~ES~ ? ';., : ..., , ,, Inspections performed by: Dates: 1st ¢ ~ ,' ;,;,,, Department of Health and Human Services approval ~ "¢', ''~ ' ''~" Reviewed and approved by: Date: .~-/~ - ~ 72-013 {Rev 9/91) MOA 25 IS 0 IS 30 45 60 \ TOBBEN SPURKLAND P.E. 203 W 15TH, AVENUE ANCH, AK. 99501 (907) ~79-~916 \ \ 90 ~, CONTROLL Ih/ UTILITY \ \ \ \ 88 · ~ 1250 S~P'--~k , : ,...:,!, ·-::' :o 5-Feel Wide Trench h,;," ., ~' ~,,i ~" LOT 6 BLOCK A SUNSET HILLS S/D AL SMITH 14120 SUNVIEW DRIVE SEPTIC SYSTEM ASBUILT DATE: JUNE 2, 1994 SHEET: 2/5 GRID: 5055 I -I/4 PVC w/ih ~/8" hol~ at 52.5 SECTION A-A 6" HoN~i~e i-ii4 PVC Holes Polntlng Up r ', i": " .m ~ ~\ /~ 4 To~o,! ~ ' ,, ~:..':...', ~III"L. 'L.~'".. ".. '.. .. ILL '.. '".. '".. '%. lid/ II II ~ln ........ " "I I~' ~' '-~ '~ ~' ,~1 96.0 I I Il P~0~°~°~°2°~[,~°-%%0~ ~,.o ~l M, roP; 140 ~ ~ ~0 1250 9o( STEP tank I ~ TBW: FIN, FLOOR ASSUWED ELEK' 100.00 TOBBEN SPURKLAND P.E. 205 W 157H. AVENUE ~gNC/-/, AK. 9950i 07) 279-5916 £OT6B£OCIfASUNS£TIII££SIIAL S/d/TH 14120 SUNVIEW DRIVE GRID: 5055.1 SEPtiC SYSTE/d ASBUILT DATE: JUNE 2, 1994 SHEEL' 3/3 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT NLrMBER:SW940140 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:SMITH ALVIN R & CHARLENE FAYE OWNER ADDRESS:14120 SUNVIEW DR ANCHORAGE, AK 99515-4132 (UPGRADE) PERMIT DATE ISSUED: 5/24/94 EXPIRATION DATE: 5/24/95 PARCEL ID:01820226 LEGAL DESCRIPTION: SUNSET HILLS BLK ALT 6 LOT SIZE: 14000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM ulkrDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL RECEIVED BY: ISSUED BY: PROVIS IONS: / / DATE T.SPURKLA/~D P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 6 BLOCK A SUNSET HILLS AL SMITH Ground Water at 8 ft Impervious Layer at 13 Tank Outlet at 94.5 Groundwater at 90 Bottom of Absorption 94 Ground elevation at testhole 98 Use Wide Trench with 2 ft of rock. Need Orenco STEP Soil Rating. From test 5/6/94 2.5 min/in = 1.2 gal/min Required Area per Bedroom: 150/ 1.2 125 sq.ft.. Number of Bedrooms 3 Required Area 375 sq.ft. Reduction Factor with 2 feet of rock .70 Length of Trench 375 x .7 / 5 = 52.5 ft. SYSTEM CONFIGURATION ~_7~_~= ~.~'~/ mO = ~, ,~[ ~ 5-WIDE TRENCH TOTAL LENGTH TOTAL WIDTH TOTAL DEPTH ROCK DEPTH COVER SEPTIC TANK 52.5 FT. 5 FT. 4 FT. 2 FT. 3 FT. 1250 Gal STEP ABANDON EXISTING SYSTEM PUMP AND CRUSH EXISTING TANK The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Design Lot 6 Block A Sunset Hills pg.1 Total head loss 30 ft. Pump delivery at 30 ft. From pump curve. Discharge per 1/8" hole at 5 feet of head. Number of holes. 33/0.42 80 33 gal per min. 0.42 gal. Spacing of holes. 52.5 x 12 / 80 = 7.88 [inches] Septic System Design Lot 6 Block A Sunset Hills pg.2 LUT £7 LlYT 88 LD? £9 TOBBEN SPURKLAND P.E. 205 W 15TH, AVENUE ANCH. AK. 99501 (907~ 279-3916 LOT 6 BLOCK A SUNSET ITIL£$ AL SMII'H 14120 SUNVIEW DRIVE SEPTIC SYSTEM DESIGN DATE: NAY 4, 1994 SHEET: I/$ GRID: 3033 I5 ££ALE~ ]" = 30~ 90 ~ .............. 100.00 1250 5-?ee! Wide Trench TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCN. AK. 99501 (907) 279-5916 LOT 6 BLOCK A SUNS~'T HILLS AL S~flTH 14120 SUNVIEW DRIVE SEPTIC SYSTEM DESIGN DATE: MAY 4, 1994 SHEET: 2/$ GRID: 5033 ! -fi4 PVC with 1/8" holes 52,5 SECI-ION A-A 6" Holfpipe I-I/4 PVC Holes Pd/ntin9 Up Sewer [Cock N/no Fi 140 1 1/4' 3 Ft, oF Cover 4~ / rOttEN SPUN~LANO P.E. 205 W 15TH. AYENUE AK. 99501 BLOCI( A SUNSF,.5[' HILLS AL SMITH 14/20 SUNV/EW ON/YE SEPtiC S)'STEM DES/ON DATE: MAY 17, 1994 SHEET: 5/5 GRID: 5033 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~1~~/ LEGAL DESOR,PT,O : 2 3 4 5 6 7 8 9 10~ 11 12 13 14 15 16 17 18 19 20 COMMENTS DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER E Monitoring? Dole: Reading Date Gross Net Depth to Net Time Time Water Drop /7" ,3 '7 -- ~ ~ ~ Y~ ~/~ PERCOLATION RA'i-E ~,/~ {minutes/inch) PERC HOLE DIAMETER ~ II TESTRUNBETWEEN ~ FTAND ~//~-~FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) '~UNICIPALITY OF ANCHORAGE Hea ~ and Environmental Prote( on Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGI~ DISI~OSAL SYSTEM SEPTIC TAN K:,~ DISTANCETMV I .~) NUMBER OF FROM WELL t ~Q~ + MANUFACqURER ~ MATERIAL ~ COMPARTMENTS INSIDE WIDTH INSIDE LENGTII LIQUID DEPTH LIQUID CAPACITY ~](~_OGALLONS. TIt. E DRAIN FIELD~ DISTANCE FROM WEL~L/0~ ¢ FOUNDATION ~"-' j' __~ TOTAL LENGTH~ NEAREST LOT LINE ~ ____OF LINE ~ of Lines [ DISTANCE BETWEEN LINES __~ __TRENCH WIDTH~IN. TOTAL EFFECTIVE Ai~SORPtlOfQ AREA .... O ~ SD, FT. LENGTH OF EACH LINE DEPTH OF FILTER DEP]II: TOP DF TILE TO FINIStl GRADE ~'~-- MATERIAL BENEATH 'rILE 7 ~ ~IN. ABOVE TILE ~-~ .IN. SEEPAGE PIT: Log Crib- .Rings_ BUILDING FOUNDA-iION__, DIAMETER _ OR WIDTH __, EENGTH DEPTH Crib Size: DIAMETER____DEPTH_ DISTANCE FROM: WELL TOTAL EFFECTIVE NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ, F'F, Class. D?pth: Well D~ To. Lot Line Bldg: S?wer Line: Pipe M~ls.0o~.~% ~'--,i I~ of Bedrooms: Remarks: ~ ~ ~ D AT E--~ (~-~'/~ APP R OV E D ~ I:::fi:::' I:::' i { 'l f::i il Fill!: I !",1 i[ ~o -~,~ 7,0 .FL w3 NAL[ACE ENGINEERING q839 TAMPA CIRCLE ANCHORAGE~ ALASKA February II, 1977 Mr. A1 Smith SS07 Bonniface Parkway Sp.148 Anchorage, Alaska 99504 Subjecti Soil test for subsurface disposal system Lot 6, Block A, Sunset liills Subdivision Dear Mr. Smith; For Engineering service in conjunction with soils analysis for Lot 6, Block A, Sunset Hills Subdivision. Total Due $75.00 Please remit to the above address. The amount of gravel that would be required to fill a seepage pit 14'X14'X 8' would be 58 cubic yards. The 16 yards I mentioned over the phone would only fill a pit 7' X 8' X 8'. A pit that small would not give the required surface area f~r drainage. I appologize for giving you the results of a wrong calculation over the phone. If you made the pit 13' X 13' X 8' i-t would take 50 cubic yards of gravel and still meet municipal requirements. Thanks~i n , Lyn~/P. Wallace PE ~ 3430-E WALLACE ENGINEERING 4839 TAMPA CIRCLE ANCHORAGEj ALASKA February ll, 1977 Mr. A1 Smith 3307 Bonniface Parkway Sp.148 Anchorage, Alaska 99504 Subject: Soil test for subsurface disposal system Lot 6, Block A, Sunset Itills Subdivision Dear Mr. Smith; Pursuant to your request, I inspected and logged the soils information, took the necessary soils samples, and conducted a percolation test for your proposed seepage pit in connection with the septic tank disposal system planned for your three bedroom residence. The field work was accomplished on February 5, 1977 and soils analyses were done the following week. The test hole was located at the approximate site of the proposed seepage pit and gave adequate information on the soil conditions of your lot. The lot is small but there is room for an alternate disposal site if the one selected should ever fail in the future. The attached boring log gives a description of the soils encountered which ranged from a well graded sandy gravel with a trace of silt to a silty sandy gravel that was compact and damp. One thin (6") layer of interbedded silt and sand was encoun- tered. When the hole was opened, seepage from on top of this silt sand layer ran down into the hole, but no ground water was encountered. The pit should be constructed with at least 2 ft. of cover over the top and at least 4 ft. from the bottom of the test hole. This would allow an 8 ft. deep seepage pit. This arrangement would allow seepage on both sides of the thin silt sand layer where the soil is acceptable to seepage. The average seepage value for the soil from 2 ft. deep to lO ft. deep is 136 square feet per bedroom. For your three bedroom home you would need a minimum of 408 ~lJare ft. of surface area in the pit. A pit 13ft. X 13 ft. X 8 ft. deep would fill this requirement. To provide a slight margin of safety, make it 14ft;iXl~ft.X 8ft. and with the well graded gravel underneath, it should be very successful. Be also advised that you must submit the well log and water samples from your well for bacteriological analysis when you have your well drilled. This information should be submitted to the Municipal Department of Environmental Protection. Enclosed is an extra copy of this information for submittal to the Municipality. If you have any problems with this soils information, please call. (333-4787) Resp~ul ly Yours, P LOT PLAN ANCF(ORAGE, AL.~$KA, TH!8 //'U'OAYOr" ,'L~-~M~j49~'7-~ ~' BOX 1~69, ~T..~R SIX INCH WATER WELL DRILLED AN~J CA~ED ~DOT-TO DRILLED AT THE RATE OF ~ PROPERTY O~/NER LOCATION OF WELL DRILLER WELL LOG: · COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF---~J~:~ THANK YOU VERY MUCH, DATE BERNIE CLAUS OF RAMPART DRILLING WORKS SERVICE CHARGE O F IYt% PER MONTH WIL[~E':, Parcel I.D. # 1, 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 HAA # IA ~°t'L\['~--~ \ GENERAL INFORMATION Complete legal description LoT ¢ Location (site address or directions) ) ~ 1,2-O Property owner Mailing address Lending agency Mailing address Agent Address Day phone _~L/,~ _ L/O ~ b Day phone Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: 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. 4. 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. NOTE: 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 structu re 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 ~vith all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm '~-'¢-¢~¢~-~ ~'¢~-l¢vt~ ~ ~ Phone Address EngineeCs signature DHHS SIGNATURE /~ Approved for bedrooms. 37q-39 /,b Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 Municipalify of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev. 1/91) Back MOA Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Well type ~ Log present (Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 tf A, B, or C, attach ADEC letter. ADEC water system number ~'//~ Date completed I O/z./~ //77 Driller Cased to / ~ L/ Casing height "~ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION J 0 g.p.m. MUNICIPALITY OF ANCHORAGE ~NViRONMENTAL SERVICES DIVISION U:I 0 2 1994 .g.p.m. RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot J Absorption field on lot Public sewer main h"///~ Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: '"~/~ 7 Nitrate 0,~ ~ ~> Other bacteria ,~)" Collected by: ~ .-~ B. SEPTIC/HOLDING TANK DATA Date installed ~'~//~/~/ Cleanouts (Y/N) '~'~ / High water alarm (Y/N) Date of pumping Tank size Jr?~,.~O Compadments Foundation cleanout (Y/N) '~' I"'d Depression (Y/N) /A~ Alarm tested (Y/N) hr/ 'b'~///-~ Pumper /"J//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J TO property line /,,~ Surface water/drainage On adjacent lots ') /o O Foundation ~ Absorption field / ~- Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed '-~-/'~ / ~ Size in gallons /,~ Vent (Y/N) "'/ "Pump on" level at / High water alarm level ~ Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Well on lot / bt--P_~ On adjacent lots '~ //_.L~p Sudace water f'"I/0 ¢.¢ D. ABSORPTION FIELD DATA Date installed (~/I / Length ,~,~,. ~-- Width Total absorption area Date of adequacy test.. Soil rating (GPD/FF) /,- ,~ Gravel thickness ~-- Cleanout present (Y/N) ~-~J/-N Results (pass/fail) ~ Peroxide treatment (past 12 months) (Y/N) Systemtype ~.~'-P~¢'CCC'LO_ Total depth f-// Depression over field (Y/N) ~ © for '~ Bedrooms After test '~/~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ~-- To building foundation On adjacent lots Sudace water Curtain drain On adjacent lots ~ /~ Property line To existing or abandoned system on lot Cutbank ~ o ,.-/-a_ 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 effect on the date of this inspection. Signature HAA Fee $ ~(~-~ °°~'~ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $. Date of Payment Receipt Number CT&E ReL # Client Sample ID Matrix Commercial Testing & Engineering Co. Environmental Laboratory Services ~~/7/~;~/~/7/7~-/~7/y~ LABORATORY ANALYSIS REPORT 94.2588-1 L6 BLKA SUNSET HILLS WATER ClientName TOBBEN SPURKLAND, P.E. WOI/K Order 78891 Ordered By Printed Date 06/01/94 ~ 16:11 ltrs. Project Name Collected Date 05/27/94 ~ 15:45 lu's. Project# Received Date 05/27/94 ~ 16:45 hrs. PWSID UA Technical Director STEPIIEN C. EDE RclcasedBy: ~ ~. Sample P, emarks: ROUTINE SAMPLE COLLECTED BY: T.S. QC Allowable Ext. Aeal Parameter Results Qual Units Method Limits Date Date hilt Nitrate-N 0.23 mg/L EPA 353.2/300.0 10 05/31/94 CMR * See Special Instructions Above ** See Sample Rmnarks Above U- Undetected, Repoded value is the practical quantification limit. D = Secondary dilution. UA = Unavailable NA = Not Analyzed Ur = Less 'lhan GT - Oreat er Than 5633 B Street, Anchorage, AK 99518-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~I~l~ Ad- Telephone:Home ~''~0~) Business Applicant Address ~ ~) A~ (c) Applicant is (check one): Lending Institution D; Owner/builder~; Buyer ~; Other ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: '- Fop._ TYPE OF RESIDENCE Single-Family¢ Multl-~m~l~!~ Number of Bedrooms I~ ~.~ Other WATER SUPPLY Individual Well"~ Community [] Public [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 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 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 regulations in effect o0 the date of this inspection. Name of Firm Address ~'~'~'f~ ~' ~"~/ ~'~/ Date DHEP APPROaCh. ,~ Approved for Approved '~% Disapproved Conditional --~] Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: WELL DATA Well Classification 'T~t-)~'~'E if A, B, C, D,E,C, Approved (Y/N) Well Log Present (Y/N) ¥~% Date Completed /'O/'Z ~¢~/"77 Yield Total Depth 11/~'~ / Case¢ to I~7~[ Depth of Grouting ~ Static Water Level ¢/~/f Pump Set At / / (~ Casing Height Above Ground /,2/~ + Electrical Wiring in Conduit (Y/N) ~--~'¢~ Separation Distances from Well: Sanitary Seal on Casing (Y/N) '~' Depression Around Wellhead (Y/N) ~0(.) To Septic/Holding Tank on Lot /00 '/¢' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot t'~() ; On Adjoining Lots To Nearest Public Sewer Line /OO '~' To Nearest Public Sewer Cleanout/Manhole [(~¢.)r .~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results /oo ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) ~?(¢?; Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) '- Separation Distances from Septic/Holding Tank: To Water-SuppLy Well J("~OI '~ TO Property Line ~/D ~ '~ To Water Main/Service Line ~'/ Course I (~)O !-~- Size (~O0~'/'J~ NO. of Compartments Air-tight Caps (Y/N) ~/~ ;'¢~ Foundation Cleanout (Y/N) /'J~ Date Last Pumped '-- ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ~'~ ! To Disposal Field ~ / To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72 026 fRev 81861 Fronl C. ABSORPTION FIELD DATA Soils R~t!i~g, in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /¢O! To Building Foundation '75 / Lot ~)Q" ~,/~l~)~¢)¢ Type of System Design Length of Field ~ / Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line IO-~ To Existing or Abandoned System on ; On Adjoining Lots '2~O 4-' 1 TO Cutbank (if present) tdOT -~/00r ~0~ .~ LIFT S~ON Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that~l have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ['~-0~{ [¢'U¢.¢¢fA~' Date Compan Receipt No. Date of Payment Amount: * Page 2 of 2 72 026 fRev 8/86) Back Location: BESSE, EPPS & POTTS 2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907; 349-6451 WATER w~Lr. TEST Subdivision: Lot: Block: Client's Name: Address Initial Reading on Meter: MUNICIPALITY OF ANCHORAGF DEPARTMED,. OF HEALTH AND ENVIRONMEN],,~. 825 L Street, Anchora~. Alaska 264-4720 #1: Time 11:15 a.m. I~2: Da'he Insp PROTECTION 99501 4-14-78 Friday Pratt Date Received: April 13, 1978 Time ._;~)..~j~f]~__ #3: Time Date - u_=32_flI2 Date Insp __~=~ g~O~PJ~- Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: First National Bank of Anchorage Mailing Address: Post Office Box 4-2090 99509 Phone: Property Owner: Alvin R. Smith Mailing Address: Star Route A Box 4033B 99507 Phone: 349-2707 3. Legal Description'~ Lot 6 Block A Sunset Hills 4: Single Family Residence: (x) Number of Bedrooms: ? Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit tt Construction Individual well (x) Co~uunity/Public System ( ) Depth of Well 115' Well Log on File Bacterial Analysis ( )no Sewage Disposal System: Permit tt Septic Tank Size Absorption Area On-site System (x) Public Utility Installed 1977 Installer Manufacturer Soils Rate Material ( ) Distances: Well to Septic to Sewer Line to Nearest Lot Line Tank Nearest Lot line ho Absorption Area Absorption Area P a c ~!~ T ~,,o Department of tIealth and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lo_t_6 Bl_ock A Sunse_~q__Hills Subdivision Co~]lent s: Approved: Disapproved Letter Attached: ( ) Date: Date: Department Worksheet: MUNICIPALITY OF ANCHORAGe' Department of Health and Environmental Protectio= · 825 m Street, Anchorage, Alaska 99501 . :~<equest for approva± of Inmivi~ual Sewer and Water F~cilities~ Property Owner :LQ)/r~ : :'~3 Mailing Address: r~.~,~. :~>< qC~3:~q. Phone 2.- Name of Buyer: Mailing Address: Lending Institution: Mailing Address: Phone: Phone: Realtor/Agent: Mailing Address: Phone: Street Location: ::~ ~J~ ~:: Single Family Residence: (~- Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply:.. *Individual Well (~) Public/Conm]unity System ( If Individual Well, well depth //Q~/ If Community System, name of system Sewage Disposal System: *~n-site System (~) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-si~e sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77