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HomeMy WebLinkAboutTANAINA HILLS LT 10 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telepho~te 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAILING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: Manu facture~ IF HOMEMADE: IAbsorption area Inside length NO, OF BEDROOMS PERMITNO~ ( ~ NO. of compartments Liquid depth DISTANCE Manut~clq~rer Well PERMIT NO. DISTANCE TO: No. of lines jLengt~of e~c]]ne Top of tile to finish grade Foundation Total length of lines Material beneath Length Width Depth Nearest lot line Trench width Q~-~es PERMITNO. ~'O~ ~ Total effective absorption area PERMIT NO. Type of crib leter ;rib depth Total effective al ~tion area TO: Depth Driller Distancetolotline.4_(O PERMITNO. ~!)~/ ~)~O '7 9 Septic tank Absorption area{s) t ,' ¢ ¢'z_ / DISTANCE TO: Building fou~ Sewer line OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVED DATE LEGAL 0 , I PL,MrD SF�f- z "-',072430742 p.2 Fie c 12 18 0 4: 6 �'� p Chit S C" - 6 � "'I F� ! � & � 1 C�- i Pump Installation Date: 1>ump.intake De�pth SiAow','op of 'Wefl C�;Ang--,- feel Nune: /ty -elf Pump SUE Pltlecs Adaptcr Btn'ial Depth, f C, V, t Pidess Adaptw -Ikrlanufacvurer,�. Natme: XLtl/��V-Jcb kN--- Pidess Adapter fwstallex-,. ",Veil Disinfected Upon Co.,Tippletjov'' Nu Mrs hod of Diskfeedry coluweilw I Pump Installer N'lue. At-mititift: Tb-� pwnp pu-11P trls-:allatinn log ti' DSD `J It la -,,s cjfr.-,mp n:stalla—on. t)evelcpment Services bepartment Bvildi% Safety Division On-Sife Water & Wastewater P-ogram 470D whore, Road PO, Box 136650 Av"n"k Bqgic,� nmch-3rege. Ar, 99507 i r (B077 'i 343-79a4 Pump Installation Log Well Drilihn, Permi! Nuqibe).: SW Dure fif Issue: Parcel Ideniffivadon 051 C�- i Pump Installation Date: 1>ump.intake De�pth SiAow','op of 'Wefl C�;Ang--,- feel Nune: /ty -elf Pump SUE Pltlecs Adaptcr Btn'ial Depth, f C, V, t Pidess Adaptw -Ikrlanufacvurer,�. Natme: XLtl/��V-Jcb kN--- Pidess Adapter fwstallex-,. ",Veil Disinfected Upon Co.,Tippletjov'' Nu Mrs hod of Diskfeedry coluweilw I Pump Installer N'lue. At-mititift: Tb-� pwnp pu-11P trls-:allatinn log ti' DSD `J It la -,,s cjfr.-,mp n:stalla—on. PEF;?.P1 Z T IqO. i'dlg::.:~IMUi'd NUhlE:ER OF:' E:EB, ROON5 = 2: THE REC!UIF?.E[:, L::IZE OF THE .'SO:(L FIBSOf~'.F:'TION 5'1.'STEM I5: ilZ:" IE F" "IF I"q :== :;TJL ;;.:F.: L_ F~ P"~ ~ 'T if-'] .... :]!. ~:.~; C!i F: E::~ ".,,." !~E:. L_ :SOIL. RFKrING ,::'.::16! F:"f',."BR :) =: 2]:9 LE.- E ,,E- .'rl~ ~ ........ THE LENGTH [:, ]: HEr,Is Z ON IS THE [_EI',IG'f'H ,.'.I1',1 FEET::, O1::' THE TRENCH OR DRFI);iqF:'IE;L.E:,. THE E:,EP]'H OF' FI TRENCH OR F']:T :[:S THE DZL=,TFINCE BETHEEN THE SUF4'.F'FIE:E OF' ]'HIE GF~-'.OUND i~['.,tD TF.IE E:OT'I"Otd OF THE Ei:4C:R',,,'FITION (:1:1'.,I FEIE'F;:,. THERE Z'.:-; NO E;E-f' HZD'T'FI FOR 'I"I-'4:EI'.,tIZI.-IE:i5. THE EiI':?.FIVEL. DE[::"rl-I l'._-q "rile HINZI',IUI"I DEPTH OF GF'.R',,,'EL. BE]"HEE:N THE OL.rTFFiLI.. P:[F::'E fiND THE BOTTCIH OF THE EXCR',/RT:[ON (IN FEET>. F:'Ef;'.I"1:1: '1" FIF'PL Z C:P"Ii'.,Ff' I.-IFIS 'rl-.~E F::ES.;PONS..; ]' E: Z L :[ 'l"tr' '1'O Z NFORH :[P',ISTFIL..L. KfTIOt",I I IqSF'EC:T:[ONS OF l::lN'v' I-'.IELL2; RDJFICENT TO I",II..IHE~ER OF RE'.'SIE:'EP'&'::EE; TI"IFIT THE I.'.[EI....L P.IlLL. SER'v'E. 1"HZ.S; DEPFiRTHEI'..KI" [:,I..IRING THE THIS PROPERT'.t FIF,I[:, THE ..................... 1- il...-] C, <.' ;:2: :3:, ][ ['-,il .'-~; IF:a" IE:E C:: 'qf" ]1: C.~ P-,II 55; F~ IF;g" EF.E F.: ESE G:." EIPK::F::]:: :[ L.L l NC'i OF FIN"r' 5"r'STEH Iq I THOUT F:' l NFIL. l NSF'E':C:T I IZilq FIND RF:'F'RO'v'FIL E:'r' ~['I--I:[ 5; [:,EPRF:T'HENT N];LL BE :51.JB,:[ECT TO F'RO:SECUTION. t,'l I H :[ MLIhl D ]: STFINCE BETklEE:H FI 1.4ELL RI'.,I[:, FIN'-? CiP,I-S I 'TE %F_"I.,.ff:IGE D i SF'OS. iFiL S'r'SUFEI"I :[ 5; &(!lEI FEE:T FOR PI F'RZ'v'FITE I,.IELL. OR ±5(¢ "Fi:) 2E'IO FEET FROH FI PUBL.]:C NEI...L [:,EPEN[:,]:NG UPON THE!: 'T"v'F'E OF F'UBLIC 14EI_I.... I'"I]:NIHLIM [:' :[ STFff',IC:E Ff':OM FI F'R]:'v'Ff'rE I.,.IEI..L. '['0 FI PB".:[',,,'FITE 'SEI,.IER L.:[NE !S ;25 FEE]' RHD TO Ft E:OHHUN:[T"r' '::;EP.IER L:[NE ~; 75 FEE]'. O"f'FIE..Ti: REg!U I REME:I',FI?:, MF-I"r' FIF'PL'v'. SPEC I F l CFI]' :[ ON"-"; Fff',ID CONE!;'FRUC:T Z 01'.,I [:, :[ FIEiRFIHS r:IRE FI'v'FI Z LF:~BLE TO ~ NSURE: PF::OPER Z 1'.,15:TFILLFIT I ON. :[ CER'T::[FV THFIT ::L: Z FIM F'F:IHILIFIF: t.,IITH 'THE REQIj:[REHENTL:; FOR ON-SZTE SFI,.IE:RE, FIN[;, !4EI....L. Si FIS .':SET F'OF?.TH Bk' THE I',IUf,I:[CIF'FILIT'T' OF I-aP.,ICHOIqFIC. iE. ;-2: I I.,.IZL. L II'.,15;TFIL_L. THE 5Yr'.'STEH IN FIL':COF:'.DFIi'qCE HITH THE CODE"2;. 3: J; IJI",I[:,EF4t.STFIND TIqFIT THE or.,!..-S:[TE SEI,.IEF~: S"r'STE:l'd I'"lFl'v' F:!F:i:C~U ].' RE EI",ILFIF;;:C'iEHENT IF:' THE RESJ:['.,ENC:E IE; REMODEL.ED TO Ir.,ICL. LIDE HORE THFIN 3 E:EDRCIOHS. ]: 5.":5' I..IE [. [:.;"r'_ ......... E:'f:ITE ............ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOI. ATION TEST [~/$OILS LOG [~PERCO LATION TEST PERFORMED FOR: ~'N~ ~ ~-~L~ LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16. 17 18 19 20 COMMENTS SLOPE SiTE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTR? Reading Date Gross Net Time Time /o /oo 7, /o rO /7 Ia /O~z ?, /0 PERCOLATION RATE RUN BETWEEN CERTIFIED BY: Depth to Water Net Drop (-,,-~2-~'~, ~ (minutes/inch) FT AND FT ~~ DATE: 72°008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~\ \ - ~" '¢'~'~ - \c,\ HAA # '~:~ V-~©\%('~, 1. GENERAL INFORMATION Complete legal description Lot 10; Tanaina Hills Location (site address or directions) 7031 Kitlisa Anbhorage, AK Prope~y owner _Mn~l-h~w Mann & R'r'i ka W~_ss~] Day phone 243-8670 Mailing address 7031 Kitlisa Anchorage, AK 99502 Lending agency Day phone Mailin. g address Agent Address Kathryn Herfindahl/Fortune Properti~vphone, 243-4210 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: 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. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: xX Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA ¢t21 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~¢¢,~t~.wate['Ain effect on the date of this 'nspection. A~a~ka Water & ~ Name of Firm ...,, ]---~'--- Phone ~ Address 7320 J Engineers signature ~ Date ~*¢~ ALASKA WATER & WASTEWATER CONSULTANTS INC IS TO BE PAID $1100 .00 AT CLOSING FOR ENGINEERING SERVICES PERFORMED. 6. DHHS SIGNATURE ~ Approved for -/-/'//~ E£ bedrooms. Disapproved. Conditional approval for 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 orderto 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. Municipality of Anchorage SEP DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~u~v,x~,~¢,~.,~.~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type --~'~ Log present (Y/N) Total depth Sanitary seal (Y/N) Health Authority Approval Checklist ~m~. [~]}~ ParcelI.D.: 011- ~"1-1,~ If A, B, or C, attach ADEC letter, ADEC water system number y Date completed Cased to /~' 2 ' Y FROM WELL LOG Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION //~ g,p.m. ~"* ~' '"/- g.p,m, Date of test Static water level / ~ 7 ,'~. Well production (~' WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~'- /~- ~' B. SEPTIC/HOLDING TANK DATA Date installed ~ ~ /g ~ ~? / Tank size Foundation cleanout (Y/N) .~ Date of Pumping ¢' -~ /x.J- q ~ C. ABSORPTION FIELD DATA Date installed ~' / ~1 Length ~/Z. ~ Width O'/Z//~:~ re.C//-. Other bacteria ¢.~ 0.~. Collected by: ~. ~..~r.),~l¢-/.~{-~/.O¢-L //¢2 ~'O Number of Compartments 2- Cleanouts (Y/N) . Depression (Y/N) /~) High wateralarm (Y/N) Pumper A../¢ .~--/"Jl/..~.~ Soil rating (g,p.d./fF or ft2/bdrm) ~.~¢/-~'/~//System type .Z~_~/~ ~ ~ Gravel thickness below pipe Effective absorption area ~/~-,C'/'2" Monitoring Tube present (Y/N) ~//_ Depression over field (Y/N) __ Date of adequacy test ~- I~¢~ Results (Pass/Fail) ~-'"~'~ -~' For '~ Fluid depth in absorption field before test (in,); /"/~.' Immediately after~,~,~gal, water added (in,): Fluid depth ~ I ~:;~ ~ (ins) Minutes later: I I ~, O Absorption rate = ~'~----'~) 4- .g,p,d, Peroxide treatment (past 12 months) (Y/N) A/,~ If yes, give date ~ Total depth /¢-. --~ / ¢,~/-- .bedrooms 72-026 (Rev. 3/96)* D, LIFT STATION Date installed Manhole/Acc~ arm level at* Size in ~ j  '~ "Pump~ /*Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot / Public sewer main On adjacent lots / On adjacent lots / Public sewer manhole/cleanout /V',4- Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~', ~ / /~ C.. ~. Propertyline ~0 1~ Absorption field Water main/service line. ~'¢ /.v- Surface water/drainage /~o/~- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water /0 /4 Building foundation /0/-/- Water main/service line ,/~0 r.~ Driveway, parking/vehicle storage area Curtain drain ~o.~ /~ ¢ ~ Wells on adjacent lots /¢¢ F. ENGINEER'S CERTIFICATION ~ I cedifythatlh~det¢rg~ldinspectionsandroviewofMuni~~ in conforman~ wit¢ ~ ~A¢~uid~lines in effect on this date. Signature ~ __ Engineer's Nam~ . ~~ R' ~% - ~'.,~ Date ~[t ~/~ HAA Fee $ Date of Payment Receipt Number 72-026 (Rev, Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section P.Q. Box 196650 Anchorage. Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# O/,/-O.,q'-/-- /c~ HAA# t'~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ~'~/ ~' ~,~/-~-~ ~,~c ,,~,,~¢.~,'~,~¢,~-- ,,~/~. Property owner Mailing address Lending agency Day phone Mailing address Agent Day phone Address 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA Will~ be held for pickup. NOTE: 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 4. TYPE OF WASTEWATER DISPOSAL: 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. 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 ~,~,~.~ · ,-~/c~.,~,z.~' Phone Address Engineer's signature Date D.A~'I~H S SIGNATURE Approved for "~ / Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: By: 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. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,~'~-' /¢ ';"~/,~'~/~ ~'"'-~, Parcel I.D. A. Well Data Well type Log present (Y/N) Total depth Sanitary seal if A, B, or C, attach ADEC letter. ADEC water system number Date completed ~'//~ ?,//¢,/z/ Driller -5~¢/d~.---,,~' --~,~.~'-', Cased to /J~¢ / Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow /~ g.p.m. ~ .-¢ g.p.~.~ Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line o~ ~o~ ~ ~z ~O ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ,¢ Nitrate Date of sample: Z' ¢4,..,¢_ ),, Collected by: Other bacteria ~<'.~¢¢~,~ ~- z¢//z_ ,¢--~¢'/~. :r B. SEPTIC/HOLDING TANK DATA Date installed ¢-"//~'~,¢ / Cleanouts (Y/N) Y/ High water alarm (Y/N) Date of pumping Tank size /¢ ,~o ~'~z.. Compartments Foundation cleanout (Y/N) >/' Depression (Y/N) ,'J ~,,-/.~ Alarm tested (Y/N) /¢q/7/ Pumper /~,¢/z~ SEPARATION DISTANCES FROM SEPTIC/HOLDiNG TANK TO: Well(s) on lot ~' /,¢ ~' / On adjacent lots To property line ;> ¢"~ / Absorption field Sudace water/drainage Foundation Water main/service line 72.026 (3/93)o Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N). "Pump on" level at . /. High water alarm level l~eets-~codes (Y/N) Manufacturer Manhole/Access (Y/N) ~-~-~-~-- _~-~'~off" Level at Cyctes tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot '"//~ On adjacent lots Surface water "t'/.-'~-''~ D. ABSORPTION FIELD DATA Date installed ¢~/~z-/~ / Soil rating (GPD/FF) ~? System type Length ~'~, ' ~ Width ~ / Gravel thickness ~ ~ Total depth. / ~J~ Total absorption area ~'~ / Cleanout present (Y/N) )/ Depression over field (Y/N) '~' Date of adequacy test ~ ,.z,.,~_ y- /,~,~2/ Results (pass/fail) ,'~--~ for J Bedrooms Water level in absorption field before test z,z~/' ~, After test '~//~ ~ '/ Peroxide treatment (past 12 months) (Y/N) /'-/ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ / ~ 2' On adjacent lots Property line To building foundation ~' / ~' ~ To existing or abandoned system on lot On adjacent lots ~.¢-z~ / Cutbank ~_~,~ Water main/service line Sudace water /~),~.~,~ ~.~.-.r~-~,~:'~' Driveway, parking/vehicle storage area '~"'~ Curtain drain .U~,.~,~: ~.,'~/~-~,~ E. ENGINEER'S CERTIFICATION I cern'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in Engineers Name J..~...~.~_~ '~'. ~--~,~/z.z~./ _ Date ~' '-( ' "~'"~ CE 817~' HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 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 ~'~,~-~-~%~' 1, GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) , Localion (address or directions) ~/_ , (b) Applicant Name ~t'/\/*,i','"/~'~ -~'~'~ Telephone:Home Business Applicant Address '70'..'z~// f~ ~"'1:'~/i ~, ~i (c) Applicant is (check one): Lending Institutional Owner/builder ~; Buyer D; Other ~ (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone ¢) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Famil~t~ Multi-Family~_~[] Number of Bedrooms -7~-' Other WATER SUPPLY Individual Well,,~' Community [] Public [] Note: If community well system, must bare 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 conhrlr]ation from the State Deparb'nent of Environmental Conservation attesting to the legality and status, Page 1 of 2 72 025(11/84) ENGINEERING FIRM PROVIDINLi ,NSPECTIONS, TESTS, FILE SEARCH, DAT.~ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this HealtR 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 lype 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. ..-~ Address ~----~ ~///~'- Date II/ Approved f~ ~/ bedrooms b~ ./] '~ Date Approved /~ ~ D,sapprove~ ~ GonOiflon~ Terms o~ GonOit}onal Approval CAUTION The Muncipality of Anchorage Department of Health and Enviroamental 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 MUNICIPALITY OF ANCHORAGE DEPT. OP HEALTFI MUNICIPALITY OF ANCHORAGE (MOAI ENVIRONMENTAL PRO'rECrlON HEAl. TH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 / Legal Description: / WELL DATA Well Classification ' ' ~-¢~"2~)~, ~" If A, B, C, D.E.C. Approved (Y/N) Well Log Present (y/N) _y'~- I~' F' J~ate Completed ~// 7/~/ Yield Total Depth I~ ~ Cased to Depth of Grouting ~~ Static Water Level f, ~7 / Pump Set At Casing Height Above Ground '~ ~ 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 To Nearest Edge of Absorption Field on Lot _ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments / ~'~' ; On Adjoining Lots / J~Z¢', On Adjoining Lots /~/~/~' To Nearest Public Sewer To Nearest Sewer Service Line on Lot t/J, ~ 6Ltc"C.t.~'~. ; Date B. SEPTIC/HOLDING TANK DATA Date Installed ~/~ ~'~_~ Standpipes (Y/N) ~ Air-tight Caps (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 / To Property Line To Water Main/Service Line -~¢_~, I Course Size ~0 O0 No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ,'~/~-Z/, ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field /7_/ To Stream, Pond, Lake, or Major Drainage fora / 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/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ' /~.~,2/~,/.~ To Water Main/Service Line .~""¢.2 i To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design ~//~ ~o/~ ( Length of Field Depth of Field Gravel Bed Thickness ~"'¢~-~ ~7'! Standpipes Present (Y/N) Date of Last Adequacy Test /',7~'-'~ To Property Line ~-'¢--~ ¢" / ~--/ To Existing or Abandoned System on ; On Adjoining Lots ~.O ~" -J~- To Cutbank (if present) Comments LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (.~..~ "Pump On" Level at _ "Pum..~j~ff'"~evel at High Water Alarm Level at ,.--~"'"~-' Vent (Y/N) Tested for Electrical Codes (Y/N) Comments Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha/ye checkCdj verified, or conformed to all MOA an~ HAA guidelines in effect on the date of this inspection. .~ ~' r..-,. // / ~'^ ._-- ' / ! Company f"~~ ~--¢"ct/L MOA No,'~"T O' Receipt No. ~..7~'~ ~.~ Date of Payment ) ~. ~ "~'..~-~ Amount: $ ~ ~'¢G.~_.~ Engineer's Seal Page 2 of 2 72-026 (11/84) 440 W. Benson Bird, Suite PENINSULA ENG TEERING Anchor~e, Alaska 99503 (907) 561-5107 April 28, 1986 Mark Ivy 7031 Kitlisa Drive Anchorage, Alaska RE: Lot 10 Block 1 Tanaina Hills Health Authority Approval 86-E-129 Dear Mr. Ivy: At your request we have performed the adequacy test on your septic system at the above referenced property and the well flow test and water analysis required for health authority approval. The septic system was tested by adding water at 5 gpm to the absorption system until 450 gallons had been added and the levels in the tank and drainfield were monitored for 3 consecutive days. The following is a tabulation of the test data: Quantity Date Time Tank Field Rate Added 3/23/86 0 Min 1.4' 2.35' 0 gpm 0 gal 15 1.4 2.45 5 75 35 1.4 2.5 5 175 60 1.4 2.65 5 280 80 1.4 2.75 5 375 97 1.4 2.80 5 450 4/23/86 0 2.6'* 2.40' 0 0 25 2.7 2.5 5 125 50 2.8 2.6 5 250 75 2.85 2.75 5 375 95 3.00 2.85 5 475 4/24/86 0 *Water was running into water softner. 3.9 2.5 0 0 tank from the home during testing from the An evaluation of the test results indicate that the absorption system is adequate for a 3 bedroom home and the well is producing 5 gpm which is acceptable. If you have any questions please call. Sincerely, Wayne Henderson, P.E. : -- ~) DA'rE RECEIVED I NSPECTI ON APPOINTM ENTS DATE DATE ~'/ m 0~L/'~' /-~ DA I NSPECTO /' E ~UNICIPALITY OF ANCHORAGE ~NVIRONMEN1AL  DEPARTMENT OF HEALTH & ENVl RONMENTAL PROTECTION  825 LStreet-Anchora.e, Alaska 99501 S{~.~} ~ ~ '~'~ ( ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete aH parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing· PROP~R~Y RESIDE~ 0f [hf~e~ent from above) PHONE ~ BUYER PHONE MAILING ADDRESS 3, LENDING INSTITUTION ] PHONE I MAI LING&~ ESS 5~S5~ LEGAL DESCRIPTION / 6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS ~ ~ One ~ Four SINGLE FAMILY ~ Two ~ Five ~ MULTIPLE FAMILY ~ Six ~ Three 7, WATER SUPPLY .,~;~' INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LITY [] Other * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8, SEWAGE DISPOSAL SYSTEM /~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY j~ ,-~Pf (~/YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN RE INITIATED. 2,~010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS . · [~]./~iN G L E FAMILY [] ONE [~'" '~TH R EE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [~/INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []~DlVl DUAL/ON -BITE DATE INSTALLED []PUBLIC UTILITY Connection Verified iNSTALLER []Septic Tank or [~] Holding Tank ~ Size: ,,,~,~ ~2~ If Tank is homemade SOILS RATING give dimensions: h~,~_~ ~' TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ./- Absorption Area to nearest Lot Line 5, COMMENTS VED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)