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Home My WebLink AboutVALLI VUE ESTATES #2 BLK 1 LT 69Vol li Vue Estate Block I Lot 69 #01§-311-43 Q6r, " 'ER ANCHORAGE AREA BO[ !JGH Department of Environmental QualitY/ ~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME -77')?~-z-/~//~ /-/¢/2ffE% MAILING ADDRESS ~/~/¢ /~¢~/¢ ~/L PHONE LOCATION /~"~L ~.~ ¥/g,~: ~'~/Z. LEGAL DESCRIPTION /_¢~- /~¢, /~/~ / SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER Z-SP,~/o~-g MATERIAL INSIDE WIDTH LIQUID DEPTH __ NUMBER OF COMPARTMENTS / LIQUID CAPACITY /&~¢~) GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER OR WIDTH LINING MATERIAL 4-v~w, CRIB SIZE: DIAMETER BUILDING FOUNDATION ?~O /¢' NEAREST LOT LINE 2-~ /¢ ADDITIONAL ABSORPTION L~ENGTH DEPTH /2C /~'/ / DEPTH ~// DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL SQ. FT, WELL: ~,~ ,~-) ~d ~ TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED NEAREST SEWER LINE REMARKS. DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTALLED BY: ,-~O./( /JIcL PIPE MATERIAL: REMARKS= Form No. EQ-031 DIAGRAM OF SYSTEM DATE I~-/ ~Z. 75z GrEATEr ANCHORAGE ArEA Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 27z[-4561 PERMIT NO.. /,SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT SEEPAGE PIT , DRAIN FIELD TO BE INSTALLED BY 'ID SIZE OF FACILITY TO BE SERVED ~ED THROUGH TEST RESULTS PLETION DATE ANTICIPATED PHONE , OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST ~AL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE ~PARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE / ~}~ ~.~..,~3 ~. TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT 2~ / 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 SEPTIC TANK· /~' / . SEEPAGE PIT SEEPAGE AREA SIZE · DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. /~, / SEEPAGE Pit /~I~7~ '/ DRAIN FIELD CAST iRON iNTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC: TANK AND SEEPAGE PIT FITTED WITh AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. TYPE DIAGRAM OF SYSTEM OR LICENSE~ DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER NCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE D SCR' e S STe ,S'NAC ORD^NCeW,T. A,DCODE. . ' GREATER ANCtlOkAGE AREA UOROU{:.,,j Department of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 Performed fo [_. ~_~.__~z% Legal Description: ..... This form reports: Soils log SOII~S I,OG - EROLA 1 ION TEST Date Percolation test Depth Feet 6- 7- 8- 10- 11 - 12- 13- 14- Was ground water encountered? If yes, at what depth? Reading Date Gross Time Net Time J Depth to Water ~ Net Drop Percolation rate minute. -Proposed installat]~-~-:- Seepa"ge Pit Drain Field Depth of Inlet .............. · Depth t-6'-b-~-~Tn--o-f--pit or trench COM~4ENTS: F_ PU 1 `-I MV UHMPAUTY of ANCHORAGE Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section _ Fax: 907-343-7997 Parcel I.D. 015-311-43 Certificate of On -Site Systems Approval Expiration Date: 7-1& V ,-2— 0Z0 1. GENERAL INFORMATION Complete legal description Valli Vue Estates #2, Block 1, Lot 69 Location (site address) 6810 Round Tree Drive Anchorage, AK Current property owner(s) Deborah Kruse & Thomas Kinney Day phone 350-3377 Mailing address Real estate agent 6810 Round Tree Drive, Anchorage, AK 99507 Rod Rodriguez 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 727-7227 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic El Water Storage ❑ Holding Tank ❑ Community Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ `J570 Date of Payment _101q IN Receipt Number 034$16 COSA # 05(_0103 Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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 (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone 907-522-7773 Address 1399 W. 34th Ave Suite 101_,_Anchorage AK 99503 Engineer's Printed Name Michael E. Anderson, P.E. Date 10/4/19 6. DSD SIGNATURE System #1 Approved for C bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for —n000n„ bedrooms, with the following stipulations: .on I U 0 - By: (nom- Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Valli Vue Estates #2, Block 2, Lot 69 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments **COMMUNITY WELL"* B. TANK DATA Age of tank(s) 45 years Tank type/material Septic/Concrete Measured operating fluid level in septic tank 38 ❑ Standpipes/foundation cleanout per record drawing Date of pumping Isaacs Pumping - 7/16/2019 ,- D. ABSORPTION FIELD DATA Seepage Pit Parcel ID: 015-311-43 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by _ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Which system tested (date installed) 10/14/74 Adequacy test date 9/3/19 ❑ ALL standpipes present per record drawing Results Pass For 3 bedrooms Total measured depth from grade 13.1 ft (max) Fluid depth prior to test 6 in Measured depth to pipe invert from grade NA* ft (min) Water added 1138 gal ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: New depth *8 in Elapsed time *0 min Final fluid depth *8 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) None If yes, enter date *No cleanout in seepage pit. Inspection Report indicates 9' of gravel below invert. Water level rose only 2" after 1,138 gallons of water was injected. Pit absorbed more than 4�0 gallons during this period. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' N/A Community Sewer Manhole/Cleanout > 100' N/A if No ❑ Yes if No ft F7 Yes if No ft Neighboring Tank > 100' ❑ Yes if No N/A ft Private Sewer/Septic Line > 25' ❑ Yes if No N/A ft Absorption Field on Lot > 100' ❑ Yes if No N/A ft Holding Tank > 100' ❑ Yes if No N/A ft Neighboring Absorption Fields > 100' N/A Animal Containment > 50' ❑ Yes if No N/A ft Community Wells > 200' Q Yes if No ft ❑ Yes if No ft Yes if No Community Sewer Main > 75' ❑ Yes N/A if No ft Manure/Animal Excreta Storage > 100' ❑ Yes N/A if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Property Line > 5' ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' P Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' P/1 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION / certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ��n&%SUVA%tM fit `c OF q .' 49th MICHAEL E. ANDERSON :5 N o. CE -4381 C�� •°,, 10/4/19 ,>' I1§1 �P��• of • ALgS �� 49th00 •T' �0 Ile 00. izabeth L. Walatka , o 00 8036 - LS • • � � �SCALE: V'= 30' d ®�Fo ' • . • • •o� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON FB 19-5, pg 74-74 BE UNLESS OTHERWISE NOTED. FB 75-2, pg 40 J REVISED 10-14-19, Added septic vent L(-� RECERTIFIED 9-27-19 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described property: LOT 69, BLOCK 1. VALLI VUE ESTATES UNIT No. 2 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 12th day of MAY , 1975. FRED WALATKA & ASSOCIATES, L.L.C. 907-248-1666 Engineers and Surveyors Municipality of Anchorage Development Services Department · Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www, ci.anchorage.ak.us (907) 343-7904" 1. GENERALINFORM,~,TION ".~ CERTIFICATE OF HEALTH AUTHORITY APPROVAL 'FOR A SINGLE FA'MILY'DWELLING ' " ".' '. '. · .".~- .-'HAA # Expiration Date: J-/L - ~ - ,O Z.~ Complete I;'gal'description .": .'LO'[' G, ~ LocatiOn (site address br~:dir~ctiohs) ':''. m ;" ""~'" ~' "~ ' "~" Current Property o'wn~r(s,). ' ':'P ILt~H I Mmhng addre Lending agency ...... Mailing address , Day phone ~ '~' Day phone Real Estate Agent V--~ I~.I~NL/~,Ht"~; ~__ .~ Dayphone Mailing Address Unless otherwise requested, HAA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: '~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: · [] Individual On-site [] Individual Holding tank [] Community On-site Public Sewer II The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for gO days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm ~ ~[:>OtP~t~.~,,.I~ '~.1~_. Phone ~7~"~qllo Address ~.-b ~. I.~ ,/~-/-~d ~/ Zo,'~ Engineer's Pdnted Name "~/,/.,~ -.~j~u,,'V-(~,,~?' Date_ /'//-~-~-O~ .' ,,._~¢ r... A/.. .. DSD SIGNATURE .. . ,, ~',~.~ ~ .~,~ .~ Approved for ~ bed'ro~ms. ' ....... Conditional approval for bedrooms, with the following stipulations: ~'~.-' ON-SITE '..'~ ~.~' WATERAND : rn.: Additional Comments By: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of),nchorage Development Services Department Building Safety ON[sion On-Site Water & Wastewater Program · 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci,anchorage, ak. us (907) 343-7g04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. VVEL~DATA ~1~¢.~ Well type , Date completed, Total depth . ~ ff. IfA, B, or C provide PWSID # Sanitary seal (Y/N) Cased to _ ff. FROM WE].L LOG ~ g.p,m. Date of test . ' ' Static water level Well production WATER SAMPLE RESULTS: Coliform , , colonies/100 mi. Areeni=: mg,/l. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSISECTION g.p.m. Nitrate , ._ mg./I. Other bacteria Date of sample: Collected by: Tankslze le00 gal. Number of Compartments Foundation cleanout (Y/N) ~'.. Depression over tank (Y/N) ~ Date of pumping m[e~. _ Pumper C. ABSORPTION FIELD DATA Date installed to-t~- 1~ Soil rating (g.p,d~~ or ft¥odrm) ..~,~-~ Length l),~kfl~,,,<, ff. Width .~t~l~ ff. Total depth !L/ ff. Eft. absorption area ~__.._~ Monitoring tube Date of adequacy test N- ~.2.-D'~. Results (Pass/Fall) Fluid depth in al~sorption field before test J I~ in. Water added $' ,,e~ gal. Elapsed Tree: ~[P ~ Final fluid depth L~ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~ O, colonies/lO0 mi. Date installed _ ID-tH Cleanouts (Y/N) High water alarm (Y/N) System t~pe L ~. ~. ~, Gravel below pipe ~ ff. Depression over field For ,, ~ bedroom New depth~in. z//~-'O g.p.d. If yes, give date I//' UFT STATION ~ Date installed in gallons .. 'Pump on" level at ~. 'Pump off' level at Datum ~ Cycles tested Man~~. ss (Y/N) in. ~J~gh water alarm level at J Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL/ON LOT TO: Septic tank/lift station on lot . /,'~,' ' ~ / Absorption field on lot ,~ Public sewer main ~ Sewer/septic service~lfie On adjacent lots On adjacent Public sewx~rnanhole/cleanout Holding~ank Building foundation -.~ ~-- Water main ~'O ~- Wells on adjacent lots ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Property line J O ~' Absorption field Water service line ~' o ~' Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I O + Water main Property line Building foundation Water Service line ~O ~' Surface water t,4 ~ Curtain drain t'4/O Wells on adjacent lots Driveway. parking/vehicle storage F. COMMENTS in. o. .mc m. -- I ~ ~e~ I ha~ dete~ined through field inspe~ons and mw~w of Municipal m~s that ~e above ..... date. Engineers Printed Name . Waiver Fee $ Il Date of Payment Receipt Number HAA Fee $ Date of Payment Receip,t Number (Rev, 12/01) l"l~Y--OS--2rdrd$ 01:~? PI'~ T SPURKL~ND 907 27e e01:5 P.01 Cc) N / \ \ ~ ~ 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 /¢.~'~ ,~ /~'27~:, _ GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, (b) (c) range) Location (address,or directions) Applicant Name ~"]"J%o/'n~' g~=_~ ~A& Telephone: Home ~A/G ~:%~ Business Applicant. i~ (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); (d) Lending Institution /-//],'/~'-/ Address .-ff~ ~/' ,,/)~(Z_ ¢' (e) Real Estate Companyand Agent Address Telephone (f) Mail the .,.NAA to the following address: 2. TYPE OF RESIDENCE Single-Family J~ Multi-Family Number of Bedrooms Other 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. 4. SEWAGE DISPOSAL Onsite [] Public [] Community [] Holding Tank [] Note: Jf 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 (11/84) ENGINEERING FIRIV1 PROVIDIN,~ INSPECTIONS, TESTS, FILE SEARCH, DA, A 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 on the date of this inspection., Date En Approved for /~L:~_.., bedrooms by Approved ,~ Disapproved ' ' Terms of Conditional Approval '~ ':CAUTION The Mu~ipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval cert!ficates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHER does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DEEP 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} WELL DATA Well Classification. Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (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 Cieanout/Manhole Water Sample Collected by Water Sample Test Results MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 DEPT. OF HEALTH & ENVIRONMENTAL PROIECTION RECEIVED Lega?/Description: L~~ If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Cased to Depth of Grouting Pump SetAt Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments SEPTIC/HOLDING TANK DATA Date Installed1~,-~,./ Size /'OO;<:~ct[ No. of Compartments~/ Standpipes (Y/N) '~ Air4ight Caps (Y/N) I Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~, Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High-Water Alarm (Y/N) ~( Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ~'3/ To Water Main/Service Line Course ~ /O G Comments Y To Building Foundation ~ t To Disposal Field ~ '~ ! To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72 026(11/84) C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I'd/7 Z¢ 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 / 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 ~"lf' ~"¢~1 C.~/~ Length of Field Depth of Field Gravel Bed Thickness C;~ / Standpipes Present (Y/N) Y Date of Last Adequacy Test To Property Line "~C To Existing or Abandoned System on ; On Adjoining Lots /O.~ 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 (Y/N) Comments Dimensions Manhole/Access (Y/N) - '~,"Pump Off" Level at '-'"'"'%--i' Vent'(Y/N) - les during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed _~,..~ ~;~'~/Date Company ~.~2'~, Receipt No. Date of Payment Amount: $ ~O" Page 2 of 2 72-026 (11/84) D~PT. OF EN¥'IRONMENTAL CONSERYATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR 274-2533 TO Whom it May Concern: A~cor~i., to re~ords on ,.e i. this o.i~e the ~ ~ ~/-~Water System i$ in compliance with the State Drinking Water Regulations Sincerely, /' ~partment of Envirenmental Quah Water and Sewer Questionnaire Date Time Subdivision ~/~ Owner's Name: Mailing Address: Questions: 1. How many bedrooms are now in your house? 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? /~ 5. Did the realtor or builder inform you that you would have to enlarge the existing sewer system if you finished the basement bedroom (s)? //~ 6. If on a public water supply, do you always have an adequate supply of 7. Is the pressure always adequate? }//{ J 8. Who was the builder? ~(9- 9. Who was the home purchased from? ~c ~- /~ OTHER COMMENTS: