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Home My WebLink AboutWILDWOOD GLEN LT 8 / /~.~.' 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 LEGAL DESCRIPTION ~<~ Manufacturer ~C~ Materi¢¢ ~ ~ Liq. capacity in gallons Inside lenDth Width Liquid depth / ~O IF HOMEMADE: DISTANgE TO: Well Foundation Nearest lot line PEhMIT NO. --~ ~~Z NO. of line/ Length~ of ~ine Total I e n~,¢f lines Trench wid~ inches Distance__between lines ~ ~ ~ Top of tile to finish gr~¢. Z Material b~neath tile Total effective absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot llne ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer line Septic tank Absorption area(si ~ DISTANCE TO: OTHER PIPE MATERIALS 8OIL TEST RATING INSTALLER /~ ~ I' ~ 72-013 (Rev. 3/78) APPLICANT t_OCATION LEGAL :--;]'fan MRRQUISS CONNIFER DR L8 14!LDHOOD GLENN PO BOX ±0-22:1.4 LOT SIZE 344-877t 40000 SQURRE FEET 'TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCFI MAXIMUM NUMBER OF' BEDROOMS = 4 SOIL RATING (SQ FT?BR)= 150 'THE REQUIRED SIZE OF' TNE SOIL ABSORPTION S"r'STEM IS: TNE LENGTH DIMENSION IS THE L.ENGTH (IN FEET) OF THE TRENCH Or-.': DRAINFIELD, THE DEPTH OF A TRENCH OR PIT IS THE DISTRNCE 8ETHEEN THE SURFfiCE OF THE GROUND RND TNE BOTTOM OF TNE EXCAVRTION ':]IN FEET). THERE IS NO SET HI[:'TN FOR TRENCHES. THE GRflVEL DEPTH IS I'HE NINZMUN DEPTH OF GRR'¢EL. 8ETI.4EEt',I THE OUTFRLL F'IPE fiND THE BOTTOM OF TNE EXE:R',,"RTION (IN FEET), PERMIT RPF'LICANT HAS THE RESPONSIBILZ]"L`' TO INFORM 'I"HIS DEF'RRTNENT DURING THE iNSTRLLATION INSPECTIONS OF FIN"r' HELLS RDJRC:ENT TO THIS F'ROPERT'¢ FAN[:' THE NUMBER OF RESIDENCES TNRT TAE HELL HILL SERVE. E:ACKFILLING OF RNL,' SL`'STE.H HITNOUT FINIAL. INSPECTION ANt:, APPRO',,,'RL B"? THIS DEF'FIRTHENT HILL BE: SUBJEC'T TO PROSECUTION. ........... MINIMUM DISTANCE F:ETt,.IEEN R HELl_ FIN[) AN'?' ON-SITE .:,E!.IHbE DISF'OSF!L. '='-":: :!.E~E1 FEET FOR fl PRIVRTE HELL OR ±50 TO 200 FEET FROM A PUE',LIC: HELL, DEPENDING UPON THE TYPE OF PUBLIC HELL. MINIMUM DISTRNCE FROM ~ PRIVWFE HELL TO R PRIVRTE SEHER L. INE IS 25 FEET RND TO R COMMUNIT'?' SEHER LINE: IS 75 FEET. HELL LOGS fiRE REQUIRED AND MUST BE RETURNED TO THE DEPflRTMENT HITHIN ~:0 DRYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MR'¢ flPPL_Y. SPECIFICRTIONS RND CONSTRUCTION DIflGRRMS RRE fl',,,'R~L.ABLE TO INSURE PROPER INSTflLL. RTION. I CERTIFY TNRT ±: t BM FANILIRR HITH THE REQUIREMENTS FOR ON-SITE SEI4ERS RND !4EI_LS AS SET FOR. TH B'¢ THE NUNICIF'RLIT¥ OF RNCHOR. RGE. 2: t HILL INSTRLL THE SL`'STEM IN ACCORDRNCE HITH THE CODES. ]:: ~ UNDERSTRND THRT THE ON-SITE SEHER S'¢STEN NRL`' REQUIRE ENLRRGENENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THF4N 4 BEDROOMS. AF'PL ! CB 'AN MARQ S ~SSU :[:, B'-'_ - -- ......... :'-- "- ........ ~ 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: 1 2 3 4 5- 6- 7- 8- 9- SLOPE SITE PLAN 10- 11 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 14- 15- 17 18 19 2O Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COM.E.TS //2 PERFORMED BY ~'~') CERTIFIED BY: 72-008 (6/79) ~ oE 0 c~ ~IUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Servmes 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 GENERAL INFORMATION Complete legal description Location (site address or directions) ~'/o z~.~ ~___~ tF~.--~-~. ~ - Property owner Jr~__.F~:~ ~..L.~ E=~E[ Day phone ~,4. Lending agency -- ~ ~ Day phone Mailing address ~ ~--~, Day phone Agent '-~ .c:,~.z~.t..~ '~, Address r,J lac .... 2. NUMBER OFBEDRO0 · Community well Pu 91ic water NOTE: If communi~ well system, provide written confirmation from State ADEC a~est- .' · S'I,)/ , · ~ng to the legah~ and status of system, _~ ., ' 4. ~ TYPE OF WASTEWATER DISPOSAL: ' - r - ' , . ~ * " · '~' ;,,'~,' ~ ' { ' '~ o.-.,te .. J ; ........ ... ...... , ~ ~ ~-z,.1 , :;, .' . .:' ' :' Hold ng tank ' . . Public sewer ' :::- " · NOTE: If community wastewater system, provide wri~en confirmation from State ~DEC a~esfing to the legali~ 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 c [ this inspection. Name of Firm Address, Engineer's Si'~natu;e Alaska Watar & Waste~ ~ter Services,, ~1, ~'.olma~ge ~r~./ Phone 6. D:~HSSzNATzRE~4C.H ,. : . 4 pp. ~: . :, .,.~ . .... . :'r::~ .... :? Condlt~ona!:~appmval.:for :; bedrooms, w~th .the following st~pulatlons.,~:~Wf,~:~}~'f~r;~r/~( Additional Comments · z : · · a,e 5:" conduct ~nSpe*tions or anal~e data before a cedificate is i~ued. The Munioipali~ of Anchorhge is not responsible f0r errom or omi~ions in the profe~ional engin~es work. ; ~.' ,: :~ 7~(~.!~1. ~ UOA~ Legal Description: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERWR~:~ E IV E D Environmental Services Division 825"L" Street. Room 502 · Anchorage. Alaska 9950!, (907) 3~3¢~44 .~ I ~°~c~{-0 Health Authority Approval Checklist · 4q~Ou, loo~ ~_~ff.j,4M Parcel I.D.: Municipality of Anch..orag. e Dept. Health & Human ~orvmes A. WELL DATA Welltype '~x',d~-'-~ IfA B. or C, attachADECletter. ADECwater systemnmnber Log present (Y/N) "'-t ~-- ,g Date completed I~_,/t/5/8 / Total depth Sanitary:seal (Y~4} Cased to ~ t '7 caSing height (above ground) Wires properly protected (Y/N) ~/~ <~ Date of test Static water level Well production, FROM WELL LOG AT INSPECTION >4.+ WATER SAMPLE RESULTS: Coliform Date of saurple: t/I Nitrate . [ o%,o0../~ CIq D.~ Other bacteria ~2~ Collected by: ~m'g~C4Pa.~~'~ B. SEPTIC/HOLDING TANK DATA ~ 14 ',t ~5~e--& I[ ~ H.,cm-,r~ Date installed IO/~l Tanksize 17..~'lD NumberofCompartments ''~ Cleanouts(Y/N) V Foundation cleanout (Y/N) N/ Depression (Y/N) 14 High Water alarm (Y/N) DateofPumping I/,~/q~ Pumper ,,4 4, /-~ot-~,~_.L C. ABSORPTION FIELD DATA Dat..installed I~/~ / Length ~f'8 Width Effective absorption area -'1 (~ Date of adequacy test 1/Z,O/c/ Soil rating ~ or fl2/bdmr) Gravel thickness below pipe Monitoring Tube present(Y/N) Results (Pass/Fall) System type ~! Total depth I Depression over field (Y/N) t,4 0 For ~ bedrooms Fluid depth tn absorpuon field before test (m.); Z . ,~ ': Imme&ately after~42gal, water added (in.): Fluid depth ~. (ins.) Minutes later: ~' Absorption rate = '>' · Peroxide treatment (past 12 months) (Y/N) blota~_- ~a,lOr.aMif yes, give date D. LIFT~ Date installed ~ np off' level at* _ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot [ OO c.~.'r'r,~-.~ ; On adjacent lots Absorption field on lot I 20 -* .; On adjacent lots Public sewer main ~ /~.~- Public sewer manhole/cleanont Sewer/septic service lille q(..~ t4~ Lift statioa SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation ~ [, ~" ~ Property line ~ ~ Abso~tion field ~0 Water maitgse~ice line ~ ID .Surface water/drainage > {oO ~ Wells on adjacent lots SEPARATION DISTANCE I~,OM ABSORPTION FIELD ON LOT TO: Building foundation ~:,O t~ Water main/service line >"' I O / -- Snr£ace water ~ I ~ / ~ Driveway, parking/vehicle storage area Curtain drain ~qe,~ ~ V-~ao'~,',,I Wells on adjacent lots 2>>' PropeWy line F. ENGINEER'S CERTIFICATION ..~ xt~<~ot~-- I~;P.,ff~->-mt~,O / I certify that 1 h. cve~eterm~ed thrufieldD~spections and review of Municipal recordx tl~Ihe Engineer sName ~~ ~ ~~ Date I /*~/~& ''~2C/:°t I/ce*~a3 ,C,~ ............................................................................................................... ...... HAA Fee $ ,.~C~(~, ~'3(D Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Date of Payment Receipt Number Alaska Water & Wastewater Services "Preserving The Last Frontier" January 22, 1996 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: HAA for Lot 8, Wildwood Glenn S/D. To whom it may concern: Comments regarding the subject HAA are as follows: WELL TEST: The static level was 233 feet. Water was pumped at a rate of 4.42 gpm for a total of 213 minutes. The results of the test are summarized as follows: Drawdown Time (min) Water Level(ft) Flow(Gal) Drawdown(ft.) 0 233 0 0 24 263 104 30 35 270 152 37 61 286 266 53 75 290 327 57 204 307 902 74 213 302 (pump off) 942 69 Recovery Time(min) Water Level(ft) Recovery(ft) 0 302 0 30 270 32 60 256 46 The water level in the well stabilized after about 100 minutes of pumping, indicating that it was recovering as fast as the water was being pumped. Based upon this data, the well was deemed to be adequate for a 4 bedroom house (600 gpd). SEPTIC SYSTEM ADEQUACY TEST: The results of the septic test are summarized on the attached Log Vs. Log plot of the septic system recovery. Telephone: (907) 337-6179 · Fax: (907) 338-3246 · 8471 Brookridge Drive · Anchorage, Alaska 99504 SEPTIC Ti~NK: The septic tank is approximately 14.5 years old and approaching the end of its structural life. The new homeowner should anticipate replacing it within the next 5 years. The engineer makes no warranty regarding the future life of the tank. SEPARATION DISTANCE FROM WELL TO SEPTIC TANK: Per my field measurements, the separation distance from the well to the septic tank is very close to the 100 foot requirement (perhaps exactly 100 feet?). All previous HAAs issued for this property indicate the distance is greater than 100 feet. In order to positively verify the distance, it would be necessary to expose the tank, and shoot the distances (around the house) with a surveying instrument. In my professional opinion, this is not justified, since for all practical purposes the separation distance has been achieved. Furthermore, due to the age of the tank, it is reasonable to assume that it will be replaced within the next 5 years. I am open to any suggestions from your department. If you have any questions, please You can also r~ach me via my pager, Sincerely, A 0wn~/tConsul t ant contact me at 337-6179. 1-800-481-1162. JAG/jag Baer2.wps ',% CT&E Ref.~ Matrix Client Sample ID CT&E Environmental Services Inc. Laborato~ Division ~~'~7~'~ 96.oi6 1 Laboratory Analysis Report WATER L8 WILDWOOD GLENN Client Name AK WATER & WASTEWATER SERVICES WORK Order 20695 Ordered By JEFF GARNESS Printed Date 01/19/96 @ 08:43 hrs. Project Name Collected Date 01/16/96 @ 09:00 hrs. Project# Received Date 01/16/96 @ 10:45 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: S~4PLE COLLECTED BY: GARNESS. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 353.2 10. 01/16/96 BMW * See Special Instructions A~ove UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed ~ = Undetected, Reported value is the practical quantification limit. LT = Less Than = Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, iLLiNOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA 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. #.~)\ ~. - [-'~OL~)- Z-]. ~ HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner ~k~/~L,~¢,_ Mailing address~ ~b ~( ~ Lending agenc¢ ~ ~o~ Mailing address~ ~}- %~_h~, Day phone Day phone, Day phone Address Unless otherwise requested, HAA will be held for pickup. '~v:.': \ NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well 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: If community wastewater system, provide written confirmation from State ADEC attesting 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 ~'/~,~-~'~/- Address 2~¢~/' Engineer's signature Phone Date 7- ,~0 - .~/ ~DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. 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 Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. MUnicipality of Anchorage, Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: If A, B, or C, attach ADEC letter. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) ParcelI.D. pAttTY 01: ANCHOP&,OE ~.~Et-,q^t SE?.v~CES DNIStON AUG - t99t RECEIVED ADEC water system number Date completed /~?-/.S-- ~/' Driller Cased to 2/ 7/ Casing height Wires properly protected (Y/N) /& # F Date of test Static water level Well flow Pump level FROM WELL LOG IZ-/..¢- $/ AT INSPECTION 7- Z.¢- Y/ sEpARATION DISTANcEs FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main ; On adjacent lots ; On adjacent lots Public sewer service line -~ 7~0 Public sewer manhole/cleanout Petroleum tank 4- 5-O~ WATER SAMPLE RESULTS: Coliform L~ Date of sample: 7- ~. ~- Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed /6?-Z7- ~c~f Cteanouts (Y/N) Y High water alarm (Y/N) '/v/ Date of pumping Tank size i~5~ Compartments Foundation cleanout (Y/N) )/ Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 4-/~ ' On adjacent lots ''/ Topropertyline ¢' /..5-- Absorption field Surface water/drainage -~ / ¢~ Foundation "/' Water main/service line 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION ',--' /C-'DF" Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed /~9 Length /-'//~ / Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating fS'o Gravel thickness f / Cleanouts present (Y/N) Date of adequacy test for ~--'~¢//~.. System type Total depth bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ¢/'~'P ' On adjacent lots '~ /4P-d) ' Propertyline ~4/'-T" / To building foundation -~-,~.z9 / To existing or abandoned system on lot Onadjacentlots '/' ']'P~ Cutbank ¢/drab ' Watermei~/serviceline Surface water -/'/P-~ Driveway, parking/vehicle storage area -/- Z'-49 Curtain drain -/-/~9-b / E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature Engineer's Name /"/' Date 7- ..~2 NAA Fee $ Date Of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/9f) Back MOA 21 NORTHERN TESTING LABORATORIES, NC. 3330 INDUSTIRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) 496-3116" FAX 456-3125 2505 FAIRBANKS STREET ANCHOF~AGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 Constructing Engineers 9601 Buddy Werner Drive Anchorage AK 99516 Attn: - Report Date: 07/29/91 Date Arrived: 07/24/91 Date Sampled: 07/23/91 Time Sampled: 1900 Collected By: CW Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Al12390 Wildwood Glenn Water Flag Definitions U = Below Detection Limit DL Stated in Result B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Method Parameter Units Result Flag Analyzed SM 418 C Nitrate-N mg/1 0.1 U 07/26/91 Reported By: William E. Buchan Anchorage Operations Manager k..~. 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) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~06~./'~' ~, _/~/~NX~gX Telephone: Home 3'~/~/ /5/"C~ ApplicantAddress ~?~/1~2 Co,~/~/~.~iE ~. ~/~/~,,~,,¢/,~?~ /~Z,/2..~./r'/~ ~.5'/~' Applicant is (check one): Lending Institution []; Ownedbuilder ~,; Buyer []; Other [] (explain); Business (d) Lending Institution Address Telephone (e) Real Estate Company and Agent Address ,c/fi, Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family J~ Multi-Family [] Number of Bedrooms Y 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 OnsiteR1 Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting' to the legality and status. 72-025 (1 $/84) Page 1 of 2 5. 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 on the date of this inspection. .ameofFirm C--'~d)~/~'~Z~' ~-d~'/'~ ,.~/c_~ Telephone Address ~0/ ~y ~ ~ ~ ~ ~/~- ~ Date ~ --~ - ~ Approved for ~,'~ ~ '~ bedroo, rm'~by Terms of Gonditional 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 0~) MUNICIPALITY OF ANcHoRAGI~ '"'"' MUNICIPALITY OF ANCHORAGE (M DEPT. OF HEALTH ENVIRONMENTAL PROTEc]'ION HEALTH AUTHORITY APPROVAL (HAA) c zC S ST - g tgS ' Legal. Description:' Well Classification 7~/~'~/~- If A, B, c~ C, D.E.C. Approved(Y/N) Well Log P~esent (Y/N) y Date Ccmpleted /~-/3--F/ Yield Total Depth ~/5-~3' Cased to ~-/~ Depth of G~outing Static Water Level ~/-//~2~)~/ Pump Set At ~2/~'/~c3~/ Casing Height Abo~ Ground /~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) / Depression Around Wellhead (Y/N) Separation Distances f~cm Well: To Septic/Holding Tank on Lot /~ % ; On Adjoining Lots /DD ~ TO Nearest Edge of Absorption Field on Lot /~)'~ ; On Adjoining Lots To Nearest Public SeweF Line ~//J To Nearest Public Sewe~ Cleanout/Manhole /~//$ To Nearest Sewe~ Service Line on Lot Water Sample Collected By O'~/~ ; Date ~ ~ SEPTIC/HOLDING TANK DATA Date Installed /o-z?-~/ Size /~3-O~ No. of Compartments Standpipes (Y/N) y Air-tight Caps (Y/N),y Foundation Cleanout (Y/N) Depression ove~ Tank (Y/N) ~/ Date Last Pumped ~-~3-'/~- Pumping/Maintenance Contzact on File (Y/N) /u/ ; fo~ Holding Tank High-WateF Alarm (Y/N) z///~ Temporaz-f Holding Tank Permit (Y/N) /~/~ Separation Distances f~om Septic/Holding Tank: To Water-Supply Well /00 TO P~ope~ty Line To Water Mai~JSe~vice Lir~ Course To Building Foundation /~ To Disposal Field /g) ' To St~e~m~, Pond, Lake, c~ Major D~ainage [Page 1 of 2] Receipt Date Pald: Amount: 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date .Installed /~ - F_ 7 - J:! Width of Field 3~ ~t Square Feet of Absorption A~ea Depression over Field (Y/N) ~/ Results Of Last Adequacy Test /3-0 Type of System Design Length of Field ~//~ ~ Eepth of Field / 3- ' Gravel ~d Thick.ss ~/ ~F ~,~ Stan~i~s ~esent (Y~) ~ of ~st A~a~ ~st ~-~ Separation Distance f~om Absc~ptlon Field: To Water-Supply Wall ,f~o ~ To P~operty Line /~' To Building Foundation ~O Lot ~v///~ ; On Adjoining Lots /~ To Water Main/Service Line '~3 To Stream/Pond/Lake/c~ Major D~ainage Course To D~iveway, Parking A~ea, c~ Vehicle Stc~age A~ea ~-~'W Con~nts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. M~ets MOA Elect~ical Codes(Y/N) Corarents ** Check Permitted Bedroom 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 ~'~- Company ~o~/~"~5' ~O.~/~.e~ MOA No. KB1/d5/s [Page 2 of 2] 2-15-84 T. ime ', ' ~' Time ~' '"time Date Date Date Inspector Inspector Inspector / Comments I/ Conditional Approval Date Sewer Installed Permit No. Septic Tank Size 125~3 [ Holding Tank Size /<3 Soils Rating Well To Absorption Area Well Log Received Well to Tank /4/4:) APPLICANT FILLS OUT LOWER HALF ONLY Property Owner ~/P ~O,,N" ~"~PT..,,~ -~".~'"/ Phone MallingAddress { ~_~'-- ~--- ~'~ ~ C//~//~ /'~'~'/ /~//~' Address .~ ~ /v'~,f~'Z-/Z'-E-''~A/ Phone Lending Institution ///~/~/~,~ .~,.2'~./"~.~ /~"~/~/~' ' Address Realty Co. & Agent /~//).'~/'["-~ .! Phone Address Legal Description ~_, 0B <~ [./~..~ / L-~:)~.J ~ ~)/~ ~ [_.. Street Location Type .Q.J Residence [~'Single Family [D Multiple Family No. of Bedrooms [] Other Wate(,,Supply ,[3-Individual ATTACH WELL LOG. A well log is required for all wells drilled since June [] Community 1975. For wells drilled prior to that date, give well depth (attach log if [] Public Utility available./ Sewe,~e Disposal ~- Individual Year Individual Installed: [] Public Utility When Con~ected to Public Utility:. [] Holding Tank NOTE: THE iNSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, April 7, 19~2 Lee HcCann SR Box 2073-M Anchorage, AK Subject: I,ot 99507 ~lldwoo( Glen oubdzv~.slon Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: well lot submitted to this office for our flies and review. e water analysis report needs to be submItted to tnzs office from the ~em Lab, 5633 B Street, for our review. Please notify t.%zs department for a reznspect~.on when noted dlscrepanc].~ have been corrected. If there are any further questions, please call this oz)~Ice at 264-4720. Sincerely, Robert C. Pratt Associate Environmental Specialist RP71/p/EH