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HomeMy WebLinkAboutSPRING BROOK VISTA #1 BLK 1 LT 4Spring Brook Vista #1 Block 1 Lot 4 #050-091-25 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 ��--7—_— �y NAME PHONE ,�iQ NEW y //A/SQA% _ _ �I [�.• �%3¢ El UPGRADE MAILING ADDRESS ---- -- ------ LEGAL DESCRIPTION L[,7 4, �- e.!! 7`:9 LOCATION �^ NO. OF BEDROOMS Well Absorptionrarea DISTANCE TO: N /� :J Dwelling [ PERMIT NO. � _.... Uy _ i Z N F Manufacturer •- --- — " _-- C/ZGF/ Material sYEE L---- No. of compartments — Lin. capacity in gallons . I10MEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. O? H Manufacturer Material Liquid capacity in gallons T !2 DISTANCE TO: WellFoundation /L/ r Nearest lot l � ine+ PERMIT O. u. Z No. of lines Length o each line Total length of lines -;2 Trench width '� Distance betwe n lines 71 '�6 inches Top of tile to finish _ Material beneath the = Total effect ve absorption area ar grade i � M i',C�j inches L �++>! 1i7• j'°%' Length .Width Depth ` PERMIT NO. Lit Q N Type of crib Crib diameter Crib depth — Total effective absorption area In In Building foundation Nearest lot line DISTANCE TO: J W � Class DISTANCE T0: Depth Building foundation Driller Sewer line Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER PIPE MATERIALS f�lJ,E'Y-Cita Pile- 191PZ� V/ SOIL TEST RATING -SG). FT ems. e--- -_ INSTALLER -- REMARKS itz6 d ) V v! - � © Earl P. Ellis LL LEGAL DATE APPROVED 6/s 217 72-01'3 (Rev. 3/78) + TYPE OF SOlL RBSORBT{OH SYSTEM is: TRENCH MAXIMUM NUMBER OF BEDROOMS = 1 0111, RHTING (SQ FT/BR)- 85 THE REQUIRED SIZE OF THE 5011 ABSORPTION SYSTEM IS: 1AE0�"~Ffl=- K 1.2 L 1_jQw=fkwpR7U- 101171='-w-1-4= 03� THE LFNGTH DIMENSION IS THE iENGTH (IN FEET) OF TUE TRENCH OR DRHINFIEL0. THE DEPTH OF 8 TRENCH (lR PIT IS THE DlSTHNCE BETWEEN THE SURFHCE OF THE GF!UUND HND THE BOTTOM OF THE EXCAVATION (I@ FEET). THERE IS NO SET WIDTH FOR TRENCHES� THE GR0�B- DEPTH IS THE MINIMUM DByTH OF GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCAVATION ({N FEET). �7111k I x Qml 0Ev-Ir x "0 ... ���U� ������ �- 12 & 103 La Al L .1 -03 41� PERM[T APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE lNSTHLLHTION INSPECTIONS OF ANY WELLS RDJHCENT TO 8ND THE NUM8ER OF RESIDENCES TART THE NEIL WILL SERVE. ___ -11" o^f! 1::11 ( :.-.1 :1 y C 10113 FQ AT by TRIPTUTITJ :E QKKA BRCKFILiING OF Elf -EY S;ST[M WITHOUT FINAL INSPECTION AND APPROVAL BY THlS DEPRRTMEHT HILL BE SUBJECT TO PROSECUTION. MIMNMUM DlSTHNCE BETWEEN R WELL AND RNY ON^SlTE SENHGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVHTE WELL/ OR 158 TO 2,00. FEET FROM R PUBLlC WELL DEPENDlNG UPON THE TYPE OF PUBLIC WELL 011113: REQUIREMENTS MAY lFlCHTl0NS HMD CONSTRUCTION DIHGRHMS ARL HVHILHBLE TO INSURE PROPER INST8LL8TION b"M79111-0 X I- FRIXIf" K If"IKS; P> F7 17 � K pwU1413 RET 141 07 it., no. ��wEL' l CKRTlFY THAI i: I 8M FHMILIRR FORTH RY THE MI -Q-4 2� l WILL L }� I UNDE H RESID��CE R SIGNED:—. 0171-1 THF REQUIREMENTS FOR ON—SITE SEWERS HND HEI -L.".5 RS SET lP8LITY OF 8NCHORHGE THE SYSTEM 144 ACCORDANCE WITH THE CODES. T THE 0M—SITE SBNEA! SYSTEM MAY REQUIRE ENLARGEMENT IF THE E'LED TO INCLUDE MORE THRN 4 B�DROOMS ERIC JOHH�ON ISSUED BY... 0 Er E GEC k',HNICAL & ®E:VEL.�.'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2260 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations�-- Land Developrmnt Performed for: Name: low. r�cic. -�(12 u 6 Z) Tel. No. _469 `97-34 Mailing Address: e�j e XA Legal Description: L d-7— r-;, Depth 1feet) So Chaactor st c 0 ]. z 3-- 5-- 6 -- 5-- 6 7� 8 9 ®- 10__ 13 1IL-- 15 16 4 O+a L_ce�-�,C UL I c( &..LC-A(u ,exp- 4 Ground Water Encountered: Yes— No� ✓ If yes, what depth AA'O- '--rn nAe.E Proposed Installation: Seepage Pit _ Drain Field_ r% Comments:tT[�J-��_''�_0: lel i���:✓ /lPer�� Performed by: '�­ . s ��J�L ? - ' m o� �_ Date:®dRe(�- zzEZ2 r 'RNI/i Municipality of Anchorage *AC Development Services DepartmentBuilding Safety. DivisionOn-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-091-25 COSA # C I Ll 0 3 _ Expiration Date: / t. GENERAL INFORMATION Complete legal description SPRING BROOK VISTA #1 BLOCK 1, LOT 4 Location (site address) 12308 PRINCE OF PEACE DRIVE, EAGLE RIVER, AK 99577 Current Property owner(s) Christopher & Jennifer Klein Day phone Mailing address Lending agency 12308 PRINCE OF PEACE DRIVE, EAGLE RIVER, AK 99577 Day phone Mailing address Real Estate Agent Sherri Sapp - ReMax Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF,BEDf200MS: 4 3. TYPE D,F WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: IndividualWell ' El Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community, Class Well ❑ Community On-site ❑ Public Water System ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 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 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. Name of Firm ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 02/10/2012 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow - and absorption rates may change due to subsurface conditions that may not be observed from the surface,' changes inland use, local soil characteristics, groundwater levels that may fluctuate during the -year and the water usage of the family being served by the system. The operational fife of all well and septic systems aro subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for __�E bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrat Advisory Other By v t Original Certificate Date: Municipality of Anchorage • Development Services Department = x Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SPRING BROOK VISTA #1 BLOCK 1, LOT 4 Parcel ID: 050-091-25 A. WELL DATA Well type PUBLIC If A, B, or C provide PWSID # Date completed Sanitary seal (YM) Total depth ft. Cased to ft. FROM WELL LOG Date of test Static water level ft. Well production WATER SAMPLE RESULTS: Coliform colonies/100mL Nitrate Arsenic: mg/I Date of sample: _ B. SEPTIC/HOLDING TANK DATA Well Log (YIN) mg/L Other bacteria Collected by: Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION ft. colonies/100 mL Tank Type/Material Septic/Steel Date installed 61978 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YM) N High water alarm (YM) N Date of pumping 5 31 2011 Pumper JRs C. ABSORPTION FIELD DATA Date installed 61978 Soil rating (g.p.d./ftz or ftz/bdrm) 85 System type Trench Length 27 ft. Width 3 ft. Gravel below pipe 8 ft. Total depth 10.9' ft. (Measured 2/9/12) Eff. absorption area 432 111:2 Monitoring tube Y Depression over field N Date of adequacy test 2/9/12 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 42 in. Water added 950 gal. New depth 53.4 in. Elapsed Time: 60 min. Final fluid depth 45 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFTSTATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _in. "Pump off" level at _in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 51+ Water main 101+ Water service line 10'+ Surface water 1001+ Wells on adjacent lots 2001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main 10'+ Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 101+ Curtain drain 50'+ (None Known) Wells on adjacent lots 2001+ F. COMMENTS Vacant system surcharged prior to testing. G. ENGINEER'S CERTIFICATION I certify that i 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. Engineer's Printed Name KENNETH M. DUFFUS Date 02h0/2012 COSA Fee $490.00II Waiver Fee $ L Date of Payment (3 a Date of Payment Receipt Number Q,25q % D Receipt Number (Rev. 11/05) 3f 0 G- Ig( qeo- z6� s g, 1 S/ So,r�G kf w _ ,A %%Fjfffe.�% 61891!/ �FEi✓CE%GddT/ar%J(`iPO�'oliEiP�/�iiYG� ASBUILT-NO CORNERS SET THIS DATE. I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SCALE - FOLLOWING DESCRIBED PROPERTY: S.ti'9/�/�,O/.O6..C� (//•rT,j .SI/pa,��.r//THIO/GOT�f DATE: .� �{c OF RC °a AND THAT NO ENCROACHMENTS EXIST EXCEPT AS �� . ' . •A. • INDICATED. IT IS THE RESPONSIBILITY OF THE /may `G = .. rH '♦ OWNER TO DETERMINE THE EXISTENCE OF ANY 6810: . ' EASEMENTS, COVENANTS, OR RESTRICTIONS ivo�zs WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: f4 °u.^. Merk Seward :. Q p LS ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN: Parcel I.D. # 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 050-091-25 1. GENERAL INFORMATION Complete legal description Lot 4 Block 1, Spring Brook Vista #1 Location (site address or directions) 12308 Prince of Peace Drive i.. . Iy.own .. '*; , -in & Ida Hazlett Day phone 694-9827 Mailing add..ress_. Lending agency Day phone Mailing address Agent Partners;Real Estate/Cindy Wilson Day phone 694-4994 AddressliQ40 Business Blvd Suite 100 Eagle River AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: 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 XXX 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. 72-05(Aew"1) Front MOAN21 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 furtherverifythat based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Phone G 6-1 - a 17034 EBOIe River Loop Road NO. Address P glr River Alaskii 99574 Engineer's signature 6. DHHS SIGNATURE V Approved for r0 213 bedrooms. Disapproved. Conditional approval for Additional Comments M M MTI C Date 10/'A'6 / OF ,;O\ ROBERT C. COWAN 12 c CE - 8801 , bedrooms, with the following stipulations: Date /0--2-%— 9R The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev.191) Beck MOAk21 RECEIVED Municipality of Anchorage OCT 26 199 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF ANC LSERVICES 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90MMMM Health Authority Approval Checklist Legal Description: Z,,07T4� %Jf� Parcel I.D.: OQ -- &ZZ– 25- A. S A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production WATER SAMPLE Coliform / Date Date completed Cased to FROM WELL LOG Nitrate 9— p.m- Collected by: (above ground) properly protected (Y/N) AT INSPECTION Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed �8 %Tank size2/ 51 Number of Compartments CleanoutsA) 7� Foundation cleanout N), Depression (Y/W)f /Av/,O High water alarm (Y/N) Date of Pumping D Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.dJft2 �ft2�5 System type T/CG�CtI Length Z Width 3 Gravel thickness below pipe _� Total depth /Oe4l Effective absorption area�3Monitoring Tube presen1— Depression over field (Yo No Date of adequacy test �(� Z4 �� Results (Pass/Fail) /iS5 For bedrooms Fluid depth in absorption field before test (in.); 2 3- `4lImmediately after gal. water added (in.): / n / Fluid depth /S (ins) Minutes later: Absorption rate f g.p.d. Peroxide treatment (past 12 months) (Y/N) /( hO --iWI t,'A yA`lf yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL WELL ON LOT TO: Septic/holding tank on lot 691k&16 On adjacent lots Absorption field on lot Public sewer main Sewer /septic service On adjacent lots "Pump off" level at* Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line 5 Absorption field Water main/service line —Surface water/drainageD/ /% a Wells on adjacent lots C) (0 fi SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: i Property line Building foundation W �f Water main/service line Surface water Driveway, parking/vehicle storage area--- /Q57/`4- Curtain dCurtain drain A10AI — 1 /VFW111 Wells on adjacent lots 00 v` F. (ENGINEER'S CERTIFICATION 1 certify that 1 have determined thru field inspections and review of Municipal in conformance with MOA, IAA guidelines in effect on this date. Signature ��CJ Engineer's Name / 0✓�•�.e, �. CUI,✓•9i✓ Date HAA Fee Date of Payment 0/").b/`1 on c� Z6 8 . Waiver Fee $ Date of Payment Receipt Number 3 / ( a'1 Receipt Number 72.026 (Rev. 3/96)* .19 P ` ROBERT C. COWAN �c • GE -8801 are MUNICIPAL.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 1. 1). # _a5L) -09 1S If f- L' 1. GENERAL INFORMATION Complete legal description _ Lot _4; Block 1; Spiting Bnook V.i,6ta Subdiv.i6.ion 01 Location (site address or directions) 12308 Eaa.t P2ince ob Peace Drive _Ea��.2e Riven, AK _ E6.tate ob Joe leconch,%ce� -- Property owner ._Dick LQL chn?,)t � Conti . ob e4 ate__ Day phone _ Mailing address CIO Remax oAEag2e Riven 16600 Center .ietd Drive Eagke 1. venom AK 99577 Lending agency Mailing add Agent At Romaszewzkai,/ REMAX OF EAGLE.RIVER Day phone Day phone 694-4200 Address _16600 CewteA ieEd D/u.ve Eagle Riven, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER 012 BEDROOMS: — 4 3. TYPE OF WATER SUPPLY: Individual well _ Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADF-C attest- ing to the legality and status of system. 4. ` TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX 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.1/81) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 i i a INGINEE $0 Phone G O)Y —X� 7 y Address � , R4gle Rlver Loo,}s NaYM Engineer's signature "t!"v 6. DHHS SIGNATURE %/� Approved for --� bedrooms. Disapproved. Conditional approval for Date I / / /'— /q bedrooms, with the following stipulations: Additional Comments Ely: 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 lendi ng 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 engineers work. 72-=(Rev.1M) Beck MOAW21 Municipality of Anchorage AL (40 Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 'A 59--ouWarcel I.D. A. Well Data Well typec-- —If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed _ _Driller Total depth Cased to Casing height Sanitary seal (Y/N) ---Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump levels SEPARATION DISTANCES FROM WELL Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line WATER SAMPLE RESULTS: of sample: AT INSPECT— — z CD v D g.p.m. J K z —_--� n m n y C On adjacent lots On adjacent lots Public sewer manhole/cleanout _ Petroleum tank lected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed _ (-5-78 _Tank size _ .m2S Compartments— 2- Clean0utS k) _�Foundation cleanout (RN) ( __Depression (YQ)- High water alarm (Y/_0 �_ Alarm tested,(Y/N) J 1 Date of pumping /o. �9� -_ Pumper SEPARATION DISTANCrS FROM SEPTIC/HOLDING TANK TO: Well(s) on lot _ �(/� __On adjacent lots _ /J/ To property line + Absorption field_ -5- _ Surface water/drainage /Do /'` Foundation Water main/service line r+ 72-026(353)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent(Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N)/N) SEPARATION DIS CEFROM on lot D. ABSORPTION FIELD DATA LIFT STATION TO: On adjacent lots at Surface water Date installed & - S- 76 Soil rating (GPD/Ft') BS�- /�G. System type T,eE,.lc N Length 27 ' Width 3 '1- Gravel thickness 6 Total depth // I Total absorption area Cleanout present 6)N) _Depression over field (1 w Date of adequacy test 7 9 `/ Results as ail) /.fss for h/ Bedrooms Water level in absorption field before test / d After test Peroxide treatment (past 12 months) (Y� r��1 E i��D -//i If yes, give date `l�a SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot J /A- On adjacent lots / /^} Property line /b ' To building foundation /r' To exi7fiing or abandoned system on lot On adjacent lots 30 (y Cutbank '`/ fel Water main/service line Surface water 0014- Driveway, parking/vehicle storage area zs ' Curtain drain E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MDA and HAA guidelines in t�ri�Se of this inspection. �. ... Ll� Signature !/r G r, O �`,`> ,,• ,C����£,,,a. , Engineer's Name 4106') 4 i Cowr1•� Date I/ ' �� Jtt oll HAA Fee $ �11O. a / Waiver Fee $ Date of Payment �/,/`��9i �) Date of Payment Receipt Number 5��9��99� Receipt Number_ 72-026 (3/93)' Back T 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 FAOILITY 264-4720 Application Dati) e�5r 1. . GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision,section, township, range) Location (address or directions) Pb- 026 (b) Applicant Name Telephone: Home Business�.— Applicant Address —�� ' �� f �T e ____/ =�c_k . •' !'`u:d_', - f: ; r�`r (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 0e)< Buyer 1J; Other Cl (explain); —_ -- ----- -- -- _ _._._..-----.- (d) Lending Institution -----.—Telephone Address _ (e) Real Estate Company and Agent �� V �% " Address —�_ Lam. Sc»r><r //� 'Telephone 7 6 J) — /6 } J —_ (f) Mail the HAA to the following address: )O) G JC L 11 P, I/ Z:—, 2. TYPE OF RESSI�DENCE Single -Family gra Multi -Family E7 Other Number of Bedrooms — 3. WATER SUPPLY Individual Well CI 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 El Community C] Holding Tank 71 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 12-025 (11.84) ►hIG FIRM PROVIDING INSPECTIONS, TESTS, FILL: SEAR", DATA AND INFORMATION dpyr myseal affixed hereto and as of the validation date shown br: w, I verily thal rrfy Investigation of thio Hrtaltht �iAyApproval shows that the on-site water supply and/or waslrewater d8po5al system Is safe, functional and adaqualo I number of bedrooms and type of structure indicated hereim. I further verify that based on the information obtained he Municipality of Anchorage files and from my investigasion and inspection, the on-site water supply and/or v/ator disposal system is in compliance with all Municipal amd State codes, ordinances, and regulations in effect on to of this inspection. EAGLE RIVER ENGINEERING SERVICES Teilephone _ of Firm _—EAGL-PtI'JEff7�tC96$7y---- — — — — & �'- 694-5195 Data _. --- �3. , Engineer's Seal C. -c:35 : v C �� oo��'ae .° es'��✓ 6. DHEP APPROVAL Approved for ileu—&— bedrooms by Approved ___X__Disapprove — -- Conditional _ Terms of Conditional Approval (15 CAUTION Date The Municipality 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 riot 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 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) UUN 1 1V` CHECKLIST - FEBRUARY 1994 RECEIVED 264-4720 Legal Description: `d f � `� r- "s //,.r/ --e; -"/ 7- /U2 -�LW Sec -1,u, / A. WELL DATA i r1v,f,.,ne'P w;f% Well Classification C/e,-.s%% If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _ Date Completed Yield _ Total Depth _ Cased to — - Depth of Grouting .— Static Water Level Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Sanitary Seal on Casing (Y/N) — Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot alX7 _ ; On Adjoining Lots ooa 7fi To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _-- Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments - - B. SEPTIC/HOLDING TANK DATA ; On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Date Installed 9 7.9 _ Size �= S ° — No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Depression over Tank (Y/N) -- /- _Date Last Pumped! Pumping/Maintenance Contract on File (Y/N))�� N14 ; for ,�`— — Holding Tank High -Water Alarm (Y/N) . ! Temporary Holding Tank Permit (Y/N) _ Separation Distances. from Septic/Holding Tank: i To Water -Supply Well o� r To Building Foundation _ L To Property Line t To Disposal Field _ -S- To Water Main/Service Line /©f To Stream, Pond, Lake, or Major Drainage Course Comments -- _ Paye 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata eR �je , Type of System Design TY,encti Date Installed 19 7 Length of Field Width of Field Depth of Field �� r Gravel Bed Thickness Square Feet of Absorption Area �% Standpipes Present(Y/N) Depression over Field (Y/N) Date of Last Adequacy Test8S- Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well D D To Building Foundation Lot To Water Main/Service Line Ma To Property Line To Existing or Abandoned System on On Adjoining Lots A%"ll_� &"rte ,n 30 To Cutbank (if present) No' C To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area - /0t Comments ei-/ tJ e:!Z-jo 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 — Vent(Y/N) Pumping Cycles 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 d461,S' Company r1e L`, T, MOA No. % a 6 S' Receipt No. 30 or �r Date of Payment` �5�+rp e U Amount: $ a"r �0; Engineer's Seal v%5 `--- ® -x.99. TEf f�'" g - �� Page 2 of 2 72-026 (11/84) Louis A. Burora CE -6736 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE:_ 616hy�—__ PWS I .D.#_ 2// -r7 ( To Whom it May Concern: BILL SHEFFIELD, GOVERNOR Telephone: 19071 Address: 214-2533 According to records on file in this office the _ S A/11yuj� Water System is in compliance with the State Drinking Water Regulations Sincerely, 1 ilWP&A�enJu/ J:/�eel^ +-- ���—'—' o---- DATE: RECf_IVEO INSPECTION APPOINTMENTS Vista Subdivision #1 TIME TIME - � _ TIME - EMTE DATE_ . —am DATE � O L Lj l.rL-� INSPECTOR .INSPECTOR ❑ One �O Four ❑ Other_ INSPECTOF MUNICIPALITY OF ANCHORAGE: MUNICIPALITY OF ANCHORAGE DEPT. OF I-EAL"fH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 JUL 2 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 CC FF REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE��F 4111A P DIRECTIONS: Complete all parts on paged. Incomplete requasts will not be processed. Please allow ten (10) days for processing. — PHONE f. PROPERTY OWNER - National Bank of Alaska 276-1132_ MAILING ADDNESS - Pouch 7-025 99510 PROPERTY RESIDENT (If different from above) PHONE -- 2. BUYER - Dennis J. Davidson PHONE 333-0860 MAILING ADDRESS - 8630 Muir Court 99504 _____ _ 3. LENDING INSTITUTION - PHONE National Bank of Alaska - Mortgage Loan 265-2883 MAILING ADDRESS Pouch 7-025 99510 _ 4. REALTOR/AGENT -- PHONE MAILINGADDRESS 5. LEGAL DESCRIPTION—�— -- Lot 4 Block 1 Springbrook Vista Subdivision #1 STREET LOCATION - 90 Prince of Peace Drive 99577 6. TYPE.OF RESIDEWCE NUMBER OF,iEDROOMS - - ❑ One �O Four ❑ Other_ 0,C SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY __ ❑ Three ❑ Six 7. WATER SUPPLY- - ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled 7l]�]i COMMUNITY - since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM _ e!r' INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PU13LICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79): -1.- THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER ' DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM L4-NNUIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED t+ ,.• INSTALLER SOILS RATING ❑ Septic Tan, kLor ❑Holding Tank Size: ) /- ` If Tank is homemade give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DAT-E+y/-/�_-� g' 72-010 (Rev. 6/79) 825 "L" STREE11' ANCHORAGE, ALA,;KA 99501 (90 7) 26/1-411 1 GECIRGF NY SULUVAN, MAYOR DUMi I MENT OF ME Ai !H AND LNIVMCNIVEN-, AL PH01 CCI MI July 10, 198.1 National Bank of Alaska Pouch 7-025 Anchorage, Alaska 99510 Subinct: Lot 4 Block I Springbrook Vista Subdivision 41. Approval for the individual sewer and water facilities cannot be granted until the following items have been completed (1) The septic tank pumped with a receipt submitted to this office. if there are any further questions, please call this office at 264-4720. sincerely, James S. RoberLs Environmenihal Specialist: JSR/lAw 5. LEGAL DESCRIPTIO �-- �� STREET A-rikN 1:2— !cl�� 6�i.—X1.1-.`-^-�_ s ---- 8. TYPE OF RESIDENCE O- - NUMBER OF BEEDROM_--- S SINGLE FAMILY 0 One 0 Four C] Other— - - - Two ❑ Five MULTIPLE? FAMILY ` ❑ Three FD Six 7, WATERSUPPLY- M 'INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled .9, COMMUNITY since June 1975, For wells drilled prior to thatdate, give well ❑ PUBLIC UTILITY depth (attach log if available,) 8. SEWAGE DISPOSAL SYSTEM -- - - — **If I INDIVIDUAL/ON-SITE** individual/on-site, give installation date - If. system is over two (2) -years old an adequacy test i, required O PUBLIC UTILITY by this Department. - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY _ INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE E-1 PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED —`)$ INSTALLER ❑ Septic Tank or - ❑ Holding Tank Size: J D- 70 If Tank is homemade give dimensions: SOILS RATING 5 TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL a 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - 5. COMMENTS U `APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE - BY (Title) LEGAL DESCRIPTION - 72-010 (Rev. 3/78) 0 1. E MUNICIPALITY OF ANCHORAGE Departm- t of Health and Environme `tl Protection 82 L Street, Anchorage, Al., ca 99501 264-4'120 t: for Approval of Individual Sewer and Water Facilities Property Owner: NATIONAL BANK OF ALASKA Mailing Address: 301 W. Northern Lights - Pouch 7-025 Phone: 276-1132 Anchorage; Kia�99-510~J Name of Buyer: Dennis J. Davidson Mailing Address: 8630 Muir Court_�� Phone: 333-0860 AnoYiorage-, a�99504 3. Lending Institution: NATIONAL BANK OF ALASKA `"Pro"rTg`ageLoan Productions Mailing Address: Pouch 7-025 Anchorage, AK 99510 Phone: 265-7.883 4. Realtor/Agent: _ None Mailing Address: _Y —_ Phone: 5. Legal Description: Lot 4, Block 1 Springbrook Vista S/D $1 --- Street Location: 90 Prince of Peace Drive Eagle River, AK 99577 6. Single Family Residence: (X) Number of Bedrooms: four Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *individual Well ( ) Public/Community System (X) If. Individual. Well, well depth If Community System, name of: system 8. Sewage Disposal System: *'On-site System (X) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site 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