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Home My WebLink AboutHIGHLAND HILLS #4 BLK 2 LT 22Highlend Hills #4 Lot 22 Block 2 #050-382-56 Municipality of Anchorage po~ 1 of -~ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-~744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000270 P]D Number: 050-382-56 U°me:dOYCE BEYETrE Wastewater System: [] New · Upgrade Address: HC 85, BOX 9512 HIGHLAND RD. EAGLE RIVER, AK 99577 ABSORPTION FIELD No. of Bedrooms: Ph°ne:(907) 694-- 1 61 5 5 · Deep Trench [] Shallow Trench [] Bed [] Mound [] Other LEGAL DESCRIPTION ,L,I 1.o GPO/S,. F~ 9 - 10 F~ -- -- -- 1.1 -- 3.1 F~ 56 e~ Gravel width: Number of line~: Distance between Iine~ WELL: [] New [] Upgrod 2.5 F~ 1 -- .. DEAN CONSTRUCTION 8/7/00 - 8/8/00 GP~ ~ TANK SEPARATION DISTANCES .s~pt~c [],aiding , •S.T.E.P. To Septic Absorption IJft Ho]ding Public/PrivatE Tank Reid Station Tank sow,r U... ANCHORAGE TANK. 1000 Well 100% 100% - - 25'+ STEEL 2 8u~oce ~oo'+ ~oo'+ - - - LIFT STATION Water Foundotlon 5"{- 10'+ - - - Curtain ~ ~n~pecUo~8 N~NE KNOW~ Drain ~emarks: BENCH MARK Bo'FrOM OF DOOR THRESHOLD ON NORTH SIDE OF HOUSE. J~ss.med BevaNom 111 .99 Department of Health and Human Services approval ~[~.'....~/ .......,,~ PERMIT NUMBER: AS BUILT D~W~~TG PARCEL iD NUMBER: SW000270 ' 050-582-56 / FLOW DIVERTER (ED)--~ / DBL2 ~ . f~ // /-NEW 100 GALLON RESERVE SFFE ,. II II NEW D~INFIELB I ) '7 I I I I /DROOM HOUSE I / GAP. AGE. ~ : .~. ,. ~.' ~. : ~ I ~~~~1 ~co 23o - ~o ;'..'.'-" ~ J ST1 17.3 - 2g.4 0 J ST2 14.1 - 35.1 ~ ~ DBL1 13.1 - 38.g J ~ ~ DBL2 13.1 - 3g,8 ~1 OLD oo ~.~ 4o.~ - ~~ I sump 1~.~ ~.g - j 001 82.4 ~0.8 - ~02 53.7 ~8.4 - J MT 54.5 59.0 - . 8/~o/2ooo ~ gF ~r,~"..~....: ..... ..';¢~ A B C FCO 23.0 - 18.0 ST1 17.5 - 29.4 ST2 14.1 - 55.1 DBL1 15.1 - 38.9 DBL2 15.1 - .7,9.6 FD 13.1 - 59.7 OLD CO 16.2 40.7 - SUMP 18.7 26.9 - C01 62.4 50.8 - C02 53.7 58.4 - MT 54..3 59.0 - K.D.W. ALASKA WATER & WASTE~VATER s~,.~= ::~,~ ........ CONSULTANTS, I NC, ............... ~'~ ........ 3REPARED FOR: PHONE NUMBER: PAGE NUMBER: JOYCE BEYETTE (907) 694-1615 2 OF .EGAL DESCRIPTION: HIGHLAND HILLS SUBDIVISION; LOT 22, BLOCK Z tYPE OF WORK: AS-BUILT OF SEPTIC SYSTEM UPGRADE PERMIT NUMBER: AS BUILT DRAWING PARCEL ID NUMBER: SW000270 - 050-382-56 ,-- P[N,~J. dfJ¢~ ~ 1(37 + / /- I~^~o~ ~ / ~r2 / Af It~f ~ 1~.47 Af~f 8/11/2000 ~.~.w. ~"' / ....... :~: ; CONSULTANTS, INC,~ ................................ N.T.S. H~.~,D H~LLS SU~9~WS]O,; LOT 22. ~LOCK 2 AS-BUILT PROFILE Of SEPTIC SYSTEM UPGRADE MUNICIPALITY OF ANCHORAGE Depadment of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995~9-6650 (907) 343-4744 Is-/' ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 31, 2000 Expiration Date: Jul 31, 2001 Permit Number: SW000270 Legal Description: HIGHLAND HILLS #4 BLK 2 LT 22 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Joyce Beyette Owner Address: HC 85, Box 9312 Highland Rd. Eagle River, AK 99577- Parcel ID: 050-382-56 Site Address: Lot Size: 99340 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: ~ ~~~ Date: ~ Issued By: /'~ ~ ~,-..,-" //.,1.~, ~,¢--'~'- Date: ALASKA WATER & WASTEWATER July 25, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade Design for Highland Hills Subdivision; Lot 22, Block 2 To whom it may concern: The existing 3 bech'oom house is currently served by a private well and septic system. The existing septic system is in a state of failure and must be upgraded prior to the sale of the house. One test hole was excavated on the property west of the existing drainfield. The proposed septic system will be designed within this 30 foot radius. We are proposing that a 1000 gallon septic tank and a deep trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a GP/SP material with some silt, to a depth of 16 feet (bottom of test hole). No groundwater was encountered during the excavation of the test hole. A percolation test performed between the depths of 7.0 feet to 7.5 feet which had a percolation rate of <1 mim~te/inch. It is our opinion that the insitu sandy soils should act as a sand filter and an application rate of 1.0 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 1.0 gallons/day/ft2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 450 ft2 f. Total Depth: 10 feet (max.) g. Effective Depth: 7 feet h. Width: 2.5 feet i. Reduction Factor: N/A ~ Minimum Length: 35 feet long · Effective absorption area = 490 ft2 6901 Debarr Road, Suite 2B - Anchorage, AK 99504 - Ph: (907)337-6179 N Fax: (907)338-3246 N akwwc.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The trench is to be installed at the base of a slope greater than 25 percent; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If assistance. Jeff re Presil you have any questions, please contact me at 337-6179. Thank you for your NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7page construction specification letter which are all part of the design package for this septic system. 6901 DebmT Road, Suite 2B - Anchorage, AK 99504 - Ph: (907)337-6179 - Fax: (907)338-3246 - akwwc.com ~ I~ XN ~ // ~[S~NO D~INRELD ~ , / AND 1000 GALLON . ~ - ~ // TEST HOLE ~ELD~,,~ I I ~ f ~ LOCATION IS WELL LOCA~ONJ [ - ~ 1~ ~ ~ ~ ~,, ~_ -~ .~ ~ ~ APPROXIMATE i - ~ ~//'~ ~ ~, ~~):'~'~ ~ BEDROOM HOUSE f , ~~,. W~EWA~ER K.~.w. '~ ~ ~- ~V..~,,~ PREPPED FOR JOYCE BEYETTE (907) 694-1615 1 OF 2 ~AL DESCRIP~ON: HIGH'ND HILLS SUBDIVISION; LOT 22, BLOCK 2, SITE P~N OF SEPTIC SYSTEM UPGRADE \ I / ~ ~ I -'~*J{"~3(P~ INSTALL DOUBLE \ / ~ ~ ~ /~ ~ ~'~INO S~PT[C TANK ~ ~NSTALL FLOW TO B~ COMPL~ELY ~ I ~IS~NG O~NFIELD ~ ~ ~ ~ ' TEST ~O~E TO eE USED ~ A /~ ~ ~ ~ / ~INSTA~ I ~ ~ ~ ~ I ~' ...... I / ~~ '/~.~ -~' - / ~ I -'" ~MUM (AT ~Y PO~), BY 2.5 = ~ FE~ WIDE. BY 35 ~ LONO. ~D 7 ~ ] FE~ OF C~, W~HED S~ER ~ ~ D~INROCK, IN.ALL TRENCH ~ ~ ] P~LLEL TO SLOPE CONTOURS. I I DATE: 7/25/2000 ~S~ WATER & WASTE~VATER K.D.W. PREPPED FOR: PHONE NUMBER; PAGE NU~BEE: JOYCE BEYETTE (907) 694-1G15 2 OF 2 ~GAL OESCRIPnON: HIGH.ND HILLS SUBDIVISION; LOT 22, BLOCK 2 ~".._~ _~"' '~ ~ o~ wo.~: DESIGN OF SEPTIC SYSTEM UPGRADE ALASKA WATER & WASTEWATER CONSULTANTS, INC. ~'~ OF / JO 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504 ]SOIL LOG - PERCOLATION TEST] ....... : ~, ... ~. ~:...~ ...:...~ PERFORMED FOR: dOYCE B~E DAYE ~E.FO.~ED: ~/./~000 ~O&'L ~"-~ .."~ DEPTH -' I TEST HOLE ~11 ~D~""~Y .... " (feed ~: ORGANICS ':~C~¢o, SOIL C~SSIFICATIONS ?~.~ ~ ~ ~ SW MH I ~~ 6 --.~. SC o I 7~ ~:t~o~ DEPTH TO DATE ~ ~?*~¢ 3ROUNDWATER 8--?~¢~t~ SOME SILT DRY 7/14/00 I ::;':-?.~ ~ DRY 7/18/00 I 9 ~ :~.~.~ DRY 7/24/00 -I ?;;~,o~ CLOCK NET TIME WATER LEVEL NET DROP ':%~¢~ ' DATE READING 11 -->,~¢~.~ ~ TIHE (HINUTES) READING (INCHES) ':?~3:~% 7/18/00 1 12:00 12 -- ?~?.. ~ 0" -~,, ~,::;~:¢. 2 12:10 10 ~:~'~". ~ 12:10 :~r:.:.,.o ~ i 4 12:17 7 ~,r~o%~, 6 12:25 8 ¢:~.:~:~% i 7 12:25 16~i ~ 8 12:33 8 B.O.H. 9 12:33 6" 17-- 10 12:43 10 0" 6" 11 12:43 6" 18-- ~2 12:50 7 0" 6" 19-- PERCOLATION RATE <1 (HIN./INCH) PERC. HOLE DIA. 6 (INCHES) 20--~ TEST RUN BETWEEN 7.0 FT. AND 7.5 FT. COHHENTS: PERFORMED BYIA~SKA WATER & WASTEWATER. I, JEFFR~ A. GARNESS, CERTI~ THAT THIS w.s ~E~[~u[~., *CCO.D*~CE WIT. *LL ST*TE *,D UU~C~.*L ~U~D[U,[S ~, [~F[CT O~ DEPTH TO DATE 3ROUNDWATER DRY 7/14/00 DRY 7/18/00 DRY 7/24/00 DeceImber 29, 1978 #780572 Lyle Snyder 6424 Tollhurst Anchorage,. Alaska 99504 Subject: Lot 22 Block 2 Highland Hills Subdivision ~4 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this departlnent to document the installation date. If 'there are any further questions, please contact this office at 264-4720. Sincerely, Les No Buchholz, R.S. Senior Environmental Specialist LNB/ljw enc: copy of permit ( erlifieh rilling by A & I, DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 ~, TELEPHONE094-2588 OWNEP, OF LAND .,. / ADDRESS '? ~..;i ,i~ LEGAL DESCRIPTION DATE- S tarred ///)/:(Z PERMIT NUMBER DEl'TH OF WELL /~:,,~ · ?· "'?' ~ ~"-/ff STATIC LEVEL OF WATER FI. /d/'/.r < '~ ;/- :/ / / ', DRAW DOWN FT. GALS. PER HR KIND OF CASING KIND OF FORMATION: From : Ft. to_ ~ Ft. o(~/ ,-~(~'0~:,t_~..?_) From ___Ft. to __ From , Ft. to ' i ~FI. _~ ~,/5'1 From~ ~Ft. to_ From ,.~" ~" ' ; _Ft. to_ ~ ~> Ft. ,),~'~}',~" (.-:,}~'77/~-~ From_ Ft. to From > ~, Ft. to ~ > Ft. ">/'[ '"t) '; (, ~Z:?o/id~ From _~ From From Froln From From From Ft. Ft. ___. Ft. . -Ft. to (" /'-_Ft. {: :-:'~" I' <,', (,: %,.-7-". From __Ft. to_ __Ft .... ,, / ..... ____Ft. to i J Ft. ..... ,. ,; 4, r /From Ft. to Ft. _ '/ ": ,/~7 ~ ~ >;h,~:z~:xf~ From _Ft. to Ft. Ft. to / ~ J' Ft. //~;v-. ~Ft. to~ Ft. From Ft. to Ft. ~ Ft. to Ft. From Ft. to Ft. ~Ft. to Ft. From_ Ft. to_~Ft. From_ Ft. to Ft Froln _Ft. to .... Ft __ From Ft. to Ft From Ft. to __Ft From_ Ft. to___Ft. From Ft. to____Ft From Ft. to_ Ft, From Ft. to__Ft From__Ft. to Ft. From__Ft. to Ft. From_ Ft. to__Ft. From__Ft. to Ft. From __Ft. to __Ft. From Ft. to.___Ft. MISCL. INFORMATION: / 7/, /'~> /',': DRILLER'S NAME L E G I::t L. FIF:I::.:; I t'"ILIH f.,ll..li','l[~:[i:[;;: Cfi:' E,E E I ...... 11 ...... THE LENGTH E:, I P1EI'.,I:[:; :[ ON 1:5 "FHE LENGt'H ':: I I",1 FEET ::, Eft:: THE "I"FitI[:'.I'.,IOH O1:;?. I)1:~'.1::1 'I"HE DIE[::'"f'I.-I (::il;:' FI TI;;:ENE:H CIR PIT Z:~; THE E:,I:!~;TFINCE: Ei:E:T!.4[.ZI!!:N THI::.: ~:';UI:;4FFICI:ii: O1'::' THE GF4:OUiWD I::It',l[:, 'f'HE E~EFI"TCff"I O1::' THE': E:::':',CI':I'v'F;Ff'I ON ,:: I I',1 F'EET ::,. THEI:;.:E :[:E; NO SET HIE:,TH F:'OF:: 'I"I:;;:EI'.4C:HE~5. 'THE GF:'.FI'v'E:L. [:,[EF'TH :[ :ii; 'T'HE h'l I I',1 :[ P1LIt"t [:,EF'TH (:IF' GI';.:I::I'v'FZI.. E~[E'FHEE'N "I'HE OU'T'f:'FII...I... F:'I i::I1'.,1[::, '1"HE E:OTTOH OF THE: I'ii:::.:',CF:I',,,'FI'I" :[ ON ,:: .I t',l F:'IEE't" >. I:: .~.F..F1L. L]:I"4G CI:: I::lN"r' :5"r'%TEh'l H:[THCIIJT F]:I",tFIL. ]:N~'~;F:'FF'I'IOI",! FIN[> I'11"[ D[i:F:'FIFi:TI"IE:f',t"I" I,.I]:L.I.. BE :~;U[iL..'rEC:T TO hl]:N:[I'"IUP1 [>I::!!;TRNE:[i[ E:[E"FI.,.IEEN FI HE:LL.. FIND :'LEIO F:'[EET I::'O[~: I::'1 F:'RZ'v'FITE I.,.IEt..L.; CIF;: ::L~:;O TO ;;i:OO F:'EE:T FF;:Ed'"I la F'I...IEil... ]: E: HELL. D,[EF'[ENDZNG UF'OI'.,I '['FiE T't'F:'E OF:' F:'IJE:I... :I: E: I.,.IEt..1 .... HE!...I.... L. OEi~i:; FII:;;:E F[:EQUZ[~:EE:, FINE:, P'IU:~;'I" E',E [;?.ETI...I[?.NE[> 't"O 'T'FiI~E OF 'I"HIi~: HELL. COI"'IF'L.E'I"ION. I:::l'v'l:::l ]: Lf:IE:L.E 'T'O :1:1'.4:;~;I..I[;:E PF;:OF1ER Z N~;TFILLFIT Z ON. I C:E[;:T ]: I::".F THI:::I'I' :1.: :[ F:li'"l I::'"I:::IHZL. ZI:::ff~: FII'f'H-I"HIE Fi:Eg!IJ'[[~:[EI'"IENT% FEll?. ON....%]:TE I::'CII:;i:TH ["?T' THE I"IlJN :1: C ]: Pi:IL ~ 'l"'r' ;bi'.: I I.,.I ]: LA... :!: N:E;TI::IL..L. "['lr.l[~: '.5'T':STEP'I :::!:: ]: IJIqDEF~'.'.'E;TFIN[:, 'f'HI:TF THE Fi:E'..::;;:[[:,E:I'.,ICE ]:.:!ii; I:':':Ei"IO[;:,EL.E:I ::, 1: G l",l E: [:, 4040 "B" STREET, ANCHORAGE, ALASKA 99503 PHONE: 907-279-2581 October 10, 1977 W.O.#: A18270 Joe Janke South Side Eagle River, Alaska Subject: Subsurface Investigation for suitablity of On-Site Sewage Disposal System; Lot 22, Block 2, Highland Hills ~4 -AND-Highland Hills #1, Rural Residence Dear Mr. Janke: This report gives the results of the above subject investigation as performed by us on October 7, 1977. The scope of the investigation was to determine the suitability of the sites for the installation of an on-site sewage disposal system. Included in this report are: Test Hole Location Sketches Test Hole Logs Explanatory Information Figures 1 and 2 Tables A and B Sheets 1-3 The investigation consisted of a visual classification of soils exposed by test pits, previously dug by back-hoe. Soils classification was performed by Alaska Testlab geologist. Logs of the test pits are included as Tables A and B of this report. In interpreting the logs, it would probably be helpful to use the explantory infozn~ation of Sheets 1-3 of this report. Conclusions and Reco~nendation: Lot 22, Block 2, Highland Hills #4: Our investigation of this property indicates the high ground where the test pit was located is ideally suited for the installation of an on-site sewage disposal system. Soils are gravely sand and sand, with no evidence of a water table. Soils of this type require a seepage pit absorptive area of 100 square feet per bedroom (gravel sand) and 125 square feet/bedroom (sand), respectfully. October 10, 1977 W.O.#: A18270 Page 2 Highland Hills ~tl, Rural Residence: Our investigation of this property indicates the area where the test pit was located may possibly be used for the installation of an on-site sewage disposal system. A 3.5 feet layer of very dense sandy gravel overlays a gray, plastic, silty gravel. The underlaying material appears unsuitable; however, the course, clean upper layer of sandy gravel could possibly be used. If your further work in this area indicates the sandy gravel soil is thicker (deeper) than as shown by the test pit, this would improve the possibility of construction the disposal system. Soil of this type requires a minimum of 85 square feet p~r bedroom absorptive area in the seepage pit, or leach lines. Because of the dense nature of this poil at this location you may wish to use a slightly more conservative figure of 125 square feet/bedroom. No water table was observed during the investigation of the test pit. It should be noted though, the free water level normally fluctuates seasonally and with precipitation. We hope this report meets y6ur needs. If we can be of Purther service, please contact us. Very truly yours, ALASKA TESTLAB T. A. Sexton APPROV/~D BY: /~ TAS/tsc To ~o O'F5 IN (0 -t) -7-ops~lL, Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, AJaska 995'19-6650 (907) 343--4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING 050-382-56 Complete legal description HIGHLAND HII_LS SUBDIVISION: LOT 22. BLOCK 2 Location (site addressordirections) HC 85 BOX 9312 HIGHLAND ROAD EAGLE RIVER, AK 99577 Property owner Maiting address Lending agency Mailing address JOYCE BEYETrE Dayphone (907) 964--1615 HC 85 BOX 9512 HIGHLAND ROAD EAGLE RIVER. AK 99577 Day phone Agent JERRY NA(3EL w/ COLDWELL BANKER./FORTUNE Day phone Address 2525 "C" STREET ANCHORAGE. AK 99505 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well x×x Community well Public water NOTE: (907) 265--9157 If community weft system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding Tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC ing to the legafity and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,250.00 at or prior to, closing for the engineering services provided. 5. STATEMENT OF INSPECTION BY ENGINEER As cedified 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/e/nd State codes, ordinances, and regulations in effect on the date of this inspection.~ /I/'fl/I/r' Name of .rm ALASKA W E* CONS,LTANTS..NC. Phon / Address 6901 DEBARR F~/OAD/S~J~ ~2B~/NOI~ORAGE, ALASKA 99504 / Engineer's Signature ~.--~/~r/[//~"""~ .-----__ ,,, , Date ,n conduct,rig th,s eva,ua,ion. *We, ,¢ eer¢ .ted a thorough, consc,ent,ous eng,,eel, ana,ye,s of the system in accordance with ADEC and IV~OA'DH~¢ Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MQA DHHS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6, DHHS SIGNATURE /,-"" Approved for ~ Disapproved Conditional approval for bedrooms 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 DHNS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. I:-'mployees 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. 1/91) Sack MOA #21 Computer Version Legal Description: A. WELL DATA Well Type. PRIVATE Log present (Y/N) Total depth 125' Sanitary seal (Y/N) RECEIVED Municipality of Anchorage AUG 1 DEPARTMENT OF HEALTH & HUMAN SERVICES ^ En_vironmental Services Division ~uNICIPALII'¥ O~* 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4~°~v~NTAL SEI~V~J~ ' Health Authority Approval Checklist HIGHLAND HILLS S/D; LOT 22, BLOCK 2 Parcel I.D.: IfA, B, or C, attach ADEC letter. ADEC water system number YES Date completed Cased to 73% YES 050-582-56 Date of test Static water level 64' Well production 3,5 WATER SAMPLE RESULTS: Coliform ~ -- Date of sample: 8/7/2000 B, SEPTIClHOLDING TANK DATA Date installed 8/7/2000 Tank size Foundation cleanout (Y/N), YES Date of Pumping: NEW C. ABSORPTION FIELD DATA Date installed 8/7/00-8/8/00 Length 56' Effective absorption area FROM WELL LOG 7/7/78 7/7/78 Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION 8/8/2000 24"+ YES 73' g.p.m. 2.95 g.p.m. Nitrate ~' ~z~ /'w-J//-- Other bacteria Collected by: A,W.W.C., INC. 1000 Number of Compartments 2 Cleanouts (Y/N). DePression (Y/N) NO High water alarm (Y/N) N/A Pumper - YES Soil rating (g.p.d./fl2 or ff2/bdrm). 1.0 System type TRENCH Width 2.5' Gravel thickness below pipe 7.07' Total depth 9' - 1 O' 509 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test NEW Results (Pass/Fail). For ,.--------B-Cd'E~rooms Fluid depth in absorption field before test (in,); ~ed (in.): 72-026 (Rev. 3/96)* Computer Version D. LIFT STATION Date installed Manhole/Access (Y/N) ~evel at*. High wa~ *Datum "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line 100'+ 100'+ N/A 25'+ On adjacent lots 100'+ On adjacent tots 100'+ Public sewer manhole/cleanout__ N/A Lift stafion _ N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10% Surface water/drainage. 100% Absorption field 5'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10% Water main/service line 10% 100% Driveway, parking/vehicle storage area. 10'+ NONE KNOWN Wells on adjacent lots 100'+ Surface water Curtain drain F. ENGINEER'S CERTIFI~A/TIO/,~, I certify that I h~ ,t~l,~r~in~'d ~'~'u of Municipal re/~or~ 't'/Nltt~ a~ve with MOA H~ gui IIb~ffect ~ Signature ,_~ {~V~ ~ Engineers Na,o ~ ~ ~OEFFR% Date ~ ~1o, O Id inspections and review stems are in conformance this date. A. GARNESS HAA Fee $ ""~ O/) Date of Payment ~'-' 72-028 (Rev. 3/96)* Computer Version Waiver Fee $ Date of Payment Receipt Number. 00'11'00 09:46 FROM'CTE ENVIRONMENTAL EE1EEO1 T'$02 P.OI/02 F-415 CT&E Environmental Services inc. Laboratory Division 200 W. potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 CT&E Ref. g: Client Name: Project Name Clienl Sample iD Matrix: PWSID Sample Remarl(~' 1004367001 Chant PO~: nla AK Water & Wast~water Cmls. Printed Da[e/Time: 08/11/GO 09:45 Hlghla~l~ Hills $/D ~rt4 cm~ecmd Dale/T~me' 08/07/00 15:00 Let 22 BIk 20utS~cle Hose BID Received Dare/Time: 0S/osId0 11:30 DrinKing Water Tecl~nical DireClor: Stephen Ecle n/a Results pQL umts Total Coliform (MF) 0 cat/100 mi AflowaBle Prep Analysis MethotJ Limits Date Date In~t~ SM9222B 08/08/00 JDT EPA 300 10.0 06108/00 SCL N~trate 3 94 0.5 ingle 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. # (~._~'~ -~?-~ - ~ 1. GENERAL INFORMATION Complete legal description Locatiop. (site address or directions) NHN Wild Mountain Drive, River, AK Prope~tY'0~ner "",' .g~rth Bcy,¢,tt¢ Mailing a~dr~'ss ' 9'312. Hiland Rd. Lending agel~ cY'-2. Ea.qlc Riv~ Day phone AK 99577 Day phone 694-1615 Address Day phone :' ~ r ' ' * 3. -TYPE OF WATER SUPPLY: · - Individual well Community well Public wate~ Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: i'r: : 3 . ~ XXX NOTE: lng to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: individual on-site ;0%' CommuqitY on-site - ! Public'sewer' NOTE: If community well system, provide written confirmation from State ADEC attest- 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 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 applicatior~ 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. S & S ENGINEERING Name of Firm 17024 I;ngl. Riv.~. Leap Rend N~. ~fM. Phone ~' ~1 y - ~.o/ '7 ¢/ Eagle River, Alaska 99577 Address --//~J,~'~' ~ DHHS SIGNATURE /~, Approved for '~ 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 courtesyto 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. 1/91) B~ck MOA ~21 Municipality of Anchorage r)EPARTMENT OF HEALTH & HUMAN SEP, VICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority ApProval Checklist A. WELL DATA Wclltyp~~ IfA, B, orC, attach ~EC letter. ~CwatersystcnluumDer ~ Logprescut~).~ Date completed ~- 7- ~ Total depth /~2 ~ Cased to / ~ 2 Casing height (a~ove ground) Sanitary seal (~'N) ,'~.5' Wires properly protected ({~) AT INSPECTION /o-.~ ~'- Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform '~ FROM WELL LOG g.p.m. '~ , (~ g.p.m. Nitrate ~, 9 1 Other bacteria Date of sample: 10 - 2, ~; - 57.,5'' B. SEPTIC/HOLDING TANK DATA Date installed/a '2 ~/,';z ~ Tank size /oO o Fotmdati0n'clearlout (Y/~ /'//0 Depressiou (Y/~ /I/'<9 Date of Pumping ct~ -/'O - 9,3"' C. ABSORPTION FIELD DATA Date installed IO '2, '/' Length 09 ~ ' Widih ..7~' Effective absoq~tiou area Date of adequacy test/O-.2g'- Collected by: 5p e V e_/~ H0J~c :/~2~'- Nmnber of Compartments ~ Cleanouts __ High water alarm (Y/~ Pumper Soil ratiug (g.p.d./fl2 or~_.,~_/.Z-.~' Gravel thickness below pipe ,5' System type % ! _ Total depth Monitoring Tube present~}'N) ffg. Y Depression over field (Y/~ Results(Pass/Fail) ~>~ ,rJ' For _~ bedrooms Fluid depth in absorption field before test (in.); 3 3 hmnediately ~Tt'ter~o~0 gal. water added (in,): z/2.. 5' Fhdd depth ,~ ~ (ins.) Minutes later: ..5-0 Absorption rate = 5/-,~O ''/-' g.p.d. Peroxide treatment (past 12 months) (Y/N) g.4'~ ~',-, o e_o~ If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons __..__------ "Pun~ "Pump ofF' level at* *Datuul E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / tO o -b' Absorption field Oil lot / O O '~ Public sewer main '~ ,5- /"/- Sewer/septic service line ,2. ff' "-it.- : On adjacent lots / O O · "/' : On adjacent lots / Public sewer inauhole/cleanout / O Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ,5-- "_,/t. Property line ,.5- '~ Absorption field ,.5'- Water mainlscrvice line / O /./t. z._/_ Surface water/drainage /OO "-f" Wells on adjacent lots / O O SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation / O '-/- Surface water Water main/sep,,icc line / tO "ff-- Driveway. parking/vehicle storage area Curtain drain 6//~ 4~,o O ~ ~7 Wells Oil adjacent lots J O O '7t- Property line F. ENGINEER'S CERTIFICATION I. certify., that I have. deternlined thru fileld inspection.s' and review o~f ~[4unicipal records .~,..,,t~w~ ~, , ~.~ ' are tn colt/brtnance w/th ~OA [l~ guidel~s in ~ect on this (late. Engineer's Nanle ff~O~..e7 C~;~,,~ Date / q 5 ............................................................... -%i. CO.~,=~=.~,~ ..~ ..... HAA Fee $ r~ Waiver Fee $ Date of Payment //~ > ~ Date of Payment Rev. 8~95 eSS: haa.wk.doc CT&E Ref.~ Matrl~ Clien~ $alnple ~D CT&E Environmental Services Inc. Laboratory Diviaion 5.4038-1 Laboratory Analysis Report WATER clieng Name 8 & $ ~N~I~IN~ WOP~K o~der 19263 Ordered By R. COWkN Printed Date 11/01/9~ ~ 15~00 hrs. Project Name Collected Date 10/2~/~ ~ 14:15 hrs. Project~ Rec,i~ed Date 10/27/95 ~ 10:10 hrs. PWeID uA Technical Director 8T~H~N C. ~D~ Sample Remarks: QC AlloWable ~t. /~nal Nlcra~e-N 2.81 D mg/b EPA 3B~,2 10. 10/30/95 CMR ~ee Sample Remarke AboVe NA ~ Not Analyzed Undetected, Reported va%~te l~ %he p~aecLoal ~at~lfioa~ion limit. I~T - ~ees Than GT - Greater ~an Mecondary dilution. 200 W. Potter Drive, Anchorage. AK 99518,1 605 -- Tek (90~) 562-2343 Fax: (907) 56~ -5301 ~tn6~m,CMTAI [ACII ITl~ IN ALASKA. CALIFORNIA, FLORIDA. I~LINO)9, MARYLAND, MICHIGAN. MISSOURI, NEW JERS~Y, OHIO. WEST VIRGINIA ~lunicipality of Anchorage DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION POUCH 6-65b ANCHORAGE, ALASKA 99501 INSPECTION REPORT ON ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL PHONE(S) ~?')] ~ '-[ -'~ S"7 LOCATION ~,~ ~L~ LEGAL DESCRIPTION PERMIT NUMBER #0F BEDROOMS SEPTIC TANK MANUFACTURER MATERIAL ~'~' ~.~ ~¢.J~ Lh$ INSIDEOIMENSIONI LENGTH /WIDTH CAPACITY IN GALS. #OF COMPARTMENTS DEPTH SEEPAGE SYSTEM []TILE DRAINFIELD NUMBER OF LINES LENGTH EACH TOTAL LENGTH DISTANCE BETWEEN LINES 'FRENCH WIDTH DEPTHS:3F'q- TILE TO GRADE FILL BELOW TILE FILL ABOVE TILE ~?SEEPAGE TRENCH OR [] PIT WIDTH ~ ]~ LENGTH TM I~ DEPTH B ~'"~" [] LOG CRIB FILl.. MATERIAL DEPTH [] RINGS- DIA. TOTAL EFFECTIVE 8BSORPTION AREA: ,7')~C') SQ. FT, CLASSIFICATION WELL I DEPTH PIPE MATERIAL INSTALLER REMARKS APPROVED B~~ DISTANCES SEPTIC SEEPAGE SEWER TANK SYSTEM LINE CESSPOOL WELL WELL SYSTEM DIAGRAM _ r-'r z~'~/LO, . BLOCK: _s.,.o,v,s,o.,' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~J~--~ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date //////~//~ ~ GENERAL INFORMATION (a) (b) (c) Legal Descr. iption (include lot, block, subdivision, section, township, range) *' // Location (address or directions) __ ~'~/~¢/_~v' ,,~~ ~ Applicant Name ~:~~.x.~ Telephone: Home Business Applicant Address _ . / Applicant is (check one): Lending Institution []; Owner/builder/[~'; Buyer []; Other [-I (explain); Lending Institution /,m//,~,~..~ (d) Address _~'~~ Rea Estate Company and Agent (e) Address ~~ ~~ Telephone (f) ~HAA to the following address: TYPE OF RESIDENCE Single-Family/[~ 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: If community well system, must have written confirmation from the Stats Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,84) ')JJOM S,JOOU!6UO leUO!SSOloJd eq~ u! SUO!SSiLUO JO S JO J JO JO~ elq!suodseJ lou s! oOBJoqouv ~o Xh!lBdlo!unlA/oq/'ponss! sf e~BoU!poo B oJoJoq e~ep eZ,qBUB JO suoRoodsu! lonpuoo lou op d3Ha to soeXoldUJE] 'shUeLUeJjnbeJ ehBhs pub leJepe~, u!euao XJs!lBs oh Jap Jo u] suofjnh!Jsu! 6u!puel ~!eq] pub seuJoq ~o sJesBqo~nd oh/~so~Jno3 B sB s!Llh seop d3HC] aql 'mtsBIv ~o eleh$ eqh u! poJels!13eJ Jeou!6ue IBUO!SSO~oJd huopuedopu! UB /~q @AoqB ~; qd~J§BJBd U! UeA!8 Suo!hBhuosoJdoJ Oq~ uodn/(lelOS posBq soiBo!~flJeo IBAoJddv X~!Joqhn¥ q~lBeH sonss! (d::IHC]) uo!hoohOJcl lelueuJuoJ!^u3 pue qhlBeH ~o hueLulJedac] e6BJoqou¥ JO Xh!lBd!ounR oq/ NOIJ. nVO IB^oJddv IBUO!h!puo0 J.o suJJol leUO!l!puo0 po^oJddBs!C] ~ poAoJddv ouoqdelel uaJ!-i jo OLUeN 'UO!loadsu! s!q~ ¢o mop uo ],oojJe u! suo!lBInOaJ pub 'seouBu!pJo 'sepoo alBhS pub IBd!o!unR lib ql!M eoUB!lduuoo u! s! LUO~SXS lesodsfp JO1BMOjSBM Jo/pue ,qddns Je~BM e1!s-uo eql 'uo!loodsu! pue uo!leO!lse^u! XLU LUOJ~ pUB selu el3eJoqou¥ Jo X~!led!o!un~ aq~ LuoJ~ peu!e],qo uo!lBuJJolu! oqh uo peseq heqh X~!Je^ Jaqpn~ I 'u!oJeq pe~Bo!pu! eJnlonJhs ~o odXj pub suJooJpoq ehenbape pub IBUO!loun~ 'e~Bs s! guols/~s lesods!p JeleMelSBM Jo/puB Xldd ns JehBM eh!s-uo aqi 1Bqh SMOqS IB^oJddv Xlpoqhnv qlleel-I s!q1 ~o uo!~eORse^u! XuJ 1Bql X~pe^ I 'MOleq UMOqS e~Bp uo!lBp!le^ eqh jo sB pub oleJaq pOX!~JB leOS/~UJ/~q pe!~!poo sV NOIJ.¥1~IBO=INI aNY '¢J. VCI 'HOB¥=IS =Ill4 '$J.$=lJ. '$NOIJ. O=IclSNI 9NICllAOBcl .g MUNICIPALITY OF ANCHORAGE (MO/~,~ MUNICIPALITY OF ANCH~..I.~TH AUTHORITY APPROVAL (HAA) DEPT. OP HE^LTH & CHECKLIST- FEBRUARY 1984 WELL DATA Well Classification ENVIRONMENTAL PROTECTION i' 2 ,q 1,987 RECEIVED 264-4720 Legal Description: If A, B, C, D.E.C. Approved (Y/N) '&'7,¢~ Well Log Present Total Depth / ~ z~ ~ Cased to Static Water Level Casing Height Above Greund Electrical Wiring in Conduit ~q~J) Separation Distances from Well: Date Completed / ~ Z." Depth of Grouting Yield '~ ~_. Pump Set At Sanitary Seal on Casing ~) Depression Around Wellhead (Y~ To Septic/Holding Tank on Lot t' c~o/ ¢' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _/'or.~ fy- On Adjoining Lots To Nearest Public Sewer Line ~'~//~ To Nearest Public Sewer Cleanout/Manhole ~ To Nearest Sewer Service Line on Water Sample Collected by ~4'..~ ¢~--/'J~/..~.c,'l~-~/',/~ ;Date Water Sample Test Results ...~-'/'~- "7'/ Comments --~ \,,J/-__'z.~. /~'~o,~,' ~%? ?~'"~,~,¢¢,~,f~¢'~ / B. SEPTIC/HOLDING TANK DATA To Property Line To Water Main/Service Line Course Date Installed Standpipes (~N) Air-tight Caps (t~N) Depression over Tank (Y/~l) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) '"'-- Separation Distances from Septic/Holding Tank: To Water-Supply Well Size ~ / c~o~ No. of Compartments ~-- Foundation Cleanout Date Last Pumped /- ~-c~"~_.~r~ ~ '' ; for Temporary Holding Tank Permit (Y/N) To Building Foundation /'¢' / To Disposal Field __ ? r~ / To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026(11/84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ?Z.-.¢ ¢/"/~/~-.- Date Installed /r.2- 2_~- -~ Width of Field Square Feet of Absorption Area Depression over Field (Y/~CJ~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ,/o ~'--/-- 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 Length of Field ,~ Depth of Field r~/ Gravel Bed Thickness ,~ .5'"' "/''-' Standpipes Present (~:;~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) '""///:} Comments D. LIFT STATION Date Installed . , / Size in Gallons ~// A "Pump On" Level at High Water Alarm Level at Tested for Eleotr, ical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certifysthatl& $ ENGIhSY~~t~:}verified' or conformed to all MO~ and H~A guidelines 'in effect on Receipt ,o. _ ~¢ --OOO ~ Date of Payment /- ~ ~-~ ¢ the date of this inspection. Page 2 of 2 72-026 (11/84) DATE RECEIVED ~ INSPECTION APPOINTMENTS TIME DATE DATE DATE TNSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. 825 L Street - Anchorage, Alaska 99501 ENVI~ONM[:N~A~ ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. ~PHONE ~AI LING ADDRESS ' ' PROPERTY RESIDENT(If different fromabov~) J ~ ''- ' ~ PHONE MAILING ADDRESS ~' LENDING INSTITUTION 1 ~ PHONE MAI LING ADDRESS 4. REALTOR/AGEN~ PHONE MAI LING ADD~ES8 5, LEGAL.DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY ~ INDIVIDUAL* I~1' COMMUNITY [] PUBLIC UTILITY NUMBER OF,BEDRQOMS [] One E~ Four ~]] Other [] TWO E~ Five ,,~ Three E~ Six ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drillea prior to that date, g~ve well depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) ]_ (_~. ~) THIS SIDE FOR OFFICIAL USE ONLY . 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] 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 [] INDIVIDUAL/ON -SITE DATE INSTALLED E3 PUBLIC UTILITY Connection Verified INSTALLER E~]Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: 1 Absorption Area to nearest Lot Line 5, COMMENTS ~PPROVED FOR '~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY v MUNICIPALITY OF ANCHORAGE IDEPI', O/: '¥..L'l;l & ENVIRONi,,',.NT;\L ; ,., ; EC:TION, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 525 L Street-Anchorage, Alaska 99501 APR l, ENVIRONMENTAL ENGINEERING DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. .1. PROPERTY~NER ~, ~ PHONE ~AILIN6 ADDRESS TROPERTY ~ESIDENT (If dif?erent from above) ' ~ PHONE 2 BUYE~ PHONE ~AILING A~E~S PHONE MAILING ADDRESS ' 4, REALTOR/AGENT . ~E MAlU~ A~PR~ 5, LEGAL DESCRIPTION J-oe STREET LOCATION 6, TYPE OF RESIbENCE S INGLE FAMILY ~ MULTIPLE FAMILY NUMBER OF BE3ROOMS [] One ~] Four I--I Other [] Two r-] Five ~, Three ~] Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June lg75. For wells drilled prior to t~t d~te, give well depth (attach rog if available,) ("~-~ -(~_~_~_~ , 8, SEWAGE DISPOSAL SYSTEM INDIVI DUAL/ON.SITE*~ [] PUBLIC UTILITY ''if irdividual/on-site, give installation date 0eh 't717. f system is over two (2) ,lears old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010(3/78) 1:~ --THIS SIDE FOR OFFICIAL USE ON~- DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR I NSP ECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY E~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED~ 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DuAL/oN -SITE DATE INSTALLED '" []PUB,,C UT, L,TY l O -A Connection Verified INSTALLER []Septic Tank or E]Holding Tank Size:~ If Tank is homemade O SOl LS RATING give dimensions: ~),~ TYPE OF TANK MANUFACTURER WELL TO: I Absorption Area to nearest Lot Line 5. cOMMENTS [~' APPROVED FOR ~-'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev, 3/78)