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Home My WebLink AboutPARK HILLS #1 BLK 2 LT 7Park Hills #1 Lot 7 Block 2 #017-142-24 MUNICIPALITY OF ANCHORAGE DIE TMENT OF HEALTH AND HUMAN SER S Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SI'rE SEWAGE DISPOSAL SYSTE! ~,ddress TANKS SEPTIC [] HOLDI.NG TYPE OF SYSTEM [] TRENCH j~BED AND/OR WELL INSPECTION REPORT DISTANCES SEPTIC ABSORPTION TANK FIELD WELL ' WELL I ~-) / ~=> ~ LOT LINE _Jj~t~o ¢: "7~1 "2. ~ FOUNDATION / ~ '~" l o 'P' / o-,~+ [] W. DRAIN {_~ OTHER F~ WELLS ~ PRIVATE [] OTHER fldentifv) REMARKS: I ..~"'~ ~ ~" Z~. ~-~;//, ~'1~ -- certify tha this inspection was ped0rmed ~ccordino to all ;leatth Depadment Approval: ~/'~¢"g--' ''~' 72-013 (3/85) [V~=W DRILLING, Inc, P.O. Box 110378 · 10330 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 86-195 DRILLING LOG Well Owner .Ii ra Arms trong/Hi§hland Des igns Use of Well Location (address of: Township, Range, Section, if known; or distance main road - '~, 7' B--2 Park Hills Subd. Domestic Size of casing Static water level _Depth of Hole~l, 52 ' (eet Cased to 152 ' feet 8] ~[t, (at:~l~) tbelow) land surface. Finish of well (check one) open end ( X Screen ( ); Perforated ( ). Describe screen or perforation,' '~ Well pumping test al; ] ~ gall0~ns pei' {~o1~) (minute) for. of drawdown from static level. 1 hours with 100% Date of completion 7 / ~ Depth in feet from ground surface WELL LOG Give details of formations penetrated, size of material, color and hardness ); ft. ~ TO 2 ~. TO 20 20 TO 112 112 TO 118 118 TO 1~9 __1.49 TO 150 ]50 _TO_ ]52 ~O. ,TO. ~O. ~O. .TO. .TO, Casing Stickup Brown_gravel: Sandy Silts Brown gravel: Gravel; Sandy, _Gravel; Silty !. ::Boulders ~ Silty damp and Boulders MUNICIPALI'W OF ANCRC)~AGI] u~Pi. OF HEALTH & ENVIRONMENTAL PROTECTION -kg. EP 1 91986 R EC El\/E_D Gravel with sand, water bearing NWWA Certified ContractOr Certificate No's. gl4 & 979 1--CUSTOMER :I;?X)7 t~]. 7ZlTH !;!J]:'IE 34 il ... 3 V 4 d I..()'1 MAX *~-.1~ (iff:;hAVE:l.. lJiii],.lG]ll :::' 75 F'I,, F;diEQLJIRli!:,~ii~ M1H...'IIF:'I..E F,~UNS (NO'[ liEXIT;I:]!ED]:I',IE.} 75 1:::"t',, Ef'~CI.I) ,~(..*. 'l't:>~lxll.::: MUST I.IAV'IE A'I" L..EA,fiFI' t'WO COI'4F:'AR'I"I*ilii~NTS ]: cer"l: j {y l:ha'L~ ].,, ]: am {aii'ci].:i. ap b!Jtll 'f'.h(.'? r,c?qu:i.r'~';nmZ~l'rL!~ {'cap c,n.-.s:i.'L(..) S~:.)l,a¢;.H'~ iZ~ll(:l k~.:?:[.:[.~ a~[~ S~:.?'[. [orLli by Lhe Plun:i(::::i. pa:l:iLy c:){ Aritho)page (MOA) and 'Lb(:,) SLate (:)[' A].aska,, ;:~. I: ,~]:L:I] :i rH~rL a :l ], tt"m:' sys'L~?m in ac:(:;cH--daiH:::e w:i.'Lh ali. I"[OA c:(::*cl(:.:)s and 3,, [ J,~d,].l a(::[l'l¢,,,l~:) l:.(::) ail PIC}A al'icl S'I:.,a'L(::) (.If A].a~il::a t'(:;)CIUJPE)ffi(::HYL!~ lOP LI'~c~ set back d:i.~[[v~aric:e[[~ [pc)lr~ all'y ex :i s'L :i li(} !,,~e].]~, WasL~(-~k~,:~t('-)r' d:i.s[]c)sa]. %,z's[:~,)[n (ii' Zl,,. :[ ur~d(ePs'('ar'H:i 'Llia'L this i::H.)rm:i.t :i.s va]id [(::)P a maximum (::~f 4 I::~c:)dpoc)ms ~'w'ly el'l:l.i[.~l'.(.j~}:~lii~li[', b~J].] i,(:)(:f1~:il'~) ali ach::l:i, tJc~na] ]:}::' A Ir:Il::'} S'I'A'I]:Oi',I IS :[N,'-3'}'AI...LIED ]:N AN ARL:-:A COVEI::~E}:) BY MOA B!t:l:l...;:)II',]13 CODES~, 'I']IEN (~.) AN I!!!]..ECTF~]:[;AI... PERM]:T AND INSPlii:C;]'I(:.]N ['.'lUST I:.:IIE C)B'rA:[NIED; (2) AS.....I3U:[I..'fS k}]:l.I. NE}I :FiE API.:'I.:;:I:)VI!!:D WI'[I. H3LFI' AN I!:]..I.i~C'[T;~]:CAI.. INSF:'ECT:I:ON RIEI:::'ORT!I AND (3) TI.IE IEL. I~CTI::U[CAL WI:)F~K MUST B[i: DOI,IF:: BY h I.]:C[]]xlSED lii]...I~i:CFRIC:[AN. Al::'l::*l :1: t:;AN I ,~ ROBtiWi'F D ,, S..:,FI:[ i.L i1: MUNICIPALITY OF ANCI-IORAGE · ~ F~p~ OF HEALTH · ,'~~ e,~'~ ~ ~ '-' OCT ~g1980 x~ .... ~ ~z,¢5/ 51.~<. ,, I ~r~y ~i~ t[mt I lmve su~eyed the foll~i~ descried prqmrty: LoT 7 ~ ~ ~1_)~. and tl~at ~ ~r~d]mnts ~ist ~cept as i~i~ted. ~xc lt~ion Note: It is the responsibility of the ~r to detennh~e the exl. ste~ce of any eas~nents, c~vet~ts, or re-strictio~m ~ich ~o not appear on the recorded sulx]ivision plat. Under no circ~stanoes should a.y data bercc~ be used for construction or for establishirg boundary or fence li.n~s. Daced at Andx)~age, Alaska, this J (~P day of k-~-~T. J? ¢~ C~RACFING D~]NEI!RS & ASSOCIATE.S ^cDUiLT H~r~ (907)349-2z~07 ' '--- DATE SCALE AEE~ ENGINEERING 1207 EAST 74th. Avl. ~ulle DRAWN BY 8HEE'r Anchoroge~ Alolk~ 99518 SOILS LOG MUNICIPALITY OF ANCHORAGE J~ PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 82.5 L, Street, Anchorage, Alaska 99S01 264-4720 SOILS LOG- PERCOLATION TEST -F' t-~ -- I g(o PERFORMED FOR: ~ I ~?'~'~ A~l~"-~"t'~ "'~-'1'2~ ,N~ ~"1 DATE PERFORMED: LEGAL DESCRIPTION: LoT "~ I"~ L~ e-,t( [ ~ .~¢1~-- ~. ~,-.~ ILk.. $ ~" ""~ f~ -.~'% SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop i ,, ;~,:'~o t. '.~o °l .2-~ (z.~") ~_ ,, I~ :oo o ', ". o q, "~"/ (t. ~-.,.") 3 ., i, ', ~o o '. 3o '~' Sq' ( ~. e.o,% PERCOLATION RATE J' ~ ' -? (minutes/inch) TEST RUN BETWEEN ~ FT AND '~ FT PERFORMED BY: ~I~"~, ~'~ / -'~'~,~.'*,'"~.~ CERTIFIED B..~ ~,~ DATE: SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST SLOPE 10 SITE PLAN 11 13- 14- 15- 16 17 18- 19 20 COMMENTS WAS GROUND WATER /~/-~ S ENCOUNTERED? L IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~ ' ,.'' · ° ~ . (minutes/inch) ? ALASKA e,,,,,RoItmeFITAL COFITROL IFIC. I~nclin~:~rin~1 G I~nui~onm~nt~l St~clics .,PERCOLATION TEST DATA SHEET ADDRESS' ZIP CODE LEGAL LOCATION __~]~ K'I"~ F/~115 .~.e .~ t vts ,or~. TOTAL DEPTH OF HOLE C~} //9 ft, ZONE TESTED c~ ft TO '~'/~ ft READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in) DATUM / / .' 5a / 0 /, ?~) , ,~&~ "., ,,.~ 5'~ ~),'~z/ /~.,' , / //. ~' ~,'~ ~. ~.: ~),'~/~ /~) /, ~// , FINAL PERCOLATION RATE PERFORMED BY _~.!jlC~j~ /~"'~ rain/in) 120o [U~sl'33rd Au~nu~. Su=,,~'~o Anchoroq~ Alosk~ 99503 · (907) 276-1361 Department of Health and Human Services Division of Environmental Services On-Site Services Section 825"L" Street Room 502 P.O, Box 196650 Anchorage, AK 99519-6650 wvwv.ci, anchorage.ak, us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL I--OR A SINGLE FAMILY DWELLING Parcel I.D. 017-142-24 1. GENERAL INFORMATION Complete legal description Location (site address or directions) HAA# Expiration Date: Lot 7, Block 2 Park Hills S/D'~ 14710 Park Hill Circle Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Don Giles Day phone 345-8113 14710 Park Hills Circle, Anch, AK 99516 Day phone Jan Penninqton Day phone 244-3099 Unlessothe~ise~quested, HAAwillbeheldbyDHHS~rpEkup. HAApickedupby: 2. NUMBER OFBEDROOMS: 4 3, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class __ Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Itealth Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family an-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners Certificates of Health Authority 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 less than 30 days old. Certificates are valid for one year for properties served by Class A or B ,/cells cra public water system The Municipality of Anchorage is not responsible for errors or omissions ~n the professional engineer:s worx. As certified by mv seal affixed hereto and as of the validation date shown below. I verifv that mv investiqetior~ based on proceaures ouuinea in me Healm Autnomy Approval bulael~nes TOt trll$ i-i~ii[i r~,L/tfiOll[y Ja, p~)iUV~I application shows that the on-site water supply and/or wastewater disoossl system is safe. functional and aaequa[e rot me numoer of oeorooms and type or structure ~ne~cated here~n. I turmer verify that based on me information obtained from the Municioaiitv of Anchoraae files and from my investiaation and insoection the on- site water supply and/or wastewater disposal system is in compliance with all applicable Municipal and State codes, ordinances, and reoulations in effect at the time of installation. Name of Firm Pannone Ena. Svc. Address P.O. Box 102954. Anch. AK 99510 Engineer's Printed Name Steven R. Pannone. P.E. DHHS SIGNATURE ~ Approved for /--/' Disapproved. Conditional approval for bedrooms. Phone 27,~-o~1 o Date 5/i5/2000 bedrooms, with the following siipulatio¢~s; auu~uu,,,~ Comments HAA Checklist X Septic System Advisory E ......~ ....~ - ;2.2 ~0 ,~ Maintenance Agreements Supplemental Engineer's Report M mlcipality of Ancho,'age Department of Health and Human ServicetllAY Division of E~vironmental Services On-Site Services Section 525"L" Street Room 50~UNICIPALI[Y P.O. Box 196650 Anchorage, AK 99519-66502~1~O~AL ~.ci.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:. LOT 7, BLOCK 2 PARK HILLS IfA, B, or C provide PWSID # __ Sanitary seal Y Cased to 152 ft FROM WELL LOG 7/1/1986 81 ft A, WELL DATA Well type PRIVATE Date completed 7/1/1986 Total depth 152 fl Date of test Static water level Well production 10 g.p.m WATER SAMPLE RESULTS: Coliform _0~colonies/100 mi Nitrate 0.642 Date of sample: 51712000 Collected by: B. SEPTIC/HOLDING 'rANK DATA Tank Type/Material STEEL Date installed 911711986 Tank size 1250 Cleanouts Y Foundation deanout _ Parcel I.D.: 017-142-24 Well Log YES Wires properly protected _Y Casing height (above ground) AT INSPECTION 5/5/2000 81 ft 3,8 g.p.m mg/I Other bacteria 0 colonies/100 mi S.R.PANNONE gal Number of Compartments _2 Depression over tank _.N High water alarm N/A Date of pumping 10/1/1999 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 9/17/1986 Soil rating (g.p.d./ft2 or ff2/bdrm) .206 Length 42_it Width 22 ft Total depth 4.5 fl Effective absorption area 924 ft2 Date of adequacy test 5/5/2000 Results (Pass/Fail) __ Fluid depth in absorption field before test DRY in Water added60p gal. Elapsed Time: ~ rain Final fluid depth DR.Y, in Any rejuvenation treatment (past 12 mo.) (Y/N & type) N (Rev. 11/99) System type BE[) Gravel below pipe 0,5 ft Monitoring tube _Y Depression over field PASS For _4 bedrooms New depthDRY in. Absorption rate >= 600 g.p.d. If yes, give date. n I II:T ._C[T/~TI~ Date installed "Pump on" level at' Datum Size in ga!lens N/A __ in"Pump off" level at Cycles tested ,~n, ,cie ........ High water alarm level at __ in Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout N/A Holding tank 100+ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on for 103 Public sewer main N/A Sewer/septic service line 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 12 Property line 80 Water main 25+ Water service line 25+ Drainage 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 10+ Surface water 100+ Wells on adjacent lots 120 Property line 21 Water Service line 25+ Curtain drain 100+ F. COMMENTS ENGINEER'S CERTIFICATION I certlty that I have determined thrOUgh t/elc~ inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E. Date 5-15-00 Absorption field 25 Surface water 120 Water main 25+ Driveway, parking/vehicle storage 30 HAA Fee $ '~ ~7). ¢ Date of Pa,ment ¢ ReoeiptNumber-¢~ /~'Tq/_~ (/¢ZJ) (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number Pannone Engineering Services, LLC Consulting Engineer SEPTIC SYSTEM ADEQUACY TEST Legal: Owner: Residence: No. of Bedrooms: Septic System: Lot 7, Block 2 Park Mills S/D, Mr. Don Giles 14710 Park I-Jills Circle, Anch. Air-. 99516 Four (4) Tank Size: 1250 gallons. Absorption System Type: _Bed Absorption System Size: 42'x22'x 0.5' Date of Pumping: Date of Test: P.O. Box 102954 Anchorage, Alaska 99510 ,,, .. ~ .......... ~.~..~ Absorption Area: 924 s.f. Installation Date: 9/17/86 Soil Rating: 206 sf/br 10-1 ~99 By: A+ Home Services 5-05-00 Test Procedure: System was inspected visually and measured. The tank was found to have 4 feet of cover. Liquid depth was measured to be 50 inches. The drain field was found to have 81 inches of cover and a total depth of 94 inches. Them was no liquid measured in the field's monitor tubes (two monitor tubes were found.) Water was added from the well at a rate of 3.8 gallons per minute (GPM) into the post tank clean-out. Liquid depths were measured in the monitor tabes. The liquid levels did not rise in the monitor tubes with the induction of 600 gallons of water into the drain field. After the water was turned off, the liquid level returned to the original level within 1440 minutes. This system is able to absorb 600 gallons per day. The well was tested in conjunction with the septic system. The static water level in the well was measured to be 81 feet below the top of the casing. The water level in the well was drawn down to 100 feet below the top of casing while the pump prodaced 3.8 GPM. It appears that the well is able to produce greater than 3.8 GPM. A well flow of 3.8 is an acceptable flow. '['he water was tested for bacteria and nitrates. The test results indicated there was no bacteria and 0.642 nitrates detected. TEST RESULTS: This system meets the code and operational requirements of Municipality of Anchorage, l)epamnent of Itealth and Social Services tbr a four (4) bedroom house. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DHHS Guidelines & Regulations. The reported results describe 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 soil 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PL:S can therefore not provide any warranty for future per[brmance nor give any estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. The content of this report is tbr 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. ,¢',¢;,"-~!~I:.'~i~:~;;~'!~;.',~ ~" . ~ MUNICIPALITY OF ANCHORAGE ~,.,.,,,,~[~:. :,,? ,, //'~ DEPARTMENT OF HEALTH & HUMAN SERVICES ;.i!~i~i~,. ,~ ' ' ,. ~,~'~1~,'_ ~/D v s on of Env ronmenta Se~ ces · J~F~ On-S~te Se~mes Sectmn ~;:"," ::. ~" ;~JS~:' "7%' ~ ' - P.O. Box 196650 , Anchorage. Alaska 99519-6650 , ~;~ , , ...... 343-4744 L.;,;!.' ,, CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcetI.D.# O1'7 -I~ -~y 1. GENERAL INFORMATION Complete legal description HAA # __~ ~0~/~ Lot 7; Blo'~'~,~,2'~~ 'Park 'H~lls" ,Subdiv~sZon '~¢ ~ locatio.n~{site':addm§s or directions) ' Prope~y owner _ Mailing address,,,~ ~4,7'~0 Par~ ~ls Cir~. Anchorage, AK 9951~ Le'nding agengy - - ' '- Day phone 14'710 Park HxD¢.£~' Cirel~ " · -' r' Anchor~q¢,, AK .... '" ....... Day phone 345-5113 investigation of this Health Authority Approval application shows that the on-site water supp y and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structu re 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 $ & s ENGINEERING 17034 Eagle River Loep Road NO, 204 Eagle Rlver~ Alaska 9~577 Address . Engineer's signature Date: /!//¢7//~J'- )nal Comments Municipality o~ Anchorage Department of Health and Human Service& (DHHS~) ~sue~'H~ th A,',ihor ty Certificates based only upon the representations given m paragraph..5.,ab0ve by an independent Pmfe~aiohal Cng rmer reg stered n the State of Alaska· Th~ DHHS does this as a ~0~'rtesy to p~ircliasers of homes g institutions in orderto sat sfy certa n federa and state requ re~'e?~ .J ons'~or a~i~ze data before a certificate is iSSued~ The ~'~i~'i~lity ~)f Anchorage is not for errors or omissions in the professional engineer's work. ~¢~¢;F~,,'~'~t'~* '.' Municipality of Anchorage DEPAP, TMENT~i~F.HEALYH & HUMAN SEP, VICES Envir~'l:nental S&vices Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Lo 'F A, WELL DATA Well type Log present ¢{~)'N) 'Y~ 5 Total depth Sanitm~ seal (~) Health Authority Approval Checklist BL< ¢T P.4¢¢< /¢,,~4. J' g/~m'cell. D.: et '7 '--I'-/;~ - . If A, B, or C, attach ADEC letter. ADEC water system nnmber Date completed '7 / t / ~ ~ Cased to / ~'~ 3- / Casing height (above grotmd) Wires properly protected ~/N) i/4- Date of test Static water level Well prodoction WATER SAMPLE RESULTS: FROM WELL LOG g.p.m .4- AT INSPECTION g.p.m. Colifornr Nitrate Other bacteria Date of sample: S EPTIC/HOL-B4N'O'T AN K DATA Date installed 1~ /30/gL-, Tank size Collected by: S & $ ENGINEERING 17034 Eagle River Loop Road No. ~atlle River, Alaska 99577 . Nembcr of Compartments 03, Cleanouts(~/N) }'¢J' Foundation cica. neet ((~/N) ¥ rcy Depression (Y/~)) /v o Iligb waler alarm (Yfl~ ' r/~ /qJ'- Pumper ~q 'k I¢0,~ J~g,qv, c~'j- Date of Pumping /i Co ABsoRPTIoN FIELD DATA Date installed (o/ 30/ Length q ~' Width Effective absorption area q 3- Date of adequacy test Flnid depth ill absorption field before test (ill.); Fhfid depth O (ills.) Minnies later: Soil rating (g.p,d,/ft2 or~ qol'- O (o System type /3 ,<- 0 __ t ~) % Gravel thickness below pipe (.9, Y~ Total depth z/. g- Monitoring Tube present(~/N) Y'~J' Depression over field (Y/19) ~o Results (~/Fail) to& J' )' Fei' /7/ bedrooms O hnmediately after ~7~/gal. water added (in.): ~9 '- Absoqrtion rate = t~ o O q- g.pA. Peroxide treatment (past 12 months) (Y/N) ~, o,v,g ~'...,~ ~.d If yes. give date -- D. LII~T STATION Date installed '-. ' Manhole/Access (Y/N) ~' level at* ~Ptunp oW' level at* liligh~ *Datum ~ tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/l:re!ding tank Oil lot Absorption field Oil lot Public sewer main Sewer/septic service line ; On adjacent lots ; Oil adjacent lots Public sewer ulanhole/claanout Lift station SEPARATION DISTANCES FROM SEPTIC/HGLDiNG TANK ON LOT TO: Building foundation / O t- Property lille ;3 o -)- Absorption field Water main/service line &o t .,_ Surface water/drainage / o o t4- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Surface water Curtain drain ~ ~ r-,'/. Water main/service line Driveway, parking/vehicle storage area b~ o t 4~ Wells on adjacent lots ! 0 o Property line ?o' ~ F. ENGINEER'S CERTIFICATION certify that I/:ave determined thru field inspections and review of 3/Junicipal reco 'd~ thatat th~h~th terns are m conJbrmance u ith MOA H~uide~nes in effect on this date. ...... ................ ~ ~" .... HAA Fee $ ~ ~ ' ~ Waiver Fee $ Date of Payment //~ ~--7c5~ Date of Payment Receipt Number /~;: (7~/) Receipt Number Rev. 8195 OSS: haa,wk.doc ~::,,, (:n~ Water Analysis Re.pon for Total Coii£orm Bacteria · ~!~,.l. ST~ L CTIO. V3 0 ~ ~VERSE, SiDE ~£FORE COL~ECTi. VG CT&E Environmental Services Inc, ACTEP~rOLoGiCAL WATER ;t',[o 3FL'C R~sutu Total Coli[Orm ~amPbov~:3Ohou:~ol~ new ~m~l, via -~-'~t~Ft;s;, meade ~end D.~ R~cekwd Tima ReCek-ed ,Anab'denl :We~flod; ~(embrane Ffk~r O ~IMO-.wUG Lab ReA No, R~CORD ,~ GPS'ON T~-ETPGgL06 ~ ~NIZSBI ]UID~NHOD £0:9I GG/60/TT J~] 6~S'ON I~E~69L06 ~ 9NIISBI qUID~BW~OD 00:9I MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIF;CATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Data GENFRAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant N a m e/~,¢'.¢,,/,~-~¢ ~ Telephone: Home (b) Business Applicant Address ~'~ ~Q~- ('~-~/¢ c ~-~¢~ ~.¢.--8 .~/~- ,,~-z_~ ~ (c) Applicant is (check one): Lending Institution []; Owner/builder,~ Buyer []; Other [] (explain); (d) Lending Institution Address ~,¢~¢~': ~:~ (e) Real Estate Company and Agent Address __~'~ ~'~ Telephone _~ (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCF Single-Family,J~ Multi~Family [] Number of Bedrooms ~ Other WA'I;'E R suPPLY Individual Well~ Community [] Public [] Note; If community well system, mest have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite./~ 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. Page 1 of 2 72-025 (1]/84) 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 r'ny 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 _~-~ ~-~-¢:"Z~2~¢',~'~ -~'r~ Telephone Address _ / ~ '0 (---~ ~ 't' ~ ~"¢?-~'~- .~c~ ~ '~ Date ~;) ---~"- ~--~ ~ Engineer's Seal ;~. DHEP APPROVAL Approved for .¢,',,.x~.¢_C¢ bedrooms by,E_-~'"~ Approved ~ Disapproved Terms of Conditional Approval *'-,,~¢,v~..~ Date Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP).issues Health Au~ority 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 r2-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOAi HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: J~4UNIClPALII'Y OF ANCHORAGE DEPT. OF HEALTH & J'~IVIRONME NTAL PROTECTION SEP 5 l! 86 WELL DATA Well Classification /y~,,.~...'fC_L_ If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) ~/ Date Completed ~'-- I -- c~ ~ Yield Total Depth /.~- '2-- Cased to ,/~'-z.~ Static Water Level /~ ! Y Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To,/~emi~/~lo[ding Tank on Lot Depth of Grouting ' -- Pump Set At /[.)¢,?z_ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot / o ~, To Nearest Public Sewer Line Cleenout/Manhole Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on ~'~--~/,~-,"~('~ ~ ; Date Comments B~'~I'IOLDING TANK DATA Date Installed f~"~ ~"~-~ Size Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) .,~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances fro~ti~Holding Tank: To Water-Supply Well ./ '~-~ To Property Line ,~o +' To Water Main/Service Line '"-'- Course _ / .~'/~ ' ''~ No. of Compartments ~ Foundation Cleanout (Y/N) Date Last Pumped /¢,~:~,._2 ; for ~ Temporary Holding Tank Permit (Y/N) '7' To Building Foundation / To Disposal Field __ / / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed . ' ~'~- Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well / To Building Foundation ,/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 .,~ Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line '2~' To Existing or Abandoned System on ; On Adjoining Lots ..~ To Cutbank (if present) Comments Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical 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 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S i g n e d / .~¢'~'~ ~_ .~.~.¢~../~ Date MOA No, Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal