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Home My WebLink AboutSOUTHPARK #2 BLK 3 LT 9outhpark lock Lot 9 020- 502 -O7 Municipality of Anchorage Page / of _'~ DEPARTMEN'I' OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~' 0'0~'~' ~',~ PIDNumber: 0~0 Name:~cO ~ ~ p~ ~ ~ p~ ~,~ Wastewater System: D New ~ U~grade ~d~ ~o~p~ ~/~ ~ ~e~-~( ABSORPTION FIELD ~ ~. ~ ?// ~ No. O~ BeSeems: ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other :So lng: Total Depth from original gr~ LEGAL DESCRIPTION LOL Block: Su~ ~ivi~ion: Deplh to pipe boHom ~m~ade: G ravel d~p'ipe Township: I Range: I Se.;tion: Fill added above odgifla, grade: ~gt h: I WELL: ~.~. ~ N~w ~< ~ Gravelwidlh: / Numberoflines: l~l~s: Yield: I Pump Set at: I Casi.9 Height Above Groun6: GPMI FhI .~. TANK SEPARATION DISTANCES ~ s~p.c ~ Ho~din¢ U S.T.~... From T~nk Fiold Slalion Tank Sewer Lines ~' ~' ~ Well ~'~. ~ --/ / Malerial: ~, / ~Number f ~ ments: >,oo, UFT STATION Lot ~ Size in gallons: Manufacturer: Line IJ I Curtain Noe~ ~ ~ PumpMake&Model IEleclricallnspecdonspedormedby: Remarks: '~ ~//,.~ ~ BENCH MARK ENGINEER'S SEAL Inspections performed by: FI~ ~c4 ~c Dates: lst_~/~'/~ . . ~ ' ~ ~:~ ~r 2nd_ '~~ ~ Department of Health and Human Services approval ~:::~:, Reviewed and approved by: ~ ~, Date:_~'/~-O~ ~' ~ ' 72-013 (Rev 9/91) MOA 25 · PERMIT NO: SW000083 ~ PID NO: 020-052-66/ SWING TIES: FROM: TO: S,T. C.O. "C" S,T. C.O. "D" COR. "A" COR. "B" 73' 34' 79' 37' TBM "B" NEW 1000 GALLON SEPTIC TANK EXISTING SOIL ABS. TRENCH NEW. M.T. 'FO ~ 'FRENCH 94.8' DBL. PAGE 2 OF 2 LOT 9 BLOCK 3 PLAN VIEW SCALE: 1" = 30' NEW 1000 GALLON SEPTIC TANK FROM HOUSE .INV. 95.1' PROFILE VIEW NO'r TO SCALE LOT 9, BLK. 3, SOUTHPARK S/D, UNIT #2 SEPTIC TANK REPLACEMENT AS-BUILT INSPECTION REPORT FLATTOP TECHNICAl. SERVICES 14530 ECHO STREET ANCIIORAGE, ALASKA 99516 SCALE:AS NOTED DRAWN BY TFM MAY, 2000 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 ¢07) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 03, 2000 Fxpiration Date: May 03, 2001 Permit Number: SW000083 Legal Description: SOUTHPARK ADDN 2 BLK 3 LT Design Engineer: 0019 Flattop Technical Services Owner Name: Scott & Paula Davis Owner Address: 4660 Southpark Bluff Drive Anchorage , AK 99516-4841 Parcel ID: 020-052-66 Site Address: 004660 SOUTHPARK BLUFF DR Lot Size: 26798 SQ. FT. Total Bedrooms: 3 Permit Sedrooms: 3 This permit is for the construction of: [~] Disposal Field Ld 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 weatl~er must be eitt~er: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: _ Issued By: LOT 10 ABANDON EXISTING -- SEPTIC TANK %` EXISTING SOIL ABS TRENCH NEW. M.T. ,' - NOTE: HOMES IN THIS S/D ARE NOW SERVED BYA~U PUBLIC WATER. THE E~CT ~`% LOCATION OF THE WATER SERVICE LINE IS UNKNOWN, HOWEVER THE ORIGINAl_ TANK WAS REPORTED TO BE 10'+ FROM THE WATER SERVICE LINE AND THE NEW TANK WILL BE FURTHER AWAY. `%, LOT 9 BLOCK INSTALL NEW 1000 GAL,' SEPTIC TANK ," LOT 8 " SYSTEM THIS AREA ...... INSTALL DBL. C.O. LOT 9, BLK. 3, SOUTHPARK S/D #2 SEPTIC TANK REPLACEM[:NT srrE PI.AN FLATTOP TECI~',i[CAL SgRV]CF, S 1 INCH = 50 FEET ]4530 ECHO STREET DRAWN BY TFM ANCItORAOE, ALASKA 99516 APRIL,2000 NOTF: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. 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 NAME PHONE [ "~ EW ~i~,.~'~{~ ~ ~ ~,~ ~ ~ ~---~)~ ~ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS ~ Z Manufacturer Material No. of c~partments ~ ~ Liq. capacity [n gallons IF HOME'DE: Inside length Width ~ Liquid~depth , ~ Well Dwelling PERMIT NO. ~OZ DISTANCE TO: 0 ~ ~ Manufacturer Material Liquid capacity in gallons = Well Foundation Nearest ,ot llne; Trench width No. oflines . Length of each En~ , Total length ~in>, Distance between lines Total effective a~sorption area~ ~ ~ ~ Top of tile to finish grade Material beneath tile----~' ,f inches ..~.,____ = 7~-~'' , Length ' Width Depth PERMIT NO. < ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Soptic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS PO b,./I 6-650 ANCHORAGE, ALASKA 99502 0650 (907) 264-4'111 7ONY KNOWI ES. MA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit ~: 840173 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 9 Block 3 Southpark Subdivision #2 A permit issued by.this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority ef Municipal Ordinance. A new permit must be obtained from this Department for any well and/er on-site sewer'system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, rKeith E. Bandt, Supe~viso Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 B, EI::'I:iF;'."I'MISN1'~ OF:' IIE:FIL. TH F:IND EI'.,IV:[F;:ONME:IqTFIL.. PROTISC'f'ION 825 L ':'!:TFd-:'.IZT., I::I1`.,IC:HORFIGE., KIK S~95E]::L F'EI:;:M I'F t",10: B, FI'I':E I E;SLIE:D: f::IF'I::'L, :1: C FII"4"I": F:IDI:>RIE:SS: COIq'TF:ICT F'hlO1`',IE: L. IE [:iF:ti. [:,ESI:'::Fi'. I F:': I..OT 1`"IR::'",' BEI:)ROC~I'dS: S~;UB[) ]: '¢ ]: .S ]: 01`.,I: SOUTH I::'FII;;:K ;11;2 LOT: :SEC'F]:CI1`.,I: ]l. -F[)I.,II',IS:,H];I::': :i.:l.N RF:I1`.,ICE: ]:1,.I 26',."SuEe ,:: 5;6:!. F"I". OR I::ICRIES;::, BI_.OOI<: L. :[ :S,'f'EI:::, E~E~:t..OI.,.I F:IF.'.'E 'T'HE OP"f' :l: OP,IS; F:l',,,'f:l '1.' LI'::IE~L. IE "['O '¢B'11.] I I",l B, ES; 1131''41 P,IG '.r'CIUI;i: 5;EF'T I C :Ei;'¢5;TE:I"I. C:HOOSE THE OF'"I":[ []1",1 THF:IT BEST F ]; TS'~ "r'OLIF~: ':::;]: TIE. .... ~" It:',;;~:'. BE: I1"--~ C::::: IHIEE'-' EE: IiZ:" I1..,,-fl. I[::" F;." ¢~ :ii:: CERT :[ F'~'r' "[taFIT: :1... ]: Fil'"l FRI"IZI....]ZFII:~:: I,I]:'[H THE: R%~]:[I]]:I:;i:EMEi",IT:E; FOF'.': EIM-5; ]: TIE 2;EIqE[;~:S F:I1`',tI::, I.,.IELL.:.S FtS SIZ"t" I:::'ORTH B~'r~ 'THE MI.I1'.,I]:E::[F'FIL.]:T'¢ [)F I::INC:HOFa::I[iiE (I'"IOF:I) F:I1`',I[:' 'THE S;TFII"E OF ;?.. :[ I.,IZI...L. :[I"~S;TFII.:.L. "I'HI~: :~i;"r"Z;TE:H Ihl FICCORE)FINCE I.,.I:[TH FILL 1~t0Kt CODES I::INB' I:;;'.EGUL. fqTIO1`',I2;., RI",II::, ]:1",1 C:OMF:'I..]:I::II",IC:E.I.,.I]:TH THE B, ES;]:C:iN CF~'.:[TEI:;:):I::I OF "r'H:[:.E; F:'ERFIZT. ."~:. :t: I.,I:[[.L. FII:::,HEI~:E 1"O F:IL.I... hE:iR [:INI) Ei;T'Fi'f'E OF lal...F:]Sl. Cl::l F.;:E[.:!U:[f~:EFIENTS F'OIq'. TFIE SET I:)]:'.E;TFlhlC;[:i:S I::'I;;'.CII','] F:11",i"r' E',,',',]::~F/"l'1`',l(ii I.,.IEI...L., !-,.IFI:S"f'EP.II::ITEI:;~: F:, :[ %F'OSI::IL fS"r'::~TEZ["I OI:E'. F'L.I[:DL:[C S;EHE~;F."I::I(::ilF: S'¢STIEM ON 'TH:J5; O]:;i: F:ff',l"r' F~I],./J:::ICE1`',IT Olq'. I'-,IEFII:;;:B'¢ LOT. 4.. :[ i. J1`.,JDEF,;::!~;TFI1`',IB, 'f'HF:[l" "i"H:t:'.ii; l::'[i~];~:['l:['l' ]:S ",,'I:IL.:[B' FOB'. f:] fdf::l',,':',;L'l"lI.Jf'l OF' ,q. E~I.:::[:'F.'.OOMS~; FI1'',II) FIi".l"*" EMLF'IF~:E!i[:3"ilEF,IT I.,.ll'L..[... F;'.E:I]:!I.J:I:I:;:E I::']N FJI:)DZTI'C[NI::IL ]: F f:[ THEN L.. ]:I:::"F !S'I"F:II' ]: O1`',1 X 5; :[I",ISTI::ILLEI::' I N ]:::lhl F:II:;~:IE]:I C:O',,,'EI:;:ED E:'~" ['4OF:I BLI]: L[) :[ NG CODES., ,::~1.) I:"11`',1 IEL. EC:T'I:;'.]:CF:IL. F'f:~:F;'.I'"IZI:T FIND I",IOT BE F/F:'[::'I:;;:OYE[:' I.'.1 l: '/'l-'lEIU'l' I::/l",l EL. EI];T~';~'. ]: C:I::IL. :[ 1`-,ISF'E:C:-I" I O1`',1 F;'.E:F'OF;i'.T.~ I:::II'qB, (:~:) 'Fl'-IIE PERFORMED FOR:, LEGAL DESCRtPTION: COMMENT ML SIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street. Anchorage. Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PEqCOLATION ENCOUNTERED? /, 'O IF YES. AT WHAT DEPTH? P E Reading Date Time Time Water Drop PERCOLATION RATE /~"~ _(minutet/inch) VEST .u. ,E EEN 72.008 (6/79) ' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HDMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWFLLING --,~'.~" ~ - ¢~'~" HAA # ~t( .~ . 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner =¢'~0 /-/' ¢ ?~,/~ ,P~,;..r Dayphone Mailing address ~ ~P~ ~/~ ~;~ ~4o~E Lending agency ~n ~ Day phone Mailing address Agent Dcxn ~.~¢_.~_R__6 ,~,~ ?~p~r ti~ Day phone Address ~¢0o ~r~z'~ ¢-~ ~C/>~ I~ too .~-/~¢,or ~.5 Unless otherwise requested, HAA will be held for pickup. NUIVIBER OF BEDROOMS: -~ 'TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water ~ If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev 1/91) From 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 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 /:[~x/-,/-~/¢ "2'-~.c/-,.,,,'¢~ / __Ce,--,.-, ;- er- Address Engineer's signature DHHS SIGNATURE P"" Approved for Phone Date /'~oy /~., ~o~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ~ ~ ~. ~ . , e . . 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 th is 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 1/93) Bacx MOA #21 Municipality of Anchorage. ,~uN c~.u ,~ _'~ ~ CF W ~ ~ DEPARTMENT OF HEALTH & HUMAN SERVICE~A~ 3 2 ~000 Environmental Services Division 825 L Street, Room 502. Anchorage, Alaska 99501 · (9~),3~3-~7~4 ~ ~TAL ~;~-~ Health Authority Approval Checklist LegalDescriotion: /-.¢'½% ¢/~$., .~'o~/~¢',~ ~ '~ ParcelI.D,: A, WELLDATA - Al,4 - /'r~C'cc.'~t pc4/.7~.,'c. Well type Log present (Y/N} ;)ate corn 31eted' Total depth Cased to Sanitary seal (WN) 0 ~o ..o8- ~ - o~'d' IfA B or C, attach ADEC letter. ADEC water system number FROM WELL LOG g,p.m Casing height (above ground), Wires properly protected (Y/N) AT INSPECTION Nitrate Other bacteria Collected by: Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of samcle: g.p.m. Number of Compartments. ~. Cleanouts (Y/N) N High water alarm (Y/N) Seil rating (g,p,d./ft2 or fF/bdrm) __L~_~ System type 7'~-¢,.c Gravel thickness below pipe /:3 ' Total depth Monitoring Tube present (Y/N) ¥'_ Depression over field (Y/N) /'q _ i~, SEPTIC/HOLDING TANK DATA Date installed ..5-/5'/00 Tank size Foundation cleanout (WN) 'r' Depression (WN) Date of Pumping h/,/f. ~lq~-,~_ Pumper C. ABSORPTION FIELD DATA Date installed 7' / I / ~ ?' Length 3d: ~""' Width Effective absorption area ~p'-'~ 5' Date of adequacy test './/2-~/oC) Results (Pass/Fail) P¢'.CJ' For 3 bedrooms Fluid depth in absorption field before test (in,); __'7_7 Immediately afterT~ ~! gal, water added (in,): Fluid depth '7~'.5~ (ins) Minutes later:. ?-- ~ Absorption rate = ~ '¢5'c2 g,p,d, Peroxide treatment (past 12 months) (Y/N) Afo~ ~ l~nc,~.,.~ If yes, give date 72-026 (Rev, 3/96)* oA LIFT STATION ~',,/· ,4, Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in gallons "Pump on" level at* *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: /'J. ~'. Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line Lift station "Pump off" level at* On adjacent lots On adjacent lots Public sewer manhole/cleanout SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~Q' Property line /I t Water main/service line ~ ,~,o ' Surface water/drainage '> ,/oo / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation Property line Surface water Curtain drain Absorption field Wells on adjacent lots '> 2_oo , Water main/service line ~ /o, Driveway, parking/vehicle storage area '~ /~, ' Wells on adjacent lots '> ~_oc~ ' F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal rocords'that~ in conformance with MOA HAA guidelines in effect on this date.. ~'~' Signature %~ ~ ~ Engineer's Name ~ t~ ~~ ~ ~o~ . Date ~7 /~ ~oo~> .... ~ .~ ~,.~'~' HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number IVIUNICtPALITY OF ANCHORAGE DEPARTI~IENT OF HEALTH AND ENVIRONIVIENTAL PROTECTION DIVISION OF ENVIRONMENTAl.. HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ._. GENERAL INFORMATION (b) (c) Legal Description (inctude lot, block, subdivision, section, township, range) Location (address or directions) Applicant is (check one): Lending Institution D; Owner/build¢; Buyer ~; Other ~ (axplain); .......... (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family;~]~ Multi-Far~_'l)y [] Other Number of Bedrooms __±~ ......... WA'rER SUPPLY Individual Well E] Comrnenity/~ Public L-'J Note: II community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, SEWAGE DISPOSAl. Onsite~ Public ~] Community [~ Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environrnental Conservation attesting to the legality and status. Page '1 of 2 72-025{11,84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified hy my seal affixed hereto and as of tile validation date shown below, I verify that my investigahen of this Health Authority Approwd shows that the on-site water supply and/or wastewater disposal system is safe, functional an'd adeguate for the number of bedrooms and type of structure indicated herein. I further verify that based on the informatton obtained from the Municipality of Anchorage files and from my investigation and inspection, the on~site water suppIy aed/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, snd regulations in effect on the date of this inspection. DI-IEP APPROVAL Approved for ~\.~ ((,3') bedrooms hy ~::;[~_.L.~£2_~4=,[ _____ Approved ~ r Disapproved Conditional Terms of Conditional Apl~rOval Engineer's Seal ~V' ," , ",'d %'~.',, CE- 6793 ," ~ ,. ,.".~ CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in lhe professional engineer's work. Page 2 of 2 12-025 (11/84) ~fONICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT 0P HEALTH AND ENVIRON~NTAL PROTECTION APPLICATION F01t I-~ALTH AUTHORITY APPROVAL CERTIFICATE 1. General Infomnation Application Date (a) Legal Description (include lot, block, subdivision, sectioa, township~ range) Loc~:ton (address or di,~ectfons) (b) Applisants Name. [~p~f~\~k~5_-:~'~=Teleph°ne - Home Business Applicants Address__~. ~'b ~ ~_~-~_ (c) Applicant is (check one) Lending Institution Bnyer ~ ;x.~Other :]: (explain); (d) Lending Inst~tuti6n ~ Address ......... .~. (e) Heal Estate Co. & Agent '-.. Address (f) Telephone Maii the IJ~A~6 the foilowing address: -- Te l~eph~e__ 2. T_y_p~e of Residence Single-Family ~__>~ Number of Bedrooms Multi-'Family Other (describe) Water Sq_pply Individual Well l~----~ 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 0nsite ~_~ Public :~ Community ~ Holding Tank l-------[ Note: If community well system, must have written coufirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information Q As certified by my seal affixed hereto and as of the validation date shown below~ I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance ~th all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection° Name of Firm (ENGINEER SEAL) Telephone g ? o DHEP Approval ~7~- Approved for ,__]5 bedrooms Approved __ Disapproved Te~s of Conditional Approval CAUTION THE MLrNICIPALITY OF aNCHORAGE DEPARTMENT OF H~ALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES blEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT~ ATIONS 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 ~ND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL ~ND STATE REQUIRE- [lENTS. ~MPLOYEES 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A® D[t~ £. Oi: Well Classification If A, B, ~ C, D.E.C. ~p~oved(Y~) ~ -~ _ ~tl ~ ~esent (~) '~ Date ~le~d Yield Static Wate~ ~1 ~t. At Casin~ ~ight ~ Ground . . ~ Sanit~y ~a~o~Casing (~__ Elec~ical wi~in~ in ~nduit (Y~) ~ , ~essioQ~ound ~l~ead (~) ~p~ation Distan~s f~ ~11~ ~ To ~ptic~oldin~ Ta~ on ~t /~ ~ ~joining Lots To ~a~est ~ge of ~so~ption Field on ~// .; ~ Adjoining ~ts To Newest Public ~ Line ~-~ . To ~est Public / ~ ~vi~ Li~ on ~t Clean~t~a~ole / ~ ~est Wate~ S~le' Colle~ed By / ; Wate~ S~le Test ~sul~ C~nts / / SE~IC/HOLDING T~ ~TA ~-~ Date Installed ~'w%~,~, %? .~<~.Size . I ,?~.--C) No. of C~nts Standpi~s (Y~) ~ Ail,-tight Caps (Y~)~ Foundation Cleancut ~Y~) ~p~ession o~,r Tank (Y~) ~ ]~te ~st Pied __ P~in~intenan~ ~n~a~ ~ File (Y~)~/~ ; fo~ ~ Holding Tank High-Wate~ A].a~ (Y~) ~/~ q~a~y Holdir~ Tank Pe~t (Y~)~/~ ~p~ation Distan~s f~ ~ptie~olding Tank: To Water-Supply ~11 ~--~.4- To }~ildin~ F~ndatio~ To ~o~ty Li]~ _, ~ / TO Dis~sal Field To ~ter Main/Se~vi~ Li~ ~O.~ To S~e~, Pond, ~e, ~ ~jo~ ~aina~ [Pa~e 1 of 2] 2-15-84 C. ABSORFEION FIELD DATA Soils Rating in Absorption Strata Date Installed '~ ( 7 ~3~- Width of Field -~ l~ Type of System Design Length of Field ~.~, Depth of Field I ~ / Gravel Bed Thickness .~ Standpipes P~esent Date of Last Adequacy Test Square Feet of Absorption A~ea Depression ove~ Field (Y/N) ~4 Results of Last Adequacy Test Separation Distance from Absorption Field: To l~%te~-Supply Well ~_~)--d) To Building Foundation ~ '7 ! To Existing or Abandoned System cn Lot ~-~/~ ; On Adjoining Lots 6[2)~ "~- TO Water Main/Service Line I~.3~-- To Cutbank(if present) ~3/~ To Stream/Pond/Lake/c~ Majo~ Drainage Course ~ /~ To D~iveway, Parking A~ea, cc Vehicle Storage A~ea ~/ Conlwents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Le~l at / Tested fo~ Electrical Code~Y/N) C~nts ** Check Permitted Bed~oc~ Rating Against HAA Request ** I certify t~Tc I ha~-. cl%~ecked, verified, o~ confccra~=d to all MOA HAA Guidelines in effect on the~fof~i~ i~ction. ' ' Company ~[~/z~ ~ c,) MOA No. KB1/d5/s [Page 2 of 2] 2-15-84 Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 · ANCHORAGE, ALASKA 99501 To Whom it Hay Concern: Accordin~ to records on file ~n this office the Water Regulations Hater System is in compliance-with the State Drinking Sincerely,