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HomeMy WebLinkAboutLAKE HILL ACRES #1 LT 14Lake Hill Acres Lot 14 #051-052-14 Municipality of Anchorage Page DEPARTMENT 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 ~'WqS-~0..~ :. PID Number: d~'l ~,.~'2./~ Permit Number:. Name: ~ Z. ~U~ E~ Wastewater System: 0 New ~Upgrade Address: ABSORPTION FIELD ~O~/~,~ ~ ~(7/ Nc. of Bed¢80ms:~ 'x ~Deep Trench O Shallow Trench O Bed O Mound O Other X '-,, Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION ~ ¢,~ GPD/Sq. Ft. Lot~ Block: ~ S~ub¢iv~ion:~/~ ~/~ Depth to.~ipe bottom from original grade:~¢ Ft. Gravel depth beneath pipe ~ I Ft. Township: Range:~ J Section:~ Fill added above original grade:~-~ Fl. Gravel length: ~ I Ft. I WELL: ~ New C Upgrade Gravel width: Number of lines: Distance between lines: ~. ~ Ft. ~ ~ Ft. Classification (Private, A,B,C): Torsi Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Instal[er: Date installed: Yield: Pump Set at: Casing Height Above Ground: C'7 GPM U~ Ft. ~' ~. TANK SEPARATION DISTANCES ~Septic 0 Holding ¢ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~O~ ~ of Compartments: Well- /O ~ t /¢( t ~ ~ ~ ~ Materia~ Number Su,ace '¢ ,+ ~ LIFT STATION Water /OO /~ Lot , ~7.r' Size in ga,,ons: J Manufacturer: Line ~O ~ ~ ~ "Pump on" level ~off" level at: High water alarm at: Foundation I Cu~ainDrain ., ' ~'' ~_ ~del JElectricallnspectionspedormedby: Remarks:~ ~;VE~ C%%~ ~ ~, ~/~ BENCH MARK Location and Description: I Assumed Elevation: E~~EAL S & S ENGINEERING ¢.:, . · 17034 "agle River LOOp Road, NO. 2~ _, . , ~' ~ ;~ Inspections performed by: ~..bm..,_~:,u:~ Dates: Ist~/ze/~¢ ~ ..... : ........................ Department of Health ces approval~_~ ~ _T ~.'.....~._,,~ ~'~-;-~'"";b~ a~Huma , <x, .......... Reviewed and approvedby~ ~~ Date: ,,~,, 72-013 (Rev. 9/91) MOA 25 Permit No.Sw950031 Page 2 of Municipality of Anchorage DEPARTMENT 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 Legal Descriptio~AKE HILL ACRES #1, LOT 14 PIDNo.: 05105214 iP C02 NEW 1000 G.~kL SEPTIC TANK C03 ~F~N~ GR~E--x FCO NEW 1000 SEPTIC , MT2 TANK FLOW DMDER INSTALLED 83.0' 83 &:~7.0' NO WATERiFOUND FCO 5.0 i; 34.0 CO:t 41.3i 70.3 C02 69.8i , 85.9 C03 72.2i 85.7 C04 79.0ii 85.3 C06 93.3i 77.4 CO7 85.4ii 90.5 C08 108.~ 89.6 MT1 82.51i 74.3 MT2 100.B 89.2 X C, £OWAN CE - 8801 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT AK3MBER:SW950031 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:SUMIqER JAMES L & OWNER ADDRESS:P.O.BOX 671923 CHUGIAK, AK 99567 DATE ISSUED: 3/20/95 EXPIRATION DATE: 3/20/96 PARCEL ID:05105214 LEGAL DESCRIPTION: LAKE HILL ACRES #1 LT 14 LOT SIZE: 17035 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15155 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 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THE SEPTIC TANK EFFLUENT MUST BE EQUALLY SPLIT BETWEEN THE TWO TRENCHES USIN/G"] MECHANICAL DEVI ;. :OEIVED BY: ISSUED BY: /~'~ ZABEL Z200 F~qQW DIVIDER OR EQUIVILANT Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 March 20, 1995 Mr. Robert A. Shafer S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, AK 99577 Subject: Waiver Request for: Lot 14,' Lake Hill Acres #1 Waiver Approval: # WR950009 Dear Mr. Shafer: Your request for waiver(s) of the required 10 foot horizontal separation of an absorption field to a tot line has been approved. The approved separation distance(s) are: Absorption Field to Property Line 5 feet This waiver approval issued in conjunction with Permit #SW950031 applies to the existing absorption field to lot line separation only. Any future upgrades to either will require all separation distances be met or another approval be obtained from this department. Sincerely, Civil Engineer On-Site Services kb MUNICIPALITY OF ANCHORAG~ Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR950009 PID# 051-052-14 HA~ HA950095 Permit ~ SW950031 Date Received: Legal Description: Engineer: 3-20-95 Lot 14, Lake Hilll Acres #1 S & S Engineering Applicant: 17034 North Eaqle River Loop, Suite 204 Eaqle River, Alaska 99577 Miriam Scott Waiver Requested: Absorption Field to Property Line - 5 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: ~//~/~ By: Name of Reviewer Rec 9: 00748 (1112) Amount: $ 115.00 Date Paid: 3-20-95 HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER &WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL iNSPECTION & FLOW TEST SITE pLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM OESIGN ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. March 3, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human S~rvic~ P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 14; Lake Hills A~r~s #I Request 9'a- ,/.66em a pee. m,~ ,to ,tep, f. ace ~ ~eptic ~.~,t.~n .~e,,cu, L~ bedroom house on ~he ,'tefe,te.nced p~ope~L~J a~J is6~e a 5' prop~bj An adequacy test performed on the existing sys~m for H~alth Authority Approval purposes found the absorption capacity of the syste~ to be inadequate. A t~st hole was excavated and a percolation t~st performed. The approximate location of the test hole is located on the attached site plan. The monitoring tube within the t~st hole has been checked and found to be dry. The proposed 1000 gallon septic tank is to be placed outside the w~ll protective radius. Attached is a site plan which depict~ the location of the proposed tank. We do not anticipate any adverse effects on n~igh§oring properties. There are no points of contamination within the proposed w~ll radius which can §e seen on the attached site plan. A ConddJtional H~alth Authority Approval is requested until the syste~ can be upgraded by June 15, 1995. If yo~..~..r.g~rz additional info,matron please contact / EN~ LOSURES 17034 NORTH EAGLE RIVER LOOP · SUITE 204 ° EAGLE RIVER, ALASKA 99577 0 O~< om~O oo~ 30¥WOdN I ]1¥08 ~ 91¥130 'S'I'N, . , ' (ENGINEER'S SEAL). .. ~.';:-;~ ;~*.~:,'.!: ~ . ~ Municipality of Anchorage : ~:* r~[~*~ ';~ ::[~;~'; ~;~r, [~)' DEPARTMENT OF HEALTH & HUMAN SERVICES ~ 'r~ "/~ ~,~ /.' % ? ~. 825 Street, Anchorage, Alaska 99502-0650 LEGAL DESCR,PT,ON: ~ t~ ~C ~,v~ ~C~tT°wnship' Range, Section: "" '- :: .... >~*' 1 2 3 4- 5- 6- 7 8 9 10- 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER \~ ENCOUNTERED? s L IF YES, AT WHAT DEPTH? .b~ pO E Depth to Water After Monitoring? SLOPE SITE PLAN OaLe: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE "~'~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' I/~-' FT AND L~'/~.' FT COMMENTS PERFORMED BY: S & S ENGINEERING ~ P--.o~v~.o vo~ CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 204 ,.~ ~ ~5~ ACCORDANCE WITH AL~ST~T~A~D ~I~IDELINES IN EFFECT ON THIS DATE· DATE: 72-008 (Rev. 4/~) ROBERT C. COWAN, P.E. ROBERT A. SHAFER, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN ON-SITE OIASTE(IIATEi~ P:[$POSAL CO~STRUCTZON PRACTICES MATERIA£ SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 14; Lak~ Hills Acres, #I GENERA L: Th~ scope of th~ project includes thc installation of a 1000 gallon septic tank outside th~ 100' prot¢ctiv~ w~ll radi~ and two l~achfi~ld tr~n~h~s to s~rv¢ th~ three b~droom r~sid~nc~ located on the referenced property. Th~ existing 1000 gallon s~ptic tank is to b~ ~xcavat~d, pumpcd~ crushed, and abandoned in place. Th~ existing crib and trench ar~ to b~ abandoned in Co~truct~on shall b~ in accordance with the approved site plan and d~sign drawings, Municipal p~rmit with any special provisions or conditions, and all applicable Stat~ and Muni.cipal Wast~wat~r Disposal R~gulations. 3. Th~ contractor shall §~ r~sponsibl¢ for obtaining any necessary underground utility locates. U~ss specifically agreed otherwise, thc property owner shall b~ r~sponsible for final grading areas subsequently depressed from soil s~ling. Contractors installing watt,water disposal systems must be c~rtifi~d by th~ Municipal H~alth Department for system installations. 0wn~rs installing their own systems must also receive prior approval from th~ Municipal H~alth Department. SEFFIC TANK INSTALLATION: I. A septic tank is to be constructed by a certified s~ptic tank manuf, act~r~r. Construction shall includ~ two 4" c~anouts for pumprng access. 2. The septic tank sha~ be sufficiently bedded to prevent s~ng or shifting of the tank. 3. All standpipes on th~ septic tank shall extend a minimum of 12 inch~s abov~ final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 14; Lake Hills Acres, #I March 3, 1995 Septic tanks installed with l~ss than 4' of cov~r shall §e insulated. A foundation el~anout shall be installed one to four fe~t from the building foundation. In the line b~twecn the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). Th~s¢ ~leanouts shall be located on undisturbed soil not more than 10' from the tank. The first ¢leanout, in line, shall be to clean toward the leachfield. The second el~anout shall be to ~lean toward the septic tank. Final grading over the septic tank shall §e such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/~b~INFIELP INSTALLATION: Excavate the proposed trench~s to the dimensions shown on the d~sign. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (roughed-up) before gravel (s~w~r rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inch~s of cover over the pipe. A silt barrier must be installed b~tween the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before pla~ing backfill. Monitor tubes shall be of four (4) inch diameter and installed approx~nately in the locations shown on the d~sign. The por~on of th~ mo~o~ng ~b~ ~xt~n~ng t~ough th~ grav~ s~ b~ p~rfor~d from th~ bosom of th~ ~n~ to th~ inv~ of th~ ~s~b~on pip~. T~ ~ ~q~v~ to th~ ~ff~v~ d~pth of th~ grav~ ~ noted on th~ Backfill over thc final gravel layer must not be less than twenty-four (24) inch~s. Insulation must be installed when the backfill depth is l~ss than thirty-six (36) inch~s. The finish grade over the trench must be mounded to prevent the formation of a depression after s~t~ng. UINIUUU I~TERIAL SPECIFICATIONS: I. Any septic tank proposed for installation must be constructed by a Muni~pally approved septic tank manufacturer. Page Three Lot 14; Lake H~lls Acres, March 3, 1995 #I 2. The followin~ pipe materials are approved for ase in septic system installations in thc Municipality of Anchorage: Type of Pipe P~rforated Solid Cast Iron Y~s Y~s ASTM D3034 (PVC) Y~s Y~s ASTM F810 (HDPE) Y~s No ASTM D2662 (ABS) Y~ Y~s Use of a type of pipe other than l~ted above m~st be approved by the inspecting engineer. Insulation shall beat least 2" t~ick extruded direct b~rialpolyStyrene (Dow Ch~i~al Company Styrofoam HI or equal). Septic tank inl~t~ and outlets shall be fitted with watertight couplings (Caulder, F~rnco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140/N, or equal) mast be installed between the final leachfi~ld grav~ layer and the native soil backfill. All lcachfi~ld gravel (s~w~r rock) shall be 0.5"-2.5" screened gravel with l~ss than 3% passing the #200 sieve. When sand is §~ing used as a filter material, its gradation specifications mast conform to current M.0.A. or D.E.C. requirements. Typically there will be a minimum of three (3) inspections required during the installation of the wastawat~r disposal system. These inspections wi~ occur a~ follows: The first inspection mast be eondu~ted after the excavation of ditch~s, pits, trench~s, or beds and before the installation of any gravel. A septic tank may be s~t in place, but may not be backfilled before this inspection. The second inspection must be conducted after the placement of the silt barrier, grav~l, distribution lin~s, standpipes, cleanouts, and insulation, but before the placement of any other backfill. Page Four Lot 14; Lake Hills Acres, March 3, 1995 #I 3. Thc final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, espee~y with the installation of multiple trenches, sand filters, pressurized distribution systems, ~tc. Thus, the inspecting engineer i6 to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction me,ting will take place on-site. The inspecting engineer wil~ not coordinate, direct or control in any way the contractor's ae~vi~ies. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.0.A. permit. There will be no contractual arrangement existing b~tween the contractor and S & S Engineering. S ~ S Enginee~in~ shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Fina~ acceptance of the contractor's work rests with the owner and the M.0.A. S g S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons p~rforming work on th~ project or the fail~re of the contractor to carry o~ the work in accordance with these construction documents. S & S En~ineering's inspecting engineer will not be r~sponsible for the construction means, m~thods, techniques, sequence, procedure~ or the safety precautions incident to this project. CONTRACTOR/INSTALLER ·~GREA~:R ANCHORAGE AREA BOR,..uGH ~./(~H~I~) Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION SEPTIC TANK: DISTANCE FROM WELL q7 REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS /¢~/'d ¢I'~'/¢'''/~'''' ~-uc'~d ~ PHONE INSIDE LENGTH MANUFACTURER INSIDE WIDTH ///~'(C N UMBER OF ~/,~ ~./~ MATERIAL~,~C ' '¢ ~""~:' COMPARTMENTS / LIQUID DEPTH LIQUID CAPACITY '~ ¢~--'~--'~ GALLONS. SEEPAGE PiT: & NUMBER OF PITS /' DIAMETER __ LINING MA TERIAL~'~/¢'/~b~'/ CRIB SIZE: OR WIDTH "~, DIAMETER BUILDING FOUNDATION NEAREST LOT LINE__ ADDITIONAL ABSORPTION DEPT, /¢ D,STAN= FROM, WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ' SQ. FT. WELL: TYPE BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: DATE ~''/'~' 77 A,'PROVED i":::':; F:'I:" E?'r'. ....................................................................................................................... E:'l::f['!i!: ............................................................. GreaTer ANCHORAGE AREA Borough DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHO N E .~PiJ~P SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION PERM,T NO.77Zq? INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED SEEPAGE Pit , DRAIN FIELD . OTHER '~ ~/~C' /~ " ,.-/,5 FINANCED THROUGH TO BE INSTALLED BY t C ~ SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY Will BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRA[N FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, SEEPAGE PIT TO RIVer, LAKE. STREAM. ., DRAIN FIELD ., DRAIN FIELD . SEEPAGE PIT ALSO CONSIDER AREA WELLS. SEEPAGE Pit , DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE Pit FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BOROUGH ORDINANCE NO. 28°68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. Russell, Oyster 694-2'/74 Civil Engineering Soils ~ Foundations 0 6' E EIv(YlNEERING 6' DEVELO~-'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 Co94-2774 or 333-5240 SOIL LOG Earl ~lis 333-5240 Surveying Land Development Performed for: Legal Description: Depth (feet) 0 1 2 3 Name: ~-~.~'~ ~'~ ~-?'~-~-~ Tel. No. ~%'~ \q Mailing Address: ~c~. c~ ~._~xG\~z~, ~'~% ~<~C7 Soil Characteristics ll 12 Ground Water Encountered: Yes Proposed InStallation: Seepage Pit__ Comments: ~_,~ ~,~ No Performed by: v'/ If yes, what depth Drain Field '~.~ ~ ~- Date: m ? ~C ~ ANCHORAGE AREA Department ~3E0n~irs~rneme~ntal Quality Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER MATE RIAL ~/]t-~[TLg' NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /I~/O GALLONS. SEEPAGE PIT: NUMBER OF PITS t . DIAMETER 7Z ! OR WIDTH /~t, LENGTH , DEPTH LINING MATERIAL ~'/~'~-/~ CRIB SIZE: DIAMETER~1 DEPTH ~! DISTANCE FROM: WELL . , BUILDING FOUNDATION ~1~ NEAREST LOT LINE ~'''~ ~ TOTAL EFFECTIVE , ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE~f~ ~t) BUILDING FOUNDATION __ CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED ~"~CI~ t-I~A- t~ 0 DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK_ SYSTEM REMARKS DISTANCES: INSTALLED BY: PIPE MATERIAL · REMARKS: DIAGRAM OF SYSTEM GreATer ANCHOrAGe AReA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C"STREET ANCHORAGE~ ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. NAME OF APPLICANT ~ INSTALLATION LOCATION MAILING ADDRESS PHONE INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TESTRESULTS COMPLETION DATE ANTICIPATED SEEPAGE FIT V/ TO BE INSTALLED SY DRAIN FIELD · OTHER NOTE: THIS PERMIT IS NOT VALID WITHOUT BOIL TEST FINAL INSPECTION: 2/~ HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK size TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCEB, REQUIREMENTS FOUNDATION TO SEPTIC TANK -- FOUNDATION tO seePage PIT ~O/ DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit Wall /5! SEPTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPtiC TANK ----- DRAIN FielD WATER MAIN TO SEPTIC TANK DRA~N FIELD /00~ TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSINg gAP OF ., DRAIN FIELD I00' EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4~ INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL BOROUGH GULATIONB REGARDING INSTALLATION.  / LICENSED DESIGNER DIAGRAM OF SYBTEM DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE.I CERTIFY~//{~THAT/?~] AM FAMILIAR WITH THE REQUIREMENTS Of GREATE~NyAGE~/J~/~//~/~ AREA~BOROUGH ORDINANCE~/~NO. 28-68 AND THAT THE ABOVE Municipality of Anchorage 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 www. oLanchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 .~ / - 0~" 2- IR' 1. GENERAL INFORMATION Complete legal description ]_ o'~ Iff' Expiration Date: Z~k~ H¢II ,~cK~:~ 1 Location(siteaddressordirections) 2ZfflS' I~;llef ~ ~,~¢/ ~ Current Properly owner(s) : L~] ¢/J7,(¢~ ,~¢ ~ay phone MailingaddressW/~:¢~ A./.,~/C~ %~f~¢'~L~ ~J~ ~¢[~¢, Lending agency Day phone Mailing address Real Estate Agent ?r'a(tC.h~-ial ~/iF~-,:! _]~.$ t~,~;J~y' Dayphone ¢2¢9~~¢~:~ / Mailing Address E~i~ ~;¢er Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tahk [] 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 Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-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 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 IRev 01,00)' 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 based on procedures outlined in the Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm i¢ eex tg Setfile. Phone Address Engineer's Printed Name ./~4',., ,-~ ..~ -~, ~ ~-~'._ Date DHHS SIGNATURE / Approved for -~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: //- / (b -'0 o Original Certificate Date: Reissue Date: 72 025 ,Rev 01 001' RECEIVED Municipality of Anchorage ,AU(~ 08 DEPARTMENT OF HEALTH & HUMAN SERVICES/vtUNiClPAui¥ O/'/~,NCHOD~ Environmental Services Division ~NVIRONMENTALSE~¥1CES 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type Pr; va Log present (Y/N) Total depth ._j, Sanitary seal (Y/N) Date of test Static water level Well production / Health Authority Approval Checklist .L,ke ~/;IJ J~cve5'w- J ParcelI.D.: If A, B, or C, attach ADEC letter. ADEC water system number '/'///~;~ Date completed Cased to -~z,,o / Casing height (above ground) FROM WELL LOG ,/ ~-~00 WATER SAMPLE RESULTS: Coliform Date of sample: ~'- ~ - 0 0 B. SEPTIC/HOLDING TANK DATA Date installed ~ - Foundation cleanout (y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed # - Length I00 / Width Effective absorption area ~00 0 · Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth ,2. 3/~, Peroxide treatment (past 12 months) (y/N) ~/0 72-026 (Rev. 3/96)* Wires properly protected (y/N) AT INSPECTION .y~o .5 g.p.m. '-~', ~' g.p.m. Nitrate ~, ,~-,~-,' ~'~,?//~- Other bacteria Collected by: ~-n~iheer Number of Compartments ~ Cleanouts (y/N)/V(.o.5 Depression (Y/N) /[/0 High water alarm (Y/N) /VO Pumper -7',/~ -~' SOil rating (g.p.d./ft 2. ~' / Gravel thickness below pipe System type 'J're n 5 / Total depth Monitoring Tube present (Y/N)?¢ $ Depression over field (y/N) NO Results (Pass/Fail) P~I,~$ For ..~ bedrooms Immediately afterlTO0 gal. water added (in.): Absorption rate = + 77,~ g.p.d. If yes, give date - '- · LIFT STATION Date installed J Manhole/AcceSS~~ High ~arm level at* C~s tested Size in gallons "Pump on" level at* *Datum E. SEPARATION DISTANCES "Pump off" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1 I ~' Absorption field on lot t 0 ~ / On adjacent lots On adjacent lots ~.tO0t Public sewer main ~o,~ Sewer/septic service line Public sewer manhole/cleanout Lift station ~'0 ~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ 7 / Property line. 3 $ / Absorption field Water main/service line /r~a~ ~/°.Surfacewater/drainage +10°r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Surface water Curtain drain Building foundation 7ff. 5'/' Water main/service line ~r-~'~ Driveway, parking/vehicle storage area / 5 ¢ Wells on adjacent lots ~' l0 0 / F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections ~ in conformance with MOA HAA guidelines in effect on this date. Signature ~ Engineer's Name ~Ou;~ ~. ~cl Date HAA Fee $ Date of Payment (~'~ © ~ Receipt Number (~ ~'~ ~.~ 72-026 (Rev. 3/96)* Waiver Fee $. Date of Payment Receipt Number 2 NUMBER O BE[ . ~'. ,, 3.'.. TYPE.OFWATER 72-025 (Rw, 1/91) F~Onl ~i MOA #2i! i the MunlC shown be ow, verify that my cat on shows that the on-site water supply oat{/for the number of bedrooms ~e information obtained from inspection the On2site water Municipal and State codes, r"c, COWAN the followihg ~stipulations: .... .,.~ i,' ,1',' ?r,:"~'~' =~ '~ ~ "' ~.~ . ~'.. ~ ,.~ j~,~l~, ,H~ '~ ~. ! ~,, ' ,~ .:. i:: i Appi;°val Ce'ri ar ~e~iste~ tibns in ~'~d~ g'iveni ir ~Hs') issues Health Authority above by an ndeoendent ~y to purchasers of homes ployees of DHHS do not ~,ofAnchorage is not Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Parcel I.D. A. Well Data Well type '~'~,~ ~ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y~ ~ Date completed '~' I ~ ? '-/ Driller Total depth /5-u t + Cased to ~o' ~' "' Casing height Sanitary seal ~'N) f Wires properly protected (~N) FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/hel~iL,~ tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION ~_~ g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank 7..5- WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: O. / ~ Other bacteria o Collected by: ~,~' B. SEPTIC/HQL-BING TANK DATA Date installed Cleanouts (~) High water alarm (Y(~ Date of pumping Tank size /~ o o Compartments Foundation cleanout ~_~N) Vr Depression (Y~) / A[ Alarm tested (Y/N) ~///~ SEPARATION DISTANCES FROM SEPTIC/I IO;DiNG TANK TO: Well(s) on lot /o'] To property line 2,~ Sudace water/drainage On adjacent lots Absorption field ./~ / ~- Foundation Water main/service line 72-026 (3,~3)* 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 "_Eump'~ Level at High water alarm level ~ed Meets MOA electrical codes (Y/N) ~ SEPARATION DI~ROM LIFT STATION TO: ~n lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~-3 - ~,~- Soil rating (GPD/FF) O, ~/--~'- System type Length /OD' _Width 2-.¢' ' Gravel thickness &' Total depth Total absorption area _ / b o o / Cleanout present (..~N) y' Depression over field (YL~O Date of adequacy test ,J/A- - //~- ~,-/ Results (pass/fail) ,d~ for ,,.r/~ Bedrooms Water level in absorption field before test "-//./4 After test 'J'~/ Peroxide treatment (past 12 months) (Y(~]~i~ /,/ If yes, give date "/~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /0/ ' To building foundation 7 '-] / On adjacent lots .-% / + /~. Sur/ace water / o o Curtain drain On adjacent lots /po / h Property line To existing or abandoned system on lot /:z Cutbank ""~ Water main/service line /,~ '''~ Driveway, parking/vehicle storage area ._4-~ / ''~ E. ENGINEER'S CERTIFICATION I ce~'fy that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number t~ ROBERT C COWAN P% (~ Waiver Fee $ Date of Payment Receipt Numar ~: .:';. ._.:;.c L~;-~:-~ . ; I,~,1 ~' DEPARTMENT OFHEALTH & HUMAN SERVICES ' ~.'!.~;.;i.-_';... ,L:.!://.:~'. ' ' '}--:. - -.~ ? .... -~- _ . ~ .. _ D~wsmn of Enwronmental Se~ces.~:: ~. ~=-~ ~-~...-.-_ ~,.: .... . . . -. · · -,- -:. , - - On-S te Se c~ Section .-.~::s ,-?:.-?.: *.-.-:.-, ..... .*.:,?..~.-,-, .,:,~ ;~: . ,._ -.. ;' .' ...-...,;-, ..;, ..; .... ** ./::;:., :,.,. CERTIFICATE OF.H~LTH AUTHORI~ -: .... -? . . ..?. ?..- ' , ?., ._. ' c-..~ ......T"' '- .............. .... ~*'~ '. ~"APPROVAL FOR'X SINGLE FAMILY:DwE~LI~':?~;:? ::":??:'~? .-~'c :,~,,..- - .......... ; --~-.-~;::~-%;~'_ ;_~;~'.,.[> f>{~:;~?;-***r~*';~%;'.~?-*~;* .'d'.~F,~;~'q~$:-,:; ;:'~-..'~<"5',~,;.. ', ;.;.. " · - ..c . ;?c; ;-~' ' - '- '; .... "' "' v~-'-%;' /, - - ' - O~d *~; · -/";-~ .. ;X: .: -} ~:;Y.X Location (site address or directions)~:~: ' ~415 ~ ~ --" '.'~..'.-::. .... ....... · ~:.- .......... Prone~ owner~ - ~ S~o~ ............... - ..... -- ...............~ nhnn~, ' -w;*;;;* -'-,-.:*.-: Lending agency ;~ay-phone ~_.?~ -.*>s~;,~e>~,~;[~Ma~llng address: .:'-' ...... ~'- .............. *" ........ , ....... ,,.--.- ..... -.-~ ,..- ........... .., ,:...~.,~.,,.~.~,~.--.,,-:,..~,~;~:, ' 5.': STATEMEN? OF INSPECTION, BY,. ENGINEER ..... -~:..:=-.'.. '., ..-- "'As ce~ified by'my seal'affixed' hereto and as of the validation date shown' below,'l veri~ that my investigation 0~ thais He~.lth ~uthoriW Approval application shows that the on-site water supply and/or wastewater disposal system is ~fe, functional and adequate for the number of bedrooms and ~pe of structure indicated herein. I fu~her veri~ that based on the information obtained from the Municipally, of Anchorage files and from my inves~ation and inspection, the on-site water supply and/or wastewater~'d Spo~ system s in compliance with all Municipal and State codes, ordinances, and regulati~'n~s'~ effe~ 0n t~"date'of this inspection. .. . '. .'-, Name. .°f ..... Firm '~~. , :The MunictPality,"0f Anch0rag~i Departmeri~-of He~ th and Human ser~ ~es"'{DHHSi: ss~$'Hea th:'Afithori~ ~.,: ,"~ ~ ' "":ii i!: :ApprOval' Ce~tifi(~te.~-I~ased on'iy :bp6n the ~iepresentations g ven n paragraph 5 a'~ove ilb~:i~'n ~;'~ondUct in~cti~fi~ ~anai~vda~a before a Ce~ificate is iSSUed; ~ The Mu'niciPaii~'~f Ah~horag~~ is 'hOt?)::':::/ Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~._~-r- ~ ~,~-V..-~ ~,~L.L.- J~..-Z-~I Parcel I.D. A. Well Data Well type '~¢.,,z~,~._ If A, B, or C, attach ADEC letter. ADEC water system number Log present ('(Z~ r-~ Date completed "-' \~1'3~ Driller Total depth ~-L~L ~c Cased to ~[~t ~' Casing height Sanitary seal ~/N) ~' Wires properly protected(~l) ,1/ FROM WELL LOG Date of test Static water level Well flow Pump level1 g.p.m. sEpARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate / Date of sample: ~ - I ~ - ?~-/,~'2-~ B. SEPTIC/HOLDING TANK DATA Date installed I °l"/'~ Cleanouts(~N) ~ High water alarm (Y~) Date of pumping '~- ~ ~-~ ~ cl~' c~, \ ~:> Other bacteria ~ Collected by: ~ ~ ~ ~J~/~J'~ ~,~/.~ Tank size ) oC>o Foundation cleanout ~N) Compartments ~ Depression (Y/~:~ ~ Alarm tested (Y/N) ~]~ Pumper '~-~¢- - ~,-~'~'~ ?'~ ~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot \~ To property line ~ Surface water/drainage 72-026 (3/93)* Front On adjacent lots Absorption field Foundation ~ ~t'~ Water main/service line \-b ~'~ CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at '~_ ~i~eht ~v~t ~rAale~; crnt ii~ lc o d e s (y/N ).~~ 37wcfEs tested SE~TATION TO: We--Il on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA t Date installed \ ~ q ~ Length ,/0 ~ IL ~-// Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/_.~ Width //¢r¢ ¢¢ ~-~F-/~z_ Cleanout present ~N) 2- ~ I / - ') ~ Results (pass~ 4 ,J Soil rating (GPD/Ft2) t.~ / 2' Gravel thickness System type Total depth Depression over field for ~ After test ~¢ ~" If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /oo To building foundation On adjacent lots On adjacent lots /~o ' ¢- Property line To existing or abandoned system on lot / Cutbank /'(~/,~ Water main/service line Surface water ~_¢~ f '~ Curtain drain '¢~4 £. ENGINEt=R'S Ct=~TIFI~ATION Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to ali MOA and-HA~ guidelines in effect on the,date of this inspection. Signature S & 5 ENGINEERING /~ ~''- '~ '. Engineer's Name Eagle Riv,'r, Alaska 995~'? ~ Date ,.'~ '-- ~ -~ ¢S" HAA Fee $ Date of Payment .~ "7/,,~ Receipt Number Waiver Date of Payment Receipt Number ROBERT C. COWAN, RE. ROBERTA. SHAFER, RE. HEALTH AUTHORITY APPROVALS S~NER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPGSAL SYSTEM DESIGN April 4, 1995 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Hea~th and Human Services P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 14; Lake Hill Acre~ #I RECEIVED APR 1995 Municipality of Anchorage Dept. Health & Human Services Please be advised all work required on the Conditional He~th Authority Approval for the referenced property has been adequately completed in accordance with MOA permit #SW950051. Also the w~ll easing has been extended and a pitl~ss adapter has §~en installed. Please issue a H~alth Autho~b~y Approval on th~ referenced property If you requi~e any additional information please contact us. Sincerely, ROBERT C. COWAN, P.E. RCC/gk 17034 NORTH EAGLE RIVER LOOP SUITE 204 · EAGLE RIVER, ALASKA 99577 ~ ~.\ ~MUNICIPALIT'Y OF ANCHORAGF~ ,;,'~,~x-.,~A,,~\,~ DEPARIME. OF HEALIH AND ENVIRONMEN ' PROTECTION ~..~,:~:r~r~, ~/~ , o~ ~ ~ ~ Anchorage~ Alaska 99501 ~,,.~,~.~}~.~,.,i , ~ L~- -",:% ."¢%FZ¢~¢X' '].. '/:{ .~¢~ ~ ~ 279-2511, ext~ 224 or 25 ...... ;:¢?'"'- I ~'' ¢ ~ ' ~~ Date Received: May 5, 1977 / REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska PacifiC Bank Mailing Address: Post Office Box 420 99510 Phone: 276-3110/40 Property Owner: Edna A. Copenhauer Phone: Mailing Address: % Selective Realty, 279-8624/Betty Rogers Lot 14 and 15 Lake Hills Acres Subdivision 3. Legal_ Description: 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: __~D~ Number of Bedrooms: o Well System: Individual well (x) Connmunity/Public System ( ) Sewage Disposal System: On-site System (x~ Public Utility - Permit ,~ J In sea 1, e¢~::¢ Instal le% Absorption Area ~: : X Soils Rate :/~ ¢ / ¢'¢' Dis%ances: Well %o Septic Tank ?_7 %o Absorption Area to Sewer Line 0(~~ Nearest Lot line to Nearest Lot Line ~: ~ Absorption Area MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENV RONMENTAL PROTECTI(~N 825 L Street, Anchorage, Alaska 99'50 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: VA FHA CONV. ~/ Mailing Address: 3. Name of Buyer: ~ a~.s Mailing Address: "7~(O /t./o. ~_ ~ ~- ..~AL.. Day Phone: 4. Name of Lending Institution: //~ [~d/(~ //~c ,~.~(-~'r' -, Mailing Address: /'~,~, [~¢~q c/~ - ~]'~.S-/~) Phone: 5. Name of Realtor or Agent: Mailing Address: /-~ 6. Legal Description: '7- G-J~7 ~7 Phone: 0-7 ~- c~/o~ ~/' 7. Type of Facility to be Inspected: No. Bdrms. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served d~4'~-- If Individual, depth of well <,~-~--~' ~,--'~ -, Sewage Disposal System Type of System: Public Utility If Individual, date of installation cc.¢.~/,.~ ~_~..,.~---' Individual (on-site) 72-003(3/76) "'~ . Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: LOt 14 and' 15 Lake Hills Acres Subdivision Comments: Affadavit Attached: (') Letter Attached: ( ) Approved [ _F /} ~ Date Dlsappro : Date: Department Worksheet N uni ip lity C a ANCHORAGE, ALASKA 99502 Of (907) 279-2511 Aachor e DEPARTMENT OF HEALTH AND ENVIRONMENTAL Pf~OTECTION (825 "L" May 17, 1977 Alaska Pacific Bank Mortgage Loan Section Post Office Box 420 Anchorage, Alaska 99510 Subject: Lot 14 and 15 Lake Hills Acres Subdivision The recent perc test conducted by this department indicates that the existing sewer system serving the subject property is inadequate for a three (3) bedroom residence and must be upgraded before we can grant final approval. Spec if ications fo~t~grade are as follows: Deep'trench fo~t~-six (46) feet in length Total depth of nine (9) feet Gravel depth five (5) feet The top of the trench should be at the same level as the outlet pipe at the top of the crib connection. Temporary approval for this sewer system will be granted if funds are escrowed to cover all installation costs. If there are any further questions, please contact this office at 279-2511, extension 224 or 225. Sincerely, William M. Dixson Principal Code Enforcement Officer WMD/ljh cc: Betty Rogers Selective Realty GREATER ANCHORAGE AREA BOROUGH 'Department of Environmental Quality T.~cx~¢~ 3330 "C" 'Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. approval~requested by: Mailing Address: ~~/~Z& 2. Property Owner: _~?~ Mailing Address: 3. Legal Description:c~~ Phone: Phone: 4. Location: Type of facility to be inspected Well Data: A. Type C. Construction %] ~m~l~ B. Depth D. Bacterial Analysis No. of bedrooms Sewage Disposal S.,y~tem: A. Installed ~/~//'~ B. Installer J;~{~ C. Septic Tank: 1. Size ~0~0~. 2. Manufacturer D. Seepage Pit: I. Absorption Area ~¢~¢.AQ~.~,2. Material E. Disposal Field' Total length of liSs ~0 -~' 8, Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line , Absorption area , Other contamination , Absorption area , Sewer Lines P~ge 2 of two pages - R,~'-~t for Approval of Individual ..... '~r & Water Facilities Legal Description Comments Approved Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) PLA T APPROVAL appr. o~v~ed by the ~¢uniczpal P/att~n~ Authority ACCEPTANCE OF DEDICATION DTI00088! REESE '° GRACE / ROAD S[CTJON LINE ,/ S. 34 S.35 GLO MON, S. 3 S. Z % E ;/~- DTI000889 FIRST ADDITION LAKE HILL ACRES SITUATE IN G.L.O. LOT I AND I/4 NE I/4, SECTION 3 , T 15 N, SUBD. THE SE R I W, S.M. A DEVELOPMENT BY , REESE TATRO RJ~$TRICTED Chuqiak, AlusKo Surveyed and Drown By: David L. Bear Registered Surveyor Date', July 1960 Scale', I in. = lO0 fl. RECEIVED R ECEI VED REC~:I"--~:~i~ij I I 9 8 · / (o.7~ I/4MILE TO MIRROR LAH~-- ~ WILLIAM STEPHEH6 z 5CALE, f',lO0' P-~?4 RFC