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Home My WebLink AboutGRANITE VIEW BLK 11 LT 7Granite View Lot 7 Block 11 #014-302-01 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 Permit Number: '~ i~(//~'~ ~)~ | /'~ PID Number: Name: ~ ~ ~O H~ ~ O E ~1 Wastewater System: ~ New ~ Upgrade Address: ~l~i ~[D~ P~ ABSORPTION FIELD Phone: ~No. of B~ooms: ~eepTrench D Shallow Trench DBed DMound DOther Total Depth from original grade: LEGAL DESCRIPTION S°ilRating: ~ GPD/Sq. Ft. Lot: ~ Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: I Range: Section: Fill added above original grade: Gravel ~ength: Number of lines: Dislance between lines: WELL: D New Q Upgrade Sravel~ ~'~ ~ Ft. ~ '~ Ft. Classification (Private. A.B.C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. 1~ SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: ~~ Date ins~: Yield: Pump Set at: ] Casing Height Above Ground: GPM Ft.I .,. TANK SEPARATION DISTANCES ~ Septic ~ Holding ~T.E.P. To Septic Absorption Lift Holding Public/Prival~ Manufacturer: Capacity in gallons: From Tank Field Station Tank S .... Lines ~/~ ~ Well , /~ /J ~ /~ ~ ~ ~ Material: ~ ~ Number of C~adments: Surface Water ~ ' -- - ~ LIFT STATION Lot Size in gallons: Manufacturer: Line ~ 0 ~ 0 ~ 0 ~ Foundation 2 ~ ~ V~ ~ * "Pump o.~at: "Pump o;,e~, at: I H,gh water~alarm at: Cu~ain ~ ~ Pump Make & Model Electrical Inspections pedormed by: Drain ~ ~O ~ ~, Remarks: Ol~ ~~ ~~/ BENCH MARK ~//~. Location and Description: B ENGINEER'SSEAL Inspections performed by: ~ DateS:2nolSt. ~/,o/,~ '//~~,~~~'~:~ :, ~~ ~ ~;., : ' ;~ ' Department of Heal~ and Human Services approval ~oviewed and approved by: ~ Date: d-~-f~ 72-013 (1/91) MOA 25 I Well -'o- .......o~i"' we// 0 I ,] N SCALE; 1' = 5o FT, TDBBEN SPURKLANB P,E, ~03 ~ 15TH, AVENUE ANCH, AK. 99501 LOT 7 ~OEl( Il F.~AN[T VIEV ,SEC. ~ IZ~I ~3V Jo S tondord Trenche; 4-~ch per£ 3' Wide 50' Long ]3' Deep ]0' Sewer rock 3' Cover 1£50 STEP TANK /. 4' Topsoil 3' Cover MiroFi I40 ~ 10 £t o£ Septic Rock / NB SCALE Monitor ELEV. llO ~OTTDM TEST HOLE ,95 TOBBEN SPURKLAND P,E. 203 ~15~h Ave Anchorage Ak 99501 LDT 7 ~LDCK 11 GRANIT VIEW SEC, 26 TI2N R3W JOHN 2UHON SEPTIC SYSTEM AS~T 9ATE, JUNE l~ 199~ SHEET, 3/3 GR)~,£334 RECEIVED JUN ~ 9 ~99~ lVluni¢ipali~y o~ An¢ Dept. Health & Hum~?o°_raqe MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 2 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930010 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:DUHON JOHN AND JOAN Y OWNER ADDRESS:9161 CLARIDGE PLACE ANCHORAGE, AK. 99516 DATE ISSUED: 2/04/93 EXPIRATION DATE: 2/04/94 PARCEL ID:01430201 LEGAL DESCRIPTION: GRANITE VIEW BLK 11 LT 7 LOT SIZE: 10015 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 343-4329 OR 343-4681 AFTER BUSINESS HOURS 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: IF THE EXISTING LEACHFIELD IS A LOG CRIB, THE LOGS MUST BE REMOVED AND THE EXCAVATION FILLED WITH INSITU MATERIAL OR SAND. IF THE SYSTEM IS A CONCRETE RING PIT AND THE SURROUND- ING GRAVELIS LESS THAN TEN FEET FROM THE NEW TRENCH, THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 2 OF GRAVEL MUST BE REMOVED AND REPLACED WITH INSITU MATERIAL OR SAND. IF ANY PART OF THE EXISTING TRENCH OVERLIES THE CRIB OR PIT, THE GRAVEL AND PERFORATED PIPE MUST BE REMOVED AND REPLACED WITH INSITU MATERIAL OR SAND. THE EXISTING 1000 GALLON SEPTIC TANK MUST BE CHECKED FOR INTEGRITY BEFORE IT IS CONSIDERED FOR USE IN THE UPGI~DE SYSTEM. ISSUED BY~,/~u4-'~'T,///-"~/''-~''~- ~ L£T LINE PERC LOC. ~ ~ ~ ~ EXIY~ CRI~ ~ EXIST TRENCH G~M PDSSIDLE TRENCH EFFLUENT TOBBEN SPURKLAND P,E. 203 ~ 15TH, AVENUE ANCH, AK, 99501 LOT 7 £LiT£K 1I GI~ANITE VIEW SEC, 9, flBl~ R3~ S.N. 916I CLARIBGE PLACE SEPTIC SYSTEM DESIGN DATE, JAN. £8, 1993 SHEET, 1./4 GRID, 8334 LOT 205 ~ ]5th. Avenue, Suite 206 A~CHORAGE~ ALASKA 9950! (907) 279-~916 SEPTIC SYSTEM DESIGN JOHN DUH~N Impervious Layer at ]..5 - 4.5 Use Standard Trench Soil Ratings. From test Jan. 8~ ],993 33 rain/in = ,,45 gal/scI.~t. red Area per Bedroom: 150/.45 = 333 sq.~::t.. F:'oundatic, n Clean Ou'k E].~:vation 96. Percc:)lati(:~r') test (~ ~.>,:~.: . Bc)ttom Ground Water Mon:[tc;r ~J 85 Top <~ Gravel (~2 Exist T'rencl'3 95 N~:.:.)ed 11. C> -[ E,e'{:: (::)+ r oc: k - Number o-F Bedr'ooms 3 L.ength o.F Trench: As long as possible within the i'"~)~)st r i (: t i or) s o~: the ~ rom ex i st ing absor pi: J. (:ir] ~yS'I:.EHnE~. Mi ni mum 50 .Feet. SYSTEI't CDNF T GI_iRGT 'l STANDARD TRENCH TOTAL LENGTH TOTAL WIDTH TOTAL DEPTH ROCK DEPTH COVER 70 FT. 3 FT. 13.5 FT. 10 FT. 5 FT. SEPTIC TANK 1000 GAL. EXISTING STEP TANK 500 GAL. ABANDON EXISTING SYSTEM EXISTING PIT Check integrity of existin~ tank. Replace baffles if necessary. Check existing crib. I~ log crib, Septic System Desi Lot 7 Block :[1 Granite View pump and fill with soil. If con- crete rings, leave in place. The :i.n~t.~llatior~ of this s~pti(~ syst. en'~ will not i:)r'~vent we~ll~s -I"t'le I~r'c]Do~ed ~.~et::~tic:: sy~:-~tem ~i 1 t not ¢:::h~ng~! the gener-~:.~l slop~.-~ o~,: TI"ii ~.~. D r' o1:~ o.~ecl ~"idg[.~ with ~ ~].op¢~ c:,~ 25-.-~:0% bo{:h to lo'~: 7 ~at~d L.ot: 8, 'Tl'~e ridge of ~"o(::k. That ~i:L:L plac:e t.h~:~ t:)o'[:to[n of tf'i~, tr-~nct'~ at (.~lm, vation 97 (top c:,f K-:i. cJ(j:je? [:)(~J. ri~] 1:1.0) The:, top c)f 'hh[~ r'c)~::k o-F t.h(a ~)xist. il'lg ~:: ~"en(: h and used ~,,~h~n '(:h :[ ~s t:,' '"opos(.~,d .~sye;'hem f a:[ 1 s. PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L/)% "--/,~ / vOt,' 10' 11 12 13 14 15 16 17 18 19 20 COMMENTS Township, Range, Section: T'I~N,~,$~, .~ ~-.~/ SLOPE SIT~ PLAN ' I N WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Deplh to Water Alter CZ- Monitoring? I~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN/ ~/i FT AND PERFORMED BY: I CERTIFY ~HCCT~ THtS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES iN EFFECT ON THIS DATE-DATE: LD? 5 LOT LDT ?1 LT 4 ,,,,iq' ?.~ We~ I I I I II ---- II I Lilt ]] IO ~ L~T 9 LDTO( o WATEr,o MDNIi TBBBEN SPURKLAND P.E, 803 ~ ;STH, AVENUE ANCH, AK, 99501 50 180 150 280 SCALE: ]' -- ]OO FT, LDT 7 :SLD£K 11 GR~INIT VIEl~ SEC. 9 TI2N 9161 CLARIDOE PLACE 250 308 SEPTIC SYSTEM DESIGN DATE, JAN, 15, 1993 SHEET, 1/3 GRID, 2334 Wel! 1000 GAL Well I I I I I I I I I I ! SO0 GAL STEP TDP Z]F HILL 110' o WATER MDNIF£R GR. SURF AT JO0' 25 0 TOE DF HILL 25 SCALE; ?$ lDO =SOFT, TQBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH, AK, 99501 LOT 7 BLOCK 11 GRANIT VIEW SEC, 9 rldN '~16 CL,4£1~GE PUICE SEPTIC SYSTEM DESIGN DATE, JAN, 15,, 1995 SHEET, ~(3 GRID, 2334 £tondard Trenche~ 0 Monitor 4-1nth per£ 0 3' ~/ide 50+' Long 13' fleep 10' Se~er rock 3' Cover lO00 ga! Concrete Tank EXIS TING EXIS TING CRI£ EXISTING TRENCH B~Tr£M ELEV ~0~- / 4' Topsoil 3' Cover Pliro£1 140 --~ 10 £t o£ Septic t~ock / ND SCALE Plonltor BOTTOM TEST HOLE 85 TD~BEN SPURKLAND P.E, 203 ~15~h Ave Anchor~Qe Ak 99501 LOT 7 J?L[TCK ]1 GRANIT VIEV SEC. 26 T]2N R3~/ JOHN 9UHON SEPTIC SYSTEM ASBUILT ])ATE, JAIV, 19, 1993 SHEET, 3/3 GR~]), 2334 MA L I~IG ADDRESS / '- f A ,,o_. · LOCATION O// / ~/ ,/ ~ I DISTANCE TO: I Absorption area ~ Z I Manufacturer Liq. capacity in gallons ~ N IF HOME.DE: Inside length ~ -- ¢ Manufacturer ~ I l Well ~ / Foundation ~ aZ I DISTANCE TO' I [flO m0 I ' ] Iv ~ ~ ~ I No. of lines ~ I Length of ~ch I)ne Total length of lines t,le~ln,*h Or Material bonea~ Depth ~ ~ I Type of crib Crib dia eter Crib depth ~ Well Building foundation DISTANCE TO: ICiass Depth Driller ~ Building foundation Sewer line DISTANCE TO 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 Dwelling Material W dth Material Nearest lot line Trench.~d~ NO. OF BEDROOMS PERMIT NO, No. pi compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance b e t~ei~.~ e s Total effec~¢ ~n area PERMIT NO. inches inches Total effective absorption area Nearest lot line ' Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER INSTALLET/~ ~ /~k.~..~ REMARKS _~. [:,EPFIRTHEI'.~T OF' HEPILTH FIF,I[:,' EN',/~F.':ONMENTFIL PROTEC'T~ON EJ:~:5 '"L"' 5;]"REET., I:INCF'IOF.:FIGE., FIN. ~ 2 ~"-:; 4- 4 ? 2:: O ' C~ !'-.1 ...... 2-7..5 :E 'l-' IFE :E; IEC t-.JJ ES: F;: F' E F: lb,1% '"'Il" F'ERMIT NO. ,' 79(14;E;:~.: ::, I:qF'F'L. I CRNT LOCFIT 1 ON LEGRI_ MCOLI~IR~ ENTERF'R I SES 9 :L r_:;:.!. CL.RR I [:,GE LT' B'.'LJ. GRRNITE 43i2 ZODIRC LOT SIZE }4.4 2 J.. ? S..': :~:40~36J S(;!t..IRF.:E FEET ]"'¢PE OF SOIL. FtBSORBTION S'¢STEM IS: TRENC:H MFIXIMUM I'.,tUMBER OF bEDROOMS = Z.': ':5OIL RRI" I NG THE REQUIRED SIZE OF T'HE SOIL FIBSORPTION SYSTEM IS: THE LENGTH DIMENSION I~':; TFIE LENGTH (IN FEET.'." OF THE TRENCH OR DRR~NFtEL.[.". THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETI.4EEN T'HE SURFFICE OF' THE GROUNP RND THE BOTTOM OF' THE EXCW',"RTION (I'N FEET). THERE IS NO SET 1.4!DTH FOR TRENCFIES. THE GRR"/EL [."EPTI'] IS THE MINIMUM DEPTH OF GRFIVEL BETI.,.IEEN THE OUTFFILL. PIPE FINE:' THE BOTTOM OF THE EXE:FI","RTION '.'.'IN FEET). F:'ERHIT RF:'PLICRNT HFIS THE RESPONSIBILIT'¢ TO INFORM THIS DEF'RRTMENT DLIRINCii THE IHSTFtLLRTION INSPECTIONS OF FtNb' 14ELLS FI[:,JRCENT TO THIS PROF'ERT"r' RND THE NUMBER OF RESI[:'ENC:E'.S THRT THE WELL P~ILL. SER'v'E. BFICKFILLING OF FIN"r' S"r'STEM WITHOUT FINRL INSPECTION FIND RPPRO',/RL. E,".? THIS [)EPRRTMENT WILL RE SUBJECT TO PROSECUTION. HINIMUM [.',ISTF]NCE BETNEEN FI I.,.IELL_ RN[:, RN"r' ON-SITE SEHRGE [:'ISF'O::'];FII.. S"r'STEM ILS ±C~O FEET FOR FI PRIVRTE I,.IEL. L.~ OR ±50 TO 200 FEET FF::OM R F'LIBI...IC FIELL DEPENDING UPON 'THE T"r'F'E OF PLIBL. IC: t.,.IELL. OTHER RE(;:!UtREMENTS I"lR"r' RPPL."r'. ::.;PECIFIC:FII'IONS FIND C:Cfl"~STRLIC'f'IOI"4 [:'IRGRFIMS RRE F~",,'RILFIE:LE TO INSLIRE PROPER INSTFILLRTION. I CERTIF"r' THRT :'i.: I FIM FFIMIL. IFIR 1.4ITH THE REQLIIREMENTS FOR ON-SITE SEI.,.IERS FIN[:' NEL..LS IzlS SET FORTH B'¢ 'rile MLINtE:IPRL I T'¢ OF' FINCHORRGE. 2: I 14ILL INSTFILL. THE S'.tSTEM IN RCCOR[:,RNCE 14ITH THE CODES. S:: I UN[:,ERSTFIND THRT THE ON-...SITE SEI.,.IER SY'STEM MR'¢ REQUIRE EIqLRRGEMEHT IF' THE RES:;I[:,ENCE IS; REMODEL. ED TO INC'L.U[:,E MORE THRN ]J: BE[:,ROOMS. .... .................... FIF F'L I CRNT f'ICCLJJ.~L.-T, ENTERPR I :C, ES I E'SUE[' BY'.~ _, TE ........ "]!'. ;:_' GRE/ ' R ANCHORAGE AREA BOF'"'qGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEN~ LOCATION MAILING ADDRESS ~P~,/~, '~C')ZI/'~ ] PHONE SEPTIC TANK: DISTANCE FROM WELL /O(~) INSIDE LENGTH NUMBER OF MANUFACTURER ~:~-~,~z./~_ MATERIAL ~//~'~"~':~'~' ' COMPARTMENTS / / INSIDE WIDTH ~ LIQUID DEPTH -- .LIQUID CAPACITY/[~/~:' GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER ~)R WIDTH //~ ' , , LENGTH / ~, DEPTH LINING MATERIAL ~'~,~,(~ CRIB SIZE: DIAMETER__DEPTH ~ / DISTANCE FROM: BUILDING FOUNDATION ~-~ NEAREST LOT LINE /~2 / TOTAL EFFECTIVE , ABSORPTION AREA (WALL AREA} WELL // 17(') / sQ. FT. ADDITIONAL ABSORPTION WELL: TYPE BUILDING NEAREST NEAREST FOUNDATION __ LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DEPTH ( DISTANCE FROM: SEPTIC SEEPAGE TAN K __ SYSTEM DISTANCES: INSTALLED BY: ~ LOT SLOPE: DIAGRAM OF SYSTEM NAME OF APPLICANT , GREATER ANchorage ARea Bor0ugi~t DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456! PERMIT NO. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION LOCATION SEEPAGE PIT ~ DRAIN FIELD TO BE ,NSTAiLED :C INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE seRVED FINANCed THROUGH SOiL TEST BEBULTS , OTHER NOTE: THIS PERMIT iS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHOI~ITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK / FOUNDATION TO SEEPAGE Pit ~ ~) . DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL. SEPTIC TANK ~ . SEEPAGE PIT~ O TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD SEEPAGE AREA SIZE ~r~ ~ ' DIAGRAM O~ S¥S?E~ , DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD ~ ..... SEPTIC TANK, SEEPAGE PIT TO RIVEB, LAKE, STREAM. _, DRAIN CAST IRON iNTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP EXCAVATION E FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. :-_::::_:::::-__: __J__ ........... :::::::::::::::::::::::::::: :--::--::-.-: ............................... :-:-~ ~ I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA J~OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORQANCE WITH SAID CODE GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # ~ ~ ~---~-~'~ Dated Performed Performed For ~)~ ~o .. Legal Description: Lot '~ Block' ~ Subdivision ~ This Form Reports Soils Log ~ __Percolation Test__ - Soil Test Must Be Logged To 4' Below Proposed Seepage System - Depth Feet 3-- 4~ 5~ 6~ 7~ 8~ 9~ ll~ Soil Characteristics Was Ground Water Encountered? If Yes, At What Depth? Reading Date Gross Time Net Time Depth to H20 Net Drop Percolation Rate Minute Proposed Installation: Seepage Pit Drain Field Depth of Inlet Depth to Bottom of Pit or Trench ' COMMENTS: Test Performed BY I~~- ~}~.~/' Date Certified BY: Date: 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.ci.ancho rage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. GENERAL INFORMATION Complete legal description Loi' Location (site address or directions) Current Property owner(s) Mailing address Lending agency HAA# .. - ,- ,., .. ~ Expiration Date: Day phone Day phone Mailing address Real Estate Agent ~-~','~, ~ '~./,',r~-~ ~A.,(~ ,~'-~4 ~i~};:~(Oay phone Mailing Address 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 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 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 proper{les 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 (Rev 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. Address Engineer's Printed Name Phone DHHS SIGNATURE V 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: Original Certificate Date: Reissue Date: 75.025 fRev O1 GO)' Municipality of Anchorage Department of Health and Human Services Division of Environmental Services OmSite Services Sectioh 625 "L" Street Room 502 P.O. Box 196650 ^nchorage, AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type __ if A, B, or C provide PWSID # / Well Log Date completed Sanitary seal / Wires properly protected Total depth __ ft Cased to _ ft ~Casing height (above ground) _ FROM WELL LOG ~ AT INSPECTION Date of test __ ~ __ Static water level ft ~ ft Well production __.~,,¢n g.p.m WATER SAMPLE RESULTS:~ Coliform__ colonies/,~,e'ml Nitrate__ mg/I Other bacteria colonies/100 mi Date of sample: ,~ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed Tank size 42-'~ gal Number of Compartments Cleanouts '"/ Foundation cleanout Date of pumping ~.¢.~. C, ABSORPTION FIELD DATA Date installed b/lO {~t~ Soil rating (g.p.d./ft2 or~t-~bdri-,~) Length ~c) ft Width .7:, ft Gravel below pipe ~O ft Total depth /~5, ft Effective absorption area/,¢d¢ ft2 Monitoring tube "./ Date of adequacy test ,~/~¢//~ ¢_.) Results (Pass/Fail) Fluid depth in absorption field before test 0¢--~ in Elapsed Time: ~¢¢" min Final fluid depth Depression over tank I'-( High water alarm System type ! ~'-~ _ Any rejuvenation treatment (past 12 mo.) (Y/N & type) in, · Depression over field For .~ bedrooms Water added ~#~ gal. New depth_/-/'~ in. ~,/~ in Absorption rate >= ~5~ g.p.d. ~"( If yes, give date ~ 72-026 (Rev. 01/00)* D. LIFT STATION Date installed ~/~/"/'ff..~ Size in gallons "Pump on" level at L~ [ in "Pump off" level at Datum '~o~tl',' ~,1 Cycles tested IQ in Manhole/Access '~/ High water alarm level at "~ -~ in Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WEL/L-~N LOT TO: Septic tank/lift station on lot J On adjacent lots Absorption field on lot J Public sewer ma~~ Sewer/se, p~b service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots Public sewer manhole/cleanout Holding tank Building foundation ~ ~ [ Property line Water main ~ ./~q.-O Water service line Drainage ~ I r_P Wells on adjacent lots Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~, 0 ~ Building foundation Water Service line 7'2 Surface water ~'~ 1 Curtain drain Bf/~ Wells on adjacent lots Water main Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date, Printed Name T, Engineer's Date ~/~-~/~0 HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number' 72-026 (Rev. 01/00)* T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Department of Health and Social Services 825 L Street Anchorage, Alaska 99501 Subject: Conditional HAA Lot 7, Block 11 Granite View S/D June 28, 2000 Gentlemen; This propex~y is at this time cormected to public water. The well was abandoned by Aarow Pump and Well Service, LLC per attached documentation. Please issue an un-conditional HAA. Yours AA~ow Pu~p & WEll SEa, vicE, LLC P,O. Box 1104-96 Anchorage, AK 99~11 OffiC6: (907) ~6-9355 · ~ice (907) Cellular; 24&3541 · Fa~ ~33-~976 5309 JOB SITE , L _i PRICE AMOUNT LABOR HOURS RATE AMOUNT TOTAL MATE RIAL TOTAL LABOR WORK ORDERED DATE COMP, TOTAL LASOF~ PAY THIS AMOUNT SIGHKFURE- (I Hereby AcknOwled§e [he S~'[Isfac[ocY Complo~lon of the A~ve Oescrib~ Work,) TERMS: ACCOUNTS PAYABLE AT lOTH OF MO~ ¢OLLOWING PURCHASE, 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) ~l~ I ~____L~[::~. ~)~ J~ Property owner Mailing address Lending agency Day phone Mailin. g address Agent (~'-';'~ ~'~-~'~'-~-~. Add ress = Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written lng to the legality and status of system. confirmation from State ADEC attest- TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~25 (Rev, 1/91) Front MOA fl21 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. NameofFirm '~%~b~-~d ~pu,,-V'~L~.~ '~.~. Phone Address ~ :~ I~ / 'c~,/-'¢7 Engineer's signature ~ ._~~z~. Date ~1"/ DHHS SIGNATURE Approved for Disapproved. ×× Conditional approval for bedrooms. bedrooms, with th~ following stipulations: This residence shall be connected to public water by 6-15-00. Money shall be plac~a ~ ~o~m,~ for !.5 times the high bid from a minimum cf 3 bid2 from certified contractors. The balance of the escrow funds shall be released ~fter,an approved Ceztifi~at= of li=~Ith A~tl~o~it~ A~6v=l h~ b==~ Issued by this department. Additional Comments The Municipality of Anchorage Department of Health and Human Sen/ices (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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ~ .I~..~TMENT OF HEALTH & HUMAN SERVICE~' ., _,^~ (~) 4~4~ ,~..~ Environmental Se~lces D~v~slon ~ o ~ ~ ~' · ~0~ 825 L ~t, Room 502 · Anchorage, Alaska 99501 (907) 343-4~4o~ ~ ~,,~, · ~ Health Authority A~roval Checklis~ ~,~'~ Legal Description: A. WELL DATA we, type Log present (Y/N) Total dePth Sanitary seal (Y/N) Date completed Cased to '~ l ~ Date of test Static water level Well production FROM WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above gmunfl) Wires properly protected (Y/N) AT INSPECTION g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed ~'~e/~.~ Tank size Foundation cleanout (Y/N) ~-/ Date of Pumping Collected by: Other bacteria Number of Compartments ~-- Cleanouts (Y/N) . Depression (Y/N) I"'.1 High water alarm (Y/N) ~// Pumper ~)~/~ ~/~ ~,w ~//~ Y C. ABSORPTION FIELD DATA Date installed ~;////~/~3 Soil rating (g.p.d./ft~'- ......... ~'~--~ .m3. ) ~ ~ -'~ System type Length .~'~::~ ' Width __ Gravel thickness below pipe ~ 4;) i' Total depth ,/~ ! Effective absorption area ,~ ~ Monitoring Tube present (Y/N),.._.~/__ Depression over field (y/N) . Date of adequacy test '~/7.-~/,~.~ Results (Pass/Fail) ~ For Fluid depth in absorption field before test (in.); Fluid depth ~/,~ (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) Immediately after;~°~ gal water added (in.): Absorption rate = ~ ~'-~) g.p.d, If yes, give date u bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed ~3/¢/~ /~_ ~ Manhole/Access (Y/N) V High water alarm level at* ¢~-- Cycles tested J~ 7/- Size in gallons "Pump on" level at* *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 On adjacent lots ~'"~ IE;~.P On adjacent lots ~ ~ ~ P. ublic-sewe,~ma~ o I e/cie a n o u t Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ¢¢---~ ~ Property line [O I Absorption field Water main/service fine ~O Sudace water/drainage ~'~' I o Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ~ (-.) Building foundation ,~ ~-~ Surface water ~ [ O Curtain drain F. ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots '"'~,.x..~ [ ~' 6. I certify that I have determined thru field inspections and review of Municipal rec~ls.fhat the.above sys!~}~t~are in conformance with M~A HAA guidelines in ~ffect on this date. ::: :' '('i , :! :'l:,~' '"' 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Department of Health and Social Services 825 L Street Anchorage, Alaska 99501 Febmary22,2000,2000 Subject: HAA Lot 7, Block 11 Granite View S/D Gentlemen; I am applying for a Health Authority Approval for this property. Public water and sewer to this subdivision was installed in 1998. The owner of Lot 7 Block 11 elected not to connect to the water and sewer. A septic system had been installed in 1993. The property is being transferred and the existing well is in conflict with the public sewer line. Funds has been escrowed to connect the residence to the public water line as soon as break up allows. Please issue a conditional HAA for this property. Yours T. Spu/kland P.E. 08:08 FROM-CT6 ~NVIRONMENTAL 581~$01 T-262 P.O~/05 F-992 CT&E Ref.n Client Name Project Name/~ Client Sampl~ iD Mntri~. Ordered By pW£ID 1fi00781001 Tobhen Spurkllmd P-E- D~inl<i~g Water Client POn Pre-Paid Cotis;NO3 Printed Datef~i~¢ 02/29/2000 16:05 Collected Dare,Time 02125/2000 9;00 Received Date/Tinge 0212512000 9:45 Technical Director Stephen C. Ede Sample 08-02-00 08:09 FRO~-CTE ENVIROHMEN%L 86i6301 T-20g P04/06 F-992 Anchorage, A~ Drinking Water Analysis Report l~r Total Coliform Bacteria ~: ' LECT1NG SAMPLE Fa~ (907) 561-~301 ........ ~TJON'S ON ~ r ~,~= ~~ r('~ BF' f'OMPl ~c.w ........ ~ PRIvsTE ~ATER ~STEM DATE ;~iti~ lab ret. no, Special purpose SAMPLE LoCaTION Treated Time Colleeted Collected By Date Received Timo Received AaalY$i~ Began Sample over 30 ho,~rs old, results Sample too long in ~ns~t; sampl~ should no; be over 48 hour$ old a* exammanon to m&ca~e rehable re~ult~- please send new sample via special dehYeE/ Angb~ical Method: ~ Membt~e ¢3 MMO-MUG N~mber o~ colom?/1 oO :m .. . OGICAL WATER ANALYSIS RaECORD BACTE~OL E. Co~ -- ~IM~MUG R~ut~: Tom~ Coliform ~~ ........ Filter: Direct Count ~. ......... C'OL~Fi~i~ verification: LTB ........ Fecal Coliform Confirmation .............................. Do SOS Group Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGEE FAMILY DWELLING .~- ~ HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone ,2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- . lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: 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) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water sup'~ly 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 Address, . Engineer s signature DHHS SIGNATURE .~/ Approved for bedrooms. Date Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipafity of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (Rev. 1/91) Back MOAIf21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Lo4 7, Legal Description: } Cased to A. WELL DATA I Well type ~, Log present (Y/N) Total depth Sanitary seal O'/N) ~/r'~'-Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed lq-/ c~ Driller ~ I ~ Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION tl.z. ol q z.. O -'"[, ~ g.p.~-~ FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding jtank on lot j I O - Absorption riel! on lot Public sewer mlain Sewer service Ii!ne ; On adjacent lots I ~.¢.,3 - ; On adjacent lots I ~ o ''~ Public sewer manhole/cleanout ~'~//'.A- Petroleum tank P"J } 0 WATER SAMPLE RESULTS: Coliform Date of sampN S. SEPTIC/HOLE lNG TANK DATA Date installed ' c/'17'7 ul Cleanouts (Y/N) High water ala~'m (Y/N) Date of pumpm~ Nitrate ~ ~ Other bacteria Collected by: 'Nj ,~_._~ 'q Tank size J~ Compartments Foundation cleanout (Y/N) y Depression (Y/N) b'///A Alarm/tested (Y/N) ~J'/'/-'~ Pumper O ?- SEPARATION Well(s) on lot To property lin Surface water/drainage 72-026 (Rev. 7/91) Front DISTANCES FROM SEPTIC/HOLDING TANK TO: I [ O ~ On adjacent lots [ O ._~ lC) Absorption field -~ Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION ~/^ /~-~ Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed R/l,)/-/~ ; ~/~.'J/'Z "] Length 3J'' Width Soil rating Gravel thickness ~:~ System type Total depth Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Cleanouts present (Y/N) Date of adequacy test for If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot .~ ! 2.~ To building foundation On adjacent lots Surface water _ Curtain drain On adjacent lots I ¢ ~ Propertyline To existing or abandoned system on lot Cutbank ~'4~ ~ ~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e¢fect ~' the' date of this inspection, Engineer's Na Date F-~'~ l I, HAA Fee $ // Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 675i ~. DIMDND BLVD. ANCHORAGE, ALASKA 99502-~9M (907) 24B.-5095 Municipal it, y o4: Anc:h~)r~age ~:.~ 2 C, ! ,c.!h..d::)jec:'l:.:N,,~ed o¥ Pumpir]g I..,.c)t: '7 Block 11 £.~r'arqi'b~..~ Vi,..=.,~,~ MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~/~ '~ ~ 2.- ~/ NAA# (b) Property owner Mailing Address [-~"~-z¢ (c) Lending Institution 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) [..of' '7r I'~ l~c~ ~1, ¢.,.-uW~l-~ ~.~., Location (address or directions) % ~yoO Telephone: (home) Telephone 3' ~/' ~ - ¢~5"C'/B u s i n ess /~ ~t q ¢~'-o7 Mailing Address (d) Real Estate Company and Agent Address ~' ~OC~ /~'~'~(! Telephone ~ ¥¥- dS--~'~ / (e) Mail the HAA to the following address: (or check here I~, if hold for pick up.) List contact person and day phone number below: .-.r.-~.~ l..~oo~.¢ $ ¥5-- 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ 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. 72-025 (Rev. 7/88) Page 1 of 2 ~ ~.o B elSed ~£"] P NIk~' IeAo~ddv leUOB!puoo ~o 9LUJS/ leUOB!puoo peAoJddes!a , ~ pe^oJddv 'lYAOl~dd~ Sill-la '9 ¢5'/ /- / II e~ea ~.~.O.~.,,C~¢,'"~ MUNICIPALITY OF ANCHORAGE (MOA) ~ . ~, .~C'~.~'~,~'~'(,~[~/"%~ Health Authority Approval (HAA) ~ ~ ~t/ CHECKLIST- FEBRUARY 1984 ~ ~ 343-4744 A. WELL' DAT~' Well Cla~fication F~<~ IfA, B, C, D.E.C. Approved (Y/N) . . Well LOg Present (Y/N) N Date Completed ~/~-o,,, ~ ~" I~'? ?' Total Depth I> ~oo ' Cased to ~> fl'~,' Depth of Grouting N, A. Static Water Level: '/7 ' Pump Set At Yield Casing Height Above Ground ~" Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y' Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot Il0''~ -/~ C~C~, ; On Adjoining Lots ~> To Nearest Edge of Absorption Field on Lot /o~, ? /~ t.¢. ~On Adjoining Lots ~> t¢,o ' To Nearest Public Sewer Line ~ ~'oo ' To Nearest Public Sewer Cleanout/Manhole '~. To Nearest Sewer Service Line on Lot :~ ' ~-5-/ Water Sample Collected by 7~. F. /~c, or~ WaterSampleTestResults ¢7J c~(i ,f-~'m /tOO ~w.,~. Comments ; Date I( / 2_/' ~ V' B. SEPTIC/HOLDING TANK DATA Date Installed ~/17/7Y Size Standpipes (Y/N) Y Depression over Tank (y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) fOoO~l Air-tight Caps (Y/N) No. of Compartments Y' Foundation Cleanout (Y/N) Y' N,A ; for N,/~. Temporary Holding Tank Permit (Y/N) ~.// SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well It g. ~ ~,~ c-. o To Property Line ~ To Water Main/Service Line ~"> ¢¢5' ' To Stream, Pond, Lake or Major Drainage Course Comments To Buildihg Foundation To Disposal Field Mn~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORP'['ION FIELD DATA Soils Rati~g in Absorption Strata Date Insbi lied c)//7/7y.~ c?~ ~ ~c/¢ Width of Field Tr4no4 .~5- Type of System Design ¢'¢¢'?~J4 Length of Field I~P I¢¢Y, ~g' ~d~ Depth of Field rd' Gravel Bed Thickness Square R!,et of Absortion Area ~f3 ~p[~' +37~' ¢-~^ Statndpipes Present (Y/N) Depression over Field (Y/N) ¢ Date of Last Adequacy Test Results ol Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well Iod'.v' ~-~,,~ To Buildi,ug Foundation p__ ~ ~c,..o,.~ c.~, Lot M,/~. To Property Line ~ ~7~ To Existing or Abandoned System on ; On Adjoining Lots ~ ff'C~ ~ To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Commen'ls To Cutback (if present) H,A-. D, LIFT ST.~,TION Date Installed Size in Gallons "Pump On" Level at High Wab;r Alarm Level at Tested fo' Meets MOA Electrical Codes (Y/N) Commen'ls Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check permitted Bedroom Rating Against HAA Request** I certify that have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ( ~;' · ,'~--~' ~ ~ · w ¢ Engineer's Seal MOA No. __ ~ -o,9-~ Receipt No. Date of Payment Amount: $ _. 72-026 (Rev. 7/88) Ba~:k Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten {10) davs ~o~ processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT~lfdifferentfromabove) ' PHONE '2. BUYE~ PHONE MAI LING AOD~ ESS 3. LE~DINGINSTITUTION ~ PHONE MAILING ADDRESS 4, REAL~OR/AGENT ] PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION LoT 7 STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE FAMILY ?(, NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY **If individual/on-site, give installation date If system is over two (2) years 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) ~..~: , THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED iNSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE NBPECTOR INSPECTOR 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 [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified __ LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -S~TE DATE INSTALLED [~]PUBLIC UTILITY ~'~ ~' Connection Verified INSTALLER I~]Septic Tank or []Holding Tank ~ Size: (/(--%~ If Tank is homemade SOILS RATING give dimensions: l TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS ' PPROVED FOR % BEDROOMS [] CONDITIONAL APPROVAL {letter must accc~{-npan~ certificate} E~'-"'-DI SAPP R OV E D , r,~ , BY (Tide) ¢ LEGAL DESCRIPTION 72-010 (Rev, 3/78) May 16, 1979 Cache Investment Consultants 700 It Street - Suite 1 Anchorage, Alaska 99501 Subject: Lot 7 Block 11 Granite View Subdivision Frank Adame Property Approval for the individual sewer and water facilities will not be granted until the following items have been completed: (1) The water analysis report be del~ivered to this office from Chem Lab, 5633 B Street, for our review. (2) The Septic tank is pumped with a receipt submitted to this office. (3) A percolation test be performed on the existing leaching. area. This will determine if the system is adequate according to National Standards. A list of private firms who perform the test is enclosed. This report must be submitted to this office for our review. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: Alaska National Bank of the North Mortgage Loan Department 3301 C Street - Calais II ~ · GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 %" Street, Anchorage, Alaska 99503 274-4561 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. 5. 6. Date Received August 3, Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1976 Se Alaska National Bank of the North 3901 Seward Highway Edwin V & Dolores Rinner Phone: 279-4585 Phone: 344-4131 8310 Wellsley Court Lot 7 Block 11 Granite View Subdivision Location: 9161 Claridge Road Type of facility to be inspected Well Data: Individual A. Type C. Construction Sewage Disposal System: A. Installed C. Septic Tank: 1. D. Seepage Pit: I. Single Family No. of bedrooms 3 B. Depth D. Bacterial Analysis On-site system B. Installer Size 2. Manufacturer Absorption Area 2. Material E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank Total length of lines , Absorption area , Other contamination , Absorption area C. Absorption area to nearest lot line , Sewer Lines EQ-034 (1/74) Page 1 of two pages 1. Type of Inspection: 2. Property Owner: MUNICIPALITY OF ANCHORAGE DEPARTIVIENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 -- 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CMRO VA RINNER, EDWIN V. and DOLORES FHA CONV XX Mailing Address: 8310 Wellsley Court, Anchorage 99507 Day Phone 344-4131 3. Name of Buyer: ADAME, FRANK O. Mailing Address: 7637 S~anlegepr,i~re.,~A~ncher~ge~,~K, Day Phone 344-3232 4. Name of Lending Institution: Alaska National Bank University Center Branch Mailing Address: 3901 Seward Highway, Anchorage, AK Phone 279-4585 5. Name of Realtor or Agent: None Mailing Address: Phone 6. Legal Description: Lot 7, Block 11, Granite View Subdivision Location: 9161 Clarid~e Road, Anchorage, Alaska Intersection of Abbott Road and Claridge Road 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: 99507 Single Family Residence No. Bdrms. 3 Public Utility Individual XX If Individual, number of dwellings presently served If Individual, depth of well Unknown Sewage Disposal System Type of System: If Individual, date of installation Public Utility Unknown Individual (on-site) EQ-037 (1/74) Page 2 of two pages - Re~ ~st for Approval of Individual 'er & Water Facilities L6gal De~cripti0n Lot 7 Block 11 Granite View Subdivision Approved ~-]~32~... n~_Disapproved Date ~'~c/-?~ Approval :.Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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) 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 3. Legal Description: 4. Location: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 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 Phone: // f 5. Type of facility to be inspected~V~ 6. Well Data: A. Type ~_~-~~ C. Construction 7. Sewage Disposal System: A. Installed ~/x~Jm~ B. Installer No. of bedrooms B. Depth D. Bacterial Analysis C. Septic Tank: D. Seepage Pit: 1. Size / oom ~¢~. 2. Manufacturer ~'~.~/om~ I. Absorption Area ~ 2. Material E. Disposal Field: Total length of lines Distances: / / A. Well to: Septic tank ×oo , Absorption area /~o Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line ~4 (1/74) Pa~e 1 of two paqes Page 2 of two pages~- Re' ,~st for !Approva~l'of Individual ~ 'er & Water Facilities : · ~ · ~. ,,, · [;ecf~ ~ Description Comments · ~eval :Valid for one year from date signed Greater Anchorage Aria Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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) 'GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St.~ Anchorage, Alaska 99503 - 274-.4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 10/~1/74 1. Type of Inspection: 2. Property Owner: Mailing AddreSs: 3. Name of Buyer: Mailing Address: CMRO LAWRENCE SEBRING VA FHA CONV: xx SRA Box 1540C Da.y Phone 344-3069 RINNER. Edwin V. & Delores E. 101E, Internat'l Airport Rd. Day Phone 272-154i 4. Name of Lending InstitUtion: Mailing Address: Name of Realtor or Agent: Mailing Address: NATIONAL BANK OF ALASKA (Maydel) P.O. Box 3-3859 Phone ~,~2~t~ 279~2506 N/A Phone 6. Legal Description: Lot 7, Blk. ll~,GPCANIT, VIEW S/D Location: near Abbott Road .Type of Facility to be inspect'ed: Single Family No. Bdrms. Water Supply Type of Supply: Public Utility individual xx If Individual, number of dwellings presently served 'unknown If Individual, depth of well unknown Sewage Disposal. System Type .of S~stem: Public Utility If Individual, date of installation Individual (on-site) Septic Tank