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Home My WebLink AboutHILLSIDE PARK PUD LT 10H USN e PK S D L 10 015 112.12 41 ,.MATERIALS TESTING · OUALITY CONTROL SOILS ENGINEERING ?204 ."leu' -c~ Ave. P.C' Bp; An:horoge, AK 9DEll 277- 0251 71~ F. O. Fc~rb~nks 452-1267 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT JPHONE J Great Alaska Construction (Jim Bender) J279-7813 J-"IuPGRADE :.'.AILING ADDRESS 2520 E. Tudor, Anchorage, AK LEGAL DESCRIPTION Lot 10 HILLSIDE PARK SUBDIVISION LOCATION JNO. OF BEDROOMS Tree Top Circle J 4 j DISTANCE TO: I :.:anufa:~urer iL,:. c~,-';ar,ty ~n gallons i '12.50 J-V, ell: ................ I Abscrpt~on area Greer j Material Steel JP E R,MI.T NO. 800295 Jrqo. of compar:menT$ JL~ouidoepth D:STA::C£ TO: J ',,'velJ l Dwelling J PERMIT NO. Mater,al j Licu,C capacity in .callons Type c4 criD J V,/ell TO: , 3-0 ' To:al length of lines ' . ,10 5 '. i',~,a t er la,D£ nta I ri tile Depth JCtib diameter Crib ae~h Buiidm~ founoat~on 6uildm~ founeation Sewer line Cia :,s DISTAI'JCE TO: Jr-,'e~es: iol Ifne ~5~ JT~ench w~%h inches inches JPSR;.;IT NO. ~/~ etlect,vt, abscrDt,on area 1470 SF JP~ir.~IT J'J'olal eHectwe :~t)sorDT,on area Nearest Io: hne j D,stanceloloT hne IPERMIT leO. SepTic Tank AbsorpTion area(s) OTHER ;~;=E t.'.Al E RI c, LS PPVC ..~'IL TEST ~ATING .: 32_0_SF/BR ::;STALLER Ab_l~ E x_~.ay_a _t_i n g _ App_r. gAv_.e_d reduction in length due to I I t i I I I J Ii i I I i _.improvement in soils in trench zone to coarse gravelly sand elev. 4'-12', ~,FPROVED I I I I DATE LEGAL 7/21/80 Lot 10 Hillside Park I I I I I I u cipality Anchor ¢ 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MA )"OR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 31; 1980 Great Alaska ConStruction 2520 East Tudor Road #2 Anchorage, Alaska 99507 Permit # 800295 Subject: Lot 10 Hillside Park Subdivision A permit issued by. this department for well and/or sewer system has expired' as .of. this date.· Permits are issued on a cal~dar 'year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well. log should be Sent to this department to.document!the installation'date. If an engineer inspected t~e installatio~ of the on-.site sewer system, please hav~ them send us the as-builts for our files. If' there are any further questions, please call this office at 264-4720. Sincerely, / S~io~ ~~n~'~cialist. LNB/ljw enc: Copy of Permit SWP/057 PERMIT NO. RPPL I CRNT LOCRT I ON LEGRL GRERT FILASKR CONST TREE TOP ClR I"ILII'-.I 'r I~.--'~--'PAL I T"'r' IDF Al'-.ir_. '~CiRAGE DEPRRTMENT b,- HERLTH AND ENVIRONblENTRL ', ~OTECTION 825 "L' STREET, ANCHORAGE, RK. 99501 · ~ 264-4720 131".l--S 'r TE SEI--IER PERM 'r T . < B002~5 > · ~ Po~L~ ~C~ o~p'' ~ 2520 E TUDOR #2 ANCH TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH LOT SIZE ~2000 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: DEPTH= 12 LEtqGTH= 'lie GRR'-..'EL DEPTH= 7 THE LENGTH DIHENSION IS THE LENGTH, (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE 5URFRCE OF THE GROUND RND THE BOTTOM OF THE :EXCRVRTION (IN FEET>. THERE IS NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE RND THE BOTTOM OF THE EXCRVRTION (IN FEET>. REgLI I RED SEPT I C TRNK 5 I ZE= PERMIT RPPLICRNT HRS THE RE~PON~IBILIT~ TO ZNFO~M THI~ DEPRRTHENT ~U~ZN6 THE INSTRLLRTION INSPECTIONS OF RNY WELLS RD~RCENT TO THI~ PROPERTY RN~ THE NUMSE~ OF RESIDENCES THRT THE WELL WILL TI--lO (2') INSPECT I OHS liRE R E ~;'~. I_, I RED BACKFILLING OF RNY SYSTEM HITHOUT FINRL INSPECTION AND RPPROVAL BY THIS DEPARTHENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISpOSRL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM A PRIVRTE. WELL TO R PRIVATE SEWER LINE IS 25 FEET RND TO A COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS ARE RVRILABLE TO IHSURE PROPER INSTRLLRTIOH. PERM I T E×P I RES DECEMBER _~:-::1_.. :::L~ciSO I CERTIFY THAT l: 'I RM FAHILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS AS SET FORTH BY THE ~UNICIPRLITY O~ RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE WITH THE CODES. ~: I UNDERSTRND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE .THAN 4 BEDROOMS. S I GNED' APPLICANT GP, E~ ALASKA CONST V4. 0 i 'pERFORMED.FOR, Great ,Al'aska Construction .... tLEGAL'DESCRIPTION: -: ~ol 10 ...... ..,:,Blocl~.' ' THIS'.;ZORM ~REPORTS: -.,,-:- n ;Visuol;.:Solls,'.,Exominotion .,-.., ;,: ~,v'.--!;rSUbdivisionHillside;.P'ark '"' .-. ::' ::','. ,...~::=¥.'1SI :.Percolation Test -:.r: DERTH . . SOIL . -"- ........ '- "- '''' · FE~--.:(:-' ".'DESCRIPTION '. ....... ':. -?NOTES,; ........ ,. "BOTTOM "OF. HOLE' WAS~:~i~ROUND.,WATER':. ENCOUNTERED, Ye~, IF 'Y?.S? WHAT~ T D E.P.T H ., LEG~I~D":r'' :::' ..' - : S ~am~le',,taken : -- , REAblNG; / E'.' ':' "'TIME fl'~.ztf0 ~ ~;:bj--:!~ -,'" :" ......... · ·:., .~S 'TIME;': "'.., =;".~I~T ;':" ! "?-'.L P . .~. .... ..~,,_,NETL:~)RAINAGE':' ' ";' ' TM .,',, 7/1 S^TUR^TTON PERTOD . .; ........ ....... ~,:. .. 7/1.4 -. ·9:05 0 Hrs ...... 10. 1./8".' '. ..... .-. ...... -0 ..:..'- · 7/1.4 12:05 3.0 Hrs. . 1.4 .3/4" ..... ~- '- 4 5/8" .,~.:,.. 7/14 1.2:35 3.5 Hrs' 1.5 5/1.6'! - ,- 9/1.6" ':¥ .', 7/14 1:05 4.0 Hrs 15 7/8" ...... 9/16" PERCOLATION RATE: 53 M~~~i~.EQ0[REMENTS: :'320 sq. ft./Bedroom ;~ ,~1~(~ PROPOSED INSTALLATION: n SJ~_..~-~'-PIT_~'~j~ F i EI~D;,, -..r'.. O OTHER · [sl ~E~O~ED BY:k~za ~. ~~'~[~_~ C[~I~F~[D BY: dames R. R~nqstad. P.[. .... ~:~ DATE: 7/14/80 Municipality of Anchorage Development Services DePartment Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 AnChorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH ,b, UTHORITY APPROVAL FOR ,b, SINGLE FAHILY DWELLING Parcel I.D. O15-122-41 1. GENERAL INFORMATION oq o Expiration Date: Complete legal description HILLSIDE PARK SUBDIVISION PUD; Location (site address or directions) 7200 TREE TOP CIRCLE Current Property owner(s) ROBERT KALTENBACH Mailing address Lending agency Mailing address Real 'Estate Agent Mailing address LOT 10 * ANCHORAGE, AK * 99507 Day Phone 346-1265 7200 TREE TOP CIRCLE * ANCHORAGE, AK * 99507 Day phone CAROL-BUTLER w/ REMAX Day phone 2600 CORDOVA * ANCHORA(~E, AK. 99503 276-2761 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 e TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [--1 Community Class Well r'~ · Public Water SYstem r-~ TYPE OF wASTEWATER DISPOSAL:'- Individual On-site Individual Holding tank r-~ Community On-site [-1 Public Sewer The Municipality of Anchorage Development serVices Department (DSD) Issues Certificates of Health Authority · Approval (HAA) based only upon the rePresentations given In paragraph 4 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) for properties serVed by a single-family on-site Wastewater disposal and/or water supply system,' DSD also issues HAAs upon request to homeowners. 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 samples, (Certificates may be reissued for a period of up to one year with valid water samples.) 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. STATEMENT OF INSPECTION 'BY ENGINEER As certified by my seal affixed hereto and as of the validation date Shbwn below, I verify that my investigation, based on procedures outlined in the Health Authodty Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structum indicated herein. I further vedfy 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(am) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone . ~Engineer's Printed Name JEFFREY A. CARNESS, P.E. 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 · Date ~/l~/Oz~- Engineer's Comments: .: ., _ In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis Of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily/identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test resulls do not guarantee futura performance of the system, nor do they guarantee that there ara no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the · operational requirements of the ADEC or MOA DSD. The content of this report is for ' the sole benefit of the owner listed above. Any re/iar~ce upon or use of this report by any Other person or party is not authorized, nor will it confer any legal right whatsoever.' DSD SIGNATURE ~ Approved for J./.. bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist SePtic System Advisory. Well Flow Advisory. (Rev. 12/01) Manitenance Agreements · Supplemental Engineer's Reort Other Original Certific~{e Date: -~-'° -,~ '~- O'Z'~ MuniCipality of AnchOrage pment Se ices Department · ' ? Building Safety Division · ~ on-sit'e Water & Wastewater Program ~'~ ~ · 4700 South Bragaw St. ,- ~I' ~ ~ ~.O~ Box 196650 Anchorage, AK 99519:6650 ',: ~I ~ ~www~i:i.anchorage.ak.us ~: I i ~'~ : ~. (907)343-7904 : ": ": H,E/ LTH[AUTHORiIT-.Y :APPROVAL ST Leg~i e ri i n HILLSIDE'.'PARK,PUD SUBDIVISION; LOT ,.10 ParcellD: 015-122-41 A. WELL'DATA : Ifa; B,'o [ prowde PWSID# 212461 - Well Log (Y/N) WAll '!1: -' ...... i ' .~ . Date )leted ',: Sa'nitary seal (Y/,.N).--.. : Wires Total depth ' ': '~ ' ,,, ft.:, Cased ~ta ~ ~;.': '.~ ,.. ff. - Casing ;i[ )ove ground) Date of test ' ~ · '.' ' . ~1~',. ! I; I'~:i ~ ": : , Staiic te~: le~,el ~'" . . . Well pr,oduction :;I:-:,:.; ,~~'~'~' g.p.m... : . . . -. - .... g.p.m. WATER SAMPLERESI : ",,' -,i i, . ~ .: Coliform lcolOnie~. "! Nitrate . .' ~" mg,/L. - :~ ' Other bacteria . colonies/100 mi, [ ng., .~. ~ Date of sample: ' Collected b~,' B. : :1-,~,. [,,. . ., ' ....... ~,.. _ SEPTIC/HOLDING TAN ~,1 . ,, ~,, ~., , ~ ............. ~, Ta,nkTypelMatena, ;--~--,',: ~. !~ · , ,.; .. i Date installed · 7/1980 - Tanks~ze; 1250 .gal. , Number of Compartments 2. - : Cleanouts (Y/N) · YES Foundation cleanout (Y/N) !,YES Depresslon over tank (Y/N). NO H gh water alarm (Y/N) N/A ~ .... ~ -l,,~:.l,l., ,11 ~l II,' ,,,~' '~i,i'. .... ; :, ..' l...,!f I Da~e'ofPumpin~ :!! '!:8/5/20031~? ·:PumperiI:'! ' '~ -':, -' !; : ROTO-ROOTER C. ABSORP,"rlON ! IELD DATJ . . .. .... ~, · . : ...... 1 ~: . . Date installed ...7/,19801, I,Soil rating (g.).d./ft o~~320 .. :. System .type' 5-WIDE TRENCH ! ', ~ ,. ;! ~"~-~";, , I . . '! t '~ ..... Lehgth 10 Width '.; ~I~ ;5.0 : :: ft. :, ~ Gra,~el below pipe 7.0 ft. Toial d~ 1470~ Monitoring tube.*YES I Depression over field NO Date~, of i . ~! ~? (Pa.ss!F.ail),. :~ , ,":'!PASS' .- ..' ;!'.;.~ . ::' ' , For. 4 bedrooms Fluid de~th in absorl: ,' 1 ....... : i - watel;'added 600 g~l.: i: ' ": Newdepth 51 in. E!apsedTime:1065 Final fluid depth DRY' : '" ~ ' ': ' ~ in. .," i' ' Absorptio 'ate>= 600+ g.p.d. Any rejuvenation st 12 m,o.) (YIN & t~pe) ~ ~ NONE KNOWN 't:' I yes, give date - ...... , .~ . ~ -'--T--'. ,'T:', / in. De LIFT STATION Date installed "Pump on" level at ~ ,,Size in gallons. ' : , in. Pump off" in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main ~ .~: Holding tank SEPARATION DISTANCES FROM SEPTiC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field Water main N/A Water service line 10'+ Surface water CLASS "A" WELL On adjacent lots 5'-t- 100'+ Wells on adjacent lots 200'+ Public sewer manhole/cleanout SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: . Building foundation 10'+ Surface water 100'+ . Wells on adjacent lots 200'+ 10'+ Property line 10'+ Water service line 10'-I- Curtain'drain NONE KNOWN Water main N/A DrivewaY, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined ihrough field in'spections and review of Municipal records that the above sYstems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date ,-% '7 ~- HAA Fee $ ~/::~) ~,.r.~ . . .. Date of Payment ..~ ' Receipt Number (Rev. 12/01) Waiver Fee $ . Date of Payment · Receipt Number Rpr 1~ O~ 03:17p Kaltenbach 907-3~6-1276 p.2 e~.?- L07- 0 .LOT 1f Lot /0 ,Block Anchorage Recording Precinct,Alosko LOT SURVEY CERTIFICATION I hereby certify thor I hove surveyed the property shown ond described 'hereon,ond thru' the Improvements situ~led thereon ore within the prop- erty lines ond do not overlop o~ encrooch on odjacent property ond,th~t no improvements on odjocenf property overlop or encrooch on the premises in ~Jestlon and lhnt there ore no roodwoys, ulili~,j lines (~ other vlsll~e eosements on sold property except os indicated hereon. Scole LEGEND ~ = Bross copped monument recovered o = Iron pipe ond/or rebcr recovered D = 2x2: hub ~ rock recovered · = 5/8"x ~O" r~b~r set this sur~ey F.B. No. Prepored by: (907)2Y9-~200 R. L.. BUTTON t~eglster, ed land Surveyor 519 ~. Eighth Ave. Anchora~e~ Alos~a 99501 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date llJ~ ! ~'/c> GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, bl0'ck, subdivision, section, township, range) LoT lC). ILL I' E. Location (address or directions) (b) Prope.y Owner ~o~Z'~ ~. Telephone: Home Business Mailing Address (c) d' gl s u on ~. _ ,; .... .--~ ~lephone Mailing Address ~' ~"~~ /~~ Real ~tate'Company and Agent ~~~ Telephone ~? q ' 7~ l/ (e) Mail the HAA to the followino address: or: Check here~ if hold for pick up. List contact person and day phone number below. . (d) TYPE OF RESIDENCE Single-Fa'mil¥/~ Number of Bedrooms · 3. WATER SUPPLY Individual Well [] Community/l~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsitex Public []*. Community [] Holding Tank [] Note: If community Well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-02S {Rev 8/86~1 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from 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 "~ ~ ~ ,¢~,/ ~ o V"~,. [ 0~,4.~ ~- ~ Telephone Address ~0 ~ /~ !~ Date N~ t/ ~Z'l / J ~ g[;:~ Seal o Approved for . ~[. 2,) bedrooms by ,App?m;ed ,,~ "' ' ' ' D~sapproved ,,, -., ~, .;.~ Terms of Conditi.o~nal Approval'. Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the'State of Alaska. The DHHS does this as a 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. Page 2 of 2 72-025 i'Rev 8/86) Back A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level Camgd to Casing Height Above Ground ' Electrical Wiring in Conduit (YiN) Separation Distances from Well! To Septic/Holding Tank on Lot !, To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer kine Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments Bo MUNICIPALITY OF ANCHORAGE (MOA). HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: LO'i- If A, B, C, D.E.C. Approved (Y/N) Date Completed i: Yield Depth of Grouting Pump Set At : I Sanitary Seal on Casing (Y/N DepressiOn Aroun¢!WellheadL /N! ; On Adjoini g Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service'Line on SEPTIC/HOLDING TANK DATA Date Installed C) ' i Size /~,~1~ No. of Compartments Standpipes (Y/N) E:)~ :: Air-tight Caps (Y/N) /V' Depression over Tank (Y/N) ''! ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) t~'/~--~- Separation Distances from Septic/Holding Tank: To Water-Supply Well 'for Temporary Holding Tank To Building Foundation Cleanout (Y/N) Four~dation, Ill ,~:1,II Date Last pUmped ! '5'~, !I~ ,~ DEPT. OF HEALTH & ENVIRONMENTAL' PROTECTION To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) To Disposal Field To Stream, LaKe i~id, ~r ~a~j°r Drainage I:1 C~r ABSORPTION FIELD DATA Soils Rating in AbsorPtiorj Strata Date Installed 7/~'D ~ Width of Field Type of Syste~ Design Length of Field Depth of Field Gravel' Bed Thickness Standpipes Prestent (Y/N) Last Adequ,acy Test Square Feet of Absorption Area Depression over Field (Y/N) I',,,~. Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ To Building Foundation . Lot ~ O 1~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments I To Property Line · or Abandoned System on ;To Existing~'' , ~; On Adjoining Lots ~ To Cutbank (if present) i '~ ' .i D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at ~ Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) '"Pump Off" Level at Vent (Y/N) ] ; :' A~dequacy Test. Pumping Cycle~s during~ Meets MOA ** Check Permitted B~droom Ra!ing Against HAA Request I certify that I hav_e checked, verifie(:~or conformed to all MOA and HAA guidelines in effeci on the date of th s insPectign. Signed ~~'._ Date ti ~1 ) ? Company ~h~~ MOrRo.. Receipt NO. ~00 . ~ Date of Payment //~ ~ ' "' *moun : E.g nee. Sea, , ~.~ .~ ..... ~ · ~ , Page 2 of 2 ~,~. l~- '.. ..-.,.'~'... 7~-o~ (,,,~) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA gg501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: November 20, 1986 PWS I.D.# 212461 To Whom it May Concern: According to records on file in this office the Subdivision Water Regul ati0ns Hillside Park Water System is in'compliance with the State Drinking Sincerely, · ~..-~- Michael P. Lewis Environmental Engineer MUNICIPALI%"f OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF m~.ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicants Name ~I [~'~'~r.('~,l-~. t~0A~Teleph~ne - Home Applicants ~dress ~7 ~ ~O~T~ kl6~T~ Business (c) Applicant is (check one) Lending Institution [--~ ;.Owner/builder ~--~ ;. Buyer Other ( plain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent (f) Address Telephone Mail the HAA to the following address: 2. Ty~e of Residence Single-Family.~-~ Number of Bedrooms 3. Wate~ Supply Individual Well~--~ Multi-Family ~-~ Other (describe) Public I----] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite ~ Public ~l Community ~-~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of :2] 5. En~ineerin~ Firm Providin~ Inspections~ Tests~ File Search~ Data and Information e 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 with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Address (ENGINEER SEAL) Disapproved DHEP Approval Approved for ~ ~';~) bedrooms A~proved '/~/ '' Telephone. Conditional Terms of Condition~l Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES ~-~.ALTH 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 ~EP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE' DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 ipage 2 of 2] 7-19-84 ae WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification A Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances fram Well: To Septic/Holding Tank on Lot ~ + To Nearest Edge of Absarption Field on Lot To Nearest Public Sewer Line ~lO ~; ~ C leanout/Manhole Water Sample Collected By Water Sample Test Results Ccrm~nts Legal Description: If A, B, ar C, D.E.c. Approved(Y/N) ~/ Date Cample~d : Yield Dep.th of Grouting Pump Set At MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION hiAY :IL 5 85' RECEIVED B. sEpTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) sanitary Seal on Casing (Y/N) Depression Around Wellhead .(Y/N) ; On i Adjoining Lots Z~ ~ + ; iOn Adjoining Lots To Nearest Public Sewer To Nearest Sewe~ Service Line on Lot : ; Date Size I~l~0 No'.' of Cc~pa~tments ;-uf~, ~) i, Air-tight Caps (Y/N) ~ ~Foundation Clean~t (Y~) N ~te ~st P~d ~ / To Property Line To Water Main/Service Line Course Comments Pumping/Maintenance Contract on File (Y/N)~//% ; for ! t~/~ Holding Tank High-Water Alarm (Y/N) ~ Temporary ~olding Tank Permit Separation Distances f=am Septic/Holding Tank: To Water-Supply Well ~ ~ To Building Foundation To Disposal Field To Stream, Pond, Lake, ar Major Drainage [Page 1 of 2] Receipt # Date Paid: Amount: 2-15-84 Ce Width of iField Soils Rating in. Abs°r~ti6n ~trata 15!2° Ty~; of System Design Date Ip~talled 7/~O I ' ! ' ~ ' ~ i'~ ii!: Le g~h~ of Field. ,05 Square Feet of Absorp~'ionlArea . Depression over Field ii(Y/N) ~ !' ~ Result.s of Last AdeqUacy Test . ~~ i Separation Distanoe f~om' : . ~ ~ . ~ !Absorption Fzeld: : : i ~ !:~ i : To Property Line To Water'Supply iWall ! ~ To Building Foundatio~ } i Of { ~: To'Existing or Abandoned System cn Lot N0~ ? i' ;i On adjoini'ng LotsI : -~ ~ To Water Main/Service~ 1- :~ Line ii ~O ~ To tream/Pond/Lake/Qr Ma3or~ Drainage To rlveway, Parking Area, or Vehicle Comments ~ . : D. LIFT STATION Date Installed :. ~ DePth of Fie~ld ~; ' i ~ Gravel Bed Thickness '7 ' ~'~0 :standpiPes Present (y/N)~/ Date of Last Adequacy Test"~/! ~'/~ ~- To~ Cutbamk(if present) 1,4o ~NL~ Area ~; ' COUrse istoram NONL~ Size in Gallons "Pump On" Level at iDimensions Manhole/Access (Y/N) ! . ]at .: i . Vent (Y/N) CYcles!during High Water A1arm Level? at Tested for Electrical Codes (Y/N) Ccm~nts Adequacy Test. [Page 2 of 2] Meets FDA Check Permitted BedrOcm Rating Against FJ~ Request : . I certzfy that I have checked, verzfzed, :or conformed to al~ ~DA H3~ Guidelines in effect on the date of this inspection, ii ' :! · : , ,I , i~ - .__'l/ /,~"'/~'/,-~ '" "-""' "'~ Signed -Date i *.. 49TH Ccn~any MOA No. KB1/d5/s : q,%--~... . ..:,<,;,.-' 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL 51-1EFFIELDt GOVERNOR Telephone: Address: 274-2533 DATE: To Whom it May Concern: Water Regulations Sincerely, : CONSULTING ENGINEER 203 W. 15th AVE'"'C" SUITE 203 ANCHORAGE. ALASKA 99501' TELEPHONE: (907) 279-3916 SiR P T ~i C LEGAL: ~,OCATION: OWNER: iRES I DENCE:: ~ATER SYSTEM: SEPTIC SYSTEM: DATE OF P UMRING: DATE OF TEST: TEST PROCEDURE: TEST RESULT: SYSTEM :iT 5 _T ;! .: ...'. :- .: LOT 10, HILLSIDE PARK 7200 TREETOP CIRCLEI SINGLE FAMILY, FOUR[BEDROOMS COMMUNITY, CLASS A -: [ :. FROM MUNICIPAL RECORDS: TANK: GREER STEEL, ,1250 GAL. 2 COMP..!' ABSORPTION SYSTEM: TRENCH ...... ABSORPTION AREA: 1470 SQ. F.T. SOIL RATING: 1320 INSTALLATION DATE: JULY, 1980 MAY 16 1985 .: ' MAY 14, 1985 .i ~, SYSTEM DO NOT HAV~' MONoToRING iPIPES THERE ARE CLEANOUTS AT BOTH iENDS iOF TRENCH. '' I. WATER WAS ADDED To THE TRENCH !il STEADY RATE OF 10 GALLONS PER J~,MINuTE='.f THE WATER LEVEL IN THE TANK! ii WAS MONITORED FOR 60 MINUTES. DURING HOUR 600 GALLONS WAS ADDED TO THE:TRENCH WITH NO RISE IN THE WATER LEVEL", IN. TANK. , ii THIS SYSTEM MEETS THE REQUIREMEN~?S'"OF THE MUNICIPALITY. i~i'i The operational life of all sept~ic isys- tems -depends on the local' SOil! iCdnd~ tions, groundwater .levels that maY tuate during the Year, and :.the !i ~ater usage of the family:being served ib~ system. These conditions are outSide th:~ control-of the eval%ator of this !S.epti:d system. We can therefore not give~ any estimate of how long the systeml !wil:~ · i requi2 continue to meet the °perati°nali ~tate-tS rements of the MuniCipality~ ."and t: !