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Home My WebLink AboutTUXEDNI PARK BLK 1 LT 13C\ALAJA ?Am., ()CAA 1E %Aoki (#21(DOP., 1 4/014 -Baa- �5 Department of Environmental Oj~lity ~".'"_" _ . 3330 C street ( - 212 East InternatiOnal AirPort Rd. -") 'Anchorage, Alaska 99503~.,~ S. uit.e 204 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Anne wileland (Wielan~klLING ADDRESS 9750 Ch~enega 'Drive 99~E LOCATION Cheneqa Drive LEGAL DESCRIPTION ~/-~ ~/~¢;/< ! SEPTIC TANK: Pe~it % 780443 FROM WELL MANUFACTURER :~3~ S'3: MATER IAL ~//*~'~ INSIDE LENGTH /~J INSIDE WIDTH LIQUID DEPTH ~:~ LIQUID caPaCitY. /~o GALLONS. SEEPAGE PIT: 7"'/"~'~. /z 47' -/~j /-5~',,7/.~z~,~ ~'C_~' d NUMBER Of PITS ~ DIAMETER ~ OR WIDTH , LENGTH , DEPTH LINING MATERIAL BUILDING FOUNDATION CRIB SIZE: DIAMETER ~ NEAREST LOT LINE~. .DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) O'-~ ~1~ ADDITIONAL ABSORPTION WELL: /,/~ t,x/,~/./_ ~.~ /-~7-- ;7"~ X~_. Z>/'Z/ L.L ~o I TYPE CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION , LOT LINE , SEWER LINE , TANK __, SYSTEM. CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED, REMARKS /~0 '~1 ~J. DISTANCE FROM: PIPe MATERI :~ ' · " ...t~ t.~:';. ' ~' :; ~, , ~REM~~ .... ~ I / "~ '?;7~ .... 4~'~'~'.~" . u//~ DATE . Form No. EQ~3~ --~ /~--~ DISTANCES: 1'~ ~1/" I DIAGRAM STEM APPROVED G.A.A.B. ~or ...... .~.~.'.-:..; ..... :.~i.o; 0'. i .; .'.:. ~ ~..., .................................................................................... Location. COT' x$ /~ / ~E~/ ~/<- Date completed ....... ,~/.cJc~;~ .... ~,~.~...~~ .................................. Depth of well ............ /~..~.;~,,-'~.~,:.-,:..c ....................................... . .................... Size of cas~g ........ ~.~~ ...... ~. . ......... ........ .,;...::.-... · ~ ...... ,.',' .~U~.'"~ . .' ' ., ~ ~' .'/ ~ · Distance to water ...... , .... ~,..,~...;~..'...,.:,;:...d ............................................................ Dfst~ce towater w~fle pumpm~ .... · .... r~ -,- -' ' ' . ~e~..~.d... ~",..t.~-.,,~[S .............. ~t r~te of ............. . ...................... : .......... ~allons per hour. I ' ~ormation from I to .. , ~, , ;. .'v .. , ".-"--' ..... i - ,~J ",~'P-' .... ,%'...,,.Z ....L, .: .~:....'..; ........ ;. .......... , ........ T. .......... : ........ 'f. Driller DELTA DI~ILLING COE~PANY' ! .' 5RA I~OX 394 ~ ANCHORAGE, ALA.~KA 99~07 PERMIT NO. MUNICIPALITY : C~F ANCOt, RAGE DEPARTMENT, HEnLTHnND:ENVIRONMEr TnL,.<OTECTION 825 'L> STREET, ANCHORAGE' n~,..'9~bl " 264-4720 ~IELL Rt4D ON--S I TE SE~4ER PERM 780443 ) AF'PLICANT LOCATION LEGAL ANNE WILELRND CHENEGA DRIVE L l~ B 1 TUXEDNI PARK ???? It STREET ANCH D9501 27~-~5~5 LOT SIZE 152075 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH MR}¢IMUM NUMBER OF BEDROOMS = 4 SOIL RRTIt~G THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:' DEPTH= 14 LEN~]TH= 47 ~]RH~.-'EL DEPTH= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND 8ND THE BOTTOM OF THE'EXCAVATION (IN'FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOR OF'THE EXCAVATION:(IN FEET). REQIJIRED SEPTIC TRICK SIZE= I 250 · BALLOt, S PERMIT APPLICANT HAS THE RESPONSIBILITY TO iNFORM THIS DEPRRTIIENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO ( 2 ) I I'-,ISPECT. IONS ARE RE(~U I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL. INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELb OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED 8ND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS I4AY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO' INSURE PROPER INSTALLATION. PERM I T EXP I RES DECEMBER ~l.- 1'...~7~ I CERTIFY THAT l: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON'SITE SEI~ERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS ~EMODELED TO INCLUDE MORE THAN 4 BEDRO01IS. SIGNED:__~~- .......... ' Performed Lena1 This 2204 For Anne qescrtntion: Lot_~3_Block..2_._.Subdtvtston form Renorts Soils Lon Yes Cleveland Rnchorage, Alaska 99503 Wileland Date Per f0rmedg-15-77 Percolation Test .neath Feet Soil Characteristics ~eau ~"~eddis1% Brown Slightly Silty Sand 'SM-SP 10-- 12-- 14~ 16 . Bottom of Testhole 18-- Was Ground Water Encountered?. No. I~ Yes, At what Depth7 Readinq Date Grnss Time Net Time Depth to H20 Net Dron Percolation Rate r~tnute Prnposed Inst~l~lation: Seenaoe Pit Drain Field Deoth of Inlet Dept--h---T-6--8ot-[om Of Pit Or--~T~enCh~_. Cn~(I~£NTS: 140 square feet drainaqe area reau~re~d ~._r_~_~.~.roo~'/l~L_ ..... minus 1' to 13 5. '' 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 SINGLE FAMILY DWELLING Parcel I.D. # 041-02:2-05 1. GENERAL INFORMATION Complete legal description HAA # Lot 13 Block 1 Tuxedni HA920181 Park Subdivision Location (site address or directions) 9750 Chenega Drive Property owner Mailing address Lending agency Mailing address Agent Address BrUce/Jennifer Talbot 9750 Chenega Drive, Anchorage, Day phone752-2660' Alaska 99507 ALASKA USA FEDERAL CREDIT PO Box 196613, Anchorage, UNIO~ayphone 563-4567 Alaska .99519 Day phone.... o Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: four (4) 3. TYPE OF WATER SUPPLY: Individual well xxx Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. ' 4. TYPEOF 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. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION '.BY ENGINEER . As certified by my seal affixed I~ere.t0 .a,',nd as of the Validation date'~ho~,n below, I verify that my investigation of this Health Authority Approval application shows that th'e On-site water supply and/or wastewater disposal system is safe, lfunctional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify 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 effec~ on tlie date of this inspection. Na~e Of Fir~ Ted Moore, P~ E. Flattop Technical p~'~ic'el;' 345-1355 Address 14530 Echo Street, Anchorage, Alaska'~ 99516· . ' Engin~er'S-signa't~ire Date This office_has_received the...pumping receipt_for_ pumping as per the Conditional Approval of March This Property is now fully 6. ' DHHS'SIGNATURE " · ',~/~- --Ap.proved for -,urea (3 -'s-pprove-. Conditional approval f~r ' the.septic 2,~6 1992. ap roved.': ~l'~' ';'~' tank bedrooms. bedrooms with the following',~tipulations: Additional Comments By: , _ . ,, Date .May 26, 1992 ..:,: .:~,.,.' .............. .. , : . . . .i' 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 rab~%)e 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, insPe.ctions or analyze .data,~e. fo~e,a ce,.rt!fica, t.e is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1,'91) Back MOA MUNICIPALITY:DF ANCHORAGE' : DEPARTMENT OF HEALTH & HUMAN SERVICES .. · ~Division of~.Enyir~i~ht"AI Service§ I · ; i on-Site'se~'i~e~ecti°n :~ P.O. Box 196650 Anchorage. Alaska 99519-6650 , ... 343-4744 · ' cERTIFICATE OF HEALTH AUTHORITY ' . :APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # _{~t.~ ~ ../'3"~,,-~- I~Z-~' HAA # 1, GENERAL INFORMATION Complete legal description Location (site address or directions),.:'. ::,':, .- :.., .,...,,~, e Property owner _ . . ... ........ Mailing address ?75', :c. Lending agency ~ I~ [~ ~X~,' ~.. ~r~B. .,.,.~'~°° Day phone Mailing address r- o. ~on e FFIX)/~b~;'~ 9e~t~ Agent ~- ~. { ~ ~c¢) Day phone Address Day phone 3-6' 3 - q,S-t~ 7 Unless otherwise requested, HAA will be held for pickup. NUMBER ,OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water If community well system, provide written confirmation from State ADEC attest- ing t° the legality and status of System. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site HOlding tank community on-site Public sewer If comm unity wastewa ter system,, provide writ!en ~on firma tion from, S,,tate A DEC '~ .'.' ~,. '~*.',.~:'~, ~J !.i,~ :' ' '... !~.:,'!/',,i ' : .. attesting to the legality and status of System. ~ .' . . 72-025 (Rev. 1/91) Front MOA It21 5. STATEMENT OF INSPECTION 'BY,ENGINEERI' "' "?~ As certified b my seal affixed hereto and as of the validation date shown , I verify that my investigation 'of thiS Health Authority Approval,appliCation shows that tl~: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 d!~.'PoSaI system is 'in coml~lianc~ 'With all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection?. Nameof F~rm F/~+' ' · "' Phone, Address Iq~3o ~c~ ~ ~nC~~,,. . ~ ~1[ '}" :-' '','~ ' ?~: .' ....... Engine~ds Sig~ature ~ :' ' ~ '"":':; Date ' 6. DHHS SIGNATURE ' APprOved 'fOr' DisapprOved. bedrooms. ' Conditional approval ' bedrooms, with t13~ folloWing"~tiPulations: / .-, Additional Comments ~;~,':~':!::'~.':, .... ,'.~:.','. ..... I~ ' - ::':,'~.:','": : i: ': ' '.,.: ?' ':' '-':' · '" ~'~' ' ',~ ":..-;, . ~~,z.,-4/--,,_~_:- "":' ~ : :~ 'i' :i, '.i" .:"I D :ate 2/..~ ~///~ By: The Municipality of Anchorage Department of Health and Human Servic;~s"(DHH'~)issues Health Authority Approval Certificates based only upon the representations given in 'Pai-agraph"5:ab0ve 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 Mun, icipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA Municipality.0f An, chorage . . Department 6f'.H~a~l'~h'&~Rd~an Services .~ HEALTH AUTHORITY APPROVAL CHECKLIST ~3 ~ Parcel I.D.r O¢/-- Legal Description: L. 13., A. WELL DATA Well type p~-~,-~,/-t Log present (Y/N) ~' Total depth I o ? t Sanitary seal (Y/N) ADEC water sYstem number If A, B, or C, attach ADEC letter. Date completed ~ 19 ? 6~ Driller Cased to I o p ' Casing height Wires properly protected (Y/N) Date of 'test 'Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 13 o' Absorption field on lot Public sewer main h~, ,4. Sewe~ ~er~ice line '~- ~'¢' WATER SAMPLE RESULTS: Coliform O er.,(/'too ~.~ Date of sample: ,,FROM WELL LOG ! g.p.m. Nitrate SEPTIC/HOLDING TANK DATA AT INSPECTION 'MUNiCiPALITY OF ANCHORAGE ENvI~:~NMEIqTAL SERVICES DIVISION RECE'IVED '; 9n adjacent lots c.o, ; On adjacent lots Public sewer manhole/cleanout Petroleum tank 7'6'" /"~ . _ ?therb.acteria .0 col Collected by: ~- ~. Date installed (' 1 7, .~, :::. ,,. ,,..,, , Tank size 'l ~-5'0 ~/~f Compartments Cleanouts (Y/N). (" ,t;,..~ 0 .; ..... ,;F,o~;d.' a.tion cleanout (Y/N) }" Depression (Y/N) -. ...... ~ , Alarmtesied~(Y~N) ' · 'N.4'. ' ' ' H~gh water ala.~['n.~[.?N) · 'N;A;,; '. ,: ~ _ p p g,:_, :" y~ ' ,,. . ,Pumper SEPARATION DISTANCES. FROM ,$E.P,)'tlO/HOLDING TANK TO: Well(s) on lot I~U.~'~.~.~.to~.'~.,'~'.Onadjacentlots .-.> ~oc,, Foundation I~(~ ~,,,~ c.c. 'To j3rbPe/t~/ line .... ~ 70 'Absorption field' '"' ~"' ; water main/service line SUrface water/drainage. "~' ¢ o'o, 72-026 (Rev. 7191) Front _ . ~" ' ~:~;: ;..,,~;:. ,i'. ,!'¢-~-? !. ,(~O~TiNU'E~:ON BACK PAGE C. LIFT STATION Date installed ....... ?, ~ ~i % ' "' Size in gallons ._ Vent (Y/N) ~' Manhole/Access (Y/N) ,p~mp on':;le~/el at :~, High water alarm level Cycles tested Meets MOA electrical codes (Y/N) ..SEpARATIO~ DI'~TANCE FROM LIFT. sTATiON-TO!:-.:,..i ::".;,.~::. ~,::.,:! . Well on lot ' '. :-.;:,: :d ,;.-:. 'On.adjacent lOts. .......... r::' ~' ~:':'t';~ -Surface Water ................ "".; :-~' ~" t ' D. ABSORPTION FIELD' DAT.~~ :..v, ;:... i.'- i:; :' v i~ :::':,~ ~'.; ;~ Date installed for ~ 0"/'7~; Soil rating I ~(o ,:c~lGo~r~ ' SyStem type' .' .-7"~.^c~ Length ~/7 Width Iota absorptiOn area '., DepresSion over r~e~a (Y/N)'' Res~u~ts (pass/fail) .- Peroxide treatment (pa~t 12 month~) (Y/N) bedrooms If yes, give date ' ~,/~_ SEPARATION DISTANCE FRoM ABSORPTION FIELD TO: "W~JI'~-~'I0t '--i3-Z"'~;,.:,, ~':~,~ Onadjacentlots, ~ ~oo~ Prope~yline ~' ~ ~,o. To building foundation ~' To existing or abandoned system on lot '0n~dj~e'ntl0ts'- > 30" ' Cutbank N, A. Water main/sewice line SuHace water > ~oo ' Driveway, parking/vehicle storage arda E, ENGINEER'S CERTIFICATION I cedify that I have checked, verified, or conformed to all MOA and HAA guidelines in'~if~cl, d~hedate'of this" ' "~' ~inspection." '" .... ..' ,~ ~ ... . ~.- Waiver Fee: $ Date of Payment ~-~0- ~ Date of Payment Receipt. Numbec, :~~- ~e Receipt Number ..... 72-026 (Rev. 3/91) Back MOA 21 ' " CHEMICAL & GEOLOGICAL LABORATORY ~,,,~. ~'=°,,k~o;,~ ~%~.\ 5633 B STREET ANCHORAGE, A~S~ 99518 TELEPHONE (907) 562-2343 FAx: (90D 561-5301 . . Ah'ALISIS ~SULIS for I~70IC~ t 51878 .- ~ Cherub Ref.~ 92.0977 S~ple ~ I Eat~lx: WATER Client Sample ID : Li3 B1 IUIEDNI P~K s/D' Client ~a~e P?~ID : UA Chen: Acct :FLATTOT Collected : ~[~ 13 92 ~ 13:45. ~s. 8PO~ : PO~ :~0~ [~C~I~D Presexve8 ~lth : AS.~E~UI[ED. Ox~ered Analy~l~ Completed :' ~R 16 92 Se~ hepo,ts to: Parameter ........................................................................ Reeults Unlt~ · ........................ ; .... - Hethod Allo~able' NIIIL~TE-I{ 1.9 mg/l EPA 353.2 10 IROU~INE SAWLE COL[ECIED BY: T.F.~. M~mber ~' SGS of the SGS Group (Soci~tO GOn~rale de Surveillance) · ../ ':-'~'~' .~-5'. ~'."'7~ .. CLEANING SERVICE · ' ~HON~ 345-2513 .. ANCHORAG E, ALASKA 99511-2688 HRS, ,~ ..: STEAM THAWING HRS. TR~PCHARGE - ' 'HRS. OVERTIME CHARGE : ' HRS, ADDITIONAL ~BOR CHARGE 'HRS. · 'pLE~sEPAYF~a~TH~S'~Nvo~cE ' "' tOTAC . ' TOTALFO~AGECLEANEDORTHA~E~. · ' ' ~' "., BLADESU~ED" . . . RO. BOX 112688 ,Job Address ..... ' DATE SALESMAN ROTC-ROOTER SERVICE CALL *' LINECLEANED -.;.i " .: ~ ' ' " .;'. : '' ' , I~l ~' b I~ . · [-I JOB NOT'GUARANTEED FOR FOLLOWING REASON ' ' · ' ' : :: ', .' : "', Municipality of 'Anchorage . WORKACCEPTEDBY. ' ' 13~.p!_He~ +h ~. H~;~a. Sc'vices -:.. ..:-.:..:.. [:. . .... -- ..,~..... ,,.~ ,,. , 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 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 13; B~ock I; T~x~dni Park 25, 1988 Location (address or directions) (b) P.r_oPe.rt¥ Owner Ann ~ie~and Telephone: Home 337-6664 Ma. [ling AddreSs 9750'Ch:~n~B~z D,~v~, Anchora.g~, ,~a6ka 99507 (c) t'ending.lnsiit~Jiior{ "" '" .. · Telephone Mailing Address,'" ' ' · (d) Business Real'Estate c°mpahy and Agent FORTUNE PROPERTIES/Mart~ Marge~on Addres~ -. --$000.A 'Str~t, Suite. 101, Anchorage., Ala6ka 99503 Telephone" 562- 7653 (e) Mailthe HAAtothefollowina address:or:Checkhere ~,ifholdforpickup. Listcontactpersonand day phone numberbelow. $ & $ ENGINEERING/~94-2979 170~4 Eag~ River Loop Road~ S~ ?04 F~g~a. ~u~: APaab~z 99~77 TYPE OF RESIDENCE Single-Family)i~ Number of Bedrooms ordered by Ann Wie~and 3. WATERSUPPLY Individual Well I~ CommunityD Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOS~,L Onsite ~]( Public I-1 Community [] Holding Tank [] Note: If community well system, must have written Confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 IRev 8/86t 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 $ ~- S ENGINEERING 17034 Eagle RiYer Lu,;~,''-;~ad-N''-, 2-hA- Address Eagle F.~vc,.", .~_1 aska 99577 Date Telephone DHHS APPROVAL .Approved for ~-Cr~)bedrooms by ~ ~ Date Approved '~ Disapproved Conditional Terms of Conditiona! Approval 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-o75 ~Rev 8/86) Back .C~F .~,5~J MUNICIPALITY OF ANCHORAGE (MOA) '~ ~ ~ ~ L _ CHECKLIST- FEBRUARy 1984 ~' ., ,'~'~ . ' ,~ 264~744 ~ ~ Legal Desc~tion: .. ~ WELL DATA Well Classification' Well Log Present,N) Total Depth / c::>~ r Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: To Septic~ Tank on Lot Cased to If A, B, c, D.E.C. Approved (Y/N) Date Completed ?-.: ~"Z..- ~i Yield Depth of Grouting '--'""-- Pump Set At Sanitary Seal on Casing<~N) Depression Around Wellhead (Y/I~ \~'~'P'~ ; On Adjoining Lots · I To Nearest Edge of Absorption Field (~n.Lot ~.c:C~ A--' ; On Adjoining Lots To Nearest Public Sewer Line I~/. ~/ To Nearest Public Sewer Cleanout/Manhole I-~ t/~'- To Nearest Sewer Service Line on Lot Water Sample Collected by '~'~ ~ ~l-.~!.~c--~(~l~,~ ;Date Water Sample '['est Results Co'mments ~. I'~ ~ ~,-Jl B. SEPTIC/I=IOL-DtN~ TANK DATA Date Installed t~/.,~ Size Standpipes([~) y Air-tight Caps~N) Depression over Tank (Y~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from SepticJq"~ Tank: To Water-Supply Well ~, To Property~Line /0 ~ ,~.~ To:Water' Ma,~ n/service Line ~,',~.,.Course ' · ' ( O~ ~ No:of Compartments ,,a Fou ndation..~anout([~N) ~ te Last Pumped '"'/...- ; for Temporary Holding Tank Permit (Y/N) To Stream, Pond, Lake, or Major Drainage 72-026 {Rev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I,o ["7 Width of Field : 'r~,~ Type of Sys[e.rn Design (-~ Length of Field ' - ' ; "' ' ~--~"7 Depth of Field / ;'~ ';df Gravel Bed Thickness Square Feet of Absorption Area ~------~'~'~ ~ Standpipes Present.(~N) (,O~.' Depression over Field (Y~) J~ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~. t:::>~:~ I'~ To BuildingLot Fou ndatio nixie, i/~ ., To Water Main/Service Line ~ O To Stream/Pond/Lake/or Major Drainage Course To Driveway. Parking Area. or Vehicle Storage Area To Prop, erty Line ~,c::> I,(..- To Existing or Abandoned System on ; On Adjoining Lots "'~'~1~" .~. To Cutban~k (if present) Co m m e nts Do Dimensions __ ' Manhole/Access (Y/N) "Pump On" Level at~ Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) . . . Tested for ~~~, _. , ~ ~. _ ~es during Adequacy Test. Meets MOA ~';: rmiCea~tsCOd es (Y/"i ~".'.:': . .:; '. . ** Check Permitted Bedroom Rating Against HAA Request ** ' I certify that I have checked, verified, or conformed to all MOA and'HAA guidelines ~'n effect On the date of this inspection. S S & $ ENGINEERING . igned ...... DaTe 11034 Eagle River. Le<3p Road No 2~ ~ Compa~la Rivar: Aleg~, 9~5~ ~No. Receipt No. / ~'~ Date of Payment ~ ~ ~ ~ *moun : Page 2 of 2 ": 72-026 (Rev 8/86~ Back FEDERAL TAX ID # 92-0040440 ANALYSIS REPORT B! SAMPLE for Work Orde= ~ 6907 DAte Repe~t hinted: JUN 2 88 @ 12:13 Client Sample ID:L13, BI, TUXEDNI S/D PWSID :UA Collected 14t! 27 88 @ h~s. Received MAY 24 88 @ 13:30 lms. P~esetved with :NONE Client Name : S & S ENGINEERING Client Acct: SNSENG? P.O.~ NONE REC'D Req % O~dered By : Analysis Completed :JUN 1 88 Send Reports to: Labozatory Supezvisoz :STUN C. EDE ' 1)S & S ENGINEERING Relea,ed By : /.~...~... 2) -;:::::; ............ .. ......... .... -.. ......................................................................................... Instruct: Chemlab Re£ l: 1189 Lab Smpl ID: 3 Mat~tx: Watez Allowable Pa~ametez Tested Result/Un~ts Method Limits NITRATE-N 0.85 ~g/1 EPA 353.2 10 Sample ROUTINE SAMPLE. Rama~ks: I Tests ?ezfozmed ' See Special Instructions Above UA-Unavailable ND- None Detected "See Sample Remarks Above NA- Not Analyzed LT-Less Than, CT-G~eate~ Than I " DEPARTMENT OF HEALTH & ENVIRONMENTAL ~-~' ~ ,. ~ , , ~',:. ;': MuNICIpALITy oF ANCHORAGE~' ' j~ ~' ~ 825 L Street- Anchor'g~, Alaska 99501:'~-- 'E .... ' ' ~: RE~QUEST FOR '"' ~ ........ ' .... ' ........ AR~R0'VAL OF iND'(vID~AL WATER DIREcTI'ON~: ~omplete all parts on page 1. Incomplete reques~ Will not be proc~d. Please allow ten'(10) days for processing, 1..,PROPERT~OWNER ~ · · ~ ...... ,, ........ PROPERTY RESIdEnt,III ditf~r~nt from a~ve) 8, LENDING INSTITUTION , : , · ~, ,.~ ....... ~ .... MAIL N.6 ADDRESS ',~ ~ ' ~ '~ I ; i ' ' ' : ~ MAIUNGADDRESS ' ; ' . ~ 6. TYPE OF RESIDENCE ' , ,I ..... , NUMBER OF BEDROOMS 2- I' :1' i !I 'l'""li;One:' '"' ' '~: B~ ,Four " I '[:~/ ,, ~ ', i i I I " i' ,,, SINGLE FAMILY i'~: ~'i :;'' ~" ~ ' , I [ [] ~wo [] Five "' i [] MULTIPLE FAMILY'. !],i "II'! ': t..! ,J []!; IThree ,j~ [] Slx [] i: Other ~ 7. WATER SUPPLY .... I:: '.!J~/' INI::JlV. IDUAL* - .......... : ,- h [] COMMUNITY ............ [] PUBLIC UTILITY ;ATTACH.WELL LUG."A wel 'log is'required for all wells drilled ...... "'s'i'~¢~Jd~ 1B75, FeFwells drilled prior to that d~{e;'give weli .... , - aepth (attacn og f avai ab eJ): Ji 8. SEWAGE DISPOSAL SYSTEM... · ~'~INDIV'I ' ' ~' .: DUAL/ON-SITE** [] PUBLIC UTILITY ILL:: ind viddal/oh-si{e,'give, installation daie .f, . I. l . Ii ~.. ,, ,, i · . :.. ,, ~. . . system IS over.two '~2~ years o d an adequacy test s requ red ii ~: ..~.~ i~ .~.. i.~., ' t[ : ' Dy this uepartmen~. ~ ~ ~ '.~NOTE: THE INSPECTION ~E MUST ACCOMPANY EACH REQUEST BEFORE:PROCESSING CAN BE;INITIATED. 72-010(3/78) t r~'~ THIS SIDE FOR OFFICIAL USE ONLY . .__' , DATE RECEIVED INSPECTION APPOINTMENTS ' TIME TIME TIME )ATE DATE DATE NSPECTOR INSPECTOR INSPECTOR DIRECTIONS: :. ~ . :- NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensions: [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SiX [] OTHER PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED .-,. PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Septic/Holding Tank -IAbsorption Area I Absorption Area to nea rest Lot Line ........... iSewer Line 4. DISTANCES WELL TO: INearest Lot Line 5. COMMENTS [~PPROVED FOR [] CONDITIONAL APPROVAL (letter must acco,~/pa)y []DISAPPROVED // DATE LEGAL D(ESCRIPTIO ' BEDROOMS certificate) 72-010{Rev. 3/78) : ;'i N cip liW AnchOrage' . POUCh 6-650 ANCHORAGE, ALASKA 99502 (907) 279-2511 GEORGE M. SULLIV,41V~ It, fA YOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (825 "L" Street) November 21, 1978 Ann Wieland 9750 Chenega Drive Anchorage, Alaska 99504 Subject: Lot 13 Block 1 Tuxedni Park Subdivision The request for approval of the sewer~and water facilities can not be approved at'this time. Before approval may~ be granted, the as-builts of the sewer system must beN submitted to this office. As of this date the engi~r~ has not done so. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RcP/ljw CC: First National Bank of Anchorage Mortgage Loan Department Attention: Kitty Post Office Box 4-2090 99509