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HomeMy WebLinkAboutLAKE HILL ACRES LTS 6 & 7Lake Hill Acres Lot 6&7 #051-053-67 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221093 PID Number: 051-053-67 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name STEVEN & JEANNIE EMERSON ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 22450 LAKE HILL DRIVE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot LAKE HILL ACRES 6 & 7 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. well J00'4:__'7_' ....._....___. - 25'+ Septic g.❑ Other. _. . TANK ® Se ❑ S.T.E.P. ❑ Holding- tic Manufacturer GREER Capacity 1000 Gal. Surface water 100'+ -- Material Number of compartments Lot Line 10'+ __ NA HDPE 2 Foundation 10'+ __ LIFT STATION Manufacturer Capacity Remarks Tank insulated. 3BR HOUS. Gal. Alarm location Electrical installed by Installer JRS PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection ection 1" 5/11/22 Zia 5/11/22 Location and description 3`' 4'h TOP OF MH / RISER ON-SITE WATER AND WASTEWATER SECTION APPROVAL �C�\ OF A ' • • -' Conditional Approval: Date i �'tpll TH .. • • • • • • • •...- . Septic System / r� Ap ro- Curtis Huffman Date �—I �`ccis •, CE 128991 ���/� �0k ✓ (� lF�• 5/13/22 . •�4 rr ��F�PROfESS10Na Note: this approval does not include well permit requirements. i\ROFESM .'" PID: 051-053-67 PERMIT: OSP221093 A—C=63.0' B—C=49.6' A—D=64.7' B—D=52,2' A—E=67.4' B—E=56.2' A—F=69.3' B—F=59.0' i o WELL __v_1 - - - - - - - F - � 7� 36R HOUSE GARAGE =---- �----------- \ GRAVEL DRIVE B A ' -- ASSUMED LOC. LOT 6 LOCATED 100' WELL RADIUS & 5'+ TO EXISTING FIELD PRIOR TO CONST. DFCO C D BM -TOP MH E OF MH CO F ` GCO GECG iMiSSiONED EXISTING ❑ CO S.T. & INSTALLED NEW 1 c \ 1000 -GAL HDPE SEPTIC TANK\ WITH NEW DFCO & DCO \ 9 \ & 5'+ TO FIELD & \ \ 100'+ TO ADJ. WELLS. EXISTING ASSUMED LOC. \ \ FIELD \ \ \ \ \ MT SEPTIC SECTION SCALEi NTS LAKE HILLACRES LOTS 6 & 7 PREPARED FOR: STEVEN & JEANNIE EMERSON 22450 LAKE HILL DRIVE CHUGIAK, AK 99567 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK©gmail.com SUPPORT® SERVICE DATE: 5/13/22 SURVEY. HOLT DRAWN: FWCS SCALE: 1" = 30' PAGE: 1 OF 1 OFAZ4 * CJ TH rtis Huffman NCE 128991 "I� 5/13/2022e ftsstovo, MUNIGIPALI 1 Y VF ANG HORAGE Ort -Site Water & Wastewater Pr*grann Po Box 195650 4700 Elnwe R06d Anchorage, Alimki 995iS-6650 Phone: (9QT) 343--79d4 Fay X07) 343,M? hltp:Afw&.rnUr1I.oq OomIi9 On -Site Wastewater Disposal System Permit Permit Number, C)SP21093 Work Type: SoptloTarnk Upgrade Tax Gode Numt)er: 0:510 tuuu Site LagaI Addness: LAKE HILL ACRES LTS 6 & 7 G:1:50+ Bite honing Address: 22450 LAKE HILL DFS, Chugial€ Owner: EMERSON STEVEN W JR $ aesJ9n Engineer; FIRSTWATER GONSULTINC This permit is for the construc:tlon vf: Effective Date; Expiration Wte; Lot Size irl Sq Ft; Total Bedrooms: W V2 5J11= 63000 ❑ Disposal Field a Septic Tank 0 Holding Tank ❑ Privy ❑ Privaw weii ❑ VVate:r Storage All Cerlstrutth5li thall be In accordance With: I, The attached approved design. - All rV3rlr,irempnt� gpgci led In Anchorage Municipal code Ghaptam 15-55 and 1.66 and Uric State of Alaaka Wastewaler Disposal Regu latlons (I SAAC ) and Drinking Waller Reg ulations j 1 SAAG80 � 3- The wastiawaier. Code requires inspeclions during the installation. The engineer shaO notify the Development -Services Department per AMC 15.65. Provide notification by ca Irina (907) 343-7-904 (24 7). 4, From October 15 to Apel 15. a subsurface soil nixorption system under constrvctlon during freezing wealher shall be either. a- Opened and Closed on the sarne day, or b. Covered, scaled. and heated to pnwenl freezing SPOCIaI Pra+risions; Lo to the beginning of the field toconfirm that the 5' sopareidon between the to nk and field will be met. Installs Cleanorut so the Field carr be [ooated in the future - t The reCorb drawing is to show the radii for wells an the Ipls to the west and south. Recelved By: Date, 5/11122 Issued By; �� Date: =� 3 U H 0 G � PDAL TY OF A GFE _; atter Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-053-67 Property owner(s) STEVEN & JEANNINE EMERSON Day phone Mailing address 2610 LANCELOT DRIVE W, NORTH POLE, AK 99705 Site address 22450 LAKE HILL DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) LAKE HILL ACRES LOTS 6 & 7 Legal description (Township, Range & Section) Lot Size 63,000 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade (D) El Holding Tank ❑ RenewalDuplex ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. gnature of property owner or autnonzed agent) Permit/Rush Fees: ,to2 a 5 Date of Payment: YAZs /GZ Receipt Number: 5052 L-1?_ Permit No. os PZ al 0 � 3 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com April 30, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: LAKE HILL ACRES LOTS 6 & 7 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000 gallon HDPE tank per the attached design and recent as-built survey to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221093, Deb Wockenfuss, 05/11/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221093, Deb Wockenfuss, 05/11/22 0 0 h 0 0 0 0 0 0 0"MSL ER _ ROA D N8955'10"E210.00 4 OF.q �q�;4p CO. 4g LH* `9 U Nn SHANE A. HOLT dpr°. LS -6914 0�0� Q" ao ��Aro fessiona% �Qo N8955'10"E21000 SUNK YSIDE DRI VE note: NO EASEMENTS APPEAR ON THIS PLA 7 - SURVEY SURVEY ORDERED BY: dar walden @ keller Williams THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 0 0 0 0 s G THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OF RECORD AS OF THE DATE OF THIS SURVEY. ANYUSE OF THIS DRAW/NG BY THIRD PART/ES /S PROHIBITED UNLESS WRITTEN PERMISSION /S PROV/DED. AS-BUILTSURVEY I" =30' NO CORNERS SET THIS DATE r/ l HEREBY CERTIFY THAT l HA VE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOTS 6AND 7LAKEHILL ACRES A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPER TYLINESAND NO VISIBLEENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 29TH DAYOF APRIL 2022 HOLT LAND SURI/EYING 9309 GROPER DRIVE ANCHORAGEAK 99507 15432 FB 222-7 223-8515 ti h N h LOT 7 544 — — WELL cm z Z ii za.a 64.9 --- -- m — ____________ a 3 ______�_ , PROP. LINE O 4 "------_ YARD LIGHT ----------------------- EEK V �_ �II QS ----------- W{ GRAPEL DRIVEWAY 3 4.------------------------------------------------ F.P.______ YARD LIGHT POST -WIRE FENCE i LOT 6 `� SHED SHED SNE yG A G YARD LIGHT YARD LIGHT OF.q �q�;4p CO. 4g LH* `9 U Nn SHANE A. HOLT dpr°. LS -6914 0�0� Q" ao ��Aro fessiona% �Qo N8955'10"E21000 SUNK YSIDE DRI VE note: NO EASEMENTS APPEAR ON THIS PLA 7 - SURVEY SURVEY ORDERED BY: dar walden @ keller Williams THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD OR OTHER RIGHTS OF WAY, OR ANY ENTITY NOT ON THE RECORD PLAT ARE NOT SHOWN HEREON, UNLESS NOTED. NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAYBE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 0 0 0 0 s G THESURVEYDATA AND MEASUREMENTS HEREONAREPREPARED FOR THE OWNER OF RECORD AS OF THE DATE OF THIS SURVEY. ANYUSE OF THIS DRAW/NG BY THIRD PART/ES /S PROHIBITED UNLESS WRITTEN PERMISSION /S PROV/DED. AS-BUILTSURVEY I" =30' NO CORNERS SET THIS DATE r/ l HEREBY CERTIFY THAT l HA VE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOTS 6AND 7LAKEHILL ACRES A NCHORA GE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLEIMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPER TYLINESAND NO VISIBLEENCROACHMENTS EXIST OTHER THAN NOTED. DATED ATANCHORAGE,ALASKA THIS 29TH DAYOF APRIL 2022 HOLT LAND SURI/EYING 9309 GROPER DRIVE ANCHORAGEAK 99507 15432 FB 222-7 223-8515 /� GREA , r'R ANCHORAGE AREA BOR,._+GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME MAILING ADDRESS (ZA ©x/za-d-PHONE /(jLn6a-'';19IS I O('gTl� c a l`'� �' LEGAL DESCRIPTION L G '�"d l SEPTIC TANK: I` r V DISTANCE pY {V�, NUMBER OF FROM WELL MANUFACTURERS MATERIAL COMPARTMENTS LIQUID CAPACITY /J66) GALLONS. INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH TILE DRAIN FIELD_ T_/�_P�L TOTAL LENGTH DISTANCE FROM WELL FOUNDATION _NEAREST LOT LINE OF LINES 1-dIN. NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTHTOTAL EFFECTIVE ' ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER y DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE IN. WELL: TYPE CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM " CESSPOOL , OTHER SOURCES APPROVED_ DISAPPROVED REMARKS — DISTANCES: INSTALLED BY: -��mq SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: . DIAGRAM OF SYSTEM DATE G.A.A.B. lip R; sm MA i? n4 AN fuO MT 4011, PASMAIMM SYSTRI 14; : 0-: ..4..11--i; 1. : " P V-::::"1.- 4SO -T- 4. -4 0=1 10 7my K71 to? pow AV, Vol 1 If Po' X Of ly 011f" 1, PjAR11 1 1 14F [011 f i[j T Ilii 1 )EPA JJTJ ( 1.1'd FjjfTT ) MT RE TRM71-4 CAR 1",f11 I PJF 1 1=1 A 11 112 ar. to 111 IT 0 IfTKAIRAI M PIT TS 111`7 MST(liACAT FIF04411"PI TIM MR&FICAT OF THE 1 P,i i ) I ; v J 1 1: 1 -1 T (A 4 1 A K T rF, f: 1': 1 1".1 171 T IF ( 11 .4 ( J� I .,j F1. Fs'T i=.'i- I '-, j�'U j 1 1 :1 1 ; -i 1:: 1-1 K! 1 1A:j..11:. : C-, KRONJI 1 Q Tbp- jqjfQyPRjj LfjOrl-I Mi CASAVRI. 1AMEM 110'" MITFIRI A . PTFN: w- Q; A A CR F, 071 n0 Y7- F"" - 1- 3: KT� -K FARM< SO X 54" Vv- is opt M KTH 1300 11 h CA P-11 F,,; w(k v , YA. "; V Rh&="PT M:'I', 1V jf- P. A =; 1=1 W& 177 ORKRYTH :-V'� 1r*"'.'.VT:Pj- p, � i j:: l 1 1 1 kJfj M fWald WIM711 kil Thifli rf FMAT, T FPSHM: T T fly Mr) rimormn. in, m T se 04. Prll;? 1,41- N 1 ';.;1 1.1 r;p M To TF"J" To f1j11sp ( A IT 1 f*j,. l j ), j:l !l,, ) q; I Fly (J: 1 IV 1 (MVIA fA AM 1 . FIND FWAY MPS I TF 5171'11 OFT D MR S011. SYMP! f S 1: I..J: 1 1 11" H VARK"Mw 6111 1 fps 0Oki PITTIT 171"Af fA FIRKIC 0711. kwom f . r mif v Cmiq 110 FAT491 AN 4 0 T (ly 1) T RMAM fARF RM Y DOME TP 1AM1)1 P FARCOMP )jj1!Hj AlUk".1 nii 1i O.f#EGEO r Russell Oyster 694-2774 Soils Er Foundations ECHNI CAL Et DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL Loc Earl Ellis 688-2280 Land Development Performed for: Name: \ . = � --ZL< zZ 7d Tel . No. Lit ` -u i I -3 Mailing Address: ONR_) Legal Description: Depth (feet) Soil Characteristics 0 1 ���.�,• � :...,'�' � :� i7 =y2� \ � ��1 j ;•. ej h;`.i`� zt.�':: Cis `�'� ' i/i �•7.�, 2 3 4 7 8%G!3� i�i1�w c/a,:t w x7 jn1G�\`e>/�� 4`f tvJ.ii•j.c;. 9. 10 11 f -7 /W52 12 13 14 15 16 Ground Water Encountered: Yes No V� If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Z��r F�L� .�� � tz�i« a«twti 2-1 ;l 1, Performed bv:Date:t_.3� / am MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-053-67 1. GENERAL INFORMATION Complete legal description LAKE HILL ACRES LOTS 6 & 7 Expiration Date: g— C9 Z Z Location (site address) 22450 LAKE HILL DRIVE, CHUGIAK AK 99567 Current property owner(s) STEVEN & JEANNIE EMERSON Day phone Mailing address Real estate agent 2610 LANCELOT DRIVE WEST, NORTH POLE AK 99705 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ X50 Date of Payment/ / Z 2 Z Receipt Number cl0 - 7 Z COSA# OSGZZ(ZO�-1 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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 Certificate of On -Site Systems 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 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 (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 5/11/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the �11M kk system and maintenance. The operational life of all well and septic systems are subject to OF �+4S1Z� these various and dynamic characteristics and are outside the control of the evaluator of the �' •�f�i well and septic system. Therefore, any estimate of how long a system will function satisfactory W�Q: • • • • • !� �) for rent discre ancies exist can be iven b First Water Consulting & encroachments, deficiencies or g•• TH curor future occupants pgts or Y grantee that no unseen enoa� � • • • •.... •—• • • • • • • ••• . • J� r 6. DSD SIGNATURE % • • • • • • • • .... . Curtis Huffman System #1 Approved for bedrooms !�+ ��29 CE 128991 •.•����'� System#2 Approved for bedrooms PROFESSIONS' Disapproved. - Conditional approval for bedrooms, with the following stipulations: By: wti Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: LAKE HILL ACRES LOTS 6 & 7 Parcel ID: 051-053-67 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 5+ gpm Date drilled CIRCA 1976 - Water storage tank volume NA gallons Total depth 220+ ft (PER MOA DOCS) Well disinfected for coliform test? ❑ Yes ® No Cased to 40+ ft (PER MOA DOCS) ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 3.33 mg/L ElNitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 12+ in. F wlrs Date of flow test for COSA 4/22/2022 Collected by Static water level at beginning of test 182 ft. Date of Sample 4/25/22 Comments COLE SULLIVAN ADDED A NEW SANITARY SEAL WITH CONDUIT B. TANK DATA Age of tank(s) NA — NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA ®Standpipes/foundation cleanout per record drawing Date of pumping NA D. ABSORPTION FIELD DATA Which system tested (date installed) 10/19/1976 ® ALL standpipes present per record drawing Total measured depth from grade 9.2 ft (max) Measured depth to pipe invert from grade 4.9 ft (min) ❑ N/A — pressurized field C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 4/22/2022 Results 0 Pass For 3 bedrooms Fluid depth prior to test 10 in Water added 450 gal New depth 17 in ElMonitor tubes go to bottom of effective. If not, state Elapsed time 1400 min depth into effective MOA IR TED — 4XED APPROX. ®Code -required soil cover over field Final fluid depth 10in ® System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: MT/CO AT GRADES. ELEVATIONS SHOW APPROX 4.1'ED & ALSO PER 2005 COSA. E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' — ®Yes if No ft ®Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water >' 100 _ ®Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >' 100 _ ®Yes if No _.WaterJylain >_10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ®Yes if No ft Private Wells >100' _ ®Yes if No ft Water Service Line > 10' ®Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. -'+ 1H ................. / ..+.. ....�....:. �j• Curtis Huffman : 4 d CE 128991 �•��,,m' ft ft ft ft M ft ft ft -3AIYG 77/lH -7AI 00 C0 -'I /iii , 6r? 00 A/ 00 �_<.:.1114 W au of 2SNOl/ 7/lhjb1�1 :779N/S 1XV0 No OLS 0-c%? N ,60 00 A/ m L i A •i F YYY LL T-1 CC i O W a 0 T i SQ_ C. J x- Tec : w } v ��bbb l q J I f- i �- E O C ---------------- 00 �_<.:.1114 W au of 2SNOl/ 7/lhjb1�1 :779N/S 1XV0 No OLS 0-c%? N ,60 00 A/ n,)nf,zw'j,6000A/ U i h W m 4 Ory z W w Z QC V N 2 66 �O OWti� w 41 hWjW O tioe3 Q Z m L 0 w zz �. F YYY LL T-1 CC i O W a 0 T i SQ_ n,)nf,zw'j,6000A/ U i h W m 4 Ory z W w Z QC V N 2 66 �O OWti� w 41 hWjW O tioe3 Q Z m 0 w zz �. w w YYY LL T-1 CC O W a T i C. J x- x.; w } v l I f- i �- m 0 w zz �. w w YYY LL T-1 CC O W a T i a �. 0000 �• Q � YYY LL T-1 N VA QQoo e� O Municipality of Anchorage 57/:%/u os , • ,., ' Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING C� Parcel I.D. 051-053—'.."['07 HAAtt 1=17_. 1. GENERAL INFORMATION Expiration Date: R — 3 — © 5 - Complete Complete legal description LAKE HILL ACRES SUBDIVISION: LOT 6 d- 7 Location (site address or directions) 22450 LAKE HILL DRIVE ► EAGLE RIVER, AK. 99577 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JERRY FULLMER Day phone (907) 440-9051 22450 LAKE HILL DRIVE * EAGLE RIVER, AK. 99577 Day phone RANNA FEKRAT w/ PRUDENTIAL. JACK WHITE Day phone 441-5815 3801 CENTERPOINT DRIVE, SUITE 200 0 ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my In ves tiga lion, based on procedures outlined In the Health A uth only Appro val Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system ls(are) 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 riles and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, end regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. 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 8 Regulations. The reported results described the performance of the system under the conditions encountered of the time of the test, and separation distances measured to readily identsable features. The operational fife of all wells and septic systems depend on the tical soils condition, groundwaterlevels 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 results do not guarantee future performance of the system, nor do they guarantee that there are 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 reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. 337-6179 Date 7 ° Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist (f Septic System Advisory Well Flow Advisory tR«. ixo,l ON-SITE Maintenance Agreements JJ�� •p Supplemental Engineer's Report �����11111111Y Other R�m Afl, /011, Original Certificate Date: Municipality of Anchorage ' Development Services Department Building Safety Division On.Ska Water b Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-66W www.d.andum ge.ak.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LAKE HILL ACRES S/D: LOT 6 1 7 Parcel ID: 051-053-0 6.7 A. WELL DATA *PER PREVIOUS MAA Well type PLUME If A, B. or C provide PWSID# NIA Date completed 01976 Sanitary seal (YIN) YES Total depth •220+ ft. Cased to •40+ ft. FROM WELL LOG Date of test Static water level _� ft. Well production 9— p.m-WATER SAMPLE RESULTS: Coltonn — '&,— colonies/100 nd. Nitrate A dL mgJL. Well Log (Y/N) NO Wires properly proteded (YM) YES Casing height (above ground) 12'+ in. AT INSPECTION 3/9/2005 184 ft. 7.5 9— p.m- Other bacteria _115) colonies/100 ml. Arsenic: N/A mgA. Date of sample: 3/9/2005 Collected by: GEG. LtD. B. SEPTIC/HOLDING TANK DATA *INSIDE HOUSE Tank Type/Material STEEL Date installed 10/19/1975 Tank size 1000 gal. Number of Compartments 3 Cleanouts (Y/N) YES Foundation deanout (YIN) vYES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 3/14/2005 Pyr JR'a PUMPING C. ABSORPTION FIELD DATA Date installed 10/19/1976 Soil rating (g.p.0ftbr t bdt0 245 System "a TRENCH Length 57 ft. Width 4 ft. Gravel below pipe 7 ft. Total depth 09.17 e, Eff. absorptions, 798 W Monitoring tube 00YE5 Depression over field NO Date of adequacy test 3/9/2005 Results (Pass/Fall) PASS For 3 bedrooms Fluid depth in absorption field before test 6 in. Water added 1543gal. New depth 0•'511n. Elapsed Time: 1195 min. Final fluid depth 11.5 in. Absorption rate >: 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 6 type) NONE KNOWN If yes, give date — **MONITORING TUBE/SUMP EXTENDS ONLY 490 INTO DRAINROCK. 00020 ABOVE INVERT OF DISTRIBUTION UNE. D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size In gallons High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAifi station on lot 100'+ Absorption field on lot 1000+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 100+ Surface water 1001+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS O. ENGINEER'S CERTIFICATION I car* that I have detemdned thnwgh field inspections and •......y T ....... 't review of Municipal records that the above systems are m conformance with MOA HAA guidelines in effect on this date. ... y"� Engineer's Printed Name JEFFREY A. OARNESS Date ti hk 74#r HAA Fee S Data of Payment LL Receipt Number (Rev. 12I01) Waiver Fee $ Date of Payment Receipt Number npr 26 OS O4:36p Prudential User 762-7544 P.2 04!25/2905 12:03 9972757904P.OEEPT E JOI;� JF PAGE 02 n1IkD.11Ma61 AAOI _ . _._ I!Z t/ t - Aa IlNdia ultra'- ...... .._.._ .. .. ..._ _.. ._ ...:.. ...__. _'.- .. ::.. _...._..__.... _ ._ .. ... _. .. ... _.. ... o r: - - - ----.. ......__._..... .o•-• -'67=':7. 7242- 77.. 1 7 --:--- . -- - -• �` u..._S:7r?9.:' .5.1.'. o'^r�!rw_2/O,:OD:' .-.....=__ - ...: - _:.•.. •-'._. - .- SURVEY•CERmncAnON--: -.._. _-.•..f+r�a .•• a� -- _ .�._�.., __._:",..__�::....: PFe Dred., b. ... _' P Y ... Ro15ert-'E.._3o.hns,._:Jr.---& ,_Assoc_-: _ . S - �r---'�G,�1�-`,'--•- M ..,,,.�.:.7:.'� I_ _-..PFSLf25siOn01 LO.p_d 2rvRY9_s=_._ CP. 'w+..w''w,w•'.sM+�w�w«r rw..�i.w i•{t`^ -_ _ t, .•.}�I._' - " _,__ 1700 pRWN AHCibRAOE ALASAA 935da_._.. _._..+- _.._. SCOW—.- _ . Rx.1aL5P. eRe_Ptet F34 N..p. FxP+BA10N JAS -•BUILT ... ).. ...___ J• •• ..._.. i.. ____ ____.. �al•,Surwy-?a. _. _07 _ ... 7ra.m 0 C YnC ! rFWJ. n Y_REJ. -- -Lt. c aw.i_•rrl,.ny tRw I _ ... - .. ..::::c : Rca E' ^ __. -----._ ..4:_23 ... __ Onto Orow ,...__._.. .____ --- 4 .. _-25-GS-' Crld: .. __-_ w0� TS6'1 -25-89 " ._......... - - . __ -P •. "e' II�•.r•. -S' -' MAL+ RUC7la1[ tiSe B7llT.. I N:«w'i.++...,..I _...4T21' ��: . �'•., ... ___ _ .•' t _ gJ ra - _.....I •.e Ir.;_..:.I LKd De.crytlon:^- M wM. �.......: t40 .'_(_ .1,01ES..7-ani -7-- ...:. :...........�«� ' tiaa�..•••. Lake..Hil7:hczes.. .. _ -Lor DAWY SIJRVET' TYPE .. ... _. _---... -_ . _- _ ' '-SYMBOLS - O T(XNmelelr Af-B111L1 - •._.. --. _- . _ '-e..»..oeoq - c), MAC "Xr Af"-WlT —...I . .�.na!rV.v.... . a'r.1LT..... LOT! -FOUND-REBAP WOOD 'FENCE "- r `• _ - _-CCNCAA;ITTE OCG -•ASSUNEO ELM - LV:PLOT'PLANS-R-LOT'SURVEYS PLOT PLANS -&-LOT SURVEYS.w..... ...___.._.. 'NOTE._.• .•,...-.. _.._._..._. .. ..... . IT IS, ­ E RESPONSIBIUT7 OF.THC_ BUILDER OR.OWNER.. PR:OR..TO._ +.-ONSTRVCTI]N, TO VERMY PROPOSED -e WLDINO CRAOE RCLAM'�r4- : ONLY T.OSC IMPPOVC-mCXTS A' ovc.CROUND AND ,1SI8Lc.T4LL.8C 1_..S'f10WN.. FCHCES-A.ELLS-SCPTIC =- KOU,T,._ $IDEWALN_-... ORIVEWAv_ .. .TO.F1NISrIZD.CRADZ AND U11LUYL WECTNCNS.AND_IO CETCRMINC_ THE C%ISTEVCE.OF ANY EASELI£NTS COVENANL•.,OR RCS7RICxDNS. -... CTC_.lRE.SNOfN1 IN. T1/f:R__APRROXIMATc_ZOCAIION, DN�Y. -IQW LtAT_P-PCVCNT _r.CME.IMPROVF-VEN S FR3A .a EINE SCCN.ANO LCCATEO. . .AV -•LEN ]] NOT AP EAR ON THE .RFCOROED • IVISION PLAT- A re <r p ..ra• p q -. "-'•"" -'UNDER NO-CIRCJMSTANCES SNOUL-r-A4 AS -BIM -r -M VS:D-FOR CO MICTION OR FOR-ESTABUSMNO BOVNDAR•.'-OR•FENCE UNES'� "71E SUP,VEYCR-TAF.ES RCWMSB:UV FORINC NITIAC'TRANSACTOM-ONLY-AILD.ASSVWCS'FINANCUL'.UAB:UTYTYI:Y-T6'[ m c CCST-OFTnE s:'RVEr U57E0'CWANCES PREVAIL OBER'SCAiAm-RLPROOUCT.-%MA-f CAU$E.=cRS'RIYUIf. ' I I L it6 address or directions) 22450 Lake Hill, Drive Lori Ryser, Mownhn nn ailing address P. 08ing agency attesting to 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 supply and/or wastewater disposal systemis in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. 5 & S ENGINEERING Name of FirmPhone °I 7 .6 °I y "' a 17034 Engle River Loup Road No. 204 Address Eagle River,'Alaska.99577 / Engineer's signature Date S' F_ q 7 OF XV .. '%, jr Al '1 1 1 1Cif}NWl'I,M{, ROBERT C.ICOWAN�@ CE -.8801 6. DHHS SIGNATURE - Approved for bedrooms. Disapproved. 'Conditional approval for bedrooms, with the following stipulations: DHHS,considers adequacy tests valid for two (2) years from the date ., ..of testing. Last adequacy test for this parcel was November 21;111995. Add!' I Comments 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is -issued., The Municipality of Anchorage, is not responsible for errors or omissions in the professional engineer's work; 72-025 (Rev. 1/91) Back MOAN21 - - MUNICIPALITY OF ANCH ENVIRONMENTAL SERVIC GE Municipality of Anchorage 1ON DEPARTMENT OF HEALTH & HUMAN SERVICES MAY 08 1 f Environmental Services Division drlrl5 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-R7ECE 9 V [ t�t Health Authority Approval Checklist C 1� AA LoT & ► O S 1 OS 3 - a9 ilE Legal Description: �o C 7 LAy F R,u. IkaEs parcel I.D.: La 'r -7 - 05 1 - 05 3. - 08 A. WELL DATA Well type PkiJATe- If A, B, or C, attach ADEC letter. ADEC water system number /A Log present (YQ 0o Date completed 1 61-7 Total depth 2.2o` ! Cased to 4 0� Casing height (above ground) I Sf Sanitary seal ON) 7ES FROM WELL LOG Date of test V Static water level o Well production g.p.m. WATER SAMPLE RESULTS: Wires properly protected ((DN) `(Gs AT INSPECTION L4 /So /9 1831 4.3+' g.p.m. I* Ae57A'.c 2j fay 4 PLuwr'R I"(, - Coliform Nitrate 2 • a ® M� /L- Other bacteria Date of sample: -l�I'I< Collected by: e & c ENft1NFFRINr. ___ 77034 Eagle River Loop Road No. 204 B. SEPTIC HOLDING TANK DATA Eagle River, Alaska 99577 Date installed I �- f 9 - 7 b Tank size 1000 Number of Compartments Z Cleanouts (5/N) yes Foundation cleanout (YO) 10 Depression (Y4M ►Ja High water alarm (Ye Date of Pumping 511 A'1• Pumper JK PvMo)d � C. ABSORPTION FIELD DATA Date installed I o - Ig -76 Soil rating (g.p.d./f12 or t2/bdrm �q S System type T2Eac�� Length 57 Width 4 � Gravel thickness below pipe - � Total depth I Zt Effective absorption area -7980 Monitoring Tube present ON) YES Depression over field (Y/.Q) �Jo Date of adequacy test I I - 21- as Results ( asks /Fail) PAss For 3 bedrooms Fluid depth in absorption field before test (in.); aC �Immediately after 5io gal. water added (in.): 50" L Fluid depth 45 (ins) Minutes later: 40 Absorption rate = 450 4- g.p.d. Peroxide treatment (past 12 months) (Y/N) Alode kao�*l If yes, give date Dn" rhfi/Ts.ttin 1,✓ "k)�r 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in Manhole/Access (Y/N) on" level at' "Pump off' level at" High.water alarm leve `Datum a C ested E. SEPARATION DISTANCES MAY O 8 19ci SEPARATION DISTANCES FROM WELL ON LOT TO: Mun Health ry of Anchorage Dept. Health & Human Servlees_ I S$ jii91holding tank on lot 1®5, + On adjacent lots 1 ao 1 f Absorption field on lot 1101+ On adjacent lots Public sewer main f-� /A Public sewer manhole/cleanout 1001-t (� /N Sewer /septic service line 251 + Lift station tj )A SEPARATION DISTANCES FROM EPTIC HOLDING TANK ON LOT TO: Foundation 0 , + Property line +5 51 a- Absorption field 1014 Water main/service line lo k 4 Surface water/drainage I c'01 4 Wells on adjacent lots 1 001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 2014 Surface water 100 1-f 1 Building foundation' �- Water main/service line Driveway, parking/vehicle storage area Curtain drain N oda ktJouJtn Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that l have determined thra field inspections and review of Municipal in conformance with MOA HAA uideline in effect on this date. Signature ` ^-=- Engineer's Name A) Obcccr✓rl,� Date s / y / q HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number I o o 1:-F MOM .. ._ .c, ..,,,...•,., a .., ;n ROBERT C. COWAN�� CE -0801 are 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 nn` APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. d�?)I Lo ' lis i --1]�)3-LAK HAA # # 1. GENERAL INFORMATION Complete legal description Lot 6 9 7; Lake Hitt's AclLe-6 Subdivizion Location (site address or directions) 22450 Lake HiU Dit.Eve Property owner Mailing address Lending agency Mailing address. H.U.D. #111-029438-203 605 West 4th Avenue Day phone le, Alaska 99503 Day phone Agent Sandy H1e,&stad ASSOCIATED BROKERS. INC. Day phone 563-3333 Address 640 (Vest 36th Avenue Suite One Anchorage Alaska 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 v 3. TYPE OF WATER SUPPLY: Individual well XX \It Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX 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 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 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 effect on the date of this inspection. Name of Firm s a, S ENGINEERING Phone 17034 Eagle River Loop Road No. 204 Address Zao;Ia R•v-r. Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Date �RPg� 1 ,an%%can„ P1 ;f:uJI Conditional approval for bedrooms, with the following stipulations: Additional Comments se - 4LITIC 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-01 LO yt 1 LoeV�P- AML_ Ae-96-SParcel I.D. A. WELL DATA l Well type h?-tiy kll'r� If A, B, or C, attach ADEC letter. ADEC water system number ti Log present (Y/&I Date completed / 9 7 b Drillery/L Total depth -Cased to Aa Casing height 12 Sanitary seal (DN) Wires properly protected ON) �4 FROM WELL LOG Date of test Static water level Well flow g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: AT INSPECTION 7 - Zz, -q l 174 V) y__ Septic/holding tank on lot 1 ' ; On adjacent lots Absorption field on lot _ 7_0 ; On adjacent lots _ JI Public sewer main Sewer service line A Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform 'tt/� 12 Nitrate e12 49 Date of sample: i �/ J'�Z Collected by: B. SEPTIC/HOLDING TANK DATA 0 m z -a c m P. n? "G rt � g.p.m. c 3� 7 Sr (n <.CD I to oCD N i"(.D1.flli 6� R)`y to _ Other bacteria — S + 6 Date installed to- 1(D'L 16 Tank size �. nfl'b Lmp<c -- Compartments L Cleanouts (27N) y— Foundation cleanout (Y/'gP lA Depression (jYA§ ) High water alarm (Y& Alarm tested (Y/N) � u, Date of pumping 7 - I`1 - 9 ( Pumper S(L �Ss Poa c_ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1 b I On adjacent lots I L ->p t + Foundation laS To property line 36 Absorption field ) b kWater main/service line 1b Surface water/drainage I oo 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N Manufacturer Manhole/Access (Y/N) SEPARATION_ DJ8T` NCE FROM LIFT STATION TO: lot D. ABSORPTION FIELD DATA On adjacent lots "Pu evel at les tested Surface water _ Date installed to - X11 _Jb Soil rating 41gA System type 4,yt Length 51 Width ��Gravel thickness 7 k 1 Total depth _1 �- Total absorption area -7 c1 S Cleanouts presentON) Depression over field (Y, R(� Date of adequacy test -7 " 272 --cif - Results fail) fkt,S for �A�� C3 as) _, bedrooms Peroxide treatment (past tz months) (Ya __ hk> IJ C— OP. l-� If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 12".) t On adjacent lots —lob 1 4- Property line l O t �- To building foundation On adjacent lots Surface water 7S To existing or abandoned system on lot u� Cutbank 'a /-6- Water main/service line_ 1J o `'t- Do t tDo 9 4- c F Driveway, parking/vehicle storage area � d Curtain drain /J/A E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & 5 ENGINEERING 17034 Eaulo Elver Loop Road No. 204 3' Signature Eagle River, fi�_ftkmm 0047,9 Engineer's Name Date _ ti, U HAA Fee $ / /U Date of Payment 1 - / Receipt Number o2.3� Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • ~� DEPARTMENT OF HEALTH & HUMAN SERVICESi�` 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. # Q �� HAA #� 1. GENERAL INFORMATION Complete legal description Lot 6 9 7; Lake Hitt -6 Acvicez Subdivision Location (site address or directions) 22450 Lake N.iU- DAi.ve Property owner H U 1J #111-029438-203 Day phone Mailing address Lending agency Day phone Mailing address Agent ASSOCIATE2 BROKERS,INC Day phone 563-3333 , Address 640 West 36th Avenue Suite One Anchonage., Ak. 99503 - Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 3 4,- 3. 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX 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. 99J105 /Cuv 1/011 Frnnt MOA 021 24 VOW �De8 (WA '�U) SZPZL •�aom sdeeui5ua jeuolssaload aul ui suoissiwo jo saoaaa aol ajglsuodsaa IOU si 96eaogouy to /l!Iedioiunn aul 'panssl si eleollilaao a ajolaq elep azApue ao suoiloodsui lonpuoo IOU op SHHQ to saeAoldw3 •sluaweiinbei alels pue Ieaapal ulepeo Aslles oliepio ui suollnlllsui bulpue1 iiagl pue sawoq to sieseyoind of Aselinoo use slut saop SHHQ ayl Te sely to 94BIS aql ui p9J91sl6aa a99ul5ua leuolssaload luepuadepui ue Aq anoge g ydea6eied ui uanlb suoilelueseidaa eqj uodn Aluo paseq saleOilluaC) lenoaddy /1!aoulny ylleaH sanssi (SHHQ) saoimeS uewnH pue ylleaH to luawliedaa aftimpuy to AllledlOiunW eqi � r 10: r/ _ jg .- ale0 :suoilelndgs bulnnollol aul ullM 'swooapeq pvv sluawwo0 lsuolllppy aol lenoaddy lsuoilipuoC) 'panoaddeslQ swooapaq aol panoaddy 38nlVNJIS SHHQ _ algia ainlsubis s, aaul6u3 ( b'� � //S66 e�selq'aanlb a16e3 1'OL'oN PEON dool -JOA-1110IGe3 7£OL L ssaaPPb aUOl�d 9NI?}33MEM3 S� s wllJ;o aw2N •uolloodsui slut to alep aul uo loa}}a ui suollsln6ai pup 'saoueulpio 'sapoo alelS pup lediolunW 1Is Cajun eoueildwoo ui sl weleAs lesodsip aaleMalsem ao/pue Aiddns aalem alis-uo aul 'uolloadsui pue u01ls611s9nul AW woal pue s91l� 9612aou0uy to AllisdloiunW 9L41 woal paulelgo uoquwaolui aul uo paseq leul /4laan aaLalanl I •ulaaau palsolpul ainlonals to ads j pue swoojpaq to aagwnu aul aol alsnbeps pup lsuollounl'ajes sl walsAs lesodsip aalemalseM Jo/pus Alddns aalenn alis-uo aui leul sMous uolleoildds lenoaddy Al!aouln`d ylleaH slut to u0ils61ls9nul Aw leul Allaan I 'Molaq umous alep uollepilen E)ql to ss pus olaaau paxills leas Aw Aq paipliao sy :A9 ig 833NIJN3 AS N01103dSNl JO LN3W31d1S "5 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 1w lk�e�s Legal Description: t-�(P-1r � 1-��- t-liParcel I.D. o r 53-69 A. WELL DATA Well type t�P ,46e•Tq-- If A, B, or C, attach ADEC letter. ADEC water system number �Io. Log present (YQ Date completed 117 to Driller V JL Total depth 22C� 1 ; Cased to 40 Casing height 11 - Sanitary seal MN) FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot lip, Absorption field on lot 12 Public sewer main 'J!'.' Public sewer service line 'aJ� WATER SAMPLE RESULTS: Wires properly protected (Sa'N) 9 -p.m AT INSPECTION ,l, o )791 x w cn LU a> +. w uti ) LLi .'� 9.p.m.a U K- a w :D LU D < z rr — ; On adjacent lots k p o W ; On adjacent lots X00 t} -Pu blic sewer manhole/cleanout Petroleum tank ,A) S 1� Coliform b GJ�%IIop ,C. Nitrate FAI C -V I -Q• Other bacteria Date of sample: 7- Vl -`l 1 �1 ' 22-y I Collected by: S & S ENGINEERING17034 Eagle River Loop Rest' . Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed 10+ kH -)Lp Tank size Iodc:�. Compartments CleanoutseYN) �J Foundation cleanout (Yo Depression (Y4g /J rj Alarm tested (Y/N 'J/ High water alarm (Y(Y&) Date of pumping 7-19-`1l P\)MPt^1v, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot kt o t On adjacent lots 1 bcD W Foundation To property line I ,- Absorption field 10 Water main/service line Surface water/drainage I ob L�.S 1 72-026 (Rev. 72-026(Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) Nigh water alarm level Meets MOA electrical "Pump on" level at Manufacturer Manhole/Access (Y. SEPARATJQNID I STANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off' level at Cycles tested Surface water _ Date installed Soil rating %.-OrS �/gz_ System type Length -Width Gravel thickness Total depth «� Total absorption area Cleanouts present &N) �J Depression over field (YA ^� Date of adequacy test 7 - Z2 -"I / Results fail) for `Pr - bedrooms Peroxide treatment (past 12 months) (Y�_/on�E Knlo�i� If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot IZc�,I On adjacent lots t oc" Property line t o To buildingfoundation ?� ~i/ To existing or abandoned system on lot � On adjacent lots �� Cutbank Water main/service line 10 % � Surface water toc> t` Driveway, parking/vehicle storage area bz-/I k Curtain drain '� )A- E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect,o.n,,thp date of this inspection. rt } Signature tx S liNGINEERING agle River Loop Road No. 204 Engineer's NamO' agk Aivve�er,Lr• Alaska 99577 1 Date N. 1: i$ NAA Fee $ ` 7� Waiver Fee: $ A Date of Payment Date of Payment Receipt Number �a y % Receipt Number 'MUNICIPALITY OF ANCHORAGE J DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date //- 6' 0S_ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Named 6/r�-r Telephone: Home 74,2- -V7_5 -_L5 Business Applicant Address P D gr7X (o70 67&3 GAh-. 6/skip 62,e c1c cS (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent — Address Telephone (f) Maif the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family,g Multi -Family ❑ Other Number of Bedrooms Telephone 3. WATER SUPPLY Individual WOO Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 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 (1 V84) Page 1 of 2 $• ENGINEERING FIRM PROVIDING i.+SPECTIONS, TESTS, FILE SEARCH, DATa, .ND INFORMATION f` 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 I>s6 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 r� the date of this inspection. r: Telephone Name of Firm Address Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent prdfessional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) m 14 % Y ,5 o Ftsbortok. St]Q r d % hlo. 1aL57-E 6. DHEP APPROVAL / Approved for l edrooms by e Approved Disapprove Conditional Terms of Conditional Approval ° CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent prdfessional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF AMORAGE C�► CHECKLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECrlot4 Legal Description: Nov111965 A. WELL DATA RE C Well Classification SI5�' If A, B, C, D.E.C. /Approved (Y/N) Well Log Present (Y/V� Date Completed 16)? t Yield Total Depth �� Cased to �8 /� Depth of Grouting 9� Static Water Level Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit(DN) H Sanitary Seal on Casing CVN) Depression Around Wellhead (Y�p Separation Distances from Well: I J . To Septic/F,ief4ing Tank on Lot J/0 On Adjoining Lots To Nearest Edge of Absorption Field to)nn of On Adjoining Lots J o A To Nearest Public Sewer Line To Nearest Public Sewerr Cleanout/Manhole P To Nearest Sewer Service Line on Lot Water Sample Collected by -54 S Ct,) G 0J 662—/AJ4 ;Date 41— Water /— Water Sample Test Results Comments B. SEPTIC4HOUBtNG-`TANK DATA Date Installed LO —1 9_2k Size l00-0 No. of Compartments 2 Standpipes a/N) Air -tight Caps/N) Foundation Cleanout (Yqy Depression over Tank (Y(9Date Last Pumped ��+ Pumping/Maintenance Contract on File (Y/N) _;Q74 ; for N � Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/UDlding Tank: To Water -Supply Well J/o / To Property Line To Water Main/Service Line Course Comments Page 1 of 2 To Building Foundation To Disposal Field &3� i To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z57 J Type of System Design Date Installed i /6 X91 26> Length of Field � 7 / Width of Field 49- Depth of Field Gravel Bed Thickness In Square Feet of Absorption Area 2iF? Standpipes Present (DN) Depression over Field (Y/a Results of Last Adequacy Test J % H Date of Last Adequacy Test S to Separation Distance from Absorption Field: i To Water -Supply Well l7iD To Property Line To Building Foundation �� To Existing or Abandoned System on 2vfl �->L N � To Cutbank (if presgnt) ^IA 1 To Driveway, Parking Area, or Vehicle Storage Area t5 C) N Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course On Adjoining Lots Comments — D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at '.Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. eS�,G U 3 Receipt No. 'o40 Date of Payment - '- Amount: $ 0 € Page 2 of 2 72-026 (11/84) gt.,Seal. ,.0 MiMI CIPAL.ITY OF ANCHORAGE DIVISION OF ENVIRONMENTIT HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Des iptic Location, (addres ( Application Date loth lock, suivision, section, ordirections) nsnip, range) (b) Applicants Naire. Applicants Address 44`0 (c) Applicant is (check one) Lending Institution �� ; Ow,rier/builder Buyer Other (explain); (d) Lending Institution-�,`7<<1, i�����y `r� �� Telephone Address (e) Real Estate Co. & Agent Address r- r Telephone 2. TSrpe of Pasidencre- Single -Family f Ralti-Family ---j Other (describe) Number of Bedrooms 3. Water Supply Individual 'Akil r-- 7F Community � Public Note: If cani unity smell system, must have written ccnf-irmtion from the State Department of Environmental Conservation attesting to the legality and status. Is the X11 adequate for the number of badrocros specified in this HAA �(v_Ilo 4. Sewage Disposal Or_site'ti Public Comounity Holding Tark Is the wastewater disposal system adequate f-cr the number of bedreYans [Page 1 of 21 The Municipality of Anchorage Department of health and Environmental Protection d not guarantee the continued satisfactory performance of the water supply and/or t':. wastewater disposal system. This approval indicates that, as of the validation a. shown above, Used on the data and information furnished by an engineer .registers. the State gf Alaska, the water supply and wastewater disposal system is safe and tional for the number of bedrooms and type of structure indicated. (DREP SEAL) 7. Mail the HAA to the following address- KB2/d5/s [Page 2 of 2I 5. Engineering Firm Providing Inspections, Tests, Data and Information I certify th4t'I ve chec d, verified, or conformed to all MOA HAA Guidelines i.I effect on the e inspection. Date Nameo Firm Telephone Address; �..�L'S�IY . �i 1gG5� �,py'0�0SD`®�, ,„, �JU le J�l� �Y S+:✓ �� .�' % - I �g�Tr Qbl�q.. UA ^ 7 Signed by do A Date ... .. .. . ... t Rabert A. Shofar :,,4 Qar 0� �fp (aTGINEER SEAL) 6.DHEP Approval 5 � r ��;u.Ur��z' late Approved for bedrooms By s LL Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of health and Environmental Protection d not guarantee the continued satisfactory performance of the water supply and/or t':. wastewater disposal system. This approval indicates that, as of the validation a. shown above, Used on the data and information furnished by an engineer .registers. the State gf Alaska, the water supply and wastewater disposal system is safe and tional for the number of bedrooms and type of structure indicated. (DREP SEAL) 7. Mail the HAA to the following address- KB2/d5/s [Page 2 of 2I MUNICIPALITY OF ANCHORAGE (MOA) n � p I� D HEALTH AUTHORITY APPROVAL (HAA) U �\ J CHECKLIST - FEBRUARY 1984 b8668 XV V1 /� �� NOI1J3102d 1d1N9NNOSIAN3 A. WELL DATA / ( s 18 H1Td3H d0 '1d3(3 fh�(C _5 se)ys0H�Nd d0 Ain i NNnvq Well Classification If A, B. cr C. D.'EfcecApproved(Y/N) 'v Well Log Present Pf ) Date,�, leted `�`l� Yie ///`ld s Total Depth �'�v� Cased to `� Depth of Grouting ��\ . s / G'r - Static Water Level Pump Set At Casing Height Above GroundZ Sanitary Seal on Casing (Y Electrical Wiring in Conduit (Y �) Depression Around Wellhead ) Separation Distances from Vkl Vx To Septic/Ue3&�Pg Tank on Lot //0 ; On joining Lots U,^J To Nearest Edge of Absorption Field on LotZO ; On Adjoining Lots " N 0(::: To Nearest Public Sewer Line l^J ITo Nearest Public Sewer Cleancut/Manhole rcs- To Nearest Sewer Service Lire on Lot Water Sample Collected By Water Sample Test Results Comments i vt Date B. SEPTICA48E94W TANK DATA ��;✓ �/y Date Install � �'� Size ��il No. of Compartments Standpipes (Y Air -tight Caps (.Y Found t* Cleanout ( i) Depression over Tank ( ) Date Lads Pumped �� b71 ix, Pumping/Maintenance Contract on File yfor r� Holding Tank High -Water Alarm ( , Temporary Holding Tank Permit ( G� Separation Distances from Septic/Ho ding Tark: j To Water -Supply Wall Z1 O , To Building Foundation To Property Line �� 7L ,To Disposal Field To Water Nlim;ft/Service Lire D 4- To Stream? Pond, Lake? or Major Drainage Course / - - CcmnTents [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorpti n Styata 2, Type of System Design Z1 4el C v/ Date Installed �J �!� ngth of Field Ls 7 Width of Field r Depth of Field Gravel Bed Thickness r}T e� Square Feet of Absorption, a er Standpipes Present (Y Depression over Field (it ,Date/ of Last Adequacy Test Results of Last Adequacy 'lest� Separation Distance from Absorption Field: To Water -Supply till /Z 0 / `' To Property Line �d To Building Foundti✓o1n- �- To Existing or Abandoned System cn Lot 7 On Adjoining Lots /Iv I / To Water Ma4a/Service Line lb U 7� To Cutbank(_if present) _ iq-____ To Stream/Pond/Lake/or Major Drainage Course I To Driveway, Parking Area, or Vehicle Storage Area 7 Continents D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm.Level at / Tested for Electrical Codes(Y/N) Comments * * Check Pe I certify th on the d to Signe Comply, KB1/d5/s nsions ess (YM) Level at Vent Pumping Cycles during Adequacy Test. Meets MOA r�m7 d Bedroom Rating Against HAA Request ** at I ave check, verified, or conforired to all MOA HAA of i ion. Date S rt w in�4` MOA No. (Page 2 of 21 in effect d¢ber4 A. Shpdhr —i Am Fc5510� ` 2-15-84 V44 TntHO iAbL AAFA yt^ 80 0 G u ; `�IAPLD IAlUA4Y �• GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received January 7, 1977 Time of Inspection 11:30 .m. Date of Inspection 1-10-77 Monday REQUEST FOR APPROVAL OF Pratt INDIVIDUAL SEWER & WATER FACILITIES FOR 1 Approval requested by: Lomas and Nettleton Company Mailing Address: 4449 Business Park Boulevard -Phone: 274-7661 2. Property Owner: Jack V. Porter Phone:688-2973/27400521x15 Mailing Address: Star Route Box 1220 Chuaiak, 99567 3. Legal Description: Lot 6 and 7 Lak Hill Acres 4. Location: see map on back 5. Type of facility to be inspected Single FAmily No. of bedrooms 3 6. Well Data: A. Type Individual B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On—site system A. Installed 1976 B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines 8. Distances: 2. Manufacturer 2. Material 220' A. Well to: Septic tank , Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - RegL t for Approval of Individual Sc r & Water Facilities R Legal Description Lot 6 and 7 Lake Hill Acres Comments Approved 1� Disapproved Date i Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date