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Home My WebLink AboutHERITAGE PARK BLK 1 LT 7r'itage Pa k Block ! Lot 7 #050-211-35 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211071 Work Type: SepticTank Upgrade Tax Code Number: 05021135000 Site Legal Address: HERITAGE PARK BLK 1 LT 7 G:0055 Site Mailing Address: 10547 TRADITION AVE, Eagle River Owner: FITZGERALD PATRICK S Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft Total Bedrooms: 0 t f f Deparnnent 3/25/2021 3/25/2022 20684 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: 3 3 MUNICIPALITY OF A Ar Development Services Department On -Site Water & Wastewater Section Parcel I.D. 050-211-35 ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) PATRICK FITZGERALD Day phone 9073205795 Mailinci address 10547 TRADITION AVENUE, EAGLE RIVER, AK 99577 Site address 10547 TRADITION AVENUE, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) HERITAGE PARK BLOCK 1, LOT 7 Legal description (Township, Range & Section) Lot Size 20,684 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank Q Upgrade 0 Duplex (D) ElHolding Tank ❑ Renewal ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: $225 Date of Payment: L Receipt Number: Permit No. OSP211071 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 March 15, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: HERITAGE PARK BLOCK 1, LOT 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 outside any deck supports to serve the existing 3-bedroom residence. The lot and area are served by public water. 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 OSP211071, Deb Wockenfuss, 03/25/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211071, Deb Wockenfuss, 03/25/21 ~.j MUNICIPALITY OF ANCHORAGE ,~jj DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ell Manu~facj~urer ,4 / ' * in gallons IF HOMEMADE: E IWell DISTANC TO: I TOp of die to finis grade ~ngth ~idth ~ C~b d~~ DISTANCE TO: icl s Depth ~uildin~ foundation DISTANCE TO: NAME ; MAILING ADDRESS LEGAL DESCRIPTION _OCATION Absorp~%area PHONE I I~d~E W ~¢/~/.rj~)~ [] UPGRADE Dwelling Material Width NO. OF BEDROOMS PERMIT NO. . No. of co?partments Inside length Liquid depth Dwelling PERMIT NO. Material Liquid capacity in gallons Foundation Total lan§th of lines Material benaath tile Depth Crib depth Building foundation Nearest lot line T r e-~z~i ~dct, h inches inches Driller Sewer line P EI3441T. NO. ~ D ista n~7~on lines Total e,~e.c~l~absorption area PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) OTHER PIPE MATERIALS RATING INSTALLER REMARKS 3895-E APPROVED LEGAL 72-013 (Rev. 3/78} Form 27 Plot Plan/Asbuilt Form !:5 6::L...::L 6 :B 2 L. OT 'S 12:E ' [qgK:.:: E [::Z'D.::: 7 '-" r,-'Z ' HER: l T!::H2iE "i" 0 H N F'T. ,'.':)Fr. F:!E:R:E:S) L. O 'i' 7 I:;' ::1N ": E: ::Ll.,.i E: L "/C i'::': 2:.: 5i:. 5 :2:.5 7.0 5. El 57'. 0 :1.., 000. 0 22:7 L.E,:. t! ~ T."jf:IT :j... ............... T F:Ii'i F:'i:: "1" .. ]:FIR: i.'.II"FH THE N ::""'. _ , ,.. ,_ ,i~' :::'i:::'n, ..... '~ ""'= l:::'Og4: ON'""S;ITE. ':Ei,IEF:5.. FINE:' k!EL.L.S FiS 2;ET FrOF::TH E',"r' THE l'lUh!:l: C: i F'FIL. i 'T'"r' OF: F:ti',IC:HORdr:iC~E ':: HOFI::' FiND THE STFITE OF RL. FISi':::FI. ;2. i P.iI!._L. li'.,i:E;'i"FiLL "i"iLIE S'~.:STIErd iN f:IE:CiZ~RE:,I::!NtZ. E 1.4iTFI FILL FIOI::t CO[:,ES FINE:, R:E:GULF!TIONS., Fii'.dE:, l N CEd','iI:::'L. i RNE:E N i 'T'H 'THE DE:S ! GN CR I 'TEF: t R C)F' TH I S PERH I T. ]:. I i.,.!:i:L.L. F:d]:,HEI:~:E ]"O F:IL.L i,!OFI f::ff.d[;, :E;7'!zi"f'E: OF: RLf:!:E;KFI REQUIREHENTS FOR THE SET BRCK [:,)::~;'FFibICE:~S F:'F:OIq I:::iN'./ E::-::iS"!"iNG i.dEL..L, k!F~STEb.iFt'TER [:,!SPOSIqL S'.r'STEP1 OR F:'LIBL. IC 5E!-,IEF~5:iEi[~: '.5'.,-'STErd ON 'r'HZ:E; OR FIh!'T' F!D..TF:iE:ENT O[[: NE:RREW LiZiT. 4. :i: UN[N~[:F;;:~S"t"f:::!!'-,i[::, THF:I'I" 'T'i...IZ:5 F:'ER:rdlT ZS 'v'FIL. ZD FOR !::t FIFiXZHtJI'd OF 3: BED~OOPiS RND RN'.ri Eb!L. FIRG[EMENT H :1: LL RiEI::!U I R:E FIN F:tE:,I::, Z T Z CtNFIL PER:rd Z T. EF' Fi L]ZFT 5iTFITTqI'-,I I:5 IN:E;'T'F:IL. LED :1:1'.,! f:l?',l F!F:ER C:O',,,'Et:;:EI)E"," MOFI E:LIII_I:)Zt'.,tG (:::F~DEE;., THEN ,:::L::, I::IN ~:.L!:::.L. .............. I.Z_.::L. F'[::'F?H!T ....FIN[::, :.:?.4::SF'F'L':TI')N I','IJST BE .qE;TRTt"dEE:'.; ..... ,';-2::, FI':;~-EIUZLTL:'; !...!ILL. l'..Z"r E',E FIF'F'F:O'v'E[::, .. '['1"}..'" T FII'.I EL. EC:'T'R:]iC:F:IL. _T!'.!:EF'ECTZCd"4 REF'OR:T.~ RF,tD ,"2':, 'THE: ,EL[EC:TP.':I '£:,::,.L_ ,.4OI:U<: k~,E~hS: [?_.'~...!(:;ENSEI2, ELF£E:TF;:IE: IFII',I. RF'F'L.:[ T:FffqT · I..:~NC .. . ......... ..................................... : .................. ................ PERMIT NO. [:,EPRRTMENT % HERLTH RND ENVIRONMENTFIL %.;OTECTtON. ...... L STREET., RNL. HURMt',E., WK. 9g,~R± 264-4728 ( 8]:0279 ::, RPPLICRNT LOCRTION LEGRL DEVCON ENT. INC. 541i OLD, SEWRRD HWY. LOT ? BLK ± HERITRGE PRRK SUB LOT SIZE 56t-t082 99999 SQURRE FEET TYPE OF Si:ilL RBSORPTION S'-r'STEM I$: TF..ENL. H MR;:-:',IMLiM NUMBER OF BEDROOMS = Z-:: SOIL RRTING <SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:.EF' TH= 1£-, L F ~"-.~ ,ST H t-- ~'~ :-]: ,S F2 ~'r~ "...' E I ...... [:.EF' TH--- 6 THE LENGTH [:,IMENSION IS THE LENGTH ,'IN FEET) ElF THE TRENCH OR [:,RRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETWEEN THE: SURFRCE OF' THE GROUND RND THE BOTTOM OF THE EXCRVRTtON (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). PERMIT RPPLICRNT HRS THE RESPONSIBILITY TO iNFORM THIS DEPRRTMENT DURING THE tNSTRLLRTION INSPECTIONS OF RNY WELLS RDJRCENT TO THIS PROPERTY RND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. BRCKFILLING OF RNY SYSTEM WITHOUT FINRL INSPECTION RND RPPROVRL BY THIS DEPRRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS · 00 FEET FOR R PRIVRTE WELL OR ±50 TO 200 FEET FROM R F'UBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPLY. 'SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F'E~:~"'IIT E>::F'I ~:E"_-~ [:,EC:E~IE:E~: 3:1.. :1 I CERTIFY THRT i: I BM FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS RND WELLS RS SET FORTH 8Y THE MUNICIPRLITY OF RNCHORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCOR[:,RNCE WITH THE ]:O[:,ES ~: I ~LINDERSTRND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLRRGEMENT IF THE RESI[:,E[.~:E /~S REMODELEZq TO INCLLIDE MORE THRN ~ BEDROOMS. RF'PLICRNT [~E',/C:ON ENT. INC. I~SUED B~ DRTE ~ '94. 0 MUNICIPALITY OF ANCHORAGE DEPARTiVIENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 SOILS LOG ~ERCOLATION TEST SLOPE 7 8 9 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? /~ O I~ O P E IF YES, AT WHAT DEPTH? Gross Net Dep~;h to Net Reading Date Time Time Water Drop PERCOLATION RATE ~--:~'- (minutes/inch) TEST RUN BETWEEN Z:~ ,.~_ FT AND (~? '~- FT CO~ENTS '~ ~.o'% p,~4~,.lR ~ ~ ~ ~% q~ C~o s~-~"~ 6 "dia hole, soaked 4 hours, hard-well compacted sotl,-]~[y strengtbr, PERFORMEDBY:~?~~ CERTIFIEDBY:~~DATE:. ~--~ t--~ 72-008 (6/79) ~--/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST BOLLS LOG PERCOLATION TEST PERFORMED FOR: ~-~ ~-- ~/~)r'~l LEGAL DESCRIPTION: o-r7 SLOPE 3 5 6 7 8 9 ....... 40 11 12 13 / / WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED: SITE PLAN 14 15 16 17 18 19 20 Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes!inchl TEST RUN BETWEEN FT AND __ FT COMMENTS PERFORMED BY: 72-008 ~6/79) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni, org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-811-35 t. GENERAL INFORMATION Complete legal description Heritage Park, CASA# O-. C Expiration Date: BLock 1~ Lo'l: 7 Location (site address) 10547 Tradition Ave Current Property owner(s) Stevens Day phone 689-1808 Mailing address Lending agency 10547 Tradition Ave Day phone Mailing address Real Estate Agent Barbara Crittenden Day phone 689-1808 Mailin'g:i'.A,,.dldres-s, - -Pruden~ci-at"V'is-t;a"-o-P Eagte 'River .... Unless~them~ise:.,~:: requeste~.COSA. ,,. will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:. 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (CASA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site System's 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 COSAs upon request to homeownem. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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. 4. STATEMENT OF INSPECTION BY ENGINEER .5. 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. Nor~hRim Engineering Name of Firm P,FI. Box 770724 Address Phone Engineer's Printed Name DSD SIGNATURE ~,/// Approved for Disapproved.. 694-7028 S~ceve Eh9 1218/10 Date Conditional approval for bedrooms. bedrooms, with the following stipulations: By: Attachments: COSA Checklist Septic System Advisory Well .Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ~L~/~ Original Certificate Date: (Rev. 11/O5) C~-Site ' ~www.~;Oi'g/onsite ,(907) 343;7904 Legat:Des~ip',~: ~rit~,,,qe P~rk, Block 1 Lot 7 parcel IO:0~0-,211, ~5 NA' ~Puibtic -Date~mpleted , ..,.,' Tetal~,~dePth ff. B, ~C,~vide'PWSID # ,Sa~ seal. (Y/N) Cased to. ft. Well.Leg (Y~) ~res l~eperly,pr~,ected (¥~1) Casing AT INSPECTfON ~¢,~water,~v~ ff. ~. W~;.~productien g.p.m, g.p.m. ~,'A~ SA~E-,RE~TS: _ Date :i~d 6 / 7 / 8 4 C~~) Y :Date,~ 6./7/84 se~:m~g: (g;p,dJft~ m..~/bdrm) ~'37 System.- type ' Trench Lengl~h 4 7' '~ ~1~. ~d~'l 3 fl: Gravel, below pip~ fl~ IVlonitoring tube y Date ~ ~test I.E~/8/'l~8 .Results (Pass/Fail~_~5.~_, 3,6 500' Flu' i(f:depth in~sorPli~: fiekl:,before~/in. ,Water added .gal,. · Elapsed ~me: min. ~Rnal,,,fluid, depth- in. A~y rejuvenatie~ ~rea~t(pas['~12 mo.) 0fiN &'type) if'yes,, gh/e.date Depression, over fmNI. FoG , bedrooms NewdeP,~8 in. 5O0 Absorption rate >= g.p.d. 'mm Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEAL~TH AUTH.O'RITY APPROVAL FOR A SINGLE FAMILY DWELLIhG., Parcel I~D. 050-213.-35 1. GENERAL INFORMATION ComPlete l,egaldescription Lot 7, ..... Location (site address or directions) Current Property owner(s) Expiration Date:. Mailing address Block 1, HeritaRe Park Subdivision 10547 Tradition Avenue Shannon Law Dayphone 563-6303 10547 Tradition Avenue, Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Un/ess other, vise requested, HAA will be held by DSD for pickup. 2, NUMBER OF BEDROOMS: 3 Crittenden Prudential Vista/Barbara Dayphone689-6464 16635 Centerfield Dr.~ Eagle River, AK 99577 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of ,Naska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a sing!e family on-site wastewater disposal and/or water suppty 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 sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid fcr 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. 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 Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the an-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 wastawater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, Phone and regulations In effec=t ~t~l~l~r~[~ltation. 17034 Eag!e River Loop Road No. 2~ Name of Firm E~;~ ~v~r, ~- e~.~ Address Engineer's Printed Name 'Robert C. Cowan, P.E. Date 5. DSD SIGNATURE J,,'/'"' Approved for ..~2._ bedrooms. Disapproved. Condiiional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: .4%- .g../- 0 / Municipality of Anchorage Development Services Department Bu~din~ Safety Db~s~n On-Site Water & Wast°water Program 4700 South Bmgaw St. P.O. Box 196650 Anchemge, AK 99519.6650 www.~a__qchorage.ak.us (50?) 343-7a)4 HEALTH AUTHORITY APPROVAL CHECKLIST LegaIDeserlptlon: LOT' 7 J~L(~C~,. J ~.AIIA.~{. [~/~2 PercellD: 05"'0 A. WELL DATA W~~ Well type pd~ ~, ~ c- ~R,rtff'~ 8, or C provide PWSID # Date completed Sanitary seal (Y/N) ~q, lm:~perly protected (Y/N). Total d~pth fl. Cased to .__..__fl; J Casing height (above ground) FROM WELL LOG J AT INSPECTION Date of test Static water level ~ ft. ft. Well production ~ g.p.m, g.p.m. WATER Colifo.~,,/' coionies/100 nd. Nitrate rngJI. Other bacteria __ Date of sample: Callect~J by: B. SE 'nC OLD/NG TA.K OAT^ TankType/Matettal ~d.~rlC. / ,~7'~,~, ~,_ Date installed '~,/? '/,~¥ Tanksize )000 gal.. Number of Comparlments_~.. Cleanouts~f/N) Foundation cleanout([~) ¥¢ .f Dep _re~__e!'on over tank (Y~ ,'~ u High water alarm (Y/N) Dateofpumping tI //,r' /o a Pumper ~t"' . i~ . in. colonies/lO0 mi. Length ~ T Total depth ! ~-. fl. Date of adequacy test C. ABSORPTION FIELD DATA Date installed ([/'//~'¥ Soil rating (g.p.dJ~ ~ ~ ft. Width ~ ft. Eft. absorption area 7~'~ ~ Monit~ing tube Fluid depth in absorption field before test ~0 in. Water added'¥ ~'/gal. Elapsed Time: ~' 7 min. Final fluJd deplh ~ in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ~/~"L ~',~°,~ Absorption rate >= System type 7,~e-~o~ Gravel below pipe ~ ft. Depression over field ~ 17 For ~ bedrooms New depth"/~ in. ~.~0 g.p.d. if yes, give date ~' D. LIFT STATION ' - Date installed Size in gallons Manhole/Access (Y/N) 'Pump on" level at in. 'Pump off' level et in. HIg~at ~ in. Datum ~ __ Cycles tested ~,,,,..,/~ld~ts alam~ & ~rcuit requirements? E. SEPARATIO, DISTANCES SEPARATION DISTANCES FROM ~'OT TO: ...... Septic tank/tift station on lot ~"/ On adjacent lots Absorption tield on lot / On adjacent lots Public sewer~ Public sewer manhole/cteanout tlc service line Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation I ! property line j 0 '4-- Water main . ~,. ,... /0 '~ Water sen, ice IIn~ ,/04- Wells on adjacent lots o~O~ 4- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /~ ~ Building foundation I q Water main Water Service line !0 ~' Surface water ]o o ~ Curtain drain tv'~ 4L K',~ .~ Wells on adjacent lots ¢~O0 ~- Absorption tield Surface water D~eway, paddng/vehicle storage .,~'0 ~' Fo COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems ere in conformance with MOA HAA guidelines in effect on this date. Engineer's PrintedNam, ~§~'/~ T ~'. HAA Fee $ Date of Payment Receipt Number (Rev. 12/00) 300. Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Lot 7; Block I~ Heritage Paab Su.bddvdAdrm Location (site address or directions) 10615 Tradition Avenue Eagle River, AK Property owner Mailing address Barbara & Carl Harrell C/O RkMAX Ob EAGLE RIVER 16600 Cent~rfield Drive Lending agency Day phone Eaqle River, AK 99577 Day phone Mailing address Agent Kathi 01mstead/ REMAX OF EAGLE RIVER Address 16600 Center~ield Drive Eaqle River, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NOTE: Day phone 694-4200 AK 99577 Individual well Community well Public water X×X If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ××X Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 {Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/orwastewaterdisposalsystem is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. Ifurtherverifythatbasedontheinformationobtainedfrom 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 Phone (/¢'~¢---Z-~ ?¢ · , 401"~" ~ING Engineer's signature ~ Date DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date 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 th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 1/21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~,~-r- "~ ~2~-- ~ ~../.-~-¢-~'c,~ ~¢l~arcel I.D. A. Well Data Well type t)~,~ J~ Log present (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to ,/C/asing height Wires prope,~protected (Y/N) FROM WELL LOG ~ AT INSPECTION. Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 SEPARATION DISTAN~ROM WELL TO: Septic/holding tack'on lot Absor~ on lot g.p.m. Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts I~ ~ High water alarm (Y~- Date of pumping Tank size Foundation cleanout Compadments J Depression.(Y~__~ ~ I (Y/N) Alarm tested Pumper ,_.~,~. ~__--~.~.,~a ,9/..- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / Well(s) on lot '~--~ o ~' ~- On adjacent lots Foundation /// To property line / 0 Surface water/drainage Absorption field ~ / /60 /~'- Water main/service line CONTINUED ON BACK PAGE 72-026 (3/93)* Front C. LIFT STATION Date installed Size in gallons Manufacturer Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) ~ SE~ STATION TO: Well on lot On adjacent lots Surface water D, ABSORPTION FIELD DATA Date installed Lc Length "¢~7 ' Total absorption area Date of adequacy test Width Water level in absorption field before test Peroxide treatment (past 12 months) (Y/¢~ Soil rating (GPD/FF) 2. ~'7 ¢'/'~,¢- System type ~ ! Gravel thickness ~ f Total depth / Cleanout present~) y Depression over' field (Y/.{~ Results~Yfail) ~/¢-~...r for ~ Bedrooms ~ O After test -~ ? ,'--/~--/~,E-- //--,,,/',~-/,'J' If yes. give date ~///~' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation ~ / On adjacent lots '~ ~-~ Surface water Curtain drain On adjacent lots ~lA~ Property line To existing or abandoned system on lot / Cutbank 'J'/.,¢- Water main/service line Driveway. parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed Signature Engineer's Name Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D.# 050-211-35 HAA# HA900357 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 7 Block 1 Heritage Park Subdivision Location (address or directions) 10547 Tradition Avenue, Eagle River, Alaska 99577 (b) Property owner Sharon Swift Telephonei(h. ome).694-0454 Business 562-2147 Mailing Address 10547 Tradition Avenue, Eagle River, Alaska 99577 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Connie Address 10928 Eagle River Road, Telephone 694-5500 (e) Mail the HAA to the following address: (or check here [], if hold for pick up.) List contact person and day phone number below: Bates Jack White Company Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Number of bedrooms three (3) Single-Famil?:JERx 3. WATER SUPPLY Individual Well [] Community [] Public []ss Note: If community well system, must have written confirmation from the State Department of Environmental 'Conservation attesting to th legality and statuS... 4. SEWAGE DISPOSAL On-site E~cc 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~)25 [Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by mysealaffixed 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. NameofFirm S & S Engineering Telephone 694-2979 Address 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Date 8-28-90 Engineer's Seal 6. DHHS APPROVAL Approved forthree ( 3~)edrooms by Approved _×××××× Disapproved Terms of Conditional Approval Conditional Date September 11, 1990 This is a replacement of the original Certificate that has been lost. The MunicipalityofAnchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated 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 DHHSdonotconductinspections 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. 7/88) Back Page 2 of 2 MUNICIP'ALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING - ~}~ HAA # 1 GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot. block, subdivision, section, township, range) Lot 7; Block I; Heritage Park Subdivision , Location (address or directions) 10547 Tradition Avenue, (b) Property owner Sharon Swift Mailing Address 10547' Tradition Ave. (c) Lending Institution Ea~le River, Alaska Telephone:(home) 694-0454 Business' 562-2147 Eagle River, Ak.' 99577 Telephone Mailing Address (d) Real Estate Company and Agent HOME@UITY NO: 4142-30546 JACK WHITE COMPANY ATTN: Connie Bates Address lOq?~ F~g~_ ~/,o~ T~r, nrt Fng~o f2.¢~*o~ ~.tb~ qq~?7 Telephone 694-5500 (e) Mail the HAA to the following address: (or c~eck here~, if hold for pick up.) List contact person and day phone number beloW: 17034 Eagle Rioter Loop Roa~ No. 204 ATTN: Ni~e~ Rhodes 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community [] Public'~ Note: If community well system, must have written confirmation from the State Department of Enwronmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site [~;( Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. 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, Iverifythat 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 Address S & S ENGINEERING Telephone 17034 Eagle River Loop Road No. 20~1 Eagle River~ Alaska 9957? Date 6. DHHS APPROVAL Approved for -~' bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional Date The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated 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 DHHSdo not conduct inspections or analyze data before a certificate is issued. The MunicipalityofAnchorageis not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) aack Page 2 of 2 A. WELL DA'~A MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) CHECKLIST- FEBRUARY 1984 343-4744 Legal Description: Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Well Log Present (Y/N) Total Depth_ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELLf To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed (.,¢-'7~-~ Size StandpipesE)NI Depression over Tank (Y/~;) Pumping/Maintenance Contact on File (Y/N) , Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well Air-tight Caps ~N) No. of Compartments ~ y Foundation Cleanout~/N) y Date Last Pumped¢~' ~:~:~- [~ -~1 o I'~t A ;for ---' Temporary Holding Tank Permit (Y/N) ~ To Building Foundation To Disposal Field To Property Line To Water Main/Service Line '~Ol'f'' To Stream, pond, Lake or Major Drainage Course Comments ~'- ~'-'[2~ 0_,~.~;~.poo ~ 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field '~¢'7 ~ Depth of Field 12.., ~ Gravel Bed Thickness ~ ' Statndpipes Present (~'4) Date of Last Adequacy Test Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~.-~,~O~+ To Property Line To Building Foundation Lot ~'"t / ¢' ; On Adjoining Lots To Water Main/Service Line [~ [ 4- To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course ~. C:>o To Driveway, Parking Area, or Vehicle Storage Area -1'~' ~ ~ To Existing or Abandoned System on Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines ~n eff~ inspection. Signed Company Date MOA No. S & S ENGINEERING 17034 Eaqle ~ vet Loop ~o-~d No. 204. Ea§lo River, Alaska 9~57Z Receipt No. Date of Payment Amount: $ 72-028 (Rev. 7/88) Back in ette~c,[.4 t.~h.e date of this Receipt ~No. "~*~' Waiver Fee: $ Date of Payment Page 2 of 2 ~-d 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) / · (b) (c) Location (address or directions) Property Owner ~ ~u~¢A/ Telephone: Home MailingAddress Io~W~ ~/~lo~ ~,/~. / Lending Institution Mailing Address Telephone Business (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here ,~ hold for pick up. List contact person and day phone number below. $ & S ENGINEEEING I/o34 Eagle RLver Loop Road No_. Eagle Riv~,~, ~l~_-_b.a .0?5?7` TYPE OF RESIDENCE Single-Family [~ Number of Bedrooms WATER SUPPLY Individual Well [] Community [] 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 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. Page 1 of 2 72-025 (Rev 8/86~ 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 beJow, 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 _~ & $ ~=NGINEERING Address 17034 Eagle RiYer Loop React No. 204 Date Telephone DHHS APPROVAL Approved for /-7~/~,~_~_~.~ bedrooms by Approved /& Disapproved Terms of Conditional Approval Conditional Date 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. Rage 2 of 2 72-025 IRev 8/86) Back EN"~U,~/¢/PAL/TY 0~ VII~ONMENT.. /'ANCHo~¢_UNICIPALITY OF ANCHORAGE (MOA) 4L SErViCES D~,,~LTH AUTHORITY APPROVAL (HAA) '~IO~HECKLIST- FEBRUARY 1984 'IUAt 2 5 ]~87 ~'~ ~C~/~D Legal Description: j~I ~--~ ~ ~ /~ ~ / WELL DATA V.~/-~2~'~-,I If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ~_c~ '~-~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Well Classification /L/~,~;;L ~ Well Log Present (Y/N). Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ,? C~/'/ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Size Date Installed Standpipes~N) Air-tight Caps(~) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: /~/~- To Water-Supply Well To Property Line To Water Main/Service Line Course Comments No. of Compartments ~. Foundation Cleanot~N) Date Last Pumped .-~ ~ ~ 2_ ~ ._,~.r~ .---¢ ~ ~" ~/',~ ;for "~'//~ Temporary Holding Tank Permit (Y/N) '*J'~'~ To Building Foundation //': ' ; ' · To Disposal Field - ~ To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026 ~Rev 8/86~ Front C. ABSORPTION FIELD DATA Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/~.,~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field /~- Gravel Bed Thickness ~,~' ~/¢" ..... Standpipes Presen~(._.~N) Date of Last Adequacy Test To Property Line f('r) /"~ To Existing or Abandoned System on ; On Adjoining Lots .~¢ /'¢' To Cutbank (if present) /"//,,~' Comments D. LIFT STATION Date Installed Size in Gallons )'~ / ~ "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed $ & $ ENGINEERING 17034 Eagle River Loop Roa~ No. 2~a4~e CompaE~igle~.!ver, Alnsk. 99577 MOA No. Receipt No. Date of Payment Amount: $ Page 2 of 2 7?-026fRev 8,86/ Back MUI%riCIPALITY OF ANCHORAGE DIVlSIfkN OF ENVIRONMENTAL HEAL%'H DEPARllV~NT OF HEALTH AND ENVIP~DNMENTA~ PROTECTION APPLICATION FOR HEALTH ~3THORI%~f APPROVAL CERTIFICATE 1 · Ge~erai Information '" Application Date (a) Legal Description (include lot, block, subdivisi,o.n~ section, township, range) LocatiOn (addmess or directions) (b) Applicants Nan~ (c) pplicant is (c eck Buyer ~; Other [~ (explain); (d) 5~ndin9 institution Ql~k Telephone Address (e) Real Estate Co. & Agent Add~ess Telephone 2. ~ Residence Single-Family ~ Nttmbe~ of Bedrooms 3. Water Su_~. Mult i-Familj! ~ O~er (~s~i~) Note: If o~,~nity ~11 system, must h~%~ v~itt~n confirmation f~om the State D~pa~tmmnt of Environmental Conservation attesting to tb~ legality and status° Is the well adequate fcaw the nun~0er of bedrocms specified in this IAAA (Y/N) Oneit~ ~-~I l~blie ,~ ~anit!~ ~ Holding Tank Is the wastewate~ disposal system adequate fc~ the r~aube~ of bedrocms (Y/N) [Pa~e 1 of 2] 2-15-84 5o Enginee~i__~_Firm P~ov~pee~tions~ Testsi Data and Information I o~.~ti~f-~t I have effect/on.th9 date of Signed by %--~'"fO .~, Date ~-~k/k~-t '~-L '\ $~ked, verifiedw or confomred to all MDA HAA CAlid~lines in ,.h.~ inspection° ~ ( ENGINF~R SEAL) Date %/~e Municipality of Anchorage Department of Health and Environn~ntal P~otection dces not guarantee the continued satisfactory p~fo~mance of the water supply and/o~ the wastewater disposal system. _This approval indicates thatw as of t_be validation date shown above, based on the data ~d information furnished by an en9irmer registered in the State of klaska~ the vate~ supply and wastewater disposal system is safe and func~- tional fo~ the number of bedrcc~s and type of structure indicated. (D~EP SEAL) 7. Mail the HAA to the foll~.;ing add~ess: KB2/dS/s [Page 2 of 2] '2-15-84 ae CHECKLIST - FEBRUARY 1984 ..,~ ~: ii!I? W~LL DATA Well Classification If A~ B~ ~ C~ D.E.Co ~p~oved(Y~) Well ~ ~esent (Y~) ~te ~,~le~d Yield Total ~p~ Card to ~pth of G~outinq Static Water ~1 ~ ~t At Casing ~ight ~ G~nd Sanit~ ~al on ~sing Elec~ical Wi~ing in ~nduit (Y~) ~ession ~ound ~l~ead (Y,~) ~p~ation Distan~s ~ ~11: .To ~ptic~°ldin~ Ta~ ~ Lot ; ~ ~joini~g Lots To ~a~st ~ge of ~so~tion Field on ~t ~ ~ Adjoining ~ts To Newest ~blic ~ Line To ~est ~blie Clean~t~aD~ole To ~est ~ ~vi~ LiP~ on ~t Wate~ S~le Collected By ; ~te Wate~ S~le Test ~sults B. SEPTiC/HoLDING TANK DATA Date Installed ~( -]~ (q~oc Size \ ~ (j ix iD ~_ No. of Ccn~pa~tments __~-~O Standpi~s (Y~) ~ Ai~-ti~ht Caps (Y~) ~ _ Foundation Clean~t (Y~) ~ _~ ~p~ession o~ Ta~ (Y~) ~ ~te ~st P,~d ~~- ~ ~ ~ P~ing~intenan~ ~n~act ~ File (~) ~ ; fo~ ~ Holding Ta~ High-Wate~ ~a~ (Y~) ~{~__ Te~~ Holding Tank ~t (Y~) ~ ~p~ation Distan~s ~ ~p~ic~olding Ta~: To Water-Supply ~11 ~ ~ ~ To ~ildinq Foundation %~ ~ TO ~o~rty Li~ ~ ~5'- To Dis~sal Field ~ ~ To ~ter Main/~vi~ Lir~ ~ %~f To S~e~, ~nd, ~e, ~ Major ~aina~ Comments [Page 1 of 2] 2-15~84 C. ABSORPTION FIELD DATA Soils Rating in Absorption St~ata~~3-] ~/ ~- Type of System Des~ign ~n-~C~[ Date Installed ~{ ~, ~ ~ngth of Field ~ Width of Field ~' ~p~ of Field %~.~ Grail ~d ~ick~ss ~ ' S~e Feet of ~so~ption ~ea ~% ~ ~. Stan~i~s ~esent (Y~) ~ ~p~ession ove~ Field (Y~) ~ ~te of ~st A~a~ TeSt~- Results of ~st ~a~ ~st ~ ~ ~ Separation Distan~ f~ ~so~ption Field: To ~te~-Supply ~11 ~ To ~o~ty Li~ ~ ' To Building Foundation ~0 ~ To Existing or ~ndo~d System Lot ~%~ kL~o~ ; ~ ~joining ~ts ~ ~Q~ To Wate~ Main/~vi~ Line > %~' To ~t~(if pre~nt) To St~e~ond~Re/~ Majo~ ~aina~ C~se ~%o~~ k~~ ~ ~, To ~iveway, Pa~ki~ ~ea, ~ Vehicle St~a~ ~ea k~ C~nts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fo~ Electrical Codes (Y/N) Dimsnsions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Con~nts ** Check Permitted Bed~oc~ Rating Against HAA Request ' I ce]~tify that I have checked, verified, of confo~n~d to all MOA HAA on the~f thi~etion.~ ~~ Company KB1/d5/s [Page 2 of 2] ~ ~~ in effect 2-15-84 DEPT. OF ENVIRONMENTAL CONSERVATION SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 / / PWS I.D..# o)-/'O~-~c~ / BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 To Whom It May Concern: According to records on 'file in th~s office the ~Water System is in compliance with ~he Water Regulations. Sincerely, State Drinking