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HERITAGE PARK BLK 1 LT 6
H itage Pa k Block ! Lot 6 #050- 211 - 34 Municipality of Anchorage Development Services Department ~ Building Safety Division On-Site Water and Wastewater Program, 4700 EImore St. '~ P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of www. ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SV/090153 PID Number: 050-~11-34 ~m~: H~ ~Mdd~h wastewatersystem: ~ New ~ Upgrade Ad~,,,,: 10613 T~di~ion Avenue ABSORPTION FIELD ~.o~: 696-1805 Number of Bedrooms: LEGAL DESCRIPTION so, Rating: Total Depth from original grade: k Township: Range: Section: Fill added above o~ginal grade: ~ve[ Len~ Ft.~ Ft. well: ~xi~i~ New ~ Upgrade ~r~w~dth: ~b~r~ O~t~,o~b~e~,e~: ~ Ft. Classiflcation(Private, A,B.C): TotalDepth: Ft. Casedt°: Ft. T°talabs°rpti°narea: ~ Ft~ PipeMateria': Driller: Date Ddlled: Static Water Level: Ft. Installer: ~ Date Installed: Yield: GPM Pump Set at: Ft. Casing Height Above Ground: ~. TANK SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. ~ Other: T~ Septic Absorption; Lift Holding ~ubli~PrivateManufacturer: Capacity: Tank Field Station Tank Sewer Line ~ ~ ~ ~ ~ ~ ~ ~ ~ T ~ ~ ~ [ ~ ~ ~ GaL Sudace Water LIFT STATION / [o,~,~ 10'+ 10'+ NA NA ~/ Size: Manufacturen Foundation 5/+ 10/+ NA NA/ /~''Pump 9n'' level at: ~ I"igh water alarm at: in. / ~ in.I in, Cu~ai, Drain N A N A N P N A Pump Mak~ ~ectdcal Inspections pe,orm~ Remarks: BENCH T~I, P~nl ...... + OnLy ~ ¢~-e e.~ Deck ~ ~ ~ Assumed Elevation: ~00,,. Nop~hRim Engineeping Inspections performed by: Dates: 1't 9/~4/0S ~,:~70~ "t~ 2nd ~, ,~.~ .. Development Se~ices Depa~ment Approval ~ m .. ~.~ Conditional Approval Date: ~ ,,..~ .... ~ .~' ~,~r~ ~.~ e ~i'~[kt (Rev. 04/06) ~ ~ RECORD NOTES: 1. New Septic Tank Piped To Old Trench. 2. Sewer Service Line minimum 2% slope. 5. Old Septic Tank Decommisioned. 4. Lots Served by Public Water System. RECORD DWG NEASURENENTS A B ST CO1 15 20 STC02 18 16 BCD 25 lO --Lot 5 Septic Lot 7 Septic 3 Bedpoom Past Foundation 000 Gallon Septic Tank -Double C.O.'s '"C /'O t0 Septic Tank Decommissioned N OFe THI~IM EN GINEERIN G PO ~ox 770724 Eagle River, Alaeka 99577 9©7. 694. 7028 HERITAGE PARK S/I] BLOCK 1 LOT 6 NE~/ SEPTIC TANK TANK ONLY J 1" = 40' RECORD DRA~/ING 9/15/09 JP o~ 3 ~ U Q~ Y F-- U C 0 ¥o o 0 0 0 (D > 0 0 Cr OLd c U C QJ ~._ 0 c ~ 0 0 ._~ U Q~ 0 0 C 0 I J_ C 0 Z Ld MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.Q. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 19, 2009 Expiration Date: Aug 19, 2010 Permit Number: SW090153 Legal Description: HERITAGE PARK BLK 1 LT 6 Design Engineer: 0838 NORTH RIM ENGINEERING Owner Name: DAVID GREENE Owner Address: 10613 Tradition Avenue EAGLE RIVER , AK 99577-0000 Parcel ID: 050-211-34 Site Address: Lot Size: Total Bedrooms: 010613 TRADITION AVE 2OOOO SQ. FT. 0 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www. muni.org/onsite (907) 343:7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Property owner(s) Site address Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size ,-~"~J/- e,, :> r- Sq. Ft. Number of Bedrooms Day phone Zip Code f ? '~-' '-? 7 Zip Code ,7 THIS APPLICATION IS FOR (~] all that apply): Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage THIS APPLICATION IS AN: Initial [] Upgrade Renewal [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: ~ '~--2~ '~) Waiver Fees: Date of Payment: ~_~' - /.w~.._- ¢ (~ Date of Payment: Receipt Number: ,;~.3 /.~ ~ (.~ ~. Receipt Number: (Rev. 11/05) I,~EERING NodhRim Engineering PO Box 770724 Eagle River, AK 99577 907-694~7028 Augustl0,2009 MOA On-Site Water & Wastewater Program 4700 Bragaw St Anchorage, AK 99519 RE: Heritage Park, Block 1, Lot 6 Failed Septic Tank The referenced property has a failed septic tank. The design calls for a new septic tank, utilizing the existing absorption trench. Public water serves the area lots so no water well conflicts are present. Please review the wastewater system design for the single family home. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Sincerely, Steve Eng, PE, Design Enclosures ' E~:!NEERING Heritage Park, Block 1, Lot 6 SPECIFICATIONS & DESIGN GUIDELINES Wastewater System Sizing: This is an existing 3-bedroom, single family home. The septic tank failed. A design is submitted for a new septic tank. The existing leach field is functioning. The neighboring lots are developed and served by public water. The old tank will be removed or properly abandoned in place. No water wells are in the area. Public water serves all the neighboring lots. No adverse impacts are expected from septic system replacement. No conflicts to the other lots will take place by this septic system construction. The easements are located on the drawing and are not encroached upon. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. · Two compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet. · 5' minimum between the tank and bed. 10' to property lines. · 3' of cover or insulation is required for trench; 1" insulation may be substituted for one foot soil cover. · Tank & solid pipe must be set on well compacted, stable soil. · 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. · All cleanouts must extend to at least ground level. · In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. · Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock. · Drain rock to be ½ inch to 2 ½ inch screened. Drain rock to be distributed uniformly throughout the trench. · Perforated pipe to be installed level with perforations down. · Silt barrier (filter fabric) to be installed above the drain rock. · Smeared trench sides must be raked or scarified before drain rock placement. · Backfill over drain rock must not be less than 36", 24" with 1" insulation. · The finish grade must be mounded to promote drainage over the trench. · Insulation must be placed over any pipe installed under driveways or parking areas. · Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, · Sewer Service Line is minimum 2% slope. · Septic Tank to be pumped every two years or when required. · Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI or equal) · Old Septic Tank to be removed or pumped, filled with sand/gravel, crushed, & buried. _.C U Q~ F- Y C F-- C 0 © (- U 0 0 O 0 C (- 0 0~ I, I U (D (3) fL 0 ~- (_3 0 ~0 _C U0 ~ L 0 ~ ~ 0 C U 0 ~ -~c 00~~ ~ 0 c ~ ~ o_~ ------ 0~ U ~ ~- ~ U O~ ~ 0~ THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES QR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON,(UNLESS INDICATED) NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES OR LOCATE STRUCTURES. ANY PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. AS-BUILT SURVEY ( NO CORNERS SET THIS DATE ) 1"=30' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT6, BLOCK 1, HERITAGE PARK SUB. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED, DATED AT ANCHORAGE, ALASKA THIS _8TH__ DAY OF__ JULY __2010__. HOLT LAND SURVEYING TEL. 345-5513 11342, FB t41-44 MUNICIPALITY OF ANCHORAGE Development Sen/ices Depa~lment On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 19, 2009 Expiration Date: Aug 19, 2010 Permit Number: SW090153 Legal Description: HERITAGE PARK BLK 1 LT 6 Design Engineer: 0838 NORTH RIM ENGINEERING Owner Name: DAVID GREENE Owner Address: 10613 Tradition Avenue EAGLE RIVER, AK 99577-0000 Parcel ID: 050-211-34 Site Address: 010613 TRADITION AVE Lot Size: 20000 SQ. FT. Total Bedrooms: 0 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received BY: ,~.~~'- ~ Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 wvnv.muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Site address Legal description (Sub'd., Block & Lot) ,/7t a,/', t-.~ 'q Legal description (Township, Range & Section) Lot Size ,-~(-Jic7 0 ~, r- Sq. Ft. Number of Bedrooms Day phone Zip Code ¢ ? ~ 7"~ .Zip Code THIS APPLICATION IS FOR ([~ all that apply): THIS APPLICATION IS AN: Absorption Field [] Initial [] Septic Tank ~ Upgrade 1~ Holding Tank [] Renewal [] Privy [] Private Well [] Water Storage [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: (Rev. 11105) Waiver Fees: Date of Payment: Receipt Number: NodhRlm Engineering PO Box 770724 Eagle River. AK 99577 907-694.7028 August 10, 2009 MOA On-Site Water & Wastewater Program 4700 Bmgaw St Anchorage, AK 99519 RE: ileritage Park, Block 1, Lot 6 Failed Septic Tank The referenced property has a failed septic tank. The design calls for a new septic tank, utilizing the existing absorption trench. Public water serves the area lots so no water well conflicts are present. Please review the wastewater system design for the single family home. I have included design plans & specs, design guidelines, & soil tests. Ifthere is need for additional information or clarification please give me a call. Sincerely, Steve Eng, PE, ~l Design Enclosures tleritage Park, Block 1, Lot 6 SPECIFICATIONS & DESIGN GUIDEIJNES Wastewater System Sizing: This is an existing 3-bedroom, single family home. The septic tank failed, A design is submitted for a new septic tank. The existing leach field is functioning. The neighboring lots are developed and served by public water. The old tank will be removed or properly abandoned in place. No water wells are in the area. Public water serves all the neighboring lots. No adverse impacts are expected from septic system replacement. No conflicts to the other lots will take place by this septic system construction. The easements are located on the drawing and are not encroached upon. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. · Two compartment, 1000 gallon septic tank. Watertight couplings on inlet & outlet. · 5' minimum between the tank and bed. 10' to property lines. · 3' ofcover or insulation is required for trench; I" insulation may be substituted for one foot soil cover. · Tank & solid pipe must be set on well compacted, stable soil. · 4 inch diameter cleanouts with airtight caps are required I' to 4' from foundation wall, prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field, not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. " All cleanouts must extend to at least ground level. · In solid pipe runs, ASTM D-3034 may be used in lieu ofcast iron. · Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock. · Drain rock to be 'A inch to 2 ½ inch screened. Drain rock to be distributed uniformly throughout the trench. · Perforated pipe to be installed level with perforations down. · Silt barrier (filter fabric) to be installed above the drain rock. · Smeared trench sides must be raked or scarified before drain rock placement. · Backfill over drain rock must not be less than 36", 24" with 1" insulation. · The finish grade must be mounded to promote drainage over the trench. · Insulation must be placed over any pipe installed under driveways or parking areas. · Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, · Sewer Service Line is minimum 2% slope. · Septic Tank to be pumped every two years or when required. · Insulation board to be extruded direct burial polystyrene (Dow Styrofoam }Il or equal) · Old Septic Tank to be removed or pumped, filled with sand/gravel, crushed, & buried. DESIGN NOTES: 1. Connect New Septic Tank To Old Trench. Septic Site is About 5% Slope. 2. Sewer Service Line minimum 2% slope. 3. Abandon/Decommission Old Septic Tank 4. Lots Served by Public Water System. --Lot 5 Septic Lot 7 iSeptic 3 Bedroom Gallon Septic Tank ~ble C,O.'s bondon Old Septic Tonk ~'~:~:~, HERITAGE PARK S/D I "= ,0' NORTHRIM .~,,,~'~,~"...~.,~ BLnCK 1 LDT 6 WASTEWATER ~o ~o~ ~,o,~, LAYBUT 907.694. 7028 TANK DNLY 8/14/o9 ~¢ 3 0 ,~ 0 ..~ I o '5- 0 - 0 0 ~ 0 0 ',~./, MUNICIPALITY OF ANCHORAGE ,,,~ , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT / NAME PHONE [~NEW MAILING ADDRESS LEGAL DESCRIPTION / NO. OF ~. DISTANCE TO: ~ ~ Manufacturer Liq' ca2acitzin gall°ns, -m ,~* IF HOMEMADE: Inside ,~4 :Width ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. 0 ~ ~ Manufacturor Material Liquid capacitg in flagons ~ ~ell Foundation ~earest lot ~ DISTANCE TO: ~ No. oflines / Length of ~. Total lengthen. Trench wi~zinches Dista rice between lines~ ~ ~ ~ Top of tile to finish grade ~ / Material beoeath tile Total effective abs~tion are~ Length Width Depth PERMIT NO. < ~ Type of crib 6rib diameter ~ Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ¢ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO, ~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOl L TEST R~TI NG I NSTA~ER c cF REMARKS t~,;:' '. ~' APPROV ED~-~ m0FESSi0~ DATE LEGAL 72-013 (Rev. 3/78) Applicant: ~ ; MUNICIPALITY OF ANCHOR~ ~ Departm~& of Health and Environmen~,.A1 Protection 825 L Street, Anchorage, AK. 99501 ~ ~ 264-4720 ~ ~ ~ (_~/"" ~./~t *" "HANDWRITTEN PERMIT - ~ ' WELL AND/OR ON-SITE SEWER PERMIT Dlea,~m. Mailing Address: ~l~ ~ ~,/~/ Location: Phone Number: Legal Description: ~(~ ~ / ~-~/%-~ i~]<'~.'~ Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: /~ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ,~ Soil Rating(sq.ft/br) /~.~ The Required Size of the Soil Absorption System Is: DEPTH / ,.. LENGTH . GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground an¢ the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall Pipe and . the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDiNG) TANK SIZE = /D~--C~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number Df residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departm~ ~ill be subject to prosecution. ~inimum distance between a well and any on-site sewage disposal system is 100 f( for a private well or 150 to 200 feet from a public well depending upon the type Df public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required ~nd must be returned to this department within 30 days of the well completion. 3ther requirements may apply. Specifications and construction diagrams are ~vailable to insure proper installation. * * * PERMIT EXPIRES DECEMBER 3L 1 9 8 3 * * * I certify that: (1) I am far~iliar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that ~edrooms. Signe~: Applicant SWP/024 (1/81) Issued by: Date: Department,', ~ Health and Environmenta ~rotection 825 ~ Street, Anchorage, AK. '~501 ~ ~.~ 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ ~])/~])~'] ~-~R 0N-SITE SEWER PERMIT Applicant: ~0 D~ .~~ Location: Legal Description: ~ ~ / Type of Soil Absorption System Is: Trench: Drainfield: ~ Mailing Address Phone Number: Seepage Bed: Lot Size: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) /~ The Required Size of the Soil Absorption System Is:' DEPTH ~ LENGTH ..C"~ ,. GRAVEL DEPTH ~ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = [~}--~--~-~ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 g 3 * * * I certify that: (!) I am fan3iliar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that ~edrooms. S igne~: ~(~LCx(C~K(~>.] "-~k ~.~ IS sued by: ~ ~,./v,,.~~ Applicant ~ ~~ ~~ ' ~ L~U©ate : ENGINEERS. INC. 712_5 OLD SEWARII-.ZHwY. ANCHORAGE, ALASKA 9950:3 ~49 -656i $01L.~ LOG -' SITE PLAN 1 2 3 c...-.----4 5 6 ~ 7 · %.. DEPTH) · JOHN E. SWANSON 183~E PgOFESSIO~ 8 9 10 11 .12 13 14 15 16 17 18 19 20 Reading Time Oepth [o Wa[er Drop Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and VVastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-211-34 GENERAL INFORMATION Complete legal description Location (site address) COSA# ("~ ~/ Expiration Date: Her'i-t;c~ge Pc~r'k, BLock 1, Lot 6 10613 Tr'c~di-I;ion Avenue Current Property owner(s) Mailing address M~rk Sudduth 10613 Trc~di-t;ion Avenue Day phone 850-499-5248 Lending agency Day phone Mailing address Real Estate Agent Mailing Address Cos$~ndr& R~un CoLdweLL Banker Day phone 223-1463 Unless otherwise requested, 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 (COSA) 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 Systems' 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 homeowners. 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. Municipality of Anchorage-' Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Heritage Park, BLock 1 Lot 6 Parcel ID: 050-811-34 Well type IfA, B, or C provide PWSID # Date comPleted Total depth ~ Date of test Static water level Well production Sanitary seal (Y/N) . Cased to .,.~ft,~q- FROM WELL LOG -,,,4 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) Wires properly protected (Y/N) Casing height (~ai~<;~ ground) AT INSP~F.~TI'~ g.p.m. in. Coliform colonies/100 mL Nitrate ~ mg/L Other bacteria Arsenic: uglL date of sample: ~ Collected by:. · coloniesll00 mL B; SEPTIC/HOL,DING TANK.DATA Tank TYpe/Matedal . Anch To. hi-< (steeL) Tank:size 10.00 gal ..... Number of.Compartments' .Foundation. cleanout (Y/N) Y Depression over tank (Y/N) N Date of pu[nping 1/8/10 Pumper JR's C. ABSORPTION FIELD DATA Date installed '8/878:3 Soil rating (g.p.d./ft2 or ft2/bdrm) 1;:)5 45 Length ft. Width ff. Eft. absorption area 7 ~ 0ftz Monitoring tube · Y 7/7/10 Pass Totaldepth 7,1 ft. Date of adequacy test Fluid depth in absorption field before test[..3, in. Elapsed Time: 60 min. Final fluid depth13 Any rejuvenation treatment (past 12 mo.) (Y/N & type) Results (Pass/Fail) Water added450 gal. in, unk Date installed 9 / 14 / 0 9 Cleanouts (Y/N) Y High water alarm (Y/N) N Trench System type Gravel'below pipe 3,3 DepresSion over field N For 3bedrooms New depth. 19 in. Absorption rate >=4 5 0 + g.p.d. If yes, give date D. LIFT STATION NA Date installed "Pump on" level at., in. Datum SEPARATION DISTANCES Size in gallons 'Pump off" level at, , Cycles tested in. Manhole/Access (Y/N) High'water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot na Absorption field on lot na 'Public sewer main NA On adjacent lots na On adjacent lots NA Public sewer manhole/cleanout Sewer/septic service line na Holding tank N A Animal containment areas na Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5' + Property line 10' + Water main 20'+ water service line 10' + 'Wells on adjacent lots 100' + SEPARATION DISTANCE 'FROM ABSORPTION FIELD ON LOT TO: Property line 10' +, 10' + Water Service line Curtain drain NA F. COMMENTS Building foundation Surface water Wells on adjacent lots 10'+ 100' + 100' + Absorption field Surface water 5' + 100' + Water main NA Driveway, parking/vehicle storage. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Si:eve En9 Date 7/7/10. COSAFee $ L~ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. 050-211-34 1. GENERAL INFORMATION CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAHILY DWELLING Expiration Date: __? .'- ./~ d_/~ Completelegaldescription HERITAGE PARK SUBDIVISION; LOT 6, BLOCK 1 Location (site address or directions) 10615 TRADITION AVENUE * EAGLE RIVER, AK Current Property OWner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address STEPHEN & KATHLEEN PALLA Dayphone.622-2623 10613 TRADITION AVENUE * EAGLE RIVER, AK * 99577 Day phone Day phone Unlessothe~ise~quested, HAAwillbehe~byDSD ~rp~k~. 2. NUMBER OFBEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage 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 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 ch-site wastewater disposal and,~or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Hea~th Authority Approval are valid for 90 days from the date of issue fcr prcl:erties servec by a ~,r;vate cr C:sss C '.veil acc ma,.,' be reissued with new water samples. (Certificates may be reissueci for a period of uI3 to cne year w~th valid water samples.) Certificates are valid for cne year for properties served by C:ass A cr B wells cra public water system. The Municipality of Anchorage is nct resl:cnsible for errcrs or cmissicns ~n the '~rcfessicnal engineers work. o 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 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. Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. 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, AKWWC. Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described ~he pedormance of the system under the conditions encountered at ~he time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local so~?s condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future perfon~ance of the system, nor do they guarantee that there are no hidden defects er encroachments. AKVWFC, Inc. 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 v~ll it confer any legal right whatsoever. Date 337-6179 DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for ~ bedrooms. bedrooms, with the fllowing stipulations: ~¥-~ ' ~ WATERAND :m~ : : WASTEWATEA ; -.. .... Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other (Rev. Criginal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.al;.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA HERITN)E,,,PARK SUBDIVIS ON{ ,.LOT 6t BLOCK 1 PUBLIC WATER Parcel ID: 050-211-3~ Well type Pueu~ If A, B, or C provide PWSID# _. Well Log (Y/N) Date completed Sanitary seal (Y/N roperly proteCted (Y/N) Cased to ff. Casing height (above ground) Date of test StaU= water level Well production WATER SAMPLE RESULTS: Coliform ,, -- . colonies/100 mL Arsenic: ,~ ,~. regal.. SEPTIC/HOLDING TANK DATA FROM WELL LOG AT INSPECTION Tank Type/Material ....... STEEL , . Tank S~ r 1250 gal. Number of Compartments ~ Foundation deanout (Y/N) YES Depression over tank (Y/N) ,NO Date of pumping 8//!8//2003, , Pumper ABSORPTION FIELD DATA I~ Date installed 6/8/'!983 Soil rating (§.p.dJft~o~..125 Length ..... 45 ft. Width ,,. 6 It. Date installed 8/8/1983 Cleanouts (Y/N) YES High water alarm (Y/N) N/A ,..CHUGACH PUPMING System type ~ TRENCH Gravel below pipe _, NO For 3, ,, bedrooms New depth **1.7 in. 450.+ g.p.d. If yes, give date 7/15/2003 Toteldepth .7.1 ft. Eff. absorptlonaraa 720 It' Monltorlngtul~*,,YES, Oate of adequacy test 6/18//2003, Results (Pass/Fall) _PASS, Fluid depth in absorption field before test ,3~.5,, in. Elapsed Time: ! 0.3,0 rain. Final fluid depth 5 Any rejuvenation treatment (past 12 mo.) (Y/N & type) **MOULD LEVEL 1 INCH INTO DISTRIBUTION UNE Depression over field Water added 690, gal. in. AbsorptiOn rate >= , SEPTIC ,,CLEAR ***MT ONLY EXTENDS 16 INCHES BELOW THE INVERT Nitrate _ - rog.IL. Other baCteria - colonies/100 mi. Date of sample: .,, - .... Collected by: - D. LIFT STATION Date installed Size in gallons Man~ "Pump on" level at in. ~ High water alarm level at ~ ~ Cycles tested. Meets alarm & circuit requirements? E. SEP^. TIO..,ST C S PUBLIC WATER in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldliff station on lot Absorption field on lot Public sewer main On adjacent lots On adjacent lots ~~-~-~~m~ ~ manhole/cleanou Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field. Water main 10'+ Water service line 10'+ Surface water. ',5'+ 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10°+ Water main Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots. 100'+ F. COMMENTS G. ENGINEER"S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA t-IAA guidelines in effect on this date. JEFFREY A. GARNESS HAA Fee $ ~ "-- Oate of Payment ;~ °22..' (~ Receipt Number ~ (Rev. ~2~ol) Waiver Fee $ Date of Payment Receipt Number ~967-$96'326T T-Q39 Po002/002 F-261 ..-~----- ~u[-28-2003 01:lg~m ASBUILT-NO CORNERS SET THIS DATE. II HEREBY CERTIFY .THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: Lot 6, Block l. Heritage P,ark Su~tXvislon AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING I~OUND- ARY LINES. SEWARD & ASSOCIATES LAND SURVEYING 688-4566 SCALE, 1" = 30' 10/17/9[ s' 24~'68 D~LS Municipality of Anchorage Development Services Department .... Budding Safety Division Or?site Water and Wastewater Program · 4700 South Bragaw St.: ' - · ' P.O. Box 196650 Anchorage, AK 199519-6650 ' www.ci.anchorage.ak.us · (907) 343-7904 CERTIFICATE Of HEALTH AUTHORI,TY APPROVAL FOR A SINGLE FAMILY DWELLING; fl ;~ GENERAL'INFORMATION :.'.:,: Complete legal des. cnpbon L.OT"~2 ;'~L/"~--- " Locat,on {site address or d,rectlons) '.. '. Current Pro~e/ty.o~ner(s) · ; Mailino address Lending agency ~,4r'/'-~ Dayphone 6q.4- oqq Mailing address Day phone" Real Estate Agent Mailing Address Un/ess otherwise requested, HAA will be he/d by DSD for pickup. 2. NUMBER OF BEDROOMS: Day phone 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 et Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Ced[ficates 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 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 for one year for properties served by Class A or B wells or a public water system. The Municipality ef Anchorage is not responsible for errors or omissions in the professional engineer's work. e STATEMENT OF INSPECTION BY E,NGINEER . .'~, · AS Certified by my Seal affixed hereto and as of the vahdatlon date shown below, I verify that my investigation, based on 'procedures outlined in the Health A~thority Approval Guidelines for this application, sh0~{ 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 flies and from my.investigation and inspection, the on-site water supply and/or wastewatar disposal system is(are} in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of InstaIlatiqn. "' :: $&~S~NGINEERING ' ;' " Name of Firm 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 ' Address Engine,e',r'~ P~r~t&~d_ N~'me .'~Ot3~,,A~" C. Phone C,:) ~,,,e ,-/ Date DSD SIGNATURE- ~' - * 1..~_. Approved for. ~ bedrooms. D[sapprove.d. · ConditiOnal 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: ~ "z~' 0 / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box lg6650 Ancttorage, AK 99519-6650 www,cLancflorage.ek.us (g0?) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST ~WELL DATA Well type ,' ,~:/ If A, B, or C provide PWSIO # ~ We, Log(Y/N) Sanltery Date completed seal ~"" Wires properly protected (Y/N) Total depth It. Cas~ ff.. Casing height (above ground) in. FROM W~ LOG AT INSPECTION Date of test Static water level ./ It. It. Well produ~/ __ _ g.p.m, g.p.m. WATE R.~PLE RESULTS: Co_l~ ~ .oolanias/100 mi. Nitrate mg./I. Other bacteria oolonies/100mL D~te of sample: Collected by: e. SEPTIC/I:I, ,.O,L,DJNG TANK DATA, TRnk ~e, ~ gal: , Number of Compartments Foundation deanout (y/N) ! Depression over lank (Y/N) D~a, te of pumping ~ f~C~(~L~_ Pumper '~'r~. I~ Date installed ~' Cleanouts (Y/N I-~--.~1~i~ High water alarm (Y/N) / Dat;~i~:~tailed .~ Soil rating (g.p.d./t~ or ~fodrm) [ ~'~"~ Length 'g~ ~" ' It. Width ~ It. ! Total depth j~.. fl. Eff. absorptionarea'7~Jfta Mon nngtube Y/e Deprassionoverfleld/~/C7 Fluid depth in absorption field before test Elapsed Time:~O min. Final fluid depthl:~" Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type '"~C---"'~'~ ~ Gravel below pipe ~ t~_ I ¢ ft. Water adde~l~ gal. . in. Absorption rata >= ~ O If yes, give date For ._~ bedrooms New depth/~),~in. ~ g.p.d. D. UFT STATION Date instelled "Pump on" level at/,, in. Datum ./ E. SEPARATION DISTANCES Size in gallons 'Pump off". level at Cycles tested Monhote/A~ess (Y/N) High water alarm level at Meets alana & drcult requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/llft station on lot // On adjacent lots Absoq3tion field on lot On adjacent lots Public sewer main / Public sewer manhole/deanout Sewer ISeptic aendceJe Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~.~ ''~ Property line ~' ~L Absorption field. Water service line Water main Wells on adjacent lots lC) J- sudacewater /00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line (.~::) 1 4- Building foundation I Water Service line (c,,~ y- Suffacewater _/¢:~) Cuflain drain ,~J'D~J(- ~,/~t/ Wells on adjacent lots /~/~, Water main /~'3 "/" F. COMMENTS ENGINEER'S CERTIFICATION I cerUfy that I have determined through field inspections and m~4ew of Municipal records that the above systems am/n conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name ~0,~.~'1.7'- C". ~'*'Ow~,~ Date Driveway, parking/vehicle storage /~ /*f'' HAA Fee $ Date of Payment Receipt Number (Rev. 12/oo) Waiver Fee $ Date of Payment Receipt Number Division of Environmental Services . On-Site Se~ices Section 6/~/~ P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 ParcelI.D.# CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING O50-211-34 1, GENERAL INFORMATION Complete legal description Lot 6, Block 1, Heritage Park S~D Location (site address or directions) 10613 Tradition Property owner Mailing address Kirk Martin~ Day phone contact Jan Lending agency Day phone Mailing address Agent D~amic/Jan Steigleman Day phone 3111 'C' Street, Suite 100, Anchorage, AK 99503 Address 261-7654 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well Community well Public water XXX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. xxx 72K)25 (Rev. 1/9~) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or Wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 17034 Eagle River Loop Ruud ;,[u. 284 Phone Eagle River, Alaska 99577 Engineer's sig~'ature ' . ~ Date DHHS SIGNATURE (,/'/'Approved for "T'zL//~F ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Cornments f.' ,'JIl[OJi 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. 72~25 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage JUN 0 DEPARTMENT OF HEALTH & HUMAN SERVlC~¢~,~t(.l~^u[y Environmental Services Division ¢.HViRONM~NTAk,sEgVICE$ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: L¢7-~,/ ~;~Z_t~..///LT~/r~.~ /g2,,~.~ Parcel I.D.: A. WELL DATA Well type ~'~..-~/_-/~.//(~,~ A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary ~t~~ Casing height (above ground) FROM WELL LOG Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well production ~ cW:::rRmSAM P LE~ Nitrate Da~: g.p.m. g.p.m. Collected by: Other bacteria SEPTIC/HOLDING TANK DATA Date installed :~///8 ~ Tank size Foundation cleanout I~N) ,/~-~ Depression (Y/~ /",/~ Pumper --~ ~ Date of Pumping ABSORPTION FIELD DATA " Date installed ~/? ,/ Length '~/-'~-/ Width Number of Compartments High water alarm (Y/N) Soil rating (g.p.d./fF o~ /,~-- System type Gravel thickness below pipe ~/~ Total depth Effective absorption area ~ ~O ~ Monitoring Tube present ~N) ~E Depression over field (Y~ · Date of adequacy test ~/~/¢¢ Results~Fail). P~S3 For 3 bedrooms Fluid depth in absorption field before test (in.); ~// Immediately aEer~/~ gal. water added (in.): Fluid depth / / (ins) Minutes later: / fo -;L Absorption rate = ~ ~0 -f g.p.d. Peroxide treatment (past 12 months) (Y/N) ,,'V'(_,) If yes, give date ,,,,,,/ / 72-026 (Rev. 3/96)* LIFT STATION Date installed /'-/ //~ Size in ga!lon~s / Manhole/Access (Y/N) "Pum~l at* High water alarm level at* ~ *Datum Cycles te~ "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~/~&/~-~ Absorption field on lot Public sewer main Sewer~ On adjacent lots On Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line ~-/"/- Absorption field ~- / Water main/service line ,/0/'/'- Surface water/drainage ¢/~? ~- Wells on adjacent lots /~//,,'~r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /[~ / Building foundation ~/~/ Surface water ///~ / 7/- Curtain drain ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area Wells on adjacent lots /L'///4 / Water main/service line I certify that lhave determined thru field ,nspections and review of Municipal reco.[~.~t.,~,~. Eb~va?~$tems are ~n conformance w~th MOA HAA gu~defines ~effect on th~s date. ~.~ ~.' ~ %, /~ i~ Engineer's Name ~, ~ [/C~ ~. ~ ~ ~ ~. ~ HAA Fee $ ~ C~-"'U ' L:.~-(2) 72-026 (Rev. 3/96)* 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 S NGLE FAM.¥ DWELUN 1. ,,GENERAL INFORMATION Complete legal description Lot ~; Block 1; Heritaqe Park Location (site address or directions) proPerty owner Mailing address ~o5 Ell.ers 20453 Lucas Avenue 10613 Tradition Eagle River, AK Day phone 694-9686 Eaqle River, AK 99577 ,Lending agency Mailing address Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 ~' TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: X~X If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72q325 (Rev. 1/91) Front MOA #21 o STATEMENT OF INSPECTION BY ENGINEER As certified by myseal 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/orwastewaterdisposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythat based on the information obtained from the Municipality of Anchorage files and from my investigation and inspe~:tion, 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. S & S ENGIN£ERING ¢ Name of Firm 17094 ~.g~c Rivcr Lccp ~ca-J N~,. 204 Phone ~-'~ - ,-~-~ 7 Address Eagle River, Alaska 99577 Engineer's signature ~¢.--~/ 2 ./~£,,¢¢--~-- Date /~'//, ~/¢)'7 DHHS SIGNATURE / Approved for ~'~'~'~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional 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 DH HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~21 Legal Description: A. WELL DATA Well type ~,L~Li/~.. '~ (/.~S/{;IA, B, or C, attach ADEC letter. ADEC water.system number MunicipalitYoF HEALTH°f Anchorage& HUMAN sERv,c __ E C E iV E D DEPARTMENT Environmental Services Division DEC 1 1 t997 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-~744 , Municipality of Anchorage Health Authority Approval Checklistoept' Hesith & Human Serwces L,clT ~ J~ ( ~,/~,/?~/Z '~/~ Parcel I.D.: O ,~' O - ,% ~ .- '~ y present (Y/N) Date completed Total Cased to Sanitary seal Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform g.p.m, g.p.m. Nitrate aria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~'~'~l ''~ Tanksize Foundation cleanout(~) t~ Date of pumping' 17~[ID !r'l ~1' C. ABSORPTION FIELD DATA Date installed ~ -~ '~ -'~ ~.~ Length ,f~ ? Width Depression (YO Pumper Number of Compartments __ .IN~O High water alarm (Y/N) ,~ Cleanouts I~,/N). 'Y¢--S Soil rating (g.p.d./ff2 or ff~/bdrm) i~' ~'¢ .System type ~ Il Gravel thickness below pipe ~ 4 %tal depth ~ t0 Effective absorption area ~) '~'t''z' Monitoring Tube present~) ~. Depression over field (Y~)~ 1~ Date of adequacy test , ~./i. 0/~r Results(~ail) '~¢:¥'~o~'~ For Fluid depth in absorption field before test (in.); ~c{ Immediately after;~°d> gal. water added (in.): Fluid depth j~, (ins) Minutes later: { ~ 5 Absorption rate '~"~'~ = g.p.d. Peroxide treatment (past 12 months) (Y/N) I~ ~,l~0,',J If yes, give date bedrooms 72-026 (Rev. 3/96)* D. LIFT STAT-ION~_ Date installed F' - Size in gallons Manhole/Access (Y/N) ~n" level at* "Pump off" level High water alarm level at* ___ *D~_ Cycles tested ~__ __ SEPARATION DISTANCES FROM WELL ON LOT TO Sept,c/holdtng tank on lot Absorption field on lot Publio sewer main ~ Public sewer manhole/cleanout Se~ice line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~ Prope~y line '~O Water main/se~ice line I~ I SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: i~ f Building foundation ~O I Property line Surface water Curtain drain Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ENGINEER'S CERTIFICATION I ce~ify that I have determined thru field inspections and review of Municipal rec~(~flhe a~ms are in conformance with MOA HAA guidelines jn effect on this date. Engineer's Name ~ ~,C~-- C . ~ *oa,~ / ) / HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 CERT F CATE OF HEALTH AUTHORITY APPROVAL FOR A S NG LE FAMILY DWELLING 1. GENERAL~INFORMATION ...... I ....... ~:'"::"-: ........ Complete legal description /-~ ~ ~' X'/~z'/*/~-~'!~;~--'"::'~, . Location (site adaress or directions) · Day phone Day phone Madmg address -' .... ........Address ' ' . . : ............. _ ......... -- NOTE: -If commu~i~ well system, provide Written confirmation ~rom.$tat? ADEG attest- .,, ., Community on-site -.~. X;".'-.:~) "Q--" ~ ' "'¥' : :" .... public's~ver ...... :/"i, - .'-' '% !~ .... '~'"""~\' ' NOTE: If community wastewater system, provide written confirmation??m State ADEC '"attesting to the legality anO status of system. 72-025 (Rev. 1/911 Fron1 MOA #21 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 adequat~ 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 wastewa'ter 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 2O441 ......... Address r-~armEgan Blvd. Engineer's signature / · Phone Date 6. , DHHS SIGNATURE v:;~._., ~'~ p d' f0r".:'.:..~~.......~__ Ap rove . .. . ................... :. .... .- ..... bedrooms. ~ ......................... , ......... ,:," -;:?-'. ......... ~, ppu u'":sa--r~ve~.' -:?'. ti0r~ai i~i~i~r~al for ............. "i ................................. ~;" '--;'.' ': ' Condi' . . ' ' ""'. ' the~follo~ving ~§tipulati~.~? . bedrooms, .with _:'~ :: . . . ..: .' ~.- . . - ..... :~:-:_ .. ... · ~.. '~,-~,, -,. ~:',,':,.,-~ 'Additional Comments ,- ,,The Munlc:pahty qf~Anchorage Department of Health and Human Services (DHHS) issues Hea th Author ty -Approval Certmfl~e, tes'based only upon the representabons g~ven in paragraph 5 above by an independent Profe~'i~al er~gi~b~r registered in the State of Alaska. The D H ~ S does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: Lo4- A. WELL DATA Well A / Log present/ Health Authority Approval Checklist IfA, B. or C,~ ADEC letter. ADEC/~ater system number / Date completed / Wires properly protec /N) / Date of test Static water level Well production WATER SAMPLE RESULTS: / Coliform / Date of sample: / B. SEPTIC/HOLDING TANK DATA FROM WELL LOG / ? AT INSPECTION / / g.p.m. / g.p.m. / Other bacteria /C~ollected by: / Date installed Foundation cleanout (Y/N) Date of Pumping C. ABSORPTION FIELD DATA Date installed Length 4/'..~ ' Width Effective absorption area 7Z O Nitrate Tmflc size / Z~4-(--b Number of Compartments Z Cleanouts (Y/N) Depression (Y/N) ,Ad' High water alarm (Y/N) Soil rating ~.p.~.,'ft2'o~ /X~ System ff~ Gravel thickness below pipe fi,//7/~' ' Total depth Monitoring Tube present(Y/N) Y Depression over field (Y/N) Date of adequacy test ///~//'~,~-Results(Pass/Fail),/~,5' For -.5 bedrooms Fluid depth in absorption field before test (in.); /2 ~" Immediately after¢22 gal. water added (in.): ~ Fhfid depth /2 ~ (ins.) Minutes later: gz/,~o~'F',5 Absorption rate = d, ~Y~, g.p.d. Peroxide treatment (past 12 months) (Y/N) /[,/ If yes, give date ~ D. LIFF STATION Date installed / Size ill galt~ Manhole/Access (Y/N) / "Pump on" level at* / High water alarm levcl at* / *Datum / Cycles tested /' // E. SEPARATION DISTANCES "Pump of F~ Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / ; On adjacent lots / / / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ; On adjacent lots Public sewer manhole/cleanout Lift station Building foundation ff, ~5' ' Property line ff'~) * + Absorption field Water maim'service line /0 ' '~ Surface water/drainage ? / Wells on adjacent lots ~00 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation /O 4- Water mai~v'service line Surface water /DO t + Driveway, parking/vehicle storage area /O t4 Curtain drain ~D ' 4 Wells on adjacent lots ~,9L) t ..~ Property line /O t ¥ F. ENGINEER'S CERTIFICATION 1 ce,'ti~b that I have determined th,'u field inspections and review of Municipal record,~J~_'~t~%aC¢--'~''~ ~v4e,ns are in conJbrmance wtth MOA IMA ~ltldehnes m effect on thts date ~-~ Signature . Date Il J Zo / q~ .......................................................................................................... ~g.~ ~mew-~%~.~,; ......... HAAFee $ ~a~ r~ .. Date of Paymeut Receipt Number Rev. 8/95 Waiver Fee $ Date of Payment Receipt Number Parcel I.D. # ~)~dO - ~J,\\ - ."z)~ 1, GENERAL INFORMATION 'Complete legal description MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section ..? - P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # ~ ~;;~o~ Location (site address or directions) 10613 Tradition, Eagle River. Alaska - ~'- ' ~- FrZtz Prop, erty owner Mailing address P.,0., Box 3425, Home% Alaska 99603 Day phone 235-2906 Lending agency Day phone Mailing address Agent Address 10928 Eaqle River Road~ Ea,qle River, Alaska Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Kathy 0£~stead/JACK {~IHITE COMPANY "Day phone 99577 ~9~-5500 Individual well Community well 'XXX Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer lng to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) r-font MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date showr~ 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 Mdnicipality 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 tlqis inspect[on. Name of Firm Address Engineer's signature S & S ENGINEERING 17034 EaaJe Eagle River, Alaska 99577 Phone Date ~:~'-'2 ~:~'~''/ DHHS SIGNATURE Approved for _~ Disapprgved. ~ 'Conditior~l approval for bedrooms. L 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 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 ce~if!cate is. issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Beck MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~°'[' L~ ~5,~__ ~ ~-~--~-r~.~_~ Parcel I.D. A. WELL DATA Welltype A ~1,-lo.~,'~ IfA, B, orC, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level ~ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on tot Absorption field on lot Wires properly protected (Y/N) AT INSPECTION g.p.m. ; On adjacent lots ; On adjacent lots Public sewer main' Public sewer manhole/cleanout Public sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed '9 ~ \ ~ ~ Cleanouts ~N) ~' High water alarm (Y~ Date of pumping (-'/-~ I Tank size ~,-Z-~'-c> Compartments '7.- Foundation cleanout (~N) ~' Depression (Y~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72~3~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed __ Size in gallons Vent (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) .~---~e[lmp off level at High water alarm level Meets MOA electric~ SEPA~ANCE FROM LIFT STATION TO: V~Crr'on lot On adjacent lots .~-~'~Cyc es tested Surface water D. ABSORPTION FIELD DATA Date installed Length ~' ~ Width Total absorption area ~-Lc"J Depression over field (Y~)) Results ~'¢~/fail) Peroxide treatment (past 12 months) (Y~ Soil rating \'1.~ Gravel thickness. Cleanouts p rese nt~_y.~'N) Date of adequacy test for IOJ~ ~J~ If yes, give date System type ~(24~,J,¢-~ ¢~.~..o Total depth - 7_7_ bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots "'U~ Property line To existing or abandoned system on lot Cutbank ~51/~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA g $ & S ENGINEERING Signature 1~O3a ~¢e Eagle Rive~ Engineer's Name HAA Fee $ /~/'~'! Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEAL%~{ AUTHORITY APPROVAL CERTIFICATE 1. General information Application Date (a) Legal Description.,( include lot,. ~ ~ ~ct bl:~ su ivisiogse ion,~_~ip~r.~e) Location (add~ess (b)Applicants N s~ Applicants A:es (c)Appliqant is (check o_~) Lending Institution ~-]; (~er/builder Buyer ~ ; Other I t (explain); (d) Lending Institution ~k/~,& i~ /'~ ~ ~.~_Telephor'~ ~ ~'~._~ ~__ (,, t%~a, Estate Co. & Agent 2. Type of R~sidence Single-Family N~.mber of ~edrcoms Multi-Family ~-~ Other (describe) 3. Wate~ Supply Individual Well ~--~ C~L'~'~nity.~ Public ~ Note: If cc~nunity ~11 system, must have w~_itten confirmation from the State Department of Enviror~ntal Conservation attesting to the legality and snatus. Is the w~ll adequate fo~_ the number of kedrc~s specified in this HAA (_~_v~_ 4. Sewage Dispcsal Is the wastewater disposal system adequate for the number of beclrocras (Y/N) ~ [Page 1 of 2] 2-15-84 5. Engineering Firm Providing Inspections, Tests, Data and Information ® I c~rtify that I have checked, verified~ or conformed to all MOA HAA Guidelir~s in effect on the date of this inspection. Name of Firm ~ 5 L'~z/~'a--a~% Address ~ I ~_~ Signed by ,jO/~Aj ~ Date ~ /'* /~t ~sap~o~d[]~ Date / '?' 6. DHEP Approval Approved for Approved ~ Terms of Conditional Approval %he Municipality of Anchorage Department of Health and Envirormmntal P~otection dces not ~uarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that~ as of the validation date shcwn above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrcc~s and type of structure indicated. (DHEP SEAL) 7. Mail the HAA to the following address: + KB2/d5/s [Page 2 of 2] 2-15-84 A. WELL DATA Well Classification ~J~$ '~" Well Log P~tesent (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Elec~ical Wiring in Conduit (Y/N) Separation Distances f~am Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Se~ Line Cleanout/Manhole Water Sample Collected By Water Sample Test Results C~nts '~)~ hZ, ~ Ca~,~;,c~r~ MUNICIPALITY OF ~C~GE (MOA) H~ ~O~TY ~PRO~ (~a) APR C~CKLI~ - F~RU~Y 1984 If A, B, ~ C, D.E.C. ~oved(Y~) Date ~leted Yield ~pth of G~outing l~dmp Set At '~EP'j~J~II~J~LTH & ENVIRONMENTAL PROTECTION Sanitary Seal on Casing (Y/N) Depression A~ound Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Se~r To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed 3-t - ~ ~ Si?~ j~ ~-/~&- NO. of Compartments ~ Standpipes (Y/N) ?~ Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N)~ Depression over TapJ((Y/N.) ~Q . Date Last Pumped _/O//J A/g-~3 S~&T~7%4 Pumping/Maintenance Contract cn File (Y/N)m/~ ; for ~J~ 6~%'T1=~/~ Holding Tank High-Wate~ Alarm (Y/N) A)//% . Temporary Holding Tank Permit (Y/N) /0//j Separation Distances f~om Septic/Holding Tank: To Wate~-SupplyWell /V/~ To P~operty Line To Nater Main/Service Line Course ~./~ To Building Foundation To Disposal Field ~CP To Stream, Pond, Take, a~-Major D~ainage [Page 1 of 2] ABSORPTION FIELD. ~TA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption A~ea Length of Field Depth of Field Gravel Bed Thickness Standpipes P~esent Depression over Field (Y/N) N0 Date of Last Adequacy Test ~,/~- Results of Last Adequacy Test ~///~ ~bF67~ ~ Separation Distance from Absorption Field: To ter-Su ly To o rty .ine To Building Foundation i O' To Existing or Abandoned System on Lot ~/~- ; On Adjoining Lots To Water Main/Service Line Z~ ~ To Cutbank(if p~esent) .N/~ To Stream/Pond/Lake/o~ Major D~ainage Course A~/~ To D~iveway, Parking A~ea, c~ Vehicle Storage A~ea Corm~nts '~6~ ~ A?-/;~c'/~-~\ i~,~/~i~(m~',97~-,v O. LIFT STATION ~J'O~ Date Installed Size in Gallons Dimensions Manhole/Access .( Y/N ) "Pump On" Level at High Water Alarm Level at Tested fo~ Electrical Codes (Y/N) "Pump Off" Level[ at Vent .( Y/N ) Pumping Cycles du~ing Adequacy Test. Meets MOA Corm~nts KB1/dL/s [Page 2 of 2] ** Check Permitted Bedroc~ Rating Against HAA Request ** I certify that I have checked, verified, or confo=med to all MOA HAA Guidelines in effect on the date of this inspestion. Con'~pany ~$~ [~C~ge~ 2-15-84 CONSTRUCTION AND OPERATION CERTIFICATE ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION. PUBLIC WATER SYSTEM ' APPROVAL TO CONSTRUCT Plans for the construction of H./-Y'LF. S/b /4' in ~'~'~:' ~1~.t~v - ;Alaska, submitted in accordance with ~8AAC80.]00 approved, z¢? [] conditionally, approved~ (see attached conditions). ~.~ ~y TITLE DATE ;: If construction has not started within two years of the approval date, this certificate is void and new plans and specificat'i~ns must be submitted for review and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. . Approved by Date or descriptive reference). The "APPROVAL TO OPERATE" section must be completed before any water is made available to the public. APPROVAL TO OPERATE The construction ofthe -~/' water system was corn pleted on i ,'-- ,' '.F .... f-~ ::!L. (date). The system is hereby granted interim approval to operate for 90 days following the cpmpletion date. BY TITLE DATE AsIbuilt plans submitted during the interim appr6val period, or an inspection by the Department has confirmed the system was constructed according to the approved plans. The system is hereby granted fna approva to operater ? /~ .,. ,,: .....(*. /./ ....... . .... ,., ;? . If/ .//'-/ - '.--' .,' ".-.. / '/i?,: ....... :- <.~-,. .,,~ ,~, . . . ~. . ' ,,.,..... .... ~ ..... . .... ~ .. ..- BY ' ' ~ TITLE ......... DATE APPLI(,,_~,NT FIL~S· OUT UPPER HA[ , ONLY ~u~r .... ~:_..~ ............ Lendin~ institution [.~.<(z,~5)._~C.~ '[~.~_ .... ~ / -'~}~_.~L~ Phone Address Zip Code Phone Realty Co. & Agent Address Zip Code Type of Resi~nce ~Sinole Family ~ Multiple Family ~o. of ~ Othor Water Supply ~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ommunity For wells drilled prior to that date, give well depth (attach log if available). Public Utility Sewer Individual Disposal ~~ Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time ~~ Date Date Date b >V//_~ Date Inspector Inspector Inspector Inspector Field Notes; ~~,~h~~ 't'~~~ ' ~ ' ~ JUN 1 4 1983 "Municipa~i~ of Anchorage' ( ) APPROVED BEDROOMS *CONDITIONS OF AP~entaJ Protection" (~) DISAPPROVED ~ ~ co.~mo.~...ow~' DATE It ' 2 - ~ ~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~ - % - ~ -7~ · Well ,o Tank Septic T~k Size 72-023 (3182) APPLI( ,.NT FILLS OUT UPPER HA . UNL¥ ' ;2 r ' ~ ;P~hone ~uyer ~ __--~ ~' : ~ ' Zip Oode C.Address ~':~2 ~F . ~ , '~. Phone Lending Institution Address Zip Code Phone Realty Co. & Agent . I /~/t _~ ZiP Code Address Type of Residence Single Family Multiplo Family ~o. of ~odrooms .... ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. ~Community For wells drilled prior to that date, give well depth (attach log if available). D Public Utility Sewer Disposal ~.' .) Year Individual Installed: .~lndividual ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Inspector Inspector Inspector Inspector ( ~APPROVED BEDROOMS~ *CONDITIONS OF App~m~ntS~ p~0t~ ,, ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* ,~ BY: Well to Tank Septic T~k Size 72.023 (31~)