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Home My WebLink AboutHILLSIDE PARK PUD LT 27Hillside Pork Lot 27 #015-312-38 Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~bc/~7 ooy~ PIDNumber: O1~'~ Name: Y'l, cl~,~l ~ L~ ~ Wastewater System: ~ New ~ Upgrade Address:7~O ~o~ ~ O~ ~ ~ ABSORPTION FIELD Lot: ~ Block: Subdiv~ion: Depth to pipe bottom from orig~e: ~h beneath pipe 7 ~ Htll~ ~r~ ~,~ ~~ Ft. Township: Range: Section: Fill added above original grad~ ~h: ~Ft.~ Ft. WELL: Q New ~ Upgrade Gravel width:/ Number of lin~stance between lines: Ft. I ~ Ft. '~ Ft. Ft.~ SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: ~ p ~t ~ ~ ~ ~ Date installed: Yield: Pump Set at: Casing Height Above Ground: TAN,. ~ GPM Ft. Ft. SEPARATION DISTANCES = septic D Holding ~ S.T.E.P. Capacity in [aliens: TO Septic Absorption Lift Holding >ublic/Private Manufacturer:~ From Tank Field Station Tank Sewer Lines Material: Number of Compa~ments: Wel~ _ .... $~ee/ Surface Water >~ ~tOo - - - LIFT STATION N, Lot ~Size in gallons: Manufacturer: Line ~' ~' -- ~ - , ~ ~ ~ ~ ~ ~ "Pump on" level at: ~ "Pump off" level at: High water alarm at: Foundation Cu~ain Pump Make & Model ~ Electrical inspections pedormed by: Drain ~ -- -- - I Remarks: Be~l~c~m~ ~c ~ BENCHMARK Location and Description: Assumed /OO 0 ~, ENGINEER'S SEAL Inspections pedormed by: Ft~F~p Te~ ~c Dates:lst 7/z71~7 ~'; ~''' ......... ;~:~ 2nd Department of Health and Human Se~ices approval ~;::,. ~ -"~ ..... Reviewed and approved by: ~ Date: ~-23-~7 "~:,~.(k~~':~:~%''~ ......... 72-913 (Rev. 9/91) MOA 25 PERMIT NO: SW970042 PID NO: 01531238 EXISTING SOIL ABS. TRENCH NEW 1250 GAL. SEPTIC TANK DBL. C.O. 'BM ~BDRM HOUSE SWING TIES: FROM: TO: S.T.C.O. "D" S.T.C.O. "E" DBL. C.O. "F" TR. M.T. "G" COR. "A" 11.5' 16' 19' 59' COR. "B" 22' 28.8' 32' 74' PLAN VIEW SCALE: 1" = 30' - 0" PAGE 2 OF 2 ~__GROUND ELEV. 99' 1250GALLON SEPTIC TANK PROFILE VIEW NOT TO SCALE INV. 93.7' LOT 27, HILLSIDE PARK P.U.D. SEPTIC TANK UPGRADE AS-BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 SCALE: AS NOTED DRAWN BY TFM APRIL, 1997 PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970042 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:SHARON MICHAEL W & OWNER ADDRESS:7240 CROOKED TREE DR ANCHORAGE, ALASKA 99516 PARCEL ID:01531238 DATE ISSUED: 3/24/97 EXPIRATION DATE: 3/24/98 LEGAL DESCRIPTION: HILLSIDE PARK PUD LT 27 LOT SIZE: 58534 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 A_ND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: Ao OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. 1 SPECIAL PROVISIONS: RECEIVED BY: ~ ~/~ DATE: ~ / Z7/97 DATE: ? - 2 -- ? 7 CIVIL & ENVIRONMENTAL ENGINEERING · ENERGY CONSERVATION & ANAJ~YSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 March 21, 1997 M.O.A. DHHS P.O. Box 19-6650 Anchorage, AK 99519 Dear Sirs: The purpose of this letter is to provide the required design narrative in support of our application for a permit to replace a leaking septic tank on Lot 27 of Hillside Park P.U.D., located at 7240 Crooked Tree Drive. A site plan and specifications are enclosed for your review. The proposed project will have no significant impact on present or future water supply and wastewater disposal systems serving adjacent properties; nor will it have any significant impact on . reserved space-surface and subsurface, or on drainage. Please give me a call at 345-1355 if you have any questions on this submittal. Sincerely, Ted Moore, P.E. EXISTING SOIL ABS. -- TRENCH TRACT F-1 (VACANT) LOT 27 HILLSIDE PARK P.U.D. ABANDON EXISTING 1250 GAL. SEPTIC TANK INSTALL DOUBLE C.O. INSTALL NEW / 1250 GALLON SEPTIC TANK 4 BDRM HOUSE LOT 28 TRACT C(VACANT) NOTE: LOTS IN THIS SUBDIVISION ARE SERVED BY A CLASS "A" COMMUNITY WATER SYSTEM. NO WELLS ARE LOCATED WITHIN 200 FEET OF THE PROPOSED SEPTIC TANK REPLACEMENT LOT 27, HILLSIDE PARK P.U.D. SEPTIC TANK REPLACEMENT SITE PLAN FLATTOP TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 MARCH, 1997 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. Flattop Technical Services 14530 Echo Street, Anchorage, AK 99516 Phone (907) 345-1355 Lot 27, Hillside Park P.U.D. 7240 Crooked Tree Drive Septic Tank Replacement Specifications 1.0 General: 1.1 The scope of the project consists of properly abandoning an existing leaking 1250 gallon septic tank and installing a new 1250 gallon septic tank to rePlace it. 1.2 Construction shall be as depicted on the approved site plan. Minor deviations from these drawings may be allowed or required by the engineer conducting the inspections. All construction procedures and material specifications shall conform with Municipal and State requirements. All separation distances shall be in conformance with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessary utility locates, and to work around any buried utilities. 1.4 The contractor shall provide adequate cover material and rough grading over all system components to ensure that proper drainage is achieved after settlement and that there are no residual depressions. Insofar as possible the contractor shall minimize damage to trees and existing lawn areas. 1.5 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 1.6 The contractor should be aware that access to the septic tank site may be difficult due to steep slopes in the vicinity of the southwest comer of the residence. 2.0 Septic Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil. 2.2 The new 1250 gallon, 2 compartment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compartment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. 3.0 Inspections: 3.1 One engineering inspection will be required during the course of the project - after the septic tank is set level and the piping connected, but prior to backfill. 3.2 The installer shall coordinate the timing of the inspection with the engineer sufficiently far in advance to ensure the availability of'the engineer. ·~ MUNICIPALITY OF ANCHORAGE 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 MAILING ADDRESS LEGAL DESCRIPTION LOCATION ~ell Dwelling [O f DISTANCE TO: I~, ~Abs°rpti°narea Manufacturer ~~~ .~ ~ . [W~th Liq, caf in gallons IF HOMEMADE: Inside lengt~ Mat~ Well / D~ ng //~I~ ~ Material DISTANOETO: ~¢, Foundati~% Nearest]otliCe~ O ines Length of each line Total length of lines Trench width Top of tile to finish grade Materiel beneath tile Width Depth Building found~t~o~ Nearest lot line Depth Driller Distance to lot line PHONE /~EW NO, OFBEDROOMS PERMIT NO, of ~.~artments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. (~//~)~., ? ~ Distence b~wa7 ~,~s PERMIT NO. are~, ................ PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE ~IATERIALS SOIL TEST RATING APPROVED DATE LEGAL PERMIT NO. DEPARTMENT !~ HEALTH aND ENVIRONMENTAL ;~-'~OTEC.'TION 825 '"2 STREET., RNCHORRGE., aK. 264-4728 8102~2 ) BF'PL t C:RhlT LOCRT I ON LEGal_ STEINaR R. HaNSEN :F.': ]KED TREE L~., HILLSIDE PaRK 4?'07 MELYIN RYE LOT .:, I ~.E ._.:,._,.:,,1 _,~.!UHRE FEET '-" 'g' ": I S "rYPE OF '_=;OIL RE,:,oRFTICN _~_,TEM : TRENCH MH,,,IMJM N tMBER 0F BE[.F..0uMz. = "~ SOIL RHT IN.~ THE REQUIRED. _,I¢.E OF THE :,UIL'-' RB_,URFTIUN"~' ' * '-':,~_,TEM '~ ' IS: [:, E F'T PI== :l_~Z LE~-~ISTH= J. 6 GRR%-"EL [:,EPTH~ G: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R 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 GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE aND THE BOTTOM OF THE EXCRYRTION (IN FEET). REG)L, I E:E[:, _.EP], I L--:. TFtl'-.I[.~,'. =. I ,¢~E-- i~Z,£1~Zl PERMIT HFFLIL. RNT HaS THE RE=.F_Nz. IBILIT~ TO INFORM THI~=, [EFBRTMEHT) ' DUF.,INb ]'HE iN=,THLLHTILN INz, FEL, TIUN=, OF aNY WELLS aDJRL. ENT TO THI'=' FROPERTz aND THE NUMBER OF RESIDENCES THaT THE NELL WILL SERVE. T l..,.ltI] ~-' ii' ") I It'-i:.F E~,-T I C~l'ql--.~'] aRE F~ EI~..~LI I ~:E[:, E:H_.KFIL. LIN~ OF aNY :,~..,TEft WITHOUT FINAL IN:,FECTI_N aND HFFR_,RL THIS DEPARTMENT WILL E,E =,UE, JEL. T TO PR3SECJTION MINIMUM DISTANCE BETWEEN a WELL AND aNY ON-SITE SEWAGE DISPOSAL SYSTEM IS ±00 FEET FOR a PRIVATE WELL OR ~50 TO 200 FEET FROM a PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVATE WELL TO R PRIVRTE SEWER LINE IS 25 FEET aND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MaY aPPLY. SPECIFICATIONS aND CONSTRUCTION DIBGRRMS RRE aVaILaBLE TO INSURE PROPER INSTRLLRTION. I CERTIFY THRT 1: I aM FaMILIaR WITH THE REQUIREMENTS FOR ON-SITE SEWERS aND WELLS RS SET FORTH BY THE MUNICIPRLITY OF aNCHORaGE. 2: I WILL INSTAL[. THE SYSTEM IN aCCORDaNCE WITH THE CODES. ~: I UNDERSTAND THaT THE ON-SITE SEWER SYSTEM MaY REQUIRE ENLARGEMENT IF THE RESIDENC:E~MODELE~4CLUDE MORE THaN S': BEDROOMS. '..~/~-/,///~ -',~--- s I,: NED: Z_C_ .......... HFFLIE. MN I ..,TEI NAR HANz, EN ISSU[D BY .... TI__. 0 RG;\N I C S 5~d .U? (.PI,L) (:RAVEL w/ SOME ......................................... 5. ()~ 1 GR7~VEL wITH R'[~/~CE SAND, T~h'\CE SILT (GP-GM) SAND IqlT~'[ SONt!: GRAVEi, r , TR2~CE SILT (SP~SI~) 6.0~ NOT ElqC('~UNT[< RED A GROUNDIelATER %JP, S NO? I:;t!ICC)UN']'ERED an:] have no'k ........ \X.,. ~ ed by '4, u: ~'eyinq ~ \.__ ,:" -''} ......... ") DOLrBLE TREE ..................................................... 0 ' MAL,[.NY Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 A~chorage, AK 99519-6650 www. cl.ancherag e.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-312 -38 t. GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s) Mailing address Lending agency ExplraUon Date: HILLSIDE PARK/~SUBDMSION; LOT 27~ LES OWENS 7240 CROOKED TREE DRIVE 7240 CROOKED TREE DRIVE ANCHORAGE, AK 99516 Day phone 346-3423 ANCHORAGE~ AK 99516 Dayphone Mailing address Real Estate Agent Mailing address NANCY S~¢-P0U.OO( w/ PRU~[m~. JACk< win: Day phone 762-5818 3201 "C" STREET, SUiTE 200 ANCHORAGE, AK 99503 Unless othen~ise requested, HAA wi#be held by DSD for plckup. 2. NUMBEROF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A 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 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. Certificates of Health Authority Approval are requlred for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/er water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for gO 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 vatid for one year for proposes served by Class A er B wells or a public water system. The Municipality of Anchorage Is net responsible for errors or omissions In the prel'essional engineer's work. Note:Alaska Water and Wastawatar Consultants, Inc. shall be pald $7OO. OO at, or pr/or ] to closing for the engineering san/fces provfded. 4. STATEMENT OF INSPECTION BY ENGINEER As ceA'fled by my seal affixed hereto and as of the ~alidation date shown below, I vedfy that my invesb'gation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that tho on-site water supply and/or wastewater disposal system is(are) safe, func~'onal and adequate for the number cf bedrooms and typo of structure Indicated herein. I turner verify that based on the Information obtained from the Municipality of,Anchorage files and from my Investiga~'on and inspection, the on-site water supp~ and/or wastewater dispoea~ system Is(are) in compliance H4th all applicable Municipal and State codes, ordinances, and regulations in effect at the t/me of installation. NameofFirm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Phone ,337-6179 Address 6901 DEBARR ROAD, SUITE 2B * ANCHORACE, AK 99504 , Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date Engineer's Comments: .... In conducEng this evaluation, AWWC, Inc. a~tempted to provide a thorough, consden#ous englnaedng analysis of tho system In accordance with ADEC and MOA ,~ r~ ~ A -v'~;~-,~/ system under the conditions encountered at tho Eme of tho test, and separation . dis'--st~--s.ro~..adi~ldan§§ablefeatu.$.Theope, t]onallifeo, all wellsand · septic systems depend on the Iocalsoils condition, ground~aterlevels that may fluctuate during the year, and the water usage of the family being set~d by the s~stem. These conditions are outside the control of the e~aluator of the s~stem. Satisfactory test resu'¢tonotguaranteefutllreperformanceofthesystem, nordotheyguaranteothat there are no hidden defects er encroachments. AWWC, Inc, can therefore not prot4de operational rsqulremants of the ADEC or MOA DSD. Tho content of this report Is for ~.'~ the sole benefit of tho owner #sted above. Any reliance upon or uce of this report by any '~t~ pr other person or petty ls not authorized, nor will tt confer any legal ~fght wha~soe~r. DSD SIGNATURE X Approved for 4 'bedrooms. Disapproved. Conditional approval for __ bedrooms, with the fllowlng stipulations: Attachments: I.-IAA Checldist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other Odginal Certificate Date: Municipality of Anchorage Development Sewices Department eundmO Safet~ oMam On-Site Water & Wastewater Program ,4700 6outh Bmgaw St. P.O. Box 196650 Ancfl0lige, AK 99519-6650 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descdption: HILLSIDE PARK SUBDIVSION; LOT 27~ Parcel ID: 015-312-38 A. W~LL DATA IfkB, orCprovldePWSlD~ 2,~246~1 ___ ___.. ~ We~ type couuu~w T ~ t~ ft. Casing height (abov~ ground) ,in. FROM WELL LOG Date of test ~ W.W_.~I4~3Eucflon g.p.m. WATER SAMPLE RESULTS: AT INSPECTION ,~J g.p.m, 2 Depression over tank (Y/N) NO Pumper Date In,tailed ,3/27/97 Cleanoute fi/N) YES High water alarm (Y/N) N/A A+ HOME SERVICES B. SEPTICAIOLDING TANK DATA Tank Type/Material STEEL Tank elze 1250 gal. Number of Compartments Foundation cleanout (Y/N) YES Date of pumping 2/1/01 C. ABSORPTION REID DATA Date Irmafled 6/03/81 Length 26 ft. Soil rating (g.p.dJft~or~j) 85 System type DEEP TRENCH W1dift 4 It. Gravel below pipe 7 Total daplh 10 It. Eft. absorption ama 364 ft' Monltedng tube YES Date of adequacy test 2/1/Ol Results(Pass/Fell) PASS Ruld depth In absorption field before test 6 In. Water added 887 gal. Elapsed Time: 1398 min. Final fluid depth 2" In. AbsorplJon rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) fl. Depression over field NO For 4. bedrooms New deplh 18 in. 600+ g.p.d. NONE KNOWN If yes, give date N/A D. UFT STATION Data Installed. Size In gallons 'Pump on' level et in. 'Pump . High water alarm level et__ .in. Da...~.~m Cycles tested Meets alamt & circuit requirements? SEPARATION DISTANCES COMMUNITY WELL SEPARATION DISTANCE~ FROM WEU. ON LOT TO: Septic tank/lift etatlon on lot At~orptlon field On lot Publlc sewer main On ad]acent lots __.--- ..,.--- Public sewer manhole/clesnout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Buftdlng founda~on 5% Property line §'+ Water main 10'+ Water sewloe line 10'+ Wells on adjacent lots 2OO'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Building foundation 10'+ Surface ~vatsr 1 oo'+ Wefts on adjacent lots 200'+ Property line 10'+ Water esrvlce line 10'+ Curtsln dmln NONE KNOWN F. COMMENT~ Abeorptlon field. §'+ Surface watar lOO'+ Water main, 1 o'+ Driveway, pa~tdng/vehlcle stamge 50'+ G. ENGINEER'S CERTIFICATION I cerZffy that I have determined ~ugh field Inspec#ons end revfew of Munh~pal records that the above systems ere In conlbrmance with MOA HAA guidelines In effect on this date. Englnse;'s PrL, tt~d Name JEFFREY A, OARNESS Date of Receipt Number. (l~v, l?JOO) Waiver Fee $ Date of Payment Recelpt Number MUNICIPAL,!TY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES - Division of Environmental Services On-Site Sen/ices Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CEF'TIFICATE C:: HEALTH AUTHORITY ~,PPF~OVAL FOR A SINGLE FAMILY DWELLING l. o6 '& 7 /~1t.~ ~ PZt r~ ?,ct, l). Location (site address or directions) Property owner Mailing address Lending agency __ D~y phone rP~"':~'d,., *4-'~cho""~v~t~ ~-~ 9~.5 /0" Day pho ne Mailing address. Ag~,:~t ~/;.r/~ ~'~,'~: I ~-c lI~ A~- Unless otherwise requested, HAA will be held for pickup: NUMBER OF BEDROOMS: Day pha ne REC:EIV£D TYPE OF WATER SUPPLY: Individual well Community well : Public water APR 1 199-( M,u;,c p~', ~t~ Of Anchorage Health & Human Services NOTE: If cOmmunity well sYStem, provide, written confirmation from State ADEC attest- ing to the legality and status of system. 'TYPE OF WASTEWATER DISPOSAL: :~"-i: ',,~ -':' ', Individual on-site community on-site · PUbliC sewer NOTE: If commUnitY wastewater system, provide written cShfirmation from State AD£O tl:ie I~galitY ~nd Stat ~¢ of syst attesting t8 72-025 (Rev. 1191) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verifythat 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. Phone 3' Y j--/_3~ Name of Firm Address Engineer's signature DHHS SIGNATURE~ ,~, Approved for /z~ Disapproved. :ConditiOnal approval for Date q/ tg/ 2 7 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 DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federa! 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 w°rkl Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501· (907) 343-4744 Legal Description: A. WELL DATA Well type Health Authority Approval Checklist ~ I~g.c "A '' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to Casing height (above ground) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Nitrate Other bacteria Collected by: Fluid depth in absorption field before test (in.); 3~ Immediately after~$ I gal. water added (in.): Fluiddepth tO.or~ (ins.) Minutes later: qE Absorption rate = ~> 6'00 g.p.d. Peroxide treatment (past 12 months) (Y/N) /Vo~ /~,ao~,~ If yes, give date N.A. Results (Pass/Fail) Monitoring Tube present(Y/N). Soil rating (g.p.d./fi2 or fl2/bdrm) ~$- ~ System type t q ~- Gravel thickness below pipe p.~-' 7 ' Total depth t t, ff' __ Depression over field (Y/N) For q bedrooms Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform iv, /! Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed 5 / ?- 7/9 7 Tank size Foundation cleanout (Y/N) Date of Pumping /v,. A, [ C. ABSORPTION FIELD DATA Date installed fi'/' ~ I Length ~o~' .Width Effective absorption area 3ff¥ Dateofadequacytest ~ / ttg! ~ 7 I gS'~ct! Number of Compartments __ Depression (Y/N) h/ High water alarm (Y/N) Pumper __/4, ~_ Cleanouts (y/N) ~.A. D. LIIqT STATION IV./}. Date installed Manhole/Access (Y/N). High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot ~ Absorption field on lot -- Public sewer main - Sewer/septic service line - Size in gallons "Pump on" level at* "Pump off" level at* ; On adjacent lots .; On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation &"' Property line ~O ' Absorption field ~ ~ ' Water main/service line 7',~1o' Surfacewater/drainage ~3, too' Welis on adjacent lots > 200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~3- ' Surface water 7> (o0 ' Curtain drain /Van e 5e eM ENGINEER'S CERTIFICATION Property Line htr-' Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots ~> ~ oo ' En~neer's Nme I-IAAFee $ .?~F~ Date of Payment Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number Parcel I.D. Cf 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 L~\~ - ?-)i ,'~ - ~C~ NAA # ~ ~Cl/~C31 ~ \ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L (b) (c) Lending Institution E'E.~ ' ~;/tNI( ' Mailing Address ~O( t,¢'E c_-?- J~E~IS~,¢4 (d) Real Estate Company and Agent ~E~LT~ Address ~00 J~%~ ~'&O ~b Location (address or directions) Property owner I~R~ ~ JU'~ ~SS~ Telephone: (home) ~"~CiBusiness ~'~'J'l~ Mailing Address ~2NO CRoo~Eb '~RE~ (e) Telephone Telephone 3 Z/41/ ._ 05 fO I Mail the HAA to the following address: (or check here~,if hold for pick up.) List contact person and day phone, number below: 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 Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-sitel~ 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, I verify that my investigation of th is Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional end 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 FL4T'rO? 'TEc~/NIC'/;c ~'~fi. Telephone Address J~30 J~CHo ~( )~NC~I ~ Date Ap I a 7,, 19 Approved for bedrooms by . / Appro~,ed ~ _ Disapproved Conditional Date .jZ"--/--TO Terms of Conditional Approval 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 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. 7/88) Back Page 2 of 2 WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Grouno Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: 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 Ccmments ~.) E. C.~ I~OVFtL MUNICIPALITY OF ANCHORAGE (MOA) Health/~Al~t[l~'ity Approval (HAA) 2 7 1990 RECEIVtD Dato Gomplotod Dopth of Groutin~ Legal Description: L ~'7 141U.,$1C~&.~ PFteK Y If A, B, C, D.E.C. Approved (Y/N) Yield Pu m p Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date L g "rr £ P.a c b SEPTIC/HOLDING TANK DATA Date,nsta,ed Size Standpipes (Y/N) y Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) No. of Compartments Y Foundation Cleanout (Y/N) Date Last Pumped ~/2. 7/?0 ;for I~,/~ , Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well .~7 ,200 To Property Line (o(~ t To Water Main/Service Line ~' 2,,.~' i To Stream, Pond, Lake or Major Drainage Course To Building Foundation To Disposal Field Comments 72-026 (Rev. 7/88) Front Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption,Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ To Building Foundation ~(~ Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course ~;~ To Driveway, Parking Area, or Vehicle Storage Area 70 /~' D P'' {v~ Type of System Design Length of Field ~ ~ ! Depth of Field ~ ' Gravel Bed Thickness 7 Statndpipes Present (Y/N) Y' Date of Last Adequacy Test q/2 ~/cio To Property Line 6~ ( To Existing or Abandoned System on ; On Adjoining Lots "~ ,~O / To Cutback (if present) Comments D. LIFT STATION NoNE 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 in effect on the date of this inspection. Signed .~~ Company Date ~; MOA No. /7¢.°o Receipt No Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Waiver Fee: $ Date of Payment Page 2 of 2 STEVE COWPER, GOVERNOR / ,_. ,, ~: ,~,-,.; 't/?~-'~ , / DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHOP~GE, ALASKA 99503 April 24, 1990 563-6775 FOR: FLAT TOP ENGINEERING Attn: TED MOORE PWSID: ~212461 According to the records on file in this office, the Hillside Park Subdivision Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, EVnEv~r~mental Fi¥'ld Officer VEC:bas MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES /~ ~'~'_ /,/ ,.~'-o~ o~' DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ~ GENERAL INFORMATION fMUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Locatior (aadress or directions) o f (b) V~ / ~ Telephone: Home (c) Property Owner Mailing Address Lending Institution l~".a,,~,'~ + Telephone Mailing Address (d) Real Estate Company and Agent Address Business Telephone (e) Mail the HAA to the followino address: or: Check here~f~ if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms 3. WATER SUPPLY Individual Well,J~ 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 O,nsite~ii~ Public [] Community [] Holding Tank I-I. Note: If community well system, must have written Confirmation fro m the S~a~e'Departmen~ of Environmental COnservation attesting to the legality and status. Page I of 2 ?2-025 (Rev 8/861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investiga!ion of this HeaJth 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/,~ Municipal and State codes, ordinances, and regulations in effect on the date of this insQectio,~ [/ Name of Firm '~"~ Telephone ~""~ ~ -' ~ ~;~ / ~:~ Address I ~)~ ~ t ~" I/'~ Engineer's Seal DHHS APPROVAL Approved for .~-~'#.~.(Z.~.) bedrooms by Approved ~ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8;86) Sack A. WELL DATA i~[¥ oF A~cHoRAG~ iV, uH~CtPAL . ,.~.~,v[C~I~IL~LITY OF ANCHORAGE (MOA) ~Nv[~ONM~NT ~EALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 [)~C 3 ~ 264-4744 Well Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~ To Nearest Edge of Absorption Field on Lot ~ To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments L~-~ ~, --~ ~; If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Cased to Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Size Air-tight Caps (Y/N) 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 ,~ O To Water Main/Service Line 50 Course ~,/O NO. of Compartments -T" I,~ Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 72-026 (Rev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed (¢~/~'/~ Width of Field ~ ~' Square Feet of Absorption Area ~:~ ~, ¢ Depression over Field (Y/N) /~ Results of Last Adequacy Test ~ ~,,.-% Separation Distance from Absorption Field: To Water-Supply Well ,~' ~'~ ~ To Building Foundation ~-~&:~ '~ Lot ~?O ~/~ To Water Main/Service Line '~ tc To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test I Z//z./~ 7 To Property Line ;~ To Existing or Abandoned System on ; On Adjoining Lots ! ~ To Cutbank (if present) 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 Date of Payment Amount: $ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have c_becked, verifiecl~r conformed to all MOA and HAA guidelines Signed . ~ Date V'~ in effect on the date of this inspection. Company MOA No. ReceiptNo. ~-00 / Page 2 of 2 72 026 fRev 8/86/ Back Engineer's Seal CONSULTING ENGINEER 203 W 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WELL: SEPTIC SYSTEM: Lot 27, 'Hillside Park PUD 7240 Crooked Tree Herb Veyran Four Bedroom, Single Family Class A Community System FROM MUNICIPAL RECORDS: DATE OF LAST PUMPING: DATE OF TEST: TEST PROCEDURE: TANK:1250 Gal. Anchorage Steel, Two Comp ABSORPTION SYSTEM: Trench ABSORPTION AREA: 364 Sq. Ft. , ..SQ.tL RATING: 85 INSTALLATION DATE: June 1981 October 10, 1987. A+ December 2, 1987 System was inspected and measured. Tank was found with four feet of cover and a liquid level of 48 i~ches'. Sump was 11 feet deep and had 1t inches of liquid. 3.50 gallons of clean waster wer~ added to the sump at a constant rate of 7 gallons per minute while the water levels in the tank and the sump were monitored. Tank level did not change. Water level in sump decreased and the sump- was dry five minutes after wa~er flow had stopped. This was probably caused by washing away the solids and organic mat that had developed. Inspector notes....qn As Built that sYstem was installed in extremely loose graveI'. TEST RESULT: T~is system meess the code r~quirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational' life of all septic syst'6ms depends on the local soil condition~, ground water levels that may fluctuate during the year, and {he water usage of the family being served by the system. These conditions are outside ~he control of the evaluator of this septic ~system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. 3601 "C" STREET. SUITE 1334 ANCHORAGE. ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 DATE: 12-2-87 PWSID #: .2124.61 To Whom It May Concern: According to the records on ¢ile in this o¢¢ice, the HILLSIDE PARK SUBDIVISION Water System is in compliance ~ith the State o? Alaska Drinking Water Regulations. Sincerely. Ronald S. Kl'ein .Environmental Field Officer DA{TE RECEIVE~) · INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE MLINICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. (bF I i!,.Li[i & 825 L Street - Anchorage, Alaska 99501 [~N~/[RONMENI.'.L ~. ;.' (~CTtOH ENVIRONMENTAL SANITATION DIVISION~q~ :,. D~ ~ ~ ~, ~ ~;~ Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW...~ ,.~ DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be proce~ed. Please allow ten (10) days for processing. PROPERTY RESIDENT (If di~rent from above) PHONE 2. BUYER , ~p~ PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~/~,~,~ P~Z'Y"~ /~ ~ I PHONE MAILING ADDRESS 4. REALTOR/AGENT ~ PHONE MAI LING ADDRESS 5. LEGAL DESCRIPTION p(~..// ~7 W,'/Isic4 P r-/c STREET LOCATI ON [ 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One ~ Four [] Other~ [~ SINGLE FAMILY [] ,Two [] Five [] MULTIPLE FAMILY [~'/Three [] Six 7. WATER SUPPLY I NDIVIDUAL* COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: ~ '~-'~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER MATERIAL TOTAL ABSORPTION AREA e ,c Hol ,n T nk~~ SewerLine [Nearest LotLine 4. DISTANCES S pt' / d' g a bs pt" WELL TO: Absorption Area to nearest Lot Line 5. COMMENTS [~,,"~PRov ED FOR ~' BEDROOMS [] CONDITIONAL APPROVAL (letter must accompanv certificate) [] DISAPPROVED DATE BY