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HomeMy WebLinkAboutLAKEWOOD HILLS LT 3Lc kcwood Lot 3 #015-312-12 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 ~c'/ i /al' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.._O15-312-12 1. GENERAL INFORMATION Complete legal description HAA# H/:~ Expiration Date: 01o1"7 2:~, c3 -I-al Location (site address or directions) Current Property owner(s) Day phone Mailing address F,0~D o x 2P. gg4g,. ^.~J~. AK Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address 4-24.1 "D" 5t;r~e~. A~_c.~o~, ~e~.&K 9950_3 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality cf 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 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 of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the 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 Flal~;oFl'e~h,l~LS_ezz[¢c~ Address 14530 Echo St. ree'c.A,cho_ca~e.^K,_~516 Engineer's Printed Name T..__h~_o_~_¢re F, Moore Phone _..,~4-5-1355 Date 4-/2_6_ZZP_01 DSD SIGNATURE Approved for _.~ Disapproved. Conditional approval for bedrooms. ~ .~-~ '.. .. ~x~ C bedrooms, with the following stipulations: Additional Comments WA:51EWAI bi-{ PROGRAM Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995'19-6650 www.ct.anch0rage.ak.us (S0?) ~4,~?~4 HEALTH AUTHORITY APPROVAL CHECKLIST LogalDescdptlon: Fa~¢ ~. /..,~k~'~4,,,o'oo~ /'/',/~ ParcollD: OtS'-~/Z- /~ A. WELL DATA Well type Pvd' Date completed I? '~ O Total depth .'~ f~ lt. Date of test Static water level Well production IfA, B, orC provide PWSID # Sa~tte~ seaJ (y~) ~' FROM WELL LOG g.p.m. Welt Log (Y/N) N Wires property protected (Y/N) y Casing height (above ground) ,~Z. in. AT ;NSPECTION ~> ~" 7 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colontes/100 nd. Date of sample: ~'/2o / o I Nitrate '~,?/ mg./L Collected by: F'~/-/¢,~ Other bacteria ~:~ colonies/100 mi. 7"e,' A Bo Foundation deanout (Y/N) Date of pumping C. ABSORPTION FIELD DATA SEPTIC/HOLDING TANK DATA TankType/Material .~,.~';~ / do,'~ Tank size ~ gal. Number of Compartments I Depression over tank (Y/N) Pumper IV o r:~ I ~/~,~- Date installed Cleanouts (Y/N) ~' High water alarm (Y/N) Date installed I~/30, / 7~' Soil rating (g.p.dJit~ or ~/bdrm) Length 33 x z.z~7..'7 It. Width Total depth lO It. Eft. absorption area F5-2, ~ Monitoring tube . Date of §dequacy test ~' ! ~.~/~,¢~'/ Results (Pass/Fail) Fluid depth in absorption field before test ~,a" in. Water added 3J i gal. Elapsed Time: I~&' min. Final fluid depth~'.~-Lfln. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type CO~c ~/~ Grovel bal~ pipe .~ ff. Depression over field For ~ b~moms N~ dep~ 7~ b'in. Y~ g.p.d. If yes, g~e date ~, D. UFT b'rATION Data installed S~Ze in gallons Manhole/Access {Y/N) 'Pump on" level at in. 'Pump orr level at __ in. High water alarm level at Datum Cydes tested Meets alarm & circuit requimrnents? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/tiff station on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/eleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 2 3' ~,~, --~,. Property line ~ ¥' ~,,, ~.c.. Watermain .'~ t~,~ Water sen4ce line ~ Wells on adjacent lots ,~, Ioo ' Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propertyline ~.?' ~, ¢.c,, Building foundation yZ' ~,~,,, Watermain '~ l~ ' Water Service line ~ to' Sudacewater ~, ~oo' Dflveway. parking/vehicle storage '7 ZE'/ Curtain drain Ho,~Z 5'~ Wells on adjacent lots '~, ;oG, G. ENGINEER'S CERTIFICATION I certify that I have determined ~reugh field inspecffons and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date of Payment Receipt Number ~/~-D~Lq ~1~(~ (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number Mmficipality ,of Anchorage George P. I! uerch. Mayor Building Safety Division P.O. Box 1~5C~0 * -1-700 S. Bmgaw Street Anchorage, Alaska 90519-('ff'~50 · (907) P~13-8301 h t t p://www.cl.anchomg¢.ak.us Public Works Flattop Technical Services ATTN: Theodore E. Moore, PE 14530 Echo Street Anchorage, AK 99516- May 01, 2001 Subject: Waiver Request forLAKEWOOD HILLS LT 3 Waiver # WR010021 Lot Line Request for Parcel ID 015-312-12 Dear Engineer: Your request for a waiver ofthe required I0 feet horizontal separation of the on-site wastewa'ter disposal system to the lot line has been approved. The approved separation distance is 0 feet. This waiver approval applies to the current on-site wastewater disposal system and lot line separation only. Any future upgrade to the on-site wastewater disposal system and lot line will require all separation distances to be met or another waiver approval from this department. If there are any further concems or questions regarding this waiver, please call our office at 343-4744. Engineering Technician III On-Site Water Quality Program g4-Z6-O1 08:$? R~M-CTE ENVII~I,ERTAL $615101 ,~~ CT&E Environmental Services Inc. Laboratory Divioion Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTION~ ON REVERSE ~DE ~ CO~ ~lJiPIII T-?09 F.e3/03 F-gZ9 200 W. Ponm' Ddve Anchorage, AK 99518 Tel' (907) r~2-23,13 Fax:. (907) 561-5301 MUST BE COMPLETED BY WATER SUPPLIER . TO BE COMPLETED BY LABORATORY  'y~m ~ E,a~IPLE to ~: [] PUBUC WATER SYILllM ID~ ...... ~ PRJVAI~ WATER SYBTEM SAMPLE DATE: SAMPLE TYPE: [~ Routine D Repeat Sample (refer to lab no. [] Special Purple r'l Tr~atad Witor I~ Unt~at~d Water ! Time Coll~:t~d Coit~:b,d~: by (tnit~): BACTERIOLCX)ICAL ~ATER AN~ Loca'Gc41 Collected fram: ANC FBI( JUN D Time. RECORD. MMO-MUG Resu~ Tobit Cm~nl E, Cea ~_ V~:Mi(m: LTB BOB COUFO~RM ee = ~N~ IB~'m~ · 04-2601 98:56 FR~I-CTE EflVIR~iO[KTAL .~ CT&E Environmental ~Me~ ~c. 56153Qt T-TOg P.OZ/OS F-929 CT&t R~fJ 10! 1963001 Cb~t Nan~ l=~lattop Technical Srv. Prelect 1~-,-,~ LOt 3, Lai~vo~ Hi~ Clltat Sample m Lot 3, l..nkewu~ Hdls Mah, tx Pr~ Wat~ 0 Pre-Paid CoBs/NO3 04/24'2001 19'.26 {)~2G"2001 12.'50 04/20/2~01 13:30 Nitra~e-N 2.71 0.500 m~L RPA 3C0.0 10n~x 0,~20~0 f SCL ~tcrobiolo~ l~bo~&tor~ Total Co~foan 0 col/lOOmL SMI89222~ CWIL & ENVlRON),fENTAL £NG[NEERLNG * ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. 14530 ECHO ST. Pii: (90?) 345-1355 April 26, 2001 ANCHORAGE, ALASKA 99516 M.O.A. Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 Dear Sirs: By means of this letter we are requesting issuance ora lot line waiver allowing the existing seepage pit serving the residence on Lot 3 of Lakewood Hills S/D to remain as close as 0 feet from the North properly line. A copy ofthe as-built inspection report and a site plan is enclosed illustrating the relevant locations. According to the as-built inspection report prepared in October of 1970 by the GAAB inspector the seepage system is located 20'+ from the nearest lot line. However, a more recent as-built survey, coupled with my own field inspection indicates that the seepage pit standpipe is in fact 5.7 feet from the north property line common with Lot 21 of Hillside Park P.U.D. Because the exact underground configuration of the seepage pit is indeterminable at this time, this waiver request is for 0 feet from the lot line to allow for the possible underground protrusion of portions of the soil absorption system up to the lot line. The adjoining property, Lot 21 of Hillside Park P.U.D., is served by a Class "A" community water system, which means that virtually the entire lots in that subdivision are available for potential construction ofon-site soil absorption systems. Thus, granting this requested waiver, particularly considering that the area in question is near the extreme comer ofthe lot, should not significantly affect the ability to install future replacement systems on the affected lot. For the preceding reasons I feel the requested Waiver can be safely granted without any adverse impacts. Please feel free to give me a call at 345-1355 ifyou have any questions. Thank you. Sincerely, Ted Moore, P.E. LOT 21 HILLSIDE PARK P.U.D. LOT 2, LAKEWOOD HILLS S/D EAST TREE ~T~ LOT 22, HILLSIDE PARK P.U.D. SEPTIC TANK C.O. DBL. C.O. WELL LOT 3 LAKEWOOD HILLS SID Z UJ O O'MALLEY ROAD R.O.W. NOTE: ALL LOTS IN HILLSIDE PARK P.U.D. ARE SERVED BY A CLASS "A" COMMUNITY WATER SYSTEM. GRANTING THE REQUESTED WAIVER WILL NOT SIGNIFICANTLY AFFECT THE ABILITY TO CONSTRUCT WASTEWATER DISPOSAL SYSTEMS ON LOTS 21 & 22. LOT 3, LAKEWOOD HILLS S/D LOT LINE WAIVER SITE PLAN FLATTOP TEC. II~CAL SEP, VIC -ES I INCH -- 50 FEET 14530 ECtlO STREET DRAWN BY TFM ANCI IORAGE, ALASIO~ 99516 APRIL, 2001 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Services Review Worksheet WR#: ~)1~1l)21 PID~: 015-312-12 HA~: 010172 Dale Received: 4-264)1 Legal Descriptio~: I,~kewood Hills Lot 3 Engineer:. 4-2~lFtattoD Technical Services 14,')~ Echo Street. Anchoraea. Ak. 99516 Applicant: Loren & Connie Dale Waiver Requested: Absomtten Field to Lot line of 0 feet. Permit~: Cdteda: 1. 2. Special Conditions: 3. Other:. Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Points: Total: Waiver Is Granted: List Conditions or Reasons for above: Waiver is not Granted: Date: ~-'~--/- ~ / Amount: 115 Date Paid: ,/ Gl' '~,TER ANCHORAGE AREA BOROF~H ~"~. . t HEALTH DEPARTMENT : ..~ ,~ , · 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME W"//i~Y~i ~ 0 ~ ~i~ 0~'~ MAILING ADDRESS &](~O ~//; '~4~iT~ PHONE SEPTIC TANK: LIQUID C~PACITY-~~~ IN~OT',:~~D~--~ ~ LJ~GI~ D DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: ~/~ .~.~)c ~Ix/O NUMBER OF PITS ~ OUTSIDE DIAMETER OR WIDTH ., LENGTH , DEPTH LINING MATERIAL -~'(::)~'Yl~-~/~'~L'~ ~,4~'L9~' .DISTANCEFROMW /S~6~1~ BUILDING FOUNDATION NEAREST LOT LINE ~ / ~ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / · SQ. FT. TILE DRAIN FIELD: A~ ~OS{~,ON AREA EN LINES ~ IN. TOTAL-'~:FEcTIVE SQ. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE NEAREST LOT LINE , SEWER LINE .DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE_ DISTANCE FROM WATER ·BUILDING FOUNDATION. SAMPLE__ ., NEAREST SEPTIC SEEPAGE OTHER ., TANK , SYSTEM , CESSPOOL ,SOURCES DISTANCES: DIAGRAM OF SYSTEM i-:-. ::. i.., ~'~'~. ~-~ _"~'"-'~-., .: - ~ :-~;., ~-. ~' · ; L.: ,,: ', :.,. ' , ~ ........ · , : . - :: , . , · '.* . : . ~ .GREATE[ iNCHORAGE AREA HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 ' '}ROUGH 279.2511 Case No. ~/~? SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT :.'/>~:',,: c' ;) '7~.,-- ¢64 ! NAME OF APPLICANT (Z,/, l" RESIDENCE ADDRESS ~ ~/"~---- LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH ~~TEST RESULTS LOCATION OF INSTALLATION ~',//-z~)P__ ~'~ '~"~P'~ ¢~ TO BE INSTALLED BY ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS t/~ ~'~OY'rt~e3LC ,PERMITTO INSTALLA AS DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED , SEPTIC TANK SIZE [~6--~ TYPE ~ SEEPAGE AREA ' TYPE ~ DIAGRAM OF SYSTE~ DISTANCES: 2-) ~-~ ~ HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with saidcode. ~ r~ ~,/~ C I ~ ~ U ~ ff~/ L /~ ~ Was Ground Water Encountered?~ ..~ ..... P~o ~"' ~ .... iiiiill ................... " (,-:--~:: ~ . ,~,~ - : ~ . ._ :~?.~..- ~_-- ' . . c; .3.-,_:MUNICIPALI~ OF ANCHO~GE~:.~:?c.~:,:?._~.?;¥~::-~, '~'. .... .~.._ ~ ..-:..~ ............ '.v,:-.YQ;~:~2k~/.. _ · ~ Division of.Env ronmental se~ices)~ .;:. ":-~ - ~ ..... On-S te Se~mes Section - - ;.;-..: :_.: .' ," '"~ :~.- ...... -~-- : ....::~ ........ ;':~Z'~' -' -7;;~' '~:~';~",'.-'~ ';~ ~;?~: ~:~;.-;~;'.:,:~.~L..-;...- - : .... .. : .': APPROVAL FOR A SINGLE FAMILY DWELLING .... ; .... . ......... ::c~mpletelegaldescription_'~ ~' "~m~ z4/~ ~- . ~.S certified '~Y m'~ ~e~i:~.fiX~d' hereto and as~t on he ~al[dati date shown ~!ow, I veri~ that my investigation o~ this Health Authori~ AP~rSVal application shows that the on-site water supply and/or wastewater disposal system is ~fe, functional and adequate for the number'of b~rooms and ~pe of structure indicated herein. I fu~her veri~that based on the information obtained from the Municipali~ of Anchorage files and from my inves~ation and insp~tion, the on-site water supply and/or wastewater dispo~l system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this· insp~ion. .Nameof Firm':~[A~:.: ~~T-~ ~G/~C~-~E Phone' 3~'- _-.~Engin~(ssg~a{'ure'~,:=:;,~ , . ~'/ -' '" ' ' Date ~-. ' ..: ~"' .. ,. :. ... .~;'~... ;;. ...... ~.,.,.: .,,, bedrooms. bedr0o'~s,:.~iWit~the~*fblloWifig:~i~tipulations: ;:,. :: '/: - ' : - ' ' '"'-' '~¥ · '" ,'' ' ' *- - ' ,' .... '"' ' ~,"'~''~'~,'':'~*~""'~'~l~Jl ' ~ ~ "' , : ·. ~,~... ~ .~ ~ .~ . ...... Add t ona Commen~ . ~., ~: ...... ~.,, · -;.. ,~ ,:v ./ , t~ I . ·-,.. . .r:~''~-~"~::; '': .~' ~'Z '''~{ [:.~ '.- 'q~'~nicl¢;'i~ of Anchor~age Depaament of Health and Human So~ices'(DHHS) i~ues Health. Authori~ ~, ~'~, Approval Ce~ificates bas~ On y upon the representabons g~ven ~n, paragraph 5above by an ~ndependent "~ ? /~; hrnfess~al enoin~r r~ister~ n the state 0f Alaska'. The DHHS d~S'ihis as a c~sy to purchasem of homes ,.r,,~ ~;~3 ,~ . . ~. , ;y . . . , ~n'~ their ending ~nst~tut[ons n order to ~t~s~ ce~mn f~era and state r~u~remen~. Emp oy~s of DHHS do not conduct inspections or anal~ data before a ce~ificate is i~u~. The Muni~ipali~:of Anchorage is not .. -,.. [,~. ': responsible for errom~.~,,,,~,~.~ ._ the profe~ionai engin~fs WorE.'-~?:, '~?~ ,~[?;)?', '?' ':~ ~ ~ ~ .~, ~- . . ', . . . .. .~ Municipality of Anchorage ,~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Descriplion: LOT' ~ ~- A KC b~oOO Parcel I.D. A. Well Data Well type i"~¢.~IDE-/,J t-~t- If A, B, or c, attach ADEC letter. ADEC water system number Log present (Y/N) Total depth Sanitary seal FROM WELL LOG Date of test '-" Static water level Well flow -'~ Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ctqo +/- Date completed Cased to --~" '~'~' v,,,, ,, / q0'4' ~ Casing height Wires properly protecled (Y/N) AT INSPECTION 7-3l- IC~O- g.p.m. 2, ; On adjacent lots ; On adjacent lots Driller Public sewer manhole/cleanout Petroleum tank t~ O~J~' WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: 0~:-~ /A, IG~ C:) Date installed ! c/,~/0 Tank size Cleanouts (Y/N) ~ (~) Foundation cleanout (Y/N) High water alarm (Y/N) ~xl//~, Date of pumping '7- Z. -7 - c~ _.~ B. SEPTIC/HOLDING TANK DATA 17_. 50 (~ Compartments Y (~ Depression (Y/N) Alarm tested (Y/N) CZ'/A Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ c~ ~ (~ On adjacent lots To propertyline ~t ~ Absorption field Sudace water/drainage ~ O ,'J ~ Foundation Water main/service line tOoM~-- PAGE C. LIFT STATION Date installed Manufaclurer Size in gallons Vent(Y/N) ."Pump on" lev/e~'~t ~ ,"Pu~off" Level at High water alarm level ~ Cycles tes~d Meets MOA electrical codes (Y/~~~ SEPARATION DIS~;E'FROM LIFT STATION TO:~ Well on lot /~ On adjacen~s S/~ce water D, ABSORPTION FIELD DATA Date installed I c::/'70 (~ Soil rating (GPD/FF) I- O c/(~ System type I;' I'T- (~ ..... ~ ~.~ ~ Leah ~'~ ~'/~/o ~Wi~h ~ Gravelthi~ness ~ ~ Total depth ~" Total ab~tion area ~5~ S. F- ~Cleanout present (YIN) ~ ~ Depress~n over field (Y/N) Date of adequacy test ~' / - ~ 5 Results (pas~fail) ~ -D for ~ Water level in abso~tion field before test ~ ~ ~' After test 30 ' Peroxide treatment (past 12 months) (WN) ~ o If yes, g~e date -- SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / © I ' On adjacent lots. (, I (~' (~ Property line To building foundation ~ Z., i (~ To existing or abandoned system on lot On adjacent lots 5 © '+ ~"~'" Surface water ~,Jo~=-- Cudain drain ¢...~ o ~ ~-- E. ENGINEER'S CERTIFICATION Cutbank Z.(2, ~ (~ Water main/service line Driveway, parking/vehicle storage area I ce~'fy that I have checked, verified, or conformed to all MOA and t-IAA Signature Bedrooms , of this inspection. HAA Fee $ ~' ~ Receipt Number Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. Laboratory Oiuision ~rd~*-a~"~ Laboratory Analysis Report ~oR~ Order 16226 9ztn~ Dal~ o7/14/95 % 11=0~ Ara. ColleCted D&ge R~caived Da~e 07/12/9~ ~ ~;O0 hrs. Sam~l~ R~rk~: $~%MPLE COLLECT~ R¥~ AIIow~b%¢ ~-- Anal EPA ]53.2 10, 07/12/95 CMI~ 2~ W. Potler Ddva, An~ho~ge, AK 99518-1606 -- Tel: {907t 662-2343 Fax: (907} 561-5301 ENVIRONME~AL FACIUTtES IN A~SKA. CALIFORNIA, ~LQRIOA, ILUNOI5, MARY~ND, MICHIGAN, MISSOURI, N~W JfRSEY. OHIO, WEST VIRGINIA TO BI~ C~pLETEED BY WATER SUPPLIER ~ PU~ILIC WATI~R BYe- EM LD. # CHEMICAL & GEOLO~, lrAL LABORATORY A DIVISION OF COMMERCIAL 7~E..~IjVG & ENGfiVEERING CO. I --- T~LEPHONE (gO7) 5~2-2343 " 5633 B Street ~.. Aac~araga, ^la,k.P. 9951B ~acteda IQ BE COMPLETED BY LABORATORY t~..I:tRIVATE WATER 'EM SAMPLE DATE: SAMPLE TYPE: wi~h lab ref. ~ ~pec~i Pu~o~ nay Year [] Trealed Water ~-~lntreated Water SAMPLE No. LOCATION -' Ar~{ysis show~ this Water SAMPLE to be; -'t'3' Satisiactmy ~1 Unsalis~ac~ory FI Sample to~ bng Jn tranaff; samp~ should not ~ over 30 hour~ old at examination to ind~le tetiable msu~s, Please sand new sample via s~ciat delivo~ mail. Date Re~iwd Time Re~ived gnal~i~l Method: Membrane Filter - No, at colonie~tO0 Lab Ret. No. Resufl' ~Anaty~ ,I READ IN$'t'RUCTI BEFORE .... t"-~'O .IM.'--- FOLU,,.,,W ' BACTERIOLOGICAL WA, TIER ANALYSIS RECORD Membtaae Filter: DR,act ~unt ' ' ~GB COLLECTING SAMPLE TNTC = TOO NumerousTo Count Coliform/10a m! OB = Other Bacteria THIS SIDE FOR OFFICIAL USE ONLY '='--~ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME · ~ '~i~~'~ INSPECTOR's1 ' /~[~'/7 INSPECTOR ~ ~.-~-~ & I,~O R DI R ECTIOVS,'~ 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [~ FOUR [] SlX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAL/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 TOTAL ABSORPTION AREA MATERIAL 4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line ] Nearest Lot Line WELL TO: [] APPROVED FOR BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) E] DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 · ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. I. PROPERTY OWNER PHONE William L. Morriseau 344-8580 MAILING ADDRESS Star Route A Box 37E 99507 PROPERTY RESIDENT (~f different from above) PHONE 2. BUYER PHONE MAI LING ADDRESS 3~'J. ENDING INSTITUTION I PHONE Security Pacific MortgageI 276-1933 MAILING ADDRESS 1011 East Tudor Road, Suite 190 99507 4, REALTOR/AGENT PHON~' MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 3 Lakewood Hills Subdivision STREET LOCATION Mile 40'Malley Road 6. TYPE OF RESIDENCE ~× SINGLE FAMILY F-I MULTIPLE FAMILY NUMBER OF BEDROOMS [] One ~ Four [] Two [] Five [] Three [] Six [~] Other 7. WATER SUPPLY ×:~ INDIVIDUAL* E'~ COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available,) 8. SEWAGE DISPOSAL SYSTEM x~ INDIVIDUAL/ON-SITE** E-I PUBLIC UTI LITY **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) 7-/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA /~' CONY 2. Property Owner: Mailing Address: 3. Name of Buyer: 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description.~O-~' ~ , Location: ~qlI-~--- ~'-~. Mailing Address: Day Phone: Name of Lending Institution: ,~-~-~u,-t ~-,~ ( ~ ~) Mailing Address I~'[ ~~V~L~O(~- (~' Phone: ~--?~'~~ Type of Facility to be Inspected: Phone: No. Bdrms.. J~ Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72 003(3/76) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT'EOTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Aleska 99501 Telephone 264-4720 ~ ; CERTIFICATE OF INSPECTION SEWER AND WATER FACILITIES 1, PROPERTY OWNER William L. Morriseau MAI LING ADDRESS Star Route A Box 37E 99507 2, LEGAL DESCRIPTION Lot 3 Lakew~od Hills subdivision 3. TYPE DWELLING SINGLE FAMILY RESIDENCE MULTIPLE FAMILY RESIDENCE OTHER (Describe) 4, WATER SUPPLY 'EZ] INDIVIDUAL COMMUNITY/PUBLIC 5. SEWAGE DISPOSAL INDIVIDUAL/ON-SITE EEl PUBLIC UTILITY HOLDING TANK (Maintenance Required) I~. APPROVED FOR_ 4 BEDROOMS EZ3 CONDITIONAL APPROVAL (See Attached) DISAPPROVED DATE 5-25-78 72-014 (3/78) BY (TITLE) Env. Ser, vices Man_~gqr, GREATER ANCHORAGE AREA BOROUGt HEALTH DEPARTMENT 527 EAGLE STREET ~uNCHORAGE, ALASKA 99501 279-2511 REQUEST FOR APPROVAL OF INDIVIDUAL SELVAGE AND WATER FACILITIES FOR Number of Bedroo~ '~ ~ c. s~z~ ~ D. Construction 6. Sewage Disposal System: mo Septic Tank (If homemade, show diagram on back) 1. Size / 4. Instal le~~7~~ ........ Approval Request for Se ge ~ ¥~ater Facilities Page T~o B. Seepage Pit 2 · Lining C. Disposal Field 1. Number of Lines 2, Total Length Required ~4easurements A. ~Vell to Septic Tank B. !~ell to Seepage Pit l~lell to Sewer Line _~_<: .~- V~ell to Property Line .~ (~c~ E. ~ell to Other Possible Contamination F. Foundation to Septic Tank /. / G. Foundation to Seepage Pit.,,~? ? Seepage Pit to Property Line~f :~-~ 8. COi~[ENTS: APPROV~'D::'/5,:::>?¢ ~' ' g~:;::::?,.. DISAPPROVED: DATE: /' ! ~:,:¢ ?/'::: .;i'::. :; '::; / DATE: APPROVAL VALID FOR ONE YEAR FROfl DATE SIGNED, GREATER ANCHORAGE AREA BOROUGH HEALTtt DEPARTMENT EDll70 FHA Form 25~3 HEALTH AUTHORITY APPROVAL INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM PART I.--TO BE COMPLETED BY FHA INSURING OFEICE Anchorage, Alaska MORTGAGOR OR SPONSOR William Horriseau SUBDIVISION NAME MORTGAGEE Commonwealth, Inc. PROPERTY ADDRESS ll,S6p O'Malley Road SERIAL NO. 111-011502-205 BLOCK NO. LOT NO. Lakewood Hills Subdivision TOYAL NUMBER: BASEMENT 4 2 J"~] Yes ['--].No WATER SUPPLY BY: [] Public system M New installation ]Community system SEWAGE DISPOSAL BY: O Community system ICan attic or other oreo be made Into additional bedrooms? (If Yes, how rnany~') live, Ii]No [] Individual [] Individual SYSTEM DESIGNED FOR NO. OF BDRMS, GARBAGE DISPOSAL 4 [~ Yes [] No [] Public system PART II.--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMEN¥ INSPECTOR'S SKETCH It is the opinion of the [] State [] County [-~Local Department of Health that this individual water-supply system [] is [] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [] State [] County tern with proper maintenance: [~Can be expected to function satisfactorily, and is not likely to create an insanitary condition [~ Local Department of Health that this individual sewage-disposal sys- ]Cannot be expected to function satisfactorily DATE SIGN } TITLE J ........ , '~'/~/ ~ ,'~/~ _ ,Sanitarian NOTE: lhe~lt~authorlW should, complete the appropriate opinion statement above and affix date, signature =nd titJein the spaces provide~. Use of th~ a~v~ grid for Health' Depurtment inspbetor's sketch as weJJ he=J~ authori~/ PART Ill.--FOR USE OF FHA OFFICE I'O 1'fie CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that the JDATE Individual water-supply system be considered [] Acceptable [~ Not Acceptable Sewage disposal be considered [~] Acceptable ["] Not Acceptable. SIGNATURE HEALTH AUTHORITY APPROVAL rCHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT FHA Form Septemt~r 2, 1970 Federal Uousin,q Administration P.O, Box 480 Anchorage, Alaska 99501 SUBJECT: Sewer System and 1;later Supply for Lot .~, Lakewood .qills Sub. Pear Sirs: Sewage disposal for the sub!ect subdivision is via septic tanks anti seepage pits and the Water ~upplie¢ are indi¥idual wells. ,.oil conditions indicate a fairly g~d percolation rate ac~pt~lo for on-site sewafo, ~r files indicate water wells to range in depth lmm 200 to 250 feet in depth~ ~el!s and sewer systems already tn the area seem to be fmctioning satisfactorily. Sincerely yours, CLI WORD P. JUI)K[NS, R,S. &hinistrative Bimctor .JRL/cm CC: Lee, Sanitarian