HomeMy WebLinkAboutEAGLEBROOK #2 BLK 2 LT 3BEaglebrook #2 Block 2 Lot 3B #017-121-63 MUNICIPALITY OF ANCHORAGE � � _s � � - DEPARTMENT OF HEALTH AND HUMAN SERVICES C5 Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES __ �L /S TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address (,X-3® 0 e/R. 99�L ® / Phone(s) Permit No. No. of Bedrooms WELL ®®® .3 LOT LINE,�- LEGAL DESCRIPTION Lot 3 Block Subdivision FOUNDATION ® ° - Township, Range, Section ® } 5firdriveway, AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, A water bodies, etc.) TANKS SEPTIC /,k ❑ HOLDING Manufacturer ®,/ f� Capacity in gallons Material No of Compartments TYPE OF SYSTEM[]TRENCH ❑ RED W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade FT FT -` __ _-_ ..— Fill added above original grade d Gravel depth beneath pipe ® FT FT G� — Gravel length .. Gravel width ® �® ® FT FT Total absorption area�y Distance between lines d r SO FT FTsea ® _ _ Number of lines Soil rating Pipe material � 3 /.50 ® SO FT /® & � Installer � G �2fY._ I C i�d5 Date installed WELLS PRIVATE ❑ OTHER tldenli}d) Classification (A,B,C) Total Depth Cased to FT FT 0 � / W/ Installer Date Installed: REMARKS: AIVACe IA'Ath oB&M rendbil"ll"fird . djT v ® _ � /1®gg lg!�Z%lbgiWA�4 Scale: S ENGINEER'S SEAL Inspections Performed / Date: 7-7-W ® ® inspection was perlormed according to all P I cerllly that this ®7 Municipal and Slate guidelines in ellect on this dale: e ^ Health Department Approval: Date: FA MUNICIpALITY OF ANCHORAGE Depar sent o[ Health & Human Ser .7es 825 L Street, Anchorage, Alaska 99501 3 4720 ON - SITE SEWER PERMIT Permit Number: 880111 Upgrade Date Issued: 07/06/88 Engineer Designed Owner Name: PAUL M" & CORLISS SCOTT Owner Addpess: 6230 ANDOVER CIRCLE ANCHORAGE, AK 99516~4349 Day Phonw: 345�22�3 Parce1 Id: 017-121�63 Lot 1.ega1: Subdivisian: E2&'�/��� � Section: 25 Township: 12N Range: 3W Lot Size 67000 (sq"ft" or a(:::reg) Max Bedroomsp Thisra Permit: 3 Total Capacity: 3 GEPTIC TANK: Minimum tOtal septi� tank capacityx 1,00C) nsc gall�" ��h septc i Lank must have at least 2 cDnpaPt0eDtim" Depth to top of iseeptic tank(s) < 4.0 feet requires in5ulati0n ova", tank(s). INFORM D"H"H"S. PRIM TO 1ST & 2ND INSPEC"TIONG BY ENGINEER, IF AFTER OFFICE HOURS, CALL 343-4681 t -ft) LEAVE A M�SSAGE" CONSTRUCT PER EWGINEERS ATTACHED APPROVED DESIGN THIS PERMIT EXPIRES 12/31/88 THIG PERMIT VALID FOR A SINGLE FAMILY RESIDENCE ONLY I CERTIFY THAT: 1" I am familiar, with then rel?quipemc-�nts for ori -site svopowis aDd wells as get forth by the Municipality (of ADChinPage (MOA) tand the gtate of Al�ska" 2. I will inirtall the system in accordance with all MDA (:,".codes and r�gulationsv and in compliancem with thee deesign Criteria of th15 p(pP0it." 3" I will adhere to all MOA and State (of Alaska paqairements [or the set hack dist�nces from any existing wastewater, disposal ssymtem or public sewerage system on this or ahy adjacent or nearby lot" 4" I unds�rstand that this permit is v@lid for a N@:imum of 3 beclroomis" I also understand that capacity of the total systern is 3 b�drooms and any enlargement wiI1 roequirew aO additiorsal parrmit" Signsod: ~- DATE: .... .... .... .... . 7,��1_~~~~ (Owner) PAU /� ORLI�� SCDTT Issued By: DATE: 7-1 -~��� PERFORMED FOR: ���o�•° ®•®•®•® I 'VER'S SEAL) a Municipality of Anchorage • 4 • ®® • ° • ®• e• DEPARTMENT OF HEALTH & HUMAN SERVI 825 "L" Street, Anchorage, Alaska 99502-0650 °•• ®® 0 ® OY C. REID, JR. SOILS LOG — PERCOLATION TEST '® C -2251 ®® Ar DATE PEFTF LEGAL DESCRIPTION: �� " " !�%��`/ ✓`' Township, Range, Section: 7-i7-11,) /F3 1-j JFC- DEPTH F` SLOPE �'j SITE PLAN (FEET) MMMMOMMME 10 i � I 11 j 12 I �II 13 �I 14 j 16- 17 18 19 WAS GROUND WATER ENCOUNTERED? _.. O S IF YES, AT WHAT L O DEPTH? P E Depth to Water Alter Monitoring? �� Date: Date Gross Time Net Time Depth to Water Net Drop 2 (minutes/inch) PERC HOLE DIAMETER 3 , ?-' / FT AND FT �. /da'_ zd 4 ' ,'>l NNE COMMENTS 5 EME ■■■116■■�■■■ 6 /4 .77 781�� 7 �FC. s A' r✓l��/�----� �■■■■�WN■ /t/<5 :%,d PERFORMED BY: /,?n /.7y 8 �j THIS TEST WAS PERFORMED IN 10 i � I 11 j 12 I �II 13 �I 14 j 16- 17 18 19 WAS GROUND WATER ENCOUNTERED? _.. O S IF YES, AT WHAT L O DEPTH? P E Depth to Water Alter Monitoring? �� Date: Reading Date Gross Time Net Time Depth to Water Net Drop (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN a ! ?-' / FT AND FT �. /da'_ zd �.�h��' �AT ��7 �fla/9 / /,98'/,47 ,'>l NNE COMMENTS EME ■■■116■■�■■■ /135 I,9/ - 1.U9 .77 781�� �FC. s A' r✓l��/�----� �■■■■�WN■ /t/<5 :%,d PERFORMED BY: /,?n /.7y ■■■ CERTIFY THAT THIS TEST WAS PERFORMED IN INEENNEINEE ACCORDANCE WITH ALLSTATE 70_nno fog,, n,•a% ■■■■■N■■ ON THIS DATE. DATE: �■■■■■■■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN a ! ?-' / FT AND FT �. /da'_ zd �.�h��' �AT ��7 �fla/9 / /,98'/,47 ,'>l COMMENTS /135 I,9/ - 1.U9 .77 781�� �FC. s A' r✓l��/�----� /t/<5 :%,d PERFORMED BY: /,?n /.7y . 7 / CERTIFY THAT THIS TEST WAS PERFORMED IN /" _ / '1 ACCORDANCE WITH ALLSTATE 70_nno fog,, n,•a% AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 20 G' PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN a ! ?-' / FT AND FT �. �'(SF I50 �.�h��' �AT ��7 �fla/9 / To _ S 1���7Rk COMMENTS 781�� �FC. s A' r✓l��/�----� `'-�''- PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN /" _ / '1 ACCORDANCE WITH ALLSTATE 70_nno fog,, n,•a% AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: � v �OF AC �® 0000., F.0 • i®R'S SEAL) y 04)®° ®� e .6 ®. ®® ®® 0069®®®. 0 ® Municipality of Anchorage ® 0 DEPARTMENT OF HEALTH R HUMAN SERVICE ®® .®® ®®•� 825 "L" Street, Anchorage, Alaska 99502-0650 I e ROY C. REID, JR. SOILS LOG ® PERCOLATION TEST®® ®®•®C -2251®®���,� 0000®• 'v PERFORMED FOR: �� ��^� DATE PERFORMED: LEGAL DESCRIPTION: L0�3g 1-�IZrh6l,-�k' Township, Range, Section: yal /Z3ul S6C. 1�>ef� DEPTH SLOPE SITE PLAN 10— WAS GROUND WATER /U � N (FEET)1'r/UL ENCOUNTERED. Net Time Depth to Water S u 2 /o n l '66- 66-6-7 IF YES, AT WHAT O DEPTH? P 12 3 ,. 4 13 6 -7 Monitoring? Date: 5 6 — 7 EnfU 8 7, rtv 9- 10— WAS GROUND WATER /U � N 14- 15- 16- 17 4151617 18- 19- Reading 819 Reading Date ENCOUNTERED. Net Time Depth to Water S 11 L /o n l '66- 66-6-7 IF YES, AT WHAT O DEPTH? P 12 '0- E Depth to Water After 13 6 -7 Monitoring? Date: 14- 15- 16- 17 4151617 18- 19- Reading 819 Reading Date Gross Time Net Time Depth to Water Net Drop /o n l '66- 66-6-7 '0- 6 -7 20 '?/ PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER a � TEST RUN BETWEEN FT AND FT cOMMENTs Soir__ cs47 3 A7 /��o ��yi,11� Fla/ l io 6 .Jo l�orJ/rR TRE 1,<157-, /'F57 i�o� %�J �✓eR/F C�>J/7)i�lu �/�"� /,� PERFORMED BY: /,L�/ 14` ""✓E�/ / �" ^ ` " ' �� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 I R ev. 4/851 A EC s ALASKA CIIUIROWnTAL COW OL HUNS, InC. a a Engineerinq & Enuironmental Studies SPECIFTCATIONS FOR t FIVE -WIDE WASTEWATER TREATMENT SYSTEM LOT 3B, BLOCK 2, 13AGLk°BROOK #2 SUBDIVISION 1,0 GENERAL 1.1 The drawings,sheets 1 through 3, shall be a part of this specification. L.2 All materials and workmanship shall meet the requirements of the Municipality of Anchorage, Department, of Health & Human Services, (DiSiiSl, the conditions of the permit, and all applicable rules and regulations currently in effect.. 1.3 All elevations and depths are advisory and are to be verified or modified in the field by a DENS approved inspector. l.4 it is the responsibility of the installer to adhere to approvers designs for installation, maintain the Specified solluration distances, and have the appropriate inspections. 1.5 If the installation is not inspected by an AECS engineer, AECS will not be responsible for the installed system. An en;iDeer at AECS should be consulted prior to construction, to determine the number of inspections that will be required and to explain what these inspections will involve. 2.0 SEPTIC SYSTEM 2.1 The existing septic tank may be used, if it meets the capacity requirements for the residence and the approval. of DHHS. Older systems may need tame integrity verified. Q not, then specifications 2.2 through 2.6 apply. 2.2 The septic tank shall be a UPC approved two-compartment tank, constructed of 12 -gauge steel with bitumastic coating, set level on undisturbed soil and insulated with overlying layer of 2 inch burial type polystyrene, 2.3 The septic tante shall be a minimum of 5 feet from the house foundation, and a minimum of 5 fees: from the absorption area. 2.4 The septic tank and Grainfield shall be a minimum of 100 feet from any private well or body of water, 150 feet from Class C wells, and 200 feet. from Class A or P wells, unless otherwise specified. Less than the required separation distance must have prior approval or waiver by Alaska Department of Environmental Conservation (ADEC). 2..5 piping shall be fitted with a mechanical- watertight calder coupling; of the inlet and outlet of the septic tank. Piping; shall be 4 -inch ASTM D3034 or cast iron, sloped a minimum of 1./4 inch per foot. 1200 West 33rd Auenue, Suite B e Anchorage. Alaska 99503 ® 19071 561-5040 ?.G C;lea?hf", t1 �= shall beinstalled,. us C, e. �;imn a3 t,,a'i. capped with air light. rain caps (Jim caps or equivac.lent), and extend: a minimum of 2 feet, above ground level. 2.7 Tf a lift: station is shown on the drawings it shall be Anchorage Tank or MOA approved equal.. (See attached 3.0 DRAI1'FTE D SYSTEM 3.1 The gravel for the tirainficld shall be V5 to 2.5 inch screened =ock with less than 3% passing the 1200 sieve. All. substitutes must have prior T7US approval. 3.2 The bottom and side of the excavation shall be raced with the backhoe blade to ensure that it has not, beer compacted during excavation. The Bottom elevation shall be level. 3.3 Monitor standpipe=(S) shall be placed as shown in the drawings, and shall be rigid PVC ASTM D3034, or 4—inch cast. iron, The section showan with holes may be drilled. 0.5 inch holes on the S --fraena centers on opposite sides of the pipe;, or a regular section of pei'F=ted sewer pipe, clamped to a sol -id section, with either a no hub coupling or a solvent. joint. A rubber rain cap (Jim cap or equivalent) shall be placed over the top of the ;,Ripe. 3.4 The distribution paps: shall be 4 -inch rigid PVC with a sni.niMUM crush strength of 2500 lbs or equal. Ali distribution pipes shall be laid level. 3.5 if the final grade of the c=rainfield is less than e feet above Phe gravel, insulation is required wising clow extruded blue styrofoam board or equal. There shall be 1 inch of insulation for every foot of soil less than the required 4 feet of cover, but there must be at least. 13 inches of soil cover even though insulation is used. The solid pipe extending from the septic tame or lift station to the drainfield shall also have 4 feet: of cover or an equivalenat layer of insulation to prevent freezing of the line. 3.0 if insulation is not necessary, the gravel shall be covered with a layer of nonwoven engineering fabric. 3.7 it, is recommended that the area excavated in the vicinity of Me drainfield shall be planted with a white clover, red fescue mix and Kentucky blue= grads. VO In.`hP CTIO S r T.? .l minimum of three inspections are required for installation of the trench. The first inspection will be of the excavation to verify that the installation will be $ n the proper soil. 4.2 The second inspection will be after placement of the gravel, monitor standpipe(s) and distribution pipe to verify propyr installation before backfin . 4.3 The third inspection shall be after the druinfie,ld is backfilled aaK the around graded. ALASKA ENVIRON NTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB 4 1_"_ SHEET NO. CALCULATED BY CHECKED BY SCALE. DATE k WX V�� sEFwen, v> i iT�, 'T pN➢h�p1E S uJDE VQP1A.l Fl�[� --- r�Zr L—il RUW REV1/ZG�Sd - 4r�Dg® F RUQ WALKWAY miry. �J12f 1;6 ®®vc 4v Fa PFwIup--c,cAY, � ,g P "'-:eO I11V83 - RECERT[FICATIOU iTHIS .A5L3UILT" WAS F®9�-IMpRA EHDM4 61�GE' 0916INAL.'AS-BUIV DATED APRIL Z8, 1988 ® "11A A— !— o r -® ® OY C. REID, JR.& ®®eCE - 2251 � �°rotessiona\V� `. A I Ilit" +toaf {, FOLNv I 9 \ \ \ a \ r yr NOTES, 6. IT SMALL BE THE RESPONSIBILITY OF T"9DUILO[ROROWNER TOY[NI/T THAT BUILDING LOCATION SHOM WEET0 ALL SUBDIVISION COVENANTS AND 01101NANCC®. 0. B4 Is Tuff ®ffflb a ft.®u Iva � Tuff ®alae w®Im / B q , ,vom e. /.ori 2 I' -MID WA.K W,1`( g�cI1,P.�' p/Fly K C�'e4}gIN I.tl�� 004 RUN ® • p11 fi. k WX V�� sEFwen, v> i iT�, 'T pN➢h�p1E S uJDE VQP1A.l Fl�[� --- r�Zr L—il RUW REV1/ZG�Sd - 4r�Dg® F RUQ WALKWAY miry. �J12f 1;6 ®®vc 4v Fa PFwIup--c,cAY, � ,g P "'-:eO I11V83 - RECERT[FICATIOU iTHIS .A5L3UILT" WAS F®9�-IMpRA EHDM4 61�GE' 0916INAL.'AS-BUIV DATED APRIL Z8, 1988 ® "11A A— !— o r -® ® OY C. REID, JR.& ®®eCE - 2251 � �°rotessiona\V� `. A I Ilit" +toaf {, FOLNv I 9 \ \ \ a \ r yr NOTES, 6. IT SMALL BE THE RESPONSIBILITY OF T"9DUILO[ROROWNER TOY[NI/T THAT BUILDING LOCATION SHOM WEET0 ALL SUBDIVISION COVENANTS AND 01101NANCC®. 0. B4 Is Tuff ®ffflb a ft.®u Iva � Tuff ®alae w®Im ALASKA ENVIRON -NTAL JOB /o7 CONTROL SERVICES, INC. i Onn \Alae+ ' 4QeA 6vanita Ctii+a R SHEET OF _ Municipality o Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 July 12, 1988 Alaska Environmental Control Services, Inc. 1200 West 33 Avenue, Suite B Anchorage, Alaska 99503 Attention: Mr. Alan C. Wien Subject: Waiver Request for Lot 3B Block 2 Eaglebrook S/D #2 Waiver Request #WR88-032, Permit #880111 Dear Mr Wien: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 98 feet. This waiver approval also includes the 5 foot encroachment of the septic system to the west lot line. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, 0�)� ;. -/&� Daniel J. Roth Civil Engineer On-site Services DJR/ljw#6 A EC ALASKA HUIROWnTAL COnTnOL SUS, InC. CS Cn Q Cngineerinq & Enuironmental Studies Jgrnc 243. 1988 Municipality of Anchorage Department OF Health V Human Services 25 J: Str,pet Anchorage, Ali. 99501 AUP: Dan Ro& Re: Lot. 3R, Block 2, 7aglehrook *2 Subdivision This lot re,guires, an upgrade to its Rbsorption field. See attached design. "hdi existing ihee wplj# The well was drilled after this system was installed. The best place for the upgrade is as designed which will utilize area above the existing trench as Well as the addltlooal. 5 root wide drainfic3-6. The well is 1€32 feet deal?, r.a:aer`: to the tar7ttc'ir, gtiiill a ;itse'c..ic levet. of 213.1 feeK On 6/1/88. a well flow 'test showed ra yield of 6.2 GPM with a drawdown of 23 feet. The well is slight3y downhill from the trench. Water samples taken 5/9/68 are satisfactory. We feel this reduction of the required separation distance will not pose a threa°t of contaminalton to the well. We request you Vaunt €a waiver -fry Walk to upgrade absorption are4, of 96 foot, which should be the closest edge of the hrencla. Also, we.zaa°e,xoquenting «a a root lEat. Time waiver,from the > wide draainfield to Weft lot -1004 Attached is a letter of non -objection from the owner of lot 4 if you have any question, please cull. Sincerely, Alan C. Wien Engineering Technician Approved by: lit e 4;q n. mmm, t ..a.wwd�aP a �P-q A`0 m0 a ®0@00000 ®bV M :A one x c�nw®sL msa� C.nREID, JR m pp o n � anm � �Q �OS `�kt�fiL"LT'a:'�• 1200 West 33rd Auenue, Suite Be Anchorage. Alaska 99503 a (901) 561-5040 5e4t5. 5 joJeR s 157Chv5 ejT Alete.4edI165A/7' e2d �f� A57' /-®i L®a/E 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 NAME PHONE I ONEW �A I'y' �4d06 5[l ❑UPGRADE MAILINGADDRESS _ _..— _- ----- --- LEGAL DESCRIPTION -a .- L L f E Fa C _c a k'_rn o K - LOCATION NO. OF BEDROOMS rryy Well Aro Par Absorption area Dwelling Ar1,7 9r,E PERMIT NO. U y DISTANCE TO: c s •S 0003 ,- I Z LZ L Manufacturer � _--- __-- -__- Mat Material 4 No. of compartments LU h _6 r`- E E t: "-T. E u t- c». N Liq. capacity7n—gal lons .v IF HOMEMADE: Inside length Al Width A/.4 Liquid depth '4 /.A? . ®= DISTANCE TO: Well Dwelling PERMIT NO. J Z Z -- 2-F Manufacturer Material Liquid capacity in gallons ®y DISTANCE TO: Well A ,"7' e 1, Foundation & j. 7 y Nearest lot line - P PERMIT NO, `fie=sCi w J LL 2 Z No. of lines Length of each line Total length of lines Trench width Distance between lines - w M- _.- �� _--_- _____ __. l I inches � h Top of file to finish grade t L� __ _. Material beneath file � Total effective absorption area ® 1 ' -inches r Length Width Depth PERMIT NO. LU d� b wa Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS -_---- - SOI L TEST RATING _-- ----- ----" -_"`- J. h,pP��� —... __._ 1 X19 %. y - INSTALLER_...-.. 9 .__..._ T, (,"- , I� �.e t' C_" It (- R�. I � F" ,! t REMARKS _ �. 1--1 r.r f=�_ `@.i �,.�.�va_ A -- - J" —cikFsr S jAE,N F" u� t� _ . - F' .> '1` >� '- E? F a� fed l-> , .. _ iv II I APPROVED DATE LEGAL 72-013 (Rev_ 317 R ) A ter.: t- en M r` cv El c - H a Q) r o Cd ° o a u Lu n �-1 tj 2 I- U% U by r -i . a ¢ w f i,+,o ; FiU 3; w -, U; 3 ; F4 E4 Fa F-4 [-4 0 h� F h4 F� [� 00: 00 O O O O O O O O O O O H H F H H F H� F F- "4 w • ii t CYi : o CD' O: O O O O O O ® O O V4 w w W w w w w w w w w rl rJ 6d Y 4 NO i+ J M rym CO A^` W Q) U : T 41 >v✓ d : : : a : �: 3., + : �: �': : 3 : ca mm �A: �-i cd O : p :s a: H i U : F� U: U i ri i r -I i g? cd i rH i U:� P, i D i P, i O Ai cd : cd : a : cd: cd a ? cd C-) i C: r i bA: U: zs : r U:70 3 v FO H H H H w w w w ub w of tet+ ile o co €ra E (M C) itl+ i m .-i ; ,-i ; .-i : m ; m ; o) : a) 4 05 i CO ; cn ( o *-t i oF. 0oo0o000000 F. H H O: O CO i 0 i CO m 00:67 0 i d+ i i C) ® ; .-I ; H N : c ; CO ; 67 6) ; 67 ; CO i 07 ri ,-i u z O O O O O O O O O O O O � E -=- DEPARTMENT HEALTH AND ENVIRON11ENTAL -_ITECT I ON 825 "L. STREET., ANCHORAGE. Ak '.. 99btil 264-4-720 I. -A EL L_ LP-.0 C -A CH P-4 I -T'E: _E. E-'-- 9-4 E -E. U`Q." F="E_:7 F-° Ir -1 1 7 PERIL IT NO. ( 8_300,91 ) APPLICANT HARR'-rt,F SHFDRE 6937 OLD SEWARD HIGHWAY 99502 349-6537 LOCATION LEGAL L30 EAGLEBROOK #2 LOT SIZE 999999 SOLIARE FEET' TYPE OF SOIL. ABSORPTION SYSTEM IS: TRENCH IIAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 140 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: E., EE F:::n 7' L_ I=- P4 02 -r H - 2Z f --j FC n %en I= IL_ E -o E®F"1- i -I = E. '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 CEPTH :15 'THE MINIMUM DEPTH OF' GRAVEL. BETWEEN THE OUTFALL. PIPE: AND THE BOTTOM OF THE EXCAVATION (IN FEET). FZa0kJ1F;?aE-u !s-1z;_7EE_ :jL 01929 r=9 p:3 F1 L_ L_ ID r_j PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPEIRT11ENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND 'THE NUMBER OF RESIDENCES THAT THE HELL WILL -SERVE. _r LII < -.2 > I N _�­ F:10 EE ul:- -F 1 0 N!F. F-1 IFR -0 ER' F;;:o E=_"G,78_0 I FRO I=- r -a -- ------ BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT I. -JILL BE SUBJECT TO PROSECUTION. I',1INIllUf1 DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I'S 100 FEET FOR A PRIVATE WELL OF: 150 TO 200 FEET FROM A PUBLIC I. -JELL DEPENDIF-IG 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 REQUIREG, AND 11UST BE RETURNED TO THE DEPARTMEhIT WITHIN 30 DAYS OF THE 14ELL COMPLETION. OTHER REG!UIREMENTS MAY APPLY. SPEC IFICAT IONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. 1=E:F?1­1 I -F aX.'F-" IFRIEZO—H-3 E-® EE o::. FE 1'-1 En E: F;;' =< --t. _L 0=-s I CERTIFY THAT 1: 1 Fill FAFIILIAR' WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE NUNICIPAL ITY OF ANCHORAGE. 2: 1 WILL INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODEE". 3: 1 UNDERSTAND THAT THE ON-SITE SE14ER SYSTE11 MA', -1 REf:iUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ---.: BEDROOIlS. -a _:� y �) ,' _-z-,uy %4. 0 ...-DATE--- ISSUED BY- - - - - -- MUNICIPA DEPARNT of REALT}{ANpOF ANCHDRAs ENVIRD, NTAL 1 GF B25 Lr Sfr® ME �. Anchor,ap®. Alms4s e 'ROJECT!(),� 19SD8 f'[RCOI_ SOILS �sa.4'a® ATION LOG —. PERCO TEST 1,. L<1ilOn! 7F=S7 �ERFOR 4' MED (0R: EDAL DE SCRIP _ TIO(V:� E� - 0^T`� PEAT-, p s,. FRO L EAJ TC) 2 RACE oRC,r,gNIC'a 'To I U' 0 3 4 a 5 l IGairID �wM ait_T-y 6 �BBLP-:5 I lol� p N rv1 7 8 0 e 7 DATE PERF DRMED: Z -SITE PLAN WAS GROUND WATER ENCOUNTERED) S A901®➢ c' O�dF-c , C' m, 'F Tip AT WHAT O-- -- - -- A%l�j ! 1(j L �"p3E3LC AT ! `.®' t1 -- Date cross N®f ---- —__.. Time !� -d'TN OF 6()pdtlG. a —"_ 'rime- C mII® .tysp � pr eP t p ✓,I A,EQ7��, ____ _. S� — _ ' e ' J.,Ln N'. L d: r PFRCOLATION RATE--- �u..�,�zi�attia cw i -EST TiUN P "'------ Er;Gn -�`� =� �$--� =�✓tyr -- EEN FT AND FT --- G�. ' 1 r A / rm 1 ^ a ry 1_® C` e- /e - r- C` a` I o �pp ri is L) d L_ , i d e-® L_ w ! -o + L- .� .) a> L) L> ACCEPTANCE OF DEDICATION TAX CE'RTIFICAT Tho of Onr ,cnc nnr/ All ran/ nrnnbrty to N89°59'56'°W 488.83' REC. P77-34 N 89''5' "W 489.12' MEAS I10.30 37.8225� 5® ` 20 Tele. 8 EI®o. Esmi00 . s ca 50 Public Access EasemE NCP15'19"W Automatically Vacated WI I 71 .I6 — — Access Becomes Available 1 ®e s North Of Lot 8 m 0 1 66,886 S.F ® -\ / ra 0 �. 1.536 AC. i , 1 VE j 54,256 S.F ��°tA � / o �� �l I I 1.246 AC. �' / 00 I I zz Thi: N6501$'22"E Fron 25.Lot 157.13' N OD cc PO Mai N N Tr. -I I _ 23.00 151,386 S. F. 1 .1> ® 0 N50,588 S.F. 3.48 AC. `1 � o N 1.161 AC. m 20 Drainage Esmt. Co 1 p1 \ 00 0 0 010 ® \ a 0 00 0 �ca 10' Tele. & Elec.Esmts, ® 10°Tole. 8 Elec. Esmts. 1 11 1 1 ®ee OD 502240 S.F �.®off® W'48 Co T or1.153 AC. ®� `� � I 1 ®� A\ rte 0\9 �- I 3 % r0 0® z �- �� 6 ARC =76.12 I _ F 1'(CHD=73.63' I o j Recovered 5/8''Rob� N 22050.00Q801L 10'2 ✓� I®.Eleo Esm4s1 I 25.00' I III OCK � s: 10° Tele. > Elec. Esmt. —�__� ® w I > O OD 20' Drainage I I 0 859736 S.F 3 Esmt. _, N 3°30;13" E N, 1 1 1.968 AC. in _� 1 ?.58.64 / Recovere "' 13108 S.F I°�0 3.012 AC. N6505G'07"W 04 ® I 154.52 (P78-158) ;�� Esmt. — I 11.78' -' \ \ i 64Q�,`p7B'�5g1 O_ r i N 16!Mi / cP 0 0 6®� p 5®S genies ° 1A 604 rt f . — ND I e. Municipality of Anchorage Development Services Department i Building Safety Division On -Site Water and Wastewater Program , 1 4700 South Bragaw St. ° + P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. _O 17 l2 f— 6 3 HAA 1. GENERAL INFORMATION Expiration Date: _3 Complete legal description ' j -o t 3 0, 13 /o fc S Location (site address or directions) K 2 30 Ari dov er Drrti� Individual Well Current Property owner(s) Jofrn E Oran& Raine_ Day phone 266 - 9 210 Mailing address X230 ht)c6c er Dr'i f}n�t rg [c 99Sf� Lending agency R &J' Al; h / twr A9 Lvged Day phone -j7?--&,6/,7 Mailing address t yoo W. 13emr o,7 )31LV /}..c/, 41c y9S0� Real Estate Agent FS co) Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. /ll eave erf /2, 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site 59 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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 valid ly system. forr 90 daysDSD from also the date of ssue for properties served by a private upon request to homeowners. ertificates or Class Cfwell and may be reissued lare 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. own 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation ate sh 'nes fo� his appfy that l cit onmshows investthat the based on procedures outlined in the Health Authority Approval on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of Investigation and inpection, the on-site water supply and/or bedrooms and type of structure indicated herein. I further verify that sbased on the information obtained from e Municipality of Anchorage files and from my 9 wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. lai•/a Teen%tal S�cl Phone 3 d_S"! 35�— Name of Firm 919S116, Address "i53C/ P zv 2 200/ Engineers Printed Name �'L��"'� F iYaore Date Na 5. DSD SIGNATURE _z Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following ON-SITE Additional Comments -. WASTEWATER Attachments: HAA Checklist Septic System Advisory _ IG Well Flow Advisory — f0aintenance Agreements — Supplemental Engineers Report Other Original Certificate By: / (Rev. IZW) F Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519650 www.ci.anchomge.ak.us (907) 34379(4 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: .._f 30 [3//r2 9*?44,004 S/D P2 Parcel ID: 0 1 -12/-6? A. WELL DATA Well type • n± If A. B. or C provide PWSID # Date completed 3 / 17 / 83 Sanitary seal (YIN) Y Total depth 18Z R. Cased to /@Z ft. FROM WELL LOG Date of test 'J//7/8? Static water level Well Log (Y/N) Y Wires properly protected (Y/N) Casing height (above ground) 20 in. AT INSPECTION 3 o ft. Well production I S g.p.m. (lj / 8 r g.p.m. WATER SAMPLE RESULTS: Coliform _L—colonies/100 ml. NitrateO. Si._,S, m9.A• Other bacteria _�Z colonies/100 ml. Date of sample: 11 / 19 / O / Collected by:Flatrb,. -7: /i Svc B. SEPTIC/HOLDING TANK DATA Tank Type/Material SCC HC / s/vir / Date installed s / 9/e3 ra�r•7/s g Tank size 1000 gat. Number of Compartments Cleanouts (Y/N) Y Foundation cieanout (YMlvderJe ipression over tank (Y/N) N High water alarm (YM) At ..{. 4 wr Date of pumping LQ / rs / O r Pumper C. ABSORPTION FIELD DATA Date Ingtalled -71YL4-9-0 Soil rating (g.p.dJW or ft=/bdrm) If OQ��. System typeL.ia/ t-tne/i - Length 89 R. Width S' C ZS ft. Gravel below pipe 2' 0 B' ft. Total depth H' ft. ER. absorption area Vii@ ft= Monitoring tube Depression over field Al 10 Date of adequacy test R /W /O / Results (Pass/Fail) —�� For. bedrooms Fluid depth in absorption field before test &Cm. Water added tiYo gal. New depth -21 -fin. 'V%S- ./.. Elapsed Time: 73 min. Final fluid depth � in. Absorption rate >= riS'G s'o. y g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) Naas Jtrrou.n If yes, give date N. A. D. LIFT STATION N• A. Date installed Size in gallons Manhole/Accm (YIN) 'Pump on" level at _ in. "Pump oft level at _ in. High water alarm level at In. Datum Cydes tested Meets alarm b circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot I Cg On adjacent kits IVB' On adjacent lots > Absorption field on lot 96 r 1 D ' Public sewer manhole/cleanout Public sewer main Sewer /septic service line 7 Holding tank N A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: S' Building foundation S Property line > 10Absorption field Water main V 4• Water service line > /O Surface water -> ! U 0 ' Wells on adjacent lots — X(0 -0 -SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5 r Building foundation > f U Water main N• 1% Water Service line IO' Surface water > 1 00' Driveway, PaftVN Ohlde storage b' �_ Curtain drain N1o2G ,gem ' Wells on adjacent lots -2,100' F. COMMENTS Watvt/ rlJued 7/121 G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections 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��r= Date Nov 29� 2 0o f HAA Fee $ 300 Waiver Fee $ Date of Payment I I / Z9 /ZLYZ/ Receipt Number 70 ?-9Q ZZ 4v— (Rev: 12100) Date of Payment Receipt Number E O�• � j a .t,` ......................... THEODQ*E F. 490RE MOV -29-01 08:38AM FROM-CHE ENVIROMENTAI SRV CUE Environmental Services Inc. s rrir�i�rrrr�rr��ri�� 9075615301 T-553 P.02/05 F-393 CT&E Ref.# 1017971001 Client PO# Pte -Paid COlts/NO3 Client Name Flattop Technical Sty. Printed Date/Time 11/28/2001 8:20 Project Namc/# Ea¢lebrook Collected DalcMn a 11/19/2001 12:45 Client Sample ID UB, Blk 2, Eaglebrook p Received Date rime 11/19/2001 14:10 Alatris Drinking Water Technical Director Stephen C. Ede /% Ordered By 4w" PWSID p Release) Sample Remarks: Allocable Prep Analysis Parameter Rewits PQL Units Method Limro Doe Date Init Waterer Department Ndrate-N 0.5000 0.500 mg/L EPA300.0 (<10) 11/19/01 SCL Microbiology Laboratory Total Coliform 0 coVl00mL SM1892228 (<1) 11/19/01 KAP MUNICIPALITY OF ANCHORAGE M E M O R A N D U M SEPTIC SYSTEM ADVISORY HEALTH AUTHORITY APPROVAL NO. Q 10 (D 0'7 Prior to a recent adequacy test on the septic system for this lot, G•S inches of standing rater was observed in the absorption field. This indicates that approximately �_$ of the absorption area is inundated. Although , this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Health Authority Approval. MUNICIPALITY OF ANCHORAGE ® DEPARTMENT OF HEALTH & HUMAN SERVICES Q Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01 `1 A 1 a.1- Ln b =11R. Complete legal description Lot 313; Btock 2; Eagtebrook Subdivision #2 Location (site address or directions) 6230 Andover, Anchorage, Ata.6 a Property owner Duane R. Wohrs Day phone '564-4704 wk Mailing address 129.40 Mtiszion Grate, Anchorage, A2azka 99516 Lending agency Mailing address. Day phone Agent Kathy Fernandez/VISTA REAL ESTATE Day phone 344-9603 Address 621 West Dimond, Anchorage Ataska 99515 Unless otherwise requested, HAA will be held for pickup. t. • Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. ® ,. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 91 a 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 S&SEN Phone 17034 Eagle River Loop !toad No, 204 Address Eagle Rlver-,-Maska 99577 Engineer's signature DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: By: (3 41�L Ert ITS-¢ Date � 111t r, 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. 72-025(Rev.1/91) Beck MOA#21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: SOT �4, �L� 7 Chu �ZaarcW A Parcel I.D. Well type 1-KAO F— If A, B, C, ADEC letter. NIA or attach ADEC water system number Log present lam") yE5 Date completed 3 `« g3 Driller[Zt sy Ilrid's ��t2ru 7uc �n Total depth ��� r Cased to h�Casing height II/a0 Sanitary seal ON) YDS Wires properly protected (8/N) XIS FROM WELL LOG AT INSPECTION Date of test � Static water level SU r a� r v 1 Well flow g.p.m. �F� g. ua Pump level UK � SEPARATION DISTANCES FROM WELL TO: Septic/ tank on lot On adjacent lots CDU y � r Absorption field on lot 91 ; On adjacent lots Public sewer main �v/ia Public sewer manhole/cleanout //,�NLR Sewer service line a5 Petroleum tank 0/UE- 411/OWe, WATER SAMPLE RESULTS: Coliform � Nitrate GWEaTFc7FF_g Other bacteria Date of sample: —a I ®92 Collected by: S CNG c1 +rz�Lll B. SEPTIC/BOLDING TANK DATA Date installed 41 "`i-�33 Tank size 1600 GALL- Compartments TWO Cleanouts&N) TNfo Foundation cleanout ®/N) YE --S- Depression (Y/8) _Ivo High water alarm (Y/& t "/A Alarm tested (Y/ /n� eAl Date of pumping _®�6 � _ Pumper_ fr.� f-tUNtE S�r2UlC�} SEPARATION DISTANCES FROM SEPTIC/H LZA- G TANK TO: Well(s) on lot Ite r On adjacent lots I; d Foundation 5 � To property line IUI± Absorption field , S r Water main/service line {o l� Surface water/drainage ,¢ 72-026 (Rev. 7/91)Front ZNts�D AP9ROxinmwr5t�V a.` QN —,ime CONTINUED ON BACK PAGE 6F- uP*_ 8v A.E,C.S. STATION N/A Date installs Size in gallons Vent(Y/N) High water alarm level "Pump on' Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Date installed ?-_�-89 Soil rating "Pump off' level at Cycles tested Surface water System type -L✓ 4J AFw Length _ 89 Width a,5 5 Gravel thickness a Total depth / $ Total absorption area Y6 SF Cleanouts present ON) Y/ -,S __2& ro7?t_ Depression over field (Y6 mc® Date of adequacy test Results (6s/fail) RAS for 1 bedrooms Peroxide treatment (past 12 months) (Y/®)---N01---k ruowN If yes, give date N /-) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot q6 On adjacent lots Property line PAR --r OF 88 U1'VA�DF_ To building foundation ID To existing or abandoned system on lot bs ovER 0 Y'v/P On adjacent lots a + Cutbank N A Water main/service line_ Surface water ._____ - Ioo f Driveway, parking/vehicle storage area Curtain drain - 0-QNCz kj,�owrJ /D ¢ S d -# lWArvED by 1J,?, issu&,p4o -88 E. ENGINEER'S CERTIFICATION WR # 69-0 , i>oPA�kIr 4rl)i I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Em HAA Fee $ ZZ -01 Date of Payment �— Receipt Number Waiver Fee: $ Date of Payment Receipt Number F-15116ILT1 5633BSTREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 53975 Chomlab RefA 92.2268 Sample # 3 Matrix: WATER Client Sample ID DRINKING WATER L3B B2 EAGLEBROOK SD #2 Client Name :3 & S ENGINEERING PWSID UA Client Acct :SHSENGP Collected MAY 21 92 0 19:30 hrs, BPO# POB :NONE RECEIVED Received MAY 22 92 6 14:30 his. Req# Preserved with AS REQUIRED Ordered By :R. SHAPER Analysis Completed MAY 27 92 Send Reports to: Laboratory Supe �via r TEPREN C. EDE I)S f4 S ENGINEERING Released By : C'_ tz4,,-- 2) ................................................ M ................................. M ........ M ........................ ...... Parameter Results Units Method Allowable Limits ------------------------------------------------------------------- I ------------------------------------------------------------------ NITRATE-N ND(0.10) mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY: J.W. Remarks: ............ ................................................................ M ............................. —M— ................... I Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than 420813BMember of the SOS Group (Soci6t6 G(5n6rale de Surveillance) MUNICIPALITY OF ANCHORAGE DEPAR`rMENT OF HEALTH & HUMAN SERVICES Q DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 7_6'-T;y 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) a (a) Legal Description (include lot, block, subdivision, section, township, range) Z,)7-,3,6 13teeX 1-&-07eve -W.P- _71-2-A% ZAJ 519 -5; Location (address or directions) (b) Property Owner Telephone: Home Business 'Mailing Address 6z,�o "VIAge f9SiL (c) Lending Institution t Mailing Address C (d) Real Estate Company and Agent Address Telephone ®� (e) Mail the HAA to the following address: List contact person and day phone nu TYPE OF RESIDENCE Single-FamilyYN Number of Bedrooms U 3. WATER SUPPLY lndividualWellx Community ❑ Public ❑ Telephone Check here E if hold for pick up. !r below. Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8i861 From Jaee i98/8 Aaer ezo-u Z to Z abed i Jom s,aaeulbue leuoissaload a4f ui suoisstwo ao saoaaa jof algisuodsaj lou si 96eao4ouy fo RipedioiunA a41 panssi si aleoijpao a wolaq elep azAleue ao suoifoadsui fonpuoo lou op SHH❑ to saa (oldw3 sluawaiinbei afels pup penpal uielno Alsiles of aapao ui suoifnIpsui buipual aia4f pue sawo4lo siasegoind of Asapnoo a se si4f saop SHHa 941 '"sely to alefS 841 ui paaalsibei aaaw6ua leuoissaloid fuapuadepw up (q anoge g 4dekeeed ui u9A16 suoifefuasaidaa ay;. uodn Aluo paseq safeoilpao 12noaddy (luoglny 4fleaH sanssi (SHH®) saoiAaaS uewnH pue 4eaH to fuawpedaa a6eao4ouy to Rfpdpunn a41 leuoifipuOO Jenaddy jeuoifipuoO to swaal panoiddesi® 99_ / _ aleRq swooapaq panoaddy aol panoaddy IVAOUddV SHH® 9 afe® auogdajal 599e waid to awBN 'uoiloadsui si41 to alep e41 uo loalla ui suoileInbei pue 'seoueuipio 'sapoo 9le1S pue ledtoiunVN pp 4fim aoueildwoo ui si wags (s lesodstp aafemalsem ao/pue Alddns aalem alis-uo 941 'uoifoadsui pup uoife6119anui Rw woal pue sail a6eao4ouy to Rliledioiunwl a4f wool pauielgo uoifewiolui eqj uo paseq le4l R1u9A ja4linl I •uianq pafeoipui ainfonafs to adAl pup swooapaq to aagwnu a4f jol alenbape pue leuopounl'ejes si walsRs lesodsip ielemalsem ao/pue Aiddns aafem alis-uo a411p41 smo4s lenoaddy Rluoglny 41leaH si41 to uoile6ils9nui Aw 1e41 Rfuan I 'molaq umo4s alep UOIIUPI19A 94f to se pue of9aa4 paxille leas Rw Rq palpliao sy CH ®RAGE P� $1ON M��tG14Jt V.V' SE�O ALITY OF ANCHORAGE (MOA) ��v,R®Nps HEALTH AUTHORITY APPROVAL (HAA) la �S . ECKLIST - FEBRUARY 1984 264-4720 Legal Description: A Z K b/y Well Classification PZ/✓ If A, B, C, D.E.C. Approved (Y/N) _ w4 Well Log Present N) Date Completed Yield Total Depth ®��P P Cased to /�Depth of Grouting _ — 0 Static Water Level -/ _.___r__ Pump Set At __ _ J+ P Casing Height Above Ground ® _. Sanitary Seal on Casing CNN) Electrical Wiring in Conduit&N) N) Depression Around Wellhead (Y(9 Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots / To Nearest Edge of Absorption Field on Lot © 0 ® ; On Adjoining Lots To Nearest Public Sewer Line_. A To Nearest Public Sewer Cleanout/Manhole _ To Nearest Sewer Service Line on Lot Water Sample Collected by _ S �J; Date 7`7 Water Sample Test Results ®—_ Y _— Comments 7�_!�'®` ® d,/A? . __. 4'r- ___ Date Installed 31604e�f Size _ No. of Compartments _. Standpipes ON) Air -tight Caps((Y N) Foundation Cleanout(Y N) Depression over Tank (Y N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) A)/A' ; for __ Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) %t — Separation Distances from Septic/Holding Tank: i 0 To Water -Supply Well /drTo Building Foundation 0 To Property Line To Disposal Field r To Water Main/Service Line /® e To Stream, Pond, Lake, or Major Drainage Course /&0 �'t- v . i. .i" k 3��.', _ °, o '" . r? "��T A6 a / t� w #,,c, ye,• a �,��. d' i r �'': rD 2- compherEp wanmC l? 7,bf ?' to . cweyf t#Ea LiFra Page 1 of 2 72-026(11/84) � ',. •'. it �' Soils Rating in Absorption Strata ® Type of System Design b Date Installed 7'% Length of Field ? Width of Field Depth of Field _ Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present Y/ ) Depression over Field (Y Date of Last Adequacy Test w Results of Last Adequacy Test Separation Distance from Absorption Field: / R To Water -Supply Well f To Property Line To Building Foundation `�, f' To Existing or Abandoned System on Lot &dor On Adjoining Lots e r To Water Main/Service Line To Cutbank (if present) w4i r� To Stream/Pond/Lake/or Major Drainage Course � To Driveway, Parking Area, or Vehicle Storage Area Comments iz Al*t1f W ,Clyr, D. LIFT STATION nstalled — Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at °° Check Permitted Bedroom Rating Against HAA Request °° Vent(Y/N) Cycles during Adequacy Test. Meets MOA I certify that;l h ch ed, v rified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 7 Company A��5 MOA No. _®( ®_ ®p Receipt No. _ SCP / Date of Payment 7. _. Amount: $ d ®S 2.2 0 Page 2 of 2 72-026(11/84) APPLK NT FILLS OUT UPPER HAI ONLY PhoneProperty Owner 3e Mailing Address < Zip Code Buyer Address Zip Code Lending Institution Phone Address Zip Code Phone Realty Co. & Agent Address Zip Code 5, Legal Description Street Location Type of Residence �Z Single Family El Mtjltiple_Family No. of Bedrooms El Other Water Supply X Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. 11 Cmmunit For wells drilled prior to that date, give well depth (attach log If available). 0 y EJ Public Utility Sewer Disposal Individual Year Individual Installed: Ll Public Utility When Connected to Public Utility: 7 Holding Tank EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. NOTE: THE INSPECTION FEE MUST ACCOMPANY 3 Time Date Inspector Field Notes: t4.,- D "11 IMORNP-w-M =� APPROVED BEDROOMS DISAPPROVED CONDITIONAL VAPPR V, DATE BY: 0 ✓CTCV C) Time Date Inspector Time Time I Data -70 Inspector Inspector MUNICIPALITY OF ANCHORAGE DEPT. OF HFA' 'TFl C, IENVIRONMENFAL PRO-IECTION of 12, RECEIVED *CONDITIONS OF APPROVAL FWell To Absorption Area Well Log Received -rj�Ld.a_ Solis Rating Date Sewer Installed Well to Tank JSeptic Tank Size d P7