The URL can be used to link to this page

Home My WebLink AboutHILLSIDE PARK PUD LT 8Hill ide Pork Lo1- 8 #015- ! 22-43 MUNICIPALITY OF ANCHORAGE ," 'DE,/"~,TMENT OF HEALTH AND HUMAN Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT SEPTIC ABSORPTION WELL ' ' TANK FIELD Phone(s) I Permit No lNG, ot Bedrooms LEGAL DESCRIPTION LOT LINE ,....-' 5 ,~ Lot S b ivisi n '~ _ Township, Range, Section '~ g J ~ -- J A~ -- ~ ~ AS-BUILT DIAGRAM (Show location of well, septic system, property hnes, toundatlon, driveway, water bodies, etc.) lC ~ HOLDING Manulacturer Capacity in gallons / Depth to pipe bottom from Total depth from original grade ~ Fill added above original grade Gravel depth beneath pipe - - , - Gravel width Gravel length ~J/.? Tote[ absor ptJo~j ~'o~area ........ SO FT P'peDJStanCematerialbetween~/~'Jines FT ~iJ ~'~ ) Installer Date Installed ~ ~ WELLS ~ PRIVATE OTHER (Identiiv) REMARKS: Municipal and State guidelines in effect on this date: / .Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SER~ 825 %" Street, Anchorage, SOILS LOG -- PERCOLATION $ Z PERFORMED FOR: 1 2 3 4 5 6 7 8 9 10 11 12 13 14- 15 16 17 18 19 20 W/l__.[_.. ~' I D/-'~ ~l ¢_~¢._ownship, Range, Section: SLOPE SITE PLAN s YES, AT WHAT ~L IF DEPTH? p E ENGINEER'S SEAL) Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN -/. FT AND FT , / , 72~8 (R~. 4185) ' ~// associates,inc. Consulting Engineers 1000 E. Dimond Blvd. · Suite 205 · Anchorage, Alaska 99515 · (907) 522-1311 June 14, 1988 Mr Dan Roth Anchorage Dept. of Health and Human Services 825 L Street, 5th Floor Anchorage, Alaska 99501 SUBJECT: HEALTH AUTHORITY APPROVAL ON LOT 8, HILLSIDE PARK SUBDIVISION Dear Mr. Roth: During our inspection of the above referenced property, the septic tank was exposed and the standpipes for the system installed providing us with adequate information .to as-built the system. During our testing, we discovered the system to be installed in accordance with the original permit and there was no groundwater present either before, during or after the test. All liquid put into the system dissappeared leaving a dry condition. The soils which were excavated were indeed 125 sq. ft. per bedroom material. We are enclosing a completed as-built/inspection form of what we viewed in the field and, since there was no groundwater at the 12 ft. depth we see no reason to do another monitor tube or additional soil testing. The system was again monitored on June 13, 1988 and found to be dry. Should you have any further questions, please let us know. Very truly/yours, CO~IN & ~OCIATES, l? / /4 1 ?/A:? ,f//'.// VBrucei~ Co.in, P.E. President BJC/~k INC. Anchora 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-41'11 GfZORG£ M. SULLIVAN, MA 'flOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION December 31', 1980 Great Alaska Construction 2520 East Tudor #2 Anchorage, Alaska 99504 Permit ~ 800563 Subject: Lot 8 Hillside Park Subdivision A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on 'a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the instgllatio~ of the on-site sewer system, please have them se~d us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, / / /~ Senior Environmental ~cialist LNB/ljw enc: Copy of Permit . SWP/057 PERMIT NO~ DEPARTMENT ~, HEALTH AND.ENV I ~ONMENTRL ~]TEL. T I ON~ 264-4~20 C~t-~--S I TE SEL-JER F'ERt'I I T ( 80056~ ) APPLICANT GREAT ALAKSA CONSTRUCTI 2520 E. TUDOR ~2 LOCATION TREE TOP CIRCLE , LEGAL LB!~ILLSIDE~PBRK~ LOT SIZE 279-78i~ ~2000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 5 SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: [:.EPTH= 1:?- LEr-~_~TH= 40 6RR"v"EL D~PTI:;= 8 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). RE[-', SEPT I C TR[-tF:~ S I ZE= 15~-30 GFILI ,,,,O~-IS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TL.-I£, (2) I r~SF"E,]TI L]f-~S RE:E RE[--.~IJ I FIE[) BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL 8ND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR ~ PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY RPPLY. SPECIFIC8TIONS AND CONSTRUCTION DIAGRAMS ARE RVRIL~BLE TO INSURE PROPER INSTALLATION. PEI~.:r'I I T E>-~P I F~:ES [:,ECEI'IBER ]~2L.. i-q- 8~l~ I CERTIFY THAT t: I 8M FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 5 BEDROOMS. S I GNED: APPLICANT GREAT RLRKSR CONSTRUCTION ISSUED BY ~_DR]"E ...... V4. 0 ~... FEET. CONSTE[JCTION -- TEST LAB PERFORMED FOR, LEGAL DESCRIPTION: THIS FORM REPORTS: 180k '~W. 48TH AVE. STE. 'C' ANCHORAGE, ALASKA 99503 :>48-1333 GREAT ALASKA CONSTRUCTION Lot 8 Block Xl~Visual Soils Examination DATE PERFORMED: 9 / 18/80 Subdivision H i 11 s i d e P a r k O Percolotion ,,Te~t ACTL-80-1458 DEPTH SOIL NOTES FEET DESCRIPTION ' "~TZ~" TO?SOIL · ~80 min/i~ I' "' TAN SILT ?~ . TAN SANDY GRAVEL ' ' 12 SF/BR t'-*.3 , GP ~~ -~ ~-4' - TAN SANDY ~I-LT- ' · -- ~ ~j~[ TAN GRAVEL tto ,. ~,¥.': ' ... - _..:.. [ . : . . .' GENERAL:-SITE :'SLOPE PERCOLATION'RATE: ~:.. : .ORAINAGE,~ REQUII~MENTSt;. see above COMMEN'$$ .... DATA CERT~II~D ~¥: Kinney R. Baxter, P.E. TEST. PERFORMEDBY'.. B. ?;. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 w,,wv.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. 015-122-43 HAA~ 1. GENERAL INFORMATION Expiration Date: .~- Complete legal description HILLSIDE PARK SUBDIV~SIOIN; LOT 8 Location (site address or d[ractions) 7280 TREE TOP CIRCLE * ANCHORAGE, AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address RALPH AND PATRICIA ADAMS Day phone 346-2231 7280 TREE TOP CIRCLE * ANCHORAGE, AK 99516 Day phone PAM SZENDER w/ DYKAMIC PROPERTIES Day phone 3111 "C" STREET * ANCHORAGE, AK 99503 261-7657 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OFWATER SUPPLY: Individual Well Individual Watf~r 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family 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 samples. (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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ ~'/'7~ ~at, or pdor to closing for the engineering serv/ces provided. 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 forthis application, , sh~wsthatthe~n-sitewatersupp~yand/~rwastewaterdisp~sa~systemis(am)safe~funcb~~na~andadequate for the number of bedrooms and type of structure indicated herein. I fu/ther vedfy that based on the infotrnation obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(am) in compliance with ail applicable Municipal and State codes, ordinances, and regulations in effect at the b'me of installation. Name of Firm ALASKA WATER &: WASTE'WATER CONSULTANTS, INC. Address 6901 DEBARR ROAD. SUITE 2B * ANCHORACE, AK 99504 Engineer's Printed Name JEFFREY A. (;ARNESS, P.E. Phone 337-6179 Date Engineer's Comments: In conducting this evaluation, AWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The repo~led results described the performance of the system under the conditions encountered at the time of the test, end separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may £ucluate dudng the year, and the water usage of the family being sen/ed by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future perfonwance of the system, nor do they guarantee that there are no hidden defects or encroachments. A WWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal #ght whatsoever. 5. DSD SIGNATURE ~ Approved for -~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ~ : WASTEWATEE .' Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Supplemental Engineer's Reort Other Origfnal Certificate Date: Municipality of Anchorage Development Services Department Building Safety Olvtslon On-Site Water & Wastewater Program 4700 6ou~ Bra~w St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchor~e~k.tl~ (;0~ ~43-~04 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HILLSIDE PARK SUBDMSION; LOT 8 Parcel ID: 015-122-43 A. WELL DATA Well type '~' If A, B, or C provide PWSII~212~)~ Date completed, _ Sanitary snar~.--------~ Wires properly protected (Y/N) _ fl. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level Well preduc~on WATER SAMPLE RESULTS: Coliform - colonies/100 mi. Nitrate - nlg./L. Other bacteria - ,colonies/100 mi. Date of sample: - Collected by: - D. SEPTIC/HOLDING TANK DATA Tank Type/Material = i SCL Tankslze 1500 gal. NumbarofCompertments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Data of pumping 1/12/'2002 Pumper Date Inalled 10//1980 Cleanouts (Y/N) YES High water alarm (Y/N) N/A ISAAC'S PUMPIN0 *PER INSPECTION REPORT. MONITORING TUBE DOES NOT EXTEND TO C. ABSORPTION FIELD DATA BOTTOM OF 5'/~-'TEM. 66 INCHES OF u-t~.CTIVE MEASURED IN FIIq n. Date installed lO/Ig8o Soil rating (g.p.d.fft~ 125 System type DEEP TRENCH Lengltt 50 ft. Width 2.5 ft. Gravel below pipe '10 fl. Totaldepltt .14' ft. Eff. at~orpUonarna 1000 fl= Monitedng tuba **YES Date of adequacy test 1,,/15/2002 Results (Pass/Fall) PASS Fluld depth in absorption fleld bafore test 0 in. Wataradded1863gal. Elapsed Time: 0 min. Final fluid depth 0 in. Any rejuvenation treatment (past t2 mo,) (Y/N & type) New depth Absorption rote >= 750 NONE KNOWN If yes, give data Depression over field ' NO For 5 bedrooms 0 in. g.p.d. D. LIFT STATION Date installed SIze in gallons M~ "Pump on" level at in. "Pump ~ . High water alarm level at __ In. ~ Cycles tested. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: COMMUNITY WELL Septic tankJliff station on lot On adjacent lots Absorp~n field on lot ~~~l~~° Public sewer main ut ~ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'4- Water main 10'+ Water sewice line l~ 10'+ Surface water, 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABsoRPTIoN FIELD ON LOT ~ Property line 10'+ Building foundation 10'+ Water main 1 Water service line ~ 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain dmtn NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end m',4ew of Municipal records that the above systems am in confon~ance with MOA HAA guidelines in effect on this date. Engineers Printed N~e Date ,z.. / -.~/o ~., dt~-~'~;t.'Y A. GARNESS oste of PU ,nt R e pt Number (Rev. Waiver Fee $ Date of Payment Receipt Number 02/05/2002 13:2~ 9072767804 · : · ROBE:ET PAGE 01 Robert E. & Assoc. 1" ~ 5n, Jan,22-02 10=31A Krantch & Assoc. 907 346 1169 P.02 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # 1. GENERAL INFORMATION Complete legal description Hillside Park Lot 8 Location (site address or directions) 72R0 Treetop Circle Property owner Mailing address Lending agency Mailing address Agent Address Alan E. or Jeanne E. Leske 7280 Treetop Circle Day phone 346-3554 Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: X Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: X Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev, I/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Environmental Management, In9. ~irnee~>~../~ess 206 g. Fir~ee~d Lnlf~ Phone 272-9336 Date 6. DHHS~ SIGNATURE /X.. Approved for _~ bedrooms. Disapproved. Conditional approval for 0-- 8c6'1 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 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. 72~325 (Rev, 1/91) Back MOA ~21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Hillside Park Lot 8 Legal Description: A. Well Data Well type Community Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) AT INSPECTION 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 N/A ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout. Petroleum tank WATER SAMPLE RESULTS: N/A Coliform Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed 10-8-80 Tank size 1500 Cleanouts (Y/N) '/es Foundation cleanout (Y/N) High water alarm (Y/N) No Date of pumping 8-5-93 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N/A On adjacent lots 200 + ' To property line 50 +' Absorption field 10' Surface water/drainage None Observed Yes Compartments 2 Depression (Y/N) No Alarm tested (Y/N) Isaac' s Pumper Foundation 7 ' Water main/service line 100 +' CONTINUED ON BACK PAGE 72-026 (3/93)° Front C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed '10-8-80 Length ~+7' Width 2..5 ' Total absorption area ]_000 Date of adequacy test 6- 7-9L~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) '12.5 System type ~r~ench Gravel thickness ]-0' Total depth '14' Cleanout present (Y/N) -'/es Depression over field (Y/N) No Results (pass/fail) ~ass for .5 Bedrooms 107" After test 110" If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation 14' 4" On adjacent lots 100 +' Surface water No~e Obse~-~,~ed Curtain drain No~e Obse~'ved [q/A On adjacent lots 200 +' Property line .55' To existing or abandoned system on lot N/A Cutbank N/A Water main/service line 100 4-' Driveway, parking/vehicle storage area 0 ' E. ENGINEER'S CERTIFICATION I cern'fy that I have checked, verified, or co/~ormed to all MOA and HAA guidelines Signature Engi ep~Name' ~,~_ ~v HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE MEMORANDUM SEPTIC SYSTEM ADVISORY HEALTH AUTHORITY .APPROVAL NO. 9~(~00 Prior to a recent adequacy test on the septic system for this lot, //O inches of standing water 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. ~ii~I~W~0N~E~TAL CERTIFICATION OF HEALTH AUTHORITY APPROVAL This is to certify that the on-site well and/or septic system inspection report for the property located at _~;jJ~,J,.~,.J~.~ and shown on the attached form has been prepared and reviewed by a registered professional engineer. Findings in this certification represent the conditions found at the site at the particular time of the site inspection and are the result of services rendered within the scope authorized by the client. Changes due to natural processes and human activity will affect the conditions described herein. EMI prepared these tasks in a manner consistent with the level of skill ordinarily exercised by members of the profession currently practicing under similar conditions. No warranty, express or implied, beyond exercise of reasonable care and professional diligence, is made. The engineer and Environmental Management, Inc., are not responsible for any claims by third parties for personal injury or economic loss alleged to arise out of this well and/or septic system inspection. ENVIRONM~~/~ ~~TALMANAGEMENT, IN . J.p~ E. Simpson, p..l~ Date Jice President EMI 5\Stan's Stuff\Misc. Office Work\Health APP Disclaimer 'r'~) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~ ~- ~:':~-'~ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date c//~/~ ~ GENERAL INFORMATION (a) Legal Description (include lot, block/.~bdivision, section, to~nge) Location (address or directions) (b) Applicant Name ,/~g('~, /~':L~./~/ Telephone: Home <~'- Z~ ~ / Business Applicant Address ~ ~ ~ ~ ~~' ~' (c) Applicant is (check one): Lending institution ~; Owner/~,uilde~; Buyer D; Other ~ (explain); (d) Lending Institution Telephone / (e) (f) Address Real Estate Company and Agent Address Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family.[~' Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] Community..~ Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite.]~ Public [] Community [] Holding Tank [] Note: If community well system, mus[ nave written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 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 this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of th~ection, r Name of Fir~ff_ - ~-A''~-//,4''/ ~ /~,~,.~'---~'J,~ ~'.~'~5~ / ~.. Telephone Date ~:~/~- ~, /~ DHEP APPROVAL__._ Approved for .,~ Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: "~'~' Well Classificatio -~,,~/~' ~- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At J Casing Height Above Ground : Sanitary Seal on Cusip/N) Electrical Wiring in Conduit (Y/N) _ Depres~~Wellhead (Y/N) _ Separation Distances from Well: To Septic/Holding Tank on Lot ~,~, _/; On Adjoining Lots To Nearest Edge of Absorption Field on Lot~'/~;OnAdjoinmgLots _____ .//' To Nearest Pu ' blic S war To Nearest Public Sewer Line e Cleanout/Manhole j/~Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results / Comments / B. SEPTIC/HOLDING TANK DATA Date Installed/'~ - ~' '~5~ Size /~ = No. of Compartments Standpipes~N) ~ ~/~-~ Air-tight Caps~N) /~,--~-~-- Foundation Cieanout (Y/N) Depression over Tank (v~) ~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~.,'~, / ,,'~ ; for Holding Tank High-Water Alarm (Y/N) /¢/~/iz Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well ~'"~"~'~'~'~'~ ~' To Property Line J--~'/ To Water Main/Service Line -/~5"/~ To Building Foundation ,7 To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 72 026 IRev $/86~ Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~ [Pt,~ Width of Field ~ ~ 'dPl Square Feet of Absorption Area Depression over Field (Y~ Results of Last Adequacy Test Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (~N) Date 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 Comments ; On Adjoining Lots ~"/O To Cutbank (if present) ¢/A To Property Line ~"~10I~ To Existing or Abandoned System on D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Pe/~ni~ted Bed¢om Rating Against HAA Request ** I certify tha~/I t~}/,~r)eck~dc¢~rified, or conformed to all MOA and HAA guidelines in effect on the Sign ed / u~/.~//~'/~--/"~/~/~ ~ Date ~:¢//~/0¢:zO¢~ date of this inspection. Company ~/~/v~/1~¢//~2~'', MOANo. -- 2/~ Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 /Rev 8/861 Back & associates,inc. Consulting Engineers MUN~ 1 ~F ANCHORAGE 1000 E. Dimond Blvd. * Suite 205 * Anchorage, Alaska 99515 * (907) 52261~,3~ OF HEALTH & ENVIRONMENTAL PROTECrlON June 20, 1988 'JUN 9,4 t988 Municipality of Anchorage Department of Health & Human Services On-Site Services 825 L Street, 5th Floor Anchorage, Alaska 99501 RECEIVED SUBJECT: LOT 8, HILLSIDE PARK SUBDIVISION Gentlemen: In reference to the above mentioned property, the original installation was not as-builted nor was final paper work available at your offices. Per your direction, we performed the following: 1. As-Built of existing system. 2. Soils test to verify soil 3. Installation of missing stand pipes. The following information D.H.H.S.: was specifically requested by 1. The existing septic tank now has two standpipes. 2. The septic tank has now been insulated. 3. The septic tank is installed under the driveway'and can structurally support the loads to be imposed, including traffic loading. The tank has been in this configuration since 1980 and has no signs of failure. 4. There is a foundation cleanout inside the house in the utility room. 5. The system, as installed, is adequate and meets all Municipal requirements. Should you have any other questions, please let us know. V~y Trul~ Yours, / S 1// pBrreUi,~/Je~tCo~in, P.E. INC. ISAACS PUMPING SERVICE (Norm Tibbetts, Owner) 6218 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 563-3300 All claims and returned goods MUST be 3578 ..... panied by this bill, ~.~a/c]&~.~ ~_~" DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 1334 ! ANCHORAGE. ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 To Whom It May Concern: Accordinq to the records on file in this o??ice, the __~:~-S~_<~--- __g_._~.__~cz~ .... _~_/~_ .......... Uater System is in comp]iance with the State of Alaska Drinking Water Regulations. RSK:sa Si ncere 1 y, Ronatd S. Klein Environmental Field O¢¢icer ¸2'