HomeMy WebLinkAboutSUNSET HILLS WEST BLK 1 LT 8Sunset Hill
West
Block 1
Lot 8
#018-203-08
GREAT,~R ]~.N~,ItOI,AGE AREA BOROI,~.~r
· :, ., . . ~, ~ER ANCHORAGI:. AREA BORO~ ~H
Dep~rlment of Luvnonmental Qu~hty
3500 Tudor ~oad ~ Pouch 6-650
INSPECTION
N? 874
LOCATION.
SEPTIC TANK:
DISTANCE FROM WELT
LIQUID CAPAC ITY.J' ~.
.ADDRESS~.~')~' '/~2 ~* -//??'f,~7-~? PHONE.
(~.) ~) - NUMBER OF
COMPARTMENTS
__GALLONS. INSIDE LENGTH. INSIDE WIDTH
LIQUID
DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS / OUTSIDE DIAMETER
LINING M A.~I'/~L
NEAREST LOT LINE
DISTANCE FROM WELL '~'~-~ BUILDING FOUNDATION
TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl
NUMBER OF LINES
ABSORPTION AREA
DEPTH: TOP OF TILE TO FINISH GRADE
//Z:/
. .
~., ) TOTAL LENGTH
FOUNDATION. ~> (~ NEAREST LOT LINE /~ ~
, , , DE LINES ,
OISTANCE BETWEEN LINES ~ ~ .~ j' ~ '
TRENCH WIDTH IN. TOTAL EFFECTIVE
SQ. FT. LENGTH OF EACH LINE ,~? ~'~' / ~)
DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL: TYPE~_~.~/,~-~/'/'j:7..~) - . .,//~- ~./ glSTANCE FROM /
, DEPTH_'~'/~:'d z//Z~"JX;~BUILDING FOUNDATION ~ ~) SAMPLE , NEAREST
NEAREST SEPTIC ,.~ SEEPAGE ~ · . ' . OTHER
DISTANCES:
DATE
DIAGRAM OF SYSTEM
///f/
GREATER ANCHORAGE AREA E~OROUGH
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMrr
PERMIT NO ........
INSTALLATION LOCATION
INSTALLATION Of: SEPTIC TANK ~// SEEPAGE PIT
TYPE AND SIZE OF FACILITY TO BE SERVED .
SOIL TEST RESULTS ~I~[
COMPLETION DATE ANTICIPATED
PFRMTT VAI TI} ONF YFAR
FINAL IN.iiPECTION~ 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INBPECTION BY THE
. L)R/~//v
MINIMUM DISTANCES, RIrQuIREMENT$
5 ft.
FOUNDATION TO SEEPAGE PIT 20 f%. , DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL 15 f%9 __.
WELL TO SEPTIC TANK .~' 0 , . SEEPAGE PII"~~
DRAIN FIELD /C~/ ALSO CONSIDER AREA WELLS.
WATER MArN TO SEPTIC TANK l0 f% .... SEEPAGE P,T _ l0 ft.
s[Pt,c TANk. __ 25 f~. S~PAe~ mT 100 ft. uma,N
EXCAVATION S FEET INTO UNDISTURBEO SOIL,
4 INCH DIAMETER CA$T lEON BIPHON PIPES ON B£FTIC TANK AND SEEPAGE Pit
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GR~v~'l IBACKFILL
CONFORM TO PiOROUGH REGULATIONS REGARDING INSTALLATION.
HEALT" 2~THORITY
I CERTIFY THAT [ AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 2S-ES AND THAT THE ABOVE
GRE ~R ANCHORAGE AREA BOROUGH
DEPARi,.,~,;T OF ENVIRONMENTAL QUALI,
3500 TUDOR ROAD
ANCHORAGE, ALASKA 99502
CASE #,
Performed For NewellConstruction Date Performed 6/9/72
Legal Descrip~T6-6'.7- Lot 8 Block_ll_Su'6di~v'~sion Sunset Hills West'
This Form Reports Soils'~g X Pe-~'~-o-l'~=t~-Test .....
Depth
Feet
3~
4
Soi 1 Charac_teri~sti c~s___
Gray-Brown Silty Sand
Fine to Medium Gravel with
Sand Seams (GW) (SW)
5
Gray Sand (SWt.
Gravel
w/Scattered "
w
Water
1 0,~.
Was Ground Water
If Yes, At What
Encountered?
Depth? 7.8
Yes
Reading Date
P-~o l a t i on' Rate
Proposed
Gross Time
Net Time
Minute
InstalTa-~-T'o-~'?' Seepage Pit
Depth to H20
Drain Field
Net Dro
Depth Of Inlet iOeP~-~ To Bottom Of Pit Or Trench.~-
COMMENTS :_. 105 sq. ft. o~ drainage area is required, e]2~.b,edroo___m_m ........
Test" Perl:'6-ff~'d By_ Carlisle ' Data
• Municipality of Anchorage �aG
On -Site Water and Wastewater Program
(907) 343-7904 s A E T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I. D. 018-203-08
Expiration Date: _ &e C � 3 M I
1. GENERAL INFORMATION
Complete legal description Sunset Hills West Block_1 Lot_8________
Location (site address) 14245 Hancock Dr. Anchorage AK 99515
Current Property owner(s) Silvia Popa _ _ _ Day phone
Mailing address 14245 Hancock Dr. Anchorage, AK 9951.5
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class _ Well
❑
Public Water System
❑
WaiverNariance request for:
4
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
Received by: _ Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ J 5 Waiver Fee $
Date of Payment/ 1A I Date of Payment
Receipt Number06 y-5 G Receipt Number
COSA # ___ 0 S_C__ a_ 1.1.5.5.1 Waiver #
Distance:
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems 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 ARCTERRA CONSULTING.,IlVC,_- _ Phone _ 696-6111 _
Address 20441 PTARMIGAN BLVD., EAGLE RIVER,_A 99577
Engineer's Printed Name _KENNETH M. DUFFUS _ Date%
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition
of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface
conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate
during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist. e•r ��- i,,
Air
6. DSD SIGNATURE
System #1 Approved for bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the f (kpvt ltd( lations:
OF � titii
iii
J 1
�t
�J
WATER AND
WAST"-V''XTE -
pROGKAM
Glc
r
i
By _. — Original Certificate Date:_% 23 .la 1__. ---
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X _ Nitrate Advisory
Septic System Advisory _ Arsenic Advisory
Well Flow Advisory _ Other-, - I 1_-1--____
COSA blue sheet 10-10-12 doc
Legal Description
COSA Checklist
Sunset Hills West Block 1 Lot 8
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 1973
Total depth 126 ft
Cased to 40+ ft
® Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 16 in
Date of flow test for COSA 9/3/21
Static water level at beginning of test 72 ft.
Comments
B. TANK DATA
Age of tank(s) 49 years
Tank type/material Septic/Concrete
Measured operating fluid level in septic tank 49"
FE -1 Standpipes/foundation cleanout per record drawing
Date of pumping 9/3/21
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1972
® ALL standpipes present per record drawing
Total measured depth from grade 11 ft (max)
Measured depth to pipe invert from grade 5 ft (min)
❑ N/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective
® Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies;
COSA Checklist yellow sheet
Parcel I D : 018-203-08
Structure served by this system
Well production at time of test 5.9 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ® Nc
® Coliform bacteria is Negative
Nitrate 4.41 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ® Arsenic less than MRL (ND)
Collected by Arcterra Consulting
Date of Sample 9/3/21
IFT STATION
j] Requl aintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 9/3/21
Results ❑✓ pass For 4 bedrooms
Fluid depth prior to test 13 in
Water added 600 gal
New depth 30 in
Elapsed time 60 min
Final fluid depth 12 in
Absorption rate 600+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
❑ Yes
if No 5+*
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No 50+*
ft
[0 Yes
if No ft
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' VI Yes
if No ft
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' ® Yes
if No ft
® Yes
if No
ft
ft
If septic tank is under driveway
comment below
*Meet code at time of installation.
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
❑ Yes
if No 5+*
ft
Surface Water > 100'
® Yes if No ft
Property Line > 5'
® Yes
if No
ft
Wells on Adjacent Lots:
® Yes
Absorption Field > 5'
® Yes
if No
ft
Private Wells > 100'
0 Yes if No ft
Water Main > 10'
® Yes
if No
ft
Community Wells > 200'
0 Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
0 Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' 0 Yes if No ft
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No ft
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S COMMENTS
*Meet code at time of installation.
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 COSA guidelines in effect on this date.
COSA Checklist yellow sheet
Municipality of Anchorage •
4.
,.° On-Site Water and Wastewater Program
-t _ (907) 343-7904
S F F E T Y
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 018-203-08 Expiration Date: 3 _2_) —
1. GENERAL INFORMATION
Complete legal description Sunset Hills West Block 1 Lot 8
Location (site address) 14245 Hancock Dr
Current Property owner(s) FNMA Day phone 261-7603
Mailing address same
Real Estate Agent Bob Brock RE/MAX Day phone 261-7603
,`q
2. TYPE OF DWELLING: //V!,, "'`' \
® Single Family (w/wo ADU) `};.1
❑ Duplex
cE DEC 1 ,, Lu'j i_,
❑ Multiple Dwellings (Single Family and/or Duple . 1-'\)/
c ,..163..-7,-
!C`_��4.
\�!6 3 i
3. NUMBER OF BEDROOMS: 4
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well ® Individual N
Individual Water Storage ❑ Holding Tank ❑
Community Class C Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
Received Date:/2,z/// 7
COSA to be released to the engineer,unless o erwise requested by the engineer.
COSA Fee $ J-o1(.o Date:
Date of Payment /05/f43 Date of Payment
Receipt Number 050goD Receipt Number
COSA# (loco/67R Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems 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 NorthRim Engineering Phone 694-7028
Address PO Box 770724,Eagle River
Engineer's Printed Name Steve Eng Date 12/15/2017
6. DSD SIGNATURE i
System #1 Approved for y bedrooms.
System#2 Approved for bedrooms
•
f 2/r S�4-7A`
Disapproved. ,
Conditional approval for bedrooms, with the following stipulafidhS-
:' 1' tOt ,'
\4 ,4 y,
z.- ON SITE ��
= WATER AND
o WASTEWAER 0Z'
'''` PROGRAM
MT SERNI\
__ x j
.----- ----14
. - J vv--- E. Original Certificate Date: 2-- Z( " 17
The Municipality of Anchorage Devlopment Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.The
Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet_9-1-12.doc
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On Site Systems A\ pproval Checklist
Legal Description: c..5 un set //s W e jt 13/ L cP Parcel I D:d/"ZO3o do
A. WELL DATA
Well type , If A, B, or C provide PWSID# Well Log (Y/N) N
Date completed /7 73 Sanitary seal (Y/N) Wires properly protected (Y/N)
TotalZ� �+
depth! ft. Cased to � ft. Casing height(above ground) / in.
# 440' 1~/L‘ FROM WELL LOG AT INSPECTION
Date of test. /z/.57 7
Static water level ft. 7 1. Z ft.
Well production g.p.m. 514- g.p.m.
WATER SAMPLE RESULTS:
Coliform G colonies/100 mL Nitrate 41
7 • 6 mg/L/
Arsenic h/d ug/L Date of sample: /O�26/ /7 Collected by: /V la( e
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Se.194 c-�.or
Aee..'rk— q Date installed / ! 7z
Tank size /2 S Ggal. Number of Compartments 2 Cleanouts (Y/N) X
Foundation cleanout(Y/N) ir Depression over tank(YIN) A( High water alarm (YIN) A/
Date of pumping ll�a (7 Pumper A f
frM 04- jLe_c-P rotJ
C. ABSORPTION FIELD DATA Q 4, O
Date installed /''7 Z Soil rating (g.p.d./ft2 or ft2/t n) 337 System type 7:e,,,c_il.
Length 3e.33') (° /ft. Width 3'/, ft. Gravel below pipe C ft.
Total depth // ft. Eff. absorption area/3 S6 ft2 Monitoring tube y Depression over field /,/
Date of adequacy test/2/S// 7 Results(Pass/Fail) f / For bedrooms
Fluid depth in absorption field before test !2 in. Water added 6---a 0 gal. New depth29' in.
Elapsed Time: 6-.0 min. Final fluid depth /ZAlin. Absorption rate >_ 61-6-Q g.p.d.
Any rejuvenation treatment(past 12 mo.) (Y/N &type) /V If yes, give date
D. LIFT STATION AIA
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off" level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 6-c..) �-I- On adjacent lots /04 l f'
Absorption field on lot /0 c /'4- On adjacent lots / 400 '4--
Public sewer main /00 f-f ' Public sewer manhole/cleanout • /d'o i1—
Sewer/septic service line 25 ' 'f" Holding tank /04 /I--
Animal containment areas 5 0 -f- Manure/animal excrete storage areas /0 0 #
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 Property line /O Absorption field 5 if—
Water
Water main /0 'f Water service line
O f Surface water /D0 P?`'
Wells on adjacent lots /OD ,04
ABSORPTION FIELD ON LOT TO:
Property line /O (1' Building foundation lQ Water main / (f
Water Service line /O <' Surface water/GO (� Driveway, parking/vehicle storage /d /�
Curtain drain 1 I - Wells on adjacent lots/OG (1-
F.
fF. COMMENTS
YA) GUJ , - L , Ew t-'-f--.c)w Swirz -/.
G. ENGINEER'S CERTIFICATION .� �"0, i.0,
I certify that I have determined through field inspections and w,ry>, F •,.:‘,s.review of Municipal records that the above systems are in x-.' v9
conformance with MOA COSA guidelines in effect on this date. $ ;i'3 (_rPig':: • '% g,p
Engineer's Printed Name S.7-.E.-4/ - . A
Date ( (/ 7 $.-,_.
(;' .'.
os
4.s3/40
y M-
COSA yellow sheet_2-6-15.doc
A/ Tis'
O
\ 5
f
Odd
LOT 9 ��•
•. BLOCK 1 + trl'
+ °' 9s4..$2., ,•
O,,
V -,o0 c'^
Fp
F/4* . °
Se
`1a
4 �, LOT 8 •
••
\ tA\ O BLOCK . d • • a AC •d
•Ate' �j0 D/W
I 2'x 4'
." d DECK a
ry., •J4 • d
I. °• fie; •o. ' WE • '
*I Oji c� 9e
.a GS.0
ROCK •WALL • °��°• tiV� �4 • 'S'4.).
al
• , •S
P
V •� f c' GP,
P
QM
SEPTIC :.
VENT •COVERED• b
(np) ENTRY .
a
..
A6,0.>Ss1. a AC'• a .t. n)
• L
•
\ O loo '°o
0� •00,•o0, •
"PFc • d LOT 7
�� J BLOCK 1
4-, \ PE9Aq
\ .O ( )
\ \ \
ANCIIORAGE RECORDING DISTRICT
ASBUILT OF:
SUNSET HILLS WEST SUBDIVISION
LOT 8 BLOCK 1 PLAT P-600 _ C�E
SURVEY CERTIFICATION:I,John L.Schuller,have conducted a —�0�,��\\\
physical survey of this property as shown on this drawing and that the cS�,_....•••.AL9 N` `�~ `6�
improvements situated thereon arc within the property lines and no of `N• 4—'•.s`11, ++ tea,
enchroachmcnts exist other that notcd. % 4 Ili /\ -{y
o l�
EXCLUSION NOTES:It is the owners responsibility to determine the r _
existence of any easements,covenants,or restrictions which do not
, ri Y
appear on the recorded subdivision plat.Under no circumstance should ,I 0 •JOHN L SCHULLER. o% 7 OIL
�� iany information on this drawing be used for construction of fences, i'+�''., 1S-10408 :- ,, ? �'�
structures,improvements,or for establishing boundary lines. ` ^ y�• � �n w
wcR'c ORDER P u iuER: on 7L I,o,,•'S-/L..aQ;'�a •'�• �,�••��.�"• 1 Crb�"
MAY 16, 20081. 20' -•nL \rreSalonot.�` Fl 1 m
08-024 AVM elckE000 a co FuaBER ������ Q�'Ic o4,
soc.cirrncc
JCS 3033 0801/53 '�r2, AND SUS q
R• AIC 995173136
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 018-203-08 COSA#
Expiration Date:
1. GENERAL INFORMATION
Complete legal description SUNSET HILLS WEST.• LOT S. BLOCK 1
Location (site address) 14245 HANCOCK DRIVE ANCHORAGE, AK 99516
Current Property owner(s) JANiCE ANDERSON Day phone 2614347
Mailing address
Lending agency
Mailing address
14245 HANCOCK DRIVE ANCHORAGE AK 99516
Day phone
Mailing Address
Unless otherwise requested,
COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
Individual On-site
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 Onsite Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional
civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the
transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal
and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site
Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well
and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one
year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or
a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
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 Certificate of On -Site Systems 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 ArcTerra Engineerin & urveyinT Inc Phone 868-3792
Address _20441 PTARMIGAN BLVD EAGLE RIVER AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date -114/30/21
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations.
The assessment of the condition of the well and septic applies only to the conditions as of the day tested.
The flow and absorption rates may change due to subsurface conditions that may not be observed from
the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the
year and the water usage of the family being served by the system. The operational life of all well and
septic systems are subject to these various and dynamic characteristics and are outside the control of the
evaluator of the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a OF At
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen �p�,.••'•""•••,'QS �)
encroachments, deficiencies or discrepancies exist. G.1�•• '•;�y��
AO
`1 * 14QTH A,
5. DSD SIGNATURE
�� Approved for _ bedrooms.
Conditional approval for bedrooms, with the following stipulations:
COSA Checidist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: l v- Original Certificate Date:
(a« „Ast.
Municipality of Anchorage
• �� Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: SUNSET rrn r S WECI r. LOT a_ BLOCK 1 Parcel ID: 018-203-08
A. WELL DATA
Well type PRIVATE If A. B, or C provide PWSID # _ Well Log (YIN) Al.
Date completed 1221 Sanitary seal (Y/N)Y
Total depth •126 ft. Cased to 40+ ft.
FROM WELL LOG
Date of test NA
Static water level NA ft.
Well production NA g.p.m.
WATER SAMPLE RESULTS:
Wires properly protected (YIN) Y
Casing height (above ground) 12+in.
AT INSPECTION
4115/08
Coliform _Q_colonies/t00mL Nitrate _4.17 mg1L Other bacteria ,Lcolonies/100 mL
Arsenic: _NZrng/I Date of sample: 4h6/2008 Collected by:AtcTerrl
B. SEPTIC/HOLDING TANK DATA
ft.
Tank Type/Material Septic/Concrete Date installed 1972 Tank size 1250 gal.
Number of Compartments 1 Cleanouts (YIN) YFoundation cleanout (YIN) _N Depression over tank (YIN) hL
High water alarm (YIN) N_Date of pumping _4/15/08 Pumper D1cDonalds
C. ABSORPTION FIELD DATA
Date installed 1972 Soil rating (g.p.d./ff or ft /bdrm) 332 System type Trench
Length 3 tft 33'& 1 e 14' ft. Width 3-18 ft. Gravel below pipe &ft. Total depth JM ft. (measured 4/15/08)
Eff.absorption area 13aft? Monitoring tube Y Depression over field rL
Date of adequacy test 4/15/2008 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test _a in. Water added_t gal. New depth 4k,5_in.
Elapsed Time:240 min. Final fluid depth .a in. Absorption rate >= OQ++ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) bLlf yes, give date
D. LIFT STATION
Date installed
'Pump on' level at_in.
Datum
E. SEPARATION DISTANCES
Size in gallons Manhole/Access (Y/N)
'Pump off" level at_in. High water alarm level at_in.
Cycles tested Meets alarm 8 circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ,50'+
Absorption field on lot •1001+
Public sewer main 751+
Sewer /septic service line 251+
On adjacent tots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout 1001+
Holding tank I00'+
Animal containment areas 501+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 51+ Property line 51+ Absorption field 5'+
Water main 10'+ Water service tine 101+ Surface water 100'+
Wells on adjacent lots 1001+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line •1o'+ Building foundation 10'+ Water main _701+
Water Service line 101+ Surface water 100'+ Driveway, parking/vehicle storage 101+
Curtain drain 50'+(None Known) Wells on adjacent lots ]00'+
F. COMMENTS
'
PER A10A RECORD DO UMFNTS (1972 Inspection Report 1974 R 1995 )tenth Authority Approvals)
G. ENGINEER'S CERTIFICATION pF q ��i
qs'It�t
I certify that I have determined through field inspections and ,
review. of Municipal records that the above systems are in i* �g9�1
conformance with MOA COSA guidelines in effect on this O P 9TH
date. + i..:....:, .:...
Engineer's Printed Name KENNETH M. DUFFUS I�r� Kenneth ,if?�
W
J, %
Date 09130/2008 ,I �F9 ti,, S D�X s
COSA Fee $430.00
Date of Payment
Receipt Number
(Rev. 11A5)
Waiver Fee $
Date of Payment
Receipt Number
SCS ReEN
1081529001
Client Name
ArcTerra Engineering and Surveying
Project Name/a
Sunset Hills West B I, L8
Client Sample ID
Sunset Hills West B1, L8
Matrix
Drinking Water
PR'SID
0
Sample Remarks
All Dates rimes are Alaska Standard Time
Printed Date/rime
04282008 14:50
Collected Datelrime
04/162008 13:30
Received Datelrime
04/162008 13:55
Technical Director
Stephen C. gale
-- Allowable Prep Analysis
parameter Results PQL Units Method Container ID Limits Date Datc Init
Metals by ICP/HS
Arsenic
Waters Department
Total Nitrate/Nitritc-N
Microbiology Laboratory
Colony Count
Total Coliform
Fecal Coliform
ND
5.00
ug/L
EP200.8
C
(<10)
0421/08 0422/08
NRB
4.17
0.100
mg/L
SN1204500NO3-F
B
(<10)
0421/08
LCP
0 colI100ml.
SM209222B
A
(<200)
04/16/08
DLC
0 col/100ml,
SM209222B
A
(<I)
04/16108
DIX
0 col/100ml.
SM209222B
A
(<I)
04/16/08
DLC
�k
LOT 9
BLOCK 1
ROCK
•
SEPTIC
VENT
(TYP)
/WELL
SJ•
LOT 8
BLOCK 1
""�\\DECK
�a yoGs �c
14 A °
COVERED.-
ENTRY
d
° d
A8 Ss d AC °°
OJ, s1 a D/W d
hi A
A ° d °
REBAR
(TYP)
ANCHORAGE RECORDING DISTRICT
ASBUILT OF:
SUNSET HILLS REST SUBDIVISION
LOT 8 BLOCK 1 PLAT P-600
SURVEY CERTIFICATION: I, John L. Schuller, have conducted a
physical survey of this property as shown on this drawing and that the
improvements situated thcrcon are within the property lines and no
enchroachments exist other that noted.
EXCLUSION NOTES: It is the owners responsibility to determine the
existence of any easements, covenants, or restrictions which do not
appear on the recorded subdivision plat. Under no circumstance should
any information on this drawing be used for construction of fences,
structures, improvements, or for establishing boundary lines.
WORK ORDER NUMBER: DALE: SCM(: -YNL•
MAY 16. 2008 1'-20'
08-024+ RAM BY: CRLCKW BYJ CRID NUMBER: BOOK AGE:
JLS 3033 0801/53
•
•
•
A
OF' ?4L�`%1�1
103 /-JOHN
L SCR: j HULLEo`
IS -10408 �^
•
LOT 7
BLOCK 1
F I ,
'QFC
•Pi AND
tz'R' AIC 1
,4,(5
MUNICIPALITY OF ANCHORAGE'
DEPARTMENT OF HEALTH & HUMAN SERVICES i
Division of Environmental Services
On -Site Services Section •
P.O. Box 196550 Anchorage, Alaska 9951M650
(907) 3434744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILLY DWELLING .
Parcel I.D. 018-203-08 HAA# H jq O IOlI
1. GENERAL INFORMATION
. �� • - .. • • • ia ava'a*1. 61 1l icilel .• :l[•I•P•f�
Location (site address or directions) 14745 HANCOCK DRIVE ANCHORAGE AK 99516
Property owner I OISMAE Aga NDaFN Day phone
M. is .•• • ••[ [•�• ••
Lending agency
Day phone
Mailing address
Agent cmir I AROSA V11 REAI TY EXECUTIVES Day phone (907) 441-6207
Address 341 WEST TUDOR ROAD ANCHORAGE AK 99503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
4
XXX
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
Ing to the legality and status of system.
72-025 (Rev. 1191) Front MOA #21 Computer version
pa, 0
Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1;800.'1j0 at,
l
or prior to, closing for the enalneerina services Provided.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
Investigation of this Health Authority Approval application shows that the on-site water supply and/or
wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of
structure indicated herein. l 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. AAA
Name of Firm ALASKA WATER & WASTEWATER CONSULTANTS. INC. phone (907) 337-6179 r'1
Address 6901 DEBARR ROAD, SUITE 2B ANCHORAGE, ALASKA 99504 .9 -/J�'J�
Engineer's Signature Date s/
In conducting this evaluation, AWWC, Inc. attempted to provfdo a thorough, conscientious engineering analysis
system In accordance with ADEC and hfOA DHHS Guidelines & Regulations. The reported results described the
performance of the system under the conditions encountered at the time of the test and separation distances
measured to readily identifiable features. The operational life of all wells and septic systems depend
on the local soils condition, ground waterlevels that may fluctuate during the year, and the water
usage of the family being served by the system. These conditions are outside the control e
the evaluator of the system. Satisfactory test results do not guarantee future performance
of the system, nor do theyguaranteo that there are no hidden defects or encroachments.
AWWC, Inc. can therefore not provide any warranty for future estimate of how long tho
system will continue to meet the operational requirements of the ADEC or MOA DHHS.
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 right whatsoever.
6. DHHS SIGNATURE
—!C Approved for bedrooms
Disapproved
Conditional approval for
Additional
am
Zb/0 /
bedrooms, with the following
Date
k(t
C✓<T�
ON-SITE
WMER AND
_ .,n r`TnnrnTCD
PROGRAM
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. 7191) Back MOA #21 Computer Version
Municipality of Anchorage
C ..
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744
Health Authority Approval Checklist
Legal Description: SUNSET HILLS W. S/D; LOT 8, BK 1, Parcel I.D.: 018-203-08
A. WELL DATA
"PER 1973 HEALTH AUTHORITY APPROVAL
Well Type PRIVATE If A, B. or C, attach ADEC letter. ADEC water system number N/A
Log present (YiN) NO Date completed 1973
Total depth •126' Cased to 40'+ Casing height (above ground) 14"
Sanitary seal (YIN) YES Wires properly protected (YM) YES
FROM WELL LOG AT INSPECTION
Date of test N/A 8/17/00
Static water level N/A 73'
Well production N/A g.p.m. 4.6 g.p.m.
6/i7/saoD — �/¢o/cool
WATER SAMPLE RESULTS: 1
Coliform 0 Nitrate 2.56 ` 7- Other bacteria 0
Date of sample: 8/17/00 3/1U Cotllected by: A.W.W.C., INC.
B. SEPTICIHOLDING TANK DATA
Date Installed 1972 Tank size 1250 Number of Compartments 1 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) "NO Depression [Y/N) NO High water alarm (YM) N/A
Date of Pumping 8/17/00 Pumper DENALI SEWER
*SEE HEALTH AUTHORITY APROVAL 7/95 BY DUSTIN HIGH
C. ABSORPTION FIELD DATA
Date Installed 1972 Soil rating (g.p.dJft2 339 System type TRENCH
Length.3 AT 33'/ 1 AT 14' Width 3'-18' Gravel thickness below pipe 6' Total depth 12.5'
Effective absorption area 1356 SO. Fr. Monitoring Tube present (Y/N) YES Depression over field (YIN) NO
Date of adequacy test 8/17/00 Results (Pass/Fail) PASSED For 4 Bedrooms
Fluid depth in absorption field before test (in.); 0" Immediately after 754 gal. water added (in.): 35.5
Fluid depth 24" (ins) Minutes later. 45 Absorption rate = 600+
Peroxide treatment (past 12 months) (YIN) NONE KNOWN If yes, give date
72-028 (Rev. 3Mr Canputer vemlon
D. LIFT STATION
Date installed Size
Manhole/Access
High water alarm
E. SEPARATION DISTANCES
at' 'Pump off" level at'
*Datum
""PER 1972 INSPECTION REPORT
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septiclholding tank on lot 50'+ On adjacent lots 100'+
Absorption field on lot ""100'+ On adjacent lots 1001+
Public sewer main 75'+ Public sewer manhole/cleanout 100'+
Sewer/septic service line 25'+ Lift station N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water main/service line 10'+ Surface water/drainage 1000+ Wells on adjacent lots 100'+
SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO:
Property line "" 10'+ Building foundation 10'+ Water main/service line 10'+
Surface water 100'+ Driveway, parking/vehicle storage area 10'+
Curtain drain NONE KNOWN Wells on adjacent tots 100'+
F. ENGINEER'S
I certify that I
of Municipal n
with MOA HA
Signature _!e
Engineers
HAA Fee S � .00
Date of Payment -Slc?7401
Receipt Number ��Cl a
72-028 (Rev. 3mr computer version
field Inspections and review
systems are in conformance
m this date.
A. GARNESS
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Sox 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D, # ~ \~- ~t"~ -'¢")~ __ HAA # _~ ¢~c~
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Property owner
Mailing address
Lending agency
Mailing address~
Day phone
_ Day phone
]
Unless otherwise requested, HAA wilt be held for pickup.
NUMBER OF BEDROOMS: , . ~ % '
· ~3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
NOTE:
If community well system, provide written confirmation 'from State 'ADEC attest-
lng to the legality and status of system.
· oF WASTEWATE"
4. TYPE DISPOSAL:
Individual on-site ,_
· ' ": ,d '::: '
Hol lng tank'. :- ::'
Community on-site
Public sewer
NOTI:: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and stafus of system.
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my inves!Lgation 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.
of Firm ~ I-~ I ~.-G -TI I~)C~ E.k~ (%! k'~l~ Phone ~-
Name
Engineer's signature '~"~.~ ~'_ ~ ~//' ' Date
6, DHHS SIGNATURE
~" Approved for bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
Date
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 · Anchorage, Alaska 99501e (907) 343-4744
Health Authority Approval Checklist
Legal Description: /--Q¥ <'(3 ~Lt% /( I ~i)k}~-.T Hltd- % t.)~}-~ _ Parcel I.D.:
A. WELL DATA
Well type J~rz...h~"- .
[fA, B, or C. attach ADEC letter. ADEC water system nalllber
Log present (Y/N) [',.)kb Date completed
Total depth /~:~ / 0~ Cased to ~ 2 & / ~)
Sauita~ seal (Y/N) Y~ ®
/?7.3
Casing height (above grotllld)
Wires properly protected (Y/N)
FROM WELL LOG AT INSPECTION
Date of test I0"1 7
WATER SAMPLE RESULTS:
Coliform O Nitrate 2~,_~ i/ L~) Other bacteria
Date of sample: i~'
Collected by: ~'~()~"a-[ } Ik~) F\iC F.k
B. SEPTIC/HOLDING TANK DATA
Date ms(ailed / q 7 ~L. Tm~k size/c~ ~(') Number of Compartmeuts /
. Cleanouts (Y/N)
Foundation cleauout (Y/N) P~0 ~ Depressiou (Y/N) /(J0 FA~ High water alm'm (Y/N)
Date of Pumping '7~/~/- 75 Puinper
C. ABSORPTION mlbD DATA
Dateiustalled /??~.~) Soilratiug (g,p.d./fiZor ft2/bdrm) 3:~c/'¢'/~'C/Svstemtype _~_~
,, fro , /cD --7 Y -
Leugth ~7 35~ [I A'i [4~ Width i~/'~ Gravel tbickuess below pipe ~ Total depth /~0' .~
Effective absorption area 15 s(¢ /~' Moaitoring Tube present(Y/N)~'.,,*3 ¢~Depression over field (Y/N) ~ ~_
Date of adequacy test ~C'~- 1'7 -~5 Results (Pass/Fail) ~g s-qe'D a~ For '~/ bedrooms
FMd depth iu absorptioo field before test (in.); ~ /% hnmediately ~mer_~q gal. water added (iu,):) g ~/
Fhfid depth - Minutes later: ~ .g.p.d.
Peroxide treatment (past 12 months) (Y/N) ~c0
~ pkt~ oP-Sr~ Vm"~
(in.) Absorption rate =
If yes, give (late
D. LllWr ST~
Date installed
Manhole/Access (Y/N)
High water alar~n level at*
Cycles tested
Size itl gallous
"PUll~ "Plm,`p off' level at*
*Datum ~
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank oil lot
Absorption field ou lot I(~)c~t-{
Pnblic sewer ~nain l',,J lA
Sewer/septic service line
: Ou adjacent lots
; On adjacent lots
Public sewer manhole/cleatlout
Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation Iq ~ (~ Property line ~OI ~ Absorption field ]C3~
Water main/service line NJ ],g, .Surface ,vater/drainage I~,J [~ Wells oa adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation ~t,~
Surface water
Curtail,, drain ~
Water nmin/service line
Driveway~ parking/vehicle storage area
Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
i certify thtat-~ve determined thrufield inspections and review o
in confort~[ance wYt~ MOA It/IA gui~teline~f? effect on this date.
Signature ~ ~
Engineer's Name a'~-)~-~ ~, ,//d(~/4
,aystems are
HAA Fee $ ~d3t9 ?~?. Waiver Fee $
Date of Payment /d - ~ (d ~- c,~_~' . · Date of Payment
Receipt Nnmber o~ ~ d/z' ~----- / (~9 / ~ ?-)~) Receipt Number
Rev. 8/95 OSS: haa.wk.doc
CT&E Environmental Services Inc.
LabQretory Division
c~ ,.~., ~s.4s4~-~ Laboratory Analysis. Report
GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3500 Tudor Road, Anchorage, Alaska 99507 279-8686
Time of Inspection
Date of
REQUBST FOR APPROVAL OF
INDIV%DUAI, SE~ER & WATER FACILITIES
FOR
Aoproval Requested By: /~ ,,' ~?:i/ ~:? </~' /,-!~-~:: ,~ /
Address: Phone
q) --~ ' '; ~?.'.~' /,'/' ? -I ....
3. Legal Description: L.~/", /1/
~~ - , r .~: ' , ~~ ~'
5. Type of Facility to be ~nspected~
Numbe~ of Bedrooms.
Depth ./~' /
Bacterial Analysis_ .
2. Manufacturer
A. Type ,...~<,- <~,, .~
, · <~:" ~,~ .;:.:~< D.
C. Construction
7. $ewege Disoosal System:
A. Installed B. Installer
D. SeepBge Pit~ 1. Size 2. Material
Disposal F~eld. Total Length of Lines
8. Distances:
A. Well To~ Septic Tank , Absorption Area
, Sewer Lines
, Nearest Lot Line
Foundation to Septic Tank
· Other Con'taminatfon .
Absorption Area
C. Absorption Area to Nearest Lot Line .
Request for Approval of I~ ¢idual Sewer & Water Facilities
Page Two
9. Comments:
Ap. oro~,a~d for One Year From Date Szgned
Greater Ancho'rag~a 8orouoh, Department of Environmental Quality
DIAGRA~ OF SYSTEM
I certify that the information contained in this request for approval to be a true
and accurate representation of the subject sewer and water facilities located at:
Signed Date
March 2, 1973.
Mr-. Iver H. Amundsen
Box 1277
Anchorage, Alaska 99510
Dear Sir:
SUBJECT: Lot 8, Block
--Sunset Hills West
k'IAR 1913
GREAT[R ANCHORAGE AREA BOROUGH
We have reviewed your sltua:~ien in light of the interpreta'l'ion cf
the 4O,C0O Sc;. Ft. -20,900 Sa. Ft. req~irerr, ent entrained in Segiicn
18 A/-C 72.030 of the :)ePar'~r'enT of Em,'ircr, me~tal Conservs~ ion ?,aste
l','eter Rcg~;iatior, s. it is our finding theft since you h~d c.,,mership
of the lot on or before Fe~r.ary 5, 1973 ann ~het you inf,gp2 to
construct a private resldence 'or your.personal use, that This Particular
Section of The Waste 'doter F:egulations is not applicabie in your case.
We would however advise you that of course all existing BoroOgh
Regulations are in effect and are applicable in all cases e~cept
where State requirements are more strirgent.
cc: GAAB-DEQ/~
3500 Tudo~
// ~ ,
3. Legal. Oe.crip'bion,- .~ ~ ~ / ..
Number of Bedrooms: .........
6. Well Data:
C. Construction D. Ba~l;,~r:ial Analysis
A. ~ns'ba!led B. Insta!Jer
C. Septic 'rani(; ]. Size 2, Manufacturer
D, Seepage Pit:
H, Disposal F~eld:
2, Material
!'oral !,ur:gi;h of I,irles
8. Distances:
A. Well To: Ue,)t~c Tank ................ , Absorption Area , Sewer Lines
, Neara~;t Lot '' , Ol;ber * · ' '
C;o ,f. aJ ~. latlo 1 ,
B, Foundation to Seot: c Tonic ..................
C. Absorption Area to Near(;at I,r)t lane ................................................ .
Request for Approval of ']' ~dual Sewe~ & ~4'ater Faeilig~q,
Page Two
9, Commellt s:
Aporoved Di.';a,,or oved !)ate
A?roval Valid for One Y~ar
Greater Anchoraqa ~rea }{orouqh Derarg,~!enh of >lr~vi',nr~,rm~t'.al Quality
I certif;, that the information cont~.ined in this ~e¢,.~ast fo-r spurovsl to be a true
and accul~ate repre~ent:at'!on o~ the (;u~iect sewe~ and wake~- 'faci.~t;~c.s located at:
Sign,~.d !)al;e
HEALTH AUTHORITY APPROVAL
INDIVIDUAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
PART L--TO BE COMPLETED BY FHA
JNSDRING OFFICE
Anchorage
MORTGAGEE
SERIAl, NO.
VA Case ~191-075
First National Bank of Anchorage
' '~ ' NHN
MORTGAGOR OR SPONSOR ,.~_ (/,,$. ~.j ~<~ ~, ~J ~)f- PROPERTY ADDRESS
A~SLN~ Iver H. and Lois M. ' Hancock Drive 99502
Sunset H~lls ~ese Sub. .
TOTAL NUMBER~
I 4
EASEMENT
2 E]¥es
] New installation
Can tattlc or other area bi made Into
additional bedrooms?
(If Yes, how martyr0
WATER SUPPLY
l~] Fu?ic system
SEWAGR DISPOSAL BY~
[] Public system
Community system [] Individual
]Community system
Individual
[]Yes
PART II..~TO BE COMPLETED BY HEALTH DEPARTMENT
HEALTH DEPARTMENT INSPECTOR'S SKETCH
It is the opinion of the [] State [] County [~J Local Department of Health ti,at this individual water-supply system
[] is [~] is not satisfactory asa domestic water supply for the subject property.
It is the opinion of the [] State [] County [] Local Department of Health that this individual sewage-disposal sys-
tem with proper maintenance:
[] Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily
is not likely to create an insanitary condition
DATE I SIGNATURE ImLE
7-10-72 j L Sanitarian
NOTE~ The health authority should complete the appropriate opinion statement above and affix date, signature ~ndtltlelnthe
PART III.~FOR USE OF FHA OFFICE
TO THE CIIIEF UNDERWRII'ER~
I have reviewed the foregoing add the pertinent FHA Complimtce Inspection Report, and recommend that the
Individual water-supply system be considered [--] Acceptable F-] Not Acceptable
Sewage disposal be considered [] Acceptable [] Not Acceptable.
SIGNATURE
CHIEF ARCHITECT
DEPUTY FOR CHIEF ARCHITECT
DATE
HEALTH AUTflORITY APPROVAL
IND~VIDI, IAI. WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM
FHA Form 2573
Rev. July 1958