Loading...
HomeMy WebLinkAboutSAND LAKE #2 BLK 4 LT 42Sand Lake #2 Block 4 Lot 42 #011-135-11 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196656 4700 Elmore Road Anchorage, Alaska 99519-6666 Phone: (907) 343-7904 Fax: (907) 343-7897 http.1/www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221046 Work Type: SepticTank Upgrade Tax Code Number: 01193511000 Site Legal Address: SAND LAKE #2 BILK 4 LT 42 G:2224 Site Mailing Address: 8132 SEACLIFF ST, Anchorage Owner: FEDOR TONYA MICHELLE Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: �toCnt L ° S;. 9-6 i � ry A Department Lot Size in Sq Ft: Total Bedrooms: 3!7/2022 317/2023 6750 ❑ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 95.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: At time of construction, the engineer shall confirm that the tank is outside the soil bearing k prism of the foundation. If it cannot be located outside the soil bearing prism, a waiver request shall be submitted for approval. Veronica Pope GE 2022.03.07 Received By: 16:46:05 -09'00' Issued By: Date: Date: 7 0 2 HUHMPAU N OF /1 HCHORIAGEE Community Development Department` Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 011-135-11 Property owner(s) Michelle Tonya Fedor Day phone (907) 441-9945 Mailing address 8132 Seacliff St. Anchorage, AK 99502 Site address Same Legal description (Sub'd., Block & Lot) Sand Lake #2, Block 4 Lot 42 Legal description (Township, Range & Section) Lot Size 6,750 Sq. Ft. Number of Bedrooms 2 APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank ❑X Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade ❑X Renewal ❑ TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2 2 5 Date of Payment: Receipt Number: �<o I D Permit No. 0S a? 2_ 1 D y6 Permit App__- : ,_.,:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. 1K March 2, 2022 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 3/2/22 Subject: Sand Lake #2 Block 4 Lot 42 – 8132 Seacliff Street Septic tank replacement Dear On-Site Services Engineer: The septic tank on the above lot has reached the end of its expected useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as adjacent wells, and septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. This property is serviced by a class A well located on lot 12 to the southwest. There is a general ADEC well waiver on record for the allowance of 100’ minimum separation for septic systems on lots 11,12,13,40,41, and 42. The new system will be a minimum of 100’ from all wells and surface water, and at least 5’ away from the existing trench and property line. Due to the proximity of protective well radii, the tank cannot be installed more than 10’ from the foundation. However, we intend to record elevations of the footer of the home at the time on installation in order to confirm that the tank is installed outside of the soil bearing prism of the foundation. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221046, Rebecca Carroll, 03/07/22 SAND LAKE #2, BLOCK 4 LOT 42 LOT 10 SHED APPROXIMATE KEY BOX LOCATION LOT 11 SHED EXISTING CLASS A WELL w/ 100' RADIUS PER 1984 DEC WELL WAIVER LOT 12 e / I .. At, ;q�ko11 • Benja i Schiller 11�F��•, CE 2592 .•mac 3/2/2022 1l1\��PROFESSIONP�.�. � On site Water and Wastewater REVIEWED FOR CODE COMPLIF OSP221046, Rebecca Carroll, 033 REFERENCE ELEVATION OF FOOTER AT CONSTRUCTION TO ENSURE TANK IS OUTSIDE OF THE 1:1 SOIL BEARING PRISM LOT 41 NOTE: NO SURFACE WATER WITHIN 100' OF THE SEPTIC SYSTEM. NEW 1000 -GAL SEPTIC TANK w/ 20" MANWAY. INSTALL 5' FROM LOT LINE TO MAXIMIZE FIELD TO TANK SEPARATION & DISPOSE OF EXISTING TANK PER UPC ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. 0 20 40 FEET EM61N[E RIXC 1"-20' 1 crrr-nin LLJ W r I Cn IL LL J I U Q U) CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FD - FLOW DIVERTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE 12.1T E E MBSS S SS89° 55' 00"E 135.00'N0° 02' 00"W 50.00'S89° 55' 00"E 135.00'N0° 02' 00"W 50.00'30' R.O.W.WOOD RET. WALL24.224.240.3 40.3 S LOT 41 EDGE OF PAVEMENT PAVED DRIVEWAYSHED Lot 42, Block 4 Sand Lake Subdivision No. 2 6,750 Sq. Ft. +/- 8132 Seacliff Street 1 Story Wood Frame House LOT 43GREENHOUSE18.3 12.38.1 1.3 G E 4.9 4.7 45.05.9 13.413.8℄ SEACLIFF STREET PROFESSIONAL SEAL Date:Frontier Surveys, LLC Project No: 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 As-Built Survey of: www.frontiersurveys.com Frontier Surveys, LLC I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on Plat:Grid:Ordered By: 907.460.1686 - info@frontiersurveys.com This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any easements, covenants, or restriction which do no appear on the record plat. Under no circumstances should this document be used for construction or for establishing a boundary or fence line. February 23rd, 2022. Legend: Scale 1" = 20' Electric Meter Mailbox Lot 42, Block 4 Sand Lake Subdivision No. 2 General Notes: 1. This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws. 2. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. 3. All measurements/setbacks are to the visual/apparent building footprint. 4. All dimensions to property lines are plus/minus 0.1ft. Boston Hoppman 22-085 02/24/2022 P-176 2224 E Elec. Pedestal Tel. Pedestal MBT Wood Deck Fence G Gas MeterE Pierre M. Stragier No. L.S. - 9812 R E GISTEREDPROFESSIO N A L LA NDSURVEYOR02/24/2022 Concrete BollardSepticS PRODUCED BY AN STUDENT VERSION 72-013 (Rev. 3/78) 1/ MUNICIPALITY OF ANCHORAGE // i' • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING 0* DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE LNEW 1. (: f'f 344_ DE MAILING ADDRESS 23 tD 1,' `•' Ci c3 R A6,' LEGAL DESCRIPTION , ++ ' G► S #2 12— p, Lh Si LOCATION NO. OF BEDROOMS SCS.r C i 1 s 21 Well Absorption area Dwelling , PERMIT NO. Uy DISTANCE TO: I`_ Q Manufacturer Material No. of compartments wF1INQk1kL L ti Liq. capacity in gallons IF HOMEMADE: E Inside length Width Liquid depth 00 4 y DISTANCE TO: Well Dwelling PERMIT NO. J �7Z O Z F Manufacturer - Material Liquid capacity in gallons O W II 1 Foundation p Nearest lot lineup PER jP ; w= DISTANCE TO: �� J Luz No. of Ii as Length of each lige Total le th of links 1 Trench wi th 1 / Distance betwe n lines H Z w Jb inches ,/V _ Top tile to finish Material beneath the i Total 0 F of 9 rade )L effecti ee abs area , T� ..�sb �" J Length Width Depth PERMIT NO. Lu C7 Q F• Type of crib Crib diameter Crib depth Total effective absorption area as Lu LLI V) Well Building foundation Nearest lot line DISTANCE TO: J Class Pi?07703C13 Depth Driller Distance to lot line PERMIT NO. J M.W . 'DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS C, % L' SOILTEST RATING INSTALLER RAPPF E i2 IN REMARKS 21, sw _ 9 � /G SLS A-) N CREDiT FOR E t 2t7 y i W&LL SIAC-16 If � tatsl p IA � APPROVED DATE LEGAL s' 1*2 AW-0,24LaT*2 J34W4 72-013 (Rev. 3/78) 1/ ��' �.� ��U Ins ��� ������ ��� �s��W ����r� \' ��P�R-MENT OF HEHLTH HND ENYIRONMENTHL\�6OTECTION ^ 825 L STREET/ HNCHORHGE� HK 99501 � �^ 2 6, - I - r:: i - -,, " C110.11^--� PERMIT NO: DATE ISSUED HPPLICANT ADDRESS: CO? -,!THC. --T PHONE , LEGFl! DES(."RIP LOT SIZE� MR.,-," BEDROOMS 840228 04/2]/84 T�T CONST 2]20 DENNIS WHY HNCHORHGE/ HK 99511 ]45�2670 !HT ko- 1"I E77 FR., E.-.-" FT: 8A X ~1 SUBDIVISION: SHNDill- HKE #2 SECTION: 10 TOWNSHIP� i2N 6700 (SQFT. OR ACRES) 2 LISTED BELOW FRE THE OPTIONS HVHILHBLE TO SYSTEM. CHOOSE THE OPTION THHT BEST FITS ... ... ..... ... �~.... ���������~���� OF HLHSKFL 2 I WILL INSTALL DEPTH TO PIPE WITH ALL Hl-'!F)CODES 4.0 GRHVEL DEPTH (FT. ) i1-0 TOM. DEPTH (FT. ) 1t,0 GRHVEL WIDTH FOR THE SET BACK 2.5 GRHVEL LENGTH (FT ) 140 GRHVEL VOLUME (CUYDS ) ��.9 TH�K SIZE (GHLS) 4I UNDERSTHND 1/0000 ** 5-0 11 RHTING (STV FT. /BR) 150 LOT42 RHNGE� 4W YOU IN DESIGNING YOUR SITE. K��E}� A 0 0 5 A 5 15 0 ]0 0 166 �L50 BLOCK: 4 YOUR SEPTIC ** THNK MUST HRVE HT LEST TWO (DOMPHRTMENTS ---- --- �... .... .... ... ..... ��������������������� [ THHl 1. I HM FHMILIHR NITH THE REQUIREMENTS FOR OOSITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPHLITY THE S. -FATE OF HLHSKFL 2 I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH ALL Hl-'!F)CODES HND REGULHTIONS/ HND IN COMPLIHNCE WITH THE DESIGN CRITERIH OF THIS PERMIT. ] I WILL HDHERE TO ALL. MDHHND SPITE OF HLHSKH REQUIREMENTS FOR THE SET BACK DISTHNCES FROM HNY EXISTING WELL/ WHSTEWHTER DISPOSAL SYSTEM OR PUBLIC SEWERHGE SYSTEM ON THIS OR HNY FA) JHCENT OR NEHRBY LOT 4I UNDERSTHND THHT THIS PERMIT IS VALID FOR H MHXIMUM OF 2 BEDROOMS HND HNY ENLHRGEMENT WILL REQUIRE HN ADDITIONAL PERMIT. IF H LIFT STHTION IS INSTHLLED IN HN HREH COVERED BY MOH BUILDING CODES' THEN (1) HN ELECTRICAL. PERMIT HND INSPECTION MUST BE OBTAINED, (2) HS-BUILTS WILL. 140T EBE. RPPROVED 14ITHOUT HN ELECTRICHL INSPECTION REPORT/ HND (]) THE ELECTRICHL WORK MUST BE DONE BY H LICENSED ELECT�ICIHN SI6NED ... ..... ... ��..... ����������... ... .... . .... ..... .... ....�� � HPPLICHNT: T&T ST�� ISSUED BY �-* DHTE� J SOILS LOG MUNICIPALITY OF ANCHORAGE +.e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 1 C�YI CJT C0nStY-U rlC?n DATE PERFORMED: CJ LEGAL DESCRIPTION:201nd Aa Kf- *-Z c\l.,(kd') V]S) Ln 7�I oc,K 41, 4of �.2. SLOPE SITE PLAN SmY) _ + 1 �P ra Ue z 3 4- 5- 6- 7 5 6 7 1 \ I (44 Y 9- 10 - WAS 10WAS GROUND WATER S 11 \ \ ENCOUNTERED? cp L ..- ! / P 12 E 1 \ � IF YES, AT WHAT DEPTH? 13- 14- 15- 16- 17 3 14 1516 17 i r C / 18- 19- Reading 8 19 COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE 1:5c E3)�Rm (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: Aa+e—:-s CERTIFIED BY: 72-008 (6/79) DA 1 T ALASKA �PUIROf1m WAL COnTROL S HIM, InC. Cngineerinq & 6nuironmenial Studies MUNICIPALITY OF ANCHORAGE June 20, 1984 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION' Department of Health and Environmental Protection 'JUL 2 41984 825 L Steet Anchorage, Alaska RECEIVED Attn: K. Bandt Subject: Lots 11, 12, 13, 40, 41 and 42; Block 4 Sand Lake #2 Dear Keith: The above mentioned lots are to be served by a class 'A' well, and separation distances were waivered (attached sheet). The residences and foundation were under construction at the time of installation of the on-site septic. The permits were issued by your department, for single family dwellings. The permits were designed, for the most part, at depths of 10 to 15 feet (total depth). In the soils rated for this area, this presented problems -in that with the depth, the excavations tended to enlarge greatly. In an attempt to circumvent this, the excavator had our office on location during the actual excavation. The lots are extremely small, generally about 6,700 square feet in size. With the class 'A' well restrictions, and the prior establishment of the foundations, the available space for on-site septic was limited. The proximity of neighboring private wells also influenced the establishment of the septic systems. In all cases, the absorption areas and septic tanks adhered to the 100 feet separation from adjacent private wells. Also separation distance (waivered) to the class 'A' well were enforced. Absorptions were confined to 10 feet within the property lines. As the absorption areas were excavated, the trench would widen -due to caving in of the sidewalls. Gravel had to be placed in the trench immediately upon verification of the proper depth. During the excavation, the area separating the septic tank and absorption area also collapsed in. The permits were issued in probably the only configuration that would fit the lots. The only compromising distances are: 1) Separation distance between septic tank and absorption area. 2) Septic tank distance from lot line. 1200 West 33rd Auenue. Suite B e Anchorage. Alaska 99503 e(907) 561-5040 The above mentioned compromising distances occurred during the excavation of the septic systems. It was felt that if a compromise had to occur, then the tank would be the exception. If you have any questions please do not hesitate to contact our office at 561-5040. Sincerely, Larry Montgomery Environmental Engineer OF Tyr Or ALASµ' STATE OF ALASKA Ji DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE A. APPROVAL TO CONSTRUCT for PUBLIC WATER SYSTEMS Plans for the construction or modification of WkTFI� WELL J SCIS T E -)'j t 0 T C► t- A -ss -414142- &oc tc 15,4AJ P L f} KEuic water system located In CG� Alaska, submitted in accordance with 18 AAC 80.100 by �1-ig KR E110- K070MENTAC d NTR6C have been reviewed and are (� approved. ❑ conditionally approved (see attached conditions). 8Y TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by v s e 6.11 5 1,rs""t tf 0 r? CO - s C. APPROVAL TO OPERATE tV N S -44 113 fxj"q` Date )lYfL SE'P6K4T)6►� F/-17 - �y C2 o w Wb �� Thkil MO CrS--- / The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. �l ¢ COCk Sia y�QLofkp ¢E� �, )J:MQ S'ti� LOTS �1�� 3, 1 ; cif 7 `� l 4 p-L61ie The construction of theme (—�-- water system was completed on I J jf 5i� I (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to ope e. BY ��— TITLE DAT E .e nim io.., t/IG11 DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2 YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEEPoMUNI-BOROUGH (Complete Section C) 4. GOLDENROD - MUNI -BOROUGH (Complete Section A) CONTROL SERVIO INC. 1200 West 33rd Aven6e;`Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 SHEET NO. -4 A OF �/// 7 Q CALCULATED BY DATE i�-7 g�p CHECKED BY DATE 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/onsfe (907)343-79D4 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING �p/ \\ Parcel I.D. bit— 09711 COSA# DED&JI) 1TJ . GENERAL INFORMATION Expiration Date: _ _ —..LR n 0 p 1 Complete legal description SAND LAKE H2 B4 L42 Location (site address) 8132 SEACLIFF STREET 99502 Current Property owner(s) CARRIE STRICKLAND Day phone 269-6294 Mailing address Lending agency Mailing address Real Estate Agent Mailing address PO BOX 241311 99524-1311 Day phone NANI PALMER W/ PRUDENTIAL BUYERS Day phone 229-2352 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site 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 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 further verify that based on the information obtained from the Municipality of Anchorage riles 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 . ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results dosWbed the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readly identifiable features. The operational life of ell wells and septic systems depend on the local soils condition, groundwater levels Mat may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. 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 Wit It confer any legal right whatsoever. S. DSD SIGNATURE rr�� V Approved for _.L_ bedrooms. Disapproved. 337-6179 Date 8 ZZ. /,, f3 o�.N.. om.4.�... ... Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other • ON-SITE WATER AND WASTEWATER PROGRAM By: Original Certificate Date: IRw HM1 Municipality of Anchorage , • Development Services Department Building Safety Division .. - On -Site Water 5 Wastewater grogram 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: SAND LA Legal 64 L42 Parcel ID: 011-135-11 A. WELL DATA Well type A If A, B, or C provide PWSID# 21383849 Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/ Total depth ft. Cased to ft. Casing height (a or in. FROM WELL LOG AT ECTION Date of test Static water level ft. Well production g.p.m. g.p.m. WATER SAMPLE RE S: Coliform colonies/100 ml. Nitrate mg./L. Other bacteria colonies/100 ml. senic: ug./L. Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material STEEL Date installed 5/23/84 Tank size" 1000 gal. Number of Compartments? Cleanouts (Y/N) YES Foundation cleanout (Y/N) Y Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 8-22-08 Pumper MCDONALD PUMPING C. ABSORPTION FIELD DATA eELow EXISTING GRA m suua Date installed 5/23/1984 Soil rating (g.p.d./8'o t /bd 150 System type TRENCH Length 20.5 ft. Width 3 ft. Gravel below pipe 11 ft. Total depth • 14.6 ft. Eff. absorption area 451 ft' Monitoring tube YES Depression over field NO Date of adequacy test 8/22/08 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 5 in. Water added 651 gal. New depth15 in. Elapsed Time: 120 min. Final fluid depth 3 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N 'Pump on" level at in. "Pump off" evei -at,— ,I . High water alarm level at Cycles tested Meets alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line areas COMMUNITY WATER On adjacent On adjacent lots sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots •' 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line P 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1 Curtain drain NONE KNOWN Wells on adjacent lots" 100'+ F. COMMENTS •• WAIVERS IN PLACE G. ENGINEER'S CERTIFICATION 041 ...•• t certify that I 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. 0 J re A. Garne Engineer's Printed Name JEFFREY A. GARNESS ooh r –79 \F� SIZZlog 04�e�e' .122�a hod Date Dpror.�gtoO\� COSA Fee 4W Date of Payment V °./gyp� /09 Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department =: Building Safety Division On -Site Water 8 Wastewater Program �\ 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL v FOR A SINGLE FAMILY DWELLING Parcell.D. 011-135-11 HAA# �/A-oaoa�Z_�� 1. GENERAL INFORMATION Expiration Date: .r 31— Q 3 Complete legal description SAND LAKE SUBDIVISION N2: LOT 42, BLOCK 4 Location (site address or directions) 8132 SEACLIFF STREET • ANCHORAGE, AK 99502 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address ROBBIN JACOBSEN Dayphone 248-7059 8132 SEACLIFF STREET • ANCHORAGE, AK 99502 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 2 Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class "A" 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 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 $470.00 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles 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 ALASKA WATER & WASTEWATER CONSULTANTS. INC. Phone Address 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. 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 8 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, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, 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 tight whatsoever. 5. DSD SIGNATURE Approved for a bedrooms. Disapproved. 337-6179 Date 5 3 0 LOZ, ',IllAlkI�AI Conditional approval for bedrooms, with the Illowing stipulations: IfE 7953 r _ By: CG� 6 _ Original Certificate Date: " 3 1 — Z (Rev 17101) \Q • • 9�c :\�� ON-SITE o f WATER AND t^ WASTEWATER pc�CrRAM Attachments: ��J •... •'��� HAA Checklist ✓ Manitenance Agreements Septic System Advisory //111))111 Supplemental Engineer's Reort Well Flow Advisory Other r _ By: CG� 6 _ Original Certificate Date: " 3 1 — Z (Rev 17101) Municipality of Anchorage • Development Services Department Building Safety Division On.Sfte Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.8850 www.d.anchorage.sk.ua (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: SAND LAKE N2 S/D: LOT 42, BLOCK 4 Parcel ID: 011-135-11 A. WELL DATA Well type CLASS 'A' Date completed Date of test Static water level Well production It A, B, or C provide PWSID# 213849 Sanitary seal Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Coliform colonies/100 ml. B. SEPTICIHOLDING TANK DATA ft. 9.p -m. Nitrate Well Log properly protected (Y/N) Casing height (above ground) in. AT INSPECTION of sample: Collected by: ft. g.p.m. ml. Tank TypelMaterial STEEL Date installed 5/23/1984 Tank size 1000 gal, Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (YM) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 5/28/2002 Pumper CHUGACH PUMPING C. ABSORPTION FIELD DATA Date installed 5/23/1984 Soil rating (g.p.d./fl`odJWff_jb 150 System type TRENCH Length 20.5 ft. Width 3 ft. Gravel below pipe 11 ft• Total depth 1C8 ft. Eft. absorption area 451 ft' Monitoring tube YES Depression over held NO Date of adequacy test 5/28/2002 Results (Pass/Fail) PASS Forbedrooms Fluid depth k1 absorption field before test 0 in. Water added 950 gal. New depth 9 in. Elapsed Time:t 5 min. Final fluid depth 3 in. Absorption rate >= 300+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main line High water alarm level at Meets alarm & circuit requirements? CLASS "A" WATER SYSTEM On adjacent lots M Public sewer manhole/deanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field "6' Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots "100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1' Curtain drain NONE KNOWN Wells on adjacent lots "100'+ F. COMMENTS " PFR 1 ORA IAICPCr`TIlMI DCDnOT "• WAIVCDC IAI Dl •rC G. ENGINEER'S CERTIFICATION OF I certify that I have determined through field inspections and a.-- H review of Municipal records that the above systems are in ""' • • .. "' .... • • . • • • conformance with MOA HAA guidelines in effect on this date. t.e. . G..... ...... Engineer's Printed Name JEFFREY A. GARNESS Q C 7953 Date 5%Id/0 i o��P 1\w P, 0lw csio�� o HAA Fee $ CM. Date of Payment J� Receipt Number Za 6Z (Rev. 12I01) re Waiver Fee $ Date of Payment Receipt Number V .•a W.V J Ya 77 Ya•Y �•••V� vj • ecA T / S- s / \� // 1 •L t 1-atesy r � o ,C I. N OF 44 ply- � : '•' •_4/~ I � , pi;It 0.44. OVIE% It is the responsibility of the owner to �etermine.• �"�:''��� 'mac% K°'r °a- strietions w4.3 hich do notsappear oo thearecordedrsu �" `t /^ �........0 division plat. Under no circumstances should any 4W ?�•,,..,.,•r data hereon be used for construction or for estab- TS OF RECORD, OTHER THANTHOSE lishing boundary or fence lines. The surveyor takes *SHOWN ON THE RECORDED PLAT, ARE NOT .responsibility for the initial• transaction only: SHOWN HEREON, LOT4-7. e- BLOCK -' 4_. a .I•ECEND • - M4!! CAP NIMYM911>f So I �.e4ACC'.SiIPW A;'?: r►LATNO. o ,Enrn,r E'k 1 0 • atsu P46P.ea.n+6 ANCHORAGE RECORDING DISTRICT Q 1016 a TAtR 0 REPAR'EO BY. DOWLING & ASSOCIATES 1476 HYDER STREET ANCHORAGE ALASKA 99501 REr 1 H'DATE -Ify DATE:/ eT: SCAL[: r/ • WORKORDER: ,IEID IOOK: G OS 214PR 91 ,P -_ �., a . ---- It MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services 44 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. # �L ll -- i;; r - I I 1. GENERAL INFORMATION HAA # '-1 (1 ", i D ',+ .. Complete legal description I -C' —I 4 r� /AN I_) Location (site address or directions) 3 2- Property Property owner DO VLe.4 ks6, (-• k Day phone � `�t` - � >C F= Mailing address cs / 32r> c_L�/ f Lending agency Day phone Mailing address Agent -o.��, ci ��� SS i k�e Rcc-kZ Day phone 176 = ,�J(.: / Address /, a r0�j t/ Bt Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well t� 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 on-site DSSeOSAL: / Ef o� tQPVqCICA Gf V �D Holding tank SUN ""mak 3 Community on-site R&Cr ` C Public sewer ` L 1998 VED 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 MOAn21 P S.' 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 furtherverify 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 TO eyi S CIEZ P Phone Address G' 1 f kz-1 Engineer's signature �� ti C Date .r 6. DHHS SIGNATURE Approved for be, --'rooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments M Date G 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) Back MOA k21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES di# +t Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-474 - 19 AtC Health Authority Approval Checklist Legal Description: yt©� Y2. R Y, q, 2&y_ Ler i,u ":2 Parcel 1. D.: A. WELL DATA 1� Well type A -If A, B. or C, attach ADEC letter. ADEC water system number n�j `r - /-Log present (Y/N) Date completed Total depth Cased to Casing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well production 9.p -m. g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: Collected by: B. SEPTICIROLDING TANK DATA Date installed y� 3 L Tank size 1 Ot9C Number of Compartments 02� Cleanouts (Y/N) Foundation cleanout (Y/N) \/ Depression (Y/N) High water alarm (Y/N) 1�1 Date of Pumping —3Iq j,�Pumper /J eLo, e ra C. ABSORPTION FIELD DATA Date installed /a 3 Ide y Soil rating (g.p.d./ft2 or ft2/bdrm) ]!�Q System type 81_ v] C� d ' Length Width J�(� I Gravel thickness below pipe %% ! Total depth Effective absorption area #J5- Monitoring Tube present(Y/N)Depression over field (Y/N) �1 Date of adequacy test 4 ' 7 bp Results (Pass/Fail) t For bedrooms Fluid depth in absorption field before test (in.); 3 Immediately after 7W gal. water added (in.): Fluid depth 3 (ins.) Minutes later: 170 Absorption rate = % `7�C) g.p.d. Peroxide treatment (past 12 months) (Y/N) P`1 If yes, give date D. LIFT STATION Date installed N 0 H Maulrole/Access (YIN) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/liolding tank on lot Absorption field on lot Public sewer main Sewer /septic service line NI/A On adjacent lots On adjacent lots "Pump off' level at* Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1 l r / / Building foundation la Property line 1\ Absorption field (v Water main service line __Surface water/drainage Ni) vt C Wells on adjacent lots 1101 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: f 1 Building foundation Water main/service line } ,5 Surface water N n l7 -P— Driveway, parking/vehicle storage area Curtain drain tQo N e Wells on adjacent lots IA5 Property line 13 F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal reg6?�& fihat the b¢.QVe�sv3ster rare in conformance with A?fOA IIAA guidelines in effect on this date. 7.,r-llg ' Signature ,y En ineer's Name I o R Li 0 r ic Ig �C laltLY 5 ca� 13e�r� Date t.r— i oc r 19 Ito HAA Fee $/ Date of Payment .� Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services �� ` DIVISION OF ENVIRONMENTAL SERVICES — 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # -Q HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) r4 xx� Location (address or directions) / k/ 3 2 g -.P-.2, �C L (b) Property owner -?c.d 67Z 0"O- AS Telephone: (home) Mailing Address (c) Lending Institution E/TTelephone Business 9 Q/ Mailing Address (d) Real Estate Company and Agent to a^fir S''� Address Telephone 5 J 3 (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family 3. WATER SUPPLY Number of bedrooms 02_`1 Individual Well ❑ Community Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public 11 Community ❑ Holding Tank ❑ Note: I community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. vee) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of 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 this inspection. Name of Firm ! �� e Lc �)�v r Ui lc�v�� t� Telephone — y� ." a Address Date j--eti Ze) l 0 9 Engineer's Seal ,y Vii.'•: !_n _ .`, .��� '�y R DHHS APPROVAL Approved for ��� Cz bedrooms by L' T�� Date Approved Disapproved _. Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Beck Page 2 of 2 r MUNICIPALITY OF ANCHORAGE (MOA) r�'y • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 - ,.- 343-4744 Legal Description: Lo) 42.. BV_'1 -SA4ND LA.ZIE ` z �� Sa I b T 12N e q Ly/ A. WELL DATA Well Classification C jass A d.2/3B qQ 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 Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size ( btx-> No. of Compartments Standpipes (Y/N) Z Air -tight Caps (Y/N) y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contact on File (Y/N) N�� ; for Holding Tank High -Water Alarm (Y/N) WIA Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply WellI0 77 To Building Foundation a To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front To Disposal Field Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 150 Type of System Design TJ25LNC{! Date Installed ��� jqP V Length of Field c2O 5 Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 4y1 Statndpipes Present (Y/N) 1/w' a Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test T3e06LO s r w SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well D 7 + To Property Line To Building Foundation 1 773 —To Existing or Abandoned System on Lot N/'A ; On Adjoining Lots oho To Water Main/Service Line >1(2 To Cutback (if present) /X/A To Stream, Pond, Lake, or Major Drainage Course Y1A To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. CC� t Signed r� Company l 0 66 'cD" Date F�ii Engineer's Seal MOA No. E o2 s Receipt No. ��. Receipt No" Date of Payment Waiver Fee: $ Amount: $ � �2 Date of Payment 72-026 (Rev. 7/8B) Back Page 2 of 2 " 1D F- - E�:,.'� 675lW.0MONDBLVD. ANCH[0AH,ALASKA 99502~JY04 (707) 248-5095 SEPTIC SYSTEM ADEQUACY TEST LEGAL: Lot 42, Block 41 Sand Lake #2 LOCATION: 8132 Seacliff OWNER: Scott Buness RESIDENCE: Single Family, 2 Bedrooms WELL: Class B, DEC Approved and Current SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: 3 Bedroom System TANK: Anchorage Tank 1000 Gal" Two Comparts" ABSORPTION SYSTEM: Trench ABSORPTION AREA: 451 Sq. Ft" SOIL RATING: 150 INSTALLATION DATE: May 1984 DATE OF LAST PUMPING: Anch. Cess Pool Feb 28, 1991 DATE OF TEST: Feb 27, 1.991 TEST PROCEDURE: System was inspected and measured. Tank was found with 4 feet of cover and with a liquid level of 46 inches. Clean out to trench was 5 feet deep and dry" Trench monitor tube was 16 feet deep and contained 3 inches of liquid. 37Ogallons of clean water was added to the trench while the water levels in the tank and the monitor tube were monitored. The water level in the tank did not change" The water level in the monitor tube rose to 16.5 inches. The next day the water level WAS checked. The monitor tube was dry, indicating that all 370 gallons of water had been absorbed. TEST RESULT: This system meets the code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system" These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants^ . < WALTER J +c E GOVERNOR /, \ DEPT. OF ENVIRONMENTAL £ONSESVaf■@N / AM020 DTSTRI" Flee / . . sea�n775 Seel J g9: 22. So: a22 290 : 2, 2eszoa:y 20, 1991 JOR:=obben Sne=:1 3 P117S ,1 3 0 4 e ear sake z2 toes to -,a & 4e -J2 2 c 4 ; esotao« =aside o£ tun =eco:a; on Zile in Luis oz2lca reveals tsar tee 6«G take z2 tots In -la a 11.0 A oloek a class « public . SeI system _s Ia co, lienee vita tsa g:o9i:io=s o£ In w3 20.05r), grate o£ Alaska Dr: 4 ng Nate- l solations. Sincerely, 9imotav .. fazaowski Q=, i:onmental sag:aaoz �4 w,w =m=:;1. k' MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M ` DIVISION OF ENVIRONMENTAL SERVICES 1, 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. #0// — 13J— // HAA # LAP29n 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or direct ons) " (b) Property owner lT'y '" i Telephone : (home) Business Mailing Address (c) Lending Institution Mailing Address Telephone �-!`f /�"I Y Yr7 .per 7e -c � / AJ l9e — (d) Real Estate Company and Agent i� °� Address T.1 0 Telephone (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 2 3. WATER SUPPLY Individual Well ❑ Communityx Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site,Z Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of 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 this inspection. Name of Firm acs _7Tr e Telephone —moi 9—J -S1 3 Address __ azo dg:r!r •, Y4 iulf— Ae_-kar?5� /�'l/C Date OF �Q p� • O � ••••o• a(7••N•••s••o•i re• ;•U•• • 9ineer a Seal••••<4 • LEROY C. REID, JR. : i} CE • 2251 ti 6.` DHHS APPROVAL Approved for—bedrooms by Date Approved; Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage isnot responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) `l • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: ef-Z m2N 2'/GJ Siff A. WELL DATA Well Classification V B, Well Log Present (Y/N) Date Completed (/ Total Depth Cased to Depth of Grouting Static Water Level Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption To Nearest Public Sewer Li To Nearest Sewe ei Water Sample C ected by Water Sam Test Results n Lot Line on Lot Pump C, D.E.C. ApprovedgpN) gin Sanitlw Seal on Casing (Y/N) n Around Wellhead (Y/N) ; On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date B. SEPTIC/HOLDING TANK DATA Date Installed—SA-1 ? Size 160D No. of Compartments 1� Standpipes Y 1) Air -tight Caps (9/N) Foundation Cleanout& N) Depression over Tank (Y/� Date Last Pumped �+� 5'4 // Pumping/Maintenance Contact on File (Y/N) ;for Holding Tank,H)gh=Watgr Alarm (Y/NTemporary Holding Tank Permit (Y/N) SEPARATION DISTANCES PROM SEPTIC/HOLDING TANK: To Water -Supply Welf //P ' To Building Foundation To PropertyLirte"' To Disposal Field To Water Main/Service Line To Stream; Pond; Lake or Major Drainage Course Comments ���'G G✓z� ver . 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /S -,o Type of System Design Date Installed .f— Length of Field Width of Field �/ Depth of Field Gravel Bed Thickness Square Feet of Absortion Area �S Statndpipes Present 6?N) IJ Depression over Field (Y/Y9 Date of Last Adequacy Test // Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well Zo D t / * To Property Line To Building Foundation Lot To Water Main/Service Line >/0 To Stream, Pond, Lake, or Major Drainage Course 161 To Existing or Abandoned System on r On Adjoining Lots To Cutback (if present) 'vim To Driveway, Parking Area, or Vehicle Storage Area AJra�, g2Y-e- 5" jam.+, . Comments.flOrc-�2, rer . 7�m c2 riocuv,?2za/45-..-.e-e ?-,r7' J44 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes Comments Dimensions Manhole/Access (Y **Check Permitted Bedroom Rating Against HAA Request** .1Pump-Offr Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify tha4havec d, verified, or conformed to all MOA and HAA uidelineinspection. g oIY'Odate of this .�Signed 0Company V°eeo• e Date ,e0j 9 esSeal a} ?tE• eeeossec cote MOA No. P?—��y ; �EC• REID, in. o e ° 2251 Receipt No. Date of Payment S Amount: $ / 7 i1 Receipt No Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 SK& STEVE COWPfR, GOVERNOR S E or L DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 November 13, 1989 Dr. Leroy C. Reid, Jr. Alaska Environmental Control Services P.O. Box 240668 Anchorage, AK 99524-0668 PWSID: # 213849 According to the records on file in this office, the Sand Lake #2, Blk 4, Lot 42 Water System is in compliance with the State of Alaska Drinking Water Regulations. VEC:bas Iry Sincerely, Vera E. Craig Environmental F1 d Officer I MUNICIPALITY OF ANCHORAGE • .� Department of Health & Human Services M DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 0/'/ P.'�— 11 HAA # 0 <� 9, -- (') 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) z 5AJL j sEc /o Location. (addre§s;or directions) (b) Property pwner /��� Telephone: (home) Business Mailing Address " (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent�/ Address �/O.S Telephone Z4— (e) Mail the HAA to the following address: (or check here`< if hold for pick up.) List contact person and day phone number below: S LTL `);ex UP 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3. WATER SUPPLY Individual Well ❑ Community Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of 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 this inspection. Name of Firm Aen Telephone Z79 5ss3 Address /-r/y "o rd /`e 995,0 Date Y //tee 6. DHHS APPROVAL Approved for 2 JI WOO, • • eiab, JR. • CE - 2251 a,� 0 Ar it Z bedrooms by 6-- Date// ✓� 9 Approved 2 \ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 CN(>' PGs pN OF P` pN �`UN\CP • ; .!4y MUNICIPALITYHealth Au hor tAAC Approval HAAHORAGE (MOA) ENV�'pN CHECKLIST - FEBRUARY 1984, 343-4744 Legal Description: 467- q -Z ffa Z '�_ A. WELL DATA 3 Well Classification II Log Present (Y/N) Total De Cased to Static Water Casing Height Above G a-1-1yX. Date Completed Depth of Grouting Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments -7-/xvc zf(d r,&�G o0 leA B, C, D.E.C. Approved (Y N) Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots ; On Adjoining Lots To Nearest Public ; Date SEPTIC/HOLDING TANKDATA -5--2,3-W Date Installed Size WZ) No, of Compartments Standpipe(Y N) Air -tight Caps (Y N) Foundation Cleanout (Y N) Depression over Tank (Ye Date Last Pumped Pumping/Maintenance Contact on File (Y/N)A)�,4 ; for Holding Tank'Hidh=Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATI,ON DISTANCES FROM SEPTICAFIDL7DK: To Water -Su PpfyWgIEI O S�P To uilding Foundation To Property C(ne ..< To Disposal Field To WatAr Mair/Service Lyne To 8'1re4m,'Pond,ILa�a or Wjor Drainage Course n 5' Comments;E`�- ';Z)1f01A)6 N-rE &AfktibiJA). %WK 4FA#7_Y - I"Sg' 0�64YJ7-. 72-026 (Rev. 7/88) Front Page 1 of 2 L-Y.e- 1,y �,„- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �{ ��® Type of System Design���� Date Installed Length Length of Field r i Width of Field Depth of Field Gravel Bed Thickness /1 Square Feet of Absortion Area Statndpipes Present ON) Depression over Field (YCN) Date of Last Adequacy Test Results of Last Adequacy Test�� SEPARATION D[STAN C_E.FROM`_ABS_ORRTION HELD: � To Water -Supply Vgdll To Property Line /O To Building FoundatTo Existing or Abandoned System on Lot On Adjoining Lots /d r 4 - To Water Main/Service Line To Cutback (if present) A)III i To Stream, Pond, Lake, or Major Drainage Course /ff 0 't To Driveway, Parking Area, or Vehicle Storage Area ,ia)c _V1r Comments 0 /Marc IA,14i✓1R D. LIFT STATION _STATION D ate I`nStize in Gallons "Pump On” Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) _ Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 1�2 ®®Z OF AZ A Signed ��— �•`��sa••e••c e.e� ®•7® Company Gl` o�j ; •• 4p ngin'��f"��Seal DateJI ��—�> s• '�1•uee • e1o1e1��� •e 0.10 et ♦Ie9•�.�e MOA No. _� , rd Receipt No. o� 06e_i:)d / � Date of Payment ll Amount: $ , 7 �� o U • Roy C. RIND, JR. : S ®# CE - 2251 Receipt No. 4- R11Egc M5 _,�w Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 1334 ANCHORAGE,,ALASKA 99503 DATE: 11-04-88 PWSID: 213849 To Whom It May Concern: STEVE COWPER, GOVERNOR 563-6775 According to the records on file in this office, the Lot 10-13, SAND LAKE #2 40-42, Block 4, Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Michael P. Lewis, PE Environmental Engineer MPL:pkk �1 MUNICIPALITY OF ANCHORAGE F HEALTH AND ENVIRONMENTAL PROTECTION DEPARTMENT OOF ENVIRONMENTAL HEALTH DIVISION I HEALTH CE RTIFICATE OF INSPECTION RAND WATER FgCILIITYY APPROVA OF ON SITE SEW264-4720 r O� Application Date O township, range) range) C UENEt{gL INirCRMA block, subdivision, section, (a) Legal Description. (include lot, e A —7 qz Location (address or directions) ,� / iy /� l r �� C7 BU51i18SS - ( Telephone: Home j a �,-c�va� Applicant Name Name t (b) � a� ev. Main); Buyer ❑ ; Other C! ( I Applicant Address _�— (c) applicant is (check one): Lending Institution Owner/buil er / — ��/TcFz _ Telephone — (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: 2. TYPE OF RESIDE CE 13 Other Single -Family Multi FanlY Number of Bedrooms dd'' M 3" WATER SUPPLY public 13artment of Environmental Conservat Individual Well 13 Comm unity If community well system, must have written confirmation from the State Dep Note legality and status. attesting to the leg 4 SEWAGE DISPOSAL Holding Tank ❑ Community ❑ Department of Environmental Conner must have written confirmation from the State Onsite public ❑ Note: If community well system, 72-025 attesting to the legality and status. • �/ i� r ir l�l 'H . HOV10iNO INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As s_etiified 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 this inspection. Marne of Firm A 0-7 5 ���-�- / Telephone _s6(—,5-0Y,0 Address — ���? G% a � Gc //Y�-e- �0 Date 1 r j.5CC-"�A" c'" �p��w�a•aBoe9.e c0•Q 3� :� �... i. •a••e e•••eac• ea•,•sc i v 04-•. _-2251 •"..; �° 6. DHEP APPROVAL �J Approved for D bedrooms by ate Approved Disapproved Conditional V Terms of Conditional Approval LAG.rJ-Te 7(6 ta- 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 DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) APR I O 1966'- CHECKLIST - FEBRUARY 1984 264.4720 �/ C�y1 V Legal Descri tion: f � . - & 7' A. WELL DATA Well Classification Gtn/e lG O'! �`� If A, B, C, D.E.C. Approved{Y�N) Well Log Present (Y/N) Date C o mpleted G Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At i Casing Height Above Ground Sanitary Seal on Casing (Y/N) r Electrical Wiring in Conduit (Y/N) &A Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 41 �j On Adjoining Lots A vA To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole // To Nearest Sewer Service Line on Lot / Water Sample Collected by /V� ; Date �U Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA � Date Installed 5_°?2_v Size 1000 No. of Compartments r -V* Standpipes X N) GL(Air-tight Caps (9N) Foundation Clle��anoufgN) Depression over Tank (Y Date Last Pumped /y� SQ2 c�eLjoq ©�� Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (YIN) Separation Distances from Septic/Holding Tank: To Water -Supply Well rT�© �- To Building Foundation To Property Line To Disposal Field To Water Main/Service Line 5 To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) .^ If 64. ( J 7� --.:) -�Aef-i, r- < c.� C. ABSORPTION FIELD DATA Soils Ratinq in Absorption Strata /Sd Tvoe of Svstem Desinn 4eocl Date Installed Length of Field X0.7 Width of Field i Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y/6� — Results of Last Adequacy Test Standpipes PresentJ! ) pui //// Date of Last Adequacy Test PA /��s le rt-, 2 Separation Distance from Absorption Field: n // To Water -Supply Well/F%r� �ydz^ P (/ To Property Line /d 7 To Building Foundation /s To Existing or Abandoned System on rn Lot - �l ; On Adjoining Lots � � '_'-? To Water Main/Service Line 40 To Cutbank (if present) /x A To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ,fi n /' r 1 Comments D. LIFT STATION Date Installed Size in Gallons Znholeccess MaY/N) "Pump On" Level at el at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that II have checl d, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed J�4J-�- o Date Company y 4ZC7 C MOA No. IN Receipt No. �� ��6� ��P� Q�•����®� • •a Date of Paymentposse + - I l7 ``cSlo �� •4 (�iM °%Q o_ 0 r*,L r ddl........ f4 Amount: $ (cy:/�®� Ye.• n .CD 9�c 7 e. P.ei4, �a.�PJ'10- �� [dc,pi-22J� 9^ Ort- l f Page 2 of 2 72-026 (11/84) t k € BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: /0 A,�rl PWS I.D.# To Whom it May Concern: Telephone: 19071 Address: 274-2533 According to records on file in this office the Lo Z?/, ,AI/�)c Z-,�, #�►ater System is in compliance with the State Drinking Water Regulations Sincerely, DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: /0 A,�rl PWS I.D.# To Whom it May Concern: Telephone: 19071 Address: 274-2533 According to records on file in this office the Lo Z?/, ,AI/�)c Z-,�, #�►ater System is in compliance with the State Drinking Water Regulations Sincerely, e MUNICIPALITY OF ANCHORAGE ~ J DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Datefi'<-s (a) Legal Description (include lot, block, subdivision, section, township, range) t) 42 A.5Atin L4irF- '-ri2.cr Row 6 Location (address or directions) _SE,a c 41 f- )� S: P— (b) Applicants Name'tj Telephone - Home Business Applicants Addres (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer E::j ; Other [:::I (explain); (d) Lending Institution Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: l 2. Type of Residence Single -Family — Multi -Family Number of Bedrooms 'Z 3. Water Supply Other (describe) Individual Well 1_�l Community — Public E] Telephone 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 TankEl 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] b _.A 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of 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 regula- tions in effect on the date of this inspection. Name of Firm ' E c 5 /mac . Telephone 4 -Go �e)4-6 Address /20a Gv _-:33 DateJ`�i�&'4 �� OF R4��B� (ENGINEER SEAL) 0 � ���TH� w /a °aa�➢'i°Ca� a. :.nom o yC,„ f/' 6. DHEP Approval/ C. Reid, a,. , I" No. 2251-L ell- Approved l Approved for _ bedrooms By l!! e x!11, 0 A$te: ` "."—/ Approved Disapproved Con d tion'al" - Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 t A. WELL DATA i MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 DEPT. (DAF HEi ENVIRONMENTAL Pr,;7tC«F,OP4` 1SSP__-1 4 '984 RECEIVED Legal Description: Z_0•7 #-2 13 Well Class ificatione';,LmAtaus -tteIf A, B, or C. D.E.C. ApprovedISN) Well Log Present (Y/N) 1.= Date Completed -Yield___l/n,& Total Depth adv i Cased to /wl Depth of Grouting s6v/f-.y_ Static Water Level ,v/yam Pump Set At Casing Height Above Ground �cd/.ut Sanitary Seal on Casing (Y/N)&,y- Electrical Wiring in Conduit (YM) A"I Depression Around Tnbllhead (Y/N)A M Separation Distances from Voll: To Septic/Holding Tank on Lot0 Iy % 1.4-- On Adjoining Lots 0 y6Q � To Nearest Edge of Absorption Field on Loth /f)7'� ; On Adjoining LotsQ /00 To Nearest Public Sewer Lire To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot t_ Water Sample Collected By Date /� l/,4 "—r Water Sample Test Results Comrents PEW /wci/+ &,jAi u /� B. SEPTIC/HOLDING TANK DATA Date Installed 4 Size /, © 6 <.,) No. of Ccupartments Standpipes oym)) Air -tight Caps N) Foundation Cleanout Depression over Tank (Y Date Last Pumpedwhy, Pumping/Maintenance Contract on File (YM) 4& ; for '//� Holding Tank High -Water Alarm (YM) �Temporary Holding Tank Permit (YIN) Separation Distances from Septic/Holding Tank: To Water -Supply GAJe11 ® l UD `+- To Building Foundation To Property Line e To Disposal Field d To Water Main/Service Lire ,iJ/1<} To Stream, Pond, Lake, or Major Drainage Course iL" Comments p�R Me,✓ AS /-TV;L-7- DEC ✓ jA + wda Receipt # Date Paid: Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ) ,�-C) e Type of System Design tKLA�c Date Installed Length of Field 2G,5 _ Width of Field 3 Depth of Field ) ,r Gravel Bed Thickness Square Feet of Absorption Area 45/ �� Standpipes Present Y _) Depression over Field (Y/® Date of Last Adequacy Test '4.)AV4- Results of Last Adequacy Test�j� Separation Distance from Absorption Field: To Water -Supply Wall 0 r©-> t +- To Property Lire /Q To Building Foundation ►S To Existing or Abandoned System on Lot 64LAI= ; On Adjoining Lots_ > 30 To Water Main/Service Line IJ To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Corwents Pee M c A!> Au;4T- 8 DLG a., )a a4 D. LIFT STATION Date Installedya Dimensions _ Size in Gallons Manhole/Access (Y/N� "Pump Or." Level at af)b�-1 "Pi.mlp Off" Level at High Water Alarm Level at /1114 Vent Tested for A.-),& Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) T' Comments �* Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. OF Signed i P••••••a..D•eD®warj gn Date CciTpan '4 1E C. S i`,v MOA No. b` �S f c� 2 irk RSu OL '� '1 q �kt fs KB1/d5/s (Page 2 of 21 �� • 6 ..Dgma � q Y C. Reid, No. 2257 •E °.,...F, 2-15-84