The URL can be used to link to this page

Home My WebLink AboutTROLL KNOLL BLK 3 LT 4Troll Knoll Block 3 Lot 4 #0§1-§21-02 Tom Fink, 825 "1.." Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 January 10, 1991 Alaska Housing Finance Corporation 520 East 34th Avenue Anchorage, Alaska 99503 Subject: Lot 4 Block 3 Troll Knoll Subdivision Permit #900073, PID #051-521-02 The subject permit, issued by this office for a single family well and/or on-site wastewater system has expired as o~ December 31, 1990. A new permit must be obtained from this office for a well and/or on-site wastewater system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this office for documentation of.the installation and to close the permit. If a private engineer inspected the installation of the on-site wastewater system, the original as-built inspection report (three-part form) must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $90.00 for an on-site wastewater permit; $50.00 for a well permit; $140.00 for a combined on-site wastewater and well permit. If you have any questions, Pro,am Manager On--tire Services please call this office at 343-4744. JW/ljm:200 e nc: Copy of Permit "Kids Are Our Future" M U N I U I P A L I I Y U F A N C H 0 R A G E Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 F'ermit Number: Date Issued: 0 N - S I T E 900075 Upgrade 04/18/90 Engineer S E W E R F' E R M I Designed Owner Address: ALASKA HOUSING FINANCE CORPORATION 520 EAST 54TH AVENUE ANCHORAGE, AK 99505 Day Phone: 561-1900 Parcel Id: 051-521-02 Lot Legal: Subdivision: ~O~L~kN°~clsUBDi "Cot'.' 4 Section: 10 Township: 15N Range: 1W Lot Size 40915 (sq. ft. or acres) Ma>: Bedrooms: This Permit: 5 Total Capacity: ~ Block: SEPTIC TANI.,. Minimum total septic tank capacity: 1,000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). INFOIRM I).H.H.S. PRIOR TO INSPECTIONS BY EN(~INEER, IF AFTER' OFFICE HOURS, CALL 545-4681 AND LEAVE A MESSAGE. CONSTRUCT PER ENGINEERS ATTACHED DESIGN. THIS PERMIT EXPIRES 12/51/90 AND VALID FOR A SINGLE FAMILY HOME. EXPOSE EXISTING SEPTIC TANK AND CHECK FOR INTEGRITY AND WATER lIGHT COUPLINGS;. I CER'¥IFY THAT: 1. I am I'amiliar with the requirements ~or on-site sewers and wells as set [orth by the Municipality of Anchorage (MOA) and the State o~ Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria o~ this permit. 3. I will adhere to all MOA and State o~ Alaska requirements for the set' back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid ~or a maximum o[ 5 bedrooms. I also understand that the'capacity o~ the total system is 5 bedrooms and any enlargement will require an additional permit. " ' I .1---- N F PERFORMED FOR: LEGAL DESCRIPTION:/--,O'JI"' 4 i Municipality of Anchorage DEPART.MENT OF HEALTH & HUMAN SERVICES . .... ,... 825 "L Street, Anchorage, Alaska 99502-0650 ...... SOILS LOG~PERCOLATION TEST ~:~ ic~._/~.qjT"~/~/I Township, Range, Section:'"~'t~ ~LOPE 81TE PLAN WAS GROUND WATER ENCOUNTERED? tl~ O ' S ,,-a.'.8 o1'to , dt4ol¢'FYES, ATWHAT -~ GL t~'' 12 - DEPTH? ~/~ p E 0ep~ W~er ~ar · ~t 13- ~onitoring7 ~D t 0att ~-~-~O I Gross Net Depth to Net 14 - Reading Date Time Time Water Drop 17- ~ 18- ~ PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN FT AND FT S & S ENGINEERING ~p~ ~ PERFORMED BY: 170;4 ~:.g~e IHV~' ! ~ R~d No. ~ ~/ ~ CERTIFY THAT ~H~ TES~WAS PERFORMED IN 72~ (R~. 4/~) . ~ /-- ANCHORA6F: ARF:A Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME Le0t~e'~D J~'~'~.* MAILING ADDRESS PHONE SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER MATER IAL CO I,~ ¢¥~ I~' NUMBER OF COMPARTMENTS INSIDE WIDTH LIQUID DEPTH lIQUID CAPACITY SEEPAGE PIT: .UMBER OF P TS LINING MATERIAL~P'Ht'/~'~''~ CRIB SIZE= DIAMETER ~IoE'PTH ~' DISTANCE FROM: BUILDING FOUNDATION ~t NEAREST LOT LINE ~ZI TOTAL EFFECTIVE ADDITIONAL ABSORPTION GALLONS. WELL ABSORPTION AREA (WALL AREA) '"~ SQ. FT. WELL: TYPE"~ ['~ IM 1[4'~' Il CONSTRUCTION DEPTH BUILDING NEAREST NEAREST SEPTIC FOUNDATION LOT LINE SEWER LINE TANK CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCE FROM: SEEPAGE SYSTEM DISTANCES: DIAGRAM OF SYSTEM PIPE MATERIAL: REMARKS; Form NO, EQ-031 · TIME DAI'~ INSPECTOR INSPECTION APPOINTMENTS' // DATE ~%~: / '1 D~.,2RECEIVEO TIME DATE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC'~II~IICtPALITY OF ANCHOi~,AGE ~ L St~et · AmbroSe, AImaa ~1 DEPT. OF HEALTfl & ENVllL~ONMENTAL ENVIRONMENTAL SANITATION DIVISION Z. ep~,,.. ZS..-47Z0 SEP 1_ 0 1981 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~F~I~ V_~.I D PHONE PHONE PHONE SINGLE FAMILY E] One [] Four [] MULTIPLE FAMILY 7. WATER IIJ~LY F-I INDIVIDUAL* ~' COMMUNITY [] PUBLIC UTI LITY [ IEWAGE OIE~]~AL IYSTEM '~ INDIVIDUAL/ON-SITE',' [] PUBLIC UTILITY [] Two [] Five I~ Three [] Six [] Other · ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attadn log if available.) /~,~"-YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72 O10 (RIV, EV7a) THIS SiDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY ['-I ONE [] THREE [] FIVE [] MULTIPLE FAMILY [] TWO [] FOUR [] SiX ~ [] OTHER 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM [] INOIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified r--lSept~c Tank or [] Holding Tank Size: give dimensions: TYPE OF TANK PERMIT NUMBER DATEINSTALLED INSTALLER If Tanklshomemade SOILS RATING MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Absorption Area to nearest Lot Line SePt~c/Holdlng Tank IAIT~orption Area Line ~. COMMENT~ DATE [:~ APPROVED FOR '~ BEDROOMS [] CONDITIONAL APPROVAL (letter must aCCOmpany certificate) [] DISAPPROVED ~ / ' 72.010 (Rev. 6/79) Trans-Alaska Realty ATTENTION:. Terrie Pisa 1577 C Street Suite 103 Anchorage, Alaska 99501 EXCAVATION WORK September 8, 1981 ROBERT A. SHAFER CIVIL ENGINEER 694-2979 MUNICIPALITy OF ANCHORAGE DEPT. OF Id£A/Ti! & EN'VIRONM[NTAL ;~,,C T.~.CTioN SEP 0 i981 RECEIVED Dear Mrs. Pisa, Reference: Lot 4; Block 3; Troll Knoll Subdivision ~ sewer system adequacy test ~ns performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity in excess of 1000 gallons. The seepage pit was charged with 1000 gallons of frech water and after a period of 24 hours all the Mater Mhich had been added to the crib had percolated out. It can be concluded from this test that the waste Mater disposal system serving the three bedroom residence located on this property is currently functioning adequately. If Me may be of further service, please do not hesitate to call. SRi~ 196X EAGLE RIVER, ALASKA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECllON 82E L Street. A~, ANska 99501 ENVIRONMENTAL ENGINEERING DIVISION Tdephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: C~m MI peris on page 1. I~ raquams will not be pr~, Ptee~e ellow ten (10} days for procwing. 1. PROPERTYO1NNER ~ PHONE Leonard/Elizabeth Bill I MAI LING ADDRESS PROPERTY RESIDENT (H dlff~en! from PHONE ~,, BUYER MAILING ADDRESS PHONE ~. LENDINQ IN,~I'iTUTION Lo~as and Nettleton % Thelma MAltING ADDRESS 4449 Business Park Boulevard 4. REALTOR/AGENT Great Lan~ Realty MAltING ADDRE~ Post Office Box 279 99577 IPHONE IPHONE 694-9125 E. LEGAL DESCRIPTION Lot 4 Block 3 Troll ~noll STREET LOCATION Subdivision ~. TYPEOF RESIDENCE ~]( SINGLE FAMILY F-I MULTIPLE FAMILY 7. WATER EUFPLY I'-] INDIVIDUAL* -~] COMMUNITY i--1 PUBLIC UTILITY SEWAGE DIEPeSAL SYSTEM [] INDIVIDUAL/ON-SITE** I~ PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Two [] Five [~X Three [] Six · ATTACH WELL LOG. A well log is required for all wells drilled since June I{)75. For wells drilled prior to that date, give well depth (attach log if available.) ** If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATEI~ 72-010(3/78) TIME DATE INSPECTOR DIRECTIONS: ? THIS SIDE FOR OFFICIAL USE ONL ~_~? DATE RECEIVED INSPECTION APPOINTMENTS TIME 3'IME DATE DA~E INSPECTOR INSPECTOR 1. TYPE OF RESIDENCE NUMBER OF BEDROOM~ I--3 SINGLE FAMILY [] MULTIPLE FAMILY [] ONE I-'1 THREE [] FIVE [] TWO [] FOUR [] SiX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL I'~ COMMUNITY [] PUBLIC UTILITY Connection Verified DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE [] PUBLIC UTI LITY Connection Verified {]~'ptic Tank or [] Holding Tank PERMIT NUM~ER DATEINSTALLED INSTALLER Size: ,I ~)O~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK TOTAL A~SORPT. I~)N AREA 4. DISTANCES WELLTO: Absorption Area to nearest Lot Line COMMENTS [] OTHER INeer~t Lot Lir~ {~"~APPROVED FOR .~ BEDROOMS [] CONDITIONAL APPROVAL (letter must ~ccompany certificate) [] DISAPPROVED DATE LEGAL DESCRIPTION 72-010 IRev. 3/78} 'GREATER A~ICHORAGE AReA BOROUGH Departmen~ of Environmental Quality' 3330 "C" St.,.Anchorage, Alaska 99503 ~.274L4561 " REQUE'ST FOR APPROVAL OF "-. .IN~I¥IDUAL SEWER & WATER FACILITIES "S· Type .of. .Inspection:. '.CHRO ~'rOp.erty Owner :. Nailing Address );ame' o{'.,Buyer :' Hailihg ~ddress: ;;am~ o'f Le~ding InstiEution: Hailing Address:.· Nam~ of.Realtor ~.r Agent: 6.. Legal FHA D~y Phone Day PhoneI Description: bT : ' ' Phone m ' I ' ' ..'. , . . . . : ..--:.": '..," ....:.[ '. ,.... .~' 8. ~later Sbpp)y ..: ' ...... Type of'.Supply:'~ Public Utility"/ Ind~vidug] If Indi~idu~i', number .of dwellings, pres'6ntly .served If Individual, depth of well Indiv.~dual 9'. Sewage Disposal'System Type.of S~st~m: Publi'c Utility (on-s.ite) If Individual, date of.instal.lation July 25, 1978 R&~ No. 851567 Great Land Realty Box 633 Eagle River, Alska 99577 Attention: Hary Ann Koehler Subject: Adequacy Test on Existing Sanitary Sewer System; Lot &, Block 3, Troll Knoll Subdivision, Chug/ak, Alaska Dear Ms. Koehler: At your request of July 18, we conducted a test of the septic system on the above described property. During the test the liquid level in the septic tank was monitored as water was added to the system. The measurements are summarized in the following table: Liquid Level Below Top Total Gallons Time of Standpipe Added 11:10 8.4 0 11:16 8.4 25 11:28 8.2 75 11:40 8.1 125 11:51 8.1 175 11:56 8.2 175 12:00 8.35 175 The meter used during the test was a Rockwell 5/8" standard water meter which had previously been calibrated by R&H Consultants, Inc. If the 3 bedroom residence on the property is to house 6 people, the average load on the system can be expected to be 450 gallons per day or .31 gallons per minute. During the test, the system accepted 175 gallons in 50 minutes. This indicates an average effluent acceptance rate of approximately 3.5 gallons per minute at the time of the test. July 25~ 1978 Great Land Realty Page -2- Because the house on the lot is occupied, we assume that the leach field was at its normal degree of saturation. We can therefore conclude that the system is disposing of effluent at an adequate rate for a 3 bedroom resi- dence. ~We appreciate this opportunity to be of service to you. Please contact us if you have any questions concerning this test or if we can be of additional service, Very truly yours, RS.N CONSULTANTS, INC. Llmne Kosikowski Staff Geologist !Jl~B/kah GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received March 3, 1976 Time Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. 1. Approval requested by: National Bank of Alaska Mailing Address: Post Office Box 3-3859 2. Property Owner: Mailing Address: Leonard E. Hill Post Office Box 531, Chugiak Phone: 279-2506 Phone: 688-3168 Legal Description: Location: Eagle River Type of facility to be inspected Well Data: A. Type C. Construction Lot 4 Block 3 Troll Knoll Subdivision No. of bedrooms B. Depth D. Bacterial Analysis Sewage Disposal System: A. Installed 1974 C. Septic Tank: 1. D. Seepage Pit: 1. Size Absorption Area On-site system. B. Installer //,,~,'~//.~7~,~ I~00C2 ~. Manufacturer ~e~r~ 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (l/74) Page 1 of two pages Mt~ICIPALITYo OF ANOtOP, AGE JAR 1976 E.C E I_V.E D. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'C' Street, Anchorage, Alaska 99503 - 2744561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES ;~ebruary 27, 1976 1. Type of Inspection: CMRO VA FHA 2. Property Owner: Leonard E. Hill Mailing Address: P.O. Box 531, Chugiak, Ak. 99567 3. Name of Buyer: Same Mailing Address: 4. Name of Lending Institution: National Bane o£ Alaska Mailing Address: P.O. Box 33859 Phone 5. Name of Realtor or Agent: None Mailing Address: Phone Day Phone Day Phone CONV XxX 688 3168 279 2506 Shirley Jones 6. Legal Description: Lot 4, Block 3, TROLL KNOLL SUBDIVISION Location: EaBle River 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: o Septic system Public Utility If Individual, number of dwellings presently sewed If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation 1974 No. Bdrms. 3 Individual Individual (on-site) EQ-037 lin4) P~age 2 of two.pages - Req/'~,~t for Approval of Individual S~-X~r & Water Facilities Legal Desertption Lot 4 Block 3 Troll Knoll Subdivision Comments Approved ~'-~,/' ~~ Disapproved Date ~ ~/7~ Approval ~Valtd for one year from date signed Greater Anchorage Area Borough. Department of Environmental Quality DIAG~M 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 and these facilities are operating satisfactorily. SIG.ED EQ-034 278-4531 4.1 630 East 5th Avenue ~tr~horage, Alaska and Water ~yst~ns for Lot 4 Block 3 T~oll ~noll ~ea~ Sir, aa suB~c~ lot is lerve~ by a semi-puBlic class Avater a~stem.' This water utility~eets with all oondi~ious with which this . department As co,ceded. The wa~er s~s~ma is app~ove~ for service to the lots as shown on the as-~uilts plaus. Should ~ou have any questions reqardin~ our review of these plans, please contact~ at 275-4531. Sincerely, Fred Sanitarian Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-521-02 1. GENERAL INFORMATION Complete legal description Expiration Date: <~' - / :2. - 0 .~ Troll Knoll Block 3, Lot 4 Location (site address or directions) 23847 Hilltop Drive, Chugiak, AK 99567 Current Property owner(s) Mike Tete Day phone 688-4289 Mailing address Same es above Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Un/ess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBEROFBEDROOMS: 3 3, TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class._A Well Public Water System TYPE OFWASTEVVATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAP,) based only upon the representations given in paragraph 5 by an independent professiona~ civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, · based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy 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(ara) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND Engineering Phone 696-6111 Address 20441 Ptarmlgan Blvd., E.R., AK 99577 Engineer's Printed Name Kenneth M. Duffus 5. DSD SIGNATURE J Approved for Disapproved. .'~ bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other APP.qffv'~D BY ~iNGINEER BUT NOT SUBFiTi~D TO ~OA. N~Iq TEST AND HAA TO BE ORDF.$~D PRIOR TO CLOSE. Legal Desc~ption: WELL DATA Well type A Date completed Total depth ft. Municipality of Anchorage Development Services Department Bulldlno Safety DMsion On-Slta Water & Wastewatar Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchorage.ak, us (907) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST Troll Knoll Block 3. Lot 4 Parcel ID: 0~1-521-02 If A, B, or C provide PWSID ~ 210778 Well Log (Y/N) Sanitary seal (Y/N} Wires properly protected (Y/N) Cased to ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Data of test Static water level Well predu~on WATER SAMPLE RESULTS: ColIform mlonles/100 mi. Nitrate Date of sample: SEPTIC/HOLDING TANK DATA Tank Type/Material Concrete Data Installed 7/74 Tank size g.p.m g.p.m. mg./I. Other bactsrla__colonies/100ml Collected by: 1000 gal. Number of Compartments 1 Cleanouts .y_Foundation cleanout .y._Depression over tank ~1 High water alarm NA Data of pumplno 06115101 Pumper JRs A~$ORPT1ON FIELD DATA Date installed 7/74 Soil rating (g.p,d./ff~or~/bdrm) ~'~' Syetamtype Pit Length 14 ff. Width 14 fl. Gravel below plpL.~., fl. Total depth 8.93 ft. Eft. absorption area 504 ~ Monitoring tube Y Depression over field N Date of edequa=y test 06/18/01 Results (Pass/Fall) Pass For.~_ bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depU'L~ln. Elapsed Time:_~,.~in. Final fluid depth 0 in. Absorption rate >=450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) no If yes, give date D. LIFT STATION Date Inst~led NA 'Pump on' level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump o~ level at CyrJes tested Manhole/Access (Y/N) In.High water alarm level at Meet~ alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift stetlon on lot NA Absorption field on lot NA Public sewer main NA Sewer/septic sorvlce line NA SEPARATION DISTANCES FROM SEPTIC~HOLDING TANK ON LOT TO: Building foundaUon 5'+ Property line ~ ' '1' Water main 10'+ Water sowlce line 1 0 ' + Wells on adjacent Iota 200'~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: On adjacent lots NA On adjacent lots NA Public sewer manhole/cJeanout Holding tank NA Property line 10'+ Water Sewlce line 10'+ Curtain drain 50'+ F. COMMENTS NA Absorption field 5 ' + Surface water I 0 0 ' + G. ENGINEER'S CERTIFICATION in. Building foundation I 0 ' + Water main I 0 ' + Surface water 1 0 0 ' + Driveway, parking/vehicle storage 2 5 ' + Wells on adjacent lots 200'+ I certify that I have determined through field Inspections end review of Municipal records that the above systems are in conforrnence with MOA I-IAA guidelines In effect on this date. Engineer's Pdnted Name Kenneth M. Duffue Date 06119101 HAA Fee $ . 7E. °° Date of Puyment e/'~/F'~ Receipt Number ,-~ ,~(~ ~ ~. ~) Waiver Fee $ Date of Payment Receipt Number 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, · based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm ~1~/'/-o[, 7"~Joic~f E~r.u.;¢~/ Phone Address Engineer's Printed Name "/-,~'~,~-/o,"~' F. ,,'w'oc,,-z, Date 5. DSD SIGNATURE "/ Approved for .-~ Disapproved. Con.ditional approval for __ bedrooms. .., C..,..,.~ . .~',- · . ..'°,,oo...,,, ¢~,%- ~ · .~..,.. ~ ,.~ ~'~' · . ~...,,...% <.. bedrooms, with the fo,owing stipulations:... ....... ~ Additional Comments ~*." ??'SITE ;.~'~ ~" WAT&h~ AND irn' = WASTEWATER : ~ PROGRAM .' %,. ..... :~J., Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other