HomeMy WebLinkAboutMOUNTAIN PARK ESTATES BLK 13 LT 1  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE . J~i~UPG RAD E MAILING ADDRESS LEGAL DESCRIPTION LOCATIC~[ v /NO. OF BEDROOMS I we~4 I Absorpt,on area Dwelling PERMIT NO. DISTANCE TO: ~ I NO. of compartments Liq. c~pacity in gallons Inside length Width Liquid depth fO~O .. IFHOME~DE: -- __ ~ O ~ DISTANCE TO: Well Dwelling PERMIT NO. O Z ( Manufacturer Material Liquid capacity in gallons Q Wail Foundation Nearest lot line PERMIT ~ N~f lines Length ~ each~ine Total length of lines Trench width Distance bet~en lines Q ~ TOp of tile ,o ~s~grado Material beneat~ ~--~--~ ~oT°tal effectiveu~absorption. ~oarea Length I Width t Depth PERMI~. <~ ~~~~~ Crib diameter~,~ Crib depth ~ Total ef fecti,,bsor~fion area~ ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ /~ ~ Class ~ Depth ~ Dril~r ~ Distance to lot line PERMIT NO. ~ S ......... J Bud ng foun~ OF ~)Ji. Sep~ank Absorption area(s) REMARKS' ., APPROVED~8~ ~ DATE LEGAL 72~ PERMIT NO: DATE ISSUED: MUNICIF'ALITY OF ANCI-IORAGk DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION/~ 825 L STREET, ANCHORAGE, AK 995¢)1 264-47~0 - OI~I--S I TE SEWER 850595 09/16/85 AF'PLICANT: ADDRESS: CONTACT PHONE: NIEL KOEINGER 10461 HAMPTON ANCHORAGE, AK 546-1170 ~95i6 LEGAL· DESCRIP: SUBDIVISION: MT. PARt{ ESTATES LOT: 1 ~ECTION: 26' TOWNSHIP: 12N . RANGE: 5W LOT SIZE: ~2500 (SQ.FT. OR ACRES) ~4¢~.~ ~ Listed below are the options availabl~ £o you in de~ignin~ system. Choose the option that best ~its your site. BLOCK: 15 your septic DEPTH TO PIPE BOTTOM -(FT.) GRAVEL DEPTH (FT.) TOTAL DERTH (FT,) GRAVEL WIDTH (FT.) GRAVEL LENGTH' (FT.') GRAVEL VOEUME (CU.YDS.) TANK SIZE (GALS) SOIL RATING (SQ.FT./BR) TRF'NCI-I BED J..'3 . DR/] I N 4.0 4.5 5.0 5.0 0.5 1.0 7.0 5.0 6.0 2.5 19.0 5.0 84.0 ** 56.0' 79.0 ** 27.5 25.4 ~2.0 1,000.0 ** 1,000.0 ** 1,000.0 *~' 167 150 · 150 ** GRAVEL LENGTH > 75 FT. REQUIRES'MULTIPLE RUNS (~NOT EXCEEDING 75 FT, EACH) ** TANK' MUST HAVE AT LEAST 'TWO .COMP. ARTMENTS I certiCy that: ~ 1. I am ~amiliar with the requirements (or on-site sewers and wells as set 'Forth by the Municipality o~ 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 [or the set back distances ~rom any existing well,'wastewater disposal system or public ,, sowerage system on this or any adjacent or nearby~lot. ~ 4. I understand that this permit is valid ~or a maximum o£ 5 bedrooms and' any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN~N AREA COVERED BY MOA·BUILDING CODES, THEN <1> AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2> AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (~> THE ELECTRICAL WORt{ MUST BE DONE BY A LICENSED ELECTRICIAN. APPLICANT: . ISSUED DY DATE: . .... .~"~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Streat, Anchorage, Alaska 99501 264-4720 SOILS LOG-- PERCOLATION TEST LEGAL DESCRIPTION: DATE PERFORMED: 1 2 3- 4- 5 6 7 8 9 SOILS LOG PERCOLATION TEST q- SLOPE SITE SP- ~ 10 11 12 13 14 15 16- 17- 18- 19- 20- COMMENTS PERFORMED BY: WAS GROUND WATER ~) SLI ENCOUNTERED? O P E IF YES, AT WHAT tEPTH? . ~/~'. Gross Net Depth to  Reading Date Net irfer ."~ · Time Time Water Drop ,o · -\"t..'t.,"' 0 ~-'/5' ~,o ~ ~ ,o~ TEST RUN BETWEEN '~'~: :~CERTIFIED BY:.~j~~__ (minutes/inch) · FT AND ~'"'~'~ FT 72-008 (6/79) GRE:~.,~R ANCHORAGE AREA BOR~,,'JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME P--' ~ ~ ~--' MA,L,NG ADDRESS ~,~-~. ~,O~. tc, o~, ~ ~,o~ LOCATION ~ d LEGAL DESCRIPTION ~ ~ [~ ~ ' SEPTIC TANK: DISTANCE FROM WELL ~ MANUFACTURER INSIDE LENG'rH INSIDE WIDTH. MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY GALLONS. SEEPAGE ):~;l': "T'~ NUMBER OF PITS __ DIAMETER L,N,NG MATER,AL BU,LD,NG ~OUNDAT,ON__, ADDITIONAL ABSORPTION .OR WIDTH CRIB SIZE; DIAMETER NEAREST LOT LINE LENGTH , DEPTH DEPTH~ DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA), WELL: TYPE CONSTRUCTION BUILDING NEAREST FOUNDATION_ , LOT LINE. CESSPOOL. , OTHER SOURCES APPROVED DISAPPROVED DEPTH , DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK .~, SYSTEM . REMARK5 DISTANCES: INSTALLED BY: ~ PIPE MATERIAL; LOT SLOPE: REMARKS: Form NO. EQ-031 DIAGRAM OF SYSTEM o,,, ' GRE~Er ANChOragE arEA BOr6ugh DEPARTMENT OF' ENVIRONMENTAL QUALITY 3330 '*C*" STREET ANCHORAGE, ALASKA 99303 .-. TELEPHONE Z74-456! SEWAGE DISPOSAL SYSTEM ira APPLICATION*AHD PERMIT HAME OFAFPL,GA.T MA,L,.G ADDRESS " U INSTALLATION LOCATION{ '~ V?~I- : p INSTAL~TION OF= SEPTIC TANK SEEPAGE PIT ~ r ' , , DRAIN FIELD ~PE AND SIZE OF FAClLI~ TO BE SERVED OTHER FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS COMPLETION DATE ANTICIPATED NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF' ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT O; ENVIRONMENTAL QUALITY AUTHORITY WILL BESUBJECT TO PROSECUTION. MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK ; FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD DRAIN FIELD ·SEEPAGE PIT . DRAIN FIELD ..................... S E EPAG E ALSO CONSIDER AREA WELLS. SEEPAGE FIT DRAIN FIELD SEPTIC TANK, , SEEPAGE PiT TO RIVER, LAKE· STREAM. CAST lEON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS· GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGA INSTALLATION. OR DIAGRAM OF SYSTE:M I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF~GREATER AN INANCE HO. Z8-68 AND THAT THE ABOVE G,,~'~TER ANCHORAGE AREA BORO?~H i HEALTH Di~P~.RTMENT I : 327 E~GLE ST. ANCHORAGE, ALASKA 99501 279-2511 N°· 550 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME /~"/-/~'/,~//~ ~ ~/,.'~/~/"~/~'//~_//'/ ADDRESS~"~---~'~ LOCATION. SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY /~:~ ~----~::) GALLONS. PHONE ~'~''-~ 7 .LEGAL DES CRI PTIO N/---~2"'~J- f'~--~'~"~ NUMBER OF / .MATERIAL ~ ~ffJ'~'~'-~'-' COMPARTMENTS LIQUID INSIDE LENGTH ~INSIDE WIDTH ~ DEPTH · SEEPAGE SYSTEM: SEEPAGE PiT: / ' ' NUMBER OF PITS OUTSIDE DIAMETER LINING MATERIAl ~ff~~ ~/~-~ DISTANCE FROM WELT /~ / , BUILDING FOUNDATION. NEAREST LOT LIN~ff~~~. TOTAL EFFECTIVE ABSORPIION AREA ~ALL AREA) ,~ SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION. , NEAREST LOT LINE NUMBER OF LINES _ =~N LINES "~ TRENCH WIDTH A~SORPTION ARE~''/'''''''- .SQ. FT. LENGTH OF EACH~LINE. ~ DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH · OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE__ WELL: LOT LINE f~/~'"~.~ ,,,~J_ _,~"~/'~)~ DISTANCE FROM /~ ~ ~,, WATER TYPE ~/~~ . DEPTH.. /~ ' ,BUILDING FOUNDATION.~//~ S~PLE ~ , NEAREST ~, , SEWER LINE/~ ~ . TANK /~ , SYST~ J~ , CESSPOOl ~SOURCES~ DIAGRAM OF SYSTEM DISTANCES: DATE - - ~ HEALIH AU|HORII¥ GREATEr ANCHORAGE ArEA BOROUGh SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT SOIL TEST RESULTS NOTEI THIS PERMIT IS NOT VALID WITHOUT SOIL TEST .o......o..........,.... FINAL INSPE~TION~ 2A HOUR NOTI~I~ FIEQUIREB. SACKFILLING OF ANY SYSTI-~M WITHOUT FINAL INSP[~TIOH BY THE HEALTH BEPARTMENT AUTHORITY WILL BE SUBJ~GT TO PROSECUTION. TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PiT WALL SEPTIC TANK ~"/ . SEEPAGE PIT TO NEAREST LOT LINE. / WELL TO SEPTIC TANK .... DRAIN FIELD WATER MAIN TO SEPTIC TANK SE~lC TANK, ~t , SEEPAGE PIT TO RIVER. LAKE, STREAM. "2.. ~ ' , DRA'N F'ELD BEEPAGEP'To/ SEEPAGE PiT /O ' CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. A INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. OR DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO, 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. CF, EATEP,, AJ;CH~?A,,~E AP. EA ~0. EAGLE STREET ALCHOR~,.,=~ AL,'~,~KA 99501 This Fc.'~ Reports a: So.~Js Lev, Depth Feet Ec!l Chsr,zcteris~ics err~ If Yes, At ~;hat P. epth ......... Location Sketch ! Reading Date Gross Time Ne: Tir,,c Depth To H20 Ne~t Drop Frcpo~ed instal~S~epage Pit /..--" Drain Field co~m::~,~: .'r'f:~,,~i, ~t o,)s-,'' /~ :...l' ~o, ~,.~ ~.~ ~/~ ' ....... ~///~ol~.t~ ~,z~f,~- ._ ~(2 t . /0~ ......... Test Perfor~d By :_ =_~ e ~ .... Data Certified By: ~j~..;.~,~<~/.~ .~____.~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ~ ~'-~ -.:~c4 ~ - L\~ haa # 1. GENERAL INFORMATION Complete legal description LOT' Location (site address or directions) Lending agency ~LE ~O~4~E Dayphone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-4325 (Rev. 1/91) Front MOA 121 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~,t~- [~(~/.F-A-~ C~C~u~-T,~G ~;~ Phone Z.-TZ.-'71II Address ~,~5 ~, ~-"'~-. ~ (o ,4-, ,,~-,~c.~_~G£, AF- Engineer's signature ~ ~ ;(" ' DHHS SIGNATURE ~ 'Ap~3roved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph $ above by an independent professional engineer registered in the State of Alaska. The DHH$ 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#2~I Legal'Description: LOT' t ~kor..F_. I.~ A. WELL DATA ' ' Well type 1~IV'^TE' If A, B, or C, attach ADEC letter. Municipality of Anchorage Department of Health & 'Human Services HEALTH AUTHORITY AppROVAL 'CHECKLIST 'Parcel I.D. ADEC water system number ' Log present (Y/N) /~ Date completed IC1'7c~ ~ Driller. /-/~ Total depth ~'~'~ (~) Cased to '40't (~ Casing height I, 2. ' (3) Sanitary seal (Y/N) ' YEs (~) Wires properly protected (Y/N) ~.S (~) Date of test Static water level Well flow '; Pump level ~ FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/l~'tank on lot cl ~ (~ $~ o~'~ 5.: . . '- I ~,~c~. r~- ~mvc~, On adjacent lots Absorption field on lot ~ ~ ~'*- ~ ~i On adjacent lots Public sewer main Iq'/,~.' ' .... ' 'Public sewer manhole?cleanout Public sewer service line' lq/~.,' . · ' WATER SAMPLE RESULTS: Co',form Date of sample: 2.-1'7 - cl ?_. Petroleum tank ~:~,~r__~_ ,~d~c~r~ ~ © 1='4~'TDP'- ~' ([~)/t'/;~) other bacteria collected by: ~-^~ ~$ B. SEPTIC/~ TANJ~ DATA Date nstalled ~'~' To,,k size Cleanouts (Y/N) y t~ ~" ' ' Foundation cleanout (Y/N) I~ ~) High water alarm (Y/N) /q/A. Alarm tested (Y/N) SEPARATION DISTAN~ZS FROM SEPTIC/HOLDING TANK TO: . Well(s) on lot cl ~' ~ Onadjacentlots~-~,o'~.-Lo, P,c~- ,,'rSFoundatio~ ' I I~l To property line ..'7.~ .Abs0rpflonfield I I'4- (~)'. Wate~main/serviceline Surfacewater/drainage' I, JO~C oE~%r,.~V~.p · 72-0~6 (Rev. 3/91) Front MOA 21 Compartments (~. ' F~o,~ Dill-IS Ft~.-F__..~ ' CO~,ITINUED ON BACK PAGE Depression (Y/N) C. LIFT STATION Date installed Manufacturer · Size in gallons Vent (Y/N) ., x ~, "puml~ on" level at High water alarm level Meets MOA electiical co'des (Y/N) ' '"'" & '¥ 0 SEPARATI N DIS ANCE FR M LIFT STATION TO: ': D, ABSORPTION FIELD DATA Length 4~ ~J ~ Width "~" ~ On adjacent 10ts Manhole/Access (Y/N) "'Pump off" level at', -- Total absorption area Depression over field (Y/N) Results (pass/fail) F'A,c~ g Cycles tested Surface water ; . Soil rating ~--Z ~'?~) System type 'IT~CNF-"J' ~'c~''~' (~) Gravelthtckness ~ ~ ~) Totaldepth Cleanouts present (Y/N) Date of adequacy test ~.-I'l-cl'z. for bedrooms Peroxide treatment (p.ast 12 months) (Y/N) "N o . ,. If yes. give date SEPARATION DISTANCE FROM ABSORPTION FIELD~~' Wellon lot Io'5' To building foundation On adjacent lots I~0' 4- (:~ Cutbank I,J/,x. Water main/service line Surface water No*Jr_- o~$F__.~-,,'CO (D Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I cetlitg that I hav? checke~, verified, or con~ormed.to of this inspection. Signatur~ Engineers Name HAA Fee $ / 7~,,~''- ' ' - Waive. r Fee; $ -.. Date of Payment ,~."'"~-t~,~, ' . .Date of.Payment Aiuni¢ipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage. Alaska 99519-6650 343-4744 January 31, 1991 Tobben Spurkland, P.E. F/~-&E ' AT- ~ '/f~' /~ 6751 West Dimond Boulevard ~/~_~ff ~/~/~/~ ~. Anchorage, Alaska 99502 ~ Subject: Waiver Request for Lot 2 Block 13 Mountain Park Estates Waiver Request ~WR910005,'PID ~017-391-50, HA910023 ~ Dear Mr. Spurkland · ' · · ' .... / / Your request for waiver of the required 100 foot horizontal / separation of a septic system to a private well has been approved./. The approved separation distance is 70 feet from the well to ,~. private septic tank and 88 feet from private well to leachfield.~ This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met'or another approval from this department. -. Sin~ffely, ,-9 Robert W. Robinson Civil Engineer On-site Services /~ohn S~5, P.E. VProgram/Manager On-site Services ljm:~6 SUBJECT OF ....... j~ · " " ECE ' ' ' :' ",~ ' ; = ' ' 'Munjc~palityofA h--nc-orage ............. ' ...... . ; . Dept. Health & Human Services u i ~--- - ~t' . ~ ~ '. : .,.~. .. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ?/~//~-'~' 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ,/~'//¢~, //~C~__/V'/C..~/7... Telephone': Home Business ,,'~zr/'~/'t'7 Applicant Address ,~.O. FoX /0-0.~'.~7 /~L~::~r'z.¢~=~'~,' ~l'/~l$~d~ ~'/0 (C) Applicant is (cheek one): Lending Institution n; Owner/builder~J~; Buyer r-I; Other I'1 (explain); . ~.~ (d) Lending Institution "--' ' Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail th.e]-IAA to the following address: ~l,~/// /~//~ U~ -' "~'~'o ~.~/ Q G ~ t,~-,~"~ t ~ I Il/,, Ro f'"5 o3zF "'" ~ o7.. /0- "'", -' .. TYPE OF RESIDENCE Single-Family)~,, Multi-Family Number of Bedrooms ~ Other WATER SUPPLY .:'. ,:' , ./-, '; . . , 1"~ ~".,,',.; ,-:- ., Individual Wel Communityn Public FI . ~ . .... , , ...:. . . . . Note: If community well system, must have written confirmation from the State Department of Enviro, nmental Conservation attesbng tothe legahty and status. '.' %' · ' , ':., ./ .;:~'~ . SEWAGE DISPOSAL" :' "'";:'~,"~' ' "r .t : ' ; "' ;" . ,., ..,,, ,: ~. Onsite Public F1 Community F1 Holding Tank[] ~"" . , . . Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attest ng'to the legaity and status , (.~'7. i i' Page 1 of 2 72.025111,84) 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 regul,ations in effect on the date of this inspection. " Name of Firm ~ _~s~f~/'e,3 Telephone ,~//~, ,~1~9~ Date /~ -/, - ~' Engineer's Seal DHEP APPROVAL ;"" Approved for'/~'-~'(~. '?b~drooms by Approved ,~. .... '~ '; ' ' ':Disapproved Conditional Terms of Conditional Approval Date £0 - t o 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 72-025 (11/84) WELL DATA Well Classification Well Log Present (Y/N) _~ Total Depth ~_a~'~ Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit {Y/N) Separation Distances from Well: MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 264-4720 If A, B, C, D.E.C. Approved (Y/N) " / a~'~te Cor~pleted ~!~'~"' Yield Depth of Grouting '""- Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot ~ ~ ; On Adjoining Lots To Nearest Edge of Ab;orption Field on Lot /O~,,'J~' ; 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 'J(- ~/ ~ a~'lJ,,~l:~,~'~... B. SEPTIC/HOLDING TANK DATA Air-tight Caps (Y/N) Size ~ No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-water Alarm (Y/N) - Separati~)n Distances from septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/service Line --'-'--' Course Comments ; for ~ Temporary Holding Tank Permit (Y/N) '"'-- To Building Foundation . 1~" To Disposal Field ,~ 0 ~ To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026[~1~84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~--~--¥ Type of System Design"~'~e44~-L. Date Installed ~-?/ ~ 10-~-8~ ~~ L~g~Id ~ Width of Field ~O~/ ', ~ , ~e~Field ~ Square Feet of Absorption Area ~ ,~-~ ~tandpip~ Present (Y/N) Y Depression over Field (Y/N) ~ Date of Last Ad~uacy T~t ~-~-~ Results of Last Ad~uacy Test ~ Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /,.~ To Water Main/Service Line - To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line TO Existing or Abandoned System on ; On Adjoining Lols ,--~0'1 To Cutbank (if present) '---' D. LIFT STATION ~ed Dimensions Size in Gallo~S'~'~,.~ Manhole/Access (Y/N) ,~ "Pump On Level at "Pump Off" Level at ~ HighWater Alarm Level at ~ )~n Tested for ~ g Adequacy Test. Meets MOA Electrical Codes (Y/N) ----'"~'- ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have.ct'~ked: verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~ ~ . Date I0-/~-A,-.-.-.-.-.-.-.-.-~- · Company~j~-~ ~~ MOA ,o. Receipt No. ....?._~',~4--~ Date of Payment Amount: $ ~ ~ ~ Engin~r's ~al Page 2 of 2 72-026 (11~84) "'. /~..:50 S 89°59'00"W 16598'o % ' I f L=~7.12~ --- .. I · I ~' ~ · I , 'c · !~\ · 'o , $ :so' N 89° §9'O0"E 195.9'5"1' I I It is the responsibility ef lhe builder or owner, prior to LEGEND: hub 8, tack-found 1:3 set "' construction, to verify proposed building grnde relotive iron rebar -found o set · to finished grade ond utility connecfians and to determine Ironpipe '-found 0 set Ihe existence of ony eosements, covenants or restrictions bras~cop -found ~ set which do not oppeer onthe recorded subdivision plat. olum. Cop -found ~ set Lot Survey.Certification ,e.'~-~;-~ .~ ii Prepored by % Robert E. Johns, Jr. & Assoc. I her eby cur tif¥ that I hove surv- a~.e~ ? e, ,, · ~.~.,,~" ,%__ .~.~,& Professional L~nd Surveyors described he,ed% end ma~ me ,eGg, TH :,'3;~ Scale: ,.~,..~,s,,~.~t~,~ ..: 49~--_- I" =4(J Drawnby;Vanguard/G.L.D Ore wl~ n the prop~Y Imm and cbnotc~wbpo~enc,cocho, [ .~f'~..;s?.~7~,~,~/,.....~'-,. iIDate Surveyed:.~ ------~' =~- Checled by: R.E.J. odJoce~ property and that no ~e~ ~e~ e ~'e/e m¥~'e'~e e e e e e~ %e es~e ·~ Ims~e~er~sanodja:mtpm~- ~'~*, .o,-~r ,: ~.~.."'.. '~'.' .E ~ Date Drawn'. ~_ Grid: pr~mises h ~ axl that lines or o~her vis, lc _,~,~,,~ s an~id ~,ty~o,--q~~'we=do~v''~"''~.,~,~.,,:,. Mountain Park Estates Subd. .... - MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Strut. Am:borage, Ala~e 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 2E~.~720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Comi~leta -,il pert~ on page 1. Inoomplete ~ues~t will not be preceded. PI_~_-~ allow tan (10) days for proce~ing, 1. PI~2P.ERTYOWNER /~ .~,'~ _ ~ I PHONE ~ LENDING INSTITUTION. ~IL~G AODR~$ , i B, TYPEOF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATE~UPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY SEWAGEDISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NUMBER OF BEDROOMS [] One [] Four [] Other  Two [] Five Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior t~_that date, give well depth (attach log if available.) "~'7' ~ ?/ *'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 INITIATED. .__~. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS -. TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DI R ECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [~SINGLE FAMILY I--1 ONE I--1 THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER ?- WATER SUPPLY ~/ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUB'LIC UTI LITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~INDIVlDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY " ~7'-"~ ( -- ~ Connection Verified INSTALLER ~) [] Septic Tank or [] Holding Tank Size: ~/O.~ If Tank is homemade SOILS RATING give dimensions:. TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ~; '~ AJoso~ption Area to nea~;. Lot Line [~APPROVED FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) ~OISAPPROV ED BY (Title) LEGAL DESCRIPTION / - v 72-010 (Rev. 3/78) .1. e GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection ,_.~,'~,,.,~,,'~'~ Date of Inspection~__~ Approval'requested by: Mailing Address: Property Owner: Mailing Address: Legal Description: Location: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR ~.r .~ + .~ ,, -~..-/~ Phone: , ' ! Type of facility to be inspected ~'c .,,~ ~d~_--'¥,'~.,z~, Well Data: Phone: No. of bedrooms C. Construction /;~'~'.~z~-~ D. Bacterial Analysis Sewage Disposal System: ~...~~~ A. Installed 7~~~ B. Installer C. Septic Tank: 1. Size ~ 2. Manufacturer ~/~- D. Seepage Pit: 1. Absorption Area~ ~ 2. Material E. Disposal Field: Total length of lines Be Distances: A. Well to: Septic tank /~--~ / , Absorption area Nearest lot line /~ /~Y~ , Other contamination ~/~ B. Foundation to septic tank ~..3~, Absorption area C. Absorption area to nearest lot line ~ / ~/~}F~ Sewer Lines EQ-034 (1/74) Page 1 of two pages · /~ A~prov'ai of' _~ & Facilities Pab~.g of two pages - Re,,...~st for I'ndividual ~"'~er Water L~e~al Description ? o ~ ~. J~ /~. .j~?.~-~ ~. Comments Approved ~~'~~ Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 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. SIGNED Date EQ-034 (1/74) 'GREATER ANCHORAGE ARLA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: .CMRO VA x 2. Property Owner: Richard Christman Hailing Address: Alpine Drive 3. Name of Buyer: Donald Rime ' ' ' Mailing Address: Box 1597. Anchorage 4.. Name of Lending Institution: Mai!lng Address: 5. Name of Realtor or Agent: Mailing Address: FHA CONV DaN Phone 344-7173. Day Phone 344-6345 ,,LOMAS & NETTLETON- Phone J~ckWhite company/Thomas Hadad 909 West Ninth Avenue Phone 277-1553 6. Legal Description: LQt 1, Block.13, Mt..ParklEstates. Location: NHl~Alpine Drive 7. .Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings Presently..ser~ed' If Individual, depth of well 247' 9. Sewage Disposal'System . Type ~f S~stem: Public Utility If~Individual, date of. installation sinqle2famil¥ No. Bdrms. 3 x Individual (on-site) x septic-tank APR ! 9 1974 e e 4. 5. 6. GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received .~-~o - 7~'-' Time of Inspection ~*~-~--) Date of Inspection ~'~-~ -7~ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Mailin~ Address: ~ ~/~/~ ~~ Type of facility to be inspected Well Data: ~ A. Type ~///~ C. Construction 7. Sewage Disposal System: No. of bedrooms B. Depth ~-~ ~ D. Bacterial. Analysis A. Installed /~7/, B. Installer C. Septic Tank: 1. Size /~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area ~'~ 2. Material E. Disposal Field: Total length of lines e Distances: A. Well to: Septic tank' ~ Nearest lot line /~',~' B. Foundation to septic tank , Absorption area Other contamination Sewer Lines/j'/-, Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages ~'~g~ 2 of tM pages - Req~'y~'=r Approval 'of Individual S~r~'') Water Facilities Approved t.~([~ ,isapproved _ Date ~) .I--' Approval \Valid for one yea~ from date signed Greater Anchorage Area Borough, Department of Enviro.~ental Quality DIAGRAM OF SYSTEM I certify that the info~ation 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. SIGNED _ , Date £Q-034 (1/74) ~"GREATER ANCHORAGE ARE/, BORO-UGH' Department of Environmental Quality 3330 "C" St.', Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF' INDIVIDUAL SEWER & ~ATER FACILITIES Type of InSpection:' CMRO VA FHA CONV x Property Owner: Christmas, Richard L. & Patricia A. Mailing AddreSs': SRA Box 1614, 99507 Day Phone 344-7173 3. Name of Buyer: Rogers, Charles E. & Ann M. Nailing Address: 3000 Lexington, 99502 Day Phone 344-7352 Mailing Address: pouch 7-010, 99510 Phone 277-5511 5. Name of Realtor or Agent: Area Realtors (Patricia Ii. ~!eatherby) Mailing Address: 3300 "C" St., 99503 Phone 278-2525 l: 6. Legal Description: Lot l, Block 13, Nountain Park Estates Location: Alpine Drive, Anchorage, Alaska 7. .Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility Home No. Bdrms. 3 Individual If Individual, number of dwellings presently served If:Individual, depth of well' 247 ft.' SeWage Disposal'System · Type .of S~stem:~' Public Utility If Individual, date of installation X Individual (on-site) 7720/71