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Home My WebLink AboutLAKE HILL ACRES #3 LT 20Loke Hill Ac Lot 20 #051-122-24 MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P,O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Oct 03, 2001 Expiration Date: Oct 03, 2002 Permit Number; SW010415 Legal Description: LAKE HILL ACRES #3 LT 20 Design Engineer: 0003 S & S Engineering Owner Name: Thomas & Elaine Elledge Owner Address: 22411 Mirror Lake Dr. Chugiak, AK 99567-0000 Parcel ID: 051-122-24 Site Address: 022411 MIRROR LAKE DR Lot Size: 22000 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field r-~ septic Tank ~-~ Holding Tank [] Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day, B. Covered, sealed, and heated to prevent freezing. Received By: Date: /0 -- ? --C2 / Issued By: ~ Date: 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 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 5 \ .-'- ~ ?-,7-. - ~_.~ Permit Number sw__.~2_L.O_.~:..~_ Property owner(s). '"~'~r~o w't.~,.~ Mailing address (1) ~.O . _~ .'~ Mailing address (2) ("_,~¢-~' Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ~ THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade r-] THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Day phone Number of Bedrooms Well Only ['"] Water Storage [] Jacuzzi [] Water Softening Unit I-'] I certify that the above information is correct. I fudher certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. V,~2 ~ S & S ENGINEERING (Signature of property owner or authorized agent) 17034 Eagle River Loop Road, No. 204 Eagle River, Alaska 99577 Permit Fees: Date of Payment: Receipt Number: (Rev, 12/00) Waiver Fees: Date of Payment: Receipt Number: ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WAI'ER INSPECTION ENGINEERING ST UOIES AND REPORTS WELL INSPECTION & FLOW TEST SITE Pt..AN~ ROAD DESIGN SOIL TEST PERCOLATION TEST STRtJ~TURAL & INSPECTIONS ONSITE WASTE'WATER E~SPOSAL SYST EM DESIGN September 13, 2001 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, Alaska 99519 REFERENCE: Lot 20, Lake Hills Acres S/D #3 This letter is a request to issue a permit to upgrade the existing system with installation of a holding tank that will serve the three bedroom residence on the referenced property above. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. Attached is a site plan which depicts the locations of the existing holding tank and proposed holding tank. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P. E. RCC / jhm Enclosure 17034 NORTH EAGLE RIVER LOOP * SUITE 204 * EAGLE RIVER, ALASKA 99577 ~ LOT 20, LAKE HILLS ACRES //8 S/D ~~~~l~grl~ SHOWN ON THIS SITE P~N a~m AS SHOWN ON ~~ / ~, ~k~ ~ AN AS-BUILT SURVEY DRAWN 5Y: ~L~ / GALLON HOLDING IT IS TIIS RBSPONSIBILTY OF THE CONTRACTOR ~ TAN~ W~TH A ES00 o,~. ~.. ~.o~.~ ~ ~,~o, ~o ~ ~ OALLON HOLDINO co~s~.u~o~. ~.... .."~ RIYCR. ~S~ 99577 /~l~ ~ ~ PHONEt (907)694-2979 ~ Z~' / ~ k ~~ ~ ~/ I O"TAIN UTIU~ ~CATES / ~ / ~ ~'/ ~ I q~ r n I NOTE: HIGH GROUND WATER CONDITIONS. / ~ ~/ / ~ ~ ~ ~ ..... ~ I~TALL ~TI-FLOTATION WEIGHTS. / / ~ / '~ .7/ 5~ [x,s~,~ ~ <A~ox,~ / ~ ~, I 1~ . / /~ SET~A~ -- 3500 GALLON __~. ~l~ X' ~ ~ -/ ~ SEPTIC TANK ~ ~'~ ~ ~ / i k CRUSHED & --~ a~ %---.. NeW- 8' I~ ~ L .... ~ .... ~ -'-._ 2500 GALLON [' _J--~---~ ~ / ~ - _ ~-'-~HOLDING TANK _ ~',-~-]~~ COVER REQUIRE INSU~TION. ~ F , d n ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVN. S SEWER a WATER MAiN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUOIES ANDREPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAl.& MECHANICAl. INSPECTIONS ONSITE WASTE'WATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 20, Lake Hills Acres S/D//3 September 13, 2001 GENERAL: 1. The scope of this project includes upgrading the existing system with the installation of a 2500 gallon holding tank to serve the three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifica, lly agreed otherwise, the property o~vner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. HOLDING TANK INSTALLATION: A holding tank is to be constructed by a certified wastewater holding tank manufacturer. Construction shall include a 6" cleanout for pumping access, and water-tight manholes. 2. The holding tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All Standpipes on the holding tank shall extend a minimum of 12 inches above final grade. 7034 NORTH EAGLE RIVER LoOp · SUffE 204 · EAGLE RIVER. ALASKA 99577 Page 2 Lot 20, Lake Hills Acres S/D #3 September 13, 2001 4. Holding tanks installed with less than 4 fi. of cover shall be insulated. The holding tank shall be equipped with a high-water alarm which registers both visually and audibly inside the dwelling. The alarm shall be positioned to allow at least 150 gallons of storage per bedroom or a minimum of 300 gallons after the alarm has been activated. 6. Final grading over the holding tank shall be such that a positive slope exists away from the holding tank. 7. On areas of high ground water, sufficient weight shall be installed on the tank to prevent flotation. MINIMUM MATERIAL SPECIFICATIONS: 1. Any holding tank proposed for installation must be constructed by a Municipally approved holding tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). INSPECTIONS: Typically there will be a minimum of two (2) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the tank has been set; lines, cleanouts, standpipes and insulation are in place; and prior to backfilling. Page 3 Lot 20, Lake Hills Acres S/D #3 September 13, 2001 2. The final inspection is to occur upon final grading of the property. Thc inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre-construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR / OWNER Municipality of Anchorage Page / o! DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Sile Wastewater Disposal System and/or Well Inspection Report Permit Number: $ ~/~) 'ZO f ~ I Name: Phone: I No. of B LEGAL DESCRIPTION Lot: Town~hlp: / ~.- ~, WELL: Block: Subdivision: ~ Ne~S~/~ ~ Upgrade Waslewater System: [] New [3 Upgrad/~ ABSORPTION FIELD r'l Deep Trench r'l Shallow Trench I'1 Bed ,/~nd t-I Other $oll Rating: Total ~_~lrom original grade: Orlllen ale Drilled: Sl.t~c w~ter Ce~el: O ~' ~(,, OsIe Installed~ ~.~ SEPARATION DISTANCES ~ Septic /Holding ~ S.T.E.P. BENCH MARK Department of Health and Human Se~ices approval Reviewed and approved by: ~ ~~ Date: ~-/~- ~ PermltNo. $~] Zol .~ / Page ~ of Z. Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: i ELEVATIDNS (NOT TO:SCALE) I 3500 GAL. HnLDING TANK SC ~ ~.l SWING TIES ~ A-C=56' ...........,, . la i~ ";~ o. ~"--"". ~'~'J~.~' -~ .......... A-~D=75;5'- B-C=66 .... OREER TANK PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 #L' STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920131 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:RICHARDSON PAUL K & OWNER ADDRESS:7817 MARINO DR.KE DR ANCHORAGE AK 99516 PARCEL ID:05112224 LEGAL DESCRIPTION: LAKE HILL ACRES #3 LT 20 DATE ISSUED: 6/16/92 EXPIRATION DATE: 6/16/93 LOT SIZE: 22000 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: HOLDING TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. THE EXISTING HOLDING TANKD MUST BE PUMPED, CRUSHED AND ABANDONED ON-SITE OR REMOVED. RECEIVED BY: ~ ISSUED BY: ,~O~ ~T'"~I'T~4 DATE: DATE: Louis Butera, RE. Registered Civil Engineer June 4, 1992 John Smith, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lake Hill Acres//3, Lot 20 Narrative Dear Mr. Smith, The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area is predominately served by holding tanks. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to holding tank systems. 4. Drainage will not be effected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. P.O. Box 773291 · Eagle River. Alaska 99577 · Telephone (907) 69-t-5195 · Fax (907) 69-{-3297 LA~E .N NO KNOWN CURTAIN DRAINS -IOLDING TANK SITE LECAL: LOT 20 LAKE HILLS ACRES #5 OWNER: RICHARDSON CONTRACTOR: N/A JOB // 92-069|DATE: 06/02/921 SCALE EAGLE RIVER ENGINEERING A P.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) PLAN 1" =60' SER VICES 694-3297 ~ - TEST HOLE · - MONITOR TUBE o - SEWER CLEANOUT + WELL SPECIFICATIONS FOR ON-SITE IIOLDING TANK SYSTEM LEGAL: LOT 2, BLOCK 1, LAKE ttlLL ACRES NO. 2 A. GENERAL The well and septic plan are for a single family residence only. The drawing and or site plan shall be a part of this specification. Ali materials and workmanship shall meet the Anchorage Department of Health and State Department Of Environmental Conservation requirements. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. HOLDING TANK 1. tlolding tank is to be accessible to pumping vehicles. 2. The tank is to be a tank that is approved by the Municipality of Anchorage with corrosion prevention standard, for septic tank as per Uniform Plumbing code. 3. The holding tank must have a six (6) inch diameter standpipe with an airtight cap lo provide pumping access. The standpipe must extend at least twelve 02) inches above the surface of the ground. 4. The holding tank must have a watertight manhole to provide access to the interior of thc tank. The manhole must be at least twenty (20) inches in diameter. 5. The holding tank must be equipped with a high water alarm which registers both visually and audibly inside the dwelling. The alarm must be positioned to allow at least three hundred (300) gallons per bedroom of additional storage after the alarm has been activated. 6. The holding tank is to secured against floatation. 7. Existing holding tank to abandoned to code. 8. Alarm and wiring to be per Municipality of Anchorage electrical code. BEDROOM CAPACITY -- 3 ,~: HOLDING TANK SIZE = +2,000 gallons .~.~ Twenty-four (24) hours notice required for all inspections. ? 825 "L" STREET ANCI-'tORAG E, ALASKA 99501 (90'?) 26,'1 4 111 (;£ORG£ M SULLIVAN January 4, 1982 Ralph Maggie Box 407 Anchorage, AK 99510 Permit ~ 810576 Subject: ~L20 LAKEIIILL ACRES ~3 A permit issued by this department for a well and/or sewer system has expired as of December 31, 1981. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, Sewer and Water Program Enclosure: Copy of Permit ~"~INIClPALITY Of A. NCHORAGE_ f'"% Department o~ Health and Environmental _;erectIon 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * W~.'~-')~-ND/OR ON-SITE SEWER PERMIT ~t: ~p~ ~A~O ~iling Address: XLegal Description: Z~r lO J~~/ ~ Lot Size: Type of Soil Absorption System Is: %/ Trench: Drainfield: _Seepage Bed: Holding Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) The Required Siz~%f/~Soil Absorption System Is: DEPTH LENGTH /~'//G~A~EL DEPTH · WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a.trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). · * REQUIRED SEPTIC(HOlDING) TANK SIZE = ~(~)~0 GALLONS * * ~Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEF~BER 51, 1 9 8 1 - * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled tO include more that 3 bedrooms. Signe~: _~.~/~.. /~.~ Issued by:/~~ Applicant ' 6"~/~/ ' ! MUNICIPALITY OF ANCHORAGE ~ '1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE(~TION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Liq. caPaCity in gallons I F HOMEMADE: inside length No. of lines Length of each line Total length of lines TOp of tile to finish grade Material beneath tile Type of crib Crib diameter Crib depth Well Building foundation DISTANCE TO: Ciass Depth Driller DISTANCE TO: Building foundatio~ Sewer line NO. OF BEDROOMS Dwelling PERMIT NO. Material No. of compartments Width Liquid depth PERM'T PERMIT NO. Trench width Distance between lines inches Total effective absorption area inches PERMIT NO. Nearest lot line D~$tance to lot line Septic tank PIPE MATERIALS SOIL TEST RATING OTHER REMARKS APPROVED 72-013 {Rev, 3/781 DATE LEGAl. PERMIT NO. 8PPLICA~aT LOCATION LEGAL ~EPRRTME~T OF H~ALTH A~J~ EH~IRO~JMENTRL PROTECTION ~ ~ ~ ~ 825 'L' STREET, ANCHORAGE, ~. 9950i ~ 264-4720 / ~ Ot4--~ I TE ~E~WER UPgRadE PERr~ X~ ~ ~ , ,~ ( 79~482 ) ~ /I, /~ ? LRKESHORE DR L28 LRKEHILL ACRES LOT 5~ZE 2265~ SQUARE FEET TYPE OF SOIL RBSORBTIOta SYSTEM IS: DRRINFIELD MAXI~IUM faUMBER OF BEDROOMS SOIL RATING (SQ FT?BR>= 550 THE REQUIRED SIZE OF THE SOIL ABSORPTIO[~ SYSTEM IS: DEPTH= 0 LE !".1G TH = C-~ GRRVEL DEPTH= 0 THE LENGTH DIMENSION IS THE LEtaGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TREtaCH OR PIT IS THE DISTRt'aCE BETI4EEN THE SURFACE OF THE GROUt'aD AND THE BOTTOM OF THE EXCAVATION (IN FEET>. THE TREI'-I~__-H IqlDTH IS 0. [-~00 FEET THE GRAVEL DEPTH IS THE MINI~IU~'! DEPTH OF GRAVEL BETHEEN THE OUTFALL PIPE RtaD THE BOTTOtl OF THE EXCRVRTIOt.a <IN FEET>. REi~L' I RED SEPT I C TRNK S I .~E= 20.00 PERMIT RPPLICRtaT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTRLLATIO[a INSPECTIOt'aS OF At'aY WELLS ADJACEt'aT TO THIS PROPERTY At~D THE NUMBER OF' RESIDENCES THAT THE HELL WILL SERVE. TI-lO < 2 > I I'-.ISPECT I 0 I'-.IS RRE REfiLl I RED BACKFILLING OF RI.aY SYSTEM HITHOUT FINAL INSPECTIOt,a R[aD APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTAl.aCE BETHEEN A HELL At.aD RNY Ot'~-SITE SEHRGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELb OR 150 TO 200 FEET FROtl R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS R~aD CONSTRUCTIOta DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATIO~a. PERI"11 T E~-'~P I RES DECEMBER _"~-.-1 , I CERTIFY THAT i: I 8[4 FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEHERS RtaD WELLS AS SET FORTH BY THE MUNICIPALITY OF Rt'aCHORRGE. 2: I HILL INSTALL THE SYSTEM IH RCCORDAt~CE WITH THE CODES. ~: I Ut'aDERSTRND THAT THE ON-SITE S. EHER SYSTEM MAY RE[~UIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE ~ORE THAta ~ BEDROOMS. S I GNED: APPLICRtaT RALPH MRGGIO ISSUED BY___~_____~___~~ ...... D AT E._ _ ~_/~'~_/'Zg_ _ _ _ Vl 2 ' ' ~ LEGRL~O~ ~0 ~ ~[C~ ~ ~e~ ~ LoT'~IZE SQUARE FEE~ ~ TYPE OF SOIL RB~ORBTION ~TEM . , ' ';~IRXI~1UM NUMBER OF BEDROOH5 =~ , . ~OIL RATING ~ THE REQUIRED SIZE OF THE, SOIL ABSORPTION SYSTEH IS: THE LENGTH DIMENSION I~ THE LENGTH (IN FEET> OF THE TRENCH OR ~RRINFIEED. THE DEPTH OF R TREHCH, OR PIT I~ THE DISTANCE BETWEEN THE ~URFRCE OF THE GROUND AND THE BOTTO~,OF THE EXCAVATION (IN FEET>. ' THERE I5 NO 5ET WIDTH, FOR 'TRENCHE~. ,' THE GRAVEL DEPTH I~ THE MINIHUH DEPTH OF GRRVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE, EXCAVATION (IN FEET>. , ' PERI'lIT APPLICANT HRS THE. RE~PON~IBILIT~ TO IMFORM THI~ DEPARTMENT DURING THE INSTALLATION INSPECTIOWS~OF RN~ WELL~ R~JRCENT TO THIS PROPERTY AND THE NU~IAER OF RESIDENCE5 THAT THE WELL WILL SERVE. ------ ~1 ~ ( ~ ) [ N~PECT I C~t~ ARE REQLI I RED --- BACKFILLING OF ANY ~YSTEM WITHOUT FINAL INSPECTION RND APPROVAL BY THIS DEPARTMENT WIL~ BE SUBJECT TO PROSECUTION.. t'IINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE iO0 FEET FOR R PRIVATE WELL; OR 15G TO 2~8 FEET FROH R PUBLIC WELL DEPENDIHG UPON THE TYPE OF PUBLIC WELL. WELL LOG~ ARE REQUIRED AND MUST BE RETURNE~ TO THE DEPARTMENT WITHIN ~ DRYS OF THE WELL CO~PLETIOtL OTHER REQUIREHENT5 MAY RF'F'LY. ~PECIFICRTIONS AND CONSTRUCTION DIRGRRM5 ARE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PEAr, IT EXPIRES DECEMBER ~.. CERTIFY THAT I RN FAMILIAR WITH THE REQUIREHENT$ FOR O~-5;ITE 5;EWERS AND MELLS; RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INS;TRLL THE SYSTEH IN ACCORDRNCE WITH THE CODES. 3:: I UNDERSTAND THAT THE ON-5;ITE SB.IER 5;YSTEM MAY REQUIRE ENLRRGEMEI/T RES;IDENCE I5; REMODELED TO INCLUDE MORE THAN 8 BEDROOMS. IF THE VI 2 QGRE/-"-R ANCHORAGE' AREA Department of Environmental Quallt¥ 3330 C Street Anchorage, Alaska 99§03 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ~.~'~TAN K: DISTANCE FROM WELL INSIDE LENGTH MAmLmNG ADDRESS~'(~' J~Ib..~ ~! C~u.j,;~-)~,.,. PHONE LEGAL DESCRIPTION ~ COMPARTMENTS ~ -'r-o ~ L , INSIDE WIDTH , LIQUID DEPTH c-3~I_IQUID CAPACITY '~'"O0 GALLONS. SEEPAGE PIT: NUMBER OF PITS ~ OR WIDTH__, LENGTH ,DEPTH ~u~,NG ~O~NDAT,ON, ~ ~.L~ L,.E .~^REA (WALL AREA) ADDITIONAL ABSORPTION WELL: TYPE ~'~/. I I~UILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES DISAPPROVED ~'~q~ DEPTH DISTANCE FROM: NEAREST ~ I SEEPAGE SEWER LINE , TANK ./L~) , SYSTEM REMARKS DISTANCES= INSTALLED BY: PIPE MATERIAL: LOT SLOPE= REMARKS: Form NO, EO-031 DIAGRAM OF SYSTEM FINANCED THROUGH GREATER ANCHORAGE AREA BOROUGH SEWAGE DISPOSAL SYSTEM m APPLICATION AND PERMIT DRAIN FIELD PERMIT OTHER COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. DRAIN FIELD . BRAIN FIELD SEEPAGE PIT CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF TYPE DIAGRAM OF I~YST£M I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA ~3OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE LoT~ W. H. s~by Star "" 101 DRILLING.',, '~. .. WATER WELLS ~, ~ i .'~ '" ;- Glennatlen 882-3413 t (-~t6 li,'¢.r't ' ' "/-'J,O~) fA-,, ~ee to pay an addition,sum of not to exc~ ten pe~ent (10%) of the ~nt~ct price ~ attorney's feeg plus co~s, for'l~ proce~gs..- ~' Municipality of Anchorage Development Services De[daHment Building Safety Division On-Sile Water and ~'Vastewater Program 4700 Soulh Bragaw St. P.O. Box '196650 Anchorage, Al( 995t9-6650 www.ct.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-122-24 1. GENERAL INFORMATION Complete legal description ~, n I~ocation (site address or directions) HAA # I-.1 Expiration Date: 22~ M~o~ Lake ~. OiO /0 - ~ C.urrent Propedyown~er~,)" Elaine Elled~,e -Ma~lingaddress'..'~2369 M£rror Lake Dr. Chugiak, Lending agency Mailing address Day phone 688-5542 AK 99567 Day phone Real Estate Agent Cle-d~n wonseme~y Mailing Address Country Real Estat'e Un/ess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: :~ Day phone 3. TYPE OF WATER SUPPLY: Individual Well Individual Water SIorage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site :~ Individual Holding tank Community On-site [] Public Sewer The Municlpalily of Anchorage Developmenl Services Departmenl (DSD) Issues Certilicates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certil~cales of Heallh Authority Approval are required I'or the transfer of lille (except between spouses) for propedles served by a single family on-site wastewater d sposal and/or wa er supply syslem. DSD also Issues HAAs upon request to homeowners. Cedilicales of Heallh Aulhority Approval are valid for 90 days from Ihe date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less Ihan 30 days old. (Cedificates may be reissued for a period of up Io one year with valid water samples.) Cedilk~,les are valid for one year for properties served by Class A or B wells or a public waler system. The Municipality of Anchorage Is not responsible for errors or omissions tn the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER o As cedified by my seal affixed hereto and as of the validation daie shown below, I vedfy that my Investiga{ion, based on procedures outlined In the lieal[h Au(horily Approval Guidelines for Ihts application, shows that the on-site water supply and/or wastewater disposal syi;lem Is(ere) safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I fudher verity Iha{ based on Ihe Information obtained from Ihe Municipality of Anchorage files and from my Investigelion and Inspection, the on-site water supply and/or wastewater disposal system ts(are) in compliance ~,ilh all applicable Municipal and State codes, ordinances, and regulations In effect at Ihe time of Instaltation. NameofFirm S & S Engineering Address 17034 N. Eagle River Loop Ste. Engineer's Prin[ed Name Robert C. Cowan DSD SIGNATURE ~" Approved for ~ Disapproved. Conditional approval for Phone 694-2979 204 Eagle River, AK 99577 Dale 1o z ~-zr' ........ :' ',~._ ._~- bedrooms. ~, ~z~ 7 .............. :.. % ~ bedrooms, with Ihe following stipulations: Addilional Comments Altachments: HAA Checklist Septic System Advisory Well Flow Advisory X Mainlenance Agreements SUpplemental Engineer's Report Other Original Cedificale Date: Municipality of Anchorage Development Services Department Budding Safeby Division On-Site Water & Wastewater Program 4700 Soutil Bragaw SL P.O. Box 196650 Anct~xage, AK 99519-6650 www.d.~'tchc~age.ak,us HEALTH AUTHORITY APPROVAL CHECKLIST LogalDescfiption: ~-eT ~0 ~A~.Ho-~. RcCt.~.~ -fO ~ ParcellD: 0~9'/- A. WELL DATA Totaldepth ~' ff lt. ifA, B, or C provue PWSlD # -- wen Log (~) ¥~ · Wires pmparly protected C~I) Casing height (above ground) ~'/4'"..~. FROM WELL LOG Static water level ~J/K: lt. Well production ] ~' -- ,~ 0 g.p.m. AT INSPECTION WATER SAMPLE RESULTS: Coliform ~) colonies/IiX) mi. Nllrata O. ~ mg.A. Data of sample: $ / 5'/o / Collected by:. TankTypa/Material H'=~-O,~- / $~'~-¢ L- Tank ~ize ~, ..~' OOgel. Number of Co.,i.~ h,mnts J Foundation deanout {~N) y f-) Depression over lank (Y~) ,~ 0 Date of pumping N/~q - ~'~.-~ Pumper ~ Other bacteria O colonies/100 mi. S & S ENGINEERING 17034 F. Jule Rlwr LoopRoid No. 204 Eigle Rl~r, Alukl 99577 Oetein,ta,ed / Cl~noum ~YN) YE -~ High water alan~ {~N) 'Y ~ · C+ ABSORPTION FIELD DATA Date installed Soil rating (g.p.dJlta or~/'odrm) System type j Leng~l lt. ~ fl. ~pe lt. Total depth _ ff. Eft. absorption are~ __1~ Mo~__ Depreselon over field Date of adequacy test ~1) For bedrooms Fluid depth in absorption field be~ Water added gel. New depth in. Elapsed Time~l fluid depth in. Absorption rate >= g.p.d. Any rejuve atment (past 12 mo.) (Y/N & b/pe) If yes, give date O. UFT STATION Data installed Size in gallons "Pump on" level at in. 'Pump off' level Datum Cycles tasted E. SEPARATION DISTANCES Septic tanMlfl station on lot AbsmpUon field on lot Public sewer main Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/ciesnout SEPARATION DISTANCES FROM WELL ON LOT TO: ~--~ '9' / Sewer/septic sewice line ~ 5" '~ Holding tank / I ~ SEPARATION DISTANCES FROM ~~TANK ON LOT TO: Building foundation. (o o/ ' Property line ~' 0 / Absorption field Water main /d//A Water service line .,~o/-d-* Surface water Wells on adjacent lots '"/5' ~' Water main ~ Driveway. parking/vehicle storage Property line Water Service line Curtain drain F. COMMENTS SEPARATION DISTANCE FROM ABSORPTION FIt:t 0 ON LOT TO: Building foundation 8udace water ~ Wells on adjacent lots HAA Fee S Date of Payment Receipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number I certify that I have determined through field inspections end ~, '~.//I~A.~,/'-~ '~'..~ review of Municipal mco~ds thet the above sy:~terns am in ....... ..:... conformance wfth MOA HAA guidellnes in effect on thi$, data. JUL-Z1-O2 O9:47AM FROla-CT&E EHVIRONI,[NTAL SRV ,M~tLK CTIE EnvlronmentJI Service. Inc. 90756151QI T-O8Z P.O2/O) F-218 CT&E Ref. R Client Name ProJecl Name/# Client Sample Ordered ~WSID Sample Remarks: All Dategrlmt~ are Alaska Stladard Time l'rlnted Dirt/Time 07/22/2002 16:06 CaUec~ed Dar e/Time 07/i 5/2002 13:00 Received Date/Time. 07/16/2002 13:10 Ttchnical Director Stephe Relented Dy '(~~ Na~'m~'a Dmp ~r t.me~.t. Tmal Hilrate/Nilrilc I.o0 U PQL 1.00 U~its mg/L EPA 300.0 Allow~le p~cp A~alysis Limi~ D~tc Date 07/20/02 Init JlTl' ~tc rob:l, olo!~' Laboratory Toml Coliform coVlOOmL SMI8 9222B 07/16/02 KAP 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 ~wAv.ci.anchorage.ak.us " (907) 343-7904 O Cst T ~' Parcel I.D. L(05"I - la;)-~'~,'-/ 1. GENERAL INFORMATION .. Complete.. legal .des. cdPtion .L o '7' CERTIFICATE ,OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# Expiration Date: ] ~-- Location (site address or directions) Current Property owner(s)T/)o~ g3 ~ £c~,,,,~ Mailing address j::). O. ~ ~,,x (,-7:3 5' 0 (~ Lending agency Day phone Day phone '2. Mailing address Real Estate Agent Mailing Address Day phone Un/ess otherwise requested, HAA wi~~ be he/d by DSD for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: I~ Individual On-site [] r-I Individual Holding tank [] [--I Community On-site [] I--I 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 5 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 propedies served by a private or Class C well and may be reissued with ne,,,/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. STATEMENT OF INSPECTION By'EN(~iNEER :': As certified by my seal affixed hereto and as of the validation date shown below, I verify that my.investigation,-. :. ba§ed on~ procedures outlined in the Health''Authority Approval Guidelines for this application, sh'o,~/th~t the'' on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the numl~er 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. Engineer's Printed Name Name of Firm s & s ENGINEERING ' ' ' Phone - ~ ~ ~/- ~c,/2~ l/~J.~4 ~agle River Loop Road No, ~ Address Z, ml. River, AlajEa gg~ ' 5, DSD SIGNATURE C-'/' :Approved for ....... ~is. approved'. Conditional approval for ...... bedrooms, with the following stipulations: Additional Comments ¥': · ' ". ' · -, ~ . ON-SITE ,0', WATER AND : ~' WASTEWA~F~ ' PROG~M ..' 2 Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ~ -'~" 0 I (Rev. 12/00) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cLanchorage.ak, us (g07) 343-79O4 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: ~LoT ~o Z.~(~.H~- ,,qc..~.~J -~ ~ Parcel ID: A. WELL DATA we, type f'R,, Date completed '7/~.?/T3. Total depth ,.,C c~ ff. If A, B, or C provide PWSID # -- Sanitary seal (~))'~-..~ Cased to ,5" g- fL FROM WELL LOG Date of test -7/~- ~/-/~' Static water level ~d/~ fL Well production I ~ - ,~ 0 g.p.m. Well Log (~N) ¥~- -~ Wires properly protected (~fN) Casing height (above ground) AT INSPECTION ~. ~!,3.- fl. ~4 8DYE.. ,.~'. c~ g.p.m. WATER SAMPLE RESULTS: Coliform ~ coloniesll00 mi. Date of sample: ~ / ~ / o ! S. ~C-P-TIC/~TANK DATA Tank Type/Material /-/~ t-O, ~G-// Nitrate O. 5-- mg./I. Collected by: Tank'Size ~. ~' OOgal. · Number of Compartments Foundation cleanout ON) ~E- J Depression over tank (Y~) Date of pumping to/,q - N~,,,~ Pumper '"'- Other bacteria O colonies/100 mi. $ & $ ENGINEERING 17034 Eagle River Loop Road No. 204. Eagle River, Alaska 99577 ' ' Date installed Cleanouts (~/N) High water alarm (~N) C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft= or ft¥odrm) System type Total depth ft. Eft. absorption area ft= Mon~~ Depression over field Date of adequacy test ~ ~il) ~ For ~ bedrooms Fluid depth in absorption field b~i~.. Water added_, gal.. New depth __in. Elapsed TimeI __~;,,,/ F!nal fi.ui_d.d_~p_tll., in. Absorption r~e >= ._~.~_.. g.p.d. · Any rejuven eatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) ~ "Pump on" level at in, ~gh water alarm level at Meets & circuit requirements? Datum ~ Cycles tested alarm in. E. SEPARATION DISTANCES Fo SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots /DO On adjacent lots j o O Public sewer manhole/cleanout Holding tank ~/I ~ SEPARATION DISTANCES FROM SE.P-T4~HOLDIN~ANK ON LOT TO: Building foundation (o ¢~ ' Property line ~- O / Absorption field Water main /d///t Water service line ~o /'~Surface water Wells on adjacent lots '"/5"/-/'- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line '' Building foundation Water main.....--.""'"'- Water Service line Surface water ~_.~----'""~'- Driveway. parking/vehicle storage Curtain drain ~ &djacent lots COMMENTS '. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date ~O /~)3,/O / HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number (Rev. 12/00) CT&E Eflvimnmefltll $efllJcou I~¢. 90'?694 1211 Cl~.~b ~D FW'J1B lOl~)gO00l 0 (~lmt ~ Prlsml Ds~'ISm~ 08713/2001 I0~$ ~ Dstr./Tk~ 05/05/2001 14;00 R,~ivM D~s/'l~mt 0Lq)6/200l 10:45 T~lmie~d Dirt~'~r S~e~ C. Ede ~300 Ni~m: CC~ recovered ool~:le c~nu*ol !;"'~& (86.6%). 0300 U 0~00 ~ F~I'A 300.0 (<10) 08/06/01 ~croblologT T~al Co~ TOTP~- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 · CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0 '11 2.)-- Z 1, GENERAL INFORMATION Complete legal description Location. (site address or directions) Property owner Mailing ~address Lending agency Mailing address Agent Day phone Day phone Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~' TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OFWASTEWATER DISPOSAL: NOTE: Individual on-site Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 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 d.ate of this inspection. Name of Firm ~a~]e l~ver J~n~tee~n~ Address P.O. ~o. "/7~3)~, N~gle ~:.-,,AK' 99577-~2~ Engineer's signature ~~' Phone Date /.z. DHHS SIGNATURE '/ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of 'Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to pumhasem 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. RECEIVED Municipality of Anchorage riFF' 2 ~ ~een ~ DEPARTMENT OF HEALTH & HUMAN SERVICES'" -" "'" ~ Environmental Sewices Division a~u.~c~P~.;T~ O~ ~c.r~,.~{~l~~ 825 L Street, Room 502 · Anchorage, Alaska gg501 Health Authority Approval Checklist A. WELL DATA Well type Log present (Y/N) Total eepm If A, B, or C, ~tach ADEC letter. ADEC water ~smm number Oatecompleted /7-~.,~.~' -? ~ Cased to ~"'5"' ~ Casing height (~d:)ove ground) Wires pmpedy protected (Y/N) FROM WELL LOG AT INSPECTION we, producUon I ~' ' 2.~ g.p.m. 4- ~, ~' g.p.m. WATER ~A,MPLE RESULTS: Coliform ~ /.z-/~: -f~r Date of ~ample: / ?--li'-'~i~ ~, / ,',,"s / ~. Other bacteda C~Wcted ~: ~ .~', ~", ,~. B. ~II~OLDING TANK DATA Date installed ~'o~ -~2.. Tank size Date of Pumplr~ C. ABSORPTION RELD DATA Date Installed Depression (Y/N) ,"f,/ High wa/~r alam~ (Y/N) ,,~ Soil rating (g.p.d./t~ or ft~odrm) Sy~m type Leng~h~clth Grovel thickne~ below pipe ~ Effective al~lotptk:~ amazon over field (Y/N) __ PeraxSde tmmmem (mst 12 months) (Y~N) It yes, g~ dam 72.o2e (Rev. ~e)- D. UFT STATION /t~,,~ Date installed Size in gallons Manhole/Access (Y/ti) _ 'Pump n-." I~vul at' 'Pump off' level at' High water al~~~------~--~~ E. S~PARATION DISTANCES SEPARATION DI~rANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absoq~un field on lot Public sewer main Sewer/septic sewtce line On adjacent lots ~-/~'~ · Public sewer manhole/olsenout Lift ~on x4'~''ft SEPARATION DISTANCES FROM SEPTIC~OLDING TANK ON LOTTO: Foundation ~-~' ' Pro~e~'yllne ¥/43 · Absorpfionfleld Water maln/sewice line 45'O' Surfaceweter/dralnege ~/~tg' Walls on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: --;~eperty line Building foundation Water main/service line Surface water --- D~-./: : parldng/vehlcle storage area Wells on adjacent lots Date of Paymem Receipt Number ~:~-15-i3 Gi:O:) FKI~'I~ I~'¢II~OI&~T~.L ~ ~, _CT&E EnvlronmemM Ses~;cm T-.OG3 P.02/03 r.-lgT I~kc I[~ AcTcs IG 120 Clk~t PO~ Printed Datet~hUe 12115/98 00:18 Co~c~d Dale/Time 12/03/9g IO:.SO gec~ved Dare, Time 12.~Y,/~ 14:00 Tedu~al Dittos. ~,pt~n C. Ede TOTmT ¢otlfom O,1OOu O.100 a~JL TITC N/ Co111100 it. no fecat I ECEIVED DEC 23 1998 Munic,pahty ul ,~,,cho~age Dept. Health & Human Sen4ces · []ravosalPage .o. EAGLE RIVER ENGINEERING SERVIOr$ P.O. Box 773294 EAGLE RIVER. ALASKA 99577 Phone 694.5195 of/ Pages PHONE IDATE CITY. STATE AND ZIP CODE JOB PHONE. .................................................................................................................................................. iVE D ............................................................... D£C.._2 :~_:!998 ..................... Municipality ot ^ncnorage ........................................................................................................................................................ Dept. Health & Human Services ~]~t' ?~t'i~p135;' hereby to furnish material and labor -- complete in accordance with above specifications, for the sum of: · ~'e~s ~'(-- dollars ($ '~-C'U°-:'"~ ). Payment to be made as follows: Authorized ~ S~gnature Note: This proposal may be withdrawn by us if not accepted within days. Arrepla~e of ~Iroposal --The,bev. pdces, specifications and conditions ere satisfactory and are hereby accepted, You are authorized to do the work as specified, Payment will be made as outlined above. Date o! Acceptance: Signature Signature TIME DATE INSPECTOR INSPECTION APPOINTMENTS TIME DATE INSPECTOR DATE RECEIVED TIME DATE INSPECTOR . . DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTH & 826 L Street. Anchor~e, AIm~a ~O1 ENVIRONMENTAL P~OTECflON ENVIRONMENTAL SANITATION DIVISION Telephone 2644720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND tl0V :3 0 1981 SEWER && f D DIRECTIONS: Complete all parts on page t. Incomplete ~eques~ will not be ptoee~ed. Please allow ten (10) days for processing. t. PROP TY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from ~bo~) PHON~ 2. BUYER MAILING ADDRESS PHONE 3. LENDING INSTITUTION MAI LI NGx/e, DD~ ESS 4. REALTOR/A~ MAILING ADDHESS PHONE PHONE 5. LEGAL DESCRIPTION ior' Zo STREET LOCATION 6. TYPE OF RESIDENCE SINGLE FAMILY r-I MULTIPLE FAMILY 7. WATER SUPPLY [~ INDIVIDUAL* I'~ COMMUNITY I-'l PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY NUMBER OF~BEDROOMS [] One 1--1 Four [] I-'1 Two [] Five [~1 Three [] Six Other · ATTACH WELL LOG. A well log is required for 811 wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESS(NG CAN BE INITIATED, :* .~ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY i'-I MULTIPLE FAMILY I'-) ONE I-'l THREE I-'1 FIVE [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER r-'l INDIVIDUAL DEPTH OF WELL C~ COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: .-'~,~'~"~D If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Absorption Area to nearest Lot Line SepticlHoldmg Tank Absorption Area . ISewer Line 5. COMMENTS [] OTHER DATE [~'~'APPROVED FOR '~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-0t0 (Rev. 6/79) #1: Time 3:~/p.m. Date 4-1/~-78 Tuesday Insp Prtt~ ·. ~,-,MUNICIPALITY'OF A~CHORAGEF~ DEP'ARTMEN._.OF HEALTH AND ENVIRONMENT,. ~,,OTECTION 825 L Street, Anchorao~. Alaska 99501 264-4720 Date Received: April 6, 1978 Time ~ i~% ~) pi]I #3: Time Date ~ I-r~)-7 ~' t~ ;~ Date Insp ~/~ ~-I --, ~D~JJ Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Phone: Property Owner: Betty C. Rhodes Phone: Mailing Address: 4290 Reka Legal Description: .Lot 20 Lake H~lls~Subdivision ~3 Single Family Residence: (x~ Number of Bedrooms: TWO Multiple Family Residence: ( ) Number of Bedrooms: Well System: Permit # Construction Individual well (x~ Community/Public System ( ) Depth of Well Well Log on File Bacterial Analysis ( ) e Sewage Permit # Septic Tank Size Absorption Area Distances: Well to Septic Tank to Sewer Line Nearest Lot line Disposal System: On-site System ~ Public Utility Installed Installer Manufacturer Soils Rate Material to Absorption Area ( ) Absorption Area to Nearest Lot Line · ' .~ ,' /- ' MUNICIPALITY OF ANCHORAGE ' · fO~ ] Department of Health and Environmental Protection -ff~/ 825 L Street, Anchorage, Alaska 99501 ~4 04-' ... '" ~quest for Approval of Individual Se~ Water: Facz.~%tzes 1. Property O~er: ~I ~ ~9 ~' ~ ~ Mailing Address: ~¢~ ~~ ~ Phone: .'.'~.~- Name of Buyer: Mailing Address: ~;~/ ~~)~~ Phone~-~/~ Se Lending Institution: Mailing Address: Phone Realtor/Agent: Mailing Address: Phone Legal De sc.r. iption: Street Location: 6. Single Family Residence: l(~'~umber of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply:. *Individual Well (~Public/Community System ( ) If Individual Well, well depth If Community System, name of system 8. Sewage Disposal System: *~n-site System }~/Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 P, age ~'T~. O Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 20 Lake Hills Subdivision #3 Comments: Affadavit Attached:/~ 'Approved: '~C ,~~ Disapproved: ~epartment Worksheet: Letter Attached: ( ) Date '- Betty C. lhhodes 4290 Re3:a Subject! Lot 20 Lake Hill Acres Sub~£vision Before this dep~rtnent~y approve the =eg~est for sa~er and water approvalw an upgrade of thc wcll will be needed. The sanitary seal on the well casing needs to be tightened so that it is air tight. If there are any questions, ple&se contact this office at 264-4720. Sincerely, Robert C. Prattw Sanitarian cc~ Realty Center 8301 Arctic ~ouXevard 99502