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Home My WebLink AboutHOLLYS HOLLOW LT CHolly's Hollow Lot C #075-061-41 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O;C- 06 I- y I COSA# Nil oct o DG s 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address HOLLY'S HOLLOW S/D; LOT C Expiration Date: 7-17-09 138 IRIS POND CIRCLE * GIRDWOOD, AK • 99587 BRUCE RAYMOND Day phone P.O. BOX 801 • GIRDWOOD, AK • 99587 Day phone 783-2842 SHARNEE EPLEY W/ REMAX ALYESKA Day phone P.O. BOX 1029 • GIRDWOOD, AK • 99587 783-4217 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or13 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 it ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how bng the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the solo benefit of the owner listed above. Any reliance upon or use of this rr3port by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _„/ Approved for 3 bedrooms. Disapproved. Conditional approval for Date bedrooms, with the !flowing stipulations: 4 S'00 '757 0 _ nesse 4 Dt��) CE 3 •' �FO� t, ^A�o Vid�sP0r0�q: sstio^oroOF ,r , �gNrr ON-SITE S.5 -c: AND . m_ WASTEWATER : • PROGRAM : In»)»NOCI eeszfc 11)1 1�\ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory By: (Rev 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: J -/ 7- 0 1 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HOLLY'S HOLLOW S/D; LOT C Parcel ID: 07.5t 06'/-9/ A. WELL DATA *DEPTH OF WELL AND CASING WAS INSPECTED AND DOCUMENTED BY ARROW PUMP AND WELL. Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed PRE 5/1977 Sanitary seal (Y/N) YES Total depth •44 ft. Cased to *44 ft, FROM WELL LOG AT INSPECTION 4/6/2009 Date of test Static water level Well production Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in \I P'Nthrft. g.p.m. WATER SAMPLE RESULTS: Coliform 10 colonies/100 ml. Arsenic: N () ug./L. B. SEPTIC/HOLDING TANK DATA 38 ft. 6.2 g.p m. Nitrate°.302mg./L. Other bacteria 0 colonies/100 ml. Date of sample: 4/6/2009 ' Collected by GEG Ltd. Tank Type/Material Date installed Tank size gal Number of Compartments _ Cleanouts (Y/N) PUBLIC SEWER Foundation cleanout (Y/N) _ Depression over tank (Y/N) High water alar Date of pumping-. Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.dift'or ft= .. m)_ System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. ab • ion area ft' Monitoring tube_ Depression over field Date of adequacy tes Results (Pass/Fail) For bedrooms Fluid dept absorption field before test in. ' Water added _gal. New depth in. psed Time: _ min. Final fluid depth _ In. Absorption rate >= g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons in. 'Pump off" level Cycles tested "Pump on" level at Datu E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: N/A Septic tank/lift station on lot Absorption field on lot Public sewer main N/A 75'+ Sewer /septic service line Animal containment areas 50'+ •10'+ Manhole/Access (Y/N High water alarm level at in Meets alarm & circuit requirements? On adjacent lots I•WR86-160 100'+ On adjacent Tots 100'+ Public sewer manhole/cleanout 100'+ Holding tank N/A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Wells on adjacent Tots SEPARATION DISTANCE FROM ABSORPTION FI Property line Absorption field Water service line Surface water Property line Water service lin B LOT TO: oundation Water main Driveway, parking/vehicle storage 100'+ Surface water in drain Wells on adjacent lots F. 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 COSA guidelines in effect on this date. Engineer's Printed Name Date 41140`� JEFFREY A. GARNESS COSA Fee Date of Payment Receipt Number 06 (Rev. 11/05) 743 Waiver Fee $ Date of Payment Receipt Number flexmis Web Detail - Documents Wanda gram DEW 'ae ana •ROT a Ma la.._.,. �• : 'CP R-10-2009 02:47A MOH: G• sis %it AAROW PUMP & WELL SERVICE, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 • Fax (907) 333-8976 Eagle River: (907) 622.9335 r (ru Ne55 Gln CUSTOMER L 7 70:883245 P.1 OKWOO OC C P42 08321 JOB SITE r / B F.2;R PO t r; rr/e Gt r it000 d J L =9=a c7 y rd 11 I SWL 3^$ I MO/IMAM PUMPcevrn — EPSON /G i o n QUANTITY! DESCR PT10N PRICE AMOUNT .5WL-37'` 10�ll yY�'(,Cos;�� yYr; " Ve r it e ri 4.! Co IAA rr A r • LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR WORK ORDERED BYI DATE COMP. TOTAL LABOR PAY THIS AMOUNT yob k Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that 1f above work Is not paid for In 90 days I agree to allow Aarow Pump & Well Service. LLC. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.6% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division. of Environmental. Services 0n- Site Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A' SINGLE FAMILY DWELLING Parcel I.D. # 075-061-41'' 1. HAA #`'HA940134 GENERAL INFORMATION Complete legal descriptiony' Lot C Holl s Hollow Subdivision Location (site address or directions) Property owner Bruce Raymond Mailing address Box 801 Girdwood, Alaska 99587 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be for pickup. NUMBER OF BEDROOMS: Two (2) TYPE OF WATER SUPPLY: Individual well xxxxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer, xxxxxx> Day phone 783-2842' NOTE: If community wastewater system, provide written confirmation•; from State ADEC attesting to the legality and status of system. • By STATEMENT OF INSPECTION BY' ENGINEER z •+ 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. Name of Firm S & ` S Engineering Address 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska. Phone 694-2979 Engineer's signature Date DHHS SIGNATURE xxxx Approved for two (2) Disapproved: Conditional approval for bedrooms, with the following stipulations: bedrooms. Additional Comments This department •has received written confirmation from the engineer regarding the Conditional Approval of 3-17-94 The corrections have been accomplished and an inspection has been come ted by th- -ngineer. The subject property meets with M i pal" stand and is ` now `approved Date April 12, 1994 CAUTION The Municipality of Anchorage Department of Health and Human Services `(DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain' federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a, certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) - Back MOA 921 99577 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT SHAFER, P.E. ROGER SHAFER, P.E. April 11, 1994 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Environmental Services On -Site Services Section Box 196650 Anchorage Alaska 99519-6650 Reference: Lot 63-C, Holly's Hollow S/D CIVIL ENGINEERS (907)694-2979 FAX 694-1211 RECEIVED APR 121994 Municipality of Anchorage Dept. Health & Human Services Attention Robby Robinson, Please reference the conditional Health Authority Approval dated 3/17/94 in your files. On April 11, 1994 we performed a flow test on the well serving the referenced property. The static water level was measured at 36 ft below the top of the well casing. The flow rate was determined to be 7.5 gallons per minute with a 4 ft drawdown. The well casing was verified to extend to at least 40 ft below the ground surface. Excavation appears to have recently occured in the vicinity of the well head and driveway. No water surfaced on the ground during the four hour flow test. Please issue a permanent Health Authority Approval at this time. Sincerely, NOR 1 Engineer A. SHAFER, P.E. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE • r+r DEPARTMENT OF HEALTH & HUMAN SERVICES ( Division of Environmenta 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.# r`i, D—Otn1_L`I HAA# n1111-1 1. GENERAL INFORMATION. Complete legal description. Loi Hb ern rt ._■% yr .� y'a Haitow Subd iv.ie.ion Location, (site address or directions) Property owner Bkuc2 Raymond Day phone 783-2842 Mailing address Bax 801 G.urdwood, Ataz lax 99587 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water 2 XXX NOTE: If community well system, `provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer 0' XXX v. NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status''orsystem. .� 72-025 (Rev. 1/91) Front MOA 821 STATEMENT. OF INSPECTION BY ENGINEER` As certified by my se& 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 investation 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 ins•ection. S & $ CNGINEERING / Phone 61P'44"2 -g;79 7034 Eagle River Eagla Rivor, Ala Name of Firm Address Engineer's signature No. 204 Date 3—/-9` REQUESTING A CONDITIONAL H.A.A. THAT THE FOLLOWING WORK COMPLETED By JUNE 1, 1994 Y 42ab THE BROKEN WATER LINE LS TO BE REPAIRED AND DEEPENE #k A DEPTH OF 10' BELOW GROUND SURFACE. PERFORM A"WELL FLOW TEST AND VERIFYCASINGDEPT DHHS SIGNATURE Approved for Disapproved. Conditional approval for Z bedrooms, with the following stipulations: 4.0l7407f t/' /7 64Buf ✓v at 692174 Li /16/LL4-- Gn 0,149_ 1-9 batt A. Shalee • <fj Q Ni. 1457:4 dt� baa �one'.\QI fin•., bedrooms. Additional Comments Date %--E/ CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev: 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I70LLyfc % f0U-ow /D, LOT <3'C Parcel I.D. A. Well Data Well type 4\Uft:m_ If A, B, or C, attach ADEC letter. ADEC water system number h�� Log present (Y/�(MIfWML Date completed &r-(5/2. S` ?"?` Driller UNKNNAN Total depth "% +1/ Cased to * 4)1+ Casing height �/ /- Sanitary seal Y/) YFS Wires properly protected (ON) )/FS FROM WELL LOG AT INSPECTION imspEcreor,s UNR;1r�rc Date of t Static water level (( 3'� Well flow t g.p.m. Pump levell 38 '4 - SEPARATION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line 16 ; On adjacent Tots ; On adjacent Tots -(_ PeR., ()wNErt_. g.p.m. / Public sewer manhple/cleanout WATER SAMPLE RESULTS: Coliform Date of sample: Petroleum tank N �N 4a4A040,cE AT T/M E CF //�S7*f 4 7iai Nitrate ()IL/L./met Other bacteria Collected by: S S /N f2/A* BSEPTIC/HQLDING TANK DATA AA _ vl\S R jtiSC(C (rSoft. Date installed Tank size Compartments Cleanouts (Y/N) Foundation clee flu /N) De cion (Y/N) High water alarm (Y/N) Alarm to Date of pumping N mper SEPARATION DISTANCES FROM SEPTI • DING TANK TO: Well(s) on lot On adjacent lots Foundation To property line Absorption field Water main/service line Su, rfaceiwater/ddriainage 72-026 (3/93)* Front WELL how `FST WAS NOTEFF P -AP D_ CONTINUED ON BACK PAGE C. L FT STATION — ()Ns Pu3`rC Date in ailed Manufacturer Size in gallo Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" Level at High water alarm leve Cycles tested Meets MOA electrical code Y/N) SEPARATION DISTANCE FROM . IFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed Soil rating adjacent lots Surface water ___^____ za t� vy 1, ,, PD/F System type a c o I thickness Total depth ® o m Z Length Width Total absorption area Cleanout • esent (Y/N Date of adequacy test esults (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months SEPARATION DISTANCE F Well on lot /N) M ABSORPTION FIELD TO: To building found On adjacent - $ Surface ater Cu' • in drain Depression over field (Y/N) for After test Bedrooms If ye • ive date On adjacent lots Property on To existing or abandoned system on lot Cutbank Water main/service line \ Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, U.ES7/ ec orrromm- r4 ttiveu,R " T To pr-P7I-/ vF Signature or con WA -762 LINE BETWEEN W L' rgNO azoic ; \ t o' Q IS TA NE0 or -4 Rows s U P T Hr oUG-H t R%+aE N 12 WEcc- I-fi RO. 4.1.0 S `p& Ta,eErrr14m- tl+Fyr� Sr w rmed to all MOA and HAA guidelines in effect on the date of This inspection. C1ct-7 7H4-7 T/ -f€ u/A-7 LUiur 13E RE?lA1-�fti�D, N6 L4-Zr:/L jiiAN JUge LS w.4zE.n Engineer's Name e River Loo Road N ager ver, Alaska 99577 Date 9 Date of Payment Receipt Number 02 5 7-2, 0 c_;2_62) Waiver Fee $ Date of Payment Receipt Number 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 09L- i a'444 W/046 1. GENERAL INFORMATION (a) Legal Description (include Ipt, blo k, subdivision, Section, township, range) //®. iac4,4e-.4 /w g.SS. 3'04.317/0 N Sen - Location (address or directions) 01 n/ N/ 1V c G;RC..6 7 G, r J vi as idk (b) Applicant Name �.1 ;wA eF �zr Telephone: Home 7 g3- 2A 74 Business 7733— �uZ r. 2-5-6 Applicant Address (c) Applicant is (check one): Lending Institution%; Owner/builder ❑ ; Buyer 0 ; Other 0 (explain); (d) Lending Institution /'I I Telephone Address (e) Real Estate Company and Agent %% %R - Address Telephone (f) Mail the HAA to the following address: 4-40 . % Gl is✓�Q �✓ ..47 -A. --c /a, . s � c cj 5" ?" 2. TYPE OF RESIDENCE Single -Family Multi -Family 0 Other Number of Bedrooms 3 /i//'1�yA 3. WATER SUPPLY Individual Well Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 0 PublicA Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA1A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,,,,,„ -/GTelephone 54 7 570 7Address tea; o i (/-�s�/� p/1••••• Date ////e2 ///1 e 7 g e es Ser. vs G -e 70 /4 ®®�� oqs ineer's Seal ..•A4.9 °�, Sao .•' y, 49TH ;--11 - • B. WAYN END' S0 e Q:Gee •C-4488• c*® 0�®fesso0-\,4.4, 6. DHEP APPROVAL /� // Approved four i' 13bedrooms by ane /j/ Date //—? d -- °6 Approved X f Disapproved Conditional Terms of Conditional Approval 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 7n_nnS /1 /1141 A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth 42 - Static Water Level MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 115/44 $� E o ),y,E Id�� Legal DescriptionIV S 7^ro.✓ g2 S �9. /,v, MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV 1 71986 If A, B, C, D.E.C. Approved (Y/N) /"/1 - Date Completed Nr1 ve)GOA/ Yield 3^ 5 p ry Cased to 04,e›.---1- Depth of Grouting Casing Height Above Ground trx Pump Set At 'fp 2.- Sanitary Seal on Casing (Y/N) �e s /o Electrical Wiring in Conduit (Y/N) (j�S Depression Around Wellhead (Y/N) Separation Distances from Well: ,t To Septic/Holding Tank on Lot /" ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot NaA):e ; On Adjoining Lots ivo,iit w/ 71m/ /O4 r To Nearest Public Sewer Line /7 -Fr -i- To Nearest Public Sewer Cleanout/Manhole C-2---0 4 To Nearest Sewer Service Line on Lot ,�,,//��,� /4' Water Sample Collected by �• 1"--�+ � ...SAN ; Date /O/BIs 4' Water Sample Test Results 5.04..--71; 5 / �pe� / / Comments e5S / r'-eol /L� 're- W- Jet` Ne,.e-ch_j _ /1 OS Sb !a " r d at, 3 be of oe mD./ D./Me g+-6� B. SEPTIC/HOLDING TANK DATA Date installed /111741.45 Size No. of Compartments Standpipes (Y/N) Air -tight : es (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To ilding Foundation To Property Line To Dis.•sal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 C. ABSORPTION ELD DATA Soils Rating in Absor• ion Strata Type of System Design Date Installed Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Fie To Water -Supply Well To Property Line To Building Foundation To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Commentso. D. LIFT STATION Date Installed 0/4/ Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha checked, ver SignDate 3,1109/,_- %/. Company, JrA 14. • r . MOA No Receipt No 206 / OD /3 Date of Payment ////7//I Amount. $ 6S- e7J ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Page 2 of 2 72-026 (11/84) 6 51—a°6 o sZ m�a®►M ' eiliVttl ELINA HF bEF R nr CE -4488 4.,h 1°10fesstcc\ ®oma Municipality of Anchorage November 20, 1986 n P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH E. HUMAN SERVICES Wayne B. Henderson P.E. Peninsula Engineering 440 West Benson Boulevard Anchorage, Alaska 99503 Subject: Lot 63C Holly's Hollow Subdivision Waiver WR86-160 Dear Mr. Henderson: The waiver submitted by Peninsula Engineering for Lot 63C Holly's Hollow Subdivision for separation of the public sewer service connect and the private well is not required. It appears that the public sewer service connect and the well both were in place prior to 1983 when the regulation separation changed from 10 feet to 20 feet. The existing separation is 14 feet and grandfather under the old regulation. Sincerely, Daniel J. Roth Civil Engineer On -Site Services PENINSULA ENGINEE. .JG 440 WEST BENSON BLVD., SUITE 206 ANCHORAGE, ALASKA 99503 (907) 561-5107 GENTLEMEN: WE ARE SENDING YOU XAttached 0 Under separate cover via ❑ Shop drawings 0 Prints ❑ Copy of letter 0 Change order GATE //VS DATE JOB S' 6 - E -/52 ATTENTION / 4,..0 aD 10t63C RE: ��s �. h I ,� / / /0o G /1 ie �1 / ,0//86 /// &ZQ-// / c a.l N ,�2p 0 Plans 0 Samples the following items: 0 Specifications COPIES DATE NO. - DESCRIPTION / /1// b h I ,� / / /0o G /1 ie �1 / ,0//86 /// &ZQ-// / c a.l N ,�2p THESE ARE TRANSMITTED as checked below: O For approval ❑ Approved as submitted 0 Resubmit copies for approval O For your use 0 Approved as noted 0 Submit copies for distribution ❑ As requested 0 Returned for corrections 0 Return corrected prints o For review and comment ❑ ❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS _ `Mn��{ Q-1Veif- o.P "th 2 / We b1-ceu-3er- 7r%its cr�%cy //14—er Sda ws 7t it ce QI i it 5 e r -vi a //N e . l /CP_ TC/ iA✓ //3 7 /tea- /� , 6 Slfr�✓y fwae.% -74'..! s-e:cAC. - er �. , 74-SoLel✓1 c.- t.0e.,-� J` COPY TO O/ .04 N n 1. • iI ra\ S S3° J 10,479 sq. ft. 'o•�' D 77 5'S4\sq. ft. E CO 40.00' 35 0"' 0 Pomo W 0 N V) • N 36° 01' E 198.07' lo O M O N 7°24'Wj u� 40.00' 10,815 r2i col L . 1 65.29' 0 50 g B A 7, 705 sq. ft. 132.78' Layout Detail Scale : r= 40-0 W// , 0 ca:1' %7 " No.2 4 MON.