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Home My WebLink AboutHILLSIDE PARK PUD LT 20 . , 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 ~, DISTANCE TO: W~ ~' Abs°rpti°~a¢ Dwelling ~" ~¢~ e / No. of compartments ~ ~ Liq. capa~it~ g~[ons Inside length Width Liquid depth J,5 ~ IF HOMEMADE: ~ ~ O ~ ~ ' 'Liq~city~ons ~ No. oflin~ Length of each line ~ Total length ~ ~renc~idt~ Distancebetweea~ _ ~. ~ .... i~s Total effective ab~n~ea ~ Top of tile to finish grade ~ Material beneath tile Length Width D~ ~~b PERMIT NO. ~ ~ ~i C t so ~ / DIS~ETO: C~ ~ ~'Buil~ounda~ N~stlotli,~ ~ ~ ~ ~ Depth Driller ~ Distance to lot line PERMIT NO. ~ Building foundation Sawer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING /6~ INSTALLER REMARKS APPROVED DATE LEGAL CORWlN & ASSOCIATES, INC, CONSULTING ENGINEERS 4321 GRAPE PLACE SUITE 204 ANCHORAGE, ALASKA 99504 (907) 561-615! April 30, 1984 Mr. Keith Bandt Anchorage Department of Health & Environmental Protection Pouch 6-650 Anchorage, Alaska 99502 Re: Lot 20, Hillside Park Subdivision NoIJ~:qO~ld T~'J~NBWNO~/IAN~I a~)Y~IOAQN¥ ~/O ~IlVdDIN~II~ Dear Keith: During repair work on the lift station at the referenced lot, it was noted that there was a discrepancy in the size of the septic tank, as shown on Permit No. 810897, and the As-built inspection report of the sewer system, dated September 2, 1981. The As-built indicated a size of 1500 gallons. The permit showed a size of 1750 gallons. The septic tank and the lift station were emptied on April 28, 1984, and the amount of water required to fill the septic tank was measured. The volume measured was 2038 gallons, giving the tank a nominal effective size of 2000 gallons. This corrected volume should be noted o~ the sewer system As-built in the DHEP files. Sincerely yours, CORWIN & ASSOCIATES, INC. Stanley Brust, P.E. Associate SB:kjh Enclosures cc: Jim White 6 E,;2.5 "'L" .E;TREET., ANCHO~.~GE:., ilK. 995~3:1.. FiPF'I. I:FINT JFIK ...N_~?~.LtL. T IJN F'O BO::':: 5~';:~ .J'3C~T 'I ON TREE L ]: NE C OU~'T LOT 20 HILL~IB, E PFIRK .=,,,g LOT ,.-, ,. ...... TYPE OF '~FI~L HE,=,...KF~UN ''-' TRENCH THE REQU~REE:, qZZE OF THE 90~L FI~::qF~'F'TZFIN :,~:,IEH ZfS: THE LENGTH [:,tHEN'=7, iON I'2; THE LEI'.iGTH ,::]:N FEET::, OF THE TRENC:H OR DRFIINF.TF:LD. THE DEF'TH OF F! TRENCH OR PIT ~::.~; THE:'.': D:[:.~;TFINC:E BETHEEN THE SUF:'.FFICE: OF THE GROUND FIND ".['Fi[:_' E:C TT .3M 3r: THE EF'.:CR'~tFI'F I (_'iN ,:Z :[ N FEET THERE I:5 NO :"_-:ET F~.IE:,TH FOF.: TRENCHEE;. ]"HE "F:F,,- I'.:-: . _~l~.P ,EL BEI"t.,~EEN THE OU"FFFILL. PIPE :,_ ,EL DEPTH ']'HE i',iT. NZr,'I..M f',EF'TH EF 1 .... ','' FINE) THE E,'FIT't'EIH OF THE EF::CFIVFIT]:E~N ,:ZZht FEE.]'::,. F'ERH I T FIF'PL'[: FINT HFs'5 THE RE.'.5F' '.:. NE, I E Z L. Z TY TO :I: NFORH TH I $ DEF'FIF.:TMEN]" E:,UF.-'. 1NG 'THE tl - . ,- - ' '-' ~NSTF.~LHTT. ON ZN'gF'E'T~ON$ OF F~.NY HELL:, F~D,TFICE:NT TI.".'I ']'HI~ F...UFEF.'.[~ FIN[:, 'THE: NUHBER OF RE$~[:,E.NCE9 THFIT '.['HE I.,.!ELL I.,.t.~LL ..,L.F.E. BFICKFT. L. LING OF FIN"~' 'E,"r':STEH HITHCILtT F'-:[NFtL TN.:,FE .... IULt AND FIPF'F.'-'v'FIL BY L':,EF'FIRTHENT UI_.L E;E 'SU~3..:rE.:CT TO F'ROSECUTDL]N. h'tlNIHUH [,IL=;TFIN':E E:ETI-,.IEEN F~ HELL FIN[:, F~.f'.,br' ON-.-LZ,~TE SEI.,.IFIGE [:,IL:;F'OS:FIL =,~=,.]'EH 1_, 1~I.3 FEET F':F,~' FI F'R~.',,,'FfTE NELL (.'.iF: '1.~"~; TO ::h..'~A FEET P'R(.'H FI FUE, L..[... HELL DEPENF.:,:[NG . F'ON THE TYF'E OF F'UE,'L~C HELL. i"I~N~HUI"1 [:,I:STFtNCE FROH Fl F'RZ',,,'FFFE FIELL TO FI ~- ..... ,,,_ .=,EI. IEF. L. INE ]:S 25 FEET FINE:, TO FI COHHUNt'T'Y 9EI.,.IER L.I~"!E: I:L:;, ?5 FEET. :THEF" F.:EQUIF.:Er~IENTL-'.; !"18Y FIF'PL"r'. SF'EC:[F~CFITION.?, FIN[.:, CON'.=.:TRUC'r'zoN E. IH.~FHH= RRE F" ~.' ' '- I'"' F'ROF'EF..: .-t H:[L ~E,I...E 'T~:"~ ~.t'.,I=,_F.E ]:I'.,t'L-:TFtLLFITIC~N. .T. CERT_TFY THAT i: 7i:. Fi.t,1 FFI.t'!IL.]:FIR I.,.iI'T'H THE F~'E':.~ tREMENT'=: FEIR _N-.=,ITE :,Et...EF:, FIN[:, HELLL:.: 8:.:5 SET FORTH E'Y 'f'HE I"IUN.TCIF'FILITY OF FINCHORFIGE. "'~' I HILL 1' ,- - '-'"-' F ..... N=,THLL THE =, -r _-, T.=H TN FICCORDFINCE F.I:[TH THE CO[:,E:~;. ,-'~,,-' ' -~ ..... 'F ...... 1F' 3:: Z UN[:,ERSTFIND .]'HFIT THE ON-.-SZTE !~;ENER _-',..-.,~E,1 HFIY REL.qUZF'.E ENI._HF:..~EHEHF THE RE:E, :[ [:,ENCE '! :F..- F.'.E.HEE:,ELE;[:, TO Z N ZLLtDE H: ~;.'E THFIH ~::.; B~.'.DF.'Or3H'£:; · l--llLIIl'-"l 'Ir C: ]1: F"FIL I -T""-r" C~F- F!I'.."IL. H L,[~.F~ ...~E ~) .'~ DEPRRTMENT F'~-"..HERLTH RND ENVIRONMENTFIL,~"~OTECTION PERMIT NU. RPFL I E. RNT ..TMK UONz, T LOCRTIOH HILL=,I[. E PRRK LEGRL LOT 2~] HILLSIBE PRRK =,UB LOT _,I~E '~:28F~8 SC4UR T't'F'E OF :,l_,IL HB_,URFTIUN = NUMBER OF BEDROOMS THE RE6~UZRED :,~E OF THE SO~L HB:,_RFT~_N _r:,TEM ~S: =F~R'v"EL ~.EPTI4== THE LENGTH DZHENS[0N ZS THE LENGTH (ZN FEET) 0F THE 'TRENCH 0R DRRZNF[ELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTRNCE BETHEEN THE SURFRCE OF THE GROUND RND THE BOTTOM OF THE EXCRVRTION (IN FEET). THERE IS NO SET HIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETHEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE E,.,_.H,,RTILN (IN FEET). PERMZT RPPL[C:RNT HRS T~ RESF'ONSZB~LZTY TO ZNFORM THZS DEPRRTMENT DURZNG THE ZNSTRLLHTZON ZNSPECT~~~~DJRCENT TO THZS PROPERT'¢ RND THE NLIMBEF ~F ~E ,IDEfJ~~ME NELL ~~ B~CK~JLL~NG OF HN'¢ SYSTE~ WJT~IT~N~.J~PEC:TJON HND ~pF'ROCHL Dr TH~S DEF'ffiRTMENT HiLL DE SUBJECT Tl~. MINIMUM [:,ISTRNCE BETHEEN R NELL RNC~F~TE SEHRbE~ DISP~SRL SYSTEM IS UPONi00 FEETTHE F~RT,pERoFPR~,',,'~TEFuBLicHELL ~>9 F~FROM%R PUBLIL, HELL DEPENDING MINIMUM [:'ISTRNCE FRON R PRIV~~2.~' FEET RND TO 8 COMMUNIT'¢ SEI.,.IER LINE IS~~75 FEET. ~ / % _ HELL LOGS RRE REQUIRED RND PIL~~~HIN 38 DH'CS OF THE WELL COHPLETION. ~ ' , , , OTHER RE~2UIREMENTS MR'¢ RPPL¥. ~~4 [:,IRGRR~S RRE R',/RILRBLE TO INSURE PROPER INSTRLLRTION.~~ . I CERTIFY THRT &: I RM FRMILIRR WITH THE RE~T~UIREMENTS FOR ON-SITE SEI4ERS RND [,.IELL~ RS SET FORTH B'¢ THE MUNICIPRLITV OF RNCHORRGE. 2: I HILL INSTRLL THE SYSTEM IN RCCORDRNCE NITH THE CODES. 2:: I UNDERSTRND THRT THE ON-SITE SENER S'¢STEM MR'¢ REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN 3 BEDROOMS. .=, I GNED: ./ RPF'L ~C~T JRK CONST ..... ZSSI_IED B ' _ ..... E:RT[ .... V4. LO[ ~ Hi:tJ~$J:~ ~ ~ )1 An~hO,~lge, ~ ;RCOLATION '1 ~L DESCRIPT ENCOUNTERED? IF YES, AT WHAT Reading Date PER FORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Aleska 99S01 2~720 SOILS LOG - PERCOLATION TEST ~ ~/c/5~?~'/~ ~/~ ~-/o/~'~' DATE [] PERCOLATION TEST LEGAL DESCRIPTION: /-3 SLOPE SITE PLAN 6 7 8- 9 10 11 WAS GROUND WATER ENCO~.TE"ED? A/O ~- O P E IF YES, AT WHAT DEPTH? ,. Gross Net Depth to i Net Reading Date Time Time ~ Water Drop 12 13- 14- 15 16- 17 18~ 19- ' NO. 1732-E June 22, 1968 COMMENTS PERCOLATION RATE ..; .:i]~Esm RUN BETWEEN , .{minutes/inch} FT AND ..... FT /7~c~ 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. Cf 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Lot 2.0; Hills±d.e Park Subd±v±sion Location (site address or directions) 10601 Crooked Tree Drive Anchorage, AK Pr°pedy owner Peter & Fran Marbarger Day phone Mailing address C/O Jack White Real Estate AnChorage, AK Lending agency Mailin. g address Day phone Agent Bonnie Mehner/Jack White Real Estate Dayphone 762-3111 Address "3201 "C" Street 'Anchorage, AK 99503 '- Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~" ~' ~'~ TYPE OF WATER SUPPLY: Individual welt Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. xx TYPE OF WASTEWATER DISPOSAL: Individual on-site Ho tank Community on-site Public sewer NOTE: If communit) attesting to the legality; 5. 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 c~mpliance with all Municipal and State codes, ordinances, and regulations in effect on the dab bf this inspection. Name of Firm ALJlU~A_ W.a ~.R &/~/}~ i~fll~l~TER Phone ~7-- ~11~ Address -- ~I~EE ~~ Engineer's signature ~~ ~ Date ~ Alaska Water & ~~. A Wastewater Consultants, ~ - - '~'" or prior to, Closing for the, ~ Engineerin~ Semices Prov~ ~ Approved for ~ bedrooms. ~ ~ ~?O~ESS~_ ~-- Disapproved, Conditional approval for bedrooms, with th~ following stipulations: Additional Comments fl'-'l'llPlJ 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 engiqeer registered in the State of Alaska. The DHHS does this as a courtesyto 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#~I RECEIVt:u Municipality of Anchorage MAR 2 5 DEPARTMENT OF HEALTH & HUMAN SERVICESMuN~oP^UTY oF ^N~ Environmental Services Division ENVIRONMENTAL SERVICI~JilJJJS'~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist Legal Description: ~ tt-'~-~0~----- P/'""""""""~/-/ /._.eT' 'Z.(D Parcel I.D.: o I~ - 5/2- -~-~' A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number'Tt' c~ I ~ Z../~ I ~ Cased~te completed Casing height (abov~ FROM~NSPECTION Date of test Static water level Well production CW~mSAM~ ~mple: Nitrate g.p.m. Collected by: B. SEPTIC/HOLDING TANK DATA Date installed cj I q ~ I Tank size ? h0~5¢.- Depression (Y/N) I~C) High water alarm (Y/N) Foundation cleanout (~N) 't/ Date of Pumping ~--/cic~ Pumper C. ABSORPTION FIELD DATA Date installed ~J J l°l ~J Length ~'zgr ~ Width Effective absorption area cl'7 ~-- Date of adequacy test E¥~5'/~) ? Fluid depth in absorption field before test (in.); Fluid depth ~ (ins) M,nutes later: Peroxide treatment (past 12 months) (Y/N) Number of Compartments ~-- Cleanouts (Y/N) ~ 72-026 (Rev. 3/96)* Soil rating (g.~ or fF/bdrm) /~'~ Gravel thickness below pipe Monitoring Tube present (Y/N) Results (Pass/Fail) System type "[-'12.~'---.~ OH Total depth . Depression over field (Y~/N~. i"J O For ~ ~' c/~)-bedrooms Immediately after W1~c~al. water added (in.): ~' Absorption rate = ~ O0 + .g.p.d. If yes, give date ~J D. LIFT STATION ! Date installed ~:~ / Manhole/Access (Y/N) ~----'-~ High water alarm level at* Size in gallons // "Pump on" level at* ?-:Z.// "Pump off" level at* /,~, .~// *Datum Cycles tested SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: ! / Foundation c~ - ~) Property line Water main/service line I0/-I- Surface wateddrainage SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I Property line tO Building foundation IO/.~ Surface water tOO /'+ Absorption field ~' Wells on adjacent lots Water main/service line Curtain drain ENGINEER'S CERTIFICATION Icertifythatl~3~e'~ete~e~d~eld~nspectionsandrevi~ inconforma~ce wit~/~A~e~cton thisdate. Signature ~ Engineer s Name Date ~~- Driveway, parking/vehicle storage area Wells on adjacent lots t cv.3~+- Pv~' are Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-B - Anchorage ~ Alaska 99504 Phone (907) 337-6179 -Fax (907) 338=3246 Consulting Engineers March 16, 1999 Mr. & Mrs. Marbarger c/o Jack White Real Estate 3201 C Street, Suite 200 Anchorage, Alaska 99516 Attn: Bonnie Mehner Subject: Septic System at Lot 20, Hillside Park S/D. Dear Mr. & Mrs. Marbarger: Per the request of your agent, Bonnie Mehner, we performed an evaluation of the septic system which serves your property. The results are summarized as follows: The drainfield is a trench type system that was installed in 1981. It consists of two trenches, one is 16 feet long and the other is 38 feet long. Both trenches have 9 feet of sewer rock below the drainpipe, per MOA records. There does not appear to be a monitoring tube in the shorter trench and the monitoring tube in the longer trench only extends about 20 inches below the invert of the drainpipe. Below that point, the pipe is full of dirt, rocks, and pieces of fractured pipe. Consequently, water level readings in the trench cannot be made until the trench is 81% full. On 3/10/99, 300 gallons of water were introduced into the 38 foot long trench. On 3/14/99 an additional 2035 gallons were introduced into the trench, bringing the total presoak volume to 2335 gallons. On 3/15/99, 2149 gallons were introduced. It is estimated that the pore space of the drainrock, in the 38 foot trench, in the 88 inches below the sump, is estimated to be around 2800 gallons. In sunma~, between 11:00 am on 3/14/99 and 12:00 ma'dnight on 3/15/99 (37 hour period), 4184 gallons was introduced into the 38 foot trench. At no point during the test was there any standing water noted in the sump (again, the sump only extends 20 inches below the drainpipe invert). Based upon this data it was concluded that the absorption capacity of the drainfield meets municipal standards for a 4 bedroom house (600 gallons per day). Prior to obtaining an non-conditional health certificate, the following work will need to be done: Locate the foundation clean-out, or have one installed. Have the solids pumped out of the lift station and verify that the float control and alarms are functional. A+ Home Services would probably best prepared to do this work. Repair the broken septic pipe in the yard. It should extend above grade and have a new jim cap on it. 4 inch plugs (with wing nuts) should be installed on all of the clean-outs in the driveway. This will satisl~ the MOA requirement that all clean-outs have air-tight caps, A copy of this punch list was faxed to A+ Home Services (Mike Blakeslee, 345-1890), Carls Excavating (Carl Elsenbast, 346-3568), and G&G Equipment (Gary Skaggs, 360-2579). If you have any questions, please contact me at 337-6179. Pres e I~aacs Pumping Service, Inc, 6215 Quinhogak Street Ao~ Atae~, AK ~507 DATE ~NVO~CE ~ 3/~8/99 ~22 BILL TO MARBARGER, PETER fO$Of TREEIJNE COURT ANCHORAGE, ALAE~CA 99516 QU.4NTITY P,O, NO, DESCRIPTION Pumpe~ & C/eaned Toff Pump - Floet ~i~h .......... Y~R~S ............ Due onm~eipt RATE CLASS AMOUNT 210,00 7'0.00 70.00 $0 /fOAD $8~°$~'15 "IV /_.07-/.--.q Lot ~ ~ Block. Anchorcl§e Recording Precinct, Alaska LOT SURVEY CERTIFICATION I hereby certif7 thru I II,va surveyed the property shown and described he~e~n~am:l th~' the impf-ovemenfs situated thereon ore within the prop- LEGEND t~: Brass capped monument recovered o : Iron pipe and/or rebar recovered arty lines and do not overlap o~encrooch o~ adjoce~ property and that no ~ -- 2x2 hub I~ tack recovered improveme~s on adjocerd ~opert7 overlap or encroach on the premises · ~n questlcn and that ~ere are no roadways, ufilit'/lines or other visible .~'.~ ~: .__~.,.(/~..~ ~/~-~ ~ ...... , e~ments on said property except os indicated hereon. Prepared ~: (907')27~- 6200 R. Z. . .?) T TON Registered Lend Surveyor 519 W. Eighth ~.?, .lncho~age~ Alaska 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, blockJC~:lil~ion, section, township, range) Location (address or directions) (b) Applicant Name ~ ~1~ Telephone: Home Applicant Address ~4 /~ ~ ~ ~l~ ~. / ~c);, ~pplicant is (check one): Lending Institution ~; Owner/builder ~; Buyer ~; Other ~ (explain); Business : · (d) Lending Institution -.,-- ---:-' Address Telephone "Real Estate Company and Agent Address phone · Mail the HAA to the following address: [] , Other WATER SUPPLY ndvdua We [:],\CommuntyJ~ Public[] · ':: : .':,;,.~;~1',~" ' ,' ' ', Note: If ~o~munity Well system, must have written confirmat on from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If com munity well system, must nave written confirmation from the State Department of Environmental Conservation attesting to the legality aha s~atus, 72-025 (11/84) Paae I of 2 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, fu hctional 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 Munici pal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm...~u/fcY. '7"e!~.~'*/O, ~,;t~'~, Telephone ,,-~/~ I/")(~ Date ,roved for "~/~'~'~ bedrooms by ~."-- ''~' ~'/"~ Date. - ~ Disapproved Conditional Terms o~"C~0nditional 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. Pa(~e 2 of 2 MuNICIpALI~'Y OF ANCHOx~GE MUNICIPALITY OF ANCHORAGE (MO,.-,/ ENVt~oiqMEN'fAt-S!:RViCE$ P?ItstCRiEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 (~:?~.~° ~7 264-4720 ~ Legal Description: ~ WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results If A, B, C, D.E.C. Approved (Y/N) 4J~_-~ (/ Date Completed Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed "~- ¢ Standpipes (Y/N) Y Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ~ '/" TO Property Line ~'O'~'~/~'"~L*C~e--- To Water Main/Service Line ,~'r Course Size _.~,.,~J~Z)___ No. of Compartments Air-tight Caps (Y/N) Y Foundation Cleanout (Y/N) Date Last Pumped ~/~ ;for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ~ Lot To Water Main/Service Line Type of System Design Length of Field ~-4'¢'~ Depth of Field /,,.~'~" Gravet Bed Thickness ~ ~ Standpipes Present (Y/N) Date of Last Adequacy Test Y To Property Line To Existing or Abandoned System on ~o ,~. o./2 ; On Adjoining Lots ~,t..~,~. To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area D. LIFT STATION Date Installed Size in Gallons //~) "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments ~ Dimensions ..~(~ # ,~/,~ ,¢& ¢¢~-~ Manhole/Access (Y/N) ~/ "Pump Off" Level at /,¢,'¢¢¢ Vent (Y/N) ~ Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify tha. t I have cj,~cked,verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Si g n ed '~)'C/.~-- ~~ Date Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal DEpT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE, ALASKA 99503 STEVE COWPERt GOVERNOR 563-6775 DATE: PWSID #: To Whom It May Concern: Accordioq_to the records on ¢ile in this of¢ice, the __ P~P ................ ~I~rP-A~ Water System is in compliance uith the State o? Alaska Drinking Water Regulations. Sincerely, Ronald S. Klein Environmental Field O¢¢icer ~ MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL m~ALTH DEPARTMENT OF ~R. ALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR WgALTR AUTHORITY APPROVAL CERTIFICATE // 1. General Information Application Date /~/~'~ (a) Legal Descript:ion (in.clude lot, block, subdivision, section, t:ownshtp, range) ~Z~ ~ //~//~ ?~ Location (address or direct:ions) Business (b) Applicants Name _~-'7~~ z~,~W- Telephone- Home (c) APplicant is (check one) Lending Institution ~--~; Owner/builder ~uyer ~--~; Other t I <~lain); (d) Lending Institution Telephone Ad~ ss (e) Real Estate Co. & Agent Address (f) Telephone Mail the HAA to the following address: 2. Type of Residence Single-Family~ Number of Bedrooms 3. Water Supply Individual Well~'"[ Multi-Family~--~ Other (describe) CommunitYF--~ Public~--~ 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 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. En~ineerin~ Firm Providing Tn~pectious~ 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 Authgrity Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and ~ype 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 om-site water supply and/or wastewater disposal system- is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection.~z~ ' Name of Firm //~'~/~w.~-~7 ,~., ~<~ ~ Telephone ~'-~ Date /~/'/ ///~" ~\'~' ......... Approved /~ Disapproved -- Conditional -- CAUTION TH~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ~.ALTH AND ENVIRONMENTAL PROTECTION (DREP) ISSUES HEALTH ALITHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DEIEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORE. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AU~HO~TY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Legal Description: DEPL OF HEAL[ii & ~NVIRONMENTAL,.- - ,.., 8E6 2 8 I984 Well Classification /~ Well Log P~esent (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot To Nearest' Edge of Absorption Field on Lot To Nearest Public Sewe~ Line C leancut/Manho le Wate~ Sample Collected By Water Sample Test Results C~u~nts ,/ If A, B, c~ C, D.E.C. Approved(Y/N) Date Completed Yield Depth of Grouti~q Pure9 Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewe~ Service Line on Lot ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Size ~2-~ 63 O No. of C(~%~artments Air-tight Caps (Y/N)/~%~ Foundation Cleanout (Y/N) Depression over Tank (Y/N) /5/~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) /¢//~ ; for ///7 Holding Tank High-Water Alarm (Y/N) /~//~ Tempora~.; Holding Tank Permit (Y/N) Separation Distances frc~ Septic/Holding Tank: To Water-Supply Well > ~-'~ / ~ To Building Foundation _4.~' '~ ~ TO Property Line .> ~ To Disposal Field ~2~~ ~ To ~ter Mai~/Service Line ¢¢~/~-~¢ To Stream, Pond, Lake, c~ Major D~ainage Receipt % Date Paid: Amount: [Page 1 of 2] 2-15-84 C® ABSORPTION FIELD ~AT; Soils Rating in Absorption Strata Date Installed //z/~/ Width of Field ~z~ ~ Type of System Design Length of Field ~ ' ~ Depth of Field~'~ ~ Gravel Bed Thickness /~' ~ Square Feet of Absorption A=ea //-~ ~'~ Standpipes Present (Y~) ~p~ession ove~ Field (Y~) ~ ~ of ~st A~a~ ~st Results of ~st ~a~ ~st ~ ~'~ ~p~ation Distan~ ~ ~s=pti~ Field: To ~te~-Supply ~11 ~ ~ ~ To ~o~rty Li~ > /o '~ To Buildi~ Foun~tion ~ ~z~ To Existing or ~ndo~d System Lot ~ ; ~ ~joining ~ ~/~ ~' To ~ter Mai~=vi~ Line ~ p ~/~ To ~t~(if pre~nt) To Stre~ond~ke/~ ~jo= ~ai~ ~ To ~i~way, P~ki~ ~ea, ~ Vehicle St~a~ ~ea 3~~ ~~ z~. D. LIFT STATION Date Installed Size in Gallons //O "Ptu~%~ 0~" Level at High Water Alarm Level at Tested fo= Electrical Codes(Y/N) Dimsnsions 3 ~ Manhole/Ac ss "Pump Off" Level at vent Pumping Cycles duwing Adequacy Test. Meets MOA ** Check Permitted Bedrccm Rating Against HAA Request ** I certify that I have checked, verified, cr confcmred to all MOA HAA Guidelines in effect Signed°n the date oI ~/~th~s ~nspectiqp. Company ~/?~-~-/~-¢~,:-, ~-~ KB1/d5/s [Page 2 of 2] Date MOA No. ENGINE]~P.S SEAL 2-15-84 BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 3~3 ANCHORAGE, ALASKA gg50] 274-~533 To Whom it May Concern: According to records on file in this office the /~~~'/~ ~/~ /~Water Systemis in compliance.with the State Drinking Water Regulations Sincerely, -APPLIC~'NT FILLS OUT UPPER HAt'"-~i'~3NLY Address T~O' Residence Single Family Multiple Family No. of Bedrooms [] Other Water Supply [] Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. Community For wells drilled prior to that date, give well depth (attach log if available). Public Utility Sewer Disposal [~' Public Utility When Oonneeted to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time 0~-~ ~,~ Date Date Date Date (,~,,` Field Notes: DEPT. ~ ~NVI~ONM~N~AL RECEIVED (~PP~OVED BEDrOOm8 ~GONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) GOND TONAL ~PP~OVAL~ Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~'~¢ / w.~ to T~.~ S~ptio T~ Si,. /&---m O