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HomeMy WebLinkAboutHILLSIDE PARK PUD LT 34Hillside Pork Lot 34 #015-122-54 Municipality of Anchorage Page 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 Permit Number: (-~'vVV'°lLIfo~ ~-~ PIDNumber: Dl~- ~ ' Name: ,~ 0 0 ~ ~.e.%/,,,~(~ ~.1 t/.I Wastewater System:~New ~Upgrade Address: 7~ J ~~ T~ ~ ABSORPTION FIELD Phone: [ No. of Bedrooms: ~ ~ Deep Trench Shallow Trench ~ Bed ~ Mound ~ Other I LEGAL DESCRIPTION Soil Rating: Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township:[~ Rang~ ~ Section~ ~ Fill added above~ ' ~°rJginaJgrade: Ft. Gravel length: ~ Ft. Number of lines: Distance~n tines: WELL: ~ New ~ Upgrade Gravel width: ~ Ft. [ Ft, Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Static Water Level: Installer: I Dateip~talled: Yield: Pump Set at: Casing Height Above Ground: J TAN K GPM Ft. Ft. SEPARATION DISTANCES ~ s~p~ic TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines A~ Material: ~ ~ / Number of Compartments: Surface ~/ LIFT STATION Water Lot Size in gallons: J Manufacturer: "Pump on" level at: "Pump off" level at: High war rm at: Foundation ~ ~0 ~ V~ Curtain Drain ~/~ ~/~ ~ ~ Pump Make & Model J Electrical Inspections performed bY: 0~0 Remarks: BENCH MARK Location and Description: ~ '~ {' b¢~ tm~ Assumed Elevation: J ENGINEER'S SEAL 2nd '~/q 1~ ,, ,.. Department o[ Hea nd Hum~ Services approval Reviewed and approved by' ~~g ~J Date ' J.,' ' '' ' / I ~ccess / AC 24 FT BC J0.5 Air L/ne ! AD 30 BD J5.5 AE 31 BE J7  ! BG I O0 AH 119 102 / ~ ~ ~ '*i~/t ................... . ~ 25 50 75 ldo ]25 TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 LOT 34 HILLSIDE PARK JOHN ROOTS 7001 CROOKED TREE SEPTIC SYSTEM AS BUILT DATE: DECEMBER 13, 1994 SHEET: 2/$ GRID: 2539 ?ro~ STEP Air Line 2O Fi I¢er 30 Hi( PVCLinen 2' [nsulotlon oil sides, ~op ond bo~fom VIE~ £ond PEA GRAVEL _~o¥o%o~o~o~o~o~o~o~ o~o%o'z'- o~o~o~ PEA GRAVEL SIDE VIE~ ~IELL TOBBEN SPURKLAND P.E. II 203 W 15TH. AVENUE II ANCH. AK. 99501 (907'~ 279-3916 18x20 SAND FILTER LOT 54 HILLSIDE PARK JOHN ROOTS SEPTIC SYSTEM SS BUILT DATE: DECEMBER 12, 1994 SHEET: 3/4 GRID: 22.5 DRAINFIELD 5 FT W/DE 22.5 FT LONG ! FT OF ROCK 2 FT TOTAL DEPTH 3 FT OF COVER Sample Access. 8-Inch Sump 5.00 96.2 1250 GAL STEP TANK WITH 4-INCHES OF INSULATION I© <1 NO SCALE 80.6 75-b 70.7 69.5 91.7 1250 Gal STEP 12" Sewer Rock 4" Distribution M/raft 140 BENCH MARK: BASEMENT F. F. ASSUMED ELEV. 100.00 FT TOBBEN SPURKLAND P.E. 203 Wl5th Ave Ak 99501 LOT 34 HILLSIDE PARK 7001 CROOKED TREE JOHN ROOTS SEPTIC SYSTEM DESIGN DATE: DECEMBER 12, 1994 SHEET: GRID: 2538 T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: HAA for Lot 34, Hillside Park December 21,1994 Jim Cross; An application for an HAA was made on December 14, 1994. Through an oversight the Municipal Electrical Inspection report was not included. Please f'md same attached. To~b~b eYours,.~ ROUGH IAN ,r,~ OOSEI~V 8B~XA'MIN~ AT. N~Xi¥ IN,~PECTi£t)N liEN COI;,'KECTION,.~ ABE'MADE, PI.EA~;E:.C'A'L[. F DO NOT RF. HOVE ~HJ~'.'NO~'ICE T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: HAA Lot 34 Hillside Park. December 14, 1994 Gentlemen; Transmitted herewith is the f'mal As Builds of the septic system installed on this property. As stated to you prior to obtaining the permit to install this system, the owner, Mr. John Roots, needs a n unconditional HAA for this property in order to transfer ownership to a relocation company. The transfer will occur as soon as approval of the septic system and the HAA are received by the relocation company. Mr. Roots is anxious to closes as soon as possible and expediency on your part will be appreciated. This system was installed during cold weather. The temperature of the materials used in the filter was measured and found to be in the low 20's. The temperature in the filter itself was found to be 22 degrees 12 inches into the sand. The outlet to the filter was capped and hot water was discharged into the STEP tank. When the tank was full, the pump timer was set at 3 minutes every 15 minutes. The warm water discharge was continued for 2 hours. The next day the filter was drained. Water coming out of the outlet was 32 degrees. The temperature in the tank was 65 degrees. The residence is vacant at present, the airpump is pumping air. Since the system is insulated, there should be no concern about freezing of the filter. As soon as the residence becomes occupied, the temperature of the filter will rise. The tank was pumped from the driveway on December 13, 1994. The driveway is 22 feet above the bottom of the septic tank. The service line to the house was found 10 feet below basement floor level. We managed to rise this line 2 feet. The driveway is level with the second story of the residence. The contractor constructed an access road to the work area as shown on the site plan. This road could be used as access for pumpers. The existing tank was pumped, crushed and buried on site. Yours Tobbe~'-¢urkland P.E. REC£IV£D DEO 1 4 1994 Municipality o! Anchorage Dept. Health & Human Services T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: HAA 940082 Lot 34 Hillside Park Attn: Jim Cross December 22, 1994 Per your comments dated 12/19/94 we are submitting a revised siteplan showing the location of the airline between the house and the sandfilter and the location of the testhole used to design the drainfield. With this additional information I hope that the HAA will be issued. Yours R[CEIVED OEO 2 2 1994 Mur~c,pahty ot Anchorage Dept. Health & Human Services 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 NUMBER:SW940428 DESIGN ENGINEER:TOBBEN SPURKLAND, OWNER NAME:ROOTS JOHN C & LYNNE OWNER ADDRESS:7001 CROOKED TREE ANCHORAGE, AK 99516 PARCEL ID:01512254 PAGE 1 OF //0 PERMIT DATE ISSUED:Il/09/94 EXPIRATION DATE:il/09/95 LEGAL DESCRIPTION: HILLSIDE PARK PUD LT 34 LOT SIZE: 32556 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /'SEPTIC 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: AND SECONDARY THIS PERMIT IS FOR AN INTERMITTENT SAND ~TER RECEIVED BY: / ~ DATE: DATE: PROPERTY OWNER AGREEMENT INTERMITTENT SAND FILTER WASTEWATER DISPOSAL SYSTEM This agreement, dated_ 0 ~ 2 (~ ,1994, is made between the Municipality of Anchorage~ D~ e~par~m~ent pf Hca!th an~ ~a~aanaSe~¢es (DP~ mid the prope~y owner(s) of q0~( This agraemon~ is made for ghe pu~oso of designing, constructing and ~osfing an ' ' 'a filter on-site was~ewater disp°s~ system on the subject property, m~e~uttent s nd ~ne property o~dr~S5 1. The prope~Y owner(s) '~11 allow DHHS ~d its representatives access to the subject propo~y/as required during the denial, consmtction and testing of tho wastewater system, 2. The prope~y owner(s) a~ee to bear ~1 costs involved in a testing program wl~eh ;~11 sample the effluent ~om t~s wastewater system tbr a period of one year. T~s testing pro.am ~11 involve fl~e eng~nee on this prtgect, _ .., sampling tho effluent every other month for 12 months for: total suspended solids, BeDs, fecal coliform, nitrates, and total '. e stapling sched~e ~11 be ~eldahl ~trogen, ~so determined on th same the septic t~ effluent temperat~e ~d ~he s~d filter effluent temperature. The prope~y owners ~11 pay all en~nee~g and labora'~o~ costs involved, M1 data ~1i be f~shed to DHHS in a timely rammer. Prope~y exeter Name (Notarize Here) T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Septic System Upgrade Permit Lot 34, Hillside Park October 17, 1994 Gentlemen; A septic system, consisting of a 1458 sq. ft. bed and a 1000 gallons septic tank, was installed on this lot in 1985. An adequacy test conducted on August 29, 1994 by S&S Engineers indicated that the system was in a state of failure and did not meet the adequacy requirements of DHHS. The 1000 gal. septic tank is located 30 feet or more below the driveway. Most likely the tank has never been pumped, a fact that probably has had an impact on the operation of the drainfield. On October 6, 1994 we excavated three testholes on the lot. As can been seen from the attached soil logs, the soil conditions are inconsistent, and it would not be proper to base the design of a standard trench on any of the observations. The soil log prepared by Alaska Environmental Services in 1985 shows 2 feet of organics, i foot of gravel and then silt, ML, to 15 feet. The top of this silt was perc'ed at 55 minutes per inch, based on a 60 minutes percolation test. Tested under today's requirements, one can assume that the rate would be more than 60 minutes per inch. Under these conditions I request permission to install an "ORENCO Sandfilter". I have made arrangements to obtain the necessary soil information this Tuesday. The requirement for soil suitability is less stringent for the sand filter than it is for a standard system. Yours /~ Tobben'~Spurkland P.E. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN 10 11 12 13- 14- 15- 16 20119187 -~! ~d~ WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After[ Monitoring? ~ ¢' ~ Date: L O P E Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ TEST RUN BETWEEN __ (minutes/inch) PERC HOLE DIAMETER -- · FT AND ~ FT COMMENTS PERFORMED BY: ~. ~ I CERTIFY THAT,~'HIS TEST WAS PI~RFORMED IN 72-008 (Rev. 4/85) DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST · p&~L~_ ~' ~L (ENGIN, EER'S SEAL} DATE PERFORMC~D: Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14- 15- 16- 17- 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Dale: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE -- (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND FT COMMENTS PERFORMED BY: ~ '~ I CERTIFY THAT THIS TEST WAS PERFORMED IN ~COOROANCEW,TRALLST^TEANDM~N,C,PAL~'OEL'NES'NEFFECTONTH'SDATE. DATE'. ~(-'- 17,/~ q ? 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 DATE PERFORMI Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20- WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P Depth to Water After Monitoring? . Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN __ FT AND FT COMMENTS PERFORMED BY: ~ ~ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOROANCE WITH ALL STATE AND MUNIClPAL GUIDELINES IN EFFECT ON THIS DATE' DATE: ~'~-~'71 l~ ~ /'~ 72-008 (Rev, 4/85) I '4Xh, ~. ~ 6~EEN~EL T L~I 50 0 50 i00 150 2& 050 300 SCALD i" = lO0 FZ TOBBEN SPURKLAND P.E. II 203 W 15TFI. AVENUE II ANOH. AK. 99501 (907) 279-3916 LOT $4 HILLSIDE PARK JOHN ROOTS 700i CROOKED TREE SEPTIC SYSTEM DESIGN DATE: OCTOBER 5, 1994 SHEET: I/$ GRID: 2558 £5 0 £5 EX/ST. BED ABANDONE EX/ST. TANK X 20 SANDF/LTER GAL. STEP TANK ££ALE; ]' = ~ FT, lSD 1~5 158 TOBBEN SPURKLAND P.E. II II 20:5 W 15TH. AVENUE ANCH. AK. 99501 (907') 279-:~g 16 LOT 34 HILLSIDE PARK JOHN ROOFS 700! CROOKED FREE II SEPTIC SYSTEM DESIGN DATE: OC[OBE£ 5, 1994 SHEET: 2/3 GRID: 2539 Fro~ STEP Air Line .5' ~i~PLING WELL 30 N;I PVC Liner 8~ Insulotlon oil sides, fop ondbottom TOP VIEE /~ PEA GR~VEL 'liter Send .................................. ~o~o ............................................................ PEA GRA VEL SIDE VIE TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 18x20 SAND FILTER LOT 34 HILLSIDE PARK JOHN ROOTS SEPTIC SYSTEM DESIGN DATE: OCTOBER 16, 1994 SHEET: 3/4 GRID: 8538 22.5 DRAINFIELD 5 FT W/DE 22.5 FT LONG ! FT OF ROCK 2 FT TOTAL DEPTH 3 FT OF COVER Somp~ Access, 8-~eh Sump 5.00 1250 GAL STEP TANK WITH 4-INCHES OF INSULATION © NO SCALE Cover 4" Topsoi/ 1250 Gel STEP 12" Sewer Rock 4" D~fribufion M~ofi 140 BENCH /dARK: GARAGE SLAB ASSUMED ELEV. !00.00 FT TOBBEN SPURKLAND P.£ 203 W15fh Ave Ak 9950! LOT 34 HILLSIDE PARK 700! CROOKED FREE JOHN ROOTS SEPTIC SYSTE/d DESIGN DATE: OCTOBER !6, SHEET: GRID: 2538 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: - C) '~' ~\ 1 2 3 4 6 7 8 10- 11 12 13 14 15 16 17 18 19 20 DATE PERFORMEI Township, Range, Section: SLOPE ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water After Monitoring? SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ~,,~ PERCOLATION RATE ,~. ~:~ (minutes/inch)/PERC HOLE DIAMETER TEST RUN BETWEEN '~""' ET AND '~A'''~L''' ET COMMENTS PERFORMED BY: '~'- ---~ I CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORO^NCE W,TH ALLSTATE^N,. M,~N,C,PAL GU,DE'-,.ES'" EFFECT ON TH'S DATE-DATE: ~4~q~ ff 72-008 (Rev. 4185) £5 0 £5 EXIST. BED $ X 22, S ABSORPTION BED : ½ © [ e'~'~'. .~ ABANDONE EXIS[ TANK ~ X 20 SANDFILTER GAL. STEP TANK SO 75 100 SCALE~ 1" = 50 Fll 158 ! 20:5 W 15TH. AVENUE ANCH. AK. 99501 l'907~ 279-5916 LOT 34 HILLSIDE PARK JOHN ROOTS 700! CROOKED TREE SEPTIC SYSTEM DESIGN DATE: OCTOBER 5, 1994 SHEET: 2/5 GRID: 2559 T. S PURKLAND P.E. 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-601 Municipality of Anchorage Division of Environmental Health Department of Health & Social Services 820 1 Street Anchorage, Alaska 99501 RE: Bimonthly Testing of Oreneo Sandfilter Lot 34 Hillside Park -- Ms. Cheil Ponder June 22, 1995 RECEIVED JUN 2 2 1995 Oept. Heatth& Htjman Services ATTENTION: Dan Roth; Transmitted herewith are the results of sampling performed on June 2, 1995. Tobben~ CT&E Ref.% Matrix Client Sample ID Client Name Ordered By Project Name Project~ PWSID CT&E Environmental Services Inc. Laboratory Division w~m-~w~-~-~w~w~w~,m,~w~w~J-~~~~~~ 95.2324-1 Laboratory Analysis Report ROOTS TOBBEN SPUP. KLA_ND, P.E. TOBBEN SPURKLAND UA WORK Order 15368 Printed Date 06/16/95 Collected Date 06/02/95 Received Date 06/09/95 11:01 hrs. 14:40 hrs. 13:30 hrs. Technical Director STEPHEN C~ EDE Sample Remarks: SAMPLE COLLECTED BY: TOBBEN. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init MOA Sand Filter Study Residue,Non-/Filterable BiochemicalOxygenDemand Fecal Coliform Nitrogen, Nitrate Nitrogen, Kjeldahl 4.5 mg/L EPA 160.2 06/11/95 06/11/95 ~AV 63 mg/L EPA 405.1 06/09/95 06/14/95 TAV 9 #/100ml SM17 9222D 06/09/95 06/10/95 TAV 0.10 U m~/L EPA 353.2/300.0 06/12/95 DJS 4.33 mg/L EPA 351.3 06/14/95 06/14/95 OAA See Special Instructions Above UA = Unavailable See Sample Remarks ~Coove NA = Not Analyzed Undetected, Reported value is the practical quantification limit. LT = Less Than Secondary dilution. GT = Greater Than 200 W. Potter Drive, A.¢horsge, AK 99518-1605 -- leh (907) 562-2343 Fa×: (907) 561-5301 CT&E Ref.# Matrix CT&E Environmental Services Inc. Laboratory Division ~~'~'~'~'~'J'~'~J~'~'~f'~'~'~'J~ 95.3484-1 Laboratory Analysis Report WATER ~ Client Sample ID L24 HILLSIDE Client Name TOBBEN SPURKLAIFD, P.E. WORK Order 17293 Ordered By Printed Date 08/25/95 ~ 15:09 hrs. Project Name Collected Date 08/17/95 ~ 13:15 hrso Project~ Received Date 08/17/95 ~ 14:05 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: SAMPLE COLLECTED BY: TOBBEN. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 57.9 mg/L EPA 353.2 10. 08/18/95 CMR BOD5 3.4 m~/L EPA 405.1 08/17/95 08/22/95 TAV Residue, Non-Filterable 2 m~/L EPA 160.2 08/18/95 TAV Kjeldahl-N 0.2 U mg/L EPA 351.3 08/23/95 08/24/95 OAA * See Special Instructions ~tbove UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed ~!= Undetected, Reported value is the practical quantification limit. LT = Less Than ~ = Secondary dilution. GT = Greater Than 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2343 Fax: (907) 561-5301 MUNICIPALITY OF ANCHORAGE DF, ATMENT OF HEALTH AND HUMAN SER~,..,ES "' Environmental Health Division '~ 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~ SEPTIC ABSORPTION Lot ,~ ~ J BIock~[~ Subdivisioni4 ~ ~ ~ , Township, Range, Section AS-BUiLT DIAGRAM (Show location of well septic system, property hnes, foundahon, TANKS - '~ ;' N ~SEPTIC ~ HOLDING ~ m ~ TRENCH ~/BED ~ W. DRAIN ~ OTHER Depth to pipe bottom from Total depth lrom original grade Gravel length Gravel w~dth ~ FT Z '~ FT Total absorption ar~ Distance between lines WELLS ~ PRIVATE ~ OTHER fldentifv) Classification {A,B,C) Total Depth F~ Cased to ,FT I~staller Date installed: REMARKS: : Cj~,~,q ~¢-~¢c, I '~ ~¢ Scale: ENGINEER'S SEAL ~~ ~p;rE,/ Cy ~)~.,,¢ Inspections Pedormed by: Date: : I ~ cedily that this inspection was ped0rmed a~c0rding l0 all Municipal and State ~elines in effect on this date: /E~ - ~ -~ ~ Health Depadment Approval: ~ ~ate:~ DEPARTMENT OF' HEALTH AND E:NVIRONMENTAL PROTECTION 825 L STREET, ANCNORAGE, AK 99501 264-.4720 PERM I T NO: D A T' E 1 ,~...~ U E. D: 850445 0 '7/25/85 APF't I CAN]': A D D R E S S: C.',ONTACT PHONE: I_EGAL DE,SCRIP: L. OT SI ZE: MAX BEDROOMS: D & S UNLIMITED 7800 DEBARR ~.206 ANCHORAGE~ Al< 99504 344-.8424 SUBDIVISION: HIL. LSIDE F:'ARK SECT I (]lxl: 1 :]."; T'C]WNSN I F': 32556 (Si]]. FT. [IR ACRES) 3 LOT: 34 12N RANGE: .".":;W LLOL, N. N/A ,..~e, p t. 1 List. ed below ape t. he optic~ns available to you in designing your ~'~ '' system. Choose the opt:Lon that best F:i. ts youp site. DIEI:::'TH TO F'IPE BOTTC]M (FT.) 4.0 4.0 4.0 GRAVEL.. DE:PTH (F"T',.) 7.0 O. 5 3.5 TOTAL DEF'TH (FT.) 11.0 4.5 '7,,5 GRAVEL.. WID]'H (FT.) 2,,5 27.0 5, C) GF~AVE:L. t....ENG'T'H (I:::'T.) 92.0 *-.~ 54.0 '.1.38.0 *"~' GRAVEL VOLUME (CU.YDS.) 63.9 54.0 102.3 TANK SIZE (GALS) t,000.0 .~..~. 1,000.0 .~'~ 1,000~() *.~ SC]IL RATING (SQ.F'T. /BR) 427 322 427 ~*. GRAVEl ..... :E:NG]'H > '75 I:::'T. RE:QU]:RES MUI...TIPL. E RUNS (NO7' E.r. XCE:EDING 75 FT,, EACH) *..~ TANK ~tUST HAVE AT L..IEAST TWO COMPART'ME:NT'S I cePt.:i. Fy that: 1.. I am CamiliaP wi'th the r'equiPements For' on-site sewer's and wells as set. ¢or't.h by the Municipality oF Anchorage (MOA) and the State oF Alaska. I will ir~sta].l the syst. em in accoPdance with all MOA c;odes and r, egulations, and in compliance with t. he design c:r'ite~ia of this pePmit. ::5. I will adher'e to all IdOA and EH:ate of Alaska r'equiPements fop t. he set. back d:Lstances Fr'om any exist, ing well, wastewaten disposal system or' public sewePage system on this or' any ad.jacent or nearby lot. 4,. I undenstand that {his pepmit is valid ¢o~- a maximum o¢ 3 bedPooms and any enlapgement wJ] ]. pequir'e an additional pepmit. IF: A L:IFT STATION IS INS'TAL. LED IN AN AREA COVE:RED BY MOA BUIL. DING CODES, THE:N- (1) AN ELECTRICAL F:'ERMIT AND INSPECTION MUST' BE OBTAINED; (2) AS-BUIL. TS WILL NOT BE AF'PRC]VED WITHOLFf' AN ELEC'fRICAL INSPE:C]"ION REF'OR'T; AND (3) THE E:L..ECTRtCAL. WORK MUST BE DONE: BY A LICENSED ELECTRICIAN. f.."~ I GNE:D AF:'F'LICAI',.IT': D & iii; UNLIMITED I SSLJE:D BY //~ . DATE: DATE." MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVl RONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: SLOPE 14 15 16 17 18 19 SITE PLAN PERFORMED BY: ~'~'~ I~A~ ~- ~'5 was GROUND WATER S ENCOUNTERED? ~ , ~ P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop ~ H~~ ~c) i, SZ ,08 ~ 515 ~o PERCOLATION RATE TEST .o5, ALASKA ENVIRON~'~-~NTAL CONTROL SERVICI:,,~ INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SCALE SHEET NO. OF CHECKED BY DATE-- 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 FOR A OF ON-SITE SYSTEHS APPROVAL $1NGL~ ?AHILY DWELLING Parcel I.D. 015-122-54 1. GENERAL INFORMATION Complete legal description HILLSIDE PARK P.U.D.; LOT 54 Location (site address) 7001 CROOKED TREE DRIVE * ANCHORAGE, AK * 99507 Current Property owner(s) GERALD & SHIRLEY FAIRLEY Day phone 544-4661 Mailing address 7001 CROOKED TREE DRIVE * ANCHORAGE, AK * 99507 Lending agency Day phone Mailing address Real Estate Agent Day phone -:Mailing address Unles~s otherwisO~ ?oquested, COSA Will be held by DSD for pickup. NUMBER OF BEDROOMS: 5 31 TYPE oFWATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] ' Individual On-site · Individual Water Storage [] t individual Holding tank [] Community Class A Well · Community On-site [] Public Water System E~] 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 or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea/affixed hereto and as of the validation date shown below, f 'verify that my investigation; based on procedures outlined in the Certificate of Qn-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. 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. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 5701 E. TUDOR ROAD, SUITE 1.01 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 557-6179 Date Engineer's 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 long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal rigbt whatsoever. DSD SIGNATURE ~"'~ Approved for bedrooms. Disapproved. Conditional approval for : WATER AND :. W^STEW ,Tm bedrooms, with the fllowing stipulations:~ 2...PROGRAM .' Z'-'.~ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report' Other Original Certificate Date:. ~ -/' (" - 1 / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 EImore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: HILLSIDE PARK P.U.D.; LOT 54 A. WELL DATA Well typeCOUUUN~TY Date completed Total depth__ .ft. Date of test Static water level Well production WATER SAMPL~ R~~t~'~ Coliform J colonies/100 mi. If(~ B, or C provide PWSID# 212461 Well Log (Y/N) Sanitary seal (Y/N) Wires properly protecte~J e~round) in. Cased to ft. Casing h FROM WELL LOG ~...~,~ECTION .~~.p.m. g.p.m. Ars'~ic: __ ug./L. Date of sample: Collected by: Nitrate __ mg./L, Other bacteria __ colonies/100 mi. Bo SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./STEEL Tanksize 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 9/,:3/2010 Pumper Date installed 12/7/1994 Cleanouts (Y/N) YES High water alarm (Y/N) YES A+ HOME SERVICES ABSORPTION FIELD DATA I'BELOW EXISTING GRADEI Date instail~'d' ' 1"2/7/1994 Soil rating ~or ft2/bdrm) 4.0 System type, ISF/TRENCH Length 24 .ft. Width 5 ft. Gravel below pipe 1 ft. Depression over field. NO For 3 bedrooms New depth 6 in. in. Absorption rate >= 450+ g.p.d. NONE KNOWN If yes, give date - 8/8/2011 AND FOUND TO BE DRY. Total depth *4.8 ft. Eft. absorption area 120 ft2 Monitoring tube YES Date of adequacy test 6/5/2010 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 480 gal. Elapsed Time: 185 min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) NOTE: ISF AND DRAINFIELD WERE INSPECTED ON LIFT STATION Date installed 12/7/1994 "Pump on" level at TIMER in. Datum BOTTOM OF TANK *SEE ATTACHED Size in gallons 1250. "Pump off" level atTIMER in. Cycles tested * A+ HOME SERVICES INCPECTION REPORT. Manhole/Access (Y/N) YES High water alarm level at 44.5 Meets alarm & circuit requirements? YES in. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: ICOMMUNITY WELLI Septic tank/lift station on lot Absorption field on lot, Public sewer main Sewer/s~ ~ Ap~na'FdSnta'm m e nt a rea s On adjacent lots On adjacent lots ~eanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field. 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ Water main 10'+ Driveway, parking/vehicle storage 10'+ COMMENTS ISF UNIT WAS DRY DURING INSPECTION. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in confomTance with MOA COSA guidelines in effect on this date. Engineer's Printed Name dEFFREY A. GARNESS Date ~/t111t COSA Fee :$ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment. Receipt Number. GARNESS ENGINEERING GROUP, CONSULTANTS & GENERAL CONTRACTORS Ltd. August 11, 2011 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 REFERENCE: Hillside Park P.U.D. Subdivision, Lot 34; 7001 Crooked Tree Drive, To whom it may concern, The subject property is served by a community well and a private septic system. We were retained to inspect the septic system for the purpose of obtaining a C.O.S.A. The septic system is an Intermittent Sand Filter system. The flushing valves for the ISF sandbox are buried several feet deep and not easily accessible. According to the original inspection report, the flushing valves were never extended above grade. The system was approved by your department four times in the same condition (12/27/1994 (HAA & Inspection Report), 8/27/1996, & 5/10/2001). Per our correspondence with your department, you are requesting the flushing valves be exposed, extended above grade and flushed before the system can be approved again. We are requesting that the system be approved in it's current state. The following items are justification for this request: · As mentioned before, the system has been approved by your department four separate times. · The ISF system has been in place 14 years without use of these valves and appears to functioning correctly (the ISF sandbox was dry during our inspection). · Standard pressurized drainfields do not require flushing valves. As a compromise, we are proposing that the M.O.A. allow for the pressure distribution system to be chemically treated with Septiclear. If you have any/itu please contact us at 337-6179. P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com 05/11/2011 0?:2@ 86867?0 A+ Home Services, Inc. Inspections PAGE 01 Name: -'~ ~,-cuo_. ~'oar, Led_ Phone Number: ............... --'- ............ ' ......... lrn~pection # ' Timer Setlin8 ........ ,' ~' o',~' ...... .'..~ 6,~ Air Flow ,.'~_ ' % --2_ _~.._..~ ..... Event Counter_ l'"~ 5"-~, '7 ' Date & Time <~ --/iT ...~/. ......... .-F?;~:--- ,-,a*. Ho,,~',e Services, Inc. lnsr~ections Phone Num, ber: Inspection/~: ........................................................................................... " O Timer Setting ...... 'L.:_ ....................................................................... Elapsed Time ............... .~,...Z/~'' ,ff""~ Event Cotlllter Date & Time Problem: ...... HOME SERVICES INC 750 t E. 140th Avenue~ Anchorage~ Alaska 99516 345-1890 CUSTOMER IN~OIC:E # Lot ~,. DATE DESCRIPTION Gallons , ' ..... Septic __... Leach Area ..... Hdding Tank ~ Standpipes/~Tim PROBLEM AREA -- CALL FOR MORE INFORMATION NEEDS TO BE DONE AGAIN iN fi MONTHS Good Shape [..i'i] Sludge buildup onbottom Jim cap missing or [i'~! Cut standpipe to 1' above ground needs replacing Floater on top Needs Septictrine 0~/~0/~010 08:2~ ~68~770 ~PLUS P~GE 01  INVOICE # 3 ? 7 4 8 7501 E. 140th Avenue Anchorage, Alaska 99516 345-1890 CUSTOMER Anchorage, ~ 99507 Block Lot DATE DESCRIPTION AMOUNT ', ' =' ..'""".i~J:~',~, ' ' __ Gallons __ Septic __ Leach Area __ Holding Tank Standpipes __ ~me ~ PROBLEM AREA -- CALL FOR MORE INFORMATION O NEED8 TO BE DONE AGAIN IN 6 MONTHS ~ Good Shape ~ Sludge buildup on bosom ~ Floater on top ~ Jim cap missing or ~ Cut standpipe to 1' above ground O Needs Septictrine needs replacing INVOICE# 36651 CUSTOMER · 7501 E. 140th Avenue Anchorage, Alaska 99516 345-1890 7001 Crooked Tree Drive Anchorage, ~ P9507 Block Lot - DATE DESCRIPTION AMOUNT - - ~~ ..~/, I RE :: . . .... .?~ :.~.:~ '~.~ ,~"~ - -" t /~Gallons ~ Septic ~ Leach Area ~ Holding Tank ~ Standpipes ~me ~ PROBLEM AREA-- CALL FOR MORE INFORMATION ~ NEEDS TO BE DONE AGAIN IN 6 MONTHS ~ Good Shape ~ Sludge buildup on bo~om ~ FIoateron top ~ Jim cap missing or ~ Cut standpipe to 1' above ground ~ Needs Septictrtne needs replacing ?__8 No, 5347226gL Pago ~ Them 53472269 Uniform Residential Appraisal Report 14 compa_~!)le properties current, off,md for sale in tl]e subiect neighbOdlOOd mRgi~ iD DdCe from $ ~g,9oD lD S 600.000 13 ~mDamble salm tn tNe sub mt ne~b~rh~d w~bin the Da~ ~eNe mm~ mngtn~ .in ~te prim from $ 400,000 to $ 595 000 [ SUBJECT ' ~ OOMPA~BLE SA~E'~ 1 ' CO.ARABLE SALE ~ 2 " COMPARABLE ~LE ~ 3 Address 7001 Crooked Tree Drive 11251 Avion Street 17000 East Tree Court Anchorage, AK Anchorage~ Alaska ~Anch~rage, Alaska I '2~22 miles W 0.20 relies S 6200 East t 12th Avenue Anehora eL, ~_a_s__k..s__ ............. 0,75 miles SW [$ 53;b $ __1.8_6,_.4.~ S~,IL i h: AFBa VALUE ADJUST~E]NTS ~_.~ESCRIPTIQN DESCRI~ION ~ +(-) $ Adju~e~ Sales or ~i~an~ng ] None ~ LOCa~on ~ Average ~S mi ar LasGholdF~e SimDl~ ~ Fee Simp~ Fee SimBl~ ~e i 3255~Average ~4~lSimilar ~ ~ G~od I~erior +~,00O ]$ N/A- Refll]~;L ,. 't. ': .i.!iS 509,000F :.. ~$ 530 000 ' '.':i'i! MLS ' _ Ageni/AMDS __ -- MLS ~ . .~:i~.yni~e~rds Municipal Re~rds ...Municipal Re~rds DESeRI~~ +{:)...S.Adi~S~e~ESC~ ~t0N ; ~(-).S None I No~ Good Similar 1986/Eff t7 19751Eff 28 C0ndi4J0n ! Similar' Above. Grade Ba~ Tml 8drms. Room Cou~t 8 3 8asemem& Hnished 638 SQ.Ft, 952 SQ.Ft. R~ms B~ow Grade 2-0-1 ; Conventional 07f01/08 j Conventional 10~08/o8 Similar I Similar Fee Simple _~ Fee _Sjm~e 3136g/Similar 49404.1Sim ilar Similar. j~uPerior :.,.. i -10,l 2 Story/Similar ~ i2 Stow/Similar i Similar , ~ilar +:Z2,000 1981/Eff 17 i . IT~$"0~ff 23 ; Superior ! ~10~ .......... i T~! ~B~.~ ~ ~Z~[ ~Gdrm~j ~"~ .... +8,~0 2~578 sq.~] +13,680~ 2,856 sq.[.~ -3~ -11.000 None i +22,300~ NO~ +~,; +~6,~0 ~ +6,0001 Simiia:r Similar GHWBB GFA Similar !Similar 3 Garage -7,O0012 Gauge (L~) i .. -6 ( Similar Similar Similar No. rLe PorcM~atie/Deok Similar +5,000~ NODe +5.1 39,980 Ne~ Ad j. 5699801Gr0ssAdL ~} %iS 542,, Average Similar . _ __ t GFA i GFA i __ ISlandard iSimilar · 2..G. arage 2 Garage (Lr~, ....... -6,:000 ExtnsvDkFence Superior Simitar 420si Similar Sale4o~List Aefustmem , __ Adjured Saie Pfic~ ~' .... " Nm Adj. 7.4 of ComDarabtes ~,:;, ;:iGr~ss Ao~. t6.t %]$ ~6,840 G~ss ~. 1~.2 % $ did nm r~eamh the see or ~ra~sfer ~ br t~ three Alaska ITEM P~e of Pdof Sol,Transfer reveal any prior sales or trarmters of the comparable sM~s for the yy~Drior to the date of see of the comparable sate Re~rds ad~onal p~or sales on page,,3). _. SUBJECT COMPAR~LE ~LE ~1 COMPARABLE SALE ~2 COMPARABLE ~LE ~3 None r None NODe : None Effete Date of D~a Source(s) i Current msmr~ of the sub'eOL~Ot_.property and comparable sales have had no other reported sales/listing activit~_o_ver th_e_p~ast~Lvear. Current Current The subject has not re-sold W~thin the past th(ee~years~ The comp_ara. in the sub he. Anchorage hj!lside. This are~ ~ one mile, Age adjustments.are : comparable sales wera found that were more recent.in terms ~f a.qe. G__rp_ss adiustment for sales are relatively la ,, e~._g_a_use_homes in this neighborhood are individually built add are lherefore ngt Partic_ularl~qeneous. Lack of tract of similar housing ~ corks!dere,,d,,a,,' ~.~iti_..ve factor~ The sales used are considered to be the .best available. Sa!e 2 was ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this Day of ~ .~4~ of 20 ] [ , by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 2. Definitions. located Anchorage, Alaska. A. Alteration. Any change to the design or function of an AWWTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On-Site Systems Approval. ,am approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On-Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On-Site Wastewater System Construction Permit mad all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of (~D ($ ~,-3...00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the ^WWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On-Site approval is issued to the new owner or transferee of the property. 5. Alterations~ Installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Opemfing Permit is: TLx..,,(c<, A yr~ r- C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. Nonwaiver. The failure o£either party at any time to enforce a provision o£this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. SeverabiliW. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: STATE OF ALASKA THIRD JUDICIAL DISTRICT M-IJNICIPAI,ITY: By: Title: Date: The foregoing instrument was. acknowledged before me this ]~_ day Iq(Y'T-AR~f~IQ ~OR-~KA My Commission expires: ~O/a ~L/ao I3 Municipality of Anchorage Development Services Department Budding Safoty Division On-Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY .APPROVAL FOR .A SINGLE FAMILY DWELLING Parcel I.D. 015-122-54 Expiration Date: 1, GENERAL INFORMATION 5"-'/o'- Complete legal description HILLSIDE PARK SUBDN~SION; LOT 34, Location (site address or directions) 7001 CROOKED TREE DRIVE * ANCI-IORAGE~ AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent CLAIR RAMSEY w~/ DYNAMIC PROPERTIES Matling address ROD COOK Day phone 261-3186 P.O. BOX 232069 s ANCHORAGE, AK 99523 Day phone Dayphone 3111 "C" ST. ANCHORAGE, AK. 99503 261-7600 Unless ogherwlse requested, HAA will be held by DSD for plckup. 2. NUMBEROF 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 ~ ~E] Individual Holding tank Community On-site B [-'] 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 professlonal civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the lransfer 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 prope~es served by private or.Class C well and may be reissued with new water sample results less than 30 days old. (Certificate may be re=ssued for a period of up to one year with valid water samples.) Certificates are valid for one year fo properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsl ,le for errors or omissions In the professional engineer's work. 4. sTATEMENT OF INSPEC'rlON By ENGINEER As ceA'fled by my seaI aftixed hereto and as of the validation date s~own below, I vad~ that my I~ vestigat~on, based on procedures outlined in the Health Authon~y Approval Guidelines for this appficafion, shows that the on-site water supp~, and/or wastewater disposal system is(are) safe, functional and adequate for the number Of bedrooms and ty~e of structure Indicated herein. I further varify that based on the information obtained from the Municipality of Anchorage files and from my lnvestigation and Inspection, the on-site water sUpp~, and/or wastawater disposal system Is(aM) In compliance with all applicable Munlc/pal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm ALASKA WATER &: WASTE'WATER CONSULTANTS. INC. Phone 3,37-6179 Address· 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE. AK 99504-' · Engineer's Printed Name JEFFREY A. (~AENESS. P.E. Date Engineer's Comments: ' In conducting this evaluafiO~o AWWC, Inc. attempted to provide a thorough, consdenffous eng[n~'lng ana~is of the system In accordance with ADEC and MOA DSD Guldelines & Regulattons. The reported results described the l~efformance of the s~stem under the co~ditk~s encountered at the ~'me of the test, and separation distances messumd to readi~' ldontfflabte features. The oporaltonal lifo of ail w~lls and septic systems depend on the Iocal so~Ts condition, §reundwater levels that may fluctuate during the year, and the water usage of the famlly being served by the system. These condi~:;ns are ¢~slde tho corbel of the evaluator of the system.' Sa~fsfacfoo/ test results do not guarantee future performance of the system, nor do they guarantee that there are no bidden defect~ or enc~'oachmonte. AWWC, Inc, can therefore not provlde any warranty or future estimate of how long tho system will continue to racet the eporatfonal requirsrnente of the ADEC or MOA DSD. The content of this report Is for tho sole benefit of the owner #sted above.,4ny reliance upon or use of this repcvf by any other person or patoIs not authorlzed, nor will It confer any legal dght v/natecever. 5. DSD SIGNATURE Approved for ..~ bedrooms. Disapproved. 'Conditional approval for __ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other O,¢na Ce f c te Date: Municipality of Anchorage Development Services Department On-Site Wate~ & Wastewater Program 4700 ~outh 8mgaw b~t. p.o. Box 190850 Anchorage. AK 09519-8850 HEALTH AUTHORITY APPROVAL CHECKLIST Legal DesctlpUon: · HILLSIDE PARK S/Di LOT 341 Pal:el ID: A. WELL DATA 051 - 122-54 Welltype 'A' IfA, O, orOpmvldeFqNSlD~ 212401~ / Da, completed ~ propedy pmtecled (Y~) Cased to lt. Casing belght (above ground) In. FROM WELL LOG Dato of test SteUc water level g.p.m. WATER ~M~IPLE RF~ULT~: AT INSPECTION ...J g.p.m. 8EPTiC/NOLDING TANK DATA Tank Type/Matelte] S.T.E.P./STEEL Tank size 1250 gal. Number of Compartments 2 Foundafiondeanout(Y/N) YES Depre~skmovertank(Y/N) NO Date Wed 12/7/94. ca noute (Y/N) YEs High water alarm (Y/N). YES Date of pumplng 5/2/Ol Pumper DENAU SEWER &: DR*IN ABSORP'nON FIELD DATA I,pEtow F~NA~ O~AD~I Date Instated ~,/7/e4 ~1 rating ~ ~Axlnn) 4 Length 24. It. wlcrdl 5.0 fL Totaldepth 4.e lt. Eft. absoq~on ama 120 fl~ Monitoring tube YES Date of adequacy test 4/28/01 Resuits (Pesli/F~l) PASS Water added 617 gal. Fluid depth In absomfion field before test 0 In. Elapsed Time: 56 min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type TRENCH Gravel below pipe 1.0 lt. Dapresslo~ over field NO For 3 bedrooms Now depth 11.25 In. Abeoq:~on rate >= 450+ g.p.d. NONE KNOWN If yes, ONe date - De UFT 8TATION Date Installed 12,/7/94 'Pump on' level at 43.5 In. Datum B.O.T. E. SEPARATION DISTANCES Size In gallons 1250 'Pump off' level at 42.5 in. Cycles tested 2 SEPARATION DISTANCES FROM VVI:I I ON LOT TO: Manhole/Access (Y/N), YES High water alarm level et 44.5 in. Meets elarm & circuit requirements? YES Septic tenk/lltt station on lot On adjacent lots AbeorpUon field on lot. Public sewer meln --.---- Public ~wer manhole/oleaneut ~ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Properly line 10'+ Water main 25'+ Water ~ewice line 25'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water sewlce line 25'+ Curtain drain 50% Building ~:mndatlon 10'+ Surface water 100'+ Wells off adjacent lois, 200'+ Absorpfion field. 10'+ Surface water 100'+ F. COMMENTS Water meln 25'+ Ddveway, paddng/vehlde storage 100'+ O. ENGINEER'S CERTIFICATION ~~ I cergfy that I have determined through field lnspec~ne end review of Munlclpe/ n~ords that ~he above sy~erns are In con~rm~ with MOA HAA guldeflnes In efi~ct on this date. Date 5"1"7/ol '~tt~'.,, _' .......... . ¢.~ HAAFee$ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number, Division of. Envi P.O. Box 190650' · '. ~ APPROVAL F,O,R Parcel I.D. # 1, GENERAL INFORMATIC Complete legal r . '~.i~. ,, Lo, description Location (site address or directions) .' Property owner Mailing address , ageqc~'~'~,,,, .:,i. Lending Mailing address Agent Ad~ Unless otherwise NUMBER OF BEDROOMS: HAA will 3;" -,TYPE OF WATER SUPPLY: '"?' ...... Individual well NOTE: ~ ' If community well ~ and si 4. TYPE OF, WASTEWATER DISPOSAL: Individual on-site ' attesting tO the leg Front MOA #~1 STATEMI ! my investig the MunlCi suppl) ordinances; a~d Name of Address Engi INSPECTION BY~ ENGINEER :ion date shown below, I verify that my application shows that the on-site water supply )nal and adequate for the number of bedrooms that based on the information obtained from ih~vestlg~ti6n and inspection, the on-site water pliance with all Municipal and State codes, inspection.: ':., ,, · · · Phone ~'~, 6<: DHHS SIGNATURE /~ :.Apl: COnditiOnal apr rooms ....... ~, bedrooms, with the following stipulations: By: (DHHS) Issues Health Authority 5 above by anlndependent ~a~ a ~(~drt%~ to purchasers of homes uirements. Employees of DHHS do not I~ iSsue~j. The Municipality of Anchorage is not responsible fo~'{ Legal Description: A. WELL DATA Well type. Log present (Y/N) Total depth Sanitary seal (Y/N) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERX~iC.~E~ E IV E D Environmental Services Division 825"L" Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 AUG 20 1996 Municipality of Anchorage Health Authority Approval ChecklistDept' Health & Human Services /-.c-r' .~¢, /L~ll.l,b-,l~/=" P, Ort~t'__ Parcel I.D. : Ol~'--IgZ.- If A, B, or C, attach ADEC letter. ADEC water system number Date completed Cased to FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed /Z/~'/~/ Tank size Foundation cleanout (Y/N) y Date of Pumping ~/iq l c~ ~ Date installed /g./t.¢ Length Z~i( i Width Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION Other bacteria g.p.m. Collected by: Number of Compartments g~- Cleanouts (Y/N) Depression (Y/N) t~ High water alarm (Y/N) Pumper A~tl,~Ofl~xb~' C.~-~gD'oOC. Y Soil rating (g.p.d./ft2 or ft2/bdrm) ~ System type dl Gravel thickness below pipe / Total depth Effective absorption area Date of adequacy test Z'Monitoring Tube present(Y/N) Y Depression over field (Y/N) /~ Results (Pass/Fail) For bedrooms __ Immediately after gal. water added (in,): Absorption rate = g.p.d. If yes, give date I Fluid depth in absorption field before test (in.); Fluid depth (ins.) Minutes later: Peroxide treatment (past 12 months) (Y/N) Do go LllVr STATION Date installed Manhole/Access (Y/N) Size in gallons "Pump on" level at* qtZ.. High water alarm level at* Cycles tested ~" SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: /~Jo tA.J~'iA., gatt Septic/holding tamk on lot Absorption field on lot Public sewer main ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~-4'~ Property line qLL) s Absorption field Water main/service line ~Z:~ t Surface water/drainage ~'/~t) t Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation qL) t Water main/service line '> <~O Surface water ~'/OO ~ Driveway, parking/vehicle storage area Curtain drain /~M ~"' O,,q/.Or' Wells on adjacent lots ~' ~,'~0 t Property line 17- t F. ENGINEER'S CERTIFICATION · .~.~.~.~::~?:%?,,, '~!e- ~?¢~ ~? ,::~ ,¢% I certify that I have determined thru field inspections and review of Municipal re~'thqi, the~abgye ~Stgms are in conformance with MOA H~ ~uidelines in effect on this date (~; ¢ `¢ ~*~ ': ~'' ', ;' ~ HAA Fee $ ~(.~C~,O© Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Rev, 8/95 OSS: haa.wk.doc August 20, 1996 Municipality of Anchorage Department of Health and Human Services Onsite Services Section P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 34, Hillside Park Subdivision Certificate of Health Authority Approval Dear On Site Services Engineer: We are hereby applying for a Certificate of Health Authority Approval for the single family home located on the subject lot. The home is currently served by a community water system and the septic system was installed in December of 1994. Both facilities appear to be in good working condition. The septic system is composed of a 1,250 gallon S.T.E.P. tank along with an 18' X 20' sand filter and a shallow 5' wide absorption trench which is 24' in length with 1' of drainfield rock beneath the lateral. An inspection completed on August 18, 1996, revealed the absorption trench and sand filter to be comPletely dry. The air pump was operating efficiently providing forced air to the sand filter. In addition, all components of the lift station are in good working condition and the entire septic system appears to be operating effectively. The home has been vacant for over two months. Since the septic system was completed in December of 1994, it has only been subjected to continued use for 18 months. An adequacy test is not required if the system is less than two years old. In addition, water tests taken from the sampling well near the sand filter taken over its first year of operation indicate the system is working as designed. Our inspection and testing of the system indicated it is operating as originally designed. Sincerely, Michael E. Anderson, P.E. Parcel I.D.# ~ ~ ' 1. GENERAL INFORMATION Complete legal deScription  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 LoCation (site address or directions) Property owner Mailing address Lending agency Mailing address Address ' Day phone Day phone · ' ~-~ Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS:'-~ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community Well systeml pr°v~de written '~nfirmation from state'A~E~ attest-.. ::.; '"'" '~' ~%~'ing to the legality and status of sYstem.. ....... r '. · '~-:,?-!:..: i,:: '-",,. '::> TYPE OF WASTEWATER DISPOSAL: ~' '~'~:'<--.,';-'!' ',,~ Individual on-site // ~ -. ?~: Public sewer and status of: Bm STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my .' .''-~ investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /~,1~ ~ ~ Phone~?~L~ / ~ Address ~-0 ~ ~ / ~ ~'~ /:¢' ~- ~ ~ Engineer's signature ~-'~ c~z~-~-~ Date ' z-//z'/~'~' 6. DHHS SIGNATURE Conditional approval for bedrooms, w~th the following sbpulat~ons¢ .; ~.;-,..~:.~:. Additional Comments By: , App~0Val Certificates based 0nlY Upon the representations given in paragraph 5 above byan independent ::. i pr0f~Jonal engineer registe~.iri{he state of Alaska. The DHHs d°es this as a co'urtes~tO'Pdrchasers of hOmes andlt~ir?nding institUtions ini0id~ er to satisfy Certa n federal and state requirements; EmplOYees Of DHHs do ·. ~a~t ·inSpect 0nS'0i" an~i~data before a Certif cat~ :i~:'riSSUed. ~he' auniciPal!~ii~f Anch0~ge iS Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type u,,~, ~ Log present (Y/N) FROM WELL LOG Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height Wires properly protected (Y/N) AT INSPECTION Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ~//~ Absorption field on lot Public sewer main Sewer service line g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Other bacteria Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /Z/Y'/'~ u/ Cleanouts (Y/N) High water alarm (Y/N) ~'// Date of pumping' / ~-~ ~/~/c/ Pumper Tank size /~ ~(~ Compartments Foundation cleanout (Y/N) ?/ Depression (Y/N) Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots 1'?/,,~ Absorption field ~ ~ Well(s) on lot To property line Surface water/drainage Foundation Wate~ main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) / High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) ~ Manufacturer /'Z~vzc ~ [ ~ ~z ~ Manhole/Access (Y/N) "'~' "Pump off" Level at ~ c~ Cycles tested ~.~ ~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot /"~,/-~ On adjacent lots r--/,/~ Surface water D. ABSORPTION FIELD DATA Date installed /~/o / ~ ~/ Length ~ y Width Soil rating (GPD/FF) ~' Gravel thickness Total absorption area / ~- ~ Cleanout present (Y/N) Date of adequacy test ~'"///',~ Results (pass/fail) Water level in absorption field before test~-~"'~ '--/ Peroxide treatment (past 12 months) (Y/N) Depression over field (Y/N) for After test ~' If yes, give date System type Total depth Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ,//-~ To building foundation On adjacent lots ~ Surface water Curtain drain adjacent lots ~/,///L~ Property line To existing or abandoned system on lot Cutbank /'%/bo >/¢__ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Parcel I.D. #  MUNICIPALITY OF ANCHORAGE ~ Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) LoT' ~'4- HI LL~iD~. Location (address or directions) (b) Property owner~ i'¥A¢..'/ ~tq ~,E l lQ 6 ('~ EOO K Mailing Address -7~O (c) Lending Institution N/, Mailing Address (d) Real Estate Company and Agent Address ~,//~ A ,C.H, Telephone: (home) N ,/~ / Telephone Business ~//q- Telephone / (e) Mail the HAA to the following address: (or check heretiC, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-FamilyCare' Number of bedrooms 3. WATER SUPPLY Individual Well [] Community ~' Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-sitex' Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev, 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm ~E~!i kl ~ ~.<;%'¢d~. Telephone Date Engineer's Seal 6. DHHS APPROVAL Approved for ~,,/~--~=L~/bedrooms by Approved )~" Disapproved Terms of Conditional Approval Date Conditional The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 · WELL DATA C} {{~ Wel Classification Well Log Present (Y/N) __ Date Completed /'"~{~xOXx'MUNICIPALITY OF ANCHORAGE (MOA) ~, (~:~:' Health Authority Approval (HAA) ,~ 0~,~>~ CHECKLIST- FEBRUARY 1984 \:¥' ~'~, 343-4744 ,L~" ,.}2-' ;~ ~ ~. ~h~ .... Lega Descr pt on: i~d~ I{A,~IB, C, D.E.C. Approved (Y/N) Yield Total Depth Cased to Depth of Grouting Static Water Level Pure p Set At Casing Height Above GrounC Electrical Wiring in Conduit (Y/N) Sanitary Seal on Casing (Y/N) Depression Around Wellhead (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 ; On Adjoining Lots On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ; Date Date lnstalled ]d)~/&G~ Size StandpiPes (Y/N) ~ Depression over Tank (Y/N) To Property Line ~O ' To Water Main/Service Line ~ ~LS- c To Stream, Pond, Lake or Major Drainage Course SEPTIC/HOLDING TANK DATA IO©© No. of Compartments Air-tight Caps (Y/N) ~ Foundation Cleanout (Y/N) ~ Date Last Pumped Pumping/Maintenance Contact on File (Y/N) f~/,~ ;for Holding Tank High-Water Alarm (Y/N) .L_I//~, Temporary Holding Tank Permit (Y/N) ~,_~/~d~ SEPARATION DISTANCES FROM SEPTiC/HOLDiNG TANK: To Water-SupplY Well ~,-~(~O ~ To Building Foundation ~i~O To Disposal Field ~ ~ Comments 72-028 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area ~, Depression over Field (Y/N) Results of Last Adequacy Test _-~ ~::~'7-1,~ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well 7~2C3~-) ~ To Building Foundation ~''--5~ ~ '¢ Lot /k,[ /A · On Adjoining Lots I To Water Main/Service Line ;~ ,¢)2.~- ~ To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ,'zJ--O ' '+ Comments'-~- ~'¢~¢ ~ '-/~u; /-I- -' Type of System Design Length of Field ,~'~-~ ' Depth of Field ,~ ~' ~ '~ Gravel Bed Thickness ~" Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line --~,O ' To Existing or Abandoned System on Size in Galloedns ~ "Pump On" Level at ~ High Water Alarm Level at %,% Tested for ~ Meets MOA Electrical Codes (Y/N) ~ Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check PermittedB~droom Rati//~Agai~t HAA Request** I certify that I/tt'a///~/ek.~d, v/~jf;,~iS~/6¢~ conformed to all MOA and HAA( inspection. /////////~ / ,, Date MOA No. effect on the date of this Engineer's Seal Date of Payment Amount: $ 72~026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 ANCHORAGE/WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 MUNICIPALITY OF ANCHOP. AGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SF_P 9 2 198g RECEIVED 563-6775 DATE: Sept. 21, 1989 PWSID: 212461 Requested By: Corwin & Assoc. According to the records on file in this office, the Hillside Park S/D Water System is in compliance with State of Alaska Drinking Water Regulations. the Sincerely, Cindy Thomas Environmental Engineer EG~oue.~,s ono~n ~o. I El : 46 ACREAGE SYSTEMS ~ENALf SEWER & ORKIN ~ ~1;~ ~ ~. 537 ~HO~. ~ ~ ~ONE ~.5~ $L320/0 ! 320 KEEP THIS SLIP FOR REFERENCE CARiONLF..SS 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~/d// ~/,4~C,~'~;~ Telephone: Home ~_~, ~' ~OOd/ Business Applicant Address 7°2,0 ~'~/'cT'~J~) /~'~'~ "~'///~/ "~'" '~'~ (c) Applicant is (check one): Lending Institution []; OWner/builder ~1; Buyer []; Other [] (explain); (d) · Lending Institution Address Telephone (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] Community~J~] 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 Onsite ~ Public [] Community [] Holding Tank [] 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 72-025 (11/84) ENGINEERING FIRM PROVIDINL~ INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm /~47'~ Telephone ~'~,/-~'~ ~-/0 Address DHEP APPROVAL ~--~....~ Approved for~'~ beOrooms b~ Approved ~.~ 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 MUNICIPALITY OF ANCHORAGE (MO~) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: MUNICIPALITY OF ANCHORAG~' DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION APR 2 9 WELL DATA Well Classification ~/¢/'¢~/7~/' If A, B, C. D.E.C. Approved(~) Welt LoggY/N) Date Completed Yield Total Depth "~ Cased to Depth of Grouting Static Water Level ~ Pump Set At Casing Height Above Ground~.~ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) ~ Depression Around Wellhead (Y/N) Separation Distances from Well: ~~ To Septic/Holding Tank on Lot "'".~.,~ ; On Adjoining Lots __ To Nearest Edge of Absor~ld on LOt __; '(:~oining Lots ~ To Nearest Public Sewer Line To Nearest Pu ~t~,~.ew.er. Cleanout/Manhole T~ ~[~st Sewer S~er~i~,~n Lot ~N:tt:rr ~:~ppl,: TCeOilte~teesdulb,; ;Date ~ Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes0N) ,,~ Air-tight Caps(~) Depression over Tank (Y~__~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well ,,~¢'O To Property Line ~--~ To Water Main/Service Line Course 16'z~ Size /d./T-)~ ,-,~ No. of Compartments Foundation Cleanou/~N) Date Last Pumped Temporary Holding Tank Permit (Y/N) To Building Foundation / To Disposal Field To Stream, Pond, Lake, or Major Drainage Comments Page I of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field ~'"~" Depth of Field -~ '~' / Square Feet of Absorption Area Depression over Field (Y(~) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot .,~/,~ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Gravel Bed Thickness ~"~' Standpipes Present CN) Date of Last Adequacy Test To Property Line ~--~ To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ,X//,~ Comments LIFT STATICI /~////A "p~ High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that l h.~/~e~d, ~.eri~ed, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~,c~;..---.(, ,~fj//..~---- Date MOA No. Company Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 BILL SHEFFIELD, GOVERNOR Telephone: (907) Address: 274-2533 DATE: April 23, 1986 PWS I.D.# 212461 To Whom it May Concern: According to records on file in this office the SUBDIVISION Water Regulations HILLSIDE PARK Water System is in compliance with the State Drinking Si ncerely, District Engineer