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HomeMy WebLinkAboutNETTLETON ACRES #2 LT 2Nettleton Acres #2 Lot 2 #015-062-06 T\) I Municipality of Anchorage S On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221345 PID Number: 015-062-06 Dwelling: W Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New W Upgrade Name ALAN HOUGH ABSORPTION FIELD Site Address 6735 LISA COURT *ANCHORAGE, AK ❑ Deep Trench ❑ Wide Trench ❑ Bed ound Phone ❑ Other ZNumber of B drooms Soil Rating Total depth original grade +a�9�23 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot NETTLETON ACRES #2; LOT 2 Ft. Ft. Fill added above original gr a Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. t Ft To Septic Absorption Holding Sewer Total orption area Number of trenches Dist. between trenches Tank Field Lift Station From Tank Line Ft2 Ft. Well 100'+ Z5;/f ANK [9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other anufacturer Capacity Surface Water 100'+ INFILTRATOR 1530 Gal. Material Number of compartments Lot Line 5'.+ + s z NA HDPE 2 Foundation 101+ i LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 Installer drainfield ARM SEPTIC SERVICES Drainfleld D3034/EXISTING CO/MTD3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 100.07 ft Inspection 111 11/3/2022 - Location and descri tion dates: 2nd p 3'"- 41h- TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp itional Approval: Septic Sy Approved this approval does not include well permit (Rev Date ��� • F :` 9s�4 ... frey rness.: Date X449 f CE -73 jji.•. 5 o Q44�o,.e C.�G� o ui7 ents. Opo #AECC884 rofess100�o� PARCEL ID NUMBER: PERMIT NUMBER: OSP RECORD DRAWING OSPNUMBER: 015-062-06 10' T & E EASEMENT — — — — — — — — — — — — — — — — — — q — — — — — A B / MH 32.4 27.1 ST1 41.2 19.0 \DBL1 42.9 21.3 - DBL2 43.5 21.6 ' APPROXIMATE 100' WELL — CONTRACTOR EXPOSED 5' PAST TANK TO CONFIRM SEPERATION; PER THE CONTRACTOR, THEY OPTED TO INSTALL THE CLEANOUT AND MTS OF THE TRENCH DURING THE SUMMER OF 2023 (PER THE HOMEOWNERS REQUEST) SHED NETTLETON ACRES #2; LOT3 BARN _ 6f MH1 !- -� DBL1&2 0 1 ST1 EXISTING \ HOUSE v c m U) o NEW IM1530 INFILTRATOR TANK _„ IN , � = ENGINEERING -SALES o CONSULTING 3701 E. TUDOR ROAD, SUITE 101 •ANCHORAGE, AK 99507 • PHONE (907)337-6179- FAX (9071330-3246 • WEBSITE: —.0evn ngice nn9.cem PREPARED FOR:To NE NUMBER: PAGE NUMBER: ALAN HOUGH 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: NETTLETON ACRES #2; LOT 2 D.J.G. TYPE OF WORK: DATE: SEPTIC TANK RECORD DRAWINGS 1/19/2023 PERMIT NUMBER: PARCEL ID NUMBER: OSP221345 RECORD DRAWING 015-062-06 TOP OF TANK AT INLET = 96.2 INVERT OF BUNG AT INLET = 95.59 J MH TOP OF MANHOLE = 100.07 INSULATION PER CONTRACTOR IM -1530 2 -COMPARTMENT INFILTRATOR SEPTIC TANK STI GRADE = 99.66-99.75 - TOP OF TANK AT OUTLET = 96.22 Of T Ltd _ 9 ENGINEERING SALES. -CONSULTING 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 • PHONE J907)337-6179- FAX (907)338 -3246 -WEBSITE:- g--gine<nng,c PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ALAN HOUGH - 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: NETTLETON ACRES #2; LOT 2 D.J.G. TYPE OF WORK: DATE: SEPTIC SYSTEM RECORD DRAWINGS 11/22/2022 INVERT OF BUNG AT OUTLET = 95.36 oil 00 '7E�2 �ss 0 +%t CY3`53 � AV LICENSE #AECC884 / LOT 3 SCALE: 1"= 60' EAST 285.00 8320W i 10' Tele. & Elec. Easement ----------------------------- Metal fence LOT 2 t®�t N 2a o ch LOT 1 '' rn f _ r ��mu�ktenc� N ss 2.0OtA i Sa ­� a5 s"Ou"Ouse 5 ax r R=50.00 L=64.68 W X\ Y- Cid; • At.. I I �'•' 49th 00 00 �,'. 1 beth L Wa(atko �� �F�� . • 8036 e • LS10R, , • �� °F�ssloOX- '�. WXVNX%7 R C_3s11 r40 EAST N _ LISA COURT RECERTIFIED 12-19-22 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection in accordance with ASPLS Standards of the following described property: LOT 2, NETTLETON ACRES SUBDIVISION, UNIT No.2 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this- 11th day of September , 2007. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED FRED WALATKA $ ASSOCIATES, L.L.C. PLAT ARE NOT SHOWN HEREON Fb 22-5, pg to BE 907-248-1666 Engineers and Surveyors UNLESS OTHERWISE NOTED. Fb ora, pg 37-38 This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. Permit Number:OSP221345 Tax Code Number:01506206000 Work Type:SepticTank Upgrade Effective Date: Design Engineer: Site Legal Address:NETTLETON ACRES #2 LT 2 G:2439 Owner:HOUGH LUKE ALAN Site Mailing Address:6735 LISA CT, Anchorage Lot Size in Sq Ft:56146 Total Bedrooms:3 This permit is for the construction of: Disposal Field Septic Tank Holding Tank Privy Private Well Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing 9/9/2022 9/9/2023 GARNESS ENGINEERING GROUP LTD Expiration Date: ¨þ ¨¨¨¨ Received By: Issued By: Date: Date: MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On-Site Wastewater Disposal System Permit Deb Wockenfuss 9/9/22 006"'UINKIPAUTY OF ANCHORAGE Development Services Department `� Phone. 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-062-06 Property owner(s) Luke Hough C/O ARM SEPTIC Mailing address 6735 LISA COURT *ANCHORAGE, AK Site address Day phone 907-688-9433 Legal description (Sub'd., Block & Lot) NETTLETON ACRES #2; LOT 2 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Absorption Field ❑ Initial Septic Tank ❑ Upgrade NA Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) 0 (w/wo AD U) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2_ 5 Waiver Fees: Date of Payment: 9' 3 ©'2 Z Date of Payment: Receipt Number: G Receipt Number: Permit No. Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221345, Deb Wockenfuss, 09/09/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221345, Deb Wockenfuss, 09/09/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221345, Deb Wockenfuss, 09/09/22 i. r_ MUNICIPALITY OF ANCHORAGE (j DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Home Planning, Inc. PHONE 399-2316 NEW ❑UPGRADE MAILING ADDRESS SRA Box 77M Anchorage, AK 99d'v7 LEGAL DESCRIPTION Lot 2 Unit 2 Nettleton Acres LOCATIONNO. Lisa Court OF BEDROOMS 4 Well Absorpuon area TO: Dwelling PERMIT NO. uDISTANCE Y , , 141 780179 f-2 n F Manufacturer Material No. of compartments y Liq. capacity in gallons Inside length IF HOMEMADE: 1250 Width Steel 2 Liquid depth dOY 2 DISTANCE TO: Well Dwelling PERMIT NO. S?H Manufacturer Material liquid capacity in gallons W= DISTANCE TO: Well 135s Foundation 34' Nearest lot PERMIT N0.78O179 U.1 s Z No. of lines Length 2 W of rpdine 1 114 Total len th of lines Trench width �1s4 r Distance between lines 36 intoes 0 of tate to finish grade 5 feet 6 inches Material beneath tile Total effective absorption area 6 inches 342 Sq. Ft. W Length Width Depth PERMIT NO. f7 g!: o Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance Io lo[ line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septie tank Absorption area(t) OTHER 30 PIPE MATERIALS 4" Plastic Perf. Pipe with C.I. Connections IL $OI L TEST RATING 85 SIT. Ft. Per bedroom P( C !h' INSTALLER REMARKS 4�t OF Ate. AF O - Y i=.:. ! Ro A E L APPROVED DATE LEGAL "'•� ,9/2 9/fP Lot 2, Unit 2, Nettleton Acres 72-013 (Rev. 3/76) JW r`W-W DRILLING, INC. /', '78-')30 MUNICIPALITY CF ANCF!OP.AGE DEPT. Cl- : ".LT: f 8 . �-CTION FEU 81080 DRILLING LOG Well Owner Richard and Glenna Weeks (Robert Milby. Qontract&L��[jy EAM. Location (address of: Township, Range, Section, if known; or distance main road Lot 2 Block 2 Nettleton Acres, Anchorage Size of casing 6" Depth of iiole 300 feet Cased to 279.6 feet Static water levet 118 ft. (ail€ C) (below) land surface. Finish of well (check one) open end ( xx ) Screen ( ); Perforated r l-� Describe screen or perforation R per o 'ons from 198-201' Well pumping test atmgallons per (IKXY)[ (minute) for --!—hours with 100'/ xg of drawdown from static level. Date bf completion 9/27/78 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness __k__TO 2 Casing stickup —2_TO 13 Silty loose gravel _liTO—ZZ_ Silty ry_, ands _V_TO 38 Hard pan —38_To 49_ Gravelly hard pan 49 TO 52 Loose clay 52 Hard pan —55 TO__Q_ Loose sand __6Q_TO—$fes_ _Clayey gravel _86—TO 117 Gravel hard pan 117 TO 120 Silty gravel. sandy. wet _12D_TO 196 Gravel ardn 196 TO 203 Wet gravel _203 TO 2p8 Gravel hard pan 203TO-21(1_ Gravel hard pan 1 —CUSTOMER n M -W DRILLING, INC. ^ N23D- MUNICIPALITY Cf A"!CHC!!OP,A.GE DEPT. C; "LT:! ENV!: OtiN.C::i.:. .. CT!ON FEB a 1s>o PAGE 2 DRILLING LOG Well Owner Robert & Glenna Weeks (Robert Milby, contractor EC EkUlf�— Location (address of: Township, Range, Section, if known; or distance main road Size of casing nepth of Hole feet Cased to feet Static water level ft. (above) (below) land surface. Finish of well (check one) open end ( ); Screen ( ); Perforated ( ). Describe screen or perforation - Well pumping test at gallons per (hour) (minute) for hours with ft. of drawdown from static level. Date of completion WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 210 Tp 213 Silty sand, seepage 213TO 217 Silty gravelly sand seepage 2_2-TO2 ?L_ Gravel with silt lenses: seepage _1 25 -To 248 Gruel har-pan: weeping 248 T02 83 Comvacted silt thr -2$3_To 791 —Be rncc, r --ypr- Apps in annrndir fractures ou -29-1-TO inn B edrock gray av TO TO TO TO TO TO TO. ,A 1 —CUSTOMER CA F= Ft t -d F -t ? f=l G E DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, t Q9501 264-4720 cL411153 14EtLL Fitt[? Citt-'S I TE 'SEINER F}EFrt'1 I T PERMIT NO. ( 780179 ) APPLICANT HOME PLANNINr, INC SRA BOX 77M 99507 349 2316 LOCATION LISA CT LEGAL L2 UNIT 2 NETTLETON ACRES LOT SIZE 0 SQUARE FEET TYPE OF SOIL RBSOF.ETION SYSTEM I DF.AINFIELD MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BF.')= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C EP—r"- cT, LE"rrTH= 114 GRF:lVE:L CAEF}TH= _ THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OP. DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THE TRENCH WIDTH FOR DP.AINFIELDS IS 3 FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REI AU I REGI 'SEF}T I C -Fn"K 12Z lD rRLLGrtdE PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DUPING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER. OF RESIDENCES THAT THE WELL WILL SERVE. --- T14n C 2 > I tFSF`EClT I CAt443 FIRE REni_i I RELY --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL; OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER, INSTALLATION. t�ERt7 I T E}{F> I F?ES GECTEMENER 711. 159 f c^- I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER, SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE-JSIRWOOKED TO INCLUDE MOPE THAN 4 BEDROOMS. SIGNED: __ c` -`--- -7--------------------- R 'P C u HOME PLANNING I14C ISSUED BY _ _ _ ___ _____DATE__l`_^_ V3. 0 =� PHO:Sf: 707.277.:581 FI�� IgG 16';.0. 47929 Jurc 17, 1975 DC:':L Enn necrs 4040 .1bl; Street Anchorage, AK Attn: A. Lahnum Subject: t2e t'.:1L to:1 i•.: rC. , $Clls Gentle -en: In rualonse to your I:. :C^L' icu:. tC _�^. 'C^tE:O)eS r:CrC :))acc, at the recuostec7.l.rcari.o:.. fcr examination of the soils for on-site ir:divicival se::a^e^r.reat:ne^t s" ^.. :ste s. The toles vxrt! place:'. ..n. _% i.:c in cer�c_..,,ince }.it Greater criteria. riAnct eria. Area ..oroi:y-h C;:; tm2 nt of Fn irona:ental Quality criteria. The l:c. t::olc locat:irns hre sho::n on fia. 1. The testholc log-, On. 7a1J1C ... Standard information, en sheets 1 to 3. The GAAG ; :bl.i::l:ed : orrclat,'on of loll textural t.,,.. the Unified Classification s"sten in term-- of square feet o1. seepage area per bedroom- is as foll.oa:S: Uniticd Seepage Area in Soil Class Sq. ft./berco^I 85 Gil 65 G;•i / 225 Sig 125 S1, 150 SM 250 M 275 CL 350 C1: 350 i llO::1, linr�irlecr:: Attu A. L;tlr::ua Jun-- 17, 1975 face 2 S011 %:i tll £Cclt•;cc rate.. in ex.cc5i, of 250 rq ft/::edrC), �. are Usually not- nllCt;i C,. C:11v:�S a: l.i t. tl.. rat'(• in Octe:".minc:l 15'. On-:itC :CrCO).::t LCT:1 tC: -. i.;.'':. iiJ::.li 1' ...: L., _tC'. C: t::C �CCpaC�C pit Curron..i.� rcm.:-J c'.1 t0 bJ •i' -1!- c tic •water tab)C. Ilased c:n tl:c: _ :: i.:... _:r t::v sur:-C:-.L"-.hufollo:•:ir:^ �: L'l'. c areas descricc.i _ tllc, •S. Ilop'..l: Intc.r•::1_l. Sec -page Test ilcle in Feet Sq. Ft./Dc=-cc.-.S 1 2 3 4 5 L/G 7 C 9 10 11 12 13 14 The Only free wall, :r Thi.: ;111, ea red two Lc, case only iso).Mcd 2.0- 9.0 1.5-12.0 12.0-14.0 1.5-14.0 1.5-14.0 2.5-1^-.0 1.2.0-1•:.0 1.0- 6.0 L.0- 8.0 C.0-13.0 3.0- 7.5 7.5-11.0 11.0-14.0 2.5- 7.5 7.5-12.0 12.0-14.0 1.5- 4.5 4.5-11.0 11.0-14.0 2.0-1.4.0 1.0-14.0 3. 0-1.4. 0 0.5-10.0 1.0-13.0 13.0-14.0 65 2C0 CS 200 II5 85 C5 125 85 200 250 85 200 20C 200 20C 200 85 200 250 85 65 85 125 85 125 encolinterud has ^l o:: 9' in 1:01C .1 . the l;'to point i:. t:... arca. I:•den in tllat .:ct:l•ntjc was :.Y / I o ' 1 14a 1 . FSG• 1 V/ (Y IIV •.. 1 :.Y / I o ' 1 14a 1 . FSG• 1 Municipality of Anchorage • -� Development Services Department j Building Safety Division e On -Site Water and Wastewater Program :. ... 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 615- QMR- ,Q/^ HAA # 650390 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lo} Cl Ne Wit 6^ Acre -s 2 Location (site address or directions) (6135 Lisa Co%,,,} Current Property owner(s) _94 5.13es. syti\1 Day phone 330 ^'TLL5 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (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 seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 Sp A1x;.,c«;„t Address 7.o3 w. %s�6 203. AncLon;�A j Als 19501 Engineer's Printed Name TobS�, ii,, V14�A 5. DSD SIGNATURE ✓ Approved for _3 bedrooms. Disapproved. Phone 2'}q- 3916 Date t3 u o S P♦��• To6 hWfiio+d J J Y`JG��� C6s21i �, 'e Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: 0_o( Original Certificate Date: S (Rw. 01N2) Municipality of Anchorage ... i Development Services Department Building Safety Division ' On -Site Water & Wastewater Program " 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LJ ?2+ Ne h4s6^ Acres *2- Parcel ID: Q 1-5'— 0 tot — 0 6 A. WELL DATA Well type ,ffi*LK{e- If A, B, or C provide PWSID # = Well Log (Y/N) it Date completed 12J 101}0 Sanitary seal (Y/N) Wires properly protected (Y/N) y Total depth 36o ft. Cased to 27`1.6 ft. Casing height (above ground) 7/6 in. FROM WELL LOG AT INSPECTION Date of test 1Lz7I4S Zq LoS Static water level —lie ft. 41-4- ft. Well production 1112- O.P.M. 2•g g.p.m. WATER SAMPLE RESULTS: Coliform _0—colonies/100 mt. Nitrate NO mg./1. Other bacteria .df colonies/100 Arsenic: 15_9 ;?11. Date of sample: fh4s ttml. Collected by: Lars .S,Rur{Lia�,d B. SEPTIC/HOLDING TANK DATA Tank Type/Material Grcw Sfect �I 9f Date installed 291 ie Tank size 11SO gal. Number of Compartments 2 Cleanouts (Y/N) y t'.'Foundation cleanout (Y/N) �Y Depression over tank (YIN) //' High water alarm (Y/N) Date of putffM9 ' 8 -• 2 05 Pumper f54G S C. ABSORPTION FIELD DATA Date installed i "�t3 Soil rating (g.p.d./ft2 or ft2/bdrm) System type .51i41LW Trenr- Length 114 ft. Width 3 ft. Gravel below pipe 0.5 ft. Total depth b.2 ft. Eff. absorption area 241 ft2 Monitoring tube Y Depression over field _Q/ Date of adequacy test :&110 Results (Pass/Fail) 4 For .3— bedrooms Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth 0 in. Elapsed Time: — min. Final fluid depth — in. Absorption rate >= Soo g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Along kAo%-+„ If yes, give date "— D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) `Pumpon' Is at _ in. `Pump off"evel at in. High water alarm le t in. Datum Cycles test Meets ala circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 7100' Absorption field on lot 7100 On adjacent lots i Ico r On adjacent lots loos Public sewer main N/q Public sewer manholelcleanout 646 1 Sewer /septic service line i25 Holding tank /✓ A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /101 Property line i 101 Absorption field %5 1 Water main ? 2.S1 Water service line > Z51 Surface water -7100, Wells on adjacent lots "7I00 r SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 r Property line i101 Building foundation % 285.00' I CTCLC.. [LCC. CSM't. LEGEND --------------- S SEWER VENT s DE • D[CK •INMLC rAMILY T• raA [ Houee 1.I DECK DD OwnL L o 64.66 \ 4 22.1 W N LISA COURT A"UILT SURVEY — - - — - — SCALE: I'- 40 FORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN ING STRUCTURES AND RATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL 'TURES OR FENCELINES. RENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES CATE STRUCTURES, AVINO SHOWN MAY BE APPROXIMATE WE TO SNOW CONDITONS. I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 2. NETTLETON ACRES. UNIT NO. 2 ANCHORAGE RECORDING DISTRICT. ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND THAT NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 19TH DAY OF FEBRUARY 2002 HOLT LAND SURVEYIN , F89T.T1 TEL. 3455513 Municipality of Anchorage Development Services Department Building Safety Division Onsite Water 8 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. 015-062-06 HAA#_ N O a D /12- 1. Z1. GENERAL INFORMATION Expiration Date:��- Complete legal description C NETTLETON ACRES SUBDIVISION 82: LOT 2. Location (site address or directions) 6735 LISA COURT * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JAMES do STEPHANIE CURBOW Dayphone 929-0402 6735 USA COURT • ANCHORAGE, AK 99516 Day phone CYNDIE PARTCH w/ PRUDENTIAL JACK WHITE Day phone 440-7775 3201 'C" STREET SUITE 200 • ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. *THE RESIDENCE IS ONLY A 3 BEDROOM HOUSE PER THE 2. NUMBER OF BEDROOMS: *3 HOMEOWNER. THE SEPTIC SYSTEM IS SIZED FOR A 4 BEDROOM HOUSE. 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for 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 engineers work. u: b15— Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, orprior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority 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 fs(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn ALASKA WATER do WASTEWATER CONSULTANTS, INC. Phone Address 6901 DEBARR ROAD, SURE 2B • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Inc. 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. AWWC, Inc. can therefore not provide any warranty or future estimate ofhow 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 right whatsoever. 5. DSD SIGNATURE _jZ Approved for '3 bedrooms. Disapproved. 337-6179 Date 3 z5 Z Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist (� Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other By: Original Certificate Date: 3 (Rb. 12101) Municipality of Anchorage Development Services Department Building Safety Division OnSRe Water & Wastewater Program 4700 South Bragaw SL P.O. Box 1966 Anchorage, AK 99519.8650 www.danctwrage ak.us (907)343.7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: NETILETON ACRES S/D #2: LOT 2. Parcel ID: 015-062-66 A. WELL DATA Well typeR� N TE H A. B, or C provide PWSID# N/A Date completed 9/27/78 Sanitary seal (YM) YES Total depth 300 ft. Cased to 279.8 ft. FROM WELL LOG Date of test 9/27/78 Static water level 118 ft. Well Log (YM) YES Wires property protected (YM) YES Casing height (above ground) 12+ in. AT INSPECTION 1/19/2001 91 ft. Well production 1.5 g.p.m. 2.0+ g.p.m. WATER 7 RESULTS: Coliform colonies/100 mi. Nitrate Q• 2 mg./L. Other bacteria 3 colonies/100 ml. Arsenic: N/A mgA. Date of sample: 2/22/2002 Collected by: AWWC. INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date Installed 8/29/78 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YM) YES Foundation cleanout (YM) YES Depression over tank (YIN) NO High water alarm (YM) N/A Date of pumping Z i O"z Pumper C^i IAO rhe f S c!v I c� s C. ABSORPTION FIELD DATA THE RESIDENCE IS ONLY A 3 BEDROOM HOUSE (PER HOMEOWNER). THE SEPTIC SYSTEM IS SIZED FOR A 4 BEDROOM HOUSE. Date installed a/49/78 Sod rating (g.p.dJftioft[E�)) 85 System type TRENCH Length 114 ft. WkIth 3.0 ft. Gravel below pipe 0.5 ft. Total depth e-5+ ft. Eft. absorption area 342 fe Monitoring tube YES Depression over field NO Date of adequacy test 1/19/2001 Results (Pas3/Fa8) PASS For'3 bedrooms Fluid depth in absorption fteld before test 0 in. Water added 584 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >. 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date D. LIFT STATION Date Installed "Pump on' level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/ltft station on lot 100'+ Absorption field on krt 100'+ Public sewer main N/A On adjacent lots 1009+ On adjacent lots 100'+ Public sewer manholeldeanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water main N/A Water service line 10'+ Surface water t 00'+ Wells on adjacent lots t00'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Munidpal records that the above systems are in conformance with MQA HAA guideUnes in effect on this date. Engineer's Printed Name JEFFREY A GARNESS —79 Date 3�isloZ •, '' '� edP�efaobnd HAA Fee $ 315 Waiver Fee $ Date of Payment 1/210/0 z Date of Payment Receipt Number o i 7533 Receipt Number (wv. IT/Ot) o%. OF Atq �4 ............................... SHANE A. HOLT ' LS -6914 { Q• . . . . . .. • �• Q S 10' TELE. t ELEC. ESN'T. LEGEND S .a% SEWER VENT SDIGL.E FAMILY FRAME HOUSE LISA COURT AS -BUILT SURVEY SCALLS 1• - 40' INFORMATION HEREON IS FDR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFI DNC STRUCTURES AND PLATTED LAT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONIN iCTURES OR FENCEUNES. VENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. :: ANY FENCEUNES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE ACATE STRUCTURES. PAVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. 1 HEREBY CERTIFY THAT I HAVE PERF13RHED A MORTGAGEE'S INSPECTION IF THE FOLLOWING DESCRIBED PROPERTY. LOT L. NETTLETON ACRES, UNIT NO. E ALASKA AND \ MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services - ' On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 015-062-06 HAA #_/A 0 /0030 1. GENERAL INFORMATION Complete legal description NETTLETON ACRES SUBDNSION: ;2: LOT 2. Location (site address or directions)— 6735 LISA COURT ANCHORAGE. AK U51 �roperty owner JOHN TRAUTWEIN Dayphone (907) 346—M3 Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: '3 *THE RESIDENCE IS ONLY A 3 BEDROOM HOUSE PER THE HOMEOWNER. THE SEPTIC 3. TYPE OF WATER SUPPLY: SYSTEM IS SIZED FOR A 4 BEDROOM HOUSE. Individual well xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site xxx Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. 72-025 (Rev.1191) Front MOA 7121 Computer Verslon Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,000.00 at, or prior to, clos)ng for the engineering services provided. 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 investgation and Ins etion, the on-site water supply and/or wastewater disposal system is in compliance with all Municip nd State'codes, ordinances,. and regulations in effect on the date of this inspection. Name of Finn ALAS' W E A A E CONSULTANTS INC. _Phone (907) 337-6179 Engineer's Signature Date In conducting this evaluationAWWC,1 a it pled to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and O HS 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 lire of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the usage of the family being served by the system. These conditions are outside the control o 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. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DHHS. 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 right _whatsoever. 6. DHHS SIGNATURE Approved for .3bedrooms By: Disapproved Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to 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. 1191) Back MOA #21 Computer Version Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 V Street. Rm 602 Anchorage, Alaska 99501 (907) 943.4744 Health Authority Approval Cheddist Legal Description: NETTLETON ACRES S/D N2: LOT 2. Parcel I.D.: 015-062-06 A. WELL DATA Well Type PRIVATE 0 A. S. or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date completed 9/27/78 Total depth 300' Cased to 279.6' Casing height (above ground) 18"+ Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG Date of test 9/27/78 Static water level 118 Wen production 1.5 9 -pin. WATER SAMPLE RESULTS: AT INSPECTION 1/19/01 2.0+ g.p.m. Conform Nitrate (rb �L Other bacteria 'a" Date of sample: 1/29/2001 Collected by: A.W.W.C.. INC. B. SEPTIC/HOLDING TANK DATA Daae Installed 8/29/78 Tank sbm 1250 Number of Compartments 2 Clearouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water ohm (YM) N/A Date of Pumping 1/18/2001 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA *THE RESIDENCE IS ONLY A 3 BEDROOM HOUSE (PER HOMEOWNER). THE SEPTIC SYSTEM IS SIZED FOR A 4 BEDROOM HOUSE. Date Ilstened 8/29/78 Son rating (g.p.dJR2 01 9b 85 System type SHALLOW TRENCH Length 114' Width 3.0' Gravel thickness below pipe 6" Total depth 5.5'+ Eliacfive obaorptton area 342 SO.rr. Mongering Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 1/19/2001 Results (Pass/Faff) PASSED For '3 Bedrooms Fluid depth in absorption field before teat (In.r 0" Immediately altar 584 gal. water added pn.r —Q- Fluid depth 0" Ina) Minutes later. 0 Absorption rate a 450+ Pom)dde treatment (pest 12 months) (Y/N) N/A If yes. at" ream 4w. alba)' oompiar V0r" D. LIFT STATION Date Installed Size Manhole/Access High water alarm level at 'Pump ofr level at' 'Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: SeptioUlding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main NSA Public sewer manhole/dearwut N/A Sewer/septic service line 25'+ LIR station N/A SEPARATION DISTANCES FROM SEPTIVHOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field 5'+ Water mainlseMce line 10'+ Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water maintservice One 10'+ Surface water 100'+ Driveway, parkingtvehide storage area 10'+ Curtain drain NONE KNOWN Wens on E F. ENGINEER'S C TI I eerV& that I ve e of Munldpal Cord e With MOA Qui !n Signature Engineer's 1/0$ HAA Fee S 36V — / Date of Payment /40 L o / Receipt Number /217 72-M (wv. Mr CWWAW VWWM Ite/d insperdlons and review systems are to conformance 3n dds date. A. GARNESS Waiver Fee S Date of Payment Receipt Number MUNICIPALITY ANCHORAGE • DEPARTMENT OF HEALTH &HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.k 016�� 062—Oh HAA If 11Q5'1/�1101 1. GENERAL INFORMATION Complete legal description L.94 a M -s tl le - Location (site address or directions) eLocation(siteaddressordirections) OSS Li.ta Coy -r Property owner �°�'� L a a u-6.4 3 Day phone Mailing address 10 L 1 Sa. coy c+ Lending agency Day phone Mailing address /- -LSCiO ,1 t.4..d -y- Agent Day phone 2 7— tQ I Y C Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 y 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site ✓ Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-0251Ra. 1911 Rml MOAN21 S. 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 66C- Ll & u r k-tA L Phone LZ 9- 3 4 I.6 Address .90 3 >-ti L' ! -G t 90 Engineer's signature , Date 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments In FAA -1 NVAR. 71 WTIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and thei r 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-= (RW.1A9 Back MOA121 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 4•£2 Ne_914•,.r Ac�t" N"- Parcel I.D. 0/5— o%a—Di, A. WELL DATA Well type 12 If A. B, or C, attach ADEC letter. ADEC water system number NIR ' Log present (Y/N) Date completed '719-7/7 8 Driller M' tv Total depth 3 Do/ Cased to 0-7c?- b Casing height D `/ Sanitary seal (Y/N) �� Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION ' Date of test 9/47172- 3.2.7 Static water level ) j 99 m u r, s f �Z 1e f7 o Well flow g.p.m. ,�; g.p.m. m o • Pump level ©p rt1 W 00 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I OR, ; On adjacent lots 7 t v o z m Absorption field on lot 12 B ; On adjacent lots -0 Public sewer main t-4 Public sewer manhole/cleanout VA Sewer service line ? S0 Petroleum tank Nr'o WATER SAMPLE RESULTS: Coliform Nitrate N Other bacteria Date of sample: 3 zqI of 3 Collected by: r S B. SEPTIC/HOLDING TANK DATA Date installed 8-41 1/-78 Tank size / 25o Compartments z Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) N High water alarm (Y/N) "A Alarm tested (Y /N) r4/A Date of pumping '71g/I Q� Pumper + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I o R Onadjacentlots > Ic.-0 Foundation 1 A- Topropertyline % 30 Absorption I ield Surface water/drainage 1-410 IU Water main/service line >A 1; 72-026 (Rev. 7M) Fran - CONTINUED ON BACK PAGE C. LIFT STATION NSA Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 8/R9��B Soil rating 8 5 System type d* T"–,A e Length t I L4 Width - Gravel thickness 1t Total depth 1- • -r+ Total absorption area 3 421 Cieanouts present (Y/N) y Depression 1. over field (Y/N) N Date of adequacy test 3%24143 Results (pass/fail) for bedrooms J Peroxide treatment toast 12 months) (Y/N) 1y If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 12'8 On adjacent lots > 16-0 Propertyline 3D To building foundation 3 47– To existing or abandoned system on lot NZA On adjacent lots > 6fl Cutbank NoN e_ Water main/service line-- > 50 Surface water �t7 Driveway, parking/vehicle storage area > SD Curtain drain N O E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to alt MOA and HAA guidelines irf effect o6the date of this inspection. Signature r' Engineer's Name I oUde!pu Vk["t-DQ Date HAA Fee $ �70 r cR% tNAIVPf FPP' Date of Payment 44– S –7 3 Receipt Number % S 82� C2 2Z[ ' 72-M (Ft v. 5/91) Beek MOA 21 Date of Payment Receipt Number n N 5. LEGAL DESCRIPTION DATE RECEIVED •-. INS ECTION APPOINTMENTS TIMETIME L e-' • . TIME D-NO)"CRtV NUMBER OF,BEDROOMS t r_t0 ❑ One ❑ Four ❑ Other DATE ❑ Two ❑ Five DATE DATE v _a ' ATTACH WELL LOG. A well log is required for all wells drilled INSP]M_1 since June 1975. For wells drilled prior to that date, give well INSPECT INSPECTOR INSPECTOR S. SEWAGE DISPOSAL SYSTEM 1 I NJVt�T'!.MUNICIPALITY OF ANCHORAGE ❑ PUBLICUTILITY DEPT. MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL P20TE004 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1 826LStreet- Anchorage, Alaska 99501 SEP 419M ENVIRONMENTAL SANITATION DIVISION • Telephone 2644720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER y� PHONE po,. MAILING ADDRESS IF PROPERTY RESIDENT fit different from above) PHONE 2. BUYER PHONE MAILING ADDRESS - 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT C PHONE -Z MAILING ADDRESS S�3 G %/hc.So t �IJa 5. LEGAL DESCRIPTION Lo - STREET LOCATION L e-' • . 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY (� Three ❑ Six 7. WATER SUPPLY 99 INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM IK INDIVIDUAL/ON-SITE" /f YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLICUTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. � e 1 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY THIS SIDE FOR OFFICIAL USE ONLY 1 NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ :INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 1 .'3 O L %rirt 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED G INSTALLER ❑Septic Tank or ❑ Holding Tank Size: �T If Tank is homemade give dimensions: SOILS RATING �S! TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA 3 4z MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area V Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS LA PROVED FOR BEDROOMS ❑ /CONDITIONAL APPROVAL Metter must acco p certificate) b_ DISAPPROVED, Cl— DATE itBY )-, ,z 14� 72010 (Raw. 6/79) Oft (5l Ok C6�eS1� �A) CV -f -t - MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE /moo DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT ECTVEpT. C: I,- LTH & //..�] \� 825 L Sveet • Anchorage, Alaska 99501 ENVIRONMENTAL i :-`,TLCTION STREET LOCATION ENVIRONMENTAL ENGINEERING DIVISION OEC 12 1978 i Telephone 264.4720 p C �^ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND R &EVE1DES G DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be prxessed. Please a;low ten (10) days for processing. 1. PROPERTY OYINERPHONE 3y�/• d 9a G MAILING ADDRESS PROPERTY RESIDENT (It different from above) PHONE 2. BUYER PHONE • A� MAILING ADDRESS 3. LENDING INSTITUTION PHONE ` {;rST�r04 since June 1975. For wells drilled jrior Lo thatdat-, qly t e,I MAILING ADDRESS 4. REALTOR/AGENT PHONE af/E MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY X INDIVIDUAL- ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled jrior Lo thatdat-, qly t e,I ❑ PUBLIC UTILITY depth (attach log if available.) Zllr �y u %InR*.A-- 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE' "If individual/on-site, give installation date �g_�}c0.CY�•PJ1CC. If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 12471 UW 7a) cN 10 I 6 �— RANDC'AP-Ey /:30 M40 1417`79 THIS SIDE FOR OFFICIAL USE ONLY -� INSPECTION APPOINTMENTS -- — _ DATE RECEIVED , i'.'.L TIM TIME LATE DATE —D—Af E T:d:,'L CTOft INSPECT OH INSPECTOR 1. TYPE OF RESIDENCE SINGLE FAMILY MULTIPLE W,11LY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2.:4ATER SUPPLY •� INDIVIDUAL _ COMMUNITY PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SE'A'AGE DISPOSAL SYSTEM :irdDIVIDUAL/ON-SITE PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSFALLEO INSTALLER i.:S^pt.cTank or ❑Holding Tank f i7^.: _ If Tank is homemade ,o c:imwvsions: SOILS RATING -Y;'E OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Sepue/Ho!dmg Tank Al sorption Area Sewer Gne Nearest Lot Lina ) eI . w v, Area to nearest Lot Line 5. COMMENTS - CY APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED B Y -IUTrtt Ca OLSC[ IPTION ...0 0 R,, o, for