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HomeMy WebLinkAboutHILLSIDE PARK PUD LT 25Onsite File Hillside Park PUD Lot 25 #015-312-19 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211357 PID Number: 015-312-19 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JAMES CAMPBELL ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7021 EAST TREE COURT, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot HILLSIDE PARK PUD 25 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. Well 200'+ __ 25'+ TANK M Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+-- Material HDPE Number of compartments 2 Lot Line 5'+ __ NA Foundation *5'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks 5'+ FIELD TO SEPTIC TANK PER MNA. *PER PERMITTED DESIGN Alarm location Electrical installed by Installer MNA — MIKE ANDERSON PIPE MATERIAL House to tank 3034 d a n Tank to 3034 ld Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection ection V1 9/18/2021 2�d 9/18/21 Location and description 3rd 4'h TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL �C`\\ -� • • • Conditional Approval: Date % *:49TM ••*�� • �" . ••••••••••. Septic System Approved - Curtis Huffman ` Date — - i�, •. CE 128991 /28/202. •' Aw PROFESS\ON� Note: this approval does not include well permit requirements. k�v voivu ion PID: 015-312-19 PERMIT: OSP211357 A—C=21.0' B—C=22.3' A—D=23.0' B—D=18,8' A—E=25,7' B—E=15.5' l� 9/28/21 SURVEY: HOLT O FWCS SCALE: 1" = 30' PAGE: 1 OF 1 M Q EXISTING 03 FIELD � w B REMOVED EXISTINGjD0 S.T. & INSTALLED NE CO _> 1000—GAL HDPECO Ln SEPTIC TANK oE�A IN THE SAME LOCATIOCODECK mWITH NEW DCO. MH Ln *BM TOP MH FCO -'-4! CANT 0 A 4'84 O O SIy��F z F�Aa1FI<Y y�USF 30 4 14.4�'r-77-77-1 s.s 3BR HOUSE 24.3 < a APPAR WATE N CONG�RETE PER DRIVE / L 7i "AST COURT V, La La v w 0 SEPTIC SECTION SCALES NTS HILLSIDE PARK PUD LOT 25 PREPARED FOR: JAMES CAMPBELL 7021 E TREE COURT ANCHORAGE, AK 99507 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK©gmoil.com DATE: 9/28/21 SURVEY: HOLT DRAWN: FWCS SCALE: 1" = 30' PAGE: 1 OF 1 AdIllp OF AL`S' * 9 TH rtis Huffman 4; CE 128991 9/28/21AMFv MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Bax 750665o 4700 EFrn ore %Ed Are[harsga. Alasle$ 995t 550 FtKmrB:1907) .343-7904 Fix, �907�343-7997 htt p: l . rfw i .O(f O h s i Le 0 n -S 3te aqtewater T) 1 s p os a[ System Permit permit Nurnber, OSP2113:57 Work Type: SepticTank Upgrade Tux Dtadju Numbvr' 01531219000 $Ite I-egal Address: fi]LLSIDE PARK PIJD LT 25 G:2530 Site MaMrig Address: 7021 EASTTRF-ECT, Anchorage Owner, CAMPBELL JAMES D Des Igrl Ertigineer; FIRST WATER DON LILTING This pe rmit is for the construction of: Effec-tiva Date Expiration Date, Lot Size in Sq Ft: Total Sedroe ms: 8Q5=21 8r25CD22 1879D Ll Disposal Field 0 Septic Tank L7 Holding Tank ❑ Privy ❑ private We][ ❑ Water Storage All constructi-on shall Ike in a-00-ordance wlth_ 1, The attached appfovad dosegn, 2. All req uiremerrts specified in Anchorage [Municipal rode Chapters 15.55 and 15.65 and the State a€ Alaska Wastewater Disposal Reg ulaleans (13AAC 72) and Grin king Wafer Regul alzons ( 1 WC60) a. Th ur wa sLowa Lur code re-qulres Imp$otlOnS OLrhA§ Rhe i nstal lation- I al a engineer sha 11 notify the Devel!opment Services Depa rtme nt pot AM C 15-65- Provid a n olifi Cation try calling (907) .343-7904 (24f7)- 4. From October 15 to April 1:5, a subsurface sail abscrpllcm system under oansUvcdon during free2ing weather shell be either a- Opened rand Closed on the same day, or b- Covered, eealed, and heated to prevent free2ing R1900iV06 By; Issued By: 8125f2021 Date: Date: . ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-312-19 Property owner(s) JAMES CAMPBELL Day phone _ Mailina address 7021 EAST TREE COURT, ANCHORAGE, AK 99507.. Site address 7021 EAST TREE COURT, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) HILLSIDE PARK PUD LOT 25 Legal description (Township, Range & Section) Lot Size 18790 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) F (w/wo ADU) Septic Tank F Upgrade Q Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: 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 25 Waiver Fees: Date of Payment: $1c? 3 /,W Date of Payment: Receipt Number: ft 3 a 9S Receipt Number: Permit No. OS P-9,113 57 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 24, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: HILLSIDE PARK PUD LOT 25 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by a Community Class A water system. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211357, Rebecca Carroll, 08/25/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211357, Rebecca Carroll, 08/25/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211357, Rebecca Carroll, 08/25/21 /'~" MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION ,REPORT ~E ,ILING ADDRESS IPHONE J~NEW I']UPGRADE DESCRIPTION k %5- JLOCATION ~ ,, Well ~ DISTANCE TO: ~ Manufacturer Liq, capacity n ga j / ~_~ IF HOMEMADE: I Manu[acturer I DISTANCE TO: Co~.u~4 J No. of lines ~ ] ~ength of each'line Top of tile to finish grade ~ Width Depth I Type of crib ~ Well ~1~ Depth Driller I ~ Buddmg foundat,o~ Absorption area Dwelling M at e ri~l.¢..~ Width2) LL~-' Foundation NO. OF BEDROOMS PERMIT NO. ~11~(o No. of compartments ~7~.. Inside length~_~ Liquid depth ~ Dwe ng PERMIT NO. Liquid capacity in gallons Material Nearest Iotline Trench width ~ ~inches Total length of lines Material beneath tile PERMIT NO. /4A/,/,¢ u~/tc i ?7' Distance between lines '~ ~ inches PERMIT NO. Crib depth Total effective absorption area Building foundation Nearest lot line Distance to lot line PERMIT NO. Sewer line Septic tank Absorption area(s) Total effective absorption area OTHER PiPE MATERIALS SOIL TEST RATING INSTALLER REMARKS APPROVEI~/ ~ , DATE LEGAL //--z /./, MUNICIPALITY OF ANCHORAGE Department?-~?. Health and Environmenta?~rotection 825 ~ ic t: a t i o n: O~/~ V P h on e Numb e r: ~pe of Soil~sorption System Is: Trench: ,~ Drainfield: Seepage Bed': Street, Anchorage, AK. u9501 264'4720 * * * HANDWRITTEN PERMIT * * * ~ ON-SITE SEWER PERMIT ,ot Size: /2? 9Q Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) ~-~ / The Required Size of the Soil Absorption System Is:' The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(~) TANK SIZE = ~ GALLONS * * Permit appliCant has the responsibility to inform this,department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection.and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 2 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on'site sewer system may._~require enlargDment if the residence is remodeled to inslude more t~_' .bedroo?/~ Applicant ate: /2F'? - SWP/024 (1/81) Holding Tank: TEST HOLE 1 ORGANICS SILT w/ TRACE SAND (ML) SAND w/ sOME SILT (SM)' 0.5' {OLE 2 ECS SANDY~ __ ,,5.0' GRAVELLY SAND w/ TRACE SILT (SP-SM) ll.0'T.D. GROUI~DWATER WAS NOT ENCOUNTERED 10.0'T.D. GROUNDWATER WAS NO'.[.' ENCOUNTERED 6-29-?7 t~~~ ~ONSULTANTS, INC. TEST HOLE LOGS THE PARKWOOD CO. 751176 PP]NCOJ2AT~ON ff'ftF, PARK~dOOD CO. TEST ~IOI,I,; NOo t (1972 T.fl. i) INCHNS i)R() 3: 05 0 9 3: 06 14.5 3:07 3~ 5 2 I 5.0 3:08 2. 5 3 J7.0 3:09 2~0 3:10 5 3: [ 1 1 ~ 5 ? ~ 5 3:]2 7 23. 25 3:13 1. 75 8 24. 25 3:14 9 25~ 0 o. '15 3:15 25. 0~ 75 3:20 3: 25 20 32.5 3.25 3: 30 25 3.0 3.3c~ 30 38.0 3:45 40 42 4,0 3:55 50 45.25 4:05 48.0 2~ 75 39.00 !NCi{t,]S ~IO'"AL DROP 1.54 ~[NU'i'ES PNR iN(Ii Locations shown are approximate and have not been measured by surveying methods. DOUBLE TP~EE 0 ' MALLEY J TEST HOLE LOCATION DIAGRA~ FOR THE PARKWOOD COMPANY MUNICWALITY OF ANCHORAGE Development Services Department` Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-312-19 1. GENERAL INFORMATION Complete legal description HILLSIDE PARK PUD LOT 25 Expiration Date: 2 r 2z Z 3 Location (site address) 7021 EAST TREE COURT, ANCHORAGE, AK Current property owner(s) JAMES CAMPBELL Day phone Mailing address Real estate agent 7021 EAST TREE COURT, ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well ® Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $550. Date of Payment 9 .l4 a0,2 Receipt Number goo a 3 5 COSA# OS C)mr.61 Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 9/17/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS 6. DSD SIGNATURE System #1 Approved for 3 System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms ��'4!�:9\��1� .� TH . - ... �.. • Curtis Huffman 9-. CE 128991 .,•��`�low SOP W,- ROFESS0 bedrooms, with the following stipulations: Y OF 4&,, WATER AND G ASTEv"ATER /9JJ)JII I By: 1 Original Certificate Date:-0— The ate:0— The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: HILLSIDE PARK PUD LOT 25 Parcel ID: 015-312-19 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA – COMMUNITY WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) — in. Date of flow test for COSA Static water level at beginning of test _ft. Comments B. TANK DATA Age of tank(s) 0 – NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NEW ® Standpipes/foundation cleanout per record drawing Date of pumping NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 11/23/1982 ® ALL standpipes present per record drawing Total measured depth from grade 8_9 ft (max) Measured depth to pipe invert from grade 5_8 ft (min) ❑ N/A – pressurized field Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate _mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by, Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 8/17/2021 Results M Pass For 3 bedrooms Fluid depth prior to test 11 in Water added 450 gal New depth 15 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time <15 min depth into effective ® Code -required soil cover over field Final fluid depth 11 in ❑ System presoaked Absorption rate 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons NES Comments/Deficiencies: .,,, E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ❑ Yes if No ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑Yes _ if No ft ❑Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *5+ ft Surface Water >' 100 _ ®Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >' 100 _ ®Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells >' 100 _ ®Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PER PERMITTED DESIGN. G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. - . .r Curtis Huffman ��� �F�j•. CE 128991 .•��c`�o kP A- OOFESF�F4SION�`��-..—� ft ft ft ft ft ft ft ft THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR P05ITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. ,X RET WALL FENCE ooP��.�F'9Lq�;pO *CP. 49 TH PA PA VA OQQ° SHANE A. HOLT 04 o piea LS -6914 .... a .°jessioW _ AS-BU/LTSURVEY 1" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 25, HILLSIDE PARK ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _20 TH DAY OF _SEPTEMBER , 2021. HOLT LAND SURVEYING 9389 GROVER DRIVE ANCHORAGE,AK 99507 9008, FB 106-33, 174-27, SCAN,217-30 907.223.8615 Parcel I.D. # 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Lot 25; Hillside Park P.U.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 Location (address or directions) 7021 East Tree Court (b) Property owner Freddie Mac #,32-205167-3C Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) (e) Real Estate Company and Agent Address $ 201 C S,f:_r~.~: Telephone 563-5500 JACK WHITE COMPANY ATTN.' K~s Kurtz 100 Anchn~g~ AK. 99503 Mail the HAA to the following address: (or check here~], if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 1_?n34 t:=~.l~ River Loop Road Eagle River, Alaska 99577 2. TYPE OF RESIDENCE " ' ' Single-Family []3X Number of bedrooms ~ v/ 3. WATER SUPPLY ~. Individual Well J- Community.iD( Public [] Note: If commu.nity well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality a nd status. 4.. SEWAGE DISPOSAL On-site ~x 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 I 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. Name of Firm Address Date 17034 Eagle River Loop Road No. 204 ...... ^~,,~ 99577 Telephone Approved ~'~l~isapproved Conditional Terms of Conditional Approval /~?b/~- 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 Mu nicipality 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 MUNICIPALITY OF ANCHORAGE (MOA) e t ' Approval (HAA) UNiC~PAL['[ ' ~ ~IRONMENTAL S[:RVICLS'DJJ~44 RECEIVED __ Date Completed Depth of Grouting WELL DATA Well Classification Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: 'To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments ~' L~- ~'/· ~' ~""~ · Legal D scription: ~ If A, B, C, D.E.C. Approvedi~N) y Yield Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ; Date Date Installed /~/~t/, ~-~ Size Standpipes [~'N) y/~ Air-tight CapsE~N) Depression over Tank (Y~ /"'/ Pumping/Maintenance Contact on Filer (Y/N) Holding Tank High_water Alarm (y/N) ~',~/~ NO. of Compartments ¥ ,'~ Foundation Cleanout<~l~i) D/ate Last Pumped ; for Temporary Holding Tank Permit SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well ,~¢:>~ I.~ ~ To Building Foundation To Property Line ~ I ~ To Disposal Field To Water Main/Service Line /~;, I ,1 To Stream, Pond, Lake or Major prainage Course Comments A --/~:2/,-,-~ .~b-~, 72-028 (Rev. 7/88) Front Page 1 of.2 C. ABSORPTION FIELD DATA Soils Rating in Absorption ~trata Date Installed ~)' Width of Field Square Feet of Absortion Area Depression over Field (Y/~ Results of Last Adequacy Test Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present~/N) Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ I.(. To Property Line To Water Main/Service Line ~. ~ I'-F To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments'""~-~ ~ ~ L~'~ ,-'-~ .~.~_~~ To Existing or Abandoned System on ; On Adjoining Lots "'~'~C:~ I+ To Cutback (if present) 'r~/'~ / D. LIFT STATION ~.~/~, Date'~,~d Size in Gall6~~ "Pump On" Level at Dimensions Manhole/Access (Y/N) "Pump Off" Level at High Water Alarm Level at ~'"~~ Vent (Y/N) Tested for ~_..~Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect inspection. Company . Date Receipt NO. Date of Payment ) ~ ~ [ ~'' ~- ~' Waiver Fee: $ Amount: $ (~(~) ~:)'~ Date of Payment 72-026 (Rev. Z188) g~ck Page 2 of 2 DI~PT. OF ENVIRONMI~NTAL CON~ERYATION ANCHORAGE WESTERN DISTRICT OFFICE / 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 December 4, 1989 STEVE COWPER, GOVERNOR 563-6775 S & S EnGineerinG .... 17034 EaGle River Loop, Suite 204 EaGle River, Alaska 99577 PWSID: #212461 According to the records on file in this office, the·Hillside Park Subdivision Water System is in compliance with the State of Alaska Drinking Water ReGulations. Sincerely, Environmental Field Officer VEC:bas 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 264-4726 1. GENERAL INFORMATION (a) (b) (c) (d) (e) Application Date Legal Description (include lot, block, subdivision, section, township, ranoe) Z~7" ZS' /-////~o¢ /'~,~'~' ~',~,~. Location (address or directions) Applicant Name ~A~/._ Telephone: Home Business Applicant Address '70~-1 ~/~T 'T3'~"~ AppliCant is (check one): Lending Institution []; Owner/builder [~; Buyer []; Other [] (explain); Lending Institution Al AS~A /v~O'l-t)Al 1~A~/4_ Telephone Address ¢'~ ,_u~ Lb ~..OO'~' / &~ L~q,L~q~' -- Real Estate Company and Agent Address Telephone (f) Mail the HAA tO the following address: 2. TYPE OF RESIDENCE Single-Familyl~ Multi-Family [] Other 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 Co~ 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. 72-025 (11/84 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'~hat my investigation of this Health Author ty Approval shows that the on-s te 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 investigatioh and inspection, the on-rote 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 . Name0fFirm ~.*/~)/Z~ ~t~'//~J,2::~,v~.., ...~C.., Telephone Address ~/ ~' ~0~ ¢~ Engineer's Seal DHEP APPROVAL Approved for ~ bedro~)ms by Approved ~.,/"~ Disapproved Terms of Conditional Approval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health AUthorit; Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered' ' ' ' ' m the State of Alaska. The DHEP does th~s 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 analyze data before a cert f cate is issued. The Mun c pa ty of Anchorage is not respons ble for errors or omissions in the~ professional engineer's work.~ WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) ,H~_~.A~L~I4~C,T:~IORITY APPROVAL (NAA) OF HE/I~t~IE~KLIST - FEBRUARY 1984 ENV~ROH~EH~AL p~OTECTtO~ 264-4720 ~[ ~'~'~ Legal Description: ~ Well Classification Oo,,'~/,,'t U~ FT' ? If A. B C. D.E.C. Approved (Y/N) Wel, Log Present (Y/N) Date Completed Yield Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separabon Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected Dy Water Sample Test Results Depth of Grouting Pump Set At 'Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) : On Adjoining Lots : On Adjoining Lots To Neat~st Public Sewer To Nearest Sewer Service Line on Lot ~ UAJ'~,~,,4. / .,//','~ .'~',,~.,'¢~',,~' : Date Comments B. SEPTIC/HOLDING TANK DATA Date Installed /f/'¢¢. ~ Size Standpipes IY/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pum ping¢ 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 Pro perty Line To Water Main/Serwce Line Course ~O~ No. of Corn partments )/ Foundation Cleanout (Y/N) Date Last Pumped y : for Temporary Holding Tank Permit IY/N) To Building Foundation /~7. To Disposal Field ~_~,~'"- To Stream. Pond. Lake, or Major Drainage Comments E~ E.I~T lC- Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 60" Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~/-~" Standpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absorption Area Z Depression over Field (Y/N) ^1 Results of Last Adequacy Test ~=',,'~-~",~' Separation Distance from Absorption Field: To Water-Supply Well ,-,~' '/' To Building Foundation Lot x/oM ~, To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Y To Property Line E,_~.¢v" To Existing or Abandoned System on ; On Adjoining Lots ~' '~ To Cutbank (if present) NO?' P'~E"$~',~';"' 70' D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MqA a.nd HAA guidelines in effect on the date of this inspection. Signed ~ ~"~Date Company/~(-lvU~O'~/'/.~ Receipt NO. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: f907) Address: 274-~533 DATE: July 14, 1986 PWS I.D.N 212461 To Whom it May Concern: According to records on file in this office the Water Regulations Hillside Park Subdivision Water System is in compliance with the State Drinking Sincerely, ,, ' APPLIC 'NT FILLS OUT uPPER HAt? ONLY ~, ~ r~ ~ Phone Property Owner L...~ { .~{~..~.{ ~. }-'"(i.(.,f ?~:: ~ (- Address Zip Code Phone Lending Institution : ] ~,/, .. ~ / I ~ ~ ~.-~ t { Zip Oode Address t), ' t ' ~ ~ t ~ ; ~ ~ L 1( .~ /'"~ L Realty Co. & Agent Phone Address Zip Code Type of Resi~nce ingle Family ultiple Family No. of Bedrooms ~ Other Water Supply ' ~ Individual / ATTACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. , Community ~ ~' < ~.-- For wells drilled prior to that date, give well depth (attach Icg if available). Public Utility Sewer Disposal ~-lndividual Year Individual Installed: ' ~Public ~ility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: Iv[UNIC~PALITY OF ANCHORAGE DEPT. OF HEALTH ENVIRONM[NTAL PROTECTION RECEIVED ( .~ ) APPROVED BEDROOMS *CONDITIONS OF APPROVAC ( I D~SAPPROVED ( ) CONDITIONAL APPROVAL* DATE ~--~ ~3 BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received 1t--. ~ '~ Well to Tank (~'E'A~f.,~:~.J~ Septic Tank Size