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Home My WebLink AboutTANAINA VALLEY LT 2 MUNICIPALITY OF ANCHORAGE D[ RTMENT OF HEALTH AND HUMAN SER ES Environmental Health I)ivislen ~)~//0 '~ / 7 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address ,~o ol B(,aroo,~s I-ELL FOUNDATION 7;4 ,v,4 / ,v,4 f~ffCFIol-I ~L TANKS [~} SEPTIC [] HOLDING .... Materra,~.~7.,~..,~ ---- tN° °1~°*"3~a~ents' TYPE OF SYSTEM TRENCH ~] BED [] W. DRAIN [~ OTHER orrgmal grade FT 0 FT ~ a *lZO SO Fr Inslal~er [)ate Inslalled WELLS PRIVATE ~' OTHER fldentilv) J Cased lo I:1 FT REMARKS: _~ ' DISTANCES ~ TO SEPTIC I FROM __-"'---~ TANK //' ABSORPTION FIELD WELL /,5' ENGINEERS SEAL i~ichael [!. Anderson 72-013 (3/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST E] SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18- 19- 20- COMMENTS WAS GROIJND WATER I~ ENCOUNTERED? /~(~ pO E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Crop PERCOLATION RATE TEST RUN BETWEEN ~ /' ~'~ (minutes/inch) (~ . FT AND JC} FT 72-008 (6/79) 5 [ ,l -- 'SO' SOILS LOG PERFORMED FOR: MUNICIPALITY OF ANCHORAGE [] PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTF. CTION T ST SOILS LOG - PERCOLATION TEST ~"~ '~' /~ ~OO~ DATE PER FORMED: ~'/~ LEGAL DESCRIPTION: 6 7 SLOPE SITE PLAN 10 11 13- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 14- 15- 16 17 18 19 Gross Net Depth to Net Reading Date Time Time Water Drop 20 PERCOLATION RATE (minules/inch) TEST RUN BETWEEN __-- FT AND ~ FT COMMENTS _~iL T~'~?' ~:~',~/-~0,~/~2~'~ ~ ~---- ~0 ~,~,~/~,~ /41 ~o¢/~r/o ~/ 0~: ~'/0 ~/~_ 72-008 (6/79) LEGAL DESCRIPTION: ,~O'~",~ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGIN~L) ,,.~'~1.~ ~/~.. DATE PERFORMED:, 7-!~' '~ Township, Range, Section: '-~.,~/ ,~'~/'~J ~ ~ 1 2 3- 4- 5- 7- 8- 9- 10- 11 13- 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? pC Oeplh lo Waler Aller~, ~, Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~"'7, ~. {minutes/inch} PERC HOLE DIAMETER . _1~. l/ PERFORMEO BY: ~ A~t~ ~//W/~ I - CERTIFY THAT THIS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE; 72~00g (Rev. 4185) TEST WAS PERFORMED IN 0 3 , 8 22 3~,645~,f. 21 35~,92 ? s.f. EAST 2i0,46' 2O 3$,§lls.f. S 66°§7'0,~' E .~ B?. I0 [~ec~ B~ Telecomm Esrrff~ 330 s,f -- 17 3B,B63 s.f 6 16 39,640 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORASE/WESTERN DISTRICT OFFICE / 3601 "C" STREET, SUITE 1334 ANCHORAGE, ALASKA 99503 STEVE COWPER, GOVERNOR 563-6775 To Whom It May Concern: According to the records on file in this office, the _~_~_~_~_~_~__~___ ~/~-~--E~-~E-~-S~J'-~m~-.m-/~--~--~_~ter SYstem is in compliance with the State o~ Alaska Drinking Water Regulations. Sincerely, Environmental Field OFficer u c p HtYof P.O. BOX 196650 ANCHORAGE, ALASKA 99519-6650 (907) 343-4200 ~R~ Tom Fink MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 12, 1988 Design In Wood 7021 Driftwood Drive Anchorage, Alaska 99518 Subject: Lot 2 Tanaina Valley Subdivision Permit 4870016, On-site Sewer Permit A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. The 1987 fees have not been paid for this permit,nor was the permit signed for to be valid for installation. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re-applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sincere, ~ /Robert W. Robinson Program Manager On-site Services RWR/ljw enc: Copy of Permit :; ;* I/, I lCqq)') WI:;'. I 'I'TIi:N CI 'J/;J.!;O ',i:~ Z [3 M E :(.) C I!~ S Z[ [:)1..I ]: h{ I~,J(:l[2JZ) Anchorage P.O. )X 19665O ANCHORAGE, ALASKA 99519-6650 (907) 264-~i.~1¢x 4 7 4 4 TONY KNOWLES, MA YOR DEPARTMENT OF HEALTH & HUMAN SERVICES January 9, 1987 Design In Wood 7021 Driftwood Drive Anchorage, Alaska 99518 Subject: Lot 2 Tanaina Valley Subdivision On-site Sewer Permit #860335 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1986. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report (three part form) must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4744. Sincerelv, ~.W. Robinson Program Manager On-site Services RWR/ljw eric: copy of permit .OE:S]:E~N ]:N IgEJCLO 702.:l. DF;: :I: F:: TNEII::U) :01::: F? L,II',IS (NE) I' X Fc!l'.'Lh I::!y !;,hl:~ IqLu'~J.c:i~p~;C!,:i.'L¥ elf ~rll::hcH-ag~? (1'4!i)(~) and zm,, :t: LU)(::h:';H"E:FI'CtF)d 'l'.ha~k t:.h:i:~ ):) L:,l" fl) J. '[. J.!:~ va].J.d F(;:)I' ,:~ m,'-zt.(:[fmlm Df' 4, l::)(¢,)(71r'c:)(:;).is:~ ~;~r'l(::l :t:1:: F~ I...]:F::'I' EFI'(.YF:!:I3N :I:E3 :!:IxlEYF~L.L.I::D :IN (~lxl hRl::~ C()VE:RI~::D t3Y Iq[:)h 'tldF:N ( J ) ~lxl IE[.I:C'II::~]:C(.~I.. I='E~l::;tlq ]:T f~,N[) :I:IxlEff:;'F:C'F:I:EIIq IqUST DIE C)13T(~]:NE:[)!l (2) ~:~F~-'f:dJ:l:LTS gJ:!:l.l_ IxlEJT }3[~: F~F'I:::'IROVE[) HI:l-HE)lIT (~N E:I.I:CTf?:!:Ct.hL ]:IxlSF:'E:E:I":I:E)N I::d~:F'E)IR'I'~i f~lqD (:2~;) TI.II:E: I:Zf. IEE;TI::U[C(~I. MC!F~I.::: I¥1LJS'r' J31:: D(:llxll: J3Y f~ I..]:E;IE:NE~E:D Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, ARchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: Township, Range, Section: (ENGIN~p~L) DATE PEREORM,=-D:. 1 2 3 4 5 6 7 8 9 10- 11 13 14 15 16 17 18 19- 20- SLOPE WAS GROUND WATER ENCOUNTERED? _ NO IF YES, AT WHAT DEPTH? Depll~ to Waler ^ller.~. ~, Moniloring? .Dr,, ? SITE PLAN Reading Time v?~'.f //oo~ /~o'I / COMMENTS .' ~O]/- ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEliNES IN EFFECT ON THIS DATE. DATE: _ 72-008 (Rev. 4185) Net Time Depth to Water ,~?1 ,~? ,~7/,~ Net Drop . o~ PERCOLATION RATE ~-'7,'/~_~ (minutes/tach) PFRC ROLE DIAMETER TEST RU~j~ BETWEEN ~'~,~"~ FTAND _ 7 195.00' ! , I ~ 3,1~,71 t s.f. 5.0o'(,} 3 I~1 IzJ- I i,¢ Oc.o ~c. ~ 3§,507 S f. zo 8 298 15'-~ :"6 W- 65977 139.00' - 32.645~.£ WEST- 659 ? 7.(R) .....] 265.?'7' 21 35~516 ~.f. 2O ~$~ 92 t ~.f. EAST 210.46' 6 32~542 .% 17 38,863 sf 16 39,640 sf. i~EVISEB .$1?'E 195.00' WflTE~, .-~d~ cE I ~9.00' '- \\ T 7 $4~550 2O 53,5rl s.f. g 19 31~ 301 ~t S 56°57'03F £ ;53~.927' I0 Elec. 8, Tel~comm I ~,4, 330 ~.f EAST 210.46' 17 ~,8,8 6 3 s.f 6 32t542 ~,f. I& 15 009, General Contractor 7021 Driftwood Place Anchorage, Alaska 99518 (907) 349-8014 September 9, 1986 Municipality of Anchorage Dept. of Environmental Health To Whom It May Concern; I, Samuel P. authorization to the sewer permit Hill, hereby give my assistant Debbie act as my agent to sign all concerned for Tanaina Valley Lot 2. Palmquist paperwork regarding (Samuel P. Hill President & Owner State of Alaska Third Judicial District This is to certify that on the ~_~-- day of ~~), 1986 before me, a Notary ~ubI~c in and for~ State of ~~sonally appeared~.nzz~ N F,=-~[]=~L~t~ known to me to be the person who executed the foregoin~ document ~n~ acknowledged to me that he executed the same as a free act and deed for the uses and purposes therein stated. Witness my hand and notarial seal the day and year first above written. motary Public ' :~ -~k~ My commission expires~2-z_/-~7 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 FIEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# t~3~\ - ~,-~\ - '--~,'~ HAA# 1, GI-'NERAL INFORMATION Complete legal description /--,o'~ ~;~1 '~/) )~J,q Location (site address or directions) Property owner Mailing address Lendin'g agency Day phone Mailing address Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well X Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site ~ Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOAt/21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Nameof Firm //~0~-'TL~:)~J ~C/.,J ~"E/~(.., Phone '~/~ ~1 Address ~0, ~O~ Z~O~75 . ~~, ~ ~¢~Z~ Engineer's signature ~ ~ ~ Date ~// /~; DHHS SIGNATURE Approved for /'~'~/~_(/~'~ bed ro o m s. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 June 1, 1993 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 REC£1VED JUN 1 1993 Munloipa~JtY o~ Anchorage Dept, Health & Human Services Municipality of Anchorage Department of Heath & Human 825 "L" Street Anchorage, AK 99502-0650 Services Subject: Lot 2, Tanaina Valley Subdivision Health Anthority Approval Certification Dear On Site Services Engineer: A conditional Health Authority Approval Certification was issued last fall on Lot 2, Tanaina Valley Subdivision pending filling of a depression over the drain field by June 1, 1993. On May 26, 1993, I inspected the drain field on this lot and noted the depression had been filled and the area regraded. The conditions of the Health Authority Approval Certification have now been satisfied. I am hereby requesting an unconditional Health Authority Approval Certification be issued for this lot. Please advise if you have any questions or conunents. Sincerely, Michael E. Anderson, P.E. 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 HAA # 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner _/~'/~,.,~,,~/E/'~ Mailing address ~' ~Z~ ~/'<~/-~-~e/,/ ~/"]/,~/'~ Day phone Lending agency Mailing address Day phone Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. 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. 72-025 (Rev. 1/91) Fronl MOA ~21 STATEMENT OF INSPI--CTION BY IE-'NGINEER 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 ,~,Jb GT~.S*o,-J ~ ~,,,,~z='-lc%-/L4,,¢6 Phone Address ~0 ~ox ~'¢077..¢ ,/~C~o,"cCd~(,-'~, ,/~ Engineer's signature "¢q//~--cJ-~zt~-~' ~ ~-¢-'-'"'--- Date 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for ,7~2'~-~'/~,J¢)~_ .' bedrooms, with the following stipulations: ! Additional Comments By: __ .- ~ Date 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 DH HS 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. 72~25 (Rev. 1/91) Back MOA ~21 Legal Description: A. WELL DATA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST ZoT~ Z 7~AIA/~/,4. [,lA l/eLI Parcel I.D. (~ II 0.'~1 77 Well type ~'¢~rc.p,g ct-?' If A, B, or C, attach ADEC letter. Log present (Y/N) Total depth Sanitary seal (Y/N) Date completed Cased to FROM WELL. LOG ADEC water system number Driller Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer service line WATER SAMPLE RESULTS: Coliform Nitrate Date of sample: B, SEPTIC/HOLDING TANK DATA Date installed $./~/G~ Cleanouts (Y/N) High water alarm (Y/N) __ Casing height Wires properly protected (Y/N) g.p.m. AT INSPECTION MUNiCiPALITY OF ANCHORAGP. ENVIP, ONMENT^L SERVICES DIVISION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank JAN 0(.; 1995 g.p.m. P, ECEIVED Collected by: Other bacteria _Tank size _ Ieee Compartments Foundation cleanout (Y/N) .Y' Depression (Y/N) ,,4'/,,//,4~ Alarm tested (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot/J¢,4¢' ¢~-~ Lo?' Onadjacentlots To property line ~o/ Absorption field Surface water/drainage 72A326 (Rev. 3/91) Front MOA 21 CONTINU ED ON BACK PAGE C, LIFT STATION Date installed Size in galtons Vent (Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Su dace water D. ABSORPTION FIELD DATA Length ~; ~' Width .2, ~ ' Total absorption area ~ Z Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ,~$? ~'/.~,~-- System type TK~'~Jc~( Gravel thickness /~ / .Total depth /o' Cleanouts present (Y/N) y Date of adequacy test ~ for ~-///2~ ~-~ bedrooms t,,I SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~J E~ TO building foundation On adjacent lots Surface water If yes, give date _ On adjacentlots ~,,.v~- ~^, ~/¢~-s Propertyline /~' To existing or abandoned system on lot Cutbank //¢,~/.v ~n~ Water main/service line Driveway, parking/vehicle storage area Curtain drain /VerY_ //~ ..~',~/ ED ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Name Date HAA Fee $ /'~) Date of Payment Receipt Number 72~28 (Rev. 3/91) Bsck MOA 21 Waiver Fee: $ Date of Psyment Receipt Number WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 January 4, 1993 (907) 349-7755 Wayne McFadden SUBJECT: Country Lane Estates Class "A" Public Water System, PWSlD 214706 Dear Mr. McFadden: I have completed a review of this office's files concerning the monitoring status of the above-referenced Class "A" Public Water System and found the following: The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on December 21, 1992. This ~does__E~z~Eet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last inorganic Chemical Contaminants Sample results were submitted to this Department on May 4, 1990. This ¢o~es_lz~e.t the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. The last Radioactive Contaminants Sample results were submitted to the Department on December 5, 1990. This dome, s_racet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. The last Organic Chemical Contaminants/Volatile Organic Chemical were submitted to this Department on November 16, 1991. This d_q.e_s meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above-referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICFS 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # _("~-\ / - (~*~-~ \ ~ '~ ~ HAA # _ L--~ (~ ~ f-~;,"-,, ("1°~ ..-~ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address 4~ (c) Lending Institution Mailing Address Telephone: (home) N,,4.. _Business m,~. (d) Real Estate Company and Agent Address ~'O O ~'O ~'~o Telephone ~ 7d"- P- 70~/ (e) Mail the HAA to the following address: (or check here [~, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single-Family ~ Number of bedrooms 3. WATER SUPPt. Y 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-site ~ 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 bel ow, I verify that my investigation of th is 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 Engineer's Seal 6. DHHS APPROVAL Approved for '3--- bedrooms by Approved /~ Disapproved Terms of Conditional Approval 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. ~ MUNIC PALITY OF ANCHORAGP (MOA) ~ ~,L~I[~,Y O~ A;%.~;~thorlly Approval (HAA) ~NV~ - : IST - FEBRUARY 1984 343-4744 Legal Description: ~o~ ~., 7~r~ RECEIVED A. 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) SPPARATION 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 0 ~-~ I~/'¢-er- of Com/~['~¢4,,~c~¢ Date Completed Depth of Grouting If A, B, C, D.E.C. Approved (Y/N) 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 B. SEPTIC/HOLDING TANK DATA Date Installed 3/,'¢/~; Size Standpipes (Y/N) 'r' _Air-tight Caps (Y/N) Depression over Tank (Y/N) _ ~ Pumping/Maintenance Contact on File (Y/N) N,//. Holding Tank High-Water Alarm (Y/N) I~,h/L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: I ooo,~ No. of Compartments ~ t' Foundation Cleanout (Y/N) P' Date Last Pumped _~ / / ~/'//cd /~ ? -¢'~ ,~ac./ ; for iv. ,4. Temporary Holding Tank Permit (Y/N) /~, 4. To Building Foundation 1'o Disposal Field To Water-Supply Well '~ ~ o~t To Property Line ~O ~ To Water Main/Service Line__~ ¢¢" To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Fronl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~/// (O~ Width of Field ~, ¢' Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well ~ <T(,,a ' To Building Foundation '~ ¢¢' Lot To Water Main/Service Line ~ ~..?' To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parkin9 Area, or Vehicle Storage Area Comments _,(' ~/.,¢~'~'~ /¢(~.¢'o~ D. LIFT STATION N,,4-. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments //3 c¥¢',,~ Type of System Design Length of Field o"O ' Depth of Field ! o~ Gravel Bed Thickness d' ' Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line 1¢~~ To Existing or Abandoned System on ; On Adjoining Lots ~ $~ ' To Cutback (if present) N, Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidel.[~9.s~irl~ffect on the date of this inspection. Signed .¢7~'~ ¢ ~ Company ~[~ ~.;~ ~c'~ ¢.,, ~ ...................... ~ng~neer s Seal MOA No. ~¢ -Ot~ Receipt No. ~ [~ ¢ 0'~ Receipt No. Date of Payment ~-' ~¢~ ¢~ Waiver Fee: $ Amount: $ ~ / ~ ~) Date of Payment 72-026 (Rev 7/88) Back Page 2 of 2 DEPT. OF ENVIRONMENTAL CONSERVATION/ / ANCHORAGE WESTERN DISTRICT OFFICE 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 February 20, 1990 STEVE COWPER, GOVERNOR 563-6775 Flat Top Technical Services Anchorage, Alaska 99502 ATTN: Mr. Ted Moore PWSID: ~t~14706 According to the records on file in this office, the Country Lan~ Estates Water System is in compliance with the State of Alaska Drinking Water Regulations. Sincerely, Officer VEC:bas