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Home My WebLink AboutKNIK HEIGHTS BLK A LT 6r 017 03a 06 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. s GREA,-,ER ANCHORAGE AREA BOR'LJGH ��G��''�� Departmentof Environmental Quality ""'" 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME��.L'Z/ va�Z4 MAILING ADDRESS &I��1jf LY •/, PHONE jam( LOCATION LEGAL DESCRIPTION�i� SEPTIC TANK: v DISTANCE FROM WELL MANUFACTURER INSIDE LENGTH INSIDE WIDTH MATERIAL NUMBER OF COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: 0/0rt " �" I.�' �✓%�2�y1 �� tL1 �l line DISTANCE FROM WELL 0e) TOTAL LENGTH / FOUNDATION NEAREST LOT LINE fOF LINES NUMBER OF LINES DISTANCE BETWEEN LINES ,4 TRENCH WIDTHZ IN. TOTAL EFFECTIVE ABSORPTION AREA 1 SQ. FT. LENGTH OF EACH LINE ; DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE �.__� ABOVE TILE�iN. WELL: TYPE_ CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION LOT LINE , SEWER LINE , TANK , SYSTEM CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED_ DISTANCES: INSTALLED BY: SEWER LINE DEPTH: ` PIPE MAT RIAL: NVI 9 . LOT SLOPE,1• REMARKS: Form EQ -032 REMARKS DIAGRAM OF SYSTEM DATE /j_ l APPROVE f Lt_)Lw- Los GREATER ANCHORAGE AREA BOROUGH $ DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM APP C ON AND PERMIT NAME OF APPLICANT ' - 1 G ADDRESS �Q Qt_e PHONE Jity INSTALLATION LOCATION 91 9/ LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK! TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS�� COMPLETION DATE ANTICIPATED ' /d's� SEEPAGE. PIT DRAIN FIELD OTHER TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT , DRAIN FI SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT , DR. TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO CONSIE WATER MAIN TO SEPTIC TANK SEEPAGE DRAIN FIELD SEPTIC TANK, SEEPAGE PIT , DRF TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO Cl EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC T. FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALL G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE --:4,40/74 APPLICANT'S SIGNATURE DIAGRAM OF SYSTEM 'URt,• K ANCHUKAGt ARA BUf' 1GN Department of Environmental Quality • -' 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME �/fI?_ t/:'` '_� MAILING ADDRESS . %� %/ /� ��'PHONE JL' rl rrC/ r ; LOCATION LEGAL DESCRIPTION i SEPTIC TANK: DISTANCE NUMBER OF FROM WELLMANUFACTURER <C:. MATERIAL— —COMPARTMENTS— INSIDE OMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH — LIQUID CAPACITY GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER OR WIDTH » LENGTH` DEPTH LINING MATERIAL?`IlZjt•el °%`y CRIB SIZE: DIAMETER DEPTH �/ DISTANCE FROM: WELL BUILDING FOUNDATION I' N NEAREST LOT LINE /T %/ TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)— SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE /' CC/C-` CONSTRUCTION i / DEPTH CDISTANCE FROM: i BUILDING NEAREST NEARESTSEPTIC SEEPAGE FOUNDATION iC LOT LINE i SEWER LINE / 7 TANK SYSTEM /--> CESSPOOL OTHER SOURCES /,/°' "� fL) APPROVED DISAPPROVED REMARKS DISTANCES: •� / z' !% 1. INSTALLED BY: PIPE MATERIAL: LOT SLOPE: REMARKS: DATE Form No. EQ -031 DIAGRAM OF SYSTEM —1 ,c I v f / 7� 0/ �LYAPPROVED G.A.A.B. yw,ion[oe f ti , 9 ♦ 34� IY � �htMt[O Lw''Ph' GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT �.1�1`r� 6LL4'c INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK —Le TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH PERMIT NO MAILING ADDRESS ST. I`, ''^ IE7414 PHONE 3 A -3 97.t 995�� SEEPAGE PIT `Z' TO BE INSTALLED BY DRAIN FIELD OTHER SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE I �p 0 TYPE.A" SEEPAGE AREA SIZE ' • All n� TYPE �r xa,rh� MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM '.1 FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT i DRAIN FIELD . rl SEPTIC TANK TO SEEPAGE PIT WALL / SEPTIC TANK �, SEEPAGE PIT i� C DRAIN FIELD TO NEAREST LOT LINE. r 1a WELL TO SEPTIC TANK �-� SEEPAGE PIT , DRAIN FIELD ALSO CONSIDER AREA WELLS. !41 I r WATER MAIN TO SEPTIC TANK � SEEPAGE PIT DRAIN FIELD , SEPTIC TANK, Qdl , SEEPAGE PIT DRAIN FIELD , TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REG(U/LATIONS ARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE�/ S % APPLICANT'S SIGNATURE F(lGM Nff F!J-Iff f. `R&M EN6-cNEERING & GEOLOG16 'L CONSULTANTS 229 EAST 51st. AVE. - P.O. BOX 6087 - ANCHORAGE, ALASKA 99503 TELEPHONE 907-279-0483 TELEX 090-35419 Civil Engineers Geologists Land Surveyors JAMES W. ROONEY, P. E. R- 1 RALPH R. MIGLIACCIo MALCOLM A. MENZIES, P.E., L.S. R�7grigineering Geologist JAMES H. WELLMAN; P.E. J UI u 1974 Qlll GREATER ANCHORAGE AREA BOROUGH 6EPt: i7(• Er. 'ENTAIL QUALITY July 12, 1974 R & M No. 462050 Mr. Tim Bushert Star Route A Box 1594 Anchorage, Alaska 99507 Re: Test Hole and Soil Log Report for Sanitary System Lot 6 Block AKnik Heights Subdivision Dear Mr. Bushert: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of July 11, 1974, and those procedures outlined in.a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Log 6 area for the purpose of defining general subsurface soil conditions for the proposed.sanitary system.. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 15 feet below ground surface. The final log prepared for the test hole has been included in Drawing.A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M ENGINEERING & GEOLOGICAL CONSULTANTS, INC. James W. Rooney Jti1R: kd lawk xc: GRAB TIM BUSHERT PROPERTY Engineering a Geological Consultants Inca LOG OF TEST HOLE ANCHORAGE FAIRBAN%S ALASKA JUNEAU ANCHORAGE, ALASKA DATE 7-1 2-74 SCALL l "-3.0 i OWN BY WED - CHKD BY WEDPft�. No. 462050 owct NO.A-OI Q r In a < - - ,TH l - - - - - g� ... 7-11-74- 0.0 . ORGANICS 0.5' y< - < '` SILTY SILT' TRACE SAND (ML) z _ 2.01 4 �< SILTY SANDS SOME GRAVEL 10 5 (SM) � iy_ 4 h t k TIM BUSHERT PROPERTY Engineering a Geological Consultants Inca LOG OF TEST HOLE ANCHORAGE FAIRBAN%S ALASKA JUNEAU ANCHORAGE, ALASKA DATE 7-1 2-74 SCALL l "-3.0 i OWN BY WED - CHKD BY WEDPft�. No. 462050 owct NO.A-OI Q r In a r 6 J`�• g� ` < '` SILTY SANDS (SM} z 10 5 iy_ 4 h k a: SILTY SANDS TRACE 7r ^s -GRAVEL. ,T 7v NO.VATER TABLE. i 3 NOTE: ..Test -hole excavated with a tractor -mounted backhoe.`_:: l TIM BUSHERT PROPERTY Engineering a Geological Consultants Inca LOG OF TEST HOLE ANCHORAGE FAIRBAN%S ALASKA JUNEAU ANCHORAGE, ALASKA DATE 7-1 2-74 SCALL l "-3.0 i OWN BY WED - CHKD BY WEDPft�. No. 462050 owct NO.A-OI GAAB-HD i Gi ITER ANCHORAGE AREA BOR® ;H r �ARTMENT OF ENVIRONMENTAL QUAL Jl 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8886 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM r MAILING C /��, 14//� /� NAME /tib 1 �� c C� (� l� -ADDRESS_5X/4 A �� / i j1 PHONE LOCATION_L'✓ I // q ! / 117�i )I LEGAL DESCRIPTION G.CJ A 4 1 K i !/l� -TANK: 11v1C/j h� A j NUMBER OF DISTANCE FROM WELL J MATERIAL �� COMPARTMENTS LIQUID CAPACITY 2 �i C2/9 GALLONS. INSIDE LENGTH INS DE WIDTHLIQ THD SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAM ER OR WIDTH , LENGTH , DEPTH , LINING MATERIAL ISTANCE FROM WELL BUILDING FOUNDATION , NEAREST LOT LINE TOTAL EFFECTI ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL XBETWEE4ES- NEAREST LOT LINE , OF LINES , NUMBER OF LINES DISTANTRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SQLINE DEPTH: TOP OF TILE TO FINISH GRADEOF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: DISTANCE FROM WATER TYPE I DEPTH BUILDING FOUNDATION. SAMPLE , NEAREST NEAREST SEPTIC SEEPAGE OTHER LOT LINE ,-SEWER-LINE; TirNK__ SYSTEM , CESSPOOL , SOURCES_ �� /�� l2'i?�/��✓ �� DI GRAM OF SYSTEM /J j DISTA CES: �h(e T L A/. L DATE l�j/ / APPROV r_ A A o GREAT R ANCHORAGE AREA BOROUGH PERMIT NO, - DEPARTMENT OF ENVIRONMENTAL QUALITY ?500 TUDOR ROAD POUCH CI -550 ANCHORAGE. ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT �.-l_ PHONE � T-- _— MAILING ADDRESS �� =- �— NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION �,�ql J .�Ep.�, DRAIN FIELD OTHER rLL�_ SEEPAGE PIT— INSTALLATION OF: tC'T%VNKI .. TYPE AND 512E OF FACILITY TO BE SERVED TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST SOIL TEST RESULTS ei COMPLETION DATE ANTICIPATED IT VA 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE FINAL INSPECTION: SUBJECT TO PROSECUTION. HEALTH DEPARTMENT AUTHORITY WILL BE y/ � -.� ' �� /'c-`� �� [I (� C/ _ TYPE@+ R1 DYI'1 COYP _eSEEPAGE AREA SIZE TYPE gE}TtE-TANK SIZE DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS 5 ft. 1p' S[ I I 4'• CAST ERON SIPHON SEPTIC PIPE k1T11 AIRTIGHT CRIB CAPS .—. _ .. 17 �[ -� . n CAST II:Ft�___J- Level \ LAST IRON INTO UNDISTURBED SOIL IE 5'--s I I < — l5' i •II BIRO; III NI HUR C I required whenever line crosses under driven. TO RIVER, LAKE. STREAM. DRAIN FIELD FOUNDATION TO SEEPAGE PIT , - t SEPTIC TANK TO SEEPAGE PIT WALL IC SEPTIC TANK 5 ft, , SEEPAGE PIT,,' DRAIN FIELD TO NEAREST LOT LINE. r:0 srccR LIN;- 40' 411'-f!V 0NL'Y Ens. 12011s[uFr. / ~J • SEEPAGE PII WELL TO `SEPTIC TANK 4�- ALSO CONSIDER AREEAn,WlELLS. DRAIN FIELD t WATER MAIN TO SEPTIC TANK 10 ft2 SEEPAGE PIT. � i-- --' 10 DRAIN FIELD _ �.�-�:'"�'� f--�alfLf'-a' �/�V i �• DRAIN FIELD SEPrtC TLK, 25 ft*. SEEPAG-E BIS r`� I I 4'• CAST ERON SIPHON SEPTIC PIPE k1T11 AIRTIGHT CRIB CAPS .—. _ .. 17 �[ -� . n CAST II:Ft�___J- Level \ LAST IRON INTO UNDISTURBED SOIL IE 5'--s I I < — l5' i •II BIRO; III NI HUR C I required whenever line crosses under driven. TO RIVER, LAKE. STREAM. kTla "}il VFLL i1lS1fJ_Ci5— CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. U:_�I L'HWAL f0 T-12�K- 50' 10 PIT- 100' L( SEKLR LIVE- 1D; 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PITIII IC FITTED WITH AIRTIGHT REMOVABLE CAPS. 10 TA!:K- RD" T^ II'f- 120' - GRAVEL BACKFILL r:0 srccR LIN;- 40' 411'-f!V 0NL'Y Ens. 12011s[uFr. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. PunllC TD 7A!IK- 200' T00' .00'-11^7' OCLY CA.'T 120;1 SEWER I i:.. sOF 7:I rAK!!IAiI foll OII ' HEALTH AUTHORITY OR LICENSED DESIGNER - ,GRAVEL RA`KFILL �,,• - AROUND CRIB. (CRIB 4' HINIItUH ABOVE WATER - TABLE) 4 INCH SEtIFR LINE. CONSIUR AKCA YELLS. -4. F.LL a• SEEPA.GC Pil ETCAVATI011 BASED ON Soil. TEST. Grade: 1'.per IGO' =HOUSor 1/4" p r foo: except 10' precrudil Etank 8 tha. should not exceed 2%. 6• per 100 on flat terrains. [AST ICON. PIPE 5 IIITn LIN- 1URON SIPIION PIPE PACE PIT RIB OACKF[Ll ' HINIHUN AP HAT THE ABOVE I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND T DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. / & DATE --�--- APPLICANT'S SIGNATURE i + DATE RECEIVED INSPECTION APPOINTMENTS t TIME 6. TYPE OF RESIDENCE TIME I� TIME DATE DATE _ J DATE ❑ Two ❑ Five ❑ MULTIPLE FAMILY INSPECTOR 7. WATER SUPPLY INSPECTOR INSPECTO� R INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled 1 IT Ur ANCHORAGE ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE ��NNt1�[IIRDEPT- OF HEALTH & PROTECTIVNONMENTAL P7OTECTION depth (attach log if available.) DEPARTMENT OF HEALTH & ENVIRONMENTAL 825 L Street - Anchorage, Alaska 99501 tt { pOq9 0�— INDIVIDUAL/ON-SITE** ENVIRONMENTAL SANITATION DIVISION b YEAR ON-SITE SYSTEM WAS INSTALLED. Telephone 264-4720 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 PHONE MAI LIN AD D E$S SAF - PROPERTY RESIDENT (If different from above) 45�,-AnO PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ` ` PHONE 7 - Co cri� — o co MAI LING ADDRESS Sk Vv Cr � V- ' 4. REALTOR/AGENT PHONE MAILINGADDRESS�� - - 5. LEGAL DESCRIPTION STREET LOCATION 1 � t 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other ';.L SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY 4Rj Three ❑ Six 7. WATER SUPPLY R 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.) 8. SEWAGE DISPOSAL SYSTEM 0�— INDIVIDUAL/ON-SITE** b YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) d U THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: I DS 0 If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS /APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) E]DISAPPROVED DATE -Q I BY Vk V/ -j I 72010 (Rev. 6/79) ALASKA C11UIR011mC11TAL C011TROL SMICCS, Inc. 6ngineerinq � 6nuironmental Studies JUNE 1 1981 1ST NATIONAL BANK/UNA BENNETTE BOX 42090 ANCHORAGE AK 99509 MUNICIPALITY OF ANCHORAGE DEPT. GF HEALTH & ENVIRONrV,ENTAL `-'OTECTION RECEIVED SELTZER — KATHLEEN STAGGS SUBDIVISION—KNIK HEIGHTS BLOCK—A LOT -6 THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 782 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SOILS RATING OF THE SYSTEM AT CONSTRUCTION WAS 250 AND NOW IS 196 SQFT/ BEDROOM. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 6-1-81 . "@q,OF T e' d� .e4 �1 -; 0 Idoy C. Rid, Jr. No. 2251.1! y'r�t Cb* oa6 RJ LJCPC.9 v}�.. 0F€SS1G�yd: -. 1220 West 25th Auenue • Anchorage, Alaska 99503 9 (907) 276-1361 _ (® DEPARTMEf_,OF riuiv I U I FML -i i t yr /AINUnvnHUC. HEALTH AND ENVIRONMENT, PROTECTION 825 L Street, Anchorage, Alaska -99501 279-2511, ext. 224 or 225 #1: Time 0/: n'1 Date -,q,c - 17 Pi Date Received: April 19, 1977��_ #2: Time #3: Time Date Date Insp bus_ Insp - Insp A REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: First National Bank of Anchorage Mailing Address: Post Office Box 720 99510 Phone: 276-6300/483 2. Property Owner: Harold Toepfer Phone: 276-6454 Mailing Address: NHN Bainbridge Road 3. Legal Description: Lot 6 Block A Knik Heights 4: Single Family Residence: (�01 Number of Bedrooms: 2 Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Public/Community System: ( ) Individual Well: (x) Permit # Depth of Well Well Log on File V 4� Construction Bacterial Analysis 6. Sewage Disposal System: On-site System (30 Public Utility ( ) Permit # Installed (Installer jo4h ) Septic Tank Size Manufacturer'02 >>> Absorption AreaY ;ls Rate _L2d 7� Material v 7. Distances: Well to Septic Tank _ �/ % to Absorption Area S to Sewer Line _ Nearest Lot line Absorption Area to Nearest Lot Line MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH 8, MUNICIPALITY OF ANCHORAGE ENVIRONIvTNFAL PROTECTION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 APR 1 J 1977 REQUEST FOR APPROVAL OF RECEIVED INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FNA CONV X 2. 4. 5. 0 7 0 Property Owner:_ Harold Toepfer Mailing Address: NFIN Bainbridge Rd Day Phone: 276-6454 Name of Buyer: Theodore & Kathleen Staaa Mailing Address: 2845 West 42nd Day Phone: 274-1511 Name of Lending Institution: First National Bank of Anchorage Mailing Address: P. O, Box 720 Name of Realtor or Agent: Fold Toepfer Phone: 276-6300 ext 483 Mailing Address: NHN Bainbridge Rd Phone: 276-6454 Legal Description: Lot 61 Block A, Knik Heights Location: NHN Bainbridge Rd Anchorage, Alaska Type of Facility to be Inspected: ex sting Single Fami1y No. Bdrms. 2 Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System Public Utility. If Individual, date of installation f.'-'RTGAGF. MAN PENDING 72-003(3/76) 2 Individual (on-site) X Marie Iiams 4/18/77 -Page Two �/ Department of Health and Environmental Protection Request for Approval of Individual Sewer and water Facilities Legal Description: Lot 6 Block A Knik Heights Subdivision Comments: Affadavit Attached: (.) Approved: Disapprov Department worksheet: Letter Attached: ( ) Date: 7 / Date: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received August 30, 1976 Time of Inspection 10:30 a.m. f� > � (�'e 4 Date of Inspection 9-2-76 Thurs. l Neale REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & 14ATER FACILITIES FOR State V.A. 1. Approval requested by: State of Alaska Division of Veterans Affairs Mailing Address: 907 Northern Lights Blvd. Phone: 2. Property Owner: Tim Buschert Phone: Mailing Address: o Chuck Hylen, Hylen CO.RZ2altors 3. Legal Description: Lot 6 Block A Knik Heights Subdidision 4. Location: On Bainbrid 5. Type of facility to be inspected Single Family No. of bedrooms 3 s 6. Well Data: In ividualA. Type Type B. Depth C. Construction D. Bacterial Analysis 7. stem Sewage Disposal System: On—site s 9 P Y y A. Installed 1973 B. Installer C. Septic Tank: 1. Size D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines 8. Distances: 2. Manufacturer 2. Material I A. Well to: Septic tank /Port v� Absorption area ' Z' Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages �. P �- MUNICIPALITY OF ANCHORAGE A�0/. • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 li REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA _FHA CONV 2. Property Owner: t 1 w. 9 y 5 e_ � e �r i_ Mailing Address: 3. Name of Buyer: ) a ro II Mailing Add 4. Name of Lending Institution: S'+- jf A Day Phone: Day e. Mailing Address: Phone: a 5. Name of Realtor or Agent: ez �Q � C3 r s c-� ` C '✓ Mailing Address:% L06'6 Q 5 ; (/tel /� s Phone: 6. Legal Description: j J Location: �/��C '�s to S ec�l o e lU2w Sewci rd rir 4kk �8'J )J/ f?h.c.s-. r;SLf �� 7. Type of Facility to be Inspected: SuT' No. Bdrms. 3 8. Water Supply Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation? idX • X9'73 72-003(3/76) Page 2 of two pages - Rec, ;t for Approval of Individual �r & water Facilities eLegal Description Lot 6 Block A Knik Heights Subdivision Comments C ,a _ "ti � c 6 � Approved - Disapproved Date App al;Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) Parcel I.D. 017-032-06 5;C)o y6� a 17 7 Municipality of Anchora ry JUN 20 2016 On -Site Water and Wastewater Progra (907) 343-7904 Certificate of On -Site Systems Approval 6 1. GENERAL INFORMATION Expiration Date: -C I Complete legal description Knik Heights, Block A, Lot 6 Location (site address) 12640 Bainbridge Rd. Current Property owner(s) Theodor Stagg Day phone Mailing address PO Box 112050 Anchorage, AK 99511 Real Estate Agent Day phone 2. TYPE OF DWELLING: M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ TZ/o-06 Waiver Fee $ Date of Payment 6 — ?-,?- /6 Receipt Number O jg5q6 COSA# OS-C/G /2 gel 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 OASite Sysf4ms 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. In conducting an adequacy test, I attempt to provide a thorough, conscientiousengineeringanalysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty -for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Phone (907) 272-8218 Date 2/5/2016 6. DSD SIGNATURE Y System #1 Approved for bedrooms a �' : Seven k. Bann System #2 Approved for bedrooms ¢�9`11. Disapproved It ��o pFES9 � Conditional approval for bedrooms, with the following stipulations: BY ` Original Certificate Date: 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory. Well Flow Advisory Other COSAbluesheet t .., .. If more than 1 septic system is on -the lot: COSA Checklist # 1 of Structure served by this system- 1 Certificate of On -Site Systems Approval Checklist Legal Description: Knik Heights, Block A, Lot 6 Parcel ID: 0,17'032-06 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Date completed Unknown Sanitary seal (Y/N)-Y Wires properly protected (Y/N) Y Total depth 202+ft. Cased to enknmn ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECT,�ON y, Date of test Unknown 1/26/2016 _ Unknown Static water level ft. 148 ft. Well production Unknown g.p.m: 4.� 9— p.m-WATER SAMPLE RESULTS: Coliform %colonies/100 mL Nitrate N mg/L �J J Arsenic �� ug/L Date of 'JL(°Q Collet s -by: B. SEPTICIHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/19/1974 Tank size 1,250 gal. Number of Compartments 1— Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 1/27/2016 pumper A+ Homes Services C. ABSORPTION FIELD DATA ana+�^-mss+BiB 2 196 SFjBR Crib/Deep Tench Date installed Soil rating (g.p.d./ft orft2/bdrm) System type Length 21 121 ft. width 17/3 ft. Gravel below pipe_ 7 / 6 'ft. 12121 Total depth_ ft., Eff. absorption area ftp Monitoring tube Y Depression over field N Date of ade4ua6y test 1 26/2016 Results (Pass/Fail) PASS For 3 bedrooms Fluid del1th in absorptionfiield before test 64 in. . Water added 482 .gal. New depth 72 in. Elapsed Time: 1440 min. Final fluid depth 64 in. Absorption rate >_450+. g.p.d. NO Anyrejuvenation treatment (past 12 Trio.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off" level at in. High water alarm level -at in. Datum Cycles tested Meets alarm & circujt requirements? E. SEPARATION DISTANCES — WELL ON LOT TO: Septic tanMift station on lot 100+ On adjacent lots 10.0+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer /septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ONLOTTO: Property line 10+ Building foundation 10+ Water main 1;0+ Water Service line 10+ $urfaee water 100+ Driveway, parking/vehicle storage 1-0+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conforrrlance with MOA COSA-guidelines in effect on this date. Engineer's Printed Name Steven Pannone Date -2/5/2016 COSA canary sheet 21r15.doc 1 -----Ag �«a@EROAD-- E�