HomeMy WebLinkAboutKASILOF HILLS BLK 4 LT 4Kas 1* 1 Off Hills Block 4 Lot 4 #015-161-37 EXPIRED PERMIT Development Services Department 's t Building Safety Division On -Site Water & Wastewater Program E e 4700 Elmore Road z_... .. x P.O. Box 196650 Mark Begieh Anchorage, AK 99507 Mayor www.muni.org/omite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: Parcel Identification Number: &t Z-16137 /1 f/./-/.iC ZIA172Z, /%/A'( I,', Legal Description Property Owner Name & Address: 661cot Hd(s mss Q �{ L GOG3Oa xa�Z'o 71-^- Pump Installation Date: Pump Intake Depth Below Top of ell Casing: feet Pump Manufacturer's Name: i ��— Pump Model: W) GZ`/ t o/�-` g s Z l Pump Size I hp Pitless Adapter Burial Depth: L0 feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Weil Disinfected Upon Completion"'es ❑ No Method of Disinfection: Comments: CGt:0w%^_./. Pump Installer Name: i Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation 's t a' MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SWO10129 P Legal Description: KASILOF HILLS BLK 4 LT 4 Design Engineer: 0041 AK Water & Wastewater Consultan, Owner Name: GENEVIEVE M. GULL Owner Address: 10800 KASILOF BLVD. ANCHORAGE, AK 99516 - Date Issued: May 23, 2001 Expiration Date: May 23, 2002 Parcel ID: 015-161-37 Site Address: 010800 KASILOF BLVD Lot Size: 26068 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ❑✓ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 57'a3 -ew Date: 5--23-01 Municipality of Anchorage Development Services Department Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-161-37 Permit Number S LVO/O/ 29 Propertyowners) G E N E V /EVE M. G U L L Day phone Mailing address (1) 10860 KASILOF BLVD. • ANCHORAGE. AK Mailing address (2) N/A ZIp Code 99516 Legal description (Lot, Block & Sub'd.) KASILOF HILLS SUBDIVISION: LOT 4. BLOCK 4. Legal description (Section, Township & Range) N A Lot Size 3 Acreq.Ft Number of Bedrooms 4 26,0619 THIS APPLICATION IS FOR: Sewer Only A Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ■ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and Is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS INC. Permit Fees: ,fid. on Date of Payment: 'S -a 3 --y/ Receipt Number. AIEyq Waiver Fees: Date of Payment: Receipt Number. ALASKA WATER F& WASTEWATER CONSULTANTS, INC. April 26, 2001 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 4, Block 4, Kasilof Hills Subdivision The existing 4 bedroom house is served by a private well and septic system. The existing septic system consists of a 1250 gallon sepic tank and dual 5 -wide drainfields. A new well was drilled on Kasilof Hills Subdivision, Lot 4, Block 4; which enchroaches upon the east/north drainfield. We are proposing to excavate and abandon any portion of the existing drainfield that enchroaches upon the 100 foot well radius of Kasilof Hills Subdivision; Lot 4, Block 4. We are also proposing to excavate the north end of the existing trench and add an additional portion to the trench.. The length is to be determined by the portion that is to be removed from south end of trench. The new portion is to be 8 feet deep maximum by 5 feet wide with 3 feet of clean, washed sewer drainrock. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you hav� any questions, please contact us at 337-6179, or 244-9612. Thank you for your assistance. .E., M.S. NOTE: Attached is a site plan drawing, a design drawing and a 7 page constniction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com u t 1 1 1 1 1 1 1 1 1 ► 1 KASILDF HILLS S/D; KASILOF HILLS S/D; 1 1 LOT 6, BLOCK 4, LOT 18, BLOCK 4, 1 1 1 1 1 1 1 1 1 1 1 1 t 1 1 � 1 1 GEI c 1 1 !:D� 1 I KASILOF HILLS S/D; LOT 5, BLOCK 4, 1 l KASILOF HILLS S/D; 1 1 LOT 19, BLOCK 4, 1 1 RAD 1 I 1 1 ---------J-L--- BOULDER SPRINGS S/D LOT 21 I I 1 I I /GCOtT ( I I I BOULDER SPRINGS S/Dj j LOT 22 I I I I I I I I qAACANTT I I I I BOULDER SPRINGS S/D 1 I LOT 23 I I BOULDER SPRINGS S/D �LOOTT 24 I i C CACANiT I 1 I I ASILOF HILLS S/D; LOT 3, BLOCK 4,—'i \ \ , 4/26/2001 ...... wr r s DRAWN BY: .— ALASKA WATER & WASTEWATER Ste: C.J.G. CONSULTANTS, INC. ^ c 100 6901 DEBARR ROAD SUITE 28 9 ANCHORAGE AK 99504' PHONE (907)337-6179 9 FAX (907)333-3246 PREPARED FOR PHONE NUMBER: PAGE NUMBER: MARY STEVENS 424-3456 1 OF 2 LEGAL DESCRIPTION: KASILOF HILLS SUBDIVISION; LOT 4, BLOCK 4, SITE PLAN FOR SEPTIC SYSTEM UPGRADE 1 / / I �I n� KASILOF HILLS S/D; LOT 21, BLOCK 7, / ! i % 1 ' 1 ` \ 1 \ SEPTIC SYSTEM UPGRADE' \ (SEE DESIGN PACE 2 OF 2)\ \ \\ KASILOF HILLS S/D; \ LOT 10, BLOCK 2, \ \ ASILOF HILLS S/D; LOT 3, BLOCK 4,—'i \ \ , 4/26/2001 ...... wr r s DRAWN BY: .— ALASKA WATER & WASTEWATER Ste: C.J.G. CONSULTANTS, INC. ^ c 100 6901 DEBARR ROAD SUITE 28 9 ANCHORAGE AK 99504' PHONE (907)337-6179 9 FAX (907)333-3246 PREPARED FOR PHONE NUMBER: PAGE NUMBER: MARY STEVENS 424-3456 1 OF 2 LEGAL DESCRIPTION: KASILOF HILLS SUBDIVISION; LOT 4, BLOCK 4, SITE PLAN FOR SEPTIC SYSTEM UPGRADE 1 { I 1D0' WELL RAD110 -' \ I 1NOTE: THE CONTRACTOR MUST HAVE THE WELL RADIUS FLAGGED FOR KASILOF HILLS S/D; LOTS 3 do 4, BLOC ► 4. BEFORE CONSTRUCTION L-----I / ► / \ APPROXIMATE LOCATION OF EXISTING 1250 GALLON I SEPTIC TANK I I I I � � 7► Co co \ o► / iCOY► gCANT EXCAVATE A TRENCH THAT IS 8 \ \ FEET DEEP MAXIMUM AND 5 I FEET WIDE LENGTH TO BE \ ADDED IS TO BE DETERMINED C PORTION THAT IS REMOVED /FROM SOUTHEND OF TRENCH. ► ADD 3 FEET OF CLEAN, WASHED I SEWER DRAIN K. ABANDON ANY PORTION OF THE EXISTING I / DRAINFIELD ON THE SOUTHERN HALF WTTHIN THE 100' WELL RAIUS OF LOT D 3, BLACK 4; I KASILOF HILLS S/D. DATE: gopAppp 4/26/2001 OF p DRAWN BY: ts" .... C.J.G. •I ALASKA. WATER & WASTEWATER SCALE: o: •:yNO 0 CONSULTANTS, INC. 1" = 40' ...... ' ' ......... ........8 PREPARED FOR: PHONE NUMBER: PACE NUMBER: D� MARY STEVENS 424-3456 2 OF 2 .y A.• ern • s,- �••�J LEGAL DESCRIPTION: oo ��•E 7953 e`p� KASILOF HILLS SUBDIVISION; LOT 4, BLOCK 4, ��4nf,• ��doG TYPE OF WORK: v�0dP�°f ..... DESIGN OF SEPTIC SYSTEM UPGRADE DOpppp ()'� i Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:SVCr&Ae. DATE LEGAL DESCRIPTION: L vT 4 a Wc.Kw 4 Township, Range, Section: DEPTH WAtio him �1t��,rl �SLOPE (FEET) 1 1 1 1 1 1 6- 7 8 9 PA 10 11 12 13 0-0 :14 16 16 17 18 fE-] SAwny G1 -AV W/T'p' F it- IS S 11.r 6AW" SO4-►D %K SITE PLAN WAS GROUND WATER `O ENCOUNTERED? �+ IF YES, AT WHAT DEPTH? DeDlh to Water All, Monlloringt 'P -IA -Dale: « C 1' 20 7 '- • U PERCOLATION RATE �'a� (mmutouinch)FERC HOLE DIAMETER TEST RUN BETWEEN Z" C FT AND f � �?K FT i" COMMENTS tL 116- stall u S 6 4" —15L-" ANPrP " . e t1+ " (Be $, to to" �/ QCt c 300 SE/j&y PERFORMED BY: 1KN r 1=�L I 6.Ye 0w"aL CERTIFY THAT THI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: J Q JL J 10 72.008 (Rov.4/85) I MaliiJ�_�'►' `ifit11i�!�1�i� 20 7 '- • U PERCOLATION RATE �'a� (mmutouinch)FERC HOLE DIAMETER TEST RUN BETWEEN Z" C FT AND f � �?K FT i" COMMENTS tL 116- stall u S 6 4" —15L-" ANPrP " . e t1+ " (Be $, to to" �/ QCt c 300 SE/j&y PERFORMED BY: 1KN r 1=�L I 6.Ye 0w"aL CERTIFY THAT THI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: J Q JL J 10 72.008 (Rov.4/85) I w Munlclpallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ��tt% AY:71': + S rZ-0^J C LEGAL DESCRIPTION:- L'u'C +1 Ti t"VLVL 4" Township, Range, Section: DEPTH ic.As iLp P a�w% SLOPE SITE PLAN (FEET) �S 1 0 2 SANaY G�wet. 3 w/twe 516-1 4 G� 53 5 6 S 04ya 7 B 9- 1011 10- 11 12- 13- 1115- 16- 17- 18- 19 2131616171819 WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ^. L 0 DEPTH? p E Depth to Water lifter, , /^ Monllorinp7 Date 20 PERCOLATION RATE (minuteannch) PERC HOLE DIAMETER .a TEST RUN BETWEEN FT AND FT XpCOMMENTS � R/ PERFORMED BY: Kw 1 inEg!- I A CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: V �� 72.008 (Rev. 4/85) Ppdw -- NRPdp�- 20 PERCOLATION RATE (minuteannch) PERC HOLE DIAMETER .a TEST RUN BETWEEN FT AND FT XpCOMMENTS � R/ PERFORMED BY: Kw 1 inEg!- I A CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: V �� 72.008 (Rev. 4/85) I----t I---- -- — Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 i Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: I PID Number: _ 00 ( ­ 1(0—.7 Name: A-14-FC., Wastewater System: ❑ New Upgrade Address: �J ABSORPTION FIELD Phone: No. of Bedrooms: ❑ Deep Trench Shallow Trench 1-1Bed 13Mound 11Other LEGAL DESCRIPTION Soil Rating: j3 / 8 / y Total Depth from original grade 6a Ar / 5!-7p PDQ Sq. Ft. Lot: Block: �S/ubdivision: K Rs I LUr� �'�) twL+� Depth to pipe bothnglnal grade: 't" ._��� r Ft. Gravel depth beneath pipe J / J Ft. Township: Range: Section: Fill added above original grade: _ Gravel length: _ WELL: El New ❑Upgrade ..,.:� - gavel det0h: ; ^ � w umnes: Number of lines: -7 I Dibetween lines: stance / I L/' (tea;';} Ft. /. V Ft. Classification (Private, A,B,C): Total Depth.. ed To: Total absorption area: Pipe material: -Ft. ^Drilled: Ft.12 2 SQ. Ft. y / I � I -W\ -) 0 Driller: a'. Date Static Water Level: Installer:/} AA A Date installed: , Yield: ��"" Pump Set at: Casing Height Above Ground: ,.- r TANK ("�- ('/ I� f't 6- Ft. Ft. ,WARATIQ,N DISTANCES Septic ❑ Holding- ❑ S.T.E.P. a 'to Septic Absorption\ Lift Holding Public/Private Manufacturer: o Capacity in gallons: From Tank Field. 1 Station Tank Sewer Lines WeW'll . „ ,, �.: ' m> Material: Number of Compartments: Surface Water f,, LIFT STATION f . Lot Line Size in gallons: Manufacturer: Foundaflon f "Pump on" level at:"Pum ewel at High water alarm at Curtain !� -� Pump Make Eed Electrical Inspections performed by: Drain 6 Remarks: BENCH MARK o Location and Description: ="(')IB.tJ. ) I l,.1 Cl.t2¢1+� �Unrf1 1 f bClf-) ,.. �(� 1 &-j ?A, OF, IA -0 Lk¢>� Assumed Elevation: /00 — ENGINEER'S SEAL .r �•.*`�".� ':-`..'1 •"fin NA XX Inspections performed by:011 Dates: 1st or Sidi t 2nd J / sP..j.....w... •� U r� Department of Health H mwSery 'sapproval t• Ro�"r' Wo.414Reviewed and approved by: i49 •�"`'•^••••"`� �����' 72-013 (1/91) MOA 25 Permit No. Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report 1 h,r 4- V1 nr.v a VA t , .,,F. , I A. - .. . .-I PAGE 1 OF t MINICIPAL.ITY OF ANCHORAGF DEPARTMFNT OF HEALTH AND HUMAN 3ERVTCE'S P,O: BOX. 196650, 825 "L." STREET, ROOM 502 ANCHORAGE, ALASKA 99519-•665() ON -.SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER -S61910028 DESIGN FNGINEER,ROBERT KNIE'FEL., P,E: OWNER NAME,ALASKA HOU;>ING FINANCE CORP ti, OWNFR ADDRES5,701 EAST TUDOR ROAD ANCHORAGE, ALASKA 99503 PARCEL ID;()1516137 LEGAL. DESCRIPTION; KASTLOF HILLS BLK 4 LT 4 LOT SIZE? 9-6068 (SO. FT:'i NUMBER OF BEDROOMS 4 THIS PERMIT, 4 DATE ISSUED: ^!07/91 EXPIRATION DATE! 3!07/92 THIS PERMIT IS FOR THE CONTRUCTION OF-, DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE IJITH, I, THE ATTACHED APPROVED DESIGN, 2. ALL REtUIREf1ENT, SPECIFIED .IN ANCHORAGE 110NICIPAI_ CODE CHAPTERS 15.55 AND .15.65 AND THE STATE OF ALASKA WASTEWATER DTSP03Al_ REGULATIONS (18W72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVT`)TONS: SPECIAL PROVI�;TONS: RECE.TVED BY, _ . _% V - - - ---- DATE -- IaSJF_D BY, - .—------- r �1 Existing] System f to be J Abandoned 1 4 SEPTIC SYSTEM DESIGN LOT 4, BLOCK 4, KASILOF HILLS DATE 11/26/90 SCALE 1" = 40' PREPARED FOR: Acreage Systems PREPARED BY: Kniefel Engineering Septic System Upgrade .9 PR MOA CE 90-030 page 1/3 v 6" Topsoil and Seed (3#/1,000 sf) 2' ( in. Native Backfill Filter Fabric and h 2' Insulation Mater -�-- J \, 6 "lie 4" perforated Pipe-,\ (ASTM 3034 or Eq.)� 3' Sewer Roc r 5' 1 10' i` Garage I House CO I Properly Adandon Existing System Lot 4, Block 4, Kasilof Hills ' 2' �Native(min.) Backfill f 611 t,Sewer Rock 5' ottom of Pipe I,,.. r 9O F't 1-6' P 1_A -Q J ro m G a � O G �--r so CO H p'C0 w � w 10, O ro 0 LO N � Q.: ,p9 eeoarroaep'p��i,�� 7!J $p'.�.IP34i••9J r`54�9 % w. jr ORf9IOO`J Ofl♦q GPp�``�g p 00 d 6 P"n No. 4114,9_,.. A C E 9 0 -,0,,, 11/26/90 page 2/3 i /2c7)�/-{GC/'(.t �lS)VVJ,�LF /5�7J/i+2A—DU"')s Si1Uo C" 7L� S L, lui -o /k, /) V f u (L iz+c-E ��-5 �vt=T CA c; j12 U v \-C:A Lo l u 3 s U A ,�-A,— I� Q1ZLN G1 U:� r- 1� w i �,l J � � � c S �-+) e � �, ,a -, ti S Il � e- � -� G- /=✓I a --� KNIEFEL ENGINEERING 8441 Miles Ct., Anchorage AK. 99504 (907) 337-1121 • Fax (907) 338-1874 a SYSTEM DESIGN GUIDELINES AND NARRATIVE LOT 4, BLOCK 4, KASILOF HILLS ------------------------------------------------------------------- 1. System Design = 4 bedrooms x 188 sf/bed. = 752 sf 2. 5' Wide Trench (3' depth, CF = .58) 4 bed x 188 sf/bed x ,58 / 5' = 88 feet length 2 Trenches Q 44' length = 88 feet 3. All materials, construction methods and required inspections to follow MOA rules and regulations. The contractor is responsible for notifying the Engineer and the MOA at least four hours in advance of all inspection needs. 4. Contractor will insure no changes have been made to the location of wells and septic systems on the adjacent lots prior to the time of construction of this system, If any changes to those systems have occurred, the engineer should be immediately contacted for review and possible changes will be made as necessary. 5. CT 7 io The OB/Fill material will be removed to the underlying gravelly sand material under any portion of the trench area. The lot slopes down from the east to the west portion of the lot. The slope varies from 2 - 3% at the system location to a maximum of 12 - 15% at the west lot line. The septic system should be properly maintained to include septic tank pumping on an annual basis and no use of a garbage disposal. The existing system will be properly abandoned to include removal and disposal of the tank since it is within the well radius area. ov 41, h ����_ogp pr30sppppf�� ,3 0 0� e` .+Bopn 4ogiJ04sed— Oon�b Jp .e RoboA E. Itnirrol 8 No. 4149 • Gi ,4 6' �a ,0,�<�� TePT c'*Ve 1 '' 1€ GIN R A L1 `�^� A @nseee eeb r�ao g Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 - SOILS LOG — PERCOLATION TEST o It haft Kniofol o Ea 06 No. 414 PERFORMED FOR: S'vs t&*S DATE PER FOR 4t�'O PurlSEE �44AAO Mme. LEGAL DESCRIPTION:L or -4. 0wc4ic 4 Township, Range, Section: OEPTH �A SQL®� `�,V� SLOPE SITE PLAN IF E E T) ^R' f --F—. r—�-1 �-1—r •� 9- 10 10 11 12 13 15 16 17 18 19 'WDA WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ' o S L w" 0 P E Depth to Water Alter, -,p Monilorinp7 __ ( A pate: 20 l r A PERCOLATION RATE I—&—(minutes/Inch)PERC HOLE DIAMETER _ TEST RUN BETWEEN fes. E FT AND ryqss� FT n �y / �w COMMENTS F-0 (L. , st9pi (AS fr G �� �� S11 � -'4+ 8® S f taltr--- PERFORMED BY: _ r • I _1� , K % M"022t_ CERTIFY THAT THI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (V Z 0 72.008 (Rev. 4/85) Q J T i� t•IL'1►7 1 20 l r A PERCOLATION RATE I—&—(minutes/Inch)PERC HOLE DIAMETER _ TEST RUN BETWEEN fes. E FT AND ryqss� FT n �y / �w COMMENTS F-0 (L. , st9pi (AS fr G �� �� S11 � -'4+ 8® S f taltr--- PERFORMED BY: _ r • I _1� , K % M"022t_ CERTIFY THAT THI TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: (V Z 0 72.008 (Rev. 4/85) Q J T i� is S! N'A Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST � _ EI �fJ Qaa�>e�oa� ter,„� PERFORMED FOR: �L; oaCt SyS R- f DATE PEANQ,,, fa _ LEGAL DESCRIPTION: {wu'r LOLS T' Township, Range, Section: DEPTH + S "0 riA`w' SLOPE SITE PLAN (F6 1 2 $ANili7 ",4met., 3 4 G� �r s,a, I 6 Sq»p 7 s GM w f rm4e s itr% 0 10 WAS GROUND WATER ENCOUNTERED] �F7 11 s IF YES, AT WHATL DEPTH? ^ 0 12• P E 13 Depth to Water Alters WA Monitoring? _A_ Dale: 15 16 17 18 19 20 Reading Date Gross Net Depth to Net Time Time Water Drop I I PERCOLATION RATE (minutes/mch) PERC HOLE DIAMETER LLTS��JJ c��,eTEST RUN BETWEEN FT AND _ FT COMMENTS S ��� PERFORMED BY: Kp f ape� I A 1 w 1=H� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: to 72.008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DE i TMENT OF HEALTH AND HUMAN SER\ .'S Environmental Health Division 825 'U' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT I.Namt -- �t�i-S DISTANCES (Address - TO SEPTIC T ABSORPTION �(l �_ �� r� i�� /►7Vi'tf / `P I�7" FROM TANK FIELD Phones Permit No. No of Betl ms WELL S / — �j�� �— _ LEGAL DESCRIPTION LOT LINE �-p `•�¢ J � /a#. --®` TO _t Sleek� Su bdm,=,'•ion = 6&&l �Ii /fi bs FOUNDATION _ - Township,Range.Section AS -BUILT DIAGRAM (Shov, location of well. septic system. property lines, loundadon. �/V /�• —LST _ driveway. water bodies, etc-) T/qqsl N'( SEPTIC ❑ HOLDING -- — Manufacturer T� Capacity in gallons Maienal � �� � L.J[L.•4<,P o. of Com padments — 9--� TYPE OF SYSTEM --rTA— Ll TRENCH ❑ BED W. DRAIN ❑ OTHER p - DeplL to Pfpe honour from "Total depth from original grade 0 original grade A 3 FT % FT —— -- FII added above original grade Gravel depth beneath pipe p _ "19— FT FT p� Gravullength Gravel width Q FT FT_V �r "(4 4 Total absorption area Distance between fines - __ 166 SO FT - - — - A In Number �I lines Son rating" —{Pipe nratenal �C./© FT — / L -� -- /.�3_ SQ FT .x'61 1 303 — Installer I Date Installed -- " — -- 44) --- WELLS --- PRIVATE ❑ OTHER (Identifv) 7 XPE"1e# G assihcabor jA.B.C1--J---- Total Depth Cased to A/ �h n—s,auE — Dare -1 FT FT — -- REMARKS: p /3' ek/5'91JO 7 -lea -Yell 10156it /Of) FAW 106))01111a' Il"bRTia 14ScD 4'k7R/r &?1fV6r1- ` 71WX f '7' de# I, Inspections Performed by. ohrAl Date. 1%i"��" � "'rte` _.,..—_ pceerlily Thal this inspection was perlorined according to all Municipal and State guidelines in etlect on this dale: 1 -lx— -�„� Health Department Approval: `<���'l^-�;.^^ � r Date:.—fes 72-012 (2;851 - - - ENGINEER "S SEAL �.7 ELECTRICATRICIAN. SlGNED 41, APPLICANT: MIES ARNOUT C/O STUART BENSON v 74-7u�^���/'D � � ���L A. 1 . 1: 1 "1 Sh H .. 37 -1 . "W 11 p 0 n: !111 :.11 F;:;j:- [:�H: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 lrzi�, ���������~� F'ERM IT NO: 860237 UPGRADE DATE 1SSUED: 07/18/86 APPLICANT: JAMES ARNOUT C/O STUART BENSON ADDRESS: 6512 E 16TH AVENUE ANCHORAGE, AK 995O4 CONTACT PHONE: 346^3989 LEGAL DESCRIP: SU8DIVISI(DIN : KASILOF HILLS LOT: 4 BLOCK: 4 SECTION: 24 TOWNSHIP: 12N RANGE: 3W 1-O7 SIZE: 26068 (SQ"FT" OR ACRES) I certi(y that: 1" I am {amiliar with the requirements or on ... site sewers and wells as set �orth by the Municipality of Anchorage <MO(h) and the State of Alaska. 2. T will install the system in accordance with all MOA codes and regulations; and in compliance with the design criteria of this permit. 3. I will adhere Lo all MOA and State of Alaska requirements 1o1 thm set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT S7ATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES� lfEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2> MOM ILTS WILL NO[ BE APPROK-,::D/ITHU1. IT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICATRICIAN. SlGNED 41, APPLICANT: MIES ARNOUT C/O STUART BENSON v 74-7u�^���/'D � � ALASKA CI UIROnMenTAL COnTROL SC<ku10ES, InC. 6nelineerinq & Cnuiranmenlol Studies July 17, 1986 Municipality of Anchorage Department of Health & Human Services 825 L. Street Anchorage, Alaska 99501 Re: Lot 4, Block 4, Kasllof Hills The above referenced lot has a conditional on its Health Authority Approval from October 15, 1984 to verify the integrity of the septic tank and to abandon any portion of the absorption area that lies within the 100 foot protective radius of the well. On July 17, 1986, work began to clear the conditionals. Approximately 13 feet of trench was inside the 100 foot radius of the well. This trench is 8 foot deep with 4 foot of gravel and 2.5 feet wide. This calculates to'104 square feet of area. This portion will be abandoned, gravel removed, filled and compacted with soil. The as -built shows this particular trench to be 25 feet total length. It actually has about 33 feet of gravel length. 20 feet will remain and is outside the 100 foot radius of the well. A new upgrade portion of drainfield is proposed to branch off to the north of the existing system and is to be 20 feet in length, 2.5 feet in width, 7 ft, total depth with 3 ft. gravel depth. This calculates to 106 square feet of area. An excavator is on site with equipment and has already dug this new trench. The soil in the trench matches the original soil log for the lot as being GM., There is a fairly good amount of sand mixed into this soil. The pert test results dated September 12, 1979 rated the soil at 133 square feet per bedroom, We request that you accept this location and design for the upgrade portion to replace the abandoned portion of the trench and issue a permit for the completed installation per our design. For the septic tank, both manhole covers and inlet and outlet pipes are being sealed. The tank itself is in good condition with no leaks. The tank was found to be a maximum of 1 foot below the surface with no insulation. Insulation and mounding of soil will be added to the tank. If you have any questions, please feel free to contact me at 561-5040. Sincerely, Alan Wien Engineering Technician Approved by: �j1200 W sl 33rd Auenue, Suite B • Anchorage. Alaska 99503.(907) 561-5040 �0 West :33rd Avenue quite B ANCHORAGE, ALASKA 03 CALCULATED BY A / DATE /� U CHECKED BY DATE SCALE ALASKA ENVIRONII ITAL CONTROL SERVICEg, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561.5040 JOB Lre � 7 �u cK ` �' fLffi/' A� a-3 SHEET NO. _ _ _. OF Z - CALCULATED BY DATE_ •�"f`�-� CHECKED BY _ _ ___-- DATE_ �Ei/h C/�u'iic oTlS Ale FoZ-rVW -To AC 1%fx1D6yA1A — /3 ' 1-&A6r// _ 3 � 6�4v�2_ ➢�aPT/� .Z, tvIb71-1 MtCa4FTWS �✓ fi � � aid 4d1D711 07� T49eri fc1 1�&WT �c�7r1 sF 61714�0?- ola all ?/AC' f,/'Fcel 76x r Fr Atax ALASKA ENVIRONA ITAL CONTROL SERVICES, INC. 1200 West 33rd Avenue Suite B ANCHORAGE, ALASKA 99503 Phone 561.5040 PRO DUG toil � In c_ C,nlm Aha n 141 COs Ln el E'ili/G� %flus SHEET 140.. ---- OF CALCULATED BY_ DATE— CHECKED BY. _. DATE--- ATE——SCALE --_.— SCALE ?mac 7'C5''r /33 'T 60/- 7,,V4 7;ea4W. dar,1 r ,,7- Af dE SeOTic whv/.0 _ sore WA" i!//feC� i�JccfTh a1�72�'T �'i��3 d� /.�%3uc i� Aa/1� Jyo�i rf�i J4 %o o%fi SST/C `TWN ALM COIITROL �LC ����, Inc.KA CI1UIR01 Engineering & Enuironmenlal SIUOIQS MUI,410PALITY O"r DEPT. Of FIEALilI R< @NVIPOMMENTAL PROTECTION September 140 1984 1986 Alaska Department of Environmental Conservation.' >a' 437 E Street Anchorage, Alaska 99501 Attn: Bruce Erickson Dear Bruce: In performing a Health Authority/Adequacy test for lot 4, block 4, Kasilof Hills Subdivision we found a discrepancy . n the location of the well/septic tank sewer system as shown on the original drawing by David J. Harmon in 1979. His asbuilt shows a 100+ feet between the well and septic tank and the sewer systems located beyond that. Our distances show that the septic tank and appro>dmately 15 feet of one leg of the drainfield falls within the 100 foot radius.` No well log is available for the lot. However, the health authority taken in 1979roval in 979 and shows84 show th water to satisfacte 105 feet ory y with 0 coliform Bacteriological tem On September 13, 1984 we prepared the asbuilts from measurements and then .locating lot lines and then going backwards to cleanout and scaling out the dra wing. All cleanouts were identified. Although it was unable for us to Identify the location of the sewer system specifically. It would appear that one part of the upper leg (appro)imately 15 feet) lies within the 100 foot radius from the well. The ground slopes approximately 20 percent form the well to the on�tte sewer system. In my opinion I doubt if the encrouchment on the system will create a health hazard. The type of soils up there is silty -sandy, gravel. The yard has very little vegetation indicates it is probably very well drained. Since it would appear that there would be a minimum probability of the encrouchment of the septic tank and a small part of the sewer system on the ground water table I do not think it would create a health hazard for this small 15 foot section of the line to lie within this 100 foot radius. We therefore would like to request a waiver of the 100 foot distance for the well to septic tank and to 15 feet of the sewer system. If indeed possible it would be possible abandon la t of he seesystem add itto the faend which liesbeyond the100foot radius from the well.. if you have any questions please let me know. . "- - 1=. BILL SHEFFIELD, GOVERNOR —+j DEFT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437"E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 MUNIcIpgU ry ENVIRON, - o OE (tvCMDRq® NTgL H $ F pROT�cTION October 15, 1984 /�U�,51986 Leroy C. Reid, PhD, P.E. ece/ Ve® Alaska Environmental Control Services 1200 West 33rd. Avenue Suite B Anchorage, Alaska 99503 and SUBJECT: Waiver Blockizontal Separation 4, KasilofBHillsnS/D11Anchorageic Tank, Lotof 4 4, , (8521 -WA -050) Dear Mr. Reid: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 82 feet on the Provide stheeas builtstand show thebedroom septic tansingle k is sefamily residence only. sealed. Sincerely, �p Bruc�rickson District Engineer BEE/dd MUN IClpal !Tv MUNICIPALITY OF ANCHORAGE `CTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION jE £325 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION RI O T NAME PHONE :-, NEW ii ('l. ti'1 is].d(1:1 -n 344�t63T3 El UPGRADE — ---- MAILINGADDRESS -- LEGAL DESCRIPTION Lot Block 4 Has!-loi iiS..:11-s Sub• -')i -v _s .on LOCATION 0' P':'all.ey east to hrO --PcL ct Or.—, Pr oim)ec- nor LF NO OF BEDROOMS VOnCOI_i_l fir, , Voncoli.f sou-th to Kasilo , 1. mile, 11. on ,. 5 UY Well Absorpti n area DISTANCE TO: 100' 1- 1.0 �AVe, � Dwell i x ) ` PERMIT NO. ./90333_ I- Z a Q N� Manufacturer r rr Tank An.chora, e Tank Material _ �tee:l. No. of compartments 2 Liq, capacity in gallons r' IF HOMEMADE: Inside length _ Width Liquid depth C� U Y Z DISTANCE TO: Well Dwelling T PERMIT NO. YZ — FQ- Manufacturer Material Liquid capacity in gallons O wT LLj Well a DISTANCE TO: 1-22' Ave. Found tion Nearest lot line �2' �AV@, PERMIT NO, LL 2 — Z w No. of lines Length of each I'ne r „ ,_ , Total length of lines Trench wid�t 9 Distance between lines Q cc F OLength To of file to finish rade P g 0 - O __inches Material beneath tile 1. 2' Total effective absoiption area Width Depth inches P 720i - w PERMIT NO. 0 a F W d wWell Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line _ Septic tank Absorption area(s) OTHER o PIPE MATERIALS j; ,[;l^OI"1 P. ' l�. iJ , i` . �.i n P. f.C. Perforated as requ_i.rcd SOIL TEST RATING f}' 133 /'3(,droou1 INSTALLER p%--' ")chachl_e ,Ixca_va-Ling — t - — REMARKSLi , a " Inc ANI f_t� 4 0 0,4 n. E�r eonnpn n ,r t'n �.ntnaRnn e � \,I k — t, �7°e D€IVIrl i"IRI'IYISIh ° �</� — ,I. 011 rlf pyoa — —_ APPROVED / TE LEGAL - )a.v i d J . i farimn , :. 9/13 '79 o f tl, ;1_o h ch 1; a. ;i. 1_o _ ;:i1_ls '3u.od., TYPE OF TRENCH MHX[MUM NUMBER OF BEDRO0MS - 5 SOIL RHTING (SQ THE REQUIRED SIZE OF THE SOIL 8BSORPTION SYSTEM IS� FT/BR) 11 - It ���M FT -P:= VIA W 0 A "? V�n L������ /'/� (::D! 111 ... F�0 1� PERMIT HPPLIt HRS THE RESPONSIUILIl: TY TO INFORM THIS DEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJRCENT TO THIS PROPERTY RNr, THE 11 ItUM8ER OF RESI0ENCES IHT THE NELL WILL SERYE �~� 1; 11 ..,UrC:-.11 '1::1 14 1 Ss 1W F � C ; -1 - 1: C) 1411 ; I it T? KEE 10 KEE GO U T TO FT W. A BRCKFILLING OF RNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVRL BY THlS DEPHRTMENT WILL BE SUBJECT TU PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL HND ANY ON`SITE SEWHGE 0ISPOSHL SYSTEM lS 100 FEET FOR H PRIVHTE WELL/ OR 150 TO 200 FEET PROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS NAY HPPLM SPECIFICRTIONS HND CONSTRUCTION DIHGRHMS HRE HVRILHBLE TO INSURE PROPEk INSTHLLHTION. O SOILS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST Pouch 6650, Anchorage, Alaska 99502 276-2221 SOILS LOG — PERCOLATION TEST 10 11 WAS GROUND WATER i S ENCOUNTERED? �'��� L O - IF YES, AT WHAT E DEPTH? 13 14 Date Gross Time Net Time Depth to Water Net Drop 16-- o°p° °OB Goo o yen 17 ,QQQ&A@�Hto r 18 °cne°o.� ea°°o �0R I° ®i i J. Harman < 19 - pROFEW���R� Reading Date Gross Time Net Time Depth to Water Net Drop yen G� 20 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS, PERFORMED BY:- CERTIFIED BY:ATE: 72-008 (7/76) ❑ SOILS LOG -� MUNICIPALITY OF ANCHORAGE e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST Pouch 6650, Anchorage, Alaska 99502 276-2221 SOILS LOG - PERCOLATION TEST PERFORMED FOR: iiel"ti: Giddings DATE PERFORMED: 9Z1.0 -- r -,V11./79 1 CI t I,I TT' LEGAL DESCRIPTION: _�O G ;�lOC.I: I"ias.i10C � d17.11_,� ;3ubd.iy-j..:.,i on DEPTH SLOPE SITE PLAN -i"--- --- -,---- -- (FEET) Lr_i- - ---_.---. 1 I J 1 I I i 5 — - 6 ercola.tio;ti '" test Lev1. T 7 --- 9 10 11 12 13 14 15q�� Or Qi 't� ,am..00aaA 1� Asa fc, � Sao a J � 9 �. ona aana n an �' H ana000 eo 17 �a aoga oo ...o ono .o WAS GROUND WATER S ENCOUNTERED? 'Io L - --- -- - - - 0 P - - IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net TEST RUN BETWEEN Time Time Water Drop jl ; I. '{t./' edroom) —C7— --T- " 0 >:1.� ,. DATE" 9/12/'? 9 1.`15 t -n, 1.5 I 10 „ 21 30 30 00 " 30 1. I. r efill 30 „ 30 :. 2 iI 30.: 1-:: r" 9:00 30 3 231-" 5" 1.0:00 " 30 .. i.i. _ 33.1:, 20 I I PERCOLATION RATE 6 _n(minutes/inch) TEST RUN BETWEEN U FT AND �G— FT COMMENTS 1a.l;or dra.iris lel i_ throuj;:h laye'r�d r i_YlE3 to coa , -„y81” 1 iurvc (F'er.c. :;ate Vs. '{t./' edroom) indicates 133 i'" -,/Bedroom accq'd. PERFORMED BY: -' . Jchachle CERTIFIED BY: ,. DATE" 9/12/'? 9 Ti Ti flal [1131 72-008 (7/76) Alpine Drilling & Enterprises INVOICE Domestic — Commercial Pump & Water Systems N° 2041 P.0 Box 110496 ,lob Name / L ation Anchorage, Alaska 99511 �a a hoc A (907) 345.0202 TO- S� Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Conplelion of the Above Described Work I PHONE 37— 3219 J DATE QUANTITY DESCRIPTION AMOUNT r / PILO— LABOR HOURS RATE AMOUNT TOTAL MATERIAL 64 TOTAL LABOR /'l WORK ORDERED BY DATE CORIP TOTAL BOR PAY THIS AMOUNT Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Conplelion of the Above Described Work I 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF s= FA TII ANID leNVlliONMsl:l"fi.AL F>ROTF.CT10'r.; DIVISION Of: ENVIROH[Vi NTAi H"' A1_'t'i i Cl-HTIFICATF. OF INSPI_C ION FOP, I lFALTI1 AUI HOHIFY APPROVAL OF ON-SITE SEwt_Ft AND WA I EH FACILI) OV -6,100 -rJI Application-- bate GENEFI[0- INFORMATION' (a) Legal Description (include lot, block, subdivision, section, township, ranee) //?le -I .-Iii Location (address or directions) (b) Applicant falai i feleonane:.Ion c Applicant Address�:- (c) Applicant is (check: one): Lending Institution I.1 ; Owner/builder;:`._I ; Buy or 11 ; Oilier ❑ (explain (d) Lending Instiitufion Address (e) Heal --state Company and Agent /Address Telephone ----_-.-.-- .- (f) Mail the HAA to the following address: Single-Family"GA (v1uiti-Parnjly L1 C.)cr 1 Number of Bedroom .------!----_-----___-- 3. WA T F II SUIPPI1.11' Individual Wcll'n Community 0 Public l -i Note: If community well systen;, inus4 have Iriiten con'iirrnation froim the Str..ie Dep_.-rtrnent of Environmental Conservation attesting to the legality and status. 4. ;°I VJACqF DISPOSAL 0nsite0 Public, ❑ Cornrnunity l'.7 flolding Tank L� IJote: If community well system, mi-ist have wi,itten confirrTietion from the State Depa.rtrn^nt of E.mnronmental Conservation attesting to the legality and status. Page 1 of 2 72-W5 (11.04) 5. �NGINPE�F{iN� t iRil/I Pfi41F1laIN(: :NSPf�f� i ICJN I r �`I':', i�ILE ,��[=,✓1fZCt i, i)A t:: AtJC] IsNf=C?s,�r(\`!�)t:! 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 v., ate rsuppIv and/or wastewater disposal s; stem is safe, functional imd adequate for the number of bedrooms anci type of structure indicated herein. I further verify that based on the information obtained from the Phunicipality of Anchorage files and from my investigation and inspection, the on-site wafer supply and/or wastewater disposal system is in compliance with all Municipal and State cosies, ordinances, and regulations in effect on the date of this inspection. i Name of i=tern .----_- p'-, ---------_------ Address _._/_/ - __-��_ - __ •/r e:. _G._J/�: fl.. Date _ Telephone --- r _ Approved for __— bedrooms Ir/Date Approved —----------- Disapproved ... _-- _---- -Kerns of Conditional Approval CAUTION he Muncipnlity of Anchorage Department of Health and Environmental Protection (DI-IF.P) issues I lealth Authority Approval certificates based solely upon the representations given in paraquiph 5 above by an independent professional engineer registered in the State of Alaska. The DFI P does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requin monis. Employees of i)[ -I( -,P do riot conduct inspections or analyse data before a certificate is issued. -the Municipality of Anchorage is not responsible tot, errors or ornissions in the professional engineer's work. Page 2 of 2 ?z-ras h t,sn; MUNICIPALITY OF ANCHOPAGI- DEPT, 01= HEACiH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: LD -1 &'0 ,23,.,1 �C A. WELL DATA Well Classification ���'�� If A, 13, C, D.E.C. Approved (Y/N) Well Log Present (Y0___Date Completed /%(, � —Yield Total Depth .6nased to Depth of Grouting Static Water Level AP I Pump Set At i Casing Height Above Ground % Sanitary Seal on Casing {l N) Electrical Wiring in Conduit ON) Separation Distances from Well: To Septic/Holding Tank on Lot Depression Around Wellhead (Y6) / F On Adjoining Lots To Nearest Edge of Absorption Field on Lot /Oa ; On Adjoining Lots — /OV To Nearest Public Sewer Line I/A To Nearest Public Sewer Cleanout/Manhole --A41A To Nearest Sewer Service Line on Lot 9 Water Sample Collected by — �S _ / ; Date — 9 —7 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed SizeNo. of Compartments Standpipe&) _ Air -tight Caps (Y ) _ Foundation Cleanout (y 1) Depression over Tank (YeV _ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) Ah ; for A/X Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) N %� Separation Distances from Septic/Holding Tank: To Water -Supply Well 9717 pp Y To Building Foundation — To Property Line 'r To Disposal Field — "t i To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026111/841 /5�_ 4_� 8v ,e'wl"1i /Y&,P- C. ABSORPTION FIELD DATA Soils Rating in. Absorption Strata /3 Type of System Design Date Installed 614/611JIk CoA//",'r Length of Field or/(' - e! P r/ / Width of Field off'/�' "" 3 /��'�'�''`'�'� " 47"&-9*'' Depth of Field �� zAOti��� RK Gravel Bed Thickness 6,16/6 ' Square Feet of Absorption Area V56 Standpipes Present(91N) Depression over Field (Ye Date of Last Adequacy Test ,,} %-� Results of Last Adequacy Test /�e4u�a- Separation Distance from Absorption Field: To Water -Supply Well %�'� To Property Line �f To Building Foundation To Existing or Abandoned System on r Lot 2fcTut a"e/ee• 4, `°1&F1AAC-- ; On Adjoining Lots To Water Main/Service Line To Cutbank (if present) .e . To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Cycles during Adequacy Test. Meets MOA I certify that I have ec d�Aveerrified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,Z-� r _ Date �i ci Company G,� MOA No. ria OZ 42® OF A/ Nit Receipt No. Date of Payment Amount: $ 4�1 A77) 'Mair- vrlev, bhda5 ?&poer Page 2 of 2 72-026 (11/84) Seay �S • eese•e egwIP e . tPRO C. EID, JR.a �8 2251 �"'4 - rY1tJlYIeTtT MUNICIPALITY OF ANCHORAGE DEPT. OF fl'ALTI-I & - p1v DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTM IRONMENTAL PkOTECTION 825 L Street - Anchorage, Alaska 99501 - - � JUIe 1ro-r?�99f9 ENVIRONMENTAL ENGINEERING DIVISION SINGLE FAMILY Telephone 264.4720 RE CE I\/ E D REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be prucassed..Please allow ten (10) .days for processing. 1. PROPERTY OWNER PHONE Keith F. Giddings and Frances L. Giddings - 344-6373 MAILING ADDRESS � P.O. Box 10-328 South Station, Anchorage, Alaska 99502 ❑ PUBLIC UTILITY PROPERTY RESIDENT (If different from above) - 8. SEWAGE DISPOSALSYSTEM PHONE 2. 13UYER ! - PHONE K.F. Hollingshead and L. Elvira Hollingshead PUBLIC UTILITY—�_ 279-6661 his w MAILING ADDRESS - -- - 718 E. 74th Avenue, Attchor-a e Alaska 99502. 3. LENDING INSTITUTION _ PHONE Spokane Mortgage Co. �/7-0543 MAILING ADDRESS 3201 C Street, Suite 2.5_0. Anchorage, Alaska 99503 4. REALTOR/AGENTPHONE none MAILING ADDRESS n/a 5. LEGAL DESCRIPTION Lot 4, Block 4, Kasilof Hills Subdivision STREET LOCATION -- NHN Kasilof Drive, Anchorage, Alaska 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ - One ❑ Four ❑ Other ❑ Two M Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY KA fNDIVIDUAL* 105 ' * 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 DISPOSALSYSTEM X� INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date 1969 ❑ 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. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED _ TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE O SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE O OTHER ❑ TWO O 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 OSeptic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS Q 0<'APPROVED FOR BEDROOMS < CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE -a2 r- BY IT V J LEGAL DESCRIPTION 72-010 (Rev. 3/78) 'rime Time e 7 "P - ". Date Date Date Inspector Inspector Inspector Comments V t"Bondlticnal Approval. �f- A.v �_.I �-n_: i�. i_� ��,� �•-_,4`. Jt-.�/��A,A!_�r�,l ��-K� (�l.(/t? N liG�-tl�W`" L Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating 0 Well To Absorption Area p� Well Log Received •z� Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner 170 l E- ,ref f71,/-, i r 75 r .., 777,- �,.Phone Mailing Address ! — Buyer 77 Addresses Lending Institution ��� �G ���,� i�C Phone s Address c Realty Co. & Agentc ( c%6,1j�,v i,�� c ,. Phone Address Legal Description Street Location Type of Residence ;M Single Family 7 Cl Multiple Family No. of Bedrooms O Other Water Supply tJ Individual ATTACH WELL LOG. A well log Is required for all wells drilled since June O Community 1975. For wells drilled prior to that date, give well depth (attach log if Cl Public Utility available.) �� n Sew ac a Disposal Vt 7 1 Individual Year Individual Installed: LI Public Utility When Connected to Public Utility:--.— tility:_ ._Ll ElHolding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 1 3'0