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Home My WebLink AboutCINERAMA TERRACE BLK 3 LT 11MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241219 Work Type: Septic Initial Tax Code Number: 02054117000 Site Legal Address: CINERAMA TERRACE BLK 3 LT 11 G:3241 Site Mailing Address: 16133 KING'S WAY DR, Anchorage Owner: MCLEOD RAYMOND S & AMY M Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: L)chartmc�nt 7/30/2024 7/30/2025 98361 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: • Effluent from the tanks may join together prior to entering the field. Reeeived-By: E ,�6ueC� 4t> /7/ Date: Issued By: � l.��r% n Date:7/3D z 5 MUNICIPALITY OF 10, Development Services Department On -Site Water & Wastewater Section Parcel I.D. 020-541-17 ANCHORAGE IRU5" ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) MCLEOD Mailing address 16133 KINGS WAY DR ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) CINERAMA TERRACE BLK 3 LT 11 Legal description (Township, Range & Section) Lot Size 98361 Sq. Ft. Number of Bedrooms Phone- 907-343-7904 Fax- 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field Fx_j Initial RX Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade El Duplex (D) ❑ Holding Tank D Renewal ❑ Multiple Dwellings El Privy R (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: 0 >0-1 Permit No. OS 10 2-91-0-19 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTormsUient FormsTerrnit Application.doc July 25, 2024 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic permit Legal: CINERAMA TERRACE BLK 3 LT 11 (16133 KINGS WAY DR) To whom it may concern: This is a request for a septic permit on the above referenced lot. The tank for the upper house (16135 Kings Way Dr) was replaced previously. This new system will support both the old house (3-bedrooms) and the new ADU house (2-bedrooms) for a total of 5-bedrooms. The old leach field will be decommissioned and a new 5-bedroom system install for both buildings, see the site. The soil log found silty gravel (GM) for the entire 14.5-foot depth, with bedrock at the bottom and no water. The slopes in the area are between 15 and 20 percent with a very small road ditch more than 50 feet away. We have more than 50 feet from the proposed leach field to the very shallow road ditch. The new secondary field has been moved to the east, uphill from the primary field. No neighboring lots will be impacted with this new system. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241219, Deb Wockenfuss, 07/30/24 SEPTIC FIELD SECTION DESIGN CRITERIA: 6.0' EFFECTIVE 5 BDRM X 150 = 750 GPD SOILS = 750/ 0.8 = 938 GPD 938 GA/12 = 79 2.0' WIDE 79' LONG (1) TRENCH 7.0' DEEP 14.5 (TH#1) 1.0 GM ORG 1. 5 ' 2.0' -7.0 -1.0 MOUND OVER FILTER FABRIC SEWER ROCK 3,3( GRADE 1"=200' PROPERTY LINE PROPOSED DRAINAGE FIELD EXISTING HOUSE EXISTING WELL 100' RADIUS -N I C K L E E N S T - SCALE: DJRDRAWN: DATE: CINERAMA TERRACE, BLOCK 3, LOT 11 Anchorage, Alaska RAYMOND & AMY MCLEOD 7/1/2024 -K I N G ' S W A Y D R - & INSULATION NO WATER OCT 2023, BEDROCK @ 14.5' Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241219, Deb Wockenfuss, 07/30/24 1"=50' EXISTING DRAINAGE FIELD TO BE DECOMMISSIONED EXISTING 3-BEDROOM HOUSE EXISTING WELL 100' RADIUS DRIVEWAY WELL NEW 1,000 GALLON PLASTIC SEPTIC TANK W/ 20" RISER, INSTALLED UNDER PREVIOUS PERMIT CINERAMA TERRACE BLOCK 3, LOT 11 SCALE: DJRDRAWN: DATE: CINERAMA TERRACE, BLOCK 3, LOT 11 Anchorage, Alaska RAYMOND & AMY MCLEOD 7/1/2024 -K I N G ' S W A Y D R - CINERAMA TERRACE BLOCK 3, LOT 10 CINERAMA TERRACE BLOCK 3, LOT 12 CINERAMA TERRACE BLOCK 2, LOT 5A PROPOSED 2-BEDROOM BUILDING SH E D S H E D SH E D SEPTIC NO NEIGHBORING WELLS WITHIN 100' TYP 4" OF INSULATION CO CO MT CO CO CO TWO DRAIN PIPE ENTER AT THE MIDDLE OF THE FIELD CO CO TH#1 1 5 - 2 0 % 1 5 - 2 0 % PROPOSED WATER LINE LOCATION PRIMARY AND SECONDARY SYSTEM, MAINTAIN 12 SEPARATION FCO NO WELL WITHIN 100' TYP. NEW 1,000 GALLON PLASTIC SEPTIC TANK W/ 20" RISER, SECONDARY SYSTEM CLASS III SYSTEM APPLICATION RATE OF 2 GPD/SF, EFF OF 5' X 32' LONG Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241219, Deb Wockenfuss, 07/30/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241219, Deb Wockenfuss, 07/30/24 z 0000 �o 077 01,0, kk ANCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: CINERAMA TERRACE LOT 11 BLOCK 3 PLAT 83-547 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary Iiiies. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE- SCALE. E-MAIL, DEC 17, 2023 1 =60 schuller(Dak.net "23- 047- 2 DRAWN BY. CHECKED BYGRID NUMBER: BOOK AGE: JLS SW3241 230364 * = FAD 5/8" REBAR 'S414Q. SUP 10 AMW OF A loor � 0 sir Ae Ay 1P 00of A' 41, 111) C�) 49TH. ............ .......... ?A 4 -M qH R N L. SCHULLE. 0 ` s LS -10408 10;' 1831 Talkeetna Street % k�v Anchorage, Alaska 99508 1 f essiono\ (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241189 Work Type: SepticTank Upgrade Tax Code Number: 02054117000 Site Legal Address: CINERAMA TERRACE BLK 3 LT 11 G:3241 Site Mailing Address: 16133 KING'S WAY DR, Anchorage Owner: MCLEOD RAYMOND S & AMY M Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 7/5/2024 7/5/2025 98361 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Re lived y: % 5 +c,/'11t/ I Issued By: A,"' -- Date: Date: -- 3 MUNICIPALITY OF ANCHORAGEC. Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-541-17 Property owner(s) MCLEOD Mailing address 16135 KINGS WAY DR ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) CINERAMA TERRACE BILK 3 LT 11 Legal description (Township, Range & Section) Lot Size 98361 1 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank El Upgrade RX Duplex (D) ❑ Holding Tank R Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: _P3,60 Waiver Fees: Date of Payment: Receipt Number: Permit No. 03(22,`-111,59 Date of Payment: Receipt Number: Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc July 3, 2024 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic tank permit Legal: CINERAMA TERRACE BLK 3 LT 11 To whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The tank will be decommissioned per the Uniform Plumbing Code (UPC). Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241189, Deb Wockenfuss, 07/05/24 1"=50' EXISTING DRAINAGE FIELD EXISTING HOUSE EXISTING WELL 100' RADIUS DRIVEWAY WELL PROPOSED 1,000 GALLON PLASTIC SEPTIC TANK W/ 20" RISER, W/ DCO PRE & POST, MAINTAIN 10' FOUNDATION & 5' FROM DECK PILES CINERAMA TERRACE BLOCK 3, LOT 11 SCALE: DJRDRAWN: DATE: CINERAMA TERRACE, BLOCK 3, LOT 11 Anchorage, Alaska RAYMOND & AMY MCLEOD 7/1/2024 -K I N G ' S W A Y D R - CINERAMA TERRACE BLOCK 3, LOT 10 CINERAMA TERRACE BLOCK 3, LOT 12 CINERAMA TERRACE BLOCK 2, LOT 5A PROPOSED BUILDING SH E D S H E D SH E D SEPTIC NO NEIGHBORING WELLS WITHIN 100' TYP Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241189, Deb Wockenfuss, 07/05/24 MUNICIPALITY OF ANCHORAGE . D[ RTMENT OF HEALTH AND HUMAN SER ,ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address ~0 SEPTIC ABSORPTION ~ TANK FIELD WELL S~ws~on Township, Range, Section ~S-BUILT DIAGRAM (ShoVer,on ol well, septic system, p~on, ~[~ ~ /~ ~ ~ ~ C / dr,veway, waterbod,es, etc.)/ TANKS /~ ~,,ff-~ N ~ SEPTIC ~ HOLDING . ,/ ~I , Material No. of Compadments Depth ,o pipe bottom from ~ota, depth from o~,gma, grade ,l F,ll added above orlg,na/ grade Gravel depth beneath p,pe Gravel length Gravel width Total absorpt,on are~ Distance between ,,neB Number ol lines ~aterial I Sod rating Installer Date Installed ~ WELLS / ~ PRIVATE ~ ER Ildentifv) Class,ficat,on (A,B,C) Total Depth %~Cased to FTI 72-013 (3/85) I}EPAI::i'.TMf~]q'T' ..," I'"IEAL. TH AND E'NV I I::'.:ONMEI',H"AI .... -R[H"E:.C."F I ON [.:.');;~5 L STREET', ANCHOF:;,'A[':')E, AK 9950.1. :.?.64-47L:.?.O F:'ERIq I "1'~ NO ~ D(.:'ITliii: I SSUEI}: 860 ;..:.~ 9.4 08 / :1. 9/86 AF:'PL ]: CAN'I": ,' I.. l,)P,l:.~:x:~: COIq'I"ACT I:::'H[)I',IE :~ I:;'.OGI:.~R I'"II~:ARRI~!i].../CONST' ,, EI',IG, SRA 6614 WAS :1: I....LA, Al'::: 99587 ::.'!; 45'""6049 SLIBDIVISION;~ CIt',IERAHA TERRACE :.1=.[., I .[ Ulxl: 1 'T'OWI',ISH I P: 11 I',1 98:L.16:1. '"" '"~. . ~,ob. I='l" OR ACRES) LOT: 11. "::t ......... , ..... k I...t.)L;I ...... R A N G E ,", 314 I.... :i. s 'L e d b e 1 o w a r' e .1:.. h e o I:::' t i o n s a v a :i. 1 a b .t. e t o y o u i n c:l e s :i. g n :i. ri g y o u r s e p t :i. c systern,, Choose 'l:..hc-..:, opt:i, on that best {'its your s:i.i:.e,, .... It"" t1:::;~', E:.] tt ,.11 ~.,,~,. tF-"II .~..E~ E:: :1[]~ !b.,~ .. :fi::::) IF:;;',: ~l'-':aB~ ][ DEPTH 'l"O PIF:'E BOTT[]M (l:::'l".) 4, C' GF~:AVEI.... :(:)1~!:1:::'"1"1'"1 (F'T,) 6 ,, () '/"O'T'AL DE.F::'TH (I::'T',,) lC:' ,, GRAVIi.:]I .... W].'DT'H (F:'T,) ;;:?,, 5 GRAVEl .... I....IT.':NG'I"H (F:'T ,, ) 57 ,, 0 GI::;..'AVti:]:I... V[]I....L]Mti.:.': (CU,, YDS ,, ) 34, 4. T'ANI<: S I ZE (GAL. S) .1., ()()C), 0 ** SOIl .... RA'T'IIq[=I (SQ,, t::'"1",, /BR) 4,'-~.. TAIqI< MLJST I...IAVli:Z AT L. EAS'I .... f'NO COMI::'AF:('I'M/N"r's I (::: e r' 'L :i. f y t h ai:.: :t.,, I am f'amil:i, ar, w:i.'Ll"t the requ:Lpements for' on.-...s:i, te sewer, s and wells as se'l:. fOi"th by the l"lun:i, cil:)al:i.i:.y of Anchorage (MOA) arid i:.he State of Alasl<a,, ::'.:..'.,, .l: w:i. ll :i. nstall 'l:.lne system in accordance with all MOA codes and r'egu].at'..:i.c, ns, and in compl:i, ance with the design cpi. ret'ia c.~f this per'mit,, 3,, I w:Lll adhere to all HOA and State of Alaska r. equirements for i'..he set l::)ack dist. ar'lces from any exisi:.ing well., wastewater d:i. spc, sa]. sys'l:.em or' pul:::,lic sewePage system on i:.his or any adjaceni:, op near by lot,, 4, I Lu"ld~:.:r'si.'..and thai:, i:.his per'r/iii. :i.s valid for' a max:i, mum of 3 bedrc, c:)ms arid any e, nlaPgemerlt will. r'.equire an addit:i, onal I:::,er'm:i.'l: .... ....... [ ............... 't~"l" BE DJ]NE BY, A I...I~!SED ELEC"FR]:CIAIxl, ............ D A T E: 1. cx:).JE:.D BY i)A'I"E: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: ~'-'~ 1 2 3 ,._--.-_4 7 $ ~0 13 14 16 17 ~t~V~e /g~wnship, Range, Section: / It ~ ~'5 ® SITE PLAN SLOPE WAS GROUND WATER /JO ENCOUNTERED? 20 S L IF YES, AT WHAT O DEPTH? p Depth to Water Alter Monitoring? ~Z~__Date: ~'¢J~ S i lqO' I Reading Date Gross Net Depth to Net Time Time Water Drop Ti, z.q .-- - ~ ,, -- ?, ~o ?.q ~ - 5- ,, _ COMMENTS '~,O t, vt/~q //v/~ -- ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) PERCOLATION RATE __ (minutes/inch} PERC HOLE DIAMETER TEST RUN BETWEEN ¢ FT AND ~ FT CERTIFY THAT THIS TEST WAS PERFORMED IN IMOTRUCTINQ ONQINERRS, INC. p L T I Soddy Warner Dr. Analwa0a Alaska SCALE lA6�0000 6040098 LEGEND: ~) Iron PII~ ' · 5/8" x 30" Rab.r [~ 8urv~/Hub &Tlek PLOT PLAN SCALE 1" =~ ~ I hereby certify that I have'surveyed Lot Ii , Block Subdivision, Anchorage Recording Precinct, Alaska, and have replaced all lost ~orners with 5/8" x 30" rebar. It is the responsibility of the owner, prior to construction, to verify proposed building location on lot, grade, and utility connections, also to determine the existence of any covenants or restrictions which do not appear on the recorded plat. Dated, at Anchorage, Alaska this *~: J CONSTRUCTING ENGINEERS, INC. 9~01 Buddy Warner Dr. Anchorage, Aieake ~46.2000 694.6098 SIX INCH WATER WELL DRILLED Drilled at The Rate Of ~78.00 PER fOOt. PrOPErtY OWNER /:b't.. ~: /~]~. ~o~ [~~ 345-6049 ~LOCATION Of WELL Site Driller 844'?714 MUN~C1PAUTY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OUT TO THE DEPTH OF 180 ~:~e~b. OEC 1 5 1986 RECEIVED WELL LOG: 0 .... 7.4' Sd,L~j..,~o.n.d g.,~u~e.J_. 3_9/. cJa.~j. 20--180' B~ocE, A ¢~ ~d ~~~ ~o~. (S~-~o~..) ~ ~ oho~g. ~ 121-~23 ~, .1/2 ¢?liZ ~¢ o~. of ~ ~ ~o~o~ off 1 1/2 ~PiiZ 4~om~¢ ~ 173 ~o 177 ~, W~, ~~ ~e Z~ o~ ~ ~ h~ ~ ~ 184 fa, ~q.e f-om ~ 30 ~e~ ~~. 7o~ ~ ~~ ~c of 7 1/2 p.v~p, a. q.~e. aAe~ v'o.t..tv~e, rio,t. 10-15 ~o_.~, & ,t~e,n. ,t~reJ.~ of. &o 720 &o ~oba~ 750 ro~l. ¢o.o/c of. ~,~,U.~9: ~18.00 f~e.~ ~2.. X 180 f.e: g3,240.00 COST INCLUDES All LabOR AND MATERIAL FOR COMPLETION Of WRITE CHECK PaYable TO rampart DRILLING WORKS FOR The sum · BERNIE CLAUS Of RAMPART DRILLING WORKS DATE Se'l~ce'w~e~t' 112Jl.~ SE:RVICE: CHARGE: O F ~V:% PER MONTH WILL BE: ASSESSED ON PAST DUE:ACCOUNTS. MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # ~ ~_~ ~-4~._'~ ~ - ~. / NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) LOT '[5K.'5, (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner Mailing Address (c) Lending Institution (d) Real Estate Company and Agent :LT~lep h 0ne; ~' '~{//" (home) Business Telephone Address Telephone (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'l~. Number of bedrooms 3. WATER SUPPLY Individual Well~' Community [] Public [] Note: If community/well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-siteW 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 below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional..and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Address Date Approved for ,~' bedrooms by _ . Date Approved ~ Disapproved Conditional Terms of Conditional Approval 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 aa 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. 7/88) Back Page 2 of 2 A. WELL DATA Well ClaSsificatiOn Health,Authority Approval (NAA) CHECKLIST - FEBRUARY 1984 343-4744 ~ Legal Description: LOT'. I1: ~ ~: _ Date Completed '~/I Depth of Grouting >/ If A, B, C, D.E.C. Approved (Y/N) Yield ~,, ~ Well Log Present (Y/N) Total Depth IB~/ Cased to Stat C Water Level Casing Height Above Gyound Electrical Wiringin Conduit (Y/N) SEPARATION DISTANCES FROM WELL:' Pump Set At, Sanitary Seal on Casing (.Y/N) ~' Depression Around Wellhead (Y/N) /~ 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 J O ~ ~ ; On Adjoining Lots I ~O 'f ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date /- B. SEPTIC/HOLDING TANK DATA Date Installed ~ Size Standpipes (Y/N) "r~,o ~ Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~f//~, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Air-tight Caps (Y/N) To Water-Supply Well To Property Line To Water Main/Service Line No. of Compartments T I,~ D Foundation Cleanout (Y/N) Date Last Pumped /'~ '",~/'~_,~? ; for Temporary Holding Tank Permit (Y/N) To Stream, Pond, Lake or Major Drainage Course .... Comments To Building Foundatipn ' ! ~., To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in AbsorPflOn~i~trata Date Installed :: ii'i~/8 Width of Field .~ ,~ TyPe.°f System Desi~' ~, · kongth of Field Depth of Field Gravel Bed Thickness To Water-Supply Well To Building Foundation ./ Lot To Water Main/Service Line. To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or. Vehicle Storage Area Square Feet of Absortion Area '70 ~-~ Statndpipes Present (Y/N) ~ .... Depression over Field (Y/N) /~ Date of Last Adequacy Test I 0// Results of LaSt Adequacy Test '~.. .~ ,~ ¢' / _ _'TT~-bL~..~ ~¢~." SEPARATIONDISTANCE FROM ABSORP'TION FIELD: ! ~"~ '/~ To Property Line ~:~ ~3 To Existing or Abandoned System on ; On Adjoining Lots .. To Cutback (if present) Comments D. LIFT STATION ~ O N~' Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments 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 guidelines in effect on the date of this inspection. '. ,.. ,.?~.;.;.: ~.~,,~.~. , Signed Company ~..~~~..~. '. ~ '~ Engineer's Seal MOA No. ReceiptNo, (~ S ,~'nT_{~/~;. /,~2,.~' ReceiptNo~. Date of Payment //(~) .//~/r~ ~ Wai~er Fee: $ Amount: $ // ~ ~) '~ .... Date of Payment 72-02s (,.v. 7/88) ..c~ page ~2 0~/2i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~-\ ~..3 OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~;:~ ~R~elephone: Home Applicant Addre~ ~/~ /~/~ ~ ~ ~ (c) Applicant is (check one): Lending Institution []; Owner/builder'S'; Buyer I-I; Other [] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent .~ T Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family'~ Multi-Family [] Other Number of Bedrooms 'T/~'/~-~ WATER SUPPLY Well/[~ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank[] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDII~,a INSPECTIONS, TESTS, FILE SEARCH, D~.. A AND INFORMATION ' ' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. ~ c~ L{. - ¢~ 0 ~ ~ Name of Firm ~..ov~9~, ~v[~.)y'~ ..~-..v'tc.. Telephone Address ~O( -'~c:L<~? ~.).~.'/,,'~e_ ~ ~"~").1/, ~tC~',,~ ~_~(~_. ¢~,~7~¢0 Date [ Z- ~,S'-~(o DHEP APPROVAL Approved for '~'~':~ledrooms bY ~~''~' '~~ ,~pproved ~ , Disapproved Conditional_ Terms of Conditional APPrOval Date CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections 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. Page 2 of 2 72-025 (11/84) ae MUNICIPALITY OF ANCHORAGE (MOa; MUNICIPALITY OF A~ A[J'~O~ APPROVAL ([']AA) DEPT, OF HEALTH & ENVIRONMENTAL PROTE~C~LiST _ FEBRUARY 1984 1986 Well . E ED Well esent (Y/N) Total Depth /~6)' Cased to Static Water Level ~/O ' Legal Description: ~.// ~ 5 If A, S, ~ C, D.E.C. ~o~d(Y~) ~ ~ ' ~p~ of ~ting Sanitary Seal an Casing (Y/N) Y Depression Around Wellhead (Y/N) A~. Casing Height Above Ground Electrical Wiring in Conduit (Y/N) y Separation Distances fTcm Well: To Septic/Holding Tank on Lot -~/O~' To Neaz~st Edge of Abscmlotion Field on Lot ,z To Nearest Public Sewer Line ~'/~ ' Cleancut/Manhole ~ Water Sample Collected By Water Sample Test Desults ; On Adjoining Lots ; O~ Adjoining Lots + To Nearest Public Sewer ' To Nearest Sewer Service Line on Lot /' Date Cc~ents B. SEPTIC/HOLDING TANK DATA Date Installed Size Standpipes (Y/N) ? Air-tight Caps (Y/N) y Depression over Tank (Y/N) A] Date Last Pumped Pumping/Maintenance Contract on File (Y/N) A) ; for Holding Tank High-Water Alarm (Y/N) A~/~ Temporaz-y Holding Tank Permit Separation Distances f~cm Septic/Holding Tank: No. of Ccmpartments ~- Foundation Cleanout (Y/N) ~ ~ 9-0 To Water-Supply Well To P~operty Line ~ ~ 0 TO Water Main/Service Line Course +/~ &2 ' To Building Foundation To Disposal Field To Stream, Pond, Lake, (Y/N) mA Major Drainage Con~nts Receipt Date Paid: Amount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption St=ara Date .Installed ~- ~' ~ Width of Field ,~' Squa=e Feet of Absorption Amea Y~ % Depression over Field (Y/N) /c/ Results of Last A~equacy Test -- Separation Distance f=cm A~sC~ption Field: To Water-Supply W~ 11 ~ f oo ' To P=operty Line Type of System Design Length of Field ~ ~'' Depth of Field 9, Gravel Bed Thickness Standpipes P=esent (Y/N) Date of Last Adequacy Test To Building Foundation Lot A/o,oe" ~,~ '$Z'.5 ; On Adjoining Lots 4- /6,o' TO Water Main/Service Line +/~ To Cutbank(if pr.esent) To Stream/Pond/Lake/c= Major Drainage Course ~/~' To D=iveway, Parking Area, c= Vehicle Stc=age Area ~/~ Ccm~ents To Existing or Abandoned System cn D. LIFT STATION -- ~.~ 0'7' ~.;~'O. Installed Size in "Pump On" Level at High Water Alarm Level at Tested for Electn~ical Codes I Con~nents Dimensions Manhole/Access (Y/N) "Pump Off" Level at Adequacy Test. M~ets ~DA ** Check Permitted Bedrocm Rating Against HAA Request I certify that I have checked, verified, c~. oonfc~n~d to all MOA on the date of this inspection. Signed ~~/~4~ut- Date KB1/d5/s [Page 2 of 2] NOIIg~lO~d ~? Hi%qH 40 'ld~G 2-15-84 JML INC. 7127 OLD SE~'ARD HIGh.,AY ANCHORAGE, ALASKA 99518 (907) 34 4'8551 LABr TORY I.D. BACTERIOLOGICAL MATER ANALYSIS TO BE COMPLETED BY WATER SUPPLIER .D. NO. (PUBLIC SYSTEMS) r, TRCLE CLASS/~-- - , , s . , ) i A B C ~Restdential TELEPHONE NUMB~ NAME OF SYSTEM CITY STATE ZIP CODE LOCATION WHERE SAMPLE WAS COLLECTED · COLLECTED BY: (SIGNATURE) TYPE OF SAMPLE (CHECK ONLY ONE THIS COLUMH) [~I~NKING WATER /CHECK TREATMENT ~ RAW SOURCE WATER D NEW CONSTRUCTION OR REPAIRS r-1 OTHER(Specify) r'-iCHLORINATED [~FILTERED ~-'IUNTREATED OR OTHER IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON=CONFORMING SAMPLE? r'l YES ~ PREVIOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) SEND REPORT TO:(PRINT FUL'L NAME,ADDRESS AND ZIP CODE NAME Co~c~.~, ~~ ..... ~C.,~ CITY~c~ ~ FOR LAB USE ~ RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR MORE [] Sample too long in transit. Sample should not be over 30 hours. [] Sample received too late in week [:)Not in proper container [] Leaked out [] Insufficient information provided. Please read instructions on form. [] Other (Specify) RECEIVED FROM RECEIVED BY DATE TIME ANALYTICAL METHOD: [~XMEMBRANE FILTER []FERMENTATION TUBE Date & Time Started Date& Time Completed LABORATORY RESULTS Analyst [] Other Bacteria [] Test unsuitable because: [] Confluent Growth [] TNTC SATISFACTORY ~UNSATISFACTORY [] ILRCTERIOLOGICAL MATER ANALYSIS RECORD FOR LAB USE ONLY TOTAL COLIFORMS FECAL COLIFORMS OTHER Membrane Filter: Direct Count _ ~ Verification: LTB BGE Final Membrane Filter Results Reported By Date Coliform/lODml Coliform/lOOml Tim6 A.M, READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORM