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HomeMy WebLinkAboutKNIK HEIGHTS BLK C LT 5Knik Heights Block C Lot 5 #017-034-05 Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 Mayor www.muni.orttlonsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number: Legal DescriptionPrope Owner Name & Address: r�LAn-V a-0 w ifR Pump Installation Date: Lf - a8 - Pump Intake Depth Below Top of Well Casing: 8 7 feet Pump Manufacturer's Name: 4%1 .MC QoMA t - Pump Model: a.'3 Q 3 L 3 Pump Size I/' -.hp Pitless Adapter Burial Depth: 19 feet Pitless Adapter Manufacturer's Name: / Pitless Adapter Installer: Well Disinfected Upon Completion' IZ Y es ;J No Method of Disinfection: C a f9 LLIE—TS I Comments: 11AriChoeA4%- j. P�+►�►� SFav,c� 11 Pump Installer Name: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: Gvv 03 0 d I O PID Number: n 17 — 0 3q— 0 5 Name i I C7 VA 1rtTl,C-L / Wastewater System: C3New Upgrade Address R—ng ABSORPTION FIELD Phone Number of Bedrpoms A_ eep Trench ❑ Shallow Trench O Bed i] Mound ❑ other LEGAL DESCRIPTION $oil Rating : /, Total Depth from original grace p M11/0 Fl, Block: Lot. Subdivision: `- Depth to Pipe bottom ham original grade- Gravel depth beneath pipe o. ) , C 5 N 4- � R"T ! Ft. 6 FI Township Range: Section: Fill added above original grade: Gravel Length: —0 — FL 0 Ft. Well: ❑ New ❑ Upgrade Gravel wdtr[ Number of Imes: 1 Distance between liner I FI Ft Ctass.6cat,on (Pnvate, A. B, C): bI Total Depth: Cased to Total absorption area: Pipe Maleenal y Ft. Ft. Fe ja L) I b L 3O L. Driller \CJ Date Drilled: static Water Level, hstanar/ J� / Date Installed: 3 Yield V \ i Pump Set at: Casing Height Above Ground: TANK GPM Ft. FL SEPARATION DISTANCES �� ��� S// eptic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding Public/Private Manufacturer Capacity From Tank Field Station Tank Sewer Line A N (_ 1+ Q�} L N V— Gal Wei 101 11 O C1 o Material: _ S T,� L Number of Compartments VL- Surface Wa'er N Q NI 0 LIFT STATI N Size: Manufacturer. Lot Line � 1 f • i Gal. 'Pump on- level at. 'Pump otr ievel High water aia" at Foundation in in in Cura,n Oran NIU ` tV' t4Ii I Pump Make d Model Electrical In pections performed by: (� Remarks BENCH MARK X15 71 tj6 '— NIL C ►2v 14 —L Location and De cation: PJo Sie�i K l-N- N R,fL 1 = Assomea E-"Stcn N / E' UVK -it =0i�«�S _ta p \i Ami'% 0G«e0944040t D i h 11. so. aa 'r��l % /C Inspections performed by: Dates: 1a' `Ii4, 3 N:'�9 2nd 1 L ID a" OrDevelopment Services Department Approval Tn� Reviewed and approved by: Date: tie cams mai 10.e• 1_'MII �, P FESS���� 0 - — — — — — — — — — — — — — i \ I r - - - - - - - - - - - -- --^=-T I I I I I .© I I I I I I I I I L ---------- —� -�- Lyell gym. = m e m ... J—M — — t,. E 1 I AVSTALLED �-aFOrPobU — — — — �— J •; � � ;., I 11250 CA TANK W/DtYERTERVALYE � �'J o :.� •:: 50 FT LONG 11 NCH I I MAL aEPW It TT _C7iVE 1 1 17 ED AV EXl8W IWNCH I 1 .; I I CRUSR O ANO XWO ExL W TANK I a I 1 I AcCt7 !T I 1 I ac 39. I I RD u I AE 78 �� •.��i��,' aE 99 O �E 1 L — — — — — —— — — — —— •���p:••. •....... r — — — — — —— — —— — �.....4..th J !....................... ....... i 1 TO N AND 1 1 6 •i♦� NO. CE -2225 •�L• .••''• F-1 411 I O 25 50 75 too 125 150 Well F4a"�••�� I SCALE! 1' = 50 Y I I I I I I I I I I &710V MAN: eormm mm w�V c"" HOUSE MUM ELEV. t00.00 FT TOBBEN SPURKLAND P.£. 203 W 15TH. AVENUE LOT 5, BLOCK C KNIK HEIGHTS SEPTIC SYSTEM AS BUILT ANCH. AK. 99501 1'1600 SHELBURNE DATE. APRIL 21, 2003 907 279-3916 PHIL GRA WUNDER SHEET- 2/3 GRID. 2836 PERMIT # SVO30010 PID # 017-034-05 KNH00052.DVG Standard Trench: 2' Wlde 50' Long 10' Beep 6.0' Sewer rock 3' Cover Sl( t Ba 6.0 ft of Septic Rock Effective O Foundatlon Clean out Monitor NO SCALE dO4b/P C' Poll 1250 go, Sept1c tank 1250 GAL SEPTIC TANK WWH MAN' eatnw MW ASSUkW EUX 100.00 TOBBEN SPURKLAND P.E. LOT 5 BLOCK C AMY HEIGHTS SEPTIC SYSTEM SCHEMATIC 203 W15th Ave PHIL GR4WUNDER DATE, JAN. 170 2003 Anchorage Ak 99501:)7q-qqlrl 11 f26W SHELBUW Rm SHEETt 3 3 GRIDi 2836 PERMIT SW030XXX PARCEL ID 1 170-034-05 KNH00053.DWG *- 15-- D 3 e C7' o aq' MUNICIPALITY OF ANCHORAGE Development Services Department 3, On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030010 �Legat Description: KNIK HEIGHTS BLK ".0 LT.:::5 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: Phil Grawunder Owner Address: 12600 SHELBURNE ROAD ANCHORAGE, AK 99516-2921 Date Issued: Jan 23, 2003 Expiration Date: Jan 23, 2004 Parcel ID: 017-034-05 Site Address: 012600 SHELBURNE RD Lot Size: 43500 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: t/ Date: 7.0 -5_ Date: ZZ23103 y Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 01-7 --0 -S 4 — Permit Number SW 0300/0 Property owner(s) �1.� ( I em uJ'u yr Day phone Mailing address (1) Ia[D b S j,_j_ e&4 e ;i? c Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) 1-e -t S 131/- (2 i.Zlam) i kL H t^ 1 Cr H i Legal description (Section, Township & Range) Lot Size I—Y751 Acre Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms �( Sewer Only ❑ 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 applicableMunicipal Codes. �___-- , (Signature of property owner or authorizefi'agent) c Permit Fees: �� Waiver Fees: Date of Payment: t (l �0 3 Date of Payment: Receipt Number: Receipt Number: (Rev. 12/00) T.S PU PaLAM P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 5 BLOCK C KNIK HEIGHTS S/D PHIL GRAWUNDER 12600 SHELBURNE ROAD Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 January 9, 2003 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 17 ft. Use Standard Trench Soil Rating. From Testhole 12/19/02 3 min/in = 12 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 15011.2 = 125 sq.ft. Total area required: 125 x 4 = 500 sgft Testhole depth 17 feet Bottom Rock At 11 feet Top Rock At 4 feet Rock Depth 7 feet Minimum Trench Length 500 / 14 = 36 ft. Use 50 ft SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 50 FT TOTAL WIDTH 2 FT TOTAL DEPTH 11 FT ROCK DEPTH 7 FT COVER 4 FT SEPTIC TANK 1250 GAL The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. ' � ♦����(� x''1,1111 ♦♦ `p, .,,. ...........11 ... 11 fir :. 49th•.0•' IS ....'r .............................. . . .i Ick•. TO EN SPURKLAND 11c °• No. CE -2225 ' Ar 111 R •. •.•••�+�1 its 50 0 50 100 150 200 250 300 SCALD 1' = 100 FT. L — -i r- - 13 I 4 44 I 1 1 �1;••� r ® I Bell I I I I I 12 1 5 1 A 11 5��� i -•� Q I ,,v �I I III L� � I I 1 11 111 6 III - fell I I I ------J L — — — — —— I S — TOBBEN SPURKLAND P.E. LOT 5, BLOCK C KNIK HEIGHTS SEPTIC SYSTfAI DES/GN 203 W 157H. AVENUE 12600 SHfLBURNf DA TE.- JAN. 9, 2003 ANCH. AK. 99501 SHUT. 1 3 GRID: 2836 907 279-3916 PHIL GRAWUNDER PERMIT # SV030XXX PID # YY KNH0C05LDWG -———————— — — — — —, Ir - - - - - - - - - - - -- •'• tea.- : ° }:. ►1 I I I I I ,© I I I I I I I I I IL ---------- —, ..� m ------- -- — J ACTALL I -BEDROOM SY57EY TH 1 11250 CAL W VE b 50 TT Loxc neL�cH I (TOTAL DEPTH 11 TT 7 TT Or SEWR ROCA; L"WMT 1 I TAE By USW TREWH I 1 I I I E+WW AND XW 1Z5TW TANK I I .�• 11 111 N I 1 I l� LLI------- ----- r — — — — — — — ---r------- — —— —� I I I I I 1 6 I I I Iq5 1 0 R5 50 75 Lav 125 150 1 . 1 SCALE+ 1'= 50 .�- Well 1 1 I a 4 108NN 5PURKLAND P.E. LOT 5, BLOCK C INK HEIGHTS SEPTIC SYSTEM DESIGN W 15TH. AVENUE ANCH. AK. 99501 12600 SHELBURNE DATE. JAN. 9, 2003 ANC : 907 SHEET.• 23 GRID2836 � 279-3916 PHIL GRA PERMIT # SV030XXX PID # YY KNH00052.DWG Standard Trench., 2' Wlde 50' Long 11' Beep 7.0' Sewer rock 3' Cover SIl t 7.0 ft of Septic Rock Effective O Foundation Clean out Monitor r1.0.1m ,,,+c NO SCALE 1 do4b�P 4� O 1250 ga! Septic tank Pqh O4eS. 1250 GAL SEPTIC TANK T❑BBEN SPURKLAND P.E.203 LOT 5 BLOCK C ANIK HEIGHTS SEPTIC SYSTEM SCHEMATIC Anchorage Ak 99Ave PHIL GRA WUNDER DATE, JAN. 17, 2003 An501 12600 SAUBVRW Ra(D SHEETS 313 GRID, 2836 PERMIT SW030XXX PARCEL ID f 170-034-05 KNH00053 DWG •. Municipality of Anchorage / ®h� er1GWIEER"E f ••••«•••••• ��h Development Services Department Q .• 'a• Building Safety Division :9 els y On -Site Water and Wastewater Program * �491H %s 47CO South Bragaw SL ��•••••«•••••••••••"••• P.O. Box 19605 9-6 0 Anchorage, AK 9951"050 www6anchoraee.ak.us • •• •«.••••• (907):53 7-004 ": T SPUMA : A -132.Soils Log - Percolation rest ��F•'"••••''����'� Performed For:11t.-Z &L foa L-+ 01 "GSI"' Date Performed: Legal Description: Lo T tj BK e tit t`1 11C .Township, Range, Section: I �,__ sa• or, Depth 0 1_ // bRGA�1lcS 2 — n 4- Loc,C 5 Jr 7- 10- 11- -10-11 S�IML 12- 13- 14- 15- 16- 17 2-13- 14- 15-16- 17 D Orr o IL4 WAS GROUND WATER t ES CC U:ITERc.7 1�� O S IF YES. AT WHAT DEPTH? LD Depth to Water Aher p klonitor)ng. E Daze: 1 C o ading Dave Gross TimeI Net Time Depth to Water Net DrcP r� b10 I S3`i1 3/G L o .o I q1 I 10 I 029 I 4� OF NOLO tc I I 51 I to I '17. til 1 J- 1c- ° 1; 01 1 t� ( i/ 3/ 20- 5'/ I t 1 L o 'J 3 '3 FERCCLATION RATE ,h4�Gesirct) FERC HCL E DIA),IET-eR W l TEST RUNSET`NEEN_FT AND -_FT C0..I,aZ_,ITS 1 e lce_ VA c l� ut-cr� 'i�.L c S ra ttic�Q —L PERFOR%IED BY: I ,� t S CERTIFY THAT THIS TESTWAS PERFOR.%IED IN ACCORDANCE VAT HALL STATE AND MUNICIPAL iICIPAL GUIDELINES IN EF261i.3FECT ON THS DATE. DATE: MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC`rION I ENVIRONMENTAL ENGINEERING DIVISION \ 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME//�� t,�� v F,c 1y //�-. &c IIT I��D - -- —---------- ..� PH�O/NF / %" tYlX1i4 NEW ❑UPGRADE: MAILING ADDRESS /1 .-5 09 '8o/L� J' _%Z l7 Nc /fo QIiG�� %��iYS�7 9 9.5-0 7 -- LEGAL DESCRIPTION LOCATION Well Absorption area Dwelling v DISTANCE TO: � ryF (�p� IvZ,N __. NO. OF BEDROOMS PERMIT NO. �7106'11' Z a LU FQ- Manufacturer Mate' / No. of compartments to city in gallons Inside length ILiq. rapa%-�IF HOMEMADE: S � Width Liquid depth x DISTANCE TO ------_®_ Dwelling Material -"� PERMIT N ���`Manufacturer r"ry 'n a� al Ion, sem_`_ w z DISTANCE TO: r - - Fo ndation G)_`_'_ Nearest lot line �- PERMIT NO. y� `wz H,z� No. of lines Length of eacfh line W/ Total length of lines �/r Trench width inches Distance bet�yejn es ab oA Top of tile to finish grade f Material beneath tile 7 9 eralaea Total effective absorption area 6 s � Lu e Width Depth PERMIT r _ Type of crib Crib diameter Cri a sorption area ��- y o� n 1. Building foundation Nearest lot line uJ Class.p- Depth !L Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER LEGAL PIPE MATERIALS SOIL TEST RATING /y S's/ vim - IN TALLER -r7ZE PP EZ ' Xry. — — - Q - 0 i i REMARKS J APPROVED �� DATE SXR. 72-013 (Rev. 3/78) F J, WAIL ?R WELL LOG MUNICIPALITY C. N( r ^ L FOSS DRILLING ASSOCIATED DEPT. c 909 CHUGACH DR. #37 I :VIRON.. -ur:•_ oN ANCHORAGE ALASKA 99503 ' I AY l 1: WELL OWNER Frank Bethard USE OF WELL Domesticl�/ WELL LOCATION Lot 5 Blk, C Knik Hts. Subdivision R E C E" "f r D SIZE OF CASING 6" DEPTH OF HOLE 89 FT, CASED TO 89 FT. STATIC WATER LEVEL 67 FT. G. P. M. 20 WITH 22 FT. OF DRAWDOWN. REMARKS DATE COMPLETED 3-25-79 PUMP TO BE SET AT 88 0 to25 25to65 __L,5to88 88 _to_ to to to to to to to to to to to to to to to Alluvium; light brown color of medium hardness Till; grey color and hard Alluvium; grey color of medium hardness Sand and gravel with water .-H DEPHRTMENT OF HERLTH HND ENVIRONMENTHL �pOTECTION //� 264~4720 PERMIT NJ. ) HPPLICANT �R� 1698K 995�7 I44 � *u LOC8TION \ LEGAL L5 Bi]< C KNlK HTS S/D LOT SIZE 4]560 SQUHRE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH � MAXIMUM NUMBER OF 4 SOIL THE REQUlRED SIZE OF THE SOIL RBSORPTIUN SYSTEM IS� �ENE �-, 0~I -, I :j_.. L_ F.'K III GO -1-F-I Q (SMIROJUK_ THE LENGTM IS, THE LENGTH (IN FEET) OF THE OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFHCE OF THE GROUND AND THE BOTTOM OF THE EXCHVIll, 1ON (IN 17F.:ET). THERE IS NU SET WIDTH FOR TRENCHES THE 13R8VEL DEPTH IS THE MINIMUM DEPTH OF, GRHVEL BETWEEN THE OUTFHLL PIPE RND THE BOTTOM OF THE EXCHVHTION (IN FEET) �L-2 T.: 171 ENE Kow �BEE �-1 - 11 1:3 W 1"T III l< SO 21 FR_ ::::�; �������I'l�� PERMIT ITY TO INFORM THIS DEPHRTMENT DURlNG THE INSTRLLAT�ON INSP�CTIONS OF ANY WELLS HDJRCENT TO THIS PROPERTY AND THE NUMBER OF RESIDEN�ES THHT THE WELL WILL SERVE I. Ic-.11 ���F7,: "IT- 1'. Il -,A �PEN.'. �0, J Y tPi"i"��� BHCKFILLING OF ANY SYSTEM WITHOUT FINHL INSPECTION AND RPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROS�C�T�O� MINI�UM DISTHNCE BETWEEN H WELL HND HNY ON-SITE SEWHGE DISPOSHL SYSTEM lS 100 FEET FOR H PRIVHTE WELL/ OR 150 TO 20@ FoET FOROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS RRE REQUIRED AND MUST BE THE DEPHRTMENT WITH1N ]0 DHYS OF THE WELL COMPLETIO�. OTHER RECUI FEMENTS MHIFICHTIO@S HND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTTON. Foo FS! to! 1-1 1: -V ENE �00, 1 lot H Y& ED- to: C; K 10 13 WIFE W! I THAI- .1 HHT1I HM FHMILIHR WITH THE REQUIREMENTS FOR ON .... SITE SEWERS FORTH BY THE MUNIClPALITY OF ANCHORHGE 2� I WILL lNSTHLL THE WITld THE CODE� ]� I UNDERSTHND THHT THE ON~SIT� SEWE� SYSTEM MRY REQUlRE MINISOM HND WELLS HS SET ENLHRG�MENT IF THE PERFORMED ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST Pouch 6.650, Anchorage, Alaska 99502 276.2224 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: COMMENTS Date DEPTH Net Time Depth to Water (FEET) 1 2 3 q l d� 5 x1 6 I X 7 8 Com,` ys 9 �v 10- 11 -----12 13 c,�;-14 is- 16 ,7 18- 8'19.20 '19.- 20- COMMENTS PERFORMED BY: 72-008 (7/76) WAS GROUND WATER S ENCOUNTERED? J, C> L O P E IF YES, AT WHAT DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop l d� x1 I X Com,` ys �v PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND �`l FT CERTIFIED BY: DATE: Lo io �a� Municipality of Anchorage ,f0 Development Services Department Building Safety Division On -Site Water and Wastewater Program 5 ♦ , t T 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. D/%— 03LOD HAA #�/S 7S Expiration Date: V-_75. irk_ 1. GENERAL INFORMATION Complete legal description L07 5 th VLC K N 1 K �4 F T S Location (site address or directions) I c2 /a &0 S H a L D 0 0— tJ I= Current Property owner(s) PIX,- 1 67rA u-uuc( er Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address l ib oy S Lt -�_ f to u- r ►n e Day phone �a Llea r.y 61!OI;U4411Day phone 96 5 -4 7 Unless otherwise requested, NAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 12/ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority 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. Name of Firm _ I n tih-t an �a r 1'� L iL"J t- Phone Al 9 - 39 � 4� Address ao 3 14 91) 3 Enaineer's Printed Name r trin k� Date ...i t� T 7 00�%y 'V �c o Tobiy.n °Fart:?cad 5. DSD SIGNATURE OOu�%a CM := 0 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments OF At Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: A Original Certificate Date: (Rev. 0f Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program . 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.cl.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo 4 6 5 )Ce ,V tA \ Y— 1-1 tF- t41+ T s Parcel ID: © / 7 — d 3' i - - A. WELL DATA Well type Date completed 5 bq If A, B, or C provide PWSID # t -4/A. Well Log (YM) Sanitary seal (Y/N) 4— Total— Total depth�ft. Cased to ft. FROM WELL LOG Date of test tv 1-7/7 Static water level fio 7 ft. Well production RAZ ' g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrate 0.6 "mg./I. Arsenic: f// mg.11. Date of sample: yko 3 B. SEPTIC/HOLDING TANK DATA Tank Type/Mateftl Aolttt„ 1 g k 54d Tank size 19,60- 6f? gat. Number of Compartments Wires properly protected (YM) Casing height (above ground) lain. AT INSPECTION 7I ft. % 1�z. g.p.m. Other bacteria colonies/100 mi. Collected by: Lc la ri cy( Date installed a/���b 3 Cleanouts (Y/N) Foundation cleanout (Y/N) 4 Depression over tank (Y/N) 4 High water alarm (YM) j1L.1 Date of pumping_ Pumper N�A C. ABSORPTION FIELD DATA Date installed LI/b Soil rating (g.p.d./ftp orft2/bdrm) System type %2kNGf� Length 00 ft. Width g.1 ft. Gravel below pipe a ft. Total depth I I ft. Eff. absorption area j2gQft2 Monitoring tube Depression over field tl Date of adequacy test WA Results (Pass/Fail) t• Forq_bedrooms Fluid depth in absorption field before test ✓n. Water added ✓al. New depth ✓ in. Elapsed Time: zmin. Final fluid depth"/in. Absorption rate >= (J0•0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) V"" If yes, give date t/ D. UFT STATION Date installed 'Pump on" level a7in. Datum E. SEPARATION DISTANCES Size in gallons ManhAccess (Y/N) "Pump off" level at _ in. gh water alarm level at Cycles tested Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1 O I On adjacent lots 100+ Absorption field on lot 1 1 D On adjacent lots 1909 * Public sewer main r(/rte Public sewer manhole/cleanout /NIA Sewer /septic service line u Holding tank NIA - SEPARATION % SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation j' Property line 3 0 Absorption field Water main N�!> Water service line !� 0 * Surface water Wells on adjacent lots i / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �g Building foundation 113 D Water main N/A Water Service line p h Surface water N (l? Driveway, parking/vehicle storage 50 Curtain drain N U Wells on adjacent lots > //9th F. COMMENTS G. ENGINEER'S CERTIFICATION I cerW that I have determined through field inspections and review of Municipal records that the above systems are in ., conformance with MOA HAA guidelines in effect on this date. /� �; , �,^..; . F :�_�, Engineer's Printed Name I O%J e y SiD u r Y,� oc H Al Date A SAA. f al, e2D b� uv HAA Fee $ �J 75 — Date of Payment `i/ydo3 Receipt Number 3 y 1yQ (Rev. 12/01) Waiver Fee $ La t< 1 I kq`_7 ! , 0 / // Date of Payment 11//03 Receipt Number 3 V j y in. 9- .51744mene N04 Oz I145. oo W' 104 t Y. Hse. I PCC P.01 'OOF SC -4 Le,- 4 8 I h�@WN—Cerw*y ftt I haw Prior a �"" =�"md 4 of ft lo". P( or A* ON l*ft/aQAW *Tw*�V*% Anchor&" A*cod#V pr9drct At&"&, aF4 that V" hw w0waft I &;s No. p jrrproaments "tod thereon are within Vw PoWtY W" vd do Mt OVOW Of sw0sch On Ow PMWV " "MCW fW4406 Cwt no kw*mrrwon prop" " 048mg Oweto wtc� w r4 prern"s on questim Ow "I #we an no roadways, transmission In" of OUW vwbm "Wwts on "ki Drowtv Orewl 0% Imeliew", h— 0 40 Vfflis !Q ,kQ Ci 10, wit , NOaOzw 14 1:00 QUILT NO CORNERS SET THIS WE I h�@WN—Cerw*y ftt I haw Prior a �"" =�"md 4 of ft lo". P( or A* ON l*ft/aQAW *Tw*�V*% Anchor&" A*cod#V pr9drct At&"&, aF4 that V" hw w0waft I &;s No. p jrrproaments "tod thereon are within Vw PoWtY W" vd do Mt OVOW Of sw0sch On Ow PMWV " "MCW fW4406 Cwt no kw*mrrwon prop" " 048mg Oweto wtc� w r4 prern"s on questim Ow "I #we an no roadways, transmission In" of OUW vwbm "Wwts on "ki Drowtv Orewl 0% Imeliew", h— SG$ SCS Ref.# 1031810001 Client Name Tobben Spurkland P.E. Project NamcI# Lot 5 Bk C Knik Client Sample ID Lot 5 Bk C Knik Matrix Drinking Nater Sample KemarKS: Parameter Waters Department Nitrate -N Microbiology Laboratory Total Coliform Results 0.658 0 All Dates/Times are Alaska Standard Time Printed Date/Time 04/09/2003 17:04 Collected Date/Time 04/04/2003 13:40 Received Date/Time 04/04/2003 15:00 Technical Directorephen CEd Released By ,/ Allowable Prep Analysis PQL Units Method Limits Date Date Init 0.200 mg/L EPA 300.0 (<=10) 04/05/03 1S col/100mL SM18 9222B (<=j) 04/03/03 KAP do Te jF Or ..... ........ "a' 14% t --S C; ... ..... ... .... fL do ir K* LL t1� pit r. OL 9- . I F' JI6 w F MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # —0 3H —d 5 HAA # _Hh `9 05 75 1. GENERAL INFORMATION Complete legal description IL 4 E i G. !4 T E L 5 - Location (site address or directions) (a 0 00 r V, P Property owner -a 1A Day phone 34 S - Mailing address Lending agency 3 °'` Day phone Mailing address - Agent P , �r� �� Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: `/ _ 3. TYPE OF WATER SUPPLY: / Individual well l/ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. J: , 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system.. - 72-025(Rev.1/91) Front MOAM21 - 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of/this inspection. Name of Firm ° 61 -5 Ll 9„� \/1,c-Li,-�4 ?-t= -Phone Address 0 3 l � '2_0 �7_n n. /% Iol_ 1.,, Engineer's signature 6. DHHS SIGNATURE Approved for. bedrooms. Disapproved. Conditional approval for Additional Comments By: Date AA*ra 06. Ao s 'a cEsn; bedrooms, with the following stipulations: UJITIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DH HS do not conduct inspections or analyze data before a certificate is Issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work _ 72-M (Rev.1/91) back MOA e21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. U l 7 E) J) CD=s A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) Date completed Driller r—b Total depth 63 Sanitary seal (Y/N) Cased to g q � tt Casing height-�� Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 3 ' 9-6` N Static water level _ 12 j Well flow C9-0 g.p.m. Pump levell 8 !' i (� SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot i 0 On adjacent lots Absorption field on lot j ,i 1, ; On adjacent lots 7 1 L> --C) Public sewer main N/ Public sewer manhole/cleanout_ Sewer service line % y Petroleum tank N CJ WATER SAMPLE RESULTS: Coliform v Nitrate Other bacteria Date of sample: j L7 �% 9 L 9 �I _Collected by: = q B. SEPTIC/HOLDING TANK DATA Date installed Tank size Compartments Cleanouts (Y/N) � Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) N�`- Alar tested (Y/N) I Date of pumping NO t/ � � (�I � � Pumper CO SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 0 Y On adjacent lots i ((51-0 Foundation To property line > / t-7)Af5 C7 bbsorption field Water main/service line . N ` � Surface water/drainage ) o 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA Date installed -3 ' / 7 - Length Width On adjacent lots 7 Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Soil rating (GPD/Ft2) / t;1 () System type 2 fE N l Gravel thickness 81 Total depth b ) Total absorption area l25� Cleanout present (Y/N) _Depression over field (Y/N) Date of adequacy test Results (pass/fail) r for Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on I On adjacent lots > / Property line To building foundation 3 9r 1 To existing or abandoned system on lot N //!- On adjacent lots C) Cutbank Nzj� Water main/service line > Is- v Surface water j�. l t� _Driveway, parking/vehicle storage area > 5 Curtain drain E. ENGINEER'S CERTIFICATION I certify that / have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. HAA Fee $ >> bo� • 00 Waiver Fee $ _ Date of Payment o \ Date of Payment Receipt Number ��� ��� ID `(� 1 _ Receipt Number. 72-026 (3/93)' Back Commercial Testing & Engineering Co. Environmental Laboratory Services :.��✓� 'r���f� e���v�c��� CT&E Ref.# 94.5372-1 LABORATORY ANALYSIS REPORT Client Sample ID LS/BC KNIK HGH Matrix WATER Client Name TOBBEN SPURKLAND, P.E. WORK Order 10245 Allowable Ext. Ordered By T. S. SPURKLAND Printed Date 10/25/94 r 07:53 Units hrs. Project Name Date Collected Date 10/19/94 Q 17:00 0.46 hrs. Project# EPA 353.2/300.0 Received Date 10/20/94 Q 17:00 MCE hrs. PWSID UA Technical Director STEPHEN C. EDE Released By Sample Remarks: ROUTINE SAMPLE COLLECTED BY: T.S. * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than 5633B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, 01110, UTAH, WEST VIRGINIA QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -------------------------------------------------------------------------------------------------------------------- Nitrate-N 0.46 utg/L EPA 353.2/300.0 10 10/20/94 MCE * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than 5633B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, 01110, UTAH, WEST VIRGINIA Time APPLII NT FILLS OUT UPPER HA! ONLY 4roperty Owner •- , .. - .. -- Phone Mailing Address -"' - - /y' -' ���•% - Zip Code Buyer Date Date Address '; j_ : • ' ,. : • j `, Zip Code Lending Institution _ �� Phone Inspector _ _ _ Inspector Address Zip Code Realty Col. & Agent f/ , ;_ _ . .. - ,,, -. ,.�� , ; ! Phone MUNICIPALITY OF ANCHORAGE Address - %i �;- .. Zip Code Legal Description _✓ _, - F`,: _. �f-T— j� ! jr,., %j ..;:; ,: . Street Location � / ! i r r' Type of Residence ``O Single Family RECEIVED ( ) APPROVED BEDROOMS ❑ Multiple Family No. of Bedrooms ( ) DISAPPROVED ❑ Other ( ) CONDITIONIL APPROVALOf' Water Supply _ DATE 2b Individual BY: ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community Soils Rating For wells drilled prior to that dale, give well depth (attach log if available). ❑ Public Utility Well Log Received Sewer Disposal Well to Tank/ Z) K) Septic Tank Size " { Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time .c.j CA i Dale Date Date Date ,. Inspector Inspector Inspector Inspector ,,11 lL`1�k Field Notes: MUNICIPALITY OF ANCHORAGE DEPT. OF H J,LTH :. {TSU ENV IROPROTECTION R f) MAR RECEIVED ( ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONIL APPROVALOf' DATE 2b BY: Soils Rating Date Sewer Installed Well To Absorption Area %i)fff) Well Log Received Well to Tank/ Z) K) Septic Tank Size 72023 PIK] I April 1, 1983 John & V;A;a chitv"Ood 3300 A-rctic Blvd, 4202 Anchorage, Al, 991A0; Subject, Int !), l3lock C. Ifnik nett is SuNlivisim ApprovaJ, f'or the individual smlur and water taoilitteo ("almot he granted until the J-o-II.-Lowbal items tlave heon covipleted.. 'I'lle water arialySivi r(Ij)QYlC, to DC sum fittedto thi-,i Ottic.'e j.ro'll-I tje Chou Lcib, 5633 to Unout, for OLN 17010aw. wle uegilc Louilz lumped with a mccAlpt. MAMMA to this departilmlit . Ple-au,e, notify thh; DeVal7thit'llt fr)z cl ):oiwipuctiall %)IIen 1.1lu noted discvepaeeleo have bec'.11 corrected. I1 there are eAlly I.m.-ther questions, please Cali, tAlis, of--L-I.ce at 204-1720. S incere I Y, 1"obelt C. Prab: Spccialif-;i, _�QUNICIPAiL (l'f ANI&()PAd - i MUNICIPALITY OF ANCHORAGE DE:PT OF I1-,1.1II & LNVIRONIVdMJ\( PI-1GIIC_TION - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 � AU2 U 19%9 � ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 R E C E - ("j +✓ 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 FRANl'?, t5 MAILING ADDRESS - - - - - s' A cff,� PROPERTY RESIDENT (Ifdifferent from above) PHONE � 2. BUYEP.m PHONE y0 �r MAILING ADDRESS 3. LENDING INS ]TUTION�m PHONE MAILING ADDRESS 4. REALTOR/AGENT �� NCA - WVE57 lkl_O i PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION - - - 6. TYPE OF RESIDENCE - - NUMBER OF BEDROOMS 4_1 SINGLE FAMILY ❑ One ❑ Four ❑ Other _ ❑ Two ❑ Five ❑ MULTIPLE FAMILY 41l-�Three ❑ Six 7. WATER SUVWY- P' 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.) S. SEWAGE DISPOSAL SYSTEM -��- Ft�- INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date . 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. 72-010(3/78) if I of J ����, �,�., � � I� � 1 1 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLEFAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY �ev ❑ 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 - SOILS RATING ❑Septic Tank or ❑Holding Tank Size: 1 If Tank is homemade give dimensions: TYPE OF TANK - - MANUFACTURER TOTALABSORPTION AREA - MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tan (� --Fk A bsorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS LST APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter milst accompan certificate) ❑ DISAPPROVED DATE -. - - - BY (Title) - LEGAL DESCRIPTION 72010 (Rev. 3/76)