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KNIK HEIGHTS BLK C LT 6
Onsite File Knik Heights Block C Lot 6 #017 - 034 - 06 (Rev Ub/U2/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191403 PID Number: 017-034-06 Dwelling:❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name DOOTY TRUST ABSORPTION FIELD ❑■ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.6 GPD/SF 10-,g Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft. Gravel depth beneath pipe 7.5 Ft. Subdivision Block Lot KNIK HEIGHTS BLK C LT 6 Fill added above original grade 1 + Ft. Gravel length 50 Ft. Township Range Section Gravel width 2.0 Ft. Beds: Number of Lines 0 Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 750 Ft z 1 Ft. Well 100'+ 100,+ 50'+ TANK Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity ANCH TANK/GREER 1000 Gal. Surface Water 100'+ 100,+ Material Number of compartments Lot Line 10,+ 10,+ NA PLASTIC 2 Foundation 10,+ 10,+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer MIKE N ANDERSON, P.E. Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 108.8 ft Inspection1s` 9-25-19 9-25-19 Location and description 2nd dates: GARAGE SLAB 3rd 4`h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp as Conditional Approval: Date 4-911-- oo e.eo e o e oeoso a 00 00'-� d�.o o°oo • eeoeeee•eao V ° MICHAEL N. ANDERSON �1'y°° CE 9 fig Septic System Approv Date Z'2 JM�,.•.�'I Note: this approval does not incNt well permit requirements. (Rev Ub/U2/18) Permit No. OSP191403 Page 2 of 2 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 Legal Description: KNIK HEIGHTS BLK C LT 6 ARK A B•. C01 28 26 CO2I7 20 TM 7 22. TCOf 10 26 CO3 15 32 C04 16 33 337 6 C05�E 2 C0071 90 97 MT 80 90' PID No.: 017-034-06 r r coz I�,�.. �� �o �MT ` u �®®!®\i\A® B.11 OG OFP FlNISH GRADE ®%/� •••���-®J®®® /-FILTER FABRIC i GRID AV I AV ®M"J • • ••� y 1 Y •49 TH ®®® 1 1.000 s. . ...... GALLON 1 .9 97 97 GM �. PLASIIC TANK 9 MICHAEL N. ANDERSON:® CP ♦®�' No. CE 9469 ®®��3-8-20 �'�• o® SEM SECTION B2 ,®®® N.T.S. DRY. AUG 2019 4 I. ®® Municipality of Anchorage mac, INE s sE>a p Y 9 m� ; Development Services Department 0 On -Site Water and Wastewater Sectionm° 4700 Elmore St. m° °°°°° °`°°°°°°°®. °;�r P.O. Box 196650 Anchorage, AK 99519-6650 ° m mem www.muni.org/onsite ° w a MICHAEL N. A.!DLR50N .ter'za (907) 343-7904CE - 49 . r °. Soils Log - Percolation Test'L -1���°= Performed For: �� � t�(it�" /TV'U., ' Date Performed: Legal Description: tic. Y1t VZ✓ la -!t 9 k } '� Township, Range, Section: 18 -k__ Date 0V,�� Net Time Depth to Water Net Drop - 2- yL73 f 3- 3- 6 is 2— 4- 4- 5- 5- 6- 6- 7- 7- ,w 8- 8- 9- 9 -11-12- 10- 11- 12- 13- 13- 14- 14- 15- 15- 16- 16- 17- 17- 18-k____ _ q� D L1i m 19- 20 - WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After Monitoring? Date: s L O P E Site Plan Reading Date Gross Time Net Time Depth to Water Net Drop yL73 f >6' , n 6 is 2— ,w PERCOLATION RATE_ (minutes/inch) PERC HOLE DIAMETER C ` TEST RUN BETWEEN _FT AND c FT COMMENTS CAI 4—PrtcIVI,4 <, ",0 6 k PERFORMED BY: (�-/f rAA I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: q yo (C:::- '`y� MUNICIPALITY OF ANCHORAGE , ent On-Site Water&Wastewater Program c '�� "tom r K.............._ \ PO Box 196650 4700 Elmore Road . Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 r� <, < ~� V httpa/www.muni.org/onsite 'rt k 'el�artmtnt R'G wptt AGE On-Site Wastewater Disposal System Permit Permit Number: OSP191403 Effective Date: 9/12/2019 Work Type: Septic Upgrade Expiration Date: 9/11/2020 Tax Code Number: 01703406000 Site Legal Address: KNIK HEIGHTS BLK C LT 6 G:2836 Site Mailing Address: 12640 SHELBURNE RD, Anchorage Owner: DOOTY TRUST Lot Size in Sq Ft: 43500 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 2 Disposal Field 2 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: The GP strata observed in test hole TH#1 shall be perked prior to construction of the drainfield to confirm perk rate. If results require a design change, construction shall stop pending Onsite review and approval of a change order. Please submit results with the inspection report. Received By: Date: ` / I `l Issued By: Le "CZ'dA aUter8 Date: 9®' MUNICIPALITY OF ANCHORAGE 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. 017-034-06 Property owner(s) DOOTY TRUST Day phone 222-3649 Mailing address 12640 SHELBURNE RD Anch AK Site address same Legal description (Sub'd., Block & Lot) KNIK HEIGHTS BLK C LT 6 Legal description (Township, Range & Section) Lot Size 43,500 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy .„;❑ ( gsoa Private Well ❑ Water Storage ❑ Sep ,, / THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: X0,9 E0 9 9 et, 7 I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. fri1X- (Signature of property owner or authorized agent) Permit/Rush Fees: 6716- Waiver Fees: Date of Payment: 9/9/143 Date of Payment: Receipt Number: #012(4-] Receipt Number: Permit No. 03pl9ig43 Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Sept 3,2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic permit Legal: KNIK HEIGHTS BLK C LT 6 To Whom it may concern: This is a request for a septic permit on the above referenced. A test hole was excavated and GM on top and GW on bottom with no water during excavation and after the 7 day monitoring period. A simple deep trench system has been designed located in a flat spot on the west-end of the lot. The new system is a simple gravity flow 3 bedroom system with an effective depth of 7 feet. This new system will not impact any of the neighboring properties. The slope is less than 2 percent to the west, see the site plan. Sincerely Ori vt Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: MOUND OVER (TH#1) o -- GRADE 3 BDRM X 150 =450 GPD .ORG SOILS =450/0.6= 750 GPD 1.0W FILTER FABRIC 750 GA/14 = 54' GM -3.0 '� 4"0 PIPE SEWER ROCK (1) TRENCH 7.0 10.0' DEEP 7.0' EFFECTIVE i GP -10.0 2.0'WIDE 12.0' 54' LONG 18 l ` SEPTIC FIELD SECTION ) I ) r - - - - -J) I \ J L -HUFFMAN ROAD- - I J I - - -1 C - - - I - - 7 C - - -1 I II II II II I ] I C C — J L _ _J_—_ C McLURE CIRC C J L D C —I I- - - II II II I II C — — J L- C - J L II I II II II ] o C - - J L- - - � d C = — J L - - � a al — 7 C - - 01 — � - - 01 o Z EXISTING WELL w I I p O 100'RADIUS I I z I I O CI m— J I— — J L — w— J _ — w \ o a r EXISTING HOUSE / 1 I I EXISTING SEPTIC �-- ��,\_–_,\ \ � `�/l\�EXISTING WELL I I I \ - -J L_ - - / / . 100'RADIUS J L - - ] I _ _ v -�— L— — — — D EXISTING WELL --�1 i /----s --' 100'RADIUS I 11 1\`�1=1 I PROPERTY LINE I I J L_ - - ,,\T-7---...,..,.:_ �'� J L_ ___ ] _ ' EXISTING WELL 1 EXISTING WELL \I~�EXISTING WELL I r 100'RADIUS 100'RADIUS I 100'RADIUS I $ ''�/ I I �\ / I C - - J I_ — �\__ '// 1 C — J I— Septic Design Prepared for DOOTY TRUST ..•-7 °.44 q44• KNIK HEIGHTS BLOCK C, LOT 6 .I ♦ Anchorage, Alaska % : 4.9 TH /\ Tr ♦% il Michael N. Anderson, P.E. DATE: 9/1/2019 j '•MICHAEL N. ANDERSON; 4601 NATRONA AVE ♦ No. E 469 ANCHORAGE,ALASKA 99516 DRAWN: DJR 1♦♦ ,� SCALE: 1"=200' ♦p r (4,'... 4P• • (907) 727-8864/FAX: (907) 345-1391 44 SS`s •4 ' \ I / \ /. \ / \ \ / ,' \ 11 1 ! KNIK HEIGHTS r BLOCK C.LOT 5 I ` I ®WELL EXISTING WELL __ REMOVE OLD TANK jl 100'RADIUS -- _ I ADD NEW 1000 17 !J GALLON PLASTIC v 7' `� TANK W/20"RISER 1 // / I '\ \ / • \ /' / / — — -J L_ — // // / I 74::: 2'CONTOURS /� I ''� ❑ / ,' / it T \�� DCS w� ��l�XISTING / II -� CO i HOUSE___ 1 11 1 I— —�_ -r-- ® O 2-3%SLOPE / � —' 1 I� WELL W I ‘• 1I1 ;,/ `----I 11 cc • • Q-r 1 D TOE OF SLOPE \\ m_1 W I I 10'UTILITY I EXISTING CRIB �-\Br�fvEw,�Y 1 EASEMENT .�� - - -,7i KNIK HEIGHTS ,, ---. i'1 / BLOCK C.LOT 6 ---_ a — — — 1 n / \ PROPERTY LINE / \\ I / \ ! \ ! r 11 I I II KNIK HEIGHTS e/VELL I BLOCK C.LOT 7 I 11 I 1 / \ \ / \ / \ / I \ / \ / \ / \ / I / \ / \ — — J L— `\ 1 Septic Design Prepared for DOOTY TRUST •.•7_ OF /14444.A KNIK HEIGHTS BLOCK C, LOT 6 �, `� Anchorage, Alaska ; .` • 49 TH /\ • -, le P.E. • i � i Michael N. Anderson, DATE: 9/1/2019 j = MICHAEL N. ANDERSON; 4601 NATRONA AVE *.c)-***. No. E 469 V ANCHORAGE ALASKA 99516 DRAWN: DJR 1# i SCALE: 1"=50' 1� ! (� (907) 727-8864/FAX: (907) 345-1391 41II, ���4 ti Municipality of Anchorage' -=' t.N: c �L Development Services Department �` ��. •S-_��41 On-Site Water and Wastewater Section ...77 �,�, 4700 Elmore St. '° 9 T ;r �� i ` P.O. Box 196650 Anchorage,AK 99519-6650 ri' r4 "i, r., WWW.munl.orglonsite j' _ •••• f" -II (907)343-7904 v` MICHAEL N. ANUERSCN ,�" "`Ju c,T. fp`'J°.•. CE-9469 i �� oils Log - Percolation Test 19�'•••. . . -„' �>t F�� `ate'6, Z��"�.� Performed For: I 1-C9 �7t4/.1 �4. g r ! -v Co Date Performed: Legal Description: Township. Range, Section: Slope Site Plan Depth (Feet) 1- OU c . 2 � ,7. c__- . �/ 1( 3- Yt !( '►'l 4 `-7 M , 5- 6 7- 8- WAS GROUND WATER 9- e^ V�,,/1 ENCOUNTERED? S 10- IF YES.AT WHAT DEPTH'? L Depth to Water After P 1 1- Monitoring? PM►1 E 12- Date: $//'4//t I 13- 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- it vi ? t"0 U 't l , Cs 16- ?/ O C," "t' 17- G �1 ti 18 (4v1/0rel fir /ice 19- 20- I ( PERCOLATION RATE yQ (minutes/inch) PERC HOLE DIAMETER 4,15/I TEST RUN BETWEEN •s FT AND CO FT COMMENTS PERFORMED BY: N/f l�. I CERTIFY THAT THIS TEST AS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 4 5, Lot 5 I 7279 I Lot 12 N89°58'00"E 300.00 - - - I 30 . E 10' UTILITY EASEMENT j"X J n Shed Iii�_ F- Kennel? r:L�., c0."^— 5 0 deck {1Wl 1 75.8 cW Shed•'<-` 0 2.0 or+ F..:" o o os 1 1/2 Story Frame 6 1 a I U) Septic vents L7;:r:j• ° m N House N.__2.0 OH .,.:.f.is O W 17.5 23.1 0 0 19.1 75.8 - O }. -17.81 O O in I-- 2.0 off 11111 Well (:)4- J ° deck Q I— 0 Lot 11 0 Lot 6 b Z l 0 0 D o o m 0 0 J Z Z W Asphalt I CO - I oJ L 10' UTILITY EASEMENT N89°58'00"E 300.00 30 Lot 10 I Lot 7 I I AS-BUILT NO CORNERS SET THIS DAT 1 OF • A ' 1 I hereby certify that I have performed a Mortgagee's inspection ,`� . �,q , of the following described property: ;LOT 6, BLOCK C, ,`Q•• •S,� l, KNIK HEIGHTS SUBDIVISION °,,• 49th L� '• 7 {. •* / Anchorage Recording District,Alaska,and that the 011- r improvements situated thereon are within the property lines / and do not overlap or encroach on the property lying -f.,, -. iz #.1 adjacent thereto,that no improvements on the property lying Elizabeth L. Walatka. p ow �t— ,� s��,•• 8036 - LS ••. hat there a thereto re noencroach roadways,transmission I ne sorestion other and SCALE: 1"= 40' �F•. • y visible easements on said property except as indicated ,0,.. ' • ' ' •,o'� hereon. I fSSIONAk- Dated at Anchorage,Alaska EASEMENTS OF RECORD, OTHER THAN 1%%.\\\` this 23rd day of APRIL , 1976. THOSE SHOWN ON THE RECORDED Recert 3-29-96, 4-20-04 FRED WALATKA&ASSOCIATES,L.L.C. PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors UNLESS OTHERWISE NOTED FB 76-3, pg 28 BE 907-248-1666 Parcel Identification Number: Legal Description Property Owner Name & Address: -o WV Do o -r --a /:, 6 q49 D 8 - E C�1,s24 Pump Installation Date: Pump Intake Depth Below Top of Well Casing: 7,;-Ifeet Pump Manufacturer's Name: Pump Model: g $ P 2 Pump SizeYZ hp Pitless Adapter Burial Depth: O Z feet Pitless Adapter Manufacturer's Name: Pules; : - lap.cer 1123t -idler; A )A W-11 Disaaafec:t.et Up•ou Compiedou` :.s ❑ i'10 Meilaod of Dis nie tS a: Comments: ___ I �s� ru.n�WeIS Service Pump Installer Name: 330 nasi 76th Avenue Anchorage, Alaska 99513 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a purnp installation log to the DSD within 30 days of piunp installation. Depai~r ne"T Mark Begich Mayor Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: Parcel Identification Number: Legal Description Property Owner Name & Address: -o WV Do o -r --a /:, 6 q49 D 8 - E C�1,s24 Pump Installation Date: Pump Intake Depth Below Top of Well Casing: 7,;-Ifeet Pump Manufacturer's Name: Pump Model: g $ P 2 Pump SizeYZ hp Pitless Adapter Burial Depth: O Z feet Pitless Adapter Manufacturer's Name: Pules; : - lap.cer 1123t -idler; A )A W-11 Disaaafec:t.et Up•ou Compiedou` :.s ❑ i'10 Meilaod of Dis nie tS a: Comments: ___ I �s� ru.n�WeIS Service Pump Installer Name: 330 nasi 76th Avenue Anchorage, Alaska 99513 Phone: 907-243-0740 Fax: 907-243-0742 Attention: The pump installer shall provide a purnp installation log to the DSD within 30 days of piunp installation. -R ANCHORAGE AREA BORk. GH GREA . Department of Environmental Quality —� yj 3330 C Street I, Anchorage, Alaska 99503 f LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCENUMBER OF FROM WELL �7�.) MANUFACTURER _ MATERIAL ,4 _// ___ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH___.__ LIQUID DEPTH LIQUID CAPACITY/W49GALLONS. TILE DRAIN FIELD: REPORT ON-SITE SEWAGE DISPOSAL SYSTEM �I�`NrS�PECTION NAME fl � --MAILING ADDRESS �� /Roy .5�.� fig_ PH( LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCENUMBER OF FROM WELL �7�.) MANUFACTURER _ MATERIAL ,4 _// ___ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH___.__ LIQUID DEPTH LIQUID CAPACITY/W49GALLONS. TILE DRAIN FIELD: WELL: TYPE -CONSTRUCTION,� BUILDING FOUNDATION CESSPOOL APPROVED DISTANCES: NEAREST LOT LINE OTHER SOURCES DISAPPROVED INSTALLED BY: /',// zy/-" SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: ' '�,f , -__ REMARKS: Form EQ -032 NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK . SYSTEM_ AGRAM OF SYSTEM r-----1 Irl DATELd- APPR G.A.A. B. 1.7 I TOTAL LENGTH DISTANCE 1=ROM WELL FOUNDATION -�- NEAREST LOT LI E v OF LINES NUMBER OF &NES/�j_ D`I9+, "'LES" D.—L— ` F' TREf1t'rr`GP N-_7--YFd--- TOTAL EFFECTIVE . r f�5 ABSORPTION AREA (4 SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DERH.�II-ter- 'w� Tn f 1 I Ij�GgA�"� fW�FFfFI�@EfULIaT{ T{{ --FW- ��FPI. WELL: TYPE -CONSTRUCTION,� BUILDING FOUNDATION CESSPOOL APPROVED DISTANCES: NEAREST LOT LINE OTHER SOURCES DISAPPROVED INSTALLED BY: /',// zy/-" SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: ' '�,f , -__ REMARKS: Form EQ -032 NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK . SYSTEM_ AGRAM OF SYSTEM r-----1 Irl DATELd- APPR G.A.A. B. FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE "`-J TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK _ ` — / FOUNDATION TO SEEPAGE PIT —, DRAIN FIELD _ r / SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT DRAIN FIELD I� / TO NEAREST LOT LINE. WELL TO SEPTIC TANK �B DRAIN FIELD WATER MAIN TO SEPTIC TANK. DRAIN FIELD / SEEPAGE PIT ALSO CONSIDER AREA WELLS. — SEEPAGE PIT / J SEPTIC TANK e9 . SEEPAGE PIT �!) n DRAIN FIELD �� TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIG T REMO ABLE CAPS. g--fJzna,014 r� GRAVEL BACKFILL. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE 3 d&C APPLICANT'S SIGNATURE FORM NO. EQ -016 DIAGRAM OF SYSTEM I. � — � GREF _.R ANCHORAGE AREA BOF JGH J PERMIT NO. - aJ 6 DEPARTMENT OF ENVIRONMENTAL QUALITY y /1/ lul lul InnI)C' 3330 "C" STREET ANCHORAGE, ALASKA 99503 II TELEPHONE 274-4561e/� / x 1151 I✓ r ez, SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT MAILIG,,AADDDR S -� �L� (� PHONELl NAME OF APPLICANT/n�X/]�� INSTALLATION LOCATION .5:'"" "%•�''�'�//u�('7 �`� -`^� _ �! v - LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK �UC�(J ' SEEP GE PIT '� /"l DRAIN FIELD —. OTHER —, TYPE AND SIZE OF FACILITY TO BEJ SERVED —.S .? I . t L46'a jo' FINANCED THROUGH ___S TO BE INSTALLED BY - SOIL TEST RESULTS170 E: TC=RWIS NOT VALID WITHOUT SOIL TEST �._ COMPLETION DATE ANTICIPATED — FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE "`-J TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK _ ` — / FOUNDATION TO SEEPAGE PIT —, DRAIN FIELD _ r / SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT DRAIN FIELD I� / TO NEAREST LOT LINE. WELL TO SEPTIC TANK �B DRAIN FIELD WATER MAIN TO SEPTIC TANK. DRAIN FIELD / SEEPAGE PIT ALSO CONSIDER AREA WELLS. — SEEPAGE PIT / J SEPTIC TANK e9 . SEEPAGE PIT �!) n DRAIN FIELD �� TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIG T REMO ABLE CAPS. g--fJzna,014 r� GRAVEL BACKFILL. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE 3 d&C APPLICANT'S SIGNATURE FORM NO. EQ -016 DIAGRAM OF SYSTEM BOROUGH ORDINA CE NO. 28.6 AND THAT TH ABOVE 1 �a 1 --j , I 1 ' �._ BOROUGH ORDINA CE NO. 28.6 AND THAT TH ABOVE GREATLk AwG110i(AL,L APIA BOROuGf, i)epartment of Lnv i ronmen to I Qua l i Ly 3330 °C" Street Anchorage, Alaska 99A3 tiMI's LOG PE ZOLATION TEST Performed for c' ��te rerfori.i'J -- - Legal this form report,: Soils loges Percolation test, Depth Feet 1-_-_ _. 3 -- 11 13 - 14 --- Was ground water encountered? S/0 �l If yes, at what depth? Lading Date Gross Time Net Time Depth to Water Net Drop percolation rate minute. Proposed instalIat n: Seepage Pit Drain FicId DLpth of Inlet Depth to bottom of pit or trenci, COMMENTS: Certified [3y: - ----_- —----Pjate: EO -040 (6/74) �l � l� : � :� � � � )�-' a 0 Vj 13 . . . . . . . . . . . . 0 0 0 0 0 0 0 ON 0 YYAq III pli -I qj *yl m Aj Vd . . . . . . . . . . . . to MUNICIPALITY OF ANCHORAGE Development Services Department" Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-034-06 Expiration Date: 2--20 1. GENERAL INFORMATION Complete legal description KNIK HEIGHTS BLK C LT 6 Location (site address) 12640 SHELBURNE RD ANCK AK Current property owner(s) DOOTY TRUST Day phone Mailing address SAME Real estate agent Day phone 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: Private Well Water Storage Community Well Public Water System Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 6� A) Waiver Fee $ Date of Payment 3216/aa g.6 Date of Payment Receipt Number //JQ/ Receipt Number COSA # /0Waiver # Distance: TYPE OF WASTEWATER DISPOSAL: Q Private Septic 0 ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 6� A) Waiver Fee $ Date of Payment 3216/aa g.6 Date of Payment Receipt Number //JQ/ Receipt Number COSA # /0Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems 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. 1 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. I acknowledge that On-Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 3-6-20 �A 6. DSD SIGNATURE �x. ero a .... System #1 Approved for 3 bedrooms °'' e tis " ° ° ` ° � ° ........ r' H PadCHAEL N. ANDERSON r <'r ' CE - 93Q�i7 System #2 Approved for bedrooms � �a°° dl//J @o OM1` �J� 7D. Disapproved '` ��Z, Conditional approval for bedrooms, with the following stipulate WATER AND Original Certificate Date: 3— 12 2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Chec=klist Legal Description: KNIK HEIGHTS BLK C LT 6 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/23/75 Total depth 103 ft Cased to 41'+ ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 30"+ in. Date of flow test for COSA 2/11/20 Static water level at beginning of test 41 ft. Comments B. TANK DATA Age of tank(s) 2019 years Tank type/material PLASTIC Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA NEW SYSTEM Which system tested (date installed) NEWq_2r-(l� ❑ ALL standpipes present per record drawing Total measured depth from grade 11.0 ft (max) Measured depth to pipe invert from grade 3.3 ft (min) ❑ N/A — pressurized field ❑- Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 0 gallons Comments/Deficiencies: NEW SYSTEM WITH VALVE TO THE OLD CRIB COSA Checklist yellow sheet Parcel ID: 017-034-06 Structure served by this system Well production at time of test 3+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes Al No ❑ Coliform bacteria is Negative Nitrate 1.51 mg/L [] Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by MNA Date of Sample 2/11/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date NEW Results F, -/]Pass For 3 bedrooms Fluid depth prior to test 0 in Water added NEW gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Fl Yes Community Sewer Manhole/Cleanout > 100' 0✓ Yes if No ft M Yes if No ft Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No ft Absorption Field on Lot > 100' 0✓ Yes if No ft Holding Tank > 100'✓0 Yes if No ft Neighboring Absorption Fields > 100' 0✓ Yes if No ft Water Main > 10'✓0 Animal Containment > 50' Yes if No ft M Yes if No ft Q Yes if No ft Water Service Line > 10' M Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' F Yes if No ft✓� Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Fl Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' ✓0 Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' ✓0 Yes if No ft Private Wells > 100' 0✓ Yes if No ft Water Main > 10'✓0 ft Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' M Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' U Yes if No ft Water Service Line > 10' P Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet O' t ea c > MICHAEL N. ANDERSCN r KR, CE -9A69 a `w N ti GVO2l 3NHn8l3HS CDco O 00'gt4 M..00ZOoOON O O =p ~w U o oU AW .1 z0 0'9Z w (P50> =_O�o°�o Y ® O. i 0Ej Iw- ¢ Fol I 9)J U U) mm._r--� (ho 0 a OW O r Q)CD Y CD o 'v °� N �_� a O 0 0 I to o 'o H m o o —°I � LL dr N c --� .6 Z _ co gyp! Q L o Y(A 0 U- o 0'9 Y' 1.)•N N N Q Q = CD Ev> � U � vim) p oQo I?_ CL f } O �=1oN `ao�@�o"y2 rom �C U y�(!� o a) V E= T O O fr = pw�o ,o� @ WW rn z saU) 0)"3 o = o- ¢ (0 i— m U F- co = O V a) 'O a3 Qrs = O` O 0) o 0'8Z f -I DI O a• �3w Z'9 b 0. t o CD wco� oEw QN � w Iw a) icAroN = m co LL Q f— T O � i IQ �lodieo IQ 1 N ¢ O O =p ~w U o oU AW .1 z0 V � w (P50> =_O�o°�o Y ® O. i 0Ej Iw- ¢ Fol I 9)J Q mm._r--� (ho 0 a OW O a)CO CD o 'v °� N �_� cs O 0 0 I to o 'o H V� o o —°I � LL dr N c --� .6 Z I co gyp! Q L o Y(A cuo)-cvO° I Y' 1.)•N N N Q Q = Ev> � U � CU E IL w z oQo I?_ CL ? co ¢coo �a o dao) O CL Q� `ao�@�o"y2 rom �C U y�(!� o a) V E= T O O fr = pw�o ,o� @ WW rn z saU) 0)"3 o = o- ¢ (0 i— m U F- co = O V a) 'O a3 Qrs = O` O 0) C7 f— coU) 'S 'O= f -I DI O o O C @-0 0 p m �3w 0. t o CD wco� oEw QN � w Iw a) icAroN = m co LL Q f— T O � i IQ a) C C N a) a3 V, O 'D U U P a) 0. N W a) � z m aQa:F1Ff�a� o U _ 0 I ¢- m m w c p m I� I� w ( m O O =p ~w xE o 0C)�w AW • %s � v z0 V � �• +/{/es • r Y ® O. i 0Ej _j I O 00 _ o . w ® 1 Fol I N • Qe'AIV Q W�Wo w�¢w <n0¢ -j cs O 0 0 I to o 'o I _ O —� o o —°I � 0 t— I a o 0 I co 0 wI I 0 wI � U � I Z ? co Z wI o co Iz f -I DI 0 J Iw oI o Iw IQ Iw I I� I� ( I � ( Io L ----------------J 1N3W3S` 3 )..J.nin.06 00'9*V� M.)00Z0o00N r- `- o o 1 a ( 1 PIA =p ~w wp wwz 0C)�w AW • %s � v z0 V � �• +/{/es • +�O40 y J • Z 0 • Y ® O. i 0Ej _j I O 00 _ o . w ® 1 Y V' • �� N • Qe'AIV Q W�Wo w�¢w <n0¢ -j cs ¢= -jz wi-a.Z) co �r 0) Lo rn cn' m CL N 0� N c�) � � U � m m LL PIA =p ~w wp wwz 0C)�w z0 ow U t- � w W0� LL Z 6j0w �o= Q W�Wo w�¢w <n0¢ -j ¢= -jz wi-a.Z) Municipality of Anchorage • '� .Development Services Department 6; Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 s - w /onsite (907) 343-7904 = CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-034-06 HAA #_ �' l Expiration Date: _7-2- -' Q Ll - 1. GENERAL INFORMATION Complete legal description Knik Heights, Block C, Lot 6 Location (site address or directions) 12640 Shelburne Rd., Anchorage, AK 99516 Current Property owner(s) Barrie & Mark Lounsbury Day phone 248-6066 .Mailing address 1640 Shelburne Rd., Anchorage, AK 99516 , Lending agency Day phone Mailing address Real Estate Agent Paul Richardson Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 240-1022 TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑✓ Individual Holding tank ❑ Community On-site ❑ 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 obtainedfrom the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply 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 Watkins Engineering, Inc. Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis 5. DSD SIGNATURE 1,""' Approved for 3 bedrooms. Phone 349-1851 Date ¢'Z6' 0' Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments •6640 Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other. ARID Original Certificate Date: '-t r By: - (Rev. 01102) D. LIFT STATION NA Size in gallons Manhole/Access (Y/N) "Pump on" level at In. "Pump o e High water a�circul�tr�eq lvl t in. Datum Cycles tested Meets alarm & E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 115 Absorption field on lot 130+ Public sewer main 100+ . Sewer /septic service line 100+ On adjacent lots 120+ On adjacent lots 120+ Public sewer manhole/cleanout 100+ Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ,ON LOT TO: Building foundation 8 Property line 20+ Absorption field 10+ Water service line 50+ Surface'water 100+ Water main 100+ Wells on adjacent lots 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:. Property line 30+ Building foundation 50 Water main 100+ Water Service line 50+ Surface water 100+ Driveway, parkingivehicle storage 17__ Curtain drain none known Wells on adjacent lots 100+ . F. COMMENTS Septic tank in carport has been barricaded off to prevent driving or parking over it. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through yield inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Cindy W. Ellis Date April 26, 2004 HAA Fee ,$ Date of Payment � 0 Receipt Number 03 (Rev. 12101) I Waiver Fee $ rAj4-- -A.0 TH •�� Date of Payment Receipt Number Wdy W. Ellis "�;_A 04-23-04 12:37PM FROM-CT&E ESI, SGS ENV SERVICES .S -GS.. SGS Retia 1041876001 Client Name Watkins Engineering Project Name/to Knik Hts, Block C. Lot 6 Client Sample IID Knik Hts, Block C, Lot 6 Matrix Drinking Water PWSID 0 Sample Remarks: 9075615301 T-095 P-02/03 F-578 All Dates/Times are Alaska Standard Time Printed Date/Time 0423/_004 12:18 Collected Date/Time 04/212004 9:35 Received Date/Time 04/21/2004 9:50 Technical DirectorStephen .Ede �c. Released B tAz Parameter Restdts PQL Units Nicthod Container ID Allowable Prep Analysis Limits Date puce Init Waters Department Nitrate -N 0.652 0.100 mg/L EPA 300.0 B (r--10) 04/21/04 J18 Hicrobiology Laboratory Total Coliform 0 col/IOOmL SM18 9222E A (<=1) 0421/04 DPT c t_ t~ po f i<un •. ._ -r " 00 _ •iX _ 6:89.'S7 1.5"E 3 VY S Shed ;+. `, •••:,, - ._. • : .. • ' u,* $PORP et acuc ��,Lr i N �F:t�'t� i�vus twit t L o.w. Mt K . i. .. i.'j •C1J.�} tJti r• t �i.•� .a r4' i �a •yam._'; .. _` � • •� I • r -7 - J r R.rEGE�•y'"rFIE'.L'::',.�/s:9 9 � d•-��-p.r. , �. No .601VAlFR6:.5F7` 7y/5 nh: gs - c0, Lt P_"" I hereby cer0fy:-:th2t .1 `harry ,;surveyed the foll-mring described property:��r.� �_• OF A4, A r •�o.N•. •�o, n �•• •'ti'S� a� a Anch��rat a Recorclin, .Precinct. Alacka, and tho the t t $ ► imt�rover'tcnl!� situntad thereon tare 'within the prcpert.- ' i I lines and d(. not o erlt: j nr encrozv h on the tc pert S 1 1044 �.1111" 3 p' s i ]J•;tl;,• arlptcent thc:rtc, shat nt� Iniprr•.i etrtr. ras nn prod-Fidjacent tl:eruto cnvro&v;t ot: the premii^S t2:1Cb11rJ1 ard that 17IC.C' :Ire n0Prod Vo6&a o Ines or other :•isib!e e.t:c:na:nts un xaic! ptepert�' cxcrptr •• NO. -3255-5 inair..uec1 hereon. f �- �� FOp~•••••oo�"•Ph0 Dated at Anchorage, Al"iska ! ���`fSSfONPoa"�� thi .._.:%lar of_',.LL�. _--- -• 19G_? t 32 CJ' tiit4 'F e iEr� f'G. Zi]l c FHEI) �S' :1SSOCIATES ' ALATKA d Or. _ TriE r` ; Enginr•rrr arA, Surveyor., , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES- M bivision of Environmental Services M 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 1. D. # 01 C)3A- C)Ln HAA # "Q'((o CC1'A 1. GENERAL'INFORMATION Complete legal description /=a c k k j4Z�gz)) - S/1j Location (site address or directions) 0 S17'-/):,.,0, Property owner Me -c A na/ /4-"� 661'0" Day phone 3'/6-- 056`1 Mailing address —1 z6 Y0 SA it 80( 1+ACfj0r CWC Atc 99,5-1� Lending agency Na -I'/ )Tao h- oOc Day phone Mailing address Agent_/-'Oo�L 23all,O 9,?Plic Pew Dayphone- 279 --76/1 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 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 MOA U21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 0 Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist / u Legal Description: —1216'1� r'O c kC kn � k I f� Parcel LD.: D ! .7 -O ,3 '/ ` �2 G (! �JJ�� t ' 2- Stie ef- A. WELL DATA Well type _ vP P _ If A, E, or C, attach ADEC letter. ADEC water system number Log present (YN . Ygj Date completed 10 /?-3/7,5' — Total depth _�t7__ Cased to 10,31' Casing height (above ground) '36 J' Sanitary seal (Y/N) _Y"aj Wires properly protected (Y/N) YpJ m �y FROM WELL LOG AT INSPECTION o `z z n_ v Date of test �_/ 23 1 ? 5� 2 / Z / / f 6rn m _ G- D Static water level r`li r •4-- "' o CD Well production 3o _ g.p,m. �'� , 8 �" g.p lr�, o o WATER SAMPLE RESIJLTS: 0 O Coliform 0 col flciorri-e Nitrate (9,56 en!% Otherbacteria 1701le rYeo.'1*0 Z Date of sample:_ 2 / Z /_/ g6 __ Collected by: %/u k1 -o,? recA Svc Ii. SEPTIC/HOLDING TANK DATA Date installed /O / zB ! -r3-Tank size /000 Number of Compartments I _ Cleanouts (Y/N) Foundation cleanout (Y/N) — Y Depression (YN N High water alarm (Y/1) A • 4, Date of Pumping 2 / 13 / 26 Pumper /30)61 Re o) -e, - C. ABSORPTION FIELD DATA Date installed 10/ 8/ 7= Soil rating (g.p.d./ftZ or W/bdrm) 12 � System type Length_ 2 <.' Width 16 Gravel thickness below pipe 6 Total depth IS' -8 " L?&<b K y' f+11 ma r�uj eve p�>r a cu�rf Effective absorption area h1 S6 0' Monitoring Tube present(Y/I) Y Depression over field (Y/N) _ ! L Date of adequacy test '2/2 I / 9 d Results (Pass/Fail) Pa.Lr For 3 bedrooms Fluid depth in absorption field before test (in.); 39''_ Immediately after �'/ gal, water added (in.): Fluid depth�� _(ins.) Minutes later: 19 _ Absorption rate = J Y,5'0 g.p.d. Peroxide treatment (past 12 months) (Y/N) Klo4e know-) Ifyes, give date _ N. 4 D. LIFT STATION N 4. Date installed Manhole/Access (Y/l) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot_ 115 ; On adjacent lots "Pump off' level at* Absorption field on lot _ r 115, ; On adjacent lots __> 106' Public sewer main nl • A. Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation k & ' Property line > 10 ' Absorption field__ _LO ' Water main/service line _>2,5"1 Surface water/drainage > 1 00' Wells on adjacent lots > t uo SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation �.. y,1"' Property Line > to' Water main/service line > 2s`' Surface water r 100' _ Driveway, parking/vehicle storage area _ = ZS'' Curtain drain Jq 0 S 49 en Wells on adjacent lots _> eOO F. ENGINEER'S CERTIFICATION j" t I certify that 1 have determined thru field inspections and review of Municipal re,�Wr (fiat trig phoy—o. #steOis are in conformance with MOA HAA guidelines in effect on this date.{' Signature 0 G� * y�u �f- %ic�+�_ v•_ <. a 4 9 0 4 a 9 P o o. 4 6 Engineer's Name _ 1hg oGtCa l�rJ c, r -e "sE31 - C i— r`4 �e 4 a 4 p �?r emir :S )AH�re -61 j J V Date MaVeti hi 199 HAA Fee $ J 06 Waiver Fee $ Date of Payment � .3S4 /Date of Payment Receipt Number � � 0 g�9�i ` Receipt Number Rev. 8/95 OSS: haa.wk,doc CT&E Environmental Services Inc. rsriiiar�rr.rrvvvsjs-..d®iiriv CT&E Ref.# 960597.3365 Client Sample ID L6 B6 KNIK HTS S/D10397-01 Matrix Drinking Water Collected Date 02/2t/96 Technical Director pWSID 0 Released Sample Remarks: - - -- --- o0 AltoWoble Prep Analysis Parameter Results Oual PaL Unity Method limps Date Date Init nitrate -u � .586 V .1 reg/L EPA 353.2 NOUN s 02/26/96 82/26/96 BMW+ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 6 264-4720 Application Date er'c<<crX 20 /26' 1 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) _ �'0r (l_ Bfc�(tc C� lrnrlr !f/r Si) — — Location (address or directions) (b) Applicant Name 1on�11I Telephone: Home _?il—S'7 2/ Business Applicant Address I e G t(o ccro t rc y F}re/-tU/-gcl-e Fj Gc %�5 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder ®f ; Buyer 0 ; Other ❑ (explain); (d) Lending Institution _ I — -�1 selzc I -ed Telephone Address (e) Real Estate Company and Agent 67(�n trcT 'at , f ac t kt A101411 umcu Address _ ( 2.36-0 /�Y, t0vy to 206 0rCYr;e Telephone __ 3 < _ (f) Mail the HAA to the following address: ; r — 2. TYPE OF RESIDENCE Single -Family ® Multi -Family 0 Other Number of Bedrooms —__ 3 3. WATER SUPPLY Individual Well 0 Community 0 Public 0 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 Q Public 0 Community 0 Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. P_1ac 1 �f 2 72-02 (11,841 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND IN. ORMATION 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. Name of Firm i= &a N -0 'e / �c < n cc< ��r�cc f Telephone Address IyS3cJ Folio/Fncfiv�cry� /�-!c 395'y( Date Fe ru e r y C> 1.96 IJ TH ur.....°'°• °°•°°••n•"°""F Engineer's Seal MEODOP.[ F. AMORE ���i "rotcss'to 41 6. DHEP APPROVAL Approved for '711,''�e_(�Aedrooms by �' �'�` Date Approved Ll— Disapproved (/ Conditional Terms of Conditional Approval CAUTION Z -- 2_-!:, —a 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. P"n 2 rf 9 MUNICIPALITY OF ANCHORAGE: MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST 264- 720RUARY 1984 FEB 2 0 1987 Legal Description: RECEIVED jCndlc ,fT _S (JD A. WELL DATA Well Classification IPI--tuez �e If A. B. C, D.E.C. Approved (Y/N) )`f, A. 6'.q r�)n t 4wf Well Log Present (Y/N) _�_ Date Completed (�� �� y 7g — Yield G 4' eN —62� Total Depth _1 Lim _ Cased to 1031 Depth of Grouting N,l). Static Water Level 3,71 Pump Set At —�;? `fd' Casing Height Above Ground — 6 rr Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot its ; On Adjoining Lots •> To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line N,14. To Nearest Public Sewer Cleanout/Manhole _ N, A. _ To Nearest Sewer Service Line on Lot N a Water Sample Collected by -r /-7 ; Date It? Water Sample Test Results r"y Comments�S a dum io on c%19/t97 { G -�tle 4t�CJF'r .vd ( in {-Ae cueti J be e:er-eti- 0 ceucvn )b Y6" t Plvcu tgilr,i /leaf. T. B. SEPTIC/HOLDING TANK DATA Date Installed _ld/ 46; /7,5 _ Size -_1, c">" �_ No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) i' Foundation Cleanout (Y/N) y Depression over Tank (Y/N) fV Date Last Pumped —10 /86` Pumping/Maintenance Contract on File (Y/N) M A _ ; for Ju, /). Holding Tank High -Water Alarm (Y/N) Al, 4- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well f fSA� r To Property Line To Water Main/Service Line _ N,& Course > t 00 Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field �� r 1M, /J To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 113 c�6r-^' Type of System Design���/� P° Date Installed !a/ Length of FieldZ"-' — Width of Field I ! ` Depth of Field — 6 i Gravel Bed Thickness — Square Feet of Absorption Area k6 Standpipes Present (Y/N) Depression over Field (Y/N) — X — Date of Last Adequacy Test Results of Last Adequacy 'Test A derctap Separation Distance from Absorption Field: To Water -Supply Well fs-T' -- , To Property Line _ 20' 'Oer Ot+"' 4c;"( To Building Foundation !1G ` To Existing or Abandoned System on Lot NA. On Adjoining Lots > 36 f To Water Main/Service Line — N° 14'• To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Ni A• Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) To Cutbank (if present) Nl14• e Dimensions Manhole/Access (Y/N) "Pump Off" Level at _ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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 Date Company ff�2L4,e! '7aeeh S�cr MOA No.6 Receipt No. oZ U o —c0.- 7 .04����q� Date of Payment '— �� — % `fid A/.ti ®� Amount: $ —fin /Ye•_,� Engineer's Seal AY*i *449-YtI � ;god Y n Page 2 of 2 0.•THLODoae F, MOORE e 7�, CE - 3589 al 72-026 (11/84) tits 1 BIT rib,$ 1 FILL A� HOME SERVICES CUSTOMER 15900 Francesca Drive Anchorage, Alaska 99516 345.1890 or 345.2444 A Block Lot INVOICE # 1266 DATE DESCRIPTION AMOUNT TOTAL REMARKS--- /-� 2,71 ZLLi?c / _ Gallons _Septic Cesspool Standpipes Time ❑ PROBLEM AREA --CALL FOR MORE INFORMATION ❑ NEEDS TO BE DONE AGAIN IN 6 MONTHS ❑ Good Shape ❑ Sludge buildup on bottom ❑ Floater on top ❑ Jim cap missing or ❑ Cut standplpe to 1' above ground ❑ Needs Septictrine needs replacing -g– ®— -- --PLEASE PAY FROM THIS INVOICE— Time APPLI( Ali PILLS OUT UPPER HAI ".ONLY -- Prenerty Owner hone Mailing Address Date Zip Code/ " - 1 �• - �../ ) ( Buyer )j/': (•' Address0 Inspector 1 Zip Code Lending Institution --— Phone Address Zip Code -Realty Co. & Agent Field Notes: f.h.. Phone MUNICIPALITY OI' ANCHORAGE '/ (/ /w l 4 Address Zip Code Legal Description Street Location � L_ •/ F /f-- CI _ _ Type of Residence --- 0 " single Family ❑ Multiple Family No. of Bedrooms Other (_) APPROVED BEDROOMS Water Supply f<lndividual 1` 1pJ ( ) DISAPPROVED ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. 71 Community ❑ .�(� v.-� ( ) CONDII ZONAL APPROVAL - DATE For wells drilled prior to that date, give well depth (attach log if available). Public Utility Sewer Disposal .)�='individual Year Individual Installed: !1 Public Utility When Connected to Public Utility: Ci Holding Tank Date Sewer Installed Well To Absorption Area <—a Well Log Received NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, Time Time Time Time v Date Date Date Date/V Inspector Inspector Inspector Inspec 01) Field Notes: f.h.. MUNICIPALITY OI' ANCHORAGE DEPT. OF HFP.111 Cot ROi ENVIRONfs1_NI AL PROTECTION I ((r� RECEIVED i (_) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDII ZONAL APPROVAL - DATE Soils Rating Date Sewer Installed Well To Absorption Area <—a Well Log Received Septic, Tank Size / ,� OcLcibor 27, 1983 'Ll'ifl and Toni S'paldling "R Ancnon.ii:jo, AK 9')5U7 �;MbjOOt.s U)t, k), jjj.O(--j< C, i<flik iieiyllts Stlbh.vi."ioll '\j.), pcoval f cl -r- tho in('1 iVid W -d SUVA3 r-' al)d 1,Mt'.C?1; tc il i J, i t j 'a1 I (, :JrallLecl until the following itollu.i havc.. heell crmlpl(Lofl. 4)1 1 e e 1) i,-. i c t. a I I K pLA Ill f) () C1 V/ i t 11 iA r C C L S ublii i L- L Od to 1_.115.5 dep�,,I:tlacnt Log ot' Lhk:� well c' -going :;Ilouid be sccJ.U(j chat I -L i"l wau"r LiyllL. electrical %lirCt; to the h(,cid are in vi.o.Latiun o:1 tho vikinicipilliLY (.-)j- julcmut.a<,Je C;OdCl:3 All(A IOUSL De Ul1Ccl:3C:(1 ill conduit. Please notify tilj.; fcn.' a roiylspocti�-m wile'll ulu 110tod lmve iJeorl (,orrect<-d. 1l_' there arkally further. please Call Lhis o£ 'ice at S1llco1:elyf Jim Robe t5 A:,sociate xriviromacmita-1. 5. LEGAL DESCRIPTION L(9T z �C e��flG�i �S STREET LOCATIOf - v �G12 _ 6. TYPE OF RESIDENCE - NUMBER OF,BEDROOMS �Q/SINGLE FAMILY ❑ One ❑ Four ❑ Other__ ❑ Two ❑ Five ❑ MULTIPLE FAMILY U/ Three ❑ Six 7. WATER SUPPLY 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.) B, SEWAGE DISPOSAL SYSTEM ^ �� r/// 7S YEAR ON-SITE SYSTEM WAS INSTALLED. 7/1NDIVIDUAL/ON-SITE** ED PUBLICUTILITY C v'Ess NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) (1�y PtnL DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTO `` INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE `MEI F 1 .-ALTH & MUNICIPALITY OF ANCHORAGE ENYIRONMENLd. P z?TECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street • Anchorage, Alaska 99501 ® 'ANi 1980 ENVIRONMENTAL. SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please allow ten (10) days for processing. 1. PROPERTY OWNEiR4PHON MAI LI N C A DDIB ESS �• C/��S �a "- CZII A/u0n/o; ��'� ���'. P—R Y RESIDENT (If different from above) PHO E I.:,SHe 2910,IVC 1<-OPAC� 2. BUYER - - PHONE MAILING ADDRESS - 3. LENDING INSTITUTION - PHONE MAILING ADDRESS 4, REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION L(9T z �C e��flG�i �S STREET LOCATIOf - v �G12 _ 6. TYPE OF RESIDENCE - NUMBER OF,BEDROOMS �Q/SINGLE FAMILY ❑ One ❑ Four ❑ Other__ ❑ Two ❑ Five ❑ MULTIPLE FAMILY U/ Three ❑ Six 7. WATER SUPPLY 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.) B, SEWAGE DISPOSAL SYSTEM ^ �� r/// 7S YEAR ON-SITE SYSTEM WAS INSTALLED. 7/1NDIVIDUAL/ON-SITE** ED PUBLICUTILITY C v'Ess NOTE; THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) (1�y PtnL ruie eine cno neeiriAl ileo nnu V � —NUMBER 1. TYPE OF RESIDENCE:� ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY of BEDROOMS �• ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY - - ❑ PUBLIC UTILITY Connection Verified __ PERMIT NUMBER DEPTH OF WELL - - DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank. or ❑ Holding Tani( Size: !,>C- E� If Tank is homemade give dimensions: SOILS RATING TYPE OFTANK MANUFACTURER p - TOTAL ABSORPTION AREA MATERIAL - jf'1 4. DISTANCES WELL TO: Septic/Holding Tank �(�(� Absorption Area % (j� Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - - 5. COMMENTS 5.) w- t,u- A..Gr AA_, V,__.itPPROVED FOR _`S� BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accorrypan certificate) ' DISAPPROVED DATE �_ <— BY y 72010 (Rev. 6/79) Tobben Spurkland P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 S Z W L R A D g U A C Y T E S T FAT 6, BLOCK C. KNIK HEIGHT SUBDIVISION Mr. Bruce Hill P.O.Box 10-2041 Anchorage9 Alaska 99511 o "V. Q of NV RANcHoRAGC It, N; . ; Residence: Three bedrooms, Single family, Finished Water System On Site Six inch Well Sewer System From Municipal Records: 1000 gal Steel Tank Greer 6 feet Deep lug Crib 454 sq. ft. Absorption Area Date of Test Feb. 21 2.2 1 1980 Test Procedure System Inspection Feb. 20, 1980 6 inched of fluid in pit, no deposits or scum in kank pit Pit has solid bottom, waste is clear Tank is full, has thin scum blancket, no heavy deposits Fluid Depths on Feb. 21. At Start of gest 5 inches Charging 500 -"gal 12 Charging 1000+gal 19 These Depths :indicate a 10x1O crib Result LL G� 4 /lel6x Fluid depth on Feb 22 4 inches This System meets the Municipal requirements for a three bedroom house �� ©F A�q� 2225-E JUNE 25, 1971 Y � � � �J'ry+�YH� . •�`��Id y G44 J4 ANCHORAGE AREA BOROUGH of Environmental Quality chorage, Alaska 99503 274-4561 Date Received January 31, 1977 Time of Inspection Date of Inspection ST FOR APPROVAL OF Palle-hh�-A SEWER & WATER FACILITIES FOR Cony 1. Approval requested by: Alaska National Bank of the North 1 Mailing Address: Phone: 278-4581 i 2. Property Owner: Tim veal. Phone: 344-7793 Mailing Address: Star Route A Box 1591-A 3. Legal Description: Lot 6 Block C Knik Heights j4. Location: Shelburne Road, see map on back i i5. Type of facility to be inspected single Family No. of bedrooms 6. Well Data: A. Type _Individual B. Depth C. Construction _ D. Bacterial Analysis i7. Sewage Disposal System: on-site system 1 A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material 103' 3 E. Disposal Field: Total length of lines i 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines , Nearest lot line _ Other contamination _ B. Foundation to septic tank _, Absorption area i C. Absorption area to nearest lot line _ EQ -034 (1/74) Page 1 of two pages MUNICIPALITY OF ANCHORAOU. DEPT, OF HCALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION-17 ROTECTIONr7 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 JAN 3 119 L- ' a 7 f -:>s- l REQUEST FOR APPROVAL OF RE IIIVED INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA_ CONV x 2. Property Owner: j_ )e Mailing Address: l� 15-1Z /q- g� Day Phone: ���-7 7 %� 3. Name of Buyer: �1 er ), `f ��✓��t%� / /� Mailing Address: _Zi2Z1Mg.0 A/2t- Day Phone:—� 4. Name of Lending Institution:.hk zV2Y 1� Mailing Address:_ --302S =, (4l<is 71— Phone: _a79' 212 / 5. Name of Realtor or Agent: _ i v d4' 5�2 /_/-ze i' Mailing Address:_sSh2 If,), Phone: o") 2C� 3 LVIl'MjJ-lame) 6. Legal Description: Z3Z6rA1- (2 R414 II -145i -S Location: 7. Type of Facility to be Inspected:. ' No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) X If Individual, date of installation 72-003(3/76) Page 2 of two pages - ReF st for Approval of Individual ° er & Water Facilities Legal Description :Got 6 Block C Knik Heights Approved Disapproved Date 09—//—? 2 Approval Valid for one year from date sighed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date
