HomeMy WebLinkAboutKNIK HEIGHTS BLK C LT 12Onsite File KNIK HEIGHTS Block C Lot 12 .2 1 gAff jKle) VALOIC-11, The 1978 field may not be tested for a 5 bedroom COSA Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number, OSP231305 PID Number: 020-412-06 Dwelling: # Single Family (SF) M with ADU E] Duplex (D) r, Two Single Family Project M New FM Upgrade Name DIKE ABSORPTION FIELD FO -1 Deep Trench El Wide Trench El Bed ❑ Mound site Address 12601 ATHERTON Other Phone Number of Bedrooms _[I Soil Rating depth from original grade 5 1.2 GPD/SF JTotal 10.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. Gravel depth beneath pipe 7 Ft. Subdivision Block Lot KNIK HEIGHTS BLK C LT 12 Pill added above original grade 0.5 Ftl, Gravel length 45 Ft. Township Range Section Gravel width 2.0 Ft, Beds: Number of Lines 0 Distance between lines FL SEPARATION DISTANCES To Septic 1 Absorption Lift Station Holding Sewer i I I Total absorption. area Number of trenches Dist. ben trenches From Tank Field Tank Line I ---. 630 F? 1 FL Well 100'+ 100'+ 150'+ TANK N Septic ❑El &T,E P r7l Holding 1-1 Other Manufacturer Capacity Surface Water 100'+ 1100'+ i GREERIANCH TANK. 11500 Gal. i i Material Number of comparlments T I Lot Line 101+ 1 10'+ 1 NA PLASTIC/DEEP BURIAL 12 Foundation I10'+ i f 10'+ LIFT STATION Manufacturer Capacity Gal, 1 Remarks Alarm location Electrical installed by Installer PIPE MATERIAL House totank 3034 Tank to drainfield 3034 MIKE N ANDERSON PE Drainfield 3034 COIMT 3034 Inspector MIKE N ANDERSON PE BENCH MARK (Assumed elevation) 102 It Insoedolot 9114/24 9116/24 dat; Location and description esn 2" ITOP OF MH LID 3"1 41" ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date 4 9TH . is 0.0• .... 0.4 0. 4 4 Septic System;. ......... I MICHAEL N. ANDERSf_,t,,J Approved Date / __k CE- 19 N> Note: this approval d not include w,9 not include well permit requirements. I Mw PROFESS Tlk k-- V. ,V&r,Uj /// /// /// /// /// /// /// /// /// /// // / /// /// /// /// /// /// /// /// /// /// /// // / / / / /// /// /// /// /// /// /// ////// /// // / // / // / /// /// /// /// /// /// /// /// /// /// /// 3 4 . 0 ' 4 4 . 0 ' 30.0 ' 8.2' 1 8 . 3 ' 6.2' 1 9 . 7 ' 9.6' 6. 0 ' 12.4 ' 2 8 . 0 ' 18.0 ' 6. 0 ' 32.0 ' 30'30' WORK ORDER No:DATE:SCALE: DRAWN: LL CHECKED: ME/RL ZONING: 1"=40'Sept 27,2024 R6 GRID No:FB BOOK/PAGE: SW2836 166/74 SURVEY CERTIFICATION: Alaska Remote Imaging has conducted a physical survey of the subject property, the improvements situated thereon are within the property lines as shown. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the Plat used for this survey. NOTE: Under no circumstances should any data hereon be used for construction or for the establishing of property lines. PREPARED FOR: Mike Anderson ASBUILT SURVEY OF: Cleanout Elec Meter Robert O. Lumpkin No. 10459 R E GISTEREDPROFESS IO N A L L A N D S U RVEYOR Lot 12, Block C, Knik Heights Subd (Plat P-452B), Anchorage, Alaska 1.Bearings and distances are record per referenced plat unless otherwise noted. 2.Not all monumentation for this survey may be shown on this document. 3.Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. ALASKA REMOTE IMAGING Surveying Mapping Land Planning LIDAR 6239 B Street, Suite 201, Anchorage, Alaska 99518 (907) 519-0339 survey@alaskaremoteimaging.comIMAGINGSURVEYING DRAFTING S U R V E Y I N G AL A S K A Septic Manhole Water Well Gas Meter 6/27/24 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231305 Work Type: SepticTank Renewal Tax Code Number: 01703430000 Site Legal Address: KNIK HEIGHTS BLK C LT 12 G:2836 Site Mailing Address: 12601 ATHERTON RD, Anchorage Owner: DIKE STEVEN E DECLARATION OF Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: LA Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: 9/19/2023 9/18/2024 Lot Size in Sq Ft: 43500 Total Bedrooms: ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing -Rem-BY: �� 5 r✓t e �� �o �'w C Issued By: Date: Date: Iq z_ —5 _ Parcel I.D. 017-034-30 Property owner(s) DIKE Mailing address 12601 ATHERTON RD ANCH AK Site address SAME Day phone Legal description (Sub'd., Block & Lot) KNIK HEIGHTS BLK C LT 12 Legal description (Township, Range & Section) Lot Size 43,500 Sq. Ft. Number of BedroomsA--�- 57 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (S all that apply) Absorption Field � Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank R Upgrade RX Duplex (D) ❑ Holding Tank El Renewal R Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Waiver Fees: Date of Payment: Receipt Number: Receipt Number: ReFrnt.No- 0-'s X 4 IOC) 2 Waiver No. C i . Aj C- OJ c,(' -k-, 0-5 GAIDevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc 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. 017-034-30 Property owner(s) STEVEN DIKE TRUST.... Day phone _ Mailing address 12601 ATHERTON ROAD, ANCHORAGE, AK 99516 Site address 12601 ATHERTON ROAD, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) KNIK HEIGHTS BLOCK C LOT 12 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) El Septic Tank Q ` Upgrade [] (w/wo ADU) Holding Tank ❑ Renewal Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. nature of property owner or authorized agent) Permit/Rush Fees: 41415- Waiver Fees: Date of Payment: 5 �� 20 L� Date of Payment: Receipt Number:_( 01 Z Receipt Number: Permit No. ©P Z 3 f 3�O �' Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermitApplication.doc Aug. 3, 2024 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: Septic Change Order OSP 231305 Legal: KNIK HEIGHTS BLK C LT 12 To whom it may concern: This is a request for a change order on the above referenced lot. The proposed new owners what a new leach field also. A new test hole was excavated and found gravels mixed with sands, GW/SW for the entire depth with no water. A simple deep trench has been designed. We are also making the field larger than the design requires per the new owners. The slope at the leach field area is about 2-3 percent, see the site plan. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSX241002, Curtis Townsend, 09/06/24 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! September 5, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: OSP221376 RENEWAL - SEPTIC TANK UPGRADE PERMIT LEGAL: KNIK HEIGHTS BLOCK C, LOT 12 The owner has requested that the septic permit OSP221376 to upgrade the existing aged steel septic tank on the above referenced lot be renewed. We conducted a recent site visit to visually look at the site and adjacent area and did not see any changes that would warrant changing the permitted design. We propose to install a 1500-gallon HDPE tank to serve the existing 3-bedroom residence. No groundwater was noted in the MOA documents for this HDPE tank. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please reissue the permit and contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231305, Deb Wockenfuss, 09/19/23 SEPTIC FIELD SECTION DESIGN CRITERIA: 7.0' EFFECTIVE 5 BDRM X 150 = 750 GPD SOILS = 750/1.2 = 625 GPD 625 GA/7*2 = 45 2.0' WIDE 45' LONG (1) TRENCH 9.0' DEEP 16 (TH#1) 1.0 GW/SW ORG 1. 5 ' 2.0' -9.0 -2.0 MOUND OVER FILTER FABRIC SEWER ROCK ‘3,3( GRADE 1"=200' PROPOSED SEPTIC EXISTING HOUSE SCALE: DJRDRAWN: DATE: KNIK HEIGHTS BLK C, LOT 12 Anchorage, Alaska STEVE DIKE 8/3/2024 & INSULATION NO WATER AUG. 2024 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSX241002, Curtis Townsend, 09/06/24 1"=50' EXISTING WELL 100' RADIUS MT SCALE: DJRDRAWN: DATE: KNIK HEIGHTS BLK C, LOT 12 Anchorage, Alaska STEVE DIKE 8/3/2024 MT TCO LOT LINE PROPERTY LINE TH#1 2-3 % NO WELLS WITHIN 100' COCO NEW 1500 GALLON TANK WILL BE 10' FROM FOUNDATION, 5' FROM DECK PILING 2ND SITE, 25' X 5' EFFEC., CLASS III SYSTEM LOCATE W/ SURVEYOR Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSX241002, Curtis Townsend, 09/06/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSX241002, Curtis Townsend, 09/06/24 D = > ATHERTON ROAD m�� -rn � — ��mrn � Om=Z D W -A z O r 0 m�Z0 m p o �� 0 - N 00 02 00 W 145.00 = m �n O z _ z --1 0 z=p p m� � mmmo O om0� Oz0m mX D z r °� (D CD c — : : 0c) N N — Cr CD QCD X (n' ca co -* -CD CD —t' (n (n' (.0 :3 c DJ 4�- 0-) CO O sy CD CD CD V 4. 00 m o m N 0 c CD N (D `rL N z z CD CD ° �' CS} CD �o 01 (Da)o O 00 000 -� c 13 (p a �,xx \ O F-+. 0 CD 'o 0 0 ° o ed a'. c4r0 . v- O -' .a O 00 CD o _boo va) CL r-+. 0 -TI ��cr� 4"�oo0 1 r . _ . c � � � � 0 r crn o • _ . � � r I I o r (a Q CD , -- •� —I 0 0 o I CD m �� ��; ,YpR �� C� i` m (n �. CD CD _ < C: rnn Z�O°CD�' �m 26.crn m o o c I co ,�� 7 c� O I ° w cD (D ,-,- .-t a — — > p� Cu CD -h cn co 0 M �<—, S a a 3 m 3� C/) -n cDcns cn '��:���a�� Z��� v�rn .��' �096' �,�� O� 10 n; CD CD CD �. cn ry 0• Ph w 0 cD � m m 0° o o M. o cr C D I O �`� �� I C o-�° niCD��,o3cn cum -� o 0-0 D � �, � cn a)� � ,-� CD CD M -0 � CD co O Cb c,� Cu r N m mcd n `? �CD Za OI -G Q�_� oo�����- �`��-m C� ( 'oc� .cow' II'Tl I ° o rnm N ��� o� 1. ?_0 03 0 < Z �i o o Q M (n CD °' CD D N a—i' (D CCDD (D z � Q- a CL o T. 3 CD ? o o �, _ °� 10 UTILITY EASEMENT CD _ . (� cn o > 0 ° o--I x I CD =�= �9°� N�.=.���� ��� N000200W145.00 m � — � l< cn CDC =r o to m mac-1° CD * _- r o� ccCD „ o D a- l `� c -,1 mamas m �l CD a —CD a �� W 11 r- Q0 � D MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221376 Work Type: SepticTank Upgrade Tax Code Number: 01703430000 Site Legal Address: KNIK HEIGHTS BLK C LT 12 G:2836 Site Mailing Address: 12601 ATHERTON RD, Anchorage Owner: DIKE STEVEN E DECLARATION OF Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: n' ` c �� Department 9/2 �/U-Z-' ,-W 43500 3 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: 09/27/2022 Date: 2 Zo Z L 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com September 16, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: KNIK HEIGHTS BLOCK C, LOT 12 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1500-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. No groundwater was noted in the MOA documents for this HDPE tank. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221376, Curtis Townsend, 09/27/22 FIRST WATER CONSULTING KNIK HEIGHTS BLOCK C, LOT 12 DESIGN DETAILS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK MUST HAVE RLS STAKE ALL WELL RADII PROPERTY LINE & EASEMENTS PRIOR TO SEPTIC TANK INSTALLATION. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221376, Curtis Townsend, 09/27/22 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 82.5 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT ~NEW [] UPGRADE IM~ILING ADDRES~ LEGAL DESCRIPTION LOCATI ON.,¢ -~ ' Wall ~Z Manufacturer ~ ~ I Materi~ ~' Liq, capacit~n gallons ..... Inside length Width ' J /~[) I IF ~u~w~MADE: iwo,, -- ~ / IWell ~.~ ~¢ Foundation t~ / INearestlotline,-~ ~ ~ z /DISTANCE TO: I [I'd ~-- /'1 ' I /0' ~E~ /No. ofhnes . ILength,~f e~h/ine Totallen~hoflines Imreno[~iCth ~ ~ / Top of tile to finish grade .... Material beoeath tile / Length -- IType of crib DISTA~NCE '1'0: ]Class DISTANCE TO: Width Depth Crib diameter Crib depth Well Building foundation Depth Driller Building foundation Sewer line NO. OFBEDROOMS No. of compartments Liquid depth PERMIT NO, Liquid capacity in gallons PERM,T NO../¢ ~g ?¢., __ Distance Total effectiv.,e, abs~or/et..~ion area PERMIT NO. Total effective absorption area Nearest lot ~ina Distance to lot line PERMIT NO, Septic tank Absorption area(s) OTHER PIPE MATERIALS. /~i~'~- ~_~-~J SOIL TEST RATING INSTALLER R:[:MARK8 < rPR¢¥E° ~'~'-013 (Rev, 3/78) ~-- DATE LEGAL F EE:.HIT NO. APF'L. It CI3NT TIMBERLINE Hui' tEz, LOCFITIOH FI'FHERTON DR L.EGFI[. L.t.2 BLK C: KNIK PITS ~'"ll ILJl IP-JJ J[[ lC: ~]; DEF'FIR. TMENT OF HEALTH FIND ENVIROIqMENTFIL.. PROTECTIOH 8R5 '"L.' STREET, FINCHORAOE, 264-47"20 ,OLD FR E,U,:., 5:44 46';02 LOT SI?E 46500 SQLIFIRE FEET T'¢PE OF SOIL RBSORBTION SYS'FEM IS: I"RENCH MFIXIHUM NUMBER OF DEDRO01"tS = 3: SOiL RRTING THE REQUIRED SIZE OF THE SOIL_ FlBSORP]"ION S'¢STEH IS: TFIE L. ENGTH [:, I MENS I ON IS THE LENGTH <IN FEET) OF THE TF.:ENCH OR DRFIINFIE!._D. THE DEPTt4 OF: Ft TRENCH OF.: PI]' IS THE DISTFINCE BE'rWEEiq THE SURF'RCE OF THE EiROUN[) RND THE BOTT'OM [)F THE E×C;RVRTION ,.'.IN FEET). THERE ):.S:; NO SET WIDTH FOR TRENCHES. TIdE GRRVEL [:,EPTH IS THE 1,11NIr,lur,1 DEPTH OF )3RFIVEL. BETIdEIEI'.4 THEE OUTFRLL PIPE RND "Fide E:OTTOM OF THE ENC'RVFYFION (IN FEET). F'ERMIT FIPFLICFINT FIFIS THE REz, F.Jf.,I_,I6ILI'f~ TO II,,IFCRH THIS DEPARTMEHT DURING THE INSTFILLPI'fIOI'.I INz, PECTI_Nz, ~]F FiN'.r' !.,.IELLS FIDJFICENT 'FO THIS:..; PROF'ERT"r' FIHD THE NUMBEF.. OF L.L._,I[.,EI'B_.E_, 'f'HFI"F THE I.,IELL HILL SERVE. 8FtCK'I~"ILL. INCi OF FiH"r' SYSTEM WITHOUT FINFIL INSPE:C:TION FIND F'~PPROVFIL E:"r' THIS DEPRF':TMENT I.,.IILL BE SIJB,¥ECT TO PROSECUTION. MINII'dUH DISTANCE E:ETP.IEEN R WELl.. AND f:lH"t' ON--'SITE SEWF~GE DISPOSFlL. S'¢S"FEM IS 100 FEET FOR f::t PRIVRTE WEI..L.~ OR ±50 TO 2¢0 FEET FROId Fl PUBLIC WELL [)EPENDING UPON 3"HE T~'F'E OF PUBLIC WELL. I,.IELL L. OI]'.iS RRE REI.';!UIF.~ED RND Musi" BE RETURNEE:, TO THE [)EPRRTMENT WITFIIN ::~0 [)R'¢S OF: THE b. IELL. COMPL.ETION. OTHER RE6!UIRErdENTS P1FI¥ RPPL¥. SPECIFICRTIONS FIND CONSTRUCTION [:,IRGRPIMS RRE FIVPII[d-':IBLE TO INSURE PROPER I'NSTRLLRTION. I CERTIFY THflT i: I tim FRMIL~IRR WITH THE REQUIREMENTS FOR ON--SITE SEWERS fiND WELLS tis SET FORTtll E:V TIdE MUNICIF'RL. IT'¢ OF RNCHORRGE. R: I I-,.IIL. I_ INSTFlLL TtdE S'¢STEM Ir.,I RCC:ORDANCE WITH THE CODES. ~: I UNF;,ERS'FRND THFIT THE ON-SiTE SEWER SYSTEM HR'¢ REQUIRE EHLFlRGEMEi',IT IF THE RES I C. EI'm,ICE~_...~7~(...,~I Lq REI'dOD~. SIGNED: FiF, PL 1CflN.i :D 'T ] I NCLIJDE HORE TFIFII'..I 2.: BEI'}R ] 3HS. IE, E'F. tLI NE'. HOMES September 10, 1978 Mr. Bob Lutje Star Route A, Box 31-L Anchorage, Alaska 99507 Subject: Soils investigation for sanitary sewer system on; Lot ].2, Block C, Knik Heights Subdivision, Anchorage, alaska. Dear Mr. Lutje: At your request of September 1, 1978, I conducted a soils investigation at the proposed location of a sanitary sewer system on the subject lot. This investigation, which was accomplished on September 8, 1978, consisted of the inspec- tion of soils removed during drilling of a 6 inch diameter, 19.0 feet deep test hole, using solid flight augers powered by a trailer mounted Mobile B-34 drill rig. After completion of drilling the test hole was filled with water and a percolation test per- formed. The results of the percolation test are tabulated on an accompanying sheet. The soils encountered are graphically shown on the accompanying test hole boring log. The soils consisted of a thin layer of Organics and organic silt 1.5 feet thick over- lying a Silty Gravel with some Sand 8.5 feet thick, underlain by a Silty Sand to a total depth of 19.0 feet. The topography of the subject lot is desribed, as a low swale trending in a northwest direction approximately bisecting the lot, with higher elevations to the northeast and southwest of 10-15 feet of height difference. Vegetation consists of dense spruce and birch to 50-60 feet tall, with a heavy ground cover bushes and grasses to 4 feet tall, and mosses. No water table was encountered. An accompanying sketch shows the subject lot with the approximate location of the test hole in relation to the property lines. I appreciate the opportunity to be of service to you. Please contact me if you have any questions regarding this soils investigation. Very truly yours, Box 191, Star Route A Anchorage, Alaska 99502 : (907) 344-9150 Attachments: Drawing of test hole boring log with location sketch, and tabulation of ' ' percolation test results. xc: Department of Health and Environmental Protection September 10, 1978 Lot 12, Block C, Knik Heights Subdivision, Anchorage, Alaska Percolation test performed on September 8, 1978, by filling 6 inch diameter, 19.0 feet deep test hole with water, and measuring the water level drop periodically for one hour. TABULATION OF PERCOLATION TEST RESULTS TIME LEVEL(inches) DROP(inches) ET(min) RATE(min per inch) 1547 5.0" start start start 1557 32.0" 27.0" 10 0.4 1607 45.25" 13.25" 10 0.8 1617 55.0" 9.75" 10 1.0 1627 1637 1647 62.0" 7.0" 10 1.4 68.0" 6.0" 10 1.7 72.25" 4.25" 10 2.4 Average percolation rate for entire hour = 0.9 minutes per inch. Average percolation rate for last one half hour = 1.7 minutes per inch. Michael B. Bergmann Consulting Geologist Box 191, Star Route A Anchorage, Alaska 99502 (907)344-9150 Z 145.0' __10' ~ Ut___ility Easement 100' 70' ' TH # 1 .... Lot'12/ Block C, Knik Heights Subdivision, · Anchorage, Alaska 145.0' Atherton Road NOT TO SCALE Distances are approximate and have not been measured by surveying methods as to location of test hole. Michael B. Bergmann Consulting Geologist Box 191, Star Route A Anchorage, Alaska 99502' (907)344-9150 T.H. No. 1 9-8-78 anics: w/some organic sil~0'^ ~dry_~ loose, r_.~edb_Lrn~.' -- 0.5' anic Silt: w/some gravel, ~trc sand, loose, dry, reddish brown. ~ (OL) Silty Gravel: w/some Sand, scattered Cobbles, dense, dry, gray brown. (GM) ........... 10.0' Silty Sand: occ zones of sandy silt, sand pred fn to vy fn, med dense, moist to vy moist, greenish gray brown. (SW-SM) NO WATER TABLE ENCOUNTERED '' 19.0'TD Test Hole Boring Log represents soils encountered on Lot 12, Block C, Knik Heights Subdivision, Anchorage, Alaska. i.L ;. · $iz¢ or.sing .......................... : ................................ ' ' ' v.h:l¢' ' ' ' ~ ~.6e : ' 'rate '~ D:st3nce to w3tcr pump,ng ............ .......................... ..at '.- . of~ ~00 ..... ~llon$ per ~our. · · .' · ... -:. · · - .... :-- . - .':,,' .-..'.- . ... , . Description of Formation ~. ,~..%, .- · from , to Sand & ~r~vel '..x_.~./,../::. .-0 10:. San~ cl~ -~.,. -.- ~..1%,~ -- ,. 10 - · '25 ~e~ ~ '~ ~ve~.~5.~- '. · '92' 93 '. .... · , .....,.,.,.--.: ~ ~,,~ ,...~. ,~; · c :,.' .,~ ;z~/~ ., ~- ~=. ~...-,>, .:.. ,- .....- , ~:1;~.~.~. -: · :.. · . ...~ -,..~ ~...- .. .... . .. ~:-.~ .... - .:"-. . ~... ~.,.~. %.: -..' . · .. . . , .. ~ ..... e. I .. "' '' ~Vc aclvls~ )'OU ~0 a~ach II,is ce, ilica~ lo )'our cleect. MUNICIPALITY OF ANCHORAGE z— 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. 017-034-30 Legal description KNIK HEIGHTS BLK C LT 12 Site address 12601 ATHERTON RD Expiration Date: 9/10/2025 Current property owner(s) DIKE STEVEN E DECLARATION OFTRUST X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. F-A&IFTIMlMAU&I COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 1. GENERAL INFORMATION Parcel I.D. 017-034-30 Complete legal description KNIK HEIGHTS BLK C LT 12 1 +; ;+ 4,4 12601 ATHERTON RD V%'0 ion ko C; a 1 %:;001 Current property owner(s) DIKE 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: * Private Well r-1 Private Well serving 2 dwelling units El Private Well serving 3+ dwelling units F1 Community Well or Public F Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic n Private Septic serving 2 dwelling units Fj Holding Tank r_1 Community Septic or Public Sewer 5. SEPTIC TANK: FI Steel R Plastic R Concrete R Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: E] AWWTS n Bed nN Deep Trench n Wide Trench n Seepage Pit Waiver request for: Expedited review requested: FO -1 Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Li LA c3 Date of Payment 911e6/7 `'J COSA# 05C-2-qL310 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 COSA Checklist Legal Description: KNIK HEIGHTS BLK C LT 12 ParcellD: 017-034-30 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled JAN 79 Total depth 93 ft Cased to 93 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 16 in. Date of flow test for COSA 9/10/24 Static water level at beginning of test 71 ft. Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) NEW M ALL standpipes present per record drawing Total measured depth from grade 10.5 ft (max) Measured depth to pipe invert from grade 3.5 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective _ ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Well production at time of test 3.5+ gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes N No X Coliform bacteria is Negative Nitrate 2.11 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L M Arsenic less than MRL (ND) Collected by Date 9/10/24 MNA C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW Results Q Pass Fluid depth prior to test _ in Water added _ gal New fluid depth _in Elapsed time _ min Final fluid depth _ in Absorption rate _ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) S4 in Effective depth used 0 in Effective depth remaining 84 in Comments/Deficiencies: ALL CLEAN OUTS SHOWN FOR OLD SYSTEM ALSO COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ❑i Yes if No _ ft ❑� Yes if No _ ft Neighboring Tank > 100' ❑i Yes if No _ It Private Sewer/Septic Line > 25' Q Yes if No _ ft Absorption Field on Lot > 100' E Yes if No _ ft Holding Tank > 100' QYes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' Qi Yes if No _ ft ❑o Yes if No _ ft Manure/Animal Excreta Storage I�> 1I00' Community Sewer Main > 75' Yes if No _ ft LoJ Yes if No _ ft ❑ N/A— Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' E Yes if No _ ft Surface Water > 100' ❑Q Yes if No _ ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS ❑i Yes if No _ ft ❑ Yes if No _ ft QYes ifNo_ft EYes ifNo_ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' QYes ifNo_ft 0 Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm MjhC/\I/1vt4ieYJ(,0 pa Engineer's Printed Name "irgK=' COSA Checklist June 2022 Phone 727-8864 Date � OF Al'Al f, A MICHAEL N. ANDLRSON ice'% �.• CE -9 69 rA 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 /� I� Parcel I.D. # 017-034-30 HAA # _XJ6 9 /Q 6&Q q 1. GENERAL INFORMATION Complete legal description Lot 12; Block C; Knik Heights Location (site address or directions) 12601 Atherton Rd. Anchorage, AK Property owner _ Paul & Julia Cossman Day phone ( 949) 400-8194 Mailing address C/O First American Title 3035 "C" St Anchorage, AK Lending agency Mailing address. Agent Address Day phone Day phone Unless otherwise requested, HAA will be held for pickup. - 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water 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 XX 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#21 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 furtherverify 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 co liance with all Municipal and State codes, ordinances, and regulations in effect on the date is inspection. ALASKA WATE W A R Name of Firm Phone Address Engineer's signature 6. DHHS SIGNATURE _ Approved for Disapproved. _ bedrooms. Conditional approval for Additional Comments M Date I Z t AV a �SiC... _,. �...sm. latlCa i$ O • bedrooms, with the following stipulations: Date/ 2 " 23 -- % I" 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Beck MOA M21 Date installed Size in gallon Sewer /septic service line 25`+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Property Owner P'V'_~/7'-~/~o/~-- Telephone: Home ~/"/'¢'" ~-I~l Business Mailing Address / (b) (c) Telephone Lending Institution Mailing Address Real Estate Company and Agent Address (d) (e) Telephone ~-~-~5:F~ ~??~ ~ f2°d'$ '~'~-~4-~:~ Mail the HAAto the followina address: or: Check here [], if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Wel~ Community [-1 Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, SEWA~ISPOSAL Onsit/e,,~J Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation frorn the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 trey 8/801 Fronl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _.'~,,~ /~,~./_-~' ,~,~"_ Telephone ~.~/~Z~'_g~.,~ Address ~'2/-z.-9.,~ ~ ~"~ ~ Engineer's Seal /~s2~ ~ C ale R, ~ erroll DHHS APPROVAL~ .p~p ~~ Approved for __ bedrooms by . Date Approved ~ Disapproved Conditional Ter~s of Conditional Approval CAUTION 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 order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86) Back MUNICIPALII'Y OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST ,. FEBRUARY 1984 264~4744 Legal Description: /_../2.- A. WELL DATA Well Classification Well Log Present (Y/N) Total Depth ~ ,~ Cased Static Water Level ~' Casing Height Above Ground Electrical Wiring in Conduit (Y/N) If A, B, C, D.E.C. Approved (Y/N) Date Completed //?'¢ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) "/' Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole ,/j Water Sample Collected by w/r~ Water Sample Test Results Comments /4'/~c ~ (f /¢~ ~ r~¢'-7'~ ; On Adjoining Lots /¢o "' ~,-~'7'" /t~o z~/ ; On Adjoining Lots //07) '~ ~'~ To Nearest Public Sewer To Nearest Sewer Service Line on Lot SEPTIC/HOLDING TANK DATA Date Installed /O~,¢' _ Size I¢~'~ No. of Compartments Standpipes (Y/N) Y Air-tight Caps (Y/N) ~' Foundation Cleanout (Y/N) Depression over Tank (Y/N) /// Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~/~' ; for Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /¢)") ¢ TO Property Line ;~' To Water Main/Service Line 2L;'~¢ Course ,'~ ~ Temporary Holding Tank Permit (Y/N) To Building Foundation '/~/~ ¢'¢~ To Disposal Field ~)'"¢ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-02Cf Rev 8'861 Fronl C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~,o~-- .~,.~/&~¢.~.~ Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) _ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ,"v/~ ~ ~(~~ To Water Main/Service Line -¢~¢' '//¢~?'- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots /~ To Cutbank (if present) D, LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) 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./~/h~ve che~erified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signe(~ ~-(-.,~,,/.~..-?,/~"J Date_ ~//~.~./~ Co m p~y~ '~_~,/'D/'//~' MOA No. Receipt No. Date of Payment Amount: $ _ Page 2 of 2 72-026 fRev 8 8RIRac~ MUNICIPALITY OF ANCHORAGE DFPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AU'f'HORIT?~P~'C~.-~t ('1'~ OF ON-SITE SEWER AND WATER FACILI'l~¥~'--- 264-4720 Application [:)ate GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Z¢;,' /z a'~_ 'ct /r~/~ Location (address or directions) (b) Applicant Name /~7~','~o~d.. Applicant Address (c) Telephone: Home ,,~4/~'- (/~,~E-~'" Business Applicant is (check one): Lending Institution []; Owner/builder/J~; Buyer []; Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent · Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family,/~ Multi-Family [] Number of Bedrooms. ~ Other WATER SUPPLY Well¢ Community [] Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL ©nsite/[~' Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation . attesting to the legality and status. Page 1 of 2 72~025 (11z84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,~',%.5'E'~ ~-~7~...,.~/../~ ,.,._ -~S Telephone Address ~Z.~-(:D ~-- oc~'~-.¢/ ,,~'e'- ,,4f,,'O..f/ Date Engineer's Seal Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA ~?~,C%\ Well Classification "-~ v'~ Well Log Present (Y/N) Total Depth Static Water Level MUNICIPALITY OF ANCHORAGE (MOAI HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Zor Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C. D.E.C. Approved (Y/N) Depth of Grouting Pump Set At (.,),,,/K~vo ~J ,,J Sanitary Seal on Casing (Y/N) _.~ Depression Around Wellhead (Y/N) .~;;t~¢-~~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /~)¢' ,,~ ; On Adjoining Lots To Nearest Public Sewer Line ,~o.-~" To Nearest Public Sewer Cleanout/Manhole ,,t/'¢~,~ To Nearest Sewer Service Line on Lot _ Water Sample Collected by z2~/¢4~./~8-'~¢P~/.J~._% ~s' ,~ . Date Water Sample Test Results Comments ,-.~,~E~ ,,,~,'40H~'¢'~ UJ~-'"~("~ ~/¢r~_ ~"T~,.~'~,/CZ~'- B. SEPTIC/HOLDING TANK DATA Date Installed /~/"7¢¢' Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: Size /4::~ _ No. of Compartments __ Air-tight Caps (Y/N) _~ Foundation Cleanout (Y/N) Date Last Pumped _ ; or Temporary Holding Tank Permit (Y/N) A)//~- To Water-Supply Well To Property Line To Water Main/Service Line Course Comments To Building Foundation _ To Disposal Field ,_~' To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11t84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed / O/~/~ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /oO~/~-~' To Building Foundation ,¢_2~' ~ I_ot --'~'¢//'~P'- Type of System Design~/~--~4c.~ Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line ~'-O'/'~'~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line /~¢~ To Existing or Abandoned System on ; On Adjoining Lots ,'oc~:;' ~/ To Cutbank (if present) D. LIFT STATION Date Installed Dimensions Manhole/Access (Y/N) "Pump Off" Level at Size in Gallons "Pump On" Level at High Water Alarm Level at Vent (Y/N..~,----///' Tested for ~.4~¢~p~ng Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) ~-------~ Comments ~"~'~ d Bedroom Rating Against HAA Request ** certify that I have.,checJ~d, vcl'i~ie¢ orAnformed to all MOA and HAA guidelines in effect on the date of this inspection. Company"~-'~'~ '~.~_~t;'~~ MOA No, Receipt No, / ~:~O / ~ CO / Date of Payment 4/,/~ ~---/D Page 2 of 2 72-026 (11/84) ~ - ' Engin'bel s Seal C/ MUNICIPALITY OF ANCRORAGE ~/~q~Z~ON/¢ENT,",~ ,, ~:.CTION t DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street- A,,chorega, Alaska 99501 FEB ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RECEIV~ REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1, Incomplete re~aests will not be processed. Please allow ten {10) days for processing, MAILING ADDRESS ' ' ~^~L~NGADD~ESS J MAILING ADDRESS 5. LEGAL DESCRIPTION II ~ One ~ Four  SINGLE FAMILY ~ Two ~ Five MULTIPLE FAMILY ~ Three ~ Six Other 7. WATER SUPPLY INDIVIDUAL* COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE~ [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give welt depth (attach log if available.) **If individual/on-site, give installation date /?~:;~' If system is over two {2) years old an adequacy test is required bv this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) [ THIS SIDE FOR OFFICIAL USE ONLY _ DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR I NSP ECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY F'~ TWO [] FOUR [] SIX r 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTN OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified_ LOG RECEIVED 3. SEWAGE D SPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified _ "INSTALLER []Septic Tank or [] Holding -rank ' Size'. ]~)1~:)~) If Tank is homemade ~olLs RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCE~ S~tic/Holding Tank Absorption Area Sewer Line [ Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5. COMMEN'FS [~APPROV ED FOR '~ BEDROOMS [ZZ] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE . BY (Title) ~ 72-010 (Rev. 3/78)