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HomeMy WebLinkAboutKNIK HEIGHTS BLK D LT 8Onsite File Knik Heights Block D Lot 8 #017-035-08 A ROW permit is required for well in the right-of-way prior to future COSA approval. ��4�M1 1 1 AI L Municipality of AnchorageI : ('S ®2020 On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201099 PID Number: 017-035-08 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Al Upgrade Name Michael R. Squires ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 12740 Atherton Road Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 478-3141 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Knik Heights D 8 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines 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 Ftz Ft. Well >100' N/A N/A N/A >25 TANK ❑! Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1,250 Gal. Surface Water >1 N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >1 O' N/A N/A N/A LIFT STATION Manufacturer Capacity Gal. Remarks Tank only permit. Tank is insulated. Alarm location Electrical installed by PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Installer A+ Home Services Drainfield CO/MT D3034 Inspector L. Tidwell BENCH MARK (Assumed elevation) 100 ft Inspection 151 6/16/20 Location and description 2 ndn Threshold of back door. aro 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ®��E Or q4 ;44,4 Conditional Approval: Date P,.•••" ••:QS���®®® `9 �....:.49th �0 o Z. .Z /, Y L .,=.f ............ .................. I......... , ' tiiICHAEL E. ANDERSON •; ®}®�J,� �iff No. CE -4381 ��o Septic System Approved Date 5 o?D�U ®� F, %.9/22/20 ••.,>•'`��'�'® Note: this does include Fa5��®+�® approval not well permit requirements.@® (Rev 05/02/18) |���T�K8|-T �� ��c��J��1 O{�� ���[l ff O17-[l���OA PERMIT ~'"'' ' `� OSP201099 ' `'^'° ' ^�� `, ° ' ' ""° "`~ / \ / \ / \ ' EXISTING WELL | � | / \ LCT 7 | 10'UTILITY EASEMENT CHAIN-LINK FENCE GREENHOUSE SHED j \ | ' . / Au*moew __-~ | ' ABaonpTow#r moH�_ U ��� �� | \ ' �- ���� � | | \/\-\SV" EXISTING ABSORPTION | TRENCH ronemmw|w SERVICE :v � 500 GALLON SEPTIC TANK DECOMMISSIONED IN PLA RETAINING WALL POST & RAIL FENCE \\ / \ LOT _ MH /.. NEW 1,250 GALLON SEPTIC SV 34.6 TANK -W120" MANWA-Y, 2CO 35.9 1,000 GALLON SEPTIC TANK DECOMMISSIONED IN PLACE. THREE BEDROOM HOME RETAINING ALL � \ / ' \ / / | \ .«» / \ \ ` p��Y�OU3�-^ ` / En^//mu WELL --� -L ----— ---- ��H��K���T �����7� | / ' ' `«' "°'^^`" ' ROAD ��^ \ / . / | / A ' B FCO 17.6 4.5 / uoxxEL c ^woERsow LEGEND Q]'CLEANOUT 2CD'DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS'FLOW SPUTTER VALVE MH - MANHOLE MT - MONITORING TUBE GV'SEPTIC VENT TH-TESTHOLE | MH 30.3 33.3 SV 34.6 37.9 2CO 35.9 39.3 LEGEND Q]'CLEANOUT 2CD'DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS'FLOW SPUTTER VALVE MH - MANHOLE MT - MONITORING TUBE GV'SEPTIC VENT TH-TESTHOLE | t if� I it" PROFILE AS -B (NO SCALE) !"|NGULATON MICHAEL E. ANDERSON R: 5.6'x13.8' BALCONY WOODEN �I Lot 4 I IZ Lot 5 q 1 41 10' UTILITY EASEMENTS HOUSE DETAIL Scale: 1" = 30' r4511 12. SEPTIC PIPES. 7.2'x14.5'. GREENHOUSE RETAINING WALL SEPTIC 5.0'x8.0' DECK 1.0'x4.0' CANT Lot 7 10' UTILITY EASEMENTS CHAIN-LINK FENCE N 89'58'E 14.5 SHED + -` GRAVEL -- IV '. POST & RAIL FENCE - O J - S 89'58'W 300' YHOUSE c'py� C FAIRMONT ROAD 300 D 1 Lot 8 m 43,500 S.F. N 0 \ O Z \ O O 104.5' rNi RETAINING WALLy o PO\J5 � Yv R \' GRAVEL. � P to I WELL — NOTE: THE WELL & PLAYHOUSE ENCROACH INTO \ / THE RIGHT-OF-WAY FOR FAIRMONT ROAD PLOT PLAN ___ AS BUILT _x_ SCALE _1=_60__ GRID S_W 2836Project No. ____2a=1671A2-___ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in c . (907) 522-6476 Phone o000�1�40 (907) 522-4625 Fax oo p04 Professional Land Surveyors kenOlangsurvey.com o F AC YjonathanOlangsurvey.com Od gs4p0 I hereby certify that I have surveyed the following described property: 0 LOT 8, BLOCK D, KNIK HEIGHTS SUBDIVISION (PLAT No. P -452A) o * 49TH* Anchorage Recording District, Alaska, and that the improvements situated thereon are . . . . . . . . . within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed 0'�0 KEN FI premises and that there are no roadways, transmission lines or other visible O0 �G easements on said property except as indicated hereon. R.OLa p L+, 40F9Fo '..LS- 202.•'' ypo0 Dated this the _-__G___ Day of __Oc-7ord. e.n-_____, _ ri'_�`_, of Anchorage, Alaska p '0R XP o c �n��FfSSIONAt• �o It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 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: OSP201099 Work Type: SepticTank Upgrade Tax Code Number: 01703508000 Site Legal Address: KNIK HEIGHTS BLK D LT 8 G:2836 Site Mailing Address: 12740 ATHERTON RD, Anchorage Owner: SQUIRES MICHAEL R Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: qtr en r v )f Department 5/11/2020 5/11/2021 43500 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The well is in the ROW. A letter of non -objection from the municipal ROW department will be required for a future COSA. Received By: Issued By:�� 6 Date: Date:S /YU 4 MUNICIPALITY OF ANCHORAGE Community Development Department p, Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 017-035-08 Property owner(s) Michael R. Squires Mailing address 12740 Atherton Road Anchorage, AK 99516 Site address Same Day phone 478-3141 Legal description (Sub'd., Block & Lot) Knik Heights, Block D, Lot 8 Legal description (Township, Range & Section) Lot Size 43,500 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade pg � (w/wo ADU) Holding Tank ElRenewal ElDuplex ❑ (D) Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / 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: ���� !o Date of Payment:J M02U Receipt Number: (� `� A 0 I Permit. No. ®J P X099 Waiver Fees: Date of Payment: Receipt Number: Waiver No. COVID-19 Permit App_.:-: :-.,c- 257- DISCOUNT APPLIED LIED PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) May 7, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Knik Heights, Block D, Lot 8 – 12740 Atherton Road Septic System Design Dear On-Site Services Engineer: The two septic tanks serving the 3-bedroom home on the property have exceeded their useful life and must be replaced. We are submitting this request for a tank replacement permit. The attached site plan identifies the location of the home and the well, septic location and proposed septic tank site. No conflicts exist between this proposed site and any other well or septic system on this lot or adjacent lots. Wells on this and adjacent lots are shown. The new tank will be a minimum of 100’ from all wells and surface water, and more than 10 feet away from any permanent foundation. The proposed site is more than 5’ away from any deck or stair supports. Please refer plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, PE 5/7/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201099, Deb Wockenfuss, 05/11/20 // // // // // // // // 10050 0 FEET 1"=50' ABANDON EXISTING ABSORPTION TRENCH. NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND KNIK HEIGHTS, BLOCK D LOT 8 FAIRMONT ROAD 5/7/2020 ATHERTON ROAD10' UTILITY EASEMENT SHEDGREENHOUSE RETAINING WALL PLAYHOUSE POST & RAIL FENCE CHAIN-LINK FENCE RETAINING WALL THREE BEDROOM HOME NOTE: DECOMMISSION EXISTING SEPTIC TANKS IN ACCORDANCE WITH MUNICIPAL CODE. PLACE FOUNDATION CLEAN OUT AND NEW CLEAN OUT AT EXISTING ABSORPTION TRENCH. PLACE NEW 1,250 GALLON SEPTIC TANK w/20" MANWAY. FCOMH 2CO SV EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE PLACE FOUNDATION CLEAN OUT. EXISTING 1,000 GALLON SEPTIC TANK. EXISTING 500 GALLON SEPTIC TANK. CO PLACE NEW CLEAN OUT. EXISTING WELL EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201099, Deb Wockenfuss, 05/11/20 MUNICIPALITY OF ANCIqORAGE DL RTMENT OF HEALTH AND HUMAN SER ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address TANKS SEPTIC [] HOLDING TYPE OF SYSTEM THENCH ~ BED ~ W. DRAIN [~ OTHER DISTANCES WELL LOT LINE ~. ~.~L~E PTIC TANK ABSORPTION FIELD WELL FOUNDATION AS-BUILT DIAGRAM (Show location el web. septic syslen/ property hnes, Ioundahon. WELLS [] PRIVATE Fl FT FT FT REMARKS: ~] OTHER (Identify) '[ Othl Oepth ~-Gased to FT ScaLe: / Inspections Performed by Nlunicipai and 81ale O'd"iflelines in eflnct on this date: "~ ~ [ ~ '- ~'-~/' tiealll~ Depadlnent Approval: ENGINEER'S SEAL 72-013 (3/85) P.O, B,¢X 196650 ANCHORAGE, ALASKA 99519-6650 (907) 264-4111 TONY I(NOWLES, MAYOR D£PARTMENT OF HF. ALTN & HUMAN SERVIC£S November 14, 1986 Darcey Bevens Engineering Geologist Alaska Environmental Control Services, Inc. 1200 West 33rd Avenue, Suite B Ancho~age, Alaska 99503 Subject: Lot Block D Knik Heights Subdivision Waiver Request WR86-155 Dear Ms. Bevens: Your request for waiver of the separation distance from the well to the original septic tank on Lot 8 Block D Knik Heights Subdivision has been granted° The required 100 foot separation from the private well to the original septic tank has been waived to 90 feet. This waiver is only good for this recent upgrade and any future upgrade will require another waiver from D.H.H.S. Sincerely, Daniel J. Roth Civil Engineer On-Site Services ALASKA B,,UIROFIITleDTAL COFITROL SI i.,olCI S, IFIC. Depa~'tment of liealth and Human 825 [, Stt'(;et Ancho~'age, Alaska 99!501 Ak'tention: Steve l)eat' Steve, This in regard.,,; to Knik Heights, Lot 8, Bleck D. Recently I d:id all :inspection on this lot when they upgt'aded the septic system, Fo~' tile upgrade they built a four bedt~oom 't~'ench and added a ,500 gallon kank afte~~ the exsistin$ :i000 gallon tank so ther'e is a fast' bedroom tank capacity total. (Jnfo~'Lunately, [he old ]000 ga].lon tank Js onJy 90 feet from the we'll. At tile time of inspection, howeve~~, the integz'ity of this old tank was vet'ified, and caulder couplings wet'e ascd on bokh in]e'h a~d outleh, No leaks we~'e obset'w~d. The well is appl'oximately the same gt'ound elevat.ion a~; the tank, The :inspection ~'epot't s;ays :it it~ a steel two compartlnent Oreet' tank, installed 7/6/77, The welt is 230 fe(~'t (l(?ep, cased to 190 feet. It ffoe:~ threugh sew.'ra] tight layer's, including gray clay and 2Tavel from 68 to 127 feet, which would undoubted)~ p~'event e:Fflu(.~nt from contanimating the water supply. The new tank was cat'efully placed over 100 feet ft'om the well. The~'efo~'e we are requestiag that the separatien distance; between th(~. 1000 gallon tail[( and the we]] on this lot be waived to 90 feet. If yoo have ~lny q~mst.ions, please call me at 561--5040. 'l'hanl( yon. Sincere]y, 1200 UJcsl 33rd Aucnu¢, Suile ~. Aachoraq¢, Alaska 99503 e(907) 561-5040 ii:; I.I.O il) ]11 V ). i~i ;I; O lxl i: I< Iq ! I< HF'.iil ,, ~1 !X)I' ;i; O1",I ,,,, ;l::i / i i3l,,~1i'...!i:iiI i,I. I;.:' ~ ;I. ;::fig t::iPd',ll;;.it;; ,;, 2! I,,I Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O (ENGIN~:S SEAL) DATE PERFORMED:., ~' -'~ -~-~'~' Township, Range, Section: f)N(,/f ¢/'~I ~(~'' SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? "fi, S YES, AT WHAT ~) IF DEPTH? . p E Depth Io Water Allar/, ~oniloring? ~ Dale: Reading Date Gross Net Depth to Net ~ . Time Time Water -~/-- D r o p ..~ t ¢'2 ~ oX. /i;17' --5'~" ¥~ ,~. 4~,, ~ i~o% /~,~ /0 -55 ,?? PERFORMED BY: D ~(~(~/~,f o' ¢~ / ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ 72-008 (Rev, 4/85) PERCOLATION RATE ~"~0, ~ (m,nutes/inch) PERC HOLE DIAMETER I-EST RUN BETWEEN ~.'~(~ FTAND 5--*~'~ FT I .~-. ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ALASKA ENVIRONN'"NTAL CONTROL SERVICE., INC. ] 200 West 33rd Avenue, Suite [3 ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO OF CALCULATED BY ~(\, DATE CHECKED BY DATE- / L .............. J CONTROL SER¥1C~ INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, AI.ASKA 99503 (907) 561.-5040 JOB /.~, ~. ~TCr~'*Z~ ~..~/vc~ ~ ~ SHEET NO OF CALCULATED ~Y '~;b~r*~ DATE CHECKEO BY DATE SCALE [ ~ ~ ALASKA ENVIRONMENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite 13 ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. CHECKED BY OF DATE ,~.~ GRE/--,,,ER ANCtiORAGE AREA BORUUGH ~ , Department of Environmental Quality '~' 3330 C Street Anchorage, Alaska 99503 INSPECT.I°N REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE .*,/ FROM WELL /V(¢ INSIDE LENGTH INSIDE WIDTH __ LIQUID DEPTH NUMBER OF COMPARTMENTS ,~- .__ LIQUID CAPACITY/(~-~-~__ GALLONS. TILE DRAIN FIELD: ! TOTAL LENGTH.~-'~ ( DISTANCE FROM WELL,/~/0'~(~i/ FOUNDATION /1¢~' _'~_ _NEAREST LOT LINE /~--~ ____OF LINES ''' NUMBER OF LINES_ ~ .___DISTANCE BETWEEN LINES .~/~ TRENCH WIDTHS4 IN. TOTAL EFFECTIVE ABSORPTION AREA~9~ SQ. FT. LENGTH OF EACH LINE ~? / DEPTH: TOP OF TILE TO FINISH GRADE_~t~ DEPTH OF FILTER Z_F~' ¢ MATERIAL BENEATH TILE .~ ~ABOVE TILE IN. WELL.: TYPE ffl¢7q ( //V . ___CONSTRUCTION DEPTH FOUNDATION__ , LOT LINE SEWER LINE , TANK.__ SYSTEM DISTANCE FROM: CESSPOOL __ , OTHER SOURCES APPROVED __ DISAPPROVED___ DISTANCES: INSTALLED BY: ¢~,~- SEWER LINE DEPTH: :PIPE MATERIAL: LOT SLOPE: ~'"'~/L REMARKS: _ ____REMARKS DIAGRAM OF SYSTEM ,2, +t~-~-~-*-~'-~ -'~---l'.'~ .... J Form EQ-032 I INS WELL DRILLING P.O. Box 3-142 FCB ANCHORAGE, AK 99501 PHONE 344-3792 DR I LLER~S WELL L'OG CUSTOMER ./'~. LOCATION SIZE ~" DEPTH A~,.~-,~9 CASING DEPTH /~O GROUTING DEPTH YIELD STATIC WATER LEVEL __ PUMP INSTALLED ~i~,~ 4D~ TYPE / FORMATIONS ENCOUNTERED AND APPROPRIATE DEPTHS TO ~ TO __ TO HOW TESTED . ~ TO ~ TO CONSULTING GEOLOGIST 13OX 476-M, STAR ROUTE A " ANCFIO[',)AGE, ALASI(A 99507 Pat e~~ · PHONE 344-7071 SOILS LOG D_~ th (feet~ Soil Description ~2~ -20- Total Depth [ ~ Was grotundwater encountered Depth to bedrock feet in ~ ? What depth . How determined Re. spectfully submitted, Gary ~. Player ~onsultmng Geologist __1 It is the ruponsibillty of the owner~prlor to construction to verify proposed building location on lot,grade,end utility connections , else determine the existence of any easements , covenants,or restrictions which do not hppner on the recorded plot. I hereby csrtlfy thor o lurvey of wes re(Ida by me under my direct euparvision and the property corners mcrked os indlcotod. CONTRACTING ENGINEER8 212 E. Intern~)tlonol Airport Anchorn(]e. Aloeke 99502 Phone: 271~-5775 SEAL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # __¢~, ~'~ - _//~,~- (,r'~ HAA # ~"~-~ 1. GENERAL INFORMATION Complete legal description __ Location (site address or directions) 12740 Ath~rton Priu~, Anchorage Property owner Mailing address Don Shields Day phone Lending agency Day phone Mailing address Agent B~th Simpson / THE SIMPSON COMPANY Day phone Address 12350 In(~stry Way, Anchora¢~, Alaska 99515 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEt)ROOMS: ? ff ,,/?z/~:; TYPE OF WATER SUPPLY: Individual well XX× Community well Public water NOTE: 345-1020 If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. ?2-025(Rev 1t91) From MOA #21 STATEMENT OF INSPECTION ElY 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 typeofstructureindicated herein. I furtherverifythat based on the information obtained from the Municipality of Anclqorage 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 s & 5 ;~HGiNEERING Phone 17rg3,l Eagle River Loop Road No. 204 Address Ea¢]ie River. &Jaska 99577 = Engineer's signature DHHS SIGNATURE ~.'X/.~__. Approved for ,,~.',¢?- (_Z/_) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 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 DH HS does this as a courtesy to purchasers of homes and their lendin9 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.  Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoT ~ l~l,.ocK P K~K ~' .~/~ Parcel I.D. L/,~¢/7--~'~1~ A. WELL DATA Well type Log present (Y/N) ~/'~'.~ Total depth Sanitary seal (Y/N) /~'~ If A, B, or C, attach ADEC letter. Date completed Cased to / c/E) ' ADEC water system number / Z/J ~I/'~? Driller ~'£/',/KI/JS. ~.~. Casing height /Z. '-~ Wires properly protected (Y/N) ~'-.5' FROM WELL LOG Date of test /'~-/l¢//92 Static water level ~F /~/,)~'/-) Well flow ~"~' Pump level g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /00¢+ lC Absorption field on lot Public sewer main AT INSPECTION ,,, _OZ o 1.1_1 /00 ~ ; On adjacent lots ; On adjacent lots /oo ~ _Public sewer manhole/cleanout /'Jo,UE' ,o~E.~¢iJT- Sewer service line ..x~d~ Petroleum tank WATER SAMPLE RESULTS: Coliform (.~/100 Date of sample: Nitrate_ O.Gt P~,~/~-. Gollected by: Other bacteria 0/ICom B. SEPTIC/:III~II~B~Iila~r'TANK DATA Date installed '~/¢/?? '¢ ~/l~'/~;(~ _Tanksize__/O00~~'/~/5~)O E~ Compartments ~ ¢ / Cleanouts (Y/N) Y~ _ Foundation cleanout (Y/N) ~[ Depression (Y/N) High water alarm (Y~ ~O Alarm tested (Y/N) Date of pumping ~/¢ / / ~ / Pumper _ ~ ¢ ~E ~/~ SEPARATION DISTANCES FROM SEPTIC/!44~.D;,%ct~.TANK TO: Well(s)oni0t //00 -/' On adjacent lots /O'-?~/' / To property line_ /O? _Absorption field_ ~¢ Surface water/drainage __/00'~ 72 026 (Rev 7/91) Front Foundation ~ Water main/service line_/D CONTINUEDONBACKPAGE C. LIFT STATION '~-'D'~'te-m~l I e d Manufacturer Size in gal~~ Manhole/Access(Y/N) Vent(Y/N) . "~ump~ "~~1 at High water alarm level _,.----'""~es tested Meets MOA electrical~~''''''''~ SEPARATION?~A-NCE FROM LIFT STATION TO: We..U..et~t On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/2'~ '~_¢ngth Z~'/'~' ~;~ Total absorption area Depression over field (Y/N) .../.Jo Results (pass/fail) /P~J~ Peroxide treatment (past 12 months) (Y/N) '~' ~/¢~ Soil rating Width ~-~'r ~~'~r~/). System type Total depth Gravel thickness .~' Cleanouts present (Y/N) Date of adequacy test for ,,,O'o.4/~7 /~X:2,o/,J If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot_ //©o · ~ On adjacent lots /'~OO ~ Property line To building foundation _-- On adjacent lots 2(56r Surface water /00 re_ Curtain drain irO /p To existing or abandoned system on lot [~' ~ Cutbank ,,'~'O/UE ~°/~ESEtJTWatermain/serviceline /0//- Driveway, parking/vehicle storage area 'A~'O ¢ F. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection, Signature Engineer's Name Date $ & S .:NGINEERING 17034 Eaflle River Loop Road No, 2[04___ agl,, River, Alaska 99577 HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA21 Waiver Fee: $ Date of Payment Receipt Number 5633 8 STrtEE [ AI4CI'IDR^GrS, At. ASKA 9t~,518 1-ELFPIIO,NE (907i 582-234.~ FAX (q~O?) 561'$~01 ,~*;,H,'/,SI.~ [Igg~[?~ [~[ ll~V0~C~ t 6;049 with 01/0¢/93 / ~I.tl:kl[', 0 61 ~]/1 ,-. MUNId'PAUTY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. (df ) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIC~viRONMEi.q].AL i;'> ;TLCTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION JUN t 8 i979 Telephone 264-4720 DIRECTIONS: Complele ~11 parts on page 1, Incomplete requests will not be pro~e~sed, Please allow ten (10) days for MAILING ADDRESS / PROPERTY RESIDENT (If different from above) PHONE 2. ,UYE~ .... PHONE MAILING ADDRESS 3. LENDING INSTITUTIO~ PHONE ~AILING ADDRESS 4. REALTOR/AGENT / PHONE' J MAI LING ADDRESS 5, LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY ~7[ WATER SUPPLY NUMBER OF BEDROOMS [] One [] Four ~[] Two [] Five [] Three [] Six [] Other [] INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILIT,Y, ,, S. 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 well depth (attach log if available.) ~ ,%:f ~,~ **If individual/on-site, give installation date ~¢'" ' ") '~ If system is over two (2) years old an adequacy test is required by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP ECTOR INSPECTOR ~NSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] MULTIPLE FAMILY [] TWQ [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER '~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified_ , . LOG RECEIVED 3. SEWAGE DISPOSAL 8YSTI;M PERMIT NUMBER puDIVIDUAL/ON -SITE DATE INSTALLED BLIC U'FILITY Connection Verified -~NSTALLER " E~Sept.ic Tank or F_~Holding Tank S~ze:_/f~) t¢ 0 If Tank is homemade SOILS RATING -- give dimensions: TYPE OF TAN~.,~ MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTAr~CESwE LL TO: Se't~;~i~/Holding Tank Absorption Area Sewer Line I Nearest Lot, Line Absorption Area to nearest Lot Line 5. COMMENTS [] CONDITIONAL APPROVAL (letter must aceom0an¥ certificate) [] DISAPPROVED DATE BY {Title) 72-010 (Rev, 3/78) 'iTl o R 0 'T E C T l 0 i'l 9q501 Da-.c .'_<o_ccJved: December 13, 1977 ::2 ; 't) l Ill(~ :~ ] ; 'P ! il!(2 I34 Lie I)a REOli].IS? I;'()Ie APPJ!OVAi, OF 1Ni)/~/i]l)UAb fl /,',W]': ?. ANI: WAft'ER ~. Lending 'l:n.~:n''~ Alaska Statebank I t 1L.J (oil F~.O<.!LlO,~3(.: ................................................................... 3 o 4: I?roperc. V Ownp-- William J. Sobolesky Phone: 349-2066 Ma.i_lin.q Ad~li:o;is: Star Route A Box 1581F 99507 Lot 8 Block D Knik Heights Subdivision Wel] Systc, m: Lo Sowo_r Liric No. arest l,ol: 1]ne to Ab.qorpt LOn tO NO. FtT-6'£;[~ [,C) '. I',]iiP Properhy Owner: Hailing Address: Mailinq Address o Realtor/Ngent: q'l~_~21Z~ Mai ling Address: Phone: Single Family Residence: Number of: Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: '?. Water Supply: * Individual Well ~) Publ_ic/Cemmunity SysLem ( } If Individual Well, well depth ~ 05- If Conu~uni[.y System, name of system Sewage Disposal System: **On-site System (~) Public Sy.~-hem ( ) If On-silo System, date of instr_allatien: _,..~_~u~ __22 .............. *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer syshem is over two(2) years old, an adeqt.~acy host is required by this dopartment. A fee of $25.00 must accompany each request before processing can be iniLia~ed. 3/'77 Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 8 Block D Knik Heights Subdivision - Comments: Affadavit Attached: ( ) Approved :~~~ DJ. sapproved: Letter Attached: ( ) Date: Department Worksheet: