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Home My WebLink AboutKNIK HEIGHTS BLK G LT 2KnI*k Heights Block G Lot 2 #017-372-20 Municipality of Anchorage Page I of 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 Permit Number: -5V,., g8 0 q PID Number: 017 " Z�7 2• " Z O Name: Wastewater System: ❑ New Upgrade Address: I2— voaP ABSORPTION FIELD Phone: No. of Bedrooms: Deep Trench O Shallow Trench O Bed O Mound O Other LEGAL DESCRIPTION soil Rating: �7 Total Depth from //g/ grade /, s6 GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe A kN�� r� Ft. 7/z Ft. Township: Range: Section: Fill added above original grade: Gravel length: u 0—/ Ft. T Ft. WELL: El New El Upgrade Gravel width: Number of lines: I Distance between lines: I Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. / dv Ot' SQ. Ft. / I% a O 1 Driller: ' �1 l i t Date Drilled: Static Water Level: Installer: G Date installed:_ o r� I Ft. Yield:Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES Septic O Holding O S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: A A Capacity in gallons: From Tank Field Station Tank Sewer Lines i welFSurfac Material: _ Number of Compartments: LIFT STATION water 0 N Lot_ Line 6:9 1 35- Size in gallons: Manufacturer: Foundation "Pump on" level at: "Pump off" level at: High water alarm at: 10 q Curtain Pump Make & Model Electrical Inspections performed by: Drain 0 �l BENCH MARK Remarks: u S4ACA6 Location and Description: iff -- 15'4 A I b a" ' �— _ Assumed Elevation: 0-0 — /" _Ft ENGINEER'S SEAL Inspections performed by: s Dates: 1s 2nd " _ Department of Health and Human Services approval Reviewed and approved by: Date: 2 JO -78 72-013 (Rev. 9/91) MOA 25 49th TUB N SPURKLAND........ [� t� NO. CE -2225 : Iss I � � I . I I TOBBEN SPURKLAND P.E. T SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE LOT T %' �1� �' KNIK HEIGHTS �s 203 AK. 995 V TOM COFFMAN DATE: NOV. 21, 121218 ANC 2 K. 9 9 0 12840 RIDGEW000 ROAD SHEET: 1/3 GRID: 2836 PERMIT # SW980442 PID # 017-372-20 KNH0C;022D!VG -- — — —---7�--—- 25 0 25 50 75 100 1125 150 SCALE I" - 50 FT, 1 swiNc n£s: � AC 77.8 FT i i 8C 73.1 FT / AD 106.5 FT A STANDARD TRENCH 8D 103.8 FT TOTAL DEPTH 1; FT AE 118.0 FT EFFECTIVE ROCK 7.5 FT BE 110.3 Fr /l 8 TOTAL LENGTH 40 FT COVER 3 FT �Z 1 I 1 0 G I TM 1000 GA S. T. I DIV RTER VALVE \ I I I � � I . I I TOBBEN SPURKLAND P.E. T SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE LOT T %' �1� �' KNIK HEIGHTS �s 203 AK. 995 V TOM COFFMAN DATE: NOV. 21, 121218 ANC 2 K. 9 9 0 12840 RIDGEW000 ROAD SHEET: 1/3 GRID: 2836 PERMIT # SW980442 PID # 017-372-20 KNH0C;022D!VG E' Wide 40' Loi 11' Dee 75' Se 3' Co v P .' 49t 1� INV EL£ Silt Borrier 7.5 f t of Septic fffeclive IVL! J)LOLL BENCH MARK: GARAGE SLAB ASSUMED ELEVATION; 100.00 FT TOBBEN SPURKLAND P.E. LOT 2 NOCK G KN1IC HEIGHTS' � � SEPTIC SvSTEP AS BUIL, 203 oroge Ave TOM COFFMAN DATE, NOV. 21, 121218 Anchorage Ak 99501 12840 RIDGEWOOD DRIVE SHEET: GRID ?536 ��4-�q��. 3/3 PERMIT /r SW980442 PARCEL ID # 017-372-20 KNN00023.DWG MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW980442 Legal Description: KNIK HEIGHTS BLK G LT 2 Design Engineer: 0007 Tobben Spurkland, P.E. Owner Name: Tom Coffman ' C Irl L r Date Issued: Nov 16, 1998 Expiration Date: Nov 16, 1999 Parcel ID: 017-372-20 Site Address: 012840 RIDGEWOOD RD Lot Size: 54000 SQ. FT. Owner Address: 12840 Ridgewood Drive Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99516-2935 This permit is for the construction of: Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: Issued By: N�� Date: h�r')" � x - S 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 2 BLOCK G KNIK HEIGHTS TOM COFFMAN Municipality of Anchorage Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 November 13, 1998 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 17 ft. Use Standard Trench Soil Rating. From Testholes Nov. 3, 1998 5 min/in = use 1.2 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 150/1.2 = 125 sq.ft. Total area required: 125 x 3 = 375 sgft Testhole depth 17 feet Bottom Rock At 9 feet Top Rock At 3.5 feet Rock Depth 5.5 feet Total Trench Length 375 / 11 = 34 ft. Diversion Valve to Existing System SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 40 FT TOTAL WIDTH 2 FT TOTAL DEPTH 1 1 FT ROCK DEPTH 7.5 FT COVER 3FT REPLACE SEPTIC TANK 1000 GAL The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. MunlciEality of Anchorage { DEPARTMENT O iEALTH & HUMAN SERVICES 825 " L" Street, .>m:horage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR:'—YL.,t C41 VVLar� (ENGINEER'S SEAL) DATE, PERFORMED: LEGAL DESCRIPTION:�BJLC )t( }-�-�� Township, Range, Section: p ETI —'�r --� SLOPE — � SITE PLAN ct vvl P4 �.... 2 L -00.S. I Ilil � V'a r� ,� • � � r r 0 0�- F S; l Lr I-00 a e__ -GM WAS GROUND WATER I ENCOUNTERED? S IF YES, AT WHAT L DEP"I H? 0 O P E Befilh to Water Aller 11 m Monitoring? Bale: I�` b . Vading SILL Date )1, N, 9q�n 3 m 4 o d el ° r v p, 6 d � a 7 d a A � 8 R s 9 10 P 11 O 12 �E 13 10 v 14 JOY 15 26KLS G 16 17 18 19 V'a r� ,� • � � r r 0 0�- F S; l Lr I-00 a e__ -GM WAS GROUND WATER I ENCOUNTERED? S IF YES, AT WHAT L DEP"I H? 0 O P E Befilh to Water Aller 11 m Monitoring? Bale: I�` b . Vading SILL Date )1, N, 9q�n Gross Time Net Time Depth to Water Net Drop 49 10 / & JOY 26KLS 20 PERCOLATION RATE _ � _ (rnm-itesnnch) �PEFiC HOLE DIAMETER (� TEST RUN BETWEEN �_ FT AND �i'2•' FT DISCLAIMER: frnundwater conditions indicated are -for the dates shown only. Past and future presence and/or depth of groundwater can not be predicted rom ese o vYU os.s. _ PERFORMED BY: I CERTIFY THAT THIS TEST WASPERFORMEDIN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GULL ELINE S IN EFFECT ON THIS DAl-t. DATE:G : •ii ' `� `� tJ `I l G ! 72-008 (Rev. 4/85) , I� B n FAIRh10NT ROAD I� LOT 8 L L I 18 I I Nell, F—- 17 / VACANT I o lw , AV - AF ;b- 5 s49th ...... ....... 10 4 ' TOBTEN SPURKLAND .� s CE-2225�e • I'ROFESSIO��•o• Ar 50 0 50 100 150 200 250 300 SCALE, 1' - 100 FT X17 15 IOBBEN SPURKLAND P LOT 2, BIS G KNIK HEIGHTS SEPTIC SYSTEM DESIGN 203 W 15TH, AVENUE TOM COFFMAN 907 2779-3916916DATE: NOV. 9, 1998 (NCH. 99501 12840 RIDGEWOOD ROAD SHEET: 1/3 GRID: 2836 PERMIT If SV980XXX PID # 017-372-20 1 N/100021.II!-1G l� F '♦i 49th -V�'� TOB EN - URKL AND •, �: •♦c'JJ' :. No. CE-2225 •,: AV ♦ ..•'« �D — tea—•— moo— �� o — �— — ._ SZ�LT S(I EFT. — — � I � I I I I I. � I STANDA TOTAL I EFFECT, TOTAL COVER LL - iTOBBEN SPURKLAND P.E. I I LOT �� BIS (�` KNHC IIL.IGHTS' I I SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE DATE: NOV, 9, 1998 ANCH. AK. 99501 TOM COFFMAN I... I ,„ 12840 RIDGEWOOD ROAD SHEET: 1/3 GRID: 2836 LPERIIIT # SW°SOXXX PID # 017-372-20 h'NHOGOPP.Di✓G Silt Barrie 7.5 Ft of Septic Effective NO SCALE NEW TRENCH (1998) j �' Wide 40' Long 11Deep 75' Sewer rcck 3' Co ver I DIVERm? VALVE 1000 gal Septic tank riu JL.HLc ruDBEN SPURKLAND P.E. LOY' 2 BLOCK G KNIK HEIGHTS SEPTIC I YS TEM AS BUILT 203 wl50-.h Ave TOM COFFMAN DATE NOV. 9, 1998 Anchorage A4<99501 12840 RIDGEWOOD DRIVE SHEET: 3/3 GRID ?836 PERMIT j SW98OXXX PARCEL ID Jf YYY KNHOG023,DWG i I MATERIALS TESTING e QUALITY CONTROL SOILS ENGINEERING 2204 Clev d Ave P-0 Box 10-1126 Anchoroge, AK 99511 277- 0231 710 Third Ave. RO Box 2540 Foirbonks , AK 99707 4521267 • 456-5155 ON-SITE SEWAGE= DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EA NEW Judy Rich 344-0501 ❑ UPGRADE MAILING ADDRESS 3301 Arctic Blvd., Anchorage, Alaska 99502 - 9502LE--GAL LE GALDESCRIPTION Lot 2, Block G, Knik Heights Subdivision LOCATION No. OF BEDROOMS Ridgewood Road 3 Well Absorption area Dwelling PERMIT NO. DISTANCE TO. i 100 40 r } 300493 f- Z Manufacturer Material Steel No. of compartments 2 Q w Greer — I- _ _ - Width Liquid depth Liq. capaaty in gallons Inside length 1000 IF HOMEMADE: I' YWell Dwelling DISTANCE TO: PERMIT NO- _ c7Z Oz Q — Manufacturer Material Liquid capacity In gallons T O Well Foundation Nearest lot line PERMIT NO. �= tu DISTANCE TO: _ 50.1.i_..._ 1V-�. -- R(1(V Q4a -_ a Z _ ___._ No. of fines Length of each line Total length of lines Trench width Distance between lines Zw J 5 __.._3Q nchcs lotal effe+t) v a sgrption arca rb�1' F H _._27 Top of trle to finish grade+r _ 0„ — Material beneath ble 4� _ Inches Length �Idlh - Depth PFRMI1 NO. w Q F Cnb depth Tot 31 eL euive absor {y�}{(a1j�l7TY C (lot Type of crib Cnb diameter a a -- —-- _ _ _ DI F! L_ 1 w Well Building foundation Nearest lune ENVIRO��r't' DISTANCE TO: Class Depth Duller Distance to lot line PhF�%jlTIN s i7'I 3 - Building foundation, S�e -0n Septic tank Absorption area(s) DISTANCE TO: r 9 dy, 8 — �. OTHER; tF>' PIPE MATERIALSPPVC C� o�.e tea na ae SOIL TEST RA71NG t IGnncv P.. a 150 SF/BR�- Cc VC. a/ - e. - INSTAL LER r - i --- - R&H Construction f,{• _ _-- - -- --- -- - - REMARKS .;-. ,s• The line from the foundation to the - - - tank had not been installed at the time of the inspection. 1 -- the system was approved uy Lite backfill inspector for and met all A' o -- Municiaplity codes and required — - regulations. - APPROVED DATE LEGAL lot 2, Block G Knik Heights Subdivision McaudPafity � I 825 "L" STREET ANCHORAGE, ALASKA 99501 f 9071 264-4111 GEORGEM. SULLIVAN, MAYOR 1)FPAR-1 `11LN1 OF- IIEAIaR AND FNVIROW/lFNTAL PR01 ECTION December 31, 1980 Judith M. Rich 9021 Granite Place Anchorage, Alaska 99507 Permit 4 800493 Subject: Lot 2 Block G Knik Heights Subdivision A permit issued by this department for well and/or sewer system has expired as of this date. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If an engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files. If there are any further questions, please call this office at 264-4720. Sincerely, /" m /S Z/,A Les N. Buchholz, R.S. Senior Fnvironmental Zci.alist LNB/ljw enc: Copy of Permit SWP/057 DEPH�T��NT Pr I-IIEHLTH 825 'i STREET, A^NCHOA~HGE'. A^K`nn 264~472� 1-4 IF L_K�P-A F-.- �U PERMIT N� O ( 80049] ) '— ^ Y,k2 HPPLICHNT JUDITH M RICH 9021 GRANITE VIEW `^ ]44�772 LOCHTION RIDGEIdQOQ R(]FiD LEGHL L2 BLOCK G KNIKHEI|ATS LOT SIZE/// 50000 SQUHRT TYPE OF SOIL RBSORPTION SYSTEM IS: TRENCH MH:x'IMUM NUMBER OF BEDROOMS ] SOIL RATING' (131.7! FT/BP)� 150 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� ��F�� E_ �� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFACE OF THE GROUND HND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EKCRVHTION (IN FEET). �Un I�� -V I V-4 I<" :AL 0 0 0 �fl:�l L_ L.-�� PERMIT HFPLIC8NT HHS THE RESPONSIBILITY TO INFORM THIS, DEPARTMENT [UP'INQ THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERYE. 10 < 1=2.� � =1 V. Z- F� F_�� 8HCKFILLING OFHNY SYSTEM WITHOUT FINHL INSPECTION FIND HPPROYHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHN�E BETWEEN H WELL HND AN' -r' OW -SITE SEHMGE DISPO'S-AL SYSTEM IS 100 FEET FOR H PQIVHTE WELL OR 150 TO 200 FEET FROM H PUBLI!_-: WELL DEPENDING UPOhl THE TYPE OF PUBLIC WELL. MINIML� DISTHNCE FROM H PRIVATE WELL TO H PRIVHTE SEWER LINE IS 25 FEET Fll%lC TO H COf"IMUN1TY SEWEI?. LINE IS 751 F'EET. WELL LOGS FIRE REQUIRED HND MUST BE RETURNEG, TO THE DEPARTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. OTHER REQUI�EMENTS �AY �PPLY. SPECIFI0�TIONS AND �N ��TR�� R CT��D��s ARE HVHILHBLE TO INSURE PROPER INSTHLLHTION. ��1 "T ��1-0 3" F�:_" IE �C" EE r-1 0 IEEE R;7" �C-D I CET"%'TIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND WELLS HS SET FORTH 8Y T�� M��IC�PRL I TY OF'A�XHOR�G� INSTIFILL TFIE 15YSTErl IN HCCORDMNCE WITH THE ]� I UNDERSTHND THHT THE ON-SITE SEWER SYSTEM MAY RE8UIRE ENLARGEMENT IF THE'. RESIDENCE IS REMODELED TO INCLUDE MiDRE TFIFiN ] BEDROOMS, HPPt I OANT DITH Pl. RJCU ~~�- ` CONS^4" 11 1806 N. 48TH AVE. STE. 'C F, J C T{ Ofd ANCHORAGE, ALASKA 99503 TEST LAB 248-1333 r? x PERFORMED FOR; Run;cel DATE PERFORMED: 8/4/80 LEGAL DESCRIPTION: Lot Block G Subdivision KNIK HEIGHTS THIS FORM REPORTS: Visual Soils Examination 0 Percolation Test ACTL 80-1414 DEPTH SOIL FEET n - n DESCRIPTION NOTES 0.5' BROWN TOPSOIL - PEAT 1.0' ORANGE TOPSOIL _ ORANGE SANDY CLAY OR SILT DENSE 0 _ BROWN MOIST z w SANDY GRAVEL -GP- Q.- 150 sq.ft. o.-- REL. LOOSE GREY -� MOIST SANDY GRAVELLY - CLAY OR SILT 12.0' LLJ REL. LOOSE GREY F- _ MOIST CLAYEY OR SILTY SAND 16.0' '�'�,®.. - -- 'Z61 4, BOTTOM OF HOLE ®,`Q�°,°°°°°° °°'°°•.��+Q� WAS Gf OUND WATER ENCOUNTERED NO 49911. "``' ••°'� �O� -- � - - - - IF YES, WHAT DEPTH LEGEND J Ringstad - Perc zone At% No. C.E. 4623-- 3) S - Sample taken < Froze -- - Waterntable ��1vnOfESS1011�`VV GENERAL SITE SLOPE READING DATE GROSS TIME NET TIME DEPTH TO H2O NET DRAINAGE PERCOLATION RATE: N/A DRAINAGE REQUIREMENTS: 150 sq. ft. /b PROPOSED INSTALLATION: 0 SEEPAGE PIT -qSI DRAIN FIELD 0 OTHER COMMENTS : s TEST PERFORMED BY: L.B. DATA CERTIFIED BY: Kinney R. Baxter, P.E. DATE: 8/4/80 ~� - - 0 z w - Q.- o.-- - LLJ F- Z - -- w 4, BOTTOM OF HOLE ®,`Q�°,°°°°°° °°'°°•.��+Q� WAS Gf OUND WATER ENCOUNTERED NO 49911. "``' ••°'� �O� -- � - - - - IF YES, WHAT DEPTH LEGEND J Ringstad - Perc zone At% No. C.E. 4623-- 3) S - Sample taken < Froze -- - Waterntable ��1vnOfESS1011�`VV GENERAL SITE SLOPE READING DATE GROSS TIME NET TIME DEPTH TO H2O NET DRAINAGE PERCOLATION RATE: N/A DRAINAGE REQUIREMENTS: 150 sq. ft. /b PROPOSED INSTALLATION: 0 SEEPAGE PIT -qSI DRAIN FIELD 0 OTHER COMMENTS : s TEST PERFORMED BY: L.B. DATA CERTIFIED BY: Kinney R. Baxter, P.E. DATE: 8/4/80 ~� WELL LOG Date Drilled: Z101) /9ge> Static Water Level Y a feet Draw Down -- feet Type Material Drilled: 0 feet to ' MUNICIPALITY OF ANCHORAGE DEPT. OF H- -LTf FX 'ENVIRONMENTAL P.-:OTECTION Of I. 1 O 1:3;11 RECEIV[-D Gallons Per Minute' Total Feet of Casing' to to to 7o %O to yr --rd y� Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. n I'� - 3q'd" � HAA # 01D U DA Expiration Date:�- 1. GENERAL INFORMATION Complete legal description lel I Gleck G knelt Hei0lis Location (site address or directions) 122400 Riaae. woos Rout/ Current Property owner(s) jcil o% K isl r Day phone 229 18091 Mailing address PO '[W 1116119 A YNW �( ft 67019/ Lending agency Day phone Mailing address Real Estate Agent Ti..a Co t- Day phone 242- 2260 Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank •❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B welts or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm SR%Ar'k6vA �nc3.,eerinw Address 203 W. I kk 5w,*Qj 203rA>uckoMNoJ_,At< Engineer's Printed Name To 66,,, Sp P6c klar,d. 5. DSD SIGNATURE Approved for __'�? bedrooms. Disapproved. Phone 7_19-39110 Date OF A( ti! 49TH lit+ Cr 2225 Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: � GC/. z2dNf. Original Certificate Date: (tt.> OIM2) Municipality of Anchorage .• • " • Development Services Department `-~_; +; Building Safety Division y. . On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo} 2 gl.ck G Kn* Haia h is Parcel it): 017 . 372 - 2 0 A. WELL DATA Well type 1941\x. Date completed ii21 so If A, B, or C provide PWSID # = Sanitary seal (YIN) ) Total depth 98 ft. Cased to 98 ft. FROM WELL LOG Date of test I,(' 1980 Static water level 95 ft. Well production 8 g.p.m. WATER SAMPLE RESULTS: Coliform .colonies/100 ml. Nitrate 0. 865 mg./l. Arsenic: 45 ffq*r" Date of sample: 46S B. SEPTIC/HOLDING TANK DATA I TankType/Material AnAt. ToA ! $fie A Tank size 1000 gal. Number of Compartments 2 Well Log (Y/N) i Wires properly protected (Y/N) Casing height (above ground) 21 in. AT INSPECTION (2 13 OS g.p.m. Other bacteria colonies/100 ml. Collected by: Date installed �I / 19 l 1146 Cleanouts (Y/N) it Foundation cleanout (Y/N) y Depression over tank (Y/N) _�[ High water alarm (Y/N) —" Date of pumping oo Pumper Z S5cs C. ABSORPTION FIELD DATA Date installed tl tj bi Soil rating (g.p.d./ft2 or ft2/bdrm)►_% System type DeeJ2 MA Length 90 ft. Width ft. Gravel below pipe _47-4 ft. Total depth S0. ft. Eff. absorption area 600 ft2 Monitoring tube Y Depression over field _LL Date of adequacy test (Z 1 0 Results (Pass/Fail) P0055 For 3 bedrooms Fluid depth in absorption field before test 33 In. Water added gal. New depth 43 in. Elapsed Time: 1340 min. Final fluid depth 33 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) ./ /0 If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on' leve t _ in. "Pump off level at in. High water alarm lev tin. Datum Cycles tested Meets alarm & cir requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot + 100' On adjacent lots +100 1 Absorption field on lot + tool On adjacent lots + loo' Public sewer main NIA Public sewer manhole/cleanout NIA Sewer/septic service line 425, Holding tank N4A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation } to' Property line *104 Absorption field +51 Water main IVIA Water service line + So' Surface water /V. O. Wells on adjacent lots +1W 1 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 4, Io' Building foundation I-101 Water main Af/A Water Service line + 50 Surface water N. o. Driveway, parking/vehicle storage 125' Curtain drain N. 0. Wells on adjacent lots +100' F. COMMENTS G. ENGINEER'S CERTIFICATION = . OF ... gsli i A, .�. I certify that I have determined through field inspections and r C2 '9 review of Municipal records that the above systems are in t 49 TH conformance with MOA HAA guidelines in effect on this date. L, ^�SE J SPUPKLAND, < Engineer's ( I Sk� 05 Printed Name T 664% Jprn mwlnl ,� `% • 022.5 Date III t+��1 �pp .... HAA Fee $ (T)o Date of Payment IZ1"iolo1;' Receipt Number I-) 5Z, (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number t=z m a T N 0 O 'Jul Np N T. r0 D � � N 1v L� a Un m ^ CO = O 0 n 71 .. V � TC W 0 m I C]&C m 0 g_ Z R80- RZ 5w . e ^ m�R 0, -i $SRp.4�I 52h 3a$DI �', 5,3i �'o' 33.o xZ .. o duo e O S �C 00.081 M „00,ZO.00 N 1N3W3SV3 linin ,Ol -------------------- 00000pp F I � ,0 6aU: �po40 I ab': ; AT9�F00 I Ln to 0 I C� 0 4�O00000 I N ml I� LA co zI r Iz r m I I O o I I o I N I I O O O O � yZ tl O x OA W qy tA mn :::::::::icicc 'iyZ 64Z 4'6£ N ,00.081 3 ,OO.ZO.00 S W W 0. O GM0 J QOOM3041�1 r 0 O O � � I ZO N xLA V EO 00.081 M „00,ZO.00 N 1N3W3SV3 linin ,Ol -------------------- 00000pp F I � ,0 6aU: �po40 I ab': ; AT9�F00 I Ln to 0 I C� 0 4�O00000 I N ml I� LA co zI r Iz r m I I O o I I o I N I I O O O O � yZ tl O x OA W qy tA mn :::::::::icicc 'iyZ 64Z 4'6£ N ,00.081 3 ,OO.ZO.00 S W W 0. O GM0 J QOOM3041�1 ,� yx Al'1 m �: m Gi I ZO N xLA Z � V n I C]&C m Z U p. i m A E�Oo 12-2t-05;C9:03SGS 907 551 5301 # 21 SCS Ret# 1058111001 All Dttm?imts are Alaska Standard Time Client Name Tobben Spurklnnd P.E. related DalcITIme 12202005 15:07 Project Namt/O Knik Heights BKO LII Collected DoteMme 12/132003 12:30 Client Sample ID KnikH:ights BKO Lt Received DatwTime 12/132005 13:36 J(atru Drinking Water Technical Director Stephen C. Ede Sample Remarks: Altoa:hlc Prep Analysis ruamctcr Reau:o POL uniu Mcthod Conaincr lD Linin Date Date Inn Nit-o:c•N 0.805 0.:00 m&IL EPA 3532 B (<-10) 12/13/05 JC Metals by ICD/MS Aracrdc 5.00 U 5.00 Microbiology Laboratory Tom1 Coliform 0 ug,`. EP200.8 C 12ilM IV16103 SCL coMmL SM^.O92LS A (<-1) 12113.'05 TLF 12-21-05:09:03 ; ;907 551 5301 a 3! y • • 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 S SGS/CT$,F-ENVIRONMONM SERVICES Tot: 907-M-2343 Drinking Water Analysis Report for Total Coliform Bacteria' • READ tNTn umo W OR RIVERM /roc SUORR CO113CTW o SAMPLE, . MUST BE COMPLETED. BY WATER SUPPLIER ❑ PUBUC WATWX SnIVA tt)tl K►RrVATE WATER SYSTRU i Q SWA Randf< ❑ Q iwd it" Fax 507-5615301 o S.nd Me" Mw. rrw � wA SAMPLE COLLECTION: SAMPLE TypE , Debt'aoo5Routlos C]Taatad Water ' a� w 13Repent a7RlPIa �UntraatW Water . n' *Zi, (refer to lab no. ' cwwt n � S 5 -[, � Special Purpose T. P«bd w L.e M F,Sune as octtector TO BE COMPLET50 BY LABORATORY Samch Reeetvinot Dae: .� �iS �Sr peow SO tcu ealq ❑ RUSH SAMPLE. Time:t 3 n�ur m.ra wu.r.6. Tamp:vvr.. Phone 0. Oelh'ary Metho : •- «R«W. Wuaon Fax 9 . Recm)md r ................................... :............. ............ ........ .............................. ................. ........... ...... QEeleNoreate>;t Water AreNsis Record: Rwd aA1`E(; ��• to 40:MUO PIA) RESULTS: ARC PSK JUn AnxryNf /pxm i2.�i3�oJ I.fOp Tow c4ft : p.yn„w AnaY•c -LO* • Ewe b Oke . AneyUpi whoa: 1497RRRAN/NLTER RE5ULI3: Phoned C3 PaxedO . oseat Oo.nc DeWtl MemtueneF eer _ _ vaxlnWnc -- SO&*wift MMO.MUG (P/A)� �S3tlaf=Ofy P.. o+..( SC ❑ .Unsatisfactory Reported By: ~� Datertlme: �/r.�o/ / -; ,.o a ew•• Rgrw.. .. ........-... .� . Foml0 FW 0053 17/17/03 Municipality of Anchorage Development Services Department • +r Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Tobben Spurkland Legal description: Knik Heights Block 6 Lot 2 • ' :rx.i:rrr`r ZD The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. _ ❑ Additional soils information needed. _ ❑ Water monitoring results inadequate. ❑ Discrepancy in Information submitted. ❑ Topographic information missing or inadequate. _ ❑ Incomplete; missing ❑ Incomplete; missing ❑ Additional adequacy lest information needed. _ ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. _ ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. Well in parking area must be protected by permanent blockage Name of reviewer. Date: Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 017 - 3 7�2- -a 0 "y_ HAA # �-\ �:V-I, SL_ . _ fw' ':; a GENERAL INFORMATION Complete legal description LCI a -�> K C --i Location (site address or directions) FsK- l-;,,> C-1 Property owner TO vr-fl Ca 11f 1.A&-4.1 Day phone 2(0/— 5 7-55_5 Mailing address i 2& �t7-ra-250L.tAJ"Z Lending agency Day phone ID Mailing address 510 1.i/ i t.LrL_. Agent i j1z_ V4, s e E l jC Day phone 2-76 ,o-2 Address es co -r'09✓� Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: / Individual well v 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 V 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 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 Phone 17' -7q -III 4,. Address �° (t�/ (5 1—�t 20 12) Engineer's signature 6. DHHS SIGNATURE x Approved for 3 bedrooms. Disapproved. Conditional approval for Additionaa Comments M al1TIC Date �tIz2)1R bedrooms, with the following stipulations: Date / 2 - A0 - '?8 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 tending institutions in orderto 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 engineers work. 72-025 (Rev. 1/91) Back MOA #21 RECEIVE Municipality of Anchorage NOV 2 3 1998 DEPARTMENT OF HEALTH & HUMAN SERM4'UP&LITY OF ANUIOUC;a Environmental Services Division ENVIRONMENTALSERVICES oIVIS, 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 1_o � A2 (3,X G 1).,,,,; k c 1. A s Parcel I.D.: 6 r 7 — 'S 7 2 -- �-Q A. WELL DATA Well type 9-- `_/ If A, B, or C, attach ADEC letter. ADEC water system number / Log present (Y/N) 7 Date completed i� o ✓ G� Total depth RS Cased to 9f Casing height (above ground) , Sanitary seal (Y/N) ti/ Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Ni ✓ i q 8-D I01 A-7 14 9 - Static water level Well production WATER SAMPLE RESULTS: Coliform M g.p.m. 'A-5 g.p.m, Nitrate _ 0 716 Other bacteria 8 Date of sample: '0/ 97 <q- Collected by: �S B. SEPTIC/HOLDING TANK DATA Ir Date installed �cf �_ Tank size Number of Compartments. o2 Cleanouts (Y/N)--�/ Foundation cleanout (Y/N) ��_ Depression (Y//N) N High water alarm (Y/N) Date of Pumping t , Pumper v C. ABSORPTION FIELD DATA Date installed o l9 Soil rating (g.p.d./ft2 or ft2/bdrm) �� System type _ / "-t4 er t I � � r Length / p Width �Z Gravel thickness below pipe. 7 n Total depth Effective absorption area 0-0 Monitoring Tube present (Y/N)_L Depression over field (Y/N) til Date of adequacy test "/A Results (Pass/Fail) N�A For 3 bedrooms Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) VIA- Immediately after °"/gal. water added (in.): Absorption rate = a.p.d. if yes, give date " 72-026 (Rev. 3/96)* D. LIFT STAT ION Date installed Manhole/Access (Y/N) 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 12n "Pump off" level at* On adjacent lots i I o -c,--) Absorption field on lot On adjacent lots > /a-t� Public sewer main N/,4 Public sewer manhole/cleanout Sewer /septic service line > 02-5 Lift station Nl, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 7,92 Property line b Absorption field 6,2 -_5, Water main/service line >,5_0 Surface water/drainage N 1 o Wells on adjacent lots > r� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 3S Building foundation 104 Water main/service line > in -t=) Surface water 1410 Driveway, parking/vehicle storage area Curtain drain N Wells on adjacent lots > !0-0 F. ENGINEER'S CERTIFICATION i certify that i have determined thru field inspections and review of Municipal recordsFthat the above systems.are in conformance with MOA HAA guidelines in effect on this date. i Signature r Engineer's Name I a bb-evt Spi 4 lt(a-m9` Ji] r i Date Ni ✓ 0-11 v, r. HAA Fee $ --�) o D Date of Payment Receipt Number eT 7 C %-2 %) 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CT&E Environmental Services Inc. zctiL Labor tory Division I►iwiiwiiiiiiwiiwiiiiiiiwiwwiwwiiwiwiiiiiwi� Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE 200 W. Potter Drive Anchorage, AK 99518-1605 Pre -Paid. Thank you. Tel: (907) 562-2343 Fax: (907) 561-5301 ❑].PUBLIC Water System L)<PRIVATE Water System Q Send Results Q Send Invoice Tobben S urkland Tobben S urkland Water System Name/Company Name Contact Name 279-3916 276-6013 Phone Number Fax Number 203 W. 15th #203 Mailing Address Anchorage AK 99501 City State Zlp Code ❑ Send Results ❑ Send Invoice Company Name Contact Name Mailing Address City State Zip Code SAMPLE DATE: 11D -a ISI Ara� Month Day Year SAMPLE TYPE: )( Routine E Treated Water Repeat Sample Untreated Water (refer to lab no. 1 Special Purpose Time Collected Locatiop Collected from: Collected: by (Initial): I-IC7 kfa114 4RI1410"lli 12610 "r. C Analysis shows this Water SAMPLE to be: XSatisfactory ; nsatisfactory J Sample over 30 hours old. Results may be unreliable. Sample too long in transit. Sample should not be over 48 hrs old for analysis to indicate reliable results. Please send a new sample via special delivery mail. Date Received: 01 li� I ppb Time Received: _ 2� Analysis Began: 14 c57/ Analytical Method: Lab Ref No. Membrane Filter MMO-MUG Result* Analyst 98.6058 LIEL i OG I r �_ W to 41; Number of colonies/100m1 Sent to ADEC: ANC FBK JUN U Fax Date: Time: Client notified of unsatisfactory results: Phone Date: MMO-MUG Result: Total Coliformn E. Coli Membrane Filter: Direct Count �-lo 14, Colonies1100ml Verification: LTB BGB COLIFORM Spoke with Time: Fecal Coliform Confirmation: _ Final Membrane Filter Results: CollformN00ml Reported By: Date: Time: 1(4-,5o hrs EDmments: Pre -Paid. Thank you. Fax TNTC = Too Numerous to Count OB =Other Bacteria �woo� EIM Member of the SGS Group (Soci6t6 G6n6rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID Parameter CT&E Environmental Services Inc. �/JO! LfF�f-7L��176f�f E7�7�1�1-iiJf�E/EEi9f7EL�i3 986058003 Tobben Spurkland P.E. n/a 2/G Knik Heights Drinking Water 0 Client PO# Printed Date/Time 11/12/98 07:51 Collected Date/Time 10/27/98 17:10 Received Date/Time 10/28/98 08:45 Technical Director: Stephen C. Ede Released By Results POL Units Method Allowable Prep Analysis Limits Date Date Init Total Coliform 8 08/100 ML, NO COLI SM18 92226 10/28/98 KAP Nitrate -N 0.716 0.100 mg/L EPA 300.0 10 max 10/28/98 10/28/98 GCP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL k -A YL — `a"b OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) V,buK IAC- -ri5 -suen LZT BLY��_ cam_ Location (address or directions) 12840 P_% N000 (b) Applicant Name 101-(N INC,a6fa Telephone: Home _L 2_5 Business 5_62-7�q7 Applicant Address _-!VOE /c� A DVC (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder'K ;Buyer Il ;Other Cl (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family C] Other Number of Bedrooms 3. WATER SUPPLY Telephone Individual Well X Community 1.7 Public [l Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,64) 5. ENGINEERING FIRM PROVIDINv 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 Heaf'th 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 inspction. Name of Firm Q e, a,;, pifrlg/ /1 / Telephone Address Date / �� ooa oa ooeo o^�000a ti�A�t3 \ x000` 900Pao 900 00000o00o0 4 Oboe 05 9 19 e0 •oo G� zms ��V y Mere Car . 353 �i ��o0po 0e 99 00000 04��>��.3 AROf'ESS1S� a w, 6. DHEP APPROVAL Approved for ',LLC' C = bedrooms b ! l f Y �� Date _ Approved ( Disapproved Conditional Terms of 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) GI AMS MUNICIPALITY OF ANCHORAGE (MOA) 1 AGN HEALTH AUTHORITY APPROVAL (HAA) { CHECKLIST - FERRUARY 1964 zea -4744 NO11,)31O23d 1'd1N9MObIAN9 '8 H11V3H aO Ad34 >JV21OHDT4V 30 jkJ11Vd0tt nV4 A. WELL DATA Well Classification IPP10 AT6 Legal Description: /wg /foC/9T:!5; two LOT BLUGIC C7 - If If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed NoV�1il�t�z r Iq�?C) Yield ( r Total Depth yeCased Io RF) Depth of Grouting Static Water Level 0a'' Pump Set At U�UwN Casing Height Above Ground f 12 /��(�� Sanitary Seal on Casing (Y/N) F: 5s Electrical Wiring in Conduit (Y/N) YE`-' Depression Around Wellhead (Y/N) NG Separation Distances from Well: f To Septic/Holding Tank on Lot (X -f' — ; On Adjoining Lots �0 r r To Nearest Edge of Absorption Field on Lot + On Adjoining Lots Q + To Nearest Public Sewer Line No To Nearest Public Sewer l Cleanout/Manhole 10Ot + To Nearest Sewer Service Line on Lot 50 Water Sample Collected by 5EP Date Water Sample Test Results -5A77j% A"�%� y Comments A 17` G /W (,(JEU W6 B. SEPTIC/HOLDING TANK DATA Date Installed 11 �� Size loco - No. of Compartments -2- \ Standpipes (Y/N) I Air -tight Caps (Y/N) Neck Foundation Cleanout (Y/N) r ONO PF 0�'J Depression over Tank (Y/N) Wo Date Last Pumped Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Ht olding Tank: Temporary Holding Tank Permit (Y/N) To Water -Supply Well JC0 + To Building Foundation To Property Line 10, '"E' To Disposal Field Sr* To Water Main/Service Line �O + To Stream, Pond, Lake, or Major Drainage Course I00I+ Comments: /1�7�� jfJ� IZ1 Q_1I.' I" V(( 2��7— Page 1 of 2 77{176 (Rov S'861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 150 Type of System Design 141 D Date Installed I( � Length of Field Width of Field INCNec�, Depth of Field / Gravel Bed Thickness 4 - Square Square Feet of Absorption Area ti>l0 Wit` Standpipes Present (Y/N)`� m i Depression over Field (Y/N) NG Date of Last Adequacy Test Results of Last Adequacy Test �i✓f�� Separation Distance from Absorption Field: i To Water -Supply Well _ loo To Property Line To Building Foundation Lot On Adjoining Lots To Existing or Abandoned System on '47-51 To Water Main/Service Line *'_15' To Cutbank (if present) "_ (0 I To Stream/Pond/Lake/or Major Drainage Course (tom + l To Driveway, Parking Area, or Vehicle Storage Area J5 4— Comments � � A_71*VW �t� �^�il(�dJ Pao -` D. LIF TATION Date Installed . Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test, Meets MOA I certify that ave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Qa / Date Company C� e 1Ei MOA No P; i 1. Receipt No. 16 � °"Q000r"0 ° p p Date of Payment Amount: $ () /) a 00 0GSlglfn Eif Oona u0 Page 2 of 2 72-026 (Rev 8'867 Back c o Care 5 Mayo53 pI?OFE550 v aao a A �g ogo D eoa000ao-�Buoeaeo eo'o ooeoa a eo v e •a a aoao •o Q ®® �aa9 Tf •53 •o S'� 00 aQ48��PESS � 0 90044 RO Location: BESSE, EPPS & POT1'S 2220 EAST 88 AVENUE ANCHORAGE, AK 99507 (907) 349-6451 WATER WELL TEST Date: JJ 1 GG> Subdivision: VNIV- HEIWr--,� 5Up0" Lot: Z - Block: Client's Name; -Joq J l ��B� Address: PZ040 2fD6W000 acNy2A-�E !�K Tester: e/L - L3Cp Initial Reading on Meter: 0/3 TIME GPM GALLONS A VOLUME GALLONS TOTAL VOLUME O yoUUm� vn��r�? 1 J3 3,5� 1 215 02 J1= 8 1. f5 U 1( 33 OD Z5 It i 47GG 2.. 1 1 10 J /Z� 2-.C42Z 13!2 7Z 1 :r 2. . g 2155; --j.Eo r2..3"Z - ZSZ Prrrinr•f-i nn Ra ha e 144 GPM 9tLu ,,, rrv, , f.. gr(1/) r-, i i,. - ISAACS PUMPING SERVICE (Norm Tibbetts Owner) 6215 Quinhagak Street ANCHORAGE, ALASKA 99507 Phone 563-3300 ORDER NO, I RHONE I Vi - 19 1 I ,' I I I I_ -- TAX �F i �D 1 RECEIVED RV TOTAL All claims and returned goods MUST be A ^ -q (� ¢ccompanied by this bill. -- -1 2872 PO iri 693 Ve �s Ir- G�!n -1011 t MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEATTIi DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date �,.,, (a) Legal Description (inclu4e lot block, subdivision, section, townshi, .range) U' I' i>05 i�� i��L<' K �•i ..� _ << ! U: 'r �, • c? X57°�d1 Location (address or directions) (b) Applicants Namel�j�/'� i ��" Telephone Ilome'if� '1 �'fiusinees��;� Applicants Address��„G (C) Applicant is (cheek ane) Lending Institution ; Owner/builder Win; Buyer ; Other E:�j (explain); (d) Lending Institution®�'^ ti Address (e) Real Estate Co. & Agent &I Address 3_5 2. TelephoneD. (f) Mail the HAA to the following address: Single -Family Multi -Family Number of Bedrooms .7 3. Water Supp Individual Well i .71_ ! Community Other (describe) _ N Public 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 r Onsite Public Community Holding Tank Other (describe) _ N Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1. of 2] S . Engineering Firm Providing_ Inspections, Testsi File Search Data and �c,b �waeion 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 onsite 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 N1unicipality of Anchorage files and from my j investigation and inspection, the on-site water supply and/or wastewater disposal System is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. j Name of Firm, Telephone�3 !• �/ 7 // Address 2. �Date�`'••�..-.r.�o°„�p,°-�M¢�'kgt-�a•.v..�..m-....��, ��°000>o os a n°>a000>o°L� (ENGINEER SEAL � 6. DHEP Approval Approved forG Y_x..bedrooms By Approved Disapproved Terms of Conditional Approval G) o NEIL Dat-------------- e..;/;/� e Conditional CAUTION a THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL FROTECTTON (DHEP) ISSUES HEALTH AUTHORITY P.PPRUVAI CERTIFICATES BASED SOLELY UPON THE REPRESEtIT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERID IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO P RtCILUERS OF ROMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. ZHPLOYEES 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. (DHEP SEAL) RR4/ej/Dl8 [Page 2 of 21 7-19-84 MUN141PALITY OF ANGHQR.AQE DEPT, Of HEALTH & ENVIRONMENTAL PP,OTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLISF FEBRUARY 1984 264-4720 RECEIVED ECEIVE Legal Description: /PGcJ %i 2- /V A. WELL DATA Well Classification % vC_ iC�If A, B, C, D.E.C. Approved (Y/N) /U//� Well Log Present (Y/N) — Date Completed — % 6D Yield S 7, / hovr Total Depth >ft _ Cased to Depth of Grouting N Static Water Level S� Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot > /00 / Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) On Adjoining Lots ? /Ota To Nearest Edge of Absorption Field on Lot > /oo _ ; On Adjoining Lots yUo To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole _ N /4 To Nearest Sewer Service Line on Lot / 5 2 5— Water Water Sample Collected by /U% N ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size —100eq No. of Compartments - o�7 Standpipes (Y/N) 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 14! Holding Tank High -Water Alarm (Y/N) At Temporary Holding Tank Permit (Y/N) �V 1A_ Separation Distances from Septic/Holding Tank: To Water -Supply Well >/o0 To Building Foundation To Property Line i /U / To Disposal Field ';�' 5 - To To Water Main/Service Line ,? s To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 C. ABSORPTION FIELD DATA z Soils Rating in Absorption Strata /S_o 4 Type of System Design %re vi c Date Installed )1 A /,qr) Length of Field "52 � Width of Field _30 M.Yw'oeh l`4 Depth of Field R 11 Gravel Bed Thickness 1'/g Square Feet of Absorption Area %E S�G 2 Standpipes Present (Y/N) y Depression over Field (Y/N) Date of Last Adequacy Test 5111- IRS - Results of Last Adequacy Test' c- 6 1_ I t n 30 1, n Separation Distance from Absorption Field To Water -Supply Well > /06 To Property Line /7 i To Building Foundation > -0 To Existing or Abandoned System on Lot On Adjoining Lots To Water Main/Service Line ?` 2 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course N 1,4 To Driveway, Parking Area, or Vehicle Storage Area i .30 Comments D. LIFT STATION N 1A Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify thatl cl ed, v r'fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed 5_11 Date �/ .7 �BS Company w -J rX e– MOA No. ST �S n J r � Utjn _ Receipt No. L 4°...°,, � 6c K�, * Date of Payment t�" 3 4 c— C r ��o !3 % °°° :{ ', Amount: $ �6 n gi .1 4\ u NEIL. 14A','.'; Page 2 of 2 72-026 111/84) �. 5. LEGAL DESCRIPTION DATER CEIVED INSPECTION APPOINTMEN STREET LOCATION TIME TIME TIME NUMBER OF,BEDROOMS El one C] Four El Other DATE DATE L4 DATE INSPECTOR INSPECTOR D ( INSPECTOR MUNICIPALITY OF ANCHORAGE {�� OF HEALTH & ENVIRONMENTAL PROTEC ICIPALITY OF ANCHOPAGE DEPARTMENT • 825 L Street • Anchorage, Alaska 99501 DEPT. OF 11=AL1 i I & ENVIRONMENTAL PkOTECTION ENVIRONMENTAL SANITATION DIVISION _ LC )ty ❑ PUBLIC UTILITY Telephone 264.4720 6 1 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEII&IryE rACjLVIEr.FA DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 00) days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If differentfromabove) PHONE ICO ATI _ 2. 13UYER ZtI.11- "SGv'S�-I PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. R ALTOR/AGENT LA4r�i( c4N)-ZA /To oy rrCy PHONE MAILING ADDRESS q0 20 L,R )-)/7 i t�L'fC"G - �. 5. LEGAL DESCRIPTION / y �©-r rC?� L 7( L /�- / q /t /1/ l / \ �1 �J r STREET LOCATION i � r 0 U 25-- 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS El one C] Four El Other . SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY 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.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE**� YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) // 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 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 El PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or O Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS UU---APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY R , non In." F/741