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Home My WebLink AboutKNIK HEIGHTS BLK H LT 17GP"~,TER ANCHORAGE AREA BOROI"~H HEALTH DEPARTMENT 327 EAGLE ST, ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROMWELL LIQUID CAPACITY__./) GALLONS. ~'~ . MATERI~L _COMP~RTMENTS INSIDE L~NGTH INSIDE WIDTH _DEPiH~ SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF FITS_ / OUTSIDE DIAMETER '~ OR WIDTH _ . ~(~"~r~ , DISTANCE FROM WELl. NEAREST LOT LINE (~.,~ '-'] TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) / , LENGTH ~'?~' , DEPTH_ d" BUILDING FOUNDATIO~ ("~~7 Z''/ SO. FT. TILE DRAIN FIELD: ATION DISTANCE F~(OM WELL / / NUMBER OF I~ //"' DISIANCE BEI"~EEN LINES ABSORPTION AREA SQ. FT. DEPTH: TOP OF TILE 1'O FINISH GRADE LENGTH OF EACH LINE DEPTH OF FILTER MA1'ERIAL BENEATH TILE IN. ABOVE TILE WELL: Ty p*E ~,.~.7 6-L- ~' ~ DEPTH ~-"~,~)'/ / NEAREST / SEPTIC LOT LINE /~ '~ SEWER LINE~Z) ~,TANK DISTANCE FROM '~ SAMPLE (. ,//~/, NEARES1' , BUILDING FOUNDATION. ./'~ t WAI'ER ,.~ ~ ,J SEEPAGE Oqg / OTHER SYSTEM / , CESSPOOL ,~ SOURCES DIAGRAM OF SYSTEM DISTANCES: DATE APPROVED GREATEr 327 Eagle St. ANCHORAGE AREA HEALTH DEPARTMENT Anchorage, Alaska 99501 OROUGH 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT ~PP~I]~ATION TO INSTALL: SEPTIC TANK L// .,SEEPAGE PIT. ~" ,DRAIN FIELD ~ ,OTHER_ FINANCED~_., THROUGH ~/~ TO BE INSTALLED BY_~ ~ >: P~CO ..... ~ TEST RESULTS ANTICIPATED DATE OF COMPLETION BELOW TO liE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS k 5' ~'* ~'~ · --- , PERMIT TO INSTALL A . _AS DESCRIBED BELOW, SIZE OF UNITTO BE SERVED ~~ , SEPTIC TANK SIZE ~ ~ TYPE ~'&~CPS E EPAG E A REA ,5~ / ~ ?~%~ TYPE DIAGRAM OF (' ' ,,YSTEM I certify that I am familiar with the requh'ements of Greaf~er Anchorage Area Borough Ordnance No. 28-68 and that the above described sy~em is in accordance with said code,/ ~ _ ~ - c:'. ~ ~ } GREATER ANCHORAGE AREA BOROUGH c(:~,~,~, HEALTH DEPAFTMEqT CASE .~t 557 '~..~,,) 327 EAGLE STREET -'~--=~~ ~' ANCHORAGE, ALASKA 99501 ~ FoWQ~[e[ Reed & Spirt[er Date Performed 5 [9 70 Descu-~pt~,O~'~ Lot ~7 BlocK~ ~uod~v~.szon.~_~hts -- Reports a: So~ls Log~ ~~~{ rest Soil Chamact eris*.ics -- r~-kT[[ with occasional coarse gravel (ML) Gray fine sand (SP) Gray sand with fine gravel(SW){ Brown silt (ML) Was Ground Water Encountered? If Yes, '+ ~,~'at Depth 6 8 10 Gmos~; Time L---"---Z Seepage Pit Net Time Location Sketch Net Dmop 7YZZZ'L Depth To H20 DPain Fleld Depth Of Inlet ...... !)ePt'"~--"~"o-'~~it Or 'i'Pen¢}"['--'~ ........ COMMENTS: Draina2e area should be 214 S~ ft ......... , , Der bedroom or 642 ft, for ~~om dwelling ' ~~ ........... Test Performed By: R. E. Carlisle Data Ce~tifled By: Date :~=--~-- ' --~-~ ...... MUNICIPALITY OF ANCHORAGE oc=- 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. 017-372 3q Expiration Date: 9 ` / �- 2-d 2`Z 1. GENERAL INFORMATION Complete legal description KNIK HEIGHTS BLOCKH, LOTS 17& 18 Location (site address) 4820 FAIRMONT ROAD, ANCHORAGE, AK 99516 Current property owner(s) JAMES & JUDITH DAVIS Day phone Mailing address 4820 FAIRMONT ROAD, ANCHORAGE AK 99516 Real estate agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 550 Waiver Fee $ Date of Payment 51-z- t4 Date of Payment Receipt Number _,3 c) q 2.0 '1 Receipt Number COSA # O S C,2a I'� a� Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 5/20/22 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the •�(� t well and septic system. Therefore, any estimate of how long a system will function satisfactory �rg•�Q: • • • . !1.9 �� for current or future occupants or guarantee that no unseen encroachments, deficiencies or /* • TM discrepancies exist can be given by First Water Consulting & ks / — I 6. DSD SIGNATURE • • '. j Curtis Huffman System #1 Approved for bedrooms ��F��s•, CE 128991 •.`�r eF *•.5/20/x2•'� System #2 Approved for bedrooms il�010ROF�E`sSSVAX\F= Disapproved Conditional approval for bedrooms, with the following stipulations: `s��Qp,�\TY OF JnAj_o,-,_ O:�3 JC WATER - ' ` Y fA AND m WAT ^ PROr�r ER n 1 SERVIGi:: i BY �`-- Original Certificate Date: -� V—z D2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: KNIK HEIGHTS BLOCK H LOT 17 & 18 Parcel ID: 017-372-17 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test .47 gpm Date drilled CIRCA 1970 Water storage tank volume 300 gallons Total depth 201+ ft Well disinfected for coliform test? ❑ Yes ® No Cased to UNKNOWN ASSUMED 40+ ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate mg/L ® Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 12+ in. FW�s ES Date of flow test for COSA 5/14/2022 Collected by Static water level at beginning of test 139 ft. Date of Sample 5/23/2022 Comments LOWER WATER VOLUME FOUND AT TEST & PER OWNER. MAY CONSIDER ADDITIONAL STORAGE, WELL SERVICES,... FOR PEAK USE AND/OR INCREASED WATER VOLUME / PRODUCTION B. TANK DATA Age of tank(s) 17 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 5/13/2022 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/12/2005 ® ALL standpipes present per record drawing Total measured depth from grade 9.3 / 10.3 ft (max) Measured depth to pipe invert from grade3.1 14 ft (min) ❑ N/A — pressurized field C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 5/14/2022 Results ID Pass For 4 bedrooms Fluid depth prior to test 37 / 36 in Water added 1000 gal New depth 63162 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 720 min depth into effective MISSING 0.8'/ 0.5' ® Code -required soil cover over field Final fluid depth 45 / 48 in (600+ GPD) ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: MT/CO AT GRADE. NE TRENCH / NW TRENCH ELEVATIONS.... Fwcs E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION `��~`~�,\�,` Al l 1 certify that I have determined through field inspections and review x4-1 ?* , • •' • .f of Municipal records that the above systems are in conformance g.' with MOA COSA guidelines in effect on this date. rJ • • • Curtis Huffman ' I �� c�sl •' • b %2092•'.\ ft ft ft ft ft ft ft ft Municipality of Anchorage Development Services Department s....... Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC221228 During a recent COSA on-site inspection and test of the potable water supply well on Block H, Lot 17& 18 of Knik Heights subdivision, the well's productivity was determined to be .47 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is .41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. · DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPI:CTOR,~, MU NICI P,~I'TY?~ ~"~ CH O RAG E DEPT. OF HEAl. TH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL F;,o'rECTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 LStreat-Anchora§e, Alaska 99501MAY 1_ g 1.981 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 ....RECE! ED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER J PHONE Robert & Edna FunkI 345-5202 MAILING ADDRESS SRA Box 1592E PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE Unknown at this time. MAILING ADDRESS 3, LENDING INSTITUTION J PHONE Unknown at this time.J MAILING ADDRESS 4. REALTOR/AGENT J PHONE Elliot C. Lawson, Jack White CompanyJ 277-1553 MAILING ADDR ES8 3201 "C" St., Suite 100, Anchorage~ AK 99503 *NOTE: Send all information and reports to Elliot Lawson at the above address. 5. LEGAL DESCRIPTION Lots 17, 18, Block H, Knik Heights STREET LOCATION Corner of Ridqewood & Fairmont Rd.- ~, ~'f2.~ ,_> 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS [] One [~ Four ~{ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG, A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, g~ve well depth (attach Io9 if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** [] PUBLIC Ul'l LITY 1970 ,~ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCES,~ING CAN BE INITIATED. 72-010 {Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]~NDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank 1Absorption Area Sewer Line Nearest Lot Line WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS ' AFPROVED FOR BEDROOMS [~ CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 204-41I'i G :OFIIiE M..SULLIVAN, F.'] A Y ( ) l:t ()iP,'~,III'M[:NTOF I IFAI.I'tl AN[} ENVIIIONMi:NT/\I tdI()TI!CilOM FIay 19, 198]. itobert/Edna Funk Star Route A Box 1592E Ancho:age, Alaska 99507 oub.]ect: Lot 1'?, 18 Block H !,n.tk Heights Sub,d'~v~.s~on Approval for the ind:i.vidua], sewer and water facilities cannot be granted until, the following 'it. ems have been comp]_e t'ed: , (2) The water analysis report need. s to be submJ, tted to th. is offJ.ce from t:he Chem Lab, 5633 B Street, 1~O12 ()~12 lleVJ eW. Tile ' ~' ' ' ... sep~..}..~ tank pumped with ve::J, ficat].on oF the gallons pumpec. '.Oh: s will need to be yeti lied by a ~.(._~_,,L~.~e_. engineer, An adequacy test needs to be performed on the existing leaching area~ This [:.est wii1 determine if the system is adequate according to National. Standacds. A listing of private firms performing the test is enclosed. '.l?his report needs to be submitted to this <:)ffJ(2e J%'or review. iff there are any gur[:her questions, please oall this office at 264-.,t720. Sincerely, Robert C. Pratt, Associa[:e Special. is t ReP/]_ j w k'..]. ]. iot C. I,awson O,o Jack White Company. ., . 3201 C Street 99503 ]~11 iot Lawson Jack ';~hite I~ealty 3201 C St:c~et ~mchor. a~e ~ Ako 99~502 81§§ Cranberry St. Anchorage, Alaska 99§02 Phone (907) 243-§302 Oune 1~ 19~1 MUNICIPALITY OF ANCHORAGE DEPT. OF i~L.'~LTH & [NVIROI~MENT~L RECI!IVED Legal.: Loc o.t ion: l~esidenco; war er; Date of Tent ?e~t ]?rocedul'e Lot 17, ltl, Jf~ }(rtJk Hoight,~ Corner F~Jrmont and Ridgewood Funk ~!wo storey, four bedroom~ 1976" ~-~ innspect_on report lints residence as three bedroom Onsi'L e we].] No municipal con~r~ruction record,'.~ Pumping test indicates I~000 Oa] tank Absorpt :i.on system~-- p:cobab].y q-' di~neter concrete crib System installed in 1970 Lystem w¢~s :inspected on Nay 26th. 65 :inches of liquid was measured in crib~ Both crib amd tank stand pipes ~;!~ot.~cd r;:i.gno of si udge del¢osits on pipe wcJ_ls. C~,mb is 8 feet deep. Tank was pumped on liay 27th~ less than 1,O00 gal was removed from tank~ Prior to p~rnl:~ing crib depth was 7~ inches, immediately after pumping depth was ?0~',: inchef;~ indicating surchar[~e of crib and t ask. On M~ 28th api~ro×imahe].y 300 u;ol 0:6 water woo added to crib~ Water was heard entering the tank at this point and charging discontinued° ¥iater levels in crib were 51)~ and ?fl}~ inches before and after adding water~ On l~[ay 29th wator a..p~h war~ l:~ Tobben Spurkland P.E. Test Result On Hay 3Oth v/ater was added to the crib at a Pate of .5 gal t)er rain m~d the following mcasuremer¢;s were t ak e n; Water Volume (gal) Dcpth( :i.~che. s) ~Y~ 6~ Stop WateP monitor absorption I[0 g~L was measured up and added to 'the crib~ water level rose to ~jS~ inche;3. Thc sy.,;tcr~] absorbed moz'¢ than Il-() Se(L in a time period of 96 min. In a 2h- hour period this is mor~ than 600 gal, the mun:[cipa~ requirement for a four bed~ room house. Jiowew~r there were sigms off previous over:[low in the sysl;em and p~usent surcharges~ The surcharge capability off the system is limited. O~h.e l;ank J.s not at the required size. m~ additionci ~ank must be added~ I reco~,~;~end that a new absorption system be installed a't :. tho same time, mainly due to the lack of ~-mrcharge capability, but also because tho expected useful life of the absorption system is shoPt ~ Elliot Law;-:o n ,Tack White j, 201 C Anchorage ~ ifl, aska Tobben Spurkland P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 MUNICIPALITY OF ANCIdORAGE DEPT. OF I-,'EALti{ & FNVIRONMENI'AL KO'friCTION jLiN 1198i RECEIVED J'urm 12, Legal The Funk Re~idence, Per the. request of I.[r~ Funk I ~:'el}eat(cd thc pu,!ping of the sepl;ic tank 3.~: his z'e~ddence. 2}).:is riffle I ROe(l Isaac I'uh:ping Service. ?}lo 2000 sal tonic t:ruck was e~t~pty prior to pulHpinf~ and rogJ.stred appmoxfimately 1200 [~al at the complet ion of the pumping opert.~ion~ Thir; does indica!:e a 1250 gal tank, not a 1000 gal as I st;,ted in my original report of June 1, 1981. I also checked the lir..ui.d ]evel J.n the cz':L1}. ~t N~.i,s date the ',,'a~e:r depth was ~;~ J'~z'~ ~'~.nk stated that his family was a h~avy user ofwa~,e:po The overf]ow indications that :[ noticed oil my original inspection o~ the system may have been cauned bysuch high wate~ consumption, With normal use and with the addit:iona], pump:lng iufoi'mation I mus~ conclude that this system pz, obably moots the municipal requirements for tank size~ absorption rate and shock loading. Tohbem Spurkla :.,'. :[:' (,'l. ti S{::~:'e¢-~L L;L~:~ L.-::-~ iL'JO Tobben Spurldand P.F_. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 Ell iot Lawson Jack Whi~e Co. ~201 C ~Jtrt'et anchorage, ~"JL~ka99..~0~':' '~ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL P~,OTECTION R[C[IVFD June 18, 1981 $ J,; W ;t,] R A D J~] ,;¢ U A C Y T E ~.; 1~ Legal Lo% lr? and 18 Block h, Knik Heights The Funk Residence As requested by Mr. 1,~unk ! repeated tge pumping of the septic tank ab his ro~sidenco~ This time I used Isaac Pumping Service~ The 2000 gal tank truck was empty prior to pufnping ~d registered appz'oximately 1200 gal at tho completion of the pumping oi.~oration. This does ind:i, cat~, a 12~O g~d. %ank~ not a 1000 gal as I stated in my original roper% of June 1, 1981~ I a].~;o checked the ]i(m:.d level in the crib° At this date ( June lOth ) the water dept:h wa~; 42 inches,, Mro Funk ~vtated thai; his £~m:L]y was a heavy use]' o1' wa'~cr~ The ow,~rflow indications that I noticed on my original inspection of the ~;ystem may have been caur;edby hJ.~h water consumption° With norm~JL use and with the a((ditJ.onal pumping information ~~- i must conclude that 'this s ~:tom meets the municipal ~.. 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received July 15, Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. Klaska Mutual Savings Bank Post Office Box 1120 John Jutsum Out of State Phone: Phone: 1976 1:30 7-16-76 Friday Pratt 274-3561 3. Legal Description: Lot 17~ Block H Knik Heights Subdivision 4. Location: Corner of Ridgewood. and Fairmont Road 5. Type of facility to be inspected Single Family 6. Well Data: Individual A. Type C. Construction 7. Sewage Disposal System: A. Install ed /~-~>, No. of bedrooms B. Depth 170 ' D. Bacterial Analysis On-site system B. Installer C. Septic Tank: D. Seepage Pit: E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank 1. Size 2. Manufacturer I. Absorption Area 2. Material Total length of lines , Absorption area , Other contamination C. Absorption area to nearest lot line , Absorption area , Sewer Lines EQ-034 (1/74) Page 1 of two pages GREATEk ANCHORAGE AREA BOROUGH Department of Environmental Quality '~0 3330 "C" St., Anchorage, Alaska ~,-,ouo - 274]. ~ REQUESI' FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACII_ITIES 1. Type of Inspection: CMRO ........ VA ......... FHA M-4'~pg Address: ~- / ~~ Day Phone Mailin9 Addwess: ~,~._~_/ ~'~- Da~ Phone 4. Name of Lenciing Institution: ~;~ Mailing Address: Name of Realtor or Ageni;: /~4' Mailing Address: ~"~/ ~ CONV __~ o Type of Facility to be 'inspected: 4,~.¢.. No. Bdrms. ~ Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If' Individual, depth of well Sewage Pisposa'l System Type :of Si/stem: Public Utilil;y ][¢ Individual, date of installation Individual (on-site) Page 2 of two pages - Re st for Approval of Individual , er & Water Facilities Legal Description Lot 17 Block H Knik Heights Subdivision Comments Approved Disapproved Date Approval=Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) FHA Form 2573 Form Approved Rev July 1958 , FEDERAL HOUSING /ti)MINISTRATION Budgel Bureau No 63-R296.8 'HEALTH AUTHO~'fY APPROVAL ~B~VIDUAL WATER SUPPLY A~D SEWAGE DII~PO~AL SY~T~ PART I.--TO BE COMPLETED BY FHA INSURING OFFK~E MORTGAGE~ .... SERIAL NO. ---- -~ ..... First National Bank of Anchorage ~ncnorage~ A~aSEa BO× 720, ~uchorage~ ~s~ j 1~-01060~203 MO~Tb~GOR'O~ ~P~SOR ~ ~oPERTY ADDRESS ' - Jo~ W. J~ts~a [E~ ~dgewood Eoad~ ~chorage~ ~las~ SUBDIVISION NAME! I~d.k Heights S/D TOTAL NUMBER: BASEMENT ] New installation I BL0~I< NC). [LOT NE? Can ~ttic or other aro~ be mflde into additional bedrooms? LIVINO UNITS BEDROOMS BATHS ~WATER SUPPLY BY: .... ~ [ SYSTEM DESIGNED FOR wAGE DISPOSAL BY: [~ [,!dividual /j ~J~ ~¢s-- Public system [] Community system PART II.,--TO BE COMPLETED BY HEALTH DEPARTMENT HEALTH DEPARTMENT INSPECTOR'S SKETCH It is the opinion of the [] State [--] CouDty ~ Local Department of Health that this individual water-supply system [] is [--] is not satisfactory as a domestic water supply for the subject property. It is the opinion of the [--] State [] County [] Local Department of Health that this individual sewage-disposal sys- tem with proper maintenance: [~] Can be expected to function satisfactorily, and [] Cannot be expected to function satisfactorily is not likely to create an insanitary condition Aug. 25, 1970 /"/,¢,~-' ¢1.~-.:/_..-~ ,/ ._/ ~-:.:. ;( ::-:?~jEnviro~ntal Health Supervisor ~~on mnt b NOTE: The heaDh ~ut~ sho~l ~plete the approprlate opinion s,ate e ~ eve ~md offix date, slgnature and title in ~he spaco~ provided. Uso of the above grid for Iqe~lth Department Inspector's sketch as well as use of the back of this form is ~t the option of the health authority. PART Ill.--FOR USE OF FHA OFFICE TO THE CHIEF UNDERWRITER: I have reviewed the foregoing and the pertinent FHA Compliance Inspection Report, and recommend that'the Individual water-supply system be considered [] Acceptable [] Not Acceptable Sewage disposal be considered [] Acceptable F-] Not Acceptable. DATE SIGNATURE CHIEF ARCHITECT DEPUTY FOR CHIEF ARCHITECT HEALTH AUTHORITY APPROVAL FHA Form 2573 INDIVlDIJAL WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM R~,. July 19.58 REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Trip_licate) ...... Wel] data: b, Depth .~) / c. Casing SJ. ze~~. Distance from well to closest existing or proposed: 1, Sewer line '~/' , 2. Septic t ankh, 3, Seepage Area ../t~ / . 4. Cesspool' 5. Property Line 6. Other souDces of possible contamination~.e,, creeks, lakes, houses, barn, drainage ditch, etc.__._.~.__.~_.___~. Sewage disposal system, a, Age of system /~7~' , b. Septic tank capacit~,~.!n..gal'lons /~ ~.% 1. If "home made" show dla~pam on reverse side of this fopm, de' Disposal field or seepage pit size and type _- . ........... ~'~. / ~ 1, Distance to prope~y, line ~72' ~ .... J ~F to house fo~dation, ~.,,~], ~ e. Perc~Latlo~ Te'st Yesults the reverse .side of this form to show diagram. ,Diagra~ should include .... following information: OFoperty lines~.w~ll location, house location, '~p~cic tank location, disposal area location, location of percolation test, an~..~ direction of ground slope. 9. The }~fo~matlon on this form is true and correct to the best of my knowleOge, TO BE FILLED OUT BY HEALTH DEPARTf. IEN. T PERSONNEL ~--~'he above described ~anitary facilities are hereby approved, subject to ~he ~611owlne condillons Conditions: .... The above described sanitary facilities are d~s~.ppPoved' '~ for the following reasons: /o7 lOT I /d dA M~$ B. ROOSERS Registered Land Survexor BRA 8ox 1618 G Anchorage~ A Ioska ,99507 (907)~45- 0927