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HomeMy WebLinkAboutKNOLL ON THE WOLD BLK 1 LT 3Knoll on the wold Block 1 Lot 3 #041-031-54 MUNICIPALITY OF ANCHORAGE m ® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L- Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME P1HONE v� {� V?--NEW __ / V" "_`."L'�—�^---I/—V_✓---------------------------J.�C3`Ot6:X.T� UPGRADE MAILING ADDRESS LEGAL DESCRIPTION Z- 3 QZ LOCATION ,P-.e NO. OF BEDROOMS U DISTANCE TO: Wel , U Absorption are I Dwelling / ! r C PERMIT Oa/7� or. 2 LU Manufacturer Y Ma eri No. of coriyWartments oL �r — �Liq. cappq.gy iinga_l ons IF HOMEMADE: Inside length Width Liquid depth Y JZ z 2 _ FQ- DISTANCE T0: Well Dwelling _ _ — Manufac '� .-___- teriat' _ PERMIT NO. ____2 -- LicFutd=capacity in gallons - w S DISTANCE TO: Well f— l Y>C) Foundation t' -U Nearest lot line {— ! O PERMIT N / r C © C- r6 Z Z w No. of lin Length of each lin __ s Total length of li es _ Trench width inches Distance �q wen lines /LJ Q� r p Top of tile to finish grade Material beneath tile /.�' 4r. Total effective tion area �.!�i 2j w Length Width Depth PERMIT NO. Q r a d W Typeof crib Crib dia eter ,Friti-depth Total eff - a so ption area Lu DISTANCE TO: Well Building fc1iindation -,'Nearest lot line J ss C (1` Depth Driller Distance to login PERMIT NO. /� Ll w DISTANCE TO: -- Building foundatir ' — O�� Sewer line ( - Septic tank ! �� Absorptio area OTHER — PIPE MATERIALS SOIL TEST RATING INSTALLER t REMARKS 1 _ +1 vy U —I 2 C�DATE LEGAL ��_nt� IRA(✓.�n>zl !/ ism 0 Z O A Z J_ Cd Lu z V P,: ra;4-3 i i i : N 3 w a , oz F44 F �Fy �FyFyy k� W U A W �Fyy Lr. FF G4 DHy Gw DHyy k� �I N: rof E a; J �: ROi Oi z:c 0 W 00 m M N v A N F7 i i i : N F �Fy �FyFyy k� W fry W �Fyy Lr. FF G4 DHy Gw DHyy k� N: rof E a; J �: ROi w' Q'i V4 V4;4 b Cd w w w w w w w w F7 i i i : N o: r4:: r: N: rof E a; J �: b m �--�: ro Ni N i ro i : N Ei ro: ro i M cn n: U •. O r-1: CO: M N : O O; O : r --I r-1: N j a): H Hi r-1: H I O O O O O O O O O O O O H H H H H H H H H H H H w w w z ! of ra 00 HO O N : Ol r-1; r1 : rl O O O O O O O O O O O O O w W is P'i W Q'i W' 0. a ♦Yi P: uO W F7 Q" (// DEPHRTMENT OF HEHLTH HND ENYIRONMENTHL PROTECTIOI .,I /uu 825 'L' STREET/ HMCHORHGE, HK. 99501 ���� `\ ''^.,.^. PERMIT NO.( 810948 ) 8 � A � \LL��}�[Y\ HPPLICHNT RICHHRD VOVES �951 APOLLO DR ]]] 8682 LOCHTION TERRY COURT LEGHL LOT ] BLK 1 KNOLL OF THE WOLC) k(-\ LOT SIZE 115000 SQUHRE F�ET TYPE OF SOIL HBSORPTIUN SYSTEM TRENCH MHXIMUM NUMBER OF BEDROOMS = ] SOIL RHTING (SQ FT/BR)­ 125 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� THE L�NGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELCl. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURF, HCE OF THE GROUND HND THE BOTTOM OF THE EXCHVATICAN! (IN FEET) THERE IS NO SET WIDTH FOR TRENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVRTION (IN FEET) V, PERMIT HPPLICHNT HHS THE IS DEPHRTMENT DURING THE INST�LLHTI�N INSPECTIONS OF HNY WELLS RDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL NILL SERVE �IF"..�� BHCKFILLING OF FNY SYSTEM NITHOUT FIAAL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTANCE BETWEEN H WELL HND HNY ;'iSTEM IS 100 FEET ��R H PRIVHTE WELL OR J. TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM Ell ISTHNCE FROM H PP. IY8TE WELL TO H PRIVHTE SEWER LINE IS 25 FEET HND TO H COMMUNITY SEWER LINE IS 75 FEET LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]S DHYS OF THE WELL COMPLETION, OTHER REQUIREMENTS MHY HPPLY. SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE HVRILHBLE TO INSURE PROPER INSTHLLHTION. I CERTIFY THAT 1 I HM FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE COD�S� ]� I UNDERSTHND THHT THE ON.SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS ' ,~,~ .sy SIGNE__,_____�_____- HPPLICHNT fl? ICHHRD ISSUED BY �_L DHTE -~^~==--~~��~���+ Y40 — T� ���.. n_-�-�.-..-. c. _ _� �__..-•�...-.-sv`:.m-�.�i.��.-.-..c��-�.v.c..ua-vss.r.s.:- sem.-cv..+s --.-._n+--i.=3h-.+lx._= _...ays�-�-suzi-.'L ::ri.+na�" �. .-''-,- !"1 '-$,111 lit'dG - 1=:t .'i} f 1�1-t[•�f•ii'.ii rt �... E P^.1 I f'i",•.tt \. YON I.,L- f-.— •_ :l - :,ri r :1. 1tJi,:#ltd `1`li� t -s . 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'� Ti�{r??J � r � 1 z;:'! tt rt• - - � _T rf=�f; r 9 i AURORA ENGINEERS, INC. 7133 Arctic Blvd. - 7, Anchorage, AK 99502 (907) 349.7724 2 September 1981 Richard Voves 7133 Arctic Blvd. # 6 Anchorage, AIL 99502 Subject: Subsurface investigation for Lot 3, Blk 1, Knoll On The Wold Subd, On 2 September 1981, examination of subsurface soils conditions was conducted on subject property to determine suitability for onsite sewage disposal. The soils were logged as follows: Doh Description 0'-21 OverinirdenWreddi_sh or.gan.i.c si_7.t Ti.11.- Scattered cobbles is ai.ze to 6 , coarse sand, _,,i.1i:, gavel, poorly graded. Gravelly sand-- Coarse sand with some gravel k" to 6", poorly graded. The native materials available at the bite will be very satisfactory for onsite sewage absorption. Sufficient length of perforated drain pipe from the septic tank to allow for 125 sq, ft, absorption area per bedroom should be provided, For instance, if the residence is to have 3 bedrooms, the required total drainage area would be 125 x 3 = 375 sq, ft, if the drainage trench is 4' wide, then the total required length of trench and drainage pipe would be 375/4 = 94'. If you have any questions, please call me at your convenience. Sincerely, /�yN"` moi✓ Robert D. Schilling, E. P.O. Box 215, Copper Center, AK 99573, (907) 822-3573 AURORA ENGINEERS, INC. 7133 Arctic Blvd. - 7, Anchorage, AK 99502 (907) 349.7724 2 September 1981 Richard Voves 7133 Arctic Blvd, # 6 Anchorage, AK 99502 Subject: Subsurface- .investigation for Lot 3, Blk 1, Knoll On The Wold Subd, Ong September 1981; examination o£ subsurface soils conditions was conducted on subject property„Gg determine suitability. for on-site sewage disposal. The soils were logged as follows: Depth Description 0'-2' Overburden -reddish organic silt 2',-7' Till -,Scattered cobbles in size to 611, coarse :sand, silt, gravel, poorly graded. 7'-17' Gravelly sand- Coarse sand with some grave k'A, to 6"Y poorly graded. The;.Dative materials available at the site will -be very satisfactory for on-site sewage absorpt_on.�. Sufficient length of perforated -drain pipe from the septic tanit;,,to allow .for .125 -sq ft, absorption area per=bedroom should be provided.. For instance,._ f the -residence is to have 3 bedrooms; -.the -required total drainage, aresv would be, 25•x 3,-� 375 sq, ft. If the drainage,trenchis 4' wide, then•:the-: total required: length, of trench and drainage:rpip.e would. be -375/4 = 94'. If.,ou have any questions,<please call me at your convenience. Sincerely, Robrt D!%� 11:i� E. P.O. Box 215, Copper Center, -AK 99573; (907) 822.3573.- - Parcel I.D. 041-031-54 D AUG 18 2015 Municipality of Anchora On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Expiration Date: � �/ -.2 C:0 - � 7 1. GENERAL INFORMATION Complete legal description KNOLL ON THE WOLD; LOT 3, BLOCK 1 Location (site address) 9110 TERI CIRCLE 'ANCHORAGE Current Property owner(s) SCHAEFER DELMAR - Day phone 907-230-6088 Mailing address Real Estate Agent _ Day phone 2. TYPE OF DWELLING: © Single Family (w/wo ADU) it% /��eas� k ma/r7er ❑ Duplex, ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well X❑ Individual Q Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: N/A Received by:��, Date: l.101 COSA to be released to the engineer, unless othenvise requested by the engineer. dt+L7Ne� COSA Fee $ CJZ1� �I Date of Payment Receipt Number clo3$ 2- COSA # COSA# MC\51'll 3� Waiver Fee $ Date of Payment Receipt Number 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. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101 Anchorage AK, 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date _ 6 lr In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of - - -- - - Anchorage and industry practices. The reported results describe the condition of the systemis on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the personroany who paid for this report. 6. DSD SIGNATURE --%/ System #1 Approved for 3 bedrooms 0 System #2 Approved for bedrooms Disapproved E. i.+1r r.,,;. AIV, 61 ON-SITE WATER AND WASTEWATER PROGRAM Conditional approval for bedrooms, with the following stipulations: ��IJi�FNjSERV1Oti5 Original Certificate Date: 9 - a. 0 " /-5— The Municipwit)Ki b horage Development Services Division (DSD) issues Certificates of On -Slee 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 LX Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_9.1-12,doc If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: KNOLL ON THE WOLD; BLOCK 1, LOT 3 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 9/3/1981 Sanitary seal (Y/N) YES Total depth 113 ft. Cased to **40 ft, FROM WELL LOG Date of test 9/3/1981 Parcel ID: 041-031-54 Well Log (Y/N) YES Wires properly protected (YM) YES Casing height (above ground) 12 in. AT INSPECTION 7/31/2015 Static water level UNK ft, 109 ft, Well production 11 g,p,m, 8.5+ 9,p,1n. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 2.45 mg./L. Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 7 /31 /2015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/16/1981 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N)NE High water alarm (Y/N) N/A Date of pumping 7/31/2015 Pumper AROUND THE CLOCK PUMPING C. ABSORPTION FIELD DATA Date installed, 9/16/1981 Soil rating (g.p.ddfeo /bd 125 System type SHALLOW TRENCH Length 28 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth *17.6 ft. Elf. absorption area 392 fe Monitoring tube YES Depression over field., NO Date of adequacy test 7/31/2015 Results{Pass/Fail) PASS Fluid depth in absorption field before test 7 in. Water added 687 gal. Elapsed Time: 120 min. Final fluid depth 7 in. Absorption rate >_ For 3 bedrooms New depth 29 in. ER1019 Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump off" level rr— High water alarm level Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank •I/1 Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 431 1 &11S (Rev. 11105) Ee� Sea�2 Y2, Tp� `22 's LOT 12 M Sfi.Ai: Ft -1"- AM' 9*0 LOT 4 / t/ eCi 2112 Story Frame H LOT 3 C4GUbV G l 10'Tele. B Eiec. Easement t 1.SSp pp < °00 / lNell e r 1 r / 1 / I 5 J rl mad / 3G.7 ti / CO I BASHER DRIVE 7 49t{h9P®� Fred WOlatka. ? ✓ ��`?f •, 3255-5 •�z's LOT 2 O AS811117 NO CORNERS SET THIS DATE Anchorage Recording Oleidd, Alaska, and that the Impnevemens adaztad iearaan ar. Iv,dn the prpatly unas and do not overlap el em'maah oa Na properly lyir® edjaoent thawto, Mm at no improweme oe the propeR;• h/iN adjacent !hereto encroach on the prembes in eaesGan and Inst there are no roadways, hensmiason lines or ader viaNle easamenta on sam property except as Indicated hereon. MUNICIPALITY OF ANCHORAGE • DEPARTMENT CF 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. # V 4/ — e) 3/' 1. GENERAL INFORMATION Complete legal description HAA # 0 l fj �QD9 Lot 3; Bkock 1; Knot on (0o.2d Subdivision Location (site address or directions) 9110 Tens. C.inc2e. Property owner Gordon 9 Romona Seven.sen Day phone Mailing address Redding, Cati6onn,i.a Lending agency Mailing add Day phone Agent John Huber. MARSTON PROPERTIES Day phone 245-1717 9re I rttr.l i.' a ar r rte .[ •• Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: I 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer — NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 421 5. M 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 s 9.SNEERING Phone 17034 .Eagle River Loop Road No. _2.04 Address , A tpgiFR QQq= Engineer's signature DHHS SIGNATURE ) Approved for �/ bedrooms. Disapproved. Conditional approval for Additional Comments Date • •tea®� rte•• y,.,y, • ,�� �rT H E•, �� /� • 4 < Jl� bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST (4 Legal Description: /_043 A)lpr. �ntiJ Ar- 'A)ald Parcel I.D. be -IL t1) A. WELL DATA Well type :SIN4IP� If A, B, or C, attach ADEC letter Date completed 5 -Vie/ Driller _YeA)A) oJe sSej Total depth _ I I -�> Cased to ( ( 3 Casing height ( � Sanitary seal (Y/N) 11 Wires properly protected (Y/N) �J Log present(Y/N) ADEC water system number FROM WELL LOG AT INSPECTION Date of test - - ( O - 241-C, j Static water level 1041 �11 InCinAU(Y OF ANCHORAGE Well flow f VIRONMENTALSERVICES DIVISION / g.p.m. g.p.m. Pump level USC U K OCT 3 0 1991 SEPARATION DISTANCES FROM WELL TO: RECEIVED Septic/holding tank on lot t nn �f ; On adjacent lots ( DC) 7 i Absorption field on lot / too ; On adjacent lots - (OD t Public sewer main /J 1A Public sewer manhole/cleanout AJ LA Sewer service line S Petroleum tank t.)e en) D w A.) WATER SAMPLE RESULTS: Coliform 4"I�2a t4cfeq Nitrates;�Alts" AQCWi /T_ Other bacteria Z( d-rn Date of sample: (n - 2 Z Collected by: car,PI*LJ5 B. SEPTIC/HOLDING TANK DATA ! Compartments II (G Z Date installed G(' - � ( Tank size (Z 1 191� G Cleanouts (Y/N) Foundation cleanout (Y/N)_ Depression (Y/N) na High water alarm (Y/N) IA Alarm tested (Y/N) Date of pumping Pumper JA t_ o 61� C✓ %2) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: l , i Wel I(s) on lot jOs7 + On adjacent lots —L O d -E- Foundation / 1 r i i To property line I O f Absorption field ( PJ Water main/service line ./0 Surface water/drainage 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pu p on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATI Well on lot D. ABSORPTION FIELD DATA On adjacent Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested TO: I(xs Surface water _ -/Z,' Date installed 5�: _P! Soil rating a 11 _ 11 System type io P Length 29) - Width Gravel thickness / Total depth Total absorption areaZ Cleanouts present (Y/N) tl Depression over field (Y/N) Date of adequacy test ( D - Z 41 -'/ 1 Results (pass/fail) __Aynt S e> for Peroxide treatment (past 12 months) (Y/N) A.) I n If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I n0 1 / r On adjacent lots_�n c% � Property line / 'n r To building foundation (�Q f To existing or abandoned system on lot Y4 / I On adjacent lots j Cutbank Water main/service line (O Surface water I n o Driveway,g g parkin /vehicle storage area -2 � f Curtain drain NI W- ' klr�llr4 A7P7;:�✓AZ �✓:/� 1r� j� E. ENGINEER'S CERTIFICATION t certify that l have checked, verified, or conformed to all MOA and HAA guidelines in S & 5 ENGINEERING ,7034 Eagle River Loop Road No. 204 Signature ifiver, Alaska 995TI Engineer's Name Date \ f:,:> - '2,;,� -e-71) of HAA Fee $ 0 Date of Payment X0-30- 9� Receipt Number �y-3P 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number bedrooms of this inspection. OF At `A� �' 9 oes.o eno° `yr e fJYFi � ' •oo.a ooeeeeae ea ee ..� •rets �os o ea d�P'30FE S`a` \ CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WORRordex# 39576 Date Report Printed: OCT 25 91 @ 16:04 Client Sample ID:L3 B1 KNOLL ON THE WALL S/D PWSID :UA Collected OCT 22 91 @ 12:00 his. Received OCT 23 91 @ 15:30 bra. Preserved with :AS REQUIRED Analysis Completed :OCT 25 91 Laboratory Supervis x PIHEH C. EDE R a I a a a a d By : ....................................................... Chemlab Ref 4: 915684 Lab Smpl ID: 13 Parameter Tested ---------------------------------------------- HITRATE-N Sample ROUTINE SAMPLE COLLECTED BY: R.D.J. Remarks: Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO Y PO E NONE RECEIVED Req d Ordered By Send Reports to: 1)3 & S ENGINEERING 2) Matrix: WATER Allowable Result Units Method Limits -------------------------------------------------------- 1.1 mg/1 EPA 353.2 10 ....................................................,.................,.........,................................. 1 Teats Pexformod See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Leas Than, GT -Greater Than 0y� scis Member of the SGS Group (Soci6t6 Generale de Surveillance) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General. Information Application Date (a) regal Description (include lot, block, .subd°visi n, secti0q, township, range) Location (a'ddress:�qt directions) (b) Applicants Nance r�._.��.ry�� - - •-•--,�-�-"`'_'- - ..�__.�.�_a-.:�.� "Iblephor:+e Applicants Address'' (c) Applicant is (check cine) Lending Institution ,�� Owner/builder 477 y Buyer OtherSD . (explain) ; C f� j�rr ,i /• / _.� (d) Lending Institution ._ - Telephor:e Address (e) Real Estate Co, & Agent Address Telephone ',„. ” - �.•`� 2, Tie of l�bsidence Single -Family i. Multi -Family .�, Other (cl:scribe Number of Bedrooms 3. water §-UppiK Individual Db 11 �!� Community � Public Notes If can --unity will system, must have writter confir_matior fr_°cm the State TYepartstent of Environmental Conservation attesting to tl-o .legality ;_ird status. Is the we _ll adequate for the numb --,r cf bedr=Ls specified in this HAA fi*) 4, Sewaae Dis oral Onsite %Q Public C,orrrnun:ity +�. Holding Tank F-:71 Is the wastewater disposal system adequate fcx this number of kedronns (Wage 1 of 21 2-1534 5. Enaineerinq }:izmi Providing Insjections, `rests, Data and ]Information I certify that I have checked, verified, or conformed effect on the,date of this inspection. Signed. � r Name of Firm Address Jt e, Signed by Date ' I' (ENGINEER SEAL) 6.DHEP Approval Approved for ,� — _ bedre:oms Approv`.> Disapproved-� 'Perms of Conditional Approval - to all MOA HAA Guidelirk-%s in Date 4 h�QH Wd/J/gtl4 C]B i�/U/�1�� TPU u$Ega.Ba:�a J.�Pa ca VO 11•�C, j�Wp000 � [i� N�Of By: Date C nd:i.tional�Us 'Ihe Municipality of Anchorage Departinant of Health and Envi-roun:)ntal Protection dces not guarantee the continued satisfactory performance of the water supply and/or_ the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information turnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func tional for the number of hedroons and type of structure indicated. ( D'rIEP SI! -A].,) 7. Mail the HAA to the following address: ICB2/d5/s (Page 2 of 21 2-•1.5--84 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL ( HAA) JUN 2 61984 CHECKLIST -FEBRUARY 1984 A. WELL DATA � "� Legal Description: " X1.01 v� ` 4t_ CL CL Well Classifications If A, Be or C, D.E.C. Approved(Y/N) Well Log Present/N) _ Date Completed 9Y/r( Yield 116v17 Total Depth /(3 Cased to f/ / ✓ Depth of Groutinq /,1-/,,2,, C�jv// foc, Static Water Level /_��� vn wi: // lgr Pump Set At /Uva w // lcx; Casing Height Above Ground"" `�� [ Sanitary Seal on Casing ) Electrical Wiring in Conduit ONDepression Around Tfiellhead (Y Separation Distances from Wall: To Septic/Holding Tank on Lot > On Adjoining Lots >1p e -j A To Nearest Edge of Absorption Field on Lott ,V � On Adjoining Lots > apo" To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole GqA-- To Nearest Sewer Service Line on Lot m y Water Sample Collected By Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size /2- s-0 No. of Ccopiartments 2 Standpipes fi,'N) Air -tight Caps N) Foundation Cleanout_ Depression over Tank (Y Date Last Pupped% Z Pumping/Maintenance Contract on File (Y/N) 'U//i- ; for Holding Tank High -Water Alarm (Y/N) A -)I1- Temporary Holding Tank Permit (Y/N)Ul7f Separation Distances frcan Septic/Holding'rank: i To Water -Supply TAb11 /00 " To Building Foundation To Property. Line/() �f To Disposal Field /g ( c To Water M�ir;iA�rvice Lire v To Stream, Pond, Lake, or Major Drainage Course Comment [Page 1 of 21 r � � 3 '/-', /c,2c, (( u. k. C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /2 Type of System Design 7_p�,pC,/, Date Installed _�=� Length of Field' Width of Field 3 f Depth of Field / Gravel Bed Thickness '7 ' Square Feet of Absorption AreaStandpipes Present 1' N) Depression over Field (Y ) Date of Last Adequacy Test , zi Results of Last Adequacy 'Ibst 12 el ?C�j.aer Separation Distance from Absorption Feld: To Water -Supply Well /0 0 ( -f- To Property Line To Building Foundation _ 3 1 To Existing or Abandoned System on Lot On Adjoining Lots 6 To Water Main/Service Line .09 Vo Cutbank(if present) /U 1A To Stream/Pond/Lake/or Major Drainage Course WA - >/o To Driveway, Parking Area, or Vehicle Storage Area 'Im 5LI F Comments nen b?/F D. LIFT STATION Date Size Installed "- f_�- Dimensions _ in Gallons WIA- Manhole/Access "Pump On" Level at � //a'- "Pump Off" Level at A High Water Alarm Level at ,t�f4 Vent .(Y/N) tiff} Tested for ;G.A- _ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (YM) 064 Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or, conformed to all MOA i on the date of this inspection, A Signed Date (", Company lnC_ MOA No. 5� '� •• KBl/d5/s (Page 2 of 21 ,pAti in effect �b•a••.b•�� s � No. 2251-E LCJ ••H,.•ob•••°°��� 40 ''ADFESSION 2-15-84 ALASKA CIIUInOWnTAL COnTROL SNIHS, InC. 6ngineerinq & Enuironmental Studies JUNE 25 1984 ANN LIPSON 3301 C STREET/SUITE 100 ANCHORAGE AK 99503 SELLER — JACK WHITE 0C) BUYER — GORDON & ROMONA SIEVERSON SUBDIVISION — KNOLL ON THE WOLD BLACK — 1 LOT — 3 ADEQUACY TEST FOR SEATER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 392 SQFT' THE SYSTEM. IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 712 GALLONS. BASED UPON THE TEST DATA THE SYS'T'EM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON6/23/84 FLOW TEST ON WELL ' THE WELL, FLOW RATE WAS 5.7 GPM FOR 2 HOURS. t" SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FORS` THIS 3 BEDROOM HOUSE. p� �Yl���q�•e��o 0 NM�.'w••• w•WO��H C. Retd, J►. ; 4 ; No. 2481 •@ �<' PROFESS10�1P 1200 fest 33rd Auenue. Suite B • Anchorage. Alaska 99503 • (907) 561-5040 Time Time e Date Date Date Inspector Inspector Inspector Comments Conditional Approval W Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank y� Q APPLICANT FILLS OUT LOWER HALF ONLY Property Owner C/jW/j/A Mailing Address f7 ��-USS/JC �� �i1`S03 ��LOpc)Cp Buyer Address Lending Institution /�/wysJ ( 7✓ CTS �- fj S �1 Phone Address 7 Realty Co. & Agent Phone Address Legal Description /� !� 13 [A:' 0-c/ //1(::�' Street Location /%TS_ Typegf Residence L5 Single Family y ❑ Multiple Family No. of Bedrooms ❑ Other Water 5opply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. Sewgp-Disposal L] Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utili y: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ,T,i n i i a r 1,7 1, 1. 9 11 ") A IC I)r wo Atichorano, AT7 T'\nol.1 On url]l(, lefol.ri Ap-or-0\7"ll for tjjt Pmwnr aml wator f -c -iji tion crinnot he rlr"ltlt(,fl unt tho fnI.I.m.yinq jt_pTjs ll;)N7(, hre-n. coinnIntr-11- wo I It; 11F)rn.ttocl t() th Of 'T icP FOr Our and r T`Clj nvi 0 Th(' w Ft t p T- a n n G r o T) o r t n r3 o. 0 r,, t j, nfFir 5 r33 "t.1-ClOt., ntir Cm From thp r"flr,,!-q Toh F)l noijfv for a rein "ortAnn whon thc? nnto-I IIMP) 1-)0011 cor-t-OCt'n(l. TF thr-re aro r)nv furthnr qun,.;tiom,;, ci,11,1 this offi.co P.i- 26.1-11'.7?0. 9.lnco.r-lv, pnhort C. 11ratt Ansociato, Pnvi.-Ionrilonteil. Flnnciali,;i-