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HomeMy WebLinkAboutKNOLL ON THE WOLD BLK 1 LT 10 i ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME & MAILING ADDRESS- * [] UPGRADE LEGAL DESCRIPTION ILOCATION Well Absorption area D~eHing .... ~ ~ Manufacturer~ ~/~¢ / PERMIT i Liq. cap~iW in gallans Inside length ~idth Liquid depth /~ ~ ~ IF HOMEMADE: ~ ~ DISTANCE TO: Well~ Dwelling PERMIT NO. O ~ < Manufacturer % ~ ~ . Material Liquid capacity in gallons ~ DISTANCE TO: Well /~ ¢ Foundation ~ ~1 ~e~resti~[lin~ ~ PERMITNO. ~_ No. of lines / Lengthofea~' Total length o, l~ , Trenchwidth~ inches Distance between lines ~ ~ ~ Top of ti[~ to finish grade ~ Material beneath tile ~ ~ If To,al effective absorption~e~ ~. inches Length ~ Width Depth ' ' ' ~ ~ ' ~ PERMITNO. :f -- ~ ~ DISTANCE TO: Well Building foundation Nearest lot line ~ Cia Depth Driller Distance to lot line PERMI~ NO. ~ DISTANCE TO: Building foundatioa Sewer line Septic tank Absorption area(s) OTHER ~ ~ - PIPE MATERIALS SOILTESTRATING / ~ ~ ¢ / APPROVED - ~ DATE "lEGAL INICIPALITY OF ANCHORAGE ~rotection -~/~ Department o~ Health and Environmental 825 L Street, Anchorage, AK. 99501 Applicant: ~F~ ~~ Mailing Address: .~,/ ~ ~ Location: Phone Nu~er: ,~ ~ ~~O Type of Soil ~sorption System Is: Trench: ~_ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ~ Soil Rating(sq'ft/br) The Required Size of the Soil ~sorption System Is: DEPTH _ /~ LENGTH EO GRAVEL DEPTH ~ WIDTH The leng%h dimension is the length(in feet) of the trench o~ drainfield. The depth of a tzench o~ pit is %he distance between the surface of the ground and the botto~ of the excavation(i~ feet). The~e is ~o set wid%h for trenches. 'The [z~vel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = /~ O O GALLONS * * Pezmit applicant h~s the responsibilit[ to inform thi~ departme~t d~ri~g the installation inspections of an[ wells adjacent to this propert[ and the n~mber of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. ~i~im~ distance between a well a~d a~y on-site sewage disposal s[stem is 100 feet for .~ pzivate well oz 150 to 200 feet from a p~blic well depending ~on the of ~ublic well. ~inimA distance from a private well to a private sewer line is 25 feet and to a coAunity sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements mai a~pl[. Specifications a~d con$tr~ction diagrams are available to insure p~oper inst~llation. * * * PERMIT EXPIRES DECEMBER 1 9 1 * * * I certify that: (1) I ~ f~iliar with the requirements foz on-site sewers and wells As set forth by the Municipality of Anchorage. (2) I will inst&ll the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include ~ore that 3 bedzooms. Date: _ SWP/024(1/81) Test I1o 1(~I 5 Table A l)aLe: May 2~ 1979 J_,ogged by: JEJ Depth in Feet From To 0 l-l/2 1-1/2 8 8 lo-Mx i0-±/2 15 Soil[ Description F-4, Browll Peat, damp, Pt F-3, Gray Gravelly veryA Silty,' well graded fine to coarse, wet, medium dense, subroundod particles, maximum particle size = 2", Group A F-3, Gray Gravelly silty well graded fine to coarse Sand, wot, medium dense, subrounded particles, maximum particl.e sJ. ze = 3/4", SM, Group A NFS, Gray silty Graveliy well graded fine to coarse Sand, damp, medium dense, subrounded parkic].es, maximum particle size = 1", SM, Group B Bottom of Tesh ltole: Frost Line: Free Water Level: 15 0 No No. Depth 1 5 2 10 3 15 Type of Dry Blows/6" M% Sample Strength Group Un~fi.e~ 12.1 L A SM 11.2 VL A Sbt 4.0 N B SM Remarks: 1 . 3. 4. 5. 6. Type of Sample, G=Grab, SP = Standard Penetration, U = Undisturbed. Dry Strength, N=None, I,=Low, M=Medium, II=Iligh. Group refers to similar material, this study on].y. Genera]. Informahion, see Sheet ~. Frost and Textural Classificat. ion, see Sheet 2. Unified Classification, see Sheet 3. lU F R O M SUBJECT //~/O /~/A / 4~,,~L~/6.,.// MESSAGE REPLY SIGNED Ftedi~rm® 4S 471 SIGNED SEND PARTS 1 AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY. DATE // SOUTHCENTRAI_ REGIONAL OFFICE June 4, 1,981 Larry Langston 2].1 W. 7th Anchorage, AK Su bj ect: SECOND FLOOR ANCHORAGE, ALASKA 99,501 (.907) 274.2533 P.O. BOX 615 KODIAK, ALASKA 99615 (907) 486.3350 P.O. BOX '1207 SOLDOTNA, ALASKA 9966'9 fgo?) 26'2-5210 P.O. BOX 1709 VALDEZ, ALASKA 99685 (907) 835-4698 P.O. BOX 10C~4 WASILLA, AI.ASKA 9968.7 {907) 376.5038 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL [ i{O'[ECTION 995oz oui'; 't 0 981 Lot 10, Block 1 Knoll on the Wold SD Contaminate separation Waiver Request Anchorage Dear Mr. Langston: RECEIVED We have reviewed the report and recommendations submitted by the Anchorage Municipal Department of Health and Environmental Protection concerning your request for a reduct:[on of the C].ass "C" protective radii for your water system. We hereby grant a waiver of 18 AAC 80. 020 which requires a minimum separation distance of 150 :feet between a class "C" well and a septic system to 140 feet in regards to the subject lot. If you have any questions concerning our review of this project, feel free to contact me. D.H.E.P. 82,5 L Street ;a~chorage, AK 99501 TLM/bab -09 L H LOCATION OF WELL Please comolete e her la, lb, or lc. A.O.L. ~aterlal... Type Top 8or,om // 3 ft. / / / ~ Thr~ded ~elded 9, STATIC rATER LEVEL; ~1o~ I~n~ ~r~ ~U~ ~"0~ ~E~Lm .... ~ ~I, ~[LL ~0 cO~PLETiO~: ~i~O~AL r~' ~Pltles~ Ad~pter ~ Inches ~v~ grad~ '' ~ater~al: ~eat ce~nt ~Othee: -,, .... Ty~e~ ~ Sub~rtlblt ~ Rec Iprocat ~ng Location: BE~SE, EPPS & POTTS 2220 EA.ST 88 AV~E ANOIC:XC~GE, AK 995O7 C907) 349-6451 Lot: Block: Client's Name: Address: Tes~r: Init/al Reading om Meter: · Pmh tJon Pntn: ~-~,'~/ GP,'!, ~-' 2-1-llour Cac^%city C~al]cna ANCHORASE/WESTEEN DISTRICT OFFICE 437 'E' STR~..ET, SUITE 303 ANCHORAOE, ALASKA 99501 February 4, 1~86 ~ 274-2533 Besse, Epps & Ports 2220 East 88th Avenue Anchorage, Alaska 99503 SL~JECT: Lot 11, Block I, Knoll of the Wold Subdivision Anchorage, Alaska (8621-FA-104) Dear Sir: The Department has reviewed the Engineer As-built plans for the subject project, Final approval is hereby given fop the water system and the "Certificate to Operate" is attached. Any future expansion ob the subject project will require additional approval ~rom this o~fice. Michael P. Lewis Environmental Engineer MPL:pkk -. - STATE OF ALASKA · . DEPARTMENT OF ENVIRONMENTAL CONSERVATION _CONSTRUCTION AND OPERATION CERTIFICATE for · : - > A. APPROVAL TO CONSTRUCT ." ' ' . . ' ' ' ' ~" · . t., , Plans for the construction or modification of Z:/' t,', ,,.,.~,/.` > /. ~.., ' :::-. ~' ..:-.~ .... In ":'~'~''~g/~t'~ :" · , Alaska: submitted In'acc0~dance'wlth 18 AA~ 80.1~:_ ;'- :" : e ~d7 -.~ ..¢~ ~ ~ / ~ have been reviewed and are . ~ approved. ' ~ ~ 1... I,~:' . · , . ,~"conditlo~ally approved (see atta~dconditions). ' ' ':~ - : .- .. _: _ . ~ - H construction has not s~a~ed within two year~ of the approval date, this certificate is void and new plans and ' . . specifications musi be submitted for r~vlew and approval before construction. . -..-... - . .'. rE. APPROVED CHANGE:ORDERS ' . - . .~: - Change (con~rac~ oreer no. er descriptive reference) Approved by Date : .,, ..... _., -:, ~,_', ,~... ~vi .j.~.,..t,, :._.t~ ..... ~ ?~.// .... ./ ./,,.t~ ,~.,i,.; , //~.,;. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" ~ction must be completed and signed by the Department before any water is made a~/ailable to the public. ' ' ' i,.l,' ,:.,-/' The construction of the ~ u, · wa~er sys[em was completed on ?'//' /'"','/ .... ~' / granted interim approval to operate for 90 days following the completion date. public (date). The system Is hereby BY TITLE DATE As-built plans subm[tted during the Interim approval period, or an ins pection by the De partment, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. ,~.:';,,.. ,/ / ..~ ; :.. /, I :: BY TITLE DATE 18-0407 (Rev. 11183) : * . ,' DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Cornplele Section C) 3. PINK . ENGINEEPJMUNI-BOROUGH (Complete Section C) 4. GOLDENROD · MUNI.EOROUGH (Complete Section A) 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 ParcelI.D. fi: ~L-/\ -Q~/ ' q(~3 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address 7300 Montagne Circle Anchorage, AK 99507 Bob a~d Kathy Rent~ 7300 Montagne Circle Day phone 337-3675 Anchorage, AK 99507 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: individual well Community well XXX Public water NOTE: If community well system, provide written confirmation from State AD£C attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAl.: Individual on-site 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 o 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. Phone ~/'~ ¢7 ¢ S & S ENGINEERING Name of Firm !7 ....... Address u Ver, ~Jca ~77 Engineer's signature ~~ DHHS SIGNATURE _~¢~._' Approved for bedrooms. Date~ ~--~ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments I II y'- mL01¢ IIIIIII 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~)25 (Rev. 1/91) Back MOA 1121 Municipality of Anchorage /~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LoC' [0 ~tuo/_c. o~ THE (,,,f.O~...c~ S//~Parcel I.D. A. WELL DATA Well type Log present (Y/N) If A, B, o~ttach ADEC letter. Date completed Total depth Cased to ADEC water system number Driller Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/,~ tank on lot Absorption field on lot Public sewer main ,LJO.,LJE Sewer service line ~/OO (.~') J.,L/AIVE,~. I/,J /~,¢,/4, FILE.~ WATER SAMPLE RESULTS: Coliform O/{©,31¢,~ Nitrate Date of sample: /--¢/_.TO/ ~.~ Sz g.p.m, g. . ; On adiacent lots ; On adjacent lots ~/~ _ Public sewer manhole/cleanout Petroleum tank ~ Collected by: Other bacteria (__.)//o o ~ B. SEPTIC/~ANK DATA Date installed ("'~/Z-3/~)J Cleanouts (~(~) ~'~'¢ High water alarm (Y~___~ ,,~-/o Date of pumping Tank size /~'~ Compartments Foundation cleanout(~0~'4) ~'~ ~¢ Depression (Y~__~ ,-'Jo Alarm tested (Y/N) ,/L,///~ SEPARATION DISTANCES FROM SEPTIC/H~C~E~!tt6'TANK TO: Well(s) on lot ,/C'//~ On adjacent Iots_/'.-~-C) To property line -~:,~ '"¢- Absorption field /~/ Surface water/drainage /L~,~/,..2~ 72-026 (Rev. 7/91) Front Foundation ~ '~(~/ Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION "~,~lled Size in gal~ Vent (Y/N) Manufacturer Manhole/Access (Y/N) ested High water alarm level Meets MOA electrical codes (Y/N)._.._ ~ SEPARATION DI..~-T-A-f~E FROM LIFT STATION TO: we.u. -0T On adjacent lots Soil rating D. ABSORPTION FIELD DATA Date installed ~o/~--~ / Length ,~'(-) ' Width Total absorption area Depression ove¢ field (Y/~ Results (~/fail) Gravel thickness Cleanouts p resented'N) Date of adequacy test for If yes, give date_ System type 'T bedrooms Peroxide treatment (past 12 months) (Y/N) /~-~¢..u'~-- /C"¢,.,'oc,,J,~J Total depth SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /(-/{/-~ On adjacent lots [ ~¢-d::) / 0 ) Property line To building foundation ,.~-~ r On adjacent lots /OO/¢~ Cutbank Surface water Curtain drain To existing or abandoned system on lot Water main/service line /¢--YO/cYu-~- ./¢/2-~'Z~cFJT~Driveway, parking/vehicle storage area E. ENGINEER'S~CATION I certify that/l/have c/h~cked, verified, or conformed to all MOA and HAA guidelines in effect or J 17034 Eagle River Loop Road No. 204 Engi~,e,e?'s Nam~Em31e ~!v_-.-, b.!~= / / HAA Fee $ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number msbection. STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION APPROVAL OF ON-SITE RESIDENTIAL WATER AND SEWER SYSTEMS PROPERTY DESCRIPTION Lot, Block & Subdivision or U,S, Su~ey Lot 11 Knoll on the Wold 7320 Montagne Circle PWSID no.215011 Subdivision 'l'his approval does not constitute a guarantee of any kind, explicit or implied, as to the performance of the water supply and wastewater disposal systems. WATER SUPPLY A recent water sample was tested and found to meet Department of Environmental Conservation drink- ing water standards for total coliform bacteria. Date TitleEnvir°nmentalEng. Asst. II May 6, 1993 WASTEWATER DISPOSAL The astewater system was: [] inspected by applicable re( Department of Environmental Conserva ~ents of 18 AAC 72; and found to be in compliance with [] inspected by a quirements of 18 AAC al Engineer who that the system complies with applicable re- [] installed by a Certified Installer of 18 AAC 72; or that the system complies with applicable requirements tested by a Professiol and that the syst Thisa Engineer who ce'~es that the performance of the system is satisfactory ~plies with the mi~-n~eParation distances specified in 18 AAC 72. )ra [] single family [] multi-~it with atotalof __ bedrooms. Title ~,~ Date 18-0404 (Rev, 8/85) DISTRIBUTION: WHITE--BANK/LENDING INSTITUTION; CANARY--APPLICANT; PINK--DEPARTMENT WALTER J. HICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 (907) 349-7755 May 7, 1993 Mr. Scott Swenor S&S Engineering 17034 Eagle River Loop, Ste. 204 Eagle River, AK 99577 SUBJECT: Lot 11, BIk 1 Knoll on the Wold Subdivision 7320 Montagne Circle Class C Public Water System ID no. 215011, ADEC project no. 9321-DW- 126-086 Dear Mr. Swenor: The Department has reviewed the information received in this office May 6, 1993, regarding the above public water system which included water samples analyses for total coliform bacteria and inorganics for nitrate. Since this is a previously approved drinking water system by this Department, verification that the water supply has been recently tested will be required to maintain compliance with State Drinking Water Regulations. Results from the recent water samples submitted were satisfactory for both total coliform bacteria and inorganics for nitrate and satisfy this concern. Therefore, for the concerns of this Department, this system is in compliance with State of Alaska Drinking Water Regulations (18 AAC 80). Attached is an "Approval of On-Site Residential Water and Sewer Systems" certificate verifying this systems status as an approved water system that is in compliance with 18 AAC 80. Thank you for your cooperation with the Department. If there are any further questions concerning this matter please do not hesitate to call. Sincerely, Michael Lu, E.I.T. Environmental Engineering Assistant II ML/pf Attachments MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH &.HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO suBMITTAL) (a) (b) Legal Description (include lot, ~ subdivision, section, township, range) Location (address or directions) IO/k/~ '7 Property Owner Mailing Address (c) Lending Institution Telephone: Home Business Mailing Address (d) Real Estate Company and Agent Address Telephone (e) ~1 lhe HAA ~o ~he lollo~in~ add~ess~ o~: Oheck hem~ it hold io~ pick up Lis~ coniac~ pemon and day phone numbe~ below. TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms WATER SUPPLY Individual Well [] Community~ Public [] / Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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 (Rev 8/861 Fronl ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation dat~ shown below, I verify that my investigation of this Hearth Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of-Firm Telephone Address Date Engineer's Seal Approved for '~/.'/¢,r.Z-E (~bedrooms by _ _ Approved ~ _ Disapproved Conditional Terms of Conditional Approval Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH biS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 IRev 8/86) Back MUNJCIPALffY OF ANCHORAGIMUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL SERVICES DIVISlJ;i~ALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 '~" R 2' ]988 284-4720 RECEIVED WELL DATA Legal Description: Welt Classification Well Log Present (Y/N) Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments If A, B, C, D.E.C. Approved (Y/N) Date Completed Yield Cased to Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date Installed ~¢~ g/ Standpipes (Y/N) '/"¢,'~"~,,~ Air-tight Caps (Y/N) Depression over Tank (Y/N) . ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) J~¢'//','~ . Size ~)O,~ No. of Compartments T Foundation Cleanout (Y/N) Date Last Pumped CJ"~/~ ;for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line To Water Main/Service Line Course To Building Foundation '~ ~ To Disposal Field /~ t To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11t84) ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~ Date Installed 31~H J~ t ~1,.~ / Width of Field ~,~ ti Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation ,,~O Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field -~ ~ Depth of Field ~ ! Gravel Bed Thickness ~' t Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or 9~nformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed "T~ ~ Date AiD~,,~[ ~!/~8 Company Receipt No. Date of Payment Amount: $ ! MOA No. Page 2 of 2 72-026 (11/84) Engineer's Seal 203W 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: .RESIDENCE: WELL: SEPTIC SYSTEM: Lot 10, Block 1, Knoll oF the Wold 7300 Montagne Larry Langston Single Family, Three Bedrooms Class C, in common with Lot 11 '~' TANK: Greer Steel 1000 G~Z :" ....... " '" ABSORPTION SYSTEM: Trench ~';' .. , ABSORPTION AREA: 500 sq.ft. SOIL RATING: 165 INSTALLATION DATE: June 1981 DATE OF LAST PUMPING: April 5, 1988. Isaac's Pumping Service DATE 'OF TEST: April 4, 1988 TEST PROCEDURE: SYstem was inspected and measured. Tank was found with four feet of cover and a liquid depthof 49 inche~'. Trench sump was 9 feet deep and had a liquid depth of 18 inches 500 gallons of clean water were added to the trench while the water levels in the tank and sump were monitored. Tank level did not change, water level in sump rose 2 inches. This level dropped 1 inch within ten minutes after water was shut off. TEST RESULT: This system meets the. code requirements of the Health and Social Services Department of the Municipality of Anchorage. NOTE The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long this system will function satisfactory for current or future occupants. DEPT. OF ENVIRONMENT/fL CONSERVATION STEVE COWPER, GOVERNOR ANCHORAGE/WESTERN DISTRICT OFFICE 3601 "C" STREET. SUITE 1334 ANCHORAGE. ALASKA 99503 J63-6775 DATE: PWSID #: To Whom It May Concern: 7 April 1988 Class C State Accordinq to the records an ?ile in this o??lce, the Lot 10 & Block 1, KNOLL ON THE IVOLD SUBDIVISION .............. Water SYstem is in compliance ~ith the o? Alaskalrinking Water Regulations. Ronald S. Klein Environmental Field O??icer MUNICIPALITY OF ANCHORAGE ~\('~, ¢~2b' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264~4720 GENERAL INFORMATION (a) Application Date (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name Applicant Address Applicant is (check one): Lending Institution E]; Owner/builder/~; Buyer []; Other bF'] (explain); (d) Lending Institution Telept~one Address (e) Real Estate Company and Agent Address Telephone (f) Mail tile HAA to tile following address: TYPE OF RESIDENCE Single-Family/~" Multi-Family [] Number of Bedrooms Other WATER SUPPLY Well [] CommunityJ~/ Public [] Individual Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,,~ Public [] Community [] I-folding 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 ENGINEERING FIRM PROVIDING ~NSPECTIONS, TESTS, FILE SEARCH, DA'I'A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown' below, ~ verify that my investigatio~ of this ?tealth 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 rites 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 _~:2(.-:.~<~-,/~ ~"~.,~,~' r' )~'~:~ Telephone Address '~,~o (~ ~2~ '.,- Engineer's Seal D I--IE P APPROVAL Approved for ~t~.~beOrooms by Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Depadment 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 MUNICIPALITY OF ANCHORAGE (MOAj ~UNICIPAI.ITY OF ~,~4,~'~.E4~. I~''1 AUTHORITY APPROVAL (HAA) D~PT. OF H~^L~- ,, CHECKLIST- FEBRUARY 1984 ENVIRONMENTAL PI~©~, '4 264-4720 Legal Description: ~LoT- 1986 RECEI\,'LD WELL DATA Well Classification If A, B,(~D.E.C. Approved (Y/N) __ Date Completed -~"~-5//~/ Yield Well Log Present (Y/N) %~_~ Total Depth /o "~ Cased to /dh Static Water Level 4~'_~ Casing Height Above Ground Electrical Wiring in Conduit (Y/N) f---'( Separation Distances from Well: To Septic/Holding Tank on Lot ,,(t~E.p To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line _ Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots 1~¢-; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ,~J.,/,"/ To Nearest sewer Service Line on Lot ~'~z")~,'~'r Water Sample Collected by ,,'¢~ .,,.~.~'~ ~.~J~J~'/ .+-~'~' ' ' Date Water Sample Test Results Comments ~=~- ~7T~(~/~ ~D~ ~?~o~.z_ ~- ~/~1~ B. SEPTIC/HOLDING TANK DATA Date Installed Z'"~/-~-~/~/ Standpipes (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~._) Separation Distances from Septic/Holding Tank: To Water-Supply Well /~'~'~) To Property Line .~¢' To Water Main/Service Line "-7~ Size ./~.~ ~ No. of Compartments Air-tight Caps (Y/N) ~L.~ Foundation Cleanout (Y/N) Date Last Pumped ~...) ~A~ ;for t--.) Temporary Holding Tank Permit (Y/N) .,O/:ff. To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Course Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed f Width of Field Type of System Length of Field , %?) Depth of Field ~/~7" Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Square Feet of Absorption Area //Z,d~¢- Depression over Field (Y/N) /[/' Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /~Z(',,) /-~r To Building Foundation _ Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots -"'~,-~'. To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) ~- "Pump Off" Level at Ve ~n~(~Y/N) ~*- Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have check_ed, v~ifi~ld. ¢r co~formed to all MOA and HAA guidelines in effect on the date of this inspection. Sit, ned '~,~/'~.-~--P ./~ ~ Date ,'00/'7/&¢~ ~ .:i~-~-i.(..% l.,~-w~--.~__ / / Company ,-~_,,~:.c._s;(~ .~?~,~ Cz~N.¢. MOA No. Receipt No. '~.(Z~(.._-') / - ~-.-"~(~._.~4~ Date of Payment S Amount: $ ~::~ ~c~ . (.~'~. Engineer's Seal Page 2 of 2 72-026 (11/84) A+Home Services 15900 Francesca Drive Anchorage, Alaska 99516 345.1890 · 345.2444 DATE ~' ~ DATE DESCRIPTION CHARGES CREDITS BALANCE PREVIOUS BALANCE If this statement doesJ].~t agree with your records p/ease not/fy us at once. //~/~/~5 /" ' '/STA TEMENT DEPT. OF ~NVIRO1NIMENTAL ~ONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA g9501 BILL SHEFFIELD, GOVERNOR Telephone: {907) Address: 274-2533 ! pws ~.D.~ :/,5-0 1 t To Whom it May Concern: ?,// : According to records on file in this office the q h. ~ J ~ Water System is in compliance with the State Drinking Water Regulations Sincerely, DA'I c RECEIVED I NSPECTIObi, APPOI NTM E NTS TIME TIME TIME DATE DATE DATE '~, A4UNICIPALITy OF ANCHORAGE , MUNICIPALITY OF ANCHORAGE DEPT. OF J~EALrH &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATIONDIVISION OCT I 3 1981 Telephone 264~720 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be prace~ed. Please allow ten (10) days for processing, 1, PROPERTY OWNER J PHONE MAILING PflOPE~TY ~ESIDENT (If different f~m above) PHONE 2, BUYER PHONE 3. LENDING INSTITUTION I PHONE MAILING ADD~ESS 4, REALTOR/AGENT J PHONE 5. LEGAL DESCRIPTION L STREET LOCATION 6. TYPE OF RESI~1~NCE NUMBER OF~BEDROOMS [] One [] Four ~'~y:~' SINGLE FAMILY ~ Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7, WATER SUPPLY ~--~IDUAL*--'/..,~~.~'- . ~/~'~" * ATTACH WELL LOG. A well log is required for all wells drilled ~ COM~~-"'L~ t/~ IJ since June 1975. For wells drilled prior to that date, givewell bi PUBLIC UTI LITY ~'~ depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM fi~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) L. E RECEIVED INSPECTION APPOINTMENTS TIME TIME DATE DATE DATE: MUNILIP/{LItY [ih MUNICIPALITY OF ANCHORAGE P~;q. of ~;:-,t ~[[ &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~I~RC)NM~N i,~L 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVEI) REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND 8EWER FACILITIES DIRBCTIONS: Complete all parts on page 1, Incomplete requests will not I]~ processed, Please allow ten (10) days for processing, 1, PROPERTY OWNEB ~ ~ PHONE PROPERTY RESIDENT (If different from above) }- ~PHONE 2, BUYER PHONE MAILING ADDRESS MAILING ADDRESS 4, REALTOR/AGENT I PRONE MAILING ADDRESS STREET LOCATION 6, TYPE OF RESIDENCE NUMBER OF BEDROOMS ~ SINGLE FAMILY ~] One [~] Four ~] Other_ _ ,j~ Two [] Five [] MULTIPLE FAMILY .. Throe [~] Six WATE[1 ,~UPPLY INDIVIDUAL* COMMUNITY PUBLIC Ul'l LITY ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled 'prior to that date, give wel depth (attach log if available,) 8, SEWAG[~.,~POSAL SYS'rEM INDIVIDUAL/rON-SIT Y* [~ PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INS'TALLED, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING 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 " PF."R MI'F NUMBER 2, WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified__ LOG RECEIVED 3; SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVI DUAI_/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []SepticTankor [] Holding Tank Size: /~)~ If Tank is homemade SOILS RATING . give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AR EA MATERIAL 4. DISTANcEs Septic/Holding Ta;~k Absorption Area Sewer Line 1 WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS L-f-;J'~- APPROVE D EOR *'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DA'rE BY