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HomeMy WebLinkAboutKAROLASKA TR A1Sep 10 20 04:61 p Anchorage irate] & Pump Ser 007'%430742 Parcei Identification Number: 0 0%,3 — 1/0 6 q Legal Description Property Owner Name Jk Address-: l�a —1taw S V"anip Instatlation Date: Pump Intake Depth Below Trip of Veit Casing: 0feet Punir, Manufactuier"s Name: Pump Model. --?A / 1'5' Pump Siaej lip Pitle';.1, Adapter Burial Deptb: /I?— feet 11 less Adapter -Maw, fa ctu rWs Nnnte: Piticss Adapter Installer: Well Drisinfeeted'Upwa Completion? Lt._�fYes D No Method of Disin-fection: Comments: Pufn T.) Installer Name. Atteutian: 4711.)0 Etvncr� Poce, P":). Sox, raq P-, A K , 3,9 C Mayor Pump Installation Log Well Drilling Permit X�, SW Date of' Issue: Parcei Identification Number: 0 0%,3 — 1/0 6 q Legal Description Property Owner Name Jk Address-: l�a —1taw S V"anip Instatlation Date: Pump Intake Depth Below Trip of Veit Casing: 0feet Punir, Manufactuier"s Name: Pump Model. --?A / 1'5' Pump Siaej lip Pitle';.1, Adapter Burial Deptb: /I?— feet 11 less Adapter -Maw, fa ctu rWs Nnnte: Piticss Adapter Installer: Well Drisinfeeted'Upwa Completion? Lt._�fYes D No Method of Disin-fection: Comments: Pufn T.) Installer Name. Atteutian: Municipality of Anchorage Page I of 2 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: ~'I,O' 9,3-O,.~ d:2,~'- PID Number: 0 ~.o'O~ ~' ~0 Name: ~¢e? ~O~ Wastewater System: Q New ~ Upgrade Address:~ ABSORPTION FIELD ~x/~n~& Phone: ~- --~--~ Nc. off, rooms: ~renoh OShallowTrench ~Bed ~Mound ~ LEGAL DESCRIPTION SoiiRating: ~GPD/Sq. Ft. Total Depth f~rade: Lot: ~¢~ ~.lBIock: Subdiv~ion: Depth lo pipe bottom lrom odg~e: G~beneathpipe Township: Range: Section: Fill added above original grade~ ~ength: ~ Ft.~ Ft. Gravel width: ~ Number of Ii.stance between lines: WELL: E~F D New B Upgrade~ Ft. 1% Classification (Private, A,B,C): Tolal Depth: Cased TO: Total ~ion area: Pipe material: Ft. Ft. ~ SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: ~% O ~ ~ ~ Date installed: Yield: GPM Pump Set at: Ft. C~sing Height Above Ground:Ft. TAN K SEPARATION DISTANCES ~ septic ~ Holding U S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank S .... Lines An~oQ~¢ ?~n~ ~ Z Material: Number of C~partments: Surface ~ LIFT STATION N ~. Water ~f~' ~ ' Lot ~ Size in gallons: Manufacturer: Line ~O~ ~ -- -- Foundation ~, ~ ~ "Pump on" level at: "Pump oil" level ~I: Nigh water alarm Cu~ainDrain ~ ~ ~ Pump Make & Model Electrical Inspections performed by: BENCH ~ARK Remarks: ~n~ A~I ~l w [~1 ~C, ~ Location and Description: ~ Assumed Elevation: ENGINEER'S SEAL . ~ ~9~3 - ' ' © ~ ~,:';'.-:.. :c A.( ..: ~ Inspections performed by: ¢/~/~ %~A ~ Dates: 1st ¢o/E/?¢ ............ ,~.,~.,,..,.~,,.,.~,.~.:, , 2nd. ~ .;..,, Department of Health and Human Services approval .... ' .... "' Reviewed and approved by: Date: '~.'"/P- ' "' ~' ¢ 72-013 {Rev 9/91) MOA 25 PERMIT NO: SW 950305 PID NO: 02009340 SWING TIES: FROM: COR."A" TO: C,O, "C" 15' C.O. "D" 22' DRIVE COR. "B" - 4 BDRM HOUSE PLAN VIEW SCALE: 1" = 20 ' INV. _ · 89.84 FINAL GRADE ELEV. 94.0'+ NEW 1250 GALLON SEPTIC TANK -I~~L DBL. C.C. 89.54 PROFILE VIEW NOT TO SCALE PAGE 2 OF 2 GARAGE NEW 1250 GALLON SEPTIC TANK DOUBLE CLEANOUT ..¢,f,,'~4.;x,~ ~,,,"& "'-'. ,', h.'.~,.. \ T~. A-l, KAROLASKA S/D SEPTIC TANK REPLACEMENT AS-BUILT INSPECTION REPORT FLATTOP TECHNICAL SERVICES 14530 ECHO STREET ANCHORAGE, ALASKA 99516 SCALE: AS-SHOWN DRAWN BY TFM OCTOBER, 1995 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950305 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:BOS GREGORY N & OWNER ADDRESS:4200 SOUTHPARK BLUFF DRIVE ANCHORAGE,ALASKA 99516 DATE ISSUED:10/03/95 EXPIRATION DATE:10/03/96 PARCEL ID:02009340 LEGAL DESCRIPTION: KAROLASKA TR A1 LOT SIZE: 64192 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: SEPTIC TANK SYSTEM 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 (iSAAC80) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS iSSUED By: '~~ff~j[~, DATE: DATE: PARCEL: 020-093-40-000-96 RESIDENTIAL SINGLE FAMILY 10/03/95 STORY HT : 1.5 EXTERIOR WALLS: WOOD STYLE : OTHER YE/hR BUILT : 1972 TOTAL ROOMS: 07 FULL BATHS : 2 HEAT TYPE : CENTRAL FP: STACKS : EXTRA VALUE: CONDO STYLE: GRADE : AVERAGE REMODELED:~,, BEDROOMS ~2 ) HALF BTHS: ~' HEAT SYST: HOT WATER OPENINGS : EXTRA VAL: CONDO FLR: CST/DESGN: EFFECTIVE YE/eR: 1974 RECREATION PHS: 0 ADD'T FIXTURES: 0 FUEL HEAT TYPE: NATURAL GAS FREE STAND : E-Z SET FIREPL: CONDO COM PROP: CONDITION : AVERAGE ...................................... AREA .................................... BASEMENT : 806 FIN/BSMT : 806 BASEMENT GAR: CAR TOTAL 1ST FLOOR : 908 2ND FLOOR : 0 3RD FLOOR : 0 AREA: HALF FLOOR: 806 ATTIC AREA: 0 RECROOM AREA: 2319 .............................. ADDITIONAL FEATURES ............................. BASEMENT: 1ST FLOOR: 2ND FLOOR: 3RD FLOOR: At~EA: WOOD DECK 683 WOOD DECK 80 ENCLOSED STORAGE 120 ATTCH/BUILT GAP, AG 768 ' ~ SOUTHPARK BLUFF DRIVE 30%/ ORIGINAL 1250 GAL. SEPTIC TANK (TO BE REPLACED DRIVE,,",, ,', 125% FENCED / GARDEN f , AREA , / OI WITH NEW 1250 GAL. SEPTIC TANK) ,, TRACT A-2 (VACANT) ORIGINAL SEEPAGE PIT 1982 TRENCH UPGRADE SURFACE DRAINAGE , MUNICIPALITY OF ANCHORAGI!! .ENVIRONMENTAL SERVICES DIVISION S -~9 2 0 35% "PILL SLop~. 30% -TRACT A-1 KAROLASKA S/D WELL RECE!¥ED 15% TRACT A-l, KAROLASKA S/D SEPTIC TANK REPLACEMENT SITE PLAN FLATi'OI) TECHNICAL SERVICES 1 INCH = 50 FEET 14530 ECHO STREET DRAWN BY TFM ANCHORAGE, ALASKA 99516 SEPTEMBER, 1995 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. Flattop Technical Services 14530 Echo Street, Anchorage, AK99516 Phone (907) 345-1355 Tract A-l, Karolaska S/D 4200 Southpark Bluff Drive Septic Tank Replacement Specifications 1.0 General: 1.1 The scope of the project consists of abandonment of an existing septic tank and installation of a new 1250 gallon replacement tank. 1.2 Construction shall be as depicted on the approved site plan. Minor deviations from these di'awings may be allowed or required by the engineer conducting the inspections. All construction procedm'es and material specifications shall confolTn with Municipal and State requkements. All sepm'ation distances shall be in confon-nm~ce with Municipal requirements, unless specifically waived. 1.3 The contractor shall be responsible to obtain any necessmy utility locates, and to work m'ound any btu'ied utilities. 1.4 Unless specifically agreed otherwise, the homeowner shall be responsible for finish gq'ading after the soil is compacted, as well as placement of topsoil and reseeding all areas disturbed by the construction. 2.0 Septic Tank: 2.1 The existing septic tank must be properly abandoned by thoroughly pumping, removing the top and backfilling with soil, or burial of the crushed tank elsewhere on the property. 2.2 The new 1250 gallon, 2 compm'tment septic tank shall be Municipally approved and shall be set level on undisturbed soil. Each compm'tment shall be equipped with a watertight manhole cover and a 4" cleanout. If the tank is buried less than 4 feet, it shall be insulated with 2 inches of approved burial type, rigid insulation. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. The waste line from the residence to the septic tank shall have a minimum slope of 1/4'" per foot, and the waste line between the tank and the soil absorption system shall have a minimum slope of 1/8" per foot. A cleanout shall be installed within 5 feet of the building foundation, and a double cleanout shall be installed within 5 feet downstream of the septic tank. Another cleanout shall be installed near the junction with the horizontal distribution pipe of the 1982 trench upgrade 3.0 Inspection: 3.1 One engineering inspection will be required after the tank is set level and the piping connected, but prior to backfill. This inspection may be incorporated with any of the above inspections. 3.2 The installer shall coordinate the timing of the inspection with the engineer sufficiently far in advance to ensure the availability of the engineer. : DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION  ENVIRONMENTAL ENGINEERING DIVISION " ~ 825 L Street- Anchorage, Alaska 99501 Telephone 264-472_0 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT NAME ~ I [] NEW MAILING ADDRESS ~ ~ Well Absorption ~rea Dwelling PERMIT / NO. ~ DISTANCE TO:~ ~/OOt ~ ~b~' ~/~ '--// ~ ~ Manufacturer ,~ ~ ~' ~ ~(, ~ Material / , No. of compartments lLiq, capacity in gallons Inside length Width Liquid depth ]~ .~O IF HOMEMADE; ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer ~ -- ~ Material Liquid capacity in gallons ~ Well / Foundation/ i Nearest lot line PERMIT NO, ~ No. oflines Length of each line 'Total length of lines Trench width - Distance between lines ~ ~ Top of tile to finish grade Material beneath tile i Total effective absorption~rea ~ Length th Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth - Total effective ahsorp~ion area ~ DISTANCE TO: Well Building foundation Nearest lot line - ~ Classy., ~ Depth Driller Distance to lot lino PERMITNO, ~ DISTANCE TO: Building~foundation Sewer line Septic tank Absorption area(s) OTHER i .... ~ D ,?o ~/ ~.. SOl L TEST RATIN6_/ ~/o ¢ ~. .'1 INSTALLER R EMAR I(S APPROVED ~ DATE -LEGAL .¢ ....... ............................. THE 'rL.~?:'[..,[._' ): ?~i; ~'. Iq ':;I:::"F 1,I 'r r. "rH r:'nF' 'r[::,F ,. "-HC'C .... ' ......... [::'J~i22J::'"['i 'l ]: :j~]; "N,.i ::' ','t, .,T .... "I"" ,.l'~, ." ': ::,']u.~,, r-.. ':::' (}i[;~tF?,,,'F[J_. ~ ',[ :' '~,.~ J~:i ~: 'J TI-ti:: Oi ")' :::' u: :::," ~:::,!:::' .:::.I"~E' TI.,. !:::: ~u::q' T'~'.:~?! O.::: TH?i: !~:::'::CF!',,,'~q't' :i: ON ':: i: N c:'E:,~:i T' ). MUNICIPALITY O~ NCHORAGE MEMORAp~OUM To:_ ~"/¢- ,' q'"~-& // / From:. ~t.~ ¢-' /?~ 19~ Date Re: ~ ~ .I,.,:: .:::7:_~ ,~ .... !,,~ I. ~t~.~ s,,~ G ...... hr~~ ':' " Signed 91-015 {Rev, 1/81) Municipality of Anchorage Department of Health & Human Services Environmental Health Division Attention Mr. Steve Morris Feb. 4, 1986 MUNICIPALITy OF ANCHORAGE DEPT. OF H~ALTH ENVIRONMENTAL PROTECTION ii' 0 5 RECEIVED Dear Mr. Morris: Reference Health Authority Approval for house on Tract A-i, Karolaska Subdivision. On Saturday, Feb. 1, 1986, I performed a Health Authority Approval inspection on the well and septic system for the home located on this lot. The adequacy test performed on the septic system showed it and the well to be adequate for a 4 bedroom house. As per our conversation on Feb. 4, 1986, I am writing this letter to bring to your attention a minor glitch in the Municipalities files for this lot. The septic system report for the system upgrade performed in June 1982 shows a 15 ft. by 12 ft. deep trench added to an existing syste~n rated for two bedrooms as verified by an adequacy test performed at that time. However, two notes written on yellow "paste on" paper attached to the permit for the system upgrade indicate that a 30 ft. by 12 ft. trench was added, thus making the system adequate for a 4 bedroom home. The current owner, Mr. Lew Pamplin, purchased the home in 1982 & he informed me that a condition of his purchasing the property was that the system be adequate to support a 4 bedroom home. Since the adequacy test I performed verified the system will support a four bedroom home and the information on the permit in your files indicates that it was upgraded to handle a four bedroom home, I would suggest that the information on the "paste on" sheets be permanently noted on the permit. 6410 Switzerland Drive Anchorage, Alaska 99516 SOILS LOG MUNICIPALITY OF ANCFtORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street. Anchorage. Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: ~,_. LEGAL DESCRIPTION: 1 2 3 4 ~---~-~_ ~- 5, 6 7 10 13 14 ~7 ~8 20 COMMENTS PERFORMED BY: ~--,)-'~'~ t g-~ ' SLOPE SITE PLAN WASOROUNDWATER RO t ENCOUNTERED7 0 P IF YES, AT WHAT ~1~ E DEPTH? Gross Net ~'~ I ~"~ Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE / 7 (minutes/inch) TEST RUN BETWEEN (O,S FT AND .~.a~ FT & lo n '/~£ 5---/>'-P'/-. .--? , 72-008 (6/79) 42(]]1(111 Sout. l'H:)ar k ~B1 u'F'~: Dr i ve Ancl'~(::)rage,~ A]l. aska 99516 F::'el::)ruary 6, 1986 I*lun :i. c:i. pal i ty !} E'l::hm' ' 'km [.:~, r Yl: Anchc~r"age, Alasl.::a AT'TN: Mr". Stew~..~ Morris [)ear" Mr. Morris: l:::'(::)l," the pLU'"l:)Osl.~:i, c.,-f (::)l::)'l.:a~J. n:i. r'~9 a muni c:L pal :i. ty 'For my onsi'ke (,,,~e].l/septic system~ i h:i,r"ed Pit,, conduct 'kl"m:, requirecl adequacy tesi:'.s. In rev:i.c.~,w:[n(;j w:i. tl"i Mr. ~3i:,ze~,mcw'(.~) yOLU'" r(~?(zcw'd~ (:)r'l my prop~rty ('Tract A.-.J,, Karolaska [~Ld::,,, ) we nc)t.:i, ced several cliscrel:)anc:i(.'..z,s; fi:or ex amp :l. e ,; the proposed not(.:e!~ a'ktacl"~ed 'k.o 'khi s .[:o1'"11~ ~,,,d"~:i. (:::1"~ :i. i"H:li caked ii'~c:].ucli nig] a 30 .Foot 'kr'encl"~,, i irldicated to I~'h'''. Si ;-zemore at that. t:i. me k,l'~at the attacl"]ed hand~a'":i, tten :i.n~;ormat:i,(::~n was morc:e accurate 'kl"~ar'~ 'khe "as-bu:[ ]. t". When I t4as :i. I~ the proc::e!ii;s (:::,'[: I:::,urcl"lasi n9 'kl"~i s prc)pc.:.)r'ky, an aclequacy test wa~ done c~n the existing crib syste~m and it .{:(:)L.u~d 'kD I::)E, :i.r'lau::leclLh','~ck(,? .For a three I:)edroom he)usE, .......... :i.t passc:q::l d ]. ~ t~,,.~(:3 add J. t i c)F~al b~:?ch"o~il~s,, :11 persc:,r'la], ly :Lr'lspected the Ul:)gl'"adecl system ,'as :L t was be:i.r'i~:} c(::)n ..... !~i;r ~..t(::: t ~:~.~(:J a r~ d j I.~ !i~ t [::) r J. o r 'k o b a c I.:: 'f: J. 1 i ,, 'l'l'l <~) ri (e~,,,~ t r" ~,r'i c I'l t,,~ a or:i. El:Lr'~a].].y excavated over 4C) .FI.:,:.)E,'I': :i.I] ].engl::h anti :i.n e>((:::ess o.F 1() · feet deep. ]'he east er'id o4: the trench had (.z.)n(::our'rkered a !,,,n~:Yker seepage so :i. t ~,~as bacl.::.{::i. ]. ]. ed and coml::)act~)::,d and 'kt"l(~.~ tl'"(.z.)l"K::h {e:,x 'l/:(.:.)zl"l(::li.~el::] s{.:~evel'"a]. .[:t~l~.)'['. (::)r'l ~:: ['] (.:+z w~.~s'k {-:.'el"lc:l. A day or so Iater i:he · k:rer'~ch k,~as ~:::i. 1:1. ed i,.,d.'!::h sewer rc)c:l.::s/ka'~:usl'H.z~,d ~:lravc?l . My 1 asr v:i. sit to vie~.~ the n(al,,~ system was just prior to bacl.::.Fill. The 'l:r~::el"~cl'q ~as a m:i.n:i.~:L um ~::)~: :];() ~:eet. 1 c)n~] ar'~d exter'H::ted c:)n I:)oth si des o.{: the kie--in dol~,u'ts].ope o{: the lateral "T" c:onrtec:t, ion '~:rom 'k'.l"~e sept:i.c tar'il.,: 'ko the cr:i.b. As I rec:aJ. 1 , 'l:he 'l:r(anclu was ~::l"l~:e ~,,,~(-:e~;t sJ.[:l(.~, o-F the t:Le-:i.n 'kl"~an on 'l.'.h~:a east end. hope tl'~:i.s ac:ld:i.t:i.c)r'~al :Ln.f:l:)rrnatic)n :i.s use.fi.ti in clear:Lng up any C:OI'I'~:;LMiSJ. C)I"I i:':lr'lc[ C:¢.')i'"ri.Y.~c:tiFI(;J the I"(')!?C:Ol'"£:I!li~ C)f'l lily up(;;lra(:led sept:i.c s'/B ..... ti.:.:,ml. "l'har'~l.:: you .[:or" your att(.:ent.:i, or'~ 'ko t.h:Ls matt(.~:.:,r. 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description 7---/~d:~(~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Day phone Day phone Day phone Address NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Unless otherwise requested, HAA will be held for pickup. NOTE: Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 II21 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, lfurtherverifythatbasedontheinformationobtainedfrom 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. Engineer's signature ~~~ ~,~~ Date ,~ . DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments BY: ~ d¢¢__~._;~ Date ~ - ';~ '~'- ¢3 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¢I21  Municipality of Anchorage ~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:'-~-/~--~ ~'-¢7/~ ~/--/ ~/~+/~1~ Parcel I.D. 0 ~ -~ ,O Well type ~¢¢/¢ If A, B, or C, attach ADEC letter. ADEC water~.~em number Log present (Y/N) ~ Date completed / ~ 7 ~- ~' Driller f I Total depth ~ ~< ~ Casedto ~ ~ Casing height / Sanitary seal (Y/N) ~ Wires properly protected (Y/N) . FROM WELL LOG AT INSPECTION DaJe of test ~" '-- / 7 -- ?~--- / Static water level / ~ Well flow / ~' g.p.m. / ~ ~ ~- C ~ g.p.m. Pump level ~ ~ ' ('~ -¢' .-~ / SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot / ~-~ Public sewer main /4 Sewer service line [~//A ;On adjacent lots ' ; On adjacent lots .~ //¢~-)(-~ / ~-~-~ Public sewer manhote/cleanout Petroleum tank /k~i//~ '~ WATER SAMPLE RESULTS: Coliform ~ Nitrate /~ .~ /";/2/~, Other bacteria Date of sample: ~-~ / ,~ / ~' ~ Collected by: J~- ~./F ~%'~'~'" (~¢-,'"¢~CP B. SEPTIC/HOLDING TANK DAT~ Date installed ~¢~ / ''~ ~'' - Cleanouts (Y/N) High water alarm (Y/N) Date of pumping 7 Tank size / ~-~'~'~'~ Compartments Foundation cleanout (Y/N) Y Depression (Y/N) /////~-'~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wen/s) I ,Cc"' d+) I on On adjacent lots . --,. Foundation [ TO property line '~,~ / Absorption field / Surface water/drainaqe /~ ~-?/e~ ~ 72-026 (Rev. 7/91) Front Water main/service line .~74''',~ CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level ...... Meets MOA electrical codes (Y/N) ~ .....~an~act u re r .-/Manhole/Access (Y/N) "Pump on'l'~/et-at- "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA ~, Date installed / ? ~ ~- Length _~..~(-r~ / v Width -~'~ ~-~ Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating Gravel thickness Cleanouts present (Y/N) Date of adequacy test for Total depth bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~¢-~ / ~'~2 ~. ~,,/ ' / On~acentlots / " Property line To building foundation / ~ To existing or abandoned system on, lot On adjacent lots ,~/~ Cutbank /~/¢ Watermain/serviceline Surface water /~/~/~ Curtain drain . E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in inspection. HAA Fee $ //~¢ Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE. ALASKA 99503 (907) 277-8378 . FAX 274-9645 Sizemore & Associates 6410 Switzerland Drive Anchorage AK 99516 Attn: James Sizemore Report Date: 03/10/93 Date Arrived: 03/03/93 Date Sampled: 03/03/93 Time Sampled: 1410 Collected By: JS Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Lab Number Method A122500 Karolaska Subdivision Tract A-1 Water Parameter * Definitions * B = Below Regulatory Min. H = Above Regulatory Max. E = Estimated Value M = Matrix Interference D = Lost to Dilution MDL = Method Detection Limit Date Date Units Result * MDL Prepared Analyzed A122500 EPA 353.3 Nitrate-N mg/1 1.3 0.2 03/09/93 Reported By: S~san C. T~fental Microbiology Supervisor Parcel I.D. # 1, MUNICIPALITY OF ANCHORAGE BEPARTMENT 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 ~.- L/(~ HAA# GENERALINFORMATION Complete legal description ;4 ¢" '7- Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Day phone Agent Day phone Ad dress NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Unless otherwise requested, HAA will be held for pickup. NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev 1/91) Fronl 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..~c?7¢/~ ~Z~/~'~/~C~ z¢ ~.-~-C'~(~¢'Phone En g i neer's sig n atu re /¢&~/~<> ~~:~ 'Date / %S SIGNATURE ~, CZ/-) . Approved for )~ ~'~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments -- ~:tIl / [.l ~ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representation~ 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. 72q)25 fRev 1191) BSCk MOA¢21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 7'~-~ A, WELL BATA we.. type :~':"i ¢ 0 ::f A. ~. or O. attach ADEC .e',ter. Log present (Y/N) ,.'~/ Date completed Cased to Parcel I.D. Total depth '-~ ~/' ,~ Sanitary seal (Y/N) ADEC water~sy~stem number //~, ~_.~ (7~,,~ [)riller Casing height / '~ ';' Wires properly protected (Y/N) ~ FROM WELL LOG Date of test Static water level Well flow /~ ? /~ Pump level ,5 ',~' /(~ g.p.m. Absorption field on lot Public sewer main Sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot / ~ (,~/ ~''¢- WATER SAMPLE RESULTS: Coliform ~ ; On sdjacent lots -~ ; On adjacent lots --"% Public sewer manhole/cleanout Petroleum tank AT INSPECTION , Nitrate Other bacteria Da~ of sample: (~' l '~ ~. '~-- B. SEPTIC/HOLDING TANK DATA ~ ~ ~ate inst.,ed ~ /% % Tan~ize / ~ ¢2¢~ Co~,ar~nt. Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~' Depression (Y/N) High water alarm (Y/N) ~'~ Alarm tested (Y/N) Date of pumping 7 A ~ ~/ ' ?~ Pumper_ /~c~(~ SEPARATION DISTANCES FBOM'SEPTIC/HOLDING TANK TO: Well(s) on lot I ~(~ , On adjacent lots ~ To property line ~/~ : Absorption field Surface water/drainage /~/dP///~ 72-026 (Rev. 7/91) Front Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons ~ Vent (Y/N) High water alarm level. Meets MOA etectribal codes (Y/N) ~cturer ¢--~ Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA ~} Date installed [ ~ ~ '~-- Soil rating ¢7--/'O System type Length ~/ ~ Width .~ // ~ Gravel thickness ~ TotaJ depth '~ / Total absorption area / Cleanouts present (Y/N) Depression over field (Y/N) ~ Date of adequacy test ~ ~' / Results (pass/fail) ~ ~ ~ ~ for ~ bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD,..,TO:/ / Wellonlot '~ 1 -~dxh / ~- ~'~ On adjacent lots -~ / ~'~ Propertyline To building foundation / 7 / -, To e.xisting or abandoned system on lot · / ..... On adjacent lots .-~'~ [C~ Cutbank O /~ ~ Surface water /"~ (? ~¢1 (~' Curtain drain E. ENGINEER'S CERTIFICATION Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe( Signature Date ~'= ffect..~ ~f~ of this inspection. HAA Fee $ /7¢,, Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 (907) 456-3116 · FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 $izemore & Associates 6410 Switzerland Drive Anchorage AK 99516 Attn: James Sizemore Report Date: 08/14/92 Date Arrived: 08/12/92 Date Sampled: 08/12/92 Time Sampled: 1045 Collected By: JS Our Lab #: Location/Project: Your Sample ID: Sample Matrix: Comments: Al19647 Tract A4 Hard Aska Water MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Method Parameter Units Result Flag MDL Analyzed EPA 353.3 Nitrate-N mg/1 1.1 0.5 08/13/92 Microbiology Supervisor MUNICIPALITY OF ANCHORAGE 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 App,icat,on °ate 4' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ~ , ~ . (b) Applicant Name ~¢~ LCW F~/,'~elephone: HomeJ~--,~ ¢7 Business ~2~/ Applicant Address (c) Appl~tis(checkone):Lendinglnstitution~;Owner/builder~,Buyer~;Other~ (explain); ~[~ ~ (d) Lending Institution Address (e).. ?ea.I Estate Company a. nd Agent Address ': '~elepl)one (f) Mail the HAA to the following address: 2, TYPE OF RESIDENCE Single-Family,~ Multi-Family [] Other Number of Bedrooms. .~ /~., 3. WATER SUPPLY Individual Well ~ C, ommunity [] 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 wel~ system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) ENGINEERING FIRM PROVIDI, INSPECTIONS, TESTS, FILE SEARCH, D. ~ AND INFORMATION 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 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. Nameof Firm d a/)",)'~-'~ 5~r~ ~ ,,~C-Telephone ~ ~/~ 7Z DHEP APPROVAL -.~c,,.,~r'- Approved for~bedrooms by A_pprove_d Disapproved Conditional Terms of Conditional Approval Date 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} MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION r f! B 0 1986 Legal Descrip. tion: WELL DATA Well Classification _Si ~q/~ ~-~J'~. i/~~'~ If A, B, C, D.E.C. Approved (Y/N) 1 Well Log Present (Y/N) ~ Date Completed //~' ~ Z Yield /- ~ (~/'~ -/~ Total Depth '¢-'2 ?. ~ Cased t/o ~ Depth of Grouting .Static Water Leve; v /E2/,,¢-. Pump Set At Casing Height Above Ground ./ ~/t __ Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Separation Distances from Well: / To Septic/Holding Tank on Lot J 50 / (~'-/'') ; On Adjoining Lots /~) To Nearest Edge of Absorption Field on Lot / ,C)d~¢');_ On Adjoining Lots /~"-) / ftC-) To Nearest Public Sewer Line /"V/A To Nearest Public Sewer Cleanout/Manhole /'~//~ ' To Nearest Sewer Service Line on~_ot . Water Sample Collected by ~ ~_/~'--Q~ f)?(¢/'~---- ;Date F.-~ /~ Water Sample Test Results ~O~-~i ff-)¢~-~, (~.'~/"~'Y Comments SEPTIC/HOLDING TANK DATA Date Installed ,(¢/a~ Standpipes (Y/N) /kC Air-tight Caps (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/Ho[ding.Tank: · TO Water-Supply Well ~ ]:.5 ~ To Property Line ~ / To water Main/Service Line Course Size /~)~-~(~ ~a/.No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation'/~.2 _ To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage Comments ::; ~age 1. of 2 72-026(11/84) ORPTION FIELD DATA Soils Rating in Absorption Strata ~,/O 1~l'//~' __ Typeof System DesignT/~_/4yE~lo;~L-')~r' Date Installed ~ ~P. ~ / F ~ ~ ........ ~/ . _ Length 01 hlela Width of Field _ _ Depth of Field _ ~¢,,.¢~.,,~ ¢¢,'~ ~ 9~l~ ~-~ Gravel Bed Thickness ~ Square Feet of Absorption Area ..~- Standpipes Present (Y/N) Depression over Field (Y/N) ~ Date of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply We, / DC/ E To ope,y Lm To Building Foundation ~ ~ / .ct TO Water Main/Service Line ~/~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ~¢~ /~[~~ .~¢~ To .~isti~ or Abandoned System on ; On Adjoining Lots /6"~L-~ / ~''~') 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 tha~qhave ch.ecke~::k~.~ied,/~=//~/]//,,'/.--'-~"~/L. ~.-~ orconformed to all MO~n~guidelines Signed /~~~~Date ~~// 0 ~ ReceiptNo. ~O~q~ Date of Payment ~¢~ Amount: $ ~ ~ Page 2 of 2 72-026 (11/84) in effect on the date of this inspection. Lo, n." / DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR O I NSP ECTOPr, MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF ~':ALTI~ &  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIO~VIRONMENIAL I ~;C"(ECTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND 8EWER FACILITIES pi REOTIONS: Complete all parts on page 1. Incomplete requests will ~ot be processed, Please allow ten (10) days for processing. 1, PROPERTY OWNER ]~, & J/' J PHONE PROPERTY RESIDENT(If different froo~above) ~ i /-,/' ~ ¢ ~/ PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION I PHONE I MAILING ADDRESS 4. REALTOR/AGENT ~} PHONE MAILING ADDRESS 5, LEGAL DESCRIPTION STREET LOCATION 6, TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATE~R SUPPLY ~' INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY NUMBER OFtBEDROOMS [] One [] Four [] Other [] Two [] Five ~,~]¢ Three [] Six ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg if available.) 8. SEWAGE DISPOSAL SYSTEM ,~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY //z~/'~,~)_ YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED~ THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified [~]SepticTank or []Holding Tank Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] TWO [] FOUR [] SIX OTHER 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area to nearest Lot Line Absorption Area Sewer Line '~e"~'~st L0t Line 5. COMMENTS DATE E[~-~'DISAPPROV ED APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) · % ;, ;,{. · September 29, 1981 Rick Kentopp Post Office Box 4-1875 Anchorage, Alaska 99509 Subject: TllN R3W Section 3 N½ NW~-4 N%',Y~ SW% Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: /' (1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this office. The number of gallons pumped need to be verified by a registered engineer. This is to verify the size of the septic hank. An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A ii. sting of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw ALASKA erlUIROrlmE FITAL Les Bucholz DHEP 825 L. Street Anchorage, Ak. 99501 COFITROL $SRUIC $, IFIC. I~nqineerinq 8 ~nuironmcnlaJ $1udies MUNtCIPALI~-Y OF ANCHORAGE [ /.. · ,O [~ May 28, 1982 Dear Les: This is to certify that we have inspected the test hole at Karolaska, Tract A1 for Rick Kentopp and verified that to a depth of 16.5 ft. there is no water. Also, the outlet end of the septic tank was exposed. The tank diameter was 5 feet with a baffle located approximately 45 inches from the outlet end. These dimensions together with our pumping of 1000 gallons from the tank earlier indicate that this tank should be a 1250 gallon tank. If you have any questions please let me know. Sincerely, Pres ident 1220 UJcsl 25th ~uenue ·/~,¢horc~§¢, Alask,~ 99503 · (907) 276q361 Hay 2,7, lq,q2 ;'k. 'P, ic:k P~eni:op1-) ]ir;i o l?,Pll ,/.~?/!, ! 5/21/8~ MUNICIPALiTy OF [; ["-~" m ANCHORAo~ NVI ': .... ~."' ~ ~. · : il' /' ,~ F , 1 RECEIVED RICK KENTOPP P.O. BOX 4-1875 AK 99509 SELLER - SAME BUYER-LOU pAMPLIN SUBDIVISION-KAROLASKA BLOCK-TRACT A1 LOT- ADEQUACY TEST FOR SEWER sYSTEM THE TYPE OF ABSORPTION sYSTEM IS A CRIB WITH AN UNKNOWN AREA. THE sYSTEM IS cAPABLE OF ACCEPTING 300 GALLONS OF WATER PER DAY. THE SURGE cAPACITY OF THE SYSTEM IS 500 GALLONS. BASED UPON THE TEST DATA THE sYSTEM IS NOT ACCEPTABLE FOR A HOME OF 3 BEDROOMS. THE SEPTIC TANK WAS PUMPED ON 5/21/82 · SEPTIC TANK ADEQUACY THE ExiSTING sEPTIC TANK VOLUME OF THIS, ~' BEDROOM HOUSE. IS ADEQUATE FOR 1220 ~esl 25Ih ~utnue ~"/'tichoraqe, ~laskQ 99503 ~* (907) 276-1361