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KASILOF HILLS BLK 4 LT 5
Onsite File Kasilof Hills Block 4 Lot 5 PID# 015-131-27 If the 1994 field is not used as an AWWTS, then it may not be tested for a 5 bedroom house. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700Elmore Road Anchorage, Alaska eVs1e'ossn Phone: 804 Fax: (907)343-7997 On-Site Wastewater Disposal System Permit Permit Number: OSP211028 Work Type: Septic Upgrade Tax Code Number: 01513127000 Site Legal Address: KAG|LOFHILLS BLK 4 L 5 8.2541 Site Mailing Address: 1074OKAS|LDFBLVD, Anchorage Owner: POUL|NDAVID &KATHLEEN Design Engineer: GARNESSENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 2/17/2021 2117/2022 ZDisposal Field ZSeptic Tank El Holding Tank El Privy El Private Well 0 Water Storage All construction shall beinaccordance 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 (1 8AAC72) and Drinking Water Regulations (1 8AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.G5.Provide notification bycalling (Q07)343'7QU4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing Received Issued By: 6 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907-34 - 7 On -Site Water & Wastewater Program MayorAustin Quinn -Davidson On -Site Sewer/Well Permit Applicati For A Single Family Dwelling Parcel I.D. 015-131-27 Property owner(s) KATHLEEN POULIN Mailing address 10740 KASILOF BLVD *ANCHORAGE, AK 99507 Site address 10740 KASILOF BLVD *ANCHORAGE, AK 99507 Legal description (Sub'd, Block & Lot ) KASILOF HILLS; BLOCK 4, LOT 5 Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: (Nall that apply) Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Day phone 907-242-4223 Sq.Ft. Number of Bedrooms 5 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: PROPOSED DRAINFIELD TO EXISTING DRAINFIELD TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: 10 FEET I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 595 Waiver Fees: a a 5 Date of Payment: 2 02 Date of Payment: Receipt Number: ©5 `� C Receipt Number: O g 6 (o C Permit No. OSP211028 Waiver No. 05UH001 001 (Rev. 01/11) Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211028, Deb Wockenfuss, 02/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211028, Deb Wockenfuss, 02/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211028, Deb Wockenfuss, 02/17/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211028, Deb Wockenfuss, 02/17/21 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this [O 'Day of '�Coovlof 20 Zl , by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as QUA S located at (legal description) has i�d-�- i11 S.L1-- 2. Maintenance, Repairs and Alterations. wner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWR: 3v: (signature) L`�(print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT Date: Z- vg I Z i 11- The foregoingwps instrument acknowledged before me this 16 day 20;(, by v% L NOTARYkjLICF R ALASKA My Commission expires: MUNICIPALITY: By: (/i% (signature) (print name) of 70& , \\\�P�PG..KC� , :NOTA ':P PUBLIC //111111111\\ Date: Z / Az Title: (rev. 05/18/2018) Page 3 of 3 LOT 5LOT 6LOT 19LOT 4KASILOF BLVD.30'30'10' X 30' ANCHOREASEMENT10' UTILITY EASEMENTN08° 25' 21"W 159.85'N81° 34' 39"E 200.00'N89° 58' 53"W 69.16'S81° 34' 39"W 131.59'S08° 25' 21"E 1 7 0 . 0 0 ' 2%EXISTINGHOUSE2 7 . 5 ' 18.6'12.7'2.0'7.0'2.0'12.7'23.0' 24.4'26.7'5.0'45.2'25.7'23.7'43.4'61.5'8 COSHEDSHEDLOT 5, BLOCK 4,KASILOF HILLS SUBDIVISIONAS-BUILTLEGEND:NOTE:THIS DRAWING SHALL NOT BE MODIFIED FOR USE AS A PLOT PLANWITHOUT THE EXPRESSED WRITTEN CONSENT OF LCG LANTECH.DRAWN DATE:DRAWN BY:SCALE:CHECKED BY:8/22/2019SCAP1" = 40'PLAT:WORK ORDER:1907966-96FB/PG: 815/55GRID:SW2541LEGAL DESCRIPTION:ORDERED BY:KATHLEEN POULINSURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THEPROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTSSITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXISTOTHER THAN NOTED.EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCEOF ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DONOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCESSHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTYLINES, OR FOR PLOT-PLAN PURPOSES.CLEAN OUTWATER WELLFENCEAsphaltConcreteOverhangWood Deck250 H StreetAnchorage, Alaska 99501Survey DepartmentPhone 562-5291MainlinePhone 243-8985AECC 668ADDRESS: 10740 KASILOF BLVD. PARCEL #: 015-131-27-000REF: 04L72A#COGravel LOT 6LOT 19LOT 4KASILOF BLVD.30'30'10' X 30' ANCHOREASEMENTN08° 25' 21"W 159.85'N81° 34' 39"E 200.00'N89° 58' 53"W 69.16'S81° 34' 39"W 131.59'S08° 25' 21"E 1 7 0 . 0 0 ' 2%EXISTINGHOUSE2 7 . 5 ' 18.6'12.7'7.0'2.0'12.7'23.0' 24.4'26.7'5.0'45.2'25.7'23.7'43.4'61.5'8 COSHED1290.4'1293.9'1315.9'1342.3'1391.9'13 1 8 1322 1326 1330 13 1 0 1306 1302129812941292 133 6 1318 12961304 13 2 4 10' UTILITYEASEMENT32.1'LOT 52.0'SHEDLOT 5, BLOCK 4,KASILOF HILLS SUBDIVISIONLEGEND:NOTES:1.THIS DRAWING SHALL NOT BE MODIFIED FORUSE AS A PLOT PLAN WITHOUT THE EXPRESSEDWRITTEN CONSENT OF LCG LANTECH.2.ELEVATIONS ARE BASED ON MOA BENCHMARKGAAB 112, WITH ELEVATION 677.78, DESCRIBEDON PAGE D-41, SHOWN ON MAP PAGE M-86 INTHE MOA BENCHMARK NETWORK BOOK.3.CONTOUR INTERVAL IS 2 FEET.DRAWN DATE:DRAWN BY:SCALE:CHECKED BY:12/19/2019SCAP1" = 40'PLAT:WORK ORDER:1907966-96FB/PG: 815/55GRID:SW2541LEGAL DESCRIPTION:ORDERED BY:KATHLEEN POULINSURVEY CERTIFICATION: LCG LANTECH, INC HAS CONDUCTED A PHYSICAL SURVEY OF THEPROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE IMPROVEMENTSSITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXISTOTHER THAN NOTED.EXCLUSIONARY NOTE: IT IS THE OWNERS' RESPONSIBILITY TO DETERMINE THE EXISTENCEOF ANY EASEMENTS, COVENANTS, RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DONOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCESSHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION, FOR ESTABLISHING PROPERTYLINES, OR FOR PLOT-PLAN PURPOSES.CLEAN OUTWATER WELLFENCEAsphaltConcreteOverhangWood Deck250 H StreetAnchorage, Alaska 99501Survey DepartmentPhone 562-5291MainlinePhone 243-8985AECC 668ADDRESS: 10740 KASILOF BLVD. PARCEL #: 015-131-27-000REF: 04L72A#COGravelAS-BUILTwith CONTOURS Municipality of Anchorage Page ! of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 ® Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Name: ~Upgrade '~u f~l ~To~ ~ Wastewater System: D New Address: ~0'7~o ~ ~: ~ ABSORPTION FIELD Phone: No of~¢rooms:- ~DeepTrench ~ Shallow Trench ~ Bed ~ Mound ~Other Total Deplh from original grade: LEGAL DESCRIPTION Soil Rating: ~ ~ GPD/Sq. Ft ~ i Lot: Block: Subdivision: Depth to pipe boltom from original grade: Gravel depth beneath pipe Township: Range:Section. Fill added above original grade: Gravel lenglh: Nurnber of lines: Distance between lines: WELL: Q New ~ Upgrade Gravelwidth: ~ FI. / ~ Ft. Classification (Private, A,B.C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: Date Drilled: Slatic Water Levek Inslaller: Date installed: Yield: Pump Set at: Casm9 Heighl Above Ground: o.~ F, ~t TANK SEPARATION DISTANCES ~Septic ~ Holding U S.T.E.P. TO; Seplic Absoq)tion Lifl Holdm9 Public/Private Manufacturer: Capacily in gallons: From Tank Field Slation Tank Sewer Lines /--~Ct~ . ~/~N[~% I~-~ O Surface Water ~ 0 ~ ~ LIFT STATION LineL°t ~ ~ Size in gallons] Manulacturer: Foundation ~ ,¢O "Pump on" level at: "Pump off" level at: High water alarm at: CUDrainrtain ~ O ~ ~/ Pump Make & Model E~ectrical Inspections performed by: Remarks: BENCH MARK Localion and Description: Assumed Elevation: 1 o~ Fh ENGINEER'S SEAL Inspections performed by: ~ Dates: 1st ~ / Reviewed and approved ~ ~~ 72 013 (Rev 9/91) MOA 25 £5 50 7,5 TOBBEN SPURKLAND P.E. II 203 W 15TH. AVENUE II ANCH. AK. 99501 (907/ 279-,~ 11~ LOT 5 B£OCI( 4 IfASILOF I]I£LS DA YE PURINTON 10740 KASILOF DRIVE SEPTIC SYSTEM ASBUILT DATE: OCL 9, 1994 SHEET: 2/3 GRID: 254I ~tandard Treac]~: 58 Fi ?o/o/ Leng!h 9 Fi To!ol Depih 6.5 FL Effective Rock Dep!h / / E~eonou~s Monl 88-~ 9~ iVO 5CALE 77,8 1c750 gol. svpt,'c BENCH MARK: BOTFOtd SIDING ~ t00.00 TOBBEN SPURKLAND P.E. 205 W1S!h Ave Anchora, Ak 99501 LOT 5 ELOCt( ~J KASILO? HILLS I0740 KASILOF DRIVE DA VID PDRINTON SEPTIC SYSTEM ASBUILT DATE: OCT. 9, 1994 SHEET: GRID: 2541 PAGE 1 OF MUNICIPALITY OF ANCHOP~AGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHOR_AGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940379 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:PURINTON R DAVID & OWNER ADDRESS:10740 KASILOF BLVD ANCHORAGE, AK. 99516 PARCEL ID:01513127 LEGAL DESCRIPTION: KASILOF HILLS BLK 4 LT 5 DATE ISSUED: 9/30/94 EXPIRATION DATE: 9/30/95 LOT SIZE: 33653 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /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 (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 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: Anchorage, Alaska 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 5 BLOCK 4 KASILOF HILLS DAVID PURINTON Groundwater at 13 ft Use Standard Trench Soil Rating From test Sept. 7, 1994 8 mix,/in: .8 gal / sq. ft. No. of Bedrooms 4 Required Area per Bedroom: 150/..8 = 187.5 sq.ft.. Total area required: 187.5 x 4 = 750 sq. ft. Existing System is for 3 bedrooms, show replacement site. Ground Slopes 20 +-% Testhole Total Depth 15 Less 6 feet 9 Less 3 feet Cover 6 Rock Depth 6.5 Add 12 inches of fill over trench Length of Trench 750 / 13 = 58 [FT.] SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 58 FT. TOTAL WIDTH 2 FT. 'RO~i{, DEPTH 6.5 FT. COVER 3 FT. SEPTIC TANK 1250 GAL. ABANDON EXISTING SYSTEM The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. Septic System Dcsigo Lot 5, Block 4 KasilofHills PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG m PERCOLATION TEST LEGAl. DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 20 Township, Range, Section: SLOPE S L IF YES, AT WHAT O DEPTH? p E Oeplh lo Water After ~donitoring? I ~. ~'~ Dale: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (m~nutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN /~ FT AND ~, -~-~ FT COMMENTS PERFORMED BY: ~' '~ I "~ ,-''~~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATEAND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~r4 ~ f~d /) ¢ ~/ 72-008 (Rev. 4/85) LOT ££ LOT ~£ / 50 100 150 TOBBEN S~AND P.E. 203 W 15TH. A~E~~I ___ 5 ]~LOCI~ 4 IOtSI£OF I]I£LS ANCH. AK. 99501 Il DAVEPURIMTON (907) 279-39 ] 6 107~0 KASILOF DRIVE LOT ~0 ~ I SEPTIC SYSTEM DESIGN DATE: SEPL 8, 1994 SHEET: I/$ GRID: 25,tl 50 75 S£ALE, I.~ -. 50 Fl, TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCFI. AK. 99501 .(907~ 279-3916 LOT 5 BLOCK 4 IfASILOF IIILLS DA VE PURINTON 10740 KASILOF DRIVE I I SEPTIC SYSTEM DESIGN DATE: SEPI, 8, 1994 SHEET: 2/$ GRID: 2541 5'tandard Trench: 58 Ft Total Length 9 Ft Total Depth 6.5 Ft. Effective Rook Depth 4' Topsoil J ft. of cover 6,5 P't oP 5'eptlc' t~ocl< SCALE 1~0 9oL :ep~,'c tonk TOBBEN SPURKLAND P.E. 205 Wl5th Ave Ak 99501 LOT 5 BLOCI( 4 YASILOF HILLS 10740 KA$/LOF DRIVE DA VID PUR/NTON SEPTIC SYSTEM DESIGN DATE: SEPT. 22, 1994 SHEET: GRID: 254 T.SPURKLAND P.E. M/~¥ ~ 1995 203 W. 15th. AVE. SUITE 203 ~o~,.~; ~d~.~y ol ancl~orage ANCHORAGE, ALASKA 99501 Oe0t. Health & Human Services (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Division of Enviroranental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 May 1, 1995 Su~ect: HAAfor Lot5, Block 4 KasilofHills HAA # 940533 Gentlemen; The original HAA for this property has been lost. I have made copy of the one signed by Robbie Robinson on 10/12/94 and request a re-authorization of the HAA. Yours !ib~x~C~Cbgn Sum k~ ~ ~d~P~.E.~, GREA,.'R ANCHORAGE AREA BORL.,GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL MANUFACTURER~~ MATERIAL NUMBER OF COMPARTMENTS '2__ INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY_(/<:cDr) GALLONS. TILE DRAIN FIELD: ~'~'~ DISTANCE FROM WELL ..~'~- f FOUNDATION _ NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA (.Lc G ~) SQ, FT. DEPTH: TOP OF TILE TO FINISH GRADE ~/'/ f NEAREST LOT LINE TOTAL LENGTH OF LINES ~:~ TRENCH WIDTFI__ IN. TOTAL EFFECTIVE LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE ('~ / ,i',','~. ABOVE TILE ___~/// IN, WELL: TYPE BUILDING FOUNDA lION CESSPOOL APPROVED · __CONSTRUCTION NEAREST LOF LINE OTIdER SOURCES DISAPPROVED NEAREST SEWER LINE DEPTH SEPTIC SEEPAGE , TANK , SYSTEM REMARKS DISTANCE FROM: DISTANCES: iNSTAt_LED By: ~. SEWER LINE DEPTH: PIPE MATERIAl_, LOT SLOPE: ~-~"~ REMARKS: DIAGRAM OF SYSTEM DATE G,A.A,B. Form LQ-032 I'l..l!iii: [.E:I'.,I(:ii'I"H D :t. I"ll:ii:l'.,l:ili; :1: ON :1: i~i; "['l-lEi: L. li!~:NG'I"FI ,:: :1: N F'Ei:~:T ::, OI:~' 'l't.llE: 'TI';?.E:I'.,ICH O1:;:I 11::,1:,~:1::~ ]: I'.,IF' :1: li!:!...l:::,. 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I~:~I~i!: ':'i;l_ll~ii~..:l'llii:CT q"(:l GREATER ANCHORAGE AREA BOROUGH~'~'~'-,'-':'~.--~':,"--'<-'-:~'" DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO, 3330 "C" STREET ANCHORACE, ALASKA 99503 SEWAGE DISPOSAL SYSTE~ -- APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCATION MAILING ADDRESS INSTALLATION OF: SEPTIC TANK /% TYPE AND SIZE OF FACILITY TO BE serVED FINANCED THROUGH SOIL 'rEST RESULTS SEEPAGE PIT DRAIN EIELD NOTE= THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING 0V ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PRf~SEcuTIoN. SEPTIC TANK SIZE ./"'?)"~") /" TYPE ~'~¢/J'<'~/~ SEEPAGE AREA SIZE MININIUNI DISTANCES, REOUIREIV~ENTS ., DRAIN FIELD SEPTIC TANK ~ .. SEEPAGE-PfT ; , DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC 'TA~i~J~-- SEEPAGE Pit DRAIN FIELD / d-fJ / . ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, ~~) -~- I , SEEP ~EJ' DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING gAP Of EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEP/~GE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL -_ CONFORM TO BOROUGH REGULATIONS REGARDING ~NSTALLATION. I CERTIFY THAT ] AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE, GR[A'[I.R AItCHORAG[ AREA BOROUGII DEPARTI4ENT OF ENVIRONMFHTAL O/l~l I'I'Y 3330 "C" Street ANCHORAGE, ALASKA 99503 Case # Performed For _ Legal Description: Lot_5____Block This Form Reports Soils Log Soil Test Must Be Logged To 4' Below Proposed Depth Feet Soil Characteristics Silty sand (SM), residual soil yellow to reddish brown with organics Gray silty sandy gravel (GM) Gravelly sand to sandy gravel (GW-SW) with trace to minor amount of silt. Medium gray slightly moist with occasional cobble size material Material remains the same. Bottom of excavation Was Ground Water Encountered? No If Yes, At What Depth? Dated Performed._S_e_pt 26, 1974 Subdivision KasilofHil[s Subdivision Percolation Test Seepage System- Reading Net Time Depth to H20 Net Dro Date Gross Time Percolation Rate MinuLe Proposed Inst¢~-i~-~n-: Seepage Pit Drain Field Depth of Inlet ................ Depth to Bottom o~--Pit or Trenc[] 1~' C OMMENTS: In accordance with Borough_requirements we would recommend a minimum of 150 square feet of seep_a_g_e__a._re_~_p_e_r~b_e_dr__o_o~n2· ............................................. Test Performed BY ___H_o.w_Ard_JL,__Orey Date Certified BY: ALASKA MINERAL & MATERIALS LA~ Date: M-W DRILLING~ Inc. P.O. Box4-1224 · 1310C International Airport Road (907) 274-461I ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Use of Well Location (address of: Township, Range, Section, if known; or distance main road Size of casing_ Depth of Hole :'"-': feet Cased to feet Static water level - ft. (above) (below) land surface. Finish of well (check one) Screen ( ); Perforated ( ). Describe screen or perforation Well pumping test at gallons per (H~'r) of drawdown from static level. 'lc.j}. (minute) for I hours with :'-' Date of completion open end ( ); ft. WELL -LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness _TO ~' ';:~ ,_ LV · . ..'".~ ~ -- _TO. - ' -'"~ TO , ',;: TO .TO. .TO. __.TO. TO. .TO. .TO. TO_ TO TO TO 2 -- STATE Municipality of AnchOrage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-131-27 HA # 0 o / Expiration Date: '7--' GENERAL INFORMATION Complete legal description ' Kasilof Hills Block 4, Lot 5 Location (site address or directions) 10740 Kasilof Bivd, Anchorage, AK 99516 · Current Property owner(s) Lisa Machamer Mailing address · Lending agency Day phone Day phone ,. Mailing address Real Estate Agent Beth Simpson / Dynamic Properties Day phone 727-2384 Mailing Address 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for plckup. NUMBER OF BEDROOMS: 4 e TYPE OF WATER SUPPLY: Individual Well · [] Individual Water storage [] Community Class Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year With'valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional-engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as Of the validation dateshown below, I verify that my investigation, -based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe,' functional and adequate for the'number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc. :. Address P.O. Box 110443, Anchorage, AK 99511-0443 Engineer's Printed Name Cindy W. Ellis DSD SIGNATURE ~ Approved for L.~ · bedrooms. - Disapproved. Conditional approval for _ phone 349-1851 Date ~-Z~-~,~ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory (Rev. 0t)02) .. X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Well type Pti Dat~; ~oml~ieted 7/75 ff. Municipality of Anchorage Development :Services'Department Building SafetylDivlsion · On-Site water & wasteWater Program 4700 South Bragaw St. _ P.O. Box 196650.~ Anchorage, AK 99519-6650 . www~muni.orglonsite (907) 343-7904 HEALTH :AuTHORri~.APpROvAL CHECKEIST Legal Description: Kasdof H~lls, Block 4. Lot 5 A. WELL DATA If A, B, or C prov!dePWSID# - .Sanitary ~ea! Total depth 150 Cased to'i 43.3 ft~ . - · I FROMWELL LOG D~te of teSt Pa~C~I ID: 015-131-27 1 Well Log' (Y/N) yes Wires propodyp.rotected (Y/N).¥ Casing height(above ground] 32 AT INSPECTION 3110/04 in. 7 17 75 Static water level 50 ,._, ft. ~ =~ __ '. ,.~' · W611'pr'o~uction 3 : ,~,g.p.m. ,,{. ::. _2.0. : ~ g:p.m. ~ , , ~, ,-~ , .,.. ~./ , WATER SAMPLE RESULTS: , : ,, ::: :; . i!-, ,~,' .... :/~ ~, [i ' ~ ~, ;"~i ~ =~':: ' Other coii'for~ !t0' ,co onles/10o mi.., 'Nitrate' ~l~g./I. i~., . bact~e.d,a colonies/100 mi. ' ~ " ' ;'i'::;'; ' ii , , ' . ,! t. ' '!;,.^ ___, :, : n~';,,; ;,,~'ar~',,ie? 3:24-04 .::' ' ' Collected by" ~Cindy Ellis P.E. B. SE.PTIC/H, OLDINGj, TANK DATA;i -i .... , '=' ~'i '[['',.. :' "! : :"' ;'::, I. '. T,'~t~Ton~i~n,terial steel ' ' ;;. '~," ~'': ~i[~,~ ;; I , ~: Datelnstalled 10-7.94 Tank~sizetj1250,, gal. · . Number of Compartments 2 - Cleanouts, (.Y IN) Y Foundat on ceanout (Y/N) Y ' : :Depresmon over,tank (Y/N).'n . · H~gh water alarm (Y/N) NA n~f~,~fn{Imnina 3-12-04 .... i; ' ' ;Pumper,A Plus Home Services , ' !,,i?J , · C. ABSORPTION FIELD DATA ' :~ :'~: i ;'i ;j' i:. ~t : :: , type trench Da, te installed .10./7/94._ ;.Soil rat.ng (g.p;d:~ ,0.~ft?.dffn). 0' ,em · Length~58 ' . ft. - ~- !,Width' 2.0 , ~. ,' J~ .; .... ff. · Gra~el below pipe.6'5 ff. D. LIFT STATION Date installed NA "lSump on" level at. Size in gallons · in. "Pump .off" le~ei at. in. Cycles tested Datum E. SEPARATION DISTANCES Fe Water Service line >60 Curtain drain None knoWn, COMMENTS Manhole/Access (Y/N) High water, alarm level at Meets alarm & circuit requirements?. On adjacent lots >100 On adjacent lots >10o Public sewer manhole/cleanout >100 ,,J~..Absorption field 20 Surface water >100 SEPARATION DISTANCES FROMWELL ON LOT TO: Septic tank/lift station on lot 101 Absorption field on lot 113 Public sewer.main >100 ~. Sewer/septic service line >50 ~ Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 20 , "' ' Property line 35 Water main >100 Water service line > Wells on adjacent lots >100 · SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT.TO: Property line 30 Building foundation 40 Water main '>100 Surface water >100 Wells on adjacent lots. >100 Driveway, pa~ing/vehicle storage >80 *There was no visible evidence of a depression, but there was snow cover.,o_.,n.~.h~.e_._t.a, nk and field. G. 'ENGINEER"S cERTIFICATION -.. , ..., . I certify tha~ I have determined through field inspections and. ' review of Municipal records that the above systems are in Engineers Printed Name Cindy W. Ellis' Date,3-29-04 . ' : ' .......... HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number in, Ref.# Name ·ject Name/# Sample ID atrix 1041411001 Watkins Engineering Xa$il0fHilh, L5, B4 Kas|lofHilis, LS, B4 Ddnk/ng Water 0 nple Ret/ia-ks: All Dates/Times are Alask~ Standard Time Printed Date/Time 03/29/2004 16:19 Collected Date/Time 03/24/2004 8:20 Received Date/Time 03/24/2004 8:45 Technical Director ~ Stephen~C/'Ede Released~~/~ w: 2/ 3 Results PQL Units Method Allmvable P~ep Analysis Container ID Limits Da~e, Date Init .rets Department Nitrate-lq crobiology Laboratory Total Coliform 4.26 O. 100 mg/L EPA 300.0 col/100mL SMI8 9222B B (<--'10') 03/24/04 SJB A (<'=1) 03/24/04 DKC BLVD. K~S~LO~ k 170.00' k o- 0 -r o z }-- ~')W r- -/----T-~ I i---~- I I, Z ,,, tn ° tn D w 10' U'~U1¥ EASE~EN~ E MUNICIPALITY OF ANCHORAGE ' - - ' '.. :" DEPARTMENT OF HEALTH & HUMAN SERVICES ' Division of Environmental Services '" ~':;i" ..... :-.- .- · -- ':: '- ...... _ -_On-S te Services Section .:-.,: "":::-'t.". ''''~ P.O. Box 196650 Anchorage, Alaska 99519-6650 -' .'.:' _ _-. :_ · :'- .:-'.._;., :'_ -:-' ' 343-4744 . . CERTIFICATE OF HEAl_TH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # "O/,~- /7>t.-~:.~'~ NAA# 1.' GENERAL INFORMATION ':LoCation (sitea:ddress or directions) /, C~ '7 t'¢O ~/~¢1 LO F /,-'D/rd. :~.-....:.....:. ::: . :..-.: -; .._. ' Day - ' .... :':::,::Mail a~-=~==s~ ~r~ ....... :,-, .... -'---:_' :-_ ...... :.->.'*:.- '?':..:.."-'::.:-..- ,.:,::~::~ _. ....... . .: ,. _ .: ....=.,, _:. __.:_: ........ Bay phooe ~ ' - ~:-,,..,.~ ~, :. ;: ;:. ~nless othe~se,requested~ .H~ well be held for mcku~ · .'-; -: :..: Individual well ' "-:.?-:: :':: "~ *- -'~--Communi~ Well .............. ".c_?:, "": .......... :'.'-"' ?'-: :'"-' s~': '_';:]':>~':t .......... :- ": :" ' .'" '-'" :' ": ;-~' '""' ': ; ,? "; :?-- ' :' '-?.' ',:.' :..q' :',?.( .:,. :'...:.:::.:~_NO~E: ~:~::..1~ comment~ well system, provide written confirmation from' State'A~EC -'-' '? ....- .... the Ii~ ... : - -' ' ~ mg to lega and status of system. ".- -:~ :~. ,. ':._. .._.._... ... . ..- :: :.,.:~..:'. ;- . , .,., .. . .......... · _ .:- 4,' '".~PE OF.WASTEWATER'DISPOSAL: / .- .... -'-, -~,:,:- ..... . ;.;~ :, . ';..::"' ,.,.:.:.; ._; >_:;.' / ':....:~ ., .:: ..-.-:' -': ..... : ...... Indiv~dual' on-site . -'. ' :. ':---' ', .':-?:.?.~?:: ,~::-:m>.;;:7-'commun ~ on-s te ' ': ..... ';...::-'._ .' - ::--; - .:-.. -:_' C:z,..' -:: - .... .-::.~:. Public sewer- ..- .... , . . -.- ._ ,-,. -.. -.. :...:,:,...--:,,:;.._ ~,-.-, -'NOTE: ' 'If commu~i~ wastewator s~stom, provide wri~en Con'firmat~on a~ost~n~ to t~o locality an~ status o~ s~stom. 72-025 (Rev. 1/91) Front MOA #21 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 num ber of bed rooms and type of structure indicated herein. I further verify that based on the information obtained from tt'ie 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. Engin~Fs signature ~'~~~ Date Phone '- : .iAdditional Comments The Municipality of Anchorage Department of Health and Human services (D';IHS)iSSues Health Authority APprdval Certificates'iiased only upon the rePresentatiOns given in Paragraph', 5 above by an independent prof~sSional.engineei registered in the State °f Alaska, The DHHS does this as a ~0Urtesy to Purchasers of homes and their lending inStitutions in order to satisfY certain federal and state requirern~nts, Employees of DHH8 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, 72~725 (Rev, 1/91) 8ack MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Wall Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) Parcel I.D. 01~ ~ I ~1 ~ 0-'7 If A, B, or C, attach ADEC letter. ADEC water system number Date completed 71'7/7~ Driller ~'- Cased to L~ %..~ Casing height / FROM WELL LOG Date of test '7///7/,¢ ~ Static water level ~ 4~ Well flow ~ Pump level1 ~ /7/'¢-~Ad SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I ~ Absorption field on lot ~l ~ ~ Public sewer main [""////~- Sewer service line r-////~ Wires properly protected (Y/N) AT INSPECTION g.p.m. g.p.m. ~¢~'~ % ~ %6 ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Nitrate /7/ B. SEPTIC/HOLDING TANK DATA Date installed ¢¢ ~( Tank size Cleanouts (Y/N) y High water alarm (Y/N) Date of pumping Other bacteria Collected by: ' /--.--% Compartments Foundation cleanout (Y/N) ,"// Depression (Y/N) t.-z,,//~ Alarm tested (Y/N) ~¢',,/,~- Pumper f"~//~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I ~ To property line ¢~. Sudace water/drainage 72-026 (3/93)' Front On adjacent lots Absorption field Foundation Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION '~ 0 ~), ~'- Date installed Size in gallons Vent (Y/N) Higl~ water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer 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 Length ~ ~ Width Soil rating (GPD/FF) Gravel thickness System type _Total depth Total absorption area 'TSL~ Cleanout present (Y/N) Date of adequacy test_ /'"////~ Results (pass/fail) Water level in absorption field before test7',,/,///A_. Peroxide treatment (past 12 months) (Y/N) /"k,/c~ Depression over field (Y/N) for After test ("'/,,'/,'~ Bedrooms If yes, (.live date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: we, on lot,¢1 To building foundation On adjacent lots Surface water Curtain drain On adjacent lots ~ / ~-¢ Property line To existing or abandoned system on lot Cutbank ~/~ ,4 ~ Water main/service line .Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on !he date of this inspecbbn. HAA Fee $ ~/'~cO ' ~-/~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 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 1. GENERAL INFORMATION Complete legal description HAA #. 3LIL'/bS Location (site address or directions) Property owner Mailing address Lending agency Mailing address. Day phone Day phone Agent ~-~ ~-v- ~- .~ Address Day phone Unless otherwise requested, HAA will be held for pickup. ,/ NUMBER OF BEDROOMS: z-/ NOTE: TYPE OF WATER SUPPLY: Individual well ~'/ .,,..?.i ~ Community well ' ~' ,., Public water : ' If community well system, provide written confirmation from State ADEC 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 MOAt/21 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. NameofFirm ~J¢'~1' (:~bt-'¢~/'-~-~.~~'~ ~bL~' Phone ~L.'Tq- &eib Address dP-O .~ dZ~ I ¢' ~1 ~ fid __% Engineer's signature ~ c:~~ Date ! Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: "Additional Comments 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 HS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfl/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) B~ck MOA#21 CT&E Ref.# Client 8ample ID Matrix ClientName Ordered By Project Name Project# PWSID Commercial Testing & Engineering Co. Environmental Laboratory Services ~',~,~'~-,4~,~',~',~.~,~f,~,~,~,~-,~-~,~-jjj~jjjj~jj~fj~ LABORATORY ANALYSIS REPORT 94.4488-5 5/4 KASILOF WATER TOBBEN SPURKLAND, P.E. TOBBEN SPURLKAND UA WORK Order 81864 Prh~ted Date 09/07/94 ~ 11:39 lu's. Collected Date 09/01/94 ~ 14:00 hrs. Received Date 09/01/94 ~ 16:10 hrs. Technical Director STEPHEN C. EDE Sample Return'ks: ROUTINE SAMPLECOLLECTED BY: T.S. QC Parmneter Resalts Qual Units Method Alloxvable Ext. Anal Limits Date Date Init Nitrate-N 4.0 mg/L EPA 353.2/300.0 l0 09/02/94 CIV[R * See Special Instructions Above ** See Sample Remarks Above U = Undetected, Reported value is the practical quantification limit. D = Secondary dilution. UA = Unavailable NA = Not Analyzed LT= Less ]ban GT = Greater 5633 B Street, Anchorage, AK 99~18-1600 -- Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE ENVIRONM~:NTAI. SERVICES DI¥1,SlON RECEIVED October 3, 1994 Mr. Robert Robinson Department of Environmental Services Municipality of Anchorage Anchorage, Alaska 99501 Dear Mr. Robinson: As per our telephone conversation on 9/30/94, I hereby respectfully request any assistance you may be able to render regarding the approval process on a new septic system. As you may recall, my wife and I are being transferred to Minneapolis, Minnesota, and in conjunction with the sale of our home, it was determined a new septic system was in order. We have tentatively scheduled the mover to pick up our household goods during the week of October 10th, and plan to depart for the Lower 48 on October 16th. Assuming that the system is completed this week and that Mr. Spurkland gets his packet to you in a timely manner, I would greatly appreciate any consideration you may be able to give me to expedite the approval process. If you have any questions please don~t hesitate to call. Sincerely, ~ R. David Purinton 10740 Kasilof Blvd. Anchorage, Alaska (907) 346-1006 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O/'~¢ / DIVISION OF ENVIRONMENTAL HEALTH ////¢¢ :_ 0?/8 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~-~ OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) &Jo. Co r 5, t:lod 4 U Location (address or directions) Applicant Name ~ ~ ~5~ T~lephone: Home Business Applicant Address Applicant is (check one): Lending Institution ~; Owner/builder ~: Buyer D; Other ~ (explain); (d) Telephone Lending Institution Address (e) Real Estate Company and Agent AddreCs Telephone (f) Mail the HAA to the following address: ~(:~- I/ ~'~ LI~ ~ ~(.L. FIh','~ ¢ ,.~ ~ (.'.) I'.g.~ 2. TYPE OF RESIDENCE "~O, ::: · .' single-Family I~, Multi'-F'amii'y [] Other ':::; .: ;'i::; :!;: l~umber of eedi:aoms "~ i' ::::%, : , .' .,, ~,~ 3 WATER/SUPPLY X ~''~ "' : ' Ind~wdual Well ~ommunity · Note: If community well system, must have written confirmation from the State Departmem of Environmental Conservation *attesting to the legality and status. 4. SEWAGE DISPOSAl. Onsite [~'//Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) r'NGINEERING FIRM PROVID .~ INSPECTIONS, TESTS, FILE SEARCH, ,. ,*A 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. Name of Firm Address ~7~0 Date /8 1q87 Telephone ~"~ Engineer's Seal DHEP APPROVAL Approved for Approved ~ Disapproved Conditiona Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNIcIPALITy OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION JUN 1 9 lg87 RECEIVED A. WELL DATA MUNICIPALITY OF ANCHORAGE (MO~,l HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Let.5', Well Log Present (Y/N) ~,O,~ _~_. 4¢ Date Completed ~ - | ~ - '7 ~' '~ Yield Total Depth J~C~ Casedto ~'~ ~ Depth of Grouting ~A. Static Water Level ~1 ~ ~0¢~ Pump Set At Sanitary Seal on Casing (Y/N) ,.3 Depression Around Wellhead (Y/N) ; On Adjoining Lots ~ j 60 100t + ; On Adjoining Lots !00 To Nearest Public Sewer To Nearest Sewer Service Line On Lot : Date / 8 3'k4~ 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 ~f/~x.,CCL, Water Sample Test Results Comments ~ Fr'dl'~ ~,-,% L4~.5. '"'J u B. SEPTIC/HOLDING TANK DA'FA Date Installed .~?F. l~ ¢ Size (,O¢O.¢1* No. of Compartments o~. Standpipes (Y/N) U, £jr~ Air-tight Caps (Y/N) __ b.¢'.,.5 Foundation Cleanout (Y/N) j · Depression over Tank (Y/N) _ /'~O Date Last Pumped . 7 Pumping/Maintenance Contract on File (Y/N) ~, 11~ ; for Holding Tank High-Water Alarm (Y/N) IN'I~ Separation Distances from Septic/Holding Tank: To Water-Supply Well To Property Line ~'~ To Water Main/Service Line Course ~J" Temporary Holding Tank Permit (Y/N) r To Building Foundation To Disposal Field o,~.. To Stream, Pond, Lake, or Major Drainage Comments Fr.m biJ,tJ6 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed .~ p '~. Width of Field 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 Lot /~ f TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test Ocr' .5 ~J coo r,', To Property Line ,/0 ! To Existing or Abandoned System on ; On Adjoining Lots --~ '~' To Cutbank (if present) D. LIFT STATION Date Installed ( Dimensions Size in Gallons k..% Manhole/A~ High Water Alarm Level'aL....... _/ Vent (Y/N) ./ Tested for ~_ / Pumping Cycles during ~equacy Test. Meets MOA Electrical Codes (Y/N) ~ Comments ** Check Be~rLitted Bed/eom Rating Against HAA Request** I certify t~a,~'.~/;h:~, verified, or conformed to all M.(~A al~J HAA guidelines in effect on the date of this inspection. Signed,.,/ !//./~/((//{ '~ Date i// ~ - , - .. Oomp~lny ~(M~~OANo. ~T~qr U ~ .0o/~_o oo/ · Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERALT~X ,D, # 92 0040440 MUNICIPALITY OF ANCHORAGI] DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION ~JUFI 2 6 1987 RECEIVED ~ i. ~ ~: ', DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECT ON :;' i ~: : ' ~ ?: ~' DIVISION OF ENVIRONMENTAL HEALTH ' :.; ' ~;':~':: !)"';i!: i CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APpROvAL OF ON-SITE SEWER AND WATER FACILITY ': :;ApPlication D,le ~ "~ GENERAL INFORMATION ~ (a) Legal Description (include lot block sub0ivision section township range): ::', Location (address or directions) :~=;;': r (b) Applicant Name ~f ~ m~[l~phone: Home ~ Business Applicant Address t*~ q~ ~a~t[}~ ~lO&, (c) Applicant is (check one): Len0ing Institution ~; Owner/buil0er ~Buyer ~; Other ~ (explain); (d) Lending Institution Address Telepnone (e) Real Estate Company and Agent Address (f) Telepnone Mail the HAA to the following address: TYPE OF RESIDE~I,CE Single-Family I~' Multi-Family [] Number of Bedrooms Other 3. WATER SUPPLY Individual Well []~]/ Community F'] Public [] Note: If community well system, must have written confirmation fyom the State Department of Environmental Conservation Onsite [E~ Public [] Community [] Holding Tank [] ' ' :.: . ..... .. Note: If community well system, must have written confirmation fro m the State Department of Envffonmental Conservation the date of this inspection, Address Date ;~ ENGINEERING FIRM PROVIDIb,.~ INSPECTIONS, TESTS, FILE SEARCH, DJ. ,A AND INFORMATION As certified by my seal affixed hereto and as of the va idation 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 thai based on the information obtained from the Municipality of Anchorage files and from my investigation and ~nspection: the on-site water supply and/or wastewater disposal system is In compliance with all Municl ;)al and State codes, ordinances, and regulations in effect on Telephone , ~(0 / ~ & [0-"1/ Engineer's Seal DHEP APPROVAL Approved for ~',~"¢--~' (-~] bedrooms by Approved )(' Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of An. chorage 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 professtonalengineer'swork:;;: , :..:i:!:ii; ::i!F:; . : r::.: .~:::~ !~::]i~:! :' :'' ,:, ::.: WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MO,%/ HEALTH AUTHORITY APPROVAL (HAA} CHECKLIST- FEBRUARY 1984 264-4720 MUNICIPALI:t¥ O¢ Ai',tf~HO~AOi~ DEPT. OF HEALTH & ENVIROHMENTAL PROTECTION 0 v 1986 Legal Well Log Present (Y/N) Total Depth l~'OI 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 /~/~ If A, B, C, D.E.C. Approved (Y/N) Date Completed "] ~ lq - '-I .'~- 'x¢- Yield ~-'. 'f' Depth of Grouting L~/fl. hl()i,0~}3 Pump Set At VJ~ ~'~L0 Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ,/~ () +. 'Y" t + ~ ; On Adjoining Lots J OO ; On Adjoining Lots lOC ~ + To Nearest Public Sewer Cleanout/Manhole _ /~/~ To Nearest Sewer Service Line on Lot ~//~ Water Sample Collected by L,. (~)c/o,x- ; Date I '~"~..J'.4 Water Sample Test Results ~&~d~O¢~ ' ' U U ' ~ t ., 0~ · t , ~ SEPTIC/HOLDING TANK DATA Date Installed · Size ~00 No. of Compartments ~-' Standpipes (Y/N) ~¢~ Air-tight Caps (Y/N) ~5 Foundation Cleanout (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 J O(D ~ 4- ¢¢"- To Property Line ~' ~ 4- To Water Main/Service Line ~/Ct Course r,o'J Date Last Pumped I ZFcJ,l, / ?afc ~ , for "-"'-'" Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field ;Z,b.~" "~ To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026111/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata I '~"'O Date Installed :,~O~'. I q"Tq ~ Width of Field t,k/~f~O~-~ '&~ Type of System Design Length of Field 5-5' Depth of Field 10 Square Feet of Absorption Area ~ ~O Depression over Field (Y/N) /~ ~ Results of Last Adequacy Test ~ t~.c~. Separation Distance from Absorption Field: To Water-Supply Well iOOt 4- "~ To Building Foundation Lot ~O~N~ To Water Main/Service Line LIO' 4- To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test ,/ To Property Line ~,0 To Existing or Abandoned System on ; On Adjoining Lots ,...~C:) I Jr To Cutbank (if present) LIFT STATION Date Installed~,x ' High Water Alarm Level Dimensions __ Tested for at Vent (Y/N) / Pumping Cycles durin_.g_A qde~uac~Test. Meets MOA Electrical Codes (Y/N) Comments ** Check I certify 1 Signed Corn Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) mitred Bed~ Rating Against HAA Request ** )d, or conformed to aJI MOA and HAA guidelines in effect on the date of this inspection. Date / ,,' MOA No. Engineer's Seal ARCTIC ENGINEERS, ]NC. July 25, 1985 Municipality of Anchorage Depto of Environmental Health and Protection 825 "L" Street Anchorage, AK 99501 Susan Oswalt RE: Lt. 5 Blk 4 Kasilof Hills Subdivision Septic Tank Standpipe Dear Ms. Oswalt: This letter is written to accompany a Health Authority Application that was perfor~=d on Nov. 20, 1984 for the referenced residence. While ~performing the test it was noted that the septic tank standpipe had shifted off of the access hole on the septic tank, which blocked access into the septic tank for pu~ing purposes° Since the time of the test, the seller had the septic tank standpipe problem fixed. On July 25, 1985, A.E.I. went to the residence and verified the realignment of the standpipe which is now in accordance with M.OoA. requirements. Please contact Carol Pope at 265-3610 when final acceptance is granted° If you have any further questions about this matter or others, please call ]~e o Sinc_erely~ Duane Mane~ Engineer DM:bf 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) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ].0?40 KASILOF (b) Applicants NameRonald & Carol Pope Telephone - Home Applicants Address 10740 Kasilof (c) Applicant is (check one) Lending Institution Buyer ~--~ ; Other ~ (explain); (d) Lending Institution 1st National Bank__ Address Business 265-3610 ~ ; Owner/builder ~[ ; Telephone P.O. Box 720 Anchorage, Alaska 99501 (e) Real Estate Co. & Agent ERA Soquet Address 2518 E. Tudor Rd., Ste. 201 Anchorage, Alaska Telephone 561-1616 (f) Mail the HAA to the following address: Multi-Family~--~ 2. _Type of Residence Single-Family Number of Bedrooms Other (describe) 3. Water Su~_~i 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. 4. Sewage Disposal 0nsite ~XX i Public ~ Community C~ 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] 5. Engineering Firm Providing Inspections, Tests~ File Search, Data and Information As certified by my sea]. affixed hereto and as of the validation date shown below, I verify that ray investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functionaI and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained f~om the Municipality of A~chorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance ~th all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Arctic Enq%n__~q. Address 1506 West 36th Ave., Ste. 101 Date November 20, 1984 (ENGINEER SEAL) DHEP Approval .Ap-pr-ovid for '~-M~(~ bedrooms Approved Disapproved Conditional T elephone_~ Date Terms of Conditional Approval CAUTION THE'MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOI~LY UPON THE REPRESENT- ATIONS GIVEN IN PARAGtLAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~NALYZE DATA ~EFORE A CERTIFICATE IS ISSUED. Tk~ MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN TI~ PROFESSIONAL ENGINEER'S WORK. RR4/ej/D18 [Page 2 of 2] (DHEP $EA~) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH ..AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 1984 RECEIVED Well Classification Individual .Well Log Present (Y/N) y Total Depth 150 Static Water Level 22 Casing Height Above Ground 12% Electrical Wiring in C~Dnduit JY/N) Separation Distances f~om Well: To Septic/Holding Tank on Lot Cased to LEGAL DESCRIPTION: Lot 5, Blk 4, Kasilof Hills sub. If A, B, or C, D. EoC. Approved(Y/N) N./A __ Date Completed 7-17-75 Yield 5.2 43..3 Depth of Grouting~__ Pump Set At Unknown Sanitary Seal on Casing (Y_~_~_~L_ N Depression Around Wellhead (Y/N) N 100' + ; On AdjoiniJg Lots 100' + To Nearest Edge of Absorption Field on Lot 100' + ; On Adjoining Lots 100'+ To Nearest Public Se%~r Line N/A TO Nearest Public Sewer Cleanc~t/Manhole N/A To Nea~est Sewer Service Line on Lot N/A Water Sample Collected By Duane Maney ;' Date 11/19/84 ~ Water Sample Test Results Satisfactory for Total Coliform ~ C~i~L~nts Well pumped 390 gallons in 72 minutes and recovered 145 gallons, in 30 minutes. B. SEPTIC/HOLDING TANK DATA Date Installed sept. 1979 Size 1000 No. of Ca~artnmnts 2 Standpipes (Y/N) Y Air-tight Caps (Y_~/N) Y Foundation C].eanout (Y/N) Depression ove~ Tank (Y/N) N Date Last Pumped <~' -- . Pumping/Maintenance Contract on File JY/N) N ; for -- Holding Tank High-Water Alarm (Y/N) N Temporary Holding Tank Permit (Y/N) Separation Distances f~cm Septic/Holding Tank: To Water-Supply Well 100' To Property Line 5' + To Water Main/Service Line To Building Foundation 135' To Disposal Field 26.5' To Stre~n~ Pond, Lake, c~ Major D~ainage N CotLr se None I~ot~d CoIrrfl~P_--t~'~ Septic tank ~.~ld n~ //~lignment with access hole on tank. [Page 1 of 2] 2-15~84 C. ABSORPTION FI ELD DATA Soils Rating in Absorption Strata Date Installed sept. 1979 Width of Field Unknown Square Feet of Absorption A~ea Depression over Field (Y/N) N Results of Last Adequacy Test 150 Type of System Design Trench Length of Field 55 Depth of Field 10' Gravel Bed Thickness 6' 660 Standpipes P~esent (Y/N) Y Date of Last Adequacy Test 11/19/84 Adequate Separation Distance frcm Absorption Field: To Water-Supply Well 100' + To P~operty Line 10' + To Building Foundation 40' To Existing or Abandoned System Lot None ; On Adjoining Lots 30' + To Water Main/Service Line N/A TO Cutbank(if present) None TO St~eam/Pond/Lake/o~ Majo~ Drainage Course None Noted To Driveway, Parking A~ea, o~Vehicle Storage A~ea 10' + 1000 gallons of water in a extremely brief duration of time (approx. 5 minute~). De LIFT STATION Date'~nstalled Size in Gallons "Pump On" Level at High Water Alarm Level at Tested fox Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets MOA Comments ** Check Permitted Bedrcom Rating Against HAA Request I certify that I have checked, verified, or conforn~d to all MOA HAA Guidelines in effect on the date Cf this inepection. Signed /¢'J~/~/_zf/'~sd / ?/27~¥L ', Date /~ ,./fi~/~¢:~. MOA No. KB1/d5/s [Page 2 of 2] ~" ~_ ~X~ .... -~"~' ' MUN [CI PJ~,~(~F ANCHORAG= '~/~..~t'~ DEPARTM 'OF ~E~~ ENVIRONME~ L , .ceived: Time i[-)'.~l~Dfl _ ~2%~ime ~3: Date 7- k/~ 7~ /; 2~/, Date Insp ~ Insp PROTECTION 99501 December 20, 1977 Time Date Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: First National Bank of Anchorage Mailing Address: Post Office Box 720 99510 Phone: 276-5300/483 2. Property Owner: Ronald L./Susan M. Pope Mailing Address: Star Route A Box 98-P 99507 Phone: 276-6300/416 his work 3. Legal Description: Lot 5 Block 4 Kasilof Hills Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) Number of Bedrooms: Number of Bedrooms: Two Well System: Individual well (x) Community/Public System ( ) Permit # Depth of Well /~ Well Log on File Construction ~~ -~ Bacterial Analysis Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # ~~ Installed ~/~'~ Installer ~/~ ~ , _ Septic Tank Size /(~ Manufacturer ~-q.~.~_ absorption area ~d~ Soils Rate /~'C~ Material Distances: Well to Septic Tank to Sewer Line Neares~ Lot line to Absorption Area Absorption Area to Nearest Lot Line h~,gBJICIP/\LHY OF ,ANCI~ UNICIPALITY OF ANCHORAGE DEPI. O~:U~A~U~.~ z~ ~}~, Depar~men~ of Health and Environmental Protection /}7~F~[~ 825 L Street, Anchorage, Alaska 99501 "-~,' 4 0 I~/,, na wdua Property Owner: Mailing Address: Name of Buyer: Mailing Address: Ronald L. & Susan M. P~Pe SPA Box 98-P Anchoraqe ~ Alaska 99507 .Phone: 276-6300 ext 416 (Mr. Pope's work phone) None Phone: Lending Institution: First National Bank of Anchorage Mailing Address: P.O. Box 720 Anchorag_9~ AK 99510 Phone: 276-6300 ext 483 o Realtor/Agent: Mailing Address: None Phone: Legal Description: Street Location: Lot 5, B~lock 4, K~efi Hi~ls-S/D K~HN Kasilof Blvd.. Arzchor~aska Single Family Residence: Multiple Family Residence: (x) Number of Bedrooms: ( ) Number of Bedrooms: Water Supply: *Individual Well If Individual Well, well depth 9~7 ¢~ ) Public/Co~m~unity System ( ) If Coimmunity System, name of system Sewage Disposal System: On-site System If On-site System, date of installation: Public System ( ) *NOTE: 3/77 A well log is required on ALL wells drilled since 6/75. ~ie Ii~ 12/19/77 Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Block 4 Kasilof Hills Subdivismon Comments: Affadavit Attached: ( Letter Attached: ) Disapproved: Date: Department Worksheet: