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Home My WebLink AboutKASILOF HILLS BLK 6 LT 2Onsite File #015-132-35 NAME LOCATION ER ANCHORAGE AREA BOR JGH !~(]~ ><)!) Department of Environmental Quality ~'~ 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEN~ ~,~/--/.L-.,~O.~T' ,~/¢'/I?'A/- MAILING ADDRESS ,'~X' z/--Z/2-J~ PHONE LEGAL DESCRIPTION ,~¢:~7~ D- /.~LOd_/~. ~ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH NUMBER OF MANUFACTURER ?,~'/¢',~-'T MATERIAL ,,~/¢E2'C~L,"93,* COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY /~r'mLO GALLONS. TILE [)RAIN FIELD: DISTANCE FROM WELL /~)~ / FOUNDATION NEAREST LOT LINE /~"/"¢ .TRENCFI WIDTH '~. IN. SQ. FT. LENGTH OF EACH LINE / ~ /-/~ // DEPTH OF FILTER ~ ~4~--' MATERIAL BENEATFI TILE '7~/>' TOTAL LENGTH 7~ /~'' ¢"¢)/'¢' OF LINES ~ / NUMBER OF LINES / DISTANCE BETWEEN LINES ABSORPTION AREA DEPTFI: TOP OF TILE TO FINISH GRADE TOTAL EFFECTIVE .t~. ABOVE TILE 5/- IN. TYPE __~/_~¢~-]~/~/o/ t~. ____CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC~ SEEPAGE ~ FOUNDATION~ LOT LINE~ SEWER LINE , TANK/5~ SYSTEM /¢¢/ CESSPOOL __ , OTHER SOURCES APPROVED_ __ DISAPPROVED REMARKS__ DISTANCES: INSTALLED BY: SEWER LINE DEPTFI: PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF: SYSTEM DATE ~ //F2~' Form EQ-032 GRF_'_! 7R ANCHORAGE ARKA BOF 3S30 "C" S I'REET A NCHORAGIE, ALASKA TELEPHONE 2,74-4 ~6 ! NAME OF APPLICANT ~J/~ ['~ INSTALLATION LOCATION SOIL 'rEST RESUt_TS ~-"~7 £] COMPI ETLON DATE ANTICIPATED TO BE INSTALLED BY ~ /' (~"' /~'-C- ~ ~/~" / '-~ /(;~ / NOTE: TI-tlS I~ERr41T IS NOT VALID WITHOUT ~OIg TEST FINAL INSPECTION: g4 HOUR NOTICE REQUIRED. ~ACKFILLING OF ANY SYSTEM WITMOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILl- BE SUBJECT TO PROSECUTION. SEPTIC 'rAN}( SIZE /~¢-~ ~¢ TYPE SEEPAGE AREA SIZE TYPE DIAGRAM OF ~Y~T~ MINIMUM DISTANCES, REQUIREMENTS __~ / 'ro NEAREST Lo'r UNE. WELL TO SEPTIC TANK /6~ / SEEPAGE'?~" (/6-~ / ALSO CONSIDER AREA ~NELLS. D F,~A I N FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. I CERTIFY TNAT I AM FAMILIAR WITH THE: REQUIREMENTS OF GREATER ANCHORAGE AREA B~I~OUGI-I ORDINANCE NO. 28-6B AND THAT THE ABOVE DESOR, EO BYS','EM ,S ,N ACOORDANCE W,T. 00=. /7/' FORm NO. ~Q-O, ~ T. H. No. 1 6-3-76 0.0I Silty Organics w/ Some Sand (PT) Silty Sand (SM) Silty Sand w/ Some Gravel (SM) ?_~0 Gravelly Sand w/ Trace Silt {SP) /40 .... ll.0' Sandy Gravel w/ Some Silt (GM) No Water Table 14.0' NOTE: Log Represents Iot 2 Block 6 Kisiloff Hills Subdivision Engineering 8~ Geological Consult(]nfs Inc. ANCHORAGE FAIRBANKS ALASKA Wallace Smith Property Log of Test Hole Anchorage, Alaska ? ;~! CONSULT.~ NTS, IN(]. JUNEA, U June 4, 1975 R & M No. 562037 Mr, Wallace Smith Box 4-425 Anchorage, Alaska 99509 RE: Test Hole and Soil Log Report for Sanitary System Lot 2 Block 6 Kisiloff Hills Subdivision Dear Mr. Smith: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of May 31, 1975, and those procedures outlined in a letter dated December ].9, 1974, by ULt. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put do;~n within the Lot 2 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor- mounted backhoe and the test hole was extended to a total depth of 14.0 feet below ground surface. One sample was recovered from the test hole and retained for grain size analysis. The results of this sample are enclosed. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do nob hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. James W. Rooney Vice-President JWR/WED/s c Enclosure ~c: GAAB 'rEST ON Insitu Material LABORATORY TEST REPORT PROJECT NO. PROJECT NAME Wallace. Smith SAMPLED FROM Test Hole No. i SUBMITTED BY. Lot 2 Block 6 Kisiloff Hills subdivision SOURCE Jackson LOCATION Anchoraqe, Alaska #ZO #3O ~40 ~50 #BO -~200 DEPTH 8-9~ DATE SAMPLED, 6-3-75 CLASSIFICATION UN~FIEO %+3 % GRAVEL % SAND % SILT % CLAY FSV LL PL PI CLASS SM REMARKS Classification based on gradation, AASHO FAA DELETERIOUS MATERIAL MINUS ~ ZOO MESH SOFT FRAGMENTS COAL ~ LIG. OR LT. WT. PART, CLAY LUMPS STICKS ~ ROOTS FRIABLE PARTICLES SPECIFIC GRAVITY ABSORPTION FINENESS MODULUS SULFATE SOUNONESS FREEZE-THAW RATIO L,A, ABRASION LOSS DEGRADATION VALUE THIN - ELONGATEO STATIC IMMERSION BRAND i%__lV2%--B% , COARSE SPEC FIN~' SPEC GRADE ORGAHIC COLOR_ MOISTURE - PERCENT 562037 RaM PROJECT NO. LAB NO. 75A-919 FIELD NO. 1 6-4-75 DATE REPORTED DATE RECEIVED 6-4-75 COMPACTION OPTIMUM MOISTURE MAX. WET DENSITY MAX. DRh' DENSITY -- CORR. MAX. DRY DENSITY % FRACTURE METHOD NATURAL DENSITY NATURAL MOISTURE WEIGHT LOOSE WEIGHT RODDED F~L~ E~nglne~ering ~ .~ologicc~l Con~ulfan?~ GE _8 Municipality of Anchorage _ =Y On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-132-35 ..Ex piration.Date: 1. GENERAL INFORMATION Complete legal description Kasilof Hills Block 6 Lot 2 Location (site address) _ 10500 Sidorof Ln. Anchorage AK 99523 Current Property owner(s) Fischer John Living Trust Day phone 907-346-1123 Mailing address 1'0500 Sidorof Ln. Anchorage AK 99523 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ;, ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ J 6 0 CL Waiver Fee $ Date of Payment Receipt Number al 4 aC16) COSA # 05C 9.61 as 3 Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system_is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. s Name of Firm ARCTERRA CONSULTING INC Phone 696-6111 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date lho Zo _ Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future ,�-a► �4, occupants or can ArcTerra guarantee that no unseen Q a T� encroachments, deficiencies or discrepancies exist. �� ® 6. DSD SIGNATURE V System #1 Approved for 3 bedrooms. t`E"'"L" FFus System #2 Approved for bedrooms. Ori®° n 00 o,s Disapproved. ®�.a�►" Conditional approval for bedrooms, with the following stipulations: \`��llttttttt((((r�( yon /r By: ON-SITE _�; WASTEWATER _Z PROGRAM'S C1Original Certificate Date: oc /'JQ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet10-10-12.doc 4 COSA Checklist Legal Description: Kasilof Hills Block 6 Lot 2 Parcel ID: 015-132-35 If more than 1 septic system on lot: COSA Checklist #. of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1975* Total depth >290* ft Cased to Bedrock*ft ❑■ Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 5/29/20 Static water level at beginning of test 29 ft. Comments * Well information based off of previous COSA B. TANK DATA Age of tank(s) 45 years Tank type/material Fiberglass Measured operating fluid level in septic tank 47 " ® Standpipes/foundation cleanout per record drawing Date of pumping 5/29/20 D. ABSORPTION FIELD DATA Which system tested (date installed) 9/12/75 ® ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 2.8 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system 1 Well production at time of test 2 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 5.31 mg/L E]Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Areterra Consulting Date of Sample 5/29/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material — Comments: Adequacy test date 5/29/20 Results Q✓ Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 450 gal New depth 7 in Elapsed time 10 min ❑■ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) — date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies- COSA ommenis/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft g Yes if No _ ft Neighboring Tank > 100' ® Yes if No _ ft Private Sewer/Septic Line > 25'2] Yes if No _ ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' 0 Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft ® Yes if No ft _ _ Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft 0 Yes if No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building10' Yes if No Foundations > _ 0 ft Surface Water > 100' 0 Yes if No _ ft Property Line > 5' ® Yes if No _ ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No _ ft Private Wells > 100' 0 Yes if No _ ft Water Main > 10' ® Yes if No _ It Community Wells > 200' 0 Yes if No _ ft Water Service Line > 10' ® Yes if No _ ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' R] Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' Water Service Line > 10' ® Yes if No _ ft Community Wells > 200' Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ® Yes if No _ ft ® Yes if No _ ft Mine MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Advisory Certificate of On‐Site Systems Approval # OSC201253 Subdivision: Kasilof Hills, Block: 6, Lot: 2 A water sample revealed a nitrate concentration of 5.31 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Since nitrates are known to slowly increase, we recommend you monitor the water quality. Please see the attached “Nitrate Fact Sheet” for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Fact Sheet From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as “blue baby” disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a medi a with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several “wet chemical” methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive “screening test”, and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. la[ve':idra�ll UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. LOT SURVEY SURVEY TYPE SYMBOLS ❑ AS -BUILT ... NO CORNERS SET •' SET REBAR 7= ::r DRAINAGE ASPHALT .RECERTIFICATION AS -BUILT ... NO CORNERS SET O FOUND REBAR 0 a. WOOD FENCE - l CONCRETE ❑ PLOT PLAN .. AS -QUILT ll VEY,,, TOPOGRAPHY ® ASSUMED ELEV. X METAL FENCE re"'ITI%I wnnn nrry IT IS THE RESPONSIBILITY OF THE CONSTRUCTION, TO VERIFY PROPOS TO FINISHED GRADE AND UTILITY C THE EXISTENCE OF ANY EASEMENTS Mfl Cl1 00 NOT APPEAR ON ThIE SURREY CERTIFICATION LOT SURVEY AS -BUILT PLOT PLAN RECERTIFICATION AS -BUILT r 1 hereby crrtlFY that I have r Phy....d surveyed the lot w dram and tlacrmed hereon w and that f have found ar C.'A"established all of the lot , corners of "' of on im plan end to the 11 of ny knod.ape ens ebULes all dnrroloaf have brm neafu-eo true o, cornet �d+ey1 Easen.nts of rectlrd othrr ttwn Vnw ihox m the ncardtd plat, err not ihovn hereon Ail tl oAc'f V't rYtG'd tYlltff o Mr+ut rntrd BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE ED BUILDING GRADE RELATIVE SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ONCOVEN NS AND R DETERMINE COVENANTS OR RESTRICTIONS ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW RECORDED SUBDIVISION PLAT. MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ��aaavrr Prepared by ,.� Robert E. Johns, Jr. & Assoc. Professional Land Surveyors Scale: 1 „ _ 50' REC. LOT SF, i Dole Surveyed Drawnby. Checked by. t ROBERy JOHN ; JR. t w 8--27-92 RF..T L.IlJ q c r Dab Drawn: Grid: W.O. 14. 4121—e! 1 oo_I ac p` tosal.AdV'O♦ Lot 2, R1ock'6, KasIIo[ 11111s Sub,. turas+" Parcel I.D. # 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 1~2- ~ ~" HAA # __ ~ GENERAL INFORMATION Complete legal description I Location (site address or directions) Property owner Mailing address Lending agency. Mailing address_ Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~' '~ Day phone TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to tl~e legality and status of system. ' ' 4, TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site V/ 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 "~JOM s,jeeu!bu8 leuo!sseJoJd eql u! suo!ss!Luo Jo sJOJJ~) Jo~ elq!suodseJ ~ou s! ebeJO~OUV jo /q.led~o!un~ eqJ. 'penss! s! eleo!~!P@o e eJojeq elep ezAIeue JO 9uo!~oedsu!. ~onpuoo ~ou op SHHQ ~o seeAoldUd=J .s~ueLuaj!nbeJ e~els pue leJepe~ u!e~eo/9s!~es o~JepJo u! suo!~nLlsu~ 8u~pue J!eql pue e~elS eq), ul peJe~sdSeJ jeeu~bue leuo~sse~oJd sewoq,~o ~jeseqoJnd o~ Xse~Jnoo e se s!ql seop SHHQ eq.L'e>iS~lV J° · . . . · ~,uepuedepu! ue ~q e^oqe ~ qde¢6eJed u! ue^!~ suop, e),uese~de~ eq~ uodn ~luo peseq seleo!~!~JeO i~^oJddV /qpoq~,nv q),leeH senss! (SHHQ) se°Fues uewnH pue q~leeH jo ~uew~JedeQ e6e~oq, 0Uv ,to X~!led!o!unl~ eq-L .- · s~uewwoo leUO!~!PPV :suop, elnd!ls 6u!~oll°J eq), q~,!~ 'suJooJpeq ' .stuooJpeq Jo~ le^oJdde leUOp,!Pu°D · pe^oJddes!(] -- e;oiddv =II:lCI.I.'CN91$ SHHG '9 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. WELL DATA Well type J~ Log present (Y/N) Total depth ,> ~-- ~C) Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number ~ Date completed I t~ --/'~-" Driller Cased to ~;~r'~ ~.~, Casing height Y Wires properly protected (Y/N) Y FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot IlO '1' Absorption field on lot Public sewer main f"///:~ Sewer service line g.p.m. AT INSPECTION ; On adjacent lots_ /Z~ ; On adjacent lots /,2-., ¢ Public sewer manhole/cleanout Petroleum tank u~ C; WATER SAMPLE RESULTS: Coliform ¢ Date of sample: ~/~*~¢)~ Nitrate //, ~ Collected by: Other bacteria B. SFPTIC/HOLDING TANK DATA Date installed qt//2/~¢ Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping Tank size Compartments Foundation cleanout (Y/N) ~/ Depression (Y/N) _ Alarm tested (Y/N) ~_~" ~//¢ ~ P U m per SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 11~ /' To property line )/(~ Surface water/drainage On adjacent lots ~' /,2. o Foundation Absorption field /~ f' Water main/service line 72-026 (Rev 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjaceni lots Surface water D. ABSORPTION FIELD DATA Date insta,led Length /¢/~' Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ~'7 _System type Gravel thickness _ ~.. -~' Total depth Cleanouts present (Y/N) Date of adequacy test for _ bedrooms if yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots "~ I ~ _Propertyline To existing or abandoned system on Cutbank 5¢~ ~ 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 the date of this in~. uection. Engineer's Name Date HAA Fee $ // Date of Payment Receipt Number Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEI-'RING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ~,,JO lux, ,*PUP, 2i,Mil~, P. ,% ) : .... , ,:, ,,q/ ,.,,, ,,3.. Member of the SGS Group (Soci~t¢ G~,¢rale de Surveillance> S CQREATERANCHORAGE AR EA BOROUGH ~9'~partment of Environmental Quality Anchorage, Alaska 99503 274-4561 Date Received December 17, 1975 l'ime of Inspection /~O~_~F]_~. .... r?~ Date of Inspection //i'/~= REQUEST FOR APPROVAL OF ~.~. Conv. 1. Approval requested by: Mailing Address: 2. Property Owner: Mailing Address: 4. 5. 6. First National BAnk of Anchorage Post Office Box 4-2090 Wallace Smith Phone: 279-4481 Phone: Legal Description: Lot 2 Block 6 Kasiloff Hills Subdivision Location: Sidorof Lane off of Kasilof Boulevard, Upper O'Malley area Type of facility to be inspected Single Family No. of bedrooms 3 Well Data: Individual ¢. Construction Sewage Disposal System: B. Depth 306' D. Bacterial Analysis . On-site system. A. Installed Sept. 1975 B. Installer C. Septic Tank: D. Seepage Pit: E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line 1. Size 1. Absorption Area Total length of lines 2. Manufacturer 2. Material , Absorption area , Other contamination , Sewer Lines B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages .:>7 '- ~-,;.; ~". MUNICIPALnY OF ANCHORAGI} ,' .. ~ ,~ GREATER ANCHORAGE AREA BOROUGH ~NVIRONMENTALPROI'ECTION : Department of Environmental Quality ~',_,r~f,~ 3330 "C" St., Anchorage, Alaska 99503 274q]F~$'li'/1975 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES RECEIVED 1. Type of Inspection: CMRO VA Mai-ling Address: 3. Name of Buyer: o FHA CONV ~ Da~ Phone Mailing Address: ___D__ay Phone Name of Lending Institution: _s~ ~~/~~ Mailing Address: ~_0~ .... z;_ ._ P,hone o Legal Description: _~ _ Location: ~.. /?~ ~_2~ FZ~_.~C~-_ 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility NO. Bdrms. _~ Individual ~<~ If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) EQ-037 (!/74) Page 2 of two pages - Re st for Approval of Individual , er & Water Facilities Legal Description Lot 2 Block 6 Kasiloff Hills Subdivision Comments Disapproved Date Ap val ,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)