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KIMBERLY MANOR BLK 1 LT 7
Onsite File MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201016 PID Number: 017-074-15 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name ROBERT & CATHERINE ORMBERG ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7741 COX DRIVE, ANCHORAGE, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot KIMBERLY MANOR 1 7 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line FtZ Ft. Well 100'+ -- 25'+ TANK ® Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer GREER Capacity 1500 Gal. Remarks Tank and line to house insulated. Alarm location GARAGE Electrical installed by MOA INSPECTED PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer A+ Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1" 2/11/2020 2�d 2/12/20 Location and description 3rd 4'h DOOR SILL ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF Al� 11 Conditional Approval: Date i * TH *��r • • ' Septic System Approve - _ Curtis Huffman �� �'c�, •,• CE c`�r `-' Z-2� - 2C) Date � 128991 ,• �'f'lF • 2/17/2020. •'�Z d.W '••....• �.... 9 PROFESSO Note: this approval does not include well permit requirements. "w' R1�1 t Kew uo/uz/ 10) KIMBERLY MANOR B1, L7 k x I X \ WELL RADIUS A—C=35.0' B—C=19.2' A—D=35.5' B—D=23.0' PID: 017-073-18 PERMIT: OSP201016 4.0'x10.6' N` STORAGE N I CIO 32.4' D < �0 °� FCO ONY A \ B NEW 1500—GAL STEP C D MH MH EXISTING FIELD MT N 89°54'W 150.00' SCALE 1" = 30 PREPARED FOR: SUPPORT®SERVICES: �,®® ROBERT & CATHERINE ORMBERG wl0F AL4 KIMBERLY MANOR BLOCK 1, LOT 7 1 7741 COX DRIVE; ANCHORAGE, AK 99516 y 9 Ul �0 FIRST WATER CONSULTING DATE: 2/17/2020 �� �� rtis Huffman �r 13030 SUES WAY SURVEY. KG �s CE 128991 a DRAWR: FWCS ����a 2/17/2020�'�® ANCHORAGE, AK 99516 SCALE: 1" = 30' �ROFESSI��A� 907-350-9566 firstwcterAK@gmcd.com Lot 9 Lot 8 \ ll Lot 20 . WOODEN FENCE I \ II I LL!:. _ jam- S $9'54 E 150.06— / 10' GENERAL / L / USE EASEMENTS Lot I 1 , \ WELL S.F. 00 � � I / 10.5'x16.3' SHED ---t / 'f 100' PROTECTIVE RADIUS COVERED STORAGE CHA N -LINK FENCE N 89'54'W 150.00 -(L- — — COX DRIVE PLOT PLAN ___ AS BUILT _X_ SCALE _1- 50=_ GRID _ SW 2940Project No. __-20-04_OLA2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone �Qo�OQO (907) 522-4625 Fox —' a F Professional Land Surveyors ken0longsurvey.com o jonothan®longsurvey.com o s 0 I hereby certify that I have surveyed the following described property: LOT 7, BLOCK 1, KIMBERLY MANOR SUBDIVISION (PLAT No. P-476) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the � � _ Day of F�1>-'-i-I------__, 2at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. ?* : 49TH ............... ... ... ....... ... . .... art, KENNETH G. LANG o 4�F 40� •.LS -5202.•' �J©G O AR • . �FfSSIONAi- AECC963 L----,' . -1 10.2'x12.7' SHED i 57.8' WELL- \ p O / Lot 6 N N v t� o O I \ WELL / I m Z F, PILINGS 0 Ln C'f- . O v 25.5' 5' GENERAL N / f USE EASEMENTS 2' STORAGE N26 0 M 32.4' : o i Lot 1 t�wZ / N 89'54'W 150.00 -(L- — — COX DRIVE PLOT PLAN ___ AS BUILT _X_ SCALE _1- 50=_ GRID _ SW 2940Project No. __-20-04_OLA2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone �Qo�OQO (907) 522-4625 Fox —' a F Professional Land Surveyors ken0longsurvey.com o jonothan®longsurvey.com o s 0 I hereby certify that I have surveyed the following described property: LOT 7, BLOCK 1, KIMBERLY MANOR SUBDIVISION (PLAT No. P-476) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the � � _ Day of F�1>-'-i-I------__, 2at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. ?* : 49TH ............... ... ... ....... ... . .... art, KENNETH G. LANG o 4�F 40� •.LS -5202.•' �J©G O AR • . �FfSSIONAi- AECC963 4.8' 8.0' 4.5'x10.3' DECK BALCONY8.0'x10.3' NY//-a WELL / I 27.2' -' F, PILINGS O I C'f- . O v 25.5' 4.0'x10.6' N / f 2' STORAGE N26 o- N 32.4' : o i Lot 1 t�wZ / � o j BALCONY / *�—SEPTIC ®j ! PIPES 11 ,v LAAAN1WOI rc N 89'54'W 150.00 -(L- — — COX DRIVE PLOT PLAN ___ AS BUILT _X_ SCALE _1- 50=_ GRID _ SW 2940Project No. __-20-04_OLA2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone �Qo�OQO (907) 522-4625 Fox —' a F Professional Land Surveyors ken0longsurvey.com o jonothan®longsurvey.com o s 0 I hereby certify that I have surveyed the following described property: LOT 7, BLOCK 1, KIMBERLY MANOR SUBDIVISION (PLAT No. P-476) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated this the � � _ Day of F�1>-'-i-I------__, 2at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. ?* : 49TH ............... ... ... ....... ... . .... art, KENNETH G. LANG o 4�F 40� •.LS -5202.•' �J©G O AR • . �FfSSIONAi- AECC963 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201016 Work Type: SepticTank Upgrade Tax Code Number: 01707415000 Site Legal Address: KIMBERLY MANOR BLK 1 LT 7 G:2940 Site Mailing Address: 7741 COX DR, Anchorage Owner: ORMBERG ROBERT W & CATHERINE R Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft: Total Bedrooms: �1»ent S Departmcnt 2/7/2020 2/6/2021 34500 ❑ Disposal Field Q Septic Tank ❑ Holding Tank. ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Provide the well location for the lot to the west and the location of the existing bed on the record drawings. Received By: UL/ Issued By: Date: Date: 4 f EpLANS MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section I Fax: 907-343-7997 ON-SITE SEPTICM/ELL PERMIT APPLICATION Parcel I.D. 017-074-15 Property owner(s) ROBERT & CATHERINE ORMBERG Day phone 9073602614 Mailing address 7741 COX DRIVE, ANCHORAGE, AK 99516 Site address 7741 COX DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) KIMBERLY MANOR B1, L7 Legal description (Township, Range & Section) Lot Size 34,500 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank El Upgrade El i Duplex (D) El Tank El Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: i. Date of Payment: oil �Ol O -V 0'0 Date of Payment: Receipt Number: o 1 (022 Receipt Number: Permit No. 6s pn 6t Nto Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Appl4ation.doc i� FIRST WATER CONSULTING 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com February 6, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: KIMBERLY MANOR BLOCK 1, LOT 7 PHYSICAL: 7741 COX DRIVE, ANCHORAGE, AK 99516 The owner has requested that we request a septic permit to upgrade the aged septic tank and lift station on the above referenced lot. We propose to install one 1500-gallon HDPE tank with lift station to serve the existing 4-bedroom residence. The lot and area are served by private water as noted on the design. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201016, Deb Wockenfuss, 02/07/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201016, Deb Wockenfuss, 02/07/20 Lot 9 10' GENERAL USE EASEMENTS 10.5'x16.3' SHED COVERED STORAGE 10.2'x12.7' SHED -- Lot 6 w ro 0 0 0 Z 5' GENERAL USE EASEMENTS I .Lots � —WOODEN FENCE Lot 7 34,800 S.F. � WELL � / I too' PROTECTi OOLCHAIN-LINK FENCE Y L�-• ^ 4.8'x8.0' 57.8' I BALCONY / 27.2' ;7, P NI N c A u 25.5 26.2' A W m x10.3' DEC 8.0'x10.3' ON PILINGS -4.0'x10.6' STORAGE 32.4' M SEPTIC /SES 0 a I MANHOLE N 89'54'W 150.00' COX DRIVE Lot 20 I WELL/ Lot 1 i PLOT PLAN ___ AS BUILT _X_ SCALE _1"_= 50__ GRID _ SW 2940Project No. ____?0=0401A1____ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, in C.. , (907) 522-6476 Phone 0000�p�O (907) 522-4625 Fax Professional Land Surveyors kenolangsurvey.com o .. F A9 p jonothon*langsurvey.com �dP •.S DO, I hereby certify that I have surveyed the following described property: LOT 7, BLOCK 1, KIMBERLY MANOR SUBDIVISION (PLAT No. P-476) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated this the __ _ Day of _4 jG_�_�____, _�_�`�_u _, at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 151 `. I 49TH v* .............. .......... O KENN G. NG o � AR ... • • ago p0� �FESSIONA7- �o AECC963 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 Permit Number: ..~/~OI~C) PID Number: Ol'"l ~::~7~- I~ N~: Wastewater System: D New ~Upgrade Address: ~7WI C~ '~;v~ ABSORPTION FIELD Phone: No. of B~oms: ~_~l~ ~.~ ~S~,ow~r~nc, ~ ~ou~ DO~ Total Depth from original grade: LEGAL DESCRIPTION S°"~'in~: .~ ~/Sq.~. Lot: ~ ~Bl°~k: ~*~L%~Subdivisi°n:~O~ Depth to pipe bottom from~ original grade: Ft. Gravel depth beneath,~ ~e Ft. Township: Range: Section: Fill added above original grade: Gravel length: ~ - ~ Ft. /~ Ft. Number~es: Distan~ between lines: WELL: D New D Upgrade G~a~ width: ~ Ft. '-- Ft. Classifica[ion (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~: ~ ~u ~. s~, ~,: ~. c~i.~ .~i~, ~o~ ~o...:~,. TAN K SEPARATION DISTANCES ~ Septic ~ Holding ~'S.T.E.P. To Seplic Absorption Lift Holding Public/Privat~ Manufacturer: . Capacity in gallons: ~ ~t~ri~: ~ ~ .u~b~ of Co~p..~.~: W~" I~ /~O //~ Surface W~ter ~ H~ ~ LIFT STATION LineL°t ~ ~ l ~ ~ Size in gallons:II Manufacturer: Fou~datioR ~ ~ ~ "Pump on" level at:~ ~ ~ "Pump off" level at:~ Highw~r~ at:m Drain ~ ~ N~ ~~ Remarks: BENCH MARK ~ ~/1'~ ~ ~ Locationan~~ /~ '" ~, 0 EN~R~$~AL Inspections performed by: ~ Dates:l st ~ : ~z~~ 2nd~ /~ Department of H~,alth a H es approval ~:~ ,,,-, ~' ~%~ Reviewed and approved b Date: ~ ' ~t~,~C~ 72-013 (Rev. 9/91) MOA 25 m FOUNDATION CLEANOUT T 1250 GAL SEPTIC TANK WO WAY CLEANOUT ~ 500 GAL STEP TANK // 8O 4-INCH MONITOR AIR DISTRIBUTION GRID BELOW SAND SECTION A-A .5 ,cf. Of Cover 4" Topsoil 4" ttolfpfpe 6" LONG l-INCH PVC WITH J~$2" HOLES AT 54 INCHES 4 RUNS AT 5 FEET 1-I/4 PVC Holes Pointing Up 90.5: 6" Sewer Rock 1-1/4" DistibuHon Pipe Mirafi 140 1.5' LAKE OTIS DRAYEL- 1" AIR DISTRIBUTION gRID 90.7 500 gal STEP fonk FUJI REGENERATING BLOWER BENCH MARKL: MODEL 4Z749 TOBBEfl SPURKLAND P.E. 203 W 15TH. AVENUE ~9NCH. AK, 99501 0~} 279-5916 LOT 7 KIMBERLY MANOR FRANK SWANSON 774! COX DRIVE II SEPtiC SYSTEM AS BUILT DATE: AUGUST 1, 1995 SHEET:.5/.5 GRID: 2940 ~UG 01 '~5 12:87 PH HUNTER ELECTRIC 987 2725589 HUNTER ELECTRIC 1335 Airport 'tlts, · Anchorage, AK 99508 (907.) 272-3006 August l, 1995 ~lobbcn Spu[kiand, PE 203 W. ]5th Avenue Anchorage, AR 99501 Fax (9/)7)276-6013 Dear Sh': On July 31, 19~-,5, l'lunter Electric completed d~e electrical installation cfa lift slation for a single family dwelling located at 7741 Cox Dr., in Anchorage. The owner's name was Doug Swanson. The iaslal]ation consisted of dedicated circuits to lill station pump, controls and air compressor. This work was done per National Electrical Code_ and Anchorage Municipal amendments. If you have any questions, please contact me at 272-3006. Si:merely, Kevin l]unter ![tunter Eleclric 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: SW950180 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:SWANSON FRANK & JANICE OWNER ADDRESS:7741 COX DR ANCHORAGE, ALASKA 99516 DATE ISSUED: 7/26/95 EXPIRATION DATE: 7/26/96 PARCEL ID:01707318 LEGAL DESCRIPTION: KIMBERLY MANOR BLK 1 LT 7 LOT SIZE: 34500 (SQ. FT.) N-U%~BER 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 (iSAAC80). 3. THE EMGINEER 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 SYSTE~ UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SA/~E DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: T.SPURKLAND P.E. 203 WEST 15TH. AVENUE SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Jim Cross Municipality of Anchorage Department of Health and Human Services On-Site Service Section 820 L Street Anchorage, Alaska 99501 June 27, 1995 Subject: Septic System Upgrade Permit Lot 7 Kimberly Manor Doug Swanson Gentlemen; We are applying for a septic system up garde permit for Mr. Doug Swanson. The existing system is not performing satisfactory, and according to Mr. Swanson, never has. The property is being sold and a functional waste water disposal system is needed. This area is known for tight soil and high ground water levels. A testhole excavated on June 14, 1995, indicated that tight silts with seems of sand and gravel was present to a depth of 16 feet. A percolation test at 3 feet showed 60 minutes per inch. Based on the site observation it was determined that the only standard system available for this lot would be a shallow bed of 2000 sq. ft. 'A bed of this size will not meet the requirements of AMC 15.65.060 E.1. which states that the disposal fields must not exceed 100 feet in length, and H.4. which states that absorption beds must not exceed 15 feet in width without approval from the Department. We request approval to install a bed wider than 15 feet. Tentatively we have shown a width of 20 feet. During construction this width will probably be exceeded in order to fit the bed on the property with the least damage to the existing trees, and to follow the natural contours of the lot. Aerobic conditions will be maintained in the bed by installing a continuous air distribution grid 1.5 feet under the effluent distribution pipes. Yours Tobbe~ Spurkland P.E. T.SPURKLAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 7 KIMBERLY MANOR DOUG SWANSON Groundwater at 8 ft. Soil Rating. From test June 14, 1995 60 min/inch. Use shallow bed with pressurized distribution, sand filter and air. No. of Bedrooms 4 Absorption rate per bedroom .3 gal/sq.ft, day Required Absorption Area per Bedroom ' 150 / .3 = 500 [sq. ft.] Required Absorption area 500 x 4 = 2000 sq. ft. SYSTEM CONFIGURATION: SHALLOW BED TOTAL LENGTH 100 FT. TOTAL WIDTH 20 FT. TOTAL DEPTH 3 FT. SAND BED 1 FT LAKE OTIS GRAVEL ROCK DEPTH .5 FT. COVER 3 FT. 500 GAL STEP TANK 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. pg.1 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ~'~ &) O ~"~ LEGAL DESCRiPTiON: LoT- 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~ O oL DEPTH? p E Depth to Water AfterMonitoring? 8 Dale: Gross Net Depth to Net Reading Date Time Time Water Drop Fll-.L PERCOLATION RATE ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~:~ FT AND ~ 7~-'' FT COMMENTS PERFORMED BY: I CERTIFY TH.A~-HIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ZgDTPF HI6H~/A Y DEEZ9 ,~,-~,= , $0 0 SO ]00 1~0 £00 ~0 300 SCALD l.l TOBBEN SPURKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 (907~ 279-3916 LOT 7 BLOCK 1 KIMBERLY MANOR 7741 COX DRIVE DOUG SWANSON SEPTIC SYSTEM DESIGN DATE: JUNE 12, 1995 SHEET: 1/5 GRID: 2940 N ~ 75 1~5 pf~flp, I'O flP, AIN F/ELD C[TX ~£IVE TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 (907) 279-~916 II LOT 7 BLOCK 1 KIMBERLY MANOR 7741 COX D£1VE DOUG SWANSON II SEPTIC SYSTEM DESIGN DATE: JUNE 12, 1995 SHEET: 2/3 GRID: 2940 IO0 9O 1 -lJ4 PVC with 1/8" holes at $4" ~ A SECTION A-A 4" Halfpipe 6" LONG I-1/4 PVC Holes Pointing lip 4-INCH MONITOR NEY/ 500 STEP EXIST. lO00 GAL SEPTIC TANK AIR DISTRIBUTION GRID BELOW SAND I-INCH PVC WITH $/$2" HOLES AT 54 INCHES 4 RUNS AT 5 FEET $ Ff. of Cover 4" Topsoil !- 1/4" Discharge -- 6" Sewer Rock I-I/4" Oistibution Pipe tdirafi 140 1,$' LAKE OTIS GRAVEL 1" All? DISTI?IBUTION GRID FUJI REGENERATING BLOWER MODEL 4Z749 STEP tank BENCH MA£KL: ITOBBEN SPURKLAND P.E. 205 14/ 15TH. AVENUE ARCH AK. 99501 (907.)' 279-3916 J J LOT 7 KIMBERLY MANOR S.D FRANK SWANSON 7741 COX D£/VE SEPTIC SYSTEM DESIGN DATE: JUNE 29, 1995 SHEET: 5/$ GRID: 2940 ,,.; DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE MAI LING ADDRESS LEGAL DESCRIPTION ~ Manufacturor ~ Mate~ ~o. of ~rtmants kiq. ~ca~aci~ ~~flall°ns I[ HO~fi~Dfi: Inside lenflth ~idth ~iquid depth TO: ~ ~ ~ Manufacturer Material kiqui0 ca0acitv in ~allons Distance between lines Q Top of tile to finish grade ~ / Material beneath tile ~f inches Total ~f~t~ absorption area Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SO~L~ST RATING /~G BfiM~KS / APPROVED DATE LEGAL 72-013 (Rev. 3/7B) F'ERMI T NO. FIF'PL I C:l=lN'r F'F.'. FtNK Sb. IRNSON I_OCFIT I ON CO,'-'.:: DF..: LEGRL L7 E::.t KIMBERL¥ HFINOR [)EPRRTMENT OF HERr_TH FINE:, EN'v' I F.:ONMENTF~L F'F.:'O ~ [=CT.t ON o.:.,=,.,,.._ '"L" STREET., FINCHORFIGE., FIE. ~E~50::L '~ ~: :,4-4 ,' ~.1~. Ii.,.! E k L_ F~ I~'-,~ [:, ,2, ~'..~.- .... __,== ][ T' E 25 E: Ii-,..ii [E f:~ F' E f-.: ~"1 :K: 'T ]:44 LOT SIZE ]:48E~D '-:;C!URRE FEET HE,_~URBTILN S¥S'FEM : TRENC:H TYF'E OF S]IIL -"--"' ] IS HRXIHUM I',ILflE, ER OF [::EDF4'F~FIHS 4 =,uIL F.:R'FIIqG (SC! FT,,"E:F.:)= .;k"-'.H. ]'HE F.:ECIUIRE[:, SIZE OF THE SOIL RE:L:;0F:F'TIIDN :,~=,TEM IS: THE LENGTH DIMENSION IS: ]"HE LENGTH (Ii",l FEET.'." OF THE: TRENCH OR [:,RRINFIELD. ]''HE DEPTH OF FI TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SURFRCE OF' THE GROUN[:' IRND THE 8OT].'OH OF THE EXC:FI","I=ITION (IN FEET.'.". THERE IS NO "-.;ET I.,-IIDTH FOR TRENCHES. ]'PIE GRIR',,,'EL DEPTH IS THE MINIMUH DEPTH OF GRFIVEL 8ETb.IEEN THE OLITFRLL PIPE FIND THE BOTTOH OF' THE EXCFIVFITION ,.'.'IN FEE:T). F'EF.:MIT RF'F'LICFIN'r HFI::5 TI4E RE:,F_N:,IBIL~[TT 'FO INFEmRM THIS [:,EF'FIR'FP1ENT E:,IJRINL]i THE · ,=., .... ,=, · ,,~ INSTFtLLFITION II't_FEE.] IufL OF RN'¢ I.,~EL.L.S RD..TFIIZ:ENT TO 'Fla.[.. PROPERT'¢ RI'.,I[:, THE: NUHDER OF F..E=,I[.,EIqL. E_, THFIT THE b. IEL. L b.IILL.._-,ER. ,E. -¥' 1---~ ~2'.~ .:." '=: ::o '-- -" -- ~-' -" .... =,~=,tEi"l FINRL INSPEC'FION RND FIF'F'ROVRL B'¢ THIS E:FICKFILLI. NG OF FIN¥ -'"--' WITHOLIT E:,EF'FIRTMENT I-,.IILL BE =,UB..1E_.T TO PF.'R'SlERIITIF~N MINIMUM DISTRNCE BETWEEN FI NELL FiND RNY ON-SITE SEI.qFtGE DISPOSRL S'¢STEM IS ±O~.'-1 FEET FOR R F'RI',,,'RTE WELL.~ OR :'L50 TO 2CiO FEET FROM R PUBLIC b.lEt_L DEPENDING UPON THE T'¢PE OF' PUBLIC WELL. 1.4ELL LOGS RRE RE6!UIRED RND MUST E:E RETLIRI"4ED TO THE DEPRRTHENT WITHIN ]!:R DF:WE; OF THE NELL COHPLETION. OTNER REC!UIREMENTS f'lR"r' RPPL¥. SPECIFICRTIONS RN[:, CONSTRUC:'FION DIRGRFIMS FIF.':E AVAILABLE TO INSURE PROPER INS].'RLLRTION. I CERTIF".r' THRT :1_: I Bfq FRHILIRR 1.4ITH THE REQUIREMENTS FOR ON-SITE ~=';E[4ERS FIND 14ELLS RS SET FORTH BY THE HUNICIF'RLIT'¢ OF RNCHORRGE. 2: I ~,4ILL INSTRLL. THE SYS'FEP1 IN RCCORDRNCE WITH THE CODES. 2:: I UNDERSTFiND THR].' THE ON-SI'rE SEWER S'T'L~TEi'q f,lR¥ REt;!LIIRE ENLFtRGEMENT IF THE RESI[:,ENCE IS REMODELED 'TO. INCLUDE MORE THRN 4 E:E[:,ROOf,'IS. .... e-' .¢ .. RF'F'L~NT F'F.:F~N F~ ?~i,.IR f-,ISON MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222~ SOILS LOG -- PERCOLATION TEST sOILs LOG PERCOLATION TEST LEGAL - SLOPE ' ../ SITE PLAN 5 6 7 8- 9- 10- 11- 14- 15- 17 18 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop z~/O ~ '~ I/)~ z ~ ~" PERCOLATION RATE bM ~'~ "~"~ ' [. (minutes/inch) TEST RUN BETWEEN ~ FT AND ~' j~ FT 72-008 (7/76) . a up P5 Certificate of On -Site Systems Approval Parcel I.D. 017-074-15 1. GENERAL INFORMATION Expiration Date: 5--27 - 2-6--U Complete legal description KIMBERLY MANOR BLOCK 1, LOT'! Location (site address) 7741 COX DRIVE, ANCHORAGE, AK 99516 Current property owner(s) ROBERT & CATHERINE ORMBERG Day phone Mailing address Real estate agent 7741 COX DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank, ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer, , ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ _ Date of Payment vZ 6on Date of Payment Receipt Number 0 goslwt Receipt Number COSA # 05C �Z 6 1 65'-� 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 2/17/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of Aw A • ' • " ' • : 7�`� j] construction (workmanship & materials), the water usage of the family being served by the/�`'• !� j system and maintenance. 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 *� TH ••* fJ well and septic system. Therefore, any estimate of how long a system will function satisfactory . ......... (� for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS' (:.. • . .... • ......:.. r Curtis Huffman 6. DSD SIGNATUREL �1�'F�i�l . • •�V, 8092901• , • � System #1 Approved for bedrooms �l F,�Fp • • • • • • �c�. l� PROFEWOO"1.41.r - System #2 Approved for bedrooms �rteZt�� Disapproved Conditional approval for bedrooms, with the following stipulation6{kkW((((((((((. OF ��i�s '+�' ori �' nf�l_591'Ti= WATER AND J SERv�',���°°, l By: Original Certificate Date: Z 0ZO 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 Legal Description: KIMBERLY MANOR BLOCK 1, LOT 7 Parcel ID: 017-074-15 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 9/7/1978 Total depth 304 ft Cased to 304 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 1/21/2020 Static water level at beginning of test 194 ft. Well production at time of test 4+ gpm Comments B. TANK DATA Age of tank(s) NEW (INSTALL 2/11/2020) years Tank type/material STEP / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping NA - NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 7/28/1995 ® ALL standpipes present per record drawing Total measured depth from grade 2_9 ft (max) Measured depth to pipe invert from grade _ft (min) ® N/A — pressurized field Structure served by this system Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 4.46 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FES zL Date of Sample 2/5/2020 C. LIFT STATION ® Required maintenance completed Age of lift station 0 years Lift station material HDPE Comments: Adequacy test date 1/21/2020 Results E Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 5 in ® Monitor tubes go to bottom of effective. If not, state Elapsed time 1440 min depth into effective ❑ Code -required soil cover over field* Final fluid depth 0 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: *System has operated with no known freezing issues for 25 years w/ approx 2.3' of cover. a 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 ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ® 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' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ 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' ® 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' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that l 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. or- AQ . TM ....•... .... ....�....;. • '. Curtis Huffman c��`c�fi /E7/20 0,�, MW �PROFiSS1QO .� ft ft 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 GENERAL INFORMATION Complete legal description LoT- ~7 Location (site address or directions) 77~/ C~ % b.P-1 v/F=- Property owner Mailing address Lending agency Mailing address Agent Address dO ' ~EA / ~okAN~ Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: ing to the legality and status of system. If community well system, provide written confirmation from State ADEC attest- 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-~25 (Rev. 1191) Front 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. NameofFirm ~ ~-~,r'l,/~Lo.~¢¢ ~ ~ Address ,~;~.-b ~ I,,/~¢ / ~-/---'¢/ Pi ,.~ i~ Engineer's signature ~-~ , Phone ,~-~ -~ ¢/~ DHHS SIGNATURE Approved for ~-~%/~---- bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments rm The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91 ) Back MOA #'21 Municipality of Anchorage ~qh',~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ~~ 825 k Street, Room 502, Anchorage, Alaska 99501 · (Db~-~ Health Authority Approval Checklist Legal Description: Parcel I.D.: ~)t~'~ ~' D~75~ I~ A. WELL DATA V~ell type ~ Log present (Y/N) Total depth ~ ~/ Sanitary seal (Y/N) Date of test Static water level Well production Date completed Cased to ~ ¢ t/ / FROM WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Wires properly protected (Y/N) AT INSPECTION g.p.m. 7 g.p.m. WATER.SAMPLE RESULTS: Coliform Date of sample: "~ ] Nitrate 2.~)c// ?/48/ Other bacteria N L~ Collected by: ~ ~ B. SEPTIC/HOLDING TANK DATA Date installed Foundation cleanout (Y/N) Date of Pumping ~/~l/~ C. ABSORPTION FIELD DATA Date installed /~oo~/~~ Tank size ]~--5 d.~ Number of Compartments ~ Cleanouts (Y/N) Y Depression (Y/N) ~'¢ High water alarm (Y/N) Soil rating _(~r ff~/bdrm) ~-~) ~) ~ Gravel thickness below pipe Length ] ~ t Width Effective absorption area Date of adequacy test ~/~¥/~) Monitoring Tube present (Y/N) / Depression over field (Y/N) __ Results (Pass/Fail) "~ For ~ System type ~"~ /! Total depth Fluid depth in absorption field before test (in.); ~) Immediately after/o/O gal. water added (in.): Fluid depth ~ (ins) Minutes later: ~' ~/4 ~'j5 Absorption rate = /~' ~ g.p.d. Peroxide treatment (past 12 months) (Y/N) /~ If yes, give date bedrooms 72-026 (Rev. 3/96)* LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* /-?/Z.'~ "Pump off" level at* *Datum ~ ,~ ¢7/,~'~ F. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line ~,¢z44'~ On adjacent lots on a~djacent lots '~' Public sewer manhole/cleanout Lift station //,.-~- SEPARATION DISTANCES FROM SEPTIC/HO,~ .......... .K ON LOTTO: Foundation J b ~ Property line ~7~E) ! Absorption field ¢~¢~ ~ Water main/service line ~,~ Surface water/drainage h-I ) ¢..~ Wells on adjacent lots ~ lO-c) SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water Curtain drain Building foundation ~ / Water main/service line Driveway, parking/vehicle storage area t Wells on adjacent lots ~> //2~5;~ ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records, that the iabove sYStems are Engineer's Name Date in conformance with MOA HAA guidelines in effect on this date. HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 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 Parcel I.D.# ~ 1'7--~ 73-1~ 1. GENERAL INFORMATION Complete legal description CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# ~ ~'~(~,~ ~"'~ Location (site address or directions) Property owner' Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA Will be held for pickup. ,..UMSE. OF sEDRoOMS: '¥ '- 3. TYPE OF WATER SUPPLY: Individual well ~/ Community well NOTE: 4. TYPE OF WASTEWATER DISPOSAL: Public water . ~,,;??;,..,~ ,.. .,?.~ !. If community well system, provide written confirmation from Sta__t~ADEC a~te S t- ing to the legality and status of system. '. -- ,'" -~'" ',~ ._. -.-.,~' · 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/gt) 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 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. Address ~-b Engineer's signature DHHS SIGNATURE (~ Approved for '~ Disapproved. Conditional approval for bedrooms. Date 0¢/¢-/¢~'- bedrooms, with the following stipulations: Additional Comments ~,/ , '.,.. Date The Mumc~pal ty of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificetes 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 ~ 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 p.rofessional engineer's work. 72-025(Rev. 1/91) ~ack MOA~I Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: /--o~ '7, /,27,,~J~-i~ ~[~,~4vv" ParcelI.D. ~)/7-' O7-~-'/~ If A, B; or C, attach ADEC letter. ADEC water system number Date completed ~/~/72~"' Driller Cased to ~ ~ ~/ Casing height A, Well Data Well type Log present (Y/N) ~" Total depth 9o Sanitary seal (Y/N) y Date of test Static water level Well flow Pump level1 Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION "' ~' g.p.m. ~' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ! ~ Absorption field on lot /,~ C~ Public sewer main Sewer service line ; On adjacent lots g.p.m. ~ ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Z WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed Nitrate Tank size qZ.// Other bacteria Collected by: I ~ ~'~..~ Compartments Cleanouts (Y/N) ? Foundation cleanout (Y/N) / Depression (Y/N) High water alarm (Y/N) Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot t~)-~ To property line J~O Surface water/drainage Alarm tested Pumper ~'/4,~ On adjacent lots Absorption field Foundation ~ Water main/service line 72-026 (3/93). Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~?f/~ Size in gallons Vent (Y/N) "'// "Pump on" level at / High water alarm level '~' / Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot //.~_~ On adjacent lots Manufacturer /~'//~ ¢~Z~o r ~',~ Manhole/Access (Y/N) Y , "Pump off" L~evel at ~-.~ Cycles tested W/y- "~/'¢--'~'-~ Sudacewater ~ I [~ D. ABSORPTION FIELD DATA Date installed "7'//..~ ~/~ ~.- Length /4,'~ Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) Gravel thickness Cleanout present (Y/N) ~//'//~ Results (pass/fail) Total depth --~ Depression over field (Y/N) for After test r,,/ Bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ) ~ To building foundation On adjacent lots ) z~ 0 Surface water h/' / Curtain drain ~ On adjacent lots Property line To existing or abandoned system on lot Cutbank ~ ~ ~ ~. 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 thedate of this inspection. Engineer's Name Date ~.t~ HAA Fee $ Date of Payment __ Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3./93)° Back T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 ~)~_,~ / Subject: HAA Lot 7/kimberly Manor PID 017-073-18 Frank Swanson Division of RECEIYED AUG 1995 M u n i c i P a!i ~ ~quAmnaCnn¢ re~i~ e s Dept. Health Gentlemen; This property is scheduled to be transferred to a new owner on August 8, 1995. The septic system has been replaced under permit # SW 950180. The final grading of the property will take place as soon as the weather permits. The water sample collected on July 31 showed 37 colonies of OB's. A resample was collected on August 2. The well will be chlorinated if the second sample also shows OB's. I am submitting this incomplete package in order to expedite the ultimate review and approval of the HAA and request that preference be given to this application in order to meet the deadline of August 8. Tobben l~tpurkland P. E.