The URL can be used to link to this page

Home My WebLink AboutKIMBERLY MANOR #2 BLK 3 LT 6 & 7Kimberly Manor #2 Block 3 Lot 6 & 7 #017-074-56 Well Drilling Permit Number: Parcel Identification Number: DAY 5L Legal Description K�Mber� �t� -2 Pump Installation Date: Date of Issue: - - Block Lot Property Qwner 'rtlame &Address: .3 Pump Intake Depth Below Top of Well Casing: feet Pump Manufacturer's Name:= - Pump Model: L5 1�0'P ct Pump Size: hp Pitless Adapter Burial Depth: Wft feet I Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: Well Disinfected Upon. Com Ietion? &12f Yes ❑ No Method of Disinfection: Comments: Pump Installer Name: ANCHORAGE WELL & PUMP SERVICE - 7640 King Street Company: Anchorage, AK 99,518 PH: (907) 243-0740 Mailing Address: City: State: Zip: Attention: The Vonip installer shall provide a pump installation log to On-site within 30 days of pump installation. Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 Mayor www muni.orcdonsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Date of Issue: _ Parcel Identification Number: Legal Description Property Owner Name & Address: y� iP �/ /V` /9lV REC30ccll arny1401" 3 5�j 751VI -eeu 0ve dwh LR. 115 - 3 1- - (10 Ane • I A k 99516 Pump Installation Date: 1A -'31-)J4 Pump Intake Depth Below Top of Well Casing: 4,5- feet Pump Manufacturer's Name: RfP TACke-f— Pump Model: _66G$1 r $ S 10% Pump Size ll�L_hp Pitless Adapter Burial Depth: 15' feet Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: t Well Disinfected Upon Completion? Yes ❑ No Method of Disinfection: Ll'oeir'll; ee_Ae&-4 Comments: r1�L,oQ twr<rl yQumP S�`QrrrC� Pump Installer Name: ✓a '` 7 Attention: The pump installer shall provide a pump installatiSn log to the DSD within 30 days of pump installation. _ MUNICIPALITY OF ANCHORAGE a.e MEMORANDUM Date 10/24/ 19 94 To: Vince Fennimore From: Dan Roth Re: Refund, Lot 6&7, Blk 3 Kimberly Manor On a recent site visit by myself, in the latter part of September revealed a ground water level in the test holes at or near ground level prohibit- ing the installation of a convention wastewater disposal system. This office will not grant a permit at this time. Please refund Mr. Bezalla's money in the amount of $320.00 Signed A�xwg' 1 01 91-015 (Rev. 1/81) On�_�� Iv`� Municipality of Anchorage REQUEST FOR VOUCHER CHECK FROM: �/�# (DEPARTMENT) TO: � NIC,IP��NLLER DATE: O 1. REQUEST THAT A MUNICIPALITY OF AN .. rf�T; - w=moi -- R g7F1 Q THIS SECTION FOR ACCOUNTS PAYABLE USE ONLY 1099 VOUCHER NO. PAYMENT DT. V I VENDOR NO. REFERENCENO. INVOICE DATE INVOICENO. OESC CHECK NO. CHECKDATE PREP APPR CHECK BE ISSUED TO: 2. THIS PAYMENT IS FOR THE FOLLOWING (SUBSTANTIATION ATTACHED): �e u c� sz w e v e vt t ,' 1' �_e . 3. �AD//I``SPOSITION OF CHECK: (1) ID�MAIL TO PAYEE (2) ❑ (MAIL TO PAYEE W/ATTACHMENT (3) ❑ NOTIFY PAYEE TO PICKUP IN TREASURY Name: Phone No.: 4. ACCOUNTS TO BE CHARGED: ITEM IC ALL AUTHORIZED USE ONLY (6) ❑ NOTIFY DEPARTMENT EMPLOYEE WHEN CHECK IS READY IN FINANCE Name: Org. No.: Phone No.: S. TOTAL AMOUNT OF CH C Is 3 a�� 6. SIGNATURES Em oyes Pho a No. Approving Authority 7. INSTRUCTIONS a. To be used only when payment cannot be made by purchase order. travel expense report, travel authorization or petty cash. b. Must be approved by department head unless approval authority is delegated in accordance with Policy and Procedure 24-7. c. Retain carbon copy for your file. 40-001 (Rev. 2/91) MOA #15 r Lor 11 '( � o' P+ f, c I- e__ 6p � tea_ J �- / , / , ,� �40 \v-4 /') 'L /\ '-V LOT 5 5U(ter T ( - 5 5UISQ --5 ITC-- ,P LA tV -JAME 5 J/ ou 5UISQ --5 ITC-- ,P LA tV -JAME 5 J/ -1 l000 Go[ cl, 10 1:1 L A W V1 11 1 ( T Pcrl-r Ir f 5 70� OF 44 V, PT I C 45 Y-!� 7,91 -5, E *0 James F. Sizemore # 1517 F P art SbC, James Sizemore & Associates Civil Engineers & Surveyors 6410 Switzerland Drive Anchorage, AK 99516 (907) 345-1572 WASTEWATER DISPOSAL SYSTEM SPECIFICATIONS LOT 6 & 7 BLOCK 3 KIMBERLY MANOR SUBDIVISION 1.0 GENERAL: 1.1 The scope of the project consists of installation of a 1000 Gallon Septic Tank ank installing a new five foot wide drainfield. 1.2 Construction shall be as shown on the approved site plan and design drawings. Deviations from the drawings shall be co-ordinated and approved by the engineer conducting the inspections. 1.3 All construction procedures and material used to construct the system shall comply with Municipal and State regulations. 1.4 Unless specifically agreed otherwise, the homeowner shall be responsible for finish grading areas after the soil is compacted. Placement of topsoil and reseeding all areas disturbed by construction is also the responsibility of the homeowner. 2.0 SEPTIC TANK 2.1 The 1000 gallon septic tank shall be Municipally approved. 2.2 The septic tank shall be set level and shall be bedded as necessary to prevent settling or shifting of the tank. 2.3 All pipe connections to the septic tank shall be equipped with waterproof mechanical couplings. A doublecleanout shall be installed within 5 feet downstream of the septic tank. 3.0 SOIL ABSORPTION DRAINFIELD: 3.1 The soil absorption system shall be constructed by excavating two 5' wide by 40' long trenches located as shown on the approved site plan. The bottom of the trenches shall be 2' below existing ground level. 3.2 The bottom of the excavation shall be level. Any compacted or smeared surfaces shall be raked to allow for proper infiltration this includes both sides & bottom of trench. 3.3 A total of 1.0 feet of sewer rock shall be placed in the bottom of the excavation with the perforated distribution pipes laid level and with at least 0.5 feet of sewer rock below the invert of the pipes. Sewer rock shall be 0.5 - 2.5" screened gravel, with less than 3 % passing the #200 sieve. 3.4 Cleanout pipes and monitor tubes shall be 4" diameter and installed in locations shown on the drawings. The portion of the monitor tube extending through the sewer rock shall be perforated. 3.5 Approved filter fabric shall be placed over the top surface of the sewer rock. Two inch thick direct burial insulation will be placed over the sewer rock prior to backfill. At least two feet of backfill shall be placed over the sewer rock. 4.0 INSPECTIONS: 4.1 A minimum of three engineering inspections will be required during construction of the system. -One after excavation of the trench prior to placement of sewer rock, one after placement of the sewer rock and the perforated distribution piping, and the piping has been connected to the discharge line from the septic tank but prior to placement of the filter fabric. The third inspection will be after final backfill and grading are complete. 4. The contractor shall coordinate with the engineer at least 24 hours prior to start of construction. PROBABLE IMPACTS TO ADJACENT PROPERTIES A) WELLS: The proposed disposal system is desiogned in accordance with the current 1994 Municipal Disposal Regulations. The separation distances from wells on adjacent properties and from the well on this property is greater than 100 ft. A separation of at least 4 feet between the ground water table and the bottom of the lkeach field will also be maintained. Therefore there should be mimimal impact to water wells from this proposed system. B) WASTEWATER SYSTEMS Since the house was originally built on Lot 6 there was not enough usable space on the lot for a disposal system, a holding tank was put in. Lot 7 was purchased by the property owner and by combining Lots 6 and 7, there is space to construct an on-site disposal system for the two bedroom home and maintain separation distances from the wells. Thge adjacent disposal systems should not be adversly impacted. C) RESERVED SPACE/SURFACE AND SUBSURFACE There is enough space beside the disposal system being constructed to build another disposal system consisting of five foot wide shallow trenches: D) DRAINAGE The location of the disposal field on the lot is in a flat area and will not interfere with surface drainage.- e T,, L Municipality of Anchorage —IFDERTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: -a ('t t t�J > 7-- l I ✓ �/'/ DATE PERFi LEGAL DESCRIPTION: 4 o" Z eC ✓ /�e,;'Z l�� ,'"Vasq "ange, Section: D PTH SLOPE SITE PLAN 1 � r 2 3 5a �GJ y �av�1 4 5 f [ c� 3 >� �l`y �9ravEl 7 f 8 2 10 11 12 13 14 15 16 17 18 19 - • labla-11 ■■■■■■■■■■ IF YES, AT WHAT DEPTH? Depth to Water Atter - / Monitoring? e� Date: MM .�. r®IMMM�._.v „�U�� y. 20 -[ II PERCOLATION RATE i (minutes/inch) PERC HOLE DIAMETER r / TEST RUN BETWEEN / ` FT AND FT COMMENTS cJ 7 PERFORMED BY: �J ' / CJ��I%C�%�^ I , " � '" CERTIFY TT�^HHAT/TTHIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELIN S IN EFFECT ON THIS DATE. DATE: ` /- 1 72-008 (Rev. 4/85) 6 MUNICIPALITY OF ANCHORAGE e� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION E ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ` ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME i A J Tr 7-- Yn�� ,v c,6 t 1 PHONE _ NEW UPGRADE MAILING ADDRESS ;=--� e, A c LEGAL DESCRIPTION L //� V w� Wo, LOCATION NO. OF BEDROOMS V _Y STANCE TO: Well Absorption area Dwelling PERMIT NO. oF-. Q wf Manu cturer terial No. of compartme rn Liq. capaci 'n gallons IF HOMEMADE: Inside length Width Li epth Z SZFQ- DISTANCE TO: Well Manufacturer Dwelling / Ma I PERIgf! Liquid �p�ci in gallons � O w= DISTA TO: Well Founda ' Nearest lot line PERMIT NO. Uj J LL z F z ¢ No. of lines Length of each line Total length of lines Trench width inches Distance between s F Top of tile to finish a e Material beneath the I Tot tive absorption area LU 0 Length Width Depth PERMIT NO. a F wa Type of crib Crib diameter Crib depth - Total effective absorption area LU DISTANCE T0: Well Building foundation Nearest lot line W Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOI L TEST RATING �l /(1 T INSTALL wC'� e Sc�N REMARKS 1' APPRO DATE LEGAL - F SOIL HBSORPTIQN SYSTEM IS� DRHINFIELD M�XIMUM NUMGER OF GEDROOMS z I SOIL RHTING (SO FT/BR)c 275 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� �F T'P� �L THE LENGTH DIMENSIQN IS THE �E�GTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHMCE B THE THE GROUND HND THE BOTTOM OF THE EXCHV�TION (IN FEET) DEPHRTMENT\��HEHLTH ��E"�' THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL^PIPE HND THE BOTTOM OF THE EXUPI VHTION (IN FEET) �N PIZ:- ..... ---- � PERMIT HPPLIC�NT HHS TH� RESPONSIBILITY TO INFORM THISDEPHRTMENT DURING PERMIT cd P'. P�OP�RTY HND THE �� NO ( 820179 BHCKFILLIN8 OF HNY SYSTEM WITHOUT INSPECTION HND san� Ln HPPL�C��T JHMES N SCOTT MINIMUM DISTF�NCE BETWEEN H WELL HND HNY ON-SITE SEWHGE DISPOSHL S9STEM IS 100 FEET FOR H PRIYHTE WELL OR 150 TO 200 FEET F��OM H PUBLI� WELL DEPENDING LOCHTION MINIMUM DISTHNCE FROM H PRIYHTE WELL TO H PRIVHTE SEWER LINE IS 25 FEET TO H COMMUNITY SEWER LINE IS 75 FEET LEGHL 1 6 MHNOR #2 DIF�GRHMS LOT C- - F SOIL HBSORPTIQN SYSTEM IS� DRHINFIELD M�XIMUM NUMGER OF GEDROOMS z I SOIL RHTING (SO FT/BR)c 275 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� �F T'P� �L THE LENGTH DIMENSIQN IS THE �E�GTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHMCE B THE THE GROUND HND THE BOTTOM OF THE EXCHV�TION (IN FEET) ��E"�' THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL^PIPE HND THE BOTTOM OF THE EXUPI VHTION (IN FEET) �N PIZ:- ..... ---- � PERMIT HPPLIC�NT HHS TH� RESPONSIBILITY TO INFORM THISDEPHRTMENT DURING THE INSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS P�OP�RTY HND THE NUMBER OF RESIDENCES THHT THE NELL WILL SERV� 'T �--.,� 2-�� BHCKFILLIN8 OF HNY SYSTEM WITHOUT INSPECTION HND HPPROVHL BY T�IS DEPHRTMENT WILL BE SUBJECT TO PROSEC�TION MINIMUM DISTF�NCE BETWEEN H WELL HND HNY ON-SITE SEWHGE DISPOSHL S9STEM IS 100 FEET FOR H PRIYHTE WELL OR 150 TO 200 FEET F��OM H PUBLI� WELL DEPENDING UPON THE TYPE OF PUBLIC WEL� MINIMUM DISTHNCE FROM H PRIYHTE WELL TO H PRIVHTE SEWER LINE IS 25 FEET TO H COMMUNITY SEWER LINE IS 75 FEET HND �TH�R REQUIREMENTS MHY HPPLYSPECIFICHTIONS HND CONSTRUCTION DIF�GRHMS If: 'M TO INSU�E PRQPER INSTHLLHTIOM- HRE |-��-�� -ft, I�CERTIF' THHT FHMILIHR WITH THE REQUIREMENTS FOR ON~SITE SEWEHS SET FORTH BY THE MUI'd ICIPHLITY OF HN�HORHGE 2I NILL I�STHLL T�E SYSTEM IN HCC�RDHNCEWITH TH� C�DES I� I UNDERSTHND THHT THE ON�SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS R�MOD��E�D TO INCLUD� MORE THHN I BEDROOMS JOTE:BDLDZNG TANK ORIGINALLY INSTALLED DOE TO BZGfI GROUND WATER. & SHALLOW D��I�J SIGZ�I'D V�Z]� Z �JI^I'�� FEASIBLE IF (GROUND WATER EVALUATION IS STABLE�� 1� � ^ .... DHTE '_-��-��_u=.~--~� Y40 /�^�~��~^��^i MUNICIPALITY OF ANCHORAGE 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 NEW 3 — J ❑ UPGRADE MAILING DDR SS LEGAL DESCRIPTION L LOCATION �c� NO. OF BEDROOMS v _Y DISTANCE TO: Well Absorption area Dwelling PERMIT NO. wQ Manufacturer Material No. of compartments y~ Liq. capacity in gallonsIF HOMEMADE: Inside length Width Liquid depth ❑ Y J V' z 2 < ❑ w = DISTANCE TO: Manufacturer DISTANCE TO: Well /'�� Well Dwelling p� f (� , , Foundation M ter'al arest lot ne PERpgyiT � "C l9 capacity in gallons ® :2 d0 PERMIT NO. U- z F No. of lines Length of each line Total length of lines Trench width inches Distance between lines XRf Top of tile to finish grade Material beneath tile inches Total effective absorption area LU Length Width Depth PERMIT NO. a F wa Type of crib Crib diameter Crib depth Total effective absorption area w rn DISTANCE TO: Well Building foundation Nearest lot line J LU Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS L..- SOILTEST RATING 27S INSTALLER _ Cl 0 REMARKS APPROVED DATE LEGAL �-r7� 76' MAXIMUM NUMER OF BEDROOMS = ] ' THE REQUIRED SIZE OF THE SOIL THE LENGTH DIMENSION IS THE THE DEPTH OF H TRENCH OR(-rLoS GROUND HND THE BOTTOM OF TH THERE IS NO SET THE GRHYEL DEPTH IN Will TH 11111ANE)THE BOTTOM OF �XCHV (SQ FT/B150 L Nk OF THE TRENCH OR DRHINFIELD lS.; E DISTHNCE BETWEEN THE SURFHCE OF THE EXC�VHTION (IN FEET) CHES 1UM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE ION (IN FEET). Eva RE.'. !LJ K: "I EA L~UCIO Rho 50 PERMIT HPPLICHNT PANS3 RESPONSIBILITY TO INFORM THI[:AU�I�G�THE/ INSTHLLHTION 1105 IF". EADIUMM OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES1H1 THE WELL WILL SERVE. / 0- B."I CIA c, 1 H�'. 11 V� "0, * ,!.:: 1c,.!! �� BRCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL 81' THIS DEPHRTMENT WILL BE SUBJECT TO PRQSECUTION MINIMUM DISTHNCE BETWEEN H WELL HND HNY ONNSITE SEWHGE DISPOCir HL SYSTEM 100 FEET FOR H PRIVHTE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPO! THE TYPE OF PUBLIC WELL `. . DEPHRTMENT . ^|EHLTH HND HNCHORHGE/ ENYIRONMENTHL}TECTf HK9��oA THE DEPARTMENT WIT4IN,Q5 DHYS OF THE WELL COMPLETION. ��r E.,-1; ��---YET 1: -1, !IiE�i: I i� O:A f5� EVE OR? 1,1 PERMIT NO ( 780257 ) TO INSURE PROPER INSTALLATION. :/ RPPLICHNT AIMS SRH BOX 166 H HNCH � LOCHTION KIMBERLY MHNOR 2 ' LEGRL 1 6 B] KIMBERLY MANOR 2 L |T SIZE 0 SQUHRE FEET� TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMER OF BEDROOMS = ] ' THE REQUIRED SIZE OF THE SOIL THE LENGTH DIMENSION IS THE THE DEPTH OF H TRENCH OR(-rLoS GROUND HND THE BOTTOM OF TH THERE IS NO SET THE GRHYEL DEPTH IN Will TH 11111ANE)THE BOTTOM OF �XCHV (SQ FT/B150 L Nk OF THE TRENCH OR DRHINFIELD lS.; E DISTHNCE BETWEEN THE SURFHCE OF THE EXC�VHTION (IN FEET) CHES 1UM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE ION (IN FEET). Eva RE.'. !LJ K: "I EA L~UCIO Rho 50 PERMIT HPPLICHNT PANS3 RESPONSIBILITY TO INFORM THI[:AU�I�G�THE/ INSTHLLHTION 1105 IF". EADIUMM OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES1H1 THE WELL WILL SERVE. / 0- B."I CIA c, 1 H�'. 11 V� "0, * ,!.:: 1c,.!! �� BRCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL 81' THIS DEPHRTMENT WILL BE SUBJECT TO PRQSECUTION MINIMUM DISTHNCE BETWEEN H WELL HND HNY ONNSITE SEWHGE DISPOCir HL SYSTEM 100 FEET FOR H PRIVHTE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPO! THE TYPE OF PUBLIC WELL WELL LOGS WE REQUIRB} HND MUST BE RETURNED TO THE DEPARTMENT WIT4IN,Q5 DHYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MHY RND CONSTRUCTION DIHGRHMS HRE HVHILHBLE TO INSURE PROPER INSTALLATION. P"HEE IF&A-1 :1 -1 ��:11: JE.'.E How ETE 112 M WT 0011 �� , !"E7 I CERTIFY THHT P I RM FHMILIHR WITH THE REQUIREMENTS FOR GN~SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHSYSTEM MHY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THH� ] ��DRO�MS Cff F:�' . DEPFiRTMPNT OF HEALTH AND ENVlRONMENTHL P��TECTION 825 /�' STREET/ HNCHORHG[�, HK9950� 264~47�0 �� ~�� PERMIT NO. ��/�� HPPLICANT LOCATION LEGAL JOYCE SCOTT SRA BX. 166-� �NCH 749�40]1 OUR 8HN LANE LT.6 BLK.] KIMBERLY MANOR S/D LOT SIZE 0 SQUHRE FEET TYPE OF SOIL ABSORF,'TIOt-,l SYSTEM DRAINFIEL.C.,% MHXIMUM NUMBER OF BEDROOMS SOIL RATING (SQ FT/BR)= 275 THE REQUIRED SIZE OF THE SOIL ABSORPTION SY' TEM IS. �F=, �-1 -%r- � ��P-,l 0 H == FEEL- F---��= THE LEW8TH DINENSION I5 THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE E'X'CAVATION (IN FEET). . �� C... P -A I I CA I- H I�� THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHYEL BETWEEN THE QUTFHLL PIPE � HHD THE BOTTOM OF THE EXCAVATION (IN FEET) � . �� L -�o �� PERMIT APPLICANT HHS THE RESPONSIBILITY -r(,")INFORM THIS DEPAF:TMENT DURIHG THE INSTALLATION INSPECTIONS OF ANY WELLS, ADJACENT TO T|fIS PROPERTY FA. - NUMBER OF RESIDENCES THAT THE WELL WILL SERVE < X P -A F-` EKE ��EE., ic,-p N—u ff BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AWD HPPROVHL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL WELL LOGS ARE REQUIRED AND MOST BE RETURNED TO THE DEPHRTMEP-FT WITHI� ]0 DHYS OF THE WELL COMPLETION. OTHER REQUIREHENTS MAY Hf -PLY, SPECIFICATIONS AND CQ|STRUCTIQN DIF��RH�YS HRE AVAILABLE TO INSURE PROPER INSTALLATION, �Irl :T -V �P� I F-". FEE ��FEE".�� I CERTIFY THAT 1� I HM FAMILIAR WITH THE REQUIREMENTS FOR AND WELLS HS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]� I UNDER,:-7THND THAT THE ON-SITE SEWER SYSTEM M8Y REQUIRE IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS SIGNED� ISSUED BY U SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION Pouch 6650, Anchorage, Alaska 99502 276-2221 TEST SOILS LOG - PERCOLATION TEST PERFORMED FOR: (��C� ��7�� DATE PERFORMED: LEGAL DESCRIPTION: LC!5i 4!!:� l 94--�k VI I-Aes(5�a--�/ MAN � r� "DEPTH (FEET) 1 2 7/ S� times 3 Ii�C-1 4- 5 6 'J 7 8 9 SLOPE SITE PIAN 11 12 13 14 15 16 17 - 18- 19- 20- C1ilut&r. PERFORMED BY: 72-008 (7/76) s:;wbA% WAS GROUND WATER S >.<T'iOtils ENCOUNTERED? L V, e,e ¢ Ui o IF YES, AT WHAT E DEPTH? 1 1�fi; VU-Z4,.Y "7, C� % L1e1 M;Aj (3j7x-e'2j;:! ) . ti y T'- i`"i/ 9Q - �"4)LL �'Sr P�rZe, 4�r✓�� &Mkjt t u r Date Gross Net Depth to Water Net Drop �-Ttime -yTime I � %d . zz j 4''Ot 24;:36 ZZ�q ii///� l� I r 11 12 13 14 15 16 17 - 18- 19- 20- C1ilut&r. PERFORMED BY: 72-008 (7/76) s:;wbA% WAS GROUND WATER S >.<T'iOtils ENCOUNTERED? L V, e,e ¢ Ui o IF YES, AT WHAT E DEPTH? 1 1�fi; VU-Z4,.Y "7, C� % L1e1 M;Aj (3j7x-e'2j;:! ) . ti y T'- i`"i/ 9Q - �"4)LL �'Sr P�rZe, 4�r✓�� &Mkjt t u r Reading Date Gross Net Depth to Water Net Drop �-Ttime -yTime I � Reading Date Gross Net Depth to Water Net Drop �-Ttime -yTime %d . zz j 4''Ot 24;:36 ZZ�q ii///� l� r c7 7(, / L PERCOLATION RATE LA1$4 A ),([" 11 (minutes/inch) Cf r TEST RUN BETWEEN FT AND 4 FT J -e,- CERTIFIED BY: DATE: �� UNICIPH►"� ENVIRONtm`.- 2221 s M v4EALTH ANp 99602 276 nchGTege Alaska T pEPAR?MENPop� y65o, A �1O�1 fEs � SOILS LOG PERCO`A PERFDRMED DATE G PERFORMED LEGAL Dtz'• .- PJ EET) Jia �� 5 _ 9 WF 10 Eo 11 t' t 12 131 14 15. 16 17 1$ 19 ,. 276-2221 ION d'I'Ia'I' Pc:rforwe.d for Mr. dames Scott-_-imberl A'anor A'o Le!)a1 Urscrihtiun: Lot 6, BlockPercolation This form re1)orts: Soils log —_—.— -- Depth Feet ,_----- .- 1 - Topsoil 2 - Topsoil 3 - CH (300) . 4 : CH (300) 5 - CH (300) 6 - CH (300) 7 _ CH (300) B - CH ( 300 ) 9 - GN CH (150) 10 _ GW - CH (150) 11 - GW - CH (150) 12 - GW - CH (150) 13 - GW - CH (150) 15- G`tI - CH (150 ) 3�S7o''o 14 - (314 - CH (1501- I f ves , at %•r �a t de,,tli? Was ground t•r� to encountered? _ 2�0 _ _ _-- -- - `- Madiny, - --Date Gross Time Met TillieUeptn to ltiater I(et Orop 2:48 ----------- ------------- --- 10- 3 1 - — - -- — - 2: 53. _. -- — .. _- - -- - — — -- - -11 - 172 - — -2-:30 - .. _ _ — -- — --- - :, ii _.__.i5T ---------•-----------•-_._-----------.-•__ - -- --- . . - 3:01_._._..-�-----------------------------2' -- -i2---lid 1-3 __... ---- - - - - --3:03-._—._- _--_ - ----- =-- ---1 ��z -- - ---- - - - --- ------ L - ------•--• ---- minute.- --------------- I'crcolation rate ll�_� v2_.-_ Drain Field ----_--___._-. •Proposed installation:/OSec{�age Pit ---- Ikyt(i of Inlet -------__—.. Ucpth to 130tLOD" of pit or trench --------------••-_-- colU1111TS: .- ----- ---- -- ------... - ��, -��%� �v�- certified Ly: ar icite: 8f19��6_ G%5 " �' `"`"�J/- hA. Drahn' P.E. Ric"hard A. Drahn, P.E. — d - - 1i(1 o•to (6/7,1) September 26, 1977 James Scott Star Route A Sox 166H Anchorage, Alaska 99507 Subjects Permit Expiration Dear Mr. Scott. A permit issued by this department; for well and/car on-site sewer installation on Lot 6 Block 3 Kimberly IManor 42 has expired since the issue date exceeds one (1) year. In the event you stili plan to install the well and/oz on -sate sewer system, a new permit is required. The original sail test may be used to obtain a current permit. If the well has been drilled$ a well log should be seat to this department to document the installation date. if you have any questions regarding the above matter, please do not hesitate to contact this ofbice immediately at 264- 47200 Sincerely, -Robert C. Pratt, R.S. Sanitarian ACP/l j h i; � , 2516 E, UDO� RD, HNCHORHGE. HK�07 TYPE OF SOIL H8SORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)-, 150 [NSTHLLHTIOhl ��IST? ��- 11 -, I;I:,`ii b 1 HZZ\ 11-:::; ��A U. -`Z �L,::, ��win 1-1 ��U EH., I CERTIFY THHT 1 I HM FHMILIHR WITH THE FOR ON—SITE SEWERS RN� WELLS HS SET FORTH BY THE MUNICIPHLITY OFlsn'7"0"ITIGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]I UNDERSTHND THHT THE ON.SITE SEWER SYSTEM MY REQUIRE ENLHRGEMENT 1 THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS. SIGNED ~.~ HPPLIYCHNT JHMES SC%82�» �� L, � OF IF11E ON MET). S;: [NSTHLLHTIOhl ��IST? ��- 11 -, I;I:,`ii b 1 HZZ\ 11-:::; ��A U. -`Z �L,::, ��win 1-1 ��U EH., I CERTIFY THHT 1 I HM FHMILIHR WITH THE FOR ON—SITE SEWERS RN� WELLS HS SET FORTH BY THE MUNICIPHLITY OFlsn'7"0"ITIGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]I UNDERSTHND THHT THE ON.SITE SEWER SYSTEM MY REQUIRE ENLHRGEMENT 1 THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS. SIGNED ~.~ HPPLIYCHNT JHMES SC%82�» �� L, � Anehoran-e, Alaska 99507 \� 276-2221 J - tiOII.S i3O(. 1'1?R(JI;r1"1'1O1'd 'I•IiS'I' Performed for Por. James Scott Leqal Description: Lot 6 Block` - - - ? `- -- -- - -- _ �)i'tc Perforre••J 8�Ib�76 _ ,_ �'imberl-Y i,.anor No. 2 This form reports: -Soils log «--_ Percolatiori test --- -"` Dep tir Feet 1 T Topsoil — 2 - Topsoil 3 CH (300) 4 _ CH (300) 6 - CH (300) 6 - CH (3oo) 7 - CH (300) B - CH X300) 9 - GW - CH (150) 10 - GW - CH (150) 11 - GW - CH (150 ) 12 - GVr - CH (150 ) 13 - GW - CH (150) 14 - GW - CH (150 15- GW - CH (150) Was ground water encountered? No - - - --- If yes, at �•/oat deal? keadin9 Uate Cross Time - --- -- - -' - --- -- - Net Time Depth to hater -- ------ Net Drop --_. _- 48 --- - - — -- -- - �` -- -- 10 1 » - --- - ---- --- --- - - - - .01 -- - -- - 3; 0----- 3 - - --- -- - - -e� 15Ti6-n. ------ 3:0---.-- -- ----- - - -- - -- 3.28 - ------ - — -- — --- -- Percolation rate��,�4minute. --'-- ,Proposed `- '---- - ----- d4 --a -__. _ " installation: /"teePage Pit Drain field Dearth of Inlet - _-._ -- __--- Depth to _ ___.__._ _ -- i�OUOm of Pit or tread ---- --- -_.— Performed [3y: � s Certified [�y:.- r�� - ,Q-0,10 (6/711) Ricnara A. Drahn, P.E. Richard R. Drahn, P.E. _ - _�_ _ . ti W 1� o c4n�cr a i N TbP Fov �oJ V - V `'1 mo 1,i:: L, sties contractor's responsibiLit-y to choc op of Foundation in relationship to Finn fl.-ado. Top of Foundation as indicataQ la oze x� o$ block above Finish Grads, N �S 52.10..E 1 52 /N9•� M G t° - /Jvr6 ,4ssuw>�'� E. s�v� Tr�.✓s I hct•eby certify that I have s Irt,,ycic3 tr.e fol;oltiinp; described proper or oagG0a.t0 GGa ee6 ,p Anchorage i'llcolcil+1L reclnct, tm is' � � � 0 '0 r 7t ( 1 Iti7) 01 77}i,ntti cl til.iied thereon are IiJ e s and no not over 1n ol, e ncronch rdjacent thereto, that no 1 npt(+ 011 olo,) \ i�G• a0 Go a as l'i t{' I�;117 ld:acent thereto encroach of f \\\ �pJp neetian ,.nd that cKa(1 there are no roar �, i� s lien q.G Got......... Oama3 ooe lines o— ther visible easement; on s+ ! �4 9� Fred Walatka as ;rdi:ated hereon. 0d s�F°.GG JY9. 32555 Dated -it Anchorage. Alaska aaGGo. aoGs 5J� • �7 PApfeSSIONAI�P��JAY ' SGALE i"= �Gi ";0 FRED WAIA"KA x. ASSCC,_,1.ES �. Engineers ane, SUl-Vol-ntc / A (5"Ac) 36� 5F9 L4 Cuv� jure flea (00 YE�� 36� 5F9 L4 Cuv� jure flea (00 -R - $0 Tea. SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF 918,50 PER FOOT. PROPERTY OWNER uce SGo. LOCATION OF WELL SITE DRILLER Benxu-e GSC" a D&,!tjtnq WELL LOG: n ___77 I CIAfa hyli.tL 48--501 wa ten bea4AAq Vlaue-t rywduc�' 15 f .uvJta.U.ed down at • W4;t 20 to 25 feed• ble U pari d is AU 4J, jat-Ge SGat�t. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF e THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS a DATE Seat 144, 1978%DA SERVICE CHARGE OF 1 %z% PER MONTH W$ it BE ASSESSE O PAST DUE ACCO /V �kd f I -Vt,lam - 2 • '� Municipality of Anchorage r" y On -Site Water and Wastewater Program <' n (907) 343-7904 s A E , r Parcel I. D. 017-074-56 Certificate of On -Site Systems Approval - - ____ - - -_ - --- - -L - — - Expiration Date: ! O' 1. GENERAL INFORMATION Complete legal description Kimberly Manor #2, Block 3, Lot 6&7 Location (site address) 7601 Our Own Ln. Current Property owner(s) Paul & Annette BeZilla Day phone Mailing address 7601 Our Own Ln. Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Fx� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well I] Individual R Individual Water Storage ❑ Holding Tank FA Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment l ok;htrp Receipt Number (13 t 6 U COSA # 05C45 15-W Waiver Fee $ 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. - In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator ofthissystem. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 9/18/2015 6. DSD SIGNATURE _ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: By:%� Original Certificate Date: Q Thk,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 - ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet—E _, c Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # + of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Kimberly Manor #2, Block 3, Lot 6.&7 Parcel ID:017-074-56 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 9/1/1978 _ Sanitary seal (Y/N) Y Wires properly protected (Y/,N) Y Total depth 50 ft. Cased to 50 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 9/1/1978 9/16/2015 Static water level 0 ft, Unknown* ft Well production 15 9,P.m. 5.7+ 9 P m WATER SAMPLE RESUL`rS: 11 p j Coliform (.7 colonies/100 mL Nitrate"n�p mg/L Arsenic ug/L Date of sample:-! �a aal-S Collected by:� B. SEPTIC/HOLDING TANK DATA Tank Type/Material. Holding_Tank/Steel 6/24/1982 e Date installed Tank size 2,000 gal. Number of Compartments 4 ! 4Cleanouts (Y1N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 7/31/15 - Pumper Northland C. ABSORPTION FIELD DATA Date,installed Length ft. Soil rating (g.p.d./f:2 or ft2/bdrm) ' System type Width ft Gravel below Pi Total depth ft. Eff. absorption Date of adequacy test Fluid depth in Elapsed Time Any before test Pe Monitoring tube _ Depression over field Results (Pass/Fail) For_ bedrooms _ in. Water added gal. New depth in: min. Final fluid depth in. Absorption rate >= g.p.d. treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons _ "Pump off" level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT -To: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+, Sewer/septic service line 25+ Animal containment Areas 50+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) in. High water alarm level at' in. Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 1,00+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 1 P+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main Water Service line Surface water Driveway, parking/vehiple storage Curtain drain -Wells on adjacent lots F. COMMENTS *Artesian well with plug. 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. Engineer's Printed Name Steven R. Pannone Date r 9118/2015 COSA canary sheet 2-6-15.doc 0 °u'z m 7-0 cl p G1w (,o pD y 01 off. i2>/ w " m� O4a�o�''/ 1 ; Y1 •�"• � a � 00 cn —Cyj MOm � N x 3 Z > goz 30• NORTH 228:50' m �o0 a C � Cxl 7OC p p CA W `a� Z CD .N Ri C p ® 971 r w w $ '� y Y m 44 11 a m cQ m� , H SOUTH 209.50' (J` Too O x ° 0 Q � o m a ,A 0 rn n ' S •i Ai A NIM, bDic= v rn - -r YwM�mvn sl z �T .os" y _ �xa 30' SOUTH 190.35 l z ?gym N = PIMI ymMm�"' pp. b n r 6 g� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWin 26R AND WATER FACILITY Application Date 1. GENERAL INFORMATION �� (a) Legal Description (include lot, block, subdivision, sec"t hip, range) I ST -e- ill Location (address or directions) -49 loaf O14� P2d�t/ � i� ff5?�9Business SG,z'�7�i 7 Telephone: Home — ----- (b) Applicant Name F' { All y �� Applicant Address � �� pz�fif Institution 11; Owner/builder11; Buyer ; Other 13 (explain); (c) Applicant is (check one): Lending �— Telephone (d) (e) (f) Lending Institution Address Real Estate Company and Agent — Address Telephone Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family 11Other Number of Bedrooms 3, WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 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. 72-025 (11/84) Page 1 of 2 , 5. ENGINEERING FIRM PROVIDIN�INSPECTIONS, TESTS, FILE SEARCH, DA fYA AND INFORMATION ation of this Health As certified by my seal affixed hereto and as of the vali daanidO�o wastewaters disposal system is safe, funcdate shown below, I verifythat my tional and adequate Authority Approval shows that the on-site water supply I and/or for the number of bedrooms and type of structure indicated herein. I further verify that based on the information yand obtained on from the Municipality of Anchorage files and from my investigation and inspection, the , a site water supply wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. lftz] Telephone Name of Firm Address 33 �;u/T, ' /7, Date Of A4� ®®� � o0a je000 oeoe ��• o ee� �® sem: T ®moo •*E®®Ejj�� saoeo e•�•�oeoe •oe•� i.a a AV ��O•ese o0e0 ��< 6. DHEP APPROVAL�Q. o Date Approved for 'fb`� bedrooms by Conditional Approved '/ Disapproved Terms of Conditional Approval EIN CAUTION upon the representations given in paragraph 5 abchave sers of homes and heirlend ng The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) independent issues Health Authority Approval certificates based solely p engineer registered in the State oain federal and state f Alaska. The DHEP does this as a courtesy to puP do not conduct inspections or institutions in order to satisfy t issued. The Municipality it1of Anchorage is yees of DHE 'ssions in the not responsible for er ors or om analyze data before a certificate is professional engineer's work. Page 2 of 2 72-025 (11/84) ALASKA 61ROf1m UAL COUROL S0;4US, InC. 6ngineerinq & 6nuironmental Studies November 24, 1986 Municipality of Anchorage Department of Health & Human Services 825 L Street Anchorage, Alaska 99501 Re: Kimberly Manor Subdivision, Block 3, Lot 6 The above referenced lot consist of a 3 bedroom single family residence served with a private well and a holding tank. On 10/21/86, I performed a well flow test, holding tank integrity test and a Health Authority inspection. The well has an artesian flow with a static water level at the top of the casing. During the entire 2 hour well flow test, the well seal remained under pressure from the water. There are no leaks from the well seal. The casing is inside a small well house measuring 2.6 feet by 3 feet by 2.3 feet high. It has a concrete slab floor and the casing extends 0.5 feet above the floor. A holding tank intregrity test was performed by having the tank pumped in my presence and 2 hours of monitoring for infiltration of ground water. Prior to pumping, all water fixtures in the home were checked for leaks and verified to be fully turned off. There was no audible leakage in the tank and after 2 hours there was no rise or fall of the minor remaining level in the tank. We feel that this is adequate verification of the integrity of the holding tank If you have any questions, please feel free to call. Sincerely, ziix � Alan C. Wien Engineering Technician Approved by: 0 ��.. Ar 0 • LEROY . REND, J : s 1 d �,.'.•� C 2251 toVl � 1200 West 33rd Auenue, Suite B 9 Anchorage, Alaska 99503. 901) 561-5040 G '0 I� MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 v ��d ti to t+s 264-4720 Legal Description: "7 xeelz �t -n2".j 'R36'd -Tee- A. eA. WELL DATA �► �•+ Well Classification I(A If A. B, C, D.E.C. Approved (Y/N) Well Log Present YY Date Completed y'� �� Yield r' P Total Depth 'd Cased to Depth of Grouting Static Water Level '�` / Pump Set At%!q Casing Height Above Ground (j�� Sanitary Seal on Casing&) Electrical Wiring in ConduitON) Depression Around Wellhead (Y& Separation Distances from Well: / To Septic/Holding Tank on Lot QA'( ; On Adjoining Lots /Orl To Nearest Edge of Absorption Field on Lot i✓� ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole ,✓�P% To Nearest Sewer Service Line on Lot Water Sample Collected by /fCCI iv/1-7/ ; Date /a Water Sample Test Results �YI`T/i CV'Q Comments (�I AllZl- � 7E57— j�L7t'i!/ EL� 70- el1;-Aleg ' p//V> B. SEPTIC/HOLDING TANK DATA Date Installed 41 Size 7G"Z No. of Compartments Standpipes A) Air -tight Caps ON) Depression over Tank (Ye Pumping/Maintenance Contract on File(ON) Holding Tank High -Water Alarm ON) Separation Distances from Septic/Holding Tank: To Water -Supply Well i To Property Line 1� ¢ To Water Main/Service Line Foundation Cleanout Y N) _ Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field /I✓�i� Course 2 -/t� /oo Comments ! #t71'3Aehb %'eH C�L�7�n/vuT �//fie Page 1 of 2 72-026(11184) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils F� Date In in Absorption Strata Width of Field Square Feet of Absorptiorea — Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments __ D. LIFT STATION Date Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness — Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On ,pining Lots To CStbank (if present) Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent(Y/N) mping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have he e% d, v Ified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed GC�f .`� Date Company /Gf MOA No.Ul /� Receipt No. �rJ 6 A °'F ,� _ Date of Payment °OF° tb a�� .�t �; 4 Amount: $ ®�Sea� i� � (dee°° eea eeee 0000°°eT,a o�t 2 2. o OY C. 12EID, JR. o ®��`° CE - 2251 a Page of s!1'�il�f� J yi�HA/J�i�lr ct.11�°Ae''r ®Qt��,°•'yl°y.$°.°°'��`�'. 72-026 (11/84) ALASKA 641ROURTAL COnTnOL SCIw IRS, InC. engineerinq & Enuironmental Studies 12/19/86 CENTRUST MORTGAGE SELLER -TOM LANG CENTRUST MORTGAGE 4000 OLD SEWARD HIGHWAY 4000 OLD SEWARD HIGHWAY SUITE 7-03 SUITE 103 ANCHORAGE ALASKA 99503 ANCHORAGE ALASKA 99503 60563 LEGAL:KIMBERLY MANOR ADDITION #2 LOTS 6&7 BLOCK 3 FLOW TEST ON WELL WELL FLOW DATE --10/21/86 A FLOW TEST WAS PERFORMED ON THE WELL. 707 GALLONS OF WATER WAS PUMPED AT A RATE OF 5.9 GPM OVER A DURATION OF 2 HOURS. THE DRAWDOWN WAS 0 ' WITH A RECOVERY TIME OF 0 MINUTES AND THE STATIC WATER LEVEL WAS 0 FEET, THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. 41 co st s b -,y e oe°°oe e°°e oso eaoce°° u� I 1 q S ° 0�0 •°< a e ee�y� LEROY EID, JR. o° 5] 1200 West 33rd Auenue, Suite 3 • Anchorage, Alaska 99503 • (907) 561-5040 %V A W■ iM L. J6%DUYS tA1 t -" J I .01 1 N V. 7127 OLD SEWARD HIG14WAY ANCHORAGE, ALASKA 99518 (907)344-8551 LAK.JORY I.D. # '1 BACTERIOLOGICAL MATER ANALYSIS TO BE COMPLETED BY WATER SUPPLIER FOR LAB USE ONLY DATE COLLECTED TIME COLLECTED TYPE 0 SYSTEM MONTH DAY YEAR 'Sa A 0 PUBLIC aINDIVIDUAL ❑ RESUBMIT SAMPLE P) Sample rejected because: I.D. NO. (PUBLIC -SYSTEMS) CIRCLE CLASS _ � i � � i � ( A ( CHECK ONE OR MORE B C Residential ❑ Sample too long in transit. Sample should not be over 30 hours. NAME OF SYSTEM TELEPHONE NUMBER L & 4,41,era �L 33 l_ / L ❑ Sample received too late in week SYSTEM ADDRESS ❑ Not in proper container ❑ Leaked out CITY STATE ZIP CODE ❑ Insufficient information provided. Please read instructions on form. ❑ Other (Specify) LOCATION WHERE SAMPLE WAS COLLECTED /s T,,o, COLLECTED BY: (SIGNATURE) RECEIVED FROM ,L TYPE OF SAMPLE RECEIVED.,BY (CHECK ONLY ONE THIS COLUMN) DATE (/- 2 l — SCP TIME DRINKING WATER ❑ CHLORINATED ✓CHECK TREATMENT [JFILTERED ANALY ICAL METHOD: UNTREATED OR OTHER MEMBRANE FILTER ❑ RAW SOURCE WATER ❑ FERMENTATION TUBE ❑ NEW CONSTRUCTION OR REPAIRS ❑ OTHER(Specify) Date A Time Started rs Date &Time Completed ac IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON -CONFORMING SAMPLE? ❑ YES J&�NO PREVIOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) LABORATORY RESULTS Analyst \ �42 f' , ❑ Other Bacteria SEND REPORT TO: (PRINT FULL NAME,ADDRESS AND ZIP CODE NAME S ❑ Test unsuitable because: J ADDRESS /L` 33 uiTc' c3 ❑ Confluent Growth ❑ TNTC CITY /¢Nf44/ STATE /�X ZIP [UNSATISFACTORY SATISFACTORY ❑ BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY Membrane Filter: Direct Count Coliform/100ml TAL COLIFORMS Verification: LTB BGB Fl FECAL COLIFORMS Final Membrane Filter Results Coliform/100ml FOTHER Reported By Date Time A.M. P.M. READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORM nLn\inn 6111 w o"WI V ---Fl. I lli. CONTROL SERVI(_,,j INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 SHEET NO. OF CALCULATED BY �' DATE CHECKED BY DATE SCALE �d Fw- r�' APPLI FILLS OUT UPPER HAS )NLY ,,NT .lProperty,Owner c.JIze wt r;s /t% r S"G'91N - Phone Mailing Address Zip Code Buyer .Jih. �how+<e,s Date Address - - Zip Code Lending Institution /i (a 5 j� �, Mu' LA q / 60 yr K - Phone Address Zip Code Realty Co. & Agent � v - Phone Address ` T Zip Code 02 - `CONDITIONS OF. APPROVAL Legal Description Q.T. 6 &/,C, ..? ✓'/1 w,.%eIr Mc vial^ 0 2 Street Location - ( ) CONDITIONAL APPROVAL* Type of Residence (-tingle Family _ ❑ Multiple Family No. of Bedrooms - - ❑ Other BY: Water Supply f�ndividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Well Log Received Septic Tank Size Sewer Disposal - ❑ -Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: Ltjl Folding Tank - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time D e _ Date Date Date Inspector Inspector Inspector Inspector Field Notes: ( ) APPROVED BEDROOMS - `CONDITIONS OF. APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* - - C�--ZS� DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size �. Well to Tank 72023 (3182)