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HomeMy WebLinkAboutTANAINA HILLS LT 13Taniana Hills Lot 13 #011-051-25 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:PID Number: tL/ia-/9AG� --_ Name: cOOla H,/ System: ❑ New ❑ Wastewater St Y Upgrade Address:,��A ABSORPTION FIELD Phone: No. of Bedrooms: / 13'6eep Trench O Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: D e Total Depth f// original GPD/Sq. . Ft. _ Lot: Block: Subdivision: ft=Depth to pipe bottom from original grade: r Gravel depth beneath pipe / Ft. %/ Ft. Township: Range: Section: Fill added above original grade:, Gravel length: 7—o;144 /�/Z Gry /;lr WELL: BIN Upgrade Gravel width: p Numberoflines: Distance between lines: ✓� Ft. /� /4) Ft. Classification (Private, A,B,C): Total Depth: Cased To: I Total absorption area: Pipe material: / /'//% Ft. /yn Ft. //.)PG SD. Ft. Driller: / ✓.4 e,C >C/•'-�/1�ltG-/s Date Drilled: ��/y Static Water Level: Installer: �ct/�%U� ¢,C Date installed: c%eJde'/'s'—..✓c%44F.2.Z/ // FL c�/J !G//ti.4L Yield: /9 Pump Set at: Casing Height Above Ground: /7//✓�F TANK GPM /Zy Ft. SEPARATION DISTANCES 12 -Septic El Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private actu reC Man uf/) �A-- Capacity in gallons: Z Fl6J0 From Tank Field Station Tank Sewer Lines Well /,Z/x/ /5/8 � ,q � ��.{Ff Material: Number of Compartments: Surface >y d %� �{� N,9 � } f7FjE LIFT STATION Water .�LaO _ Lot%F>F �F� iL//A nf� Size in gallons: Manufacturer: Line 7 Foundation �./}F� z � �� ._ "Pump on" level at: "Pu el a7T gh water alarm at: Curtain ' NbcuN� rPump Make&Mu5cl Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: Assumed Elevation: s F ENGINE, 't SEAL 6 0V f s�fi'46i .•^ .f.I� Jyr'sj'�" • °)'�(jf GINE' 1-4, / f/%% Inspections performed by: �eEo�^���� Dates: 1st Io/ Department of Hea and I-Inan Services approval by: v Dater Reviewed and approved 72-013 (Rev. 9/91) MOA 25 M SOUTH TRENCH MONITOR TUBE - CAPPED - PERFORATED IN SEWER ROCK, SOLID ABOVE. FROM TANK FILTER FABRIC 4° CIA. PERFORATED PIPE - LAID LEVEL WITH HOLES DOWN. SIDE:NALL OF TRENCH 5/4" - 3° DIA. SEWER ROCK Al z ° , m mil.K NL'EY CE -1576 "° �� m D ��� ��4gaavvv��• 2' O" WIDTH OF 70BEL FLOW SPLIT -ER VAVLE NORTH TRENCH 8351' I° 1 VIIDTHG" OF TEST HOLE ;r5 BOTTOM OF H31 E ELEVATION = 75.54' NOTE: CONSTRUCTION NOTES AND MATERIALS ARE TYPICAL FOR BOTH TRENCHES. VERTICAL CONTROL = 100.00' TOP OF FOUNDATION n ABSORPTION SYSTEM SECTON (AS -BUILT)) NTS 7 i C C CZ 0 c O �o C CJ Q x CD oma, D P O 0 G m m z p�0-1 �D fJ T Z O z O CCA 510 T gym= CA o G) = , m 3 m <z> f zy� I m-� Cn c o o 0� S� o <D� (D • CA z m O CD C5 a C 0 =� n m o cn � W v o � m z 0 V !D O O —DBLCO-2 - TCO -1 TCO- 2 DBLCO-1 �� L O y i 9M, 98.9' 96.4' \ I O 88.85' I i S TO ABSORPTION SYSTEM _ 2,000 GAL. GREER 88'82 STEEL TANK 88.51' v F IT z 8445' 84.39' o a; 9TH* m °J° m J{{II D. KEN J CE 157Z cA Q O x i Z� o m :5m D _ 0 -1 D T o Z K O c Z 2 0 1� o f� r o 3 m= Z D Q�m�5 0 cn o o O <Do (D • cA Z _ o) Z M 3 5 < C n O (A v O _ RASPBERRY ROAD \ \ \ LOT 13, BLOCK 1, TANAINA HILLS 65,068 BE 50' a 30' 60'A\V 1.52 ACRES AV SCALE 1"-60'-0' \ \ HORIZONTAL DIMESIONS ITEM. i DESCRIPTION " B C D 1 FOUNDATION CLEAN OUT 2 DOUBLE CLEAN OUT—^. 1.0.3' 35.7' 3 TANK CLEAN OUT S1 10.3' 43.5' 4 TANK CLAN 0'JT R2 ! 11.2' 53. 5 DOUBLE CLEAN OUT -2 20.7' 56.9' 6 BORE, FLOW SPLITTER 57.7' 615 7 ISOUTH TRENCH CLEAN OUT ,L,1 40.1 29,4' 8 "^'4H TRENCH MONITOR TJK, 60.5' 61 4' ' 9 SOUTH TRENCH CLEAN OUT A2 94.0' 100.0' 10 NORTH TRENCH CLEAN OUT #_I 30.5' 30.0' ,. MONITOR TIJ 'NORTH 7RENCH @ 55.0' 69.9' 12 NORTH TRENCH CLEAN OUT #2 91.3' 102.3' 15 TP ;';5 69.8' 77.3 T4 EXISTING 1NELL 67,8' 81.0 307,9:1 N90'00'00"11 NOTE THE SYSTEM INSTALLED HAS BEEN DESIGNED TO MEET THE REQUIREMENTS FOR A (6) BEDRWIA RESIDENCE,. ETN THOUGH THE CURRENT H04E IS ONLY (2) BEDROOMS, THE DENOTES CLEANOUT UNDER PORCH THAT CURD NOT BE DETERMINED FOR SURE. ABSO4PTION SYSTEM PLAN EASBUILT) �®_0_%_%%y- 4,s0. NTS m®l'. ol sawn we m .d aero iRA/9l rtvlsfom pe no. awa. :Tele steer ao. y Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST ' • 45.� • li✓ elm++ 11.811-D LAST. KLNI,FY- PERFORMED FOR: %"' //� /�'�« DATE PERFORMEMIA X LEGAL DESCRIPTION: <�'-/3 �.C! i T,v Township, Range, Section: DEPTH �'7 SLOPE SITE PLAN (FEET) Q/2L'/✓icJ/6 //u�;�p�0�� �� 1 2 3 N/ 4 5 6 7 8 9 10 A/ 11 12 13- 14- 15- 16- 17 314151617 18 19 - WAS GROUND WATER ENCOUNTERED? a S IF YES, AT WHAT L 0 DEPTH? p E Depth to Water After Monitoring? Date: _ Reading Date Gross Time Net Time Depth to Water Net Drop 112 2 20 ./ PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 9�L FT AND - �O FT COMMENTS> './JAYG.� ^-Ifs.✓iTd�rC�i.J(' /-c79 s" 0�7iS�. 7/his ttiAS'�v,E:i�yAr�/d'J� i'O G'�.T.4,!�L/6i� �Jis:.��✓e� �".t=c�,�'�r�=�i,z�Jo_�. ./✓s�G�E TGs>c/,%,,,eLs/�r✓��JC— PERFORMED BY: F,w l7 iC�E/* JL� I ERTIFY THAT THIS TC -ST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. IRATE: 72-008 (Rev. 4/85) 1j /10 /� «'P MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970128 DESIGN ENGINEER:DOUGLAS T. KENLEY, P.E. OWNER NAME:KIMBALL JOHN H OWNER ADDRESS:6800 KILIAK PL ANCHORAGE, ALASKA 99502 PARCEL ID:01105125 LEGAL DESCRIPTION: TANAINA HILLS LT 13 LOT SIZE: 69116 (SQ. FT.) NUMBER OF BEDROOMS: 6 THIS PERMIT: 6 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 't—Al S P�= cjfO4' PAGE 1 OF 1 DATE. ISSUED: 6/10/97 EXPIRATION DATE: 6/10/98 ('C — O LI 1 `-� 00�� � Q a 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BYy: �f e.�DATE: L/ pp ISSUED BY: � /i- DATE:���D /Z j � -�� �^ r 1, - -- — = r » /� / � d \ t egeoeGe/m ,] \ } \ §Jm rn \` L163>500 W39T \ ma aw ® -----�------- - « ! »!|!! m>r� Ga£ gkEzE. !, 2« KIMBALL ' \; __. 6800KILI a m£ _ !Ll 3,&G f#4V+d�/C� +hora* Alaska / i y W 0 J� —1 0 Z m Z Z m 1 Z MIN. LSO N_ J n - �SS � os' -= o Ly�A >nI0 0➢_ cn pi O �_ A z O o o5v n�� n Ty AT� 11 III c'Vm ➢ pm y 7UX � m Oi0 Nim O nO O ➢�ll�ly �c��m_.y any `,iin Aoz 1A n� v r mil^o pc� o!l ➢�� II n Qy Noo tO�o nz s'o m y a 0 0 nti y ti v y W 0 J� —1 0 Z m Z Z m 1 Z MIN. LSO N_ J n - �SS � os' -= o r - o o5v n�� n Ty 3'-0' T n m�nnl O<yy ➢fly 03'O x�a " CO3 0 m [�iO��L�,l%�`w� T.Gg(SI1v9LC�l, `�'.L. • °n, 0 m JOHN KIMBALL CNII __I6800 KILIAK DRIVE z 13! a hi a, r4evA- vA Anchorage, Alaska Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 4✓i0 K./Cf7"G/�' DATE LEGAL DESCRIPTION: �OYl�.�.t' 7;;)/A-94lAJfl /c(;Township, Range, Section: DEPTH I SLOPE (FEET) Q.0 C'A��G-S F—F—T-7-1 F- 1 2 3 lY/ 4 IhY �JJ� 1 6- PI41 7 I 9 10 11 12 13 14-�.�..--I , e,c J,� 15 16 17 18 19 5°f i .. .. �� s e e s o e•,. '0% D li _AB 1. Kl WJgtEY: r. SITE PLAN WAS GROUND WATER �U ENCOUNTERED? S IF YES, AT WHAT ,_ LO r' DEPTH? p E Depth to Water RD r 3/ Monitoring? �'we Dale: Reading Date Gross Time Net Time Depth to Water Net Drop 0 Z FT [. — 8 %a.. z 9 er 1!9 ZO PERCOLATION RATE zz' (minutes/inch) PERC HOLE DIAMETER ' TEST RUN BETWEEN 2- FT AND ` FT COMMENTSE!�/�it� U.r.J.vv'-fi.P.iS?®L 4- f1CC,�US�/JF!'�/inJAdC e PERFORMED BY: fJ eZ,-) GGA/ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7 72-008 (Rev. 4/85) Municipality of Anchorage tt- DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: "���'� ��'•���_�' S i DATEPERFORM a_ LEGAL DESCRIPTION: G"T i��.r/ / AtiAi�JA />'/--.4aoWnship, Range, Section: ' FDEPTH- SLOPE SITE PLAN (FEET) Ok'G�N tL'S ,-1- 7'L 2 / 3- 4- 5 4 5 6 7 t 9 / 14 15 16 mit r -y ,f4AN-47 /fGNSv' ✓i �,-y �ia,✓J7 WAS GROUND WATER ENCOUNTERED? U S IF YES, AT WHAT L X DEPTH? O P — E Depth to Water After _ Monitoring? Dale: Reading Date Gross Time Net Time Depth to Water Net Drop 'o ;•'7g 20 PERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER /. TEST RUN BETWEEN 2' FT AND /10 FT COMMENTS �Et �•�Ar �.�� P-1��.cJ.YL,s!I.tIC Gtf.?J Ot7nJc Te -/i c.%9� t.�i'=-'i .c -/..r/.,2 iL. S/ 'TGA G/.4�G✓.Sy /17 PERFORMED BY: �'�'��� "- 7�L�I �% +? CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON TH ATE. DATE: Z' 72-008 (Rev. 4/85) NS KIMP.O, BOX 101 88130 ANCHORAGE ALASKA 60�" 7345-15215 1r 2 G��ni�e A,w C, o(810cG< l) C/,aA/ AK4 gICyJ��QiJ l(6llvb�c� L jti /A) 7`71,. OluJ n:, Tl r Iq /1 1 rj c Le i r✓ /YI "q fvo km /a l Km N 4 ry c) 5,47r©yam GAf�mnlA C�rl/ e%� 11, l�R,V;,q(VeAfc S n/ C zNcJ r N c c f- N ofd a ATL j S i 6 J L /V ®(IL j� G l✓ i7� rY% Ol() r\ Z-1 E1- ZV t 41) Cl v� �� N �7` C;)Wk� � ` IQiNQnG %`°4 .p FRGn i v 7—ri- c. TA(e- dwwvR (Tn.rrA44 FtfJ %l#417— /P MORE lvv qK Pg(; cEPds a v 7-141> rdy4 r Z IvC'"L.d /fSaF h /�. e, O. ® Municipality iy of Anchorage Department of Health and Human Services — 825 " U Street Rick Mysrrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor 343-4744 November 15, 1994 Mr. John Kimball P.O. Box 111666 Anchorage, AK 99511-1666 Subject: Lt. 13, Tanaina Hills Subdivision Permit#SW930448, Parcel ID #0 11-051-25 Dear Mr. Kimball: The subject permit, issued October 26, 1993 by this office for a single family well and/or on-site wastewater system, has expired as of October 26, 1994. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If the on-site wastewater system has been completed and a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as -built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater and well permit. If you have any questions, please call this office at 343-4744. Sincerely, Call'i qhv,�� .E. Program Manager On -Site Services JC/kb cc: Douglas Kenley, P.E. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930448 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:KIMBALL JOHN H OWNER ADDRESS:6800 KILIAK PL ANCHORAGE, ALASKA 99502 PARCEL ID:01105125 LEGAL DESCRIPTION: TANAINA HILLS LT 13 LOT SIZE: 69116 (SQ. FT.) NUMI3ER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED:10/26/93 EXPIRATION DATE:10/26/94 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL 11ul4jpl atiwii] ISSUED B DATE: lb 2 b 1 7) DATE: David & Melody Kiester Residence Lot 13, Block 1, Tanaina Hills Subdivision Anchorage, Alaska PERCOLATION TEST RESULTS and GENERAL SITE INVESTIGATION REPORT During the week of October 10-15, 1993 the above reference 1.5 acre site was inspected and soil perk tests performed for the application and approval for installation of an on-site waste water disposal system.. The site is located at the intersection of Raspberry Road and Kiliak Place in Anchorage, Alaska. The system is being installed to support a 5 -bedroom waste water system (the design calculations were based on a 6 -bedroom installation for conservatism). The new tank will be 1,500 gallons to support a 5 -bedroom system. The site is on the South side of Raspberry Road and the West side of Kilian Place with a gradual slope ranging from approximately 2% to 10% in the east -west direction and 1%-3% in the north -south direction. The immediate area that has been selected for the waste water disposal system has an average slope of 1%. The site is moderately treed with birch, spruce, and alders. It appears that there are no obstructions that would prevent surface water runoff. There is a relatively low area in the far West end of the property that may collect some runoff in the spring of the year. On-site observation and physical survey shows that there are no water wells nor private waste water disposal systems within a 100' radius of the proposed system. Consultation with owners of neighboring properties revealed that all adjacent waste water disposal systems are performing adequately. No surface water was observed at the time of the inspection and it appears that there is no potential for contamination of adjacent water wells or streams. Results from a total of four percolation tests have been provided. However on test (PT#4) was obtained from an earlier investigation of the site performed by DOWL Engineers. Three other percolation test were performed in conjunction with this site investigation. Two tests were performed at the proposed location for the waste water system and a third was performed at a location that is proposed as a back-up site in the event the system is ever replaced. The results of this tests is attached to this report. The test site had adequate percolation rate to support the proposed 5 bedroom residence. Subsurface soils were found to be dense silty sands overlain by 12" of surface organics. The percolation rate for the primary site was found to be site 10 min/inch. (However 0.6 gpd/s.f was used instead of 0.8 gpd/sf for conservatism). Percolation for the secondary site was found to be 5 min/in. Water wells in the immediate area have been reported to be approximately 100' deep. There are no other wells within 100' of the proposed well on this site. If there should be any questions concerning the percolation rates or characteristics of the site please call me at 561-1011 S� V' re -T-P Douglas T. Kenley, P.E. C.E.#8176 a"s n'°ti,, __^ eHcaly •ooa,o4ouv v a ° 4 a .,,.W „....•..,...., ,„,... ,,, aAltl0 VNIIOHVO LOOS 9 s $ w ¢ V e �, ens � w n.°P•a iPn 3ON301S3N ki31S31N AOOl3W 8 OIAVO � +1 � � $�N E a 11 HE x@ os \ R I w � I al I I F I 5 Qo� 88 ❑�V�V I � 1 O(p� �r�j I I I IIt I I I m'a'd'ARIN3N,j.svmnoo »«�_,m} ; _�e. _i ,»r 9 .!. 4 1 9; � � � k ■ 4 ) (§ - § \/! �| ) .! k ■ - § \/! k ■ at s 3ea� . Municipality of Anchorage DEPARTMENT%�� OF HEALTH & HUMAN SERVICES off.°" O 825 "L" Street, Anchorage, Alaska 99502-0650 —� � � SOILS LOG PERCOLATION TEST c� Dou cs T. Kenley o i 2(j PERFORMED FOR: �UI �` l-ae, DATE PERFORM ED�9�Yi °Op9�Oh e'er„>�No LEGAL DESCRIPTION: U ('S t(r. 4 J'(rhl4ti,i6 1"1+Ittxownshlp, Range, Section: DI EPS jy , , SLOPE SITE PLAN,, O 1 2 .... 3 4 5 6 r1 6 7 8 9 10- 11 o 11 12 13- 14- 15- 16- 17 314 151617 18 19 20 �n e9 eye, .1-f 5`. 1M 1t,r:"`1,, pavlc IYL. t4 1 il{-ter E IQ/r.' WAS GROUND WATER ENCOUNTERED? �0 _ S T WHAT al/A P 1[)" E E f/ l� Wale Monitoring? pale: IF YES, A DEPTH? Depth to Wal Monitoring? Reading Date Gross Time Net Depth to Time Water Net Drop 1 p l0 7et3e- to z,Iy t n 1 ■■l■■■■tNEMNo MENEM IF YES, A DEPTH? Depth to Wal Monitoring? Reading Date Gross Time Net Depth to Time Water Net Drop 1 p l0 7et3e- to z,Iy t n 1 PERCOLATION RATE _I `L:— (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN _{�FT AND F7 �.�-<. �4 •fG✓ �lV,i":Iml1, Ifs A�' �J , PERFORMED BY ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS 72-008 (Rev. 4/85) r _ ,0 CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: 7 lI/ Tr-,- 7I �.^ I{ �ENGNE8�r6,S Y4j I r-,- - � ry �(,�� �s Municipality of Anchorage c9 't h DEPARTMENT OF HEALTH & HUMAN SERVICES e.o` .<o a•� 825 " L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST �5�,; DPP Irr;T.I(enley ;' Y CE -8176 I/ FI49FoPepn ,en��f`�. �.; PERFORMED FOR: SIA L- hi, D !-//,,I�c'YI DATE PER FORMEs '?7'i'�� `. �"'�f.'�i✓ LEGAL DESCRIPTION: VjY I �AVtrl I't 11' 11jownshlp, Range, Section: ' I SLOPE SITE PI AN DEPTH4Y!("''r (FEET) 2 3 4- 5- 6- 7- 8 568 Sr l w•S� 9 10 WAS GROUND WATER —M ENCOUNTERED? t) 11 s IF YES, AT WHAT1 I /r L 12 DEPTH? ly F'1 P !' E Depth to Water After 13 Monitoring? N Date: /0— 2 14 1P101-1 51617 15- 16- 17 18- 19- Reading 819 Reading Date Gross Time Net Depth to Time Water Net Drop W/ @ a-1, t-�F--- 0 ,p u ti /P 20 'n PERCOLATION RATE I— (minutes/Inch) PERC HOLE DIAMETER / TEST RUN BETWEEN r -1 FT AND FT COMMENTS J . n-tt:--<t' (w k_1 C.�l- O l",c-Y e d PERFORMED BY: 1(f' I:p�. /�'t't' I P-` } .AX" CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG —• PERCOLATION TEST PERFORMED FOR: UAV, A f" C-' lei,, DATE PERFORM LEGAL DESCRIPTION: L7�7! �I� I ! �1Ft;�,n�. LI;IJyTownship, Range, Section: DEPTH f-.,,lF��� SLOPE SITE (FEET) 2 3 Im 4- 5---- 6- 7- 8- 9- 66789 51 10- 11 12- 13- 14-- 15 2131415 16- 17 18 19 20 COMMENTS 4o Ii l GlaVe') Loo ZV_ PERFORMED BY: .r)0—" ACCORDANCE WITH ALL STATE AND 72-008 (Rev. 4/85) oo. Jim T. Kenley CE -8 176 ............ IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? A" Reading Date Gross Net Depth to Time Time Water Net Drop o /0 D J 2- 0 lb I(+r! n PERCOLATION RATE (minutes/inch) PERO HOLE DIAMETER rEST RUN BETWEEN � % FT AND N, � FT _ CERTIFY THAT THIS TEST WAS PERFORMED IN PAL GUIDELINES IN EFFECT ON THIS DATE. ,DATE: zo �7-_ / / ! I c) 7 I f - "-IV,)lf-IA%J�I.AAM mry ta" ir. 4 f2 r LOT --,.SAN C) ZAN b .r.-+F1UiJ/ GRAVEL S14TI,5A;)D GRAVIV �--WEr 5AUI) 4kVLI, 7' P Uta P 9) FA20 rr) i py "k -j- I T /'o G. p C -13POWM C4AYI 5MO A y COAA 1SAM,4)1 C 7RAVEL SA/VO GRA VR_ \ Municipality of Anchorage • -- Development Services Department Building Safety Division On -Site Water and Wastewater Program 5 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. oii-oci-2s COSA# OyL 10 /063 Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 23 Taniana Hills Location (site address) 6800 Kiliak Place. Anchorage, AK 99502 Current Property owner(s) John Drew and Wendy Wells Day phone q52-o4o8 Mailing address 6800 Kiliak Place, Anchorage. AK ngs02 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation 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. Name of Firm Pannone Engineering Services LLC Phone 272-8218 Address P.O. Box 200217Anchorage AK ggsio Engineer's Printed Name Steven R. Pannone P.E. Date loeo r-,5— Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis orthc system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of encountered at the time of the test, and separation distances measured to readily identifiable features. the system under the conditions The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the •.•a o A/p� year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and ••� p.�,...••••••�•OF q : '7±' satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future`�•.�, performance nor give any estimate of how long the system will 0 continue to meet the o rational requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any ; AiXsteven tt Ponnone f�: 00 other person or party is not authorized nor will it confer any legal right whatsoever. 4 No CE 8140 ! C �-""� 5. DSD SIGNATURE �e `�•' f •,����ra�ra�Q� •� Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: — ' ( O Inev. nmst , Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 2;Taniana Hills Parcel ID: 021-092-2s A. WELL DATA Well type F Date completed Sligligg If A, B. or C provide PWSID # Sanitary seal (Y/N)y Total depth 24g_ft. Cased to sca ft. FROM WELL LOG Date of test ah5L994 Static water level 221. ft. Well production 28 g.p.m. WATERSAMPLERESULTS: Coliform Iv4_colonies/100 mL Nitratti emg/L Arsenic: & III ugA Date of sample: K12of2oio B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 22+ in. AT INSPECTION g/2o/2020 S.o+ g.p.m. Other bacteria colonies/100 mL Collected by: Laura Pannone Tank Type/Material GreerSteet Date Installed 6hr/igg7 Tank size 2000 gal. Number of Compartments a Cleanouts (YIN) Y Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 12hhoog Pumper _A+ Home Services C. ABSORPTION FIELD DATA Date installed 61i8hgg7 Soil rating (g.p.d./ft2 or fe/bdrm) o.8 System type Deep Trench Length 72 ft. Width 2 ft. Gravel below pipe -4 ft. Total depth 11Z ft. Eff. absorption area Sha ft2 Monitoring tube y Depression over field N Date of adequacy test S 2o/2oio Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 25 in. Water addedgso gal. New depthi in. Elapsed Time: 2o min. Final fluid depth 25 In. Absorption rate >= tiro+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION n 1 Date installed Size In _ Ions 'Pump on' level at _ in. 'Pump off" Datum _ r . Z, E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) High water alarm level at in Meets alarm & circuit requirements? Septic tank/lift station on lot goo_ + _ On adjacent lots loo+ Absorption field on lot zoo+ On adjacent lots loo+ Public sewer main moo+ Public sewer manhole/cleanout zoo+ Sewer /septic service line zs+ Holding tank ioo+ Animal containment areas so+ Manure/animal excrete storage areas aoo_+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation io+ Property line zc+ Absorption field 3o+ Water main ioo+ Water service line aS+ Surface water loo+ Wells on adjacent lots Loo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line so+ Building foundation so+ Water main soo+ Water Service line _zc+ Surface water aoo+ —�_ Driveway, parking/vehicle storage io+ Curtain drain None Kms„ Wells on adjacent lots goo+ F. 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. Engineer's Printed Name _Steven R Pannone, P& Date �Oo COSA Fee $ Waiver Fee $ _ Date of Payment 2 � U Date of Payment Receipt Number O Z q (Rev. 11105)"0� --- Receipt Number _SS; G SCS ReEN 1102264001 Client Name Pannone Eng. Srv. Project Name/N Lot 13 Tanicena }fills Client Sample ID Lot 13 Tanicena dills Matrix Drinking Water Sample Remarks: Parameter Results LOQ Metals by ICP/MS Received Date/Time 05202010 13:30 Arsenic 6.31 5.00 Waters Department 0524/10 AYC Total Nitrmc/Nitritc-N ND 0.100 Microbiology Laboratory E. Coli Negative I Total Colirorm Negative 1 Printed Date/Time 05/27/2010 9:59 Collected Date/time 0520/2010 12:00 Received Date/Time 05202010 13:30 Technical Director Stephen C. Ede Allowable Prep Analysis Units Mcthod ConlaincrlD Limits Date Date Wt ug/L EP200.8 C (<10) 0521/10 0526/10 NRB mg/L SM204500NO3-P B (<10) 0524/10 AYC 100ml. Sh1209223B A 100mL SN1209223B A 0520/10 DLC 0520/10 DLC 07/29/2015 06:43 FAi Ben Lally From: Ben Lally lbenially@gd.notl Sent: Wednesday. June 09, 2010 3:26 PM To: 'appraisals@residentialmtg.com' Subject: 6800 Kiliak Place, Anchorage, AK Buyer.Herman To whom It may concern; 0 001 On June 6, 20101 Inspected the above described property and found it had three bedrooms, two X baths and one full bathroom. l trust this was the Information you had requested. If you have a" further quesj ns feel free to give me a call. Ben ! Er45T 30783. i S , I I 1 i•. } P.. I - � ' iii •, _ M1 EASEMENTS OF RECORD, OTHER THAN .THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON ' Fb OZ -2 - 8E P3 70 05/11/2010 10:15 8686770 APLUS PAGE 01 NORTHLAND PUMPING SERVICE, INC. Your Protessionat Septic Pumping Service Comparry 7501 E.140th Avenue ANCHORAGE, ALASKA 99516 (907) 344-7146 • FAX (907) 669-6770 TO Wendy Drew 68001Gliak Place Aachorage,AK 99502 TERMS Rtf 248.7744 10/08 2000 Tank locat 1W Gallons K Septic septic Fust week is December rate increase began Ang. 2004 Dons, 2 standpipes, 3 hoses 2' from SSW comer of house Leach Area INVOICE 20896 >� DATE P.O.# (Lt � i� 111 •' / $155.00 r00 _ Holding Tank ❑ PROBLEM AREA. CALL FOR MORE INFORMATION EDSTO DE DONE AGAIN IN 8 MONTHS Z Standpipes ❑ Good Shape ❑ Sludge buildup on bottom ❑ Floater on top 1 Jim cap missing or ❑ Cut standpipe to t' above ground Q Needs Septictrine sl!i Rn . ❑ needs replacing -* �J Vol,n pvmP -�) *11z'*11z'wa.s Nlljoe Municipality of Anchorage • Development Services Department �i Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 011-051-25 COSA# lj[0dD�M Expiration Date: — (o — 1. GENERAL INFORMATION Complete legal description Lot 13 Taniana Hills, Anchorage AK Location (site address) 6800 Kiliak Place. Anchorage. AK 99502 Current Property owner(s) David & Melody Kiester Day phone 266-2487 Mailing address 6800 Kiliak Place, Anchorage, AK 99502 Lending agency Day phone Mailing address Real Estate Agent Linda CardozalPrudenfial Jack White Day phone 440-9361 Mailing Address 3801 Centerooint Drive Ste. 200 Anchorage AK 99 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite 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. Name of Firm Pannone Engineering Services LLC Phone 272.8218 Address P.O. Box 102954, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date 2/23106 Engineers Comments: In conducting an adequacy test,l attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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. •••�waq The operational life of all wells and septic systems depend on the local soil condition, ground water • p•`�Y QF aaa4 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 of this system. All systems eventually fail and 00 ## satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future —� performance nor give any estimate of how long the system will continue to meet the operational i requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed ♦ ; $leen k. F nnone : above. Any reliance upon or use of this report by any other person or party is not authorized nor will it ��c �Nc�E 8149 -' confer any legal right whatsoever. �i ^tb: �.• S. DSD SIGNATURE �haaa;••• ,_Z Approved for —3—bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Arsenic Advisory Septic System Advisory Well Flow Advisory Nitrate Advisory Maintenance Agreements Supplemental Engineer's Report Other By.Z;lZVp/ Original Certificate Date: 3-1-06 (R�v. 11Aa) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw, Street P.O. Bon 196650 Anchorage, AK 99519-650 www.muni.org/onsite (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 13 Tonlans hills Parcel 0-011-051.25 A. WELL DATA Well type P If A, B, or C provide PWSID # _ Date completed 811511994 Sanitary seal (YM) Y Total depth _tJ&_fL Caged 101 PUL FROM WELL LOG Data of test 81191994 Static water level 114 ft, Well production 18 g.p.m. WATER SAMPLE RESULTS: ldorm Q_col� �a L Nitrate 0.896 mg/L Afsebic:LAP /%— Date of sample: I= B. SEPTICIHOLDING TANK DATA Tank TYPe/Material _OlyerSt *I Tank size _ jp gal. Number of Compartments j Well Log (YM) Y Wires property protected (Y/N) T Casing height (above ground) 12+ in. AT INSPECTION 2HU26t16 107 ft. 7.6 9 -P.M. Other bacteria -k- colonies/100 mi. Collected by: Laura Pannone Date installed 4115m97 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) g High water alarm (YM) WA Date of pumping &UXIQQL. Pumper -Northland Pumalna C. ABSORPTION FIELD DATA Data installed 6M8H997 Soil rating (g.p.d./fe or ft=/bdnn) U_ System type -sec Trench Length 7181 R Width 2 fL Gravel below pipe fL Total depth 9.= ft. Eff. absorption area lafe Monitoring tube Y Depression over field y Date of adequacy test _&Mt)2Qp8 Results (Pass/Fail) Pns For 3 bedrooms Fluid depth in absorption field before test pM in. Water addedo gal. New de pM in. Elapsed Time: 33 min. Final fluid depth Qa in. Absorption rate „ I& (iib-} g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No d If yes, give date 0 D. LIFT STATION Date installed Size in 'Pump on" level at _in. 'Pump Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklllft station on lot 100+ Absorption field on lot 100+ Public sewer main 100+ Sewer /septic service line 13+ Animal containment areas 100► in. Manhole/Access (Y/N) High water alarm level at in. Meets alarm a circuit requirements? On adjacent lots 100+ On adjacent kits 100+ Public sewer manhole/clesnout 100+ Holding tank WA Manureianimal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation Aa Property 4' Absorption field_1_Q+ Water main 100+ Water service line 25+ Surface water 100+ Wells on adjacent lob 100+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line +0+ Building foundation 25+ Water main 100+ Water Service line 25+ Surface water 100+ Driveway. parkinglvehide storage 12+ Curtain drain Nona Observed Walloon adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems ala in conformance with MOA COSA guidelines in effect on this date. j F %Ste,en R. Rcrrcnet � Engineer's Primed Name ft"n It PON" Date e- (273la v ���; r� .••. COSA Fee $ T f 6V Date of Payment Receipt Number T Qt 3 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number SCS ReEN Client Name Project Name/N Client Sample ID Slatria PNSID Sample Remarks: 1060720001 Pannone Eng. Srv. Lot 13 Taniana Lot 13 Taniana Drinking Water CO All Dates/Times are Alaska Standard Time Printed Date/Time 02/17/2006 14:52 Collected Date/Time 02/122006 13:00 Received Daterrime 02/132006 11.34 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Ing Nitrate -N 0.696 0.100 mgIL EPA 353.2 D (<=10) 02/13/06 JC Metals by ICP/MS Arsenic Microbiology Laboratory Total Coliform 6.42 5.00 ug/L EP200.8 C (-10) 02/14/06 02/15/06 TK 0 coV100mL SM209222D A («I) 02/13/06 DPT ID 1In A ,=,. � .: � is �• � �` . - r• H _� �'�'�fo -- -- N . - ji EE- � - - '--..__.---�'-•--+--- - ---- --`- 1 ,1�_"'; "- --.... _ _ .l � • •'T_ :fel, .. • .—:.N_. y � u Im 77 .. -< _- -�•'' ... 1iy: _.� ... .k�+..y.' _�„ •I.Lt�I I,;w� I^r. 1 �1 -•.J. T�a '� .�: ?G{C�S�{•G� . 't�,10 _' •1:..�- : .-. 1 � r�.� �-'ij •'�3'_7•-iL f : Y - CC in cr i ,1 _ •. C�..'I -�—';; 'ice 1 'I _..-. ... ., i ww 1 Lki ui Ul Ln Qk 00 jn »o I N 177 - -• i' ': t .. :..- i •''� .::. �-t .... ....' to :' ' ::: � .... • o _ T_.�.------ -- •-Wit;-r-a`;. `".._... _�__�'�_.___�—..t_.� --_.:- � - :':- �--------:i' _ ... .W - .1 .. y�. ��- ...�� .... ...... ;moi—�•--- t _---•__ � .... _.__±__--__-- i .._ : ... .. .. 1 : _ 1 _ i ._ __.,. _._... :: •� is , 1 i j i _ :r DD 1 ... r I MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services to On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # ��/ O.5 /` �v HAA It � X11 �'A 1. GENERAL INFORMATION Complete legal description 'CD f / f�� Ai /9 ✓/ /�/�S Location (site address or directions) Property owner /�9,/ '�A// Day phone 3'`10 - 6 yS7 Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. �i;l9iil]�:Z� • : �Z� 1TrF� 3. TYPE OF WATER SUPPLY: Individual well Community well Public water K Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site f 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. 1191) Front MOA X21 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm �� �z �✓� qPr� ��� Phone 9ogi Address Engineer's signature 4" 6. DHHS SIGNATURE X_ Approved for �C bedrooms. Disapproved. Conditional approval for Additional Comments 411TIC Date & 5 •C�) w � P,T1i CE 0176 .... bedrooms, with the following stipulations: Date 7-22-27 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 courtesyto purchasers of homes and their lending institutions in orderto 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(RW.1191) Back MOAM MUNICIPALITY OF ANCHORAGE Municipality of Anchorage eNVIRONMFNTALSER DEPARTMENT OF HEALTH & HUMAN SERVICES JUL 02 Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-1&7-4 rt E i Health Authority Approval Checklist Legal Description: Goy I'S / A -/c.15'' Parcel A. WELL DATA OA/- as'/-.zs Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present(Y/N) Total depth Sanitary seal (Y/N) Date of test Static water level Well production Y Date completed �4A-ls ✓'~ / 9 V //91t Cased to %y9/ f. FROM WELL LOG !o yf't i8 WATER SAMPLE RESULTS: Coliform ep" Casing height (above ground) 171 AJ Wires properly protected (Y/N) i AT INSPECTION g.p.m. g.p.m. Nitrate a, 7 Other bacteria Date of sample: -Vz9 9 Collected by: 1- e4f"O -ez� B. SEPTIC/HOLDING TANK DATA Date installed "' 16- 99 Tank size a044 G•QJNumber of Compartments 2 Cleanouts (Y/N)_ Foundation cleanout (Y/N) _�_ Depression (Y/N) '/ High water alarm (Y/N) 'Jlly Date of Pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftz or ftz/bdrm)0, Aff— _ System typed Length r/ Width Gravel thickness below pipe F Total depth A� Effective absorption area A'���fiA Monitoring Tube present (Y/N) Y Depression over field (Y/N) AJ Date of adequacy test '��� JVX rEOAesults (Pass/Fail) _ For bedrgplDs Fluid depth in absorption field before test (in.); Immediately after gal. water a d d (in.): Fluid depth _ (ins) Minutes ate : Absorption rate = g.p.d. (past 12 months) (Y/N) _ If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) Size in gallons "Pump o//n"�level at* level at* High water alarm level at* �f3at'um ed E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 49 eV -1 On adjacent lots SOC if Absorption field on lot Public sewer main ?en On adjacent lots /1040 71 Public sewer manhole/cleanout d 0f7 Sewer/septic service line Za SFA Lift station 'Jli9 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation By�i Property line 87F¢ Absorption field�� Water main/service line ZJr-f/�%Surface water/drainage X'C'a V��/Wells on adjacent lots 00AP° lf/ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line Surface water ffU'f'/ Curtain drain A/W `SK— F. ENGINEER'S CERTIFICATION Building foundation 0 ��• Water main/service line ,z,3" : ;/ Driveway, parking/vehicle storage area Wells on adjacent lots «nff� i 9i'�4 I certify that I have determined thru field inspections and review of Municipal recon— ak , in conformance wit MOA HAA guidelines in effect on this date. ' Signature 4& T�� f rp •;t Engineer's Name 4.111n �s T • (L+"1 �• A KENI Date HAA Fee $ Vk-). GL Waiver Fee $ Date of Payment 1- cq- Receipt Number 6Q- ��) / (-><�- 2)(,0 72-026 (Rev. 3/96)* Date of Payment Receipt Number CC 8170 are