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HomeMy WebLinkAboutFISCHER BLK 3 LT 1BFischer Block 3 Lot 1 B #015-292-03 Municipality of Anchorage _. Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. 1j P.O. Box 196650 Anchorage, AK 99519-6650 Page / of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW040213 PID Number: 015-292-03 Name: Robert & Nila Jackson Wastewater System: ❑ New 0 Upgrade Address: 10161 Klingler St. Anch. ABSORPTION FIELD Phone: 3 Number of Bedrooms: 346-2085 ❑ De nch ❑Shallow Trench ❑Bed ❑Mountl ❑ONer: Soil Rating: TOWI Depth from original grade: LEGAL DESCRIPTION GPD/Fl° FL Block: Lot SubdMsimc Depth to pipe bottom from original gra Gravel depth beneath pipe: 3 1B Fischer FL Ft. Township: Range: Section: Fill addedabove original grade: Grave the Ft. Ft. Gravel width: Number of lines: ce between lines: Well: ❑New ❑Upgrade Ft. Fl. lion (Private, A, e, C): Total Depth: cased m: Total absorptlon area: Pipe Material: FL FL Ftp Driller. Date Ddllatl: Static Water Level: Installer: Denali Excavating Date Installed: 6/29/04 FtW Yield: Pump sat ab eight Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES O septic []Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ubrc/Private Manufacturer: Anchorage Tank Capacity: 1250 Gal, From Tank Field Station Tank sevrerLine Material: Number of CDrrparmn.ma: well 103 100+ NA NA 100+ steel 2 soda.. Water 100+ 100+ NA NA LIFT STATION an acturer: Lot Line 70 35 NA NA NA Gal. "Pump on" level at: 'Pump off' level at High water alarm et Foundation 10+ 10+ NA NA in. m, in. Pump Make & Model Electrical Inspections performed by. curtain Dain NA NA NA NA Remarks: Old tank abandoned in place. BENCH MARK Location and Description: top of FCO Assumed Elevation: 100.0 Ft Engineer's Stamp ZOF A< 9 �P�49�� Ste. ` '9 Cindy W. Ellis at 6/29/04 Inspections performed by: y Dates: 1 *TH �.* ,...._..per 2n 6/30/04 .•• ••/{/ Development S rvices Department Approval �`.. C' dy W. Ellis tDate: 'O� CE-1077 Reviewed and approved by: =l'}•.- .:le�,c` ...... . " I' OFESSIOt4ALO �� t° UTILITY EA6 EMENT (� y — — — — — — — — — — — — — G'O9� CD '.3-6 CD 1 10 cc ( ¢RI \ O O� N �Y O <i J O C quo �gc . c m ma c cy rn O U) U I � d I Z � I LL m ° I I o s1 \ LL \ W 3LL E'Lb / WJ / N � \ W N W J � Z / F s I y / I � � I CD m m w � _ ° / 3 J >_ a � a I n a KLINGLER STREET F-1 =� N •-- M M M M C � L rn O Lr) � W 0%00 A ~ Y 1 M i O fa O ry dCMM p p H d Q C L CL: Q 0- _j J O 0 C:?M W O MONiN a; N n 1�1u mm�Lo �P t *.��OC ooP; ••. N �- N 0 oma: : � ��•. 00 004��• �., � Goo ���b�•• :� 0',00 S •a, � o U m r-1 M C � L rn O Lr) � W 0%00 A ~ Y 1 M i O fa O ry dCMM O d Q C L CL: Q 0- _j J O 0 C:?M W O MONiN a; N n 1�1u mm�Lo It z w v FINAL GRADE FCO 99.13 93.29 92.85 1250 GALLON g2.56 STEEL SEPTIC TANK N.T S. To Existing Drainfield AS -BUILT Fischer S/D Blk 3 Lot 16 OF _ OFA Record Drawing of Septic Upgrade Robert & Nila JacksonooCO.. Watkins Engineering, Inc. TH y�0 o as D •..,... ••� Parcel ID: 015-292-03 �• rp/, D Permit No. SW040213 �O �p •, CIN W.0577 13 �p P.O. Box 110443 • 72¢-b� o =CindyW.E. Anchora a Alaska 99511 0443 930 ft Phone: (907) 349-1851, Fax: (907) 349-1934 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Jun 22, 2004 Expiration Date: Jun 22, 2005 Permit Number: SWO40213 Parcel ID: 015-292-03 Legal Description:,Tl! C.:_ Design Engineer: 0844 Watkins Engineering, Inc Site Address: 010161 KLINGLER ST Owner Name: Robert & Nila Jackson Lot Size: 44952 SQ. FT. Owner Address: 10161 KLINGLER RD Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE, AK 99516-6620 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: & - Z2> -vim( Issued By: AL Date: 0 I _ Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-292-03 6% BVi a" 6' <O V Number SW ZD Property owner(s) Robert & Nila Jackson Mailing address (1) 10,161 Klingler Road Day phone 346-2085 Mailing address (2) Anchorage, AK Zip Code 99516 Legal description (Lot, Block & Sub'd.) Fischer S/D, Blk 3, Lot 1B Legal description (Section, Township & Range) Lot Size 44,952 Acres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade P7 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of Vroperty owner or authorized agent) Permit Fees: "T 1r7 /(-) Waiver Fees: Date of Payment: (/ ?-04 Date of Payment: Receipt Number: 34,,z: --Receipt Number: (Rev. 12100) Watkins Engineering, Inc. RO Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis®gci.net June 16, 2004 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: Fischer S/D, Blk 3, Lot 113 Septic Tank Replacement To Whom It May Concern: Attached please find an application to install a new 1250 gallon steel septic tank at the referenced 3 bedroom house in Anchorage. The existing tank was installed in 1992 without a permit. In conjunction with the sale of the property, the tank was exposed and found to have holes in it. It is proposed to abandon it in place. The tank will be placed more than 100 ft away from any private well or surface water. The homeowner has requested that a 1250 gallon tank be installed, even though the requirement for 3 bedrooms is 1000 gallons. No work is proposed for the drainfield at this time. I am not aware of any adverse effect that this upgrade would have on any adjacent properties' water and wastewater treatment needs. Thank you for consideration of this permit application. If you have any questions or need further information, please call me at 349-1851 or 360-3389 (cell). Yours truly, iale wf� Cindy 7EIlis, P.E. President 100th Ave 0 1A 0 OFq. Proposed Septic Upgrade - Site Plan Watkins Engineering, Inc. 1 C Robert & Nila Jackson Parcel ID: 015-292-03 0 WELL 1 B I.. 0 '� . LLO GO�m;m'., DEISCE - 10577 Cindy W. Ellis, P.E. P.O. Box 110443 June 16, 2004 Anchorage, AK 99511-0443 ° 2C Scale 1" = 100 Fischer Blk 3 e6B'o^.GQ R- Dav-Dor,' ilD Fischer SJD Blk 3, Lot 16 0 OFq. Proposed Septic Upgrade - Site Plan Watkins Engineering, Inc. a� s Robert & Nila Jackson Parcel ID: 015-292-03 O�GJ�P TH �C '� . LLO GO�m;m'., DEISCE - 10577 Cindy W. Ellis, P.E. P.O. Box 110443 June 16, 2004 Anchorage, AK 99511-0443 0 �4p��oo Scale 1" = 100 Phone: (907) 349-1851 Fax: (907) 349-1934 e6B'o^.GQ i 160'OS L M„S'b,'b OoO N h 10- UTIL., EASEMENT (� N O rn (D a J QUI \ N d \ I_ P- C.t N O N o al \ta N> O —_ U a) a -i cpt a> W M�OZ O O o Om I=wY C O fin2 v oco LL 'Fo N CD P Y V O i NjYC� CLC i \C U N cND fa in a> (u?: N\vi m x °� a) W y °COL — \ N y sLL e.�q 3 IE / N W m PIt Imo\ a m m / IC) F N= Z 03 0 / I I i I o�tie I I N N / 4-- K P o � 3 F / w J � Q / K S ' 0 n I a Q_ rt G6'6b L 3„Z5,9OoO S KLINGLER STREET --------------- m m N w N N 0 N m co it 2 _ w O CU N 0a)m O � � oQa _ a) moU) O � Y U � Q 0 Umm } y W >m 7 � N J in 7 p m Q JV O E= O 0 w N I Q C7 Z I w y 9)Z Q > 7 I- a7 -3 oo00�0044 Off: °,B4 OQ. -4K 3f Q O'.. et V M 01 ai M L M O Ln r4 W 01 W Y � � � M Y c ry aS O m o C U O aQo.. M y N a o `i° a J RE? d= N LL O MZ) UM a d Y'aU-.gN CD d 0 Ln yet II CD ZO O U W N �m C_ i VI t �a1 r d Vd is a`a°'a vu) \\ MUNICIPALITY OF ANCHORAGE / \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ❑N �O5 C C Z(il-A{.3OV UPGRADE MAILING ADDRESS /s5/ 6 I LEGAL DESCRIPTION Cor / -0 SLY 3 )C15H(m SvrS-D LOCATION NO. OF BEDROOMS 3 DISTANCE T0: Well Absorption area Dwe=g, o PERMIT NO. O O .Y �Z Manufacturer Material No. oZ mpartments W 4 JTIFF' to Liq, capacity in gallons IF HOMEMADE: Inside length Width Liquid depth dDbe DISTANCE ell Dw PERMIT NO. 2? � Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: Well Foundatio Nearest lot h f ^ i ~naFr PERMIT NO 8(,) OI 3 t� Z No. of lines Length ch line Total length of lines Trench wt Distance between lines f = w --M 3T_' Z Inches w1 f Top of tile to finish grade Material beneath tile Total effective absorption area D 7r Inches �•]� 5F' -Lerth Width Depth PERMIT NO. W f7 <I- W (1 Type of Crib Crib diameter Crib depth active absorption area rn DIS Building foundauo Barest lot line .j Class Depth Driller Distance to lot line ER MIT NO. ,rvATE W i Building foundation Sewer line Septic tank DISTANCE TO: Absorption areals) OTHER PIPE MATERIALS G C1C'4.0 t FS SOIL TESTRATI G ZS' � Baz7h INSTALLER C ♦ S C. Av�ATI CT REMARKS _ IC �h/.'TALL r .! . till Ctl-A,)OLM r �I ivqpm &a a 1 a e . ire �/J']'•,•. No. 205 •E Zvi ' \ 1'PROFESS����� APPROVED /�� DATE jL�EEGG(%AL��'//�� 72-073 (Rev. 3/78) f-IUIV I C I F- AL I 7-Y t7F ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 e 264-4724 L7N—S I -i'E SEWER F='ERM I T PERMIT NO: 860193 UPGRADE DATE ISSUED: 06/24/86 APPLICANT: ROBERT A. JACKSON ADDRESS: 10161 KLINGLER ANCHORAGE, AK 99516 CONTACT PHONE: 261-4300 LEGAL DESCRIP: SUBDIVISION: FISCHER LOT: 1B BLOCK: 3 SECTION: 15 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 1.25A (SQ.FT. OR ACRES) I,certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install thesystem in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK. MUST BE DONE BY LI ENSED ELECTRICIAN. SIGNED DATE: APPLICANI: ROBERT Ajj� JACKSON ISSUED BY - (/i� ;j�41(! --------------- DATE:/ --- To Ae insu/10dpvaY .0ee rnntli �lf%9n Ay Z!,12 L enirh 7J." u kld . Z 4*doelt/Pr<i _ C Soi� s On�<J /I6 ��i�i ►.. jf'nVl><EO Aega, _ �;� EFrny IZ'=rIerro) - :57 I _ �"TANDR�I `'DETAIL.. IT frJf�-)'��rnc n�:lo.Y i (o r a2� IiENGr4• W ronI = 2� 1/J''E NClI �EGn o.J 3 i -�/''�C' w/scaC.s �57arJap.F,ca fc'Eq�IREr � o —�TO BE jC.f•n)n)E CrED AV -� — XW-- I's Z.O "off f_EFT • I I — l NT• Qcw/JELTEO � I Fl= ID�Do)rl M i ' I I I TQcu.�r =c en erJ ' ' I I I 1r COO I 1 I I 2//2rrSV l4*�oN/ ENTRE TCEr.rc.l /^� ' 1 � I♦ P�ONTC�C/C �4PPrER I I I I �.r F�.crr�c�n�c� F•� I I e v c I � I SceEENt-�%cr. i Utz �A E%EAt'n{ (moi 7>r STraN�`naDS r I zG-I 1 I 1 i I I I I I I Ei;m+inq -Uia nfi DISCOnnactecl Sep c ._ FOUnj4{ wi Woll If O LOT CORNERS FOUNDATION !— DRAINAGE ARROWS NOTES= 1. IT SMALL BE THE RESPONSIBILITY OP THE BUILDER OR OWNER TO VERIFY THAT BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES. 2. IT 13 THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS WITH RESPECT TO ALL UTILITIESF4 DRAIN4kcC, S. THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN FROM THE RECORDED PLAT DESCRIBING THAT PARCEL. INSTRUMENTS RECORDED F;'.;Z.-. TO ATTLR T11u TILIY., C.• T!4_ F.S_OP.DEV PL1T.A-�E.14" RHnWN ON THIS PLAT. • ` ,� r •r NGINEERS S Municipality o1 Anchorage r •°" '' • ,� DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 r e - ? �; ,•r �; SOILS LOG — PERCOLATION TEST ` ''•, r' 'w Vit. •.�:".. .,- "•. PERFORMED FOR: CPoeFrrr 1Aelcl") DATE PERFORMED:_ C. 119! r LEGAL DESCRIPTION: L 16 SLK 3 Fj"er ';Le Township, Range, Section: &jc.loeA6 rDEPT—H-1 SLOPE SITE PLAN (FEET) $ILT (OL -Pt) 1 'SILT (ML) 3 4 �ND (.5 P) 5 6 7 Ste A«a'npAMyli- - sort. so�a..>� aNALy_r5 8 0 flr7 11 1 15Ar40 (ZP) 12 13 14 15 16 r9--BoTTo,h or 17 Tca� NoLr 18 iU11 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT A4 DEPTH? Depth to Water Altjjr Monitoring? 21 rot :_ Date:.(a�L $f._ I Reading Date Gross Net Depth to Net Time Time Water Drop F [171 J 20 -{ lul PERCOLATION RATE (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTST'ED 7-0sATyle n>•c ma�. /230th vievree v ,.iEp RA�e T_. i%�e TF.� ..�nxv TfOn._en ..r:_ rn.�•,.. ..,�w..s� . tL... ,.. _... 0...._ � /O�e�/ee� PERFORMED BY: �'PtcffR 1 2&y4, ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT 72-008 (Rev. 4,85) 'y�RTIFY THAT THIS TEST WAS PERFORMED IN DATE. DATE: G jlg�FG . - (-IFil ::R ANCHORAGE AREA" "*'-JGH cfl�� Department of Environmental Quality 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME R. -b rT ntinNsnn/ MAILING ADDRESS !'O 8QX 1/63 I -h -f/ 975/el PHONE LOCATION F3 13rMN ()ft -el LEGAL DESCRIPTION r'i LQ,fk-r le 7- /13 SEPTIC TANK: DISTANCE ' r NUMBER OF FROM WELL MANUFACTURERMATERIAL 'S%- 111. 166671 COMPARTMENTS 2 INSIDE LENGTH — INSIDE WIDTH LIQUID DEPTH — r IQUID CAPACITY—LL GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER =0R WIDTH iL, LENGTHJ2,r DEPTH LINING MATERIAL �MT CRIB SIZE: DIAMETER 4^D DEPTHS DISTANCE FROM: WELL I'l3 r r i TOTAL EFFECTIVE BUILDING FOUNDATION 35 , NEAREST LOT LINE h 7 ABSORPTION AREA (WALL AREA) q20 SQ. FT. ADDITIONAL ABSORPTION WELL: TYPEIAIDIU DVIL(fD —CONSTRUCTION -A" Mi /A4 6Q2Pu71efwj DEPTH 1:f0 r DISTANCE FROM: BUILDING r NEAREST r NEAREST r SEPTIC SEEPAGE FOUNDATION 5�� ± , LOT LINE 10 } SEWER LINE ?6"r" TANK Lf SYSTEM CESSPOOL 1%)M OTHER SOURCES AKIP klVr'ZJ� APPROVED 1/ DISAPPROVED REMARKS DISTANCES: DIAGRAM OF SYSTEM N INSTALLED BY: e y 2 fI PIPE MATERIAL: 011 I'VE d0'I " •9'� �.j..` �j 3lxdrcral 'q'-Ij ij" d �= 14we LOT SLOPE: REMARKS:`Sn/L llsr AV I?tr(+ •,� _tuglts : //AQ PM 44n n DATE 19 Z APPROVED n•'�'��� �l G.A.A.B. Form PW -036 M -W DRILLING, Inc. n P. O. Sox 4•1728 • 2811 Dawson A C 907-279-1741 ANC1i0RAGE, ALASKA 99509 DRILLING LOG Well Owner olert Jac::con Use of Well SO� Location (address of: Township, Range, Section, if known; or distance main road _, Fischer Suldiv'_cion .,x-, £_,, Sec 15, :1C:, R�• Size of casing ----60 nepth of Hole--I-:LO---feet Cased to --1 —e0 feet Static water level 1°0 ft. (aV ove) (below) land surface. Finish of well (check one) open end ( x ); Screen ( ); Perforated ( _ ). Describe screen or perforation 3 x j"x�' clots/foot fr= 160. to 17$t' level. Well pumping test of —4gallons per (k u) (minute) for--j--hours with 1C05 ft. of drawdown from static level. Date of completion 27 Jan 72 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and.hardness 0 TO 10 Siltv Grnvel G9A13D3f] 10 TO 16 Sand 16 TO Tp Silty ravel I1Ji1Jad 111N1vVlv(�ajANj 20TO 37 Gobble Grevel =VXGW I+1J' dQ '1d34 --jL_TO_95 Silty Gre:•elt Bron 05 TO 160 Silty Grsvelt Blue 160 TO 176 Sandy Grevelt wsterbearir- 176 Tp Ieo Silty Grevelt ^r,•tn TO TO TO 4;s;•ne E. •rlertlerb TO TO TO 1 — CUSTO\MER 9(' L.ARECR ANCHORAGE AREA R. LJGH '•� O V 10 v 1"J' DEPARTMENT OF ENVIRONMENTAL DUALITY PERMIT NO. 3400 TUDOR ROAD I.OUCH 6.650 ANCHORAGC. ALASKA 99402 TCt C•woN[ 279.8666 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT •`��� N�A�9�-- MAILING ADDRESS��f_�tY1�..1..G�t'PMONE INSTALLATION LOCATION�TH n�`xf� x/� LEGAL DESCRIPTION T/I!N//LS LT I -AS RS/l1- 3 `... ��YfICy I•0�Q I INSTALLATION OF: SEPTIC TANK f-' SEEPAGE PIT /4_. DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED t DRwi flNµ/f F,71,61 If (5 o� c� TO BE INSTALLED BY SOIL TEST RESULTS ?'r' u{r �tICO �I• , `ND11y 6. NOTEL THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED 1922 PFRMTT VAITa ONF YFAR FINAL INSPECTION, 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTME14Tss37 AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE /000 TYPEStPP1 Or rOOrTPtPSEEPAGE AREA SIZE TYPE MINIMUM DISTANCES.REQUIREMENTS FOUNDATION TO SEPTIC TANK S ft• FOUNDATION TO SEEPAGE PIT 20 ft* DRAIN FIELD 10 ft. . SEPTIC TANK TO SEEPAGE PIT WALL 15 ft. SEPTIC TANK 5 ft, SEEPAGE PIT 20 ft • DRAIN FIELD 10 ft. TO NEAREST LOT LINE. WELL TO SEPTIC TANK , J O • SEEPAGE PIT DRAIN FIELD Ia o A ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK 10 fto, SEEPAGE PIT - 10 ft. . DRAIN FIELD 10 ft• SEPTIC TANK. 25 ft' SEEPAGE PIT 100 ft' DRAIN FIELD 50 ft' . TO RIVER. LAKE. STREAM. - DIAGRAM OF SYSTEM C' CAST IRON SIPHON SEPTIC PIPC WITH AIRTIGHT MIC IAr.0 / CAPS _ — nL IIILr, OKOIST19AE0 SOIL • IAI I TS• i IMI Kul XI RINUN C 1 mulnd MHeenr IT" Lr01/N .kr drlxeHA7. .'fir: _ � — •:� L,RAHLAA(`CIILL 4,,L.,. CA1A. (CRIS , NIRIAUN PROVE WATER IA R INCH SIVER :INE. COMILIN AREA NELIS. S(EPACE PIT EXCAVATION CASED ON SOIL TEST. 10 anal 1•.Nr 10- Ar WM 114• P r /N0: RAcnt 10• Pea Nly MOOSE 4."A IN. LNuld Alt P.ams n. AO A• Nr IN M Iles CAST IVAN SIPTIC4nJM. N:fO VA. (A 1tlCN OISTPPCEO CAST IRON SIPHON PIPE SOIL \ �S[CAAO[ IIT J T CRIS es AVEL RACtrlll t t0' MINIMUM 1 G(API{T IAS tlnr 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. � DAT[ `2/S — " " APPLICANT'{ SIGNATURE MILL-."! VSS' 1'1 S) A:.l�S CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING OAP OF ICrftIPUAt EXCAVATION S FEET INTO UNDISTURBED SOIL, In'T8':2= Co. 10 PIT. 100' LO SECER LICC- 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT :Jtl-BURL IC FITTED WITH AIRTIGHT REMOVABLE CAPS. -- 10TA•:R- 80" ' 10 PI I. 170' All Sf l'CR flat• GRAVEL BACKFILL Ani. An• o1LT' EAST IRON SCUIR LICE CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION, to. IC TO TA -'K- 700' I0 RIP - 200' • 100'•211.OCL, CA`T IPC, SCUCR LICE IOf•'. Al S111PCC ' HEALTH AUTHORITY' N:1'AA�nAIIOx OR LICENSED DESIGNER .'fir: _ � — •:� L,RAHLAA(`CIILL 4,,L.,. CA1A. (CRIS , NIRIAUN PROVE WATER IA R INCH SIVER :INE. COMILIN AREA NELIS. S(EPACE PIT EXCAVATION CASED ON SOIL TEST. 10 anal 1•.Nr 10- Ar WM 114• P r /N0: RAcnt 10• Pea Nly MOOSE 4."A IN. LNuld Alt P.ams n. AO A• Nr IN M Iles CAST IVAN SIPTIC4nJM. N:fO VA. (A 1tlCN OISTPPCEO CAST IRON SIPHON PIPE SOIL \ �S[CAAO[ IIT J T CRIS es AVEL RACtrlll t t0' MINIMUM 1 G(API{T IAS tlnr 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. � DAT[ `2/S — " " APPLICANT'{ SIGNATURE -ATF.P AP;CNOQAr,C Apr.. DEP APlME[IT OF ENV IRONVENi•AL QUAL1Ti CASE € 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed For Robert Jackson Date Performed 25 juiv- 1472. Leoal Descrir.tion: Lot 1B Plock 3 Subdivision Fisher This Form Reports SoilsLoq XIC— Percolation Test — r)enth Feet aracteristics 1 Top— The GW fras very loose with soil a high cobble and pebble 2 content. The Gw—Sp contact was erratic with respect to 3 — depth. The Sp was compact with some erratic pebble A — layers. 5 Gw 6 — 7 8 -Sp 9— In— Was n— Was Ground Water Encountered? No If yes, At what Depth? *)^. I^#- iV rior Readinq Date Gross Time Net Time Denth to H2O Net Drone i I i Percolation Rate Minute ll Prnnose� Instaation: Ser.pane PitPrain Field Der)th of Inlet 4_feet_Depth To [ioftom of Pit Or Trencha-4_reet CMENTS: 3 feet sg at_1�0_se�ftLbdrn; 3 fee��,g_t`$5__�q ft/bdrm —_- calculated avernke.I1Q._sa�LL>xirn.___..—.--. Test Performed Ry percco Oata Certified Py Oai, J2 E N I Q: 0..•)FIFt-Z TAl T ao for ri ..O1EC 1N^_ --- CVA Ok �Id e2 T J�r� Cf 1N13 b"\1 Ilibtl C•Er'1 T11rltl1ED 1M ESECM ♦tli fO Ctl l[C tbw - ZA C d.O-rzC ON 1N12 bl-Y1 •MO 1NC I NE f6A CEMVr4;"V: 1 "VAC 2'IH AEAE91ME 2�1 PROPosEo New Z14�u.JFl6l.o �2! Foo"CIATI-,J DE=K POUIE- SCAB ?d.; -l'•i?5 R: l�^il�'✓wi,)E ��r�f:� v�cfs] ssso f e� lu me F'F22EE Fbb2 9 b0112 7NI'YO 7Jc't�dad l, , LC,: _ '�: e'.� ,•vr cins-z ct� kErrs - bt 0',YI, 1.. t 1, 1N...1:- Municipality of Anchorage I`1�pyE 84' s • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. 015-292-03 HAA # (4U,�- Expiration Date: % - -0 4 1. GENERAL INFORMATION Complete legal description Fischer Blk 3 Lot 1B Location (site address or directions) 10161 Klingler St., Anchorage, AK 99516 Current Property owner(s) Robert & Nila Jackson Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 10161 Klingler St., Anchorage, AK 995 Day phone 346-2085 Day phone Beth Simpson / Dynamic Properties Day phone 727-2384 3111 C Street, Suite 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 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 Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and om my wastewater disposal rinvestigation on-site water system is(a e) incompl ance w tle l applicable Municipal State codes,�o ordinances, and regulations in effect at the time of installation. Name of Firm Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511-0443 Cindy W. Ellis Date 8/17/04 Engineer's Printed Name Y 49TH` 5. DSD SIGNATURE ate: Cyttdy W. Ellis L,""' Approved for 3 bedrooms. �" CE10577 Disapproved. S1110 Conditional Conditional approval for bedrooms, with the following stipula t Attachments: Checklist X Maintenance Agreements HAA HAASupplemental Engineer's Report Septic System Advisory Well Flow Advisory Other By: �..L/ Original Certificate Date: (Rev. 01102) Municipality of Anchorage Development Services Department Building Safety Division Qn Sife Water &Wastewater Pro ram g SA [YY , unT` org/onsite id to I au g prdperlyprotected(YIN)�Y � _ 1 height (vtl12.5aegrr in. µ 3PZz €C i tfS = ri 9-p m. ,., ." s,.v. v� uw uN��•; l QIJUUM CI Dy... WaMlns Cnpineerinq inc. Date installed 6-29 04 Number of Compartments 2 Cieanouts (Y/N) Y 17epression over tank (YM) N High water alarm (Y/N) NA" Pumper NA ,'Fs.n � s' �*e,�•'s�.f �" •�r� k�:� : � ' ay�Y w.' 4��b"•�''��',"�+2 .tip v�'e £ -. �` N 2. .;: Soil rating (g p d/ftz or fTz/bdrm) 125 System type deep trench I• Width 2:0ft Gravel bel`bwpipe 6 0 _ g p"7k r{ `! k , , 'y wu. °c,"4u"�k` ,-U,'� '��"'u '. 97a"„"' E absorption area 3 ft Monitoring"tube Depression over field N '..- .4sults (PasS%Fall) PASS For 3 bedrooms fl el a ore est in Wafer added 4 gal New depth es 2e in _ Frgal flwd d®pth sg�ri: Absorption rate > 450 d 2e in ga on IVIQI II IVIG/-- Dump o in High water alarm level at in. ,ydeb.., �:k,a .. �, as ;u �•'• ..�... �. .. s tested Meets alarm & circw r � iamg rounpauun face water 100+ Dnveway parking/vehicle storage 30+ 100+ IIs on adjacent lots `i records that the above systems are in t n Receipt Number SGS Ref.# 1044755001 Client Name Watkins Engineering All Dates/Times are Alaska Standard Time Project Name/# Fischer Blk 3 Lot 13 Printed Date/Time 08/04/2004 1 Client Sample ID Fischer Blk 3 Lot 13 :00 Collected Date/Time 08/04 /2004 15:20 Matrix Drinking Water Received Date/Time 08/04/2004 15:43 Technical Director Stephen Ede PWSID 0 Released 4y --Y , Sample Remarks Parameter Results Allowable P ys' PQL Units Method v_ Container ID Lunits D Dates Init Waters Department Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 B(<=10) 08/04/04 JJB Microbiology Laboratory Total Coliform 0 coUl00mL SM209222B A (<=I) 08/04/04 DKC i K ,SO.OS L M„Btb,b0.0 N N m N FCZW 0 L` N LT LD x x -- 10' UTILITY EASEMENT F¢ II I Oz ¢2 m� I I p O m I F ro N N0NO m Kw go> = OO:<Oz W N a2 ~ Oy U¢p- Z� I y NNN2 a mezzo ¢Ob iz i e LL E'Lb ¢Nm F F 2 2 Z N ' O O y F z � U LLzo ri oU W QA Ke ww¢a u N z�NN p=j 11 U O I w Ow2 w JW F6 rtl ¢� Oy-2Q o ¢ z ppwM I: WAN Ow 0 OI,= h ar3w moo=r a LG'Sb L 3„Z5,90o0 S _ KLINGLER__ STREET - W N Ln to N M co A a Zw z ¢ z 0 mF Np 06 4z z— z 00 rF aw 0M O0 yLL Op FW J� Um _O wZ az N N O H p 0 0 N O QQ F¢ Oz ¢2 O Q�wO 2 p O ¢www Y=wF F ro N0NO m Kw go> = OO:<Oz N a2 ~ U¢p- QO y NNN2 mezzo ¢Ob iz ¢Nm F F 2 2 Z N ' O W LLzo ri oU W QA Ke ww¢a u slaw z�NN p=j 11 U O O Ow2 ¢'pw JW F6 rtl ¢� Oy-2Q o ¢ z ppwM mQ WAN Ow I.. OI,= �>to ar3w moo=r z ¢ z 0 mF Np 06 4z z— z 00 rF aw 0M O0 yLL Op FW J� Um _O wZ az N N O H p 0 0 N O . r MUNICIPALITY OF ANCHORAGE:;, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ' DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 2644720 1. GENERAL INFORMATION Application Date Z3 i. (a) Legal Description (include lot, block, subdivision, section, township, range) - I �srr / I3 FSNCrc Sclea � 6 e+�c Location (address or directions) /0/6/ J0�1M 11 Zr)Q (b) Applicant Name AO150 M -j j%,cs6crQI Telephone: Home G?Business �1 �130o Applicant Address A•kiy (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 9(; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: L`Z 03 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY t Individual Well V 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: 11 community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. ` Page 1 of 2 . • 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DAIA AND INFORMATION' As certified by my seal affixed hereto and as of the validation date shown below, l verify that my Investigation of this Health ' Authority Approval shows that the on-site water supply and/or wastewater disposal system is sale, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verily 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 - ,eq E�M_ r MnS Telephone 3W — (CM Address _--CD E AvG I`ikjc&n"ahE Date e I'M C.) DHEP APPROVAL Approved for! C JV— be Approved Terms of Conditional Approval Engineers Seal CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. , . Page 2 of 2 72-M V 1/84) I MUNICIPALITY OF ANCHORAGE (MO.../f HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 12!84 284-4720 Legal Description: ni jr_ S�IBD A. WELL DATA Well Classification If A. B. C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed 647-717 Yield l Pm Total Depth /90 Cased to X80 Depth of Grouting A 41A Static Water Level 1(01 Pump Set At r)"t4' nf,1 nl a Casing Height Above Ground Fr Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot /00 Gr ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot —lroi rr ; On Adjoining Lots To Nearest Public Sewer Line 4IZA To Nearest Public Sewer CleanouVP arest Sewer Service Line on Lot i9 Fr Water Sample Collected by ^'* mss E -C: - -1 7R2i� ; Date ggp(o Water Sam Comments B. SEPTIC/HOLDING TANK DATA Date Installed /977- Size /Z 5_0 No. of Compartments Z Standpipes (Y/N) 1�f Air -tight Caps (Y/N) ;� Foundation Cleanout (Y/N) Depression over Tank (Y/N) Al Date Last Pumped Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) — A-'100 Temporary Holding Tank Permit (Y/N) 114 Separation Distances from Septic/Holding Tank: To Water -Supply Well /0=) � To Building Foundation /o To Property Line loot Fr To Disposal Field 19 ^ To Water Main/Service Line SUr rr To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-02601184) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed 7�?1�2ea Length of Field Width of Field T� Depth of Field —� S Gravel Bed Thickness Square Feet of Absorption Area 375 .�r Standpipes Present(Y/N) U Depression over Field (Y/N) -JDate of Last Adequacy Test tiE3 Results of Last Adequacy Test fQE-03 Poe D Separation Distance from Absorption Field: To Water -Supply Well /r0* C, To Property Line 100f Fr To Building Foundation t'r To Existing or Abandoned System on Lot /% ; On Adjoining Lots "./Ar To Water Main/Service Line s-o+F* To Cutbank (if present) N� p To Stream/Pond/Lake/or Major Drainage Course rcwor• Fr To Driveway, Parking Area, or Vehicle Storage Area SO + Pr Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tgsted for Electrical Codes (Y/N) _ Comments — Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) during Adequacy Test. Meets MOA •• Check Permitted Bedroom Rating Ilgainst HAA Request .• I certify that I hive geckqo� v®iEVr cg§formed to all MOA and HAA guidelines in effect on the date of this inspection SignedalP� 7/ZS/'-" Company MOA No. / Receipt No. ( cx-) Date of Payment 1 ' —� ~� OF 4.1 %1% Amount:$ ioS.0(13.*~ 90 0 a1 i .•'• n50Z 'ON I/� ; ItN,wr n •lea ' y',I Page 2of2 / / c •. Dol• It. roll :' • ? ............. ..6.0 n BESSE, EPPS S POTTS 2220 FAST 88 AVlUIUE ANC210RAG$, AK 99507 (907) 349-6451 HATER {ELL TEST n Date: Arpm.3, lf$k Subdivision: _ ' FISG{tFr- i5ujaD. Lot: /F3 Block: Client's dame: aUf,�;n-r drr-11.40" Address: /010 IL1N6LM l3N'CllO�'l�i•E ' Tester: , c -w M/SIRAy✓►i Initial Reading on Meter: 3170 TIME GPM GALM4S A VOLUME CvAa1S TOTAL YOLUMS /nrT rcmlN� 17 BOO 1 = 3v !S 20 3 90 !l = 45 .0 66 3236 12:15 3.1 '0 3330 1:15 115 7 3 1z, 00 .9(0 3 7-90 50 4:00 .5 Z10 7120 274 0 0 4-00 .133 ---1,4 11 z 30 --30 3a 3 50 1 ' Z 51 113 50 34,20 NOTES: Prodim-lon Ratr.: 1.2-5 GP:1 24 -Hour Capacity18CO Callous SESSE, ", PS & POTTS n AIUNCIPALITy OF ANC C1NIP.NORAGF DEPT. OF HEALTH g ONMENTAL PROTECTION el 5 W6 RECEIVED June 25, 1986 Mr. Dan Bowles Municipality of Anchorage Health Department 825 "L" Street Anchorage, Alaska Re: Lot 113, Block 3, Fisher Subdivision Dear Mr. Bowles: The well located on the above-cited property is located over 100 feet from any septic system and over 50 feet from the nearest roadway. Very truly yours, w6 KV,,, Mike Krieber Civil Engineer smh ENGINEERING, PLANNING, SURVEYING 2220 E 88th Ave. /Anchorage, Alaska 99507/Telephone 907349-6451 /344.1352 "Providing a quality personalized service to those building Alaska's future" MUNICIPALITY OF ANCHORAGE n ' • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ,&/- L•B , B L/t 3 61 a Location (address or directions) —/0/",/ FA g R (b) Applicant NamaLoazd r Telephone: Home -3���' z�� Business 7t, Applicant Address 10/G/ I-I'lA C-gN (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain); ty (d) Lending Institution JqA S 1156414- Telephone Address lot w �Calte l (e) Real Estate Company and Agent tj/ Address Telephone (f) Mail the HAA to the following address: AEt=M—W _R L u . 2. TYPE OF RESIDENCE Single -Family®. Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual WelljK 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 Onsile,RJ Public ❑ Community ❑ Holding Tank ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025(11154) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 1.3 As certifidd by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of Ihis Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is sale, 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 Slate codes, ordinances, and regulations in effect on the date of this inspection. , , Name of Firm Address Date �tfl•rD✓1tC �-5,d, 22 C�tsiA'Ce;?0 I'v /C�J<a�/!, !eC%%��yyyy✓✓��[Cfj.zeelpr.0x /S— `l.`Y/ G..-i�.6, //(!/Cyu<ct' 7P-l.J /l`.0 '�a. / /ct•u-v (f lch 4%»� (' ccilf� jv�j icerw otn fly -eel 0M.&t ,lx:A.fkr+ , (1172) DHEP APPROVAL Approved for Approved Terms of Conditional Engineer's Seal v t&-(rc-z" _Yl_.._- A . CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct Inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-02S (1 1184) MUNICIPAUTY OF ANCHORAG2 - DEPT. OF HEALTH 6 EWIRONWWAL PROTECTION MUNICIPALITY OF ANCHORAGE (MO*.) HEALTH AUTHORITY APPROVAL (HAA) MAY 0 81986 CHECKLIST - FEBRUARY 1884 284-4720 �lRRR`E C E I V E D Legal Description: ��+/- �Z ,� Soe_ 1-6 W A. WELL DATA Well Classification51 (s— ��/J✓ If A. B, C. D.E C. Approved (Y/N) Well Log Present ©N) Date Completed �T�E p �,- 197-2 Yield y V. P Total Depth ZB_P Cased to / B G Depth of Grouting Static Water Level /(P/ Pump Set At (/.AJICA)a_" Casing Height Above Ground � _ Sanitary Seal on Casing Y�M) Electrical Wiring in Conduit OY N) Depression Around Wellhead (Ym NO Separation Distances from Well: r To Septic/Holding Tank on Lot 8 ; On Adjoining Lots To Nearest Edge of Absorption Fiel /2 S ; On Adjoining Lots %-5d + To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by R i -/V-1 ; Date '6!;V4 34 /,"q/. Water Sample Test Results Comments 7e& •+aJ wew 1 ova nic. 01VVY (kA- r�8»1 w i��3i RFuL"f B. SEPTIC/HOLDING TANK DATA Date Installed 8" 21' 7 Z Size 1AS0GAL• No. of Compartments Z Standpipes 6)N) Air -tight Caps ON) FoundationCleanout&N) Depression over Tank (Y(q lyO Date Last Pumped BM/j- -30 y98 Pumping/Maintenance Contract on File ON) ; for — Holding Tank High -Water Alarm (Y/N) — Temporary Holding Tank Permit (YIN) Separation Distances from Septic/Holding Tank: �I To Water -Supply Well � r i To Building Foundation To Property Line JIM 70 To Disposal Field �S To Water Main/Service Line �� To Stream, Pond, Lake, or Major Drainage Course /.�,..�� Comments /d1/Wr('O PUi?iP PUevi �4N0 IAJsPe�N 11kPo1 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /18 5r� ,� Type of System Design SEt V- ?IT' Date Installed .71 .4 1 q412- Length of Field Width of Field /8 r Depth of Field 6 7 Gravel Bed Thickness 6/ Square Feet of Absorption Area 420 Standpipes Present (Y/N) it Depression over Field (149 No Date of Last Adequacy Test i Results of Last Adequacy Test UN 71SFlkC7i7 ( (! / frifL 3 ,178() Separation Distance from Absorption Field: To Water -Supply ` 14-:; X71 PP Y Well To Property Line '� To Building Foundation 3S To Existing or Abandoned System on Lot ; On Adjoining Lots t To Water Main/Service Line t25 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area � 95 Comments 5�r A7779L11LV Pt*6.4 -fZE-t4- Aw/I D. LIFT STATION AIA Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access(Y/N) _ 'Pump Off' Level at Check Permitted Bedroom Rating Against HAA Request •' Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA - Icertifythatl ave checked,verified, or conformed to all MOAandHAAguidelinesi Signed ti Date/ 8(0 Company A�0 / MOA No. Receipt No. in C51 Date of Payment SSSSL Amount: j Page 2 of 2 72-026 111, H) n effect on the date of this inspection. Seal