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Home My WebLink AboutKNIK HEIGHTS BLK C LT 14Knik Heights Block ¢ Lot 14 #017-034-32 Municipality of Anchorage Page 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: ~,~v' 95OO/'/,~ PID Number: Q//'~ - O~ -~ .. N~: Wastewater System: ~ew Q Upgrade Address: ABSORPTION FIELD Phone: No. of Bedsores: ~eep Trench ~ Shallow Trench D Bed ~ Mound ~ Other LEGAL DESCRIPTION SoiiRating: ~' ~ GPD/Sq. Ft. Total Oepth from ~ai grade: Subdivision: Depth to pipe bottom from original grade: Gravel deplh beneath pipe ~Range: ~ Seclion: Fill added above original grade: Gravel length: Township: /' I ' '" Gravel ~: Numbe~f lines: Dislance beiween lines: WELL: ~ew ~ Upgrade ~ ~ F,. ~/~ F~ Classification (Private, A,B.C):' Total Depth: Cased To: Total absorption area: Pipe materieh Date installed: )riller: Date Orilled:, Slahc ~ter Level: Installer: SEPARATION DISTANCES ~,,ti~ ~ Ho~,~ ~ S.T.~.P. Number of Compartments: s~f~~// . ) ~/~ LIFT STATION Water Cudain ~/A ~ / Pump ~~ Electrical Inspections pedormed by: Drain . BENCH MARK Remarks: ,,. Location and Description: Assumed Elevation: Inspections performed by: ~ 2nd ¢~/~5/Yb ~;~ '> '~ ' Reviewed and approved by: Date ~ 72-013 (1/91) MOA 25 Permit No. ~;~ ~g}g2~-/~,~ Page 2 of ivlunicipality al: Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 345-¢7¢4 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: KNIK HTS LOT 14 BLK C PID No.: SCALE 1" -50' 300.00 S 89°58'00 LOT 14 30' 1250 GALLON SEPTIC TANK 300,00 [ 10' UT[L EASEH£NT WELL HSE g 89°58'00' w MONITOR TUBE o SEWER CLEANOUT WELL -- - LEACHFIELD -- -- - EASEMENT SWING TIES A-C = 81.3 8-C = 70.4 (NDT TD SCALE) 7/26/95 STATE OF ALASKA DNVISIQN al~ MININI~i & WATER WAT£[~ WELl. RECORD LOCAllON OF ~ tONtKETCH WELL 0 WN FJ;I: D~HB ME~a~ ;~M:~;I~ t~ ~orou~' s~ ~ D~H: ~ DATE OF ...... ~ ......... .............. ; O~th ~ , r, ~,~ ~..:.:.. ~-: .. ..... :,. :: ...... :,,, ~ _. _ ~ /~__ ~ ~ ~,,,,, ~ : o~~=_ :..: .................. ~~~. ' ..... / /~; · G~V~ PA~K ~PE, , ......... PUMP INTAKE O~H: __ ft H~; ~L DI~INFE~ED UPON COM~~YE~ PAGE 1 OF 1 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:SW950048 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:HAGMEIER JOHN C & JUDITH A OWNER ADDRESS:2204 CLEVELAND #201 ANCHORAGE, AK 99517 DATE ISSUED: 4/17/95 EXPIRATION DATE: 4/17/96 PARCEL ID:01703432 LEGAL DESCRIPTION: KNIK HEIGHTS BLK C LT 14 LOT SIZE: 43500 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHOP~AGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AACS0) . 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) 4.1 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 Bo COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: / Louis Butera, P.E. Registered Civil Engineer April 4, 1995 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Knik Heights Lot 14, Block C Narrative & Permit Application Dear Mr. Cross: The proposed welt and septic systems will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity and large lot size. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \C:\WPWIN60\WPDOCS\1995\95-021A.NAR O P.O. Box 773294 · Eagle River, Alaska 99577 · Telephone (907) 694-5195 . F,'~ (907) 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: Knik Heights Lot 14, Block C 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the cont~actor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 1. 'rite trench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 11' at any point. 4. The trench gravel is to be covered with typar fabric material. 5. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 6. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 7. ~e septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 11' GRAVEL DEPTH = 8' under pipe, 2"over pipe TRENCH LENGTH = 50' TRENCH WIDTH = 3' SOIL RATING = 0.8 GPD/ft2 BEDROOM CAPACITY = 4 SEPTIC TANK = 1,250 gallons minimum Twenty-four (24) hours notice required for all inspections. C:\WPWIN60\WPDOCS\ 1995\95-021A.SPC BLOCK C BLOCK 0 I LQT 2 I I LOT I I , i[ _-~ ~oo~ / F---'~ ........ ~., ~ PROPOSEO I ~ LOT 3 ~ LDT [4 ~ . ~ WELL I LOT 3 ~ TH3 )] '~ [~ - ~,2~;,~..~ u-~Tr ....... .... ;7,57~-~~ F ~ - TEST HOLE * - MONITOR TUBE ~ FIELD CHECK TO VERI~ 100' o - SEWER CLEANOUT DIST. TO SEPTIC TANK LOT 15 ~ - WELL PROPOSED L~CHFIELD NO KNOWN CURTAIN DRAINS ,- EXISTING L~CHFIELOS NO SURFACE WATER ~SEMENT :WELL a SEPTIC SITE PLAN ~WNER:~LEGAL: HACMEIERKNIK HEIGHTS, LOT 14 BLK C ~........~..-.~**. ~o~ ~ 95-o2~1 D~'r~: o~/o~/9~I SCALE 1"= ~00' ~ EAGLE RIVER ENGINEERING SERVICES : ~ EAGLE RIVER, A~. 99577 ' ~ (907) 694-5195 FA,V: (907) 694-3297 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907} 694-5195 ERES Project No.: 95-021 Calculated By: LB Date: 4/4/95 Single Family 4 Bedroom Dwelling Deep Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = 600 Percolation rate = 7.2 Wastewater application rate = 0.8 Required absorption area = 750 Trench width (W) = 3 Gravel depth (D) = 8 gallons minutes per inch gallons per day per square foot square feet feet feet Required length = Required absorption area / 2 / D Required length = 750 / Required length = 47 feet 2 / 8 SINGLE FAMILY ON-SITE WORKSHEET ERES PROJECT NUMBER: 95-021 CALCULATED BY: LEGAL DESCRIPTION: KNIK HTS. LOT 14 BLOCK C NUMBER OF BEDROOMS: 4 WATER USE PER BEDROOM: 150 GALLONS PERCOLATION RATE: 7.2 MINUTES PER INCH DEPTH TO GROUNDWATER: 17 FEET DEPTH TO IMPERMEABLE LAYER: 17 FEET ANTICIPATED DEPTH OF COVER: 3 FEET MOUND OR BED SYSTEM WASTEWATER APPLICATION RATE: 0,5 ABSORPTION AREA REQUIREMENT: 1200 MINIMUM BED LENGTH 12 FEET WIDE BED 100 15 FEET WIDE BED 80 TRENCH SYSTEM WASTEWATER APPLICATION RATE: 0.8 ABSORPTION AREA REQUIREMENT: 750 SHALLOW TRENCH OPTIONS 5 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) LENGTH (FT) 1 131 2 105 2.5 95 3 88 3.5 81 4 75 LB USABLE SOIL STRATA TOTAL USABLE DEPTH: 1 1 USABLE SOIL STRATA DEPTH: 8 GALJSQ.FT SQ.FT FEET FEET GAL/SQ.FT SQ,FT DEEP TRENCH OPTIONS 3 FEET WIDE TRENCH EFFECTIVE REQUIRED TRENCH DEPTH (FT) LENGTH (FT) 4 94 4.5 83 5 75 5.5 68 6 63 7 54 8 47 RECOMENDED DESIGN FIELD SYSTEM: D GRAVEL DEPTH: 8 FEET TRENCH OR BED WIDTH: 3 FEET LENGTH: 47 FEET TOTAL EXCAVATED DEPTH: 11 FEET (B=BED, S=SHALLOW TRENCH & D=DEEP TRENCH) Municipality o! Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Ataska 99502~0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: DATE PERFORMED: Township, Range, Section: /,,'/,4 1 2 3 4 5 6 7 8 9 10 11 12 13 SLOPE OUNO WATER , AT WHAT ¢ WAS Gl ENCOU IF YES, ~ DEPTH Oeplh lo V~ ~ Monitoring I -.'- / .( PERCO Waler After SITE PLAN Reading Date (]ross Net' Depth to Net Time Time Water Drop / 14 15 16 17 18- 19- 20 COLATION RATE /4./ J4 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FTAND ... FT COMMENTS ~/~T ¢¢ ,~,, ~ ~ .~ ~-~ /..~ ~2 ~%-/~~ PERFORMED BY: ~-~/~'~J' I ~~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE ANO MUNICIPAL GUiDELiNES IN EFFECT ON THIS DATE. DATE; 72-008 (Rev. 4/85l PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~/¢~/z;., ,,~/,,~ ,,,z/"/z~'/,¢ ~,,-.r Township, Range, Section: ,,.'/4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 lg 17 18 19 20 COMMENTS SLOPE 3ROUND WATER ENCOUNTERED? ,AT WHAT Ih Io Water Alter g? r~ Oate: S I'T'E PLAN Reading Data Gross Net Depth to Net Time Time Water Drop ~ '. )N RATE '4Yt/~ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~ FTAND FT ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THiS DATE. DATE: 72-008 (Rev 4/85l PERFORMED FOR:__ Municipality pi Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~/o~' /z./ ,.~/,.'Y"C ,,i'l",v',',4' H~ Township, Range, Section: 1 i 10 12 SLOPE 13¸ WAS GROUND WATER ENCOUNTERED? 14- ~S, AT WHAT DEPTH? O~ gept ~ " Mon PE th Io Waler Alter g? ~ r2 Oa~e: SITE PLAN Reading Date Gross Net Depth to Net Time 'rime Water Drop 15 16 17 18 19 20 ;OLATION RATE 7, ~1 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~' FT AND 7 FT COMMENTS PERFORMED BY: &~"~e~.C I __~~-'~--)~-- CERTIFY THAT THIS TEST WAS PERFORMED IN ALL STATE AND MUN,OI~*L GU,DEL,NES ,N EFFECT ON THIB ACCORDANCE WITH 72-008 IRev. 4/85) GP'~TER ANCHORAGE AREA BOROI"~H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 N.° 684 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: ADDRESS . . J DISTANCE FROM WELL~-c'~7, LIQUID CAPACITY GALLONS. MATER,A~_ 5%>% NUMBER OF / COMPARTMENTS INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS / .OUTSIDE DIAMETER '--~ OR WIDTH /'7 _ &/:>~,.)D,STANCE EROM WELL /~o NEAREST LOT LINE~? / ~ ~- __. TOTAL :FFECTIVE ABSORPTION AREA (WALL AREA) ,' .~ / , LENGTH/'~ ~'~ , DEPTH BUILDING FOUNDATION. SQ. ET. TILE DRAIN FIELD: DISTANCE FROM WELL ~--- --~~N ~....~. , NEAREST LOT LINE NUMBER OF LINES / DISTANCE BETWEEN LINES ~ TRENCH WIDTH ABSORPIIO SQ. FI. LENGIH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE' TOTAL LENGTH OF LINES I N ....~T'~L EFFECTIVE IN, ABOVE TILE TYPE/~/'~/ ~ DISTANCE FROM WFLL: //u ~ DEPTH ~ , BUILDING FOUNDATION. .~ NEAREST ~ SEPTIC SEEPAGE LOT LINE ., SEWER LINE TANK r~ , SYSTEM WATER SAMPLE . CESSPOOL ., NEAREST OTHER , SOURCES DISTANCES: DATE DIAGRAM OF SYSTEM APPROVED · HEALIH AUTHO/R~ ~( GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERM,T NO./LIe NAME OF APPLICANT '~'~'i/ INSTALLATION LOCATION INSTALLATION OF; SEPTIC 'rANK FINANCED THROUGH COMPLETION DATE ANTICIPATED SEEPAGE Pit TO BE INSTALLED BY Ch(!; '" NOTE: THIS PERMIT I~ NOT VALID WITHOUT SOIL TEST FINAL INGPECTION~ 24 HOLJR NOTICE REQUIRED· BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCES, RFQUIREMENTS SEEPAGE AREA SIZE TYPE DIAGRAM OF SYSTEM FOUNDATION TO SEEPAGE PIt"~/"~- (~) SEPTIC TANK TO SEEPAGE PtT WALL / SEPTIC TANK -~) ,SEEPAGE PIT TO NEAREST LOT LINE. / WELL TO SEPTIC TANK L ~) '.~'" SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS, /(; ' It:, ' WATER MAIN TO SEPTIC TANK , SEEPAGE PIT DRAIN FIELD SEPTIC TANK, ,~ 5 SEEPAGE PIt , DRAIN FIELD TO RIVER, LAKE, STREAM. _, DRAIN FIELD DRAIN FIELD " CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL ~ ~ CONFORM TO BOROUGH REGULATIONS REGARDING ~:~STALLATION. HEALTH AUTHORT¢ 5(" I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM rs IN ACCORDANCE WITH SAID CODE. ' CASL ¢ [!e p t h Feet .... r Gray silty fine sand and well graded fine to medium sand (SP)&(SW) 1 ..... ~ ....... [:'raj ~ UC, c'd:L O;~ :r, :et ;,,' ................. 150 sou~;~%;r o~ dr~aSe surface ~s re~u~red per bedroom. Test Perfor, med B'¢; R, E, Carlisle Municipality of Anchorage Development iServices DePartment Building Safety DiviSion On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CD~?IFICATE OF HEALTH AUi:H~RiTY AI~PI~0VAL FOR A SINGLE FAMILY DWELLING P,~:(~el I.D. o~i'~£o3'4-32 1: (~F='i~L INi=oi~MA¥10N Expiration [~a{e: ,, '7 - '~ /*" 0 ~ Coi'h'pleteleghld~scdPtion KNi~ H~:i~'l-I~' su'Bl~i',Jl§i~h, LOT 14, BL'bCK C, L6c,~ion (si{~ address' o~ dir~tion~) i2~31 'A?~¥dN "~ *' AN~:H'015,AGE, AK. 99~1 6 'cdi-r~ht Pr0~3ei'ty Owner(s) Mailing' add~e~ Lehding ~gency Mailing address Real ~state ANDREW ANb AU§bN LAVEN Day P~one.345-2332 12501 A'h-l~'i~:l:ON D~v~' * ANaHORAGE, AK. 99~1'6 D~y~Rbhe 6ay'¢~dhe Mailing address Unles's othei'Wis~ f&~Ues'~d, HAA Will be 'held by D'SD ~o?PickLip. 2. NUiviBER OF BEDRoOI~: 4 'i'YPE OF WA~R SU~SLY: Individual Well · Individual Water Storage Community Class Well D Public Water System [-'] TYISE OF WAsYEWATi~i~ DISPOSAL: Individual on-site · I, Individual. Holding tank E] Coi~tnunity On-site D Public Sewer E] The Municipality of Anchorage Developmeht Services Departmer~t (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/er 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 pFoperties Served by a private or Class C well and may be reissued with new water samples. (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 bedreoms and type of structuro indicated herein. ! 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 GARNESS ENGINEERING GROUP, Ltd~ · Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507. Phone Engineer's Printed Name ' JEFFREY A. GARNESS, P.E. Date 337-6179 .Engineer's Comments: : In conducting this evaluation, GEG, Ltd. a:ttempted to provide a thorough, conscientious engineering analysis of the system in accordance wi~h ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. Tl~e operational life of all wells and septic systems depend on the local soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the so/e benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE Approved for L~ Disapproved. Conditional approval for bedrooms. bedrooms, with the fllowing stipulations: Attachments:' ' .r HAAChecklist- septic System Advisory Well Flow Advisory Manitenan~ Agreements Supplemental Engineers Reo~. Other By: / J//D" Original Certificate Date: (Rev. 12/01) · A. ':WELLf DATA Well ~=e '~'~'0k'~ Date,l ¢hpleted.,.: 7/1. 4/1:, 995,, ..~Sahila/3),.. :,8~1, (Y/N) YES "~ ~ i::'- ' '- ',. ,~ ?. : .... ' .;.~,q, , ,~' , ~' . ,.~, ' ' '' Total ~pth 150 ~. :j ' ? ~,Cased to ,'r150 ~. ,~ : .,, ca~iB~'~ei~ (abbv~ ground) :' ..'~ : ' ~ .¢'FROM;WELL'LOG;:. '-' "'j ATih~'~ION ":" Static Water level ~ ',: ~ ,67; '~,'~, ;.','ff..~ :.., '' .,! ' ' .'67 . : ff. .... ' .... ~ ;-~ :~ ~' ' ..":. ::i , ~., .. .... ~ ....... Well: producbon. --~h :':-;~'11 , .... Lr,,: ,,:~, 'g.b.~ J~ : [: ' .,j ~4.96,' , g.P.~. MuniCi:Pality An horage:'; ,:i Development sentices Department ::' 'r . : .~Bdilding safety... _ _ Division i_ - ~ . On-Site Water & wastewater Program . - ! ~ · " !i ;4700 South Bragaw St.:! .... ~, P.O. B°xii96650 Ahch~rage, AK 99519'6650__ _ _ i ,~ ' : ~www. ci.anchorage.ak.us .. ; ii:~ ~;(907) 343-7904 '.' .' ~. ' · '. , ~ · !--',. , . ',, , , iHE LTH AUT:HORITY ;APPROVAL' CHECKLIST , ',. ' ~m,,. .... : ¢ .... ., , t,. . ; . .,: i . . KI~IK·HEIGHTS SUBDIVISION;, LOT 14, BLOCK C,' :.,Parcel ID: 0i7=034-32 B,'.0r.C ~r'6vide PWSID# :;N/A .. , Well L0~ (Y/N) y~-S ¥1L'S: 24 in. WATER 'SAMPLE RESULTS: . ~':: ; ,:~ . :,; ,,,,~, Cohform:: colomes/lO0 mi. :: N kate ~ m_~.lL. ' , Other bacteria , '¢-nlnni~*/tl3f3 mi. Arseq~q. ,:. N/A rog.IL ~ . ;: .; , Date,of sample: ,3/22/2004 Collected by: GEG~ LTD. B. SEPTICIHOLDING TANK DATA ,; .~! J,r ':' : ::':. .' . .',-~'. . . - '.,; ~ ' . ' ' 'j~ ',!' '. :.j :' ;'i , I :, ,' ; :'. ..... . ' Tan~ Fype/Matenal ~~'. ~~%.¢ ~ % ~' ':1 ~ I : ' Date i~stalled , · 7/25/1995 . Tank~zg, 1250 gal..~.t;;; Numberof,Compadments ~ 2 , Cleanouts (Y/N) YES Foundation cleanout (Y/N) ~ES ~..Depre~ion over.tank (YIN) NO : :'High water alarm ~/N) . N/A Date of p~mp~ng 3/20/2004., Pumper · t ,,[-- ,,J McDONALDS PUMPING Da[~~ Installed 7/25//1~95 Soil rabng ~r ffTbdrm) 0.8 · Sv~te~ Nne : TRENCH Le~gth ~,' - ' fi; , :~ ,,~,W~dlh ,,' , ,,,~L,, , ;.t ff. ,..Gravel below pipe ' 8 ... Total de~th *12.3 ,ff.: ~E~.:abSOrpJ'ion ~ e~ 750. fl': :'~'6nit¢~ing tube YES ;;; ~Db~ression oVerfieid 'NO Date 9f adequacy test /20/2004 , j , LResults (Pass/Fro) PASS , ,, ,- For 4 bedrooms 'Fluid depth in abso~t on field befOre test 72.5 iB * ' "Water added 664 aal',, ,' r ' N*W Elapsed :!~me. .340 mm~, .:;;: , ~Fmal timd depth ,79.5 in.~:: ¢i AbsorPti6fi rate >= , .600~-- , ~,p d O~:'*¢~'~&JiSh ~EO~8¢t ~as':i2:~°'~ ~' &'l~¢e~! ";~[ ¢ ~°~' ~q~N' :' ; ]~"'Yes' give da{° "0.6 ~ BELOW -- . INERT OFiDSTRIB~ION.LiNE ' : ':~ ~ ;~: ~;.; ' ' ,, ' ;~.,' ', " ' ' ~ ,,, ,, ,. ,, ;,;;;r ,,, i . . D. LIFT STATION Date installed ~"Pump on" level at in. SEPARATION DISTANCES "Pump off" in.. ~ High water alarm level at in. ,' Cycles te~ted ..Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: 100'-t- 100'+ ' N/A 25'+ ' , On adjacent lots ' .On adjacent lots 100'+ 100;+ Public sewer manhole/cleanout Holding tank N/A Septic tank/lift station on 'lot Absorption field on lot Public sewer main sewer/septic Service line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO~ '. "i~'.' i' Building foundation ~ ', 10'+ Property line ', 20'+ ', '.~Absorption field . · 15'+ Water main N/A - Water service line .10'+ Surface water 100'+ Wells on adjacent lots' 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT.TO: . · Property line 10'+ ' Building foundation 10'-t- Water~ main N/A Water service line 10'-!- Surface water 100'-!- . Driveway, parking/vehicle storage Cudain drain NONE KNOWN Wells on adJacentl°ts. 100'+ 5'+ F. COMMENTS ...... : 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 HAA guidelines in effect on this date. Engineer's Printed Npme JEFFREY A. GARNESS Date '4""// ~' /O'~r' Waiver Fee $ Date of Payment" · '.Receipt Number ,, 03-2g-04 04:51PU FROU-CT&E ESI, SGS ENV SERVICES S SGS Ref.# Client Name Project Name/# Client Sample ID Matrix 1041403001 Garness Engineering Group, Ltd. Knik Hts S/D L14 B6 Knik Hts S/D L14 B6 Drinking Water 90?5615301 T-836 P.02/03 F=163 All Dates/Times are Alaska Standard Time Printed Date/Time 03/29/2004 10:20 Collected Date/Time 03/22/2004 15:00 Received Date/Time 03/23/2004 14:40 Technical Directo¥ ~ Step~ejF~C. Ede Sample Remarks: AIl~wable Prep Analysis - Parameter Results PQL Units Melhod Container ID Limits Date Date Init Waters Department Nitrate-N - 0.100 U 0.100 mg/L EPA 300.0 B (<=10) 03/23/04 JJB Microbiology Laboratory Total Coliform col/iOOmL SMI8 9222B A {'<=1 ) 03/23/04 DKC Municipality of Anchorage Development Services Department . · Building Safety Division .' On-Site Water a~d Wastewater Program 4700,South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING -O.~Y-~'~ NAA#' /-il/) O I0 1,5'o Expiration Date: 1. GENERAL INFORMATION Complete legal description LoS I ~. ~/oc ~ Location (site address or directions) I ?- ~' ! Current Property owner(s) /'~¢,~,'~,,,', ~ ¢/-';~ t~,~l~,l' Dayphone '3~/5--'z$~O Mailingaddress I~$Ot Al-~e,-/o,~ ~,,~ /~^Cl~o,'~v~,e, ~ ~9~/~- Lending agen~ ~5~ ~o~, ~y~ o~1 Dayphone. ~-~8~ Mailingaddress ~8ot ~"~/.~ ~4o~q ~ e~o.7 RealEstateAgent ~r~y C~ ~ Dy~,c P~.Dayphone ~qq-o~y UailingAddress ~111 '~" ~t.~ 5~,~ tO~ ~o~ ~ ~ ~ Unless othe~ise requested, H~ will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well [] [] [] [] 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 5 by an Independent professional civil engineer registered in the State of Ataska. 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 cf issue for propedies served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (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 pmceduras outlined in the Health Authority Approval Guidetines for this application, shows that the on-site water supply and/or wastewater disposal system is(ara} 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 ell applicable Municipal and State codes, ordinances. and regulations in effect at the time of installation. Name of Firm ~(~/.-/.=,? ")',,c/~, c-,n/ .C<'r',,';~'/ Phone Address Engineer's Printed Name -'/'~,,=, ,=,fo ,'~' F'. ~c,o,.-~_ Date 5. DSD SIGNATURE I,/"" Approved for bedrooms. '~, .,- Disapproved. Conditional approval for . bedrooms, with the following st~pulabons: Additional Comments ~'/ 0N-SITE ~ W~TERX~D · ~,,~ ~-. ,,,~ .' ~, ', .- Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: L'il - ! "~ - 0 I Municipality of Anchorage Development Services Department Building Safe~ Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.ancharage.ak.us (907) 343-7904 HEALTH AUTHORITY ,AJ:~PROVAL CHECKLIST Lega~Descript~on: L'o~' lq: O'/oc~'~ /<',~,~' .~'.'x/O- Pamel ID: QCT-o:~f- WELL DATA Well t3q3~ P' v ~. If A, B, or C provide PWSID # Date completed 7//f/f$ ' ' Sanite~seal (Y/N) Y' Totaldepth J.,r,P__fi. Casedto ~4'0 ft. '.' FROM WELL LOG · ~, well Log (Y/N) T Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION in. Date of test 7/'/¥/9,~' ' Static water level ~' 7 fi. Well production II g.p.m. WATER SAMPLE RESULTS: "' : C~ilform (;:) Oolonies/lO0 mi. Nitrate ~O,b" mgJ1. Date of sample: ~//7. /OI C;oilected by: ,- ~ ft. ~', ~> g.p.m. Other bacteria ~:~ colonies/lO0 mi. SEPTIC/HOLDING TANK DATA Tank Type/Material ~'~.~, ~,- / 5'/~,, / Tanksize IZ$4~ gal. Number of Compartments Foundation cteanout (Y/N) ~' ~' Depressio~ over teak (Y/N) Date of pumping ~/~'/o ~ Pumper ,4*t* I'~,~,~ Date installed Cleanouts (Y/N) ¥ High water alarm (Y/N) Depression over field tv For ~ bedrooms New deptha'/, g' in. Dam insmll~ Len~ ~0 fl. ~d~ ~ fl. G~el bel~ pi~ ~ fl. To~ dep~ I ~ fl. Eft. ~so~ti~ area ~ · M~itoring tube . W Da~ of adequa~ ~t y/~/~t R~ul~ (Pas~Fail) ~ Fluiddep~inabso~fi~fl~dbe~ret~t ~ ~. Wateradd~W gal. Elaps~ Time: ~ min. F~al fluid de~T~. ~ ~. ~s~n m~ >= ~ ~ g.p.d. ~y rejuvenation ~ent ~t 12 mo.) ~/N & ~e) ~ If y~. g~e ~ ~.d D. UFT STATION /~/. ,,4. Date installed 'Pump on" level at in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump off' level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: - Septic tank/lift station on lot ~ I~"O' ~' · . Absorption field on lot Public ~ewer main Sewer Isepflc service line Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? in. · . ' . On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIClHOLDING TANK ON LOT TO: Building foundation ~. ~ ' Property line ~ ro ' Water main ~/. ,~., ' Wells on adjacent lots Water service line Absorption field SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Propertyline ~, ,'4)' Buildtngfoundafion '== Water Service line ~ tO ' Surface water ~, I=,o 0 Curtain drain ,~/o,~a Ye~,~ / . Wells on adjacent lots F. COMMENTS Surface water '~ ~o=, G. ENGINEER'S CERTIFICATION Water main ~'. R.. Driveway, panVJng/vehicie storage I certify that I have determined through field inspections end review of Municipal recon3b that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name T./I ~'o~"~ ,~ ~o,...(.' . Date' 7~'//~"; ~ HAA Fee $ Date of Payment R .e~. ipt Number (Rev. 12/00) Waiver Fee $ Date of Payment Receipt Number 0'4-.Q9-01 IT':36 FR~I-C1T E#¥II~I#EtlTAL ~__ CT&E F. nvtn~'.non'-J Serves thc. 5615101 - ToZt$ P.QZ/61 F-169 CT&£ Clleu! N~ M~triz Ordered By PWSlD We, Corn ~,s~t:nonC Nflr~c*N EPA 34)0.0 I 0 max 04/02,,01 To~ Co~re~n 0 col/IO0~T. SMI8 9~'?~R 04/0:2/01 (~.~/ DEPARTMENT OF HEALTH & HUMAN SERVICES '~ Division of E ~vironrnent~ Services ~ ' ~ . , ~ICIPALITY OF ANCHORAGE - ' . , ' ' , Ou-Site Se~ices Section' ~SNZA[S~Rg~C~SDiViSiON P.O, Bo~ 196650 A~chorage Alaska 99519-6650 343-4744 · · CERTIFICATE OF HEALTH AUTHORITY "- APPROVAL FOR A SINGLE FAMILY DWELLI'NG' : .aroe, GENERAl. INFORMATION Complete legal description Lot I Block C; 'Kh~k Heights Location (site address or directions) 12501Atherton Rd. Anchorage, AK Property owner ___Jerry & Kay Smith Mailing address 1 2501 Atherton Rd. Day phone 345-9508 Anchorage, AK 9951 6 Lending agency Mailing address Day phone Agent Bonnie Mehner/ Jack White R.E. Address Day ph°ne_ 762-31 37 Unless otherwise requested, HAA will be held for pickup. NUIViBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: Individual well xx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status c~f system. TyPE oF WASTEWATER DISPOSAL: 72-025 (Rev. 1/91) Front MOA #21 Individual on-site : ×× .H.°lding tank: _ : ¢,ommunitY On,site -- : Public sewer ; NOTE: If community WasteWate~sYstem; Provide written confirmation from State ADEC attesting to the legality:and status of system. STATEMENT OF INSPECTION BY ENGINEER As certified bymy seal affixed llereto and as of the validation date shoWn below, I verify that my investigation of this Health Authority Approval application shows that the on-site watersupply an~l/0r wastewater disposal ~ystem is safe, functional and adequate for the number of bedrooms and type of structu re indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files arid from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in corn pliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. . ' Name of Firm Address Engineer's sig nature _ ~r Phone 337-6179 cie ~ Date "7'/'7//~ ALASKA WATER & WASTEWATER SHALL BE PAID $675.00 AT CLOSING FOR THE ENGINEERING SERVICES PROVIDED. INVOICE SUBMITTED TO JACK WHITE REAL ESTATE. DHHS SIGNATURE !../__ Approved for ~'.~ U/~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Corn ments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72,025 [Rev. 1/91) Back MOA CZ1 Municipality of Anchorage DEPAR'TMENT OB HEAETH~A~HLIMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Health Authority Approval Checklist A. I WELL DATA Well type "~1 U~rT(F_ i Log present (~N)_, :Total depth :Sanitary seal (~). Date completed Cased to I .So ' Casing height (above ground) Wires properly protected (Y/N) . If A, B, or C, attach ADEC letter. ADEC water system number. Date of test Static water level Well production FROM WELL LOG AT INSPECTION WATER SAMPLE RESUI_TS:. Coliform ¢ Date of sample: (~-~l - c~ ~ Nitrate ~ [ ~,~.~/¢" Other bacteria Collected by: ~'~ L~ B. SEPTIC/HOLDING 'TANK DATA Date installed -~/~C~(~/% Tank size 'i Foundation cleanout (Y/N) ; Date of Pumping C~ ABSORPTION FIELD DATA Date installed I~coO G~ Number of Compartments ~ Depression (Y/I~) /t'Jo High water alarm (Y/N) Pumper ~' %,q,q¢_s Soil ratin rff~drm) 0,~ g.p.m. .___ Cleanouts ~l__~). 2 System type e [~E-~--~ · i Peroxide treatment (past 12 months) (Y/~ h ~'X ~-16f;cy If yes, give date Length ~0' Width '% ' Gravel thickness below pipe _ Total depth Effective absorption area ~6~~ ~*~. Monitoring Tube present~) ~ Depression over field ~/N) Date of adequacy test ~¢~ 1~(8 Results~/Fail) ~ For ~-~ bedrooms Fluid d¢~th in absomtion field before test (in.); (~" Immediately after FLuid depth ~6~ (ins) Minutes later: /~ Absorption rate = ~00~ g,p.d. LIFT STATION /'~///~ Date installed Manhole/Access (WN) High water alarm level at* Cycles tested Size in gallons "Pump on" level at* g//~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot. Absorption field on lot Public sewer main Sewer/septic service line / o6 ~ .¥ . "Pump off" level at* ~L///~ ._ On adjacent lots On adjacent lots /~0 F Public sewer manhole/cleanout_ ~-J/~+ Lift station SEPARATION DISTANCES FROM SEPTIC/I-I~I;~NG TANK ON LOTTO: Foundation I 0 ' .F Property line I ~ ~/- Absorption field / (~ Water main/service line l o % Surface water/drainage I Cv3 ~-F Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line [0 ~- Building foundation 10 I 4- Water main/serviceline / ca ' ~' Driveway, parking/vehicle storage area ~'~a~ Wells on adjacent lots /O ~ Surface water Curtain drain F. ENGINEER'S CERTIFICATION I certify that I ha/y~e.t~.~ ill conforman~ witI~/j Signature l ~.-~/~ Engineer s Name Date 7/-7/~ HAA Fee $ ' Date of Payment ~_~J~ Receipt Number z:'~' ~ ~// z~'/~x-.''~ 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number CT&E Clie~ Name Project Name/# Client Sample ID Matrix Ordered By PW,~ID 983255002 AK Water & W~tewater Services N/A Kn~k FII~, Lot 14, ~1~ C Dd~g Watez Sample Client PO# Printed Date/Time 07/02/911 16:15 CollectedDalo/Ttme 06/29/98 16:05 Received Date/Time 06/:30/98 10:45 Technical Directar: Stephen C. ~ ¢ol/qOOtoL SHI~ 93228 0,100 U 0.100 ~/L EPA 300,0 /'rep Anatys{s Date Oate Init 06/30/98 TMW 10 max 06/3C/98 06/30/9~ RHV T :~OM:i~ GASTALD! LAND .SURUEY PHQN~ 0 : 90~2489~62 .O0'9~t /~,O0,Z:O, O0 N L / / ,O0'!ii'l, [ M,,OO,Z~O,O0 N C~VO~ NOI'EI':IHJ.¥ Al~r. 16 2004 07:07AM Pl [2] MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 017-034-32 HAA # GENERAL INFORMATION Complete legal description Knik Heights Lot 14, Blk C Location (site address or directions) NHN Atherton Drive, Anchorage Property owner Jobun & Judy Hacjmeier Day phone 248-6789 Mailing address 2204 Cleveland Suite 201, Anchorage, AK 99517 Lending agency Mailing address Agent Address N/A Day phone N/A Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State AD~J~,~attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my inves_ti_gation 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. 694-5195 Name of Firm Eagle River Engineering Services Phone Address P.O. Box 773294, Eagle River, AK 99577 Engineer's signature Date DHHS SIGNA'rURE ~' Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev 1/91) Back MOA #'21 Municipality of Anchorage Department of Health and Human Services HEAl. TH AUTHORITY APPROVAL CHECKLIST Legal Description: ~/,//~ .~. Well Data Well type /)pC/L//¢¢zr% Log present (Y/N) ~//¥~ Total depth /~'" Sanitary seal (Y/N) ~/~ Parcel I.D. Date of test Static water level Well flow // Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed ~ - / ~,, ~ 2 ~ Driller Cased to /~-o ' Casing height Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION ~ rlA SEPARATION DISTANCES FROM WELL TO: g.p.m. / / / ; On adjacent lots Septic/heldiRg tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots Public sewer manhole/cleanout g.p.m~ % /GO ~ >/LA Petroleum tank >/D//-~ WATER SAMPLE RESULTS: Coliform ~- Date of sample: Nitrate Collected by: Other bacteria B. SEPTIC/~G TANK DATA Date installed _~7/~/~//9--~ Tank size /~-~P Compartments Cleanouts (Y/N) . ~/~-~ Foundation cleanout (Y/N) Ye ~ Depression (Y/N) High water alarm (Y/N) ~//~ Alarm tested (Y/N) _ Date of pumping /¢ //~ ~ /h:~) Pumper SEPARATION DISTANCES FROM SEPTICtH~b-E~NG TANK TO: Well(s) on lot 7~/U¢ On adjacent lots To property line ~/' / 0 / Absorption field Sudace water/drainage :/~/0(> / Foundation Water ma~lservice line '/' 72-026 {3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ested Meets MOA electrical codes (Y/N) _ .~"'- SEPARATION DISTA~[CE-F~(~M LIFT STATION TO: W~.Clcon-lSf'- On adjacent lots Manufacturer Manhole/Access (Y/N) .--f~ .._~~Level at Sudace water Z D. ABSORPTION FIELD DATA Date installed 7 - ~ ¢ ~ ?'~- Length _ ~ / Width Total absorption area ?Y"P Date of adequacy test/~///'¢ ' . Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil ratiI~j (GPD/FF) ~' Gravel thickness Cleanout present (Y/N) ~/~-.~ ./~/L~-/~) Results (pass/fail) . /~/¢~_5' System type ~',~L~'~/~/~-./- / J Total depth / / .Depression over field (Y/N) for .Z/ Bedroorns After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot '/- To building foundation On adjacent lots Surface water Curtain drain ~ On adjacent lots _ 7,/-/{.~ P [ Property line To existing or abandoned system on lot Cutbank /~//t~ Water main/service tine Driveway, parking/vehicle storage area /~'' E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in tiol~. Signature ,- ~;~ Engineer's Name Loui~ /k. t~uter41 ~ CE-6736 HAA Fee $ Date of Payment . . Receipt Number /c:~¥j ~/~) 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number ~c~ive~l Da~ 06/09/95 ~ 1~45 }~- Basle Remarks: 8AMPL~; CO-o]~C'TED BY: L,~. ~].lo~ble E~t. CT&E Environmental Services Inc. Laborato~ Div~slon r.a~.~rj, a-l,a,~,a,l.a-,ar.a~.a-.araragar~r,a~Jjj~f~jj~~ Drinking Water Analysis Report for Total Coliform Bacteria ~0o w. ,oito~ ~ Aneho¢~oe, AK ~9~lB-16OB READ INSTRUCTIONS ON ~EFE~E EIDE BEFO~ COLLECTING SAMPLE Tel: (907) 562-2343 Fox: (907} 561-5301 J ~alysis shows (h[s Water SAMPLE to b~,: ~'P~VATg WA~R SYSTEM o Sample over 30 hours old, re, suits may be unrolloble Samplo too long in transit; sample should not be over 48 hours aid at ,xamination to indica~ r~liablo rosults, Please send Date Received ..... ~P SAMPLE DATE: ~ SAMPLE 'i~YPE: D Repeat Sampl~ (f~r roudne sample with lab re~ no. ) o Special Pu~o~e S~LE LOCATION Day Year [] Treated Water Untreated WMor Time Collected Collected By An alysi~ Began Analytical Method: ~'/ Moilabrane Filter MMO. MS, JG * Nutllber ofeolonle~/lO0 mi. S~nl ~o A.D.E.C. ~ Fb~ Jun Clien~ notified of un*aliSractory res:Ills: Date: Time: BACTERIOLOGICAL WATER ANALYSIS RECORD [] CoiilmertL$: MMO.MUG Result: Total Coliform Verification: L,TB F,esl Caliform CnMIrmatton ENVIRONMENIAL FACILITIES IN ALA¢4'O~, CALIffORNIA, FLOflllDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI, Nk"W JERSEY. OHIO. W~I~T V{flGINI DATE-RECEIVEb r INSPECTION APPOINTMENTS TIME TIME TI DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR MUNICIPALITY OF ANCHORAGE DEPT, OF HEALI'H & DEPARTMENT OF HEALTH & BNVlRONMENTAL PROTBGT~IRONMEN'I'AL 825 L Street - Anchorage, Alaska 99501 OCT 2 1980 ( ~ ENVIRONMENTAL SANITATION DIVISION ~ Telephone ,64-47~0 REOUEST FOR APPROVAL OF INDIVIDUAL ~ATER AND SE~ER ~ACILITIES DIRECTIONS: Complete all parts on page l. lncomplete requests will not be processed, Pleasea ?w~en (10) days for processing. / PHONE . 1. PROPESZY ~WNER . MAILINGADDR~S ~ PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAI LIN~ A~DRESS ~L~NDI~G ~ST~TUTION ~ / PHONE MAILING ADDRESS // 4, REALTOR/AGENT - ~ PHONE MAILING ADDRESS 5, LEGAL DESCRIPTION STREET LOCATION , A~'~z~-_~_ ~,~ ,~/~, 6. TYPEOF RESIDENCE ~ SINGLE FAMILY [] MULT PLF FAMILY NUMBER OF~BEDROOMS ~] One [] Four ~ Two [] Five ,~ Three [] Six [] Other 7. WATER SUPPLY /~;,;~/~'~---/' ,~¢7'~ ~ ~TZ~ ~ NDIVIDUAL~ COMMUNITY /~_~. ~ PUBLIC UTILITY ATTACH WELL LOG. A well Io§ is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach tog if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSI~G~N BE INITIATED. 825 "L" STREET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR OEPAFtlMEN FOF HEALTI] AND ENVIRONMENTAL PROTECTION Syverson/Derrick Property October 8, 1980 Stephen L. Syverson Star Route A Box 1561U Anchorage, Alaska 99507 Subject: L3t 11 Block C Knik Heights Subdivision Approval for your individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report be delivered to this department from Chem Lab, 5633 B Street, for our review. (2) Fill in the depression around the cleanout to the tank. This will need to be re-inspected by this department when completed. If there are any further questions, please call this department at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw CC: ~nfac Mortgage Company 401 Eas% Northern Lights Boulevard Suite 2].2 99503 ALASKA ~BUIBO~ITI~B1-AL COF1TBOL S~RUIC~S, IBC. 1220 ~]¢sl 251h Auenue o Aachoraqe, Alaska g05o3 o {go7) 278-1361 ALASKA ~F1UIROFlm~F1TAL COF1TROL SeRUIC~$, IF1C. ~nqinee~'inq 6 ~nuironmenIol $ludies MUNICIPALITY OF ANCNORAGE DEPT. OF I-.'[ALTH & ENVIRONMSN FAL pFO [ECTION SEP 2 6 1980 RECEIVED 1220 ~esl 25th Aucnu¢ * Anchora§¢, Aie, sk(I 99503 · [907) 276-1361 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ,8. Date Received Time of Inspection Date of Inspection Mailing Address: Property Owner: Mailing Address: REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Phone: Phone: Type of facility to be 'inspected .C//~J/~/~-/:~.¢)/:/ No. of bedrooms Well Data: A. Type.~~ C. Construction ~~~ Sewage Disposal System: A. Installed ~m. C. Septic Tank: 1. D. Seepage Pit: 1. B. Depth /~/ D. Bacterial Analysis /??/ B. Installer Size /~"Jz:_.,'::.,..~.t/,,/ 2. Manufacturer Absorption Area //~-.~?~:~"~./>:::- 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank ~ , Absorption area ., Sewer Lines Nearest lot 'line B. Foundation to septic tank , Other contamination /'~' / , Absorption area C. Absorption area to nearest lot line EQ-O34 (1/74) Page 1 of two pages GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CIqRO VA FHA **** 2. Property Owner: Syverson, Stephen L. & Sheryl Mai-ling Address: sR~ Box 1581 B, Anchorage! Ak. Day_ Phone 3, Name of Buyer: same as owner Mailing Address: Same as owner ~O,a,y Phone 4. Name of Lending Institution: Amfac Mortgage Corporation o Mailing Address: 705 W. 6th Avenue, Suite 201 Name of Realtor or Agent: None Mailing Address: 277=8588 Phone Phone Lot 11, Block "C", Knik Heights S/D CONV 344-8549 Same as owner 6. Legal Description: Location: NHN Atherton Road (Third Home on the left) 4 Type of Facility to be inspected: Home No. Bdrms. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served 1 If Individual, depth of well 142 ft. Sewage Disposal System Type of System: Public Utility *** If Individual, date of installation Individual (on-site) June, 1971 EQ-037 (1/74) Page 2 of two pages - Re ~st for Approval of Individual · ,er & Water Facilities Legal Description Approved ~, ....... proved Approval Na'lid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)