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Home My WebLink AboutKNOLL ON THE WOLD BLK 1 LT 4Knoll of the Wold Block ! Lot 4 #041-031-53 Permit Number:. SW020289 LOP, AN &: DUBY BAXTER USAEDA CMR 410 BOX 423 APO AE 09096 Phone: No, of BedrOOml: (011 ) -49-6131-627-9587 4 LEGAL DESCRIPTION I 4 KNOLL ON THE WOLD Municipality of Anchorage Development Servlces 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 On-Site Wastewater Disposal System and/or Well Inspection Report PID Number:. 041-031-53 [] Upgrade~ WELL: [] New Wastewater System: D New Tank SEPARATION DISTANCES TF.~ SEp~ ,~,~__l~d~on Uft Tonk Slot]on Page 1 of 3 · Upgrade ABSORPTION FIELD ID#p Trench O$holk~w Trench DBnd [:]Mound C]Ot~r 1.2 ~ ~ 10 M~ ~ SEE DWO n 7 ~ SEE DWO ~ 45 n 2.5 ~ 1 - n 630 ~.~ D 3034/ F-810 ~C, INC. 9/6/02 TANK · Septic ~ Holoqng 13 S.T.F..P. ANCHORAGE TANK 1250 Well 100'+ 100'+ - - Surface Water I00'+ 100'+ - - Lot Une 5'+ ' 10'+ - - Foundation 5'+ 10'+ -- -- Curta;n Dmin N0tNE KNOWfl Remarks: OLD SEPTIC TANK WAS PUMPED AND RUED WITH DIRT. N/A STEEL ~ - LIFT STATION BENCH MARK TOP OF CONCRETE SONATUBE AT COLUMN ON SHED Inspections performed by: AKWWC, INC. Dates: 1st 9/6/02 2nd 9/6/02 3rd 9/11/02 Development Services Department Approval R~viewed and approved by: ~j ~ ~ Do,e: /~/,,'/-- i I I I UT2 2 DSL4-~ / / I \ 1250 GALLON SEPTIC TANK \ \ ~RESERV~ S~ ./ \ / HOUSE \ x DSL! 84.53 45.07 ~ ~ DB~2 65.8.1 48,65 PTIC "ST1 87~1 52.64 ~ 74.86 ~.04 SUMP 107.62 95.37 AI..ASILA WATER & WASTEWATER °~'~ ~.~;.o. , · CONSULTANTS, INC. 1 LORAN A DUBY BAXTER 011-49-61~1-627-9587 2 KNOLL ON THE WOLD SUgOIVI$1ON; LOT DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE SW020289 241-051-55 TOP OF' TN~K AT INLET . 100.7~..,_ IN~ OF 8UNO AT IN~ ~ 1~.12~ NEW 1250 GALLON SEPTIC TANK FINN. GRN~E - 104.7 - 105.35 .~TOP OF TANK AT OUI'~ -- 100.7 ~N'.~R~ O~ Bt.~G AT OUT[ET ~ gg.91 F1NN. ¢~.~F' . g4.47 93,28 · HIG~!E:s"r POINT I~ OF PIPE - 90.26 NO CROUNDWATER :.. /-RELATNE ELEVATION NO BEDROCK ,~ / AT BOTTOM OF TH !o7' - ~.7~ ALASKA WATER & WASTE~VATER CONSULTANTS, INC. LORAN &: DUBY BAXTER 011-49-6"151-627-9587 KNOLL ON THE WOLD S/D: LOT 4; PROFILE DRAWING OF SEPTIC SYSTEM UPORADE 9/15/02 DRAWN BI": B.S.O. $¢..,.~ N.T.S. 50F5 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 Upgrade Date Issued: Aug 13, 2002 Expiration Date: Aug 13, 2003 Permit Number: SW020289 Legal Description: KNOLL ON THE WOLD BLK 1 LT 4 Design Engineer: 0041 AK Water & Wastewater Consultan' Owner Name: Loran & Duby Baxter Owner Address: USAEDE Total Bedrooms: 4 APO, AE 09096- Parcel ID: 041-031-53 Site Address: Lot Size: 45263 SQ. FT. Permit Bedrooms: 4 This permit is far 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: Issued By: Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.a k.us (907) 343-7g04 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 041-031-53 Permit Number Properly owner(s) LORAN & DUBY BAXTER 011-49-6131-627-9587 Day phone Mailing address (1) USAEDE CMR 410 BOX 42.3 Mailing address (2) APO. AlE Legal description (Lot, Block & Sub'd.) Zip Code 09096 KNOLL ON THE WOLD S/D: LOT 4 ~l~-Y-.I Legal descdpUon (Section, Township & Range) Lot Size /-.~5o-~ (o.'~ Acre~ THIS APPLICATION IS FOR: Sewer Only []~ Sewer and Well Sewer Upgrade [] N/A Number of Bedrooms 4 Well Only Water Storage THIS PROPERTY CONTAINS: Hot Tub [] Jacuzzi [] Swimming Pool [~ Water Softening Unit [] Therapy Pool I certify Ihat 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. ALASKA WATER & WASTEWATER CONSULTANTS, INC. (Signoturc of propcrty owncr or outhorizcd egcnt) Permit Fees:~J{ 4 ~{).~" Date of Payment: ~'l~l Receipt Number:. ,~5~ Iq Waiver Fees: Date of Payment: Receipt Number: ALASKA WATER WASTEWATER CONSULTANTS, INC. August 8, 2002 Municipality of Anchorage Development Service Department Building Safety Division On-Site Water 8,: Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 4, Knoll on the Wold Subdivision To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system consists of' a 1250 gallon septic tank and a deep trench type drainfield. The drainfield is completely surcharged and must be upgraded. A test hole was excavated north of the existing septic system in the area of'the upgrade. The septic system will be designed around the 30 foot radius of this test hole. We are proposing that a new 1250 gallon septic tank and a deep trench type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. TRENCll DESIGN: a. Percolation Rate: 4 minutes/inch b. Proposed Application Rate: 1.0 gallons/day/ft2 c. Number ofBedrooms: 4 d. Design Flow: 600.gallons per day e. Minimum Absorption Area: 600 ft2 f. Total Depth: 10.5 feet (max.) g. Effective Depth: 7 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 45 feet total length k. Effective absorption area = 630 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPIIY: As can be seen on the attached topography site plan, the average 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: {907) 338-3246 * Website: akwwc.com topography in the area of the proposed drainfield is a 10% to 15% slope running from approximately southeast to northwest. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincereli,' ^~ NOTE: Attached is a site plan drawing, a design drawing, a topography site platt, a soils log. and a 7 page construction speci, fication letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com LOT 11, BLOCK 1 KNOLL ON IHt WOLD (SEE DESIGN PACt 2 Or 2) I I I LOT ,R, BLOCK KNOLL ON l~r WOLO LOT ~, BLOCK 1 KNOLL ON "Il. Ir WOLD $/D LOT 12, BLOCK 1 KNOLL ON THE WOLD AI SKA WATER & WASTErS, WI'ER 8/7/2002 DRAWN BY: SCALE: 1" = 100' PAGE NUMB[R: 1 OF2 I I ! ..... CONSULTANTS. INC.- PR[PARED FOR PHONE NUMBER: LORAN &: DUBY BAXTER 011-49-6151-627-9587 LEGAL DESCRIPTION: KNOLL ON THE WOLD SUBDIVSION; LOT 4. TYP£ OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE / ! E~(IST1NO 4 BEDROOM HOL~E LOT 1, BLOCK 1 KNOLL ON THE WOLD LOT 2. BLOCK 1 KNOLL ON 'fi*Ir WOLD S/D DRAJNFIELD. EXCAVATE A T~ENCH THAT IS 10.5 ~.t.l OE[P MAXIMUM BY 2.5 FEET WTDE BY 45 tLLl LONG. ADD 7 W'LLi OF' CLEAN, WASHI~] SEWER DRNNROCK. INSTAU. /' TRENCH pARa,FL TO SLOPE CONTOURS~/ / / FLOW ON~'RT-LRDOUBLE CLE~OLrrS INSTAL[ FOUNDATION \ \ 1250 GN. LON SEPllC TN'JK SE AI~ANOONED pER UPC~.~ ~ EXI~-T~NO DRNNFIrl n ALASKA XVATER & WASTEWATER --- CONSULTANTS, INC. PREPARED FOR: PHONE NUMBER: LORAN &: DUBY BAXTER 011-49-6151-627-9587 t.[GAL DESCRIPTION: KNOLL ON THE WOLD SUBDIVISION; LOT 4, T'tPE OF WORK: DESIGN OF' PROPOSED SEPTIC SYSTEM UPGRADE 100' DATE: 8/7/2002 DRAWN BY: C.J.G. SC.N-E: 1" = 40' PA(;[ NUMBER: 20F2 \ ('-SEPTIC AI.a~SKA WA'l/ER & WASTEWA'I ER JSOIL LOG - PERCOLATION TESTJ . LECAL DESCRIPTION: KNOLL ON THE WOLD S/D; LOT 4 ~Oi~_l'.. PERFORMED FOR: LORAN & DUBY BAXTER DATE: 7/26/2002 qj~.ee.-..~ -, ....'<,~._~ ~:~ ,,~ · ....... _~ I~EPT~4 ~ i,,t) _~_~! ORGANICS )TEST HOLE 19-- 20 SOILS LOGGED BY: COMMENTS: GM & SM SOIL CLASSIFICATIONS :.~,, GW - * ORG ~ GP ~ ML ~ GM ~ CL GC ' ' OL ,, SW MH SP CH SM OH SC DEPTH TO GROUNDWATER DATE DRY 7/26/2002 DRY 8/2/2002 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 7/.10/2002 1 .1:40 - 6" - 2 ,3:50 10 3" ,3' 3 3:50 - 6" - 4 4:00 10 ,3 1/2' 2 1/2' 5 4:00 -- 6' -- 6 4:10 10 3 1/2' 2 1/2' 7 4:10 - 6' - 8 4:20 10 3 1/2' 2 1/2' 9 4:20 - 6" - 10 4:30 10 3 1/2' 2 1/2' 11 4:30 - 6" - 12 4:40 10 5 1/2" 2 1/2' PERCOLATION RATE 4 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 7.0 FT. AND 8.0 FT. A FOUR HOUR PRESOAK WAS PERFORMED: [] YES [] NO JEFFREY CARNESS PERCOLATION TEST PERFORMED BY: ZACHAR~-I CALL PERFORMED BY AKWWC. INC. I. JEFFREY A. GARNESS, CERTIFY THAT THIS WAS/PERFORMED WITH ALL STATE AND MUNICIPAL GUIDEUNES IN E~LCT ON THIS DATE: IN ACCORDANCE II r 12. BLOCK 1 ON THE WOLD LOT ON ~ KNOLL NAM~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/~-)~ WELl_ INSPECTION REPORT PHONE T~N EW 7q5 -3-a~.~ I [] OPORADE MAILING ADDRESS LOCA~.~ON Well DISTANCE TO: ~ z Manufacturer Absorption area Dwelling Material IWidth I?ide length ~ ~ufacturer ~~ ~aterial jWell ~ . Foundation /~ ~. INearestlotline D]STANCE TO: ~ / ~ ~ ~ [ No. of lines /~ j Le~g(J,~f ~ac~e Total ,engt] of Ii'ds ' Trench Top of tile to finish gra~ ~ ) ' ~ Materia~)ene~ the NO. OF BEDROOMS PERM,T NO. o~/O ~,$p~ Liquid depth Length //% ~pf'"cr ib ~ DISTANCE TO: Class DISTANCE TO: PERMIT NO, PERM,T NO. 2/¢' Distance between lines Crib diameter Depth Building foundation OTHER PIPE MATERIALS Total effective absorption are¢ PERMIT NO~.. //' Cri b d"~ -~J~a' effectiv%orption areaW" Buildi'ng 'o'~'.~L, Nearest lot line ~ / Driller Distance to lot line Sewer line SOIL TEST RATING //~// INSTALLER ff / REMARKS Septic tall k PERMIT NO. Absorption APPROVED 72-013 (Rev. 3/78) DATE LEGAL THE L. ENGTH E:, I MEN:S )Z ON IS THE LENGTH ,::IN FEET) OF THE TRENCH OR DRFIINFIELE:,. THE:: .................. ' .... _ [.El-. t~.t OF 1::I ~t~EI,I_.H fir PIT ZS T..E [:,ISTFINCE BETNEEN THE '= F..'FFI'*~=~. CF '1"1...11}~ '*T GROUi',ID FIN[) THE E;OTT]M OF' THE THIEF.':E ZS i'.,IO SEE]" I.,.II[:,TH FOR 'I"REI'..If.';:HES. THE ._R ,I=L. [:,EF'TH I::]; THE MII'.4IMI...II"I [:,EF'TH OF GRFI',/EL EETI.,.IE::21'.I THE OUTFI=ILL PIPE FIND THE ['2, O"I"TOM OF:' THE EXCFI',,,'F:ITZOI'.! ,' IN F'EE'I"). J ~:~:/.= ~.]c,;~ ~.,..lt % IF;~.'. EE ~:::, %i!; E: F::" *'IF" % C:: .... C' IF:~ IP,i~ ~-.::Z :'%5; % ;:¢.~Z E:E .... :::;L ;Z;-;'~: ,".Sf.;~ ~Z-Z~ ~,]ii f:::~ L. ii.,,...., ~]} ~'..,,il .'.'EE;; I:'ERM I "1" I::hC'F'L I C:RNT t. IFr. S THE F;'.ESPOI'.,I:!.:; I B t L. I 'f"¢ TO I NFORN TH ]; 5; [:,EF'RRTMEI',I]" E:,IJ,~;~: I l'.~l]i THE ! N':]i;TFtl..J....,q]" I ON ]; NSPECTZ ON'..'~ OF Fli',l"r' I.,.IELL. S FID.'rFICEN"f' TO 'r'H :[ S !='ROF'EF.:T'¢ FiI',![:, THE t'-,tUME:ER OF:' RE% I [:,ENCE'.;!; "r'l.-IR'l" "I'HE I.,.IELL I.,.I ILL :SER'v'EE. 8RCKF:'ILL. I NG OF RN'?' :.:.i;"¢:STEM P~I THOUT F:'i NRL II'.,ISPEC:T I ON R;'.,ID RPPRO',/RL B'¢ THZ 5; DEF'RRTMEI'.,KI' NILL E',E :SUBJECT TO PROSEC:UTIF$1. MIN].'i"P...li','I [)I:.S]"I::tt',IC.:E E:E;TNEEN F:l P4ELI._ FI~.,ID FII",I'¢ ON-SITE SEt.4FIGE [:,I:SPOE;FIL. 2S"r':E;TEM ];5; :Z.I;~EI F:'EET FCIR ¢::~ PRZ',/FITE NEL. L OR :;LS.~E~ TO ;2:E~EI FEET FROH F1 PLIBLIC t.,.IELL. DEPENDING UPON THE T'¢F'E OF F'LIE',L. ZC NEL. L. r,I]:NZr,IUM [:,ZSTFINCE FROM Fi PI:;;'.Ik,'FI]"E P.tELL. TO FI F'RZ',/FITE SEI.,.IER LINE TEl FI COMMIJI',IZ T"r' SEt.,.tER L]:NE ;I:S 75 FEET. !'.!ELL. LCICi~E; FIRE RE(;¢..I]:REI} FII',II} MUST E:E RETURNED TO THE E:'EPRRTI"IENT I,~I'I"H:[N :~:E~ [)l:::]"r':~; OF' TH~ HE:LL. COklPLE"f'ION. OTHER RE6!U ZREMENTS MFI"r' RI::'PL"¢. 5F'ECi F i C:RT I ES,IS f:ll"4[::' E:I]NSTRUCTI ON DI RGI:;;'.Fd"1:S RRE Fl","f:lI L. FIEsL. E TO II",I$URE PROPER I NSTF:IL[_RTI ON. ]: CE,~;:"f' I F'¢ ]]'"lWf' :J,,; it.' FIM F:FIMILII=II~: P,IITH THE RE',6~U~REMENTS FOR ON-:SITE 5~I'.IERS RND P~ELL.'.S FIS SET FORTH B~'r' "r'H~ MUN~C~PFtL.~"I"'¢ OK FINC:HORFiG~. 2: I I.q~LL INS"f'FILL, THE S"r%TEM ~',I FICCORDFINCE t.4~TH THE CODES. ]:: I L.INDIERS'f'F:IN[:, THFI"f' THE ON.-.S; SEP.IER S'.,.'SI"E PIFI'¢ REI;~IJIRES ENLF:IRGIEMENT IF' ]"HIE RESiI}ENCE ]:S; REMODELEI} "l"l]) It",ICLI. M(]f;;:E: :EE:,ROE$1S. G I GNE[:,: FIF'F'L Alaska Testlab 4040 "B" Street Anchorage, Alaska 99503 Phone (907) 270-1551 ( Te[ecopler (907) 272-5242 ) June 5, 1981 Bob Milby P.O. Box 3114 Palmer, Alaska 99645 Re: Test Hole ~4 ATL Report A18859, Dated May 22, 1979 Dear Mr. Milby: The soils of Test Hole #4 are referenced as Group A and Group B in our report. Group A soils are found extensively in Test Hole #1 which had a measured percolation rate of 3.6 minutes/ inch. Since the soils of Group B are even cleaner and more permeable, it is our opinion that a percolation rate of 5.0 minutes/inch is quite conservative. The system can be placed anywhere in the zone from 6 to 15 feet below the ground sur- face. Very sincerely, MRN/m9 Attachment ALASKA TESTLAB Melvin R. Nichols, P.E. Manager / / --4 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 ~ --~/-- -~ NAA# GENERAL INFORMATION Complete legal description Mailing address Lending agency Mailing address Agent Address Location (site add'ress or directions) Property owner Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3, TYPE OF WATER SUPPLY: Individual well Day phone ~5 .m ,~ .7~-~ Day phone :¢'~ ~/~/ Day phone Community well Public water NOTE: If community well system, provide written confirmation from State ADEC 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. 1191) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER Address Engineer's signature ~.~~ 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, lfurtherverifythatbasedontheinformationobtainedfrom the Municipality of Anchorage files and from my investigation and inspection, the on-site water ~upply 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 ~¢'r-'-j..r'~-- % ~/~..¢~¢/~.~5' Phone .--~"-~ Date DHHS SIGNATURE ~/~ Approved for ~,-LZ~? Disapp ~o'ved. Conditi~)nal 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. 72~25 [Rev. 1191) Bacx MOA #2! ( Municipality of Anchorage DePartment of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~-- ~ z¢~/ /~'~0/'// ~ ~',~'- /,~,~//~ Parcel I.D. t'~) y/ A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed Cased to ./.~// ADEC water system number /Y/'// Casing height /"---~" / Wires properly protected (Y/N) / Date of test Static water level Well flow Pump level FROM WELL LOG /¥ SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot //'~"~¢Zz / Absorption field on lot ,-/~.¢ .,~ / Public sewer main Sewer service line g.p.m. AT INSPECTION ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout /¢¢v/~-'p et role um tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: Nitrate d2/~'~ /' "~ Other bacteria Collected by: '~' -¢~/~'J'~'" S.PT,C/.OLD,. TA. D^T^ Date installed · , Cleanouts (Y/N) High water alarm (Y/N) Tank size ,/~-'~.'-~¢~'2 Compartments ~ / Depression (Y/N) Foundation cleanout (Y/N) / //'/,/¢ Alarm tested (Y/N) /d//'/¢ Date of pumping SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot //'~,/,/' On adjacent lots To property line .~/~ / Absorption field Surface water/drainage ,~/0o Foundation Z'//~' Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE / C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot //'/¢ On adjacent lots Surface water /¢/'/'~ D. ABSORPTION FIELD DATA Date installed Length .._%-- O" Width Soil rating Gravel thickness Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Cleanouts present (Y/N) Date of adequacy test for System type Total depth / / bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ,.//---~ 2 On adjacent lots ":>/'~ ~¢ / Property line To building foundation ~ ~ / To existing or abandoned system on lot ) On adiacent lots ,.>/~-2-"o Cutbank /1./,,~ Water main/service line Surface water /V'/~ Curtain drain ,/t/',~' / Driveway, parking/vehicle storage area ,-~ D" E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date HAA Fee $ /,? ¢¢¢ (2 Date of Payment Receipt Number 72-026 (Re,,'. 3/91) Back MOA Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVI.qlON OF COMMERCIAL TESTING & ENGINEERING CO, 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: {907) 561.8301 ~&LIBI~ RE.qULY$ for I~/O1C~ t 56~77 : 3UL 24 92 I 08:00 htG. Laboratory ~upe~mo~: ~T~IP~EN C, E~DE ~ ~P0t : Units Msthod ..................................... i Tests P~rfo~d ' 3~0 Special InmtructiOns Above ~D. Hone Dota~tad "See Sa~plo Re~rk~ kbove MUNICIPALITY OF ANCHORAGE, Department of Health & Human, Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 ,, Parcel I,D, Cf CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING (~/-~ / - [("}_~ I - ~-~,~ NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4; Block I; Knoll on the Wol~ Location (address or directions) 9100 Teri Circle (b) Property owner Sanders ;Telephon.e: (home) . Business Mailing Address 9100 Teri Cire.~.e, Anchorage, Alaska (c) Lending Institution Mailing Address C~. M. A. 0.. Telephone (d) Real Estate Company and Agent Address 2600 Cordova Street Telephone 276-2761 RE/MAX PROPERTIES ATTN: Charlotte Sch~osstein Suite 100 Anchoraqe, Alaska 99503 (e) Mail the HAA to the following address: (or check hereJig(Xf hold for pick up.) List contact person and day phone number below: S & S ENGINEERING 17034 Eagle Ri,vet Loop Road No~ ~ Eagle River, Alaska 99577, 2. TYPE OF RESIDENCE Single-Family~[X Number of bedrooms 4 3. WATER SUPPLY Individual Well Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, Iverifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional.and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my' investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Telephone S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 9~577 Name of Firm Address Date 6. DHHS APPROVAL Approved for Approved __ bedroomsby ~~: ~ Date Disapproved Conditional Terms of Conditional Approval The MunicipalityofAnchorage Department of Health and Human Services(DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraphSabovebyan 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 DHHSdonotconductinspections 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authorlty Approval (HAA) .;.c:i/,,L/v,O. HE.C~I"IST-;~i F. ,EBRUARY 1984 Legal Description: ~ ~ r~ [ Pump Set At Sanitary Seal on Casing((..t~N) "-/ Depression Around Wellhead (Y~) A. WELL DATA Well Classification Well Log Present ~(5~) ~ Date Completed Total Depth ~?~'¢- Cased to [~Z"~ Depth of Grouting Static Water Level / Casing Height Above Ground t~'~ ~ Electrical Wiring in Conduit4:~/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field qn Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by ~'~-~ ~-~'~ I~--~le~'~ ; Date Water Sample Test Results ~¢~\~'~' /:~-~-'~-"( ; On Adjoining Lots \ \"-4~¥ ; On Adjoining Lots \ To Nearest Public Sewer Cleanout/Manhole , I Comments B, SEPTIC/HOLDING TANK DATA Date Installed'~.:)~t-~-~3~ Size Standpipes (,~/N) 7 Air-tight Caps4_1~TN) Depression over Tank (Y/~) Pumping/Maintenance Contact on File (Y/N~ Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water-Supply Well To Property Line To Water Main/Service Line No. of Compartments ~ Foundation Cleanout ¢~N) ~ ! Date Last Pumped /~ ~ \ \ - ~ ~ 14'//~ ; for ~ -- Temporary Holding Tank Permit (Y/N) ~//A To Building Foundation To Disposal Field To Stream, Pond, Lake or Major Drainage Course Comments A~ ~:)~'~¢--' ~:~--~-F-~---~ 72-026 (Rev 7/88)Front Page 1 of 2 Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~-\~ -~) \ Length of Field Date Installed I Width of Field ~ Depth of Field \ Gravel Bed Thickness ~6:) c;>'~f~Statndpipes Present 4:~¢7N) p4 Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: Type of System Design To Water-Supply Well \ "~"-~'~ ~ To Building Foundation/ Lot ~/lg To Water Main/Service Line \ b To Stream, Pond, Lake, or Major Drainage Course \,._~I...~L_ To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots / To Cutback (if present) Comments D. LIFT STATION "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ........ __Vent (Y/N) -PB~rping~Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect,o~ e date of this inspection, Signed S & $ ENGINEERING ~' ~ ~ ...... ~ '"~'~ ' .. .... 17034 E~gle River Loop Roa~ No. 204 Company Eagle ......~ ...... ~.~ . ~ / ~'~ ~> / Receipt No. ./~- ~/ ~ - ~-~ Waiver Fee:$ / ~ '¢~ Date of Payment Receipt No. Date of Payment Amount: $ 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & G,E~OLOG~'CAL .LABORA~O~L~LS OJ; A/~A;~'(A, /li¥C'~ FEDERAL 'lAX ID # 92-0040440 0ate gep,'al, [h,:zm,:d I~F.C i~ ~-9 ~ fi:O'; P.O ii llOtlll DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE / / INSPECTOR INSPECTOR INSPECTOR,,.,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION~vlUNICIPAUTY OF ANCF~ORAGE 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER ANDSEWE DIRECTIONS: Complete all parts on page 1, Incomplete requests will not be processed, Please allow ton (10) days for processing, MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3, LENDING INSTITUTION ~ I PHONE I ~AILING ADDRESS 4. REALTOR/AGENT ~ PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [~ Four SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 7, WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev, 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS .[~]" ' SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO ,,~] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY ~ INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3, SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~JN~)IVI DUAL/ON -SITE DATE INSTALLED PUBLIC UTILITY ~t Connection Verified INSTALLER []Septic Tan~k or [] Holding Tank ,~;-/] Size: / ~)~i ~ If Tank is homemade SOILS RATING give dimensions: / )/ ,~'~' TYPE OF TANK "~N/ MANUFACTURER ~., TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area JSewer Line J Nearest Lot Line WELL TO: / ,~"(3I /.') I Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79)