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Home My WebLink AboutTANAINA HILLS LT 17 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231129 PID Number: 011-051-20 Dwelling: N Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑Q Upgrade Name CROPPER ABSORPTION FIELD 0 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7021 KITLISA DR ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.8 GPD/SF 9 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 6 Ft. Subdivision Block Lot TANAINA LILLS LOT 17 Fill added above original grade 0 Ft. Gravel length 63 Ft. Township Range Section Gravel width 2 Ft. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 756 Ftz Ft. Well 1001+ 1001+50'+ TANK 9 Septic E]S.T.E.P. [0:1Holding [3Other Manufacturer Capacity GREER TANK 1250 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 10'+ 101+ NA PLASTIC 2 Foundation 10'+ 101+ LIFT STATION Manufacturer Capacity Remarks TANK DEMO PER UPC, Gal. Alarm location Electrical installed by Tank to PIPE MATERIAL House to tank 3034 d3034 Installer MIKE N ANDERSON, P.E. rainfield Drainfield 3034 CO/MT3034 Inspector MIKE N ANDERSON, P.E. BENCH MARK (Assumed elevation) 102 ft Ins 1,16/16/23 8/17/23 Location and description eat sn 2� TOP OF MANHOLE 102 3rtl 41h ON-SITE WATER AND WASTEWATER SECTION APPROVAL�QQ*Oer�Stamp .� Q At Conditional Approval: Date 1 •.;.y.'?, ,, 49LI • . .. . .. . . yo•.• MICHAEL t1. A1DtRSCI� '9 •� Septic System/ j Approved f�^ , c>V 9 t;"°;,'•.[e/qt-••``'� �_ Date6nts. Not this approval does not include well permit requirem%ti fist r5=�,o�•- 0111,► tmev uolcu 7 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program s' PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite r Department On -Site Wastewater Disposal System Permit Permit Number: OSP231129 Effective Date: 6/14/2023 Work Type: Septic Upgrade Expiration Date: 6/13/2024 Tax Code Number: 01105120000 Site Legal Address: TANAINA HILLS LT 17 G:2123 Site Mailing Address: 7021 KITLISA DR, Anchorage Owner: CROPPER RYAN Lot Size in Sq Ft: 42300 Design Engineer: FIRST WATER CONSULTING Total Bedrooms: 4 This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: 5 S �(� TO I% LIL Date: 1 Issued By: Date: UH C P \ T '\\f OF HCH0F-\z GE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 011-051-20 Property owner(s) RYAN CROPPER Day phone Mailing address 7020 KITLISA DRIVE, ANCHORAGE, AK 99502 Site address 7020 KITLISA DRIVE, ANCHORAGE, AK 99502 Legal description (Sub'd., Block & Lot) TANAINA HILLS LOT 17 Legal description (Township, Range & Section) Lot Size 42,300 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field 0 Initial ❑ Single Family (SF) x❑ (w/wo ADU) Septic Tank ElUpgrade M (D) ❑ Holding Tank ElRenewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 4 5� ,5_ #3!55T7 Waiver Fees: _ Date of Payment: 6/3 Date of Payment: Receipt Number: 1 IZC6,6 ()/3135 Receipt Number: Permit No. Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! June 9, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: TANAINA HILLS LOT 17 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench and 1500-gallon HDPE septic tank to serve the existing 4-bedroom residence. The design is based on the 1986 existing test hole data conducted by Tobben Spurkland, PE. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 3-8% at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231129, Curtis Townsend, 06/14/23 Performed For: Legal Description: Municipality of Anchorage Development Services Department On -Site Water and Wastewater Section 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 WWW muni hrrl/on41tP (907)343-7904 Soils Log - Percolation Test 4 fyi,; .yI!A!7. V(9 Re t \y' Date Performed: Township, Range, Section: 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18• 19- 20 - COMMENTS 40IA4 & Noo r WAS GROUND WATER ENCOUNTERED? �Q s IF YES, AT WHAT DEPTH? L 0 Depth to Water Ager r p Monitoring? LP E Date: ALO Reading Date Gross Time Net Time Depth to Water Net Drop •• ..49T..H '- ......`°� . .... A ••• MICHAEL N. ANDERSON d i•'. CE -9469 V. •��. Soils Log - Percolation Test 4 fyi,; .yI!A!7. V(9 Re t \y' Date Performed: Township, Range, Section: 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18• 19- 20 - COMMENTS 40IA4 & Noo r WAS GROUND WATER ENCOUNTERED? �Q s IF YES, AT WHAT DEPTH? L 0 Depth to Water Ager r p Monitoring? LP E Date: ALO Reading Date Gross Time Net Time Depth to Water Net Drop Fz. 0 � I t, S✓/ PERCOLATION RATE `"( (mint ranch) PERC HOLE DIAMETER V F TEST RUN BETWEEN FT AND 4, 45— FT PERFORMED BY: tz1-4.1 CERTIFY THAT k' HIS TEST A PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DA E: 74 Z W W WELL K I T L I S A D R I V E 30' 30' LOT 16 LOT 10 LOT 11 W FIRST WATER CONSULTING TANAINA HILLS LOT 17 DESIGN CALCS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC SYSTEM NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231129, Curtis Townsend, 06/14/23 FIRST WATER CONSULTING DESIGN DETAILS: TANAINA HILLS LOT 17 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231129, Curtis Townsend, 06/14/23 N ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: TANAINA HILLS SUBDIVISION LOT 17 PLAT 65-83 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul( any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary haes. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any casements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: EMAIL; VI L, MAY 29, 2023 "=40' schullerOak.net 23-040 DRAWN BY; ICHECKED BY: GRID NUMBER: B-06-K/PAGE: JLS SW2123 230151 * - FND 5/8" REBAR '"4'USINA. MWAft4wW 1 StjR AM 0 F 4 L-A 4�' 49TH4 �K ...................... *JOHN L. SCHULLER: 0 LS -10408 1831 Talkeetna Street 6 AMW Anchorage, Alaska 99508 Ar �,O�\ ANW Ofession& \' (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE DB ITMEN'r OF HEALTH AND HUMAN SER~, ZS Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELl.. INSPECTION REPORT Address LEGAL DE$CRIPT[ SEPTIC E~(.,~,~_.~jG [] HOLDING 'l ' TYPE OF SYSTEM _~?,~R E N C H [] BED J, W. D[IAIN E] OTHER Total depth from original grade ~ FT P,pe material '~'/ Date Installed FT ~ PRIVATE~'/~i:~.,.~6 [] OTHER {Identify) Classdmahon (A,B.CI ¥otal Depth ~ Castled FT? FI REMARKS: WELL LOT LINE FOUNDATION DISTANCES SEPTIC TANK Io2. ..5-O 12_ ABSORPTION FIELD WELL Meeicipal and State §uidelines in effect Health Department Approvah 72-013 (3/85) by: //~,/~ cerlily 1hal this inspeclioE wes pedormed eccording to all Date ~R'S SEAL ~'o JUNE 2b, [971 l:)wr'lii: I, i, ~ ii. I . I"II!:iAI,'t'H ~-~BID t'!Ng]itR[II".II~'IIEI',I'I(~I.. ',.?. d~/I..--/I.'? ~q O I::f/, r ? / :Jcl Ct]I',FI't.>41TF I:':'1'1 ]NI[ :~ L.[YI' Si]:ZIE:: :5~5()()~ (~;D..FT. (]1::~¢.ll..,Id::.,:,) Fc~r'Lh by t.h~ I'q~.un:i.c:ipa:t:ii:y cfi' (.~r'u.::l"n:~raD~ (YlO(.~) and th~.'~ ~'~.. ]: ~,~:i.].:l :ir'~i'..~'.l] ]. 'l...Im~ ~:iyl5'k./;)ll! :i.r'lac:[:cn~[:l~:~r~c:~:~ ~:i.i.h a:l.:!. ,~1'1~:t :i.]"~ ~:~::)lilt::t].:i.,:~;:i'~;, wi. th t.h~, d~:~i~:i, gl'i c:r~.t.r.~m:i.~'t [:)t t.h:i.~ cl:iuii:.,:'~nc~:~, tr~::~m any ~:.~xJ~i'L:i. rlg ~n::~t, ~,~a~tit~.?w~.~t.~r. d:i.~il::~cl~:~a:l. i1: I::: P~ 'I'IItEN ( :t } l:11xl l:i!:l..l}:iZ]'l'l::;; :1: I](-~1.. I:::'~i::l::ll"l :[ '1" N]:f..I.. NDT ~::l!i!:: (qI:::'F:'R[iVED N]ZTI-I[)I.IT g.;l',l, F[I I!}:I.Iii:CTI:;:]:C~'~I. NI]l:lt::: I*II.II!3T Blil!: D[INIZ IB :1: PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O 7.4%/Wz../~..']- /~.u~_: Township, Range, Section:.~z~7 ~- 7~/, ~[~ ~V/ ...... ' SLOPE SI~dP~AN / ' ' WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Monllorin§? ~ Dale: Reading Date Gross Net Depth to Net Time Time Water Drop PERFORMED BY ~0 ~ I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: WE: ~,/~oc~ 72-008 (Re¥. 4/$~) SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska ggB01 264-472.0 SOILS LOG - PERCOLATION TEST PERCOLATION TEST PERFORMED FOR: 2 3 4 5 6 7 8 9 10 11 13- 14- 15--- 16- 17- 18- 19- 20- f ,'/ ~ ~d v SITE PLAN WAS GROUND WATER, DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~~ (minutes/inch) TESTRUN BETWEEN ~ FTAND ~ , FT CERTIFIED BY: DATE: 72-008 (6/79) '~00/ ~f O~Gld~ Ikl~ II I. qXC~klC~4 V I50 ' el.,51:kl -~PtI.~KLAN)/-..r~:: f -%, ..,, ,^ L h,, .' o . 4- . , ~03W I':'' 't'" II :'>l I/~ u~,',.,',,,-,,/-,, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF NEALTH & ENVIRONMENTAl.. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Stroet-Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME LEGAL DESCRIPTION ~, ~,~/ T~,~,4i~,,~ ~t, Ils LOCATION V¢/u,4~',v,~ H, II s ~: l------"'DISTANCE TO' .b~ e~CC~.B p .OS~(-~ l AbsorptionT/acea DISTANCE TO: Top of tile to finish grade [ Dwelling / /~ _Material · Material Foun~/ Nearest lot Tot~Tlength of lines ~f Trench width Material beneath tile Depth NO. OF BEDROOMS PERMIT NE). No, of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. ~oo P, Distance between lines Total effective absorption area PERMIT NO. Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS /) .~o~4 SOIL TEST RATINO INSTALLER REMARKS ~ct6.,~CZ ~¢~-¢_ oo~!~, p/~¢~ 04' APPROVED 72-gl 3 (Rev~.-~8) DATE LEGAL WATER WELL RECORD STA'TE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geoiogicol 8~ Geophysioel Surveys -o'-"'- o'- i . _, /" /&' 7 .,.-. .S.;~ ., MUNICIPALI1Y O: ANCHORA~)E DEPT. O; ~,u.l'H ?~ GOT-l- ~82 s~J_ wE J OWNER OF W~LL: / ~ Auger E~ Jotted E] Bored ~ Othor: Typo: ~}~?r':¢l i' ; '~ .... ) omete : ~.GROUTItCG WoH Grouted: C~ Ye, r~ NO s~uewwoo I~UO!l!PPV :suol~elnd!~s I~U!MOIIOj eql ql!M 'su~ooJpaq Jo; leAoJdde leUOp,!puoo 'SLUOOApeq //f 'peAoJdd~s!a -- '1 °; ~PRe; °;Nd d~$ S-~HQ · uo!loedsu! s!ql jo e~p eq3 uo ~oe~e u! suo!3eln§eJ pue 'seoueu!pJo 'sepoo e~e~S pu~ Ied!o!unR lie M3!M eou~!ldLUo9 u! s! LUe3S~S IgsOdslp ~a~Me~Se~ ~o/pue ~lddns Je3~ e~!s-uo eM3 'uogaedsu! pue uog~gse^u! ~LU LUOJJ pUe sel!J eDe~oqouv Jo ~!led!o!unR Luo~ peu!e3qo UO!3~LUJOJU! eq3 uo peseq 3eq~/gpa^ JeqMnj I 'u!eJaq pa3eo!pu! eJn3on~3s jo ed~ puc SLUOOmeq ¢o ~eqLunu eql Joj e~enbep~ pue leUO!3Oun¢ 'ejes s! u JeSses lesods!p ~e3e~e~se~ ~o/pue ~lddns Je3eM e3!s-uo eqi 3eq3 SMOqS uo!~olldd~ le^oJdd¥ ~poq3n¥ q~leeH s!q3 ~o ~uJ ~q~ ~JpeA I 'MOleq UMOqS e~ep uol3Bp!lsA eq~ ~o s~ pue o3eJeq pexgje I~eS ~Lu ~q pe!J!Meo s¥ '9 a~NI~N~ AB NOIIO~dSNI ~0 IN~iVlB "S SC[IL. Fi: FI f' '1_' i'.,! ()i 'TH[i; F;:E[;!U!Fi'.Et:;, E;I;~:E OF THE T'HtE L.Et'-.![HH [)]iJ"lEl"rlfi];!(i]lq I'_;B "Ff"llE t_EI'.,II~!iTH (I!'.4 FEE"F) OF:' I"l...tli!i; I't:;;~Ei'-,!C:I-..I 'I'HF~ I)I~;!':'"I"H Cfi:' 1:::t 'I'F~:E;i'.,tC:H ()R PIT :ES THE D'['E;"I"I::II'.,IE;E; B!ZT'I,.IEEi"~! 'l"l'.lI{ ?i;L.I,~;'.I::'I';:IC:E; C~F:' (]I;i:OI..II'.,!D !:::II",ID 'THE !~O'I'TOM OF' THE; EF::CFI',,,'FIT:I;Cff.,! (I1'.,I FEI'CT). T'I"IEI:;~I{ ;[Si; I",!O SET !,.t!!.:;,Tl~l FOI:?. I"HE; C:iF.~'.FI'v'I:!;I.. I::,Ei;F"I"H IS 'I't"~E I'"tlI'.,I!!"IUt"! [)E;I::'TH CIt:: Ii]ilq!F!'v'lL:;I... ErETI,IIEEN f'I..IE OLrTf::'FIL.L FIND THE ~:CfI'TCff,t CiF:' THE{ Ei:.:',CF!'v'F:!-!' ]1_' 01'..! ( i F,I FE;E'I" ;'.,. I"tiN!FILIf'"I DISTFtI',IC:E ElETl,lli::Ei'rf.,I I:::1 1-,.!ICI..L FIi',I(':, Flf',l"r' CII?.-'SIT[F: ;I..OO l::[[!:[ii:'l" FCff4'. F:I F:'F~:~',,,'F:ITE{ i.,.!E:L.L ()Fi: &~i'.;O TO ;_.'2. OO FEE'T FIq:CIi'"I I:::1 pLIE!:I_IC: !,!EL.L. I::,E:F:'I~i:!",IDII",ICi I_I!::'C~B! "['HE: "I"~'~P!~: OF F:'UEILZC: I,]EL..I .... !vlIF,!IMLIM DiS, TFIbIOE: FI:;:'.CIFI FI F'I:;~'.]:VF:I"I'L( I.,IEI..L FO F:I PF~:I'v'I':IT!E :i:i;IZl,~iEl:;[: l..IIqE I'E; ;]:'~!i F!EIET F:IND TO F:t C:Oi"IMI...II".!IT'~" :~:iE:I.,.IEt~: i..ZNIE Z[S 'i:~:i FEET. I,.IEL.L L. CI(:~iE; Fff;~'.E [;~'.E:(i:!LIIF~'.EZ:, l::li",lD MI.J?[' E[tZ I:;i:ETIJIE2',IE!:D TO I"F'IE!: l::,l~i:l::'l:::!F;~:"!'h'f!i~:t",!T t.,I!THIN :Z:J:O Dl:::l"r"_:]!; Cfi: "t'F!!Z I,.IE:!.L. C:CII"IPL..ETIC~I",!. O l'HEl:;ir [;i:EL~:!LI Z FirEMEBI-f':E; I'"lt::l"r' F:IF'I::'L."r'. :i:.:,F:'[.::C: Z F' I CF'IT I OF,IS t::IF.I[) I::!'v'I::IILI::I[:~&..E!: TCI :ILf',ISIJF;:~E: PF"-'.'OF'EF~: I C:Ef';~T I f::'"r' '!"HF!T ::L: I F:IM F'I:::II"IlL.]:I::tt';~' lqli'H '!"I'IE F:'O~:TH B"r' THE i"ll..IF, I:[C:Ii:'I::IL. IT"d ;~i:: i I'.11 L..L. ]: B!STI::I[.I.. THE: !:i;V:E;TE!"I I !",I FIC:C:O[;;:[:'FIi'qCE I'.! I TH T'HE CODE?:;. :i:: Z I..JI",ID[iff;~?FFII'-,!D FHF!T 'THE OI",I'""SIT[E F:Ei:SIDIENC:E ]:S I,i:E:MO[)EI_ED TO II'.,!C:LLII)E I:::ff::'F'l .. :t: C: F:I['.,I T , ?.[~...D ............................ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST [~/SOl LS LOG [~ERCO LATION TEST PERFORMED FOR: DATE LEGAL D ESC R IPTIO N:~,L 1 2 3 4 6 7 8 1 SLOPE SITE PLAN 10 ~--~- 11 12 13 14 15 16 17 18 19 20- COMMENTS WAS GROUND WATER S ENCOUNTERED? k) ~ L O P E IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN ,~'t ~/ (minutes/inch) .~ . FTAND ~O~ FT CERTIFIED BY: 72-008 (6/79) MV UMUPAUTiY OF ANCHORAGE o � Development Services Department �`�r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-051-20-000 Expiration Date: Legal description TANAI NA HILLS LT 17 Site address 7021 KITLISA DR Anchorage AK 99502 Current property owner(s) CROPPER RYAN X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: 9/22/2023 bedrooms, with the following stipulations: Original Certificate Date: 6/22/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 COSA Checklist Legal Description: TANAINA HILLS LT 17 Parcel ID: 011-051-20 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled 6/20/82 Total depth 157 ft Cased to 157 ft N Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 20 in. Date of flow test for COSA 5/19/23 Static water level at beginning of test 133 ft Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: NEW PLASTIC TANK INSTALLED D. ABSORPTION FIELD DATA Which system tested (date installed) NEW ❑Q ALL standpipes present per record drawing Total measured depth from grade 10 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A —pressurized field. ❑ Per record drawings, field is insulated. 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: COSA Checklist—June 2022 Well production at time of test 5+ gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes AN No 0 Coliform bacteria is Negative Nitrate mg/L X Nitrate less than MRL (ND) Arsenic Collected by . Date 5/19/23 _ ug/L 0 Arsenic less than MRL (ND) MNA C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date NEW Results ❑� Pass Fluid depth prior to test in Water added _ gal New fluid depth _in Elapsed time _ min Final fluid depth _ in Absorption rate _ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 2 in Effective depth remaining 72 in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Fi Yes if No _ ft Neighboring Tank > 100' Fol Yes if No ft Absorption Field on Lot > 100'❑ Yes if No _ ft Community Sewer Manhole/Cleanout > 100' ❑� Yes if No ft Private Sewer/Septic Line > 25' ❑� Yes if No ft Holding Tank > 100' [j]Yes if No _ ft Neighboring Absorption Fields > 100' Animal Containment > 50' g Yes if No _ ft Ri Yes if No—ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No _ ft Di Yes if No _ ft ❑ N/A- Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS Q Yes if No _ ft ❑� Yes if No _ ft Yes if No _ ft E Yes if No _ ft ❑� Yes if No _ ft Surface Water> 100' Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ❑� Yes if No It EK Yes ifNo_ft 0 Yes if No _ ft If tank or field is under driveway comment below G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm lel iC/C, (lt Anacy9Uyr V� C , Phone 727'$864 Engineer's Printed Name -�iurrP Date 2z - a / X g� OF• . � a4w vC* MICHAEL N. ANDERSCN COSA Checklist—June 2022 ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: TANAINA HILLS SUBDIVISION LOT 17 PLAT 65-83 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoulc any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE: E—MAIL• JUNE 20, 2023 1 "=40' schuller0ok.net 23-040-1 DRAWN BY: CHECKED BY GRID NUMBER: B"/PAGE JLS SW2123 230151 * = FND 5/8" REBAR 0 F AW .......A.� P ti / �': • 'CSS' 0 49TH PAO.... .. . . ... . . . .. .. .. .. • . V FFA /.... ........ .............. '.� i ••. OHN L. SCHULLER.� e 44 = LS-10408AW Ofe s sloe �. 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Fnvironmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORI'rY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lot 17; Tanaina Hltls Subdivision Location (site address or directions) 7021 KZtZZsa DCZv¢ Property owner Kathl¢~n Whittaker Mailing address 809 ¢obb£¢ston~ Court Day phone _(214) 880-4350 C~dar Hi~l, TEXAS (2~4) 291-8751 Lending agency Mailing address Day phone Agent D¢~a Nading/H.R.T. R~AL ESTAT~ Address 341 W. Tudor Rd. Suite 103 Anchorage, Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 '4 TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: Day phone 561-2220 AK If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /~oT /'~ ?~tN~IfAJ~ HIc(..S .~//) Parcel I.D. A. WELL DATA Well type /¢''¢qt/~T;~''- Log present(~N) Total depth _/~r~ r' Sanitary seal ~.~N) If A, B, or C, attach ADEC letter. Date completed Cased to /~' ~ / FROM WELL LOG Static water level Well flow Pump level - SEPARATION DISTANCES FROM WELL -FO: Septic/holdlnCtank on lot /~'_-2 /' Absorption field on lot //.,~--~ / Public sewer main __ Sewer service line '~o¢/' Casing height Wires properly protected ~.~N) ADEC water system number ~.¢/~/?Z. Driller ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform (/~//o~.~ Nitrate_ O./O /4¢~/.~_ Date of sample: ~ ~'/~/~- ~ Collected by: Other bacteria B. SEPTIC~I~ TANK DATA Date installed Cleanouts4~)N) High water alarm (Y/~_)) Tank size .,//2__~'~ __Compartments . Foundation cleanout ON) (r"~- ~ Depression (Y/~__)~ Alarm tested (Y/N) Date of pumping ~/7~/ SEPARATION DISTANCES FROM SEPTIC/4"NDLDh'¢E~'TANK TO: Well(s) on lot /0Or On adjacent lots To property line ~ Surface water/drainage __Foundation / ~- Water main/service line 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION ,,UOM ~.~ ID/~.~.~/',.,~-~- ~alled Manufacturer S iz e i n g ~ ...............~ Manhole/Access(Y/N) ~ Vent (Y/N)_ ~elat -- ~p off" level at High water alarm level ~ ~ Cycles tested __ Meets MOA electrical ~~---"- S EPARAT~...~ C E FROM L, FT STATION TO: Well_~.~:~H~t On adjacent Pots Surface water D. ABSORPTION FIELD DATA )/e T',~&-AJCH U?~YL/4D~ /A2 o~'- ~/~t. uE5 A~-TTc-"/C. Date installed ~/-~,/~-- //!/~/~ So,lratng /~///'~)z'~?~"~'~ystemtype Length z:~//~O, Width -.'~',/'-~' Gravelthickness ~,'/~' Totaldepth Tota, absorption area .qZ C,eanouts present ! Depression over:field (Y~_~ ,/~ Date of adequacy test Results/(~fail) /'~/~ .% .,~ for ~ Peroxide treatment (past 12 months) (Y/N) -/~/tZC'~-/('t)O (.w'/.-/ If yes, give date bedrooms Well on lot /~1 To building foundation On adjacent lots ~O-~ Surface water ./(/.o/C/~E~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots /CPO r ¢_ Property line ~ ~ ( To existing or abandoned system on lot Cutbank ,/~/./E- /°/'¢E..~-~Z-~Water main/service line Driveway, parking/vehicle storage area Curtain drain .'(./~x,.'g ,/('.,t/'O~¢J E. ENGINEER'S CERTIFICATION I certify thatlhavechecke¢~vedfied, orconformed~~ to all MOA and HAA gu/dehnes in effect on the dat~°~tl?!s Signature //~/ ~ ............... ' . ',.~ Eng.nee~,'~?O34, ~ "~'~, Eagle River Loop Read No. / E~le River, Alaska ~577 / ,~-.~ Date ~/~ ,,' ,;.,~ HAA Fee $ Date of Paym~,nt Receipt Number Waiver Fee: $ Date of Payment Receipt Number chemlab Ref.$ ;93,2419.-3 client 8ample ID :L17 TANAIN/% HI[,[,5 ~D Client Na~e :8 & S ENGINEERING O~dered By ~R, SHA~R progecte ~ ~SlD t UA Remarks: ROUTINE SAMPf~ COLLLC~D ANCHORAGE, AK 69515 TEL: (907) 562.2343 FAX~ (907) ~61.5301 Order . , :6651~ Re~r't Completed ~06/01/93 Collecte. d :05/25/93' 0 20~06 hfs, Received ~05/26/93 0 14t45 hfs, QC hlloweble Ext. Anal Parameter Results Qual, Units Method Limits Date Date Init ~E;;;:~ ....................... ~'6-~ ............ ;4E"-~;~'-~i;;T~;~'; ...... ~ ............. 6~;'"5~ ==~==='"====='~="'~ ........ '= ......."=~' '= ' UA = Unavailable * tnstructJ.ons At,or ...... >,,,,~,,._ undetected - ..' .'-¢. ~,,.? N~,,. Hot Analyzed pract i gu~nt f 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 264-4720 GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) Applicant Name ~~_ Telephone; Home ~¢~ Y~'~ O~ BusJ.es8 · I1I Applicant is (check one): Lending institution D; Owner/builder D; Buyer ~]; Other ~ (explain); Address Telephone Real Estate Company and Agent (e) Address ,,~ ~ ~ l Telephone ~ ~ ~ (f) Mail the HAA t0 the following address: I'YPE OF RESIDENC[: · Single-Family ~ Multi-Family Number of Bedrooms Other WATER SUPPLY Individual Well/~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/,~ Public [] Community [] Holding Tank [] ,Note: If community well system, must have written confirmation from the State Departmeot of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-ox5 ¢~,8,,~ ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto snd as of the validation date shown below, I verify that my investigatior~ of thins Authority Approval shows that the on-site water supply and/or wasteweter 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 investigatio~ and inspection, the on-site water supply ~nd/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 _ --~ Telephone _ ' Address ..... ~-~ ~ '. ~ 9225-~ - ' '~ "~ k", .' .'Engineers Seal ~ ;,>.,... .' ,,,, DHEP APPROVAL . ~ Approved for ~--~,~,)- bedrooms by _ . ___ [3ate Approved __~'~. Disapproved Conditional Terms of Conditional Approval CAUTION Tile 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 72-025 (11/84~ WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: I --~ MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SEP 2 4 RECEIVED ~IDL~ Well Classification 1~ r~,..,~ Well Log Present (Y/N) Total Depth I ~'~ Cased to __ Static Water Level J~. I Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Y If A, B, C, D.E.C. Approved (Y/N) J'~/~ _ Date Conlpleted ~ ' ~ ' ~- Yield ~'~'~ ~' ,/ Depth of Grouting NiD,¢,,/I"~ Pump Set At ~'oTTOH Sanitary Seal on Casing (Y/N) ~ Depression Around Wellhead (Y/N) ~ Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot _ To Nearest Public Sewer Line N Cleanout/Manhole ~ ~2' t',/1].~ _ Water Sample Collected by Water Sample Test Results Comments _ ~ ; On Adjoining Lots __ I I"t c'-~ ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot B. SEPTIC/HOLDING TANK DATA Date installed _ ~A4 I Standpipes (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well J ~ To Property Line ~, .~O_~ To Water Main/Service Line Course _ Size I~,j~ No. of Compartments "r"~'~;~ Air-tight Caps (Y/N) ~_ Foundation Cleanout (Y/N) Date Last Pumped ~/I ~/~:~ J"'¢//¢~' ;for Ternporsry Holding Tank Permit (Y/N) To Building Foundation J~- To Disposal Field 7 To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed H~ ~ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well //~' To Building Foundation ~2~ ~ Lot /'~ ¢:~/~'//-~ To Water Main/Service Line ~ I ~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design ~ Length of Field -'-'-'-~ ~::? Depth of Field Gravel Bed Thickness Z~,~. ~ ~ ,..~,~2 Standpipes Present (Y/N) Date of Last.Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots "~ To Cutbank (if present) Comments D. LIFT STATION NON - Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments 'Page 2 of 2 72-026 (11/84) ** Check Permitted Bedroom Rating Against HAA Bequest ** I certify that I have checked, verified, or_conformed to all M,,OA add HAA guidelines in effect on the date of this inspection. Signed ,c~~ Date Company MOA No, ReceiptNo. ~O~[ '0~ ~. t~r ~_ Date of Payment CI ' ~c~,~p 5'%v*"' '~ Amount: $ ~'~' H ~t: 4~TM ;~ ~ ~'.' Engineer's Seal '¢,t', JUNE 25. t971 . COHSULTING ENGINEER ~ ,,3 ~ ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WATER SYSTEM: SEPTIC SYSTEM: LOT 17, TANAINA !{ILLS 7021 KITLISA C. RICHARD SINGLE FAMILY, ON SITE WELL FROM MUNICIPAL TANK: GREER ABSORPTION SYSTEM: ADSORPTION SOIL RATING: INSTALLATION EDROOMS i~i:',CO RDS: ~ TWO COMP. 1250 GAL. TRENCH 528 SQ. FT. MAY 1982 DATE OF PUMPING: JUNE 17, 1986 DATE OF TEST: JUNE 17, 1986 TEST PROCEDURE: SYSTEM WAS INSPECTED AND MEASURED. TANK WAS FOUND WITH THllEE1'~,EET OF COVER, LIQUID LEVEL OF 49.5 INCHES. TRENCH WAS FOUND EIGHT b~EET DEEP, WITH A LIQUID DEPTH OF 5.5 FEET AND TWO FEET OF COVF;R. 210 GALLONS OF WATER WAS ADDED TO THE TRENCH SUMP AT A CON3;'I?/?~'? ITATE OF 6. 5 GALLONS PER MINUTE. THE WATER LEVELS IN THE " JAN,, AND SUMP WERE MONITORED. THE ADDITION OF THIS VOLUME OF WATEI~ C.'~U!31£~> TIlE LEVEL IN THE SUMP TO RISE 14 INCHES AND THE LEVEL ZN "}'.:; TANK 1.5 INCHES. TDE INFILTRATION RATE WAS MONITOI~ED F(v.', ,, !{OU(~S. DURING TDIS TIME THE SYSTEM ADSORBED 88 GALLONS. OVi',;: A 24 HOUR PERIOD THIS IS EQUIVALENT TO 325 GALLONS. TEST RESULT: THIS SYSTEM DO'?; NOT MEET THE OPERATIONAL~ [ -REQUIREMENTS OF THE MUNICIPALITY [~i~' ANCHORAGE. A FOUR BEDROOM/ I SYSTEM MUST ABSORB AT LEAST 600, GALL, eMS PER 24 HOURS. THIS SYSTEM/ [.ABSORBS 325 GALLONS. ~J'~27/'h"~'~ ¢,/~'~ Because of the shallow depth of cover over the drain field, (2 ft.) the possibility of groundfrost int~-fer:i, ng with the infiltration was investigated. The drainfield wa:3 mol~it:ored for a week by taking water depth readings every two day:~. ':'i~e water level dropped at a constant rate of 6 inches per dcv,' ' !w:n rose again as soon as the septic tank began to discharge. A ;: fool probe was also used to probe for frost. No frozen mater~.,,, ,.,.,~;~<~ Eound. To meet the operation requJr,:,z : .:; of the Municipality the absorption trench must be cxto;. :?>?oximately 20 feet. The exact depth, length and amount '; .v,,'ei can not be specified untill a soil investigation has : / ~,; 203 W. 15th AVE "C" SUITE 203 CONSULYING ENGINEER ~ .'. '2,;,::~ ~ ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: LOT 17, TANAINA '." ~ LOCATION: 7021 KITLISA OWNER: C. RICHARD TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS MET: YES WELL YIELD FROM WELL LOG: 30 GA NS PER MINUTE PUMP YIELD: 6.5 GA! LONS PER MINUTE DATE OF INSPECTION: JUNE '' : 986 TEST PROCEDURE: TEST FOR COLIFORMS.. TEST RESULT · '"'~. · ' ,~.. N/. k<,[< ',', . WELL WAS PUMPE;' /..T A CONSTANT RATE OF 6.5 GALLONS PER ;<';;;UTE WIIILE THE DRAWDOWN WAS MONITORED WI'PI[ ,\N ACOUSTIC PROBE. THE WELL WAS PUMPED 30 MINUTES. THE STATIC LEVEL WAS FOUND AT 111 F'EET 13ELOW TOP OF CASING. AFTER 30 MINUTES OF PUMPING THE WATER LEVEL HAD STABILIZED AT ]24 FEET. FIVE MINUTES OF RECOVERY HAD WA'?F',!~ LEVEL AT 112 FEET. WATER' WAS TES,...) F'OR COLIFORM BACTERIA ON JUNE 18, 1986. '7;<S? WAS NEGATIVE. THIS WELL MEE'L ' THE REQUIREMENTS OF THE MUNICIPALITY O .... The MunJ_cipal ~ ~:i;~ement for well flow is 150 gallons ~: ',. :ter per bedroom per 24 hours.This v~e] . '::-pas.'~es this requirement. The assessmenL ; t~;c condition of this well applies only t~ !}'~ conditions as of this date. The flow ::ate of the well may change due to subsurl n,,~ conditions that may not be observed from the surface, and changes in land use and ( ':nc:: ~.actors that may impact the conditions ,.>f the aquifer feeding the well. .MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRObbH~NTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR [{EALTH AUTHORITY APPROVAL CERTIFICATE General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, raoge) Location (address or directions) Applicants Address__ Owner/~uilder ; (c) Applicant is (check one) Lending Institution _~_[ ;~q.~ ~ Buyer ~ ; Other ~--~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. ~yp__e_ of Residence Single-Family [.~ Number of Bedrooms Mnl ti-Family Other (describe) 3..4ater_ S~upoly . /~ Individual '..;ell ~ Commt, nity ~--] Public I--Z[ / Note: If community well system, must have written confirmation from the otat Department of Environmental Conservation attesting to the legality and stat~s. 4. Sewage Disposal Onsi Pu, lie [--] Comm nity old ng T nk ~<ote: I~ community well system, must have written co~ffirmation from the State artment of Environmental Conservation attesting to the legality and stat~s. 5. Engineering Firm Providin~ Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Anthority 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 strncture 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 regula- tions in effect on the date of this inspection. Name of Tel ephone_ ,_dpex/. X~pZ/~,J (ENGINEER SEAL) DHEP Approval -~f i ~ ~ '" !., ,'. II !t ~ Approved for 4i ~ , x bedrooms B_,~ '~ ~ d. Approved .... Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASEl) SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PAP~kGRAPH 5 ABOVE BY ~N INDEPENDENT PROFESSIONAL ENGINF, ER KEGISTERED IN TIlE STATE OF ALASKA. TIlE DHEP DOES Tills AS A COURTESY TO PURCUASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MEN'iS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ~aNALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBI.E FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (OHEP SEAL) RX4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALI~ AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Well Classificatio]J _~{V ~)-~_' Well Log P~esent 7Y'~N Total Depth F~/ Cased to Static Water Level /~3~ Date Cont~lete d- ..-hz PUmp Set At Casing Height Above Ground /~ Elec~ical Wiring in Conduit/~..Y~N) Sepazation Distances f=om Well: Legal Description: If A, B, or C, D.E.C. Approved(Y/N) ~I~ /0/~'~/~ Yie].d ~_~2~ ~pth of G~outing , Sanit~y ~al on Casing ~) ~pression ~ound ~l~ead To Septic/Holding Tank on Lot----/~/ ~C-' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot...//~f )6,; On Adjoining Lots To Nearest Public Sewe~ Line . ~/~ To Neazest Public Sewer Cleancut/Manhole /~)/Z~--. , To Nearest Sewer Service Lin? on Lot Wate~ Sample Collected By ~ ~/~/~ ~ __~ Do. re /~)A'Z Water Sample Test P~sults -~_~' '~2~ ~ , , ' ' Be Standpipes/~)'-~ f' Air-tight Caps,) Foundation Cleanou~) Depression ove~, Tank _(~? Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ~/z~-; for Holding Tank High-Wate~ Alarm (Y/N) /~'~ ~mporary Holding Tank Permit .(Y/N).~,/~' Separation Distances f~czn Septic/Holding Tank: To Water-Supply Well _ / To Property Line To Wat~? Main/Service Line To Huilding Foundation /&7~/ To Disposal Field 7/ To Stream, Pond, Lake, c~ Major Drainaga Receipt ~ Date Paid: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~./,~,/~ Width of Field Square Feet of Absorption Area /~¢Q '~'~ Type of System Design Length of Field ~/~? Depth of Field Gravel Bed Thickness ~ ! Standpipes Present ~/~) Depression ov'er"~ield (Y~ Dat~ of last Adequacy Test Results of last Adequacy Test ~ ~C~u ~/~9~o ~ . Separation Distan°e from Absorption Field: To Water-Supply Well //,4/ ~ To Property Line /// To Building Foundation j~m~ ~g/ To Existing or Abandor~d System co Lot /%3 I¢~ ; On Adjoining Lots 1~ 30 / To Water Main/Service Line 1c %L~/ To Cutbar~(if present) AJ To Stream/Pond/Lake/or Major Drainage Course .~-/~)d)/ To D~iveway, Parking Area, or Vehicle Storage Area De LIFT STATION Date'Installed Si~ in Gallons "Pump On" Leal at High Water Alarm/~/1 at Tested for Electrical/~des(Y/N) ~/ Manhole/Access (Y/N) . "Pump Off" I~vel at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets ~OA ** Check Permitted Bedrocm Rating Against HAA Request ** I certify that I have checked, verified, o~ conforrr~d to all MOA _Hj~~t%~ in eff~ on the date of this inspection. Signed~,~l~/%~/~,.t ~ Date _ KB1/dS/s [Pa~ 2 of 2] APPLIC hiT FILLS OUT UPPER HAL ONLY Buyer Address Zip Code Realty Co. & A~nt Phone Address Zip Code Street Locatl~ Type of Resl~nce ~Slngle Family ~ ~' Individual A~ACH WELL LOG. A w~l Icg Is required for all wells drilled since Jun~ 1975. ~ Community For wegs drilled prior to that date, give well depth (attach log If available). ~ Public Utility Sewer Disposal ~' Individual Year Individual Installed: ~, ~ Public Utility When Connected to Public Utglty: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ~.~ ~)~.~ DEPT~ 0~ F?~= ~ (J~) APPROVED BEDROOM8 'CONDITION8 OF APPROV~ ~ ~ ~ ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' BY: Soils Rating Date ~wer Installed Well To Absorption Area Well Log Received ~%~ % Well to Tank Septic T~k Size / ~ ~'~ 72.023(3/82) October Ronnld Logan 7021 Kitlisa Anchorage, AK c~9502 .,ubJ~..ck. l,ok 17 ~* ' ' ' Approval for the individual sower and wa'her facilities cannot . . 2% .]l. have !')eon c,omD].at,el. }:)a granted unt. il the followinq '' ~,q ' . ~' .,UbnLtt..d to this office for.' our fil¢~s and well log .... '' '~' . '['he w~q.'tor alia] sis report nec, ds %o be $~ll')nlitted to this office from the Chem .Lal), 5633 ~% Stree't, for our review, t 1 ~ .-,e notify · p'~-, this Deparhra;-'n% for a r¢~:i, nspection whe~n the llo-l;~d disc]?epanc'[es. _ have beeh corrected, If[ there are any further questions, ~].aase o. all this office at 264-.4720, RP197/n/EH Robert C. Pratt Asf~o¢;late t,nvlro~ mental [ T)~c~ al ~ s'['