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HomeMy WebLinkAboutSCIMITAR #1 BLK 3 LT 10I � �S�— ►3a-3c� >c 1 c w ch 3: I I I'D.! 'At ct PA: f cV -1 t 04 W9. cl 1 .21 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 SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940080 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:ROLLINS JOSEPH J OWNER ADDRESS:P.O. BOX 266 ANCHOR POINT AK 99556 PARCEL ID:05113230 LEGAL DESCRIPTION: SCIMITAR #1 BLK 3 LT 10 LOT SIZE: 35693 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 4/19/94 EXPIRATION DATE: 4/19/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 1.5.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS PERMIT IS FOR DRILLING A NEW WELL ON AN EXISTING DEVELOPED LOT. THE EXISTING WELL MUST EITHER BE PROPERLY ABANDONED OR IT MUST BE MAINTAINED IN SERVICE AND CONTINUE TO PROVIDE BENEFIT -,TO THE PROPERTY. DATE: RECEIVED BY: ISSUED BY: >ac�rt�l & "'TH- DATE:_Ilt44-4 i t � - LU Ij _ , a LAI V I ) MUNICIUALTTV OF' 07,INCIK-)PAGE flea I and v i rcmi tic n a L P rol-ec ],(),irth FlooTi Wcst 8 ,2 L > f iti, c I Anchorage, M,.-islla 99:)O1- 279--2`;1.1., x -,)2,1, 225 HNSUCTION REPORT t)jqj" r -A �5 P) 1()NE NAML O'C,L% C6vk9i' [rJ(i I ON- —(2- 61 ( C—V— L Ou V, SC R 11' 1 ioN; L I C) c—, m i4c� V- S ,FM -1C TAM<: CiIS] ANCF I NUiNIM-11 OF 100 IV A. 1 U I A( I I') I 1 1 V1 (-�P_Vct L S COIAIJA;R f M11 It FROM wIJ-1- TH,F' ORAIN Wel-I 7 cl,`,) s S vj. DetAll. Well. Distance To: Lot Line B.Idg: 2o' Sewer (AfTe: Pipe Materials: IT' of Bedrooms: Installer: %If Remarks: I C lo I m- I DI`IANCF I I I Of 4',I -1_t_ 00 F0 U 1 1 4 6-0 :\;) I I., I I (,I 1 1I( ! OL 0 ("', UNI N(;,I ,� ", It' oil Lines h 1 1_I 1. _, r 11 �, I I r; TOT Al f -FF P f I jr P I! TOP 10 1 41"[1 N SII P HE 'A I 17'. p A G L P' I v/wrji-- )IH Log Crib Crib Size: 0 i Cit:4: ';t -[-L ----Rings- )I ,'l EPF ECT IVI BUIIJAN(i I IOU kt AM -51 10F 101 : ON /\[I[- APT -A) f Wel-I 7 cl,`,) s S vj. DetAll. Well. Distance To: Lot Line B.Idg: 2o' Sewer (AfTe: Pipe Materials: IT' of Bedrooms: Installer: %If Remarks: DEPARTMENT 01:7HERLTH HND ENVIRONMENTHL PROTECTION �2^��/��� 825 '� STREET/ HNCHORRGE/ 279-2511 11' T, PERMIT NO. ( 77650 ) MPPLICHNT DEHN_CONS` BX. 115 E. R. 694 9]87 LOCHTION CHICKLOu LEGHL LT. 10iY�11ITHR LOT SIZE ]5200 SQUHRE FEET TYPE OF SOIL DBSORBTION SYSTEM TRENCH MAXIMUM NUMBER OF BEDROOMS � ] SOIL RHTING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ����1--j ���(39 -11- 1-4 �EF, 11— IF -E F --m 7' 11-- 0� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE I5 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE HND THE BOTTOM OF THE EXCAVATION (IN FEET). ��� ���� ����� ���� ������� � �F1 C"-� K., FIR (--v- FEE, F�:" I--��� f-� 1 c.-.1 PA ..... ...... _ H PHCKHGE PLANT MHY BE INSTHLLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOLLOWING CONDITIONS� 1 EITHER H CLASS l OR II NSF APPROVED PLAN]'MHY BE INSTALLED, 2 H CONTINUOUS MHINTENHNCE HGREEMENT IS REQUIRE[ IF H MAINTENHNCE � AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRE'D TO ENLARGE THE SOIL HBSQRPTION SYSTEM HND/OR YOU MAY BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL HND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL OTHER REQUIREMENTS MAY HPPLY� SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS ARE HYHILHBLE TO INSURE PROPER INSTALLATION. �����-1 FEE F" Jr. F! FEI Fp IEEE C;����� I CERTIFY THAT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR OWSITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPALITY QF ANCHORAGE. 2:I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES'. ]� I UNDERSTHND T1 -10T THE ON-SITE SEWER SYSTEM MAI, -'REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. � SIGNED�_��� APPLICANT DEAN CONS (D���� ����� ���� � � BF1'-"KFIL1-ING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL HND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL OTHER REQUIREMENTS MAY HPPLY� SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS ARE HYHILHBLE TO INSURE PROPER INSTALLATION. �����-1 FEE F" Jr. F! FEI Fp IEEE C;����� I CERTIFY THAT 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR OWSITE SEWERS HND WELLS AS SET FORTH BY THE MUNICIPALITY QF ANCHORAGE. 2:I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES'. ]� I UNDERSTHND T1 -10T THE ON-SITE SEWER SYSTEM MAI, -'REQUIRE ENLRRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. � SIGNED�_��� APPLICANT DEAN CONS 0 & E GEO :CHNI CAL & DEVEL ?HENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 6BB-2280 Soils Et Foundations Land Development Performed for: Name: Tel . No. Mailing Address: Legal Description: ,far /o, 1624: /,67741e'--Y-"P:;; rl/& �1 D�7e th feet 0 2 3� 5- 6 _6 7 11 _� 12_- 13 14 15 16 Soil Characteristics Ground Water Encountered: Yes---,,— No. If yes, what depth�� Proposed Installation: Seepage Pit Drain Field Comments: Performed by:_ --- « % ` - Date: ,j'/Y /17'� 9 _ `,. , i ' � �:, ems. MUNICIPALITY OF ANCHORAGE • Development Services Department J Phone: (907)343-7904 On -Site Water & Wastewater Section Fax: (907)343-7997 Parcel ID 051 -132-30 Certificate of On -Site Systems Approval OSC251520 Expiration Date: Legal description SCIMITAR #1 BLK 3 LT 10 Site address 19978 TULWAR DR Current property owner(s) ELLIS EMILY X The On-site system(s) is/are approved for Conditional approval for Comments or conditions: 3 bedrooms 11/5/2026 bedrooms, with the following stipulations: By: ; ` . ' ,. ,�, Original Certificate Date: 11/20/2025 This tificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject sy em(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, D velopment Service 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 submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other MUNICIPALITY OF ANCHORAGE Complete legal description Scimitar #1 Block 3 Lot 10 Location (site address) 19978 Tulwar Dr. Chugiak, AK Current property owner(s) Emily Ellis Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well serving # 1 dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: ❑ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 6. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 48 - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ Waiver Fee $ Date of Payment t t Date of Payment COSA # c> -5C1 2,0 Waiver # COSA AppllcaGon Apr2025aoc Legal Description: COSA Checklist Scimitar #1 Block 3 Lot 10 Parcel ID: 051-132-30 If more than 1 well andlor septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA (South) (North) 0 Well log is filed with Onsite (or attached) Well #1- Well #2 8/24/81-5/10/94 740-407 Date drilled Total depth ft Cased to 123-154 ft © Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground) 33 in. Date of flow test for COSA 11/10/25 Static water level at beginning of test 210 ft. Comments *Well 2 wellflow used for this COSA. B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 11/10/25 ❑ Required maintenance completed, if AWWTS Comments: D. DISPOSAL FIELD DATA Which system tested (date installed) 8/5/77 ✓❑ ALL standpipes present per record drawing Total measured depth from grade 7.3 ft (max) Measured depth to pipe invert from grade 4 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 3.3' ❑ 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 CommentsfDefieiencies: COSA Cheddist_May2025.doac Well production at time of test 0.5 gpm Water storage tank volume 300 gallons Well disinfected for coliform test? ❑ Yes 91 Ne Coliform bacteria is Negative Nitrate 0.216 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 11/5/25 STATION ❑ Require ntenance completed Age of lift station Lift station material Comments: Adequacy test date 11/10/25 Results 2 Pass Fluid depth prior to test 15 in Water added 500 gal New fluid depth 15 in Elapsed time 10 min Final fluid depth 15 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 47.4 in Effective depth remaining 24.6 in E. SEPARATION DISTANCES From Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100' ✓❑ Yes if No ft Neighboring Tank > 100' ✓❑ Yes if No ft Sewer ManFiole/Cleanout > 100' ❑✓ Yes if No ft Sewer Service/Septic Line > 25'Z Yes if No ft Disposal Field on Lot > 100' Fv� Yes if No ft Holding Tank > 100' Fv� Yes if No ft Neighboring Disposal Fields > 100' Animal Containment? 50' R Yes if No ft ✓❑ Yes if No ft Manure/Animal Excreta Storage > 100' Sewer Line/Main > 100' Q Yes if No ft F/� Yes if No ft ❑ NIA — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundation > 10' M Yes if No ft Surface Water > 100' ❑✓ Yes if No ft Field to Foundation > 10' © Yes if No ft Tank to Property Line > 5' F,4 Yes if No ft Field to Property Line > 10' Q Yes if No ft Water Main/Service Line > 10' © Yes if No ft F. ENGINEER'S COMMENTS Wells on Adjacent Lots: Wells > 100' Community Wells > 200' © Yes if No ft ✓❑ 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 Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date il t I Zvi Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the famify being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. COSA Check ist_May2025.docx MUNICIPALITY OF ANCHORAGE r ��\ DEVELOPMENT SERVICES DEPARTMENTf '�\ 907-343-7904 ®n -Site Water and Wastewater Section J�1 Fax: 343-7997 www.muni.org/onsite --- Septic Tank Advisory Certificate of On -Site Systems Approval # OSC251520 Subdivision: Scimitar #1 Block:3, Lot: 10 The septic tank for this property is 48 years old. Some previously installed fiberglass tanks have been replaced because they leak. Leaking septic tanks are a hazard to public health. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT � �\ 907-343-7904 On -Site water and wastewater Section = Fax: 343-7997 www.muni.org/onsite �— Well Water Advisory Certificate of On -Site Systems Approval # OSC251520 Subdivision: Scimitar #1, Block: 3, Lot: 10 This well's productivity was determined to be .5 gallons per minute. The recommended well productivity under (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum recommendation, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. -7 1) U 30 LL C C T C z I ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SCIMITAR SUBDIVIS-40NUNIT Nol LOT io BLOCK 3 PLAT 74-186 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing an6' that the improvements situated hereon are within the property lines and no erchroachments exist other than noted. Under no circumstance shout any information on this drawing be used for construction of fences, stractures, 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: DAZE: SCALE;E-MAIL sy DEC 19, 2023 1 =40 schuller@ak.net 23-125 DRAWN BY. JCIIECKED BY. GRID NUMBER: BOCR7PAGE: JLS NW1 261 230368 * = FND 5/8" REBAR k, 4411111110101� %k Amr I SUR Adw S�<D 4, AMMWW vt N j_ OT A 1 h� AW 0 %4 low, 49TH ................ . ........ -z I ?A ?A /7J .................. :...� -� •.J4 N L. SCHULLER.-'0 R • LS -10408 1831 Talkeetna Street ...... �\ 6 AW Anchorage, Alaska 99508 `� Of \'0 ANW (907) 227-1455 office e 13� S S i'D n AW" "W (907) 274-4992 flax MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-132-30-000 Expiration Date: 11/3/2024 Legal description SCIMITAR #1 BLK 3 LT 10 Site address 19978 TULWAR DR Chugiak AK 99567 Current property owner(s) MCI NTYRE CHRISTOPHER J X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 12/18/2023 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 MUNICIPALITY OF ANCHORAGE Development Services Departments Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-132-30 Complete legal description Scimitar #1 Block 3 Lot 10 Location (site address) 19978 Tulwar Dr. Chugiak, AK Current property owner(s) Christopher McIntyre Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: © Private Well Private Well serving 2 dwelling units Private Well serving 3+ dwelling units Community Well or Public Water Storage 4. TYPE OF WASTEWATER DISPOSAL: © Private Septic Private Septic serving 2 dwelling units Holding Tank Community Septic or Public Sewer 5. SEPTIC TANK: Steel Plastic Concrete ® Fiberglass Age 46 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: AWWTS Bed ® Deep Trench Wide Trench Seepage Pit Waiver request for: Expedited review requested: Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $_ Waiver Fee $ Date of Payment f Z 2- Z3 Date of Payment COSA # 05 CZ 3 l H 6 V Waiver # COSA Application—June 2022 Legal Description: . COSA Checklist Scimitar #1 Block 3 Lot 10 Parcel ID: 051-132-30 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA V Well log is filed with Onsite (or attached) well #1- Well #2 8/24/81-5/10/94 Date drilled Total depth 740407 ft Cased to 123-154 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 33x in. Date of flow test for COSA 11/15/23 Static water level at beginning of test 220 ft. Comments *Well 2 wellflow used for this COSA. B. TANK DATA Measured operating fluid level in septic tank 49" Date of pumping 11/20/23 Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/5/77 W ALL standpipes present per record drawing Total measured depth from grade 6.3 ft (max) Measured depth to pipe invert from grade 4 ft (min) N/A — pressurized field. Per record drawings, field is insulated. Monitor tubes go to bottom of effective. If not, state depth into effective 2.3' 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 0.5 gpm Water storage tank volume 300 gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L 0 Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 11/3/23 STATION Requir int( Age of lift station Lift station material Comments nce completed Adequacy test date 11/15/23 Results 0 Pass Fluid depth prior to test 0 in Water added 450 gal New fluid depth 0 in Elapsed time in min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 72 in Effective depth used 44.4 in Effective depth remaining 27.6 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' 0 Yes if No Community Sewer Manhole/Cleanout > 100' Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'/ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Yes if No ft 0 Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 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' 0 Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' V Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' W Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS 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 Areterra Consulting Phone (907)-6966-6111 Engineer's Printed Name Kenneth Duffus Date 11414 05 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The + C 'V[ flow and absorption rates may change due to subsurface conditions that may not be observed from the { surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year r 3 and the water usage of the family being served by the system. The operational life of all well and septic 4E gsystemsaresubjecttothesevariousanddynamiccharacteristicsandareoutsidethecontroloftheevaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. /` KENNETH OF CE 711 46s IF COSA Checklist June 2022 Q�JER iq a R��U'LSULTI NG Eq' .1.571.. December 19, 2023 AtzcTE1111A CONSUI,TING, INC 20441 Ptarmigan Bld, Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Scimitar #1 Blk 3 Lot 10 —Well Investigation The owner requested we obtain a COSA for the sale of the subject lot. The septic system did pass the adequacy test for the existing 3 -bedroom residence. The property has two wells identified in the MOA records and we tested northern well identified as "Well #2" by Steven Henslee for the HAAC approval on 6 / 25 / 94. Per our COSA checklist this well is 407' deep, is cased to 154, had static water level at 220', and production was 0.5 gpm. The water sampling from the house spigot came back as negative for coliform and non -detect for nitrate and arsenic. As all this information satisfies MOA code we did not test the southern well labeled "Well # 1". Per your COSA review comments we have verified with the current owner, who purchased the property in 1994, there was a third well on the property prior to his purchase that was decommissioned in the front yard area but there is no evidence of the exact location. As noted in the MOA files Well # 1 was drilled in 1981 and produced 0.33 gpm in the 1994 testing by Henslee. Per the homeowner, the well pump in Well #2 was replaced in recent years (approximately 2019), a 300 -gallon reserve tank was installed, and the well pump was removed from Well # 1 as it was not needed. The owner has retained Well # 1 for future use if necessary. The plumbing and electrical line are still available between the house and Well # 1 and the sanitary seal is intact. A new as -built survey has been completed showing the locations of both existing wells. We do not expect there to be any adverse effect on adjacent lots by retaining Well# 1 for future use. If you have any questions, please contact me at 696- 6111 /FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. qer'u e M. Duffus, P.E. 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 Well Water Advisory Certificate of On -Site Systems Approval # OSC231464 Subdivision: Scimitar #1, Block: 3, Lot: 10 This well's productivity was determined to be .5 gallons per minute. The minimum well productivity required under (AMC 15.55) for a 3 -bedroom residence is .31 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. SMal ng Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org MUNICIPALITY OF ANCHORAGE • C DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# 05/ /3036 HAA# 1'�t�liliC I.� 1. GENERAL INFORMATION II Complete legal description Sr�n� fQr �U6rTi l/ # h 3 2. 3 4. Location (site address or directions) Property owner _ J-69sep/1 f 2W tom ._ Day phone Mailingaddress Lending agency Day phone Mailing address S/��7 Agent G es r I� �a m %gan lSCcc�7 Day phone-- Addressid-- Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: j TYPE OF WATER SUPPLY: Individual well —�— Community well Public water MUNICIPALITY OF ANC uRAr3t ENYIROW WAL SERVICES DIVISION JUN 0 71996 RECEIVED 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 — Fiolding tank - community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 Rev 1191) Front MOA x21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm .S/_(-/-1 a>)JUIL"-s Phone 244-7096 Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. bedrooms. W Date l-Z_9� r, (Vth z:;a•�n n ', cra9aa .''• 91••"hill •�•'• � +a, ` s Conditional approval for _ 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 orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA M21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 5CLN1LrL`� Parcel I. D.: A. WELL DATA C 2 60T1,4.5 5E1?V1a6 T/d/.S 1-07' Well type PVT If A, B, or C, attach ADEC letter. ADEC water system number A11_9 Log present (Y/N) Y41- iJ- Date completed e Z4- y- 4 Total depth L4(0 107_ Cased to Casing height (above ground) _22116 f U Sanitary seal (Y/N) y -Wires properly protected (Y/N) rt / FROM WELL LOGZ AT INSPECTION Z Date of test 9 2� S, — "96 Static water level 1500 �Z 45/(' / Z/, / Well production g.p.m. IM 1 0.3 g.p.m. (Nor 77E5rEn) 00(W - WATER SAMPLE RESULTS: e_AC.'e(:ji 7, z• Coliform T 2 �(� Nitrate 6-2S-yE Other bacteria _ Date of sample: r ft, 7'z' y(,�_ Collected by, B. SEPTIC/HOLDING TANK DATA T/-1I<EAI FROM 14 01-9 F/L-CS, A. A Date installed 8i eS' /% Tank size /000 Number of Compartments- 2 _ Cleanouts (Y/N)� Foundation cleanout (Y/N) __ V Depression (Y/N) _ /V High water alarm (Y/N) _ IVR Date of Pumping J, ZZ 1,9& Pumper JA9AIW94', AJrY7P _;Qs C. ABSORPTION FIELD DATA .t e 144 Date installed Soil rating (g.p.d./ft2 or ftz/bdrm) System type &:C -Z A'1 / Length "�� 261 Width J Gravel thickness below pipe T�'.Total depth J. Effective absorption area%a 5�% Monitoring Tube present (Y/N)_ Y Depression over field (Y/N) A/ Date of adequacy testy'��,�— Results (Pass/Fail) �/�SS For _ %=3 bedrooms Fluid depth in absorption field before test (in.); (2 Immediately after`i3 gal. water added (in.). 0 Fluid depth _ (ins) Minutes later: Q Absorption rate = _�� _g.p.d. Peroxide treatment (past 12 months) (Y/N) /J If yes, give date _/V/; 72-026 (Rev. 3/96)" D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Size in gallons "Pump on" level at* *Datum urnp off' level at* E. SEPARATION DISTANCES ,r' 157/941CC-! MG1-151- Rr:,D TU NE-qRr_:5r wcLL SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /4,5 ` On adjacent lots _AIMMI—VG &JM -111V 12U Absorption field on lot 72' On adjacent lots _1VW711A16 wzy-111i 12V Public sewer main Al,,9 Public sewer manhole/cleanout /V/9 Sewer /septic service line _ /V�9 Lift station /l/; SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation 83 _ Property line ro Absorption field /Z ;ter Water main/service line /V4 Surface water/drainage . 1&)Ah5 Wells on adjacent lots _ O (0/577 ren C69)— SEPARATION DISTANCE F190M ABSORPTION FIELD ON LO -f TO: Property line Building foundation 1 Water main/service line57 ` Or 6/?EY/72 Surface water --&Q/VC Driveway, parking/vehicle storage area 40 Curtain drain F. ENGINEER'S CERTIFICATION Wells on adjacent lots 200 [�/,ST; MCC -10) I certify that I have determined thru field inspections and review of Municipal records that th( in conformance with MOA I -IAA guidelines in effect on this date. c ETRi Signature ne,�5 Engineer'sNa� yL/t/.S4Z Date A11e%JSUR,C1n,EX1r_s 51 -IOW _0f=R22 !/ Nor 1.3E MA16V /9s" sine HAA Fee $ Date of Payment _ Receipt Number _ 72-026 (Rev. 3/96)* > L all-11n6ur r4),�3&tW,o Waiver Fee $ Date of Payment Receipt Number )ove systems are of ; MUNICIPAIITY OF ANCHORAGE MEMORANDUM WATER DELL ADVISORY "_'_EALTH .-=HORITY APPROVAL NO. During a reCent :iea'_-h AUt.norltj% Approval on-site- inspec"on and test of the notable water supply well on Lot F� qq Block _� of Subdivision, the well's productivity was d'eterm'ined to be 0.31 gallons per minute. The minimum '."e_1 __ dUctivlty requ]Yed by tills Department- (AMC epartment(AMC 15.55) ror a 3 be-droom residence is Ota i gallons per minute. ,_lt o'_:c_: ti -,e su'Dject well currently exceeds this minimum reC ireme.lt, ail par -es conccrned are advised that t1he production capacity of the e11 may fluctuate. ReStYlctlo,n. of no n-crit=cal ..'a i --c— s -h as wash._r.g Cara and =r:ater�na _a;;ns arid ---dens 'S a(.w150:'j/ 1":U..t ,^,c a'�aC T°1, t '-. 'd '"^ all COPies o' the Subject :� .� Health Aut'r.ority Apo -oval. -SKI -H Consultants 1700 Vashon Circle Anchorage, AK 99515 Cf -Q —YR-T IR N -5 _fvI (T T A L. DATE: _% S JOB NO TO: `7j .m 16114 'C/mIT SUBJECT: L07- ZOII. di ,k- ,?�J{ MESSAGE: _ 6/ a,KGj -�1�'Hrr col / e k- arc 7.1 9�p FROM: ,fi 1yazy 1 No. of Pages Attached: Anchorage, AK 99515 PROJECT: WELL DATE OF TEST: LOCATION OF WELL (Legal Description):_SLCI1 n;hlr */ LIQ R2 WELL DEPTH: 467 _ FT. CASING: 4 FT SCREEN: Lif 1541 DATE DRILLING COMPLETED:DRILLER: :,L k&'ZLgz21L STATIC WATER LEVEL (Top of Casing): 2/ % FT DATE: � -2,$. 9(� Clock Time tiapsea Pumping Stopped, ilme wince Started/ Min. Depth to Water, ft. Drawdown/ Recover Pumping Rate GPM IO:Qo 0 f7 (swl) 0 0 Start — _—_2 0 2 -22- f _mss - _ �.0 30-Z 3,69 IS 3 — 10eZ7 - Aly 45 0) 50 50 3co z gs a t __ j/ :00 our F 3037 _j5 �S 90 — 1321 ours g 12r�3o150 3 7 –36 0, —� Oo ours t6 Recovft 1,03aff _1:S30 0 - 0.6 2:00 ours 1391 - 0. Z e L-oo RECOVERY t 0 t' 391 0 t/t' t Z.q4 -- 2:Io 0 0 Z;1a 15 $ t1,41 ?—'20 38 + 1 1,47 Z tZ5 25 1.47 y¢ 2;3 S5 +r i 2;35 39 -r 1.47 ;`, :, 11 Remarks 3-torugqe- Phis s-hotic 26y< 08:45" (0-U01(o le: 10 L 275 { +109' 1t00.23 Comments: We// no, /not fesfecl. Measwcd .s a frG wofel- level on this daie - 457,' esfimo fed sfor-cir of Well is a�P�a�c, goo yal/marls. CT&E Environmental Services Inc, AAL Laboratory Division AeAW1d1r,WA1r"A F" Laboratory Analysis Report CT&E ReU 962562.962562001 Collected Date 06/25/96 Client Sarnple M Lot 10, 131k 3 Scimitar Matrix Drinking Water Technical Dir(-,cfor; Stephen C. lode Released by _.5`/ v _� Sarnple Remiark; Parameter Nitrate -N TotaL Coiiform R esu'. :S 0' POL uni is Method A, low0a Prep Analysis ln�r Ojai. L`rnits Data )ate _ 0.100 U D, 100 m-97— EFA 3?3.2 - 06/26/96 ESC coL/100mL SM18 9222E 76/26/96 TAV ss oo u10 coil U Undetected L - Less nan GT - G?eater than D - Secondary Di LJtion J - Below the C51.lorat50n raingr 200 W. Paler Drive, Anchorage, AK 99618.1605 — Tei: (907) 562-2343 Fax: (907) 561.5301 3180 Pager Road, Fairbanks, Al( 99709.64.71 — Tel: (907) 474-8666 F9x: (9071;: 474-9685 ENVIRONMENTAL FACILITIES 114 ALASKA, CA-- FORMA FLORIDA, ILLINOIS, MARYLAND, WCHIGAN, MISSCUM, NEN JERSEY, 0410. WEST VIRGINIA MAT -SU TEST LAB Mile 3.2 Palmer-Wasilla Hwy. Midtown Community Business Park P.O. Boa 2749 Palmer, Alaska 99645 Phone: 745-3005 Fax: 745-3010 WASTEWATER ANALYSIS FOR FECAL COLIFORM BACTERIA APPLICANT INFORMATION Name:—SQL/-/ Mailing Address:_ %7f O (SCI S�7 CtrL/r gx Phone: ZV Z-70 -6 c� 74T -///0 _ PWSID No:_L// Sample Information Legal Description: ZQ7 �C /7/DCh Date Collected 72,2(._ Time Collected: �27CC Collected By: Sample Type: FECAL X Treated: _ Untreated: _THIS SECTION TO BE COMPLETED BY LAB Sample Rejected: over 48 hours in transit _Confluent growth TNTC: Colonies too numerous to count RECOMMEND RESAMPLE WITHIN 24 HOURS FINAL MEMBRANE FILTER RESULTS: 15-- Fecal Colonies/100ml ._ — -ILD—Other Bacteria (Maximum = 100 colonies/100 ml) Date Analysis Completed: 7-S-- JC2 Reported By: MICROBIOLOGY LABORATORY RECORD -COLIFORM ANALYSIS Date Received: Time Received: Lab Number: Date Test Started: Time Test Started: _Analyst: _ TEST' RESULTS T@S7 METHQD DATElTIMElANALYST Membrane Direct Count:_ Blue Colonies/100m1 Filter(MFC) Color: Blue Other -�— Fecal (EC) Tube # F24 Hr. MAT -SU TEST LAB WATER QUALITY TESTING Mile 3.2 Palmer-Wasilla Hwy. Midtown Community Business Park P.O. Box 2749 Palmer, Alaska 99645 Phone: 745-3005 Fax: 745-3010 DRINKING WATER ANALYSIS FOR TOTAL COLIFORM BACTERIA APPLICAN V INFORMATION: Name: ,Kt- H Address: /l Sample Information: Phone: a �i_ 7dY ai,� PWSID No: Account No. or Code: Paid: Single Family Residence Multi Family Residence_ Legal Description of Property: z- ccs, ./6-3 � ,�,��;7��� &X-6-- _ Date Collected:_ -3 -f • Time Collected:) 1 o O Collected By: S Sample Type: Routine:_X Repeat Sample #: Treated:__Untreated: Fecal: THIS SECTION TO BE COMPLETED BY LAB ANALYSIS RESULTS: Satisfactory Unsatisfactory *Sample Rejected: Over 48 hours in transit x. RECOMMEND RESAMPLE WITHIN 24 HOURS MMO-MUG METHOD RESULTS: Total Coliform Bacteria (P = Present / A = Absent) E. Coli Bacteria 14 (P = Present / A = Absent) Fecal Coliform Bacteria (P = Present / A = Absent) Date Received: Z -.;> -?P Time Received: Lab Number: / �l Date Test Begun: %-%'c- Time Test Begun: „f%C' Analyst:_ Date Completed: ?i3 p(P Time Completed: o Fjya Analyst:_ C• REFER TO BACK SIDE FOR INSTRUCTIONS 1_I. a �1-1 CT&E Environmental Services Inc. zq1t1k r Laboratory Division rray►i��r�►�s.►.alpr�.vri®ii�iiosi®•I►,saiinii®ie®iswr r�.,r Laboratory Analysis Report CUF; Ref."" 961405.11528 Collected Date 04/22/96 Client Sample LD L10 93 5CWl-1 AR,NI ) 130-01 Nfatri.e DrinkJng Water Technical Director: Stephen C. Cde Rele.used Bv Parameter Nitrate -u aesVt t OC POL units Method At tovabts Prep Analysis Init Ouat Llmitc Oat^. Date 0.100 U 0.100 m9/L EPA 353.1 04/23/96 EMB u • Undetected LT Less that, GT Greater than 0 • Secondary Dilution J - Wow the calibration r 200 W. Potter Drive. Anchorage, AK 99518-1605 — Tel: (907) 562.29x3 Fax: (907) 561.5301 31 80 Peyer Road, Fairbanks, AK 99709.5471 — Tel: (907) 474-8656 Fax (907) 4749685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLQPIOA. ILLINOIS, M14ARYLANO, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA. SKLH Consultants 1700 Vashon Circle Anchorage, AK 99515 9616 10 June 1996 j,\ To: Municipality of Anchorage, DHHS/On-site Services'09g JAN ,C'\,QS Fr: Steve Henslee, P.E.Mu"Hea\th Deft Re: Lot 10, Block 3, Scimitar Subdiv. #1 While reviewing my submittal of 7 June 1996 for a Health Authority on the above property, I found the attached letter and drawing were inadvertently omitted from the submittal package. Please include these documents as part of your review. Please call with any questions. Sincerely, xe C. Henslee, P.E. CE 7604 June 5, 1996 SKLH Consultants 1700 Vashon Circle Anchorage, AK 99515 Scimitar Subdivision #1, Lot 10, Block 3 Health Authority Submittal 9616 Attached are two well logs for two existing wells on the above property. The first well, Well #1, is a 740 -ft well drilled in August 1981 per the well log. No permit appears to have been issued for this well, The second well, Well #2, is a 407 -ft well drilled in May 1994 under MOA permit number 940080. This well log was never filed with the MOA as indicated by MOA letter dated 19 April 1995. 1 am submitting this log to close out the permit. The well which was to be abandoned as part of permit 940080 was abandoned with bentonite clay and concrete at the same time Well #1 was drilled per the driller who did the work. Also attached, is a site sketch of the two existing wells showing the well locations using swing ties taken from the house corners. I found not potential source of contamination within the 100 -ft protective radius of either well. I- � r` V'�,,-SOIL WELL DR����1�y � Ctcs 1305 W. 45TH STREET ANCHORAGE. ALASKA 99503` PHONE 272-9343 \DRILLING LOG - Well Owner ! I ( ru L- ' 1 a l Use of Well 1 Location (address of: riTownship, Range, Section,, if known; or distance main road -- f':, Size of casing Depth of Hole r feet Cased to / feet (0al Static water level 2 ft. (above) (\low) land surface. Finish of well (check one) open end Green ( ) Perforated ( ) �, �4 rr (, 0-J:� •4' ��-' �- i , . <, l Describe screen o pe foration ' Well pumping test at � �' gallons per (hour) (inute) mfor [ C! hours with `�' ft. of drawdown from static level. Date of completion l' WELL LOG Depth in feet from. ground surface Give details of formations penetrated, size of material,\color.and hardness TO C� 1 TO 4'0,, i . �' .._C� 14, C (,I I(J -,:)(I C� — TO ri TO C. J ` y (' tic (^ t' L C, TO .e �, s� l , ��- c> ti ��' < TO tc!1.Q TO .fin �. ('��C� �t1('•t) V,`c. %�� 1c E� %.ct �c �< 'l:�i lc•Z-� <j �� !(` 1''� C (;_ ( i TO C�� QLl _a l Cc c� r �r )Z'<" ��c � � 1 TO CSC �_ f. 1, (��r' 1_ 1 1tiLe , <<., �•' 0 TO l�C�e�� �U�-1' T`c`a C��Ctj i�rX'c<<c1�(1 rl iri LU > 1= itN xIL I LL� 4; V�l ro to MWE cd; .,i.. b.04 Olt co: I G)! 43 OD 0., 0 I . V.4: oz , gv 0 C) 04 ad' to Cd W 0 a 43! 4-2 ! Cjll :J o _P I jii , (4 (di 14, Id, t m 44- FI � N' � N r ,-+t � t'� �� uj Ch G 0 0 0 0 0 O E/1 Lri C\i V'V ci 00: W CO 44 VIP, ad 11 rDATE RECEIVED INSPECTION APPOINTMENTS --- --TIME -- --- --- --- - _-__-_._-.__._.______ -- - - - - - - - - - Q� L) DATE DATE DATE - - -- - -_ --- ._. _._. _.._---.._--- INSPECTOR INSPCCfOfi- -- - - _.-- -----INSPECT R ] One L7 Four [] Other__ .. -�. )R Two ❑ Five MUNICIPALITY CP ANCHORAGE --�� MUNICIPALITY OF ANCHORAGE DEPT ( �iLCTION — c< DEPARTMENT OF HEALTH PROTEC78I9D71RCi\; \ ATTACH WELL LOG. A well log is required for all wells drilled 825 L Street - Anchorage, Alaska 99501 \\ ENVIRONMENTAL SANITATION DIVISION \� Telephone 264-4720 EC EIvpREQUEST FOR APPROVAL OF INDIVIDUAL [Xi INDIVIDUAL/ONSITE" WATER AND SEWER FACILIT DIRECTIONS: Complete all pans on page 1, Incomplete requests will not be processed. Please allow ten (10) days for processing, HOPE RTY OWNER PHONE Magnuson, Timothy____ - - - - - 688=9265 MAILING ADDRESS -- _ - ---------� ------- --- --- -------,n- PER•TY RESIDE�-7 IIF dlfentnt Irom arjrovcl PHONE 2. [3UYER Dailey, Terry -— --PHONE and Nancy -------- -- MAILING ADDRESS - - _-- ----------- ----- 3. LENDING INSTITUTION i -- PHONE MAI LING ADDRESS -"------------- -- -- 4. REALTOR/AGENT PHONE John Parker Totem Realty 694-9494 MAILING ADDRESS - -- - -- ------ - - - ---- 5. LEGAL DESCRIPTION --- Lot 10, Blk 3 Scimitar Sub Ti"EiCETE660ioN --- - -- - -- NHN TULWAR DRIVE _ 0. TYPE OF RESIDENCE NUMBER OF,13EDR60MS IgJ SINGLE FAMILY ] One L7 Four [] Other__ Two ❑ Five i_ -I MULTIPLE FAMILY Three ] Six 7, WATER SUPPLY — [gJ INDIVIDUAL` ATTACH WELL LOG. A well log is required for all wells drilled 7 COMMUNITY since June 1975. For wells (II filled prior to that clate, give well O PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM —"-- [Xi INDIVIDUAL/ONSITE" DEC 1977 -_YEAR ON-SITE SYSTEM WAS INSTALLED. U PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. �/ L %ztiq�2 /J -J , / Wil, MO f D', T L11.10 u sup if J C) ;I r Totem. Reall.y 13C)", 911! G 0 J7 III) j ,.C, ul 3J. ou, k sc ilr, t" ar Li 1)(� i % 1.5 ton p p r c "!a for 1- 1 ;,-, ; r.O cannol- I until (A)c f0llm.lil-1q j.1-r3lis lial—, C(,)In)- The watc-,,- ana.'Y s �--- repori- w—:1s t n 1,c, delivc,redi C')'L.reetf 1.01, .1. C, Cl o the sop, i. `]1,1c -"Id T h e s c! -v I- C: p L s I -a o I I .-!. ice to).- c - a C, , I T v - I I J , I , pc'- On %., 1) 1 -1 Ij " t., any -tht,z de.c�crepalncy h&`, c-, c [, etl Lm: e c : c Si ncej- ely , L7 131.1chl-so; Li'M" / 1- I w #l: Time MUNICIPALIJ TY OF ANCHORAGE DE:PARTF - OF H AL; AND ENVIRONME' L PROTECTION 825 L S , Anchoraap.. Ala6Xa 99501 264-4720 Date Received: December 20 # 2T�_me dk 3 : Time 1977 Date Date Date _ Insp--- Insp Insp — — REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1.. Lending Institution Request: Alaska Teamster Credit Union %Jean Oldre Mailing Address: 2. Property Owner: Dave Deans Contractors Mailing Address: Box 11_5 Chickaloon Street 99577 Phone: Phone: 694-9387 3. Legal Description: Lot 10 Block 3 Scimitar Subdivision 4: Single Family Residence: (x) Number of Bedrooms: Three Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: individual Well (x) Community/Public System ( ) Permit # __A Depth of Well 400' Well Log on File moi) Construction CAM Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit# � ^2(P 5-0 Installedl977 installer Septic Tank Size _ fy�.� ManufacturerQ, Absorption Area 3.3 Soils Rate ?�—.- Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line _ Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 10 Block 3 Scimitar Subdivision^� Comments: Affadavit Attached: ( ) Letter Attached: ( ) Approved: U� Date: /�^ Disapproved: Date: - Department Worksheet: �,.ZG 7' --- MUNICIPALITY OF ANCHORAGE��./�-0(77 Department of Health and Environmental. Protection 825 :L Street, Anchorage, Alaska 99501 ii 7.64-4720 =quest for Approval of individual Sewer and water_ Pci.lities 117 A; O 1. Property Owner: Mailing Address: <owi K)-cTv�P-S--- ?C 6,,,94-'738'/ 2. Name of Buyer: Mailing Address: ---- — �- -- Phone: 3. Lending Institution: ONl�------ Mailing Address: cin. Phone:-��o�l�� 4. Realtor/Agent— Mailing Address: Phone: 5. Legal. Description: _ ��$ Lp� �- Street Location: -- 6. Single Family Residence: (IX Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual. Well ( Public/Community System ( ) If Individual Well-, well depth 9� If Community System, name of system 8. Sewage Disposal System: *'bn-site System (✓) Public System ( ) 7:f On-site System, date of installation: - *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two (2) years old, an adequacy test .is .required by this department. A fee of $2.5.00 must accompany each request before processing can be initiated. 3/77