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ANGELS PLACE LT 3
Angel's Place Lot 3 #017-112-65 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program. 4700 S. Bragaw SL P.O. Box 196650 Anchorage. AK 99519.6650 Page of www.ci.anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: 5dit"03-DIIS PID Number. µ0. Wastewater System: []New Ef Upgrade es M"Gan iF,3o tib t- -f ABSORPTION FIELD Prone N~ N Bebomu- D Dep TrNxh O ShaMw Trerrtl O BM MpurW O Otrvr LEGAL DESCRIPTION Sod Radq 5Cape's TNN Dpm hom wqg l gilds (.� F•. Bock Lot 5u harm Depth m Fele Wm ham W" grade Grl.el 1"h heneam p». o. AFI A ifs Q _ n Ft. Toensmo Range section. FA aeead 11 "-0 Wads C." Llrytn _ Well: ❑ New ❑ Upgrade Gravel wqh I O Nu of Ince 3 DntNw hee»en Was I Ft. AS Ft C:ash6ouon tPaale. A B. ey (� L TNN DiFth cash q'. TNN aeeNpti Nu Pipe Matt" L R. Ft /50 Fls Sb M -a° Y0 ✓ Oreler Dlle D.W.sta Wa1M LevN hellMr Dale NNNIy' Ft rm° Pump See &I Cawp HpM Mae GrgeW TANK Gven Ft. FL SEPARATION DISTANCES p Septic ❑ Holding ❑ S.T.E.P. XDther. To Septic Absorption LIR Holding PubliHPdvat N.rklt,rna.r apsoty From Tank Field Station Tank Sewer Line 0 r1_ IF— N C p AY Z D 15oaa1 wee 115 if 6, 100 Nilenll /tire a59 Numper N Companments Z— s'eace Wager rtlo NIC) NI LIFT STATION ate Nanulachaer LotLne 3D 5n 3D l.Scv Get C,D FourMlel{rl I O �17 I D PuTmp7 M'IeVN N'. 'PupW wi' NatnpI111.° L �/Ll Hqn wNN 'e" 11 /' 4..� i. C • j 'L. N / SC m cDr.n N I Pip ElpinfJl hFp.N�Me by . u°am o f/ Rem!•ks BENCH MARK _ �LN Lx.e3 a� S Aswm E,. eaocn VKC&4 roA too�1 g1 vuf' a CL e A • lo,t?" Cr 491H 6�l r r/I Inspections performed by: s Dates: 1F'/11%� allele.».. - 0' �. 2 n b IR o3 .....»..._ . Development Services Department Approval i�w= T aSpurk bed Reviewed and approved by: Date: _rp - //- 0 3 IRs. over 44 Fo"..e,��,,..• ,�QQFESSIO�`v.' LOT 2 I I I I I I I I I I As"w Da - 115 FT 6C 26.0 AD 503 I W 25.5 AE 75 BE 71 CRUSH D AAV BWa riCRUSH AND lx1ED LOT 3 1 I 1 I E I u I I I I I I I . 8 WTAUM 10' x 15• Mom BENW Amw 25 0 25 50 75 1019 125 150 Dorm sw SCAL£r 1'= 50 FT. ASSWED LU 100.00 FT 1UCCUV srUlncunU P.L. LOT 3 ANGELS PLACE SEPTIC SYSTEM AS BUILT 203 W 157H AVENUE JON AND LAURIE MAPES DATE: MAY 22, 2003 (NCH. AK. 99501 907 279-39/6 11 5301 RABBIT CREEK ROAD SHEET. 213 GRID. 3137 PERMIT #SVO30118 PID # 017-112-65 AN000032.DVG NO SCALE Monitor Sm 0.5ff 1 SrV& Mock . 13 FT lxnw Sw O(=O ADVANMr AX20 ,•rte;.•• Iy• ' 49th W1 SPURKLAND No. CE -2223 ADVANT£X AX20 80"m som ASSWIfD [t[v. !00.00 i7 TOB203 W1 h AveND P.E. LOT 3, ANGEL'S PLACE SEPTIC SYSTEM SCHEMATIC 203 WISth Ave JON AND LAURIE MAPS MAY 21 2003 P79 -291f, 11 Anchorage Ak 99501 DATE , SMf RA6e9r7 OfIr MOND SHEETi j j GRID, 3137 PERMff SW030118 017-112-65 ANG00033.DWG JUN-11-2003 11:32 AM T SPURKLAND V07 276 6013 P,01 ......a..wi:ti. "XL 54R- l ICES. IN �37-wrT7Q ` � TOt2766313 x1aStFue, 5/22/2003 6101 VAO2 1/1 Rightrax ^ uh KAneters D,w Sl#r4r Ohddan 4M Z%u 3lIstELTSDNt Yotaq �1.p00 iMi/ECT7D111 MX WVY)249-77 s, aterot 747�7Yq FINN !D'S IIKMC MAIN~Hole oa 0ou sol aABW C11UIt 10 ni.n• M? LSA t+rWMiewarMai..:000 �Ig2j28 a FM AllOids PUM Coor,ati w Dbwfloos MNO*01LLTO M!!Tv' amC LIFT STATiOM 24$P@dit I=f �teaiwflen M NO NONCDM►t1�ItCE Ofl VAM Q m utocnOeq LtgNiiALAB WLAAIED a g" DI'llspocrmWUWVAMM AT Ne7R C) 00 N0T =k=L UWnL•11lINSpeMON • • COMNi�l7f1'l'ror�rw� onllr) • . ,.• MARK H tiNSEN P.E. CWSULIPG Cw6-NCC':1 1CUM LAWFATVIT ►.O. Be. 4.333 ►.tw, u1 19040-4373 Pw . (147) 7*3-4771 F" (907) 744-4721 H,w.,l: w.a. �wlaW Mww.l North Star EarthmQYore, Inc. HC 01 Box 0195 Palmer, AK 99645 Fax: 7453114 / 40 7- 7Vf; - !!t Docombor 23, 2002 Work Order: 0207 Project: Mateiials Testing Subject: Sieve Analysis Gentlemen: The following Is the sieve analysis of the sample taken on 12/21102. MOA Filter Sand Side Percent Passing Spec.- #4 pec. #4 100 100 010 76 #20 43 040 10 #60 1.5 #100 0.5 0-2 #200 03 0=1, :0'd The sample conforms to the above specificali..ns. Approved By, Mark Hanson IZd4 94L 406 7'd'N3S"VH*NNVW Ltd ££:10 ZOOZ-iZ-.3C Municipality of Anchorage Development Services Department +..r Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET To: Tobben Southland Legal description: Angels Place Lot 3 The attached paperwork has been reviewed and Is being returned for the following reasons: Original signature or stamp missing on Calculation error in design. _ Additional soils information needed. _ Water monitoring results inadequate. Discrepancy in information submitted. _ Topographic information missing or inadequi CVS i"Y fclet) 0�_ / / k(/a5 Incomplete; missing Maintanence Aoteemeht, Bectricnl Reoort. Pu Incomplete; missing Datum Manhole. tank to wells on adjacent lots Additional adequacy test information needed. Water sample unacceptable. _ Measured/proposed distances/dimensions missing. _ Locations of all soils, percolation and water monitoring tests not shown. _ Proposed system too deep for soils information submitted. _ Well log required. _ Omission in narrative. _ Insufficient fill over tank or field._ Other. Name of reviewer: Jeff Date: 5-27-03-6-03 VI - Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK & If" 3 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030118 Legal Description: ANGELS PLACE LT 3 Date Issued: May 07, 2003 Expiration Date: May 06, 2004 Parcel ID: 017-112-65 Design Engineer: 0007 Tobben Spurkland, PE Site Address: 005301 RABBIT CREEK RD Owner Name: JONATHAN G. & LAURIE D. Lot Size: 34875 SO. FT. Owner Address: 5301 RABBIT CREEK ROAD Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE, AK 995164905 This permit Is for the construction of: Q✓ Disposal Field Z✓ Septic Tank Holding Tank ❑ Privy Private Well E] 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. 5. The following special provisions. THE SAND USED AS THE FILTERING LAYER BENEATH THE SEWER ROCK SHALL BE A CLEAN COARSE SAND WITH LESS THAT 4% PASSING THE 100 SIEVE AND 2% PASSING THE 200 SIEVE. A SIEVE ANALYSIS SHALL BE PROVIDED ON THE SAND USED OR OBTAINED FROM AN APPROVED SOURCE. S'r"-�' ENG/Pr-FiefDrSiGN Tv f!N i9Dvi4�liT�x S istt,-f DA 7 -it- D tirA1' l G, ; 003 /17140 ro. Received By: Issued By: Date: _/s 03 Date: EZ70 Municipality of Anchorage • i- Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0/7-1/ 2 —6r Permit Number SWO30 / /R Property L'] Day phone �5 V5— o S o Mailing address (1) h ?SCJ 1 �a �� LruG l2� Mailing address (2) d&C fO/?4&t AM Zip Code 75T16 ^ Os Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size 3¢ 87r Acreq.Ft. . THIS APPLICATION IS FOR: Number of Bedrooms 3 Sewer Only ❑ Well Only. ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade [�/ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above Information Is correct. I further certify that this application Is being made for a Single Family Dwelling and Is In accordance with applicable Municipal Codes. (Signature of property owner or authorized Permit Fees: _ rf Waiver Fees: Date of Payment: 413010 7 Date of Payment: Receipt Number: -5 `{ b 0 5 Receipt Number: (Rev. 12/00) T.SPU Pi TilLAND, P.E. 203 W 15th. Avenue. Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 3 ANGEL'S PLACE S/D JON AND LAURIE MAPES 5301 RABBIT CREEK ROAD Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 May 16, 2003 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable test holes are also enclosed. The septic system design is based on the following: Ground Water at 4.8 ft. on 5-15-03 Use Mound with Advantex 20 Soil Rating. From Test Hole 12/13/02 20 min/in - 4 gal per sq.ft/day a 37.5 sq.ft/bedroom No. of Bedrooms 3 Total area required: 112.5 sq fl Remove Topsoil and replace with Filter Sand 8" Total of Sewer Rock Bottom Rock At Existing ground level Insulate Cover 2 feet Use 10x15 ft Total Depth: 1St Filter Sand 1S ft Sewer Rock 0.8 ft Cover 3.0 ft AX20 Advantex Treatment System The installation of this septic system will not prevent wells and septic systems from beingh installed on the adjacent lots. There are no developed or natural surfacetsubsurface drainage courses on this or on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. 50 0 50 !00 150 200 cCA F/ Y = 100 FT. aAZ v *m -¢- Well RABBIT CREEK ROAD r - 49th fel t SPURKLAND 250 300 LOT 1 I 1 I LOT 2 II I I 11 II I I LOT�3 Lw: `�- II II �I r 0 y 03 W a TH. AVEu E LOT 3 ANGELS PLACE SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE JON AND LAURIE MAPES DATE: JAN. 20, 2003 (NCH. AK. 99501 907 279-3916 11 5301 RABBIT CREEK ROAD SHEET- 1/3 GRID: 3137 PERMIT 11 SV030XXX PID 11 XXX AN000031.DV0 I � I , II I I CRM AAO RW DOW ,AW — CRM Aw — 1 aw 7T 3 1lI 25 0 25 50 75 10a 125 150 SCAL£t Y = 50 FT. TOBBEN SPURKLAND P.E. LOT 3 ANGELS PLACE SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE JON AND LAURIE MAPES 907 7779-39165916 DATE: JAN. 20, 2003 (NCH. 5301 RABBIT CREEK ROAD SHEET. 2/3 GRID. • 3137 PERMIT /SV030XXX PID 1/ XXX AN000032.DVG NV OZW Xld X31Ndnad SW &"11f- EII M+ 1 NO SCALE 1250 got STEP tank WCH MAN. CAR" sus ASSIAND EUV.. 100.00 FT I TOBBEN SPURKLAND P.E. I I LOT 3, ANGEL'S PLACE I I SEPTIC SYSTEM SCHEMATIC203 V15th I Anchorage Ak 99501 Ave Anchornge JON AND LAURIE MAPS DATE- APPRIL 19, 1003 AnSMI RAORT CRMr ROAD SHEETi 3/3 GRID, 3137 IP£RAI/T/SW0300XX PARCEL ID / XX AN000033 DWG IPARCEL ID / XX AN000033 DWG I • • f • I Municipality of Anchorage i,,jP PjkEER'S SEAL) 11a Development Services Department h %t9 1 Building Safety Division % * 497 S} *, A 1 On -Site Water and Wastewater Program • «.«.».»»w»` 4700 South Bragaw SL t, P.O. Bax 196650 Anchorage. AK 99519.6650 .9 �• "'»»•«« f� www ci anchorace.ak.us �� To ben Spuriland (007) 343.7964 � f�iJrJ,% C61Z7! V't/ Soils Log - Percolation Test Performed Fcr:cS OatePerfortned: ^ (� Legal Description: n�.l 1S PIuC�- Township. Range. Section: SIMP Site F Depth tcs 5111A,j Se.k40 ?o Llr L4 s 4S;14 1 ; y%y41o3 V;AS DP.oi No YlATER y I I I I I I ,1 ESCCC::iERE]7 S IF YES. AT YlMAT DEPTH? to 0 Depth to WeerAfter �L v 6tonittiringoring7 ti E Dare: 1 03 yha f D'5 Reading Dare Gross Time Net Time Depth to Wale' Net Drcp 1 'Oy-,?V-�SOA<l 1 rly I 1 — �� I : 2.1 3o Nlnl I -7 18 I a 1 I I I 3o I7 -17*1e. I R-1 3 o I7 5/e. S�8 -7 61A 16r� FECAE 02 (r xrtiSeC) FERCY.CLSOIAMETER TSST F.L'\ 5ET7r5E.`I _EL F7 AND 15 FT COMMENTS - PERFORMED BY: S t t, S CERTIFY THAT THIS TEST WAS PERFORMED IN ACCOROARCE WITH ALL STATE AND t:UMCIPAL GUIDELINES IN EFFECT ON T'rlS DATE. DATE: 1 !'• I _ A) t- ., !•"� MUNICIPALITY OF ANCHORAGE • DE. ATMENT OF HEALTH AND HUMAN SER'. ES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES -:ict" C11r Admess TO SEPTIC ABSOOPTION WELL iRRM ,auv nun VnOM15) FE ! t i S: t' a• REMARKS: /$ft c OK � r a+5 r =. � :z..* 5rtlj 60 lied M 7v LG,ciftAj Crib. I � Municipal and Slate guidelines in died on this date: Health Department Approval: WELL PA I S4 / LOT LINE IJA qg 'VQ. FOUNDATION PA &j (( 114 - AS -BUILT DIAGRAM t5now location of wen. septic system. propeny lines. lounaanon, anvewavwater bones. etc I Inspections Performed by. Dale eerbly that this Inspection was perform wore ENGINEER'S SEAL to all�Cie .C. TANKS ❑ SEPTIC (t'5 (N J HOLDING Wnutactuter Capacity in gallons Materwt No. of companments TYPE OF SYSTEM ,`, ❑ TRENCH 4� BED ❑ W. DRAIN ❑ OTHER UPplh to pipe bottom Iron ; original grade 1,5.1 6� FT Total oepth from onginal grace _Vo_ Fitt 80aeo above on nal g,aoe FT Gravel Guilin beneath pipe 6,6, Gravel lengm 3 FT Gravel w.alh —2 -02 - Iota[ aasorpnon area 6 So FT I Distance bHween ones Numoer of floes Safilling " 9 1 SO FT p.pe mill 3 msuner Date lnstaeeo WELLS }'PRIVATE ❑ OTHER (Identily) Uaas�Lcehon IA.b.Lf I Total beam I LaH'o to ! t i S: t' a• REMARKS: /$ft c OK � r a+5 r =. � :z..* 5rtlj 60 lied M 7v LG,ciftAj Crib. I � Municipal and Slate guidelines in died on this date: Health Department Approval: WELL PA I S4 / LOT LINE IJA qg 'VQ. FOUNDATION PA &j (( 114 - AS -BUILT DIAGRAM t5now location of wen. septic system. propeny lines. lounaanon, anvewavwater bones. etc I Inspections Performed by. Dale eerbly that this Inspection was perform wore ENGINEER'S SEAL to all�Cie .C. MLJF'4 I C I F--sfaL I TY MF= fa 1VCHC]Fzint GEZ- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 ON—S I TE SEWE=F1 F1FEE F -:M I T PERMIT NO: 850595 DATE ISSUED: 09/17/85 APPLICANT: JOHN CHRESTMAN ADDRESS: 5301 RABBIT CREEK ROAD ANCHORAGE, AK '99516 CONTACT PHONE: 345-4197 LEGAL DESCRIP: SUBDIVISION: ANGEL PLACE LOT: 3 DLOCK: NA SECTION: 34 TOWNSHIP: 12N RANGE: 3W LOT SIZE: .75A (SQ.FT. OR ACRES) MAX, BEDROOMS: 2 Listed below are the options available to you in designing your septic system. Choose the option that - - - - - - - - - - - - - - best fits your - - - - - - - - - site. - - - - - - - - - - - - - - - - - TF--<ENCH L3EIE) , W . 13F_;�A I F1F DEPTH TO PIPE BOTTOM (FT.) 4.0 4.5 a 4.0 GRAVEL DEPTH (FT.) 2.0 0.5 '�� 2.0 TOTAL DEPTH (FT.) 6.0 5.0 i 6.0 GRAVEL WIDTH (FT.) 2.5 220 1� 5.0 GRAVEL LENGTH (FT.) 190.0 ** 41:0'3 107.0 ** GRAVEL VOLUME (CU.YDS.) 44.0 33.5 49.6 TAN), SIZE (GALS) 1,000.0 ** 10000.0 ** •1,000.0 ** SOIL RATING (SQ.FT./BR) 380 ,299 380 ** GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) +�* TANK MUST HAVE AT LEAST - - - - - - - - - - - - - - TWO COMPARTMENTS - - - - - - - - - - - - - - - - - -'- - - - - - - - I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska.. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3.'I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is,valid for a maximum of 2 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION'MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN'ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BEEJ DONE BY A LICENSED ELECTRICIAN. SIGNED / / /� %Z� DATE: /z/G_- - _1rt7d,—----------- APPLICANT: .00HN CHRESTMAN ISSUED DYE DATE. ^� F h 1-1Ut4 I CO I L- I TY GF HMCOV4- l&ClE DEPARTMENT L. HEALTH AND ENVIRONMENTAL i"OTECTION 825 'L' STREET, ANCHORAGE, AY,. 99501 264-4720 L_L_F1t4F7 Etit-J—:. I TE SEWER PERM I T PERMIT NO. C 830975 ) APPLICANT JOHNNY D CHRESTMAN SRR BOX 1505H 99507 345-5094 LOCATION LEGAL L3 ANGEL'S PLACE LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BP,)= 3�0 THE REQUIRED SIZE OF THE SOIL ABSORP T IO -N SYSTEM IS: FIEFJTH= c7,L-ENG11 H= -so-ons GRRklEL F>EFJTH= 2 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THE TREVJjZG" LJ I LOTH I S S. EDCDED FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). FQE=CALJ I REO "aEFJT I CT 17FIt4K 1 12" E= == ILEDEDED C3FiL_L_CDt4S~ PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TLJQ < 2 ? FIRE RECAU I REF? --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OP, 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER. LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F&EF21 1 I T E}SF" I RE"> F7EE=E1'1EDER TAL, AL<9E:' I CERTIFY THAT 1: I AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FEND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLI ISSUED BY 1 CHRESTMAN V4. 0 1 Y SOILS LOG Y MUNICIPALITY OF ANC HORAGE 1 / DEPARTMENT OF HEALTH AND ENVIFiONK�:tJT/I L7Y'ROTE,IiUE K PERCOLATION r- •• .. _. TEST 825 L. Strout, Anchwa0•, Alasko 99'EIllr, 2G? 4770 .V I 1 SOILS LOG - PERCOLATION TEST JUL PERFOII%IFD FOR Ave ye, Nny��: ��_�c-f?VI�r"OnMEO: LEGAL tIESCRIPTION: �O L ✓` ��'AC ` __ _— u C7 -t -i'..,. SLOPL SITE PLAN 1 I Iz ; I(I I I,�' y nprq n;c- �I I t.5 3 Veru ;ne 5 -ands 1.� ! .I I a 5 -t��• !t� t ,(uM)- Sl�tl,I r� 961 A e 7 r(S #`1��, `11 Mj-9 r`� v�j-sces'-5i,o;Ii L)—LA6 lt- 11 -i 15- I 5- •�� �r 040'G WAS GROUNE) WATE17 ENCOUNTERED' 4p -cc.) — I- O 1' IF YES, AT WIIAT (O ! F DEPTIP 1 Rcadmg Date G•u.s T unr Z �•Z�•4Z Ll; jr - 2— 191..7 5:15 Ir M;A MEMMMEM ,D _ts,, I •.t v ,o 10m;n I .E8 c7 — ----..._ ■M■■■ 10MIn I- .oZ mm■■■■■m Depth to Net T.mc Water Drop -M 191..7 0 Ir M;A MEMMMEM ,D _ts,, I •.t v ,o 10m;n I .E8 -to-m;ft -y3 ■M■■■ 10MIn I- .oZ ■' 1 ■ ■■■■■■ Nm nmm■ m C:: 00 MEmommmui N. -I Depth to Net T.mc Water Drop -M 191..7 0 Ir M;A 0`f2 ,D _ts,, I •.t v ,o 10m;n I .E8 -to-m;ft -y3 10MIn I- .oZ 1 J _. i -11� coca • - '+ . L4p�o� 20 PEnCOLATION RATE TI'ST nt1N IILTVlt:EFt 1—�•ITrA'�aD �.!1ZS,PY. 'r COM11:dht1T5 -PJC. 0."rt? �NC•••r PERFOI:.•.7ED BY: -N1L1 ]/% CFIITIFIFUIIY: 72.006 ;;'7R1 S' `tet f / �• Z- -;� ASKA LnUIROMMIAC C01111ROL SCRUICB, Inc. Cngmrrnrl 6 [nvironmrntcl 510itt Mut,,PALI fNVGr'4 r �OF q.yCyv�AGf PERCOLATION TEST DATA SHEET ^� C1,52 CLIENT Kar-,'. iCov00.Gs — -- DATE---5'?_Z-82 /r ��l VEQ Ili ,itESS ZIF CODE (moo IG(l lL'..! ". LOCATION O . Itii':;. !lEl'i!1 Oi. 110:. _(t. Z01..' TESTED TO READING i I CLOCK TIME NET TIME DEPTHTO NET DROP RATE (min/in) iN DATUM 0-__ - .13 --�------� io 10 20 to — _- -- I .77 1 Flii L PERCOLATION RATE WCL LCC Date.Drilledt A -75-R3 Static Water Level 11) feet Draw Down N/A feet Type Material Drilledt 0 feet to 25 Crev clav/gravel 75 feet to 30 yrAVPI w/water 30 feet to 37 ClAv/boulderm 37 feet to 149 bedrock w/water to to Hefty Drilling S.R.A. Box 1553 H A nchorage,Alaska 99507 Gallons For Minute 4 Total Feet of Casing 148 MUNICIPALITY OF ANCHORAGE DEPT. t b ENVIRONMENN PROTAL PROTEC110N IAPB G 1997 RECEIVED � 'O S "- r— CD CF) CD CD L, - A C6 IT IT co CIO I- r - C) O rn rn LOA Lt_ 0 O L n 0 -X- 0 X,0 � U � O }}� CO o � � 0 U (B L a) 06 U) L E Q. O � 00 A ll N O N N r N 0 C O Q X W O O O LO I N ti 0 m U M J W Q J J LU z Q c 0 Q U U) m 0) J O O O Q N (Ti L O U C Q U) Q ry W W 0 W w O OJ N LO U) a) a3 0 A' J W 2 75 W J In O 2 a) c 0 Q O Q c m U co X M 0 0 N c a) E 0 U ►1 0 0 0 0 CL U) 0 Q -0 cC Q 0 3 U N V N 4-1 U) N a O O O X N .a O 0 O U N C N N ON CD O — O _ L U L > O 4+ C _Q V ^ 0 0Z O Q> _U -o N E N O Q U a v0- ,—c N — ca 0 O 3 Q .N 3: z cn CL 0 LO O O O a. Q Ea) Q. i N v 0) O L Ej>X ,d; O M O cn N >, O N 0 N E -0 '> 0 Q >1 o CL 0 N O _ _ . 0 0> N LO Q 4-1U OC: LL 70 Q c O C U O 0) O (n v� Q Q 4=. _ ai a� Z W O uo, i O N �- cLa O E U -0 a I— O U= .o ,o U cn a L a a CD CD m CO C'', C7 I O O CD (3 en j j 0- cA Q t N p 4 co CY ' 00 0 O Q) `O v m .y O U- LL �ijr.-ssxra L N E ❑ a O OL U) 0 C n LL Q) N -0 oo Q7 > U �(Ci (1)co > I 0O I' z O Lo F-- N r O r LL O z C) 1.6. w z U Lw T-: LO CD M Y Q W Q O Z W W c� U) W O C3 0 W fr U Q w LLJU J W /w V W Q CD LO o L U � V ai "D cB � a� v a� a) a 0 CL �. E mo O U U U U cA co CY ' 00 0 O Q) `O f� m N O U- LL � L N E ❑ O a a) W QJ U) 0 C n LL Q) N -0 ElQ) U > co a) z p Cr1 O d ❑ 0) C (n � W mo °' CL O J a� o cY) LL W ,,U) VJ w Cl) >. Q) L Q V, w ~ a Q) > ❑ � ❑ J O F- a _a- W L- O LL O U z O a w a N M U) U) n3 a) LL A a) U O U U _U) M ❑ a� Q) C) Q i-- T U N a W Q ui Q. Q) 0) m Q a) (D U) ❑ U c M FL a) 3_0 ❑ U a a_ Q) Q) A El a) m U) FullQ _w LL z O Q w U) Cfl 4 z: a) U m I ■ O U Q) N T� a� > O O Q Q O Q a O In E L Q) _ s i O � U M 4? Um �s CL L CU Q) m 0 N 0 i 0 E m U- LL L 4— L O O QJ C COSA Checklist Legal Description: ANGEL'S PLACE; LOT 3 Parcel ID: 017-112-65 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA X Well log is filed with Onsite (or attached) Date drilled 8/25/1983 Total depth 148 ft Cased to 148 ft X Sanitary seal is functioning correctly ❑N Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 3/19/2024 Static water level at beginning of test 11.6 ft Comments B. TANK DATA Measured operating fluid level in septic tank 'N/A Date of pumping "AWWTS 0 Required maintenance completed, if AWWTS Comments: `SEE ATTACHED MAINTENACE REPORT D. ABSORPTION FIELD DATA Which system tested (date installed) 5/19/2003 ❑0 ALL standpipes present per record drawing Total measured depth from grade 2.9 ft (max) Measured depth to pipe invert from grade ft (min) M N/A —pressurized field. * ❑ Per record drawings, field is insulated. ** Q 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) N/A If yes, enter date Well production at time of test 0.6+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ® No Q Coliform bacteria is Negative Nitrate mg/L R Nitrate less than MRL (ND) Arsenic ug/L R Arsenic less than MRL (ND) Collected by GEG, LTD. Date 3/20/2024 C. LIFT STATION M Required maintenance completed Age of lift station 21 years Lift station material FIBERGLASS Comments: ANGEL'S PLACE; LOT 3 Adequacy test date 3/19/2023 Results 0 Pass Fluid depth prior to test 0 in Water added 454 gal New fluid depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in d Effective depth remaining 6 in Comments/Deficiencies: 'NO RECORD OF INSULATION OVER DRAINFIELD. DRAINFIELD MAY BE SHY ON COVER. NO INDICATION OF FREEZING DURING SITE VISIT. **BASED UPON GEG ELEVATION USING TOBEN SPURLANDS' BENCHMARK, THE NORTH MT IS 0.14' DEEPER THAN THAN I.R. ELEVATION AND SOUTH MT IS 0.07' SHALLOWER THAN THE I.R. ELEVATION. BOTH MTS REMAINED DRY THOUGHOUT TEST COSA Checklist June 2022 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' Community Sewer Manhole/Cleanout > 100' ❑ Yes if No *50'+ ft E Yes if No ft Neighboring Tank > 100' o■ Yes if No ft Private Sewer/Septic Line > 25' Q■ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50'+ ft Holding Tank > 100' W Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' g Yes if No ft R Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' no if No ft Q 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 **5+ ft Surface Water > 100' ❑ Yes if No *50'+ ft Tank to Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' Q Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ ft Water Main > 10' 0 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 �[� �- *AWWTS **MET CODE AT TIME OF CONSTRUCTION. 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 Gamess Engineering Group, LTD. (GEG) Phone Engineer's Printed Name Jeffrey A. Gayness Date _ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 907-337-6179 OF A(,1A ".....�.....:...*. v 1 ItE-7 53 Q� LICENS£�� pr0fessFoP°a #AECC884 ����OgOc� MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this R Day of Aw-At_ of 20 2�, by and between "iCjKaek Moab herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as located at (legal description) 15-19c) E veltra2cem kxpc E r AniclbRAv- OAK cns-i (o 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) D101 Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. Zna It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 _pXv� Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. = Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. pW5Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. 4102, Owner agrees that any sale or transfer of title of the property will not occur without anew Certificate of On -Site Systems Approval. 1,n Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. /jtyN Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed.invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 N �11 cid a-� to do m N O N co J a A d oQa� F n haw 1pa c z O to O O Z Ln v. cN E E O V a MA M 4-i O M N to CG P-4 Sonja Blewett From: Al Thomerson <alaskatennis@hotmail.com> Sent: Wednesday, April 3, 2024 1:39 PM To: Sonja Blewett Subject: Septic Sent from my iPhone Hi Sonja responding to your email our septic has never frozen. Thanks Al Thomerson. lzt r-� Ln 4-j u c 0 t4 jEM E UC cu 0 Ch LL:3 (3) -C _0 V) U 4-J ro 4-J 0 u �L- E oA 4� 4-J 0 C) 0 u u -C 4� 0 4-J u CL CL C: dl0 co 0 0 J_— 4-J V) O O 0 ro 4-J Q) LO -0 0) E 0 0 Ln Q) O 0 -0 0 Lfi W - >- CL A0 4-J .—IL U -0 W 2 -0 Q) u > 2 c < L- a) L- E cu E C2- 0 o CL < V) C: -1 E 4-J c -1-j -0 ui Ln u 0 0 Q) E Q) co _0 —Ln C E u u m cr <i J0 Ul) C) 4� CL 41 LU m V) V) uj u fu w Lf) 4-J u 4-J Ln > C: -0 4-J c Co E = E cu >0 Ln 0 0 < 0 a) u b.0 1- 0 E L- CL 4 -J X >- L- CL ;7 LLJ 41 4-J 0 C. 0 E m U V) 0 L- V) c 4- ro > V) E -j . Ui 4- V) 0- c 0 (U -;-j V) 4-J > LU 0 m :3 0 w u v) I z C) rri rr o 0 rr, (A Cn C U) 0 z To: Page: 06 of 19 2023-11-1701:06:55 GMT 19073086608 From: Wes Anderson 455 777 t� !! /!l!s■�/!!■! ■■ !!! an 0905 !! ■ on also as ■ a on ■ tt� t_ !o no an small ■ ! of on ■ l [#� JvahainexO Field Maintenance Report AnchorageTank Annual Insoection 907-272-3543 Property OwnerlTracking It pH (6-9) Operator AI & Heidi Thomerson E✓ > A+ Home Services Tech Site Address N. Contact Phone 15280 Evergreen Ridge Street, Anchorage AK 99516 Recirc Amps 907-349-3439 AX Site IDN Casty IDN Pad N RTU NUL N Date of Last inspection AX -101569 SW 030118 201356 RTU101600 07/20/2022 Retrieve O&M Info Daily flow Recirc ratio_ Timer settings: Perform Field Sampling/Observations NTU ((1}15 t NTUs) pH (6-9) DO (2-6) Non -typical ❑ suttide ❑ Cabbage ❑ Decay E✓ > LA Odor of Sample Current , Typical I�Musty ❑ Earthy ❑ Moldy Non -typical ❑ suttide ❑ Cabbage ❑ Decay Oily film In PVU [1, Yes Q�.�No Foam in tank I–]Lj Yes N. Check Control Panel Biomat: ZNormat ❑ Excessive Recirc Amps Discharge Amps Previous Current Previous Audible and visual alarms [�`OK Dial tone (telemetry only) ❑ Yes ❑ No Inspeet/Clean Pump System Clean Riserllid Inspect Clean Riserfl.id ..................... l Splice Box .................... Pump Float Cords ................... Float cords Floats ........................ © 2 Pump ........................ T Biotubev Filter ................. '[?j Biotube Pump Vault ............a�1* Clean Recirculating Splitter Valve....... 2 [f Comments Measure Sludge/Scum Hurt— Scum 1 st compartment Current Previous Current Previous Clean Odor: �Nonnal ❑ Pungent tateralsfOrifices Q r*'r' Biomat: ZNormat ❑ Excessive 2nd Compartment Current Previous Current Previous Inspect/Clean Discharge Pump System Inspect Inspect Inspect/Clean AdvanTex Filter Inspect Clean Odor: �Nonnal ❑ Pungent tateralsfOrifices Q r*'r' Biomat: ZNormat ❑ Excessive Pod Bottom ® El Bridging/Ponding: jJ None/Minor ❑ Excessive intake Vent ❑' Inspect/Clean Discharge Pump System Inspect Inspect Clean Riserllid Floes Q splice Box Pump Float cords Inspec"ervice Other System Components Inspect Clean Inspect Clean Disinfection Equipment ❑ ❑ Dispersal Laterals/Orifices ❑ ❑ Observations I:!)Ir i> Additional Services Rendered Cleaned textile shoots? ❑ Replaced UV items? ❑ Replaced/Used other items? Parts Used: W = Warranty, B = Billable (✓ appropriate selection) W a Item Number Description Final/Safety Inspection [?RSV reinstalled ff Uds bolted on C4anitold reconnected; flush valves closed L7Controi panel reactivated Summipry/Recommendations 1 Z System performing; no further action needed ❑ Tank needs pumping Call for service ❑ Other? Signature t o b `- , Q -a L>�? t� _ -._ Date � � ! � Fax completed form to 1-866-384-7444 Municipality of Anchorage -� Development Services Department p Building Safety Division _ On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017- 117, -Kr COSA # C)C1 l?_;61 U Expiration Date: / - a 9- /10 1. GENERAL INFORMATION Complete legal description L. f 3 , An qol s P leAc e Community On-site ❑ Public Sewer Location (site address) S-3ai Ra66%F' Cr'ee1< Current Property owner(s) 1~t ke E leaf/, !Z&., C4 r.;t _ Day phone '7'fg- 17 9 2 Mailing address Lending agency Mailing address 10961 tkinnah PI." 4EVle i{rr-vii A -k 99S'77 Day phone Real Estate Agent t<c4jti ., Fernanceez. Pruclenhz ( .t..Dayphone 273-7S6? Mailing Address SE01 Dr. Ang1j A-1,- 99570? Unless otherwise requested, COSA will be held by DSD for pickup. P 1 ♦a✓e eat I Co n n or e. Z T 3 7?0 3 ct+he.� COSA rradr ,,6� rircic-«�, 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well 91 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm _ Fla flap T«h,, ca l Phone 3 YS'- IT CS - Address IYS30 EcAo �LinJcv� >;�1� f}���. 4 -AC 99s11 Engineer's Printed Name 'Ago do-. F. ""ere Date IG / ZZ / 2GY>q 5. DSD SIGNATURE `,Y • :Ta'O::ORF Approved for bedrooms. (' °•.,c/ `$57 � Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: /0 -o?- (R" oZ (Rw 11105( Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: f!a.%3_ Angels Place Parcel ID: nr7-Itz-ers— A. WELL DATA Well type _° ✓ %' If A, B, or C provide PWSID # = Well Log (Y/N) Y Date completed jol'ZS/63 Sanitary seal (YIN) r Total depth 116 ft. Cased to l Y ft. FROM WELL LOG Date of test 8 / 2•S- / 63 Static water level ! 2 ft. Well production H g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 mL Nitrate <o. / mg1L Arsenic: _<-C ug/L date of sample: 912,9 /09 B. SEPTIC/HOLDING TANK DATA Tank Type/Material M , an %e). e,-4 I4el Tank sae f TOO gal. Number of Compartments 2 Wires properly protected (Y/N) 7 Casing height (above ground) VY n. AT INSPECTION 9/27/ 09 7 ft. O.SF g.p.m. Other bacteria 0 colonies/100 mL Collected by: Flaf/oP Teti Xdec Date installed 5-/19 /03 Cleanouts (Y/N) Y Foundation cleanout (YIN) Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping N- A. Pumper V.A. CS�ee 4EH.rh. el /1'[✓an %ex ree-iceece wj C. ABSORPTION FIELD DATA Date installed X/ 19 /0 Soil rating (g.p.d.0 or ft2/bdrm), ��/�S/z System type Mak .0 Length /S ft. Width 10 ft. Gravel below pipe O • S ft. +SaAsf Total depth �LC ft. Eff. absorption area !S0 f? Monitoring tube Y Depression over field N Date of adequacy test 9 / Z9 /09 Results (Pass/Fail) PctU For _S bedrooms Fluid depth in absorption field before test O in. Water added 4 7 gal. New depth I in. Elapsed Time:%r� min. Final fluid depth _0- in. Absorption rate >= 11/S�s g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) "o -mi I<Ao ecp + If yes, give date M• D. LIFT STATION oc t4el- r%� !l'rtn eo Date installed S!2 -Z! 0't Size in gallons P"'V ""'t Manhole/Access (Y/N) w 'Pump on' level at S'l in. 'Pump off level at in. High water alarm level at 39 in. Datum '7onT h.ft Cycles tested 14F Meets alarm 3 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 116" Absorption field on lot 160, Public sewer main V. A. Sewer /septic service line > .2 S, Animal containment areas N• A. On adjacent lots tc,c On adjacent lots — tew ' Public sewer manholetcleanout V. A, Holding tank N • A, Manure/animal excrete storage areas N. A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10' Property line 30' Absorption field Water main ".A. Water service line > ►o' Surface water � roa• Wells on adjacent lots _7 / y0 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line SD ' Building foundation X0 ' Water main x/ A. Water Service line '�> /0 ' Surface water > 16Pf l Driveway, parking/vehicle storage 5'0 Curtain drain Nvni fan Wells on adjacent lots !tea F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this dato. . •; S,A 4S ... •.•..+�s r. coon II" Engineer's Printed Name 7-1ltodarr T: /'Too Date to / 22 / 2LG 9 t ' COSA Fee $ Y90 Waiver Fee $ Date of Payment L Date of Payment Receipt Number O .50I G Receipt Number (Rev. 11/05) SCS ReLM Client Name Projeet Name/B Client Sample ID llfatrix S;unplc Remarks: 1095281001 Flattop Technical Srv. LOT 3 Angel's Place Lot 3 Angel's Place Drinking Water Printed Date/time Collected Date?ime Received Datelfime Technical Director 10/14/2009 16:13 09/29/2009 11:20 09/29/2009 14:00 Stephen C. Fade Allowable Prep Analysis Pammcta Results POL Unity Method Container ID Limits Date Date Init Metals by ICP/M3 Arscnic ND 5.00 ug/L CP200.8 C (<10) 10/08M 10/13/09 NRB Waters Department Total Nitralc/NitritrN ND 0.100 Microbiology Laboratory Colony Corot 0 Total Coliform 0 Fecal Colifurm 0 mg/L SM20 4500NO3-F D (<I0) coV100mL SM209222B col/100ml. SM209222B coV100ml. SM209222D A (<200) A (<1) A (<1) 10/09/09 LCI: 09/29/09 DLC 0989/09 DLC 09/29/09 DLC JUN -8-2009 10:408 FROM: on r0 of intim■ ■ ■r■ o ON on TO:18663847404 144 319 an I loss as swum M on 0 on ■ ■ romps ■■ a_ p Rihrar>Tem a Recd MaWmamw Report Annual Inspection P:2/4 AnchorageTank & Welding, Ins 907-272-3543 p -a u-...,b,g. an.m. Mike E Kathleen Curry Mike Blakeslee VA AdO Cw.ror ru.. 5301 Rabbit Creek, Andm age AK 99516 907 277-4358 Atw4we CaW#0a /r• trV NIL/ DW of Ll bm b AX -101569 1 SM30118 10=008 RdtA"* 0AM hero Daay low - nobs: odio Tsrwr.e*Vc carr homeowner beforehand 748-1792 Pei [a., F*M Ssp*NneJObeenations MTU M5 it NTU91 PN" DO Rao ILMWAI-Ordiwa Pod Bohan ❑ ❑ odor w ewapl. 1,1" UvAn r mrw" ❑&w&i mw-ty d ❑s.tlda 13c"o, OD.d.v oay su. ti PVU []yes ® No Few. In eat ❑pus qM Check Cartrol PON not* Ampe MOW"ARW !-'�_•� I ce•3 Aut%W Mrd wtlM "mw OK Dol bw ftekwo"ahl w• y�.�� rrpftUClrar PDaP Nratew "so" ruw,d n..................... spade Det....................1 F" Coral ................... dear. ........................ PUM ........................ ��r votuw r w......... R1 aim" Ptow reads ............(� Racb-A" Spaetar ve....... ❑ Mdawra Skldpa/Scurn skdae saw ISICompartmnn 01V 4, PrVAt Mat Pm%iow 6+d Comp.nment Ctm.M Plwotw Coram RrAotw InapecUClsan AdvanTex F9ter Odor. ❑Atgent awmae q Nomrl nmroe.dy. BddpinpMWKWW ryy NMWkf.tor MEmwdra Inapect/Clean Dwchnme pump SwM SPSM BM rw.e Dads Ittapect/8ervlca ower aretwn Co vgww- DbNnteon Etrr mwd ❑ ❑ Drrpasd Lwwmnwices ❑ ❑ obswradom A4dRIDMl Swrioea Rwrdwr d ❑ Q...d spade e1Kea1 ❑ nepkmd Uv rmrr ❑ neOWAdAkmd other swrw? Parte uvea: w. vmmvw , B . IImm ,m (v approprl.M waceau Firal/taMy Imapeotlon U Ptsv mknused 19 Llds bated at 19 Mwttdd wea.woted: arch wa.a aei:.d NePwdl.l pwal Mw8va ed Sawnfflary/cornreerAaSSerra / SyuwmPork-r mstthw&vftnftxded ❑lsrttewespumpiq tar www ❑Oen! Pate�I�� Fax completdrd form to 1.866-3847404 6 / Mrrwte ❑ CMan ❑ ILMWAI-Ordiwa Pod Bohan ❑ ❑ k.1a1 Vart ❑ ❑ DbNnteon Etrr mwd ❑ ❑ Drrpasd Lwwmnwices ❑ ❑ obswradom A4dRIDMl Swrioea Rwrdwr d ❑ Q...d spade e1Kea1 ❑ nepkmd Uv rmrr ❑ neOWAdAkmd other swrw? Parte uvea: w. vmmvw , B . IImm ,m (v approprl.M waceau Firal/taMy Imapeotlon U Ptsv mknused 19 Llds bated at 19 Mwttdd wea.woted: arch wa.a aei:.d NePwdl.l pwal Mw8va ed Sawnfflary/cornreerAaSSerra / SyuwmPork-r mstthw&vftnftxded ❑lsrttewespumpiq tar www ❑Oen! Pate�I�� Fax completdrd form to 1.866-3847404 6 / PrI 1 ra r ri w CD ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN 11IUNICIPALITY OF ANCHORAGE AND TI IIS MEMORANDUM OF UNDERSTANDING made and entered into as of this .:L6? Day of O e o e of 200 q, by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AW WTS), described as D 11AAj TE � located ate� ei S �f a . c7-_3 Anchorage, Alaska. 2. Definitions. A. Alteration. Any change to the design or function of an AW WTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AW WTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of �Z )"�- R'o ($ 0.00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AWWTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations, Installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AWWTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWNVTS Operating Permit is: �Z F A RL C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWWTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: By:�r .� Date: MUNICIPALITY: By: Title: Date: STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me thiaq d y of De 20_°, by 0 n the (cul0e& A1c�1681�o s 2L44, OFR CLILSGL N FARM BLIC FOR ALAS Nares°� ,. JUINY ROSE DAY M Com sion expires: W"�"�0�� 'Ai38.1010 J Municipality of Anchorage O °� ° • -- Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL ' ° "• P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. HAA #Ijk 03Q Expiration Date: l — / /- 0 3 1. GENERAL INFORMATION Complete legal description Lo -1 3 AN61^La Pt Acc. Location (site address or directions) 1530 t R A'T3P> IT L 2 F F_ k Current Property owner(s) i ot-1 14 /\? k.S Day phone Mailing address Lending agency Mailing address Day phone Real Estate Agent 141+4 07v et.r . 1� L_ 11�/ Day phone _ 7&9-586b Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 7J 3. TYPE OF WATER SUPPLY:, TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site [� Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of titte (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm to --e &I Jr.oO t:- Phone x -74-391b Address VG 1 t�- L -Gr H zV Engineer's Printed Name S. DSD SIGNATURE L-"'� Approved for bedrooms. rV_(s�visX Date y-2?—d� 0pOeLUe40Y.e � k'�g4eeee �.• .. yn S,wr4kad C8'333.d Disapproved. Conditional approval for bedrooms, with the following stipulations: \\V�r-.•• •..;aha Additional Comments �� ; ON-SITE i �,—;—ifAT€R IND WASTEWATER Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other to By:L/ „� / 0_4;7Original Certificate Date: G-11-0-3 rR«.01= Municipality of Anchorage • �" Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ek.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lel 3 ANI,= -4 PiAe x Parcel ID: O/?- //St-- 6Z;"- A. WELL DATA Well type ?- Date Date completed A:aF-8 3 Total depth !J ft. If A, B, or C provide PWSID # �A Sanitary seal (YIN) Cased to _q R FROM WELL LOG Date of test 8 -M- tp3 Static water level I Z R Well production y 9— p.m- WATER SAMPLE RESULTS: Coliform, —0—colonte3/100 ml. Arsenic: I/ mg.A. B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) 2' Wires properly protected (YIN) Casing height (above ground) la + n. AT INSPECTION / LAJ O -L- < aq ft. 01 is g.p.m. Nitrate ha mg.11. Other bacteria W>colonies/100 ml. Date of sample: —/t='l o ly Collected by: Y S pv . 110 m J Tank Type/Material A d v e n 1 eK A y Z v Tank size /0'0(7 gal. Number of Compartments 7 - Date Installed 2! %o Cleanouts (Y/N) Foundation cleanout (YIN) i Depression over tank (Y/N) 1� High water alarm (Y/N) _ Date of pumping IA. N /A C. ABSORPTION FIELD DATA Date installed �/ Sall rating (g p•d./fe or felbdrm) _'Z System type 14 OJ rn of Length 167 ft. Width 10 ft. Gravel below pipe D, 9 ft. Total depth 11:5- •:5 ft. * Eft. absorption area /dL-* Monitoring tube 4-1 Depression over field N Date of adequacy test N�i4 Results (Pass/Fail) 7 For 3 bedrooms Fluid depth in absorption field before test ✓n. Water added ✓gal. New depth —&-fin. Elapsed Time: vfmin. Final fluid depthw�' in. Absorption rate >= ✓ g.p.d. ✓ iy Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) If yes, give date 1 • % F; 14.w Sit-►t� D. UFT STATION Date installed r 3 Size In gallons 1 9-0-0 Manhole/Access (Y/N) 'Pump on" level at3/ 'Pump o1P level at*. %6 High water alarm level at� in. Datum lop >r/ W14 Cycles tested L"I Meek alarm & circuit requirements? 'iL 5 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot I I b On adjacent lots 1 / 01:2 Absorption field on lot 1100 On adjacent lots i IO' ' Public sewer main N/A Public sewer manhole/cleanout Sewer /septic service line too Holding tank N�i4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ) b Property line 30_ Absorption field AJ C) Water main NIAC Water service line 3 Surface water 1410 Wells on adjacent kits > /CIO SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 50 Building foundation J7 D Water main Water Service line&g6 Surface water 1 `� I D Driveway, parking/vehicle storage `J D Curtain drain HI I d Wells on adjacent lots I" 4 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field 'inspections and review of Municipal records that Me above systems are in conformance with MOA HAA guidelines in effed on this date. Engineer's Printed Name ! e b b e ✓t 9 n u V, V to K t Data ✓C — Y 7 - HAA Fee $ 375 00 Date of Payment 6 t 6 Receipt Number 3 s r (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage a �, ' Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 030213 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 3 of Angel Place subdivision, the well's productivity was determined to be 0.6 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. W q- 0 m r U) -D mo 50 u-� m .4W N al 0 0 z 3 -2• -Cit • • t •aar.•; SCS Ref -4 1032660002 Client Name Tobben Spurkland P.E. Project Narrate Various Client Sample ID Angels PI U Matrix Drinking Water Pw SID 0 Sample Remarks: Parameter Ramps Watara Dopartmant Nitrate•N 0.100 u Microbiology Laboratory Toul Coliform 0 :eC) 36.630, • a" All Dates/Times are Alaska Standard Time Printed Datdl7me 05/19/2003 11:42 Collected Daleffime 0915/2003 15:50 Received DateMme 05/15/2003@16:15 Technical Director Stephe . de Released ljy/pi1,l ��. ✓Ar/. POL Units Method 0.100 mVL EPA300.0 coVICOmL S\419922213 L Alla bk Prep Analysis 1 Limits Date Due bit (<-10) (<-I) 05/15/103 JS 05/15/03 KAP t MUNICIPALITY OF ANCHORAGE n DEPARTMENT OF HEATH AND ENVIRONMENTAL PROTECTION � � 7 b DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATEINSPECTION OF AUTHORITY APPROVAL ITE SEWER AND WATER FACIIL TY OF ON-SITE j I _ 0I 264-4720 F Application Date 1. GENERAL INFORMATION (a) Legal Description (includ lot, block, subdivision, section, township, range) 8c Ler j aq �it/sFcs �:AeE Tiz.J j�J sEc �� Location (address or directions) (b) ApplicantName �'�� Telephone: Home �/3/Y7 Business Applicant Address 5201 mP 7- ax fid. �G� /2e ;7 1,5Z (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent f�erlE1 <'+Ye ES J u11 77/r d;r Address Telephone 5-&Z -7&<3 (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 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 the legality and status. 4. SEWAGE DISPOSAL Onsite 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. Page 1 of 2 72-025 0+,80 43 14. -ter 5. - ENGINEERING FIRM PROVIDI. INSPECTIONS, TESTS, FILE SEARCH, D. A 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 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. Name of Firm Address Date Cl OF, �s asre=sx I -2251 1 6. DHEP APPROVAL I cz Approved for ' , 2 bedrooms by Date �` -9-8 —B 7 Approved x Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 72-025 P veal n MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANOWF&TH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIV" 84ECKLIST - FEBRUARY 1!184 284-4720 APR 61987 �,�-j Legal Description: A. WELL DATA RECEIVED T/ 9 3 W fee 3 Well Classification ?r/✓RTZ-- If A, B. C, D.E.C. Approved (Y/N) _414 Well Log Present/7.Y,//N) Date Completed a^ZS gj Yield t*� Total Depth l / Cased to r Depth of Grouting Static Water Level `% / Pump Set At /1 i Casing Height Above Ground Sanitary Seal on Casing Y N) Electrical Wiring in Conduit(ON) Depression Around Wellhead (ye Separation Distances from Well: / i To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot /80 ; On Adjoining Lots X09 fi To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot I -S fi Water Sample Collected by /BELS ; Date Amt 3-11-57 Water Sample Test Results SdFrt['7oZ� Comments %}9 6JaC fz c.1 72'3% Z-/447. B. SEPTIC/HOLDING TANK DATA Date Installed 04 1 195'3 Size ALSO No. of Compartments Standpipe&N) Air -tight Capr(ON) Foundation Cleanou&) Depression over Tank (Y6j Date Last Pumped Pumping/Maintenance Contract on Fite (Y/N) -Alk ; for Holding Tank High -Water Alarm (Y/N) — 4-11 Temporary Holding Tank Permit (Y/N) </ Separation Distances from Septic/Holding Tank: To Water -Supply Well /yY r . To Property Line To Building Foundation i To Disposal Field 2S To Water Main/Service Line /O To Stream, Pond, Lake, or Major Drainage Course lev 7 Comments 064665a4C41fcL ScE' 4770CAb FKef12'7_ ro,q _r14/e /P&ZeA(.fU_; /��' ar✓,✓ee -77%%! [d)urPAb PJ1711 WitTa0'i/erlr &MAJ✓4t o1/ /,✓ec7- ^0 oo77en Page 1 of 2 72-026(1 U84) G 3 i9�✓6er f f'cdz'G' ` . C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Ti % Type of System Desigln, Date Installed /D-2 S-gS Length of Field %3 r Width of Field Zz l Depth of Field L To Z•f LT -// Gravel Bed Thickness O S Square Feet of Absorption Area %Y (o Standpipes Present&) Depression over Field (Y© Date of Last Adequacy Test Results of Last Adequacy Test d14 i Separation Distance from Absorption Field: r i To Water -Supply Well /8'0 To Property Line y or l To Building Foundation To Existing or Abandoned System on Lot On Adjoining Lots /a -7- To tTo Water Main/Service Line /cl �t To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /ew r'/ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Install Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at •• Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that 1 haav h/er ked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed "-"--` - ij Date L17 Company /9te5 MOA No. Bt,O A7r f � P', — OF A4 %i Receipt No. 02 - O O — 0 02 7 �'Q;• •9 ' A *� .4•• 4 • y�i Date of Payment `� e6 ^ �T %"••• .. .• ,•••� * ; Amount: $ / o o . s I I • REID, JR t✓eu re6 ♦� -2251 - Page 2 of 2 j. SrPre_ W4& Aa'&r/T �fi\`•uvC`SS �� r2-026(11,64 �. ;�lhDu/b ectcr/'i I INVoICE N( 018377 Q4 7 "i4r.ty ®SEWER AND DRAIN RAIN CLEANING SERVICE f rl000mm P.O. BOX 112688 D�®� PHONE 34.5-2513 ANCHORAGE, ALASKA 99511-2688 (— �oK *6 C h reS- ma n Job Address ..z c,+Qe�ctA of $ ESMA� A� TEFMS _ b DS Ll�loC. '� ^ CUSTOMER ORDER �cn�gLS PLEASE PAY FR CM THIS INVOICE TOTAL FOOTAGE CLEANED OR THAWED TOTAL PROBABLE CAUSE OF STDPPAnc #IA _ ;� BLADES �SED� LINE CLEANED I O JOB NOT GUA6EEDFO FOLLOW WORK ACCEPTED By G REA pry I v