HomeMy WebLinkAboutTHE LANDINGS BLK 1 LT 10The Landings Block 1 Lot 10 #020-061-17 1Municipality of Anchorage •:'.t' r.ra, \ ;.. Development Services Department - BuildingSafetyDivision '•"" - On -Site Water and Wastewater Program. 4700 S. Bragaw SL P.O. Box 196650 Anchorage. AK 99519-6650 Page I Of 3 www.ci.anchorage.ak.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. W D03 S PID Number. CaO-061-1-7 Nan,sRO �"'125cri Wastewater System: ❑ New In Upgrade ABSORPTION FIELD Prone Nurbr of B.boan.' D Daap Tr.ndl O Shallow T. d O BW 13 MMW 0 other. Sal Rawq /. Q Total D.pbl from original ¢ad. r: LEGAL DESCRIPTION D P F Block: I La: I s.es.l.la. I" Depth to pW boom barrl?nbnal7ada: coeval Mph beneath pp•: r1c �aAL "" Fl. 311 e Fl. To~ P: Range: sa 1 Fa added tl 019-M Orws: 3.-; Glare[ L _30 Ft. il. �vF1. Grovel wWbt kkniD.r or Boas: D41ams b.Iw...I lie[.: Well: 5�EIN ❑ Upgrad I oQ Fl. FL ClaavrKNlon (Pwale, A Tolal D•pft cak.a w ToW abwrpeon an" P M155' %A . Fl. FL 350F� 5 M 30 `i 0 D~ Dade DrMd: SINKWNM l."; Wlalbr Dale awWad. � O/ .L Cn•w H. ht rnow Grmr4 TANK FL FL SEPARATION DISTANCES Q7 septic []Holding I] S.T.E.P. Other. cw.al To Septic Absorption Lilt Holding PublirRnvat MPitl1` From Tank Field Station Tank /. e%•�/ . (00y Gov -73, Ioa`S7 wan"4hy67 NOf Dang anmamr Wag . Bunn walar in% -75*% '23 ` LIFT STATION a3' �. S GN MaMa4�r aO.. /V o,t rHL,•yar CA�cA•aal Lot UN ,SO ` ` 10` A 'Pomp an•WN N. J'/ 'Pu NN'. G Wyh wl.rN: 3 6 im Feuridaf o II ID a M. "I ti , — Pura Make a Modal R" rea'�o Elan" ln.p.rkons Wdorm.d by M.C.A.r. Curran Drain I0r K) R•m.ae. BENCH MARK L'itrTR4NGH LarslKn arW oe.awlKm �1G G/4 V4 ta1O ASA yCE PLRc wn wATH BO OM 5,'d;,74 .}- Ewawn r!T- %✓/./ SA -a li..a-4uRC �X/JT/nG N✓ 100 FL •sce7*6C P�M/ann GAR vjN 80 /�N/J Ady„/DO� E D. « �' Cur D a J cr.v...r ...- _ " • • CI: Inspections performed by: 17034 Eagle River Loop Road, No. 204 iN I I f C / S , 2nd //�'X/ C � / -P 1 ROBERT C. COWAN '• +•� Development Services Departrr nt 6pproval� ?�/�t �`"c�f.` cE-es01 •a-� I�tt��F, . Reviewed and approved by: ����✓ � Date: A/ l,tl2�=`+'��F_yti ,,. PERMIT No. SW000498 PAGE 2 OF 3 Municipalit of Anchoraqe DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 10 BLOCK 1, THE LANDINGS S/D P.I.D. NO. 020-061-17 LOT 9 100' WELL RADIUS /' / SEPTIC AREA LOT 7 ' / A�-FV1 �FV5 Y AIR LINE / J / ST Tl TBM e FCO GRAVEL V 1000 GALLON IE SEPTIC TANK (FAT ALBERT) (LIFT STATION) LOT 11 1' = 40• A % ROBERT C. COWAN CE -8801 f= ���:' PERMIT No. SW000498 PAGE 3 OF 3 Municipalityof Anchora e DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.D. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 10, BLOCK 1, THE LANDINGS S/D P.I.D. NO. 020-061=17 FINAL GRADE, LIFT STATION 100.8' Msuunon.A 2" INSULATION MTI=1 ST1 ST2 104.0' 550 GALLON FAT ALBERT WITH PUMP ASSEMBLY MH 101.4' 100.5,_l 00.5' 1000NGALLON POLYETHYLENE SEPTIC TANK CONCRETE BLAST MT 1=104.6 DIST. LINE=104.91 GRADE A GROUNDWATER AT 98.1' 94.6' B.O.H. 100.2 w G VALVES IGINAL GRADE BOTTOM OF SAND=102.6' N. T. S. FROM FE4.IDL.Y LIGHTS METRIC INC FAX N0. : 9073733894 Jan. 26 2001 02:20PM PI ....•.... • �. r may. • .�+•.•.r� .n W.a .vt..:. .ri4.i yiii�'.'..1:..� •W..1y J.'r L•. .^1-J.; 'o._ SI. c 7w✓:.rst+Xw Pt17C.'!T u :4 mcw wn5. l'cT «.p�t.:4 yr N+M•i4.q•c �1-�-'i Rlcntt.. UNDEKL�'ZfluNl7� l�v�l� - �1J � F►rJ�1,(� �!xIT- Y+C�V MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 3434744 1-145-D1 ca 11:00A4.` 1-22-01 0 S": 00P/„L ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW000498 Legal Description: THE LANDINGS BLK 1 LT 10 Date Issued: Dec 07, 2000 Expiration Date: Dec 07, 2001 Parcel ID: 020-061-17 Design Engineer: 0003 S & S Engineering Site Address: 004021 LANDINGS CIR Owner Name: Ron Simpson Lot Size: 21233 SQ. FT. Owner Address: PO Box 100303 Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage . AK 99510 - This permit is for the construction of: Disposal Field G Septic Tank Holding Tank ❑ Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (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. AT THE TIME OF CONSTRUCTION THE ENGINEER SHALL PERFORM A SOILS TEST WITH A PERCOLATION TEST AND GROUND WATERIBEDROCK CHECK IN THE VICINITY OF THE PROPOSED I.D.S.F. 12-70-00 SFE ENOOVE-FRO' 4MCkFO /%IftiDED PES-16AI FROA4 A SEPTIC SYSTFrt v 9 Hpl_ l-vz! 7oUlk,. SO/L QDES Nor fk'IsT. Received By: Issued By: de✓z 4�rz Date: 1Z/7/ov Date: 12 —( vD December 18, 2000 ROBERT C. COWAN, P.E. CMLENGINEERS (907)694-2979 FAX(907)694-1211 Municipality of Anchorage Department of Health and human Services NE&THAlTHOFM PO Box 196650 A S Anchorage, AK 99519-6650 Attention: Dan Roth SEWERSWATER Reference: Lot 10, Block 1, The Landings Subdivision `MD(TENSK)KIS Permit # SW000498 Dear Mr. Roth, SEWER& WATER wrpEcnON In accordance with the On -Site Wastewater Disposal Permit #SW000498, an additional soils test was performed on 12/12/00 (soils log attached). Water was found at 6 1/2 feet and fill down to 8 1/2 feet with organics near the original ENG7NEERINGSTI"ES ground surface. ANOREPORTS This means there is not 2 feet of unsaturated native receiving soils and therefore is not eligible for the installation of a leachfield. We therefore have no alternative but a'ET teS to install a holding tank. Please be advised that a 2000 gallon holding tank will be installed under the above referenced permit instead of the proposed intermittent dosing sand filter. SITE PLANS We also request the horizontal separation distance waivers be amended as follows: (1.) 70 feet between the well on Lot 10 and the proposed holding tank. ROAD DESIGN (2.) 72 feet between the well on Lot 7 and the proposed holding tank. (3.) 80 feet between the proposed holding tank and the surface water SORTEST (creek) to the south. If we may be of further service, please give us a call at 694-2979. PERCOCATM TEST Sincerely, STRucnAvLS Robert C. Cowan, P.E. MCHANCAL NiSPEcrw's RCC/skh ONSITE WASTEWATER DMPOS.ALSYSTEM OEMN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577 Municipality of Anchorage . DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ROBERT G COWAN JN d1"rI�1— PERFORMED FOR: JN N S/MPSO n/ DATE PERFORME"; --1—. 4orw GLe I T//t- LAr'o144STownship. Range, Section: LEGAL DESCRIPTION: DEPTH 3 'v C-9.4sa R ��� SLOPE SITE PLAN (FEET) 2-1 \` 3 r `�' FILL 4 Gn�r, L 5 SOm4- oAGAnif 6 B I t. �• 9 y GM/e,, L to - 11 0 11 12- 13 14- 15- 16- 17- 18- 19- 20- COMMENTS 4151617181920COMMENTS ILSUIAsENNiam u 11MEMNE■NEEMI M WAS GROUND WATER Yl f ENCOUNTERED? S I L IF YES,ATWHAT O DEPTH? 1 P 6 %)� 1 1//(/a#E Depth to Wafer After r Monitoring? -6 4'- gate Ixi)S CD r Gross Reading Date Time Net Time Depth to Water Net Drop R1S0 K Ia /a o0 Jr F/ -L _ c O S3 — go 30 n,� Co 4 S" 6t) S } '— D PERCOLATION RATE y g (minutesvmch) PERC HOLE DIAMETER G y TEST RUN BETWEEN I FT AND ai FT ENGINEERING n/ /�� PERFORMED BY: t ^ Cagle ne''iy`eI,r� Loop ppppSS2277 / CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH y LE 6)kYe ATUkMARL GUIDELINES IN EFFECT ON THIS DATE. DATE: id- /IS'/00 72.008 (Rev. 4/85) ROBERT C. COWAN, P.E. CMLENGINEERS November 15, 2000 (907)694'2979 FAX(907)694.1211 MUNICIPALITY OF ANCHORAGE MALTMAMNOAIr Department of Health and Human Services APPROVALS PO Box 196650 Anchorage, AK 99519 SEWER&WATER Reference: Lot 10; Block 1; The Landings Subdivision MAINMENSIO S Request you grant a permit to upgrade the existing septic system, tank and lift station with a Intermittent Dosing Sand Filter (IDSF) s ERcncN ER system, to serve the existing three bedroom dwelling on the referenced property. This system Includes a 1000 gallon Premier HDPE septic tank, a 550 gallon Fat Albert HDPE lift station tank, lift station and a 10'x36' sand filter with air line and compressor. Also REPORTS T DANDES request that you waive the following horizontal separation distances on Lot 10: (1.) Eighty feet between the proposed Premier HDPE septic WELLINSPECT,oN SROWTEST tank, Fat Albert 550 gallon lift station tank and surface water (intermittent stream). (2.) Seventy feet between the proposed sand filter and surface SITE PLUS water (intermittent stream). (3.) Seventy-three feet between the proposed Premier HDPE ROADDESI`N septic tank and the existing well on Lot 10. (4.) Eighty-five feet between the proposed Fat Albert tank and SM TEST the well on Lot 10. (5.) Seventy-five feet between tile proposed Premier HDPE septic tank and the existing well on Lot 7. PERDouTICN TEST (6.) Eighty-four feet between the Fat Albert 550 gallon lift station tank and the existing well on Lot 7. STRUCTURALS WSKCDOAL raPEcno'S The following Is pertinent information for your consideration: ON SITE WASTEWATER DtSPOSALSISTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER ALASKA 99577 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On -Site Sewer/Well Permit Application d a 0 — 0 / — 7 NOTE: Application must be fitleA out completely SINGLE FAMILY DWELLING Parcel taentriZnon Number Property Owner Name �0 P% StMPSO n/ Day Phone 3y S -7a 90 Mailing Address p.0. 430x /0O303 AryC.NOAAc.4.. flk Zip Code q9S/O Legal Description 10 1 he. -and i n & LotLotBlockBlocknam Lot SiZ �cre�Sq. Ft. C noon Ta p , (�„ /0 LkLJ. T — [ VC, Number of Bedrooms s 3 � Inspections wiil't a conoucieu by: K Approved Engineering Firm r-1 Municipality (permit fee included) /� nM Does your house contain any of the following: ❑ Hot Tub ❑ Swimming Pool ❑ Therapy Pool ❑ Jacuzzi ❑ Water Softener Unit This application is for: ❑ Sewer Only ❑ Sewer and Well XSewer Upgrade ❑ Well Only ❑ Water Storage 1 certify that the above information is correct. I further certify that 5 R 5 ENGINEERING this application is being made for a Single Family Dwelling and 17034 E b River L RaqNo. in accordance with applicable Municipal Codes. Eagle River, Alask0015 r99 Ov+^erAyeit Driller Fees: oZ 0 •O c7 Receipt a n 17 0L/,5-&� D- �Permit a $ W 0004 48 Waiver Fees: 0,0 y Receipt Nt ��� t� / 7�� — Waiver N 72012 (Rev. 4,S8)*W e8)' �d �0 I V V Pagc 2 Lot 10, Block 1, The Landings Subdivision A. SURROUNDING TOPOGRAPHY: Lot 10 is heavily vegetated, with the area immediately around the system covered with grass lawn. The remainder of the travel line for any surfacing effluent is covered with indigenous plants. Any surfacing, migrating effluent would receive some treatment as it passes through this vegetation. Because of the existing topography, effluent would probably have to meander parallel with the intermittent stream, certainly in excess of the requested separation distances prior to reaching the surface water/intermittent stream. Because of the limiting factors on Lot 10, the proposed location appears to be the only remaining space available on Lot 10. The existing creek is intermittent and is probably nonexistent during some portion of the year. B. SOIL ABSORPTION: From the well and soils logs from Lot 10's existing well and septic systems, the top 2 feet of soil are silt/sand mixes. The next 12 feet are sandy gravel with silt layers throughout, which should provide good effluent treatment as well as keeping any spill/overflow localized by the immediate area absorption and vegetation. The sand/gravel mixes should provide good effluent treatment. The silt layers should provide a fairly impervious separation layer between the source of contamination and groundwater, providing protection to groundwater and aquifers in the immediate area. C. PERMEABILITY: The referenced soils should provide a good catchment for any overflow of surfacing effluent. Coupled with the vegetation, the soils should effectively isolate the surface water and wells from contamination from surfacing effluent. D. HORIZONTAL SEPARATION: Proposed septic and lift station tank and surface water 80' Proposed sand filter and surface water 70' Proposed septic tank and existing well on Lot 10 73' Proposed lift station tank and existing well on Lot 10 85' Proposed septic tank and existing well on Lot 7 75' Proposed lift station tank and existing well on Lot 7 84' E. WATER TABLE The wells logs for the wells in the immediate area show static water levels of about 30', plus or minus a few feet. This would indicate a fairly flat water table gradient (see attached well logs). Page 3 Lot 10, Block 1, The Landings Subdivision F. ADDITIONAL CONSIDERATIONS: (1.) The existing system has been in service for nineteen years with no apparent adverse effects to surface water, the onsite well or surrounding properties wells. Water samples from Lot 10 and Lot 7 wells show satisfactory water quality. (2.) The proposed upgrade would replace an aging septic system with leak - free, noncorrosive HDPE tanks and a Class III treatment system, which produces a high quality effluent. This system also requires annual checks, further minimizing the risks associated with the requested waivers. (3.) The proposed tanks are not a continuous source of contamination. The HDPE tanks are highly noncorrosive, and are expected to remain leakfree indefinitely. Waivers between the wells and leachfield (sand filter) are not required, due to the 100'+ separation distance. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas, or drainage patterns by the granting of the requested waiver. The requested upgrade will not prevent future development on adjacent properties. If we may be of further service please contact us @ (907) 694-2979 Sincerely, / Wobertwnaan,�GoP.E. RCC/mjc v 4. �. :go .1i;ai I13 VOo j44R f T All dp f Q O � Y:1 W W F\ Z �J �; Q yy Z \ W O M\ J \ � T LalJ 0 3(n WOO\ �. 0 ow 0 004,0 ou J WELL RADIUS snip ya \\ 100 U 113M 01\ C3 \ \ \ a\ S \ \ � 0 a o U C Ln 0 W .. Vm M 0 \ \ 7 I, Ot \ E -C i; m Ii a N co \\ \ O -� v] o In V) \\ \\ W mho0 to \ \ Q M V) N7 AV A c� \ • e \ o W swnw Hti w•Qi asa.lit t fit% �'ap� fr —O \ice b �au�sC4 ' a Suite Q MN�M , $u NVId-311S I NOIS30 1 017 = „l ��� ��� /■ � ' i | g■ . r �! �u\ !@> • -§■b / | ■ kE § . �& (!{§u ! `\ \)'. ,- . E 2 E )| k §u `/ 2 o. - I §\ � pp 2� @ k /� { LO °k 0 =Ln § z �|t -_■ ƒ inin 0 . c ± k/ a - §E �k LJ Um Rk _ \§ L) (< jj ]m c ( ° \i/ o j / j LLJ �. ooƒ 4 ) CL C:) \ » o c E -Il e @ )f! «G `. ! !kE 31JQd N>@Q 3' * 4~f: 1 i ,e tiG�l tl :r o u ox i LL: 00 •'!� zW z >I tl �;:� / 00 0 �W ;= m >... r z y : SW 5. e r: > po Q M ° Y > u > ai C4°o >> U) W^ ro �� V E- XM Ao 2u 0 0 5660 b �--i z a K M w X�� °"= WSs E a u Q ger «V sb 6 V, u�t 0 G a Ey , ew O tit Z. u - :< Sul rl s a - i J 0 i r2 Mz ey Ne . o0 }•t `6a' oW «� gbW. 00 W W04 m .4 ^� +IVJS NOISM 'S '1 'N �50LL.S L.GEi•t''••j' �y MUNICIPALITY OF ANCHORAGE ;.:.,.. C DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRU. ECTIDN O E110OLATION 523 L. So,M. A•..wy.. Alm&& 96W 2" r" SOILS LOG - PERCOLATION TEST : �;,:• tv9f-.33'77 PERFORMED FOR:_� R O �� _OAT[ ►[RFORYED 7 I H - o• •-~ •' MALDESCRIPTION: L. I O � I I 1+ 6' L '%//V V15 oiiril SLOE STTEPLAN T :•J{�, 11 16 18 17 to 0 oLc fo MDL d L t R•d"y lbl� frac No Do* w No -Z SI�Ty' ;h1�D ■■■■..■■■E mmomommmum TNFr _I .+� F A r rL L'_ I F E IL a y SANr) -c-, /Z W ;o•nt 7 I SL_s= LSCS ■ KEN e � /oo o 1D � ••, J 022. IOa ,/i t1 WFSGAOVNDTVATER ' ENCO'JNTl REo7 - T2 rN E IF YES AT "AT DEP1Nr L,0 I 1' 11 16 18 17 to 0 oLc fo MDL d L u . Z 20 C5 & C� C 7 �; � rtncuLArION RA►E I..:,W,..nw•1 TEST HUN OFTwEEN FT AND r► COMMENTS SEE A•jr,dCN•'-_ .`!<;GN OF P/SUP sysre.•^. /sic/.g /"OVA-J9of F�R/�dEG �v/c._ AJEC/� —o gc Fci+: r�,vF� %� PRov'IDE MA - ;re- r0%r TZt'i.Ocwt# ►roAMrDEr_GP_N��r/.�;t�Ivc1_. C10TIFIID0V /J1i/i... DArE : ):fiN cF Ga/Z/ivc: 3.>'' 4L6"W'" t f3l /FReRL 30/r•r 7 F2GE/�Se= e-eT /3 Y, /f7 /Z. /3 vu< R•d"y lbl� frac No Do* w No ■■■■..■■■E mmomommmum TNFr tk o .+� F A ■ovenaonmm ■■ ■ KEN ,L ■��iinaa��� � ••, J 022. IOa ,/i MOW MONO mini amini omaImm oIwo, u . Z 20 C5 & C� C 7 �; � rtncuLArION RA►E I..:,W,..nw•1 TEST HUN OFTwEEN FT AND r► COMMENTS SEE A•jr,dCN•'-_ .`!<;GN OF P/SUP sysre.•^. /sic/.g /"OVA-J9of F�R/�dEG �v/c._ AJEC/� —o gc Fci+: r�,vF� %� PRov'IDE MA - ;re- r0%r TZt'i.Ocwt# ►roAMrDEr_GP_N��r/.�;t�Ivc1_. C10TIFIID0V /J1i/i... DArE : ):fiN cF Ga/Z/ivc: 3.>'' 4L6"W'" t f3l /FReRL 30/r•r 7 F2GE/�Se= e-eT /3 Y, /f7 /Z. /3 vu< R•d"y lbl� frac No Do* w No T..r lk" TNFr tk o .+� F A ,L � ••, J 022. IOa ,/i u . Z 20 C5 & C� C 7 �; � rtncuLArION RA►E I..:,W,..nw•1 TEST HUN OFTwEEN FT AND r► COMMENTS SEE A•jr,dCN•'-_ .`!<;GN OF P/SUP sysre.•^. /sic/.g /"OVA-J9of F�R/�dEG �v/c._ AJEC/� —o gc Fci+: r�,vF� %� PRov'IDE MA - ;re- r0%r TZt'i.Ocwt# ►roAMrDEr_GP_N��r/.�;t�Ivc1_. C10TIFIID0V /J1i/i... DArE : ):fiN cF Ga/Z/ivc: 3.>'' 4L6"W'" t f3l /FReRL 30/r•r 7 F2GE/�Se= e-eT /3 Y, /f7 /Z. /3 vu< RECEIVED DEC 01 2000 Munrcipality of Anchorage PROPERTY OWNER AGREEMEN1Dept. Health a an Services FOR THE MAINTENANCE Or AN ON -SITU WASTEWATER DISPOSAL ig SYSTEM This agreement, dated October 21 2000, is made between the Municipality of Anchorage Department of Health and Human Services (DIMS) and the property owner(s) of: Lot 10, Block 1, The Landings Subdivision This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The property owners agree to the following: Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional engineer. This inspection and operation statement shall verify that the engineer has inspected all effluent and air pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Sinature) Ronnie V. Simpson (Printed Name) (Notarize Ilere) 1. STATE OF ALASKA NOTARY PUBLIC SARAH M. �GAM`BLI My Comm. *xptnu �-_a s i (Signature) (Printed Name) AZunicipality of .Anchorage V0. Nix 1lXi(Lill•.\nchnrnL!c,Aht.%1m!YLi 1!)di(Lill•Tdcphnnc (!X171114:4 Killl•15i[(!MIiYAa•tl'-MNI ` ° 47(X)nniLanr S1mcl • .\nchonigc, Ahts1u Y..Ai117 ' •' a •' xric.munLurg Mayor Mark Begich T3uildIns; Snl'ety Dixislon 1/19/2006 Watkins Engineering, Inc. P.O. Box 110443 Anchorage, Alaska 99511 Re: Request to Amend Waiver Number W11000100 The Landings, Block 1, Lot 10 Parcel ID #020-061-17 Dear Ms. Ellis, Your request to amend the subject waiver issued December 29, 200 is approved. The approved separation distances are as follow: 1. 80 feet from the septic tank and the lift station on the subject property to surface water, 2. 55 feet from the absorption field on the subject property to surface water; 3. 81 feet from the well on the subject property to the septic tank on the subject property, 4. 73 feet from the well on the subject property to the lift station on the subject property; 5. 83 feet from the well on The Landings, Lot 7 to the septic tank on the subject property; and 6. 75 from the well on The Landings, Lot 7 to the lift station on the subject property This waiver approval only applies to the existing separations noted above. Any future upgrade to the on-site wastewater disposal and/or water supply system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Julie Makela, P.E. Civil Engineer On -Site Water & Wastewater Program Community, Security, Prosperity Watkins Engineering, Inc. P.0 Box 110443, Anchorage, AK 99511 (907)349-1851 cwellis®gcl.net January 16, 2006 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: The Landings, Block 1, Lot 10 Request to Amend Waiver To Whom It May Concern: I am requesting a Certificate of Onsite Approval for the subject lot in Anchorage, which is served by a private well and an Intermittent Dosing Sand Filter (IDSF). On December 29, 2000, a waiver was issued for separation distances between the septic system and 1) the well on Lot 10, 2) the well on Lot 7 to the north, and 3) surface water. I request that the distances be amended, as follows: Septic tank/lift station to surface water 80 ft (no change) IDSF to surface water: 55 ft (reduction from 70 ft) Septic tank to Lot 10 well: 81 ft Lift station to Lot 10 well: 73 ft (change from 85 ft) Septic tank to Lot 7 well: 83 ft Lift station to Lot 7 well: 75 ft (change from 84 ft) The original waiver request had the locations of the lift station and the tank reversed, and thus, the distances are reversed. The lift station was installed closer to the wells than the septic tank, as can be seen on the attached septic system asbuilt. A reduction in the distance between the IDSF and surface water is requested. The location of the main creek channel shown on the septic asbuilt has not changed. However, there was some pooling of surface water noted at 55 ft from the drainfield. I believe that this is a seasonal phenomenon caused by snow melt. In several visits to the property, I observed standing water in different locations. When the temperature was below 150F, no water was noted within 70 ft of the drainfield. However, at 25'F, water was noted at 55 ft. Watkins Engineering, Inc., January 16, 2006 The Landings Blk 1 Lot 10, Waiver Modification Request page 2 ort Conditions noted in the original waiver application have not changed. I believe that the granting of this waiver will not have an adverse effect on human health or the environment. Thank you for consideration of this request. If you need any further information, please call me at 349-1851. Sincerely, 04,e U" l Cindy Ellis, P.E. President PERMIT NO. SW000498 PAGE 2 or 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION PA. Boz 196650 • Anchorage, Alaska 99519-6650 • Telephone, 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 10 BLOCK 1 THE LANDINGS SID P.I.D. N0. 020-061-17 / _100' WELL RADIUS // LOT 7 .4 rvl-rv5 AIR (rAT (urs GRAVEL AVE q LOT I z G� 0 LOT 9 to . 4o• tpt[tt C COWAN '+±1�`D MUNICIPALITY OF ANCHORAGE Department of Health 3 Human Services OnSlte Services Waiver Review Worksheet WR#: WR000100 PID#: 020-06147 HAM Permit#: �Q Date Received: November 16, 2000 Legal Description: The Landings Lot 10, Block 1 Engineer. S & S Engineerin 17034 Eagle River Loop Road #204 Eagle River, AK 99577 Applicant: Ron Simpson Waiver Requested: 80' between tank and surface water•70' between sand filter and surface water•73' between tank and well; 85' tank and well•75' between tank and well on lot 7 Criteria: 1. Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: 2. Special Conditions: 3. Other. .......... Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: 5'r F /9 Yd f NEQ Date: By: i9,4 Al Name of Reviewer .......... Rec#: 06456 Amount: $920.00 Date Paid: 11/16100 t �• 12/29/00 MunicipaUty of .Anchorage George P. li'uerch, Mayor Bttilding Safctt• Division P.O. Iktx 19G(150 a 4700 S. 13ragaw Strect Anchortgc, Alaska 99519.66.50 a (007) 343-&301 h ltp://uitiv.cl.anchortge.uk.tts Robert C. Cowan, PE S & S Engineering 17034 Eagle River Loop Road, #204 Eagle River, Alaska 99577 Subject: Waiver Request for The Landings Subdivision Lot 10 Block 1 Waiver Request Number WR000100, Parcel ID # 020-061-17 Permit Number Sw000498 Dear Mr. Cowan: Department or Public Works Your request for a waiver of the required 100 feet separation from the proposed on-site wastewater disposal system to water wells and surface water has been approved. The approved separation distances are as follows: Septic tank/lift station to surface water 80 feet I. D. S. F. to surface water 70 feet Septic tank to on -lot water well 73 feet Lift station to on -lot water well 85 feet Septic tank on to Lot 7 water well 75 feet Lift station to Lot 7 water well 84 feet This waiver approval applies to the proposed septic tank/lift station/I. D. S. F. system to surface water and water wells on the subject property and Lot 7 separations only. Any future upgrade to the on-site wastewater disposal system will require all separations distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, */9 lapg Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program WA/VER REQUEST FOR LOT V 910Ck / TME SURA.. J WhIVER REQt6EfT NUMBER WR000/00 WAIVER )QBOwCST FOR /ioR1LoN1rAL faPAKAT/O,ur Of: -PRoPot6D $EPT/C 7gND L/PT STAr/ov 2,tAAo To Ja/rF*cc"nK 80 --PROPOSED S1►ND PIL71)C IJ& S/r?Facf A,#rxK 70 J. L -PROPOSED SEPT/C 7ANk 4W ExIST/NCs NaLI.ONc.r /O 77/ "PR0POS a0 L I P r S7Mrlw rtd/K ro ws+.l. oa, Lor /0 8S'/ WWW ►RojowlP Pr/c TANk Faclsr/Nb BELL ON Lo7 7 f E %S / co'oPROFosiD t/Pr Srar/a.. TI*NAt AJrO EKISTiNL %"fLL CW LOT % B4' �r sae vao rHr fEPrlc O/t•n�- THIS EN(RoaCNA►EAv i H&,F KEN TKE PERA.ITJ lvr/ftUED TO GO✓lTRuo 7' TK/1 CovVE�✓T/ovAL A.AfTEwRTEle fYJTEr� pr THE Alojv#eo.XIAtATE D/JTA4C6S L/frEO fPOVE, N/r•' rttw EM6/AtCf�Q PRV►otEf To (�vf7RUC7 19N T. S• f. %QA. / t t1eo..r/<E y..ELtf /v 4/w4r; %IND N.A A. P, fEIT/c TAf,K An,D N.D. 1. E. L/fT TMvK 73 /4 ro ruA LL! N 4 N f. fT/av TUESE TANk SKOUL.0 411✓E K L EM*/e AS T/4BY ARE epvrT/Pac Dr<p la, oN-GORRoJ/vE �/%TEK/AL. wet-(- P# rA — PIE t,6tL f /.✓ ourim/ov a.E/rE t„M/vorp B r' 7NE A.O. E.C. J. D• w• X. fur S. t R. 0. /N /586• THE P/P6POtE0 rEPwK/yrieaf j'ODAr A?E 4CA'ALLY SL/6N1'L) FMpT/IER Rw/rY Aro To Z7E•4f 73Igr ARE Ca.,J/vE/rf0 SAFE /v RsJPfCT To PoTeA,not Li.AxoP&L.IP hwfT6a,tr5K (H•O.OF.-A40mr). f/NCE TNEfe rmVT WELL #&vr Berm /N PtAcF, vATEK SP7MPlso *oovE so"A,, !/wT/NO"JCY T7w, WITI-f REShLTf 049 NO PA•CTso'/w PRESENT 1 NO vlfRifTieS AFr&Cr/►OLE, I/ THE CktRfvT 0010SoaPTiOW FIELD If f6 FffT f/tO.w rqC &ZA.IJ /v Qum I,N►C/! If PROPoffj To pE PfRPtANE✓TLle ABAvOOA'EO WHEN PIE I. Af. F IS e*A/frauCrmP /00A* At -A -Y F.Pa. "'I& wELLf /v /1uESTiaw. ItRrc^CE TvC'obR/O-PNV' //LRCES Tlar p.ELIJ 41061PAVICA,T Aeom 7-I46 SOU RC EI pF COIVr#*A 1A,*7/ov /N Q4 Er77,9&, SkRFf}C6 WWr1ER rRIJ SkKppCE 4.ArI S IS /ANr'ERMllT A07. I F Set, -$46E PirFA rlALL,Y Pop CIGHTS fRo.+ 77♦C iwmex /A+ q6'. trSTiow ouro rNE 6R4ua,p SwleFACE Mir 10.4 7W woKLO 6E /r 1*lo/ RfcrioN rROW wao-LD rXNvCRtE *9(CRoS.S TKE D/sr'% or- /p0 f Dux ro roPoGawON Y 1 S L OPE S. N N N SURFACE' 1.-►oTER 1.,4,w& 2 /7EETS SIT/GATINb (/R(kA*ST�H'Ca N N N coo r'o TusTIFY. _ry vao rvrvry rvrn �+ (w r W .4 TE je rgBi- r,- ' 40' SO SOIL • SORBT/oN N N N WWW 3 I TO 40' IS ,60gvEL ' r xxx N N N 000 nG0 �ry �rvv avv r�� PEa.LEA91��ry �V y/prER TAricE (�/Qqp/ENT W E«f ARE ToAobRl►RutwttY otGRAPIarr FR°•+ Tn.�K1 $RAPIf w r N YM i%.I.I r tj.L Y f/vR12 oNr4L SfpA-nIt- T/°N 2S 23 x=.92t-� GA'Aw0 ToipL �S• C Ova" S ioN 6Rl?,v7- • 11-22-00 09:10 Ltd FROM -CTE ENVIROMENTAL 5615301 T-820 P.04/05 F-294 ME Environmental Services Inc. Labomtory Oivislon tvo�oar/a aaiiiiai 200 W. Potter Drive drinking Water Analysis Report for Total Coliform Bacteria 7 l:1 07) 582-2343,e•,Bos READ INSTRUCTIONS ONREYBRSESIDE BEFORE COLLECTING SALE Fax- (907) 661-5301 oPBE OMPLETEDBYLABORATORY MUST BE COMPLETED BY WATERER SUPPLlEF ® h' Water SAMPLE to be: 0 PUBLIC WATER SYSTEM I.D. R pC PRIVATE WATER SYSTEM Send Refuar Serf Iwrurler .e�" : r Loop Road No. 204 M . at, a rvery as a w.,es uw V MY O Send Reruln t7 ,.wu.n. '" l I - onics/l00 m1. Result• 1007239 A ysrs shows t Is Sat.3factory 0 Unsatisfactory 13 Sample over ID hours old, results may be unreliable D Sample too long in transit; sample should not be over 48 hours old at examination to Lidicate reliable results. Please send new sample via special delivery marl. Date Received 7 /6 Time Received epi, Analys0l Bepa AnaiTtkal Method: 0 TMv mbr==cG Tier DATE: TM m O O SAMPLE Month Day SAMPLE TYPE: 2f Routine D Treated Water 0 Repeat Sample (for routine sample zit Untreated Water with lab ref. no. —� 0 Special Purpose Time Collected SAMPLE LOCATION Collected By LOT -7 Uwe: 1 THE L/jratM J 14 9.30 on" 06 C. rMw bier Analyst Sent to A.D.E.C. Aneh Flake Jun Fazed Date;' Time: Client notified of unsatisfactory results: Fho❑❑ sed Spoke with Fazed Due Time: BACTERIOLOGICAL WATER ANALYSIS RECORD Cell MMO MUG Resale Topv l Colifor; Jr Colonies/190m! Membrane Filter: Direct Canal ' Verification: LTB BGB COLIFIRM_. Fecal Coliform Conarmetlea Float Membrane Reported By Comments: ENVIRONMENTAL FACILITIES IN i J CulirurmnGo ml Time , b&f) hes TNTC- Te. N..w.n To C"M as -Oaffo revue 3MMember of the SGS Group ISociate Giotto'; de Surv, glance) CALIFORNIA. FLORIDA. ILLINOIS. MARYLAND. MICHIO^N MISSOURI. NkW JERSEY. OHIO. WEST VIRGINIA • 11-22-00 09:09 FROM -CTE ENVIRONIENTAL ALCUE Environmental Services Inc. G ririrrrrrrrrrirrri� 5615301 T-820 P.02/05 F-294 CTLE ReCO 1007239001 Client POp Client Name S & S Engineering Printed Date/time 11/2112000 16:55 Project Namato N/A CollectedDate/rime 11/15/2000 20:30 Client Sample ID Lot 7 Blk 1 The Landings S/D Received Date/time 11/16/2000 14:35 Maims Drinking Water Technical Director Stepben C. Ede Ordered BY / Released BY /I d / MID 0 O n d A, Sample Remarks: Allowable Prep Analysis Paramety Remits PQL Unita Method Limits Dat' pre [nit Waters Department Nitrate -N 0.500 U 0.500 mg/L EPA 300.0 microbiology Laboratory Total Coliform 0 coVI00mL SM189222D Y 10 max 11/16/00 SCL 11/16M 1DT --- - - x ormation from , (:;_ :to .: GGC .I p GfiuvEL kjj,Um�l Lou - For.......... 1................I.. A�^A^ .............................................................. •✓..•..l Location...`!°.....I.^/.C�l..`..L'.................. t , , Datecompleted....... Fv......5........y.`. ................................................................ Ta � Depth of well................. ' I Sizeof casing.................... . . .............................................................. Distanceto water....... .l........ .....................................................r...... .... Distance to water while pu :apu;g ......... J.................:.................:.::at rnt;J of .................................... ........... gallons per hour. S GP,tr'. ;. --- - - x ormation from , (:;_ :to .: GGC .I p GfiuvEL A�^A^ •✓..•..l .A -r,0. rTUN ` t , • Ta � I DELTA DRILLITIG COMPANY •r, .. o• ;r • •H• iu. , 11-12-00 09:10 L16 FROM -CTE ENVIROMENTAL 5615301 T-820 P.05/05 F-296 ME Environmental Services Inc. Laboratory Civision Drinking Water Analysis Report for Total Coliforr READ INSTRUCTIONS ONREYERSE SIDE BEFORE COLLECTING MUST B E COMPLETED BY W ATER SUPPLIER D PUBLIC WATER SYSTEM I.D. N PRIVATE WATER SYSTEM Send Rmks GSenllevofre S IL 5 ENGINES 1 e y Alaska 99577 .. OM Y »r 200 W. Potter Drive i Bacteria Anchorage. AK 99618.1606 Tel: (9071562-2343 SAMPLE Fax (907) 561.5301 TO BE COMPLETED BY LABORATORY VAn ysis shows this Water SAMPLE to be: Satisfactory p Unsatisfactory O Sample over 30 hours old, results may be unreliable 13 Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send . new sample via special del tiv� mail Date Received Time Received y1�----� Analysis Began S / Analytical Method: Q �Obranc -MUGtlter —S'—JnRies/100 ml. 1 U10 00,239 Re,ult` ® O V SAMPLE DATE: I Mouth Day Year SAMPLE TYPE: )6 Routine 0 Treated Water D Repeat Sample (for routine temple )v Untreated Water with lab ref. no. ) D Special Purpose Time Collected SA.IIPLE LOCATION Collected By $;cu 16 " z..v,— ro Bek t rwt c.>•-n:.cl' �A . Ftme Print Comments: Z Sent to A.u.■.... Analyst ® da Anch Fbks Jun ❑ Faxed Date: Time: Client notified of Unsatisfactory mule: ❑ ❑ Pbosed Spoke Mtn Faxed Dote'. Time: BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Reales 701111 Collferm E Cell Membnas Fitter- DVM Count Colooles1100 ml Verification: LTB r— Fecal Coliform Coorrlwatioo Final Membrane a Reported By BGB COLIFIRM_ 0 rr ��Coo�liforlltn/loo ml Date "� Time � hrs rnrc. rw N.o....r T. C. oil -oa..a.m.,. a EKM Member of the 909 Group (Societe Gln6rals de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND. MICHIGAN, MISSOLIRI, NEW JERSEY, OHIO. WEST VIRGINIA 11-22-00 09:10 FROM -CTE ENVIRONIENTAL 5815301 ME Environmental Services Inc. T-820 P.03/05 F-296 Cr&E Ref.N 1007239002 Client PG# Cllent Name S & S Engineering Printed Date/Time 1121/2000 16:55 ProjectName/A' NIA CollectedDate/Titne 11/152000 20:00 Client Sample 1D Lot 10 Blk 1 The Landings SID Received Date rime 11/162000 14:35 Matrix Dritildng Water Technical Director Stephen C. Ede Ordered By Released By PWSID 0 Sample Remarks: Allowable Prep Anslyas Parameter Reults PQL Units Method Limits Date Date Init Waters Department Nitrate -N 0.500 U 0.500 mg/L EPA 300.0 Microbiology Laboratory Total Coliform 0 col/100mL SM18 9222D 10 max 11/16/00 SCL 11/16/00 JDT lhtf of ANf4♦ - IlrllTwllT M uiYML AffOUK[f � wuo- a Mu U Sett 1.7 ft." J Wloo•ul 1V lyk"wl 60.0 Ory. Nr11Uw bblw IRY1. to, n.nlw 1001 Nrfyl. NM (Ttl 111 tD•fflfl . r t. Ib V.I." Anch"': The Landi gs 1 Y0Ttt Y1ll ,fj0001 '. 11. II11M,U W Ilrtttlw Irw AWI.I.rwtlW ., Vern•Dr1111nR ar fi7tarnrS88a i A:L.u1 SRA 4005 B y ! Nllllry C.W.ry ..+ p1111rylrwlt ..• P Mt MW (..+ To 1/_bU .Illu. ToIT". 11. �� - � ~ - A.M. Y• lhtf of ANf4♦ - IlrllTwllT M uiYML AffOUK[f � wuo- a Mu U Sett 1.7 ft." 1_•.Iwl. - Ory. Nr11Uw bblw 6N r t. Ib V.I." Anch"': The Landi gs 1 11. II11M,U W Ilrtttlw Irw AWI.I.rwtlW ., ,i• Mlt N MLLI Tim Buckley i A:L.u1 SRA 4005 B y ! Anchorage.99502 L I Nuot W A,. 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Ntnidl ..❑wtloowt`❑CtMrt ' _ IL NIIIL�(I/ MIIMId ). r �•`L1.IM tl�Irw /loo 5}�{ Ib wwl<I �f.I f ,Tlooi..Qt.LMnDb... ❑A.cllnutlry . �, ❑At, ❑IIMII . • v.. . 1 l� ' If MTIA NLL pt1AAtTM•/ ytTI/IPTIIt1 ♦ p.._. to 1 � ■ >r. :. , ..�, ,, : � ,• . . - dry ooll 0 0,111.4 W.r oo )•rINl111w W IAI. IMr1 Is W kit N w IwwINM W NI bI1 + „ - Yc{♦.A��p�y`yy�A♦ Aejj�� Vemle Drillinr ui,f i µ.. 64.10 507 - - •+tKlr:gv. p.q•9p F..•rn. r+rMui ... or". Itt_y.w too 11HrIMIwi ;YIMt� U.141, MS. IIM� blllw tAMb•t..ttWr •rt lhtf of ANf4♦ - IlrllTwllT M uiYML AffOUK[f � wuo- a Mu U Sett 1.7 ft." 1_•.Iwl. - Ory. Nr11Uw bblw 6N tIN1 Ib V.I." Anch"': The Landi gs 1 11. II11M,U W Ilrtttlw Irw AWI.I.rwtlW ., ,i• Mlt N MLLI Tim Buckley A:L.u1 SRA 4005 B y ! Anchorage.99502 L I Nuot W A,. N WII W.O. - "- - Mt MW (..+ .A. IIIR HITIII (twwbtN) 1wbs. PoNlw WI. N f_Ylalw ~ l Mll tot r n • ." 62 TITo- w MI{� Tvocaslnjfu aft' �t.i. QOL11 tool , ❑Nur/ ❑41..w ❑O.t _ ❑A.Itw ❑OtMrl j{i� ❑Ary.1 .. :❑twN / � Y"0x.1111 {.00ll ❑IN..ttf .❑fa�.n1.1 .. IrrIw : ❑AttNw } ❑1/11 -:A. ❑TIt1 WII �. M11 1 t• ❑OI n lam" A CAIMl.-. Twr..1.1, QWII.1 �bJll. 1.11. Wil.%drilled In) -61—tL ,�Y •=1. Iw. M SII. Mu . �"• 4 /I.IM TO Mill '. "•.. ,_. . I Tna�an 11nA II.00" I _yaY .._ t✓'INIM.l flwl 1"' •. ` lo-lUl . y fa l.o.w IbW It. - - '. .. •• ..... ... _. o `q., fTATIC %AM Ltvlll NJ II. � cim "tor'Of cas init •_ A11004 !Nitl 10. IV V IM MtL Nlw IW hrru. yW.�Itl llw'�„3�M1. /+Ylry [t_t.A.w 11• Mu. .IAI twRlTlwl - I. Aoo1•W1 III g • "' 3Ihloo1 ANItw�!"• IWMI .1.W /nN - IL WYTIMI;d, WIT IIMINI(❑tH: ®Y . Ntnidl ..❑wtloowt`❑CtMrt ' _ IL NIIIL�(I/ MIIMId ). r �•`L1.IM tl�Irw /loo 5}�{ Ib wwl<I �f.I f ,Tlooi..Qt.LMnDb... ❑A.cllnutlry . �, ❑At, ❑IIMII . • v.. . ' If MTIA NLL pt1AAtTM•/ ytTI/IPTIIt1 ♦ p.._. to 1 � ■ >r. :. , ..�, ,, : � ,• . . - dry ooll 0 0,111.4 W.r oo )•rINl111w W IAI. IMr1 Is W kit N w IwwINM W NI bI1 + „ - Yc{♦.A��p�y`yy�A♦ Aejj�� Vemle Drillinr ui,f i µ.. 64.10 507 - - •+tKlr:gv. p.q•9p F..•rn. r+rMui ... or". Itt_y.w too 11HrIMIwi ;YIMt� U.141, MS. IIM� blllw tAMb•t..ttWr / � T ..- Municipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 December 19, 1991 Roger Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 Re: Waiver Request for Lot 10 Block 1 The Landings Subdivision, Waiver Number WR910056, P.I.D. 020-061-17 Dear Mr. Shafer: Your request for waiver of the required 100 feet separation between a wastewater absorption field and surface water has been approved. The approved distance is 84 feet. This waiver is conditional until fill is imported and placed around the absorption field to remove the low areas that are causing water to pond. This waiver is also dependent upon the subject surface water remaining free of contamination from the absorption field in question. This approval is for the existing separation between the absorption field and surface water. Any future upgrade to the absorption field will require all separation distances be met or another approval from this department. Sincerely, Daniel Roth Civil Engineer On -Site Services OSS#80 Co currence I1ti� /a Smi h, P. . Program Manager On -Site Services MUNICIPALITY OF ANCHORAG Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR910056 PID# 020-061-17 HA# HA910514 Permit # Date Received: December 3, 1991 Legal Description: Lot 10 Block 1 The Landings Subdivision Engineer: Roger A. Shafer, P. E., S & S Engineerina 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Applicant: Ronald Crumbaker Waiver Requested: Leachfield to creek - 84 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: iC Waiver is NOT Granted: List Conditions or Reasons for above: ud' ,el/7AC,%f> Date: 12--17-71 By: of Reviewer Rec #: 23262/9326 Amount: $ 590.00 Date Paid: Dec 3. 1991 1I IWA)vEl3 IYEOurfr FOR <OT /O Dur / TKE 1,7.vDi.v6J SkOP. �Jv,fivEi? REQuEST vuHoEl? w49/00S6 SEPrlc FEET FJP1�H—RBJoRPT/0 /`LElI� �o fkRrac�r w�+TE� N/STpR� Tl-(E_sE rtc._S;'J-.T_F ±_vN 7W/fs d_oT /r %�—T_rifAiCH TY_l°f �:.�Ad.SoR/-T1o.V F!Etp TK�T_is_CotiSTRNcT_ED 3.S Ft /pro nv_E G R �_u a•.p. _%rf E S_YS_TE-'r �s rKfAv 'Np_i�NOT_F__J� GI✓ D)4/.G-/�vi}.L_.itifobcTiev 1PFr'o�4_T_S_/_^! �UPD,✓_/�_SITE—✓J��-r �P�oror .gnH_cKEa> EvE,pY_�/iv6—AI°PEA�P6D._ � B.E_�5.__7'KE_E.�G-In%EEiQ—R£PoRJ_ED, Nf}J_�gLREADY OEEN_.D/_S_C.uffEO.��'O 'gG�°�� �Y TKE PROPER_Tj' Ot.iv.ER._��routD--T_NE__i1gE h'PPRauEO T�Yr/ IJ i41Q�A_T.��pT—Potio,tiG__s'uRF.ncf—wr£.R.—Tkil—sHvk�n T'KE STI�E��+_TNAT-(S—?HE—SkDrEGT pF�"k/3—f�.RIvER—/S_S�!{FT_ L_.!�/.S.TAAiGE—f/1'p�_+-_TKE ADSDRPT/O.� FI£[D,_AS TKFE_ !s 1 Y� Ef�M __T7PAvF/�-S63—Dow a TKE_SL oPE_T_KE_._Sf /?AR.A TlG.L. raufN 27__TK9T_M Y _O�YL rGyT_ F/igh TN/s___AOSogP_T/ON .�►ELb wouLO—_T/?ivvE/�SE_/.v—.R 'P/rRf�►-L��-__Q►RF_CTon� TO TF(r__SkOlF_-c-T__ST/PE9/f.__/f A�.i _ '�FPLkFNf FRONt__T/�E'__�6Sa,fP_tlon�—F_l�_/-d D/!7—l�_TEIPSE_cT !P_�ov_�s'�_r_KRr T_KE—P_o�vD/NG—Scr�e��cE_c..pr�R—i_�Pa©GE�r_ LsBE sa c�seFu �� j' co Nc l�uTu✓i'� I:CO.•�-T_�"''/aAT/O.✓ OF R.v_Y�liKI�/3_CF t�.HTEIQ_�E /qTl_�'/OkT�G T_0—TK/J—�B.sonpT�e!v F/Ett�, HEALTH AUTHORITY APPROVALS SEWER& WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSYSTEM DESIGN December 2, 1991 Munic.ipatity o6 Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, ACaska 99519-6650 REFERENCE: Lot 10; Stock 1; The Landings 4021 Landing C.Ercte ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVILENGINEERS (907) 694-2979 FAX 694.1211 W 0 q \ Cy�I:�)LD MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION DEC 0 a 1991 RECEIVED Request you issue .the attached condi ti.onat Heafth Certi.6,icate and grant a waiver 6or the horizontat aepanati.on distance between a amatt creek and the septic system Located on the re6erenced property. The Certi6<cate is 4eque6ted on .the condition .the zuA6ace water ponding aAea noted on .the attached sketch .is 6-itted and .the ground stoped away 6rom the septic teach6ietd by mid -bummer, 1992. we are in the procelia o6 aoP,iciiing bids bort .the work so money can be escAowed. The septic system aerv.ing the property was .inatatted in May, 1981. A certi6.icate 06 approvat was issued .in November, 1982. There was another Certi6.icate a.Cong with associated wa.ivera between the septic system and private we2.P6 .issued .in August 1986 and again .in Juty 1987. However, at this .time we 6i.nd a ama t atream stowing only 84 6t. 6rom the septic system. Either this atream had been overlooked dun,ing the previous approvals due to its minimat size ort perhaps .it did not exist until recentty due to drainage pattern changes in the area. Reber to the attached sketch jot the atreama' .location and elevation6. Although the septic system is higher in elevation than the cheek we beet the .issuance o6 the waiveA may be justi6ied 6or the 6ottowing rea,6=6 : 1. The creeks' minimal size (approximately 0.1CFS) and the haat it has gone undetected to date suggests there may be certain .times o6 the year when .it .is non-existent. 2. The area between the septic system and the cheek is highly vegetation which would prevent direct, unhindered migration 6rom the septic system to the cAeek. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Page Two Lot 10; Stock 1; The Landinga DecembeA Z, 1991 3. 16 the aepti.c ayatem were to even over6tow at.towing sewage to migrate toward the cheek, the actuat meander tine o6 the eb6tuent wound moat ti.keCy be .in ezceaa o6 100 6t. 4. There appears to be no other ptace on the property to retocate the aept.ic ayatem in exceaa o6 100 6t. 64om the creek. 16 you have any queati.ona or requite additi.onat .Ln6ormatton 6on your review, pteaae contact us. S.incerety, ROGER J. SHAFER, P.E. RJS/gm L .. EQUITY 110 -AO -B1 t 1115• t CCZTT o9- '.. 14: 41"cR QQ ; 1 �Cl18 1 0 -r. v' r1t / IOv" -ref' � �� �'i } !� Fr1D• 0p 1 n PHH HOMECUSTY 96 e of eve, // a0*/ W60d / rc10%•71e j W011 Govttcci Irl •--��98�9 7.°13 j00* 49' 1 •'�, Iti 9:R J. -H SFER PX 'f +%I%FGPAOFESS0OA- 0"" 17-1 1 X'k% Vat--% Aa T7T NC a easements shown r LK s As-8u11r'ere 'AS ��lIL�r��� q��S,,+ as shown on th• raeord�d P1 en re suD- {� *N�" lter the plat anyeasements b dre or�after the plat date es de11n ed w1thim Idtd49Itf 71t1e Search No./ 6 .dtd9/ 2, under no circumstances u any ata hereon be used for construct o or for. establishing boundary Oe fences'I asp. 9. he surveyor ictlon only slbility finitial or the l[e[ D LOT _1i. BLOCK CAA°C CAP Ma MCYCMt IRON M►t TX�h 4,4N IV&a I RD/1!/ I6*0' fKATNo•� ) All AR MAeel1•/MO I eninmnRoaE RECORDWG DISTRICT a NVa&TAQR- 14?6_HYDER_STREfT JM" Kat! Ov*W4 ,_ 15"s �e 1ATt: oYt "A": �#- 4o• rvnRtxvePt• R . -3,911 z/!.'�� 9/ ,� gi-tee �_ ,"'`_- 117"'POMPT9 r1 ITI^ MIR M_PmAJ Km:ll I6-ze-Zi � n Municipality P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 of ! �i', (907) 264-4111 Anchorage TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH 8 HUMAN SERVICES July 24, 1986 Neil Hawthorne NHawthorne-Engineering 7127 Old Seward Highway Anchorage, Alaska 99502 Subject: Lot 10 Block 1 The Landings Subdivision Waiver Request, WR86-098 Dear Mr. Hawthorne: The previous well -to -septic tank waiver for the subject lot granted by this department has been voided by the State Department of Environmental Conservation. All waivers granted prior to July 10, 1985 must be re-evaluated in accordance with State guidelines. The waiver for the subject property will be "reinstated" under the following conditions: 1. The lift station and tank must be inspected to insure that they are structurally sound and no significant corrosion is evident. Mechanical couplings should be present on all inlet and outlet connections. 2. The nitrate concentrations of the wells on the subject lot and Lot 7 should be determined. This testing should show that both wells are free from contamination. The existing well to septic system separations will be considered acceptable if the above conditions are satisfied. Waivers of the 100 foot separation requirement have been granted for the following: Neil Hawthorne NHawthorne-Engineering July 24, 1986 Page Two Distance to Distance to tank lift station Well on Lot 10 71' 86' Well on Lot 7 73' 88' Distance to trench 96.5' 100' A letter of non -objection has been received from the property owner of Lot 7. Sincerely, Stephen S.( Morrisv Civil Engineer On-site Services SSM/ljw 1 NHAWTHORNE-ENGINEERING July 9, 1996 Stephen Morris Anchorage Dept, of Health and Human Services 825 L Street Anchorage, AC 99501 Re: Waiver - Lot 10 Blk 1, The Landings Dear Steve: �1 7127 OLD SEWARD HIGHWAY ANCHORAGE, ALASKA 99502 907-344A711 MUNIC1PA1.m OF ANCHORAO� DEPT. Of HEALTH & RECEIVED Please consider this a request fora waiver of the separation distances from two wells to a septic tank, lift station, and a trench. Well A and the septic system are on Lot 10, while Well B is on Lot 7, Blk 1, The Landings. Existing distances (feet) Septic Tank Lift Station Trench Well A 71 86 96 112 Well B 73+ 88+ -en 1/� loot— The owner of Lot 10 has requested a letter of non -objection from the owner of Lot 7. The enclosed sketch shows the general surface drainage. If any piping up to the lift station became blocked, the- wastewater would flow out a basement floor drain or toilet, not onto the ground sur- face. The only well log I could find in the neighborhood is for Lot 10 and it is enclosed. While soils are called SP, the grain size distri- bution curve by Alaska Testlab (Lot 7) shows a good distribution of 400 100, and 200 screen material. Testing on Lot 9, west of the property, showed "clay, silt mix" soils. A "waiver" was granted by your office in 1981. Please call if you have questions. (oerel _ Neil H�wt orne, PE NH:ck Enclosure 1,-r 7 yo✓se 2'Well s Z. -i- 8 . t } } 1 4'{ i I I. � .:• �.i it..�T - Trf A Q M1 C fw 7wt4- SCALE PATE 1,-r 7 yo✓se 2'Well s Z. -i- 8 . t Q M1 C fw lalatt✓ El � 9G f 'Svr �+•��� Els '!04 t Nouse 80 CL,w Ln {, Flr- F1 = /Vo Lo10 - Svrf EI NHAWTHORNE - ENGINEERING S / TE .SKET c N 7127 Old Seward Highway L a T /O / 12 [ k. t Anch., AK 99502 344-4711 THE LAND/NFS inn 1AB0RATO IES, INC. uBo oar 1.D. S?✓ 7127 OLD SEWARD HIGH, X ANCHORAGE, ALASKA 99518 j (907)344-8551 �. r BACTERIOLOGICAL WATER ANALYSIS TO BE COMPLETED BY WATER SUPPLIER FOR LAB USE ONLY DATE COLLECTED TIME COLLECTED TYPE OF SYSTEM MONTH Y YEAR E3 PUBLIC ERINDIVIDUAI ❑ RESUBMIT SAMPLE .. Sdo Sample rejected because: I I.D. NO. (PUBLIC SYSTEMS) CIRCLE CLASS CHECK ONE OR MORE I I I I i- I A B C Residential ❑ Sample too long in transit. NAME OF SYSTEM TELEPHONE NUMBER Sample should not be over 30 hours. ❑ Sample received too late in week SYSTEM ADDRESS ❑ Not in proper container ❑ Leaked out ❑ insufficient information provided. CiT STATE ZIP CODE Please read instructions on form. LOCATION WHERE SAMPLE 19S COLLECTED ❑ Other (Specify) 'COLLECTS B : SI ATURE) RECEIVED FROM Q h TYPE OF SAMPhC RECEIVED BY 41hzij //e (CHECK ONLY ONE THIS COLUMN) DATE ad & (n TiME e'DRINKING MATER ❑ CHLORINATED ANALYT AL METHOD: ✓CHECK TREATMENT ❑ FILTERED 13UNTREATED OR OTHER MEMBRANE FILTER 13'RAW SOURCE WATER ❑ FERMENTATION TUBE ❑ NEW CONSTRUCTION OR REPAIRS ❑ OTHER(Specify) Date I Time Started 1yw6 At. Date I Time Completedt'n�a 7fg4 IS THIS SAMPLE A CHECK SAMPLE TO A PREVIOUS NON-CONFORMING SAMPLE? ❑ YES ErWO PREVIOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) LABORA Y R ULTS %�_��� Analyst ❑ RESUBMIT SAMPLE NAIE.ADDRESS AND ZIP CODE SEND REPORT TT/:(PR1NNT�T /tWLL NAME �i�—�G h/iF!lJlh�/TL°a1 c Test unsuitable because: ❑ Confluent Growth ADDRESS ElTNTC CITY STATE ZIP —/ SATISFACTORY [a UNSATISFACTORY ❑ BACTERIOLOGICAL WATER ANALYSIS RECORD FOR LAB USE ONLY TOTAL COLIFORMS Membrane Filter: Direct Count Q Coliform/10Om1 LTB FECAL COLIFORMS EJ FECAL BGB Final Membrane Filter Results Coliform/100ml OTHER Reported By Date Time A.M. P.M. READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORM TG�/9/i� F s M !�' SUBJECT MESSAGE r -pe 046 SIGNED REPLY %GT!/f/hS DATE REDIFC)FaM 4S 474 SEND PARTS 1 AND 9 WITH CARBON INTACT - [_�_��• PART 7 WILL BE RETURNED WITH REPLY. 9 MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION r� ENVIRONMENTAL ENGINEERING DIVISION 825 L Street. Anchorage, Alaska 99501 Telephone 264-4720 / ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME / ON S PHONE �-N-S377 NEW ❑UPGRADE MAILING A RESS /✓,[ D oX /Y cfJ LEGAL DESCRIPTION L O I / A ' LOCATION t f 04 �1/�GLE O. F BEDROOMS �J Uy DISTANCE TO: We I^O a _/ Absorption area Dwelling . Ci /..V • PERMIT NO, ry� yt d Or i Z W f Manufacturer Material 6 L No. of compartments W Liq. capacity in &lions IF HOMEMADE: Inside length Width Liquid depth -1VZ DISTANCE TO: Well Dwelling PERMIT NO. _ Manufacturer Material Liquid capacity in gallons O W = DISTANCE TO: Well / %D Foundation Nearest lot line O PERMIT NO. -1 U.Z f Z W r O No. of lines I Length of each ling T� Top of tile to finish grade /•T� Total length of lines Trench width (7[ inches Material beneath We / r� inches Distance between lines Total effective abs3 tQ area W Length Width Depth PERMIT NO. l7 is. F W A Type of crib Crib diameter Crib depth Total effective absorption area W rn DISTANCE TO: Well Building foundation Nearest lot line J —1 Class 1 Depth Driller Distance to lot line PERMIT NO. W � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area a OTHER PIPE MATERIALS !✓r J T < 0 3 SL SOIL TEST RATING A d 10N INSTALLER .✓D ¢rCJe„i � S REMyy.RKS, / 4141df4 Did ELL D — u 1 o u,vD/47'1 . Id 416! I N 0 0 7—,9 'r/6AA r a AP OVED `J DATE LEGAL s'^ 72V 3 (Rev. 3178) MlJr4I (-- I F=n L_ I T'T (D F= nr.icHORF=l GF j • DEPARTMENT Or HEALTH AND ENVIRONMENTAL PEOTECTION 825 'L STREET, ANCHORAGE, AK. 99 1 264-4720 Q WELL F4t4E> C3t4SITE SE4.4ER PERM I T -- PERMIT NO. C 810354 APPLICANT ANDERSON BROS. PQ BOX 129 ANCH. 694-3377 LOCATION BOUNTY CIRCLE I%&D LEGAL LOT 10 ELF; 1 THE LANDING SUB LOT SIZE 21233 SQUARE FEET LAN 2A-a�-01 TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH filth AxtkL MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: I?EF,TH=/ LLEt+I(3TH= -42r C3Rn V EL C?EF"'-r 3. THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DP,AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIF! FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). RE:inU I REI7 SEPT 10' TF lr-IFS S I ZE= 1C-10ID GF=l L_L _or-tS 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. -9 --- TWEo C 2 7 I tJSF"ECT' I CANIS FIRE RECAU I REE] --- 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 OR 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'ERr1I T EXP' I RES E>ECEMEAER Z 1s 15+^01 I CERTIFY THAT 1: I AM FAMILIAR. WITH THE REQUIREMENTS FOR OM -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IFI 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:. If 00000-- 710 Avdooro,I '& "s (fees/, Co , ISSUED APPLICANT ANDERSON BROS. V4. 0 ✓SOILS t l:C�.��' Lb C. (/'VIUNICIPALITY OF ANCHORAGE O .PERCOLATION •t DEPARTMEht0FHEALTH AND ENVIRONMENTALPA6.ECT10N'' TEST + i •I 525 L &r"t. AnNrorq•, AW48 6601 26"M .;N u; S+•l..m \ SOILS LOG — PERCOLATION TEST �C9¢-3377 ^• toll ,, PERFORMED FOR: Ar m T) (FR 5 O /J • _4 R O s DATE PERFORMED. '.',•' 1.10 R. I I I+E '(-f�N�INLIS LEGAL DESCRIPTION: SLOPE -SITE PLAN DEPTHO- �j I (FEET) I 0 R C) />r•N 1 1-z 5 I LTy 5&JD 2 3 4 6 6 13- 14 - is. 16- 17- 18 6-1718 19 IL Emmm ®®®m momm i WASGROUNDWATER SES L _ ENCOUNTERED) Tp.z I E IF YES. AT WHAT Q ^ DEPTH) I vLt: BOLE dti � I rft M®ns®®®®®E11 Gran ■031,13mma Mal !EER -season R••d'uq Thr Tr Tiff" WIN '• Drer,..; ■�,►zona®��� toll .tool... - am mmmumms jw of • }/••w•.• tool, •a� is;:,` •:. to I to O.gs, 0.1732-E . Ju e22,1968 t i Emmm ®®®m momm i WASGROUNDWATER SES L _ ENCOUNTERED) Tp.z I E IF YES. AT WHAT Q ^ DEPTH) I vLt: BOLE dti � I rft M®ns®®®®®E11 Gran ■031,13mma Mal !EER -season R••d'uq Thr IH - 20t_j l PERCOLATION RATE I^anamAneAl CSEE E7��/ TEST RUN BETWEEN FT AND FT 'COMMENTS /% SEE ,4rr�4c'erD S/lEiLii OF RIZOP s)�srE'M• 1ic/1f Mou/vr� of cy/1rtvEG wi�c. ,vEep ro g E FcArre /✓Cv 170 PAD:"r.D - M i} 7G Fo Ti t3 B , M PtFORMED BY: CERTIFIED BY: �",/Pp"" DATEi U eP774 o,c Gy/z/i-vE t EN47-N Re? -30/ s,; ; j• R4E,0f_$a 4e -5o REFe2 To ,EMD 2E TffiS 4e—o7— :. R •./ GJ� /T Ly,� IL. . Gran Nn DW* to Nw 0.q .� • • R••d'uq Thr Tr Tiff" WIN '• Drer,..; toll .tool... - jw of • }/••w•.• tool, •a� is;:,` •:. to I to O.gs, 0.1732-E . Ju e22,1968 t i too 441 k .4 - to 20t_j l PERCOLATION RATE I^anamAneAl CSEE E7��/ TEST RUN BETWEEN FT AND FT 'COMMENTS /% SEE ,4rr�4c'erD S/lEiLii OF RIZOP s)�srE'M• 1ic/1f Mou/vr� of cy/1rtvEG wi�c. ,vEep ro g E FcArre /✓Cv 170 PAD:"r.D - M i} 7G Fo Ti t3 B , M PtFORMED BY: CERTIFIED BY: �",/Pp"" DATEi U eP774 o,c Gy/z/i-vE t EN47-N Re? -30/ s,; ; j• R4E,0f_$a 4e -5o REFe2 To ,EMD 2E TffiS 4e—o7— :. R •./ GJ� /T Ly,� IL. . n Municipality of Anchorage MEMORANDUM DATE: June 25, 1987 TO: File, Lot 7 Block 1 and Lot 10 Block 1 The Landings S/D FROM: Stephen S. Morris, DHHS SUBJECT: Waiver WR86-098 The two conditions required for the approval of the waiver request referred to above have been satisfied. Setback waivers to the wells on Lot 10 and Lot 7 Block 1 The Landings S/D have been granted to the septic systems components referred to in WR86-098 dated July 24, 1986. cc Neil Hawthorne, P.E. NHawthorne Engineering z ^ Well Log For........... L.t.. Location... ..... ZK.tl11/.IJGS 1Ul ........ a-/O._L: FLK 1 Date completed........".. S.. ".......................... Depthof well....................................................................... . .... Size of casing......... ..... ...................................... .... . Distance to water .......... .......... :.................................................. ........ i .......:: . Distance to water while pumping ...;., ..,at rates of ............... ...... az.....................gallons per hour. ---� Formation. from ; to", GrdvEL or—ep V24Vff .440 Sa.vA Gt241JL t� -48`: S/ , "'C'PA eF OF ANCHOR , -:.'. .. IRUIU.:gr A 't,0�:CTION ->-. d or ........... 11ARPF2 ... .... Driller �• DELTA DRILLING COMPANY • SRA BOX 39A 6 i • r - - ANCNORAGE.ALASKA 99507 . r r Trictl., -iz�V14- Municipality of Anchorage Development Services Department Building Safety Division On-Sfte Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/0nsfte (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 020-061-17 1. GENERAL INFORMATION Complete legal description The Landings, Blk 1, Lot 10 COSA # N00019 - Expiration Date: r-- — O G Location (site address) 4021 Landings Circle, Anchorage, AK 99516 Current Property owner(s) Brian Roit Day phone 261-7652 Mailing address 3111 C Street. Suite 100, Anchorage, AK 99503 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well o❑ Individual On-site ❑o 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 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-sfte 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-sfte 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 Watkins Engineering, Inc. Phone 349-1851 Address P.O. Box 110443, Anchorage, AK 99511 Engineer's Printed Name Cindy W. Ellis Date Jan. 17, 2006 5. DSD SIGNATURE Approved for _3 bedrooms. Disapproved. nay W. Ellis CE -1057 Conditional approval forbedrooms, with the following stipulations: Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: Original Certificate Date: (R«. 111W) Municipality of Anchorage Development Services Department Building Safety Dhdslon ` Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 198850 Anchorage, AK 995198850 www.muni.org%onsfte (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: The Landings. Blk 1 Lot 10 Parcel ID: 020061-17 A. WELL DATA Well type Pri If A. B, or C provide PWSID A Date completed 65.81 Sanitary seal (YM) Y Total depth 51 _ft. Cased to 51 fl. FROM WELL LOG Date of test 6-581 Static water level 31 ft. Web production 5 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colontes/100 mL Nitrate 40.1 mg/L Arsenic: 10_005 mg/I Date of sample: L2-_19-05 B. SEPTICIHOLDING TANK DATA Wati Log (Y" Y Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION 12-22-05 rt. 3.5 9.p -m. Other bacteria 0 colonies/100 mL Collected by: Cindy W. Ellis. P.E. Tank Type/Material HDPE septic tank Date installed 1-22-01 Tank size 1000 gal. Number of Compartments 2 Cteanouts (Y/N) Y Foundation cleanout (Y/N) 3 Depression over tank (YM) N High water alarm (YM) NA Date of pumping Jaa 6.2 Pumper DenaliPumping & Excavating C. ABSORPTION FIELD DATA Date installed 1-22-01 Sop rating (g.p.dAe orfe/bdnrr)6.0 System type IDSF Length 30 R. Width 12 ft. Gravel below pipe 0.25 ft. Total depth 3.5 11. ER. absorption area 360 fe Monitoring tube .== Depression over fiekl N Date of adequacy test 12-22-05 Results (Pass/Faiq PASS For 3 bedrooms Fluid depth In absorption field before test 0 in. Water add Bed 16 gal. New depth 0 in. Elapsed Tkne: 0 min. Final fluid depth 0 in. Absorption rate » 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date NA D. LIFT STATION Date instatled 1-22-01 Size in gallons 550 Manhole/Access (YM) Y 'Pump on' level at 19 in. •Pump of ' level et 11_ in. High water alarm level at 23 in. Datum bottom of tank Cycles tested 10+ Meets alarm 6 circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 8V/ 7T ' On adjacent lots 100► Absorption field on tot 102 Public sewer main 100+ Sewer /septic service line 50+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Animal containment areas 100+ Manure/animal excrete storage areas 100+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 11 Property line 11 Absorption field 10 Water main 100+ Water service line 70 Surface water 80• Wells on adjacent lots OX SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO. Property line 10 Building foundation 40 Water main 100+ Water SeMtre one 90* Surface water 55' Driveway, parkingkohicie storage 50+ Curtain drain None Known Mills on adjacent lots 102 F. COMMENTS: Well is located in utility easement - encroachment permit approved `Waiver #000100 approved Dec. 29, 2000. See attached waterer modification request Compressor in garage - rebuilt in 2005 G. ENGINEER'S CERTIFICATION PtQ,....5?F..h " I certf& that I have detem9ned Brough flea inspewons and review of Municipal records that the above systems are in >t' 4911* conlbrrnance with MOA COSA guidelines in effect on fhis date. -"`ll Engineers Printed Name Cindy W Etlls, P.E.Cind` W. Ellis Date Jan. 17.2008 COSA Fee $ 4f 'sl/it Date of Payment Receipt Number (Rev. 11105) Kfd Waiver Fee $ Date of Payment Receipt Number SGS/CTBE ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM IDS ' RIVATrE�yyATER SYSTEM l� Send Rewhs )a Send Invoice wrr sF.N.� ' H5 F �Ci GII 'S y.yy Fa N Bacteriological c. S. LD Cm. SAMPLE COLLECTION: MwM �. Mti.wr.0.1wI01..I.wbsa.m Date: 12 ©z1b5 YmM a0 Y. 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Falc 907.561-5301 Lab Ref No. 1058235 ❑ Send Results 0 Send Invoke W W bywn N�r'CwprN Neu. Ga"�• Iurr Pnw MurWN FaM Bacteriological Water Analysis Record: sur zoc . SAMPLE TYPE: Trensponed to Lab By:IX Same as collector Othen ..w .. TO BE COMPLETED BY LABORATORY Sample Receiving: F Temp: Delivery Method: Received By. Comments: ❑ Sample.over 30 hour old; Rewhs maybe unreliable ❑ 4e Hour Walver For Remote ❑ Routine ❑ Treated Water ❑ Repeat Sample ❑ Untreated Water (refer to lab no. 1 ❑ Special Purpose ❑ RUSH SAMPLE Phone #: ............................................................................................................................................ Bacteriological Water Analysis Record: SenttoADEC: MMO-MUG (PIA) RESULTS: ANC FBK JUN Analysts Began: /LljSA S�IOI� Total Coldorm: Datertlme: Analyst: 7< E Coll: Sent to Client Analytical Method: MEMBRANE FILTER RESULTS: Phoned Q Faxed Direct Count Colonies1100ml. DateMme: Membrane Filter Vedficagw: Spoke with: MMO-MUG (PIA)LTB: -(BGe: Satisfactory Ec: Unsatisfactory TMTC.iee Nwnwwab Ceae Reported By: DaterrIme: 4.24 ;?A — /.2 oe .0e..1� s ur. Form # FW- 0053 12/17/03 lluseslnas01V1NK GroupDatalPubBc1D000MENTTORMS7approvedlColi Form 121703.x19 SCS RtEN 1058235001 Client Name Watkins Engineering Project Name/# The Landings Blk I Lot 10 Client Sample ID The Landings Blk 1 Lot 10 hlatrls Drinking Water PWSID 0 Sample Remarks: All Dates/rimes are Alaska Standard Time Printed Date/time 12/29/2005 11:39 Collected Date/time 12/19/2005 14:15 Received Date/time 12/19/2005 15:00 Technical Director Stephen C. Ede Matala by SCP/MS - Arsenic 5.00 U 5.00 Microbiology Laboratory Total Coliform 0 ug/L EP200.8 C 1222/051227/05 SCL coVIOOmL SM209222B A (<-1) 12/19/05 TLF Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Nitrate -N 0.1000 0.100 mg/L EPA 353.2 B (<-10) 12/19/05 JC Matala by SCP/MS - Arsenic 5.00 U 5.00 Microbiology Laboratory Total Coliform 0 ug/L EP200.8 C 1222/051227/05 SCL coVIOOmL SM209222B A (<-1) 12/19/05 TLF 01/10/2006 17:14 2728738 HILDONEN PAGE 01 \: J v' rri av t ' is . oy o 6N ;5 kq ' ., a,0 o • '.hc?p'`�' .'fR•dME ��r�S,�•;sf Not1�E't , �E ; 6N 'S CALF /,•c 4(1' • 9 't �tr • / /- • <.,./� '^t' .1 : • /t/OTE: ��iSEMBNI'.E•VG2d �. _ 'I, .' � Co�CR,i•� •,klaH aB.lFc 7100 DacUMENT BX 44! • '• s .: ••' off• � •page a 69 V 3. S7i,4AID P.IPC;. AcdrD x 4 JAN, 200(6. 4/1• S KD • .. .. �1. 04.6. -`Qt .; • . • A!1 THE INFORMATION HEREON IS FOR 'THE USE OF' . 9 1 IVY LENDING INSTITUTIONS SPECIFICALLY 70 SHOW ANY CONFLICTS OETWEEN EXISTING STRUCTURES EASEMENTS OF.RECORD. OTHER THAN- ANO -PLATTED LOT UNES OR EASEMENTS AND IS ' .THOSE SHOWN ON THE RECORDED NOT TO BE USEb FOR POSITIONING ADDITIONAL PLAT, ARE NOT SHOWN HEREO �� STRUCTURES OR'FENCEUNES. 'ASBUILT" No Corners set Book pe ria I hereby r:ertey,that I have surveyed the toeowing described proPen Lbt X10 Block ,� �(1, OF A.4q 1%1 .r... 44RD/N6S 4't50, Anchorage reeordlnp district Alaska, and that to i a!y�p•��•• ••a••S�9�I ImOc amOnts situated thereon ere whin the propany.lines and do not overlap or encroach on 49 IM * Ii the property Iying adjacent thereto. tat no Improvements an property lying adie4ant "tato .00 • ••�:•lnt••t••... ••••••••••. :•• eflCrOadt Onthe promises In QUeellOn and that then are no roadways, trenSmIESI0r1lines 0r Other �'i..••..•.`'�:.:.:.: i.�i•..�f vlalON *moments on sold property except a3. indicated hereon. I 'd• ; wnu H,tdonan .TA N. 2 a o 6 �1�oi PFFssioa�t��+~S�+ ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNIC PALITY OF ANCHORAGE AND IZOn ndall THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this 43_�day of 3unapig of2000, by and between _/�0/1 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 (AWWTS),described asTrlfZ(rtliKGff p�i�s lo�catteid+tf at "fkt Law di wets . 6 t L I Let 10 , Anchorage, Alaska. ¢621 LRnQ(inJs Ci�.2 2. Definitions. A. Alteration. Any change to the design or function of an AWWTS 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 AWWTS 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 1z ero — 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 AWWTS Operating Permit is: 4'Yt/L[L6LC C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS arc 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: X0111 /CCirr16 Anchorage: Purchasing Office 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: ✓%-t— Date:7�p STATE OF ALASKA THIRD JUDICIAL DISTRICT MUNICIPALITY: By: Title: Date: ) ss. The foregoing instrument was acknowledged before me thisl,'�2— day of I (L , 20W, by Q.� (� 1 V1 the /Hh .)bf i behalf of the Municipality of Anchorage. N ' o ALA��� ��• F •• mmissionexexpires: S • .Z= '. Fi/BUO �i 41, ... • •V,s ��` Municipality of Anchorage 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.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL SUBMITTAL COMMENT SHEET TO: Cindy Ellis Legal description: The Landings Block 1 Lot 10 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 Inadequate. _ ® Incomplete; missing Pumping date o r- ® Incomplete; missing Monitor Tune o '—� ❑ 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. Need Right -of -Way approvel for well in utility easement. Name of reviewer: TTeeff Date: 1-19-06 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "La Street Room 502 P.O. Boz 196650 Anchorage, AK 99519.6650 www.cf.anchorage.ak.us (907)343-4744 CERTIFICATE OF HEALTH,;AVTHORITY_APPROVAL FORA SINGLE FAKEY`DWELLIlli Parcel I.D.'OaO �-06/— /7 HAA# O / ODS 9 Expiration Date: 1. • GENERAL INFORMATION Complete legal description Lot 10, Block 1, The Landings Subdivision Location (site address•ordirections) 4021 Landings Circle Current Propertyowner(s) Ron Simpson Dayphone 271-5438 Mailing address PO Box 100303, Anchorage, Ak 99510 Lending agency Mailing address Day phone Real Estate Agent Dynamic/Bryan Roit Dayphone 261-7652 Mailing Address 3111 C Street Ste. 100, Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site IKI Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 less than 30 days old. 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. 72025 (Rev. 01.0)' 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 based on procedures outlined in the Health Authority Approval Guidelines fcr the Health Authority Approval application show 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. 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S d S ENGINEERING Name of Firm 17034 Eagle River Loop Road Np.404 Phone 6'I — a A 7 t) Address Eagle River, Alaska 99577 Engineer's Printed Name Robert C. Cowan Date 3/ ILD/ 0;= Anti.. 6. DHHS SIGNATURE JG Approved for_ bedrooms. Disapproved. Conditional approval for Additional Comments ROBERT C. COVIAN �FT CE -8301 ;? -, It;f J... bedrooms, with the following stipulations. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: 9—a — 0/ Expiration Date: S - / Reissue Date: 72 025 (Rev. 01,00)* Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water S Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.andu)rage.ek.us (907) 3437904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 10 131-0W< / THE LA-yoi,v(-1Parcel ID: 02.0 —06/-/7 A. WELL DATA Well type /'R I v rrr tE If A, B, or C provide PWSID # = Well Log 0N) W S Date completed 6 /S/$ I Sanitary seal &N) Y e J Total depth ICI ft. Cased to 40 4 ft. FROM WELL LOG Date of test (c S / -6 I Static water level 31 ft. Well production S g.p.m. WATER SAMPLE RESULTS: Coliform (% oolonies/100 ml. Date of sample: ) ) a 3 1 01 B. SEPTICJHOLDING TANK DATA Wires property protectec&/N) Y-'-' Casing height (above ground) j a + In. AT INSPECTION 1�a3/o/ 6, / 9— p.m- Nitrate 0-y' mg.A. Other bacteria O colonies/100 ml. Collected by: S R 5 ENGINEERING to& Rlnr, Aladw !9577 TankType/Material SEpi'C- /Poj.Yrl-rNyWtNC Tank size 0 0 O gal. Number of Compartments a Foundation cleanout&)YEJ Depression over tank (Y& Ne Date of pumping OW/4 —^' k u Pumper C. ABSORPTION FIELD DATA Date installed 1/3, } /0 Length '30 ft. Soil rating (g.p.dJftr or ft2/bdrm)_0 EX.11 ►a Date installed d/ r/ 0 I Cleanouts 49N) YE I 1 N ✓.} T Iti.AiA� � High water alarm (Y/N) 7 4N K System type I. O • S . $1, ft. Gravel below pipe 0.137 ft. Total depth $"/I ft, Eft. absorption area 3 G 0 fe Monitoring tube Y es Depression over field N G rb JA7 ruM Date of adequacy test N - M i.✓ Results (PasslFail) For 3 bedrooms Fluid depth in absorption field before test _ In. Elapsed Time: _ min. Any 12 mo.) (YIN 8 type) in. T— gal. New depth_ in. Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed I// V/ °/ Size in gallons ti's 0 "Pump on" level at4 � in. "Pump off" level at q b in. Datum -FOP 'A M11� w" Cycles tested a E. SEPARATION DISTANCES SEPARATION DISTANCES FROMVfLL ON LOT TO: Septic tankRift station on lot -13 r� µ ' Absorption field on lot Public sewer main P1 /? Sewer /septic service line Manhola/Access(%4 N) yt J High water alarm level at 36 in. Meets alarm b circuit requirements? * WR000rv0 On adjacent lots On adjacent lots /00 t /00 �t Public sewer manhole/deanoul Holding tank N /A SEPARATION DISTANCES FROM SEPTiCMOLDING TANK ON LOT TO: Building foundation I I Property lineII i Absorption field Water main N /A Water service line 10. t Surface water . 4t - Wells on adjacent lots rV /A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ! O ' Building foundation 10 Water main d �� Water Service line 10 �t Surface water "7S ' Driveway, parkirgivehicie storage S 0 + Curtain drainyo-y c k wo w+v Wells on adjacent lots 10 h/ F. COMMENTS G. ENGINEER'S CERTIFICATION y(P, iSfa 1 car* that I have determined Through Reid inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines /n effect on this date. COWAN " A ROA EXT C• CCi4y'l1 ✓ r p . /a Engineer's Printed Name `�y'� CE -8801 Date HAA Fee $ t Waiver Fee $ Date of Payment 1 Date of Payment Receipt Number Receipt Number (Rev. 12/00) 01-30-01 08:12 LtE FROM -CTE ENVIRONMENTAL 5815301 ME Environmental Services Inc. Laboratory Division rinrJaoFv�nritF� T-494 P.03/03 F-715 200 W. Patter Drive Drinking Water Analysis Report for Total Coliform Bacteria TNA"`I . AK 9 18•1605 READ 43 INS71UCTIONS ON REVERSE SIDE REPOSE COLLECTING SAMPLE Fuc: (8071661.6301 o PUBLIC WATER SYSTEM I.D. N ' f PRIVATE WATRRSYSTLM pr send AM& p smiffspow Eagle River, Alaska 9877 �a O sedaaMa O SeMIfMMein a SAMPLE DATE: 9D �1•+ M Month Day Year SAMPLE TYPE: Ufa Routine G Repeal: Sample (for routine eample withAab ref. no. ) o Special Purpoea SAMPLE LOCATION O Treated Water Unwanted Water Time CoReetad Collected By Antlysia Sfaws this Water SAMPLE to be. 1j Satitiaetory CI Uneatisfactory O Sample over 30 hours old, teaults may be unreliable a Samplt too long in transit: umpie should Rot Le over 48 hours old et examination to i0iate reliable emits. Please send ,•. ne- sample via special de iv ry mail. LOT 10 64-0c f. -rHG (Oa C. ryas. Nw Analytical Metbd:Ffha MMO Mu • Number of coleniear100 ml. Rath* Analyst 101 �q 14 -E_ Fblu Joe ❑ Fated Dau: _ Time: Client FWHed of amaWfaetory resold: 1 a d Spat abn Fated Deet _ Tim - BACTERIOLOGICAL WATER ANALYSIS RECOEID MMO-MUG Kamm Tow California E Can Maabrata P1ttr. Dtnd Cps ColsaMNloa d Verification: LTR 5Gs COLDTRM_ mre-nwft M.grlcn Fee) comer' Coanrm*o Final Membrane `P11u► Rushe Colifferrowtoo W ReportedlyReportedlyY' ? aft Time Vo51�— to Commend: Munba of the ENVIRONMENTAL FACUT1ES IN ALASKA CWFORNIA FLORIDA, IWNOIS, MARYLAND, MiNSOURL NEW JERSEY. ONTO. WEST VIRGINIA Dab Reeelved Tim m Jveas Aatlyda Itepa LOT 10 64-0c f. -rHG (Oa C. ryas. Nw Analytical Metbd:Ffha MMO Mu • Number of coleniear100 ml. Rath* Analyst 101 �q 14 -E_ Fblu Joe ❑ Fated Dau: _ Time: Client FWHed of amaWfaetory resold: 1 a d Spat abn Fated Deet _ Tim - BACTERIOLOGICAL WATER ANALYSIS RECOEID MMO-MUG Kamm Tow California E Can Maabrata P1ttr. Dtnd Cps ColsaMNloa d Verification: LTR 5Gs COLDTRM_ mre-nwft M.grlcn Fee) comer' Coanrm*o Final Membrane `P11u► Rushe Colifferrowtoo W ReportedlyReportedlyY' ? aft Time Vo51�— to Commend: Munba of the ENVIRONMENTAL FACUT1ES IN ALASKA CWFORNIA FLORIDA, IWNOIS, MARYLAND, MiNSOURL NEW JERSEY. ONTO. WEST VIRGINIA 01-30-01 08:21 FROM -CTE ENVIRONMENTAL G . ME Environmental Services Inc. `�rrrrrrrrrrrrrrrii� CT&E Retia 1010414001 Client Name S & S Engineering Project Namda The Land=s Client Sample M Lot 10 Block 1 Matrix Drinking Water Ordered By PWSID 0 Sample Remarks: 5615301 T-494 P.02/03 F-715 Client POI! Printed Date/Time 01/2612001 15:51 Collected Date/time 01/23/2001 14:30 Received Date/Plme 01/232001 15:00 Technical Director �rSte�phen Released By -� eter RemitsRemitsAllowable Prep Analyse Param PQL Units Method Limits Date Date Init Natere Department Nitrate -N 0.500 U 0.500 mg/l. EPA 300.0 Microbiology Laboratory Total Coliform 0 col/100mL SM18 9222B 10 max 01123101 CCP 01/23/01 SKW MUNICIPALITY ANCHORAGE O DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services 44 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 I.D.# r)q0-(7�)LrUl-1-) HAA# 1. GENERAL INFORMATION Complete legal description Lot 10; Btoch 1; The Landings Subdiv.i.aion; Location (site address or directions) 4021 Landings C.i¢cLe Property owner c4umkah04 Day phone Mailing address Lending agency a_AI.A_C_ ATTN, AQMP Kfeven Day phone 562-2181 Mailing address - 406 We.6t Tudo4 Road Anchotaae, Alaska 99503 Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XX Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-02i(R".1L91) Front MOAR21 lz.vow + 8 ndL'.wiao-u •Njom slaaw6ua leuo!ssalad ayl ui suo!ss!wo jo siaja jol alq!suodsaj lou s! a6eio4ouV to Al!ledio!unyy a41 •panssi s! aleo!1!liao a aiolaq elep ozAleue jo suo!loadsui lonpuoo lou opSHHOlosaaAoldw3 sluawaimbaialelspue lerapalu!epao/ys!lesoljapiou!suo!lnl!lsu!6u!pualna41Pue sawo4lo siase4omd of Asaunoo a se s!41 saop SHHO a41-Lmselyto a1e1S a41 ui paials!6ai ja9u!6ua leuo!ssaloid 3uapuadapu! ue Aq anoge S 4dei6end ul uan!6 suo!leluasaidai 041 uodn Aluo paseq sale3!1!v93 IenaddV Al!joylny 411eaH sanss! (SHHO) sao!niaS uewnH Pue 411BOH to luawlieda0 e6ejo4ouV to Al!ledl3!unyy 041 z6 7-77-al Oleo s :suollelnd!is 6u!mollo; eyl yl!m 'swoojpaq b— 'c::oele0 0 sluawwo0 Ieuo!i!ppv Jo; Ienadde leuop puo0 •panaddes!0 swoojpeq £ Jo; panaddV -�?`- 3unIVNJIS SHHO 'S 01 N399 3AYH 1661 `61 n9=oza 03nm 7YAObddY A1R10H1nY Hnm 3H1 d0 SNOI116NOD 3H1 71Y einleu6!s s jaaul6u3 "566 tnSeW78ifff of e3 ssaippv tpz **N pvo8 dool JeAla 0I6ca C£CL L euoyd VNIN33NION3 S 15 wJIj;O eweN •uo!loadsui s!yl;o elep eyl uo loa;la ui suo!leln6ai pue 'saoueu!pio 'sapoo elelS pue Ied!o!uniN pe yl!m eoue!ldwoo ui si walsAs lesods!p jalema;sem jo/pue Alddns Salem ells-uo eyl'uo!loadsu! pue uolle6!isanu! Aw woj; pue sal!; a6ejoyouV;o Al!led!o!unyy eyl ww; pau!elgo uo!lewio;u! O41 uo paseq le4l A;uanjayunl I •u!aiay paleo!pu! ainlonils;o adAl pue swoapaq;o jagwnu eyl jo; elenbape pue Ieuo!loun; 'ales s! welsAs Iesodslp Jelemalsem Jo/pue Alddns jalem eps-uo aLyl 1e43 smogs uo!leo!idde IenaddV AluoylnV ylleaH s!yl;o uo!le6!isanu! Aw leyl ApJOA I 'molaq UMOyS elep uollep!Ien e4110 se pue olaJay paxll;e Ieas Aw Aq pa!;!liao sV 833NIJN3 AS N01103dSNl AO LN3W31VIS 'S MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH b HUMAN SERVICES •y 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 Parcell.D.# mat-1-I(ilnl- 1-1 1. GENERAL INFORMATION HAA # Li G1c11()!�+ I +-j Complete legal description Lot 10; Block 1; The Landings Subdivision Location (site address or directions) 4021 Landings Circle, Anchorage, Alaska Property owner Q rxhn 0,4 r, 1 1 n,kn- Pe Y Day phone Mailing address Lending agency Mailing add Day phone Agent Pat Lester/ROMEQUITY Day phone (510) 246-6538 Address 1855 Gateway Boulevard, Suite 950, P.O. Box 4039, Concord, California 94524-4039 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. T2 -025(A".1/911 front MOA 621 Of row xm (ten •..d) smu *)pom sleaul6uo IeuolssajoJd eyl u! suo!sslwo Jo sioJJa jo; elq!suodsoi IOU si e6eJoyouy jo A1!led!o!unyy elll 'panssl si eieolj!poo a eJojaq eiep ezAleue Jo suo!loodsui lonpuoo IOU op SHHO jo saaAoldw3 •sluawaJ!nbei aleis pue IPJapaj u!Pvao Ajsl3Ps of iepJo u! suollnl!lsul 6u!puel J!ayl pue sawoy jo siaseyoJnd of Asatinoo a se s!yi saoP SHHO 841 •L'4sely jo a1e1S eyl u! paJals!5aJ Jaau!6ua IeuolsseloJd luapuedapu! us Aq enoge g ydziBmd ul uaAl6 suolieluasaidaJ eq; uodn Aluo paseq saleo!j!liaC) IenoJddy iq!Joylny ylteaH senss! (SHH(3) sao!AiaS uewnH pue 141I89H jo lueuivrda4 s6eJoyouy jo /4!!ed!olunw at4i — Z'olta :AS - S3uawwo0 Ieuolllppy S/ ,f d n OJ SUN nogg 7-1/-470-4 muo!3PInd!ls 6ulmolloj eyl yl!m 'swooJpaq Joj IPnoJdde Ieuoll!puo0 v •panoJddes10 /+ `%:00 0 w ^dNp\SS3j0ydo .,..R...V.. r 4.c��s�'i�; �.'•,�"—fit elep -swooJpaq Joj panoJddy 38f3.WNJIS SHHO '9 'dn-Xraaq 6utads zag;e pajji; si Paae t;yoeat otadas ayq punoae Paae 6uZpuod .7agPn aoe;ans ayg uotapu03 ayg UO TPAoadds asanbaE emjeu6ls sla9ul6u3 LZS66 WIselV VaelB e16e3 y'cN peoy oo-jjsARJ of e3 9£OL l ssaJPpb' OuNd QNM33Nlf)N3 S 8 5 wJe j jo GLUVN volloadsul s!14l jo eiep ayl uo loajja u! suolivInBei PUP 'seoueulpJo 'sopoo e3PlS PUP Iedqunw Ile Lipm 60UPIIdwoo ul sl walsAs lesodslp Jalemalsem JO/pue Alddns Jalem ells-uo ayl 'uolloadsul PUP uol3P6llsanul Aw woJj PUP sal!; 06eJ0youy jo ,(j!ledlolunyq eyl way Paulelgo uollPwJojul eyj uo paseq 3ey1/3uaAJat4vnj I •u!aay paleolpul emloruls jo ad/4 pup swooJpaq jo Jagwnu ayl Joj elenbape PUP Ieuolloun j 'e jus sl walsAs lesodslp Jalemalsem JO/PUe /llddns Jalem 9)!s-uo eyl leyl smogs uo!leolldde IenoJddy /l!Joylny gjlvaH slyl jo uollP6llsanul Aw leyl /j!Jan I 'molaq umoys eiep uo!3ep!IBA ayl jo se PUP olaJay paxljje Ives Aw Aq pailpiao sy 1133N[DN3 X113 N01103dSNl d0 LN3W31V.LS 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,o+ (Q-A I MK `-A,,d�< Parcel I.D. A. WELL DATA Well type +� If A, B. or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Drillers 3e�fA' �Tilliu Total depth ' Cased to N O I' Casing height / , t Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Wires properly protected (Y/N) u %, T :�r FROM WELL LOG , 31 y g.p.m. vK SEPARATION DISTANCES FROM WELL TO: AT INSPECTIOI 0w;0NMLNTAk UOP-kt WYItIGN /0-11-91 CCT,311991 RECEI.V Q U. S g.p.m. uK Septic/holding tank on lot * -70-t ; On adjacent lots / 1)O ,+ Absorption field on lot -K R(0, ; On adjacent lots / DO ,t Public sewer main A) /A Public sewer manhole/cleanout Al f Sewer service line 2 6,f Petroleum tank (.7 oNG /Now Al Lk9 Ai V" q t AN ed WATER SAMPLE RESULTS: Coliform t(ISf A c-tQM- NiIrate .4j4-fWtO"N _A214 Other bacteria -zeta Date of sample: (O - b rl Collected by: B. SEPTIC/HOLDING TANK DATA Date installed* - Z f ' 61 Tank size aco s�A Compartments Z Cleanouts (Y/N) 1 Foundation cleanout (Y/N) Depression (Y/N) ►J High water alarm (Y/N) AI Alarm tested (Y/N) PJ Date of pumping f O - f Pumper (a + em mS U '1Ge S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: r Well(s) on lot -70 f- On adjacent lots I n r e) t Foundation to To property line I f-AbsorptionfieldWatermain/se`lrvicelin eD i Surface water/drainage �O �" 1 .rY/1� WAk-;n - 72.026 (Rev. 7191) Fmm CONTINUED ON BACK PAGE C. LIFT STATION Date installed (r( A 1 Manufacturer— 5 Ger T Size in gallons t AL'IM nhole/Access (Y/N) - t Vent (Y/N) "Pump on" level at 'lo. l� ' ` +'Pump off" level at 41 ' High water alarm level - 1.0 Cycles tested 40 Meets MOA electrical codes (Y/N) Lt�f•v�Ktiolu.AiA�M loc.nied or> f7vf'sidc-of"Hci�se_"�., , SEPARATION DISTANCE FROM LIFTSTATION Well on lot =I _'O t On adjacent lots ' (00f Surface water100 rt D. ABSORPTION FIELD DATA Date installed S = Z 1 - 8 ( Soil rating f DD ��$ System type <<o -,fir .A Length- ( WidthLAK Gravel thickness 3•S Total depth Total absorption aiea D I Cleanouts present (Y/N) y Depression over field (Y/N) Date of adequacy test Results (pass/fail) S for 3 bedrooms Peroxide treatment (past 12 months) (Y/N) If yes, give date A)I14 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot G% On adjacent lots (no tt Property line To building foundation, 3S To existing or abandoned system on lot On adjacent lots 'So I' Cutbank_&2 J4 Watermain/service line ( D 4 IV r Surface water _ g ��, Driveway, parking/vehicle storage area 7N 0 4 Curtain drain ►1 �lA !-i✓ W/�wTL `� -iF WIAIVer , gt"OIA,•fed 4- E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on r `of this inspection. OF Am s 1 Signature S 8 S ENGINEERING T age xiver Loop Road No. 204 49TH *�aO ''' , Engineers Nam(Fa leRiver Alaska 99577 " Date IO -30��{ e•010 ��� n1.5 AFEkP.E •A�,/ 1S +�1F�p%iOFESS113% , ac ��i 0.0L HAA Fee $ Z 70' •� Waiver Fee: S - ' Date of Payment Date of Payment Receipt Number 3 /� / g9�lo �� Receipt Number a 3.Ztc'1_ I C1 Flo 72-M (R". 3191) a.ck MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING 3 ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ►NILTSIS REPORT 1T SIMPLE for I13Eordert 79061 Date Report Printed: OCT 10 91 4 15:59 Client Sample ID:L10 11 THE LANDINGS Client Ram PN31D :UI Client Acct Collected OCT 7 91 4 14:15 hrs. EPO E Received OCT 7 91 4 14:70 hzm. Req I Prssezvsd vith :AS REQUIRED Ordered By Analysis Completed :OCT 9 91 Laboratory Supetvls z STIPREN C. EDE Released By : /<:� tzl/ :S L S ENGINEERING :SNSINGP :R. SHAPER Send Reports to: 1)S i S ENGINEERING 2) PO E NONE RECEIVED .................................................................................................................................... Chemlab Ref E: 915172 Lab Smpl ID: 1 Mattis: NITER Parameter Tested Result Units Nethod NITRATI-N ND(O.10) mq/l EPI 757.2 Sample ROUTINE SINTLE COLLECTED IT: R.D.J. Remarks: Allowable Limits 10 .............................................................................................................. 1 Tuts Performed Sao Special Instructions Above Ul-Unavallable ND- None Detected •• See Sample Remarks Above El- Not Analyzed LT -Less Than. CT -Greater Than r2A SGS Member of the SGS Group (Soci6t6 GAn6rale do Surveillance) i CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562.2343 ! 5633 8 Street Anchorage. Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. 1t A PRIVATE WATER SYSTEM A+nr PAw. ho. S $ 5 ENGINEERING M.g A"m rIi034 Ea.le River Loop Road No.204 ]Eagle River, Alaska 99577 Cor 5uw ZP Coo. SAMPLE DATE: Mo. SAMPLE TYPE: F( -)—F7] 1---11-!-1 Day Year 4i.Roullne ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory /O Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received /C)'e�°ll Time Received 1430 Analytical Method: Membrane Filter • No. cl colonies1100 ml. SAMPLE Time Collected Lab Ref. No. Result* No. LOCATION Collected Dy 2 I m 3 ► u m 4� I u m r; r% r �( READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LSD BGC Fecal Coliform Confirmation Analyst ColiforrN100 ml Final Llembrane Filter Results Coliform/100 ml Reported Dy Date lo, g�q (630 TNTC = Too Numerous To Count a•m• p.m. PART ONE OF TWO OB = Other Bacteria REMAINDER. TO FOLLOW HEALTH AUTHORITY APPROVALS SEWERS WATER MAIN EXTENSIONS SEWERS WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION t FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURALS MECHANICAL INSPECTIONS ADEQUACY TEST FORM LEGAL DESCRIPTION: APPLICANT: �11I�JL-nl DATE OF TEST: NUMBER OF BEDROOMS: SEPTIC TANK SIZE: tip TYPE OF ABSORPTION SYSTEM: ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVILENGINEERS (907) 694-2979 FAX 694.1211 TIME METER READING TOTAL VOL. (Gal.) LIQUID LEVEL COMMENTS S.T. M.T. M.T. o IV W 0,1011 511 -1) 2 183 5o`i�1 o Vol 00 2 y1 V4 M:ter.• ••. e.l�A� RESULTS: /�/ �a`r••�Y�T' ra°a . c P ONSITE I WASTEWATER OISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH ��— -7 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL L�t3 OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 6 I/A /8 7 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lor to Bir 1 T c mp,Ngs- 5z j I) N 23Q Location (address or directions) (b) Applicant Name w Me Et. 1P r Telephone: Home 16:5:736d Business Applicant Address :24o, ta-6 j'.ttnS C.*ee f e (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderAT; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone - --- Address (e) Real Estate Company and Agent Address ;. Telephone 277�� to 'tom (f) Mail the HAA to the following address:.'- T'I, `t"1 I //I 2. TYPE OF RESIDENCE Single -Family Multi -Family de Other Number of Bedrooms v Z 3. WATER SUPPLY Individual Well.0, Community ❑ Public ❑ Note: If communitywell system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DJSPOSAL Onsitexl/ 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 n-029 (1 1194) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, 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 .1 • r+ti2L)T 1 Y LOVI 1 " �na Y Telephone 344- • a4 % 1 1 Address _,c ii;L 7 0 s ii �JY� r2 e-'- 99 S f 8 Date . 124 Jjy:J NATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria in a sample of that water. No warantee ooe,, or certification is expressed or implied concerning the long term a�t�� .•'' ''• ; LJ3 adequacy or safety of the water supply. 6 ,e ' , '•; •i 0 ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval 0" a a inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day NUL H THonNc ` CL1 as'determined by methods approved by the Municipality of Anchorage Q 6;.,• CE. 4369 Department of Health and Human Services. No warantee or �4 rra;.''•......' 4, vJq certification is expressed or implied concerning the long tens ��4aoeuu��oa adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. 6. DHEP APPROVAL Approved for - tAece-Ca edrooms by `Q �'"` Date Approved Disapproved Conditional Terms of Conditional Approval r 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 engineer's work. Page 2 of 2 72-025 m/84t ....... .... .. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) Of ANCNOmGE CHECKLIST - FEBRUARY 1984 MuNSERVICESClVI510N ICIPP.L11'f 284-4720 �i Ep(VIRONI�ENTAL 1 198 Legal Description: L.ZLo . -0r-oe ✓ (�ibJ 1 �NSt j13L 53 T1f N , �saJ A. WELL DATA EC�11�l`' Ep Well Classification PKIxIA rE I1 A. B, C, D.E.C. Approved (Y/N) AJJA 10 IN �M Well Log Present (Y/N) Y Date Completed G — — 8 I Yield 7 B7 J Total Depth SI Cased to 40 Depth of Grouting NIA Static Water Level -I I ' Pump Set At UN r"a"7N Casing Height Above Ground $� Sanitary Seat on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on Lot 9f'e� ; On Adjoining Lots > too To Nearest Public Sewer Line .4J /A To Nearest Public Sewer Cleanout/Manhole A� ]A To Nearest Sewer Service Line on Lot ' 30 Water Sample Collected by M N ; Date G AM 4 /87 .-v Water Sample Test Results r aw.a t S NOS • NO�D Comments SE6 5, "DJEAPIC 1JAr✓iEC .N<M0 B. SEPTIC/HOLDING TANK DATA Date Installed Size 1 000 No. of Compartments 2 Standpipes (Y/N) Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped I -,a& -A6 Pumping/Maintenance Contract on File (Y/N) NJ4 •; for Holding Tank High -Water Alarm (Y/N) NSA Temporary Holding Tank Permit (Y/N) N 1A Separation Distances from Septic/Holding Tank J. To Water -Supply Well To Building Foundation 10 To Property Line �� �4 To Disposal Field To Water Main/Service Line 3D �1" To Stream, Pond, Lake, or Major Drainage Course NIA Comments Page 1 of 2 72-026111;641 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata too Type of System Design Te vic>a Date Installed S — a I — 8 f Length of Field 43 r Width of Field tJH icAl641N Depth of Field S Gravel Bed Thickness S-§ Square Feet of Absorption Area Rob Standpipes Present (YIN) —� Depression over Field (Y/N) NI Date of Last Adequacy Test G -2 b - RG Results of Last Adequacy Test 9 - 3 8 DE'M Separation Distance from Absorption Field To Water -Supply Well 96 ',X' To Property Line i .S I i To Building Foundation —35' To Existing or Abandoned System on Lot M> N C ; On Adjoining Lots 30 1+ To Water Main/Service Line 30 To Cutbank (if present) AJ/A To Stream/Pond/Lake/or Major Drainage Course A/ 1A To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed t y__Z 1 ! `Lit Dimensions � �- Size in Gallons 2S !b Manhole/Access (Y/N) "Pump On" Level at 0 A "Pump Off' Level at Q, High Water Alarm Level at - - Vent (Y/N) Y Tested for - 1 Ib Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) i Comments A't� w(. �•..� o»/y ... S .�4.:2. J?tco.•a••.�.�oQ 141..-s /,W71- '7-7-8 Check Permitted Bedroom Rating Against HAA Request •• I certify that l v c ck d, erifie , r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date G/1--7 �11 Company Mx,kj i-",, ,a MOA No. CTI' Al Receipt No. �U / U U / s�Q•� •' n Date of Payment r T 7J W Amount: $/�� �— V % "' e, • CE -4369 Page 2 of 2 72026 (11,841 tom. n CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 5622343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIERII TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM I.D.M 9 Address City SYSTEM State Phone No. SAMPLE DATE:® ® M Mo. Day Year Zip Code ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. 1 ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO. LOCATION Collected By 1 1 L-10 8 ( The I.LI► Ibiy iSIy.arl unlui 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analysis shows this Water SAMPLE to be. t Satisfactory ❑ Unsatisfactory ❑ Sample too long In transit; sample should not be over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mall. Date Received 4 - 7,-S � Time Received A. 0 Analytical Method: Membrane Filter No. of colonie f1lXl ml. e Lab Ref. No. Result' Analyst Mo ME on so on BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Collform1100ml Verification: LTB -BGB Final Membrens FI l `alts O Collforrn/100m1 Reported By e=Vale O64CA2 Time: EXU a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria i CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. t _ 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID 9 92-0040440 ANALYSIS REPORT BY SAMPLE Client PO# : N/A Req #: Client Smpl ID: L10 B-1 THE LANDINGS Sam..ple Pec'd : Mi 25 87 Ordered By : N. HA.THOPNE Send Reports To: f1EILHAWI'HOFNEPE 7127 OLD SEMRD HWt ANCHORAGE. U. 99518 Special ROUTINE SAMPLE BY NEIL HAWTHORNE6-24-87fl 1820 HRS Instruct: OUTSIDE SPIGOT Chemlab Ref 0: 6720 Lab Smpi ID: 1 Parameter Tested ----------------------------- NITRATE-11 Sample Remarks: {fork Order No. : 1324 Cl lent Account : HA:THOT Date Repert Printed: JUN 30 67 9 11:49 Released By : SCE �l v Reports Address 12 NEIL P.ANTHORNB 7172 CLD SEG'ARL ANCHORAGE. AE.. . . Matrix: Vater Allowable Fesult/Units Method Limits ------------------------------------------------ NVO. I) mr,11 10 I Tests Performed * See Special InstructicnsAbove ND= None Detected .* See Sample Remarks Above NA= Not Analyzed LT=Less Than, CT -Greater Than CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FEDERAL TAX ID M 924MO440 AIIALYSIS REPORT BY SAMPLE Cl lent FGA : WA Req s: Cl lent Smpl ID: L10 B-1 THE LANDINGS Sample Recd : JUN 25 67 Ordered By : N. HAWTHORNE Send Reports To: NEIL HA THORNEPE 7127 OLD SEWARD HWY ANCHORAGE, AK. 99518 Special ROUTINE SAMPLE BY NEIL HAI,TF.ORIIE6-24-8721620 HRS Instruct: OUTSIDE SPIGOT Chemlab P.ef s: 6720 Parameter Tested --------------- TOTAL COLIFORn Sad e Remarks: Lab Smpl ID: 2 Matrix: Water Resiit/Onits ---------------------- 0 col/100ml 1 Tests Performed • See Special InstructionsAbove NO- None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, CT -Greater Than Work Order No. : 1324 Cl lent Account : PAWTHOT Date Report Printed: JUN 30 E7 9 11:50 Released By : SCE'<L Reports Address s2 NEIL HA.T90711E 7172 OLD SLWARD ANCHORAGE, AK. Method Allocable Limits r -- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date % Z9 A i 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lto t Ile L!�=„J'.t S4 TIt At /23w Location (address or directions) /7 (b) Applicant Name M _ Ewe me� 7 Ill Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 0; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Real Estate Company and Agent b I& X Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ;5 Community ❑ Public ❑ Telephone 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 Onsiter 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 72.025 111.84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. 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 AY,:a f 2 1L t! O rt p— E — Telephone 34-4 4-7 11 Address i 1 2% 0 .S Nwy 9.9 S/S Date i /9 /P6" WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria in a sample of that water. ito warantee rrc:aggll, or certification is expressed or implied concerning the long term -o', adequacy or safety of the water supply. �� •'••�•• :l f Ott -SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Appp inspection merely certifies that the subject on-site sewage disposra •E system accepted at least 150 gallons of water per bedroom pei� day as determined by methods approved by the Municipality of AnchQi'a'fe Nt,L , •VT cn*4=: Department of Health and Human Services. No warantee GQ EP;,•, CE A369 �•`� certification is expressed or implied concerning the long t� sP��'•.,,,,,,.•'�F',a adequacy of the on-site sewage disposal system. Construction data�m`1?,r; reported on buried system components is from MOA files and was L��•4�^� not verified during this inspection. 6. DHEPAPPROVAL Approved for bedrooms by �� -4 i1 °'^-'° Date Approved 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 engineer's work. Page 2 of 2 72-025 ill/64) MuN, ICIPALITY OF ANCHOBAG: f^ DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIfONA1ENTAl PROTECTION HEALTH AUTHORITY APPROVAL (HAA) -: U I 10 Gffi CHECKLIST - FEBRUARY 11)84 26111-4720 $EFEIVED .Legal Description: L 1 O S4 TfI Al Je3(A) A. WELL DATA Well Classification &II& -e If A. B, C. D.E.C. Approved (Y/N) Well Log Present (Y/N) —x— Date Completed & — e I Yield Total Depth Si , Cased to > Ao Depth of Grouting Static Water Level !?I " Pump Set At Un F k% Casing Height Above Ground 16 Sanitary Seat on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Separation Distances from Well: of i To Septic/Holding Tank on Lot I On Adjoining Lots l00 4 � b.,t.•ivwr � To Nearest Edge of Absorption Field on Lot 9G Z ; On Adjoining Lots 106 4 - To To Nearest Public Sewer Line AIA To Nearest Public Sewer 0 Cleanout/Manhole Az JA To Nearest Sewer Service Line on Lot _so t Water Sample Collected by �� s �- ;Date /2 [ �8L Water Sample Test Results $ Comments B. SEPTIC/HOLDING TANK DATA Date Installed S f g) Size 1 0 00 No. of Compartments x Standpipes (Y/N) Y Air -tight Caps (Y/N) i� Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) N/A. ; for Holding Tank High -Water Alarm (Y/N) AeM Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank J To Water -Supply Well 71 w� To Building Foundation �p i To Property Line /o ; To Disposal Field l., i To Water Main/Service Line .10 To Stream, Pond, Lake, or Major Drainage Course A) Comments Page 1 of 2 72-026(11,84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata foo Type of System Design Tri r+ Date Installed .1-/R I Length of Field 4.1 Width of Field Depth of Field Gravel Bed Thickness It Square Feet of Absorption Area 30 Standpipes Present(Y/N) Depression over Field (Y/N) AJ Date of Last Adequacy Test % Results of Last Adequacy Test —et:A� ;:ii, M Separation Distance from Absorption Field y, To Water -Supply Well 9% L To Property Line /D �► To Building Foundation —2O 114- To Existing or Abandoned System on Lot ;i,/ Z/2 ; On Adjoining Lots Te 14- To +To Water Main/Service Line To Cutbank (if present)V14 fw r�eL�3 t? To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed' Dimensions Size in Gallons „? Manhole/Access (Y/N) y "Pump On" Level at 0 8 "Pump Off' Level at i High Water Alarm Level at 1 - D Vent (Y/N) _Y Tested for _> Jo Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N)AaDr�cey.a! Comments Y Check Permitted Bedroom Rating Against HAA Request** Icertify thcegce/,ver d, or conformed to all MOAand HAA guidelines in effect on the date of this inspection Signed; (Lei/ Date Company f MOA No. e�OF AL9�@ a p s . .•••....../%� Receipt No. �Q �) t4 U Q.� . • •,�!�- t Date of Payment -7' 1 0'cK(p a• � � : ^ _': ­ 0 p x � Amount: $ �� ��� 'Eh Se*AI G- ...:� Page 2 of 2 72-026 (11,84) I. HCIL HAW O4N= CE -4369 vL NY.....•• • F^ �14\.P o 12' NHAWTHORNE-ENGINEERING 7127 OLD SEWARD HIGHWAY ANCHORAGE. ALASKA 99502 907-344-4711 y- S+e ✓e �orrl S / ' 0 A ,) H H S MUNICIPALITY O OF ANCHORAGE DEPT. OF HEALTH b ENVIRONMENTAL PROTECTION x (0 6 So AUG 71986 �J„eh /44- 9 -95 --oz RECEIVED r ver i X&-- o -% Sf-eve; �ja✓G insfeeied' 4he Se q-17; �aL✓)4 ctnd C,i� jr�aZ�ior� ec►-lne%'JIoNS As i, t StP �,c -tan k % hey cert' ,n goce !r )A Cpv� 1� s �(,�JG✓G c,15e t. �✓1 G /Cf �' R Gi ✓ Q Z e 11, 4 reLL e r e S 0 L �S 7t e+le -t-ems 0.�J< Sh C e ee/Y n n CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA.. INC. \ ANCHORAGE INDUSTRIAL CENTER 6637 8 STREET ANCHORAGE- ALASKA 99510 TELEPHONE MM 562-7343 J: OV40Y (W.1 fm V21;Le1C+�] Q.= Neil Hawthorne CL= P. O. # ' ADDRESS 7127 Old Seward Highway SAMPIFS RD==:7-24-86 -Anchorage. AK SAMPIFS OMTE)=: ' }fit ¢7>s'1ZCN To: Daniel J. Bacon ANAI=., 7-25-86 Mr= BY: Stephen C. Ede IAB SAM= NO. 8627 CLIESlP SAMPLE'I:D.: MATRI* Water MEMM: EPA 600/4-79-020 Method 352.1 Sample Identification (1) Int 7 The Landings (2) Lot 10 The Iaridings (3) Bois Int 156A MID= SAMPIE,4 WILL BE HELD UNM: Not held Nitrate-::, mg/l ND (0.10) �D (0.10) 0.89 ND - NCHE E 'ZD= DEI£CPICN Lim= ni ( ) INVOICE'# ' .5F175 j� TEST PIT WORK ORDER A/939S A' LOGGED BY O. Na it A TEST DOEPTH RESULTS SAMPLES ELEVATION, N E DEPTH �f?► Brown Pen{' mol'si,soil I NII grown SM M4 S; v/ •/rata non-P/as/lc '?ravalj moisf� densQ- 2 -2.:•• 1 3 �) grownis% _gray irmvrf� 4"k�e Eo « arse—s4nd—occafrblr-3—ia revnded 4o Subrovnded 4 :5 P. 5 t f6 8 ..10 I ^. y- erroynd Waler level 80/10 of Ter,<BY. Lard 7 -?9 -So 11 Tesi M duo 8-80 12 13 TEST KEY: W • MOISTURE CONTENT LL & LIQUID LIMIT PL • PLASTIC LIMIT MA• MECHANICAL ANALYSIS LOG OF TEST PIT FIGURE 2. ♦ fit' •!o>° M \e°J •$ •r;: •E •J JJ '� � . got pcp ♦ (. / I to w •cb "i tj� o� \♦ , �L � - w G � o \\ j w f �et PI { \ e 1{ 192, IN S S,03122' W p+10 q� •;••�•••• ' b-• i i I ��.\. `i •\ y��01' � '• •' I • J� /•��• a 00 .356 ir � ? 7°' � ♦6, _�� 'i �:.. ',:..I . . � I �.., / .../=♦qui♦ 0?� `\ B , / s \ o s 10 o�\ �• o J l E1w1. °o S •10 Naar u e G\`G0 41 •� 10 N ♦♦ t � e'♦ � f0 k. L OC oN of TE 0 T PIT.. , l APPLIrNT FILLS OUT UPPER HAIL' ONLY 'Poe, qY Owner . Cr0 NS7`yl t/C Y/ /.• y Al / /✓ y '� �' S Phone ^r Mailing Address/� /( P-0/' 2_C' r-, O 41.,&4U// A --e - X-- Zip Code C 9 13,Vv- o Buyer �r0 `P•[7' r/ GV/cf sr /1c. C -:- Address Zip Code Lending Institution /7 L /4 Uf 41 A 4- Intone �'/✓ j3 n .C,✓ d it Address Zip Code Date Really Co. & Agent //// y p r /'r.P 4 f— Y y Phone Address S l[ no X 2- d G u ,& ea; / Zip Code c r' r _ 0t`i Legal Description Street Location A /v Type of Residence Single Family O Multiple Family No. of Bedrooms_ ❑ Other Water Supply t� -Individual D �Q'�/jt(. /gyp i.Ccb . H WELL LOG. A well log Is required for all wells drilled since June 1975. [Falls O Community trilled prior to that date, pros well depth (attach log If available). O Public Utlllty OFANCHOPAGE ��JW-rye h+N' Sewer Disposal c1 . 1 G I Individual E�OaSy LL`SI 6-1-91 Year Individual Installed: .C,cf� ? /�� � � ��• etc✓cam ❑ Public Utility When Connected to Public Utility: - ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time A Date Date Date Date Inspector Inspector Inspector Inspect �a rlJ. Field Notes: G } 6` OFANCHOPAGE ��JW-rye h+N' MUNICIPALITY OFeT C` I1 --".TA R L lu ENVIRJI1.:ct.:A_ l..O.EUION (:O\l 5 1982 ( `J) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' f / DATE BY: ( .� Solis Rating Date Sewer Installed Well To Absorption Area (DO Well Log Received 4/0 Septic Tank Size (b LDo 5-st I Well to Tank I D