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HomeMy WebLinkAboutT15N R1W SEC 8 LT 93Onsite File S r � ....... uO NnV 1 M7, Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 J �y�'., _.,Page �J j�of ON-SITE WASTEWATER INSPECTION REPOR .6 Permit Number: OSP171335 PID Number: 051-151-15 ��� A`' `` Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑-N 0 Upgrade Name: Neil & Sherri Collins ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑■ Bed ❑ Mound Address 27642 S. 4440 Rd., Vinita, OK 74301 ❑ Other Phone Number of Bedrooms Satt Retia Total depth from original grade 231-1159 4E 3.42 Ft. LEGAL DESCRIPTION Dep invert from original grade Gra Fd th beneath pipe Subdivision Block Lot Lot 93 Fill added above original grade Grav 1.84 Ft. t. Township Range Section T15N, R1 W, Section 8 r Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches --Dist. between trenches From Tank Field Tank Line Ft' t. Well >100' >25' TANK X Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 11500 Gal. Surface Water >100, Material Steel Number of compartments 2 Lot Line >10' NA Foundation >10' LIFT STATION Manufacturer Capacity Curtain Drain NA Gal. 2 Iseptic tank; " ' Remarksnsulation installed over se Pump on level at in. Pump off level at in. High water alarm at in. 1.5'-2' add'I soil cover added to drainfield. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Tank to D3034 drainfield Installer Northern Excavation & Construction Drainfield CO/MT Inspector Tyler Perron - Alaska Rim Engineering BENCHMARK (Assumed elevation)100 ft Inspeectionction 1s` 11/8/17 11/13/17 Location and description 2M 3rd 4t+ Concrete fnd apron, 2.4' from NW dwelling corner. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL OF A�q�l1 Conditional Approval: Date P.��.......�.gs.�e�'/' co. ;9 9TH :.......IlG l[ .Y.. .. . ' Mar. Shreves Approved f ( Date I a 01 1 �1 I� J'j.'•.�� CE 9351 �#8111 ROFESSI ` lt\\\\\ /I/,/ Inspection Report_9-1-12.doc I Scale 1" = 50' 5 COs (EXISTING)` 30'x34.5' BED SOIL ABSORPTION SYSTEM (EXISTING) SWING TIES C06 C07 F.G. 97.64' A B FCO 26.3' 19.4' CO 2 66.2' 44.4' CO 3 102.9' 77.1' DBL CO 4 114.5' 86.3' DBL CO 5 115.6' 1 87.3' ST 1 117.8' 89.1' ST 2 127.4' 97.3' DBL CO 6 /1500 GALLON STEEL SYSTEM DBL CO 7 130.3' 99.8' NOTE: — COs 4,5,6,7 ARE NEW. — REPAIRS WERE MADE TO THE EXISTING FCO, ABSORPTION FIELD COs, AND MTs. — ALL ARE IN THEIR ORIGINAL LOCATIONS. — CO2 & CO3 ARE UNCHANGED. 4" PVC PRIOR TO SEPTIC TANK of ALq�ii�i i gTH010 � z 0i .. Mary Lhreves ��j��ct> ••, CE 9351 •: ����+ 1PROFESS``®�1' +,Or talo // // q1 I 10' MIN. r/--rB- COC01 t ­U1L1_lrvt WLLL RADIUS WEL (WELL IS IN ST NDBY MODE SEE LETTER DATEq APRIL 1, 1994; SHED THIS PROPERTY S RUED BY WELL o LOCATED ON LOT 92) co 10' MIN. — 5 SOIL COVER +2" INSULATION CAPPED VENTS F.G. 96.27' l� X03 COS G. 95.9 C06 C07 F.G. 97.64' Ci D O.G. 95.80' Z EL 93.71' 0 O X M N M A G M DOUBLE—SWEEP D iCOs 6&7 1500 -GAL I.E. m ABSORPTION 93.12' K /1500 GALLON STEEL SYSTEM z / SEPTIC TANK / � CO3 / \ \ CO2 \ DOUBLE—SWEEPSC COs 4&5 / �Ffi�C�F FCO / c A BM=100' (2.4' FROM CORNER; X CONCRETE FNDN APRON) B / I DWELLING 55.8' ­U1L1_lrvt WLLL RADIUS WEL (WELL IS IN ST NDBY MODE SEE LETTER DATEq APRIL 1, 1994; SHED THIS PROPERTY S RUED BY WELL o LOCATED ON LOT 92) co 10' MIN. — 5 SOIL COVER +2" INSULATION CAPPED VENTS F.G. 96.27' l� X03 COS G. 95.9 C06 C07 F.G. 97.64' O.G. 95.80' EL 93.71' SOIL I.E. 1500 -GAL I.E. ABSORPTION 93.12' SEPTIC TANK 92.96' SYSTEM WATERTIGHT EL. 88.88' COUPLERS (EXISTING) L4 L, Ln ON INLET AND OUTLET 4" PVC AT UNIFORM SLOPE OF SEPTIC TANK BETWEEN SEPTIC TANK AND SAS MIN. SLOPE -2R (Y4" PER FOOT) SEPTIC SYSTEM PROFILE Conventional Single Family Residential SEPTIC SYSTEM DESIGN DWG. LEGAL DESCRIPTION Lot 93, Sec (20320 Scenic Scaled As Shown ALASKA RIM ENGINEERING, INC. 8, T15N, R1W Drive, Chugiak) W0: 17-00741 DATDF 11 /14/17 SHEET 1 OF 1 v�,"PA`lrr MUNICIPALITY OF ANCHORAGE On-Site Water& Wastewater Program PO Box 196650 4700 Elmore Road • Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax: (907)343-7997 httpalwww.muni.orglonsite 11411111 NM C HOP pVt On-Site Wastewater Disposal System Permit Permit Number: OSP171335 Effective Date: 11/1/2017 Work Type: SepticTank Upgrade Expiration Date: 11/1/2018 Tax Code Number: 05115115000 Site Legal Address: T15N R1W SEC 8 LT 93 G:1257 Site Mailing Address: 20320 SCENIC DR, Chugiak Owner: COLLINS NEAL A& SHERRI L Lot Size in Sq Ft: 108900 Design Engineer: ALASKA RIM ENGINEERING Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Il Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing ptije.60.ALJU,Ar IrReceived By: � Date: / U 7 Issued By: Date: ifIto 7 MUNICIPALITY OF ANCHORAGE . \ t I T Community Development Department #r„., Phone: •.7 .•3-790• '<-) Development Services Division Fax• :0 ''51- _. On-Site Water& Wastewater Program OCT 3 0 2017 ON-SITE SEWER/WELL PERMIT APPLICATION �Q 7, Parcel I.D. 051-151-15 `t Or 6 8 L Property owner(s) Neal & Sherri Collins Day phone 231-1159 Mailing address 27642 S. 4440 Rd, Vinita, OK 74301 Site address 20320 Scenic Drive, Chugiak Legal description (Sub'd., Block & Lot) Lot 93 Legal description (Township, Range & Section) T15N, R1 W, Sec 8 Lot Size 108,900 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ' 1 l tz i., ti ./ /' -------- '1 �1 (Signature of property moiler or authorized agent) Permit/Rush Fees: a5 —/ Waiver Fees: Date of Payment: Io/ 3o/1 Date of Payment: Receipt Number: aa4_I I Receipt Number: Permit No. OSe ll 1336 Waiver No. Permit App_:.: ::..c ALASKA RIM ENGINEERING, INC. ENGINEERS—PLANNERS—SURVEYORS r 9131 E. Frontage Road Palmer,Alaska 99645 Telephone(907)745-0222 Fax(907)746-0222 Online at: www.alaskarim.com October 26, 2017 Municipality of Anchorage, D.S.D., On-Site Water and Wastewater Department 4700 Elmore Road Anchorage, AK 99519 Re: Lot 93, T15N, R1 W, Section 8 Septic Tank Replacement ARE Project No. 1700741 The subject property is served by a well and a septic system. The well is shared with the adjacent lot, Lot 92, with an approved Water and Well Agreement, dated 7/31/93 (see attached). There is a single-family dwelling on the lot. Our firm conducted a septic adequacy test on this septic system. The septic drainfield passed the test and does not require replacement; however, the septic tank failed the test and will be removed and replaced. This design narrative addresses the septic tank replacement. Also, during the adequacy test, the five cleanouts in the septic bed were noted to have become disconnected from the subsurface pert pipes, and the foundation cleanout was noted to be damaged. We are proposing repairs to all the cleanouts as well. The design narrative is summarized as follows: GENERAL SITE PLAN AND SEPARATIONS: All surrounding properties are served by onsite wells and septic systems. The proposed replacement septic tank will be installed in the same location as the existing tank therefore all required setbacks to surrounding wells are satisfied. There are no surface waters within 100' of the proposed replacement septic tank. There are no wells within 100 feet of the proposed replacement septic tank. Even though this lot is served by the well on Lot 92, there is an onsite well on Lot 93. Included with this report is a letter dated April 1, 1994, by David Dayton, P.E., addressing this onsite well. He states the well is in "standby mode and could be re-connected although it is a low producing well". During the adequacy test, our field technician noted this well is capped with a welded steel cap. The replacement septic tank will be installed outside the 100 ft well protection radius(see attached, Replacement Septic Tank Design drawing). SEPTIC TANK DESIGN: The proposed septic tank will consist of a 1,500-gallon Anchorage Tank septic tank (see attached, Anchorage Tank septic tank information). A benchmark was established on the concrete apron along the foundation of the existing dwelling, elevation 100 ft(see attached, Site Plan). The IE's of the tank inlet and outlet are shown on the Site Plan drawing. These are established based on the elevation of 92.6 ft of the bottom of the existing septic tank. The outlet line from the new septic tank will be connected to the existing sewerline and two opposing cleanouts will be installed between the septic tank and the drainfield. The existing septic tank will be excavated and removed from the site. CLEANOUTS REPAIR; ADEQUATE COVER: Our technician also noted that the cleanout pipes in the drainfield have become disconnected from the pert pipe in the drainfield. We are proposing to excavate and re-attach the cleanouts to the drainfield pert pipes. Also, the FCO appeared to be damaged and will also be replaced. T 15N, R 1 W, Section 8, Lot 93 Page 2 of 2 Septic Tank Replacement Proposal October 26,2017 Also, it was noted there are areas over the septic drainfield and septic tank that lack adequate cover. Additional material will be added to achieve adequate cover, and will be reported with the as built documentation. The proposed septic tank will not adversely affect the surrounding properties. If you have any questions, please contact me at 907-745-0222 or at marvs@alaskarim.com. Sincerely, ALASKA RIM ENGINEERING, INC. /'// /1(J(/17 /��--- ��•' O F At 'hi ? 0) •gs'r9 Mary L. Shreves, P.E.Senior Engineer Attachments: ' "• ' 9 • MOA Fee Sheet �j'e Mary hreves • MOA Onsite Permit Application form �'��'•.�• CE 9351 • MOA Plan Public Inquiry iry Parcel Details �� ;i HpFESS��N;����+ drawing• Site 1111M1 • Surrounding Wells drawing /OI �'�f 7 • Anchorage Tank septic tanks information sheet • Water and Well Agreement, dated 7/31/93 • Letter, David Dayton, dated 4/1/94 7 8. A Z N 73a sEA Nm A DOUBLE-SWEEP rnA. COs (PROPOSED) A s 1500 GALLON STEEL z SEPTIC TANK (PROPOSED) -•REPAIR 5 CO3 f (PROPOSED) �� \= CO3 u 04 I05 CO2 7 30'x34.5' BED SOIL ABSORPTION SYSTEM /rF sF,��� REPAIR FCC (EXISTING) / �.���' (PROPOSE' BM 100' / \ (2.4' FRAM CORNERS ' CONCRETE FNDN APRON) DWELLING 55.8' _ 1 / V II 100' PROTECTIVE WELL RADIUS e WEL (WELL IS IN ST NDBY MODE I SEE LETTER DATE APRIL 1, 1994; SHED THIS PROPERTY 5 RVED BY WELL b LOCATED 0 LOT 92) / to \ m \ / I / -- 10' MIN. -•- -10' MIN. - ADM'IONAL COVER TO BE ADDED OVER BM-100' SEPTC TANK TO ACHIEVE >4' OF COVER. C01, CAPPED VENTS •�� i TO BE REPAIRED /f C04 k C05, El / PROPOSED CO? CO3 G. 99.7 n I O.G. 99.52' +p y sk, L 97.43'_ SOIL I.E. 1500-GAL I.E. ABSORPTION 4. PVC 96.65' SEPTIC TANK 96.68' 1\s-, (EXISTING) IN EL. 92.6' 1\ i PRIOR TO SEPTIC TANK WATERTIGHT COUPLERS 4' PVC AT uNIFORM SLOPE ON INLET AND OUTLET BETWEEN SEPTIC TANK AND SAS Of SEPTIC TANK MIN. SLOPE-2% p'4" PER FOOT) - . SEPTIC SYSTEM PROFILE U. , �•�`��‘oF�A'ii�ir Conventional Single Family Residential �P`�--•'"-•1Aswr � SEPTIC SYSTEM DESIGN DWG . LEGAL *i49 TH OF * ow oeSCRI nON ii....iF 1 = r Tt Lot 93, Sec. 8, T15N, R1W 4. fir„: Mary~•.•Shreves • ¢ C� y lr r 04, �'.• CE 9351 �'�� (20320 Scenic Drive, Chugiak) V iF,rj '•• ••••�$sr ,rlfii1iR0FESS\C3%, � //J Scale 1" = 50' WO: 17-00741 ,�, �00 I DESIGN COMPLETED ALASKA RIA! ENGINEERING, INC. DATE 10/30/17 DATE SHEET 1 OF 2 Anchorage Live Page 1 of 2 Anchorage L i v e" Search by Owner Name or Address 20320 SCENIC DR -COLLINS NEAL A&SHERRI L Reap L________ ___ --------- r 100' 0 RADIUS LT 84B L APPROX LOCATION 100' SEPTIC SYSTEM _40 U 1 0. 7'`3 . .IM 0 100' `� RADIUS \, /,......: LT 94 LT 93 LT 9. LT 116A LT 15B 1 C_in rg.o c,, Mapd.l.4a About Parcel Details 1 Privacy Disclaimer Opt Out SURROUNDING WELLS T15N R1W SEC 8 LT 93(Residential Property) Tax ID:05115115 Site 20320 SCENIC DR Address: Square 108900(2.5 Acres) Drainage: GOOD Footage: Zoning: R6 Grade to EVEN Street: Land Use: SINGLE FAMILY Street ALL WEATHER Feature: Class: Residential Traffic: LOW http://anchoragelive.com/ 10/24/2017 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 'L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAl.. SYSTEM AND/OR WELL INSPECTION REPORT A~dress FROM ~ TANK FIELD LEGAL DESCRiPtiON LOT LINE Township, Range, Sec0on AS-BUILT DIAGRAM {Show local{on ol well septic syslem, p~ope~y nes, ounda ion, -- ~-/~ ~ ~ l ~ ~ , ~ driveway, water bodies, etc.) TANKS TYP~ O~ SYST~ , WELL8 __ ~ PRIVATE l~r~,~ ~ OTHER (Idm~lltv) REMARKS: .... Munlclpsl and State guidelines in ellecl on this dale: /~'/~ 72-013 (3/85) F'i:.!r, ll-cL'L bJu. l~ll:jE.!l~f, :~c~t, .LI;:j: ]: i:IF:'EJF;:t~'I :f). I'l ,, I"1 ,, ::3 ,, F:'R :t: I::IF~ '1'(::) :!: N',::iF:'I:i:C I' ]: Eft,IS FlY 1::l",l(3 ]: I'4I:::I::i:F~ !, ]: I:;: (~I:::'TI::!:I:;: DF:F:':LI:;E: II!::)LJI:~I:~, CI::)N'Ir:~CT ;5/K:!;'"'4(:>EI:t f:'d',lD !.,.,[.::(~VLi: (:'~ CCiNSI'I::;:UC'I F'Iii:F~ I:I',I("F[I~,IliEI!:F'~S (,~I'Tf,'~CJlI!i:I:) (-1Fq'::'F::C)VJii:D '1'I"I]:!3 F>Ei:t;:I"I:!:'I I::XF:':EFi'.I::t3 :L2/::!;:I./D9 ¢.X, hl:O g,qL..]:I:) FOb: /'~ Ii(:] I'.IIE. JERRY BRANDT D('~I'E :: k/~ EAST 329,8 / - 50' R.O.W. EASEMENT · wA NO STREAMS +100" I o NO NEIGH WELLS +100' / % ~-- EXISTING '.'.'.'.'.'.'.'.'.'.'.~ %'.'.'.'. ~., SEEPAOE PIT ' ~ ~, _ ~ ~ ~ ~ .... .. .,.,........~/~ %. :::: - ~~ F ~ / ..v.v.vr.v:l ~ .... T~K " .'...'....'~.' 85.8' J I ~ TEST HOLE I ' · MONITOR TUBE o SEWER CLF~NOUT ~ I ~ - :WELL N 89' 58' 50" E 529.8 ...... FXISTINO LEACHFIELD ...... FROPO~U L~OH~bD SEPTIC SITE PLAN JOB ~ 89-0981 DATE: 08/~0/891 SCALE 1" = 50'_? EAGLE RIVER ENGIneERING SERWCES ' (907) 694-5195 FAX: (907) 694-3297 ~'~'~':~'~'~"' SPEC]:FICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: T15N, R1N. Sec.8. LOT 93 GENERAL The b~e]l and sepbic p]sn are 'f:or a ~ing'le 'f~mfi'l~ res'idence 3 AI'I maten'ia~'ls and wo~'kmanshfip sha'l'l meet the Anchorage Depaptmenb Health and State Depaptment o'¢ Env'i ronment8-1 (Sonsenvat ien 4 All soil tests ape advisopy to the des'ign and are to be ver,'i-f~ied or mod'l~'i~d in the '¢-ield by the engineer. 5 Ali excavat'ions 8nd depths ar, e advisory and are to be verfif'ied of modfff'ied ~n the f-ield by the contractor, to meet Municipe-liby o'f Anchepage, Depaptmenb of Env'lponment:al (}onser'vation nequffpements It 'is the nesponsfib'~'iity o'f the owneP to obtain a]'l neces~;aPy pePmit:s The excavat:ion 'is to be exactly 'in the ar'ge shown on th~¢ s'ite p'lan, any deviation r'equffnes engfineer appr'oval. It is a~]ways recommended tha1; a SLII'VeyOp lo(sate the headrest ]ot line posit-ion and the 'locat'ion of 8ny easements. BED ~ . The bed is to 'l:o]lo~l the natural land contour, to maintain ul~ifor'm tota'l depth of the bed bottom. 2. The bottom o¢ the bed she"II be leve'l, plus of minus 3. ]he tota'l ctepth e'f the bed exc~va, tfion is not to exceed po'i n t. 4 The sewep 'line is to rep]ace the existinq ,,~(,wct line th~ ]cads to the ex'istfll'~q tal'~k w'ith c]eanouts 5. The bed grave' 'is to be covered with typar fabric mater'rial. 6. Soi] or combfln,ation of sei'l and extruded board insu'latfion to a~ depth o'f 4' or equ'iva'ient is t:o be pieced ever the leach'f'ie]d. 7. the area over the bed ts to be 'f~nish graded to pr~event pondfng e'~ 8. The sept:Sc tank a~nd ]eachfqeld must not be c]osen than 100' to exi$~tino,, pn'iva~e we]] . 150' to anV. Class "C" we]'l , or 200 '~ee't to) any community ~ee'l'l . RECOMMENDED LEACIIF:IELD DII~ENStONS TOTAL DEPI~II = /.5' GRAVEL DEPTII = 6" BEt) LENGrl4 :~ 34.5' [3ED N;[DTI!:', 30' Soft] R~tin,c¢ ~; t38 E}edroom Capac',ity = 5 Septic T~II~< Size ', 1500 ga~]. Absor'bb'ion Ar, ma = 1035 S.F. A~3ANDON EXISTING TANK AND SEEPAGE PIT 13Y PUMPING, CRUSIflNG. FiLL. ING WITIt EARTH. INSULATE FI-OW LINES AND BED WiTll 2" BURIAl. FOA~ AND 2' EARTII COVER OR ~' EARTH COVER. AN D MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage,' Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LFGAL DESCRIPTION:__ Z~O ~'- ~-'~ 1 2 3 4 5 6 7 8 9 10 11 13- 14- 15- 16- 17- 18- 19- 20- COMMENTS DAT5 P E R F 0 R M E [}: .~ff"~'/~'.,//~' SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? Y~' LS. IF YES, AT WHAT ~,{ DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~*~' ~ (minutes/inch} TEST RUN BETWEEN ~ FT AND ~ , FT PERFORMED BY: 72-008 (6/79} Eagle River Engineering Services Eagle RIve~ AK gg$77 694-5195 • r6f .By P .O Municipality of Anchorage `; •'tom z.' On-Site Water and Wastewater Program (907)343-7904 SAF ETY Certificate of On-Site Systems Approval Parcel I.D. 051-151-15 Expiration Date: 3 -I SH 1. GENERAL INFORMATION T15N, R1 W, Sec. 8, Lt 93 Complete legal description L'ocation'(site address) 20320 Scenic Drive, Chugiak Neal and Sherri Collins Day phone 231-1159 Current Property owners) ' . ''` "", 27642 S. 4440 Rd., Vinita, OK 74301 Mailing address s. Aaron Asbury Dayphone 231-1159 Real Estate Agent,°p 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 0(c -to rdeckse- 'o 3. NUMBER OF BEDROOMS: 4 -I'{,e i P,1-1- . 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class C Well 0 Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: • Distance: 2.//97/Received by: Date: /Z7 COSA to be release s.Kle engineer,unless othe , 'se requested by the engi 1•er. COSA Fee $ AV? '5 Waiver Fee $ Date of Payment 12-1Sl 1 Date of Payment Receipt Number 681-fae Receipt Number COSA# (Yo C«S9 Waiver# 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 Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Alaska Rim Engineering, Inc. Phone 745-0222 Address 9131 E. Frontage Rd., Palmer, AK 99645 Engineer's Printed Name Mary L. Shreves Date 12/4/17 •� ��OF A[ta�i®® 5 co/ ,4-,- **7 l',. 6. DSD SIGNATURE ® ;•)4T� � System #1 Approved for bedrooms s • ; System 0 13 Mary Shreves •,L.„M y tem #2 Approved for bedrooms ® %+ CE 9351 •%V�'0 Disapproved #'49/11e,5);••.•.....••'P�,`��®0 ®A� PROFESS��N®®®�® Conditional approval for bedrooms, with the following stipula ��l� ®®®®®®® ri Fkg uka 0-1/1 Lk- c3 .hp Iiei. uI 0-6w1,04,i ss tZ F-ev. Cc9C( r 6 ✓W- ,i(--- t vt_ lc g . pet -- t`tw,,Lt,, 1,Sn. S G' Ott D vim. tf N 0 P \0 ;L / C49 - J a (A/ S 0 r.ma vr2 19- 1 t1;cp -66v- `A c(0 d4 ii vtt t`�>, les r,21 I4 4.6,,,N,e.,±qii 06.-o-114 1441- .C1-0v(. 11--r-I-Pc kieo t vvoc wax vu..ekLar, c_oriLf2_ vv rii 6 p v w v'if ..-, Cl/v Z©-V8 o--t, s - '--0 VA-lC, .I S - '--ka: j • I ,1f- £ V'L NI- t S ' ,IF f, - By: tom. 1 Original Certificate Date: 16- 1 The Municipality of Anchorage Development Services Division (DSD)issues Certificates of On-Site Sys �\>�1��ir�veal (OF ,••h sed only upon the representations given in paragraph 5 by an independent professional civil engineer registered ii l tate of Alaska. The I I . ipality -, of Anchorage is not responsible for errors or omissions in the professional engineer's work. := ON-SITE rill:- i: WATER AND 7. ATTACHMENTS: WASTEWATER iz! COSA Checklist X Nitrate Advisory -1). PROGRAM '•,.....\.� OSe tic System Advisory Arsenic Advisory �� Well Flow Advisory Other .--I rSERV '• ' ; COSA blue sheet f c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: T15N, R1 W, Sec. 8, Lt 93 Parcel ID:051-151-15 A. WELL DATA Well type C If A, B, or C provide PWSID# NA Well Log (Y/N) Y Date completed 6/16/84 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 140 ft. Cased to 140 ft. Casing height(above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 6/16/84** 10/16/17 Static water level 40 ft. 89 6 ft. Well production 15 g.p.m. 7.8 g.p.m. WATER SAMPLE RESULTS: Coliform A colonies/100 mL Nitrate <MRL mg/L Arsenic <MRL ug/L Date of sample: 10/16/17 Collected by: Brandon Jones B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 11/8/17 Tank size 1 500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) NA Date of pumping New Pumper NA C. ABSORPTION FIELD DATA Date installed 11/29/89__ Soil rating (g.p.d./ft2 or ft2/bdrm) 138 Sf/br System type Bed Length 34.5r-9,, s Width 30 ft. Gravel below pipe 0.5 ft. Total depth 3.42 ft. Eft-. absorption area 1035 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/16/17 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 946.4 gal. New depth 4 in. Elapsed Time: 144---- 4_ 4 0min . Final fluid depth in. Absorption rate >= 600 g p d Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed NA Size in gallons Manhole/Access (Y/N) "Pump on"level at in. "Pump off'level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATIOSTANCES T T WELL ON LOO-: Septic tank/lifts ation on lot 146 On adjacent lots 100 Absorption field on lot >100' On adjacent lots >100' Public sewer main >100' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank X75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: 5' 10' Building foundation Property line >5' Absorption field Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >10' 40' Water Service line >10Surface water 100 Driveway,parking/vehicle storage Curtain drain >50' Wells on adjacent lots 100' F. COMMENTS ** Lot 93 served by well located on Lot 92B, per Well Agreement, dated 7/31/93. G. ENGINEER'S CERTIFICATION ``.�,(S•OF A�, ,.z.,� I certify that I have determined through field inspections and CO:...• '•. • • �-7 / review of Municipal records that the above systems are in 3*: /i - - conformance with MOA COSA guidelines in effect on this date. ,,.ii TM.,.�• Name Mary L. Shreves y. -�, Engineer's Printed Na a do;lis, Mary V.Shreves = 12/4/17 ' Date �i -rp ••.• CE 9351 • F -i'+'±;`FE 550" ` COSA canary sheet_2-6-15.doc . S89'57'37"W 329.80' _ _ i • 3" BRASS CAP MCKINLEY VIEW NE 1/16 S89'57'37"W 279.81'(R&C) LEGEND: (C)=CALCULATED DATA (M)=MEASURED DATA ,e (R)=RECORD DATA PER PLAT ohu=OVERHEAD UTILITIES LOT 9 3 NAT.=NATURAL PED=PEDESTAL 50' I (TYP.)=TYPICAL w w 108,900 S.F. °° NEIGHBORS c- o io PRIVY SATELI TE /� co L5 DISH / Q�\ ,n q Z �, / o �- 0--4 N1(0,likP / co7I w ti co W 4" PLASTIC / NAT GAS o co co RISER (TYP.) o o c ) €.'-') Os/ OS o V 0 0 H SO. ( , c.4" °P...,C.2.0- / o o /-,NA o U� 0 re v , UTILITY 4 4- ca moo. a�yl 6 • POLE 0 co N 33 N N CARPORT al WELL O X 0 'oo X25.0' DECK 0 0cd P (TYP) Z z BUILDING ss•o- nneu UTILITY 3" AL-CAP l» . 50, -P. PED MONUMENT S89'58'12"W 279.88'(C) I+ FENCE p N89'58'30"E 279.97'(R) X o_ Q U L() I 'I a H LOT 116A LOT 116B N 0 a I NOTES: 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY PERFORMED FOR NEIL COWNS, IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION. REUSE OF THIS DRAWING FOR ANY PURPOSE NOT STATED ABOVE WITHOUT THE EXPRESS WRITTEN CONSENT OF ALASKA RIM ENGINEERING, INC. IS A VIOLATION OF FEDERAL COPYRIGHT LAW. EXCLUSION NOTE: IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. SURVEYED BY: FARMER SURVEYING LLC. MAILING ADDRESS: 6183 N. STEEN RD. WASILLA, ALASKA 99654. OFFICE: 9131 E. FRONTAGE RD. SUITE #20, PALMER, ALASKA 99645. PHONE: (907) 355-0620 EMAIL BCFARMER®MTAONLINE.NET 17-171FS UNDER CONTRACT TO: ALASKA RIM ENGINEERING INC ``""„'' RF ALASKA RIM ENGINEERING, INC. ♦`����•�F• A�il/�� AS—BUILT 9131 E. FRONTAGE RD. ♦ ••.;9 PALMER, ALASKA 99645 �♦�P'• '•;r'F �/ PH: (907)745-0222 : FAX: (907)746-0222 L'•• 9TH �'� •.9 'I� w..01.Palm( EMAIL: akrim®alaskarim.com : WEB: www.alaskarim.com i• .•4 9 — i ;* 0 ,,(5-‘-' WO: 1700741 • a ,,�f - % RE PAGE: 1 of 1 FB: 17-04FS i••.' : Robert J. Farmer :o Engineers: Planners: Surveyors SCALE: 1" = 50' FILE: 1700741AS I� Z ...:O615s I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED ez. ,. UNDER MY DIRECTION ON THEA FOLLOWING DESCRIBED PROPER : ly pR_r_...... ,1„. ♦ T15N, R1 W, SECTION 8, GOVT LOT 93, SEWARD MERIDIAN, , KA. Ill t i �t���‘%�` -,y i-� SURVEYED ON ANCHORAGE ETHE CORD14 h ING DOFF DECEMBER,IA2017. 02017 . FROM : MMM CONTRACTING PHONE NO. : 6881238 May27 1997 09;31AM P1 r • / . d r · ~e~s,4s 1o sn.lel~ pue/(l!le~el eq1 o1 'O~CIV ~le,~ luoJ~ UO!~P. UJJ!~UOO uell!.h'~ ap!AOJd 'U.1~7,~,4~ J~7~4~SB44.41!unuJLuoo tl :31ON :A-latins UaJ. VM aO ;dA.L. 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'9 i J a3eO aJnleu6ls sJ99u!6u3 L9566 elV'3le! °4o ssaJppy t Is Jeleuoa aIzoz J `l.6% auoyd " 3'd uoiAed'8 pl^?a wJ!j;o aweN ! •uogoodsu! s!yl 10 alup ayl uo 100149 u! suolleln6al pue 'sooueu!pJo sapooalelS pue led!0!unyl pe yli n'aoueiidwoo u! s! wa;sts Issodsip Jelsma;sem Jo/pue Aiddns Ja;em ops-uo ay; 'uo!10adsui pue uo!;e6!jsan6! .(w woJ; pus sa!!;a6eJoyouy;o I(;!!ed!o!un!nl ay1 woJ; paule;qo uollumolui ayl uo paseq ley;d;uanJaylJn; I'u!alay poleolpui ampnJls;o ado pue swoojpaq;oJagwnuaylJo;a;enbapepueleuogoun;'a;esstwalsAs!esods!pJalemalsemJo/pue Alddns Ja;sm al!s-uo ayl;eyl smogs uo!lso!Idde IenoJddy Ajuoy;ny Qe0H s!4110 uo!le6!lsanu! Aw leyi AplaA I 'molaq urinoys alep uo!3spilen 04110 se pus olaJay pax!;;e Inas Aw dq pollipoo sy V33NION3 AS NOLLOUSNl d0 1N3W31V1S 'S Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL. CHECKLIST Legal Description: A. Well Data Well type Log present (Y/N) Total depth _ / Sanitary seal (Y/N) Date of test Static water level Well flow Pump level1 Parcel I,D, (~.z~./- /,~--// -~-~ FROl'vl WELL LOG If A, B, or C, attach ADEC letter. ADEC water system number' Date completed _ ~,/]¢, ,/~-c( Driller .~-f'-~ Cased to / ~/o Casing height Wires properly protected (Y/N) ~/¢ '7 ; On adjacent lots _ ; On adjacent lots Public sewer manhole/cleanout Petroleum tank SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot .~ 45 Absorptien field on lot ~'l' ~ ¢¢~ Public sewer main /¢?/(¢- Sewer service line / ~)~¢- WATER SAMPLE RESULTS: Coliform Date of sample:_ Nitrate <~, / ~'~ Other bacteria Collected by: ?~ --~.do.~ B. SEPTIC/HOLDING TANK DATA Date installed Il/?.4:/~/ Cleanouts (Y/N) High water alarm (Y/N) Date of pumPing .Tank size i .~.'~)(~ Cornpartments Foundation cleanout (Y/N) "¢ Depression (Y/N) /~/R- Alarm tested (Y/N) ';b/-~6/¢ ~ Pumper ...]-/'2~' % SEPARATION DISTANCES I--ROM SEI TIC/HOLDING TANK TO: Well(s) on lot To property line /'~ ~' Surface water/drainage On adjacent lots /'.-~>¢~ Foundatien ?~- Absorption field ~ o' Water main/service line ...,~..,;>.,~- 72-026 (3/93). Front CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" Level at .Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed //////~ ~/~-~ Length .~ ~/, ~J Width Total absorption area /'o.~ Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GFZB/Ft2) Cleanout present (Y/N) Results (pass/fail) Gravel thickness ~'/~'"~ System type Total depth ~, Depression over field (Y/N) for ~ Bedrooms After test ,¢..// ¢-/~c..- If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots Surface water Curtain drain On adjacent lots / ~o-f- Property line /o'? To existing or abandoned system on lot Cutbank x,/?/¢~ Water main/service line Driveway, parking/vehicle storage area / E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name Date David R. Dayton P.E. 20210 Donalar St. Chugi~k, Alaska 99~7 HAA Fee $ ',-~(3 0 ~ Date of Payment 4~ ~-~O F Receipt Number ..~-? 43 / ~'~-5~2¢'3.-h , , ~l~c&~,.,,~ Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)' Back D. R. DAYTON, P.E., R.LS. ~~L~ Chugiak, Alaska 99567 20210 Donalar April 1, 1994 Adequacy Test Legal Description: Lot 93, Sec. 8, T15N, R1W, S.M. Date of Test: March 28, 1994 Septic Tank: 1500 gallon, 2 compartment, steel tank Absorption System: 34.5' x 30' bed Soils Rating: 138 sf per bedro~n Requirements: 5 BR - 750 gallons per day Test: Water was pumped into the bed while measuring volume and water level rise at timed intervals. After pumpimg was stopped, the water level drop was measured at timed intervals. The results were plotted on a graph of time and gallons absorbed and extrapolated yo 24 hrs. Results: ~ The system is currently functioning adequately for a 5 BR home. D. R. DAYTON, P,E,, R.L.S. ~ Chugiak, Alaska 99567 20210 Donalar (907) ~ 696-2417 April 1, 1994 Municipality of Anchorage Dept Health & Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Attn: Mr. John Smith Re: Lot 93, Sec 8, T15N, R1W, SM. Dear Mr. Smith, Since the 12/1/89 Inspection report for a sewer upgrade on Lot 93, the owners have connected to a well located on the S½, Lot 92, T15N, R1W, ( See attached well agreement). The well on lot 92 is the well tested for this Health Authority Approval. This well is an excellent producing well and is situated such that it could be utilized as a Class C well in the future. The well on lot 93 is still in existance and meets the separation req- uirements. It is in a standby mode and could be re-connected although it is a low producing well. Please review the Health Authority Approval data and issue the Health Authority Approval based on the well on lot 92. sin~ely, David R~ Dayton [3. R. DAYTON, P.E., FI.LS. Ft~P9q~~ Chugiak, Alaska 9!)567 20210 Donalar (907) ~,~ 696-2417 April 1, 1994 Well Flow Test Legal Description: IDt 93, Sec 8,T1 Date of Test: March 28,1994 Well Depth: 140 ft. Static Water Level: 99 ft. Requirements: 5 Br.-- 750 gallons 5Nt R1W, S.M. day. 9~stx The well was tested with P_he existing pump through a hose bib. Water vol~ne and drawdownwere measured at timed intervals. Recovery was measured after pumping was stopped. Results: The wellpreduced 6.1 gallens per minute with a maximum drawdown of 14 ft. The well fully recovered within 12 minutes after pumping was stopped. The well is currently producing adequately for a 5 BR home. Note: The test was performed on the well located on the S½, Lot92, Sec 8, T15N, R1W. FROM David R. Dayton P.E. 20210 Donalar St. Chugi=k, Alaska 99567 SUBJECT MESSAI'~-E I~E~!.~F~r~__~ 4S 468 POLY PAK (50 SETS) 4P468 [ --~ NOREPLY NECESSARY SIGNED TOFROM REPLY - - - DnTE i WATER THIS A(JREEMENT IS MADE BET~VEEN WAI .T AND JOAN M(X)I)Y (OI~ERS OI: SEC. 8 TISN RIW LOT 93, SEWAI~ ~diRIDI~) A~ STEPI~ANIE STUDICKI (OWNER OF SEC. 8 TISN RIW SEll4 LOT 92B, SEWARD MERIDIAN, HAROI,STEF SI IB0. 'I~E PURPOSE OF THIS AGREEMENT IS FOR THE M()( )I)YS TO .)IYlA]N TI l[~ USL OF '~ WELL ON MS. S~DNICKI'S PROPERTY (LOT 92-13). ~. WE, WAI.,T AND JO~N MOODY AGRLL~X'FO PAY STEPHANlll S'ITI~NICKI THE ~;UM C~[: 52000 FOR THIS SERVICE. WB ~I.L PROVIDE THE PUMP AN1) AI..L NI iEl~ El) HA I~I)WARE TO SET IT HL I'IIMP, WI! WlI.I. ALSO PAY TO MAINT~N THE I~VE~ T 'I~'I.'V[' WE SHO~.D SELL OUR HOME, 'l]tlS COST (EI..I!CTRICITY, WEI..L AND 1'[ IMI' MAiNTIiNANCI!) WILL BE 'I'R~SFI!RRED TO TH .! NEW OWNERS. ALSO, IN THE ~!VliNT THAT A HOUSE IS BUII.TON I.OT 92-B THF BY 1 ~ll~ 1 W( ) HOMhS AND THIn. FORE ALL COSTS ~I.L BE SHAREI) l!()l IAI.LY TO MAINTAIN ']'HE WELL ~ PUMP ~D PROVIDE EI.ECTRICITY TO RUN lT. ' THIS SERVICE APPLIES O~.Y FOR '1'~ SINGLE DWELI..1NG THAT NOW EXISTS ()N I..OT 93. .M.I. WATER ~GHTS REMAIN WITH THE OWNER(S) OF LOT 92-13, · HAROLSTI~f; SUB., SE 1/4, SEC 8, T-15N,RI W, SEWARD MI iRII)I~, THE ~DERSIGNED AND ~Y OF THEIR SUCCfiSSOR~ IN INTERliST WAIVE ANY ANO M..I. CLAMS OF ~VERY TYPE AND I)]KSCRIPTION RE1 ,A'I'EI) IN , ANY MANN]iR TO T~ USE OF WA'PER PROVIDEI) UNDER THIS AGIOiI!MI iN'F, INCLUDING 'I]ql~ X~q2I.L ~D TRANSMISSION LINES TO ALL I'ROPEICTY SUBII5CT TO THIS AGRI~I.iMISNF, AS AGAINST STEPH~E S~IUDICKI OR HER SU(X~I~SS()RS IN IN'I'I!RI!ST, · THIS AGId~EMI~N'I'IS ltlNDING ON ALI.. Fl TIIRIiOWNFI{S A ':O / ~ 1 iN T (~N ~1) [.OTS ~'l~h SI ICIt A 'I'IME THAT OR UNTIl. ANOTHER MUTUAL AGRIiEMENT IS MADE TO DISSOLVE TI'lIS AGId!IiMliN'I'. County of. -- ~- State of. ~(~(J~-.f& ss. On this day personally appeared before ,r,e ~C} }tgt'l~-~'~AJ~wOt. I1)c,,(.j: ,<,w/...l(i)/,((/~c{.j~((l to me known to be the individual, or individuals described in and who ~xecute~ the ~J. thin am.~o~egotng instruments and ac~owledge that '4~.~ip signed the same as ~, free and voluntary act and deed, for the us~s and purposes therein mentioned. Given under my hand and official .seal this ~ day of i~[~ ., 19 93. (Signature of .Notary) (Printed Name of .Notary) Notary Public in and ~or the State of ~( &.d A,~ Res tdtng at __~.~t ~ ~/(~c~ ~U-. My Commission ExPires MyComm~ss~ Odo~r AKUSA 01265 R 06/26/87 050799 At~CliORAGE I;FC. DISTRICT REQUESTED rd'f ~7~L~'4~.~o~ '93 SE? 10 10 19 MUNICIPALITY OF ANCHORAGF Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Paroeli,D.#.(~"! /~"'/ /~" HAA#__ ~=~c~C~ .- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner //~.~ '~¢¢"~:"¢~P~'L~'7/ 'Telephone: (home)Lc~:)~"'~¢?-'OBusiness. Mailing Address \~;>,2-~'~, ~.~1~..~__-¢.~!..4.~¢~.. ~--~.~ ~-~--.~¢--, ) ~ ~.~,"~"~ _ (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the'HAA to the following address: (or check here,i~.Jf hold for pick up.) List contact persen and day phone number below: 5 & $ ENGINEERING 17034 Eagle Ri,Vet Loop Road NO. 204 --~agle River, Alaska 99577 TYPE OF RESIDENCE Single-Family~ Number of bedrooms WATER SUPPLY individual V~ell ;'~ Community E] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. SEWAGE DISPOSAL On-site"~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the. legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ')tJObA s,J~eu!au9 leUO!SSBJoJd ~ql u! sue!ss!we Jo sJoJJe Joj elq!suodseJ leu s! eSBJoqouv ;o Xl!lBd!o!u n ~ eqJ. 'penss! s! eIBOWHeO B ~Jojeq B1Bp BZ41eUB JO Suo!lo~dsu! ~onpuoo leu op SHHQ jo se~XoldLu3 'slueweJ!nbeJ ~lBls pUB leJepaJ u!B1JeO X~s!lBs o~ JepJo u! suoilnl!lsu! §u!puel J!eql pub s~woq ~o sJesBqeJnd el XsalJnoo B SB s!ql seop SHHC] BqJ. 'B~SBI¥ JO e1Bi8 ~ql U! peJels!aeJ Jeeu!Due IBUO!SSeJoJd luepuadepu! uB,~q e^oqB S qdBll}B~ed U! ue^!D suoBB~ueseJdeJ eql uodn,~lUO peeBq pelBo!j!JeO iB^oJdd¥ Xl!Joqlnv qllBaH sense! 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WELL DATA ~ MUNICIPALITY OF ANCHORAGE (MOA) , ,,(,~¢.~,~, ~ ,He.i~.!t,b Authority Approval (HAA) ~'~'ri~."~,~.,,J'' ',. :',',.: ~6H~C.~.LIST' FEBRUARY 1984 ~" 343-4744 ~} Legal Description: _U--~,5'~ ::i. ( "' I/ Well Classification Well Log Present (YL[~ 1~ _ Date Completed ~ \c>t'l [ Yield Total Depth/C:~,~-~ Cased to--'~"~ Depth of Grouting Static Water Level ~--?-~ Pump Set At \ Casing Height Above Grou~'d .~ ~ - /) Sanitary Seal on Casing<~:~N) Electrical Wiring in Co~d~J'ii~:'7/-~ .... ~¥-"-~-:' ~)Depression Around Wellhead (Y/~ SEPARATION DISTAN~E:S FROM vvF:f32i To Septic/Holding Tank on Lot [,¢,"""2 ~A')On Adjoining Lots T0 Nearest Edge Of AbSOrption Field or~ Lot. ~ ~u::, ¢¢ ; On Adjoining Lots \ L To Nearest Public Sewer Line ~//~ To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot "~ I.~-- If A, B, C, D.E.C. Approved (Y/N) __ To Property Line 1'o Water Main/Service Line _ \ ~ To Stream, Pond, Lake or Major Drainage Course 72-026 fRev 7/88) Front To Disposal Field ,/ Page 1 of 2 Water Sample Collected by _/_~_~ ~-~ ~"~ ~,~.~,_...~(~_4 r---b~.; Date ~ '-~ ~ WaterSampleTestResults_~,~~ ~ ~ ~, ~ ~ ~~ Comments ~ ~ ~P ~ ~ ~' B. SEPTIC/HOLDING TANK DAI~~ ~ ~ ~ ~oO¢, Date Installed ~ ~ _Size ~¢~ No of Compartments ~% Standpipes~N) _ ~ Air-tight Caps ~N) ~( Foundation Cleanout (Y~) ~ Depression over Tank ~¢ ¢~ ¢~ D~te Last Pumped t ~ - ~ Pumping/Maintenance Contact on File (Y/N) ~[~ ; for ' ' Holding Tank High-Water Alarm (Y/N) ~ Temporary Holding Tank Permit (Y/N) ~/~ S~ARAZIQN DISTANCES FROM.8~q~C~¥OLDING.ZCNK: ~'o Water-Supply Well ~' _ ~:~o-~uilding Foundation ~ ~1~ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Depression over Field (Y/N) Results of Last Adequacy Test ~'~,Z:::"~I ~. SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments _~--~v(--' ~'-J~/T-Ca-~ '"l--m '~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutback (if present) D. LIFT STATION ¢/~,~ Date.~.~lfed Size "Pump On" Level at ~ High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** ~ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company . Date MOA No. ENGINEERING 17034 Eagle River Loop Road No. 204 ///o/,¢ 2' Receipt No. Date of Payment Amount: 72-026 (Rev. 7/88) Back Receipt No Waiver Fee: $ Date of Payment Page 2 of 2 Contractual Agreement J.R.'s Cesspool Pumping hereby agrees to service the septic tank located at ]Jot 93 Section 8 Township 15 North Range 1 West. J.R.'s will remove the septic waste every 30 days or less if required by occupant Walter Moody. The fee for this service will be the discounted "Fre- quent Service" rate of $63.00 per pumping. The starting date of service will be 2/9/89 until the system is up- graded to municipal code. J.R. 's Cesspool Pumping Barbara J. Gibbs - Manager Wa~r Moody - occupant Last date of service by J.R.'s - 1/9/89 I~UNIC, IPALD'Y OF ANCHOP, AGD DI~PT, OF HEALTH & ENVJP. ONKAF:NTAL pROTECTiON RECEIVED