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Home My WebLink AboutTERRACE HEIGHTS BLK 1 LT 18Terroce Height Block Lot 18 #017-074-44 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221007 PID Number: 017-074-4,+ Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name ELISE DEGEORGE ABSORPTION FIELD - NONE -----❑-Deep-Trench__❑ Wide-T-r_ench_❑-.Bed__❑_Mound--- - SitSite Address e UPPER DEARMOUN RD: ANCHORAGE, AK 99516- - - ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot TERRACE HEIGHTS 1 18 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft' Ft. Well -- -- -- 100'+ 25'+ TANK ❑ Septic ❑ S.T.E.P. ® Holding ❑ Other Manufacturer Capacity Surface water -- -- -- 100'+ ANCHORAGE TANK 2000 Gal. Material POLY -COATED STEEL Number of compartments 1 Lot Line -- -- -- 5'+ NA Foundation -- -- __ 10'+ LIFT STATION - HOLDING TANK Manufacturer Capacity Remarks Holes cut into baffles. Existing alarm set in tank. Gal. Tank anchored - no groundwater observed at install. Alarm location LIVING ROOM Electrical installed by EXISTING Installer MIKE ANDERSON PIPE MATERIAL House toan tk 3034 Tank to 3034 grainfield Drainfield CO/MT 3034 Inspector FWCS & MNA BENCH MARK (Assumed elevation) 100 ft Inspdection X51 05/16/22 2nd 05/16/22 Location and description 3" 4'h TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL ��\�,1 Conditional 4 �1�1� Approval: Date ��Q.,.•'' .�� meg.• .;�� j •• •••• ••••�•% Septic System Approved - �Z3 " rr �•.• Curtis Huffman •: ��sjF�..0 Date s/f78991. •��/ �ll� pROFESSIO-� Note: this approval does not include well permit requirements. PID: 017074-44 PERMIT: OSP221007 N 89 54'00" W 87.81' APPROX. WELL LOC. 00 `r 04 N Vi F;1 .0_ APPROX. WELL LOC. i A14.40 0 0 p O - 0 14.3' B O 00 O N P7 Pr1 N N STAKED 100' WELL RADII PRIOR TO C CONST. CO STAKED 100' WELL RADII PRIOR TO BM: TOP OF MH CONST. RISER / MH D POWER POLE LOT 19 DECOMMISSIONED EXISTING LOT 17 HOLDING TANK & INSTALLED NEW SHED 2000 -GAL HOLDING TANK AS NOTED WITH ALARM & NEW DFCO. LLJ FCO ,/-DCO A—C=62.9' 99.55 BM MH B—C=35.4'T FlNAL GRADE A—D=71,4' 96.05 B - D = 4 3.5' 95-M 20OG-GALLON EPDXY-STEEL TANK ANCHORED. TANK USED EXISTING WIRING & REGRADED SURFACE TOPO, NO ALARM. ALARM LOCATED IN GROUNDWATER ENCOUNTERED LIVING ROOM. & SOILS WERE NOT PERCABLE. SEPTIC SECTION SCALEt NTS TERRACE HEIGHTS BLOCK 1, LOT 18 PREPARED FOR: ELISE DEGEORGE 7840 UPPER DE ARMOUN ROAD ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK©gmail.com SUPPFORT SERVICES: 'k OFAL4§ C* 9 * -11 11111! TH DATE: 5/23/2022 tis Huffman SURVEY. LCG CE 128991 DRAWN: FWCS 5/23/22 SCALE: 1" = 30' FEssIoK�' w I 0 } w p~ Q p m wo�� m N } Z H >2w X= p w �=i " V D O ... .. wa: :.• CO op IN .�pu 'mo w� z ZZI¢a .t .Q ao •¢ N l0 � 3: N W cc: > V dHw Y 2 V m F— O oa°z 61TU0 °�u_ W o m J wF- r, un¢ Ou_O!n O Z w O 0 N 00 Fes- •J ZWw Fpm ml=7�v¢~ z� Y 1- p d o = 8wz> ZR gLD m LL M.00190 00S 2M'HZ WOa wa^ La p t/i zz° Z GZ .0-0 ,10g o1 1u¢a O1 t , ,6'6Z- X X— X I 'SLU � 30= o�mCl o N o £'8Z ' X I 0 0 x o JpwK. F r FZ�Q N U U m n Q .1 I _aa 6Z¢ 0 U ltl tJl Vl a- 00 N J N X d Z 0 t=�Zw H00_ p uw� O Y K ( C LL O z N W n7 X Lij �--- o f w N �a JO ( LU I Gvt w¢=a <Z Wzooz m >} p C) O 00 �� 0- It o-'Z QQJ U Lu W > (n OF V�Lil 2i 0w Di r O >Z Z Y X ( aviO ¢¢Da u �S V V) l 0 C7 N QO CL I > w O Lu Vi 1-- I= w O I o0 w 06 1 .-' I O Ln o 00Ir O CD v FD Ln CL -- - (� i I z �) :•:•:':•:•: Z'9Z n o .+.�—t .. ' . • . X X ( LUZ O Z Ln Ea-� CO ¢ o I v LI) 00 v a �,.'.•.•.•.'.•.'.'.•.'..'.;�8 0 W U z O N ID oma, �N� _ p > W c v w 3..00.90 v U c� c u ,00'Z£Z o00N z w 0 N Q �n a aou N F-3 ¢ m rn �000c�o p� °,r i o f LL 0 U) p V) 2 0 Z� m .A�O m W z = \ Q G O = O f— in 0 W 00 (D •' Z OU O � W 0 0 ¢ z W 0 off. W F- O ' F-I w to �' U d 0 > -jam OQ Z m s . 4 ..tea o .5��0 e9 0 a o Llj o 0 Z X � cn o W W D W ,- J 4p00000 �� z W w Q W ir Q 0 MUNICIPALITY Or ANCHORAGE On -fit@ Water & Wastewater Progmr1 PO Bax 1965h1] 4700 Elmore Road Anchorage, Alaskp 99519-ot 5Q Phcne:19-07) 343-7904 Fax' (907)343-79IJ7 http:riwntw_rnum.org)ansrt.e On -Site Wastewater Disposal System Pe rmit Permit Number; OS 21007 Work Type- Septla'7a lik Upgrade T3Y Cad& NumlhQr: n 17.n7AAAnno Site Legal Address: TERRACE H.ErGHTS BLIP 1 LT 18 G:2gd0 Site Mailing Address: 7848 UPIPER DE ARM OLJN RD, Anchsrag-o Owner: C EGEORGE ELISE Dos lgrl Enjineer: FIRST WATER CONS ULTIN This permit is for the aanstrucHon of - 12 Disposal Fie Id ❑ Septle Tetrik 0 Holding Tank ❑ Privy EffeGtive Date; Expiration aat�p- 1 )28)2022 Lot Size in Sq Ft: 20372 Total Bedrooms: 3 ❑ Private well 0 Water Storage All construction shall be in a-coor-daMe with; 1. The attached approved design. 2. All req ul remenis specified in Anchorage Mrs nlppO I oeode Cbaplers 15.55 and 15.6E and the Slate of Naska Wastewater Disposal Regulations (1aAAC72) and Drinking Water Regulabons (1WC80) 1 The vfastewster code- rwqu iraz ir,�pArAnnR rL i ring +ha me +f all, 11Qr5 7bi: sn:jinsvr wha11 nalify the Di d*lo p me n I Services Department per AMC 1$_65. Prxvide notification by calling (907) X43-7904 (240). 4_ From Clictoter 15 to Wl'15, a subsuiface soil absorption system under oonslrr.i.:tion during frats�,ing weather shall be either_ a. Opened and Clod on the same day, or b. Covered, sealed, snd heated to prevent free2in� Special Provisions: Tank Wrial depth is limited to 4 ft with groundwater up to 2 ft abs top of tank - Received Dy_ r Issued By: 6y9 fz2 112111222 Date- Date: Development Services Department A`l Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-074-44 Property owner(s) ELISE DEGEORGE Day phone Mailing address 7840 UPPER DEARMOUN ROAD, ANCHORAGE, AK 99516 Site address 7840 UPPER DEARMOUN ROAD, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) TERRACE HEIGHTS BLOCK 1, LOT 18 Legal description (Township, Range & Section) ....... Lot Size 20372 Sq. Ft. Number of Bedrooms 3 - APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank ElUpgrade Q (D) El Holding Tank 0 Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: # ;2 g 5 Waiver Fees: Date of Payment: IZ/�?Z Receipt Number: _._1811 y Permit No. OSP,221007 Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com January 7, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: HOLDING TANK UPGRADE PERMIT LEGAL: TERRACE HEIGHTS BLOCK 1, LOT 18 The owner has requested that we obtain a septic permit to upgrade the existing aged steel holding tank on the above referenced lot. We propose to install two 1500-gallon epoxy coated 10-gauge Advantex tanks with 18 holes cut in the baffles in series with an alarm to serve the existing 3- bedroom residence. Per MOA record documents, testholes performed previously show impermeable insitu material with no groundwater present to 16. The existing 4000-gallon holding tank has had no known buoyancy issues for 30 years. If at construction it appears there is any possibility of groundwater, each tank will be anchored with 2 3800-pound concrete blocks, which with tank and a minimum of 2 of soil cover will be 1.5 times greater than the buoyancy force assuming groundwater at grade. Also and regardless of groundwater observed, indicated or not all connections, including the connection between the tank and manway riser will be bentonited and prior to final backfill the tanks filled and observed for leaks to confirm water-tight connections. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221007, Rebecca Carroll, 01/28/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221007, Rebecca Carroll, 01/28/22 Municipality of Anchorage Page I of ~-~ DEPARTMENT OF HEALTH 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 Permit Number: _,,~__~/._.~ 200.~ ....... PID Number: .._O~1_~-O''/334, Name:CoNRAbI~,IE zARI',tDT Wastewaler System: n New ~Upgrade ^Sd,o.: ABSORPTION FIELD 7~o UPPE~ LEGAL DESCRIPTION So,, Rahng Tolal depth from orig,na, grade: Townsh,p: 12 H IRange 3~ I Sochon: 2~ F,II added above o,,g,nal grade Gravel length: Gravel width Number ollines: JO~l~n~tw~lin.: WELL: New Upgrade SEPARATION DISTANCES o Septic ~Holding ~ S.T.E.P. Water >10~' ,.A. LIFT STATION Drain BENCH MARK Remarks: N~ ~ ~, Ho~OtN~ ENGINEER'S SEAL Inspections performed by: FzA~oP Tec~ Evc5. Dates: 1st ~/ r % THEODORE F. I~OO~E ~ , H e~lth///~~~n.~e~s ~pprov~l ~,~.. Dep~rtment O~ Reviewed and approved by: ate: Per~l! No.. ~1~/Cl200q3 Page .2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH 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 Description: LoT I~: ~tk I ~ TERRt~£ E~'lG~!T~ PID No.: OI7OT33G LOT I$ House LARI~ 8oX PLAN VIEW t GRou~tb EI. Ev~TIOIq oF ~4~ ~ ~ ~.2 ' ~top Technical Set 14530 Echo Street ' Anchorage, ~ka 9f ~18 ~,~LET I / % ~ '.. --L.~'.~Z~ I PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920093 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:ZARNDT CONRADINE G OWNER ADDRESS:7840 HILLSIDE WAY ANCHORAGE, AK 99516 DATE ISSUED: 5/20/92 EXPIRATION DATE: PARCEL ID:01707336 LEGAL DESCRIPTION: TERRACE HEIGHTS BLK SEC 25, T12N, R3W 1 LT 18 LOT SIZE: 20416 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: HOLDING TANK SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. 1 OF 5/20/93 1 SPECIAL PROVISIONS: DATE: DATE: UPPER D__..E]qR ~ OUN ~/£LL LOT Iq VACANT OI4 LoT ~ ~czttop Technical Servicee 14530 Echo Street .Anchorage, Alaska 99516 E xI.ST t,qG PROPOSE Sa'pTIC T,q Nk, qooO To B~"~.. ~__HoLDIN fa '~'~''T''~¢o HOLb~G R£ AB/¥4b:,N£ b V,~CA~T LOT 3 LOT Iq { BoosE o J~'~I~' To ~/£LL ON LOT ~ LOT I$, 8L~: I~, TEl?RAcE HOLDING 'I"AN, K J~EPLACEI~EHT SITE PLAN b,q"f 1~: A SuR V~',~Eb ALL LOCAT'IoN ~ ~ MUNICIPALITY OF ANCHORAGE DE, ~TMENT OF HEALTH AND HUMAN SER', -"S ..,, Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON*SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name(~.~. ~, a~L~ Tn DISTANCES ~' SEPTIC ABSORPTION Pnone{~) i . O .o ct ~or~ms ' WELL ~*~ o~sc.,..,o. LOT LINE " -- B SEPTIC ¢OLOING TYPE OF SYSTEM ~CH ~ BED ~ W. DRAIN ~HER [o,~,a~,¢,~a,eao,~ SOFT Om.~O.s,.n. ',~.,.,,.e* FI ,'"'"' ,, ~ PRIVATE ~ OTHER (Identifvl HE~A~K8: U~,J I't~:' ~"~ , . ~~ O~ .~;~ _~l~ ~ ~d ~OJ~ Ins e ,onsPedor by .............. .,..~...._~._. ~ _ . .~. ..~,.. .... , ....... Permit No: Date Issued: Applicant: ~NICIPALITY OF ANCHORAGE F"~ Department ~ 'Health and' Environmental ~otection Pouch 6-650, Anchorage, AK 99502 264-4744 On-site Sewer/Water Permit HANDWRITTEN Address: Legal Description: S/D: ~,'~ ~'G'V~ Lot: /8 Block: Section: ~a~K' Township: 77~--/ ,. Range: Lot Size: ~ ~o .(Sq. Ft. or Acres) Lot Location: '~'~ ~W ~/~ Max Bedrooms: ~ ~ Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. TRENCH BED W. DRAIN ~ th to pipe bottom(ft~.~),~/;~ ~- . ..... -- -' - '- ' G~ll depth (ft.)/ ~-~r~ ~~ ~7~ ~' Gravel ~ (ft.) ~ ~ ' ' -- F Tan~ize ilal~ ~ ~ ** th 75 f~t requires multiple runs (not exceeding 75 teet each) Gravel leng ** Tank must have at least two compartments I cer:tfy that: 1. I am familiar with the requireme~ts for on-st~e sewers and wells as set forth by the Municipality of Anchorage(MOA) and the State of Alaska. 2. ~ will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere ~o all MOA and S:ate of Alaska requirements for the set back distances from any existing well, wastewater disposal system public sewerage system on this or any adjacent or nearby 4. I understand that this permit ts valid for the maximum number of bedroom stated above, and any enlargement or modification will require an additional pe~i~. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE 0BTAINED;'(2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. Applicant SWP/024 .rev.1/85 PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9- 10- 11 13 14- 15 16 17 18 19 20 Municlpatlity of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? P E: Oe~31h lo Water ~er ~J//~ '~ . ~oflilorifig? Oat~ Gross Net Depth to Net Reading Date Time Time Water Drop 5. ~'~, Io~ ~'~. PERCOLATION RATE (m,nutes/~nch) PERC HOLE DIAMETER TEST RUN BETWEEN --FTAND FT , )Corwin & associates,inc. Consulting Engineers 4790 Business Park Blvd. · Bidg, D., Suite One o Anchorage, Alaska 99503 · (907) 561-6151 September 22, 1986 Ms. Susan Oswalt Department of Health and Human Services 825 "L" Street Anchorage, Alaska 99501 SUBJECT: LOT 18, BLOCK 1, TERRACE HEIGHTS SUBDIVISION ANCHORAGE Dear Susan: Corwin & Associates, Inc. performed five (5) soils tests on the above referenced property on 9/16/86. These test holes were located in the only conceivable point where well and/or existing septic would allow. Our results indicate there is no possibility for construction of a standard on-site wastewater treatment system on the subject lot. We recommend the installation of a holding tank as the only means to provide for wastewater disposal on this property. The new holding tank may be installed within proper separation distances to the well and other surrounding properties. Should you have any questions, or need any additional information, please let us know. Very truly yours, CO~N & AS~IATES, INC. BJC/'d ,~ ~ ~ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME [PHONE I I~NEW MAILING ADDRESS I · L~GAL DESCRIPTION LOCATION ND. OF BEDROOMS Manufacture~ M=terlat No. of compartments Liq. capacity in gallons IF HOME.DE: Inside length V*dth Liquid ~epth PERMIT ~O --kZO (~ ManufacturerDISTANCE TO:.~ Well /~, Dwetling ~--1 ~ Materia~~---- Liquid ~ ~ DISTANCE TO: ~ No. of line, Length of each line Tota, leng,h of line, Trench width ,.chis . O inches ~ k Type of crib Crib diameter Crib depth Total ef fecti~ absorption area ~ Weft Building f~ndation Nearest lot line ~ DISTANCE TO: ~ ~Jass Depth Drdler D~stance to tot line PERMIT NO. m Building foundation Sewer llne Septic tank Absorption area(s) ~ DISTANCE TO: REMARKS .' PERMIT NO. MU~4ICIPALITY OF' F~4CHORF~GE .... t ~:~ DEPART.E,. ,' HEA T. AND E,.,V,RONMENTAL OTECT,ON 825 ', ~TREET, ANCHORAGE, AK. 9~, I I~'~'~ O~--S I TE SEWER UPGRADE PERM I T ~/ . ( 80065i ) APPLICANT LOCATION LEGAL QURCKY TUCKER 2~70 CANARY CT, RNCH UPPER DERRMOUN ILT 18'E~K'-i'~TERRRCE'~TS'S?D ." LOT SIZE 24~-4220 22000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MA×IMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT?BR)= 200 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= LE~GTH= ~ GRAVEL DEPTH= e THE LENGTH DIMENSION IS THE LENGTH (IN FEET> OF THE TRENCH OR DRRINFIELD. THE DEPTH OF R TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GR~VEL BETWEEN THE OUTFRLL PIPE AMD THE BOTTOM O~ tTH~XCRVRTION (IN FEET). PERMIT RPPLICRNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS RDJRCENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. TWO ( 2 > INSPECT IONS RRE REQU I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION A~ID RPPROVRL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSRL SYSTEM 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET PROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MIt~IMUM DISTANCE FROM A PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY RPPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTRLLRTION. PERM I T E×P I RES DECEMBER 31~ ~L950 I CERTIFY THAT l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE ................... o GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Certified October 22, 1980. Quacky Tucker 2370 Canary Court Anchorage, Alaska 99502 }741916 Subject: On-site Sewer Permit [800062 . . ~ Lot 18 Block 1 Terrace Heights Subdivision ~2 This department has on two occasions observed that the new sewer system installed at Lot 18 Block'l TerraceI, lleights Subdivision ~2, On June 5; 1980} has filled with water. The hous~ is still under'construction and has not been occupied. It appears that'the sewer system has:failed due to ground water intrusion. By this notice, under the direction of the Municipal Legal Department, this department is revoking permission to uso the septic system effective November 12, 1980. This ( 19 department is receptive to two(2) alternatives: Abandon the.failed septic s~stem and obtain .a permit to install a two-thousand(2,000).;gallpn holding tank; or (2) Provide this department with Soils engineering tests, which indicate.the system is i~ a dry strata and is functioning due to.physicai ~r~inage of. th~ l~t. This letter will serve asia Noti~.of'Violation on ~unicipal Ordinance, 15.65.020(A). You,.as respondent, have all the rights provided by 3.60~045 or,the Municipal Ordinances governing administrative hearing procedures. · ' .~.~ Tucker~ ~3~tober 22, 1980 JPage Two If there are any further questions, please call department at 264-4720. this Sincerely, Lynn Lindquist Principal Code Enforcement Officerl: LL/ljw ~: cc: Ken Norman ' : , Muncipal Legal Departmen~i: ' ~-\ MUNICIPALITY OF ANCHORAGE / -' ,~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE ,UPGRADE ~,L DESCRIPTION Absorptton area~, e Dweging ~3~; ~ DISTANCE TO: No. of mines Inside length Nidth Liq. cap~cit¥ in gallons IF HOMEMADE: ~ Dwelling DISTANCE T Top of tile to finish grade Length Well Depth DISTANCE TO: OTHER er INSTALLE ~epth Trench width Driller foundation Septic tank NO. OF BEDR~_~S No. of comp~___.~nt$ Liquid depth PERMIT NO. P£RMITNO.{~0 D~)t Tot; PERMIT NO. IAbsorption area APPROVED DATE LEGAL PERMIT NO. APPLICANT LOBATION LEGAL QUACKY TUCKER 2~70 CANAR~COURT UPPER DEARMOND RD / MUN 1' C "r pi=IL Z TY ENVIRONMENTAL PROTECTION DEPARTMENT OF HERLTH AND 825 '~L~' STREET,, ANCHORRGE., RK. [,-IELL RI'-,ID ON--~; T mE SEHEE PEER [ m ~:~_ ( 800062 ) 243 4228 TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH 20371 SQUARE FEET MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 225 THE REQUIRED SIZE OF THE SOIL RBSORPTION SYSTEM IS: DEPTH= :3-2 LENGTH= 5'~=' GRI---IVEL DEPTH= 8 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND RND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRRYEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCRVATION (IN FEET). REQU I RED SEPT I ¢ TRI'4t-~ $ I :::'E= 1250 Gt:ILLONS 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. ------ 'TWO 4~;~) Ir~sPECTIONS liRE RE(;~UIRED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 3.00 FEET FOR A PRIVATE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS ?5 FEET. WELL LOGS PRE REQUIRED AND MUST BE RETURNED TO THE DEPRRTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICATIONS AND CONSTRUCTION DIRGRRMS PRE RVRILRBLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF RNCHORRGE. 2: I WILL INSTALL THE SYSTEM IN RCCORDRNCE WITH THE CODES. 3: I UNDERSTAND THRT THE ON-SITE SEWER SYSTEM MRY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MO~E THAN 4 BEDROOMS. './4. 0 4040 "B" STREET ANCHORAGE, ALASKA 99503 (907) 278-1551 August 16, 1979 W.O. ~A19036 Grid #2940 Area i Bob Beregon c/o Cook Inlet Realty 619 East 5th Avenue Anchorage, Alaska 99501 Subject: Subsurface Investigation for Suitability of On-Site Sewer, Lot 18, Block 1, Terrace Heights Subdivision Dear }~. Beregon: We hereby transmit the results of the above referenced investi- gation performed by Alaska Testlab on August 14 and 15, 1979. The scope of this project is the investigation for suitability of an on-site sewerage system. Included in this transmittal are: Site Plan Test ]lole Log Explanatory Information Figure 1 Table A Sheets 1-3 The exploration was conducted using a track mounted, continuous fllght solid stem auger drill rig owned and operated by Denali Drilling, Inc. The drilling was supervised, and the test hole logged by Mr. O. }latch, Alaska Testlab geologist/senior fJe!d technician and the percolation test performed by Mr. J. Williams, Alaska Testlab field technician. ~.;hen drilling was completed a 3/4 inch slotted PVC pipe was ~.nserted into the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water and left overnight to saturate. On returning the next day, the hole was refilled with water and the drop in water level carefully monitored over the next 60 minutes. This procedure is not a standardized percolation test, however, we understand the Municipality of Anchorage, Department of Public ]lealth and Environmental Protection, prefers tests perforated Jn this manner to evaluate a site for proposed on-site sewage system. · Bob'Beregon 'August 16, 1979 Page Two Using the above test, the observed minimum percolation rate was 20 minutes per inch. We recommend the system be designed for an absorption area of 225 square feet per bedroom. This recommenda- tion is based on criteria in the "Manual of Septic Tank Practice", U.S. Department of llealth, Education and Welfare, Public ]~ealth Service. We recommend that the seepage trenches be inspected prior to installing the system as the above recommendations are based on a six inch diameter test hole. The seepage trench will provide a much clearer picture of subsurface conditions than a test hole. If conditions are different than encountered in the test hole, it may be necessary to modify the design. We hope this report meets your pr6sent needs. If we can be of further service, please feel free to contact us. Very sincerely, .ALASKA TESTLAB James R. Finley, Jr., P.E. Geotechnical Engineer Approved by: Melvin R. Nichols, P.E. Laboratory Manager JRF/ms Attachments cc: Cook Inlet Realty o UPPER 87.20 I0 o 0 SITE PLAN · Test ~ole ~1 Table A WO ~A19036 Date: 8/14/79 Logged by: O. IIatch Depth in Feet From To 0.0 1.0 1.0 .2.5 2.5 10.0 10.0 16.5 Soil Description Brown Peat, damp, soft, Pt F-4, brown Sandy Silt with trace gravel, damp, stiff, ML F-4, brown to tan Gravelly very Sandy Silt, damp, stiff, rounded to subrounded particles to 2", ML F-4, brown very Silty Sand with some gravel, damp, very dense, rounded particles to 2", SM .''Bottom of Test ~ole: Frost Line: Free Water Level: 16.5 Feet None Observed None Observed Remarks: 2. 3. 4. General Information, see Sheet 1. Frost and Textural Classification, see Sheet 2. Unified Classification, see Sheet 3. Observed percolation rate = 20 minutes/inch. MUNICIPALITY o Development Services Department `' ih p P - --' Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-074-44 Expiration Date 1. GENERAL INFORMATION Complete legal description TERRACE HEIGHTS BLOCK 1, LOT 18 Location (site address) 7840 UPPER DE ARMOUN ROAD, ANCHORAGE AK 99516 Current property owner(s) ELISE DEGEORGE Day phone Mailing address Real estate agent 7840 UPPER DE ARMOUN ROAD, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ❑ Single Family (w/wo ADU) ® Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic ❑ Water Storage ❑ Holding Tank Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ / �-/ 6 - ene Date of Payment A-- 6 `2Z ZZ Receipt Number Z/ (0 D �Z Date: Waiver Fee $ Date of Payment Receipt Number COSA # 06C 22 111301 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 5/5/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to `+ OF ��111 these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory � — •' -.-Y for current or future occupants or guarantee that no unseen encroachments, deficiencies or *: 11I -I ' discrepancies exist can be given by First Water Consulting & FWC5 � _ ..... _ . vti r_ 6. DSD SIGNATUREC"' "' , Curtis Huffman ' System #1 Approved for 3 bedroomi, s rf FcCE 128991 . ��r� System #2 Approved for bedrooms �>>`F,PRO ES ONa��`� r Disapproved tlllll(((ffrrrr�� Conditional approval for bedrooms, with the following stipuE��Ty i oNZ, UN wq ,S/TF � �m S? -I- /V5 M J0'O J \ 1 By: �.... Original Certificate Date: 5 �' 2Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: TERRACE HEIGHTS BLOCK 1, LOT 18 Parcel ID: 017-074-44 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 2.2 gpm nate-dr-ille"/a-980 ter-storage-tangallom Total depth 180 ft Well disinfected for coliform test? ❑ Yes ® No Cased to 180 ft ® Coliform bacteria is Negative ® Sanitary seal is functioning correctly Nitrate 6.51 mg/L ❑ Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/L ® Arsenic less than MRL (ND) Casing height (above ground) 12+ in. Collected by_ FW'N Date of flow test for COSA 4/11/2022 Static water level at beginning of test 51 ft. Date of Sample 4/11/2022 Comments B. TANK DATA Age of tank(s) NEW years Tank type/material HOLDING TANK / STEEL -POLY Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Which s stemtested (date installed) ElALL standpip\e present per record drawing Total measured depth fr mo grade _ft (max) Measured depth to pipe invert from gr deft (min) ❑ N/A — pressurized field \� ❑ Monitor tubes go to bottom of effective. If not, state depth into effective C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: NEW TANK & CONNECTIONS BENTONITED Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test in Water added gal New depth _ in Elapsed time min ❑ Code -required soil cover over field Final ffG u depth in ❑ System presoaked Absorption ra` ate '�gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatmen (N_ st 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies:. FRES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' if No ft Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft L------NEighboring-Absorption-F-ields->-TOO' ft Community Wells > 200' ® Yes if No ft nimal-C-ontainmant-�-50' N -Yes i -No ft ® Yes if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells >' 100 _ ®Yes if No ft Water Main >AO' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below F; ^,n Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation---! O' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes' ,f-- 0 _ ft Wells on Adjacent Lots: Water Main > 10' ®Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ®Yes if No ft Community livctts> 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. .... 9�>>l g'49 Z-�2 .. ..••Curtis Huffman FFG, CE 128991 .•�`�/' .5/20/2Z .��i tt� PROFESSIONS` MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On -Site water and wastewater Section Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC221189 Subdivision: Terrace Heights Block 1 lot 18 A water sample revealed a nitrate concentration of 6.51 milligrams per liter (mg/Q.,- The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Madmg Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. MCIPAU Y OF ANCHORAGE irr��.''_S.`.._T"Jas.._.�_�.'..+._:._.i�,'.r .•..--m,--.,,.oax..,--• _—:.��, � E��$ •y.—�.S:Sx^a+./--. _ ,sn Development Services Department `� ` , i Phone: 907-343-7904 On-Site Water & Wastewater Section - Fax: 907-343-7997 Parcel I.D. 017-074-44 Certificate of On -Site Systems Approva Expiration Date: _ C(— ZZ? - 1. Z ' 1. GENERAL INFORMATION Complete legal description Terrace Heights Block 1 Lot 18 Location (site address) 7840 Upper Dearmoun Road Current property owners) Scott & Jamie Rowley Mailing address Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Private Septic ❑ Water Storage ❑ Holding Tank F71 Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5Waiver Fee $ // T Date of Payment t0 �� 020'a i Date of Payment Receipt Number 06 1,3 06 Receipt Number COSA # OJ G 2 113 ckC� 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date 2 i0 Z� OF. A� qst) co 6. DSD SIGNATURE • • • • • • r . / ... System #1 Approved for CI bedrooms �1}" �)te•:.er; 'h. ':ran'r-'ore' System #2 Approved for bedrooms PPPP s; . ; Disapproved�� Conditional approval for bedrooms, with the following stipulations: rUl �J p - WAT AS7-!.r 1 SATE R Z= JJ0 M \�� JJ`92NT SERVIGES��`��• Inti Original Certificate Date: .2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA Checklist blue sheet X Nitrate Advisory �� Arsenic Advisory Other -cam `_ (- - 1e 010 _ (lis to" 1�C�c� COSA Checklist Legal Description: Terrace Heights Block 1 Lot 18 If more than 1 septic system on lot: COSA Checklist # 1 of I A. WELL DATA N Well log is filed with Onsite (or attached) Date drilled Total depth 180 ft Cased to 180 ft FM Sanitary seal is functioning correctly Iii Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA "'°" Parcel ID: 017-074-44 Structure served by this system 1 Well production at time of test 2.4 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes Lj No © Coliform bacteria is Negative Nitrate gal tit?` mg/L itrate less than MRL (ND) Arsenic ug/L M.Arsenic less than MRL (ND) Collected by ~, : '. �. P S Date of Sample Static water level at beginning of test 50 ft. Comments •.rt E:,t I r : B. TANK DATA Age of tank(s) 29 years Tank type/material "c11oy5t"' Measured operating fluid level in septic tank N/A ❑ Standpipes/foundation cleanout per record drawing Date of pumping 5/17/2021 D. ABSORPTION FIELD DATA N/A Which system tested (date installed) ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective, if not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: HOLDING TANK COSA Checklist yellow sheet C. LIFT STATION ❑ Required maintenance completed Age of lift station N/A years Lift station material N/A Comments: Adequacy test date N/A Results Q Pass For 4 bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' L!�J Yes Community Sewer Manhole/Cleanout > 100' Yes if No ft FV1 Yes if No Neighboring Tank > 100' Z Yes if No it Private Sewer/Septic Line > 25' ❑ Yes if No Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' Yes if No Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' Yes if No [Z Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' El Yes if No ft Fv� Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ft ft ft ft ft 0 Yes if No ft Property Line > 5 L!�J Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' R1 Yes if No ft Private Wells > 100' [j Yes if No Water Main > 10' [] Yes if No ft Community Wells > 200' >R Yes if No Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) BuildingFoundation > 10' _ Yes if No ft If absorption field i� under -driveway comment below Property Line > 10' ❑ Yes if No ft Wells on -Ad - Water AdWater Main > 10' ❑ Yes if No ft Private Wells > 100' ❑ Yes if No Water Service Line > 10' El Yes 'tf ft. Community Wells > 200' ❑ Yes if No Surface Water > 100' El Ye" s if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. rz j 111-D 6Z,t COSA Checklist yellow sheet OF A(`�s�i�t .. . ..... ft It ft ft ven R.P ;nnore ft It ft ft DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section www.muni.org/onsite 6 i 907-343-7904 Fax: 343-7997 Septic 'Wank Advisory Certificate of On -Site Systems Approval #OSC211349 Subdivision: Terrace Heights Block 1 Lot 18 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 29 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. � �� Mailing Address �P O� Box 196650 *Anchorage, Alaska 9919 6650 *www murn org , 06/01/21 Isaacs Pumping Service Type Date Num Due Date Clr Rowley, Scott Sales Receipt 01/28/2019 6979 01/28/2019 X Sales Receipt 04/09/2019 8734 04/09/2019 X Sales Receipt 04/12/2019 8740 04/12/2019 X Sales Receipt 06/03/2019 8816 06/03/2019 X Sales Receipt 08/27/2019 8951 08/27/2019 X Sales Receipt 10/04/2019 9037 10/0412019 X Sales Receipt 12/13/2019 9159 12/13/2019 X Sales Receipt 02/03/2020 9222 02/03/2020 X Sales Receipt 03/17/2020 9258 03/17/2020 X Sales Receipt 04/27/2020 9300 04/27/2020 X Sales Receipt 05/27/2020 9352 05/27/2020 X Sales Receipt 07/08/2020 9451 07/08/2020 X Sales Receipt 08/13/2020 9516 08/13/2020 X Sales Receipt 09115/2020 9571 09/15/2020 X Sales Receipt 10/26/2020 9690 10/26/2020 X Sales Receipt 11/19/2020 9730 11/19/2020 X Sales Receipt 01/07/2021 9785 01/07/2021 X Sales Receipt 03/26/2021 9848 03/26/2021 X Sales Receipt 04/23/2021 9891 04/23/2021 X Sales Receipt 05/17/2021 9915 05/17/2021 X Page 1 Nitrate Advisory Certificate of On -Site Systems Approval # OSC211349 Subdivision: Terrace Heights Block 1 Lot 18 A water sample revealed a nitrate concentration of 6.64 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. � � Mailing Address P O Box 196650 *�Ancliorage, Alaska 99519 66�a0'� www muni orgy �z{ From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Ma�hng Address P O Box 196650 � Anchorage, Alaska 99519 6650 *www muni org k Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-074-44 COSA # (~-~ Expiration Date: GENERAL INFORMATION Complete legal description Lot 18, Block 1, Terrace Heights Subdivision Location (site address) 7840 Upper DeArmoun Road Anchorage, AK99516 Current Property owner(s) Jessica R. Matich Day phone 360-6446 Mailing address 7a40 Upper DeArmoun Road Anchorage, AK 99516 Lending agency Mailing:address Real Estate Agent .., Mailing Address .:. Day phone Day phone Unless otherwise requested, COSA will be held by DSD for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class __ Well [] Public Water System [] Four (4) TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this. application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. DSD SIGNATURE ~ Approved for Disapproved. bedrooms. Phone 522-7773 Conditional approval for bedrooms, with the following stipulations: -.. By: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 11105) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Westewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE'SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 18, Block 1, Terrace Heights SubdivJeion A. WELL DATA we, type Date completed 9119/8o Total depth 18o E. Date of test Static water level Well production Parcel ID: 017-074-44 IfA, B, or C provide PWSID # Well.Log (Y/N) Y Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Cased to 180 ft, Casing height (above ground). >18 FROM WELL LOG AT INSF;ECTION 9119180 8111110 130 ft. 132.0 ft. 4.o g.p.m. 1.2 g.p.m. WA~ER SAMPLE RESULTS: Coliform 0 colonies/100 mL Arsenic: N/D ug/i B. SEPTIC/HOLDING TANK DATA Tank Type/Material Hoiding/Steei Tank size 4,00o gal. Foundation cleanout (y/N) Y Date of pumping 6{~010 C. ~RPTION FIELD DATA Date installed Length f. Total depth .ft. Date of adequacy test. Fluid depth in absorption field before test Elapsed Time: min. Final fluid depth Any rejuvenation treatment (past 12 mo.) (Y/N & type) in. Nitrate 5.74 mg/L Other bacteria 0 colonies/100 mL Date. of sample: 8/6/2010 Collected by: M. Anderson Number of Compartments One Date installed 5/21/92 Cleanouts (Y/N) Y High water alarm (Y/N) Depression over tank (Y/N) N Pumper Isaac's Pumping Service Soil rating (g.p.d./ft~ or ft2/bdrm) ~ System type Width ft. Gravel below pipe ft. Eft. absorption area ... ft2 Monitoring tube Depression over field Results (Pass/Fail) For bedrooms ,in. Water added gal. New depth - in. .in. . Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on' level at in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >7S'** Absorption t'=ld on lot Public sewer main Sewer/septic service line Animal containment areas N/A Size in gallons ... "Pump off' level at~ Cycles tested >25' in. Manhole/Access (Y/N) High water alarm level .at Meets alarm & circuit requirements? On 'adjacent lots >100' On adjacent lots >1o0' Public sewer manhole/cleanout Holding tank NIA Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >s' Property line >$' Water main NIA Water service line >1o' Wells on adjacent lots>1oo' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field N/A Surface water >1o0' Water main Driveway, parking/vehicle storage Property line Water Service line Building foundation Surface water Wells on adjacent lots Curtain drain in. F. COMMENTS: **Lot is Served by a Pnivate Wall and a Holding Tank. N/A ~ '/1001 ~ that I have dete~ined thigh field ~nspections and review ~ Municipal taco.s ~at the above systems am in En~inee(s Printed. Name Ui~ael E. ~demon, P.E. Date,Payment Receipt Number (~)~--~ Waiver Fee $ (Rev. 11/05) Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 101183 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 18 of Terrace Heights subdivision. This inspection revealed a nitrate concentration of 5.74 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. 0 0 m .-~ 'm 0 (I) 0 o? 0 o o~ ;0 -o 0 m m o o~ m Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcelm.' O/.7-- O 7 ~ ."/~ 1. GENERAL INFORMATION COSA# O ~-~ Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TERRACE HEIGHTS S/D; BLOCK 1, LOT 18 7840 UPPER DEARMOUN RD * ANCHORAGE~ AK * 99516 PAUL &: SYB1L LEEPER (LMNG TRUST) Day phone 336-0005 Day phone JOHN O'HARA W,/ REIdAX Day phone 110 W. 38TH~ #100 * ANCHORAGEI AK * 9950.3 257-0442 Unlessothenvisemqueste~ COSA willbeheldbyDSD~rpickup. 2. NUMBER OFBEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ~ Individual Water Storage Community Class Well ~.~ Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding tank · Community On-site [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (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 vedfy 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 vedfy 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337-6179 Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The repo~fed rosuits described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwator lovels that may fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions are outside the control of the e valuator of the systom. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachmenls. GEG, LTD. can therefore not provide any warranty or futura estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this reper~ by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~ Approved for 3 bedrooms. Disapproved. Conditional approval for ON-SITE ,.- WATER AND bedrooms, with the filowing stipulations: ~'~)_*Oo Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.rnuni.org/onslte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Bo TERRACE HEIGHTS S,/D; BLOCK 1, LOT 18 ParcellD:. , WeII typo PRIVATE If A, B, or C provide PWSID# N`/A Date completed 9,/19,/1980 Sanitary seal (Y/N) YES Total depth 180 ft. Cased to 180 ft. FROM WELL LOG Date of test 9`/19`/1980 Static water level 130 .ft. Well production 4.0 g.p.m. WATER SAMPLE RESULTS: Coliform; {~ colonies/100 mi. Arsenic:l"~ r~7 ug./L. SEPTIC/HOLDING TANK DATA Tank Type/Material HOLDING,/STEEL Tank size 4000 .gal, Number of Compartments 1 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Niirate I~, ~Smg.JL. Date of sample: 3/5`/2009 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 3`/6`/2009 14 2 ,ft. 0.98 .g.p.m. Other bacteda ~ colonies/100 mi. Collected by: GE(:; Ltd. Date installed ' 5,//21/1992 Cleanouts (Y/N) YES High water alarm (Y/N) YES Date of pumping Pumper AROUND THE CLOCK PUMPING ABSORPTION FIELD DATA [HOLDING TANKJ Date installed Soil rating (g.p.d./ft2or ft~/bdrm) System type Total depth ft. Eft. absorption area ft2 Monitoring tube ~--"'~Depression over field Date of adequacy test Res~ ~ For bedrooms / · Fluid depth in absorpt'on r~ ~eld~in. Water added ' gal. - New depth in. Elapsed Time: ~ Final fluid depth in. Absorption rate >= gp.d. ~treatment (past 12 mo.) (YiN & type) NONE KNOWN 'If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N~ _--.- "Pump on" level at ~1 at__ ~ ~ C~ts alarm & circuit requirements?. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer/septic service line Animal containment areas. N/A N/A N/A 25'+ 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank 75'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTI~iNG TANniN LOT TO: Building foundation 5'+ Property line 5'+ Absorption field Water main N/A Water service line 10'+ Surface water. Wells on adjacent lots 75'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: N/A 100'+ JHOLDING TANKJ Property line Building foundation. Water main Water service line Surface water ' ay, parking/vehicle storage Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. CARNESS Date ~l J-~/0 ~ COSA Fee $ '~ Date of Payment Receipt Numbe~)O~/qq (Rev. 11/05) Waiver Fee $ Date of Payment. Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage, ak.us (907) 343-7904 Water Well Advisory, Certificate of On-Site Systems Approval (COSA) # 090061 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 18 of Terrace Heights subdivision, the well's productivity was determined to be 0.98 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3-bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.munLorg/onslte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR .b, SINGLE FAHILY DWELLING cos 05;;zq 1. GENERAL INFORMATION Expiration Date: / '-- ~" ,~- ~) '~' Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency TERRACE; HEIGHTS SUBDN1SION; LOT 18~ BLOCK 1 7840 UPPE;R DeARUOUN ROAD * ANCHORAGE, Al( 99511 MICHAEL BRICE; Day phone 344.-9312 PO BOX 112322 * ANCHORAGE;t AK 99511 Day phone Mailing address Real Estate Agent Mailing address ~MT MACKEY-HORNAK w/ RE;MAX PROPERTIES Day phone~ 110 W. 38th AV~. SUITE 100 * ANCHORAOF. AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well ~r~ Individual Water Storage Community Class Well [~] Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ~ Individual Holding tank Community On*site [~] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewatar 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4, STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installafion. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 537-6179 Date Engineer's Comments: In conducting this evaluafion, GEG, LtD. attempted to provido a thoreugi~, conscientious engineering analysis of the system in accerdance with ADEC and MOA DSD Guidelines & Regulations. The repoded results described the performance of the system under the conditions enconntered at the t~Yne of the test, and separation distances measured lo readily identifiable features. The operational lifo of alt wells and septic systems depend on the local soils condition, groundwater levels that may flucfuate during the year, and the waler usage of the family being served by the system. These condilions are outside the control of the evaluator of the system. Satisfacfery test results do nol guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continua to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon er use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE ~ Approved for "~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: f~,~." ,ti ~4~' ...,-~.u,~ ti' .... IF ...... .............. ~; ON-SITE E~: WATER AND ~ [ WASTEWATER Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: / O '" .,T).,..~'-- O ~ Municipality of Anchorage ~ Development Services Department OmSlta Water & Wastewater Program 4700 Bragaw elmer P.O. Box 196650 Anchorage, AK 99519-6650 w~v.muniJ3fg/onslte (9o7) 343-?9o4 CERTIFICATE OF 0N-SITE SYSTEHS APPROVAL (~HECKLIST Legal ~tion: TERRACE: HEIGHI~ SUBDNISlON; LOT 18, BLOCK I Parcel ID: A. WELL DATA Well ~ I~'A~: If A, B, or C pmvlda PWSlD~ N//A Date completed 9/~9/~9eo, Sanitary eeat(Y/N) YES Total dapth 160 lt. Cased to 180 ft. FROM WELL LOG Date of test 9//19//1980 Static water level 130 ft. Well production 4.0 g.p.m. WATER ~MPLE RESUI.'I'S: Coliform 0 colonies/100 mt. Amenic: ~J~_ ugJl.. SEPTiC/HOLDING TANK DATA Tank 'rype/M~tedal HOLDIN0//STEEL Tank size 4000 gal. Number of Comparlmants 1 F~undation deanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 9//5//2006 Pumper Oate of eample~~ wal L~g (Y/N) YEs Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION ~o/o/2ooo 128 ft. 1.09 g.p.m. Other bacteda 0 ooloaiesJl O0 mi. Collected by: OEG~ Ltd. Date In~tetled 5/21/1992 High water e~ (Y/N) YES ISAAC'S PUMPING AB$ORFTION FIELDDATA HOLDING TANK Date installed Soil radng (g.p.dJft~or flYodm~) System type ~ Lengm ft. Widm~ ,ft. ~ ft. To,~ ~epm .~ E...~o~,o..roe .= M~_~____J.t~ Oep~.~. ove,~ Res ult~./,pas~'all) For bedrooms Date of adequacy test , _ Fluid depth in absorption ~ Water added gal. New depth Elapsed ~ Final fluid depth in. Al)soq3tion rate >= g.p.d. .;~3y,reJ~enation treatment (past 12 mo.) (y/N & type) If yes, give date D. UFT STATION ate instellad Size in gallons Pump on" level at in. 'Pump off" . High water alarm level et ~ Cycles tested. Meets alarm & circuit requirements?. Absoq~Uon field on lot Public sewer main Sewer/~eptlo ee~ce line ,Animal containment ames E. 6EPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tenlulilt station on lotN/A ./^ ./^ 25'+ 50'+ On adjacent lots lO0"f On adjacent lots 100'+ Public sewer manhole/cteanout N/A Holding tank 75'+ Manure/animal excrete storage ama,, 100'+ SEPARATION DISTANCES FROM SEPTI~INO T~C}N LOT TO: Building foundation ~'~ Property line 5'+ Absorption field N/A Water main N,/A Water service line 10'+ Surface water 1 Wells on adjacent lots 100'+ HOLDING SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Pro~en'y line Building foundation. Water main Water sewice line S~parking/vehicle Curts' ' Wells on adjacent lots TANK F. COMMENTS O. ENGINEER'S CERTIFICATION I certify ~at I have determined through field k~pect~x~ and date. ~g~ee~ P~ ~ J~ ~ ~N~ Da, I o/~o/0 ~ cosA Fee s Date of .aymant Receipt Number (R~v. ~ Welver Fee $ Date of Payment Receipt Nun~er AS-BUILT Lot 18, Block 1, Terrace Heights · ' CONSTRUC'I3ON SURVEYORS-PLANNERS-ENGINEERS West Benson Boulevord0 Suite 200 Phone: ~nchoroge, Alaska 99503 Fax: 66-82 ~k~ 2940 o~c. 2006L2~ Reft 92L150 No'irt.: "11.11s DRAMNG iS NOT TO B[ M00~F'IED FOR US~ AS A PLOT PLAN, >~r*~ ~ Uichael Bric SURVEY ~ i~CAlION: LA.q~ hae amdueted e ph)mScal .mJrwy ofm~t~ Sept. 28, 2006 NRB Soal*~ 1'-30' e~. APH 907 276 4429 RE/MAX PROPERTIES, 12 O0 O? p.m, 10-10-2006 UPPER DEARMOUN. ROAD 69'54'00" W 87.81' o. 24.2 34,2 ~ EXISTING HOUSE LOT 19 LOT 2 LOT 18 --¥ 10' U~UTY EASEMENT -~ S 89'54'00" E 87.81' LOT 3 LOT 17 POWER POLE LOT 4 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O,'7 -0'73' -3~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Current Property owner(s) Mailing address 7~¥o Lending agency /.Z,~ ~,,~ o~,-.,-~ H AA #/.,//~ ~'"('"("~d//-/./.~ Expiration Date: ~et?. A ~' Day phone Mailing address Real Estate Agent ,j'-~ M~,'¢.~ ?¢,z-o-~! J'e-,-cce ,?¢,,4.~ Dayphone '3'~'~--,~z.~ff MailingAddress ~'lq3 ~ z3,-~ /~,',.., ,+,,c~,o,'?~, ~ ~eC'~3 Unless otherwise requested. HAA will be held by DHHS for pickup. HAA picked up by: NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System Well "5 TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding Tank [] Community On-site [] 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,'cr 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. 72 025 ,Rev 01 001' .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 for 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. 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. o NameofFirm ~'/~Pt~i~ ~-~cA,.,;¢~,/ ..C~,'-,~,~-.,c- Phone Address I~C~ ~c4o ~/'2 ~c4o~ ~ Engineer's Printed Name ~o~o~c ~ /~oo~ Date ~*~ /// __bedrooms. DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: /..-~. - / ,~ - ~' C Original Certificate Date: Reissue Date: 72 025 iRev. O~ 00:' Legal Description: A. WELL DATA Well type F~/' Date completed Total depth Ce Municipality of Anchorage R E C E I V E Department of Health and Human Service~' Division of Environmental Services On-Site Sewices Section 825 '1." Street Room 502 SEP I $ 2000 P.O. Box 196650 Anchorage, AK 99519-6650 www.cL anchorage.ak.us (907) 343~744 MUNIC~PN. ITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL CHECKLIST Date of test Static water level 1 7 o Well production · WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Date of sample: ~/3'o/E. coc~ TAh-- DATA Tank Type/Material /.-fo [,~'f,~,~ / S/-w~/ Date installed ,C/?-!/9 g Tank size Cieanouts ¥ Foundation cleanout '/' Date of pumping ~ / ~. ~. / c~, If A, B, or C provide PWSID # __ 9//~8o Sanitary seal ~4) ft Cased to /~9~, tt FROM WELL LOG ft g.p.m Parcel I.D.: Well Leg Y'a ./ Wires properly protected 'r' Casing height (above ground) / 3' AT INSPECTION t? 5' It I. t"7 g.p.m Nitrate 3. ?'/' mg/I Other bacteria 0 colonies/100 mi Collected by: /~/,,/-/c~ ?~-,~ iN. ~,pc,, gal Number of Compartments I Depression over tank N High water alarm Pumper .~.,~ ~,,c,/' ABSORPTION FIELD DATA M.A. F~,I,~;~ 7~, ~ Date installed Soil rating (g.p.d./f12 or fl2/bdrm) __ Leng1~ ff Width __fl Gravel below pipe Total depth ft Effective absorption area fF Monitoring tube Date of adequacy test Results (Pass/Fall) Fluid depth in absorption field bafom test in Water added Elapsed Time: min Final fluid depth in Any rejuvenation treatment (past 12 mo.) (Y/N & type) System type ft __ Depression over field For bedrooms gal. Now depth Absorption rate >= If yes, give date in. g.p.d. 720~6 (Rev. D. LIFT STATION Date installed 'Pump on" level at __ Datum Size in gallons __ in "Pump off' level at __ Cycles tested E. SEPARATION OISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 4-~,~--' M.,4, · Absorption field on lot Public sewer main Sewer/septic service line in Manhole/Access High water alarm level at __ in Meets alarm & circuit requirements On adjacent lots ~ t4,~ · On adjacent lots ~> too, Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main Drainage '-> t~,c> ' Property line Water Service line Cudain drain F. COMMENTS Absorption field ~'. Surface water ~. Properly line 3 I' Water service line ~ ~o' Wells on adjacent lots :> '~,f-' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: A/. ,,k Building foundation Surface water Wells on adjacent lots __ Water main Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Murdclpal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name -'/~-,~'o~'¢ F. /woo~-c Date E~p~' //~ Zoc~ Waiver Fee $ Date of Payment Receipt Number 72.026 (Rev. 0 UO0)' MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# ~c~ 5)-~ ~ GENERAL INFORMATION Complete legal description Location (site address or directions)' ?~7~'¢," ~ap~,- 0¢ ~-~o~ Ro( Property owner ('on ,~c.~,,4¢' ~:~e~ ~ ~ -' Mailing address ~'.0. Lending agency F:~,~ " ' Mailing address " Agent Address Day phone ' 3'/~-- Day phone Day phone '~?Y '~'/~a 4 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ,~. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I 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. NameofFirm ~=1,~'~,~, 7-¢c.~nt'¢,~l ,,.ce,,-~'c~' Phone.. ~'~'5-- t3'..~,~" Address Engineer's signature '~T'~ ~ ~ Date ..~'-/~/P2 DHHS SIGNATURE Appr. o.ved for Disap'l~roved. ;;5'~,,,~., ~/~',~' ) b ed rooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Mun cipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /-, t~, B/h' .~ ~, 7~rr~c~ ~f'.J' Parcel I.D. A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal If A, B, or C, attach ADEC letter. Date completed Casedto I~O' FROM WELL LOG Date of test Static water level ~ ~ t Well flow ' ' '~' Pump level -- AD_.E~C.~w, ater system number Driller Casing height Wires properly protected (Y/N) AT INSPECTION g.p.m. 661t t f l~ t,%l' y,~ MuNtcIPALITY'OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISlO~ I:!AY 2 2 1992 g.p; ECEIVED' SEPARATION DISTANCES FROM WELL TO: ~holding tank on lot t Absorption field on lot N. Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots '~, loot Public sewer manhole/cleanout N. Petroleum tank WATER SAMPLE RESULTS: Coliform t9 eof Ii'ocli.( Nitrate Date of sample: q [l~'/'~ ~. Collected by: Other bacteria ~ col B. S~II~I~I~/HOLDING TANK DATA Date installed , -"-~'~/'~ I I ? ~. Tank size ~OO~ ~,c~l Compartments I .~ *~ ';,,./ ~..*. Cleanouts'{Y/,N)' ,'"r',;, Foundation cleanout (Y/N) '1" ~ Depression (Y/N) High w. ater I~larm (Y/N) '"'"' Alarm tested (Y/N) ~ '~' Date o~ pumping /V. ~.. (_-/Y4c,J~) Pumper ~J. ~', SEPAR~TIO.N D. ISTANCE. S FROM,, SEPTIC/HOLDING TANK TO: Well(s)oni~)t," IO,.5"--.-. On adjacent lots ~. lC'o' Foundation 'To propertyllne " Surface water/drainage · Absorption field t¢'~ ~ " N,A.' .... Watermain/serviceline ' ~ ~O~ 72.026 (Rev. 7/gt) Fronl CONTINUED ON BACK PAGE C. LIFT STATION N, ~,'. Date Installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) - SEPARA3:ION DISTANCE FROM LIFT s:r~,¥1(~N TO: Well on lot · On adjacent Ioi~ D. ABSORPTION FIELD DAT/~ f{,~, Manufacture~' Manhole~Access (Y/N) "Pur~p off" leve at Cycles tested Surface water Date installed " Length ' ' Width · iTotal absorpt on area. Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) {Y/N) Soil rating System type Gravel thickness . .Total depth .. Cleanouts present (Y/N) Date of adequ, acy test for If yes, give date bedrooms Well on lot To building foundation On adjacent lots Surface water Curtain ~r~in' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: On adjacent lots Property line To existing or abandoned system on lot Cutbank 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 HAA Fee $ I'~0 ' Date of Payment '~,/~--'~ f cr',~_,./'" ~ 72-02~ (Rev. 3/91) BeCk MOA 21 Waiver Fee: $. Date of Payment .. Receipt Number .~ INSPECTION APPOINTMENTS 'IME TIME TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGE ~UNICIPALI~ OF AN~O~GE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT- OF 825 L Strut - A~hora~, (~ ENVIRONMENTALTele~oneSANITATION~47~ DIVISION~ ff I ~ Ir~DEC 1 1980 PHONE 1, PROPERTY OWNER PHONE PHONE MAI ING ADDRESS lB. LEOAL DESCRI"TION 6. TYIE (~: RESIDENCE NUMBER OF~BEDROOMS [] One [] Four ~;"'~SINGLE FAMILY [] ,,,,Two [] Five [] MULTIPLE FAMILY ~ Three [] Six [] Other ?. WATER SU LY INDIVIDUAL° [] COMMUNITY [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.} 8. SEWAGE DISiK)SAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 721010 (R~v. 6/79) _, THIS SIDE FOR OFFICIAL USE ONLY ' ~ · 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY I'-'1 INDIVIDUAL · [] COMMUNITY I'--I PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM I-'lIN DIVIDUAL/ON -SITE r-IPUB LIC UTILITY Connection Verified I'")Septic Tank or I-'lHolding Tank Size: If Tank is homemade give dJmenslons: TYPE OF TANK NUMBER OF BEDROOMS 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE I--I THREE [] FIVE [] TWO I-'1 FOUR [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER BOLLS RATING ' MANUFACTURER TOTAL ABSORPTION AREA MATERIAL SepticJHolcling Tank Absorption Area JSewer Line. [] OTHER 5. COMMENTS DATE [~"~PPROVED FOR . '~ BEDROOMS r-'l CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72.010 (Rev. 6/79)