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HomeMy WebLinkAboutDEARMOUN #2 BLK 2 LT 14becirmoun #2 Block 2 Lot 14 #018-401-43  Municipality of Anchorage Development Services Department Building Safely Division On-Site Water and Wastewater Program. 4700 S. Bmgaw SL P.O. Box 1~6650 Anchorage, AK 99519-6650 Page of www. ci.anchomge.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. ~5 (3~O 3'Z(~ PID Number: ~ EIIE.~ ~z~:,~_[a~oz~k~' WastewaterSlfstem: [-'lNew I--IUpgrade 13ct00 Don~.~.~ $~-r..¢Ji- ~g.i~;,n...,q ABSORPTION FII=Ln LEGAL DESCRIPTION ~,~,,~. R. PL Ft, Ft, Well: ~.y.i~l~,~ [] New [] Upgrade ~,~t~ R. ~ ~[ r~ TANK SEPARATION DISTANCES I~,~p~c I'-lH~ing [] S.¥.E.P. Fmm~ Septic Al~o~p~ Lift Holding ~ub~ic/Pri~ate .... ~ Capa~ Tank Field Slafiol~ Tank Sewer Line AI'~-~'IJ3~ ~.. 'T~.n s~w~ ~00'+~~'/l LIFT STATION BENCH MARK ,nspections performed by: L"a~'~ SDu~[~-t"~,f~C~ Dates: 1st [ i'4-O1~ ~ ..4O, TH ~ ,:.- ,/ ' Development Services Department Approval Revievw~ and Approved by: ¢~/./~_ ///~ Date: i'- / O --t9 7 LIlT LIlT ]0 LIlT 9 LIlT ]3 ~ LIlT iS 50 75 100 125 150 SCALE, I' = 50 ET, A B 19' 7' $7' 42,$ I;PURl(LAND EN¢INE£RINO 2os .' ~$TN. AVENUE (907) 279-$9~6 PERMIT # ANDROMEDA ROMANO-LAX 15900 DONALD STREET SEPTIC SYSTEM ASBUILT I DATE: DECE, BER7,2OOSI SNEET,' I/2~ GRIm2935I PID # · Sp d urklan Engineering Environmental Consulting and Design Municipality of Anchorage Development Services Department Building Safety Division On Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519 September 7, 2006 Subject: WAVIER AMENDMENTS LOT 14 BLOCK 2 DEARMOUN #2 Gentlemen: I am writing to request amendments to the separation distance waivers for the well on Lot 14 Block 2 Dearmoun #2. On October 29, 1990 a waiver was granted reducing the required separation between the well and septic lank on the above referenced lot to 80 feet. The absorption field was not listed in the waiver. On August 18*h, 2006 the measured distance between the absorption field monitor tube and the well was approximately 96.5 feet. It is unlikely that the nearest comer of the absorption field is closer than 80 to the well, as the previous analysis indicated that the risk of contamination at a separation of greater than 80 feet was minimal we request that the absorption field be added to the waiver. On lvlay 1 a, 1996 a waiver was granted reducing the required separation between the well on lot 14 and the septic tank on lot 13 to 95 feet. It is possible that the nearest edge of the absorption field serving lot 13 also encroaches upon the 100 foot well mdins of lot I4. Adding the existing drain field to the existing 95 foot waiver should clear up any ambiguities regarding the separation distance requirements for the well serving lot 14. If you have any questions, please contact me a 279-3916. Sincerely, Spurkland Engineering 203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng~gci.net MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519~6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Date Issued: Oct 05, 2006 Expiration Date: Oct 05, 2007 Permit Number: SW060326 Legal Description: DEARMOUN #2 BLK 2 LT 14 Design Engineer: 0007 SPURKLAND ENGINEERING Owner Name: ELLEN BIELAWSKt Owner Address: 13900 DONALDS STREET ANCHORAGE, AK 99516-3530 Parcel ID: 018-401-.43 Site Address: 013900 DONALD'S ST Lot Size: 23727 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. - (EMERGENCY TANK REPLACEMENT) - SEPTIC TANK INSTALLATION MAYBE LOCATED NO LESS THAN FIVE FEET FROM ANY PROPERTY LINE OR BUILDING FOUNDATION; TEN FEET FROM ANY WATER SERVICE LINE; ONE HUNDRED FEET FROM ANY SURFACE WATER; AND ONE HUNDRED FEET FROM ANY PRIVATE WELL; AND THE SEPARATION DISTANCES REQUIRED BY 18AAC72 FROM WATER SUPPLY WELLS. Received By: __ ~ Issued By: ~j/"~, Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bmgaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www. muni.org/onsite (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Day phone Zip Code Zip Code Property owner(s) ~l[~o. Mailing address S,teaddre s Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size ~-~),~ ~/'~ Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR ([~;] all that apply): THIS APPLICATION IS AN: Absorption Field [] Initial Septic Tank '~ Upgrade Holding Tank [] Renewal Privy [] Private Well [] Water Storage [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signel~'u~e'~of pr?p?d~o~ne~~ gent) Permit/Rush Fees: Date of Payment: Receipt Number.' (Rev. 11/05) Waiver Fees: Date of Payment: Receipt Number: Environmental Consulting and Design SEPTIC SYSTEM DESIGN DEARMOUN #2 BLOCK 2 LOT 14 Municipality of Anchorage Development Services Dq~artment On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 September 21, 2006 Subject: Septic Tank Installation Permit Dearmoun #2 Block 2 Lot 14 Ladies and Gentlemen: I amwritingtorequest a septictankreplacementpermit. The existin~tankwas installed in 1973 andis only77 feet from the well. The proposed location of the new tank is greater than 100 feet fi.om the well serving this property and meets all the setback and s~aration distances required by AMC 15.55 & AMC 15.65. Surface Water: No surface water was observed with one hundred feet of the proposed septic tank location. The installation of this septic tank will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoffwill not result fi.om this installation. If you have any questions or concerns, please contact me at 279-3916. Slnc~rely, Civil Engineer th o 203 West 15 Avenue Suite 203, Anchorage, AK 99501, Phone. (907) 279-3916 Fax: (907) 276-6013, SpurldandEng~gci.net L£T 1£ LOT ~0 LOT 9 25 0 25 SCALD 1' = 50 FT, m m Well ~ANK LOT 15 ~EXI' SPURKDIND ENGINEERING 205 W 15TH. AVENUE 4NCH. AK. 99501 (907) 279-5915 ANDNOMEDA RONANO-LAX 15900 DONALD STREET SEPTIC SYSTEM DESIGN DATE: SEPT. 21, 2006 SHEET: l/2 GRID:2935 PERMIT # PID # DEARMOUN#£b£U41.DWG CONNECT TO / EXISTING CRIB 3 FEET COVER (MIR) CONNECT TO EXISTING LINE 1008 GALLON SEPTIC TANK SPURKLAND ENGINEERING il 203 ~lSth Ave Anchorcge Ak 99501 P7~-flDI6 DEARMOUN ~t~ BLOCK 2 LOT 14 ANDROMEDA ROMANO-LAX SEPTIC SYSTEM DESIGN J PERMIT t~l SWO~OOXX PANOEL ID t~t { GRE R ANCHORAGE AREA BOI JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL~.~L'~ "/¢ MANUFACTURE~L~ MATERIAL~-~ NUMBER OF COMPARTMENTS INSIDE LENGTH ~ INSIDE WIDTH ~ LIQUID DEPTH LIQUID CAPACITY t~)<~) (~ GALLONS. SEEPAGE PIT: NUMBER OF PITS I DIAMETER --OR WIDTH ~L~, LININ M ~--- 'O~J¥"l~J G A.~HIAL~ CRIB SIZE: DIAMETER BUILDING FO U N DATIONL'~(."~~' · , NEAREST LOT LINE ~ 9 '~ ADDITIONAL ABSORPTION LENGTH ~I, DEPTH DEPTH (0~ DISTANCE FROM~ WELL TOTAL EFFECTIVE WELL: TypE~.~C) f~'~l~'~U N 1'"¥~,] CONSTRUCTION :; ~BUILDING NEAREST FOUNDATION __ LOT LINE -:~ESSPOOL APPROVED OTHER SOURCES DISAPPROVED DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE TANK SYSTEM REMARKS DISTANCES'~ SV 0 ~''~ ~ INSTALLED By:?3i !! Z'",)~I/2 -~-~,~~'',, SLOFE: REMARKS..~ DIAGRAM OF SYSTEM GREATER ANCHORAGE AREa BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT iNSTALLATION OF: SEPTIC TANK / SEEPAGE PIT / , DRAIN FIELD FINANCED THROUGH TO BE INSTALLED BY ~ g~-~/~- SO,L TEST RESULTS /-~2w~/v/'- PHONE , OTHER NOTE: THIS PERMIT lB NOT VALID WITHOUT ~OIL TEB~ FINAL INSPECTION: 24 HOUR NOT~CE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE MINIMUM DISTANGE~, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~.~ ) FOUNDATION TO SEEPAGe' PIT ~ ~) SEPTIC TANK TO SEEPAGE PiT WALL /',~ / TO NEAREST LOT LINE. WELL TO SEPTIC TaN~ /[)~ / ) ALSO CONSIDER AREA WELLS. , SEEPAGE PiT SEPTIC TANK. 6~ SEEPAGE P'T /~') ) DRAIN FIELD TO RIVER, LAKE* STREAM. EXCAVATION S FEET INTO UNDISTURBED SOIL. DIAGRAM OF SYSTEM GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. ,y-l~-? A,PLIOA.T', "O.e te~ is voor~h a t~housand opinions" Performed For ~'dO~,v~ //~//Xd~AiJ .Date Performed ~-~/-'7_3 Leoal Oescrirtion: Lot /Z?eBlock ~-~Subdivision /~/flw~J This Form Renorts Soils Loo m~cg- Percolation Test Qeoth Feet Soil Characteristics Was Ground Water Encountered? /.~/~ ~?o^ I¢ Yes, At what Denth? Readin~ Date Gross Time Net Time Depth to H20 Net Dron Percolation Rate Hinu~e Proposed Installation: Seepage Pit Draim Field De~th of Inlet Denth To Bottom Of Pit Or Trench Z~ ~,~ Date, ~ ~-/- 7~ ' RECEIVED PERMIT NO. MUN I C I PF~L I TY OF Rr~CHORRGE DEPRRTMENT OF HERLTH 8ND ENVIRONMENTRL PROTECTION 825 "L' STREET, RNCHORRGE, RK. 99501 2E, 4-4720 i~IIELL PERI"1 I T 80010~ ) RPPLICRNT HRROLD W. DERRMOUN BOX868 WRSILL8 RK. 376-5511 LOCRTION 3/4 MI DERRMOUN RD. LEGRL LOT SIZE 21780 SQUARE FEET MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS 100 FEET FOR R PRIVRTE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC NELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO 8 PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS RRE REQUIRED RND MUST BE RETURNED TO THE DEPRRTMENT WITHIN 30 DRYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MRY RPPLY. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. PERM I T E:~P I RES DEI__.~EMBER I CERTIFY THRT l: I 8M FRMILIRR WITH THE REQUIREMENTS FOR ON-SITE SEWERS 8ND WELLS RS SET FORTH BY THE MUNICIPRLITY OF 8NCHORBGE. 2~ I WILL INSTRLL THE SYSTEM IN 8CCORDRNCE WITH THE CODES. V4. 0 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907-343-7904 On-Site Water and Wastewater Section Fax: 343- 7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Advisory Certificate of On-Site Systems Approval # OSC201176 Subdivision: DeArmoun #2, Block: 2, Lot: 14 A water sample revealed a nitrate concentration of 10.8 milligrams per liter (mg/L). 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Fact Sheet 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. Jeff Garness From: David Harper <dlharper2@gmail.com> Sent: Wednesday, April 22, 2020 5:23 PM To: Jeff Garness Subject: 13900 Donalds Street Anchorage, Alaska Hello Jeff. The well serving the above address has been viewed with a down hole camera. No breaks or incoming water was found when the camera was lowered to 50 feet from TOC. We also ran a dry napkin above the camera and it was retrieved dry. David Harper Aarow Pump & Well Service, LLC h Parcel I.D. Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 018-401-43 Certificate of On-Site Systems Approval Expiration Date: GENERAL INFORMATION DEARMOUN #2 BLOCK 2 LOT 14 Complete legal description 13900 DONALD ST Location (site address) BRIAN LAX Current Property owner(s) Day phone Mailing address Real Estate Agent AMBER HEVERLY 240-3444 Day phone 2. TYPE OF DWELLING: [] Single Family (w/we ADU) [] Duplex [] Multiple Dwellings (Single Family and/or Duplex) 2 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well [] Individual Water Storage [] Community Class __ Well [] Public Water System [] TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank Community Public Sewer W. ~ . ~ ...- NONE alver/vanance request for: , · J r,,v,,X'>,,,,~' i/,\g,k Received by: j u x~,,:% f¢~'~ ~ COSA to be release~ineer, unless othe~ise requested by the engineer. Distance: Date: COSA Fee $ (""~0 '~' )ateo, Payment Receipt Number O'"'"J ~"~'""'~ ~ COSA # C)~C. I "P'D I ~ Waiver Fee $ Date of Payment Receipt Number 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 SPURKLAND ENGINEERING Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND DSD SIGNATURE ~/'~System #1 Approved for ~ bedrooms System #2 Approved for __ Disapproved Conditional approval for Phone 279-3916 Date 10/22/13 · A bedrooms bedrooms, with the following stipulations: By: .-- ~/~/? Original Certificate Date: / ~ "~-~ ~ "/-~ The ~a~l~i~ ~;ge Development Sen,,ices Division (DSD, issues Ce~tificate, 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 engineeCs work. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory X Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: DEARMOUN #2 BLK 2 LT 14 018-401-43 Parcel ID: A. WELL DATA Well type PRIVATE IfA, B, or C provide PWSID # -'- Date completed 11/1980 Sanitary seal (Y/N) Y Total depth 76 ft. Cased to 76 ft. FROM WELL LOG Date of test 111/1980 46 Static water level Well production 10 WATER SAMPLE RESULTS: NEG Coliform colonies/100 mL ND Arsenic gp.m. 8.29 Nitrate mg/L 10/15113 ug/L Date of sample: Y Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 18+ AT INSPECTION 10/22/13 45 6.5 Collected by: in, ft. g.p.m. ANSON MOXNESS B. SEPTIC/HOLDING TANK DATA SEPTIC)STEEL Tank Type/Material Tank size__1000 gal. Number of Compartments 2 Foundation deanout (Y/N) Y Depression over tank (Y/N) N Date of pumping November 2013 Pumper A+ Home Services Date installed 10/17/06 Cleanouts (Y/N) Y High water alarm (Y/N) N C. ABSORPTION FIELD DATA Date installed 5~73 Soil rating (g.p.dJft2 or~/bdrm) 85 Length 21 ft. Width 16 ff. Total depth 12 ft, Eft. absorption area 444 ~ Monitoring tube Date of adequacy test 10/22/13 Results (Pass/Fail) PASS Fluid depth in absorption field before test__55 in. Water added Elapsed Time: 140 min. Final fluid depth 67 in. NO Any rejuvenation treatment (past 12 mo.) (YIN & type) System type CRIB Gravel below pipe 6 ft. Y N Depression over field __ 2 For bedrooms 340 gal. New depth 71.5 in. 300 Absorption rate >= g.p.d. If yes, give date D. LIFT STATION Date installed -- ''Pump on" level at -- Datum --- Size in gallons -- __ in. "Pump ofF' level at -- Cycles tested --- .in. Manhole/Access (Y/N) -- High water alarm level at --- Meets alarm & circuit requirements? --- in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 96'* Absorption field on lot NA Public sewer main 25'+ Sewer/septic service line Animal containment areas 100'+ 50'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ NA Water main 100'+ Wells on adjacent lots ABSORPTION FIELD ON LOT TO: 10'+ Property line 10'+ Water Service line 50'+ Curtain drain 100'+ On adjacent lots 100'+ * On adjacent lots Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100'+ St+ Property line 10'+ Water service line . 5'+ Absorption field Surface water 100'+ 10'+ Building foundation Surtace water 100'+ Wells on adjacent lots 100'+ 1NA Water main 50'+ Driveway, parking/vehicle storage F. COMMENTS * WAIVER ON FILE 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 LARS SPURKLAND 10/23/13 Date COSA brown sheeL10-10-12.doc Municipality of Anchorage Community Development Department Development Services 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 # 131559 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 14 of Dearmoun #2 subdivision. This inspection revealed a nitrate concentration of 8.29 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. UT/L,, .% /JS. ° W LOT/5 50 Lot /~ , Block ~ Anchorc~ Recording Di*trict~ Alasko .LOT SURVEY CERTIFICATION LEGEND Brass or Aluminum capped monument reoovered 0/-C~'07 0 Iron pipe and/or rebar reoovered. 2 x 2 hub & taok reoovered · 5/8" x 30" rebar set this survey x , Fence Line (Approx. Location} Ret Date © 07-20-c FB. No. Prepared by: [$o7)z79-6200 B.t. BUTTON t?egistered l~nd Surveyo~ 519 W. £/ghfh Ave, ~e Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and 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 ParcelI.D. OI8,- 'tol- '1~, 1. GENERAL INFORMATION Complete legal description Location (site address) 13qoo COSA # Expiration Date: ~lk ?. /--olL [~/ CurrentPropedyowner(s) EIt¢,, ~;,-I~,~.,s k,; Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: '2. 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 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 cedified 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. Address 203 ~J. I~k: ~T~_. Zo3; ,,4~chor~,%, ,,,~K Engineer's Printed Name bedrooms. 5. DSD SIGNATURE /--"" Approved for ~ Disapproved. Conditional approval for Date .~,~loJr. "~'1 ~ ~ OF bedrooms, with the following stipulations: ~'; WATERAND ; mc = ; WASTEWATER ; - Attachments: COSA Checklist Septic System Advisory Weft Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: i - / O ~ O "~ (Rev 11/05} Municipafity 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 CHECKLIST Legal Description: ~34-~,~o~,~ '~7.. (~tK 7_ Lo{' ]~ Parcel ID: Ot~- ~/-~:7/~2 A. WELL DATA Well type Date completed A/'~,V Total depth -~ ft. If A, B, or C provide PWSID # -' Well Log (Y/N) %// Sanitary seal (Y/N) Y wires propedy protected (Y/N) Cased to -Jrt, ft. Casing height (above ground) ~-I~. FROM WELL LOG AT INSPECTION Date of test A/or [citgo Static water level 4~ I ft. -~O ff. Werl production IO g.p.m. (o ...~ g.p.m. in. WATER SAMPLE RESULTS: Coliform ~_/.c°l°nies/100 mL Nitrate .~.~ mg/L Other bacteria .,~ colonies/100 mL Arsenic: Z~ j~/~'~' Date of sample: ~-I~-o~, Collected by: L.~, B. SEPTIC/HOLDING TANK DATA Tank Type/Material .~'~¢-~ / ~,~ f~.l Date installed ~/l?7- Tank size Iob~) gal. ~, Number of Compartments ~- CleanOuts'(Y/N) Foundation cleanout (Y/N)..,~' Depression over tank [~r/r~.] /V High water alarm (Y/N) C. ABSORPTION FIELD DATA Date installed 5/:~.~ Soilrating (g.p.d./f~orft~/bdrm) ~' Systemtype Length 7, [ ft. width I G ff. Gravel below pipe ~, ff. Total depth I ~- ft. Eft. absorption area ~ ~1~ f~ Monitoring tube "~ Depression over field/V/ Dateo, ade. uac test Resu,ts(Pass/Fa,) For bedrooms Fluid depth in absorption field before test ~/o in. Water added ~'70 gat. New depth_ -~ ! in. Elapsed Time: "~'.~ min. Final fluid depth [/~,~ in. Absorption rate >= ~2eO g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /V'o If yes, give date - D. LIFT STATION Date installed J "Pump~ in. E. SEPARATION DISTANCES Size in gallons "Pump off" ~1~~. Cycles~d Manhole/Access (Y/N) High water Meets ~.&'"circuit requirements? in. 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 /V'.o. On adjacent lots 9S On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas /~. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~' ~ ' Property line > lot Absorption field Water main /V'/A Water service line 7 I0 / Surface water Wells on adjacent lots ),tOO ~ /V.o. ~5o~ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~ t0~ Water Service line ~ I0 I Curtain drain /V*. O. F. COMMENTS: ~'~' /qea~r~J Building foundation ~1o ~ Water main A//A Surface water /V'. o. Driveway, parking/vehicle storage Walls on adjacent lots 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. EngineeCs Printed Name L3m COSAFee $ Date of Payment 9 -- '"'~- 0 ~_o Receipt Number ~ ~-' ~ ~) -~' ~ Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 060435 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 14 of Dearmoun #2 subdivision. This inspection revealed a nitrate concentration of 5.87 milligrams per liter (rog/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 S 89° ..~'O:P"~ ..~ /~_5. ~ ET/L. , -~ ~x ~~ d~ VEO ~,,,~ I O~ ~y EOT 15 ~,- ~, /d ~loo~ ~ ~:- .... :..~.:~:..,:...~;.. Anchoro~ Recording District, Alosko [~..=.nt. of rIeor~ etb~ then ~eM LOT SURVEY CERTIFICATION LEGEND , I ~ ~tlfy t~t I~ve ~veyed the ~ep~fy shown end ~scrlbed ~ ~ass or Aluminum ca,ed monument recovered ~ i~ ~ ~j~nt ~y ~ep or en~oh ~ t~ pmm{~lt · 5/8" X ~" rebar set this survey ~tl~ ~ ~t ~ are no madwoye, utility I~. ~oth~ villble X ~ Fence Line (Ap~ox. L~ation} S~le/ .zz~ ~, Date Pre.red by: 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 Parcel I.D. # O!q~ - qC~\ -- L~'~ '.~ GENERAL INFORMATION Complete legal description Location (site address or directions) ! % :~ ¢'~ ~ o f'-i ~, L% .%-F fZ. '~ ~. '~- Property owner 'F'~t)~)'-¢ ~Ntq -T-F_P!T~LL~ Mailing address Day phone Lending agency Mailing address Agent "~A~.~Z~A- Address D ~d;~ Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community we!l Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 structu re 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 T-oS~Et,.i ~'¢~-\~L,~t-¢~ ~. Phone ~-7~'-%°,~o' Address ~0 7> ~ / ~-¢-.~ h¢ ,¢-0 ~ Engineer's signature Date / DHHS SIGNATURE ~,~ Approved for '~-'-- Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: AdditionalComments Note: The well for this property meets existing Stat~ and Municipa~-~Codes. There are nitrates present. It is su~s%ed that a ~er~iodic testing be performed to insure the wells is 7.05 mg/1. EPA 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 DH HS 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. MUNiCiPALiTY OF ANr~H(J~U4~t: [=.NV[RONMENTAL SERVICES DIVISION Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES APR 1 5 1996 Environmental Services Division 825"L" Street, Room 502. Anchorage, Alaska 99501. (907)343-47R E C E IV E Health Authority Approval Checklist LegalDcscription: LOT Iq:l A. WELL DATA Well type Log present (Y/N) Total depth Sanilary seal (Y/N) Date of test Static water level Well production IfA, B, or C, attach ADEC letter. ADEC water system number Date completed NO I,/ J q ~ Cased to 7~ i Casing height (above ground) y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION lq il WATER SAMPLE RESULTS: Coliform ¢ Date of sample: ~'/-- ~'~-- Nitrate Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed ~-O/~q~'m Tank size /~ Foundation cleanout (Y/N) ~ Depression (Y/N) Date of Pumping "3'//~/~ & Pumper C. ABSORPTION FIELD DATA Number of Compartments ~ Cleanouts (Y/N) . High water alarm (Y/N) Date installed O~-/I~V'~ Soilrating (g.p.d./fl2orfl2/bdrm) ~ Systemtype~¢ Length ~ Width J~ Gmvel~cb~sbelowpipe ~ Tot~depth 8,~ I Effective abso~tion area q qq Mo~tofingTubepresent(Y~ y Depressionoverfleld~ N Date of ad~ test U/~/q~ Resets ¢ass~l) ? For ~ b~ooms Fluid depth in abso~don field before test (in.); ~ I~iately ~er ~g~. wa~r add~ (in.): ~ Fluiddepth ~ (ins.) Minutes later: ~ Absomtionrate = ~ ~ g.p.d. Peroxide tma~ent (past 12 months) (Y~ ~ ~ yes, give da~ D. LIFY STAT1ON ~'4~ Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Damm Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holdiag tank on lot ~ O l Absorption field on lot Public sewer main Sewer/septic service line ; On adjacent lots ; On adjacent lots ), IOt9 Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: t Bmlding foundation 5 Property line '~ I 0 [ Absorption field Water main/semice line >~ Surfacewater/drainage ~/g;O Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 3 ~ I "1' Water main/service line 7 ~ ~ I Surface water ~ I ~) ~ ~,~,4 ]~'0 Driveway, parking/vehicle storage area ,~ ~.. ~ i Curtain drain 1~4 I I~) Wells on adjacent lots .~ I Or3 1 Property. line ~ ~ F. ENGINEER'S CERTIFICATION ~'- ! certify that 1 have determined thrufield inspections and review of Municipal record~ that (he h~o~e systems are in conformance with MOA ~ guidelines in effect on this date. S*a re Date HAAFee $ ,~,~ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 May 1, 1996 Tobben Spurkland, p. E. 203West 15thAvenue #203 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 14 Block 2 De Armoun Subdivision #2 Waiver Request #WR960016, PID #018-401-43, HA960145 Dear Mr. Spurkland: Your request for a waiver of the required 100 foot horizontal separation of a private septic tank on Lot 13 Block 2 to the private well located on Lot 14 Block 2 has been approved. The approved separation distance is 95 feet. This waiver approval applies to the existing septic tank and private well separation only. Any future upgrade to either will require ail separation distances be met or another approval from this department. If there are any questions, please call our office at 343-4744. ~incerely' ~ ~rd~ V Jcl,,;esP' Williams Civil Engineer On-site Services JPW/ljm: Temple Waiver ~MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#'_V~(~!~[c PID# 018-401-43 HA# HA960145 Permit Date Received: April 30, 1996 Legal Description: Lot 14 Block 2 De Armoun ~2 Engineer: Tobben Spurkland, P.E. 203 West 15th Avenue #203, Anchorage, Alaska 99501 Applicant: Trudianne Temple · Waiver Requested: Private well on Lot 14 Block 2 to the septic tank located on Lot 13 Block 2 of 95 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: ~/~fC ~ ~0l ~0~ {~A=~9 ~o~ ~ Waiver is Granted: ~ Waiver is NOT Granted: List Conditions or Reasons for above: ~ ~ ~,~/~ Date: Roc #: ~ Amount: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Jim P. Williams Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Waiver Request Lot 14, Block 2 DeArmoun #2 RECEIV£D APR 30 t996 Municipality ot Anchorage Dept. Health & Human Sen/ices April 30, 1996 Gentlemen; Per your request we are applying for a waiver of the separation distance required between a msidendal well and a septic tank. The well is located on Lot 14, Block 2, DeArmoun #2. The septic tank is located on Lot 13, Block 2. A field measurement shows a distance of 104 feet between the well and tbe standpipe to the septic tank. A as built of the septic system on Lot 13 indictaes that the septic tank was installed with its long axis pointing towards the well. Assuming that the septic tank is 8 feet long and that the standpipe is 7 feet from the end of the tank, it is possible that the tank is encroaching three feet into the 100-foot protective radius. The well on Lot 14 was installed in 1980. At that time the Owner of Lot 14 obtafmed a waiver from the Municipality to instalI the well 80 feet distance from the septic tank on lot 14 in order to stay 100 feet from the septic tank on lot 13. The owner at that time measured 100 feet pluss from the septic tank standpipe on Lot 13 and installed the well. The Municipality approved of the installation. In 1990 the waiver for well to septic tank separation for Lot 14 was reissued. Justification and documentation for the waiver were submitted to the Municipality. We request that the information submitted at that time and the analysis performed by the Health Department be revised to cover the septic tank on Lot 13. We request a waiver to 95 feet. Yours '%--¢ '; T. Sl~rkland P.E. (, .o / oo 3 3500 TUDOR ROAD ANCHORAGE. ALASKA 9g~07 27~8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL.__ LIQUID CAPACITY C~P~R~TS ' ~GALLONS INS,ge LENGTH INSIDE WIDTH .... DE~ SEEPAGE SYSTEM: SEEPAGE PIT: / NEAREST LOt LINE__~"~'~ ~FIELD: ~ FOUNDAIION TOTAl. LENGTH DISTANCE ~:ROM WELl . NEAREST LOT LINE. , OF LINES NU,~.eR C~ uNes 01ST~NC~ t,ENC. W~)t. IN. tOt~ ~FEC~V~ WELL: h'PE~ DEPTH NEA.E'~T SEPTIC LOT LINE , SEWER LINE TANK DISTANCE FROM WATER · BUILDING FOUNDATION SAMPLE , NEAJlEST SEEPAGE OTHER · 5YSTE,~ CESSPOOL SOURC~ DISTANCES: DIAGRAM OF SYSTEJ~A G.A.A.B. Tom Fink, Mayor Municipality oW Anchorage Department of Health and Human Services 825 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 343-4744 October 29, 1990 Tobben Spurkland, P.E. 6751 West Dimond Anchorage, Alaska 99502 Subject: Waiver Request for Lot 14 Block 2 De Armoun #2 Waiver Request %WR900047, PID 0018-401-43 Dear Mr. Spurkland: Your request for waiver of the required 100 foot separation of a septic system to a private well has been approved. The approved separation distance is 80 feet from well to septic tank. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-site Services Concur: # ~; //// // ~Program Manager On-site Services ljm:#6 MESSAGE REPLY SIGNED SI~ID PARTS ~ ~,ND 3 II, TACT - PART 3 WILL a~E RETURNED WITH REPtY. (REDIFORM]® 4S 472 POLY PAK I50 SETS] 4P472 · ,. 2 +-.2 =- ~-o'~ . ~o%~5~ ~751 W Oimond ~'~ C-~'~,~ ¥ . <~ Anchorage Alaska 99502-~904 x; ~ (90'7) 248-5095 ~ iu-~iitv,m u.,,~'~'of Ar, choraf4e October 16~ t990 [)h~isi-uq,. of Envirol]nnental Health Depar'tment of' Health and oocl~t ~el S.20 ~. Street Anchor ag% "' ~ ~' - ' ah~_,k a. 99501 Sub REoUE.ST FOR WAIVER OF SEPARATION DISTANCE FOR PRIVATE WELL TO SEPTIC TANK LOT 14, BLOCK 2 DEARMOUN ~2 Gent e Ten, w'e 8re submitting a request for waiver from the separation distance ...[.:. ,.d in Title lb, AlaskaAdrninistrative Code, Chapter 80.020. Dur Tu:' ,:~n Heaith Adthcr ty inspection on October' 2, 1990 it was ,r"~:~-~'~.~ ,.i._ .. ~ I.i ,'~ '~ .' I' that tt~e horizontal distance_ _ between tl~e welt and the ooept n_" iTar, k was apopox 'rateiy 80 feet, 20 feet less than the required 100 feet. Theweil was installed in 1980 under permit ~8000t03, Awetl h)gwas subrnitt~ t. but identified the Innation as Lot 13 Block o of Dearmoun ~ 2 Prior to installation the Owner notified the Health Department that in order to maiqtain the required t00 feet separation distance to the septic svstem on Lot 13, the maximurn separation between the well and the septic tankon lot t4 had robe80 feet. This notification was in writing and a "waiver" is noted on this notification. rhis lot was developed in May !973, At that time the residence was served by a community welt ~ but because of separation difficulties, the joint use ended in t980. By researching the files at the Health Department 'we obtained 4 well logs inthe immediatelv vicinity of this location. Welt logs for tots 2,7, and t4 of Dearmoun S/D are very similar and give a consistent picture of the subsurfsce conditions. water bearing strata deeper than 70 feet, static water level at 40-50 feet. silt and ciav materials for rqost of Uae depth. Wai¥~r Request Lot 14, 5iock 2 Dea~'moun ~2 Octol:,ep 10, t990 pg2 The mform, ation from the four well logs have been summarized in the f~, nw n~ table, LI4/B2 L2 L7 L14 installed i 980 19 ,"c 1976 196d Tota! r:~apth 76 168 86 190 W ~tqr, ,-~ai 74 19~ ~7 ...... ..... ,o 188 Oa>'/GHt Thick. ness 64 100+ 42 / 00+ ..~'b' tc, i Iow~ng tile procedure recommended by DEC when analyzing the ~ ...... 1 forcontamlnatlon, I arrive at thefollowlngpolnt~ Distance to Water Bearing Strata (>70) Sol! Sorbtlon ( 50% of soil is Silt or Clay) PermaPility (40'oT lmpervlousmaterials) Gradient ( Slopes away from well SeparaNon ( Trta] 55 3 3 3 2.5 ! 7 0 {onc'i~is!on. Almost Sure to Joe fr'ee from any ,, I .... ,.,j F;e~Wa]6! Please Issue a waiver for this property. '¥ or.irs Torm of contamination from ./ . / . '~oT ~, ~'-' ' ; ,4/ ~-~t,9Oi",/Vz /,-,,= /,',, - , .......... ~ t' "---'. xC--' '1 . .... :,!,.,, I. . ~ . "<",,,? I I F:,.. ;v:'.?//:L,.'''~ .... /,~ Ix', :. --. ~ ~ ~ ~. ............ ~0,'" xOl3~'''' ~ =~'4' , "£' ..'./, / ~ ~ ., · ' . ~.~., ~ , }' ..¥, ~ ~ ~.~-;~,.,,~;~--' /~ t,~,,//.'~'~,u · - t:' ' ' ! / .-fY fl " ,~ J . 'r ,'../ ,:'/ ", t I,~. ~ , ,~,,.-. ,4", .......................................... ~, ........... ~*, ....... ~)- ': , , . ' ; , " i · /A I I / "' ' '1 ' t X/ "~ · ' ~: ' t . //'{'k .......... :v,.:==.-.I ....... : .................................... i;'\ ' ' This t,, ....... ,/*, ~$/i~:~, ,, ., ~.. ".. ,;t~q''' .Anchot~ ro~ot~in~ Pro¢i~cJ; Alalk~, ~n~ that' tho imptOvomonti sltu~te~ lh~to~fl &rt within th~ ~r~p~rty ]inos ~ad ~0 ~Ot Ov~tJ~p Ot DATE RECEIVED ~' INSPECTION APPOINTMENTS TIME '~ TIME TIME DATE DATE DATE ,NSPECTOR ,NSPEOTOR ,NSPEDTO ~U.ICI.ALITY OF ANCHO.A.E MUNICiPALI~ OF ANCNORAQE 825 L Street - Anchorage, Alaska 99501 ~NVIRONM~NI,', ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE I S DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proc~sed. Please allow ten {10) days for processing. PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION cop 14, 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other /~ SINGLE FAMILY ~ Two [] Five [] MULTIPLE FAMILY Three [] Six 7. WATER SUPPLY  INDIVI DUAL* * ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June lg75. For wells drilJed prior to that date, give well [] PUBLIC UTI LrTY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM /~ YEAR ON-SITE SYSTEM WAS INSTALLED. INDIVIDUAL/ON-SITE** · [] PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] ONE [] THREE [] FIVE [] OTHER [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified [] Septic Tank or [] Holding Tank Size: j ~"~--(~ ifTank ishomemade give dimensions: TYPE OF TANK TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DATEINSTALLED INSTALLER SOILS RATING MANUFACTUR ER ~.j~_ ~ MATERIAL Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line 5. COMMENTS DATE [~//A~PP ROVE D FOR ~ BEDROOMS [] DISAPPROVED CONDITIONAL APPROVAL (letter must accompany certificate) 72-010 (Rev. 6/79) '(~ ENVIRONMENTAL ENGINEERING DIVISION JUL2, 41979 Telephone 294-4720 DIRECTIDNS~ Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. MUNICI~Lt', MUN C PAUTY OF ANC,ORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT 825 L Street - Anchorage, Alaska 99501 PHONE PHONE PHONE t /ff - 1. PROPERTY OWNER, MAILING A DRESS 2, BUYER 3.-LENDING IN ITUTION 4. REALTOR/AGENT MAI LING ADDRESS STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS - [] One [] Four [] Other ~ .SINGLE FAMILY ~-~ ¢)" B ,-~'~"Two [] Five [] MULTIPLE FAMILY ~ Three [] Six 7, WATER SUPPLY []/ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for ail wells drilled ~ COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM · [~ INDIVIDUAL/ON-SITE** I ndvdual/on-s,te, g,ve,nsta at,ondate /~'~/'7L If system is over two (2) years old an adequacy test is required [] PUBLIC UTILITY by this Department, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72~)10(3/78) ,/~ THIS SlOE FOR OFFICIAL USE ONLY~ DATE RECEIVED I NSPECTI ON APPOI NTM ENTS · TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY [] ONE I~] THREE [] FIVE [] TWO [] FOUR [] SIX [] OTHER 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTI LITY Connection Verified 3, SEWAGE DISPOSAL SYSTEM []INDIVIDUAL/ON -SITE []PUBLIC UTILITY Connection Verified []S~or F~Holding Tank SizeT'~m~ If Tank is homemad~ give dimensions: TYPE OF TANK TOTAL A8SORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE iNSTALLED INSTALLER SOl LS R ATI NG 5. COMMENTS [~APPROVED FOR ~_~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accomp2~'C~ertificate [] DISAPPROVED / / DATE BY {Title) / LEGAL DESCRIPTION 72-010 {Rev, 3/78) 3. 4. 5. GREATER ANCHOP~GE AREA BOROUGH Department of Environmental Quality 3500 Tudor Road, Anchorage, Alaska 99507 279~8686 Date Recel ved~.~ T~me of ~ Date of Inspection REQUEST FOR APPROVAL OF I~IVIDUAL SEt~E~ & ~A~R FACILITIES FOR Aoproval Requested D/t Address: ' Legal Description: Location: ~etl Data: C. Construction ~' ~ D. Sewage Disaosal System: A. Installed C. Septic Tank: D. Seepage Ptt~ 1. ~. Disposal Field: Dfstances: Depth Bacteria] Analysis We]l To: Septic Tan~-~ / , absorption Area ~' ~ ' ~J ~ ~, Sewer , Nearest Lot Line /~ // Other Contamination .~f, Foundation to Septic Tank /% .... . " ~ Absorption Area AbSorption Area to ~learest Lot Line //c.' / Approval of Comments: ual Sewer & Water Facilities Aporova] Valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify ~,aat the information conoa~ned in this request for approval to be a true and sccu~:~te ?:epresentatiou of the subject sewer and water facilities located at: Signed Date