HomeMy WebLinkAboutPRESCOTT LT 2Prescott
Lot 2
#015-242-25
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program RA£h B`
4700 Elmore Road
ufs ,
P.O. Box 196650
Mark Begich Anchorage, AK 99507 $ "
Mayor www.muni.org/onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue: 16
Parcel Identification Number:A7�• Zq 2.29
Legal Description
?QCs
L_+ 2—
Property Owner Name & Address:
J oSeN 1, 1. e.wta, t?
1210) Ij ra , a sk
n k. rd 7
Pump Installation Date:
Pump Intake Depth Below Top of Well Casing: -r feet
Pump Manufacturer's Name:AY /I/) co
U b "t)
Pump Model: '7,SF 311 — >V/;-
vISPump
PumpSize _N hp
Pitless Adapter Burial Depth: -feet
Pitless Adapter Manufacturer's Name:
Pitless Adapter Installer:
WellDisinfectedUpon Completion? es ❑ No
Method of Disinfection:
Comments:
/° ` V'lC t/a%i .
Pump Installer Name:
ANCHORAGE WELL & PUMP SERV.
330 EAST 76TH AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
Municipality of Anchorage
Community Development Department Page 1 of 3
On-Site Water & Wastewater Program
4700 Elmore St. • P.O.
Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141470
PID Number: 015-242-25 ❑ New ®Upgrade
Name: MICHAEL CHESTER
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ® Bed ❑ Mound
Address:
12101 GRAIFF STREET *ANCHORAGE, AK 99507
❑ Other
Phone:
No, of Bedrooms:
Soil Rating:
Total Depth from original grade:
(907) 250-4283
5
2.0 GPD/Sq. Ft.
SEE DWG Ft.
LEGAL DESCRIPTION
Depth to pipe inert from original grade:
Gravel depth beneath pipe:
SEE DWG. F.
0.66 Ft.
Subdivision:
Block: Lot:
FII added above original grade:
Gravel length:
PRESCOTT
— 2
SEE DWG.
25+
Ft.
Fl.
township: anger
— —
section:
—
Gravel width:
Beds Number of lines:
Distance between lines:
15 Ft.
3
5
Ft.
SEPARATION DISTANCES
Total absorption area:
375
Number of trenches:
—
Dist. between trenches:
—
To
Septic
Absorption
Lift
Holding
Pu Pinata
From
Tank
Field
Station
Tank
Sewweerr Lines
SD. F6
Ft
Well
too'+
100'+
100'+
-
25'+
TANK ❑ Septic ® S.T. E. P. CHolding ❑Other
Manufacturer:
copacity:
Surface water
100'+
100'+
100'+
—
ANCHORAGE TANK
2000 Gal.
Lot Line
5+
10'+
s•+
-
N/A
-Material:
STEEL
Number of compartments:
2
LIFT STATION
Foundation
5'+
10'+
5'+
—
Curtain Drain
NONE KNOWN
Manufacturer:
Capacity,
ANCHORAGE TANK/ORENCO
2000/70 cal.
Remarks: OLD TANK WAS DECOMMISSIONED PER UPC'Pump
on' level at:
TIMER/32-
Pump off- level at:
TIMER/22"
High water alarm at:
53736"
THIS IS AN ADVANTEX SYSTEM
WITH TWO (2) AX-20 PODS
pump Make h Madel:
ORENCO PF-50
Eleatrkol Impectlons performed by:
ORENCO PF-20
M.O.A.
PIPE MATERIAL SCH 40
House to tank EXISTING Tank tO D2665
drainfield
Installer
Drainfield D3034CO/MT D3034
PETERBUILT CONSTRUCTION
Inspector GEG, Ltd.
BENCH MARK (Assumed elevation)
101.51 Ft.
Inspection
La=^fan and Description:
Dates: 1st 11/15/14
2nd 11/19/14 -
3rd 11/19/14
4th 11/19/14
BOTTOM OF TRIM @ SE CORNER OF HOUSE
ENGINEER'S SEAL
Community Development Department Approval
ooPF �04�
Conditional approval:
Date:
apo T
0....:..... .. ................0
O.� .:...... e...
ss
`/
E-7953
o1P w p
44 emceef
Approved:
/� , Date: �a -S"/
�Q4a, Profession,00
PERMIT NUMBER:
OSP 141470
AS -BUILT DRAWING
JIBS
Il
y II
W
O
�: :. �j.•.: vv RADIUS
:,tORIVhYyAY ��'...
BEDROO TNG 5.
Wit: ':: • .• M HOUSE
NEW ADVANTEX AX -20
TREATMENT PODS
PARCEL ID NUMBER:
015-242-25
MH2 ANEW 2000 GALLON S.T.E.P.
TANK W/ ADVANTEX CONTROL
PANEL
�<.. NEW ORENCO PUMP VAULT
�MT1
MT2
SHED MT3 V pp2C0
COi
1989 S&S ENGINEERING TESTHOLE*
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
3701 E. NOOK R . SUITE 101 • ANCHO9AGE, M 99507 • PHONE (907) 507-6179 • PAX (907) 3 UO ' WESSOE: ��, nwmengl
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
MICHAEL CHESTER 250-4283 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
PRESCOTT; LOT 2 PNB
TYPE OF WORK: DATE:
AS -BUILT DRAWING 12/2/14
ST1
68.17
20.72
ST2
74.74
30.15
MH1
75.48
31.43
MH2
73.55
31.78
ADV1
64.44
19.24
ADV2
69.20
26.25
ADV3
60.82
17.77
ADV4
65.73
I
z
109.25
77.20
MT2
105.73
77.86
MT3
w
w
N
C01
129.78
102.83
CO2
131.57
102.79
J
w
1-
LJ
102.61
MT4
I-
102.38
0
Lo
L
w
F
�
0
o
Q
(I
cD
AS -BUILT DRAWING
JIBS
Il
y II
W
O
�: :. �j.•.: vv RADIUS
:,tORIVhYyAY ��'...
BEDROO TNG 5.
Wit: ':: • .• M HOUSE
NEW ADVANTEX AX -20
TREATMENT PODS
PARCEL ID NUMBER:
015-242-25
MH2 ANEW 2000 GALLON S.T.E.P.
TANK W/ ADVANTEX CONTROL
PANEL
�<.. NEW ORENCO PUMP VAULT
�MT1
MT2
SHED MT3 V pp2C0
COi
1989 S&S ENGINEERING TESTHOLE*
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
3701 E. NOOK R . SUITE 101 • ANCHO9AGE, M 99507 • PHONE (907) 507-6179 • PAX (907) 3 UO ' WESSOE: ��, nwmengl
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
MICHAEL CHESTER 250-4283 2 OF 3
LEGAL DESCRIPTION: DRAWN BY:
PRESCOTT; LOT 2 PNB
TYPE OF WORK: DATE:
AS -BUILT DRAWING 12/2/14
ST1
68.17
20.72
ST2
74.74
30.15
MH1
75.48
31.43
MH2
73.55
31.78
ADV1
64.44
19.24
ADV2
69.20
26.25
ADV3
60.82
17.77
ADV4
65.73
1 25.14
MTI
109.25
77.20
MT2
105.73
77.86
MT3
129.47
102.73
C01
129.78
102.83
CO2
131.57
102.79
CO3
133.12
102.61
MT4
133.22
102.38
A.
.:.1.:.1•,.7.
�OFESSI�P.
GIVEN THE FACT THAT THE NEW BED WAS CONSTRUCTED WITHIN THE PERIMETER OF THE OLD BED,
IT WAS DIFFICULT AT BEST TO DETERMINE WHERE THE 'ORIGINAL GRADE' WAS. THE OLD BED WAS
CLEARLY TOO DEEP IN THE SOUTH/SOUTHEAST SECTION. THE NEW €iED,DOES NOT EXTEND AS FAR
TO THE SOUTH OR TO THE EAST AS THE OLD BED. IN ADDITION, THE BOTTOM OF THE NEW BED IS 2
FEET HIGHER IN ELEVATION THAN THE OLD BED. THIS WAS ACHIEVED USING M.O.A. FILTER SAND.
PHOTOGRAPHS OF THE BOTTOM OF THE ORIGINAL BED WERE PROVIDED TO THE MOA. IN SHORT,
THIS WAS THE BEST EFFORT TO ATTAIN ADEQUATE SEPARATION TO GROUNDWATER. AN
ADDITIONAL FACTOR OF ENVIRONMENTAL SAFETY IS PROVIDED BY THIS BEING A CATEGORY III
ADVANCED TREATMENT SYSTEM.
PREPARED FOR:
MICHAEL CHESTER
-Tj /• PMUNIENUMBER:
ARNESS ENGINEERING GROUP Ltd 907-250-4283
• , PAGE NUMBER:
= CIVIL & ENVIRONMENTAL ENGINEERS snl u as rl,a, cera 9 3 OF 3
/ 3]01ET000RROAD SUITE 101 •ANCHORAGE AK 99507• PHONE907337-6179-FM90]336-32C6•WE&SITEwrvwamessennein co
�/ LEGAL DESCRIPTION:
DRAWN BY[
PRESCOTT S/D; LOT 2 A.J.G.
.�� TYPE OF WORK: DATE:
PROFILE AS -BUILT OF SEPTIC UPGRADE 12/8/2014
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GIVEN THE FACT THAT THE NEW BED WAS CONSTRUCTED WITHIN THE PERIMETER OF THE OLD BED,
IT WAS DIFFICULT AT BEST TO DETERMINE WHERE THE 'ORIGINAL GRADE' WAS. THE OLD BED WAS
CLEARLY TOO DEEP IN THE SOUTH/SOUTHEAST SECTION. THE NEW €iED,DOES NOT EXTEND AS FAR
TO THE SOUTH OR TO THE EAST AS THE OLD BED. IN ADDITION, THE BOTTOM OF THE NEW BED IS 2
FEET HIGHER IN ELEVATION THAN THE OLD BED. THIS WAS ACHIEVED USING M.O.A. FILTER SAND.
PHOTOGRAPHS OF THE BOTTOM OF THE ORIGINAL BED WERE PROVIDED TO THE MOA. IN SHORT,
THIS WAS THE BEST EFFORT TO ATTAIN ADEQUATE SEPARATION TO GROUNDWATER. AN
ADDITIONAL FACTOR OF ENVIRONMENTAL SAFETY IS PROVIDED BY THIS BEING A CATEGORY III
ADVANCED TREATMENT SYSTEM.
PREPARED FOR:
MICHAEL CHESTER
-Tj /• PMUNIENUMBER:
ARNESS ENGINEERING GROUP Ltd 907-250-4283
• , PAGE NUMBER:
= CIVIL & ENVIRONMENTAL ENGINEERS snl u as rl,a, cera 9 3 OF 3
/ 3]01ET000RROAD SUITE 101 •ANCHORAGE AK 99507• PHONE907337-6179-FM90]336-32C6•WE&SITEwrvwamessennein co
�/ LEGAL DESCRIPTION:
DRAWN BY[
PRESCOTT S/D; LOT 2 A.J.G.
.�� TYPE OF WORK: DATE:
PROFILE AS -BUILT OF SEPTIC UPGRADE 12/8/2014
Municipality of Anchorage
Community Development Department - Development Services Division
® P.O. Box 196650 - Anchorage, Alaska 99519.6650 - 4700 ElmoreRoad
Info and Help: (907) 343-8211
INSPECTION:.Voice: (907) 3436300 Fax (007) 249-7777
Inspection Report - Electrical
APPLICATION NO. RETROE141653
Master/Standalone Permit Permit Type: Electrical Res
NotOW pleasemea pnor to inspection Kequestea op4iwy Hannaman sal- Scneduie Date:1Y1u3(1D14
channaman@alcanelectric.com Preferences -AM
Insction #: 334286
Address of Project: 121 1 T Parcel: 01524225000
90
cts
er CHESTER MICHAEL L & DONNA L
Contractor (967)563-3787 ELECTRICAL & ENGINEERING INC- P.O. BOX 91499
Inspector:
Date:—/ 2' 3 - 4219�X
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141470
Tax Code Number: 01524225000
Work Type: Septic Upgrade
Permit Effective Dates: November 05, 2014 to November 05, 2015
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: PRESCOTT
Site Legal Address: PRESCOTT LT 2 G:2740
Owner/Address: CHESTER MICHAEL L & DONNA L
12101 GRAIFF ST ANCHORAGE AK 995078083
Site Mailing Address: 12101 GRAIFF ST, Anchorage
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy
All construction must be in accordance with:
Lot Size in Sq Ft: 97038
Total Bedrooms: 5
N Private Well N Water Storage
ra:o-d
jzres
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
QJ:1
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
November 18, 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road,
Anchorage, Ak 99519-6650
(907)343-7904
REFERENCE: Change Order Request for Prescott S/D; Lot 2. Ref: OSP141470
To whom it may concern,
Construction has begun on the aforementioned project. Due to the depth of the existing bed below
original grade (over 5 feet below original grade at the southeast corner), we are proposing to
rebuild a smaller portion of the bed and install an Advantex advanced treatment system. Attached
is a design drawing showing the proposed new bed rebuild.
If you have any questions, please contact us at 337-6179.
ISM
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
Municipality of Anchorage
P.O. Box 196650 0 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
htti)://www.muni.or-q/Onsite
Development Services Division
On -Site Water and Wastewater Program
tnenr S
ti� e
i
y r'
Department
**** VARIANCEIWAIVER REVIEW ****
Waiver#: OSP141471 COSA#: Permit#:OSP141470
PID#: 015-242-25
Legal Description: Prescott, Lot 2
Engineer: Garness Engineering Group
Applicant: Michael Chester
Your request for a waiver of the required 50 feet horizontal separation from the absorption field
to a 25% or greater slope has been approved. The approved separation distance is 10.0 feet.
Your request for a waiver of the required 15 feet maximum absorption field bed width has been
approved. The approved width is 36 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
® Adjacent properties are not affected by this waiver.
...................................... ........................................ I
Waiver is Granted: X Waiver is not Granted:
(S
Date: �y Approved b
Name of Reviewer
..............................................................................
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
On -Site Sewer/Well Permit Application
For A Single Family Dwelling
Parcel I.D. 015-242-25
Property owner(s) MICHAEL CHESTER Day phone 250-4283
Mailing address 12101 GRAIFF STREET, ANCHORAGE, AK, 99516
Site address 12101 GRAIFF STREET, ANCHORAGE, AK, 99516
Legal description (Sub'd, Block & Lot) PRESCOTT S/D LOT 2
Legal description (Township, Section & Range)
Lot
APPLICATION IS FOR:
(® all that apply)
Absorption Field
Septic Tank
Holding Tank
Privy
Private Well
Water Storage
Sq.Ft. Number of Bedrooms _-5,
APPLICATION IS AN:
Initial
❑
Upgrade
Renewal
❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
TYPE OF DEWELLING:
Single Family (SF)
(w/wo ADU)
Duplex (D) ❑
Multiple Dwellings ❑
(SF and/or D)
DRAINFIELD TO 25%+ SLOPESZBED WIDTH Distance: 10'/—
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees: s�6 q Waiver Fees: G%OS
Date of Payment: !o ,1 B <y Date of Payment: O 0(t t
Receipt Number: 61(16SCr Receipt Number: 0j y/JS(r
Permit No. 0_1�0/yl y �Lc Waiver No. 6.5W 1 usy;z /
(Rev. 01/11)
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS � -=
November 4, 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road,
Anchorage, Ak 99519-6650
(907) 343-7904
REFERENCE: Proposed Septic Upgrade for Prescott S/D; Lot 2.
To whom it may concern,
The subject property is served by two private wells and a septic system consisting of a 1500 gallon
septic tank, a 500 gallon lift station and a bed type drainfield. The drainfield is in a state of failure
and needs to be upgraded. We are proposing to replace the tank and lift station with a new 2000
gallon S.T.E.P. tank and to excavate the bed, remove all contaminated material and re -build the
bed in place at a higher elevation. The design criteria is the same as the 1989 permit (4890109).
See the attached 1989 S&S Engineering soil log for soil and groundwater data. To be conservative,
at least one (1) foot of M.O.A. filter sand will be imported and the elevation of the bed raised (at
least 1 foot above the existing elevation) to increase separation to any groundwater.
BED WIDTH WAIVER: The existing bed is 36 feet wide. We are requesting you waive the
width of the bed from 15 feet to 36 feet. Care will be taken during installation to keep the excavator
off of the footprint of the new system.
SURFACE WATERS: 'There are no surface waters within 100 feet of the proposed septic
upgrade.
TOPOGRAPHY: The topography in the area of the proposed upgrade is approximately 10% in
the direct area of the bed. The topography below the drainfield is generally 15-25% running
southeast to northwest.
SLOPE WAIVER REQUEST: A small (4-6 foot) cutbank exists along the south edge of the
driveway as it passes the drainfield. The slope is approximately 10 feet from the drainfield at the
closest point. We request that you waive the distance to cutbank to 10 feet. During our inspection,
the drainfield was completely surcharged but no daylighting was noted from any slope near the
drainfield. Based upon this fact, we believe there is minimal risk associated with granting this
waiver.
3701 East Tudor Road, Suite 101 'Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
Page 2 of 2
I am unaware of any adverse impacts this installation would have on any surrounding wells or
septic systems. If you have any questions, please contact us at 337-6179.
%Sincerely,
f 1
P.E., M.S.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com
i
GALLONS PER DAY (GPD): 750
PERCOLATION RATE/S: 20 MINANCH
PROPOSED APPLICATION RATE: `2.0 GPD/FT"2
MINIMUM DRAINFIELD SOTT.: 375
'CATEGORY III ADVANCED TREATMENT SYSTEM
MAXIMUMDEPTH: EXCAVATIONOF
WIDTH: 25 FEET CONTAMINATED MATERIAL
LENGTH: 15 FEET
M.O.A. APPROVED SAND FILTER: ASNEEDED
TO RAISE BED ELEVATION 1 FOOT ABOVE THE
BOTTOM OF EXISTING BED V�V\,#1900 Q
EFFECTIVE: 0.5 FEET
REDUCTION FACTOR: N/A -
ACTUAL SQ.FT.: 375 WFr.
Col
CHANGE ORDER FOR OSP141470
GEG, Ltd. HAS AN 8 PAGE SPECIFICATION +• + \
LETTER THAT PERTAINS TO THIS DESIGN. TO
OBTAIN A COPY OF THE LETTER CONTACT "•.':-+ '."'s`'°�
GEG. BY PROCEEDING FORWARD WITH THIS:•146RIVE
'
INSTALLATION, THE ENGINEER, WELL DRILLER, WA+':
CONTRACTOR AND PROPERTY OWNER AGREE _ BEDROEXISTINGS
THAT THEY HAVE READ THESE OM HOUSE
SPECIFICATIONS AND AGREE TO ACCEPT THE FC
}.0
TERMS AND CONDITIONS OUTLINED.
.��'
NOTE: CONTRACTOR SHALL
HAVE THE 100' WELL RADII
FLAGGED BY A REGISTERED
LAND SURVEYOR PRIOR TO -
CONSTRUCTION
INSULATE SEWER LINE
UNDER DRIVEWAY W/4"
BLUEBOARD 4'WIDE
i NOTE: PRESSURE SERVICE
LINE TO BE SLOPED SUCH
THAT IT DRAINS COMPLETELY
AFTER EACH PUMP CYCLE.
EXISTING (NEW) 2000 GALLON
S.T.E.P. TANK W/ADVANTEX
CONTROLPANEL
PROPOSED ORENCO PUMP VAULT
MTr�—_ °IM I CONVERT TO 4" PVC
�I Imo—PROPOSED NEW BED
11 I I FOOTPRINT, SERVED BY
II 1 I BEDROOM ADVANTEX
1 SYSTEM
MT�CO OCOCOMT
SHED j 1
I I
I J
1989 S48 ENGINEERING TESTHOLE
/EXISTING BED FOOTPRINT
GARNESS ENGINEERING GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
PREPARED FOR:
MICHAEL CHESTER
PHONE NUMBER:
(90� 250-4283
PAGE NUMBER:
2 OF 3
LEGAL DESCRIPTION:
DRAWN BY:
PRESCOTT S/D; LOT 2
A.J.G.
TYPE OF WORK:
DATE:
�- DESIGN OF PROPOSED SEPTIC UPGRADE
11/18/2014
�OFESSI��i
EXISTING -
BOTTOM OF
SYSTEM, 1.0
FEET BELOW
URIGINAL GRADE
IN 1989.
FILTER FABRIC
i�31�1�6Y11I\LI[�P�IYc7FY�7L�Ki�.�aaa[U��[.YI Iii
•.iii///ilii/L
ADDITIONAL VOF M.O.A. SAND FILTER.
F�--3
II�
BOTTOM OF EXCAVATION,
REMOVALOF
CONTAMINATED MATERIAL
ORIGINAL TESTHOLE WAS 11 FEET DEEP
WITH A HIGH GROUNDWATER READING
OF 5 FEET BELOW GRADE. PER
AS -BUILT DOCUMENTS, BOTTOM OF BED
WAS 1.0 FEET BELOW ORIGINAL GRADE.
ADDITIONAL FILL HAS BEEN PLACED
OVER DRAINFIELDlTESTHOLE AREA.
HIGH GROUNDWATER READ
4 FEET BELOW BOTTOM OF BE ASED
UPON 6/13/1989 GROUNDWATER READING
BOTTOM OF TESTHOLE 10 FEET
BELOW BOTTOM OF BED"
GARNESS ENGINEERING GROUP, Ltd
°-= , CIVIL & ENVIRONMENTAL ENGINEERS
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
MICHAEL CHESTER ( 907) 250-4283 3 OF 3
LEGAL DESCRIPTION: DRAWN BY:
PRESCOTT S/D; LOT 2 A.J.G.
TYPE OF WORK: DATE:
PROFILE DRAWING OF PROPOSED SEPTIC UPGRADE 11/4/2014
TOP OF NEW
SAND SHALL BE
12" HIGHER IN
ELEVATION THAN
SOL 'I'OM OF
EXISTING BED
1989 S&S
TESTHOLE
fROFESS\
• .I
DRIVEWAY;'.
R,„ x EXlSTlN
GS
E BEDROOM HOUSE
E" a
�HEDI ,I
I ,'I
o MTj
II CO wF�
T " 109 S&S
I EXISTING BED TO BE
REBUILT AT V HIGHER ELE\
'TING 1500 GAL[
'TIC TANK AND L
STATION TO BE
REMOVED AND
LACED WITH Al
.LON S.T.E.P. TIA
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T " 109 S&S
I EXISTING BED TO BE
REBUILT AT V HIGHER ELE\
'TING 1500 GAL[
'TIC TANK AND L
STATION TO BE
REMOVED AND
LACED WITH Al
.LON S.T.E.P. TIA
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T " 109 S&S
I EXISTING BED TO BE
REBUILT AT V HIGHER ELE\
'TING 1500 GAL[
'TIC TANK AND L
STATION TO BE
REMOVED AND
LACED WITH Al
.LON S.T.E.P. TIA
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N 89 .59' .4n" w Ina 55
N 89 59'E 304.92
Od
/4� J�rH*
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g
AA 'SHANE A. HOLT
THE INFORMATION HEREONIS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICT5 BETWEEN EXISTIN55TRUCNRES AND PLATTED
14
LS -5914.' Jo -0
LOT LINES AND/OR EASEMENTS; AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCNRES, IMPROVEMENTS,
FL.p...._...'
OR FENCELINES,
EASEMENTS OF RECORD, OTHER
�rop
THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
rp„ 1p
S,sq
slon
HEREON(UNLESSINLICATED)
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE,
AS BUILT SURVEY I" = 40'
NO CORNERS SET THIS EMS
I
ri HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 2, PRESCOTT SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS.
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 8 TH_ DAY OF
OCTOBER , 2014.
HOLT LAND SURVEYING
600 HIGHVIEW DRIVE
ANCHORAGE,AK 99515
fD02. FB IBa-2o 395-5513
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES C) , "-a�_\ a - a ,�)
Environmental Health Division
825 " L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
DISTANCES
121,0/' IqAJ4r, /,/
Phone(s) Permit No. No. of Beer,
(-77 e 2- 02 0/0,r/
LEGAL DESCRIPTION
Lot Block Sub A ion
2, 1�Ife SCO r7 -
Township, Range, Section
fZ h/ 31,d , z Z
TANKSk/�$ 7 j
SEPTIC ❑ HOLDING
Manufacturer I Capacity in oallo
Material
No. of Compartments
TYPE OF SYSTEM
❑ TRENCH X BED
❑ W. DRAIN ❑ OTHER
Depth to pipe bottom from
Total depth from original grade
original grade mrx
FT /• FT
Fill added above original grade
Gravel depth beneath pipe
FT
r� /.S FT
Gravel length f
Gravel width If
FT
316 FT
Total absorption area
tit, -
®•
Distance between lines
SQ FT
� � FT
Number of lines
Soil rating
SQ FT/2,J341
Pipe material
PRIVATE ❑ OTHER (Identifv)
FT
70 SEPTIC ABSORPTION
FROM TANK FIELD WELL
WELL /DD r ICO )C
LOT LINE
FOUNDATION S r f f7(7 rV-
AS-BUILT DIAGRAM (Show location of well, septic system, property lines, foundation,
driveway, water bodies. etc.)
12■mi
mmmo
®M!Fo
Omni
LIDO 6:-fi 0+4049 dAl.
�, I
h/- ����� `/v G�'�.
Scale: -',S
inspecti�^^Perform edby:
Kkt—�
ENGINEER'S SEAL:
m��
�OF 'll!
,r± i
Date:
/`V i/
tit, -
®•
Rf�° ��
r�ij
Et�erfy Raver Looe R8a'd No. 204
c°av :iqc/ yyy
t Eagle
F,agIB Y6fF a
certify tha this inspection was performed according to all
p p g
Municipal and State guidelines in effect on this date:
��� �/
�
G
8 bo r; A. Shjes_.�
i t1
;
G'l
Health Department Approval: -JM ITI i
`,'\
Date: Il 8 Cl
t ct� . ° \..�
'-R; k
ata f-rQc.lC
72-013 (3/85)
t�`ti._^- -
MUNICIPALITY OF ANCHORAGE
Department oF Health & Human Services
825 L Street, Anchorage, Alaska 99501 343..4720
ON~SITE SEWER PERMIT
�
Permit Number: 89O109 Upgrade `�i 0\On 0/Cn
Date Issued: 06/27/89 Engineer Designed
Owner Name:
BARBARA FIT -NS
Day Phone:
Owner Address:
12101 GRAIFF
345~0782
ANCHORAGEI, AK
99507
Parcel Id:
015�2-el 2�25
Lot Legal:
Subdivision:
PRE13(307'T
Lot: 12 Blcock: 0
Section: 24
Township:
12114 Range. 3W
Lot Size
97038 (sq,f't"
or acres)
Max Bedrooms:
This Permit:
5 Total
Capacity: 5
SEPTIC TANK: Minimum total septic tank capacity: 1,00 gallons` Each septic
tank must have at least 2 compartments" Depth to top o[ septic tank(s) < 4.0
[eet requires insulation over tank(s),
THE EXISTING DEEP TRENCH MUST BE PROPERLY ABANDONED,
TO BE INSTALLED IN ACCORDANCE WITH ENGINEER/S MOUND DESING"
NOTIFY DHHS PRIOR TO ALL INSPECTIONS" THIS PERMIT IS ISSUED FEN
THE EXISTING 5 BEDROOM SINGLE FAMILY RESIDENCE ONLY, AND
EXPIRES ON 12/31/89"
I CERTIFY THAT:
1. I am familiar with the requirements for on-site sewers and wells as set
forth by the Municipality Of Anchorage (MOA) and the State of Alaska.
2" I will instalI the system in accordance with all MOA codes and regulations,
and in compliance with the design criteria o[this permit,
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances {rom any existing well, wastewater disposal system or public
sewerage system is or any adjacent or nearby lot.
--?rmit is valid 'ior a maximum oTF 5 bedrooms I
capacit�y of t.he total syst.em is 5 bedroom.; and
Are an additional permit"
- DATE:
' DATE:
-~—�/.�~'
�
^4 � � 1
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SCALE
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Municipality of Anchorage//e
r..eaora ea°
DEPARTMENT OF HEALTH & HUMAN SERVICES 44 �iju-t
825 "L" Street, Anchorage, Alaska 99502-0650 ( t/wh U..* mm 1d�iS is e
SOILS LOG — PERCOLATION TEST Ro
PERFORMED FOR:/G &A -/�/ S DATE PERFORMED:_
LEGAL DESCRIPTION 2 /�` IC0 l T Township, Range, Section:
DEPJ'H/� O 2 SLOPE SITE PLAN
1 `
2j/r S� — 225jVFc r/�/J
3
4
12-
13
14-
15-
16-
17-
18-
191
41516171819
20
COMMENTS
l.✓ r1 Tc -7e
ifo 1�04 d�
h.:;%
S & S ENGINEERING
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
Depth to Water
Monitoring? -
S
/ L
CS O
P
1 E
`s:
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
rr
i L a
y
o
i
,
y
PERCOLATION RATE `-' (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN --Z==, FT AND Z FT
PERFORMED BYEagle RiyAMp Alaska V"IJ
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUI
72-008 (Rev. 4/85)
/�- CERTIFY THAT THIS EST WAS PERFORMED IN
ON THIS DATE. DATE: Z3 S
b}
DOC Co. dba
SULLMN WATER WELLS
P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759
rj t - : i i ,, �1 t.:r r h� DEPTH OF WELL
OWNER OF LANDS s' t3 � � r;e7Eyet. _' t-
ADDRESS { ' 'ai fir ` 1 :> f `t STATIC LEVEL OF WATER FT. t
LEGAL DESCRIPTIO
r . t ;„ £,a DRAW DOWN FT.
ry
DATE -Started r Ended' _ t--�-- GALS. PER HR
PERMIT NUMBER
KIND OF CASING } t p
KIND OF FORMATION:
From
Ft. to
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t,�tUNIGIPAIITY OF ANgi
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MISCL. INFORMATION:
? d ,ti
..
DRILLER'S NAME
,
PERMIT NO:
DATE ISSUED:
1-14- 1 HIP
1: CT 1
10" wus
U.. 1:
-F "V ,
1 J FTT
all HIP ED H -1 CA 10
10 GO 110.�
DEPARTMENT
OF
HEALTH
AND
ENVIRONMENTAL
PROTECTION
825
L
STREET,
ANCHORAGE9
AK 99501
264-4720
870041
04/06/87
APPLICANT: ALAGKA USA FCU / TED MOORE P"[
ADDRESS: 4000 CREDIT UNION WAY
ANCHORAGE, AK 99503
CONTACT PHONE: 563-4567
LEGAL DESCRIP: SUBDIVISIOLOT: 2 BLOCK: N/A
SECTION: 24 TOWNSHIP: 12N RANGE: 3W
LOT SIZE: 2.22A (SQ.FT" OR ACRES)
I zertify that:
1, I am familiar with the requirements for wells as set
forth by the Municipality of Anchorage (MOA) and the State of Alaska,
TO I wiIl install the system in accordance with all MOA codes and regulations,,
and in compliance with the design criteria of this permit.
3. I will adhere to all MOA and State of Alaska requirements [or the set back
distances from any existing well, wastewater disposal system or public
sewerage sysLem on this or any adjacent or nearby lot,
SIGNED _ ^_,vC~____~____^__ DATE: ^���~���`
APPLICANT: MASKA ORE
ISSUED BY DATE:
' a ala�lVrl 101,111111.Ui UCl V1GC.1
14530 Echo Street
=nzclieraa--lasku-99sig
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P►aa
P0169
DS_l3pA�'
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11
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POJ Ac *
1-07 2� PREScarT S/�
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Pom S v TS .4ALF ® �/
r . ...............:........
THEODORE F. MOORE
i
rtTrN6 oR •. CE - 35E39 ML �
�6 �1 �'• .� • •`� ®
PA3/ 2S/ a 7
P
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PWM 6Y' TPM
MUNICIPALITY OF ANCHORAGE ` J
` ® 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
Q
'P' L L_ e N
PHONE
EW
`v
�{ j / O 2Z
O UPGRADE
MAILING ADDRESS
SRA o 3 i
LEGAL DESCRIPTION
Lv—' 2F_ Sic,oii
LOCATION
NO. OF BEDROOMS
v Y
Well ' O Absorption area
DISTANCE TO:
Dwelling n
e.
PERMIT NO.
S2 0/340
F Z
LU F
Manufacturer
Material
s% L
No. of compartments
� 0
Liq. ca � city in gallons Inside length
IF HOMEMADE:
Width
Liquid depth
az
DISTANCE TO:
Well Dwelling
PERMIT NO.
_j
= Z F
Manufacturer
Material
Liquid capacity m gallons
Lu
DISTANCE TO:
Well �,
�l.f.�
Foundation
o
Nearest lot line
�.�
PERMIT NO.
q.2Q,
J LL z
No. of lines
Length of each lin
Total length of lines
Trench width
Distance between lines
P z =
/ Q
Uo inches
—�
cc F-
Top of the to finish grade
/
Material beneath tile
Total effective absorption area
Q inches
6
W
Length Width
Depth
PERMIT NO.
C7
QF-
as
Lu
Type of crib
Crib diameter
Crib depth
Total effective absorption area
ti
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
Lu
Z'
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
CAsi
c
SOIL TEST RATING
?AXCIOW;M4�
INSTALLER Ji'
O - 0 C
�
.�.
REMARKS
1a A AT q F%
S®/ L k^y 6: 12- GED LITH
P - TA c9 F S ! L SLS
Arm b G +24t 1= L_
A lI
.v G CiF ry�
ZAA
COO. NCR 2225-E.°c�0
•/
JUNE 25 1911
u
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Lo
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2
APPROVED , ' DATE LEGAL
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INSTALLHTION
. ~
DEPHRTMENT OF HEHLTH
HND
ENVIRQNMENTHL
PROTECTION
~
825 "L' STREEh
HNCHORRGE, HK. 99501
264-472�
IN HCCORDHNCE WITH
THE CODES.
11) 141 `^�s-�
ON-SITE SEWE�
AS W 14 HE:
M F=xG�H-1 1-11---
PERMIT NO.
( 8201]6 )
BEDROOMS.
HPPLICHNT SHM
L��ZEN[�Y
SRF -1
BQX ]78L
99507
]45�10�2
LOCRTION
LEGHL L2
PRESCC!TT
LOT
SIZE 980@0 SQUHRE FEET
TYPE OF SOIL
HBSORPTION SYSTEM 1,E];: TRENCH
MAXIMUM NUMBER OF BEDROOMS 5 SOIL RHTING
THE REQUIRED SIZE OF THE SOIL HBSORPTIQN SYSTEM PS -
E31 M
S
�M W-1- W1 —; ��p ���� ���V K01": L.. �IEEE ������ �--, ; "
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD
THE DEPTH OF: H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHC[� CN-F.THE
GROUND HND THE BOTTOM OF THE EXCHVF')1TION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF QRHYEL BETWEEN THE OUTFALL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET).
������� ������ "Y' q%-9 ������ ���� �
�
PERMIT HPPLICRAFT
HHS THE
RESPONSIBILITY
TO INFORM THIS DEPHRTMENT DURING THE
INSTALLHTION
INSPECTIONS
OF HNY
WELLS ADJHCENT TO THI5 PROPERTY HND THE
NUMBE� OF RESIDENCES
THHT
THE WELL
WILL SERVE,
~--~ 1- H"s M �E."- 1:1 W I iq 001 FAZ EE7 ��������� __
BHCKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROYHL BY THIS
DEPHRTMENT WILL BE SUBJECT TO PROSECUTIOKi
MINIMUM DISTHNCE BETWEEN H WELL HND MY QN-SITE SEWHGE DISPQSHL SYSTEM IS
100 FEET FOR A PRIVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTHNCE FROM H PRIVRTE WELL TO H P�IVHTE SEWER LINS IS 25 FEET HND
TO H COMMUNITY SENER LINE IS 75 FEET.
WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN I0 DHYS
OF THE WELL CDMP1.17I0N.
OTHER REQUIREMENTS MHY HPPL? SPECIFICHTIONS HND HGRHMS FIRE
HVHIL�E)LE TO LF|TION.
F::" E 9-1 1 1- ���I rRr':
FE: W KIM Q W W F-1 ED M 0" -0 fl-
JAE I��
| I CERTIFY THHT
� U I HM FHMILIHR WITH THE
REQUIREMENTS FOR ON-SITE
SEWERS
HMD WELLS HS SET
FORTH BY THE MUNICIPHLITY
OF HNCH0RHCiE.
! 2: I WILL INSTALL THE SYSTEM
IN HCCORDHNCE WITH
THE CODES.
| -h I UNDERSTHND THHT THE
ON-SITE SEWE�
MHY REQUIRE
ENLHRGEMENT IF THE
� RESIDENCE I:1 REMODEMD TO
INCLCDE MORE THHW 5
BEDROOMS.
ISSUED BY-_
SAM LHZENBY
417aa_,A-
V4.0
A -s
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DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
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825 L. Street, Anchorage, Alaska 99501 264-4720
COMMENTS
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TEST RUN BETWEEN _:4=_ FT AND 5 FT
PERFORMED BY: PA )C1My1q2, /�"CLe. 4ibA(/ CERTIFIED
72-008 (6/79)
DATE:
46(
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0
Municipality of Anchorage
� IIa
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON—SITE SYSTEMS APPROVAL
Parcel I.D. 015-242-25
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
2. TYPE OF DWELLING:
41
PRESCOTT; LOT 2
Expiration Date:
12101 GRAIFF STREET *ANCHORAGE, AK
MICHAEL CHESTER Day phone
12101 GRAIFF STREET *ANCHORAGE, AK
N Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY:
Day phone
250-4283
TYPE OF WASTEWATER DISPOSAL:
Individual Well
N
Individual On-site
E
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: _ rl[ a Distance:
Received by: �'4 Date:
COSA to be released to the engineer, u less o emise requested by the engineer.
rush
COSA Fee $ o2b$.5C) t )101.10 = 112�.fO0 Waiver Fee $
Date of Payment 11`t c , Date of Payment
Receipt Number 1(0,3G Receipt Number
COSA # 05Q,;,4 1 l,' 30 Waiver #
S. 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, UD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. rhe reported results 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, groundwater 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 the system. Satisfactory test
results do not 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 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 report by any
other person or party is not authorized, nor will it confer any legal tight whatsoever.
6. DSD SIGNATURE
System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
0
bedrooms.
bedrooms.
Phone 337-6179
Date
bedrooms, with the following stipulations:
-- �\``�ittOF
utttUrrirrrr
J= ON-SITE
WATER AND
=o o
WASTEWATER Zc
��R.. PROGRAM P
Original Certificate Date: tl a -/r, -/ 7
The Munfbipafit)ror Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory ✓ Other
,Rw llnsi
If more than 1 septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: PRESCOTT; LOT 2 Parcel ID: 015-242-25
*ASSUMED BASED UPON 1987 WELL LOG. NOTE: BOTH WELLS ARE PLUMBED TOGETHER. WELL FLOW
A. WELL DATA IS THE COMBINED TOTAL FLOW OF BOTH AND THE WATER SAMPLE IS A BLEND OF BOTH WELLS.
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES/YES
Date completed 6/21/82 & 4/87 Sanitary seal (Y/N) YES YES Wires properly protected (Y/N) YES YES
Total depth 200/400 ft. Cased to *40+/51.25 ft. Casing height (above ground) 12+/12+ in.
FROM WELL LOG AT INSPECTION NORTH/SOUTH
Date of test 6/21/82 & 4/87 9/18/14
Static water level 65/85 ft, 42/43 ft,
Well production 0.5/0.41 g.p,rn, 0.57 —9-P m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate 0.923 mg./L. Collected by: GEG. Ltd.
Arsenic: ND ug./L. Dateofsample: 12/1/14
B. SEPTIC/HOLDING TANK DATA ADVANTEX SYSTEM W/ 2 AX -20 PODS
Tank Type/Material STEP/STEEL Date installed 11/15-19/14
Tank size 2000 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping NEN` Pumper —
C. ABSORPTION FIELD DATA BELOW FINAL GRADE
Date installed 11/15-19/14 Soil rating ( .p.d./ft r ft /bdrm) 2_0 System type BED
Length 25 ft. Width 15 ft. Gravel below pipe 0.66 ft,
Total depth *5.45+ ft. Eff. absorption area 375 ft' Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test in. Water added =gal. New depth =in.
Elapsed Time: min. Final fluid depth — in. Absorption rate >= 750+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date
D. LIFT STATION
11/15-19/14 YES/YES
Date installed 11/15-19/14 Size in gallons 2000/70 Manhole/Access (Y/N)
TIMER TIMER
"Pump on" level at 32 in. "Pump off" level at 22 in. High water alarm level at 53/36 in.
BOTTOM OF TANK YES
Datum BOTTOM OF PUMP VAULT Cycles tested NEW Meets alarm & circuit requirements.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO
Septic tank/lift station on lot
100'+
On adjacent lots 100'+
Absorption field on lot
100'+
On adjacent lots 100,+
Public sewer main
N/A
Public sewer manhole/cleanout N/A
Sewer /septic service line
25'+
Holding tank N/A
Animal containment areas
50'+
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM
SEPTIC/HOLDING
TANK ON LOT TO:
Building foundation 5'+
Property line
5'+ Absorption field 5'+
Water main N/A
Water service line
10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD
ON LOT TO:
Property line 10'+
Buildingfoundation
10'+ Water main N/A
Water service line 10'+
Surface water
100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
PER THE OWNER, THE WELLS ARE PLUMBED TOGETHER AND OPERATE SIMULTANEOUSLY.
G. ENGINEER'S CERTIFICATION
I certify that 1 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. GARNESS
Date 17/�i/t4
(Rev. 11105)
f A. Gar ess:
n C 7953 m�
n.
profes
Municipality of Anchorage s
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) # 141630
During a recent COSA on-site inspection and test of the potable water
supply well on Block , Lot 2 of Prescott subdivision, the well's
productivity was determined to be 0.57 gallons per minute. The minimum
well productivity required by this Department (AMC 15.55) for a 5 -bedroom
residence is 0.52 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.
A' 89 59' 30" Vv .?04 ti
P/ 89 59' E 304.92
P
:' 49 TH Op
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
qn SHANE A. HOLT / m O CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND 15
LS
-6914.'y�0� NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
a�dN °Tegsion8l Xo�oo HEREON(UNLESS INDICATED)
4OQO4�p0� NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS,
ANY PAVING SHOWN HEREON MAY 8E APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE.
AS BUILT SURVEY I" = 40'
NO CORNERS SET THIS DATE
G
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 2, PRESCOTT SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 3 RD DAY OF
DECEMBER 2014.
HOLT LAND SURVEYING
600 HIGHVIEW DRIVE
ANCHORA6E,AK 99515
1201, FS IFS -2.169-75 345-5513
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
AND EVIWL 1,604t.
THIS
AS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
L4� 13ay of w of 20 by and between �9 �"1 iYYL las
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AWWTS), described as
located at (legal description).
2. Definitions.
Alteration. Any change to the design or function of an AW WTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On -Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code (hereinafter, "AMC") 15.65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On -Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations. Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS, the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider approved by the municipality and the
manufacturer of the AW WTS for the entire term of the AW WTS In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay
for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AW WTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor, the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
r
H. Owner agrees that the AWWTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction, maintenance and repair of the
Owner's AWWTS.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such party thereafter to enforce each and
every provision hereof.
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing, executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with, and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement, the only authorized representatives of the parties
are:
a. Owner:
b. Municipality: Director Community Development or designated authority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
By: (signature)
® (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
Date: -- �
.tn4 rl
mkt CA, -:E • Lk-KA-C�
The foregoing instrument was acknowledged before me this�'�day of aw • ,
20L4� by lli n .114 KE LL/.Z _....01111i,
.,::4� -��
NOTARY PUBLIC FOR ALASKA
My Commission expires 1 � i�
MUNICIPALITY:
By: (signature)
Date:
name) Title:
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 l.D.# f HAA#
1. GENERAL INFORMATION
Complete legal description
Lot 2; Ptesco-tt Subd.Lv.ib.ion;
Location (site address or directions) 12101 Gna,L!! St,,.e.et
Property owner ALASKA USA FEDERAL CREDIT UNION Day phone
P.I.D.# 574
.a :t:
Ivi ... y — . —
Lending agency Day phone
Mailing address
Agent S otioN Fa.A,6b019ti07 Day phone 786-2882
Address- AZaska USA Fedena2 Cjced.i t Union
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 5
3. TYPE OF WATER SUPPLY:
Individual well XX
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site XX
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State ADEC
. attesting to the legality and status of system.
72-025 (Rev. 1191) Front MOA #21
b. J I A I tMtN 1 UI- INSt'EGTIUN 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 furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm S & S EAIGINEERING Phone
17034 Eagle River Loop Road NO. 284
Address Eagle River, !Alaska 99577
Engineer's signature
6. DHHS SIGNATURE
_K_ Approved for S- bedrooms.
Disapproved.
Conditional approval for
Additional Comments
Date 6- 2-0 — 41 f
bedrooms, with the following stipulations:
By: .OH(\l SM t n4 Date
111TIr,,
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.
72-025 (Ray. 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human Services _
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: of 2,; pee Se- pt Parcel LD
A. WELL DATA
Well types; �.i h ,ui�u If A, B, or C, attach ADEC letter. ADEC water system number tj PA
21-2-
Log present (Y/N) Date completed - - _8 Driller �ey ro
m5 &JLQJ .
ZCi (a eao,`� ( Sz
Totaldepth44:�2 (4co S Cased to Casing height (Z f
Sanitary seal (Y/N)
Wires properly protected (Y/N) ti
B. SEPTIC/HOLDING TANK DATA
Date installed (o Z 13 ' C52 Tank size /! 0 0A Compartments Z
Cleanouts (Y/N) Foundation cleanout (Y/N) T— Depression (Y/N)
High water alarm (Y/N) A)! tA Alarm tested (Y/N) ! (.
Date of pumping Z O - c1/ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
r r r
Well(s) on lot ISO f On adjacent lots 100 f- Foundation /0
To property line Lo f Absorption field (0 f Water main/service line 10
Surface water/drainage I OC) r�
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
FROM WELL LOG AT INSPECTION
T
Date of test
8 2 -
G y
Static water levell�Je��S-y
Static
5. �.p p�
". o
t < D
Well flow
g.p.m. 9�►i+*"'
C
Pump level
V [� UK
M
Lo
SEPARATION DISTANCES FROM WELL TO:
H m
Z
Septic/holding tank on lot
8 ; On adjacent lots
r �
! OC) t (Oto +
Absorption field on lot
; On adjacent lots (
Public sewer main
Public sewer manhole/cleanout 161.1/6
Sewer service line
r
112 Petroleum tank AJ DNE "QW A)
WATER SAMPLE RESULTS:
},
Coliform -,4%A AC1 0(4
Nitrate -15&tj`` cta!j 2 ((-:1 Other bacteria
Date of sample:
c1 Collected by: `>4
B. SEPTIC/HOLDING TANK DATA
Date installed (o Z 13 ' C52 Tank size /! 0 0A Compartments Z
Cleanouts (Y/N) Foundation cleanout (Y/N) T— Depression (Y/N)
High water alarm (Y/N) A)! tA Alarm tested (Y/N) ! (.
Date of pumping Z O - c1/ Pumper
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
r r r
Well(s) on lot ISO f On adjacent lots 100 f- Foundation /0
To property line Lo f Absorption field (0 f Water main/service line 10
Surface water/drainage I OC) r�
72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed (n _ tS `I Manufacturer Ak ik'
Size in gallons t4 Manhole/Access (Y/N) (-t
Vent (Y/N) "Pump on" level at 3 "Pump off" level at Z
High water alarm level I Cycles tested (a
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
r
Well on lot ( OD •f On adjacent lots 1 60 / f Surface water loo ' -1
D. ABSORPTION FIELD DATA
Date installed q — t ` 8 9 Soil rating Z 25 0/66_ System type a,,,�
Length 5-:5- Width _3 (o Gravel thickness 6P"vwerd-1ju6c-k -Total depth
Total absorption area ( q eg 0 Cleanouts present (Y/N) ti
Depression over field (Y/N)
Results (pass/fail)
Date of adequacy test
for
Peroxide treatment (Past 12 months) (Y/N) - 011A If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
r r
Well on lot (00 f On adjacent lots Ino Property line /0 rf
To building foundation / 0 f To existing or abandoned system on lot / O f
On adjacent lots 3 0 f Cutbank A,I1 Water main/service line
r
Surface water to f
1 Driveway, parking/vehicle storage area
Curtain drain �_ �' p;21C�i�/.az �nISPE-e-rlai.l f -26j oleT (LrrC!A7)
E. ENGINEER'S CERTIFICATION
,4
ZZO 4
bedrooms
certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect -pr hf &:'iate,gf this inspection.
S & S ENGINEERING
Signatureoop verf
Eagle River, Alaska 99577 rg °
Engineer's Name
Date
,' .,
HAA Fee $ 1—I L� Waiver Fee: $
Date of Payment —) -G> > Date of Payment
Receipt Number D��U�.% 1 15� Receipt Number
72-026 (Rev. 3/91) Back MOA 21
CHEMICAL & GEOLOGICAL LABORATORY
A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO.
5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301
ANALYSIS REPORT BY SAMPLE for RUSHoxded 37327
Date Report Printed: AUG 16 91 @ 15:58
Client Sample ID:WELL `11 L2 PRESCOTI S/D Client Name :S & S ENGINEERING
PWSID :UA Client Acct :SNSENGP
Collected AUG 14 91 @ 12:30 hrs. BPO PO 1 NONE RECEIVED
Received AUG 15 91 @ 15:15 ills. Req
Preserved with :AS REQUIRED Ordered By :R. SHAEER
Analysis Completed :AUG 16 91 Send Reports to:
Laboratory Supervfs x JSTEPHEN C. EDE 1)S & S E1dGINEERING
Released By ( C11-9 �j.�t� d 2).
==.....,na _..oe._ o=. ............... ......... .....................
Cheml.ab Ref #: 911163 Lab Smpl ID: 1 Matxix: WATER
Allowable
Parameter Tested Result Units Method Limits
------ -----------------------------------
171TRATE-N 3.7 mg/1 EPA 353.2 10
{
Sample ROUTINE SAMPLE COLLEC'T'ED BY: R.D.J_
Remarks:
e=ss=z,m_I
y
TestsPerformedLpVT
i=azen''vmSee aSpecial
�Instructions Above UA -Unavailable
ND-
None Detected
" See
Sample Remarks Above
Ilk-
Not Analyzed
LT -Loss
Than, GT-Gxeater Than
`0"SGE7 Member of the SGS Group (Societe Generale de Surveillance)
a i\
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL t \ g,- Qa®i
OF ON-SITE SEWER AND WATER FACILITY 1�1
264-4720
Application Date 'i1 11 7
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
I.o f 2 Prucm AA 5 / D
Location (address or directions)
1210 / Crrra I XA
(b) Applicant Name Fri Sm; 1% Telephone: Home Business 7b6 -268 7
Applicant Address `/,, fie CtSA Fece Crea(/ 661 r6 1(a GG Ceecfef &A tan Or 99.s_W
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution A -k USA r -cc! Cred1f Uofran Telephone 7B6"- 20 87
Address `(660 Co-ea;UACOR Drt*✓e/� AcAoratt, kh 99S03
(e) Real Estate Company and Agent N. R.
Address -4
Telephone
Mail the HAA to the following address:
(N.,t (
2. TYPE OF RESIDENCE
Single-Family[Z Multi -Family ❑ Other
Number of Bedrooms
3. WATER SUPPLY
Individual Well ® Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite,R Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 (11/94)
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm ��� �tc�n�ca( SPrdiC?/ Telephone
Address /h'S 30 Ec Aa SA ,4nc tiar aqe .46r 99S/ 6'
Date
6
.•Q,oGM
o F If
4.91—H !' •. �r
8: 7HE0D0RE F. MOORE
CE - 3589 •: ,.�
4{ry ••®
6. DHEP APPROVAL
Approved for _r ' CO bedrooms by �` "�� '�' � "" `6 Date
Approved
Disapproved
Terms of Conditional Approval
Conditional
CAUTION
Engineer's Seal
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
MUNICIPALITY OF ANCM119AWIPALITY OF ANCHORAGE (MOA)
ENVIRONMENTALSERVIEE;NL4XL.SjfpjdAUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
APR 14 1987 264-4720
RECEIVED
A. WELL DATA
Legal Description: 1-n f 2 Pru teff -SID
Well Classification Prtva fe If A, B, C, D.E.C. Approved (Y/N) N' A.
Well Log Present (Y/N) Y Date Completed #l-6/21162 *V2-1/5 Yield 6 M
of top' # t ✓r Z'
Total Depth :WP !1001 Cased to V �' Depth of Grouting N A.
Static Water Level Sit to each well Pump Set At
Casing Height Above Ground 16 at 't• Sanitary Seal on Casing (Y/N) Y
Electrical Wiring in Conduit (Y/N)
r
Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/Holding Tank on Lot Ica ; On Adjoining Lots > <<'a
To Nearest Edge of Absorption Field on Lot ; EO ; On Adjoining Lots too'
To Nearest Public Sewer Line N` 4• To Nearest Public Sewer
Cleanout/Manhole N. A• To Nearest Sewer Service Line on Lot N.14.
Water Sample Collected by -r F=" ; Date 'y'(2 l® 7
Water Sample Test Results Sufti 4eec{r3r Ao C0111orm or cAtre (,acltrict
Comments Idle((_( # t 42 are (umyed {o feAvI Coin b1fl«e told .00C
A. -7 i/..er raMp 1Mi'7ruroc{ AoriI 1Q67
wait Y 41 d is a(le�uuf t �o� ,1 %evil av n °{tocere
B. SEPTIC/HOLDING TANK DATA
Date Installed 6(Z81B 2 Size(sem ( No. of Compartments
2
Standpipes (Y/N) V Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y
Depression over Tank (Y/N) IN
Pumping/Maintenance Contract on File (Y/N)
Date Last Pumped y /6l S 7
;for
Holding Tank High -Water Alarm (Y/N) IN, 14. Temporary Holding Tank Permit (Y/N) N, %•
Separation Distances from Septic/Holding Tank:
To Water -Supply Well 1084
To Property Line (GU '
To Water Main/Service Line NIA.
Course
+A-
Course too'
Comments
Page 1 of 2
72-026(11/84)
0
To Building Foundation
r
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 85' - t 25' Type of System Design Tr'eAcA
Date Installed 6 26 / B 2 Length of Field [oY
Width of Field 3611 Depth of Field
Gravel Bed Thickness 30 "
Square Feet of Absorption Area 967 ver ev-L4,r h Standpipes Present (Y/N) Y
Depression over Field (Y/N) N Date of Last Adequacy Test
Results of Last Adequacy Test A• der &C a f e So r S b earoomr
Separation Distance from Absorption Field:
To Water -Supply Well 2 O' To Property Line x 2a 1
To Building Foundation `1 0' To Existing or Abandoned System on
Lot N,14. ; On Adjoining Lots > 30 '
To Water Main/Service Line N, 4. To Cutbank (if present) N, A.
To Stream/Pond/Lake/or Major Drainage Course > foo `
To Driveway, Parking Area, or Vehicle Storage Area > 5'0 `
Comments
D. LIFT STATION N,,+ ,
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
— "Pump Off' Level at
— Vent(Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date 11 1'6 7
Company f- la l-Fw Poch Svcr MOA No. 96 - OS -2
Receipt No. V �7
~ 0 �l —�
Date of Payment Zzl-iF �•8s'�mb�®
ov ����
Amount:$ fl' d ,°••°°•° ;'® Engineer's Seal
4'••° /A,'°°off'®®
�1.... °.............. oo. e...O
Page 2of2• .°°.°..°°...�°.
fi -.i rHt'ODOn'c F. lv=RE
72-026(11/84)`�^FF°°B•.° -4`*4F
011'-
11' -
Time
Time
APPLI( ;NT FILLS OUT UPPER HA;,- ; ONLY
Time
F;roo@rty (Owner
v. s
Time
I
Phone
Mailing Address
X/Go ":/,,,'C-..4� Zip Code
? 1' -
Buyer
Date
Date
/s-
L LL -0
Address
Inspector
/ Zip Code
I
Lending Institution
/ - -
j rJ�i =-' �` _ ;� f_ e J:�._-)
Phone
AddressZip
S _1
..�.Code
%
Realty Co. & Agent
Field Notes: _t-`��gL�t¢�cc"(,
/l C G aU _, /1
X"'`�r"V _
''"" "f�,,�UNICIPALITY O ANCHORAGE
C /G�ri� G2��y DEPT. Of HEF.LTH
Phone
Address
i./ IRONTe))py�{{NTAL PROTECTION
Zip Code
Legal Description
/ -J co !/ -X 0
Street Location
/Q
!7 fl--�/�/ / I -
RECEIVED
Type of.Residence
(d-) APPROVED BEDROOMS
`CONDITIONS OF APPROVAL
le Family
f
( ) CONDITIONAL APPROV4'
❑ Multiple Family
No.
of Bedrooms
❑ Other
BY:
Watters Supply
fl'
Date Sewer Installed
Well To Absorption Areal</-,�
WellLog Received
Individual
�..-5 �..
Well to Tank I Za
ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975.
❑ Community
-
For wells drilled prior to that date, give well depth (attach log if
available).
❑ Public Utility
Sewer 'sposal
Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
- NOTE: THE INSPECTION
FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
! n �rl
Time
I
r�'.I�J
? 1' -
Date
Date
Date
/s-
L LL -0
Date
Inspector
Inspectors
I
.Inspector
Inspector
F'�Ct
7
i Y
P
Field Notes: _t-`��gL�t¢�cc"(,
/l C G aU _, /1
X"'`�r"V _
''"" "f�,,�UNICIPALITY O ANCHORAGE
C /G�ri� G2��y DEPT. Of HEF.LTH
ri
U /-P~
i./ IRONTe))py�{{NTAL PROTECTION
G
..
Clrl12 1
RECEIVED
(d-) APPROVED BEDROOMS
`CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROV4'
DATE
BY:
Soils Rating
Date Sewer Installed
Well To Absorption Areal</-,�
WellLog Received
�..-5 �..
Well to Tank I Za
Septic Tank Size �-�