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MOUNTAIN MANOR BLK 2 LT 3
Mountain manor Block 2 Lot 3 #050-671-18 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161062 PID Number: 050-671-18 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: MATTHEW & GAIL LAVER ABSORPTION FIELD ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 18720 ROADS END CIR., EAGLE RIVER, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4' 0.8 GPD/SF 12 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4 Ft. Gravel depth beneath pipe 8 Ft. Subdivision Block Lot MOUNTAIN MANOR 2 3 Fill added above original grade Varies 0.25 to 1.21 Ft. Gravel length 47 Fl. Township Range Section Gravel width 2 FL Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area o Number of trenches Dist. between trenches From Tank Field Tank Line '7577- OWWFt= Ft. Well 100+ 100'+ 100'+ NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1250 Gal. Surface Water 100'+ 100'+ 100'+ NA Material STEEL Number of compartments 2 Lot Line 5'+ 1Q'+ 5'+ NA NA Foundation 5'+ 10'+ 5'+ NA LIFT STATION Manufacturer Capacity Curtain Drain NA *50'+ NA NA Gal. Remarks *None known. Existing tank Pump on level at in. Pump off level at In. High water alarm at in. decommissioned per code and new 1250-gal S.T. Installed. Pump make and model Electrical Inspections performed bTanktoy Installer Flintstone Enterprises PIPE MATERIAL House tc tank 3034 dra nfield 3034 Drainfield 3034 CO/MT 3034 Inspector ARCTERRA BENCHMARK (Assumed elevation) 100 ft Inspection ection t$' 4/18/16 2nd 4/19/16 Location and description 304/20/16 4" Bottom of siding COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin low OF AL\ Conditional Approval: Date Ar TH � P KENNETH N. DV- / c9 7 18 / , /�ti°.i Approve Date �%� ° ,�s' FTaS10P i r AS -BUILT SYSTEM DETAILS/SITE PLAN Permit OSP161062 B -E=11,6' MOUNTAIN MANOR LOT 3 BLOCK 2 PID# 050-671-18 x B -D=12,5'99.60 m C -D=18,1' B -E=11,6' C -E=25,8' A -F=55,3' B -F=12,3' o 4 A-13=54.9' y— �. B -G=12,8' A -H=14,3' B-1-1=49.3'94, SEPTIC i OF AL,,'S� 9TH KE S / —71 1'ROFgSS10T3�' ssr3 �� Mau FINAL GRADE I SEWER ROCK I 47' PREPARED FDRI MATTHEW & GAIL LAVER 18720 ROADS END CIRCLE EAGLE RIVER, AK 99577 907-854-5153 FIELD BOOKS BOUNDARY: N /A STAKING: N /A ASBDILT.. JLS DN Fly: ACAD FIM- FILE CoNvuTED: DRAW CHECKED: DATE: GRID: JOB No.: SCALE, 1' = 30' N R fi 79.90 ew SCALE, NTS RcTeRR ARC 1 ERRA OF ALS t, 4% CONSULTING, INC ` 212 E. 51 Ave, Anchorage, AK. 99503 A01 Y �� c Office (907) 868-3791, Fax (907) 868-3793 / * 49TH b�4 c�'suliwsn`` I SOILS PERCOLATION TEST i 71.�F' / 4G p F7;SS tSP ,I/ Performed for: Matt &Gail Laver Date Performed: 04/14/2016 \ Project: MOUNTAIN MANOR B2, L3 TEST HOLE # TH 16-2 Depth (Feet) SEE ATTACHED SITE PLAN 15- Org/OL GM/SM w/ cobbles & boulders to 1-2' B.O.H. 16- 4 -BR ADVANCED RESERVE 17- 4 GPD / SF = 150 SF 150SF/2X6'ED=13T 18- USE 20T X 2'W X 6'ED 19 - HOLE PRESOAKED 20- PRIOR TO TEST FOR HOLE LOCATION Was Groundwater encountered? NO What depth? NA Depth to water after monitoring? DRY Date? 4/21/16 Reading Date Gross Time Net Time Depth of Water Net Drop 1 4/18/16 1:00 6" 2 1:30 30 min 4 5/16" 1 11/16" 3 * 1:31 6" - 4 2:01 30 min 45/16" 111/16" 5 * 2:02 6" 6 2:32 30 min 4 4/16" 1 12/16" 7 8 9 10 11 12 * Water Added Percolation Rate 17 (min/in) Perc Hole Diameter 6" Test Run Between 3 feet and 4 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. On -Site Wastewater Disposal System Permit Permit Number: OSP161062 Tax Code Number: 05067118000 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 Work Type: Septic Upgrade / Permit Effective Dates: April 12, 2016 to April 12, 2017 Z-.(96) Design Engineer: ARC TERRA CONSULTING INC Subdivision: MOUNTAIN MANOR a Site Legal Address: MOUNTAIN MANOR BLK 2 LT 3 G:0254 ( 1 1 Owner/Address: LAVER MATTHEW M & GAIL C 18720 ROADS END CIR EAGLE RIVER AK 995777920 Site Mailing Address: 18720 ROAD'S END CIR, Eagle River Lot Size in Sq Ft: 52606 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field -f9-Septic Tank N Holding Tank N Privy N Private Well N 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 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 By: V//.s h6 MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-671-18 Property owner(s) MATTHEW & GAIL LAVER Day phone 8Sy—SlS3 Mailing address 18720 ROADS END CIR., EAGLE RIVER, AK 99577 Site address 18720 ROADS END CIR., EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) MOUNTAIN MANOR B2, L3 Lot Size 52606 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (® all that apply) Absorption Field 1k Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN Initial ❑ Upgrade M Renewal ❑ TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. or authorized agent) Perm Okush Fees: S(.� Date of Payment: Receipt Number: o?) -7(49 Permit No. BSP I b doh 2 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. a �RCTERR� ARC 1 ERRA CONSULTING, INC 212 E. 5181 Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 April 7, 2016 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit — MOUNTAIN MANOR B2, L3 It has been determined that the absorption field of the subject property is saturated. Subsequently, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system. A diverter will be installed to the existing system to act as a reserve. The general slope of this lot is from north to south at a grade of approximately 3- 81yo over the septic area. On April 1, 2016 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 3 -bedroom single-family residence. We propose to install a single 47 -foot trench. Groundwater was not encountered at excavation or at monitoring. The property and adjacent lots are served by private water. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868- 3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. D fus E. Attachments: On -Site Sewer Application Wastewater Absorption System Details/ Site Plan Soils Log/ Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 ELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA MOUNTAIN MANOR LOT 3 Ipr 1i O� pro.. � �WD >RDXR FLAG PROPERTY LINES`-- WELL INEWELL RADII & EASEMENTS PRIOR TO C❑NSTRUCTI❑N NO PUDLIC WELLS WITHIN 200. OF PROPOSED SYSTEM, NO PRIVATE WELLSVITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200. OF PROPOSED WELL EXCEPT AS NOTED. ,or SOFA k /� 04 `-- (LCE crn E 11N1, , Cy/��/L�i/ \ sshOx�� BLOCK 2 Scaler 1'= 100' DESIGN DETAILS PAGE 1 OF 2 3 BDRM X 150 GPD = 450 GPD 450 GPD/.8 GPD PER SQ. FT. (9 MIN/IN.)= 563 SQ. FT (563 / 2 x (8' GRAVEL) = 35 FT, TRENCH USE 1 TRENCH - 47' (L) X 2' (W) X 8' (ED) Total depth of system Is 12' max from orlginal grade. Total depth of gravel below distribution pipe is 8' . NOTES; 1. VERIFY OR INSTALL 1000 GAL & INSULATE TANK IF <4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL. MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ, 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK, 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... PREPARED FOR; MATTHEW & GAIL LAVER 18720 ROADS END CIRCLE EAGLE RIVER, AK 99577 907-854-5153 FIELD BOOKS DoMpUTBD: BOUNDARY: DRAWN: BMW STAIONG: N A CHECKED: KMD ASBUILM JLS DATE 4 16 DWG. FILE CRUD: NW0254 ADAD "�' FILE '� No.; 16-128 II N 4STALL Cos & f� NN N, WASTEWATER DISP❑SAL SYSTEM DETAILS MOUNTAIN MANOR LOT 3 BLOCK Z S84.00'00"E \ 70.0n' ---7L w 10 UTILITY ESM' UL T ESM' \ WELL O£0/C OA,yT VG CO 3A^'Z' J'e; v FLAG WELL PAVED o RADIUS D/W T � CO T20, 7H16-1 ^' N NO TOP OF SLOPE b� FLAG' PROPERTY LINES WELL RADII & EASEMENTS PRI❑R TO C❑NSTRUCTI❑N PREPARED FOR: MATTHEW & GAIL LAVER 18720 ROADS END CIRCLE EAGLE RIVER, AK 99577 907-854-5153 FIELD BOOKSVID. SWNDA . MAW STAYING N/A ASSUar. JLS DAM6 DWG. RIE 5,Dom`FILE9F k Scale: 1•= 30' PAGE 2 OF 2 �EtCTER�,� ARC 1 ERRA ^� CONSULTING, INC ' 212 E. 51n Ave, Anchorage, AK. 99503 1 Office (907) 868-3791, Fax (907) 868-3793 b�9 ✓l• TING SOILS PERCOLATION TEST Performed for: Matt & Gail Lavey Date Performed: 04/01/2016 i oF AL\�� 4t, Project: MOUNTAIN MANOR B2, L3 TEST HOLE # TH 16.1 Depth (Feet) SEE ATTACHED SITE PLAN Org/OL GM/SM w/ cobbles & boulders to 1-2' B.O.H. 19 - HOLE PRESOAKED 20- PRIOR TO TEST FOR HOLE LOCATION 7 FW Was Ground water encountered? NO What depth? NA Depth to water after monitoring? DRY Date? 4/7/16 Reading Date Gross Time Net Time Depth of Water Net Drop 1 4/2/16 1:00 6" 2 1:30 30 min 2 11/16" 3 5/16" 3 * 1:31 6" - 4 2:01 30 min 1 2 12/16" 3 4/16" 5 * 2:02 6" - 6 2:32 30 min 212/16" 34/16" 7 8 9 10 11 12 * Water Added Percolation Rate 9 (min/in) Perc Hole Diameter 6" Test Run Between 5 feet and 6 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. Municipality of Anchorage June 23, 1986 P.O. B .196650 ANCHORAGE, ALASKA 99519-6650 (907)264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Judy A. Nickell SR 2 Box 7299 Skyline Eagle River, Alaska 99577 Subject: Lot 3 BLock 2 Mountain Manor Subdivision On-site Well Permit 11860101 - Issued April 25, 1986 On May 20, 1986, The Anchorage Assembly approved a new ordinance regulating on-site wastewater disposal systems (septic systems). All septic systems constructed after the effective date of this ordinance are subject to the provisions of this ordinance. Our records show that you currently hold a permit for the installation of a septic system. We strongly urge that you contact this office prior to constructing your system. Any changes in the code that could impact the construction requirements of your septic system will be identified and brought to your attention. Please contact the Environmental Services Division at 264-4720. Thank you for your cooperation. Sincerely, (7 Susan E. Oswalt Program Manager On-site Services SEO/SSM/ljw �� M Trrtifirb 43ritting b, DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759 OWNER OF LAND Sy 6 Z JU o + ✓t% I C /!E/,L LEGAL DESCRIPTI 343cK M 0,%f DATE -Started C Ended - PERMIT NUMBER KIND OF FORMATION: From.._ -Q._ -_.Ft. to -.-,2 —_FLis DEPTH 01- WLLL _/c� a �j -r c Sr%I1C LLVELOF WATER FT. Ivy DRAW DOWN FT. GALS. PER HR V 0 KIND OF CASING b From. Ft. to ___,Ft. From Ft to Ft From Ft. to t. _--- _- _ .. _ _ _ __.--__ . From_ Ft. to n Ft. 4%J4✓ � i FromFt. to Ft. From-�G�_Ft.to- FL C`�r4'.�-'✓�. From Ft. to— Ft. From36'Ft. toS-3 Ft. �ld� '`� From Ft. to --Ft From 3 Ft. toJ` y w Ft._,fA j4 A, __6kj4Urc. From Ft. to Ft. From_4 �iY_Ft. to%,5_Ft._C4 r / �_ �I _ � L_ From Ft. to____ Ft. --- From -7 �_._Ft. to-_-, i_ Ft. _�R,,�,� - _ _ _ From- ..--__-Ft. to_ Ft. _�— From_ZFt. to - �f____Ft._t; ,�_��r /1fi✓CL From Ft. to._ ---Ft. From��_Ft. to�4 From Ft. to Ft. From�Ft. to_��`__Ft..— —`r -�-'�-------- - - From _._____- M� Ft. t t)jp-__Ft. _— From bFt, to_J_0_Ft._S_,0 w �i7 --- Q 1~C - From FiyF/ pFp�C/TI, Ft.�dl,__.p�_�t From —FL x"''4_644.1 e-� From-___-- Ft. q��f(�yR .-�Vq.__Ft.to� From__Ft. to_ p_ , Ft._ J��n_-__"' �r� Z From_--_/t(�to—S�y2Ft8 T 'Q FST /a --- From /IS Ft. to._Ic_l_Ft. ,W Tr�,.+7 SAL, ��"��� From ___IGt. to�Ft,�' From Ft. to _.L�SJ_I Ft. From Ft. to----,— Ft. L<,j'�}'7��_�l From_ Ft. to_ Ft -- _ -- MISCL. INFORMATION: nurr r rine lVeMG This well is producing ,gallons ter per hour. Set pump @ feet. INVOICE :YVOICE NO. MOON DRILLING DATE SR BOX 668, BOGARD RD. YOUR P. O. NUMBER PALMER, ALASKA 99645 TELEPHONE 745-4071 TERMS SALESMAN Lot Blk Sub WELL LOG DEPTH CABIN IN FT. FORMATION DEPTH CASIN IN FT. FORMATION DEPTH CASIN FORMATION IN FT. 1 101 --201- 102 --202- -2 10820a -3 4 104 204 8 108 206 8 109 206- 7 107 207 a 108 --208- 9 109 209 10 110--210 1 1 111 211 12 112 212 18 118 213- 14 114 214 18 118 -215- 16 118 -216- 17 117 217 18 118 218— 118 219 _19 0 120 220 1 121 221 22 122 -222-- 129 22a --23 24 124 224 —226- 28 128 26 129 229 7 127 227 28 128--229 29 129 229 —230- 80 I 130 1 131 291 82 192 282 88 139 239 84 134 234- 5 138 238 86 139 298 197 297 38 30 138--2a8-- 39 199 2a9 40 140 240 41 1 1 141 241 4' 142 242 48 149 248 144 244 OAR 1-11.11 Aj 1: AZT E F" own L~X "I^"r 10 F"* 14 Tull T. -0 1[1�::ll 0011 1E.--3 lF.E.: DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION --x ^ 264^4720 , AM Tull ~~Es X~1 - IE OAR EHE U... L- MEE FRA -1 X~� � PERMIT NO: 860101 DATE ISSUED: 04/25/86 APPLICANT: JUDY A. NICKELL ADDRESS: SR2 BOX 7299 SKYLINE EAGLE RIVER, AK 99577 CONTACT PHONE: 694 789 LEGAL DESCRIP: SUBDIVISION: MT" MANOR LOT: 3 BLOCK: 2 SECTION: 6 TOWNSHIP: 14N RANGE: 11AJ LOT SIZE: 43560 (SQ"FT" OR ACRES> certifv 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 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 1, or the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or ne�rby lot" ^ SI8NED DATE: ---�-~ ~��-�����----�� APPLICANT: J0DY A,'NICKELL ISSUED BY DATE: � � � MUNICIPALITY OF ANCHORAGE Hea and Environmental Prote on Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM }M MAILING ADDRESSO,-a�l PHONE �9`�" LOCATION 2Q- -- I-- LEGAL UF:SCRIPTION___W—sz__�_�_Z_-_-M l _ A hOn- SEPTIC TANK: DISTANCE FROM WL1L_J-00 ___ NIANUFACIURER_ _ ______MATEiRIAI_ INSIDE LENGTH TILE TILE DRAIN FIELD: INSIDE: WIDI LIQUID DEPTH -- NUMBER OF _-_-_COMPARTMENTS _ 2_ LIQUID CAPACITY 41. GALLONS. TOTAL LENGTH OG DISTANCE FROM WI.LL_ _I0U_-FOUNDATION.__�__-_NEARLST LOT LINE___.._________...__.0-OF' LINE # of Lines -___��—_.___ DISTANCE BETWEEN LINES _- .____-__ TRENCH WIDTFI �o IN. TO]AL EFFECTIVE ARSORPI ION AREA __sem-U ._----_-__ SO. FT. LENGTH OF EACH LINE DEPTH OF FILTER ` DF_PTII: TOP OF TILL: IO E INISII GRADE _MATERIAL BENEATH TILE ,,--'S __IN. AE30VE TILE IN, SEEPAGE PIT: DIAME!ER.--OR WIDTH-_-, LENGTH_.__, DEPTH Log Crib _Rings_ Crib Size: DIAMETEll- -..__DEPI-H. —DISTANCE FROM: WELL TOTAL. EFFECTIVE BUILDING FOUNDAI ION ___ , NEAREST LOT LINE ____ . ABSORPTION AREA (WALL AREA) ____ SQ. FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: Pipe Materials: # of Bedrooms: Installer: Remarks: APPROVED __ e W" I J e (W rr<i' h Sett d��j,•F 4 f*A�i} a In �j Y_..� i ^ .7fi1 'ii". .�'iF3p. c' + i .. � %: rt ':C4 M a.;^t � 1�..: j, I t i e jee eo n � Al A&SUILT , ,. t hembY cart* that 1" hive 6nrVeY th{/ems' following 1 R 1 ty p " ,� �►gChdR Q' Precincts ._A'T*Gka+ "&I'dt . t11M the ' -='RICo[tit'ri!: improvements situated thereon .aro.,mithin.the 'P COOM Une .end do,not -overlap or encroach ,on'the'PrcptrtY tyingadjacent thereto, that n0 iiqprovements on . e erty il�s:adlacent thereto encroach•on the preausesm �. and that there are no roadways, transmission question fines or onset visible easements on said property except �. as indicated hereon Dated at Eagle River, A Ja ROBM fir s a n M 1+ V= t, Ew R usr�i�► GREATER ANCHORAGE AREA BOROUGH �N(N011.10[ , DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO, 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT 46 NAME OF APPLICANT .�%G! 4 { MAILING ADDRESS ✓'y�/ ill e" HONE INSTALLATION LOCATION r('/�t^za '} LEGAL DESCRIPTION I &// /// /�(` 'A � INSTALLATION OF: SEPTIC TANK il—� SEEPAGE PIT DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED 3 47,01J FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE woo TYPE SEEPAGE AREA SIZE ,�- (TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK I — FOUNDATION TO SEEPAGE PIT a& DRAIN FIELD AQ , SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT �d`p DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK l�U d SEEPAGE PIT DRAIN FIELD ` UO ALSO CONSIDER AREA WELLS. 0 / WATER MAIN TO SEPTIC TANK —, SEEPAGE PIT DRAIN FIELD It')t SEPTIC TANK, , SEEPAGE PIT — DRAIN FIELD [ ®� TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. , OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBE D ``SYSSTTEM 15 IN ACCORDANCE WITH SAID CODE. " DATE / 3 / APPLICANT'S SIGNATURE ����������� �� �������� DEPHRTMENT / 1EHLTH AND ENVIRONMENTAL TECTION� >(/ 825 'L' STREET/ ANCHORAGE, HV 99b01 LL�J 279-2511 �H _ _' . _��_ __. 4E_� ��4� �����o� �— r PERMIT NO. ( 77724 ) 10: tW F9 HPPLICHNT lH0llAS8,.DAVIS PO. BX E R � 88 E. � LOCHTl,ON RDS. END KD. LEGAL LT. 2 MT. MANOR S/D LOT SIZE 52000 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL. RATING (S(.'! FT/BR)= 165 THE REQUIRED SIZE OF THE S8IL ABSORPTION SYSTEM IS� ��5 �FEE �C3 -T_ iE. F-1 ��F-`V" 1`5 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH 8F H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCH\�|TION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL. DEPTH IS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFHLL PIPE AND THE BOTTOM OF THE EXCHVHTI8N <IN FEET). �Fj r -A K -F, Ir ;E Q% Q) ������!:.E.- Vf. FA C -3i FE ��L_ Fl r-4 J- I'-) �... ... ...... ......... ........ .......... ........ ........ H PHCKHGE PLANT MAY BE INSTALLED AT THE PERMITTEE'S OPTION SUBJECT TO THE FOL1 8WING CONDITIONS: 1, EITHER H CLASS I OR II NSF APPROVED PLANT MAY BE INSTALLED. 2. H CONTINUOUS MAINTENANCE- AGREEMENT IS REQUIRED. IF A MAINTENANCE AGREEMENT IS NOT KEPT CURRENT YOU MAY BE REQUIRED TO ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY BE SUBJECT TO PROSECUTION, J.- L.4 C� � ���������� �F;;? F.E. ��-7i 1.1 1 F?l C: BHCKFILLING OF ANY SYSTEM WITH0UT FINAL. INSPECTION AND APPROVAL. BY THIS DEPARTMENT WILL BE SUBJECT TO PR8SECUTI8N. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL. SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL WELL LOGS ARE' REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIHGRHMS HRE HYHILHBLE TO INSURE PROPER INSTALLATION. �FEE �����F-! ��-7� I CERTIFY THAT 1� I HMFHMILIHR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTHLL THE SYSTEM IN ACCORDANCE WITH THE CQDES ]� I UNDER'. THHT THE ON�SITE SEWER SYSTEM MAY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN _-Z BEDRQOMS. SIQNED:~___���... ..... �~__��~��~����__���_ APPLICANT THOMHS&DHYIS ISSUED ...DHTE~~~~ 0 Et E GEO .CHNI CAL Et DEVEL 'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russe# Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Er Foundations Land Development Performed for: Name: /Nc»vi7s o,-� ,OA4'i,s Tel. No. Mai l i ng Address: p �, S? >< Sr , C4C-1 z� i�'�.e, A� %'mss �7 Legal Description: Lvr - E'�%C. r7; eLr_, �9z 6�%' /B® Depth (feet) Soil Characteristics 0 1 ML 2 3 4 ec . 7;Z 57 6 7 8 9. 10 11 K�/NOD,ti>' .rJixrcliZE D,� To /Z `y3 ,QED G�E,s/JE 12 13 ylr_' = ciJ 14" 1577 c 's 16 �':as` i�% Ground Water Encountered: Yes- No ! If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: f (e°6,'4 • 42 Date: Date: .> /C) '41111V.- .7.7 • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS Parcel I.D. 050.671-18 Expiration Date: 1. GENERAL INFORMATION Complete legal description MOUNTAIN MANOR BLOCK 2 LOT 3 Location (site address) 18720 ROADS END CIRCLE EAGLE RIVER AK 99577 APR 2 5 .la5-( -7-z7167 Current Property owner(s) MATTHEW & GAIL LAVER Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 18720 ROADS END CIRCLE EAGLE RIVER, AK 99577 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF-WASTEWATEI Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released aeer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number c11 f b COSA# 650WOLI Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATJ STATEMENT F 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 4/21/2016 Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future -+�\ occupants or can ArcTerra guarantee that no unseen OI' AZ X� encroachments, deficiencies or discrepancies exist. W- �� �!f e®4/ \y. 4 10 . `A C1 T11 6. DSD SIGNATURE System #1 Approved for U bedrooms. System #2 Approved for bedrooms. Disapproved. n KF.\�H1'H Vit. r(7l�il�r C n yea 4 oil n •Ess iO r \\av' Conditional approval for bedrooms, with the following stipulations: \cY OFAk, AND WASTEWATER By e Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet 10.10A2.cm Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the tot: COSA Checklist # of Structure served by this system _ Certificate of On -Site Systems Approval Checklist. - Legal Description: MOUNTAIN MANOR BLOCK 2, LOT 3 Parcel ID: 050.671.18 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Date completed 411986 Sanitary seal (YM) Y Total depth 121 ft. Cased to 121 ft. FROM WELL LOG Well Log (Y/N) Y Wires properly protected (YIN) Y Casing height (above ground) 24 in. AT INSPECTION Date of test 411986 3/2812016 Static water level 109 ft. 111 ft. Well production 5 g.p.m. 6.7+ g.p:m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2.10 mg/L Arsenic: ND ug/L Date of sample: 3/28/2016 Collected by: ARCTERRA B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC l STEEL Date installed 4!18/2016 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping NA- NEW TANK Pumper C. ABSORPTION FIELD DATA Date installed 4119/2016 Soil rating rg.pd -IN or ft2/bdrm) 0.8 System type DEEP TRENCH Length 47 ft. Width 2 ft. Gravel below pipe 8 ft. 7t2 INV Total depth 12 ft. Eff. absorption areal ft2 Monitoring tube Y Depression overfield N Date of adequacy test NA - NEW FIELD Results (Pass/PNI) PASS For 4 bedrooms Fluid depth in absorption field before test _ in. Water added_ gal. New depth_ in. Elapsed"Time:' min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" levefat _ in. ` "Pump off` level at _ in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tankilift station on lot 100'+ Absorption field on lot 1001+ Publicsewermain 754 Sewer /septic service line 25'+ Animal containment areas 504 SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 1004 Public sewer manhole/cleanout 1004 Holding tank Manurelanimal excrete storage areas 1001+ Building foundation 51+ Property line 5'+ Absorption field 5'+ Water main 101+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 104 Water main 10'+ Water Service line 101+ Surface water. 1001+ Driveway, parking/vehicle storage 104 Curtain drain 504tNONE KNOWN) Wells on adjacent lots 1004 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA. guidelines in, effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 412112010 COSA:canary sheet„?-646.doc ": �trt OF AL t in. ANCHORAGE RECORDING DISTRICT AS BUILT OF: MOUNTAIN MANOR SUBD. LOT 3 BLOCK 2 PLAT 77-23 SURVEY CERTIFICATION: I, John L. Schuller, have conducted a physical survey of this property as shown on this drawing and that the improvements situated thereon are within the property lines and no enchroachments exist other that noted. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. WORK ORDER NUMBER: DATE;SCALE: E-MAIL• APR 21. 2016 1"=30' 16-021 DRAWN BY: CHECKED BY GRID NUMBER: 600K/PL JLS NW0254 160125 OO = FND REBAR OF A` i .... 49 ......... .......... IN L. N L. L� .. 3 R.: LS -10408 ADL IVI) 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax Municipality of Anchorage • Development Services Department Building Safety Division .. On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING p Parcel I.D. 050 -(Oy— 1 d COSA# bboZ.1Pq 1. GENERAL INFORMATION Expiration Date: 1 — 19 — ©eq Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MOUNTAIN MANOR SUBDMSION: LOT 3, BLOCK 2 18720 ROADS END CIRCLE • EAGLE RIVER. AK + 99577 TOM LIGHT Day phone 441-8283 18720 ROADS END CIRCLE • EAGLE RIVER, AK * 99577 Day phone PAM REYNOLDS W/ PRUDENTIAL JACK WHrTE Day phone 242-9975 3801 CENTERPOINT DRIVE, STE. 101 + ANCHORAGE. AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I 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 fs(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 337-6179 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 71 30 t o R Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering anaWs of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results desorbed 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 He 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 right whatsoever. 5. DSD SIGNATURE Approved for-3—bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory `— Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other — J'fey mess.-' CE -7953 . : Ne -PSI•,.•...•-by•% ONSITE • WATER AND : WASTEWATER PROGRAM linal Certificate Date: 7? — 19 O 8 Municipality of Anchorage �•-��l Development Services Department I Building Safety Division .� On -Site Water 8 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: MOUNTAIN MANOR SUBDIVISION: LOT 3, BLOCK 2 Parcel ID: 050 - 6 71 -/$ A. WELL DATA Well type PRIVATE If A, B. or C provide PWSID# N/A Well Log (Y/N) YES Date completed 4/1986 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 121 ft. Cased to 121 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 4/1986 7/24/2008 Static water level 109 ft. 110, ft. Well production 5 g.p.m. 8.25 g,p,m, WATER SAMPLE RESULTS: Coliform Q colonies/100 ml. Nitrate L d' mg./L. Other bacteria n colonies/100 ml. Arsenic: � "NIO ug./L. Date of sample: 7/29/200 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/FIBERGLASS Date Installed 8/23/1977 Tank size 1250 gat. Number of Compartments 3 Cleanouts (YIN) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A 10 Date of pumping 7/25/2008 Pumper SANITARY .PUMPERS C. ABSORPTION FIELD DATA BE OW EXISTING GRADE Date Installed 8/29/1977 Soil rating (g.p.d./ft'o t /bd 165 System type TRENCH Length 46 ft. Width 4 ft. Gravel below pipe 5.5 ft. Total depth •8.5 ft. Eff. absorption area 506 ft' Monitoring tube YES : Depression over field NO Date of adequacy test 7/24/2008 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth In absorption field before test 43 In. Water added 660 gal. New depth54in. Elapsed Time: 140 min. Final fluid depth"'49in. Absorption rate >= 450+ g.p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **3" INTO LATERAL "•1" BELOW INVERT D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off" leve High water alarm level at in. Cycles tested 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' Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A 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 'S' Building foundation 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 G. ENGINEER'S CERTIFICATION 1 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. 100 O '•.Je Engineer's Printed Name JEFFREY A. GARNESS 00 o Date7T 1 c� S� �Opp0o� COSA Fee O Date of Payment $ a D Receipt Number 3$ Irog (Rev. 11105) . Garnes B sai a V•73A.f F°Qr '/O r elD1G��oo Waiver Fee $ j % Date of Payment $ S Receipt Number. SGS ReLN 1083813001 Client Name Gamcss Engineering Group, Ltd. Project Name/N Mountain Manor B2,L3 Client Sample ID Mountain Manor B2,L3 Matrix Drinking Water PN'SID 0 Sample Remarks: All Dales/rimes are Alaska Standard Time Printed Date/rime 08/112008 15:34 Collected Date/time 07/302008 8:30 Received Dale/rime 07/302008 15:25 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results POL Units htcdwd Container ID Limits Date Date Inil Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/31/08 08101/08 NRB Waters Department Total Nitmic/Nitritc-N 1.85 0.100 mg/L SM20 4500NO3-F B (<10) Microbiology Laboratory Colony Count 0 coVI00mL SM209222B Total Coliform 0 colIl00mL SM209222B Fecal Coliform 0 coU100ml. SM209222B A (<200) A (<1) A (<I) 08/06108 1DZ 07/30/08 DLC 07/30/08 DLC 07/30/08 DLC rti7/29/2008 12:27 FAX 907 786 7401 USGS GEOLOGY OFFICE 12001/001 to S84 goo ao"E C _S /7 I o , 3, C91 IV 41 6' --_0 e Ottk \\ D We j/ q °ojo' 2� ,rsC � se ,nom\ .ii •/� •� fi c ve,•. •i. i.. 1 i N Sc -a 4; l , 40 L: -3- Ai /o `AS -BUILT NO CORNERS SET THIS DATE E. 4F.. q <:11a .VAf J 1+ rV-4t. ... —r✓ F iia!•/•J✓•�P : �'r'' EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. R C J F -2- I hereby certify that I have performed a Morta ee'7 in- Spection of the following descrl1b1ed proper : —a•—�� �� GH�I TQ /H NOY Stibd, Anchorage Recording Precinct, Alaska, and that the Improve- ments situated thereon are within the propperty lines and do not overlap or encroach on the property lying adjacent thereto the to, that no Improvements on property lyingadjacent encroach on the premises in question and that there are nc roadways, transmission lines or other visible easements or said property except as indicated hereon. Dated at Anchorage. Alaska 97 thl �� O ay c+ SoD fv...i+Q✓ 10 WALATKA dt ASSOCIATE: tern and Surveyors Kyle Maus From: apw@gci.net on behalf of Jim Sullivan [apw@gci.net] Sent: Wednesday, July 30, 2008 12:29 PM To: Kyle Maus Subject: 18720 Roads End Kyle On 7-29-08 We extended well casing 18" + above ground we also installed MOA seal and conduit. Thanks Jim Sullivan, CPI Arctic Pump & Well, Inc. PO Box 770197 Eagle River, AK 99577 (907) 688-2510 (907) 258-2510 (907) 745-2510 Alunicipalit-NT Of Anchorage CI1. IAn 1!NiliN) •.lnchnni>:r, .Va.k:: 10.619-6167A1 • 47(X) P.hnurc Ibuul ti (111iec: (!X)71 &tA-ttY11 • Flux: 1!X17 Ytt:3 801X1 lugv./M�em.nnmi.orq Mayor.t/nrkMylich Develoltn4ent Sen4ces Delrurtment 8/18/2008 Jeff Gamess Gayness Engineering Group, Ltd. 3701 E. Tudor Road, Suite101 * Anchorage, Ak. 99507 Subject: Waiver Request for Mountain Manor Block 2 Lot 3 Waiver Request #WR080055 Parcel ID #050-671-18 IIAA# 080269 Dear Engineer, p1C Il( Department Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, /A l vv �� Jeffrey I Poet Engineering Technician On -Site Water & Wastewater Program Community, Security, Prosperity Municipality of Anchorage Development Services Department • Building Saftty 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 Waiver Review Worksheet WR#: 080055 PID#: 050-671-18 HAM 080269 Permit#: Date Received:IB 12/08 Legal Description: Mountain Manor Block 2 Lot 3 Engineer: Jeff Garness Garness Engineering Group, Inc, Applicant: Tom Light Waiver Requested: 5 feet separation distance absorption field to property line. Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: ......@................. ...................... Maecenas...... Message ..... @seems Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: Date: D By: ..........................Mesa......... Rec#: 38154 Amount: $175.00 Date Paid: 8-12-08 ............................ 0.9 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS July 29, 2008 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Lot Line Waiver for mountain manor; Lot 3, Block 2, To whom it may concern: According to the as -built survey the drainfield is approximately 5 feet from the west property line. There are no septic systems within 50 feet of our client's drainfield. In short, there are no concerns associated with this encroachment. We are requesting that your department issue a 5 foot waiver from the drainfield on the subject property and the west property line. We are unaware of any, adverse impacts this waiver would have on adjacent wells or septic systems. If you have any 3c..1tions, please contact us at 337-6179. Thank you for your assistance. M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: www.gamcsscnginecring.com MUNICIPALITY OF ANCHORAGE U DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date Mcg 26 /98 7 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L,4 3 Black 2 MalaniGin I'tanor S /.D Location(addressor directions) 1t OGcr�S End Cc/'G fQ EGc 11 i�l✓Cr (b) Applicant Name Chain -Exec Re(ocahi+n Telephone: Home Business(ti)6-) Syy-2S6y Applicant Address 600 MO/Igomr_ry S . Sun Fran cu Co (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Cen /n -4f MOO ? qa e_ Telephone S6 / - 193 0 Address yo 0 O 0/d Sew ci -a 4n Choc k H So3 (e) Real Estate Company and Agent�y Gen I-er - tn r; aH-e �rryyJ Address 8100 b4xr-Ame1/ 13a AnatiorFul I+k 99S07 Telephone _ 3 kill - as -01 (f) Mail the HAA to the following address: 6-�V(oC for orck- p 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ® Community ❑ Public -0 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 ® 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. 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Aw legl A1!a8n I 'mo!aq umo4s alep uo!leP!!en 94310 se pue oiaa814 pax!11e leas Aw (q pa!1!laao sy N0IlVWH0dN1 ONV V1V0 `HOHV3S 3l1d `S.LS31 `SNOIlOUSNI ONIOIAOHd WHid ONIH33NION3 '9 ssaappy iJS66 zl i a j"'.)u 15- Off -�7 O£ ,4 auogda!al rr»neas !"zrvy�� wa!dloaweN �S9 -Sh£ gfnj •uo!loodsui s!141 to alep a4l uo loage ui suo!le!nBei pue 'seoueu!pao 'sopoo aleiS pue !ed!o!unW Ile qj!m aoue!!dwoo ul s! wets (s !esods!p aalemalsem ao/pue A!ddns aalem el!s-uo oq3 'uo!loadsui pue u0!ie6!isanu! (w woai pue sa!!i abeao14ouy to (i!!ed!o!unW 9143 wool pau!elgo uo!lewaolui aql uo paseq legl (pian jeglanl ! •u!aaa4 poleo!pu! ainlonals 10 adAl pue swooapaq 10 aagwnu a41 aol alenbape pue !euo!louni'ales s! wags (s !esods!p aaiemalsem ao/pue (!ddns aalem ails-uo a431e41 smogs !enoaddy tluo4lny 4lleaH s!14310 u011e611sanu! Aw legl A1!a8n I 'mo!aq umo4s alep uo!leP!!en 94310 se pue oiaa814 pax!11e leas Aw (q pa!1!laao sy N0IlVWH0dN1 ONV V1V0 `HOHV3S 3l1d `S.LS31 `SNOIlOUSNI ONIOIAOHd WHid ONIH33NION3 '9 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIVISION CHECKLIST - FEBRUARY 1984 264-4744 MAY 2 8 1987 A. WELL DATR E C C I V L D Legal Description: Lot` 3,. B(odr 2, Mounlfarn Monor S/p Well Classification Pr(vaFe If A, B, C, D.E.C. Approved (Y/N) N, A. 7 X. 9BrPn+ mtar S/ ?- 7 Well Log Present (Y/N) i Date Completed `l Yield S'009 .,v- loe, Total Depth 121 Cased to I ?-I' Depth of Grouting N,A, Static Water Level Ito' Pump Set At fin k Casing Height Above Ground 36 Sanitary Seal on Casing (Y/N) — Electrical Wiring in Conduit (Y/N) i Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 1 KI r ; On Adjoining Lots > /Ud To Nearest Edge of Absorption Field on Lot 1 /S ; On Adjoining Lots > loo To Nearest Public Sewer Line N, A. To Nearest Public Sewer Cleanout/Manhole N, A, To Nearest Sewer Service Line on Lot 1% A. Water Sample Collected by F1ak4r tech Svcs- ; Date S/ 2 2 / 97 c— " Water Sample Test Results v – U cgAd&#,^n / t00^1 0.69 oVa Nehw- -e Comments PcAmp F54 00 S'/ 22/ 87 S Aawe,-,e s f-e«ary /our+ip'�nr/ cif S9egeg, cee eeS moi �[.oefY✓ /we/ A, o(rm ev jl�r ^ 110 fo / / 2 FA (, "/ n e Ar At.^ B. SEPTIC/HOLDING TANK DATA Date Installed S/ Z9/g7 Size12� No. of Compartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped 6 /Y /8l Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well f YI To Property Line To Water Main/Service Line Course > ('90 Comments Page 1 of 2 72-026 (Rev 8/86) Front 7 to' ; for N. A. Temporary Holding Tank Permit (Y/N) JW. 4. To Building Foundation /of To Disposal Field 2T To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 16S cl 6[3oCrm Type of System Design Trench Date Installed 8 / 29 / 7 7 Length of Field Y6 / Width of Field '18 t Depth of Field Gravel Bed Thickness 66 ` ✓ Square Feet of Absorption Area SOE Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Y /11 Results of Last Adequacy Test Ao(e_rau k -ror 3 hPofraoms Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line I HS a I t To Stream/Pond/Lake/or Major Drainage Course To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area So Comments Ab.corphao :P(.e I'd o -6r on s'/ 2-7-/c97 ceF/cr howe vuc Kt v'm rt ✓cant in f -t r -- �^— -_ _, D. LIFT STATION N• A. 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 ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify thattrI have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed J: 4 ..c- Y - Date 6-/ Z 8 / 8 7 Company FF(ur 7-tr1+ Svcr MOA No. 87-0sZ Receipt No. �� !�0 E— /7` Date of Payment-02—� Amount: $ l d o0 Page 2 of 2 72-026 lnev 8/86) Back %Ik e. "•`d Engineer's Seal 40TIivl°a ® ' THEOU0i2E F. ASOORE ��'•, CE - 3589 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 Wi' SANPL, E6. , )2 , [' -111'IvJJ r 1, , " ; ." C, !PC, BY � fla. R » ; W5 9t - 0 om i cui/l 6101b 1 "F,141zW '; f @s »muw" KP b1i RIEP,jkl J A ill,; jR 4 4, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date G / I?- / 8(_ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) 40 30 3, SjoGlr ZM fh Location (address or directions) Roads 45net Circle C c-wle- Rf�<' (b) Applicant Name/���t�f /11rCFcC// _ Telephone: Home 6171-37190 Business Applicant Address _S R FK 7299 Shylone Or, F~/0 Rim.;. (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution_(rhQ�►1 — ISX« Rc('C99//w'9 S Telephone —_ H16) y Wy Z 6-6- Y AddressMa�Egarn�ry�ltf 9'y/// (e) Real Estate Company and Agent Or-=pnef/oY �r Address _ `TUU f c r Ate I/ Kd An CA r «� #Or 99sV 7 Telephone —3 "✓N'_�s a _ _. (f) Mail the HAA to the following address: holo! Ap JOICIV t4 ___-- r 2. TYPE OF RESIDENCE Single -Family ® Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well 9 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 5a 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. Pana 1 of 2 72-025(11 84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 7"CC6";C4V/ Sk#-V/CW Telephone 315' i34U- Address I N530 Echo fl, Anch�e i Ak V95-16' Date dl /Z/ &6 Engineer's Seal 6. DHEP APPROVAL C6 Approved for _ /5�.�.z bedrooms by Z�k V to Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) ,,;:t 1,3 , CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: tw"#? iw.i^ NLacnor S /D A. WELL DATA Well Classification Priteal EG If A, B, C, D.E.C. Approved (Y/N) All, A. Well Log Present (Y/N) Y Date Completed y yet Yield� A«+ Total Depth I L!. Cased to z/� Depth of Grouting Aft 4. Static Water Level /49" Pump Set At "Ok Casing Height Above Ground 36" Sanitary Seal on Casing (Y/N) Y Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Y Depression Around Wellhead 1Y/N) N To Septic/Holding Tank on Lotyyi� ; On Adjoining Lots IlSO, To Nearest Edge of Absorption Field on Lot I'!SI ; On Adjoining Lots 7 ts.0I To Nearest Public Sewer Line A. To Nearest Public Sewer Cleanout/Manhole N. A. To Nearest Sewer Service Line on Lot N.A. Water Sample Collected by TP ; Date A"l2l66' Water Sample Test Results Sa u AcApry — no CalPAvin+ o e vAto- �aclfYr<<t Comments I_1 0 Ill AAli gI:to] M111ICI _1:1:i711IT Date Installed 8/29177 Size�2 No. of Compartments 2 Standpipes (Y/N) i Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped 6/V hyd Pumping/Maintenance Contract on File (Y/N) Ns A. ; for IVDA• Holding Tank High -Water Alarm (Y/N) N. A. Temporary Holding Tank Permit (Y/N) N• A• Separation Distances from Septic/Holding Tank: To Water -Supply Well INI� To Property Line To Water Main/Service Line M.A. Course too Comments Page 1 of 2 79_n9a11na� To Building Foundation to To Disposal Field 2? To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata l6� a'�Q�(r"' Type of System Design _rreOC4 Date Installed 812? 7% Length of Field Yd ' . iw-e'' btu+ s/�w•*1,�.`Aa} +r r+ Width of Field Kd Depth of Field Gravel Bed Thickness 66a Square Feet of Absorption Area JrmD Standpipes Present (Y/N) Y Depression over Field (Y/N) Al Date of Last Adequacy Test 4Y /it 186' Results of Last Adequacy Test AG<<+ ,WWAO icte 3 boaltro0^1 Separation Distance from Absorption Field: To Water -Supply Well I r1ieA To Property Line > l0' r To Building Foundation a To Existing or Abandoned System on Lot N•A. ; On Adjoining Lots > 3G+ To Water Main/Service Line &A. To Cutbank (if present)N..4 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION A*A. 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 ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed � /' S 00-4 Date 4-11V 86 Company fkf9V rich Servat / MOA No. 95_"0T'g Receipt No. 316 KO q Date of Payment 3 --&(o Amount: $ Lo J Engineer's Seal Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES WAIVER REVIEW WORKSHEET DATE RECEIVED: April 15, 1986 LEGAL: Lot 3 Block 2 Mountain Manor Subdivision ENGINEER: Ted Moore, P.E. Flattop Technical Services APPLICANT: 14530 Echo Street Anchorage, Alaska 99516 WAIVER REQUESTED: q'Z Imo. f /c'` f' ` i� I I a - "X CRITERIA: 1) Geology: Points: A. Water Table oz - �•> 93� 61•� CF 01. ek,f4(as.,° B. Soil Sorption C. Permeability %g3C33Cz sir 2-0(0.4) /.6 D. Water Table Gradient E. Horizontal Separation q22 TOTAL: 3 9 2) Special Conditions: 3) Other: WAIVER IS: granted, with conditions listed below: Ajo v7 Ct•,.t�c.,dL not granted for reasons/ listed below: tJIle 1,11 e-- 747 e. 06r r�� ....'t C (/ rV (X. f ., ( (..! R ok i«ir i'l.. e..r(/I.� .... ti'.•n4l . DATE: ('-' - Z- R (v NAME CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. April 15 , 1986 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 M.O.A. Dept. of Health and Human Services P.O. B o x 6-650 MUNICIPALITY OF ANCHORAGZ Anchorage, AK 99502 DEPT. OF HEALTH &, ENVIRONMENTAL PROTECTION Attn: Steve Morris APR 1510. Re: Waiver of DEC Separation Criteria Lot 3, Block 2, Mountain Manor S/D RECEIVED Dear Mr. Morris: By means of this letter I am requesting a waiver of the required well -to -absorption field separation criteria, down from 100 feet to 92 feet, for the subject property. The attached sketch shows the configuration of the site. The well log dated 4/1/78 shows a total depth of 479 feet. The only water encountered was at the interface between the overlying soils and bedrock, 103 feet below ground level. The driller reported a yield of 30 gallons per hour. When I tested the well on April 11, 1986, the static level at the start of the test was 260 feet below ground surface, and I measured a yield of 11 gallons per hour. A water sample taken that day had no contamination by coliform or other bacteria. The septic system was inspected and approved by the Health Department on 8/29/77. The inspection report indicates a 100 foot separation between the well and the drain field, but I measured the distance to be closer to 95 feet on 4/11/86. Because obstructions prevented a direct measurement, we are requesting a waiver down to 92 feet. The septic system did absorb water at an adequate rate for a three bedroom residence. Topographic and geologic considerations support the granting of this waiver. The land surface slopes generally down from the well towards the absorption area, with the ground elevation at the cleanout being approximately 10 feet lower than at the well. Since this is part of a significant hillside, there is every reason to assume that the underlying bedrock surface slopes in a similar direction. The majority of the soil in the 100 feet above the waterbearing stratum at the bedrock interface was classified by the driller as hardpan, which should be relatively impermeable, causing the effluent to percolate away from the well. No water table was encountered in the soils test for the wastewater disposal system. I Based on these facts, it is my opinion that the requested waiver can be granted without risking potential contamination of the well. The owner is considering having work done on the well to increase it's yield up to the three bedroom requirement it was originally approved for, so I am requesting that the waiver specifically allow this to happen. Please give me a call if you have any questions. Sincerely, Ted Moore, P.E. .0".rWW'S'A OF A Ott CO) •.' S * s� 49TH �'�*® �'zf.. • • ......... 1�� A:•THEODORE F. MOORE ®� ad CE - 3589 N U, cc \JA to II E cc a ta ------- o. --- ly Ck - Ki Q V cc \JA to cc ta ------- --- ala . At o a4•a� 5. LEGDESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS , TIME TIME TIME DATE ❑ One ❑ Four ❑ Other DATE DATE ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY INSPECTOR * ATTACH WELL LOG.A well log is required for all wells drilled INSPECTOR INSPECT ❑ PUBLIC UTILITY MUNICIPALITY OF ANCHORAGE DEPT. OF 1'_,ALT1 1 81 S. SEWAGE DISPOSAL SYSTEM DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE(M)OIIONMENTAL P'.III ECTION' 1 J INDIVIDUAL/ON-SITE** 825 L Street- Anchorage, Alaska 99501 0* �Jl o 19 1980 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Pleaseallow -ten 110) days for. processing. 1. PRPER Y OWNr PHONE MAIL ADDRESS 21 PROPERTY R5SIOENT If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. INSTITUTION PHONE ONDIJNG MAI LING ADDRESS 9 j 4. REAL R/AGENT PHONE MAILING ADDRESS ala . At o a4•a� 5. LEGDESCRIPTION STREET LOCATION j 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY ❑ One ❑ Four ❑ Other i ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY INDIVIDUAL* * ATTACH WELL LOG.A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM 1 J INDIVIDUAL/ON-SITE** lq`1-1 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)1 llti THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER / DATE INSTALLED INSTALLER n--{k❑or Holding Tank ❑Septic Ta��{�� Size: I �'J" If Tank is homemade give dimensions: SOILS RATING i l u S— TYPEOFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 161 APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) Ut —DISAPPROVED DATE r O BY "'1NiCIPALITY OF ANCHORAGE 1b +r DE r HEALTH AND ENVIRONMENTA,. PROTECTION 825 L Street, Anchoraap,, Alaska 99501 264-4720 Date Received: April 20, 1978 #1i Time :30 a #2: Time 43: Time Date sday Date Date Insp Narllx Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. -Lending Institution Request: Mailing Address: Phone: 2. Property Owner: John Thomas/Harry Davis Phone: Mailing Address: % Jo Davis, Executive Realty 276-7777 3. Legal Description: Lot 3 Block 2 Mountain Manor Subdivision` 4:, Single Family Residence: (xj Number of Bedrooms: Three " Multiple Family Residence: ( ) Number of, Bedrooms: 5. Well System Individual Well ( q Community/Public System ( ) Permit # Depth of Well Well Log on File ( )NO Construction Bacterial Analysis 6. Sewage Disposal System: On-site System (Y) Public Utility ( ) Permit # .77724 Installed Installer Septic Tank Size 1.(� C�cal�ah5 Manufacturer \, Absorption Area _.5C^1_� Soils Rate \Ind Material 7. Distances: Well to 'Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Page Two Department of,Health'and Environmental Protection Request for Approval of Individual. Sewer and Water Facilities Legal Description: Lot 3 Block 2 Mountain Manor Subdivision Comments: Affadavit Attached: ( ) Letter Attached: ( ) Approved: Date: Disapproved:-- Date: Department Worksheet: J ! J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES ' 1. Type of Inspection: CMRO VA FHA CONV 2. Property Owner: Mailing Address: Day Phone: 3. Name of Buyer: Mailing Address: Day Phone: 4. Name of Lending Institution: Mailing Address: Phone: 5. Name of Realtor or Agent: Mailing Address: Phone: 6. Legal Description: Location: 7. Type of Facility to be Inspected: / No. Bdrms. 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) J - If Individual, date of installation 72-003(3/76)