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SUE TAWN ESTATE #2 BLK 1 LT 4
Sue Tawn Estates #2 Block i Lot 4 #051-471-26 SUBANInj' IjAm 2 6 Zft Municipality of Anchorage Community Development Department Page 1 of 3 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:/Avww.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151299 PID Number: 051-471-26 ❑ New ❑✓ Upgrade Name: Michael Watson ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 23536 Creek Rd, Chugiak AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade It GPDlSF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft.. Gravel depth beneath pipe Ft. Subdivision Block Lot SUE TAWN ESTATES #2 1 4 Fill added above original grade - - Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft' I I Ft. Well 124.2 NIA NIA N/A NIA TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity I 1250G,1. Surface Water 100+ N/A NA NIA Material Steel Number of compartments - 2 Lot Line 79.8 N/A NA N/A NA Foundation 8.8 N/A NA N/A LIFT STATION Manufacturer Capacity Gal. -i Curtain Drain 50+ NIA NA N/A Pump on level at Pump off level at High wEIW Wwm at Remarks TANK REPLACEMENT ONLY in. in. in. Pump make and model Electrical Inspections performed by to PIPE MATERIAL House to tank 3034 Tdrainfield n 3034 Installer - eld JRs Septic Pumping LLC Grainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft InspectionLocation 1 9/21115 01/19/16 and description dates: z"° SW Corner of House - 3`d 4" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineers Stamp Conditional Approval: Date r'Sti OF, 4trq��ll /tk 49 TH evenctnnorae r A W,A, Date W PP roved V Inspection Report_1-1-12.doc /M CREEK ROAD WELL (E) Q z W g � W w a w w Q 79. Q �ss O 1250g I `t L. 95.03 TANK ORE LOT 4 i B " COLLAPSED 12509 SEPTIC TANK DECOMMISSIONED PER CODE 41Z-- ' INSTALLED 1250g SEPTIC TANK PER CODE 3 r VERIFY FOUNDATION CLEAN OUT AND INSTALL IF MISSING \\—DRAIN INSTALL DOUBLE CLEAN OUT DRAIN FIELD (E) 5� \sem ABBREVIATIONS FC 5 5 0 o 5 wo TANK CLEAN OUT NO. CO# CLEAN OUT NO. mw w w o� U U 0 U 1250g I `t L. 95.03 TANK ORE LOT 4 i B " COLLAPSED 12509 SEPTIC TANK DECOMMISSIONED PER CODE 41Z-- ' INSTALLED 1250g SEPTIC TANK PER CODE 3 r VERIFY FOUNDATION CLEAN OUT AND INSTALL IF MISSING \\—DRAIN INSTALL DOUBLE CLEAN OUT DRAIN FIELD (E) 5� \sem ABBREVIATIONS FC FOUNDATION CLEANOUT T# TANK CLEAN OUT NO. CO# CLEAN OUT NO. DCO DOUBLE CLEAN OUT (E) EXISTING PROFILE SCALE: 717"7=110�T� �T LLC T � NOTES: PANNONE ENG SVC, LLC - DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SUE TAWN ESTATES #2, BLOCK 1, LOT 4 MICHAEL WATSON 23536 CREEK ROAD PLAN CHUGIAK, AK 99567 OF A.�. sq'q&.. ... Q9. .Steven R. Pannone CE 8149 01/25/16 Scale 1 "=50' P.I.D. NO OSP151299 Sheet 2 OF A B FC 22.8 _ 29.8 T1 17.0 39.6 T2 18.3 45.8 DCO 19.5 48.0 CO1 24.5 56.0 CO2 44.0 89.9 MT 43.6 89.0 OF A.�. sq'q&.. ... Q9. .Steven R. Pannone CE 8149 01/25/16 Scale 1 "=50' P.I.D. NO OSP151299 Sheet 2 OF 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: OSP151299 Tax Code Number: 05147126000 Work Type: Septic Upgrade Permit Effective Dates: August 31, 2015 to August 30, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SUE TAWN ESTATE #2 Site Legal Address: SUE TAWN ESTATE #2 BLK 1 LT 4 G:1160 Owner/Address: WATSON MICHAEL S PO BOX 670252 CHUGIAK AK 995670252 Site Mailing Address: 23536 CREEK RD, Chugiak Lot Size in Sq Ft: 78468 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y 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 B Issued By: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-471-26 Property owner(s) Michael Watson Mailing address P.O. Box 670252, Chugiak, AK 99567 Site address 23536 Creek Road Day phone Legal description (Sub'd., Block & Lot) Sue Tawn Estates #2, Block 1, Lot 4 Legal description (Township, Range & Section) Lot Size 78,468 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: Date of Payment: (® all that apply) Receipt Number: Permit No. 6030612g9 Waiver No. Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑x Upgrade IN (w/wo ADU) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE./ WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or authorized Permit/Rush Fees: Waiver Fees: Date of Payment: /5� Date of Payment: Receipt Number: 6 ) Receipt Number: Permit No. 6030612g9 Waiver No. Permit App__ :;L:c. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(oaneneak.com August 24, 2015 Subject: Monastery, Lot 2 Septic Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 12508 Septic Tank to be issued for this property. The existing 1250g tank is collapsing and the pumper has been pulling rocks from the tank. It wit] be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1250g septic tank that will be connected to the existing drain field. This lot and the surrounding lots are served by private wells.. There are no wells within 100 feet of this system. 1. Upgrade Tank Design. a. See Sheet 1 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank. The proposed septic tank upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes from southwest to northeast at approximately 5% in the vicinity of the system. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 CREEK ROAD r RE LOT 4 w COLLAPSING 1250g SEPTIC TANK (E) DECOMMISSION PER CODE SNF' INSTALL 1250g SEPTIC TANK (P) PER CODE VERIFY FOUNDATION CLEAN OUT AND INSTALL IF MISSING INSTALL DOUBLE CLEAN OUT DRAIN FIELD (E) \ss SEPTIC AREA (E) NOTES:PANNONE ENG SVC, `LLC P.O. BOX 100217 ANCHORAGE, AK 99510- PHONE (907) 272-8218 FAX (907) 272-8211 _—���- `\\ �� O...... a lt iC,.> �y�j �........ ....... / S'te've'n'R Pan'non e•/ PF.•. CE 8149 .•F�j �+ cs ., , ���oi.s.s.- — \ ��1 Date s�24/2015 TANK REPLACE Scale P.I.D. NO 051-471-26 SUE TAWN ESTATES #2, BLOCK 1, LOT 4 MICHAEL WATSON 23536 CREEK ROAD CHUGIAK, AK 99567 PERMIT NO. OSPxxxxxx PLAN Sheet 1 OF 1'�'_.MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE a 60 qct d Q NEW ❑ UPGRADE MAI LING ADDRESS /p ( /+ LEGAL DESCRIPTION LOCATION �0 Qcl NO. OF BEDROOMS D DISTANCE TO: Well � o` . fi Absorption area I F� Dwelling Fi PERMIT NO. ©2. o Y F zzManu W< < cturer �L Y1 t pt 'sTl C Mat i I �. (lS I I. No. of compartment y Liq. capacity in gallons a IF HOMEMADE: Inside length Q Width Liquid dept - 6C7z DISTANCE TO: Well Dwelling PERMIT NO. 2 z < Manufacturer Material Liquid capacity in gallons O w= DISTANCE TO: Well _ I—I , Foundation °J- , -'� lot Nearest lipp��e { 'V � PERMIT NO `9 p ©�•,© J z w ~ No. of IineN �,� Length g� each lin; j Total len17 iho lin Trench vydtlt J (V inches Distance betwee lines F Top of tile to finish ada j FT.tg. Material beneath tile inches Total eff ctive absorption area 1400PT w Length Width Depth PERMIT NO. C7 a F wa Type of crib Crib diameter Crib depth Total effective absorption area UJ rn DISTANCE TO: Well Building foundation Nearest lot line - J J Cie{s �.D `` I l V Depth Driller Distance to lot line PERMIT NO. Lu DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS (?i P,S'( SOIL TEST RATING INSTALLER rt I REMARKS A•O fill { I well I I APPROV DATE LEGAL q - 7 F 72-013 (Ret/A/78) U � L__ :5::- T %,p C_q g:;:-_ DEPARTMENT OF HEALTH HND ENVIRONMENTAL PROTECT -160 Le, 825 'L' STREET, ANCHORAGE, HK 99501 264-4720 /)�/��M icj "A 0; EF 1 -A E=-_ rlr-�:! Ll - 9ql'IN1, PERMIT NO. ( 780207 ) &n6/». APPLICANT HL LHRSON BOX 594 EAGLE RIVER 694-2304 LOCATION MOUNTAIN ROAD LEGAL L4 B1 SUE THWN SUGD #2 LOT SIZE 70000 SQUARE FEET TYPE OF SOIL RBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS - 4 SOIL RATING (SQ FT/BR)� 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: fl,1W 611" C3KFA%fEwL. THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ������ ������ ���� ����� ���� ���:��� `PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE 'NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. �9 - 9 Tl::3 < 22 �Fr. ���... ... ���� 1"HIATEE BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OK 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. X'T_ IFETIF" X INEHAS ETlEmCTEErlE3EEFz �� I CERTIFY THAI i: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]' I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED:... - APPLICANT RL LHRSON DHTE y� ISSUED BY -++_��._�__++__ 0 & E GE011-11CHNI CAL & DEVELL-�MENT CO. - - Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Soils Et Foundations Land Development Performed for: Name: L22c Tel. No. Mailing Address: Z2vx 5-rrrr! Legal Description: �c�� acvr� !r.,c�/� .z�/✓�'y Al Depth (feet) Soil Characteristics 0 1 ML_i� 2 3 4 5 6 7- 8 $ ?7cv ur p 2s 7� rve r 9 2 10 11 12 13 14 15 16 Ground Water Encountered: Yes No '� If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: Performed by: Date: 41-". r` 2z -'T- /9 ';�k Dr4tfiu by A & L DRILLING COMPANY SOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 7 OWNER OF LAND & Q19S -) RuSTtG N6'4t, 6,v F9<RSK+$DEPTH OF WELL 00 ADDRESS STATIC LEVEL OF WATER FT. LEGAL DESCRIPTIO^' o� �' tSCK -1 `�� %pwdv C'S% 9d DRAW DOWN FT. DATE. -Started "% Ended qb 1 /7 JGALS. PER HR PERMIT NUMBER KIND OF FORMATION: KIND OF CASING io From 0 Ft. to 2 Ft. 0 ur<�RvBrrC� From— Ft. to Ft. Ft From Ft. to (� Ft. Sia,..O 4,,e)2t6s< P/?acALd-65 5 From—Ft. to - Ft. From Ft. to G S� Ft. 9' 60 uL 4OC.¢SFrom—Ft. to Ft. From Ft. to-AL—Ft. C4v'rr 6,&4, e4 el- 6,W447z jrFrom Ft. to - Ft, From Ft. to /-20 Ft. 6 EdXoc le Frmn Ft. to- Ft. From Ft. to Ft. 4 60 Z 6 c tl 139 (<F_.� From Ft. to - Ft. From_ A-). Ft. to /S S Ft. 6F,61 6c /c S64/0- Frmn Ft. to Ft. S� omRYZ G}rom From (A—" Ft. to/3f 174oc/c %4o/<crJ F Ft. to Ft. From W Ft. to )Lb Ft. Rae- From Ft. to Ft. From .7co Ft. to�?73Ft. 6657dQaex 6eakr__"j S From Ft. to -Ft. From =7 7 3 Ft. to-3-0Ft. 31�✓/k "C l< .So <r 9 . From Ft. to Ft From—Ft. to Ft From Ft. to Ft From Ft. to Ft From Ft. to Ft From Ft. to Ft MISCL. INFORMATION: / u 7 Cs4s/� s i�. r1 S "vTw� From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From—Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft_ DRILLER'S NAME EDEPA TME:r+ITF825 ir"1-lE ALTH-...ND HfirdCtlOF;rt�,�iYdrlENTAL� ,�i:iTEC:TIfird 501. 264-4720 PERMIT NO. ( 780114 ) APPLICANT II r=''T'r C_Hl ifs'=: i IF 1=ILFi:_,P::hi L'LI BOX 594 EAGLE RIVER 694 2309 LOCATION MT ROAD _ LEGAL L4 B:1 SUE TAWN EST '� :' LOT SIZE =14 �. SQUARE IFtl'.E FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DI=POSAL. SYSTEM Is .tOO FEET FOR R PRIVATE WELL, OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. WELL. LOGS FSI' -E REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION D1:FIEiRAMS ARE: AVAILABLE TO INSURE PROPER INSTALLATION. F= EE F- ' lrl :Lr -H- B: R _E IIµ::: FEE < tl E a = 9 11 F =e E R _ ;a._ : f0-- =" ? "=" I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON -'SITE SEWERS FIND WELLS AS SET FORTH BY THE: MUNICIPALITY OF ANCHORAGE:.. -. I WILL. INSTALL THE SYSTEM IN ACCORDANCE. WITH THE CODES. _,IIIraEEi:--G O- _ _ U'__P/L �.------------------- AF'PLICAhdi' R`_=•l IC HO MES f-' ALASKA^� _6& A)Q ISSUEDE;','' -' -' V3. 0 Municipality of Anchorage • On -Site Water and Wastewater Program o*' (907) 343-7904 'nrr CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I. D. 051-471-26 Expiration Date: C/ —/ �—) (o 1. GENERAL INFORMATION Complete legal description Sue Tawn Estates Block 1 Lot 4 Location (site address) 23536 Creek Rd Current Property owner(s) Watson Day phone 244-1930 Mailing address Same Real Estate Agent Cindy Wilson, Partners Day phone 244-1930 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System MR TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Received by: Date: 13 COSA to be released to the engineer, unless other/ Ise requested by the engineer. COSA Fee $ Date of Payment 'r? Receipt Number �� ll,cJ COSA # (55C�t (v Lt j� Date of Payment Receipt Number Waiver 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is, (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date -..'_V5'28%2d16� .. 3e f .'V r 6. DSD SIGNATURE System #1 Approved for C1 bedrooms. System #2 Approved for z� bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: .v, I, LI\ 11111 �y l V=J Original Certificate Date: Co- The Municipality of Anchorage Devlopment Services Division (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9.1-12.doc If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate ®f ®n -.Site Systems Approval Checklist Legal Description: SUE T4iA' E.ST47'X',1' B/ L l/ Parcel ID: 4'5/--V Z/- 29- A. WELL DATA Well type._ If A, B, or C provide PWSID # -7- Date Date completed V. 7 %8 Sanitary seal (YIN) Total depth eft. Cased to gi ft. FROM WELL LOG Date of test . Static water level %y ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform Q colonies/100 mL Nitrate 3.5-2 mg/L Arsenic IAA ug/L Date of sample: /0 B. SEPTIC/HOLDING TANK DATA Well Log (Y/N) Wires properly protected (Y/N)_ Casing height (above ground) Z n. AT INSPECTION S !t A6 % 5 ft. Q.6 g.p.m. Collected by:(Z1n.n.� Tank Type/Material�/ L', Cry` Date installed _�`Z l�/3 Tank size 4? 5Ogal. Number of CompartmentsZ Cleanouts (Y/N) - �! Foundation cleanout (Y/N) _ / Depression over tank (Y/N) Al High water alarm (Y/N) � 1� Date of pumping /�F fa1 ( Pumper C. ABSORPTION FIELD DATA Date installed ,q/ZW7d* Soil rating (g.p.d./ft2 o ft2/bdrm System type 7Rgf Ui Length S— ft. Width 3 ft. Gravel below pipe 46� _ ft. Total depth _ 2 ft. Eff. absorption area Z/09 fe Monitoring tube Depression over field „� Date of adequacy test /f Results (Pass/Fail) �_ For bedrooms Fluid depth in absorption field before test _e in. Water added_ gal. New depth_ in. Elapsed Time:.' min. Final fluid depth 6 in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Aza If yes, give date D. LIFT STATION /v4 Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot -- / 00 if Absorption field on lot 460 Public sewer main r+ Sewer /septic service line Z s Animal containment areas _ 6 `,t SEPTIC/HOLDING TANK ON LOTTO: Manhole/Access (Y/N) —in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots .. /110- `f On adjacent lots m a -f' in. Public sewer manhole/cleanout • /00 r F Holding tank Manure/animal excrete storage areas /OG �r Building foundation Sof Property line AQ �� Absorption field Water main 16"1,- Water service line �D �f" Surface water Wells on adjacent lots i ABSORPTION FIELD ON LOTTO: i Property line %0 `14 Building foundation /d'`f Water main /O Water Si rdice'line /Q �f Surface water Driveway> paiNngtvehide storage f r Curtain drain s B t Wells on adjacent lots l I 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/ ST�yF5 fi—LN t, Date COSA yellow sheet_2-6-15.doc btQven W. Enfl FE/62567/ ` Municipality of Anchorage Ms. .. Development Services Department r° ':;:-_ Building Safety Division s'a'; E',.y: 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) # OSC161195 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 4 of Sue Tawn #2 subdivision, the well's productivity was determined to be .5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is .41 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. Municipality of Anchorage �r • Development Services Department Building Safety Division s On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-471-26 COSA# O 5C., 1. GENERAL INFORMATION Expiration Date: / Complete legal description SUE TAWN ESTATES #2, BLOCK 1, LOT 4 Location (site address) 23536 CREEK ROAD * CHUGIAK, AK 99567 Current Property owner(s) LOUIS & ROSE MOWER Day phone 208-442-0257 Mailing address Lending agency Mailing address PO BOX 672109 * CHUGIAK, AK 99567 Day phone Real Estate Agent KAY HANKS w/PRUDENTIAL VISTA Day phone Mailing address 16635 CENTERFIELD DRIVE * EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 242-1223 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. TYPE OF WASTEWATER DISPOSAL: Individual On-site N ❑ 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 is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The 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 right whatsoever. 5. DSD SIGNATURE l/ Approved for ' / bedrooms. Disapproved. Phone 337-6179 Date �17,,_3 /it OF � I .... .i. .. ......... h �le A. G ness: �O o4CE-x795/ �� �st' '•.Jia/!1•• •.c�G O 40��dpr Conditional approval for bedrooms, with the following stipulations Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other By:— (�Zj�x_ (Rev. 11105) ofess, mij," ON-SITE ••';`s'�``% WATER AND ; Tn= WASTEWATER ; PROGRAM G� J�JJi10�NT SES _ Original Certificate Date: Cl - -1 _// / Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SUE TAWN ESTATES #2, BLOCK 1, LOT 4 Parcel ID: 051-471-26 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 4/7/1978 Sanitary seal (Y/N) YES Total depth 300 ft. Cased to 89 ft. "BEDROCK" FROM WELL LOG Date of test 4/7/1978 Static water level Well production 74 ft. 0.5 g.p.m. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24 in. AT INSPECTION 11/4/2009 71 ft. 0.50 WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate)--Y7mg./L. Other bacteria colonies/100 ml. Arsenic: NO ug./L. Date of sample: O i / Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/FIBERGLASS Tank size 1250 gal. Number of Compartments? Date installed 4/27/1978 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 11/9 / Pumper ONE STOP SERVICES C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 4/27/197$ Soil rating (g.p.d./Wo 2/bdr 85 System type TRENCH Length 34 ft. Width 36 ft. Gravel below pipe 6 ft. Total depth *12.08 ft. Eff. absorption area 408 ft2 Monitoring tube YES Depression over field NO Date of adequacy test **12/l/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in. Water added 739 gal. New depth DRY in. Elapsed Time: 0 min. Final fluid depth DRY in. Absorption rate >= 600+ g,p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **PRE SOAKED ON 11/30/2009 WITH 2000 GALLONS D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' leve Manhole/Access h water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ 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'+ 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 o v -A \.•--.I ..... PA; `I certify that I have determined through field inspections and d it- �* review of Municipal records that the above systems are in sO' ' ' ' ' ' '' ' 'f ' .l ' .. .. ' ' ' ' ' . . conformance with MOA COSA guidelines in effect on this Q date. �`� e f . Y . :...... ess••' .. . Engineer's Printed Name JEFFREY A. GARNESS �Q �� i . l/CE 795 0�,r � •mac G Date /2 /11 '' Ao 4�DW,ro f e s sioi_oo COSA Fee $ �01 c Waiver Fee $ Date of Payment qr I Date of Payment Receipt Number CQ13, Receipt Number (Rev. 11/05) SGS Ref.# 1113881001 Client Name Garness Engineering Group, Ltd Project Name/# Sue Tawn�-- 1, L4 Client Sample ID Sue Tawn Es't, L4 Matrix Drinking Water Printed Date/Time 08/23/2011 13:47 Collected Date/Time 08/16/2011 12:10 Received Date/Time 08/17/2011 8:53 Technical Director Stephen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 Waters Department Total Nitrate/Nitrite-N 2.47 0.100 Microbiology Laboratory E. Coli Negative 1 Total Coliform Negative 1 ug/L EP200.8 C (<10) 08/18/11 08/22/11 NRB mg/L SM20 4500NO3-F B (<10) 08/19/11 AYC 100mL SM20 9223B A I OOmL SM20 9223B A 08/17/11 DLC 08/17/11 DLC Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650/. Anchorage, AK 99519onsite 50 / w www.muni.org/onsite (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING II Parcel I.D. 051-471-26 COSA# I Doo qq 1. GENERAL INFORMATION Expiration Date: 7— / (`` o — 1'0 Complete legal description SUE TAWN ESTATES H2, BLOCK 1. LOT 4 Location (site address) 23536 CREEK ROAD • CHUGIAK. AK 99567 Current Property owner(s) LOUIS & ROSE MOWER Day phone 208-442-0257 Mailing address Lending agency Mailing address Real Estate Agent Mailing address PO BOX 672109 • CHUGIAK. AK 99567 Day phone KAY HANKS w/PRUDENTIAL VISTA Day phone 242-1223 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well N 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A GARNESS, P.E. Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 6 Regulations. The 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 tical soils condition, groundwater levels that may nuctuato during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator ofthe 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 St URE (//Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing Attachments: COSA Checklist Septic System Advisory Well Flow Advisory 337-6179 Date __W12/10 Arsenic Advisory Maintenance Agreements Supplemental Engineers Repot Nitrate Advisory Other By: (P.. r IAs) \1T VF GicyO • •ONSITE • :�'�;; WATER AND ; m- WASTEWATER PROGRAM Original Certificate Date: V—/ (o — l O Municipality of Anchorage �\1 Development Services Department T 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 Le gal Description: SUE TAWN ESTATES#2, BLOCK 1, LOT 4 Parcel ID: 051-471-26 A. WELL DATA Well type PWATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 4/7/1976 Sanitary seat (YIN) YES Wires properly protected (YIN) YES Total depth 300 ft. Cased to 89 ft. Casing height (above ground) 24 in. "BEDROCK" FROM WELL LOG AT INSPECTION Date of test 4/7/1976 11/4/2009 Static water level 74 ft. 71 " ft. Well production 0.5 g.p.m. 0.50 g.p,m, WATER SAMPLE RESULTS: Coliform colonies/100 mi. Nitrated• 5 Gmg.IL. Other bacteria 0 colonies/100 ml. Arsenic 5 �ugA. Date of sample: ) (7 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/FIBERGLASS Date Installed 4/27/1978 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 11/6/2009 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA E ow EXISTING GRAr)F Date installed 4/27/1978 Soil rating (g.p.cl ft'o /bd 85 System type TRENCH Length 34 ft. Width && 3 'PF ft. Gravel below pipe 6 ft. Total depth •12.08 ft. Eff. absorption area 408 ft' Monitoring tube YES Depression over field NO Date of adequacytest *012/l/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test DRY in.. Water added 739 gal. New depth DRY In. Elapsed Time: 0 min.. Final fluid depth DRY- In. Absorption rate >= 600+ g.p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — **PRE SOAKED ON 11/30/2009 WITH 2000 GALLONS D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN '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'+ 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'+ 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 I certify that I have determined through field Inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines In effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date -a /I 2i ko COSA Fee S Date of Payment / Receipt Number P1S.S 7 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Certificate of On -Site Systems Approval (COSA) # 100094 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 4 of Sue Tawn Estates 32 subdivision, the well's productivity was determined to be .5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is .41 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. ffm SGS ReLM 1101478001 LOQ Units Method Container ID Client Mme Garness Engineering Group, Ltd Printed Datelrime 04/13/2010 13.53 Project Name/M Sue TaW n Estates LA,B I Collected Date/Time 04/082010 10:15 Client Sample ID Sue Ta"m Estate b BI Received Date/Time 04/082010 13:20 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Container ID Allowable Limits Prep Analysis Date Date Init Metals by ICP/MS Arsenic 5.000 5.00 ug/L EP200.8 C (<10) 04/09/10 04/12/10 SCL Waters Department Total Nitmte/Nitrite-N 2.56 0.100 mgfL SM204500NO3-F B (<I0) 04/09/10 AYC Microbiology Laboratory Colony Count 0 col/IOOmL SM20 92228 A (<200) 0410&t10 DLC Total Coliform 0 coVl00mL SM209222D A (<I) 04/0&110 DLC Fecal Coliform 0 COVlOOmL SM209222B A (<I) 04/0&'10 DLC MOV -03-08 03:53PM FRCII- T-180 P.002/002 F-827 • tri, ��+ ,,Va7'X7iY'F. f♦ SShorty A. )lolr e; IiJ�i^•,• uegt� TN! INFOLMATION tI UM IS FOR THE USE OF LWIND Iw1TITUTIONS SPECIFIWLT TO SM ANY CONFLICTI EASSMENTS OF NECOND, oTSEt unci 1 ESISTING. ETENCT%=8 AM PLATTED LOT LINES Tx" TV= Sm" OS THE OR EASEMENTS AND IS NOT TO BE U130 FON POSITIOUIN4 6CONDFD PUT, An Sol ADDITIONAL ST1141=1 ON FENCIUMS POW 11111011 30' i..4q',. 1 40' I AS41110 EIMT (SO CMWS UT Tlhl DATE) I Wets conify that I Mw Wforwed a NortpEieh ilrImlion of the following dwr(btd prapertyh LOT 4, RLOCL 1, NE TAiN ITTAT98 ADDITION 110. t AntherW leaerding o(otrlst, Alaska and that the lyrcvv to situated thereon are within the property time W do not overlap or encroach an the property lying edieant Uwarsto, that no lopro"W94 an propmem lying ed3smt thereto encroach an thi Pnlalew In gwetlon and that owe ere no rm wys, tr o lssicn linos, or otmw visible estaellnt/ on said property ":opt K Indicated hereonjADsted at Anchorage, Aleap this esy of Air:/ SOLT AND ASSOCIATES LASo SIATVEyals • S'i/7 rn 12,L�v MUNICIPALITY OF ANCHORAGE dLY)Q. L-LPSD•_- _y! DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 r • ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 - REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 7- PROPERTY OWNER (4 � �• �Q vASo�c/ ❑ Three ❑ Six l/J(71 /j Q /� ( MAI 7,G AODDR ES��/- OINDIVIDUAL* COMMUNITY E 1=51 UPHONE PROPERTY RESID�E�NpT�Il�f�differe from b le)e ❑ PUBLIC UTILITY .`.u4D 2. BUYER ) /- '4o -4 r'S /�DSe l�Oc�e� PHONE'^ ��.. W MAI LI NG ADDR ESS / f INDIVIDUAL/ON-SITE** 3. LE ING INSTITUTIO /a,s PHONE iS 7/ Mgl."G ADDRESS �f /n ` /A // NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. nK/iC_--7-ONE 4. REALTOR/ ENT // '�J(G'' /7 7p�JCL,4/�/ !L. % 9q —a -3p �/{�G c MAILING AD S'©/•~r-'�m"Df�V /7 -Q /� LL6`/(�C� •f L�- / 7`l u 5. LEGAL DEStCRIPT ON 'STREET N_ / 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS El One �I Four ❑ Other IW SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY *ATTACH WELL LOG. A well log is required for all wells drilled OINDIVIDUAL* COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM //L 7 **If /7�• f INDIVIDUAL/ON-SITE** individual/on-site, If system is over two (2) years old an adequacy test is required over ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) q+.0 (`&ol¢.°o THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLEFAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMITNUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM EKINDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED Septic Tank or ❑ Holding Tank Size: l a 50 If Tank is homemade give dimensions: INSTALLER SOILS RATING TYPE OF TANK MANUFACTURER TOT //L //ABSO TION AREA 4l0 9 MATERIAL 4, DISTANCES WEI-L TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [CI— APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)