HomeMy WebLinkAboutPETERS CREEK BLK 4 LT 5Peters Creek Block 4 Lot 5 #051-115-23 Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water&Wastewater Program 4700 Elmore St. •P.O. Box 196650 Anchorage,AK 99519-6650•http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number OSP181322 PID Number 051-115-23 ❑ New ■Upgrade Name: ABSORPTION FIELD TITANIUM INVESTMENTS OF ALASKA Address: ❑ Deep Trench 0 Shallow Trench 0 Bed / ound 777 MAIN STREET, SUITE 600, FOR WORTH,TX 76102 0 Other No.of Bedrooms: Sol Raing Total Depth from origin: : . Phone: (907)854-8404 4 GPD/sq.FL F. LEGAL DESCRIPTION Depth toplpeInvert from anginal grade: Grave • pth beneath pipe F FL Subdivision: Block: Lot: Fill added above original grade. G Grave;larva,. PETERS CREEK 4 5 0'�g�\� Ft FL Township: - Range: Section: - Gravel width. 'Beds Number of lines: Distance between lawn. FL FL SEPARATIONDISTANCES al absorp'. aroa: Number of tranches: Dist.between trenches. To Septic Absorption Lift Holding PublIcfPrivete From Tank Field Station Tank Sewer Lines SO.Ft. FL Well N/A I - - 25'+ TANK • Septic 0 S.T.E.P. :Holding ❑Other Manufacturer. Capacity C') Surface Water 100'+ z - - ANCHORAGE TANK 1250 1= Gal. U/ Lot Line 5'+ x - - Malertel Number of ccmpartmen�s Ili NSA IFoundation 10'+ STEEL LIFT STATION 2 Curtain Drain — NONE KNOWN - Marufaaurer. I Gvl. Remarks: 'Pump on'level at 'Pump el"level at HO weter alarm at Pump Make 8 Model, Efectrlcel Inspections performed by . PIPE MATERIAL EXSITING/ EXSITING/ House to tank D3034(NEW) Tank toeld D3034(NEW) Installer EXSITING/ ARM SEPTIC SERVICES, LLC Drainfield EXISTING CO/MT D3034(NEW) Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Fl Inspection Looebdn end Descdptiom Dates: 1st 1/3/2019 2nd - 3rd - 4th - BOTTOM OF SIDING NEAR FCO ENGINEER'S SEAL Community Development Department Approval •.��_.,,,,,..1.11'I_��•,♦ • Conditional approval: Date: 1, ''•;�' �r 4 4e %\ ♦♦ A A • • � J•``'rey G. ass ;=•�� ♦♦6%"... •.( 'CE-7 53 '�� J �. Approved: \ t"-� - Date: i��� r LICENSE 'PROFESS\11 CON 4 #AECCB84 lnapeclton Report_1.1-12.doc PERMIT NUMBER RECORD DRAWING PARCEL ID NUMBER: OSP 181322 051-115-23 — _ _Y _x_.,--_—. .L_ X X — X X v —I� — Y— X X X A r 7( X k--x--='fir Ix 10'POWER EASEMENT x I1 µTI 1 I x \\ ./ x EXISTING SEEPAGE PIT. I FENCE LINE EXACT PERIMETER LOCATION IS UNKNOWN.PASSED x SHED ADEQUACY TEST ON 9/4/2018 I x r INSTALLED DOUBLE I x CLEANOUTS(DBL1 8 DBL2) x NEW 1250 GALLON x NOTE:THE OLD SEPTIC TANK x I STEEL SEPTIC TANK WAS DECOMMISSIONED PER UPC PER THE CONTRACTOR I I x SS2 NOTE:THE NEW SEPTIC TANK I x 10'4-FROM THE FOUNDATION S1‘ INSTALLED OR PERMANENT DECK FOUNDATION SUPPORT(SONOTUBE). _ X CLEANOUT(FCO) T e%%///////////� x I A x x A B x IEXISTING FCO 25.8 6.2 4 BEDROOM ST1 23.1 14.2 x HOUSE ST2 30.3 17.0 x IDBL1 32.9 18.6 DBL2 34.0 19.1 x MT 69.3 50.1 x °. LOT 6,BLOCK 4; ' . . x PETERS CREEK S/D I • ° d .. I °• •' - W 1/2 OF LOT 4,BLOCK 4; I x .. PETERS CREEK S/D il I 4•.r. x x WATER LINE °' . . (APPROX. x n LOCATION) x x SCALE: I ' I d .. I 1•-20 x d x ° KEY BOX I (APPROX. ° ' ♦ s LOCATION) x • ar 1 GARNESS ENGINEERING GROUP, Ltd ENGINEERING-SALES CONSULTING °a-"�M � : • 3701 E.TUDOR ROAD.SUITE 101'ANCHORAGE.AK 99507•PHONE(907)337-6179•FAX(907)338-3746 WEBSITE:www.gemessenglneemg.aom 1... , „ PREPARED FOR PHONE NUMBER: PAGE NUMBER: •� ' • J, re-A G- ess r ■ TITANIUM INVESTMENTS 854-8404 2 OF 3 #• E-7953 '� �.: PROJECT/LEGAL DESCRIPTION: # rJ ••.• ' PETERS CREEK SAD; BLOCK 4, LOT 5 DRAWN J.L.M. ♦�.,e)''!•r ....''\.,4 i� TYPE OF WORK: DATE: ICENSE,4 PROFESS\:�� L RECORD DRAWING OF SEPTIC TANK UPGRADE 1/10/2019 ti ICENS 4 i%mom* J ^° PERMIT wmwBEn RECORD PARCEL OSP181322 DRAWING 051'115-23 FINAL GRADE = 100.68'100.74 ST1 ST2 TOP OFTANK 11111 / TOP OFTANK ATINLET= 05.44 ATOUTLET = 84.55 . • NEW 1250 GALLON SEPTIC TANK INVERT OF BUNG \ (RATED FOR INVERT OF BUNG AT INLET = S478 � 10' BURIAL) AT OUTLET=94.74 / GARNESS ENGINEERING ������ Ltd ���l���� �l���1�����l�� ����� � • 3701 E.TUDOR ROAD.SUITE 101•ANCHORAGE.AK 99507•PHONE(907)337-6179'FAX I907)338-3246•VVEBSITE.wvAcgameuervIneenng.com PREPARED FORPHONE NUMBER: PAGE NUMBER /'` A. TITANIUM |NVEST�ENTS 854'84O4 3OF3 5�—' pmusoruc�uosonn�no:. DRAWNBY: ' - H^sq/ �- ' PETERS CREEK SX]; BLOCK 4. LOT 5 ' J.L.M. • 4. TYPE opwonx DATE: LICENSE 4 RECORD DRAWING OFSEPT|CTANKUPGRADE 1/10/2019 �e omw `II°�m��— ~/ — 04, MUNICIPALITY OF ANCHORAGE mens On-Site Water&Wastewater Program No' Se, ' • f r PO Box 196650 4700 Elmore Road t t Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite t • z, ti tai r � l)charrmilli hCH00."GF On-Site Wastewater Disposal System Permit Permit Number: OSP181322 Effective Date: 9/18/2018 Work Type: SepticTank Upgrade Expiration Date: 9/18/2019 Tax Code Number: 05111523000 Site Legal Address: PETERS CREEK BLK 4 LT 5 G:1360 Site Mailing Address: 23305 GLENN CT, Chugiak Owner: PENNYMAC LOAN SERVICES LLC Lot Size in Sq Ft: 10430 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field IZI Septic Tank ❑ Holding Tank ❑ Privy 0 Private Well 0 Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: 14 Issued By: ,►, �j��,i��,, Date: Cr 70 1•��56789 / MUNICIPALITY OF ANCHORAG SEP 101018 •, tri ., Community Development Department Phone: 907-34 "2 4 • h Development Services Fax: 907- 343-7•• L 9 On-Site Water & Wastewater Program Mayor Dan Sullivan -OR`Site Se r/Well Permit Application 6---) � .$49176/:. For A Sin e Family Dwelling P rcel LD. Pr erty owner(s) (FORECLOSURE)C/O JANET-AMOR W/REAL ESTATE Day phone 343-8805 BROKERS OF ALASKA Mailing address 1577 C STREET, SUITE# 101, ANCHORAGE,AK 99501 Site address 23305 GLENN COURT, CHUGIAK,AK 99567 Legal description (Sub'd, Block& Lot ) PETERS CREEK S/D; BLOCK 4, LOT 5 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (®all that apply) Initial ❑ Single Family (SF) Absorption Field ❑ (w/wo ADU) Septic Tank ® Upgrade Duplex (D) ❑ Renewal ❑ Holding Tank I 1 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. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 01/6 Waiver Fees: Date of Payment: viola iol o Date of Payment: Receipt Number: O fD5 Receipt Number: Permit No. AM Waiver No. (Rev.01/11) GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING September 7, 2018 Municipality of Anchorage Development Services On-Site Water&Wastewater Program 4700 Elmore Roade Anchorage, Alaska 99507 Phone: (907) 343-7904 Reference: Septic Tank Upgrade Design for Peters Creek S/D; Block 4, Lot 5 To whom it may concern: The existing 4 bedroom house on the referenced property is served by public water and a private septic system. The septic system consists of a 1250 steel septic tank and a seepage pit type drainfield that were both installed in 1978. The septic tank is over 40 years old and is believed to be in a state of failure since the liquid level is below the normal operating levels in the tank. We are proposing that a new septic tank be installed on this property. We have performed a septic adequacy test on the seepage pit on 9/4/2018 and it absorbed more than 600 gallons/day. We are proposing that a 1530 gallon Infiltrator plastic tank be installed if burial depth will not exceed 4+ feet of cover. The existing septic tank appears to have 4' — 2" to 4' — 4" of cover over it. We are proposing the contractor excavate the sewer line back to the foundation to see if the sewer line elevation can be raised enough to allow for a plastic tank and/or if the area around the proposed tank can be graded in a fashion that excessive soils can be remove without making a depression. If 4 foot maximum cover cannot be achieved for the plastic tank, a 1250 gallon steel septic tank will need to be installed instead. We recently received an updated as-built survey from Buku Saliz, RPLS. On his survey, he shows a 10' power easement along the north property line. We submitted a COSA for reissuance on 4/4/2018 which we included a Robert Johnson, RPLS survey which did not show this easement. Given the location of the seepage pit standpipe, it is possible that the perimeter of the seepage pit (below grade) may encroach into the 10' power line easement. The property is in the process of transferring title and we will be submitting for an updated COSA. We are currently working on obtaining letters of non-objection from the utility companies associated with this potential encroachment. These will be submitted with the new COSA forms and our record drawing of the septic tank upgrade in the near future. Please do not hes. :te to call us at 337-6179 if you require further information. Thank you for your as • tance. Since ely e`r:r • Garn-. P.E., M.S. Pres.- t 3701 East Tudor Road,Suite 101 *Anchorage,Alaska 99507-1259 Phone: (907)337-6179*Fax: (907)338-3246*Website: www.garnessengineering.com v v \ \ m Q M C I ------T-----FOUR WHEEL DRIVE --- --------- r-,\ - � �\v_______ , -* m Oo m , I � -r 1 I r �\ te$ X0 Dom+ PZ I 1 1 I I \ \ \ • " co Pm I LOT 9,BLOCK 3; LOT 10,BLOCK 3: I LOT 9,BLOCK 4; I \\ ` \\ Z m —I PETERS CREEK S/D I PETERS CREEK S/D I PETERS CREEK S/D I \Xi \� \ Tm53 m b M I I J \ \ \ O • cno X M I • \ •\ m = Cr LOT 8,BLOCK 3; LOT 11,BLOCK 3; LOT 8,BLOCK 4; \ '\ \ —I PETERS CREEK SID PETERS CREEK S/D PETERS CREEK S/D ' \\ ` IT � I ch I N y 0 G \ -♦ T i- + 1 �- 1 I R1 r \• �\ Z X Z I I I zo \ rn Cill LOT 7,BLOCK 3; LOT 12,BLOCK 3; LOT 7,BLOCK 4; ; \\\ Q g m M. �• '1' PETERS CREEK 5/0 PETERS CREEK S/D j I PETERS CREEK S/D ! >o •\ a� 1 I m Z , (/1 N m Cli "2r —I I- I I -=m x C I, m- to d I ///, r LOT 6,BLOCK 3; LOT 13.BLOCK 3; 2 z! LOT 6,BLOCK 4; y / Z r.Cl) I�� . I PETERS CREEK S/D PETERS CREEK SID m Q z PETERS CREEK S/D m : C m /// wm , " /`� Z I I I IG i� // ttb,.......a. C / D D I LOT 5,BLOCK 3; I LOT 14,BLOCK 3; I Z I m g O// n Pll VI O r I PETERS CREEK S/D I PETERS CREEK S/D I'1 *t�'- // Z &Z ,` _� r `I` L I I k /4/ �N A 0) O - r I W 1/2 OF LOT 4,BLOCK 4; / 1 p rO i I , PETERS CREEK S/D \ 0 c) 0 0 LOT 4,BLOCK 3; LOT 15,BLOCK 3: \ y N o O Z I PETERS CREEK S/D PETERS CREEK S/D I I E 1/2 OF LOT 4,BLOCK 4; \1%\ Cl) tO�� m m 1:1 , I I 1 PETERS CREEK S/D ' Q� • r Z Q Z 1Cn N k< Mk 3 ---m m---I I I- + -I I I J \\\ /// Co N C U) I ' t4 I \ / v m LOT 3,BLOCK 3; LOT 16,BLOCK 3; LOT 3,BLOCK 4; y I \\ // Q n PETERS CREEK S/D PETERS CREEK S/D I PETERS CREEK S/D m • \\ / �" Wm o I • , ---D �--� I J z \ r \ ZI \ LOT 2,BLOCK 3; I LOT 17,BLOCK 3; I LOT 2,BLOCK 4; m m \\ A n 11 C PETERS CREEK S/D PETERS CREEK S/D PETERS CREEK S/D z p \ • • I I I I r // CD. P• �1� � m I I I I ■� ��\\ • �;�• Z LOT 9,BLOCK 3; I LOT 9,BLOCK 3; I LOT 9,BLOCK 4; u�!y // .V C7�G �"� / ( PETERS CREEK SID I PETERS CREEK SID I I PETERS CREEK S/D I / 0•n°, -• •• �l�— -L �Lj —1 I / ■- • •� :1w �• ■ - - - — - - - - --- - ; SF.Ed1►1CaFSMJ-- ----- - --- � I // ♦�- / , i y• < // / , • • I ,/ � I ,/ �/ i ,/ r \ / —X—1L� X — X— X — r — v —iv _ X — X X X ♦ A ASNI(Em z — x — x/-4-- r-----)(— —' X x 10'POWER EASEMENT I\ x .7_M� I—_- 1___— 1 I x __ x EXISTING SEEPAGE PIT. I FENCE LINE EXACT PERIMETER LOCATION _ IS UNKNOWN.PASSED x SHED ADEQUACY TEST ON 9/4/2018 I x I INSCLTALLEANOUTS DOUBLE x IF BURIAL DEPTH ALLOW I I x INSTALL A 1530 GALLON EXISTING SEPTIC TANK TO BE I INFILTRATOR 2-COMPARTMENT x DECOMMISSIONED PER UPC---1 't. SEPTIC TANK-SEE NOTE. I O 10'+TO x x CO FOUNDATION INSTALL I 0 OR SONTUBES FOUNDATION x ‘' CLEANOUT x 10'+ — X _ I / NOTE:THE EXISTING SEPTIC TANK HAS F COVER.THE . CONTRACTOR x L EXCAVATE THE e .//' EXIIST NOG SEEWEOR LINE AS FAR BACK TO THE FOUNDATION AND TO SEE IF THE ELEVATION OF THE SEWER LINE CAN BE x RAISED TO ALLOW FOR THE MAXIMUM I EXISTING BURIAL DEPTH OF 4 FEET OF COVER OVER 4 BEDROOM THE INFILTRATOR PLASTIC TANK. IF THE " HOUSE MAXIMUM BURIAL DEPTH CANNOT BE I ACHIEVED EITHER BY GAINING ELEVATION ON THE SEWER LINE OR REMOVAL OF I GRADE IN THE AREA OF THE PROPOSED PLASTIC TANK,THAN A 1250 GALLON STEEL LOT 6,BLOCK a; SEPTIC TANK WILL NEED TO BE INSTALLED. PETERS CREEK S/D I a I x Id. 'O I W 1/2 OF LOT 4,BLOCK 4; I °a a PETERS CREEK S/D x a. . .. /_WATERLINE I <d•' a' x x d' ° ° (APPROX. LOCATION) (r.), as • a . a xI • /— d a. I x • •4 GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER SCALE: ° a • THAT PERTAINS TO THIS DESIGN.BY PROCEEDING • • FORWARD WITH THIS INSTALLATION,THE 1•=P0' - ENGINEER,WELL DRILLER,CONTRACTOR AND • 4. KEY BOX PROPERTY OWNER AGREE THAT THEY HAVE d VOCATION) APPROX. READ THESE SPECIFICATIONS AND AGREE TO • • ACCEPT THE TERMS AND CONDITIONS OUTLINED. . .4'' ...• .vis\\\‘if , .. .••k OF I444 . te Awl N. c a .. 1 \ GARNESS ENGINEERING GROUP, Ltd •% *` :91i * *'; IiimoommEk ENGINEERING SALES CONSULTING t____�. • — 3701 E.TUDOR ROAD,SUITE 101•ANCHORAGE,AK 99507•PHONE(907)337-6179'FAX(907)339-3246•WEBSITE:www.gamossengineenng.oom M ... �� ; PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0 .• 'e �y '. `'= ess j= C/O JANET AMOR 343-8805 2 OF 2 ••0� ••• I _'if PROJECT/LEGAL DESCRIPTION: DRAWN BY: •�.��P••• CE 7915 1�•.• ' 41 F j, PETERS CREEK S/D; BLOCK 4, LOT 5 J.L.M. X11 FQ•�'�'••'l,J,�.•••••.••'((``''��'��P�,' 'TYPE OF WORK: DATE: REVISED LICENSE,1�1�"S`\..**•• DESIGN OF SEPTIC TANK UPGRADE 9/17/2018 #AECC884 J LOT 1 \\ LOT 2/ LOT 4 S 89°54'30" E 70.00' S 89°54'30" E 35.00' — x X X v v v s, X 11 ,r \/ A n x 10'POWER EASEMENT x 1_I I x . x I I x SHED x I x x I x x(11 x LOT 6 IL/ SEPTIC I7I STANDPIPES x 26.0' o WOOD j _ O t` BECK , I CO CO Z7 30.5' 5.4' x ai E112 i in LOT 4 in C", ,. 2 c co 2-STORYcri CC oC.n FRAME ;,•, 0 5.0' HOUSE M i Z I— r 21.0' 6 ::l''. D .Z .• � Cl) 1 8 , , 30.5' ' -1 6.9' -- • x x 'GRAVEL : i: DRIVEWAY:::: ,': LOT 5 A W1/2 LOT 4 I 10,461 sq. ft. 6 5,228 sq. ft. x 1 UTILITY FIELD INLET POLE - ` CATCH BASIN WEST 70.00' Z WEST 35.00' in in 0 — — — — — -GLENN COURT- — — — li •' ' 17 ',, *..4, THV '•* '. / . 0 10' 20' a �, � • • •• Bukii.Saliz �o / • i J' LS14837 .••J("= �f/�< '.. .'•c•- --= I HEREBY CERTIFY THAT I HAVE SURVEYED THE //rll�P�°`E \ION\.-\,0` ` FOLLOWING DESCRIBED PROPERTY: LOT 5&W1/2 LOT 4,BLOCK 4,PETERS CREEK • SUBDIVISION EASEMENTS OF RECORD,OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT(P-373)ARE NOT SHOWN HEREON. ANCHORAGE RECORDING DISTRICT,ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY WITHIN THE PROPERTY LINES AND NO VISIBLE AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT ENCROACHMENTS EXIST EXCEPT AS INDICATED. BOUNDARY SURVEY MAY DISCLC DATED THIS 23rd DAY OF AUGUST,2018,AT ANCHORAGE, UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON ALASKA. BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT, LLC Land Surveying Services 907.290.8949 AS-BUILT NO CORNERS SET THIS DATE SCALE 1"=20' WWW.FIXEDHEIGHT.COM JOB N113123 E PLA S MUNICIPALITY OF ANCHORAGE Development Services Department �\ Phone: 907-343-7904 On -Site Water & Wastewater Section \� Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-115-23 1. GENERAL INFORMATION Complete legal description PETERS CREEK BLOCK 4, LOT 5 Expiration Date: 22 "ZCi Z( Location (site address) 23305 GLENN COURT, CHUGIAK AK 99567 Current property owner(s) TITANIUM INVESTMENTS OF ALASKA LLC Day phone Mailing address Real estate agent 5751 KROGER DRIVE STE. 242, FORT WORTH TX 76244 2. TYPE OF DWELLING: ® 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 WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank, ❑ Community Well ❑ Community ❑ Public Water System ® Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 556 Waiver Fee $ Date of Payment I I a61'196 -P6 Date of Payment Receipt Number -80 619.33 Receipt Number COSA # oncao 06 Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 1/22/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic ���, \ applies only to the conditions as of the day tested. The flow and absorption rates may change �► ori due to subsurface conditions that may not be observed from the surface, changes in land use, �� (�'AVA local soil characteristics, groundwater levels that may fluctuate during the year, quality of A construction (workmanship & materials), the water usage of the family being served by the '/'���' • • • • •.ems system and maintenance. The operational life of all well and septic systems are subject to �.• 7 f these various and dynamic characteristics and are outside the control of the evaluator of the * ;TM * �� well and septic system. Therefore, any estimate of how long a system will function satisfactory ... ..... -49 for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWCS . ... ......... /I Curtis Huffman / 6. DSD SIGNATURE �# �°F••, CE 128991 ••��// } c���jo* 1/22/2020•.� System #1 Approved for bedrooms • • • • - �`�� PROFESSI���-� System #2 Approved for bedrooms \��OFESS\Q*O. Disapproved Conditional approval for bedrooms, with the following stipul tiROR((((((!((`(� OF'`G','�rrs pTF�, AND a V\IASTEV r. s ' t111�"x.11' r_ Original Certificate Date: 2�2� The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: PETERS CREEK BLOCK 4 LOT If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA — PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments B. TANK DATA Age of tank(s) 1 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 50" ® Standpipes/foundation cleanout per record drawing Date of pumping 1/22/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 3/20/1978 ® ALL standpipes present per record drawing Total measured depth from grade 11.8 ft (max) Measured depth to pipe invert from grade *4.7 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective *7_1 Parcel ID: 051-115-23 Structure served by this system _ Well production at time of test gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by_ Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 1/13/2020 Results 0 Pass For 4 bedrooms Fluid depth prior to test 12 in Water added 700 gal New depth 16 in Elapsed time 1310 min ® Code -required soil cover over field Final fluid depth 7 in ® System presoaked Absorption rate 600+ and (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced 2000 gallons Comments/Deficiencies: *Per DCO invert & bottom of pit elevations. NES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ft ft ft ft ft ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *10'+/- ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *PER 2019 COSA – crib MT 10'+ to PL & field is assumed to encroach into 10' utility easement. G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. �11-ft-;–Cf-moo -49 TH ....•..... :. Curtis Huffman 1 ``��,•. CE 128991 ����1i�'°ROFESS aN��'�-•ate ft ft EPLP-N-� s.s.��r�. Municipality of Anchorage w� •, rte o - _ - � ' i_ On-Site Water&Wastewater Program <" _,� � (907)343-7904 SA ETV ge 15 Su e CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-115-23 Expiration Date: ` _ 1. GENERAL INFORMATION Complete legal description PETERS CREEK SID;BLOCK 4,LOT 5 Location (site address) 23305 GLENN COURT,CHUGIAK,AK 99567 Current Property owner(s) TITANIUM INVESTMENTS OF ALASKA Day phone (907) 8548404 Mailing address 777 MAIN STREET,SUITE 600,FOR WORTH,TX 76102 Real Estate Agent EXP REALTY.LLC-PETE CARPENTER Day phone (907) 854-8404 2. TYPE OF DWELLING: ▪ Single Family(w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage 0 Individual Holding tank 0 Community Class Well 0 Community On-site 0 Public Water System Public Sewer 0 WalvarNertance request for: N/A Distance: - Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee$ Waiver Fee$ Date of Payment 112.9111 Date of Payment Receipt Number Receipt Number COSA# 650a c a25 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E.TUDOR ROAD, SUITE 101 `ANCHORAGE,AK,99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date I 1 l / I Engineer's Comments: In conducting this evaluation,GEG provided an engineering evaluation of the wet andror septic system in accordance with the ��'S% - guide and regulations established by the ktun •c pa!y of Anchorage and industry practices.The sported recuts describe the •.•c 1�� condition of the systems on the dates of the evaluation.Separation distances were measured to readily identifiable features. 4•P\\•• " •4 , . Hidden defects or encroachments may exist that were not identified during the evaluation.The operational fife of at wets and septic =()• 0. systems depend on a variety of variables including,but not limited to,sod conditions,groundwater levels(that may fluctuate during = `�,� : *.••• the year),quality of construction(materials and workmanship),and the water usage of the farcy ubhizing the system/s.These / conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the 490 system's;therefore,GEG makes no warranty(express or implied)regard the future performance of the weft or septic system. GEG makes no representation whether an alternative wet or septic system can be instated on the property in the event either of the 0,�,,,,,f current systems fad.The content of this report is for the sofa benefit of the person/party who retained GEG.Retance upon the •• information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not v.!:C,% I r duty person/party rtr p� per. • • E-79x3 authorized.In short GEG disavows an 1 d to anyone other than the a who for this re S •�•• � � ,,t I I i••'<P4 6. DSD SIGNATURE � �iFESSa'P��� LICENSE 4.rrr������� System#1 Approved for bedrooms. #AECc6E System#2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: C—Crfrljt 41- 6OrkV—rekk CS C.. I T1579(.0 t(a tl t 113 w . 0 [9 II 02- By: L 1= Original Certificate Date: /—3 d- (q The Municipality or Anchorage Develop,emt Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered In the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev.10117/12) If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: PETERS CREEK SID; BLOCK 4,LOT 5 Parcel ID: 051-115-23 A. WELL DATA PUBLIC WATER - 11 se If A, B, or C provide PWSID# Well Log (YIN) Date comple -. Sanitary seal(YIN) Wires properly protected ► 1) Total depth ft. Cased to ft. Casing heigh :•ove ground) in. FROM WE •G SPECTION Date of test Static water level '. ft. Well production g.p.m. g.p.m. WATER SAMPLE RE . S: Coliform colonies/100 ml. Nitrate mg./L. Collected by: enic: ug./L. Date of sample: \ B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 1/3/2019 Tank size 1250 gal. Number of Compartments 2 Cleanouts(YIN) YES Foundation cleanout(Y/N) YES Depression over tank(Y/N) NO High water alarm (YIN) NO Date of pumping NEW Pumper - C. ABSORPTION FIELD DATA Date installed *3/201978 Soil rating p.d./ or ft2/bdrm)UNK System type *SEEPAGE PIT Length *12 ft. Width '12 ft. Gravel below pipe *8 ft. Total depth ."11.8+ ft. Eff. absorption area *384+ ft2 Monitoring tube YES Depression over field NO Date of adequacy test "'9/4/2018 Results (Pass/Fail) PASS For 4 bedrooms ... Fluid depth in absorption field before test 4.5 in. Water added 2,828 gal. New depth 15 in. Elapsed Time: 840 min. Final fluid depth 6.25 in. Absorption rate>= 600 g.p.d. Any rejuvenation treatment(past 12 mo.)(Y/N &type) NONE KNOWN If yes, give date - *PER 9/12/2003 MEMORANDUM BY MIKE ANDERSON,P.E. (SEE ATTACHED) "BELOW EXISTING GRADE PER GEG SITE VISIT ON 9/4/2018. "'HOUSE HAS BEEN VACANT MORE THAN 30 DAY.2,000 GALLON PRESOAK PERFORMED,IMMEDIATELY FOLLOWED BY ADDING 828 GALLONS FOR SEPTIC ADEQUACY TEST. 10 MINUTES AFTER ADDING ALL WATER AND WATER WAS SHUTOFF,LIQUID DEPTH DROPPED TO 13.5 INCHES. D. LIFT STATION Date instal e. Size in gallons Manhole/Access • "Pump on" level at in. "Pump off' ley- - High water alarm level at in. Datum Cycles tested Meets alarm &circuit redo - E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: AVVWU PUBLIC WATER Sep :•• ift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main -"Ms is sewer manhole/cleanout Sewer/septic service lin- Holding tank Al.... .n ainment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+TO PVT.&200'+TO PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+TO PVT.&200'+TO PUBLIC F. COMMENTS 'CENTER OF PIPE TO NORTH PROPERTY LINE SCALES APPROXIMATELY 12 FEET (SEE ATTACHED SURVEY) EXACT DISTANCE FROM PROPERTY LINE TO EDGE OF SEEPAGE PIT IS UNKNOWN.LETTER OF NON-OBJECTION OF ASSUMED ENCROACHMENT OF SEEPAGE PIT ON POWER LINE EASEMENT WAS GRANTED BY MEA. MT APPEARS TO BE F-810 PIPE,AND APPEARS TO BE FUNCTIONAL. G. ENGINEER'S CERTIFICATION .. 4 • a, P,.•••""" ....... •c� I i • . 1 I certify that I have determined through field inspections and i, 4 . • review of Municipal records that the above systems are in ' , q'• • • conformance with MOA COSA guidelines in effect on this i° 1," G. ess c date. I(^: Je y • Engineer's Printed Name JEFFREY A.GARNESS �0.---",... CE 7 5� • •; �: Date I )144I� �1�� ��P �� 4• rESS ��, LICENSE Ilia w"s* *AECC884 (Rev.10/12/12) LOT 1 \ LOT 2/ LOT 4 S 89°54'30"E 70.00' S 89°54'30"E 35.00' x , X _ Y - V r v .. .. . n . . --I(—',__ I 10'POWER EASEMENT _I I I I > Y II SHED 1 I 1 I r x ''1, I SEPTIC I STaNOPIPES LOT6 Z 26.0' o r /...i�� , ih O "� 5.4'f- ,ZX1 , 30.5' i E112 = T- LOT 4 h M _ M I- (AD 2-STORY - 0 o FRAME n Z 5.0' HOUSE <,) _ I— o :. --..-1 7.0' 21.0' O w.. u'% (/) t 1 30.5' 6.9' -+- 1 „ GRAVEL . i DRIVEWAY LOT 5 4. W1/2 LOT 4 10,461 sq.ft. w 5,228 sq.ft. , FIELD INLET UT POLE ` I CATCH BASIN I \ ~ `^'EST 70.00' �V ' WEST 35.00' in 0 - - - - - -GLENN COURT- - - - I �PSF.. OF ,.4441111,,s*;'49 fH -.`t 0 10' 20' LIIIId - c' • Buku .5.37.)11' ,o 'i 11..„.... IS-14837 ->`-'= . *. I HEREBY CERTIFY THAT I HAVE SURVEYED THE 7'11,9`o�R�FESSI ORA-•• 4),`^ FOLLOWING DESCRIBED PROPERTY: ``t��...�'`'''` LOT 5 8 W1/2 LOT 4,BLOCK 4,PETERS CREEK SUBDIVISION EASEMENTS OF RECORD,OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT(P-373)ARE NOT SHOWN HEREON. ANCHORAGE RECORDING DISTRICT,ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY WITHIN THE PROPERTY LINES AND NO VISIBLE AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT ENCROACHMENTS EXIST EXCEPT AS INDICATED. BOUNDARY SURVEY MAY DISCLOSE. DATED THIS 16th DAY OF JANUARY.2018,AT ANCHORAGE, UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON ALASKA. BE USED FOR CONSTRUCTION OF FENCES,IMPROVEMENTS,OR FOR ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT, LLC Land Surveying Services 907.290.8849 AS-BUILT NO CORNERS SET THIS DATE SCALE 1"=20' WWW FIXEDHEIGHTCOM C X14 ; .( C , cjk • . Municipality of Anchorage ��°` On-Site Water&Wastewater Program < ._li„ (907)343-7904 • 5 A T 6189 /0iiiit� CERTIFICATE Oti i- STEMS APPROVAL E 3 jZ 3HE Parcel I.D. 051-115-23 ° 5�� �U D Expiration Date: tQ ti w 1. GENERAL INFORMATION 01 6 8 1,°' Complete legal description PETERS CREEK SID; BLOCK 4,LOT 5 Location (site address) 23305 GLENN COURT,CHUGIAK,AK Current Property owner(s) (FORECLOSURE) Day phone Mailing address Real Estate Agent JANET AMOR W/REAL ESTATE BROKERS OFAK Day phone 343-8805 2. TYPE OF DWELLING: II Single Family(w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well • Individual On-site U Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNanance request for N/A Distance: - Received by: Date: /2/ ,D COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee$ 3O5 ' Waiver Fee$ Date of Payment "L/ 51iQo Date of Payment Receipt Number 64,(416-) Receipt Number COSA# () i S!SQ' Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG provided an engineering evaluation of the well and/orseptic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the datefs of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not Identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwaterlevels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well orseptic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person✓party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the personlparty who paid for this report. 6. DSD SIGNATURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Phone 337-6179 Date G1 �i 6 1� OF �* •• : # 49 ........ .....�.................. 0 Gayness_ ::R40 1�� pFr LICENSE 4\\ #AECC884 Disapproved. l / Conditional approval for bedrooms, with the following stipulations: 0s P(2/922 I E-713VA`V T-"' f 11 r- 'ST FSS/TF o BOG G�'�T G� ICES SAM N�6� --t- ( ��& t LX Original Certificate Date: 1 2t( -10 The Municipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 10112112) 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E.TUDOR ROAD, SUITE 101 'ANCHORAGE,AK,99507 Engineer's Printed Name JEFFREY A. GARNESS,P.E. Date 7/2,// Engineer's Comments: In conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system in accordance with the �4��11‘�1 it b 1 guidelines and regulations established by the Municipality of Anchorage and industry practices.The reported results describe the 4��< OF/ ,,�. condition of the systems on the date/s of the evaluation.Separation distances were measured to readily identifiable features. 4,4•P'•`,.••••••. .... .♦ Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic a \ fl 1 +. systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during a the year),quality of construction(materials and workmanship),and the water usage of the family utilizing the system/s.These * A g ik... * °O conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the system/s;therefore,GEG makes no warranty(express or implied)regarding the future performance of the well or septic system. /� 0 GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the /;.u1,., .. . • ,f-,-,� IN• „ current systems fail.The content of this report is for the sole benefit of the person/party who retained GEG.Reliance upon the • r •. G,mess_ : = information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not ♦ E \_ c� authorized.In short,GEG disavows any legal duty to anyone other than the person/party who paid for this report. �•♦JJ,r%•../g ` (. • 6. DSD SIGNATURE 111 ORES -'K LICENSE ,•114" �/ % s/i� �� System#1 Approved for bedrooms. #aEccaaa 0 /0,6 ro„41/�O System#2 Approved for bedrooms. r ,TAF ': ' • ._ s Disapproved. `/ - /CES D\\1 • xConditional approval for ( bedrooms,with the following stipulations: 2 Q vtA1244 ci-- Cl4r c - c(Cs P12?i3 Z Z) Fi i dao cw( __ Original Certificate Date: 10 -211 si 0 The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: n COSA Checklist N Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev.10/12/12) If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: PETERS CREEK S/D; BLOCK 4, LOT 5 Parcel ID: 051-115-23 A. WELL DATA PUBLIC WATER - k .e If A, B, or C provide PWSID# Well Log (Y/N) Date comple -: Sanitary seal (Y/N) Wires properly protected 1) Total depth ft. Cased to ft. Casing heigh ..ove ground) in. FROM WE OG SPECTION Date of test Static water level P. ft. Well production g.p.m. g.p.m. WATER SAMPLE RE - S: Coliform colonies/100 ml. Nitrate mg./L. Collected by: enic: ug./L. Date of sample: _ B. SEPTIC/HOLDING TANK DATA *NEW TANK TO BE INSTALLED.REQUESTING CONDITIONAL COSA APPROVAL. SEPTIC TANK UPGRADE PERMIT ISSUED.SEE PERMIT#0SP181322 Tank Type/Material *SEPTIC/STEEL Date installed 3/10/1978 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N)**YES Depression over tank(Y/N) NO High water alarm (Y/N) NO Date of pumping 4/4/2018 Pumper ARM SERVICES C. ABSORPTION FIELD DATA Date installed ***3/201978 Soil rating kp.d./ or ft2/bdrm)UNK System type ***SEEPAGE PIT Length ***12 ft. Width ***12 ft. Gravel below pipe ***8 ft. Total depth ****11.8+ ft. Eff. absorption area"'384+ft2 Monitoring tube YES Depression over field NO Date of adequacy test '*"'9/4/2018 PASS 4 q y Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test 4.5 in. Water added 2,828 gal. New depth 15 in. Elapsed Time: 840 min. Final fluid depth 6.25 in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - **NO FCO WAS LOCATED BY GEG ON 3/30/2018 OR 9/4/2018,THEREFORE THE EXACT LOCATION OF THE FCO CONNECTION INTO THE HOME IS UNKNOWN (FCO PRESENT PER MICHAEL ANDERSEN,P.E 2016 COSA.A NEW FCO WILL BE INSTALLED WHEN NEW SEPTIC TANK IS INSTALLED. ***PER 9/12/2003 MEMORANDUM BY MIKE ANDERSON,P.E. (SEE ATTACHED) ****BELOW EXISTING GRADE PER GEG SITE VISIT ON 9/4/2018. HOUSE HAS BEEN VACANT MORE THAN 30 DAY.2,000 GALLON PRESOAK PERFORMED,IMMEDIATELY FOLLOWED BY ADDING 828 GALLONS FOR SEPTIC ADEQUACY TEST. 10 MINUTES AFTER ADDING ALL WATER AND WATER WAS SHUTOFF,LIQUID DEPTH DROPPED TO 13.5 INCHES. D. LIFT STATION Date installe• Size in gallons Manhole/Access ► "Pump on" level at in. "Pump off' lev- -i —• High water alarm level at in. Datum Cycles tested Meets alarm & circuit req ' - :• E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: AVVVVU PUBLIC WATER Sep :•. ift station on lot On adjacent lots Absorption field on lot- On adjacent lots Public sewer main •lic sewer manhole/cleanout Sewer/septic service line Holding tank _ A •ntainment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 'S'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+TO PVT. &200'+TO PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+TO PVT. &200'+TO PUBLIC F. COMMENTS *MET SEPARATION DISTANCE AT TIME OF INSTALLATION. •'CENTER OF PIPE TO NORTH PROPERTY LINE SCALES APPROXIMATELY 12 FEET (SEE ATTACHED SURVEY) EXACT DISTANCE FROM PROPERTY LINE TO EDGE OF SEEPAGE PIT IS UNKNOWN.LETTER OF NON-OBJECTION OF ASSUMED ENCROACHMENT OF SEEPAGE PIT ON POWER LINE EASEMENT WAS GRANTED BY MEA. ST1,ST2,&MT APPEAR TO BE F-810 PIPE.ALL THESE APPEAR TO BE FUNCTIONAL.SEPTIC TANK PIPES TO BE REPLACED DURING SEPTIC TANK UPGRADE. I .��\\S\\, , G. ENGINEER'S CERTIFICATION ���P;•.••" 1 •4 ...� l certify that I have determined through field inspections and • 9 �• • review of Municipal records that the above systems are in • conformance with MOA COSA guidelines in effect on this o •• •• • • date. ♦c^•. J ff =; . Garn=-s:: Engineer's Printed Na e JEFFREY A. GARNESS ..•xs, ••. E .•:. Date ZI/ tf .•44 ROFESS\ �b LICENSE I l%„`ice #AECC884 (Rev. 10/12/12) / X=-1.-----r— X— r— Y— Y— v—` -'--r X N N \ y i-— x— k---77----A- 1 —— I3‹ 10'POWER EASEMENT A \ F > i i x EXISTING SEEPAGE PIT. I FENCE LINE x EXACT PERIMETER LOCATION } IS UNKNOWN.PASSED - x I SHED ADEQUACY TEST CN 914/2018 x I INSTALL DOUBLE x x CLEANOUTS I x IF BURIAL DEPTH ALLOW INSTALL.A 1530 GALLON EXISTING SEPTIC TANK TO BE ,, I ii INFILTRATOR 2-COMPARTMENT x DECOMMISSIONED PER UPC---1SEPT(C TANK-SEE NOTE. [)x •xli INSTALL FOUNDATION x = I CLEANOUT x X �//, " NOTE:THE EXISTING SEPTIC TANK HAS 4'-2"TO 4'-4'OF COVER.THE CONTRACTOR SHALL EXCAVATE THE EXISTING SEWER LINE AS FAR BACK TO THE FOUNDATION AND TO SEE IF THE ELEVATION OF THE SEWER LINE CAN BE x RAISED TO ALLOW FOR THE MAXIMUM IEXISTING BURIAL DEPTH OF 4 FEET OF COVER OVER 4 BEDROOM THE INFILTRATOR PLASTIC TANK.IF THE HOUSE MAXIMUM BURIAL DEPTH CANNOT BE I ACHIEVED EITHER BY GAINING ELEVATION < ON THE SEWER LINE OR REMOVAL OF I GRADE IN THE AREA OF THE PROPOSED PLASTIC TANK,THAN A 1250 GALLON STEEL LOT 6,BLOCK K SEPTIC TANK WILL NEED TO BE INSTAL I FD.! PETERS CREEK S/D I •. ,, - A 1 X '4• W 1/2 OF LOT 4,BLOCK<; 4 PETERS CREEK SiO I _ � xIi 4 'a WATER UNE x I •' (APPROX I x •a' ! LOCATION) N I :• /// x : _ < • GEG,Ltd.HAS AN 8 PAGE SPECIFICATION LETTER a SCALE: I THAT PERTAINS TO THIS DESIGN.BY PROCEEDING 1 , a FORWARD WITH THIS INSTALLATION,THE 1"=20' x • .. ' , ENGINEER,WELL DRILLER,CONTRACTOR AND a, I KEY BOX (APPROX. PROPERTY OWNER AGREE THAT THEY HAVE e READ THESE SPECIFICATIONS AND AGREE TO x . _ I LOCATION) ACCEPT THE TERMS AND CONDITIONS OUTLINED. At '-.4 A , 'SIJ .6** a • �:•+ .5'.vr:.9'r='Rr 7.,..-,,,,,.'�.•..J�.C`: •�.C� {,—• % GARNESS ENGINEERING GROUP, Ltd �:...........•." ; it ,, .\. • • -vaoteol,.. spa At-e •Nx : ENGINEERING'SALES=CONSULTING -.a- : ;s-x:A�s^�-sAs. �r-r.;::a ' IPf 3701 E TUDOR ROPD,SUITE 101•ANGI'IOEAOE AK 99507'PHONE(907)3178.79'PAX(G07133N-.12 5 W®SISE:vrrw.9 �9 �G.mm •••, • �C�; :;_0 PREPARED FOR: PHONE NUMBER PAGE NUMBER 0(n: J' -k. • M CIO JANET AMOR 343-8805 2 OF 2 �0 s: CE- •-tt• v,� PROJECT/LEGAL DESCRIPTION: PETERS CREEK SR);BLOCK 4,LOT 5 DRAWNM, ,��•ip,c,0 ..i• t' 1 • TYPE OF WORK DATE LICENSE+�■ SS, �• DESIGN OF SEPTIC TANK UPGRADE 91612018 #AECC884 DESIGN LOT 1 \ LOT 2 / LOT 4 S 89°54'30" E 70.00' S 89°54'30" E 35.00' X — c X X x v 7 v .. .. 14 X n A ,t - X - X X 10' POWER EASEMENT x (_) I x x I i x SHED I > x I x x x i x > x f•1 I , LOT 6 , x 1:.) SEPTIC ( ) STANDPIPES I 26.0' Z o /WOOD�/7 M O co 70 , 30.5' S.4' — of E112 LOT4 u; CO > 1 co 2-STORY c r o FRAME in 0 5.0' HOUSE co = Z 21.0' ca •;.7;i D 17.0' ! . �:: b O U' CO K 8' x 30.5' pi K x x x GRAVEL DRIVEWAY:: MiM LOT 5 . W1/2 LOT 4 10,461 sq. ft. 5,228 sq. ft. 1 At x UTILITY r FIELD INLET POLE `il CATCH BASIN WEST 70.00' ��� WEST 35.00' in in — — — — -GLENN COURT — — — _�`P. 'i...46-, /II11 *: 4. TH /\ . ', 0 10' 20' �'. B• uk. :aliz �o' -i�-z-r-,.• LS-14837 •••,J�"= r I HEREBY CERTIFY THAT I HAVE SURVEYED THE ',/r�i0'°R.••`....••.0\\'� FOLLOWING DESCRIBED PROPERTY: LOT 5&W1/2 LOT 4, BLOCK 4, PETERS CREEK SUBDIVISION EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED SUBDIVISION PLAT(P-373)ARE NOT SHOWN HEREON. ANCHORAGE RECORDING DISTRICT,ALASKA AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY WITHIN THE PROPERTY LINES AND NO VISIBLE AND IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT ENCROACHMENTS EXIST EXCEPT AS INDICATED. BOUNDARY SURVEY MAY DISCLOSE. DATED THIS 23rd DAY OF AUGUST,2018,AT ANCHORAGE, UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON ALASKA. BE USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS,OR FOR ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT, LLC AS-BUILT NO CORNERS SET THIS DATE SCALE 1"=20' Land Surveying Services 907.290.8949 WW.FIXEDHEIGEDHEIGHT.COM JOB#18123 MATANUSKA ELECTRIC ASSOCIATION,INC. LETTER OF NON-OBJECTION September 12.2018 Pennymac Loan Services LLC 3043 Townsgate Rd Suite 200 Westlake Village CA 91361 Re:Lot 5 Block 4 Peters Creek Subdi vision(Plat P-479,Anchorage Recording District) Dear Pennymac Loan Services LLC: MEA has no objection to the encroachment of a drainfield located in the utility easement as depicted on the attached as-built survey drawing,subject to the following conditions: 1. The improvement will in no way restrict or limit the current or future ability of MEA to fully enjoy the benefits of the easement for any and all utility purposes that it presently enjoys under the easement. 2. MEA will be held harmless by the landowner from liability for any and all damages or injury to any person or property that may result from the existing and future use of the easement by MEA,its contractors,or assigns. 3. MEA will be held harmless by the landowner for any and all liability arising out of or relating to any use of the easement by others under a Letter of Non-Objection. 4. The landowner will be liable for any damages caused to MEA facilities by the improvement in the easement. 5. The landowner will be responsible for any special construction costs incurred by MEA due to the improvement in the easement. 6. The landowner will assure compliance with all applicable safety codes relating to the improvement in the easement. 7. Use of this letter by the landowner,their successors or assigns will constitute acceptance of these conditions. 8. Alteration of these conditions shall invalidate this letter. 9. This letter is not effective unless it is recorded in the Anchorage Recording District before ownership of the referenced property is changed from the above named landowner. Sincerely, Manny Lo z Land Services nage STATE OF ALASKA)SS- THIS IS TO CERTIFY that on this 12 day of September.2018 before me,the undersigned,a Notary Public in and for the State of Alaska,duly commissioned and sworn as such,personally appeared manny Lope Z. Known to me and to me known to be the individual(s)named in and who executed the foregoing instrument and acknowledged to me that he/she/they signed and sealed the same as a voluntary act and deed for the uses and purposes therein mentioned. IN WITN WHEREOF, I have hereunto set my hand and official seal the day and year first above written �t J`'��o'oZGaO H 1_YNIy otary Public in and of Alaska My commission expires Return to:MEA,PO Box 2929,Palmer,AK 99645 )* �AIAS Parcel I.D. 051-115-23 Municipality of Anc On -Site Water and Wastewater (907) 343-7904 Certificate of On -Site Systems 1. GENERAL INFORMATION Expiration Complete legal description Peters Creek, Block 4, Lot 5 S Ar Err AUG 012016 3 Val << �" Da . Location (site address) 23305 Glenn Court Chugiak, AK 99567 Current Property owner(s) Blake & Lucinda Isaacson Day phone 854-3360 Mailing address Real Estate Agent 21324 Conley Avenue Chugiak, AK 99567 2. TYPE OF DWELLING: (] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual IX Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request Received by:1 0/% Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5210.00 Date of Payment 2 04901 10 Receipt Number 61a_kjg1 COSA# ©50101592 Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my Seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone 522-7773 Date 7/28/2016 bedrooms, with the following stipulations: By: Original Certificate Date: '- 160 —j(61 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet—E '- ', c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Peters Creek, Block 4, Lot 5 A. WELL DATA - No Well on Lot. AWWU Water System. Well type Date completed _ Total depth ft. Date of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal (YIN)_ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate Arsenic ug/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) Date of pumping 8/1/2016 Pumper Sanitary Pumpers Parcel ID: 051-115-23 Well Log (Y/N) Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION ft. ft. g.p.m. g.p.m. mg/L Collected by: Date installed 3/10/78 Y TI C. ABSORPTION FIELD DATA Date installed 3/20/78 Soil rating (g.p.d./ft2 or ft2/bdrm) Unknown System type Absorption Pit Length 12 ft. Width 12 ft. Gravel below pipe 8 ft. Total depth 12 ft. Eff. absorption area 384+ ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/10/16 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 12.5 in. Water added 1,800 gal. New depth 35 in. Elapsed Time: 1,440 min. Final fluid depth 12.5 in. Absorption rate >= 600 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 Manhole/Access (Y/N) "Pump on" level at in. `Pump off" level at in. High water alar level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES - Property Served by AWWU Water System. WELL ON LOTTO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation > Property line >51 Water main >10, Water service line >10, Wells on adjacent lots >100, ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10, Water Service line >10, Surface water >100, Curtain drain None Noted Wells on adjacent lots >100, Absorption field >5' Surface water >100, Water main >10, Driveway, parking/vehicle storage >10' F. COMMENTS Municipal files indicate the septic tank is nearly 40 years old. It may be near the end of its useful life. 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 Michael E. Anderson, P.E. Date 7/28/2016 COSA brown sheet -1 0-1 0-12.doc Municipality of Anchorage s Development Services Department Building Safety Division q On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-115-23 COSA # C1 Expiration Date: t'o l - 1. GENERAL INFORMATION Complete legal description Peters Creek, Block 4, Lot 5 Location (site address) 23305 Glenn Court Chugiak, AK 99567 Current Property owner(s) Bear Steams Asset Backed Securities Trust Day phone Mailing address 3476 Stateview Boulevard, Fort Mill SC 29715 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site ✓❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑✓ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 5/5/2012 5. DSD SIGNATURE _ Approved for Disapproved. T bedrooms. Conditional approval for C3 M 6 AMIRSOn; Z� r CE, sa -wit bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: /Z'(J , Original Certificate Date: ! ' �— (Rev. 11105) Municipality of Anchorage • Development Services Department =" Building Safety Division On -Site Water & Wastewater Program ` 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Lot 5, Block 4, Peters Creek Subdivision Parcel ID: 051-115.23 A. WELL DATA Well type — If A, B, or C provide PWSID # Well Log (Y/N) Date completed _ Sanitary seal (Y/N) _ Wires properly protected (Y/N) Total depth ft. Cased to ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform coloniesll00 mL Nitrate mg/L Other bacteria colonies/100 mL Arsenic: ^ mg/l Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material septic/Steel Date installed 3110/78 Tank size 1.250 gal. Number of Compartments TWO Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping 5/31/12 Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 3120/78 Soil rating (g.p.d./ftz or ftzlbdrm) Unknown System type Absorption Pit Length 12 ft. Width 12 ft. Gravel below pipe 8 ft. Total depth 12 ft. Eff. absorption area 384+ fe Monitoring tube Y Depression over field N Date of adequacy test 5/24/12 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 24 in. Water added743 gal. New depth 39 in. Elapsed Time: 1.440 min. Final fluid depth 24 in. Absorption rate >= 600 g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at_ in. "Pump off' level at _ in. High 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 On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line>5� Absorption field >5' Water main NIA 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 >10' Water Service line >10' Surface water >J W Driveway, parking/vehicle storage >2B Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: Property is Served by AW WU Water System. G. ENGINEER'S CERTIFICATION i/\i'• go I certify that 1 have determined through field inspections and Alk; review of Municipal records that the above systems are in �•-••' conformance with MOA COSA guidelines in effect on this date. ••� •�+*� Engineer's Printed Name Michael E. Anderson, P.E. 1�j�6�,,• Date 6/5/zo12 COSA Fee $ 'J 10 (1 Date of Payment ('01 'sh a CJ" Receipt Number ro—)'1 // w G (Rev. 11/05) Waiver Fee $ _ Date of Payment Receipt Number, L j)7At liur.P,dez Municipality of Anchorage • Development Services Department " Building Safety Division �•: -- On -Site Water and Wastewater Program ` 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051.115.23 HAA Expiration Date: — / — o rp 1. GENERAL INFORMATION Complete legal description _ Lot 5. 81 4. Peters Creek Subdivision Location (site address or directions) 23305 Glenn Court Current Property owner(s) _Jeremy D. and Michelle L Roth Day phone 6945690 Mailing address 23305 Glenn Court Chuolak. AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:. Four 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates 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 Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system Is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations In effect at the time of Installation. Name of Firm _Anderson Enalneedna Phone 522.7773 Address P.O. Box 240773 Anchorage AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 10/27/2005 49th' 5. DSD SIGNATURE Approved for bedrooms. ,♦i� N� t�"� Disapproved. ♦h♦♦s;01 Conditional approval for bedrooms, with the following stipulations: Attachments: NAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:_ (Rw ,zoo) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program .. .,. 4700 South Bragaw SL P.O. Box 198850 Anchorage, AK 99519850 www.d.anchorage.sk.us (9(17) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 5, Black 4 paten Creak S bdbftlon Parcel I0: -R51.11 I A. WELL DATA Wen type _ If A, B, or C provide PWSID S _ Data completed _ Sanitary aeai (YIN) _ Total depth IL Cased to fL FROM WELL LOO Data of test Static water Wei R Well production O.P.M. WATER SAMPLE RESULTS: Conform cotonles/100 ml. Nitrate mgA. Date of sample: Collected by- B. y B. SEPTIC/HOLDINO TANK DATA Well Log (YM) Wires Property protected (YIN) Casing height (above ground) in. AT INSPECTION fL Other bacteria colonin/100 mi. Tank TypelMaterial Seeticl3tna) Data Installed 3=978 Tank size 1150 ga- Number of Compartments Unkn Cieanouts (YIN) Y Foundation cleanout (YIN) X Depression over tank (YIN) 19 High water alarm (YIN) N Date of pumping E702 Pumper oars C. ABSORPTION FIELD DATA Date krate W 3Cl9I1978 Son rating (g.p.dAe or fe/bdrm) Ilan System IYPa A4e2132211Ph Length 1T IL Width 32' ft Gravel below Pipe 3' fL Total depth 1$ fL EH. absorption area We Monitoring tuba X Depression over ryeld g Date of adequacy test 3809R5115 Results (Pan/Fall) Pus For iltSR bedrooms Fluid depth In absorption field before test g in. Water addedj)fi gal. New depmM in. Elapsed Tone: 19 min. Final fluid depth JU in. Absorption rate 809 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN 6 type) _ N If yes, give date D. LIFT STATION Data installed 'Pump on' level at _ in. Datum Size in gallons 'Pump oft' level at _ In. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot NIA Absorption field on Jot _IIIA Public sewer main NIA Manhole/Access ('Y/N) High water alarm level at in. Meets alarm d circuit requirements? On adjacent Jots WA On adjacent lots _NIA Public sewer manhole/cleanout NIA Sewer /septic service One _NIA Holding tank WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >S Property One >' Absorption field >S Water main Ai Water service One >1O' Surface water >IW Wells on adjacent lots VW SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line _Mr__ Building foundation >1tP Water main >MO' Water Service line >10' Surface water MT Driveway, poftWvehicig stDraQe >T Curtain drain None Noted Wells on adjacent kris >2W F. COMMENTS G. ENGINEER'S CERTIFICATION AT .7�. 1 view that I have determined through field systems are and ° 49th j review of Municipal records that Me shove systems ere in conformance NO MOA HAA guidelines in effect on this data. tt Engineer's Printed Name Michael E Anderson P E �rao No c am0 .. No. a-�x1 Data 1aMMS HAA Fee S '%30 r— Date of Payment / 0 - Z6, O t+ Receipt Number 74(00/ (Rev. 12MM Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage ••�� � + -- Development Services Department << Building Safety Division � �s On -Site Water and Wastewater Program 4700 South Bragaw St. . P.O. Box 196650 Anchorage, AK 99519650 www.cl.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-115-23 HAA # v -?0 4 35 -Expiration Date: 9 — /a — O 4 1. GENERAL INFORMATION Complete legal description Lot 5, Block 4. Peters Creek Subdivision Location (site address or directions) 23305 Glenn Court Current Property owner(s) Kelly Sprague Day phone 688-3351 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Century 21 North Realty Day phone 352-5100 991 North Norman Street Suite 100 Wasiila. AK Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Four 4 TYPE OF WASTEWATER DISPOSAL: ❑ Individual On-site ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates 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 affuced hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority 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 Anderson Enaineerina Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson. P.E. Date 9117/2003 �'/fes 4�, jyir I 49th =MICHAEL L ANDERSON = 1 5. DSD SIGNATURE No. a=sel f ✓ .. i Approved for � bedrooms. eee .«........�,,�;;�••• Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments oN-SITE ••'n= WATER AND : n` �e"r'r° cT�LerArcD PROGRAM Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other -By- ��A� //l�, (/— dam/ Original Certificate Date: (Rw.. 12M Municipality of Anchorage • Development Services Department Building Safety Division " On -Site Water& Wastewater Program 4700 South Bragaw St. P.O. Box 198850 Anchorage, AK 995198850 www.ci.anchorage.ek.us (907)343-7904 A. WELL DATA Well type Date Completed Total depth ft. Date of test Static water level Well production g.p.m. HEALTH AUTHORITY APPROVAL CHECKLIST If A, B, or C provide PWSID 0 Sanitary seal (Y/N) Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: Coliform colonies/l00 ml. Nitrate ft. Date of sample: Collected by: B. SEPTICIHOLDING TANK DATA Well Log (Y/N) Wires properly protected (Y/N) _ Casing height (above ground) In. AT INSPECTION mg.A. Other bacteria ft. g.p.m. colonies/10o ml. .Tank Type/Material $eotic&Vel Date installed 312011978 Tank size 1,250 gal. Number of Compartments Unknown Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) y High water alarm (Y/N) N Date of pumping 8122/2003 Pumper Ars Pumping C. ABSORPTION FIELD DATA Date installed 312011978 Soil rating (g.p.d./ft2 or ft2Axtrrn) j1p(noy System type Absorption Pit Length 12 ft. Width 12 ft. Gravel below pipe B ft. Total depth J.& ft. Eff. absorption area M44 ftp Monitoring tube Y Depression over field N Date of adequacy test 811912003 Results (Pass/Fail) Pass For f91 bedrooms Fluid depth In absorption field before test J, in. Elapsed Time: jjil mina Final fluid depth 14 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water addedU] gal. New depth2l in. Absorption rate >= 600 g.p.d. If yes, give date D. LIFT STATION Date installed Size In gallons 'Pump on' level at _ in. 'Pump off level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot WA Absorption field on lot WA Public sewer main WA Sewer /septic service line WA Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots WA On adjacent lotsJN A Public sewer manhole/cleanout WA Holding tank WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >S Property tine , >.' Absorption field >S Water main >10' Water service line 3,10' Surface water >100' Wells on adjacent lots 400 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >70' Building foundation >10' Water main 3,10' Water Service line MW Surface water >100' Driveway, parldng/vehide storage 2,2F Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that I have determined through Reid inspections and 4wa review of Municipal records that the above systems are in „, = 49 h ooMavmance with MOA HAA guidelines In effect on this date. ,* ^Iu L E. /WOERSOe Engineer's Printed Name Michael E. Anderson. P.E. i No. CE -4381 Date SM212003 HAA Fee $ Date of Payment Receipt Number (Rev. 12'00) Waiver Fee $ _ Date of Payment Receipt Number ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522.6778 FAX MEMORANDUM DATE: September 12, 2003 TO: Jeff Poet FROM: Mike Anderson, P.E. SUBJECT: Lot 5, Block 4, Peters Creek Subdivision Septic System Dimensions Certificate of Health Authority Approval On Friday, September 12, 2003, with the assistance of a backhoe we uncovered the absorption crib located on the subject lot. The crib was found to be composed of cinder block and measured at 12' long by 12' wide with an effective depth of 8'. The total effective absorption area then becomes 384 square feet. The Health Authority Approval Checklist has been modified to include these dimensions and is attached for your review. Please let me know if you have any questions. Seo. 5. 2003 12:34PM 9075226119 Ho.3783 P. 3/4 J;igeE�k,�tl,, y.7�b8 Leart.4 �i Vf Seo. 5. 2003 12:35PM 9075226119 No -3783 P. 4/4 Lat 5 15r-4 ?dim cry 0 bC,Au; = NtTlg, WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8 Geophysical Surveys Drilling permit N•. LOCATION OF WELL (Please complete either la• la of Is.) A.D.L. No. -LailBorough 114 ubdivislon Let Block 4. Ib. I/4gtn. ref—of—eta Section Na. ToanaMPN❑ 3❑ Rang• 1[3Meridian Wo le. 013TANCE AND DIRECTION FROM ROAD INTERSECTIONS ' Street Address end Arae of Well Location t // 4 �7J•� 3. OWNER OF WELL: 4011 Address: f^[ a/ /..ldr. y G/.e 2. WELL LOG peeBalew Material Type Top 3YlfeeBolfent • d• WELL DEPTH: (final) L41 19 ft• S. DTE OF COMPLETION Y/4L J�1L� ..� A — •- —,LL g. ❑Cable tool 81talary ❑Driven ❑Dug ❑ Augur ❑J•tt•d ❑ Bored ❑ Other t ?-USE: 0 Domestic O Public Supply O Industry ❑ Irrigation 0 Reeharga O Commerical O Telt Wall O Other: r �•So �^ r In S. CA31NO: O Threaded $J Welded sie.. (A In. to // % ft. Depth Welghr Ibs./ft. dlo.. I.. te_fr. Depth SNakvph-ft, 9 142 S. FINISH OF WELL: Type: Diameter, Wot/Mash Slse: Length: Set bet.*" ft. and ft. Backfilling Gravel pack " 10. STATIC WATER LEVEL:10.0 to. O Above or ® Bala. land surface onto Ea+ipm•nl used: . 11. PUMPING LEVEL Belo. land surface and YIELD ft. after bra, Pumpin0 9•p. m• It. after hro, pumping_g•p.m. • 12.GROUTINa Well Grouted: ® Yes ❑ Ne Material: 0 Neat Content ❑ Other: L ' is. PUMP: (it available) NP Length of Drop Pioe ft. capacity a.P••• O Salim. 0 Jet ❑ Oantrlflcal ❑ other • / 14.111EMARNS: ��•PO/•t� �J f )% �OS GP 7- Ig. WATER WILL CONTRACTOR'S CERTIFICATION: 13. Water Ta. pe ra lure —• ❑ f ❑ C This well ptdri lied and or .t Jurisdiction and this report Is true to in b st of my knowledge and belief; a .L' .ter aim/r�r 1•larad Beine Contract License Number Address: n ' ,c .r 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 J„/v r�A_ 1. GENERAL INFORMATION (a) , Legal Description (include lot, block, subdivision, section, township, range) ' %3 4 pa-izrs Cj-.t 5/D 51C.? T,S,tJ Location (address or directions) /7 Pere S CreGL (b) Applicant Namely �dY4 iTale Telephone: Home 0/8 33•x! Business 3 77- 2323 Applicant Address t.>ter. C eee L. (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder V(; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution .tri r �1C. Telephone Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: ?ILC -V- ULp Ina. 11 373- 2323 e-'ES,re�� 2. TYPE OF RESIDENCE Single-Familyr Multi -Family ❑ Other i Number of Bedrooms, 3. WATER SUPPLY Individual Well ❑ Community ❑ Public Mf 1_4 . for—ry Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. e 4. SEWAGE DISPOSAL Onsite pr Public ❑ ,: Community ❑ Holding Tank ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page t of 2, 72-on(111e4) k 5 ENGINEERING FIRM PROVIDING INSPECTIONS; TESTS, FILE SEARCH, DATA AND INFORMATION As`certd;ed by my seal'affi ed hereto and as of the validation date shown below, I verity 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. , i E Name of hr'm /lf�a ftl e Y h E Ek Telephone �'F '{ 4-71( .. Address iDate WATER WELL NOT Th 5!cce Authority ppt2Yal inspe on merely certlffes at suer produced gallons per bedr ,.per ay and ted labor ry tests s — no - i sent f colifo aeter n a sampI that wa No w ee r or rtificat 1s',ex ssed or ted con ning th ong terns tF adequacy:or.'safety,of he water 'supply. ' " ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. , 1 6. DHEP APPROVAL i .• 1 Approved for _.bedrooms byVDate ,. r Bisepprored Conditional Terms of Conditional Approval l(iIl6H N IL LtlQ7ls- GO6 i�/�OKiy«. SGOlJ svtO/Hi_Z^/f 7'O OUCL• T01 P LOng-a tDK 7D OKa/G L(J 714 eIA140, eC7D6ir 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 s certificate Is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work r ' . Page 20214 - �7t-08111/Bq MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 hl:iirXIPALITY OF ANCli08AG: DEPT. OF HEALTH R ENVIP.O.W,ENTAL PROTECTION 131986 2844720 RECEIVED Legal Description: _S&PW A. WELL DATA* S !O � T II SN Well ClassificationIf A, B. C. D.E C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield� �sdaM Total Depth Static Water Level Cased to Casing Height Above Ground Depth of Grouting _ Pump Set At Sanitary Seal on Casing (Y/N) Ile 5 Electrical Wiring in Conduit (Y/N) /40 Depression Around Wellhead (Y/N) yes Separation Distances from Well: To Septic/Holding Tank on Lot �� / ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot _lab / ; On Adjoining Lots �� { To Nearest Public Sewer Line To Nearest Public Sewer i Cleanout/Manhole To Nearest Sewer Service Line on Lot 6 g Water Sample Collected by ; Date /r Water Sample Test Results S _ ro ) v 0v s ro -} � a_ ni- - - 11 ?• B. SEPTIC/HOLDING TANK DATA -7 '7? Date Installed 3-80.7? Size4� No. of Compartments 1fdtYNDuJ.d Standpipes (Y/N) y('S Air -tight Caps (Y/N)�Foundation Cleanout (Y/N) Depression over Tank (Y/N) Date Last Pumped -40 �dG Pumping/Maintenance Contract on File (Y/N) for __A/Ap Holding Tank High -Water Alarm (Y/N) —d%�� Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well p To Building Foundation To Property Line �� ~ To Disposal Field To Water Main/Service/Line 57 To Stream, Pond, Lake, or Major Drainage Course dfiq Comments Page 1 of 2 72-026(11,84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 1ZA& '.f/2W Al Type of System Design 'r!� P Date Installed &a? -2'9 7.7 Length of Field UNh'.VAWA/ Width of Field—4WW"Wti Depth of Field Na W Se ¢ 'OAo i_0 ^ 12 4 %12 Gravel Bed Thickness Square Feet of Absorption Area WAI Standpipes Present (Y/N) t f/D CA1� Depression over Field (Y/N) /✓C Date of Last Adequacy Test t!rr'ZO -Slo Results of Last Adequacy Test Separation Distance from Absorption Field To Water -Supply Well/Q7 To Property Line i To Building Foundation / �6 To Existing or Abandoned System on e,dG r Lot �✓ cA�e ; On Adjoining Lots S� `� i To Water Main/Service Line To Cutbank (if present) et�4 To Stream/Pond/Lake/or Major Drainage Course ,/0 To Driveway. Parking Area, or Vehicle Storage Area / �y Comments "X Te -S+ ante ryas IiQ %, 1Ar 6-4/ GM /V C) (.JA 1"e r D. LIFT STATION M/A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at _ Tested for Electrical Codes (Y/N) Comments 7 days I a te r - e2 Ic yar Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA .. Check Permitted Bedroom Rating Against HAA Request •• Icertifythatl v k9 v rifled conformedtoallMOAandHAAguidelinesineffect onthedateofthisinspection Signed h ate 7IRT/96 Company IWW rka ro., MOA No. Receipt No.OF A,* vi` rf a A" .. n Date of Payment ��(? `$b ! : r� tl� gA T• •� Amount: $ mph I''t Page 2 of 2 72-026 (11,84) r. v {• ^ NEIL I4'41R'rW.01II::- C' C: -4'C'.1 �i�'�^r •., •�. x•49 #1: Time 10 Date 3-1 Insp Pra I ,MUNICIPALITY OF ANCHORAGE.. V1c z DEPARTME._ P :OF HEALTH AND ENVIRONMEN, :PROTECTION 0 S��L 825 • L Street, Anchoraa. Alaska 99501 aC'P 264-4720 Date Received: March 7, 1978 �,m• #2: Time in,m),orn #3: Time ,Q_,2'noe _ 8 Friday Date A -11 --IQ n ),n Date Q-Icl-7Q l i, , an Insp 01 I'ns Insp n 11h� REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Phone: 2. Property Owner: Kelly/Janet Sprague Phone: 688-3357 Mailing Address: Star Route Box 1080 99567 3. Legal Description: Lot 5 Block 4 Peter's Creek Subdivision 4: Single Family Residence: (xk Multiple Family Residence: ( ) Number of Bedrooms: Four Number of Bedrooms: 5. Well System: Individual Well (x) Community/Public System ( ) Permit # Construction Depth of Well 106' Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Septic Tank Size Absorption Area Installed 19747 Installer Manufacturer Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line 1 Page +,Ywo 5epartment of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 5 Block 4 Peter's Creek Subdivision Comments: 6 tk Affadavit Attached: ( Letter Attached: ( ) Approved: Date: Disapproved: Date: Department Worksheet: " CoIArCAcT' Mc Qcob Prcl" RECEIPT FOR CERTIFIED MAIL, DR DATE - STREET AND N0. 00 P.O.. STATE AND 21P CODE OF110N\l SERVICES FOR AdDIT1- L —�'--i.- 9As �e .Rem end fat *11 «.d RETURN WM1e EelnerY to +e.nsa. +nlY-••--••-6ff I ueurT , t. sR..s he . m. +ea ...r. aur.rs _ fs# SERVICES Wile Eetirery to +eeonee +•ly-••-•-•. Sff _ —� . i _.—--..............._..........._................ • DEUVERTO AODREfSEE ONLY Q SPECIAL_DELIVERY (*Oro tM r•wir.� ---- .............. �' PS Ferr. X800 NO INSURANCE COVIRAGE MOVIDED— ES.• elh.r +id.) `� Is$ *m NOT IOR INTERNATIONAL MAIL .CPO: 1913 I+eua.f 6. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR. INSPECTOR - ' INSPECTOR n MUNICIPALitY Ur MUNICIPALITY OF ANCHORAGE DEPT. OF I -,—f Gi I & NTAL F^.JTLCTION \ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEPjW(>af !`VJ 825 L Street - Anchorage, Alaska 99501 *ATTACH WELL LOG. A well log is required for all wells drilled 1 !r,r� a Maar 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. Please allow ten (10) days for processing. 1. PROpE`RTY NER ^, PHONE MAILING ADD SS cam. O ORO S r PROPERTY RESIDENT (lf different from above) P 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTIO % PHONE 76 3 A 7 MAILING ADDRESS / 8p O E A -,-r /A .-,0vc %fiAff �111111elz 4. REALTOR/AGENT PHONE MAILING ADDRESS 6. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS SINGLE FAMILY 13 One El� ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY 13T�INDIVIDUALe *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 - [!!T'INDIVIDUAL/ON-SITE" / 9 9 9 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) 7, THIS SIDE FOR OFFICIAL USE ONLY 1. TYPEOFRESIDENCE 0 SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATERSUPPLYPERMITNUMBER E,INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM C5110NDIVIDUAL/ON SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER eptic Tank or ❑ Holding Tank Size: �Z �� • If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK 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 S. COMMENTS L? APPROVED FOR _ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE X+ BY 72010 (Rev. 6/79) \ MUNICIPALITY OF ANCHORAGE Department of Health and Environmental Protection �i,� Q2(- -� 825 L Street, Anchorage, Alaska 99501 [Ct� 264-4720 :tequest for Approval of Individual Sewer and Water Facilities . 1. Property Owner: Mailing Address: 2. Name of Buyer: 3. 4 5. 6. 7. FM Mailing Address: Lending Institution: Mailing Address: Realtor/Agent: Phone: Phone: Mailing Address: Legal Description: Street Location: rnc,ne : Single Family Residence: (tom Number of Bedrooms: 7 Multiple Family Residence: ( ) Number of Bedrooms: Water Supply:_ *Individual Well (mK Public/Community System ( ) If Individual Well, well depth i If Community System, name of system Sewage Disposal System: "On-site System (14 Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77