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MORGAN LT 1
Morgan Lot 1 #051-154-46 Municipality of Anchorage ' - Development Services Department Building Safety Division On -She Water and Wastewater Program, 4700 Bragaw St. P.O. Boz 196650 Anchorage, AK 99519-6650 Page of www cf anchorage.ak.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW060172 PID Number. 051.15446 Nanl, Wastewater System: []New ® Upgrade "d'°" PO BOX 671806 IAK, AK 99567 ABSORPTION FIELD Phone N WIW dr Sed o 14, O Deep Tm e h ® ShYlow Trench O Bed O MM4 13 oow TdWDeohean« 4•d• LEGAL DESCRIPTIONSoil 1.2 GPDFj 1.2 4 FI. Bock t.m S�dwdm Dagn to P" twdom lean mg. 71id• Gce dWh twed, pipe MORGAN 2 Ft. 2 FL 7o~1P Rerpe, sw. Fd ceded eowe W" Qr a C.e LWQM 0.43.0.5 Ft. 70 Ft. Well: ❑ New ❑ Upgrade GrevNwWt Nu wof 1 Dutsce tWwean lr,ee NA 5 Ft. FL cli"101 eha, (Plwete. A a. W. Tam Depm t; e w Taal eceagm enc Ppe MatarieL PRIVATE •EXISTING Ft. FL 500 Ft I D3034 & SCH40 Dyyr DN DMW ste Wsm Le 1,WNW Drs hMalbd. FL DIRTWORKS 1 10120/06 Y" P pSMa c..g lWyn Aew. �o'+b TANK GPM Ft. FL SEPARATION DISTANCES ❑ Septic ❑ Holding 0 S.T.E.P. ❑ Other. To From Septic Tank Absorption Field Lift station Holding Tank PuaiuPmar Sewer Line '�" ANCHORAGE TANK r 1500 ca w.F 100'+ 100'+ 100'+ NA 25'. Me,«W STEEL Nunn«o 2 100'+ 100'+ 100'+ NA LIFT STATION Wf"WMW Lot Lir 5'+ 10'+ 51+ NA 1500 cM ANCHORAGE TANK • ORENCO 5'+ 10'+ 5'+ NA anp un IevMM • Dnp wrx qn wwa.wmM Faa de pn 44 in 42 in 48 in. NA t . 50 + NA NA P,Fnp Me e a Model EMaricel V.Pwt a perMmed w C~ D.., Franklin 244504011 412h ED'S ELECTRIC RB1n *BENCH *None known. Material consistent along trench. Previously MARK existing septic tank & field abandoned in place per code. pend eupua• BOTTOM OF SIDING — LOWEST LOG 100 FL Engineer's Stamp Inspections performed by: KND ENGINEERING. INC. Dates: 1f1 10120/06 \ 2nd 10/20/06 �p(�.OF •A�,'Qs+ it, Development Services Department Approval .r C2: y 0� Conditional Approval Date: . .»... ».. .. /� Kenre.h N•1 /LQ C Cc 711 O Reviewed and approved by: Date: I It 171.�40o PROFESStONP4^►�' (an twa) M AS -BUILT SYSTEM DETAILS/SITE PLAN Permit: SW060172 MORGAN S/D, LOT I PID#; 051-154-46 C I N8905%4V'25"kk 99.96 1 co LLJ I y LLI W T. SEpnWAIP 1500 CAL LIFT STA. EXIST.3 BDRM HO T 1 USEoi- /25. am-soll" Log) YI PROPOSED BDPM ADDITION FCO cc <z I r u 50 40' ElSCALE '=40' F:ELO BOOKS LSFMT 30 9 STAKftQ CHEMM. KMD A -C= 28.1 DATC' 11112LC 0� Mr. 7.1 0 " '- 06-045 B -C= 47.8 7 �vv.vv U S89*54'25'W 300.00 GRAF qr <z I r u 50 40' ElSCALE '=40' i 70.0* .AW PREPARED FOR: CALEB SLEMONS P.D. BOX 671806 CHUGIAK, AK 99567 688-6260 KEN H U. DUFF 7116 ilia b F:ELO BOOKS 9.16 99 9 STAKftQ CHEMM. KMD A -C= 28.1 DATC' 11112LC 0� Mr. cm NW1257 "-Ao '"; (see below: " '- 06-045 B -C= 47.8 7 A -D= 35.6 U 001 FINAL GRADE 00.2 B -D= 52.5 n A-E= 62.3 T " Tm s rLM fWg,,. B-E= 76.3 0' GAL A -F=101.4 S.T..p. TANKa "tEWER RdCK' 3-F= 75.6 i 70.0* .AW PREPARED FOR: CALEB SLEMONS P.D. BOX 671806 CHUGIAK, AK 99567 688-6260 KEN H U. DUFF 7116 ilia b F:ELO BOOKS co~m. 00'•^r Johnson 0""w kmd STAKftQ CHEMM. KMD xsp"�"* Johnson DATC' 11112LC 0� Mr. cm NW1257 "-Ao '"; (see below: " '- 06-045 SCALE, NTS 90.7 88.7 a 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 0 i EDS ELECTRIC INC 0 November 15, 2006 Caleb Slemons PO Box 671806 Chugiak, AK 99567 To Whom It May Concern: 907 272 4590 ED'S ELECTRIC INC. P.O. BOX 210767 ANCHORAGE, AK99521 11/16/06 09t12am P. 001 Subj: Septic lift station lot 1, sub. Morgan, 20906 Tarika Ave, Chugiak Alaska. ANCHORAGE (907) 272.4591 Fax: (9071272-4590 Ed's Electric, Inc. installed control panel and final tennlnations on subject project, to the code requirements of the National Electrical Code and the Municipality of Anchorage. Note: Underground wiring Installed by others Thank you, Dwayne R Bruns Ed's Electric, Inc. cc K & D Engineering MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW060172 Legal Description: MORGAN LT 1 Design Engineer: 0070 KND ENGINEERING Owner Name: CALEB & JONNE SLEMONS Owner Address: PO BOX 671806 CHUGIAK , AK 99567-1806 Date Issued: Jun 21, 2006 Expiration Date: Jun 21, 2007 Parcel ID: 051-154-46 Site Address: 020906 CRABTREE ST Lot Size: 43560 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of. ❑✓ Disposal Field [D Septic Tank E] Holding Tank E] Privy Private Well Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date: Z3 G c Issued By: Date: Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05-1- /54- ql( JV^'&e Property owners) fit_ fQ� (!� ! . `�A_fn,t Day phone cey! -SL's -Co l77 Mailing address P.Q. &;bX 6700/ Zip Code S6 Site address Z c7lo Af tKA CH0cVRK Zip Code '? Legal description (Sub'd, Block & Lot) Z-07- f Legal description (Township, Section & Range) 4-3157,00 V Lot Size , 57.00 Sq. Ft. THIS APPLICATION IS FOR (®all that apply) Absorption Field Upgrade Septic Tank Renewal Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms THIS APPLICATION IS AN: Initial ❑ �5� Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. of property owner or authorized agent) Permit/Rush Fees: 'I It V Waiver Fees: Date of Payment: 61 to /0 G Date of Payment: Receipt Number: 7 6`5 V & Receipt Number: (j (Rev. 17/05) "— .. K D ENGINEERING, INC. 20441 PTARMIGAN BLVD. June 12, 2006 Munidpality of Anchorage Development Services Department On -Site Water &Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Sewer Upgrade — Morgan Lot 1 Gentlemen: The owner has requested we proceed forward to obtain a septic permit to upgrade and replace the existing septic system and tank for the subject lot. The existing septic tank and field will be abandoned in place and in accordance with municipal standards. On May 26, 2006 a testhole was performed for the proposed system. The results of this test are attached. The general slope of this lot is from east to west at a grade of approximately 0 — 5%. We have designed our system utilizing the testhole we excavated for the 4 -bedroom house (3 bedroom existing plus a 1 bedroom addition). The lot is served by an individual well. We propose to install a 5' wide shallow trench. Water was encountered during the excavation and monitoring at 9'. No exterior foundation cleanout exists and in the event that elevations of the existing residence and addition won't permit a gravity -flow system a 1500 -gallon lift station will be installed in lieu of the 1250 -gallon septic tank. If a lift station is deemed necessary, the absorption field will be pressurized with 2.3' hole spacing and 1.25" pipe. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, 1K ED Engineering, Inc. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test Owner/ Contractor Specs ELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PL I MORGAN S/D, LOT 1 353 11 Book 228 Pepe 142 AD 8r -44 NO PUBLIC WELLS WITHIN tar 13F PROPOSED SYSTEM NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTE& NO SEPTIC SYSTEMS WIMIN 200' Di PROPOSED WELL EXCEPT AS NOTED. . +_\ OF i� Vr N8936.00'E 329.91 (77-1132 10' U" ESMt LOT 2 i LOT I 30 W .g W m Pq $� Q ry U 30 ii 3° 3r n Book 249 Pepe 274 DESIGN DETAILS 4 BDRM X 150 GPD = 600 GPD 600 GPD/1.2 GPD PER SO. FT. (1.0 MIN/IN.)= 500 SO. FT (500 / 5' (W)) x 0.7 (RF) (2.0' GRAVEL) = 70 FT. TRENCH USE 1 TRENCH - 70' (L) X 5' (W) X 2.0' (D) Total depth of system Is 4.0' from original grade. Total depth of gravel below distribution pipe Is 2.0' . NOTESI 1. INSTALL 1250 GALLON SEPTIC TANK b INSULATE IF < 4' COVER 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MAXIMUM 2X SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS. PREPARED FOR, CALEB SLEMONS P.O. BOX 671806 CHUGIAK, AK 99567 688-6260 / KENNETH U. D r CE -17118 , 'ff • • •' V I sstD�N i FIELD BOOKS COMPUT ED: sa 'AO deAwe kmd STuwa aE KMD ASBtRi: Johnson DATE: 1 DBa BBE: Cato NW1257 '(see below °B "" 06-045 Scale, 1'= 100' PAGE 1 OF 2 1E D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11 11 '25' A NOW WASTEWATER DISPOSAL SYSTEM DETAILS MORGAN S/D, LOT 1 P`V 99.9 rbe ST. SEPTIC abandoned) — In 1o. 0-So/a 13.52' 0o m EXIST. 3 LOT 1 BDRM HOUSE N fV) I 1 w PROPOSED 1250 w GAL SEPTIC I ANK Ln a ui PROPOSED BDRMvwi w 89°54'25"W I nT 1 :4 (04, TH* 4`�a ........ .i �U}ESSION � 300.00 PREPARED FORS CALEB SLEMONS P.O. BOX 671806 CHUGIAK, AK 99567 688-6260 FIELD BOOKS B0IOA"- Johnsc aruoq Amuan Johnsc D FIE: "CA° mE (see b TH#06-1 CIO rca 0 5 0 Ca"wiCa o"A""' kmd O1EO'm- KMD CAM 8/31/9( cm NW1257 " "' 06-045 E 1D O 30 ME Scale, 1'= 30' PAGE 2 OF 2 IE HDENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11 KN D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS PERCOLATION TEST Performed for: Caleb SlemonsDate Performed:_ 5/26/06��� Project:_ Morgan SID Lot 1 TEST HOLE tt 06-1 Depth 12- ORG/OL SEE ATTACHED SITE PLAN FOR HOLE LOCATION SP/gp—sand w/ gravel and occasional cobble to 1' B.O.H. INSITU MATERIAL 20- SUITABLE AS FILTER Was Groundwater encountered? YES What depth? 9' Depth to water after monitoring? 9Y Date? 6/3/06 Keadmg Date Gross Time Net Time Dept to {Vater Net Drop 1 5/26/06 1:00 6" 2 1:05 5 min dry 6" 3 1:06 6" - 4 1:11 5 min d 6" 5 1:12 6" 6 1:17 5 min d 6" 7 1:18 6" 8 9 10 11 12 Water Added Percolation Rate < 1 (min/in) Perc Hole Diameter- 6" Test Run Between 4 feet and 5 feet I, Kenneth hl. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. aICINI D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 696-6111 / FAX (907) 696-8111 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS LEGAL DESCRIPTION: Morgan Lot 1 GENERAL: I. The scope of this project includes the installation of a septic tank and/or drainfield to serve a single-family residence on the referenced property as delineated on the attached Municipality of Anchorage (MOA) permit and site plan. 2. Construction shall be in accordance with the approved site plan and design drawings; MOA permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. KND Engineering, Inc (KND) assumes no responsibility of the accuracy of the as -built survey provided by the owner or owner's representative. 4. The owner or contractor is responsible to notify the engineer of any discrepancies noted on the design plans or drawings prior to commencing work. These discrepancies could be, but not limited to, possible encroachments, surface water, varying soils, unplatted easements, types or use of dwellings on or adjacent to property, nearby public wells, etc. 5. The contractor shall be responsible for locating any necessary underground utilities, easements, property lines and surface water. The owner and/or contractor shall ensure, if deemed appropriate, that a registered land surveyor prior to construction flags all setbacks. 6. The contractor shall be responsible for verifying all pertinent separation distances and component layout. 7. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 8. The MOA Development Services Department On -Site Water & Wastewater Program must certify contractors installing wastewater disposal systems. Owners installing their own systems must also receive prior approval from said MOA Department. SEPTIC TANK / HOLDING TANK / LIFT STATION INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded with proper material and compacting to prevent damaging, settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above the final grade. 4. Septic tanks installed with less than 4 foot of cover shall be insulated. The contractor will ensure that the fill over the tank does not exceed the burial depth rating. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 feet from the tank. The second cleanout, in line, shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. Page 1 of 3 Reference: Morgan Lot I 06/12/2006 Page: 2 of 3 7. All H.D.P.E. tanks shall have a vertical length of 4 -inch perforated drainpipe besides the tank extending to the bottom of the tank to above grade to monitor ground water. 8. All tanks shall be anchored when there is not enough adequate soil cover to resist buoyancy forces in high -groundwater areas. 9. All holding tanks and lift stations shall have an audible and visual alarm inside the residence. 10. All lift stations shall be wired in compliance with the Uniform Electrical Code and all MOA guidelines. 11. The contractor shall remove the old tank, or abandon it in compliance with the Uniform Plumbing Code. The contractor is solely responsible for the abandonment procedure. ABSORPTION TRENCIVDRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavaction become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the sewer rock is installed, the distribution pipe is installed level with the perforations facing downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitoring tubes shall be four- (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through thegravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 6. All advanced technology waste water disposal systems (Advantex, Biocycle, Intermittent Dosing Sand Filter, etc...) shall be constructed, installed, maintained and monitored per manufacturer's specifications and MOA requirements. MINIMUM MATERIAL SPECIFICATIONS: I. A MOA approved septic tank manufacturer must construct any septic tank proposed for installation. 2. The following pipe materials are MOA approved for use in septic system installations: Tvneof PipE�rforate 52H Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). S. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. If deemed necessary, a sieve analysis should be performed. 7. When sand is being used as a filter material, its gradation specification must conform to current MOA or DEC requirements. Reference: Morgan Lot 1 06/12/2006 Page: 3 of 3 INSPECTIONS: Typically there will be three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the sewer rock, distribution lines, standpipes, and cleanouts, but before the placement of the silt barrier, insulation, or any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and attached plans and in accordance with the attached MOA permit. All materials, components, and construction practices shall comply with the MOA's and the State of Alaska's latest ordinances, regulations, or policies regarding wells and septic systems. The failure of the inspecting engineer to notice a material or construction non-compliance does not relieve the contractor of his/her responsibility to correct such deficiency. There will be no contractual arrangement existing between the contractor and KND Engineering, Inc. KND shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the MOA. KND shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. KND's inspecting engineer will not be responsible for the construction means, methods, and techniques, sequence, procedures or the safety precautions incident to this project. BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER AND/OR WASTEWATER SYSTEM (S), THE PROPERTY OWNER, CONTRACTOR, AND WELL DRILLER ACKNOWLEDGES HAVING READ AND ACCEPTED THESE SPECIFICATIONS. nw GREi "R ANCHORAGE AREA BOR, `GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL . SYSTEM C7 NAME-V���' � � n 1��3 MAILING ADDRESS 5AOA ��U /!~' ��/? PHONE{ LOC ATION f7l � WGAE7�t - /A VVI 'LEGAL DESCRIPTIONddTI`a// -ye6 33 7/S� iC%LtJ !Yxsy SEPTIC TANK: nal un4 \ fY1 &csvL DISTANCE !NUMBER OF 5����� jt j /�.$ COMPARTMENTS FROM WELL /ZMANUFACTURER / MATERIAL INSIDE LENGTH INSIDE WIDyTH LIQUID DEPTH LIQUID CAPACITY/ 10 GALLONS. S'!�e-weO 6f,,e.40r1 CL !�e(1J ©'CDNV df �NJi%�Y� y F'X0`? TILE DRAIN FIELD: �f ll TOTAL LENGTH r DISTANCE FROM WELL FOUNDATION � _LNEAREST LOT LINE/00 OF LINES /,SIT Yd NUMBER OF LINES— DISTANCE BETWEEN LINES TRENCH WIDTH AI IN. TOTAL EFFECTIVE s J ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE T DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE IN. ABOVE TILE IN. r WELL:vy/%DrdS'•CccS TYPE %/* CONSTRUCTION DEPTH �� DISTANCE FROM: BUILDING NEAREST �j NEAREST SEPTIC '' SEEPAGE s FOUNDATION LOT LINE ! `J / SEWER LINE , TANKj�, SYSTEM J CESSPOOL N/4 0 , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: t� INSTALLED BY:�GiY•S�-jPj° SEWER LINE DEPTH: PIPE MATE RI AL:"L�� LOT SLOPE: REMARKS: �T/Z""'r) � Farm EQ -032 DIAGRAM OF SYSTEM DATE7� APPROVED .7 � r ��o /'r� fy f -l"' G.A.A.B. Q Cf _ ARE` -R ANCHORAGE AREA Bc) ,UGH DEPARTMENT OF,ENVIRONMENTAL QUALITY 3330 '•C•' STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM ® APPLICATION AND PERMIT h c --> U PEAT FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. /f,1% TYPE d��dSEEPAGE AREA SIZE � lig' TYPE SEPTIC TANK SIZE f�-�F' MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT - DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL r� I i SEPTIC TANK � SEEPAGE PIT �� DRAIN FIELD/—,( TO NEAREST LOT LINE. WELL TO SEPTIC TANK /"' ®� SEEPAGE PIT DRAIN FIELD I0 lI ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTI jANK foG SEEPAGE PIT DRAIN FIELD i ��/�K✓ SEPTIC TANK, __� —. SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE _ DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DIAGRAM OF SYSTEM DATE e' � � [i APPLICANT'S SIGNATURE FORM NO. EQ -016 ) f, - f NAME OF APPLICANT l MAILING ADDRESS (s PHONE � INSTALLATION LOCATION LEGAL DESCRIPTIONr`' INSTALLATION OF: SEPTIC TANK SEEPAGE PIT . DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY NOTE:. THIS PERMIT IS NOT VALID WITHOUT SOIL TEST SOIL TEST RESULTS�a COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. /f,1% TYPE d��dSEEPAGE AREA SIZE � lig' TYPE SEPTIC TANK SIZE f�-�F' MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT - DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL r� I i SEPTIC TANK � SEEPAGE PIT �� DRAIN FIELD/—,( TO NEAREST LOT LINE. WELL TO SEPTIC TANK /"' ®� SEEPAGE PIT DRAIN FIELD I0 lI ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTI jANK foG SEEPAGE PIT DRAIN FIELD i ��/�K✓ SEPTIC TANK, __� —. SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE _ DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DIAGRAM OF SYSTEM DATE e' � � [i APPLICANT'S SIGNATURE FORM NO. EQ -016 ) f, - f R 0 Et E GEOTECHNICAL Ef DEVELOPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 688-2280 Soils Er Foundations Land Development SOIL LOG Performed for: Name: � ���� '�� � 6X A(� Tel . No. Mailing Address: AfdX -:57x12 %2-7, C11VQI.Q/<r Al - Legal Description: /or iS `I > �5-E6 ,oO , 7"j�: n/ / / iA/, :5,sL! Depth (feet) Soil Characteristics 0 0 F 3 4 6 7 8 cel 9 l0 11 12 r! Ground Water Encountered: Yes 40p' %L No If yes, what depth_LL Proposed Installation: Seepage Pit Drain Field G---�- Comments: Performed by: Date: --Z 7 �l� 7f) V\. Cx. M_9-- e '4 m PA✓N�U • Municipality of Anchorage sx� On -Site Water and Wastewater Program (907) 343-7904 f E T Y —17 Certificate of On -Site Systems Approval Parcel I.D. 051-154-46 Expiration Date: 1. GENERAL INFORMATION Complete legal description Morgan, Lot 1 Location (site address) 19914 Crabtree St. Current Property owner(s) Caleb & Jonne Slemons Day phone Mailing address PO Box 671806 Real Estate Agent Day phone 2. TYPE OF DWELLING: Ej 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 El Individual F� Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Pubiic Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment 02 �G i J Date of Payment Receipt Number 022' i Receipt Number COSA # 05Q 5-10 24 Waiver # 6. 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Alk. 99510 Engineer's Printed Name Steven R Pannone 6. DS7DGNATURE System #1 Approved for __�L bedrooms System #2 Approved for bedrooms Disapproved Date 5/6/2014 Conditional approval for bedrooms, with the following stipulations: By: / t Original Certificate Date: _2 I.` Thb-N uni /fy chorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the repr sentations 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 sheer ° ,. 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: Morgan, Lot 1 Parcel ID: 051-154-46 A. WELL DATA Well type Private If A. B, or C provide PWSID # Well Log (YIN) N Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth Unknown ft. Cased to Unknown ft FROM WELL LOG Date of test Unknown Static water level Unknown ft Well production Unknown g p m WATER SAMPLE RESULTS: Casing height (above ground) 18+ in. AT INSPECTION 5/5/2014 M 2.4+ ft. Coliform N6b colonies/100mL Nitrate 1.63 mg/L Arsenic Il fl ug/L Date of sample: 1 23 12415 Collected by: C Ti S B. SEPTIC/HOLDING TANK DATA Tank Type/Material S.T.E.P./Steel Date installed 10/20/2006 Tank size 1,500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping Pumper -,7RnS 9/ C. ABSORPTION FIELD DATA Date installed 0/20/2006 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Shallow Trench Length 70 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth 4 ft. Eff. absorption area 500 fe Monitoring tube Y Depression over field N Date of adequacy test 5/5/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 612 gal. New depth 1 in. Elapsed Time: 240 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed 10/20/2006 "Pump on" level at 44 in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons 1,500 "Pump off" level at 42 Cycles tested 4 Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ in. Manhole/Access (Y/N) Y High water alarm level at 48 Meets alarm & circuit requirements? Yes On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ 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 50+ 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 Steven R. Pannone Date 5/6/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. 014) CRABTREE STREET (BLUEBERRY STREET PLAT 77-113) S00'13'42"E 145.22' (M&R) SOO"14'55"E (R) 10' UTILITY EASEMENT ANC$p1tAGE REBASIS OF BEARING Cp G DISTRICT "W 145.22' (R&M ASBUIE"F: MORGAN SUBDIVISION LOT 1 PLAT 77-113 ? O f �� \' SURVEY CERTEFICATION: I, John L. Schuller have conducted a �,/r Q,1! 4 physical survey of this property as shown on this drawing and that the �..• 1 Improvements situated thereon sre within the property lines and ao /0- �J:' 49TH °f'*I encroachments exist other than noted. Under no cncumstattce should / tr any information on this drawing be used for construction of fences, /......... .... . • ...... structures, improvements, or for establishing boundary lines, EXCLUSION NOTES:It is die owners responsibility 10 determine .A �• •' U • " , • "L the existence of any easements, covenants, or restrictions Which �I ° '.JOHN L. SCHULLER. do not appear on the recorded subdivision LS -10408 �•� WORN OROM NUM "W-- ».,`. -•.1u I'er '• �y Jk SEPT 25, 2007 w„a.ngaay.eq aA •• X12. •Y a 08-045 °"""°" �� °`D s7 0703/50 �\�\� ssioru � ���& O J Q U N h_ Hz W Z 0 V� J / f 0 N • OZ Uw 00- 0" 01 mO 61 N �. O NO N •v 30.3' 73.7' M b N M MM 00 N 7.5' 31.7' 9.3' r w w 0W Z I_'. --I 7.5' a N 0 N o Z_ � b X a 0 H� J WCC �r N0 zo.o Ow X S U W YO b Lj to Li 3 Qt3 �N �O ink U N 00 Z 000 - .. 42.0' 28.4' 00 U) m Z 00 to ® W x V ANC$p1tAGE REBASIS OF BEARING Cp G DISTRICT "W 145.22' (R&M ASBUIE"F: MORGAN SUBDIVISION LOT 1 PLAT 77-113 ? O f �� \' SURVEY CERTEFICATION: I, John L. Schuller have conducted a �,/r Q,1! 4 physical survey of this property as shown on this drawing and that the �..• 1 Improvements situated thereon sre within the property lines and ao /0- �J:' 49TH °f'*I encroachments exist other than noted. Under no cncumstattce should / tr any information on this drawing be used for construction of fences, /......... .... . • ...... structures, improvements, or for establishing boundary lines, EXCLUSION NOTES:It is die owners responsibility 10 determine .A �• •' U • " , • "L the existence of any easements, covenants, or restrictions Which �I ° '.JOHN L. SCHULLER. do not appear on the recorded subdivision LS -10408 �•� WORN OROM NUM "W-- ».,`. -•.1u I'er '• �y Jk SEPT 25, 2007 w„a.ngaay.eq aA •• X12. •Y a 08-045 °"""°" �� °`D s7 0703/50 �\�\� ssioru � ���& O MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # n:5�nl — 14))-� - i-", HAA # L_� (lei(^r "\ AL9 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Morgan Subdivision Location (address or directions) Tarika Drive off Cranberry (b) Property owner Robert and 'Darlene Alano Telephone: (home) Business Mailing Address (c) Lending Institution Fannie Mae Telephone Mailing Address ATTENTION• Anne Morris (d) Real Estate Company and Agent TODAY'S REALTY/Marianne Kohler Telephone (e) Mail the HAA to the following address: (or check here ®, if hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road/ Suite 204 Eaqle River, Alaska 99577 2. TYPE OF RESIDENCE V Single -Family IA Number of bedrooms 3 3. WATER SUPPLY Individual Well)U Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site IR Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date S & S ENGINEERING 17034 Cagle River Loop Road No, 204 Eagle River, Alaska 99577 Telephone'U�..� d b r� r inear.. a Y; `•� " ObGi"1 A. ShCi2,(' � yam•: �: 'f rqo. 14W44 6. DHHS APPROVAL VZ Approved for S bedrooms by Date Approved Disapproved Conditional Terms of Conditional Approval :25 s,. __` } _:y .fit .rfi_ �)r3i-.t •....�1 s,.. '�` b.�C/A4'\'1,�4�'�}•. �.'1�1 j.. ... s.: - -. q. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 UJ o a MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA)' , Q CHECKLIST - FEBRUARY 1984 Rj p ©' 343-4744 CO Q Z , Legal Description: L-=rT- 1 tAc3zcaan l S1Z> J O 4-14 A. WELL-bA Well Classification 'r-Mr>iVic>1 10V— If A, B, C, D.E.C. Approved (Y/N) —4Ar_ Well Log Present (Y)S) M Date Completed q1Yield 4,0 La?M Total Depth- a Cased to Depth of Grouting Ca - 3-010) Static Water Level \Z Pump Set At Za` Casing Height Above Ground `Zw Sanitary Seal on Casing 0) y Electrical Wiring in Conduit ON) V Depression Around Wellhead (Y Vt p tJ SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot lb&:�' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot �b� ; On Adjoining Lots I00�� To Nearest Public Sewer Line I` � To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 25 Water Sample Collected by c S��'� �lv ; Date S-3'�1 U Water Sample Test Results SA�'�SF 'car lam, 1T6Zv-� Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size 1000 No. of Compartments Standpipest)N) yr Air -tight Caps(ON) V Foundation Cleanout (YO t4 Depression over Tank (Y& N Date Last Pumped 8-25-�jo ')h Pumping/Maintenance Contact on File (Y/N) P4 It,- ; for Holding Tank High -Water Alarm (Y/N) liar Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 10'_..' -I' To Building Foundation To Property Line o To Disposal Field To Water Main/Service Line IC) To Stream, Pond, Lake or Major Drainage Course I0C) Comments 72-026 (Rev. 7/88) Front Page 1 of 2 51 13- k i- C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata�Type of System Design Date Installed `� Z1� �� Length of Field '4.c3` Width of Field �Depth of Field LO Gravel Bed Thickness Square Feet of Absortion Area Statndpipes Present &N) J Depression over Field (YA9 Date of Last Adequacy Test �'3 `� a Results of Last Adequacy Test F�-z= 2` SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well lOa "4 - To Property Line V'=� % + To Building Foundation lo' To Existing or Abandoned System on Lot I/,- ; On Adjoining Lots k 4 - To Water Main/Service Line to 14- To Cutback (if present) f--)1� To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 3a� Comments D. LIFT STATION Date Installed Ions "Pump On" Level at_� High Water Alarm Level at — Tested for Meets MOA Electrical Codes Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level ent (Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" \ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.�r„',ti 5 & S ENGINEERING Signed!!/=034 Eagle {.Iver -Loop Road No 2104 Company �agla River, Alaska 99577 Date MOA No. Receipt No. e;2;)-'I7cl Date of Payment o � Amount: $ /� D Receipt No r` n No. tti4�7•Ss " '=vim a ° t4Y�: Waiver Fee: $ Date of Payment 72-026 (Rev. viae) Back Page 2 of 2 , GEOLOGICAL LABORATORIES- . F ALASKA, � INC.. fELEPHONE(907) 582.2343 5833 B4 rest $ 5 s Anchorage, ska 98518 y o 8 r We AnalysisReport for Total-CoIfform Bacteria TO BE COMPL BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D#i PRIVATE WATER..SYSTEM �� ing4 2q7 � Name Phone No. o,a S & S ENGINEERING } Mailing A9944 Eagle River LooP,RWd �� 204Eagle River, Alaska 99577 1 Ctly State Zip Code SAMPLE DATE: ® © c O Mo. Day Year SAMPLE TYPE: F�!(— Routine ❑ Check Sample (for routine sample with lab ref. no. ❑Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE NO. LOCATION "'_;. Time Collected Collected By 1 RL -5 2 3 4 L 5 READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TO` E COMPLETED BY LABORATORY 11—Anal is shows this Water SAMPLE to be: Satisfactory ❑ ljnsatisfactory ElSI ample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Timb Received Analytical Method: Membrane Filter ii® ' 3No. of colonies/100 ml. Lab Ref. No. Result* Analyst 90.3413 M U m U M L ----i m BACTERIOLOGICAL WATER ANALYSIS RECORD M Membrane Filter. Direct Count ColifonnHoo mi Verification: LTB BGB Final Membrane Filter Results q Coliform1100 ml Reported B Date Time: a.m. p.m. TNTC = Too Numberous To Count OB = Other Bacteria r CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET E ANCHORAGE, ALASKA 99518 - TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 Client Sample ID:L1 MORGAN S/D PWSID :UA Collected SEP 3 90 @ 10:15 his. Received SEP 4 90 @ 14:00 bra. Preserved with :AS REQUIRED ANALYSIS REPORT BY SAMPLE for Work Order 1 27007 Date Report Printed: SEP 10 90 @ 14:01 Client Name : S & S ENGINEERING Client Acct : SNSENGP P.0.1 NONE RECEIVED Req 1 Ordered By : R. SHAPER OF.\NOFVfry�F � rS�� o O R i i -0O J T 6.i s 25 G Analysis Completed :SEP 5 90 Send Reports to: Laboratory Superviso/r :S�TEP�HEN C. EDE 1)S & S ENGINEERING Released By �Typ,(� C �� 2} ................................................................................................................................... Special Instruct: Chamlab Ref 1: 903413 Lab Smpl ID: 3 Parameter Tested NITRATE -N Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RLS. Matrix: WATER Result Units ------------------------- 0.29 mg/l Allowable Method Limits -------------------------------- EPA 353.2 10 ...................................................................................................... 1 Tests Performed See Special Instructions Above UA -Unavailable ND. None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than Ip, I o', n I �l- ORAGE _ C/ 5. LEGAL DESCRIPTION MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF A CH DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEbFIf).1bf HEA TH & 825 LStreet -Anchorage, Alaska 99501 ENVIRONMENTAL P,OTECTION • ENVIRONMENTAL ENGINEERING DIVISION OC+�� 1978 Telephone 264.4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AN[J EE E� VCE&IES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER � �Gf" P✓U PHONE GAO �' J s�% � MAILING ADDRESS /�� a�X S74 ley �i4 ��� ' PROPERTY RESIDENT (If different from above) PHONE --r-4 C' 3K'73 2. BUYER PHONE 7 4NG ADDRESS eOX 42 4�2 ,—:�r 7 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT ' PHONE i` IM 126 1( MAILING AODRESS / C/ 5. LEGAL DESCRIPTION VIASTREET LOCATION 17 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY K'' Three ❑ Six 7. WATER SUPPLY `j41 INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM **If V1 INDIVIDUAL/ON-SITE** individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-01 U ("3/78) &- �Lx � I /Sv) 45 - i i7 &0-11�)1G� I e' -A0 � lt� �c-rmr� i'/�c�J' �A6d_j_0tPts` -) 'D JS �SD �Ly� cn n,pr61nG�(= �r�Lc�ilco Y L"h"D THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE - INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OFRESIDENCENUMBER ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLICUTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) E&- DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78)