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POTTER HEIGHTS BLK 2 LT 1
Municipality of Anchorage Page / of ,DEPARTMENT OF HEALTH AND HUMAN SERVICES :. ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: -LLLbC't'Jic~(z::~Lo PID Number: ~._~c-~.('~ ~ ~ N~: ~H N~ 5 ~ ¢ P P ~ ~D Wastewater System: D New ~ Upgrade Address: ABSORPTION FIELD Phone: No. o~edrooms: ~ Deep Trench D Shallow Trench ~ Bed ~Mound ~ Other LEGAL DESCRIPTION so,, Rati~g.~ Total Depth from original grade: GPD/Sq. Ft. ~ ~ Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: Range: Section: Fill added above original grade: Gravel length: ~.5 - ~ Ft.I ~O Ft. WELL: ~ New ~ Upgrade Gravelwidth: Numberoflines: Distance ~etween lines: I 5 ~t. ~ 3 5 Classification (Private, A,8,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. ~ ~ ~ SQ. Ft. ~ Driller: Date Drilled: Static Water Level: Installer: Date installed: Yield: GPM Pump Set at: Ft. Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~Septic D Holding B S.T.E.P. TO Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Slalion Tank Sewer Lines ~ ~ ~( ~ , / O ~ O Material: Number of Compartments: Well ~O ) / / ~ - ~ S T( ( ~ s~f~c~ - - LIFT STATION Water ~ ~ Lot / _ Size in gallons: Manufacturer: Line ~ ~ ~' ~ / ~ ~ __ "Pump on" level al: I "Pump off" level at: High water alarm at: Foundation / I CurtainDrain ~ ~ _ ~ _ Pump Ma~e & Model Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: I Assumed Erevatiom ENGINEER'S SEAL ~,. . Inspections performed by:. Dates: 1st 2-/~-5¢ ~.~Z4~T"'o ; -"-' ' Department of Health ~Huma~vices approval ~¢':~"'~ ~;'-:;,' Reviewed and approved by: ¢ Date: *( 72-013 {Rev. 9/91) MOA 25 P~rmif No. Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, AK 99519-6650' Tel: 343-4744 On-Site Wastewater Disposal System/Well Inspection Legal Description: LOT 1 BLOCK 2 POTTER HEIGHTS SUBD. PID No. Page',)- of W.O. 95001 Date ~ Report PO~.E AT NOR'I~ET CORNER NAiL IN EAST SIDE ASSUMED ELEV=--95.14 UNSUBDIVIDEI~ LOT 2 PROPERTY UNE OFFSET CLF~NOgTS 'PJB£ S~E~ (600SF) (Tm) EXISilNG 1REE (TYP.) ~-.0' PERF PVC ('PIP) W/ 3/16" HOLES t.O" SOUD P"..~ TANK c z LOT 1 BLOCK 2 PO{i~R HEIGHTS SUBD. SCALE: 1" = 30' GREGORY M. PUINAM CE 7892 Per~if No, Ml~nieipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ° Anchorage, AK 99519-6650 ° Tel: 343-4744 On-Site Wastewater Disposal System/Well Inspection Legol Descripfion: LOT 1 BLOCK 2 POTTER HEIGHTS SUBD. PID No. Page__of__ W.O. 93001 Dale ~ Report XIST. GRADE --2" DOW HI-50 INSULATION OR APPROVED EQUAL. SEE NOTE 12 OEOTEXTILE FABRIC. SEE NOTE 1,3 2'-6" MIN. COVER (2'-0" MIN. AFTER SETTLMENT) SEE NOTE 15 4" MONITOR 104.85 1000 GAL TANK 104.15 LT 104.25 CENT /104.15 LT 104.25 CENT RT .,.:..:'-.:..-..-:?- .. ,.. ~..... :,~-..,:' · ~ ;. ,..-'.? :. .... : '...~ :'"i.=.,.....,.:,:.L.:..,.:,:., SEWER ROCK PER MUNICIPAL SPECS. SEE NOTE 10 ELEV. 99.4' 4.0' PERF, PVC @ 5' O.C.(TYP) SEE NOTE 9 (~ TYPICAL SECTION HOR: 1" = 10' VERT: 1" = ,5' PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON~SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW940166 DESIGN ENGINEER:LANTECH OWNER NAME:SHEPPARD JOHN J JR & OWNER ADDRESS:7041 POTTER HEIGHTS DR. ANCHORAGE, AK 99516 DATE ISSUED: 6/02/94 EXPIRATION DATE: 6/02/95 PARCEL ID:02028134 LEGAL DESCRIPTION: POTTER HEIGHTS BLK 2 LT 1 LOT SIZE: 45671 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DURING CONSTRUCTION OF THE BED, IT MUST BE CONFIRMED THAT A MINIMUM OF 2.0 FEET OF UNSATURATED INSITU ACCEPTING SOIL EXISTS THROUGHOUT THE BES~,,L BED~AREA. BY: Permit Nql Municipality of Anchorage Department of Health and Human Services P.0. Box 196650' Anchorage, AK 99~19-6650 ~ Tel: 34~-4744 Page W.O. 93001 Dafe 11-15-93 On-Sike Wastewater Disposal SysLem/lqell Inspection Report Legal Description: LOT I BLOCK 2 POTTER HEIGHTS SUBD. PID No. PO~FER POLE AT NORTVE~T CORNER UKSUBDIVIDED NAIL IN EAST SIDE ASSUMED ELEV=96.14 t0' PROPERTY i / ~ k~t /~ /' Vel ~/ t SYSTEM (846SF) ~ / / / /~/ ~ ~ ~/ ~ MAY BE REUSED SUBdECT TO VISUAL LOT 2 PlPff ELEVATION Or ~05.3 AT CLEANOUT LOCATION /J / / / / / ~ ~ ~ ~ ~ , RROViDE 2" RiDGiD iNSULA~ON 5UBD. Permit Nb'. Municipality of Anchorage ~el'VlOe~ ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 ° Anchorage, AK 99519-6650 ° Tel: 343-4744 0n-Site Wastcwatcr Disposal System/Well Inspection _egal Descr.?ion: LOT 1 BLOCK 2 POTTER HEIGHTS SUBD. PlO No. Page % of ~ _ W.O. 95001 Date 11-15-95 Report 2" DOW HI 50 INSULATION OR APPROVED EQUAL. SEE NOTE 12 GEOTEXTiLE FABRIC. SEE NOTE 1.5 / / /2'-6' MIN. COVER (2'-0" MIN. / / /AFTER SETTLMENT) SEE NOTE 15 /// ~ i ' X' ~' ~: ~ ; ~ ~ : ~'~' ~-'~' ELEV. 99,4 ~ INVERT ~ 104.7' ~SAND F~LTER PER MUNICIPAL SPECS S~E NOTE 9 (~ TYPICAL SECTION HOR: 1" = 10' VERT: 1" = 5' :. Permif No. On.--Si{ e Municipaii(y of AnchoPage DepaPLi~icil[ o[ Heal[Ii aiid H'uma~ SePvices ~T~TT~NTI~FITNTq~&l Q~9~TF'~Q T/TU}'~T~NT Wastewate~' Disposal Sysle~x~/WelI I~:xspeclion LOT I BLOCK '~e POTTER HEIGHTS PID No. W.O. 95001 Date 11-15-93 Repor'L i !2 i3 i4 ~5 NOTE, i~ ;HE !.~ iici?,z C,. iE AT ~JRRFNTL Ai,.,iEi;D~D c~,~ ','i:; %~/:Pi, S',iR'.F, ,_,2,~?UCTEq ON :i !2 9% q,'i.CTi,.~ STRLJSFURES, W~LLS, %EPIC ::; ELt~ ZBSEF.'E~ /,uTmi 2~C FT OF PROPOSED SrSTEL,'. SiTE ARE '!-,HCWN C)i~ DE%iCh! DRAWING% :_C,:DERGr{OLI!'.'[) BTq!TiFS, DNOPFRT'! ;:i',cc, E'dSF!N,'2. /'/EL LS, V,,/,FFP WAYS. DRAiN/,CF FACILiTiES, LAKES, ~Oi',D%, A;~D O~HER FACILITIES REQUIRliIC PROPOSED SE:~i;C SYSTEM i~,',T~ 1HE EiqCiNEFR O~ ai~ OBSLRVED 'q I ~' .... ."T* ,2C)N~-'TR:ICTiOi,i A !,Hh!iM',M m,F THREE THE E!i~ :iEE~; FLE;Eu. ~HE ELl' ":E :2%PLC .. ;;.q %iaA=L SF AFTER Tk'F P~ ,'kC:EL!Ei'~T C,F CF:AVEi, D~STRiBL!ThDi. Tale Fi:&L .~ ,<-, ,~ - ': -~ :,_, =.~ ,,~. ,,~.,cz;':,~ .-,,~"'*> <-~,*,r_.,,, .,:c TIL LOS '2' ! E 5 "dAll;--'L~r~F ~---c Ti~r, , ~ [ !E.&~EST TEilT!i ;:F~," ,c"' ",,,_¢ k4E~F. .... ..... . ZCU?.:Ei;T S~iALL C;C ms~,,U.'ED ' ..... ,¢Fn~ ?~cD F-LA ~ 'qF SF ','E¢ 772-' TO TdF SPECI}IEC DEPTHS. DO i..OT mOk~TAMiFiA]E ROCh 'v'v'lihi i{,,'~Ti',,'E MA~ERi/,' c, OR a,z= i~SU, L~O~r~ BC,'A~'D c~d~,_u BE ~" THICK DOW H ~5 iidSL.itBO/,.R2 .)R ENGNEER ~?PROvTD EOLIAL. rZ~EOrL,xf',LE SHAL; BF h.,I~RA~i ~4OS OR ENG~blEER' APPROVED EQUAL. LAP All '~'~' ~ MIH. ¢Es , uSED ,A,S ~ ,v~l .... ~ FLL SHAt L BE CLLAN ,"qqD FREE O~ ORGANICS, iRASH AND CONSTROC:TiON DEBRIS. SLOPE ,c.'.L FILL MA]ERIAL TO DRAIN AT 2% MIN SLOPE, AHD 5:1 [,/iA>( SLOPE, AND Ii',! SUCH ,~ MANNER THAt PONDIHG AT OR NEAR THE D~tA!N FiElD DOES NOT OCCUR THE F]I~ SHALL BE LEFT AT 6" HIGHER THAN qpn ,/~, T{-~ ALLOW FOR SETTLEMEFH SEED SIJRFACE AFTER COMPLE'IiNG li\ISTA[i &TON AS RER iviUNiC!PAL qPEC% J PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 5"~a,9 )_ /, /3~.T°wnship, Range,secti°n: ) // A,/ /~ 3 a,,,j ~Gd_ ]9' WASGROUND WATER ENCOUNTERED? SLOPE SITE PLAN S IF YES, AT WHAT OL DEPTH? ~, (,~ p E Depth lo Water After, Monitoring? ~ Date: I) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE '~ , ~ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~-' ~ -FT COMMENTS PERFOR.EOB : CERT,FYT.ATTH,STESTWASPERFOR.ED,N / ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ,, EFFECT ON THIS D^TE. D^TE: //~//~/~) ~ .. 72-008 (Rev. 4/85) SENTEC Inc. November 29, 1993 7801 E. 36th Ave. Suite A Anchorage Alaska 99504 Phone (907) 333 6881 Fax (907) 333 1085 Department of Health and Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, AK 99519-6650 RE: Tatom Well and Septic Approval L1 B2 Potter Heights Subd. Sir: Please find the attached application for well and septic adequacy approval along with a design for an upgraded drain-field system for the above property. As is indicated on the adequacy test, the drain field has failed. It is requested that conditional approval be given base on the proposed design subject to further ground water monitoring during June of 1994. This will allow better design information and more favorable weather conditions for installation. If you have any questions, please give me a call. Very truly yours, PROJECT JOB NO. PAGE ' subjEcT ..... BY ~ CK / 0F WELL DRAWDOWN/RECOVERY STAGE DATE DA'rE NOTES: TIME ~TIME DEPTH Q ~O J >SC I ~ G/~D ........ (~IN) (MI,~) , ~)~ ....... ~G~M), , (Q)(~T)=GALi (GAL)., .... (GAL/FT) ~: z / ............ . ...... ~ ~ ~, } g. ~ " ::.:.:.::.:..:.:.:.:.:.:.:. :. :.. :.: :::.:.:.:.:.:..:..: :::::::::::::::::::::::::::::................. ======================================================================================== ', ,''- '""'"' ~';'""?'-?J2""":"-, 7,2.x;¥rX.;2, ' "' ' ''-' - · '. SUeJEOT 8Y ~ CK --", ~ OF~ SEPTIC SYSTEM DRAWDOWN STAGE No'rEs: TIME ATIME DEPTH 'A D GALLONS ABSORBED = (GAL/F'T)(~D) ~,~ / ~ ' · ''' ~ '""'":: '" ' ' · "'-'.' '".' · "'.' .... -I . . .,... ...... .... ........... :::::::::::::::::::::::::::::::::::::::::::: PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P O BOX 196650 825 "L" STREET' ROOM 502j~ ~~-'' ' ' ~'~ 0:> ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW930366 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME~EARSLEY JOE & JAMI OWNER ADDRESS:1326 B ST. #2 ANCHORAGE, AK 99501 DATE ISSUED: 9/15/93 EXPIRATION DATE: 9/15/94 PARCEL ID:02028129 LEGAL DESCRIPTION: POTTER HEIGHTS BLK t LT 4 LOT SIZE: 43560 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL O~VISIONS: c~ DATE: ISSUED BY: · ~/: ./~' /_~'~ il: " V ~ DATE, NOTE, Permit No.' On-Site Legal Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, AK 99519-6650 * Tel: 343-4744 Wastewater Disposal System/Well Inspection Description: LOT 1 BLOCK 2 POTTER HEIGHTS SUBD. PID No. Page__ W.O. Da~e of 9.5001 11-15-9.5 Report AT NOR'i~ET CORNE]~ '~M - NAIL IN EAST SIDE ASSUME/) ELEV=96.14 UNSUBDIVIDED LOT 2 10' PROPERW (WP) {WP) ~JS~N~ mEE (~YP.) 7.25" P~F PVC (WP) W/ 3/~" .OL~S INSPEC~ ~O ~P~VAL BY ~N~ IF E~S~NG LOT 1 BLOCK 2 POTTER HEIGHTS SUBD. SCALE: 1" = 30' CE 7892 Permit No. Muaicipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, AK 99519-6650 * Teh 343-4744 Page__of__ W.O. 93001 Date 11-15-95 On-Site Wastewater Disposal System/Well InspectiOn Report Legal Description: LOT 1 BLOCK 2 POTTER HEIGHTS SUBD. PID No. ~2" DOW HI-30 INSULATION OR APPROVED EQUAL. SEE NOTE 12 , / ~--~GEOT£XTILE FABRIC. SEE NOTE 13 / / /2'-6" MIN. COVER (2'-0" MIN. / / / AFTER SEETLMENT) SEE NOTE 15 /// '----------_~- ~__+___+, .... ~ ............................................ ,~ 1250 GAL i2 .... ~" ...... , ............. ~ '".~:'": :' .~ :~.,-?-~? ~:i.' ~:~ '..'.: ~ ~:d ?~ ' : :" '-':"":.". "-..'.:.:.'. ~':'"-':"- STATION ~[[ [((. :..:..:.k (: c ::;,:.,. ~...:. :{ :,~' ELEV. 99.4'-- ~ 3 q/4" PERF. PVC ~ 5' O.C.(~YP) INVERT = 104.7' CAP ENDS SAND FILTER PER MUNICIPAL SPECS SEE NOTE 9 TYPICAL SECTION rq~.' - HOR: 1" = ~0' , ~.~ v~T: ,": ~' 5;~~ ....... $ ~. % CE 7892 ,~'~'~ DA~ i' ~T Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-$650 343-4744 November 15, 1994 Mr. Joe Earsley 1326 "B" St~.met, #2 Anc~e, AK 99501 Subject: Lt. 4, Blk. 1, Potter Heights Permit #SW930366, Parcel ID #020-281-29 Dear Mr. Earsley: The subject permit, issued Septe~nber 15, 1993 by this office for a single family well and/or on- site wastewater system, has expired as of September 15, 1994. A new permit must be obtained from this office for a well and/or on-site wastewater system NOT installed by the expiration date. If you have drilled the well, a well log must be sent to this office for documentation of the installation and to close the permit. If the on-site wastewater system has been completed and a licensed Professional Engineer has inspected the installation of the on-site wastewater system, the original as-built inspection report must be sent to this office for review, approval and documentation. All inspection reports must be submitted within 30 days of construction completion. When applying for a new permit, the fees are: $320.00 for an on-site wastewater permit; $120.00 for a well permit and $440.00 for a combined on-site wastewater aud well permit. If you have any questions, please call this office at 343-4744. Sincerely, James Cross, P.E. Program Manager On-Site Services JC/kb cc: Thomas Fuglestad, P.E. COMMERCIAL TESTING.& ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Chemlab Ref .-~ :93.5960-~i Client Sample ID :TATOM RESIDENCE Matr ix = WATER R[~Ft)RT of ANALYSIS UI~PER } OTIER CREEI{ ROAD 5633 B STREE~- ANCHORAGE AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :HORN LAND SURVEYING Ordered By :GREG PHTNAM Project Name : Project~ : PWSiD :UA Sample Remarks: ROUTINE SAMPLE COLLECTED BY: GRiEG PUTNAM~ WORK Order :'72890 Report Completed : 11/10/93 C. ollected :11/03/93 @ !4:25 hrso Received : t ~./04/93 @ J, 4~ 20 hrs. Iechn],ca.[ Dlrec'tor~S~EFHEN ~, / QC Allow8ble Ext. Anal Param]eter Results Qua]. Units Method Limits Date Date Init Nitrate---N 1. ! mg/L EPA 353,2./'300,0 i0 11/05 CMR See Special Instructions Al~3ve UA = Unavailable See Sample Reread'ks Above NA = Not Analyzed Undetected, Reported value is the practical quantification limit, LT = Less Tb~n Second~ry dilu'tion~ CT = Greater Than ~SG-~ Member of the SGS Grouo (Soci~t¢ G~n~rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA. COLORADO. UTAH, ~LLINOIS, OHIO. MARYLAND, WEST VIRGINI,~.. WEW JERSEY. SOUTH CAROLINA COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE DEFORE COLLECTING SAMPLE 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 MUST BE COMPLETED BY WATER SUPPLIER .~ Send Results El Send lnvoice TO BE COMPLETED BY LABORATORY Analysis shows this Water SAM?LE to be: Satisfactory [] Unsatisfactory [] Sample over 30 hours old, results may be unreliable [] Sample too long in transit; sample should ,~,~.~b¢~ ' not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. z,p c,,4~ Date Received \\/z~ Time Received Conuct nmle ! ! Analytical Method: ~embrane Filter n MMO-MUG ' : * Number of colonies/100 mi. Lab Ref. No. Resulff Analyst Treated Water Sent to A.D.E.C. ~-~Fbks Jun Untreated Water Client notified of unsatisfactory remits: Phoned Spoke ,aSth Date: . Tim< /~/( Month -- Da)' SAMPLE TYPE: [] · [] SAMPLE LOCATION Routine Repeat Sample (for routine sample with lab ref. no. . ) Special Purpose Time Collected Collected By Pica:: Print Faxed Faxed Comments: BACTERIOLOGICAL WATER ANALYSIS RECORD M2MO-MUG Result: Total Coliform Membrane Filter: Direct Count E. Coli ~ Colonies/lO0 ml Verification: LTB BGB COLIFLRM Fecal Coliform Confirmation Final Membrane FilteiZResults ~ ReportedBy ~ ,/~////¢. ' Date / /,"-% PSTime ColiforndlO0 ml hfs 77~r1'C = Too Numerous 7'0 Count OB = Other Bacteria PART ONE OF TWO: ~J~ Membe~ofmeSGSO,o.p(Soo~a~ REMAINDER TO FOLLOW ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAt ........................ o~noc 1. O~JUln U~,~ULII~,a, MUNICIPALITY OF ANCHORAGE I, DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE · [] UPGRADE !MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS Well Absorption area Dwelling PERMIT NO. _~v DISTANCE TO: /'~...~" ' ~'' /~" I- Z Manufacturer Material ~ ~ No. of compartments Liq. capacity in gallons Inside length Width Liquid depth ,/~:)£) ~) IF HOMEMADE: ~, ,x DISTANCE TO: Well ..z~Z' Dwell.lng PERMIT NO. O ~ <~ Manufacturer Material Liquid capacity in gallons O DISTANCE TO', Well /, ~_~ ~ Foundation , Nearest lot line PERMIT NO. ~' ~ ~ Top of tile to finish grade Material beneath tile Total effective absorpti.on area Cl ,.~, ~.~-' ~,~ inches Length Width Depth PERMIT NO. ~ I- Type of crib Crib diameter Crib depth I Total effective absorption area LU Well Building foundation Nearest lot line co DISTANCE TO: .j Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ~'6'q" .el '4~.,~"~~ / PIPEMATERIALS .~l" &y'..MZ~ z,.~,~J! N...~)-/m,~2.~c~JS, r~ t:*,,,~,l/ :~ SOIL TEST RATING ' ' INSTALLER -~ ~V~ )~/: -~ /~' REMARKS · APPROVED DATE / LEGAL ,,..~; ~. 72-0?3 IRev. 3/78) 4 '~ J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HE,ALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ~EW ~~ ~~ ~' ~/~/ ~- ~7~ ~ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS J Well Absorption area Dwelling PERMIT NO. 2 ~ DISTANCE TO: /~ 0 ' ~ / /~* ~ Z Manufacturer Material No. of com~rtments Liq. capacity in gallons Inside length Width Liquid depth _/~ O0 IF HOME.DE: ~ ~ ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O ~ ~ Manufacturer Material Liquid capacity in gallons D Well Founda~ ~ Nearest lot line PERMIT NO, ~ ~ DISTANCE TO: /~ ~'~') /~' ~ NO. of lin~, Length of each Pine T,ta..~ of I,nes Trench width Distance between lines F ~ ~ Top-of tile t~finish grade Ma~6~-~th tile ~ . Total effective absorption area O ~. ~ ~ inches ~ ~ Type of crib Cfi r Total effective absorption area " DISTANCE TO: Well ~ ~ng ~.~a~, Nearest lot line ~ Class Depth D Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) PIPE MATERIALS f ~' ~),~ ~H A~ ~O~ -- -~, INSTALLER { ~ ~ ', ';' ')' ' CE-1411 , ~:,- . APPROVED DATE LEGAL 72-013 (Rev. 3/78) ) 'L .... MUNICIPALITY OF ANCHORAGE ~. , · DEPARTMENT OF HE,ALTH & ENVIRONMENTAL PROTECTION I ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE I [~] NEW MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS I Well Absorption area Dwelling PERMIT NO, DISTANCE TO: ~/ ~ * /~ ~ ~ ~ Manufacturer Material No, of compartments Liq, capacity in gallons Inside length Width Liquid depth ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O z ~ Manufacturer Material Liquid capacity in gallons ~ Well Foundation Nearest 10t line PERMIT NO, ~ No, of I nes Length of each line Total length of IjBes Trench width Distance between lines ~ -- To~ oftileto finish grade r Material beneath tile ¢~?.j; inches . Total effective absorption area Length _ _:~,.~.. Width Depth PERMIT NO. ~ ~ Type of crib ~ Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER APPROVED DATE LEGAL 72-073 (Rev. 3178) DEF:'ARTME!]',I'I" OF HEALTH AND ENVIRONMENTAL PROTECTION 8F2.5 L. STt:?EET, AI',ICHORAGE, At':: 9950 1 PERM I T NO: DAT~ ISSUED: AF:'F"L I CANT: ADDRESS: CONTACT PHONE:- S50450 HAND WRITTEN C ~?/26/85 BILL AND CHERYl_ TATOM 1744 BEL. LEVUE ANCHORAGE, AK 9 ?~1~ 349-S789 LEGAL DESCRIP: LOT SIZE:: LOT L.O.'[;AT I ON '.' SUBDIVISION: POTTER HEIGHTS SEC"F I ON: :1.4 ]"OWNSH I P: 1.1 Iq 4567 J. (SQ. F-T. OR ACRE:S) PO'TTEF~ HEIGHTS DRIVE .- L.C)T: i BL. OCK: 2 RANGE: 3W I certify that.~ t. I am familiar with the r'equJ~rements [or on-site sewers and wells as set [orth by the Mur~icipality o[ Anchorage (MOA) and the State oF Alaska. 2. I wi].l instaI1 the s~stem in a~copdance with all MOA codes and regu].ations, and in compliance with the design criteria o[ this permit. :3. I will adhePe to all MOA and State oF Alaska Pequirements Cop the set back distances F~om any existing ~ell, wastewatep disposal system or public sewePage syst. em on this.of a~y adja.cent or neaPby IF A LIFT STATION IS !NS]"ALLED IN AN AREA COVE:RED BY MOA BUIL. DING CODES, THEN ('l) AN ELECTRICAL F'ERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUIL. TS WII_L NOT BE APPROVED WI]'NC)UT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAl_ WORK MUST BE DONE BY A LICENSED ELECTRICIAN. AF'F'LICAN]": BII,..L. A~ CHERYL TATOM MUNICIPALITY OF ANCHORAGE Departmental Health and Environmenta~rotection Pouch 6-650, Anchorage, AK 99502 264-4720 Permit No: On-site Sewer/Water Permit HANDWRITTEN Date Issued: Applicant: Address: /_~Z Legal Description: S/D: ~?-7-~--~ Section: Lot Size: Lot Location: Max Bedrooms: Listed below are the options available to you in designing your septic system. Choose the option that best fits your site TRENCH BED/ W DRAIN Depth to pipe bottom(ft.) ~ f~z ' Gravel depth (ft.) ~ Total depth (ft.) /, ~ Gravel width (ft.) ~-f~ ~ / Gravel length (ft.) z/? ~ ~ Tank size (gal.) /~.~ ~-~ Soil rating (sq. fto/br) / z ~ *~ Gravel length 75 feet requires m~ · ,~ {f~!!i~Ui~a~Ve at least tw~ comparm~mlet~tPsle ru~s (~t exceeding 75 feet each) 1o I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage(MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for the maximum number of bedrooms stated above, and any enlargement or modification will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BHILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. App lican't / DATE: ISSUED By: ~~__ ~,~ DATE: SWP/024 rev. 1/85 ~=-7 ~-f Lot: / Block: Township: //~/ Range: MUNICIPALITY OF ANCHORAGE DEPIARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST SOILS LOG [] PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: LoT I i ~'~..o~,Y-. ?_, 1 2 3 4 5 6 7 8 9 10 11 12 13 SLOPE WAS GROUND WATER ENCOUNTERED? 14 15 16 17 18 19, 20- IF YES, AT WHAT DEPTH.) SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT COMMENTS ,.~'r~ ~,..~ /,~?"~.~,~-- ~ ~ ~-2~'~) ~ O~&. ~ ,~ ~~ PERFORMED BY: ~, ~ ~~ CERTIFIED BY: ~*D, ~;LI,~ DATE: 72-008 (6/79) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "U' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST~ '~-I DATE PERFORMED: LEGAL DESCRIPTI£ 1 2 3- 6 7 10 11 12 13 15 16 17 18- 19- (ENGINEER'S~) Township, Range, Section:'7~/[/~v/ ~"~) SLOPE SITE PLAN % 91,.3_,., . it ANCHORAGE & pROI'Ec~tO~ Reading Date Gross Net Depth to Net Time Time Water Drop ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85~ CERTIFY THAT THIS TEST WAS PERFORMED IN (ENGINEER'S SEAL) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PE.PORMED FOR: F'No,''.,/ "/".'¢..~,, / '-t'."~ ~' OATE PE.PORMEO: ~ SLOPE SITE PLAN 13- 14- ~7 18 ENCOUNTERED? S ,EVES, ATWHAT DEPTH? p E Depth to Water ~(tr _ Monitoring? ID~O ?~J~lC, Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ TEST RUN BETWEEN __ (minutes/inch) PERC HOLE DIAMETER __ FT AND __ FT COMMENTS 72-008 (Rev. 4/85) ALASKA ~nUlROgmegTAL COgTROL S~RUtC~$, Inc. J~nciinecrinq § I~nuironmcntal $1ucli¢~ PERCOLATION TEST DATA SHEET CLIENT ,~ve zip CODE TOTA~ ,~T, O~ ,OLE ~. ZONE TESTED Lo-/: i READING # CLOCK TIME NET TIME DEPTH TO NET DROP RATE (min/in) DATUM I1: q/ FINAL PERCOLATION RATE ! (min/in) 1200 UJcst 33rd Aucnu¢. Sui,~'~¢e. Anc-~re§~, Alosb 99503 · (907) 276-1361 ALASKA ~I~UII~OI~m~FIT^L COnTI~OL SERUICES, Inc. 1200 gJest 33r~ ~uenue. Suile B./~nchoroqe, /~[osko 99503-(907) 561-50~0 TO SUBJECT~:~ ~ ~ ~ MEMO date job no. job nameT'..~/,~-J~ 1'~4~t-'J~:~cIE:: from subject c., 'z - ~ copies file [] [] .FI [] name Porath Architects 301 Danner Avenue, Suite 280, Anchorage, AK 99502 (907) 349-8516 1200 West Dimond Blvd #1495 Anchorage~ Alaska 99515 ~907~ 349-6075 [907~ 349-6075 March 17, 1986 SUBJECT: Potter Heights Lot 1 Block 2, Initial Septic Inspection Municipality of Anchorage Department of Health & Environmental Protection 825 L Street Anchorage, Alaska 99501 ATTN: Robbie Robinson Dear Mr Robinson: I am presenting your agency with verfication and/or certification of observations made during the Subject initial septic inspection. On August 10th 1985 an initial septic inspection was accomplished, at my direction~ on the Subject property~ and concerns about the seepage was noted. My field inspector observed no seepage into the excavated bed. My field supervisor/inspector will be available, as well as myself should your agency require further information. Please feel free to contact me at 349-5552 or 349-6075. Sincerely, Robert D Schillfng CE 1411 Field Inspector WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Seologicol 8~ Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either Io~ lb or lc.) A.D.L. No. ,o.llBoro.g, Subdivision Lot Block I~.I I/4qtr$. Section No. TownshiP N['~ Range E['-] Meridian DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3, OWNER OF WELL: Streel Addre .... d Area of Well Location Feet Below 4. WEL~PTH: {final) 5. DATE OF COMPLETI~.~ Material Type Top Bottom Type: : '0. STATIC WATER LEVEL:~ '~ ~. ~ ~ ~. ,, ff: ofl~r h~. ~umping -.'g.p.m- Length of D[op Pi~e ft. capacity g.p.m. ~ : . · . ' : · .. :-"': · . MEMORANDUt¥t DATE: August 12, 1985 TO: Laura Crow, Accounting FROM: Environmental Health Division SUBJECT: Request for Refunds - Account # 2460 Please make arrangements for the following refunds. Most were due to over- payment or should not have even come to this office to begin with. Thank you. Jack White Company 3201 C Street, Suite 100 Anchorage, Alaska 99503 Receipt # 349242 Amount $45°00 Account # 2460 U.S°S #3042 Lot 74 W~ SE¼ - Health authority approval which is a duplex and should have gone to State D.EoCo David Plunkett 200 West 34th Avenue Anchorage, Alaska 99503 Receipt # 347121 Amount $45.00 Account # 2460 Lot 6 Block 2 Lampert Estates Subdivision - Health authority approval which is a multi-family and should have gone to State D.E.C. Billy Go Andrews P.O. Box 100-560 Anchorage, Alaska 99510 Receipt # 341204 Amount $145o00 Account #2460 Lot 9 Block 4 Rockhill Subdivision - Applicant paid for a MOA inspection~ however, had a private engineer perform the necessary installation inspections. Only being charged for the permit fees of $30.00. S & S Engineering SR B 196-X Eagle River, Alaska 99577 Receipt #349351 Amount $45.00 Account # 2460 Lot 2 Sleepy Acres Subdivision - Health authority approval as a conditional this appplication was to remove the conditional approval and should have not been charged a second fee. S & S Engineering SR B 196-X Eagle River, Alaska 99577 Receipt # 346953 Amount $20.00 Account # 2460 Lot 7A Block A Timberlux Subdivision, Permit # 850317 - Applicant was charged for a permit, by mistake, that did not belong to them. Laura Crow - Accounting August 12, ]985 Page Two Marvin Johnson 4300 Arctic Boulevard #46 Anchorage, Alaska 99503 Receipt # 332980 Amount $15o00 Account # 2460 Lot 3B Groll Subdivision - Well permit #850069, applicant obtained a well permit without realizing his engineer(S&S Engineering) had obtained it for him. Bill/Cheryl Tatom 1744 Bellevue Anchorage, Alaska 99515 Receipt #346901 Amount $15.00 Account # 2460 Lot 1 Block 2 Potter Heights Subdivision - Well permit #850283, applicant obtained a duplicate well permit for the same property. He obtained an On-site Sewer/Well Permit on July 26, 1985 (#850450), therefore, this is a duplicate on the well. Laura J. Ward Office Associate LJW cc: Subdivision files attachments -- -'~, MUNICIPALITY OF ANCHORAGE ~ POUCH 6-650 e ANCHORAGE, Al( 99502 o PHONE 264-6400 FINANCE DEPARTMENT CASH RECE,PT NO. 346901 OESCRIPTION Org/CC Acer/Obi Task ~ption Cost Center, WA/WO 6 Amount ( .......... ~ // ----~ ~ t ~ ~ ~/..j / - T~ 40-007 (Rev. 8/78) DISTRIBUTION; White-- Treasury; Yellow-- Customer; Pink-- BookI~ Goldenrod-- Department P.O. '~'"OX 6650 ANCmORA,,¢,~_. ,~LASKA :6~-4, ! '! (907) ~ ' ' TOi'J Y k',~,.',? ;VL ES. DEPARTMENT OF HEALTH & HUMAN SERVICFS January 10, 1986 TO: Permit Applicant Subject: Permit # 850205 Lot 2 BLock 1 Potter Heights Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installstion of the on-site sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation° If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit Municipality of Anchorage ?G Er On -Site Water and Wastewater Program V s (907) 343-7904 S A r E T Certificate of On -Site Systems Approval Parcel I.D. 020-281-34 Expiration Date: 1. GENERAL INFORMATION: Complete legal description POTTER HEIGHTS; BLOCK 2, LOT 1 Location (site address) 7041 Potter Heights Drive*Anchorage 99516 Current Property owner(s) Caryn Rea Day phone 907-229-8972 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ -6-50 Date of PaymentI Z Receipt Number_ COSA# 05C,_-20 12,07 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: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: I "Zz In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic 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 system/s on the date/s 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 upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; theretore—(3tti-makes no warranty (express or implied) regarding the future performance of the well or septic 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 to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. CIGNATURE System #1 Approved for � bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, #AECC884 e_1n&%u%T&ns: with the f>,`ATER AND m r- �G _v hI Cf< Z J m P,R0G6AN4 60; v . B —' Original Certificate Date: y: 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other a rTa_-� Rye Rduis;c y aCApefv LI) COSA Checklist Legal Description: POTTER HEIGHTS; BLOCK 2, LOT 1 Parcel ID: 020-281-34 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA [01 Well log is filed with Onsite (or attached) Date drilled 1111/85 Total depth 248 ft Cased to 244 ft C Sanitary seal is functioning correctly 00 Wires are properly protected Casing height (above ground) 12+ in. Date of f low test for COSA 7/11/21 Static water level at beginning of test 200.2 ft. Comments B. TANK DATA Age of tank(s) 27 years Tank type/tnaterlal .SEP71C,STEE Measured operating fluid level in septic tank 50" iJ Standpipes/foundation cleanout per record drawing Date Of pumping 7/3/21 Well production at time of test 4.4+ 9 p Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L rRArsenic less than PIRL (ND) Collected by GEG, LTD. Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A D. ABSORPTION FIELD DATA BED Which system tested (date installed) 7/14/94 Adequacy test date 7/11/21_ R-81 ALL standpipes present per record drawing Results Q Pass For 3 bedrooms Total measured depth from grade 4.0 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade 2.91 ft (min) Water added 473 gal ❑ N/A — pressurized field 7 New depth in Monitor tubes go to bottom of effective. If not, state 120 depth into effective 10" Elapsed time min p (®] Code -required soil cover over field Final fluid depth 1 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) gallons Gallons introduced N/A If yes, enter date N/A Comments/Deficiencies: 61-4 Lf J2517.7— COSA 251ZZ COSA Checklist yellow sheet 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 Community Sewer Manhole/Cleanout > 100' ✓� Yes if No ft ® Yes if No ft Neighboring Tank > 100' F/ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' [✓ Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No ft M Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓0 Yes if No ft E] Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No *51+ ft Surface Water > 100' Z]✓ Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' M 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) ft ft Building Foundation ? '10' RYes if No * ft If absorption field is under driveway comment below Property Line > 10' r7l Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓[]Yes . if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS *METC_OD_EA_ TIME OF INSTALL, **BASED ON DIMENSIONS OF BED, ITIS REASONABLE TO ASSUME THAT SOUTH-WEST CORNER IS PARTIALLY UNDER DECK. G. ENGINEER'S CERTIFICATION t certify that / 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. �....:.. .. ... , • .....:....,I u�, 'ess• �• CE 7.53 COSA Checklist yellow sheet �� ry A roo� fesstor NAECC884 Arctic Effluent Services, LLC. pnBox 11m92 Ax 995 11 oo +1 9078653249 a/aoka.x,o@omox.00m BILL "TO stevaAbmle 7041 Potter Height Dr. Anchorage, AK 99516 USA -- ������� ���=���� ��0=��-���D� $ |mvQ|oE A1033 oXre 05/25/2022 TERMS Net 30 DUE DATE 06/24/2022 DATE - DESCRIPTION` QTY RATE ` AMOUNT - � 05/25/2022 Cameroinnpeoton Camera Inspection of2leach field 1 300l0 300.00 pipes for septic system closet to house and under deck b,verify nnpiling penetrations through leach filed piping. ------------------------------------------`--`----`------------------`--`-------' mv/mEffluent Semmsmammyou rmouppounovow ,Local Alaska etjs/ess� PAY M,ENT 300l0 'A/plook mmammu,nmxr"u,n�auom,rau�mmms, BALANCE DUE $0.00 PAID DEVELOPMENT SERVICES DEPARTMENT , On -Site Water and Wastewater Section www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 221207 Subdivision: Potter Heights Block 2 lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSH / property is 1.48 years old A leaking septic tank may be a source of contamination to the aquifer. 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N N %.DD .. .. _ ULa0.. ys y C C C U QLou nG �L CLW d Q N N< Ln _ (L< O W L7)c:tALu O O v, _ o M O I aw Ju t7 ce)n- opq�0� LLwy =0 W �i o m wm m z ►--� W F Iz r' uj a map 3v 4Y� J MCS o�O z ELL z O Q !f C� g QZO�I .-0 F- CL � egoco ° ° ° �QZell ©0 W Q o�W� Q z s w O -� · ~ue~sXs jo sneers pue Xflle6~I ~q~ o~ 030V ~ Luog uofleuJgluoo u~H~4 ~p!Ao~d '~S/fs Ja~e/~SeM X~!unu~uoo ~1 :=liON Je~es o!lqnd e3!s-uo X~!unwwoo ~t ue), 8u!PlOH e~!s-uo lenp!A!pUl :-IVSOdSIQ I:I~.LVM;LLSYM dO ~dAJ. · u~alsA's jo snie~s pue Xl!lel3aI aq~ o~ [~u! -~sa,l~e 030V a~elS uJo.~] uo!~euJJ!juoo ual~!J~ ep!AOJd 'LUalS/fS Ila/~ /g!unLu~uoo ]1 'S '~ /¢' ~. --¢ ?Z euoqdXeQ euoqd X~a O..O '..L. ~c/O ~ O/-./~/..~' /5-~c '-C// ..~o ~ 'O'c/' sse~ppv sse~ppe 6u!I!~IAI Xoua6e §uipue-1 sse~ppe 8U!l!elAl Jeu~o XpedOJd (suoj~oeJ!p Jo sseJppe e~!s) uo!JeoO-I Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ,/, / ~ 2. PO~'Td~"~ I-)& /¢~ /-/7-5 ~Parcel I.D. A, Well Data Well type ?,< / vAr~_ Log present (Y/N) Total depth Sanitary seal (Y/N) ~ .~'if A, B, or C, attach ADEC letter. ADEC water system number ~/d) Date completed Driller Cased to Casing height ~ ~ 5 Wires properly protected (Y/N) C~ ~ FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ) ~- 7 ! Absorption field on lot / 3 ? ' Public sewer main Sewer service line .g.p.m. AT INSPECTION J RECEIVED g.p.m. D~O I ~ Munic;p~iity o~ Anchorage Dept, Health & Human Services ; On adjacent lots .; On adjacent lots Public sewer manhole/cleanout Petroleum tank /,/.~,~ WATER SAMPLE RESULTS: Coliform Date of sample: /// B, SEPTIC/HOLDING TANK DATA Date installed / Cleanouts (Y/N) High water alarm (Y/N) /k(' O Date of pumping Nitrate m'~//,~ Other bacteria Collected by: Tank size )000 ~j,~ ,L, Compartments Foundation cleanout (WN) ~-~3 ~:~ 5, Depression (Y/N) Alarm tested (Y/N) / '~//~.//% ~ Pumper r''~O ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: / / Well(s) on lot /,,~2, '~ On adjacent lots To property line ~/' ' Absorption field .! Surface water/drainage Foundation ~ ~) Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE LOCATION'OF WELL STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD BOROUGH SUBDIVISION I LOT BLOCK SECTION QTRS SECTION 'TOWNSHIP J RANGE.I []s MERIDIAN LOCATION/SKETCH: . · DEPTHS MEASURED FROM:[-Icasing top r-lground surface BOREHOLE DATA: Depth Material Type and Color From To WELL OWNER: WELL DEPTH: Depth of hole: -?,:> '? Depth of casing: / DATE OF COMPLETION ft [] ground surface DEPTH 3'0 STATIC WATER LEVEL: . ? ~.,/;7 ft below 1~] top of casing Date: METHOD OF DRILLING: .[~ air rotary [] cable tool [] other USE OEWELL: [] domestic [] irrigation [] monitor supply [] other ft. Plato: ./~) in. to//.(') ~Zft WELL INTAKE OPENING TYPE: [] open end [] screened [] perforated ,]~] open hole Depths of openings: to ft SCREEN TYPE: Diam:- in. Slot/Mesh Size: Length: ft GRAVEL PACK TYPE: Depth to top: GROUT TYPE: Volume: Depth: from fL to ft DEVELOPMENT METHOD: Duration: PUMPING LEVEL AND YIELD: ;~? ',~ ft after ~// hfs pumping~<'~.----% gpm PUMP INTAKE DEPTH: ft Horsepower: __ WELL DISINFECTED UPON COMPLETION? [~] YES [] NO CONTRACTOR INFORMATION: Regis~erqfl Busiqess Name Signature of Authorized R~spresentative Date REMARKS: PLEASE MAIL WHITE COPY OF LOGcTO: DNR/DIVISION OF WATER PO BOX 772116 EAGLE RIVER AK 99577-2116 Z. I Uti . ~ 1 .~ Ip i",.~~ ~11~ ~Z., ~ I I~.~ (_/11'/7 ~ Ld ..... ~'~.~% f~ndrew F. Ports ~ SURVEYOr'8 0E~TIFIOATIOB I HEREBY CEnTIFY THAT I HAVE SURVEYED THE PROPERTY DESORIBEO ON THIS PLAT ANO THE IMPROVEMENT8 SITUATED THEREON ARE LOOATED AS SHOWN ON THIS PLAT. LEGEND O LOT CORNERS FOUNDATION DRAINAGE ARROWS NOTES: I. IT SHALL SE THE RESPONSIBILITY OF THE BUILDER OR OWNER TO VERIFY THAT BUILDING LOCATION SHOWN MEETS ALL SUBDIVISION COVENANTS AND ZONING ORDINANCES. ~, IT IS THE RESPONSIBILITY OF THE BUILDER TO VERIFY ALL ELEVATIONS WITH RESPECT TO ALL UTILITIES. $, THIS PLAT REPRESENTS THE PARCEL OF PROPERTY DESCRIBED BELOW TAKEN FROM THE RECORDED PLAT DESCRIBING THAT PARCEL. INSTRUMENTS RECORDED PRIOR TO OR AFTER THE FILING OF THE RECOROED PLAT ARE NOT SHOWN ON THIS PLAT. 4. THE INFORMATION ON THIS PLAT IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS , THE PLAT iS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCES, '"' :P/oPo*~g P~oe PI~n LOT I, bLOCK Z POTTER HEIGHTS .- BESSE, EPPS 8~ POTTS 2220 E. 88th. AVE. ~549-6452 ANCHORAGE, ALASKA 99507 DRAWN BY~ C-C CHK, BY ~ FLD. BK., 549-6454 [ S CALE~ I";' DATE, IDWG. NO. ~'~=/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 .~ '"' GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name Z~'/4/. '2'-,,,¢,-~/-'l Telephone: Home ~ Business Applicant Address /7~'? ,~ ~4.~W~ J'Jc/uc..f-~IZt'f~..~= ~ (c) Applicant is (check one): Lending Institution []; Owner/builder J~; Buyer []; Other [] (explain); (d) Lending Institution ,z~/~ ~y~ ~' Address ~/~ (e) Real Estate Company and Agent ~ ' Address Telephone (f) TYPE OF RESIDENCE Single-Family'[ Multi-Family [] Other Number of Bedrooms ~ WATER SUPPLY Individual Well ~¢' Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 SEWAGE DISPOSAL Onsite ~, Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting [o the legality and status. 72-025 (11/84) ENGINEERING FIRM PROVIDe_ ~ INSPECTIONS, TESTS, FILE SEARCH, I;~.~/A AND INFORMATION ~ ~,s certified by my seal affixed hereto and as of the validation date shown below, I verify th at 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 fifes 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 ~.c~/'~/i,,~ ~'~ ~~ Telephone ~-Z/~/ ~ ~3 Address ~o~ ~1~ t3~ ~ ~"~ ~ ~°3 Date ~ -/~ ~ Engineer's Seal DHEP APPROVAL Approved for '~"'~"~' bedrooms by Approved / Disapproved Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a c~rtificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 01/84) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MO~ 8NVI~ON/vIIiNTAL PI~OTE~TIoN HEALTH AUTHORITY APPROVAL (NAA) ~4~ 0(~ ~' CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~ Well Classification ,/'~./~ / ~Aur~'- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) "( Date Completed "?--/?~' ~ Yield Total Depth ~ Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Welt: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot .,/~, -~ t Depth of Grouting ~ - Pump Set At 'Z-"r'~ ~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots ~..¢~..~ To Nearest Public Sewer Line ,,4,/~,~ To Nearest Public Sewer Cleanout/Manhole ////./4 To Nearest Sewer Service Line on Lot , Water Sample Collected by ,,~', Z~. ~:::~¢o~/.,',~.~ ; Date .~- 4-,~ ,/-- Water Sample Test Results Y Comments B. ~OLDING TANK DATA Date Installed ~ Size ~ No. of Compartments Standpipes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~./,~ Separation Distances fro~Holding Tank: To Water-Supply Well .)~0 / To Property Line /'~ ! To Water Main/Service Line /b/~ Course .A/./..~- Foundation Cleanout (Y/N) Date Last Pumped .X)~.~ · for Temporary Holding Tank Permit (Y/N) To Building Foundation ,,/,~'" To Disposal Field 7 / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ./¢ -~ / To Building Foundation ~-.~' / Type of System Design Length of Field /__~/ t Depth of Field ;~o 5' ! Gravel Bed Thickness ,/ / Standpipes Present (Y/N) Date of Last Adequacy Test Lot ../M.~'.4¢ TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area ~./..~ (~Z~t ~,~ ~/f',t.l~"'¢~.~ ~,.~ ,,~O~') Comments LIFT STATION ,,,~)//~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** 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. Date ~-/,~,~ ..~'" MOA No, Signed~ c o m pa n Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal