HomeMy WebLinkAboutPROSPECT HEIGHTS BLK 1 LT 11—j–V H0,-- 51Z112-13
2.13
Municipality, of Anchorage
Community Development Department Page 1 of 3
On -Site Water & Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191027 PID Number. 015-091-02 ❑ New M Upgrade
Name:
KATHERINE SARBER
ABSORPTION FIELD
❑ Deep Trench Z Shallow Trench ❑ Bed ❑ Mound
Address:
9901 PROSPECT DRIVE *ANCHORAGE, AK
❑ Other
Phone: No. of Bedrooms:
Soil Rating:
Total Depth from original grade:
(907) 230-0091 5
3 GPD/Sq.FL
2.5 FL
LEGAL DESCRIPTION
Depth to pipe invert from original gmde:
Gravel depth beneath pipe:
SEE DWG. FL
0.5 FL
Fill added above original grade:
Gravel length:
Subdivision: Block: Lot:
PROSPECT HEIGHTS 1 11
SEE DWG.
50
FL
FL
owns Ip: anger ec on:
Gmvel width:
Beds Number of lines:
Distance between lines:
5 Ft.
—
_ FL
SEPARATION
DISTANCES
Total absorption area:
250+
Number of trenches:
1
DISL between trenches:
_
To
Septic
Absorption
Lift
Holding
PublIc/Pdvate
From
Tank
Field
Station
Tank
Sewer Unes
so. FL
FL
Well
'50'+
'50'+
`50'+
25'+
TANK m Septic ❑ S.T.E.P. ❑Holding ❑ Other
Manufacturer.
Capacity.
Surface Water
•501+
`50'+
'50'+
INFILTRATOR
1530
Gal.
Lot Line
5'+
10'+
5'+
-
N/A
Material:
Numberof compartments:
HDPE
2
LIFT STATION
Foundation
101+
10'+
101+
-
Curtain Drain
NONE KNOWN
Manufacturer. capaclty.
INFILTRATOR
1060 Gal.
'Pump on' level at
TIMER I
'Pump of level at
TIMER
Highwater alarm at
44"
Remarks: *CAT II ADVANCED TREATMENT. TOP OF TANK AND BOTTOM
OF TRENCH INSPECTED BY MOA ONSITE EMPLOYEE TIM ECKLUND
Pump Make & Model:
Electrical Inspoctions performed by:
GOULDS PE51M
MOA
PIPE MATERIAL D30341
Tank to SCH. 40 PVC 1785/
House to tank EXISTING/D3034 Tank
kold SCH. 40 PVC 2665
drain
Installer
WILCO EXCAVATION
Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd.
BENCH MARK (Assumed elevation)
102.94 FL
Inspection
Location and Description:
Dates: 1 St 2/11/2019 2nd 2/11/2019
3rd 2/11/2019 4th 2/13/2019
TOP OF MANHOLE (MH) LID
Community Development Department Approval
ENGooINEERF
p
_ 4
Conditional approval: Date:
�o�Q� ' po
,�....... ........
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e/y'\"A.. Gar.. ess.:
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pp Dater
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04 Profess', -=1
LICENSE
#AECC884
Inspecgon Report _7-1-12doe
PERMIT NUMBER:
OSP191027
/ NEW 1060
SINGLE -COMPARTMENT
INFILTRATOR PUMP
TANK WITH QUANICS
PUMPS AND CONTROLS -
NEW 1530
2 -COMPARTMENT
INFILTRATOR
SEPTIC TANK -
m
sf�
. f _a
;!• NEW
A B
C01 97.9 75.8
STI 137.9 119.7
ST2 '132.7 116.5
MH1 124.7 111.9
VP1 110.7 98.9
PODI 107.7 97.1
PGD2 105.6 96.2
VP2 104.0 95.8
FD 103.9 97.0
CO2 118.8 114.0
MT1 120.6 116.1
CO3 111.9 122.9
MT2 109.8 121.0
C04 101.6 95.7
SUMP 1 64.5 1104.6
PARCEL ID NUMBER:
015-091-02
NOTE: SWING -TIES WERE GENERATED BY
SCALING DISTANCE FROM AN AUTOCAD
DRAWING OF SURVEYED PERFORMED BY
FRED WALATKA & ASSOCIATES, LLC
i
l �F<<R9� %
r /
/ EXISTING
WELL
I r
I soyp I 50' WELL RADIUS
FOR ADVANCED
j TREATMENTSYSTEM
I 1
1 �O
1 \
\\
\ OLD DRAINFIELD �\ i
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\\\\\ OJ
NSTALLED FLOW
DIRECTOR (FD)
NEW QUANICS ATS -8 -AC \ g
AEROCELL UNITS
1i11i1' j1'lIn 11,
All��'111111��
/1''����1.
AS EIV'UP,Ltd
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ENGINEERING �vSALES,,CONSULTING au.mvm-a_
3701 E TUDOR ROM, SURE 101 'ANCHORAGE, A1C 99507 • PHONE (907) 337-6179 - FAX {9071338-3246'WEBSITE-
PREPARED
WEBSITE
PREPARED FOR:
KATE SARBER
PHONE NUMBER:
230-0091
LEGAL DESCRIPTION:
PROSPECT HEIGHTS S/D; BLOCK 1, LOT 11
OF WORK:
RECORD DRAWING OF SEPTIC SYSTEM UPGRADE
PAGE NUMBER:
2OF3
DRAWN BY:
J.L.M.
DATE:
4/10/2019
\
t
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1' = 40'
tnt
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ASSUMED ROUTE OF
SEWER SERVICE LINE
:i
..Y 4
PARCEL ID NUMBER:
015-091-02
NOTE: SWING -TIES WERE GENERATED BY
SCALING DISTANCE FROM AN AUTOCAD
DRAWING OF SURVEYED PERFORMED BY
FRED WALATKA & ASSOCIATES, LLC
i
l �F<<R9� %
r /
/ EXISTING
WELL
I r
I soyp I 50' WELL RADIUS
FOR ADVANCED
j TREATMENTSYSTEM
I 1
1 �O
1 \
\\
\ OLD DRAINFIELD �\ i
U
\\\\\ OJ
NSTALLED FLOW
DIRECTOR (FD)
NEW QUANICS ATS -8 -AC \ g
AEROCELL UNITS
1i11i1' j1'lIn 11,
All��'111111��
/1''����1.
AS EIV'UP,Ltd
- u ..-v -- • a
ENGINEERING �vSALES,,CONSULTING au.mvm-a_
3701 E TUDOR ROM, SURE 101 'ANCHORAGE, A1C 99507 • PHONE (907) 337-6179 - FAX {9071338-3246'WEBSITE-
PREPARED
WEBSITE
PREPARED FOR:
KATE SARBER
PHONE NUMBER:
230-0091
LEGAL DESCRIPTION:
PROSPECT HEIGHTS S/D; BLOCK 1, LOT 11
OF WORK:
RECORD DRAWING OF SEPTIC SYSTEM UPGRADE
PAGE NUMBER:
2OF3
DRAWN BY:
J.L.M.
DATE:
4/10/2019
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PREPARED FOR:
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KATHERINE SARBER
PHONE NUMBER:
ARNESS
ENGINEERING
GROUP,
Ltd 230-0091
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: Y ENGINEERING, SALES-,
]1ETUDOR RQAB.SUIE 10t-AYGHOPAG, H B5T•PH.NE (WI
LEGAL DESCRIPTION:
CONSLILTING PAGE NUMBER:
3]id119•FA%(LpT)>��a6 4YFD9TEwvm.panesavy ,np mr 30F3
11
DRAWN BY:
J.L.M.
_ :'
F PROSPECT HEIGHTS SID; BLOCK 1, LOT
�1j :....• v
+'t1
TMP OF WORI(Q
DATE:
aa+++'•
ieE
RECORD OF
CAT. II AEROCELL SYSTEM
AND DRAINFIELD
4/1012019
Permit Number: OSPI91027
Work Type. Septic Renewal
Tax Code Number: 01509102000
Site Legal Address. PROSPECT HEIGHTS BLK 1 LT I I G:2441
Site Mailing Address: 9901 PROSPECT DR, Anchorage
Owner: SARBER KATHERINE E & STEVE M
Design Engineer RN SS ENGINEERING GROUP LTD
This permit Is for the construction of:
0 Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy
3ELM
All construction shall be in accordance with:
1 The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (1 BAAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417),
W*cs, dace: i0ilb-Zab&O-r"A on- syste m -u nder-constru ction, & riribkoziLgisivae at her
shall be either:
a. Opened and Closed on the same day, or
overed, seated, and heated to prevent freezing
Special Provisions: The proposed 1530 gallon Infiltrator tank (settling tank) shall be two compartment, not v
single compartment as shown on the tank diagram.
�) 111;1
Date:fr
Date:
W
MUMURAUTY OF ZZ�HCHORA GE
Development Services Department kms, Phone: 907-343-7904
On -Site Water & Wastewater Section - Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 015-091-02
Property owner(s) KATE SARBER Day phone 230-0091
Mailing address 9901 PROSPECT DRIVE *ANCHORAGE, AK 99516
Site address 9901 PROSPECT DRIVE *ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) PROSPECT HEIGHTS; BLOCK 1, LOT 11
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field Fx_1 Initial ❑
Single Family (SF) 0
(w/wo ADU)
Septic Tank El Upgrade ED
Duplex (D) ElHolding
Tank El Renewal
Renewal x
Multiple Dwellings ❑
Privy ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
SEE OSP171000
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: � NG -f
Date of Payment: '9ya/lg
Receipt Numberr� o6yvC�
Permit No.
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Quafflics
GARN ESS 1ENGINEEWIN G GII O U P9 Ltd Advanced TMIa[mcnt�Sys«.m.
ENGINEERING - SALES CONSULTING p
February 6, 2019
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic System Upgrade for Prospect Heights; Block 1, Lot 11
To whom it may concern:
The permit for the subject lot was issued in January of 2017. Per conversations with the owner,
she would like to proceed with the install. We are proposing to install the septic system as
designed in 2017, with one minor change. The initial design proposed a single compartment
1530 septic tank, we would like to change that to a two-compartment infiltrator septic tank. We
are requesting that your department re -issue the permit for the subject lot with the special
provision that the 1530 infiltrator tank be two-compartment.
We are unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If you have any questions, please contact us at 337-6179. Thank you for your
assistance. f A
Sincerely,
Jeffreykl'. Gambs.s, R.E., M.S.
Prdside�nt/
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
By: (signature) Date: /
(print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this day of - ='Lts� U
20L4, by �Y�ii SAA a /�
Nb,tARY PUBLIC FOR ALASKA 0 / 8 Notary Public
My Commission expires: /��� 3 , JEAN L. STANLEY
State Of Alaska
Emy
ommission Expires May 3, 2018
MUNICIPALITY:
By: �„` �,(� t� C>�it9U ( (signature) Date: C7 a a 7
R�� cC,(k ar rp �� (print name) Title:
'/~UNICIPALITY OF ANCHOtLAGE
HeaZ i and Environmental Protec
Fourth Floor West
825 L Street
Anchorage, Alaska 99501
279-2511, x 224, 225
LOCAl-ION d Br"LEOALDESC, IPT,ONI-'_+' II Bk .!
INSPECTION REPORT ONLSITE ,SEWAGE DISPOSAL SYSTEM
SEPTIC TANK:
DISTANCE f
NUMBER OF
COMPARTMENTS
INSIDE LENGTH ~ INSIDE WIDTH
LIQUID DEPTH
LIQUID C A PAC I T¥ ~.~GA L LON 5.
DISTANCE FROM WELL //(-~"/FOUNDATION
ABSORPTION AREA___W® SQ. FT. LENGTH OF EACH LINE
DEPTIt: TOP OF TILE l'O FINISH GRADE /g ~ I DEPTH OF FILTER
NEAREST LOT ,¢¢"( ge' G~(~ /
LINE_ ,,,,.).'/.~_ TOTAL LENGTH
OF LINE
TOTAL EFFECTIVE
MATERIAL BENEAT:~q_TILE__3O IN. ABOVE TILE 7 IN.
SEEPAGE PIT:
Log Crib Rings
BUILDING FOLINDATION __
DIAMETER __OR WIDTH__ EENGTH ,, DEPTH
Class:~.~..,~ , Depth:
Well Distance To: Lot Line
Bldg: Sewer Line:
,~ of Bedrooms: ~ /
Installer: ,~3 e. 131.9"/-0 X3 .6.~.t-¢. ,
Remarks:
, . 1~-~ ~-~ p-t ~
Crib Size DIAMETER___DEPTI% DISTANCE FROM: WELL
TOTAL EFFECTIVE
NEAREST LOT LINE___ , ABSORPTION AREA (WALL AREA)
i i
0^TE9--1--77 APPROV~
SQ. FT.
¢., :'1
GrEATer ANCHOrAGe Area BorouGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3330 "C" STREET ANCHORAGE, ALASKA 99503
L/~ ~' ~ TELEPHONE 27/1-,~561
SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT
NAME /~ MAILING.
TYPE AND SIZE OF FACILITY TO BE SERVED
FINANCED THROUGH
SO~L TEST RESULTS /C)(")
PSRMIT NO. '
. OTHER
TO BE INSTALLED BY
%~ (~ ,/1 ~/ /C~/~c,. NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE_ I ~-~ TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK _ ~%-- ~
FOUNDATION TO SEEPAGE PIT
SEPTIC TANK TO SEEPAGE PIT WALl
SEPTIC TANK _ , SEEPAGE PIT
TO NEAREST LOT LINE·
WELL TO septic TANK. / O ~
DRAIN FIELD _ / O0 i
WATER MAIN TO SEPTIC TANK
DRAIN FIELD
SEEPAGE AREA SIZE
, DRAIN FIELD.
, SEEPAGE Pit
ALSO CONSIDER AREA WELLS·
· SEEPAGE PIT
SEPTIC TANK=, . , SEEPAGE PIT .
TO RIVER, LARE. STREAM.
· DRAIN FIELD_
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
PITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL
CONFORM TO BOROUGH REGULATIONS 7~iNG iNSTALLATION.
TYPE
DIAGRAM OF SYSTEM
CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAge AREA BO~:~OUG-H ORDINANCE NO. 28-68 AND THAT THE ABOVE
Depe/'~mnt of Health and Environmental'-'!otection
~l& ":~- -'-~:-'. C. omm N-~,~-'"'L %'7
Anchorage, Alaska 99507
.~,=~i~ ?_ 7~ '~/~
L_ !1 qTZTZ...-
Depth
Feet
i-'-
2-
3-
5 -
6-
?-
8-
9-
11 -
12-
13-
14 -
Was ground water encountered?
If yes, at wnaL deuth?
Rca~ing,, Date Gross Time Net Time Del)th to Wate, Net iJcop
PercolaLion rate Illl llU re. '
'Proposed installation: aeepage Pit Drain Field
Dui)Ch of Inlet ~' , lJeptJ~i~"lJbi~b~'"~fF-ll)it or trenci, .... ~) .....................
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COSA Checklist.docx
COSA Checklist
Legal Description: PROSPECT HEIGHTS BLOCK 1, LOT 11 Parcel ID: 015-091-02
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____
A. WELL DATA
Well log is filed with Onsite (or attached)
Date drilled 7/1977 Total depth 200 ft
Cased to 26 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA *5/8/2024
Static water level at beginning of test *17.9 ft.
Well production at time of test *14 gpm
Water storage tank volume *UNKNOWN gallons
Well disinfected for coliform test? Yes No
Coliform bacteria is Negative
Nitrate 5.75 mg/L Nitrate less than MRL (ND)
Arsenic ug/L Arsenic less than MRL (ND)
Collected by Date 3/5/2024
Comments *Sullivan evaluated / conducted the water storage/pump well flow tests (see attached Sullivan
report) as previously performed by Aarow in 2020 / MOA record docs & past issued 2020 COSA.
B. TANK DATA
Measured operating fluid level in septic tank 44”
Date of pumping 5/29/2024 – 1530 TANK
Required maintenance completed, if AWWTS
Comments: ONLY 1530 TANK PUMPED
C. LIFT STATION
*Required maintenance completed
Age of lift station 5 years
Lift station material PLASTIC
Comments: QUANICS SYSTEM – *REQ MAINT.
D. ABSORPTION FIELD DATA
Which system tested (date installed) 2/13/2019
ALL standpipes present per record drawing
Total measured depth from grade 4.4 ft (max)
Measured depth to pipe invert from grade 2.5 ft (min)
N/A – pressurized field.
Per record drawings, field is insulated.
Monitor tubes (MT) go to bottom of effective (ED).
If not, state depth into effective
Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced gallons date
Any rejuvenation treatment (past 12 months) N
If yes, enter date
Adequacy test date 5/15/2024
Results Pass
Fluid depth prior to test 1.5 in
Water added 750 gal
New fluid depth 6 in
Elapsed time 1440 min
Final fluid depth 1.5 in
Absorption rate 750 gpd
FIELD STATUS – POST RECOVERY
Effective depth (per record drawings) 6 in (MOA 0.5’ ED)
Effective depth used 1.5 in (Final Fluid Depth)
Effective depth (ED) remaining 4.5 in
Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots &
appears approximate.
COSA Checklist.docx
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100’
Yes if No *50+ ft
Neighboring Tank > 100’ Yes if No ft
Absorption Field on Lot > 100’ Yes if No *50+ ft
Neighboring Absorption Fields > 100’
Yes if No ft
Community Sewer Main > 75’ Yes if No ft
Community Sewer Manhole/Cleanout > 100’
Yes if No ft
Private Sewer/Septic Line > 25’ Yes if No ft
Holding Tank > 100’ Yes if No ft
Animal Containment > 50’ Yes if No ft
Manure/Animal Excreta Storage > 100’
Yes if No ft
N/A – Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10’ Yes if No ft
Tank to Property Line > 5’ Yes if No ft
Field to Property Line > 10’ Yes if No *5+ ft
Water Main > 10’ Yes if No ft
Water Service Line > 10’ Yes if No ft
Surface Water > 100’ Yes if No *50+ ft
Wells on Adjacent Lots:
Private Wells > 100’ Yes if No *50+ ft
Community Wells > 200’ Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER’S COMMENTS
*MAY MEET CONVENTIONAL SEPARATIONS, BUT SYSTEM MEETS CATII SEPARATION DISTANCE REQUIREMENTS.
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/29/2024
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to
these various and dynamic characteristics and are outside the control of the evaluator of the
well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting &
05/29/24
Date: 5/8/24
P.O. Box 670269 Chugiak, AK 99567
P: (907) 688-2759 F: (907) 688-2259.
Brent Western
9901 Prospect Dr., Anchorage
FLOW TEST REPORT
Static: 17.9’
GPM: 14
DRAW-DOWN: 2.8’
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as of this IA-KDay of M of 20by and between
OS 1 QAAroo r , herein a "OWNER," and the Municipality of
Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),
described as
QUANICS CATII SYSTEM
located at (legal description)
PROSPECT HEIGHTS BLOCK 1, LOT 11
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
�—Throughout the term of this Agreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Page 1 of 3
Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On-Site Systems Approval.
Ve Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term, The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system, or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severability. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
T `V
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ARM Septic Services, LLC
Maintenance Checklist: Advanced Treatment System
Operational Checklist: Advanced Treatment System
Legal Description:
Street Address:Qa 0 Pray QcC �F ✓�
Service provided on: Date: �-3^Zffime:
Service provided by: C1ompany: Technician:
Date of last service: `0 — Z. a 2 ii By: ou Other.
1. Type of Aerocell Treatment System:
Cat II -AeroCell Treatment System
❑ Cat III -AeroCell Treatment System
=1 a L-1) � -
2. Conditions at media filter: Acceptable ❑ Unacceptable
a. Evaluate presence of odor within 10 ft of perimeter of system:
None ❑ Milo ❑ St ron ❑ Chemical ❑ Sour
b. Source of odor, if present:
3. Manhole Risers and Pipe Caps: Acceptable ❑ Unacceptable ( e G r1�K
�� o c eJt
a. Cover/s intact: 'Yes ❑/�No Cc%P ck-" l'
b. Method of securing cover: Sc!3A"?
c. Insulation present on all lids? WYes ❑No
d. Any plumbing leaks or water intrusion: ❑ Yes STN
e. Surface water/infiltration into components: ❑ Yes LJ No
4. Venting/Air supply: acceptable ❑ Unacceptable
a. Air supply unit operating properly. S 'yes ❑ No
b. Venting appears operable. 8�yes [--]No
5. Media surface: Ucceptable ❑ Unacceptable
L1 Yes N'No
a. Biomat on surface.
®.Yes ❑ No
b. Uniform spray pattern.
L1 Yes ®No
d. Ponding in/on media.
❑ Yes [tNo
e. Plugging/clogging of nozzles.
❑ Yes 5No
f. Media appears to be settling.
Yes ❑ No
g. Appropriate maintenance performed.
h. Pest activity at surface.
❑ Yes 5 'No
6. Effluent quality
a. Effluent odor after passing through media filter: None El Mid 11 Strong
Clear F1 Brown El Black
b. Effluent color after passing through media filter:
17933 Old Glenn Highway *Chugiak, AK 99567
office/fax: (907) 688-9433 Email: ARMServicesAKCoutlook.com (PAGE 1 of 3)
ARM Septic Services, LLC
7. Tasks for recirculating/discharge flows: t Acceptable ❑ unacceptabler�
a. If applicable, Jandy valve functioning: ❑ Yes
El No U N/A
b. If applicable, Jandy Valve basin dry: ❑ Yes
❑ No [8: N/A
c. Cleaned collection system in Aerocell unit: ❑ Yes
❑ No Not Necessary
d. Design recirculation ratio: 80 : 20
e. Actual recirculation ratio (Estimated): 6-tu
8. Pump System: NlAcceptable ❑Unac,c.}e,p//table
a. Control panel in Auto: k,s ❑No,.�.((//
b. Timer settings IFS Panel (No Override timer): I�Yes
ON: OFF: \7M
Override ON: Override OFF:
�/A
C. Floats in correct placement: it es
❑ No
d. Floats working properly: PiYes
❑ No
e. High water alarm operational: gi�i'es
❑ No
f. High water alarm count:_
g. Pump Run Counts: 9 3
h. Pump Run Time: 11 L1 :
ARM Septic Services, LLC
11. Is tha.Type m%,,, ins system functioning? "„"•9 �^9 (if no, describe in comments) ❑Yeso
b. Phone fne WMWV O Yes No
Ji�'FUA
12• Does this system receive an advisory notice/warning? (if so, describe in comments)❑ No
'Yes �/
13. is the system in satisfactory condition/pass inspection? (if no, describe in comments) ❑ Yes o
other Corti:
n
Service Provider Dame: ?'
17933 Old Glenn Highw Chugiak, AK 99567
office/fax: (907) 688-9433 Email: ARMServicesAK@outlook.com (PAGE 3 of 3)
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• Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
Parcel I.D. 015-091-02
1. GENERAL INFORMATION:
N�
Expiration Date: Z V
Complete legal description PROSPECT HEIGHTS: BLOCK 1 LOT 11 fi
Location (site address) 9901 PROSPECT DRIVE "ANCHORAGE, AK 99507
Current Property owner(s) KATE SARBER Day phone 230-0091
Mailing address 9901 PROSPECT DRIVE *ANCHORAGE AK 99507
Real Estate Agent Day phone
2. TYPE OF DWELLING:
® Single Family (w/wo ADU) �.
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS:
5
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
❑
WaiverNariance request for.
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ a!® Waiver Fee $
Date of Payment 9
Receipt Number 61,W q 156-
COSA # CSS C �761 plc /
Date of Payment
Receipt Number
Waiver #
COVID-1 9
2570 DISCOUNT APPLIED n�
ARIVI Septic Services,
Maintenance Checklist: Advanced Treatment System
3, -fationai Checklist. ,advanced Treatment Svstem
Legal Oescription,
V -Z
Street Address:Of —,;�j
A r
S(:;t;ir;e Provided on. Date -5 Time: H . -i;�
Service provided by: Company:
Employee:
,-
of last sewice r7J
By: ;You Other:
1. 7f pe of Aerocell Treatment System:
Cat 11 -Treatment S\,stern
Cat III - I reatnient Sysle
2. Conditions at media filter: .,,^Acceptable Unacceptable
a F-,-Iluale presence of odor vMhin 1 0 ft of perimeter of system:
Non,
f,.,IIVJ Strong —1 chenlica!
Sour
3. P.1anhole Risers and Pipe Caps:
'-',,.acceptable
ai errs intact Yes a
b MenlOd Of Securing cover,
Any plumbing leaks or water intrUSIOII. '.--j Yes 2 -No
d Surface v/ater/infiltration into comPonents: Yes No
4. Venting/Air Supply:
,-y�cceptable Unacceptable
-1 All' supply unit Operating properly :� Yes No
n Venting appears operable- -,,,,-Yes L.- NO
5. Media surface: = i cceptabie U: iaccepiable
"n SUTfaCO Yes No
0 Uniform Spray pattern -A Yes No
rnEd!a Yes No
of noZlesA
Yes No V
!-A dip. appears to be settling Yes ZNo
g Appropriate maintenance performed. -`-'Yes No
h Pest activity at surface. Yes r yNo
6. Effluent quality
a ienl odor after passing through media filter- None Mild Strong
Effluent color after passing through media filter: .,t� Iear Brown ,_j Black
24738 ChUgiak, Drive "Chugiak, AK 99567
Ph: (907) 317-9133 office/fax: (907) 688-9433 Emait: ARMServicesAK@0LJtt001(.00I11 (PAGE 1 of 3)
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:
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; therefore, GEG 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.
DSD SIGNATURE
KSystem #1 Approved for �J bedrooms
System #2 Approved for
Conditional approval for
M
bedrooms
Garnets,•
�VWLJTY, O,c6/4
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 Vr�� Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheef_70-10-12.doc
00
COSA Checklist
Legal Description: PROSPECT HEIGHTS; BLOCK 1, LOT 11
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 7/77
Total depth 200 ft
Cased to 26 ft
❑® Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 5/15/20
Parcel ID: 015-091-02
_ Structure served by this system _
'Performed by Aarow Pump & Well Service
Retained by homeowner not GEG, Ltd.
Well production at time of test *325 Spm
Water storage tank volume unk gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 8.91 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L W Arsenic less than MRL (ND)
Collected by *Aarow Pump & Well Service
Date of Sample 5/15/20
Static water level at beginning of test *51 ft.
Comments It is our understanding that there is a buried water storage tank in the yard near the well.
GEG did not evaluate the water storage/pump system.
B. TANK DATA C. LIFT STATION
Age of tank(s) 1 years ❑ Required maintenance completed
Tank type/material ac'r ..E Age of lift station 1 years
Measured operating fluid level in septic tank N/A Lift station material HDPE
❑ Standpipes/foundation cleanout per record drawing Comments:
Date of pumping
D. ABSORPTION FIELD DATA
Which system tested (date installed) 2019
Adequacy test date New
® ALL standpipes present per record drawing
Results R Pass For 5 bedrooms
Total measured depth from grade 4.3 ft (max)
Fluid depth prior to test - in
Measured depth to pipe invert from grade 2.2+ ft (min)
Water added - gal
❑ NIA — pressurized field
New depth - in
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
Elapsed time - min
❑ Code -required soil cover over field
Final fluid depth - in
❑ System presoaked
Absorption rate 750+ gpd
(Required if vacant for greater than 30 days prior to
Any rejuvenation treatment (past 12 months) no
date of test)
Gallons introduced n/a gallons
If yes, enter date n/a
Comments/DeflclencieS: Data is only for 2019 drainfield only. An evaluation was not performed on the 1977 drainfield.
Drainfield is shy on cover by approximately 4 inches near the south end of trench.
The majority of the drainfield has adequate cover.
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'
El Yes
*50'+
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No
ft
121 Yes
if No ft
Neighboring Tank > 100' M Yes
if No
ft
Private Sewer/Septic Line > 25' 1771 Yes
if No ft
Absorption Field on Lot > 100' [D Yes
if No
*50'+ ft
Holding Tank > 100' E✓ Yes
if No ft
Neighboring Absorption Fields > 100'
if No
ft
Animal Containment > 50' My Yes
if No ft
M Yes
if No
ft
ft .
If septic tank is under driveway comment below
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes
if No
ft
M Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
El Yes
if No
ft
Surface Water > 100'
❑ Yes if No *50'+ ft
Property Line > 5'
D Yes
if No
ft
Wells on Adjacent Lots:
F-1 Yes
Absorption Field > 5'
Q Yes
if No
ft
Private Wells > 100'
❑ Yes if No *50+ ft
Water Main > 10'
E1 Yes
if No
ft
Community Wells > 200'
E] Yes if No ft
Water Service Line > 10'
0 Yes
if No
ft .
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
F-1 Yes
if No
ft
Private Wells > 100' ❑ Yes if No *50+ ft
Water Service Line > 10'
0 Yes
if No
ft
Community Wells > 200' M Yes if No ft
Surface Water > 100'
❑ Yes
if No
*50'+ ft
F. ENGINEER'S COMMENTS
*CAT 11 advanced treatment system
The engineering evaluation/seal does not apply to the well flow test performed by
Aarow Pump & Well Service.
G. ENGINEER'S CERTIFICATION a� OFA%
I certify that I have determined through field inspections and review41 r��
of Municipal records that the above systems are in conformance with
MOA COSA guidelines in effect on this date. I * g
1
N" 1, t
0� e`fflearo.est.
��4d?�'. •� X7953
COSA Checklist yellow sheet o
rofess'oa
kAECC884
so
.� ---- ---�-- •-. _ ..ti.,. -.. -. , , ....". zuv v-v..v �-LUJJ 1 ! LVIIOI�C
I�
i OF A�
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L� O thto 0
I ••s Y
00 �°flim eth L. Vt"CIatk0 1'2,
�
8036 - LS
r QressI0KA� Irl,
SCALE: V'= 64'
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON Fb 16-8, pg 57 BE
UNLESS OTHERWISE NOTED, Fb 19-2pg 20
1 Lot 5
rtr � e
RECERTIFIED 2-28-19
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's Inspection
of the following described property: LOT 11, BLOCK 1.
PROSPECT HEIGHTS SUBDIVISION_ _
a
Anchorage Recording District. Alaska, and that the
I situated thereon are within the property lines
and do not overlap or encroach on the property lying
adjacent thereto, that no Improvements on the property lying
adjacent thereto encroach on the premises in euestion and
that there are no roadways, transmission lines or other
visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 14th _ day of OCTOBER . 2016.
FRED WALATKA 3. ASSOCIATES, L.L.C.
907-248-1666 Engineers and Surveyors
MUNICIPALITY OF ANCHORAGE
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
THIS MAINTENANCE .AND REPAIR AGREEMENT, herein the "AGREEMENT" made and
entered into as /offiis _N Day of of 200, by and between
wit�,C t�J� �✓ZS herein the "OWNER," and the Municipality of
Anchorage, herein the "�ttNIC[PALITY", in accordance with Anchorage Municipal Code
(AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this
Agreement agree as follows:
I . Advanced Wastewater Treatment Systems. The Municipality grants permission to the
Owner to utilize and operate annm Advanced Wastewater Treatment System (AWWTS),
described as 5 bef��ct7w1 \i1�1Cnf1�C S '-1(�V��t C Tte'A' wtLi
located at (legal description)
Pros o eL7 i-� t" IIj I L+ /I
2. Maintenance, Repairs and Alterations.
(Owner is required to read, understand and initial each section)
C Throughout the term ofthisAgreement, the Owner shall enter into a service agreement
with an AWWTS service and maintenance provider approved by the Municipality or the
manufacturer's representative. The AWWTS shall be maintained in a satisfactory
condition capable of performing as designed and producing treated septic effluent in
accordance with the equipment's approval for operation in the Municipality.
It shall be the responsibility of the Owner during the term of this Agreement to pay for all
repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This
includes an annual maintenance fee (typically $400 to $600).
Owner agrees that only maintenance and repair personnel approved by the Municipality
or the manufacturer's representative will inspect and make any necessary maintenance,
repairs or permitted alterations to the system.
Owner acknowledges that regular maintenance of an AWWTS reduces the potential
failure of the system, which could include sewage backup and costly repairs or drainfield
replacement.
(rev. 05/18/2018) Pagel of 3
L-�7� Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
[,FIq Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor,/installer and approved by the Municipality are the governing
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
(/T Owner agrees to maintain remote monitoring of the AWWTS as required by the
AWWTS approval.
3. Term. The term of this Agreement shall begin on the date of approval by the
Municipality to operate the installed system. or upon transfer of title, and shall continue
while the AWWTS is operational or until title is transferred.
4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this
Agreement shall in no way constitute a waiver of the provisions, nor in any way affect
the validity of the Agreement or any part hereof, or the right of the Municipality
thereafter to enforce every provision hereof.
5. Amendment. This Agreement shall only be amended by authorized representatives of
the Owner and Municipality. Any attempt to amend this agreement by either an
unauthorized representative or unauthorized means shall be void.
6. ,Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be
brought in the Superior Court for the Third Judicial District of the State of Alaska at
Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the
parties under this Agreement.
7. Severabilit•v. Any provisions of this Agreement decreed invalid by a court of competent
jurisdiction shall not invalidate the remaining provisions of the Agreement.
(rev. 05/18/2018) Page 2 of 3
OWNER:�
By: (signature) Date: (�a
/SLI r �F (print name)
rr .
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The Foregoing instrument was acknowledged before me this day of
20 QQ bv'«E(�. it c,, --,K)
_"N lowry Public
6 Al NINA N, DUIMN
stmo of Alaska
NOT-RY PUBLIC FOR ALASKA MV�5r tertl�slan pxFires
My Commission expires: ao"
MUNICIPALITY:
By: signature)
(print name)
Date: -5`-Z1-26
Title:
(rev. 05/13/2018) Page 3 of 3
ARN/1 Septic Sel-vices, 1.1,C
7. Tasks for recirculating/discharge flows: 'Acceptable L Unacceptable
9. Primary Tank Acceptable .i acceptable
a Sludge and SCUM, level checked: No Sludge/Scum levels. P
b. Tank needs to be pumped:
No
c. Tank lids/caps secured after inspection: No
cl, Last Dale Tank pumped,
10. Drainifield:
a. Type of Drainfield (circle one): Bed
a If applicable, Jandy valve functioning:
— i ; Yes
f- ,
L- No 2N/A
yes L: No
U. If applicable. Jandy 'Valve basin dry: 'Yes
No
N/A
Inches
c. Cleaned collection system in Aerocell unit Yes
No
LSn, t !,t! e c -a s S a r
Inches
C Design t'QC1rCUIa1jon ratio ;,0
42� N 0
Actual recirculation ratio ('Estimated):
8. Pump
System: -4cceptable L-.'Unacceotable
a
Control panel in AWC:
b.
Timer settings
ON: OFF 1
Override ON: Override OF":
C.
Floats 111 Correct placement:
d.
High water alarm operational:
,to
a
High water alarm Count:
Pimp. rLill time: 11
g -
Pump run Courts
h
Effluent Filter serviced: 2,yes
No
Ir
Tank lids secured after inspection: Yes
I —, I No
I
aNeep hole functional: �_y Yes
No
9. Primary Tank Acceptable .i acceptable
a Sludge and SCUM, level checked: No Sludge/Scum levels. P
b. Tank needs to be pumped:
No
c. Tank lids/caps secured after inspection: No
cl, Last Dale Tank pumped,
10. Drainifield:
a. Type of Drainfield (circle one): Bed
5-vjide Deep -French
b. Design Effective depth: inches/feet
C. C hecked Liquid Levels in Drainfieid:
yes L: No
MT#1 Liquid Level:
Inches
MTm2 Liquid Level:
Inches
MT43 Liquid Level:
Inches
MT#4 Liquid Level:
Inches
d. Is there any surfacing effluent?. J Yes>K
42� N 0
11. Is the system in satisfactory condition/pass inspection? (if no, describe in comments)
12. Does this system receive an advisory notice/warning? (if so, describe in comments) Yrs;
12. Is the remote monitoring system functioning? (if no, describe in comments) Yeses;
13, Type of monitoring system?:
1 if
24738 Chugiak Drive *Chugiak, AK 99567
Ph: (907) 317-9433 office/fax: (907) 688-9433 Email: ARMSe I-vicesAK@OLJ L look. coin (PAGE 2 of 3)
ARI''[ Septic S ;rvices, LLC
Service Provider': Date:
24738 Chugiak Drive 'Chugiak, AK 99567
Ph: (907) 317-9433 office fax: (907) 688-9433 Email: ARMServicesAK@outtook.com (PAGE 3 of 31
I : , �: David Harper I L �� �; i`.r,rjrn
2�-g
Ujt�L.: 9901 Prospect Drive
Date: May 20, 2020 at 2:46:02 PM
c: Pierce Blewett i ivrt C cia, £ ,sson;it�lec, i nc.Uc
Pierce, pump test date on the above property was 5-15-20 as was the
sample date. Samples will be forwarded to you from SGS. Static was 51
feet at beginning of test. The pump was refilling the storage when we
arrived. The pitiless adapter was pulled to the top of the casing and flow
test was conducted from that point. The well was drawn down to 1feet
and ran for a period of time, approximately 30 minutes. Recovery was
gauged at that level of 3.25 GPM. Total time for the above was about 2
hours. Depth of well measured at +- 200 feet but couldn't be sure as
the probe wire got stuck in the well. The well head appeared t be up to
MOA requirements as per height and well seal and conduit.
David Harper
Aarow Pump &Well Service, LLC
Sent from my Phone
�v�P A-4)(
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT 05 907-343-7904
�.,
On -Site water and wastewater Section
Fax: 343-7997
www.muni.org/onsite
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC201214
Subdivision: Prospect Heights, Block: 1 , Lot: 11
A water sample revealed a nitrate concentration of 8.91 milligrams per liter
(mg/Q. The Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While
private wells are not subject to this regulation, EPA standards are based on existing
health information and can therefore be used to gauge the relative quality of water
from private wells. Please see the attached "Nitrate Fact Sheet" for important
information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -Site
Systems Approval.
i ��� � � �Mail�ng Address P O Box 196650 *Anchorage, Alaska 99519 6650 *www murn org ,
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
..-, Division of Environmental Services
-- On-Site Services Section
_ P.O. Box 196650 Anchorage Alaska 99519-6650 .
-' '- "'- ' .....'"' '343-474 /'?':.
''.- ' . -~ :' : " · Z; ;.~:".':, -.::;. ,-_s-Z-A._.'~- ,;' ~ ; "-.',L:"'~; - -
.... CERTIFICATE OF HEALTH AUTHORITY ' ";' "
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. ¢ ~ ' '
1. GENERAL INFORMATION -.;,,_..,¢,,~,, .......
'Complete legal description. - Lnt 1 ~= Block 1 ~ P~os~e.~t H~J, gh~z Su.6~vi~on~-
Location (site address or directions) 9901 Prospect DriP6, Anchorage, Alaska
Property o'wn~ r
Mailing address
Lending agency
Mailing address
TAnm~ H?.B¢.# Day phone "
P.O Box 111405; Anchorage, Alaska 99511 ..
Day phone
Agent Br, n~x'¢. Ma:h~¢_~/JAC. K WHITE ~0MPANY Day. phone
Address 3201 C Street, S~ite 100, Anchorage, A~4~ 99503
Unless otherwise requested, HAA will be held' fo~:pickup: .'- -- .' ~ ¢
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
..................... Individual well
~. CommuB ty. well:i: .... ' : '
Public water.
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site- '- · .-..-....,~: .. . ..
Holding tank
NOTE:
Cc mmunity on-site "
Public sewer -
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 [Rev. 1/91) Front MOA #21
:suogelnd!3s 6UIMOIIOJ eH~-.Hj!M 'SLUOOJpeq
JOJ I~AoJddB I~UOp,!puo0 : ....... .
'peAoJdd~s!a
~I=I=INIIDN:1 Ag NOIIO~idSNI ..dO IN=I~I.L'~.LS
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Parcel I.D.
A. WELL DATA
Well type -~',~_~ I_~ .~L I~ If A, B, or C, attach ADEC letter. ADEC water system numbe, r ( N~..~' ~
Log present (Y/N) ~/ Date completed ~- -/~ - '~ "~ Driller ~A~,~J~ z=. ~'f/a~
Casedto .2~ _- Casing height /_.~ ,,../c
Total depth
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well flow
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot
Absorption field on lot ~
Public sewer main
Public sewer service line
; On adjacent lots
; On adjacent lots
Public sewer manhole/cleanout
Wires properly protected (Y/N)
AT INSPECTION m 0
g.p.m.
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~.P,J/~/~Y~"]Lz~'~, Nitrate-~R~-J~r-'lLz~r~ ~.11%,~
Date of sample: --~ - ~---~--~ I Collected by:
Other bacteria
B. SEPTIC/HOLDING TANK DATA
Date installed ~'- ]- '~F"'~
Tank size
Cleanouts (Y/N) ~ Foundation cleanout (Y/N)
High water alarm (Y/N) ~J/~l Alarm tested (Y/N)
Date of pumping z_ .-7 - /O -C'7 I ,/~ ~o'/,/~" Y~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot ! CO -~ On adjacent lots. / ~o -t
To property line / F) ~F Absorption field
Surface water/drainage / O0 '~
,~ Pr ) Compartments
C/:-' : Depression (Y/N)
/
z
Foundation
Water main/service line
72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION '~
Date installed
Size in gallons , ~"~
Vent (Y/N) r"J'Pu~'level at
High water alarm level
Meets MOA electrical codes (Y/N) '~
' SEPARATION DISTANCE FROM LIFT ST
Well on lot On adjacent Io%
Manufacturer
Manhole/Access (Y/N)
"Pump off" level at
Cycles tested
Surface water
D. ABSORPTION FIELD DATA
," ~Date installed ~ - ! - '~ ~ Soil rating / ~ x~,/~ ~ System type
:. Length {.co ~ Width %/~"
_ Gravel thickness .'~o
--Total a. bsorption area "~1'O ~./~'~.c)!,~['~P~ C,l~a. nouts present (Y/N)
-- 5'-44-
.Depression over field (Y/N) ~,J Date of adequacy test
"."Results (pass/fail) '~¢~ '~-~ / for z¢
Peroxide ~reatment (past 12 months) (Y/N) ~)./f~ If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot ~ ~'~-~ On adjacent lots I Oo '4-
Surface water
Curtain drain
To building foundation ~..~
On adjacent lots I ¢)o ~
/
'1
Total depth
E. ENGINEER'S CERTIFICATION
bedrooms
Property line [ O '~
To existing or abandoned system on lot ~/~
Cutbank , x)/(~ Water main/service line fQ ~
. Driveway, parking/vehicle storage area :~ O ""/
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines
S & S ENGINEERING
17034 Eagle Ri~er Loop Road
Eagle River, Alaska
Signature
Engineer's Name
Date 7 ~"~ '-~ /
~ of this inspection.
Waiver Fee: $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Lot 11, Block 1, Prospect Hts
Location (address or directions)
9901 Prospect Drive, Eagle River, Ak
(b) Property owner Thomas C. Heber Telephone : (home) 346-1783Business 265-8461
Mailing Address 9901 Prospect Drive, Eaqle River, Ak 99577
(c) Lending lnstitution First National Bank Telephone 265-3403
Mailing Address Box 100720, Anchoraqe, Ak 99510
(d) Real Estate Company and Agent N/ A
Address
Telephone ' '
(e) Mail the HAA to the following address: (or check herer-I, if hold for pick up.)
List contact person and day phone number below:
gnginmmr
2. TYPE OF RESIDENCE
Single-Family~ Number of bedrooms 4
3. WATER SUPPLY
Individual Well [~ 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 I~ Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legality and status.
72~)25 (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 th is
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.
NameofFirm EaGle River EnGineering ServT~e~hone 694-5195
Address P.O. Box 773294. Eagle River. Ak 99577
Date
6. DHHS APPROVAL
Approved for ~ bedrooms by
ApProved ,/-~' Disapproved
Terms of Conditional Approval
Conditional
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
·~_~O.'*c~.~5~ ~ MUNICIPALITY OF ANCHORAGE (MOA)
.~(~ ,~ ,,~ ~) Health Authority Approval (HAA)
,G,~;~ ~,~ .~ CHECKLIST-FEBRUARY343.4744 1984
~0~ c_~~ v~ Legal Description:
A. WELL ~
Well Classification
Well Log Present (Y/N)
Total Depth
Static Water Level ~' ~ ~ ~ PumpSetAt
Casing Height Above Ground
Electrical Wiring in Conduit (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on 'Let 7".-'~¢"
To Nearest Edge of Absorption Field on Lot
To Nearest Public Sewer Line ,4,,/.4-
To Nearest Sewer Service Line on Lot
Water Sample Collected by
Water Sample Test Results
If A, B, C, D.E.C. Approved (Y/N)
Yield CD~ ~' ~,~,,.~
¢-/,¢¢ /
Sanitary Seal on Casing (Y/N) ,Y J
Depression Around Wellhead (Y/N) /'P -'
; On Adjoining Lots ,.¢-/¢,2
~3 '" '
~-'41,,~, ; On Adjoining Lots
To Nearest Public Sewer Cleanout/Manhole
;Date ~/=~¢o
Comments
B. SEPTIC/HOLDING TANK D~T)A
Date Installed
Standpipes (Y/N) )/ Air-tight Caps (Y/N)
Depression over Tank (Y/N) /v/
Pumping/Maintenance Contact on File (Y/N) ,4~/,4-
Holding Tank High-Water Alarm (Y/N) ~'' ?~
No. of Compartments
/P' Foundation Cleanout (Y/N)
Date Last Pumped /4¢'//.7/
; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field 7~
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water-Supply Well /'~'~ ?
To Property Line ¢'/'* /
To Water Main/Service Line ~'/~' ~
To Stream, Pond, Lake or Major Drainage Course
Comments .~YF/~,~,'~,-~f /.;,~,-,',-~. ,'~' s~,2
72-026 (Rev. 7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Type of System Design /'~'~
Length of Field ,¢ ~ /
Depth of Field /~-" (/,~.¢_.~.,~k~ ?
Gravel Bed Thickness '~'¢ /' /
Square Feet of Absortion Area ~-'¢'V' Statndpipes Present (Y/N)
Depression over Field (Y/N) /'~ Date of Last Adequacy Test
Results of Last Adequacy Test ~,/~ ~ - :~-'~//¢'~ ~ ~ ~
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water-Supply Well ,¢'J~ / ~ To Property Line /',~ /
To Building Foundation ~5'-- ' To Existing or Abandoned System on
Lot /~ /"¢ ; On Adjoining Lots .¢
To Water Main/Service Line /"/¢ '~ To CUtback (if present)
To S~ream, Pond, Lake, or Major Drainage Course
To DriVeway, Parking Area, or Vehicle Storage Area ¢-,~'"
Comments
D, LIFT STATION /¢,/~
Date Installed
Size in Gallons
"Pump On" Level at
High.Water Alarm Level at
Tested for
Meets.MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (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...~?...:.,effecton.,; tbe~,,;:,~,~ date of this
inspection. _._..~...._~ ~ ~:¢.~,~ ~ :;:' ,~.! ;, . .,..,.
Signed ___ ~
Company ~ ~ . ' ....
Date ~/~ ~ Eagle River, AK 99577
MOA No. ~/- ~
Receipt No. ~ ¢ ~,~ ¢ ~ / Receipt No.
Date of Payment ~-~ ~ -~ O / Waiver Fee: $
Amount: $ /~ ~~ Date of Payment
72-026 (Rev. 7/88) Back Page 2 of 2
,.
iig40 Business givd, Suite~2ubZ'
P,O. Box 773294
Eagle River, Ak. 99.577
694-5:~5
Fox 694-5297
ILegal: X,~' //
Owner: ~r
Dote:
/pe of test:
[] Well Flow Tes'~ D Septic Test Only 1~' Well & SapS. lc Tes! D Other:
Meter
Time Reading
I
Monitor
Level
J~'~ 1,
i
Well
Level
Tank
Level
GPM PSt
Remarks'
NORTHERN TESTING LABORATORIES, INC.
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 907-277-8378 · FAX 274-9645
3330 INDUSTRIAL WAY FAIRBANKS, ALASKA 99701 907-456-3116 · FAX 456-3125
Eagle River Engineering
PO. Box 773294
Eagle River AK 99577
Attn= Louis Butera
Report Date:
Date Arrived:
Date Sampled:
Time Sampled:
Collected By:
08/31/90
08/27/90
08/27/90
1120
Our Lab #:
Location/Project:
Your Sample ID=
Sample Matrix:
Comments:
A104395
Prospect Heights
L11,B1
Water
Flag Definitions
Below Detection Limit
DL Stated in Result
Below Regulatory Min.
Above Regulatory Max.
Below Detection Limit
Estimated Value
Date
Method Parameter Hnits Result Flag Analysed
EPA 300.0 Nitrate-N mg/1 4.6 08/28/90
Reported By: Francois Rodigari
Anchorage Operations Manager
Tom Fink,
Mayor
unicipality of nchora ¢
Department of Health and Human Services
825 "L" Street
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
September 25, 1990
Lou Butera, P.E.
Eagle River Engineering Services
PO Box 773294
Eagle River, Alaska 99577
Subject: Waiver Request for Lot 11 Block 1 Prospect Heights S/D
Waiver Request #WR900037, PID #015-019-02
Dear Mr. Butera:
Your request for waiver of the required 100 foot separation of
a septic system to a private well has been approved. The
approved separation distance is 93 feet from well to leachfield.
This waiver approval applies to the existing septic system to
well separation only. Any future upgrade to either will
require all separation distances be met or another approval
from this department.
Sincerely,
Daniel J. Roth
Civil Engineer
On-site Services
Concur:
Susan Oswalt
Acting Program Manager
On-site Services
DJR/ljm
ij]
jg ~ ~ ~, TS
fit--
ii[ Z-a r,~L ./?. 72 . -
~oT~O~
LEveL
JOB
EAG~LE RIVER ENGINEERING SERVICES
P.O. Box 773294
EAGLE RIVER, ALASKA 99577
LETTER
Phone 694-5195
Subject
MUNICIPALITY OF ANCHORAGE
DE~tl OF H~AL~ &
ENVIRONMENTAL PROTECTION
SEP 1_ ~lU~d
RECEIVED
[] Please reply ,,/,,~o reply necessary SIGNED ....,.,.~,,. ,.~.~_.......~
'i'
l
'l
1
i
lying idjicent thet,~ ln~O,~ Off the premll~ In qu~t~fl and that ther, Ir, flo todwlyl. ~ ;?O eo~IMe.~ ..~.
........ ~. q~?Ori~t~k% ~~
A
694-5195
Fox 694-3297
Eagle River Engineering Services
11940 Business Blvd, Suite //205
P.O, Box 775294
Eogle River, Ak. 99577
Dote:
Type of test:
[:3 Well Flow Test [] Septic Test Only ~Well & Septic Test [] Other:
Meter Monitor Well Tonk GPM PSI Remorks'
Time Reoding Level Level Level
/.2;, ~.,~,... ·
/:2 ; :;,-'q ~-~i'..~'~¥o -~ ~ " ~ ~ ~ ~' / "
,..,/~ I I =~/ " I F/ .... --. '""*
! I I _ I
RIVER ENGINEERING
SERVICES
Lou Butera, P.E.
P.O. Box 773294
Eagle River, Alaska 99577
Telephone (§071 694-5195
September ll, !990
Dan Roth
Civil Engineer
On-Site Services
Municipality of Anchorage
P.O. Box 195650
Anchorage, AK 99519-6650
RE: Lot I! Blk l, Prospect Hts.
MUNICIPALITY OF ANCI'-IORAGI]
DEPL OF HEALTH &
ENVIRONMENTAL PROTECTION
0.m---
SF_P 't '&,1990
RECEIVED
Dear Mr. Roth,
At the request of our client, Mr Tom Heber, we are submitting
information necessary for your determination of a waiver of private well
to septic !eachfield separation distance of ?' to 93'.
The septic leachfield was installed in i977 and inspected by the
MOA at that time. The well was noted on the report as being
distance which was actually measured at 93' to the closest point, the
monitor tube. The leachfie!d portion within the 100' radius is then
only the end 7' section of a 60' leachfie!d. The leachfield recently
passed an adequacy test and has been in place since 1977 having
developed a long term clogging mat. As evidenced by water samples the
septic system seems to have effectively reduced possible containments
to acceptable levels.
The subsurface soil is rated at 100 S.F/Bedroom. This is
consistant with soil logs researched throughout the area showing perc
rates of 85-100.
Surface topography is such that the ground slope steeply away from
the well toward the septic at an average 10~ slope. This slope is
continued at an increasing percent toward the West away from the well.
Well logs researched in the area show there to be a shallow bedrock
layer varying in depth from 15' to 27' as evidenced by well casing
depths. I would assume that the bedrock plane or slope follows the
general hillside surface slope. This has probably been proven out in
past land use or waiver studies. The sub3ect well has a casing depth
of 26' with the total water supply from water seepage thru bedrock
fractures. Fractured bedrock is located above the casing end to near
ground surface in the well location. Well static water level is 24'
below ground surface.
The lots in this area are large with low population density. The
variance from 100' should be considered minor.
If you have any questions or any further concerns please call me
at 694-5195,
Sincerely,
Louis Butera, P.E.
'~i DATE RECEIVED
· INSPECTION APPOINTMENTS
~ TIME
TIME TIME
)ATE DATE DATE
INSPECTOR INSPECTOR INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF 1!SALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTI~J'~JVIRONMENTAL F%OTECTION
825 L Street - Anchorage, Alaska 99501
Telephone 264-4720
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAC '-
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
J PHONE
1. PROPERTY OWNER
William D. and Dora J. Saylor 349-1163
MAILING ADDRESS
SRA Box 250, Anchorage, AK %~ PHONE
PROPERTY RESIDENT (If different from above)
PHONE
2. BUYER
Thomas C. and Sandra K. Heber
VIAl LING ADDRESS
2911 Laurel Lake, Kingswood, TX 77339 PHONE
3. LENDING INSTITUTION
National Bank of Alaska 276-1132
MAILING ADDRESS
301 W. Northern Lights Blvd., Anchorage, AK 99503 PHONE
4. REALTOR/AGENT 277-1553
Elliot C. Lawson
MAI LING AD DR ESS
Jack White Company, 3201 "C" St. Suite 100, Anchora~e~ AK 99503
**Note: Please send all correspondence relating to this property to the above agent.
5. LEGAL DESCRIPTION
Lot 11, Block 1, Prospect Heights
;TREET LOCATION
NHN Prospect Drive
NUMBER OF~BEDROOMS
TYPE OF RESIDENCE [] One ~} Four [] Other~
~ SINGLE FAMILY r~ Two [] Five
[] MULTIPLE FAMILY [] Three [] Six
7. WATER SUPPLY
INDIVIDUAL*
[] COMMUNITY \ ~..~,~_,~
[] PUBLIC UTILITY
* ATTACH WELL LOG. A well log is required for all wells drilled
since June 1975. For wells drilled prior to that date, give well
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) ~ ..)~¢_~
1. T. YPE OF RESIDENCE
[] SINGLE FAMILY
[] MULTIPLE FAMILY
2. WATER SUPPLY
[] INDIVIDUAL
[] COMMUNITY
[] PUBLIC UTILITY
Connection Verified
3. SEWAGE DISPOSAL SYSTEM
[] I NDIVI DUAL/ON -SITE
[]PUBLIC UTILITY
Connection Verified
[]Septic Tank or [~Holding Tank
Size: [~ ~% c~ If Tank is homemade
give dimensions:
THIS SIDE FOR OFFICIAL USE ONLY
NUMBER OF BEDROOMS
[] ONE [] THREE [] FIVE [] OTHER
[] TWO [] FOUR [] SIX
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
TYPE OF TANK
TOTAL ABSORPTION AREA
4, DISTANCES
WELL TO:
PERMIT NUMBER
DATE INSTALLED
INSTALLER
SOILS RATING
Absorption Area to nearest Lot Line
5, COMMENTS
MANUFACTURER
MATERIAL
Septic/Holding Tank JAbsorption Area
ISewer Line
INearest Lot Line
DATE
[] CONDITIONAL APPROVAL (letter must accomp/~ertificate)
72-010 {Rev. 6/79)
T.H-I
7 -26-73
SANDY SILT, WITH SOME
SAND AND GRAVEL
TRACE ORGANICS {SM)
GRAVElly SAND WITH
TRACE TO SOME SILT
AND COBBLES ($P-GM)
O.OI
2.0*
Test hote excavmed
:'!':-:' I~ E:nglneering ~ Geological Consultants
' ' -~~=~ ALASKA au.=~u
No Water Table T.D.
wilh tractor m0dnte6 boc#h0l.
Kin'cold And Son Construction :,
LOGS OF TEST BORINGS·
/~nchorage Alaska
DArE 7.27.73 ~C4L£ I" = 2' OWN a~' ~ R.S.
e-KO aY W.E.I~.
NO. 36639 owe NO. Ao
