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HomeMy WebLinkAboutDONAHUE LT 1I)onahue
Lot 1
#015-494-08
LEVEL
SWING T1ES
A B C
C 173.5'137.0'
LEVEL
r]
4-BDRM SF.
LEVEL
Al '
10' TELE & £LEC £SMT
1 LE 7ELEC ESNT
NOTE. • SLOPES EXCEEDING 259 W£RE NOT OBSERVED
WITHIN 50 FEET DOWN GRIDI£NT OF THE PROPOSED
ABSORPTION FIELD LOC471"
NOTE.• THIS IS NOT A SURVEYED PLAT. WELL t SEPTIC
LOCATIONS TAKEN FROM ON -SNE WATER AND WASTE WATER
DEPARTMENT DOCUM£NTATIOA! ALL LOCATIONS SHOWN ARE
APPROXIMATE.
25 0 25 50 75 100 125 150
SCALE., I' = 50 FT
Septic!
Area
4ml
/D
OT 2
VACANT
0
SPORKLAND ENGINEERING DONAHUE LOT 1 EPTIC SYSTEM ASBUILT
203 V 15TH, AVENUE ALENE WHITNEY BA 7E., JULY 10, 2013
ANCH AK. 99501
(907) 279-3916 11 6100 MOOSE MEAB17V LANE CIR., ANCHORAGE, AK 99516 SHEEP 1/1 GRIBt 2638
PERMIT # OSP121269 PID # 015-494-08 DONAHUELISC50-ASB.OV6
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSPI21269
Tax Code Number: 01549408000
Work Type: Septic Upgrade
Permit Effective Dates: August 31, 2012 to August 31, 2013
Design Engineer: SPURKLAND ENGINEERING
Subdivision: DONAHUE
Site Legal Address: DONAHUE LT 1 G:2638
Owner/Address: BURNETT GILBERT S & TERESA L
6100 MOOSE MEADOW LANE CIRCLE ANCHORAGE AK 995161733
Site Mailing Address: 6100 MOOSE MEADOW LANE CIR, Anchorage Lot Size in Sq Ft: 52696
Total Bedrooms: 4
This permit is for the construction of:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By:
`91112-
Issued
111Z
MUNICIPALITY OF ANCHORAGE
T
Community Development Department Phone: 907 -343 -
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel l.D. 015 - `19y- 08
Property owner(s) AknE wwe. Day phone
Mailing address
Site address (cIDD M00% &A -pow (Ane
ur,.
A4oro4e,
Al, CR51(o
Legal description (Sub'd., Block & Lot)
Absorption Field
❑
L- 1
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms L
THIS APPLICATION IS FOR:
THIS APPLICATION IS AN:
(® all that apply)
Initial ❑
Absorption Field
❑
Septic Tank
Upgrade
Tank
❑
Renewal ElHolding
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
property owner or
Permit/Rush Fees: a.00— T&-*-ko'^l,t�_Waiver Fees: _
Date of Payment: TK -b-'1 to Date of Payment:
Receipt Number: 01ALA 0 G% Receipt Number:
Permit No. 05 iP 1 a12•1oo1 Waiver No.
GABuilding\On Ske\Forms\Client FormsTermit App_01 041 1.doc (Rev. 1/11)
SpwM aimd Engomme ong
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
DONAHUE LOT 1
Municipality of Anchorage August 23, 2012
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Rd.
Anchorage, Alaska 99519
Subject: Septic Tank Installation Permit
6100 Moose Meadow Lane Circle
Ladies and Gentlemen:
We are submitting an application to move the recently installed BioCycle tank at the above referenced
property. The submittal consists of one (1) drawing showing the present improvements on the lot and the
proposed improvements of the lot, of which only the septic tank is subject to this permit application.
The installation of this septic tank will not prevent wells and septic systems from being installed on the
adjacent lots. There are no developed or natural surface / sub surface drainage courses within 100 feet of
the proposed septic tank location. The proposed septic tank will not change the general slope of the area.
Ponding and/or concentration of surface runoff will not result from this installation.
If you have any questions or are in need of additional information please contact me at 279-3916.
Sincerely,
Lars S P.E.
P
Civil Engineer
203 West 15a` Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
LEVEL
LEVEL LOT I I `
DONAHUE
4—BORM ST'.
iEvrL
y�E gg'
X+
10' TELE & fl£C £SMT
r k 1 Lf & ELEC ESMT
Septic!
Area
NOTE SLOPES EXCEEDING 25X WERE NOT OBSERVED
BTI EERY DOWN GRADIENT Of THE PROPOSED
ABSORPTION RELD LOCATION.
NOTE THIS IS NOT A SURVEYED PLAT. WELL k SEPTIC
LOCATIONS TAKEN MM ON—SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE.
Foum
25 0 25 50 75 100 125 150
SCALE I'=50 FT
S/D
2
VACANT
SPURKLAND ENGINEERINGAK. 99501 I I DONAHUE LOT 1 I ASEPTIC SYSTEM ASBUILTI
ANC W 15TH. AVENUE
ANCH, ALLENE WHITNEY BATE.- BATE.- AUGUST 23, 2012
e907) 279-3916 6700 MOOSE MEADOW LANE C1R., ANCHORAGE; AK 99516 SHEET* 2/4 GRID, 2638
PERMIT # OSP121210 PID # 015-494-08 DONAHUEL1SC50IpERMIT PID # 015-494-08 TR.DWGI
I SLOE FMH.SHED GRADE AWAY
FROM TOP IN ALL OIRECMM6
AOADSTABLE RISER71-1/4'
AILONS FOP 8' TD 2'-EXTE (O 7O fM'ALCHAD£ (RW OF TANK1. PLL DISLYURC.T
EFFLUEN4• PLL INFLUENT
I'-0•� M4LUEE/T
g 4 �
o AERA70M O
b CHAMBER APRAVIBE'RY
i
•u Nk
CLARIFIER DISCHARGE
��" CHAMBER CHAMBER ; �.q
Tn y
BOTIOM OF TANK
I'�--
8-0"t -I2' BLUEBOARD INSULA BOP
4' SAND/GRAVn
LEYFI/NG CONRSE
O9UPACTEO
BIOCYCLE SYSTEM OPERATING WATER LEVELS
NTS
INSTALLATION
1. EXCAVATE A 10' x 10'. 10' DEEP HOLE FOR SIOCYCLE SYSTEM.
2 PUCE A MMBMUM OF 4' SAND OR GRAVEL FOR LEVELING COURSE IN N BOrRLN OF THE EXCAVATIONm,
COUPACT AS NEDIMREO.
3. PUCE 4 SHEETS OF 2'x 8' x 2• DIRECT BURIAL ROD INSULAWN ON TO' OF COMPACIED LEVELING COURSE
TALL PROTECT
OMEBONS OF FISERCLASS TANK. TAKE EMA CARE M ASSURE THAT INSU ARON COLMSE IS LEVEL
4 BAOfFIL AROUND LANK UP 10 INVERT OF }• MTLIIEJIT AND 1-i/4• EFFLUENT LINES WTN FREE-FLOXINO NSF ...........
IF ,,••• •1111.1
sF
w
Ap 4 th
0............... s..... �
/......... . ........... ....... •
L SPURKLAND ...�Al
��.. No. CE-11500 '.�, AV
IIIIPI6iF;;
SPURKLAND ENGINEERING DONAHUE LOT 1 1 ISEPTIC SYSTEM DESIGN
203Wg115TH. A VENUE Allene Whltney DATE, August 23, 2012
W779-.741 6100 MWYE- MEAMV LANE ON.., ANCHBRA£E. AK 99516 SHEETT 1/4 &IDN P638
PERMIT # 0SP1110XX PIB # 015-494-08 B17NAHUELIB4.BV6
Municipality of Anchorage
Community Development Department Page (of 3
On-Site Water and Wastewater Program
4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • hftp://www.muni.org/onsite • (907) 343-7904
ONSITE WASTEWATER INSPECTION REPORT
Permit Number: 05? 121210 PID Number: 015'494'09 ❑ New N Upgrade
Name: TEe,�sA BuRNe T"('
ABSORPTION FIELD
❑Deep Trench Shallow Trench El Bed ❑Mound
Address
M r
Moose Au Cie.
411 I tenow L
❑ Other
Phone
Phone -74
Number of Bedrooms
Soil Rating
Total depth from original grade
3,C)GPD/SF
3 Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
2• Ft.
Subdivision t Block Lot
NW1Atlue LOT `
Fill added above original grade
I Ft.
Gravel length
Ft.
Township Range Section
Gravel widthBeds:
5 Ft.
Number of Lines
—
Distance between lines
— Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
-3t� Fiz
1
_.... Ft.
Well
t
Imo}
IODt},
��t
k/n
NA
I}
TANK El Septic ❑S.T.E.P. ❑Holding Other
Manufacturer
BaCYGL
Capacity
500 Gal.
Surface Water
lei•
106+
t
100}
Material
RaQt "h55
Number of compartments
Lot Line
551{
10.5t+
5tf
�N)A
IVA
NA
Foundation
to +
51+
NA
LIFT STATION
Manufacturer
6loG,XI6
Capacity
1500 Gal.
,51}
Curtain Drain
i$
b
r�
5) r}
r+
5'+AI
A
Remarks EiuS•il(JOf $$TEM A
A6ANU0� PE2
Pump on level at
Pump off level at
High water alarm at
25
4
MDA RU3? .2z.5
in.
`5 in.
in.
Pump make and model
Electrical Inspections performed by
Ukv
MOA
Installer n_,•. `
PIPE MATERIAL House to tank rank to
303y draiMield Self y
F�IhfY CoN$1RIJGTIOvy
Drainfeld _C4_4 40 CO/MT f810
Inspector LAPS
BENCHMARK (Assumed elevation) (op It
Inspection 1" g 2 l2. S 3 12
Location and description
y^^
dates:
&Yom Sipf Sul Coma
l
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
En�nker,,,Vamp
Conditional Approval: Date
��, . • .u! d�
i! 49TH '';{{�����'
•..
X
f ..
I�tRSE.SPURKLAND:�/
©'�Z
5 0 i
Approved Date :2
Inspection RepBft_14-1.&!W
> a
ON
PVC DISCHARGE
BIOCYCLE SYSTEM OPERA77NG WATER LEVELS
NTS
INSTALLA77ON
F7 OSWO GRADE AWAY
TOP W ALL DIRECRONS
PVC INFLUENT
Q' TANK
2' BLUEBOARD INSULARON
4' SANO/ORAM
LEVELING COURSE
COMPACTED
1. EXCAVATE A f0' x HY x 10' DEEP HOLE FOR MOCYCIE SYSTELL
2 PLACE A WARAlf OF 4' SANG OR 6WAVEL FOR LE14MG COURSE IN THE BOTTOM OF THE EXCAVA710U
COMPACT AS REOPWED.
3. PLACE 4 SHEE7S OF 2'x 8'x Y DIRECT BURIAL ROD RPSULAWN ON TOP OF COWACIED Ll'VTLOfG COURSE
TO PROTECT BOTTOM OF FWZG ASS TAMIL TAKE EXTRA CARE TO ASSURE THAT INSULATION COURSE IS LE4Ei.
W ALL MECOONS
l BAaCFTLL AROUND TANK UP TO INVERT OF 4' INFLUENT AND 1-1/4' EFFLUENT LWES WRI FREE-FLOMNG NSF
SPURKLAND ENGINEERING
203 V 15TH AVENUE
ANCH. AK. 99501
TERESA BURNETT
:PTIC SYSTEM DESIGN
DATE, JULY 11, 2012
I PERMIT # OSP111OXX PID # 015-494-08 DUNAhUELID4.DVG
SWING TIES I
A 1 B 1 C
C 37.0 19.5
D 1 86.01 87.5
f96.51035
I
E�
0
LEVEL
INSTALLED 4 -BEDROOM SEPITC SYSTEM
1500 GALLON BTOCYCLE AWWTS
SHALLOW TRENCH ABSORPTION FIELD
TRENCH LENGTH 42 FEET
TRENCH WIDTH 5 FEET
EXCAVATION DEPTH 3 FEET
SEWER ROCK 2 FEET
fNSULATION 2 INCHES
COVER 2 FEET (MIN.)
10' T£LE & ELEC ESMT
1 L£ 7ELEC MT
NOT£.• SLOPES EXCEEDING n.V WERE NOT OBSERVED
WITHIN 50 TEST DOWN GRADIENT OF 1H£ PROPOSED
ABSORPTION FIELD LOCAl70N.
NOTE. THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC
LOL:ATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE
25 0 25 50 75 100 125 150
SCALE, 1' = 50 FL
Septic
Area
ISPURKLAND ENGINEERINGI I DONAHUE LOT I I ASEPTIC SYSTEM ASBUILTI
203 V 15TH. AVENUE TERESA BURNETT I BATE, AUGUST 7, 2012
ANCH, AK. 99501
(907) 279-3916 6100 MOOSE MEABOV LANE C1R., ANCHL1RA6E, AK 99516 SHEET' 2/4 6R1B+ 2638
IPERMIT # OSP121210 PIB # 015-494-0B BTINAHUEL1SC50-ASBBVGIf OSP121210 P1B # 015-494-08 Bl1NAHUEL1SC50-ASB.DVG
LEVEL LOT 1 I
\
\
D17NAHUE
SID
^
LEVEL
LEVEL
A
LUT 2
ED EXISTING SEPTIC
'
'ER UPC REOlI1REME
4-8DRM SF.
VACANT
SWING TIES I
A 1 B 1 C
C 37.0 19.5
D 1 86.01 87.5
f96.51035
I
E�
0
LEVEL
INSTALLED 4 -BEDROOM SEPITC SYSTEM
1500 GALLON BTOCYCLE AWWTS
SHALLOW TRENCH ABSORPTION FIELD
TRENCH LENGTH 42 FEET
TRENCH WIDTH 5 FEET
EXCAVATION DEPTH 3 FEET
SEWER ROCK 2 FEET
fNSULATION 2 INCHES
COVER 2 FEET (MIN.)
10' T£LE & ELEC ESMT
1 L£ 7ELEC MT
NOT£.• SLOPES EXCEEDING n.V WERE NOT OBSERVED
WITHIN 50 TEST DOWN GRADIENT OF 1H£ PROPOSED
ABSORPTION FIELD LOCAl70N.
NOTE. THIS IS NOT A SURVEYED PLAT. WELL & SEPTIC
LOL:ATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
APPROXIMATE
25 0 25 50 75 100 125 150
SCALE, 1' = 50 FL
Septic
Area
ISPURKLAND ENGINEERINGI I DONAHUE LOT I I ASEPTIC SYSTEM ASBUILTI
203 V 15TH. AVENUE TERESA BURNETT I BATE, AUGUST 7, 2012
ANCH, AK. 99501
(907) 279-3916 6100 MOOSE MEABOV LANE C1R., ANCHL1RA6E, AK 99516 SHEET' 2/4 6R1B+ 2638
IPERMIT # OSP121210 PIB # 015-494-0B BTINAHUEL1SC50-ASBBVGIf OSP121210 P1B # 015-494-08 Bl1NAHUEL1SC50-ASB.DVG
N.T.S
BloCycle Wastewater Treatment
O
5' X 42' Shallow Trench:
5' wide
42' Long
Excavation Depth 30'
2' Sewer Rock
2' Insulation
2' Cover (max.)
3/16' holes P 30 inches oz
4—BEDROOM RESIDENCE
NOT TO SCALE
BENCH MARK BOTTOM SIDING I' BioCycle Wastewater Treatment
SW HOUSE CORNER. ASSUMED ELEV. 100' B.O.H. ELEV=86.1
SPURKLAND ENGINEERING DONAHUE LOT 1 SEPTIC SYSTEM ASBUILT
203 W15th Ave T£RESA BURNETT DATE: AUGUST 7, 2012
Anchorage Ak 99501
279-3916 11 6100 NOOSE HEABOW LANE CBL, ANCHORAGE, AK 99516 SHEET, 314 GRIDi 2638
PERMIT if 17SP121210
PARCEL ID B 015-494-08
B0NAHU£L15W1D£-ASB.DWG
Municipality of Anchorage
e} Community Development Department - Development Services Division
P.O. Box 196650 - Anchorage, Alaska 99519-6650 - 4700 Elmore Road
f Info and Help: (907) 343-8211
,o« INSPECTION: Voice: (907) 343-8300 Fax (907) 249-7777
Inspection Report - Electrical
APPLICATION NO. RETROE121413
Master/Standalone Permit Permit Type: Electrical Res
Notes: Please Callao Meet. Requested by: William BrickweIL4,40-9351-brickwell.inc@gmail.com Schedule Date:08/20/2012
Preference:AM
Inspection #: 200918
Address of Project: 6100 M OSE MEADOW LA E CIR,' Parcel 0154 408000
Legal: DONAHUE LT 1 G2638
Description of Work: Add (1) circuit for bio -cycle septic system / tb
Contacts
Owner BURNETT GILBERT S & TERESA L -
Contractor (907)345-2923 BRICKWELL INC- BRICKWELL, WILLIAM P.— - -
Inspector Comments:
OAJ
Ins ector. i t� n �i
P Date: c � � � -,;;2o %� _
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP121210
Tax Code Number: 01549408000
Work Type: Septic Upgrade
Permit Effective Dates: August 01, 2012 to August 01, 2013
Design Engineer: SPURKLAND ENGINEERING
Subdivision: DONAHUE
Site Legal Address: DONAHUE LT 1 G:2638
Owner/Address: BURNETT GILBERTS & TERESA L
6100 MOOSE MEADOW LANE CIRCLE ANCHORAGE AK 995161733
Site Mailing Address: 6100 MOOSE MEADOW LANE CIR, Anchorage Lot Size in Sq Ft: 52696
Total Bedrooms: 4
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: The AWWTS Maintenance Agreement shall be submitted prior to approval of
the final inspection report.
Received
Issued By
MUNICIPALITY OF ANCHORAGE
Community Development Department
Development Services Division
On -Site Water & Wastewater Program
Mayor Dan Sullivan
ON-SITE SEWERIWELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. O(5- 494- CS
Phone: 907-343-7904
Fax: 907-343-7997
Property owner(s) TsaE.sq &meTT Day phone 242-1(444
Mailing address (otob ftloo5e n eAtxiw LAnE C?r. , Ancttoa c=. Ak 99sa.
Site address — 5AME —
Legal description (Sub'd., Block & Lot) DONAttuc. Lo -r 1
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms A
THIS APPLICATION IS FOR:
THIS APPLICATION IS AN:
(® all that apply)
Initial ❑
Absorption Field
Septic Tank
Upgrade 54
Tank
❑
Renewal ElHolding
Privy
❑
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
Permit/Rush Fees:
Date of Payment:W23/<11a
Receipt Number: ®a�Jva.�
Permit No. S10la Qo D
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
G:\Building\On Site\Fonns\Client FonnsTermd App_010411.doo (Rev. 1/11)
A-Ak SPuMand ��go�c�c�rro�g
Environmental Consulting and Design
SEPTIC SYSTEM DESIGN
DONAHUE LOT 1
Municipality of Anchorage July 19, 2012
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Rd.
Anchorage, Alaska 99519
Subject: Septic System Installation Permit
6100 Moose Meadow Lane Circle
Ladies and Gentlemen:
I am writing to request a permit to upgrade the septic system for the above referenced property. The
proposed system will serve a 4 -bedroom single-family residence. The existing system was installed in
1983 and is not functioning adequately. The existing tank and drain field will be abandoned per MOA
code requirements. Soil logs, design calculations, a site plan, design drawings and construction
specifications are enclosed for your review.
Design Calcs: Groundwater observed at a depth of 9.5feet below ground surface (7/9/12)
Soil Rating. From Test hole (7/2/12)
7.3 min./in = Max Application rate 3.0 gal per sq.ft./day
No. of Bedrooms 4
Required Area per Bedroom: 15013 = 50 sq.ft.
Minimum area required: 50 x 4 = 200 sq.ft.
System: We are proposing an BioCycle Advanced Wastewater Treatment System, and a shallow trench
absorption field. The absorption field will be 42 feet long, 5 feet wide and contain 2.0 feet (300 sq.ft.
effective) of sewer rock.
Soils: Three test holes were excavated on July 2°d, 2012. See the attached soil logs. Ground water was
monitored for through July 9, 2012. Ground water was observed at 5.5, 4.0, and 9.5 feet below the
ground surface.
Surface Water: No surface waters were observed within 100 feet of the proposed septic system.
Topography: No slopes greater than 25% were observed with 50 feet of the proposed drain field. The
ground surface slopes down towards the north at approximately 10% in the vicinity of the proposed drain
field.
Waivers: None required.
203 West 15`" Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
Ak Spuftland Eimohnew'plmg
Environmental Consulting and Design
The installation of this septic system will not prevent wells and septic systems from being installed on the
adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or
concentration of surface runoff will not result from this installation.
If you have any questions or concerns, please contact me at 279-3916.
Sincerely,
ars land, P.E.
Civil Engi
203 West 15"' Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
I
,II
Lr I
OT 4
I LOT 5
BIRCH
ROAD �I'S-T,e"LOTSMOOSE
MEADOW LANE CI LE
GAnta
,. 30' RDAD £SMT
I I
I
LOT 1 I
i
til I
EN
I
l y
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ell
a I
I W
IW
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UE
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_ 10' TELE &
—
— — — —
—
-----
10' TELE &
ELEC ESMT E�
�Se�tic /
r n
\
I
LOT 3 \
LOT 4
RA VEN WOOD SID
�P(
Its
NO1F.• THIS IS NOT A SURVEYED PUT. WELL k SEPTIC
��
LOCATIONS TAKEN FROM ON—SITE WATER AND WASTE WATER
AMF 4L'�•
le
4
th
DEPARTMENT DOCUMENTATION. ALL LOCATIONS SHOWN ARE
..........
...........
........A...
.
APPROXIMA TE.
/
/.... �.
/
........................y.
S SPURKLAND
.ro 0
50 0 50 100 150 200 250 300
SCALD I' = 100 FT
ISPURKLAND ENGINEERINGI I DOMMUE LOT I I (SEPTIC SYSTEM DESIGN
203 k X 99501 TH. AVENUE
ANCH, AK. TERESA BURNETT DATE, JULY 11, 2012
(907) 279-3916 6100 MOOSE MEADUW LANE CIR., ANCHORAGE, AK 99516 SHEET, 1/4 GRIDr 2638
I PERMIT # OSP1110XX PID # 015-494-08 DONAHUMSC100M I
LEVEL
1 �THI
LEVEL LLTr 1
DONAHUE
4-BDRM SF.
LEVEL
NOTE: SLOPES EXCEEDING 25% WERE NOT OBSERVED
A WRH/N 50 F££T DOWN GRADIENT OF THE PROPOSED
{Y� ABSORPTION FIfLO LOCATR1At
NOT£.• INS /5 NOT A SURVEYED PLAT. WELL d SEPAL
LOCA
TONS TAKEN FROM ON -SNE WATER AND WASTE WATER
DEPARTMENT DOCUNWA170AC ALL LOCATIONS SHOWN ARE
APPROMAN IF.
25 0 25 50 75 100 125 150
SCALE I' = 50 FT.
Septic!)
Area
S/D
2
VACENT
ISPURKLAND ENGINEERINGI I DONAHUE LOT I I ASEPTIC SYSTEM DESIGN I
203 V 15TH, AVENUE TERESA BURNETT I BA TE.- JULY 19, 2012
ANCH. AK, 99501
(907) 279-3916 6100 MDDSE MEADDV LANE CIR., ANCHURAGE, AK 99516 SHEEP 2/4 GRID: 2638
PERMIT # 0SP111OXX PID # 015-494-08 DONAHUELISCIOO.DVG
I
i
INSTALL 4-DEDROOH SEPAC
SYSMM
1500 GALLON B/OCYCLE AWWIS
'
SHALLOW TRENCH ABSORPTION FIELD
TRENCH LENGTH 41 FEET
T143
TRENCH WIDTH 5 FEET
EXCAVATION DEPTH J FEET (MAX)
k
SEWER ROCK 2 FEET
INSULATION 1 INCHES
1 FEET (MIN.)JL
Iln\YID
—COVER
—
10' ME & ELEC 54r
14Y TELE i ELEC ESMT
NOTE: SLOPES EXCEEDING 25% WERE NOT OBSERVED
A WRH/N 50 F££T DOWN GRADIENT OF THE PROPOSED
{Y� ABSORPTION FIfLO LOCATR1At
NOT£.• INS /5 NOT A SURVEYED PLAT. WELL d SEPAL
LOCA
TONS TAKEN FROM ON -SNE WATER AND WASTE WATER
DEPARTMENT DOCUNWA170AC ALL LOCATIONS SHOWN ARE
APPROMAN IF.
25 0 25 50 75 100 125 150
SCALE I' = 50 FT.
Septic!)
Area
S/D
2
VACENT
ISPURKLAND ENGINEERINGI I DONAHUE LOT I I ASEPTIC SYSTEM DESIGN I
203 V 15TH, AVENUE TERESA BURNETT I BA TE.- JULY 19, 2012
ANCH. AK, 99501
(907) 279-3916 6100 MDDSE MEADDV LANE CIR., ANCHURAGE, AK 99516 SHEEP 2/4 GRID: 2638
PERMIT # 0SP111OXX PID # 015-494-08 DONAHUELISCIOO.DVG
XT.S
BioCycle Wastewater Treatment
O
5' X 42' Shallow Trench:
5' Wide
42' Long
Excavation Depth 30' (max.
2' Sewer Rock
2' Insulation
2' Cover (max.)
3/16' holes P 30 Inches o.c.
4—BEDROOM RESIDENCE
NOT TO SCALE
BloCycle Wastewater Treatment
ISPURKLAND ENGINEERING I I DONAHUE LOT I I I SEPTIC SYSTEM DESIGN
203 W15ora Ave TERESA BURNETT DATE, JULY 19, 2012
Anchorage Ak 99501 6100 MOOSE MEADOW LNE CIR., ANCHORAGE, AK 99516 SHEETi 3/4 GRID- 2638
279-3916
PERMIT # OSPI110XXX
PARCEL IB # 015-494-08
BONAHUELIBEDBW6
SLOPE H'SHEO GRACE AM r
FROM TOP M ALL OIRECRONS
ADA"AS'SFR B' /
ALLOWSF'B' TO T-0'
'X (TOP TANK}
/1-1/4' PVC DISCHARGE
EFFLUENT ! 4'PLC B*LUENT
/
IrmDENr
r -o•z
4 Y
- 4
MA
ZR
o i AERA®RTINF
c CHAMBERCHAMBER
�
�
3
O 3i
CLARIFIER _ARGE
CHAMBER CHAMBER ; o .
V] ip
(BOTRAM OF TANK
/
2' BLUEBOARD INSULATION
4' SANO/ORA VEL
LOVEUNO CO/RSt:
COMPACTED
BIOCYCLE SYSTEM OPERA ANG WATER LEVELS
NTS
INSTALLA AON
1. EXCAVATE A 10' x 10' x 10' DEEP HOLE FOR BWYCIE SYSTEM.
2. PLACE A MIBMUM OF 4' SAND OR GRAVEL FOR LEU&" COURSE IN THE BOTTOM OF RIE EXCAVATION
COMPACT AS REOORED.
I PUCE 4 SHEETS OF 2' x B' x 2' DIRECT'XBAL RTOO INSULATION ON TOP OF COMPACTED LEKUNC COURSE
TO PROTECT BOTTOM OF FW?aASS TANK. TAKE EXTRA CARE TO ASSURE THAT WREARON COURSE IS LEVEL
IN ALL O/RECRONS
\\
* 1Nfall
..m`*
4. BACKFlLL AROUND TANK UP TO INVERT OF 4' INFLUENT AND I-1/4' EFFLUENT LNES NOH FREE-FLOWNO NSF
�� C� ... ...
me •• •,
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AND
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SPURKLAND ENGINEERING
DONAHUE LOT 1
SEPTIC SYSTEM DESIGN
203 V 15TH, AVENUE
TERESA BURNETT
DATEr JULY 11, 2012
ANCH, AK. 99501
(ann P79-391A
6100 MOOSE MEADOV LANE CIR., ANCHORAGE, AK 99516
SHEEP 1/4 GRID 2638
PERMIT # OSPI110XX PID # 015-494-08
DON4HUELID4.DV6
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www. ci. a nchoraae. ak. us
(907)343-7904
Soils Log - Percolation Test
Performed For: Teresa Burnett Date
Legal Description: Donahue Lot 1 Township, Range, Section:
Tta"3
Depth
15
16
17
18
19
ORGANILS
SILT LOAM
SILT (Tt2Av4LLY
SILT (GM)
GVAVCLLJ Silt/
SILT
w)
WAS GROUND WATER
Yes
Gross Time
C' t�ZO ENCOUNTERED?
Depth to Water
Net Drop
7/3/12
S
IF YES, AT WHAT DEPTH?
9.5'
L
Depth to Water Atter
7/3/12
D
P
Monitoring?
10'
E
Date: 7/9/12
7/3/12
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
7/3/12
9:27 AM
0 MIN
13.4375"
10.8750"
7/3/12
9:37 AM
10 MIN
13.0000"
2.5625"
12.5625"
7/3/12
9:47 AM
10 MIN
14.0000"
1.4375"
12.0625"
7/3/12
9:57 AM
10 MIN
14.1250"
1.9375"
12.5000"
7/3/12
10:07 AM
10 MIN
14.0000"
1.6250"
12.4375"
7/3/12
10:17 AM
10 MIN
13.9375"
1.5625"
12.3750"
7/3/12
10:27 AM
10 MIN
1.5625"
PERCOLATION RATE 6.4 (minutes inch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 3.0 FT AND 4.0 FT
COMMENTS PRE-SOAKED. -MEASUREMENT FROM FLOAT
PERFORMED BY: ANSON MOXNESS I L." , . CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL IDEL NES IN EFFECT ON THIS DATE. DATE: 6/19/2012
Municipality of Anchorage
Development Services Department
Building Safety Division
y�r On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchorace.ak. us
(907) 343-7904
Soils Log - Percolation Test
Performed For: Teresa Burnett Date
Legal Description: Donahue Lot 1 _ _ Township, Range, Section:
Tta" I
1-Iq1//! I OR0N10
Izle"161�alA
a
CCrr•t�StV,
of SAQ
-j�a0 in Jqn —�
17-
18-
19 -
COMMENTS -PRE-SOAKED. {
Site Plan
Reading
/
WAS GROUND WATER
9-
Depth to Water
ENCOUNTERED? Yes
7/3/12
S
10-
5.375"
IF YES, AT WHAT DEPTH? 6 L
6.625"
7/3/12
B,o,►� Depth to Water After o
11-
4.625"
P
Monitoring? 5.5' e
12-
7/3/12
Date: 7/9/12
13-
5.9375"
1.625"
17-
18-
19 -
COMMENTS -PRE-SOAKED. {
Site Plan
Reading
Date
Gross Time
Net Time
Depth to Water
Net Drop
7/3/12
9:29 AM
0 MIN
5.375"
6.625"
7/3/12
9:39 AM
10 MIN
4.625"
1.25"
6.25"
7/3/12
9.49 AM
10 MIN
5.9375"
1.625"
4.625"
7/3/12
9:59 AM
10 MIN
6.000"
1.1875"
4.625"
1 7/3/12
1 10:09 AM
10 MIN
6.000"
1.375"
4.625"
7/3/12
10:19 AM
10 MIN
6.0625"
1.375"
4.5625"
7/3/12
10:29 AM
10 MIN
1.375"
PERCOLA1 [ON RATE /.3 (minus finch) PERC HOLE DIAMETER 6
TEST RUN BETWEEN 3.5 FT AND 4 Fr
PERFORMED BY: ANSON MOXNESS I (!1J� CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUID LINES IN EFFECT ON THIS DATE. DATE: 6/19/2012
Municipality of Anchorage
Development Services Department
Building Safety Division
yi1 On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650 Anchorage, AK 99507
www.ci.anchoraae.ak. us
(907) 343-7904
Soils Log - Percolation Test
Performed For: Teresa Burnett Date
Legal Description: Donahue Lot 1 Township, Range, Section:
-rW I1Z
Depth
%/1 /1 dRirANICS
wJ C�isw)
SAAo
in &AAD
10-
11-
12-
13-
14-
15-
16-
17-
18-
19 -
13 o r WAS GROUND WATER
ENCOUNTERED? Yes
S
IF YES, AT WHAT DEPTH? 5' L
0
Depth to Water After P
Monitoring? 4' E
Date: 7/9/12
I Reading I Date I Gross Time I Net Time I Depth to Water I Net Drop
PERCOLATION RATE
TEST RUN BETWEEN
(minWesAmh) PERC HOLE DIAMETER
FT AND FT
PERFORMEDBY: ANSONMOXNESS I (A'ysi QM CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL IDE INES IN EFFECT ON THIS DATE. DATE: 6/19/2012
Spaftotimd Engomewumg
Environmental Consulting and Design
Single Family On-site Wastewater Disposal System
Construction and Material Specifications
Subject Property: DONAHUE LOT 1
Date: July 19, 2012
General:
1. The owner shall contract with a contractor to perform the work outlined in these
specifications and plans in accordance with the attached MOA permit. There is not
contractual arrangement between the contractor and the Engineer. The Engineer shall
be the owner's representative and will inspect the work to document the contractors
activities. Final acceptance of the contractors work rests with the owner and the MOA.
2. The scope of the project includes the procurement and installation of a 4 -bedroom on-
site wastewater disposal system at the location depicted on the attached site plan
drawings. The scope of the work also includes the installation of an BioCycle AWWTS
and a drain field comprised of 1 trench, 5 -feet wide x 42 -feet long, 3 feet deep, with 2
feet of septic rock below the distribution piping. The location of the drain field is shown
on the attached site plan drawings. The total depth of the field will be 3 feet below the
existing ground surface. All components of the proposed septic system must be
constructed a minimum of 100 feet from any surface water and 100 feet from water
wells in the area. A minimum of 4 feet of earthen cover is required over the septic tank
and a minimum of two feet of cover is required over the drain field. In addition to the
required earthen cover, 2 -inch thick, 40 psi, direct bury board foam shall be installed
directly over all installed piping.
3. Construction shall be in accordance with the approved site plan and design drawings and
any special provisions noted on the Municipal well and/or septic permit. All materials,
components, workmanship and construction practices shall comply with the Municipality
of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA,
Development Services Department, On-site Water and Wastewater Program (DSD)
policies.
4. The contractor is responsible for obtaining all underground utility locates, layout of the
proposed system, and verifying and maintaining all required separation distances to lot
lines, surface water, wells, steep slopes, etc.
S. The property owner shall be responsible for final grading any depressions formed from
settlement of backfill material. The property owner is also responsible for vegetation of
all areas disturbed by septic system installation activities.
6. Contractors installing wastewater disposal systems must be certified to do so by the MOA
DSD, On-site Water Wastewater Program. Property owners installing their own systems
must receive advanced approval from MOA DSD prior to system installation activities.
7. The contractor shall ensure that ALL materials being used are in compliance with the
most current guidelines established by the Municipality of Anchorage. Refer to
203 West 15`h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspur1dand@gci.net
,&_& SpurHand ENUOMBOT'ma
Environmental Consulting and Design
"Standards and Specifications for Component Parts and Materials Used in the
Construction of On-site Wastewater Disposal Systems", Dated December 2000, as
provided by MOA DSD, On-site Water and Wastewater Program.
Septic Tank Installation:
1. A new septic tank, of the size specified in the design drawings, shall be procured from a
qualified manufacture/supplier if the existing septic tank is found to be defective.
2. The burial rating of the tank shall be adequate for the actual burial depth encountered.
3. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank.
4. All standpipes on the tank shall extend a minimum of 12inches above the final grade.
5. Tanks installed with less than 4 feet of cover shall be insulated.
6. The sewer service line from the house to the tank shall have a minimum slope of 2%
unless prior approval is obtained from the engineer.
7. The inlet and outlet lines from the tank shall be bedded in drain rock or the soil shall be
sufficiently compacted to prevent future settlement of the soil.
8. Septic tank inlets, outlets and cleanouts shall be fitted with water tight couplings.
9. A cleanout shall be installed 1 to 4 feet from the foundation.
10. Post tank cleanouts shall be installed per MOA requirements. Does not apply to
pressurized lines.
11. In areas with high ground water, the septic tank shall be sufficiently anchored to resist
buoyancy forces when there is not adequate soil cover to resist uplift force. The
contractor shall refer to the engineer for direction regarding this matter.
12. The tank backfill shall be graded sufficiently to ensure positive drainage away from the
tank.
13. All holding tank and lift stations shall have an audible and visible alarm inside the
residence being served.
14. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform
Electrical Code. A municipal electrical permit and inspections must be obtained where
required by the MOA.
15. The contractor shall verify that the septictank/lift station is a minimum of 100 feet from
any residential water well, 150' from any class'C' well and 200 feet from any community
water wells. Additional separation distances must also be maintained.
16. The contractor shall remove or abandon the existing tank in compliance with the Unform
Plumbing Code.
Drain field Construction:
1. The drain field shall be excavated to the dimensions outlined in the design drawings. If
any discrepancies are noted, contact the engineer immediately for clarification.
2. The drain field shall be installed parallel to slope contours.
3. The bottom of the drain field shall be within 2" of level. If the sidewalls or bottom of the
excavation become smeared, they must be raked or scarified prior to the placement of
filter sand or drain rock.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
&.,-Ak SPLIT Old EROOMc BTEOng
Environmental Consulting and Design
4. The drain field must be a minimum of 5 feet from the test hole excavation.
5. Distribution pipe is to be installed level with perforations facing downward, atop a level
bed of drain field rock. Septic rock shall then be placed atop the distribution piping to
provide a minimum of 2" of cover, level across the entire width and length of the trench,
above the piping.
6. A silt barrier must be installed at between the final drain rock and the native soil backfill.
The silt barrier shall cover the entire drain rock surface.
7. Monitor tubes must be 4" in diameter, installed in the locations depicted on the design
drawings, and extend a minimum of 12" above final grade. The portion of the
monitoring tube below the septic rock must be perforated and the portion above the
drain rock shall be solid.
S. Backfill over the final gravel layer must not be less than 2 feet. Insulation must be
installed when the backfill depth is less that 3 feet.
9. Drain field back fill shall be mounded to prevent depressions from forming due to
subsequent settlement of backfill material.
10. The contractor shall verify that the drain field is a minimum of 100 feet from any
residential water well, 150' from any class `C' well and 200 feet from any community
water wells. Additional separation distances must also be maintained.
Inspections:
1. A minimum of two inspections are required by the Municipality of Anchorage. These
inspections must be conducted under the supervision of a Professional Engineer licensed
to practice in the State of Alaska.
2. The first inspection must be conducted after the excavation of the drain field and before
the placement of any gravel. The septic tank may be set in place, but may not be
balled.
3. The second inspection must be conducted after the placement of the silt barrier, gravel,
distribution lines, stand pipes, cleanouts, and insulation, but before the placement of any
backfill.
4. The contractor shall provide a legible copy of all field notes relating to system layout and
construction to the engineer for the use in preparing the record drawings.
S. The contractor shall coordinate all inspections with the Engineer. A minimum of 24 hours
notice is required prior to the start of construction. If necessary, a preconstruction
meeting will be held on-site.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
NEW
G C©N ST
'�Y3-5'710
F-1 UPGRADE
MAILING ADDRESS
C) ELVIN AV EE A;N(,H 03
LEGAL DESCRIPTION
D i ON V L'— d
LOCATION
NO. OF BEDROOMS
1154A Ave-
q
Well
Absorption area
Dwelling
PERMIT NO.
UY
DISTANCE T0:
Iq
14AN iY1R-JTT-,ff
i2
Manufacturer
12 TZ
Material
S
No. of compartments
W�
��L
Tlvc�
ti
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
�
Y
DISTANCE TO:
Well
Dwelling
PERMIT NO.
j a z
Z<
0K<
Manufacturer
Material
Liquid capacity in gallons
O
w =
DISTANCE TO:
Well Q
Foundation
Nearest lot ine
PERMIT NO.� �lrrEN
J LL z
No. of lines
Length of each 4ine
Total length of lines
Trench width
Distance between lines
P Z W
inches
H
Top to finish
Material beneath tile
Total
of tile grade���
/
effective � s�ptigarea
!f4
p
bl inches
Length
Width
Depth
PERMIT NO.
W
a
a F-
Type of crib
Crib diameter
Crib depth
Total effective absorption area
W 1
W
DISTANCE TO:
Well
Building foundation
Nearest lot line
Class
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
�
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
_
Lie
SOIL TEST RATING
310
INSTALLERIx
, ✓'
7-0W
REMARKS
F *:.49 •; r'
et °3i.•• JUNE 25, 197_U ••� ���
.� . . e�
•......• air
-L
A ��
APPROVED DATE LEGAL
-�-'
& 15� �o�
1'� e3
72-013 (Rev. 3/78)
L,
MUNICIPALITY OF ANCHORAGE
Department ,f Health and Environments Protection
825 L Street, Anchorage, AK. J9501
264-4720
# # # HANDWRITTEN PERMIT # #
Permit # WELL AND ON-SITE SEWER PERMIT
&�rMailin `F 7o
Applicant : � , ,�C , ,��•Q.,�/_.S'�' .,-t% 6 q Address: �-
Location: Phone Number:
Legal Description: / �o�/,¢,yty�� Lot Size:
Type of Soil Absorption System Is:
Trench: _ Drainfield: Seepage Bed: Holding Tank:
Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br)'
The Required Size of
DEPTH LENGTH
the Soil Absorption System Is:
� r
_ GRAVEL DEPTH WIDTH
The length dimension is the length(in feet) of the trench or drainfield. The
depth of a trench or pit is the distance between the surface of the ground and
the bottom of the excavation(in feet). There is no set width for trenches.
The gravel depth is the minimum depth of gravel between the outfall pipe and
the bottom of the excavation(in feet).
* * REQUIRED SEPTIC(HOLDING) TANK SIZE = �Z GALLONS #
Permit applicant has the responsibility to inform this department during the
installation inspections of any wells adjacent to this property and the number
of residences that the well will serve.
* # * TWO(2) INSPECTIONS ARE REQUIRED # #
Backfilling of any system without final inspection and approval by this department
will be subject to prosecution.
Minimum distance between a well and any on-site sewage disposal system is 100 feet
for a private well or 150 to 200 feet from a public well depending upon the type
of public well. Minimum distance from a private well to a private sewer line
is 25 feet and to a community sewer line is 75 feet. Well logs are required
and must be returned to this department within 30 days of the well completion.
Other requirements may apply. Specifications and construction diagrams are
available to insure proper installation.
* * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells as
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I u rstand that the on-site sewer system may require enlargement if
e nce is remodeled to include more that 3 bedr
Signet: Issued by.
Applicant
Date:
SWP/024(1/81)
,L 6-,,
01 is
PERFORMED FOR:
LEGAL DESCRIPTION:
DEPTH
(FEET)
1
2
3
4-
5
6
7
8
(MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION `� <ERCOLATIONE
TEST
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
DATE PERFORMED:
"l ' 43 j cje- 5 r5-lr A /f
t
SITE PLAN LC-,
9 I 111 1 1
11 WAS GROUND WATER S
ENCOUNTERED? 1 f 0
P
12 ,v y
r IF YES, AT WHAT
13
DEPTH?
14
Date
o
19
1`�9F
••..
m ---Tl
Pilo
20
15
••r
SOF A����
��
16
�'
•
17
•
s••N NHro •
18
�. r
COMMEN
Reading
Date
o
19
1`�9F
••..
m ---Tl
Pilo
20
1%�
COMMEN
Reading
Date
Gross
Time
Net.
Time
Depth to
Water
Net
Drop
m ---Tl
/,'30
00.
PERCOLATION RATE 3r;?•.r_(min(jtes/inch)
TEST RUN BETWEEN '� �' . AND
PERFORMED BY: t%rT w l ��{ CERTIFIED BY:%! _' c 11, , t- : DATE: /
O
72-008 (6/79) i
M sW DRILLIN,6, Inc.
P.O. Sox 10-378 • 1d300 Old Seward Highway
(907) 349-8535
ANCHORAGE, ALASKA 99511
DRILLING LOG
Well Owner SIT' "AR hANMIT Use of Well DrM8t:ic
Location (address of: Township, Range, Section, if known; or distance main road
Lot 1 Donahue- Subdivisi m
Size of casing 6 Depth of Hole 201 feet Cased to 198 feet
Static water level 167 ft. Cib-`i &) (below) land surface. Finish of well (check one) open end
Screen ( ) ; Perforated ( )
Describe screen or perforation ` mane
Well pumping test at 10 gallons per (IMY) (minute) for 1 hours with_ 10M, Wit.
of drawdown from static level.
Date of completion Y0. ZgS
WELL LOG
Depth in feet from
ground surface
Give details of formations penetrated, size of material, color and hardness
0 TO 2.
Casing stickm
2 TO G
On anis
G
`
_�
4 TOS
malty Z _
To
�
�1.8T0
5 6_TOhti1
5 71 nand
�I tv TO 1613
i.1 Y pXavel
168 To 1S 1
181 O---I(—)Q_
Si1t v clav
1(48 TO 2171 Wat er—hoarinvrs rnd
TO
lox? AV5
.---
TO
MVWA
erlj fi'r. i?a
TO �o�`. NI4 A. i
TO - -
3 — CONTRACTOR
Municipality of Anchorage
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904®
4�CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
A116 13 29 A
t
'lose <
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-494-08 COSA #�
Expiration Date: -
1. i GENERAL INFORMATION
Complete legal description DONAHUE LOT 1
Location (site address) 6100 MOOSE MEADOW LANE CIR., ANCHORAGE, AK 99516
Current Property owner(s) TERESA BURNETT
Day phone 242-9644
Mailing address SAME
Lending agency
Day phone
Mailing address
Real Estate Agent
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage ❑
Individual Holding Tank
❑
Community Class Well ❑
Community On-site
❑
Public Water System ❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and: may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater'disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Spurkland Enginneering
Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501
Engineer's Printed Name Lars Spurkland
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Phone 279-3916
Date AUGUST 8, 2012
of A4gs `1+
49
SPURKLAND
1)5,10
Vz
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By: _
(Rev. W05)
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date: 3-0-6—/2—
Municipality of Anchorage a>°`
• '� Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: DONAHUE LOT 1 Parcel ID: 015-494-08
A. WELL DATA
Well type PRI
Date completed 5/83
Total depth 201 ft
Date of test
Static water level
Well production
If A, B, or C provide PWSID #
Sanitary seal (YIN) Y
Cased to 198 ft.
FROM WELL LOG
5/30183
167
10
WATER SAMPLE RESULTS
ft.
g.p.m.
Coliform NEG colonies/100 mL Nitrate ND mg/L
Arsenic: ND ug/L date of sample: 6/29
B. SEPTIC/HOLDING TANK DATA .
Tank Type/Material BIOCYCLE/FIBERGLASS
Tank size 1500 gal. Number of Compartments 4
Foundation cleanout (YIN) Y Depression over tank (Y/N) N
Date of pumping NEW Pumper NA
C. ABSORPTION FIELD DATA
Date installed 8/2112
Length 42 ft.
Well Log (YIN) YES
Wires properly protected (Y/N) Y
Casing height (above ground) 12+ in.
AT INSPECTION
7/5/2012
164
3.3
ft.
9—
p.m-
Collected by: SPURKLAND ENG.
Date installed 8/2112
Cleanouts (YIN) MANHOLE
High water alarm (Y/N) Y
Soil rating (g.p.d./ft2 or felbdrm) 3.0 System type SHALLOW TRENCH
Width 5 ft. Gravel below pipe 2.1 ft.
Total depth 4 ft. Eff. absorption area 300 ft2
NEW
Monitoring tube Y Depression over field N
Date of adequacy test Results (Pass/Fail)
Fluid depth in absorption field before test_ in. Water added--- gal.
Elapsed Time:_ min. Final fluid depth — in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
For --- bedrooms
New depth-_ in.
Absorption rate >= --- g.p.d.
If yes, give date
D. LIFT STATION
Date installed 8/2/12
"Pump on" level at 25
Datum RIM
in.
E. SEPARATION DISTANCES
Size in gallons 1500
"Pump off' level at 45 in.
Cydes tested NEW
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100+
Absorption field on lot 100,+
Public sewer main NA
Sewer /septic service line
Animal containment areas
25'+
50'+
Manhole/Access (YM)
Y
High water alarm level at 22'5
Meets alarm & circuit requirements? Y
On adjacent lots
On adjacent lots
100'+
100'+
Public sewer manhole/cleanout NA
Holding tank NA
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5+ Property line 5+ Absorption field 51+
Water main NA
Wells on adjacent lots100+
Water service line 10,+ Surface water 100+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10+
Water Service line 10,+
Curtain drain 50+
F. COMMENTS
Building foundation 10+
Surface water 100'+
Wells on adjacent lots 100,+
Water main NA
Driveway, parking/vehicle storage 25'+
G. ENGINEER'S CERTIFICATION �Q'C.•�F... 9s !!!
J certify that I have determined through field inspections and
review of Municipal records that the above systems are in10 ..:'. Q . —...
conformance with MOA COSA guidelines in effect on this date. 0,
LARS SPURKLAND �� SPURKLAND; /
Engineer's Printed Name t p�
Date 8/8/2012
PP SIONP_^
COSA Fee $ H q (). a o Waiver Fee $
Date of Payment 9' 0.) 2, Date of Payment t- q o. D-0
Receipt Number D? r7 I Q C� Receipt Number -710 Q
(Rev. 4/10)
in.
(115th Avenue)
MOOS MEADOW LANE CIRCLE
q — — I
a
FY)
po
UNSUBDIVIDED
1.4
fence
0 Se060 11%r
N89055'50"E 120.93
ravel driveway
30' Road Easement
I
Wood fenGeJ%
2.0
LOT 1
------------------- T - -------
10' Telephone & Electric Easement
N89059'00"E 165.32
Lot 4, RAVEN WOODS SUBD.
SCALE: 1 "= 30'
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FB 12-4, pg 50-51
OF A4Q�j
- 4r
*.-'49TH*
.... ........
Fred walatka
No. 3255-S
<A�
BE
8372T
LOT 2
AS -BUILT NO CORNERS SET THIS DATE
'W
Well
.0 OH
C14
CNV 7.
C14
is
ce)
3.7-
2 Story
w
Fr
ree
00
1yoo
use
hed
20.0 0
0
A30.0
cleck
z
------------------- T - -------
10' Telephone & Electric Easement
N89059'00"E 165.32
Lot 4, RAVEN WOODS SUBD.
SCALE: 1 "= 30'
EASEMENTS OF RECORD, OTHER THAN
THOSE SHOWN ON THE RECORDED
PLAT ARE NOT SHOWN HEREON. FB 12-4, pg 50-51
OF A4Q�j
- 4r
*.-'49TH*
.... ........
Fred walatka
No. 3255-S
<A�
BE
8372T
LOT 2
AS -BUILT NO CORNERS SET THIS DATE
ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND
REPAIR AGREEMENT
MEMORANDUM OF UNDERSTANDING
BETWEEN MUNICIPALITY OF ANCHORAGE
AND
THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this
Q'? Day of of 2012-, by and between .jetzi �r
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Memorandum of Understanding agree as follows:
1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality
grants permission to Owner to utilize and operate an Advanced Wastewater
Treatment System (AW WTS), described as 0, b C Y c r located
at (,100 0100'56 m e AO- d L, ,� r C, 2[« Anchorage, Alaska.
2. Definitions.
A. Alteration. Any change to the design or function of anAW WTS that
Includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design. Prior to
performing any alterations to an AW WTS the owner must obtain a
Wastewater Disposal System Construction Permit from the Municipality
pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65.
B. Certificate of On -Site Systems Approval. An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with AMC 15.65.
These approvals certify that the systems are adequate for the homes that
they support and meet the codes that were in place at the time of system
construction.
C. Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
D. Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AW WTS that were included in
the original design which would allow the AWWTS to continue to
perform as designed.
E. Permit (Construction) An On -Site Wastewater Disposal System
Construction Permit as defined by AMC 15.65.
F. Permit (Operating) An Advanced Wastewater Treatment System
Operating Permit. An annual permit, issued by the Municipality, that
allows the Owner to operate an AWWTS, upon meeting all the
requirements of this agreement, the conditions of Operating Permit, the
requirements of the On -Site Wastewater System Construction Permit and
all relevant provisions of AMC 15.65
3. Fee. Owner shall pay to Municipality an annual fee of '?- ,_. ,
($ O.LX .00), payable on or before the issuance of the operating permit and annually
thereafter. The annual fee is due on or before the anniversary date of the approval by the
Municipality of installed system.
4. Term. The term of this Memorandum of Understanding shall be for the life of the
AW WTS.
The term begins on the date of approval by the Municipality of the installed system and
shall continue while the AW WTS system is in use or operational or until the property is
sold or title is transferred by owner and a new certificate of On -Site approval is issued to
the new owner or transferee of the property.
5. Alterations. Installation and Removal of Additional Equipment. Owner agrees
not to make any alterations, removal of parts or additions to the AW WTS without a
Construction Permit from the Municipality.
6. Maintenance and Repairs.
A. Throughout the term of this Memorandum of Understanding, the Owner shall
maintain AW WTS in good repair. In addition, it shall be the responsibility of the
Owner during the term of this Memorandum of Understanding, and any extensions or
renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2)
maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs.
Further, Owner agrees to comply will all applicable ordinance, laws, regulations,
rules and orders for the AWWTS.
B. Owner agrees to provide the Municipality a written schedule of routine
maintenance and repairs which have been performed on the system pursuant to the
terms and conditions contained in the Owner's AW WTS Operating Permit. This
schedule shall be submitted to the Municipality annually upon the renewal of the
permit. The schedule of maintenance and repair contained in the Owner's AW WTS
Operating Permit is:
C. Owner acknowledges that the fine schedule for failing to maintain and repair an
AW WTS are codified in AMC 14.60.
D. Owner agrees that only maintenance, repair personnel certified by the
Municipality will inspect and make any necessary maintenance, repairs or permitted
alterations to the system.
E. Owner agrees to grant the Municipality reasonable access to test and inspect the
AW WTS upon 24 hours written notice.
F. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
G. Owner agrees that the relevant provisions of the standard specification guidebook
for AW WTS is the governing professional guidelines for the construction,
maintenance and repair of the Owner's AW WTS.
7. Nonwaiver. The failure of either party at any time to enforce a provision of this
Memorandum of Understanding shall in no way constitute a waiver of the provisions,
nor in any way effect the validity of the Memorandum of Understanding or any part
hereof, or the right of such party thereafter to enforce each and every provision
hereof.
S. Amendment.
A. This Memorandum of Understanding shall only be amended, modified or changed
by a writing, executed by authorized representatives of the parties, with the same
formality of this Memorandum of Understanding was executed and such writing shall
be attached to this Memorandum of Understanding as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this contract, the only authorized representatives of the parties are:
Owner: J- AE m y L, r<T E 4- L. -
Anchorage: Purchasing Officer
C. Any attempt to amend, modify, or change this contract by either an
unauthorized representative or unauthorized means shall be void.
9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of
Understanding 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 Memorandum of Understanding.
10. Severability. Any provisions of this Memorandum of Understanding decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining provisions
of the Memorandum of Understanding.
OWNER:
By:
Date: 9' A06 ( 2
STATE OF ALASKA
THIRD JUDICIAL DISTRICT
MUNICIPALITY:
By:
Title:
Date:
ss.
The foregoing instrument was acknowledged before me this
20�, by ar-e_rr�Ali
NOTARY PUBLIC FOR ALASk
My Commission expires: 1 5 1 S
day of l ,
Municipality of Anchorage
-- Development Services Department
Building Safety Division
.� Onsite Water and Wastewater Program , t,
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995195650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015494-08 COSA # 09 0MO
Expiration Date: I I' 3 I— 0—CL
1. GENERAL INFORMATION
Complete legal description Lot 1, Donahue Subdivision
Location (site address) 6100 Moose Meadow Lane Circle Anchorage, AK 99516
Current Property owner(s) Charles and Fontaine Pearson Day phone
Mailing address 6100 Moose Meadow Lane Circle Anchorage, AK 99516
Lending agency Day phone
. Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSO for pickup.
2. NUMBER OF BEDROOMS: ThfBe (3)
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well (] Individual On-site
Individual Water Storage ❑ Individual Holding Tank ❑
Community Class Well ❑ Community On-site ❑
Public Water System ❑ Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also Issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval
are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my Investigation,
based on procedures outlined in the Certificate of Onsite Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Finn Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineers Printed Name Michael E. Anderson, P.E. Date 8122!2009
.•&): v
5. DSD SIGNATURE 0',�� tAM
�' • CE -4381
Approved for bedrooms. tI f `�Fe •� Z y
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory K_
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: - 3 � -09
(R.AIMS)
Municipality of Anchorage
Development Services Department
Building Safety Division .. ...
�— On -Site Water& Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 6650
www.muni.orglonsrg/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _ 1.5—W70-62
0'62 COSA# _
1. GENERAL INFORMATION Expiration Date: �g
Complete legal description DONAHUE LOT 1
Location (site address) 6100 MOOSE MEASOW LANE CIRCLE *ANCHORAGE, AK
Current Property. owner(s) GARY k LINDA COUTURE Day phone 346-2299
Mailing address 6100 MOOSE MEASOW LANE CIRCLE *ANCHORAGE, AK
Lending agency Day phone
Mailing address
Real Estate Agent NEIL THOMAS W/ COLDWELL BANKER Day phone 265-9106
Mailing address 3000 CENTRE STREET 101 *ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certiried 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 tiles and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines b Regulations. The reported results described the performance of the
system under Me conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party, is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
_U� Approved for 1-1 bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the filowing
Phone
337-6179
Date '91:) 47 to 8
�J: WATER AND
Attachments:
COSA Checklist _l� Arsenic Advisory
Septic System Advisory 1l Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Reort
Nitr a Advisory �^ Other
#a- I'M
Original Certificate Date: 49gA?
\ Municipality of Anchorage
y.
1 Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage. AK 99519.6650
www.muni.org/onsile
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: DONAHUE LOT 1 Parcel ID: OK= 9!�
9-409
A. WELL DATA
Well type MATE If A. B, or C provide PWSID# N/A
Date completed 5/30/1983 Sanitary seal (Y/N) YES
Total depth 201 ft. Cased to 198 ft.
FROM WELL LOG
Date of test 5/30/1983
Static water level 167 ft,
Well production 10 9.p -m.
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.
Arsenic: ,Lr ug./L.
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ In.
AT INSPECTION
9/12/08
162 ft,
6.87 g.p.m.
Nitrate-&nmg./L. Other bacteria 0 colonies/100 ml.
Date of sample: 9/12/08 Collected by: GEG Ltd.
Tank Type/Material SEPTIC/STEEL Date installed 8/1/1983
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) - N/A
Date of pumping 9/2/08 Pumper ANCHORAGE CESSPOOL PUMPING
C. ABSORPTION FIELD DATA
Date installed ' 8/1/1983 Soil rating (g.p.d./ft'o /bd 310 System type TRENCH
Length 124 ft. Width 3 ft. Gravel below pipe 5 ft.
Total depth *9.25 ft. Eff. absorption area 1240 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 9/12/08 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 40 In. Water added 680 gal. New depth 50 in.
Elapsed Time: 1120 min. Final fluid depth48 in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN if yes, give date —
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in. "Pump off' leve High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on tot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+
Public sewer main N/A
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main
N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
P
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION ' -' _
I certify that I have determined through field inspections and p a'.' y 1' ""'
'o
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this ..... .,,„
date. O J t Garn ss.
Engineers Printed Name JEFFREY A. GARNESSO04 r E— FFG
Date ! / 1 f O Pouf eealot'0\
COSA Fee $_
Date of Payment '0 9
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
\ Municipality of Anchorage
' Development Services Department �{
j Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
Septic System Advisory
Certificate of On -Site Systems Approval # 080341
During a recent adequacy test on the septic system for Lot 1 of Donahue
subdivision,
54 inches
of standing water was observed
in the absorption
field. This
indicates
that approximately 90% of the
absorption area is
inundated. Although this system passed the adequacy test, the remaining life
expectancy may be limited.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval
GARNESS ENGINEERING GROUP, Ltd.
- _ ' - .,.-, CONSULTANTS & GENERAL CONTRACTORS 1--_1• •- : ,..
October 6, 2008
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
P.O. Dox 196650
Anchorage, Alaska 99519-6650
Rcf.. Donahue, Lot 1. Inspected Septic System:
On 10/3/08 a G.E.G. Field Technician went out and re -inspected the drainfield that serves the referenced
property. Our inspection found that the liquid level was n 87.5 inches below top of pipe and per our initial
visit, the bottom of the lateral distribution line is ca 81.5 inches below the top of pipe. After the inspection we
spoke with the homeowner who mentioned his daughter was doing a considerable amount of laundry at the
time of the M.O.A. inspection, which could have resulted in the elevated levels in the drainfield. In short, the
system now appears to be functioning within the allowable operating level.
IW have 1 questions, please contact us at 337-6179. Thank you for your assistance.
P.E., M.S.
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259
Ph: (907) 337-6179 • Fax: (907) 338-3246' Websitc: www.gamesscngincering.coni
IIS r14 A,
1"•.5o I �`
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L' In the responsiblllty of the owner to deter•
lite the latstence of any easements, covenants or
aatrietlona which do not appear on the recorded
Jbdivlslon plan. Under no circumstances should
ny data hereon be used for new construction or
u establLhlnp boundary or fence limas.
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SGS Ref#
1085002001
Client Name
Garness Engineering Group, Ltd.
Project,,N me/B
DonahucLI
Client Sample ID
Donahue Ll
Matrix
Drinking Water
PWSID
0
Printed Date/Time
09292008 8:24
Collected Date rime
09/122008 14:10
Recehed Date rime
09/122008 16:15
Technical Director
Stephen C. Ede
Sample Rcmwks:
Allowable Prep Analysis
Parameter Results PQL Units Method Container ID Limits Date Date
Init
Metals by ICP/Ms
Arsenic
Waters Department
Total Nivatc/Nitritc-N
Microbiolocry Laboratory
Colony Count
Total Coliform
Fecal Coliform
ND 5.00
ND 0.100
0
0
0
ug/L
EP200.8
C
(<10)
0923/08 0926/08
NRB
mg/L
SM204500NO3-F
B
(<10)
0923/08
3DZ
col/100mL
SM2092228
A
(<200)
coV100ml.
SN1209222B
A
(<I)
coU100m1.
SM209222B
A
(<I)
09/12/08 DLC
09/12/08 DLC
09/12/08 DLC
W -A
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bmgaw Street
P.O. Box 196650
Anchorage, AK 99519.6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015- LiQy -M
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
COSA# CZP05q 1
Expiration Date: it -�I 3 ` OG
DONAHUE S/D• LOT 1
6100 MOOSE MEADOW LANE CIRCLE • ANCHORAGE, AK
GARY do LINDA COUTURE Day phone 346 12299
Ginn unnec ucennw IANC MRMF w ANCHMRAGF. AK
Day phone
NEIL THOMAS w/ COLDWELL BANKER Day phone 2659106
2525 'C' STREET • ANCHORAGE. AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
a
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
— Th MOrttctpallty oMehoraga DevelopmentServices'DepartmentjDSD)issues-Certificates-of On--Site-Systems—
Approval
nsite SystemsApproval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineers Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the b'me of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
Those conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
J� Approved for Li bedrooms.
Disapproved.
337-6179
Date 17 D C
Conditional approval for bedrooms, with the fllowing stipulations:
,Y OF��ii��
,o
)N -SITE
tTER_AN D
iTFWATFR
innn. u
01
Attachments:
COSA Checklist 9y7))��
----4rsenic Advisory _
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineers Reort
Nitrate Advisory Other
By,. Original Certificate Date: a ' 7 3— OCP
IRw, 11/ 1
Municipality of Anchorage
• Development Services Department
Bullding Safety Division
On-Ske Water & Wastewater Program
4700 Bregaw Street
P.O. Bax 196850
Anchorage, AK 99519-6850
www.muni.orglonstte
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLI
Legal Description: DONAHUE S/D: LOT 1 Parcel ID:
A WELL DATA
Wen type SATE If A, B. or C provide PWSID# N/A
Date completed 5/30/1983 Sanitary seal (Y/N) YES
Total depth 201 ft. Cased to 198 ft.
FROM WELL LOG
Date of test 5/30/1983
Static water level 167 ft.
Well production 10 —
9 -p.m -WATER SAMPLE RESULTS:
Coliform "4 0 oolonieW100 mt.
Arsenic: _UD–ug./L.
B. SEPTICIHOLDING TANK DATA
Nitrate -A–mgA.
I
Well Log (YM) I YES
Wires property protected (Y/N) YES
Casing height (above ground) 12+ in.
{
AT INSPECTION
8/4/2006
I
163 ft.
4.5 g.p.mi
I
Other bacteria 410 cotonies/100 ml.
Date of sample: 8/4/2006 Conected by: GEG Ltd.
* 8/ $/oce
TankType/Material SEPTIC/STEEL Data installed 8/1/1983
Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation deanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) I N/A
Date of pumping 7/14/2006 Pumper
ROTO ROOTER {
C. ABSORPTION FIELD DATA PRELOW IEXSnNO GMj
Data insWlled a/1/1983 Son rating (g.p.dJftbr� 310 System type TRENCH
Length124 ft. Width 3 ft. Gravel below pipe 5 ft.
i
Total depth 9.13 ft. Eft. absorption area 1240 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 8/4/2006 Results (Pass/Fan) PASS For 44 I bedrooms
Fluid depth in absorption field before test 34.5 in. Water added 665 gal. New depth 41 in.
I
Elapsed Time: 240 min. Final fluid depth 38.5 in. Absorption rate >= 600+ g.p.d.
I
Any rejuvenation treatment (past 12 mo.) (YM 3 type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at _in. "Pump ofl IT& water alarm level at in.
Cycles tested Meets alarm & circuit requirements?,
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAIR station on lot 100'+ On adjacent lots 100'+
Absorption held on lot 100'+ On adjacent lots 100'+
Public sewer main N/A
Sewer /septic service line 25'+
Public sewer manhole/cleanout N/A
Holding tank N/A
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 5'+
Curtain drain 'NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I car* that I have determined through fled Inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Data CJI t'11D b
COSA Fee S 7s*
Data of Payment g��o
Receipt Number
(R«. I IM)
Waiver Fee $
Date of Payment
Receipt Number
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dno the aeistence of any easements, covenants or
setrietions which do not appear on the recorded
jbdlvlslon plan. tinder no circumstances should
ny data hereon be used fur new construction or
it establLhlns boundary or fence ]laaa
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MUNICIPALITY OF ANCHORAGE 1
• '� DEPARTMENT OF HEALTH & HUMAN SERVICES
f
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # ) 1'S•- I -AO -� —ISR
1. GENERAL INFORMATION
HAA# WQ01'21C)�)Q 1
Complete legal description Loa ( ,Uo K A fl of Su B.
Location (site address or directions) /0100 MOOSE- MEA Dow
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well ✓
Community well
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
Community on-site
Public sewer
NOTE: 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
/AM CHot2AGE Ale
Property owner
NoRMAN +
ALICE GoM MELL
Day phone '_N4G- 3-ISq
Mailing address 6loo MoosE
MEADOW CANE, AMM.
Al< �tk5►�
Lending agency
NORWEST
Day phone 2-7fo- `lzso
Mailing address
2550 DFNAL( ANCH, Ak 99sa-3
Agent ' LoRET"CFl
PETERS
roRTVNE PROP.
Day phone 562- 7653
Address 2525
"C" ST
ANc4. Ak 99 503
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well ✓
Community well
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
Community on-site
Public sewer
NOTE: 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
Lis Vow MOBS (l6/l 'ABk!) SLO-LL
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IOU OP SHHO jo seeAoldw3 •sluawailnbei alels pue Impel ulelaao A4sl;es olaapio ul suollnlllsul 6ulpual alayl pue
sawo4;o siesepind of Asapnoo a se slyl saop SHHO a41 'eNSeld;o a1BIS a41 ul paaalsl69a aaaulbua leuolssaloid
luepuedepul ue Aq anoge 9 ydea6eied ul uanl6 suollelueseidej eqj uodn Aluo paseq saleoippeo Ienoiddy
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woa; paulelgo uollewaolul eql uo paseq )Byl Aluanaaylan; l `ulaaay paleolpul ainlonals;o adAl pue
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U33NION3 AS N01103dSNl 30 .LN3W31HIS '9
Municipality of Anchorage
MAIMLE
Department of Health and Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lo -C l poNA Hvg� SOB, Parcel I.D.
A. Well Data
Well type P'RI VAT F- If A, B, or C, attach ADEC letter. ADEC water system number
N , fl
Log present (Y/N) i Date completed 5 /30/S3 Driller M k/
Total depth 2 o i
Sanitary seal (Y/N) _
Date of test
Static water level
Well flow
Pump levell
Cased to 198 Casing height 24
FROM WELL LOG
5-10301 S3
167
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 12:3
Wires properly protected (Y/N)
AT INSPECTION
$ 1 18 J 93 MUNICIPALITY OF ANCHORAGE
IRONMENTAL SERVICES DIVISION
MUNICIPALITY OF ANC JV%UE
InONMENTALSERVILE � DIVISION AUG
g g.p.m.
2 4 1993
AUG 2 `:I W73' RECEIVED
RECEIVED
On adjacent lots > too
Absorption field on lot I $ TO C•o . ; On adjacent lots > iuo
Public sewer main ? lot Public sewer manhole/cleanout
Sewer service line = lou Petroleum tank NO KI I✓ o a s6ie v r b
WATER SAMPLE RESULTS:
Coliform D col /(loom a Nitrate a• 1 ry+ 2 Other bacteria neo e- r� ec>rleo(
Date of sample: 8119193 Collected by: FLAT-roP TcCN. svCs,
B. SEPTIC/HOLDING TANK DATA
Date installed S It � 8 3 Tank size 1250 Compartments Z
Cleanouts (Y/N) y Foundation cleanout (Y/N) y Depression (Y/N)
High water alarm (Y/N) N .A - Alarm tested (Y/N) N .A
Date of pumping 1/411s Pumper RoTo - ROOTER
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot 123 On adjacent lots -;7 loo' Foundation 19
N
To property line - 20, Absorption field to Water main/service line 50
Surface water/drainage > 00
72-026 (3M)• Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots
D. ABSORPTION FIELD DATA
Manufacturer
Manhole/Access (Y/N)
"Pump off" Level at
Cycles tested
Surface water
3 I o Ft_A3 DR M
Date installed 811113 Soil rating (GPD/Ft2) 0.48 GPD/ FJ_L System type TRENcH
Length 12 4 ' Width 3 ( Gravel thickness S1 Total depth 9
Total absorption area 12 y0 Cleanout present (Y/N)
Date of adequacy test 8 118 � 193 Results (pass/fail)
Y Depression over field (Y/N) N
PASS for
4 Bedrooms
Water level in absorption field before test 2 � After test 31
Peroxide treatment (past 12 months) (Y/N) tont E K N DwN If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 1 o 8 On adjacent lots
-> loo'
Property line
To building foundation 3 -7' To existing or abandoned system on lot NA,
On adjacent lots > So' Cutbank NA A • Water main/service line > 20'
Surface water > 100
Curtain drain WtAE ossEP✓6 a
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
Is
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
drys •o b � � • �AA
Signature %►
•]'�1:�
.
;!
Engineer's Name ThcooOorc %: P'Icor,�
�� ;•••...:....•:`....•,.,�.��
a, .<THEODO„E
Date e/ 2 y 19-?
F. 6,1GORE 41
^,..,-. Q_353,? F1
Pw
HAA Fee $
Waiver Fee $
Date of Payment
Date of Payment
Receipt Number �� b %5/% ���
Receipt Number
72-026 (3/93)' Back
COMMERCIAL TESTING & ENGINEERING CO.
eENVIRONMENTAL LABORATORY SERVICES
l L:
SINCE 1906
PEPORT oli. ANAI*,YSTS 5633 B STREET
C" I i e rt i I a b Ref. 93 , 4 i 36-4ANCHORAGE, AK 99518
Client t,.,ample IP I.1 D',-)NAH(jF SUR BACK HOSE BIT) TEL: (907) 562-2343
Mat'. r i WATER FAX: (907) 561-5301
( , 1 i e W ft N;--, "'il e. -PLATTOP TECHNIMAL SRV
WORK Order-
1-,,"665
"tu(Jeret"i 13y
j�e-
port
Project Name
Coi.lccted
:08/16/9'1
@ 10:00 h-r�4.
Pro je(JAV
Rec:e' j Ved
0 12:10 hrs,
P 1W <0 T f j :UA
Techrdc.,31- Director,�;TEPIJEN
C:.
Dr-':
Role 'A By
Sample Reimo k- -. ROUTINE SAMPLIL' COLf.ECTED BY - C14RI S.
Q(' Allowable Ext. Anal
Piiramet.er 1-4esults Qual Units Method kimits Date Date In t
N' , Ltrate- 11 0.10 H mg/L ETA 353.2P00.6 10 08/18 1:1.114
'See 'Specj,�-.il Tri,tructicn��, Move UA 'UnavaiJ.able
See S,mvqpl�*� Rentarks Above HA = Not Analyzed
11 Undeteved, Reported iaiue i,-, the qmnt if lu---it im 1.1.1wit. I.A! [.,eso; Than
I) Se,.-.-emdary ch'hition. GT Grc'ater Than
(WIGS Member of the SGS Group (SociLR6 G6n6rale de Surveillance)
AEO
ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA
Time
APPLIC
NT
FILLS OUT UPPER HAI ONLY
Time (
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Property OwneC
j
Phone
Date
Date
Date
Date z
Inspector
Inspector
Inspector
Inspector
Mailing Address
Zip Code
Buyer
MUNICIPALITY OF ANCHORAGE
pQ ii'
HC/`f
IO.N'
Address
dC
Zip Code
0 G 1 2 `s J
Lending Institution
RECEIVED
( `j) APPROVED BEDROOMS "CONDITIONS OF APPROVAL
Phone
Address �(( dG {2
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l �._)C{ i-! Zip Code
Realty Co &Agent
DATE
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Phone
Address
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Q
Legal Description
Well to Tank a
Septic Tank Size Z s
t-` ? /t i [ `.
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t..,1 ( e 0. (;") Or t.'I
Street Location
Type of Residence
N Single Family
❑ Multiple Family
No. of Bedrooms
❑ Other
Water Supply
Q" Individual
ATTACH WELL LOG. A well log is required for all wells drilled since June 1975.
❑ Community
For wells drilled prior to that date, give well depth (attach log
if available).
❑ Public Utility
Sewer Disposal
(; Individual
Year Individual Installed:
❑ Public Utility
When Connected to Public Utility:
❑ Holding Tank
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
Time
Time
Time
Time (
�c�
ryS,tG�
Date
Date
Date
Date z
Inspector
Inspector
Inspector
Inspector
Field Notes: ., � `} ,
"`�`"�-
MUNICIPALITY OF ANCHORAGE
pQ ii'
HC/`f
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N
ENV IROtifJiLN-IAL PROROTcCTIOtj
dC
ex c.t o
0 G 1 2 `s J
4,C)
RECEIVED
( `j) APPROVED BEDROOMS "CONDITIONS OF APPROVAL
( ) DISAPPROVED
( ) CONDITIONAL APPROVAL'
DATE
Soils Rating
Date Sewer InstalledWell
To Absorption Area t 09
Well Log Received
Q
3
Well to Tank a
Septic Tank Size Z s
72023 (3182)
1