HomeMy WebLinkAboutDRAKE BLK 3 LT 2BDrake
Block 3
Lot 213
#017-462-13
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Pump Installation Log
Well Drilling Permit Number: _______________ Date of Issue: ____-____-____
Parcel Identification Number: ____-____-____
Legal Description Block Lot Property Owner Name & Address:
Pump Installation Date: _____-_____-_____
Pump Intake Depth Below Top of Well Casing: __________ feet
Pump Manufacturer’s Name: ___________________________ Pump
Model: _____________________________________
Pump Size: ____________hp
Pitless Adapter Burial Depth: _________ feet
Pitless Adapter Manufacturer’s Name: _________________________
Pitless Adapter Installer: ____________________________
Well Disinfected Upon Completion?;;<HV No
Method of Disinfection: _____________________________
Comments:
Pump Installer Name: __________________________________
Company: ___________________________________________
Mailing Address: ______________________________________
City: ___________________ State: __________Zip: _________
Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation.
017 462 13
DRAKE 3 2B
WORMAN MICHAEL BROOKS & ELIZABETH
3120 MERGANSER AVE
ANCHORAGE, AK 99516
03 20 2023
50
GOULDS
50C2118212
.50
10
MARTINSON
PELLETS
ANCHORAGE WELL & PUMP SERVICE
7640 KING STREET
ANCHORAGE AK 99518
Municipality of Anchorage
On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP211452 PID Number: 017-462-13
Dwelling. ❑E Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New FEI Upgrade
Name
BRITTANY NERLAND
ABSORPTION FIELD
❑ Deep Trench ❑ Wide Trench 0 Bed ❑ Mound
Site Address
3120 MERGANSER AVE *ANCHORAGE, AK 99516
❑ Other
Phone
Number of Bedrooms
Soil Rating
depth from original grade
907-351-4726
**'`4
*2.0 GPD/SF
JTotal
SEE DWG. Ft_
LEGAL DESCRIPTION
Depth to pipe invert from original grade
SEE DWG. Ft.
Gravel depth beneath pipe
0.52 Ft.
Subdivision Block Lot
DRAKE; BLOCK 3, LOT 2B
Fill added above original grade
SEE DWG. Ft.
Gravel length
20 Ft.
Township Range Section
N/A
Gravel width
18 Ft.
Beds: Number of Lines
3
Distance between lines
6 Ft.
SEPARATION
DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
360 Ftz
'
Ft.
Well
*50'+
*50'+
*50'+
-
25'+
TANK ❑ Septic N S.T.E.P. ❑ Holding ❑ Other
Manufacturer Capacity
ANCHORAGE TANK 1500 Gal.
Surface Water
*50'+
*50'+.
*550'-1-
_
Material
Number of compartments
Lot Line
*5'+
*5'+
*5'+
-
NA
STEEL (EPDXY)
2
Foundation*1
�'+
*1 �'+
*1.0'+
-
LIFT STATION
Manufacturer
Capacity
Remarks *AWWTS**SECOND COMPARTMENT OF STEP TANK
ANCHORAGE TANK
**5500 Gal.
-SEE 40 SCALE FOR 4 BEDROOM DRAINFIELD SIZING CALCULATIONS
Alarm location
REMOTE MONITORING
Electrical installed by
CAPSTONE
Installer
PIPE MATERIAL House to tank D3034 Tank to
drainfield
A+ HOME SERVICES
Drainfield D3034 CO/MTD3034
Inspector GEG AND MOA
BENCH MARK (Assumed elevation) 100.00 ft
Inspdection 15` 1/5/2021 2 n 1/10/2021
ocation and description
aro 1/10/202 4`h 1/11/202
[FRONTDOOR THRESHOLD
ON-SITE WATER AND WASTEWATER SECTION APPROVAL
Engineer's Stamp
X060 �
Conditional Approval: Date�9S��Q
-. 0
�..... y. ... ..--....... D
_ . ...
`ness:
Septic System
Approved -� `r 20
e A. G '
Q y 1p
C �-. o
��— Date
z00�4 f I. ,; z:z.,-'-• � o0
Note: this approval does not include well permit requirements.
4000 O(O'
AEc'884
�.. ..nvu 101
PERMIT NUMBER: PARCEL NUMBER:OSP211452 RECORD DRAWING 017-462-13
A I B
FCO
51.2
3.0
MH1
51.9
16.1
MH2
53.7
20.0
VP1
54.0
21.7
Al
56.0
27.1
VP2
57.8
31.2
MH3
58.7
33.0
C01
41.5
83.6
MT1
39.3
82.0
CO2
50.7
95.0
MT2
52.2
96.9
CO3
46.0
89.3
MT3
45.0
93.3
C04
50.1
76.9
MT4
30.6
78.1
DRAKE;.BLOCK
3, LOT 2A
MERGANSER AVENUE
- - - - - - - - - - - - - - - - -
EXISTING PRE;SURE
THE RESERVE SITE WILL BE REBUILDING
THE NEW DRAINFIELD IN PLACE
4 BEDROOM DESIGN CRITERIA:
NUMBER OF BEDROOMS: 4
GALLONS PER DAY (GPD): 600
PERCOLATION RATES: '<1 TO 22 MIN/INCH
PROPOSED APPLICATION RATE: "2.0
MINIMUM DRAINFIELD SQ.FT.: 300 FT'
:PER TESTHOLES IN MOA RECORDS
"AW WTS
4 BEDROOM DRAINFIELD DESIGN:
MAXIMUM DEPTH: AS NEEDED FOR
REMOVAL OF CONTAMINATED MATERIAL
WIDTH: 18 FEET
LENGTH: 20 FEET
M.O.A. APPROVED SAND FILTER: AS NEEDED TO
REBUILD THE EXISTING FIELD AT AN ELEVATION
OF 0.1' HIGHER THAN THE EXISTING BED
EFFECTIVE: 0.5 FEET
ACTUAL SQ.FT.: 360 FT'
NEW
JIM VAULT-/
)U TREATMENT
DRAINFIELD
/-DIRT PLUG PER
CONVERTED TO 4" LINE PRIOR TO DRAINFIELD
DRAKE; BLOCK
3. LOT 2C
EXISTING 3
BEDROOM
HOUSE
O 0
FC.
NEW 1500 GALLON EPDXY COATED STEEL TANK
APPROXIMATE LOCATION OF WATER LINE
PROFESSIONALLY LOCATED DURING
f INSTALLATION BY DERIC HART WITH
f "ARCTIC EFFLUENT' \
%1 \
I
- N
SCALE:
I \ 1"=40'
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1� i� •t� E-753
�®LICENSeO�.�ROFESS
#AECC 84 ®d�gN•'a®gyp®
ENGINEERING- SALES � CONSULTING
3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE. AK 99507' PHONE (907) 3376179 • FAX (907) 338-3246 • WEBSITE w.vw.9.��%.�9u+eenny wm
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
BRITTANY NERLAND
907-351-4726
2 OF 3
LEGAL DESCRIPTION:
DRAWN BY:
DRAKE; BLOCK 3, LOT 26
D.J.G.
TYPE OF WORK:
DATE:
SEPTIC SYSTEM RECORD DRAWINGS
1/13/2021
�..... .. .................•d
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1� i� •t� E-753
�®LICENSeO�.�ROFESS
#AECC 84 ®d�gN•'a®gyp®
PERMIT NUMBER:
OSP211452
TOP OF TANK
AT INLET = 94.22
INVERT OF BUNG
AT INLET = 93.64
TOP OF MANHOLE #1 = 98.66 TOP OF MANHOLE #2 = 98.65
GRADE = 98.52-98.63
24" INSULATED MH RISER
2" INSULATION PER
CONTRACTOR
-- ----------------
57"
---- ----------
57" - 1572
GALLONS
45" MINIMUM
WATER LEVEL
TOP OF MANHOLE #3 = 98.52
FROM NS500
PIPE INVERT AT INLET = 94.90 —/
WEEP
1500 -GALLON EPDXY COATED STEEL SEPTIC TANK
DRAINFIELD
PUMP VAULT
rFINAL GRADE = 98.48
TO DRAINFIELD
— TOP OF TANK
AT OUTLET = 94.20
INVERT OF DISTRIBUTION PIPE = 99.80
80% RETURN
BOTTOM OF PUMP VAULT = 90.45 BOTTOM OF OLD DRAINFIELD ELEVATION
(FIELD MEASUREMENTS) = 99.18-99.22
INSULATION PER CONTRACTOR
. .............
NEW NS -500 AEROCELL TREATMENT POD
1.5" SCH. 40 PVC
FEED LINE
PARCEL ID NUMBER:
017-462-13
20% O PUMP VAULT
FINAL GRADE = 102.79-103.29
' BOTTOM OF EXCAVATION ELEVATION = 98.28
INSULATION PER CONTRACTOR
FILTER FABRIC
0
Z
W
Z
(D
>-
N
ti
N
p
m ,Lf)
W
X—
Z
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.-
w m
w
O
z
a
a
a
o
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okif
RECOMMENDED FLOAT SETTINGS
(FROM BOTTOM OF TANK)
cr
• TIMER OVERRIDE = 55"
• HIGH WATER FLOW= 54"
• LOW LEVEL CUTOFF (ON/OFF) = 46"
W�4 1
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r W -J
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i
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BOTTOM OF BEDITOP OF SAND = 99.28 .
I
' ®0
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®00 �' effrey . �e s :�wm
♦ % CE- 953
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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
poBox 1y66s 40oElmore Road
Anchorage, Alaska mys19'anno Phone: e04 Fax: (o0r)o43-ryn7
»np://wwpw.mun|.unn/onoite
O0 -Site Wastewater Disposal System Permit
Permit Number: OSP211452 Effective Date:
Work Type: Septic Upgrade Expiration Date:
Tax Code Number: 01746213000
Site Legal Address: DRAKE8U{ 3 L 2B G:2834
Site Mailing Address: 3120 MERGANSER AVE, Anchorage
Owner: NERLANDBRITTANY N&TAYLOR C
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
R1 Disposal Field ZSeptic Tank [] Holding Tank [] Privy
11U0/2O21
11/1D/2022
Lot Size in8qFt: 3300
Total Bedrooms: 3
171 Private Well OWater Storage
All construction shall beinaccordance 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 (1OAAC8O)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.S5.Provide nudfiootionbycalling (9O7)343-7SO4(24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall beeither:
a. Opened and Closed onthe same day, or
b. Covered, sealed, and heated 10prevent freezing
�����
Issued By:
MUNICIPALITY OF ANCHORAGE
Development Services Department __ Ir Phone: 907-343-7904
On -Site Water & Wastewater Section Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 017-462-13
Property owner(s) BRITTNEY NERLAND Day phone 907-351-4726
Mailing address 3120 MERGANSER AVE *ANCHORAGE, AK 99516
Site address 3120 MERGANSER AVE *ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) DRAKE; BLOCK 3, LOT 2B
Legal description-jownship, -Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(Z all that apply)
Absorption Field
0
Initial ❑
Single Family (SF) M
(w/wo ADU)
Septic Tank
[-XI
Upgrade M
Duplex (D) El
Holding Tank
El
Renewal
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A WAIVER REQUEST FOR:
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: -9,575-, Waiver Fees:
Date of Payment: 10/� Sa0c2 I Date of Payment:
Receipt Number: 5 9 3 66 Receipt Number:
Permit No. 0 S Pd- i y 5 a Waiver No.
GAIDevelopment ServicesXBuilding Safetyk0n Site Water and Wastewatefforrns\Client FormsTermit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211452, Deb Wockenfuss, 11/10/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211452, Deb Wockenfuss, 11/10/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211452, Deb Wockenfuss, 11/10/21
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP211452, Deb Wockenfuss, 11/10/21
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: 5W y2-6 f 3'y PID Number: n1__1 -'" gtt)Q — 13
Name:
,;, 6
Wastewater System: New ❑ Upgrade
e, /17. /- I r- r) -e-,
Address: /►., n
ABSORPTION FIELD
Phone: No. of Bedrooms:
3 _/ c1 -15 K +
❑ Deep Trench ❑ Shallow Trench ❑ Bed I� Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth fromoriginal grade:
GPD/Sq. Ft.
Lot: Block: Subdivision:
Z 01 �7
Depth to pipe bottom from original grade:
%�
Gravel depth beneath pipe
f
}ter^d� C G�
Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length:
_
1 I Z N
31 Ft.
C, C) Ft.
WELL: tj A ❑ New ❑ Upgrade
Gravel width:
iii `
Number of lines:
Distance between lines:
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Ft.
Ft.
f .3'YO SQ. Ft.
". � " I" n v% -
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
Ft.
7 / 1611 Z-.
Yield:
Pump Set at:
I I
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION DISTANCES
kSeptic ❑ Holding ❑ S.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer: r
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
AA C4 c:14
Well
fCC r
fGc=
iUL�
�,A
N,A,
Material:
Siac(
Number of Compartments:
Z
Surface
Water
10,c?
f-
A
LIFT STATION
Lotr
Line
y(}
a
J 0
%lei
ti A
N I\
Size in gallons:
2 SG
Manufacturer:
Ac,,, I,.
,
:
,
Foundation
7 �
is
!
I
!L A
N.A,
"Pump on" level at:
fl.14 `
"Pump off' level at:
S,w�
High water alarm at:
3:f. ,
�I,3
Curtain
! i'v a
f �,C,
4+�
a !
Pump Make & Model
Electrical Inspections performed by:
Drain
IV , /r
lT
1 c V 4%1 r. C .^
Remarks:
Et o5
�E BENCH MARK
Location and Description: ((� �11
N.E. Cc �C
-o N.` t31 + ; t0 O pOb
Assumed Elevation:
EENTAt' *tt
491—H 11
1001
Inspections performed by: 14en j G.�� /0 tU ,,n-o'Dates: 1st 7
2nd c) J
00 400044181
0 '
44.4444444 •-•.4.•s0 64•e4e4�
ftp r S. Me
•.`
#6353 •'�
Department of Health and Human Services approval
�Gttl`t �3
p`0FE 5
Reviewed and approved by: ��1''� I� Date: �Z
72-013 (Rev. 9/91) MOA 25
Permit No.
Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description LOT 2B, BLOCK 3 DRAKE SUB'D PID No:
HOME
HOME
/ p O
,ry M
C/L MERGANSER AVE.
M .1
52.7 1400se
53.3 Lcl 28
MANHO
6.5
CIO.
TANK DETAIL
LOT 2A
HOME
1" = 50'
urt N 89'59'59• E 110.00'
K5 m««, TBM E = 100.0'
— TBM OTTOM OF SIDING AT HOUIE CORNER.
� z
5W LF
/New 1500 gal sep
tank w/lift sta.
SEE TANK DETAIL
LOT 2B
LOT 2C;
GENERAL NOTES
1) ELEVATION OF M = 100.00
2) ELEVATION 0 REPARED GROU SURFACE AT BED = 98. ��•�\F OF q����lil
3) ELEVATION F ABSORPTION FIELD ISTRUBTION PIPING= 00.4 '�� ;.
4) WATER T LE ELEVATION (6-6-92 = 94.30' 9 ��
70 5) CLEv TION OF (3otto✓rl M0NI ORru6 TU J = 98 �I
C r y S.. Mey
E-635 ��
S- 5-92 3:42 PM ;ANCHORAGE TANK & WELDING INC
907 277 3715;# 3/ 3
OSI ® I ASA
NET DISCHARGI'E; GPM
DRAWING NO. 3
ASSEUSLE'D LIFT STATION TANK
£ /Z #!4TL£ LLZ L06
ONI DNI07SM n }MVJ HLOV'iOHONV! Hd ZV:£ Z6-9 -8
PAGE 1 OF 1
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT
PERMIT NUMBER:SW920134
DESIGN ENGINEER:ARCTIC SLOPE CONSULTING GROUP
OWNER NAME:LIEBNER KEVIN M
OWNER ADDRESS:3120 MERGANZER AVE
ANCHORAGE, AK 99516
PARCEL ID:01746213
LEGAL DESCRIPTION: DRAKE BLK 3 LT 2B
SEC 28, T12N, R3W, SM
LOT SIZE: 33000 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
DATE ISSUED: 6/16/92
EXPIRATION DATE: 6/16/93
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS: -,qle, l j / r"T s��CL/%u����r `t"4S`w77o�
RECEIVED BY: ft2i tel?. DATE: Co lue,I?z
ISSUED BY:
L ! DATE:
June 9, 1992
Mr. Dan Roth
Municipality of Anchorage
Dept. of Health and Human Services
825 L Street
Anchorage, Alaska 99501
Re: Septic System Approval
Lot 2B, Block 3, Drake Subdivision
Dear Mr. Roth:
Attached is the permit application for a septic system on the above referenced lot. Below is a
narrative of probable impacts to adjacent properties.
1. Wells - There are no existing wells within 100 feet of the proposed new septic system.
2. Wastewater System - The proposed system will have little effect on the future fields on
the lot and adjacent lots.
3. Reserved Space - A future field could be placed to the south of the house on the lot.
This system would also have to be a mound system due to groundwater.
4. Drainage - The lot fairly flat (2-5 %). Positive drainage away for the field will be
maintained. No concentrated surface water will be directed toward the field and no
existing streams are within 100 feet of the proposed field. Ground water will be 4 feet
under the field and will be draining away from existing and possible well sights on the
lot.
The installation of this on-site system will have no probable impacts to adjacent well or septic
systems. The proposed system's separation distance radius will include parts of adjacent lots,
but will not interfere on-site systems on these lots.
V truly yours,
Carey S. eyer, .E.
Sr. Civil ngin
CSM: KMA:1110-0026
R: Carey $. Oyer
�c9••. ,,�' rr
Permit No.
Page I of I
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description LOT 2B, BLOCK 3 DRAKE SUB'D PID No:
LOT 2A
0 0
1" = 50'
0
0
M M
att u /N8 9'59'59' E 110.00' a TN Z
G 10.0•FR N. 9EIBA b
OM b
a 7ei I
10.0'
N. 1 s?3
N. OF 1,12! S.F.
�ru�osc� F,;c ISI
o.0l1
a Tt4�� ao«a ro,
u ,Lo•
o\ SWQE F-1
.\ HoW >
F
5 i �� s; -S
Eem
r.K JI'^ �
D
Wre:
1) ItAL PAL 2' or ireso LAMP
ow? PIPE cRossjw< Pets vA�!
At•L PIPE FRom TANK To FtfkO
SHALL HAY 41
Nn cur ,K cifa;.+5 yr sFkr m S
wd 2G0 of ��v(�o61! d
4L em
PRePo:ED %
�tPt �0
(JPoPcs�d �O
�5
i Sao G Sep{; Tu^ k'
T� LOT 2C
LOT 2
�0
OP
O 0
OF
O.
01.
9th
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Meyer i
�j�G�353
l
it
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7
'ermit No. Page 1 of 1
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description LOT 28, BLOCK 3 DRAKE SUB'D PID No:
AREA OF SEPTIC
MIN. OF 1,125 S.F.
3:1
B'
A 55' 1
3' 3'
MONITORING TUBE
DISTRIBUTION LATERALS 3'
6• 1-1/2* 0 PERFORATED PIPE 6.
3.1 CC) 3'
9. IfnECTION TUBESITYP.) 3;1
4 f SOLID PVC PPE N/END CAP
6'
'-MONITORING TUBE
3:1 A 3 3
V N 6•
ABSORPTION BED PLAN VIEW
NOT TO SCALE 20'R E C E I V E
3:1
9'
CLEANOUT TO LIFT STATION J U N 16 1992
(TYPICAL)
Municipality of Anch rage
MONITORING TUBE
-SLOPE 70 DRAIN Dept. Health & Human ervices
��
SOIL BACKFILL
2 MIN.
1. f RIGID INSULATION I
31 Y MIS 1 + 3•
12 (MIN)
LEI MMIIT�SVATOIF
EXISTING
N
GROUND
1-1/7' 0 PERFORATED PIPE 4
WATER TABLE
SECTION A—A
NOTES:
NOT TO SCALE
OF���>1�, 1)
1. CONTRACTOR TO VERIFY MIN. S0. FOOTAGE PRIOR TO PLACING TOPSOIL. � �
32. . CAUTION SHALOLNBEATAKENTTO MNIMIZEEREMOVAL CFE EXISTING PERMIT. .`�
VEGETATION OUTSIDE OF SEPTIC AREAS. '`P, • • • • • •,'� ///
4. AREA SHALL BE SEEDED TO PREVENT EROSION. G! •' 9 /
i //
4.9th .••••••.••
p '• Ca S. Mey i
P —6353
//
/// F'�' �•'••.....•••'• FSG`'
DATE: 6, Its lgz- SHT.: OF �
PREPARED BY: iCg A
SUBJECT:
Pe
ARCTIC SLOPE CONSULTING GROUP, INC.
Engineers • Architects • Scientists • Surveyors
PROJECT WO -002-6 - OZ !
C4 30 9prn e.aGly h G aCG. epTs 0,( 9PM
W iA / 7
._ .
l� cacl a s a�
JUN 16
5 u ►
Cipality of
Dept.i u
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i
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1
S. Mer
ci3,•i• 6353
nc�ccinrlA-
301 Danner Avenue • Anchorage, AK 99518-3035 • PHONE (907) 349-5148 • FAX (907) 349-4213
A subsidiary of Arctic Slope Regional Corporation
h
•
DATE: SHT.: OF ARCTIC SLOPE CONSULTING GROUP, INC.
PREPARED BY:
SUBJECT: Engineers • Architects • Scientists • Surveyors
PROJECT:
7ANIK SrZS
3 /3pR�'IS k� �SC3 GPD,}S13jq
R C-0 L) 1 /3 A-Rfa
ela. y
EN
301 Danner Avenue • Anchorage, AK 99518-3035 • PHONE (907) 349-5148 • FAX (907) 349-4213
A subsidiary of Arctic Slope Regional Corporation
SUBURBAN PRINTING
ARCTIC SLOPE CONSULTING GROUP, INC.
ILJ Engineers • Architects • Scientists • Surveyors
301 Donner A -.w Anchorage, Alaska 99518-3035
Telephone: (907) 349-5148 Fax: (907) 349-4213
SOILS LOG — PERCOLATION TEST
`)?OF SS14N�'�
PERFORMED FOR:bC ✓: ✓l nn L i e bn t /` nn T f s T d o L E A/ DATE PREFORMED: / 7
LEGAL DESCRIPTION: L Z /J A /k 3 . !J ru S /,o Township. Ranee. Section: % /Z A) 1, 4 3 W S eG. Z 6
SLOPE SITE PLAN
- - - (.rr 0tv '1r�Gs
1- V I
�eEG �GGcttiO.�t
2-
4 a 5Vol t sand
3_
4 �aM v r No le-
5-
G5-
6-
6-
7-
7-
8-
8-
9-
WAS
9-
WAS GROUND WATER S
10- ENCOUNTERED? S L
IF YES, AT WHAT DEPTH? N , S r 0
11- P
Depth to Water After g
12- Monitoring? 4, 0 Date z
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
5� Dl4
/2;
O
i/1 Ir
rb
Q2;A
31 Al
7 V6
:.Sq
D: n
6 q// G
1t r,
' z
0Mi
PERCOLATION RATE 2 0 M l"/,',) 1(minuteshnch) PERC HOLE DIAMETER Co
/�
� TEST RUN BETWEEN Z FT AND )12 FT
COMMENTS Pl r— Sore k to i or 7 houpe ,
PERFORMED BY: H en ALItC P Mk A CAk&4 M81 -44z -P— CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:I ��� z
ARCTIC SLOPE CONSULTING GROUP, INC.
Engineers -Architects *Scientists -Surveyors
301 Danner Avenue Anchw"s, Alaska 99518-3033
Tslphone: (907) 349-5145 Fes: (907) 349-4213
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: Ae 'l L; e bq e,- I e J B o l e A 7, DATE
LEGAL DESCRIPTION: L_ 2 /3,P /3 I k Al 41-41s t .5,j 6 . Township. Rance, Section: T l 2 N 0 )Q 2 GN , eJ &G 26
SLOPE
3 _,CLAI eN 50YA5 SANG
4- n(1
�rn 6
olTu
I4o(c
s
6-
7-
8-
9 -
WAS GROUND WATER
10- ENCOUNTERED? Yes
IF YES, AT WHAT DEPTH? H, 5
11-
12-
13-
14-
15-
16-
17-
18-
19-
20 -
Depth to Water After /
Monitoring? y L S Date L
S
L
0
P
E
SITE PLAN
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
15130112
2;5
0
5 '12-
G
It '1
y; 20
3o
l
3 7/8"
I ;/@
1l it
25
r,
1 7 31411
(q,
"
x.55
30
�11c
m'I /- ll
PERCOLATION RATE 2 2 i A (minutes/inch) PERC HOLE DIAMETER _(Q^
((�� aII TEST RUN BETWEEN I 11Z. FT AND Z. FT
N
COMMENTS re.So(<e A far 7 %ou/'s
PERFORMED BY: 4W 4CAMAN CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5
ARCTIC SLOPE CONSULTING GROUP, INC.
Engineers - Architects - Scientists - Surveyors
301 Donna' Avenue Anchorage. Alaska 99519-3035
Telephone: (907) 349-5149 Foy: (907) 349-4213
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: 1 ,e 6 e,, I l E ST 1lvLE *3 DATE PREFORIvffiD�!tO7S 2
LEGAL DESCRIPTION: 2 Alk I Dea k E Township, Range, Section: % l2l�,f�. R 3 LU Ste Z 6
SLOPE SITE PLAN
0RGANttS
Pe c, Teif
3-SANp cu/same GRAVIzL
I' nn
6_ /3npom ero�G
7-
9 -
Gross
Net
Depth to
WAS GROUND WATER S
10-
Date
ENCOUNTERED? Ycs L
Time
Water
IF YES, AT WHAT DEPTH? G, D ` O
11-
P
7 '4
Depth to Water Afterg
I� I5Z
12-
Monitoring? 5 , 0 d Date
13-
3-
14-
15-
16-
17-
18-
19-
20-
14-15-
16-
17-
18-
19-
20-
COMMENTS
COMMENTS
PERCOLATION RATE O. i P"41%'l (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 2 V2 FT AND 3 FT
PERFORMED BY: K EN AI a 1-4 M, Ac k rc A M A• N i C AR E V M E7 Y 9 R CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5/-3014 2
Gross
Net
Depth to
Net
Reading
Date
Time
Time
Water
Drop
7 '4
O
Z
12:50
5
/7/�
G„
3
12; 5o
O
7 ''Iz-
0
N
i zr55
5
05/6
5 "16
5
1 2:6S
0
6 �1/1
0
G
1:00
5
1
5 3w
7
1,
1:00
0
7 tit
0
1:6S
5
1 5/6
5 s/
9
i: 0 5
O
7 3/6
O
to
''
) :10
5
I 7/6
5 Yz
PERCOLATION RATE O. i P"41%'l (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 2 V2 FT AND 3 FT
PERFORMED BY: K EN AI a 1-4 M, Ac k rc A M A• N i C AR E V M E7 Y 9 R CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5/-3014 2
Pa9 c Z o�Z
ARCTIC SLOPE CONSULTING GROUP, INC.
Engineers - Architects a Scientists a Surveyors
301 Danner A— Anaharoge, Moeka 99518-3015
Telephone: (907) 349-5148 Fox: (907) 349-4213
SOILS LOG - PERCOLATION TEST
pR0FESSS�I���?►
PERFORMED FOR: e % e DATE PREFORM D: (3 2
LEGAL DESCRIPTION: l 2 Q 3r kra l<G S j0A -'V;G;0' Township, Ranee. Section: T /Z N . R 3 w , s r c 2,6
SLOPE SITE PLAN
DEPTH
(FEET) I I I T
1-
3-
4-
5-
6-
7-
3-
9-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
-
10-
11-
12-
13-
14-
15-
16-
17-
18-
19-
20-
COMMENTS
WAS GROUND WATER S
ENCOUNTERED? L
IF YES, AT WHAT DEPTH? 0
P
Depth to Water After E
Monitoring? Date
PERCOLATION RATE 0, 9 ';�41 (minutes/inch) PERC HOLE DIAMETER /� 0
TEST RUN BETWEEN Z V7- FT AND 3 FT
PERFORMED BY: ._(f1Ed1Uj7'!i A1. ACK l--Am,+N I 6AR L y RIC Yt lq CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S Lin I9 Z-
Depth to
Water
PERCOLATION RATE 0, 9 ';�41 (minutes/inch) PERC HOLE DIAMETER /� 0
TEST RUN BETWEEN Z V7- FT AND 3 FT
PERFORMED BY: ._(f1Ed1Uj7'!i A1. ACK l--Am,+N I 6AR L y RIC Yt lq CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: S Lin I9 Z-
MA'Y-29-92 THU 15:05 FLATTOP TECHNICAL-
P.03
�w R...
pppp
y
"6N INCd 98rn7,1 _-
.................
.:,..�
e Municipality ofAnchorage
0
DEPARTMENT OF HEALTH & HUMAN SERVICES
"
�
�TIICOUu,.i i,
�+' •.�
/
826 L" Street, Anchorage, Alaska 99502-0650
Cl• • ;�;,,.
��rlpn►t�...
�r
$OILS LOG -- PERCOLATION TEST
'
J-mwa1
"erg
`4
rig
i-
PERFORMED FOR: _ .yi n L.l �' J/7�P r" �� �
_ .
DATE PERPORMID: l
LEGAL DESCRIPTION: L„��._ L'�J:� L71�btl�e �/D Township, Range, S6CtI0n� 'r" r'$,/�(,
DEPTHp SLOPE SITE PLAN
S ri Roweduh ramy GaaM
2 rt '
3
4
5 Many Co hb��r
6
12
Gra�Y Sy ll�rSand'
WAS GROUND WATER
ENCOUNTERED?
13 d' my
M4 SctADt y
14patn,S
Mtar 10041 m
16
. I.
17
18-
19-
20-
r
819204
s
IF YES, AT WHAT5,5 rS�Z��i2 O
DEPTH? .r.R�..�.^.....,,w.. P
u'-8" t�14�91 E
Depth to Water Atter DI -011 t 0./ia f4 I
Mooltorinp7 111.9" Date, 111teesi
srrr7o� C�tCte
,P
PERCOLATION RATE (mmutoe/Inan) PERO HOLE DIAMETER _. .
TEST RUN BETWEEN FT AND FT
PERFORMED BY: 15101 khol ncA 9 4. e. I CGRTIFV THAT TH13 7EST WAS PSPv ORMED IN
ACCORDANOE WITH ALLSTATE AND MUNIOIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72.008 (Adv. 4/85)
17 * ARCTIC SLOPE CONSULTING GROUP, INC.
u Engineers • Architects • Scientists • Surveyors
301 Donner A~n Mchoroga, Alaska 99518-3035
Tdphons: (907) 349-5148 Fox: (907) 349-4213
SOILS LOG - PERCOLATION TEST
(ENGINEER'S SEAL)
50f& IT FDR-
(NC7 Vi,k tDf IraU
dil1?-?05e3 601-1
PERFORMED FOR: K c v j ,,t h t b n e ,^ TG s� 14 o l e- 04-S DATE PREFORMED: A//6/,F?-
LEGAL DESCRIPTION: L 0 2- l3 D, --k- Slo Township, Range, Section: % /Z/t.J t A 3 w� S eG Z
SLOPE SITE PLAN
DEPTH
1-
3-
4-
�� i
5-
6-
7-
9-
10-
11-
12-
13 -
-
79-10-11-12-13- a
19-
20 -
COMMENTS Pl g- Sp a K rd tui` /Z
WAS GROUND WATER S
ENCOUNTERED? /V L
IF YES, AT WHAT DEPTH? 0
P
Depth to Water After
Monitoring? Z, 5 Date b It /%Z E
Reading
Date
Gross Net
Time Time
Depth to
Water
Net
Drop
5, i% 30 M ;'n
A
PERCOLATION RATE 2 ] '14.1 (minutes/inch) PERC HOLE DIAMETER �
TEST RUN BETWEEN A/ FT AND V 11P FT
PERFORMED BY: K�FAFA1 FZ il4 M, /i L K E R #7AN I e' -A R I Y MC ?E R CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 5/30 /1?-
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
ti aW Al
PHONE
t�lq—Lf/, J
D NEW
55-11I%'6RADE
MAILING ADDRESS
LEGAL DESCRIPTION
L-. RKF_
LOCATION
NO. OF BEDROOMS
V Y
DISTANCE TO:
Well
Absorption area
Dwelling
PEaMIT NO.
66 V a
aZ
Q
ur l.-
Manufacturer
1
x k s r l
Material
No. of compartments
y
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
Y
,jaZ
DISTANCE TO:
Well
Dwelling
PERMIT NO.
O z F
Manufacturer
Material
Liquid capacity in gallons
O
LU
DISTANCE TO:
Well
Foundation
Nearest lot line
PE T N
�( 8b_
H u. W
No. of lines
Length of each line
Total lengt oUfflines
Trench wi tlA /��(
—kdnches
Distance between lines
HM
O
Top of tile to finish grade r
Material beneath tile
inches
Total effeAive absorption area
Q
w
0
Length
Width
Depth
PERMIT NO.
a H
wa
Type of crib
Crib diameter
Crib depth
Total effective absorption area
W
DISTANCE TO:
Well
Building foundation
Nearest lot line
J
J
Class
Depth
Driller
Distance to lot line
PERMIT NO.
WW?
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
SOIL TEST RATING
1 �
T
INSTALLER �Q
R
Q
1
L.
REMARKS
1
5
APPROVED
�.
DATE LEGAL
�;-- n+
jj!��
111
72-013 (Rev. 3/78)
I
' LA
M U r-4 I � I' "=IL. I -r V (--IF= F4 rA C " F=1 C3 FE '
DEPARTMENT uy HEALTH AND ENVIRONMENTAL f,,0TECTION
.825 "L" STREET, ANCHORAGE, AK 99501
264-4720 V
C -j N I TE !S EE t4 E: FR Fj�' FE F?_ 1-11 -r (J-D&J-1
PERMIT NO. 800124 &D. i
lk- -
APPLICANT ROBERT A. BROWN SRA BOX 1542X 99507 -Aj-sK_,(l_a49 4135
LOCATION A 0
LEGALN LOT SIZE 3300 SQUARE FEET
R W W-1
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 175
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
DEEF:*-F-"= :1_k3 L-FEN13-r"= Me 13F�F-IVE:L_ 71
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).
F?. e 0 U I F;;?- e 0* _43 e F=" -r 10 -T F=l N K "-=; I a e - �L 1-7100 0 F4 L_ L_ 0 N -c:;
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.
--- -rWSCI <;2 > I "4_5 F=" FE 1C. -r I W-3 N <-; F4 F;;','e FR. e � U I FZ E: U> - - -
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 15
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 15 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTALLATION.
f=*'E=FZM I -T- [-=XF=* I FZIEE:E; ENIEECEEME�aFZ MA - JL ___,4e 10
I CERTIFY THAT
1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 2 BEDROOMS.
Losak -------------------------
- 41,47-4
SIGNED: WPLICANT R - BERT A. BROWN
By_!� ---------- - ----- .___DATE_ V4. 0-
n
December 31, 1979
825 L" STREET -
ANCHORAGE, ALASKA 99501
907} )54-4111
Robert A. Brown
Star Route A Box 1542X
Anchorage, Alaska 99507
Permit m 790509
Subject: Lot 2B Block 3 Drake Subdivision
A permit issued by this department for well and/or sewer
system has expired.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
If an engineer has inspected the installation of the
on-site sewer system, please have them send us the as-bu.ilts
for our files.
If there are any further questions, please contact this
office at 264-4720.
Sincerely,
%
Les N. Buchholz,R.S.
Senior Environmental Speci st
LNB/ljw
enc: Copy of Permit
DEPARTMENT HEALTH AND ENVIRONMENTAL ITE: CT I ON
825 STREETv ANCHORAGE, AK. 9b__l
264-4720
C, r-4 »»--'= u 11 i" FE "_�F- F-::-- tJ F-:_ F-' F-" E_.`. :1::.`T_PERMIT NO. ( 790509 )
-
APPLICANT ROBERT A. E=:F*'OWN SRA BOX 1' �4'2X 349 41 .i
LOCATION GANDER ST.
LEGAL L 2 B E: RAF.::E ' /D LOT SIZE 33000 SQUARE
T`•r'PE OF 'OIL.. HBSORBT I ON SYSTEM TEM I S : TRENCH
MAXIMUM NUMBER OF BEDROOMS = SOIL RATING (SQ FT•/BR) = 175
THE REQUIRED SIZE OF THE 'SOIL ABSORPTION SYSTEM I S :
Cx IE:.'E F..." " F N, 4 =: .".... 1 _» IW �N a e _� 1-$ — - a-� A� FTFA l E= l...».. E.-" E = =" 7"
THE LENGTH DIMENSION I S THE LENGTH 0N FEET) OF THE TRENCH OR DRA I NF I E:L_ D.
THE DEPTH OF A TRENCH OR PIT 15 THE DISTANCE BETWEE: N THE:: SURFACE OF THE
GF::iwt►.atdD AND THE BOTTOM OF: THE EXCAVATION 0N FEET).
THERE IS NO SET WIDTH Few R TRENCHES.
.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GF~'AVEL.. BETWEEN THE OL_►TFAL..L.. PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
1 1 �'-' E" Cx ^"> E F--• -r' T -13=11402 S I u " W : flL. n I C3 C3 C! Fl G........ R....».. CA r4 "_.
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM RM THIS DEPARTMENT NT D!»ERING THE
INSTALLATION INMPECTIOC• S OF ANY WELLS ADJACENT ACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
IF 1.4 9..l C-_ 2Z -".A 114 "a F" E � 3 IT T #::I�-� '� � t -==r IFS` Es FZ El C-:! C3 11: r.-*.-,, _.._ _..........._....
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION Hf' D APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT BJE CT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A !•`BELL... AP'D ANY Y ON -•.SITE SEWAGE DISPOSAL S'•r`STEn M :E
j,(; 0 FE='•E=.T- FOR H PRIVATE WELL; OF!
150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE: TYPE : OF PUBLIC WELL.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE.
AVAILABLE TO INSURE ►._ RE F'E:OPER INSTALLATION.
F:-" F=
GAAB-HD.I GR ER ANCHORAGE AREA BOROL
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
1q / MAILING 187 7 -
NAME CJ l�E_SE" __, ____ ADDRESS—'3'
�� 'r1L1tYC 4-2 `16 PHONE
LOCATION tt l'Mf1 & LEGAL DESCRIPTION <-CI.T_ �3 Aci}JC,t 's"
SEPTIC TANK:
NUMBER OF
DISTANCE FROM WELL / MATERIAL S�c1c?K zS h t_�_. COMPARTMENTS
LIQUID CAPACITY 1661) GALLONS. INSIDE LENGTH INSIDE WIDTH
SEEPAGE SYSTEM:
SEEPAGE PIT:
LIQUID -
DEPTH
f ,
NUMBER OF PITS a`g —OUTSIDE DIAMETER OR WIDTH_ ___! -!K' , LENGTH 1- DEPTH %
LINING MATERIAL /�i DISTANCE FROM WELL / BUILDING FOUNDATION
i
NEAREST LOT LINE 1G ___— TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELL
NUMBER OF LINES
ABSORPTION AREA
FOUNDATIO
DISTANCE BETWEEN LINES
SQ. FT. LENGTH OF EACH LINE
NEAREST LOT LIN
TRENCH WIDTH
TOTAL LENGTH
OF LINES
IN. TOTAL EFFECTIVE
DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE
WELL:DISTANCE FROM hROP WATER
TYPE dibil/ hk111LD DEPTH (a (� -,BUILDING FOUNDATION._ SAMPLE / AIG NEAREST
NEAREST SEPTIC i SEEPAGE I OTHER �,UC'
LOT LINE ��% '� , SEWER LINE , TANK 196 SYSTEM__ 690 CESSPOOL Akb_'G , SOURCES X%(''ti
DISTANCES:
0// Ccw /ro;i
Le,ei'h Pidd 10
DIAGRAM OF SYSTEM
/DATE
G.A.A.B.
GREA I t,R ANCHORAGE AREA BOR,�,JGH
DEPARTMENT OF ENVIRONMENTAL QUALITY
3500 TUDOR ROAD POUCH 6-650
ANCHORAGE, ALASKA 99502
TELEPHONE 279-8686
SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT
> _ n i
PERMIT NO.f-�Ie?e
z77-OiOY
NAME OF APPLICANT ;iiii-
"', "-- (�(//J�/�,{/n
G ,gtV4M�j/'"'�"�
MAILING ADORE55
- - PHONE
INSTALLATION LOCATION
11
LEGAL DESCRIPTION Wr
�-
�!
INSTALLATION OF: SEPTIC TANK '"
PIT IV
DRAIN FIELD OTHER ,
f.Q;rFjPAAGE
TYPE AND SIZE OF FACILITY TOBESERVED
%
�1l�
FINANCED THROUGH L
-r
TO B5 INSTALLED BY
/1
SOIL TEST RESULTS
��
NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
COMPLETION DATE ANTICIPATED
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE I�W TYPE ✓�c wl _ SEEPAGE AREA SIZE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK
FOUNDATION TO SEEPAGE PIT f DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL �J
SEPTIC TANK , SEEPAGE PIT C DRAIN FIELD
TO NEAREST LOT LINE. /
WELL TO SEPTIC TANK D SEEPAGE PIT `
DRAIN FIELD ALSO CONSIDER AREA WELLS.
WATER MAIN TO SEPTIC TANK SEEPAGE PIT ,
DRAIN FIELD
SEPTIC TANK, o SEEPAGE PIT `� DRAIN FIELD ,
TO RIVER, LAKE, STREAM.
CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF
EXCAVATION 5 FEET INTO UNDISTURBED SOIL.
4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT
FITTED WITH AIRTIGHT REMOVABLE CAPS.
GRAVEL BACKFILL��
CONFORM TO BOROUAr�.REGULATIONS REGARDING INSTALLATION
V
HEALTH UTHORITY
OR
LICENSED DESIGNER
n
h
TYPE
DIAGRAM OF SYSTEM
1 CERTIF TH I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AR OROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE
DESCRIB SYSTE IS IN ACCORDANCE WITH SAID CODE.
DATE-`` LICANT'S SIGNATURE .-.-
j R&M ENGi► -iEERING & GEOLOGIC.-., CONSULTANTS
229 EAST 51st. AVE. — P.O. BOX 6081 — ANCHORAGE, ALASKA 99503
TELEPHONE 907-279-0483 TELEX 090-35419
Civil Engineers Geologists Land Surveyors
JAMES W. ROONEY, P. E. RALPH R. MIGLIACCIO
MALCOLM A. MENZIES, P.E., L.S.
Engineering Geoiogist
JAMES H. WELLMAN, P.E.
June 13, 1972 R & M No. 26515
Mr. Ken Wilson
Wilson Excavating
P. O. Box 4-623
Anchorage, Alaska 99509
RE: Test Hole and Soil Log Report for Sanitary System
Lot 2B, Block 3, Drake Subdivision
Dear Mr. Wilson:
We are submitting herewith results for a second test boring completed at
the subject site.
The second test hole was put down approximately 60 feet southwest of
TH I within the Lot 2B area for the purpose of further defining general
subsurface soil conditions for the proposed sanitary system. Excavation
for TH 2 was accomplished with a tractor -mounted backhoe and the test
hole was extended to a total depth of 12 feet below ground surface. Iden-
tification of the soil strata thicknesses and respective Unified Classifi-
cation symbols are shown on the boring log.
Ground water was not encountered in the test hole.
We appreciate being given this opportunity to be of service to you. Should
you have any questions with regard to the above, please do not hesitate
to contact us.
Very truly yours,
R & M ENGINEERING & GEOLOGICAL CONSULTANTS
/James W. Rooney
JWR:wwb
E nclo sure
cc: Greater Anchorage Area Borough
RECEIVED'
JUN 14 "S14 RM
GD6PTEOF ENVIRONMENTAL QUALITY
R ANCHORAGE AREA H
ANCHORAGE FAIRBANKS JUNEAU
a
T.H.-2
6-8-72
0.01
ORGANICS
2.51 '
4.0'
SILTY SANDY GRAVEL (GM)
Grey
6.5
SANDY SILT (ML)
Grey
'
9.0'
SILT W/ SOME GRAVEL
Grey, dense (CH)
na
L
12.01
No water table
Note : Hole excavated with tractor mounted backhoe.
t
Daniel Weise Property
_!ngineering 8r Geological Consultants LOG OF TEST HOLE
NCMORAOE PAIR9ANX9 ALASKA JUNEAU
Anchorage Alaska
DATE 6-8-72 SCALE I" =2' OWN BY GAW CHKD BY WED PROD. No. 26515 DWC3 NO. A-02
^r
ORGANIC
SILT
Redish
brown
ti
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SILT
W /SOME GRAVEL
Redish
brown
o:P•a.
.� •'a•.•• •
'D. • ��•
.:�... ��
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;
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O
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Size of casing.. Six —Inch
TL per.
rom to 41
OX
rave -50
rm-
a- Grqv,o 66
I Mt
IVA
FOSS DEMM
AUN
1336 INGRA PH. 279-2846
ANCHORAGE, ALASKA 99501
ys"MAI.4 40 um
We advise you to attach this certificate to
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Legal Description: DRAKE; BLOCK 3, LOT 2B
Parcel ID: 017-462-13
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system
A. WELL DATA
FM Well log is filed with Onsite (or attached)
Date drilled 3/17/1972 Total depth 68 ft
Cased to UNK ft
X Sanitary seal is functioning correctly
X Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 6/14/2024
Static water level at beginning of test 12.5 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank
Date of pumping *
Q Required maintenance completed, if AWWTS
Comments: *SEE ATTACHED MAINTENANCE AGREEMENT
D. ABSORPTION FIELD DATA
Which system tested (date installed) 1/11/2021
0 ALL standpipes present per record drawing
Total measured depth from grade 3.7 ft (max)
Measured depth to pipe invert from grade 2.56 ft (min)
❑ N/A — pressurized field.
0 Per record drawings, field is insulated.
MR Monitor tubes go to bottom of effective.
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)
If yes, enter date -
Well production at time of test 7.3+ gpm
Water storage tank volume 0 gallons
Well disinfected for coliform test? ❑ Yes 01 No
El"Coliform bacteria is Negative
Nitrate Y mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L [Arsenic less than MRL (ND)
Collected by GEG
Date 6/14/2024
C. LIFT STATION
0 Required maintenance completed
Age of lift station 3 years
Lift station material STEEL
Comments:
Adequacy test date 6/14/2024
Results Q Pass
Fluid depth prior to test 0 in
Water added 796 gal
New fluid depth *1.75 in
Elapsed time 17 min
Final fluid depth 0 in
Absorption rate 600+ god
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 6 in
Effective depth used 0 in
Effective depth remaining 6 in
Comments/Deficiencies: *ONE MT HAD 0.75" OF LIQUID AND OTHER TWO MT'S WERE DRY
COSA Checklist June 2022
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'Community
❑■ Yes if No ft
*50'+
Sewer Manhole/Cleanout > 100'
❑Yes
if No
ft
QYes
if No
Neighboring Tank > 100' ❑■ Yes
if No
** ft
Private Sewer/Septic Line > 25' QYes
if No
Absorption Field on Lot > 100' ❑ Yes
if No
*50'+ ft
Holding Tank > 100' g Yes
if No
Neighboring Absorption Fields > 100'
**
Animal Containment > 50' QYes
if No
❑i Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ❑■ Yes
if No
ft
Q Yes
if No
❑ N/A — Served by Community Well (not on lot) or Public Water
ft
ft
ft
ft
ft
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' R Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft
Tank to Property Line > 5'
❑■ Yes if No ft
Field to Property Line > 10'
Q Yes if No ft
Water Main > 10'
R Yes if No ft
Water Service Line > 10'
M Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100'
Community Wells > 200'
❑ Yes if No *50'+ ft
g Yes if No ft
If tank or field is under driveway comment below
F. ENGINEER'S COMMENTS
*AWWTS **SEPTIC ON DRAKE; BLOCK 3, LOT 7 COULD NOT BE FOUND. SEPARATION DISTANCE UNKNOWN
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 Garness Engineering Group, LTD. (GEG) Phone 907-337-6179
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 o�bopp0
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 C�
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 C 'd
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 .........G
or septic system can be installed on the property in the event either of the current systems fail to perform e. �1 GI,,ess:' G
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG �O CE 7 53 p
to perform the evaluation. Reliance upon the information provided in this report by any other person or party Q s �co4
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
LICENSED p�0 T es5l0n���
COSA Checklist June 2022 0ECC8B4 �dO0000d
4
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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 3 R Day of - IU el � of 20 ) 1/, by and between
Rebecca and Chad Sherwood herein the "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 Qeanics
located at (legal description)
Drake BS L2B
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
sI 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
1:::�Pr 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 draintield
replacement,
(rev. 05/18/2018) Page I 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
C 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.
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.
6)�3
0Owner 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. Choiee 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
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Parcel I . D. 017-462-13
Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION:
Complete legal description DRAKE; BLOCK 3, LOT 213
Expiration Date: ^/ q 20 ZZ
Location (site address) 3120 MERGANSER AVE *ANCHORAGE, AK
Current Property owner(s) BRITTANY NERLAND Day phone 907-351-4726
Mailing address
eaf"Estate Agent- -
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
_.Tayphone..
3. NUMBER OF BEDROOMS:
4
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:
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
COSA Fee $ Waiver Fee $
Date of Payment
Receipt Number
COSA# 0SC.2a1 OO 9
Date of Payment
Receipt Number
Waiver #
tet,
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: Gamess 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
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•cutside the control of GEG. Satisfactory test results do not guararztpp.future_performance.ofthe
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.
6. DSD SIGNATURE
System #1 Approved for _V_ bedrooms
System #2 Approved for bedrooms
Disapproved
Date: j 13
Conditional approval for bedrooms, with the following
#AECC884
IJ
ON-SITE �m=
OrWATER AND
WASTEWATER o
PROGKAM
Original Certificate Date:L —Zo ZZ
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
0
1, T
Legal Description: DRAKE; BLOCK 3, LOT 213
If more than 1 septic system on lot: COSA Checklist #
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Date drilled 3/17/72
Total depth 68 ft
Cased to UNK ft
FOR Sanitary seal is functioning correctly
❑ Wires are properly protected
Casing height (above ground) 18+ in.
Date of flow test for COSA 10/6/21
Static water level at beginning of test 23.3 ft
Comments.
B. TANK DATA
Age of tank(s) NEW years
Tank type/material .S EPMEEI
Measured operating fluid level in septic tank N/A
❑ Standpipes/foundation cleanout per record drawing
Date of pumping EPDXY COATED STEEL TANK
D. ABSORPTION FIELD DATA
Which system tested (date installed) 2022
❑ ALL standpipes present per record drawing
Total measured depth from grade 4.01 ft (max)
Measured depth to pipe invert from grade 2.99 ft (min)
❑ N/A — pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced N/A gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 017-462-13
of Structure served by this system
Well production at time of test 5.5+ gpm
Water storage tank volume N/A gallons
Well disinfected for coliform test? ❑ Yes ❑ No
❑ Coliform bacteria is Negative
Nitrate 12.5 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L ❑ Arsenic less than MRL (ND)
Collected by GEG
Date of Sample 10/4/21
C. LIFT STATION
❑ Required maintenance completed
Age of lift station NEW years
Lift station material PVC
Comments:
Adequacy test date
Results ❑✓ Pass For 4 bedrooms
Fluid depth prior to test - in
Water added - gal
New depth - in
Elapsed time - min
Final fluid depth - in
Absorption rate 450+ gpd
Any rejuvenation treatment (past 12 months) N/A
If yes, enter date
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'
*50'+
Community Sewer Manhole/Cleanout > 100'
❑ Yes
if No ft
✓ Yes
if No ft
Neighboring Tank > 100' 0✓ Yes
if No ft
Private Sewer/Septic Line > 25' Yes
if No ft
Absorption Field on Lot > 100' ❑ Yes
if No *50'+ ft
Holding Tank > 100' ❑✓ Yes
if No ft
Neighboring Absorption Fields > 100'
Absorption Field > 5'
Animal Containment > 50' [✓] Yes
if No ft
I] Yes
if No A#A- ft
Private Wells > 100'
❑ Yes if No
*50'+ ft
Water Main > 10'
Manure/Animal Excreta Storage > 100'
Yes
Community Sewer Main > 75' 2] Yes
if No ft
0 Yes
if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10'
Yes
if No
ft
Surface Water > 100'
❑ Yes if No
*50'+ ft
Property Line > 5'
[]
Yes
if No
ft
Wells on Adjacent Lots:
Yes
if No
Absorption Field > 5'
F-1
Yes
if No
ft
Private Wells > 100'
❑ Yes if No
*50'+ ft
Water Main > 10'
❑
Yes
if No
ft
Community Wells > 200'
O Yes if No
ft
Water Service Line > 10'
®
Yes
if No
ft
If septic tank is under driveway
comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
Q
Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
Yes
if No
ft
Private Wells > 100' ❑ Yes if No *50'+ ft
Water Service Line > 10'
M
Yes
if No
ft
Community Wells > 200' Yes if No ft
Surface Water > 100'
❑
Yes
if No
*50'+ ft
F. ENGINEER'S COMMENTS
*AWWTS **WATER LINE PROFESSIONALLY LOCATED BY ARCTIC EFFLUENT DURING INSTALLATION
***SEPTIC ON DRAKE; BLOCK 3, LOT 7 COULD NOT BE LOCATED -
G. ENGINEER'S CERTIFICATION o� OF v�A
1 certify that l have determined through field inspections and review o
of Municipal records that the above systems are in conformance with p�
MOA COSA guidelines in effect on this date.
COSA Checklist yellow sheet
�0 eif rey�A. ess.
QO9 t�' C-7953
4 ,tV'o I) ofessioCIO\
#AECC884 440040�C'c'
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Lot 2A W
0
0
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MERGANSER AVENUE
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EAST 110.00
a
Septic vent
(typ)
asphalt
0, �o C?
Manhole (tyJ
Metal
brick retaining w
i
33.0 1
k 3 story
cv frame
house o
1.0
0
0
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32.0
�O
LOT 2B
2.0'0 .
H
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well
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1
1
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L-----------------
10'
----------------
10' Utility Easement
EAST 110.00
EASEMENTS OF RECORD, OTHER THAN Lot 7
THOSE SHOWN ON THE RECORDED FB 21-7 4
PLAT ARE NOT SHOWN HEREON pg 0
UNLESS OTHERWISE NOTED. FB 16-5 pg 52
0
CY)
AP
SCALE: 1 "= 40'
Lot 2C
OF ' A�
49th'
00
4� �, .Elizabeth L. Wala 0
s� 8036 - LS '' 'v a
�F .y�� ..
t�`�''•...•'•!ao.s
f �orrssiot+nt-
RECERTIFIED 1-12-2022 �� 1r 0
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that 1 have performed a Mortgagee's inspection
in accordance with ASPLS Standards of the following
described property. LOT 213, BLOCK 3
DRAKE SUBDIVISION
Anchorage Recording Precinct, Alaska, and that the
improvements 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 question and
that there are no roadways, transmission lines or other
— — _ visible easements on said property except as indicated
hereon.
Dated at Anchorage, Alaska
this 15th day of JUNE 2016.
FRED WALATKA & ASSOCIATES, L.L.C.
MB 907-248-1666 Engineers and Surveyors
This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary
survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The Information contained on this drawing shall not be used to
establish any fence. structure or other improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original
client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered,
the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product.
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 i_ 4 Day of an l.v of 20 , , by and between
, herein the "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 Mani ani C 5
located at (legal description) (3
r kkkl SL-L-GJGiIvi* Si Grp 1�1�c ii� 7),
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
E4Owner acknowledges that the Municipality may request records of maintenance and
repairs from the manufacturer's representative or maintenance provider.
U1 Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be
assessed in accordance with AMC 14.60.030.
cl- 11
Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS. The Municipality will give at least 24-hour notice.
�k Owner agrees that any sale or transfer of title of the property will not occur without a new
Certificate of On -Site Systems Approval.
Y� Owner agrees that the AWWTS installation and maintenance requirements as provided
by the AWWTS vendor/installer and approved by the Municipality are the governing
��Ownefagrees
guidelines for the construction, maintenance and repair of the Owner's AWWTS.
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
OWNER:
By: r� (signature) Date:
-� C rrna (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this �11' day of c. 11.s �• ,
2022, by
NOTARY UB ICF R ALASKA 7ERWINA
Public
PINE®A
My Commissio' expires:_�%3''Z 6„
Slats c, Alaska . .
My Commission Expires Mangy 24,
MUNICIPALITY:
By: (signature)
(print name)
Date: % 41
Title:
(rev. 05/18/2018) Page 3 of 3
Nitrate Advisory
Certificate of On -Site Systems Approval # OSC 221009
Subdivision: Drake Block 3 Lot 2B
A watersample reveale&a nitrate concentration of 12.5 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.
From Northern Testing Laboratories, Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate
is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of
ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the
oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners,
food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is
associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of
young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood
stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the
concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered
from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home
water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best
method forlimiting nitrate in well water is source control. This can include avoiding overdosing of
fertilizer near the well and maintaining good separation distances between septic tank leach fields and
the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged
ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a
spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect
the activity of nitrate in water. This laboratory uses several different wet chemical methods approved
under the public water supply laboratory certification program. They also have test kits available, which
the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test kit results
against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend
using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples.
C 0 eldi 01144 TO 1 7 8 9 70
',Kb& s
AUG 15 2016 -• Municipality of Anchors_ •6 ti
On-Site Water and Wastewater Program
(907)343-7904 e1 0! 6 8 L 9 g� s a F E T r
Certificate of On-Site Systems Approval
017-462-13 p
Parcel I.D. Expiration Date: 2- --10 -17
1. GENERAL INFORMATION
Complete legal description Drake, Block 3, Lot 2B
Location (site address) 3120 Merganser Ave
Current Property owner(s) Daniel & Judy Knecht Day phone
Mailing address 3120 Merganser Avenue Anchorage, AK 99516
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: 3
4. TYPE OF WATER SUPPLY.: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual LI
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: Date: •
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 6:94 1 �/q Waiver Fee $
Date of Payment ?/161/4 ' Date of Payment
Receipt Number O5Q7Receipt Number
COSA# Q��&1�7 7p Waiver#
5. STATEMFVT:OF INSPECTION BY_ENGINEER
4:
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.
In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA
guidelines and regulations'.The reported results describe the performance of the system under the 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 soil
condition,ground water 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 this system. All systems eventually fail and satisfactory lest results do not guarantee future
performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty
for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed
above.
Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218
Address P.O. Box 100217, Anchorage Ak. 99510 .
Engineer's Printed Name Steven R Pannone Date 7/6/2016
i*• TH �1" 7
• . 1 •* ol
•
6. DSD SIGNATURE %-••• • l�'Ow ••-
' eSystem #1 Approved for Z bedrooms �. ',Seveni 12..'annone :
System #2 Approved for bedrooms �9 iq,•, CE-8149 ..,- /,'
Disapproved �t PROFESst nr
���+�
/" Conditional approval for 2 bedrooms, with the following stipulations:
6.9-1—/ 7 (c r , v i s ---o c v v-
.,1\? ltti:rti r
il e4 +�op., OF gN� ars
rr
1rf ��/'7 1 '//2� _ ONSITE ��,-
-1 -1 1 V .LC 1 — r
' .-% WATER AND rn
Pk-k--,! I o WASTEWATER z
<Q Jam_
O
/ilnti�� w •
•
y- Original Certificate Date: 11 A3' ' t,C,
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet f c
If more than 1 septic system is on the lot:
COSA Checklist# 1 of "
Structure served by this system 1
Certificate of On-Site Systems Approval Checklist
Legal Description: Drake Block 3, Lot 2B Parcel ID:017-462-13
A. WELL DATA
Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y
Date completed 3-17-72 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 68 ft. Cased to 68 ft. Casing height(above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 3-17-72 6-22-16
Static water level 28 ft. 40 ft.
Well production 20 g.p.m5.3+ g.p.m.
WATER SAMPLE RESULTS: � (Of X71 -2dl Ta
p
Coliform colonies/100 mL Nitrate 1). O mglL
Arsenic Ai ug/L Date of sample: o/i c( o t Le Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 7/10/92
Tank size 1 600 gal. Number of Compartments 2 Cleanouts(Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) Y
Date of pumping 7/5/16 Pumper A+ Home Services, Inc
C. ABSORPTION FIELD DATA
Date installed
7/10/92 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.4 g.p.d/sf System type Mound
Length 60 ft. Width 18 ft. Gravel below pipe 1 ft.
3.5
in%0
Total depth ft. Eff. absorption area.134 ftz Monitoring tube Yes Depression over field NO
Date of adequacy test 6-24-16 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth in absorption field before test 0 in. Water added 453 gal. New depth 2 in.
Elapsed Time: 1 30 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d.
No
Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed 7/10/92 Size in gallons 250 Manhole/Access(YIN) Y
"Pump on" level at 53 in. "Pump off' level at 65 in. High water alarm level at 47 in.
Datum Top of RiserCycles tested 4 Meets alarm&circuit requirements? Y
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot 100+ On adjacent lots 100+
Absorption field on lot 100+ On adjacent lots 100+
Public sewer main 75+ Public sewer manhole/cleanout 100+
Sewer/septic service line 25+ Holding tank 100+
Animal containment areas 50+ Manure/animal excrete storage areas 100+
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+
ABSORPTION FIELD ON LOT TO:
Property line 10+ Building foundation 10+ Water main 10+ .
Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+
Curtain drain 50+ Wells on adjacent lots 100+
F. COMMENTS 1 r
J'•"5/9 c r repec--E- O.,rea La IL � (�..l r.•-.Loi�GT/I
/- V
G. ENGINEER'S CERTIFICATION roF , ��1�
I certify that I have determined through field inspections and ��p'st. _4 t���
review of Municipal records that the above systems are in *; , • TH 11 •,*�4
conformance with MOA COSA guidelines in effect on this date. % ••••*• 1 •iO
Steven Pannone
Engineer's Printed Name •• tleveri .••onnone
7/6/160,IN........*::
' �
• CE-8149 . �
Date �1 `,c,p ••.... 0 :
COSA canary sheet_2-6-15.doc .
• Municipality of Anchorage
•_1t1;14' Development Services Department -
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # osc161359
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 3, Lot 2B
of Drake subdivision. This inspection revealed a nitrate concentration of
12.8 milligrams per liter (mg/L) was reported for the property's well water
sample. 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.
Iii'
El FILE COPY
IULLI VAN
ifej WATER WELLS
Drilling • Piling• Pumps Date: 11-7-16
P.O. Box 670259 Chugiak, AK 99567
P: (907) 688-2759 F: (907) 688-2259
Pannone Engineering
3120 Merganser Avenue
Anchorage,AK 99516
Well Camera Report
High Static, Run Pump, Static only fell to 22'.
Ran camera to 50', casing appears to be intact and perforation free.
Pannone Engineering Services iic
Steven R. Pannone, Principal
Registered Professional Engineer
E-mail:sieve@panengak.com
October 26,2016
Municipality of Anchorage
Development Services Department
On-Site Water&Wastewater Program
4700 Elmore Rd.
P. O. Box 196650
Anchorage, Alaska 99519
Subject: Drake, Block 3, Lot 2B
Conditional COSA Request
Ladies and Gentlemen:
I am writing to request a conditional COSA be issued for this property to accommodate its sale at the end of the month.
The drainfield had one foot of fill added to create sufficient cover. The new top soil was seeded but due to the time of
year, the grass has not started to grow. There is no future work needed to be completed,just time for the grass to grow.
We are requesting that the unconditional COSA be completed by next summer once the grass has grown.
If you have any questions or concerns, please contact me at 272-8218.
Sincerely,
•4 - 9t. Aqk
J `. *i
y
t.
•
•
I
Ic4eSteven R.Pannone
/ E.81 /'
I.1� ��h• .7/0 ,.l�Y.•�i
Permit No. Page of
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone:343-4744
On—Site Wastewater Disposal System and/or Well Inspection Report
Legal Description LOT 2B, BLOCK 3 DRAKE SUB'D PID No:
0
I
HOME /O HOME HOME
O•
-9O
II
M
C/L MERGANSER AVE.
1 " = 50'
6
M
w,stlF w M N'399.'C 110.00'
\11 + I //
M.`
52.7 �oVae i ==•'• 3u ___�
28 7
MANHOr�� ✓ J►�.'I" ` TEIM E " 100.0
miNoro� 6.5 __ ��"0° TBM '"OTT OM OF SIDING AT HOUSE CORNER.
CD. ..1.Y.. gr
.04
TANK DETAIL 5 ' LF 1 E
LOT 2A
New 1500 gal SPP.ic
tonk w/lift sto.
.SEE TANK DETAIL LOT 2C
LOT 2B
-.
GENERAL NOTES \
\\.,
7.<
1) ELEVATION OF BM = 100.00 \2) ELEVATION `%%%%%%%%%%%%>>3) ELEVATION OF ABSORPTON FPREPARED IELD STRL BTIONTP PING 0.4 ' _ P�� •O• F' A�gS>riiii
4) WATER T LE ELEVATION (6-6-92 = 94.30'
/0 Si EL 6.V rION OF (3e rrorl► Maki oR 1Uc, Tu03E z 98 �4 ���• ' •9�}��i
O' 49th �N
90 .
I CC> . ''• C. .y▪ S. Mey •'
'�.)
it,"c2, '. E-635 ",:::
MERGANSER AVENUE .8438W
0 0
M
EAST 110.00
eptic vents
Q6 \
brick retaining wall
I 1
_ 1 14 OH
--�
33.0 11.0
3 story
dk N frame
I asphalt house
ci
10 v
65.9
Q
CV
-I I. —.. 32.0
septic tank.--O• .. --
• septic vents \-2.0' OH
0 0
o Q
o 0
o 0
co co Lot 2C
Lot 2A W W
o 0
0 C)
r---
co 0
o o
a)
w LOT 28 r • 49th j' •-p
09
/,1C3' ••Fred Wal atka :P, or
�� s'••. •3255 - 5 •• 00
•
o • . • • • '`pa
Welt ■ °FESSIONM.
a l 1\\1��
AS-BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed a Mortgagee's inspection
of the following described property: LOT 2$ BLOCK 3
DRAKE SUBDIVISION
L
10'Utility Easement Anchorage Recording Precinct,Alaska,and that the
——— _ improvements situated thereon are within the property lines
EAST 110.00 and do not overlap or encroach on the property lying
adjacent thereto,that no improvements on the property lying
Lot 7 adjacent thereto encroach on the premises in question and
that there are no roadways,transmission lines or other
visible easements on said property except as indicated
hereon.
SCALE: 1"= 40' Dated at Anchorage,Alaska
EASEMENTS OF RECORD, OTHER THAN this 15th day of JUNE 2016
THOSE SHOWN ON THE RECORDED FRED WALATKA&ASSOCIATES
PLAT ARE NOT SHOWN HEREON. Engineers and Surveyors
FB 16r5 pg 52 MB (907-248-1666)
DocuSign Envelope ID:5F123813-0674-40FB-9C130-2AEC2CD26877
Pannone Engineering Services, LLC Po Box 100217
Consulting Engineers Anchorage,AK 99510-0217
Ph (907) 272-8218 Fax (907) 272-8211
www.panengakcom
WELL& SEPTIC SYSTEM ADEQUACY INVESTIGATION
Legal: Drake S/D Block 3 Lot 2B .••`C- 0r 44 44.
Address: 3120 Merganser Drive ••" "..... .
Owner: Dan & Judy Knecht ,
Number of Bedrooms: 3 ► :
ince
Septic System House Septic • `—�"� � ' •
•
Tank Size: 1500 gal S.T.E.P. ♦ 'Steven R. Ponnone •
'
Absorption System Type: Absorption Bed, Effective depth 6" .,�• /
81
Absorption Area: 1340 SF V
h •�:•
• •ESS.\
Installation Date: 7/10/1992 1"-910
(All info found from ADEC records)
Date of Investigation: 6/15/thru 6/24/2016
Test Procedure:
Septic System: System was inspected visually and measured. The tank was found to have 4 feet of cover. The
drain field was found to have 2+ feet of cover. The field monitor tube had six inches of standing water prior to
adding water to the system. This would make the water level in the system at the lateral line invert. This shows
us that the system is saturated. I contacted Mr. Jeff Garness, P.E. of Garness Engineering Group to discuss the
results of his test. He informed me he had the two monitor tubed deepened to the bottom of the system because
they did not extend all the way through the system. He informed me that the system was saturated. I contacted
Mr. Mike Blakslee of A-Plus Home Services, they were the contractor that extended the monitor tubes. He said
they extended the monitor tubed completely through the drain rock and to the underlying sand. He also indicated
the system was saturated, the drain rock was not biomatted (Coated with black biologically rich material that
clogs off the pours of a drain field and causes the system to fail) like a system in failure.
The 1992 system was disconnected from the STEP Tank and connected to the original 1980 drain-field on June
20, 2016. A diverter valve was installed in the lift station manhole to control the direction of flow. The reason
this was done was to determine if the 1992 drain-field was in failure or just saturated. The water levels in the
1992 drain-field were monitored, and the system was observed dry three days after disconnecting the system.
PES performed an adequacy test of the 1980 and 1992 systems. The 1980 system was tested on 6/22/2016. The
system was dry at the beginning of the test. PES injected 475 gallons of water into the drain field and the water
levels rose one inch and returned to a dry state within 30 min of turning the water off. PES tested the 1992
system on 6/24/2016. The system was dry at the beginning of the test and the water levels in the west monitor
tube rose two inches with the introduction of 453 gallons of clean water. The water level returned to dry within
30 minutes of turning the water off.The east monitor tube remained dry during the entire test. Based on these
two tests, both of these systems are able to absorb in excess of 450 gallons per day as required by code.
Well: This property is served by a private water system. The well has a stick up of 15 inches and the sanitary seal
is intact. The static water level was measured at 23 feet below the top of casing. We drew water from the well at
a rate of 5.4 gallons per minute for 90 minutes and the static water levels did not change. This well is able to
produce in excess of 5 GPM.
Conclusion: The 1992 drain field is operating in accordance with the MoA guidelines. I believe there was a
leaking water closet(toilet) or sink that over loaded the drain field. Tank levels were monitored and there was no
/11/2016
Page 1 of 2 /Y
DocuSign Envelope ID:5F123813-0674-40FB-9C50-2AEC2CD26877
r
indication of water infiltrating into the tank. Note: The 1980 system was deemed unusable by the MoA due to a
nearby test hole excavated in 1992 indicating ground water within four feet of the bottom of the drain field 1t
was used only to determine if 1992 system was actually in failure or just saturated. The water system also meets
the operation and code requirement of the MoA.
SPECIAL NOTE:
In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system
in accordance with MoA guidelines and regulations. The reported results describe the performance of the system
under the 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 soil condition, ground water
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 this system. All systems eventually fail and satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects
or encroachments.Therefore, we cannot provide any warranty for future performance, nor can we estimate
remaining life of the system. The content of this report is for the sole benefit of the owner listed above.
Inspector's Qualifications
Mr. Pannone is a registered Civil &Environmental Engineer specializing in the planning, design and
construction of sanitation facilities. He is a lifelong Alaskan with more than 30 years of engineering and
construction experience. Mr. Pannone's background includes experience in survey, design, construction, testing,
and monitoring of engineered projects. He has worked all over the state of Alaska, including extensive time in
the arctic and remote regions. He takes a practical approach to design,taking into account how and who is going
to be doing the construction. He has hands on experience in the construction of water and wastewater systems,
buildings and large earth works projects. Mr. Pannone is a certified ADEC water/wastewater designer and
sanitary surveyor.
Mr. Pannone is the founder of Pannone Engineering Services, LLC., this privately owned company was founded
in February of 1991. The company has specialized in the design, testing and installation of on-site water and
wastewater systems.Pannone Engineering Services, LLC have performed engineering designs, analysis and
evaluations of water and wastewater systems throughout Alaska. The types of systems have ranged from small
single-family wells and septic systems to large commercial systems serving greater than 250 people daily.
ROI/
re (11/2016
Pave 2 of 2
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES M},
O 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' \
HAA # 4Qq.a
Parcel I.D. It
1. GENERAL INFORMATION
Complete legal description
Location (site address or directions)
Da hone Lie
V ( J�1 I iE I�nL y P
Property owner _ ( a V g q S I O
Mailing address
Lending agency
Mailing
Day phone
Day phone
Agent
Address �egye cc�11
Unless otherwise requested, HAA will be held for pickup.
2, NUMBER OF BEDROOMS:
3, TYPE OF WATER SUPPLY:
Individual well
Community well
X
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
q. TYPE OF WASTEWATER DISPOSAL:
Individual on-site X_
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 l/91) Front MOA#21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm —AS C r. 1 m c- Phone _Sy 9-5144?)
Address
Engineer's signature
6. DHHS SIGNATURE
_ Approved for
Disapproved.
M
3 bedrooms.
Conditional approval for
Additional Comments
SvLt I
Date 7 2
y` C
A" ?
S• Car S. MeY • ��,�
353 S'
!slkOROFEW
bedrooms, with the following stipulations:
Date 8,S 92_
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates 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 orderto 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 (Rea 1/91) Back MOA #21
Municipality of Anchorage
Department of Health & Human. Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: a 2 1 k -3 D,. Ice- Parcel.I.D.
A. WELL DATA'
Well type I hiJ 4 Ft If A, B, or C, attach A DEC letter
ADEC water system number N6,dL
Log present (Y/Iqp /J a Date completed ed 2 — I7 L Driller tj?%
Total depth 8 —Cased to, Casing height
Sanitary seal &N) Y<s Wir . es properly protected (DN) Yys
Date of test
Static water level
Well flow
FROM WELL LOG
Pump level
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot loct-
Absorption field on lot
Public sewer main --b
Sewer s&viceline i
P
On adjacent lots 100
On adjacent lots too
Public sewer manhole/cleanout 1 00
Petroleum tank toot
WATER SAMPLE RESULTS:
Coliform 0 K Nitrate 2• 6 Other bacteria, Q
Date of sample: 7?_J/ I Z Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 71Z/4L TanJk size 1A0 n q, Compartments
Cleanouts (VN) Ye's Foundation cleanout ('JN) 2c 5 Depression (YON k) 52
High water alarm (Yo - A)c) Alarm tested, (YJ@ Uo
I -4,J j' J, I I
�) 'S Pumper
Date of pumping e'J C64
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Wells on lo�t "-foc —On adjacent lots too —Foundation
To property line N5—Absorptionfi eld 'Water main/service line
Surface water/drainage 00
72-026 (Rev. 7/91) Front e CONTINUED ON BACK PAGE
O
AT INSPECTION
C:
2.
C.
Ri
r—
r)
X0
M
rn
g p n13
CD
00
K5
rn
cn 0-
<
Q Q
N'
On adjacent lots 100
On adjacent lots too
Public sewer manhole/cleanout 1 00
Petroleum tank toot
WATER SAMPLE RESULTS:
Coliform 0 K Nitrate 2• 6 Other bacteria, Q
Date of sample: 7?_J/ I Z Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 71Z/4L TanJk size 1A0 n q, Compartments
Cleanouts (VN) Ye's Foundation cleanout ('JN) 2c 5 Depression (YON k) 52
High water alarm (Yo - A)c) Alarm tested, (YJ@ Uo
I -4,J j' J, I I
�) 'S Pumper
Date of pumping e'J C64
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Wells on lo�t "-foc —On adjacent lots too —Foundation
To property line N5—Absorptionfi eld 'Water main/service line
Surface water/drainage 00
72-026 (Rev. 7/91) Front e CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed 14Z Manufactures• -A -S V;/1 /.:`•,,
Size'in allons `250 v2
9. Manhole/Access (^Y -%N) Yes
Vent") �c s "Pump on" level at-' G f2 =Pump off' level at
High.wateralarm level S.25,' Cycles tested ��ao'o� .
Meets MOA electrical codes ON)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot. " 100 r On adjacent lots' I G ° F" ' '" Surface water` `l G o+
D. 'ABSORPTION FIELD DATA
Date installed: 7h All Soil rating • ~I GPfJI�F /
.. 9 GSystem type /n
Length'' G G 2 Width, Gravel thickness 1 Total depth
,Total absorption area I Z00 5 r- Cleanouts present (�N) ^ `cs
Depression over field(Y6 do Date of adequaoy test Ne j
Results'(pass/fail) for bedrooms
Peroxide treatment (past 12 months) (YON AJO If yes, give date`
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Wellonlot 1001,_On adjacent lots IO6I Property line tGh�
To building foundation 15 r To existing or abandoned system on lot
On adjacent lots 160 Cutbank Iool' Water main/se rvi ce line r°d�
Surface water 100E
Driveway, parking/vehicle storage area 25
Curtaindrain
E. ENGINEER'S CERTIFICATION
Gr '%
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines 1n effect on the
Signature m
f '`
Engineer's Namel
Date ?I I RZ tI M
,HAA Fee $
Date of Payment
Receipt.Number
72-026 (ReV. 3/91) Back MOA 21
\ Waiver Fee: $
• Date of Payment
0
Receipt Number
F
S.
s
ate of this inspection.
#6353 b' j
I
MUNICIPALANCHORAGE
• � DEPARTMENT OF HEALTH
&HUMAN SERVICES
Division of Environmental Services
I I 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. # a ;2— �/' ;;_I—/_3
1. GENERAL INFORMATION
HAA # INVM "cz
Complete legal description 10 f 2 6, /310c tt 3, D Ca k
Location (site address or directions) 3120 Mer unser Avtncce
Property owner I-e✓tn d,(ebnel- Day phone 26_5'--2Y21
Mailing address P.o. 0o). 10377tf' /}11c4or"1;' 41- 995-/6
Lending agency
Mailing
Day phone
Agent Judy Cal y Forfvne Prontrlia> Day phone Slz-7653
Address 3�aa A" Stf+_ chcrj, , /41- 99Sa3
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
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 x21
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 of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I further verify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm FlaFio� 7erh� iccc/ S pwirei Phone 3'/S- i 3yS"
Address ),y530 Ccho/ Sf. f}nGhOrcrC/Q� 19-k 9951
Engineer's signature Date ff /Zi /9/
6. DHHS SIGNATURE
A
Approved for bedrooms.
Disapproved.
conditional approval for Z7jbedrooms, with the following stipulations:
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates 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. 151) Back MOA N21
Municipality of Anchorage
Department of Health & Human Services
HEALTH• AUTHORITY APPROVAL CHECKLIST
Legal Description:„'1- 2 61' 61k3 p/mke _s/o Parcel I.D. ,�9/7/3
A. WELL DATA
Well type PraJaF[ If A. B, or C, attach ADEC letter. ADEC water system number NIA.
Log present(Y/N)
Date completed 3/ 7 2 Driller Fos j
Total depth r5B' Cased to 6B Casing height
Sanitary seal (Y/N') r Wires properly.protected (Y/N) —
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
3/1 i72
' 2&'
20
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot 127, to C. 0.
g. p. m.
AT INSPECTION
m
oz
1'7'
►'f'1
0
3'Z n
7'y+
gPL”N
n
r
N
`m O
m
�
r
v
,.
ck
m
On adjacent lots >
fool
'
Absorption field on lot 1 yo' ; On adjacent lots > loo
Public sewer main ' N• A. Public sewer manhole/cleanout N '�•
Public sewer service line N. A. Petroleum tank " None "05Se.ved
WATER SAMPLE RESULTS:
.Coliform o col /100. M-1 Nitrate 2. 7 fi v / Other bacteria D cot / 100 ^t
Date of sample: 1t 02 9/ Collected by: rftert!o% TtcAhSvC.
B. SEPTIC/HOLDING TANK DATA
Date installed 61`22/7Z Tank size 1000 got Compartments /
Cleanouts (Y /N) 1 Foundation cleanout (9N) ins,d�a^ Depression (Y/N) N
High water alarm (Y/N) N -A. Alarm tested (Y/N) j N• A:
Date of pumping n / 21 / 9 f b y - ='suau
n y.
+i - , ♦ 1 1 1
SEPARATION DISTANCES FROM.SEPTIC/HOLDING TANK TO:
Well(s) on lot f 29 ' I;T- c.o. On adjacent lots 15-61 • Foundation 23' {ron c.�.
To property line 10' Absorption field S' Water main/service line > fol
Surface water/drainage > 1.0&
72-028 (Rev. 3191) Front MOA 21 - CONTINUED ON BACK PAGE
C. LIFT STATION N. A.
Date installed
Size in gallons
Vent(Y/N)
"P.ump on" level at
S
,
Manufacturer
Manhole/Access(Y/N)
"Pump off" level at _
High water alarm level Cycles tested
Meets MOA electrical codes (WN)` "
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION FIELD DATA
:Date installed S / Z3 / ao Soil rating 17S /ate'^ .System type TrencA
;Le hgth HG's Width N' Gravel thickness -7 Total depth /1,
Total absorption area 5Go c' Cleanouts present_(Y/N) Y
Depression over field (Y/N) N Date of adequacy test n
Results (pass/fail) Past for 8 bedrooms
Peroxide treatment (Past 12 months) (Yo If yes,,give date N, .4.
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot 190' On adjacent lots 100' Property line 30'
To building foundation 2S' To existing or abandoned system on lot un k.
On adjacent lots > ?o' Cutbank N, A. Water main/service line > 10'
Surface water > too ' Driveway, parking/vehicle storage area Trench lJat-r es ctnofer
, `t'" ofr;Leway. • No {rteL;n3 �ra5/e`nv rePorfro(
Curtain drain None wen
',n 11 y�J a� Ser1i/ce_
E. ENGINEER'S CERTIFICATION
I certify that 1 have checked, verified, or conformed to all MOA and HAA
Signature
Engineer's Name T<,to done F• I IUOrL
Date 11 /21 /9/
. uc
HAA Fee $ Z. /y/ -1
Date of Payment
Receipt Number Z3.1 c±
72-028 (Rev. 3/91) Back MOA 21
the date of this inspection.
m�.v,,.......;�; $4.,
A
..........................d
'0 ..•..... n...rte•.!...�,.... uFS 1.1
. THEODORE F. MOORE 0
k ,% CE - 3539 y'''4
Waiver Fee: $/�
Date of Payment
Receipt Number cx
Municipality of Anchorage �� A
Department of Health and Human Services dhh5
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
December 20, 1991
Judy M. Calt
Realtor
Fortune Properties, Inc.
3000 "A" Street, Suite 101
Anchorage, AK 99503
Re: Health Authority Approval No.HA910562
Lot 2B, -'-Block 3 Drake Subdivisionr,
Dear Ms. Calt:
I have read your letters of December 3 and 4 concerning the
referenced Health Authority Approval (HAA).
The HAA for your client's lot in Drake Subdivision was issued
conditionally with the provision that the vertical separation
between the lowest part of the wastewater disposal system and
the seasonal high water table be verified as a minimum of four
feet. This vertical separation is required by both state and
municipal wastewater disposal regulations.
It is our understanding that your engineer installed a
monitoring tube as a means of verifying the current depth to
groundwater and that groundwater was monitored at a depth of 11
feet. Since the bottom of the existing wastewater system is at
a depth of 11 feet, it is apparent that the required four foot
vertical separation to groundwater does not exist. Resolution
of this deficiency will require that a new wastewater system be
constructed at a shallower depth.
I want to assure you that we will work with you to minimize the
negative impact of the regulatory requirements on your client.
If you would like to discuss this matter further, please contact
my office or Mr. Lee Browning, who is the division manager for
all of the department's environmental programs, at 343-4928.
Sincerely,
Helen D. Beirne, Ph.D.
Director, Health and Human Services
cc: Will Gay, Executive Manager, Enterprise Activities
Lee Browning, P.E., Manager, Environmental Services
1.
FORTUNE PROPERTIES, INC.
3000 A Street, Suite 101 • Anchorage, Alaska 99503 • (907) 562 -SOLD (7653)
December 3, 1991
Dr. Helen Bierne, Director
Municipality of Anchorage
Dept. of Health & Human Services
825 L Street
Anchorage, Alaska 99519
RE: Health Authority Certificate for 3120 Merganser, Drake L2B B3 .,
Dear Dr. Bierne,
As Will Gay discussed with you this afternoon, I have been extremely
frustrated in the application of the Municipal Health Department's apparent
new policy with respect to issuance of a Health Authority Certificate.
On November 4, 1991, an agreed contract of sale was executed on my
listing at 3120 Merganser, Drake Subdivision Lot 2B, Block 3, owned by Mr.
Kevin Liebner and Ms. Corinne Kenney, with an expected closing before
mid-December. Upon my recommendation, Mr. Theodore F. Moore, P.E., was
retained to accomplish adequacy tests of the water supply and wastewater
disposal systems and to procure the required Health Authority Certificate.
After searching the Municipal records regarding the existing septic
system, Mr. Moore conducted adequacy tests of the wastewater disposal
system on November 12. On November 21, Mr. Moore verified to the Health
Department on the Certificate that the on-site water supply and
wastewater disposal system is safe, functional, and adequate and that the
on-site water supply and/or wastewater disposal system is in compliance
with all Municipal and State codes, ordinances, and regulations in effect.
Last Wednesday, I learned from Ted Moore that apparently Mr. Dan Bolz
had some concerns regarding granting unconditional approval, apparently
stemming from a complaint filed well over a year ago by Mr. Liebner and Ms.
Kenney regarding the neighbor on Lot 2C's unlawful discharge of water onto
their property. As a result, Mr. Liebner, the homeowner, met with Mr. Bolz
yesterday. Mr. Liebner learned that, apparently, the Health Department
Municipality of Anchorage
December 3, 1991
Page Two
had internally earmarked Mr. Liebner's lot back in 1990 as having a supposed
groundwater problem. Apparently, this determination resulted from Mr.
Liebner's filing a complaint with the Health Department regarding the
neighbor's unlawfully sump pumping water from his leaking basement into a
dry well and onto Mr. Liebner's property.
This septic system was originally installed and approved by the
Municipality in June 1972. The system was upgraded on May 23, 1980, again
certified and approved by the Municipality. Neither Mr. Liebner nor Ms.
Kenney was notified by the Health Department of any concerns regarding
groundwater or their sewage disposal system, which apparently stemmed
from their complaint regarding unlawful actions of their neighbor. If they
had been notified of any such concerns, they would have taken action to
alleviate those concerns last Spring in anticipation of selling the house.
Alternatively, if a change in policy affecting the granting of an
unconditional Certificate had been made a part of the file so that the
Engineer could have discovered this, a proper test hole could have been dug
in mid-November, 1991, to determine the groundwater level when a backhoe
was already on site to accomplish other repairs to the septic system under
the direction of Mr. Moore,
The Certificate itself states, "The Municipality ... issues Health
Authority Approval Certificates based only upon the representations given
in paragraph 5 above by an independent engineer registered in the State of
Alaska. The DHHS does this as a courtesy to purchasers of homes ...
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."
Mr. Liebner and Ms. Kenney will be severely damaged in the event that
the sale of the house falls through or if the bank forecloses on the house as
a result of the Municipality's actions in refusing to grant an unconditional
Certificate at this juncture.
If it is a proposed new blanket policy of the Municipal Health
Department to require groundwater monitoring prior to issuing a Health
Authority Certificate for an existing on-site septic system, I would think it
incumbent to put the matter before proper hearings. Such a policy would
radically affect the buying and selling of almost any home on the Hillside.
Municipality of Anchorage
December 3, 1991
Page Three
As a minimum, since the Department has apparently identified
subdivisions and/or lots of potential concern with regard to the issuance of
an unconditional Certificate, it would seem to be incumbent upon the
Department to notify the affected homeowners before a sale of the home is
in the works and application for the Certificate is made.
1 spoke to John Smith at the Department this afternoon, and he
indicated that it would be at least ten days before any reconsideration
would be made. Again, we are hoping to close on the house next week.
I would certainly appreciate your assistance with reconsideration of
this issue. I am sure that Mr. Moore, P.E., would be happy to provide the
Department with a duplicate certificate for unconditional approval of the
existing, previously approved by the Municipality, on-site septic system at
3120 Merganser.
Thank you very much for your assistance.
Sincerely,
?Me6L�
Judy M. Calt
Realtor
cc: Ted Moore, P.E.
Kevin Liebner
Corinne Kenney
Municipality of Anchorage
% Department of Health and Human Services tlh5
Tom Fink, 825 "L" Street
Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650
December 6, 1991
Judy M. Calt
Realtor
Fortune Properties, Inc.
3000 "A" Street, Suite 101
Anchorage, AK 99503
Re: Health Authority Approval No. HA910562
Lot 2B, Block 3 Drake Subdivision
Dear Ms. Calt:
I have read your letters of December 3 and 9 concerning the
referenced Health Authority Approval (HAA). The letters bring
up several important issues and questions regarding this
department's policy in reviewing and issuing HAAs, which attest
to the legal and adequate operation of on-site water and/or
wastewater disposal systems.
Anchorage Municipal Code (AMC) 15.05 and 15.65 establishes the
authority and criteria this department uses to issue HAA's.
These codes specify that a HAA can only be issued when the
on-site systems comply with all state and local regulations and
codes.
The Alaska Administrative Code (18 AAC 72.025.b) specifically
prohibits the installation or use of an on-site wastewater
disposal system unless the vertical separation between the
lowest part of the soil absorption system and the seasonal high
water table is at least four feet. The AMC also specifies this
four foot vertical separation requirement.
This department has always sought to ensure that on-site
wastewater disposal systems are constructed and operated in
accordance with the above cited regulations. There has been an
increase in emphasis but no policy change in this regard.
The HAA for your client's lot in Drake Subdivision was issued
conditionally with the provision that the four foot vertical
separation between the bottom of the subject system and the
seasonal high groundwater be verified.
Judy M. Calt
December 6, 1991
Page Two
In response to both of your letters, I have asked my staff to
review the propriety and justification for issuing the
conditional approval. A review of available file information
has yielded the following data:
1. 1/9/89 - Groundwater was measured at a depth of 12 feet
on adjacent Lot 2A, Block 3.
2. 6/5/75 - Groundwater was measured at a depth of 10 feet
on adjacent Lot 2C, Block 3.
3. 6/8/83 - Groundwater was measured at a depth of 6 feet
on adjacent Lot 3, Block 3.
4. 11/29/90 - Groundwater was measured at a depth of 8.5
feet on adjacent Lot 7B, Block 2 (across Merganser Ave.
from the subject lot).
This data appears to support a logical and reasonable concern
that the subject wastewater disposal system, which is 11 feet
deep, may not have sufficient vertical separation to
groundwater. For the system to have adequate separation,
groundwater would have to be monitored at a minimum depth of 15
feet. Based on the above information, I am persuaded that the
issuance of the conditional approval was justified.
It should be noted that the above data is public information
that is readily available for review prior to preparation and
submission of a HAA application.
I am not sure that I can give you a satisfactory answer as to
why the HAA was issued unconditionally in 1986 for Lot 2B. I do
know that we have exercised a heightened awareness to potential
groundwater contamination from encroaching septage since 1987
when dozens of wells were polluted in two Eagle River
subdivisions. The apparent cause was septic systems and the
result was extension of public water and sewer to serve the
homes affected. Another contributing reason for the oversight
in 1986 is that there were only two adjacent water table tests
at that time. Now there are four.
While it may be suggested that the private engineer or this
department's reviewing engineer should have required monitoring
with the 1986 HAA, that did not happen. Now, however, we are
aware of the possible conflict with the water table and it needs
to be addressed.
Judy M. Calt
December 6, 1991
Page Three
I want to assure you that we will work with you to minimize the
negative impact of the regulatory requirements on your client.
Staff has advised your engineer, Ted Moore, that we would accept
water table monitoring now if that would be preferable to
monitoring next May. If you would like to discuss this matter
further, please contact my office or Mr. Lee Browning, who is
the division manager for all of the department's environmental
programs, at 343-4928.
Sincerely,
Helen D. Beirne, Ph.D.
Director, Health and Human Services
cc: will Gay,. Executive Manager, Enterprise Activities
Lee Browning, P.E., Manager, Environmental Services
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_r—
• MUNICIPALITY OF ANCHORAGE •
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
,14n 7- Z R BCL iu
Location (address or directions)
(b) Applicant Name eyl .) L/EB.>Erz_ Telephone: Home _3 0 Business 349 -(o4S5!
-- Applicant Address
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain);
(d) Lendirig Institution A,4-,ntsi� SA- () Telephone S�3— �H
Address
(e) Real Estate Company and Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
Single -Family fP( Multi -Family ❑ Other
Number of Bedrooms 3L
3. WATER SUPPLY )
Individual Well Ld Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2 72-025 ( 1 1/84)
5. ENGINEERING FIRM PROVIDINIRISPECTIONS, TESTS, FILE SEARCH, DAMIAND INFORMATION 61
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
Name of Firm - 1; s
It -
Address 2 ZZc> C ref
Date
6. DHEP APPROVAL
Approved for L� bedrooms by
Approved �X Disapproved
Telephone 317 —61015
Engineer's Seal
Terms of Conditional Approval
Conditional
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11184)
A. WELL DATA
• MUNICIPALITY OF ANCHORAGE (M*
MUN;CIPALITY O° 4w'ungen_c
DEPT. UP 11H jjL H AUTHORITY APPROVAL (HAA)
ENVIRONMENTAL PRCC14ECKLIST- FEBRUARY 1984
264-4720
i%JG 31996
RECEIVED
Legal Description: !,:,7- ^2_443 j.3t
Well Classification -77�-Jv1!-cc If A, B, C, D.E.C. Approved (Y/N) N JA
Well Log Present (Y/N) Date Completed�f7 r 7 Z' Yield -7 }0
Total Depth Cased to 62 Depth of Grouting N/A
Static Water Level -7.e ZL FT Pump Set At ld
Casing Height Above Ground /9 Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) { Depression Around Wellhead (Y/N)
Separation Distances from Well
To Septic/Holding Tank on Lot /Z+/-% : On Adjoining Lots
To Nearest Edge of Absorption Field on Lot / ZVf rT- ; On Adjoining Lots
To Nearest Public Sewer Line n.r )'q To Nearest Public Sewer
Cleanout/Manhole A-' /A To Nearest Sewer Service Line on Lot .7 f -T
Water Sample Collected byAq 1ii3eF_
+- o-rm ;Date ?�:!?7 �0
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed ZZ Z Size [own No. of Compartments 7i
Standpipes (Y/N) � Air -tight Caps (Y/N) � Foundation Cleanout (Y/N)
Depression over Tank (Y/ / J Date Last Pumped
Pumping/Maintenance Contract on File (Y/N) ..i A ; for ii A
Holding Tank High -Water Alarm (Y/N) AJJq Temporary Holding Tank Permit (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well /Zo r .Cr To Building Foundation iS Gr
To Property Line A -r To Disposal Field /n C7 -
To Water Main/Service Line SOy' FT To Stream, Pond, Lake, or Major Drainage
Course w / lA
Comments
Pagel of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
V
Soils Rating in Absorption Strata SF/13.Z Type of System Design_��.1CW
Date Installed S0. 5/,R / Length of Field VO r -7 -
Width of Field ',�+_ to0 Depth of Field
Gravel Bed Thickness r7 Gr
Square Feet of Absorption Area _rinn .-S-F= Standpipes Present (Y/N)
Depression over Field (Y/N) AJDate of Last Adequacy Test ✓
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water -Supply Well /Zo >< Fr To Property Line wr
To Building Foundation 1�710 71- FT To Existing or Abandoned System on
Lot - W�r ; On Adjoining Lots IC1C3i Fr
To Water Main/Service Line ^�/A To Cutbank (if present) � 4/ik S
To Stream/Pond/Lake/or Major Drainage Course AiP6
To Driveway, Parking Area, or Vehicle Storage Area
Comments QAC f<aa
d 4-27_7.ska " �:Y .
/Jove.v.,fo.z � 198'S,
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
�1 +
S�+er� opt, u wo34C rw.di
Dimensions
Manhole/Access (Y/N) —
"Pump Off" Level at —
Vent (Y/N1/
Cycles during Adequacy Test. Meets MOA
Chc!fR Permitted Bedroom Ratin Against HAA Request "
I certify that I hav the Fc d, fie , o onformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed Date "/n2
Company MOA No.
Receipt No. 2c -,o 1— C�iOl 0
Date of PaymentFs-s -&.0 oOF q(�09p
Amount: $ -BOJ �� ��M•„•••� ' ��O,11ff,,
m
r00110�
®_?
Page 2 of 2
C ale ..Merrell w
2055-E V
72-02e (11/e4) �tl� 9�co ••....c...,•' �,4��®
Seal
• MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720 ,��� i
Application Date 41
1. GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
_S
Location (address or
•s /ZG
Address
(e) Reap Estate Company and Agent
Address
Telephone.:
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
--+'-Single-Family Multi -Family ❑ Other
3 _
Number of Bedrooms
.3 WATER SUPPLY
!!(
Individual Well tal Community El Public 11_
,. Note: Ifcommunity well system, must have written confirmation from the State Department ofEnvironmental
attesting to the legality and status.
e4 �-•xx�.;4•r
k s
Yt� •5•s�i ;T Ayk .y
<�, td,
' f teT T�eR' �t4A
a 5AF
r
-onservation {
4. SEWAGE DISPOSAL
Onsite }at 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.
Pagel of 2 72-025 (11/64)
5'1 SSD x/03 Business
(b)
Applicant Name = ?/
Telephone: Home
•
Applicant Address
(c)
Applicant is (check one): Lending Institution ❑ ; Owner/builder) ; Buyer ❑ Other ❑ (explain);
` w
(d
-A' 5/6'� �S•Z
Lending Institution`.
Telephone G -j' 7 s <
Address
(e) Reap Estate Company and Agent
Address
Telephone.:
(f) Mail the HAA to the following address:
2. TYPE OF RESIDENCE
--+'-Single-Family Multi -Family ❑ Other
3 _
Number of Bedrooms
.3 WATER SUPPLY
!!(
Individual Well tal Community El Public 11_
,. Note: Ifcommunity well system, must have written confirmation from the State Department ofEnvironmental
attesting to the legality and status.
e4 �-•xx�.;4•r
k s
Yt� •5•s�i ;T Ayk .y
<�, td,
' f teT T�eR' �t4A
a 5AF
r
-onservation {
4. SEWAGE DISPOSAL
Onsite }at 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.
Pagel of 2 72-025 (11/64)
5. ENGINEERING FIRM PROVIDANSPECTIONS, TESTS, FILE SEARCH, DVA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
the da
Name
Addre
Date
6. DHEP APPROV#L,h
1VI ,Id�_.t
Approved for bedrooms bYd-
� Date
Approved DisapprovConditi
Terms of Conditional Approval
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority.
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the. State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending;
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the .
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNIOPANTY OF AtV0JMGj
ll OF HEALTH 6
• MUNICIPALITY OF ANCHORAGE (MO INVIRONMENTAL pROTEaION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984 NOV 1 !
264-4720
Legal Description: flh�i� U°)
A. WELL DATA
l'
Well Classification If A, B, C, D.E.C. Approved (Y/N)
G.a vv
Well Log Present ) _� —�7- %Z Date Completed _ Yield�
Total Depthp g ----_-
Cased to Depth of Grouting
Static Water Level / Pump Set At ��--
Casing Height Above Ground
Electrical Wiring in Conduitl
Separation Distances from Well:
Sanitary Seal on CasingON) —
Depression Around Wellhead (Y(:p
To Septic/Holding Tank on Lot /"'E76'f f ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot /ZD f ; On Adjoining Lots�—
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected by Date //-C
Water Sample Test Results S.o7�sF.a-c7-•9'/'t.
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 9 y%-�2 Size Zed No. of Compartments 71
Standpipesoy I Air -tight Caps6N) Foundation Cleanout (Y/N)
Depression over Tank (/ 1�
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High -Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water -Supply Well -7/--
To Property Line y0 f i
To Water Main/Service Line
Course
Comments
Page 1 of 2
• ,' 72-026(11/84)
Date Last Pumped // 67
for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
0
C., ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
136tearistalled Length of Field %J /
Width of Field y6 '��Depth of Field
Gravel Bed Thickness
Square Feet of Absorption Area / Standpipes PresenhOV
Date of Last Adequacy Test
i 5�4i Tfsi �°
Depression over Field (Yo—
Results of Last Adequacy Test
Separation Distance from Absorption Field: /
To Water -Supply Well /tea / 7� To Property Line
To Building Foundation To Existing or Abandoned System on
Lot G G ;,On Adjoining Lots
To Water Main/Service Line /1/ /� To, Cuutbannk (if present) y ivF
To Stream/Pond/Lake/or Major Drainage Course w ��✓�E5=y�
To Driveway, Parking Area, or Vehicle Storage Area
Comments �!�S heaJfk G.u.>yioir+f c✓A-S CL,rrglovtsQ r..n
D. LIFT STATION
Date Installed
Size in Gallons —
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent(Y/N).
" Check Permitted Bedroom Rating Against HAA Request "
Pumping Cycles during Adequacy Test. Meets MOA
I certify that Ihave checked, verified, or conformed to all MOA and HAA gui lines in effect on the date of this inspection.
Signed Z%Ih/, Date
CompanMOA No.
Receipt
Date of Payment
u
Amount: $
Page 2 of 2
72-026 (11/84(
PROCESSING CAN BE.INITIATED� - - -
:Cpc��
e w..
''Time
Time
t tr
'APP.LI NT FILLS OUT',UPPER
Property Owner
r ' �. f i - �, �' _
>`
Phone '�'+ r.
.•,
i •ui.
'Adaress
4. _ r. -
1
" -
��S
.Mailing' E' /�/-
. /Y! rA�i; , f i; /! /\/i^.+ n.
Date - -' c. t
Beier
Date k' s'.
Date '.k'
-
Address 1
.. . -
- a-,','°� •Lp:Code + '
-
Lendinglnstitution„ -' -
- "'- -' •�-
i
Phone '
'address, rut'- 1, Zip.Code
Inspector '' r
-: ..
Realty CO. -&-Agent
y. ..s .. ; -.. ' ` Phone....'§-.
,
r
'm
AdGress (_.. -, ::
._ .. '',-.; �4• (. i t,_.+' .- LpCode
Legal Description
Y�
Field Notes eY4
x OF ANCHORAGE
' *MUNICIPALITY
OF HE!`�Ttl
Street Location' o ('zz
,./-/�, /`Y/l'_1.�•!J_���i' 1.,'
Type of Residence a„ / ,. •, + .r : r
C�ngle Family
' ❑•; Multiple. Family `4'
No of Bedrooms',
Other..
ae -a' ,ry.r r < ,•l . ..
r
Water PPIy •:. w).
r r vt-m a.r v -o-
_, T ^, _•.,r .�--;
Individual}• •+
,, s ,,bt A r x "" sm
ATTACH WELVLOG. 'A well log Is ,required for, all wells drilled since June 1W5.".
1 ❑ Community -
�' - ' .:'
For wells-drdletl prior,,t that date( give. well depth (attach1og if available)
El, Public.Utility.,
x — Ll
{�
Sewer `Disposal-
r i ' r :.•• "', •% d ' n,• r,.,
tfYlndlVldUal"
`�
'Ye r Individual Installed
? ±'` l '
O_'Pulilic Utilit Y
,• ;,s .- When Connected toPublw Utility.:"
❑ HoldingTank
`Well Log.Recerved �?'
.x
- NOTE: THE INSPECTION; FEE'MUST ACCOMPANY EACW REQUEST BEFORE
PROCESSING CAN BE.INITIATED� - - -
:Cpc��
e w..
''Time
Time
TimeTime
Date - -' c. t
Date
Date k' s'.
Date '.k'
-
to-ai-
Inspector °
Inspector '
Inspector ± - ` s
1
Inspector '' r
Field Notes eY4
x OF ANCHORAGE
' *MUNICIPALITY
OF HE!`�Ttl
.. f`EPT
f ' ' ENVIRO'�Jt NTAL PROIE `ION
f• . a - .�,' f
y
OCT 14 ram
j R VV E,D
x r
.P {
('' APPROVED BEDROOMS 'CONDITIONS OFAPPROVAL
(, (DISAPPROVED - ' 1
:( • 1 CONDITION L PRpO-VAL
DATE,,Y6
BY
r
T
x — Ll
{�
ti•
x
h.y r
.Y
Sdils Rating
Date Sewer Installed _.
'+Well ToAbsorption Area. �'(py. 1 fi' •
`Well Log.Recerved �?'
m
�S'- 2 ' -
"Well
.r
•7
, vt ,. (�
Septic Tank Size,'
--� ..]2.02313182)
0
5. LEGAL DESCRIPTION
DATE RECEIVED
OT
INSPECTION APPOINTMENTS
. , . /
-�
TIME, '
TIME
TIME
`
EJ One ❑ Four EJ Other
DATE r
DATE
DATE ,
123-' Three ❑ Six -
V
Jo
INSPECTOR (lY� �I
INSPE/ OFAI
INSPECTOR��\
MU(NVIPAUTY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF 117ALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT ECTIMI RONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
JUL 2 4 1980
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720 RR FFCEE vv EE
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWA AIC LI -nn
DIRECTIONS: Completeall parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER
(W01)q-4 n •4 ('I cv(,L' -0- Ur0L,i,N
PHONE
3y9 13S
MAILING ADDRESS
p
`5AA3 y ) I� k ,Tv1(l-tGrcr'e, .qk el -11 7
PROPERTY RESIDENT Of different from above)
PHONE
[rt'Vt 2
2. BUYE.R,/ /'
iF >%�iv1 �it.�)r�e1' •1, l.to('{�ir'(v\ ?t'Ivle�'4`I-(o�ll
PHONE
r
MAI LING ADDRESS _
3. LENDING INSTITUTION ' \
PHONE
I
MAILING ADDRESS
`,,..'✓✓
4. REALTOR/AGENT J'/
PHONE
� �
MAILINGADDRESS v / r•j
/ /. J /
5. LEGAL DESCRIPTION
_
OT
/CCL- Ui/ter Sd. ✓ .dv
STREET LOCATION _
SAIA t3ex K
.Z cd ?^ .�-. < s. S.'rl BT ///A11Ar[) /t
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
EJ One ❑ Four EJ Other
�� SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
123-' Three ❑ Six -
7. WATER SUPPLY
® INDIVIDUAL*
_ "ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 3975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
li%2- v/JJr,. j/ /,'I. •. - a ).✓ /9Yfb
IN INDIVIDUAL/ON-SITE**
YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79), t/ Q r r...0 - \ — r: nl� s
�l�.�. Ir�__'�.
72-010 (R., 6/79)
•
_ THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
NUMBER OF BEDROOMS
❑ SINGLE FAMILY
❑ ONE ❑ THREE
❑ FIVE ❑ OTHER
❑ MULTIPLE FAMILY
❑ TWO ❑ FOUR
❑ SIX '
2. WATER SUPPLY
PERMIT NUMBER
❑ INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
DATE DRILLED
-
❑ PUBLIC UTILITY
,
r
Connection Verified
LOG RECEIVED -
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
❑INDIVIDUAL/ON -SITE
DATEINSTALLED - ..
E] PUBLIC UTILITY
Connection Verified
INSTALLER
-
❑Septic Tank or ❑ Holding TankQ.
Size: / 000 If Tank is homemade
SOILS RATING- -
-
give dimensions:
TYPE OF TANK
MANUFACTURER
S'i�r�cK STEEI
TOTAL ABSORPTION AREA
MATERIAL
-
4. DISTANCES
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot .Line
WELL TO:
Absorption Area to nearest Lot Line
i
5. COMMENTS -
-
per.
liqo4vu
0_J
an,6-�
Q112A,
(/
FOR. _� BEDROOMS
,❑APPROVED
L{Y CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
- -
DATE -
/y
's
BY
- �–Y 46
72-010 (R., 6/79)