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CONTOUR ACRES BLK 1 LT 6
Onsite File Contour Acres Block 1 Lot 6 #017-451-06 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211020 PID Number: 017-451-06 Dwelling: © Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name Kevin Casey AORPTION FIELD ❑ De Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5201 Country Club Lane Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 /SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original a Gravel depth beneath pipe Ft. Subdivision Block Lot Contour Acres 1 6 Fill added above original grade Ft. Gr ! length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between ches From Tank Field Lift Station Tank Line Ft2 _ t. TANK ElSeptic 21 S.T.E.P. ❑ Holding ElOther Well 1001+ 1OO1+ { Manufacturer Greer Capacity 150OGal. i Surface Water 100'+ 100'+ j Material Number of compartments I I Lot Line 59+ 51+ NA Plastic 2 Foundation 101+ 101+ LIFT STATION Manufacturer Greer Capacity 1500 Gal. Remarks New STEP tank connected to existing deep trench system. Alarm location Garage Electrical installed by ACES PIPE MATERIAL House to tankTank to D3034 drainfeld D3034 Installer ACES Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft InspectionLocation dates: 1 9/23/21 2nd 9/23/21 and description 3id 10/7/21 4'h Porch foundation post ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date��� rl►a� U'lik OF 491h System wut�La��Z'1;e9'� Approved Date �9 .26�a c^i45 KENNETH M. �F% ISeptic ���'CE 11 �a ♦ ,jam Note: this approval does not include well permit requirements. 461killisti (Rev 05/02/18) AS -BUILT SYSTEM DETAILS/SITE PLAN Permit ❑SP211020 CONTOUR ACRES BLOCK 1 LOT 6 PID# 017-451-06 x I . SEPTIC \ VENT X (tYP) x ' \ X x I \ X x I• D \FENCE C X • � • LEANTO x DECK FCO 1 LEANTO \ PSHED EXISTING A. - -HOUSE HOUSE \ BRICK 'r WALK D/W f 9 � ' � Imo' I Y 4•• WELL I SCALEi 1' = 40' o 0 M A -C=52,0' 99.61 m B -C=44.3' A -I)=55.3' w N❑TESD m a m2' GE❑F❑AM INSULATI❑N, EXTENDING 1' BEYOND TANK, g o BACK FILL OVER TANK (GM) WEIGHT 100-120 LBS/CU.FT. ;7.9 a JD�511R 13 W500 GAL a STEP TANK 88.56 SCALES NTS IF PREPARED FOR: KEVIN CASEY 5201 COUNTRY CLUB LN ANCHORAGE, AK, 99516 FIELD BOOKS COMPUTED: BOUNDARY: N A DRAWN: KS❑ STAIONG N A CHECKED: KIVID ASBUILT. SLS DATE 1/3/22 M. FILE: GRID: SW2837 ACRD FILE FILE I "No' 20203 SCALE; NTS A 14.0' w a LEANTO N89'56'02"W 270.10' (N89'59'00"W 270.00' R) 10' UTIUTY ESMT �x 1 -x� �x f �x �x x x 1 x f . SEPTIC 1! VENT LOT 6 f (Lya) BLK 1 k ' k x 1 • x � ■AIH ' ■ MH dp x 1 1k 7c DECK 2'x15.5' i CANT f LEANTO 29.5' o 2' DECK o ru 2'x9.5' �i 20.5' n OVERHANG FP CANT EXISTING 17.3' 1a.n' 9 HOUSE PORCH CANT BRICK WALK PAVED D/W WELL 0 N89'59'09"W 270.37' (N89'59'00"W 270.00' R) COUNTRY CLUB LANE ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: CONTOUR ACRES SUBDIVISION LUT 6 BLOCK I PLAT P-661 SURVEY CERTIFICATE: I, John L. Schuller. Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is tete owners responsibility to determine the existence of any easements, covenants. or restrictions which do not appear on the recorded subdivision plat. DEC 29, 2021 I 1"=40' I achullw**, et 21-172 *" °� a 800Ksr °" JL5 SW2837 220114 sib. of 49T Ji .. ........................L ' HN L. SCHULLER. o LS -10408 1�\► f e9 siana� �"�! 00-0 40 rrn (0 n LLJ � O 0 b V) D U'Y 0 0 = FND IRON PIPE O = FND REBAR = FND AL CAP % jYD Ap 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227---1455 office (907) 274-4992 fax Carroll, Rebecca M. From: Carroll, Rebecca M. Sent: Friday, August 27, 2021 11:44 AM To: Dea Duffus; Kevin Casey Cc: Anderson Contracting & Environmental Septic Subject: RE: Deep burial septic tank Please note Greer's comment about 125#/cu.ft. cover. Looking at the soils log for this property, it looks like insitu is dense, silty soils. We have had some instances where the Greer HDPE tanks have been warping enough that they break the connection either at the manway riser(s) or pipe connections on lots with heavy, wet soils. We are working with Greer on a solution for these lots, but this may be another problematic site. You may want to consider using a lighter, certified fill for almost the entire depth (certified D1 has been suggested). Becca Carroll Onsite Water and Wastewater Municipality of Anchorage 343-7908 From: Dea Duffus <dea@arcterra.net> Sent: Wednesday, August 25, 202111:32 AM To: Carroll, Rebecca M.<rebecca.carroll@anchorageak.gov>; Kevin Casey 415drive r@att.net> Cc: Anderson Contracting & Environmental Septic <aces.info907@gmail.com> Subject: Fwd: Deep burial septic tank [EXTERNAL EMAIL] Here is the note from Greer Tank for permit OSP211020- Contour Acres Blk 1 Lot 6. We will be using the 1500 gallon deep bury tank with lift pump and installing 2' of Geofoam directly above the tank and extending one foot beyond the tank in all directions. dea Begin forwarded message: From: Jason Greer <igreerOgreertank.com> Subject: RE: Deep burial septic tank Date: August 25, 2021 at 9:54:14 AM AKDT To: Dea Duffus <dea(a,arcterra.net> Dea, Greer will warranty this tank for this installation as long as no more than 125# per Cubic Foot of overburden. Thank you, Jason Greer General Manager Greer Tank & Welding Fairbanks, AK 99701 907-452-1711 907-378-1397 1 From: Dea Duffus <dea@arcterra.net> Sent: Monday, August 16, 20214:00 PM To: Jason Greer <igreer@greertank.com> Cc: Carroll, Rebecca M.<rebecca.carroll@anchorageak.gov>; Ken Duffus <ken@arcterra.net> Subject: Deep burial septic tank Jason, We have a situation in Anchorage where a residential property is in need of an 11 foot deep burial septic tank. The current situation is a 1250 gallon steel tank with a 500 gallon lift station that was installed in 1993 at a depth of 10.7 feet. We are proposing to replace the tanks with your 1500 gallon MOA Effluent Lift tank that is approved for 10 foot of overburden with 2 foot of Geofoam placed directly above the tank and extending one foot beyond the tank in all directions to decrease the weight of the soil over the tank. We are trying to get this installation done this month as the family have been pumping the tank regularly this summer and can not go into winter this way. The MOA has given us verbal approval with the stipulation that the manufacturer must also approve this solution. The existing sewage outflow is from a basement level bathroom and the existing terrain is flat to slightly raised to the drainfield. I have attached some drawings with current elevations and our proposed excavation. We will be able to maintain a maximum depth over the tank to eleven feet and believe this design in provide adequate protection for the tank. Thank you for taking the time to review this information and we look forward to your approval of this installation. Dea Duffus ArcTerra Consulting, Inc (907) 696-6111 dea@arcterra.net N O N CII W H CD X LO 00 Z O F- W W 11 CD W = Q tl I LL F-- 00 Of n ry'Ile W 0 E- J Q m S C/) W W U) Of Q Q S ry (D D z o F- F- C/) Z X 0 W U ui E n 0 z b co LA wl F - z 0 i 2i i w z W Z 0 z Lli co Z 0 w U) z Cl) M LO co U) C(6 0 N 2 E tn LO W tn C: cu W 0 E LL CL 12 0-) fla 0 E 0 X U) LO co co E2 W EW 2 LL CA a) 6 m co E 0 W N of 0 �E E -0 - <r w (D m 00 ry n ry C) W0 C? F— > (D < I (3) W 00 00 1 m = (1) 0 w . . > > 3: w Ln W E T w (D w uj U) ui U D(D EN oz o > 00 00 En O cu -E cu U) U) z Co E JE 0 w () MUNICIPALITY OF ANCHORAGE 11 „t On -Site Water & Wastewater Program �o S PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Depal-tment On -Site Wastewater Disposal System Permit Permit Number: OSP211020 Effective Date: 2/11/2021 Work Type: SepticTank Upgrade Expiration Date: 2/11/2022 Tax Code Number: 01745106000 Site Legal Address: CONTOUR ACRES BLK 1 LT 6 G:2837 Site Mailing Address: 5201 COUNTRY CLUB LN, Anchorage Owner: CASEY KEVIN C & PATRICIA D Lot Size in Sq Ft: 98550 Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: Date: Date: 2 �� MUNICIPALITY F ANCHORAGE Development Services Department y. Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-451-06 Property owner(s) Kevin Casey Mailing address 5201 Country Club Ln, Anchorage, AK Site address 5201 Country Club Ln, Anchorage, AK Day phone Legal description (Sub'd., Block & Lot) Contour Acres Block 1 Lot 6 Legal description (Township, Range & Section) Lot Size 98550 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank Upgrade (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) ❑ ❑ Multiple Dwellings ElPrivy (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. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: $225 Waiver Fees: Date of Payment:2-Z-,7 J Date of Payment: Receipt Number: 0y Z ti c4G Receipt Number: Permit No. OSP211020 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211020, Deb Wockenfuss, 02/11/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211020, Deb Wockenfuss, 02/11/21 Municipality of Anchorage Page t 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 Na.~.~;~.T.. ~. ~~[ ~ Wastewater System: ~ New ~Upgrade Address: ~~ ~M~ ~ ~ q~l ABSORPTION FIELD Phone: ~No.~drooms: ~epTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other Total Depth from original grade: LEGAL DESCRIPTION Soil Rating: ~'~PD/Sq. Ft. Lot: ~ Block: [ Subdivision: Depth to pipe bottom from original g~de~ Gravel depth beneath pipe Ft. WELL: u New ~ Upgrade Gravel width: ~(Ft. Number of lines:~ II Distance between li*es: ca[ion (Private, A,B,C): · ~ Total Depth: Cased To: Total absorption area: Pipe material: Driller: / Date Drilled: Static Water Leveh Installer: Date installed: ~/~ ~ Yield: GPM11 Pump Set at: Ft.II Casing Height Above Ground::Ft. TANK SEPARATION DISTANCES ~eptic U Holding U S.T.E.P. To Septic Absorption Lift Holding Public/PrivateManufacturer: Capacity in gallons: Surface Water ~'~ I¢~ ~¢% ~ ~ LIFT STATION FounOation CurtainDrain , _ ~~ ~()~ ~ _ ~P"~ Make & Model .~ I Electrical Inspections performed by:~ Remarks: BENCH MARK Location and Description: Assumed Elevation: Ft. ENG Inspections performed by: 17c:4 =,G~ *Iv, r ~ *~, ~: 1st ~1/~/~ 0 Department of Heal d Huma rvJces appr~va ~evieweO and appmve~ by: Date: 72-013 (Rev. 9/91) MOA 25 Permit No. SW9303 ! 6 Page 2 of 2 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 DRIVE' CONTOUR ACRES SUBDIVISION, Legal Description: RI OCK I; I (3T R PID No.: ~q1745106 CO1 ~ FINAL GRADE /97.7. MH, / _ . MT /964' 96.9' MT N:T.S. 86/ 86 q~.// ~ · 80' NO WATER FOUND x ~ EXIST . 1~50 GAL SEPTIC TANK ' ~ /INTEGRITY VERIFIED HOUSE _ ~ ~ E~STING TRENCH ABANDONED '- /, ~, THE FUTURE 72-013 A (2/91)MOA 25 o,,.,00 i':,¢;o't :~U'.(1(}7,¢: 3'" 3464 I [" .T k, Lgb.l.,., IC¢,L SERV 0 0 0 0 ¢.~T NI-iXT INSPI:;~C'.I.'ION l:i 3 i)0 NOT (]ONCB0~L UNT'.f.L D h '.'f. '.(',: 9 / 2 / 1993 .I. ,'1 .~: :'::, N (i ']7 I' C E 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:SW930316 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:MALLIN ROBERT E OWNER ADDRESS:5201 COUNTRY CLUB LN ANCHORAGE, AK 99511-1251 DATE ISSUED: 8/23/93 EXPIRATION DATE: 8/23/94 PARCEL ID:01745106 LEGAL DESCRIPTION: CONTOUR ACRES BLK 1 LT 6 LOT SIZE: 98550 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS August 18, 1993 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. ~unicipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street Anchorage, Alaska 99501 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 ~EFERENCE: Contour Acres Subdivision, Block 1, Lot 6 [equest you issue a Dermit to uDgrade the septic system 3erring the four bedroom house on the referenced DroDerty. An adequacy test performed on the existing system on July 26, 1993, for Health Authority Approval purposes found the ~xisting system to be in a state of failure. test hole was excavated and percolation test performed in the area of the proposed upgrade. Attached is the proposed upgrade design. ~ r/~~Vl ROAD DESIGN /~_~' /J ~S/LSU/lsu SOILTEST ~ Ne do not anticipate any adverse effects on neighboring properties by the installation of the proposed septic upgrade. IIf you have any questions or require additional information for yo' ew, please contact us. PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SiTE WASTE WATER DISPOSAL SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 1"=50' SCALE COUNTRY UPGRADE CLUB LANE ~ m '"'""ED Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O DATE Township, Range, Section: SLOPE /~ WAS GROUND WATER Ill\ ENCOUNTERED?V~/(~ S L IF YES, AT WHAT ~ O DEPTH? P E Depth lo Water Monitoring? SITE PLAN / G~ros/ Net Depth to Net Reading Date Time Time Water Drop :1~ lo qv;,' ~v" ~2¢ ~o q ~/r" ~,. PERCOLATION RATE 5'~ im,nutes/mch) PERC HOLE DIAMETER i~1! TEST RUN BETWEEN ~TAND (~ FT COMMENTS ,~Cz:~ L~ G~ ~k~_ ~ /~~ PERFORMED B- ~.. ~ ~t t ~ ~ M. ~ I/// ~ % ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ~cco. D..C~N~~~c,.*~ GU,OEU~F~C~ O. T.~S ~*TE. ~*~e 72-008 (Rev. 4/85) GREA,CR ANCHORAGE AREA BORL.,GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE /2 NUMBER Of FROM WELL /~ MANUFACTURER ~ MATERIAL COMPARTMENTS / INSIDE LENGTH //O INSIDE WIDTH LIQUID DEPTH __LIQUID CAPACITY /~_~"--C~ GALLONS, SEEPAGE NUMBER OF PITS / LINING MATERIAL BUILDING FOUNDATION__, ADDITIONAL ABSORPTION DIAMETER __ OR WIDTH CRIB SIZE: DIAMETER NEAREST LOT LINE ~/~-- / / LENGTH ~___~, DEPTH /¢ DEPTH '~//~~CE FROM: WELL ////g / TOTAL EFFECTIVE ? 7~ ABSORPT,ON AREA <WAL. AREAl SQ. FT. WELL: TYPE Or, I[~_~ 6 /1 CONSTRUCTION BUILDING FOUNDATION __ NEAREST , LOT LINE CESSPOOL , OTHER SOURCES NEAREST SEWER LINE --~ APPROVED DISAPPROVED REMARKS DEPTH DISTANCE FROM: / SEPTIC / SEEPAGE / ___, TANK /O~, SYSTEM //~/~ DISTANCES: INSTALLED BY:_~/Q..,*.,,,2-~/_ ~'~'~)_ ~ PIPE MATERIAL: LOT SLOPE: REMARKS: Form No. EQ-031 DIAGRAM OF SYSTEM DATE ~///'2~/7~'~ APPROVED ~ :/~__ ~j~t~__~ ~ G~/.A.A.B. · :IF I- L .I. C:FIN T L.. 0 E: FI*T' I ON L. EGFII .... i'"1 :[ K,E MFILIEF._.' ~!O..1'-4'['F.?¢ CLUE: LFINE t242.: C:F.:ESC:ENT [:,R LOT S I ZE 'E.~ =:550 '}.;L::!I...IF:II;.:E l=liii:E]" "l"'¢F'li.:.': OF:' SOIL. RE:S]RE:].'IOI"~ S'¢S"I"EM IS' TF..:ENCH I"'IF:I::-::IMUM NI...IHE:ER OF bE[.F..uuH .... = 4 :,uIL RRTING ,::SQ FT,.."BR)= THE R[.=(.:.!I..I I RE[:, :, I,:E. OF THE :.u I L HE,.:,L E.F ]' I ON :, ~r :,'f Er1 I :=, E'.'::. E: F:" T' ["~ =:= 'T'FIE LENG'TH [) I hlE['~I fin IS THE LEN6TH ,:: I NUFEET ::' OF THE FF. EN_.H I._1~. [:,RFII NF::' I ES....D. TFIE:. DE:F'TH OF FI TRENCH OR PIT I'-=; THE D IE, TRNCE BETWEEN THE SURF'RCE OF 'THE GROUN[':' RND THE BOTTOM OF THE E',:':;CRVRTION '.'.'IN FEET). THERE ~'.]4; NO SE]" WIDTH [:'OR TRENCHES. THE GRFI'v'EI... DEPTH TL=.; THE.". M INIMUH DEPTH OF GRR',,,'EL BETWEEN THE OUTFF:ILL F'IPE RNE:' "1"[4[..: I:~)OTTOM OF' TH[.'] E::':',C:RVRTION '.'.'IN FEE:T). E[F::IC:KF ILL I NG OF Rl",l"r' S'¢S'I"EM I,.I I THOU'T F I NFIL I I",I:,F E..7 I .. I"..I RI'.,IE:, FIF'F'F.:O',,,'FtL. E:'.r' 'I'H I :~i; E:,~':PFIRTMEt",tT W ILL. BE: '..SUELIECT 'T'O F'ROSEC L T I ON. MINtMUH [)IS'T'RI'.IE:E BETWEEN FI WELL FIND FINY ON-SITE SEWFIGE DISPOSAL. S'¢STE:M ISi; 1OO FEET FOR R PR I'v'RTE WELl_ OR 2F~O FEET FOR Ft F'UBL. I C WEI_L WEL. L LOGS FIRE RE6.!LIIRED FIND MUST BE RETURNE[:, TO THE [:,EPFIRTMEN]" W I]"HII'.4 .7...::0 E:'f'=l"r':i'~; OF' THE WELL. COMPLETICIN. 'Z.;F:'I!.:..'CIFIC'FrTIONS FIND C:ONSTRUCTION DIFIGRFII'dS RRE R',,,'RIL. RBL. E TO INSLIRE PROPEF;i: I t'.4S;TRLLFIT I ON. I CE:R'T'IF'¢ THRT ::L: I FII'd FRMILIFIR WI'TH THE REQUIREMENTS FOR ON-SITE SEWERS FINE:, WEL. I....:E; FIS SE'I" F:ORTH B"r' THE MUNICIPFIL. IT'¢ OF RNCHORRGE. 2: I WILL INSTFIL_I... THE S'¢STEM IN RCCOR[:'FINCE t.4ITH THE CODES. ]:: I UNDEF.:S]"IaND THFIT ]''PIE ON-SITE SEI4ER S'¢STEM I"1R'¢ REQUIRE ENLFIRGEI'dENT IF' THE: RE]S IDENC[E IS REMODELED TO I NCLU[:,E MORE THFIN 4 BEDRCE)I"15S. 4040 "B'" STREET, ANCHORAGE, ALASKA 09503 PHONE: 907-279-2581 May 25, 1976 W.O. ~17708 Grid 2837 Mr. Mike Mauer 1243 Crescent Drive Anchorage, Alaska 99504 Subject: 'Subsurface Investigation - Lot 6, Block 1 Contour Acres Subdivision Dear Mr. Mauer: Transmitted herein in accordance with your instructions are the results of the above referenced investigation as performed by us on May 20 and 21, 1976. The scope of this project is investigation for suitability of an on-site sewerage system. Included in this transmittal are: Vicinity Map Test Hole Location Sketch Test Hole Log Explanatory Information Figure 1 Figure 2 Table A Sheets 1-3 The exploration was conducted using a Nodwelt mounted Mobile Drill Model B-50 drill rig with a continuous flight solid stem auger. The rig is owned and operated by Denati Drilling Inc. Drilling was supervised, the test holes logged and.percolation .test performed by Mr. Terry Barber, Geologist with Alaska Testlab. The .test hole was placed at the approximate location shown on Figure 2. The log of this test hole is included as ?able A of this report. In interpreting the log it would be helpful to utilize the explanatory information contained in Sheets 1 to 3 of this report.. When drilling was completed a 3/4" slotted PVC pipe was inserted in the hole to aid in determining the free water level. For the percolation test, the test hole was filled with water Mr, Mike Mauer May 25, 1976 Page Two and left overnight to saturate2 On returning the next.day, the hole was refilled with water .and the drop in the water level carefully monitored over the next 60 minutes. This procedure is not a standardized percolation test, however, we understand that the Anchorage Department of Environmental Quality prefers tests performed in this manner to evaluate ~ a site for a proposed on-site sewerage system. Using the above test, the observed minimum percolation rate was 11 minutes per inch. No water table was observed during drilling, but it should be noted that the free wa~er leVel normally fluctuates seasonally and with precipitation. ~We hope this report meets your present needs. If we can be of further service, please feel free to contact us. 'Very truly yours, ALASKA TESTLAB R. Mark Hansen RMH; pks Attachments APPROVED: ~elv~n R Nichot , . · Laboratory Supervisor I- I I I I I 7 5 $ 8 COUhfTRY CLUB Lane 4 'T'EST' l-4'Ot-~ LO c,~.'r' ;o ~ s~6'rc.'n F'IG. 2. Date: Logged: May 20, 1976 T.B. Test Hole No. 1 Depth in Feet From To 0 0.5 0.5 7.0 7.0 16.0 TABLE A WO% 17708 Soil Description' Brown organics with peat and roots. F-4, light brown slightly sandy silt, (ML), wet to damp, soft to stiff, NP, includes -.gravelly layers. F-4, brown slightly sgndy silt, (ML), damp, stiff', NP, include~ ~ravelly layers, becomes more dense with depth... Sample No. Depth 1 2 3 4 'Remarks: 2-5 ~5.0 10.0 16.0 1) 2) 3) Dry M% Strength Type of Sample G G G G Unified Classification ML ._Type of Sample, G=Grab, SP=Standard Penetration Dry Strength: N=None, L=Low, ~{=Medium, H=High Unified Classification: See Sheet 3'. NOT SUBDI' ED HUFFMi~ IV t~OA D 264L50' F ~ t. 70' 7 .... /.zOo oo' Or/~i'n of L~ear/ng ~I000' 270' '"~' .... lO' ELEC 5 T~ lC EASEMENT 3 C. A. Sub. 650-S. 1962 ....... GENE ~AL UTILITY 6 EASEMENT SCALE: I" = I00' NERSHIP AND DEDICATION CERTIFICATION OF APPROVAL BY THE BOA5 ARE TH[-' OWNERS OF THE PROPERTY I HEREBY CERTIFY THAT THE SUBDIVISION PLAT ,ND 'THAT WE HEREBY ADOPTTHIS PLAN SHOWN HEREON HAS B£~::N FOUND TO COMPLYWI1 .... NSEN1, AND DEDICATE AL.L S1RE~:;TS THE SUBDIVIS,ON REOULATIONS OF THE GREATEF ¢:~ OPEN SPACES TO PUBLIC OR PRIVATE ANCh,~AOE ~' ATTING BOARD, AND THAT SAID PL, HAS BEbN APPROVED BY THE BOARD BY PLAT RES L'JTtON t, 3 ' . ........ DATED ....... 19 ..... ~, AND THAT TH~ PIAT SHUWN HEREON HAS BEEN A~ROVED FOBREC( , EX'~FICIO RECORDER, ANCHORAGE. . ./ OWNER GREATER AN~ORAGE PLA~TI~ ATTESTS DEPUTY CLERK ,Gr QL • �- Municipality of Anchorage =� On -Site Water and Wastewater Program a' (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 017-451-06 1. GENERAL INFORMATION Complete legal description,_ Contour Acres Blk 1 Lot 6 Expiration Date: _a, - i q, o? Da,? Location (site address) 5201 Country Club Lane _ Current Property owner(s) Kevin & Patricia Casey Day phone __ Mailing address Real Estate Agent 5201 Country Club Lane, Anchorage, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $� Waiver Fee $ Date of Payment _ f 202 2- Date of Payment Receipt Number g q Iia Receipt Number COSA # DS C21 1 OD FJ Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CON_S_ULLING IANC. _ ...... ...... Phone 696-6111 Address 20441_ PTARMIGAN BLVD, EAGLE_ RIVER AK 99577____ Engineer's Printed Name KENNETH M. DUFFUSDate 1/12/22 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future - �• occupants or can ArcTerra guarantee that no unseen .� cli encroachments, deficiencies or discrepancies exist. - ,� ��.•<(� - * flQTHJ * . 6. DSD SIGNATURE System #1 Approved for / bedrooms. r�xnET?;` `` "��, 101111' System #2 Approved for bedrooms. AW Disapproved. Conditional approval for bedrooms, with the following stipulations: _ ___..___.__._ ON-SITE WASTLYZATER Jc� PROGRAM By: ! Original Certificate Date: 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 -10-10-12 doc Legal Description: COSA Checklist CONTOUR ACRES BLK 1 LOT 6 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled "1976 Total depth *213 ft Cased to * 40+ ft ® Sanitary seal is functioning correctly U Wires are properly protected Casing height (above ground) 25 in. Date of flow test for COSA 9/25/20 Static water level at beginning of test 220 ft. Comments * information from previous COSA B. TANK DATA Age of tank(s) New years Tank type/material STEP/Plastic Measured operating fluid level in septic tank New ® Standpipes/foundation cleanout per record drawing Date of pumping New tank installed 9/23/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 9/2/93 ALL standpipes present per record drawing Total measured depth from grade 11 ft (max) Measured depth to pipe invert from grade ft (min) N N/A — pressurized field 01 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 gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 017-451-06 of Structure served by this system 1 Well production at time of test 5.4+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes E Nc ® Coliform bacteria is Negative Nitrate 1.97 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L *1 Arsenic less than MRL (ND) Collected by ArcTerra Date of Sample 1/6/22 C. LIFT STATION [■1 Required maintenance completed Age of lift station New years Lift station material Plastic Comments: Adequacy test date9/25/20 Results Q✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 14 in Elapsed time 60 min Final fluid depth 0 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) 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' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft [0 Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ft ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® 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_ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' 0 Yes if No Water Service Line > 10' ® Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ft ft ft ft ft iR 49111 * �� i KENNETH M CE; ❑ S i� 177�'+� ft ft ft ft ft MUNICIPALITY OF ANCHORAGE ' DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage,'Alaska 99519-6650 343-4744 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION Complete legal description Lo'-F' Location (site address or directions) Property owner Mailing address Day phone ~L~--... ~0'7 I ~ Lending agency Mailing address Agent ~o..~o { "~ o-~-L~.'t- Address _.-~o'~ Unless o~h~'~ise requested, H~ will be held for pickup. 2. NUMBER OF BEDROOMS: 3. ~PE OF WATER SUPPLY: Individual well 'CommUnity well ~u~ lie water Day phone Day phone 4, NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of sYStem. ~TYPE OF WASTEWATER DISPOSAL: i. r~ Individual on~-site Holding tank on'site . .,Community Public sewer NOTE: If community wastewater system, Provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev. 1/91) Front MOA#21 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 ~ ~Ft- '''~' ~ Phone Address ~ "b ~ "5 Engineer's signature ~ 6. DHHS SIGNATURE '- -' ~c, Approved for bedrooms, ~ :,~ Disapproved. .- - ~ Conditional approval for bedrooms, with'th~~ folloWing stipulations: Additional Comments 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-(~5(Rev. 1/91) Back MOA~Z1 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. Well Data Well type ~ Log present (Y/N) I~'1 Total depth .,~ ~- / ~ Sanitary seal (Y/N) ~/ Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number Date completed '~ ~' ~ Driller : Cased to ~ ~.-/ "~ Casing height Wires properly protected (Y/N) FROM WELL LOG g.p.m. AT INSPECTION I ~, 7-~--~ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform t Date of sample: Nitrate ,1 ~ Other bacteria Collected by: ~ ~ B. SEPTIC/HOLDING TANK DATA Date installed ~/~/~ ~ Tank size / ~-~t~O '(' b-¢...~(~ Cleanouts (Y/N) 7 Foundation cleanout (Y/N) High water alarm (Y/N) h~//3~ Date of pumping Compartments Depression (Y/N) Alarm tested (Y/N) I~///~ Pumper ~/~ ~ ¢ .E, Well(s) on lot Ji~tjl~ To property line /~3 "~ Surface water/drainage SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: On adjacent lots Absorption field ~ Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) ~'/ off" lB "Pump Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot ,~ (~ On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed ~/'5/q ~ Length / CT ~ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/FF) D, Width ~' Gravel thickness //7/ ¢~ ~ Cleanout present (Y/N) y J~ ~-~ ~ ~ ~ Results (pass/fail) ~' / System type ,-~ I Total depth Depression over field (Y/N) for y Bedrooms After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 4 ~ ~ To building foundation ~:~ On adjacent lots Surface water Curtain drain ~,-~. On adjacent lots ,~ !,~--J~ Property line To existing or abandoned system on lot Cutbank ~O ~ ~. Water main/service line Driveway. parking/vehicle storage area ' '~5 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on' the date of this inspection. Signature '~-'~- ~ Engineer's Name "'-~¢~ J,,/ ~c/Y' ~. ~ 1,1_/ Date ~/{~-~/~..~ HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # (~t-'~ -L~ - C~lr3 1. GENERAL INFORMATION Complete legal description Lot 6; B10 Ck" I i HAA# ~['~ Location (site address or directions) Property owner Mailing address 5201 Country C~3.tb Lan2 Anchoraq2, AK 99519 Dr. Robert and Wend~ Mallin Day phone P.O. Box 111251 Anchorage, AK 99511 345-3466 561-1588 (h) (w) Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: NOTE: 4 ~ XXX Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Si STATEMENT OF INSP~;CTION 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 inves_ti_gation 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. Phone Name of Firm *. ......... Address 17034 Eagle River Loop. Road No. ~ Eagle River, Alaska 99577 Engineer's signature DHHS SIGNATURE Approved for /'J' Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: 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. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: '~='L~mC..I~ ~ ) L..-~'1'- (x~ Parcel I.D. A. Well Data Well type"~ I v/-/~ ~ Log present (Y~) 4 Total depth /,~ M/~_ / / Sanitary seal (LY.,/N) Date of test Static water level Well flow Pump level1 If A, B, or C, attach ADEC letter. ADEC water system number /~/~>. Date completed %/~ Driller ~/~ Cased to ~----J'~2 ''f'''- Casing height /~-'/--/-- / Wires properly protecte~l) / FROM WELL LOG g.p.m. AT INSPECTION / PALIT¥ OF ANCHORAGE c~z?' ENVIRONMENTAL SERVICES DIVISION z-~-'-, ~ g.p.~p 'J ,~ RECEIVED Absorption field on lot Public sewer main Sewer service line SEPARATION DISTANCES FROM WELL TO: Septic/l'u3Mlm3 tank on lot J 4:~.. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank ~ L/-~ WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate ~, ~/~//-~ Other bacteria ~'~ Oollectedby: .~' / ,.~ B. SEPTICI~ TANK D, ATA Date installed '~/'~,~ Tank size Cleanout~N) / Foundation cleanou~N) High water alarrr~/N) /-~ '"/ Date of pumping "~/~ .~ SEPARATION DIST_~S FROM SEPTIC/I'I~ED~G TANK TO: Well(s) on lot /~Z, / On adjacent lots To property line /~ C/_- Absorption field Foundation Water main/service line Surface water/drainage 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons VentrON) y High water alarm level "Pump on" level at Meets MOA electrical code~N) ~ SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot I I ~/ On adjacent lots Manufacturer ~/~'4/?~ ~-~- ~ "Pump off" Level at i~.~ t/ Cycles tested -.~ I ~ ~'n~ Surface water D. ABSORPTION FIELD DATA Date installed 9/c~/ Length / ~'~' Width Total absorption area /'~-~ Date of adequacy test Water level in absorption field before test treatment (past 12 months) (Y~'~.) Peroxide Soil rating (GPD/FF) System type -'~---~ ~ ~--~, / Gravel thickness Total depth presen'~N)~ . / (Y~ Clcc, ncut '"/ Depression over field Results (pass/fail) /L/~..~ '~'7/~/-'~or ~- Bedrooms ._ /7'~ After test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //~.~ / On adjacent lots //~ 4:2' -/- Property line To building foundation .~:~ r To existing or abandoned system on lot On adjacent lots ,~4:2~ r Cutbank /.j/'~L.,//--~ Water main/service line Surface water / Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in, Signature ~ Engineer's Name Date 7~~~ HAA Fee $ ,,.~)O Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number inspection. ~:~',.,, ....... ' ' /~IJIliJ~IPALIT¥ OF ANCHORAGE Ii I 'R OF H~ALTt' & "- MUNICIPALITY OF ANCHORAGE ~E~ : "' ~ DEPARTMENTOF HEALTH & ENVIRONMENTAL PROTECT~t~ ....... ~ ,' %~I ~- ENvIRoNMENTALENG/NEERING mws,oN JUE 1979 - ~ Tetephone264-4720 __ REQuEsT FORAPP"OVAL OF INDIVIDUAL WATER AND SE~~L~I~ DIRECTIONS= Complete aH parts on page 1. Incomplete reques~ will not be p~d~Please allow ten (10) deys for processing. ~AI LI ~GADDR ESS ' ........ P~OP~RTY RESIDENY (Ifldifferen~ ff~m aboge) .... PNONE MAI LING ADDRESS .... ~ [ LENDING INSTITUTION ...... ) * PHONE; r MAILING ADDRESS '4. k~LTOR/AGENTrr ' ) ' / : ' ' '; I 'PHONE' MAI LING ADDRESS '~ ,, [;~--~NDIVI DUAL* * ATTACH WELL LOG. A well Icg is required for al we Is dr lied [] COMMUNITY ~since June 1975. For Wells dril ed pr or to that date, give Well [] PUB LIC UTI LITY depth (attach Icg if avai able.) 8. 2EWAGE DISPOSAL SYSTEM ...... ' ..... ~ m~m:w,n,,~.~r~, e,'~c** **If Indlwdual/on-slte. give ~nsta/lat~on date . ~ ;~;YI ~L~; YI;~ .... If system is over two (2) years old an adequacy test is req~J red ' by this NOTE: THE INSPECTION FEEMUST ACCOMPANY EACH THIS SIDE FOR OFFICIAL USE ONLY FIME DATE INSPEC'I=OR INSPECTION APPOINTMENTS TIME DATE NSPECTOR DIRECTIONS: DATE RECEIV'ED .... i ,,, TIME DATE INSPECTOR 1. TYPE OF RESIDENCE J[]~ SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM /~ I NDIVI DUAL/ON -SITE []PUBLIC OTi LITY Connection Verified .l~]Septic Tank or [] Holding Tank Size: I r'~.~ If Tank is homemade give dimensions: TYPE OF TANK ~-0, ~) 4, DISTANCES WELL TO: Absorption Area to nearest Lot Line [] ONE [] NUMBER OF BEDROOMS THREE [] FIVE [] TWO ~ FOUR ] [] OTHER [] SlX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOGRECEIVE~y~ ¢'~rt'~ PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTURER MATERIAL Septic/Holding Tank ~Absorption Area Isewer Line r ~ Nearest Lot Line 5. COMMENTS [~A-iSPROVED FOR ~'~ BEDROOMS [] CONDITIONAL APPROVAL (letter_must accompany.~ certificate) r--1 DISAPPROVED I BY (Tier2 ~~ DATE LEGAL DESCRIPTION 7'2-010 (Rev. 3/78)