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CONTOUR ACRES BLK 2 LT 1
4�0t1-LlS1- Iwo-*) Municipality of Anchorage Development Services Department Building Safety Division :�-• " On -Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Pogo 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW030126 PID Number. 017-451-17 Name: JUDY GOWER Wastewater System: O New ■ Upgrode Address: 5340 COUNTRY CLUB LANE ► ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-4997 5 ■ Deep Trench D Shollow Trench D Bed D Ltound D Other LEGAL DESCRIPTION Sol Rating: 0.8 Total Depth from original grade: 6.9 MAX GPD/Sq. F1. Ft. Block: Lot: Subdivision: Depth to pipe boffam from original Emile: Gravel depth beneath pipe: 2 1 CONTOUR ACRES SEE DWG. rL 5.0 rL Township: Range: Section: Fill added above original grode: Grovel length: — — — SEE DWG. rL 96 (2 ® 48) FL WELL: ❑ New [I Upgrade Gravel s9dM: 2.5 Number of Orr: 2 Dietanu between Goes: 12.5+ pL R CGreMkalbn Prhrote. A.e.0 : Toto l Coved To: Total absorption area: 960 Pipe material: D 3034/ F-810 R FL so.m Cruor. \ We Drilled: Stale water Level: Installer AKWWC, INC. Date ketal 5713-14/2003 FL YIsW: Pump Set ftCoabg Height Above Ground: TANK GPN R rL SEPARATION DISTANCES ■Septic 0Holding OS.T.E.P. DOther To Septic Absorption Utft Holding ble/Privete Manufacturer. ANCHORAGE TANK CapoNq In gale"" 1500 From Tank Field Stat on Tank ewer un« Well 1000+ 1 Do'+ — — 25'+ mate"! STEEL Number of compartments 2 Surface water 100'+ 100'+ — — — LIFT STATION Lot Une 5'+ 10'+ — — — Sire N golons: Lianufxturer. Foundation 5'+ 10'+ — — — Pump un level atmp a aL• High water olerm at Curtain Drain NONE KNOW Pomp wow ElectAcd Impeatlar performed by. Remarks: BENCH MARK Location and Description: THE EXISTING DRAINFIELD WAS COMPLETELY ABANDONED. TOP OF STEP ® DOORWAY THE EXISTING 500 GALLON SEPTIC TANK THAT WAS AFTER THE EXISTING 1000 GALLON SEPTIC TANK WAS Astun"d °'ration' 107.12 FL COMPLETELY ABANDONED. ENGINEERS SEAL 04o F o " 4 4 `S`�4op0 AKWWC, ao�? INC. Dates: 1st/ / Inspections performed by: 5 13 2003 ...... ....... ..:....�0 2nd 5/13/2003 ...J.. ...N 3rd 5/14/2003 ff... orne's * � m E 7953�o��OQ 4Q��4c Development Servic s Department Approval'/ -p Reviewed and approved by: Date.3 ed 0\\ O Prof (Rev. 12/01) esslon oO40O�0�0 IPERMrTSW0 NUMBER: AS—BUILT DRAWING °017 - ID 4- NUMBER: SW030126017-451-17 10' urnLRY EASMENT " •�•I -------------------------- ST1 87.18 49.57 DBL1 93.64 48.86 DBL2 94.57 48.95 ST2 137.96 104.63 ST3 143.82 114.79 DBL3 1145.821118.01 DBL4 147.08 119.94 C01 152.02 131.49 MT1 151.13 132.60 CO2 117.90 139.59 MT2 119.94 139.29 CO3 161.96 145.18 MT3 161.33 146.57 C04 1130.241150.25 MT4 133.22 150.77 ,, _ TH 2 WELL \ BL2 .. DBL 1 rI- INSTALLED FLOW SPLITTER. $Tl r '.: •%± ;! •" �'''; :� \ NOT EXTENDED ABOVE GRADE `"jam^ :� \' ...,'•, •� } > } M EXISTING 1000 GALLON CONCRETE SEPTIC TANK. INSTALLED IN JULY 1973. INTEGRITY VERIFIED ON 5-13-2003— 6/6/2003 �4 p 4 <, c G KA WA1 `R R WA DRAWN BY: 5;4� � bb --k-7 .._... .111 M_._ _..•.._..__..___._._.. 7 ALAS 'L WASTE C.J.G. CONSULTANTS, INC. SCALE 7 0 * �' . y 6901 OEBARR ROAD. SUITE IB • ANCHORAGE. OK 0950E 'PHONE (907)117.6179 • FAX (907030.1246 1"= 40. �............:... REPARED FOR: PHONE NUMBER: PAGE NUMBER: JUDY GOWER (907) 345-4997 2 OF 3 QO ,J fI Garn ss.: .CAL DESCRIPTION: Q o - 3 oL CONTOUR ACRES SUBDIVISION; LOT 1, BLOCK 2, IPE OF WORK: rofese10�� �o AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 04pptt��,o� EW DRAINFIELDS },•�.•;•� / {� it .�:; �..:,. , . %:'• .:••:' td co NEW 1500 GALLON - " • . `• a •• •:.: ' j SEPTIC TANKISTING ,, _ TH 2 WELL \ BL2 .. DBL 1 rI- INSTALLED FLOW SPLITTER. $Tl r '.: •%± ;! •" �'''; :� \ NOT EXTENDED ABOVE GRADE `"jam^ :� \' ...,'•, •� } > } M EXISTING 1000 GALLON CONCRETE SEPTIC TANK. INSTALLED IN JULY 1973. INTEGRITY VERIFIED ON 5-13-2003— 6/6/2003 �4 p 4 <, c G KA WA1 `R R WA DRAWN BY: 5;4� � bb --k-7 .._... .111 M_._ _..•.._..__..___._._.. 7 ALAS 'L WASTE C.J.G. CONSULTANTS, INC. SCALE 7 0 * �' . y 6901 OEBARR ROAD. SUITE IB • ANCHORAGE. OK 0950E 'PHONE (907)117.6179 • FAX (907030.1246 1"= 40. �............:... REPARED FOR: PHONE NUMBER: PAGE NUMBER: JUDY GOWER (907) 345-4997 2 OF 3 QO ,J fI Garn ss.: .CAL DESCRIPTION: Q o - 3 oL CONTOUR ACRES SUBDIVISION; LOT 1, BLOCK 2, IPE OF WORK: rofese10�� �o AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 04pptt��,o� PERMITNUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: SW0 SW030126 017-451-17 4' OF BLUEBOARD GRA INSULATION . 91LGRADE E TOP OF TATANK AT N AR / UTLET O - 89.03 89.09 \\ IN. NEW 1500 GALLON INVERT OF BUNG SEPTIC TANK AT INLET - 88.31 9fOOUTLET ELET - 888.OF B8. AT T28 UPPER LOWER FINAL GRADE Lf 1 90.29-91.09 &L[ EORIGIN=LFINAL GRADE - ORIGINAL GRADE TH#1 90.11-90.J5� 86.91-88.23 FABRIC INVERT OF PIPE - 86.44 (AVG.) 0'+ BOTTOM OF TRENCH - 81.33 (AVG.) FABRIC INVERT OF PIPE - 87.79 (AVG.) BOTTOM OF TRENCH - 82.76 (AVG.) TH#1 RELATIVE ELAVATION OF BOTTOM OF RELATIVE ELAVATION OF BOTTOM OF TESTHOLE 73.00 (TESTHOLE DRY) TESL OLE - 73.23 (TESTHOLE DRY) DATE: O O 'r 6/6/2003 e. _�._'•:..� DRAWN BY: p�•``C�,...... ��� ALASKA WATER & WASTEWATER C.J.G. - 5 ' CONSULTANTS, INC.---•------ �.. 6901 DERARR ROAD. SUITE 29 - ANCHORAGE. AK 99504 - PHONE (907),137.6179 - FAX (907)338.3246 N.T.S. ' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JUDY GOWER (907) 345-4997 3 OF 3 QQ '•.� y A. am ss,- LEGAL s; LEGAL DESCRIPTION: Q �Q�1' ' —7953 CONTOUR ACRES SUBDIVISION. LOT 1, BLOCK 2 � TYPE OF WORK: �o4dP Tegalo�ok� PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE �O fessW\ MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Sl I U Q 1Z (D c) Date Issued: May 12, 2003 Expiration Date: May 11, 2004 Permit Number: SW030126 Parcel ID: 017-451-17 Legal Description: CONTOUR ACRES BLK 2 LT 1 Design Engineer: 0041 AK Water & Wastewater Consultan* Site Address: 005340 COUNTRY CLUB LN Owner Name: Judy Gower Lot Size: 130957 SO. FT. Owner Address: 5340 Country Club Rd. Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE, AK 99516 - This permit is for the construction of. ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-451-17 Permit Number 5(A.030126 Property owner(s) JUDY GOWER Day phone 345-4997 Mailing address (1) 5340 COUNTRY CLUB ROAD • ANCHORAGE. AK Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) LOT 1. BLOCK 2: CONTOUR ACRES SUBDIVISION Legal description (Section, Township & Range) N/A Lot Size l�i09�� % Acre Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 5 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS INC. -4signeture of pr PermitFees: $40D Date of Payment: Receipt Number: 3 `2 Waiver Fees: Date of Payment: Receipt Number: 3 os- 0R /.SD Lo Jeu sA( ALASKA WATER & WASTEWATER CONSULTANTS, INC. May 8, 2003 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade for Lot 1, Block 2; Contour Acres Subdivision To whom it may concern: The existing 5 bedroom house is served by a private well and septic system. The existing septic system is undersized and the drainfield is completely surcharged and must be upgraded prior to selling the house. Two test holes were dug on the property north of the existing septic system. The septic system will be designed around the 30 foot radius of test hole #1. We are proposing that a new 1500 gallon septic tank and also dual deep trench type drainfields be installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 0.8 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: 4 & 120 minutes/inch b. Proposed Application Rate: 0.8 gallons/day/f12 c. Number of Bedrooms: 5 d. Design Flow: 750 gallons per day e. Minimum Absorption Area: 938 f32 f. Total Depth: 8 feet (max.) g. Effective Depth: 5 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 2 @ 48 feet long (96 feet total length) k. Effective absorption area = 960 f12 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246 • Website: akwwc.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography in the area of the proposed drainfields are 5-15 percent slopes running approximately southeast/cast to northwest/west. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you{have any questions, please contact us at 337-6179. Thank you for your assistance. A I I M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, two soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246' Website: akwwc.com u JL __________ OI -------- J �-------- ----------------i -------------------^----- I I p' I I I I HERBAGE HILLS S/D; 0I HERBAGE HILLS S/D: I I HERBAGE HILLS S/D; I I LOT 1, BLOCK 3 LOT 8. BLOCK 1 I I LOT 1. BLOCK 1 1 1 LL) I I I I LLI i I LL -1 ----- �_-_-_ HUFFMAN EQN) _---_--�__-_ PROPOSED SEPTIC SYSTEM I(SEE DESIGN PAGE 2 OF 2) 1 -------- I ---- ALTERNATE SITE ------------- / i -- — � i f EXISTING / WELL ' 1 . I I 1 I S BEDROOM EXISTIINSEPTIC H#2 1 I HOUSE SYSTEM O' I �% LiJI I Z ---�� I �1 I ml i I �I I U�� ---------------------------^----J ------�c----------------------------� --------- Z) 01 I 1 UI I 1 1 CONTOUR ACRES S/D; LOT 2. BLOCK 2 ' / I I I 5/8/2003 !• t - DRAWN BY: Z.T.G. ALASKA WATER & WASTEWATER sGn CONSULTANTS, INC. .. 6901 DFPAPP ROAD. SUITF 28 • ANCHOPAGF. AK 9950E PHONF (907)337-6179 • FAX (907)338-3746I" 7)338-3746 _ 100''.......... — , ................, v `^ PAGE PREPARED FOR PHONE NUMBER: NUMBER: iy7, ri JUDY GOWER 345-4997 1 OF 2 J ffr y 4y1' Gorne • 7 LEGAL DESCRIPTION: CONTOUR ACRES SUBDIVISION; LOT 1, BLOCK 2 &mss ,, �`� 0, o TYPE OF WORK:+�V• SITE PLAN FOR PROPOSED SEPTIC SYSTEM UPGRADE by ,;;"1� ;� HUFFMAN ROAD — — — 10' UTILITY EASMENT — — — — — — — — — — — — — — — — ALTERNATE SITE WILL REQUIRE THE USE OF AN ADVANTEX TREATMENT SYSTEM V -PROPOSED DRAINFIELD. EXCAVATE TWO RENCHES THAT ARE 8 FEET DEEP MAXIMUM rY 2.5 FEET WIDE BY 48 FEET LONG EACH (96 FEET TOTAL). ADD 5 FEET OF CLEAN, WASHED SEWER DRA)NROCK. INSTALL TRENCHES PARALLEL TO SLOPE CONTOURS. THH#2 WELL 0 EXISTING SEPTIC SYSTEM TO BE COMPLETLY ABANDONED PER UPC 41 h FE 5/8/2003 DRAWN BY: �s�iws Z.T.G. ALASKA WATER & WASTE, WATER SCALE: CONSULTANTS, INC.�" = 40� 6901 DFRARR ROAD. SUITE 2R • ANCHORAGF. AK 99506 • PHONF (907)337.6170 • FAX (907)35,$266 PREPARED FOR: PHONE NUMBER: PACE NUMBER: JUDY GOWER 345-4997 2 OF 2 .ECRL DESCRIPTION: CONTOUR ACRES SUBDIVISION; LOT 1, BLOCK 2 TYPE OF WORK: DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE '•.J fr or ess.: 1 �'O!P� E •'� FFG N 0 INSTALL DOUBLE / CLEANOUTS PROPOSED 1500 GALLON SEPTIC TANK I EXISTING FOUNDATION CLEANOUT THH#2 WELL 0 EXISTING SEPTIC SYSTEM TO BE COMPLETLY ABANDONED PER UPC 41 h FE 5/8/2003 DRAWN BY: �s�iws Z.T.G. ALASKA WATER & WASTE, WATER SCALE: CONSULTANTS, INC.�" = 40� 6901 DFRARR ROAD. SUITE 2R • ANCHORAGF. AK 99506 • PHONF (907)337.6170 • FAX (907)35,$266 PREPARED FOR: PHONE NUMBER: PACE NUMBER: JUDY GOWER 345-4997 2 OF 2 .ECRL DESCRIPTION: CONTOUR ACRES SUBDIVISION; LOT 1, BLOCK 2 TYPE OF WORK: DESIGN OF PROPOSED SEPTIC SYSTEM UPGRADE '•.J fr or ess.: 1 �'O!P� E •'� FFG �� '•' j wnn�iuuiw snnesineeeiwneu mu• ALASKA WATER & WASTEWATER CONSULTANTS. INC. Q eeoi ocaNu aow, sunE u • µcwrtwL AK. we" • vewc eos —ene •riot: se • wEesnc ok..aoom SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION CONTOUR ACRES SUBDMSION; LOT 1, BLOCK 2 O� s f ey A. ess: PERFORMED FOR: JUDY GOWER DATE: 5/2/2003 a.� C -7953 `4b DEPTH\ (lest/ — ORGANICS TEST HOLE 1 �4po �Ofa»{On q4 DOD�op� 1 SOIL CLASSIFICATIONS —' 2 GWORG i 3 J GP — ML GM CL Ti 4 GC OL °• •°° o SW MH j I 5 •'• L SP CH Tri 2 i SM ' : OH 6 SC � I w/ COBBLES DEPTH TO I THROUGHOUT GROUNDWATER DATE _ 8 DRY 5/2/2003 DRY 5/7/2003 9 ------------------------ ------- SITE PLAN 10 11 DATE READING CLOCK NET TIME WATER LEVEL NET DROP 12 13 14 15 p O.FI. 16 17 18 19 PERCOLATION RATE 4 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.0 FT. AND 4.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ❑ NO SOILS LOGGED BY: ZACHARIAH GALL PERCOLATION TEST PERFORMED BY: MATT FISHER COMMENTS: W PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS P RFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: <b TIME (MINUTES) READING (INCHES) 5/5/2003 1 3:36 — 6" — 2 3:46 10 2 1 2" 3 1 2" 3 3:46 — 6" — 4 3:56 10 338" 258" 5 3:56 — 6" — 6 4:06 10 3 1 2" 2 1 2" 7 4:06 — 6" — 8 4:16 10 3 1 2" 2 1 2" 9 4:16 — 6" — 10 4:26 10 3 1 2" 2 1 2" 11 4:26 — 6" — 12 4:36 10 3 1 2" 2 1 2" ALASKA WATER & WASTEWATER yVQ� CONSULTANTS, INC. � ; 6901 DMW ROAD, SM 29 • M000". M 99704 • PHONE: 907 7-!179 • FAX: (907)33&--3248 • WESSf1E OWW4 n •. .....:. SOIL LOG — PERCOLATION TEST ... ..........LEGAL .... PERFORMEDERFORON: CONTOUR JUDY GOWER RES SUBOMSION; LOT 1, BLOCKDATE: 5/2/2003 OQQO�J' ff a A. ar es \�Q C 795 eG D f 4000 �cadv 0 (feet ,ORGANICS TEST HOLE 2 ��4000��6�� 2 3 4 5- 6-1 ML w/ 7 THROUGHOUT 8- 9- 10-1 910 11 12- 13— B.O.H. 213B.O.H. 15- 16- 17 51617 18 19 DEPTH TO DATE GROUNDWATER DRY 5/2/2003 DRY 5/7/2003 DATE READING CLOCK TIME NET TIME (MINUTES) • NET DROP (INCHES) Illllllll 3:58 — 6" — 2 4:28 30 5 3/4- 1/4% HumIIIIIIIII 4:28 — 6" — 4 4:58 30 5 3/4w 4'5 1/4- 5 4.58 — 6" — 6 5:28 30 5 3/4- 1/4' DEPTH TO DATE GROUNDWATER DRY 5/2/2003 DRY 5/7/2003 DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 5/7/2003 1 3:58 — 6" — 2 4:28 30 5 3/4- 1/4% 3 4:28 — 6" — 4 4:58 30 5 3/4w 4'5 1/4- 5 4.58 — 6" — 6 5:28 30 5 3/4- 1/4' PERCOLATION RATE 120 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 5.0 FT. AND 5.5 FT. A FOUR HOUR PRESOAK WAS PERFORMED: 0 YES ❑ NO SOILS LOGGED BY: ZACHARIAH GALL PERCOLATION TEST PERFORMED BY: ZACHARWi GALL COMMENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS?WP RFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: $ MUNICIPALITY OF ANCHORAGE _ DEPARTMENT OF HEALTH AND HUMAN SERVICES 61-7-45 ,,, 4� / '�/ 7 Environmental Health Division I 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name "cel z,` c' c' �'Pr DISTANCES TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address WELL JOT Phone(s) Permit No. No. of Bedrooms LOT LINE7� G LEGAL DESCRIPTION Lot Block ;z_/ Subdi isionI tc�r+7->,vt� /S re 3 FOUNDATION / Township, Range, Section %,2 J12 L/ W S 7 _ys—/ �0 T AS-BUILT DIAGRAM driveway, water bodies, (Show location of well, septic system, property lines, foundation, etc.) TANKS JW SEPTIC ❑ HOLDING I Manufacturer ['� / h- /Yxe d rc2 Capacity in gallons el Material '5Y No. of Compartments TYPE OF SYSTEM ❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from original grade FT Total depth from original grade FT Ah b� k S lot a• Fill added above original grade FT Gravel depth beneath pipe FT Gravel length FT Gravel width FT Total absorption area SQ FT Distance between lines FT Y f Number of linesT7ng SQ FT Pipe material .S P rt 3,T Installer Ke /¢Clieto.r EA>�+ryr�ref Date Installed �/'Az z—Z3 WELLS ❑ PRIVATE ❑ OTHER v) Classification (A,B,C) Total D FTJ Cased to FT Installer Date Installed: REMARKS: _ /_ I J 71,43- T z'tt / S 70 ro r �r e. c Th Q e ry+ p/f �d Scale: Inspections Performed i. 2e by: ENGINEERS SEAL :. /x'73 7�'r� L�* I Date: 5,Z -t� _ 8 certify t 's inspection was performed according to all Municipal and State guidelines in effect on this i Health Department Approval: , c Date' 72-013 (3/85) MUNICIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 ON - SITE SEPTIC TANK PERMIT Permit Number: 890213 Upgrade �J �Q ��LL\�87(:)a�� Date Issued: 09/21/89 Engineer Designed Owner Name: ROLAND GOWER Day Phone: Owner Address: 5340 COUNTRY CLUB 279-3564 ANCHORAGE, AK 99516 Parcel Id: 017-451-17 Lot Legal: Subdivision: CONTOUR ACRES Lot: 1 Block; 2 Section: 2 Township: 12N Range: 4W Lot Size 130957 (sq.ft. or acres) Max Bedrooms: This Permits 3 Total Capacity: 3 SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). PERMIT EXPIRED DECEMBER 31, 1989. NOTIFY DHHS OF INSPECTIONS AT 343-4681 OR 343-4744. 'PERMIT IS BEING ISSUED TO ALLOW CORRECTION OF DRAINAGE PROBLEM, AND IS NOT TO BE CONSTRUED AS AN UPGRADE TO TOTAL BEDROOMS. I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska reqkirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms. I also understand that the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit. / Signed: DATE: (Owner) ROLAND GOWER ' --------------------------- ------------------ A EC 5 ALASKA C11UIROW11TAL COnTROL a Engineerinq Enuironmental Studies O SRUICCS, Inc. P. 0. Box 240668 Anchorage, AK 99524-0668 (907) 279-5553 September 20, 1989 Municipality of Anchorage Department of Health & Human Services 825 L Street, Fifth Floor Anchorage, AK 99501 RE: Lot 1, Block 2, Contour Acres #3 Enlargement of septic tank Recently I visited the property which is owned by Dr. Roland Gower. He was having trouble with the line from the septic tank and seepage pit that had either settled, or had been flooded. We looked over the system and in evaluating the tank, we decided that possibly, since the concrete Precon tank has only a single compartment, it might be advisable to add a 500 gallon tank after the existing tank. This would give a better degree of treatment. The existing septic tank is 85 feet from the well, and there is sufficient room to add the additional 500 gallon tank in line, and install it at a greater distance than 100 feet from the well. We would like you to issue a permit for the additional 500 gallon tank to be added after the existing single -compartment steel tank. If you have any questions, please let me know. LCR/sr Sincerer yours, Lero C. Reid, PhD PE, DEE President 3 ALASKA ENVIRONMENTAL JOB /o f CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B SHEET No. of ANCHORAGE, ALASKA 99503 CALCULATED BY 2eDATE (907) 561-5040 CHECKED BY DATE SCALE PROD=2WI �Irc.. Gmlm, M. 01471. GRE PER ANCHORAGE AREA BOF' -UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 9b&_Z/_ MAILING ADDRESS L° + � PHONE 12'/L 6- LOCATION 176W114#20 / LEGAL DESCRIPTION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL MANUFACTURERyet(0►� MATERIALCOMPARTMENTS '3 le nn.Ss INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY ���� GALLONS. SEEPAGE PIT: i NUMBER OF PITS 1 DIAMETER OR WIDTH_, LENGTH, DEPTH `0 � jam, / LINING MATERIAL`© �� CRIB SIZE: DIAMETER DEPTH `0 DISTANCE FROM: WELL /05- S TOTAL EFFECTIVE /, A%� BUILDING FOUNDATION 60, NEAREST LOT LINE � OSABSORPTION AREA (WALL AREA) -SQ. FT. ADDITIONAL ABSORPTION WELL TYPEy CONSTRUCTION `-''lC DEPTH BUILDING o�5 NEAREST . NEAREST ' SEPTIC FOUNDATION LOT LINE SEWER LINE TANK �5 CESSPOOL -,OTHER SOURCES APPROVEDAV DISAPPROVED REMAR DISTANCES: INSTALLED BY: � ( "�" PIPE MATERIAL: iQ` LOT SLOPE:` REMARKS: ue/" A") AIt" Form No. EQ -031 DIAGRAM OF SYSTEM SEEPAGE SYSTEM. DISTANCE FROM: DATE ?j2V75 APPROVED - G.A.A.B. 0 q GREATER ANCHORAGE AREA BOROUGH ri DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 0 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 ,q//nn"((// /MV�81� I" v ck SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT NAME OF APPLICANT�vL - �' i`/�MAIILILI.N�G� `ADD�DRESS PHONE INSTALLATION LOCATION LEGAL DESCRIPTION 2-, INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED ������/✓��/-������t���/�`� / N�z2� FINANCED THROUGH TO BE INSTALLED BY 6�•'G:/ f-rte/+-fi`� .li✓L•EF®/�� 41r/r.�z/�%E�t/�j• SOIL TEST RESULTS /y �ciL TrJl- NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST I %-� COMPLETION DATE DATE ANTICIPATED 6IXoL FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE_ LY J TYPE-J�L��- C/�� SEEPAGE AREA SIZETYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT �� DRAIN FIEL SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT r DRA11 TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD --� SEEPAGE PIT ALSO CONSIDEI WATER MAIN TO SEPTIC TANK SEEPAGE P DRAIN FIELD _ SEPTIC TANK, ---vS—/ , SEEPAGE PIT �`/l) DRAII TO RIVER, LAKE, STREAM, CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRI EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TAI FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLP G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE FORM NO. EQ -01 6 DIAGRAM OF SYSTEM r • '~ Municipality of Anchorage �°. . ` On-Site Water and Wastewater Program' { '' (907): 343=7904 S �.`, Y Certificate of On-Site Systems Approval II I /� r , Parcel I: D. 017-451-17 Expiration Dale: �J Ll 1 I ) 0 2 V 1. GENERAL INFORMATION: Complete legal description CONTOUR ACRES: BLOCK 2, LOT 1 Location (site address) 5340 Country Club Lane *Anchorage 99516 Current Property owner(s) Estate Sale Day hone Mailing address + 3 Real Estate Agent Phone P hone 2. TYPE OF DWELLING: (5� Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 I 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual �C] Individual Water Storage ❑ Holding Tank ❑ Community ClassWell ❑ Community ❑ Public Water System ❑ Public Sewer F. ❑ Waiver/Variance request for: Distance: l ;i Received by: Date: COSA to be released to the engineer; unless otherwise requested by the engineer. t i COSA Fee /�J� ;Waiver Fee $ I Date of Payment ���GoZ� d Date of Paymeht Receipt Number �1 J o��j l C� Receipt Number COSA # 1966 go ti Waiver # i ,i 5. STATEMENTOF INSPECTION BY ENGINEER As certified by,my_seal affixed hereto and as of the validation date shown below, I verify that my' investigation, based on procedures outlined in the 'Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6'179 Address: 3701 East Tudor Road Suite 101- Anchorage,.Alaska 99507 J Engineer's Printed Name: JeffreyA Garness Date` _ 'L. f Z,U I 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 datels of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s: therefore. GEG makes no warranty (express or implied) regarding the future perormance 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 personlparty 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. #AECC884 6. DySIGNATURE �/ System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved n �( 0F AIyC Conditional approval for bedrooms, with the following stipu; `>z"� Hp •- -.� fp,TER o PR�G`i\A 13y: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of on -Site Systems. Approva (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. ATTACHMENTS: v COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 74 COSA Checklist Legal Description: CONTOUR ACRES. BLOCK 2, LOT 1 Parcel ID: 017-451-17 If more than 1 septic system on lot: COSA Checklist# ' of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 197�10I Total depth 240+ ft Cased to UNKNOWN ft © Sanitary seal is functioning correctly (] Wires are properly protected Casing height (above ground) *8.25 in. Date of flow test for COSA 4/5119 Well production at time of test 4.4+ gpm Water storage tank volume NIA gallons Well disinfected for coliform test? ❑ Yes W No 0 Coliform bacteria is Negative Nitrate 5.61 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 3430/20 Static water level at beginning of test 241 ft. Comments PHOTO PROVIDED TO MOA FOR 7/26/19 COSA B. TANK DATA C. LIFT STATION Age of tank(s) 4i ° 11 years ❑ Required maintenance completed Tank type/material f" .,. �a , ' Lift station material Age of lift station — years ,,z Ag Measured operating fluid level in septic tan — ❑� Standpipes/foundation cleanout per record drawing Comments: 47 YEAR OLD TANK IS CONCRETE Date of pumping ktcv.irVa4-"r-1 SS„� 'ON 3/30120 f1f'� a- 2Giq D. ABSORPTION FIELD DATA s^o,i"'m Which system tested (date installed) _ Adequac test date 415119 y — 0 ALL standpipes present per record drawing Results Q✓ Pass For 5 bedrooms Total measured depth from grade 7_9 ft (max) Fluid depth prior to test 5 in Measured depth to pipe invert from grade `2_25 ft (min) Water added 945 gal ❑ N/A - pressurized field New depth 48 in Fn� Monitor tubes go to bottom of effective. If not, state Elapsed time 120 min depth into effective 4.e — Final fluid depth ..44 in ❑ Code -required soil cover over field Absorption rate 750+.gpd ❑ System presoaked (Required if vacant for greater than 30 days prior to NONE Any rejuvenation treatment (past 12 months) date of test) If yes, enter date NIA Gallons introduced _gallons Comments/Deficiencies: CcSA COSA Checklist yellow sheet E 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'g5+ EE Yes Community Sewer Manhole/Cleanout > 100' Yes if No ft ❑ Yes if No _ ft if No _ ft _ Yes if No ft Private Sewer/Septic Line > 25' [E Yes if No _ ft Neighboring Tank > 100' _ _ It Private Wells > 100' ❑✓ Yes if No _ ft Water Service Line > 10' Absorption Field on Lot > 100' Yes if No _ ft Holding Tank > 100'✓1 Yes if No _ ft Neighboring Absorption Fields > 100' Yes Animal Containment> 50' ❑E Yes if No _ft 0 Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main >75' [DYes if No _ ft Q 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' Q Yes if No _ft Property Line > 5' Q Yes if No _ ft Wells on Adjacent Lots: Absorption Field > 5' EE Yes if No _ ft Water Main > 10' [Z] Yes if No _ ft Water Service Line > 10' 0 Yes if No _ ft Private Wells> 100' Community Wells > 200' Yes if No _ ft Yes if No _ ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Pleaseenter distances if less than required) Building Foundation > 10'✓Q 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 _ It Private Wells > 100' ❑✓ Yes if No _ ft Water Service Line > 10' Q Yes if No —ft Community Wells> 200' Yes if No _ ft Surface Water> 100' Yes if No _ft F. ENGINEER'S COMMENTS 'APPROVED PER 1973 INSPECTION REPORT IN MOA RECORDS "CONCRETE TANK PIPE IS APPROXIMATELY 3' FROM THE DRIVEWAY. IT IS UNKNOWN IF PART OF THE TANK IS UNDER THE DRIVEWAY. oo�6gc`Jp�O G. ENGINEER'S CERTIFICATION o OF .. I certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with Op* g FI 9 �O MOA COSA guidelines in effect on this date. D •Je r Car n s.- /9b.3 ./sb.s �o �Oq%�bd f[.�.a•u•o�,�o COSA Checklist yellow sheet P� o f e 5 Sion o aAECCBEA ��000`a��C' MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Advisory Certificate of On‐Site Systems Approval # OSC201141 Subdivision: Contour Acres, Block: 2, Lot: 1 A water sample revealed a nitrate concentration of 5.61 milligrams per liter (mg/L). 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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. Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Nitrate Fact Sheet 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 for limiting 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 medi a 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. • Municipality of Anchorage r a On -Site Water and Wastewater Program a (907) 343-7904 Certificate of On -Site Systems Approval Parcel I. D.017-451-17 1. GENERAL INFORMATION: Complete legal description Contour Acres; Block 2, Lot 1 Expiration Date: 10-2-69-11 Location (site address) _5340 Country Club Lane *Anchorage, AK 99516 Current Property owner(s) Estate Sale Day phone Mailing address Real Estate Agent Kevin Taylor Day phone 907-244-7437 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ SSC) Waiver Fee $ Date of Payment Date of Payment Receipt Number 100 Receipt Number COSA # 65r,196151 Waiver # S. 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: Gayness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE C System #1 Approved for 5 bedrooms System #2 Approved for Disapproved + Conditional approval for By: bedrooms bedrooms, 0 o . �F... -96400 /) * : TiS1 7.0, ` `,J��fJ y A.�6er-rxdss;• ( E79 3 ` f �p f o pro f essiol�p10 cQQ go-tTy dvF `J y� with the followinpti ulat `E��r"ERA�D m^� SJ99�1 SERVICES Original Certificate Date: —7-2-6-19 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 COSA Checklist Legal Description: CONTOUR ACRES; BLOCK 2, LOT 1 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1973(?) Total depth 240+ ft Cased to LINK ft n Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) *8.25 in. Date of flow test for COSA 4/5/2019 Static water level at beginning of test 241 ft. Comments *SEE ATTACHED PHOTO T. Z B. TANK DATA Age of tank(s) 461,16 years Tank type/material 11Mn TlE X Standpipes/foundation cleanout per record drawing Date of pumping 8/29/2018 D. ABSORPTION FIELD DATA Which system tested (date installed) 5/13-14103 ❑■ ALL standpipes present per record drawing Total measured depth from grade 7.22+ ft (max) Measured depth to pipe invert from grade *2.25 ft (min) ❑ N/A — pressurized field Q Monitor tubes go to bottom of drainfield. If not, state depth into effective 4.8 FEET Parcel ID: 017-451-17 Structure served by this system Well production at time of test 4°4+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑■ No Er Coliform bacteria is Negative Nitrate mg/L Q Nitrate less than MRL (ND) Arsenic ug/L Q Arsenic less than MRL (ND) Collected by GEG Date of Sample 6/28/2119 S (b (2- 1fve ;C.s P'.V C, C C, C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: 46 YEAR OLD TANK IS CONCRETE Adequacy test date 4/5/19 Results ✓❑ Pass For 5 bedrooms Fluid depth prior to test 5 in Water added 945 gal New depth 48 in Elapsed time 120 min ❑ Code -required soil cover over field Final fluid depth **44 in ❑ System presoaked Absorption rate 750+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) N/A Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: *SOUTH DRAINFIELD INSULATED PER MOA RECORDS AND SHY ON COVER BY APPROXIMATELY 0.28 FEET "SEE ATTACHED LETTER COSA Checklist yellow sheet q� 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' 0y/ Yes *g5,+ Community Sewer Manhole/Cleanout > 100' F1 Yes if No ft Q,/ Yes if No ft Neighboring Tank > 100' Q Yes if No ft Private Sewer/Septic Line > 25' 2✓ Yes if No ft Absorption Field on Lot > 100' Q✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Wells on Adjacent Lots: Animal Containment > 50' Yes if No ft Q Yes if No ft ft Private Wells > 100' Q✓ Yes if No ft Manure/Animal Excreta Storage > 100' 0 Yes Community Sewer Main > 75' Q Yes if No ft MYes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0y/ Yes if No ft Surface Water > 100' F71 Yes if No ft Property Line > 5' 0✓ Yes if No ft Driveway/Parking > 0' ❑ Yes if No, comment Absorption Field > 5' 0✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10' F,/]Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' [0 Yes if No ft Driveway/Parking > 0' Ffl Yes if No, comment Property Line > 10' Q Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes _ if No ft Private Wells > 100' Q Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' QYes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS `APPROVED PER 1973 INSPECTION REPORT IN MOA RECORDS **CONCRETE TANK PIPE IS APPROXIMATELY 3' FROM THE DRIVEWAY. IT IS UNKNOWN IF PART OF THE TANK IS UNDER THE DRIVEWAY. _0o6000p � G. ENGINEER'S CERTIFICATION o OF I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with Q 9 T Q MOA COSA guidelines in effect on this date. ' ' ' ' ' ' ' ' ' uO Jef........ ess;' ... E— 79 z� Q a 4�,P�e�•� \��'o0G COSA Checklist yellow sheet 40� pr o f e s s'1o�'°�� Y #AECC884 Nitrate Advisory Certificate of On -Site Systems Approval # OSC191318 Subdivision: Contour Acres, Block: 2, Lot: 1 A water sample revealed a nitrate concentration of 6.25 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 for limiting 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. 111£ �� � �§�JN�� irE Addressf �xJ:96��O�� c o �ge,�, ask9�G1�50�*��►w n�Ro ``` GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING April 121h, 2019 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Adequacy test for Contour Acres; Block 2, Lot 1 To whom it may concern: �,n srr, os"r�a .waso�:-s.asux�ens; t�eal�r- On 4/5/2019 a septic adequacy test was performed for the purpose of obtaining a COSA. Prior to starting the test, the liquid level in the drainfield was approximately 5 inches in MT1 (per MOA record drawings). After the introduction of the first 744 gallons, the liquid level in the trench rose to approximately 40.5 inches. An additionally 201 gallons were introduced over the next 40.5 minutes causing a rise to 48 inches in the Monitoring tube for a total introduction of 945 gallons. After allowing the drainfiled to recover for approximately 120 minutes, the liquid level in the drainfield was 44 inches. The extrapolated adequacy test is as follows: ® 201 gallons introduced ® 7.5 -inch rise from the 201 gallons • 201 gallons/7.5 inches equates to 26.8 gallons/inch O The drainfield was allowed to recover for approximately 120 minutes • The liquid level in the drainfield dropped to 4 inches • 4 inches x 26.8 gallons/inch equates to 107.2 gallons absorbed ® 107.2gallons/120 minutes = 0.89 gallons/minutes • 0.89 gallons/minute x 1440 minutes equates to 750+ GPD It should be noted the ONLY the south trench was tested. It should also be noted that the home was vacant for approximately 3 weeks prior to the adequacy test. The liquid level in the north trench did not chpnge throughout the adequacy test (38 inches). 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineedng.com In N W 0 VA H U FFMAN ROAD N 89°59'110°W 400.021 113' ELECTRIC Esmlr. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — _ I rI a' I I ¢ I O � I = I a I I � I as �u I I as s I I s I e DWELL a '� I I ABpNALT EWAY 1 DRI V 38.2 . I �Q I e B I �GJ°j O?G• I aF I FP`s I I � I m 13 I I I I � I a" I —---------------------------------------------------------- I -------------- ---------_--__--_---_------_— ----_ 1 D' UTILITY ESM`P. N 89059'011°E 431 .08 0 In 19 0 M 0 Z�o0000000 OF At D *CO-' 49 TH .y* SHANE A. HOLT LS -6914 G e • • • 9J�0 o4�4ap •' •.....•• co 4�n jes sionat AS -BUILT SURVEY NO CORNERS SET THIS DATE SCALER" = 40' I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 1, BLOCK 2, CONTOUR ACRES SUB. ANCHORAGE RECORDING DISTRICT, ALASKA AND THAT THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST STRUCTURES OR FENCELINES. OTHER THAN NOTED. EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. DATED AT ANCHORAGE, ALASKA THIS _29TH_ DAY OF 2003. NOTE: ANY FENCELINES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES _MAY HOLT LAND SURVEYING 8987, F_B106-7 OR LOCATE STRUCTURES. TEL. 345-5513 44 Municipality of Anchorage Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. CS�,(j�► P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Q Parcell.D. 017-451-17 ' HAA# Q_-7�Q2-9 1. GENERAL INFORMATION Expiration Date: /0 '/— O 3 Complete legal description rCONTOUR ACRES SUBDIVISION: LOT 1, BLOCK 2, Location (site address or directions) 5340 COUNTRY CLUB LANE • ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address JUDY GOWER Day phone 345-4997 5340 COUNTRY CLUB LANE • ANCHORAGE, AK 99516 Day phone BILL MEHNER w/ PRUDENTIAL J.W. Day phone 317-0710 3201 "C" STREET, SUITE 200 " ANCHORAGE, AK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid . water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: in conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AKWWC, Inc. can therefore not provide any warranty or future estimate othow long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will It confer any legal right whatsoever. S. DSD SIGNATURE Lr Approved for S bedrooms. Disapproved. Phone 337-6179 Date _� A. 0 3 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineer's Reort Other OF ON-SITE�'ci WATER AND ; n' WASTEWATER : % ln� • ... • •_cS _.�A By: Original Certificate Date: % — %' 3 (Rev. 17!01) Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak•us (907) 343-79W HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: CONTOUR ACRES S/D; LOT 1. BLOCK 2. Parcel ID: 017-451-17 A. WELL DATA Wen typePRIVATE-If A. B, or C provide PWSID# N/A Date completed -1973 Sanitary seal (Y/N) YES Total depth 237+ ft. Cased to 40+ ft. FROM WELL LOG Date of test Static water level 4 ft• �O Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 2.78 mg./L. Well Log (Y/N) NO Wires properly protected (WN) YES Casing height (above ground) 12+ in. AT INSPECTION 5/15/2003 236 ft. 5.19 g.p.m. Other bacteria O colonies/100 ml. Arsenic: N/A rngJL. Date of sample: 5/15/2003 Collected by: AKWWC. INC. B. SEPTIC/HOLDING TANK DATA 7/1973 Tank Type/Material CONCRETE/STEEL 1 Date installed 5/13-14/2003 1000/ Tank size 150 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YM) NO High water alarm (Y/N) N/A Date of pumping .5-16-2003/NEW Pumper McDONALDS PUMPING C. ABSORPTION FIELD DATA Date Installed 5/13-IV2003 Soil rating .pp d r fti'bdrm) 0_.8 System type TRENCH Length 96 (2 O 48) ft Width 2.5 R Gravel below pipe 5.0 ft. Total depth 2Aa-9.93ft. Eff. absorption area 960 R' Monitoring tube YES Depression over field NO Date of adequacy test ._,.. NEW _ Results (Pass/Fall) I - For 5 bedrooms Fluid depth in absorption field before test � in. Water added.,:_ gal. New depth =in. Elapsed Time:. - _ min. Final fluid depth = in. Absorption rate >= 750+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - 0. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements?, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot •85'+/100'+ Absorption field on lot 1006+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 1006+ Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 1009+ Wells on adjacent lots 1000+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 109+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION ' n� ��'� •� 'gig 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in • • • • "' • ' • ' ' • ' • ....• • • ' • • • conformance with MOA HAA guidelines in effect on this date. 1. Engineer's Printed N2m, JEFFREY A. GARNESS "Q Sy 1, 7953 /Date �►lh�� p._"__.tie, HAA Fee $ = � r IS • Waiver Fee $ _ Date of Payment r� tj '� Date of Payment Receipt Number l Receipt Number, (Rev. 12101) COUNTRY CLUB LANE N 0"O9'3C'W 305,OC ti i o�ner.r 1 Sm op � m. ., i C 4 Y >.� 0"a 0 - pi ti i o�ner.r 1 Sm MUNICIPALITY OF ANCHORAGE DEPARTmENT OF HEALTH AND ENVIRONMENTAL rROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 ©I % Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subd Location (address or directions) 5 3 4-0 6;"M ren C (b) Applicant Name ly�241Z y� Applicant Address .- -0 cotat (c) Applicant is (check one): Lending Institution section, township, range) I r Telephone:_ Home 3-3011 Business Owner/builder L"7; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Telephone Address (e) Real Estat Address Telephone � (f) Mail the HAA to the following address: ��l "'o7/" —&575Z 4r— Pia4 ap -- 2. TYPE OF RESIDE E Single -Family Multi -Family ❑ Other Number of Bedrooms 5 3. WATER SUPPLY / Individual Well [�T/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 POSAL 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. 72-025 (11/84) Page 1 of 2 (49/ L 0 990-ZL Z to Z 968d 'M AOM s,a99u!6u9 lguolssalo.id 941 ul suolss!wo ao s.ione aol alq!suodsai lou si 96eaoyouy to Aj!ledlo!unVy ayl •penssi si ales!ilpao g aaopq elep azo leue jo suo!loadsui lonpuoo jou op d3H(I to s99Aoldw3 •sluawaa!nbaa alels pug leaapai u!epoo �(islles o1 aap,io u! suo!1npisu! 6u!pu9l a!ayl pue s9wo4 to saaseyoand of �tselinoo a sg s!43 s90p d3Ha 9yl T)lsgly to a1e1S 1841 ul paa93s!6aa aa18u!6ua leuo!ssaloid 1uepued9pu! ug �(q anoge g 4dei6eied ui u9A!6 suo!jejuasaidaa ayj uodn �Slolos paseq sajeo!i!laao lenoaddy Al!ao4lny 4l!g9H sanss! (d3H0) uolloaload lelu9wuoa!Au3 pue y11e91-1 to juawpedaQ 96eaoyouy to Apled!ounlN ayl f 1)" : uinvo7 03 3 leap s,aaaul6u3 S ........ . 1 �. �ar.e•ac e e � es 1 d Z Q oleo S' /QoZ ss9APPy auoydalal � d- , p� � -wa!d to aweN uo!loadsu! s!41 to alep 941 uo ioaila ui suo!jeln6a.i pue `saougulp.io'sepoo alels pue ledlownW Ile 141!M eoue!idwoo ui si walsAs lesods!p aajemelsem jo/pue �(lddns aajem el!s-uo 1843 'uo!joadsui pug uo!je6lis9Au! �(w woai pug sal!i 96eaoyouy to Al!led!olun" ayj woai poulelgo uo!lewaolui ayj uo paseq jeyj Ajp9A jegpni l -ulaaay pejeo!pui ainimis to adAj pue swooapeq to aagwnu 941 joi ojenbape pug leuoljoun j'ales si walsAs lesods!p aalemalsem ao/pue Alddns aajem aj!s-uo 91431e41 SM04S lBAoaddy Allaoylny 411729H s!41 10 uo!je6!is9nu! Aw 1e43 ApJOA 1`'molaq umoys ejep uollep!leA 9y1 10 se pue ojaaay pex!ile leas Aw Aq pa!i!pao sy .9 NOIIVWaOdNI aNV V1Va'HOdV3S 3'IId'S.LS31'SN01103dSN1 JNMIAOHd WHId ONIH33NION3 'S MUNICIPALITY OF ANCHOR/ ENVIRONMENTAL SERVICES Dl1 ..JN MUNICIPALITY OF ANCHORAGE (MO. i HEALTH AUTHORITY APPROVAL (HAA) - 1 3 1987 CHECKLIST - FEBRUARY 1984 264-4720 RECEIVED E Legal Description: .4i-,Px Sum A. WELL DATA Well Classification It A, B, C, D.E.C. Approved (Y/N) -�U/� Well Log Present (Y/N) ZU Date Completed a4A%g6*-1e'" Yield Total Depth � �� Cased to "*40 Depth of Grouting un&�w Static Water Level Z g Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) t , Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: p To Septic/Holding Tank on Lot `� i' ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot �� ; On Adjoining Lots >d� To Nearest Public Sewer Line Vtoo To Nearest Public Sewer Cleanout/Manhole 7lOO s To Nearest Sewer Service Line on Lot 7 Water Sample Collected by Ems. •� IGLU e ; Date -7 Water Water Sample Test Results rrvr 140 G7 Comments ' 501 /?�GCf;, Gat'yl �- L Z3 _D i` &Z3lGv) B. SEPTIC/HOLDING TANK DATAQN1► fNow', OF �'� t0ee bAa l'�� / Date Installed J44 ITV -Size • No. of Compartments Standpipes (Y/N) r Air -tight Caps (Y/N) Foundation Cleanout (Y/NN)) Depression over Tank (Y/N) N Date Last Pumped 1077067 Pumping/Maintenance Contract on File (Y/N) /JIA ; for &L A Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well Z3�A To Building Foundation To Property Line 7/00 / To Disposal Field 2S / To Water Mai ervic Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Z 0 /J '. Soils Rating in Absorption Strata 2' 23- Ar Type of System Design L l� ��S Date Installed 1873 Length of Field *.5;e--.-- i Width of Fieldy�t,� Depth of Field�e� .0 696 %Oe ='Gravel Bed Thickness sP�- GL191?2.P.GL' Square Feet of Absorption Area *5e�'F'J�Standpipes Present (Y/N) Depression over Field (Y/N) /� n Date of Last Adequacy Test Results of Last Adequacy Test �. A?. Separation Distance from Absorption Field: I / To Water -Supply Well /`,0 To Property Line O0 To Building Foundation To Existing or Abandoned System on Lot— %y A_ !�_� ; On Adjoining Lots ,-,PZE70 To Water Mai ervic Line �� t� To Cutbank (if present) rZA_ To Stream/Pond/Lake/or Major Drainage Course 7 2,nO r s w ! To Driveway, Parking Area, or Vehicle Storage Area Comments AIF *;OX 6#W414 r`Z Old D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments ** CheckPer tied Bedro, I certify thaW ke Signed Company Receipt No. cor-0 Manhole/Access (Y/N) "Pump OfYJ�at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Rating Against HAA Request ** ed, or conformed to all M A and HAA guidelines in effect on the date of this inspection. =---Date �D ? $ 7 % OA No. s�%s Zls Date of Payment Z0 -19—,P7 Amount: $ 4 6 Page 2 of 2 72-026 (11/84) C, a Engineer's Seal i, •a a , •••moan i • Br a Corwin e :® o E-5283 °er ���c�®epi° "'.•.i�,.vam. 21 Acl /77 �5JLU:57 ,C o f / (26AWOule i