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HomeMy WebLinkAboutCHUGACH PARK ESTATES BLK 1 LT 12 Onsite File Chugach Park Estates Block 1 Lot 12 #051 - 481 - 43 Municipality of Anchorage UESL `� On-Site Water and Wastewater Program • (907) 343-7904 �I /PTA ON-SITE WASTEWATER INSPECTION REPOR JUL 2 3 2018 Permit Number: OSP181189 PID Number: 051-481-43 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: MARY R. ZIEMBA ABSORPTION FIELD Address ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 20533 White Birch Road, Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 11 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 3 Ft. 8 Ft. CHUGACH PARK EST. 1 12 Fill added above original grade Gravel length Township Range Section Varies 1.46 - 2.18 +/- Ft. 32+ Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES 3 Ft. Ft. Toi Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 512+ Ft2 1 Ft. Well 100+ 100'+ -- NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface Water 100'+ 100'+ -- NA ANCHORAGE TANK 1250 Gal. Material Number of compartments Lot Line 5'+ 10'+ -- NA STEEL 2 NA Foundation 10'+ 10'+ -- NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA *50'+ NA NA Pump on level at Pump off level at High water alarm at *None None known. Original system decommissioned per code. in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer Northern Excavation drainfield Drainfield 3034 CO/MT 3034 Inspector Mike Anderson BENCH MARK (Assumed elevation) 100 ft Inspection V'7/17/18 2'd 7/17/18 Location and description da3`d 7/18/18 4d' 7/20/18 Cement landing COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp .= c O F 4 %Ill, Conditional Approval: Date .��Y'�;• .':<1..s�4I,, r C1.• r . ' q *. 49TH v`f i� , :"^•. MCI-IAEEL N. ANDLRSCN . d ri— ,, / e v.:-•.• CE-9469 ..;;� ,, AppraVed� (nom`, - /� ^-�' Date 7_� ^ ,1I-p b. �t • ••,i• v...; O\aN.oa Inspection Report_9-1-12.doc PERMIT #0SP181180 PID: 051-481-43 10' UTIL ESMT. NEW 4-:R FIELD P/L STAKED CO. H 10� S: \ MT ' ��) G I- <1` NEW 1250-t AL S.T. •COs TH2O18 CO o ODM F; C CO"E I(s!? illp*BM B A FCO,.. 3-BR HOUSE — 107.4 // -===f 2ND STORY DECK SCALE: 1" _ A—C=32.3' 9.14 98.7 Id B—C=30.0' a \- A—D=31.6' g 11 rr r 1 1 B—D=37.7' GRADE A—E=21.1' .„:„....„<97.76") (-97.0 _ �95,5� B—E=47.9' E MIERrA V""� A—F=27.1' 0 _—_,1250—GAL ,r B—F=49.1' `� SEPTIC 92.5 C92.5V-" T TANK SEWER ROCK 8' A—G=53.8' B—G=62.4' 93.6 93.46 _ ____,..<84.56>\ I o«C. A—H=54.6' (78.5$ wc+ B—H=63.3' I 32+ SCALE: NTS PREPARED FOR: -41416'46:11k MARY R. ZIEMBA4.' c .OF AL`s\� CHUGACH PARK ESTATES BLOCK 1 , LOT 12 i -..1—.1� FY A Eagle River, Alaska p * 49 * o Michael N. Anderson, P.E. DATE: 7/20/2018 /, N. ANDERSON A. j No. CE 9469 42- 4601 Natrona Ave. DRAWN: BMW , -')/(.q / Gjor 0w� Anchorage, Alaska 99516 , (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' \���=i 1/17/18 80(-( ��N;"°" MUNICIPALITY OF ANCHORAGE oent t \ On-Site Water&Wastewater Program •o S0^ . ', PO Box 196650 4700 Elmore Road • Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 �y �. 1 'q` http://www.muni.org/onsite H �_ epartment M<HONPV On-Site Wastewater Disposal System Permit Permit Number: OSP181189 Effective Date: 7/17/2018 Work Type: Septic Upgrade Expiration Date: 7/17/2019 Tax Code Number: 05148143000 Site Legal Address: CHUGACH PARK ESTATES BLK 1 LT 12 G:1161 Site Mailing Address: 24245 PLATSEK DR, Chugiak Owner: ZIEMBA MARY R Lot Size in Sq Ft: 54551 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: El Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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: AAV Date: 7 • Witte, QA' LeQ_Q Issued By: fk Date: NV MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division - Fax: 907-343-7997 On-Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I,D. 051-481-43 MARY R. ZIEMBA 907-644-2861 Property owner(s) Day phone Mailing address 24245 PLATSEK DRIVE, CHUGIAK, AK 99567 Site address 24245 PLATSEK DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) CHUGACH PARK ESTATES, BLOCK 1, LOT 12 Legal description (Township, Range & Section) Lot Size 54,551 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ( Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank (1 Upgrade Duplex (D) ❑ Holding Tank I I Renewal n Multiple Dwellings ❑ Privy II (SF and/or D) Private Well ❑ Water Storage 17 5 THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST f' istV1CA•. II I certify that the above information is correct. I further certify that this i ift ccordance wi applicable Municipal Codes. 68z S y7 � S.!• Ire roperty owner or authorized agent) Permit/Rush Fees: 5101 Waiver Fees: Date of Payment: Vali$ c_-K. 15 t Date of Payment: Receipt Number: 2211 l - Receipt Number: Permit No. W 1S I 1 gq Waiver No. cklec el O S i% Permit App_9-1-12.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 July 10,2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Permit Legal: CHUGACH PARK ESTATES BLOCK 1, LOT 12 To whom it may concern: This is a request for a septic permit on the above referenced lot the old system has failed. A test hole was excavated and found clean sand with a trace of silt and gravel pockets for the entire depth. The perc rate was found to be 2.3 minutes therefore a simple deep trench was designed with an effective depth of 8 feet. No water was measured in the test hole during or after the excavation. The tank will also be replaced at the same time : -- : = - • . . • • . •. The slope at the proposed trench is location is 7-12%, but then flattens out with no cut banks w' hin 100 feet. The lot and area is served by private water Ind this system will not impact any of the neighboring properties due to the lot layout. `19Miv.r41440►1,4„., f^, r(4,. Please call me if you have any questions. /--It At4. Sincerely, //v.‘(__ Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 DESIGN CRITERIA: OUND OVER•RIG. GRADE 1' 3 BDRM X 150 = 450 GPD ILTER FABRIC SOILS = 450/1.2 = 375 SF & INSULATION 375 SF / (2 x 8' ED) = 24' L -3.0 --- IF <3' COVER 4"0 PIPE (1) TRENCH 8' 11.0' MAX DEPTH SEWER ROCK 8.0' EFFECTIVE —11.0 2.0' WIDE 24' LONG —►I 2' Hi— OPPITIONAL 4—BR SYST. W/ 1250—GAL S.T & 32' L X 2'W X 8'ED TRENCH W/ RESERVE SEPTIC FIELD SECTION P/L STAKED DECOM.EXIST. CO: L S.T. FIELD PER CODE&INSTALL `NEW 1000-GAL S.T. o. MT,. TH2018 CO /y 182 . , s ' ELEV.DECK • 3-BR HOUSE FCO LOT 11 107.4 2ND STORY DECK LOT 12 PLANTERS I •X4'OUTHOUSE 1.12 66 //". • PLANTERS GARAGE © IBARN/SHED APPROX.WELL LOC. 0 L.—....r-t [i V o��NF.`�P 5.8 N (GRAVEL DRIVEWAY oi,c. Li Ln N90°00'00"W 250.32 1 / 3 ------ ------ Septic Design Prepared for .1.:41" Ilk N MARY R. ZIEMBA 411% OF AZ4 CHUGACH PARK ESTATES BLOCK 1, LOT 12 Gj�. T �� °Y °A * .49 .. * 7 Chugiak, Alaska # 0 Michael N. Anderson, P.E. DATE: 7/10/2018 / CHAEL N. ANDERSON j Z4/..,,,, 9 4601 Natrone Ave. DRAWN: BMW 1 . Ar Alaska 99516 1\Anchorage, sloo, i (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 50' \111b._711:41°- r (sL `'11, z'M nI Lor W Y1. ADI.WELLS 200'+ OF PROPOSED FIELDS NO SLOPES>20% W/IN 100'OF PROPOSED FIELD 0,7 a 5•' P/L STAKED 1, 9 1- E' 'r DECOM.EXIST. CO; 15 S.T.&FIELD PER \ e, CODE&INSTALL NEW 1000-GAL S.T. ,:•.. MTS. TH2O18 .�.ysx NI CO 18 1 —iitim � I + ELEV.DECK — 3-BR HOUSE FCO LOT 11 107.4 LOT 12 M 2ND STORY DECK ?va( PLANTERS •X4'OHi$t a 1I..2 6.6 ' a PLANTERS lf BARN/SHED APPROX.WELL LOC. GARAGE P\.10P� J :5.8 ry (GRAVEL DRIVEWAY I '0 La N N90"00'00"W 250.32 1 0 0 — 6 M PLASTEK DRIVE \ ..---- Septic Design Prepared for �, ``` MARY R. ZIEMBA .SN, OF•AL-1 ‘' CHUGACH PARK ESTATES BLOCK 1, LOT 12 ie`S.7. ,1- . 7 0 Chugiak, Alaska * 49TH /N *V/ Michael N. Anderson, P.E. DATE: 7/10/2018 # ANDEBRSON. ,, / 4601 Natrone Ave. 1 ..7177 :" r Anchorage, Alaska 99516 DRAWN: BMW , t, ..ir (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 50' `�`�=i ,., gJN ER' .6 �).e Municipality of Anchorages'. Development Services Department r��'� • � On-Site Water and Wastewater Section s�:4 9 T al i •'. �� �7 4700Elmore St. �•••• ••••• •• �•'..� �-,, } i_ P.O. Box 196650 Anchorage,AK 99519-6650 ..........) K.,. www.muni.org/onsite e :•• •••..•.•...,•••, F (907)343-7904 , • MICHAEL N. �r^�•� ANDERSON •�� `✓`,.• CEr 9 69/• •��f Soils Log - Percolation Test I .00 QI1,e eF�p yr �a��..�...� Performed For: NI Ag 1 ZIEM 84 Date Performed: -.77',4,---7-. Legal Description: erf(r4C// P4je, ES?_ Z,/, L /Z Township, Range,Section: Slope Site Plan Depth (Feet) 1- L / piA,1 2- 046-/0 I- 3- 3- - 4- 5- s 1V--Sr,i 6- q yr f i,4 h 7- 8- WAS GROUND WATER 9- ENCOUNTERED? NLS S 10- IF YES,AT WHAT DEPTH? L - Depth to Water After P 1 1- Monitoring? b1 V E 12- Date: /0 l/'i3 13- 1/0/ i 14- Reading Date Gross Time Net Time Depth to Water Net Drop 15- i/3//S /0 al/,J & N 7 C7/t;%11J 16- +t (D * 1/ 41/4• 17- - 126/1 , & // V/(., 18- 0 (p y V/G., • 19- 20- PERCOLATION RATE 2-. 3 (minutes/inch) PERC HOLE DIAMETER 6, TEST RUN BETWEEN 5 FT AND & FT COMMENTS P/lE—so4k6» P/l/0L 7r, j E,.j 4t ,e4-7),,tie-4 J-D 771Z. V/6,1774- PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: NAME ,'R ANCHORAGE AREA BOR. Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYS~'EAA LOCATION LEGAL DESCRIPTION SEPTIC TANK: FROM WELL INSIDE LENGTH MANUFACTURER ~ MATERIAL INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY/g"~"-~ GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL F ~-~ FOUNDATION NUMBER OF LINES / DISTANCE BETWEEN LINES / ABSORPTION AREA (:;~--~c~ /~ DEPTH: TOP OF TILE TO FINISH GRADE / ._!~d TOTAL LENGTH / NEAREST LOT LINE OF LINES .TRENCH WIDTH-- IN. TOTAL EFFECTIVE SQ. FT. LENGTH OF EACH LINE MATERIAL BENEATH TILE ~ I'N. ABOVE TILE IN. WELL: TYPE _ BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION NEAREST NEAREST LOT LINE __, SEWER LINE__ OTHER SOURCES DISAPPROVED DEPTH SEPTIC SEEPAGE TANK SYSTEM REMARKS DISTANCE FROM: DISTANCES: iNSTALLED By:~ -~ SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM DATE //~/7/~ APPROVED. ~~"'~--"--"~ / / ~- G.A.A.B. Form EQ-O32 PERMIT N0. APPLICANT ~IM SWAN, LOCATION CIRCLE DRIVE LEGAL Li2 AK1CHUGRCH PARK EST. lr-ll_'li'-,I I C I iL I T'-r' I]F Ft[-41'-;~ ~'FII'~E DEPARTblENT OF HEALTH AND ENVIRONMENTAL r-"c.:0TECTION 2516 E. TUDOR RD.., ANCHORAGE, AK. 99507 276-222i L. IELL R~-4[-',' Ol~l-'=...=. I Ti SEL4E~-: ( 76798 ) P. 0. B0X 82 WASILLA F' E F: f-1 I -- y-) ¢... ~, 6r_-38-29~n ~ LOT SIZE.-,....,U~='=-.'-'~-~d SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS' TRENCH MFtXIMUM NUMBER OF BEDROObiS = 2 SO I L RAT I NG ( SQ FT,..'BR) = ,...,._ .... b_,TEM IS THE REQUIRED SIZE OF THE SOIL RBSnRF'TION c ,c , . C, EF'TH= t2 LE[4GTH= I 6 GAR%eEL [:,EPTH= :--: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REI~IU I RED SEPT I I--: TANK ~ I ZE= tOC-IO ISRLLI]~-IS THEm (~:') INSPECTIONS I=IRE REm~!UI BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS i00 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERI'-I I T '...'FILI D FOR (~II'-.IE 'T'ERF-: FRC, I'-I I SSIJE I CERTIFY THAT i: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ~: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. S I GNED ' - RPPL I CANT T I~ ~f4AN MUNICIPALITY OF ANCHORAGE Department of Health and Environmental Protection SOILS LOG Performed for Legal Description Date Performed ~/'? 2 4 12 14 16 18 20 Date Net Time Depth Net Drop Percolation Rate minute Performed By ~.~ ~_,~_. _ .~/~~--._ PERMIT NO. DEPARTMENT HEALTH 8ND ENVIRONMENTAL .OTECTION 25i0 E. TUDOR RD., ANCHORAGE, AK. 9950? 276-2221 ~4ibb F'EF~£-I IT 76282 ) APPLICANT LOCATION LEGAL ~PECIAL SERV~,¢E~ CIRCL~ DRIVE Li2 Bi CHUGACH PARK EST BOX 82 WASILLA LOT SIZE 688-2960 ._,4._,41 SQUARE FEET MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS IOO FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DRYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'ERMIT ~'RLID FOR ~Dt4E' '¢ERR FR~Dbl ISSLIE I CERTIFY THAT i: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. APPL I CANT SP~C I AL ~ERV ICES A & L DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 · TELEPHONE 694-2588 OWNER OF LAND ADDRESS LEGAL DESCRIPTION L~ /_,~ ~ ! Cl.~,/~/c/~_.-~d/~_ DATE-Started ~/~/7g Ended PERMIT NUMBE~/ ~ ~ DEPTH OF WELL STATIC LEVEL OF WATER FT. DRAW DOWN FT. j O GALS. PER HR :i DO KIND 6F CASING ~ ~-O~) r 70 KIND OF FORMATION: From (~ From ! /~' From /o~__~ From 7--~- Ft. From / ~d~. Ft. From ~,Oo Ft. From ~1~ Ft. From~Ft. From ~-g' Ft. Ft. to ~ Ft. O¢,~,&'~O4L~',~o From__Ft. to__Ft. Et. to i/~ Ft. 5-~0¢ ~d~Z From~Ft. to_ Ft. Ft. to /AC Ft. ~ gO/~~g Fromm_Et to Ft. _ Ft. to~Ft. '~ ~ ~& From~Ft. to Et to J~$ Ft. ~ ¢ &~'~ From~Ft. to~Ft. to ' ,OO F to--Ft, j~ ~?D~D~e~ From~Ft. to__Et to--Ft. ~ ~o~. From~Ft. to~Ft to ~,5~ Et. F~O~C~ ~~Z from~Ft, to Ft to'Ft. ~OO~ ~$~ From~Ft. to~Ft From Ft. to ' Ft From__Ft. to Ft. From__Et. to Ft.. From Et. to Ft. From__.Ft. to Ft. From Ft. to Ft. From Et. to Ft, From__Ft. to__Ft From__Et. to__Ft. From__Et. to__Ft. From Ft. to Ft. From__Ft. to__Ft. From__Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: a~-~2 ~ ~ ~/ 'Fo'r~ o ~-/~o ~ DRILLER'S NAME ~c~~ MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-481-43 Expiration Date: -2-2%4-20'2 1. GENERAL INFORMATION Complete legal description CHUGACH PARK ESTATES BLOCK 1, LOT 12 Location (site address) 24245 PLATSEK DRIVE, CHUGIAK, AK 99567 Current property owner(s) ADAM & KAUAI FITT Day phone Mailing address Real estate agent PO BOX 670770, CHUGIAK. AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 9 0 G U I o Date of Payment U,, D Receipt Number COSA #_ D�2G201623 Waiver Fee $ Date of Payment Receipt Number 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 11/10/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to r ASl�� these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory g�Q: • ,� ��� for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FW CS ' * • TH .....•.* 6. DSD /SIGNATURE rr Curtis Huffman /v System #1 Approved for bedroomsF29 CE 128991 Aw� �l F�FVSSION'" System #2 Approved for bedrooms l\\\ P OFESSOP \\\� Disapproved Conditional approval for bedrooms, with the following stipulations: By: lnn Ei&� Original Certificate Date: l 12LI Z0?(D 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 Legal Description: CHUGACH PARK ESTATES BLOCK 1 LOT 12 Parcel ID: 051-481-43 If more than 1 septic system on lot: COSA Checklist # of _ Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 6/6/1976 Total depth 360 ft Cased to 222 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 10/6/2020 Static water level at beginning of test 169 ft. Well production at time of test 1.9 gpm Comments B. TANK DATA Age of tank(s) 2 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 10/6/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/17/2018 ® ALL standpipes present per record drawing Total measured depth from grade 11.8 ft (max) Measured depth to pipe invert from grade 3.8 ft (min) ❑ N/A —pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 1.86 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) WN Collected by4 Date of Sample 11/9/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 10/6/2020 Results E Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 670 gal New depth 1 in Elapsed time <5 min Final fluid depth 0 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) N If yes, enter date N"N 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 ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No 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: 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' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / 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. Ak Aw .' ..M .. .... •.......... � Curtis Huffman CE 128991 AiW� ft ft ft ft ft ft ft ft • --- E G8 P G� •`t r Municipality of Anchorage On-Site Water and Wastewater Program • ��U, (907) 343-7904 S A F E T Y CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-481-43 Expiration Date: ( 0 r0-6' ---t 1. GENERAL INFORMATION Complete legal description CHUGACH PARK ESTATES B1,L12 Location (site address) 24245 PLATSEK DRIVE,CHUGIAK,AK 99567 Current Property owner(s) MARY R. ZIEMBA Day phone Mailing address PO BOX 670681,CHUGIAK,AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: ' Date: 1/2- //`u COSA to be released ti e e eer, unless otherwise requested by the engineer. COSA Fee $ 21.D0 ,C0 Waiver Fee $ Date of Payment .-417-31,116 Date of Payment Receipt Number C 41 1tL O f Receipt Number COSA# Date t3S< 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 ANDERSON CONSTRUCTION&ENGINEERING Phone 345-3377 Address 4640 SHOSHONI DRIVE,ANCHORAGE,AK 99516 Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 7/19/2018 c" e <:;'''')<** A e i�' 6. DSD SIGNATURE ®p v•i..,..MICHAEL N. n.NDL SON „ r° 1.1 System #1 Approved for ( bedrooms. e�-s,;;. C�;9a 9 .`..1•:-,,';� System #2 Approved for bedrooms. i1111fD•,• 7 1 •,-,.',. .."-:- ‘1,,i ' Disapproved. � a � -pro Conditional approval for bedrooms, with the following stipulations: �!,,,,` Ur- �ti-t,,V,1/4 ' ON-SITE c: WATER AND �` WASTEWATER o 'N PROGRAM J C_- rc By: `d-r—L'`-- Original Certificate Date: 7 a.G 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 If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system _ Certificate of On-Site Systems Approval Checklist Legal Description: CHUGACH PARK ESTATES B1,L12 Parcel ID: 051-481-43 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (YIN)Y Date completed 6/6/1976 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 360 ft. Cased to 222.5 ft. Casing height (above ground) 12 in. FROM WELL LOG AT INSPECTION Date of test 6/6/1976 6/26/2018 Static water level 170 ft. 163 ft. Well production 2 g.p.m. _— 2.5+ g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/1 00 mL Nitrate 1.52 mg/L Arsenic: ND ug/L Date of sample: 7/3/2018 Collected by: First Water Consulting B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC!STEEL Date installed 07/17/2018 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping NA-NEW TANK Pumper____ C. ABSORPTION FIELD DATA Date installed 07/17/2018 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 System type DEEP TRENCH Length 32ft. Width 2 ft. Gravel below pipe 8 ft. Total depth 11 ft. Eff. absorption area 512 ft2 Monitoring tube Y Depression over field N Date of adequacy test NA-NEW SYSTEM Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type)___ If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off' level at in.High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements?_ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ — On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank _100'+ Animal containment areas 50'+ _v Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION OF AC.�s ;9.94.7.• `R I certify that I have determined through field inspections and �4. • review of Municipal records that the above systems are in /el* • ; 4 9 7 H conformance with MOA COSA guidelines in effect on this date. %'"" "••'• •••••••••• • Engineer's Printed Name MICHAEL N.ANDERSON,PE � MICHAtL N. ANDERSCN ;, �'.• •446 •`r •� Date 0711912018 f h'�,�••7 .//t� ,•;\o;,y! COSA canary sheet_2-6-15.doc Frontier Surveys, LLC Project No: 18-262 Date:July 24th, 2018 NORTH Ordered By:Mary Ziemba/ Brent Western Plat:72-188 Grid:N/A Scale 1"=50' N90'00'00"W 113.35 • SI / di / 1 / of 0o ti co.02 2ND STORY DECK or �/ .78 ,,,e CP d°/dt * lIIInni o 40.1' of :� :1 p tsi cd od 16.2 COVERED STORAGE 8 A. CN N �,, PAD LOT 11 40.1 :;,; of _61.6 ro �� r� .:::::'s 8 LOT 12 ° 2ND STORY DECK yeV PLANTERS / ^I...& 4'X4'OUTHOUSE-4/t /i/ Chugach Park Estates S /I — Lot 12, Block 1 S rr1 / i ____y 7— 54,551 sq.ft.+/- ,-- Platsek Drive 6.6 • //�_ \ N. 2 Story Wood Framed House 1 ❑ PLANTERS W/Detached 2 Car Garage cv~ I 20.2' GARAGE II*. U 30.3' 1 N \ I \ 85.8 tel S. _ \......s..._<_a: N90"00'00"W 250.323• i� cd 0 ro \[..._. ........ I Legend: X Electric Meter/Outside Power co-) Telephone Pole X Gas Meter g Deck ❑ Bollard -*- Light Pole 0 50 100 25 i S; Septic MI Water Well —op— Over Hanging Power ��smosii Feet General Notes: 1.This document Is created for the purpose of a single property transaction and is subject to Federal Copyright Law. 2.Excepting for gross negligence,the liability for this survey shall not exceed the cost of preparing this survey. 3.All measurements/setbacks are to the visual/apparent building footprint. 4.Dimensions to property lines are plus/minus O.lft. ```��..•••\‘‘‘‘I t 111 This survey complies with ASPLS Mortgage Location Standards.The survey represents visible improvements and OF q 111 conditions at the time of the survey.This document does not constitute a boundary survey and is subject to any �P'( '•. 4 11 inaccuracies that a subsequent boundary survey may reveal.It is the responsibility of the Owner to determine S� /// the existence of any easements,covenants,or restrictions which do not appear on the record plat.Under no Lj •' `'� '.•-9 // circumstances should this document be used for construction or for establishing a boundary or fence line. *; i 4911�\ .* / As-Built Survey of: ' � ,.qLot 12, Block 1 Chugach Park Estates j • 1 E FREDERIC W. Nud ER .7 I,Frederic Wagner,herebycertifythat this F •• NO.LS.9946 g Mortgage Inspection Survey was performed by me,or '//c1, • '. 7/24/2018 under my direct supervision on July 24th,2018. //IF��A ••o ��� Frontier Surveys, LLC FRONTIER Il14'1?FESSIONA . * ‘‘‘‘‘‘‘,......4s" � 650 W.58th Ave.Suite E Anchorage,Alaska 99518 1 1 Sury. - ,.+ 907.460.1686-info@frontiersurveys.com .••• • •t PROFESSIONAL SEAL www.frontiersurveys.com t 6 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.# 051-481-43 HAA# HA930084 GENERAL INFORMATION Complete legaldescription Lot 12 Block 1 Chugach Park Estates Location (site address or directions) Platcek Drive Property owner Dan/Susan Gates Day phone 248-0412 (h) Mailing address PO Box 273 Chugiak, Alaska 99567 272-5565 (Dan Lending agency Mailing address Day phone Agent Eva Day phone Address wk) Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: three (3) TYPE OF WATER SUPPLY: Individual well xxxxxx Community well Public water NOTE: 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 xxxxxxxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 Tobben Spurkland, P.E. Phone 279-3916 Address 203 West 15th Avenue #206 Anchoraqe, Alaska 99501 Engineer's signature Date DHHS SIGNATURE xxxx Approved for three (3) Disapproved. Conditional approval for bedrooms. bedrooms, with the 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 engineeCs work. 72-025 (Rev. 1/91) Back MOA #21 ( Municipality of Anchorage ~i~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescription: J'J'~"/~J C~C~"~'~ ParooII.D. 0~1-- L~-L}_~ A. WELL DATA Well type ~ Log present (Y/N) ~"/ Total depth ~ Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date completed ~/~/~7 ~ Driller Cased to ,-~-, ~.~ Casing height Y ADEC water system number Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION oa,eo,,.t Static water level [-7 ~) .[ ~ q Well flow ~ g.p.m. '~, ~ Pump level ~ (~ ~ 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 1,2- WATER SAMPLE RESULTS: Coliform 0 Date of sample: ¢~"/I ¢' Nitrate ~. ~e/~ Other bacteria' Collected by: .-~ c4.z~Y'- 'it- B. SEPTIC/HOLDING TANK DATA Date installed J 0/'7/7 ~ Cleanouts (Y/N) ~/ High water alarm (Y/N) Date of pumping Tank size 1 ~ Compartments ~-~ Foundation cleanout (Y/N) N/ Depression (Y/N) !"////~ Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~' 1~0 To property line ~ Surface water/drainage On adjacentlots /% / ~Z~0 Foundation ~ 0 Absorption field ~' 't~ Water main/service line ,~/~'~-~ 72-026 (Rev. 7/91)Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed J~/'7/7 ~ / Length ~..O Width ~ T~)tal absorption area ~ Depression over field (Y/N) J~ Results (pass/fail) ~ Peroxide treatment (past 12 months) (Y/N) Soil rating <~"-'-'-~ Gravel thickness Cleanouts present (Y/N) Date of adequacy test for If yes, give date System type Total depth bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ /,~) To building foundation On adjacentlots ~ Surface water ~ g) P'/~-- Curtain drain 1'~ / C) On adjacent lots ~ 1 '~) Propertyline To existing or abandoned system on lot Cutbank H f) v/~__ Water main/service line Driveway, parking/vehicle storage area r-//^ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe~ on the date of this inspection. 72-026 (Rev. 3/91) Back MOA 21 HAA Fee $ / ~70 ,~[2~) Waiver Fee: $ Date of Payment ~- - ~' ~- r~.~ Date of Payment Receipt Number -~rZ f--~/'7/~ f ~,~4"'~.~ .~ Receipt Number Municipality of Anc.ora e Department of Health and Human Services Torn Fink, 825 "L" Street Mayor P.O. BOX 196650 ' Anchorage, Alaska 99519-6650 343-4744 March 11, 1993 Tobben Spurkland, P.E. 203 West 15th Avenue 9206 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 12 Block 1 Chugach Park Estates S/D Waiver Request 9WR930016, PID 9051-481-43, HA930084 Dear Mr. Spurkland: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. waived distance is 9 feet. The This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Civil Engineer On-site Services WR~ WR930016 Date Received: Legal Description: MUNICIPALITY OF ANCHORAGA Department of Health and Human Services On-site Services Section Waiver Review Worksheet PID# #051=481-43 HA# HA930084 Permit 9 Feb 22, 1993 Lot 12 Block 1 Chugach Park Estates Subdivision Engineer: Tobben Spurkland. P. E. 203 West 15th Avenue 9206, Anchoraqe, Alaska Applicant: Dan/Susan Gates Waiver Requested: Lot line waiver - 9 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 99501 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: Name of Reviewer Rec %: 24478/6550 Amount: $ 70.00 Date Paid: 2-22-93 6751W. DIHOND BLVD. ANCHORAGE, ALASKA 99502-~904 (907) 248-5095 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 I Street Anchorage.~ Alaska 99501 February 22, 1993 Sub j ect: Lot 12 Block 1 Chugach F'ark Estate Lot Line Waiver- Gentlemen; During an HAA inspection of subject property it was observed that the be.c]ir~nir~g of t. he absorption trench may be within 10 feet from the lot line. The exact loc:ation of the beginnir~g of the trench can not be physically defined, but measurements from the end of the trer"~ch locates the beginning approximately 9 feet from the lot line. The trench is 20 feet long and one foot of the tr'ench :Ls with:~n 'the 10 foot. setback. We request a lot line waiver of two feet. Yours GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Eagle River Area Date Received November 30, 1976 Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. l. Approval requested by: First National Bank of Anchorage Mailing Address: Post Office Box 720 Phone: 2. Property Owner: Timothy; Swan Phone: 745-4094 Mailing Address: Box 87 Chugiak, 99567 3. Legal Description: Lot 12 Block 1 Chugach Park Estates 4. Location: Platzek Drive e Type of facility to be inspected Single Family Well Data: A. Type C. Construction Sewage Disposal System: A. Installed 1976 No. of bedrooms 3 Individual B. Depth 350' D. Bacterial Analysis On-site system, Permit #76790 B. Installer Hamilton Excavating Size lrO00 2. Manufacturer Sunset Absorption Area 260 sq. ' 2. Material Total length of lines , Absorption area , Other contamination C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank , Absorption area , Sewer Lines C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: Mailing Address: ' ~/~'.-~' '? ~ 3. Name of Buyer: Mailing Address: 4. Name of Lending Institution: FHA Day Phone: Day Phone: CONV /~ Mailing Address: 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: ~7~ Location: Phone: Phone: 7. Type of Facility to be Inspected: No. Bdrms. o Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: ,individual Public Utility If Individual, date of installation ~ Individual (on-site) 72-003(3/76) Page 2 of two pages - Re ~t for Approval of Individual r & Water Facilities Legal Description Lot 12 Block 1 Chugach Park Estates Comments Approved~'~..~-'.~ Disapproved / / Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality Date%k~k~)~, , DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) ,,~' / I:: × I'¢, 1': i"G I ~ ~ ...... - LOT. SURV~ CERTIRCAflON: ff IS THE CONTRA~OR5 RES~NSIBI~ I HEREBY CERTI~ THAT I HAVE SURV~ED ~E TO ~EG T¢ OF FOUNDATION IN ~ER~ SHOWN AND DE~RIBED HEREON AND RE~T~N TO RNISH GRADE. LEGEND: THAT THE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPER~ LINES AND N~ LEGAL DE~RI~ION: ~ s/e ~[~*~ sET T~S SURVEY PRFPAREO BY: GERED V. RANDA~ JR. REG LAND SURVEYOR SCALE