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HomeMy WebLinkAboutHUNDRED HILLS BLK 3 LT 2Hundr d Hil'ls lock Lot 2 078- ! 8 ! -04 ""rte00 MUNICIPALITY OF ANCHORAGE oenr 's On-Site Water&Wastewater Program �o isx. PO Box 196650 4700 Elmore Road :. j ..! Anchorage,Alaska 99519-6650 Phone: (907)343-7904 Fax:(907)343-7997 httpa/www.muni.org/onsite H �`_ 1)cparttncnt 4hCHORPoo.' On-Site Wastewater Disposal System Permit Permit Number: OSP181305 Effective Date: 9/7/2018 Work Type: Septic Upgrade Expiration Date: 9/7/2019 Tax Code Number: 07818104000 Site Legal Address: HUNDRED HILLS BLK 3 LT 2 G:1160 Site Mailing Address: 950 WOLF DR, Eagle River Owner: DOTY KATHLEEN M Lot Size in Sq Ft: 101887 Design Engineer: NORTH RIM ENGINEERING Total Bedrooms: 3 This permit is for the construction of: 0 Disposal Field Il 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 Special Provisions: A test hole is required prior to construction of the drainfield to confirm minimum separations to impermeables and seasonal high groundwater, as well as the percolation rate. A 7-day groundwater reading shall be taken, but construction can proceed at your own risk prior to the 7-day monitoring. If the results require a design change, construction shall stop pending On-site review and approval of a change order. Please submit results with the inspection report. lir 717 Received By: _ ''' Date: / Issued By: i ealtitc7Z/" Date: o0l8 MUNICIPALITY OF ANCHORAGE (c.. 7-.. , v$f [ er Development Services Department '1�R Phone: 907-343-7904 On-Site Water & Wastewater Section .8 0 �43-7997 X45 ' ptpfil ON-SITE SEPTIC/WELL PERMIT APPLICATION a SEP O 3 2018 1'4 ti Parcel I.D. 078-181- O 1-1 c> a 9 ch Property owner(s) , 4 7 1 D OT/ Day phone Z2 3"" Mailing address 7,50 AJOL.P 68 v _ Site address SANt F_ Legal description (Sub'd., Block & Lot) /7/vj16/2ED /{/a S /33 e Legal description (Township, Range & Section) Lot Size /0/, 8F 7 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field l:, Initial ❑ Single Family (SF) 7t- (w/wo ADU) Septic Tank P Upgrade Holding Tank ❑ Renewal Duplex (D) 111❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. P./5 (Signa ure of property owner authorized agent) Permit/Rush Fees: 5(o Waiver Fees: Date of Payment: R wile Date of Payment: Receipt Number: Dit03b Receipt Number: Permit No. av l o 1' I;J5 Waiver No. G:1Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc \CRTF l M ENGINEERING SteveEng.com Steve Eng,PE,PH 907-694-7028 SteveEngPE@gmail.com Date: 9/4/18 Number of Pages: To: MOA On-Site Services Subject: Hundred Hills Block 3 Lot 2 Septic System Upgrade An existing septic system is failing on the subject lot.A previous soil test reveals silty sandy gravel soil and no groundwater. The design calls for a new 5'-wide trench and a new septic tank. The old trench will be connected via diverter valve. The entire subdivision is on private water wells and septic systems. The terrain slopes southwest and is flat slope at the trench site.The system size is a single family at 3 bedrooms. Please review the wastewater system design for the existing 3 bedroom home. I have included design plans& specs, design guidelines, &soil test. If there is need for additional information or clarification please give me a call. Thanks-Steve -or * k • ,jt1 2TF �IIVwaaapp, sr • ENGINEERING SteveEng.com Hundred Hills 3 botn2Wr" SPECIFICATIONS & DESIGN GUIDELINES t eopg •pFESS,r,'A+.r0' Wastewater System Sizing: This is an existing 3-bedroom, single family home. This is a developed subdivision. These lots are large and a homestead parcel lies directly west.No adverse impacts are expected from trench/tank upgrade.No conflicts to the other lots will take place by this septic system construction upgrade. A previous soil test reveals silty sandy gravel.An application rate of 0.8 GPD/FT2.Trench Length=562.5 FT2/5'x 2 =57' trench,4' effective. A new 1000 gallon septic tank will be installed; Decommission old tank per UPC.New Diverter Valve to be installed,connect to existing trench, "ON"to new trench.The water well is 93'deep,exhibiting no bedrock-a new soil test will be conducted prior to construction to verify. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications(AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • Two compartment,New 1000 gallon septic tank. Install Double Cleanouts. • Install Diverter Valve; "ON" to new trench. Decommission old tank per UPC. • 10' minimum between the tank trench. 10' to property lines, 16' between trench and existing seepage pit. • 3' of cover or insulation is required for trench; 2" Minimum thickness for insulation can substitute for l' cover. • Tank& solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required 1' to 4' from foundation wall,prior to any 90 degree bend in 4 inch line, in each tank compartment, and two adjacent opposing cleanouts between the tank and the absorption field,not more than 10' from the tank positioned to provide cleanout access towards the tank and towards the absorption field. • All cleanouts must extend to at least ground level. • In solid pipe runs,ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock from drain-rock. • Drain rock to be 'A inch to 2 inch screened. Drain rock to be distributed uniformly throughout the trench. • Perforated pipe to be installed level with perforations down. • Silt barrier(filter fabric)to be installed above the drain rock. • Smeared trench sides must be raked or scarified before drain rock placement. • The finish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron,PVC ASTM D3034,PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene(Dow Styrofoam HUequal) 4- o6M / 307. Slope / ~/I. DESIGN NOTES: 1\ 1. Total Depth of Trench is 8'. 2. Sewer Service Line minimum 2% slope. 3. Private Water Wells. 4. Decommission Old Tank Per UPC. 5. Connect Old Trench Via Diverter Valve. 6. Test Hole Prior To Construction. Lot 1 / / 30 . lope 30% Slope I / Septic AN ft. , N QA, MQ'0 00479 30% Sloee 5% Slope / / •0% Slope / Existing Trench 5%Slope New Trench ew TH Location a New 1000 G llon eptic Tank w/DCO's m Hr'' = Flat Slope o 1 I � It: o a A Fr 40Q v ' z ") Driveway nn • r0a 'HP yr V- co New Diverter Valve Lot 3 Flat Slope Decommission Old c PER SetUPC ic Tank 0 R100 100 Existing well Flat Slope Septic 0 Existing Well N t NOR THRIM ''� 1• = 60' ��.... •...� HUNDRED HILLS ENGINEERING yam?:••• SteveEng.com .*'4' '' -•.m' '•• BLOCK 3 LOT 2 DESIGN� Po Box 770724el".11.." LAYOUT EGO* Ritmo; Alaska 99577 ./5/, WASTEWATER 907.694. 7028 1 UPGRADE SEPTIC °a 9/7/18 r, 3 Foundation Cleanout 7 Tank Cleanouts Fin ade Opposing Cleanouts Between Septic Tank & Trenches go' ,., 4 Foot Cover or Equal Diverter Valve r-- I 1000 Gallon 'Anchorage Tank' Mounded Cover To Match Terrain Or Equal Monitor Tube Solid Pipe leanout DESIGN NOTES: I I 1. Depth of New Trenche is 8'. 2. Septic Tank & Solid Pipe to be Placed on Compacted, 1111111 L.' Stable Soil, Free from Boulders. Filter Fabric 3. Sewer Service Line is Minimum 2% Slope & 3' Cover. _;1 :" 4. Water-Tight Couplings. :. i:%%%%i 5. See Specification Sheet. '=: _='='=.=-=' 6. All Work To Conform to Municipality of Anchorage (AMC) '•. ''IP� ��!- Requirements & Specifications. 4 _•:; ::!:::::!: 7. Maintain 3' Cover Over Trench Or Insulate. '' ei''`'='`: Drain Rock !-: !=!=!=!= =.=_ :: z. 8. Public Water System. . .:.:.:.:.:. 9. Install Diverter Valve To Old Trench & New Trench. .1 ; : :e:.: 10. Match Line Elevation To Existing Line. '`I ''11"4 "r09191k' 5' %N OR THRI M .-.c.- ' e :49it .'� TRENCH END VIEW HUNDRED HILLS ENGINEERING i :49m SteveEng. com � %S SEPTIC TANK PROFILE BLOCK 3 LOT 2 PO Box 770724 ."".' (.' t . SEPTIC SYSTEM Eogle River. Alaska 99577444'4'.,e4,1J' 907.694.7028 UPGRADE °°t*9/4/18 'DrownsE r°" 1• = 5 l SHEET of 3 SE MUNICIPALITY OF ANCHORAGE Dr~'-%RTMENT OF HEALTH AND HUMAN SEF:-'~!ES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT U a m ~,//~/',¢/~:' ..S' /"~-'/f./-.<7//~L_C~ DISTANCES ABSORPTION ^dd .... TANK FIELD LEGAL DESCRIP,ION LOT LINE Township, Range, Section /2~, /~/ /~ drIveWay`AS~LT`jA~RAM(Sh~ati~n~f~eH~septi~sy~t`m~r~pertyh~es~f~undah~water bod,es, etc.) TANKS ~ SEPTIC ~ HOLDING ~TRENCH ~ BED ~ W. DRAIN ~THER Total depth fro rigina[ 9raOe Depth to pipe bottom from:Hi added above origma[ grade ' J ~ or,ginal grade FT } FT FT / _ · otal absorption ~rea Distance between lines ber~ SOFT FT, Num oil rahng ~lpe material SQFT  Date Installed WELLS ~ PRIVATE, ,V OTHER{~ Classilicahon (A,B,C) ~ ~~ Cased to [1 [1 ~J"l/~ municipamnd State guidelines in ~ll~t'~n this date: Health Depadment Approval: Date: , .SCALE MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION -,,-"~ 1 ~, 1988 RECEIVED  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPgSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME [] UPGRADE MAILING ADDRES'~ DISTANCE TO: Well Absorption area~ Dwelling ' PERMIT NO. ~ Manufacturer Mator~ ~ ~ ~o.o~compartments Liq. capacity [n~l~s // inside length Width ' Liquid depth f ~ IF HOMEMADE: ~ ~ DISTANCE TO: Well . Dwelling PERMIT NO. O Z ~ Manufacturer Material ' Liquid capacity in gallons ~ Well Foundation~ ~ Nearest lot bn~ f PERMIT ~ ~ DISTANCE TO: /OdI . ~ N~;~IO~) ~Z ,o. of lines Length of each ,in~,,, Total length of li~s, Trench width Distance between ~ ~ ~ Top of tile to finish grade I Material beneath t, le Total effective absorption area ~ q 1~ inches Length Width Depth PERMIT NO. ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area m Well Building foundation Nearest lot line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. m Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER ., ~ / SOIL TEST RATING q$ ~ REMARKS v PERMIT NO. [:,EF'~RTMENT C',~HERLTH FIND EN ~ I R_ NMEN1 H.. F~DI'ECT I ON 264.-4720 PFLI _,PNT LOCFtT I ON L. EGRL CL. IFF JOHNSON MI L.E O r " 11. JLF HR t L ;2 B ,7~ HUN[:'RED HILLS L~t~e, E. R. E,U,,., '" .... "- LCIT =, I,~E 694-'B. 709 ±00~EEi SQURRE FEEl' TYF'E OF =,LIL ~E,=,UF. FI lLN .zT=IEM I=,. TREN_.H MR::.::IMI_IM NLMBER OF E:EE:,ROOMS := L IL RRTING (S9. FT,'"BR)= :.'L._~. THE F.:E3]i..IRED SIZE OF ]"HE =,OIL RBSORPTION =3r.=,TEM IS: [:" E--- F~ T ~-~ := c. - - ' ....... -__ -__- LEE ~'-~ ~ '¥ kt ==-. 4- 7~' ,.i~ F..: R %." E L_ It., E F T tq .--- F~ THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRRINFIELD. THE DEPTH OF 8 TRENCH OR PIT IS THE DISTFtNCF BETWEEN THE SURFBCE OF 'THE GROUND FtND THE BOTTOM OF THE EXCFtVRTION (IN FEET). THERE lis NO SET WIDTH FOR TRENCHES. THE GRRVEL DEPTH IS THE MINIMUM DEPTH OF GRBVEL BETWEEN '[HE OUTF~L[. PIPE RND THE BOTTOM OF THE E','-~:CFtVRTION (IN FEET). PERMIT' BPPLIC~NT H~S THE RESPONSIBILITY TO INFORM THIS DEPBRTMENT DURING THE INSTRLLBTION INSPECTIONS OF ~NY WELLS] ~DJ~CENT TO THIS PROPERTY 8ND THE NUMBER OF RESIDENCES THRT THE WELL WILL SERVE. '-r I.....~ C, .:' ---" ':. I I' 4 _. F E --- T I ,3 1'-41 ._. R F.:: E E~CKFILLING OF ~NY _~=TEM WITHOUT FINAL IN=,FEL. TIJN ~ND ~PF'ROVRL BY THIS [:,EF'~RTMENI' WILL BE ..,UBJEbT TO F'Rn'~EF: TION. MINIMUM DISTRNCE BETWEEN R WELL RND RNY ON-SITE SEWRGE DISPOSRL SYSTEM IS i00 FEET FOR R PRIVRTE WELL OR t50 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTRNCE FROM R PRIVRTE WELL TO R PRIVRTE SEWER LINE IS 25 FEET RND TO R COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MRY RPPL. Y. SPECIFICRTIONS RND CONSTRUCTION DIRGRRMS RRE RVRILRBLE TO INSURE PROPER INSTRLLRTION. F'EZF.'h] I l' E.---.F Z RES E.. EL.E~qBF£F.: gl ..... I _.EF: T I FY THFtT t: I RM FRMILIRR WITH THE REQUIREMENTS FUR UN.-.~ITE =,EWEF._, FtN[:, LIELI__, H .... ET HNCH_ ".. ~-' . FZRTH BY THE MLINICIPRLITY OF - · OF. HL~E 2' I WILl_. INSTRLL THE ='rz, TEM IN HCL. OF..[:'~qN_.E 14ITH THE CODES ]:: I UNDERSTRN[;~THRT THE ON-SITE SEWER SYSTEM MRY REQ_IIRE ENLRRGEMENT IF' THE ..=;i:ESI[:'EN'~~' ~'E~E~ZLI[:'EIGNED: _.~.~~" ___/---- MORE THRN 3. E;E[:,F.:OOM.:";. ,._=::==:, .............. ..... ,,.,.-,. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~ ' ~25 L. Street, Anchorage, Alaska 99501 254-4720 SOILS LOG- PERCOLATION TEST [] SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 2 ~ 3 6 7 ~ 8 9 ,~z//?/ SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19 2O COMMENTS PERFORMED BY: WAS GROUND WATER ENCOUNTERED? DEPTH? Robert A. No. 1457-[ ~& S._iEng/,neering Gross Net Depth to Net Reading Date Time Time Water Drop ~ ~ ~ ¢3' ~, ,r I~ / PERCOLATION RATE '~' ~/1 (minutes/inch) TEST RUN BETWEEN Y / ~ ! FT AND -- FT MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW920114 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:KENSHALO JAMES L & OWNER ADDRESS:HC 85 BOX 9290 EAGLERIVER, AK 99577 PAGE 1 OF 1 DATE ISSUED: 5/29/92 EXPIRATION DATE: 5/29/93 PARCEL ID:07818104 LEGAL DESCRIPTION: HUNDRED HILLS BLK 3 LT T13N, R1W, SEC 10, SM LOT SIZE: 104887 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (iSAAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: OWNER OF LAND ADDRESS LEGAL DESCRIPTION DATE - Started PERMIT NUMBER · erlifiei Drilling by DOC Co. ~lba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 * TELEPHONE 688.2759 I /I DEl'TH OF WELL 72 ~I~ TC ST.ATIC LEVEL OF WATER FT. ~,~" /~/~' ~ ~'~ ~"'~ H/~' DRAW DOWN FT. Ended ~//? e) ' GALS. PEg HR /c~ ~ ~ / ,N O CAS,NG KIND OF FORMATION: From _/~ Ft. to From ~ Ft. to From__Ft. to From~.~ Ft. to From _~' ~'~ Ft..to From__ Ft. to Ft. From___Ft. to Ft. From Ft. to Ft From Ft. to Ft, From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From ' Ft. to Ft. From__.Ft. to Ft. From Ft. to Ft. From '~ Ft. to Ft. Ft. C ~d", ~I C~ ~"7'/c:../¢ JtO From Ft. ~,~/& ~" '~ ~.C,~-.~O~ ~_ From Ft. , CO~<~ From Ft. ~ ~J~C ~ From _ From From From From From From From From From From From From Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft, Ft. lo Ft Ft. to Ft. __.Ft. to Ft, Ft. to Ft.. Ft. to. Ft. Ft. to Ft.~ Ft. to. Ft. Ft. to Ft. MISCL. INFORMATION: % DRILLER'S NAME AS-BUILT I hereby certify that I have lurveyed the followh~ Anchorage 2eeordmg Precinct, ~ and that the improvements situated thereon are within I er~ ~.ymg a~]a~en~ mere~o e~r~lcn o~1 ;ne · "'.-l:'~~'a~ F,,,,a, m''~,,;~..,~a - :" * ' . t:,:'[E Fi:H t 'T' F:JF:'F'L,.. I E:FIFt"f' I. ' T RTI Z N L,. E GI:::II .... L)EI='FIRTHEIqT HEFILTH FII",I[> EN"," I ROI'-,IHE:.'I'.,ITF:IL. 7:(YT'E::CT' I ON L::'~.'.:".:;:l.6; E. 'TL.i[:,O[;.". R~[:,.., FINCHOF~'.F:t(:~iE".., FII-:::. 2::76-222:1. IL.-It EFZ: b.. Il .... F" IE~£: F:.' It'-lt ][ ,:: 76511:2 > Wi3L.F NFl'./ I...;;2: E:Z-: HI. JNDRED H]:LL.. :E;UB J.,OL:.i.'l:.'::lC10 '.E; '.:., I. II=tR:I::':' I=EET i','ltlqlPIL.IH [:,ISTFIi'.4C':E BETNEEN FI NELL... FIND F:IN"r' IDN-Sz;I'T'E :E;EF.IFIGE [.':,I'.:SF'O:51:'"tL. ::LEIFJ FEET FOR FI F"F:'.].'VFITE NELL. OR 288 FEET FOR R F'IJBL]:C !.,JEL. L.. NEL. L.. LOC~:5 FIRE REQUIi:;-'.ED FIND HLIST BE F.:ET'UF::i'.41ED TO THE [:,E:PI=IIT"H'"IENT NITHIN ::~:~3 OF' '1"FIE NEL. L COP1PLETION. SPEC I F :I: CFIT ION.':.:.; FIN[:, CONSTRUCTI ON D I FIGF..'~HS FIRE: FIVFI :[ LFIBL..E TO :1: NSUF:'.E:' PROPER I t'-,IST FIL..LFtT 101",I. F" E: IF~:: tt'""'~ :E T' "..." Fit IL_ % [::, F" ~::~ F:'.: C::~ ~'"-,,~ [.:E ".~" E IF.~ E~." F" ~-:: ~:::) If'"'~ ][ .CC'; ~:2: Lit E: I ~.EF 1 IF ~ THF:t'T' kEf lEi'41:, FOF.'. C~I'.,t-'_'-SITE :,E[IE.F.'.=, FII'.,I[:, NEL_L2:5 FIE; L::.r, ET :1.: i F:IH r=FfPIII..IIZlR l.,.lI"r'H THE F,:'.El'..:!t..II '" ........... -'~ ' '"" F:OF.:TH E."r' 'f'HE' J ltjl,l[ ..] FI" LZ I ~ CIF' FINCHOF:::FICiE. ;2: I NILL IF,I':.ZFFILL.. THE S"r'STEH IN FtCCOF::[:,FINCE I.,.I]:TH THE CF'I[:,E'_:. :5; I C:'iI",IE I]:,: ...~....'_7 ....... ~.~:'r-¢.¢-.~'.-~----''--=--~-. ...................... FIF'F'L. :t: [::FtI~', T'/\ C1 I ~.TOHNSON s:.'.:;UEi:::, ..................... r:: FITE ......... ..,--. WATER WELL LOG WELL LOCATION DEPT, OF IfE/,.LTH Ei ENVIRONMENTAL PRO [ECTION FOSS DRILLING 1336 Ingra Street Anchorage, Alaska 99501 Oo~n~o~ USE or WELL SEP $ 1976 RECEIVED SIZE OF CA~ING &' DEPTH OF HOLE~Z~T. ¢A8~ TO, y~ STATIC WATER L~VE". ~ ~ ~. rIE~ I D GAL.~'ER.MZN. WZTa FEET Or DRAWDOWN. REMA[UfS DATE COMPLETED,, PUMP TO BE SET AT to ........ to ___to ..... to to to __to , to ,, , ,,,,tO , ,, to__ tO , tO__ tO__ to to to Municipality of AnChorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING o',7~ _ lg~ - OH Parcel I.D. ,-,.~ v -'70/ ,n2. 1. GENERAL INFORMATION COSA # ~ C / ¢ t/b~'~/~" Expiration Date: Complete legal description.. ~o. ~ ~ ) Location (site address) Current Property owner(s), Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: ',-~ TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: '~, Individual On-site [] Individual Holding Tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Cedificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Phone Address Engineer's Printed Name DSD SIGNATURE \,/ Approved for Disapproved, bedrooms. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nifr ../;/' i~ - ') ,,"' ate X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: (Rev. 11/'05) Municipality of Anchorage Develo,pment Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Well type ~.,,tcn-~ Date completed ~_~- Total depth. C~ fi; IfA, B, or C provide PWSID Sanitary seal '(Y/N) __.~$ Cased to FROM. WELL LOG Date of test ~//~ Static water level ft. Well production ~, cl g.p.m. WATER SAMPLE RESULTS: Coliform /IV/~ colonies/100 mL Nitrate ~,5/'/'~ mglL 'Arsenic: .~ L~ ug/L date of sample: L~5"~/3.o/O B. SEPTIC/HOLDING TANK DATA Parcel ID: O ,,C'0 --'7o/--0 Well Log (Y/N) Wires properly protected (wN) casing height (above ground) AT INSPECTION ft. g.p.m. in.+ Other bacteria/t/¢'O 'coloniesll00 mL Collected by: '/' ¥/-- ~'~ Tank s~ze~~ ~gal. Number of Compartments ;~ Cleanouts (Y/N) Founda..t~o~'~ear~.(Y/~)~,~,~. h.. D6pression over tank (Y/N) ~ High water alarm (Y/N) A/O 'Date ofpmmg.... :~,(~7~a_~..?,O...,''Pumper '~ ~..,'5 C. ABsoR~y~FIELD D~A. " , .~;~ ~ } , ':.. ken,th ~ ..... '"'~f '~ Width gt ft. lotal depth ~ t ~. tiff. ~b,orption ama ~ ft~ Monitorin~ tube Date of adequacy test ~/~o Results(Pass/Fail) I Fluid depth in absorption field before to~t in. Wator edded Elapsed lime: t~ min. Final fluid depth ~" in. Absorption rate ~ny miuvenation treatment (past ~2 mo.) (y/~ & type) System type ~.O "T~ tl, c ~ Gravel below pipe. ft. Depression over field Afl O For ~ bedrooms New depth ~/ in. /'~0 ~ g.p.d. /t~J/~3f- yes, give .. If date D. UFT STAT O. Date installed Size in gallons "Pump on" level at ~_~,~1:~~ ~ Cycles tested E. SEPARATION DISTANCES High water alarm level at Meets alarm & circuit requirements? in. SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot i O(~ ~ "~ Absorption field on lot Public sewer main ~I/~ Sewer/septic service line/ ~).~. Animal containment areas '~"0 On adjacent lots { O 0 -~- On adjacent lots Public sewer manhole/cleanout Holding tank V4J/J3-- Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation ~-- I.{. Water main { · Wells on adjacent lots Property line!'~:~ It Water service line Absorption field Surface water SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line I0/4- Water Service line ( (~ Curtain drain V~t~, Building foundation Surface water I Wells on adjacent lots Water main (0 ~ -~ Driveway, parking/vehicle storage F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I 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. Enginee¢s Printed Name Date J 0 /,3- 7. ~ / O COSAFee $ ~0 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS Ref.# 1105754001 Client Name S & S Engineering Printed Date/Time 10/29/2010 8:13 Project Name/# L2,B3 Hundred Hills Collected Date/Time 10/25/2010 9:50 Client Sample ID L2,B3 Hundred Hills Received Date/Time 10/25/2010 15:25 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements. Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 10/26/10 10/28/10 KDC Waters Department Total Nitrate/Nitrite-N 0.549 0.100 mg/L SM20 4500NO3-F B (<10) 10/25/10 AYC Microbiology Laboratory E. Coli Negative 1 100mL SM20 9223B A 10/25/10 DLC Total Coliform Negative I 100mL SM20 9223B A 10/25/10 DLC p.1 ~chorage ~cor~ Prec~ct, ~a~ and ~provemen~s situated ih~on ~e ~h~ ~]e ~ope~y lin~ ~d do not over]ap or en~oa~ on tke prop~ty lying adjacent thereto, that no improvements on prop- e~y ly~ adjacent the~to en~oa~ on the prem~ quesi~n and that ~ere ~e no roadways, ~ran~ission Dated at ~g]e ~ver. SCAT.M: ~e~D~ L~n~ S~veyor Phone fl94-2543 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING --/ol- C) Z. HAA# 1. GENERAL INFORMATION Complete legal description L~ ~2. j~ ~,- '~ Location (site address or directions) Property owner Mailing address Lending agency Mailing address Day phone Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well NOTE: Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer 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 [ ~- ~/~,-E~,-/ ~'~ u ~" ~'~¢..¢~ ~-'- Address ~ ~ ~ ~ Engineer's signature ~~~ Phone Date '7'//~/~ ~ DHHS SIGNATURE ._~ Approved for Disapproved. bedrooms. ~_' ./~.~.~/,,.¢.~ional approval for . bedrooms, with the following stipulations: Additional Comments By:~~ ~ Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~025 (Rev, 1/91) Back MOA ~21 6751W. DIMSNB BLVD. ANCHSRAGE: ALASKA (907) 248-50e5 Municipal it.y of Anchorage D:Lv:i sion o..F Env:i. rc;nmental Health l}epar'~:.ment o'F l...leal'~.ih and Social Servic:es 820 I Stree'l:: hn(:::hc~rage, A1 aska 995():1. J ~ ~ [ v 6 ,~ 19 9 2 Lot ") Bl. ock 3 HLu'~dred Hills A c:ond:i, t:i.c:~nat HAA w~as :i. ssued -For th:i.s ].ot w:L th the (:::ond:Lt:i. on that a 't:.he (.~x :i. st:i. ng we]. ]. be rep:!, aced ,, A new we]. ]. has been ir'~s't::al :Led,, Bo'l:h~,...-]"r.:.. 1 .I.' =.'" ar e operat. :i. or) al and p ]. umbed :i. r]'~::o pl"'6H~L~r(.:.))t [~d'] k. Enclosed are ~,~ell ].og .For new well and test result, s from water sample. F':i.r'st sample came t..~c..'.: w:L'l':h OB TM"I"C, Well was sterilized RECEIVED JUL 6 19' 2 Munici;~ality of Anchora e DepL ~le~lth & Human Ser~/~¢es CHEMICAL & GEOLOGICAL 4BORATORY A~DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. TELEPHONE (907) 562-2343 ' 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER NaPRIVATEWATER SYSTEM  Phone No. Mairing Address City i State Zip Code Mo. Day Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. [] Special Purpose SAMPLE No. LOCATION 51 [] Treated Water .,,Untreated Water Time Collected Collected By TO BE COMPLETED BY LABORATORY Analysis, shows this Water SAMPLE to be: r-I Uns~ ,tisfactory [] San~ ~le too long in transit; sample should nott e over 30 hours old at examination to in Jicate reliable results. Please send ne~ sample via special delivery mail. Analytical Method: Membrane Filter * No. of colonies/100 mi. Lab Ref. No. 2063t7 Result* A .1~ .E .C- -~/~h~'' ~ BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count ~ Coliform/100 mi Verification: LSB BGB BEFORE COLLECTING SAMPLE TNTC = TOO Numerous To Count OB = Other Bacteria Fecal Coliform Confirmation Final Membrane Fl~.R.~ults /~,,~ ~ Reported By ~ ~. ~ _ ~ Date Time: Coliform/100 mi CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE [907) 562-2343 FAX: (907) 561-5301 ,~,NALYSIS RESULTS £o~ INVOICE ~ 55119 Chemlab ~e£.~ 92,2976 Semple ~ .t ~at~x: WATE~ Client Sample ID PWMID ColL~cte~ ~e~a~¥e~ with 3UX 22 92 ~ 13:00 JUN 22 92 ~ 15:30 Client Nm~ ;TOBBEN SPURKLAND, P.E. Clien~ Acc~ BPO~ : PO~ :NONE RECEIVED Req~ : ~desed By :~OBBE~ SPURKLAND, P.E. knaly~is Completed : 3U~t 2& 92 ! Send ~epoz~s to: 1])TOE~EN S?URKLAND, Sampi~ ~OUTIN~ SAMPLE COLLECTED BY: 1 Tests ?e:fo~med ~ee Special Instxuct~ons ~ov¢ U~Unava~labi~ HD- None Detectsd See Sample Roma:ks ~bove N~- Not Mmlyzed LI=Less Than, GT~G~eate~ Than ~-~~-~r~-~ M~mh~r nf thR S(~S Group (Soci~t6 G6n6rale de Surveillance) Parcel I.D. # 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 HAA # GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address "~,~,,~u.~ ~__.~w~z~ Day phone He-- W2-' o Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site Holding tank Community on-site Public sewer 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 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 Address ~ ~ ~ 1~ ~ Engineer's signature ~~ Date / 6. DHHS SIGNATURE Approved for bedrooms, Disapproved. Conditional approval for ,~ bedrooms, with the following stipulations: Additional Comments Date 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 Municipal!ty of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA ~21  Municipali;~y of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /"'%.E, ~.~4d.(v'~(~ ~,'11~ Parcel I.D, ~ 50 ~ A. WELL DATA Well type 1~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. Date cor~oleted -- t l'/~'?Casedto ~ ~' / Date of test Static water level Well flow Pump level '7 ~'- FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ADEC water system number Driller Casing height Wires properly protected (Y/N) AT INSPECTION '- '70 ; On adjacent lots ; On adjacent lots g.p.m. Absorption field on lot Public sewer main Sewer service line N 0 Public seWer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ Date of sample: ~/.~"~ Nitrate Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) ~ High water alarm (Y/N) Tank size Date of pumping Foundation cleanout (Y/N) 7 t,///~,. Alarm tested (Y/N) ~lZ-l~ 7.- Pumper ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line Surface water/drainage On adjacent lots Absorption field Compartments DepreSsion (Y/N) Foundation 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) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Man ufactu rer 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 ~/~ / ~1 Length. /~ ~ Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Soil rating ] '~ ~, System type 'T Gravel thickness ~ Total depth Cleanouts present (Y/N) Date of adequacy test 3,/~.~/,~ for ~ bedrooms If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots ~,~'C~ Surface water Curtain drain On adjacent lots ~:~,~ Property line To existing or abandoned system on lot Cutbank ~'~ Water main/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Engineer's Nam(~ Date L~I l~, ~---' HAA Fee $ Date of Paymsnt ~'~ Receipt Number ,~' ~ ~'~/ ~"//7/'Z~,/~ Waiver Fee: $ Date of Payment Receipt Number 203 WEST 1SYN. AVENUE SUITE 20~ ANCHORAGE, ALASKA 99502-5904 (907) 279-~916 SEPTIC SYSTEM ADEQUACY TEST LEGAL: LOCATION: OWNER: RESIDENCE: WELL: Lot. 2~ Blc)c:k 3 Hur~dr'ed F.lills S/D M.i. 1 (:z.~ ~i~..]i!; Hi gh]. and Re)ad Ja/i)e~ Kenshal e Single Fami].y~ 3 F:'r:Lvate,~ On Site SEPTIC SYSTEM: FROM MLJNI[)IPAL.. RECORDS: 3 Bedroom System TANK: Anchc)rage T'ank 1000 Ga].. 'l"~c) Cc)mpart. s. ABSORPTION SYSTEEM: Trench ABSORF:"TiON AREA: 480 Sq. Ft. SI) I I.... RAT I NG: INSTALLATION DATE: June :::.~;~ 198:L DATE OF LAST PUMPING: Apr:L1 2.~ 1992 JR's F:'ump:i.r'ig DATE OF TEST: March 23~ 1992 TEST PROCEDURE: System was inspected and measured. Tank was .Feund with 2.5 ~(:eet o~: cover and with a liquid level c~: 51 inch ..... es. No tr'ench clean out was -~oun(::l. Trench sump was 7.5 deep with 56 inches e.F wat. er. 5()0 gallons o-F clean water' was added to t. he trench wh:i. le the water ].evels in t. he tank and the sump were monitored. The water level in ~ihe tank d:i.d not (:::hange~ while 'Lihe ].evel in the sump rose 11 inc:hes. The next day the water ].evel in the sump was c:he~=kect. TI'"JE~ ~atE.:,r' ]. E,V~:~]. had dr'c)pped tc) 57 ~ i nd:i. c:at= i r'u;t that: mere than 45() gallons e.F water' had been absc~r'bed. TEST RESULT: Th:i.s system meets 'the code requ:i, rements (::H: the Heal th and Sec:i. al Servi c:es Department o-f the Mun:i.(:::Lpality o.F Anc:herage. NOTE The operational li.Fe o,x.. all sept:i.c systems depends on the Iocal s(::~:L I cond i t :[ (Ins v grour'~d~gater ]. evel s that may ~ 1 uctuate dur'ing the year',~ and '~:he wat:er' usage c:)~ the ~:amily being ser'ved by the system. These (::(::~nd:Ltic)ns are outside the c(:)ntrc~l cH: the evaluator o~ this sept.:Lc sysi=em,, We can there,:ere not g:i.w~) any estimate o~: hew l(~ng 't:his system wi].]. .func:tien sat:is~:a(::tory .For c:L.(rrE, ri'J= or' ~LttLll'"e 203 WEST 15TH. AVENUE SUITE 206 ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 RESIDENTIAL WELL INSPECTION LEGAL: Lcd: 2, Block 3 Hundred Hills S/D LOCAT I ON: Mi 1 e 8.3 ,~ Hi (~]l'"~ 1 and Dr ~m Ye OWNER : James Konshalo TYPE OF WELL: F'ri~/~,:~'t.{:~,9 S:i. ngle Fl~;~l~i],y WELL LOG AVAILABLE: Yes INSTALLATION REQUIREMENTS MET:Yes WELL YIELD FROM WELL LOG: :i.O GF'M with 5 ~: m~ ri drawclown WELL YIELD FROM TEST: 260 galloF'~S per day DATE OF INSPECTION: Marc:h .7.':3,~ 1992 TEST PROCEDURE: Well was [)umped dry and the fate of recovery was measured with an acoustic l:.)robe .For 5 hour'..~,. 'T'he well recov- ery rate was ~ounc',l between .17 gallc:)ns per minut, e anct .198 gall. .... ].c)ns ,oer minute. TEST FOR E.COLI AND TOTAL NITROGEN: Water was -I':.es'ted ~:cq'" E.Col:i. and total nitrogen on March 26~ 1992. E.Coli 0,, 't"otal Nitrogen ND (None Detected),, Max,, allowable Total Nitrogen 10 mg/1. TEST RESULTS: Th:ks well does not meet the re:qu:i, remer"~ts c,f the Munic:ipal:i. ty o'f Ar'~c:horage. The Mun:i.c:ipal reqLl:i.r"ement -For we].], flow is 150 gallons (::)~ water per bedrc)om per day. This we].l pfc)duces less than 300 gal].c)ns per day. 'T'c:) meet Municipal reclu:i, rement the well must be deepened or another we].l dr:i. lled. Storage tanks ~vil]. not serve as reservc~:i, rs bec:ause the well itsel~ c:an not. produce eric)ugh water. The Munic-' ipality will issue an conditional approval i'F t:unds be escrowed for a well upgrade when weather allows. ,' DATE RECEIVED ~ INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE NTAL PROTECT,'-' DF_PT OF HEALTH &  DEPARTMENT OF HEALTH & ENVIRONME ~Ij~RON~E 825 L Street - Anchorage, Alaska 99501 NI'AL PP,©TECTION ENVIRONMENTAL SANITATION DIVISION ,~U ~'i 1 1981 Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEV~I~ ~"A~L~r~E~) DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER I PHONE Clifford F. JohnsonI 694-9709 MAILING ADDRESS Star Route Box 9126 99577 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE James Kenshalo MAILING ADDRESS 3. LENDING INSTITUTION I PHONE National Bank of Anchorage % Ruth La BarrI 265-2883 MAILING ADDRESS Pouch 7-025 99510 4. REALTOR/AGENT I PHONE I MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 2 Block 3 Hundred Hills Subdivision STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One [] Four [] Other~ [] SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY *ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY YEAR ON-SITE SYSTEM WAS INSTALLED. Upgrade Permit ~810434 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTI LITY Connection Verified INSTALLER []Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANuFAcTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank IAbsorption Area [Sewe[ Line [ Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [~//APPROVED FOR .5 BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY ' / ~ '~" .... :' , MUNICIPALITY OF ANCHORAG ~ . /~ /; Department of Health and Environmental Protection '//~~[/ 825 m Street, Anchorage, Alaska 99501 ~~/// 264-4720 "' ~~uest for Approval of individual Sewer a~d Water Facilities 1. Property Owner: ~~ ~ ~Lg~~ Mailing Address: ~ ~ ~/~ ~ ~~ Phone: Mailing Address Mailing Address: Lending Institution: 4. Realtor/Agent: Mailing Address: Phone: ~/~ Phone: Phone: o o Legal Description: Z~J~ ~U~cJ Z////-~ Street Location: ~ L~/~/ ~ ~. Single Family Residence: (~/Number of Bedrooms: _~, . Multiple Family Residence: ( ) Number of Bedrooms: Water Supply: * Individual Well (~'/ Public/Co~nunity System If Individual Well, well depth _/ ~ O If Community System, name of system Sewage Disposal System: *~n-site System (/Public System If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each request before processing can be initiated. 3/77 RECEIVED OF AD DR~SS i~ FOR ~ H OW~PAID