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HomeMy WebLinkAboutSKY RANCH ESTATES #1 BLK 4 LT 2Sky Ranch Estates #1 Block Lot 2 #015-301-10 Municipality of Anchorage I Development Services Department: - Building Safety Division - On -Site Water and Wastewater Program, 4700 Elmore St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci anchorage.ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: S W 0901-4g PID Number: 015-301-10 "°'Ti'n Anc ,en son Wastewater System: ❑ New KUpgrade Aoarass 4D1 5. Silvct Lan ABSORPTION FIELD PNone Nun,oar of Bedrooms ADasp TraneA O Snellow Trento E3 Bad t] Mound D Oaw LEGAL DESCRIPTION Sod Rating I.0 TOW D"M eon, ongnal 91,48 IR Gpome Ft. BIOQ Lot ^/ ' I o S1uDtliMCaon.1 1 u Sid ReAn ' I Dapa, to ppe Whom eon ongiinn�a grade Gravel Gsph Ear aaN ppe IO 1 P F� GSkle, OL FI. FI TownWp Rarpe S"on FA a,4,4 above ong1nal graoe 5 — I O Gravel LmVlh 3o O. Ft. P,, Well: p 1 [:]New El Upgrade Gravel vndlh. al NumDar of Inas I DiNance Pelween IMa G 1511n FI. Fl Cbs.fiuln t (Pnvate. A, C): TotaDaptn Cased to TOM aoaorpbon wea 1000 Papa L[Ltonai /, p1, A0 FV(_ Ft. Ft Flt JCI, DNIar Date Need Staw Water Level InaWMr• A+ "ortiF, Seru�CXo Dab Initial" y/22 O FL Ybld Pump set M Caang Napnl Aoova Cranio TANK GPM il. FL SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P.(Other, To From Septic Tank Absorption Field Lift Station Holding Tank ubiriprivate Sewer Line Clio C d-10- Gel I(ooD wed 1 -75+ , -75+ 1 354 /V q 1 25 + Mslenel F P_ GLSS, NunDar of Compann,ents 4 Surface water 1001+ ICo+ 10p /VIA LIFT STATION Lot LSM 5+ r/�� - 1 1_5 t : 51 4- /� AiA ie 16CD Gal nuaaa�war /1 USO l.. CI Q. Foundebon 1 5+ 1 1 S /V/A 'Pump on. Nuel at a5 'Pump OR level at 1 49 /z N.gn weler warm at zz Ij r M M. Cunrn Drrn A(A A(JA NIA N/A Pump Mate a MUPN M&Y0' a Elanral abyewons Parlumad by MkAn; Remarks -� �" I �Xdy 11n lank r4tlGn[lon EQ- i10 Cd1 BENCH MARK ixi Jin Or4in F 0 IES Louton and a.arpaon. ,1 A / E5,60"N Sic )r� 11. SE ASd R mIr ta� A RWI bvakon 1 1 1 In Div T ' ra1J 105TAIlec7 In ( k/ n 100 FL �1 Inspections performed by: LAQS J r y n Dates: 1M ZZ Engineer Stamp = n4 2z o °— Q, vn- I Al Development Services Department Approval % S 49THY' Conditional Approval Date: '/'... . CSR . ... / fr.;%..LARSJE. ..... I �CA C�i rII..�o�}oy Reviewed and approved by: Date: 3 �' v 119 / OFE S0�A� (Rev owd) Environmental Consulting and Design 77 SEPTIC SYSTEM DESIGN SKY RANCH ESTATES #1 BLOCK 4 LOT 2 Municipality of Anchorage October 8, 2009 Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 Subject: Septic System Installation 5441 Whispering Spruce Drive Ladies and Gentlemen: The septic system upgrade at Sky Ranch Estates #1 Block 4 Lot 2 was completed on September 22nd, 2009. Due to the proximity of the well, the new absorption field is located 16 feet from the existing absorption field. The effective depth of the new absorption field is 10 feet. Waiving the required 20 foot separation distance will not adversely impact either system. Mitigating Factors The percolation rate of the soil was observed at 60 minutes/inch. This rate should inhibit lateral movement of the septic system effluent. A BioCycle Treatment Tank has been installed. A line waiver is also required. The existing absorption trench is 1.5 feet from the property line along Whispering Spruce Drive. The system has operated in this condition for over 20 year with no negative consequences. This location will not impact neighboring septic systems. If you have any questions or concerns, please contact me at 279-3916. Sincerely, Lars Spurk and, P.E. Civil Engineer 203 Nest 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurklandoagci.net T.N. 5 t21Y.= 8; I STANDARD TRENCH Nn EUI1:= 97.7' ANx stme ro4v R R14x' AVAY Of?! W N AU AXTTAW L I =i 4' PVC AIMW 0 PPRXWY OWSEP 0 CLAP1FER h essa a C/NYxR IT TANG xu3wl Rm"TDN �= INSTALLATION L EXCAVATE A 10' x 10' x 10' DEEP NZE FDR B10CYCLE SYSTEM 2. MACE A KININ.N CL' 4' SAND LOP GRAVEL FLR LEVELAS CARSE IN TIC BDTTaY Dr TIE EXCAVATIM COWACT AS RMHRED _ sr TO PROTECT DOTTTaV LE fIBLRGLASSITAAIK. TAKE EXTRA CAREATEN To ASSLRE THAT 1NKLLATILN CTARSE ISOV TDP IF COWACTED LEMING LEVEL IN ALL DIRECTION.Y. t. A4I� AL ARaW FR L� SLoNORT it 4' MI LENT AND 1-1/4' EFFLLENT LASS VITH FREE-FLLNING NSF SANDAGPAVEL BACKFILL 1LNITLR TUBE O -1/I' SCICBaE 40 PVC V/ L0' )AZES P 30' O i % ..... \tilt i P( ..... ♦�j1 "IF Aw SEVER ROCK .... '� 49th• ........... ...........� • ; � ..... 0 .... ....... .. .... .. . to t LA S SPURKLAND BENCH MARK 80ROM SONG 0 'A' ON SOE PIAN ASBUOL ASSUMED WAY70N 100' KLAND ENGINEERING SKY RANCH ESTATES 11 BLK 4 LT 2 SEPTIC SYSTEM ASBUILT W 15TH. AVENUE TINA DOWD-AND RSON DATE: OCT. 7, 1009 I. AK. 99501 5441 WHSPERING SPRUCE DRIVESHEET. 1/3 GRID: 2737 279-3916 11T # SVO90178 PID # 015-301-10 SkyRanchCstatestlBIL?D3dwq S� LOT 1 I LOT 2 / / LOT 3 P ANK Q DEEP TRENCH fNCH WIGHT 30 IEET OTAL DEPTH 12 FEET DTH 2 FEET K DEPTH 10 FEET SNSUU AON 2 INCHES VER / 2 fFET A BANDONED EXISTING ANK PER MOA CODE CONNECTED EXIS17NO DRAIN FIELD m / TO stoCYCLE WITH BUTEMY VALVE n. Rj5.0 / SWING TIES F, A B C 23.4 12.1 T sl E D 42.1 23.1 rn o �i CE pR��E G SPRU \ / WN�SPER1 Norc THIS IS Nor A SURR71D PLAT. WQL a SEPIK �.....; P-g LoCAwNs rAKrm 1RoM oN-SITE wA1ER AND wAsrr WATER OEPART)!!NI DDCIlYEN1A11011All LOUIIONS SHOWN ARr .•• .APPROXIMAMRS PUR SCALE+ I' = 30 FT• y BENCH MARK ® "A" SPURKLAND ENGINEERING SKY RANCH ESTATES ,/1 BLK 4 LT 2 SEPTIC SYSTEM ASBU/LT DATE. OCT.7, 1009 203 W 157H. AVENUE ANCH. AK. 99501 TINA DOWD— ANDERSON SHEET.- 2/3 GRID: 2737 /nn9) oTe_mta 11 5441 WHISPERING SPRUCE DRIVE PERMIT # SVO90178 PID # 015-301-10JKylCQI1LRGS ca tr�n���c��. ..1 c7 -2z- d 9 P /1.00 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water b Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 16, 2009 Expiration Date: Sep 16, 2010 Permit Number: SW090178 Parcel ID: 015-301-10 Legal Description: SKY RANCH ESTATES #1 BLK 4 LT 2 Design Engineer: 0007 SPURKLAND ENGINEERING Site Address: 005441 WHISPERING SPRUCE DR Owner Name: TINA ANDERSON Lot Size: 13866 SO. FT. Owner Address: 401 S. SILVERTIP LN Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99516-2310 This permit is for the construction of: 0 Disposal Field Q 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. 5. The following special provisions. A. The well casing shall be extended to at least 18 Inches above ground level. B. The permit includes waiver W R090052 allowing the septic tank and drainfield to be 75 feet or greater from the onsite potable water well. AW; ��Ct r /C1 '-rG of vl.t. flv ir"^L� A. 7 / f'o rrpj�. Lille, 'f'rn,., -r✓e. elj-`'l✓)/? Received By: Issued Date: q I 4/0� Date: C1l6 d% Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program �enr No 1�w e Department **** VARIANCE/WAIVER REVIEW **** WR#: 090052 HAM_ Permit#: 090178 PID#: 015-301-10 Legal Description: Sky Ranch Estates #1 Block 4 Lot 2 Engineer. SDurkland Engineering Applicant: Tina Dowd Anderson Your request for a waiver of the required 100 feet horizontal separation from thcabsorption field and septic tank to the private well has been approved. The approved separation distance is 75.0 feet. This waiver approval applies to the proposed absorption field to private well separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................... Waiver Is Granted: X Waiver is not Granted: Date: I9 16Q009 Approved by: Name of Reviewer ............................................. ..... a...... 0.8... 0............. Rec#: 075923 Amount: $1,050.00 Date Paid: 9110109 **** VARIANCE/WAIVER REVIEW **** Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 15 - 301- 10 Propertyowner(s) TMS,- Do -A A.,aerso. Day phone 3(cO-(.31-IS G1 Mailing address jo l 5 S'\vai34� o�„�y R(o~& 1 AI.) Zip Code 46 Oa3 Site address 5441 W6'2eu,Ij s4r Drove, A+x6ra4r.AKZipCode 9151 - Legal description (Sub'd., Block &Lot) Sk, 'V"d £sInA4. & I 91 4 L{ Z Legal description (Township, Range & Section) Lot Size �3� $6� Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field 10 Septic Tank IR' Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ c� Number of Bedrooms THIS APPLICATION IS AN: Initial ❑ Upgrade IR' Renewal ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: 57-q O Waiver Fees: '4 1 y 4 0 Date of Payment: Oji -/0-09 Date of Payment: y - / y - O!j Receipt Number. d 7 eZ 3 Receipt Number. O 7 .r 9 2 3 (Rev. 11/05) Spa Malmd Eflgonmong Environmental Consulting and Design SEPTIC SYSTEM DESIGN SKY RANCH ESTATES #1 BLOCK 4 LOT 2 Municipality of Anchorage September 4, 2009 Development Services Department On Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, Alaska 99519 Subject: Septic System Installation Permit 5441 Whispering Spruce Drive Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system for the above referenced property. The proposed system will serve a 4 -bedroom single-family residence. The existing system was installed in 1973, with an upgrade in 1981 and did not meet COSA operation requirements. The existing tank will be abandon per MOA code requirements, the crib and trench will be left in place and connected to the BioCycle unit via a valve for possible use in the future. Soil logs, design calculations, a site plan, design drawings and construction specifications are enclosed for your review. Design Calcs: No Groundwater observed to a depth of 18.5 feet below ground surface (9-1-2009) Soil Rating. From Test hole (9-1-2009) 60 min/in = 1.0 gal per sq.fl./day No. of Bedrooms 4 Required Area per Bedroom: 15011 =150 sq.ft. Total area required: 150 x 4 = 600 sq.ft. System: We arc proposing a BioCycle Advanced Treatment System, and a deep trench absorption field. The absorption field will be 30 feet long, 2 feet wide and contain 10 feet (600 sq.R. effective) of sewer rock. Soils: A test hole was excavated on September 1, 2009. Sec the attached soil logs. Ground water was monitored for through September 7", 2009. Ground water was not observed. 203 West 151h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCagci.net `- aPwk nd EROMOR88001MU Environmental Consulting and Design Surface Watters: The are no surface waters within several hundred feet of the proposed septic system upgrade. Topography: The lot slopes west at a slope of 2 % Waivers: Well to septic tank & absorption field (included w/ submittal). The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. If you have any questions or concerns, please contact me at 279-3916. Sincerely, r Lars Spurkland, P.E. Civil Engineer 203 West 15i° Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, LspurklandCgci.net spar hlmd EnOMOMIM0 Environmental Consulting and Design September 8, 2009 Municipality of Anchorage Development Services Department Building Safety Division On Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519 Subject: WAVIER REQUEST SKY RANCH ESTATES #1 BLOCK 4 LOT 2 5441 WHISPERING SPRUCE DRIVE Ladies and Gentlemen: With this submittal we arc applying for a waiver of the 100 foot separation distance required between the septic tank and the absorption field and a private well. The existing septic system did not meet COSA operational requirements and must be upgraded. Due to the location of the well on the property and the location of neighboring wells, no area exists on the lot that does not impact well set back requirements. I was unable to locate a well log for the above referenced property. Neighboring well depths range from 206 feet to 262 fcct deep. The well logs indicate impermeable layers of clay and silt. On August 101h, 2009 the static water level was observed at 169 feet below the top of the well casing. Steady pumping of 1010 gallons of water from the well at a maximum out put of 3.0 gpm causal a draw down of 5 feet. Water samples were collected from the exterior hose faucet on August 10'h, 2009. Water quality analysis for bacteria, nitrate and arsenic showed 0 coliform or other bacteria per 100 ml, 0.258 mg/l of nitrate -nitrogen, and below the detection limit for Arsenic. The proposed septic system consists of a BioCycle Treatment Tank followed by a 30 foot long deep trench subsurface absorption field. A soils analysis was conducted on September 1", 2009. The following sine conditions were observed: a layer of organics; silt to a depth of 9.5 feet, silty sand from 9.5 feet to 18.5 feet. Ground water was not observed. A percolation test was conducted at a depth of 34 feet and a percolation rate of 60 minutes to the inch was observed. Mitigating Factors: The well head is located up gradient from the septic tank R absorption field. If the septic tank were to overflow, it would drain away from the well head, making surface flow contamination from the septic system impossible. 203 Nest 151h Avenue Suite 203, Anchorage, AIC 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net kuh��- SPUTMand EIMUMOROOToOg Environmental Consulting and Design NMI 77� Water quality analysis indicates that the nitrate levels are well below the required standards and in line with expected back ground levels. This is an indication that the well is not currently influenced by septic system discharge. Advanced treatment of the wastewater by the BIOCycic unit greatly reduces the strength of the waste. A maintenance agreement with BIOCycle insures that the septic system is operating properly. The septic system is in a high traffic area and any malfunction should be detected immediately. Neighboring well depths range from 206 feet to 262 feet deep. The well logs indicate impermeable layers of clay and silt. Waiver Request: 75 feet from septic tank to well. Included for your review is a site plan showing the proposed location of the septic system upgrade, soils logs conducted in 2009, the well logs for neighboring properties, and water quality result from water samples collected on August 10'h, 2009. If you have any questions or are in need of additional information, please contact me at 279-3916. Sincerely, blo p4461 Lars Spurkland 203 Nest 15'h Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (907) 276-6013, SpurklandEng@gci.net x PADOCK LANE / H I I%I II n FLOr 6I I LOT 27I \ I S I LOT 5 \ I I L - -- - -- --`-_ --- ---__ -- r-- --- emelt--- ---- ---� LOT 26 Il LOT 1 T 3 I (, I LOT I ftp w 23 I fell Lol LOT 4 fell Ict ell / 't\\\ LOT LOT 16;:- N07C.• THIS IS NOT A SURVLTED PIAT. WELL Q SEPTIC MOM TAKEN RMON-SITE WATER AND WAS1E WATER DEPARTMENT DOCUMENTATION. All LOCATIONS SNOWN ARE APPROXIMATE. 50 0 50 100 150 m P50 300 SCALE, 1' = 100 FT. 5441 WHISPERING SPRUCE DR/VE 4 LT 2 11 SEPTIC SYSTEM DESIGN DATE • SEPT. 3, 2009 SH£ET.• 1/3 GRID: 2737 C) car 1 iP L;�=-- ' L G LDT 2 TO BIOCYCIF W/TH BllTERfLY NOTE: INLS IS NOT A SORVEYED PUT. w£LL 4 SEPTIC LOCATIONS TAKEN FROM ON-SITE WATER AND WASTE WATER DEPARTMENT DOCOMENTATION. ALL LOCATKNJS SWWN ARE APPROXIMATE. 875.0 LOT 3 Q DEEP TRENCH N LENGHT JO FEET DEPTH 12 FEET '2 FEET DEPTH 10 fEET ATION 2 INCHES SCALEt I' = 30 FT. SPURKLAND ENGINEERINGSKY .RANCH ESTATES 11 ELK 4 LT 2 SEPTIC SYSTEM DESIGN 203 W 15TH. AV£NU£ DATE: SEPT. •l, 2009 ANCH. AK. 99501 TINA SP RNDOWD- ANDERSON SHEET. 2/3 GRID: 2737 907 279-3916 S�sf WHISPERING SPRUCE DRIVE PERMIT # SV090XX PID # 015-301-10 SkyRanchEstates#1B4L2D2.dwg A7 I STANDARD TREAW�� MTs 9Ax FW411A11171 a,10 W Stir[ Fauvm RAW AVAr neon nF 0 ALL RlRLUM 1 m h OOF�PITFRICYR OxWuWR 0msoKR RQ CMYBLR Lr TAX ''—,T�2' YCC8I�PD A51.tA1RH INSTALLATION L EXCAVATE A 10' x 10' x 10' DEEP HOLE FOP BIDCYCLE SYST£IL R. PLACE A MINI" OT• I' SMD LR GRAVEL FO? LEVELING CDGPSE IN AE BOTTOI O• Tl[ EXCAVATILML CO4°ACT AS REOWREA _ Sr TD PRDTECTT BOrM LF FIBLRGLASSIAAW,CT TAKE EXTRA CAREA>D ASSLR THAT AdUATIM CLLRS£ ISLEEVEL IN ALL DIRECl/OVS 1. BACKFILL L� INVERT LUT AND 1-1/I' EMLENT LIAES 61TH FREE-FDVGMr MTK AF DLS�S BR CAP END SAND/GRAVCL BACKFILL G7 R -1/P' KAM SEVER ROCK ' ` • ' SPURKLAND ENGINEERING Sf(j' RANCH ESTATES1 BLK 4 LT 2 SEPTIC SYSTEM DESIGN 203 W 157H. AVENUE TINA DOWD-AND RSON DA Tr.- SEPT. �, ?009 ARCH. AK. 99501 5441 WHSPERING SPRUCE DRIVE SHEET. 1/3 GRID: 2737 907 279-3916 PERMIT # SV090XX PID # 015-301-10 SkyRanchEstatesilBIL?Md g Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519.6650 www.munLorg/onsite (907)543.7904 Soils Log - Percolation Test Performed For. Tna tka — it 1e Sores Date Ferro Legal Description: SIZr Q act, 8 LAEtl_ 64 L2 Township, Range, Section: 17 18-�r\ Y M_ -1 WAS GROUNDWATER ENCOUNTERED? L s IF YES, AT WHAT DEPTH? L O Depth to Water Atter p Monitoring? 01-j E Dole: 9 9 OItXER' . �.49TH`L�1 RS SPURKLMD.. j 00 I� rmed: Site Plan Depth Gross Time Net Time (Feet) Net Drop s r _ o¢rrhu1.1, 1 121/y to 2- 3- 121 y ,r 4 U 5- 6- -AIr r (ML) it LV DO m 7- 1/1'1 8- 9- 10- 11- 17 18-�r\ Y M_ -1 WAS GROUNDWATER ENCOUNTERED? L s IF YES, AT WHAT DEPTH? L O Depth to Water Atter p Monitoring? 01-j E Dole: 9 9 OItXER' . �.49TH`L�1 RS SPURKLMD.. j 00 I� rmed: Site Plan PERCOLATION RATE _( r�+p'r " V ^.•.`•`.• TEST RUN 13ETWEEN�FT AND�c _FT fj COMMENTS n f 1 (1 PERFORMED BY: ' AOC JCuroj I r>o M.7 CERTIFY THAT THIS TET AS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDE INES IN EFFECT ON THIS DATE. DATE: 9@0e, 0 Date Gross Time Net Time Depth to Water Net Drop 9 i II'A ,� O vNi 121/y to 0 M 121 y ,r KReading U -AIr it LV DO m 1/1'1 PERCOLATION RATE _( r�+p'r " V ^.•.`•`.• TEST RUN 13ETWEEN�FT AND�c _FT fj COMMENTS n f 1 (1 PERFORMED BY: ' AOC JCuroj I r>o M.7 CERTIFY THAT THIS TET AS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDE INES IN EFFECT ON THIS DATE. DATE: 9@0e, 0 .L:06�t_ SpuM and En&awormg Environmental Consulting and Design Single Family On-site Wastewater Disposal System Construction and Material Specifications Subject Property: SKY RANCH ESTATES #I BLOCK 4 LOT 2 Date: September 4, 2009 General: 1. The owner shall contract with a contractor to perform the work outlined in these specifications and plans in accordance with the attached MOA permit. There Is not contractual arrangement between the contractor and the Engineer. The Engineer shall be the owner's representative and will inspect the work to document the contractors activities. Final acceptance of the contractors work rests with the owner and the MOA. 2. The scope of the project includes the procurement and installation of a 4 -bedroom onsite wastewater disposal system at the location depicted on the attached site plan drawings. The scope of the work also includes the installation of a new BioCycle tank, a drainfield comprised of 1 trench, 2 -feet wide x 30 -feet long, 12 feet deep, with 10 feet of septic rock below the distribution piping. The location of the drain field is shown on the attached site plan drawings. The total depth of the field will be 12 feet below the existing ground surface. A minimum of two feet of cover Is required over the drain field. In addition to the required earthen cover, 2-incti thick, 40 psi, direct bury board foam shall be installed directly over all piping beneath the driveway and over the drain field. 3. Construction shall be in accordance with the approved site plan and design drawings and any special provisions noted on the Municipal well and/or septic permit. All materials, components, workmanship and construction practices shall comply with the Municipality of Anchorage's latest ordinances regarding wells and septic systems, as well as MOA, Development Services Department, Onsite Water and Wastewater Program (DSD) policies. 4. The contractor is responsible for obtaining all underground utility locates, layout of the proposed system, and verifying and maintaining all required separation distances to tot lines, surface water, wells, steep slopes, etc. 5. The property owner shall be responsible for final grading any depressions formed from settlement of ball material. The property owner Is also responsible for vegetation of all areas disturbed by septic system Installation activities. 6. Contractors Installing wastewater disposal systems must be certified to do so by the MOA DSD, Onsite Water Wastewater Program. Property owners installing their own systems must receive advanced approval from MOA DSD prior to system installation activities. 7. The contractor shall ensure that ALL materials being used are in compliance with the most current guidelines established by the Municipality of Anchorage. Refer to "Standards and Specifications for Component Parts and Materials Used in the Construction of Onsite Wastewater Disposal Systems", Dated December 2000, as provided by MOA DSD, Onsite Water and Wastewater Program. Septic Tank Installation: 203 Nest 15th Avenue Suite 203, Anchorage, AIC 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurklandas gci.net Cr�go�c�c�r�Ong Environmental Consulting and Design 1. The tank shall be level and sufficiently bedded to prevent settling of shifting of the tank. 2. The sewer service line from the house to the tank shall have a minimum slope of 2% unless prior approval Is obtained from the engineer. 3. The inlet and outlet lines from the tank shall be bedded in drainrock or the soil shall be sufficiently compacted to prevent future settlement of the soil. 4. Septic tank inlets, outlets and cleanouts shall be fitted with water tight couplings. 5. A cleanout shall be installed 1 to 4 feet from the foundation. 6. Post tank cleanouts shall be installed per MOA requirements. Does not apply to pressurized lines. 7. In areas with high ground water, the septic tank shall be sufficiently anchored to resist buoyancy forces when there is not adequate soil cover to resist uplift force. The contractor shall refer to the engineer for direction regarding this matter. 8. The tank backfill shall be graded sufficiently to ensure positive drainage away from the tank. 9. All holding tank and lift stations shall have an audible and visible alarm inside the residence being served. 10. All lift stations shall be wired in compliance with all MOA guidelines and the Uniform Electrical Code. A municipal electrical permit and Inspections must be obtained where required by the MOA. 11. The contractor shall verify that the septictank/lift station is a minimum of 100 feet from any residential water well, 150' from any class'C' well and 200 feet from any community water wells. Additional separation distances must also be maintained. 12. The contractor shall remove or abandon the existing tank in compliance with the Unform Plumbing Code. Drainfield Construction: 1. The drain field shall be excavated to the dimensions outlined in the design drawings. If any discrepancies are noted, contact the engineer immediately for clarification. 2. The drain field shall be installed parallel to slope contours. 3. The bottom of the drain field shall be within 2" of level. If the sidewalk or bottom of the excavation become smeared, they must be raked or scared prior to the placement of filter sand or drain rock. 4. The drain field must be a minimum of 5 feet from the test hole excavation. S. Distribution pipe is to be installed level with perforations facing downward, atop a level bed of drain field rock. Septic rock shall then be placed atop the distribution piping to provide a minimum of 2" of cover, level across the entire width and length of the trench, above the piping. 6. A silt barrier must be installed at between the final drain rock and the native soil backfill. The silt barrier shall cover the entire drain rock surface. 7. Monitor tubes must be 4" in diameter, installed in the locations depicted on the design drawings, and extend a minimum of 12" above final grade. The portion of the monitoring tube below the septic rock must be perforated and the portion above the drain rock shall be solid. 203 Nest I 51 Avenue Suite 203, Anchorage, Ai: 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurkland@gci.net alLih Ong O� Environmental Consulting and Design 8. Backfill over the final gravel layer must not be less than 2 feet. Insulation must be Installed when the backfill depth is less that 3 feet. 9. Drain field back fill shall be mounded to prevent depressions from forming due to subsequent settlement of backfill material. 10. The contractor shall verify that the drain field is a minimum of 100 feet from any residential water well, 150' from any class'C well and 200 feet from any community water wells. Additional separation distances must also be maintained. Inspections: 1. A minimum of two inspections are required by the Municipality of Anchorage. These inspections must be conducted under the supervision of a Professional Engineer licensed to practice in the State of Alaska. 2. The first inspection must be conducted after the excavation of the drain field and before the placement of any gravel. The septic tank may be set in place, but may not be backfilled. 3. The second Inspection must be conducted after the placement of the sift barrier, gravel, distribution lines, stand pipes, cleanouts, and insulation, but before the placement of any backfill. 4. The contractor shall provide a legible copy of all field notes relating to system layout and construction to the engineer for the use in preparing the record drawings. 5. The contractor shall coordinate all Inspections with the Engineer. A minimum of 24 hours notice Is required prior to the start of construction. If necessary, a preconstruction meeting will be held on-site. 203 Nest 15i' Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916 Fax: (866) 354-1597, Lspurklandl✓gci.net ADVANCED NVASTE\VATF.R TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING IIr.TNVEF.N MUNICIPALITYor ANCHORAGE AND Tia V.A- Andemn TI IIS MEMORANDUM OI' IINDEMIUANDING made and entered into as of this Day of of 20_0., by and bethvicen Tna herein the "OWNI:R;' and the Municipality of Anchorage. herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein. the Parties to this Memorandum of Understanding agree as follows: L ADVANCEDNN'ASTF.V4'ATEI%TRI?ATMEN7'SYSTEMS. Municipality grants Permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS). described as g;oCy_de located at Sy'll W sah r,4cc Drive Anchorage. Alaska. 2. Definitions. A. Alteration. Any change to the design or function of an ANVWTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to Performing any alterations to an A W WTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter. "AM("') 15.65. B. Certificate of on -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AN'N'TS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations Installation and Removal of Additional Equipment. Owner agrees not to make any alterations, removal of parts or additions to the AW WTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AW WTS in good repair. In addition, it shall he the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws. regulations, rules and orders for the AWWTS. 13. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AN'WTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AIVWTS Operating Permit is: QK "Aj C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWN'TS are codified in AMC 14.60. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AW WTS that were included in the original design which would allow the AWW'fS to continue to perform as designed. I?. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AW WTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of ($ .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the A W WTS. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the ANVWTS upon Zd hours written notice. F. Owner agrees that anv sale or transfer of title of the property will not occur without a new Certificate of On -Silt Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook lir AV<'Vv'fS is the governing professional guidelines for the construction, maintenance and repair of the Owner's ANVWTS. 7, non A giver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof. or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of -Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: iAa " - An65on Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction- Choice of I,aw. Any civil action arising from this Memorandum of Understanding shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the Slate of Alaska shall govern the righty and obligations of the parties under this Memorandum of Understanding. 10, Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. ONN'NF.K: IIJ4,f_ Uatc: _qkffg STATE OP+� rkfilcat i1 SS o ^f; MIINICIPAI.ITV: fly: Title: I)atc: ss. F'^ The foregoing instrument was acknowledged before me this 1 `I day of 5-r zoo . by - _1i 0 aviel A_ t�deYs+x NOTARY PUI� IAC f R41-, .S:-r'r My Commission expires: 01-01-13 BRIAN S. DANIEL NOTARY PUBLIC -NOTARY SEAL STATE OF MISSOURI CASS COUNTY MY COMMISSION EXPIRES JAN. 1, 2013 COMMISSION /09407732 // MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAf. PROTEC;'fION h ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501-relephone 264-4720 ©- ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME/A PHONE LJ NEW �IUPGRADE _ MAI LING ADDRESS 7Q Q LEGAL DESCRIPTION 2 LOCATIO�N,/� N0. OF BROOMS Well Absorption area Dwelling PERMIT NO, Uy_ DISTANCE TO: ~2 a Q �/—� Manufacturer L—� t� Material No. of compartments Liq. capacity in gallons Insid ngth IF H ME MADE: Width Liquid depth z DISTANCE TO: Well Dwelling T PERMIT NO. U Z Q T F Manufacturer Material Liquid capacity in gallons O LL, y DISTANCE TO: WeII ,� Foundation _�. �_ N rest lot line ,f 'a Ca �V PERMIT NO. / r �j LLJ u- z a z Lu No. of lines — Length of each line Total length of lines _�1 Trench width 3(l inches Distance b tween lines � �- p. Top of rile to finish grade Material beneath rile 41Z Total effec ve aIbEption area Length Width Depth PERMIT NO. W Q f- Type of crib Crib diameter Crib depth Total effective absorption area a. a W N Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. .J W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING r � INS -FALLER REMARKS 1 APPROVED DATE LEGAL i 72-013 (R�G.3/78) P U M70 F-7 =p PA K— --p L f ir RA u HEALTH FIND 0 TE I.-.: T 10 hl 82-5, 'L-" STREFIT., ANCHORAGE: AK. 99501 P-4 F__- 14 E-7. lf�" 1_11 P, Q- F.i.* F::,# F" !E.',-. F;-" Pel 1 -0 APFI ICAkIT �.';IIFIRON MC-IRRIE.; 700 W. 41ST, SIJITFE. J.k.'12 ZI 10 0 LOj­:FIT IOP -J WHISPE RIN('i SPRtJCE L.EGAI.- J.- 2 B 4 SKI. RANCH 181--100 FE E'r TYI:`F OF Si.IIL ABSORf",r,):or-j S'T'STEVI IS: TREhICH PlAe"1111LIM NUMBER OF BEDROOMS = 3.: C;OIL RAT' IP -JG F'T.,-'Bf;:.)= 22u-5 THE REQUIREL'I S12E OF T'HE -;OIL.. FIB'S-ORPTION sT,s,,,rEm fl. L_ FE: P -A C."i'"'r 15- W 0 F, F 4 E E_ F=`F THE LEN(riill-1 DIMPISION IS "I"HE LENGTH (IN FEET? OF THE TRENCH OR DRAINFIEL.r.). THE DEF"IT-1 OF A TRENCH OR PIT IS THE DISTANCE BETWEEki THE SURFACE OF- THE G,ROUND FIND THE BOTTOM OF THE fl'e`;CAVATJOPI FEET). "I"HERE IS P -JO SIET WIDTH FOR 'TRENCHES, TFIE GRAVEL. [)EP,rH I-,-: THE PlINIMUM DEPTH OF GIRAVEL. BETWEE1`4 THE ou"u"I'll 1, PIF E AND THE BOTTOM OF' THE U -Jr." 1',','I.*N FEET). APPIL.ICANT HAS THE RE-;POhISIF_,,vIL_I TIT' TCI INFORVI 'THIS DEPARTrlr-"rrr f)I.IRING INc_','TFjLL.ATION INSPECTIOPIS. OF Atllr' WEI.,LS ADJACENT TO THIS PROPFRT'r; FIND THE NUMBER OF RESIDENIMS THAT THE kIEL_L WIL.1 SEF''; E. 3. 1%1 lf�F, lc� 1 IC -1 it -A IF".1,11 F^:° I--_- F;,� lF.EF. IIJ *T, F -i", EE BACKF"IL.L_.TPl(--i OF ANY S..."YSTEM IdITHOUT FIP4A1._ INSPECTION FINE:, APPRO%,IAL. EDIT' DEPARTMEhIT 14IL.I.- BE SUBJEC"r TO PF,OSECUTILDN. PIP-11PIUM DISTANCE BETWEEN A WEI-1 AND APVT1 ON-SITE SE1,4AGE DISPOSAI SYSTEP'll :f ':i , ', 10ti:'.,, FEET FOR, A PFS' I'' ATE f-JELl- iFr, .150 TO 20CI FEET FROPI A PLIBL_IC 1.,.IELL- DEPEP-jr,ll'-JG UPl'_,N THE T`?PE (')F F`UBLIC t,]E[.L,. MIr-JIMUM DI.'..5TF-IP-JCE FROM F-1 PRP,'ATE WELL TO A PRJ%-'ATE SEklEF, [..INE IS 25 FEET Aklf) IT-) A COMMUNITY SEWER UPIE IS 75 FEET. OTHER REQUIREMEPVTS MA'T' APPLY. CT"ECIFICATIONS FIND CONSTRUCTION DIAGiRAM.C..; ARE W,,'AI[..AB[J`.' TO IN". -;URE PROPF..."R 111-ISTAL.L..ATION. r-1 1. 7, F I CER'TIPTI THAT I AM FAMILIAF, WITH THE REU74.)IREMENTS FOR ON--S-J"ITE SEWER''.*; AND 14EL.L.r; FIS ':,-ET BY THE MUNICIPAt IPTI OF ANCHORAGE, 2: 1 W11-1- INSTAU THE SYS"I"EM I.P.1 ACCORDANCE WITH THE CODE UP-MER.STAND THAT THE ON -S - ITE SEWER -S. SIT' '_:`,TEl`l PlAY REI.-..!LIIRE'. P-JUIR13EMENT IF 'THE REC-M)ENCE I,, REMODEUE'D TO INCL.UDE MORE THAN BEDROOrTE,7. "J GNED:_ +IROf-J MORRIS 4� Vj ( ` SOILS LOG MUNICIPALITY OF ANCHORAGE os DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PE=RCOLATIONX TEST B25 L. Stroot, AnchornUe, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:E L c ART a 9— DATE PERFORMED: LEGAL OESCHIPTIbN: 64- e'. Bk q. (SV,,%4 9A K C F 3T/t=N-T A4 =c StOPE SITE PLAN 2 T)wy 3- _ep k) IAA '( I _a,4A T WAS GROUND WA] "ER 11 - ENCOUNTERED? No L 0 1, 12 - IF YES, AT WHAT E DEPTH? 13 - 14 Reading Datp. Gloss Time "6A Depth to Water 0 F A 0 4 9 M No 2225-E 19 JUNE 25,1971. Reading Datp. Gloss Time "6A Depth to Water 5 IT; To kot �p Reading Datp. Gloss Time Not Tinw Depth to Water Net Drop qc 20 NA ID �t'\\ PERCOLATION RATE _`p_ EST RUN BEIWL? _�12 FT AND FT COMMENTS Re—r, 0 914 AL1 e, P7 c*/� 560/ o L 1r;7,2 PERFORMED BY: 12-008 (6/79) CERTIFIED BY: DATE: ct-t-eA I -1 Y -a"6 -j- �a .. GRE"ER ANCHORAGE AREA BOF.UGH r � Department of Environmental Quality Wo! 3330 C Street Anchorage, Alaska 99503 II INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM 11 NAME ` -1"1 Ail tCS V (,VN MAILING ADDRESS � C% `-1G;rrt%�,PsI- / PHONE LOCATION �� 0 l)aarCC_. e)-/4) LEGAL DESCRIPTION SEPTIC TANK: i DISTANCEIUB' )ZCn S 0 NUMBER OF ti FROM WELL ��� �� MANUFACTURER <��� �(.t - MATERIAL " 1 COMPARTMENTS? INSIDE LENGTH _�_ INSIDE WIDTH i LIQUID DEPTH LIQUID CAPACITY I C,' i () GALLONS. SEEPAGE PIT: _�� ( � I NUMBER OF PITS I DIAMETER OR WIDTH�_� LENGTH --)-S DEPTH r / LINING MATERIAL Y �� CRIB SIZE: DIAMETER_DEPTH� DISTANCE FROM: L,r�_bk_ TOTAL EFFECTIVE BUILDING FOUNDATION I � , NEAREST LOT LINE It /fir; ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION WELL:�- WELL 10(j I I� �I�e. cc.- �SQ. FT. TYPE � 9 XAO. CONSTRUCTION QJ.QQ-QA DEPTH � GI 0 r DISTANCE FROM: BUILDING NEAREST FOUNDATION -,LOT LINE CESSPOOL OTHERSOURCES APPROVED DISAPPROVED NEAREST SEPTIC SEWER LINE -,TANK_ REMARKS DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY: f. PIPE MATERIAL: Gil LOT SLOPE:I,. REMARKS: i I DATE L' G , /��j APPROVE -` -L Form Form No. EQ -031 SEEPAGE SYSTEM - . V l� G.A.A.B. Y, --- XDM. D� GREATER ANCHORAGE AREA BOROUGH o �,Q ggqo DEPARTMENT OF ENVIRONMENTAL QUALITY PERMITNO 3339 "C" STREET ANCHORAGE, ALASI<A 99503 TELEPHONE 274-4561 OgD( /IfD IAK"' SEWAGE DISPOSAL SYSTEM --® APPLICATION AND PERMIT NAME OF APPLICANT INSTALLATION LOCAL' LEGAL DESCRIPTION e - I >.,.z K MAILING ADDRESS ���=��rVIW��(.lS� _ PHONE. S?-+-"�� INSTALLATION OF: SEPTIC TANK `__ SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED a�W o-&,, _ FINANCED THROUGH L z 73 t/ TO BE INSTALLED BY DRAIN FIELD _ OTHER 501E TEST RESULTS -S=v NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL, TEST COMPLETION DATE ANTICIPA"rED FINAL. INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WIT14OLIT FINAL_ INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL., QUALITY AUTHORITY WILL BE. SUBJECT TO PROSECUTION. SEPTIC TANK SITE c'o____ TYPE. SEEPAGE AREA SIZE CM ,/J._ TYP> MINIMUM DISTANCES, REQUIREMENTS 131AGRAM OF SYSTL'M - � I - FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT _ -61 , DRAIN FIELD I SEPTIC TANK TO SEEPAGE PIT WALL f S SEPTIC LANK --5- , SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK �V I SEEPAGE PIT n�l DRAIN FIELD ALSO CONSIDER AREA WELLS. I WATER MAIN 7p SEPTIC 'TANK SEEPAGE PIT DRAIN FIELD _ / I SEPTIC 0, ( I � TANK, -i6 -,SEEPAGE PIT __ DRAIN FIELD TO RIVER, LAKE, STREAM. CASTIRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGH'i REMOVABLE CAPS. GRAVEL BACKFILL. CONFORM TO BOROUGH REGULATIONS REGARDIN0- G I STAL CATION. ,( G.A.A.B. OR LICENSED DESIGNER 1 CERTIFY l'HAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 26,66 AND THAI' THE ABOVE DESCRIBED SYSTEM 15 IN ACCORDANCE WITH SAID CODE. I ---i% - I DATE ._. G 3 APPLICANT'S SIGNATURE FORM NO. EQ -016 r GREATER ANCHORAGE ARRA BOROUGH DEPARTMENT OF ENVIRONL/IENTr3,L QUAL ITY Case # 3330 "C" Street ANCHORAGE, ALASKA 9950; Mars Excava4,„0 Performed For �L ESQtis Dated Performed--_V, erformed .S-//-� 3 Legal Description: Lot_ 2 _Block —�_—Subdivision _cvrclia}.a{—�� This Form Reports Soils Log X __-- — — _ _Percolation Test Soil Test Must Be Logged To 4' Belol•! Proposed Seepage System - Depth Feet Soil Characteristics 1 4� ror avid (o I ---- ---- 2alm S•�� .5",",I7 grRvel 3 4 5 , 7 -� 84 94 1 0 11 1 2' 13 •Z' 14— Was Ground Water Encountered?_Av _ I< If Yes, At What Depth? - _- - --- - ReadingDate — Gross TimeNot Time G---- -- DoPth to H2O Percolation Rate --- - Mt nu Proposed Installat To See;;ait Drain Depth of Inlet th i.o Eottoii of Pit or -------------------._._ r, C0Mh'ENTS: Net Drop Field Trench Test. Performed BY 11ate Cert i F i r,d R — I_._1 --J-i---I-i--1-I_1`i DoPth to H2O Percolation Rate --- - Mt nu Proposed Installat To See;;ait Drain Depth of Inlet th i.o Eottoii of Pit or -------------------._._ r, C0Mh'ENTS: Net Drop Field Trench Test. Performed BY 11ate Cert i F i r,d R — 0A 0 Yl q�-j Municipality of Anchorage -� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw 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 Parcel I.D. ' O IS- 40l -10 COSA # OCI 03 ? Expiration Date: �f' —/ 3 / O 1. GENERAL INFORMATION Complete legal description SKI RANCIA £STATES 1 BIK 4 LT 2 Location (site address) 401 5, 51LV6QTI P i-AN6 Current Propertyowner(s) TINA ANDEft5on Dayphone 360-631-1861 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will he held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ®. Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ L,50 The Municipality of Anchorage Development Services Department (DSD) issues Certificates 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. Name of Firm SPLIDUYD 94066RI Nlr Phone 2l4-3916 Address 203 W. 151I` AVE, 5TE "Zozi AN014DIZA&C- , AK Engineer's Printed Name L.AES SPNQKLAWD Date 1017107 5. DSD SIGNATURE Approved for 4— bedrooms. Disapproved. OF y 49TH s�9'r�ii X . O O tARSE.9'UFKLAND i o� ^� Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By; L). Original Certificate Date: (Re, IV05) Municipality of Anchorage o,• • "` Development Services Department j' 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 Legal Description: Sky RAIJC.11 £S A I ES t3, 1310 Ll Z Parcel ID: 0715 — 301— 10 A. WELL DATA Well type 6J If A, B, or C provide PWSID # Date completed UA{2r% iw,G� Sanitary seal (Y!N) Total depth �l( ft. RRR Cased to y0 ft. FROM WELL LOG Date of test Unkflt uA Static water level Unk=nown f. Well production W%6Dwn g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate 0.7 59 mg/L Arsenic: Nt7 ug/L date of sample: tc jiCK"i B. SEPTIC/HOLDING TANK DATA Tank Type/Material l�io ivc�e' Flee 36; Tank size I U0 gal. Number of Compartments 2 Well Log (Y/N) Wires property protected (Y/N) Y Casing height (above ground) H g in. AT INSPECTION Ild Zcr b`i ft. 3.0 g.p.m. Other bacteria _9-- colonies/100 mL Collected by: c`rs jx_�hlaol Date installed Z2 04 Cleanouts (YIN) lrlan kle Foundation cleanout (YIN) y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping atw Pumper C. ABSORPTION FIELD DATA Date installed 9 22 Soil rating p.d.lft or felbdrm) System type D OL6Q TPC -AJC Length 30 ft. Width ft. Gravel below pipe to ft. Total depth � ft. '= Eff. absorption area IrP fl? Monitoring tube y Depression over field Date of adequacy test Ahvi 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 'Pump on' level at 25 in. Datum &I We 9;•11 E. SEPARATION DISTANCES Size in gallons /(ODD Manhole/Access (YIN) Y �!! 'Pump off level at yI-Xin. High water alarm level at Z1Z 2 in. Cycles tested N W Meets alarm 8 circuit requirements? Y SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 791+ Absorption field on lot -T51+ Public sewer main N/A 1 Sewer /septic service line 25 r Animal containment areas 50 It. i On adjacent lots }5 t On adjacent lots -'S 1t - Public sewer manhole/cleanout Holding tank /VIA Manure/animal excrete storage areas I Do 14 - SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1 I I Building foundation 5 } Property line 5 t Absorption field S t i 1 Water main N/A Water service line 25 + Surface water_ 1C0+ Wells on adjacent lots X51 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property tine Ir 9, 5 r Building foundation IDt Water main 1 1 to 4 Water Service line It7 t Surface water IDa t Driveway, parking/vehicle storage Curtain drain AA 0. Wells on adjacent lots SA F. COMMENTS G. ENGINEER'S CERTIFICATION �� OF. At loll i 1 certify that I have determined through field inspections and hP"4 IIt' review of Municipal records that the above systems are in , ; 49TH conformance with MOA COSA guidelines in effect on this date. • : /(�� i 4�s/?....... Engineer's Printed Name L Ars JOulYLah nKLAVC` j _ � Date 1101-T101 1 COSA Fee $ 2 Waiver Fee $ Date of Payment 0 �� O Date of Payment Receipt Number 7 L/ -5-3-% Receipt Number (Rev. 11105) SOS RcLN Client Name Project Name/N Client Sample ID Malrix Sample Remarks: 1094089001 Spurkland Engineering Sky Ranch Estates #I U4,L2 Sky Ranch Estates N I B4,L2 Drinking Water Printed Date/Time Collected Date/rime Received Date/Time Technical Director 08/18/2009 14:02 08/102009 16:40 08/102009 17:03 Stephen C. Ede Allowable Prep Analysis Pm mctcr Results PQL Units Method Container II) Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 08/13/09 08/17/09 NRB Waters Department Total Nitmtc/Nitrite-N Microbiology Laboratory Colony Count Total Coliform rccal Coliform 0.258 0.100 mg/L SM20 4500NO3-r 1) (<I0) 08/13/09 LCE 0 col/IOOml. SN120922211 A (<200) ORt10/09 DLC 0 col/IOOml, SN120922211 A (<I) 08/10/09 DLC 0 col/IOOml. SN120922213 A (<I) 08/10/09 DLC I 0 N b 0 T ,SZ'S L ,90'6')3 M„90,b irk J®f' '0 pAll f 0 N a N J < • •OO OQ /i 0.0s Q LL: W 0 10 Yb v7� •L W2CWW yO� 5Y 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 1. D. # � I� )1- 1 n HAA # �^Q9 21)In_l I 1. GENERAL INFORMATION Complete legal description �o z g V� q S A ," r4 Eg �``� a-- I Location (site address or directions) ` li�/(SPe r �� a �prLte- 2 Property owner e V7 V-% u—Ws �V ark Day phone 5ys - 49` L?S Mailing address`( ;3Per�iu Lending agency « Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: —0 ' 3. TYPE OF WATER SUPPLY: I/ Individual well Community well Public water yphone___?�' 6^ 1 q q NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA N21 Municipality of Anchorage O Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LA R K `l S ky 4 2 S� Parcel I.D. A. Well Data Well type K If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 1973 b Li Driller Total depth > /to % Cased to Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump levell SEPARATION DISTANCES FROM WELL TO: 7 16 % Casing height W Wires properly protected (Y/N) AT INSPECTION © / 7 ! � 9 2) MUNICIPALIIY OF ANCHUIwUI: LLr 6 E-WIRUNMENTAL SEk1'ICES DIVISION (0 5>. -IS ()C ► 2 :' 1993 I/ S g.p.m. -� 11,RECEIVED Septic/holding tank on lot `? (o ; On adjacent lots 7 / D _� Absorption field on lot 177 ; On adjacent lots > / C) S Public sewer main N�ie-\_ Public sewer manhole/cleanout N�.4 Sewer service line > / c7 Petroleum tank rq 1 j 0 WATER SAMPLE RESULTS: Coliform 0� J Nitrate 0. L? Other /bacteria -� Date of sample: 10/0 L a� 7l 9 Collected by: �-�-c a r -r B. SEPTIC/HOLDING TANK DATA Date installed 11'I �l 73 Tank size Compartments Cleanouts (Y/N) /Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) Date of pumping Pumper �o � o 1p -m o r� ur SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: p Well(s) on lot Q (a On adjacent lots > //-S7 Foundation To property line 7 10 Absorption field ED Water main/service line > 7 b Surface water/drainage H ) r7 72-026(3/93)' Front CONTINUED ON BACK PAGE COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES SINCE 1900 lwml I)b L\j KW'P1'� " , I , , 0l?'J oI T44AI , .1 0 , , 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 C 1.1, on'l , vj,=Irkc /%;) 4N j � I PI, r 8 IffN Oj.do,r �'/I 1)') 5 Hv 0,011131,14 -j-10NNI.AND 10%a 1 Coltod:erl P -co I %en:)A 0/0'//93) 0 hi-:; IJA 'r("Av J. c;j] 7I i (1 [-.0 t ;-I 1111-T�i X I'lk" 4 I 'D 13YS11 IAN'T OtIol 1311 i t i'1(`"[--.)7.(.11 I ) ot Ing/j, ll'A I VW; C R, MUNICIPALI I Y OF AINK-HURAUt ENVIRONMENTAL SERVICES DIVISION OCT 2 8 1993 RECEIVED No! 'H It n PC) r (A V ,� I I A I'm I 1100-NosGsMember of the SGS Group (Soci6t6 G6n6rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA COMMERCIAL TESTING & ENGINEERING CO. AK DIV CHEMICAL & GEOLOGICAL LABORATORY TELEPHONE (907) 562-2343 5633 B Street Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # Q�Y—P-RIVATE WATER SYSTEM Cay SAMPLE DATE: \ Mo. Day Yeerf SAMPLE TYPE: '®- Routine ❑ Check Sample (for routine sample with lab ref. no. ❑ Special Purpose TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination Zip Codo to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received ( (J50 Analytical Method: Membrane Filter ❑ Treated Water ,Untreated Water SAMPLE Time Collected No.LgCATI f Collected 2 3 4 5 READ INSTRUCTIONS ' No. of colonies/100 ml. Lab Ref. No. Result' 93.53x9 I m I�I mm �J �u BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count KV Ana st Collform/100 ml BEFORE Verification: LSB BGB Fecal Coliform Confirmation COLLECTING SAMPLE Final Membrane Filter Results Coliform/100 ml Reported By Dete �Jd TNTC = Too Numerous To Count Time: OB = Other Bacteria PART ONE OF TWO: SGSMember of the SGS Group (So(REMAINDER TO FOLLOW Muni ipality ®f Ancl .arage t Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 November 30, 1993 Tobben Spurkland, P.E. 203 West 15th Avenue #206 Anchorage, Alaska 99501 A Subject: Waiver Request for Lot 2 Block 4 Sky Ranch Estates #1 Waiver Request #WR930071, PID #017-301-10, HA930673 Dear Mr. Spurkland: Your request for waiver(s) of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance(s) are a private well to the septic tank of 90 feet; a private well to the drainfield of 95 feet; and a lot line waiver of 0 feet. This waiver approval applies to the existing septic system to well separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely jhn r: Daniel J. Roth Smi Civil Engineer am On-site Services On-site ljm:#6 manager Services r -31 MUNICIPALITY OF ANCHORAC, Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR930071 PID# 015-301-10 HA# HA930673 Permit # Date Received: October 28, 1993 Legal Description: Lot 2 Block 4 Sky Ranch Estates #1 Engineer: Tobben Spurkland, P.E. 203 West 15th Avenue 0206, Anchorage, Alaska 99501 Applicant: Henry J. Walsworth Waiver Requested: Lot line waiver - 0 feet: Well to septic tank - 90 feet; well to drainfield - 95 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other. Points: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for. above: Sf1' '917, C/.(Ei% Date: //- V_3 Rec #: 25400/0866 N Amount: $ 625.00 iewer Date Paid: 10-28-93 Should have paid $920.00 for well to drainfield waiver /3 f9/vE�Q /�EC�uES i Fon � or z �Zk � SkY /�irNCI� FST: �% MgIVF6 RE U65T NuM8b>? WR93007i tvt4rvER Fol? ow-tur 6vFLL ro vpPi-c 4exa arloA CRlB TqC-&CH OF 7o NNh 95- 11rl A era SOT LINT lwh1tvE/?, _. s EP Ti ( pts r-1. — »> TN/s sYsr ca,vsrnucrto /.v T/rcs oo� errILE P/Q 6/vg 19PP1?0i14c. r -OR T,,- P161-0 TO PC- CONST/ %S P►�v^a Tli� ON.-Lof G-ficG Avd f-FFT FRtl•Vr T/lam /oTt/.r� /• S!✓+°7ic TSN/� ffUw�"v�t{ ftir9s NuT G/vEN �l°Prevv�R Ff>R FNLrPar1CII�t� avo¢ 7-H�F Fiv6lAvF 2 H,'F5 /vOw Z %kE 4,ffl5cgjo7'/c,1v SYS, --e- r if �oNiT�acT�O /,v // �%L M/�T ire r'i-j C P F - t? c . q t4- r -e Is /0 art ,v/t "I rkr- fPofoffVPTtoa SYSTEM©oc..vS-LOPh�rF�o iK l-e;GG /N QuFs;/o r,; R,vr port 1vrrtsLEr��u _ A Trrt�r�'OAYcI ME 40SURPTI01v Sr.<rCll W/U NOT Fl -o", r0t--6/?Vf T -WF- P T' [71619 7; Yrf'FRO `2- a- 7 -RE 1-�LLL /ti auFST/oN w/$ S 1NI3 —L e/% /R/ /%7?, r/fF, r / z b�Q o Z ro 7-1a / �-t / S ( U r71? F 5 Po Al a r RpE 17-I-( T/ t u- F L L 4 06 1.0T # TMrrer A 0rkFS U -F_ LGJ rti rig TMMFQIiF7F F7�FA 'l1f¢T 41-c /?EFLFcr C0,41017T1oti5, 7- 0 T-6 t- 7 -0T -6t- OF T !-eE la ELLS /'/'ma -*I? ry ,� :210 /(/ em,6, t-l9Y'lE►?3 OF �S/L rt' Sr4NIq ' 5/L7'p� S��v�Y GrP�vr�L �1'P��9r� Oec�o r l4 W/4 r6V► G/?Aviz,: L -' 5 A�tia /s E N C0 1N i 6r,CkQ. rklf ry VE /4 C®NF/N5.O 19a"Ir,6/? 8(f7— /F QC,: Catii Ce,5rZl—�/n4Y lllfloiFcr670 P/?O'Vt S6tr2F4-cam Cv�T/9narn�i4T/rsll�;! /Jcc� 7—HE f1Lrr S0/1. l367I„CrEN u-ke/?r w�T�r�1s Eticounij-F_/i'�r� mac y-1.Go.f GR o-ttiO w19-rk1� 5/4 -roc /oLc,S C/Cf}-TE T/-(Iq % N 0 CiTs i Nle 6veLL /,v Alar Fon r/,(c 1f L oew r -,6b FkC- F_N611VFF/i kris PF-Rp(;gmFY A 6 -F[ -j- TEST FOr? //.4.N. /9 .3- 0./o Poi 6S a Omer.? O rME t^DilruwrNG, T11(e t7 -14r -/c w/�; G�vr,L 1s �r CeFr PMRIA, r1c : PLOv, TFsj rAr, Pwrw jo 10K r a" r- 4. S G. p. /h , N A, 0 7'14 IT ti. r L c PIF,' -5 :b AA9— v /. 3 z b�Q o Z ro 7-1a / �-t / S ( U r71? F 5 Po Al a r RpE 17-I-( T/ t u- F L L 4 06 1.0T # TMrrer A 0rkFS U -F_ LGJ rti rig TMMFQIiF7F F7�FA 'l1f¢T 41-c /?EFLFcr C0,41017T1oti5, 7- 0 T-6 t- 7 -0T -6t- OF T !-eE la ELLS /'/'ma -*I? ry ,� :210 /(/ em,6, t-l9Y'lE►?3 OF �S/L rt' Sr4NIq ' 5/L7'p� S��v�Y GrP�vr�L �1'P��9r� Oec�o r l4 W/4 r6V► G/?Aviz,: L -' 5 A�tia /s E N C0 1N i 6r,CkQ. rklf ry VE /4 C®NF/N5.O 19a"Ir,6/? 8(f7— /F QC,: Catii Ce,5rZl—�/n4Y lllfloiFcr670 P/?O'Vt S6tr2F4-cam Cv�T/9narn�i4T/rsll�;! /Jcc� 7—HE f1Lrr S0/1. l367I„CrEN u-ke/?r w�T�r�1s Eticounij-F_/i'�r� mac y-1.Go.f GR o-ttiO w19-rk1� 5/4 -roc /oLc,S C/Cf}-TE T/-(Iq % N 0 CiTs i Nle 6veLL /,v 4 1f L oew r -,6b G+p(rw,,�Idle V k,)gSTftv4Tw/? S %f TEM ON /9 .3- 0./o fz ajoiff. V, 7- w. 2 =Ida., i u —6v a 3zf% 73 T 8 0ffiz vNrO S�/ ��•v y0, 21 CdN c �- Usioni 4C/5 /. v 3 Saiz so z« t >szs /(00/ )4.r= GGG d, o 4 E Z vv �rE Tq 4E Nd INrv. T 8 0ffiz vNrO S�/ ��•v y0, 21 CdN c �- Usioni 4C/5 /. v 3 F:»IL.1 F;� ��M 1-0 6751 N. DlMUND BLVD. ANCHORAGE, ALASKA 99502~3904 N0N>[)MUo'uFxwk, HuKx*r (907) 248~5095 ENVIRONMENTAL SEKYICES DIVISION Municipality of Anchorage October 2B,M� � � R lq 1993 � ,4� Qivision of Environmental Health ~ .,., Department of Health arid Social Services ���»r�U�y�K� B20 � Street RECEIVED K � � �� Anchorage, Alaska 99501 - -.. . ~. Subject: REQUEST FOR WAIVER OF SEPARATION DISTANCES FOR PRIVATE WELLS TO SEPTIC FIELD LOT 2 BLOCK 4 SKYRANCA ESTATE #1 Gentlemen, kie are sabmitting a regmest -For waivers from the separation distances stated in Title 113, Alaska Administrative Code, Chapter - 80. 020. hapter80.020. Waiverc3 were granted for the trench in 1981 with respect to the lot line and the well by a notation on the imst'allation inspec- tion report " 95'waiver from well to trench, O.K. to put trench next to road easement lot line." Dmring a ��eI� inspection om Oct. 7.1993 it was discovered that L1 -he top of the well.casing on Lot 2 was 96 feet distant from the stamdpipe to the septic tank. The files indicate--, that this is a 1 -compartment concrete tank. The s�amdpipe may 6e located in the middle of the tank. A waiver is therefore required for the tank to well distance. The Following waivers are requested: 1. Well to Septic tank 90 feet 2. Well to DrainfielCI 95 -Feet 3. Lot Line to �rainfield 0 feet. We have included available well logs for wells in the neighbor- hood. The well depth ranges from 286 feet to 262 feet. Imperme' able layers of clay and silt are common in all., Surface contamination of the well is not likely due to ground sloping away from the well, and the location of the residence. Yours Tctbberk Spur J,and P.E. V _- __-______--e__ WEL L RADIUS LOTS 24 AND 25 W W LOT I SEPTIC SYSTEM wet m, N 0 / / SPRUCE 15 0 15 30 45 60 75 90 SCALE; I' = 30 FT TNBBEN SPURKLAND P.E. LOT 2 BLOCK 4 SKY RANCH EST, H SEPTIC SYSTEM LAYOUT 203 W 15TH. AVENUE11 HENRY WALSWORTH DATE: OCT.26, 195' ANCH, AK. 995015441 WHISPERING SPRUCE SHEET 1/1 GRID: 2737 'Well Log i,-�!q D cet? .................. I................. Location ...... ../ ........................ .y. Date comp:'Lev'ea....... 4...... ...1.,....%................................................................ . . �........................................................................ Depth of vre11.................. Sizeof casir„g.............. ........,.......................,.......................................................... Distance to water.......... �,................................................. Distance to water while pumping.... .. .....................`......at rate of.................4.� ..................gallons per hour. /«6 10// . - -- Formation from to es r2Q V�:' f f30P.-4 vF. e� DELTA DRILLING COMPANY SRA BOX 394 B ANCHORAGE. ALASKA 99607 !vS ,K s 74 ��~� Driller IN I 1 Log rC I "rC:For.................................................. ............................................ Location . ".'............... ...=..,.%....................,r...........`�P3....... C.f.. Datecomple-(,ed........ -,�)........ / ........<'....................................................................... Depth of well........`...... � ........... ......... ........................... .................. I...................... s i/ Sizeof casing........` ............................................................................................... Distanceto water ................................................................................................. Distance to water while pumping ....... ....'...................................at rare of...............................................gallons per hour. DELTA DRILLING COMPANY SpA SOX 391 B ANCHORAGE. ALASKA 99507 . ................................ Dxiller.... Formation I from to _ 1 16 DELTA DRILLING COMPANY SpA SOX 391 B ANCHORAGE. ALASKA 99507 . ................................ Dxiller.... 1336 Ings street Mchorage. Alaska 99301 r WELL OWNEA.,,,L�,i'n�y.fr, .f .T f , n USE OF W�[L�,}�� , I TAP ATTAW I �'� X I.[ �n�f I� ice^ _C�� 11/.. �.L SIZE OF CARINGYj.'jDEPTH OF HOL&;L. CASED TO FT i STATIC WATIM LEYEL,;2,2.7 FT. YIEID..LQ GAL.PE$.MIN, WITH_ FEET OF DA1,Wl>OWN. REMARKS DATE COMPLE;r rip ( 4 ( J7: _ PUMP TO BE SET AT— L.toile c2gto&]p C�ijp2,t O� %S'Zt 0 0 OF -tom /.ata1av0 ,'Pt C=t0i&�y 4atogP j g.Qt0��b '�24i1Zt o�2p ._tor , to_. ..to. .t 0. .to� ,.._t0. „wt 0. .,_t 0. ,4 a Pi P� A AI > j >i +>N: RF'14 b4 r-4 4 � i M am 4 w V C,J:: al H ej V-1 cvI; E-1 k4g?2 HEOPH cj. CCF, rn 1-4 cm n .4 4 Ni C\J N Cd 04 Cd C4 C4 C9 $4 Cd cc cc w k, 9W 9% w RW lk I& ko ka ft r -i > > > > U), t'l vi I M kor i Ox. >i >i w ru W.: CIJ! coi .,ii cd' cd >i >i W C) ro IG U2 z 0 0 i.4 d! Wi r-4 i bn�4i �4i C): Ni Gx Q Ni bfi Lo Ni 0; N� col a tri 0: \.D: vi N.: 0: 'cl; \0: (X):: Col 66666666 14 1.4 1-4 PI 1-4 H pq H cv: : co: of C) i Oi VN ol 0::: d. 1VN: �,O:: \,C) i 00 ai VN \0' 0 0 0 cl: Im at m lk 44 ik 04 0 MA 5. LEGAL DESCRIPTION +_ a S L- j1L �zr C DAT, ,ECEIVED INSPECTION APPOINTMENTS I IME TIME TIME DATE DATE DATE n tK SINGLE FAMILY _ ❑ Two ❑ Five ❑ MULTIPLE FAMILY INSPECTOR INSPECTOR INSPEC R MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HEALTI I & 825 L Street - Anchorage, Alaska 99501 PNVIRONMENTAL P-GTECHON • ENVIRONMENTAL SANITATION DIVISION APR 1 6 s(:;8'1 Telephone 264-4720 depth (attach log if available.) REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW fGbbtiVI,6_Sr1 DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OW ER \alp) 3 ' YEAR ON-SITE SYSTEM WAS INSTALLED. PHONE ? u6xar 'C`-- o,. , Q__ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. MAILING ADpDHE66r � L- S cJ � W , S v_r (v PROPERTY RESIDENT (If differlant from abo e) I PROPERTY PHONE _ 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT (� �M J� Q r�J h \ ' \ 7 ► l � 'C- f 1 S PHONE' of � � �� 2� C� MAILINGADDRESS ';�l0(D t'�) - '-� ti MA 5. LEGAL DESCRIPTION +_ a S L- j1L �zr C �— e-5 STREET LOCATION 5 8 1 �) �s'? �.�-, v— V r v L-44- -44 -6. 6.TYPE OF RESIDENCE I NUMBER OF,BEDROOMS E] one El Four ED Other tK SINGLE FAMILY _ ❑ Two ❑ Five ❑ MULTIPLE FAMILY FXR Three ❑ Six 7. WATER SUPPLY Tl� INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well a ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - P ) �v KL y .+ % & ^— k. 4444 .r- �e5 r-'ke- INDIVIDUAL/ON-SITE** \alp) 3 ' YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY ? u6xar 'C`-- o,. , Q__ NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 2 uP — (11A-0MQA ( t CHEMICAL & GE YLOGICAL LABORATORIES ty..' ALASKA, INC. TELEPHONE (907)-279.4014 ANCHORAGE INDUSTRIAL CENTER 274.3364 5633 B Street 4v — �` It, ...ttarine Drinking Water Analysis Report -for Total Coliform Bacteria _ TO BE COMPLETED BY WATER SUPPLIER II TO BE COMPLETED BY LABORATORY WATER SYSTEM: I.D. NO. Water System Name Phone No. Mailing Address City State - Zip Code SAMPLE DATE: C1-1 LTJ I Mo. Day Year SAMPLE TYPE: ❑ Routine ❑ Check Sample (for routine sample ❑ Treated Water with lab ref. no.— 1 ❑Untreated Water ❑ Special Purpose SAMPLE Time Collected NO. LOCATION Collected By 3 4 51 06.1220 (b) Rev. 1976 Date Collected READ INSTRUCTIONS na. o....r�.d BEFORE Analysis shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. Date Received Time Received Analytical Method: ❑ Fermentation Tube ❑ Membrane Filter Lab Ref. No. Result' Analyst L� 48 Hours Confirmatory 24 Hours 48 Hours *No. of colonies/100 ml_ or No. of Positive portions. BACTERIOLOGICAL WATER ANALYSIS RECORD source- a.m. Tlme aecalvetl n.m. Lab. No Presumptive loml loml 10m1 loml loml 1.0ml 0.1ml 24 Hours 48 Hours Confirmatory 24 Hours 48 Hours EMB Broth 24 hours: Broth 4e houre: COLLECTING SAMPLE Multiple Tube Report: 10ml Tubes Positive/Total loml Portlona Membrane Filter: Direct Count Collform/100m1 Verification: LTB BGB Final Membrane Filter Results Coliform/100m1 Reported By Date p.m. ....................._. WooD FErut~�,15g �°j ,r'� P v 6 rtefeeHrtzn°^ n dee De! r ° �' i '33,% .James Karl Dowling o EASEMENTS OF RECORD, OTHER THAN o sT`•n 1564.5 THOSE SHOWN ON THE RECORDED 7.°" ee °Y PLAT, ARE NOT SHOWN HEREON. lgh, �.1t ,.•4. , 1 .. I� a''wi4 J �, a.:1 L< tH IA'a [.1 - LEGEN'D: . BRASS CAS P MONUMENT ` —LOT SURVEY CERTIFICATION-- o IRON PIPE qV STEEL. PIN LOT 2 BLOCK 4 n SURVEY HUB 8h TACK SKY RANCH ESTATES SUBIDIVISION ANCHORAGE RECORDING DISTRICT ISIONS DATE BY PREPARED BY: DOWLING •&. -.ASSOCIATES Residence of: 804 EAST' te 2 ANCHORAGE, 1ALASKA 5th Ave Su199501 5581 Whispering Spruce, DATE: Anri 1 1 21 1 BY'FS SCALE: 1 30 W'0' 81-094 FB. Diary GRID: 2737. Tobben Spurkland P.E. 8155 Cranberry St. Anchorage, Alaska 99502 Phone (907) 243-5302 March 23, 1981 MUNICIPAUn OF ANCHORAGC DEPT. of N`A`TfV--CiION ENVIRONMENI�� i' Mrs. Sharon M. Morris Dall Realty, Inc. 700 W. 41st Avenue Anchorage, AK 99503 Subject: Sewer Adequacy Test Lot 2, Block 4 - Skyranch Estate Dear Mrs. Morris: Per your request, I conducted a sewer adequacy test on the above property. On March 19, I pumped the septic tank and poured water into the crib until water was heard entering the septic tank. At that time the liquid level in the crib was 6'-4". 24 hours later I measured the water level in the crib. At that time it was 5' - 6-1/2". I again filled the crib until the liquid level was 6' - 4". A total of 90 gal. was used to fill the crib. This volume of water is the same amount that had drained from the crib during the preceeding 24 hours. The Municipal Code requires an absorption rate at 150 gal. per bedroom; in this case, 600 gal. for a 4 -bedroom house. This system is therefore highly inadequate and must be replaced. The septic tank is a 1000 gal. tank, sufficient for a 3 -bedroom house, but not large enough for a 4 -bedroom house. An additional tank must be installed. Ir order to upgrade this system, I suggest that a test hole be dug between the septic tank and the fence. The purpose for this test hole would be to establish if groundwater is present and also to perform a percolation test so that an adequate system can be installed. Based on the information you furnished me, I would estimate that a trench 80-90 feet long with 6 feet of gravel backfill will be needed. The cost of a system like this could be from $3,000 - $4,000, depending on the exact dimensions of the trench. If I can be of any assistance to you in this matter, please contact me. - f 1 0.49!B YN . TOI�gNo' e CAN ' ' . E . atm N 2225-E G / d -P JUNE 25, 1911 S/ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Qualityb 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received December 27, 1976 Time of Inspection :09 a.m. Date of Inspection 12-2 -76 Tuesday REQUEST FOR APPROVAL OF Pr t INDIVIDUAL SEWER & WATER FACILITIES FOR M".A 1. Approval requested by: Coast Mortgage Company Mailing Address: Post office Box 1200 Phone: 279-0665 2. Property Owner: Peter D. Shaw Phone: 344-4601 Mailing Address: NHN Whispering Spruce Drive 3. Legal Description: Lot 2 Block 4 Sky Ranch Estates 4. Location: See map on back 5. Type of facility to be inspected Single Family No. of bedrooms 3 6. Well Data: A. Type Individual B. Depth 198' C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On-site system A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area �, Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Rec ;t for Approval of Individual S �r & Water Facilities Legal Description Lot 2. Block 4 Sky Ranch Estates Comments Approved Approval;Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 1 certity that the intormation containea in this request for approval to De a Lrue ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date MUNICIPALITY OF ANCHORAGE Z DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1 2.510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA XXXX FHA CONY 2. Property Owner: Peter D. Shaw J w` ss�«<�-,fir Mailing Address:—�! �`� � -`-� Day Phone: 344-4601 3. Name of Buyer: John H. Webster Mailing Address:—P•0. Box 8-9010 Day Phone:_ 349-1232 4. Name of Lending Institution: Coast Mortgage Co. Mailing Address: P.O. Box 1200 Phone:_ 279-0665 6. Name of Realtor or Agent: Polar Realty Russell Schmieder Mailing Address: 1.01 E. International Airport Phone:_ 272-1541 6. Legal Description:_ Lot 2 Block 4 Skyranch Estates Subdivision Location: 7. Type of Facility to be Inspected: Single Family Dwelling No. Bdrms. 3 8. Water Supply Type of Supply: Public Utility Individual_ XXX If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) X= If Individual, date of installation 'mown 72-003(3/76) 06-1220(a) Rev. 1973 ALA,. DEPARTMENT OF HEALTH AND SOCIAL S6, CES DIVISION OF PUBLIC HEALTH Lab No. INDIVIDUAL AND SEMI-PUBLIC DATE BACTERIOLOGICAL WATER ANALYSIS- OFFICE INDIVIDUAL ❑ SEMI-PUBLIC ❑ CHLORINE RESIDUAL PPM I .REPORT RESULTS TO NAME ADDRESS CITY - - --— ZIP CODE _ ADDRESS OF SOURCE - - '- - Analysis shows this Water SAMPLE to be: ❑ Satisfactory ❑ Unsatisfactory ❑ Questionable ❑ Sample too long in transit; sample should notbe over 48 hours old at examination to indicate reliable results. Please send new sample. E] Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATERIS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY - DATE COLLECTED - _ TIME COLLECTED " Sample. Collected From FI Kitchen Tap ❑ Bathroom Tap ❑ Basement Tap ❑ Other (List) Well — ❑ Dug ❑ Driven ❑ Drilled ❑ Bored -- — — SOURCE: ❑ Spring ❑ Cistern ❑ Other— Dug ther Dug Well or Cistern Construction: Walls —FI Wood ❑ Concrete ❑ Metal ❑ Tile Brick or - Top — FI Wood - ❑ Concrete E]Metal ❑ Open Top ❑ Concrete - - LOCATION: — ❑ In Basement - ❑ Basement Offset ❑ Under House ❑In Yard ❑ Other —_ Building Sewer Septic DISTANCE TO: or Other Drainage Pipe -----Feet. Tony Feet; Tile Seepage Cess- — — — Field — Feet. Pit Feet. Pool —.— Feet. Privy Feel. Other Possible Sources of Contamination MATERIAL: Building Sewer - ❑ Cost Iron ❑ Wood- ❑ Tile ❑ Fibre ❑ Asbestos - ❑ Plastic Joint Material - Type — Cement GENERAL: Does Water Become Muddy or Discolored? ❑ Yes ❑ No When? —. - - Diameter of Well - _.Depth Feel. - - - Well Casing Material Diameterr Depth Length of W.—N.Depth Drop PipeFrom Bottom Feet. Offset in In Utility PUMP LOCATION: ❑ In Well ❑ Basement ❑ In Basement L] Room On Top ❑ OF Well ❑ Other PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes ❑ No New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑ No Signature --- De 1220 (b) BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 READ INSTRUCTIONS Date Receivedam t — _ _Time Received _ pm Lab. No. — —_ ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lactose Brolh IOcc locc locc IOcc IOce 1.Occ 1.Occ 24 Hours 48 Hours— Brilliant Green - e 24 Hours 48 Hours EMB Lactose Broth, 24 hrs. Coliform Density MF Results Reported by This analysis indicates Coliform Organisms to be: — AGAR 48 hrs. Grams stain —_ (Most probable No. per 100cc) a.m. - Dale - p.m. Absent Present _ �F 4 arcxouct a,i� I � a l e O i Q J GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality °�,�oy ,,y• 3330 "C" Street, Anchorage, Alaska 99503 2.74-4561 Date Received J'/-,�e 17 Time of Inspection Date of Inspection -_- - -� 47 REQUEST FOR APPROVAL OF INDI IDUAL SEWER & WATER FACILITIES s - g FOR 1. Approval requested by: Mailing Address: 5�G �,«,� /�/1�, Phone: s,/—/ 2. Property Owner:Phone: i Mailing Address: 3. Legal Description: _o 4. Location: 5. Type of facility to be inspected No. No. of bedrooms 6. Well Data: A. Type � — Q B. Depth C. Construction _ i� D. Bacterial Analysis 7. Sewage Disposal System: ` A. Installed /973 7 B. Installer 0 C. Septic Tank: 1. Size ( 0o jnL 2. Manufacturer a _ D. Seepage Pit: 1. Absorption Area l 2. Material �r1 Yeo E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank 9 l0 / , Absorption area 16)0_/fi , Sewer Lines , Nearest lot line /0 'l -f , Other contamination _ B. Foundation to septic tank l�% Absorption area Z C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Req_-st for Approval of Individual S ar & Water Facilities Legal Description J-"/c'�jA'ic✓� 'z//, L 4,2 Comments Approved �A- �2����Disapproved Date Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM �5 /t "JCLt / A, v �C_ID —CA w / ZJ V o 1 1.Cl"1.I Iy 6IICl6 wit: Illlurluul.lufl l.vll vu lllcu lit 611 is IIU1 VVVI vY"I w ". " W1— -- accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) P April 4, 1974 Chariot F, annoo Mountain Wrrvrine,s 462 famelot Who Anchor,: e. Alashil 99504 SMUT: Lot 2, Block 42 Sky Ranch Lqtate�, Door Ir, Jackion: Tho iWeVIOn of your 10WOV dnd Wor on the a"NjjCQ proppy, rovenled Ono. or Problem. The well casilo will nave vo re ;q,jrj y1th a n approv0d sanmapy CaD such is the Ono It tot Y Vlock 7, T11", "PIQ Pending sn"J"Ory results On tho "Ov WlYsIs W a roin%onction 0,, by this Office your requost for aiprovl VIII q0 coynjp[vd PIP" "IN this OffiCe When ready t,Y Calling M-001, ononslop 145. Ir You onv oup"tions; plobso 40 not he'RaTe to Coll Incerely, "Illinn romin"", NvIronmental Control officer WhIko 06-1220(a) P 1973 tea: DEPARTMENT OF HEALTH AND SOCIALS[ 'WES DIVISION OF PUBLIC HEALTH Lab No INDIVIDUAL AND SEMI-PUBLIC DATE BACTERIOLOGICAL WATER ANALYSIS INDIVIDUAL El SEMI-PUBLIC ❑ CHLORINE RESIDUAL PPM REPORT RESULTS TO OFFICE Analysis shows this Water SAMPLE to be: ,.❑ Satisfactory - ❑ Unsatisfactory ❑ Questionable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. ❑ Bottle broken in transit, please send new sample. SANITARIAN'S REMARKS COMPLETE THIS SECTION ONLY IF WATER IS AN INDIVIDUAL SUPPLY SAMPLE COLLECTED BY - — DATE COLLECTED _ - TIME COLLECTED Sample Collected From -❑ Kitchen Tap ❑ Bathroom Tap ❑ Basement Tap ❑ Other (List)Well — ❑ Dug ❑ Driven ❑ Drilled ❑ Bored — SOURCE: ❑ Spring ❑ Cistern ❑ Other—_.—__— DugWell or Cistern Construction: Walls—❑ Wood ❑ Concrete ❑ Metal El Tile Brick or Top — ❑ Wood ❑ Concrete ❑ Metal - ❑ Open Top ❑ Concrete LOCATION: ❑ In Basement ❑ Basement Offset ❑ Under House ❑In Yard ❑ Other - Building Sewer - Septic DISTANCE TO: or Other Drainage Pipe Feet. Tank Feet, Tile Seepage Coss. Field Feet. Pit Feel. Pool Feet. Privy --Feet. Other Possible Sources of Contamination --- MATERIAL: Building Sewer- ❑ Cast Iron ❑ Wood ❑ Tile ❑ Fibre ❑ Asbestos Cement ❑ Plastic Joint Material - Type GENERAL: Does Water Become Muddy or Discolored? . ❑ Yes E] No When? — — — Diameter of Well . Depth — Feel. Well Casing - Material DiameterDepth Length of - Water Depth Drop Pipe From Bottom Feet. Offset in In Utility PUMP LOCATION: ❑ In Well ❑ Basement ❑ In Basement ❑ Room On Top ❑ Of Well ❑ Other — PURPOSE OF EXAMINATION: Illness Suspected? ❑ Yes ❑ No _ New Source of Supply? ❑ Yes ❑ No Repairs to System? ❑ Yes ❑ No Signature - - ---. 06.1220 rot BACTERIOLOGICAL WATER ANALYSIS RECORD Rev. 1973 _ ) READ INSTRUCTIONS Din Dole Received - —Time Received _-- _-pm Lab. No ON REVERSE SIDE BEFORE COLLECTING SAMPLE Lactose Broth IOcc IOcc IOcc l0cc lOce 1.0ce 1.0cc 24 Hours - - 48 Hours - Brilliant Green 24 Hours 48 Hours EMB — Lactose Broth, 24 his Coliform Density — MF Results Reported by This analysis indicates Coliform Organisms to be: AGAR 48 hrs.--- Date rs.— —Date Absent — Present — Gram's stain — (Most probable No. per 100cc) a.m. C. LIFT STATION 11/14 Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed 12 2�i`7 N 6/318/ Soil rating (GPD/Ft) dV System type Cry G � Length 7 Width —3 Gravel thickness 6 / Total depth /02 Total absorption area -7Y2 t 6, � & Cleanout present (Y/N) Depression over field (Y/N) , y Date of adequacy test fU `7 r %R / O f ��11for -7> —Bedrooms 3 Results Pass/fail() _ Water level in absorption field before test 7� After test 5 1 Peroxide treatment (past 12 months) (Y/N) �LIf yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot Cl On adjacent lots a / t�-o Property line To building foundation 7 To existing or abandoned system on lot Nim On adjacent lots ,69 C9 Cutbank 1\4 0 V? 40 Water main/service line Surface water 2- Driveway, parking/vehicle storage area Curtain drain a E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name o Date 5 e L -f S� U Y, oe HAA Fee $�-SOo �� Waiver Fee Date of Payment % o 6 _. 3 Date of Payment i a -a g 0 Receipt Number % 02 � 4U U b 8�8 Receipt Number U �— 72-026 (3/93)' Back 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 furtherverify 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 _Lo �p­-- 4 y k� Phone z�Q'-3 Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. Conditional approval for Additional Comments bedrooms. ItITIt Date bedrooms, with the following stipulations: Date /2 - Z- Z3 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 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY —� 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified_ PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS y Cb -`APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must ac iApany certificate) U.061SAPPROVED DATE - an" •rf r � BY 72-010 (Rev. 6/79)