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MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
hftp://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP241123
Work Type: SepticTank Upgrade
Tax Code Number: 01506207000
Site Legal Address: NETTLETON ACRES #2 LT 3 G:2439
Site Mailing Address: 6705 LISA CT, Anchorage
Owner: ELDRIDGE WILLIAM D
Design Engineer: GARNESS ENGINEERING GROUP LTD
This permit is for the construction of:
Effective Date:
Expiration Date:
Lot Size in Sq Ft:
Total Bedrooms:
6/12/2024
6/12/2025
68373
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By: Wit— O G? Date:
Issued By: -- Date: �! �'
ON -SITE SEPTICMELL PERMIT APPLICATION
Parcel I.D. 015-062-07
Property owner(s) WILLIAM ELDRIGE
Mailing address 6705 LISA COURT *ANCHORAGE, AK
Site address 6705 LISA COURT *ANCHORAGE, AK
Day phone 907-310-3686
Legal description (Sub'd., Block & Lot) NETTLETON ACRES #2; LOT 3
Legal description (Township, Range & Section)
Lot Size Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
([D all that apply)
Absorption Field
❑
Initial D
Single Family (SF) Mx
Septic Tank
RX
Upgrade 0
(w/wo ADU)
Duplex (D) ❑
Holding Tank
❑
Renewal ❑
Multiple Dwellings ❑
Privy
❑
(SF and/or D)
Private Well
D
Water Storage
F1
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.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Date of Payment: 2-o Z
Receipt Number:
Permit No. C)
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
GADevelopment Services\Building Safety\On Site Water and WastewaterTormskClient FormsTeffnit Application.doc
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241123, Curtis Townsend, 06/12/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241123, Curtis Townsend, 06/12/24
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP241123, Curtis Townsend, 06/12/24
LOT 7
BLOCK 2
PLAT #79-37
-ABBO TT ROAD -
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,p., - E - E - E - E - E E - E - E - E
S 89*5!j z2E�E 120.00p)
Im LOT 4A
PLAT #96-56
LOT 2
PLAT #75-193
cz),
R=50'
-LISA C T-
ASELS MORTGAGE LOCATION SURVEY NOTES.
NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE
RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS
MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS
MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE
CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES
NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT
A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN
THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR
OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY
EXTENT OF THE PREPARED SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED
FOR SERVICES IN PREPARATION OF THIS PRODUCT.
RECORD DATA PER PLAT #75-193
0
FOUND 5/811 REBAR,, NO CAP
-._._..—,-GRAVEL
DRIVEWAY
OVERHEAD UTILITIES
_0pp
POWER POLE
UTILITY PEDESTAL
SEPTIC PIPE
WELL
DECK
CONCRETE
OF A�
A
of JAW 0 'N
6 kk
57
•
*
491-H
SCALE: 1" = 40 FEET
flxl 7")
*** �09 4/0� /*
(11
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41
-,Ryan G. Johnson . -
No. 192159
1 612OZ4*
Aw
1�0
AS -BUILT OF:
SGS North America Inc.
200 W. Potter Drive, Anchorage, AK8
Lab Reference Number
Ph 907-562-23431FFax: 907- 61 5301
Chain of Custody & Sample Receipt Form for Private Drinking Water Analyses (Non-PWSID)
CLIENT INFORMATION
Company Name:
Phone:
Please indicate the water source for these samples:
Contact:
/
Private residential well/water system
E-mail (Required for
reporting):
Mobile Food Cart
Address:
Non -regulated private water system
City/State/Zip
Other (please list):
SAMPLE INFORMATION
CAN KIT
o
P
u°
0
E
Please complete all applicable fields below including sample location,
m
collection date/time, and all analyses requested.
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Sample Ident�cationlLocation
Collection Date
Collection
Time
(am/pm)
i°- a
i°- 3
a
>�5a' c3
5I361
`5
X
Collecte in ui
Date
Time
R ... fv\d# b ab By:
Date
Time
�r
`T1Jt� R
Methd84 payment:
❑ cash ❑ checkt # iicard
Amount paid: $
ample Comments/Special Instructions:
SAMPLE CONDITION (FOR LAB USE ONLY)
yes no n/a
Are samples RUSH or SHORT HOLD TIME? ❑ ❑ ❑ Delivery Method: ❑ Client ❑ Alert Courier ❑ Other:
If yes, have you notified the tab? ❑ ❑ ❑
For preserved waters (other than VOA vials, LL-Mercury or ❑ ❑ ❑
microbiological analyses), was pH verified and compliant? Temperature upon receipt (if applicable):
Are there any issues with the samples? (i.e. frozen,
incorrect containers, past 30 hour hold time) ❑ ❑ ❑
This section used for immediate notification of UNSATISFACTORY coliform results only:
Analysis Began:
Reported to:
Reported to:
Analyst:
Total Coliform
Signature:
Result
E.Coli/Fecal
Initials
Dale
Time
Other Bacteria
Email Positive Total Coliforms/E.coli to Project Manager, QC Notices, Micro, and Data Management.
FW083 KitRequest COClemplates_BottleGuide_20201014
MUNICIPALITY OF: ANCItORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephone 26444720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME PHONE [ .~j!~EW
o.,v Co. I []DPGRADE
MAILING ADDRESS
LOCATION Zt~/~ ~ OVZ~.~ NO. OF,_~BEDROOMS
I WelJ . A~orption area ~'-~lling ' PERMIT 0.
ILiq. capacity in gallons I ........ I Inside length Width Liquid depth --
B e ~ DISTANCE T¢ell Dwell,n. _/ PERMIT NO~
~ ~ Manufacture I Material Liqui ,~Ety in gallons
- ~~~ .. ~ ~ Foundation ~ . ]Nearestl0~Jine ~ER~I~NO.
~ ~ ~ ~~h of eaCh~ige Total len~h of ICes I Trench width Distance between lines
~~ ~Bh g?? Material De~ .. M Total erreD, lye a~sorptlon apea
~ I Lenq~ ~ ~:idth Depth ~ ~ _ PER~ITNO.
~ -.Z~STAN - -~ Building founda,~ Nearest ,~lln~ -
OTHER
PIPE MATERIALS ' '~
SOIL TEST RATING
REMARKS
APPROVED
72-013 (Rev. 3/78)
-/
FI F' F' L ! C FIIq 'r
L '3r' R'T I
t.,.. E'.' I~j F:I I...
DEF'F::lr~::THEI'.,KF I.-I[EI:::!I...'FH FINE:, E]q','IIq":i'-DtENTFqL ETEZTION
..HP..LE.::,L hi C:C NiST.
L.. I '.RHI ~1
L :~:/~',tE T T I_. E T Cd'.,! RF:F.:ES
TI'rlF'E OF SI:I]~L hE,:,.I.f t.l:_l',t :E;"rlSTEI'"I .'[.'j-~;'
HFI;:.::]:f"IUh'I NLP1E~E'R CF' E:EE:,F..:CIC~hlS =
THE: Fi:E:I'j:!IJIFRE:D SIZE:~s'%7_OF' THE :5OIL RE:SOF.~F'TION~S'.r'S'T ~:1"1 I'E;:. ~~~)
IE:. E F" 'T ,.-, :== ::L ;~ ~. E N ,:~ T' H .......... ;~:: ',3, F~: ,~ %." E L C:~ E F"-'~'"' H ........ ,~ ", ~
Tr.iE LENGTH DZP1ENSZON I9 THE LENG'TH ,::ZN FEET::, OF THE TRENCH OR DRFIINF::'IEL. D.
TFIE DEPTFI OF FI TRENCH OR F:'IT tS THE DISTRNCE BE'THEEN THE: SUF:F::FICE OF' ]"HE
C~F'.OI...IND FIN[:, THE BOTTOM OF THE EXE:FI',,,'FIT ~ ON ,:: ~ N FEET ::,.
THERE I:5 NO SET HIDTH FOR TRENCHES;.
THE GRR',,,'EL DEF'TH ]:S '1"HE H~NIHLIH DEP'FH OF GF:FI'v'EL E~ETHEEI'.,I THE OLITFFILL. F'~F'E
FINE:, THE: E:OTTC~H OF TFtE E:=:CFI',,,'FIT ~ ON < Z hi F'EET ::,.
F'E:'F.'M"T FIF:'PL. IL-RHT k'IR.S 'r'HE ...... ,"' _
...... F: E =,F .Ihl_,:., I E: I L l Tq.' TO l I'.,IFF F.'H TH I S DEF'I:qF;KFHENT r2,1_lFR I NG THE
BISTFiLLRT ~ Clf.,I ZNLqF, ECT I Cff.,IS OF Rf.,t'¢ HELLS RE:,...TFiCENT TO TH Z S PF.':OI::'EF.~Th.' FIND THE
hI_MEEF.: CF' F::[E:SIF.:,ENCES 'THRT THE: HELL H.T, LL :LS, EI~:',,,'F.
E:F:P::::KF'"IL, L, IN(.) LqF' FIN'T' :5'~"S"I"EI'"I 14ITHOLIT FINflL IIq:SF'ECTIOI'.~ FIND RFrf~ ': ' ...." '"P I.... E:"r' "I"HZ':::'._,
DEI::'FIFRTHENT t,.IILL~ DE SIJB..TECT TO F'F.'ZSEZ .TZZN.
PIlI'.,IIP'IL.IH [:,ISTFINCE E,[.I,~IEE. I'.,I tq HELL. I::INE:, FIl'.,l'.r'
::LOZI FEET F'CI[,:: FI f'F' ",,~" ' ' kg" ".. :, 1 HELL. E:,E:PEI'.~!D.T.I'.,IC:i
· .l ,HirE. I.,]EL.L OFf: J.....u TID ;~E~O F'EET F'ROH I::1 F E'L 'L-:
.F:"::N THE' T"r'F'E OF F'IJEL 'lC I.,.IEL[ ....
I"I.T.I",I]HUM E:'I:.-T, TF1NCE FROH I"q F[,:.I ,hire HELL TO la FF,.T.'v'FYFE 5;EHEF;: LINIE
TD R CCtP'Ih'ILINIT'?' :,E. LtE. F:. LZNE: Z:5 ,."r~, FFET.
14EL. L LJ.T.,3S; %.E F.:E:QLIIRED FIND HU'E,T DE F.:ETJF'N[~'[, TF~ TFIE DEF'FIRTh'IENT I.,.IZTlaZN ~:O Bi'ir:;
I": F' THE.~ HELL.. "." HF'LE:T l 'l H.
R[:.f1[.~ll.::, I'"IFt'¢ FJF'Fq_'¢. .::,PEC.T. FICFI"F'I':H'F FiND CONSTRJC:TIi-iN [::,ZFIGRRH:S H[:.[.'.
R',,,'FI I L. FIE,'LE T -J ]: hIE, F:'F' F'F.':IDF'[ER I NS"I'FILLRT I CIN.
I E:EI:RTIF'¥ THFIT
1.: I FIH F:FIMILIF!F'. HITH TFIE: F::E:L.-~LIIf~:EMEI'.,ITS FOR Oi'.,I-L"SIT[C SEHEF,'S RN[::, P.IE:LI...::.:; FI:.:..; :'SET
F'OF,:'.TH E::'t' THE HUiqlCIF'FIL. IT'¢ OF FINC:HOI'~'.FIGE.
2.: ! HII..J... It'.,I:STRI_L THE SWS'TE:]"I IN FIC:C:OF~'.DFINCE HITH THE COl)E?,,.
~:: I UNE:,EI~:'STFtND THFIT THE Ot'.,f-:'.SITE :SEFIER ::S'¢s'r'EH HFI'T' r?.EL:.!LIIF~'.E E[I'.,ILFIF;i:GEHENT IF THE:
RE::SIC, ENC:E IS; F~:EMODELEI)'f'O INCLUDE HOF.:E THFIN
5 ] GNEr;, . ................................................................... ~'~-s . /~/~=c Z)
FIPF'L :I: CFINT CRRLES;OI'.,t CON"_':;T. CCI
J~/"'SOI LS LOG
PERFORMED FOR:
I.EGAL DESCRIPTION:
: ,vlUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Aleska 99501 2~ ~.720
SOILS LOG- PERCOLATION TEST
[] PERCOLATION
TEST
DATE PERFORMED: . (,"~1
5
6
8
9
~0
~3
~6
~7
~8
~9
20
COMMENTS
NO. 1732,E
Juno 22, 1968
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
s
L
0
P
E
Reading Date Gross Net Depth to Net
Time Time W~ter Drop
PERCOLATION RATE Iminutes/inch)
TEST RUN BETWEEN FT AND FT
72-008 (6/79)
SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 725
I:::)RILLED AT THE RATE Of ,~,2'/000 PEr FOOT.
PROPERTY OWNER
DRILLER
WELL LOG:
723 .... 725t 7.bze. C~a~J~L. 4ho~.tn.¢ c* q.i.~c!, o.fi. tao~ze~. 3 ZcJ 4 ~?liZ v~d.th. SO fe.e;L o.f.
Co.o4 o.fi /,)eJ~J. Se.c_d.: ~/.~ ..... vv
COST INCLUDES ALL LABOR AND MATERIAL FOr COMPLETION OF SAID DRILLING.
7 o oo
~NRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THF SUM OF
THANK YOU VERY MUCH,
DATE
BERNIE CLAUS OF RAMPART DRILLING WORKS
~ERVlOe CHArgEOF ~V~% PER MONTH WILL BE A~SE[SED ON PA~T DUEACCOUNT~.
',': ' ;':' '= :~ DEPARTMENT OF HEALTH AND ENvIR°NMEN~'AL"PR°TE'CTI°N ::::
· ;:: DIVISION OF ENVIRONMENTAL HEALTH ;'~ ~i::~! ~:: ::? "
'(a) Lega~escription (includeJot, block, subdivisi~section, t0wnship, range)
Applicant ~am~/~ ~2~
Applicant Address ~d~
(c) Applicant is (check one): Lending Institution
(explain);
(d)Lending Institution e (~ ~-~ A'(~ Telephone
Address
(e)Real Estate Company and Agent
Address
Telephone
(f) Mail the HAAto the
f~ll~owing address:
2. TYPE OF RESIDENCE
~...... - ../Mulli?Familv [] :. Other
Single-Family
Number of Bedrooms .... ~
3? WATER SUPPLY
Page 1 of 2
IndividuaI Well.~~ 'Community[] Public[] :::
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Onsite/~/ Public[] community• Holding Tank[] :::~ . ' ' i::' i ~:
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status. · ·
ENGINEERING FIRM PROVIDIF,~ INSPECTIONS, TESTS, FILE SEARCH, D~..A AND INFORMATION
As certified by my seal affixed hereto and es of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-site water supply and/or westewater 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 rites and from my investigation and inspection, the on-site water supply and/or
wastewater disposal system is in compliance with afl Municipal and State codes, ordinances, and regulations in effect on
the date f-thisi~speot'on.
Name of Firm /-~,~¢-s-~-~~ ~-~'~,-'¢2~..~ ~' --~'~ Telephone
Address _ ~'~-~ .~--,¢¢--~ ~-- . .
Date ~ '-'-//3 -
DHEP APPROVAL
Approved for * ' C bedrooms
Approved Disapproved ConOitional
T~rms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
,~pproval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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.
: '; J.: : ' :,; ':;, ; ; .; ' -' ·
· i; , :, (;\:: :. ; :"; '; , ': ~'. : ! ,':~ ~.'~.' ; , , ;' : · · :
MUNICIPALi-P,* oF ANCRo/~AG~
DEPT. OF HEALTH &
MUNICIPALITY OF ANCHORAGE (MO,~,i ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA) ilt \i O ':i 1986.'
CHECKLIST- FEBRUARY 1984 ' ' ~
Legal Description: ~/~ ¢ .
WELL DATA
Well Classification -- ~-F /~/.,4/¢.//_y. If A, B, C. D.E.C. Approved (Y/N)
Well Log Presen~"~N) .%/'.~¢ 7:~ Dat/Completed ~.~'.~f'-'/-E~'"'-' r~'¢?/~ Yield
Total Depth /~-~ .~ Cased to /L~%¢'- /
Static Water Level _ ~;-~'~
Casing Height Above Ground ___.'.~.~¢
Electrical Wiring in Condui~tN)
Separation Distances from Well:
To Septic/Holding Tank on Lot
To Nearest Edge of Absorption Field on Lot /'¢,'¢'¢~ /Tz- ; On Adjoining Lots
To Nearest Public Sewer
To Nearest Sewer ServiCe Line on LOt
Depth of Grouting
Pump Set At ~/.-/d/-"~¢~'¢¢,'!//
Sanitary seal on Casin~) ~/-
Depression Around Wellhead (Yc~
; On Adjoining Lots ,-'/¢~'¢¢
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results
Comments - -~-~-~--
B. SEPTIC/HOLDING TANK DATA
Date Installed ..~" .-,~._-/-- ~/' Size-.d- ~'-~'~ No. of Compartments
Standpipe~l)~'¢ Air-tig~Ca~N) ~,~.~_~ Foundation Cleanout~)
Depression over Tank (~ ,~/~ , , Date Last Pumped
Pu mping/Maintenance Co~tract on File (Y/~~¢ ;for ~ /
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/Holding Tank:
To Water-Supply Well ~ ~ / ~
To Property Line -,-=~ ~ ~ To Disposal Field ,-~
TO Water Main/Service~ine /~~- /~ T0 Stream, Pond, Lake.
or
Major
Drainage
Course ~/ ~'~ ~/ ~ ~-'~ ....
_ Temporary Holding Tank Permit (Y/N)
/
To Building Foundation
Page 1 of 2
72-026(11/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed
Width of Field
Square Feet of Absorption Area
Length of Field -~'~
Depth of Field
Gravel Bed Thickness
Standpipes Present. N)
Depression over Field (v~ /,~/,? Date of Last Adequacy Test
Results of Last Adequacy Test ~/7/% ~¢
/
Separation Distance from Absorption Field:
/ /
To Water-Supply Well /¢ ~ ~' To Prope~y Line ~
To Building FoundatiOn ~ ~ To Existin~ or Abandoned System on
/ ~ ~ _ ~__
Lot ~.¢~ ~/~-~,%¢~, ; On Adjoining Lots
To ~in/Service Line ,_~ /~ ~o C~present) ~.~.~
To Stream/Pond/Lake/or Major Drainage Course .~.~ -~
To Driveway, Parking Area, or Vehicle Storage Area ~¢~* /~
Comments ~>~ -~/.¢(~ ~'~ ~ ~(~ ~
LIFT 8T~TIO~
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that ~ave c h..~/~ed, verified, or conformed to all MOA and HAA guideli nas in effect on the date of this inspection.
Signed ~"~/-"¢~ ,-~'~ ,~---~ Date ~'-/'-~ ~-¢~
CompanyZb/~,~ ,~¢~,% MOA No.
ReceiptNo. %~ O~l O
Date of Payment
Amount: $
Page 2 of 2
J &unicipah Yof
Anchorage
P.O. B~. 196650
ANCHORAGE, ALASKA 99519-6650
(907) 264-4111
TON Y KNO WLES,
MA YOR
DEPARTMENT OF HEALTH & HUMAN SERVICES
July 8, 1986
Carey Meyer, P.E.
Besse, Epps and Potts
2220 East 88th Avenue
Anchorage, Alaska .99507
Subject: Lot 3 Bl~oZ~-Nettleton Acres Subdivision #2
Waiver Request, WR86-087
Dear Mr. Meyer:
This department has granted your request for a waiver of 100 foot
separation required between a septic tank and well on the subject
lot. This distance has been waived to 97 feet.
This waiver is valid for the existing three bedroom single family
dwelling only.
Sincerely,
Stephen S. Morris
Civil Engineer
On-site Services
SSM/ljw
June 16, 1986
John Kennedy
DHEP
825 "L" Street
Anchorage, Alaska 99509
MUNICIPALITY OF ANCHORAQFz
DEPT. OF HEALTH &
~NVIRONMENTAL PROTECTION
? o 1986
REC iVI D
Health Authority Approval
Variance Request
Settleton Acres No. 2, Lot
Dear John:
We have completed the testing and application preparation
regarding acquiring a Health Authority Approval for the
above-referenced lot and have identified a deficiency.
The deficiency identified is that the septic tank is closer than
100 feet from the well. The 1981 on-site sewer inspection
report was approved by the Municipality of Anchorage showing the
tank's installation and indicating a 100' separation° This is
not the case; the actual separation is 97'.
We request a variance to the requirement that the tank be 100
feet from the well for the following reasons:
The system has functioned with no adverse health impacts.
satisfactory water sample test result was obtained. The
well is cased to greater than 40 feet.
2. The existing house sits between the well and the tank.
3. The system was approved by MOA in 1981.
Should you have any additional questions, please feel free to
con~ct me at 349-6451.
Very truly yours,
Carey ,~..JMey~ PE
smh
ENGINEERING, PLANNING, SURVEYING
2220 E. 88th Ave./Anchorage,. Alaska 99507/Telephone 907-349..6451 /,~o/~,4.1352.
"Providing a quality personalized service to those building Alaska's future"
8ES~E, EPPS &
2220 EAST 88 AVENUE
ANCHOfiA~, AK 99507
(907) 349-6451
WATER ~'~r.r. T~SST
Location:
Client's Name:
Tester:
Initial Reading on Meter:
Rate:/mt,-' ~ GPM 24-Hour Capacity... C~llc~s
NUMBER I I ~ [APPROVAL
NAME ,
ADDRESS ,,~'-
/
SHIP FROM ~ SPECIAL INSTRUCTIONS --
~ STORE
~ STOCK
DI~T,
This purchase Is made under my
SearsChargo Acconnl Sacurlly Agree-
menl or my SeamChorge Modernizing
Credit Plan Account Securlly Agree-
ment which Is incorporated herein by
reference. This sale Is subject to lhe
approval of the Credit Sales Depart.
maul of Soars, Roebuck aad Co.
X
PURCHASED BY
I1 Ihe sale is on Easy Payment Mod-
arnlzlag Credit Plau (EP/MCP), use
applicable contract form.
this purchase is made under my
Discover Cardmember Agreement
Which Is incarporated herein by refer,
enco and I a~Jthorize the Issder to pay
Sears. This sale is subject to the
approval of the Discover Credil Card
Department.
X
PURCHASFD BY
THIS IS PART
DESCRIPTION
REGULAR
PRICE
/,.:~,..., ~,.) ;:., ,.~. ~
i .., ,:",/,., /,' :::'"'"
___OF A _ PART ORDER.
for shopping at $~_J~/~$
SELLING SELLING
REDUCTION PRICE
SALES I~'
TAX
DEPOSIT
PLEASE RETAIN THIS COPY FOR COMPARISON WITH YOUR MONTHLY STATEMENT,
OR IN CASE OF RETURN OR EXCHANGE.
16087-100 8/85 Seato Forme Management BALANCE
TIME
. MUNICIPALITY OF ANCHORAGE MUNI~LI~F ANCHORAGE
(~4
~ Telephone 264~4720
~EQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEW~IVI~
DIRECTIONS; Complete allparts on page 1. Incompleto requests w not be processed Please allow ten 10) days for processing.
1. PROP~RTYOWNER ' PHONE ' '
MAI L'l ~ A~DR ESS
PROPERTY R~SIDE~T (If di'ffeFent from'above]~ ' PHONE
2. BUYER / / ' PHONE
MAI L~ADD
MAtLI G DDR~S' -
5. LEGAL 'DESCRIPTION - - /
STREET LOCATION ,/ -
' NUMBER OF BEDROOMS
6, TYPEOF R~SlDENCE ~ One ~] Four ~ Other
~ SINGLE FAMILY ~ Two ~ Five
~ ~ULTIPLE 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.)
S. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED,
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
I 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
[]PUBUC UT UTY
Connection Verified INSTALLER '
[]Septic Tank or E3Holding Tank
Size: /~)~:~ If Tank is homemade SOILS RATING
§ive dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AREA MATERIAL
4. DISTANCES Septic/Holding Tank Absorption Area ]Sewer Line Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
d/;:PPROVEDFOR ,BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate)'
[~] DISAPPROVED
72-010 (Rev. 6/79)
DIRECTIONS TO PROPERTY TO BE INSFECTED
Sewer and Water Program
Note:
be sure to put colour of house or other
landmarks that will make it easy for the
inspector to find. Accurate directions
will save time and not cause delays in
scheduling.
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COSA Checklist
Legal Description: Nettleton Acres #2 L3
Parcel ID: 015-062-07
If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _
A. WELL DATA
n Well log is filed with Onsite (or attached)
Date drilled 5/15/81 Total depth 125 ft
Cased to 125 ft
❑■ Sanitary seal is functioning correctly
X Wires are properly protected
Casing height (above ground) 12+ in.
Date of flow test for COSA 5/30/24
Static water level at beginning of test 63.2 ft.
Comments
B. TANK DATA
Measured operating fluid level in septic tank N/A
Date of pumping NEW - plastic
❑ Required maintenance completed, if AWWTS
Comments:
D. ABSORPTION FIELD DATA
Which system tested (date installed) 6/25/81
M ALL standpipes present per record drawing
Total measured depth from grade 11.0 ft (max)
Measured depth to pipe invert from grade 5.2 ft (min)
❑ N/A — pressurized field.
❑ Per record drawings, field is insulated.
❑M Monitor tubes go to bottom of effective.
If not, state depth into effective
❑ Presoaked required if
(Required if house vacant or field not used for more
than 30 days prior to date of test)
Gallons introduced _gallons date
Any rejuvenation treatment (past 12 months) none
If yes, enter date -
Well production at time of test 1.4 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes ® No
N Coliform bacteria is Negative
Nitrate mg/L Nitrate less than MRL (ND)
Arsenic 11.4 ug/L ❑ Arsenic less than MRL (ND)
Collected by GEG
Date 5/30/24
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/14/24
Results 0 Pass
Fluid depth prior to test 0 in
Water added 452 gal
New fluid depth 0 in
Elapsed time 0 min
Final fluid depth 0 in
Absorption rate 450+ gpd
FIELD STATUS — POST RECOVERY
Effective depth (per record drawings) 72 in
Effective depth used 0 in
Effective depth remaining *72 in
Comments/Deficiencies: Invert at Sump is 21 inches lower than CO installed near beginning of trench. *Assumed
COSA Checklist June 2022
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well on lot)
Septic Tank/Lift Station on Lot > 100'
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
Community Sewer Manhole/Cleanout > 100'
fi Yes
if No
ft
5■ Yes
if No ft
Neighboring Tank > 100' ❑■ Yes
if No
ft
Private Sewer/Septic Line > 25' rN-1 Yes
if No ft
Absorption Field on Lot > 100' FO -1 Yes
if No
ft
Holding Tank > 100' [E Yes
if No ft
Neighboring Absorption Fields > 100'
or septic system can be installed on the property in the event either of the current systems fail to perform
e .-A. Gc n ess.:
Q�
Animal Containment > 50' Q Yes
if No ft
Q Yes
if No
ft
LiCEMSE~'S�.nP� f e s s ion
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' g Yes
if No
ft
[■] Yes
if No ft
❑ N/A — Served by Community Well (not on lot) or Public Water
From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required)
Building Foundations > 10' Q■ Yes if No ft Surface Water > 100' [E Yes if No ft
Tank to Property Line > 5'
Field to Property Line > 10'
Water Main > 10'
Water Service Line > 10'
F. ENGINEER'S COMMENTS
Mi Yes if No ft
M Yes if No ft
❑m Yes if No ft
Yes if No ft
Wells on Adjacent Lots:
Private Wells > 100' M Yes if No
Community Wells > 200' ■] Yes if No
If tank or field is under driveway comment below
ft
ft
G. CERTIFICATION & 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, indicates that the on-site water
supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation, unless noted otherwise.
Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179
Engineer's Printed Name Jeffrey A. Garness Date
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in
accordance with the guidelines and regulations established by the Municipality of Anchorage and industry
practices. The reported results describe the condition of the system/s on the date/s of the evaluation.
Separation distances to identifiable features. Hidden defects
o
OT
were measured readily or encroachments may
exist that were not identified during the evaluation. The operational life of all wells and septic systems depend
o
o\ 95��
upon a variety of variables, including (but not limited to) soil conditions, levels (that may fluctuate
groundwater
during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing
H
the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not
...... .. --- -. --•-. ''° ..
guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding
the future performance of the well or septic system. GEG makes no representation whether an alternative well
'e
or septic system can be installed on the property in the event either of the current systems fail to perform
e .-A. Gc n ess.:
Q�
adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG
to the Reliance the information in this by
CE -1793 -
perform evaluation. upon provided report any other person or parry
(including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever.
LiCEMSE~'S�.nP� f e s s ion
COSA Checklist June 2022 #RECCW4
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LOT 2
T #75-193
LOT 7
BLOCK 2
PLAT #79-31
Im LOT 4A \
PLAT #96-56
a" LISA C T-
ASPILS
MORTGAGE LOCATION SURVEY NOTES:
NO TITLE REPORT WAS PERFORMED FOR THIS SURVEY, EASEMENTS SHOWN PER THE
RECORD PLAT. THERE MAY BE ADDITIONAL EASEMENTS NOT SHOWN HEREON. THIS
MORTGAGE LOCATION SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH ASPLS
MORTGAGE LOCATION SURVEY STANDARDS. IT IS A REPRESENTATION OF THE
CONDITIONS THAT WERE FOUND AT THE TIME OF THE SURVEY. THIS SURVEY DOES
NOT CONSTITUTE A BOUNDARY SURVEY AND IS SUBJECT TO ANY INACCURACIES THAT
A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. THE INFORMATION CONTAINED IN
THIS DRAWING SHALL NOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OR
OTHER IMPROVEMENTS. UNLESS GROSS NEGLIGENCE IS DISCOVERED, THE LIABILITY
EXTENT OF THE PREPARER SHALL BE LIMITED TO THE AMOUNT OF FEES COLLECTED
FOR SERVICES IN PREPARATION OF THIS PRODUCT.
( )
RECORD DATA PER PLAT 75-193
0
FOUND 5/8" .EBA , NO CAP
------ —
GRAVEL DRIVEWAY
E E
OVERHEAD UTILITIES
-C)- P
POWER POLE
@
UTILITY PEDESTAL
8
SEPTIC PIPE
SEPTIC 'TANK. LII
WELL
ITEC:
CONCRETE
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o
4
40' 8 AW. '
�, ! 49TH
SCALE. 1 40 FEET #• ••!! .l..... •. •..li
(11"x17 )
• . i . • i . • • 0 0 • • . • i •
i -Ryan G. Johnson,
'• No. 192159 •'
• • • • •
MVA~
AS -BUILT OF: