HomeMy WebLinkAboutPANORAMA TERRACE BLK 1 LT 4APanorama Terrace Block 1 Lot 4A #015-092-38 72-013 (Rev 9/91) MOA 25 Municipality of Anchorage Page I of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW9703 4 PID Number: 015 -61Z -3S' Name: Wks+ Q.oak+�T Wastewater System: ❑ New Upgrade Address: 17_O I y k"' " i L. E To ABSORPTION FIELD Phone: No. of Bed rooms: Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: I. GPD/ IS— S—Lot: Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe A 1 ANO 5 '-2— Ft. p E3 Ft. Township: Range: Section: Fill added above original grade: Gravel length: Z.. O _ t Ft. Ft. WELL: ❑ New ❑ Upgrade Gravel width: Number of lines: Distance between lines: FL t Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: 1 J Ft. Ft. J l Z_ SD. FL 5, Driller: Date Drilled: Static Water Level: Installer: Date installed: FL 20. ✓1 t Z Z Yield: Pump Set at: Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES ❑ Septic O Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines 3 hoc, G L 1I ) to &_0 Well 13� lot ?O Material: )t ibrt Number of Com artments: Its Surface LIFT STATION Water H N1 E Lot _ Size in gallons: I Manufacturer: LineS _ 5 I C _ Foundation 3 _ Ll 3 Z "Pump on" level at: t' "Pump off" level t: q t1 1 F High water alarm at: 2— Z_ / y Curtain t4 Ci ice) Pump Make & Mocel Electrical Inspections performed by: Drain L. .! ✓Komi BENCH MARK Remarks: Location and Description: Assumed Elevation: ENGINEER'S .SEAL s Inspections performed by: _S Dates: 1S'.. IL�Jg 7 2nd I' -Q1 �. Department of Health and Human Services approval Reviewed and approved by: 6Date-17/2--lB 72-013 (Rev 9/91) MOA 25 TOBBEN SPURKLAND P.E. PANORAMA TERRACE, BUCK I LOT 4A SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE ROBERT L. WEST DATE: DEC. 5, 1997 (NCH. AK. 99501 907 279-3916 9501 NETTLETON DRIVE SHEET: 2/3 GRID: 2440 PERMIT # sws7o3s5 PID # 015-092-38 PAT014A2.DW6 OF • � I . •• •. 1W c - AV •� •� AV 149th..... :.. 0 ................... ............. . i............ .... . TOB N SPURK AND.. C No. CE -2 s �v=SAV i •1 �4F''•• ••......... ••••••' • 4 'RIFFS ••aa��. �� Well I I I I I I I I I I I I I I « I �I 1I QiOCYLL� 1250 GAL; CO CRETE S. I ( m I ` j•` I O " I GAS LINE ARD TRENCH : I 1 L DEPTH 11 FT TO TA fNGTH 32 FT I � 1 � EFFECTIV CK DEPTH 8 FT I I I ... I I I I I �- will I I I 25 0 I 25 0 75 100 I I I I I 125 150 SCAL I TOBBEN SPURKLAND P.E. PANORAMA TERRACE, BUCK I LOT 4A SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE ROBERT L. WEST DATE: DEC. 5, 1997 (NCH. AK. 99501 907 279-3916 9501 NETTLETON DRIVE SHEET: 2/3 GRID: 2440 PERMIT # sws7o3s5 PID # 015-092-38 PAT014A2.DW6 4 -INCH INSULA LEGEND: 1. PRIMARY TREATMENT, SEPTIC TANK 2. AERATION TANK J. CLARIFICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION 97.3 AIR LINES +++ BACKFILL —+ + + O 3 O + + O + + BIOCYCLE 6000 1250 gal Septic tank CONCRETE EXISTING 94.3 Standard TrenchtL - 2' Wide 1250 SEPTIC TANK 32' Long ll' Deep S' Sewer rock 3' Co ver 97.0 INSULATIHN 92.3 °000`U 0- o00 SILT BARRIER °0°0°00000°0°000 00°0°0°0°0°000°0°0-0 000000 0 0 0 0 0 0 0 o`c, 0000 0 0 0 0 0 0 0., 0 0 0 0 0 0 0 0 000000,0 0 0 0 0 0 0 0 0 0 0 0 00000 0 0 0"0 0 0 0 0 0 0 0 0 0 0 0 0 0 100000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0"0 .. 0 0 0 000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 840„o„o„o„o„o�o„o„o„o„o„o„o�o„o„o„o„o„0„0„0„0 0;,,,, 84.0 NH SCALE BENCH MARK. DHTTHM SIDING ASSUMED ELEV. 100,00 TUBBEN SPURKLAND P.E. PANMRAMA TGERRACE BK 1 LOT 4A SEPTIC SYSTEM AS BUILT 203 W15th Ave ROBERT WEST DATE: DEC, 6, 1997 Anh ge Ak 99501 ham,11 9501 NETTLETLIN DRIVE SHEET 3/3 GRID: 2440 PERMIT ND EV910395 IAC COPS . F 17 - l - 9-7 Zpvv\ PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970395 DATE ISSUED:11/19/97 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. EXPIRATION DATE:11/19/98 OWNER NAME:WEST ROBERT L OWNER ADDRESS:9501 NETTLETON DR PARCEL ID:01509238 LEGAL DESCRIPTION: PANORAMA TERRACE & BLOCK 1, LOT 4A LOT SIZE: 32400 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: `�/OCrgc�2) DISPOSAL FIELD SYSTEM V 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: 1. ASSURE MINIMUM SEPARATION DISTANCE BETWEEN NEW DISPOSAL,' FIELD AND EXISTING CRIB (2 TIMES CRIB GRAVEL DEPTH); 2. NOTE ON AS -BUILT HOW EXISTING CRIB WAS ABANDONED. RECEIVED BY: ISSUED BY: DATE: it- ( ?. C DATE: (/./9- 97 T oSPURK AN1 7D P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN PANORAMA TERRACE, BLOCK 1, LOT 4A 9501 NETTLETON DRIVE Municipality of Anchorage Department of Health and Social Services 820 I Street Anchorage, Alaska 99501 We are submitting an application for the installation of a septic system upgrade for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following : The available area is limited and partially tree covered. The owner wants to use a BioCycle system to reduce the foot print of the system, and to prevent progressive failure of the drainfield. No Ground Water or Impervious Layer to 17.5 ft. Use Standard Trench with a BioCycle Unit Soil Rating. 30 min/in = 1.2 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 150/1.26 = 125 sq.ft.. Total area required: 4 x 125 = 500 sgft Outlet Existing Tank 2 feet below ground Testhole depth 17.5 feet Bottom Rock At 11 feet Top Rock At 3 feet Rock Depth 8 feet Total Trench Length 500 / 16 = 31.25 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 32 FT TOTAL WIDTH 2 FT TOTAL DEPTH 11 FT ROCK DEPTH 8 FT COVER 3 FT EXISTING 1250 GAL CONCRETE SEPTIC TANK BIOCYCLE TREATMENT PLANT The installation of this septic system will not prevent wells from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or 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. TOBBEN SPURKLAND P.E.ANORAMA TERRACE, BLOCK I LOT 4A SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE ROBERT L. WEST DATE: NOV. 5, 1997 ANCH. AK. 99501 9501 NETTLETON DRIVE SHEET.- 2/3 GRID: 2440 907 279-3916 i PERMIT # PID # 015-092-38 PAT014A2.DWG .OF 1 9S1♦♦ .............1.430 •' ••. AV Ar 149th..•• ♦♦ �.............. .......... ...:.... i.....; .�... ...... ......... 0. T❑ BEN SPURK •AND jr I ♦jc✓J% No. CE- z 5 _� ♦ i I I •..'���i ♦ I 1 Ilri��S� ����• We11 I I I i I I I I I I I I I I I I I I I I I ABAND(31k'd0r; CRIB I I 1250 GAL; CO CRETE 5.7. i 1 I � q I ; , INSTA GAS LINE ARD TRENCH m L DEPTH 11 FT TO TA NGTH 32 FT EFFECTIV CK DEPTH 8 FTI . .... I I I I I I I i 25 0 I 25 075 100 I I I I I 125 150 SCAL : 1, = o FT. I TOBBEN SPURKLAND P.E.ANORAMA TERRACE, BLOCK I LOT 4A SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE ROBERT L. WEST DATE: NOV. 5, 1997 ANCH. AK. 99501 9501 NETTLETON DRIVE SHEET.- 2/3 GRID: 2440 907 279-3916 i PERMIT # PID # 015-092-38 PAT014A2.DWG 1250 gal Septic tank CONCRETE EXISTING LEGEND: 1. PRIMARY TREATMENT, SFITIC TANK 2. AERATION TANK J. CLARIFICATION TANK 4. DISCHARGE TANK 5. SOIL ABSORPTION Standard Trencl.- 2' Wide 32' L ong 11' Deep 8' Sewer rock 3' Co ver 1250 SEPTIC TANK 3 FT COVER AIR LINES + 1=11 1=I I Ell 1=111=1 11 I_' 1=111=11 FII-, BACKFILL— + °o"o + °o°o°O°0'0 +' 000000000°0°0°0`0 SILT BARRIER _ o°o°000°o°o°000°o°o'o _+ _ = + 0°0°0°0°0°0°0°0°0°0°0°0°0`0 ° 0 0 0 o O o 0 0 0 0 0 0 0 O O O O O O O O O J O O 0 0 O'O + O O+ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O`U 3 O 00000000000°00000000000000000000000000 + 4 000000000000000000°0°0000°00°0000000000000„ 0„0„0„0„0„0_0„0„0„0„0„0„0„0„0„0„0„0„0„0„0„0 0� + L 4 +' NY SCALE BIOCYCLE 6000 BENCH MARK, CONCRETE SLAB ASSUMED ELEV. 100.00 TO3BEN SPURKLAND P.E. PANORAMA TGERRACE BK- I LOT 4A SEPTIC SYSTEM DESIGNS 203 115th Ave Anchorage Ak 99501 ROBERT WEST DATE NOW 6, 1997 9501 NETTLET17N DRIVE SHEET: 3/3 GRID: 2440 PERMIT NO 9V97OXXX PID # 015-192-38 PAT014A3DWG I (ENGINEER'S SEAL) Municipality of Anchorage { DEPARTMENT OF HEALTH & HUMAN SERVICES ,: 825 -L" Street, Anchorage, Alaska 99502-0650 SOILS LO, 7G -- PERCOLATION TEST PERFORMED FOR: V.-1��4?'�(—� Vt/'�°-'s� _ DATE PERFORMED: I LEGAL OESCRIPTION:_TAAo12-AwA Tpl_tl- Township, Range, Section: SLOPE SITE PLAN 2 4- 5 ly 7 8 gU T TO lit D 1- 9 Po I—=- 10 —= 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? _ 5 L O P E Dale: _ Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (mmutesiinch) PERC HOLE DIAMETER L_J _ TEST RUN BETWEEN FT AND FT DISCLAIMFRL froundwater conditions indicated are for the date5 dateshown only. Past and future presence and/or depth of groundwater can not be predicted from these obs - tons. Z y PERFORMED BY: � - I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ftl71I /g - - 72-008 (Rev. 4/85) 6, V'/ i�le 14AI"- (ENGINEER'S SEAL) -. Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: �!—,��G� V`"t� _DATE PERFORMED: 3�q LEGAL DESCRIPTION: P"()N .AM& Tej?2 L Township, Range, Section: I Lo1-Y- A- SLOPE PTE r_1 SITE PLAN 1 2 3 4111111l ', ^ Li 6 7 8 9 10 11 12 13 14 15 16 17 18 19 LDoSP- poi—, vwi D I� f4ot-G WAS GROUND WATER \` 1 ENCOUNTERED? 11 IF YES, AT WHAT DEPTH? Depth to Water All - a l Monitoring? PT�_lDale: I&A _ LNI Reading Date Gross Time Net Time Depth to Water Net Drop iLL Ll• 'q•1 JPAA—' a lL 3.__5 15w4r" rr Yb 1� 49 1 0 li/TGs f2•. Pl.S 1 3 1 o _v S 4- )11,4, 20 L J i( PERCOLATION RATE (minuteslinch) PERC HOLE DIAMETER TEST RUN BETWEEN ` FT AND � Z— FT DISCLAIMER GrnundwatPr conditions indicatPrl are for th da a hown only. Past and future presence and/or depth of groundwater can not be predicted rom eseerva ions. PERFORMED BY: !�J 1 7 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL ; :-ATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: _ 04 -7 72-008 (Rev. 4/85) GPFATER ANCHORAGE AREA BOROP SH HEALTH DEPARTMENT ,»J NO 213 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM j NUMBER OF DISTANCE FROM WELL MATERIAL COMPARTMENTS _ -_ LIQUID CAPACITY Zr %'-' GALLONS. INSIDE LENGTH '�--�LIQUID INSIDE WIDTH -- DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH / LENGTH r DEPTH / LINING MATERIAL �� = -.DISTANCE FROM WELL 1% BUILDING FOUNDATION- NEAREST LOT LINE �� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) /�" SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL_ NUMBER OF L AB RPTION AREA_ CE BETWEEN LINES FT, LENGTH OF EACH NEAREST LOT LI TRENCH WIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERTAt BEN€AitlT[E IN. ABOVE TILE WELL: TYPE DEPTH— WELL: FROM /; WATER DEPTH v BUILDING FOUNDATION. SAMPLE NEAREST NEAREST / B SEPTIC e SEEPAGE „ n. OTHER LOT LINE ,��� � SEWER LINE-, TANKSYSTEM CESSPOOL SOURCES_ DISTANCE DIAGRAM OF SYSTEM ` ou- /)/ // / APPROVED DATE HEALTH AUTHORITY iv z��i''Z�� _ GC 7 MAILING ADDRESS PHONE NAME LOCATION 1 =� LEGAL DESCRIPTION.L/2-% �f/1 /�/1 ��Ai,/ SEPTIC TANK:l j NUMBER OF DISTANCE FROM WELL MATERIAL COMPARTMENTS _ -_ LIQUID CAPACITY Zr %'-' GALLONS. INSIDE LENGTH '�--�LIQUID INSIDE WIDTH -- DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH / LENGTH r DEPTH / LINING MATERIAL �� = -.DISTANCE FROM WELL 1% BUILDING FOUNDATION- NEAREST LOT LINE �� TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) /�" SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL_ NUMBER OF L AB RPTION AREA_ CE BETWEEN LINES FT, LENGTH OF EACH NEAREST LOT LI TRENCH WIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERTAt BEN€AitlT[E IN. ABOVE TILE WELL: TYPE DEPTH— WELL: FROM /; WATER DEPTH v BUILDING FOUNDATION. SAMPLE NEAREST NEAREST / B SEPTIC e SEEPAGE „ n. OTHER LOT LINE ,��� � SEWER LINE-, TANKSYSTEM CESSPOOL SOURCES_ DISTANCE DIAGRAM OF SYSTEM ` ou- /)/ // / APPROVED DATE HEALTH AUTHORITY GAAB-HUS2 GREATEI_.;ANCHORAGE AREA .__ DROUGH Case No.� HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT lPAP- c2 % NAME OF APPLICANTMAILING ADDRESS//6-� PHONE NO. u/ RESIDENCE ADDRESS LOCATION OF INSTALLA,�TTIION /7/GzSiOI �/�l��L-�Trrt/ LEGAL DESCRIPTION 7 � 44 �� /—� APPLICATION TO INSTALL: SEPTIC TANK L/ , SEEPAGEPIT '� , DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY � FINANCED THROUGH TO BE INSTALLED BY Z/� I� Z �iL'C�%'f (16�.Mi( TEST RESULTS ANTICIPATED DATE OF COMPLETION_ �LCs%7C; BELOW TO BE FILLED OUT BY HEALTH DEPARTMENTd� `!%Lit- ��f��l��l✓ THIS IS TO SERVE AS 154 &Z--17~- �5— PERMIT TO INSTALL A - AS DESCRIBED BELO SIZE OF UNIT TO BE SERVED _ .SEPTIC TANK SIZE / G `slYPE� 12L SEEPAGE A DISTANCES: �✓/I//%ifs%Gi�� P1 7- r -r —r61' &P, LtA)CT = 2,0' 0 --LAD A HEALTH AUTHORITY OR LICENSED DESIGNER I certify that I am familiar with the requirements of Greater Anch5prage Area Borough Ordina cc No. 28-68 and that th� above described system is in accordance with said code. �o��u� DATE C 55d APPLICANTS SIGNATUR'A/ ' DIAGRAM OF SYSTEM GAAB-HD.2 GREATEV ANCHORAGE AREA ._,,DROUGH Case No.� HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT L c���� MAILING ADDRESS PHONE NO. RESIDENCE ADDRESS LOCATION OF INSTALLATION LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK, SEEPAGE PIT DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITYr'�iiUc9i'? o' s --� :a FINANCED THROUGH TO BE INSTALLED BY )-2044A"f2 [Lvsr�L0"o0sk-� PERCOLATION TEST RESULTS fie© �C' ANTICIPATED DATE OF COMPLETION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS , PERMIT TO INSTALL A AS DESCRIBED BBE,L�OW. SIZE OF UNIT TO BE SERVED SEPTIC TANK SIZE L�}�TYPE SEEPAGE AREA TYPE DIAGRAM OF SYSTEM DISTANCES: Health Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE APPLICANTS SIGNATURE 327 � k Su,�� ;�e�``�•,,s'r,^,eEi.�...� performed For �� a, F F:£,�.. DE:se'ritotior, R o� ��- R`w cepa 4 . a: m R Depth F'eeY a ,wl 'The S�div,�e�ts wev� CVyyi P u cJ LU i f h CL vh U {arc Ee t,.tent. Tkev'e was � hrq� Vojjvr co�fev�4. Encountered?116 4 •. :J-,� rl et Test TesC performed 1 Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-092-38 Expiration Date: 1. GENERAL INFORMATION Complete legal description PANORAMA TERRACE SID; BLOCK 1, LOT 4A Location (site address) 9501 NETTLETON DRIVE, ANCHORAGE, AK, 99507 Current Property owner(s) TOM & ELIZABETH CRAWFORD Day phone Mailing address Real Estate Agent 9501 NETTLETON DRIVE, ANCHORAGE, AK, 99507 DAR WALDEN W/ KELLER WILLIAMS Day phone 952-7370 865-6406" 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 MAY 2 0 2014 L 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well U Community On-site U Public Water System ❑ Public Sewer ❑ WaiverNariance request for NIA Distance: - Received by: 7 COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ S" - Waiver Fee $ Date of Payment 6_-U41 Lf Date of Payment Receipt NumberReceipt Number COSA # _( 6 2-0 F Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the vali fdo:ul , ho r7 below, I verify that my investigation, based on procedures outlined in the Certl;icate of Of, 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. /further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507 Engineer's Printed Name Engineers Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, VD, attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readllyidentifiable features. The operationallife ofall wells and septic systems depend on the local soils condition, groundwaterlevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGAFATURE v/ System #1 Approved for Iq bedrooms. z System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the Phone 337-61179 Date 5/Z 6, /fq OF ANcy������. ON-SITE tldflk,TER ANO WABTEVVATER cz, u> Original Certificate Date: The &Vniciality� orage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon there, sen tions given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rov In1191191 Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA PANORAMA TERRACE S/D; BLOCK 1, LOT 4A Parcel ID: 015-092-38 `PER GEG INSPECTION. "ASSUMED BASED UPON SURROUNDING WELL LOGS.. Well type PRIVATE If A, B. OTC provide PWSID# N/A Date completed -1970 Sanitary seal (Y/N) YES Total depth `105+ ft. Cased to '•40+ ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: 'Vo ug./L. Nitrate 131ca; mg./L. Date of sample: S l Well Log (Y/N) NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 5/2/2014 105 ft. 6.42+ g.p.m. Collected by: GEG, Ltd. B. SEPTIC/HOLDING TANK DATA `DOUBLE CLEANOUTS BEFORE TANK. SEPTIC/CONCRETE `"SEE BIOCYCLE MAINTENANCE REPORT. 10/9/1970 Tank Type/Material SIOCYCLE Date installed 12/1-2/1997 1250 1 Tank size 1600 gal. Number of Compartments 4 Cleanouts (Y/N) YES/YES Foundation cleanout (Y/N) 'YES Depression over tank (Y/N) NO High water alarm (Y/N) "YES Date of pumping 5113 11 Pumper /q i Norv) r C. ABSORPTION FIELD DATA BELOW EXISTING GRADE TO BOTTOM OF MT Date installed 12/1-211997 Soil rating .p.d./ft r ft%drm) 1-2 System type TRENCH Length 32 ft. Width 2 ft. Gravel below pipe 8 ft. Total depth '12.0 ft. Eff. absorption area 512 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 5/2/2014 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 50 in. Water added640 gal. New depth 62 in. Elapsed Time: 120 min. Final fluid depth 59 in. Absorption rate >= 600+ g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION LIFT STATION INTEGRAL TO BIOCYCLE UNIT. SEE ATTACHED MAINTENANCE INSPECTION REPORT. Date installed Size in gallons Manhole/Access (Y/N)— "Pump on" level at in. "Pump off' level at wa er alarmlevel at E. SEPARATION DISTANCES Cycles tested Meets alarm & circuit requirements? 'APPROVED AT TIME OF INSTALLATION IN 1970 SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot '74' TANK/101' BIOCYCLE On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout NIA Sewer /septic service line 25'+ Animal containment areas 50'+ Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 51+ Water main N/A Wells on adjacent lots 100'+ Water service line 10'+ Surface water 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date gr ZchY (Rev. 10112112) N/A Driveway, parking/vehicle storage 10'+ /CE7 �l20 �fl''F • i pROFESSI��i�� •a , SGS Ref.P 1141731001 Client Name Gamess Engineering Group, Ltd Project Name/# 9501 Nettleton Client Sample ID 9501 Nettleton Matrix Drinking Water Printed DatelTime Collected Date/Time ReceiVed Datc/Thne Technical Director 05/21/2014 15:33 05/06/2014 13:30 05/06,/2014 16:12 Stephen C. Ede Sample Remarks: Note: Unpreseived container 1141731001-D collected 5/7/14 (a,) 10:00 am. Allowable Prep Analysis Parameter Results LOQ Units Method Container Ill Limits Date Date brit Metals by ICP/MS Hardness as CaCO3 192 5.00 mg/L SM21 2340B C 05/12/14 05/13/14 EAB Waters Department Total Nitrate/Nitrite-N 5.68 0.100 mg/L, SM21 450ONO3-F B (<10) 05/13/14 AYC Microbiology Laboratory B. Coli Negative 1 I00mL SM21 9223B A 05/06/14 KCT Trial C-obl m! Ngauvc 10OmL SM21 i2231 1 w K CT Private Individual Analysis Chloride 11.3 0-100 mg/L EPA 300.0 D (<250) 05/14/14 05/15/14 DSH Conductivity 380 1.00 umbos/cm SM21 2510B D 05/13/14 CDE Fluoride ND 0.100 mg/L EPA 300.0 D (<2) 05/16/14 05/16/14 DSH PH 7.80 0.100 pH units SM21 4500-H B D (65-8.5) 05/13/14 CDE Sulfate 15.4 0.100 mg/L EPA 300-0 D (<250) 05/14/14 05/15/14 DSH Total Dissolved Solids 256 100 mg/L. SM21 2540C D (<500) 05/08/14 SLC Alkalinity 151 10.0 mg/L SM21 2320B D 05/13/14 CDE Aluminum ND 20.0 ug/L EP200.8 C 05/12/14 05/13/14 EAB Antimony ND 1.00 ug/L EP200.8 C (<6) 05/12/14 05/13/14 EAB Arsenic ND 5.00 ug/L EP200.8 C (<10) 05/12/14 05/13/14 EAB Barium 10.5 3.00 ug/L EP200.8 C (<2000) 05/12;14 05/13/14 EAB Cadmium ND 0.500 ug/L EP200.8 C (<5) 05/12/14 05/13/14 EAB Calcium 59100 500 ug/L EP200.8 C 05/12/14 05/13/14 EAB Chromium 2.98 2.00 ug/L EP200.8 C (<100) 05/12/14 05/13/14 EAB Municipality of Anchorage Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 41209 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 1, Lot 4A of Panorama Terrace subdivision. This inspection revealed a nitrate concentration of 5.68 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. § 00 u \ \ c ■ _NETTS TON DRIVE _ _ __ !!! « \ \\�\j _NETTS TON DRIVE _ _ __ « \ BioCycle Alaska 4971 Thompson Drive Homer, AK 99603 226-2476 office 399-0331 cell Email: biocyclealaska@gci.net 9501 Nettleton Anchorage, AK 99516 272-0171 1st Quarte BioCycle Location Install Date: 12 --97 Tank #: 36 MAINTENANCE DESCRIPTION COMMENTS PRIMARY CHAMBER SCUM LEVEL OK HIGH BE SURE YOUR ALARM IS AERATION CHAMBER & AERATION SYSTEM BLOWER SIZE 0 80 120 L/MIN ALWAYS ON "NORMAL" NOT ON AERATION PRESSURE O HIGH LOW 'MUTE" NOISE LEVEL K HIGH GENERAL CONDITION POOR SYSTEM: AIR LEAKS LEAKS AIR DIFFUSER/AIR SUPPLY POOR MIXED LIQUOR CONDITION ODOR YES CLARIFICATION CHAMBER SLUDGE ACCUM IN HOPPER LOW HIGH CLARITY OF EFFLUENT CLE FAIR CLOUDY DISCHARGE CHAMBER DISCHARGE PUMP OPERATING YES NO ALARMS CHECKED AND OPERATIN AIR/POWER OYESNO HIGH WATER NO I st Quarter 2014 maintenance was performed BY: LARRY BETTS (862-7434/CHRIS 331-7978) DATE: �.D^ T IJ '10C�yeje Alaska 2nd Quart 3705 Arctic Ave. #313 Anchorage AK 99503 (907)274-0314 Email: hiocyclealaskat_79 i.net �aiCgrcfe Loc�t6®r� Cclstcarrser Nettleton }rage, AK 99516 _ _ ___ 171 install Date: 12 --97 -- COMMENTS MAINTENANCE DESCRIPTION PRIMARY CHAMBER SCUM LEVEL OK HIGH BE SURE YOUR ALARM IS AERATION CHAMBER & A.L-RAT[ON SYSTEM ALWAYS ON "NORMAL" NOT ON BLOWER SIZE 60 08 €zo L/MFN HIGH LOW - "MUTE" AERATION PRESSURE0-2 NOISE LEVEL 0 ' HIC GrNERAI CONDITION Oki. ) ' POOR LEAKS SYSTEM AIR LEAKS � AIR DIFFUSERAiR SI PPLY O POOR t MIXED LIQUOR CONDI HON ODOR YES CLARIFICATION CHAMBER SLUDGE ACCUM IN HOPPER L' I-I1GId CLARITY QG EPFLUEM FAIR CLOUDY DISCHARGE CHAMBER ,�;:'� DISCHARGE PUMP OPERATING t NO ALARMS CHECKED AND OPERATING AIRPOWER NO HIGH WATER /r ES NO 2nd Quarter maintenance performed by: BY: LARRY BETTS 862-74341CHR€S 331-7978) DATE;_ l _ ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND David P and Petra B Nickerson THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this k Day of of 20 -Li by and between herein the "OWNER, and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AW WTS), described as located at (legal description). Panorama Terrace, Lot 4A, Block 1 2. Definitions. Alteration. Any change to the design or function of an AW WTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certifieate of On -Site Systems Approval (COSA). 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 Anchorage Municipal Code (hereinafter, "AMC") 15.65. 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. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On -Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations. Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall maintain their AWWTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the municipality and the manufacturer of the AW WTS for the entire term of the AW WTS In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement, and any 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. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the A W WTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor, the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the fine for failing to maintain and repair an AW WTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved 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 AW WTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AW WTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AW WTS. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall be attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement, the only authorized representatives of the parties are: a. Owner: David & Petra Nickerson b. Municipality: Director, Community Development or designated authority C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER: ` By: (signature) Date: avid is era a (print name) Petra Nickerson STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) 5/6/14 The fgregoi instru�negt was acknowledged �iefore me thi day of y� 20/Cf,by /Jcli /�/ll/C�LErS� Y-4 t3;�i' iSGr� NOTARY PUBLIC FOR ALASKA My Commission expires:.3oLi2((p/.S MUNICIPALITY: By: (signature) name) NOTARYPUBGC SALGEA.NICKERSON STATE OF ALASKA AyrCotrrnissfon Expires August 30.2015 Date: Title: LOCATION OF WELL �v DE T OF NATURAL RESOURCES VISION OF WATER A AUG 2 011992 WATER WELL RECORD Al ACVA nu...,.. BOROUGH Sul�brIOBDNIBIO�.�,. Lor Btoac EAF�dr�q'ER'MLASKA $EcnON TowNwIP RANGE MErnnuw f [jjyllt�[INCIEace Z ❑S OW LOCATIONISKETH: WELL OWNER: ZnnQ1l �QnC'a/ DEPTHS MEASURED FROM:CJeasino top ❑oround surface WELL DEPTH:. DATE OF COMPLETION Depth of hole:ft BOREHOLE DATA Depih„ Depth of c#*4-, #t Z, Material: Type an# Color From " To DEPTH T STATIC W LEVEL: Lfi below) Mp of casing ❑ ground surface 4 Date: Z Z3 ❑ �D OF ORI�LCINO: ak rotary ❑cable tool 1 �6 ravel �� �� USE OF WELL: [/domestie ❑ irrigation 0 monitor ❑ public supply ❑ other f nc� �7 1 STICK- ft. Diam: �in. to ��i ft ng type: _in. to It (03 Casing &�vn CL / tDJ q I WELL INTAKE OPENING TYPE: X open end 0 screened ❑ perforated ❑ open hole nd , ( 91 �59 Depths of openings: to ft 5q 116 SCREEN TYPE: Diam: in. Slot/Mesh Size:. Length: ft �€ tQ r:n� y p 1 1 (7[ � Q GRAVB�W*T;`'PE U Volume Used: Depth to top: GROUT TYPV: Volume: Depth: from It to ft DEVELOPMENT METHOD: Duration: PUfjIPlJjtfi LEVEL AND YI€lD: 1'1J ft after ____L_ hrs purnping IL 9Pm PUMP INTAKE DEPTH: ft Horsepower: WELL DISUUFECTED UPON COMPLETION? YES ❑ NO rOR INFORMATION: REMARKS: 2r111,11-0 �, tyiteYArise5 �j 1(� Qo�- PLEASE MAIL WHITE COPY OF LOG TO: DNR/DIVISION OF WATER ate PO BOX 772116 EAGLE RIVER AK 99677-2116 MG DIPP_�' DRILLING * �* 7529 E. 6th Avenue • Anchorage, Alaska 99504 0 (907) 333-6435 July 14, 1954 mr. Greg Groenweg The following info-^ation is your cony of the well log for the property locate:: at Lot 2, Hillside Heigf,ts Subdivision. This should be retainea as your permanent record of improvements to your property. WELL LOG 0 TO 5 Feet Top soil 5 11 Sand, gravel 11 15 Sandy silt 15 28 Silt; sand, gravel 28 32 Silt, gravel 32 40 Silty San(], gravel 40 45 Gravel 45 51 Fine sand 51 75 Sand, gravel 75 78 Sand 78 85 Sand, gravel 85 96 Gravel 96 .101 Find sand, silt 101 103 Sand, gravel 103 115 Fine sand, silt 115 117 Sand, gravel 117 121 Silt 121 138 Sandy silt, gravel 138 142 Fine sand, silt 142 146 Sand, gravel 146 152 Silt 152 157 Silt, gravel 157 160 Sand, gravel 160 173 Fire sand 173 181 Silt 181 190 Sand, gravel 190 200 Gravel WATER 10 GALLONS PER MINUTE STATEMENT 200 Feet drilled and cased @ $20.00 per foot = $4,000.00 185 Feet galvanized pipe @ $1.50 per foot = 277.50 255 Feet wire @ .50 per foot = 127.50 Pump pitlessadapter 400.00 Setting pump 5 pitless adapter = 150.00 Total $4555.00 Thank you for specifying BIG DIPPER DRILLING for your water well needs. This will entitle you to two chances in the drawing for two round trip airline tickets to Hawaii. Tne drawir.c will be held in December. Sincerely, Cuek ���c ilE�)7CJ�S4 Y%IIJ� T /a -1 l k 3&-)l N59_ 06,i08a/,� C. R. Fron W 7.?- °"11er Licensed Bo s- dt"- 7CZ. EZT `IDE2ILLEI�G `v " im.1% POBox 10-681 - 13Q�'9v sTE P. . ` Anchorage, Alaska 99511 8f/� 4lCYi� F3 Ni MI ., 172 feet - SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF DRILLED AT THE RATE OF '33.00PER FOOT. Wrth rd W Gay , PROPERTY OWNER I"h l�hA l7,�,1 ( CMI.i–r4Fla - LOCATION OF WELL SITE— qri Ar1J F;�/tG�iDC� //TS DRILLER ^2JLLiJ C(r[� aP ?anPNv �Li %f in.r. WELL LOG: s fes, jnn�* g -tau?.( 35"S c,4 l:,Lmdo"t.. - 63 137' ccav=ac J SetrQty� �ma.1:1 �au.�dcRa. 7f� CCa4. r:Y 137--16Tr "o" A czay..W giiat)'ej. 1sq Used n, i, cy �ratad 165--172' Wa.#,uL. Qfit �T L oee� caa2©e,ta,lr& tp-cA 170 to 17.2 1Jn /2 f In! ion of 79 OPM lvGth 35 Pt""' of. vake- h-fzmd # an twor - 14 5 ."f !?1' •1T0 �(z'f•� e I ,.t YV � - 3.4}�fE+�:it v t. ^ • s 1 -- `17Oi .�N3 5S• (]n ro j.t Of iL!•{ ! {lfa .,. i 7i• QQ� P" 2 �Nf L '� it�1?"'xr04 �P�t ct.iY fic�.Xd Y lTK'��• 's!: Futa.74�"fY4. 7rd19},fi.Nw �dQ TU •: e rt7 J . ...:. n -.n �.:.r a�•Y ii.*l:ts",..4 �sJl $�k4Y4 ty1 Y1�i%3C;. .-�. '��� �i RtF l'T �yYi4}k.Y 44.k'j' 3 9 �rtYM?!7 lsdti"zd.,:; ., '.' ...., .., , �r• f..: '- .. '+.a :-:, .. '. '. - ,,F ,' �S� +_ uftr� COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING :_' ow S,� n3 t1SF. %IQ �'*- WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ' THANK YOU VERY MUCH: BERNIE CLAUS OF RAMPART DRILLING WORKS DATE ...r. ... ,�:... ;ti. �tj; `. i -\•J r\.. .. t�� Y'�` i ��. `L SERVICE CHARGE AF t % X ?ER MONTH WILL HE ASSESSED ON RAST DUE ACCOUNTS ,r a' Municipality of Anchorage Development Services Department �: C. - Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. 7 P.O. Box 196650 Anchorage, AK 99519-6650. 1'• W".ci.anchorage.akus (907) 343-7904 ,• .' CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING - Parcel I.D. 015-092-38 HAA# ;7':� •� �. ,.. Ex'iration Date: R :_' S ='03 1. GENERAL INFORMATION " P Complete legal description PANORAMA TERRACE SUBDMSION: _LOT 4A BLOCK 1. '' ' Location (site address or directions) '9501 NETTLETON ' DRIVE ' • ANCHORAGE, AK 99516 Current Property'owner'(s) BILL do JANA`LLOYD Dayyphone Mailing address . Lending agency'•, ,= _ z c Dayphone ' Mailing address,.-, ,; :,_ .:... ,:.:`. •.' .; BLAKE � BURER �w REMAX . PROPERTIES ; ="' 257=0152'' Real Estate Agent `' Day phone Mailing address 2600 CORDOVA STREET + ANCHORAGE. AK 9950j-. Unless otherwise requested, NM will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well a Individual On-site ' " Individual Water Storage ❑ Individual Holding tank ❑ CunityClass On-site Well ❑ Community O ❑ .'P . ub I I I i . c Water System ❑ PubliC Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions In the professional engineer's work. Note: Alaska Water -and Wastewater Consultants, Inc. shall be paid $ at, or prior to closing for the engineering services provided. ' . ' 4. STATEMENT OFJN9P9%ON BY ENGINEER As certified my saffixed hereto and as of the validation date shown below, I verify, a m investigation, bad on procedures outlined In the Health Authority Approval Guideliner th(s � tic shows that th,Q'lsn-site water supply and/or wastewater disposal system is(are) safe, fundi for the number of bedrooms and type of structure Indicated herein. I further verify that based t information obtained from the Municipality of Anchorage riles and from my investigation and inspec on-site watersupply and/or wastewater disposal system'is(arp) in compliance with all applicable Munn and State codes, ordinances, and regulations In effect at the time of installation. Name of Firm ALASKA WATER do WASTEWATER CONSULTANTS. INC. Phone ' 337-6179 Address 6901 DEBARR ROAD, SUk 2B ' ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date J� 2 03 Engineer's Comments: - In conducting thisevaluation, AKW WC, Inc. attempted to provide a thorough, . conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test. and separation, distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwaterlevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future perfoimance of the system,"nor do they guarantee that thereare no hidden defects oi' encroachments. i9KWWC, Inc. can ihen3fore not provide any warranty or future estimate of how long the system will continue to meet ft. -. operational requiminents of the ADEC or MOA DSD. The content of this report is for the sole benerit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor Mi11 it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. % Conditional approval for 4 bedrooms, with the tllowing stipulations: At the time of title transfer the new property own r shall sign rhe atrarhpd maintanence agreement which shall he rptnrnpd to this affire before an Attachments; • - HAA Checklist X Septic System Advisory Well Flow Advisory Manitenance Agreements Supplemental Engineers Reort Other By: 4(lr Original Certificate Date: (Rev. 14101) Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Sragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ct.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: PANORAMA TERRACE S/0; LOT 4A. BLOCK 1. Parcel ID: 015-092-38 A. WELL DATA Well type PMVATE If A. B, or C provide PWSID# N/A Date completed N1970 Sanitary seal (Y/N) YES Total depth i14+ ft. Cased to 40+ ft. FROM WELL LOG Date of test Static water level f ` t Well production g.p.rr WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 3.56 mgA. Well Log (Y/N) NO Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION 4/10/2003 113 fL 6.35 g.p.m. Other bacteria 0 colonies/100 ml. Arsenic N/A mg./L. Date of sample: 4/1012003 Collected by: AKWWC, INC. S. SEPTIC/HOLDING TANK DATA 10/9/1970 Tank Type/Material CONCRETE/BIOCYCLE Date Installed 12 1-2/1997 1250 Tank site 160 gal. Number of Compartments 1/4 Cleanouts (YM) YES Foundation deanout (YM) YES Depression over tank (YM) NO High water alarm (YM) N/A Date of pumping 4(23/2003 Pumper McDONALDS PUMPING C. ABSORPTION FIELD DATA']@ !"NO GRAD7 Date installed 12/1-2 �' Soll rating p.d r ft9bdrm) 1. r2 System type TRENCH Length 32 ft. Width 2 IL Gravel below pipe 6 ft. Total depth •11.9 ft. Eff. absorption area 512 fe Monitoring tube YES Depression over field NO Rate of adequacy test 4/10/2003 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth In absorption field before test 42.5 in. Water added 717 gal. New depth 78 in. Elapsed Time: 161 min. Final fluid depth 64 in. Absorption rate y= 600+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. BIOCYCLE *RECENT BIOCYCLE MAINTENANCE INSPECTION Date installed 12/1-2/1997 Size in gallons 1600 Manhole/Access (Y/N) YES "Pump on" level at 25 in. "Pump off" level at 44.5 in. High water alarm level at 22.5 in. Datum BOTTOM OF TANK Cycles tested *N/A Meets alarm & circuit requirements? YES E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: *INSTALLED PRIOR TO OCTOBER 1973 Septic tank/lift station on lot *747100'+ On adjacent lots 100'+ Absorption field on lot 1001+ On adjacent lots 1009+ Public sewer main N/A Public sewer manhole/cieanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property line 50+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingtvehicie storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in """ " ' ' • ""'' """ conformance with MOA HAA guidelines in effect on this date. f ey A. c ss Engineers Printed Na�ln'e JEFFREY A GARNESS o ' •• C —7953 Date HAA Fee 525. Rt�iS �-1 Waiver Fee $ $ � Date of Payment 3 Date of Payment Receipt Number Receipt Number (Rev. 12101) u J L. -31-1990 1612 Mr.I RF/MW PROPER lILS INC. tei Ctb V&4 P. km 3niao N0131113N a a O m 0 N D a _� `" r00 1 D vl 0 A 0 O I; O • D C D n . m o :t r c w C11 � w P.y $ % S .It-. os S E a �r�.r'3 S4p7�1 g 0 Eva Its 0 X -4 r a I � ® Y`u x Y' S zT Q ~ N 0 N o ,t'tr �II o� 1N3W3Sv] Alllilfl ,r)l ,00'Otl 3 ,00,ZO.00 S z•d best-s�z-r.os I comma .IaT�nQ B .laTgng dT01E0 EO 60 Jdd 0 N m Co A 0 O • D u_ . . .� A'S :t r Q ~ N 0 N o ,t'tr �II o� 1N3W3Sv] Alllilfl ,r)l ,00'Otl 3 ,00,ZO.00 S z•d best-s�z-r.os I comma .IaT�nQ B .laTgng dT01E0 EO 60 Jdd 04-18-03 04:00PM FROM -CUE ENVIRONWNTAL SRV SGS Ref.# 1031948001 Client Name AK Water & Wastewater Consultants Inc. Project Name/# Panorama Terrace L4A Bic 1 Client Sample ID Panorama Terrace L4A Bk 1 Matrix Drinking Water 9075615301 T-247 P.02/03 F-939 All Dates/fimcs are Alaska Standard Time Printed Daterl'irne 04/18/2003 13:50 Collected Date/Time 04/10/2003 18:00 Received Dale rime 04/11/2003 12:33 'rechnical Director Stephens C. Released IlY Sample Remarks: Allowable Prep Analysis Parrntelcr Results PQL Units Methud Limits Date Date Init Waters Department Nitrate -N 3.56 0.200 mg/L EPA 300.0 (<=10) 04/11/03 JS Microbiology Laboratory Total Coliform 0 col/100ml- SM18 92228 (<=1) 04/11/03 KAP MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0IS- —0 9 z - 3,5 1. GENERAL INFORMATION i�EC:EIVED AdUL 0 8 7998 UNICIPALrrY OF ANCHORAGE NVIRONMENTAL SERVICES DIVISION HAA # V\PS 980178 Complete legal description L Ot 11A, 6/1c 11 Pcmorc�mci Tevra« S/b Location (site address or directions) 93-01 IVel-f 1-e ko c Property owner Day phone (3e-01 68/ -6So Mailing address 103 Po!v Lune}� K m;� 983& 2 Lending agency Mailing address Day phone Agent Ca�-ot DoctfAj-¢ Pe Mc,vA Day phone 2 7,4'' Z?4'i Address 260 orGP�ua S�. f%cl7cy aGP, i}(c �150� Unless otherwise requested, HAA will be held for pickup. Z. NUMBER OF BEDROOMS: I 3. TYPE OF WATER SUPPLY: Individual well v Community well Public water 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.1791) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation dates h own 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 Elaf{r,e 7T_acA1) ier J Se`v«(ePhone Syr -13ss Address gcAe S><,, Arl,)oratP /fir 99S1lz Engineer's signature J74 - 57 Date ✓u iy !. 1998 DHHS SIGNATURE Approved for L) k- bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: Date -7- l o ` q.g-- 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 orderto satisfy certain federal and state requirements. Employees of DHHSdo 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 921 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: L,a t yAl P3 /Gc k / Pan aroma TeVr. Parcel I.D.: O IS -09 2 - 36 A. WELL DATA Well type Pr i v a Fe If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) N Date completed 1 7 Total depth ISD' Cased to 7 yoCasing height (above ground) Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS: g.p.m- Wires properly protected (Y/N) AT INSPECTION 18" Y _- -9/s-/ 96� (by SnKrlclune:�( � •� Coliform O col. /rao I,,,Q Nitrate 3.-7 my /-e Other bacteria Nvne ✓e�or/co( Date of sample: 7 / I /96 Collected by: FlaAlop -Tech. Ste[ B. SEPTIC/HOLDING TANK DATA 12 / 2 /97 16009 610cycle y Mr. H. Date installed r o / i97o Tank size � Number of Compartments 1 Cleanouts (Y/N) I- -7— Foundation Foundation cleanout (Y/N) N �` Depression (Y/N) N High water alarm (Y/N) _N•.f. Date of Pumping 7t8/9B Pumper C. ABSORPTION FIELD DATA c•v, not YP9'o( @ Date installed 12/'z/ 27 Soil rating (g.p.d./ft2 orft2/bdrm) /, 2 System type 7-re,?cl Length 32, Width 2 Gravel thickness below pipe Total depth 13 Effective absorption area SI 2 rY Monitoring Tube present (Y/N) r Depression over field (Y/N) N Date of adequacy test N- A. ( NtW) Results (Pass/Fail) PaU For bedrooms Fluid depth in absorption field before test (in.); 0 Immediately after_ gal. water added (in.): _ Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* If yes, give date N. 14- D. LIFT STATION Date installed 12 / 2 12 7 Size in gallons 00 ri Sic, CY c / Manhole/Access (Y/N) % "Pump on" level at' 2S" "Pump off' level at` High water alarm level at` 22 V401 `Datum Tog gaff Cycles tested N• ' jr Auia»cr, way e,/ E. SEPARATION DISTANCES cxf""� ci'nr/nlYerhi�ti SEPARATION DISTANCES FROM WELL ON LOT TO: 101' 1U (jruCYcll Septic/holding tank on lot 71 iv eo#7 c. S. T, A On adjacent lots > Absorption field on lot 13s-, On adjacent lots > oa ' Public sewer main N. A Public sewer manhole/cleanout N• /f . .Sewer /septic service line 7 2s ' Lift station 101 2"&C Y C ie SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 16'' Property line 7 10' Absorption field to Water main/service line > 10Surface water/drainage 10 100 ' Wells on adjacent lots > 1ao' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1(I' Building foundation 5V Water main/service line > 10 ' Surface water > �Y>' Driveway, parking/vehicle storage area > fa ' Curtain drain Nand feel) Wells on adjacent lots > 100' F. ENGINEER'S CERTIFICATION i certify that 1 have determined thru field inspections and review of Municipal ren in conformance with MOA HAA guidelines in effect on this date. Signature J Engineer's Name T hAeaad'e F. 1`100—e Date Ju 1 ��� 19996 HAA Fee $ 300 >C, Date of Payment —7 9g / Receipt Number 0 3 9 0 5r, (% 72-026 (Rev. 3/96)" Waiver Fee $ Date of Payment Receipt Number are JUS -04-1998 16:41 CTBE ESI ANCHORAGE �. KirEnvironmental �► iiim Inc CT&E Ret.# Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 982087007 Flattop Technical Srv. n/a 4A/I Panorama Terrace Drinking Water u' 9075615301 P.03i05 Client PO# Printed Date/Time 07/04/98 16:21 Collected Date/Time 07/01/98 15:00 Received Date/Time 07/01/98 17:00 Technical Director: Stephen C. Ede Released By Allowable Prep Analysis Parameter Results POL Units Method Limits Date Date tnit rotat Coliform 0 col/100mL We 92220 07/01/98 TMW litrete-M 3.31 0.100 mg/L EPA 300.0 10 max 07/02/98 07/02/98 RMV r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ::.. 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264.4720 99507 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete req es will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER �[N SINGLE FAMILY PHONE Ronald Morris V ❑ Three ❑ Six — F344-9993 MAILING ADDRESS MAI LIN - SRA Box 52-B Anc orage,Ak. 99507 , ❑ COMMUNITY PROPERTY -RESIDENT If differen from above) - _ ! / � PHONE NSA Nettle n R. 344-9893 2. BUYERPHONE Lgl INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date Robert West. 344-4587 MAILING ADDRESS`, - Vnh by this Department. P.0 Box 6525` n ra 3. LENDING INSTITUTION PHONE The Lomas & Nettl to Co 274-7661 MAILING ADDRESS 4449 Business PAr Bl Anchor , k. 9 3 4. REALTOR/AGENT PHONE Alaskan Realty 274-2634 MAILING ADDRESSt. 319 Gambell St. An�horage,Ak. 99501 5. LEGAL DESCRIPTION LotA B k STREET LOCATION NSA Nettleton Dr. Anchorage,Ak. 99507 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other �[N SINGLE FAMILY ❑ Two a Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ® 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 ❑ PUBLIC UTI LI TY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - Lgl INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) THIS SIDE FOR OFFICIAL USE ONL . INSPECTION APPOINTMENTS DATE RECEIVED -- TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 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 TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ❑ APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3178) 0 Florence Fifth Floor F R 0 Laura Harrison m Sewer and Water SIGNED Redif rms 4S 471 SEND PARTS 1 AND 3 WITH CARBON INTACT - 9 PARTS WILL BE RETURNED WITH REPLY. DETACH AND FILE FOR FOLLOW-UP DATE POLY VAN (50 SETS) NP 171 S'z-/-> --` l GREATER ANCHORAGE AREA BOROUGH �pV Department of Environmental Quality 1 �J 3500 Tudor Road, Anchorage, Alaska 99507 279-8686 l Date Received Time of Inspection Date of Inspection—E REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR w Zr 1. Aopro al Requested By e_.� Address: `^u.,J Phone:�1, 2. Prooerty Owner ° :Ac �Y Phone: A' 3. Legal Description: ,_-- 4. Location: 5. Type of Facility to be Inspected: Number of Bedrooms: f� r 6. Nell Data: A. Tvpe rs, B. C. Constructions C,,�.:1/;-_Y D. 7, Sewage Disnosal System: ftf .fC A. Installed I�17a B• Septic Tank: 1. Size 2. Depth Bacterial Analysis Installer Manufacturer D. Seepage Pit: I. Size 2. Material E. Disposal Field: Total Length of Lines g. 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 tj Request for Approval of Indiv' al Sewer & Water Facilities Page Two 9. Comments: Anrroved44 Uv Z c� bJi�approved Date 5���7j Approval `:valid for One Year From Date Signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subiect sewer and water facilities located at: Signed Date REPORT OF INSPECTION -INDIVIDUAL SEWAGE -DISPOSAL SYSTEM PRIMARY TREATMENT consists of ❑ Septic tank. ❑ Cesspool. Septic Tank: Distance from well, feet. Material, Number of compartments Total liquid capacity, gallons. Capacity inlet compartment, gallons. Inside length, ---feet. Inside width, fee[. Liquid depth, feet. Cesspool: Distance from: Well, feet; foundation, _feet; nearest lot line at ❑ front, ❑ side, ❑ rear, feet. Inside diameter, feet. Depth, feet. Liquid capacity, gallons. Lining material SECONDARY TREATMENT consists of ❑ Tile disposal field. ❑ Seepage pits. Other.. Tile Disposal Field: Distance from: Well, feet; foundation, feet; nearest lot line at ❑ front, ❑ side, ❑ rear Total length of tile lines,— feet. Number of lines, . Distance between lines,_ Trench width, _inches. Total effective absorption area in bottom of trenches, Length of each line, feet. Depth, top of the to finish grade, Type of filter material: ❑ Gravel. ❑ Broken stone. Other_ Depth of filter material beneath tile, inches. Depth of filter material over tile, Seepage Pits: Number of pits- . Outside diameter, feet. Depth, feet. Lining material Distance from: Well,_ feet; building foundation, feet; nearest lot line at ❑ front, ❑ side, ❑ rear Inspection made by: ❑ State. ❑ County. ❑ Local Health Authority. Inspected Date of inspection 19_ REPORT OF INSPECTION -INDIVIDUAL WATER -SUPPLY SYSTEM Distance to nearest public water main,_..—feet. Size of main, inches. Individual wells ❑ are ❑ arenotcustomary in neighbprhood. Give most recent record of failure of wells in immediate vicinity to furnish adequate supply of water Properties in neighborhood ❑ are ❑ are not being developed with both individual water -supply and sewage -disposal systems. Lot size: feet wide- --feet deep. Dwelling ser back from front property line, feet. Individual water supply from: ❑ Drilled well. ❑ Driven well. ❑ Dug well. ❑ Bored well. Distance of well from: feet. — feet. _square feet. inches. inches. feet. Building foundation, —feet; nearest lot line at ❑ front, ❑ side, ❑ rear, feet, cast iron sewer, feet; tile sewer, feet; septic tank, feet; disposal field, feet; seepage pit, --feet; cesspool, feet; other sources of possible pollution, feet. Well construction: Diameter, inches. Total depth, feet. Type of casing, Depth of casing, feet. Approximate depth to pumping level of water in well, feet. Approximate yield, gallons per minute. Sealed watertight to depth of feet. Exterior space around casing sealed with: ❑ Cement grout. ❑ Puddled clay. ❑ Ordinary backfill. Well cover: ❑ Concrete. ❑ Wood. ❑ Metal. Openings in well cover watertight: ❑ Yes. ❑ No. Pump: ❑ Shallow well. ❑ Deep well. Length of drop pipe, feet. Pump capacity, gallons per minute. Located in: ❑ Basement. ❑ Pumproom off basement. ❑ Pumphouse above ground. ❑ Pump pit. Pumproom properly drained: ❑ Yes. ❑ No. Pump mounting watertight: ❑ Yes. ❑ No. Type of storage: ❑ Pressure. ❑ Gravity. Capacity, gallons. Has bacteriological examination of water been made? ❑ Yes. ❑ No. If answer is "yes," give date Quality of water ❑ is ❑ is not satisfactory for human consumption. Installation ❑ does ❑ does not comply with approved exhibits, if any. Inspection made by: ❑ State. ❑ County. ❑ Local Health Authority. Inspected by Date of inspection I/ 19_ (TITLE) 19_ GPO 889-088 %EATER ANCHORAGE AREA BOROUt�I DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 DATE RECEIVED: ZZ--z-'%Z INSPECT: T I M E : /� :'e �-;) "� /z —.f --�'/ REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES FOR C{ �; ,�,r,� 1 . APPROVAL REQUESTED BY: ADDRESS: PHONE: �7/ 2. PROPERTY OWNER: S�%��� PHONE: 3. LEGAL DESCRIPTION: 4. TYPE FACILITY TO BE INSPECTED: STREET: NUMBER OF BEDROOMS: 5. WELL DATA: A. TYPE B. DEPTH C. SIZE D. CONSTRUCTION " tivot-LrVA E. BACTERIAL ANALYSISC Z'%-71. 6. SEWAGE DISPOSAL SYSTEM: A. SEPTIC TANK (IF HOMEMADE, SHOW DIAGRAM ON BACK) 1. SIZE 2. AGE 3. MANUFACTURER��C�%� 4. INSTALLER APPROVAL REQU��T FOR SEWER & WATER FACILITES PAGE TWO B. SEEPAGE PIT 1. SIZE 2. LINING C. DISPOSAL FIELD 1. NUMBER OF LINES�� 2. TOTAL LENGTH /e0-77 7. REQUIRED MEASUREMENTS A. WELL TO SEPTIC TANK B. WELL TO SEEPAGE PIT C. WELL TO SEWER LINE D. WELL TO PROPERTY LINE E. WELL TO OTHER POSSIBLE CONTAMINATION/(//Z F. FOUNDATION TO SEPTIC TANK i G. FOUNDATION TO SEEPAGE PIT i H. SEEPAGE PIT TO PROPERTY LINE 4� 8. COMMENTS: APPROVED: PROVED: DATE:—ZZ — -7 DATE: APPROVAL VALID FOR ONE YEAR FROM DATE SIGNED. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY