Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
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