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KENO HILLS BLK 2 LT 3
Onsite File Keno Hills Block 2 Lot 3 #020-171-06 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211242 PID Number: 020-171-06 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name PIERRE & MEGAN NICOLET ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ® Mound Site Address 17300 SPAIN DRIVE, ANCHORAGE ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 4" 2 GPD/SF JTotal 0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade +0.5 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot KENO HILLS 2 3 Fill added above original grade VARIES 3.16-3.21 Ft. Gravel length 20 Ft. Township Range Section Gravel width 15 Ft. Beds: Number of Lines 3 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 300 Ft2 -- -- Ft. Well 50'+ 50'+ 50'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ® Other ADVANTEX Manufacturer ORENCO / ANCH. TANK Capacity 1500 Gal. Surface Water 50'+ 50'+ 50'+ Material COMPOSITE PLASTIC Number of compartments 2 Lot Line 5'+ 5'+ 5'+ NA Foundation 10'+ 10'+ 10'+ LIFT STATION Manufacturer ORENCO Capacity 1500 Gal. Remarks GROUNDWATER AT 3'+ FROM GRADE. BED INSTALLED AT EXISTING GRADE. FIELD INSULATED Alarm location BASEMENT Electrical installed by DRS ELECTRIC Tank to PIPE MATERIAL House to tank 3034 3034 Installer J RS drainfield Drainfield 3034 CC/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdection V1 8/25/21 8/26/21 Location and description Zed 3`d 8/30/21 4" 8/31/21 TANK MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF Conditional Approval: DateAve TH Septic . • • • . Curtis Huffman Aro edstem Approved RA4CCA.-0;01Date Gi�.•CE128991 ,? l 0.1 l 'tow �� TFC . Pi7/202 t, . �� ' �����'ROFESS1dNA Note: this approval does not include well permit requirements. ��ROFiSS~ trcev uoivu !O) PERMIT: OSP211242 PID: 020-171-06 A -C=29,2' B -C=78.2' A -D=34.8' / MT \ 15'X20' MOUNDED y 0 BED. REBUILD FOR 4BR RESERVE \TH21-1 MT H G�- O \� \ < Yx (k WELL 50' WELL RADIUS 35'+ TO SLOPE LOT 3 BREAK BLK 2 B -D=83.6' DECOMMISSIONED EXISTING A -E=36.6' �! C� SYSTEM & INSTALLED NEW 1500—GAL ADVANTEX SYST. W/ NEW DFCO & LS. TH21-1 6' OF TOPSOIL M TOP MH B -E=78.3' D C AX20 POD 15' X 20' BED / MOUND DFCO A -F=35.8' MMISSIONED PUMP FOUND AT CONST. CRIB BASIN E 100'23 / MT \ 15'X20' MOUNDED y 0 BED. REBUILD FOR 4BR RESERVE \TH21-1 MT H G�- O \� \ < Yx (k WELL 50' WELL RADIUS 35'+ TO SLOPE LOT 3 BREAK BLK 2 B -D=83.6' DFCO 99,98 MH BM MH A -E=36.6' 102.94 TH21-1 6' OF TOPSOIL B -E=78.3' AX20 POD 15' X 20' BED / MOUND 1' A -F=35.8' FABRIC & INSULATION FOUND AT CONST. 6' OF SEWER ROCK 100'23 SM/GM TOPOF 99.73 97.03 1'+ MOA SAND B -F=61.3' 96.16 1500 -GAL OBSERVED A -G=48.5' 98.73 ADVANTEX FAP 2.0 TANK PUMP BASIN B -G=71.5' FROM GRADE SEPTIC SECTION OF MOA A -H=57.7' B -H=62.0' A -I=47.6' KENO HILLS B2, L3 B -I=49.6' PREPARED FOR: 85.73 PIERRE & MEGAN NICOLET 17300 SPAIN DRIVE ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 Sues Way Anchorage, Alaska 99516 (907)350-9566 FirstWaterAK®gmail.com 1 311 SLOPE TYP, 100.2 99.73 ORIGINAL GRADE MT MT 102.94 TH21-1 6' OF TOPSOIL ONLY 1' 15' X 20' BED / MOUND 1' of ORG/OL FABRIC & INSULATION FOUND AT CONST. 6' OF SEWER ROCK 100'23 SM/GM TOPOF 99.73 1'+ MOA SAND GRND. WATER OBSERVED 98.73 AT 3'+ BOTTOM FROM GRADE SEPTIC SECTION OF MOA 8/30/21 SAND SCALE; NTS 14' 85.73 BOH NOTE: 1.5' PRESSURISED HOLE SPACING SUPPFORT$SERVICES: ��_\ OF ALww�' C S .d \ 1 c 9 Tx 1, DATE: 9/7/2021 /, rtis Huffmani SURVEY: JLS 1 �fh CE 128991 ` DRAWN: FWCS 9/7/2021 SCALE: 1" = 30' \ '%0FESSIO0 i' PAGE: 1 OF 1 N90000'00"E 385.93' ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: QQ = FND 5/8" REBAR KENO HILLS SUBDIVISION LOT 3 BLOCK 2 PLAT 71-150 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a /! . O• .A 1 ti LAND V physical survey of this property as shown on this drawing and that theAwl, �1 improvements situated hereon are within the property lines and no `�' • 1 �� enchroachments exist other than noted. Under no circumstance should �..° 4 9TH °.'� , ,� o� V �1 NN any information on this drawing be used for construction of fences structures improvements, or for establishing boundary lines. RA •p � g ry PA � EXCLUSION NOTES: It is the owners responsibility to determine ... ' ' . ' ' ' ' 'i''A U*1 the existence of an easements covenants or restrictions which co .J HN L. SCHULLER.• - , y ` N LS -10408 do not appear on the recorded subdivision plat. + � / '"�--;- •°°�'" � . • �� / 1831 Talkeetna Street WORK ORDER NUMBER: DATE: SCALE: n E-MAIL• to oQ, ' •,,,��,, � Anchorage, Alaska 99508 SEPT 6, 2021 1 =60 schuller®ak.net Ar fit, ° es 'ona �' '~' 907 22'7-1455 office 21—O77—Z DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE- \\ f SI ` � ( JLS SW2637 210318 \\�� n,3\ (907) 274-4992 fax o< '9� s 3 f MUNICIPALITY OF ANCHORAGE On-Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:fJs,,,,wJ.muni.argtonsite p��nr i On-Site Wastewater Disposal System Permit Permit Number: OSP211242 Effective Date: 7/1/2021 Work Type: Septic Upgrade Tax Code Number: 02017106000 Site Legal Address: KENO HILLS BLK 2 LT 3 G:3438 Site Mailing Address: 17300 SPAIN DR, Anchorage Owner: NICOLET PIERRE J Design Engineer: FIRST WATER CONSULTING Expiration Date: 7/1/2022 __ ._ Lot Size in Sq Ft: 102366 Total Bedrooms: 3 This permit is for the construction of: Q Disposal Field 21 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Issued By: `r 7/1/2021 Date: Date: 7 A- __ IIIIIIIIIIIII IIIIIIIIIii 11-111 111 111 IIIIIIIIIq 111111111111 111 111 =10 I KOW-IM 1 ON-SITE SEPTICMELL PERMIT -APPLICATION Parcel I.D. 020-171-06 Property owner(s) PIERRE & MEGAN NICOLET Day phone Mailing address 17300 SPAIN DRIVE, ANCHORAGE, AK 99516 Site address 17300 SPAIN DRIVE, ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) KENO HILLS 132, L3 Legal description (Township, Range & Section) Lot Size 102,366 Sq. Ft. Number of Bedrooms ;5� � APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Q Initial ❑ Single Family (SF) Z (w/wo ADU) Septic Tank E Upgrade FE Duplex r_1 (D) Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: �W 575, Waiver Fees: Date of Payment: 05 2 6 9 Date of Payment: Receipt Number: a 7 2 S Receipt Number: Permit No. 0 SP,a 1 �( Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forn Client Forms\Permit Application.doc FF -45[ C O N S U L T i N U A7 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com August 25, 2021 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: KENO HILLS BLOCK 2, LOT 3 Groundwater was monitored today (8/25/21) at 9' from grade, which requires a design change per the attached modified design. Based on this design change, a pump basin will be installed with 2 pressurized trenches and the existing crib will be decommissioned. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. �' l.iF .IE'tfdlER ��. r .name 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com June 22, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: KENO HILLS BLOCK 2, LOT 3 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one shallow trench and a 1500-gallon Advantex tank / system to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted. No groundwater was observed at test hole excavation or monitoring. The slopes are moderate at 0-5% at the proposed upgrade location. Steep slopes in excess of 25- 35% are 30+ from the proposed field, but the site and design meet the steep slope provisions of AMC 15.65.210 B.4. The system is sized for 4-bedrooms and the reserve site will be in the same location as the proposed field as a remove & replace upgrade in the future if needed and/or the crib provides another appropriate 4BR reserve. This is a problematic lot restrained by slope, extremely small useable septic area, slower percolating soils, creek, wells, The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211242, Deb Wockenfuss, 07/01/21 DESIGN CALCS: 4 BDRM X 150 GPD = 600 GPD 600 GPD/1.5 GPD/SF. = 400 SF SAS 400 SF / 5 x 0.7 RF (2' ED) = 60 FT. TRENCH USE 2 TRENCHES - 30' (L) X 5' (W) X 2'(ED) TOTAL DEPTH FROM EXISTING GRADE, -5' MAX USED REDUCED APPLICATOIN RATE C� 1 DECOMMISSION EXISTING CRIB 60 LF 1 1/4" PVC WITH 3/16" HOLES @ 2' SPACING (TYP) NOTES: STAKE REQUIRED SETBACKS PRIOR 100' WELL RADIUS E- 100' WELL W RADIUS ' i- Cn � 10a `Lpp V e. Cjh 100' WELL AN= RADIUS W/IflNw=W M/ OFCQ OCO t W. MMISCRIB SIGN F O y ww E� JSP ego �P� WELL r ryryo.3TO !y SLOPE APPROX. 100' CREEK SETBACK ----TOP ON SLOPE \ APPROX. 50'/ CREEK SETBACK h LITTLE SURVIVAL CREEK APPROX. LOC. NO SLOPES >25% WITHIN 30' OF PROPOSED FIELD. KENO HILLS BLOCK 2, LOT 3 PREPARED FOR: PIERRE & MEGAN NICOLET 17300 SPAIN DRIVE ANCHORAGE, AK 99516 TO CONSTRUCTION PAVED D/W LOT 3 BLK 2 10' UTILITY ESMT N90 00'00"E FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 FirstWaterAK@gmail.com �SyFO O 0 385.93' SUPPORT SERVICES: � a . DATE: 8/25/2021 SURVEY: JLS DRAWN: FWCS SCALE: 1" = 60' PAGE: 1 OF 2 ZZ NO WELLS OR SURFACE WATER WITHIN 50' 50' OF PROPOSED SEPTIC SYSTEM OF 9 TII (irtis Huffman a, f� CE 128991 8/25/2021��� ��sstoK�' #1 DESIGN DETAILS: INSTALL NEW 1500—GAL ADVANTEX TANK SYSTEM. MAINTAIN 10'+ FROM FOUNDATION, 50' TO WELLS, 5' TO FIELD & DECK SUPPORTS WITH 4' OF COVER OR INSULATION. INSTALL 2 401 x 5'W x 2'ED TRENCHES —5' MAX FROM GRADE w/ 3'+ OF COVER MAINTAINING 50' TO WELLS / SURFACE WATER, 10' TO LOT LINE,.... INSTALL PER AMC 15.65, 15.55, & MASS ... TANK BEDDING, SEPARATIONS, MATERIALS,... KENO HILLS BLOCK 2, LOT 3 PREPARED FOR: PIERRE & MEGAN NICOLET 17300 SPAIN DRIVE ANCHORAGE, AK 99516 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 APPROX. CREEK SE- FirstWaterAK®gmail.com DATE: 8/25/2021 �rti's Huffman �v SURVEY: JLS CE 128991 4 DRAWN: FWCS g/25/2021 �'� AO SCALE: 1 F 30,�nsslvgg PAGE: 1 OF 2 F'W", r s I Water CONS U L T I N G 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAKLwginail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: KENO HILLS B2 L3 DEPTH Gross Net Time Time FEET OG SOILS 6/16/21 ORG/OL 1 12/16" 2 30 min 3 12/16" 4 30 min 5 12/16" 6 7 SM/GM 8 9 10 11 12 13 14 BOH 15 16 17 18 19 20 • 7H %: .. ..::... Curtis Huffman �� �Fc •, CE 1289916120.12 1 80FEMON ..� PERFORMED FOR: PIERRE & MEGAN NICOLET TESTHOLE # 21-1 DATE PERFORMED: 6/14/21 GROUNDWATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 6/22/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION 8/25/2021 - GROUNDWATER AT 9' Reading Date Gross Net Time Time Depth to Water Net Drop 6/16/21 30 min 6" 12/16" 30 min 6" 12/16" 30 min 6" 12/16" PERCOLATION RATE 40 (MIN/ INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6" PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16". PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/22/2021 N90000'00"E 385.93 $ ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: KENO HILLS SUBDIVISION = FND 5/8" REBAR LOT 3 BLOCK 2 PLAT 71-150 SURVEY CERTIFICATE: 1. John L. Schuller Have conducted a A%W O F 4h�L physical survey of this property as shown on this drawing and that the . • • . Off' improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should / 4TH •. ,,� �'�► any information on this drawing be used for construction offences, ;4, structures, improvements, or for establishing boundary lines.RA.... ................ / PA EXCLUSION NOTES: It is the owners responsibility to determine F .. ':• ' '° '''•..'. ..•'''''• o • JOHN L. SCHULLER.• o / the existence of any easements, covenants, or restrictions which # ,�. •, do not appear on the recorded subdivision plat. �� '., LS -1(408 .•' `�� •,,,,,,,,�, ,,,,,,,�. J / 1831 Talkeetna Street WORK ORDER NUMBER: DATE: SCALE: n Anchorage, E-MA{L + , ; Zj: `� /eAlaska 99508 schutlerfak.net aAr a� AMW JUNE 9, 2021 1 =60 21-077 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: �fe$s©n4N �' •� (907) 227--1455 office JLS SW2637 210175 �`� �►''''�` (907) 274--4992 fax Jou n Lill, ,., Yki• ERutd. We WO&Q or �� N t tL']�G�ALIT a ��c° un ori � , ; in 7 ,de 4� 1i,ttl�rti.,Iof ffic rnitt�i r,:rf von, amrrtid It ochk. c, i- l . ; . Ya c t ,K�t ° Tr ,�t em S The Vaf r� at;il ;a+ ci 'r a t r, ,. $ 10 erkt A ,rte„ ��x ri c ;; '.n�(A", — d. w—un bed as AN AIQVANTEX�SMWEIA k NO ,HILLS BZ, 2t iand , her2 iwi . ( -%vner i- re u rod to rcac. -un&rFitand amici. initial C S of ;) ' Tit�� ��k�fi:'I team of this grccmc� vt,°tie ��,LICT,; ttentai"ut, a.S' rift's ►g�i=���7�i�i %with a ri NV77S service and mmi:r�t���i►� � r��i �t� Toved by the i'vfiapil:i ali! Y, or dv trr ± u,t t r rY ax. x tai th1c. '.t .;MV "V trr tt is ii'rt i s r a t rf 4,r�air171c ofriii7ifcu ir4xi1ctrt trtr pit rui:r7 wixh the e ui 'rr�c t ��E x����l fir ►������i n cr< the,\Mur,061a `...... uI, 'ap x�%v'P' VT r�dL��'� ULy r u to pay Or Ott cos t bi 11 LTIJSiy tic puteiltt"'l rl,TV'll 01"I ER. � 1 By / alum) Date: �{' 2 % -e ( -----_(print name) STATE Of ,ALASKA ) TI-IIRD JUDICLAL DISTRICT- — — — The foregoi ig instrument was acknowledged before me this day.of t 20 L( by MVV U4 -' � G � � l C 61.x.-� . , M. SERA TUINIUA Notary Public LIC k 'OR- ALASI A State of Alaska My, O isslon expires: jn My Commission Expires Mae 15, 2025 MUNICIPALITY: By:- (signature) Date: O z l (print name) Title: Page 3 of3' a (rev. 0511 &1201 8) GRE ER ANCHORAGE ARI::A UU L H Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ONqSITE SEWAGE DISPOSAL SYSTEM NAME ~A ~::,,"~'~'~'~'~'~'~,'~'~'"~'~//-~'~-'~'~' MAILING ADDRESS ~t~',,~,,~-~ ~_~.,//./.~/~'~r'.~,,,,?~.~ E LOCATION ~/~/~ ~~ LEGAL DESCRIPTION ~/~ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH , MANUFACTURER f,~'/'.'~"'~-~" MATERIAL INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY /---:;~J--~ ~ GALLONS. SEEPAGE PIT: NUMBER OF PITS / DIAMETER .,~_2- / . OR WIDTH ~, LENGTH ~- DEPTH ~/~/~ ~' LINING MATERIAL ~/~c/~_~, CRIB SIZE: DIAMETER ~/~ ~DEPTH f /DISTANCE FROM: WELL//~-<~ / TOTAL EFFECTIVE BUILDING FOUNDATIONf//Z'm'%~' NEAREST LOT LINE -~-~ ABSORPTION AREA (WALL AREA) 7~Z- SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE/,~'/~'/~/'/*~'~'~ CONSTRUCTION ~'J~//~'~ X/~-~ DEPTH BUILDING NEA REST /~ ~_ NEA REST SEPTIC FOUNDATION/~/~, LOT LINE SEWER LINE/~-, TANK CE$SPOO l/-,/g/J./~--' APPROVED OTHER SOURCES ·,/-/~'/C/~'~- ~"/f,/,m~_./'// DISAPPROVED ~"--/ ~-~--~ DISTANCE FROM: / SEEPAGE //~-~, SYSTEM INSTALLED BY: PIPE MATERIAL: LOT SLOPE: Form No. EQ-O3'/ DIAGRAM OF SYSTEM DATE G.A.A.B. GreaTer ANChORaGe ArEa BOROUgh DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 9'9503 TELEPHONE 274"456! PERMIT NO, SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT SEEPAGE PIT ~ ~i , DRAIN FIELD INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH COMPLET,ONDAtEANT,C,FatED × MAILING ADDRESS ~ , OTHER NOTE; THIS PERMIT I$ NOT VALID WITHOUT SOIl. TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTIO/N. / ~ ~ DIAGRAM OF SYSTEM ., DRAIN FIELD SEEPAGE PIT d/E~''~) '/ ALSO CONSIDER AREA WELLS. SEEPAGE PIT MINIMUM DISTANCES, REQUIREMENTS // FOUNDATION TO SEPTIC TANK ~ FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL ,~ ~ ~ SEPTIC TANK ., SEEPAGE PiT ~ / TO NEAREST LOT LINE. WELL TO SEPtiC tank /L~/ DRAIN FIELD WATER MAIN TO SEPTIC TANK /'4~1 / DRAIN FIELD ~ j SEPTIC TANK, ~/ /~ , SEEPAGE PiT f/ ~ DRAIN FIELD . TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION ~ FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. / G.^.A~. OR Department of Environmental Q~ty 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST Performed for /~ ~/~~,~_.. Date Performed Legal Description:_ ?m~j This form reports: Soils log ..g. Percolation test Depth Feet 5- If yes, at what depth? Reading Date Percolation rate Proposed ~nstallat]on: Depth of Inlet COMb'.tENTS: Gross Time Net Time minute. Seepage Pit Drain Field Depth to bottom ~-{-~it or trench Depth to Water Net Drop Performed By: ........... ~_ .... _Certified By: EQ-040 (6/74) Date: Certificate of On -Site Systems Approval ` _ �- Parcel I.D. 020-171-06 Expiration Date: 1. GENERAL INFORMATION Complete legal description KENO HILLS BLOCK 2 LOT 3 Location (site address) 17300 SPAIN DRIVE ANCHORAGE AK 99516 Current property owner(s) PIERRE & MEGAN NICOLET Day phone Mailing address Real estate agent 17300 SPAIN DRIVE ANCHORAGE AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 2e Waiver Fee $ Date of Payment g 7 120 9'1 Date of Payment Receipt Number a"d�. Receipt Number COSA # 0 SC a 1 i V3 2 �2 Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 12/14/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the •�f(i "'�•q well and septic system. Therefore, any estimate of how long a system will function satisfactory �A.:Q: •' • . for current or future occupants or guarantee that no unseen encroachments, deficiencies or g ' discrepancies exist can be given by First Water Consulting & FWCS ' / *' •� Piz '* - W . .: ...... r 6. DSD SIGNATURE "" "' 1 Curtis Huffman / System #1 Approvedfor bedrooms ���PF��s•,. CE 128991 y Approved for bedrooms lj��`oP1 FESSIONP���"r System #2 A Disapproved Conditional approval for bedrooms, with the following stip `l ttiRTR ((((( 4_\1y OFq ((rr1-i �\ O /r�r r _WATER AND m v 'AT z m p ER ko 'J 'SERVI�E����`,~ BY /i� & &tau Original Certificate Date: 11,51AO a The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: KENO HILLS BLOCK 2, LOT 3 Parcel ID: 020-171-06 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled CIRCA 1974 Total depth 51 ft (PER DOCS & ACOUSTIC READINGS) Cased to UNKNOWN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/28/2021 Static water level at beginning of test 34 ft. Well production at time of test 6 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.30 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 11/30/2021 Comments __________________________________________________________________________________ B. TANK DATA – NEW TANK Age of tank(s) 0 years Tank type/material ADVANTEX / COMPOSITE PLASTIC Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station 0 years Lift station material PLASTIC Comments: D. ABSORPTION FIELD DATA – NEW FIELD Which system tested (date installed) 8/2021 ALL standpipes present per record drawing Total measured depth from grade 3.2 ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date NA – NEW FIELD Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *50+ ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No * ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No * ft Community Wells > 200’ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No * ft If absorption field is under driveway comment below Wells on Adjacent Lots: *Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *MEETS CAT III SEPARATION REQUIREMENTS. G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 12/14/21 Received Date/Time 11/30/2021 13:13 11/30/2021 12:40Collected Date/Time 1217687001 Matrix SGS Ref.# Client Sample ID 17300 Spain Client Name Project Name/# Printed Date/Time 12/14/2021 14:12First Water Consulting Services (FWCS) Technical Director Stephen C. Ede 17300 Spain Drinking Water Sample Remarks: Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID EWW12/03/21SM21 2540Cmg/LTotal Dissolved Solids 183 10.0 (<500) A Metals by ICP/MS DSD12/06/21SM21 2340Bmg/LHardness as CaCO3 12/03/211675.00 C Waters Department (Provisional Cert for Nitrate-N) EBH12/10/21SM21 4500NO3-Fmg/LTotal Nitrate/Nitrite-N 4.30 0.200 (<10) D Microbiology Laboratory M.A11/30/21SM21 9223B100mLE. Coli Negative 1 B M.A11/30/21SM21 9223B100mLTotal Coliform Negative 1 B Private Individual Analysis EWW12/07/21EPA 300.0mg/LChloride 12/06/2112.9 0.200 (<250) A EWW12/02/21SM21 2510Bumhos/cmConductivity3045.00 A EWW12/07/21EPA 300.0mg/LFluoride 12/06/21ND0.200 (<2)A EWW12/07/21EPA 300.0mg/LSulfate 12/06/2113.9 0.200 (<250) A EWW12/02/21SM21 2320Bmg/LAlkalinity11410.0 A DSD12/06/21EP200.8ug/LAluminum 12/03/21ND20.0 C DSD12/06/21EP200.8ug/LAntimony 12/03/21ND1.00 (<6)C DSD12/06/21EP200.8ug/LArsenic 12/03/21ND5.00 (<10)C DSD12/06/21EP200.8ug/LBarium 12/03/2116.0 3.00 (<2000) C DSD12/06/21EP200.8ug/LCadmium 12/03/21ND0.500 (<5)C DSD12/06/21EP200.8ug/LCalcium 12/03/2152100500C DSD12/06/21EP200.8ug/LChromium 12/03/21ND5.00 (<100)C EWW12/02/21SM21 2320Bmg/LCO3 Alkalinity ND 10.0 A 2 of 6 Received Date/Time 11/30/2021 13:13 11/30/2021 12:40Collected Date/Time 1217687001 Matrix SGS Ref.# Client Sample ID 17300 Spain Client Name Project Name/# Printed Date/Time 12/14/2021 14:12First Water Consulting Services (FWCS) Technical Director Stephen C. Ede 17300 Spain Drinking Water Parameter Results LOQ Units Method Allowable Limits Prep Date Analysis Date InitContainer ID Private Individual Analysis DSD12/06/21EP200.8ug/LCopper 12/03/2130.5 1.00 (<1000) C EWW12/02/21SM21 2320Bmg/LHCO3 Alkalinity 114 10.0 A DSD12/06/21EP200.8ug/LIron 12/03/21ND250(<300)C DSD12/06/21EP200.8ug/LLead 12/03/211.01 0.200 (<15) C DSD12/06/21EP200.8ug/LMagnesium 12/03/21884050.0 C DSD12/06/21EP200.8ug/LManganese 12/03/217.33 1.00 (<50) C DSD12/06/21EP200.8ug/LNickel 12/03/21ND2.00 (<100)C EWW12/02/21SM21 2320Bmg/LOH Alkalinity ND 10.0 A EWW12/02/21SM21 4500-H BpH unitspH7.7 0.100 (6.5-8.5) A DSD12/06/21EP200.8ug/LPotassium 12/03/21578500C DSD12/06/21EP200.8ug/LSelenium 12/03/21ND5.00 (<50)C DSD12/06/21EP200.8ug/LSilver 12/03/21ND1.00 (<100)C DSD12/07/21EP200.8ug/LSodium 12/03/215980500C DSD12/06/21EP200.8ug/LThallium 12/03/21ND1.00 (<2)C DSD12/06/21EP200.8ug/LZinc 12/03/2161.7 10.0 (<5000) C 3 of 6 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and _ entered into as of this R1 Day of of 20,2,1 'by and between ��� { �' i�l Y�.i"n 5�°, r►.. jj` rtl� , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as l- -300 located at (legal description) KtAp L3 C3,;z- 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) W I Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in r accordance with the equipment's approval for operation in the Municipality. �a It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, �j repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 vrt Owner acknowledges that the Municipality may request records of maintenance and �( repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. CIO Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. C%(l� Owner agrees that any sale or transfer of title of the property will not occur without a new �^ Certificate of On -Site Systems Approval. r Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this 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 Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OWNER: _ By: ``- =-=` °°�� r `�---signature) Date: (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this � 'day of f !K7, 'TA PUBLIC FOR ALASKA —11y Commission expires: MUNICIPALITY: J By: _ (signature) � RebeCC� �I-v Z/ (print name) BENJAMIN SISSEL Notary Public State of Alaska My Commission Expires Dec 1, 2024 Date: Title: (rev. 05/18/2018) Page 3 of 3 U L`I \:1 Vim' J to U {I1 L I T L+J o W ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-171-06 1. GENERAL INFORMATION Complete legal description KENO HILLS BLOCK 2, LOT 3 Expiration Date: be C 02 2 1 Location (site address) 17300 SPAIN DRIVE, ANCHORAGE, AK 9951 Current property owner(s) PIERRE & MEGAN NICOLET Day phone Mailing address Real estate agent 17300 SPAIN DRIVE, ANCHORAGE, AK 99516 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Q aD + Waiver Fee $ Date of Payment 0 /1.2 0-2. % Date of Payment Receipt Number 7 1 7,2o z Receipt Number COSA# 0SC2fIS0,( a�Slz c 26�43Z Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN PE_ Date 8/26/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to Or— A4 these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or ""r G) •� �� discrepancies exist can be given by First Water Consulting & dr � TH •• FI~i, ........ 6. DSD SIGNATURE• •• •-" �/ • • • Curtis Huffman JSystem #1 Approved for 7 bedrooms �i� �,� •. CE 128991 - �� �F,�• • .$r?size • •��,.-� System #2 Approved for bedrooms ���FOpROFESSiQW_-.� Disapproved Conditional approval for bedrooms, with the following stipulations: OF FNi By: �Original Certificate Date: / �% O02 % The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other z FNi By: �Original Certificate Date: / �% O02 % The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: KENO HILLS BLOCK 2, LOT 3 Parcel ID: 020-171-06 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled CIRCA 1974 Total depth 51 ft (PER DOCS & ACOUSTIC READINGS) Cased to UNKNOWN ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 5/28/2021 Static water level at beginning of test 34 ft. Well production at time of test 6 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 4.73 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 5/28/2021 Comments __________________________________________________________________________________ B. TANK DATA – NEW TANK Age of tank(s) 0 years Tank type/material ADVANTEX / COMPOSITE PLASTIC Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping C. LIFT STATION Required maintenance completed Age of lift station 0 years Lift station material PLASTIC Comments: D. ABSORPTION FIELD DATA – NEW FIELD Which system tested (date installed) 8/2021 ALL standpipes present per record drawing Total measured depth from grade 3.2 ft (max) Measured depth to pipe invert from grade ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date NA – NEW FIELD Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100’ Yes if No *50+ ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No *50+ ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No * ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No * ft Community Wells > 200’ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10’ Yes if No ft Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No * ft If absorption field is under driveway comment below Wells on Adjacent Lots: *Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *MEETS CAT III SEPARATION REQUIREMENTS. G. ENGINEER’S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 9/7/21 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received January 12, 1976 Time of Inspection Date of Inspection C",/~, REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Cony. 4. 5. 6. Approval requested by: First National Bank of Anchorage Mailing Address: Post Office Box 720, 99510 Phone: 279-4481 Property Owner: Thomas P. & Allyson Gallagher Mailing Address: Star Route A Box 475G, 99507 Phone: 344-6438 (h) Z/~-~b~b (w) Legal Description: Location: Lot 3 Block 2 Keno Hills Type of facility to be inspected Single Family Well Data: Individual No. of bedrooms A. Type d~.~,.o...~- B. Depth C. Construction D. Bacterial Analysis Sewage Disposal System: On-site system. 53' A. Installed 7-1-74 B. Installer C. Septic Tank: l. Size ~.~ 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines Distances: A. Well to: Septic tank , Absorption area , Sewer Lines , Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages o MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Type of Inspection: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION JAN 1_ 2 1976 RECEIVED CMRO VA FHA CONV ×× Property Owner: Mailing Address: Name of Buyer: Mailing Address: Thomas P. Gallagher and wife~ Allyson Gallagher - ~, ' ~ Day Phone/./- Day Phone 4. Name of Lending Institution: The First National Bank of Anchorage Mailing Address: P. O. Box 720, Anchorage, Ak 99510 Phone 2~'9-4481 Name of Realtor or Agent: Mailing Address: Phone 6. Legal Description: ~/'~-~-J~/Y' ~ ~..~ j...~.~. Locat ion: Type of Facility to be inspected: ~:~~Z~- No. Bdrms. 3 Water Supply Type of Supply: PubLic Utility :, IndiVidual If Individual, number of dwellings presently served If Individual, depth of well ~ Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) EQ-037 (I/74) Pag~ 2 of two pages - R~ )st for Approval of Individual ,~er & Water Facilities ~&~g%1 ~Desc'ripti0n Lot<3,~BtOoR'~2 Keno.-. Hi'lls ~ Commehts ' ' ~.'~ ." ....... Approved ~ ~~~ Disapproved Date A~/oval 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 subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74)