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MARVIN LT 2
Marvin Lot 2 #051-312-41 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://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP221453 Work Type: SepticTank Upgrade Tax Code Number: 05131241000 Site Legal Address: MARVIN LT 2 G:0653 Site Mailing Address: 15214 HUSKY ST, Eagle River Owner: SILVERNALE KEVIN Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: n�cnt llel)az•tment 11/2/2022 11/2/2022 11/2/2023 40345 ❑ Disposal Field R1 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: Date: Date: ! I-Z'Z2- 3 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERIWELL PERMIT APPLICATION Parcel I.D. 051-312-41 Property owner(s) Kevin Silvernail Mailing address 15214 Husky St, Eagle River, AK 99577 Site address 15214 Husky St Legal description (Sub'd., Block & Lot) Marvin, Lot 2 Legal description (Township, Range & Section) Lot Size 40,345 Sq. Ft. Number of Bedrooms 3 Day phone 907-240-2078 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 19 (w/wo ADU) Septic Tank ❑X Upgrade F Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. i (Signature of property owner or authorized agent) Permit/Rush Fees 4 ,3(mo Waiver Fees: Date of Payment: 111d'22 Receipt Number: 0 l q(j 09� ) Permit No. QS p �2a 1 L15-3 Day 1s- Permit App_:-:- ._."c.; Date of Payment: Receipt Number: Waiver No. November 1, 2022 UTE E E R I N G Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPUANC OSP221453 Tim Ecklund, 11/02/22 PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677.7766 (FAX) FORGECIVIL.COM MOA Development Services, On -Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Marvin Lot 2 - 15214 Husky St Septic system design Dear On -Site Services Engineer: The owner of the above lot has a septic tank that has reached its end of useful life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the 3 -bedroom home as well as the wells and septic location. No conflicts exist between this proposed system and any other wells or septic system, whether on this lot or adjacent lots. We are replacing the septic tank with a larger 1,500 -gallon tank per the request of the homeowner. The new septic tank will be a minimum of 100' from all wells and surface water, and more than 5' away from the absorption field. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin hiller, PE o � I w I I LL i o � I -------------------------� I iamjis ANsnH f ry Q 1NDsv3 ,,inun ,dZ )IIII, — — F— O C) w U i N f( < � F W Z:5 U)Om W w J U) ir p W Z LOQ Z `— W Z W p �O (DLL cr W c� ` I I � I I t I I i I I I I I O > m ¢ZW F- 0 F— I V O W Z z mow¢>L�jWLq O m z M O O v 0 Q _ ~ — p W O O O Q p CLCO W UptiL��cWIW- 0 800 0= H>_ 1— W W U - N Op W I 4 I ao ! I u, Zro ° m � I (I z0 I LLJ -i w;y3 w I j I Z< Fe w U)� 0if // I 3 1 w E L ` I I � I I t I I i I I I I I O > m ¢ZW F- 0 F— I V O W Z z mow¢>L�jWLq O m z M O O v 0 Q _ ~ — p W O O O Q p CLCO W UptiL��cWIW- 0 800 0= H>_ 1— W W U - Municipality of Anchorage �. Development Services Department •="� =";• Building Safety Division =. On -Site Water & Wastewater Program, 4700 South Bragaw St. ; , y r P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW030039 PID Number. 051-312-41 Name: A ALASKA HOUSING c/o DAN GEEK w/ GEEK CONT. Wastewater System: ❑ New ■ U rade Y P9 Address: P.O. BOX 111373 * ANCHORAGE, AK 99511 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 242-9650 3 O Deep Trench O Shallow Trench ■ Bed O Mound 0Other LEGAL DESCRIPTION Soil Rating: 0.5 CPD/5a. Total Depth from original grade. R *0,41-1,47 R Block: Lot: Subdivision: Depth to pipe bottom from oe4nal grade. Gravel depth beneath pipe. — 2 MARVIN SEE DWG. R 1.13 FL Township: Range: Section: Fel added above orlglnol grad.: grovel length: — — — SEE DWG. R 53 rL WELL: ❑ New ❑ Upgrade Grovel width: 17 Number of IYae. Dietcnce between lines: 1 5.5 rL R Classification PrWo. AB.0 . Total Ds Coeur To: Total absorption area: Pipe material: R R 901 so. FL D 3034/ F-810/ SCH 40 PVC Driller\tJ Date Drilled: U I Static water Level: I kletalNr. BEEK CONSTRUCTION Dots kutoled: 3/8-10/2003 R n.la:Pump Set At Casing Height Above Ground: TANK CPM R R SEPARATION DISTANCES E3 Septic 0Holding ■S.T.E.P. 0Other To From Septic Tank Absorption Field Uft Station Holding Tank Publie/P wale serer tines Monufocuuer. ANCHORAGE TANK Capacity In gallons: 1250 Well 100'+ 100'+ 100'+ — 25'+ Material: STEEL STEEL of cora rtmems: '� 2 Surface water 100'+ 100'+ 100'+ — — LIFT STATION Lot Una 51+ 10'+ 5'+ — — Size in gallons Manufacturer. 1250 ANCHORAGETANK ORENCO SYSTEMS Foundation 5'+ t 0'+ 5'+ — — 'Purap on Isvul aL• mp off -.level ot: Wgh water aloin, at: lo 41 " 41 " 45" Curtain Drain NONE KNOWN Pump Make k Model: ;20 OSI OS HHF Electrical Inspections performed by. B P.1 Cabet S C1,EC.T21t- Remarks: BENCH MARK Location and Description: *TO TOP OF 2 FEET M.O.A. APPROVED SAND FILTER TOP OF DECK NEXT TO HOUSE (SOUTHEAST CORNER) —THE EXISTING SEPTIC TANK AND DRAINFIELD WERE COMPLETELY ABANDONED. Assumed Elevation; 100-00 FL RECEIVED VERBAL APPROVAL FOR DESIGN CHANGE ON 3/7/2003 ENGINEER'S SEAL BY JOE GOODALL.qsp� •� �0' Inspections performed by: AKWWC, INC. Dates: 1st 3/8/2003 *�': 4.. ............ COQ 2nd 3/8/2003 Nes 3rd _3/10/2003 Qa eff Gar s": O Development Se ices Department Approval dp'°� ' c - ' v� Reviewed and approved by: Date:. (Rev. 12/01) ProfaSslo(I°oQoO 4p0000O�� PERMITNUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: SW0 - SW030039 051-312-41 20' UTIM EASEMENT JAMES WAY ..•OF 9. v f1. * 3/13/2003 _ _-......__a DRAWN BY: �40 ALASKA NVATER & WASTE AVATERSSE C.J.G. o0 4 y( CONSULTANTS, INC. 1 " = 30, ; , • • • • •' "' • "' • ""*• 001 DFRARR ROAD. SUITE 28 • ANCHORAGE. AK 90504 • PHONE (907)337-6179 • FAX (907 339.3246 .PARED FOR: ALASKA HOUSING PHONE NUMBER: PAGE NUMBER: Q c/o DAN GEEK w/ GEEK CONT. (907) 242-96502 OF 3 QP ' ey G ss. ;AL DESCRIPTION: Q ocG LOT 2; MARVIN SUBDIVISION ,4. •, C 7953 �a Tit. � IE OF WORK: T�DodPfe�o\ �oasio���v AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE �0044�71 A B DBL1 40.66 52.63 DBL2 41.22 • • 42.17 54.02 •.L :I ••/, :: � .. • • f• Y .tip ... ..• / �i 14 A 65.78 MT2 / ..•OF 9. v f1. * 3/13/2003 _ _-......__a DRAWN BY: �40 ALASKA NVATER & WASTE AVATERSSE C.J.G. o0 4 y( CONSULTANTS, INC. 1 " = 30, ; , • • • • •' "' • "' • ""*• 001 DFRARR ROAD. SUITE 28 • ANCHORAGE. AK 90504 • PHONE (907)337-6179 • FAX (907 339.3246 .PARED FOR: ALASKA HOUSING PHONE NUMBER: PAGE NUMBER: Q c/o DAN GEEK w/ GEEK CONT. (907) 242-96502 OF 3 QP ' ey G ss. ;AL DESCRIPTION: Q ocG LOT 2; MARVIN SUBDIVISION ,4. •, C 7953 �a Tit. � IE OF WORK: T�DodPfe�o\ �oasio���v AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE �0044�71 A B DBL1 40.66 52.63 DBL2 41.22 53.08 • 42.17 54.02 •" :. 46.17 57.55 IA, 47.37 I �i 33.05 65.78 MT2 / INSTALLED DOUBLE MT3 77.32 93.22 CLEANOUTS 75.84 102.87 1250 GALLON zg�NEW v S.T.E.P. TANK �m2 0 n L I II I I A-- --- Ml NEW DRAINFlELD 7 _! ..•OF 9. v f1. * 3/13/2003 _ _-......__a DRAWN BY: �40 ALASKA NVATER & WASTE AVATERSSE C.J.G. o0 4 y( CONSULTANTS, INC. 1 " = 30, ; , • • • • •' "' • "' • ""*• 001 DFRARR ROAD. SUITE 28 • ANCHORAGE. AK 90504 • PHONE (907)337-6179 • FAX (907 339.3246 .PARED FOR: ALASKA HOUSING PHONE NUMBER: PAGE NUMBER: Q c/o DAN GEEK w/ GEEK CONT. (907) 242-96502 OF 3 QP ' ey G ss. ;AL DESCRIPTION: Q ocG LOT 2; MARVIN SUBDIVISION ,4. •, C 7953 �a Tit. � IE OF WORK: T�DodPfe�o\ �oasio���v AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE �0044�71 A B DBL1 40.66 52.63 DBL2 41.22 53.08 ST1 42.17 54.02 ST2 46.17 57.55 MH 47.37 58.41 MT1 33.05 65.78 MT2 27.74 78.39 MT3 77.32 93.22 MT4 75.84 102.87 ..•OF 9. v f1. * 3/13/2003 _ _-......__a DRAWN BY: �40 ALASKA NVATER & WASTE AVATERSSE C.J.G. o0 4 y( CONSULTANTS, INC. 1 " = 30, ; , • • • • •' "' • "' • ""*• 001 DFRARR ROAD. SUITE 28 • ANCHORAGE. AK 90504 • PHONE (907)337-6179 • FAX (907 339.3246 .PARED FOR: ALASKA HOUSING PHONE NUMBER: PAGE NUMBER: Q c/o DAN GEEK w/ GEEK CONT. (907) 242-96502 OF 3 QP ' ey G ss. ;AL DESCRIPTION: Q ocG LOT 2; MARVIN SUBDIVISION ,4. •, C 7953 �a Tit. � IE OF WORK: T�DodPfe�o\ �oasio���v AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE �0044�71 -- C PERMrTNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW0 SW030039 051-312-41 FINAL GRADE TOP OF MANHOLE INSULATION 99.44-99.69 - 100.31 (AVG.) TOP OF TANK ST, ST2 MH AT INLET - 95.90 /- TOP OF TANK / AT OUTLET - 95.85 INVERT OF BUNG I I NEW 1250 GALLON I I AT INLET - 95.35 S.T.E.P. TANK INVERT OF BUNG AT OUTLET - 95.18 -FINAL GRADE - 101.97-102.62 FABRIC ELEVATION OF 4TER - 93.43 RELATIVE ELEVATION OF BOTTOM OF TESTHOLE - 87.43 DRICINAL CRADE - 98.37-99.43 -TOP OF SAND 'S�-INVERT OF PIPE - 99.09 (AVG.). - 97.96 (AVG.) DISTRIBUTION LINE IS 1.25 INCH PVC BOTTOM OF BED w/ 1/8 INCH HOLES SPACED EVERY - 95.93 (AVG.) 29 INCHES ON CENTER (12 HOLES PER LATERA P2 HOLES TOTAL)/ ALASKA WATER &; WASTE NVATER -- CONSULTANTS, INC. 6001 DFBARR ROAD. SUITE 2B • ANCHORAGE. AK 90504 • PHONE (907)337.6179 • FAX (007)318-5246 PREPARED FOR: ALASKA HOUSING PHONE NUMBER: PAG c/o DAN BEEK w/ BEEK CONT. (907) 242-9650 LEGAL DESCRIPTION: LOT 2; MARVIN SUBDIVISION TYPE O F WORK: :PROFILE AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE 1/13/2003 o OF INN BY: C.J.G. 7 1- c 40• .... :... E NUMBER: 3 OF 3 Qoa4 ey a ess Mar 18 03 09:41p Dan Beek 907-868-1019 p.2 FROM : BRICKWELL FAMILY FAX NO. : 345-2923 Mar. 19 2003 08:19PM P1 B�1Gx 5,�:�"GTj�IG 11425Avion Sheet Anehornpe, AX 99516 3-13-02 To who it may concern: #1 Brick's Electric has performed all wiling necessary for the Orenco septic system at the fol- lowing location: Lot 2 Marvin Subdivision All work performed as per current National Electrical Code Sincerely, ;r v t. William Brickwell— nwne.r Phone: 907-345-2923 * Far: 907-770-2933 * CeU: 440-9351' �i MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030039 'Legel Description' :MARVIN LT,_2- Design Engineer: 0041 AK Water & Wastewater Consultan- Owner Name: Alaska Housing c/o Dan Beek Owner Address: PO Box 111373 Anchorage , AK 99511-3843 Date Issued: Mar 06, 2003 Expiration Date: Mar 05, 2004 Parcel ID: 051-312-41 Site Address: 015214 HUSKY ST Lot Size: 40345 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. G/ i� t_� s Yv'A L,C,+ I t�cl {�z 13 1 Ars KjN ��tq'�Q je /-j-1w aAJ S3if Lon • /1 jSiyti c(1^^c c �fwc �oe 4 iov o' aIc DA1 T�w�•' o j �O�SC . tSCt-� w i �) S.�s11, i�Rve �' P^�R �Ic_ � TI��TON'lfi I .G�r2�—Pf�PS Received By: Date: Issued By:,, IJ&A Date: 3 d3 Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-312-41 Permit Number (,d C 300 7 - Property owner(s) ALASKA HOUSING c/o DAN BEEK Day phone 242-9650 Mailing address (1) P.O. BOX 111373 * ANCHORAGE. AK Mailing address (2) Zip Code 99511 Legal description (Lot, Block & Sub'd.) —LOT 2: MARVIN SUBDIVISION Legal description (Section, Township & Range) N/A Lot Size Acre Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS, INC. j AA RuSR -. Permit Fees:w'71)1) tit 50 550._ Waiver Fees• Date of Payment: -3-6–o,3 Receipt Number: 32 l X02 Date of Payment: Receipt Number: ALASKA WATER & WASTEWATER CONSULTANTS, INC. March 3, 2003 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bmgaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Septic System Upgrade Design for Lot 2; Marvin Subdivision To whom it may concern: The existing house is served by a private well and septic system. The existing bed is in a "surcharged" condition and is believed to be encroaching upon groundwater. A test hole was excavated on the property. The proposed septic system will be designed around the 30 foot radius of this test hole. We are proposing that a 1250 gallon S.T.E.P. tank and a bed type drainfield be installed. Comments regarding the design are summarized as follows: 1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. TRENCH DESIGN: a. Percolation Rate: 2.5 minutes/inch b. Proposed Application Rate: 0.5 gallons/day/f12 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 900 ft2 f. Total Depth: 3.5 feet (max.) g. M.O.A. Sand Filter: 2 feet h. Effective Depth: 0.5 feet i. Width: 15 feet j. Minimum Length: 60 feet long k. Effective absorption area = 900 ft2 NOTE: The distribution lines are to be 1.25 inch sch. 40 pvc with 1/8 inch diameter holes spaced 29 inches on center (12 holes per lateral/ 72 holes total in entire system). 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 6901 Debarr Road, Suite 2B • Anchorage, AK 99504 Ph: (907) 337-6179 0 Fax: (907) 338-3246' Website: akwwc.com 4. TOPOGRAPHY: The average topography around the proposed drainfield is relatively flat. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Sincerely P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a bed detail drawing, a soil log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B • Anchorage, AK 99504 Ph: (907) 337-6179 • Fax: (907) 338-3246' Website: akwwc.com / \�� �� \5N• R2W k 115, SE \��• 5C ti e LOT 141; SE 1/4, SECTION 25, T15N, R2W V \\ LOT 1,; MARVIN S/D�'' �\ EXISTING \ SEPTIC EXISTING \\ 3 BEDROOO \ HOUSE _ JAMES WAY _ PROPOSED SEPTIC UPGRAD I (SEE DESIGN, PAGE 2 OF ASEPTIC ARS LAKERIDGE TERR. S/D LOT 7, BLOCK 3. SYSTEM --A 1 TH/1 -------�------------- ASEPTIC ARS LAKERIDGE TERR. S/D LOT 6. BLOCK 3. DATE: 3/6/2003 DRAWN BY: ALASKA. WATER & WASTEWATER J.L.M. CONSULTANTS, INC. SCALE: 6001 DFRARR ROAD. SUITE ?R • ANCHORAGF. AK 99504 • PHONF (907)337-6179 • FAX (907)338-3?L6 1 ~ — loo, PREPARED FOR ALASKA HOUSING PHONE NUMBER: PAGE NUMBER: c/o DAN BEEK w/ BEEK CONT. 242-9650 1 OF 3 LEGAL DESCRIPTION: LOT 2; MARVIN SUBDIVISION TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE ARLC LAKERIDGE TERR. S/D ... .... ' of a LOT 8, BLOCK 3, W 7953 e ••' `gyp`±, •C I�i1..�n Off! .... WI / 1 I wl ;—r-----7 ASEPTIC ARS LAKERIDGE TERR. S/D LOT 7, BLOCK 3. SYSTEM --A 1 TH/1 -------�------------- ASEPTIC ARS LAKERIDGE TERR. S/D LOT 6. BLOCK 3. DATE: 3/6/2003 DRAWN BY: ALASKA. WATER & WASTEWATER J.L.M. CONSULTANTS, INC. SCALE: 6001 DFRARR ROAD. SUITE ?R • ANCHORAGF. AK 99504 • PHONF (907)337-6179 • FAX (907)338-3?L6 1 ~ — loo, PREPARED FOR ALASKA HOUSING PHONE NUMBER: PAGE NUMBER: c/o DAN BEEK w/ BEEK CONT. 242-9650 1 OF 3 LEGAL DESCRIPTION: LOT 2; MARVIN SUBDIVISION TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE ... .... ' of a . ... ....... ..... ss.* 4� I�Y�d '• 7953 e ••' `gyp`±, •C I�i1..�n Off! .... \ INSTALL FOUNDATION \ CLEANOUT? -EXISTING SEPTIC BE COMPLETELY I -EXISTING BED 10 BE COMPLETELY ABANDONI WELL I I I N I of ---------- -— _.-----� -- --MT_ --- =—=.�1 I 7 t 20' UTILITY EASEMENT I N PROPOSED DRAINFIELD. EXCAVATE A BED THAT IS 3.5 FEET DEEP MAXIMUM BY 15 FEET WIDE BY 60 FEET PROPOSED 1250 GALLON LONG. ADD 2 FEET OF M.O.A. APPROVED SAND FILTER S.T.E.P. TANK AND THEN 0.5 FEET OF CLEAN, WASHED SEWER DRAINROCK. THE DISTRIBUTION LINES ARE TO 1.25 INCH SCH. 40 PVC WITH 1/8 INCH HOLES SPACED 29 INCHES ON CENTER (12 HOLES PER LATERAL/72 JAMES WAY HOLES TOTAL). SEE DETAIL DRAWING. PAGE 3 OF 3. NOTE: THE CONTRACTOR SHALL HAVE THE 20 FEET UTILITY EASEMENTS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO ANY CONSTRUCTION. lIf<T�!'•'��al�."���� DRAWN BY: AJ ASKA WATER & WASTEWATER J.L.M. CONSULTANTS, INC. SCALE: 6001 OFRARR ROAD. SUITF 79 • ANCHORAGF. AK 99504 • PHONF (007)337-0179 • FAX (907)338-37L6 I" — 30• PREPARED FOR: ALASKA HOUSING PHONE NUMBER: PAGE NUMBER: c/o DAN BEEK w/ BEEK CONT. (907) 242-9650 2 OF 3 LEGAL. DESCRIPTION: LOT 2; MARVIN SUBDIVISION TYPE OF WORK: DESIGN OF SEPTIC SYSTEM UPGRADE lilli�' 'um - ,J f y A. or ss: I� CE -795 THE DISTRIBUTION UNES ARE TO 1.25 INCH SCH. 40 PVC WITH 1/8 INCH HOLES SPACED 29 INCHES ON CENTER (12 HOLES PER LATERAL/72 HOLES TOTAL). HOLES SHALL FACE DOWN.-•\ T— i --— — — — — — — — — — — — - --� n I 1 I h { I T+� _T I in I O MT -}— L -------------------- i I 0 FROM S.T.E.P. TANK FEET ///---FINAL GRADE. MUST HAVE THE DISTRIBUTION UNES ARE TO 1.25 INCH SCH. 40 / 2+ FEET OF COVER. PVC WITH 1/8 INCH HOLES SPACED 29 INCHES ON / CENTER (12 HOLES PER LATERAL/72 HOLES TOTAL).--\ GRADE FABRIC 0.5 FEET OF EFFECTIVE -i -------------- :�.• r • ^,_ ,. 3.5 FEET DEEP MAX. • �: ry •-tel Y •:' A :� � ,� � �y, •.a � •�: 4�iti �{•:. L.� �� ?vt �'i ..:•�'.�.�.-:.r `: �••.: �: ,i.,:3.t :•'�{ a: 2 FEET OF M.OA APPROVED SAND FILTER —13 FEET WIDE ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DFRARR ROAD. SU1TF 7R • ANCHORAGE. AK 99506 • PHONF (907)317-6170 • FAX (907)338-376 PREPARED FOR: ALASKA HOUSING PHONE NUMBER: c/o DAN BEEK w/ BEEK CONT. (907) 242-9650 IECAL DESCRIPTION: LOT 2; MARVIN SUBDIVISION TYPE OF WORK: DETAIL DRAWING OF PROPOSED DRAINFIELD 3/6/2003 0 �'`3!••04 DRAWN BY: {�: 4N.T.S. TSCALJ.L.M.gGs: E ... PAGE NUMBER: 3 OF 3 ff y... °6 E 7953 ei Q 4 ro Nape � ssl0npoocr OF o o ALASKA. WATER & WASTEWATER CONSULTANTS. INC. 0*?' 0. .. . . ..... .. .......a 6601 . sun go • AK 6950{ • A"E- 60 7-6179 • FA%: (907)&m-3244 • WasrTE: a,""a. SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION LOT 2; MARVIN SUBDMSION (/Q Je fr A. Go ess:' PERFORMED FOR: ALASKA HOUSING c/o DAN BEEK DATE: 2/27/2003 0�4 J —79 3 '• `��p 6 �D�ofesslo� & (feet) �Z ORGANICS TEST HOLE 1 4��DO00000d o 1 FILL SOIL CLASSIFICATIONS ' 2 ORGANICS ``�� GW ORG \^• W EXISTING i 3 is rt. GP ML SEPTIC I i HIM GM CL SYSTEM --A I V I GC OL EXISTING 4 WELLi- °o •°ems SW MH J._.�,... Y 5 t SP CH SM OH r _ 6 SC EXISTING 3 BEDROOM HOUSE 7GM/SM �------------- -- -- -- -- 8w/ SOME SP _ JAMES WAY _ _ T"#' LENSES ___—_� THROUGHOUT PROPOSED SEPTIC UPGRADE 9 SITE PLAN 1 "=100 10 11 12-1B.o.H. 13 14 15 16 17 18 19 PERCOLATION RATE 2.5 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.0 FT. AND 4.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ZACH GALL COMMENTS: DUE TO THE VISUAL APPEARANCE OF THE SOILS. WE RECOMMEND USING A 0.5 APPLICATION RATE. PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTIFY THAT THIS W S PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 0 DEPTH TO GROUNDWATER DATE B' 2/27/2003 6' 3/3/2003 6' 3603 2:45 - DATE 18— READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 2/27/03 1 2:45 - 6" — 2 2:55 10 1" 5" 3 2:55 — 6" — 4 3:05 10 2" 4" 5 3:05 — 6" — 6 3:15 10 2" 4" 7 3:15 — 6" — 8 3:25 10 2" 4" 9 3:25 — 6" — 10 3:35 10 2" 4" 11 3:35 — " 6- — 12 3:45 10 2" 4" MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAM PHONE ❑ UPGRADE MAILJjqG ADDRESS 1. c LEGAL DESCRIPT ON N��p•Q � -T LOCATION NO. OF BEDROOMS 3 U DISTANCE TO: Well�,c, ` �� Absorption�r@a� F/ Dwelling PERMIT NO. Y Manufacturer Majt'al No. of compartments wWC ,16/ �7 Cl cc�� F Liq. c pacity in gallons IF HOMEMADE: Inside length Width. Liquid depth Y Well Dwelling PERMIT NO. J V`Z DISTANCE TO: 02 Material Liquid capacity in gallons Ia„ Manufacturer OI Well Foundation Nearest lot line PERMIT NO. = DISTANCE TO: T J LL z No. of lines Length of each line Total length of lines Trench width Distance between lines Z w inches � F Top of the to finish grade Material beneath the Total effective absorption area 0 inches W Length Width Depth PERMIT NO. C7 Q Ir W i w Type of cribCrib ,tet diameter Crib depth Total effective absorp ' re Lu en Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. J J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER P MATERIALS P SOI L TEST RATTInIN INSTALLERS J rr ( 1v �/� t \ REMARKS % I t V, 1VV it ANeROVEO DATE LEGAL �� I/ I�� 72-0%2_,Mev. 3/78) %-7 MUNICIPALITY OF ANCHORAGE Departments` f Health and Environmenta' ',Protecti 825 Street, Anchorage, AK. _9501 \dam 264-4720 # # # HANDWRITTEN PERMIT Fermi'' # WELL ANDS--DN-SITE SEWER PERMIT V" S �� Applicant: Do'fy /34k6c Mailing Address: Location: Phone Number: Legal Description: /51Vf 94fJ S -r_ d o % l yLot Size: 1C) - 9 3 Type of Soil Absorption System Is: J Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: DEPTH_ LENGTH haS� _ GRAVEL DEPTH 3 / WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet).. There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(MtD-H+G) TANK SIZE _ ��GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * # * TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection.and approval by this department) will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feeti for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more tha 3 bedroq Signed: k ,�- Issued by: Applicant Date: 617; SWP/024 (1/81) ;EZ ly3 Xo.�� Jef SOILS LOG 1 Iv)UNICIPALITY OF ANCHORAGE DEOF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION PARTMENT TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: :"r�C_v V1 N M -Orr^ -P. Oly DATE PERFORMED: 4 8 V LEGAL DESCRIPTION: S 2_5 - / I S/J ' L W II SLOPE SITE PLAN 4 F 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMM E 6IV� SANDyIS IL -Ty C-KAVtt_ (t - ILLS ( st tt7 SAI40y G2AVFL ,� SANOy G./l7-H OCc�-510NAL GRAvCL ■NEON' MENIM NNINN ONION 0 No NNINN NNINN ONION IN MOWN MOWN ONIEN WAS GROUNDWATER Yp S L jANOy ENCOUNTERED? / O P IF YES, AT WHATE / DEPTH? 0 V2- Reading Date Gross Time Net Time MIN. Depth to Water TT Net Drop r © 10 82 /0:60 3C -Y3,0' I i/;oo .3e 10 7o /d t ;oZ - - Z >!-/Z /0 7d ,07 -f _ C2 1/ -13, - 88 - 1 :^ C .-Of .07 t 14 o : z ' — S 35- — lie/'3S /O 7 065- 0 Y6: PERCOLATION RATE -3-7 (minutes/inch) TEST RUN BETWEEN 41 FT AND ?_ FT ?CTIA [/ 7_� /1,40 % A PERFORMED BY: CO&"OT- / .I OtiN50// CERTIFIED BY: 72-008 (6/79) DATE: C(5-YA C-C�y A zq- RE _ �--. TURN TO: Division of Geological and' 'ihysical Surveys (OGGS) STATE OF ALASKA / 6DEPARTMENT OF NATURAL RESOURCES 3001 Porcupine Drive (Te )ne: 277-6615) Anchorage, Alaska 99501 1 W A T E R W E L L R E C O R D U.S.G.S. Local No. Drilling Permit No.Drilling Company Name(.p {l/y Please complete either la, lb, or Ic. A.D.L. No. r LOCATION OF WELL P Mer idian )a. f le. o Range Borough Subdivision Lot Block It. Fraction Section No. Tlwnship 4 2— / / / L S Distance and Direction from Road Intersections - 3. OWNER OF WELL: il-[ Address: t.vAy Street Address and Area of Well Location % 6SFJry �" re{ "^� / �) rG' '� /�• - • - 2. WELL LOG Feet Below Surface Material Type Top Bottom -/J U / �i 4. WEL DEPTH: (completed) Surface Elevation Cate of ompletion ft. 5. ❑ Cable tool .Rotary ❑ Driven ❑ Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: 6. USE: e Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commercial ❑ Test Well ❑ Other: - - -' 7• CASING: ❑ Threaded ©-Weeded �-3--i n. to LL'_ ft. Depth Weight 7 7 lbs/ft. in, to ft. Depth // .,�, s-^ O l -c' I -e i /v _ !Jh t - <• !J 'i Y -a L' S C S. FINISH OF WELL: Type: �(l k -e rs h Diameter: slot/mesh size: � G Length; �L? Set between / /% ft. and /az I/ _ ft. Fittings- i /�G elll Ci' 6�; z I ���. 9 i i .. Ut �.`l�' / l G v`� 9• STATIC WATER LEVEL: ft. ❑ Above ®Below land surface Type of Measuremen t 10. PUMPING LEVEL below land surface - - ft. after _ hrs. pumping �_ 9•P•m• ft, after hrs. pumping 9•P•m• li. WELL HEAD COMPLETION: ❑ In Approved Pit Pitless Adapter L inches above grade 12. GROUTING: Well Grouted: ❑ Yes ® No Naterial: ❑ Neat Cement ❑ Other: 13. PUMP: (if available) HP j Length of Drop Pipe / � L,� ft. capacity _� 9-P• Type: Submersible, ❑ Reciprocating L�O _1 Jet []Other: 14. REMARKS: 15. WATER WELL CONTRACTOR'S CERTIFICATION: - This well was drilled ((under my jurisdiction and this report is true to the best of my knowledge and belief: &� '('S 7 `r/ h l /moi / P� ��53 bS Con[�act L c n e Number RRegiste red Business Name > ) [ y Address: (. ) 3 5�� 7 �^ 1���f N //4? / A/X Signed:, Da te: n�_vvu Coov Distribution: WHITE - State DGGS, PINK - Driller, CA14ARY - Customer ALASKA CWIROnm NAL COnTROL SMIUS, InC. Cngineering & 6nuirownental Studies October 26, 1983 Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Robbie Robinson Dear Mr. Robinson: This is in reference to Lot 144, T15N R2W Section 25 located on the corner of San Bofel Drive and James Way in Eagle River. The soils log done on September 10, 1983, by AECS Inc., showed there to be a water table at 10.5 feet, and that the most suitable strata for building a septic system in was a silty sandy gravel from 2 to 5 feet. The soils below this became silter. Therefore, a permit was issued for a system to be built that was 5 feet deep with 3 foot of rock, and 165 feet long. The excavator, however, disregarded the permit and dug the trench to a depth of 6 feet below natural ground level. He subsequently encountered water at that depth. I saw the trench myself, as I was asked to go to the lot and figure out a solution, on September 28, 1983. As there was a ladder handy, I climbed down into the trench and walked around it, looking at the sides of the trench walls to see if any seeps were coming out any closer to the surface than 6 feet. I observed none, and in fact was quite interested in the situation because I had never seen so consistent a water table in which it is at the exact same level everywhere. Most test holes I have observed with groundwater have seeps at various levels over the test hole walls, rather than from just one level as was the case here. I redesigned the system to be a bed, in which the excavator was to fill in the old trench and start over, digging to only 2 feet below natural ground level and laying a bed of gravel and pipe over this. In this manner he would be 4 feet above the water table and effluent would be seeping into the proper silty sandy gravel. However, when he excavated the bed, he inadvertently pushed the water at the bottom of the old trench over towards the septic tank, filling the depression around the tank and making it appear that the water level was now at three feet below ground level. Consequently, the operation was once more closed down, and a water monitor was ordered to keep things safe. I went back on October 25, 1983, to check the level of the water down the monitor tube, and noted that it was only 5.5 feet below ground level. This would suggest that the septic system was only 3.5 feet above the water table, which would be inadequate. It occurred to me, however, that possibly the water monitor tube was inaccurately representing the water table, due to surrounding ground freezing up and snow falling into the open tube. Therefore, on October 26, 1983, I had Don Baker use a backhoe to dig a hole almost 7 feet deep to demonstrate that there was no water table to that depth. This hole was dug 9 feet away from the bed and 6 feet away from the water monitor tube. 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 276-1361 Consequently, it appears that the present location of the bed is adequately at least 4 feet above the water table. Sincerely, Darr Bevens Engineering Geologist Approved by: L Jr., Phd PE PJrident Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-312-41 Expiration Date: 1. GENERAL INFORMATION: Complete legal description MARVIN S/Q; LOT 2 Location (site address) 15214 HUSKY STREET, EAGLE RIVER, AK 99577 13-2 �- 2020 Current Property owner(s) DAVID KOWALSKI POC - MARIE BROSSOW Day phone 250-2245 Mailing address P.O. BOX 773843, EAGLE RIVER, AK 99577 Real Estate Agent KATHI OLMSTEAD W/ REMAX Day phone 244-8020 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) 1-71 Duplex 17-1 Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: .3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well z Individual z Individual Water Storage 1-71 Holding Tank E] Community Class Well El Community 1771 Public Water System 1771 Public Sewer 1_71 WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55Z Waiver Fee $ Date of Payment &2'L111 9 Date of Payment Receipt Number & clza� Receipt Number Iq 1&6 COSA 0/ / 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. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: I sju)l In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system oOF in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the O evaluation. Separation distances were measured to readily identifiable features. Hidden defects or rr encroachments may exist that were not identified during the evaluation. The operational life of all wells ��* = 1-9 �U and septic systems depend upon a variety of variables, including but not limited to, soil conditions, d • • • .. •' ' • • • • • • • •' • groundwater levels (that may fluctuate during the year), quality of construction (materials and f workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ko, ':t. ..f . ....... ........ are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q J' ff, Gar ess. system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of 0, -P 'j E_�g the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately the future. The content of this report is for the sole benefit of the person/party that retained GEG toea r V �Q professlo� o� perform the evaluation. Reliance upon the information provided in this report by any other person or �OOpoo�� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE OFtf�-���/� System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the followinputs�G SN ) By: Original Certificate Date: 12—Z 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 Nitrate Advisory I` Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.doc COSA Checklist Legal Description: MARVI N S/D; LOT 2 Parcel ID: 051-312-41 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/18/83 Total depth 129 ft Cased to 120 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 12/6/19 Static water level at beginning of test 111.7 ft. Comments Well production at time of test 4.4+ gpm Water storage tank volume NONE gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 6.81 mg/L ❑ Nitrate less than MRL (ND) Arsenic ND ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 12/4/19 B. TANK DATA C. LIFT STATION Age of tank(s) 16.5 years ❑ Required maintenance completed Tank type/material STEEL Age of lift station 16.5 years Measured operating fluid level in septic tank *40.5 Lift station material STEEL ❑ Standpipes/foundation cleanout per record drawing Comments: 'THIS IS A STEP TANK. L.L. IN 2ND COMPARTMENT. Date of pumping 6/7/2019 BOTH COMPARTMENTS WERE ALMOST THE SAME (1.25" DIFFERENCE). D. ABSORPTION FIELD DATA PRESSURIZED BED Which system`tested (date installed) 31&70103 Adequacy test date 12/6/19 ❑ ALL standpipes present per record drawing Results R Pass For 3 bedrooms Total measured depth from grade *4.3 ft (max) Fluid depth prior to test 0 in Measured depth to pipe invert from grade * ft (min) Water added 477 gal ❑ N/A — pressurized field 0 New depth in ❑ Monitor tubes go to bottom of effective. If not, state 0 depth into effective Elapsed time min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) Gallons introduced —1,981 gallons If yes, enter date Comm ents/Deficiencies: 'ELEVATION SHOTS PERFORMED AND FOUND ELEVATION OF BOTTOM OF MTS WERE SIMILAR TO RECORD DRAWINGS. `"SEPTIC SYSTEM PRESOAK PERFROMED ON SAME DAY AS TEST. TIM EKLUND WITH MOA ONSITE DEPARTMENT VERBALLY APPROVED PRESOAK AND ADEQUACY TEST COULD BE PERFORMED ON SAME DAY ON 12/6/2019 COSA Checklist yellow sheet 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 Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'✓] Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No * Animal Containment > 50' ✓❑ Yes if No ft ❑r Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No **5+ ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells > 100'✓0 Yes if No ft Water Main > 10' r❑ Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' ❑r 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 If absorption field is under driveway comment below Property Line > 10' Ft -,l Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS *WITH CAVEAT - NO ABLE TO VERIFY SEPARATION DISTANCE TO 1976 TRENCH ON LOT 1; MARVIN S/D. NO STANDPIPE VISIBLE ON WEST END OF THIS TRENCH. PER 2010 S&S ENGINEERING INSPECTION REPORT AND RECORD DRAWING, WELL ON LOT 2, MARVIN S/D IS 100 FEET FROM THIS TRENCH. **MET SEPARATION DISTANCE AT TIME OF INSTALLATION. G. ENGINEER'S CERTIFICATION / certify that / 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. COSA Checklist yellow sheet 0 F A f�%% 49 H Jt�ff�y CEGar ,re J 9. — y �� ZG1. 0��Ao� pro f e ss;o�3Qv #AECC884 q41 Nitrate Advisory Certificate of On -Site Systems Approval # OSC191604 Subdivision: Marvin Lot 2 A water sample revealed a nitrate concentration of 6.81 milligrams per liter (mg/Q. 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. From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years, but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. fi d , �-S?'`lm5`'- 'z`'7"" Lift Station/Pump Vault <7 Maintenance Log Own e rP4 t t- ro c Street AddressJJ7J i z Septic Tank: -Sludge level .inches -Pumping: required Yes *Pumping completed ('yes no Lift station: -Pump basket cleaned(�no -Effluent filter cleaned (:Ono -Control floats cleaned (Ce,no -Proper float settings confirmed no s *Operation satisfactory (2Les no Alarm System: -Dedicated electrical alarm circuit (ves') no -Audible and visual alarm inside dwelling es naa '4 -Alarm system operation satisfacto[y) not satisfacto Manhole Riser -Ground water intrusion at riser to tank connection jesQno -Ground water intrusion around pipe penetrationsypes o -Weep hole functional/ eno _s -Manhole lid: Functional 1-`ve,,:-P no Insulated � 'es no Properly Secured (yes - no Other -All manufacturer required inspections and maintenance completed @s no Comments: Qualified Maintenance Provider: Technician (9,41- /E r 0 Company /< q, Signature 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 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my ingest! ation and inspection, the on-site water supply and/or wastewaterdisposal,"system is incompliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Cro.+s� rv��+a�j- Gr.St�e�n3 396-ZCOU/69-1-SL'a%$ . Name of Firm va v N 9by192A Phone Address / Engineerssignature �°f'�� Date OF A4. r 4 ! � V 0 X .ZRR NO. 17324� 10 no June 82. 19$®� .Vo 6.• 6l[HS=SIGNATURE ' Approved for 3 bedrooms. 5,; y Disapproved. Conditional approval for bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued., The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.., 72-025 (Rev. 1/81) Back MOA M21 - Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1- z M arvi 11 S Vt' Parcel I.D. 0<31- 312- +1 A. Well Data Well type PR'V ✓ If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) O J '7 -`Lc- Date completed 1D -)8-B3 Driller Total depth i z15 Cased to l3o1 Casing height 1'Z Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell y Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION o Z 10- C33 'Z -I 8- 94 I°i1 m y A Z r 78 r 6& N 0 -7.0 g.p.m. (0 ® co g.p.m. Z < 7 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot t Ibv� ' Absorption field on lot 4-100 ; On adjacent lots On adjacent lots Public sewer main +Z-vo Public sewer manhole/cleanout Sewer service line 4- 5v Petroleum tank WATER SAMPLE RESULTS: Coliform cls Nitrate 6 66 Other bacteria Date of sample: Z-) 1-94 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed i I /Z-5 Tank size 10 Compartments Z Cleanouts (Y/N) y Foundation cleanout (Y/N) r\1 Depression (Y/N) N High water alarm (Y/N) NF1 Alarm tested (Y/N) Date of pumping �- 14- Pumper BIZ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 4- two On adjacent lots To property line V 1c, I Absorption field Surface water/drainage 4- 100 4- too Foundation M 1 I t Water main/service line + 25' 4 5 in G. O " Z 72-026(3W)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer _ Size in gallons Manhole/Access Vent (Y/N) "Pump on" level at - Pi High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTAN FROM LIFT STATION TO: D. ABSORPTION FIELD DATA Date installed On adjacent lots Soil rating (GI'R2) Z-1 s Length 4-7' Width Z$ Gravel thickness off" Level at Surface water S4/ 4°" System type Total depth -I- Total absorption area 131 (� 5�- Cleanout present (Y/N) y C )) Depression over field (Y/N) N Date of adequacy test 2-18-9 Results (pass/fail) Pr�-15 for 3 Bedrooms Water level in absorption field before test -1 After test Peroxide treatment (past 12 months) (Y/N) A/ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot + I bo On adjacent lots To building foundation 30/+ 4-1 Property line �- i o1 To existing or abandoned system on lot On adjacent lots + ice' Cutbank -4-1 dO Water main/service line Surface water + Driveway, parking/vehicle storage area Curtain drain 4 too' E. ENGINEER'S CERTIFICATION i— 1q' i certify that i have checked, verified, or conformed to all MOA and HAA guidelines in effect on. the, -date of. jhis inspection. , E Signature .- Engineer's Name Date Z ` Z 3 HAA Fee $ 3C U Waiver Fee $ Date of Payment 2 /?-7-A/ Date of Payment Receipt Number Receipt Number 72-026 (3193)' Back AL Commercial Testing & Engineering`: Co. •AN& Environmental Laboratory Services®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®® $1NCE 1908 6 5633 B Street REPORT of ANAI'YSIS Anchorage, AK 99518-1600 C`.tW Fief > ? ;C, 1.0669 --L Tel: (907) 562-2343 C1.jent: S@%)1e ilk -[,2 11ARV1:14 SUB, Fax: (907) 561-5301 C4f33 rix WATER Client Name tCCINS` RUCTING 'iJIGINt?EYES Ordered By CHUCK IANDLRS Project Nam projectit f?t•2SID aUA Sample Remarks- SAMPLE COLT,ECTE D BY: C.A.L. WORK Order :757ei4 Printed Date :02/16/94 @ 09°40 trs. Collected slate :02/11/94 @ 09:05 hrs. Received nate : 02/11/94 @ 13.-00 tars,. Technical Director :S-TEPHEN C. Released By ; �C���� f SSC A11OWablf-: l"HIC . Anal ParameterI2t:sul:t:> dual°[hits° Me l�od i'ittlil..5 Date Date itait Nitrate --N 6.66 trig/LI EPA 353.2/300.0 10 02/14 LCki ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA See Special_ Instructions Above_._UA = Unavailable e i;r- e ,amble Remarks Above NA = alyzed Not Analyzed U = Undetected, Reported value is the practical quantification limit, up = 1..ess Than a 0 D = Secondary dilu=LiOn. GT - l',rLgate> Than a �± �+ ��N �SE38 Member of the SGS Group (Soci6t6 G6n6rale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA Parcel I.D. # MUNICIPALITY OF ANCHORAGE Department of Health& Human Services M}ij • `� DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING HAA# da— &-j0 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2 Marvin Subdv. Formerly lot 144 T15N R2W Sec. 25 Location (address or directions) (b) Property owner H.U.D. Telephone : (home) Business 271-4342 Mailing Address 922 W- Sth Ave., Anchc�raqp, AK. 9983-3 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here ®, if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family ® Number of bedrooms 3 3. WATER SUPPLY Individual Well IR Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site U Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025(Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmEAGLEJ WZR_ENGINEERINr, SEBVIGES Telephone EAGLE RIVER, AK 99577 Address n__ n_. 110X771994 Date S/y, 694-5195 f e°L•OO PO.^.Vn �.i.. p a _ • sov � O�•GEO�•i0�0�� iJ�CC oe��. Louis A. 6ufara ° �4 CE -6736 ` F a�pO Oo eo oo oeo p� .7 'n110F E Js`O�\tfa.7� 6. DHHS APPROVAL « �J q Approved for bedrooms by to Approved y� Disapproved Conditional Terms of Conditional Approval Note: The well for. thi Municipal Codes. it is suggested insure the wells concentration is s property meets existing State and There are nitrates present, however, that periodic testing be performed to continued suitability. Nitrate 8.3mg/1. ....CAUTION.. The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 � OF PN��OO 4J�uN`G\t' � • � A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) a CHECKLIST - FEBRUARY 1984 343-4744 Well Classification fore ✓e -f-= Well Log Present (Y/N) Y Date Completed Total Depth /�`7 Cased to / �� Depth of Grouting Static Water Level Legal Description: f -9 1"a I✓I'� Sk 6r (v i-�r...ei7 /.,r ivy 7 -Is- 1v �-_ cZw aks- /o/ P:? If A, B, C, D.E.C. Approved (Y/N) � 4 Yield 63 j'/' -/x! Pump Set At l ae ' Casing Height Above Ground 30 Sanitary Seal on Casing (Y/N) t' Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) "" SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot L On Adjoining Lots io z To Nearest Edge of Absorption Field on Lot /mss - ; On Adjoining Lots ��ao To Nearest Public Sewer Line /�//" To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot EV Water Sample Collected by Date Water Sample Test Results 61'3 Comments B. SEPTIC/HOLDING TANK DATA Date Installed /1�s' Size No. of Compartments _ Standpipes (Y/N) ev Air -tight Caps (Y/N) .o�`� Foundation Cleanout (Y/N) u Depression over Tank (Y/N) A-)- Date Last Pumped Pumping/Maintenance Contact on File (Y/N) "'�� ; for ^ �� Holding Tank High -Water Alarm (Y/N) fir' Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well �/ To Building Foundation -Qi To Property Line'U To Water Main/Service Line do ' To Disposal Field /Z ' To Stream, Pond, Lake or Major Drainage Course !' Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed �' �' Width of Field �9_7e Type of System Design Length of Field 'Z vj� Depth of Field Gravel Bed Thickness G " Square Feet of Absortion Area Statndpipes Present (Y/N) r Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test �� / SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well i =.s To Building Foundation `f6 Lot N1a To Water Main/Service Line To Property Line `/O To Existing or Abandoned System on On Adjoining Lots t 3 To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course - To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION N/Li Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" .k ";: I certify that I have checked, verified, or conformed to all MOA and HAA eI(As In':effeot,on the date of this inspection. Signed y� Eagle River Engineering Services n®off, Company p 0 Box 773894 ; ° ngineer's Seal Eagle River, AK 99577 Date •S/�/�� `' 694.195 MOA No. X/-.2cs�)s, j ^ a WI rIC' �/ 'l J Receipt No. �3 —3/ / Date of Payment J` `7` — Amount: $ P/.;? D .') C) Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION 2. Application Date May 28, 1986 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; Manv.in Subdivision Location (address or directions) Cohnen ab 7omu way and Sanbow6e2 (b) Applicant Name Don Bakers Telephone: Home 688-4842 Business 561-4896 Applicant Address 963 SanbowUet, Eagte R.iveh, A2a4ka 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 0 ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution R attand Montgage Telephone Address Eag.2e R.iveA, A.2aska (e) Real Estate Company and Agent none/neginanci.ng Address Telephone (f) Whe HAA to the following address: S 9 S Engineelt ing SRB 196X _ Eaq.2e Riven, A2aeha 99577 TYPE OF RESIDENCE Single -Family g( Multi -Family ❑ Number of Bedrooms 3 Other 3. WATER SUPPLY Individual Well [Z] Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite V Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval 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 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of f=irm S & S ENGINEERING Telephone Address SR B 196X Date EAGLE RIVER, AIC 99577 JUN 31986 I }1q,."nOfirSa��i i 6. DHEP APPROVAL ✓5 Approved for /bedrooms by 20? �� �'' Date C Approved Disapprove Conditional Terms of Conditiona Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z•75�Type of System Design Date Installed 0 —\"O- 83 Length of Field 47 7 Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area '5ZS Standpipes Present¢/N) Depression over Field (YQ / Date of Last Adequacy Test -5- Results Results of Last Adequacy Test "� s�Pr�satr- r fin- 3 gfL� Separation Distance from Absorption Field: To Water -Supply Well j �� ( To Property Line To Building Foundation `i'o To Existing or Abandoned System on Lot a P ; On Adjoining Lots 3� 1 To Water Main/Service Line L To utbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area t 5) �- Comments D. LIFT STATION Date Installed Dimensions Size in Gallons I Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that h.vac ertik I �erN , or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed b 5 tIVG�IV M Date JUN 31986 SR B I 96X Compan UME RIVER, AK 99577 MOA No. �wr��w�� Receipt No. �1?66 bC% � <� � yeah• 'R Date of Payment 0% •••'•aif Amount: $ <9 5 r • •ti eNj Page 2 of 2 72-026 (11184) A. WELL DATA Well Classification S `r--• MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION J a ISI 0 4198E Legal Description: z Ff F 1 v rAMR V n M A -a a!tti1 If A, B, C, D.E.C. Approved (Y/N) Well Log Present$/N) / Date Completed lU' I'8" Yield Total Depth 17-'0\ Cased to Depth of Grouting Static Water Level 7 g Pump Set At Uri N Casing Height Above Ground Sanitary Seal on Casing <YPN) Electrical Wiring in Conduitp/N) Separation Distances from Well: To Septic/HotcTin'g Tank on Lot N o.S G+flwl Depression Around Wellhead (Y/49 ; On Adjoining Lots To Nearest Edge of Absorption Field oLot ; On Adjoining Lots L To Nearest Public Sewer Line 4 To Nearest Public Sewer Cleanout/Manhole r A To Nearest Sewer Service Line on Lot (A - Water Sample Collected by S i+ 6�'J Ca ; Date Water Sample Test Results S -m,5 e -F-&, `'r Comments 4 4..��- `�I�-D 't�ST SP -L � i `^��u `CZE PU r»7L� c'� %Q r +mss csf 0"9 B. SEPTIC/H@tBtNGTANK DATA Date Installed l -to-S3 Size \ No. of Compartments Standpipes<O/N) Air -tight Caps ON) Foundation Cleanout (Y,(1,qD. Depression over Tank (Y�q Date Last Pumped Pumping/Maintenance Contract on File (Y/N) tDIA ; for Holding Tank High -Water Alarm (Y/N) P Temporary Holding Tank Permit (Y/N) N "� Separation Distances from Septic/Hnfd+Rg.Tank: r To Water -Supply Well ) o0 To Property Line To Water Main/Service L Course Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field 11/ To Stream, Pond, Lake, or Major Drainage