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LAMPERT ESTATES BLK 1 LT 4
a soft Lampert tastates I t: Municipality of Anchorage • �" Development Services Department 'tai JC7E'' Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw SL page I of3 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage ak.us (907) 3417904 ON-SITE WASTEWATER DISPOSAL SYSTEM ANDIOR WELL INSPECTION REPORT Permit Number: swo�oaa� PID Number. Name .S San PY'lAI Wastewater System. []New ❑Upgrade "redy �� h, la L�� T 99� - �. 7 ABSORPTION FIELD Numnera Baaaan o Deep TW4fi❑ SMIaw Tte 13 BW 13~4 XDme Plana 648-35 Sod Rama TaN nam ovml 7w. L LEGAL DESCRIPTION GPDIFI" Sypl' 4Ww tnDer Depth IPpaanatom nam'g^ +a' GevN Oepn Wne�m ppe .. Black La 7 FI. 1 d+'� $• ion Fd baW Coca gnaw las• Gr. Len7n 7ownslnP ka•ys � F. Gavel vnrnn NNIwt of DiNa Well: ❑New ❑ Upgrade Ft. TNN tlw 11=vaa j/� a. 7aN Dapm Caaw to /ALV/l/1 � iCtl) Cies ,rl(Prn/eu AB. (1///ff F� P Ft DNe lnstNiNl /I ,, suaw.eLaN ml yea F U °feet FI .T05 1 LL�'e x / r Na Punq SNn • -vas^° TANKS c GPM FI. Ft SEPARATION DISTANCES ❑ Sep!ic ❑ Holding s.T.E P. ate❑ Other. JJM To Septic Absorption Ldl Holding uoiirJPnvate Gy From Tank Field Station Tank Sewer Line Nof caro.t WNi 108' 10� 1019 o y/�u ♦✓ re!) 100- _ f 7 LIFT AT ON e srlsowWo10) Led .. aa..a Z a 1 1F LNL" 3S ( 1 a 1 'P.dW on'M+NN 'Pump a"++Nal r 1 `�/ d FoxbY.an 5 1-7 Er _) n Pump FeN`V' R a.,u; t�sPV?aM Wrl EY •S; Soo r. c( ; c�l..+w.�n —. one Ramrxs f LL .1_ _ _ _ .,... BENC ARK s removede SUM Engineering Inspections performed by: 1�Ctltgak�A.imka 9956799567 — Dates: 2n11" 9±E-07 Development Services Department Approval Conditional Approval Date: Reviewed and approved by: (Rl a•ad) Date: .4- / A In, I / '/U FI Engineers Stamp lo A. Shole, dr ti•. 1137-l�•� � P)rc fiN Its..'J�.e i L� �7•AY r+` PERMIT No. SW070224 PAGE 2 OF 3 Municipalit of Anchora e DEPARTMENT OF HEATH AND HUMN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 *Anchorage, Alaska 99519-6650 • Telephone; 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 1, LAMPERT ESTATES P.I.D. No. 051-102-58 OBERG ROAD SHED S[ E NPT71) C •N[• a s J .• LOT 5 3 LOT 3 r Y 9A O • �9'A 9 CALF: 1' - 40' 100' WELL RADIUSENGINEER STAMP 10' UTILITY EASEMENT p♦Iy FRIENDSHIP LANE `g } A. !I•dr . 1uu ./ PERMIT NO. SW070224 PACE 3 OF 3 Municipalit of Anchorage DEPARTMENT OF HEATH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL LOT 4, BLOCK 1, LAMERT ESTATES P.I.D. NO. 051-102-58 STI ST2 99.4' FINAL GRADE MH NEW 1250 91'8' GALLON S.T.E.P. 91'6' SYSTEM FINAL GRADE ORIGINAL AND MT1=101.5' MT2=101.1' FINAL GRADE MT1MT2 2' INSULATION au.n lwtiiwa• int MT1=98.1' MT2-98.1' BOTTOM OF SAND -96.t' DIST. LINE=98.4' GROUNDWATER AT 92.1' 87.1' D.O.H. N. T. S. A B ENCIN STAMP FCO 15.0 7.0 Ab-• Q,�'q vs STI 16.0 8.0 ,� »••• •;4S ST2 19.5 12.5 MH 21 .0 _74 TV 41.0 42.0 •/{• #9L f• TV 32.0 34.5 „„ ,••••„• MTI 39.0 26.0 9 �o• A,� r� MT2 42.5 43.0 \\ '?CVLT95V0Q'r.'� Nov 08 2007 1:37PM Risins Son Electric, Inc. 622-6777 P,2 Rising Son Electric. Inc. /,.= I A016 \Voodland Drive :- Eagle River. AIC 99577 rt, T ` (907) 622-6777 t� November 8, 2007 Tweed Excavating & Construction Richard Shafer 15861 S. Birchwood Loop Chugiak, AK 99567 Re: Lot 4 Lampert Estates - 22647 Friendship Lane - Chuglak, AK 99567 Dear Richard: The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, .� 9 Kevin S. Hornbuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 cc: file MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW070224 Legal Description: LAMPERT ESTATES BLK 1 LT 4 Design Engineer: 0003 S & S ENGINEERING Owner Name: SUSAN PRUITT Owner Address: 22647 FRIENDSHIP LANE CHUGIAK . AK 99567-6151 4 1 �U� �'* b rk Date Issued: Aug 30, 2007 Expiration Date: Aug 29, 2008 Parcel ID: 051-102-58 Site Address: 022647 FRIENDSHIP LN Lot Size: 19851 SO. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit Is for the construction of: ❑d 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 tailing (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. Received By. /W Date: c7/ r// 7 NED. mgj�xm Municipality of Anchorage t' Development Services Department c Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEPTIC/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O S 1— 10D: — S-!6 Property owner(s) vt 5 Rh Pr L4 /W: Day phone b'Z'0-35 9' Mailing address otocD7 / EX,C Site address SG)f'✓) Zip Code Legal description (Sub'd, Block & Lot) �f% B�OL� IziY! �Cr� Legal description (Township, Section & Range) Lot Size 1Q. S51 Sq. Ft. THIS APPLICATION IS FOR (®all that apply): Absorption Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 THIS APPLICATION IS AN: CodeUS -615/ Initial ❑ Upgrade 19 Renewal ❑ 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. S' 4 S i#N (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: _V_/0/0 Y Date of Payment: Receipt Number: 00 5/3 8 Receipt Number: (Rev. 11/05) June 7, 2007 ROBERT C. COWAN, P.E. CMLENGINEERS (907)694.2979 FAX(907)694.1211 IEALTHAINIORITY MUNICIPALITY OF ANCHORAGE APPNOVALS Development Services Department P.O. Box 196650 Anchorage, AK 99519 SEWERAWATER LMID(TENSIOM REFERENCE: Lot 4, Block 1, Lampert Estates Subdivision SEWERBWATER It is requested that you issue a permit to install a new I.D.S.F. septic system to serve .RPECRON the existing three bedroom dwelling on the referenced property. The existing trench is in failure. ENGNEERNGSTMES A test hole was excavated and a percolation test performed. The approximate location of ANDREPORTS the test hole is located on the attached site plan. At the time of excavation 12/5/06, ground water was not found. After monitoring, no ground water was found. WELL INSPECTION We do not anticipate any adverse effects on neighboring wells, septic systems, reserve APTD'NTEST areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. SITEPIANS If you require additional information, please contact us. Sincerely, ROAD DESIGN 40.1 - SM TEST Robert C. Cowan, P.E. RCC/bjj Enclosure PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 034 NORTH VG: 77?)4-EAGLE RIVER. ALAS KA 90 F" 11 = 401 DESIGN kvM3AIN(3 n CIO" no X� SITE -PLAN W - otN . ;wipCno.es >On r _GN O ooa hl/ rl nOm na a !b � �qp M-0 2 I� 0 f Ix f. 1 1 H� fM N y to r? ARM �m !'ly o Y,Sr O � y co O y to r? ARM 46. � o Y,Sr � � U 30 I O O N � r — m O Z+c W -nO x i in 0v00 ur, ON n V) r� N a 1 =Cm O=i aKN O ..<Z N 8 -4o m 46. W N I N O I I l�J OV W 0v00 V/�//)� J n + ♦� C', 1 =Cm aKN O X- �A I o 46. N. t s DESIGN I.D.S.F. DETAIL ./) ~� M V-71¥ ;d / | € G 4rJ m- e ® w an � ?a r � t-4 m CD r > \4 ... k § k c x . \ � Q z m C 0 m \ \ \ r & � \\ ƒ 2 G w S ! § m � m q � \ ' § § |\ ! ■| ` � I ` , k -� ci ��f��� u Municlpallty of Anchorage Development Services Deparlment eulhthlg Safety Division • +.e OWSlle Water a11d Wastewater Plogtent 4700 South eragaw SI. P.O. bow 196650 Anchorage, AK 095196650 w" Levu' q 91uk.us (907) 343.7004 Soil Percolation Test Performed rot: _ I >osiou JZi�t'`'- Dale L Legal Do ctiptlon: „U t 81 t I e t !EE I �r Townehlp, Range, Section: Slope Depth 10- moo• 50 H 14 S WAS COUNTS WATEn o ENCOUNTE11ED7 Q s IF YES, AT WtIAT DE1,1111 L Deplh to Web, Aller D Monllorlog7// I !-gyp Data: —Wig ig J' Site Plan Reading Date Gross TMne Net lhne Deplh to Water Not Drop FC76e4 h d O 6 UCS � o 23/ q`'fie 4211 .2 Y56 - prtos50to -YA rw,uvr rnrn rinie• (_ 1reeMrh) PERC ROLE DIAMEIEn (Cl TEST RUN BETWEEN FT AND _FT 1 r PERrORMED M s-1 A /' PERFOnMED IN ACCORgAHCE WI1ll A STATE AND EFrECTON11113DAtE. DAIE: 7b:50 O 1 2rz o lt;- 30 S 11 7-15 :25 U t/ rr O HEALTHA THONTY APPROVALS SEWER 6 WATER WN EMNSONS SEWERaWATER INSPECTION ENGINEERING STUDIES ANOREPORTS WEILINSPECTION L PLOW TEST SOILTEST PERCOLATION TEST STRUCTU AL✓1 MECHANICAL NSPECIORS ONSITE WASTEWATER D9SPOSALSVSTEM DESIGN ROBERT C. COWAN, P.E. ROBERrA. SHAFER, P.E. CMLENGINEEnS (907)694.2979 FAX(907)694.1211 INTERMITTANT DOSING SAND FILTER SPECIFICATIONS Lot 4, Block 1, Lampert Estates Subdivision June 7, 2007 GENERAL STATEMENT OF WORK The work and plans covered by these specifications consist of furnishing all labor, materials, tools, transportation, and equipment necessary to complete an Intermittent Dosing Sand Filter system as described herein and on the attached drawings. All work under this project shall comply with current Municipality of Anchorage (MOA) Regulations. The scope of this project includes the installation of a new I.D.S.F. septic system to serve the existing three bedroom residence located on the referenced property. The Contractor must carefully examine the project documents, have full knowledge thereof, have investigated the site, and be satisfied with the conditions affecting the work. Conditions include, but are not limited to those bearing upon transportation, disposal, handling and storage of materials, availability of labor, water, electric power, roads, and uncertainties of weather, physical conditions at the site including all underground utilities, the conformation and condition of the ground, the character of equipment and facilities needed preliminary to and during prosecution of the work. The Contractor must be satisfied with the character, quality and quantity of surface and subsurface materials or obstacles to be encountered. Any failure by the Contractor to become acquainted with the available information will not relieve him/her from responsibility of performing the work as stated in these specifications and drawings. Location of utilities will be the contractor's responsibility. Page 2 Lot 4, Block 1, Lampert Estates Subdivision June7,2007 SEPTIC TANK/ LIFT STATION /AIR COMPRESSOR A. General The work under this section consists of the performance of all operations pertaining to furnishing and installing the septic tank/lift station, air compressor and piping to the sand filter. B. Materials Tank a. Septic tank shall be a two compartment tank of at least the minimum size indicated on the drawings and MOA approved. b. First compartment shall have a separate 4" pump -out riser. The second compartment shall have a separate 4" pump -out riser. HDPE septic tanks are required to have a 4" monitoring pipe installed next to the tank extending to the bottom of the tank. 2. Manhole Riser or Lift Station Tank a. An additional second compartment manhole riser shall be capable of being equipped with the following: 1. A junction (Nema 4x) box or equal, bonded or attached to the pump basin. 2. UL listed electrical cord grips, installed in the J -box. 00 b. An additional tank (M.O.A. approved) may be provided for the effluent pumping assembly and the items in (a.) above. 3. Effluent Pumping Assembly, Controls, Alarm & Piping a. Effluent pumping assembly shall be of approved materials, including the following: 1. A 110 volt or equal U.L. Listed effluent pump. Pape 3 Lot 4, Block 1, Lampert Estates Subdivision June 7, 2007 2. High-density PVC cylinder housing the pump, with level controls and screen, serving as a baffle to prevent the screen from clogging. 3. All piping shall be PVC or other non -corroding material. b. Pump controls and alarm system shall be an approved system with the following options consisting of: 1. Event counter 2. Elapsed time meter 3. Program timer 4. 10 watt heater 5. Remote alarm panel option with a minimum of 80 DB sound pressure at 24", operating temperature 30AC to 65AC, continuous sound to be located in the home. 6. Oil -tight visual alarm with push -to -silence feature. Automatic audio -alarm reset. 7. 15 amp motor rated toggle switch, double pole, double throw with three positions; manual (man), automatic (auto) and center (off) (H.O.A.). 8. Nema 4x -rated, fiberglass, or equal, enclosure with hinged cover. 9. All controls to be installed as per manufacturer's recommendations. 10. Control panel to be installed on outside wall of home within sight of septic tank/lift station. c. Piping from the septic tank to the sand filter is to be 1 1/4" PVC schedule 40 solvent weld piping properly bedded as described in Materials Specifications and sloped to drain back to the lift station. Insulation board 2" thick and 2' wide centered over pipe is to be placed where soil cover is less than 4' depth over pipe. Page 4 Lot 4, Block 1, Lampert Estates Subdivision June 7, 2007 d. The airline from the house to the filter is to be HDPE arctic insulated pipe 3/4"-2" SDR - 11. The compressor will have a gauge (0-10 psi) and be extended into the living area or garage for easy monitoring by home occupants. 4. Air Compressor a. Air compressor shall be a THomAs LINEAR SERIES model number 5060-A or 5070V -A or M.O.A. approved equal. CONSTRUCTION SEQUENCE In order to insure proper installation, the system is recommended to be installed in the following order: I. Sewer line from house to tank H. Septic tank/lift station M. Sand filter IV. Leachfield bed (if required) V. Final grading CONSTRUCTION 1. Construction Instruments Contractor shall provide instruments such as transits, or levels, for establishing proper elevations and levelness of pipe or materials. 2. Pipe Laying All pipe shall be laid with material free of large or sharp rocks and organic matter. Each section of pipe shall be handled carefully and placed accurately. The spigot end shall be fully inserted pointing in the direction of flow and glued in place to make a water tight seal. Page S Lot 4, Block 1, Lampert Estates Subdivision June 7, 2007 Each section of pipe shall be properly supported to insure true alignment and an invert which is smooth and free from roughness or irregularity. At all times, when work is not in progress, open ends of pipe and fittings shall be closed so that no undesirable substance will enter the end of the pipe or fittings. 3. Bedding of Pipe for Sewer Lines The pipe should be bedded with materials free of large or sharp rocks and organic matter, compacted. Native materials may be used as back fill material above the pipe, provided it is free of large rocks and organic matter. All lift stations shall be installed in accordance with the manufacturer's recommendations and standards. Electrical installation is to be in accordance with the National Electric Code (latest adopted edition) by a licensed electrical contractor, with M.O.A. inspection where required. If MOA inspection is not required, a licensed electrician is to provide a letter to the Engineer stating that the system meets or exceeds all applicable codes. 4. Excavation Excavate to proper depth to allow gravity flow, install tank level, tolerance 0.05 foot, on undisturbed or compacted classified sand fill material. Create a level sand surface over the tank and add 2" burial foam +35 PSI directly over tank. Mound unclassified soil over tank with a minimum of 2 feet of cover and anti -flotation weights that may be required in areas of shallow ground water. 5. Connections All connections to be as per MOA requirements, PVC 3034 piping with Caulder or equivalent couplings for inlet riser pipes. All tank connections are to be completely water tight. Page 6 Lot 4, Block 1, Lampert Estates Subdivision June 7, 2007 SAND FILTER The work under this section consists of the performance of all operations pertaining to furnishing and installing the sand filter. A. Materials 1. Sand Filter a. Liner (if required - not required for bottomless sand filter) - OSI Model LI or equivalent. 30 mil PVC cut and fabricated to provide water tight enclosure of filter sand volume. Seams to be permanent as per Manufacturer's recommendations. All connections, such as boot flanges, through sand filter to be permanently bonded to the liner. b. The Contractor shall provide a washed sand to meet ASTM C-33 Concrete Sand Specifications with the additional requirement that all but 1% of the materials passing the #100 sieve be removed. All aand shall be approved for use by the Municipality of Anchorage (M.O.A.). If the sample does not meet specifications, all sand will be removed and replaced. c. The Contractor shall be responsible for providing pea gravel that shall be a washed material containing no fines (00/o passing the #100 sieve) and a maximum size of 1/4" diameter. d. The Contractor shall provide the manifold assembly. The manifold assembly shall be of approved materials with orifice shields and flushing assembly. All drilled holes to be cleaned of burrs and pipes flushed, prior to assembly. Flushing valve to include riser to finish grade. Lateral distribution piping is to be laid level (@ t 0.05'). e. Sidewalls and top of the filter box to be insulated with 2" direct burial polystyrene insulation. f. The Contractor shall be responsible for providing filter fabric. g. Air coil in sand filter to be geoflow WF164-24 150 LF placed 6" above bottom of sand. Pape 7 Lot 4, Block 1, Lampert Estates Subdivision June 7, 2007 Construction of Sand Filter The sand filter construction is to follow procedures as outlined below, as applicable to this design. Pea gravel and filter sand are to be hand leveled to proper depth (tolerance within 0.05 feet) in filter, taking care not to allow mud or fine soil material into the filter or gravel layer. This would include any soil material picked up by excavation machinery buckets while loading specified material. The Contractor should estimate filter material volumes such that allowance is made for wastage of material in contact with the ground at site. The area over the sand filter to be finish graded with a minimum of 2 feet of cover and to prevent ponding of surface water run off. Side slopes shall not exceed 3:1. The Engineer will reject any sand or pea gravel that does not meet specifications or is contaminated in transit or while handling. If such material is placed in the filter, all soil material maybe required to be removed and replaced with new material. CONTRACTOR/ INSTALLER ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE AND _f i 6e(t k Reg L�— THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this Day of of 20_, by and between ju� Re herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows: 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AW WTS), described as' S) 5 located d)at .COT B/if' / �An.t��GsfiF�Ys Anchorage, Alaska. 2. Definitions. A. Alteration. Any change to the design or function of an AWWWTS that Includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AW WTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AMC") 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AW WTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AW WTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fre. Owner shall pay to Municipality an annual fee of 0 1 o ($ (7 .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the A W WTS. The term begins on the date of approval by the Municipality of the installed system and shall continue while the AW WTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations. Installation and Removal of Additional F,auinment. Owner agrees not to make any alterations, removal of parts or additions to the AW WTS without a Construction Permit from the Municipality. 6. Maintenance and Repairs. A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AW WTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AW WTS. B. Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AW WTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AW.WTS . C9 Operating Permit is:. 144 hR . C. Owner acknowledges that the fine schedule for failing to maintain and repair an AW WTS are codified in AMC 14.60. D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AW WTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AW WTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AW WTS. 7. Nonwaiver. The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: Owner: N Ar � (( k PR "-ff— Anchorage: Purchasing Officer C. Any attempt to amend, modify, or change this contract by either an unauthorized representative or unauthorized means shall be void. 9. Jurisdiction: Choice of Law. Any civil action arising from this Memorandum of Understanding 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 Memorandum of Understanding. 10. Severability. Any provisions of this Memorandum of Understanding decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Memorandum of Understanding. OWNER: K By: Date: STATE OF ALASKA THIRD JUDICIAL DISTRICT MUNICIPALITY: By: Title: Date: ) ss. The foregoing instrument was cknowledged before me this qday of 2007• by �/%l,��e// .(� >�rwrl� 9 N1.Gi/ -11 V" aY.......!ho NOTARY PLIOLIC FAJR ALASKtii o;•oc ""°°F. ;^� My Commission expires: 1 - PUNIC �'''•,;rfate of P�� MUNICIPALITY OF ANCHORAGE Development Services Department �v On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 �\�Q ` N \ ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Permit Number: SWO60344 Legal Description: LAMPERT ESTATES BLK 1 LT 4 Design Engineer: 0003 S & S Engineering Owner Name: SUSAN PRUITT Owner Address: 22647 FRIENDSHIP LANE CHUGIAK . AK 99567-6151 Upgrade Date Issued: Oct 23, 2006 Expiration Date: Oct 23, 2007 Parcel ID: 051-102-58 Site Address: 022647 FRIENDSHIP LN Lot Size: 19851 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, seated, and heated to prevent freezing. 5. The following special provisions. - (EMERGENCY TANK REPLACEMENT) - SEPTIC TANK INSTALLATION MAYBE LOCATED NO LESS THAN FIVE FEET FROM ANY PROPERTY LINE OR BUILDING FOUNDATION; TEN FEET FROM ANY WATER SERVICE LINE; ONE HUNDRED FEET FROM ANY SURFACE WATER; AND ONE HUNDRED FEET FROM ANY PRIVATE WELL; AND THE SEPARATION DISTANCES REQUIRED BY 18AAC72 FROM WATER SUPPLY WELLS. Received By. 2ez� Date: /01 y�C G Issued By. 1 Irl'-' Date: /0 /� Municipality of Anchorage Development Services Department e Building Safety Division` On -Site Water and Wastewater Program 4700 Bragaw, Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEPTICMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. OrJI' Itt)2." 5 Property owner(s) 5 L -y5 Ci V1' P— (L�t�i �7 1 Day phone '3S� Mailing address22 6` f / T r i e�{�iS± p L,?eZj]Lj�j;cxkdk' Zip Code 99 S6� Site address S G l L� Q Zip Code �1`A ✓h r Legal description (Sub'd, Block & Lot) Goo 4 9164 Corm pdyt � �"1 Legal description (Township, Section & Range) 3Lot Size I q 851 Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR (®all that apply): Absorption Field 11 Septic Tank K Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION IS AN: Initial El Upgrade K Renewal ❑ 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. �y S 8 S ENGINEERING 2, `7 ti , (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: (Rev. I V05) 17034 Eagle River Loop Rad No. 404 R ACO. " Waiver Fees: O 9 —77o N '' Date of Payment: joh'* Receipt Number: nq ROBERT C. COWAN PE October 19, 2006 CMLENGINEERS (9M 694-2979 FAX (907) 6941211 /EALTHAUTNOPoTY MUNICIPALITY OF ANCHORAGE "'PRO% `A Development Services Department P.O. Box 196650 Anchorage, AK 99519 SEWER& WATER ""H°`TF1S1ONS REFERENCE: Lot 4, Block 1, Lampert Estates Subdivision SEWER&WATER It is requested that you issue a permit to replace the existing septic tank currently INSPECTION serving the existing three bedroom dwelling on the referenced property with a new 1250 gallon steel S.T.E.P. tank. 04ONEERNGSTLOES We do not anticipate any adverse effects on neighboring wells, septic systems, reserve ANDREFORTS areas or drainage patterns by the installation of the proposed septic tank. The construction of this system will not prevent any future development on any of the adjacent properties. WELLMSPECTION If you require additional information, please contact us. ' & FLOW TEST Sincerely, SITE PLANS Vobert6. Cowan P.E. RCC1bjj ROAD DESIGN Enclosure SOLL TEST PERCOLATION TEST &TPoICRxm& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSISTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER ALASKA 99577 1" = 40' 1 DESIGN I SITE -PLAN r O V) r O y Ift T mkt 0m� oz.. woo "Or vmr) )OM f)V D -1` s z'" ZCVCA q• �► iy 9 O � I 1- 3 { F�M I 12 I D MN� 1 N V VIE OZ AVMWaa m�F I r lV/ oo� I O soN o CJ) Vl ti m �p� f F ID OOfn f � CJl �Oy D Q nom DI Drp f F i w r KI zI flnm 1 D Z Dnp A N m I � = O O q• �► iy 9 O � I 1- 3 { F�M I 12 I D 1 N V VIE OZ m�F I r lV/ oo� I O soN o CJ) XO q• �► iy 9 O � I 1- 3 { F�M I 12 1 7 Y b I '-3 i o CJ) � CJl �Oy D Drp f vI/1 t z� flnm D Dnp N m � = O O 72-013 (Rev. $/78) 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 REP013T NAME �' PHONE NEW ❑UPGRADE MAILINGADDRESS C LEGAL DESCRIPTION LOCATION ✓ .. NO. OF BEDR `•.1J OMS cry DISTANCE TO: Well (O D Abiorption area c. �✓ Dwelling �� PERMIT NO,Z `?U��� l0 a Z Manufacturer Material No. of coW,)artments W H of to Liq. capacity in gallons IF HOMEMADE: Inside Width Liquid depth 0 D CE TO: Well Dwelling PERMIT NO. D',Z T — F. anufacturer Mater' � jd rnn y my in gaacR�IlonsL"' w DISTANCE T0: Well Foundation Nearest lot line PERMIT NO. .��O�h S t © J LL Z No. of lines Length of each I' Total length of li e Trench width Distance betwee lines FZw cQi� / � inches & F.- Top of U e o finish grade Material beneath tile Total effective a sorpthan rea p ( ' inches_ L.�� Len Width Depth PERMIT NO. W C7 o F- W n' Type of cri Crib di ter Crib depth Total effective a ion are (nell u' ing foundation Near of line DISTA CE TO >A41 J Cl Depth Driller Distance tq lot line PERMIT N� J Y LU DISTANCE T0: Building foundation Sewer line C Septic tank Absorption area(s) `p16* OTHER PIPE MATERIALS 'P3C)J4 SOIL TEST RATING I SID C— It s INST LLER R[ -M KS C uF It w W APPROVED DATE LEGAL 142-7 [7 72-013 (Rev. $/78) tIT fi �� 7Ht��tR #,c,_%LTH NCHORAGC bA U � ` ky & b TAL rpC,i-CTION Y A & L DRILLING COMPANY JAN 4 109 BOX 97, EAGLE RIVER, ALASKA 99577 • TELEPHONE 694-2588 RECEIVED M`,y E C E I V E D OWNER OF LAND %sI / ! t ( s ;' i ; DEPTH OF WELL ADDRESS ? t '. F'i" /- '' ! ;. ,% "' :% ` ' STATIC LEVEL OF WATER FT. — LEGAL DESCRIPTION 1 /j[-({ ! e% ' !' '-' "•� / DRAW DOWN FT. _ DATE - Started (� 0 12 " Ended Z/!y GALS. PER HR PERMIT NUMBER ° I KIND OF CASING KIND OF FORMATION From Ft. to 14 Ft. From Ft. to— _Ft. ) 0 1_1 �i '" f� F? /" ` ` From - Ft. to Ft. From Ft. to— —Ft. From /; _'� �i Ft. to '/, .- � FY. (� ,, ' % .-�. G� F� �' ,_� aL" m Fro Ft. to Ft. From ' `A<. Ft. to "`�! i Ft. _ /"i %-'(.. 4 . ,.,1/ Froin -Ft. to Ft, From -'!L—Ft. to -, "F7 ` Ft. f/; From --_—Ft. to Ft- From " _Ft. to?3 `1 Ft. h %, ut-.l From Ft. to Ft. From Ft. to Ft. From Ft. to ---Ft. From Ft. to Ft._ From Ft. to__Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Froin -Ft. to Ft. From Ft. to Ft. From Ft. to Ft. Froin—Ft. to Ft. From Ft. to Ft. Froin—Ft. to Ft._ Froin—Ft. to— Ft. Froin—Ft. to Ft. _ From Ft, to Ft. From Ft. to Ft. From Ft. to _Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft- MISCL. INFORMATION: DRILLER'S NAME . TYPF Cif" ;Oil._ AE111,:S_ORBTT0N P: -s: TRU!"NCH MAVIMU11 NUMBER OF SOIL. RATINF'i ('wX) THE OF' THE Soft- AV..r;:'.ORPTXON 1sys.'rF.'M 1%,;: CR U_ P, "ll" 1 -1 --1gL-- - *�� 0_ -:;,# '314 . � f X C', X F, A" "T"Y' TR.F`TJGH OR' DRAINFIFUJ), CJ F"" TREric:H OP PIT TS THF DIS"TTINCE THE". SURF'AGE' OF' THE ORCIUND ANO THF. D k.'. F, F1 F.". T ME NT 01" HEALTH AND ENV I RONMENT!"9L.. FROTECT I Okl FOR TRENCHES. THF I CIRAVEl- DEPTH 80,5 'l..' :'T'REET.. ANGHOPA(1V:,- OF THE A K'. 99-1.14 � I" t�1.1_1 In k_ A : V, T I _- _ : F�� UtEll", , P"� F" "C".. - "E. 1 ' X K-_.� "I" mit rA 11-1'" :1 W. _--, -.:; -,;;: j-, 0 9 4 UE'" I., _ 0 fF-11 1"4 V.' A; HP -4..... :E, I Ir-,.,. IA -0R F` F� VH- 11-1 1: "ll" PERMIT P-40, � -F80896,s' ') APP11- I CANT PITTCHEI-L FRUITT F1.,:TFRKXN9 15r,)4 71r,1101 �27�6,;71 1-C."W"ATX CjN PETERS' CREEY I-ECIAL. J-4 P1 L-AMPEF."T F'111'1'r'T TYPF Cif" ;Oil._ AE111,:S_ORBTT0N P: -s: TRU!"NCH MAVIMU11 NUMBER OF SOIL. RATINF'i ('wX) THE OF' THE Soft- AV..r;:'.ORPTXON 1sys.'rF.'M 1%,;: CR U_ P, "ll" 1 -1 --1gL-- - *�� 0_ -:;,# '314 . � f I: #s THE I .. ENOT1.1 (IN f.�'€ ET) of 'rHE' TR.F`TJGH OR' DRAINFIFUJ), nii,,, rw".Pni OF FT TREric:H OP PIT TS THF DIS"TTINCE THE". SURF'AGE' OF' THE ORCIUND ANO THF. F;OTTOtq OF` THE EXCAVATION (IN FEET), THELRE I":" N() 1,M)TH FOR TRENCHES. THF I CIRAVEl- DEPTH U.; THE t-uramum or -':r m Of.' GRAVE1. Kl+.W.Ah-A THE". OUT!"AL.L. PIPE ANVA THE UOTTO111 OF THE (,XCFWFITION (Ihl � I" t�1.1_1 In k_ A : V, T I _- _ : F�� UtEll", , P"� F" "C".. - "E. 1 ' X K-_.� "I" mit rA 11-1'" :1 W. _--, -.:; -,;;: j-, 0 PEF411'r APF1l;JCAhl"f' HAS THE R.f-, . SpOtT1.,.,-JJ?-1L.XrY TO INF=OFJq THI.G, r*zPARTMENT C)LIF!1: -40 THEE INSTAI.A.ATION OF' AN'i WELJ.._.',.-,' ADJACENT 10 THI.C. PF471PERTY AW'.1 T14...:1 NUMBE'.F.' OF' F,'F'S, I D E N GE THn'r 1' [ -I Fm ["I I- t'l 11-1-4 5, E R V E. J1 I ( . - . tF' r ,:.4 __ ....... V,4AC,KF:JlA_1NG' OF' Fit.4%) SYSTEEN WITHOUT F111AL. INL:J',E('J.1J1N ANC', APPROly1fIL, File THV� DFPARTt,lFi'NT 1411,1. PrE. '.,,RJf31JEC:T TO MINIVION E.W.TWEXEN A WVU., AND ANY 0N,5rrt, su-111GE 100 FU.T.A' F'0R Fi PRIVATE WFI-J_i OR 19"1 TO 20Q� FE."EJ F'ROM A PUE)UG ME11. l,`,EFE.NDTNQ UF',ON THE.: TYPE'.'. OF" PUBI-IC: WEI-1- NEI-L. l".0135 ARE... REQUIREC.1 AND BE VtFTURNED TO THE WITHIN L-AYS, OF TH' 14:11-1 C(AMPL.EETI ON. o'n-Ef,", MAY APPI-Y. SPEC" f F -J G'ATI AND C:OW.1.'TFJ,)CTIOk1 AVAIL'AF)LE To INSI.M.F. PROPER INSTFILL.ATION. .1: J` X E-" PE"', Ei, M F.�, V7 r-wp. " :1_, ". a ... I I" __1 I .fw I I k, � T. M.,RT"W"? THAI, J.: I fir -1 HTTH TFIF. F`OR OW-SITEFWL� fv,":; F-OR'TH F,"il THE 11UNU."IPALITY ()F' ANCHORAGE'. 2 1 t(III.J.- L. THE S'YF.-',*rEVl IN ACt'."ORDANCF. Ill ITH THE' THAI' THP: Ohl,.F,;TTE SYSTEM MAY RF'0UIF-rK F`Nl_AP'MFl1ENT IF, TWE NG.4 -1 13E.Dr F. RENOr.11F1J_F1J) TO INIELUDE: MORr-.- THFir 3 ........... L TV'-` ANT PUNJITT I By. Co L r" I 222 11, c I e -e c, a I, d 7, Iic; C) r a V! (3 C, r C) cn n Yes r c 0 Soils Lon 'I (,, �-, a r zi c c S r.i S S, Sa"d with cis Oval CAMS NT) hOLLgm OE Test Hole- 4. TYPE OF WASTEWATER DIS t Individual ArF2•S'yD� Holdin i 'ura:�x,J srrY ti d f , q tank r'�q �tiCommunity'on 1= }r , Public sewer. NOTE" If corrr�munitywaste 'attesting to the7egah 72-025 (Rev. 1/91) Front MOA #21 1 ` aterSys tem, provide written confirmah ty end status of system.' '\ S in frorrPState ADEC "._ 'J a MUNICIPALITY OF ANCHORAGE 0 Y� - , 3 • , DEPARTMENT OF HEALTH ;& HUMAN SERVICES DIVI9106 of Environmental Services ` A _ On -Site Services Sectlorr� x F �' ._{• P.O.'Box196650 Anchorag®;Alaska -,99519=6650 343-4744 r x ", CERTIFICATE OF HEALTH AUTHORITY , APPROVAL FOR A SINGLE FAMILY DWELLING F Parcel I # .i S' S HAA W A`q,- 010(0 # „1 ..>GENERAL INFORMATION .: .,...� . {. ,. �,= , /__� ,.., -• -- . _.: ,,.. � ,; , .Ata.: , ,Complete legal desoription Lot 4;' B26c� i;"Gamp�ct ;Ebtat¢6 ., = } 7i i, ,ay, ,Locations (site address or directions) 22647'F�c c endbh cp Cane z` n 0 u9 AK" 99S¢7_ „ r Property owner.-MctcherP2 Pnuc tt I]ay phone` �?"8g 3560 Mailing address 702 GI 32nd Su%te 202'`- Anchonagy AK ` 99503` F -i.i '[t TiJ E t ' Lending agency Day phone Mailing ,4 address Agent awnftoffd -v -7:1;l 4. TYPE OF WASTEWATER DIS t Individual ArF2•S'yD� Holdin i 'ura:�x,J srrY ti d f , q tank r'�q �tiCommunity'on 1= }r , Public sewer. NOTE" If corrr�munitywaste 'attesting to the7egah 72-025 (Rev. 1/91) Front MOA #21 1 ` aterSys tem, provide written confirmah ty end status of system.' '\ S in frorrPState ADEC "._ 'J a j 5. 'STATEMENT OF INSPECTION BY ENGINEER ,- K{ As certified by my seal affixed hereto and as of Nite `validation date shown"below, I verify that my `t r; investigation of this Health Authority Approval application; shows that the on-site water supply P y to forthe numberof bedrooms and/or wastewater dis osal system is safe; functional and adequa and type of structure indicated herein. I furtheryerify that based on information obtained from the Municipality of Anchorage files and from my invest�ation and inspection, the on-site water , supply and/or wastewater disposal system js in compliance with all Municipal and State codes, , ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING- Phone >6 ql"/ a °i 7 q ? 79S4. Eagle River Loop R084 Y r 1, ..,: _. Address ; M ' Date Engineers signature 171 e.nl .n r I. :1 t •,.-. J,yl ,e. ,� I t !.-rl. 3 i • f (.t n,`2i,,� f,o t. e�..a. , 5 :� 5 t I_ 1 F. �. b�1 ki.`/j f if), /� •.3 V i•� ,%a 1 , r ,.� 1 r�-ti5., t ,.* - v [ �c S S E - aC• 7JL i�r l� r a Fi-_t SE t J :a `N ,��.r t t ,..1-t {!'s` 1 - t c1 c r t tt y i if•t` ria ^o xis t " ;l r i •.� ..� 7 C 1 r�. t1 1 } vh� . r ' I;< 1 t` 7 cr. r Hu•; ROB _C. S r t uir f r .. r t ,Tf et-Z,ft� i i f ♦ s N It i t v r 6 DHHS SIGNATURE !i{,. U r bedr0om8 y$a.��I v +i '!' r' h�� Y�}rx �T� Lt-. xi B t 1'4rfi;�ci +44�Y,.' 1 i ]i t , t }iA ut%'/.bF%TfR+,yY'i�ol(tr tM1.,1 rf�e {d��a}5e�rt °1�t )IU- + , it rX'l nF- ^ �y13+�:1LF•t�.. �3tt33 t titt+i,.a �Ir Rb"hS'i i:.r:.�Ia'3'tk€ix ff:.� «i'4. ,�•,3�;°j`lk!'�.+. rpt +a..Lyy 2"4.e+.i+7`•t�++t'}FC,4C"7rs3fil'P-Y"'"pT6"T7,'^" Fid"T".<'�°A'} c- ..5 �1C!>!"I¢_9` " ras�Egk'Wr� -`Disapprt%i�eY •gyYn6.lififw rR_C3�be �s�t,��f'�f1���fyTTrrtna'@;F'�?fti'tY}�al�fj�t'-19��`hyPuJtrq'Fdi�iUa yT.-"Y'•Y-.F3s}i��� �-�:- F-.iI�k'ry r f 5 K� ��1 r� -��� '- Conditional a rovai for,Fl '�'�```�`''bedrooms`,�' with+the, following -_-stipulations t i h r �. ei�3 �+,a,f : f c i J t i � 1 - ,f fhS t.� {• l �.i'f�i�a lFur. r,�, �,,,{. r ' Y �,�. , si 7 'Pi•,�.. 1 m+T! aa'va asz �r. Fi S.f a sJviTf�,y tr i9V iii rga3 rlti�r - r �i }� + L if _ - i y4f Yrge �+i'�' Yves P��i'4�y - ; t ✓ ' s i - t.- > r ) [ >,S�i-r K a T ✓�� Y t KSni = r .r '.� - T Y'M1l �1hg5rT `ten } l { •mgt ! i,f + a 3 r If •;r , ,r 'f rr t/ s `- 1 Fv ♦ - �r Addltlonal•Comments, J11r 1, T.1. ibl srtment of:Health; on'the represents Date ions given in paragraph 5 above by an mdepenc e DHHS does this as a courtesy to purchasers of hoi ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I-c�r a e,"L_ \ V,,-- Parcel I.D. 0,5- ) w -z. 57-o A. Well Data Well type ' t�l:TA, If A, B, or C, attach ADEC letter. ADEC water system number ,� lay Log present N) _ 4 Date completed \1 11 -?f3 Driller AA L- _ Total depth -2,49" t " Cased to 47> m T. Casing height Sanitary seal (?N) r Wires properly protected (VN) Date of test Static water level Well flow Pump levels FROM WELL LOG Is71 AT INSPECTION 3 , Z� 1 Ln'L ` — tea, o g.p.m. _ a .Z--g-P.M. �] SEPARATION DISTANCES FROM WELL TO: Septic/beldiag tank on lot _ loo ` ; On adjacent lots ].00 ��- Absorption field on lot % D o ` ; On adjacent lots oo Public sewer main A4 Public sewer manhole/cleanout '� a Sewer service line "2-15 l� Petroleum tank zs `A - WATER SAMPLE RESULTS: Coliform O o,ka Other bacteria o Date of sample: �< � %)� Collected by: CNGINECRING Loop ROW No. 204 Eagle River, Alaska 99577 B. SEPTIC/HAL-WWTANK DATA Date installed I o _ I e, Tank size � do 0 Cleanouts(WN)Foundation cleanout .- N) Compartments High water alarm (Yo �A Alarm tested (Y/N) Depression (Ya a lA Date of pumping S -GIS Pumper Ste_ mss c-ooc �- LoL�cS�ry t,J L(L�VSQ.ry� SEPARATION DISTANCES FROM SEPTIC/HOtBtNG TANK TO: Well(s) on lot On adjacent lots Cot,. \k Foundation S' To property line to `'�- Absorption field 1,51 Water main/service line 1 a ` k Surface water/drainage I L>o 7M2s(3/93)•Front CONTINUED ON BACK PAGE e �c Uy m T. Opal f Absorption field on lot % D o ` ; On adjacent lots oo Public sewer main A4 Public sewer manhole/cleanout '� a Sewer service line "2-15 l� Petroleum tank zs `A - WATER SAMPLE RESULTS: Coliform O o,ka Other bacteria o Date of sample: �< � %)� Collected by: CNGINECRING Loop ROW No. 204 Eagle River, Alaska 99577 B. SEPTIC/HAL-WWTANK DATA Date installed I o _ I e, Tank size � do 0 Cleanouts(WN)Foundation cleanout .- N) Compartments High water alarm (Yo �A Alarm tested (Y/N) Depression (Ya a lA Date of pumping S -GIS Pumper Ste_ mss c-ooc �- LoL�cS�ry t,J L(L�VSQ.ry� SEPARATION DISTANCES FROM SEPTIC/HOtBtNG TANK TO: Well(s) on lot On adjacent lots Cot,. \k Foundation S' To property line to `'�- Absorption field 1,51 Water main/service line 1 a ` k Surface water/drainage I L>o 7M2s(3/93)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DJSTAtgCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent tots Manufacturer Manhole/Access (Y/N) tested at Surface water Date installed \ C>—'1(6 Soil rating (GPD/Ft') \ �� ��gR System type TP- OA Length "77 Width 2' Gravel thickness 3 / Total depth Total absorption area '��o Cleanout present (DN)_Depression over field (Y& N Date of adequacy test Results fail) s for 3 Bedrooms Water level in absorption field before test d u After test tz� Peroxide treatment (past 12 months) (Yo If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot leo `'� On adjacent lots o p "— Property line To building foundation 25" 1.- Toexistingor abandoned system on lot S `� On adjacent lots 3 , \ � Cutbank ti \ Water main/service line Lo�� Surface water Driveway, parking/vehicle storage area 2� Curtain drain E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. _ G� _ Signature �Dl�f Engineers Name co k//y ; Date a s' -7 S— & i HAA Fee $✓ Waiver Fee $ Date of Payment L> -�� S 1 Date of Payment Receipt Number % �o ( ��i�a �/ Receipt Number 72-026 (3/93)' Back 4-71S/6`77 MUNICIPALITY OF ANCHORAGE MUNIC AL TY OF ANCHORAGE DEPARTMENT OF HEALTH &ENVIRONMENTAL PROTEC71p NN DEPT. OF I I ALTIi & L&IRONMENTA1. PC;C%7cCTION 825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION JAN 2 5 1979 Telephone 264.4720 Q (� F REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER �,�1'�Pt�T1EJ D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten -(10) days for processing. 1. PROPERTYOWNER lyl itctNe t k lC Pf tt PHONE MAILING ADDRESS _ ✓ / -3q�S C+trJ xk�vt , v\c LA1- PROPERTY RESIDENT (If different from above) PHONE ❑ MULTIPLE: FAMILY _ Three ❑ Six 2. BUYER - PHONE - '/n� }C +I Jv,� 7�2-3t/S5l MAILING A ADDRESS _.,( - /- '3 4 2S . Pc" i Cir k1\,V\ �' 1/\i� ( C) fG fd C- 3. LENDINGINSTITUTIONpp PHONE Vo., lhrjFe Cvrd,t- UV"A AI�r,A 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** - - ADDRESS MAILING ADD"' - i /li 9 / 7 7 N �ln Nct fn J ANc(n J7'_K 9 4. REALTOR/AGENT PWONE , /AkodNMPS MAILING ADDRESS - - - - 5. LEGAL DESCRIPTION J + I—C) �y I C7 C V. I —a vv% 1-c" f'r> / �P�PdS ` rer l< STREET LOCATION —' 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS V!;, SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE: FAMILY _ Three ❑ Six 7. WATER SUPPLY X INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior toihat date, give well ❑ PUBLIC UTILITY depth (attach log if available.) _ 2 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date__. If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. G -V 1 V f3/ /i51 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE CDi SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM CUINDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED p �� 0 INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING 1 TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL `(, 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS 16�--APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must ac m ny certificate) tYDISAPPROV D �j DATE BY (Ti e c LEGAL DESCRIPTION 72-010 (Rev. 3/78)