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Home My WebLink AboutLEOS LT 1Leos Lot 1 #051-053-43 Municipality of Anchorage Page 1 of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _ SW970326 PID Number: 051 05343 Name: I Wastewater System: V<ew ❑ Upgrade Address: P. 0. sox 670495, Chugiak, AK ®� ABSORPTION FIELD Phone: No. of Bedrooms: -- IV ileep Trench ❑ Shallow'rrench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original gr cls: • f--> GPD/Sq. Ft. Lot: Block: Subdivision: N/A Leo's Depth to pipe bottom from original grade: Gravel depth beneath pipe _1 AYG, 5Z C;' Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: _ = Ft. �;L.'— Ft. WELL•• t� New ❑ Upgrade _ Gravel width: 'f Number of lines: Dislance between lines: —E ! Ft. I NSF: Ft. Classification (Private, A,B,C): Total Depth: Cased To: r Total absorption area: Pipe material: rC�i/YI F�-3n} _br'r✓2.f<� 220 Ft. � !~� Ft. 1 , 0 1 7 SQ_. Ft. Dr ler: J)r�II1G Dat�errDrilleId: L/N{�'N Static Water Level: 1�S,�o Ft. Installer: i o i'iIIOI,j Ni CLVN�•. Dat installed: ,` Zj-2la1j7 Yield:Pump et at: Casing Height Above Ground: TANK • GPM �s Ft. I, a Ft. SEPARATION DISTANCES _ septic El Holding ❑ S.T.E.P. To Septic Absorption Litt Holding PubliwPrivate Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines /60,116f4-, T^/,Ik !, oeao WellMaterial:' /D% 3 / IVIA Number of Compartments: Surface Water > /SC7 ° > /So' N// -A N A �/57C7 LIFT STATION N/A Lot Line Line % 'L � /D � �(/ i/'!r� in gallons: Manufacturer: Foundation �/ / r f0 "Pump on" level at: "f' "level at: High water alarm at: Curtain Drain - .._, _ Pump Make el Electrical Inspections performed by: Remarks: s BENCH MARK _ Location and Description: aro e slab ' Assumed Elevation: 100.0 EN41 SEAL °T Inspections .,r, ' performed by: Dates: is �1, , /J �- 2nd 2L -L7 7 ..... ...`..`. MICHAEL E. NIDER 3rd 12/ 23/9 7 tilV% Department of Health and Human Services approval �� U 4381-E Reviewed and approved byll �� Date: t 2 179- I.. 11 „ -1- [. Permit No. SW970326 Page? of 3 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lot 1, Leos Subdivision PID No.: 051 05343 _ A � - - --- - --- - _A5 pi_ 57,5- - / 30X MEA 6,3 (p��• 1. %Fi Esmt. a \ y -I \\I LEGEND SP1 septic Pump, compartment 1 n ItSPZ C Clean out MT Monitor Tube e-1 � PLAN AS -BLT 1 201 /reserve site � r 000, gallonC4 ~� - - - Septa e I an - SP / - . -SP1. e E 2 �;. C3 TC5 F a ,. /ra�S�PiiGSl trend- MT TN ICNREL E. A MON; �• ` Permit No. SW970326 Page e 3 of 3 — Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196660 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: Lot 1, Leos Subdivision PID No.: 051 05343 ly RK v �,!�'° __ _ y I�� . � apo o; •� 1 I - • 0 Ovop b �\\ . _ \ V\f�\\Ni1\�0��\ij`\\%\\\(7c..\ e u C 7 _•_ -_ ._. - .. Rue.°IL °G ..C 0 I o . p ._ .. .p°°. - • ° ,° o-oGc°s ese- - bob, ELEVATION AS—BLT _. 101 - C1a 1g, LEGEND SP1 Septic Pump, compartment 1 e� u - - �� CPZ Clean Out 2 , _/j ,.dD..',. MT Monitor Tube r J t'w� ............... MIOHP,F.L E. ANDERSON.!,- Z( 431-E +r Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ;!/[ L0n/7-i te,7-//t1G DATE PERFORMED: LEGAL DESCRIPTION: ��/ Township, Range, Section: SLOPE SITE PLAN ,q�PTH �T -.— N 2 C A /SM 3 4- 5 5 69 /a a. 7 a , 8 ! -- s / D 11 12- 14 2 14 / . n D 1s 16 / o 17- 18 7 18 u 0� . 19 .V 20 -t # 3 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Both to WNW AP f wftrim? iJ o�E 118e S L O P E Reading Date Gros Time Net Time Depth to Water Net Drop 1 7 /6 /7 74;4A %o / al 1.3! PERCOLATION RATE (mmutewinch) PERC HOLE DIAMETER -7 Y" TEST RUN BETWEEN FT AND b FT COMMENTS -- PERFORMED BY I "� OXRTIFY THAT THIS TFST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72 -Ml (Rev. 4185) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970326 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:BEEZLEY TRAVIS W & KIMBERLY OWNER ADDRESS:22318 LAKE HILL DR CHUGIAK, AK 99567 PARCEL ID:05105343 LEGAL DESCRIPTION: LEOS LT 1 LOT SIZE: 18787 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: ,, J 4;,rg7, 1� P'\ L � _'2) L�) PAGE 1 OF 1 t�1Q� C(vac k�� DATE ISSUED: 9/19/97 EXPIRATION DATE: 9/19/98 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: DURING CONSTRUCT ON,�ROVIDE ADDITIONAL TEST HOLE TO ENCOMPASS HF` EP CEIQEN IELD. n RECEIVED BY: DATE: C/ ISSUED BY: DATE: / `/ September 4, 1997 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 1, Leo's Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: We hereby apply for a permit to install a new septic system on Lot 1 , Leo's Subdivision. The attached site plan and backup documentation identify the location, size and components of the new septic system proposed to serve the three bedroom home on the lot along with the reserve system site. The lot is currently occupied by a mobile home which will be removed prior to construction of the new house. The well currently onsite will serve the new home. The existing septic system is in failure and will be abandoned in place. The testhole placed in the area of the proposed absorption trench revealed silty sand with a percolation rate of 39 minutes per inch. No groundwater was encountered during testhole placement nor was any detected during the ensuing monitoring period. We are therefore proposing placement of a 50' long by 10' effective depth absorption trench for disposal of septic effluent. 3' of cover will be placed over the trenches once construction i s complete to prevent freezing. The ground surface of the lot slopes from north to south at varying grades ranging from 0 to 1% and from east to west at approximately 3%. The surface of the ground in the area of the new trenches is fairly flat. If the system is constructed as designed the following statements apply: Lot 1, Leo's Subdivision September 4, 1997 Page Two 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the area. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern w i I I be maintained. Sincerely, ,✓uE"t, Michael E. Anderson, P.E. Attachments AREA MAP sSCALE 1" a 100' L4 Aa, Vej I m ALTERNATE SITE, 3" , EXISTING FAILED TRENCH: TH 2 SITE PLAN' SCALE lto 20' Tynele Se.,O0M Noble 50' TOTAL FOUNDATION CLEANOUT o 1,000 GALLON SEPTIC TANK 50' X 10' EFFECTIVE DEPTH ABSORPTION TRENCH SYSTEM PLAN NO SCALE LOT 1, LEO SUBDIVISION DESIGN FACTORS: Three Bedroom Home Perc. Rate: 39 Min./Inch Application Rate: .45 GPD/SF SYSTEM REQUIREMENTS: Deep Trench System New 1,000 Gallon Septic Tank 10' Drainfield Rock 3 Bedrooms X 150 GPD / .45 GPD/SF = 1,000 SF of Absorption Area 1,000 SF/20 SF/LF = 50 LF Trench Length Therefore: Construct a Deep Absorption Trench System With One Lateral 50' in Length with 10' of Drainfield Rock Beneath the Lateral. Distribution Pipe in Trench Placed at 3.5' Below the Original Ground Surface. t ne t%%/// %%% MW,► 8i4Ct!%L. a G�-'�•Gx�t LC FANPAC. G.. 4 Itt ,v � bQ,pJuEF14W J TtJ�a` 3=0� TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 3' of Cover over Septic System. S J g lc iarsss { e +w Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST jENGINEEA'S!SEAk; PERFORMED FOR:�r / DATE PEIiFORMEI LEGAL DESCRIPTION: Township, Range, Section: I I i/- O �- 2, 10 4' n b 11 .. . 12- 13-/" 2 13 " 14- 15 ✓ 'o 16- 17- 19- 20 617 19 20 � v" 0 e14 - en -1 /S. f �p if -BDN SLOPE WAS GROUND WATER Net Time ENCOUNTERED? Net Drop S IF YES, AT WHAT 0 / L DEPTH?/ s E (leO to Water AIWt a � � � 7 reoolwng? _ Date: LAN 3 Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE3 ` (mmutesrinch) PERC HOLE DIAMETER / TEST RUN BETWEEN / / `�?�FT AND FT COMMENTS I��GaII +YdS fe— ec/ Cnr� �s ��_ _sem_ PERFORMED SY: I' ' `i ! IFY THATT IS`TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 724X18 (Rev. 4/851 (ENGINEER S' SEACj} Municipality of Anchorage. DEPARTMENT OF HEALTH 8 HUMAN SERVICES , 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST; '7 '' A. ire PERFORMED FOR: DATE PERFORMED LEGAL DESCRIPTION: / �/� ��/t✓ ��g� Township, Range, Section: SLOPE � SITF Pt ON °•rte` -%''1 �L• 2 3 4 SM 6 7 13.1 1 0'1:�P4 14- is- 16 - 17 81920 18- 19- 20 COMMENTS 0 WAS GROUND WATER ENCOUNTERED) S IF YES, AT WHAT O DEPTH? P E Depth to Wear Aper Al" Moltilming?0// 22L� Date: % nJ Reading Date Grow Time Nat Time Depth to Water Net Drop grlz8 AP 7 —1'3 `Z- I: ,44— 255,44- $.8 1 -L-1- -L 7, 8.7, 4 -- ii PERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER TEST RUN aETWEE _�y —FTA ND i/✓�" ��G S 62tA"- i ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: Lot 1, LEO'S SUBDIVISION GENERAL: 1. The scope of this project includes the acquisition and placement of a new 1,000 gallon septic tank and the construction of A new 50' long by 10' effective depth absorption trench. The distribution pipe in the trench to be placed 3.5' below the existing ground surface. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining a I I underground utility locates and for the layout of the septic system and verification of the location of all lot lines. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1.A new 1,000 gallon septic tank must be procured from an approved source and installed at the location shown on the Site Plan. Lot 1, Leo's Subdivision September 4, 1997 Page Two 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. Lot 1, Leo's Subdivision September 4, 1997 Page Three 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trenches to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). SEP -19-97 08:45 FROM:MW/DPW OFFICE ID:563 5389 PAGE 1/5 FAX MEMO To: Anthony Kim With: DHHS From: Mike Anderson Date: September 19, 1997 Subject: Lot 1, Leo Subdivision Septic System Permit Message: S C:P 19 199'1 w1unicipahly Ot KlChOrage Dept. Health & Human Services Attached is a site plan which shows the well in the right of way at the northwest corner of Lot 1, Leo Subdivision. The well apparently serves Lot 16. Lots 16 and 17 are owned by the original homesteader with the house on Lot 16 and his septic system on Lot 17. The well was installed prior to subdivision In what is now the road right of way. The well will be moved on t o Lot 16 next year. I have also attached an inspection report from 1988 which describes the well on Lot 1, Leo. We are hoping the permit can be issued yet today. Thanks for your help. Let me know if you have questions or comments. 5 -Pages Being Transmitted SEP -19-97 06:45 FROM:MW/DPW OFFICE ID:563 5369 PAGE 2/5 SEP -19-97 08:4B FROM:MW/DPW OFFICE P 4. __Zf�_6L_GAttONS, 4. p, SEEPAGE P11i V, 7e, ANCHORAGE AREA BOROUGH baimimaut of r1fty1ronmental Qwauty 0 TER, . . . . . . Tudor Road — Pouch USO , Anchorage, Alaska 99502 Y.. a I. V-1 I nth? IC TAW NCE FROM WELLpe__ ID:563 53B9 SYSTEM PAGE 5/5 atprml lop OF 10 FINISH GRADE - - -- -DIP"i OF P1111111 MATERIAL BENEATH ABOVE TKF— DISTANCE FROM' ...'WELL, WATER —2� SAMPIE_9:e4_J"_ , I`YPEdnd!a_ta= DEPTH. -,11URIVING FOLMIDATION.. NEAREST NEAREST SEPT SEEPAGE of OTHER RIOT LINE SEWER IINE. !!L�e 1AMt'd-1, PSTEM:_,e=_��'Cf SSPOOL�'., SOURCES DIAGRAM OF SYSTEM w ji0STANCESi ,� " EP1M UID CAPACITY INSIDE jeNd�INSIDE V�IDTH� P 4. __Zf�_6L_GAttONS, 4. 1!.9 SEEPAGE $VjTEMt SEEPAGE P11i V, 7e, Z; "NUMBER OF Pits OUTSIDE DIAMETER — OR WIDIH..�, LENGTH DEPTH r PLINING MATERIA 4 e. C' Skewe' BUILDING FOUNOATION.&IL-', 0111ANCC FROM WEIt- '14A II 7. il I- �A4 NEAREST 101 IINE--AA2 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREAf So.$?. I! F ME DRAIN FIEIDI JUT 0. TOTAL I DISTANCE FROM WELL—., FG)UNPAIIIII ARESt LOT IIN1_ OF LINE ------- 4� It NUMBER OF FINES DISTANCE BETWEEN TINES TRENCH WIDTH Ir" EFFECTIVE 'Nisao W ADSORPTION ARE - —SO, FT. i[NOTH OF EACH IINI_ q atprml lop OF 10 FINISH GRADE - - -- -DIP"i OF P1111111 MATERIAL BENEATH ABOVE TKF— DISTANCE FROM' ...'WELL, WATER —2� SAMPIE_9:e4_J"_ , I`YPEdnd!a_ta= DEPTH. -,11URIVING FOLMIDATION.. NEAREST NEAREST SEPT SEEPAGE of OTHER RIOT LINE SEWER IINE. !!L�e 1AMt'd-1, PSTEM:_,e=_��'Cf SSPOOL�'., SOURCES DIAGRAM OF SYSTEM w ji0STANCESi P 4. 4. r II 7. il I- �A4 I! F JUT 4� It 'Nisao W TYPE OF SUIL HBSORBTION SYSTEM IS� TRENCH MHXIMUM NUMBER OF BEDROOMS = 4 SOIL RHTING (SQ FT/BR)� 125 �� _�� BHCKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON~SfE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIYHTE W2LL OR 200 FEET FOR H PUBLIC WELL SPECIFICHTIONS HND CONSTRUCTION DIHGRHMS HRE RVHILHBLE TO INSURE PROPER INSTHLLHTION JI 11 jj jl:m:: MA I ER ANCHORAGE AREA BM JGH Department of Environmental Quality " 3330 C Street Anchorage, Alaska 99503 _ INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ' L4_ _ MAILING ADDRESS - 3 D —PHONE(9 LOCATION LEGAL DESCRIPTION (0_1 R® liAvrl" SEPTIC TANK: �j DISTANCEs1 (j��— NUMBER OF FROM WELL '��0 MANUFACTURER MATERIAL �(�„(/ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH----- LIQUID DEPTH LIQUID CAPACITY GALLONS. TILE DRAIN FIELD:' -- TOTAL LENGTH 1 DISTANCE FROM WELL --FOUNDATION NEAREST LOT LINE_ OF LINES NUMBER OF LINES — DISTANCE BETWEEN LINES TRENCH WIDTH— IN. TOTAL EFFECTIVE r ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE WELL: TYPE _- �_ CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION_ LOT LINE___, SEWER LINE CESSPOOL APPROVED DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ -032 OTHER SOURCES DISAPPROVED REMARKS IN. ABOVE TILE IN. EPTH — DISTANCE FROM: SEPTIC SEEPAGE TANK , SYSTEM_ DIAGRAM OF SYSTEM DATE 3 ) ? APPROVED _��` \ G.A.A. B. L�0n1tptUC 0)2 !3e -1t %au• .,One test is worth a thousand opinions" 2204 Cleveland Anchorage, Alaska 99503 Performed For Klondike -Alaska Date Performed -1/25/77 Lenal Descrintion: Lot 1 Block Subdivision Leo Su dav2-S1nL This Form Renorts Soils Loo yes Percolation Test_ tenth Feet 2 4- 6— it Characteristics 8 Gravelly Sand (SP) 10- 12- 14 0- 12- 14 16 Bottom o-Tes-f--HoTe- 18 — 20— Was Ground Water Encountered? No If Yes, At what Denth? �RPadinq Date Gross Time Net Time Depth to H2O Net Dron Percolation Rate Minute Proposed Installation: SeP_ndae Pit Drain Field Depth of Inletp Deth To Bottom 0f Pit Or Trench_ _ cr)WIENTS: 125 Square Feet drainage area required -per.-bedroom. No ground water or bedrock encountered. Test Performed By David Paul — Data Certified By3,y��1_Q! Date : — 1__[_2 5 (7.7_-_ PIRR 16 '89 09:89 RE/MAX OF ERGLE RIVR L SLE RIVER ENGINEERING SERV ES P.O. BOX 773294 EAGLE RIVER:, ALASKA 99577 ®�).\ -'0jd-1-tiz WELL AND SEPTIC ADEQUACY TEST REPORT TEST DATE: February 22 & 23, 19B8 LEGAL: Lot 1, Leo's Subdivision LOCATION: Peters Creek, Alaska RECEIVED RESIDENCE: Single Family, 3 Bedroom;, JAN 21 192 Municipality of Anchorage WELL YIELD: 3 Gallons per Minute Dept. Health & Human Services WATER SYSTEM: Private Well SEPTIC SYSTEM: From Municipal Records Tank: 1000 Gallons Absorption System: Trench Types INSTALLATION DATE: 1977 upgraded INSTALLED ABSORPTION AREA.' 504 Sq. Ft. ORIGINAL SOIL RATING: 125 rrom original soil log report/estimated T E 9 T P R O C E D U R E SEPTIC_ The leaohfield was filled with water from the on-site well at a rate of 2.7 GPM for a total of 3,191 gallons. The septic tank and laachfield l;quid levels were monitored referencing a measurement below the top of the :standpipe. During the test, water was added through the tank cleanout tube and the leaohfield water level was monitored as water was added and then absorbed into the surrounding soil. The wator level in the septic tank did not rise during or after the addition of 3,191 gallons of water showing that the leaohfield had accepted the entire amount. A total rise in liquid level in the leaohfield was recorded as 0". Measurements were taken of the leaonfield liquid level, with a satisfaotory return in liquid level. 'file monitoring indicates the septic :,ystem will accept the required 150 gallons per day of effluent, per bedroom, which is the required absorption rate for Municipal approval, WELL: The well was pumped at a :steady flow rata of 2.7 GPM. Total drawdown from a static water levc3l of 141 feet was 60 feet after 18 hours, of pumping. At this point the water surface loyal in the well vo•is static at 201 feet below the top of well casing. With the use of an electronic sonar and calculation of total water amount for drawdown cycle, the yield and/or recovery rate of the well was, monitored and calculated at maximum rate of a.0 GPM for the first stage of recovery. This yiald/r':joovery rate is they maximum rate and will dccrcase as the well it-, raoovering. • 1 Well/Septic AdNquacy lest Report Lot 1. Lao's Subdivision T E S T R E. S U L T S Page 2 The well yield/recovery rate and 'Septic system soil absorption rate meats the requirements of the Municipality of Anchorage for a 3 bedroom single family residence as of'the day the SYstem was tested. A= the systems were not in normal us® prior to tasting, one may realize a reduction in absorption/recovery upon resuming daily usaggS. Assessment of existing subsurfaae conditions by the inspeoting c;n;iineer is limitad to information obtained from the available monitoring tubes and Municipal record search. We do not guarantee the validity or quality of subsurface tests and inspections preformed by the original inspecting engineer or authority. This report is limited to absorption rate tasting and wurfaoe eepgration measurements as currently required by the Municipality of Anchorage and does not verify water quality other than the bacterial and nitrate content. The operational life and the matter of compliance with State and Municipal codes, for all wator and septic :systems depends on the local soil conditions, groundwater levels that may not be observed from.the ::urfaoe without additional teeting, water usage of the home, being eerved by the system, and the detail of required testing procedure. Septic systems expire with use and future environmental oonoerns may require more extensive testing, which could render the leaohfield unusable. This i:, true of all septic Wyetems. Our absorption test requirement of +450 gallons per day for thio home allows for a considerable life span for the septic syztem when placed under typical. home usage. The following should be noted: 1. The well was tested by delivetry of water directly out the top of the well. Therefore the integrity of the water line was not verified by our ta5t. 2. Well to septio tank separation distance ie 90'. This distance will require a formal application for waiver of separation distance from the Municipality. Permit Tea $410.00. Engineering fee = $75.00. RECEIVED JAN 21 1992 MUOICepality of Anchorage Dept. Health & Human Services • N.U•ypy ►•+y�y.yl�••wNr oN Louis A. Boom X44 e �� •• id CE4736 � a All d f— C) CY) 0) 0) ITIq I- 00 CY) (3) A ti co LO rn rn Q ca r F—Y) CO OO J M o qt N n U) Cl) cn cn Q) a) a 70 ca rn J (n Q CO w 2 06Q 0 W N a) 0 Q 0 L- CL c (D O 0 cY) 0 a) L- CL CL ca cu N cn a) CD O a) N c O a) M c 0 cu 0 U) m C 0 0 a) s cn 0 0 a a) m O m 0 Q Q c6 N 0 c 0 1 L 0 ca LO C d E 0 .+ Zi N N LO a) m 0 m m U a) U c rAl 0 O C O CL N d •� CL Q- O 3 t 'V N V •= N � .a M .0 C� L a) CC� •a% E ,N O U i d o_ .0 O 0 C •N 'p C.5in c d C C.o a) .0 E ^ D N a) -0 Q cn > > • N E p o .N -2 Q N LL = a< CU a N cn c od o a) cn z Q vCL v a) r- c > = Q - '0 o O M 0 d O C . C. C. N NC O E _ •� C m L x x d N � ca O A C0 mN I+ ,Q O ...•C w cn C? N Em O Q Z+ 0 0 a) > 4. o > �L+ V a) L "O LLC. d 0 N c = U C:Q o a) r. m N •a0--,, •y F Q CL Y L .) z U)o L cLa 2UQI-0 Uo U) Nv Q o= v Q S 1— N C Q C Q �" Q W 0 0 Z Itti orn O) AdAz I— ti 0 0 O7 O7 C m O LL t LL U COO 947�77 c L O _F- J I c 0 co 0 Q _a CE O Q Q. 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N0 {i MW W �I O W N co W co } co W N z O N ❑ N cc } J a IL M w W F- LL w a } F- m M U cn Z LL O i N N M E E O O U UU Ela O U) > U M r^ 0) VJ C co U) L m a 0 U J N co a Q ca to L- a- O ❑ El Ln a W H W H CO LL w a } H C co F— cm O ❑ ca N ❑ L Q U N C � Um ❑ N .2 U O cn N a co El0 U) O Z H tU'� P: (D W 0) N Q L6 J U O F - (D 0 w b5 r& cu M, O O LL N co O v E O � N Q o Q o c o 0 0 U N/A N/A N/A Benjamin Schiller, P.E. (907) 522-7773 Ocn saJ O N E V)M0 4— coM � L c # O O a) LL O (::� 4- f0 �O U aJ cii Q 410 U acu Ln v L a u OO CLJ `° o 4 U 4J CLO C O O N OE � N O m Q O U U*) O � O Q � >. o O N ra cv o � Q o >, � o �, 0 ~ *' Q LU Ln o cn Q1 N m a L � C N a,o CD W m >� u Y c 0 3 N Ot c 4J c3i -0 W °� m L 4� Q " f° V' ° an 4-1Ln L c O v aJ E J co '} teN^1 CLO L` tto L O a+ W C 4- O U � z IO a E cB `n Q O v U cu U -0 o O 3 LLJ U cn h- Ov C H MUNICIPALITY Development Services Department p p Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-053-43 1. GENERAL INFORMATION Complete legal description LEOS L Expiration Date: 6 " ZS___ Z I Location (site address) 24336 LEO'S ROAD, CHUGIAK, AK 99567 Current property owner(s) BRIAN M. RICHMOND Day phone Mailing address Real estate agent 24336 LEO'S ROAD, CHUGIAK, AK 99567 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ _550 Date of Payment 'S — 11 - �1 Receipt Number 7 15- COSA # QJ GZ 1 1 1 1 1-1 Waiver Fee $ Date of Payment Receipt Number Waiver # STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 3/15/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to of a��lil these various and dynamic characteristics and are outside the control of the evaluator of the i• • l well and septic.system. Therefore, any estimate of how long a system will function satisfactory ;0" • • • !1�9 �� for current or future occupants or guarantee that no unseen encroachments, deficiencies orJ discrepancies exist can be given by First Water Consulting & FWf,S ' *. 9TH •'* Ir 6. DSD SIGNATURE Curtis Huffman j System #1 Approved for bedrooms rr� ��••, CE 128991 s �l ROFES ONP��4... System #2 Approved for bedrooms 1\��TF�F�PROFEW*.� Disapproved Conditional approval for bedrooms, with the following stipulations. SIT Y(pF%al ti INATE ITE m ST =,' � ATEA rn oo AM Q �J \-C Z�l i�VJ/iJTSERVIC�SC; B 4Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Other—(;�� COSA Checklist Legal Description: LEOS LOT 1 Parcel ID: 051-053-43 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled UNKNOWN Total depth 175'+ ft (Per acoustic soundings at test) Cased to UKNOWN ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 3/10/2021 Static water level at beginning of test 143 ft. Well production at time of test 1.35 gpm Comments B. TANK DATA Age of tank(s) 24 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 49" ® Standpipes/foundation cleanout per record drawing Date of pumping 2/18121 D. ABSORPTION FIELD DATA Which system tested (date installed) 4/11/2017 ® ALL standpipes present per record drawing Total measured depth from grade 15.7 ft (max) Measured depth to pipe invert from grade 6.7 ft (min) ❑ NIA — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ® System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced 2000 gallons Comments/Deficiencies: Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FW' 's Date of Sample 3/12/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 3110/2021 Results M Pass For 3 bedrooms Fluid depth prior to test 27 in Water added 500 gal New depth 53 in Elapsed time 1420 min Final fluid depth 22 in Absorption rate 450 and Any rejuvenation treatment (past 12 months) N If yes, enter date FITS 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 ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® 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' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION Amw*il I certify that I have determined through field inspections and review . • of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. . TH . , ..': .... .... • Curtis Huffman CE 128991 '0ARW PROFESSO ft ft ft ft ft ft ft ft Septic Tank Advisory Certificate of On -Site Systems Approval #OSC 211114 Subdivision: Leos Lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 24 years old. Typical replacement costs range from $8,000 to $11,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 20 -year-old steel tank MAY look like. Mailing Address P ;O Box 196650* Anchorage, Alaska 99519 6650 *www murn org • '� Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-053-43 Expiration Date: 1. GENERAL INFORMATION Complete legal description Leo S Lot 1 Location (site address) 24336 Leo's Road Current Property owner(s) Travis BeeZley Day phone Mailing address 3220 E 41 st Ave #1 Real Estate Agent Day phone 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual R Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Pi ihlic Water System ❑ Public Q -,-,-r ❑ WaiverNariance request for: Distance: !' � � � Received by:." � � - Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 14 o Waiver Fee $ Date of Payment 41 19{) 3 C Date of Payment Receipt Number 20� �3 G Receipt Number COSA# d�CI3! I �J 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 Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Phone (907)272-8218 Date *'*F49 R */ 1 :5 even Pannone CE -8149 10 � 8149 � Conditional approval for bedrooms, with the following stipulations: By: k/, w j U, Original Certificate Date: ti ZS The Municipality of Anc raga 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. e , 7. ATTACHMENTS: COSA Checklist X Nitrate Advispry Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet c . L If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Leo's Lot 1 Parcel ID: 051-053-43 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed LINK Sanitary seal (Y/N) Y Total depth UNK*ft. 15 L+ Cased to UNK*ft ��YY FROM WELL LOG Date of test Static water level Well production ft. Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) 12 in. AT INSPECTION 4/4/13 150 2.6 WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 4/4113 Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank size 1,000 gal. Number of Compartments 2 Y N PES ft. g.p.m. Date installed 9/26197 Cleanouts (Y/N) Y Foundation cleanout (Y/N) _ Depression over tank (Y/N) _ High water alarm (Y/N) N Date of pumping 4/10/13 Pumper JR's Pumping C. ABSORPTION FIELD DATA Date installed 9/26/97 Soil rating (g.p.d./ft2 or ft2/bdrm) 0.45 GPD/SF System type Deep Trench Length 56.5 ft. Width 4 ft. Gravel below pipe 9 ft. Total depth 14.5 ft. Eff. absorption area1,017 11:2 Monitoring tube Y Depression over field N Date of adequacy test 4/4/13 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 24 in. Water added 458 gal. New depth 29 in. Elapsed Time: 150 min. Final fluid depth 24 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons _ in. "Pump off' level at _ Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Access (YIN) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS * Nitrates less than 5 G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date !3 o COSA brown sheet_10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage11 0+ in. no 31Aprovelkenls on ad scent thereto encroach mt #ite premises ori and Sere are rro roadways, transmission lines or other visible easements on said ppeTty xoept as bubmted hereon 'Dated at We River. Alaska this t —4 _ day of _.Ll-c— . _ 191—L, ROBERT C. JOHNSON '�4 4�- jV: ,- SCAM Registered land Surveyor No. 880-i 5 1' Mone Q907j 77-0456Ea gle ver, Alaska `99577 MUNICIPALITY OF ANCHORAGE ° DEPARTMENT OF HEALTH & HUMAN SERVICES: ; Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051 05343 HAA #�— 1. 'GENERAL INFORMATION Complete legal description Lot 1 , Leos suhdiv; si on Location (site address or directions) 22318 Lake Hill Drive Chugiak, AK Property owner Travis & Kimberly Beezley Day phone Mailing address 2231A Lake Hill pr; v@ Chugiak,AK 99567 Lending agency Day phone Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Three � 3. TYPE OF WATER SUPPLY: Individual well *** Community well Public water Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site *** Holding tank Community on-site _ Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Flov. 1/91) Front MOA X21 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 investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Anderson Engineering Phone 563-7155 Address P -O- Box 240773 Anchorage, AK 99524 Engineer's signature Date 12/24/97 6. DHHS SIGNATURE V Approved for bedrooms. Disapproved. Conditional approval for 0 Additional Comments G WTic / �• h ' i'xr,}�••,:T<ijt�k��S:. f114D6i'•i0i c L;T 43£1-E ti`s It bedrooms, with the following stipulations: Date 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-M (Rev. 1/91) Back MOA 021 Municipality of Anchorage RECEIVE DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division n� CC 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34A944 Q 1997 'MUDept. "ucjpality Of Anchorage De Health Authority Approval Checklist p Health & I•luman services Legal Description: Lot 1. Leos Subdivision Parcel I.D.:_ 051 05343 A. WELL DATA Well type Private If A, B, or C, attach ADEC letter. ADEC water system number _ Log present (Y/N) N Date completed Unknown Total depth 220' _ Cased to >50' Casing height (above ground) 11 Sanitary seal (Y/N) _ Y Wires properly protected (Y/N) Y _ FROM WELL LOG AT INSPECTION Date of test 12/20/97 Static water level 148.6' Well production _ g.p.m. 2.0 g.p.m. WATER SAMPLE RESULTS: Coliform D Nitrate !�9 I - Other bacteria o Date of sample: 12/20/97 Collected by: A. Haral B. SEPTIC/HOLDING TANK DATA Date installed 9/25/97 Tank size 1 , 000 Number of Compartments Two Cleanouts (Y/N) Y _ Foundation cleanout (Y/N) _ Y Depression (Y/N) N High water alarm (Y/N) Date of Pumping New Pumper Construction C. ABSORPTION FIELD DATA Date installed 9/26/97 Soil rating (g.p.d./ft2 or ft2/bdrm) .45 System type Deep Trench Length 56.5 ' Width _4 ' Gravel thickness below pipe 9 ' —Total depth 14 .5 ' _ Effective absorption area 1 , 01 7 SF Monitoring Tube present (Y/N) Y Depression over field (Y/N) N _ Date of adequacy test- New Const. Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in.): _ Fluid depth (ins) Minutes later: Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)' If yes, give date D. LIFT STATION - None on Lot Date installed Manhole/Access (Y/N) High water alarm level at* — Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot > 10 0 ' On adjacent lots > 10 Absorption field on lot >100' On adjacent lots > 10 Public sewer main > 10 0, Public sewer manhole/cleanout Sewer /septic service line >20' Lift station None on Lot SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation >51 Property line Absorption Water main/service line > 10 1 Surface water/drainage > 10 0 1 Wells on adjacent lots >� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line > 1 n ' Building foundation > 1 n ' Water main/service line Surface water >100' Driveway, parking/vehicle storage area > 5 Curtain drain None on Lot Wells on adjacent lots >100' F. ENGINEER'S CERTIFICATION I that I have determined thru field inspections Municipal � certify and review of records�t�afo .A �f,tems are in conformance with MOA HAA guidelines in effect on this date.�rty. s«eq � �..P. Signature aq0 . �H I �f � tr Engineer's Name MinhaPI P.._ Anr3PrGnn, P_F., IAsL. Date 12/24/97�U4 4381-E Fley 0 HAA Fee $lr (f ) Waiver Fee $ Date of Payment ( D, . �0- r1 I Date of Payment Receipt Number ) -Sg� y Receipt Number 72-026 (Rev. 3/96)* JAN -05-1998 18 26 CT&E ESI ANCHORAGE CST&f: Environmental Services Inc. CT&E Ref.# Client Name Pl' j%t Name/# Client Sample ID Matrix Ordered By PWS1D Sample Remarks: ' Sampled by: M.E.A. 977700001 Anderson Engineering Lot 1 Leds 8/17 Lot 1, Leds S/D Drinking Water 0 9875615301 P.02/03 Client PO# Printed Date/Time 01/05/98 15:54 Collected Daternme 12/28/97 15:00 Received Date/Time 12/29/97 08:45 Technical Director, Stephen C. Ede Released Allowable Prep Analysis Parameter Results_ PQL Units Method LimitS Date Date Init Nitrate -N 0.100 U 0.100 mg/L EPA 300.0 10 max 12/30/97 RMV Water$ Deportment Analyses Totet Coliform 0 col/100mL SM18 92228 12/29/97 TMW �4. JAN 09 199 09:15AM MATANUSKA ELECTRIC P.2i2 STATEMENT OF NONOBJECTION FOR ENCROACHMENT WITHIN UTILITY EASEMENT Matanuska Electric Association, Inc. (MEA) has no objection with the location of a wastewater disposal system service line across and within the MEA easement within the following property; Lot 1, LEO'S SUBDIVISION, according to Plat No. P-295, Anchorage Recording District, Third Judicial District, State of Alaska Situated within Section 3, Township 15 North, Range 1 West, Seward Meridian This non -objection is conditioned by the stipulation that MEA will be held harmless from any and all damages to the encroachment that may result from the existing and future use of said easement. Matanuska Electric Association, Inc. General Manager or KCs Representative January 8, 1998 Date MEA ACKNOWLEDGMENT STATE OF ALASKA ) ) Ss. THIRD JUDICIAL DISTRICT ) The foregoing agreement was acknowledged before me this 8th day of January, 1998 by Robert G. Ylvisaker. (9 , Ezj�L& Notary Public for the State of Alaska My commission expires: I- - V HAR01MFORMONON06 JROOT =A,M.�CROBERTS 'rime _ Time ne e— Date Date s Date J�2—� •7 .c7 Inspector Inspector Inspector Comments Conditional Approval O } f - Z- ' - -� r Date Sewer Installed Permit No. Septic Tank Size / S Holding Tank Size Soils Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner F N �s�, E N4i�}`( i�' SCi�r �c Phone Mailing Address Buyer r).3 i o �s 1-4, l C.�\UC I Q� % k pct �� Address Lending Institution V -P 7(cl"�G-y'\, Phone Address c�,�00 )EV. ss I;X.ir r1'%-.)\ Realty Co. &Agent Phone Address Legal Description .f? ra Street Location ISG �_� } l 1 J _ r �/� J Typ�f Residence) Single Family. ❑ Multiple Family No. of Bedrooms _ ❑ Other Watt Supply A Individual ATTACH WELL LOG. A well log is required for all wells drilled since June O Community 1975. For wells drill d a to that date, give well depth (attach log if ❑ Public Utility avaiiable.)s Sew a Disposal 2 i Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: O Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. fq a(,(M491(.f „f Eagle River Area Aa G GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality �c�'fPLU IATUA9y �`°`3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received December 7, 1976 Time of Inspection g•,, n gL2� Date of Inspection %% Mcnw66u REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR, Conv. 1. Approval requested by: Peoples Bank and Trust Mailing Address:' 'Pouch 7-007 Phone: 279-7511 2. Property Owner: Max Bivens Phone: _ i LxoO /21r_� � Mailing Address: % Star Realty, 3. Legal Description: Lot 1 Leo Subdivision 4. Location: 5. Type of facility to be inspected Single Family No. of bedrooms 3 6. Well Data: A. Type Individual B. Depth IAL, C. Construction D. Bacteria] Analysis 7. Sewage Disposal System: On—site system _Arot,4_es1 c 1%9 -I h&q f o A. Installed AVpy,a loll,& B. Installer C. Septic Tank: 1. Size l,ppo 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material" E. Disposal Field: Total length of lines 8. Distances: A. 41e11 to: Septic tank 1, /pAbsorption area /(D��, Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank Absorption area _ C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Re st for Approval of Individual . er & Water Facilities Legal Description Lot 1 Leo Subdivision Comments Approvedg7C R.C_ Disapproved Date Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date 1. 2. 3. CI MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Type of Inspection: CM Property Owner: Max Bivens MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION DEC 11976 RECEIVED VA FHA__CONV xx Mailing Address: C/0 Star Realty Day Phone: 279-2491 Name of Buyer:_ Dennis H. and Jenny D. Erickson Mailing Address:_ 9900 Whitefish Circle Day Phone:— 274-7112(busl 349-1730 (hm) Name of Lending Institution: PPopleG Bank & TruGt Mailing Address: Pouch 7007, Anch. Ak_ 99510 Phone: 279-7511 5. Name of Realtor or Agent: Max Biv nG — s ar RPal ty Mailing Address: 640 West 36th Ave. Phone:_ 279-2491 6. Legal Description: Lot I., Leo's Subdivision Location: Peter's Creek, Alaska 9 91 Type of Facility to be Inspected: Well and Se Water Supply Type of Supply: Public Utility_. If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System Type of System: Public Utility If Individual, date of installation 72-003(3/76) ndividual xx Individual (on-site) xx January 0, 1977 640 Veest 36th Avenue ,x 'Choragej, 2kla8ka D9503 St 4 This doparty�ient oan approve your requoW, for your sawar UO cl varify the s m 0knOl also to POOSJjaiy u cira c, the Ok.:i,qUacj sewer aystem. If the eXistinq aemlor SyStf;'mi U not: adr:C; tAAtFs, t:holl. ra "OUS teat must boy n'lG int!d and We Will thWA i -JS" s aPPOrGAt fOr cons true. !t . on . T� thore caro aany further gxAei : ions, lea rjo contact thir3 offico at 279* -2511., extePanion 224 or at the above addreas. 8inE"_ 3rely, 11mbort C, Pratt v R,51 Vaixitaari an. January 10, 1..977 Isa"lh )AVOWI 640 Viest :36thV'OWLI£", �` iCIiG c r Alaml-w 99503 ` o-cir requost too' Heger W'd watOr aPPr(V,-41 can 3100 f)" granted at thi.g tires. iiefore we c:aii a373,)rOVO gess awWOr 3YStev„ Y4:)'A vriII "0ad to gollow t f1 set of instrua i.ms wIGIOSQ' , Boforo the well can bn approved# the Weil, cnSing Wuclt. be t 279-25110 223 or 224.. Oanitarlan s 1 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received April 21, 976 Time of Inspec on Date of Inspect or REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITI FOR Conv. 1. Approval requested by: First National Bank of Ancho ge Mailing Address: Post office Box 270 Ph ne: 279-4/81 2. Property Owner: Max Bevins p one; 27 —2491 Mailing Address: 640 west 36th Avenue 3. Legal Description: Lot 1 Leos Subdivisio 4. Location: Mile 22 Glen Highway 5. Type of acility to e inspected Sing amil No. of bedro ms 3 6. Well Da a: Indivi ual -� servin ` on A. Typ B. Depth C. Cons ruction s D. Bac erial Analysis - 7. Sewage D sposal System: On -sit y stem I A. Install d Approx 1960 B. Install r C. Septic Ta k: 1. Size 12. Manufact e D. Seepage Pit: 1. Absorption Area 2. aterial E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area _ , Sewer Lines , Nearest lot line Other contamination B. Foundation to septic: tank , Absorption area _ C. Absorption area to nearest lot line _ EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Re( st for Approval of Individual . ?r & Water Facilities Legal Description Lot 1 Leos Subdivision Comments Approved Disapproved Date Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily, SIGNED Date EQ -034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 -- 274 4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Type of Inspection: CMRO VA FHA Property Owner: �W Mailing Address: 640 West 36th,, AnchoragQ Day Phone 279-9491 Name of Buycr: KarshbdUu,LLar>rn and Paulin,- r _ Mailing Address: Star m-. Box 1219A ngialc Day Phone 688-394 Name of Lending Institution: The First National Bank o f Anchorage Mailing Address: P.O. Box 720, Anchorage Phone 279-4481 5. Name of Realtor or Agent: Max Bevins -- Star Realty Mailing Address: 640 W. 36th Phone =9-2491 6. Legal Description: Lot 1, Leos SID 7 9 9 Location: Mile 22 Glen apZ Type of Facility to be inspected: Singe Family Reaidenc-x- No. Bdrrns. 3 _ Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well unknown Sewage Disposal System Type of System: Public Utility If Individual, date of installation G0-031 (1/7,11 Individual Individual (on site) xx _ 4 racxeei[t aRG j 3 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality Pto„n,4 3330 °C” Street, Anchorage, Alaska 99503 274-4561 Date Received 0/-9 76 Time of Inspection �IDate of Inspection pect on REQUEST OF INDIVIDUAL SEWERR&AWATER AFACILITIES FOR T �L. A 1. Approval requested by: 3e 'fu PCXCi,fIG /))or4 ore•_ Mailing Address: 31cj LV 5�—' vim, Phone: - 9,'S -O/_ 2. Property Owner: n1 �l,,5ar? Phone: Mailing Address: 3. Legal Description: LSLI , L e,0 �5 s !� _ T n�;lC as cl�Y��, ��,y �u�ay 4. Location: S_.�c _��.s.��.� P�',fe�-,s r�r��crr�c�, 5. Type of facility to be inspected !/�o r» {, No. of bedrooms Ll 6. Well Data: A. Type jj-)�J_ur U.a B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: 0 n - 5 C- A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line , Sewer Lines EQ -034 (1/74) Page 1 of two pages GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER a WATER FACILITIES 1. Type of Inspection: CMRO VA X_ FHA CONV 2. Property Owner:��__y��SA�Mailingn g Address: D a y P h o n e ______ 3. Name of Buyer: Mailing Address: _ /06 g4 cJA_ay _Phone 4. Name of Lending Institution: _- �.S67cc),er7 AG'/r'✓G Mailing Address-:<-_ 5-r" 41)5 Phone Z7Z- g501 5. Name of Realtor or Agent: 571 �,��ya 114 Ak 1,;&04 /_ Mailing Address: `/o �36 Phone Z'79- Z5z9/ _ riro5f- 13 ' L'��uY1 t7' � l t.i f fz. iro�l /;I' f�rM`1 AA 1Z i'Am C_V=sb'1 r-.'ru`r- . 6. Legal Description: 4®% /� Location: 7-r--Ac14C0 In A P_ /SET SPI C'�C 6Gv 7. Type of Facility to be inspected: _ ��.��= No. Bdrms. 8. Water Supply Type of Supply: Public Utility _ Individual If Individual, number of dwellings presently served If Individual, depth of well 7 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation EQ -037 (1/74) Individual (on-site) MALL 1 p'. eclii'ity Pacific Mortgage CoiVoration 319 WEST 5TH AVENUE ANCHORUGE, ALsMKA, MMI Page 2 of two pages - Requ ; for Approval of Individual Se- , & Water Facilities Legal Description Comments Approved Disapproved ,`is<', ��iDate Approval'Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED EQ -034 (1/74) Date !V=hr is, Ay", Lao S .,Wkjvjsjy� a-11"" I" " InsPa"t ty "s COM000 AWDIr lnir�, 3A, MIN CtZnan for ✓ bacOarkl3jim! water L111ySIS, 1170 of HapacVon thal ohs 3=111 ZOP30LI aystan 00CAargho Sway on tha Prowne. Ar Wn Qua P�LZLA.- cmn= grm approval, 7tts Z.41.04. As supay pit st3alc as ;,7;,, KrZ2 LLMink NO! Otis WYNow for wpgrah 30 zjwtjzu Zj !" havs SAY 01MQns AM call no it MAW Em, is!. .,...v.... Zly: 17.. AnOsy, Sonitarjan REQUEST FOR. APPROVAL OF (L/ INDIVIDUAL SEWAGE AND WATER FACILITIES ( (Fill out in Triplicate) S_. blanw of person requesting approval_ �� l• Q/�.��p 2, atamn of property: 3. :.ega] 4. NumLer of ,bedrooms in house 5. Water. Analysis; a. Bacterial b. Detergent 6, Well data: a. Type_ b. Depth c. Casing Size J d, Distance from well to closest existing or proposed: I 1. Sewer line t 2. Septic tank 3. Seepage Area 4. Cesspool, 5. Property Line 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. 7. Sewage disposal system, a. Age of system11 b. Septic tank capacity in gallons 1000Qry�;'�- c. Name of septic tank manufacturer 1. If "home made" show diagram on reverse side of this -f form. d; Disposal fiend or seepage pit size and type (r.�� (f,111 h6 1. Distance to property line to house foundation 9. e. Percolatim Test -results f-. Percolation Test performed by . Use the reverse .side of this form to show diagram, Diagram should include -the foi-lowing, information: property lines; -well location, house location, tank location, disposal area location, location of percolation test, aLld direction of ground slope. The h,f,,riration on this form is true and correct to the best of my knowledge. 0 gnatuyj of Applicant TO BE PILLED OUT BY HEALTH DEPARTTIENT PERSONNEL IzThe above described sanitary facilities are hereby approved, subject to the following conditions; Conditions;— / V The above described sanitary facilities are disapproved for the following reasons; _xLIA, 3�� Signature of Of, ^° / g ] Date t7l.�-.�.;,`�� Approval is valid :For one year following the date of approval. CPJ:cw