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Home My WebLink AboutBRUIN PARK #1 BLK 2 LT 10A Onsite File Bruin Park # 1 Block 2 Lot 1OA #016 - 102 - 30 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191316 PID Number: 016-102-30 Dwelling: Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name Jerry & Connie Bonham ABSORPTION FIELD ❑Deep Trench Wide Trench ❑Bed ound E] Site Address 11130 Forest Drive El Phone of Bedrooms Soil Rating Total depth fr original grade pNu;�m�b_e, GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Bruin Park #1 2 10A Fill added above original gr Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total a orption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ 1 00' I % 1 TANK [:1 Septic 9 S.T.E.P. [:1 Holding ❑ Other Manufacturer Anchorage Tank Capacity 1500 Gal. ` / Surface Water 100'+ 100'+ Material Number of compartments Lot Line 51+ 5 NA Steel 2 Foundation110'+/ 10'+ I LIFT STATION Manufacturer Capacity Remarks o re n eo 250 Gal. Alarm location (e) in house Electrical installed by Capstone electric PIPE MATERIAL House to tank 3034Tank to 3034 drainfield Installer A+ Home Services Drainfield COIMT3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 230.0 ft Inspdction 151 9/11/19 9/30/19 Location and description 2nd 31' 411' Concrete pad under deck. ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date S`:.. en H'. Pnnnoi:i = , 4; i''l G �Y G,;�_ `Do Septic System ApprovedOJ o� Date 5 o�0�d Note: this approval does not include well permit requirements. Vti 3r ,1lCV V01V4/ 10) o� nen �� To CC)Cnt/� <' W-uvz 7 CO � s O(m cQ-- z(nmF�Z• r�D c�Ta)§ FTI '�00O00r x � tmi� � D— GZ7� �D>ND c�mz-�z�To iD -� iM.. m!.0u) = r> -M -80-Z20 -0>00 0 ={ O.. - rC�Oz i O m O z D^-< O O 41 C7 D > O W zlm 0 CO D m mD * r -+f- �O --{� O M m 1;0 m FTI 0':5; :-u CL FTl n U) \ i/) I I c I Z L— — — — — — — Fq M \ \ 'o' ALJ n y n �b - — — — — — — — Dr — — — — — — — — — — — o r- M m \ m� f cNn \ 2j (-)0. m 0 0 r > 1 -TU o N D> o i- cn Z m t a O N 0� 'u Z cn m \ Jul 1O'Elec Esmt m ---- mo- 7 vD--q \ - r' �ocj / T o -n > 171 f— m \ \ / z w \ \ (9 — D \ --� m � O o (! i \ m cM ( / \ � W N m W O) c0 D Z CO O N -{ ( 1 D F9 A ( rn0O I+ cil bo m � o NOTES: PANNONE ENG SVC LLC P.O. 801 1807 PALMER, AK 99645 PHONE 907 745-8200 FAX 907 745-8201 �.��\\\� OFA �\ �Sg�P� 9s�9't� REVISIONS DATE 10/1/2019 SCALE - RECORD DRAWING BRUIN PARK �* *fir • •••• .•• .• 1„ = 50' #1 B2 L10A JERRY & CONNIE BONHMAM ORE DRIVE9 $'leve . 15 n'oae�r CE 8149 II `t P.I.D. NO 016-102-30 DRAWN ACP PERMIT.�� SITE PLAN t�1�. ..... SHEEP19�316 ANCHORA11130 AK 516 2 OF 2 o OF ..Z"'%% pp co .....A.... . 49 jrH*' SHANE A. HOLT �LS-6914 fessionak Ngo AS-BUILTSURVEY 1" =30' W CORNERS SET TATS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY _" e P 4'��111 V ANCHORAGE RECORDING DISTRICT ALASKA, AND THAT THE THE I N r 0 R MA I 10 H E N S F R T 11 E, U I 1"T SHOW ANY M S VISIBLE I PROVEMENT SITUATE THEREON ARE WITHIN �l � 0 6`1 L,CTS BE W_�a 0,.T_REl NO TO BE USED FOR POSITIONING ADDITIONAL AN ;C L A SIR11-1URES, LGT LIN"s lMPRJVE'!ENfS, A D"GR AND s i OR H nc i N, E -S THE PROPERTY LINE AND NO VISIBLE ENCROACHMENTS E 'Efl� T N E D coxa, c= THAN THOSE ap DN THE RCIOR) r LA_ , ARE No' SNOW; EXIST OTHER THAN NOTED. r.ERec'SUCFER P4 DATED AT ANCHORAGE,ALASKA THIS DAY OF N 0 ` E: F F N �l A Y A � P E A R 0 N H I S �U.FJING —RE NOT tc, 1�� USED TO ill -T. 2019 RopsRly LIN 0" "'G� , ON A D 1) 1 NIA - 'o 1 M IR OV F M Etna. A F vi t4 G s N i E R E ON N Y A rwN MAY Y 6 E A R OR 1 MALE I E D U L 0 X E 1 VE SO 0 tW AN N I OR HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 '44r- Srll • "�'0,- ..,\;::,-,-IC MUNICIPALITY OF ANCHORAGE On-Site Water&Wastewater Program - ,S. ��z e t;t. , -•-•—•,;; PO Box 196650 4700 Elmore Road - v P..f A; Anchorage.Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343.7997 : . . '`u'.` http://mvw.muni.oro/onsite �^. ' t : \ t0 Department On-Site Wastewater Disposal System Permit Permit Number: OSP191316 Effective Date: 7/31/2019 Work Type: SepticTank Upgrade Expiration Date: 7/30/2020 Tax Code Number: 01610230000 Site Legal Address: BRUIN PARK#1 BLK 2 LT 10A G:2633 Site Mailing Address: 11130 FOREST DR, Anchorage Owner: BONHAM JERRY V& CONNIE S Lot Size in Sq Ft: 14510 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907)343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The well may be within the T&E easement. If the asbuilt survey shows it in the easement, letters of non-objection are required prior to IR approval. • Received By: (�I�, / 4,,,e/igira----/-----z--7-7-7 Date: fIssued By: 9 Date: AY V gplsin3 MUNICIPALITY OF ANCHORAGE Community Development Department �' Phone: 907-343-7904 Development Services Division _ Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 016-102-30 Property owner(s) JERRY & CONNIE BONHAM Day phone Mailing address 11130 FOREST DRIVE ANCHORAGE, AK 99516 Site address SAME Legal description (Sub'd., Block & Lot) BRUIN PARK #1 B2 L10A Legal description (Township, Range & Section) Lot Size 14,510 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank LJ Upgrade [ Duplex (D) (i Holding Tank ❑ Renewal ❑ Multiple Dwellings [ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Igt (Signature of property o er or authorized agent) Permit/Rush Fees: og`J Waiver Fees: Date of Payment: '-1 .3/!9 Date of Payment: Receipt Number: OR-i316 Receipt Number: Permit No. £Y$pJg1311 Waiver No. Permit App_.-:• Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191316, Deb Wockenfuss, 07/31/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191316, Deb Wockenfuss, 07/31/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191316, Deb Wockenfuss, 07/31/19 MUNICIPALITY OF ANCHORAGE D! RTMENT OF HEALTH AND HUMAN SER ,ES 0 '2-' / 7 .- Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~.~r~ TANK FIELD WELL LEGAL DESCRIPTION LOT LINE Lot I Block Subdiwsion I¢ ~ ~/~ P~ FOUNDATION Township, Range, Section ~~ ~ ~ ~ drlveway,AS'BUILTwaterDIAGRAMbodies, etc.)tSh°w Iocabon of well, septic system, property hnes, foundabon, TANKS i ~ SEPTIC/&'~ ~,*~ ~ HOLDING Manulactufer Capacity In gallons ~ ~ '~,,r.a. ~o.o, oo~..~e~. ~ X~ TYPE OF SYSTEM '~ ~) ~,,E,C, ~,EO ~ W.O,A,, ~ OT,E, ~~r~' /Z~ Depth to p,pe bottom from Total depth from orig,nal grade -~ ~ ' ~~~ original grade Fill added above original grade Gravel depth beneath pipe / 4; ~*¢~'.'*~', . ~'~ / lnstalle Date Installed WELLS : ~ PRIVATE ~ OTHER (Identifv) I ,~ / , / ~ Class,flcation (A,B,C) Total Depth 1 Cased ,o / ~ - InstaHe~ Date Installed: ¢~ ~/~ ~~}, inspections Pedormeo by: I ~edil~ that t~is ins~e6tm was pederm~ ao¢er¢i~ t8 all Health Depadmen, Approval: -'~ ~' ~~ Date: 72-013 (3/85) WELL CONSTRUCTION LOg ~g co.~' ~W-W~.T.T.-VERN"S DRILLING A ENT ~ ::Dri~Jid, ~ERN. Type o~ ,i~~ ROTARY (address & legal descriptiofl)T,~ ~ ~ BRUIN PARK SUBDIVISION ~' . 6,~ ~ . 132' casing: dopth,, 132', !eve, ~ ,t~ (,,ov,..,0~ lend rval, and size: : teld,'tssted by (pumping, bailing, air) ~.t ]~ hours with ft. of drs~own fro~'~tati~ DRILLER'S MATERiAl. LOG Oepth below la~d~ lye description of ~trata :~:' , ,.:...'eur f ace. Q: 'to loin ,-,feltIi s i~ t 'sand (sizewithof ~ra~e lmate[Jill':~" color, ha rdneh of, drill.lng,~l.,:; , and water content) usos ... PERMIT ~ 870068 ' 6~3-87 Oatl we'll completed Nearest community ANCHORAGE Location sketch or remarks Old well grout sealed & cut off 10' below ground level. Cap welded on to seal. ~ ~,'~.,,O:.1-'t o 12 0 ~to 130 ,130 to. 132 ,~}i-;" "to to ,,, to hard 'pan silt. & zravel blue silty olay wi;th gravel sandy'gravel - H20 15 gpm 4 L C}"I" ~ :1. 0 :t: !:ii~ S L!li!i: D !.3 Y' ALASKA ,dIROFIFFI FITAL COF1TROL SehuiCe$, IFIC, ~nqineerinq $ (!nuironmenlol Studies April 29, 1987 Munic{pality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 iRE: Lot 10, Block 2, Bruin Park On 3-6-87, ~ Health Authority ~nspection was performed on the above referenced lot. There are no standpipes in the absorption field to accurately locate it. The location is estimated from the sewer asbu~lt dated 10-6-75 and from a site investigation of surface conditions. Referring to the site plan diagram, it appears that the majority of the drainfield is off the property into a R~ght of Way Easement for Reader Road. This road has not yet been constructed. Ir order for the owner, AHFC, to sell this property, ~he sewer system must be upgraded onto the lot and abandon what is off the property. This will also require the well be moved to allow for adequate upgrade area. As you can see from the site plan diagram, the avai. lable upgrade area is very l~mited due to the small size of the lot. From our soil test on 4-8-87, we recommend a mounded bed serial distribution system. See attached design. This will require a lift station. The existing septic tank will be properly abandoned. Any future upgrades on this lot will require a holding tank. If you have any questions, please call. Sincerely, hD, Pres '~e~t PE Alan Wien Engineer Technician 1200 UJcst 33rd Aucnue. Suil¢ B ,, Ancho~'c~q¢. Al~sk~ 99503.{907) 561-5040 PERFORMED FOR: Municipality of Anchorage ~* 825 "L" Street, Anchorage, Alaska 995 SOILS LOG -- PERCOLATION LEGAL DESCRIPTION:Lo'T"/o ,~/,~'~ ~ .~,~¢¢/,~ '~,,4.~K Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN WAS GROUND WATER ,]._~ ENCOUNTERED? S / L t-F YES, AT WHAT //(~ O DEPTH? p Depth Io Water Alter /~,.; Monitoring7 Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN . /5~o ~r/~,~,.~ (mmutes/inchl PERC HOLE DIAMETER ,/' ~' FT AND Z-~ . YZ PERFORMED BY; /~ ''~ /4. ZJ '~,,~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. 72-008 (Rev, 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: ~-~-~'7 ALASKA ENVIRON...,~NTAL CONTROL SERVICES, INC. 1200 west 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. OF CHECKED BY OATE SCALE ........ ~~t ...... ~,,,/~,~ ~~ .......................... i ............. ~ ........ C. REID, JR. Ct ALASKA ENVIRC. AENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 SHEET NO. OF CALCULATEDBY ,f~' ~"~/~/ DATE CHECKEDBY DATE SCALE ..<O/z.- ; 204-1 ,' ~, Inc Grcton, I~as$ Ol~TJ ALASKA ENVIR(~. _, AENTAL CONTROL SERVICES, INC. ].200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99.503 (907) 561-5040 SHEET NO, / CALCULATED BY CHECKED BY / SCALE / OF ~ DATE DATE PI~OUCT 204-1 ~lnc., G4~. ~ O[41L ALASKA ENVIR(~. **,,tENTAL CONTROL SERVICES, INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 :OE /.~7'- /,~~ ~ ~ .~Z~,x/' SHEET NO. ~ OF CA'CU,.ATED'",' /¢- ~wW DATE CHECKED BY SCALE DATE GRL ....R ANCHORAGE AREA BO,., Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 GH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: FROM WELL -- MANUFACTURER MATERIAL INSIDE LENGTH. INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY/Or-JO GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL /50 NUMBER OF LINES ~' ABSORPTION AREA DEPTH: FOUNDATION ~- DISTANCE BETWEEN LINES TOP OF TILE TO FINISH GRADE NEAREST LOT LINE TRENCH WIDTH~tt~_ IN. FT. LENGTH OF EACH LINE ~ "~ DEPTH OF FILTER MATERIAL BENEATH TILE__ TOTAL LENGTH OF LINES 9(~f TO~AL EFFECTIVE IN. ABOVE TILE IN, WELL: TYPE ~ BUILDING FOUNDATION CESSPOOL CONSTRUCTION~ ~'~ NEAREST NEAREST LOT LINE -~:~'~ , SEWER LINE__ OTHER SOURCES DEPTH SEPTIC ,~9 SEEPAGE TANK , SYSTEM APPROVED_ DISAPPROVED REMARKS DISTANCE FROM: DISTANCES: DIAGRAM OF SYSTEM INSTALLED BY:'~'~' ~,~C~ SEWER LINE DEPTH: PIPE MATERIAL:~-~L LOT SLOPE: REMARKS: DATE //~/~z~/"):APPROVED / ! G.A.A.B. Form LQ-032 Gte R ANCHORAGE Area Bo DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 'GH PERMIT NO.. SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION lOCATiON ,~-~.,~--~-r- Ma,L,NG ADDRESS P.ONE LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED ~ SEEPAGE PIT DRAIN FIELD K ~ OTHER TO BE INSTALLED B, ,J'--;/,/-W ZOCZ:W NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TESI' FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, DIAGRAM OF SYSTEM MINIMUM DISTANCES, REQUIREMENTS / FOUNDATION TO SEPTIC TANK ~ FOUNDATION TO SEEPAGE PIT DRAin FIELD SEPTIC TANK TO SEEPAGE Pit WALl SEPTIC TANK ~ / , SEEPAGE PIT TO NEAREST LOT LINE. WELL tO SEPTIC Tank ~"~0 / DRAIN FIELD ., DRAIN FIELD / seepage PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK, /~J) / , SEEPAGE PIT TO RIVER, LAKE, STREAM. SEEPAGE PIT ., DRAIN FIELD CAST IRON into AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET into UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC: TANK AND SEEPAGE Pit FITTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. 7-,o g,O-~:: , L c ~.,¢.,,,~t~.~ , '~. ~,.,.:.o.,,,--~¢~ G .A .A .B. OR LIEENSED DESIGNER I CeRTiFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE 7/'~'~ /~"' APPLICANT'S SIGNATURE ~ ,'~. ~ FORM NO. EQ-01 6 ~ GRr"~ER ANCHORAGE AREA BOROUGH Depa, ,~t of Environmental Quality 3330 "C" Street Anchorage, Alaska 99503 Performed for Legal Description: This form reports: Depth Feet ri_ (155) MRs'.. CHARLOTTE: BRADLEY Date performed LOT qO BLOCK 2~! BRUIN PARK SUBD.:lVl$1ON Soils log X. Percolation test ORGANIC OVERBURDEN (w/ 4" CossCES) POORLY GRADED GRAVEL GRAVEL-SAND MIXT1URE LITTLE FINES m 8- SD 9 - .= (275) 10- ll - C LA'Y EY SANDS~ SAND-CLAY MIXTURES 12- 13- 14- 16 WATER LEVEl.'_ (TYPESOIL NOT SEEN~ BUT ASSUMEID SAME AS ABOVE) Was ground water encountered? Yma If yes, at what depth? _!? ' ( NOTED TRICKLING IN FROM SIDES AT 10--12~! LEVELS) Reading Date Gross Time Net Time Depth to H20 Net Drop Percol ati on rate I mi nu te, Proposed installation: Seepage Pit ..... Drain Field .X~.i_~..SE~_~A.~GE BED~:( SEE USPHS~ Depth of Inlet SUGGEST SER~ES SYSTEM.SEEPA:GE(WID~SHALLOW) BEDS.FOLLOWiNG ~CONT. OURS FOR~LEVELNESS.,WiTH MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 016-102-30 1. GENERAL INFORMATION Complete legal description Bruin Park #1 B2 Ll OA Location (site address) 11130 Forest Drive Current property owner(s) Jerry & Connie Bonham Mailing address Same Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Expiration Date: g^ q- 20? IJ Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic F.Fl 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 $ .`m Z 4/1 .56 Date of Payment J �% 1=6_ Receipt Number 0331)(1_ COSA# 05(_16119 Waiver Fee $ Date of Payment Receipt Number Waiver # COVID-19 2957o DISCOUNT APPLIED 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. In conducting an adequacy test, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE System #1 Approved for L( bedrooms System #2 Approved for bedrooms Disapproved Phone (907) 745-8200 Date ?oO5-05 .r cE °F gsllal COP �v I 49 TH '•fir 4SCev r'anncme' CE 8149 cs r �o�ss�o�a .� Conditional approval for bedrooms, with the following stipulations: � r Y:- Original Certificate Date: JJ� �((�� JJ The Municipality of Anchorage Developmen SZices-Division (DSD) issues Certificates of On -Site Systems Approval representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Anchorage is COSH Checklist Legal Description: Bruin Park #1 B2 Ll OA Parcel ID: 016-102-30 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 613/87 Total depth 132 ft Cased to 132 ft R Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 7/9/2019 Static water level at beginning of test 34.0 ft Comments B. TANK DATA Age of tank(s) 9!119 years Tank type/material STENSI,6 Measured operating fluid level in septic tank FW Standpipes/foundation cleanout per record drawing Date of pumping n/a D. ABSORPTION FIELD DATA Bed Which system tested (date installed) 6/26/87 Q ALL standpipes present per record drawing Total measured depth from grade 3.5 ft (max) Measured depth to pipe invert from grade 3.0 ft (min) ❑ N/A — pressurized field FE -1 Monitor tubes go to bottom of effective. If not, state depth into effective 0 Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: see Part F. COSA Checklist yellow sheet Well production at time of test 2.06 gpm Water storage tank volume n/a gallons Well. disinfected for coliform test? ❑ Yes El No Coliform bacteria is Negative Nitrate mg/L 2Nitrate less than MRL (ND) Arsenic _16� ug/L ❑ Arsenic less than MRL (ND) Collected by Pannone Engineering Date of Sample 4/27/2020 C. LIFT STATION ❑® Required maintenance completed Age of lift station 9/11/19 years Lift station material Steel Comments: Adequacy test date 7/9!2019 Results ED Pass For 4 bedrooms Fluid depth prior to test 4 in Water added 600 gal New depth 8 in Elapsed time 200 min Final fluid depth 4 in Absorption rate 600 gpd Any rejuvenation treatment (past 12 months) If yes, enter date no 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 Community Sewer Manhole/Cleanout > 100' Q Yes if No ft F✓` Yes if No fi Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 17771 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' M Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft 2 Yes if No ft Q Yes if No ft Water Service Line > 10' ❑✓ Yes if No Manure/Animal Excreta Storage > 100' if septic tank is under driveway comment below Community Sewer Main > 75' MV Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: 7✓ Absorption Field > 5' if No Yes if No ft Private Wells > 100' M Yes if No ft Water Main > 10' Q Yes if No ft Community Wells > 200' Q Yes if No ft 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' 7✓ Yes if No ft Private Wells > 100' []✓ Yes if No ft Water Service Line > 10' F/ Yes if No ft Community Wells > 200' Q✓ Yes if No ft Surface Water > 100' IZI Yes if No ft F. ENGINEER'S COMMENTS This drain field is operating at approximately 95%-99% used and is likely at the end of its useful life. G. ENGINEER'S CERTIFICATION l certify that l have determined through field inspections and review Of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet OF ALgs��co �� STC- •1 -en F',. Panne^e CE 8149 "%OFESS UIQ' Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 9951.9-6650 www.ci.anchorage.ak.us (907) 343-7904 Septic System Advisory Certificate of On -Site Systems Approval # OSC202285 During a recent adequacy test on the septic system for Block 2, Lot l0A of Bruin Park 41 subdivision, 4" inches of standing water was observed in the absorption field. This indicates that approximately 95% of the absorption area is inundated. Although this system passed the adequacy test, the remaining life expectancy may be limited. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval Arsenic Advisory Certificate of On -Site Systems Approval # OSC201185 Subdivision: Bruin Park #1, Block 2, Lot 210A A water sample revealed an arsenic concentration of 10 micrograms per liter (ug/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards'are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. MaiUrig Address P O Box 196650 *Anchorage, Alaska 99519 6650*�wrvw muni org MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERT, F,CATE OF,NS ECT,ON FOR EALT AUT OR,TY A ROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) If1.~ 7~ T' ~Z, (b) Property Owner /¢~ Mailing Address (c) Lending Institution Mailing Address Telephone: Home Telephone (d) Real Estate Company and Agent Address ~ Telephone Business (e) Mail the HAA to the followin(3 address: or: Check here Iq, if hold for pick up. List contact person and day phone number below. TYPE OF RESIDENCE Single-Family~ Number of Bedrooms WATER SUPPLY Individual Well'S[ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72-025 fRev 8/86) Front 5. ~ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ,/~''''L~ ~' Telephone Address /.7_-~rJ ~.! J~ /'~" ~2~/7'~" Z~ /4/~'v~,''/ Date DHHS APPROVAL Approved for~ ~ (~-) bedrooms by ,~ '~ '~ff~ Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION 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. Page 2 of 2 72-025 fRev 8/86) Back MUNICIPALITY OF ANCHORAGE (MO~; HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ,~7"/~ WELL DATA If A, B, C, D.E.C. Approved (Y/N) Date Completed ~--~-~ 7 Yield /~"/ Depth of Grouting Pump Set At ,~,/~ /,~'/ Sanitary Seal on Casin ) Depression Around Wellhead (Y~_.,~ Well Classification Well Log Present~q)~ Total Depth /~'- Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit~N) Separation Distances from Well: ! To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Man hole Water Sample Collected by ,~-~'~ Water Sample Test Results Comments ~Z.~ ; On Adjoining Lots ! /.,~' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ~,~//~r/ ;Date B. SEPTIC/HOLDING TANK DATA Date Installed Standp pes ,) Air-tight Caps ; ) Depression over Tank (Yi~_' Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ,,~/,,'~ ! Se paration Distances from Septic/Holding Tank: To Water-Supply Well /.~O / TO Pro, perry Line ~) ~' T~' W~t~r;l~j~ervice Line /0 "/" . , . ,~.. Coursb, ~.~.~ /~-o 7 Size /-"~ No. of Compartments Foundation Cleanout Date Last Pumped 'for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~-'-~'~ Square Feet of Absorption Area Depression over Field (Y{~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot /O "7c' To Water Main/Service Line Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ~N) Date of Last Adequacy Test To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on /, ; On Adjoining Lots /'~ To Cutbank (if present) /, D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(~N) Comments Dimensions Manhole/Access~N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** Signed ~/'~-~//-~"-'--' Date Company ~C~' MOA No. Receipt NO. ~--'~ ~, --~ ~ Date of Payment ~ ~ ~ Amount: $ ~ ~.~' ~ / ~~ Page 2 of 2 72-026 (11/84) Location (address or directions) 7. F q- 7.z,~ o (b) Applicants Name ~O'~?~. ,'~50/~ HAfLT'~' Telephone - Home Business Applicants ~dress ~//~ ~ (e) Applicant ~is (check one) Lending Institution ~ ; ~er/butlder ~ Buyer ~ ; Other ~ (~plain); ' ' (d) Lending Institution Address (e) Real Estate Co. & Agent Telephone - 1'5 A (f) Mail the HAA to the following address: Telephone Z. Type of Residence Single-Family~ Number of Bedrooms 3. ~.ter Supplx I'adividual Well~[ Multi-Family ~-~ Other (describe) Community~-~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal 0nsite ~ Public ~-~ Community ~-~ Holding Tank ~-~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. En~ineerin~ Firm Providin~ Inspectionp~. Te.sts~ File Search~ Data and Information As certified by my seal affixed hereto and as of the validation date shown below, ! verify that my investigation of this Health Authority Approval shows that the on-si~e water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furthar 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 regula- tions in effect on the date of this inspection. Date DHEP Approva! Approved for Approved_.~ bedrooms (ENGINEER SEAL) ; . i' I~ ":' 'r~ ' · · · ' ~£~'/- z/~ Disapproved __ Condition Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT p~SPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 ae MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classification Well Log P~esent (Y/N) Total Depth Static Water Level Cased to MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION fiA¥ 0 RECEIVED Legal Description: L~.~-lC), ~ ~ If A, B, c~ C, D.E.C. Approved(Y/N) lq/~k Date Campleted ~O/~E /'7! Yield Casing Height Above Ground'--J'~ Electrical Wiring in Conduit (Y/N) Separation Distanaes from Well: set At Depth of G~outing ~O~Q ~ Sanitary Seal on Casing (Y/N) Y Depression A~ound Wellhead (Y/N) N To Septic/Holding Tank on Lot 79' 6~)~'g- To Nearest Edge of Absorption Field on Lot jO To Nearest Public Sewer Line . ~ ~ ~ To Nearest Public Sewer Cleancut/Manhole . ~O/k~- To Nearest Sewer Service Line on Lot Water Sample Collected By ~ ~ . ; Date Water Sample Test Results On Adjoining Lots I oO~ ; On Adjoining Lots ! ~ 7 B. SEPTIC/HOLDING TANK DATA Date Installed I~ lb I.~ Size I OO No. of Ccm~pa~twents I Standpipes (Y/N) ~/. . ai~-tight Caps (Y~). ~ F~ndation Cleanout (Y~) N ~ession o~ Ta~ (Y~) N ~te ~st P~d ~/~.~ 1 P~ing~intenan~ ~n~act ~ File (Y~)~ ; fo~ ~/~ Holding Ta~ High-Wate~ Ala~ (.y~) .~ ~ra~y Holdi~ Tank ~r~t (Y~)W/~ Sep~ation Distance ~ ~ptic~olding Tank: To Water-Supply ~11 ~ 7~ . To ~ilding F~ndation ~ O To Property Line ~ To Water Main/Service Line Counts To Disposal Field To Stream, Pond, Lake, c~ Major Drainage Receipt $ ~%%6~- Date Paid: ~'-'- '"~'%~" Arno un t: ~/~-ol)__ [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed I D/~/7~ Width of Field ~ ~ I/ Square Feet of Absorption Area ~/~C.~ Standpipes Present Depression over Field (Y/N) I",/ Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ~ [i; ~ To Property Line To Building Foundation ~ ~ To Existing or Abandoned System cn Lot I\~ ~ 1,9 ~ ; On Adjoining Lots To Water Main/Service Line ~ O ~' To Cutbank(if present) To Stream/Pond/Lake/c~ Majo~ Drainage Course To Driveway, Parking Area, or Vehicle Stc~age Area Type of System Design Length of Field ~O Depth of Field ~ Gravel Bed Thickness ~. ~ !,Y/N) NON , i Con~rents D. LIFT STATION Date Installed Size in Gallons "P~np On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dim~ ns ions Manhole/Access !.Y/N)... "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Con~ents Check Permitted Bedroom Rating Against HAA Request I certify that I have checked, verified, or confor~d to all MOA HAA Guidelines on the date of this iD~pection. Signed ~ Date~/~i/~ ;'- Company MOA No. ~ ~--~ I/ KB1/d5/s [Page 2 of 2] in effect 2-15-84 CONSULTING ENGINEER 203 W. 15th AVE '°C" SUITE 203 ANCHORAGE, ALAS KA 99501 TELEPHONE: [907) 279-3916 M~':3, 198§ RESIDENTIAL WELL INSPECTION LEGAL: LOCATION: OWNER: TYPE OF WELL: WELL LOG AVAILABLE: INSTALLATION REQUIREMENTS MET: WELL YIELD FROM WELL LOG: PUMP YIELD: DATE OF INSPECTION: TEST. PROCEDURE: TEST FOR COLIFORMS: TEST RESULT: LOT 10, BLOCK 2, BRUIN PARK 11130 FOREST DRIVE MARTY ROBINSON RESIDENTIAL ON FILE YES 10 GPM. 5 GPM AT 50 PSI MAY 2, 1985 WELL WAS PUMPED FOR 90 MINUTES AT A CONSTANT RATE OF 5 GPM. AND A CONSTANT PRESSURE OF 50 PSI. TEST WAS NEGATIVE The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. MUNICIPALITY OF ANCHORAGE DEPT, OF HEALTH & ENVIRONMENTAL PROTECTION 0 3 1985 RECEIVED CONSULTING ENGINEER 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 May 3, 1985 SEPTIC SYSTEM TEST LEGAL: LOT 10, BLOCK 2, BRUIN PARK LOCATION: 11130 FOREST DRIVE OWNER: MARTY ROBINSON RESIDENCE: SINGLE FAMILY, THREE BEDROOMS WATER SYSTEM: ON SITE WELL SEPTIC SYSTEM: FROM MUNICIPAL RECORDS: TANK: SUNSET PLASTIC, 1000 GAL. ONE COMP ABSORPTION SYSTEM: SHALLOW TRENCH ABSORPTION AREA: 450 FT.SQ. SOIL RATING: 155 INSTALLATION DATE: OCTOBER 1975 DATE OF PUMPING: MAY 3, 1985 DATE OF TEST: MAY 2, 1985 TEST PROCEDURE: SYSTEM WAS INSPECTED ON MAY 1, 1985. LIQUID DEPTH IN TANK WAS 51 INCHES. THERE WERE NO STANDPIPES ,MONITORING PIPES, AT THE END OF THE ABSORPTION FIELD. ON MAY 2, THE TANK WAS CHARGED WITH WATER AT A STEADY RATE OF 5 GPM. THE WATER DEPTH IN THE TANK WAS MONITORED THROUGHOUT THE TEST. THE WATER LEVEL IN THE TANK ROSE TO 65 INCHES IMMEDIATELY AND STAYED AT THIS LEVEL . THE TEST WAS TERMINATED WHEN 450 GALLONS OF WATER HAD BEEN ADDED TO THE SYSTEM. AFTER TEN MINUTES THE WATER LEVEL IN THE TANK WAS DOWN TO 54 INCHES. TEST RESULT: THIS SYSTEM ACCEPTED 450 GALLONS OF WATER IN 90 MINUTES WITHOUT SIGNS OF DISTRESS. THE MUNICIPAL CODE REQUIRES THAT SEPTIC SYSTEMS CAN ABSORB 150 GALLONS OF WATER PER 24 HOURS PER BEDROOM. THIS SYSTEM MEETS THIS REQUIREMENT. The operational life of all septic systems depends on the local soil conditions, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this septic system. We can therefore not give any estimate of how long the system will continue to meet the opera- tional requirements of the Municipality and State. ~' . . . " _~ DATE RECEIVED ' ~'.. INSPECTION APPOINTMENTs {~.~ 'lk/-/~g ?IME' " TIME TIME ' DATE DATE DATE MUNICIPALI~ OF ANCH~ ~UNIClPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC~RONMENTAL PROTECTION 8~ L Street - Annotate, Al~a ENVIROnmENTAL SANITATION DIVISION DEC 3 lg7g · R E C E i V E D. , ~l~TiO~8: ~ompl,t~ all p~rt~ on patio ~. In~om~l~I~ r*qu**~ ~ill not ~ ~ro~d, Pl~a~o 811o~ ton ~0} dag~ for MAILING ADDRESS PROPERT~ RESIDENT flf different ~r~ above)~ ~ PHONE 2. BUYER - PHONE ~~ ~ . ~ P~ ~ ~ ~ 3 ~. /~ ~1 3. L~Nb'IN~'INSTITUTIO~ /--~ ..... ;,--~ ~ I PHO~ M&I LING ADDRESS 4. REALTOR/AGENT I PHONE- MAI LING ADDRESS J5, LEGAL DESCRIPTION STREET LOCATION ' J6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS [] One J~ Four [] Other J~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY ATTACH WELL LOG. A well log is required for al wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) ~YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 ( R~ 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] NDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM [] INDIVIDUAL/ON -SITE []PUBLIC UTILITY , Connection Verified []Septic Tank or [] Holding Tank Size: If Tank is homemade give dimensior~s: THIS SIDE FOR OFFICIAL USE ONLY [] ONE [] TWO PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER NUMBER OF BEDROOMS DATE INSTALLED ' li~I~'~'ALLER SOl LS RATING [] THREE [] FIVE [] FOUR [] SIX TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line Septic/Holding Tank IAbsorption Area ISewer Line OTHER Nearest Lot Line 5. COMMENTS [~"-APP ROVE D FOR ~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-01o (Rev. 6/79) / SOUTHCENTRAL REGIONAL OFFICE / SOUTHCENTRAL REGIONAL OFFICE / MACKAY BLDG. 338 DENALI STREET ANCHORAGE 99507 / JAY S. HAMMOND, Governor June i9i 1975 Mr. LynnCoad Department of Environmental Quality Greater Anchorage Area Borough 3330 C Street Anchorage, AK 99503 Subject: Lot I0 Block 2 Bruin Park Subdivision Dear Mr. Coad: Th.is office has no objections to the location of the septic tank at least 50 feet from the well on the subject project. However we will require that the seepage system be located 100 feet from the well. S i ncere I y, · Ct~erry, P.E.~/ Regional Environmental Supervisor