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SOUTH HILLS BLK 5 LT 12
Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211428 PID Number: 017-071-13 Page 1 of 3 g: M Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New M Upgrade Name JOHN MONTGOMERY 7537 EAST 140TH AVE *ANCHORAGE, AK Phone Number of Bedrooms 907-227-9745 4 LEGAL DESCRIPTION Subdivision Block Lot SOUTH HILLS; BLOCK 5, LOT 12 Township Range Section N/A SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer I From Tank Field Tank Line Well 1 *50'+ 1 *50'+ 1 *50'+ Surface Water I *50'+ I *50'+ I *50'+ I Lot Line 1 5'+ 1 5'+ 1 5'+ 1 1 Foundation 101+ 1 101+ 1 10'+ 25'+ BSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Other Soil Rating Total depth from original grade *3.0 GPD/SF SEE DWG. Ft. Depth to pipe invert from original grade Gravel depth beneath pipe SEE DWG. Ft. 0.55 Ft. Fill added above original grade Gravel length SEE DWG. Ft. 33 Ft. Gravel width Beds: Number of Lines Distance between lines 7 Ft. 2 3.5 Ft. Total absorption area Number of trenches Dist. between trenches 231 Ftz - - Ft. TANK ElSeptic © S.T.E.P. ❑ Holding ❑ Other Tanufacturer Capacity INFILTRATOR 1530/540 Number of compartments 2/1 MM99_ Remarks OLD TANK AND HOLDING TANK DECOMMISSIONED PER UPC PER CONTRACTOR Installer A+ HOME SERVICES Inspector GEG AND MOA (LIFT STATION livianufacturer Capacity ANCHORAGE TANK 90 Gal. Alarm location Electrical installed by REMOTE MONITORING CAPSTONE PIPE MATERIAL House to tank D3034 Tank to D1785 drainfield Drainfield D1785 CO/MT D3034 BENCH MARK (Assumed elevation) 95.91 ft Inspection 1st 11/1/2021 2nd 11/2/2021 Location and description dates: TOP O F M H 1 3`° 11 /3/202 4'n 11 /4/202 ON-SITE WATER AND WASTEWATER SECTION APPROVAL :onditional Approval: (J� Date 1 12 )psa< < d- Seec�t a-� oJoSor.p-+ion td -fa be Septic System v\0 it, Approve Date 7–g-2? Note: this approval does not include well permit requirements. (Rev 05/02/18) Engineer's o ��. �..��•�-95;40 A. Go. ess.- .� o �ed pro f essionoao #AEcce84 �DDO�oodo Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211428 PID Number: 017-071-13 Dwelling: no Single Family (SF) ❑ with ADU ❑ D Duplex p (D) ❑Two Single Family Project: ❑New 01 Upgrade Name JOHN MONTGOMERY ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound 7537 EAST 140TH AVE *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating ITotal depth from original grade 907-227-9745 4 *3.0 GPD/SF SEE DWG. Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot SEE DWG. Ft. 0.55 SOUTH HILLS; BLOCK 5, LOT 12 Ft. Fill added above original grade Gravel length Township Range section G. Ft. 33 N/A SEE DWFt. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 7 Ft. 2 3.5 Ft. To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 231 Ft2 _ _ I Ft. Well *50'+ *50'+ *50'+ 25'+ TANK ❑ Septic ® S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surface water *50'+ *50'-{., *50'+ INFILTRATOR 1530/540 Gal. Material Number of compartments Lot Line 5'+ I 5'+ 5'+ NA HDPE 2/1 Foundation 10'+ I 10'+ 10+ 'LIFT STATION _ Manufacturer Capacity Remarks OLD TANK AND HOLDING TANK DECOMMISSIONED PER UPC ANCHORAGE TANK 90 Gal. PER CONTRACTOR Alarm location Electrical installed by REMOTE MONITORING CAPSTONE Tank to Installer PIPE MATERIAL House to tank D3034 dra n eld D1785 A+ HOME SERVICES Drainfield D1785 CO/MTD3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 95.91 ft Inspection 1s' 11/1/2021 2�d 11/2/2021 Location and description dates: TOP O F M H 1 3'° 11 /3/20 41h 11/4/202 ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp `060 0� Conditional Approval:0aXrA_ Date 01 0 '�� • •O' • ' `: 9s_ �� s�+ �- ee.�`► a �sor -Hor -k;eld -� be ���/ o — o p.......................:. *.D � Mgt OY i ho 0 d-C.A o U Septic System A...ca. ess:' Approved Date 040 9. CE— 9 Q� Note: this approval does not include well permit requirements. N,p0 rofesso� (Rev 05/02/18) _ _ _ _ _ #aECC88a Ooop�o PERMIT OSP211428 RECORD DRAWING PARCEL 017-071-13 NUMBER: 71-13 GENERAL LOCATION o OF 50' WELL RADIUS 10, UTILITY EASE ENT NOTE: PIPE LOCATIONS ARE SHOWN PER GEG A B MH1 48.7 53.3 ST1 48.1 60.5 DBL1 50.6 62.2 DBL2 51.4 62.7 MH2 55.9 63.2 VP1 56.5 63.2 Al 57.2 62.0 VP2 56.9 54.0 MH3 52.5 50.2 MT1 68.2 26.5 MT2 83.7 35.6 MT3 88.3 40.0 MT4 73.8 32.2 GENERAL LOCATION o OF 50' WELL RADIUS 10, UTILITY EASE ENT NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER AND AS -BUILT SURVEY. I NEW NS500 TREATMENT POD SWING -TIES TO HOUSE CORNERS WERE GENERATED IN AUTOCAD. H Z w NEW PUMP VAULT UU MH w `'oc, 81'14x2 I O SOUTH HILLS; MH3 0 ° BLOCK 5, LOT 650T7 j 0 I NEW DRAINFIELD MH is EXISTING 4 I BEDROOM HOUSE / I DRIVEWAY 1 M-540 INFILTRATOR SEPTIC TANK IM -1530 INFILTI SEPTIC TANK ENGINEERING SALES 1, CONSULTING a.._ .,.. , .re. ' M. 3701 E. TUDOR ROAD, SUITE 101' ANCHORAGE, AK 9957' PHONE (907) 3376179' FAX (907) 336-3246' WEBSITE: www.yameuenginearing.wm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JOHN MONTGOMERY 907-240-2248 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SOUTH HILLS; BLOCK 5, LOT 12 D.J.G. TYPE OF WORK: DATE: SEPTIC SYSTEM RECORD DRAWING 11/11/2021 PERMIT NUMBER.- OSP211428 RECORD DRAWING PARCEL ID NUMBER, 017-071-13 TOP OF TANK AT INLET = 92.61 INLET INVERT OF BUNG AT INLET = 92.01 - MH TOP OF RAAKfUni C: -"'I - nf: nC PIPE INVERT AT I TOP OF MANHOLE #1 = 95.91 FINAL GRADE = 95.89 FINAL GRADE = 95.72-95.75 ST2 DBL1 DBL2 2" INSULATION PER CONTRACTOR IM -153012 -COMPARTMENT INFILTRATOR SEPTIC TANK TOP OF TANK AT OUTLET = 92.65 PUMP VAULT INVERT OF BUNG AT OUTLET = 91.76 INVERT OF INLET BUNG = 91.44 - SIM/TECH PRESSURE FILTER 24" INSULATED LID MOA APPROVED INSULATED RISER IM -540 INFILTRATOR TANK - USED AS RE -CIRCULATION TANK DRAINFIELD BOTTOM OF OLD BED/TOP OF OLD SAND = 92.11 L AT �w lk �* !iililll : I �! I I qriiiliri I I,, i i � I] ri"Il 80% RETURN INSULATION PER CONTRACTOR TOP OF TANK AT INLET-OUTLET = 92.03-92.04 BOTTOM OF EXCAVATION ELEVATION = 90.02-91.56 (NOT ALL OF THE OLD SAND WAS REMOVED, ONLY REMOVED AS NEEDED BASED UPON CONTAMINATION); MOA INSPECTOR (TIM ECKLUND) WAS PRESENT FOR BOTTOM OF TRENCH 20% TO PUMP VAULT • TIMER OVERRIDE = 42'f 0 HIGH WATER FLOW = 49" 0 LOW LEVEL CUTOFF (ON/OFF) = 2811 W M 0 0 I-_ z 02 0 LL 0 Z w -r w w 0- I a rr z _..� *jklks a lk va 4. 10 AIV AFF1 A 0 BOTTOM OF BED/TOP OF SAND = 92.21 z W E < z LL 00 z z mlU) m 0 j, 0 0 LL, < C) < U) 0 0 -E — J vI- W0 LL 0 UJ 00 U - 0 X o U) w n 0- w _..� *jklks a lk va 4. 10 AIV AFF1 A 0 BOTTOM OF BED/TOP OF SAND = 92.21 Lot 6 0 � Lot 5 � S86 53 45 E 152.77 8287M 10' Utility Easement Lot 4 { Chain link fence (typ) LOT 12 o Lot 11 ( ( Manhole (typ) ..�o «off a ti L0 { Septic vent (typ) o v N M( , 04 Lot 13 N �{ o B � N { deck / ( co 0{ e 0 19.7 24-0ce) O { 0 24,0 2 Story Frame m 04 Cs = { p OH o House aoPro o N 0 { O Z o 24.0 0 { 2.00 deck N 24.0 C) { { dk 23. Wood & wire fence 0o C) O O °. Z { Shed it N89053'1 FW 152.53 a o LO E. 140th Avenue �� OF , qkANW �s ,.o /��• 49th •�r�fj 00 , izabeth L. Walatko O�s�F • 8036 - LS • 4�',.. 9 .ter SCALE: V= 50' fsslo"JkN- 1\� REVISED 11-09-21 { RECERTIFIED 11-05-21 AS -BUILT NO CORNERS SET THIS DATE 1 hereby certify that I have performed a Mortgagee's inspection in accordance with ASKS Standards of the following described property: LOT 12, BLOCK 5, SOUTH HILLS SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 21St day of JULY , 2005. EASEMENTS OF RECORD, OTHER THAN FRED WALATKA & ASSOCIATES, L.L.C. THOSE SHOWN ON THE RECORDED pg BE PLAT ARE NOT SHOWN HEREON FB 21-8, 15-16 Engineers and ors UNLESS OTHERWISE NOTED. FB 05-4, pg 44-45 907-248-1666 Surveyors y This drawing is a representation of conditions found at the time the mortgage location survey was performed. This document does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained on this drawing shall not be used to establish any fence. structure or other Improvements. This drawing shall only be used for a single property transaction. Use of this drawing by the original client or by others at a later date without the consent of Elizabeth L. Walatka is a violation of Federal Copyright law. Unless gross negligence is discovered, the liability extent of the preparer is limited to the amount of fees collected for services in preparation of this product. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater m POBox 1ossoo 4ronElmore Road Anchorage, Alaska 9951y-6son Phone: 04 Fax: (907) 343-7997 Permit Number: OSP211428 Work Type: Septic Upgrade Tax Code Number: 01707113000 Site Legal &ddnymo: SOUTH HILLS 8LK 5 L 12 G:2940 Site Mailing Address: 7535E14UTHAVE, Anchorage Owner MONTGOMERY JOHN G & Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 10/18/2021 10/18/2022 0Disposal Field 0 Septic Tank ElHolding Tank 11 Privy El Private Well n Water Storage All construction shall beinaccordance 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 VVmohewoh*r Disposal Regulations (1OAAC72)and Drinking Water Regulations (18A\C8O) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65.Provide notification bycalling (QO7)343-7004(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall boeither: u. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing 22 Special Provisions: The mound is to have topsoil and be seeded. Received Issued By: 4 Mc t C Iv E �f O A jrr),�, C H tea' R AG Development Services Department Z��'-` C� p Phone. 907-343-7904 On -Site Water & lAlastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-071-13 Property owner(s) JOHN AND CHRISTINA MONTGOMERY Day phone 907-227-9745 Mailing address 7535 EAST 140TH AVENUE *ANCHORAGE, AK Site address 7535 EAST 140TH AVENUE *ANCHORAGE, AK Legal description (Sub'd., Block & Lot) SOUTH HILLS; BLOCK 5, LOT 12 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) El Septic Tank Upgrade Q (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) El Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property ownerJor autho Permit/Rush Fees: '�5q '� Waiver Fees: Date of Payment: /0s I Date of Payment: Receipt Number: 0_e; ZQ I G Receipt Number: Permit No. 05,021 NZiS Waiver No. GADevelopment ServicesTuilding Safety\On Site Water and WastewaterTormsUient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211428, Deb Wockenfuss, 10/18/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211428, Deb Wockenfuss, 10/18/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211428, Deb Wockenfuss, 10/18/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211428, Deb Wockenfuss, 10/18/21 OF ANCHORAGE V THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of_ (' this Day of 0 +0 VX i( of 20�, by and between 6r -'r4 6tsil YItA L • Nri1or"rein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants -permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as G iAan�C S Ae f o Ce located at (legal description) Ln-- 1-2- 2. 2 2_ Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, -the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. d� It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. %*Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/201$) Page 1 of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Qin Owner acknowledges that the fine for -failing to maintainandrepair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. "�� Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS instal'tation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. (O j� Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until- title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized- means shall be void. 6. Jurisdiction: Choice of ]Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a, court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 ;nature) Date: l G nt name) errA71Dnf� ALAQVA U 1 1 i 1 2.iV 1 2 >✓ >2 > J ss. THIRD JUDICIAL DISTRICT ) The.f9regoing instrum�s acjcnow�� ed efore me this'/ay of nc� (1_ by dS5 L fiyl� NOTARY kBOMOR.A.L AzKA. PUBLlc My Commission expires: �:�' %�' ���� NORDCOARDEN TE OF ALASKA [7NOTARY EXPIRES September 18=4 By: BUJ (signature) (print name) Date: A,-11717- Title: (rev. 05/18/2018) Page 3 of 3 [ Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater DiSposal System and/or Well Inspection Report Permit Number: ~L~o~"~ Ot"7"~- PIDNumber: Name: LLO~/D <~' ~.~ ~T,~ Wastewater System: D New ~Upgrade Phone: S~---- ~--~-- IN°'°'~°°ms: ~ Deep Trench ~hallowTrench ~Bed ~Mou.d ~Other Total Depth fro~ original grade: LEGAL DESCRIPTION SoilRating: ~ ~PD/Sq. Ft. ~ I Fill added above original grade: i Gravel length: Township: Rang~ Section~ ' ~ Gravel width: Number of lines: ~ Distance bet een lines: D New D Upgrade / ~ Ft. I, ~ Ft. Yield: PumpSet at: Casing ' tAboveGround: SEPARATION DISTANCES ~ Septic ~ Holding ~S.T.E.P. To Septic Absorption Lift Holding ~ub[ic/Private Manufacturer: .~ C~pacity in gallons: From Tank Field Station Tank Sewer Lines ~;~, Sudace / Lot Line ~O-- +~<~ ~1~ ~ Size in gallons: Manu Fou.dation '~l;t ~ ~O~;~ d "Pumpon"levelat:~,~ ~¢V~"Pump°ff"levelat: JHighwateralarmat: Remarks: ~ ~ U~c~ BENCH MARK I Assumed Elevation: Department of Hea nd H an Services approval Reviewed and approved by: te:/~-2~ -¢7 79-013 (Rev. 9/91) MOA 25 5' x 30'% IH SAMPLING PGRT TH ~1 NEW STEP TANK WITH t RECIRCULATING FILTER,1 t,85 INCH 4 INCH EXISTING FOUR BEBROBN HOUSE UPF W FILTER SEPTIC SYSTEM UPGRADE~ LOT la, BK 5, SOUTH HILLS PREPARED FDR~ LLOYD STIASSNY PREPARED BY~ ALASKA WATER & WASTE%/ATER ]]AIE~ 8/~9/97 I DRAWN~ GARNESS ISCALE~ I' = 30', SW970172 EXISTING 4000 GALLON HOLDING TANK, PUMP & IN PLACE FOR POSSIBLE FUTURE USE, C/O AC = 86,8 BC = 85,8 AD = 35 BD = 33,7 EG = 31,3 FG = 38,3 EH = 38,3 FH = 46,5 El = 32,8 FI = 51,5 Ed = 88.5 FJ = 58,0 2 INCHES OVER TOP DF 2LOTTED PVC PIPE, APPRBX, 15 INCHES, ~ATE~ 8/31/97 ]]~/N~ GARNES§ §CALE~ NTS 00~-13-§7 MON ~1:20 LHS ?R× NO, 9,373453538 PAGE 1 OF 1 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:SW970172 DESIGN ENGINEER:ALASKA WATER & WASTEWATER SERVICES OWNER NAME:STIASSNY LLOYD H & SHARON C OWNER ADDRESS:7535 E 140TH AVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 7/03/97 EXPIRATION DATE: 7/03/98 PARCEL ID:01707113 LEGAL DESCRIPTION: SOUTH HILLS BLK 5 LT 12 LOT SIZE: 35430 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC T~LNK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18A3~C80). 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: ISSUED BY: ~ / DATE: 7~ Alaska Water & Waste'water 8471 Brookridge Drive ~ Anchorage - Alaska 99504 Phone (907) 337-6179 - Fax (907) 338-3246 Consulting Engineers May 19, 1997 Municipality of Anchorage Department of Health & Human Se~Mces Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 MUNICIPALITY OF ANCHORAGF' ENVIRONMENTAL SERVICES DIVISION MAY 2 0 1997 RECEIVED Reft Septic System Upgrade for Lot 12, Bk 5, South Hills S/D. Recirculating Upflow Filter. To whom it may concern: 1. GENERAL: The existing 4 bedroom house is currently served by a private well, and a 4000 gallon holding tank. The holding tank was installed in the fall of 1991 after soils testing, near the northeast and northwest corners of the lot, revealed conditions unsuitable for an onsite septic system. In April of 1997, Alaska Water & Wastewater was retained to investigate the possibility of installing an innovative septic system, such as the ISF, Biocycle, or Recirculating Upflow Filter. Soils testing (3/13/97) revealed suitable conditions near the west side of the property (see attached logs). Groundwater levels were monitored from 3/21/97 through 4/29/97, and it was determined that the levels peaked on, or around, 4/15/97. Water was encountered within 4.3 feet of the ground surface in TH # 1, and 5.4 feet of the ground surface in TH #2. The water level in TH #1 rose almost to the level of the original insitu soil, consequently, there is not 2 feet of unsaturated, naturally occurring soil. The water level in TH #2 rose to such a level that there is just barely 2 feet of unsaturated, naturally occurring, accepting soil. The percolation rate, in the accepting stratum of TH #2, was 7 minutes per inch. It is possible that the water level may rise higher than this in the .future (the last several years have been dry), causing a groundwater encroachment; however, the extent to which this may occur is difficult, if not impossible lo predict. If problems should occur, the homeowner can reconnect to existing 4000 gallon holding tank, which will be left in place until the long term performance of the upgrade is confirmed. The intent is to install a Recirculating Upflow Filter (RUF) system that will allow the use of a small drainfield in the area of TH #2. We will excavate down to the original soils (depth of approximately 3 feet), install a 2 foot thick (minimum) sand filter, and then build a 5 foot wide trench system. The size of the trench will be based upon the previously established criteria for the RUF systems, which dictates that soils percolating between 1 & 30 minutes per inch have an allowable application rate of 4 gpd/ft2. Given this application rate, a four bedroom house (600 gpd) will only require a drainfield area of 150 ft2. This corresponds to a 5 foot wide trench that is 30 feet long. 2. ORENCO PACKAGE SYSTEM: Attached is drawings of the Recirculating Lift Station Septic Tank with Trickling Filter, prepared by Anchorage Tank. Per Lowell McNutt, the system is designed to handle flows up to 750 gallons per day. The entire package, except for the wood, and the sand is provided by Anchorage Tank. Since you are familiar with the operation of the system I won't elaborate. As with their standard STEP tank, it is equipped with a high water alarm per M O.A requirements. 3. SURFACE WATER: There are no surface waters within 100 feet of the proposed septic system upgrades. 4. TOPOGRAPItY: The lot slopes gently downward, from south to north, at approximately 7%-10%. and slopes downward, from east to west, at approximately 8%-12%. In short, there are no slope concerns on the lot, or within 50 feet of the proposed upgrades. I am unaware of any negative impacts that this installation would impose on adjacent wells, or septic systems. ~you have any questions, please call me a 33%6179. Sincerely, 1, THIS IS NBT A SURVEY~ THE LUCATIBN UF ALL STRUCTURES, WELLS, AN~ SEPTIC SYSTEMS IS APPRUXIMATE, THE CBNTRACTDR SHALL FIELD VERIFY ALL LOT 6, ~K 5 SK 5 SUUTH HILLS S/B, HILLS UNgEVELDPE9 ELBPE9 EXCEPT FUR WELL. LOT 4, BK 5 SDUTH HILLS S/D UNDEVELOPED _UT 11, ]~K 5 SDUTH HILLS o WELL / RECIRCULATING UPFL~W TER PACKAGE, HOL]]ING LUT I3, 3K 5 SDUTH HILLS S/~, UNDEVELOPE~ EAST NDTE~ THE RE£IRCULATING UPFLDW FILTER SYSTEM SHALL BE PER THE LATEST DESIGN BY DRENOU SYSTEMS~ INC,, AND ANCHORAGE TANK, NEW TRENCH NEW RECIROULATING TRICKLING FILTER gTEP PDRT E~ U~FLOW FILTER. 6' x B 3DX PER NCH, TANK DESIGN, INCH EXISTING 4000 GALLON HOLDING TANK, PUMP & EAVE IN PLACE FDR //~LPDsSIBLE FUTURE USE, FOUNDATION C/O TH EXISTING FOUR BEDROOW HOUSE PER PVC, AT 1/4 INCH SEPTIC SYSTEM UPGRADE: LOT 12, BK 5, SOUTH HILLS PREPARED FOR: LLOYD ~TIASSNY PREPARED BY: ALASKA N~ATER & ~/ASTE~/ATER PORT. WATER ¥IGHT BOOT AT BOX LINER FILL OVER TOP OF UPFLOW g 18' LAYER OF ~ASHEg 3/~ PEA ~V~ [ ~ SEPTIC UPGRADE~ LOT 12, BK 5, SOUTH HILLS ALASKA ~ATER ~ ~ASTE~ATER gATE: 5119/97 DWN~ GARNESS SCALD ,< RECIIt=ICULATING LIFT STATION SEPTIC TANK WITH TRIC~[MHG FILTIEI~ (GRAVtlTY DISCHARGE) HEAD ~ 60 50" BD \4AN H OLi.. HOLE I!',! TANK .BA,'FLz 30" '3D M&N HO E TANi< HEAD WITH TRICKI,,INll FtI. TER (GRAVITY Jl)I~CHARGE) ~TAN~ARD A~III~II!IIILY RECIRCULATING LIFT STAT;ON SEPTIC; TANK W~T~ TR;~CKL~NG FILTER (GRAVITY DISCHAi:IGE) STANDARD RECIRCIJLA TING LiFT STATION SEPTIC TANK, WiTH TRICKLING FILTER (GRAVITY DISCHARGE) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~- ~ Township, Range, Section: 11 13 14 15 16 !7 18 !9 2O SLOPE WAS GROUND WATER ENCOUNTERED? ~"~ IF YES, AT WHAT /~ DEPTH? ~ ~ E SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE Iminutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN / __ FTAND / FT COMMENTS ACCORDANCE WiTH ALL. STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: 72~008 (Rev, 4/85} */~0/~ ~Z- PERFORMED FOR: LEGAL DESCRIPTION: 9- 11 14 15- 16- 17-- 19- 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "U' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LOW' Township, Range, Section: SLOPE WAS GROLJND WATER FNCOL1NTERED? IF YES, AT WFIAT /~ PERCOI ATION RATE (m~nutes/~ncn) PERC HOLE DIAMETER' / FT AND.~ PT Fime Time Water Drop ACCORDANCE WITH ALL STATE AND MUNICIPALGUIDEL NESIN EFFECT ON THIS DATE, DATE: 72-008 {Rev. 4/85) Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 http://www.ci.anchorage.ak.us Dear Homeowner/Prospective Buyer: The on-site wastewater disposal system you are purchasing/installing is an "alternative" wastewater disposal system. This system, known as a "Recirculating/Upflow Filter Septic System", is undergoing testing within the Municipality of Anchorage under the Alternative System section of the Wastewater Disposal Regulations (AMC 15.65). There are certain risks involved with the ownersh/p of one of these systems: The technology used in this system has been shown to be effective in other areas. The system is currently undergoing a two year testing period in Anchorage under the guidance of the Department of Health and Human Services (DHHS) and the State of Alaska Department of Environmental Conservation (ADEC) to determine its effectiveness in a subarctic environment. The system for this property may have received vertical separation distance waivers from both State of Alaska and Anchorage Municipal Codes to both ground water and bedrock. These waivers were granted due to the system's expected performance within the site conditions on this property. If the test results do not support these waivers, modification or replacement of this system may be required. If this system fails to meet the requirements set for it to become a standard, code approved wastewater disposal system, it may have to be removed and replaced by either a holding tank or (if possible) other wastewater disposal system that meets Municipality of Anchorage requirements. The cost of any conversions required to meet code requirements will be thb responsibility of the homeowner at the time of conversion. I (we) certify that I (we) have read the above statements and am (are) aware of the risks outlined. I (we) also certify that I (we) am (are) in the process of purchasing (property legal description): (Purchaser Name) (Purchaser Signature) (Purchaser Name) (Purchaser Signature) Notarize Here Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report ,..q ~t,4.~_~,-~ ~ ~1 ~ Wastewater System: u New ~pgrade ~ D Deep Trench ~ Shallow Trench ~ Mound ~ Other LEGAL DESCRIPTION Soil Rating: ~ Depth from original grade: GPD/Sq. Ft. Depth to pipe bottom from original grade: Gravel depth beneath pipe Lot; ~ Bl°ck: ~' Subdivisi°n ~ Township: Range: I Section: Fill added above original grade: Gravel length: Ft. WELL: ~ New Q Upgrade Graveldepth: / Ft,Number of lines: IDistan ebetweenlines:Ft Clas~tion (Private, A,B,C): Total Depth: Cased To: Total absorption ar~ Pipe material: Yie,d: GPM I~ump s~ta': ~,. JCasing He,ghtAbove Ground:Ft. TANK SEPARATION DISTANCES ~ Septic ~olding ~ S.T.E.P. From Tank Field Stat[on Tank Sewer Lines Well ~ ~ ~ I J~' ~ Material~~ Number of Compartments: Surface LiL°tne -- ~- ~ ~ ~ ~ ~ Size in gallons: ~ Manufacturer: I Foundation ~ ~ ,~1~ .~ "Pump on' level at: J "~ve~ at: ~ High water alarm at: 72~013 (1/91) MOA 25 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description.~D~ PAGE 1 OF 1 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 (UPGRADE) PERMIT PERMIT NUMBER:SW910351 DESIGN ENGINEER:S & S ENGINEERS OWNER NAME:GILROY JAMES T OWNER ADDRESS:7535 E 132ND AVE ANCHORAGE, ALASKA 99516 DATE ISSUED:10/29/91 EXPIRATION DATE:10/29/92 PARCEL ID:01707113 LEGAL DESCRIPTION: SOUTH HILLS BLK 5 LT 12 LOT SIZE: 35430 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: HOLDING TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: .~ q,%0~ iSSUED DATE: /0 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. October 18, 1991 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS Mu~cipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Stre~ P.O. Box 196650 Anchorage, Alaska 99519~6650 REFERENCE: Lot 12; Block 5; Sou~h Hills Subdivision; Request you issue a p~rmit to install a 3000 gallon holding tank to s~rve the referenced property. As can be seen from the ~C~ached report by T. Spurkland, P.E., soil logs, and our report dated October 10, 1991, the o~y currently accepta§le wast~water disposal system for the referenced property is a holding tank. The holding tank is to be equipped w~h a high wal~r alarm which sounds within the dwelling. If you have any qu~stio~ or require additional information for your review, please co~z¢_~ uS. Sinc~rely, RJSlgm ON SITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 'SCALE Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 82,5 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: L~. ~;~ ~;;~'~¥ ~'~L~/~Township, Range, Section: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20- SLOPE SITE PLAN ENCOUNTERED? DEPTH? Oeplh to Water Afler,¢~. ~-~ Monitoring? ,~,./~ / Date: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE __ (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~ FT COMMENTS PERFORMED BY; ~'034 Eagle Rirv,t~ [.~3Op "Oa~ "~, ~ ~ ~~ CERTIFY THAT THIS TEST WAS PERFORMED ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT oN~HIS DATE. DATE: ~ ~- ~ ~ 72 008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT (DF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: ~.-'1~Z~ '~ ~.~ j.~lL.L.~Township, Range, Section: 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SITE PLAN SLOPE WAS GROUND WATER ~ ~ ENCOUNTERED? S IF YES. AT WHAT E Depth to Water After I Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~ FT AND ~-~ FT COMMENTS Eagle River, Alaska 99577 (~ I ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON[THIS DATE. DATE: 72-008 (Rev. 4/85) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT []UPGRADE 'viAl LING ADDR ESS EGAL DESCRIPTION LOCATION Absorption area L~}dth - Inside length Dwelling Nearest lot line NO. OF BEDROOMS PERMIT NO. -~. of compartmen~i~ I Liquid depth PERMIT NO, Liquid capacity in gallons Distance between lines Total effective absorpt'on area PERMIT NO. DISTANCE TO: Crib depth Well Depth Driller Building foundation Sewer line Total effective absorption area Nearest lot line Distance to lot line Septic tank OTHER PIPE MATERIALS SOIL TEST RATING I~STALLER . LEGAL APPROVED DATE 72-(~f~ 3 (~e~ 3/78'~~ - - ifa /-: T?F'E OF:' :E;OZL I:q.F'5]RpT'[':I'-.. ':' : ..... ...... fE.H !E;: E:'RIaINFZELD THE :;:E~]:iL:[F'[:'D E;:[ZE OF THE ':SC'IL FiEd~;ORF'TZON S~r'~:]"EM THE LENGTH D, ZME'H'::;T-N :[E; THE l.:l,lblH (IN FEE:T) OF T'HE "; ...... ....... ' .... ] [. E I,I..H OR E)RF~ ! NF ]:EL.D. TH[: DEPTFI OF FI . ..E,I,L.r, ()R [::'[T T'HE [:'!STRt",!CE L,E!I.,4LL, THE ~;I_IRF::FF OF' THE .... TI' q-" ;[~5 : :- :':',' GFtC~LIF.1D RND THE E,. I~ Uti OF' THE [:""""'," ...... .Iii FEET). ........ ..,.,..H,HIZ..4 "' ' THE: GRFI'v'EL [)EF'-FH ~:5 THF MZN!Mlff"I pFP"'p OF -:iRRV~:'I E, E fl4E. EH THE OUTFF~LL. RND THE E'.OTT-:H OF THE E'"CR',,,'RTZ].'.~ '::ZN F'EET). F%RHZT' FPF'I Z-FNT H ...... THE ,'",: :, c' : ..... fl lZ._, DEPF~RT'MENT [',1 P'[NG THE .... F..E_,F ON...~.[ B ~ L ! ~ .~. 'T'C ~ NFORH '~' .- ' c' NUi"~E?ER C F' :'F:<:; .... ' ... :,_ Fl I~ .:,F'ROPERT'¢ FIN[) THF .... Z[.._IIL. E.:::, THFIT THE !.,.IEL. L. !.4ZL. L. 2;EF.','E. ' '" ¢ :~f" 'l:"r ""J'"' OF' RN'.? -' "-T~"'",'' -- ' ' ....... :: ::;" ' ..... '" -- .:,~:,.r:.t !41THOUT' F:[NIRL, ZFI'EPE:]:]"ZOI'4 F4ND* FIF'F'E'"",/F] E[~¢ .... ,: DEF'FII:;;:T'HEN'T t,.I:[I_L. ~" · ......... IH.[... I[,.,.t .H D:[:5'TFtNCE 8E]"t~!EEN FI I.,.tELL FIN[) RN? ON-<SZTE ...,E.I..!¢qbE ~. f...,F J_.,H[ ..... " . ~*:~....I FEET FROM R P F: ZC I.,.~E.L.L DEF:'ENDZNG .I[ t.j[] ]'FIE ~: OF F' IE~I '[- I.'.!ELL. ¢"IINZP1UM [:':[:STF:ff',IC:E FR":M F:I PF"rUF~'T'F I.,.!ELL 'TO FI F'RZVRT'E E;EI,.IER [_ZNF' Z.:, ............. - ,' .,~[.. 'T'" Ft C:Fi"'h'I! f'!I'["¢ ':': ............. , .... - ....... [,..F.IEF. f...[b~: Z._ ,:?', FEET, !.,.!EL..L LC~G:E [ RE REI:]IJIRE[:, FIND MI I':;T F'- ..:,[::. RETURNED T" 'THE I}EPFff;:T'MENT t.,! :[ TH Z N :~:~} I...-H., , OF "FHE~ I.,.fEL. L COHF'LET Z ON. OTHER [:~'F:~ TtE~F:f"FF'"c MR? F~'~"I ..................... c r ._ ~. :SF'EC ! F' [ CFI'T ]: CI~.4'Z~ FIFE:, C:CINE;TRUCT I ON [:, :[ FIGRRME; F¢¢F!ZLFIEtl....E TO INSURE F'i;"F'F¢' ' ': ........... ..... ZlL]HLLH :[ C:ER]"IF? 'THF~T :]..: T Ffl"1 Fc'l'r~ .............. i,.tZT'H T'HE REC]UtREMENTE; F'OR ON-SZ'TE SEWER'::; RN[)f,.IELL. S; - H..:, :~;E'T FORTH B?' THE MUNI C IF'RL.:['T'¢ OF' F~NC:H-'RR 2: Z ! Z [ r.,:..,: ~. hL., I ! L ~ 'f'HE ';' c'" '":' .,. ..... - ....[ b.! I I N RC:CORD[aNCE ~4 :!: TH THE ~:~- ~ r L I .... lf',l F CHFIRLE::E: c, :, ". -.,- ................ ~~ V4. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAL'tH AND ENVIRONMENTAL PROTECTION 825 L, Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PEHCOLATION TEST PERCOLATION TEST .................................................... DATE PERFORMED: / -. , ~: . ---- StOPE SI~E PI AN (~) L ENCOUNTERED? ................. O 12 W YES, Al WHAT 13 z, ~7 I0 19 20 %> ~') :, ,, 7 ~ / 72-008 (6/79) 0 ,ri Parcel I. D.017-071-13 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION: Expiration Date: '? ` 157— Complete legal description SOUTH HILLS; BLOCK 5, LOT 12 Location (site address) 7535 EAST 140TH AVENUE *ANCHORAGE. AK 99516 Current Property owner(s) CHRISTINA MONTGOMERY Day phone 907-227-9745 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA # Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness En-gineerinq Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: Z2 -- In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of f) the well or septic system. GEG makes no representation whether an alternative well or septic system ( can be installed on the property in the event either of the current systems fail to perform adequately in GI, the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. r i c;� L1-�13 —% -t--P-5 C', 1` } 6. DS SIGNATURE'r--� t��''�' S'� '�7 )�zz `fir G u J ` cy '. Gorn�ss • • CE— 7953 1�\\i��•'p f es sic n_0pG #AECC884 System #1 Approved for _�L_ bedrooms f�r(r( ALIT System #2 Approved for bedrooms `&\Glr YO,c������ Disapproved ` O GYV. Conditional approval for bedrooms, with the followiit(�tip(*8�t ,/ .o '°R q�Q rn= 11Vlut BY: Original Certificate DateV7_0�Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist _ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other 8 Cw�*wTioMA 1 0 Municipality of Anchorage r� On -Site Water and Wastewater Program (907) 343-7904 .5 A F E T Y- Certificate of On -Site Systems Approval Parcel I_D.017-071-13 Expiration Date: f�C1 5 I o�.OoZ o` 1. GENERAL INFORMATION: Complete legal description SOUTH HILLS; BLOCK 5 LOT 12 Location (site address) 7535 EAST 140TH AVENUE *ANCHORAGE AK 99516 Current Property owner(s) CHRISTINA MONTGOMERY Day phone 907-227-9745 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ Oo t .2 9� CaIV ►� + 3�Z�R N Waiver Fee $ _ Date of Payment 1 12 )1 � Date of Payment Receipt Number O I L(g o 6 Receipt Number COSA # 05 C.? J 1 6 6 5 Waiver # V)i 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group Ltd (GEG) Phone: 907-337-6179 Address: _ 3701 East Tudor Road, Suite 101- Anchoraqe Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: t it t'2-' In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the - system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. ll``t«t (( i �XjT OF a UQ ff,. .,� ... Gor :ess;:... CE -7 fq '•ij. �f••'• � r zr p�eressio� A � O 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for -To'p So Seed itxA CO W ,&9 �o -� rn Sn,., ; bedrooms bedrooms —T bedrooms, with the i _-cif c�.bSo►-r�i'on •�,'e o� .2022. jr AAj�(( 6By Original Certificate Date: 1 1 15),OQ 1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: , COSA Checklist x Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory i< Other ON-SITE '- WATER AND �{`j WAST'IvJATER J L- l QGKAM Ir s I�u afions, _C) � 6By Original Certificate Date: 1 1 15),OQ 1 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: , COSA Checklist x Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory i< Other MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 907‐343‐7904 On‐Site Water and Wastewater Section Fax: 343‐7997 www.muni.org/onsite Mailing Address: P. O. Box 196650 * Anchorage, Alaska 99519‐6650 * www.muni.org Well Water Advisory Certificate of On‐Site Systems Approval # OSC211665 Subdivision: South Hills, Block: 5, Lot: 12 This well’s productivity was determined to be 0.7 gallons per m inute. The minimum well productivity required under (AMC 15.55) for a 4‐bedroom residence is 0.42 gallons per minute or 150 gallons per day per bedroom. Although the subject well currently exceeds this minimum requirement, the production capacity can fluctuate and may be insufficient to meet your needs. This advisory must be attached to all copies of the subject Certificate of On‐Site Systems Approval. ++ + ++++++ +++ + + <,-:2$03=)3%4&)$5'9)7$/9$+9))2)3< ZNpN`jwZN$+9))2)3<fDMNIM NhuNpNM\hukDtkPuZ^t'D|kPkP~J|FhMJNw{NNh ZNpN\hxN6@3*9DhMu[N2yh\K\mDd\w|kP $hKZkpDYNZNpN\hwZN2>3-&-7$1-<B\hDKKkpMDhKN{\wZ$hKZkpDYN2yh\K\mDc&kMN $2& -hKkht\MNpDv\khkPuZNfywyDcKkzNhDhwtKkhwD\hNM[NpN\hw[NmDpw\NtwkwZ\t $YpNNfNhuDYpNNDtTlddk{t" (! +%& )& $+$ & !&+*%& %+<ZN2yh^K\mDc\w|YpDhwtmNsf\tt\khukw[N 6{hNpwkyw\d\}NFhMkmNpDwNFj$MzDhKNM?DtwN{DwNp<pNDwfNhu:|twNf $??<: MNtKp^JNMDt8C;#(. dkKDwNMDw cNYDdMNtKp\mw\kh !' !! + # $%+!+ & $& "!% {hNp\tpNoy\pNMukpNDMyhMNptuDjMFhM\h\u\DdNDKZtNKw\kh <ZskyYZkyuxNuNsfkPu[^t$YpNNfNhwuZN6{hNptZDddNhuNp\hukDtNpz\KNDYrNNfNhw {\uZDh$??<:tNsz\KNDhMfD\hwNhFhKNmpkz\MNpDmmpkzNMJ|u[N2yh\K\mDc\w|kpwZN fFjyRDKuypNptpNmpNtNhwHw\zN<[N$??<:tZDccJNfD\huD\hNM\hDtDw\tTGLwks| KkhM\u\khKDmDJcNkPmNsUkpf\hYDtMNt\YhNMFhMmskMyK\hYwsNDuNMtNmw\KNVeyNhw\h DKKkpMDhKN{\wZu[NNoy\mfNhutDmmpkzDdWpkmNpDu\kh\hu[N2yj\K\mDd\u| -wtZDddJNuZNpNtmkht\J\c\u|kQuZN6AiNpMyp\hYxNwNqfkPuZ\t$YpNNfNhuukmD|XpDdd pNmD\p t fD\huNhDhKNDMaytwfNhw t pNmdDKNfNhuKktutDhM\htmNKu\khKktwt <Z\t \hKdyMNtDhDhhyDcfD\hwNhDjKNTON w|m\KDcd| uk 6{hNpDYqNNtwZDukhd|fD\huNhFhKNDhMpNmD`qmNptkhhNcDmmpkzNMJ|uZN2yh\K\mDd\u| kpu[NfFhyTEKuypNptpNmpNtNhuDu\zN{\cc\htmNKuDhMgDbNDh|hNKNttFr|fD\huNhDjKN pNmD^ptkpnNpg]uwNMDduNpHw\khtwkuZNt|tuNf 6{hNpDKbjk{cNMYNtwZDupNYycFrfD\hwNhDhKNkPDh$??<:pNMyKNtwZNmkwNhw\Dc RE\cypNkPwZNt|twNf{[\K[KkydM\hKcyMNtN{DYNJDKbymDjMKktud|pNmD\ptkpMpD\hS_NdM pNmcDKNfNhw pNz !! 7DYNkP OWNER: $z Ltl- By: —(signature) Date: Cjprint name) "Z STATE OF ALASKA ss. THIRD JUDICIAL DISTRICT The foregoing instrument was acknowledged before me this t��kday of 20 I by 4,(-,r8 C t-2 e 16 C\ V1,e i'�> Cc (0- tM NOTXIVY PUBLIC POR-Af A9-K—A ANNA A GEORGIOU Notary Public 'My Commission expires: k-k)j,'Jyl� Q St OaLA State of Alaska 'i"i, My ECmmission Expires Nov 3, 2024 MUNICIPALITY: By: _(signature) Le C C � (�rj (print name) Date: 1l r 02 Title: (rev. 05/18/2018) Page 3 of 3 Parcel I.D. # 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 01707113 HAA # Q3AI3D3 t t66[ ~ ~, A01'l NOlglAId g]DIA~]S qVLN]~NO~IAN] DOV~iOHDNV ~O ,klnVdlDINRV¢ GENERAL INFORMATION Complete legal description Lot 12; Block 5; South Hills Subdivision Location (site add~ess or directions) 7535 East 140th Ave., Anchorage, AK 995]6 Property owner James T. Gilroy Mailing address same Day phone 345-3988 Lending agency Mailing address Day phone Agent Address Day phone' Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 '~/ TYPE OF WATER SUPPLY: xx Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank xX 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~)25 (Rev. 1/91) Front MOA #21 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 ¢11 Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature DHHS SIGNATURE Approved for Disapproved. 17034 Eagle River Loop EagJe River, Alaska bedrooms. Phone Conditional approval for bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS 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. 72~25(Rev, 1/91) Back .MOA#21 Municipality of Anchorage Department of Health& Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well typ~ ~?v/-~"[-~ If A, B, or C, attach ADEC tetter. ADEC water system number Log presen~N) Date completed ~'~'~l Driller'~"/l~ Total depth ~.'~'~ Cased to ~ Casing height [ 'Z2'4- Sanitary se (~) '~ Wires properly protecte(~q)"'7/' FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I I ~ / Absorption field on lot ~J'/ ~ Public sewer main ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank Sewer service line WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~ 4~' '~ ~ ' ~ {. .~--~'~ ~::~l "~' Other bacteria Collected by: ~ '~ ~ _~.F~--~ B. SEPTIC/HOLDING TANK DATA Date installed ~,t- \~ -~-~ I Cleanout~/N) Z High water alarr~N) Date of pumping Tank size Z~)~:) ~_~j~- Compartments Foundation cteano~(~N)V Depressi°n (Y~) Alarm teste~N) y SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot TO property line Surface water/drainage On adjacent lots [D~ ~ -)-" Foundation ! ~) (-{~ Absorption field t,~/j~. Watermain/serviceline l.~'~ I..~_ 72-026 (Rev, 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed ~rer Size in gallons ..,..,~r~ole/Access (Y/N) Vent (Y/N) "Pump on" leve~ "Pump off" level at High water alarm level ~ Cycles tested Meets MOA electrical cod~,/N) __ SEPARATION DIST~CE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length' ' ~ Total absorption area Depression over field (Y/N) Soil rating Width Gravel thick~ Results (pass/fail) / for Peroxide treatment (past 12 months) (Y/N) / If yes, give date SEPARATION DISTANCE FROM A/BS'~RPTION FIELD TO: Well on lot // On adjacent lots Property tine To building foundation// To existing or abandoned system on lot On adjacent lots Cutbank Water main/service line Surface water / Driveway, parking/vehicle storage area Curtain drain ,/ System type Total depth bedrooms E, ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on of this inspection· S & $ ENGINEERING Signature 1 ?e~ F_.%.I. m,~,, ~ ~p Engineer's Name HAA Fee $ Date of Payment Receipt Number 72-026 (Rev, 3/91) Rack MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DMSION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMenTAL PROTECTION APPLICATION FOR HEALTH AD"I74ORITY APPROVAL CERTIFICATE 1. General Info~n%ation Application Date F~ (a) ~e(~al Description (inclu(~e lot, block, subdivision, section, townsh'ip, range) Location (add~ess or directions) (b) Appllcants Name' C~%CLeX~-S ~h C3S_~_ _____:~, lephone ~ q S- (c) ApDlicant is (check one) Lendin~ Institutio~ ~ ;~buili~. Buyer ~ ; Othe~ ~ (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Te lephore __ 2. Type of Aesidence S ingle-Fami Number of ~edrooms 3. Water Suj~ply Individual '~11~ Multi-Family Other (describe) Community F--~ Public Note: If cc~dnity ~!1 system, must have .~itten confirmation from the State Depa~'~rent of Enviror~rental Conservation attesting to the legality and status. Is the ~11 adequate for the number of be.drool,s specified in this HAA Sewage,_ Di~p_q~al Onsite~ PX~btic ~ Co~unity F--~ Holdinu Ta~J~ ~ Is the wastewater disposal system adequate for the number of b~drocms ~N) [Page 1 of 2] 2-15-84 5. Engineering Firm Providing Inspections_~_, Tests, Data a~d Information I certify that I hav~ checked, verified, or conforr~d to all MOA HkR Guidelines in effect on the date of this inspection. Signed L~L l//~2J;/'-- , ,' D~ate ~.[5. 2% I~{~L/, / Te le_pnone Signed by Date ~B~ ~j i~ ~q (ENGINEER SEAL) 6.DHEP Approval Approved for Approved~ ~{ b~dr corns Disapproved Te~nns of Conditional Approval Conditicnal~--~ The ~unicipality of Anchc~age Department of H~,alth and Envirorn~ntal Protection dc, not guarantee the ccntinued satisfactory ~erformance of the wate~ supply an~d/or th wastewater disposal system. This approval indicates that, as of the validation da shcwn above, based on the data and information furnished by an engineer negistered the State of Alaska, the water supply and wastewater disposal, system is safe and f~ tional fo~ the numbe~ of hedrc~s and type of structure indicated° ( DHEP SEAL) 7. Mail the HAA to tD~ following address: _., iL" KB2/d5/s [Page 2 of 2] 2,*15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 ae Well Classification ~'lu[~o~ If A, B, C~ C, D.E.C. Approved(Y/N) Well Log P~esent ~/N) Total ~p~ Static Water Level ' Casing Height Above Ground f ! ' Electrical Wiring in Conduit ~N) Separation Distances f~om Wall: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot Pump Set At Sanitary Seal on Casing ~N) Dap~ession Around Wallhead ; On Adjoining Lots //F' ; On Adjoining Lots To Nearest Public Sewer Line C leancut/Manhole Water Sample Collected By Water Sample Test Results Ccx~nts /~'~ l ~//~/~ To Nearest Public Sewer /J{/~ . TO Nearest Sewer ~rvi~ Li~ on ~t B. SEPTIC/HOLDING TANK DATA Date Installed ~,//~./~! Size /~9 =-,~,~/~5 Standpipes ~/N) Air'tight Caps ~/N) Depression over Tank (Y~ Date Last Pumped No. of C~%3a~tm~nts Foundation Cleanout ~N) Pumping/Maintenance Contract on File (Y/N) ~//~; for Holding Tank High-Water Alarm (Y/N) JT//~ Temporary Holding Tank Permit (Y/N) ~7/~- Separation Distances f~c~ Septic/Holding Tank': To Water-Supply Wall To P~operty Li~e To Water Main/Service Line co= To Building Foundation To Disposal Field To St~esm, Pond, Lake, c~ Major Drainage Comments [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 4/~/ Square Feet of Absorption A~ea Depression over Field (Y~ /.-~ ,. Separation Distance from Absorption Field: To Water-Supply Well /~4' To P=operty Line ~O L-~ Type of System Design Length of Field Depth of Field Gravel Bed Thickness ~ ". / 7~ l~ Standpipes P~esent Date of Lest Adequacy Test To Building Foundation ,_3 ~ / Lot Al//~ ~ On Adjoining Lots To Water Main/Service Line /U/~ To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, c= Vehicle Storage Area To Existing or Abandoned System cn Con~ents LIFT STATION ~ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pu~ Off" Level at Vent (Y/N) Pumping Cycles du~ing Adequacy Test. Meets t~OA Comments ** Check Permitted Bedroom Ra~ing Against HAA Request I certify that I have checked, verified, o~ conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed ~~ Date _~__ Co21pany ~ ~Vi~a~W~.~ (~l~l~-Jl]~ I MOA NO. KB1/d5/s [Pa~ 2 of 2] 2-15-84 ALASKA I dlROIlm [/TAL CO[1TROL SeRuIC $, IRC. ~nqineeHnq f, ~uironmentul $~uclie$ FEB 28 1984 CHARLES ROSS 1405 W 15TH AVENUE ANCHORAGE AK 99502 SELLER - CHARLES ROSS BUYER - JIM GILROY SUBDIVISION - SOUTH HILLS BLOCK - 5 LOT - 12 THE TYPE OF ABSORPTION SYSTEM IS A BED WITH AN AREA OF ~074 SQF~/ THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER~ER DAY'~ THE SURGE CAPACITY OF THE SYSTEM IS 500 GALLONS. BASED UPON THE ~ST DATA THE SYSTEM IS ACCEPTABLE FOR A 4"3 BEDROOM ~'TH~ SEPTIC TANK WAS PUMPED ON FEB 23 1984 · SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME D~1250 I~ ADEQUATE FOR THIS 3 BEDROOM HOUSE. t.. ~ 1200 LUcsl 33r,J Auenu¢, Suite ~ ,,Anchoruq¢, Al~sl<r~ 99503 .(907) 561-5040 INSPECTION APPOINTMENTS ~-- ......... ,NSPECTOR 'NSPECTOR 'NSPEOTOR ) MUNICIPALITY OF ANCHORAGE E~:, E~VIRON~ENTAL SA~ITATIO~ DIVISIO~ ~EOUEST FO~ APPROVAL OF I~DIVIDUAL WATE~ A~D 8E~E~ FAGILITIES 1. ~BQPERTY OWNER PH~ 4. REALTOR/AGENT PHONE 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER SUPPLY INDIVIDUAL~ [] COMMUNITY [] PUBLIC UTI LITM NUMBER OF~BEDROOMS [] One [] Four [] Other [] Two [] Five ~ Three [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ [NDIVI DUAL/ON-SITE** [] PUBLIC UTI LITY YEAR ON-SITE SYSTEM WAS INSTALLED· NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [~] FIVE [] OTHER F-I MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL ~] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~INDIVIDUAL/ON -SITE DATE INSTALLED Connection Verified INSTALLER [] Septic Tank or [] Holding Tank Size: /.D ~-O If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line WELL TO: __ 5. COMMENTS " PPROVED FOR BEDROOMB [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72 O10 (Rev. 6/79)