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THE VILLAGES TR 8A
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: '%~/q~6 i~ PIg Number: ~1~O "~:Wo~'~INS"~OM~ ~&~_% Wastewater System: ~ew D Upgrade ~°*~*~,o, ~o¢ 1~7~ ABSORPTION FIELD Phone: ~ No. of Bed?~m: ~ Deep Trench ~'Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRIPTION S°ilRagng: ~/ GPD/~ T°talDepth 'r°m°riginalgraOe:~ I __ Lot: Block: Subdiv~ion: Deplh to pipe bol~om ~rom origina~ grade: Gravel depth beneath pipe Township: [ Range; I Section: Fill added above original grade: Gravel length; WELL: ~Now ~ Upgrade Gravel widlh: Number of lines: Classification (Private. A,B,C): Total Depth: Cased To: Tolal absorplion area: Pipe material: Driller: DaIe~,~ ~Dri' ed: Slafic Water Level: Instal er' '' Yield: Pump Scl at' Casing HeigM Ab0~e Ground: SEPARATION DISTANCES o s,p~ic ~ Holding ~ S.T.E.P. TO Septic Absorption Lifl Holding )ublic/Prlvate Manufacturer: Cspacity in gallons: From Tank Field SJ~JJo. Ta.k ~ow~r L,.6, ~OCyc k ~ Surface wat~ uo'~ lid+ 1~o' + LIFT STATION LineL°t ~0~ ~0{ Size in gallons:II Manufacturer: "Pump on" level at: "Pump oft' evel at: High waler al r at: Remarks: BENCH MARK ~ENGIhE~R'S SEAL . Inspections performed by: Dates: 1st ~ Department of th an( ~ Services appr/oval , ": ,:, Reviewed and approved b~LI *v~' Date:. , t · ' <~ ..... N ~ ~~ O ~ ~ I I ~ INAGE GOES UNDERGROUN I ~ X ~ 25 FT BRAI~ EA~EN~ I · ~ ~ / ~ ~1~ ~ I ~ .:. ~ / ~ PRIMARY ABSORPTION FIELD' . ~ I %:'. ' // ~ 49th~ f~ ~f~-- -- -- ~ ~ .... ~ '-'-- -- --~ .... '* ........... ~'"'* ................. ~'~'~ ~ ~ & / I / I TOBBEN SPURKLAND P.E, ~0~ ~A ~ V/~AGES SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE ANCH. AK. 99501 Jl~ WORTNIN~TON DATE: JULF SO, 1996 .(9o7/ 279-3916 SHEET: 2/5 GRID: SW960058 P/D 020-291-37 I-W/OO8A2. OWG C RECEIVED NOV 9 Ml~t opt, i~ 47t¼ INCH INSULATION 5' X 50' DRAINFIELD AIRCOktPRESSOR AIR LINES 99. 7 SILT BARRIER BENCH MARK GARAGE FLOOR 98~ Y9~ ORIGINAL GROUND 90.4 INVERT ELEVATION AT BOTH ENDS OF 89.8 BEDROCK 8s.8 5 - WIDE DRAINFIELD El' LEG£NI): BIOCYCLE 6000 IE 95.84 1. PRIMARY TREATMENT, SEPTIC TANK 2. AERATION TANK 5. CLAN/FICA T/ON TANK 4. DISCHARGE TAN/( 5, SOIL ABSORPTION TOBBEN SPURKLAND P.E. 205 Wl5th Ave Anchoraqe Ak 99501 .279-397~' SW960058 II LOT ~A 2'~IE VILLAGES JIM WORTHINGTON SEPTIC SYSTEM AS BUILT DATE; JULY 30, 1996 SHEET: 2/2 GRID: 5657 TVIOO8A 3. D WC PID 020-291-37 I-~-orn ; HLPtNb DN'ILL'ddeP .54~ 0~'0Z U¢%.ZM.I~6 Ld~15 RM LOCATION OF WELL eOROUGH eUBDIVI$10N LOT eLOCK / / LDCATION/$KETCH: STATE OF ALASKA DEPARTMENT OF NATURAL RE$OI.IReES DIVISION OF MINING & WATER MGMT WATER WELL RECORD SEC?ION QTRS WELL OWNER: []s []w ,, '; h~',.] Ill DEPTHS MEASURED FROM:[~cesing top E]ground surface ItOREHOLE DATA: Materiel Type and Color Depth From To /? CONTRACTOR INFORMATION: , 'i.< ,/ .,/.','.:;' / ../: ,',' ~ / , , Registered Business Name 2' .. _.,~;?;;,..,, . ,,, ,., ,¢:;,~,.,¢..<' ,¢ · . .... O~te DEPTH; DATE OF COMPLETION Depth of easing. ~:'/~',7 Date; STATIC WATER LEVELt below [] top of casing [] ground surfaae METHOD OF DRILLING: [~re]r rotary [] cable tool [] other USE OF WELL~ J~J domestic ~ irrigation [~ monitor E~ public supply [] other CASING STICR-.,UP~ ,.,?, ft, Diem: (~ in, to ~C) ft Casing tyPe: ,~;~;;~,/~ ' . ~ ~ J~, to ~ft WELL INTAKE OPENING TYPE; ~ open end ~ screened ~ perforated ~'openhole Depths of openings: _ to ___~ it SCREEN TYPE= Diem: Slot/Mesh Size: .... Length: GRAVEL PAOI( TYPE; Volumo used: Depth to top~ GROUT TYPE: Volume: Depth: trom ftt0 DEVELOPMENT ,M. ETHO?.I . Duration: ;~,;" ' ,. ft PUMPING LEVFL AND YIELD: ,.,, ft after .¢; hr~ pumping~_ . gpm PUMP INTAKE DEPTH: ft Horsepower: WELL DISINFECTED UPON COMPLETION? YES [~ NO REMARKS= PLTASE MAIL WHITE COPY OF LOG TO: DI'~R/DIVISION OF MINING & WATER MGMT St, Suit9 800 AnchoFags, Ak 99503-5935 Ph(907)762~2538,Faxfg07~S62-1NR4 0CT-29-1996 09: 43 FROM ~kAI,IC:HORAGE AGO TORTS TO 2?66013 P. 01 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT -~.~\,%~[~ PERMIT NUMBER:SW960038 DATE ISSUED: 3/29/96 DESIGN ENGINEER:TOBBEN SPURKLAND, ]P.E. EXPIRATION DATE: 3/29/97 OWNER NAME:WORTHINGTON JAMES M & TERESA C OWNER ADDRESS:P.O. BOX 112278 ANCHORAGE, ALASKA 99511-2278 PARCEL ID:02029137 LEGAL DESCRIPTION: THE VILLAGES TR 8A LOT SIZE: 42027 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WBLL 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 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: 1.) 2.) RECEIVED ISSUED BY:_..~ CONSTRUCT SYSTEM IN ACCORDANCE WITH THE ATTACHED DESIGN (REVISED MAY 24 1996). BIOCYCLE FOLLOWED BY A 5' BY 50' DRAINFIELD. (DEPTH NOT TO EXCEED 2') CONSTRUCT SYSTEM IN ACCORDANCE TO AMC15.65.060 REGARDING SETBACK REQUIREMENTS TO SURFACE WATER AND SLOPES EXCEEDING 25%. DATE: DATE: T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 RECEIVED MAY 2 4 1996 Municipality of Anchorag. e Dept. Health & Human Serwce8 James Williams Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 Subject: Permit No SW 960038 PID 02029137 Tract 8A The Villages May 24, 1996 Dear Mr. Williams; The owner of this lot and I field located the intermittent stream on May 20, 1996. The stream is not flowing within the plotted easement, but rather to the east of it. The actual location is shown on the attached siteplan. Due to the location of the stream, the location originally suggested for this wastewater disposal system is not suitable. We therefore proposes an alternate location as shown. Three testholes were dug in this area and bedrock was found at approximately 8 feet in all three. No groundwater was obsetwed. The soil was perc'ed last fall with a percolation rate faster than 1 minute per inch. A sieve analysis of the soil classifies it as sand with gravel. Mr. Worthington is at a standstill at the moment. Please review this at your earliest convenience, so that Mr. Worthington can proceed with the construction. His plan is to drill the well before starting the house. Yours T. SpurkYand P.E. 203 W 15th. Aveoue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN TRACT SA, THE VILLAGES JAMES WORTHINGTON Bedrock at 8 feet Due to bedrock, lot slopes aud perc rate USE BIOCYCLE. Soil Rating. < I lnin/in Poorly graded sand with gravel Phukan May 20, 1996 Percolation Rate: 1.2 x 2 = 2.4 gal/ftsq. No. of Bedrooms 4 Required Area per Bedroom: 150/2.4 = 62.5 sq.ft. Use 5-Wide with .5 feet of gravel. 62.5 / 5 = 12.5 ff per bedroom Total leogth reqoired: 4 x 12.5 -- 50~,~. ft. Separatioo to bedrock 6 feet Sewer rock .5 ft Cover 3 ft. The installation of this septic system will not prevent wells fi'om be iustalled oil the adjacent lots. There are natural surface drainage courses oil this and tim adjacent lot. The plotted stream is seasonal and water is flowing during breakup and alter heavy rainstorlns. The proposed septic system does not interfere with this drainage course. The proposed septic system will uot change the general slope of the area. Ponding and/or concentration of surface ranoff will not result from this iostallatiou. 25 D 49th , I, 25 ~ 75 IOBBEf No. CE O0 125 150 203 W 15TH. AVENUE ARCH. AK. 99501 \\ GE GOES UNDERGROUND \ \ \ \ BIOCYC6 F/ELD~ /I. PLANt BEDROO. WxTESiO~i~CE PROPOSED 4 FF ELEV. 144.~~' ~ / 0~ "~ ell BEDROCK [~ IOFE UFIL. LOT 8A 2IIls' FILLAG15S J/kt WORTH/NO[ON SEPTIC SYSTEM DESIGN DATE: SHEET: 2/3 GRID: $657 85/21/1995 88:41 9072773177 PHUI<AH CONSULTZNG PAGE 82 Municipality of Anchorage DEPARTMENT OF HEAL'I-H & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~ SLOPE SITE PLAN 1 2 4 5 6 7 I/z~ 10- 11 13- 14- 15- 16- 17- 18- 19- 20- WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH7 Deplh lo Waler ^lief / MonitorinD? ~ Reading Date Net Time Dopth to Water Net Drop PERCOLATION RATE __ (mm~teshnchJ PERC HOLE DIAMETER TEST RUNBETW£EN __FTAND __ FT Pi:RFORMED BY: ~ '~ CERTIFY TNAT TNIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) / PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 8 10- 13- 14- 15- 16- 17- 18 19 20 COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST SLOPE SITE PLAN IF YES, AT WHAT DEPTH? Depth Io Waler Afler Monitoring? DaLe: __ , ' '~, (E~!GINEER;S SEAL) Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __._ (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN PERFORMED BY: CERTIFY THAT TFIIS TEST WAS PERFORMED IN 72-008 (Rev. 4/85) PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW960038 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:WORTHINGTON JAMES M & TERESA C OWNER ADDRESS:P.O. BOX 112278 ANCHORAGE, AK. 995].1-2278 DATE ISSUED: 3/29/96 EXPIRATION DATE: PARCEL ID:02029137 LEGAL DESCRIPTION: THE VILLAGES TR 8A LOT SIZE: 42027 (SQ. FT.} NUMBER OF BEDROOMS: 4 THIS PERMIT: THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM AEL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. TEE 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 (iSAAC80) . 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 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. PERMIT) ~ OF 3/29/97 SPECIAL PROVISIONS: 1.) CONSTRUCT SYSTEM IN ACCORDANCE WITH THE ATTACHED INTERMITTENT SA1ND FILTER DESIGN, INSTALLATION MAINTENANCE MANUAL (MOA-DHHS MANUAL). 2.) CONSTRUCT SYSTEM IN ACCORDANCE TO AMC15.65.060 REGARDING SETBACK REQUIREMENTS TO SURFACE WATER 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 96-03~29 11:49 RCVo SEPTIC SYSTEM DESIGN TRACT 8A, THE VILLAGES JAMES WORTHINGTON Bedrock at 11 feet Due to bedrock, lot slopes and perc rate USE INTERMITTENT SAND FILTER Soil Rating. < 1 miu/in Sandy Gravel per sieve analysis (1977) Percolation Rate: 4 gal per sqft. No. of Bedrooms 4 Required Area per Bedroom: 150 / 4 = 37.5 sq.ft. Use 5-Wide with 3 feet of gravel. Reduce required area to 58% 37.5 x .= 21.75 sq ft. Total m'ea required: 4 x 21.75 = 87 sq. ft. Total Length: 87 / 5 = 17.5 l.f. Separation to bedrock 4 feet Sewer rock 3 fl Cover 3 fi. The installation of this septic system will uot prevent wells fi'om be installed on the adjaceut lots. There are natural surface drainage courses on this and the adjacent lot. The plotled stream is seasonal aud water is flowing during breakup and after heavy rainstorms. "s'Y4':e:n,~?-ddt!°-!m?vrs!b!efert!:eeffiuenttvreaz!:fi:zzt:';amatt~t. The proposed septic system does not interfere with this drainage course. The proposed septic system will not chauge the general slope of the area. Ponding and/or concentration of surface runoff will not result fi'om this installation. ~5 O 49th / SCALE; 1~\= 50 FT. \ \ \ \ IlO0 .... O0 \ · , ; pRkbPOSE 96-03-29 I1:48 RCVO 18 0 FL UTIL. SAND FILTER J SECONDARY TRENCH J I PRlt/ARY TRENCH/ ~ J INTERA411TENI' SAND FILTER ALTERNATII/E ANCH. Al<. 99501 d14t WORTH/NO[ON DATE: FED 15, 1996 .(907) 279-3916 SHEET: 2/$ GRID: $657 96-03~29 11:49 8~YO From STEP 18 ~'ELL ,5' L PEA 6RA~L TOBBEN SPURKLAND P.E. 205 W 15TH. AVENUE ANCH. AK. 99501 _(9o7~ 279-3~] ~ 18x20 SAND 1,'I£TER fRAC[ 8A [HE VII-LACES Jl/,/f V/O£THINCTON SEPTIC SYSTEM DESIGN DATE: MARCH 29, 1996 SHEET: 3/4 GRID:3637 96-93-29 1]:49 F~FVI~ DRAINFIELD 5 Fl' HI/DE 17.5 FT LONG 5 Fl- OF ROCK 6 ET TOTAL DEPTH 5 FT Of' COVER 17.5 8-Inch Sump 5,00 ft 1500 GAL STEP TANK WITH 4-INCHES OF INSULATION NO SCALE 3' Sewer Rock 4" Distr/buBon M/raft 140 1500 Gal STEP BENCH MARK: BASEMENT F. ?, ASSUMED ELEV. 100.00 FT TOBBEN SPURKLAND P.E. 205 H/15/h Ave Anchoraqe Ak 99501 ', 279 -,3978 TRACT 8A THE VILLAGES JIM WORTH/NO[ON SEPTIC SYSTEM DES/ON [ DATE MARCH 29, 1996 SHEEl? 4/4 GRID: 5657 '. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOIL, S LOG -- PERCOLATION TEST ~.~ ,~. ~ . ~. PERFORMED FOR:~ -- DATE LEGAL DESCRIPTI Township, Range, Section: 1 2 3 5- 6- 7 8 9 10 11 12 13 14 15 16 17 18 19 20- COMMENTS 'L ? ' SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT L DEPTH?-- FAoflitoring? Date: ~' Date Gross Net Depth tO Net Time Time Water Drop PERCOLATION RATE ~ (m~nutes/mch} PERC HOLE DIAMETER T, EST RUN ETWE N FT AND FT /', ~ERFORMED e~: ]-~5 , ' 1'-7 '.5 ACCORDANCE WITH ALL STATE AND MUNICIPAL GUH]ELINES IN EFFECT ON THIS DATE. 72-008 (Rev. 4/85) CERT,F~ T]Q T.,S TEST WAS PERPORMED ,N Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0050 SOILS LOG -- PERCOLATION TEST PERFORMED FOR; ~'/4~ ~/~'O " ~ LEGAL DESCRIPT,ON.'~ ~'~r'~-~,- CJ ~/*J" Township, Range, Section: 3-7 4 5 6 7 8 9 10 11 '12 13 14- 15- 16- 17 18 19 2O WAS GROUND WATER ENCOUNTERED? SLOPE S L IF YES, AT WHAT 0 DEPTH? p E Monilering? (-,~ 'Y.,~ Oale: SITE PLAN Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION HATE ~,~. L (mmuteslmCh) PERC HOLE DIAMETER . TEST~U~.E~WEE~ ~ F*^~D ~''/~T . CERTIFYTHA THIS l'EST WAS PERFORMED iN 72-008 (Rev. 41851 Rick Mystrom, Mayor Mtmicipa ity of AnChorage Department of Health and Human Services 825 'L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 Dear Homeowner/Prospective Buyer: The on-site wastewater disposal yeti are interested ill purchasing is ~ul "altemalive" wastewater disposal system. This system, known as a "Biocycle Aerated Wastewater Trealment System", is undergoing lesdng wilhin the Municipality of Anchorage under Ihe Allernalivc Syslem seclion el' Ihe Wastewater Disposal Regulations (AMC 15.65). There are cerlain risks involved wilh Ihe ownership of one of Ihese syslems: This system has been shown to be effeclive in edict areas. Tile syslem is currendy undergoing a two year lesting period in Anchorage tamer Ihe guidmlce of Ihe Deparlnlenl of Heallh and Human Services (DHHS) and Ihe State of Alaska Department of Envil'onmenlal Conscrvatkm (ADEC) to delermine its effectiveness ia a subarclic environmenl. Tesling results on syslems inslalled iii 1994 have been very encouraging. Collies of initial lest resulls are available fronl Ihe DHHS. 2, Tile Biocycle system has not been tested and approved hy thc Nalional Sanitation Foundation (NSF). Currently, Aochorage Municipal Code for Wastewater Disposal Regulalions requires proprietary equip]nent to have NSF approval. This approval or changes to Ihe Waslewater Disposal Regulations through Municipal Assemhly aclion will be necessary prior Io Ihis system being approved as a slandard system. The "Biocycle" syslem for Ibis propeay may have received verlical separation (lislance waivers fi'om bolh State of Alaska and Anchorage Mllnicipal Codes It) hoih ground water and hedrock. These waivers were granled (hie Io the syslem's expected l~rl'(')l'lllallce withill the site colldiliollS oo this property. If the test results do not support Ihese waivers, modificalion or replacemenl oflhis system may be required. If Ihis syslem fails to meet Ihe requirements set for it Io become a standard, code approved waslewaler disposal syslem, it may have lo be removed and replaced hy either a holding tank or (if possible) oilier waslewaler disposal syslem dial meels Municipalily of Anchorage rcquh'emenls. The cost of ally COlWersions require(l to meel code requiremenls will he lite resprmsihilily of the homeowller at Ihe lillle of collversJo~l. I (we) cerlify thai I (we) have read the above slatemcnls and am (are) aware 1)1' Iht risks oullined. I (we) also certify thai I (we) aln (arc) i~ tile process of lit,'chasi~g (property legal description): Name) Notarize Here (Ptlrchaser Nallle) (Purchaser Signature) PROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated (~f'M~c.t~ ~%,\ 199J.~_, is made between tile Municipality of Anchorage Department of Health and Human Services (DHHS) and the property owne~r{s) of: This agreement is made for the purpose of maintaining an on-s~te wastewater disposal system on the subject property. The property owners agree to the following: Allow the Municipality of Anchorage the perpetual right of entry to tile property during normal working hours, to allow for effluent sampling or evaluating the general state of repair or function of the system. Submit to the Municipality of Anchorage, on an annual basis, an inspection and operation statement from a registered professional eugineer. This iuspection and operation statement shall verify that the engineer has inspected ali effluent and ah' pumps, timers, and alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Signature) (Printed Name) ~,~_P~xc.~> \_ \ \_ .QCoc~Notarize Here) (Signature) (Printed Name) / / / / / / / MUNICIPALITY OF ANCHOr;AGE DEPARTMENT OF NEALTH & ENVIRONMENTAl_ PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage. Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND?~iI~ WELL INSPECTION REPORT LEGAL DESCRIPTION PRONE 'J- EW LOCAT'ONv/ /¢¢- NO. Well - ACsorptlon area Dwelling ¢ PERMIT NO. ~ j/M%nufac~urer¢~¢ '~(~A ....... ¢ I MaterFal ¢ F-~l~mpartments ~ ~ N [Liq, capacity in gallons IF HOMEMADI- Inside length ~ '-~'7 ~2'¢ &. ~ ~ ~d% ILiquid ~ /~ PERMIT NO. in gallons Found@tion Nearest lot line DISTANCE TO: OTHER PIPE MATERIALS Materla] bene ¢-~ 2//~,¢/~ -i~, Total effective absorption ~.~ . Building fo~ation J Nearest lot line / .... SOl L 'rEST RATING / INSTALLER REMARKS APPROV .D . DATE 72-013 (Rev. 3/78) LEGAL I:::'ERI.'I :Ii T l..l.CI. .... [L. RRTING ,::'5(;! F.T,.."B[ ........ d THE t;;:['.':1.::!1_.1:[ I:~:EE:~ ..... m'" I- F ': '" I L : ":' ' ' :'"' :,]..='.[: .... THE tie ...... [~.[ I ION ':" ":" "r _, ] E[ I :" ' Z::,.'-' THE LEI..I.GT,LI F.:,:I:HEI.qE;ZOI.4 Z;~ "['FIE LEN6TH (:[hi FEEl"> OF THE TRENCH OR [:,RRII..]FIEL.[:,. THE DEPTH 01:::' FI TF;:Ei'.I.L-.'H OR PIT If_~; THE F.:,I2;TF:II.qCE BETI.,I.EEI..I. T;.i,~Z ~;IJI:~:F'FICE OF:' THE GROLINB, l::ll.'l.D THE BOT'I"OH OF THE E;:'::CRVR]-ION (IN FEET>. ]"I.-I.E;RE 1~7 NO SE7' 1.4IDTFI FOR TRENCHE'.'S. TI-iE GF,'FI',,,'EL. DEF'I'H I2; THE H:IiqZi',ILIM DEPTH OF' GRFI',,,'EL. BEI"HE[SN THE: OUTFFtLL. F'IF'E: Fliq[:, THE E:EFI'TC~H OF THE: EXCFI',,,'FITIOI'.I. ,::IN FEET>. Ff..[.Ill[ ItFFL,[.,.-NI H _. THE RE._[-II_ZE, ZLZT~ TO .T. NFORH ..... ':' ~1 '; · I I"I.:E;TFILI.. FYF Z - N .[lC. PE..... I 1., N :, OF:' Fff',Fr' HEL. L:5 FID,TF:IC:E~NT TO TH ~_, F'FirOPEF.:"F'T' FINE:' THE hlI...IHE:EF;: OF: g,E::,I[.,EN_.E.:, THFIT THE.' HELL I.'.I:[L.L ..... Ll.,. E. E, dUI~'-.I'ILLZI",I.~ OF FIJ"I.'T' z ,: ..... ::. - ...... ; .... ...,. ...... let'1 ~-4.ITFIEIUT F:[FI.FIL :[I~I.....FEL. TI_II. FII.',IE:' i'::IF[ F. ,hi. EPT' lll.I_. I)EF:'I:::IFt']'I"IEI",IT H ILL E. E .::,I...IE,.J E -.T TL'J f [,~. _ ...,E ...UT 1 E N. HII.'I.].'HUI"I DIE;TFIi",IC:E BETHEEN R .klELL FIN[:' FIl'q"r' Ol"l.'"E;I'l"E ::'!;EI-'-IF,3E tel6) FT£ET F'OI~: FI PF. rI',,,'FITE: HELL OF: :1..5C~ "FO ;2~"~ FEET F'ROH Ft I::'UE~I....IC I-,IELL DEF:'EI.'I.E:']:I.'I.G l.Jl:::'ON TH[if T'T'F'E OF: PUEII...IC P1ZI.'I.]:I'IlJPI DZ~V['F:II",ICE F~'.OH FI F'~!ZVF"ITE F.IELL 'TO [~ F'[~:ZVF:I"I"E L~',EI,.IE[~: LZhlE TO FI COHHIJNZT'¢ [:~;E!-qER LINE IE; 75 FEET. HELl... I..C,3:5 FtI';:E: F'.EQUIF~'.IED FIN£:, HUST Bi.'"': f~:ETUF;tI'.I.E[:, -['O THE [)EF'FIF;FFHEI..I.T l.,l.]:THIl.'.l OF' 1"HE I.,.IEL. L C:OI"IF'LETIOhl. CFI"HEFi: REC!LI:[REFIENT% HFI'¢ RPPL'T'. :SPEC:IF'ZCFITIOi'.I.S Ri'.,I[:, CONSTRLICTIOI'.,I [:,ZFIGRFII.,'I'_::.:, FIVFI ! IJ':IBLE TO ]: N2;LIRE: F:'ROF:'E[;;: I NS"I"FILL.FII" l :[ CEI~'.TIFY THFIT t: I RH FFII,"IIL. ZFIE/ H z'rH THE F:EC!UI[~EHEhlTS FOF; ON-2;ITE E;EF.IERE; FIND HEL. I...Z F'O[;:"I'H B'T' THE [fll..If.,lIC:IPFiL I T'T' IDF F/NCHORRGE. ~:: I HILL INE;TFII..,,L 'THE: S'T'E;TEH IN RCCORDRNC:E I.,]I1'1...I THE CODEE;. Z: Z UNDEF'.STFIND THFIT THE ON-...:SZTE :SEI.,.IER S'T'STEH HFI'¢ I~:E:QUZFrE ENLF/~tGEHENT ;IF' 1'HE RE::~;Z[>E:NC:E: :IS R[Zh'IOI:>EL.ED 'TO ZNCLUDE HORE THFIN 3: BEDt;?.OOH:5. "'i . .= ..., ...... :7: .... : ................................ ~ .......... ~-/ CONSTF{dC-1-1©N TEST L_AB 1800 W. 48TH AVE. STE, 'C' ANCHORAGE, ALASKA 99503 248-1333 PERFORMED FOR: Steve LEGAL DESCRIPTION: Lot 8 Block Tract THIS FORM.,:REPORTS: EgVisual Soils Examination DATE PERFORMED: Subdivision ?he ~'illages (~ Percolation · Test .~. DFPTH SOIL FEET DESCRIPTION NOTES Brown Silty gravel/ with trac. Brown silty gravelly sand ~'Bottom O£ test hole' Bedrock BOTI'OM OF HOLE WAS GROUNB~WATER ENCOUNTERED No IF YES, WHA;~'DEPTH LEGEND_ ® -- Perc zone ®S- Sample ~taken ~ -- Frozen zbne ~ -- Water table GENERAL.. SITE .SLOPE READING :'!..: DATE GROSS TIME' .: NET TIME: :. DEPTH TO .H~O .NET DRAINAGE ~4/23/79 9:25 24 Sat. Pr. 34" .~4/24/79 No water ¢',T ,, 0 20" I¢ ,, 3,5 '70" 50" ~" " 4.0 73.5" 3.5" PERCOLATIq~ RATE: 1"/9 rain, _DRAINAGE REQUIREMENTS: PROPOSED~INSTALLATION :.- .El SEEPAGE PIT ~ DRAIN~;: FIE-ILD E] OTHER.',:': - : COMMENT~,: Bedrock encountered at 10' 160 square feet drainage area requ.~red per bedroom. TEST PERFORMED B~; David Paul DA:FA CERTJFIED BY: Kinney R. Baxter DATE'.': 5/28/81 NEW UTIL. ESMT, A5 REPORTED [3Y CEA, LEGEND FND. B.C. FND si8" REBAP, ELEVAT ION ..~ PROPOSE b DRAINAGE HOUSE 113~- . r r ~i't is the ~i~ of the owner to . ~ ~ ~t~-''~ ..,%,,.' ~,/¢'~ determine the existence of any easements ',, r. '" covenants, or restrictions which do not appear on the recorded subdivision plat. PLOT PLAN Gordon Shore! o llsso¢ia/es LandSurveying- Civil ~ngineer~g Le~alDescripffon,'LOT8 ~HE VILLAGE5- Lot Survey Ced if~ti0n ~s~ ~d ~ ~e~,~ ~t ~e ~w~t~~d ~por~h m ~~lno ~~ on tho ~1~ ~ ~ t~t p9VLl UMCC PA TY OFANCHORAGE Development Services Department J Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 020-291-37 1. GENERAL INFORMATION Complete legal description THE VILLAGES TRACT 8A Expiration Date: q ` J - Zf Location (site address) 19405 VILLAGES SCENIC PKWY, ANCHORAGE, AK 99516 Current property owner(s) CARON LANCUP LIVING TRUST Day phone Mailing address Real estate agent 19405 VILLAGES SCENIC PKWY. ANCHORAGE. AK 99516 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: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 5 5 0 Waiver Fee $ Date of Payment 19 2-1 Date of Payment Receipt Number -70 012 Receipt Number COSA # 0 5 C.2 1 1�2 q2, 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 5117/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to .41 these various and dynamic characteristics and are outside the control of the evaluator of the,dw•i well and septic system. Therefore, any estimate of how long a system will function satisfactory �g�Q:' • • for current or future occupants or guarantee that no unseen encroachments, deficiencies or J discrepancies exist can be given by First Water Consulting & FW i 5 ' * . TH ....•.* r 6. DSD SIGNATURE Curtis Huffman j System #1 Approved for bedrooms CE 128991 . �l FpF� .�/17/�1 `F�� System #2 Approved for bedrooms �i PROFESSIONS Disapproved Conditional approval for bedrooms, with the following stipulations: Y OF 61 I r WATER AND R' WAST,Ei'ATER z� J , J Nr SER\X"�0�`��\ f-3 �ZI By: vim- Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: THE VILLAGES TRACT 8A Parcel ID: 020-291-37 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 6/3/1996 Total depth 251 ft Cased to 20 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 5/6/2021 Static water level at beginning of test 57 ft. Well production at time of test 1.3 gpm Comments B. TANK DATA Age of tank(s) 25 years Tank type/material SEPTIC — BIOCYCLE / FIBERGLASS Measured operating fluid level in septic tank * ® Standpipes/foundation cleanout per record drawing Date of pumping 2/24/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/29/1996 ® ALL standpipes present per record drawing Total measured depth from grade 6 ft (max) Measured depth to pipe invert from grade NA ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) WES Collected by :> Date of Sample 5/6/2021, C. LIFT STATION ® Required maintenance completed Age of lift station 25 years Lift station material FIBERGLASS Comments: SEE MAINTENANCE REPORT Adequacy test date 5/6/2021 Results Z Pass' For 4 bedrooms Fluid depth prior to test 1 in Water added 600 gal New depth 5 in Elapsed time 1400 min ® Code -required soil cover over field Final fluid depth 1 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: FWD E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment? 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. • .6� TH .... • ....t..�.�... . Curtis Huffman �Fc •. CE 128991Aiw .• �� .5122/21.PROFESSV#.-�.w� ft ft ft ft ft ft ft ft MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT' made and entered into as of this ray Day of 4101z' C" of 20 z I , by and between -1' P. Gw , herein 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 A BIOCYCLE SYSTEM located at (legal description) THE VILLAGES TRACT 8A 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. %f 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. 05/18/2018) Pagel of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair 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. C Owner agrees that the AWWTS installation 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. 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 patties 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 OWNER: By: 5(iC� (signature) Date: J • P C14.lev,1 (print name) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before ane this 2608ay of 2021 , by Rt,, S.P• CnMvr. — NOTARY PUBLIC FORrALASKA SIERRA GRAY Notary Public My Commission expires: <TvKe /?, zoz3 State of Alaska [My Commission Expires Jun19, 2023 MUNICIPALITY: By: / Vt& (signature) int naive) Date: (J Z Title: (rev. 05/18/2018) Page 3 of 3 - 1 Anchorage AK 99503 Email: crbioak@gmail.com (907) 274-0314 Ist kA t"Warter InspectionReport art` Homeowner Info Customer Name: Ron Caron and Frances Lancup Address: 19405 Village Scenic Parkway Tank#: 21 Install Date: Aug. 1996 Area Potter Marsh Initial Inspection: Alarms Tested: Air 171 High Water 171 Battery Tested: Yes ❑ No ❑ N/A (Please make sure alarm is on "normal", not "saute") Does system have a septic tank ? No 171 Yes ❑ (Recommend pumping tank every 2 years) Is System Lid Locked? Lid hardware in working order? Is there any noticeable odor? Yes W1 Repaired ❑ Yes [VI Repaired ❑ Strong ❑ Mild ❑ None A System Inspection Inlet plumbing in working order? Solids pillow normal? Yes [V] Replaced F Yes 171 Requires Pumping ❑ v � Are all aerators functioning? Any buildup of solids? Yes 1;4Replaced ElYes ❑ No FVJ Clarification return system operating? Any buildup of solids? Yes FVJ Adjusted ❑ Yes ❑ No [,4 pH Reading: (pH of 6-8 is ideal) 7.5 Pump float operating? Yes 0 Replaced ❑ Filter cleaned? Yes [71 N/A ❑ Dissolved Oxygen PPM (2-5 is ideal) It -5 Alarm float functioning? Yes Z Replaced ❑ Turbidity of discharge (in FTU) (Under 35 FTU is considered compliant.) 83 Any buildup of solids? Yes ❑ No Discharge line condition: Good 1 Replaced ❑ Comments: 1�e1 faced CHscharu- i3unip_. 1leeommend panel upgrade Has emailing or mailing of form been requested? Yes 1-1 No ❑ Inspected By: Chris Date: 02/24/2021 (contact office to request...) GLC co CD a rn X 44 F �C) di � rn taa r� m ao az C11 E CO ONNV38 30 SISVO r�'s� � o (�i ,6l'9SZ) ,Z8"SSZ M,,92,/-9.69N?°xa scot lWS3 Ainan ,o i �nH� r•-� ` Q Ld LL. w 1�— 1Nb� O� � O J X x me ys 0 II II oe �%: [' > # Ln O( 3 X U N Z F�0: CO Q x3z d �o � v C3J` ;za<° N 0 I— ftf" ll E mus a � '•, :'Q fie, o_ O O o'tis N M z i�CD 0CA 0 O \ 1lbM W 0 0 S U M Zn _0 m 11 b � C., — GO Do C,3 75 r_ \ O F >cu En Ei O p W v O R o H O U ca 3«SS Ooz 0N- o;b� 2 4 tn _ a ,6S'S8Z Z,6Z.Z8S z = o y N a N lWS3 3Jb Nlb tJ� SZ �j— `{ •� _ s c o „ Nis _ U m 13 "�I O 'U O 0 ZO tO m L r.m a FLo ' .y Q U w cy > .O �U„ ,� a„i ca x U % MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTrFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ~--~ J / GENERAL INFORMATION (a) (b) (c) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) \~'~,~ kA~g.t.~01"¢- '~CG¢'~C '~"..~..~o,*~,.~j o~ Applicant Name ~~~0 / - ~ ~ ( ~ Li) ~ Telephone: Home ~ ~ l · Applicant Address ~ ~ ' ~ C~-~ ~L '~n'~ Applicant is (check one): Lending Institution ~; Owner/builder~ Buyer ~; Other D (explain); (d) Lending Institution , ~,,~_~ Telephone Address (e) Real Estate Company and Agent _.~J_J.~ Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family~,~* Multi-Family [] Other ...~, Number of Bedrooms ~.~ WATER SUPPLY Individual Well~:~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental 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 1 of 2 7~0~5~11.~4) FNGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORN~ATION As certified by my seal affixed hereto arid 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 (.'~.~ .----~._._._._._._._~,'~%~.-- ~-'%("i"~ (~f~S~Telephone ~--'700~ Dale DHEP APPROVAL .Approved for '¢'~'CCbedroomst...,,....._ by ~ Approved Disapproved Terms of Conditional Approval Conditional Date CAUTION The Muncipality of Anchorage Depadment of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based aolely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHEP do not conduct inspections or analyze data before a certificate is issued, The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) 2o'1 September 14, 1981 Randel/Carin Cazac Post Office Box 4-486 Anchorage, Alaska 99509 Subject: Lot 8 Villages Tideview Subdivision (Villages Pine Ridge) Approval :for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) The depression around the well casing needs filled in with impervious type soil so that away from the casing. This will need to be after it has been corrected. to be it slopes reinspected If there are any further questions, please call 'this office at 264-4720. Sincerely, James S. Roberts Associate Environmental Specialist JSR/lw cc: National Bank of Alaska Pouch 7-025 99510 . D, E. RECEIVED INSPECTION APPOINTMENTS DATE DATE DATE ~-NSPECTOR ---- INSPECTOR INSPECTOR DEP¥ OF HFALTH & MUNICIPALITY OF ANCHORAGE E'""l~o' ' ' PFIOTECT~llum NM[NTAL [i~OrFCTION DEPARTMENT DF HEALTH & ENVIRONMENTAL ENVIRONMENTAL SANITATION DIVISION REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed, Please allow ten (10) days for processing. ~ PROPERTY OWNER PHONE MAILING ADD~ESS PRO[ ERTY RESIDENT {If different from ab~ve) PHONE MAILING ADDRESS 3. LENDING INSTITUTION . , PHONE MAILING ADDRESS , ~ REALTOR/AGENT PHONE MAILING ADDRESS LEGAL DESCRIP'TION STREET LO CA T([~N [] One E~ [:our [~"-~1NG LE FAMILY [] Two [] Five [] MULTIPLE FAMILY ~;]---Three [] Six WATER SUPPLY ~]~" INDIVIDUAL"' [] COMMUNITY [] PUBLIC UTILITY [] Other ATTACH WELL LOG, A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg f available.) SEWAGE DISPOSAL SYSTEM [~"~ INDIVIDUAL/ON-SITE'* [] PUBLIC u'r LITY YEAR C N-SITE SYSTFM WAS INSTALLED, NOTE: THE INSPECTION PEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS ~[~]"~Sl NG LE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY Z/iNDiViDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified. LOG 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~--~INDIVlDUAL/ON -SITE DATE iNSTALLED []PUBLIC UTI LITY Connection Verified INSTALLER []Septic Tank or []HoldingTank Size: /~z~2 If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER , TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding//O Tank Absorption//~- ~Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS .I~/-AI~R OV E D FOR __~BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED 72-010 (Rev. 6/79) /~UNICtPALITY OF ANCHORAGE DEPT, OP HEALTH [NVIRONMENTAI. PROTECTION RECEIVED WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Well Classification ~'~)1~=~ ~,~',l~j"t'}~'--- If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _.~_~:~, Date Completed ~'~'t,~? |. I ~L Yield Total Depth ~-~.'"~C') % Cased to ~-~;;'/ Static Water Level ~"~5 ~' Casing Height Above Ground ~ Elect¢ical Wiring in Conduit (Y/N) . '~(;'~ Separation Distances from Well: TO Septic/Holding Tank on Lot [ ~ O To Nearest Edge of Absorption Field on Lot _~,."~. To Nearest Public Sewer Line Depth 0f Grouting ~'"~ Pump Set At _ ~! Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots ; On Adjoining Lots ____ To Nearest Public Sewer I £)o .4-- _LO-O ',-5'- ' Cleanout/Manhole ~ ,/f~t¢ To Nearest Sewer Service Line on Lot ' Water Sample Collected by '~'.--~"~.v"-~. ~:~'~.(AF~z~_'.L ;Date _ i'~/l Water Sample Test Results _ L~,.' ."'4~. '~?'-Zf-"~l(Z~' '¢'"-- I',Q(C, (~,L..~.~r,.=~¢.4,~ SEPTIC/HOLDING TANK DATA Date Installec~"~"~U? ~'"'"' Size ~ (';;:~¢) No. of Compartments Standpipes (Y/N) N(',~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: ! To Water-Supply Well ~ ~ ~ To Property Line . ~'/)0 To Water Main/Service Line _ ~_~_ I,_~ Course _~ ~:)~ I,f-- Foundation Cleanout,(Y/N) Date Last Pumped ~ \ -_~7 ~;' ;for ~/A Temporary Holding Tank Permit (Y/N) . To [Building Foundation To Disposal Field To Stream, Pond; Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Depth~f Field Gravel Bed Thickness Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot Standpipes Present (Y/N) ~'~'~ Date of Last Adequacy Teat I~-~/¢~'/~ (-[, TO Water Mai~ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line "70 To Existing or Abandoned System on ; On Adjoining Lots ~,,~ To Cutbank (if present) D. LIFT STATION Date Installed Dimensions __ ,. Manhole/Access (Y/N) Size in Gallons "Pump On" Level at J / "Pump ~".~:~.:lNat TestedHigh Water Alarm Level atJ ~~.~ for ~~e ----~ , (/ __ .~' ts MOA Electrical Codes~ Comment~/, ** Check Permitted Bedroom Rating Against HAA Request ** I certify that ~ecked, verified, or conformed to all M O,~ an¢ HAA guidelines in effect on the date of this inspection. Signed r_ .~ VV~-~,~, ~, ~'~&(H~Date I~/1~/~ ~' Page 2 of 2 72-026 (11/84)