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T15N R1W SEC 5 LT 39
Onsite File T15N R1W Section 5 Lot 39 #051-032-26 1981 field does not meet separation to groundwater. Diverter valve removed for 2021 COSA. Municipality of Anchorage Community Development Department Page On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP121300 PID Number: 051-132-26 ❑ New ✓ 1 of 4 Upgrade Name: Mark & Melissa Bauer ABSORPTION FIELD Address 22158 Davidson Drive ❑Deep Trench / ❑ Other Shallow Trench ❑Bed Mound❑ Phone Number of Bedrooms 3 Soil Rating 1.2 GPD/SF Total depth from original grade 3.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot 2.5 Ft. 0.5FL 39 Fill added above original grade Gravel length Township Range Section 0 Ft. 75 Ft. 1 5N 1 W 5 Gravel width Beds: Number o Lines Distance between lines SEPARATION DISTANCES 5.0Ft. N/A N/A Ft. To From Septic Tank Absorption Field Lift Station Holding Tank Sewer Line Total absorption area 375 Fe Number of trenches 1 Dist. between trenches N/A Ft. Well 117.6 107.7 N/A N/A 97 0 TANK 0 Septic • S.T.E.P. 0 Holding ■ Other Manufacturer Capacity Surface Water 100+ 100+ N/A N/A Anchorage Tank 1000Gai. Material Number of compartments Lot Line 61.2 13.2 N/A N/A NA Steel 2 Foundation 23.8 48.2 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A Gal. Remarks Pump on level at Pump off level at High water alarm at in. in. in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank PVC TankPVC drain£eld JR's Septic Pumping Drainfield PVC CO/MT PVC Inspector Steven R. Pannone BENCH MARK (Assumed elevation) 100ft Inspection 1st dates: 1 10/15/12 2nd 10/15/12 Location and description 3" 10/16/12 a'" Corner of House COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date PP� Engineer's Stamp � .. .....9' • e!� g • 4 ri J 'Steven �f'.. ' annofde of •. CE 814 Approvediilrii,Date - i nspection Report_1-1 . / / 'W -44 �� _, '\ / � A B [C 2.7 � T1 21.9 30.8 T2 312 42.8 DC1 33J 44.5 DC2 34.7 45.9 DY 35.4 46.5 C1 62.0 75.2 M1 60.3 73.4 C2 62.3 53.2 M2 00.8 51.4 TH-2 75LFx5\NxO�5'ED.xIV'[0. TH-1 \ || GARAGE WELL (E) � 1000SEPTIC TANK ABANDONED PER 000E \_NEW 1 K INSTALLED DCO AND DV DAVIDSON DRIVE /O3.4 cc 14 az E � cn 0 � NOTES: RECORD DRAWING PANNONE ENG SVC, LLC P.O.BOX lVDZl7 ANCHORAGE, AKS9510 PHONE /y07\272-8218 FAX (907) 272-8211 PLAN 115N. R1W, Sec 5, Lot JQ MARK & MELISSA 8AUER 22158 DAVIDSON DRIVE CHUGIAK, AK 90567 Arco •i • •:r `"�� • Y� ` r'0 Al* �mm� �°' � ° Steven on� n�e CE 8149 nuru. pr11* FESSI Date 10/22/12 Scale l"=a/ P.I.D. NO 051-132-26 PERMIT NO. OSP121300 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK WAS IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALLED 1000g SEPTIC TANK. INSTALLED NEW SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS ENCOUNTERED AT 9.0' BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. AN APPARENT WATER TABLE WAS NOT OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 9.0 FEET BELOW EXISTING GRADE. 95.7 FOUNDATION CLEAN OUT TH-1 98.8 FR.I 95.6 OR ML SM/ GM 0.5= 94.8c 60 RIGID INSULATION FILTER FABRIC 4" 0 DRAIN PIPE DRAIN ROCK 6' ABOVE PIPE INV 97.8,,, Y 88.8 8/31/2012 9/11/2012 10008 j"954 SEPTIC TANK (P) DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 10009 (E) PERC RATE = 1-5 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 375 SF SYS. TYPE: WIDE TRENCH 0.5' E.D. MIN LENGTH: 75.OLF USED 75LF X 5' WIDE, 0.5' E.D., 3.0' TD TOTAL AREA: 375 SF TH-2 DRAIN ROCK SECTION R lu 5" z O -J O V Z 97.84 67.6 90.8 10/15/2012 FILTER FABRIC o DRAIN ROCK 6" ABOVE PIPE INV O 4' 0 DRAIN PIPE 97.8 PROFILE TRENCH SEE DESIGN LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC ABBREVIATIONS CU COPPER DIP TH FC T# C# M# R.I. DCO DV FS BFG OG FG TS&V DUCTILE IRON PIPE TEST HOLE FOUNDATION CLEAN OUT TANK CLEAN OUT NO. CLEAN OUT NO. MONITOR TUBE NO. RIGID INSULATION DOUBLE CLEAN OUT DIVERTER VALVE FLOW SPLITTER BELOW FINISH GRADE ORIGINAL GRADE FINISH GRADE TOPSOIL AND VEGETATE NOTES: RECORD DRAWING PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 DESIGN DETAILS T15N, R1 W, Sec 5, Lot 39 MARK & MELISSA BAUER 22158 DAVIDSON DRIVE CHUGIAK, AK 99567 1-€: 1.%gsll1 49 Steven 'ann.ne•P \\�t124;6'. Date 10/22/12 Scale NTS P.I.D. NO 051-132-26 PERMIT NO. OSP121300 Sheet 3 OF 4 1 2 3 4 5 e 7 6 9 10 11 12 13 14 15 18 17 18 19 TEST HOLE 1 OR/ ML GW BOH ORGANICS/ SILTS WELL GRADED GRAVEL DATE PERFORMED: 10/15/12 10/15/12 SOILS LOG - PERCOLATION TEST SLOPE X TH SITE PLAN WAS GROUND WATER ENCOUNTERED? Y IF YES AT WHAT DEPTH? -7.0-' DEPTH TO WATER AFTER MONITORING? DATE:--1/- SLOPE TH X READING DATE CLOCK TIME NET TIME WATER LEVEL READING NET DROP NO PERC 2 3 4 5 6 COMMENTS: Test hole excavated by FLINTSTONE ENTERPRISES. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: RECORD DRAWING PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SOILS LOG T15N, R1W, Sec 5, Lot 39 MARK & MELISSA BAUER 22158 DAVIDSON DRIVE CHUGIAK, AK 99567 ��•' d\ *9 Steven R. nnone r�r+Ps. CE 8149 el Date 10/22/12 Scale NTS P.I.D. NO 051-132-26 PERMIT NO. OSP121300 Sheet 4 OF 4 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121300 Tax Code Number: 05103226000 Work Type: Septic Upgrade Permit Effective Dates: September 27, 2012 to September 27, 2013 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: T15N R1W SEC 5 Site Legal Address: T15N R1W SEC 5 LT 39 G:1557 Owner/Address: BAUER MARK A & MELISSA 22158 DAVIDSON DRIVE CHUGIAK AK 995675245 Site Mailing Address: 22158 DAVIDSON DR, Chugiak Lot Size in Sq Ft: 108900 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: / Date: (Th— Issued T Issued By: Date: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION 0 Parcel I.D. 051 X132-26 Property owner(s) Mark & Melissa Bauer Mailing address 22158 Davidson Drive, Chugiak, AK 99567 Day phone Site address 22158 Davidson Drive Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T15N, R1 W, Sec 5, Lot 39 Lot Size 108,900 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (® all that apply) Absorption Field El Septic Tank Holding Tank Privy Private Well Water Storage El APPLICATION IS AN: Initial Upgrade Renewal TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance. I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 5' O Date of Payment: b\\'a. Receipt Number O a 12 3 Cr% Permit No. 051° a`.00 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services Lic Steven R. Pannone, Principal Registered Professional Engineer E-mail: stevePpanengak.com September 12, 2012 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 196650 Anchorage, Alaska 99519 Subject: T15N, R1W, Sec 5, Lot 39 Septic System Permit Upgrade Request Ladies and Gentlemen: I am writing to request a permit to upgrade the septic system be issued for this property. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed. A new 1000g septic tank and drain field will be installed. The existing drain field will be re -used as a reserve. This lot is served by a private well that is located over 100 feet from this system. The surrounding lots are also served by private wells. There are no wells within 100 feet of this system. 1. Soils. A single test hole was excavated by Pannone Engineering Services in August of 2012, and the ground water monitored for seven days. Groundwater was encountered in the test hole monitor tube at 9.0 feet below existing grade after the seven day monitoring period. Bedrock was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 1.2 gallons/day/square feet should be used for conventional wastewater system. 2. Soil Absorption System Design. a. See Sheet 2 of the design package 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The topography slopes from south to north at approximately 2% - 3% in the area of the proposed drain field. There are no steep slopes in the vicinity of the proposed drain field. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, •i • • • % Steven R. Pannone s 1 \ e Steven R. Pannone, P.E. Owner/Civil Engineer Attachments - Soils Log - Septic System Design Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 NOTES: GARAGE 7OLF x 5'W x 1.0' E.D. x 4.0'E.D. TH-1 119.6 WELL (E) w FOR CONSTRUCTION 112.9 3BR HOUSE (E) 1000g SEPTIC TANK (E) ABANDON PER CODE 1000g SEPTIC TANK (P) INSTALL DCO AND DV DAVIDSON DRIVE (50' R.O.W. EASEMENT) PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 PLAN T15N, R1W, Sec 5, Lot 39 MARK & MELISSA BAUER 22158 DAVIDSON DRIVE CHUGIAK, AK 99567 83.4 33.4 1- z 6.1LJJ > I 2 0 • 0 cs 0 5 • Date 9/26/12 Scale 1 ”=50' P.I.D. NO 051-132-26 PERMIT NO. OSP121300 Sheet 1 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: INSTALL 1000g SEPTIC TANK. INSTALL NEW SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS ENCOUNTERED AT 9.0' BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 9.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 0 0 TH FILTER FABRIC 4' 0 DRAIN PIPE DRAIN ROCK 6' ABOVE PIPE INV 2.5 2.0 1.01 f`. .ftl4 10.0 8/31/2012 9/11/2012 - 0 000 10009 SEPTIC TANK (P) DESIGN PARAMETERS PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g (E) PERC RATE = 1-5 MPI SOIL RATING: 1.2 GPD/SF AREA RQD: 375 SF SYS. TYPE: WIDE TRENCH 1.0' E.D. MIN LENGTH: 65.25LF USE: 70LF X 5' WIDE, 1.0' E.D., 4.0' TD TOTAL AREA: 402.3 SF PROFILE 0. DRAIN ROCK SECTION m m FILTER FABRIC 13° DRAIN ROCK 6' ABOVE PIPE INV s a. "0 DRAIN PIPE TRENCH SEE DESIGN LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC ABBREVIATIONS CU COPPER DIP TH FC T# C# M# R.I. DCO DV FS BFG OG FG TS&V DUCTILE IRON PIPE TEST HOLE FOUNDATION CLEAN OUT TANK CLEAN OUT NO. CLEAN OUT NO. MONITOR TUBE NO. RIGID INSULATION DOUBLE CLEAN OUT DIVERTER VALVE FLOW SPLITTER BELOW FINISH GRADE ORIGINAL GRADE FINISH GRADE TOPSOIL AND VEGETATE NOTES: FOR CONSTRUCTION DESIGN DETAILS PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 T15N, R1W, Sec 5, Lot 39 MARK & MELISSA BAUER 22158 DAVIDSON DRIVE CHUGIAK, AK 99567 ,ie. OF A4 .:f- • i. ..41;55.:1-7 i*}�f CE R�OR t�g814.... .O%... lhm\ Date 9/26/12 Scale NTS P.I.D. NO 051-132-26 PERMIT NO. OSP121300 Sheet 2 OF 3 1 2 3 4 5 6 7 8 9 TEST HOLE 1 OR ML SM! GM ORGANICS/ ROOT MASS SILT SILTY SAND AND GRAVEL . 8/31/12 9/11112 10 11 12 13 14 15 16 17 18 19 BOH DATE PERFORMED: 8/7/12 SOILS LOG - PERCOLATION TEST SLOPE X TH SITE PLAN WAS GROUND WATER ENCOUNTERED? Y IF YES, AT WHAT DEPTH? -9.0' DEPTH TO WATER AFTER MONITORING? -9.01- DATE: 9/11/12 SLOPE X TH READING DATE CLOCK TIME NET TIME WATER LEVEL READING NET DROP 1 8/7/12 8:05 - 1.12 - 2 8:11:45 6.75 MIN 7.15 6.03 3 8:12 - 1.12 - 4 8:18:55 6.9 MIN 7.15 6.03 5 8:19 - 1.12 - 6 8:25:50 6.8 MIN 7.15 6.03. PEROLATION RATE 1.13 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3 FT AND 4 FT COMMENTS: Test hole excavated by FLINTSTONE ENTERPRISES. Prec hole was presoaked. Test run for at Least one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: FOR CONSTRUCTION PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SOILS LOG T15N, R1 W, Sec 5, Lot 39 MARK & MELISSA BAUER 22158 DAVIDSON DRIVE CHUGIAK, AK 99567 /To-* j*:49nI /\ *// tee=n ,'n none l`CE8149 �j+Qs.r Date 9/26/12 Scale NTS P.I.D. NO 051-132-26 PERMIT NO. OSP121300 Sheet 3 OF 3 i , 1 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 NAME umj F Chai.Lcs v PHHONNEQ Q/ 6883466 CIrNEW ■UPGRADE MAILING ADDRESS Pa gex 36-1, G1t1t iik gaskA. LEGAL DESCRIPTION C� LsTh9 S.S Tis N RI VJ LOCATION --�-- I I n at Rig 4i1 NMI2 n c( Sok clu ooJ -Airs hl p NO. OF BEDROOMS ¢ SEPTIC TANK J1 Well DISTANCE TO: Inei4-' Absorption area �-1 Dwelling le1 PERMIT NO. 910Oze Manufacturer /i1,4 -4t tek Material Mee I No. of compartments Lip. Li capacity in gallons IFIF HOMEMADE: Inside length Width Liquid depth x J22 Oz Q 2 I -- DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well I bO+- pynrjairit �-/F^} Totalv�sr of lines J Nearest I 30'4�Vf Trench width line inches PF I DO3� Distance between lines No. of linesDYf� N Length of each line Top of tile to finish grade Material beneath tile 6' 4- inches Total effective absorption area SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J J w Class Depth Driller Distance'to lot line PERIy]JT NNO. ^ jj(( l l �( DISTANCE TO:oP Buil ng f undation Sewer ling 1 cIOD i-- Septic tanks" IID Absorption areals) OTHER PIPE MATERIALS PVC ' SOIL TEST RATING INSTALLER I ACS' aA1A sees REMARKS IP ‚3 n APPROVED // j DATE,.LEGAL / -/µ 72 .14,9 /7R) i r•-1 A_i r-4 ]: ®_ I'ThR L_ I 'i_' - i=S 1~ i=i t-°8 a_: i ;c! FZ E4 U E DEPARTMENT Lir" HEALTH AND ENVIRONMENTAL , r:OTECTION nil Ili 825 .'L. STREET. ANCHORAGE: AK. 99501 hhda 264•--47'20 r -=i rA D ®gin N - =° i t 1= J1LvNU 4 #4. 688-34E6_ PERMIT 8_' -3465 - PERMIT NO. ( 810030 ) APPLICANT WADE CHARLES PO BO.; 352 CHUGIAK LOCATION OFF END OF BIRCHWOOD ARIA++TRIP LEGAL L39 55 T15NRIW LOT SIZE 120000 SQUARE FEET TYPE OF SOIL. ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 =OIL RATING (SQ FT'BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: L_Er-1=--1= 2- G OF- i=Y °� E1— C.EF T1--1= C:e E F- '1-1-1= a - 6 -- THE LENGTH DIMEN'_ION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT I'= THE DISTAPNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). 1=:EC!V I FREC:. =.EF•t I C 171=11'-a1=:: _° I E= ee° ®_sf1_-.L_or-.1S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY -AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. — TIs-1Ce <2> I t-1SF'ECt I Ot-°Js _.- E:ACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE 'SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM I 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. E; of * I F°E' a CoEc:EF 1BEF: 3..rL= ISIS: I CERTIFY THAT 1: I FIM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE =EWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT WADE CHARLES ISSUED BY !(„/1422-___C:iATE__9 V4.0 O & E ENG VEERING & DEVELOI ,VIENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 SOIL LOG Performed for: Name• \A7/4 0 L C,I n /IL E S Earl Ellis 688-2280 Tel No 6."- 34'64 Mailing Address. IS C X h / `a PO 6//q 1C 7 /4- g, 9 /d 6 7 Legal Description. Lor 3 7, 5 EC-, 5 / I /JY/!l, , 1 V', - Depth (feet) Soil Characteristics 0 / op iv/1,- 2 200 11//j../Z. 3 / 4 5 eo44/gce s / eCie-P 2-S 8 ' 7 /2"c4 10 11 �? 12 5 13 14 15 16 'P`LOT PLAN ry0 SE_LILo PERC. TEST Ground Water Encountered: Yes Y No If yes, what depth /i 1 aro ,v :49v Proposed Installation: Seepage Pit Drain Field 0oeo.." c Comments. s. „e a�wvs e m :o Earl P. Ellis e eP14 s� N a NO. 1745-E a Performed by: " @ ie2e1 - r-> Date. 4 'T1 It 'r1 'T1 '11 'z1 'T1 I'm 'i7 It y H III H H y y H H H H H H H H H H H H O O O O O O O O O O H H H H -33 H H H H y 40 O T 0�v m 0 CA X mP AM N i m n D =r � r C) D D � r o > 4#to CD Ci V D C7 r, 'C t CA z C "i 00 D �• -r-. w � D D C/) re F y 40 O T 0�v m 0 CA X mP AM N i m n D =r � r C) D D � r o > 4#to CD Ci V GAAS-HP.1 GRI ‘ER ANCHORAGE AREA BOROUJ', DEFMATMENT OF ENVIRONMENTAL QUALFI 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME //. L`/ JQ- (!fi%!`4%C14 MAILING /i ADDRESS %i ,� f X ( %V L° ////\ l PHONE LOCATION 2O /J er/41:ci-'-T>I� /1 LEGAL DESCRIPTION (17,71.6,/;) -SFC: L) 71S41 /edi< 1) S,/i4 SEPTIC TANK: / DISTANCE FROM WELLMATERIAL 5^`C7-.` NUMBER OF COMPARTMENTS ,� S i`tz 1 /- G (('2 11 LIQUID LIQUID CAPACITY GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH SEEPAGE SYSTEM: /SEEPAGE PIT: NUMBER OF PITS / ( `/,( /OUTSIDE DIAMETER /2- OR WIDTH ��- /LENGTH DEPTH �T LINING MATERIAL �h/%i,X l'r(ej DISTANCE FROM WELL /0o' / BUILDING FOUNDATIOW")J r / NEAREST LOT LINE 0. `� ' `' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ FT TILE DRAIN FIELD: TOTAL LENGTH - UNDATION NEAREST LOT LINE OF LINES NUMBER OF DISTANCE FROM WEL ABSORP ION AREA DISTANCE BETWEEN LTRENCH WIDTH IJ OTAL EFFECTIVE LI DEPTH: TOP OF TILE TO FINISH GRADE SQ FT LENGTH OF EACH LINE DEPTH OF FILTER MATERIAL BENEATH TILE IN ABOVE TILE WELL: TYPE k2 -I 1 IlE'l7 - DEPTH LT� �°/JC NEAREST LOT LINE !� ! 6 SEWER LINE r -% DISTANCE FROM } WATER , BUILDING FOUNDATION -, SAMPLE NEAREST SEPTIC 9/I SEEPAGE /r7 2 TANK SYSTEM COIL / CESSPOOL OTHER SOURCES DISTANCES: -6/7/V- ZJ117/9T- 1-010 L. E rQ -I--t 1101w-L'� Lo{- /NJ>77I 3/•xAC-o DIAGRAM OF SYSTEM .Sc/mt c,, icek.: 171) DATE APPROVED r� .A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-650 ANCHORAGE, ALASKA 99502 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT PERMIT NO NAME OF APPLICANT MAILING ADDRESS PHONE INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL. TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL. BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT - DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, SEEPAGE PIT DRAIN FIELD TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO DESCRIBED SYSTEM I5 IN ACCORDANCE WITH SAID CODE. DATE APPLICANT'S SIGNATURE 28-68 AND THAT THE ABOVE (Th 3 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-032-26-000 1. GENERAL INFORMATION Complete legal description T15N R1 W Sec. 5 L39 Location (site address) 22158 Davidson Dr. Current property owner(s) Mailing address Real estate agent Expiration Date: Robert S. Thomas Day phone (334) 235-4416 22158 Davidson Dr., Chugiak, AK 99567 Miriam Guido 2. TYPE OF DWELLING: [71 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 795-3905 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well E Private Septic Fx I Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment 5 Z 2 Date of Payment Receipt Number 09 5 3 Z% Receipt Number COSA # 0 .SC ) 11 a 8 I 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 Walden Construction Consulting & Engineering LLC Phone 354-6661 Address 2422 W James T Circle, Wasilla, AK 99654 Engineer's Printed Name Robert L Walden Date 5/25/2021 By: �C �Lli' U LuU9 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 COSA Checklist blue sheet _ Y`"Z -A 6. DSD SIGNATURE .................... •..:.; System #1 Approved for J bedrooms^ r p. S -Rr , '1 r �;E„ System #2 Approved for bedrooms) Disapproved- ._ Conditional approval for bedrooms, with the following stipulations: lllttt((((((( o W\\NR0, 0 By: �C �Lli' U LuU9 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 COSA Checklist blue sheet Legal Description: T15N R1 W Sec. 5 L39 Parcel ID: 051-032-26-000 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 2/28/81 Total depth 98 ft Cased to 98 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 50 in. Date of flow test for COSA 5/5/21 Static water level at beginning of test 9.6 ft. Comments B. TANK DATA Age of tank(s) 9 years Tank type/material Measured operating fluid level in septic tank 49.5 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 3/3/21 D. ABSORPTION FIELD DATA Which system tested (date installed) 10115/12 ❑ ALL standpipes present per record drawing Total measured depth from grade -eft (max) �bb-ft Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Well production at time of test 7.7 gpm Water storage tank volume n/a gallons Well disinfected for coliform test? ❑ Yes ❑ No OR Coliform bacteria is Negative Nitrate 0.974 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Brandon's On -Site Services, LLC. Date of Sample 5/5/21 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: n/a Adequacy test date 5/5/21 Results 7 Pass For 3 bedrooms Fluid depth prior to test 0/0 in Water added 460.6 gal New depth 0 in Elapsed time 0 min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 460.6 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) none date of test) Gallons introduced n/a gallons If yes, enter date Comments/Deficiencies: The bullrun valve has been removed due to the old Feld being in the water table. COSA Checklist yellow sheet 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' P/� Yes Community Sewer Manhole/Cleanout > 100' 7✓ Yes if No ft F7V Yes if No ft Neighboring Tank > 100' 2 Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' FV -1 Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' 0 Yes if No ft Water Main > 10' Animal Containment > 50' 0✓ Yes if No ft F/� Yes if No ft 0✓ Yes if No ft Water Service Line > 10' [D Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' M Yes if No ft M Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' P/� Yes if No ft Surface Water > 100' QQ Yes if No ft Property Line > 5' [71 Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' FV -1 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' ❑✓ Yes if No ft Community Wells > 200' 0✓ Yes if No ft Water Service Line > 10' [D 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' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' Fv� Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Q✓ Yes if No ft Water Service Line > 10' Q Yes if No ft Community Wells > 200' M Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet S 9 10 77 •--1111 ; Municipality of Anchorage On-Site Water and Wastewater Program m <i. 2,, I 3 (907) 343-7904 12- _ ti Certificate of On-Site Systems Approval `` OL s 8 L.90) Parcel I.D. 051-1.3`x=26 Expiration Date: 7- '" cp -- I s? 1. GENERAL INFORMATION Complete legal description T15N R1 W Sec 5 Lot 39 Location (site address) 22158 Davidson Dr. Current Property owner(s) Kerry & Steven Anson Day phone Mailing address 22158 Davidson Dr. Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by.: Mir/ '4l Date: I/l'' ' COSA to be released to the engineer,unless .therwise requested bill engineer. COSA Fee $ Sa6 Waiver Fee $ Date of Payment cliZil 1? Date of Payment Receipt Number 053630 Receipt Number COSA# FJ 5 C l Q /1 f 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 4/24/2018 OF A��Sil co.. 6. DSD SIGNATURE %••• 1(� l ••••••y System #1 Approved for . bedrooms .Seven R. Pannone CE-8149 System #2 Approved for bedrooms ����9s•. r� Disapproved �k ygO•FESjON Conditional approval for bedrooms, with the following stipulations: ors-S\1 . �p,TERA N EB 0 pRoGRA • Original Certificate Date: L d —L 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 COSA blue sheet r If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: T15N R1 W Sec 5 Lot 39 Parcel ID:051-132-26 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 2/28/1981 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 98 ft. Cased to 98 ft. Casing height(above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test 2/28/1981 4/13/2018 Static water level 60 ft 23.7 ft. Well production 10 g.p.m. 2.2 g.p.m. WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate 1.56 mg/L Arsenic ND ug/L Date of sample: 4/13&1712018 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/SteelDate installed 10/15/2012 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A Date of pumping 4/5/2018 Pumper JR's Pumping Service C. ABSORPTION FIELD DATA Date installed 10/15/2012 Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 GPD/SF System type Wide Trench Length 75 ft. Width 5 ft. Gravel below pipe 0.5 ft. Total depth 3.0 ft. Eff. absorption area 375 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/13/2018 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test O in. Water added 450 gal. New depth 0 in. Elapsed Time: 90 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. G. ENGINEER'S CERTIFICATION �� ,�4614 I certify that / have determined through field inspections and ,:j.... '� `•v �• ),-•.y�1��review of Municipal records that the above systems are in , • v /\ •.* y conformance with MOA COSA guidelines in effect on this date. I•••.•:��1�il, ••••• 6 Engineer's Printed Name Steven Pannone i' .Sleven W.•'annone:••� Date 4/24/2018 �� g�. CE-8149 ....01 *"' COSA canary sheet_2-6-15.doc Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-132-26 Expiration Date: .2.J 2. — 13 1. GENERAL INFORMATION Complete legal description T15N, R1 W, Sec 5, Lot 39 Location (site address) 22158 Davidson Drive Current Property owner(s) Mark & Melissa Bauer Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: (it I Uel Received by: Date: 1Z1 COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 9 3b — Waiver Fee $ Date of Payment 101-111-a Date of Payment Receipt Number 0 LCI- 5 G+ Receipt Number COSA# 05C > alyCg Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services Address P.O. Box 100217, Anchorage, AK 99510 Engineer's Printed Name Steven R. Pannone 6. DSD SIGNATURE LV. System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for By: Phone 2724218 Date 10/23/2012 .even t 13gnnanie • CE 8149 .; l%W bedrooms, with the following stipulations: \\`s<,`,Ve OFA/V if���i ON -SI WATER AND 7-'0 WASTEWATER PROGRAM if'I11FNT SPRv\GtoaCYt Original Certificate Date: /7 2 -12-- The(( icip-- Ity o A a Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet r c Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: T15N, R1 W, Sec 5, Lot 39 Parcel ID: 051-132-26 A. WELL DATA Well type Private. IfA, B, or C provide PWSID # Date completed 2/28/1981 Sanitary seal (Y/N) Y Total depth 98 ft. Cased to 98 ft. Date of test Static water level 60 ft. Well production 10 g.p.m. FROM WELL LOG 2/28/1981 WATER SAMPLE RESULTS: Coliform Ndr colonies/100 mL Nitrate Z3Z mg/L i Arsenic 4 0 ug/L Date of sample: 10/ t i /17 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic / Steel Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Depression over tank (Y/N) N Date of pumping New C. ABSORPTION FIELD DATA Date installed Length 75 10/15/2012 ft. Well Log (Y/N) Y Wires properly protected (Y/N) Casing height (above ground) 2'+ AT INSPECTION 10/11/2012 27 3.3+ g.p.m. ft. Collected by: ?FS - in. Date installed 10/15/2012 Cleanouts (Y/N) High water alarm (Y/N) N Pumper Soil rating (g.p.d./ft2 or ft2/bdrm) 1.2 gpd/sf Width 5 375 ft2 Total depth 3.0 ft. Eff. absorption area New Date of adequacy test Fluid depth in absorption field before test Elapsed Time: System type Wide Trench ft. Gravel below pipe 0.5 ft. Monitoring tube Y Depression over field N For bedrooms Results (Pass/Fail) in. Water added gal. New depth min. Final fluid depth in. Absorption rate Any rejuvenation treatment (past 12 mo.) (Y/N & type) >= If yes, give date in. g.p.d. D. LIFT STATION Date installed N/A "Pump on" level at Datum in. Size in gallons "Pump off" level at Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 117.6 Absorption field on lot 107.7 Public sewer main 75+ Sewer /septic service line 97.0 Animal containment areas 50+ Manhole/Access (Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ in. Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 23.8 Property line 61.2 Absorption field 5.1 Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 13.2 Water Service line 95.6 Curtain drain 50+ F. COMMENTS Building foundation 48.2 Water main 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Wells on adjacent lots 100+ G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 10/23/2012 COSA brown sheet 10-10-12.doc r�P /fir* 48Th .1 even ': Aannarie. rt CE -8149 • r PROPOSED R.SER n BEY. (ASSMIED) PEILEZ Ms&A[O) MRble CORNER M ONT ENALIMO SETBACK saE PUILI NG areea REM ..Dne SMACK 38 0 0 O 0 0 0 Z 0 0 0 n 330.06' S89° 53' 43"E 50' BLM ESMT DAVIDSON DRIVE -J 50' BLM ESMT DAVIDSON DRIVE 330.06' S89°53'43"E N00° 06' 00"W UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION LISTED DISTANCES PREVAIL OVER SCAUNG. FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST OF THE SURVEY. REPRODUCTION MAY CAUSE ERRORS IN SCALE. J LOT SURVEY SURVEY TYPE J FOUNDATION AS -BUILT O FINAL STRUCTURE AS -BUILT ❑ PLOT PLAN ... AS -BUILT ... LOTSURVEYSURVEY ... TOPOGRAPHY AS -BURT... NO CORNERS SET I I RECERTIFICATION AS -BUILT... NO CORNERS SET SYMBOLS SET REBAR W DRAINAGE o FOUND REBAR 0 0 0 WOOD FENCE 00a ASSUMED ELEV. x X X METAL FENCE [':::::7:. { ASPHALT CONCRETE WOOD DECK Fart" PLOT PLANS & LOT SURVEYS IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE ANO UTIUTY CONNECTIONS AND TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. NOTE: ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SHOWN. FENCES, WELLS. SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION. ONLY. SNOW MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. SURVEY CERTIFICATION PLOT PLAN I bray cwry Nat I Mw MYIay „mewl e» lot Peen sof Nebel Nam mC eat I Iw,n IPM N tortablahool a of IM lot canon lnwER OM en an plat Pto ea NO of my e+,NO CM NRur. a Monaca hors BERN masted tan and ewe. FOUNDATION AS -BUILT I, Rebel E — at. t, , eery that I Ir,o Rale m d M -BM arm al IM la atlas on Na W cal Not a 0,t a.,a,aaa cad aN.matan as wan as eab as no .wean., Mann Mamba tor FINAL STRUCTURE AS -BUILT Robert E My r.. hanay cMlly that I law pvknn.0 ea -Bat *nay el IM abuav m We tot ate Rata to a„a,awne as Inkornation o than lee, ea true we ue naepnnw, Now awaaYa 0 I 41 21 — S o, wer o f11t;Ofeseionot�1►��t# 4 IRIP Prepared by Robert E. Johns, Jr. Sc Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE, ALASKA 99504 Scale: 1"=60' Rec. Lot S.F. Rec. Plat File No. Date Surveyed: 11/01/12 Drawn Dy. REJ Date Drawn: 11/01/12 Grid: 1557 Checked b mK W D 12-482 Legal Description: Lot 39 T15N R1W SEC 5 /1-tMeb Municipality of Anchorage Development Services Department Building Safety Division , On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORASINGLE FAMILY DWELLING Parcel I.D. Oct` 0 3 Z7- Z-�P 1. GENERAL INFORMATION Complete legal description '7%3"-4 ���� s �; G or •Location (site address or directions) .2iix-4----0-4v'.SO-0-z7e-, Current Property owner(s) Y') //./-141 #4Z Day phone ,Z / —3a 6—z. Mailing address Pa 130 f (01 "L(3 S U, uo rl' XL Clq S 01 Lending agency Day phone Mailing address Real Estate Agent • Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. ln�so,� 6/,/ay HAA# °W ZL_I Expiration Date: - % - 0 4/- 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 d TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. 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 Health Authority 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 i -4S 7' Phonef Qa7) rf<6 -'io73 Address 99‘ ' �, . c��Fi,t71�.c�-- Engineer's Printed Name ,O6!d6 --9s" i.���Lrs �/ Date. 5. DSD SIGNATURE •'1/ Approved for 3 bedrooms. Disapproved. Conditional approval for dam,®%Mi.4.t�� •oo 000' %1 s CE 8178 .• ...� . • .�- Vf12,PRES.SICitgiliv bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements • Supplemental Engineer's Report Other (Rev. 01/02) Original Certificate Date: 6- /- D "1 Municipalityof Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 'Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL: CHECKLIST Legal Description: A. WELL DATA Well type f�,¢ic>-4'725. Date completed 27 "/P Total depth ! `/12 ft. nor' 3 9: • If A, B, or C provide PWSID # Sanitary seal (Y/N) Cased to '98 ft.' FROM WELL LOG : 00/ Date of test Static water level ". Well production' I'I WATER SAMPLE RESULTS: Coliform Arsenic: B. SEPTIC/HOLDING TANK DATA Tank Type/ Material 5.efFf7"—/e, rte✓ G Parcel ID: Well Log`(Y/N) Y Wires properly protected (YIN)Casing Y eight (above ground) 36 in. ii AT INSPECTION 6 Z .7"oP ft colonies/100 ml: mg./I. g• Nitrate 2• a 6 mg../1 I: Tank size /"°O gal.' Foundation ,cleanout (Y/N) i� q Date of puri ing "y ' / g Number of Compartments Depre`ss'or over tank (Y/N) l ! 3, qr g.p.m. , Pumper E; r ABSORPTION FIELD DATA Date installed % /�'/ : ' Soil rating (g p.d./ft o Length 3° ft 'I , Width' I, Other bacteria - 1" colonies/100 ml. Collected by Date installed' G ' �8/ Cleanouts (Y/N) :.1 High water;alarm (Y/N) Total depth: .g ft Eff.'absorption'area 300' ft2 Monitoring tube Date of adequacy' test • ' i �• �, � Results (Pass/Fail) ��-5-5' Fluid depth in absorption field before test28/'In Water added 6/zgal. i Elapsed Time: 83 min. Final fluid depth 39'n'n: � ; Absorption rate >_ 5r5"0 Any rejuvenation treatment (past 12 mo.) (Y/N & type) Jf yes, give date System type Gravel below pipe ' . ft. Depression over field For .3 bedroomsl/ New depth Win. g.p.d. D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off" level at in Datu Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic to k/lift station on lot /00'1- On adjacent lots /4 CY Manhole/Access (Y/N) arm level at Meets alarm & circuit requirements? Absorption field on lot /40)4-A-/ On adjacent lots Public sewer main AZ -.0 Public sewer manhole/cleanout 'J�A Sewer /septic service line 2s '" • Holding tank ")h% SEPARATION DISTANCES FROM EPT /HOLDING TANK_ ON LOT TO: Building foundation I8/ Property line is F Absorption field Water main i%' • Water service line •Z Wells on adjacent Tots '"0'��. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line le' C{ Building foundation 2 '` ' Water main • .fed '"A - in. Surface water /° b 14. 7 t *9 Water Service line 25i4 Surface water iO0'`,d' ; Driveway, ' ' ' ' ' rage 4)0,4 -7k -- Curtain Curtain drain .4-* 7-- Wells on adjacent Tots /t ° 74 F. COMMENTS G. ENGINEER'S CERTIFICATION ! certify that ! have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name 4a"c-,c c. '-' 7:::-,64.30z 407 Date 5 - �1b • D HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) 2 X4.30 rot\ 44?b.•. .. �� f%9i1 r rt! � . • • :..� '.ot �s T. MeV '• ' CE S1T6 j .• i I'i .•'•.` �^ Waiver Fee $ Date of Payment Receipt Number ill Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176 Legal Description Address Applicant Date of Test Inspector Work Order System Data Well depth Static water level WELL FLOW TEST Lot 39, Section 5, T15N, R1 W, S.M. 21135 Davidson Dr., Chugiak, Ak. Carolyn Kunkle 13 -May -04 Fred W. Kenley #04108 98' 22.3 Casing above ground 36" TEST DATA TIME Meter Diff. Cum. Flow Static Difference Comments reading Volume Rate Water Feet G.P.M. Level (Ft.) 1:29 46739 0 0 0.00 22.3 0 1:39 46774 35 35 3.50 22.1 0.2 1:49 46808 34 69 3.40 23.6 -1.3 1:59 46841 33 102 3.30 23.9 -1.6 2:09 46876 35 137 3.50 23.7 -1.4 2:19 46910 34 171 3.40 22.2 0.1 2:29 46944 34 205 3.40 23.7 -1.4 2:49 47013 69 274 3.45 22.2 0.1 3:09 47080 67 341 3.35 23.7 -1.4 3:29 47149 69 410 3.45 22.4 -0.1 3:59 47250 101 511 3.37 23.3 -1.0 4:29 47351 101 612 3.37 22.4 -0.1 4:59 47502 151 763 5.03 23.9 -1.6 5:29 47675 173 936 5.77 22.6 -0.3 Stopped well test 5:3822.3 0.0 *See comments below System Passed Yes System Failed Comments 936 gallons was produced in 4 hours with an average yield of 3.9 GPM. The well recovered completely in 9 minutes. �t� a o*0.49TM .. _ .. • DOU AS . KEIT.: CHUGtt°Va..."4" .•' • • • •r •• 2 of 2 Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176 Legal Description Address Applicant Date of Test Inspector Work Order System Data Tank Volume Number of Bedrooms SEPTIC SYSTEM ADEQUACY TEST Lot 39, Section 5, T15N, R1 W, S.M. 21135 Davidson Dr., Chugiak, Ak. Carolyn Kunkle 13 -May -04 Fred W. Kenley #04108 1000 gal. 3 Absorption System Trench Absorption required (150 gal./bedroom) 450 Gallons TEST DATA TIME Meter Diff. Cum. Flow Septic Trench Difference Comments reading Volume Rate Tank Level (In.) Level 1:29 46739 0 0 0.00 48-1/2" 28.37 0 1:39 46774 35 35 3.50 II 35.13 6.755 1:49 46808 34 69 3.40 38.25 9.875 1:59 46841 33 102 3.30 40.37 11.995 2:09 46876 35 137 3.50 " 43.75 15.375 2:19 46910 34 171 3.40 44.87 16.495 2:29 46944 34 205 3.40 43.5 15.125 2:49 47013 69 274 3.45 44.37 15.995 3:09 47080 67 341 3.35 48-1/2" 43.5 15.125 3:29 47149 69 410 3.45 II 43.75 15.375 3:59 47250 101 511 3.37 44 15.625 4:29 47351 101 612 3.37 II 44.13 15.755 Stopped septic test 4:59 41.75 13.375 5:52 39.25 10.875 System Passed Yes System Failed Comments The trench absorbed approximately 500 gallons in 83 minutes. A total of 612 gallons was intro- duced into the system. The trench is capable of absorbing greater than 450 gallons in a 24-hour period. •' M .R'4�•' `; •. fr Page 1 of 2 .ttii 49 1. ..i.-.. -' i.•� nv1" % . : t4 k.. C) CJ Lo J 1 C'J co \ C (;) LIJ ' I IrDA /A .r -A /r / PIr IJV VL_/1/VINIC_/V/ L.L/I t...• (509° 52'4r E 330.10' B) •- S89°53'20"E 330.19' —.. 1 1/2 STORY 1,1000 FRAME GARAGE 19.7' 9.1' 109.4' 75.9' 3N A$ S 3Nr. &45KfT19ALL' COURT CONCRUU PAD 280.19'A o sv osv GOVERNMENT LOT39 RA/5f0 Cr4RODN Bf0 NOTES 1. THE MEASURED DIMENSIONS AND THE RECOVERED AND SET MONUMENTS SHOWN ON THIS AS—BUILT SURVEY WERE PART OF A BOUNDARY SURVEY PERFORMED BY McCLINTOCK LAND ASSOCIATES, APRIL 16th -21st, 2003. THIS DRAWING ADDS AS—BUILT INFORMATION. 280.21' ou to PAVt IfNT fOGG -• S / nT_ L_v / 4DAVIDSON 50' RIGHT—OF—WAY EASEMENT 1NO9 °53'43"W N89 °53'48"W DRIVE (BOOK 151, PAGE 348) 330.06' B) 330.21' 1 50.00' M w 1>i -1j ! Q0 0 m •- zZ w N O (n 2 1-1 3 < o C9 to "s 0 FOUND REBAR LIES N49°23'W, 0.7', FROM THE TRUE CORNER. SET 314" BRASS CAP MONUMENT SET 2" ALUMINUM CAP MONUMENT SET RAILROAD SPIKE FOUND 5/8" REBAR WELL o si ou or XX XX XX (XX XX XX) oo+�� OF 444444 `�Q,.•,....I•••u"o0 •�y1 * • • * ...49E1. e vo . 0r^"" •WIWAM McCUNTOCK. O AV e• •• LS 5480 •.• i, � INPAw 10!i!6M6!!!5:47iD SCALE 0 25 McCLINTOCK LAND ASSOCIATES, INC. 11940 BUSINESS BLVD, SUITE 205 EAGLE RIVER, ALASKA 99577 (907) 694-4499 FIELD WORK DATE: 5-07-04 DRAWN DATE: 5-12-04 PARTY CHIEF: CL DRAWN BY: JC LEGEND SEPTIC VENT ELECTRIC POLE TELEPHONE PEDESTAL MEASURED DATA RECORD DATA FROM THE DEPENDENT RESURVEY AND SUBDIVISION OF SECTIONS 5 & 6, T15N, R1W, S.M. (BOOK 164, PAGE 132) (XX XX XX B) RECORD DATA PER PLAT No. 85-42 (XX XX XX C) RECORD DATA PER PLAT No. 86-39 (XX XX XX 0) COMPUTED DATA FROM THE DEPENDENT RESURVEY AND SUBDIVISION OF SECTIONS 5 & 6, T15N, R1W, S.M. (BOOK AS -BUILT / BOUNDARY SURVEY 1 hereby certify that I have, or someone under my supervision has, surveyed the property described es: GOVERNMENT LOT 39 SECTION 5, TOWNSHIP 15 NORTH, RANGE 1 WEST SEWARD MERIDIAN, ALASKA Anchorage Recording District Monuments have been found and/or set as indicated. The improvements situated thereon are Within the property lines and do not -encroach or overlap onto adjacent properties, nor do any improvements from adjacent properties encroach or overlap onto ---this property, except as _indicated hereon. The necessarilytyasl wesmayshavewn in measurred. Additionalrodataesiare fm theshownoherrecrd eontshould notanorenbot e construed to 'replat' or 'resubdivide ony property and is shown for information only. Drafting and reproduction may produce grophic Inconsistencies; therefore scaling should not be attempted to determine unshown dimensions. Only easements from the recorded subdivision plot noted above are shown hereon and it is the responsibility of the owner to determine if any other easements, covenants, or restrictions exist. ©McClintock Land Associates, Inc. (MLA) 2004 This document is copyrighted and is authorized to be used for one real property transaction orproject only. Any copy is to be considered unauthorized unless it recorderears an ' original officeadato. Copyrightnature restrictionslty in (but note re—use restrictior a ons)oware waived if this document has been officially recorded. Lending institutions may also make additional copies for their own records. Liability to MLA Is limited to fees received for this project. FiELD 000K: 214-26 PLOT SCALE: 1"-50' GRID: NW 1557 DWG NAME: ABO2-270 J08 Na 02-270 INSPECTION APPOINTMENTS..t/CJ-C-erg DATE RECEIVED � " "- TIME TIME ME DATE DATE DATE �` L\-Ov-S\' ` N1,.lyS INSPECTOR INSPECTOR I NSPECTO to DEPARTMENT • MUNICIPALITY OF ANCHORAGE u p IT1' OF ANCHORAGE OF HEALTH & ENVIRONMENTAL PRO'rEM�1�C DEPT.T.OF HEALTH & 825 L Street -Anchorage, Alaska 99501 ENVIRONMENTAL P::OTECTION SANITATION DIVISION Telephone 264-4720 APR 6 1981 OF INDIVIDUAL WATER ANDREEV FIVIEIDIES -1 ( q ENVIRONMENTAL REQUEST FOR APPROVAL DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days fo processing. 1. PROPERTY OWNERPHONE (0/lam r�Q Gv„�, (lies-,� r� ‘ife_ciza o MAILING ADDRESS /�•�// -. . O . 30A 35z Ox•i, / ��C '17e-r/l4 S l j-6 7 PRQPE/RTY RESIDENT/(If different from above) ,/ // / (' q // C.Ci }” j %_SGT. 3- / o Ns� (% (.S-/vD . /��y(! e': / /&ee / JP LCJQ/,e ///e P. PHONE 2. BUYER ✓ PHONE MAILING ADDRESS 3. LENDING INSTITUTION 4/cz-ckq /6,z-/.fei/ &ie.; 4 PHONE MAILING ADORES // /� E--c•-�e. It OCG / 4 . 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION £U/- 39 - Sei. 1' 7u/ns((9 /s—,f%. ,-t.--,yv /,G2i)y./— Jeee•,r_,, e/'1ed,"ea, STREET LOCATION T -/ /�Au/D.SO/� ✓/P. , l /Fc4 e6)o 07) it ter, 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS O One O Four IN Other -S SINGLE FAMILY ■ Two ■ Five O MULTIPLE FAMILY CB --Three ■ Six 7. WATER SUPPLY * drilled L'_f INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells • COMMUNITY since June 1975. For wells drilled prior to that date, give well O PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM f- INDIVIDUAL/ON-SITE** 727 YEAR ON-SITE SYSTEM WAS INSTALLED. • PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE O SINGLE FAMILY O MULTIPLE FAMILY NUMBER OF BEDROOMS D FIVE • ONE • THREE ■ OTHER • TWO ■ FOUR ■ SIX 2. WATER SUPPLY ■ INDIVIDUAL PERMIT NUMBER DEPTH OF WELL IN COMMUNITY O PUBLIC UTILITY Connection Verified DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM • INDIVIDUAL/ON -SITE PERMIT NUMBER DATE INSTALLED ---1.. V OPUBLICUTILITY Connection Verified INSTALLER L)Qe OSeptic Tank or • Holding Tank Size: /UV?) If Tank is homemade SOILS RATING sS give dimensions: TYPE OF TANK MANUFACTURER oP tJ-2-. (Yi,--- TOTAL ABSORPTION AREA MATERIAL __ 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS fAPPROVEDFOR Th BEDROOMS certificate) (letter must accompany • CONDITIONAL APPROVAL D DISAPPROVED DATE BY 72-010 (Rev. 6/79)