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Home My WebLink AboutT15N R1W SEC 9 NE4NW4NE4NE4Onsite File T15N R1W Section 9 NE4NW4 NE4NE4 #051-102-05 Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191225 PID Number: 051-102-05 Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade Name: BRINKA ZONA REVOCABLE TRUST ABSORPTION FIELD - EXISTING ❑ Deep Trench ® Shallow Trench ❑ Bed ❑ Mound Address 22938 HOMESTEAD ROAD, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 5 0.8 GPD/SF 6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.5 Ft. Gravel depth beneath pipe 2.5 Ft. Subdivision Block Lot NE4NW4NE4NE4 Fill added above original grade VARIES 0.25 — 2.7 Ft. Gravel length 122 Ft. Township Range Section 15N 1 W 9 Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 940+ Ft2 2 6 Ft. Well -- 100'+ NA NA NA TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Gal. Surface Water -- 100'+ NA NA MaterialNumber of compartments Lot Line -- 10'+ NA NA NA Foundation -- 10'+ NA NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA *NA NA NA Remarks Connected to existing tank w/ diverter to Pump on level at in. Pump off level at in. High water alarm at in. existing bed. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank Tank to 3034 drainfield Installer J Rg Drainfield 3034 co/MT 3034 Inspector FWCS / MNA BENCH MARK (Assumed elevation) 100 ft Inspeection 1" 6/19/19 6/192019 Location and description 2nd ction 3'd 6/20/19 4" 6/20/19 BOTTOM OF SIDING COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Conditional Approval: Date e =z4' ^\ �or* 49TH *� y5 ''MICHAEL N. ANDERSON- NDERSON.• cc� " —/ No. CE 9469 M 612.6/191• ✓ _ Approv- I✓"1-., �' Date �� /� Ssi0�� a*,,,%.®.. — inspection Keport_a- i - iz.aoc PERMIT: OSP191225 PID: 051-102-05 GRPvO� 12 � o I'" WELL DECOMMISSIONED 2 APPROX. LOC. A as o OF WATER LINE. ,r N� 0 �' ESR Nps •s. oEG�` B o. GPN� FCO m A EXISTING 1500 -GAL SEPTIC TANK CO CO ® G gE0 CO gyJS(�N D MT Cos E DIVERTER, ® CO F COs. MT CO / SPLITTER C 0 G MT �— Co MT NEW ZRE�C��S H TH19-1 SCALE: 1' = 30' A—C=40.8' FCO CO CO CO DIV CO MT MT C04 B — C = 81.9' co cog 98.60 FINAL GRADE 97.00 A—D=66.9' 95.90 ORIGINAL GRADE �— B — D = 5 0.0' A -E=69,0' FILTER FABRIC °;o oRc/oL B—E=52.7' EXISTING SPLITTER -'j2.40 92.40 A - F = 7 6.6' 1500 -GAL S.T. SEWER ROCK GM/SM 89.90 B—F=63.7' A - G = 7 7.7' CO 96.90 FINAL GRADE MT 96.15 GRND. B—G=65.9' ORIGINAL GRADE �O sa.ao R. 0 1 ®11.s' A — H = 5 3.4' FILTER FABRIC 6/19/19 B–H=89.7' 14.0 TH19-1 2.40 92.40 81.90 BOH SEPTIC SECTION =89R CK0 SCALE: NTS PREPARED FOR: f OF A "j ZONA BRINK REV. TRUST L T15N R1 W SEC 9 NE4NW41NE4NE4 22938 HOMESTEAD ROAD, CHUGIAK, AK 99567 * T—H* ro Michael N. Anderson P.E.MICHAEL N. ANDERSON DATE: 7/10/2019? No. CE 9469 w 4661 Natrona Ave. DRAWN: FWCS�' �`�Af Anchorage, Alaska 995160 7/10/19 ti (907)727 8864/FAX: (907)345 1391 SCALE: 1" = 30' ROssco�P F];ffi--4 ilffiffnrsnr('\>#K< ARcrrs Punap & Weu- Iruc. Jim Sulliran, CPI PO Box 770197 Eagle River, AK99577 (907) 688-2510 {907) 243-228? iinr ?,arcticpump.com Well Decommissioning Log Legal Address: Subdivision: T:15n Rlw Block: Section 9 ne4nur4ne4ne4 Lot: Lot: On-site Water & Wastewater Program certified contractor performing the well decommissioning: Name: Jim Sullivan Signature: Company: Arctic Pump & Well, Inc Well Decommissioning Date 7-17-I9 Method of Decommissioning: AMC 15.55.060L1 a.I b.E c.E] Location: Use the space below to provide a drawing of the property showing the following items: r North Arrow o Decommissioned well r Other water wells on the propefy o Two separate swing tie distances for each well shown on the drawing Note: the swing tie distances shall be measured from either permanent structures or the property corners. l-J ano st Y4 frru,r{,!urd Lut{g &/ I),} lrl l,sl / Arctic Pump & Well, Page I of I Inc. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: '(907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP191225 Work Type: Septic Upgrade Tax Code Number: 05110205000 Site Legal Address: T15N R1W SEC 9 NE4NW4NE4NE4 G:1359 Site Mailing Address: 22938 HOMESTEAD RD, Chugiak Owner: BRINK ZONA REVOCABLE TRUST Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING This permit is for the construction of: Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 6/Z01/9 60H l»cnr Is, llcharement 6/17/2019 6/16/2020 1:•11 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: 1. The well on the lot is to be decommissioned. 2. Show the water service line on the Record Drawing. Received B� Issued By: Date: 117 Date -17/19 5 MUNICIPALITY OF ANCHORAGE =fit Development Services DepartmentPhone: 907-343-7904 On -Site Water & Wastewater Section - '� Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-102-05 Property owner(s) REVOCABLE TRUST BRINK ZONA Day phone 9072234663 Mailing address PO BOX 672306, CHUGIAK, AK 99567 Site address 22938 HOMESTEAD ROAD, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 5N R1 W SEC 9 NE4NW4NE4NE4 Lot Size 108,900 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field 0 Initial ❑ Single Family (SF) Q (w/wo AD U) Septic Tank ❑ Upgrade 0 Duplex ❑ (D) Holding Tank ElRenewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. i (Signature of property owner or authorized agent) Permit/Rush Fees: J_ 5 Waiver Fees: Date of Payment: f0 //O//q Date of Payment: Receipt Number: Receipt Number: Permit No. 6509 / li aS Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 June 12, 2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: T15N R1W SEC 9 NE4NW4NE4NE4 PHYSICAL: 22938 HOMESTEAD ROAD, CHUGIAK, AK 99567 The septic field has failed and we request a septic permit to upgrade the system on the above referenced lot. We propose to install two shallow trenches to serve the existing 5-bedroom residence. The design is based on the recent test hole conducted on June 4, 2019. The slopes are moderate at 3-8% at the proposed upgrade location. The lot is served by public water and area lots are served by either private or public water. The design will not impact any of the neighboring properties. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191225, Deb Wockenfuss, 06/17/19 Michael N. Anderson, P.E. ZONA BRINK REV. TRUST Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191225, Deb Wockenfuss, 06/17/19 Michael N. Anderson, P.E. ZONA BRINK REV. TRUST Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191225, Deb Wockenfuss, 06/17/19 Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 Fax 345 -1391 SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: T15N R1W SEC 9 NE4NW4NE4NE4 PERFORMED BY: FWCS / MNA - I MIKE N. ANDERSON CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 6/12/19 DEPTH FEET OG SOILS 1 2 ORG/OL 3 4 5 6 7 8 GM/sm 9 10 11 12 13 14 15 BOH 16 17 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 6/7/19 30 min 6 2 13/16 6 2 14/16 6 2 14/16 PERCOLATION RATE 11 (MIN / INCH) TEST RUN BEWTWEEN 3.5 & 4.5 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16 TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: 11 DATE: 6/11/19 TESTHOLE # 19-1 DATE PERFORMED: 6/4/2019 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: ZONA BRINK REV. TRUST 6/12/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191225, Deb Wockenfuss, 06/17/19 Municipality of Anchorage w Development Services Department Building Safety Division On-She Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.cl.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO090168 PID Number: 051.102.05 N.°a BRINK Wastewater System: ❑ New ❑ Upgrade Address: 372306 CHUGIAK, AK 99567 ABSORPTION FIELD PMne: NdrMer a Bedredru: 0 Deep Tra W o Shallow Trench ® sed O Mound D other: LEGAL DESCRIPTION Sce ReMp Tow Daireneom apirw grtle EXISTING GPDrFIs P. Mml, LN: SuOhNrgn: Dean b VP bottom Tom appal grid,: Gtv deem,,neem pipr. NE4NW4NE4NE4 Ft. P Tmnsn.p. Rupe: seawn: F! emed ,now upinal Wade: Garel Length: 15N 1W 9 Ft. Ft. Well: ❑ New ❑ Upgrade Grew wwm: Num rof leas Dsanoetatweenlhea I Ft. I Ft. Clssuqutrn (Pmale. A a. q: Taal Dean: Cesed W. Taal Wsorpoar use: ppb Metenal: EXISTING PRIVATE Ft. I Ft. Fr 1 3034 PVC Dmrr Des Dara: sww, W ala Lew: halalw: Ons Mwrd: Ft. JR'S PUMPING 1 9115109 Yield. Perp sett: ces•p H"m Aeore ""p TANK GPM F,. F,. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To septic Absorption un Holding ublio?tnatea,urf O1.. �N- From Tank Field Station Tank Sewer Dne Anchorage Tank 1500 Gal. W°° 100+ 100+ 100+ Mery a Steel Numoe, of cornw nenr: 2 S.W.lw 100+ 100+ LIFT STATION La we 10+ 10+' Gal. foVlWetial 15.5 13.8' • • P•np °n r " n: 'Pure W rw at Nph voter alum al h. h In. 100+ 100+ . . Pump Meas a Mode Erancel hspeWane pedanrd by: cumin Dram E: SEPTIC TANK REPLACEMENT EXISTING TANK ABANDONED BENCH MARK Loudon end Deet pW: PER CODE HOUSE DECK mid Ennawn. 100.0 FL Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 109115/2009 'k*nSILIkslit 1111 2nd 911512009 p� .. 1 ♦♦i �• : �:' ♦i Development Services Department Approval ; .;:} ♦♦ 49TH Conditional Approval Date: ■ •.. „ .... ........1..... •Steven••R.••Pcnnone. i 1� ' 2 ' n ♦♦� ° No. CE 8149 ♦♦i`�00.�''' Reviewed and approved by: Date: ♦♦♦1 tWer. ogahl �E551��• % I / I I % \ I EXISTING \\ . � WELL I � I I I I It I I 11 NEW 1500 GAL \ � I SEPTIC TANK \ I EXISTING TANK \ 1 0 + I ABANDONED PER CODE —\ \\ 10 '+ T i TF \ C) fO I � I gI mml E NI XISTING L j W I ABSORPTION FIELD W C7I �I I / € NOTE: THIS IS NOT AN AS—BUILT SURVEY LOCATION LOCATION OF HOUSEONOON LOT IS APPROXIMATE � NOTES: PANNONE ENG SVC, LLA. _—+�pF A ��1 Dote /29/09 RECORD DRAWNG P.O. BOX 100217 ANCHORAGE, AK 99510 C� • " �qSl�) gale PHONE (907) 272-8218 FAX (907) 272-8211 Scale r=50' �'• ..... P.I.D. NO T15N RiW SEC 9 NE4NW4NE4NE4 % 51-102—D: MARMN BRINK Steven R. Pannone j PERMIT NO. PLAN CH PO IAK. AK 99 67 /','�tl "sgq+r=t' Sheet F128 SWING TIES A FC B T 1 16.8 17.0 T2 25.9 26.2 FC 4.1 35.6 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:NEW 1500g SEPTIC TANK, ABANDON EXISTING TANK PER CODE, CONNECT TO EXISTING BEDS. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 20 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 5. EXISTING TANK SHALL BE ABANDONED IN ACCORDANCE WITH THE CODE BY PUMPING, CRUSHING, AND FILLING WITH COMPACTED CLEAN EARTH MATERIAL. Z COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT F> TANK CLEAN OUT NO. C# CLEAN OUT NO. M(/ MONITOR TUBE NO. R.I. RIGID INSULATION DCO qZ'� DV DIVERTER VALVE FS FLOW SPLITTER O o U 98.3' NEW 1500 g SEPTIC TANK DESIGN PARAMETERS SEPTIC TANK REPLACEMENT NEW 1500 GALLON SEPTIC TANK WITH DOUBLE CLEANOUTS INSTALLED. EXISTING TANK ABANDONED PER CODE. NOTES: DESIGN NOTES 93. ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT TH TANK CLEAN OUT NO. C# CLEAN OUT NO. M(/ MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 T15N R1W SEC 9 NE4NW4NE4NE4 MARVIN BRINK PO BOX 672306 CHUGIAK, AK 99567 LEGEND —w—w— WATER LINE/ WELL RADIUS — — -- EXIST'G SEPTIC NEW SEPTIC ---0 CHAINLINK FENCE P,�(G v....... lt) 9/29/09 Kik Scale * l� NTs ... I P.I.D. 2 / s1-loz-c ••te'ven •R�•Pannode %PERMIT NC „a , 81 /SWO90168 2 OF MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 28, 2009 Expiration Date: Aug 28, 2010 Permit Number: SWO90168 Parcel ID: 051-102-05 Legal Description: T1 5N R1W SEC 9 NE4NW4NE4NE4 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 022938 HOMESTEAD RD Owner Name: MARVIN BRINK Lot Size: 108900 SO. FT. Owner Address: PO BOX 672306 Total Bedrooms: 5 Permit Bedrooms: 5 CHUGIAK , AK 99567-2306 This permit is for the construction of: ❑ Disposal Field [?] Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: ��^ I Date: Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 051.102.05 Property owner(s) Marvin Brink Day phone 688.5864 Mailing addressP.O. Box 672306, Zip Code 99567 Site address 22938 Homestead Road, Chualak Zip Code 99567 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T15N R1W S9 NE4NW4NE4NE4 Lot Size 108.900 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank ED Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 5 THIS APPLICATION IS AN: Initial ❑ Upgrade El Renewal ❑ I certify that the above Information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Pannone Engineering Services, LLC (Signature of property owner or authorized agent) Permit/Rush Fees: 3 Waiver Fees: Date of Payment:F1g $ Date of Payment: Receipt Number: (/-5 � 2gZ Receipt Number: (Rev. 11/05) Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(aoanenaak.com August 26, 2009 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: T15N R1W S9, NE4NW4NE4NE4 EMERGENCY Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new septic tank be issued for this lot. The proposed systems will serve an existing five -bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a five -bedroom house and is operating adequately for five bedrooms. The tank is near collapse and gravel is present in the tank. The baffles are completely corroded through. The surrounding lots are served by private water systems and are over 100 feet from the proposed septic tank. This lot is served by private water and the well is located greater than 100 feet from the proposed system. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. Number of Bedrooms: 5 b. Septic Tank Size: 1,500 gallon 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: This lot slopes to the west at approximately 1-5 percent based on existing contour information. The proposed installation will be located in the central portion of the lot adjacent to the property line. Mailing: P.O. Box 102954, Anchorage, AK 99510-2954 Physical: 11301 Olive Lane, Anchorage, AK 99515 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 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, Steven R. Pe CE 8149 j Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 11301 Olive Lane, Anchorage, AK 99515 Telephone: (907) 272-8218 FAX: (907) 272-8211 00 o ll Q �Q1` O 3 01 � Q J m rrf X10 .IIS i II .�14LU1j 1 a_q }� 3 � MUNICIPALITY OF ANCHORAGE �� S / — 7 0-C DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 " L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES J Tp FROM SEPTIC ABSORPTION WELL Address IoOS(_._��I Sim TANK FIELD WELL Phne Permit No. No. of Betlroor9a no�(st) /ilL•�Ii 1�Z- p '7/ LOT LINE l� �o l}--' LEGAL DESCRIPTION Loc Block Subdivision r FOUNDATION Zp Township, Range, Sectio( t 1 / AS -BUILT DIAGRAM (Show location of well septic system, property lines, Iounaaeon, / IV f/ d rvuway, water bodies, etc.) ANKS .� SEPTIC ❑ HOLDING MMaamractwer Capacityin gallons 1 I 1 Metenal No. of Compartments TYPE OF SYSTEMZ I ❑ TRENCH BED ❑ W. DRAIN ❑ OTHER Sf Depth to pipe bottom fromTotal depth from original gradeonglnal mt_ grade A- FT �'I�FTFtll added above onglnal grade Gruvel depth beneath pipeC? FT Graveilongui Gravol width �l P� FT �� FT Total absorptmn area Distance between lines f QFT____ La W FT A t Number of Imes Sod rebng SOFT Rpe materml �jp�tj t t Installer Date Installed a � G WELLS PRIVATE ❑ OTHER (Identify) Classification (n,e,q TOIeI Depth Cased to FT FT TLI Install. "� Date Installed' 8 REMARKS: � ( i _r e Scale: t Inspections Performed by. -EN(yMIE¢iFi9,, AL ( r ,we c• � Date. 9C n .� % • �c S & S ENGINEERING t 17034 E'I to River Loop Road No 204 cer i that this i specliun was performed according to all ,a Z rk t A. lihar4ee' q: 4 p �� q g Municipal and�09lVu�dll{I ri11 B��eTon' thi9d�� 2%/!S /pp tGi `��]'ic n��•".tp:,vT"'ru°, A�gi,C� a4roaaM^4,1isv� /.. Health Department Approval: Date: L-1 _"k 72-013 (3/85) MUNlCIPALITY OF ANCHORAGE Department of Health & Human Services 825 L Street, Anchorage, Alaska 9950! 343 ON-SlTE SEWER PERMIT Pero.:i Number: 880244 Enlargement :ate Issued: 10/25/88 Engineer Designed /w`we: GECRETAHY OF H,V"D, Day Phone: Owner Address: 605 W.4 AVE. SUITE 81 694-2979 ANCHUKHGE� AK 99501 parcel Ida OKI l02 05 Lot =5 lsion: - Lot: - Slack: ~ 8ect1on: 9 Township: 15N Pm)ge: 1W NE4 NW4 NE4 NE4 Lot Size 2^5 A (sq,iL, o, acres> Max Bedrooms: 7his Permit: 5 Total Capacity: 5 SEPTlC TANK: Minimum total septic Lank capacity: 1,500 gallons" Each septic tank must have at least 2 compartments. Depth to top of septic tank(s) < 4"0 f,ei requires insulation over tank(s). IN5iALL PER ENGINEERS ATTACHED DES7GN, MAXIMUM DEPTH OF BED NnT TO W/tED 4"51" NOTIFY DHHS PRIOR TO EACH INSPECTION BY THE ENGINEER" THIS PFRMI| IS ISSUED FOR THE EXISTING SINGLE FAMILY RESIDENCE AND EXPIRES 12/31/88" / uLCT1FY THAT: 1. I ew vamiliar with the requirements for on -mite sewers and wells as set :,'Lh by the Municipality of Anchorage (MOA) and the State of Alaska" 1 will install the system in accordance with all MOA codes and regulations, �r/d in compliance with the dQsign criteria of this permit. A. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system an this or any adjacent or nearby lot" 4. 1 understand that this permit is valid for a maximum of 5 bedrooms. I also underst that the capacity of the total system is 5 bedrooms and ^/.r enla,pem96t/ will require an additional permit" '.; 1,.y'� d' (Owner) . /ed 8y: SECRETARY OF H,U"D, -_-9 DATE: DATE: ~'~~r~~~~v~--- PERFORMED FOR LEGAL D 1 2 3 .o n 4- 5 5 b 6 v 7 b PIII rbo� 9 10 11 12 1;i ti fi%E2 /'G-22— 88 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST f 0'-e SM pGGr�. // // /vl U v // 07 acv g ,5_ ju r 14- NbG NF Al % SEC r(OAI y DATE PERFORMED: WAS GROUND WATER 1%%1 ENCOUNTERED? 1 0 S IF YES, AT WHAT L O DEPTH? P E Depth to Water After 1lonitorinD7 A�.� Date:.d is PERCOLATION RATE (minutes/inch) PERG HOLE DIAMETER TEST RUN BETWEEN FTAND-5' FT S 1k b CIYVabvccnuw PERFORMED BY:17024 Eagle River Loop Road No. 204 vgoe River Alaska 99577 ACCORDANCE ALL STATE AND MUNICIPAL GUIDEON 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: �� y_� MUNICIPALITY OF ANCHORAGE �r//�\\1` DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION onmIMcnTAi cnicrnEERI lG DWISI0101 825 L Street r Anchorage,Alaska99507 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME L— IPHONE I 3(/ _SG' PINEW ❑UPGRADE MAILING ADDRESS .57/ LEGAL DESCRIPTION T l -ly le I W s 11/ oft f/ F& LOCATION OF BE'JX/ODMS Uy DISTANCE TO: Well -0 C7� Absorption area Dwelling JNO. ERMI WQManufacturer Materio. of compartments Liq. capacity in gallons IF HOMEMADE: Inside length Width iquid depth DISTANCE TO: Well Dwelling PERMIT NO. O= z 4 Manufacturer Material Liquid capacity in gallons p w= DISTANCE TO: 1 Well tioe � Foundatio Nearest lot line Y C / PERM T NO 2C3 (env w u 2 2 wC��/1 I—Qcc`fes F O N,. of lines Length of each line Top of rile to finish grade .,••• 3 ( Total length of Ii q s Material beneath tile Trench width / inches Distance betweenlines Total effe tive absorption area w Length Width Depth PLKIVIII NO. a Q F- Type of crib — Crib diameter -- Crib depth Total effective absorption area Lu w w _ DISTANCE TO: — Well Building foundation Nearest lot line Cla dAh Depth Driller Distance lot line PERMIT Nf)zo�, p w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS �IQO✓A SOIL TEST RATING INSTALLER n 1 1 REMARKS Gf V% e L ti 3 �v 1 L- APPR VED Z" p DATE LEGAL '%-/d 2- 72 -013 -(Rev. 3/78) D CJ iukera fffipb Drilling fwg by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 6882759 OWNER OF LAND a' # _ Fr t7 DEPTH OF WELL =' ADDRESS v F' c7 a- {, STATIC LEVEL OF WATER FT. LEGAL DESCRIPTIOT N.7�y N��L� /UE� NE �d �t��_9 "'PDRAW DOWN FT. J4 5Mr DATE - Started r t `} Ended 71J 7 GALS: PER HR — PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From Ft. to Ft. Ft. " From Ft. to Ft. _ From From-Ft.toFt Ft. From Ft, to -Ft. - Ft. to Ft. From From Ft. to Ft r. ' From Ft. to Ft. _ Ft. to Ft From Ft. to Ft. From Ft. to Ft - From Ft. to From Ft. to ' f Ft. r' 4• "� ' From Ft. to Ft_ Ft. From Ft. to From Ft. to Ft. From Ft. to-Ft.- oFt._From_ From- Ft. to t FL `�> • '' u'"'-'` �- `' �'� I From Ft. to Ft. _ From Ft. to a. Ft.From Ft. to Ft.. From Ft. to //0 Ft. 1 `r ""' ( =_z�" From Ft. to Ft._ From Ft. to Ft ="' < t fir r k r-70 LL ` ' From Ft. to Ft._ From -Ft. to__' R ..! Ft. . i From Ft. to Ft.. From Ft. to Ft. " From Ft. to Ft, From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft. _ From - Ft. to Ft From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft MISCL. INFORMATION: DRILLER'S NAME - -pt ��I 'll 'T� DEPHRTMENT '� HEHLTH HND EN�IR�NMENTHL `ROTECTION 825 STREET/ HNCHORHGE, HK5 J. 264^4720 � PEpMIT NO .. 820668 HPPLICHNT LT BENNETT PO BOX 10~]62 99511 ]49~8604// ' LOCHTION - LEGHL T15NR1NS9 NE4NW4NE4NE4 LOT SIZE 999999 SQ(- IFIRE TYPE OF SOIL HBSORPTION SYSTEM IS� TREN�H MRXIMUM NUMBER OF BEDROOMS � 4 SOIL RHTING (SQ FT/BR)� 165 THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS� T 9, q� I�� ° THE LENGTH DIMENSION IS THE LE GTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH [)F H TRENCH OR PIT I� THE DISTHNCE BETWEEN THE SURFH�E OF THE GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET) THERE 1S NO SET WIDTH FOR TRENCHES THE GRHYEL DEPTH IS THE MIl'.1IMUM DEPTH OF GRHVEL 9ETNEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHYHTIDN (IN FEET) PERMIT HPPLICAN T HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTnLLHl' IUN INSPECTTOMS OF RNY NELLS HDJHCENT TO ITS PRnPERTY HND THE NUMBER OF RESIDENCES TI HT THE NEL-L. WILL SERVE ___ �� n- 9 ��IF IF B�CKFILLING OF HNY SYSTEM WITHOUT FINHL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT HILL BE SUBJECT TO PROSECUTIUN. MINIMUM DISTHNCE BETWEEN H WELL HND HNY ON-SITE SENHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE' WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHNCE FROM H PRIYHTE WELL TO H PRIVHTE SEAER LINE IS 25 FEET HND TO H 11,111,11 IN SENER LINE IS 75 FEET. WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]8 DHYS OF THE NELL COMPLETION. OTHER REQUIREMENTS Mf -TY HPPLY. HND CONSTRoCTION DIHGRHMS HRE HYHILHBLE TO INSURE PROPER INSTHLLHTION. �� IF;::., IF=, �� :�� I CERTIFY THHT J. I HM FHMILIHR WITH THE REQUIREMENTS FOR ON-SITE SEWERS HND NELLS HS SET FORTH BY THE MUNICIPHLITY OF HNCHORHGE 2I WILL INSTALL THE SYSTEM IN HCCORDHNCE WITH THE CODES ] I UNDERSTHND T REQUIRE ENLHRGEMENT IF THE RESIDENCE IS RO0MS S________..... ..... _____DRTE...� *0` MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST ❑ SOILS LOG ,✓ \ PERCOLATION V \ TEST' PERFORMED FOR: �+��✓ DATE PERFORMED: —//��Z. LEGAL DESCRIPTION:-7,/,57,A/e/ SLOPE SITE PLAN DEPTH (FE 0A1 / Qeo 1- 2- 3- ---4- 5- 6- 7 i C , 10 11 r 12 13 14 15 16 17 18 19 20 COMMENTS WAS GROUND WATER y y S ENCOUNTERED? L 0 P -dPU IF YES, AT WHAT E DEPTH? f+ Readin 9 Date Gross Time Net N Time Depth to Water Water Net Drop 4 7•/s 2 32 � � � /.� 71Y2s 3 � �•/s �S 3z G�3�G .l.� � ' •%$" � .jam � 310 �• /-� PERCOLATION RATE •r/ `� TEST RUN BETWEEN PERFORMED BY: // r4/ •/�`7CERTIFI 72-008 (6/79) nch) i. 249 EAST 51ST AVENUE April :1., 1976 P -O, DOX 8087 ANCHORAGI'. ALASKA. 99503 TELEPHONE_ 9C7-2751-0483 TFL" OO1-33419 Mr. Mike Beaver 3506 Iowa St. Anchorage, Alaska R & M No. 656209 RE: Test Hole and Soil Log Report for. Sanitary System Section 9 T15N, R311, S.M. Dear Mr. Beaver: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of March 30, 1976 and those procedures outlined in a letter dated July15, 1975, by Mr, Rolf Strickland of the Greater. Anchorage Area Borough Department of Environmental Quality. Two Test Holes were put: down within the area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with an auger type drilling rig and the test holes were extended to a total depth of 19.0 feet below ground surface. The.final.log prepared for the test holes has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. James W. Rooney) Vice President JWR/pe xc: Municapility of Anchorage ria [a asps 249 EAST 51ST AVENUE April :1., 1976 P -O, DOX 8087 ANCHORAGI'. ALASKA. 99503 TELEPHONE_ 9C7-2751-0483 TFL" OO1-33419 Mr. Mike Beaver 3506 Iowa St. Anchorage, Alaska R & M No. 656209 RE: Test Hole and Soil Log Report for. Sanitary System Section 9 T15N, R311, S.M. Dear Mr. Beaver: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of March 30, 1976 and those procedures outlined in a letter dated July15, 1975, by Mr, Rolf Strickland of the Greater. Anchorage Area Borough Department of Environmental Quality. Two Test Holes were put: down within the area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with an auger type drilling rig and the test holes were extended to a total depth of 19.0 feet below ground surface. The.final.log prepared for the test holes has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. James W. Rooney) Vice President JWR/pe xc: Municapility of Anchorage Certificate of On -Site Systems Approval Parcel I.D. 051 102 05 1. GENERAL INFORMATION Expiration Date: J 0.x1 1 9 d P Complete legal description T15N R1 WSEC 9 NE4NW4NE4NE4 Location (site address) 22938 HOMESTEAD Current property owner(s) SENA Mailing address Real estate agent 2. TYPE OF DWELLING: R Single Family (w/ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic R Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System El Public Sewer ❑ Waiver request for: NONE q 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 Date of Payment Receipt Number 03 Receipt Number COSA # O S C a 21 d f 6 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 C&M ENGINEERING Phone 8545558 Address 20182 TULWAR Engineer's Printed Name CHARLES BALZARINI Date 1/20/22 6. DSD SIGNATURE System #1 Approved for -5 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms OF A/co gst� o : r49 TH •. • CHARLES G BALZARINI �F6)J , • CE -13854 bedrooms, with the following stipulations: \ �! OF �r ows\ Np J o^ PRO 5�� By: 1CC,&e64 1,, &000 � Original Certificate Date: 3 42 1 a 011) 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 COSA Checklist yellow sheet COSA Checklist Legal Description: Parcel ID: 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 Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume 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) Collected by Date of Sample Comments __________________________________________________________________________________ C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: ALL standpipes present per record drawing Total measured depth from grade ft (max) 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 Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date Results Pass For bedrooms Fluid depth prior to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies: B.TANK DATA Age of tank(s) years Tank type/material6WHHO Measured operating fluid level in septic tank Standpipes/foundation cleanout per record drawing Date of pumping D.ABSORPTION FIELD DATA ______________________ Which system tested (date installed) T15N R1W SEC9 NE4NW4NE4NE4 051 102 05 11 1 Property is on public water 12 Septic 50 2/28/22 trench 2019 1/19/22 5 7 0 4.3 750 0 10 0 750 NA NA ✔ 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to:(Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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.2/02/22 ✔✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ There is a diverter valve installed after the tank that allows switching between the new (2019) and old (1988) field. Recommend that the diverter be kept on the new field. Certificate of On -Site Systems Approval Parcel I.D. 051-102-05 Expiration Date: 1. GENERAL INFORMATION Complete legal description T15N R1W SEC 9 NE4NW4NE4NE4 Location (site address) 22938 HOMESTEAD ROAD, CHUGIAK, AK 99567 10-1q- l i Current property owner(s) ZONA BRINK REVOCABLE TRUST Day phone i Mailing address PO BOX 672306, CHUGIAK, AK 99567 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: 5 4. TYPE OF WATER SUPPLY: Private Well ❑ Water Storage ❑ Community Well A ❑ Public Water System Public Sewer Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ a36 Date of Payment iDWM Receipt Number 0/2-36 D COSA# 65C10191lb TYPE OF WASTEWATER DISPOSAL: Private Septic Holding Tank ❑ Community ❑ Public Sewer ❑ Waiver Fee $ _ Date of Payment Receipt Number, Waiver # Date: Distance: 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 ANDERSON CONSTRUCTION & ENGINEERING Phone 345-3377 Address 4641 SHOSHONI DRIVE, ANCHORAGE, AK 99516 Engineer's Printed Name MICHAEL N. ANDERSON, PE Date 06/26/2019 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 these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by FW and Anderson Construction & Engineering. 6. DSD SIGNATURE11 _ System #1 Approved for Sbedrooms System #2 Approved for bedrooms Disapproved AW 1*49 *f MICHAEL N. ANDERSON: No. CE 9489 ry / AV �FESSIO�� Conditional approval for bedrooms, with the following stipulations: m WASTFWATPQ Jfi PROGRAM 1^- Original Certificate Date: 7_11F41? 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 Alelw �-Ifrmllqn- Legal Description: T15N R1W SEC 9 NE4NW4NE4NE4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA — PUBLIC WATER ❑ Well log is filed with Onsite (or attached) Date drilled Total depth _ft Cased to _ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) _in. Date of flow test for COSA Static water level at beginning of test _ft. Comments Parcel ID: 051-102-05 Structure served by this system Well production at time of test _gpm Water storage tank volume_ gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate _ mg/L E]Nitrate less than MRL (ND) Arsenic — ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample B. TANK DATA — 9/15/2009 1500 -Gal C. LIFT STATION - NA Age of tank(s) 10 years ❑ Required maintenance completed Tank type/material SEPTIC / STEEL Age of lift station years Measured operating fluid level in septic tank 50" Lift station material ® Standpipes/foundation cleanout per record drawing Comments: Date of pumping D. ABSORPTION FIELD DATA — 2 x 61'L x 5'W x 2.5'ED — @ 0.8 GPD/SF = 940+SF Which system tested (date installed) 6/19/2019 Adequacy test date NA — NEW FIELDS ® ALL standpipes present per record drawing Results ❑ Pass For bedrooms Total measured depth from grade 6.25+ ft (max) Fluid depth prior to test _ in Measured depth to pipe invert from grade 3.75 ft (min) Water added _ gat ❑ N/A — pressurized field New depth _ in ® Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time min ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced _gallons Comments/Deficiencies COSA Checklist Private Sewer copy 2.docx Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date 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 ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Surface Water > 100' ® Yes Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Wells on Adjacent Lots: Property Line > 5' ® Yes if No ft Private Wells > 100' ® Yes if No ft Absorption Field > 5' ® Yes if No ft Community Wells > 200' ® Yes if No ft Water Main > 10' ® Yes if No ft If septic tank is under driveway comment below Water Service Line > 10' ®Yes if No ft Surface Water > 100' ® Yes if No ft 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 ft Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist Private Sewer copy 2.docx 6/26/19 0 s. ASBUILT SE61ARD & ASSOCIATES I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE>1iy� FOLLOWING DESCRIBED PROPERTY: OF AZ DATE 9T-W5i -1�6-T igCeE-PT AS A rte- MiAT Nl= �-4�CHM iNDICATED. IT IS THE RESPONS1131LITY OF THE SIRVEYING 694-082c. • MUNICIPALITY OF ANCHORAGE Department of Health & Human Services p r DIVISION OF ENVIRONMENTAL SERVICES •�j�1 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 051-102-05 HAA # 1. GENERAL INFORMATION (Must be completed prior to submittal) HA88-0523 (a) Legal Description (include lot, block, subdivision, section, township, range) T15N R1W Section 9 NE; Location (address or directions) Homestead Road (b) Property owner H.U.D. #111-034528-203-06 Mailing Address (c) Lending Institution Mailing Address Telephone : (home) Business Telephone (d) Real Estate Company and Agent John Dymond % The Realty Store Address 8040 Opal Circle, Anchorage, Alaska 99502 Telephone 243-1022 (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: S & S Enaineerin 17034 Eagle River Loop Road Suite 204 Eagle River Alaska 99577 2. TYPE OF RESIDENCE Single -Family Ei x Number of bedrooms five ( 5 ) 3. WATER SUPPLY Individual Well Pgx Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-siteKX 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. 7M25 (Rai.7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING Telephone 694-2979 Address Date 17034 Eagle River Loop Road, Suite 204, Eagle River 99577 Engineer's Seal 6. DHHS APPROVAL Approved foFive(5)bedrooms byr"` Date September 12, 1989 Approved : xxxxx Disapproved Conditional Terms of Conditional Approval This department has received written documenation of the Conditional Approval of December 8, 1988 ( install clenaout on line 1 — 4 feet from ;dwelling) has been completed and inspected. This property is now approved. CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before certificate is issued. The Municipality of Anchorage is not responsible forerrorsoromissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 ROBERT SHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS . r (907) 694-2979 FAX 694-1211 Septembea 11, 1989 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION HEALTH AUTHORITY CC` J 1989 APPROVALS Muni i.paf ity ob Anchorage RECEIVED DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street SEWER &WATER P.U. Box 1966650 MAIN EXTENSIONS Anchorage, AQas/_ a 99519-6650 REFERENCE: NE%;NW4;NEo;NEo; SEC.9; T15N;RIW; S.M. SEWER &WATER This tetter i6 to inborm you the boundati.on c2eanou# ha6 been .in6taUed INSPECTION on the reberenced property a6 aequined by .the conditional Health Authority Approval .i66ued on December 8, 1988. Request you .i66ue 4inat Health Authmity Approval bon the reUerenced ENGINEERING STUDIES property. AND REPORTS S.icereky, WELL INSPECTION / & FLOW TEST T A. SHAFER, P.E. S/gm SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 Parcel I.D. # MUNICIPALITY OF ANCHORAGE • _ Department of Health & Human Services A DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING v.c/- / Gam- GS HAA # ARP - 051!,3- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) NE,; NW,; NE;; NE;; Section 9; T15N; R1W Location (address or directions) Homestead Road, last house on the left (b) Property owner HUD Mailing Address #111-034518-203-06 (c) Lending Institution Mailing Address Telephone : (home) Business Telephone (d) Real Estate Company and Agent THE REALTY STORE/John Dymond Address 8040 Opal Circle Anchorage Alaska 99502 Telephone (e) Mail the HAA to the following address: (or check hereX3, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17Q34 Eagle River Loop RQad, Suite 204 Eagle River Alaska 99577 2. TYPE OF RESIDENCE Single -Family EX Number of bedrooms 5 3. WATER SUPPLY Individual Well XX Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site X% 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. 72-025(Bev.7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verifythat 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 Address Date S & S ENGINEERING Eagle River, Alaska 99577 Telephone g 9 6. DHHS APPROVAL 11 Approved for blJc(SJ<bedrooms by Date Approved Disapproved / Terms of Conditional Approval �^ Conditional CAUTION L /,2,- �-`� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given.in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible forerrors or omissions in the professional engineer's work. 72-025 (Rev. uas) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) p� Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 •C��P1F Su, 343-4744 a� a Legal Description: 1� A. WELL DATA Well Classification If A, B, C. D.E.C. Approved (Y/N) Well Total Log Present ON) Date Completed � o? Depth Z Cased to 2_ 14) Depth of Grouting Static Water Level Casing Height Above Ground 121 Electrical Wiring in ConduitV?N) _ SEPARATION DISTANCES FROM WELL: Pump Set At Yield 10.0 (-A O 4- / Sanitary Seal on Casingo/N) Depression Around Wellhead (Y,fp I I To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field o Lot 1 �� I k ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by `7* 611 14S&Z-tr!�G ; Date Water Saml Comments B. SEPTIC/HOLDING TANK DATA 11 Date Installed 2 # Size 1 0 ��of Compartments Standpipes45?N) —Air -tight Caps CON) Foundation_ _ Depression over Tank (Y/6) Date Last Pumped Pumping/Maintenance Contact on File (Y/N)' N ; for `-"— Holding Tank High -Water Alarm (Y/N) I" Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well nL-_::;�14- To Building Foundation �Q I To Property Line 1 0 A- To Disposal Field To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments TWG ��St�iaot �0Jr-101 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �)/�� Type of System Design T�Ielii Date Installed I — Ic�A — ag Length of Field 4j�:? Width of Field 7� I Depth of Field L� • S 1132,5 Gravel Bed Thickness D•S Square Feet of Absortion Area liy ¢ Son pipes Present IDN) v Depression over Field (Y/N• Date of Last Adequacy Test ilia Results of Last Adequacy TeOCA �) 4r�Q2 Qf1 s� SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well Cc, I_k- To Property Line I To Building Foundation To br Abandoned System on � Lot Z� ; On Adjoining Lots �o t k To Water Main/Service Line I o To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course � o� 1 To Driveway, Parking Area, or Vehicle Storage Area 105 +- Comments D. LIFT STATION n ateInstalled �! Size in "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — "Pump Off' Level at ent(Y/N) _ "Check Permitted Bedroom Rating Against HAA Request" during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on inspection. Signed S $ S ENGINEERING Company 17034 Eagle River Loop Road No. 204 .g Date MOA No. 'off 3 Poraint Nn C:�p v / ///// Rcroinf Aln Date of Payment &Z3 Waiver Fee: $ Amount: $ 120 Date of Payment 72-02e (Rev. nee) Back Page 2 of 2 t e A. Shei mr IJo. tear -a � :r' NROtG35'A mar 10 : °� CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID N 92-0040440 IPBORPiO PIES ANALYSIS REPORT BY SAMPLE for Work Order # 9560 Date Report Printed: OCT 5 88 @ 13:06 Client Sample ID:NE 1/4, NW 1/4, NE 1/4, SEC 9, T15N, R1W Client Name S & S ENGINEERING PWSID :UA Client Acct SNSENGP Collected SEP 29 88 @ 15:15 hxs. P.O.# NONE REC D Received SEP 30 88 @ 16:00 hrs. Req # Preserved with :NONE Ordered By Analysis Completed :OCT 4 88 Laboratory Sup exyi ox TEPNEN C. EDE Released By .�• C - Special Instruct: Send Reports to: 1)S & 3 ENGINEERING 2) Chemlab Ref #: 2838 Lab Smpl ID: 9 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits '----------------------------------------------- AffNdTS-N 1.5 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: ................................................................................................. 1 Teats Performed ' See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT-Gxeater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 0/ 8 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Secli`ow -9 NE14 /lWX14 Location (address or directions) 15OX 0360 ui wi'2ee�J 19i: A?4' aj Cl u_gis/If (b) Applicant Name Will/ c``Telephone: Home (503) 92q-351CBusiness �' 3V0Z_ Applicant Address 23(083 i�/10 U /10 Maio Q/2 (c) Applicant is (check one): Lending Institution; Owner/builder; Buyer ❑ ;Other ❑ (explain); (d) Lending Institution G//7Gi /9aJl2G sem_ Telephone_ Address 701 i7 _7_a,,&.,- f�'c> �a--�r/ r /O-2_ e'/!%i c_ Alt fly, (e) Real Estate Company and AgentL/4 P — Address Telephone 4200 _ — (f) Mail the HAA to the following address: / ?mv /yt 0-n CJ yf�-- %�® F OX /—t 2. TYPE OF RESIDENCE Single -Family f, Multi -Family ❑ Other Number of Bedrooms 5� — 3. WATER SUPPLY Individual Well, Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL 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 n-028(11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA(A AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. / Name of Firm _ � C. ,c�W��—_ Telephone /n1�` Address �/4 ( S_ Ce4 .tea i � 4&,,_-kx9 Date ,9Z13 Date 6. DHEP APPROVAL & Approved for e,�4 e bedrooms by _ Approved Disapproved Terms of ConditiApproval —.— CAUTION Engineer's Seal Z3 ............. F. Charles Kenlay o CE 62;1 F 0. �c �qy� RDFE "ism The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely 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 72-825 (11/84) MUNICIPALITY 01: /040iORAG;? DEPT. UI'' HEALTH & MUNICIPALITY OF ANCHORAGE (MOAT ENYI2ONMENTAL PPQ1[C110N HEALTH AUTHORITY APPROVAL (HAA) C CHECKLIST- FEBRUARY 1984 �,l � J 1986 264-4720 04, Legal Description: T� I. N, ✓4 n!W % NCs,% r A. WELL DATA Well Classification 'Srn e W►l Iy If A, B, C, D.E.C. Approved (Y/N) Y Date Com �� Yield /Sop Well Log Present (Y/N) Completed 71 �, Total Depth 2lCased to 2i4 Depth of Grouting NSA Static Water Level —J6Co, Pump Set At dht&"d2n ` Casing Height Above Ground (2 'r Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Separation Distances from Well: i To Septic/Holding Tank on LoOn Adjoining Lots X00 To Nearest Edge of Absorption Field on Lot /i0 r On Adjoining Lots /00 /f To Nearest Public Sewer Line AV -4 To Nearest Public Sewer Cleanout/Manhole — N/A To Nearest Sewer Service Line on Lot 8` - Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA — : Date I Date Installed 8F Z 12 Size IZ6 No. of Compartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Yes Depression over Tank (Y/N) It Date Last Pumped j (y 1gF3(o Pumping/Maintenance Contract on File (Y/N) t�4 ; for Holding Tank High -Water Alarm (Y/N) VA Temporary Holding Tank Permit (Y/N) N � Separation Distances from Septic/Holding Tank: To Water -Supply Well /00 / t To Building Foundation To Property Line /0 G>'/ta>< 1",4 , To Disposal Field To Water Main/Service Line Course Comments Page 1 of 2 72-026(11/84) 1¢ i To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata $ Type of System Design 7 Date Installed Z/16-. Length of Field Width of Field � � Depth of Field �7 r Gravel Bed Thickness 4� Square Feet of Absorption Area CP7�0 Standpipes Present (Y/N) Y Depression over Field (Y/N) N / Date of Last Adequacy Test Results of Last Adequacy Test S 'aC tc Separation Distance from Absorption Field: To Water -Supply Well ono / t To Building Foundation 3s' Lot APO To Water Main/Service Line /00 2! To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION To Property Line To Existing or Abandoned System on On Adjoining Lots /4101 _A To Cutbank (if present) 6;1 877 Date Installed AA Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at 'Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check Permitted Bedroom Rating Against HAA Request '• I certify that I have checked, ve ifled, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date Company ieE l WMOA No. Receipt No. Date of Payment � ' i " � � R `y CP �06 .,,",►"��rgirlE1�ieal Amount:$ .4 (L ...... d—,°- i� Page 2 of 2 72-026 (11/84) f. Charles K May °. CE 62n Gs` APPLIC JT FILLS OUT UPPER HAL ONLY Property Owner . ';/ Z IA,1,0,,# /V, Phone Mailing Address 7 3 e-1 Time e Date Buyer Address Zip Code Lending Institution ilk,��c- 1-E�rR�L /7 c`- Phone Address Zip Code Realty Co. & Agent Inspector Phone Address Zip Code c Legal Description Z /f 7�y(� AIW XV, AlL X41 ,t J v}.r/ /L/,C , X1 ��. /i %/ 5W, S1 Vv, � /"7 Street Location _'/]/ D C)/tel t - Ty a of Residence Single Family Field Notes: ❑ Multiple Family No. of Bedrooms._ MUNICIPALITY OF ANCHORAGE ❑ Other Wter Supply N, Individual 261n $& - ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal n A Individual Year Individual Installed: ❑ Public Utility Lu4`I �S -a'Ss When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time e Date Dale Date Date C- LID Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGE DFnT C,..,_..iT:i o, ENVIRUi Lei :f , . A ...U. D -TION O��T ; N 2 9 182 � RECEIVED YPPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDI tONAL AnPROVAI' 2 DATE CPA BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received MO Well to Tank Septic Tank Size ,t3I lazl e -L_ n',�J A r' I2 -lei -'?Aa pca� I)ecember 9, 1982 William 13. and Linda M. Hammond sR 2 Box 5324 Chugiak, AX 99567 Subje=ct: td} l/4 PII,J�,/4 P-3I;�/4 sec 9 T15N 51W B /approval for the individual sewer and water facilities cannot be granted until the following items have been completed: ° n vael.l log submitted to this office for our files and review. ''he depression or pit around the well canine, needs to be filled with impervious type soil so that it slopes away from the well casing. C 'Phe water analysis report needs to be submitted to this office from the Chem Lab, 5633 S3 Street, for our revieca. i'lease notify this Department -for a reinspection when the noted discrepancies have been corrected. if there are any further questions, please call this office at 264-4720. Sincerely, Robert C. 'Pratt Associate Environmental ST)eciali._,t RP246/p/EH O 4411 f' b O q) b I^ A