HomeMy WebLinkAboutT15N R1W SEC 18 LT 193BOnsite File Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT rmit Number: OSP191478 PID Number: 051-232-47 ,elling: Q Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Name HEARTY HOMES LLC Site Address 18222 WERRE ST, CHUGIAK AK 99567 Phone Number 4 Project: ❑ New W Upgrade SORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound ❑ Other _—ITotal depth from original l LEGAL DESCRIPTION —1 —1-1 1 Depth to pipe invert from original grade r[. Gravel depth beneath pipe Subdivision Block Lot 193B Ft. Ft. Fill added above original grade Gravel length Township Range Section 15N 1W 18 Ft. Ft. Gravel width Ft. Beds: Number of Lines Distance between lines SEPARATION DISTANCES To Septic Absorption Holding Sewer Lift Station Total absorption area Number R trenches Ft. Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 113.3 TANK ❑r. Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1500 Gal. Surface Water 100'+ Material Number of compartments Lot Line 5.0'+ NA POLY 2 Foundation 10.0'+ LIFT STATION Manufacturer Capacity Remarks Gal. Alarm location Electrical installed by Installer PIPE MATERIAL House to tank Tank to 3034 drainfield 3034 JRS SEPTIC Drainfield CO/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 160 It Inspdeation 7" 11/14/19 2nd Location and description 3rd 4a' W Bottom House Trim ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date of sof ia�P Steven R. Pannone - Septic Syste 7 �p c: CE 8149; Approved $� �sj�� Jrequire �lirD.o.[ssctat{�a c . this approval does not include well permits. rao„n�m�r�ui l m Ln�o��=� I f >o�� z. m � ` co D U) �prOrx � mm -p- O m- nC/') C II Ln F9 �10 NO-<� �-G�- zzZ7 ,o-- imoUZ rOtnOZ cn p =1 50-u>D OG� m ,pm -p C- O C O m I I O D Wino O QrnUD (n O Z m D O Vj O (Am L0Z fel oz Q i n Nm �)j U) M I ; \ m \ lli0 � I \ Lo M Lo 4 w II \ % \ m 0 4 i ! �� � I m � m w E E I mm 0 v cn a \ M _\� �Ln I Doo I o� \ oo 1 / t� E mD I Y m m \ ec \ E 4 \ I I W -- n Z _ Z -, DoN D 41 m Ln ou VYERf�E S I EET N � NOTES: PAN:NOINE ENG SVCLLC REVISIONS DATE RECORD DRAWING P.O. 80X 1807 PALMER, AK '99645 ... — 20200203 PHONE 907) 745-8200 FAX(907) 745-8201 P.'' SCALE T15N R1 W S18 L193B , F49 1" = 60' P.I.D. NO DRAWN JRL SITE ADDRESS: 18222 WERRE ST $seven anriaae 051-232-47 HEARTY HOMES LLC CE 8149 PERMIT NO. 3771 TWILIGHT LANE OSP191478 SITE PLAN ° SHEET ANCHORAGE, AK 99518 1 of 1 PLAT NO. 69-248 LOTS 193A & 19 3 B OF B LM LOT 193 LOT 1938 31,757 S.F. AS -BU I LT N 90000'00"E 234.98' PROPERTY DEPICTED ABOVE AND THAT NO 14.6' 0 ENCROACHMENTS EXIST EXCEPT AS INDICATED. —X9.2--x--i 0' IS THE RESPONSIBILITY OF THE OWNER TO x of 0 2000 E. DOWLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99507 APPS ON THE RECORDED SUBDIVISION PLAT. 28.4.' UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR SHED M EXISTING GRAVEL DR. � x GARAGE ^ N N F.B. JOB N0. 28.4' NOTE: NO CORNERS SET THIS DATE NEIGHBORS I LT193BAB 40.0' . WELL o PORCH a x SEPTIC SYSTEM EXISTING x in I N OLDunurr ci BUILDING 8.0' �x ROOM x r DECK °D x of x 3 32.0' OI x ox x ZI � 1 I II ROW RESERVE -----------------3' N 90°00'00"E 234.98' 0 M _ JERRY AVENUE AS -BU I LT I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO GASTALDI LAND ENCROACHMENTS EXIST EXCEPT AS INDICATED. SURVEYING, LLC 0' IS THE RESPONSIBILITY OF THE OWNER TO JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS, 2000 E. DOWLING RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT ANCHORAGE, ALASKA 99507 APPS ON THE RECORDED SUBDIVISION PLAT. PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA GRID DATE HEREON BE USED FOR CONSTRUCTION OR FOR NW1054 8/13/2020 ESTABLISHING BOUNDARY OR FENCE LINES. ANCHORAGE RECORDING DISTRICT, ALASKA F.B. JOB N0. NOTE: NO CORNERS SET THIS DATE 2020-02 LT193BAB in z 30' WI .®.®\/it,• OF A4• °49TH9 go00 Jeffery A. Gastaldi •. a' °a LS -6091 a �� ♦ sf�r °.e 8/13/2020 ;• �Jz 0 POA °•..e...•°®• 65J®41# r0fessional L°� • 1 "=30' MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program POBox 1y56aO 47oOElmore Road Anchorage, Alaska Vso1SG8su Ph 904 pax�(no7)r*n'7oor PermitNumben DSP191478 Effective Date: Work Type: 8apUoTankUpgrode Expiration Date: Tax Code Number: 05123247000 Site Legal Address: T1GNR1VVSEC 18LT183B G:1054 1O/25/201S 10/24/2020 --- Owner: HEARTY HOMES LLC Design Engineer: PANNONEENGINEERING SERVICES This permit iafor the construction of: El Disposal Field 2 Septic Tank 0 Holding Tank El Privy Lot Size inGqFt: 31757 Total Bedrooms: 4 []Private Well [] Water Storage All construction shall behmaccordance 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) 1 The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.85.Provide notification bycalling (QU7)343'7gO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall boeither: a. Opened and Closed unthe same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: M, 1. Property changed title in2O1Qwithout eCOSA ACOSAisrequired toclose this permit. 2. The water service line routing to the house shall be professionally located prior to placement of the septic tank to confirm minimum 1Oftseparation. /,I - /� Received By: Date MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-232-47 Property owner(s) HEARTY HOMES LLC Day phone Mailing address 3771 TWILIGHT LANE, ANCHORAGE AK 99518 Site address 18222 WERRE ST Legal description (Sub'd., Block & Lot) T1 5N R1 W S18 Ll 93B Legal description (Township, Range & Section) Lot Size 31,757 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. 1 further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 9a S oo Date of Payment: 1 ID I Z[ � z of �] Receipt Number: I�02 y35 (_i Permit No. Permit App__- Waiver Fees: Date of Payment: Receipt Number: Waiver No. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191478, Rebecca Carroll, 10/25/19 Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com October 25, 2019 Subject: T15N R1W S18 L193B Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade Septic Tank to replace an existing 1,250 -gallon Septic Tank to be issued for this property. The existing tank has reached the end of its useful life, it will be removed per code. Currently the lot is developed. The proposed system will utilize a replacement 1,500g septic tank that will be connected to the existing drain fields. This lot and the surrounding lots are served by private wells. There are no wells within 100' of this upgrade. There is an attached shed on the southwest corner of the house in close proximity to the proposed tank. This tank installation will have no adverse effect on the house due to the proximity to the shed. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located 5'+ from any property line 10'+ from building foundation 10'+ from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.745.8200. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer 3Ylc5Ciiltg. P.O. ]L'fl 11.807 Y G' rnr A:.. 99645 ele hone: (907) 7f _820 FAX: t907) 745-8201. DESIGN PARAMETERS i / On -.t Wate4�4 PRIMARY SEPTIC SYSTEM M M °N0. BEDROOM: 4(600 gpd) _ REVI FORN ZpETANK SIZE: 15008 OS 8, y � a v1 rn / Z N N N O Q; TRUE NORTH +:g SCALE -/I"= 60'LLJ I > / WELL E121.0 / \ 165 \ r — � 35.4 W � / DRIVEWAY \ I— CONFIRM Ri TING OF / i W Cl _ W WATER LINE WATER SERVICE UNE(E) 3 / / ry W 00 WELL RADIUS W 99.8 _J SHEDS SBD // / / I j�d m In a� 'y W CJ — ss ss — NEW SEPTIC _ _ — _ _ WELL E r r — — — / IUYo � J Q 0) ABBREVIATIONS / — — MOVE AND REPLACE 1500G TANK P ,y V7f�x W Y / N TH TEST HOLE I J PER MOA CODE I WE 0u- -_ N 7 = Q (P) PROPOSED `Z0-. (n Ib O W (E) EXISTING ^� — _ —_1 CO CLEAN OUT N0.93B- — _ `�' W d�/ '� �' 1 I zoo n LL,i Q FC FOUNDATION CLEANOUT 2 W~ W FS FLOW SPLITTER100 b _ x MT MONITOR TUBE N0. _ — r 'Y _ JY' ss� W ZDO 0 W � t. r LoW r, (J TYP TYPICAL - - — - l as Q = Z Z w\ W— CLASS ..A.. f w AL 60 a W 150 WETLANDS W I— W (n O Z W Y Y W W W WN U Q WELL(E)-----Op —I p-- 1 D o �L Z W Z 0 o i� On -Site Water 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: OSP131035 Tax Code Number: 05123247000 Work Type: Well Initial Permit Effective Dates: March 28, 2013 to March 28, 2014 Design Engineer: Subdivision: T11 5N R1 W SEC 18 Site Legal Address: T15N R1W SEC 18 LT 193B G:1054 Owner/Address: HENRY JOSHUA P & MELISSA J PO BOX 671571 CHUGIAK AK 995671571 Site Mailing Address: 18222 WERRE ST, Chugiak This permit is for the construction of: N Disposal Field N Septic Tank N Holding Tank Lot Size in Sq Ft: 31757 Total Bedrooms: 4 N Privy N Private Well Y 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 Issued By Microsoft Word -Permit App_9-1-12.doc - Permit App_10-12-12.pdf http://www.muni.org/Deparknents/OCPD/developmenVonsite/Docume... MUNICIPALITY OF ANCHORAGE n�ekj Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D.0'V o<7,5,R-9'7 Property owner(s) Gs urr 1114 A, -,y Day phone Mailing address t<?l_� 7 / Cfc.®,o(- X(- � o Site address IeF,= Cfi.�,"a tel- 99��C7 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) > L` 0141 Lot Size,&! 5 S7 , Ft. Number of Bedrooms ' APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial( Single Family (SF) V (wlwo ADU) Septic Tank ElUpgrade ElDuplex (D) ❑ Holding Tank Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage THIS APPLICATION INCLUDES A VARIANCE 1 WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. owner or Permit/Rush Fees: aim I Waiver Fees: _ Date of Payment: I b Date of Payment: Receipt Number: 0 Receipt Number: Permit No. ©S Pk;io35_ Waiver No. Permit App_9-1-12.doc 1 of 1 3/25/2013 8:51 AM 0 a a Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION l )C qAC) �S P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ff✓9'7r'YD/ PID Number: 05-1 237-y % Name: iso Wastewater System: ❑ New AK Upgrade on A�riHIf Address: sizes w�r�� CtiW ,„/c E f9r61'7 ABSORPTION FIELD Phone: �8F "�Nvy No. of Bedrooms'. L./ 0 Deep Trench ya Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: - U GPD/Sq. Ft, S' + Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 9 y ' Ft. �i + FL Township: Ran41 1 ge', / section: /8 c< Fill added above original grade'. O Gravel length', p + FL O Ft. WELL:�xr3?/Nf ❑ New ❑ Upgrade Gravel width: i Numb ero/ines: L:f Distance between lines. FG i U Ft. Classification (Private, A,B.C): Total Depth: I Casedl Total absorption area: Pipe material: r -"Ft^ FL d 40 SO, Ft. 1F910 /c—k 3Y Driller'. ea re Drilled: Static Water Level: Inn"sstaller: OwNem B.+•r=fr� Dateinstalledp� - 17-17,PFL //G w/IN SON .tPG Ze%z` Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES VSeptic C1Holding ❑S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufactures Capacity in gallons. From Tank Field Station Tank Sewer Lines c4, 'zsD Well Z r / �O w / A /v f� ,�/ /V 1O Material: TEFL Number of Compartments: 2 Surfac Water /05' 9a' /oo' LIFT STATION w� Lot /J O 9 .3 / Size in gallons: Manufacturer _ -- Line Foundation ' r 30 "Pump on" level at: ump off' level at: High water alarm at: Curtain/V'*Pum ake B Model Electrical Inspections performed by, Drain Remarks: rl UAe.01 ro +'wTa+'N BENCH MARK S' is 74e Sl Location and Description: c s •' oT r /er07 Assumed Elevation: ENG=�F,F _ , 1 Inspections performed by: CRSS _Dates:1st ""'""~""yt'•• 2nd y �js, Loula A. Borers Department of Health and Human Services approval j *i''4iA'�. � � ,�•' Reviewed and approved by: —�ttt Date: #T¢ -9B % wr"�i" 72-0131 Rev. 9/91) MOA 25 / \�, , ,0 an L _. 9 �/t L �. 7- U�-1 � 3rd -12X1- A Permit No. SW970401 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 a Anchorage, Alaska 99519-6650 Tebephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: 100' WELL RADIUS NEW WATER LINE LOCATION Z 00 505' trench o N 5x25' trench W . C3 N CREEK 5ET0p �. 120' WANED DISTANCE LOT 192 TITSEPTIC TANK - T00, c� DRIVEWAY eX15TINQ HOU5E i NOTE.- RU added on the slope to the south of the new leachf{etd to maintain 35' sepenrtion. 94.5 ELEVATIONS (NUT TO SCALE) T 1935 234.98 W TOP BE HBSC SPIGBi IN REAR A.... EO ELEV = 100,00 ORIGINAL GROUND LEVEL ATS / 97.8 R1938 R2 93.8 89.8 09.8 m 2 O GWT R 84.3 Oaa PID No.: 05123247 SW/NC T/ES A -C = 115.e� B—C = 140.5' A—D = 99.6 B—D = 90.7' A—E = 104.9' B—E = 108.6' ® - TEST HOLE • - MONITOR TUBE o - SEWER CLEANOUT 6 - WELL — — - EASEMENT - PROPOSED LEACHFIELD - EXISTING LEACHFIELD SCALE 1"=50' 9/2/98 ENGINEER'S SEAL �.P��c,,. ............ y .................. V�". LOUIS A. BUTERA.� J '• CE -6736 ����'pROFESS10ko-�eG K&R CONSTRUCTION 18221 WERRE CHUGIAK, AK 99567 TO MOA: THIS NOTE IS TO INFORM YOU OF THE COMPLETION OF A NEW SEPTIC SYSTEM LOCATED ONLOT 193 TI5N RI W SEC 18. I AM THE OWNER OF THIS PROPERTY. MY SON RUSSELL WORKED WITH EAGLE RIVER ENGINEERING SERVICES FOR 2 YEARS ON THIS TYPE OF PROJECTS. WE PROVIDED THE EXCAVATION AND INSTALLATION. EAGLE RIVER ENGINEERING SERVICES PROVIDED THE SITE PLAN AND INSPECTIONS. THANK YOU FOR YOUR CONSIDERATION IN THIS MATTER, RONALD HARRINGTON----OWNER SEP 2 199 MunicspaIlly 1 {umar) Sery ceS Dept. Health & Municipality of Anchorage Department of Health and Human Services 825 "L" Street Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650 Mayor http://www.ci.archorage.ak.us September 18, 1998 Louis A. Butera, P.E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for T15N Rl W Section 19 Lot 193B WR980055, PID #051-232-47 Dear Mr. Butera: Your request for waiver of the required 100 feet horizontal separation of an on-site wastewater disposal system to surface water has been approved. The approved separation is 92 feet. This waiver approval applies to the existing on-site wastewater disposal system and surface water separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances to be met or another waiver approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-Site/Water Quality Program MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# WR980055 PID# 051-232-47 HA# Permit # SW970401 Date Received: September 2, 1998 Legal Description: T15N R1W Section 18 Lot 193B Engineer: Lou Butera, P.E., Eagle River Engineerigg Services PO Box 773294, Eagle River, Alaska 99577 Applicant: Ron Harrington Waiver Requested: Waiver _request of a leachfield to surface water of 92 feet Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: List Conditions or o� rurri�i�armA/ X Waiver is Reasons for above: f6d' E,yd/. Wep 9-z-98. NOT Granted: Srgy N,Tr,4e eb LFrrE�z Date: 7-14 - f8 Rec #: 04150/4932 By: Amount: $ 920.00 Name of Reviewer` Date Paid: Sept 2, 1998 V Eagle River Engineering Services SEP 02 RECEIVED Louis Butera, P.E. P.O. Box 773294 (907) 69"P44 ITY OF ANCHORAOI Eagle River, AK 99577-3294 (907) 694!TRff'I'ei cFUHir•pq nw,< September 2, 1998 Dan Roth On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 193B T15N Rl W Sec 18 Waiver Application Dear Mr. Roth: RECEIVED S rP 2 1998 Municipality of Anchorage Dept. Health & Human Services We are applying for a waiver of separation distance for a portion of a leachfield that is within 92 feet of a surface water course. The leachfield is in place and is located in a small triangle of available area sandwiched between the creek setback, a waivered setback to a Class C well and the well serving the lot. The leachfield encroached on a bend of the water course, there is no where to move the leachfield. This leachfield is a new installation and is installed to current guidelines and replaces an old septic tank and undocumented pit that was within the 100 setback. Ground surface contouring is such that any possible surface effluent flow would actually follow a path to the west that is +100 feet distance to the water. It is our opinion that this variance from the code would not create a health concern or problem and request your approval. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1997\97-045-wnv2 �A°-'` C�� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 11 O �-Y\ o () r'Yl LU t PAGE 1 OF 1 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970401 DATE ISSUED:11/21/97 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:11/21/98 OWNER NAME: RONALD HARRINGTON OWNER ADDRESS:18222 WERRE ST PO BOX 3775 PALMER, AK 99645 PARCEL ID:05123247 LEGAL DESCRIPTION: T15N R1W SEC 18 LT 193B LOT SIZE: 31757 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: PROPOSED TRENCHES MAY NOT BE LOCATED LESS THAN 35 FEET FROM A CHANGE IN SLOPE OF 259- OR GREATER. RECEIVED BY: DATE: //- D 5 -77 ISSUED BY: /- Ll f ,fLO� DATE: Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax October 16, 1997 Jim Cross, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: Lot 193B T15N R1W Sec 18 Narrative & Permit Application Dear Mr. Cross: The layout of development for the subject lot, an adjacent creek and the surrounding lots wells has seriously affected the amount of land available for septic system placement. The proposed septic upgrade will require a variance of the standard 50' setback from a 25% slope break to a distance of 35'. This setback distance will be accomplished by recontouring the existing slope or adding fill. This variance from the code required 50' is not felt to be a concern for effluent surfacing or detrimental septic system performance. The test hole for this system showed a sand layer from 3.5'-17' deep. This sand layer meets the sieve requirements for a filter sand which should allow use of a trench type system design. A waiver of horizontal separation distance to the class C well on lot 192 to the North has been received from the Alaska Department of Environmental Conservation evidenced by attached letter. There appear to be no other impacts on neighboring lots. The drainage of the site is not expected to be a factor in this design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. \1997\97.045 -NAR TONY KNOWLES, GOVERNOR \.� ill.. DEPT. OF ENVIRONMENTAL CONSERVATION 1f Phone: (907) 269-7519 Fax: (907) 269-7506 DIVISION OF ENVIRONMENTAL HEALTH DRINKING WATER & WASTEWATER PROGRAM 555 Cordova St. Anchorage, Alaska 99501 October 13, 1997 Mr. Lou Butera Eagle River Engineering Services P.O. Box 773294 Eagle River, Alaska 99577-3294 Re: BLM Lot 193B, T15N R I W Section 18; Waiver Review ADEC # 9821 -WV -262-022 Dear Mr. Butera: I have reviewed your submittal of September 11, 1997 for the site conditions to allow replacement of a failing on-site wastewater system near Mink Creek in the Eagle River area. The information provided indicated that the waiver could indeed be granted but only if the replacement field follows what is in Table F in the 18 AAC 72 regulations. The percolation rate has come out at 0.2 minutes per inch, which would require a special sand, as defined in Table F, and either a bed type construction or a shallow trench. Please advise any authorizing agency of this finding. Inspection and sign -off of as -built plans shall be performed by a professional engineer registered in the State of Alaska. Arrangements for this inspection work are the responsibility of the developer. The on -cite systems will need to have as -built information turned in for review. The Department will check to see that the development conforms to the original plan that has been authorized. If construction or operation have not begun within two years after issuance of the waiver, the approval is void, and plans must be resubmitted to the Department for review and approval. Respectfully, William R. Rieth, P.E. Environmental Engineer WRR/cf Eagle River Engineering Services Louis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AK 99577-3294 (907) 694-3297 fax SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: LOT 193 T15N R1W SEC 18 11/24/97 A. GENERAL I. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health and State Department of Environmental Conservation requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage, Department of Environmental Conservation requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. The waterline is to be relocated to be 10 horizontal distance from the leachfield and septic tank. B. SEPTIC TANK 1. New septic tank shall have a minimum capacity of 1250 gallons and be of MOA approved design. 2. Existing septic tank and pit are to be abandoned by pumping, crushing and filling in place with lime mix. C. TRENCH 1. The trench is to be located exactly as shown on the site plan it is recommended that the engineer stake the location prior to construction. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 9.5' relative to ground surface at test hole. 4. A new sewer line is to replace the existing sewer line that leads to the existing system. The effluent line within the trench shall be laid level within 0.03'. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 120' to the Class "C" well on Lot 192 to the north, or 200 feet to any community well. RECOMMENDED LEACHFIELD DIMENSIONS: TOTAL DEPTH = 8' GRAVEL DEPTH = 4.0' under pipe, 2" over pipe TRENCH LENGTH = 60' TRENCH WIDTH= 5' SOIL RATING= 1.0 GPD/ft2 BEDROOM CAPACITY= 4 SEPTIC TANK = 1250 gallons ADD FILL TO MEET SLOPE SETBACK REQUIREMENTS Twenty-four (24) hours notice required for all inspections. \ 1997\97-045-spc-trnch.doc O O 0 Percent Finer N W S N m V O O 0 0 O O y� � N 0Aik qk{ 0 0 0 0 0 0 "` V fm 0 0 < 0o cn0a0 m w cnv oD co co w e u 1 o 0 Zp o 0 0 0 y, m A N C N N O � 00 m m p ° c `V �A1 N =i V�Ni NCD �i0 o _o Z a b 0 p 1 ui '=g.2 n 3 OZ ', k hn rKCDau .. m CD � i Z N W N o o W 40 'n -u 0 d V O Am Co o, < 3' p cT T N toCD /V CL CL as CL Vim o �zV S c vJC wI o m n M C/) o N C N N O � m S.�01 n Cl) o CD N D CD 0 0O°°�v�„ as m m O O< 7 N N u n u u n S a CD .. CO CO `,<, l< a a m ow0oowma.0 rKCDau O v N N N � i Z N N o o W -4 v H' 0 0 C) W w CA M "-101 120' WAIVED 01STAN C E - - - ------ LOT 192 --- --,-_--100 E ---- --- - --- - 234.98- 1250 GAL l00' CC 5et� K SEPTIC TANK 6� TOTAL- / I . 98 /�O�AjE wAtER UN0 j' DRIVEWAY EXISTING97 HOUSE ' nrracTeo —I 96 sHeo o ,wo ,rn tU0• CREW 9010 19TH 1 J! ,,/ �,o h- 95 £ eRFj'K +t gNd. ..moi ' , � i '- .,, , "-94 g00P0 1 F,el OF 93 i ---------- --- 234.98 NOTE: Sloe break Slope in be taken NOR1N 0K CR0 down to <25% or fill added to of maintain 35' seperation from ® — TEST HOLE septic to slope break • — MONITOR TUBE o — SEWER CLEANOUT TOPOGRAPHY DETERMINED USING — WELL ARBITRARY BENCHMARK — — — EASEMENT NO KNOWN CURTAIN DRAINS — PROPOSED LEACHFIELD — EXISTING LEACHFIELD WELL/SEPTIC SITE PLAN ' oF�q o00 oo��. (� p0 o ..... , S o �P,•• ' •,, �0 • �� o * :49TH LEGAL: LOT 193b OWNER: Harrington CONTRACTOR: N/A �, �, JOB 97-O45C DATE: SCALE 1 = 40' EAGLE RIVER ENGINEERING SERVICES LOUIS A. BUT RA �� �0�0,�••.,�:E-6736 P.0. Box 773294 .••aoo EAGLE RIVER, AK. 99577 •• (907) 694-5195 FAX: (907) 694-3297 oROF'• �� 4pp`l�essi��000 EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 Eagle River, Alaska 99577 (907) 694-5195 ERES Project No.: 97-045 Calculated By: LB Date: 10/24/97 Legal: Lot 1938 T1 5N R1 W Sec 18 TEST HOLE 1 Single Family 4 Bedroom Dwelling Shallow Trench Subsurface Wastewater Disposal Field Water use at 150 gallons per bedroom = Percolation rate = Wastewater application rate = Required absorption area = Trench width (W) = Gravel depth (D) = 600 gallons <1 minutes per inch 1 gallons per day per square foot 600 square feet 5 feet 4 feet Required length = Shallow trench factor' Required absorption area / W Shallow trench factor = (W + 2) / (W + 1 +2 D) Shallow trench factor= 0.50 Total Excavation Dept = 8.0 feet Required length = 60 feet Natural sand used for filtration, see attached sieve. '* ;=• 49TH '•.?'� LOUIS A. BUTERA;'. i4 cs '•• CE -6736 ,•' Z�� 44�4p�PROF E SSt�NPQ� � W 1 , 2 O "q, 3 O 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Tops,. 11417 liI (-Ie , / 1,2- R47-.1 (f w) Loos, dry /,rou.y f., , We- ; Gr -y, WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After/ �;' y Date: Reading Date Gross Time Net Depth to Net Time Water Drop i.h.r, i !iti_ u.' / • .�'Municipality of Anchorage Z .......... DEPARTMENT OF HEALTH & HUMAN SERVICES "L" "arc Low%A. 8vtam : 4,r� e T° 825 Street, Anchorage, Alaska 99502-0650J' CE -67Th ° - " SOILS LOG — PERCOLATION TESTt1" axe® ;G� air PERFORMED FOR:_/y ar "01J 2 �oNDATE PERFORMED:. O �3 97 LEGAL DESCRIPTION: ZIT 113 7 4 Township, Range, Section: ,p T/ 1W g r� nP H / SLOPE SITE PLAN 1 , 2 O "q, 3 O 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Tops,. 11417 liI (-Ie , / 1,2- R47-.1 (f w) Loos, dry /,rou.y f., , We- ; Gr -y, WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to Water After/ �;' y Date: Reading Date Gross Time Net Depth to Net Time Water Drop i.h.r, i !iti_ u.' / 1 g'—/3-17 l- av Z JPERCOLATION RATE a' z S (minutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN /' FT AND � FT COMMENTS PERFORMED BY: 2er !� 6` CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: zo — D N^ 7 7 72-008 (Rev. 4/85) X11 UHC CC0 , L� 7 V OF M CCH0RA C' 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. 051-232-47-000 Legal description T1 5N R1 W SEC 18 LT 193B Site address 18222 WERRE ST Chugiak AK 99567 Current property owner(s) HEARTY HOMES LLC Expiration Date: 12/29/2023 X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: The well that did serve this property was on an abutting lot and was decommissioned by Cole Sullivan to code. Original Certificate Date: 9/29/2023 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaIjune 2022 Development Services Department r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-232-47 Complete legal description T1 5N, R1 W, SECTION 18, LOT 1938 Location (site address) 18222 WERRE STREET, CHUGIAK, AK 99567 Current property owner(s) HEARTY HOMES, LLC/ANDY RICHMOND Day phone 815-621-3436 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public f Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age � 4 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ _5 50 Waiver Fee $ Date of PaymentPL�Lllp Date of Payment COSA # 0JG 2.3)Waiver # COSAAppflcaGon June 2022 COSA Checklist Legal Description: T15N, R1 W, SECTION 18, LOT 1938 Parcel ID: 051-232-47 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 LL DATA ❑ Well log I with Onsite (or attached) Date drilled depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) Date of flow test for COS Static water I beginning of test ft. Well production at time of test _ n Water storage tank vol gallons Well disinf or coliform test? E] Yes ®No oliform bacteria is Negative ate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/l- ❑ Arsenic less than MRL (ND) Collected by Date B. TANK DATA [FT STATION Measured operating fluid level in septic tank *1 ❑ Require 'ntenance Date of pumping 'SEE NOTE Age of lift station ❑ Required maintenance completed, if AWWTS Lift station Ial D. ABSORPTION FIELD DATA *WEST TRENCH/ EAST TRENCH Which system tested (date installed) 6/17-18/1998 Adequacy test date 9/8/2023 FM ALL standpipes present per record drawing TO1�O Results Q Pass Total measured depth from grade *8.04/ 6.9 ftft (�) F MrS Fluid depth prior to test **28 5 in Measured depth to pipe invert from grade *4.5/4.5 ft (min) Water added 1000 gal ❑ NIA — pressurized field. New fluid depth `43 in ❑ Per record drawings, field is insulated. Elapsed time 240 min ❑ Monitor tubes go to bottom of effective. Final fluid depth 14 in If not, state depth into effective *-3.57-2.4' Absorption rate 600+ gpd 0 Presoaked required if FIELD STATUS — POST RECOVERY (Required if house vacant or field not used for more than 30 days prior to date of test) Effective depth (per record drawings) 48 in Gallons introduced 2000 gallons 9/8/2023 date Effective depth used 20 in Any rejuvenation treatment (past 12 months) NONE Effective depth remaining 28 in If yes, enter date Comments/Deficiencies: *WEST / EAST TRENCHES. EAST TRENCH HAS 2" STEEL MONITRING TUBE. **TESTED WEST TRENCH ONLY. WEST AND EAST TRENCHES WERE DRY PRIOR TO PRESAOK. EAST TRENCH REMAINED DRY THROUGHOUT TEST. —FILLED TO TOP OF DIST. LINE IN CO NEXT TO MT FOR WEST TRENCH. CO AT BEGINING OF WEST TRENCH REMAINED DRY. WATER HAULS WERE USED TO PERFORM ADEQUACY TEST. COSA Checklist June 2022 E. SEPARATION DISTANCES V'rawWabvate Well on Lot to: (Please enter distances if less than required or if community well on lot) 0 Yes Septic Tank/Lift on Lot > 1(0 * ft Surface Water > 100' Community Sewer Ma eanout > 100' Tank to Property Line > 5' Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if ft ate Sewer/Septic Line > 25' [:]Yes if No ft Absorption Field on Lot > 100' ❑ Yes if ft Tank > 100' ❑ Yes if No ft Neighboring Absorption Fie _ 0' if No ft Animal Containm _ 0' ❑ Yes if No ft ❑ Yes if No ft Manure/Animal Excreta Storage > , nity Sewer Main > 75' ❑ Yes if No ft ❑ Yes if ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No * ft Surface Water > 100' ❑ Yes if No **92+ ft Tank to Property Line > 5' ❑■ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' no Yes if No ft Private Wells > 100' Mn Yes if No ft Water Main > 10' [E Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *TO PROPOSED NEW FOUNDATION (PER OWNER) - NOT INSTALLED YET. **WAIVER GRANTED TO DRAINFIELD - SEE WAIVER # WR980055. ***10'+ PER PANNONE RECORD DRAWING. G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Gamess Date C1 12.3 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry oboop practices. The reported results describe the condition of the system/s on the date/s of the evaluation. OF A i4 Separation distances were measured to readily identifiable features. Hidden defects or encroachments may o 9 exist that were not identified during the evaluation. The operational life of all wells and septic systems depend t . • S�Q upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate��' �I during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing 60-,4 T) �* the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not .... • . • • . • • . • 3uarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding �Q f the future performance of the well or septic system. GEG makes no representation whether an alternative well t - -- or septic system can be installed on the property in the event either of the current systems fail to perform Q1 f sr A.° Garnets. adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG �Q s, E-79 3.•: ceG to perform the evaluation. Reliance upon the information provided in this report by any other person or party Q �I (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. ��P P " • • • ti�AO 0 LICENSE oress af�io0 COSA Checklist June 2022 #AECCasa �4 oQ C? 1,3 2,3 HE FIELD NOTES PROVIDED BY GARNESS EGINEERING GROUP VERIFYING THF I Avnt IT nF THF FIELD. 9/28/21 v'�'1 T2 �� ? �;-' it g`��✓ S � , C.O q DIAGRAM OF SYSTEM - OVERVIEW/SKETCH OF LAYOUT WITH LABELED PIPED 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 * Ph: (907) 337-6179 * Fax: (907) 338-3246 * gamessengineering.com Municipality of Anchorage ka On -Site Water &Wastewater Program ` (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-232-4.7 Expiration Date: 1. GENERAL INFORMATION Complete legal description T15N, RIW SEC18, LOT 193B Location (site address) 18222 WERRE STREET *CHUGIAK, AK 99567 Current Property owner(s) JOSHUA & MELISSA HENRY Day phone 764-7082 Mailing address 18222 WERRE STREET #CHUGIAK, AK 99567 Real Estate Agent DAWN BURTON Day phone 373-4037 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: id COSA to be released to the engineer, unless othenNse requested by the engineer. COSA Fee $ Li t b E Date of Payment `�� 1I 113 C/i+Y_n Receipt Number0-DP, DMq G COSA#I CJI 0110 Date: '311;V1I3 Waiver Fee $ Date of Payment Receipt Number Waiver* 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 (:ARNFSS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE _—V System #1 Approved for bedrooms. Phone 337-6179 Date 3 e% Syster #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: ON-SITE WATER AND WASTEWATER pROGRA The Municipality or Anchorage Develop, emt 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory their Original Certificate Date: 3 3 (Rev. 11105) If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: T15N, R1W, SEC18, LOT 1938 Parcel ID: 051-232—Or7 A. WELL DATA *PER GEG INSPECTION **PER SURROUNDING WELL LOG Well type PRIVATE If A, B, or C provide PWSID# N A Date completed PRE -1965 Sanitary seal (Y/N) YES Total depth *69 ft. Cased to **40+ ft. FROM WELL LOG Date of test NO WELL LOG Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate ND mg./L. Arsenic: ND ug./L. Date of sample: 2/21/13 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments E Well Log (Y/N) NO Wires properly protected (YIN) YES Casing height (above ground) 12 in. AT INSPECTION 2/20/13 36 ft, 0.70 9.p -m. Collected by: GEG. Ltd. Date installed 6/17-18/98 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping k*is Pumper .T4- s P"Y" b i ria C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 6/17-18/98 Soil rating (g.p.d./ft or Ybdrm 1_0 System type SHALLOW TRENCH Length 60 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth *8.08 ft. Eff. absorption area 600 f? Monitoring tube YES Depression over field NO Date of adequacy test **2/21/13 Results (Pass/Fail) ***PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 211 in. Elapsed Time: 120 min. Final fluid depth 16 in. Absorption rate >= 600+ g,p,d_ Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **PRE—SOAKED ON 2/20/13 WITH 2000 GALLONS OF LIQUID. ***WEST TRENCH WAS TESTED ONLY. EAST TRENCH HAD 17 INCHES OF LIQUID IN IT AT TIME OF INSPECTION. D. LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access "Pump off" level y m� High water alarm level at in. Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES WELL IS LOCATED ON NEIGHBORING LOT SEPARATION DISTANCES FROM WELL ON LOT TO: (MINK CREEK #1 LOT 2) Septic tank/lift station on lot 100'+ On adjacent lots *85' (LOT 192) Absorption field on lot 100'+ On adjacent lots Public sewer main Sewer /septic service line 25'+ Public sewer manhole%leanout *100'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line ***10'+ Surface water 100'+ Wells on adjacent lots 100'+PVT/****l20'PUBLIC SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10'+ Building foundation 10'+ Water main N/A Water service line ' ***10'+ Surface water **92' Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots100'+PVT/****120'PUBLIC F. COMMENTS *APPROVED ON 10/21/77 INSPECTION REPORT. **WR980055 ***ASSUMED, PER LOUIS BUTERA, PE ASBUILT 9/2/98 ****ADEC WAIVER TO CLASS "C" WELL ON LOT 192. 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 COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 31 r 9113 (Rev. 1 1ro5) Municipality of Anchorage pP 4 sz, Development Services Department Building Safety Division s h F On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 131076 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot 193B of T15N Rl W Sec 18 subdivision, the well's productivity was determined to be 0.7 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.42 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division _ On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-232-47 1. GENERAL INFORMATION COSA # n�e 1331 Expiration Date: Complete legal description Lot 193B, Bection 18, T15N, R1W, S.M. Location (site address) 18222 Werre St. - Chupiak, Ak. 99567 Current Propertyowner(s) Lynn Griffis Dayphone 688-2097 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O. Box 672277 - Chuv.iak. Ak. 99567 Day phone Ray Dahl Dayphone 776-77611_ Unless otherwise requested, COSA will be held by DSD for pickup. G �"�- Vj r y ° A 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well fJ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Individual On-site E} Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 Certificate of Onsite 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 FirrrtS & S Engineering Phone 694-2979 Address 17034 Eagle River Ln. Rd. - Ste /1204 - Eagle River, Alk. 99577 Engineer's Printed Name Robert C. Cowan Date 7/2 -I -AC COWAN 5. DSD SI NATURE a i ROBERT CE G 880011 �fI , JY•� CE Approved for _ 1� bedrooms. tF t � ............. t 'v..�. .Ii ,,, raj Disapproved. Conditional approval for bedrooms, with the following stipulations: COSA Checklist X Septic System Advisory Well Flow Advisory _y_ Nitrate Advisory Arsenic Advisory . Maintenance Agreements Supplemental Engineer's Report Other BIN • / rt -(/1 Original Certificate Date:^ O� (Rev IV05) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw, Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onske (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: LOT- 113 Sri. (g� TISK j iztt� Parcel ID: 05t -P -32--q7 A. Wou ►cR Ii3Fi Well type C-IVRTr-)K- If A. B, or C provide PWSID # = Date completed). l°('�r� Sanitary seal Total depth —Il_ft. Cased to _% t ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: IH Coliform colonies/100 mL Nitrate 0-1 mg/L Arsenic: Q mgA Date of sample: io G 66 B. SEPTICIHOLDING TANK DATA Tank Type/Material<-/ g i Tanksize I7-50 gal. Number of Compartments 2 Well Log (YCP #" Wires properly protected (91) qt's . Casing height (above ground) 1Z i- in. AT INSPECTION ;25' a3' ft. *15 g.p.m. Other bacteria 0 colonies/100 ml Collected by: SA -S F f�7FL��liVG Date installed Li 7 - 4,114'/16 CieanoutsCWN) `{EZ Foundation cleanout(M1) Yret Depression over tank (Y® _J�n High water alarm (Y& Az Date of pumping bio Pumper 6/}V_') IT6F-y 'Rs"A'lri , C. ABSORPTION FIELD DATA Date installed 6 .7'L 94 Soil rating ((p.d.e: ft2/bdrm) /" D System type StOttkn(o Tn-Fx:cN Length Tt. Width 5 r ft. Gravel below pipe ft. Total depth 9ft. Eft. absorption area _�_Mfe Monitoring tube ` Depression over fieldA-'O Date of adequacy test Z Ob Resu Pas ail) e RsS For AL bedrooms Fluid depth in absorption field before test -L in. Water added gal. New depth 23"in. Elapsed Time:al l min. Final fluid depth L in. Absorption rate >= 6CO+ g.p.d. Any rejuvenation treatment (past 12 mo.) ( type) &P 0 If yes, give date D. LIFT STATION IJ'A Date Installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Cycles tested at _ in. High water alarm level at Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: u76r , Clu L-e�)T 10061+ 3l4 Septic tank/lift station on lot 121 Absorption field on lot IM, Public sewer main iJ Sewer /septic service line 25 (+ r Animal containment areas + On adjacent lots i m I+ On adjacent lots 1W I t Public sewer manhole/cleanout 131 )1 Holding tank IJ 1 A Manure/animal excrete storage areas /DO f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10 I Property line I D /-+- Absorption field 5 r+ Water main x7 H Water service line 10 a" Surface water I co Wells on adjacent kits a0 '*- - in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 I -} Building foundation 10 IWater main &)/A Water Service line t0 I+ Surface water QZ Driveway, parking/vehicle storage O Nod Cti ndP Curtain drain WAOC- KR-'Yvc'N• Wells on adjacent lots 1 do f- 'D¢auE Lcel f - F. COMMENTS jt 1.4 FS C wKL- 0" DoT /92 wn.vco BY r+�--- G. ENGINEER'S CERTIFICATION AnE c- /o /r3 / g 7 w A`� OF 1 certify that I have determined through field inspections and 10' review of Municipal records that the above systems are in fit! conformance with MOA COSA guidelines in effect on this date. �n1r Engineer's Printed Name K O 6 E-/tT C. o w 9' ORE N1 c Co% Date �� Y- �0 G , CE -8801 COSA Fee $ If 3 o. eo Waiver Fee $ _ Date of Payment 7 a r /0 C Date of Payment Receipt Number O $ 3 70 -a- Receipt Number, (Rev. 11105) Municipality of Anchorage • �` Development Services Department Building Safety Division ` On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Health Authority Approval # 060331 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block , Lot 193B of T15N R1 W Section 18 subdivision, the well's productivity was determined to be 0.93 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. 07/13/2006 11:30 9072767004 ROBERT E JOHNS JR PAGE 01 a.. rats+ L-/92 rbT.RA.r NUMIl Y Yi>Aomm �rB lvEL4 L OC•bTEO OH L - /93A I 3a yvEsr 234. vB ' . 832? ',wt - • � I I c fb W o �Ni WEJ� 23 F. SIB � OLO Ouno Nplttf iAr Row JERR f7vE � y UNOOU NO CIRCUMSTANCES SHOULD AN AS -PNET BE USED rCR C067PUCDDN OR rOR ESfAA SHING BOUNDARY OR 1410E UNES THE SURVEYOR TAKES RESPONSIBILITY FOR THE KHAT. TRANSACDON ONLY AND ASUIES rNANQAL UADERY OVLY FOR THE COST OF THE WRVFY. LISTED DISTANCES PREVAIL OMR 5CAUNG. R[PROOLICl1ON MAY CAUSE ERRORS N SCALE Urr MANTY SURVEY TYPE SYMBOLS FQRnAYWI AL-t.LT • SET REBAR OR� = ASPHALT ANAL SMVXTJK AS-O&T O FOUND 1®M•r..: .e--a—B 11D00 FENCE '`�'•�•�CONCRETE Kor RAH ... AT.i,LT... YFaT ... 7�IMNT ® ASSIMED ELEV. w—±.—iv METAL F04M ® WOOD Om PLAT PLANS k LOT SURVEYS NOTE IT IS THE RESPONSIBIUTY OF THE SULDER OR OWNCR, PRIOR TO ONLY THOSE: BAPROVEMENTS ABOVE GROUND AND VISIBLE WILL DE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE 0401114. FENCES VKUS. SEPTIC CLEANGUTS. SIDEWALKS. DRIVEWAYS. TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE' ETC., ARE SHOWN M THEIR APPROXIMATE LOCATION. ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROV040M FROM BONG SEEN AND LOCATED. WNICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERVASE NOTED, SURVEY CERTIFICATION Prepared by ROT PLAN o• OF +. E Robert E. Johns, Jr. & Assoc. . -,.. . ••�P�••" w v ••� ••, 1 Professional Land Surveyors row A + •ty `. WEI2 AVE ANCNORA.M ALARA 9115M K Rq LOl il•. RK. PIOI no H4 f S 1t Y ^ O , Y FOUMA110N AS.R0.T DOW 9R�1•t 5-17-06 Dr by CAKkea by. .«:..r7« -,RaBEA /11 A r•-� .pli JL �_' REJ MLJ orl. oar `5-16-06 ' NWLUS,4 6129/99163 �� % 41, ,� X1L �,MpE AS_�T •11 f1•F0 ft. L�I� Dwavi m M` �••�^^-� •w r�„� M,MM,.M•• 4411 A,�� ` LOT 193-B of Bb MM LOS, 193 1�wo�CA SEC 10i T15N,RU Wo SH 2 3 4 7 8 9 13 .14 1�4 '40 17 ."A 22 This indenturojilade thin : Jnr; ,, day of Xt'­,a 4:?17 41-� P 1976, bOtWeen :11ERDERT WEM"and ALMA H. WERREp grantors and : CALVIN WEMi grantone A t Whoroaso said.grantore are the ownere-in fee-simplo,' ofa parcal.of land in town of Chugit.%ke in,thotgtate,of Alaska, described herain's133 r:0 t Ai ii j. -v Lot 193h Of 13W1 LottI931 'locate % 't, . the South one-half (S. 1/2) of the :iv) :ifliorthoast-ono!-guar or (NE'I/4):1,bf t . . 4 the Southeast ono -quarter (SE'1/4)- .it" of,, the Southwant 'ono-quhrtor:* (SW 1/4) -.Ii,I-i- of Section 'Eighteen '(18) , T o w I I a h i ?P, �j; f, i 14;1. - pi"! 15 Northt.1,Ran(jo 1,W ont, Seward�,141'- Moridiftne..Alaskat- Doing withinAllo lv%� Anchorage Recording District,' Thir Judicial j)intrictj,.Stata ofAla A is al *4 ll on which they have'sunk,.aiwell -tho"locationlof1whic a pprox- a Lmately,9 feet`4 ,west of,tlib.bantern`bbundarylof%'said ;lot and approximately 40!foat-aouth,!-,Of 'the'northorn ,,boundary; of viid.:la.t "X .tnd',I'kftVQ agreed with thetqranteo, 1'who,io owner"iiiin i fee,simple-of. iv a Pa rFa . I of land..adjoininik that �'odt' he grantoraAascribod'ab0 vo, describedh Xi erein.ft ono -half (Sri/2) Lot 1938 Of t'DL!4 Lot, 193, the South - one of .the 'T NOrtheaet ono- quartsr (N V 114)l of '!;A J` the Eontheant'one-quarter '(Gr Of the Sauthwast one-quartor'(SM0 1�CIP 1�14 Y,of Section-Lightoonl(IS)'Townshi P t.:�91104 -'- IS llorthfr.;tRanga l-,,Wustf, Geward"':- �'�Moridian,.'.Alaska , being withlW'tha Knchorifyo Rocording Diatrict,"*.ThIrd k Y- 1­4�t;JudLcial Diutricte-BtAte of Alaska. -ant �o 'tojilm the easeinent'.-heroinafter describedt j",`Jr Now this indenture witnoonoth as follows$ .,For good and valuable Ponaideration,by the If ,.thefsald grantors.".hereby., grant unto said c(djacont ownor, Is heirn-and assigns# full'.'And fres,and exclusive right' and uthority:by. himself or.themselvag,,, his or their. sorvants,or) 23 24 .25 26 21 28 29 30 31 32 This indenturojilade thin : Jnr; ,, day of Xt'­,a 4:?17 41-� P 1976, bOtWeen :11ERDERT WEM"and ALMA H. WERREp grantors and : CALVIN WEMi grantone A t Whoroaso said.grantore are the ownere-in fee-simplo,' ofa parcal.of land in town of Chugit.%ke in,thotgtate,of Alaska, described herain's133 r:0 t Ai ii j. -v Lot 193h Of 13W1 LottI931 'locate % 't, . the South one-half (S. 1/2) of the :iv) :ifliorthoast-ono!-guar or (NE'I/4):1,bf t . . 4 the Southeast ono -quarter (SE'1/4)- .it" of,, the Southwant 'ono-quhrtor:* (SW 1/4) -.Ii,I-i- of Section 'Eighteen '(18) , T o w I I a h i ?P, �j; f, i 14;1. - pi"! 15 Northt.1,Ran(jo 1,W ont, Seward�,141'- Moridiftne..Alaskat- Doing withinAllo lv%� Anchorage Recording District,' Thir Judicial j)intrictj,.Stata ofAla A is al *4 ll on which they have'sunk,.aiwell -tho"locationlof1whic a pprox- a Lmately,9 feet`4 ,west of,tlib.bantern`bbundarylof%'said ;lot and approximately 40!foat-aouth,!-,Of 'the'northorn ,,boundary; of viid.:la.t "X .tnd',I'kftVQ agreed with thetqranteo, 1'who,io owner"iiiin i fee,simple-of. iv a Pa rFa . I of land..adjoininik that �'odt' he grantoraAascribod'ab0 vo, describedh Xi erein.ft ono -half (Sri/2) Lot 1938 Of t'DL!4 Lot, 193, the South - one of .the 'T NOrtheaet ono- quartsr (N V 114)l of '!;A J` the Eontheant'one-quarter '(Gr Of the Sauthwast one-quartor'(SM0 1�CIP 1�14 Y,of Section-Lightoonl(IS)'Townshi P t.:�91104 -'- IS llorthfr.;tRanga l-,,Wustf, Geward"':- �'�Moridian,.'.Alaska , being withlW'tha Knchorifyo Rocording Diatrict,"*.ThIrd k Y- 1­4�t;JudLcial Diutricte-BtAte of Alaska. -ant �o 'tojilm the easeinent'.-heroinafter describedt j",`Jr Now this indenture witnoonoth as follows$ .,For good and valuable Ponaideration,by the If ,.thefsald grantors.".hereby., grant unto said c(djacont ownor, Is heirn-and assigns# full'.'And fres,and exclusive right' and uthority:by. himself or.themselvag,,, his or their. sorvants,or) tiaK 1.UIIbL1ULLIU11 ItL NU.W(-000-0VJV 1 2 9 4 5 6 7 8 UCt U15131 b:UU P.U1 �♦ .11i1F � kgents, to enter upon the land of the grantor and to pass and repass by a loot -path to and lrom.caid well and to tako water from the well pump for all domestic purposes to the uao of the said -adjoining owner, his heirs and assigns forever, or at the option of Paid adjoining..owner, his hairs or assigns, he or they have the right and authority to utilize a pipe from said aall'to the house on tho land of said adjoining owner and by a pump or other means to draw water from said well for all domestic 9 purposes exclusively and to the exclunion of any use by the 10 grantors. The granted shall have access necessary to effect 11 repairs of the -aforementioned pipe and pump. This interest is 12 conveyed in parpetuity on.the condition that the grantee, his 13 heirs and assigns forever, keep the well in good order and free 14 from contamination. 15 DATED at Anchorage, Alaska, this day of . , 16 1976.• 17 19 FZ111 21 •22 23 Hat ort Werra, grantor. • . erro, grantor TB OF ALASKA ) RD JUDICLAL DISTRICT ...) 24THIS IS TO CERTIFY that before hie, the'undersignod 110tar; 25 Public for Alaska, duly•.commissioned and sworn'se such, poroonally 26 appeared -118RBERT WERRE', • known to me to lie the individual described 21 heroin and who executed the foregoing instrument* and he acknoH- 28 ledged to me that lie signed and sealed the ■ams an his free and 29 volunta ry sot and deed for the uses and purposes therein mentioned 30 S1 0 WITNESS HY .hand and official seal this is r4. day of. W2r III . .5 .2 3 4 Is, moll"' ww 1976. My Commission Expires, STATE OF ALASKA of A TIJIRD,, JUDICIAIJ DISTRICT f.tfa mejxthq,, eirsignad 14a THIS'IS -TO -CEkllpy thatl:befor und . I 10 1. il I I . . porsona rub),ja,for,.Al&0X1kr:-dUlY-. POwm's uionod.and.'sW9rz appearad ALMA: M- toona to b6..the.LndLv1dual.dencri herein. . and who oxecuted-tho foregoing instrument, and%ahe acknc ledged to me that she signed and.,sealed.tho%pome aa.he r;free:si 4 1 purpoegg'therain mentit voluntary &ct;.aand deedifortthe.4uges'Panc .4, eli WITNESS MY hand'and`• of iiCia I'seali this' day of A 1A Is!I1, Aj. IlV 4A) 'If.. 1; Notary Vublie -in anazur Ar_avK_e,.'w* F/ q At ' All.. Commission Upireast' s. 4.0t, 5 - 0 %Ie I` r .•i'4' Y,11 q:Tqi, - 20 V -'i' `6b ri; DIS 2 1 Al 4* , 1 .1 4 :kO ;.I • V ,J...'•. 'f,% tic W A' 1y;i-xtI '22 j. uy -Tit. 11 23. 24 A Pic 25 0 26 -0 1 28 #4 29 o..' !C II �30 31 • 32 RIM Norp"Ift 11 A MIDLAND MCA""* AT LAW mt will $to AVIpV# "3- REQUEST APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) Z.. Name of person request i a proval� 2• Name of properrty% owwnner/� 3• ;.eyel descAl44, , /V ..f 4, Number of bedrooms in house-- 5. Water Analysis: a. b. Detergent` 6, Well data: a. lype b. Depth_ l�Q c. Casing Size d. Distance from well to closest existing* or proposed: I. Sewer line 2. Septic tank -- G 3. Seepape Area i4 Ci 4. Cesspool' +——� 5. Property Line �Y 6. Other sources houses, barn, ofr� possible contamination, drainage i..e., creeks, lakes, ditch, etc. 7. Sewage disposal system. a. Age of systern� b. Septic tank capacity in gal.ions f(1p p c. Name of septic tank manufacturgniL_A S F. 1, q 1. If "home made" show diagram on reverse aide of this form. d: Disposal field or seepage pit size and typ,e__.__ J �- )(/�- C k1 J3 1. Distance to property line`_ to house fc,indati.on �` e, Percolation, Test results f. Percolation Test performed by `0. Use the reverse .side of this form to show diagram. Diagram should include -the following information: property lines; 'Well location, house location, TWA tank .location, disposal area location, .location of percolation test, aWI direction of ground slope. 9. The ;,rtor,c tion on this form is true and correct to the best of my knowledge. Signature of Applicant Date Signed TO BE FILLED OUT UY HEALTH DEPARTMENT PEPSONNEL O~Phe above described sanitary facilities are hereby approved, subject to the following condafions: Conditions; QJKWz-t. Q The above described sanitary facilities are disapproved for the following* reasons; Signature ofy Approval is valid for one year following the date of approval. CPJ:cw