HomeMy WebLinkAboutWILLIAMSON #1 BLK 1 LT 11 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221101 PID Number: 015-073-28 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New © Upgrade Name A ORPTION FIELD Existing Crib Ashley Bais ❑ D Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 5135 E 98th Ave Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 DIS F Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Ft. Subdivision Block Lot Williamson 1 11 Fill added above original grade Gr I length Ft. Ft. Township Range Section 1 Gravel width Ft. Beds: Number of Lines Dist a between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between t ches From Tank Field Lift Station Tank Line Ftz Well 100'+* 25+ TANK Z Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. I Surface Water I100'+ I Material Plastic Number of compartments 2 Lot Line 59+ I NA TATION Foundation 101+ I Manufacturer Capacity Gal. Remarks *Well to the North (Lot 12) 86' from tank. Septic tank field verified 5'+ from absorption field. Alarm location Electric ' alled by PIPE MATERIAL House to tankTank to D3034 drainfield D3034 Installer A+ Drainfield CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection�� 5/23/22 nd 5/23122 Location and description dates: 2 3`d 5/24/22 4th Bottom of south east corner O.H. ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ♦'�� ,411 """�•..�y.. Conditional Approval: Date ��� ��'"� ��, r• MW 49I1i*••fi s KENNETH S v �� Septic System CE 71 r Approve Date -3--20 �#,t,. p' � f• � ��;;����• Note: this approval does not include well permit requirements. (Rev 05/02/18) I I AS -BUILT SYSTEM DETAILS/SITE WILLIAMSON #1 BLOCK 1 LOT 11 DRIVEWAY, PLAN Permit EISP221101 PID# 015-073-28 EXISTING BUILDING 0 —7Z_1 Al A—C=29.8' FIELD BOOKS B—C=34.0' BOUNDARY. N ZA A—D=30,8' STMNG: N /A B—D=34,4' AMUILM HOLT A—E=32.5' DWG. FILE B—E=35.0' ACAD FILE 'FILE A—F=37.2' OR B—F=37 2, A—G=39:2' B—G=37.4' Rn A—H=39 2' B—H=36:9' d. SCALE, NTS 1000 GAI SEPTIC AM" F AZ4, "A Ar PREPARED FORi ASHLEY BAIS 5135 E 98ND AVE of 4 in#A ANCHORAGE, AK If :-* 4. SCE 7_7. 6 w A 7- ...... 'Ao %msslovol> dw FIELD BOOKS compulm: BOUNDARY. N ZA DRAWN: KSQ STMNG: N /A CHECKM KMD AMUILM HOLT ' DATE5/24 , DWG. FILE GRID: SW24; ACAD FILE 'FILE " N 22121 SCALEt 1' = 30' SCALEi NTS ncnt Municipality of Anchorage Q '1 n i - Uepnrtmcnt P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Proqram * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221034 COSA OSC 221237 Permit#: osp221101 PID#: 015-073-28 Legal Description:Williamson #1 Block 1 Lot 11 Engineer: Arc Terra Applicant: Ashley Bais Your request for a waiver of the required 100 feet horizontal separation from the Well on lot 12 to the Septic tank and Crib on lot 11 has been approved. The approved separation distance is 75 This waiver approval applies to the Existing Error! Reference source not found. only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department ❑The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property. [Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: �_- —3 20 _2-Z Approved by: Name of Reviewer ............................................... ■ ............................. ■ **** VARIAN C E/WAIVER REVIEW **** v �RCTERy 4� June 2, 2022 ARcTrxKA CONSULTING, INC 20441 Ptarmigan Bid, Eagle River, AK 99577 Office (907) 696-6111, Fax (907) 868-3793 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Separation Waivers - Williamson #1 Block 1 Lot 11- OSP221101 On May 11, 2022, a_ tank replacement permit was issued and during the installation of the new tank, we have moved the tank outside the other conflicting wells. We are requesting Well to Septic System Waivers for the well on Lot 12 to septic tank on Lot 11 of 86 feet and to the septic crib on Lot 11 of 75 feet. We did field verify that the new tank is 5' from the crib but did not further verify the location of the crib which was installed in 1975. After the installation of the new septic tank, an updated survey has been performed which shows the new tank is outside of two well radii but the well on Lot 12 Blk.1 Williamson #1 was drilled too close to both the septic crib and the old septic tank. Reviewing previous water samples taken on Lot 12 show results in 1985 as "satisfactory" and on 2/25/94 nitrates at 0.18mg/ L. New water samples were taken on June 1, 2022, and we anticipate results on June 6ffi. We replaced the steel septic tank with a new plastic tank that will reduce any leakage and we have placed the new tank at least 10 feet further away from the previously approved location. We do not expect there to be any adverse effects to the existing wells or this septic system operations in the existing location. If you have any questions, please contact me at 696-6111 /FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. KennethuVl. D s, P.E. Attachment Previous Water Samples Lot 12 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 D~P~ O~ ~NVIIRON]MENT~ki~ CONS~tV~T[[O~ BII. L SHEFFIELD, GOVERNOR ANCHOI~AGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHOP~GE, ALASIfA 99501 274-2533 May 16, 1985 Ms. Darcy Bevens Alaska Environmental Control Services, Inc. 1200 West 33rd Avenue Suite B Anchorage, Alaska 99503 SUBJEOr: Horizontal Separation Waiver Between Well and Septic TaM~, Lot 12, Block 1, Willia~on Subdivision 8521-WA-158 Dear Ms. Bevens: The department has revi~ved thes ubject waiver request and hereby waives the horizontal separation between 'the well and septic systems to 75 feet on the subject property for a 3 bedroom single family residence only. Sincerely, SE/dd District Engineer 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: OSP221101 Work Type: SepticTank Upgrade Tax Code Number: 01507328000 Site Legal Address: WILLIAMSON #1 BLK 1 LT 11 G:2437 Site Mailing Address: 5135 E 98TH AVE, Anchorage Owner: BAIS ASHLEY Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 5/11/2022 5/11/2023 12320 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ 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: • For a COSA, a waiver will be required for the separation between the field on the lot to the well serving Lot 12 Received By: Issued By: ` v Date: Date: 3 MUNICIPALITY OF ANCHORAGE F� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-073-28 Property owner(s) Ashley Bais Day phone Mailing address 5135 E 98th Ave, Anchorage, AK Site address 5135 E 98th Ave, AnchoraLye. AK Legal description (Sub'd., Block & Lot) Williamson #1 Block 1 Lot 11 Legal description (Township, Range & Section) Lot Size 12,320 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑x Upgrade (w/wo AD U) Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: - 22 5 Waiver Fees: Date of Payment: W^ 2 ? - z z Date of Payment: Receipt Number: (9c, Receipt Number: Permit No. O S pe'Z 0 1 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221101, Deb Wockenfuss, 05/11/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221101, Deb Wockenfuss, 05/11/22 GRE' ANCHORAGE! AREA BOI: Department of Environmental (;~uality 3330 C Street Anchorage, Alaska 99503 JGH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME t'J/---~N/~ '~/~'g LOCATION ~'d]~-% MAILING ADDRESS ?)¥~"~ / ~ _ (v ,:~,<?') ~:~'SZ'~'~' PHONE _!~ </~'?' LEGAL DESCRIPTION SEPTIC TANK: DISTANCE ~t,~J~ ~ ., · FROM WELl [@o) MANUFACTURER~.~/?)~'?' NUMBER OF COMPARTMENTS INSIDE LENGTH INSIDE WIDTH .LIQUID DEPTH .LIQUID CAPACITY 2c']¢?¢'~ GALLONS. SFEPAGE PIT: NUMBER OF PITS DIAMETI-ZR _ OR WIDTH LINING MATERIAL ~___ CRIB SIZE: DIAMETER BUILDING FOUNDATION'S ~, NEAREST LOT LINE ~ . LENGTH__, DEPTH DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ~)¢ .SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE BUILDING FOUNDATION CFSSPOOI APPROVED CONSTRUCTION NEAREST LOT LINE OTHER SOURCES _ DISAPPROVED NEAREST SEWER LINE REMARKS DEPTH DISTANCE FROM: SEPTIC SEEPAGE TANK SYSTEM DISTANCES: INSTAL. LED BY:~.~'~ LOT SLOPE: Form No, EQ-031 DIAGRAM OF SYSTEM DATE' I)/~',' __ SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY SOil TEST RESULTS --~'x~(~}'~/J/'"~/~'/~'~ ~'/~-~'~'/? NOTE~ THIS PERMIT IS ROT VALID WITHOUT SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE BEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION, SEPTIC TANK SIZE ./'~/'J~/~/~ ~'/~*~/' TYpe "-:~'~'~,'/~'~J~..?! SEPTIC TANK ~, SEEPAGE PIT , DRAIN FIELD WELL TO SEPTIC TANK //>4/ i SEEPAGE PIT /L//x WATER MAIN TO SEPTIC TANK //] CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WiTH AIRTIGHT REMOVABLE CAPS. GRAVEL DA~:KFILL 12OO West 33r(~ Aven~e ",~ite B ANCHORAGE, 'ALASKA ,03 6HECKED BY . DATE (~07) 561.5040 GREATER AI~CIIOI</\G[ AI~EA Department of IZnvironmental (]uality 333() "C" Street Anchorage, Alaska 99bU3 ,";()II,S 1,O(; Iq'HIOI,ATION TEWI' lhis form reports: Soils log_~ ................... Percolation test Depth Feet 10- 11 - 12 - 13 - 14-- Was 9round water encountered? ~.<? ........ If yes, at wi)aL i~r~:ol ati on rate minute, -Proposed )nstallatlon: Seepage Pit Orain Field Dept'l~--t-O"iJ6~¥Oi~l-b:F-'pi t or trench I)epth of Inlet ................ · C014MENI'S: Eq 040 (6/74) GREATER I\NCtlOId\GI: AkLA BOROIJ(,, iJel)artment of Lnvironlnental (}ualiLy 3330 "C" Street Anchorage, Alaska 99b03 ,'*{)II,S I,O(, PEllOI,ATION TI';ST ~erforlled for .,~'~o ~<- ;)ate PerformrJ This form reports: Soils 'log_~ .................... Percolation test D e p t h Feet 1 - 2- 3- 5- 6- 7- 9- lO- ll - Was ground water encountered? _~..o .......... If yes, at wi~at depth? Reading Date Gross Time Net Time _~e?_th_!!o~W.a_te_r_ Net Urop .Proposed installa~i~h-:-~e~)a~e Pit Drain Field DeptS-'~"b~in-}[F-pi t or trencii I)ep~h of Inlet ................. · COMMENTS: E(~ OdO (6/74) rp mv V7, ct L', R a w A; tam -A AND CASED OWI' 11-01.1-lu. I. -(.)CATION 017 Wl-*-'I.I..Wi)" RT--IpV-IA- MAI: WELL LOG:* L g" '90 il ............... :—Ir— kK---U6 60 f0o0t; IxondA OR. .41Ault".11I.C.4 20 Rcc'e" oqx- IJECI COST INCI.UDJ---S ALL I-ABOR AND'MATTA-RI'Al.' 1=013 COMPLIZ-114N OF' SAlq WRI.Tr-- CHECK l PAYABL E4 TO RAMtb�An*r- jDmi, LING WQ I -S F R THANK You' Vr---, RY. M IYC H. la(�R' Nlk- US, RAM PAR T DRII:WNG WO W LB ON 00UWTS, .9mvitr CHARGE 0 r.- I %a.% 'R IvION-rii. IL'*", ki' PH . ....... .. GOST INCLUDES ALL LA[]OF~ AN[] MATITFIIAL FOIq COMPL, bTFIObl OF [3AID DItlL,I, ING. VVRITE CHE:CK PAYAE3L~ TO RAMP/kRT ..DFtlI.I.ING INOFtKG FOFg TI-lIE SUM OD f ~2f)f~)ko(I[} ' ~ TIhANK YOU VFZRY MUCH. rGE • '-� Municipality of Anchorage BG On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-073-28 1. GENERAL INFORMATION Complete legal description Williamson #1 Block_1 Lot 11 Expiration Date. Location (site address) _ 5135 E 98th Ave. Anchorage, AK _ Current Property owner(s) Ashley Bais Day phone Mailing address 5135 E 98th Ave. Anchorage,.AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class _ Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Well to Tank*,Well to Septic** (**MOA waiver 5/16/85)Distance: 86'* 75'** Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5 6 �� Waiver Fee $ Date of Payment Jt' �Z6 �0,22 Date of Payment _ Receipt Number 03 a i g 6 Receipt Number COSA# OSC�2 23% Waiver# 0SV 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 ARCTERRA CONSULTING,_INC. Phone _696-6111 Address 20441 PTARMIGAN_ BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date Engineers Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future �� �►\ occupants or can ArcTerra guarantee that no unseen i O 4 encroachments, -deficiencies or discrepancies exist. �•,��iA= _ �ft� f 1 01 T F1 6. DSD SIGNATURE _ QQ System #1 Approved for J bedrooms. c;Eti,_r" r O.'' 71 System #2 Approved for bedrooms. 'Fn z Y pp 1.. Ar Disapproved. V%, By: Conditional approval for bedrooms, with the following stipulations: k�`\ �,o wff Yf n.rcr��/i Original Certificate Date: V J-(?CZZ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory _. Arsenic Advisory Well Flow Advisory Other _____ COSA blue sheet 10-10-12.doc Legal Description: COSA Checklist Williamson #1 Block 1 Lot 11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA 0 Well log is filed with Onsite (or attached) Date drilled 9/15/1975 Total depth 226 ft Cased to 123 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 4/20/22 Static water level at beginning of test 62 ft. Comments B. TANK DATA Age of tank(s) New years Tank type/materialSeptic/Plasic Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping New Install 5/23/22 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/7/1975 ® ALL standpipes present per record drawing Total measured depth from grade 13.5 ft (max) Measured depth to pipe invert from grade x 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 Comments/Deficiencies: x9' Gravel COSA Checklist yellow sheet Parcel ID: 015-073-28 Structure served by this system Well production at time of test 6.1 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ® No It Coliform bacteria is Negative Nitrate mg/L ® Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Arcterra Consulting Date of Sample 4/20/22 C. LIFT STATION ired maintenance completed Age of lifts years Lift station material Comments: Adequacy test date 4/20/22 Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test 51 in Water added 450 gal New depth 58 in Elapsed time 30 min Final fluid depth 51 in Absorption rate 450+ gpd Any rejuvenation treatment (past 12 months) 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 V Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' Rl Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® 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 0 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 Surface Water > 100' ® Yes if No ft Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ❑ Yes if No 86* ft Water Main > 10' ® Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ❑ Yes if No 75** 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 *Waiver requested for 86' Well to Tank. **Existing 75' Waiver granted 5/16/1985 on Lot 12 G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet • • �i Q • Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 s a CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-073-28 Expiration Date: \r 131 01 1. GENERAL INFORMATION Complete legal description WILLIAMSON#1 BLOCK 1, LOT 11 Location (site address) 5135 EAST 98TH AVENUE,ANCHORAGE,AK 99507 Current Property owner(s) MICHAEL DEMARAY Day phone Mailing address 5135 EAST 98TH AVENUE,ANCHORAGE,AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 TYPE OF WASTEWATER DISPOSAL: 4. TYPE OF WATER SUPPLY: Individual Individual Well ® Holding Tank ❑ Individual Water Storage ❑ Community ❑ Community Class Well ❑ Public Sewer ❑ Public Water System ❑ WaiverNariance request for: Distance: Received by: �i �./ ,/ Date: _Ja71/3/ COSA to be released to the engineer,unless otherwise ,r•oested by the engineer. COSA Fee $ 5 Waiver Fee $ Date of Payment i r'15O/1P Date of Payment Receipt Number QaC16/110 Receipt Number COSA# Q S c i&a7 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 ARCTERRA CONSULTING,INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 11/06/2018 Engineer's Comments:This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use,local soil characteristics,groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, \t✓11'FU_1 I , ArcTerra can not give any estimate of how long a • 4\ r y system will function satisfactory for current or future • OV occupants or can ArcTerra guarantee that no unseen �� i.j .s, ' „ OF aL \ encroachments,deficiencies or discrepancies exist. j T� �F C Ar � 11 6. DSD SIGNATURE ��c\ * �' 1 System #1 Approved for 3 bedra tis^cn N� # KENNET" " oLFtR' 71I. System #2 Approved for bedrooms. o " # ' c ' " Disapproved. Conditional approval for bedrooms, with the following stipulations: • IVo-� E)6 i #o lio�� t(1STGI(le d (,Ji'o1A:f c �e r rni , 5 a v\n e -k aro L .v 19 9 Q _ Mo has n o re cO �l S e..r�t � r� -ccx r 5 a -e , d o� b LLrui o.;n cl w he ei� e, e,r' P nSfec.-hoes Weire endue-led dura, •l «ektri . By: Original Certificate Date: j J i 3/ I S' 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 `172,.n as,t a 6 r COSA blue sheet_10-10-12.doc 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: WILLIAMSON#1 BLOCK 1, LOT 11 Parcel ID: 015-073-28 A. WELL DATA Well type PRVT If A, B, or C provide PWSID#_ Well Log (Y/N) N Date completed 9115/1975 Sanitary seal (Y/N)Y Wires properly protected (Y/N) Y Total depth 226 ft. Cased to 123 ft. Casing height(above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 9/15/1975 10/26/2018 Static water level -- ft. 66 ft. Well production -- g.p.m. 5.8 g.p.m. WATER SAMPLE RESULTS: `112.911% Coliform Ne9 colonies/100 mL Nitrate tS mg/L Arsenic: Nb ug/L Date of sample: 112(0) `$ Collected by: ARCTERRA B. SEPTIC/HOLDING TANK DATA � r?gae _® Tank Type/Material SEPTIC/STEEL Date installed 7JJJ19W-- /9q_ Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y _ Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 10/26/18 Pumper Northland Pumping C. ABSORPTION FIELD DATA Date installed 7/7/1975 Soil rating (g.p.d./ft2 or ft2/bdrm) 200 System type CRIB Length 21 ft. Width 19 ft. Gravel below pipe 9 ft. Total depth 13.5 ft. (Measured 10/26/18) Eff. absorption area 720 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/26/18 Results(Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 28 in. Water added 950 gal. New depth 36 in. Elapsed Time: 1440 min. Final fluid depth 27 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ _ Absorption field on lot 100'+ _ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 10'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS ONLY ONE OCCUPANT FOR SEVERAL YEARS. *TANK HAS BEEN REPLACED SINCE ORIGINAL. SEPTIC TANK LEVELS NORMAL AT 50". 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. i! OF L S� 1 Engineer's Printed Name KENNETH M.DUFFUS /A,' Date 11!612018 * A 9 TH /`j * COSA canary sheet_2-6-15.doc / KENK M i U , • `; Air MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 0 % 'id 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # 0SC181628 Subdivision: Williamson #1 Block:1, Lot: 11 The septic tank for this property is 26 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. • %Yl r� 31y 77S7717, 7 7,4 ,{�' r 2 . l 4 — + t'.e ',..,..A , A' • iitP1,; . < '' i1a v. ; 5f .'''' B n. •- % ` 5; ES „...1-0? t * __tr44. • `�;y.rr -',.-:....:2;;;...-, ;; • y * r `J, , :*11";'-t.'''44r' .. filtG K ' (r3k T ., rf < 4- :'. ,e:. •Jr _ rt -5.a i\ , v .. YM44r F. L`FR'P1( '' -t -!';',5'-'4g""2114-4,t , t : " '�'i :', a\1 ! 1 i y' r 4 `'c .rf.r 7`r� w•¢ y v .y s` r <4� t%, 4 j h+, rq� •rs. :�,viz �'}�..;..-.;,,,N.�!�?titrric • ' .r.• ~ w } .c�" ,-.1 ...r • • �. t , -sl JL .. t c•C.)=,� •2.•• ••.i 'i k4Tir 4 J p l••' , V1/4.:'' .` '... �♦ s w Id,"`f"6.... .P?.r. r -b. rr i '4.,::,,1::‘, _73,6,,,./:'v..„ ;:-,-t.: 1 . a fix` ,Sy i ...?",7! _.<✓y' s�.1 t r Yx-- 'q,,-.-:-1 r` 1• + Ly„ t ''Ile '41:'''S'":,-,-‘:- ,' Sty+. M a _�•may(-moi"' :,...',•.7.,v, • 4. �`. Itg t '.< y?ta`r1 ,.*. 24 4,,:? `*3. ./l p•:;11 {�=�CAt' mei ` k' P,.r.47: r/-,;/..i• rh1 .'_ r0./..-'*....• Z fes,? i,�' � 1 I.` a Pi. r '� • 4 - .-,t: . J -•1., ' ti -•.fib } t7.5 ,`. 41 'A((f' ��if''t=:rS tr1}.. �7.), M r .its i. !;:. .<+, N ri- v°''51� •1 r.7'.011 / t n 2.., •} ' ,k w v' v , 3x,4 .. ' `4 r ,rA15 �,N� 7• . dt IX s S.'' t9 tJ.. 'R S 4 ' }"r1'Z w \ %S.:',,5,‘,,,' L{,� J. J. (' + S. w4'7,,, `1• •w 's' ...‘3,-, >> Y A{(,L^ '1'? .<r- '" 6..,m,'d`,i J. gCrU IJa \4 1{.li. 'V ,.< . r 1 • T • 2 ) y p r Ft ''��� < rr Mailing Address. P.O.Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org W AlO ._ _ _ E. 98TH AVE _ _ CA O N34'00'00"E 88.00' ______4* ,1,— m..---\/\--€0-- . ,7, WELL rs O :t7 4. GRAVEL io D/W a (n r. Ui OAOInCr) ik (� d Cn O 8.2' '�d O _ 15.7' 9 k '091 10.0'91 `— '"� — " O ..6). 0. ,, ANT DECK x O m coO a 8.3' 19.4' ^'- —x_ o > pi x— m 01 m 9g, x x EXISTING A 0 r, t-' I J HOUSE N Z u y= 0 O .ax x a c4—w C I a —x—o — 52.2' I . eD _ 2.7' CANT = X x — — o0 11,3' x O ,-.I = _ m — -- Z0 x W oI LOT 11 — "x 1 9.1 S\E�Pt IC , BLK 1 / o Xx (typ) / o • 11.6'• i 0- I • `•° SHED i 2 x a v I x � I I 9.8' x a I 15' UTILITY ESMT I 2 I S34'32'20"W 48.80' S33'58 04"W 39.20 (S34'00'00"W 49.17' Rec) (N34'00'00"E 38.83' Rec)' ANCHORAGE RECORDING DISTRICT,ALASKA AS-BUILT OF: 0 =5/8" REBAR WI YELLOW PLASTIC CAP WILLIAMSON SUBDIVISION ADD. No.1 0 =FND 5/8"REBAR W/AL CAP LOT 11 BLOCK 1 PLAT 70-192 `_``"\\ SURVEY CERTIFICATE:I,John L.Schuller,Have conducted a i v, OF.4.701,61400i \�` VI , LAND vk physical survey of this property as shown on this drawing and that the / . • .:`4s ' .•: •. \0 Sr,, ,�r, improvements situated hereon are within the property lines and no i/cS�• I �I 'CV Gt enchroachments exist other than noted.Under no circumstance should %&. 49 j '•7 �/ Na Cl any information on this drawing be used for construction of fences, C / / V a , 0 r structures,improvements,or for establishing boundary lines. / - 5 cn �`' 0 EXCLUSION NOTES:It is the owners responsibility to determine $ �D • ; T OHN L. SCHULLER: °/ 0 ' .� the existence of any easements,covenants,or restrictions which `�. �,� ,. do not appear on the recorded subdivision plat. 1 ter, LS-10408 4,4% "t••o.,..,...,.,...." 1 co„ ��/ 1831 Talkeetna Street WORK ORDER NUMBER: DME SCALE E-MN ,,ey /.Z-10••/•$ ai/ Anchorage, Alaska 99508 DEC 10, 2018 onA*BY (NECKED BY'GRID ra D eO (fry A��P°fessionot .es.rAl. (907) 227-1455 office 18-074 JLS 2437 180245 �\ (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-.Site Services Section P,O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTiFiCATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELt. lNG HAA # 1. Gi=NERAL INFORMATION ~_~_i L'~ [ V'-./' /[//~~L~--'~ ~ \- COmplete legal description Location (site address or directions) ' ~' ~'~--~ Lending agency ~ / / Mailing address Agent __~~::~2~ Day phone ~r--~~--~ -''~ ~::~(~('~ Address Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ ~ " TYPE OF wATER SUPPLY: Individual well Community well NOTE: TYPE OF WASI'EWATER DISPOSAL: individual on-site Holdiag tank Community on-site Public sewer NOTE: Public water ~ If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm '~ ~"~:~ 3/~'E¢¢¢,¢7'¢~ ~ ~¢~. Phone ~--~¢~-/~ Address ~/~ ~ ~[ /"~ ~ ~/~ ~ ~' . ~ ~ ~ ~ ' ~ ~9 ~ ~ Engineer's signature ~G~~ ~~ Date ~--'/~ '-- 5-~ ~... .... ~.. -,. ~-. ~ ' DHHS SIGNATURE ~ Approved for'Y~-'~-~L~'-~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.  Municipality of Anchorage Depar[ment of Health & Human Services HEALTH AUTHOFIITY APPROVAL CHECKLIST Legal Description: i~]'/~/ ~'~.lf'll>o)~_.¢~/~r.,arceI I.D (~" / '~- A. WELL DATA Well type_/~//)/~-/~- /~lf A, B, or C, attach ADEC letter. ADEC wate~r system number Log present (Y/N) /~? Date completed /~ c/- ~/~% 7'~Driller Total depth '~'"'~' (' Cased to / '~ ~'':'':'':'':'':'':~'/ Casing height Sanitary seal (Y/N) /. Wires properly protected (Y/N) Date of test Static water level FROM WELL. LOG Well flow g.p.m. Pump level SEPARATION DISTANCES FROM WEI7L T,T,T~ Septic/holding tank on lot / Absorption field on lot /~ Public sewer main Sewer service line ; On adjacent lots ; On adjacent lots _Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~'~ Nitrate B. Sr!PTIC/HOLDING TANK DATA Date installed Cleanouts (Y/N) ~ff Tank size / (00 ~"~ (~) _ Foundation cleanout (Y/N) /~(~ / Other bacteria ~ Collected by: J , ~? ~"~ .../~-2.//'~ ~ Corn_ partments ~(~ Depression (Y/N) ~ High water alarm (Y/N) Alarm tested (Y/N) Date of pumping ~ -- 7 ~..~C~ ~ ~u~per_~._.~_~6~__// ,, SEPARATION DISTANCE,, FR~M SEPTIC/HOLDI~,T¢~ ~/~ ~,~, /~' Well(s) on lot ~ ] .~ On adjacent lots '~. ~ Foundation To property line ~'-- ' Absorption field '~ Water main/service line Su rface water/drainage /¢'~¢¢ C. LIFT STATION Date installed Man u factu ~../¢~ Size in gallons M~A cccccccccccccccccc~ess (Y/N) Vent (Y/N) "Pump on" level at ~ "Pump off" level at High water~a.{m level // Cycles tested Meets MOA electrical co~;(-Y[N) SEPARATION DISC'TANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Length ¢~f %idt; / ¢/~i ating ravel thickness Total absorption area Depression over field (Y/N) Results (pass/fail) _ /,~ System type ~-~-/~/i~ ~ ~ Total depth ~/ );~ Cleanouts present (Y/N) ,~/ Date of adequacy test / for Peroxide treatment (past 12 months)(Y/N) ~//'/(_/'~//~'M~../~/'~f~/~S, give date SEPARATION DISTANCE FROM ABSORPTION / Wellon lot /(~d~ On adjacent Iots~~ Propertyline To building foundation On adjacent lots Cp Surface water / Curtain drain E~61~BER'80ERTI~IOATIO~ To existing or abandoned system on lot /~/¢ F?./~/¢ ~ Water main/service line Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Signature /,~¢- Date HAA Fee $ ? '~0 ,. d~ Date of Payment ~'" ~'/ '~ ~ Receipt Number ~'~¢~'~g C,~h'F"'~? ~ 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number NORTHEIRN TIESTING LABORATOFIIES, INC 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (907) ,155-3116 · FAX 456 3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277-8378 · FAX 274-9645 James Sizamore 6410 Switzerland Drive Anchorage AK 99516 Attn: J. Sizamore Report Date: 08/11/92 Date Arrived: 08/06/92 Date Sampled: 08/06/92 Time Sampled: 1320 Collected By: JS Our Lab #: Location/Project: Your Sample ID: Samp].e Matrix: Comr~ents: Al19452 Lll B1 Williamson Subd, Water MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Date Method Parameter Units Result F].ag MD~ Analyzed EPA .......................................................................................... 353.3 Nitrate-N mg/1 <MDL ~'~"i .........08/04/92 ~eported By: Susan--?. ~ifental Microbiology SuperviBor APPLIC'" NT FILLS OUT UPPER HAl. -' ONLY P~operb:Owner DOI'I~I & Karen Wonnell Mail.lng,ACdr~ss 5135 E. 9Rt:h. Anchorage~ AK Zip Code 99502 Buyer U~lknowr~ Address Zip Code Lending Institution U rik ~lOWrl Phone Address Zip Code Realty Co. & Agent Coldwel 1 Banker Jack White Company/E11 lei; Lawson Address .~/1 ll~n ~,~.; -~tJ'~t:~ l~lO: Anchorage, AK ZipCode 99~03 LegalOescript~n Lot 11, BloCk 1, Williamson No. I Phone 277-.1~;3 StreetLocatio~ 5~.c{_~ F_ qR'~h (n,F'~ R'l~nh Rd.: Ta×'i Map Pa?, Type of Residence X] Single Family [] MulUple Family No. of Bedrooms 3 _ [] Other Water Supply ~i~ Individual ATTACH WELL LOG. A we~l 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 ~ Individual Year Individual Installed: [] Public Utility When Connected to Public Utllgy: [] Holding 'rank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, Time Time Time Time Date Date Date Date Inspector Inspector Inspector In s p ectl(,~.~ Field Noles: ~NVIRO~MENI'AL ~ ~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITION~ APPROVAL' Soils Rating Date ~wer Installed Well To Absorption Area '~ 7_ 7-- 7~ WolltoTank ( ~ ~ ' Septl0T~kSIze Dorm and,x~t~.en Wonnell 51,35 [.. !)Bth Anehoracj~ r AK 99502 Subject: Lot 11 ~lock iL Williamson No. 1 Approval 15or the individual sewer alld %;at~L- facl ltl(:o Calll]ot be granted until the f.o].].ovlil%(] t t-~,,,-, have beoll {~ompleted" The septic tank l)tlllll)ed Illth a receipt submit, tod to this ..~ O department. An adequacy test nee(is to be performed oi! 'tile oxistin9 leach:Lng area. '.t'hi,~i test w±ll determ'[ne if the system adequate according to National Standards. A listin9 of private firms performing the test is mlcloped. This roport ne~('l..°, to be ,'~ubmitted to this office :_For our review. four.' (4) inch cleanout needs to be inst'alled to the ].ca¢:hirlg area° }.,xposc the well for our inspection to determine proper construction, also to insure ~ni. nim~lm distance req~liroments are mi~t between tho well and sewer system. Please notify this Departraent for a rein:~pectJ_on when tile noted ,]:L,.,crc. pan.,l{ .... have beel~ corrected. If there are any further querltJ, ons, oleaso call this office at 264-4720. ,gincerely, JR8 9/p/Ell F, uelo~lure cc: Coldwell Banker Jack White Conlpany/ E1].iott Lawson 3201 "C" 13t., [iuite 100 Anchorage, AK 99503 Jim Robot t.q CONSULTING ENGINEER TELE?HONE: {907) 279-3916 Ellio~ Lawson Coldwell- Banker/Jack White 3201C Street Anchorage,Alaska 99503 SEWER ADEQUACY TEST October 28, 1983 V~UNICIPALUY OF ^NCHOP, AG5 DEPT. OF ~FALll & J~NWRONMENTAL PRO [ECTION. OCT 8 RECEIVED LEGAL LOCATION OWNER RESIDENCE WATER SYSTEM SEWER SYSTEM DATE OF TEST TEST PROCEDURE ~ 2225-E . TEST RESULT Lot 11, Block 1, Williamson Subdivision 5135 E 98 Donn Wonnell Three Bedroom Single Family Unit On Site Well From Municipal Records. Tank 1000 gal. Sunset Plastic~ One Compa{nmenn Absorption Log Crib. Dimentions Unknown System Pit Size 21x 19x 9 Absorption Area Installation Date 720 sq. ft. July 1975 Soil Rating 200 October 25, 1983 System was inspected on ?0~x~bemr2~!_~[983. T~nk was full( 49½ "~:rib was dry.'~ On October 25, 1500 ~. was added to/~he crib in increments of 5L~. The-~f~llowing measurements were taken: VOLUME DEPTH -0- -0- 500 10 1000 1!5 1500 21 Oct. 26 14 System meet Municipal three bedroom units Time 1.00 pm Time 11.00 pm. Requrements for MUNICIPALITY OF ANCHORAOE DEPARTMENT OP HEALTH & ENVIRONMENTAL PRO'ItECTiON ,,,BLS,r...,-A,,.,..eg, ~ Telephone 264-4720 ' REQU EST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS~ Complete all parts on page 1. Incomplete requests will not ba processed. Please allow ten {10) days for processing. 1. PROPERTYOWNER. <~ . PHONE MAI LING ADD R ESS ~ ~OPERTY RESIDENT ( f d fferent from ebove) ' MAILING ADDRESS 3, LENDING INSTITUTION PHONE MAILIR(~ ADDRESS 4. REALTOR/AGENT , [ PHONE MAILING ADDRESS ~ ~- ~ ' '- STREET LOCATION ' 6. TYPE DF RESIbENCE NUMBER OF BEDROOMS .~.~ SINGLE FAMILY [] MULTIPLE FAMILY 7. WATER ,,UPPLY ~5NDIVIDUAL' COMMUNFFY [] PUBLIC UTILITY E~ One [] Four [] Other [] Two [] Five ,~ Thrae [] Six * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled or or to that date, gwe well oeDth (attach log if available.) If individual/on-site give installation date If system is over two ',2) years old an adequacy test is required nv this Deuar[men'£. 8, SEWA(IE DISPOSAL ,,YSTEM ~,~ INDIVIDUAL/ON-SITE'~ [] PUBLIC UTILITY NOTE: THE INSPFCTION FEE MUST ACCOMPANY EACH RE[QUEST BEFORE PROCESSING CAN BE INITIAI'ED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TiME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE ~'- [] FIVE [] OTHER [] MULTIPLE FAMILY .. [] TWO [] FOUR [] SIX 2, WATER SUPI~LY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER E~]Septic Tank or [] Holding Tank Size: If Tank is homemade 801LSRATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE B~tle) LEGAL DESCRIPTION 72-010 (Rev. 3/78) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Aprll 27, ].9?6 Time of Inspection //,L~_. Date of Inspection 344-7180 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. l. Approval requested by: Alaska Mutual Savings Bank Mailing Address: Phone: 2. Property Owner: Dennis & Cynthia Sigler Phone: Mailing Address: star Route A Box 78-A Legal Description: Lot 11 Block 1 Williamson Subdivision Location: East 98th Avenue off of Birch Road, see map Type of facility to be inspected Well Data: Individual A. Type Single Fam:Lly No. of bedrooms 3 Size Absorption Area length of lines B. Depth Approx ZLSO' D. Bacterial Analysis On-site system B. Installer 2. Manufacturer 2. Material , Absorption area , Other contamination , Absorption area , Sewer Lines , 4. 5. 6. C. Construction 7. Sewage Disposal System: A. Installed 197~ C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: Total 8. Distances: A. Well to: Septic tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line EQ-034 (l/74) Page 1 of two pages Page 2 of two pages - Req~ t for Approval of Individual SE r & Water Facilities Legal Description T,ot 11 Block 1 Williamson Subdivision Comments A p pro ved ( ~/~A '~A//~, '/~/~ .W--/Ci.sa ~,p r9 ve d Date -'/ ~p~v~V~a~f~i~n~ee Y~ar from date signed Greater Anchorage Ar~a Borough~Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in 'this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAL'rH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAl. OF INDIVIDUAL SEWER and WATER FACILITIES I. Type of Inspection: CMRO. VA 2. Property Owner:_ ~,~ ~% Mailing Address: -'~'~-~'~ ~'~×"~ 3. Name of Buyer: ~ ~ ~ ,'~ ~, ~.. Mailing Address:_ ~ 4. Name of Lending Institution: ~.~.:~¢~ Mailing Address: 5. Nameof Realtor or Agent: ~ 6. Legal Description: V,~)-~ ~ ~-~ ~c~ ~ . Location:__~ c~%~ MUI~IICtPAI.IW OF AN('HOP, AGI! t!NVIRONME~',ffAL P; oil~crl¢)N FHA CONV/~ ' Phone: 7. Type of Facility to be Inspected: ~--~-;~-~x, 8. Water Supply No. Bdrms. _i'i~ Type of Supply: Public Utility Individual ~,, If Individual, number of dwellings presently served If Individual, depth of well, d-~?~5~. ~¢~>t,)/ Sewage Disposal System Type of System: If Individual, date of installation Public Utility Individual (on-site)~,""~, 72-003(3/76)