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HomeMy WebLinkAboutWILLIAMSON BLK 2 LT 5Williamson Block 2 Lot 5 #015-073-20 Devefapment Services Department building SaTety ! iMsicn O tee, On- Sitie Wger & Wastewater pragraiin 4/00 Bragaw 51 reel n; ;� �; P.G. gox 196850 - ,mark 8egich Anchorage, AI: 94519-6650 Mayor wwaanuni arni nnsife I907'1'43-79.04 Pump Installation Log Well Drilling Permit Number: SW_ Date of Issue: _ parcel Identification Number:_ Legal Description ,VV JL�L IAM,Son/ G -a pump Installation Date: /437/17o? Property Owner Name & Address: I& e'r /1A0.5xr 1 P� 6311 AAZOW- pump Intake Depth Below Top of Well Casing: 80 feet pump Manufacturer's Name: 'AfRoal pump NIodel: 37 �%/rIOOFI Pump Size 1/2-- hp pitless Adapter Burial Depth: /d feet pitless Adapter Nlanufacturer's Name: 111%DA1Af1- pitiess Adapter Installer: l Disinfected Upon Comnfetian' wes i_; No ijf YTetho /1,2 0&e Comments: Pump Installer -Name: 5TAx ml-:. w4vY pf Attention: The pump installer shall provide a. pump installation log to the DSD within 34 days of pump installation. CAAB HDI GREATER ANCHORAGE AREA 130ROUr H HEALTH DEPARTMENT _ 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 _ INSPECTION REPORT ON-SITE SE=WAGE DISPOSAL SYSTEM NAM LOCATIONC F' 3 �-' /1.i-� MAILING �i-- ADDRESS - _PHONE (=���G"l AL-I� _LEGAL DESCRIPTION SEPTIC TANK: �� i SEEPAGE SYSTEM_L cid) CESSPOOL__, DISTANCE FROM WELL '(Y —MATE LIQUID CAPACITY SEEPAGE SYSTEM: SEEPAGE PIT: c/,�._- NUMBER OF COMPARTMENTS / A LIQUID INSIDE LENGTH INSIDE WIDTH DEPTH_" NUMBER OF PITS_ OUTSIDE DIAMETER_ OR WIDTH -/ 7t LENGTH f/ DEPTH-�, LINING MATE RIAL--l-L45 DISTANCE FROM WELL BUILDING FOUNDATIONS/� i _� sr� NEAREST LOT LINE___ . TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)__ -i lJ _SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL . FOUNDA NUMBER OL LINES__�L—DISTANCE ABSORPTIO DEPTH: TOP OF TILE TO FINISH GRADE FT. LENGTH OF EACH LINE NEAREST LOT TRENN WIDTH TOTAL LENGTH OF LINC-SS_. IN. TOTAL OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPES /���GL��� ., DEPTH_ / (c' ` _ BijDISTANCE FROM FOUNDATION._ �uT SAMPWATERE_ %lT -, NEAREST LOT LINE CCC _, SEWERNEARESLINE U rSEPTI'�, TANKC _ �� i SEEPAGE SYSTEM_L cid) CESSPOOL__, OTHER SOURCES_ DISTANCE=S: 1% �N- l8' DIAGRAM OF SYSTEM �lwa'V-C/ nol— fef d �BLI S.GI DATE 7c — P r vjat- L 12 GAAu:nD-? GREATEF XNCHORAGE AREA, ' ) OiUGH Case No. ,? HEALTH DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279-2511 _ /7j. SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT -L4 L`+—_ MAILING ADDRESS7// 1 PHONE9NO��Ki �-S RESIDENCE AODRESS��---/—,_ LOCATION OF INSTALLATION'; —LEGAL DESCRIPTION S� 1? -UL Z— WLGvvwlc`"`.—r �"=--- APPLICATION TO INSTALL: SEPTIC TANK_—, SEEPAGE __,_ _ , DRAIN FIELD__—, OTHER TO SERVE THE FOLLOWING FACILITY- ✓ `� ulym fi t_ �— FINANCED THROUGH PERCOLATION TEST RESUL TO BE INSTALLED BY ANTICIPATED DATE OF COMPLETION �_— BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS �Y uy� -- , PERMIT TO INSTALL A DESCRIBED BELOW. SIZE OF UNIT TO BE SERVED .L6WAREA —_, SEPTIC TANK SIZE___TYPE �� Od-, SEEPAGE AREA ---"TYPE /tl . DISTANCES: pj to v tn�.ur�, Vh�v-'Zo DIAGRAM OF SYSTEM e /� ®e HEALTH AUTHORITY OR LICENSED DESIGNER ;/ I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. —0,4 (1j v.'r lo -1 1 -'J'Tr, DATE / �� APPLICANTS SIG NATO RE Aie_--_ ME e /� ®e HEALTH AUTHORITY OR LICENSED DESIGNER ;/ I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. —0,4 (1j v.'r lo -1 1 -'J'Tr, DATE / �� APPLICANTS SIG NATO RE Aie_--_ REA.TL'R ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT CASE A 327 EAGLE STREET ANCHORAGE, ALASKA 99501 �' /O f Performed For flohK-S Date Performed ' f /7 ?o Legal Description"Lot _Block2_ SibdL% S5 01'I This Form Reports a: Soils Logue Depth Feet Soil Characteristics Location Sketch / F t �+ ra.i• Was Ground 'Mater Enenuntered? M Ao If Yes, At Vvt Gro.ss Time Net Time ^ Depthn To B20 Y Net DroP'� a� I ErCn�.n � .�: �j... .'y- �''�'t" ._).....�i�1PlUt�'.�.......�......... ........ ,.......,�. _.-,�.-..-.. c.:ti, ....... _..... ,e..... .o.»..,..m. ........ I^cF.osa'In .tela oni Seepage Pit l" Drain Field Depth Of Inlet o ..1 3.:. Depth To BoM Of-% Or COMMENTS: , l n -" I a F/, d , 1 f. 7 �'� •..P' O 1 ,f .. ....1 /1 ,','�f,' I r%?I I /1 .--Aloo.Ir) h e.„,7.,<.�.�,.....r r..,...,�..-,.. <..r., .. Test Performed ��sf �t�'ia I. �,�. i.�f ei ,�'l^ S`I�f. ill l) B}': z Data Certified By:. Date: 1 / F t �+ ra.i• Was Ground 'Mater Enenuntered? M Ao If Yes, At Vvt Gro.ss Time Net Time ^ Depthn To B20 Y Net DroP'� a� I ErCn�.n � .�: �j... .'y- �''�'t" ._).....�i�1PlUt�'.�.......�......... ........ ,.......,�. _.-,�.-..-.. c.:ti, ....... _..... ,e..... .o.»..,..m. ........ I^cF.osa'In .tela oni Seepage Pit l" Drain Field Depth Of Inlet o ..1 3.:. Depth To BoM Of-% Or COMMENTS: , l n -" I a F/, d , 1 f. 7 �'� •..P' O 1 ,f .. ....1 /1 ,','�f,' I r%?I I /1 .--Aloo.Ir) h e.„,7.,<.�.�,.....r r..,...,�..-,.. <..r., .. Test Performed ��sf �t�'ia I. �,�. i.�f ei ,�'l^ S`I�f. ill l) B}': z Data Certified By:. Date: Parcel I.D. 015-073-20 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: / 1p - ✓ / _ 1. GENERAL INFORMATION Complete legal description Williamson, Block 2, Lot 5 Location (site address) 5311 Woodcrest Circle Anchorage, AK 99507 Current Property owner(s) Justin Clem Day phone 764-9494 Mailing address 5311 Woodcrest Circle Anchorage, AK 99507 Real Estate Agent Day phone 2. TYPE OF DWELLING: �, 0 Single Family (w/wo ADU) S ❑ Duplex 40U 2 -.014 3. Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Pubiic sewer ❑ Waiver/Variance request for: Distance: Received by: Z�i c 2,C_.._- (4� 1 Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �Jy2� �r Waiver Fee $ Date of Payment Date of Payment Receipt Number (`a'� ��� G Receipt Number COSA # (5-')u { 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date ,d'Or• q�gSda4 49?H •. 6. DSD SIGNATURE io >Y � L �y ®...w a.n.... ................/ System #1 Approved for J bedrooms 0 MICHAEL E, ANDEBsoN : e • CE -4381 r System #2 Approved for bedrooms ®�® ri�9•8, Z2 ,V •, ���o Disapproved e,ti`Bs"0:���" Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: " C Z Th Mun alit nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r l- c 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, Block 2, Lot 5 Parcel ID: 015-073-20 A. WELL DATA Well type Private If A, B. or C provide PWSID # Well Log (Y/N) N -Date completed Unknown _ __Sanitary seal (YIN) Y - Wires properly protected (Y/N) Y Total depth UK ft. Cased to >40 ft. Casing height (above ground) 12 in. Date of test Static water level Well production FROM WELL LOG Unknown Unknown Unknown WATER SAMPLE RESULTS ft. 9-p M. Coliform 0 colonies/100 mL Nitrate 3.95 mg/L Arsenic ND ug/L Dateofsample: 7/29/14 B. SEPTIC/HOLDING TANK DATA AT INSPECTION 7/31/14 45.4 ft 3.3 g.p.m. Collected by: Anderson Engrg. Tank Type/Material Septic/Concrete Date installed 6/9/1970 Tank size 1,080 gal. Number of Compartments 1 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Dateofpumping 8/25/14 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA Date installed 6/9/70 Soil rating (g.p.d./ft2 orft2/bdrm) 120 SF/BD System type Abs. Crib Length 11 ft. Width 14 ft. Gravel below pipe 6 ft. Total depth 11 ft. Eff. absorption area 360 f 2 Monitoring tube Y Depression over field N Date of adequacy test 7/31 /14 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 39 in. Water added 450 gal. New depth 54 in. Elapsed Time: 1,440 min. Final fluid depth 39 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 _ "Pump on" level at Datum No Add On Manhole - Gravity Flow to Absorption Trench. in. Size in gallons "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: >50' Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? Septic tank/lift station on lot On adjacent lots > 100' Absorption field on lot 901** On adjacent lots >1 00' Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line >25 Holding tank N/A Animal containment areas >50 Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line > r � Water main >1 0Water service line >10' Wells on adjacent lots >50' ABSORPTION FIELD ON LOT TO: Property line >10, Building foundation >10' Water Service line >10' Surfacewater >100' Curtain drain >50' Wells on adjacent lots 94' Absorption field >5' Surface water >100' Water main N/A Driveway, parking/vehicle storage > 10, F. COMMENTS "Waiver on file allowing decreased separation distance. G. ENGINEER'S CERTIFICATION 4:1�4OF,e',� ....... 44 I certify that I have determined through field inspections and LQ.•� s/f ,� review of Municipal records that the above systems are in ` 49 •;9 T conformance with MOA COSA guidelines in effect on this date. ;,, •� Michael E. Anderson, P.E. �...:...........� .........�.. Engineer's Printed Name / V„' MICHAEL E ANDERsgN :W, Date 8/9/14 I So. CE -4381 ; �a A +1' 1;+0 COSA brown sheet 10-10-12.doc Municipality of Anchorage Development Services Department r Building Safety Division On -Site Water and Wastewater Program s x F E T Y 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-073-20 COSA # i �'5 Expiration Date: 1. GENERAL INFORMATION Complete legal description WILLIAMSON BLOCK 2 LOT 5 Location (site address) 5311 WOODCREST CIR., ANCHORAGE, AK 99516 Current Property owner(s) MICHEAL MOSLEY Day phone 242-7587 Mailing address Lending agency Day phone Mailing address Real;,Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well R] Individual On-site Q Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site 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 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 Spurkland Enginneering Address 203 W. 15th Ave., Ste 202, Anchorage, AK 99501 Engineer's Printed Name Lars Spurkland 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 279-3916 Date 11/16/2011 ,� ��•OF .114.1 l i ' � ,. orf LARS SRURKLAND:, ,✓ 115 0 . �� ,.,'✓ Conditional approval for bedrooms, with the following stipulations: WATER AND 0"T' W • v • •P110rPAM Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By:Original Certificate Date: (t I (Rev. 11/05) Municipality of Anchorage �V, % &, • Development Services Department° 4 � Building Safety Division s On -Site Water & Wastewater Program "1.1' 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Wr, LLt Ar4igr, QtoLk_ 2. Lot 5 Parcel ID: o t5 -o13 - ZD A. WELL DATA Well type f ry . Date completed 41K"Wr\ Total depth unk+'nft. If A, B, or C provide PWSID # = Sanitary seal (Y/N) Y Cased to _220—ft. FROM WELL LOG Date of test u► h k%o Nt n Static water level know V ft. Well production uhucv►oM+n g.p.m. WATER SAMPLE RESULTS: Coliform N- E�colonies/100 mL Nitrate 3aN mg/L Arsenic: t\(D ug/L date of sample: fl 3 13. SEPTIC/HOLDING TANK DATA Tank Type/Material SQ ,clcfmc,(L�f_ 6\03C Well Log (Y/N) Al Wires properly protected (Y/N) Casing height (above ground) 17- in. AT INSPECTION, (4 3 (( IN ft. g.p.m. Collected by: LABS Swur��ahb Date installed Tank size Joao gal.. Number of Compartments Cleanouts (Y/N) 7 Foundation cleanout (Y/N)':.. Depression over tank (Y/N) I% High water alarm (Y/N) Date of pumping; , L;16\1 Pumper 4+ 4om6 r- C. ABSORPTION FIELD :DATA Datel installed Soil rating (g.p.d./ftz or ftz/bdr ) t' System type Cr; .a Length J1" ft. Width ( q ft. Gravel below pipe Co ft. Total depth IL ft. Eff. absorption area 3(,o if Monitoring tube Y Depression over field N Date of adequacy test '3I, I Results (Pass/Fail) P455 For bedrooms Fluid depth in absorption field before test 31 in. Water added 500 gal. New depth `f� in. Elapsed Time: 420 min. Final fluid depth -11 in. Absorption rate >= 950 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) /von( Known If yes, give date ----' 44 Fvn Inspeellan Repori, the tged�w2 on ARRA A e.ovy Tv be, 3M" \ J Pp �foM �tn�n �e �imen$�on5 SjlS�ertr� 1u.S a�aVec PK 544 cenfl s'%m �y�r,TA"y[tOil ' Y a D. LIFT STATION Date installed "Pump on" level :at in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off" level at Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 50+ (—%d) Absorption field on lot 9O -* Public sewer main _ NJA Sewer/septic service line 2S� t Animal containment areas 1,00 1+ (/V.a, Manhole/Access (YIN) — High water alarm level at in. Meets alarm & circuit require ents? On adjacent lots t+ - -On adjacent lots -100 i f' Public sewer manhole/cleanout _ NIA Holding tank N�A Manure/animal excrete storage areas lb©�+ N,D) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: i Building foundation Property line 5'-F Absorption field Sty' Water main /V ,A Water service line 1®+ Surface water IOD'+ l;Ai,©1 Wells on adjacent lots 5614- }o weii o,, LoA b� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property -line lolBuilding foundation 100' ' Water main /VIA I Water Service line Its 4- W'water ltd� { (AD. Driveway, parking/vehicle storage -,7!5Ac. Curtain drain 50'-F (Ml Wells on adjacent lots *q4 F. COMMENTS (�^^ *WA%VeP- on ti� G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COjSA guidelines in effect on this date. Engineer's Printed Name _CARS Sour 11,,a ,A Date 1112 111 COSA Fee $ Date of Payment Receipt Number (Rev. 4/10) Waiver Fee $ Date of Payment Receipt Number 0 F A jq1k i • RKLAND.c� %, 15 0 ..� p rel t h LL - 0 : ►= U) V1 Cc) L) LLJ )r N W O Z 0 t Z to W (n _ V) j V' QS w at Z Z rn Q (14 J U-) N L � � N (L 7 W 41 JMuaN O -- U-) O p. O) 11 ) i Q) _ Co < Z V) Q OQ p Z Q W � m W J MVV)) a I 31 O CY) r_ 'tz 0 d• Q ;Z I0 a i 0 ) �y z 3 J Z < Z W O) Lil Ar'�Wx )a A W-1_ rcal C9�� rcv= �vwO �W>OON[ V1 Cc) L) LLJ )r N W O Z 0 t Z to W (n _ V) j V' QS w at Z Z rn Q (14 J U-) N L � � N (L 7 W 41 JMuaN O -- U-) O p. O) 11 ) i Q) _ Co < Z V) Q OQ p Z Q W � m W J MVV)) a I 31 O CY) r_ 'tz 0 d• Q MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT 01= 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 DWELLING Parcel I.D. N O 15' `C_-3-7 3 -- Z o— - v-93^6 HAAtt 4P� 9404"C)) 1. GENERAL INFORMATION - Complete legal description Location (site address or directions) _ 5311 wo�DC40t� ve- — LJIL6y, /'9ICH&(=(. "r ri Property owner Nr_o C'LD'L -5-� Day phone 3 5/6 Mailing address — S31/ ckl�� 4 `Q- A'L Lending agency Day phone Mailing address_— — Agent Pc-, i11 A->� c)-r-rVa, L,5 Av_ e== — Day phone �cz2iy� 2GYa Address uoruw X/%Aso,J 4t,r- Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well --_ Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site �- Holding tank —_ Community on-site —_ Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/B1) Fronl MOAH21 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 furtherverify 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�-..,-., d R.n_� voon M. Phone 20210 Donator St. Address Chuglak, Alaska 97567 Engineer's signature 6. DHHS SIGNATURE Approved for �! bedrooms. Disapproved. Date Conditional approval for bedrooms, with the following stipulations: Additional Comments /I CAUTION 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. 72-025)Rev. nl) Back MOAN21 ® Municipality of Anchorage ACUL MCM Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Wrr_Parcel I.D. o/s, - 0 5- 2-3 A. Well Data Well type 2,-/ ✓tom Log present (Y/N) All If A, 13, or C, attach ADEC letter. ADEC water system number completed 6//C Driller _ c!k_ Total depth �GQ Cased to Zl!?l� Casing height Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Wires properly protected (Y/N) FROM W4-LL—LOG peelers 14Aq i 9,eeo AT INSPECTION --z, SEPARATION DISTANCES FROM ELL TO: at .rer Septic/holding tank on lot 78 �P— .;,On adjacent lots Absorption field on lot 26) I ; On adjacent lots Public sewer main �;D x Public sewer manhole/cleanout A� _ Sewer service line _5✓�` Petroleum tank Allam * W/F v(Vg 0r1 KiLi�; v WATER SAMPLE RESULTS: Coliform ra Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size 1 C�8o Compartments__ Cleanouts (Y/N) --Y Foundation cleanout (Y/N) Depression (Y/N) _/V High water alarm (Y/N)�/� _Alarm tested(Y/N)v� Date of pumping _Pumper ALC7''11<X) uQ / armPn�h SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot -Z IV On adjacent lots % Foundation /7' To property line 2-0 + Absorption field er !Water main/service line 9 _ Surface water/drainage /ov ¢ V w!}IJ�R.ad w=lL 7&ozs(3W)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 97U Soil rating (GPD/Ft) l Z- S System type Length // Width Gravel thickness & I Total depth Total absorption area 3 Cw Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test esults (pass/fail) / f tj; for 3 Bedrooms Water level in absorption field before test �� Aftertest /% '1 Peroxide treatment (past 12 months) (Y/N) X/ yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: y Well on lot On adjacent lots 9Irl Property line To building foundation On adjacent lots_ Z/ /0 - f.. To existing or abandoned system on lot No N Cutbank NJ/)- Water main/service line Z�y- Surface water /(Yo t Driveway, parking/vehicle storage area Curtain drain A00J J -)e W111L,6,e- o -J E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P.E. Signature 20210 Donalar St. Chugiak, Alaska 99567 Engineer's Name Date HAA Fee $ ��o Date of Payment Receipt Number 72-026 (3W)' Back Waiver Fee $ Date of Payment Receipt Number �'o. aza', � a•�� �� G Il6li' r I, -I MUNICIPALITY OF ANCHORAGE \ <,, DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION IA ;V.p - DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 / Application Date [ 7 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) JXT- 5 13(.Ocl�. 2 Location (address or directions) i3 11 �Woo>acx� o (b) Applicant Name a ✓e ',,� Telephone: Home 34 E' "21S 60 business. �'��� 99 Applicant Address _ 7 (� e� Z�C>-_ %�, _ _ (c) Applicant is (check one): Lending Institution ❑ Owner/builder; Buyer I ; Other ❑ (explain); —� (d) Lending Institution __ Telephone Address _— (e) Real Estate Company and Agent 6 Address _ Telephone _ (f) Mail the HAA to the following address: ti �E� 6r." ✓."-.:.fes �i:n� 2. TYPE OF RESIDENCE Single-Familyjg Multi-Family[3 Other Number of Bedrooms 3. WATER SUPPLY Individual Wel,A Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsitel� Public ❑ Community El Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm —1�t%Nle �s�l 1� ENC' I I�[:C•Ic I Q16 Telephone Address4-4i(�w,ziUQ'�3Z] A)h 1/P -A V-) ciiii 6ici sv-- Date (51 Z y7 ""gtee /, — -- -- 6. DHEP APPROVAL Approved for 7411.0 - Approved Engineer's Seal �0 o000y00s 000i?o,;o�oo�° °00000°° eprotesslovl\_ bedrooms by rc"r^ ,4 71 nU �� Date Disapproved (� Terms of Conditional Approval Conditional CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DFIEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA). HEALTH AUTHORITY APPROVAL (HAA) >✓�' CHECKLIST - FEBRUARY 1984 284-4720 11� rr (> 1 t. j r Legal Desc�ript/i e , _f., f ,l ) �(i) tel i,ee 0'Lf5Pi✓ � G� _✓ !7> A. WELL DATA Well Classification =PJDIVIC>U f1 1-' If A, B, C. D.E.C. Approved (Y/N) Well Log Present (YC/N) —�"� . Date Completed S0.mF �Z� Yield 6!1 DrY� `)3�2$f/$6 Total Depth t C2, Cased to V_f- Depth of Grouting ^/©M AS Static Water Level 49- 7 — Pump Set At — /V few N R Casing Height Above Ground Sanitary Seal on Casing (Y/N) --K z-? Electrical Wiring in Conduit (Y/N) �`+ Depression Around Wellhead (Y/N) A/o Separation Distances from Well: To Septic/Holding Tank on Lot —< On Adjoining Lots fJ To Nearest Edge of Absorption Field on Lot —�_ ; On Adjoining Lots. — To Nearest Public Sewer Line Cleanout/Manhole __ Water Sample Collected by _ Water Sample Test Results _ Comments��5� B. SEPTIC/HOLDING TANK DATA — To Nearest Public Sewer To Nearest Sewer Service Line on Lot I "&" . : Date G n Date Installed Size _16 O No. of Compartments _ Standpipes (Y/N) Air -tight Caps (Y/N) — e Foundation Cleanout (Y/N) _•— Depression over Tank (Y/N) _ �/� . Date Last Pumped Pumping/Maintenance Contract on File (Y/N) 6 /�L— ; for Holding Tank High -Water Alarm (Y/N) _!C/_,CL_ Temporary Holding Tank Permit (Y/N) ,� F Separation Distances from Septic/Holding Tank: r' rte. To Water -Supply Well l To Building Foundation Z To Property Line :2-d "4 To Disposal Field _ 3?e> G To Water Main/Service Line _—%/ -- To Stream, Pond, Lake, or Major Drainage Course N ONc en/ r7_6�1;f /O0 r _ Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata" � Type of System Design !L Date Installed / %� Length of Field Width of Field >/ � � Depth of Field � 7L Gravel Bed Thickness 61 Square Feet of Absorption Area � �� � Standpipes Present (Y/N) ` Depression over Field (Y/N) N Date of Last Adequacy Test ��/ '� II Results of Last Adequacy Test 14J9_4 .7e_ -�P, r' -3 00 m . Separation Distance from Absorption Field: To Water -Supply Well `0� To Property Line .� To Building Foundation To Existing or Abandoned System on Lot 1/oM&_ On Adjoining Lots I DB (-f- To Water Main/Service Line ' jt�a� To Cutbank (if present) Mbeyd To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area .404- Comments 4'f` Comments — D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at — High Water Alarm Lev( Tested for Electrical des (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Icertify thatIhave hecl eriieconformedtoall c Sign '' to Company /� MOA No$ Receipt No. n( Date of Payment 1 Amount: $ Page 2 of 2 72-026 n veal Vent(Y/N) Pumping Cycles during Adequacy Test, Meets MOA and HAA guidelines in effect on the date of this inspection. TSEa -- E-0 or �0 A4,1. ® •ieu ewy�e•eooe.ee�e o.°, o. C v/pv4884ry-asvn a V En o ®A proit:sslo��� �® Engineer's Seal of Anchorage September 19, 1986 P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY RNOWLES. MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Wayne Henderson, P.E. Peninsula Engineering 440 West Benson Boulevard Anchorage, Alaska 99503 Subject: Lot 5 Block 2 Williamson Subdivision Waiver Request, WR86-132 Dear Mr. Henderson: Your request for a waiver of the well -to -septic system separation requirements have been granted for the subject lot. The separation distance between the seepage pit and well on the subject lot has been waived to 90 feet. The separation distance between the well on Lot 4 and the seepage pit on the subject lot has been waived to 94 feet. These waivers are valid for the existing septic system only. Any upgrade or enlargement of the septic system on this :Lot is not covered under this waiver. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw PFATINSULA ENGINEERIING 440 W. Benson Blvd. Suite 206 September 2, 1986 Municipality of Anchorage Health Department 825 L Street 5th Floor Anchorage, Alaska Attn: Susan Oswald RE: Lot 5 Block 2 Williamson Subdivision Waiver Request Dear Ms. Oswald: Anchorage, Alaska 99808 (907)861-8107 Request a waiver of the 100' separation distance between well and septic tank to 78' and well to absorption field to 90' on the above referenced lot. The septic system has been tested and is functioning adequately and the well delivery is good (5 qpm). The soils rating is 125 S.F./B.R. and the lot slope is relatively level between the septic system and well location. If you have any questions please call. Sincerely, y Wayne i'Lnd erson, P.E. WH: J's 1PENINSi7LA ]OTGINEERING 4.40 W. Benson Blvd. Anchorage, Alaska 99508 Suite 200 (907) 581-5107 September 2, 1986 Mr. Dennis Moore 5311 Woodcrest Circle Anchorage, Alaska RD: Lot 5 Block 2 Williamson Subdivision Septic System Adequacy Test Dear Mr. Moore: Per your request we have performed the adequacy test on the above referenced absorption system. The system consists of a septic tank and a seepage pit. The system was tested by running water at 5 gpm into the seepage pit and monitoring the levels over a 3 day period. A dosage of 450 gallons was added to the system on 2 consecutive days with the results tabulated below: Septic Date Time Tank Pit Rate Quantity 8/26/86 0 Min. 25" 58" 0 gpm 0 Gals. 10 25 62 5 50 25 25 '70 5 12.5 45 25 '73 5 225 65 25 78 5 32.5 90 25 82 5 450 8/27/86 0 27 53 0 0 20 27 64 5 100 45 27 '73 5 225 65 27 '78 5 325 90 27 82 5 450 8/28/86 0 30 56 0 0 The test results indicate that the absorption system is working adequately for a 3 bedroom home. There are some separation distances from your well to your septic; tank and absorption system, which are less than the required 100' and from your. neighbor's well on Lot 6 to your septic tank is also less than the required 1001. A request for a waiver of these separation distance requirements will be necessary for approval of your system. I will request a waiver along with the Health authority approval application. If we can be of further assistance please call. Sincerely, 1` '2-e�.--- Wayne Henderson, P.E. W,?- I I S cf". C� �u,rueY� iJ� WC 000t'E_S 7" Ci RC -L -j SoP�Ic Sv�s�cM W c�hC, �e.vt r�[rSON o dde-cA 4� 4s-13vdf s�'NW .....::'C//Si l �.'�L� 9TFI • ...... .....L. -e' I B. tlyN%` tN4eliSoN a •.,. CE4488 ,ti �AP�/b..'••....••'.� —,7-- SURVEY CERTIFICATION: I hereby certify that I have surveyed the property .hewn and do LE311 an roe hereon and that the Improvements situated thereon are within the property lines enol no ancroechmonn oxlrt other than noted. PLEASE NOTE: It Is the contract LEGEND: BET FOUND Wo. •` ��... ? ENGINEERS • PL.ANNERS • EIURVEYGRCI -pr's responslblllty to check top 6/8" REBAR • O v of foundation In relation to HUB & TACK O ca onn.ov. 440 WEST BENSON BLVD. 272-9231 finish grade and building tot- MONUMENT ® (D — ANCHORAGE, ALASKA 99503 502.5291 becks In reletlon to lot final AL -CAP G gand easements. PK NAIL X IRON PIPE @ Two: LEGAL DESCRIPTION: �Es—v—✓T 7— a!P,1Cr .14 ZU90 )'e- NO, �•Ji%C/� ASSUMED Z)47ZZ0/ /98,1/1 ec,�/- Z-07- eats: S, .vcw< f.r GV/�.� 1I''iVN V aZ. Z� CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. .TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street --_ Drinking Water Analysis Report for, Inorganic, Organic, and Radiochemical Contaminants TO BE COMPLETED BY PUBLIC WATER SUPPLIER PUBLIC WATER SYSTEM: I.D. NO. Peninsula Engineering Public Water System Name 440 W Benson Anchorage, AK 99503 ty to e �Ip�cTe Note: Check box to loft of contaminants listed below for the analyses desired. SAMPLE DESCRIPTION: Collected By W. H. L4, B2 Williamson Sample Location Source Typo ❑ Surface Water Sample Date I 19 l Mo. ❑ Routine Sample ❑ Special Purpose Sample ❑ Ground Water Fill $ 6 Day Year ❑ Untreated Water ❑ Treated Water TO BE COMPLETED BY CERTIFIED LABORATORY INVOICE #39916 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ahnratory Name Sample No. Station No. 5633 "B" STREET Address ANCHORAGE, ALASKA 99502 City Stale Zip Code INORGANICS NITRAIE ONLY Limit Mg/I ❑ Arsenic (0.05) ❑ Barium 0-) ❑ Cadmium (0.010) ❑ Chromium (0.05) ❑ Fluoride (2.4) ❑ Lead (0.05) ❑ Mercury (0.002) ❑ Nitrate - Nitrogen (10.) ❑ Selenium (0.01) ❑ Silver (0.05) ❑ Turbidity (1 NTU) RADIOACTIVITY Limit C) — ❑ — ❑ ND Indicates Not Detected 9/12/86 Dale Analysis Completed 4181-1 Laboratory Analysis No. ETY 9/10/86 Received by Date ORGANICS (15) Limit ❑ Endrin (0.0002) ❑ Lindane (0.004) ❑ Methoxychlor (0.1) ❑ Toxaphene (0.005) ❑ 2, 4-1) (0.1) ❑ 2,4,5 - TP Silvex (0.01) ❑ --- RADIOACTIVITY Limit ❑ Gross Alpha (15) ❑ Radium 226 & 228 (5) ❑ Gross Beta (50) ❑ Strontium - 90 (8) ❑ Tritium (20,000) ❑ -- Slenature of aboratory Supervisor Mg/I 9/15/86 Date moorlRd CHEMICAL & GEOLOGICAL, LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for - Inorganic, Organic, and Radiochemical Contaminants TO BE COMPLETED BY PUBLIC WATER SUPPLIER PUBLIC WATER SYSTEM: ITE I.D. NO. Peninsula Engineering —_ Public Water System Name 440 W Benson Anchorage, AK 99503 Ity a�--Zip CocTe Note: Check box to left of contaminants listed below for the analyses desired. SAMPLE DESCRIPTION: Collected By L5 B2 Sample Location Source Type ❑ Surface Water ❑ Ground Water Sample Date M Mo. ❑ Routine Sample ❑ Special Purpose Sample �1 0 8 6 Day Year ❑ Untreated Water ❑ Treated Water TO BE COMPLETED BY CERTIFIED LABORATORY INVOICE #39916 CHEMICAL. & GEOLOGICAL LABORATORIES OF ALASKA, INC. abwalory Name Sample No. Station No. 5633 "B" STREET _ 4181-2 ANCHORAGE, ALASKA 99502 City Stale Zip Code INORGANICS NITRATE ONLY Limit Mg/I ❑ Arsenic (0.05) ❑ Barium (1•) ❑ Cadmium (0.010) ❑ Chromium (0.05) ❑ Fluoride (2.4) ❑ Lead (0.05) ❑ Mercury (0.002) ❑ Nitrate •• Nitrogen (10.) ❑ Selenium (0.01) ❑ Silver (0.05) ❑ Turbidity (1 NTU) ❑ RADIOACTIVITY — ND Indicates Not Detected 9/12/86 Dale Analysis Completed Laboratory Analysis No. ETY 9/10/86 Received by Date ORGANICS Limit ❑ Endrin (0.0002) ❑ L.indane (0.004) ❑ Methoxychlor (0.1) ❑ Toxaphene (0.005) ❑ 2, 4-D (0.1) ❑ 2,4,5 - TP Sllvex (0.01) RADIOACTIVITY Limit ❑ Gross Alpha (15) ❑ Radium 226 & 228 (5) ❑ Gross Beta (50) ❑ Strontium - 90 (8) ❑ Tritium (20,000) ❑ --- -- Signature Laboratory Supervisor Mg/I pCi/I 9/15/86 Date reported CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 5633 B Street +y. - Anchorage, Alaska 99518 Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I TO BE COMPLETED BY LABORATORY L1 PUBLIC WATER SYSTEM I.D.k =jj_LT MPLE b `X PRIVATE WATERT YSTEM -S/D7 Name ' ) " y V Phone No. 440 ON , I Mailing Address City State Zip Code SAMPLE DATE: �a L P Mo. Day Year SAMPLE TYPE ❑ Routine ❑ Check Sample (for routine sample with lab ref. no. ) El Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time Collected NO, LOCATION Collected By 1 1 i 2 L — 3 4 5 L_ --J Analysis shows thiS Water SA to e. 9 Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. 04 Date Received _��' Time Received Analytical Method: Membrane Filter I No. of colonies/100 ml. Lab Ref. No. Result" Analyst I I FT -1 L 17� U En BACTERIOLOGICAL. WATER ANALYSIS RECORD READ INSTRUCTIONS Membrane Filter: Direct Count Collform1100ml BEFORE Verification: LTB BGB II COLLECTING SAMPLE Final Membrane Filter Res u s 1 Coolllform/100ml Reported By �� _Date_ y °y Time: S U a.m. p.m. TNTC == Too Numberous To Count OB = Other Bacteria CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. A -In TELEPHONE (907) 562-2343 5633 B Street ' Anchorage, Alaska 99518 —^° Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIERICAKADI 1-O BE COMPLETED BY LABORATORY El PUBLIC WATER SYSTEM I.D.N E t b PRIVATE WATER SYSTEM Name Phone No. Malllno Address City SAMPLE DATE: SAMPLE TYPE gysa 3 State m i o 11E61 Mo. Day Year Zip Code E)Routine ❑ Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose ❑ Untreated Water SAMPLE Time NO. LOCATION � Collected LL_� 4 ZJ�Z WI /lam 5>7n� J //!LLo � 2 jI 3 L 4 1 —J 5 L READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Analysis shows this Water 0 e. l� Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not be over 30 hours old at examlllatlon to Indicate reliable results. Please send new sample via special dellveryy email. Date Received -% " /,q— Time Received _-41"U Analytical Method: Membrane Filter No. of colonies/100 ml. Lab Ref. No. Result* Analyst FT51 c-6 ❑7 BACTERIOLOGICAL. WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTB-- Final TB _Final Membrane Flit Res Its Reported By � TNTC = Too Numberous To Count OB = Other Bacteria Coilform1100ml _-BGB d oil rm1100ml Data Time: % S (/ a.m. p.m. September 17, 1986 Steve Morris MOA Health Department Dear Sir: I, Bette J. Overvold, owner of Lot 4 Blk #2 in the Williamson subdivision do not object to having my neighbors, Jan and Denny N. Moore, owner of Lot 5 Blk 2 Williamson subdivison, seepage pit only 94 feet from my well Sincerely, --�x Bet e J. Overvold UNITED STATES OF AMERICA, ( ss. (Individual Acknowledgment) STATE OF ALASKA. THIS IS TO CERTIFY that on this .-I 81l -A- day of —�-C - - 1i3 1 before me the undersigned, a Notary Public in and for the State of Alaska, duly commissioned and sworn, personally appeared __4sad--J&Z'�q, to me known to be the person described in and who executed the above and foregoing instrument, and acknowledged to me that t he— signed the same freely and voluntarily for the uses and purposes therein mentioned. WITNESS My Hand and Official Seal the clay and year in this certificate first above written. OFF+CIAL SEAL STATE OF ALASIUI NOTARY e�U®LI� o Notary Public in and for the Slate of Alaska, N !t'.ftlj II expi s _ 1 residing at _— �' me�Wr�p I 5. LEGAL DESCRIPTION T __67 -)' 1st; Wil--_11.4in�v 5e4 �i.510 ,1 Ji STREET LOCATIION'7- - I / 6, TYPEOFRI'SIDENE - NUMBER OF BEDROOMS [ ' SINGLE FAMILY ❑ One EDFour ED Other_ ❑ .. Two ❑ Five ❑ 'MULTIPLE FAMILY (�rThree ❑ Six 7. WATER�_S�U.�`PLY' Je INDIVIDUAL* ATTACH WELL LOG. A well log is required for all wells drilled i ❑ COMMUNITY since June 1975. For wells drilled Prior to that date, give well ❑ PUBLIC UTILITY -- depth (attach log if available.) — 8.SEWAGE DISPOSAL SYSTEM 11/^INDIVIDUAL/ON-SI-rE**' YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE. INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-410(pev. 0/79)�� n y�'\J THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON-SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER ❑Septic Tank or El Holding Tank Size: 100 If Tank is homemade give dimensions: SOILS RATING - TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL t 4. DISTANCES WELL T0: Septic/Holdiny Tank Absorptio Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS - 17�- APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED 1 DATE BY 72-010 (Rev. 6/79) —" d", ij) A 826"L"STREET• ANCHORAGF, ALASKA 99501 .0110i,',' lj (907) 2_G4-4111 r Gf ORCI N9. �u! LIVAN. o i DFPARI-M!NT01' 11 fAL111 AND ENVIRONMENIAI_PROIFUMN August 1.8, 1981 Richard Eischens Star Route A Box 78-C Anchorage, Alaska 99507 Subject: Lot 5 Block 2 Williamson Subdivision Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be submitted to this office from the Chem Lab, 5633 B Street, for our review. (2) A cleanout needs to be installed to the seepage pit.. This will need to be reinspected by this office. (3) The septic tank pumped with a receipt submitted to this office for our review. (4) An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Spokane Mortgage Company 3201 C Street, Suite 250 99503 SEPTIC SYSTEM ADEQUACY REPORT Job No. 81-1613 Date of Report: 8/19/81 Date of Test: 8/17/81 LEGAL DESCRIPTION: Lot 5, Block 2, Williamson Subdivision PERFORMED FOR: Dennis Moore 5311 Woodcrest Circle SRA Box 78C Anchorage, Alaska 99507 276-4868 Work REQUESTEr -Z: Spokane Mortgage 3201 C Street Anchorage, Alaska 99501 277-0543 TYPE OF SYSTEM: Septic Tank Leach Field NUMBER OF BEDROOMS: 3 Septic Tank Was Pumped? Yes A13SORPTION RATE: 470 gallons/24 hours SURGE RATE: 120 gallons in 12 minutes NOTES: 65ichael E. Anderson w� �0 s'•, 4381- E ; 841 g�P�OFE SS10����ro" Day 1 Day 2 Day 3 Init 96" 96" 9412" 360 96" 94 z" 120 91 Z" TEST PERFORMED BY J.T. REPORT PREPARED BY K.B. APPROVED BY: MICHAEL E. ANDERSON, P.E. leet, EATER ANCHORAGE AREA BOROUGH rtment of Environmental Quality J0�'C" Anchorage, Alaska 99503 2.74-4561 Date Received Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF �ld� INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: Q� �lr��[�_ ^ C��'1��Phone:�I 2. Property Owner: Phone: _ Mailing Address: 3. Legal Description: .L���`_(�1y�„�j�,��^_ 4. Location: 5. Type of facility to be inspected of bedrooms 6. Well Data: p .�f`�`\1 A. Type e � �s1, , �� „�4 �e _ B. Depth e Cj_ 3' ,x C. Construction D. Bacterial Analysis 7. Sewage Disposal System; A. Installed) > rjt�B. Installer C. Septic Tank: 1. Size -_pi 2. Manufacturer C v)\ D. Seepage Pit: 1. Absorption Area _(sz^Q__ 2. Material E. Disposal Field: Total length of lines 8. Distances: 1 A. Well to: Septic tank __, Absorption area e7.tI _., Sewer Lines Nearest lot line _ Other contamination B. Foundation to septic tank _ Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Rei st for Approval of Individual ar & Water Facilities Legal Description L - L Mr I , 1,� � k ox Y� �U Comments Approved Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 14 I 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. 0(011 cll EQ -034 (1/74) Date rAUhIICIP.-LII. .,. ;a.iCH[7iiAiil. �� .ntwoum qr. Ur - �� • L GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" St., Anchorage, Alaska 99503 - 27,4-x4561 � F REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES 1. Type of Inspection: CMRO VA _ FHA CONV 2. Property Owner: l) (Y. `V/ (,CL. Mailing Address: Ll_ _ Day Phone - 3 . Name of Buyer: Mailing Address: 4. Name of Lending Inst ——_--Day Phoned itution:(��-lC c11L��ICadC�� Mailing Address: //Q0 / ,_6 dPhone6•% 3j, 5. Name of Realtor or Agent: Mailing Address: j�� Phone /y - 6. Legal Description: -- 0� .�, , y/ / zd(1 0' LocationL19 7. Type of Facility to be inspected: \'�IRC�If'_/-C��7C_ No. Bdrms, 8. Water Supply Type of Supply: Public Utility Individual C _ If Individual, number of dwellings presently served _ If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on. -site) If Individual, date of installation _Z Q _ EQ -037 (1/74) 0/c/1- C/_L.r