HomeMy WebLinkAboutWILLIAMSON #2 BLK 3 LT 2Williamson #2
Block 3
Lot 2
#015-074-02
Municipality of Anchorage
On-Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP181001 PID Number: 015-074-02
Dwelling: ® Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: El New Z Upgrade
Name:
KEITH & EMILY LONG ABSORPTION FIELD - EXISTING
Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed El Mound
5005 E 98th Avenue, Anchorage, AK 99507 ❑ Other
Phone (Number of Bedrooms Soil Rating Total depth from original grade
4 GPD/SF Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision
Block Lot Ft. Ft.
WILLIAMSON #2 3 2 Fill added above original grade Gravel length
TownshipRange Section Ft. Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES Ft. -- -- Ft.
Tol Septic Absorption Holding Sewer Total absorption area Number of trenches --Dist.between trenches
From Tank Field
Lift Station Tank Line Ft2 -- Ft.
Well 200+ , II% + + NA 25'+ TANK Z Septic 0 S.T.E.P. 0 Holding 0 Other
Manufacturer Capacity
Anchorage Tank 1250 Gal.
Surface Water 1 00'+ "V.. + NA Material Number of compartments
Steel 2
Lot Line 5'+ NA NA
- + NA
Foundation 5'+ LIFT STATIONManufacturer Capacity
Gal.
Curtain Drain NA *50'+ NA NA
Pump on level at Pump off level at High water alarm at
Remarks *None known. New 1250-gal S.T.
in. in. in.
Installed per code & connected to existing Electrical Inspections performed by
field. Old ST decommissioned per code. Pump make and model
PIPE MATERIAL House to tank 3034drainTank toeld 3034
fi
Installer Mike Anderson Drainfield CO/MT 3034
Inspector ARCTERRA BENCH MARK (Assumed elevation) 100 ft
Inspectiongr Location and description
dates: 1 1/11 /18 2�a 1/12/18
Td 4°' Bottom of Siding
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL -evis Engin
gin
4,7,_c,„- OF ALAS\ 1
Conditional Approval: Date /<S� ,j- 1
� * 49TI1 ?* +
gd -i 6 ,`gyp 711-
if
A ro, cd V��. �, Date (^ \ '"vF'F.ssto`�`!
pp \\`�
eer's Stamp
Inspection Report_9-1-12.doc
AS-3UILT SYSTEM DETAILS/SITE PLAN PernitOSP181001
WILLIAMSON #2 BLOCK 3, LOT 2 PID#015-074-02
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SCALE: 1' = 30'
A-C= 26,5'
B-C= 27.5'
A-D=32.0'
30.5' W 99.88 00.31 SUMP
B-D= _ �' TSSUMP
FINAL GRADE
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PREPARED FOR' T
/r.. ' -N.!0"-- KEITH & EMILY LONG R r E/?p
/ �1.. / . * V 5005E 98TH STREET ti t R q ra
* 4 • TH 9 \ / ANCHORAGE, AK 99507 y° �t
I
FIELD BOOKS COMPUTED: z m
KENNE D � S : L
%'. C �![! •�• �� / BWNDARY:BOUNDARY DRAWN: BMW i �', S\`
1 r�,� .. �� STAKING: STAKING cNeacED:KMD \
... ,8 �e/ AseulLr: HOLT Dare: 1/26/18 •_.� 0�
1N.
\ A FESSIO�P DWG. FILE: GRID: SW2437 'c($. r , TI`C' • \e�_,
\``' ACAD FILE: JOB No.: 17240 fR' AK.99571'
FILE
JN`CIP�LIiy OR MUNICIPALITY OF ANCHORAGE ,coent 6,
On-Site Water&Wastewater Program �o f;
�R
PO Box 196650 4700 Elmore Road
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
Lir http://www.muni.org/onsite
1 epartment
�''CNOM1p'�
On-Site Wastewater Disposal System Permit
Permit Number: OSP181001 Effective Date: 1/8/2018
Work Type: SepticTank Upgrade Expiration Date: 1/8/2019
Tax Code Number: 01507402000
Site Legal Address: WILLIAMSON #2 BLK 3 LT 2 G:2437
Site Mailing Address: 5005 E 98TH AVE, Anchorage
Owner: LONG KEITH J & EMILY C Lot Size in Sq Ft: 13688
Design Engineer: ARC TERRA CONSULTING INC Total Bedrooms: 4
This permit is for the construction of:
O Disposal Field C Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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
( (Y7(1
Received By: IIJC
) �l i Date:
Issued By:
Date: i 8
MUNICIPALITY OF ANCHORAGE
�- 907-343-7904
Community Development Department Phone:
Development Services Division
Fax: 907-343-7997
On-Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
015-074-02
Parcel I.D. 854-3900
Property owner(s)
Keith & Emily Long Day phone
5005 E 98th Street, Anchorage, AK 99507
Mailing address
Site address
5005 E 98th Street, Anchorage, AK 99507
Williamson #2 Block 3, Lot 2
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section) 4
Lot Size 13688 Sq. Ft. Number of Bedrooms
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(® all that apply) Single Family (SF)
Absorption Field [ I Initial I I (w/wo ADU)
Septic Tank 1>1 Upgrade Duplex (D) U
Holding Tank [ I Renewal n Multiple Dwellings n
Privy ❑ (SF and/or D)
Private Well ❑
Water Storage P
THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: A /5 Waiver Fees:
Date of Payment: I`91t Date of Payment:
Receipt Number: /�, OS 67-LID Receipt Number:
Permit No. OS p i OG/ Waiver No.
Permit App_9-1-12.doc
tRCTER6,4
ARC T ERRA
. g CONSULTING, INC_.
212 E. 50 Ave,Anchorage,AK.99563
' era Office(907)868-3791,Fax(907)868-3793
��F9°p SULTING•�e ,
.577
January 5, 2018
Municipality of Anchorage
Development Services Department
On-Site Water &Wastewater Program
P.O. Box 196650
Anchorage,AK 99519-6650
Subject: Septic Tank Upgrade Permit- Williamson#2 B3,L2
The owner has requested we proceed forward to obtain a septic permit to
upgrade the 41-year old steel septic tank. Per pending COSA submittal after
tank installation we request an expedited permit.
We propose to decommission the existing 1250-gallon septic tank per code and
install a new 1250-gallon tank in the same location to serve the existing 4-
bedroom house.
The adjacent lots are served by a Class A well. There is no surface water within
100' of the proposed tank. We do not expect there to be any adverse effect on
adjacent lots by the development of this tank. If you have any questions, please
contact me at 868-3791 / FAX 868-3793.
Respectfully submitted,
ArcTerra Consulting, Inc.
Br . Western
ner's Representative
Attachments: On-Site Sewer Application
20441 PTARMIGAN BLVD • EAGLE RIVER,AK 99577-8736 • PH(907)868-3791 • FAX(907)868-3793
r
4_____________. r
_______________________
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EAS1--
2018 SEPTIC TANK UPGRADE:
Decommission existing septic tank
per code&install new 1250-gallon
tank maintaining 5'+ from
foundation / existing field &
100' + from private water wells &
200'+ from class A wells.
GREh , ER ANCHORAGE AREA BOR1,. JGH
P I
vl, Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
_INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
�.L{ _ MAILING ADDRESS y—pcseG-/�-- PHON
�� •
NAME .�- �`�ft'J---- � - r
�^fU _LEGAL DESCRIPTION f4� ��/�aiN �� J 1�—
LOCATION _--- __ --- ------
SEPTIC TANK:
NUMBER OF
DISTANCE .aka Q� MATERIAL _��ee---,1 .--COMPARTMENTS
FROM WELL JC�h? MANUFACTURER _
INSIDE LENGTH �- _ INSIDE WIDTH_ _-LIQUID DEPTH .___ I (QUID CAPACITY/a$____--O GALLONS.
--aRmf
+ / TOTAL LENGTH
DISTANCE FROM WELLI. /##ll FOUNDATION OW(^_NEAREST LOT LINE_! - -=-=OF LJNFS-
NUMBER OF LINES / DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE
ABSORPTION AREA (7 4416 9 -- SQ. FT. LENGTH OF EACH LINE -- --7-G /
�/ DEPTH OF FILTER �' G
MATERIAL BENEATH TILE.-� IN. ABOVE TILT IN.
DEPTH: TOP OF TILE TO FINISH.GRADE ------
WELL:
TYPE.�_Q k, I CONSTRUCT ION -_...— NOTES
BUILDING NEAREST NEAREST 1. The S/D Class A well is 200'+ from
FOUNDATION . LOT LINE — SEWER LINE_ the proposed tank placement.
--__ .._..._.. ......_. __ 2. No surface water noted within
100' of proposed tank placement.
REM/
DIAGRAM OF SYSTEM
2018 SEPTIC TANK UPGRADE: h4o 5if
Decommission existing septic tank per
code&install new 1250-gallon septic $'` ���`� y-q,v ...
tank and two post-tank cleanouts per
code, maintaining 5'+ from foundation &
existing field,and 10' + from water line. f'
a r" , Io` v ei , su,>,P
W 5a1 ,o
CONTRACTOR TO VERIFY SEPARATION - �r � -.. ----:;°'
--�%,
APPRoveo
TO WELLS, PROPERTY LINE, ETC... ° r G.A.A.B. II
PRIOR TO CONSTRUCTION.
�IGRDN,ER ANCHORAGE AREA BORt,.,JGH
Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON-SITE SEWAGE: DISPOSAL SYSTEM
NAME UI_ �`p__ls4_/_i% __ MAILING ADDRESS ; -/- -__ _r �- - PHONfz
LOCATION DESCRIPTION-4-A,/k
SEPTIC TANK:
DISTANCEAz,,
$ NUMBER OF
FROM WELL z,,�_ MANUFACTURER _=?2ele4L,MATERIAL _Z�7Aae�l —COMPARTMENTS '�• -
INSIDE LENGTH- — INSIDE WIDTH_-__._ LIQUID DEPTH ,__LLQUID CAPACITY44SD GALLONS.
TtL-H3 RA"ELI]; -- — ---- —
//���� TOTAL LENGTH ,,//
DISTANCE FROM WELLI "AL _ FOUNDATION_aO(__NEAREST LOT LINE_�� _OF LINES 7U _
NUMBER OF LINES __4/_— DISTANCE BETWEEN LINES TRENCH WIDTI-1 —61N. TOTAL EFFECTIVE
L /U
AI350RPTION AREA - C6 54. FT. LENGTHOF EACH LINE----
/ DEPTH OF FILTER
DEPTH: TOP OF TILE TO FINISH GRADE _ MATERIAL BENEAT FI T ILE _ ✓OLIN. ABOVE TILE`�� IN.
WELL:
TYPE_ —iii 41'1ao_L�_ CONSTRUCTION _ ___ DEPTH _.__ DISTANCE FROM:
BUT L -DING NEAREST NEAREST SEPTIC SEEPAGE
FOUNDATION__, LOT LINE SEWER LINE TANK---, SYSTEM
CESSPOOL
OTHER SOURCES
APPROVED____-_DISAPPROV
D --REMARKS
DISTANCES:.✓J/�2-�
� �� -----�------
INSTALLED BY:
SEWER LINE DEPTH:
PIPE MATERIAL:
LOT SLOPE:
REMARKS; /C949 0
Form EQ -032
DIAGRAM OF SYSTEM
DATEI19"11- 6 APPROVED
14()(15
01
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1/ 'co fife
H ^ N k.,G IW*Y ::IF. u.:a: lC IF�" FIN_— 1 .T " q u -.-u IF-- [F`11 Y" -•Y H:-
DEPARTMENT
_Df-_PARTL91"-ENT OF HEALTH FII'dD E.PdVIRONMENTAL. PROTECTION
2516 16 E. TUDOR RD., ANCHORAGE, qRAGE, F9K 9950(l
n. '# PA ---, 15". ➢:: 1- NEE. r. S, E 11_41E: Ei Fl F" E'E E"n = PA JI::.._ -
PERMIT NO. < 76773
Flf'PL.II` ANF UJtd[,. 4.t -1[r2 N. CSTT=IRR S'T'
274-280''
LOCATION E. ::0TI-I
L..E13iriL I_2 Ea_k:: -: Ld:El...l._TFIC'IS:CJt,I L..CI"F ...[''.E: 13688 S(!L.II'i[tliE: FF..:E.l'
TYPE OF 'SOIL FiF'E,ORBT.T.ON SYSTEM IS: TF*:k_NCEi
- RAT'It,ll- �::::;O FT;'BR):::- 1i0
MAXIMUM NUMBEROFFEBEDROOMSBEDROOMS.- b SOIL
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I S :
Elm If_=: F01....Y.. tl--Y __:: --: Y....... E::. Y" -"Y n::':e B' fl --Y --= 25
THE: LENGTH DIMENSION T.'I TEIt,= LENGTH (IN FEET) OF THE: TRENCH OR DRnI:NFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE:: DISTANCE BETWEEN THE '=;1..RFAC::E: OF THE
GROUND AND TT -1E: BOTTOM OF THE EXCAVATION ATION (IN FEET).
THERE 15 NO SET WIDTH FOR TRENCHES.
THE I:.RAVE.L_ DEPTH IS THE MINIMUM DEPTH OF 13RFP'iEL_. BETWEEN THE OUTFALL PIPE
AND THE. BOTTOM OF THE: EXC:R':AT':[L.N (IN F'EE:TY
ITT EE GA II._9 K ff«;° F7 fce IE:. F::" -p- :R.: n::I": '-F F1 E' -dl V_: a" „_'" IF_ _
Y " L.A n:_ w -c� ;,-: ::;" JC Y" Y "c`; IFu" Y = ET -T- I ul n Y" -.•Y '.-i± H=G E' '-, Ye._ If -', Y iii: o;;:? 4_G :I[: FR: IEE: IE:,:"
BACKFILLING OF ANY SYSTEM WITHOUT FI:t'dEiL INSPECTION AND APPROVAL. BY THIS
DEPARTMENT WI:L.L.. BE. SUBJECT TO PROSECUTION.
C'CEI'd7:1'1L-11''I D:[:-.'I"HtdC:E: f.-:.E"fWEEt+I h"I WEL.L.. FIPdI:; IiY+1'r' ,:,Pd._:3I'rE S3E:WETL:E: DT:-,PCr-,RL... SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WE:L. L.
SPECIFICATIONS FIND CONSTRUCTION DIFu_t<:FIMS ARE AVAILABLE TO INSURE I -ROPER
F" E_: K P1 Z 1 N? F1 fl__.:IC K--- Y=' u:: it IF:'_ ED F4 E %" EE rl Fe F= Y':; = K "u 11 "1 1-
I. CERTIFY THAT
1: I. AN FAMILIAR WITH THE. REQUIREMENTS FOR ON --.ITE; SEWERS AND WELLS AS `ET
FORTH BY THE MUNICIPALITY OF ANCHORAGE,
2 I WILL. INSTALL.. THE IC:F.-:: WITH THE: CODES,
3: is UNDFSf�:F,TAND THAT THE"uON-SITE EI1-�EWEl;Evll-YSTEM MAY RI?G!UIRE: ENLARGEMENT IF THE
RESIDEiNC:E. IS REMODELED TO INCLUDE MORE THAN 4 BEDRl:AedCL.
SIGNED: .... J-4-....���K .kl�ueea...._....._...,......_...._
ISSUED BY
r,11 i�'k
V
Ts-farvA David imddl 9/11136,_
100al DOWNIVIOn: , Lot 2, , Block 3 Wilmlao ubdivi s ion. #2
ihis Ann reports: Soils log _ -Yes F-100colalow w,
Depth
Fact
3 1
Sandy Gravel, moist
(GP -GW)
6 -
7
Gravelly Silt, moist
12 -
14
As graum ARA'ancounture-AA No if y2s, at VIA APIK?
No bedrock encountered
c.7 i 1 -j Date ROSS five in to t 1. no
A -
-1 - - ------ --- 17 71 -71 T
MOMMUn I
propmd MWIVIA sn'Tagy Pit Drain Mid
-PIA of inlet Rpth to' boub of pit or trwh
J 0 yquaVV, I eep, Art ed, ner, bedroom,,from,
minus 2 to 9 feet.
jyfoy: Dayid Pau l-triii nd A WO j. 9/20/76
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•� Municipality of Anchorage
On-Site Water and Wastewater Program 4 is:a L
(907) 343-7904 SA (TV
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 015-074-02
Expiration Date: 1-3 d^f�
1. GENERAL INFORMATION
Complete legal description WILLIAMSON#2 BLOCK 3, LOT 2
Location (site address) 5005 E 98TH STREET,ANCHORAGE,AK 99507
Current Property owner(s) KEITH &EMILY LONG Day phone
Mailing address 5005 E 98TH STREET,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: 4
TYPE OF WASTEWATER DISPOSAL:
4. TYPE OF WATER SUPPLY: Individual
Individual Well ❑ Holding Tank ❑
Individual Water Storage ❑ Community ❑
Community Class A Well ® Public Sewer ❑
Public Water System ❑
Waiver/Variance request for: Distance:
6 / Date: 1 50//25
Received by: 1 i./i /� /_. �• �•-
COSA to be released to the engineer,unless othe - r`1ested by the engineer.
COSA Fee $ .r 'O Waiver Fee $
Date of Payment i/2.&/( Date of Payment
Receipt Number 06,71C-10 Receipt Number
COSA# d`x.��167?- 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 12/18/2017
THIS COSA DOCUMENT CANNOT BE USED TO TRANSFER TITLE UNLESS ALL VENDORS(ENGINEERING,SURVEYING,CONTRACTORS,ETC...ASSOCIATED
WITH THIS COSA ARE PAID IN FULL AT OR BEFORE CLOSING. 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, 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 ��`�
encroachments,deficiencies or discrepancies exist.
6. DSD SIGNATURE wri`49 TI I► ' �y
i
System #1 Approved for (.1( bedrooms. �,
IF KENNETH M. DAVM ` /
System #2 Approved for bedrooms. 1 'raqq 7116 �"/
Disapproved. n •FFs;io �
Conditional approval A.
\����
for bedrooms, with the following stipulations:
..�Q����Y oF;4iy ,
- �� do
ON-SITE 1 .
WATERT Rt
AND
WAS TtWATER z
co PROGRAM c
go
` v SERV\6.-
By' "`�_. Original Certificate Date: 1-.3 0—l?
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet 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#2 BLOCK 3, LOT 2 Parcel ID: 015.074-02
A. WELL DATA-CLASS A
Well type A If A, B, or C provide PWSID# 210639 Well Log (Y/N)
Date completed Sanitary seal (Y/N)Y Wires properly protected (Y/N)
Total depth ft. Cased to ft. Casing height(above ground) in.
FROM WELL LOG AT INSPECTION
Date of test
Static water level ft. ft.
Well production _ _ g.p.m. __ g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate mg/L
Arsenic: ug/L Date of sample: Collected by:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC I STEEL Date installed 1/11/2018
Tank size 1250 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 NA-NEW TANK _Pumper
C. ABSORPTION FIELD DATA
Date installed 10/11/1976 Soil rating (g.p.d./ft2 or ft2/bdrm) 100 System type DEEP TRENCH___
Length 40 ft. Width 3 ft. Gravel below pipe 5 ft.
Total depth 10 ft. (Measured 12/13/17) Eff. absorption area 400 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 12/13/17 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 25 in. Water added 1000 gal. New depth 60 in.
Elapsed Time: 1125 min. Final fluid depth 25 in. Absorption rate >= 600+ 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 -PUBLIC WATER
WELL ON LOT TO:
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main Public sewer manhole/cleanout
Sewer/septic service line Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main 10'+ Water service line 10'+ Surface water 100'+
Wells on adjacent lots 200'+
ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain 50'+(NONE KNOWN) Wells on adjacent lots 200'+
F. COMMENTS
: •:: ••- : - -•: .;, ;.:: �: • :: :.:::_:_• . Similar
conditions as found with the 2005 COSA-with heavy sludge in the sumps,especially north sump. Subsequently,used the southern
sump for testing. Levels rapidly rose to invert and dropping quickly back right after test with the next day at pre-test level.
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. s '•
OFElL
Engineer's Printed Name KENNETH M.DUFFUS `QtS't�,
Date 12/18/2017 / , TH • p ,
airwAsowei
` KENNETH M. Slir
COSA canary sheet_2-6-15.doc /
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AS-BUILT SURVEY 1" = 30'
RD CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 2, BLOCK 3, WILLIAMSON NO. 2 SUB.
THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN EXIST OTHER THAN NOTED.
HEREON ( UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS _25TH_ DAY OF
NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE _JANUARY , 2018.
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. HOLT LAND SURVEYING
9309 GROVER DRIVE
ANCHORAGE,AK 99507
9745,F8118-50,149-30,186-70 345-5513
Municipality of Anchorage
• Development Services Department =
Building Safety Division
On -Site Water and Wastewater Program
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. 015-074-02 COSA# OSC 11It-1SS
Expiration Date:
1. GENERAL INFORMATION
Complete legal description WILLIAMSON #2 BLOCK 3 LOT 2
Location (site address) 5005 E. 98TH, ANCHORAGE, AK 99516
Current Property owner(s) KRISTIN KROM
Mailing address
Lending agency
Mailing address
Day phone 345-5766
Day phone
Real Estate Agent il P L,eerlj Day phone .< S` % - v t L `/
Mpiling�Address
Unless otherwise.reguested, COSA will be held by DSD for pickup.
2.' NUMBER,OFIBEDROOMS: 4
3. TYPE OF WA'TERSUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
❑
Individual On-site
o❑
Individual Water Storage
❑
Individual Holding Tank
❑
Community Class A Welle❑
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
_jz Approved for _ L bedrooms.
Disapproved.
Phone 279-3916
Date 12/22/2011
y
�•'
sPURKLAND
1II15012
p
�a
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Arsenic Advisory _
Maintenance Agreements _
Supplemental Engineer's Report
Other
By: Original Certificate Date:
(Rev. 77(05)
Municipality of Anchorage
• "� Development Services Department °
Building Safety Division
On -Site Water & Wastewater Program
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: bl1«ihmSon 4 2 86ck 3 Lot 2 Parcel ID: 015-0--H-C"2-
A.
15-oil-O'Z
A. WELL DATA
Well type A
Date completed -
Total depth — ft.
If A, B, or C provide PWSID # 2.tWo3 K Well Log (Y/N) —
Sanitary seal (Y/N)= Wires properly protected (YIN)
Cased to — ft. Casing height (above ground) — in.
FROM WELL LOG AT INSPECTION
Date of test —
Static water level — ft. ft.
Well production — g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform — colonies/100 mL Nitrate _ mg/L Collected by:
Arsenic: ug/L date of sample:
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material C'eerl swe Dateinstalled Iot1 l5}L
Tank size Z50 gal. Number of Compartments Cleanouts (Y/N) Y
Foundation cleanout (Y/N) �Y_ Depression over tank (Y/N) L/ High water alarm (Y/N) N
Date of pumping '8151201% Pumper Zs-A� s km i2 Service
C. ABSORPTION FIELD DATA
Date installed l0 a t9 }t. Soil rating (g.p.d./ft2 o ft2/bdrm loo System type Deep TrcnJ\
Length 40 4 ft. Width 3 ft. Gravel below pipe 5 ft.
Total depth to .5 ft. Eff. absorption area qOO fe Monitoring tube i Depression over field N
Date of adequacy test 2011 Results (Pass/Fail) ass For 1'14X bedrooms
Fluid depth in absorption field before test!151 in. Water added 1600 gal. New depth 69 o in.
Elapsed Time: 50 min. Final fluid depth 53163 in. Absorption rate >= 00 g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) None Khowrn 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 n. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit re irements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOTTO: COMrgan ty WEU
Septic tank/lift station on lot On adjacent lots
Absorption field on lot On adjacent lots
Public sewer main — Public sewer manhole/cleanout
Sewer /septic service line — Holding tank
Animal containment areas Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5 + Property line 5 "t Absorption field 5 �+
Water main to 1 + Water service line 10 + Surface water ]Do '+
Wells on adjacent lots 't loo+ 12.0,+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line to F Building foundation 10' 1- Water main lo` F
Water Service line to Surface water loo'+ CICU. Driveway, parking/vehicle storage 10'+
Curtain drain Co �+ 01.0 Wells on adjacent lots 't1o0,+ zoo t
F. COMMENTS n 1
G. ENGINEER'S CERTIFICATION r �� OF AZ q 1
1 certify that / have determined through field inspections and
review of Municipal records that the above systems are in j 9T
conformance with MOA COSA guidelines in effect on this date.ta�
Engineer's Printed Name ARS S y¢Yj� a�� 3}�• jJ� spURKLAND.' j
11500 4�
Date V. 12011 r
(�l A�?tlOC�P�
COSA Fee $ `AolC) — ++ Waiver Fee $
Date of Payment r -a- C lam\ Date of Payment
Receipt Number Receipt Number
(Rev. 4110)
N 89°52'
SURVEY ORDERED BY:
JERRY DEWHURST @
REMAX PROPERTIES
82°08'45,
FSMt
W 133.15
11
THE INFORMATION HEREON 15 FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONPLIOT5 BETWEEN EXI5TIN65TRUCTURE5 AND PLATTED LOT LINES AND/OR EA5EMENTS: AND IS
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES.
EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
HEREON( UNLESS INDICATED)
NOTE: FENCELINE5 THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO OETERMNE
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AN0/OR ICE.
A5 -BUILT SURVEY I" = 30'
NO CORNERS SET THIS DATE
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
LOT 2, BLOCK 3, WILLIAMSON NO. 2 SUB.
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
EXIST OTHER THAN NOTED.
DATED AT ANCHORAGE,ALASKA THIS 7TH DAY OF
DECEMBER . 2011.
HOLT LAND SURVEYING
600 HIGHVIEW DRIVE
9745, FB 118,50,149-30 ANCHORAGE,AK 99515
345-5513
Municipality of Anchorage ,.• -,
Development Services Department
• / Building Safety Division ..
Onsite Water & Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 ! _ .n G SS
www.ci.anchorage.ek.us fp�jW
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. HAA# ()50A!ye
1. GENERAL INFORMATION Expiration Date: CD - 9-06
Complete legal description WILLIAMSON SUBDIVISION #2• LOT 2. BLOCK 3.
Location (site address or directions) 5005 EAST 98TH AVENUE • ANCHORAGE, AK 99516
Current Property owner(s) DAVID LUND Day phone 346-2610
Mailing address 5005 EAST 98TH AVENUE * ANCHORAGE, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual Well ❑
Individual Water Storage ❑
Community Class _A -Well
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
0
Individual Holding tank
❑
Community On-site
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (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 seat affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application,
shows that the onsite 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 riles 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, Ltd. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiable features. The operational life ofall wells and
septic systems depend on the local soft condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for —111L bedrooms.
Disapproved.
Phone 337-6179
Date
Conditional approval for bedrooms, with the following stipulations:
Attachments:
HAA Checklist Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
BY cfkZ/t/• �f Original Certificate Date: 6-9–os–
(R".
–9–os–
(n". aAi)
Municipality of Anchorage a o
• Development Services Department
11
Building Safety Division `:. , , , e:
On -Site Water R Wastewater Program
4700 South Bragaw St.
P.O. Box 1966W Anchorage, AK 99519-6650
www.cl.anchorage.ak.us
(907) 343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: WILLIAMSON SUBDIVISION #2: LOT 2. BLOCK 3. Paroel ID: 015-074-02
A. WELL DATA
COMMUNITY WELL
Well type "a" If A. B, or C provide PWSID# 2106218
Date completed Sanitary seal /N
Cased to ft.
FROM WELL LOG
Date of test
Static water level ft.
Well production 9•p•m-
WATER SAMPLE RESULTS:
Coliform colonies/100 ml.
S. SEPTIC/HOLDING TANK DATA
Nitrate mg./L.
Date of sample: _
Tank Type/Materiel STEEL
Well Log (YM)
protected (YIN)
Casing height (above ground) in.
AT INSPECTION.
ft.
g.p.m.
Date installed 10/11/1976
Tank size 1250 gal. Number of Compartments 0 Cteanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YM) N/A
Date of pumping 5/12/2005 Pumper MCDONALDS PUMPING
C. ABSORPTION FIELD DATA 16SELOW EXISTING GRADOMT1 MT2
Date installed 10/11/1976 Soil rating (g.p.d./ft'orjj� 100 System type TRENCH
Length 40 ft. Width 3 ft. Gravel below pipe 5 ft.
Total depth •10.1-10.711. Eff. absorption area 400 fe Monitoring tube YES Depression over field NO
Date of adequacy test 5/12/2005 Results (Pass/Fail) PASS For 4 bedrooms
48.5
Fluid depth in absorption field before test 4 69 m * Water added "610 gal. New depth 69 in.
48.0/
Elapsed Tlme: 125 min. Final fluid depth 69 in. Absorption rate >= 600+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (YM 8 type) NONE KNOWN If yes, give date
$0106 GALLONS ADDED PRIOR TO FIRST READING. SEE ATTACHED LETTER.
sl, due_ cnck ; S C (oyc i nE] i0cr fcxalitmS
D. LIFT STATION
Date installed
"Pump on" level at _in.
E. SEPARATION DISTANCES
Size in gallons
Cycles tested
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/ itt station on lot
Absorption field on lot
Public sewer main
line
High water alarm level at
Meets alarm & circuit requirements?
COMMUNITY WELL
On adjacent
On
Public sewer manhole/cleanout
Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 59+ Property line 5'+ Absorption fleld 5'+
Water main 10'+ Water service line 100+ Surface water 100'+
Wells on adjacent lots • 100'+/200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main 10'+
Water service line 10'+ Surface water 1000+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots ' 100'+/200'+
F. COMMENTS
*PRIVATE WELL/PUBLIC WELL
G. ENGINEER'S CERTIFICATION
I certify that I have determined through Held inspections and *'•7*
review of Municipal records that the above systems ate in "•"" ... ' "• • • """""
conformance with MOA HAA guidelines in effect on this date.
... .. . ....... ..........
r A. Go ass:
Engineer's Printed Name JEFFREY A. GARNESS .� ' , E�
•
Date d
HAA Fee $ T� Waiver Fee $
Date of Payment ��r'G� Date of Payment
Reoeipt Number Receipt Number
(Rev. 12101)
GARNESS ENGINEERING GROUP, Ltd.
SOMPOMOVISMOMM CONSULTANTS & GENERAL CONTRACTORS
May 23, 2005
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650,
Anchorage, Ak 99519-6650
(907) 343-7904
Subject: IIAA for Community well & private Septic System. Lot 2, Block 3, Williamson
Subdivision #2.
To whom it may concern:
The subject lot has a 4 bedroom house on it which is served by a community well and a private
septic system. The results of the field investigation and adequacy test is summarized as follows:
SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a 3 foot wide trench, which is 40
feet long, and has an effective depth of 5 feet. Prior to starting the test it was noted that the liquid
level in northwest (MT2) end of the drainfield was 0.5 inches into the lateral line and the liquid
level in the southeast (MT1) end was 31.5 inches below the invert. A total of 52 gallons was
added to MTI which caused the level to rise 33.5 inches (approximately 2 inches in the lateral
line). The water was then switched to the double cleanouts in the middle of the drainfield. The
liquid level then dropped 11 inches to 73 inches in MTI (approximately 9 inches below the
lateral line). An additional 610 gallons of water was then added to the trench through the double
cleanouts which caused no rise in the drainfield. Based upon this data, it was determined that the
absorption rate o the trench exceeds 600 gallons per day, as required for a 4 bedroom house.
If you have ap uestions, please contact us at 337-6179.
P.E., M.S.
3701 E. Tudor Road, Suite 101 * Anchorage, Alaska 99507
Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessenginecring.com
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AS -BUILT SURVEY (NO CORNERS SET THIS DATE)
1'•3O
1 HEREBY CERTIFY T WT 1 WVE PERFORMEOA
MORTGAGEEB MSPECTgN OF THE FOLLOYANG
DESCRIBEDPROPERTY
LOT S. MOCK 3. WILLMMSON SUR NO. t
ANCHORAGE RECO REON ARE
:G pSTRItt. AIASNA ANDIWT
THE VISIBLE I4INIOVEMENTS SR WTED THE
THE WDaIwLTIOH HEREON 4 FOR THE USE OF LENDING"rTLITIONS SPECIFICALLY T08l10W ANY COWUCTS BETNEEN VATHIN THE MR RTY LINES AND NOVISIBLE
EXISTING STRUCTURES ANO PATTED LOT LINES OR EASEMENTS AND D NOT TO BE MD FOR POSITIOMNG ADDITIONAL ENCROACHMENTS EXIST OTHER TI NOTED.
STR%XWRESORFEHCEUNES DATEO AT ANCHORAGE. AL/ THIS 19TH—
EASEMENTS OF RECORD. OTHER THAN THOSE SHOWN ON THE RECORDED P T. ME NOT SNOYM HEREON (UNLESS INOIWTED) HOITI— g'�YIN-�TS.B 11630
ROTE ANY FEWELINES SI ARE LOCATEDAFFROIUWTELY AND ARE NOT TO BE USED TO DETERMINE PROPERTY LINES TELSXSS313
OR LO TE STRUCTURES
MY PAVING SH WY BE APPIOXIWTE DDE TO SNOWCONOITIONS
`t Ly04A0f Aqf
t
y'J s o
V �= GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 2.74-4561
3.
4.
5.
6.
Date Received February 18, 1977
Time of Inspection J,( -)1)a
Date of Inspection-J�7
REQUEST FOR APPROVAL OF �PJ,)uldv
INDIVIDUAL. SEWER & WATER FACILITIES
FOR MID IDYU u -W
CM-tj i
ont/ _ 6L( 1j71
--- — -4
Approval requested by: Alaska Mutual Savings Bank
Mailing Address: Post Office BOX 1120 _ Phone: 274•-3561
Property Owner: _David R_/Diana L. Lund Phone: 344•-9132
Mailing Address: _5005 East 98th Avenue — ---
Legal Description: Lot 2 Block 3 Williamson #2 --
Location: 5005 East 98th Avenue
Type of facility to be inspected Jingle Family No. of bedrooms
Well Data:
A. Type
C. Construction
Commun i
B. Depth
D. Bacterial Analysis
7. Sewage Disposal System: on-site system
A. installed 13. Installer
C. Septic Tank: 1. Size
D. Seepage Pit: 1. Absorption Area
E. Disposal Field: Total length of lines
8. Distances:
2. Manufacturer
2. Material
A. Well to: Septic tank ---_, Absorption area `, 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 S it & Water Facilities
Legal Description _Lot 2 Block 3 Williamson #2
Comments
Approve y yDisapproved Datec:�— 77
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
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.
SIGNED
EQ -034 (1/74)
Date
_ MUNICIPALITY OF ANCHORAGE
a DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTIqWCIpAtlly O ANCplt)>RA4I(`
2510 East Tudor Road, Anchorage, Alaska 99504 276.2221 MPll Oi' li'AlTf4 t':
�MVIRt�taN,eML�I. Nc;c�n:CTlciAf
REQUEST FOR APPROVAL. OF
INDIVIDUAL SEWER and WATER FACILITIES HE I
1. Type of Inspection: CMRO _VA_ _FHA --_E
2. Property Owner: LUND, David R. & Diana L.
Mailing Address:— 5005 E. 98th Drive __-Day Phone: 344--9137
3. Name of Buyer: none
Mailing Address: _
Day Phone:_
4. Name of Lending Institution: Alaska Mutual Savings Bank _
Mailing Address: P. 0. Box 1.120 __-Phone:_ 274-3561 ex: 217 _
5. Name of Realtor or Agent:
Mailing Address:
6. Legal Description:. Lot 2, Blk 3, Williamson Subd. , Addn 112
Location:_ 5005 E. 98th Drive
7. Type of Facility to be Inspected:._ septic —No. Bdrms.
8. Water Supply
Type of Supply: Public Utility xxXx__Individual
If Individual, number of dwellings presently served
If Individual, depth of well
9. Sewage Disposal System
Type of System: Public Utility ----Individual (on-site)_—XXxx--
If Individual, date of installation_ —
Requested by Doreen Deppe
Loan Processor
72-003(3/76)