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SEACLIFF BLK 2 LT 2
Seacliff Lot 2 Block 2 #011-221-36 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP2011499 PID Number: 011-221-36 Page 1 of 2 Dwelling: LM Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade vame Kyle DENTON 9300 JACLAIRE LN, ANCH AK ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound F7 r, - - Phone Number of Bedrooms 4 LEGAL DESCRIPTION LJ vallyl Soil Rating Total depth from original grade GPD/SF Ft. Depth to pipe invert from original grade Gravel depth beneath pipe Ft. Ft. Subdivision Block Lot SEACLIFF BLK 2 LT 2 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Total absorption area Ft z Beds: Number of Lines Number of trenches Distance between lines Ft. Dist. between trenches Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer From Tank Field Lift Station Tank Line Well 50'+ TANK p Septic ❑ S.TZP. ❑ Holding ❑ Other Manufacturer GREER TANK Capacity 1000 Gal. Surface Water 1001+ Material PLASTIC Number of compartments 2 Lot Line 10'+ NA Foundation LIFT STATION Manufacturer Capacity Gal. Remarks * COMM. WATER Alarm location Electrical installed by Installer MIKE N ANDERSON, P.E. Inspector MIKE N ANDERSON, P.E. Inspection ection 151 12/14/20 2 nd V 4th PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Drainfield CO/MT 3034 BENCH MARK (Assumed elevation) 100 ft Location and description NW CORNER OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL onditional Approval: Date Septic System Approve �_ %,,,,,1 _ ( Date 12 I?`ZO Note: this approval does not include well permit requirements. (Rev 05/02/18) Engineer's Stamp 0 r 8 i • 9 D . t 'i CE� 67 �k Permit No. OSP201499 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On—Site Wastewater Disposal System and/or Well Inspection Report Legal Description: SEACLIFF BLK 2 LT 2 PID No.: 011-221-36 TCO2 C04co C05 ITC01 I BENCH, CORNEOF SIDING I DRIVEWAY NEW 1000 GALLON PLASTIC TANK ASBUILT SCALE: 1"=50' SEPTIC SEPTIC SECTION N.T.S. LINE ®®®®®s®®®lk®®® ® 49— TH �.....;.,s� ... ♦.....e►....,....,s ... .......... 0 - :.MICHAEL N. ANDERS( %' No. CE 9469 .J2-15-20 MARK A B col 19 CO2 310 20 CO3 41 31 TC01 42 32 TCO2 45 35 C04 48 42 C05 50 43 TCO2 C04co C05 ITC01 I BENCH, CORNEOF SIDING I DRIVEWAY NEW 1000 GALLON PLASTIC TANK ASBUILT SCALE: 1"=50' SEPTIC SEPTIC SECTION N.T.S. LINE ®®®®®s®®®lk®®® ® 49— TH �.....;.,s� ... ♦.....e►....,....,s ... .......... 0 - :.MICHAEL N. ANDERS( %' No. CE 9469 .J2-15-20 r \O N0005'14110000 N0005'14110000 i & 2 --------- IACLAIRE/ANS-------------- MUNICIPALITY OF O n;_: () Development Services Department' On -Site Water & Wastewater Section Parcel I.D. 011-221-36 ANCHORAGE RVS R ON-SITE SEPTIC/WELL PERMIT APPLICATION Property owner(s) KYLE & KRISTIN DENTON Mailing address 9300 JACLAIRE LN, ANCH AK Site address 8521 EMERALD STREET, ANCH AK Legal description (Sub'd., Block & Lot) SEACLIFF BLK 2 LT 2 Day phone Legal description (Township, Range & Section) Lot Size 14,500 Sq. Ft. Number of Bedrooms 4 Phone: 907-343-7904 . Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank Q Upgrade 0 Duplex (D) ElHolding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: $270 (COVID-19) Waiver Fees: Date of Payment:I-L//D1Zo Receipt Number: D/01301 Permit No. OSP201499 Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client FormsTermit Application.doc Dec 10, 2020 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New septic tank permit Legal: SEACLIFF BLK 2 LT 2 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. The existing system has two tanks, one is concrete and other is steel. The steel tank will be replaced with a new 1000 gallon plastic tank and a 20 inch riser. All of the necessary cleanouts between the tanks will be installed. This tank replacement will not impact any of the neighbors or encroach on any wells, septic or open water issues. The entire subdivision is services by AWWU water. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 40".0, �GRE�fER ANCHORAGE AKtA Dul"'w" Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON SEWAGE DISPOSAL SYSTEM E -ti C MAILING ADDRESS— NAME NAME LEGAL DESCRIPTION LOCATION SEPTIC TANK: QJ. V�� 5 F� NUMBER OF MATERIAL. C t�z=� COMPARTMENTS DISTANCEEJC o e �� FROM WELL MANUFACTURER % U GALLONS. INSIDE WIDTH LIQUID DEPTHLIQUID CAPACITY INSIDE LENGTH �— SEEPAGE PIT: ORWIDTH_u _LENGTHa. DEPTH DIAMETER � NUMBER OF PITS DISTANCE FROM: WELL DIAMETER. DEPTwf-L CRIB SIZE: y TOTAL EFFECTIVE Gr � SQ. FT. � NEAREST LOT LINE ABSORPTION AREA) LINING MATERIAL BSORPTION AREA (W BUILDING FOUNDATION—� / ADDITIONAL ABSORPTION WELL: DISTANCE FROM DEPTH, CONSTRUCTION / SEPTIC,--' SEEPAGE � - TYPE /' NEAREST j SYSTEM NEAREST E/ TANK BUILDING LOT LINE�� SEWER LIN �— FOUNDATION � �' . OTHER SOURCES CESSPOOL /REMARKS APPROVED DISAPPROVED DISTANCES: -------�'� INSTALLED BY: PIPE MATERIAL: --- LOT SLOPE:--- REMARKS: DIAGRAM OF SYSTEM' DATE %sir$ . 7 U APPROVED L, G.A.A.B. ` |117.m/ //r n I:-..nL /n nnu o4,imi, /'+',//,- ...-.��``°.` / 825| ' STREET/ HNCHORHGE, HK� i01 � ^ 279-2511 ' ���� ����� , PERMIT NO. ( 77206 ) co� � 77 HPPLICANT DEHN JHCLHIRE z-,)�24]~2]]1 LOCHTION DIMOND LEGAL L2 B2 SEHCLIFF 5UBD ` LOT SIZE 10000 SQUHRE FEET TYPE OF SOIL HBSORBTION SYSTEM IS� TRENCH MHXIMUM NUMBER OF 4 SOIL RATING' (SQ FT/BR)� 150 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: ���-11 --- 11-9 — "E-3 �t0i "'o , W1 — A. W YR. ������ ��F"IF�� � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OF THE GROUND HND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRHYEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXCHVHTION ():N FEET). lot U.-�*�q L -H 1 F;� EE: 01, -11 -1 0=0 01 K 15 X 6- 4 W W CH K< to ix ��EEO ��r J.' tC-')J IRI F -e E -E ��k � ". I [ ff.: F u: �.,) � BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS DEPAR TMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTHNCE BETWEEN H WELL HND ANY ON ..... SITE SEWAGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 200 FEET FOR H PUBLIC WELL SPECIFICHTIONS HND CONSTRUCTION DIAGRAMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTI(:1N. F-0 L- :1. �� F� C-) fl:�� VJ E:- ���F::' C'i I.: I CERTIFY THAI 1: I HM FHMILIHR WITH THE REQUIREMENTS FOR ON --SITE SEWERS HND WELLS HS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTHLL THE SYSTEM IN HCCORDANCE WITH THE CODES ]� I UNDERSTHND THAT THE ON-SITE. SEWER SYSTEM MHY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS SI Till. I ISSUED BY �p .~~�__UM|����~~�.��~����_, BOMHOFF & ASSOCIATES, INC. Engineering - Planning- Surveying 1020 West International Airport Road April 26, 1977 Mr. Len Dean 9300 Jaclaire Anchorage, Alaska Dear Mr. Dean: Anchorage, Alaska 99502 Telephone(907) 279-5522 Attached is the soil log from the visual inspection completed April 26, 1977. The general soils classification is a gravelly, sand mixture that is poorly graded to a depth of approximately 8 feet. From 8 to 12 feet deep, the soils are generally a sandy gravel (GP) and are well drained. No standing water was apparent in the test hole and the water table was not encountered. The surface area is generally flat and standing water was evident from frost thaw. The minimum seepage area for the leach field is recommended at 150 S.F./ bedroom. The depth of pipe and seepage bed material should be installed per the Municipality Dept. of Environmental Quality Recommendations. Sincerely, BOMHOFF & ASSO T INC. Ja rsD7.Voeller, P.E. Manager, Client Relations JDV/lmi highways • airports • drainage • planning • shopping centers • subdivisions • streets • water , sewage 1 V J B®MH®FF & ,ASSOCIA"I ES, INC. Engineering - Planning - Surveying 1020 West International Airport Road Anchorage, Alaska 99So2 'Felephone(9o7) 279-5522 LOCATION Lo 2- 2 Seacliff Subdivision, Alaska BORING NO. STATION ELEVATION 0 Visual Inspection 12 .. Fine silty sand (SM) 1 ? 13 w/grass cover 2- 0 15- 3- 3 Brown.gravelly sand (SP) 4 Moist Fine Grained - 5- 6- 6 •••• Poorly graded gravelly sand (SP) 7- B. B a• ' 9. I0- ::: Gravel -.Sand (GP) 11 ,.:O• Mixture - w Poorly graded 12 ? 13 a14 0 15- 17 Is 21 22 23 24 25 I No water table encountered By: BCR BORING NO. — STATION ---- __- _ ELEVATION O—IT — I 2 4 f � 5 P 7i I I Ll -3, 9 10 20 17'X % 21 22 24 !CrX�Xy�a C hisihways • airnnrts . cirninaup . nlannincl . shonnino cPnrPrc . RIIF1fI1 VI CllI IIC • ct• tC .. UIOIP• . CP\wla l4P 4 BOMHOFF & ASSOCIATES, INC. Engineering - Planning - Surveying 1020 West International Airport Road Anchorage, Alaska 99502 Telephone(907) 279-5522 April 28, 1977 Mr. Les Buchholz Dept. of Environmental Quality Municipality of Anchorage Parkgate Building Anchorage, Alaska Dear Mr. Buchholz: h;LW"_'PASlly ,ft,i r'Rdlfi�rr�'�V if-` I V This letter is in reference to the soils analysis conducted on Lot 2, Block 2 Seacliff Subdivision for Mr. Lynn Dean. The test hole was completed to the maximum depth of twelve feet. The question arose as to the aspect of whether or not a water table would be encountered at the depth of eighteen feet. From inspection of the test hole it was evident this material became a cleaner and more well graded gravel as the depth increased. Also the size or aggregate increased in size with increase in depth. Exca- vation below the depth noted was extremely difficult without framing the hole due to sluffing. It was also noted that the large gravel pits in the area are located directly to the north approximately five hundred .feet. The materials inspected and those found in the gravel pits are very similar. It is also noted that these gravel areas had been exca-. vated to a much greater depth than that of the test pit at Mr. Dean's, and no coater table had been revealed. It is the opinion of this office that finding a water table at the depth of eighteen feet at Mr. Dean's is extremely unlikely and therefore the extra depth not required. If you have any additional questions please contact me. Very truly yours, BUALHOFF & ASSOCIATES, INC. Bruce C. Robson Civil Engineer BCR/cd cc: Mr. Lynn Dean highways • airpoegs • drainage • planning • shopping centers • subdivisions • streets • water • sewage MUNICIPALITY OF ANCHORA U5 R Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 011-221-36 Expiration Date: 3 — 17'2-0Z 1. GENERAL INFORMATION Complete legal description SEACLIFF BLK 2 LT 2 Location (site address) 9300 JACLAIRE LN, ANCH AK Current property owner(s) KYLE & KRISTIN DENTON Mailing address SAME Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Z Water Storage ❑ Holding Tank ❑ Community Well © Community ❑ Public Water System Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 60C 0 Waiver Fee $ Date of Payment?, % 2--r) _ Date of Payment Receipt Number Ol %81l Receipt Number COSA#- 0_SC_Za62q 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727`8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name MIKE N ANDERSON, P.E. Date 12-15-20 6. DSD SIGNATURE System #1 Approved for 4 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for e` CE - bedrooms, with the following stipulations:*�����.���" Ferri ,9 r� ptv c y 4 G ` R �- 3 1�0 `40GA ^� l By: Original Certificate Date: % -c-1 r 17-Z The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: SEACLIFF BLK 2 LT 2 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Comm. well ADEC 210485 B. TANK DATA Age of tank(s) new years Tank type/material Measured operating fluid level in septic tank NEW ❑ Standpipes/foundation cleanout per record drawing Date of pumping * new 1000 gallon plastic tank installed D. ABSORPTION FIELD DATA EXISTING CRIB Which system tested (date installed) 4127177 ❑ ALL standpipes present per record drawing Total measured depth from grade 16 ft (max) Measured depth to pipe invert from grade 7 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 0 gallons Comments/Deficiencies: COSA Checklist yellow sheet of Parcel ID: 011-221-36 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ Nc ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 11/30/20 Results 0 Pass For 4 bedrooms Fluid depth prior to test 8 in Water added 600+ gal New depth 12 in Elapsed time 1440 min Final fluid depth 8 in Absorption rate out 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 Neighboring Tank > 100' ❑ Yes Absorption Field on Lot > 100' ❑ Yes Neighboring Absorption Fields > 100' ❑ Yes Community Sewer Main > 75' ❑ Yes From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' p✓ Yes if No ft Surface Water > 100' R Yes if No ft Property Line > 5' 0✓ Community Sewer Manhole/Cleanout > 100' if No ft [_j Yes if No ft if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft if No ft Holding Tank > 100' ❑ Yes if No ft if No ft Animal Containment > 50' ❑ Yes if No ft if No ft if No ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' p✓ Yes if No ft Surface Water > 100' R Yes if No ft Property Line > 5' 0✓ Yes if No ft Wells on Adjacent Lots.- ots:Absorption AbsorptionField > 5' Yes if No ft Private Wells > 100' Yes if No. Water Main > 10' F/� Yes if No ft Community Wells > 200' Q Yes if No. 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' 0✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' F/ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓[1 Yes if No ft Private Wells > 100' Water Service Line > 10' F/� Yes if No ft Community Wells > 200' Surface Water> 100' [] Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION ! certify that 1 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 ft ft U Yes if No ft [D Yes if No ft 'pl �, •vr~ ',� i 1. ♦ � :s a . ... . MICHAEL N. ANr)LR5C'4 .~ CE -94 9 1�r �!R ^ • • � . �' S .yam JJ/ 0 k1unicipafity of Anchorage . l � Development Services Department ;' 4 • Building Safety Division+• _ On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. DII -221-36 COSA# Qq 0206 1. GENERAL INFORMATION Expiration Date: / — I — / 0 Complete legal description SEACLIFF S/D• BLOCK 2. LOT 2 Location (site address) 9300 JACLAIRE LANE • ANCHORAGE. AK • 99502 Current Property owner(s) KYLE DENTON Day phone 301-9793 Mailing address 8521 EMERALD STREET • ANCHORAGE. AK • 99502 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: 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 N Individual Holding tank ❑ Community On-site ❑ 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 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 seal affixed hereto and as of the validation date shown below, l 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 (les 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. Phone 337-6179 Address 3701 E. TUDOR ROAD, SURE 101 ' ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date (.Ib to 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 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE —AZ Approved for Lf bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other gy; e (Rev IM) �Ga�ness.•' P7.153 16 PAi•'cA�4 I Eo aO�c�� l t flkrr� OF,gty�,y�� G� . ••ON-SITE •••'� WATERAND WASTEWATER PROGRAM ' Original Certificate Date: 7— 0 51 - 09 Municipality of Anchorage Development Services Department ' ' Building Safety Division On -Site Water 8 Wastewater Program " 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SEACLIFF S/D; BLOCK 2, LOT 2 Parcel 0:0I1-12-1 36 A. WELL DATA Well type COMMUNITY If A, B, or C provide PWSID# 210485 Well Log (Y/N) Date completed Sanitary seal (Y/N)_ Wires properly protected (Y/N Total depth ft. Cased to ft. Casing height (ab round) in. FROM WELL LOG AT I CTION Date of test Static water level Well production g.p.m. g.p.m. WATER SAMPLE RES Coliform colonies/100 ml. Nitrate mg./L. Other bacteria colonies/100 mi. enic: —ug./L. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA *INSIDE HOUSE Tank Type/Material SEPTIC: CONCRETE/STEEL Date installed 4/27/1977 1000/ Tank size 50G gal. Number of Compartments 1/1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) "YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 9/4/2008 Pumper ANCHORAGE CESSPOOL PUMPING C. ABSORPTION FIELD DATA] -BELOW EXISTING GWQE Date installed 4/27/1977 Soil rating (g.p.dJfeo /bd 150 System type CRIB Length 18 ft. Width 17 ft. Gravel below pipe 9 ft. Total depth ! 16.75 ft. Eff. absorption area 630 ft2 Monitoring tube YES Depression over field NO Date of adequacy test *05/21/2009 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test51 in. Water added 600 gal New depth 86 in. Elapsed Time: 280 min. Final fluid depth56 in. Absorption rate >= 600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date "HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE–SOAKED ON 5/20/09 WITH 1000 GALLONS OF WATER. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot Public sewer main Sewer /septic service line areas COMMUNITY WELL On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM 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'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 1009+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 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. Engineer's Printed Name JEFFREY A. GARNESS Date 6 b.. Cil COSA Fee $. C7 O Waiver Fee $ Date of Payments �O Receipt Number �� 7 (Rev. 11/05) Date of Payment Receipt Number $.AD P , O Z �o�v n n � N m oNNaSZ oN 0 O $ ° D C m � �g n CA o wa z nN c � ND a m o(n s •p D m z N = �m o8t�n x 4 I m N {T Z N z M rn rn�N 0000 poa1 o ppp D oz LANTECH Tq�p� •• •• • •A '•.� OO O O Z 2: :(D OD mcOc cx SS �oA N 2 �I'I D nip Q,XNF = 4S•.• �: J �p �Zrn 4�p0o.. ... 00 =oOm N A m (D �-0 : a.k a r N 0 O r 0 0 N ~ y > O m N N m"coo 0 A CO _ n -moi, O C 0 00 OD—1 W D cn o N 00 a � 0• sea i 4 x a' 4 .A Ino' E\I^I N O R^yn or1Lo o Q_.x SE' on S'.r.F goS Xr "C:3� L� �w3og9sQ� d4go�'�S 0 It -7 23, ?4 X32 .zgg3= sg� 543e ss ry 3Rws �o,y Ro3;r e.i Roti; gdv uit SgE o't;: S�� R�o5Fr"i 3or� 8e O a "0 3^,i 'rq RQ R;a r.^o; ;o r O J .00.001 M „00,90.00 N —X—X—X—X—X —X—X—X — X —X—X- 1N3W3SV3 kinun .oL — — — — — — — — — — — _ v Q 0 Y r O OD 19.7 a\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\�� X—X—X— J 0 26.7' u = X O N O pN NZ N m� Ln O 35.2' 13_._� ...._._.� 5.5 .................:... 0 0 • w ,00.001 3 „00,90.00 S W O 3NVI _ 381V-IOV N r O TODD N °o N 0 0 Y r O OD 19.7 a\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\�� X—X—X— J 0 26.7' u = X O N O pN NZ N m� Ln O 35.2' 13_._� ...._._.� 5.5 .................:... 0 0 • w ,00.001 3 „00,90.00 S W O 3NVI _ 381V-IOV 1�5 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services Onsite Services Section it P.O. Box 196650 Anchorage, Alaska 99519-6650 (907)343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING Parcel I.D. # 011-221-36 HAA # A (Z(f'-� ?S 1. GENERAL INFORMATION Complete legal description SERC IFF SUBDIVISION• LOT 2 BLOCK 2 Location (site address or directions) 9300 JACLAIRE LN Property owner CLYDE SAUER Day phone (907) 229-9675 Mailing address 9300 JACLAIRE LN. ANCHORAGE AK 99515 Lending agency Mailing address Agent i Address Day phone Day phone I (ca. 4-!c Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well Community well xx Public water - NOTE: !f 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 xx Holding Tank Community on-site Public sewer NOTE: ff community wastewater system, provide written confirmation from State ADEC Ing to the legality and status of system. 72-025 (Rev. 1/91) RUA MOA #21 Camputer Version _ _ Note. Alaska Water and Wastewater Consultants, Inc. shall be paid $700.00 at,� or prior to, closing for the engineering services provided. S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verity that my investigation of this Health Authority Approval application shows that the onsite water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal, nd State codes, ordinances, and regulations in effect on the date of this inspection. , , � Name of Firm Phone (907) 337-617$_ Engineer's Signature Date w1,-. In conducting this evaluation, AWING, In / a0196dto provide a thorough, conscientious engineering anaym of the system in accordance with ADEC and t'L4 S uidelines & 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 readilyldentiflab/e features. The operational life of all walls and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the fsmily being served by the system. These conditions are outside the control of o 4�����4 the evaluator of the system. Satisfactory test results do not guarantee future performance o F A Y N g Pe �,.......,,4, of the system, nor do they guarantee that there are no hidden defects or encroachments, p� ` /• S AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MDA DHHS. • ; • , .4 f J 7• , :.. �. The content of this report is for the sole benefit of the owner listed above. An 111 �j� reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DO e fr}� A. GarxlEs's 6. DHHS SIGNATURE " CE -7953 - Approved for _�— bedrooms Disapproved Conditional approval for Additional 0 bedrooms, with the fallowing stipulations: Date -- i The Municipality of Anchorage Department of Health and Human Servicas (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 angineer's wcdc 72-025 &W. 1181) Back MOA 421 Computer Version Municipality of Anchorage K E C E I V E u DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division JUN 28 200 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-47 MUNICIPALITY OF ANCH �IWWMENTAL SERVICES DIVIS!- Health Authority Approval Checklist Legal Description: SEACLIFF SUBDIVISION; LOT 2, BLOCK 2 Parcell.D.: 011-221-36 A. VVELL DATA Well Type "A" If A, B, or C, attach ADEC letter. ADEC water system number 210485 Log present (YM) Date completed I Total depth Cased to Casing height (above ground) Sanitary seal (YIN) Wires properly protect ) FROM WELL LOG AT INSPECTION Date of test Static water level Well production -9 -P.M. gtp-m- WATER SAMPLE RESUL Coliform Nitrate Other bacteria Datemple: Collected by: B.SEPTICIHOLDING TANK DATA Date installed 4/27/77 Tank size 1000 + 500 Number of Compartments 2 Cleanouts (YIN) YES YES * N/A Foundation cleanout (YMNO ) INSIDE HOUSE Depression (YIN) 'High water alar (YM) Data of Pumping 6/23/2000 Pumper OLD MCDONALD C. ABSORPTION FIELD DATA Date installed 4/27/77 Soil rating (g.p.dJfi2 or ft2/bdr) 150 System type CRIB Length 18' Width 17' Gravel thickness below pipe 9' Total depth 16' Effective absorption area 630 SQ FT Monitoring Tube present (YM) YES Depression over field ('Y/N) NO Date of adequacy test 6/27/2000 Results (Pass/Fall) PASS For 4 Bedrooms Fluid depth in absorption field before test (in.); 78" Immediately after 701 gal. water added (h): 89" Fluid depth 80" (ins) Minutes later. 273 Absorption rate = 600+ GPD Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give 72-028 (Rev. 3nr Computer Vemlon D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm E. SEPARATION DISTANCES *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septio/holding tank on lot Absorption field on Public sewer main at" "Pump off' level at* On adjacent lots ---..- Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Absorption field — Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line Surface water 10'+ reo 200'+ Building foundation 10'+ Water main/servioe line- re ine_ 0 .. Driveway, parking/vehicle storage area_ 10'+___ Curtain drain _ NONE KNOWN Wells on adjacent lots 200'+ F. ENGINEER'S 1 certify that 1 I of Municipal n with MOA HA Engineers HAA Fee S "3 /(7z) Date of Payment Receipt Number 72-028 (Rev. 3W)• Computer VerWw inspections and review 9ms are In conformance Is date. Waiver Fee Data of Payment Aeoeipt Number u .A to 'd Z00ln r- 0 -i co 1NUMV3 A11111f1;01 8 Otly r, V7 cu J 35.2' 10 13,2' PIT 1 •.a v o Tr G 9 (.4 fr., 8 u .A to 'd Z00ln r- 0 -i co :-2'd 1NUMV3 A11111f1;01 8 Otly r, V7 35.2' 10 13,2' PIT 1 •.a v o (.4 ca D :-2'd .00'001 3 „00,60.00 T 3NVI ` 381VIOVP r- 0 V 0 L►n '0" 1114-1 Xw S. dos E£ I" o6n 99F 'ON RUd ONO NHWMH 100 Wtl OSS 03M 0002-LI-AVR a N &LSIA 7dLLNHQOBd TLDS 9L£ L06 AVd SD OT NOW 00/9Z/90 4 Otly V7 35.2' 13,2' PIT 1 •.a v .00'001 3 „00,60.00 T 3NVI ` 381VIOVP r- 0 V 0 L►n '0" 1114-1 Xw S. dos E£ I" o6n 99F 'ON RUd ONO NHWMH 100 Wtl OSS 03M 0002-LI-AVR a N &LSIA 7dLLNHQOBd TLDS 9L£ L06 AVd SD OT NOW 00/9Z/90 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 DWELLING Parcel 1. D. # O f — e9-0-1 — 3 L, 1. GENERAL INFORMATION - HAA# 148950030 Complete legal description L(o Iy- EA- L_ I r= f:�- Location (site address or directions) i re - tzq-_e Property owner I j:ssC a -Y Cc Day phone g7 y - 7 4 73 Mailing address _ 9i 'g_`i G lCr0'_ Lending agency �4 � a Day phone Mailing address 3 o A S �' c_ -4 - Agent �- a r �- �c� wCc�� ieA (, U L� (� Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water ✓ �/ ��J 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.1191) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER Al By: 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 I o b e �A v rV �a n a� 1�- ��. Phone �7� - �� / ... Address Engineer's signature tol 151—Gi # Date NUTION 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 Stateof Alaska. The DHHS does this as courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of D14,11i 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 engineers work. ` 72-M (RW. 1/91) Back MOA #21 DHHS SIGNATURE wit :'°. CcQ_225 Approved for bedrooms. `� `JJ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments — NUTION 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 Stateof Alaska. The DHHS does this as courtesyto purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of D14,11i 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 engineers work. ` 72-M (RW. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: )_0+4 Parcel I.D. A. Well Data Well type I) A "I If A, B, or C, attach ADEC letter. ADEC water system number �2 1 0 Y O S Log present (Y/N) Date completed Total depth Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Cased to FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Driller Casing height Wires properly protected (Y/N) AT INSPECTION On adjacent lots ; On adjacent lots ublic sewer manhole/cleanout Sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Nitrate Collected by: Other bacteria Date installed ? l;`/ Tank size Compartments Cleanouts (Y/N) y Foundation cleanout (Y/N) 1__1 Depression (Y/N) High water alarm (Y/N) it Alarm tested(Y/N) W f�. Date of pumping Iia 1� y Pumper A\A(I-4 - C -,--3S �d o z t� f� zr r o m. M W > < �_ n z Cleanouts (Y/N) y Foundation cleanout (Y/N) 1__1 Depression (Y/N) High water alarm (Y/N) it Alarm tested(Y/N) W f�. Date of pumping Iia 1� y Pumper A\A(I-4 - C -,--3S �d SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot N/A On adjacent lots Foundation ' <`;) .f To property line f V + Absorption field l n r Water main/service line i �•' Surface water/drainage I �% 72-026(3/93)'Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Date installed 1 / Soil rating (GPD/Ft2) Length i Width / % Gravel thickness _ Total absorption area Cleanout present (Y/N) / U1 iy. Date of adequacy test I r r `+ Results (pass/fail) Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Surface water System type I ' I Total depth 1_' Depression over field (Y/N) N ,t for _.-_Bedrooms After test _ If yes, give date Well on lot �_ On adjacent lots / -f', Property line �_.. To building foundation ' To existing or abandoned system on lot iF1 On adjacent lots Cutbank ' i Water main/service line Surface water / % / Driveway, parking/vehicle storage area Curtain drain 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. HAA Fee $ �?66 C0 Waiver Fee $ Date of Payment / _ v2l/— %S� Date of Payment Receipt Number Receipt Number 72-026 (3/93)' Back MUNICIFAL1IY Ut ANCHUKA61- % G ` DEPARTMENT` -:r HEALTH AND ENVIRONMENTAL-_'ROTECTION l`\ 825 L Street, Anchorage, Alaska 99501 �sy ` 279-2511, ext. 224, 225 Date Received: April 6, 1977 lst Inspection: Time. 2nd Inspection: Time Date/_��/_y j ��tic s. Date Inspector �� ¢/ Inspector A)D 'Cxr2n 1uL" ntiexgC t Lu qk� REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Alaska Mailing Address: Pouch 7-012 99510 Bank of Commerce Phone: 279-5641 2. Property Owner: Lynn Dean Phone: 243-233'1 Mailing Address: 9300 Jaclaire Lane _ 3. Legal Description: Lot 2 Block 2 Seacliff Subdivision 4. Single Family Residence: (x) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 5. Well Data: Type Community Depth Construction Bacterial Analysis Well Log Filed ( ) 6. Sewage Disposal System: On-site system (x) Public Utility ( ) Permit 9 Installed _ 970 Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material 7. Distances: Well to Septic Tank to Sewer Lines Nearest Lot Line Absorption Area to Nearest Lot Line to Absorption Area Page Two., Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 2 Block 2 Seacliff Subdivision Comments, Affadavit Attached: ( ) Approved: Disapproved: Department Worksheet: Letter Attached: ( ) Date: 4/—J- 7 '%g Date: GREATER ANCHORAGE A R'r_ I, BOROUGH 1'UN�CIPAUTy of ANC"jr)! 'G' Department of Environmental Quality DEFT. °` `iFA`T"" 3330 "C" St., Anchorage, Alaska 99503 - 274-EA96T' t,tA1' FORPR INDIV.IDUALSSEWER &PWATERLFACILITIES 1. Type of Inspection: CMRO VA FHA CONV xxx 2. Property Owner: Limn Dean ---; ; Mailing Address: OU0 Jaclaire Lane Anch Day Phone 3. Name of Buyer: Lawrence L: Jesclaxd Jr. Mailing Address: 6961 Colonial.Court Anch. Day Phone 4. Name of Lending Institution: Alaska Bank of Commerce Mailing Address: Pouch 7012, Anch. 99510 Phone 279-561 x355 (Vicki) 5. Name of Realtor or Agent: N/A Mailing Address: 6.. Legal Description 2/2 Seacliff Subdivision 7. Phone Location: 3000 Jaclaire Lane, Anchorage, Alaska 99502 Type of Facility to be inspected: ter Supply single family dwelNo. BdrmsC4 Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well vage Disposal -System Type -of System: Public Utility Individual (on-site) If Individual, date of installation MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH a ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 APR REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATERFACILITIES RECEIVED 1. Type of Inspection: CMRO VA FHA CONY xx 2. Property Owner: Lynn Dean Mailing Address: 9300 Jacarie Day Phone: 243-2331 3. Name of Buyer: Jesclard, L. L., Jr. & C. J. Mailing Address: 6961 Colonial Ct. Day Phone: 243-5658 4. Name of Lending Institution: Alaska Bank of Commerce Mailing Address: Pouch 7012 Phone: 27()-5641 5. Name of Realtor or Agent: Mailing Address: Phone: Legal Description: Lot 2 Block 2 Seacliff Subdivision Location: 9300 Jacarie Anchorage, Alaska 99502 7. Type of Facilitv to be Inspected: SFD No. Bdrms. 2 3 a Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System 72-003(3/76) Community Type of System: Public Utility Individual (on-site) x If Individual, date of installation 1970 til : (I)CJ nnz April 14, 1977 Lynn Dean 9300 Jaclaire Anchorage, Alaska 99502 Subject: Lot 2 Block 2 Seacliff. Subdivision This department can not findlany records on file of a sewer system on the subject property. After investigation, I found only one standpipe. This department requires two (2), one (1) for the septic tank and one (1) for the seepage area. Before approval may be given, you will need to follow the instructions enclosed. Note: both standpipes must be available (before this test can be performed. if there are any questions, please contact this office at 279-2511, extension 224 or 225. Sincerely, Robert C. Pratt, R.S. Sanitarian RCP/ljh cc: Alaska Bank of Commerce Pouch 70912 99510 REQUEST FOR APPROVAL OF INDIVIDUAL SEWAGE AND WATER FACILITIES (Fill out in Triplicate) 1- Rame of person requesting approval - 2. Lama of property owner 1--4 X L 3. -le?,-al description 4. Number%of_bedrooms in house 5. Water -Analy- ..is: a. Bacterial b. Detergent 11 6, Well data: a° Type b. Depth c Casing Size d. Distance from well to closest existing or proposed 1. Sewer line 2. Septic tank 3. Seepage Area 4. Cesspool - 5. Property Line 6. Other sources of Possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. 7. Sewage disposal system. a. Age of system V, b. Septic tank capacity in gallons C. Name Of septic tank manufacturer 1. If "home made" show diagram on reverse side of this form. d; Disposal field or seepage pit size and type -V t.)Ok -I (3L -o (-Ie–' 1. Distance to property line to house foundation I c 4 e. Percolation,Test results f. Percolation Test performed by `0. Use the reverse.side of this form to show diagram. Diagram should include the following information: property lines; -well location, house location, naptic tank location, disposal area location, .location of percolation test, a.d direction of ground slope. 9. The 1„r,r•,u3tion on this.Mi"m is true (an)d correct to the best of my knowledge. ” SigYr,ature dof Appfldcant Date Signed `T0 BE FILLED OUT BY HEALTH DEPARTMENT PERSONNEL The above described sanitary facilities are hereby approved, subject to the +ollowing conditions: Conditions: a Q The above described sanitary facilities are disapproved for the following reasons: Signature of `3fi• i���-J fv� Date ; Approval is valid for one year following the date of approval. CPJ:cw June 5, 1968 11r. Mervyn Eggleston 9300 Jaclair Lane Anchorage, s Alaska 99503 8UBJECTi Approval of Water "supply Serving Lot 2, Block 20 Seaeliff Subd. Dear Mr. Egglestont The Creator Anchorage Area Borough tioalth Department Is pres"ntly working on obtaining approval of na water supply serving the subject subdivision, When conditions for. approval have been obtained, we will give you our approval for this water supply. Nedi.c;PI Director Hyt rMlf ?'F. Strickland, R. 5 Sanitarian RRSisrr CC: rederal 1 ottsing Advi.nintRation Small. business Administration