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HomeMy WebLinkAboutGREENLAND (P-268) BLK 4 LT 6 reenlond Lot 6 Block 4 (P-268) #015-172 O1 A Municipality of Anchorage On-Site Water and Wastewater Program • (907) 343-7904 Page 1 of 1 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181425 PID Number: 015-172-01 Dwelling: ■❑ Single Family (SF) ❑ Duplex(D) ❑ Multiple(SF and/or D) Project: ❑ New El Upgrade Name: ZACHARY RINKER ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed I Mound ❑ Other Phone Number of Bedrooms Soil Rating Total depth f , original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft, Ft. GREENLAND, BLK 4, LOT 6 Fill added above original gr--- Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total a•.•rption area Number of trenches Dist.between trenches From ' Tank Field Tank Line Ft2 Ft. Well 100'+ 50'+ TANK ❑■ Septic ❑S.T.E.P. ❑ Holding ❑Other Manufacturer Capacity ANCH TANK 1250 Gal. Surface Water 100'+ Material Number of compartments Lot Line 10'+ NA STEEL 2.0 Foundation 101+ I LIFT STATION Manufacturer Capacity Curtain Drain UN Gal. Pump on level at Pump off leve High water alarm at Remarks in. in. Pump make a • odel Electrical Inspections performed by PIPE MATERIAL House to tank 3034Tank to 3034 Installer drainfield MIKE ANDERSON Drainfield CO/MT Inspector MIKE ANDERSON, P.E. BENCH MARK (Assumed elevation) 100 ft Inspectiondt1� 12/8/18 2" Location and description es: 3r° 4'° BASEMENT DOOR SIL COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL EaitTelt‘� � rNk • Conditional Approval: Date ,...'''' ,V.:°..c- •° o 1. T 1 .*�dt r,•. . rf r1 .• MICHAEL N. ANDERSON :°'�tl-- r '•• CE-9 69 •:�� i �fte, r'I i ' , °•'-. ,.- Approved v..__ .,L ....... Date IZ ig >►®oo,•~-6. Inspection Report_9-1-12.doc ' Permit No. OSP181425 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: GREENLAND (P-268), BLK 4, LOT 6 PID No.: 015-720-01 MARK A B B CO1 50 51 CO2 66 65 TC01 55 55l TCO2 65 63 z CO3 67 67 ,_X—X—X—X—X—X—X �,+ IS) I /+/ xi +i� + xI 1 I x 00,3 NEW 1 250 TEEL TANK CO3, CO2 OLD TANK x•.COMMISSIONED PER UPC x TCO2 0 x I _ _ _ .. . _ . __ .--- __ 0 TC01 ----0 col X / \ 1 i X 1/ X / X I / X >< / X i Ell III FCO B i \\ /�� I -X—X— E �` / ' / 1 , x 1 EX I ING WELL 1 I x IIEI rCO' rTCO1 CO2 CO3 4\\\\\�11 + (/ 1002 .. k OF• 47 44• •.647 .I IIPA=Mell : -'1 : ' •49 TH " *.• t • • 1.250 • SRO.TANK j /��'• !` / SRO.TANK r • •• ' MICHAEL N. ANDERSON! 'gi SEPTIN.T.S.CTION X444 P i\\'u`p�..�1 MUNICIPALITY OF ANCHORAGE Development Services Department ; Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-172-01 Property owner(s) RINKER ZACHARY & WOOD ALECIA 50 Day phone Mailing address 4801 JUMAR AVE Site address same CP-Z6c6) Legal description (Sub'd., Block & Lot) GREENLANDYBLK 4 LT 6 Legal description (Township, Range & Section) Lot Size 27,000 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ (w/wo ADU) Septic Tank ❑ Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renew- ❑ 6 7 8 9 70 Multiple Dwellings 111Privy ❑ � T, (SF and/or D) Private Well ❑ 'di RUSH' Water Storage ❑ , NOV 8 2018 n THIS APPLICATION INCLUDES A R REQUEST -45 -: I w 01 6 8 L Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. MAN (Signature of property owner or authorized agent) Permit/Rush Fees: (t344 b0 Waiver Fees: Date of Payment: 11118116 Date of Payment: Receipt Number: Receipt Number: Permit No. OS 1 18(42v5. Waiver No. G:IDevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Nov. 27, 2018 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: New Septic Permit Legal: GREENLAND BLK 4 LT 6 To Whom it may concern: This is a request for a new septic tank permit on the above referenced lot. The tank is over 38 years old and needs replacement. After the installation we will be moving forward with a new COSA. This permit will not impact any of the surrounding neighbors due to this design. Please call me if you have any questions. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch,Ak 99516 Ph 727-8864 II 4 • /�t9k-.E S 'SCI ,t �oWc1( (A9r 'f'1',H /0o` 2. P"w O 1`aH k— (a fey c • 3. ea, 9e (.04e , • 115th Avenue R R S: S 89'53'20" E 100.00' • 30• Lot 6 ® ® li rem /745-0 9 4)/044 ®2 sept c ' J Stondpipes O Rin o " n (.1 (.1 • a) y •-• e 3 Septic (� 7 Stondpi s . [...it'`J . o m rib IL ..c.d��0�e�� t'. 41• M Shedi o 4922i. �'� l., i. i NOTE: �, o ; /G��� �J THIS AS-BUILT SURVEY IS O, i BASED ON THE FOUND IRON O ` ��i/�, 22.2.±( O ' PIPES ALONG LUNAR AVENUE.' O—. • �„ O / I PER AS-BUILT SURVEY 48.2 • PERFORMED BY THOMAS SMITH. Z Existing N `• MICHAEL N. AnDERSOA!•: MUNICIPALITY OF ANCHORAGE DE ,:t'rMENT OF HEALTH AND HUMAN SER ES A t ,?/?,2. d / Environmental Health Division f/ 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Address Phone(s) J Perrmt NO .~No of Bedroolns LEGAL DESCRIPTION LOt Block Subdivision Townsh,p. Range, SecUon TANKS ~] SEPTIC ~ HOLDING Manulacture~ ~-~ Capac~al~s. Material ~ No Of Compadments / TYPE OF SYSTEM []TRENCH ,~ BED [] W. DRAIN [] OTHER ong mai g, ade ~,, ~¢' Fdl added above original grade / Total depth frorr, original grade FT , ,~-- Ins~aaer ~ Date ~ _/O~ ~ . FT-- TO FROM "~ DISTANCES SEPTIC TANK ADSORPTION FIELD WELL / 7.5%/ LOT LINE WELL FOUNDATION //'~' ~ /// ~-~-~ ~' AS-BUILT DIAGRAM tShov,, IocaUon of well. septic system, properly hnes. loundaUon. WELLS I~] PRIVATE [] OTHER (Identify) Classd~cauon iA,B C] ~ ~ ota_l~Deptt~' Cased to Install(i .~ Date Installed. REMARKS: Scale: InspecIions Pedormod by: 1, z?,., 'J J ' (~ ' (/ .... cedily Ihat Ihia inapeclien was periormod according to all ~unicipal and Stale guidelines in effect ae this date: __ %~-/ / g'/. '..'? ?' ENGINEER'S SEAL Municipality of Anchorage DIdPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG ~ PERCOLATION TEST 8 9 10 11 12 13 14 15 16 17 18 19 2O DEPTH (FEET) ~1~;~'~ ~ ~ ' · ...:;....! . -, ~':; 3 , 4 .,:.~2 ... 5 6 7 · ..'.,. ~ :, ~ ~., ' DATE PERFORMED Township, Range, Section: SLOPE SITE PLAN WASGROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Deplh Io Waler After ,, Monitoring? /,J Date: ,?'/~'/,A ' Gross Net Depth to Net Reading Date Time Time Water Drop /~ 0 /~ ~ ,~ ~,~ PERCOLATION RATE _'~ (m,nuLes~r~nch) PERC HOLE DIAMETER TEST RDN BETWEEN ~, F FTAND ~, I~'*'"'_FT ' P PER.ORMED ~Y: '~ ~ /, ' ~ CE~.Y ~A~ ~H,S tESt WAS ~R.O~MED ,N ACCORDANCE WITH ALL STATE AND MUNICIPAL 6UIDELINE~ IN EFFEO] ON THIS DATE DATE: 72-008 (Rev. 4/85l ~: , OI J .3,0.0'~.2/, IO0. O' -J s.~c. '...'x~. s ,~o ~-------5/8" I.P. TYP. S &S ENGINEERS (907) 274-$~97 5510 SILVERADO WAY , SUITE A'? ANCHORAGE , ALASKA PLAN' AS'BI. qLT: y~' !, (.;R,D' DRAWN BY' BFB NOTE FOUNDATION ONLY [£' f"= 50' *by certify thcl I,hove ~urvtyed lhe followin9 d~.sctJ5~ pro~rly~Lot ~ ,BIK.. ~'~ ..;- GREENLAND SU'BD. Anchorogo Rocot¢[n{ pra:inc1,AJc~ko,ond Ihol ~ptovoment~ ~lluoled lh~recn ar~ wifhln the properl~ iir, e~ end ~ r. ol overlap Or encrooch on d lh,~ 15 ~oy of' SEPTemBER I$&O -n-h~ra-o '~ ~- herespon~l~ilify of 1he ~n~r Or builder,prior to con;truC:lcr.,~o verify propo~¢d . '' r, 9 grace relctlve to fini;heC grcde'ond ulillty cc,~cctions c~d '.o detcrmino [~.' ' 99502 JCHECKED BY: NAME MAILING ADDRESS MUNICIPALITY OF ANCHORAGE DFPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHONE LEGAL DESCRIPTION Well Absorptiona~.~a..~ ~, Dwallh, g z~ _O ~ DISTANCE TO: .- I ~ ~) ~Z Manufacturer Material~. , ~ ~ lNo, ofco~artments Liq,~apaci~allons ~ IF HOMEMADE Inside length Width L qu d depth ~ I DISTANCE TO: / ' I~' 'g PERMITNO. I Well · , I Foundation _~ :Nearest lot line ~ ~ ~ I DISTANCE TO: lb ¢ ~O '1 ~0 ~z IN~,of~nes~ . ILengthofe¢lin~_~ ITota]len¢~flin~ ITr~chwidth .. Distancebe~¢e~lines ~ ITop olti~e to finish grade ~ ~ Material Beneath tile . , - ~ I ~ngth Width I Depth -- PER~I~O. -- ~ I~s A ' Depth Drili~r ~ ~~ ~ I ~ DI~ANCE TO: Building foundation Sewer line J S~tic tank Absorption area(s) OTHER PIPE MATERIALS SOl L TEST R.ATING~.~ I NSTA L):I~R / REMARKS DATE LEGAL F'ERMIT NO. AF:'PL. iCRNT FRFINK BETHAR£:, E;RA BO,s~', i69L=,' K LOCAl"ION I<LI=ITT R[:, LEGAL. LT: 6,BI'(: 41GREENLAND ':;D LOT SIZE T'¢F"E OF SOIL. RBSORF'TION SYSTEM IS: TRENCt4 DEPF:IRTMENT 0,. HERL]"FI AND EN',/'IRONMENTRL. I'-'R'OTECT'ION 825 '"L'" S, TREET, ANC]--1ORFIGE., FII<. 264-4720 It....[ i L_ 9. ..... I~'=, ~"-.~ E::, C_', tf-., ..... '_.=': ][ 1- E :E:'"; E [..q E; F-." 27C~)E~ SQIJFIRE F'EET MI..t,:.:,]I1LIt NLli"IBER OF E,L[.,ROUIL = 4 SOIL E. FIT]N.~ ,::SL:.] FT,'"E:R)= J.E;5 THIS: R'E~, ..... IRE[:, SIZE OF THE SOIL RE_UF.FTILN lC:" IE F" T F-! == ';:'" .... 1._ E ~"-,,~ L--i T F! == ':" '="' F" THE LENGTFI DIMEI',ISION IS THE LENGTH <IN FEET) OF' THE TRENCH NR [:'RRINFIELJ}. 'THE [)EPTH OF R TRENF:H OR PIT IS Tt"IE DISTANCE E:ETNEEN THE SURFACE OF' THE GROUN['., AN[:, THE 80TTOM OF THE E:XCA',,,'FITION (IN FEET). THERE IS NO SET 14I[:,TH FOR TRENCHES. THE GRAVEL [:'EPTH IS TFIE MINIMUH DEPTH OF GRFIVEL BETNEEN TH[~ OUTFRLL PIPE Ftl'.,IO THE BOTTOM OF THE Ek.:E:RVATION (IN FEET). F'EF.:MIT F~F'F'LICANT HFIS THE '- ~ '-' ' " F.E=,F .dq=,JE, ILIT'r TO INF'ORM THIS DEF'FIRTMENT E:'URING THE I N2:,1 I"iL. LI'tT I OH ZNSPECT I ONe;_ OF FIN'¥' I.,.IELt. S laE)..IFIF:ENT TO TH I S r"'~'~"'r, ~ r"""-"""~"r-..r~ ~ ¥' FINE:' THE NI..MBEF? OF F..E=,I[:'EHL. E'~, THAT THE !4ELL NILL SERVE. ............. qf' B-.~ C, ,:'. ,~ .'":"' ':, Z !"-,~_.':: F' E r: T ]: L--, !'-,1 L5 R F..: E: F~.-" E.---L-! IJ .~: F~: E [: '- "- " '= ' "" ..... RF'F'F.' ]VRL BACKFILLING OF I-3N'¢ .':,~r=,TEFI I.'.IITHOUT FINAl_ .[N=FE_.TILN AI",IC' B"r' TFIIS [:,EPFII:;.:TMENT WILL BE ::,JE,._IEL. T TO FF.'L.=,I:-]L. LITION HINII'dUM [:,ISTlaNCE DETI.'.IEEN PI NEL. L FIND FIN'¢ ON-SITE SEWAGE [)ISF'OSAL S'¢SI"EM IS :U30 FEET FOR FI PRIVATE NELl_ OR '-'[...=.;8 TO 2E4C~ FEET FROM FI F'UBLIC NELL [:,EPEN[:,ING LIPOI'..I THE TYPE OF F'UE:LIC NEI..I_. MINIMUH DI'.STF::Ii",ICE FROM R PRIVATE NELL TO R F'RIVFITE SEI.qER LINE l:S 25 FEET FIN[:, TO R COr'IMUI'4IT'.r' SEI4ER LINE IS 75 FEET. NELL LOGS PIRE RE~UIRE['., AND i"IUST BE RETURNED TO THE B, EPRRTI'IENT I.,.IITHIN OF THE NEL. L COMF'LETION. OTHER F.:E6]LIIREMENTS i'dFl'¢ FIPPI..'¥'. SPECIFICATIONS AND COI'.~STRUCTIOI',I [.',IAGRFIMS ARE FIVAILABLE TO INSURE PROPEF.'. INSTALLATION. I CERTIF'¢ THAT :1.: I Fffq FFIMILIRR NI'rl-.t THE F.'.E~2UIREMENTS FOR ON-SITE SEI.,.IERS FIND 14ELLS RS SE]" F:'ORTH BV THE MUi'.,IICIPALIT'¢ OF RNCFIORAGE. 2:: I NII_L IIqST'RLL 'THE S'.r'STEH IN FICCORDFINCE NITH THE CO[:,ES. ]i:; I UNDERSTRN[:, TFIAT THE OI'..I-S]:TE SEI.,.IER S'¢ST'EM I"lFl"r' F.:EOUIITE ENLARGEMENT IF'" THE RESI[:,ENCE IS REMO[:'ELED TO INCLUDE: MORE THAN 4 BE[.',F.:OIDMS. / FIF F L I CFtI'.4TFF,.FtNK BI~'HA'F,,,[: I ~,2;I..IE[:, E:"r'_. ~ .......... [:'I::ITE ........... "."4, I."_."1 [] SOILS LOG PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-222'[ SOILS LOG - PERCOLATION TEST F,~.--~or('l CO~ .~t ru c-ttoq LEGAL DESCRIPTION: L.~J~ ~ ~ ~2~O(~,~--. 4 7 8 'q.5-1'~ 9 DATE PERFORMED: ¢ ~_~I~TCO LATI O N L..,'}f '~ SLOPE SITE PLAN 10 11 12 13-- T.D. 14 15 16 17 18 19- 20- COMMENTS ¢-~i1'~ iF'~ PERFORMED BY: WAS GROUND WATER S . , , , ENCOUNTERED? '~(~ L ~ O IF YES, AT WHAT ~ E ~1.~ ' i , DEPTH? Gross Net Depth to Net ReadingDate Time Time Water Drop I 8/~q ~:~o '- - ~0'4" - - 2_ w: 25 I% Lo' 5'1~' I ' 14" PERCOLATION RATE ~'O (minutes/inch) TEST RUN .ETWEEN __ I¢ FT A~ ~ FT CERTIFIEDB ~ . : DATE: 72 008 (7/76) • • • t Municipality of Anchorage � On-Site Water and Wastewater Program (907) 343-7904 SAFETY CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-172-01 Expiration Date: 3 -1 a —I 1. GENERAL INFORMATION Complete legal description GREENLAND S/D BLOCK 4, LOT 6 Location (site address) 4801 JUMAR DR, ANCHORAGE. AK 99516 Current Property owner(s) _ZACHARY RINKER& ALECIA WOOD_ Day phone Mailing address SAME Real Estate Agent ,� ,..•,;c`.: 2. TYPE OF DWELLING: Q 4/0 ® Single Family (w/wo ADU) 1,9 N ❑ Duplex . 04 ❑ Multiple Dwellings (Single Family and/or Duplex) 957 £ Z� 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by:/114.4` Date: / I/ I l<(,V COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 52.L Waiver Fee $ Date of Payment 11114119 Date of Payment Receipt Number .232231 Receipt Number COSA# 0 SC t 7 U pOZ 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 MIKE N ANDERSON,P.E. Phone 727-8864 Address 4661 NATRONA AVE. Anch Ak 99516 Engineer's Printed Name MIKE N ANDERSON,PE Date 11/19/18 OF 4/ • 01,4. ° � • 97 Pt °° • yI . 6. DSD SIGNATURE •• •°° .s °°/AICHAEL RSCN N. • ANCE r�_ �r °•, -9469 11 •1,. System #1 Approved for bedrooms. � • �^,•y ry/�!�e System #2 Approved for �.�P• ,r I.^ y pP bedrooms. a� c,r<<,�,,,,, Disapproved. ���-N°c1-7 Conditional approval for bedrooms, with the following stipulations: \<��„ , , Ill ON-SITE �r WATER AND j WASTEWATER z T PROGRAM <54 -^ Original Certificate Date: � Z"( Z C 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 Adv,isorc= • 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: GREENLAND S/D BLOCK 4, LOT 6 Parcel ID: 015-172-01 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) NO Date completed PRE-1975 Sanitary seal (Y/N)Y Wires properly protected (YIN)Y Total depth 92'+ ft. Cased to *40'+ ft. Casing height(above ground) 12+ FROM WELL LOG AT INSPECTION Date of test 11/17/2018 Static water level ft. 72 ft. Well production g.p.m. 5.5 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic: ND ug/L Date of sample: 11/0912018 Collected by: MNA B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 1Z- Tank -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 (YIN) N Date of pumping NEA__ Pumper N� C. ABSORPTION FIELD DATA—1985 SYSTEM TESTED Date installed 8-10.87 Soil rating (ft2/bdrm) 150 System type BED** Length 41-49 ft. Width 12-42 ft. Gravel below pipe 0.5 ft. Total depth 3.25 ft. Eff. absorption area 967+ ft2 Monitoring tube Y Depression over field N Date of adequacy test 11-17-18 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600+ gal. New depth 1/2" in. Elapsed Time: 1200 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) UNKNOWN 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 ir.. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer/septic service line 25'+ Holding tank NA Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 100'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 101+ Water Service line 10'+ Surface water 100'+ • Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(None Known) Wells on adjacent lots 100'+ F. COMMENTS *WELL WAS INSPECTED BY AAROW SEE LETTER IN THE FILE **BED SYSTEM ONLY TESTED. OLD DEEP TRENCH WAS DRY. G. ENGINEER'S CERTIFICATION � 1. Fo .,‘ I certify that I have determined through field inspections and f-'c,. .° _ - ° ° `' • review of Municipal records that the above systems are in ' °��� `v, conformance with MOA COSA guidelines in effect on this date. ` �'• Q Y °'' Engineer's Printed Name MIKE N. ANDERSON.PE Gtr '••MICHAEL N. ANDERSON:: Date 11119/2018 CE 9 9/ COSA canary sheet_2-6-15.doc 115TH AVENUE 0 b M co S89° 53'20"E 100.00' 10' CEA RIGHT OF WAY EASEMENT (PER BOOK 1044,PAGE 619.) 30' I LOT 6 NOTES 1) THIS DRAWING SHALL NOT BE © MODIFIED FOR USE AS A PLOT 2 SEPTIC PLAN WITHOUT THE EXPRESSED I STAND PIPES WRITTEN CONSENT OF LCG LANTECH. -- x -- x---- —X-----• I— +' x 2) SNOW AND ICE MAY CONCEAL W I.-. / MINOR SURFACE FEATURES. w'J y I5 b / — O 3) THIS AS-BUILT SURVEY IS BASED 0 o. + 0 CO m ON THE FOUND IRON PIPES 0.1— 3 SEPTIC o ALONG JUMAR AVENUE,PER I— Z N STAND PIPES N LOT 5 AS-BUILT SURVEY PERFORMED Q F' BY THOMAS SMITH LS 3167, a W CM DATED SEPTEMBER 15TH,1980. 1 c5 SEPTIC - x 0 THESE IRON PIPES ARE 1 0' STAND PIPES INCONSISTENT IN GREENLAND o s I o SUBDIVISION BY APPROXIMATELY p I ° 1.5 FEET. UNDER NO 0, o CIRCUMSTANCES SHOULD ANY SHED DATA HEREON BE USED FOR ___, A ESTABLISHING PROPERTY LINES. - I „ , , . X ____ a 48.2' •22,2' { N EXISTING 24.0'HOUSE o --4—29.6' r ‘I./ 24.2' T_ 30' oa��000p�O� N89° 53' 20'W 100.00' 0 . �.i— '•.1 00 co co 0* 49TH /\ •.- �O O JUMAR AVENUE A. w... : . .. . - -,•... •, STEVEN CALLA( AN °v s ' . LS-12034 ••. p 4pr0 fessiono\ X40 ORDERED BY: MICHAEL N.ANDERSON PARCEL#: 015-172-01-000 SURVEY CERTIFICATION:LCG LANTECH,INC HAS CONDUCTED A PHYSICAL SURVEY OF THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE LEGAL DESCRIPTION: ADDRESS: 4801 JUMAR AVE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO ENCROACHMENTS EXIST OTHER THAN NOTED. AS-BUILT EXCLUSIONARY NOTE:IT IS THE OWNERS'RESPONSIBILITY TO DETERMINE THE LOT 6, BLOCK 4, EXISTENCE OF ANY EASEMENTS,COVENANTS,RESTRICTIONS OR RIGHT-OF-WAY TAKINGS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO GREENLAND SUBDIVISION CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION,FOR ESTABLISHING PROPERTY LINES,OR FOR PLOT PLAN PURPOSES. LEGEND: 250 H Street SEPTIC STANDPIPE O Overhon iiia Asphalt Anchorage,Alaska 99501 s___ a p”. WATER WELL Q T ) ` Survey Department FENCE X Wood Deck ° Concrete Phone 562 5291 DRAWN DATE: 12/11/2018 WORK ORDER: 18166 '�' '�r'"� Inc Mainline DRAWN BY: ADS PLAT: P-268 Phone 243-8985 CHECKED BY: SC GRID: SW2636 all-eA t`ec&ulee' e"91 ePA.c'19•'44thA,'e` 4 AECC 668 SCALE: 1"=40' FB/PG:812/31 REF:2011L01 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4'LO~ Braga~ S;tre~t P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF 0N-SITE SYSTEHS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-172-01 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address GREENLAND S/D; BLOCK 4, LOT 6 4801 JUMAR DRIVE * ANCHORAGE, AK * 99516 DOUG MACARTHUR Day phone 4801 JUMAR DRIVE * ANCHORAGE, AK * 99516 229-1538 Day phone REAL ESTATE BROKERS OF ALASKA Day phone 297-2912 3300 C STREET, #200 * ANCHORAGE, AK * 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 '3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well', ~ [] Individual On-site [] 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 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 ceRified by ............ ~ ..~ ' -,'~- ~ .... ~ '" my se~ amxeo he~u~o and as o~ u~e wlidodu, u~L~ o,OvVh below, ! investigation, based on procedures outlined in the Certificate 'of On-Site Systems Approval Guidelines for this appfication, 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 Municipafity of Anchorage files and from myinvestigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compfiance with afl appficable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd.. Address 5701 Eo TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 557-6179 Date' 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 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 authorfzed, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE bedrooms. Disapproved. Conditional approval for bedrooms, with the following s[ipuCtit~)F Attachments: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11/05) Original Certificate Date: Arsenic Advisow Maintenance Agreements Supplemental Engineer's Report Othec Municipality of AnChorage Development Se ices Department 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 CERTIFI'CATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal DeScription: GREENLAND S/D; BLOCK 4, LOT 6 Parcel ID: WELL DATA Well type PRIVATE Date cOmpleted PRE 1975 Total depth *92+ .ft. *PER IfA, B, or C provide PWSID# N/A Sanitary seal (Y/N) YES Cased to **40'+ ff. GE(; INSPECTION. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) **PER AAROW PUMP AND WELL INSPECTION. SEE AR'ACHED. NO YES 12+ in. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform (~ colonies/100 mi. Arsenic: J~J~ ug./L. FROM WELL LOG AT INSPECTION 1/4/2011 ft. 71 .ff. g.p.m. 5.5 g.p.m. Nitrate/~) ~'~ mg./L. Date of sample: 1/4/2011 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size.. ! 250 gal. Number of COmpartments -- Foundation cleanout (Y/N) YES 2 Depression over tank (Y/N) NO · Other bacteria Collected by: __ colonies/lO0 mi. GEG Ltd. Date installed 9/15/1980 Cleanouts (Y/N) YES High water alarm (Y/N) N/A Pumper. ONE ~;TOP SERVICES Date of pumping 1/5/2011 ABSORPTION FIELD DATA 9/15/1980 Date installed 8/1.0/1987 83 TOTAL Length 41-49 ,ft. *6,9 '1980 TRENCH I'BELOW EXISTING GRADEI ~ 1987 BED 165 TRENCH rating (g.p.d./ft2o~ 15o System type BED Soil 3 4 Width 12-42 ft. Gravel below pipe 0.5 664 Total depth *3.7 ft. Date of adequacy test Fluid depth in absorption field before test O. in. Elapsed Time: - min. Final fluid depth 0 Any rejuvenation treatment (past 12 mo,) (Y/N & type) **TESTED 1987 BED ONLY. PRIOR TO TEST. NOTE: Eft. absorption area 967 ft2 Monitoring tube YES *'1/4/2011 Results (Pass/Fail) PASS Water added. 660 gal. in. NONE Depression over field NO For 4 bedrooms New depth 0 in. Absorption rate >= 600+ g.p.d. KNOWN If yes, give date - 1980 TRENCH WAS DRY. PRESOAKED' BED WITH 1000 GALLONS OF WATER BED WAS INSULATED PER 1987 INSPECTION REPORT. 2'+ SOIL COVER. De LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access ~ ~ "Pump off" level_~ High water alarm level at Cycles tested. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot. 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ ¸in. 100'+ Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Water main N/A Wells on adjacent lots 100'+ Property line Water service line. PRIVATE/150'+ PUBLIC 5'+ 10'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONiE KNOWN Absorption field 5'+ Surface water. 100'+ Building foundat on. 10'+ Water main Surface water 100'+ Wells on adjacent lots 100'+ N/A Driveway, parking/vehicle storage 10'+ PRIVATE/150'+ PUBLIC F. COMMENTS G. ENGINEER'S CERTIFICATION ! 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 Pripted Name JEFFREY A. GARNESS Date C I I ~.t /,~ o l iI COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $, Date of Payment Receipt Number ' NOTE: THIS AS-BUILT SURVEY IS BASED ON THE FOUND IRON PIPES ALONG JUMAR AVENUE." PER AS-BUILT SURVEY PERFORMED BY THOMAS SMITH, LS 31§% DATED SEPTEMBER 15TH, 1980. THESE IRON PIPES ARE INCONSISTENT WITH OTHER MONUMENTA'RON IN ' GREENLAND SUBDIVISION BY APPROXIMATELY 1.5 FEET. UNDER NO CURCUMSTANCES SHOULD ANY DATA HERt-'ON BE USED FOR ESTABLISHING PROPERTY LINES. 30' Legal DascriptMn: ^S-BUILT ". ,. L:ot 6, Block 41 Greenland SUbdivision 115th Avenue 30' S 89'53'20" E 100.00' -- 29.6':1: .~ F~und 2" IP Lot Septic Standpipes Septic (i~)Stendptpes P 22.2'+ o O 48.2 ~ _ Exlstlng House 2'4.0 :.!.:...:,:.:.:.:,:,:::,..}. N 89'53'20" W i:i!:?i::'/ Found 100.00' -Jumer Avenue L.~t'5 - - NOTES: 1) THIS DRAWING SHALE NOT.BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. 2) SNOW AND ICE MAY CONCEAL MINOR SURFACE FEA'IIJRES. ~d_,,,d a~ Mike Mulneoux~'Reol Est. Brokers of AK. Legend: [.:,,:'::.:,,-:..,::A~ha t ::,:,',':::::;: -~ ' Septl~ Standpipe (~) t~:".":'.' Water Well ~) In~n~m~'~I I~JR~'Y' CERTIFICATION: LANTECH hoe condaeted a phy~lc~ survey at' th~ · . prnpert¥ ~ ~h~n en thl~ dra~l~g and certltl~e that the Irnprovameat~ "slluatedth~ean ore ~f, hln ~e properly II~ea O~er tha~ nnted, EXcJ.U~IONARY NOTE: It Is the owners' responsibility to determln~ the exletance' of nr~¥ eaeemante, covenanL% rash'lotions or tek, ga ~[~ da not appear an the recorded .ubdl~alon plat. Under .n0-~l~mstaneea should any dot~ hereon be ueed for con~tructlon, Fax: 561-6626 .'for eetabll~h~g pr~e~y Ilnel, ~ far plat-plan · SW2656 January 12, 2011 ora~ ay: PL '764/69 Scale: 1"=40' ' Checked ~ dMZ · LAND & .CONSTRUCTION SURVEYORS-PLANNERS-ENGI~ 440 'West-Benson Boulevord, Suite 200 Phone: 562-529"~ _ Alaska 99503' ·, P!o6"P.268 o,~. 2011-~01 Aarow Pump & Well Service LLC (907)346-9355 Inspection Report Lot 6, Block 4, Greenland Run camera down well to 50'. No perforations in casing were found. Brian R. Wille Aarow Pump & Well Service LLC · : DEpAR~r~ENT'OF'HEALT~& HUI~IAN SERVicES : ~'~ : NOTE: ff commun/ty wastewa~e~ ~,~tem, prowde wn~ten cohtTrmatiOn from State ADEC 72-025 [Rev, 1/91 ) Front MOA #21 Computer Vers[o~ Note: Alaska. Water, and Wastewater Consultants,/nc.. shall be paid $~r~.~ at~l or prior to, closing for the engineering services providec~. 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 wastawatar disposal system is safe, functional and adequate for the number of bedrooms and type of strdcture indicated.herein. I fudher ~/erify.that based on the information obtained from the Municipality of Ancl~omge f]le~ and fi;om my in~estigatio~'and insp'~_~on~ th~ on-site Water. supply end/or wastewater dispOsal system Is' in compliance with alllM~unici~,al~d State codes ofdinancas and regulatiofis in effect · ontt~e date 0!{his=Inspection.:, .__ i./ .~'/~'1 , i i" ' ' :' '" - Add;esS r 6~01 DEBARR R"OAO./S'IJI~NCh~RAG'I~, ALASKA 99504 "' / . ~ ': Eng :n~e~ Sig~i~tUr~-' ~~ ~' '":i.',. ~'- :[~Da{~'.:.'.': ~/c~t'~,~ . -...' . In con'd~Jcling this eval(~ation, A~~eughj'cohsclebtious bngineering.~bblysis of the performance of the system u.n, de~ th~~ ~u .et red. at the.t(rne of the test, and separation distances measured to read~lY /de~tffiab/a features: TI~ o-pe~.atiOn~l /if& of~a/i Wei/i~rand ~e'Ptic'System~' de,nd .-'::'. ":" ' on the/ocli s~i/s.~ondltion,; grounE ~'ater Ia.reis ~hat may flUctbate during !he;year, and the'water 'usage of the fatal/J4 being served b~th~ System. These'conditle~is aye edta/de the'control of the e~a'/uatO~' Of ~fie system. Satisfacto/y test results do not guarantee fut~'e'~erformance ; of the system, n~r d~) they guarantee that there a~.e no hidd~n d~fec~s ~)r encrcachmentS. At444/C~ ~nc. can therefore not proWd, e any warranty foK fu'tUre e§timate'of how /ong the system w/II COntinue to meet the oporationa/ requirements of the ADEC or MOA DHHS. The COntent of this report Is for the sole benefit of the owner/Isted 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 whatscever. 6; DHHS SIGNATURE .r...~-: .APproved Disapproved Conditibnal approval for bedrooms . bedrooms, with the fo[lowing stipulations: Additional Comments · . By: 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 th61r 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. 1/§1) Back MOA fY21 Computer Version .- RECEIVED Municipality of Anchorage SFP 0 DEPARTMENT OF HEALTH & HUMAN SERVICES /~'.~ Environmental Services Division 825 "L" Streetj Rm 502 Anchorage, Alaska 99501 (907) 343-474MUNICIPALITY ENVIRONMENTAL SE~ISION Health Authority Approval Checklist Legal Description: GREENLAND SUBDIVISION; LOT 6, BLOCK 4 Parcel I.Di: A. WELL DATA *PER MOA RECORDS IfA, B, or C, aEach ADEC leEer. ADECwatarsystem number NO Date completed *PRIOR TO 1975 Cased to 40'+ YES Well Type PRIVATE Log present (Y/N) Total depth 92'+ Sanitary seal (Y/N) FROM WELL LOG N/A g.p.m. 0.5 mq/L (u) Collected by: 015-172-01 Nitrate N/A Date of test Static water level N/A Well production N/A WATER SAMPLE RESULTS: Coliform 0 Date of sample: 8/25/2000 B. SEPTIC/HOLDING TANK DATA Date installed 1980 Tank size Foundation cleanout (Y/N) YES Date of Pumping 8/25/2000 C. ABSORPTION FIELD DATA Date installed 8/10/87 Length VARIES Effective absorption area Date of adequacy test Fluid depth in absorption field before test (in.); Fluid depth 4- (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)' Computer Vemion Casing height (above ground) 1 Wires preperly protected (Y/N) YES AT INSPECTION 8/25/2000 69' 6.0 g.p.m. Other bacter's~'/~,/R R~'~'C/0~ A.W.W.C., INC. 1250 Number of Compartments Depression (Y/N) NO High water alarm (Y/N) Pumper DENALI SEWER & DRAIN 2 Cleanouts (Y/N) YES N/A Soil rating (g.p.d./ft2 or fl2/bdrm) 150 System type BED Width VARIES Gravel thickness below pipe 0.5' Total d~pth 4' 967 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO 8/25/2000 Results (Pass/Fail) PASS For 4 Bedrooms 2 Immediately after 1073 gal. water added (in.): 4.75 60 Absorption rate = 600+ GPD NONE KNOWN If yes, give date D'. LIFT STATION ~ Daie installed ' Size in.._gallon~ Manhole/Access (Y/N) ~at*_ "Pump off" level at* High wa~ *Datum ...¢y~es~Fested E, SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main 100'+ 100'+ _On adjacent lots 100'+ On adjacent lots 1 o0'+ Public sewer manhole/cleanout N/A Sewedseptic service line 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ Property line 5'+ Water main/service line 10% Surface wateddrainage 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Absorption field 5'+ Wells on adjacent lots. 100'+ 150'+ FROM CLASS "C" Property line 10'+ Building foundation 10'+ Water main/service line 10'+ Surface water 100'+ Cudain drain F. ENGINEER'S C/~TIFI~/AT/~ I certify that I ~ave/de~7~[n~ thr of Municipal ~ecer~s w, th MOA Signature ~ Engineer's Nam~.~ Date 'NE KNOWN field inspections and review systems are in conformance )n this date, JEFFREY A. GARNESS Driveway, parking/vehicle storage area 10% lo0'+ FROM PRIVATE .Wells on adjacent Iots150'+ FROM CLASS "C" HAA Fee $ ?*© O- ~ Date of Payment co Receipt Number 0(~ ~'% ~ 72-026 (Rev. 3/96)* Computer Version Waivar Fee $. Date of Payment Receipt Number APPL:' NT FILLS OUT UPPER HAl ONLY Buyer ' / Address Zip Code Lending Institution ';'-- ~-~, Phone Address Zip Code Realty Co. & Agent / Type of Residence ~ Single Family ~ Multiple Family No. of Bedrooms ~ Other Walor Supply ~.~'~ ~ Individual ~ O~4 ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ~ CommunityT For w~LIs drilled prior to that date, give well depth (attach Jog (f available). Sewer Disposal  Individual Year Individual Installed: / Z/ ¢' (~ _ Public Utility When Connected to Public Utility: ~ ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Date Inspector Pield Not~k~k.v,~~ 6 (~ - Time Date Time Date Inspector Inspector Date Inspector MUNICIPALITY OF ANCHORAGE DEPT. OF H~ALTH 8, ENVIRONMENTAL PROTECTION APPROVED BEDROOMS J U N 'j ' REC[IVED ) DISAPPROVED ) CONDITIONAl_ APPROVAL* DATE I.¢ - ~ C; r~ BY: *CONDITIONS OF APPROVAL Dale Sewer Installed Well To Absorption Area cf_ / t-- ~ ~' We, to Tank (o o Well Log Received Septic Tank Size ,'}oils Rating 72023 (3 IP2.) D~,~E RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTQFtt · MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE  DEPARTMENT OF HEALTH & ENVIRONMENTAL  825 L Street - Anchorage, Alaska 99501 t ENVIRONMENTAL SANITATION reViSiONhl0¥ 0 1980 Telephone 264-4720 DIRECTIONS: Complete all parts oll pa§e 1, incomplete requests will not be processed, Please allow ten (10} days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION ~F~,~ ~_ IPHONE MAILING ADDRESS 4, REALTOR/AGENT PHONE MAILING ADDRESS LEGAL DESCRIPTION STREET LOCATION fi. TYPE OF RESIDENCE ~ [ NUMBER OF~BEDROOMS [] One ~- Four ~ SINGLE FAMILY [] Two [] Five E~] MULTIPLE FAMILY {~Z Three ~ Six [] Other 7. WATER SUPPLY INDIVIDtJAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVI DUAL/ON-SITE~* [] PUBLIC UTILITY *ATTACH WELL LOG. A well log s required for all wells drilled since ,June 1975. For wells drilled prior to that date, give well depth (attach Icg if available,) L~Z~[ ~.P,.~ ~d~ {~'{~C~V c.~ }C~?O YEAR ON-SITE SYSTEM WAS INSTALLEDi NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FiVE [] OTHER [] MULTIPLE FAMILY r~ TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER []INDIVIDUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified iNSTALLER . E]Septic Tank or []Holding Tank Size: I~%~>"'0 If'Tank is homemade SOILS RATING give dimensions: I ~ -~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: Septic/Holdin9 Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5, COMMENTS ' ^PPROVEDrOR BEDBOOMS [] CONDITIONAL APPROVAL {letter must accompany certificate} [] DISAPPROVED DATE BY