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ARVESON LT 3
Arveson Lot 3 #015 -273 -OS Municipality of Anchorage Page a of 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 Permit Number: Sky 0507,151 PID Number: o Name: I Wastewater System: Upgrade ABS RPT 0 FIELD Address: S Phone: No. of rooms: 3 Q ❑Deep Trench hallow Trench D Bed O mound ❑Other LEGAL DESCRIPTION Soil Rating. Total Depth Ifom Original grade: t'� GPD/S& Ft. Lot: Block: u i inion: Depth to Pipe bottom Irom original grade: i zjv,Y. Gravel depth beneath pipe / , Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ft. Fl. WELL:��1200New O Upgrade Gravel depth: Number of lines: Duuncebelowlgw Classification (Priva s, A,B,C): Total Depth: Cased To: Ft. Total absorption area: D Ft. Pipe material: 15-010, V Wal+ 117 Ft. > fiz!Ft. Driller. Date Drilled: Static WaterLewl: SQ. Ft. Installer: Date ns Iled: l u Ft. Yield: Pump Sol at: Calling Heigh`Above Ground; I GPM LM) Ft. I 1%o -Ft. TAN SEPARATION DISTANCES ptic Idinp ❑ S.T.E.P. To From Septic Absorption Llh Holding LiNwPirivate Manufacturer: Capacity In gallons: Tank Field Station Tank Sewer Linea 11,6-0 Well 10S�I �/ Of Material: Number of Compartments: rL Weis 8rfac > D' IrDI > It�O' IFT STATION LotSize Line I e (' in gallons: Manufacture . Foundation 1 / I "Pump on" level al: "Pump on" lav High water alarm at: Curtain Drain L /f Pump Make i Model Elec napectiona performed by: Remarks: BENCH MARK Location arld Description: s ej Komc' Assumed Elevation: ' ENGINEER'S SEAL L4,;e I GDrit F Ai �0 am ®A Inspections performed by: r rIA-- Dates:1 S a � e a est aneao®meaaaa ®aa4�e�r•'ti a• 2nd aMichael E. Anderson Department of Health d m rvices approval ®®� ;ey�® 438' -EAir Reviewed and approved by: Date: 72.1111 111011 UnA 99 Permit No. page L of s Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 * Anchorage, Alaska 98519-6650 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report �ODIICI tOM1 pYgM Bh11n120.it IM1ddldl ®� MK., Orlon, Mla. 01171 10 0* NX TOLL RR 1-M2&M Permit N0.S_Y4 930"1 Legal Page of Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6660 0 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report ... ....... .......... N! PID NO.: ...... ... . ..... .. ... . . ......... -i L......... .. I am= M 51® . . ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i . . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . . PRW2041 *0%4) *1 AW tWe WC. kM. MW 01471. TOO* W MLL Mff I -W225 -M ,1_.E,. Anders" 4381 - E De 9 ztt ....... .. ... ...... M 4f -A . . .. .... .. ... . ............ —... . . ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i . . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . . PRW2041 *0%4) *1 AW tWe WC. kM. MW 01471. TOO* W MLL Mff I -W225 -M ,1_.E,. Anders" 4381 - E De 9 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930281 DESIGN ENGINEER:ANDERSON ENGINEERING OWNER NAME:PEABODY TIMOTHY C & LAUREL A OWNER ADDRESS:11120 JEROME ST ANCHORAGE, AK 99516 PARCEL ID:01527308 LEGAL DESCRIPTION: ARVESON LT 3 LOT SIZE: 10006 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 DATE ISSUED: 8/10/93 EXPIRATION DATE: 8/10/94 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. (THE ATTACHED APPROVED DESIGN. 2. ALL RE TS 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE : �Z- DATE • �� ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, ALASKA 99524 July 27, 1993 Municipality of Anchorage Department of Heath & Human Services 825 "L" Street Anchorage, AK 99502-0650 Subject: Lot 3, Arveson Subdivision Septic System Design Impacts to Adjacent Properties Dear On Site Services Engineer: The drainfield on the subject lot has failed and requires replacement. Unfortunately, the lot is small and room for a replacement system is limited. We have completed a soils test which indicates 36' of deep trench is required to adequately serve the house. A 5' length of the existing trench will need to be reconstructed to accomodate the entire 36' length. We propose to exvate the existing trench, including all material in the - trench as well as any contaminated soil on the side walls and bottom of the Bch. The excavation will extend 15' into the old trench to provide the mandated 10' separation between new and old systems. The excavated material will be treated as necessary with chlorine and either buried onsite or hauled to the Municipal Landfill. The excavated area will then be backfilled with clean gravel material similar to the inplace material with the same percolation rate. No groundwater was encountered during testhole excavation and none is expected during the monitoring period. We will continue to check for groundwater during the permit review period and pass the results on to you. If the system is constructed in accordance with the attached design the following statements can be made: 1. The system, if constructed as designed, will have no adverse impact on the wells currently in use or to be placed in the future on lots in the area. Lot 3, Arveson Subdivision Septic System Impact July 27, 1993 Page Two 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserved space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. Sincerely, Michael E. Anderson, P.E. OF Al Ott� AWtV, o-.0 f ° �h ee aieEoO ©J068a6 ©o3���sppseemoo e so ©mev o oee eooeoo oneSd�S'�e oo Rl i, Michael E. Anderson 4361 -E .� -, p � awn tp^�.���® SHEET NO, OF CALCULATED BY DAT CHECKED BY_ DATE SCALE �J 110r + _ I PRWWf NI41E'es Inc.. Craton. Mm 01471, JOB !:121 ice/ �/► 1�/y SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE SCALE 1 i 2,01 0 •: r ®.••V—n' a ®• OYfiYBYee'ePiii'i� •` s a eeeeeeee.e�: s�Michael E. Anderson w 0, •e 4381- E �a'a �e`� • RQF r_r N •��, f y 9 Q ~``•eeewe�`�• F�Ss PAODUCT 20.1-1 (Single SAeels) 205.1(Padded) ®e Inc., Groton, Matt. 01171. To Order PHOK TOLL WE 1.80P2254 AO JOB w 1 ✓ SHEET NO. ,C�dEylAd CALCULATED BY I DATE CHECKED BY DATE SCALE I Z. 10 LAUAL tN1r: _ . -9 PRODUCT 2041 (Single Sheets) 205.1 (Padded) ®® Inc., Groton, Mass. 01471. To Order PRONE TOLL ME I-BOP22 -M NCS �hn�� sY51'�Nl C�°�J of. A 4 ®e®a-000 �6®°cos djY�J` �1e'C�'•B 6� o° Anderson Wchael C u2 G d381 E °A Q�n b®100.090°°fl�`1��/ .47T n RO JOB Loi' 3, /+AVESo.J SvQ SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE RLR iN F! E'LA CA I -W L411 OBJ PGR CA LA" 0 4 14rc --t► Cj M "j . /INC" 4vr LJC4 -r Aon Aewe- /- z- G. P D. �Fr. Z BcbRoorns x ISO G. P. SDO !i'T. Z O mm® w°®•m eceem °°®`fie -, ea em pp smm m® mei. ee �% Michael E. Anderson 4381 - E ea \s` r ®�f0FE6S1�e � KWIC 311-+'StO NMI MI (POW) ®611C. WN, MW 0471 To ar nay[ MU r+It 1400 MMX I�V Fr, Z r- 35T , 7 rr.' i �A'TVRA'l. BA UPJ K.e /Vi p,Vn� � � Od�"7L 7"J'L�-N CH. GEotcxTit<- FAU&)C.,. T� cN Sir-rio �t . Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST ®' SEAL �'` '► TME'`or Co ' Awl a { 00 G"as 00090 m .4® . Dom aa.oa 0..e 6.® . x � Michael E. Andemon 13 1 I r� q Depth to water cuter Monitoring? am 14 15 16 17 18 19 A PLAN -_�� ---�---� --_i�--_- 20 PERCOLATION RATE (minutsWinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS No Nkz PERFORMED BY:� � HAT,THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 74L 19-r 72-008 (Rev. 485) T� q PERFORMED FOR: Fri I Gf1f�� V 1 DATE PER LEGAL DESCRIPTION: LoT �, �1'�IrJryN Township, Range, Section: -0ERT.K fr IOL. SLOPE ..,.., ♦ Q • 9 •n 2 °♦ � ♦ 3 e o o • qo 4 5 •a'o 6-0 o °a ° o ° � 7 ° ° e 8- 4,0 �0 �e 9 ° 10 v ° WAS GROUND WATER--- e . o ♦ ENCOUNTERED? 11 0 ' ° S L ° ♦ e IF YES, AT WHAT O 6 ♦ DEPTH? P 12 _ .I E 13 1 I r� q Depth to water cuter Monitoring? am 14 15 16 17 18 19 A PLAN -_�� ---�---� --_i�--_- 20 PERCOLATION RATE (minutsWinch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS No Nkz PERFORMED BY:� � HAT,THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 74L 19-r 72-008 (Rev. 485) OFAft® Municipality of Anchorage w i. �T DEPARTMENT OF HEALTH & HUMAN SERVICES �� r ®' v 825 " U' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST jl'y�{�k��'® °�ti`Y�®w°� <,"`° ••a®• • _�1 `p1, rd p o0 ooawa• 'Ya.•N .0 MIC IqG' w � l w..�,,�.,., PERFORMED FOR: TIM 1 1CI�f/yVY DAT��i�MED: 1,F4 no�..•.^,�t�P LEGAL DESCRIPTION: WI 2 � °. `/ �wl r/ ! ■■�■■■� v O Q 4 00, V %A 5 0 eo .ii0 p�•I 8 p'0V p 6w 9 0�P'rl° 10 P '061 11 O. p!'. 0 •°f •'0 12-0 •o ,� . 13 .. • • .. ° 14 O O a opB 1 15 00 oie 16-- 6 17 17 oo,a. o.• o:• �N 18 _ 19 SLOPE Section: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth to WAK After Miewing? Oela S L 0 P E 20-{ UPERCOLATION RATE 3 (mmutesnnch) FERC HOLE DIAMETER TEST RUN BETWEEN �yy FT AND yy FT COMMENTS �JG{'i W)I-dCi�Cirb PERFORMED BY: I 71111-44j , � ^ASRTTFV-fFiAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: - �'b'-7(�-j 72-008 (Rev. 4/85) ■■�■■■� �, ■rte■■�■■��■■ 20-{ UPERCOLATION RATE 3 (mmutesnnch) FERC HOLE DIAMETER TEST RUN BETWEEN �yy FT AND yy FT COMMENTS �JG{'i W)I-dCi�Cirb PERFORMED BY: I 71111-44j , � ^ASRTTFV-fFiAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: - �'b'-7(�-j 72-008 (Rev. 4/85) boa 17( /nS �4vIle e/ ®IJ^ �e4 rr at^ce ' ,P CjU Ye�rl) 4^ct %ruck c%tve r ( 1 S yf ltrS) ve &e -el k:>^P 6yec./ ct7- Wilder- Co. TD'- R Lcl -� I Vftr T used welders E d clv,., p -�o 4ad 44e_ J � j/1' c1rgi, r-ocit -{O /%&t t%evM, 0^ Week eAc/s .T' v5ec( lel r �d�r s c +0 e( �.��� ��� k l/ fie_ e��� r•, lal. c 4-14�1;y 4�o n.. We S 4 rn U*r /r j i4nd wC,5 1A S�J�c�ed / A 5 cJ. J^ P S eeTor-) 910^1� Z 3LIy- ( 550 Ilia � //t Z 11 y --9' ( s'3 MUNICIPALITY OF ANCHORAGE 0 DEPARTMENT 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 NAME❑ FloG�}� ��� PHONE NEW ❑UPGRADE MAI LINGADp,Rc7 S .- LEGAL DESCRIPTION 4 LOCATION NO. OF PEDROOMS - UY DISTANCE TO: Well Absorption area Dwelling PERMI �G r CL ZQ W E. Manufacturer Material No. of compartments rn Liq. capaci An gallons IF HOMEMADE: Inside length Width Liquid depth Y JC z DISTANCE TO: Well Dwelling PERMIT NO. 2 i.- Manufacturer Material Liquid capacity in gallons C w= DISTANCE TO: Well Foundation Nearest lot line PERMIT NO.p A Q�V V;). J LL Z �Zw No. of lines Length of each line Total length of lines Trench width inches Distance between lines f p Top of the to finish grade Material beneath the inches Total effective absorption area W C7 Length Width Depth PERMIT NO. Q H W° Type of crib Crib diameter Crib depth Total effective absorption area LU DISTANCE TO: Well Building foundation Nearest lot line J J Class Depth Driller Distance to lot line PERMIT NO. W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INST ER D REMARKS OVE DATE LEGAL 72-013 (Rev. 3/78) � ' �'-� TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FT/BR)= 85 THE REQUIRE[ SIZE OF THE SOIL ABSORPTION SYSTEM IS: EE F" Ir hi= #� ���1:�iT+A= C5 �F1F4N--d'1E_"L_ ��1E�F--T*4--j= CER THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD, THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE 15 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��������C. n ���- T - 1 v - I F f � I��� ����� ���� �����: '. I r - A E ; ; PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. 7- 00 C:) ���� :1 Jr -4 S�; F 1 0::# r4�� 1=1 FZ EE K Er CA K.J X F;1 EE: Ell BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION, K&F-11"IX-T" �, ���� I CERTIFY THAI' 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED _�.................................. / n�' HPPLICHNl�—�LOLHND PETc���ON A ���I �I 9=1 L.. X K � H:.—"# F- ���� ����� ' [EPHRTMENT HEALTH AND ENVIRONMENTAL ROTECTION 825 'L' STREET, ANCHORAGE, HK 99501 ~~ '----- - —° 264-4720 1 '7 E"K.' tJF"C3F;!9=1KTm1"7 KEEIR!"I X -1- PERMIT NO ( 820421 ::- APPLICANT HPPLICHNT ROLHND PETERSON SRH BX 17430P LOCATION JEROME ST LEGAL LT.] HRYESON S/D LOT SIZE 40000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SO FT/BR)= 85 THE REQUIRE[ SIZE OF THE SOIL ABSORPTION SYSTEM IS: EE F" Ir hi= #� ���1:�iT+A= C5 �F1F4N--d'1E_"L_ ��1E�F--T*4--j= CER THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD, THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE 15 NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��������C. n ���- T - 1 v - I F f � I��� ����� ���� �����: '. I r - A E ; ; PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. 7- 00 C:) ���� :1 Jr -4 S�; F 1 0::# r4�� 1=1 FZ EE K Er CA K.J X F;1 EE: Ell BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION, K&F-11"IX-T" �, ���� I CERTIFY THAI' 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED _�.................................. / n�' HPPLICHNl�—�LOLHND PETc���ON P& G R E ,Z ANCHORAGE AREA BO!' Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 3%H INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 0161&5 SL4 114C ' MAILING ADDRESS 130x/eO PHONE LOCATION SEPTIC TANK: 9 LEGAL DESCRIPTION /dr— 3/L(/Eso�'!' DISTANCE /�i�rne NUMBER OF FROM WELL/0 /Z MANUFACTURER MATERIAL � COMPARTMENTS / Sop t lE,�'>�q7��vvvl v INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY ._ GALTONS. A0,,0.7.0N4/ TILE DRAIN FIELD: TOTAL LENGTH DISTANCE FROM WELL FOUNDATION 7NEAREST LOT LINE_ lQ , OF LINES NUMBER OF LINES//�� DISTANCE BETWEEN LINES C TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA /.I I I. OLENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE MATERIAL BENEATH TILE_✓A 4(. ABOVE TILE WELL - TYPE CONSTRUCTION BUILDING NEARESTNEAREST FOUNDATION LOT LINE , SEWER LINE CESSPOOL , OTHER SOURCES APPROVED_ DISAPPROVED REMARKS DISTANCES: INSTALLED BY: SFIf' SEWER LINE DEPTH: e PIPE MATERIAL: LOT SLOPE: REMARKS: �S Form EQ -032 O wok SEPTIC TANK_ IN. DEPTH DISTANCE FROM: SEEPAGE SYSTEM Gtl�� i'LG�l1 . DIAGRAM OF SYSTEM d1r ki.Mlk ArfO �A� k ►� 1 r5 iNV ,Aj# F1([/U• DATE W, o�3—.VAPPROVED ME G.A.A. B. GARB -HD -I GP` 'ER ANCHORAGE AREA BOROI' ".. a - OL, ARTMENT OF ENVIRONMENTAL OUALI . _ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279.8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME G//'�` ADDRE S ��� ��-�� �� PHONE LOCATION 1'�'' �`O!LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL dpU LIQUID CAPACITY Z�� —GALLONS NUMBER OF %TERIAL COMPARTMENTS INSIDE LENGTH ✓ INSIDE WIDTH LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS --OUTSIDE DIAMETER— � OR WIDTH___,, LENGTHDEPTH LINING MATERIAL �D� �=' . DISTANCE FROM WELLZ_Q49 ! BUILDING FOUNDATION -2Q �f NEAREST LOT LINE �/�'C' TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL NUMBER OF LINES ABSORPTION/AREA FOUNDATION `4,lEAREST LOT LINE STANCE BETWEEN LINES SQ. FT. LENGTH OF EACH LINE TRENCH WIDTH TOTAL LENGTH OF LINES IN. TOTAL EFFECTIVE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: �.fi.�/�s�.seo�/ G'��rr�Gr�or� �EPTH ��� BUILDING FOUNDATION. �/ _SAMPDISTANCE FROM LE NEAREST i NEAREST I / SEPTIC SEEPAGE / I OTHER I nT I INF FWFR LINE f . TANK SYSTEM_. CESSPOOL/ , SOURCES.ew DISTANCES: DIAGRAM OF SYSTEM /9"TD c = /Dc0 moi' j C C DATE �/ APPROVED f G.A.A.B. GREA, ER ANCHORAGE AREA Bok j JGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3500 TUDOR ROAD POUCH 6.650 ANCHORAGE, ALASKA 99502 TELEPHONE 279.8686 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT '314 C�A/vv�c.� (.'Lt -r-1 MAILING ADDRESS L6'X Y� -� `��' I<�%"� 4'rSI NAME OF APPLICANT PHONE INSTALLATION LOCATION LEGAL DESCRIPTION 'J f ! v l,!tii INSTALLATION OF: SEPTIC TANK ^ SEEPAGE PIT DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED `/" '-"�"��2'-U-}�I 2_ A /n 1 ` � /, S FINANCED THROUGH TO BE INSTALLED BY ��� - SOIL TEST RESULTS � L� +-V"1.0 NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE I J1� TYPE ✓fer-( o, cey,, i&t SEEPAGE AREA SIZE .may". itil-tyr TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD I SEPTIC TANK TO SEEPAGE PIT WALL �� —64 SEPTIC TANK, SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD J� ! DRAIN FIELD SEEPAGE PIT %orIfi ALSO CONSIDER AREA WELLS. SEEPAGE PIT / 6� SEPTIC TANK, SEEPAGE PIT / DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. HEALTH AUTHORITY OR LICENSED DESIGNER DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. _ DATE APPLICANT'S SIGNATURE rp RECEIVED s� 6 `1911 . °P1 °s1�i1�C�i�vlNav rr4j"*A �AL Tr" OL `7 r GRED R ANCHORAGE AREA BOROUGH DEPAR, NT OFEN IRONME% °,L C��1Ai_ CASE # 3500 TUDOR ROAD ANCHORAGE, ALASKA 99502 Performed For Q, s3gler _ Date Performed 9/20/71 Legal Description:- Lot 3 Block Subdivision Arveson This Form Reports Soils--og x Percolation Test Oepth Feet Soil Characteristics Brown clayey silt (CL) 1 -- Gray sand (SW) 2- 3— Gray sandy gravel (GW) with sand seams Was Ground Water Encountered? -no If Yes, At What Depth? Jam, ---- �- -- • - Reading Date, I Gross Time Net Time Depth to H 2 Net Drop I i I I i 1 i f i Jam, ---- �- -- • - Reading Date, I Gross Time Net Time Depth to H 2 Net Drop i r c9 UV avn na1.C rilfiuGe Proposed Installation:- ation: Seepage Pit x Drain Field Depth Of Inlet Depth To Bottom Of Pit br Trench COMMENTS: -" 110_square feet of drainage area is required per bedroom. Test er ormea By R. E. Carlisle Data ertf 1e -d By:19ationaL Testtn9--5Tis. Inc. Date SEP U 3 2C •j Municipality of Anchor On -Site Water and Wastewater Progra C/ (907) 343-7904 01 6 fl 4 Certificate of On -Site Systems Approval Parcel I.D. 015-273-08 1. GENERAL INFORMATION Complete legal description Arveson; Lot 3 Location (site address) 11120 Jerome `Anchorage 99516 Current Property owner(s) Kim & Tim Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well 10 Individual Water Storage ❑ Community Class _ Well ❑ Public Water System ❑ WaiverNariance request for: N/A Received by: Expiration Date: / - 3 " L_ — Day phone 907-727-0633 Day phone TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. Date: 1gllr Q�sh _ COSA Fee $ 624( + 31560 o �� 1 b Waiver Fee $ Date of Payment Date of Payment Receipt Number 0-71 �J �J 61 Receipt Number COSA # 05C15 14 6 Waiver # 5. STATEME F INSPECTION BY ENGINEER As certified by my seaQxed 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 Garness Engineering Group, Ltd. (GEG) Phone _ (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date t' 1S In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of - -- - - - - - Anchorage and industry practices. The reported results describe the condition of the systems on the— dates of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of ail wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the sysfem/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future 9edormance of the system/s; therefore, GEG makes no warranty (express or unplied) regard. -ng thefutureperformance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail. The content of this report is for the sole benefit of the person icady who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person/party who paid for this report. 6. DSD SIG System #1 Approved for bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the following The Mur upon the ON-SITE WATER AND WASTEWATER PROGRAM Original Certificate Date: I — 7 — /.5 - 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: f / COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_41-12.d. 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: ARVESON; LOT 3 Parcel ID: 015-273-08 A. WELL DATA *PER SUROUNDING WELL LOGS **PER GEG INSPECTION Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) Date completed 1971 Sanitary seal (Y/N)-)LES Total depth **165+ft. Cased to *40+ ft. FROM WELL LOG Date of test Static water level ft. Well production g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.624 mg./L. NO Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 8/13/15 121.1 ft, 2.1 g.p.m. Collectgd by: GEG. Ltd. Arsenic: NO Date of sample:8/14/15 B. SEPTIC/HOLDING TANK DATA *IN LAUNDRY ROOM; SEE ATTACHED EMAIL FROM RYAN AT WILCO CONTRACTORS Tank Type/Material SEPTIC/UNK, Date installed 6/22/82 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/27/15 Pumper NORTHLAND PUMPING SERVICE C. ABSORPTION FIELD DATA Date installed 8/14-15/1993 Soil rating (g.p.d./ft or /bdr 1.2 System type SHALLOW TRENCH Length 52 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth ** 10,8+ ft. Eff. absorption area 520 ft2 Monitoring tube **YES Depression over field NO Date of adequacy test 8/13/15 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 621 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **MT EXTENDS 44" BELOW INVERT. D. LIFT STATION Date installed "Pump on" level at___in. E. - SEPARATION DISTANCES Size in gallons Manhole/Acoess "Pump ofP level High water alarm level at in. Cycles tested Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankillit station on lot 100'+ On adjacent lots Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main NSA Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank Animal containment ams 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: i r )Q A0 v Property line Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *50'+ TO 1969 (YEAR) SEPTIC TANK ON LOT 2 ARVESON G. ENGINEER'S i certify that! have determined through rmid inspections and review, of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name _ JEFFREY A. GARNESS Date. 911,&, (Rev. 1.1/05) 4 • Off i 1. lj 8 1� 7 *' lld �./J, (j '�L=//•'^%^ `�v `�,./3 moi, �� ASSJ,LLSEWARD Q ASSOCUATES e,-'y47�f3ii a`NSu'�st`Y?lA '•3. f - i 11 INE9CM—TUD. IT IS THE RESPONSISBUTY OF 7T!FR,-m a�*yx'tJ%.3 dpi - 1 a.s 4137. s, R RE®n n a ,�}.aa nAn xvey Ai+ DATA HMM✓. m USEDFopLWs9�. i irbM3�� i i ✓ G t c'– s 1u-. CR n•: ya..az— i MANY a G 3jjj i � a { f r 4 • Off i 1. lj 8 1� 7 *' lld �./J, (j '�L=//•'^%^ `�v `�,./3 moi, �� ASSJ,LLSEWARD Q ASSOCUATES 4-082Q 1 J e,-'y47�f3ii a`NSu'�st`Y?lA AND 700' NO ' V-0-017 AS - .Ts- r INE9CM—TUD. IT IS THE RESPONSISBUTY OF 7T!FR,-m a�*yx'tJ%.3 dpi - 1 a.s 4137. s, R RE®n n a ,�}.aa nAn xvey Ai+ DATA HMM✓. m USEDFopLWs9�. i irbM3�� i i ✓ G t c'– s 1u-. CR n•: ya..az— i MANY a 4-082Q 1 J David Garness From: Ryan Wilkinson <ryanwilco.excavate@9mailcom> Sent: Wednesday, September 02, 2015 9:35 AM To: David Garness Subject: Jerome t I t ZrJ j �anF To whom this may concern I Ryan Wilkinson with Wilco contractors confirmed that there is a usable foundation clean out inside the laundry room in the basement of the house on Jerome Street if you have any questions give me a call 242- 9863 Sent from my iPhone On Jul 28, 2015, at 8:44 AM, David Garness <Davidra garnesseneineerin�.com> wrote: Ryan, Attached is the design for Southpark #2; Block 3, Lot 30. If you have any questions feel free to give me a call David J. Garness, EIT Consultant Garness Engineering Group, Ltd. 3701 E Tudor Road, Suite 101 Anchorage, Alaska 99507 Phone: 907-337-6179 Cell: 907-632-4528 Fax: 907-338-3246 Website: www.arnesseneineerin� com <Southpark #2; Block 3, lot 30 design.pdfs Municipality or Anchorage •� Development Services bepattment Building Safely Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ct.anchorage.ak.us (907)543-7904 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1. GENERAL INFORMATION HAA# Expiration Date: Complete legal description T.nr ar Aon qn iiiris4nn Location (site address or directions) 11120 Jerome S t . Current Propertyowner(s) Steve Avni Day phone 522-1241 Mailing address 11120 .Tprnmp St- Anrhorn&P, AK 94516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless oflierwise requested, HAA will be held by DSD for pickup. eW&F �.— 7 �1 /0 Z. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well R Individual Water Storage ❑ Community. Class Well ❑ Public Water System ❑ Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ Tile Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the Slate 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 sample results less than 30 days old. (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 encineer'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 Health Authority 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 S & S Engineering Phone 694-227 Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date 7///oZ- OF ri ROBERT C. COWAN iti 5. DSD SIGNATURE tCE-8801 44 .,•. f•�C , + P , `�� Approved for L _ bedrooms. It �v Disapproved. Conditional approval for bedrooms, with the following stipulations: ON -SIT E Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: !� /+ / C 1 c- �'/ / Original Certificate Date: / - G .Z 1P!• 121001 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.enchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /- 0 % 3 4 R J E SU r✓ A. WELL DATA Well type Qr bT 6 Date completed Total depth L76 4 ft. Data of test Static water level Well production If A, B, or C provide PWSID # Sanitary seal ON) Yt/' Cased to 40 f ft. FROM WELL LOG I WATER SAMPLE RESULTS: Coliform oolonies/100 ml. Arsen�A. B. SEPTICIHOLDING TANK DATA ft g.p.m. S/D Nitrate 1 3 mg./I. Date of sample: 6A1/07 - Tank Type/Material S'L.o %r � / S TAE t_ Tank size -'S-o gal. Number of Compartments _.�L O/s- - Z is - 01 ParcellD: Well Log (Y)Q N0 Wires property protected (9/N) YL 1 Casing height (above ground) 1X* in. AT INSPECTION /0/11/00 1917 ft. S-.6 g.p.m. Other bacteria a oolonies/100 ml. Collected by$ & S ENGINEERING 17034 Eagle RIM Loop Rad Na 204 Eagle River. Alaska 99677 Date installed 6 / Ir Z Cleanouts O1) Yc S Foundation cleanout WN) Yt f Depression over tank (Y(513j i High water alarm (YA9 r" 0 Date of pumping 6/al /0'X Pumper N o A z y L Ate+ A P r, Pr (- C. ABSORPTION FIELD DATA Date installed B 11TH Soil rating p.d or fe/bdrm) _t Length r ;L ft. Width S- ft. J 11(4 4) v System type T.t Gravel below pipe ft. Total depth (( ft. Eff. absorption area E3 0 ft= Monitoring tube -Lt--f Depression over field N 0 Date of adequacy test 10 /r Al • o Results ESS Fail) Ol-jJ For, IV bedrooms Fluid depth in absorption field before test O in. Water added 60 � gal. New depth a �0 rin. Elapsed Time: 30 min. Final fluid depth r r 3 "in. Absorption rate >= 6 0 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) u ° r''#- K r • "'A" If yes, give date — jf Mr Gµtcrcd.a 6/}Y/01 ANA Fcrva Ta a* Art'. D. LIFT STATION Date installed Size in gallons _ 'Pump on' level at _ in. 'Pump ofr level at Datum _ ested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot Absorption field on lot /00 + Public sewer main k / a Sewer /septic service line a ,r r-�- water alarm level at in. Meets alarm b circuit requirements? On adjacent lots On adjacent lots /o0 rf- /O0 f Public sewer manhole/deanout 'VA Holding tank /`r OA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Buildingr foundation �� Property line j S Absorption field r Water main V Water service line / I r Surface water O Wells on adjacent lots 0 0 rd -- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r � Property line j/ Building foundation / 0 t' Water main Water Service line 0 r'r Surface water AV t Driveway, parkinglvehide storage Curtain drain Nsat Wells on adjacent lots /00 + 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 HAA guidelines in effeon this date. Engineer's Printed Name tC o0LRT C. Date 7f' 1 Ac Z. HAA Fee $ .3 -7,r- Date S - Date of Payment 7(1/0.2, Receipt Number o ;ta // ? (Rev. t2W) Waiver Fee $ Date of Payment Receipt Number S r} 1 1 wn Men OON5IIIUCLOo r3---a�iME�:5 4a resr e0tsw eLw. 1w 440 AMOI /�LA9t11 99703 762-6291 lo. 761-6826 y °"'�' JUDY MATTSON wlth'CITY MORTGAGE 9M+. torso 1,.e r Mw••w • rwr r tr ......._ ., ....-........... �.......... MMM M IFw M h• ✓anw•✓Y wM N✓ IM M•L py/901 M02 11 Y M �.✓( Mw•Y N M•M• M ✓YII.I M./� •,,,..• ..,M....z. «......... �w.•••r. r+ Yom w.. r r...r✓es •..t/ •v ••• .••✓ M •� Y wWwYn ✓ Yr ✓li/✓. ✓wV t� O••Ltat OtotYD//® •� O r� e„u R- .fM.Lf� „a_ s/+e n.wa:-m '� "O1' , � Y +utr 19. 1993 0[9 te7f •c+ �•n. LOT 2 b Y N 90'00.00 W 133.4' —t _ r • yO y �t��t�t�t�t�t��l �--� 33' (' • LOT 3 W s s.e _ }; cs N • :r m $ ~ TWO STORY ° HOUSE .0 X .OF A qsF m O ......................... a9m '•9 o' 0 u' 111 4 L 76 3 LS -7613 ,? r '� ••..... N.90.00'00' E 1 .♦ I • ..r•.•'Y' •'.�...r•s �r �. poatio Qy S8 S LOT 4 ; 33' sLl r«r 7 I�pz .c./® 9ir.O 1 1 wn Men OON5IIIUCLOo r3---a�iME�:5 4a resr e0tsw eLw. 1w 440 AMOI /�LA9t11 99703 762-6291 lo. 761-6826 AS—OU1t.T OF: LCfMl9LXV LOT 3. ARVESON SUBDIVISION °"'�' JUDY MATTSON wlth'CITY MORTGAGE 9M+. torso 1,.e r Mw••w • rwr r tr ......._ ., ....-........... �.......... MMM M IFw M h• ✓anw•✓Y wM N✓ IM M•L py/901 M02 11 Y M �.✓( Mw•Y N M•M• M ✓YII.I M./� •,,,..• ..,M....z. «......... �w.•••r. r+ Yom w.. r r...r✓es •..t/ •v ••• .••✓ M •� Y wWwYn ✓ Yr ✓li/✓. ✓wV t� O••Ltat OtotYD//® •� O r� e„u R- .fM.Lf� „a_ s/+e n.wa:-m '� "O1' , � Y +utr 19. 1993 0[9 te7f •c+ �•n. Municipality of Anchorage ® Department of Health and Human Services p Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel I.D. 015-27-308 HAA# Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 3, Arveson Subdivision Location (site address or directions) 11120 Jerome Street Current Property owner(s) Tim Peabody Day phone 3446990 Mailing address 11120 Jerome Street, Anchorage, AK 99516 Lending agency Mailing address Real Estate Ag Mailing Address Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Public Water System 4 -�ro/od TYPE OF WASTEWATER DISPOSAL: X1 Individual On-site ] ❑ Individual Holding Tank ❑ Well ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 sample results less than 30 days old. 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. -2-025 (Rev. 0 V001' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipa�a&nd State codes, ordinances, and regulations in effect at the time of installation. ENGINEERING 17034 Eagle River Loop Road No. 2C4 Name of Firm Eagle River, Alaska 99577 Phone 6 c7 7 — 9 -7 c/ Address Engineer's Printed Name 6. DHHS SIGNATURE Robert C. Cowan Approved for 4_ bedrooms. Disapproved. Conditional approval for Additional Comments Date a �r . 't•..RC2ERi C. CCW,,N •••t •�� u Cc -3001 i, bedrooms, with the following stipulations. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: ��� / ��o—�� Original Certificate Date Expiration Date 2025 (Rev. 01.001' — a%— v Reissue Date: /D-,2-�-0C Municipality of Anchorage • Department of Health and Human Services Division of Environmental Services ��vv On -Site Services Section 825 "L" Street Room 5028 E V E ! V E P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 OCT 2 5 2000 HEALTH AUTHORITY APPROVAL C,HECKLIXINICIPALITYOFANCHORAGE ENVIRONMENTAL SERVICES DIVISION Legal Description: Lo % -3 0Parcel I.D.: 0 l S -a 7-309 A. WELL DATA Well type f R1Va Tc Date completed u iK If A, B, or C provide PWSID # Well Log Sanitary seal YS- f Total depth / 76 f ft Cased to 'to f ft FROM WELL LOG Date of test Static water level ' ft Well production g.p.m WATER SAMPLE RESULTS: 11V Wires properly protected Y¢ -J Casing height (above ground) 9 a- f in. AT INSPECTION 10 /r 9doo 137 ft S'. G g.p.m Coliform 0 colonies/100 ml Nitrate A-11 mg/I Other bacteria O colonies/100 ml Date of sample: 10 6-0/ 00 Collected by: S & S ENGINEERING B. SEPTIC/HOLDING TANK DATA 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank Type/Material S*P Tl C .S T 6 4-L Date installed 6 q x Tank size )AS -0 gal Number of Compartments Cleanouts YCJ Foundation cleanout 'Y6J Depression over tank 'N 0 High water alarm N 0 Date of pumping or/60 Pumper wahTHL,ANO "m,4d. c C. ABSORPTION FIELD DATA 511.91-1�0 w Date installed i3 is'�WS Soil rating g.p.d./ft2 or ft2/bdrm) J - -A System type i fr-jd Length eft Width S ft Gravel below pipe ft Total depth 8 ft Effective absorption areaS-a0 ft2 Monitoring tube Yf-J Depression over field Date of adequacy test 1o199/'0o ResultsPas Fail) P4SS For bedrooms Fluid depth in absorption field before test 0 in Water added &7 gal. New depth a 10 in. Elapsed Time: d min Final fluid depth 1 3 in Absorption rate >= 6 ° 0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 110,'4- K �' 0 d If yes, give date — 72-026 (Rev. 01100)' D. LIFT STATION Date installed "Pump on" level at in E. SEPARATION DISTANCES Size in gallons "Pump o " eFat' in High water alarm level at in Cycles tested Meets alarm & circuit requirements, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot )60 -tOn adjacent lots / Absorption field on lot /00 "F On adjacent lots Public sewer main N a" Public sewer manhole/cleanout Sewer /septic service line aS �-/- Holding tank N 14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation G Property line /S Absorption field Water main NSA Water service line J0 f 4- Surface water - Drainage N /a Wells on adjacent lots yob /4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line I ( / Building foundation 10+ Water main �J 1A Water Service line I e I Surface water I o 0 /f Driveway, parking/vehicle storage__ f Curtain drain Hb -✓e ct Jowpr Wells on adjacent lots /1f o F F. COMMENTS G. ENGINEER'S CERTIFICATION 01 ��r° °sa1d �. I certify that I have determined through field inspections and ✓Jf sL✓lr.;ti review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. o" "' "' S"AM T FOURT V. 150wnN i,k- /g Engineer's Printed Name GE•$9301 Date I O a Sh o HAA Fee $ �� Waiver Fee $ /6 � Date of Payment Date of Payment Receipt Number Hra7 Receipt Number 72-026 (Rev. 01/00)' MUNICIPALITY OF ANCHORAGE • ''° DEPARTMENT OF HEALTH & HUMAN SERVICES AM Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D.# a/sZ? 308 HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions)�i—AMS �rf t�. Property owner Mailing address a_GL Day phone`, Lending agency Ckrf dKWCI�z Day phone -.---� Mailing address Agent Pd ' Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Y 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site — Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 lZ8 VOW Noes (t8/L *AGU) BZO-ZL •maom s,ioeuibue leuoisseloid eqj ui suoissiwo ao sions aoj elgisuodsaa jou si 96eaoyouy jo Al!ledioiunyq ayl -penssi si aleoillpeo a aaojaq ejep azo leue ao suoijoadsui jonpuoo jou op SHHO jo s99AoIdw3 •sjuewaainbei ejejs pue jeaapaj uppoo A4sijes ofaapio ui suoijnjijsui 6uipuel aiegl pue sawoy jo saasegoind of Asajanoo a se siyj saop SHHd ayl'eMsely jo MIS ayj ul pejelsi6aa jeout6ue leuoissajoid juepuedepui ue Aq anoge g gdea6ejed ui U8A16 suoijejuesaidej eqj uodn Aluo paseq s9jeoijijJ9O Ienoaddy Ajijoglny OUCH sanssi (SHHCD saoinaaS uewnH pue yjleaH jo juaw:pedaQ 96eaoyouy jo Aj!Iedioiuny4 eqj :suoileindils 6uimolloj eqj 14l!m 'swooapaq AW um np uos,epuy •a 1301js)yy ) E� tl �tytlr m�j°, oODo o.atl P oems O DG �®�+BDgorm 63Gm° mr 0140(0 °r° ! /x1414 J, 4LAr 41 Qy� �ZiS•��R�°�ou�oeDoaB,��,�,� sjuawwou Ieuoijippy aoj Ienoidde leuoilipuo0 panoaddesid •swooapaq Joj panoaddy 3unIVNJIS SHHO §T— algia __ �� �,,,m ,,���.,�, �� U. einleu6is s,jaau16u3 2 Sf� "7r� ��tniot . "LLo�2 x 2• •C?4 SSW PPV auoyd waif jo aweN •uoijoedsui sl14l jo ajep ayj uo loolle ui suoijgn69a pue 'seoueuipao 'sopop ejejS pue IedioiunW Ile yl!m aoumIdwoo ui si welsAs jesodsip aalumelsem jo/pue AIddns aalenn alis-uo a141'uoiloadsui pue uoile6iIsanui Aw wojl pue sol!j a6eaoyouy jo AjiIedioiunVy aql woj j peuielgo uoilewaojui eqj uo paseq jeyj Ajiaan jogpnj I •uiaaay paleoipui einlonils jo adAl pue swooapaq jo jegwnu ayl aoj alenbepe pue jeuoijounj'ejes si welsAs lesodsip jelemelsem ao/pue AIddns jalem alis-uo a14l leyl smogs uopoildde Ienoiddy Aliaoylny ylW9H siyl jo uoile61lsanui Aw jeyl ApJGA I 'moleq unnoys ejep uoilep1Ien 914110 se pue ojaaay p9xijje leas Aw Aq pollpeo sy it '9 a33NION3 A13 N01103dSNI 30 1N3W31V.LS 'S Municipality of Anchorage aL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: /km"N L_3 Parcel I.D. OIW0$ A. Well Data Well type Oki ViN�& If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) N Date completed Driller Total depth 1117 32 I Cased to > fel Casing height Sanitary seal (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump levell SEPARATION DISTANCES FROM WELL TO: Wires properly protected (Y/N) g.p.m. AT INSPECTION g�/�j MUNICIPALITY OF ANCHORAGE r ENVIRONMENTAL SERVICES DIVISION 5.5 - un 4l g AUG 2 3 1993 RECEIVED Septic/ I tank on lot ' t aV ; On adjacent lots > 15a i Absorption field on lot > I I4� ; On adjacent lots > 1�A Public sewer main li/,Q/' Public sewer manhole/cleanout A//,f— Sewer J�, — Sewer service line > e7 1 Petroleum tank 4=4VL A(14-- I SAMPLE RESULTS: Coliform 0 Nitrate 1.1(o Date of sample: 1,11& I3 Collected by: B. SEPTIC/HOLDING TANK DATA Other bacteria Date installed sol $v' Tank size 11,1%7 44941 Compartments ?/ Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) NIA -1- Alarm tested (Y/N) Date of pumping 7wLD, PumperI/r k -1A N 4/�� SEPARATION DISTANCES FROM SEPTIeA4CbD#d*'TANK TO: Well(s) on lot = 109, On adjacent lots /2� t Foundation 6' To property line /4 Absorption field 5 Water main/service line > 37, Surface water/drainage > 150 72-026 (3/93)" Front CONTINUED ON BACK PAG' j J 1v C. LIFT STATION installed Size in gallon Vent(Y/N) High water alarm level Meets MOA electrical codes (Y/N) ::;Ot� D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) level at "Pu LIFT STATION TO: On adjacent lots Surface water Date installed ���! 93 Soil rating (GPD/Ft2) System type 9t&tfow r Lengths Width Gravel thickness `� , Total depth Total absorption area SZ10 r --T— L— Cleanout present (Y/N) Depression over field (Y/N) 4 Date of adequacy test _H N 5 ' �I lnitls (pass/fail) for Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: If yes, give date ---`^ Well on lot >4(0/ On adjacent lots > /to' Property line 11 To building foundation /(—I To existing or abandoned system on lot Ir, v s-/SCAL On adjacent lots �j Cutbank /J1k Water main/service line > Surface water 150 If Driveway, parking/vehicle storage area Curtain drain 81A-' E. ENGINEER'S CERTIFICATION 1 certify that !have checked, verified, or conformed to all MOA and HAA guidelir9es in e, ff ee ate of this inspection. aq Irl n %� Irl e U Signature �J��r' �a� {,sy////j /�� /{ (� / �] r`/�� ' / �V�/iPp l.- f �..�.rJ G.r/e-J V.'� Q..0 A i1® Engineers Name -3 ® �n gMichael E. Anderson A �_r� T Date B/Zs/9-� 6� sm0 a�a� - omp A , '0 4 f-' � +• r r _ HAA Fee $W Waiver Fee $ Date of Payment 6'a3— 93 Date of Payment Receipt Number C i6_9 f7� 76. Receipt Number. 72-026 (3/93)' Back III MUNICIPALITY OF ANCHORAGE O DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 4- -74 6, 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Z Location (address or directions) (b) Property Owner�Telephone: Home Business Mailing Address 1�� $13` ° • Li�i►3�; ,+1 Qj (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone r (e) Mail the HAA to the followina address: or: Check here U, if hold for pick up. List contact person and day phone number below. I 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well( Community 13 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community O Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/881 Front 5. ENGINEERING FIRM, PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm e Telephone G � `� ' '' Address Date 6. DHHS APPROVAL / Approved for &) bedrooms by Date Approved �/K Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev 8/86) Back A EC s ALASKA EnU1R011 nTAL COnTROL RUM, InC. a Engineerinq S Enuironmental Studies April 27, 1988 Municipality of Anchorage Department of Health & Human Services 825 L Street Anchorage, Ak. 99501. Re: Lot 3, Arveson Subdivision MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION MC037; iii RECEIVED It has been brought to our attention that 'the subject lot residence is a 4 bedroom single family home instead of 3 bedrooms as our 4/18/88 application form stated. The sewage disposal system is sized for 4 bedrooms and the adequacy test performed 4/11/88 shows the system is more than adequate for the 4 bedrooms. The well is also adequate for 4 bedrooms. If you have any questions, please call. Sincerely, Alan C. Wien Engineering Technician Approved by: Leroy C. Reid Jr., PhD, PE President *",%% TA to 04* • sees•ssss/s/ss//oi .f.� Asee a ne iK6�•e•*$ `• OY C. REID, R. Il •e• CE - 2251 e• ryw A 9T • u i ,, kk prc, e:�'t�, ���►i.� 1200 lest 33rd Auenue. Suite B • Anchorage. Alaska 99503 a (907) 561-5040 S L• MUNICIPALITY OF ANCHORAGE a,7� 6� DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL �Q�gB-' [�(qQ OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date �•� ��0 i 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal. Description (include lot, block, subdivision, section, township, range) T /AA.� Q?i-j sa / Location (address or -directions) , Z to, (b) Property Owner _)(7/ //�- Telephone: Home Business Mail ing,Address (c) sLending Institution:,�A.t ��d l 'ff-V--4 Telephone Mailing Address f ��,''n c,r 9rllD3 (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followina address: or: Check here 25, if hold for pick up. List contact person and day phone number below. A s 1'a ra 2. TYPE OF RESIDENCE Single-Familyz Number of Bedrooms `3 3. WATER SUPPLY Individual Well k Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (Rev 8/86) Front 0 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, l verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or `wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. /`�" Name of Firm ec S -7►c Telephone S �Ya Address / o�.Df� dJ ��rorl J�lr-� /Yk44's Date T�P� � OJ A4°9i��4 ff *CO� 49TH �•..i.• •ee@& •.•.•i *r l Y C. REID, JR. : AT '. CE - 2253 a / Or's Seal � • ��' Ir 4 Professio�� �.� 6. DHHS APPROVAL Approved for bedrooms by L Approved _ _ Disapproved Terms of Conditional Approval Conditional CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (Rev. 8/66) Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 4TELEPHONE (907) 562-2343 5633 B Street r. = Anchorage, Alaska 99518 `"'°""'°""• Drinking Water Analysis Report for Total Coliform` Bacteria TO BE COMPLETED B(Y'WWAATEER SUPPLIER TO BE COMPLETED BY LABORATORY ❑ PUBLIC WATER SYSTEM 1. D.# L� f Analysis shows this Water SAMPLE to be: PRIVATE WATER SYSTEM V Satisfactory Name ❑ Unsatisfactory ALASKA ==i'<Vir•: , ;'. N7; �L CO Phone SERVICES ❑ Sample too long in transit; sample should ..,—evrt,: not be over 30 hours old at examination Mailing Address Anchoraigo, Alaska 99$08 to indicate reliable results. Please send new sample via special delivery mail. City State Zip Code SAMPLE DATE: Mo. Day 1 Year SAMPLE TYPE: Routine Check Sample (for routine sample with lab ref. no. ) ❑ Treated Water ❑ Special Purpose 4 Untreated Water SAMPLE Time Collected NO. LOCATIOyy Collected By 72 3 4 5 READ INSTRUCTIONS BEFORE Date Received Time Received �. Analytical Method: Membrane Filter Y " No. of colonies/100 ml. Lab Ref. No. Result" Analyst m ( I En BACTERIOLOGICAL WATER Membrane Filter: Direct Count Verification: L COLLECTING SAMPLE Final Membrane Reported By i f. TNTC = Too Numberous T6 Count OB = Other Bacteria PART t Or z f � YSIS RECORD CD Coilform/100ml B m Coilform/100mi Da_ d�d� Ti — a.m. i?.• REntAiNDER TO FOLLOW CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. " � ,°� 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 lABORATO RIES Client Sample ID:L3 ARVESON S/D PWSID ;UA Collected APR 7 88 0 11:50 Ills, Received APR 7 88 8 17.:20 lira, Pxeseru.®d with :4 deg. C ANALYSIS REPORT BY SAMPLE for Work Order # 5981 Date Report Printed: APR 11 88 0 11:18 Client Name AECS Client Acct AKECSRP P.Q.# NONE REC D Req # Ordered By : L. REID Analysis Completed :APR 8 88 3end Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)AECS Released By _.- - f f 2) r P Special Instruct: Chemlab Ref #: 9597 Lab Smpl ID: 1 Matrix: Water Allowable Parameter. Tested Result/Units Method Limits NITRATT-N ND(0.10) mg/1 EPA 353.2 10 ",ample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY L. REID. 1 Teats Performed Ser Special Instvuctions Above UA -unavailable ND- None Detected Se Sample Remafts Alcove NA- Not. hnalYwed Ll. -Leas Than, GT-Gzea%er Than qI hi MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONPT• of I -AL7H & 825 L Street - Anchorage, Alaska 99501 ENVIRONNtENTAL No i -CTION ENVIRONMENTAL ENGINEERING DIVISION MAR 2 7 Telephone 264-4720 nn REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEUR- �I�.' R DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE Lei; N If RCe c} kf MAILING ADDRESS 01-E sr &-tf LG1cY LD r 3 A11,C-5za%/ X&AD V PROPERTY RESIDENT (If different from above) PHONE 2 BUYER MAILING ADDRESS i 3. LENDING I ITUTION PHONE Ff P-5 si9Y /M6 e-0,4 ^1 MAILING ADDRESS 4. REALTOR/AGENT PHONE 2 74t MAILING ADDRESS 5. LEGAL DESCRIPTION L-67 ,4 r�Y 5vt! u v STREET LOCATION DcL Y 6. TYPE OF RESIDENCE NUMBER OF BEDROOM SINGLE FAMILY E:1 One our ❑ Other 1:1 Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ -Six 7. WATER �SUPP -'Y L T INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPP SYSTEM Ili INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED 72-010(3/78) f THIS SIDE FOR OFFICIAL USE ONL% INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE - INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE _ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY NI INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified . PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM 'El INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED P .INSTALLER E.7Sep`�ank�oI ❑Holding Tank Size: Of Tank is homemade give dimensions: SOILS RATING T EOFTANK MANUFACTURER- TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line ' Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE Y'�_ (� , _� .0m BY (Title_) LEGAL DESCRIPTION 72.010 (Rev. 3/78) J J. J GREATER ANCHORAGE AREA BOROUGH Q O Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 L E S Date Received h L 3 — Time of Inspection 0 o 0 a. Date of Inspection . REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES /--1 FOR C. Construction D. Bacterial Analysis _ 7. Sewage Disposal System: 7- ?s -Y A. Installed lcl 11 � B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line , Sewer Lines , EQ -034 (1/74) Page 1 of two pages 1. Approval requested by: Mailing Ad dress:j�,���� ����� o Phone: a"1 1 Saj 2. Property Owner: Phone: Mailing Address: 3. Legal Description: -e�-- 4. Location: 5. Type of facility to be inspected S No. of bedrooms 6. Well Data: cl---�\ A. Type B. Depth C. Construction D. Bacterial Analysis _ 7. Sewage Disposal System: 7- ?s -Y A. Installed lcl 11 � B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line , Sewer Lines , EQ -034 (1/74) Page 1 of two pages GREATER ANCHORAGE ARL,'. BOROUGH II '" Department of Environiiie:nt�al Quality ;n-'%,,••' 3330 "C" St., Anchorage, Alaska 9950 9 3 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES June 20, 1975 1. Type of Inspectioi-1: CM20 VA FICA CONV x 2. Property Owner: SIGLER,, Dennis L. & Cynthia F. Mailing Address: Day_ Phone 3. Name of Buyer: JACKSQN, Warran M. & Beth J. Mai 1 in(] Address : sox 180 SRA Day Phone 349-1729 4. Name of Lending I ti s t i t u t i o n: First National Bank_ of Anchorage. South Center Branch Mailing Address: Box 4-2090 Phone 274-1521 5. Name of Realtor or Agent: Robert S. Leggat - Tanner Magowan Mailing Address: 3766 Arctic Blvd. Pone3`l 6. Legal Description: Lot 3, Arveson Subdivision Location: NHN Jerome presently served 7. Type of Facility to be inspected: SFD No. 6drms. 4 8. Water Supply Type of Supply: Public Utility Individual x If Individual, number of d+trellings presently served If Individual, dep;:h of well 9. Sewage Dispos�.I- Sys-i;,,'m TYPO -0 System: Public Utility Individual (on-site) x If Individual, date of installation Page 2_of two pages - Re t for Approval of Individual r & Water Facilities Legal Description Comments Approved Disapproved Date Appr 1,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 File No.: 4-1 June 30, 1976 Dennis ato Cynthia Sigler ca/* Teresa Cushnie First National Boa of Alaska Smith Center Branch P.C. box 4-2090 Anchorage, Alaska "689 SUBJEC` *- Lot 3. Ar son Subdivision - Dennis. L. send Cynthia Sigler Property Dear Mr. and Mass. Sigler. - An approved sewer system was installed = the subject property In October, 1971. The installation was for a two (2) bedroom Orale family drteling. The request for a four (4) bedroom singto family dwelling cast be given at this time. Before this Deparftent can give approval. your systom must be upgraded to its present status. A permit must be obtained ttemgh this office before any upgrade is done on your system. it you have any questions regarding this matter, please ccntacat me at 274-4381., extension 137. Sincerely, EnvironMental control Meer Iii RC /lW oa: Robert Laggaat Tamer Miagowan Realty