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HomeMy WebLinkAboutFISCHER BLK 1 LT 3B2Fischer
Block 1
Lot 3B2
#015-292-24
Municipality of Anchorage
Community Development Department Page 1 of 3
On -Site Water $ Wastewater Program
4700 Elmore St. • P.O. Box 195650 Anchorage, AK 99519-8850 • http:/Avww.muni.org/onsits • (907)343-7904
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP141466 PID Number: 015-292-24 ❑ New ®Upgrade
Name: CHERYL SHELLABARGER
ABSORPTION FIELD
❑ Deep Trench ® Shallow Trench ❑ Bed ❑ Mound
❑ Other
Address:
5120 SPRUCE CREEK CIRCLE 99507
Phone: No. of Bedroome:
(907) 830-6261 3
Saff Rabng:
4 CPO/Sq. Ft.
Total Depth from anginal grade:
4.0 MAX F.
LEGAL DESCRIPTION
Depth to pipe Invert from anginal grade:
Gravel depth beneath pipe:
3.5 MAX Et,
0.5 Ft.
Subdivision: Block: Lot:
FISCHER 3B-2
owns ip: — anger — ec ion: —
F11 aaa.a shave original grade:
SEE DWG. Ft
Gravel oath:
Gravel length:1
25 F.
da Number of Ilnes between nose:
5 n.
IDistance
—
Ft.Total
SEPARATION DISTANCES
a°earytian area:amber
125 SQ. Ft
o Iranehw:
1
Dist. between tmnehw:
T° Septic Abso ption Lift Holding Public/Private
From Tank Field Station Tank Sewer ansa
Well
too'+
*85'+
100'+
—
25'+
TANK ❑ Septic ® S.T.E.P. ❑Holdin []Other
Surface water
100'+
100'+
100'+
—
Manufacturer:
GREER
capaaa,
1500 Gal.
Lot Line
5'+
*6'+
5'+
—
Material-
Number of rnmpartmente:
N/A
STEEL
2
Foundation
s'+
10'+
5'+
—
LIFT STATION
Curtain Drain
NONE KNOWN
Manufacturer. capacity:
GREER/QUANICS 1500 cal.
Remarks: *SEE #OSP141467
Pump on Mel at:
TIMER
rap o IeM ob
TIMER
High water ala. at:
46
OLD TANK DECOMMISSIONED PER UPC.
Pump Mace s Mmol:
Bectrkal Inspections performed by:
THIS IS A QUANICS AEROCELE CAT II SYSTEM
GOULDS PE51M
MOA
I
PIPE MATERIAL SCH 40
House to tank D3034 Tank to D2665
drainfield
Installer
NORTHERN EXC.
Drainfield D3034 CO/MT D3034
Inspector GEG, Ltd.
BENCH MARK (Assumed elevation)
100.00
Inspection
Dates: 1st 10/29/2014 2nd 10/29/2014
Location and Description:
3rd 10/29/2314 4th 10/30/2014
BOTTOM OF SIDING AT FCO
Community Development Department Approval
approval: Date:
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PHONE NUMBER:
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GARNESS ENGINEERING GROUP Ltd 83°-826,
PAGE NUMBER- . CNII&ENVIRONMENTALENGINEERSm w nmm n -n a,z r 3 OF 3
]01E. MOOR ROgp, S01TE 101'ANCHORAGE. PN 9950]'PMONE 90n 33]8P8'iAX (PO 3383296'WE651TE wfm.e
LEGAL DESCRIPTION:
.�� FISCHER; BLOCK 1, LOT 3B2 D�DNJ.G.
TYPE OF WORK:
PROFILE ASBUILT DAT11 /5/14
Municipality of Anchorage
Community Development Department - Development Services Division
P.O. Box 196650 - Anchorage, Alaska 99519-6650 - 4700 Elmore Road
Info and Help: (907) 343-8211
INSPECTION: Voice: (907) 343-8300 Fax (907) 249-7777
Inspection Report - Electrical
APPLICATION NO. RETROE141610
Master/Standalone Permit Permit Type: Electrical Res
Inspection #: 331767
Address of Project: 5120 SPRUCE CREEK CIR Parcel: 01529224000
Contacts
Contractor (907)868-3593 INTELLIGENT DESIGN, LLC" 13841 SAVAGE DR
Owner PISCOYA THOMAS G & SHELLABARGER CHERYL M
Inspector Comments:
—n�
Inspector:
�P pi2
t,NS—i�iL
Date:— //— !O —0-0/ �
On -Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Permit Number: OSP141466
Tax Code Number: 01529224000
Work Type: Septic Upgrade
Permit Effective Dates: October 28, 2014 to October 28, 2015
Design Engineer: GARNESS ENGINEERING GROUP LTD
Subdivision: FISCHER
Site Legal Address: FISCHER BLK 1 LT 3B2 G:2537
Owner/Address: PISCOYA THOMAS G &
SHELLABARGER CHERYL M 5120 SPRUCE CREEK CIR ANCHORAGE AK 995076824
Site Mailing Address: 5120 SPRUCE CREEK CIR, Anchorage Lot Size in Sq Ft: 11370
Total Bedrooms: 3
This permit is for the construction of:
Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
/o: 3z
a�o-o
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received
Issued By
Municipality of Anchorage
Development Services Division
On -Site Water and Wastewater Program
went
NOV� F
a
y r'
epal tment
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSP141467 COSA#: Permit#:OSP141466
PID#: 016-292-24
Legal Description: Fischer, Block 1. Lot 3132
Engineer: Garness Engineering Group
Applicant: Cheryl Shellabarger
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 8 feet.
Your request for a waiver of the required 100 feet horizontal separation from the absorption field
to the two private wells, one on the subject property and one on Fischer, Block 1, Lot 3B1 has
been approved. The approved separation distance is 85.0 feet.
This waiver approval applies to the proposed absorption field only. Any future upgrade to the
on-site wastewater disposal system will require all separation distances be met or another
approval from this department.
® The affected adjacent property owner(s) have been given a 7 day notice regarding this
waiver.
❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected
adjacent property.
❑ Adjacent properties are not affected by this waiver.
..............................................................................I
Waiver is Granted: X Waiver is not Granted:
Date: Approved b
Name of Reviewer
.............................................................................
MUNICIPALITY OF ANCHORAGE
Community De artment •
p Phone: 907-343-7904
Development Services Fax: 907- 343-7997
On -Site Water & Wastewater Program p
Mayor Dan Sullivan UBMITT ,,'
On -Site Sewer/Well Permit Application OCT 2 02014
For A Single Family Dwelling Gretchen Stutter
Parcel I.D. 015-292-24
Property owner(s) CHERYL SHELLABARGER Day phone 830-6261
Mailing address 5120 SPRUCE CREEK CIRCLE *ANCHORAGE AK 99507
Site address "51_Z0 SPRUCE CREEK CIRCLE *ANCHORAGE AK 99507
Legal description (Sub'd, Block & Lot ) FISCHER BLOCK 1 LOT 3/B2
Legal description (Township, Section & Range)
Lot Size Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR: APPLICATION IS AN: , TYPEOF DEWELLING:
all that apply) Initial
Absorption Field ® ❑ Single Family (SF)
Upgrade ® (w/wo ADU)
Septic Tank ® Duplex (D) ElRenewal ❑
Holding Tank ❑ Multiple Dwellings ❑
Privy ❑r.00T
ITT
Private Well 11�� !Water Storage ❑/ n 20a4�
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
DRAINFIELD TO 2 WELLS NORTH LOT LINE AND EXISTING DRAINFIELD Distance 85',85',8' S=
1 certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees:
Waiver Fees:
Date of Payment: 16la& 14 Date of Payment: l obm/ lc
Receipt Number: 53y-7 Receipt Number: �/
Permit No. Waiver No. [3n 5PA/A/
a4�P (Rev. 01/11)
�
GARNESS ENGINEERING GROUP, Ltd Fido....Id'�a`��
t,
CIVdL & ENVIRONMENTAL ENGINEERS
-� -
October 28, 2014
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Septic System Upgrade for Fischer; Block 1, Lot 3-132
To whom it may concern:
The existing 3 bedroom house is served by a private well and septic system. The
drainfield is in a state of failure and needs to be upgraded. We are proposing to install a
shallow trench type drainfield, and a MOA CAT II approved system consisting of a 1500
gallon STEP tank, a 650 Aerocell pod and a Quanics control panel. Both a Biocycle &
Advantex systems are approved alternatives; however, an MOA approved change -order
will be required. One testhole was excavated on the property and the proposed drainfield
is designed around the 30 foot radius of this testhole. Comments regarding the design
are below;
1. SOILS: See the attached soil log which shows the soil rlassifications, groundwater
monitoring, and the percolation test results.
2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications.
3. SURFACE WATERS: There are no surface water concerns.
4. TOPOGRAPHY: As can be seen on the attached topography drawing, the average
topography around the proposed drainfield is flat. In short there are no slope concerns.
5. WELLS TO DRAINFIELD WAIVER REQUEST: We are requesting an 85 foot waiver
be granted from the proposed drainfield to the existing wells on Lot 3-132 & Lot 3-131.
The following are mitigating factors for the justification of these waivers:
Attached is the well log for the subject property. The well depth is 267 feet. The soil
appears to be a variation of silty gravel.
The topography of the lot is such that if the proposed drainfield were to overflow, the
effluent would travel in the opposite direction of the well heads.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www,garnessengineering.com
Page 2 of 2
• Water samples results for Lot 3-B1 (8/3/05) indicated no bacteria present and 0.81
mg/L nitrate levels. Recent water samples results for Lot 3-132 (9/12/14) indicated no
bacteria present and 2.10 mg/L nitrate levels. In short, the water quality is within MOA,
state, and EPA requirements.
• We are installing a CAT it septic system which produces an effluent that is much
higher quality than standard septic tank effluent. The system will be continually
monitored, be under a maintenance contract, and be inspected as required.
6. DRAINFIELD TO LOT LINE WAIVER REQUEST: Due to site constraints, we are
requesting an 8 foot lot line waiver to the north lot line. Spruce Creek Circle borders the
north property line, in short, there are no other septic systems within 10 feet of the
proposed drainfield.
We are unaware of any adverse impacts this installation or waivers would have on
adjacent wells or septic systems. If you have any questions, please contact us at 337-
6179. Thank you for your assistance.
P.E., M.S.
3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com
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LEGAL DESCRIPTION: DRAWN BY: �♦,j� FQ')c 110 I1l(�••P
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LEGAL DESCRIPTION: DRAWN BY: �♦,j� FQ')c 110 I1l(�••P
FISCHER; BLOCK 1, LOT 3B2 D.J.G.TYPE OF P ••. 1
SITEWPLAN DATE: 09/17/2014 ,,�4 5s�**
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Ut23ftiN UKI I LNIH: GEG, Ltd. HAS A 8 PAGE SPECIFICATION / \
NUMBER OF BEDROOMS: 3 LETTER THAT PERTAINS TO THIS DESIGN. \
GALLONS PER DAY (GPD): 450 TO OBTAIN A COPY OF THE LETTER
CONTACT GEG. BY PROCEEDING FORWARD
PERCOLATION RATE<INCH \
PROPOSED APPLICATION
RATE:
ON RATE: 4.0 (CAT IQ WITH ISELLDRILLEERENGINEER.
R, CONTRACTOR AND \
MINIMUM DRAINFIELD SO.FT.: 113 FT2 PROPERTY OWNER AGREE THAT THEY N
HAVE READ THESE SPECIFICATIONS AND
DRAINFIELD DESIGN: AGREE TO ACCEPT THE TERMS AND S E P -M— —
—
MAXIMUM DEPTH OF EXCAVATION: 6.0 FT CONDITIONS OUTLINED.
WIDTH: 5 FEET AREA SCALE:
LENGTH: 25 FEET NOTE: THE CONTRACTOR 1" = 40'
M.O.A. APPROVED SAND FILTER: 2 FEET SHALL HAVE THE NORTH &
EFFECTIVE: 0.5 FF EAST LOT LINES, ALL WELL
REDUCTION FACTOR: N/A RADII, AND APPROVED WAIVER
ACTUAL SO.FT.: 125 FT' DISTANCES FLAGGED BY A
SPRUCE CREEK CIRCLE
REGISTERED LAND SURVEYOR — — —
PTI OLD CRIB TO BE FILLED AND PROPOSED 1500 GALLON
\ DECOMMISSIONED PER UPC. /.�"�� STEP TANK.
FISCHER S/D ARE EXISTING TANK TO l�X —_ —_
LOT 384, BK 1 BE DECOMMISSIONED(
PER UPC. Fs�%
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=— CIVIL & ENVIRONMENTAL ENGINEERS
3701 E. IDWR R01D, SME 101 • MCHOP , M 99507 • PHONE (907) 337-6179 FM (907) 338-3248 WEB;RE: xv .9amaeeen9 ^veno ... . ........... .....
PREPARED FOR PHONE NUMBER PAGE NUMBER. e y A. Go nes
CHERYL SHELLABARGER 830-6261 2 OF 3 ����� _ 3
LEGAL DESCRIPTION: DRAWN BY: 10110 IN:•'
FISCHER; BLOCK 1, LOT 3—B2 DJG f '••••..... •
TYPE OF WORK: DATE: ♦♦ �I%FESS\U —b
♦ SEPTIC SYSTEM DESIGN UPGRADE 10/6/14
STANDARD TANK CONFIGURATION
NOTE: FLOAT LEVELS ARE FROM BOTTOM OF PUMP. (t) IS FROM BOTTOM OF TANK.
'JANDY VALVE FLOAT IS INSTALLED ONLY ON CAT. 111 INSTALLATIONS.
"ON/OFF FLOAT ADJUSTED FOR CAT. II OR CAT. III APPLICATION.
ELECTRICAL WIRE/S ( SUPPLIED BY CONTRACTOR)
SEE INSTALLATION MANUAL FOR SPECIFICATIONS -
4" CLEANOUT
QUANICS AEROCELL CAT. 11 OR CAT. 111
QUANICS AEROCELL SYSTEM
CATEGORY 11 OR CATEGORY 111 CONFIGURATION
(3 TO 4 BEDROOM SYSTEMS)
QUANICS CUSTOM CONTROL PANEL
WITH SENSAPHONE REMOTE MONITORING
SYSTEM AND OPTIONAL JANDY VALVE
ACTUATOR SWITCH (NO LOW LEVEL
G"AN" ALARM TERMINALS) .
24" INSULATED LID
4" BY 4' WIDE RIGID
INSULATION CENTERED
OVER PIPES
QUANICS AEROCELL 650 TREATMENT MODULE
WITH INTERNAL DIVIDER WALL AND CLEANOUTS
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SUPPLIED BY GREER TANK ----------- - - ---- --
10 GAUGE. RATED FOR 10' BURIAL _ �}
GOULDS PE51 M FROM ALASKA PUMP OR
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INSULATED JANDY VALVE BASIN.
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FOR CAT. 111 3YSTEMS
NOTE: ALL PIPE IS TO BE SCHEDULE
40 PVC UNLESS NOTED OTHERWISE.
NOTE: ALL PIPING FROM S.T.E.P TANK TO
AEROCELL MODULE SHALL BE PLACED ON
SUITABLE BEDDING MATERIAL THAT IS
MECHANICALLY COMPACTED. LL LINES SHALL
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EACH PUMP CYCLE AND WILL NOT RETAIN ANY
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GROUNDWATER
DATE
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9/22/2014
13'
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9130!2014
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CIVIL& ENVIRONMENTAL ENGINEERS _.:..:::: _._ .:::-_.
•
3701 E. TUDOR ROAD. SUITE 101'ANSHOR E,AK99597-PHONE (907 33]81]9' PAX (MIP 338 SN6WES31TE: wux.gamescenglnrenng.[om
•.•.•..••..•.• ..........I
SOIL LOG - PERCOLATION TEST
•+��
CE-7953
LEGAL DESCRIPTION:
RIscHER; BLOCK 1, LOT 3132
�♦ F� , •�D/Z�/1 � :.✓��:
PERFORMED FOR: CHERYL SHELLABARGER DATE: 9/24/2014
��1,� pROFESS��P.��•
,\\\\����•�
DEPTH .-
(feel)
ORG
TEST HOLE #1
=="—=
Per •
dl000
�o�cL�SIFI TIONS
SITE PLAN
2
t�vcipORG
3G
P ML
oo°
GM CL
GC OL
q '>d�{'o°o
ON o •sadGP MHSP
�e
CH
OH
Q
SC
GP
7 0o°a
00 °
DEPTH TO P�
`,V
N
8::°;;';o°o°
V
SCALE:
0
1" = 100'
oo°
12
13
SM/ML
14
15 g.O.H.
16
17
18
PERCOLATION RATE <1 (MIN./INCH) PERC.
HOLE DIA. 6 (INCHES)
19
TEST RUN BETWEEN 6 FT. AND 7
FT.
20
A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES ■ NO
SOILS LOGGED BY: DAVID GARNESS PERCOLATION TEST PERFORMED BY:
DAVID GARNESS
COMMENTS: PERCOLATION READINGS ARE WITHIN 1/16 OF INCH.
PERFORMED BY GEG, Ltd.
I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PER OR ED IN
ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: O (qk
GROUNDWATER
DATE
DRY
9/22/2014
13'
9!2512014
12.83'
9130!2014
12.5
10!2!14
DATE
READING
CLOCK
TIME
NET TIME
(MINUTES)
WATER LEVEL
READING
NET DROP
(INCHES)
09/2512014
ABSORBED 10 GALLONS OF WATER IN LESS THAN 10 MIN
J
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SGS
SGS Ref.#
1144475001
Client Name
Garness Engineering Group, Ltd
Printed Date/time
09/17/2014 16:31
Project Name/#
Fischer; Bl, Lot3 B2
Collected Date/Time
09/12/2014 11:23
Client Sample ID
Fischer; B 1, Lot3 B2
Received Date/Time
09/12/2014 14:22
Matrix
Drinking Water
Technical Director
Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals by ICP/MS
Arsenic ND 5.00 ug/L EP200.8 C (Q0) 09/15/14 09/15/14 ACF
Waters Department
Total Nit'rate/Nitrite-N
2.10
0.100 mg/L
SM21 4500NO3-F B (<10)
09/13/14 NLL
Microbiology Laboratory
E. Coli
Negative
1 IOOmL
SM21 922313 A
09/12/14 MEV
Total Coliform
Positive
I 100ml-
SM21 9223B A
09/12/14 MEV
SGS
SGS Ref.#
1144560001
Client Name
Garness Engineering Group, Ltd
Project Name/k
Fischer B I Lot 3B2
Client Sample ID
Fischer BI Lot 3B2
Matrix
Drinking Water
Sample Remarks:
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
09/22/2014 8:34
09/17/2014 10:12
09/17/2014 11:30
Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Inst
Microbiology Laboratory
E. Coli Negative 1 IOOmL SM21 9223B
Total Coliform Negative 1 IOOmL SM21 9223B
A 09/17/14 MEV
A 09/17/14 MEV
08-12-05:16:03
fo-�4 10+
SCS ReLM
1054914001
Client Name
Gameas Engineering Group, Ltd.
ProjectName/q
FiischerLot 3B•I,Block I
CUMt Sample ID
Fischer Lot 3B-1, Block 1
platrix
Drinking Water
PWSM 0
Sample Remarks:
907 561 5301 p 2/ 4
All DatWnmes are Alaska Standard Time
printedDate/Time
08/!212005 12:58
Collected DatuTime
05/03/2005 9:40
Reeelvod Date/rime
08/03/2005 12:50
Technical Director
Stephen C. Ede
-- Allowable Pmp Analysis
Pa,nm w Ravtts POL Units MaUod CentalmrM Llmiu Date Dam talt
Waters Department
Nitmm-N 0.810
NScrobiology Laboratory
Total Coliform 0
0.100 mg/L EPA 300.0 B 0101 08/03/05 JCM
coVtOOmL SM209222B A (<-11 08/03/05 TLF
G��QGRC-'``"ER ANCHORAGE AREA BOr"JGH
�l Department of Environmental Quality
3330 C Street
Anchorage, Alaska 99503
INSPECTION REPORT ON—SITE SEWAGE DISPOSAL SYSTEM
NAMEDi11 [%1 fiStJatf P41%d 'MAILING ADDRESS IfOi 4, ` `3eb PHONE .2.214
LOCATION —SX% C_ Affil— X�/✓C1ji�-� LEGAL DESCRIPTION /07 -S(32 �, 3jr- I Pt.SLr-/b)0,S(,L
SEPTIC TANK:
DISTANCENUMBER OF
FROM WELL MANUFACTURER 5117 5411 L- MATERIAL1-751J) Ue COMPARTMENTS h
INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH " LIQUID CAPACITY GALLONS.
SEEPAGE PIT:
NUMBER OF PITS /r/,��7 DIAMETER OR WIDTH �LENGTH, DEPTH 6 —7
P
LINING MATERIAL L7: CRIB SIZE: DIAMETER IVY_ DEPTH-AL
DISTANCE FROM: WELL
TIVE
BUILDING FOUNDATION'S NEAREST LOT LINES , ABSORPTIONCAREA (WALL AREA) 3? j'� SQ. FT.
ADDITIONAL ABSORPTION
WELL:
TYPE %IUbi\J CONSTRUCTION �Gf[z.f- b DEPTH
BUILDING NEAREST NEAREST SEPTIC
FOUNDATION LOT LINE SEWER LINE TANK_
CESSPOOL OTHERSOURCES
APPROVED i/ DISAPPROVED REMA
DISTANCES: As DIAGRAM OF SYSTEM
INSTALLED BY: 0 - r
PIPE MATERIAL: 6W (iV f_, /PckV
LOT SLOPE
REMARKS: 4' qL)a /"PS
Form No. EQ -031
p I 3QiY
ouo-e� iI
Y16
Lia + A
DATE -1 Iia �� APPROVED
DISTANCE FROM:
SEEPAGE
SYSTEM-
DISTANCES:
YSTEM_
G.A.A.B.
,�. GREATER ANCHORAGE AREA BOROUGH
i 4 DEPARTMENT OF ENVIRONMENTAL QUALITY
II�1II'ry�Ye��I�(II1L��'' Y
3330 "C" STREET ANCHORAGE. ALASKA 99303
TELEPHONE 274.4361
�VVVW.e • ''
PERMIT NO.
10/ TU) COAIs r.
SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT
JFLOo✓ J PF06. i"1/ DA/rT /d 0 / E. 53,eO '3 - S6 -3b
NAME OF APPLICANT = n _ n MAILING ADDRESS PHONE
INSTALLATION LOCATION-.ShL1l LE (�/�/G e/L. �KL/ �CLt7L
LEGAL DESCRIPTION LOT
INSTALLATION OF: SEPTIC TANK pp SEEPAGE PIT •� DRAIN FIELD/ OTHER
TYPE AND SIZE OF FACILITY TO BE SERVED 3 '5,P f ����« G.in
FINANCED THROUGH TO BE INSTALLED BY 4 c -
SOIL TEST RESULTS 113171
/ 3 �/,a / NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST
S -0-W-.2
'
COMPLETION DATE ANTICIPATED �A'/ 7
P/r /'/ z /�/ x
FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE
DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION.
SEPTIC TANK SIZE�J 9- '21- TYPE • SEEPAGE AREA SIZE TYPE
MINIMUM DISTANCES, REQUIREMENTS
FOUNDATION TO SEPTIC TANK /
FOUNDATION TO SEEPAGE PIT DRAIN FIELD
SEPTIC TANK TO SEEPAGE PIT WALL
SEPTIC TANK SEEPAGE PIT/
DRAIN LD �.
TO NEAREST LOT LINE.
/i1
C/LOJVO L. .'y
/
ELL TO SEPTIC
TANK
GRAIN FIELD /��/
SEEPAGE PIT
ALSO CONSIDER AREA WELLS. O
WATER MAIN TO SEPTIC TANK
. SEEPAGE PIT
DRAIN FIELD
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 6 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.
G.A.A.B.
OR
LICENSED DESIGNER
DIAGRAM OF SYSTEM
I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28•S8 AND THAT THE ABOVE
DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. A,
DATE 7/ APPLICANT'S SIGNATURE
FORM NO. CO -019
f
(�onalzucllon' E7csE xvc ) L
"Ont test Is worth a thousand npfnlont"
0010 TUDOR ROAD. ANCNORAO[. ALASKA 00007 a TtLI•"a"S 713.0472
Performed For Eldon Pedderson Date Performed 4-11-_7.4
Legal Description: Lot„.�JLBlock-_Subdivision ELSA
•` This Form Renorts Soils Log yes Percolation Test______
Denth
Feet Soil Characteristics
•Medium 3 ze•Coarse Gravel,.Graded
i 'GW -GP (e5)
Aln
�\ v
�Gravely'f)ilty ::and, graded 5M(2y0)
10 Coarse Gravel, graded GW -GP
Bottom of Test. Pit 9 minus 12 ft..
Was Ground Water Encountered? no
If Yes, At what Depth?
Reading Date Gross Time Net Time Depth to H2O Net Or
Percolation Rate tlinute
Proposed Instatetion: •Seenaae Pit ves Drain Field
Deoth of Inlet Depth Yo Bottom Of Pit Or Trench
VNIIENTS: 110 sq. ft. drainago area required per bedroom minus 2 ft. to -67 Pt
No bedrock or water tablo to minus 12 Pt.,
'Test Performed By Jim Mack Data Certified By:Construction Testl
Lau tanager Date: -11-74
omm�.
�MENEM
�'IVER
WHO
�1
ONE
sole
N�
Reading Date Gross Time Net Time Depth to H2O Net Or
Percolation Rate tlinute
Proposed Instatetion: •Seenaae Pit ves Drain Field
Deoth of Inlet Depth Yo Bottom Of Pit Or Trench
VNIIENTS: 110 sq. ft. drainago area required per bedroom minus 2 ft. to -67 Pt
No bedrock or water tablo to minus 12 Pt.,
'Test Performed By Jim Mack Data Certified By:Construction Testl
Lau tanager Date: -11-74
, •
-
+' „^t Sri.: '
•
vG'r ' M -W DRILLING, ine.
P. O, Box 4.1224 • 1310C International Airport Road
• °
(907) 274-4611
,r~%•:�"
ANCHORAGE, ALASKA 99509
.' • �'
DRILLINGLOG
1 Well Owner
'•'
Nderain i rnctrue+lnp
;;
Use of WellUo�r
j
Location (address of: Township, Range, Section,
if known; ordistance
main roadr�'
Size of casin n .
g epth of Hole •( .7 feet Cased to ?67
j tt•'n•'•'� �L `r
feet
,; Lx•<.: .,L.'.
Static water levet 2/,5 fL aboJa i
( ) (below) land „
d surface. Finish of well (check one)
Screen (
); Perforated ( ,
open end x
1 .<'. ':.
.. ..,. E I•' ..
• ..�i rlk t+.,G is
Describe screen or perforation
' Well pumping test at ;"_gallons per (horst)( minute) for t h : '•} +'
h` "tn...
ours
of drawdown from static level.. _
wit . fL
Date of completion
F ' e • 7)• -
WELL LOG S.
Depth in feet from
..
ground surface
Give details of formations
penetrated, size of material,
color and hardnesi
TO lr
t;sn:!v'W`6)• :;ravnl
O f.�
-To..
Ciar
allty (:r 1
•.v�
.;«
TO a7
!
slIty'voxd
c7 TO FO.,
bilty' Ci••y<.1'
- •, ':.:,,;:, .
(7 TO 7q
tilt }, iS �r:.-4=1 rY
i ..
--L—TO-11
Ity Cr:.vvlt eal.cly-
rF TO 1�7
a llu (Ir::vsl i...
107 TO 158
c_+11 `C.rn�e� r cilt•�r: , _.._.__ ...._ _ ..
4 '
1� TO 171,
::ediu� C'ravflt clr-•n. ch.ry
:>
' 17 TO4
t::r11 Greve c
TO
'�llty Crete'r ennll to cadiun
t`
( •r.
'.✓t TO Lft
C.rnvelly rcrdeup
'e' i
TO
} ectiva "rev 2t rlirhtlI e+ed•:
noj:1 uat.r
t'+rarep botto•4-of-'
:or:::ntlon.
TQ
r
Xeynn L ..Rtberg I.j
:t.:•. i
Municipality of Anchorage ,rto
On -Site Water & Wastewater Program
(907)343-7904
ILI
NO
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL .'
Parcel I.D. 015-292-24 Expiration Date: '2� Z' I
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
FISCHER; BLOCK 1, LOT 362
5120 SPRUCE CREEK CIRCLE *ANCHORAGE, AK
CHERYL SHELLABARGER Day phone 830-6261
5120 SPRUCE CREEK CIRCLE *ANCHORAGE, AK
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community ClassWell
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for. n/O Distance:
Received by: Zee Date:
COSA to be released to the engineer, unless othemise requested by the engineer.
COSA Fee $/(�S . 5d
Waiver Fee $
Date of Payment / ! !rQ �IY
Date of Payment
Receipt Number
Receipt Number
COSA # LJS
Waiver #
11iZI�ry
oV375G
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test and separation
distances measured to readily identifiable features. The operational life 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, CTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
X System #1 Approved for '-2)— bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following
Phone 337-6179
Date ((I r 7 7
OF
ON-SITE
iATER AND
By' Original Certificate Date: ZY /
The Municipality orAnchp age Develop, emt 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 engineerreg,'stered in the State of Alaska.
The MunicipalityofAnchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory
Arsenic Advisory
Well Flow Advisory Other
1p.v llnM
If more than I septic system is on the lot:
COSA Checklist # of
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: FISCHER; BLOCK 1, LOT 3B2 ParcellD: 015-292-24
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES
Date completed 9/6/1974 Sanitary seal (YIN) YES Wires properly protected (YIN) YES
Total depth 267 ft. Cased to 267 ft. Casing height (above ground) 12+ in.
FROM WELL LOG
Date of test 9/6/1974
Static water level
Well production —
WATER SAMPLE RESULTS:
AT INSPECTION
9/12/2014
237 ft.
5.2+ g.p.m.
Coliform 0 colonies/100 ml. Nitrate 2.10 mg./L. Collected by: GEG. Ltd.
Arsenic: ND ug./L. Dateofsample: 9/17/2014
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 10/29-30/2014
Tank size 1500 gal. Number of Compartments E Cleanouts (YIN) YES
Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) YES
Date of pumping NEW Pumper —
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 10/29-10/30/2014 Soil rating .p.d./ft r ft2/bdrm) 4_0 System type SHALLOW TRENCH
Length 25 ft. Width 5 ft. Gravel below pipe 0.5 ft.
Total depth *4.7 ft. Eff. absorption area 125 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test NEW Results (Pass/Fail) PASS For E bedrooms
Fluid depth in absorption field before test = in. Water added =gal. New depth =in.
Elapsed Time: = min. Final fluid depth= in. Absorption rate >= 450+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date —
D. LIFT STATION
Date installed 10/29-30/2014 Size in gallons 1500 Manhole/Access (YIN) YES
"Pump on" level at TIMER in. "Pump ofP level at TIMER in. High water alarm level at 46 in.
Datum BOTTOM OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankAift station on lot
100'+
Property line 5'+
Absorption field on lot
*85'+
Public sewer main -
N/A
N/A
Sewer /septic service line
25'+
Animal containment areas **50'+
On adjacent lots 100'+
On adjacent lots
Public sewer manhole%leanout N/A
Holding tank
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
5'+
Property line 5'+
ASsorption field
5'+
Water main
N/A
Water service line 101+
Surface water
1004
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line *8'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1'+
Curtain drain NONE KNOWN Wells on adjacent lots *85'+
F. COMMENTS
*SEE WR#OSP141467 **SEE AS -BUILT SURVEY; TWO SMALL DOG RUNS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSH guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date 1111111
(Rev. 11/05)
...................
p J f rA. Garn ss,
CE—
m
NOTE :
NO _4SE&ENTS Ar ,% ON TlIS
LOT ON THE RECORD PLAT 70- 170.
PROPERTY BOUNDARY IS COMPUTED FROM
THE MONUMENTAION ALONG THE SOUTH
AND EAST SUBDIVISION LINES.
000ppppO� �
`4c-aT—H
VAA%y� 'SHANE A. HOLT
QO eA .. LS -E91.4 �?O
V K Jz
SPRUCE CREEK
CIRC,-' E
O
O
SINGLE FAM/LY
FRAME HOUSE
DSCX
-- i
a lr!
L
N 89 53'45" W 135.14
7 n5 N 84 53' 10" E 6.70
i'
onr«
z
survey orsered by:
AS V
-BUILT SU2VEY = ZOO VALESA L MEAN @
NO CORNERS SET THIS KELLER WILLIAB5
A I
DATE NOVEMBER IA. 2014
V `3 I TY 141VC'I VCJC
_l __
I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
___
OF THE FOLLOWING DESCRIBED PROPERTY
I
LOT 3 6 2, BLOCK 1, FISCHER SUB.
THE INFORMATION HEREONIS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY
CONFLICTS BETWEEENEXISTING STRUCTURES AND PLATTED LOT LINES ANDIOR EASEMENTS; AND IS
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR PENCELINES.
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
EASEMENTS OF RECORD, OTHER THAN TH05E APPEARING ON THE RECORD PLAT, ARE NOT SHOWN
THE PROPERTY LINES AND NO VISIBLE ENCROACH"ENTS
HEREON C UNLESS INDICATED)
EXIST OTHER THAN NOTED.
NOTE: PENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO OETERMNE
DATED AT ANCHORAGE,ALASKA THIS _15TH_ DAY OF
PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS.
_NOVEMBER , 2014.
ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO MESSIVE SNOW AND/OR ICE.
HOLT LAND SURVEYING
600 HIGHVIEW DRIVE
ANCHMAGEAK 99515
ADVANCED WASTEWATER TREATMENT SYSTEM
MAINTENANCE AND REPAIR AGREEMENT
BETWEEN MUNICIPALITY OF ANCHORAGE
THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this
0— Day of of 20j_t/by and between
herein the "OWNER," and the Municipality of Anchorage, herein the
"MUNICIPALITY." In consideration of the mutual covenants contained herein, the
parties to this Maintenance and Repair Agreement agree as follows:
1. Advanced Wastewater Treatment Systems. Municipality grants permission to
Owner to utilize and operate an Advanced Wastewater Treatment System
(AW WTS), described as
located at (legal description).
`F66)01( 1552- 6
2. Definitions.
Alteration. Any change to the design or function of an AWWTS that
includes the installation or removal of any parts, components or pieces not
included in the original construction permit and design.
Certificate of On -Site Systems Approval (COSA). An approval by the
Municipality of existing water and wastewater disposal systems given at
the time of property sale and title transfer in accordance with Anchorage
Municipal Code (hereinafter, "AMC') 15.65. These approvals certify that
the systems are adequate for the homes that they support and meet the
codes that were in place at the time of system construction.
Damage. Any man-made or natural change in a system that would inhibit
the system from performing as designed.
Maintenance and Repair. The scheduled and as needed replacement of
existing parts, components and pieces of an AWWTS that were included
in the original design which would allow the AWWTS to continue to
perform as designed.
Permit. An On -Site Wastewater Disposal Permit as required by AMC
15.65 to construct and operate an AWWTS.
3. Term. The term of this Maintenance and Repair Agreement shall begin on the
date of approval by the Municipality to operate the installed system or issuance of a
COSA, and shall continue while the AWWTS is in use or is operational or until the
property is sold or title is transferred by the owner and a new COSA is issued to the
new owner or transferee of the property.
4. Alterations, Installation and Removal of Additional Equipment. Prior to
performing any alterations to an AWWTS, the owner agrees to obtain an On-site
Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65.
5. Maintenance and Repairs.
A. Throughout the term of this Maintenance and Repair Agreement, the Owner shall
maintain their AWWTS in a satisfactory condition capable of producing treated
septic effluent in accordance with the equipment's approval for operation in the
Municipality. The owner shall enter into a service agreement with an AWWTS
service and maintenance provider annroved by the municipality and the
manufacturer of the AWWTS for the entire term of the AWWTS. In addition, it
shall be the responsibility of the Owner during the term of this Maintenance and
Repair Agreement, and any renewals thereof, at the owner's sole expense, to pay
for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement
costs, and (5) inspection costs.
B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules
and orders for the AWWTS.
C. Upon request by the Municipality, the owner agrees to provide the Municipality a
written schedule of routine maintenance and repairs which have been performed
on the system. When a record of maintenance is documented and maintained by
the system vendor, the owner agrees to allow the Municipality access to this
information.
D. Owner acknowledges that the fine for failing to maintain and repair an AWWTS
may be assessed in accordance with AMC 14.60 for improper discharge.
E. Owner agrees that only maintenance and repair personnel approved by the
Municipality will inspect and make any necessary maintenance, repairs or
permitted alterations to the system.
F. Owner agrees to grant the Municipality reasonable access to test and inspect the
AWWTS upon 24 hours written notice.
G. Owner agrees that any sale or transfer of title of the property will not occur
without a new Certificate of On -Site Systems Approval.
H. Owner agrees that the AW WTS installation and maintenance requirements as
provided by the AWWTS vendor/installer and approved by the Municipality are
the governing guidelines for the construction, maintenance and repair of the
Owner's AW WTS.
6. Nonwaiver. The failure of either party at any time to enforce a provision of this
Maintenance and Repair Agreement shall in no way constitute a waiver of the
provisions, nor in any way affect the validity of the Maintenance and Repair
Agreement or any part hereof, or the right of such party thereafter to enforce each and
every provision hereof
7. Amendment.
A. This Maintenance and Repair Agreement shall only be amended, modified or
changed by a writing, executed by authorized representatives of the parties, with
the same formality that this Maintenance and Repair Agreement was executed
with, and such writing shall be attached to this Maintenance and Repair
Agreement as an amendment.
B. For the purposes of any amendment modification or change to the terms and
conditions of this agreement, the only authorized representatives of the parties
are:
a. Owner:
b. Municipality: Director, Community Development or designated authority
C. Any attempt to amend, modify, or change this contract by either an unauthorized
representative or unauthorized means shall be void.
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
By: (signature) Date: 1?A1OJr 1!
S 1� (print name)
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
The foregoing instrument was acknowledged before me this )Ci day of NDdeM er
20& by Ak-RfAa� L • FO.L ..l tlC?px- �"VO 11111t._
n r.ym _Dam,. _� �° 1•
NOTARY PUBLIC FOR ALAS ♦ 'x
My Commission expires: - "I) ate_
n
11 UMCIPALITY:
By: (signature) Date:
(printnarne)" Title:
8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance
and Repair Agreement shall be brought in the Superior Court for the Third Judicial
District of the State of Alaska at Anchorage. The laws of the State of Alaska shall
govern the rights and obligations of the parties under this Maintenance and Repair
Agreement.
9. Severability. Any provisions of this Maintenance and Repair Agreement decreed
invalid by a court of competent jurisdiction shall not invalidate the remaining
provisions of the Maintenance and Repair Agreement.
OWNER:
By: QZ, A . -N, 41 ti (signature) Date: 1 ltIL4
i:' .r b erlu VAGI kn e,- (print name)
STATE OF ALASKA )
ss.
THIRD JUDICIAL DISTRICT )
The foregom$instrument was acknowledged before me this iR day of N91tMb ,
20 1 by 1Gm (Cl t Ili11eX ```p�NN� Ori,
NAVA
NOTARY P L FO ALASKA
My Commission expires: oZ
OC)s
MUNICIPALITY:
By: (signature)
- ))eh (print name)
Date: I J LZ --F-Z/
Title: GG
MUNICIPALITYANCHORAGE
• DEPARTMENT OFFHEALTH
&8 HUMAN SERVICES 1
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
Parcell.D.# M1 >-ac°n_Qu HAA# ��°1��LkLj1
1. GENERAL INFORMATION ' &VII
Complete legal description I OI B Chi' 14EQ Gi gp
2.
3.
4.
Location (site address or directions) 571 70 5,pmce Crank Circle-
Property
Ir I
Property owner Reeve, Dr -ac d E9/)Anra Day phone 34fo- 2742
Mailing address 4ovG
Lending agency
Day phone
Mailing address
Agent Ralph WOl rrQa. Dayphone 5GZ-io4G4
Address VISTA
Unless otherwise requested, HAA will be held for pickup.
NUMBER OF BEDROOMS:
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.
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 (Ra. 1/91) Fwl MOA 621
5.
6.
STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation of this Health Authority Approval application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and Inspection, the on-site water
supply and/or wastewater disposal system is In compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm SWA GAsulkarils Phone 34 -5 -L941 -
Address
Engineer's signature
DHHIGNATURE
Approved for
Disapproved.
bedrooms.
Date 8-3-93
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
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 tending institutions in orderto 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.
72m5(R".1/91) 11tk MOAN21
• Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST (�
Legal Description: - L302 F15CHER IIID Parcel I.D. n
A. WELL DATA x
Well type M If A, B, or C, attach ADEC letter. ADEC water system number -NA-
Log present (Y/N) Date completed �74 Driller NO Ent on � 1r- nwt
Total depth 20.1_0 Casedto-- 2%%
l 0,
Casing height- 2411
Sanitary seal (Y/N) - y Wires properly protected (Y/N) Y
Date of test
Static water levet
Well flow
Pump level
AT INSPECTI(?RNICIPALITY OF ANCHORAGE
7-l4
t IRONMENTALSERVICESDIVISION
242. AUG -_4 1993
7
fJA ECTIVED
SEPARATION DISTANCES FROM WELL TO: (015TW4CES FRM C&NN(To GO OR MT)
Septic/holding tank on lot ® 100 ; On adjacent lots 110
Absorption field on lot -- 108r. ; On adjacent lots 135
Public sewer main h)4 Public sewer manhole/cleanout NA
Sewer service line - _NA Petroleum tank "WE VI513LE
WATER SAMPLE RESULTS:
Coliform - Nitrate
Other bacteria
Date of sample: 7-13- 83 Collected by: S POLLEN
B. SEPTIC/HOLDING TANK DATA
Date installed 4--24.74 Tank size 1110135 Compartment 0-h:ar REGORPED
Cleanouta (Y/N) � Foundation cleanout (Y/N) Y Depression (Y/N) N
High water alarm (Y/N) NA Alarm tested (Y/N)- NA'
Date of pumping , %- a_93 . Pumper ' )btD - R6=R
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: ,FROM C.o. TO.C.o. In.T., 02 wru.: CAsIvG)
onlot
Well s 1—On adjacent lots Foundation
• © m t
To property line 6 Absorption Iield- 2S 'Watermain/service line NA
Surface water/drainage NDNF
72.026 (Rev. 7151) F=1 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent(Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Manufacturer
— Manhole/Access (Y/ N)
' -.'Pump off' level at
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot ' On adjacent lots
D. ABSORPTION FIELD DATA
Cycles tested
1 ,
Surface`taater
,1
O. , p (D
Date installed 4'-24.74 Soil rating I13QAdrm System type Pit
r O
Length 23 N
Width lT Gravel thickness A Total depth 8,7
Total absorption area Cleanouts present (Y/N)
N adequacy
Depression over field (Y/N) Date of test
Results (pass/fail) PA33 for 3 bedrooms
Peroxide treatment (pastil months) (Y/N) If yes, give date —NA
SEPARATION DISTANCE FROM ABSORPTION FIELD TO: (FRorn {'1•T. To waL C.As)ao op KT-.)
Well on lot �G9t © Onadjacentlots -Propertyline 4
%
To building foundation . 45 To existing or abandoned system on lot WA
Onadjacentlots Cutbank NONE Water main/service line Na
Surface water NONE Driveway, parking/vehicle storage area
Z8t
Curtain drain iJDIJE
E. ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines In effect on the date of this Inspection.
- .aQ
Signature i i t ' 449h
Engineer's Name %S r.6 `MrA=er
Date �I7604
-
D.inxEN Frtorn moe RecoRDs'..
® sc/sLco reom sur•ve.YAsawnT DA MO 3(&U&90 (, ty pkbfESStON���
-MEAsupzo w/C47rM TAPE OR CALCULATCO F90M ,
IUOIRCCT mCAsu /Y1E1(TS +�'
HAA Fee $ 0 /
�% Waiver Fee: $
Date of Payment 8 �� 93 Date of Payment
Receipt Number aJ197-9 9339 Receipt Number
72-M (Aw. 3/91) 8�k MOA 21
n
i
353
Z9
� � ni„LtL CFLEK C��cGCE �
J. E
D �O: ' �� a .�'�• / �, �/
h
1
Scor
al
14—
/047,/70
¢
we//
/04TH _ ..1uCe/ uC _ A
_./1.
M �E
OF Al,
—�. * •'40TH : ,
ASMIL
It is the responsibility of the owner to determine
the existence of any easements, covenants, or re- V
strictions which do not appear on the recorded sub-
division plat. Under no circumstances should anyNOTE
C m
data hereon be used for construction or for estab-� SHOWN ON THE RECORO.O HERT,HARE NOT
TH
lishing boundary or fence lines. The surveyor take. ON.
� HERE
responsibility for the initial transaction only. SHOWN HERE
LOT fez.
F/sc,vCF• <q,F?/)iu/-inn/ (PLAT w. )
ANCHORAGE RECORDING DISTRICT
IPREPAREO aT: MWUNG & ASSOCIATE!99501 1426 HYDER STREET
ANCHORAGE, ALASKA
—• WORK ORDER:
® M47S CAP NOMOAIEMT
0 IROM PIIS
0 REEAR PROP•COR.PMO
q Mum • TACK
GR
NORTHERN TESTING [ABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 (90714563116• FAX 4563125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907)277 -8378 -FAX 2749645
DRINKING WATER ANALYSIS REPORT FOR TOTAL COLIFORM BACTERIA
Reeve Public Water System I.D.f
5120 Spruse Creek Circle
Anchorage Ak 99516 Date Received: 07/13/93 Time Received: 16:00
Date Analyzed: 07/14/93 Time Analyzed: 16:30
Date Reported: 07/16/93 Time Reported: 14:04
Next Sample Due: 8/93
Collected by: J Pollen
Sample Type:
Routine
Method of Analysis:
Membrane Filtration
Comments:
Comments:
S - Satisfactory
U - Unsatisfactory
POS . Positive Test Result
ND - None Detected
TNTC - Too Numerous To Count (>200 Colonies)
CG - Confluent Growth
HSM - Heavy Sediment Masking, Results May
Not Be Reliable
SA - Sample Age >30 Hours But <48 Hours,
Results May Not Be Reliable
Old - Sample Age >48 Hours, Too Old For
Analysis
R - Resample Required
NT . No Test
* f Colonies/100 ml ** 0 Colonies/ml
Sample Sample Total* Fecal* Other* HPC**
Location Date Time Labf Coliform Coliform Bacteria Result Comments
--------------------------------------------------------------------------------------------
1 Bathroom Faucet 07/13/93 13:18 AB1861 0 NT 0 NT S
_ �"-J2
Susan C. Tifental
Microbiology Supervisor
M014000 FA
Reeves
Anchorage AK
Attn: -
NORTHERN TESTING LABORATORIES, INC.
3330 INDUSTRIAL AVENUE FAIRBANKS. ALASKA 99701 190714563116•FAX 4563125
2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 190712778178 • FAX 274-9605
Our Lab /:
Location/Project:
Your Sample ID:
Sample Matrix:
Comments:
Report Date: 07/16/93
Date Arrived: 07/13/93
Date Sampled: 07/13/93
Time Sampled: 1318
Collected By: JEP
* Definitions *
B - Below Regulatory Min.
H - Above Regulatory Max.
A124720 E - Estimated Value
M - Matrix Interference
Bathroom D - Lost to Dilution
Water MDL - Method Detection Limit
Lab
Number Method Parameter
A124720 EPA 353.3 Nitrate -N
S..x 'r)�o
Reported By: Susan C. T fental
Microbiology Supervisor
Unite Result * MDL
mg/1
0.6 0.1
Date Date
Prepared Analyzed
07/14/93
MUNICIPALITY OF ANCHORAGE
• Department of Health & Human Services rt
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # HAA # 01C1n, _qm",
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location (address or directions)
_512o ST:kOr t= CeE=K
(b) Property ownep +� � (4 '�r��
Telephone:(home) )`) Business �11)
. . . A
Mailing Address
(c) Lending Institution I �' Telephone _ N A
Mailing Address
(d) Real Estate Company and Agent 14P 2FAI��_
Address N
Telephone
(e) Mail the HAA to the following address: (or check here 9,1f hold for pick up.)
List contact person and day phone number below:
CALL. 'n9- gSt,7/r CO2wInl -
2. TYPE OF RESIDENCE
Single -Family Number of bedrooms 3
3. WATER SUPPLY
Individual Wellx Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rw. 7/88(
I
Page 1 of 2
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 CmA IN , AS-z)x. Telephone Z79- 6�366
Address? a , LAX ZiotOO5; Amcfl z;r—D523
Date —iI n Ic/o
;►
.... -.rte 0
y,L.•.a ; y Engineer's Seal
6. DHHS APPROVAL
Approved for ^p-�!Sedrooms by ^� /"'` L'�'r Date 7 — 26' 9 U
Approved Disapproved Conditional
Terms of Conditional Approval
"".'-'ice , Ui-e'C"�' �••t—cti-c��J � G�
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 orderto 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.
72US(R«.7/Ba)BaCk Page 2 of 2 .
MUNICIPALITY OF ANCHORAGE (MOA)
Health Authority Approval (HAA)
CHECKLIST - FEBRUARY 1984
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISIC
I U L 17 1990
343-4744 RECEIVED
Legal Description: 13ISiocI;
F%SU VPL_ S)t31?
A. WELL DATA
Well Classification If A. B. C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) 4__ Date Completed 114 Yield — 5 Q t A
Total Depth21¢-V Cased to 2L'71 Depth of Grouting
I
Static Water Level Zia Pump Set At �A
Casing Height Above Ground 21 Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 100, :On Adjoining Lots I Opt
To Nearest Edge of Absorption Field on Lot 100 y ; On Adjoining Lots 100"t-
To
00"To Nearest Public Sewer Line WIA— To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot '
Water Sample Collected by�ti1111=1XF. ;Date �� �3�go
It
I
B. SEPTIC/HOLDING TANK DATA
Date Installed .4174 11 Size 100Q�a_� No. of Compartments N I a
Standpipes (Y/N) Air -tight Caps (Y/N) _Foundation Cl anout (Y/N)
Depression over Tank (Y/N) Date Last Pumped 9n
Pumping/Maintenance Contact on File (Y�/1N ; for �� ��
Holding Tank High -Water Alarm (Y/N) �` Temporary Holding Tank Permit (Y/N) IACD
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: i
To Water -Supply Weil pD ' To Building Foundation Q I3►
To Property Line ��t \
��� ' To Disposal Field �6
lfi To Water Main/Service Line ` 1
r,,' 0To Stream, PondL , Lake or Major Drainage Course 1
I .
Comments
72-M(Rw. 7/W)Font Page 1 of 2
C. ABSORPTION FIELD DATA Q I �y
Soils Rating in Absorpti n Striata 113 't' Type of System Design F'I j Jit $Z�F
Date Installed A 1� -7Q 4 Length of Field 23'
Width of Field Depth of Field
Gravel Bed Thickness W I A
Square Feet of Absortion Area i�ZO A Statndpipes Present (Y/N)
Depression over Field (Y/N) Date of Last Adequacy Test —7 X3192
Results of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well oo, To Property Line
To Building Foundation 2 O%'.� To Existing or Abandoned System on
Lot It., ; On Adjoining Lots 1001+
To Water Main/Service Line To Cutback (if present) N J
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area A
Comments J�F(T2�1t1-Xl�nl �rJM P�1 O A Q�CD2JY
Date Installe Dimensions
Size in Gallons Manhole/Access (Y/N)
"Pump On" Level at "Pump Off" Level at
High Water Alarm Level at Vent (Y/N)
Tested for umping Cycles during Adequacy Test.
Meets MOA Electrical Codes (Y/N)
Comments
"Check Permitt Bedroom Ra g Against HAA Request"
I certify that I a checked, if' d, or conformed to all MOA and HAA 9#01 fneSelts�gffect on the date of this
Inspection . t^ < y i., A. ". 1. -
Signed s z9''• .f P' `.,%qPM
Company»--• Engineer's Seal
DateC)AJ
CI-Z(r x'• a +2.Cow4� wrr
MOA No.
b. CE3263 �
Receipt No. ?QQ .�3 da yo 3
Date of Payment —
�% 9U
Amount: $
Receipt No.
Waiver Fee: $
Date of Payment
72-M (R+v.7/85) Buk Page 2 of 2
r
11,
CHEMICAL & GEO
TELEPHONE
Drinking Water
LABORATORIES OF ALASKA,
5673 B Street
Anchorage, Alaska W18
lysis Report for Total Coliform Bacteria
TO BE COMPLETED BY WATER SUPPLIER
❑ PUBLIC WATER SYSTEM I.D.N
t PRIVATE WATER SYSTEM I
r ejew I nL Ass oG, { 2-79- S8 6 (o
Name Phone No.
C>, Savo �c 23o rocJB
MaillAddress
e-14
City State ` Zip Code
SAMPLE DATE: ©
Mo. Day Yes
SAMPLE TYPE:
Routine
Check Sample (for routine sample
with lab ref. no. - I ;i ❑ Treated Water
❑ Special Purpose ❑ Untreated Water
SAMPLETime Collected
N0. LOCATION Collected By .1
2
3
4
6
W4,191 40
READ INSTRUCTIONS Mad
BEFORE Valli
COLLECTING SAMPLE Final
TNTC = Too Numberous To
OB = Other Bacteria
gi.
i
TO BE COMPLETED BY LABORATORY
Analysis shows this Witer SAMPLE to be:
Satisfactory
CI Unsatisfactory
❑ Sample too long In trLnslt; sample should
not be over 30 hour�old at examination
to Indicate reliable results. Please send
new sample via special delivery mall.
Date Received 7x13—`16
Time Received 12�
Analytical, Method: Membrane Filter
No. of colonies/100'ml.
Lab Ref. No. Results Analyst
902424
I
U
U
U
S BACTERIOLOGICAL WATER ANALYSIS RECdRD
p oEc
ri s Filter. Dlrsct Count 1PqR 0,1K Colllorm/t00m1
•.a on: LTB_ Oq 808
t"brons Filter Results Cofuonn/100mt
If By �.�ra�}Dote
Time: A.M.
r. ►�i1111tiYJl ,I'OLr�o.4�'.y 'tip
9T!CT
r'
CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC.
••^•• ^�•• 5633 B STREET a ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562.2343
FEDERAL TAX I.D. #92.0040440
I
IKILISIS REPORT IT SIMPLE for Mark Order 1 2S182
Date Report Printed: JUL 18 90 4 10:25
Client Sample IMS 12 ►LOCK 1 PISCal Client Naso : CORMIN i ASSOC.
PNSID sOl Client lest : CORWIN?
Collected JOL 11 90 1 12:2S hu. P.0.1 NONE RECEIVED
Reeeired In 13 90 1 12:45 hre. Req 1
Preasated with s13 REQUIRED Meted 11 t IRUCL CORRIN
In.lyele Completed :JUL 11 90 Sad Reports to:
Laboratory Supertieot :STLPLtN C. LDLReleased By : 1)CORMIK i 1SSOC.
................. ......-----................................................... _.......................
sp.e1.1
Instruct:
Chenlab Ref 1: 902424 Lab Sopl ID: 1 liattli: NITER
far amtor Tested Iseult Units t Method
-------------- __________________________________________________________________________
NITRATE•N KD(0.10)
sT/1 LPl 051.2
v�[ (� g0 '0
Sample ROUTINE SI)(PLt. SIMPLI COLLICTLD 11 SIC.
Remarks:
lllowable
Limits
10
......................................... ................. .......... ...................... ....................
1 Iests Perforerd See Special Instruction loot+ UA-Unanllable
ND- Nom Detaeted •' See Sample Remarks lbote
Il. Kot lnalysed LT-Lers Than, CT-0reater Then
MA Pe
r0lEiIIIIIIIIIIII
8. LEGAL D IPTION
F ANCHORAGE
MUNICIPALITY OF ANCHORAGE E T. O,- I -AL; : w
' DEPARTMENT OF HEALTH A ENVIRONMENTAL PROTECTION Eh;pIRON:.';NT:;L i... XTION
�sC
825 L Stmt • Anchorpe, Alaska 9880/
ENVIRONMENTAL ENGINEERING DIVISION APR 12 19?9
Telephone 264.4720
REQUEST FOR APPROVAL OF INDIVIDUAL �F E�ED
lam/ QJ
WATER AND SEWER
DIRECTIONS: Complete all parts on page 1. Ineompleq requests will not M prooswd. Plaine allow ten (10) love %P pmmairo
1. PRO TY OWNER
❑ One ❑ Four ❑ Other
PHO E
�)
❑ MULTIPLE FAMILY
03 Three ❑ Six
MAI ING DDR SS /
CM INDIVIDUAL'
702
PR T ESIDE (If diffe t from ab
since June 1975. For wells drilled prior to that date, give well
�TT
depth (attach log if available.) . -
0.SEWAGE DISPOSAL SYSTEM
+IONE
MAFLIN41 ADDRESS
.
3. LENDING INSTITUTIO
If system is over two (2) years old an adequacy test is required
PHONE J
G C
c
2 _ I��O
MA LING ADDRESS
�oZ 6
l ALTOR/AOENT
rPHONE
MAI LINGA R
r0lEiIIIIIIIIIIII
8. LEGAL D IPTION
STREET L ATI N
lam/ QJ
8. TYPE OF RESIDENCE
NUMBER F BEDROOMS
SINGLE FAMILY
❑ One ❑ Four ❑ Other
Cl Two ❑ Five ;
❑ MULTIPLE FAMILY
03 Three ❑ Six
7. WATER SUPPLY
CM 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.) . -
0.SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE"
"II individual/on-site, give installation date�,
❑
If system is over two (2) years old an adequacy test is required
PUBLIC UTILITY
by this Department.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
O��v
I
THIS SIDE FOR OFFICIAL USE ONLY ) I
_ -
INSPECTION APPOINTMENTS
DATE RECEIVED
TIME
TIME
TIME
DATE
DATE
DATE
INSPECTOR
INSPECTOR
INSPECTOR
DIRECTIONS:
1. TYPE OF RESIDENCE
❑ SINGLEFAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE
❑ TWO
❑ THREE ❑ FIVE ❑ OTHER
❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON-SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATEINSTALLED
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: /000 If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL TO:
Septic Holding Tank
Absorption Area
r Line
meet Lot Line
Absorption Aree to nearest Lot Line ..
5. COMMENTS
APPROVED FOR 3_ BEDROOMS
❑ CONDITIONAL APPROVAL (letter mu accompany certificate) b
DISAPPROVED
DATE ,.
By(Title)
LEGAL DESCRIPTION
72-010 (Rev. 3178)
St'RUCE� CRCE4< CIFZC.i
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�1 '.',VAUL E. FOX
0o r'•, 3745 - S �,tn
EASEMENTS OF RECORD. OTHER THAN
THOSE SHOWN ON THE RECORDED PLAT.
ARE NOT SHOWN HEREON.
rr 11
� PK P
W
O
Zell
�. -7
AS -BUILT NO CORNERS SET THIS DATE
I hereby certify that I have performed At Mortgegee•a
inspection of the following described property "
Anchorage Recording Precinct. Alaska, and that the
Improvements situated thereon are within the property
lines and do not overlap or encroach on the property
lying adjacent thereto, that no Improvements on prop-
erty lying adjacent thereto encroach on the premises
In question and that there are no roadways, trans-
mission lines or other visible easements on said prop-
erty except as indicated hereon. -
Dated at Anchorage• Alaska -
t. Z t; ay of A r.+. r— /i 19�
✓/ ,r»
to
FIELD BOOK No.'17_
R&M CONBULTANTB. INC.
•NO.N99R9
09nwour•
sLANN9e9
SYR V9VOR9
April 27, 1979
Mr. Dave Hero
SRA Box 17185
Anchorage, Alaska
5029 CORDOVA • BOX 9087 • A"CNO.AG9. ALASKA 99502 • IN. 907-279-0441 A Tl%. 09025290
R&M No. 951110
Re: Adequacy Test on Existing Sanitary, Sewer System; Lot 3B-2, Block 1,
Fisher Subdivision, Anchorage, Alaska
Dear Mr. Hero:
Per your request of April 23, 1979, we conducted a test of the sanitary sewer
system on the above described property.
During the test the liquid level in the seepage pit was monitored as 400
gallons were removed and 1400 gallons were pumped back into the seepage pit
to the inlet level. All liquid levels were measured below the top of the
standpipe and are shown in the following table:
Initial Liquid Second
Water Third 24 -Hour Total
Reading Removed Reading
Added Reading Reading Drop
(gallons)
(gallons)
8.5' 400 9.2'
1400 6.95' 7.8' .85'
The average specific capacity is 49.7 gallons per inch based on two sets of
readings showing 47.6 and 51.8 gallons per inch. After twenty four hours the
liquid level was measured again at 7.8 feet. It had dropped .85 feet or 10.2
inches. This indicates an average effluent acceptance rate of 506.9 gallons
per day for the surrounding soils. If the 3 bedroom residence on the
property is to house 6 people, the average load on the system can be expected
to be 450 gallons per day. We can therefore conclude that the system is
disposing of effluent at an adequate rate for a 3 bedroom residence.
We appreciate this opportunity to be of service to you. Please contact us if
you have any questions regarding this letter or if we can be of additional
service to you.
Very truly yours,
R&M CONSULTANTS, INC.
Ernest R. Rahaim
Staff Geologist
ERR:GS/rm/AT&SI-B
ANCHORAGE
4.Ga7rySmith
Manager
FAIRBANKS mNUY V.L..z wAS.LLA
MUNICIPALITY OF ANCHORAGE
DEPARTMEN .OF HEALTH AND ENVIRONMENT. PROTECTION
825 L Street, Anchorage, Alaska •99501
tr/ 279-2511, ext. 224 or 225
C
Date
Date Received:
April 15,
1977
Insp
t ) yS{.h
#1: Timet/
#2: Time
#3: Time
Date _
Date
tl^-�Q•�7 (/'� �, S
Date t4_,19--7-7 c�,Z,
Insp i4k��
Insp
t ) yS{.h
Insp aoll-,
REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES
w�UAC?uc/,7AP-e t
1. Lending Institution Request: Alaska Mutual Savings Bank 0,,6,Wenirt i -
Mailing Address: Post Office Box 1120 99510 Phone: 274-3561
2. Property Owner: George Shafer Phone: _Qt/c1-3�9�1
Mailing Address: NHN Spruce Creek Circle
3.
Legal Description: :Lot 3B Fischer Subdivision
4: Single Family Residence: poq
Multiple Family Residence: ( )
Number of Bedrooms: 2
Number of Bedrooms:
5. Well System: Public/Community System: ( )
Permit #
Construction
Depth of Well
Individual Well: (x)c
Well Log on File ( )
Bacterial Analysis
6. Sewage Disposal System: On-site System (KXF Public Utility ( )
Permit # Installed Installer
Septic Tank Size
Absorption Area
Manufacturer
Soils Rate
Material
7. Distances: Well to Septic Tank to Absorption Area
to Sewer Line Nearest Lot line Absorption Area
to Nearest Lot Line
MUNICIPAUTr OF Ar.'C1t0VL2
DEPT. 0.1 ICALT.1 Zt
1 MUNICIPALITY OF ANCHORAGE [rcn::orc,+FNr.+I. r���r.r.TloN
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
2510 East Tudor Road, Anchwapa, Aloka 99504 278.2221 AP 415 19(7
REQUEST FOR APPROVAL OF RECEIVED.
INDIVIDUAL SEWER and WATER FACILITIES
1. Type of Inspection: CMRO VA FHA CONY
2. Property Owner: George Shafer
Mailing Address: NITN Spruce Creek Circle Day Phone: -- SLI &J - 3 201 S4 .
3. Name of Buyer: MERO, David E. & Jeannette S.
Mailing Address: 540 N. Hoyt Day Phone: 344-2416
4. Name of Lending Institution: Alaska Mutual Savings Bank
Mailing Address: P• 0. Box 1120 Phone: 274-3561
�. Name of Realtor or Agent: Jim Ward @ Ward Realty
Mailing Address: Phone:
6. Legal Description: Lot 3B, Fischer Subd.
Location:
7. Type of Facility to be Inspected:— Water & septic No. Bdrrns. 2
8. Water Supply
Type of Supply: Public Utility Individual 1oticr
If Individual, number of dwellings presently served
If Individual, depth of wel
9. Sewage Disposal System
Type of System: Public Utility Individual (on-site) xyv
If Individual, date of installation
72.00300)
Page .Two
Department of Realth and Environmental Protection
Request for Approval of individual Sewer and Water Facilities
,' Legal Description: Lot 3B Fischer Subdivision
Comments:
Affadavit Attached: '(')
Approved:
Disapproved:
Letter Attached: ( )
Date: ���;2 57— 2,Z
Date:
Department Worksheet:
1/ f?
110) tIL-2
I
- .' �4
i GREATER ANCHORAGE AREA BOROUGH
Department of Environmental Quality
3330 "C" Street, Anchorage, Alaska 99503 274-4561
Date Received /L/<s/7-/-
Time of Inspection
Date of Inspection
REQUEST FOR APPROVAL OF
INDIVIDUAL SEWER & WATER FACILITIES
FOR
1. Approval requested by: _I
Mailing Address:
2. Property Owner:
Phone: 3 v 6 el 3f
Phone:
Mailing Address: Z?or /1/8 X �� rlr g96-07
3. Legal Description: 36Z
4. Location:
- u
5. Type of facility to be inspected ,a4 ( ,,. No. of bedrooms
6. Well Data: v
A. Type. B. Depth
C. Construction �,,�nw D. Bacterial Analysis
7. Sewage Disposal System:
A. Installed /o% 1-74z B. Installer
C. Septic Tank: 1. Size /oro 2. Manufacturer
D. Seepage Pit: I. Absorption Area 3 a o `' / 2. Material 1aV
E. Disposal Field: Total length of lines
8. Distances:
A. Well to: Septic tank /to I , Absorption area /00 (+ Sewer Lines /o;,
Nearest lot line /O f Other contamination
B. Foundation to septic tank—,I'/, Absorption area </5
C. Absorption area to nearest lot line -
EQ -034 (1/74) Page 1 of two pages
.. —.. ... ._--.
r.�.n. _ _.._.. .._. .. .. .._.... .... ..
.. ♦. 1, _ • fes,
Qage'2 of.two pages - R�t for Approval of Individual.' zr & Water Facilities
leV '.Description
Comments �_ —
Approved .Z�4LYt4,- Disapproved Date
Approval,Valid for one year from date signed
Greater Anchorage Area Borough, Department of Environmental Quality
DIAGRAM OF SYSTEM
�r
L certity 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 Date
EQ -034 (1/74)