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T15N R1W SEC 8 LT 1
T15N RWI ECTION- 21, #051-091-01 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP230153 PID Number: 051-091-01 Dwelling: rm-1 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name PAUL & MICHELLE HOKKANEN C/ ARM SEPTIC SERIVES A ORPTION FIELD Site Address ❑ D Trench ❑ Wide Trench ❑ Bed i ound 21128 BOWERY LANE, CHUGIAK, AK Other Phone Number of Bedroo�p1s SoilRating Total !:p�original grade 907-688-9433 u 1sF FL LEGAL DESCRIPTION 3 ze zy Depth to pipe invert ^eG l depth beneath pipe Subdivision Block Lot Ft. - Fill added above oriI length Township Range Section Ft. T1 5N 1 W 8 Gravel width Beds: Number of Lines Dist a between lines SEPARATION DISTANCES Ft. _ Ft. To Septic Absorption Holding Sewer 71,16 rption area Number of trenches Dist. between t ches Tank Field Lift Station Tank Line Ftz From - _ Well 100'+ EXIST. - - 25'+ TANK ❑ Septic El S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Surfacewater 100'+ EXIST. - _ INFILTRATOR SYSTEMS 1530 Gal. Material Number of compartments Lot Line 5'+ EXIST. - - NA PLASTIC 2 Foundation 10'+ EXIST. - _ L ATION Manufacturer Capacity Remarks *NEW CO'S AND MT'S INSTALLED IN EXISTING Gal. DRAINFIELD AND LINES JETTED/CLEANED. Alarm location Ele r tailed by PIPE MATERIAL House to tank D3034 Tank to D3034 Installer drainfield ARM SEPTIC SERVICES, LLC Drainfield EXIST. Co/MTD3034 Inspector GEG CONSULTANT, JODY MAUS BENCHMARK (Assumed elevation) 100.00 ft Inspection 1m 4/14/23 2 Location and description nd 3b 4m BOTTOM OF LAP SIDING NEAR CORNER "A" ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 0oo600p�b Conditional A PProval: Date i.._`.-9s�40 pr�P. 7 0 .�14 gTH�i Septic System .�e #pr '-A._.Gonness. Q Approved (,cJ Date � Z �p�;V . �cE-7g�3 :ceoO Q ,.P Note: this approval es not include well permit requirements. �4p �'�ofesslooma #AECC884 (Rev 05102/18) P,0 0 ����� PERMIT NUMBER:p © ! l-+ PARCEL ID NUMBER: OSP231053 RECORD DRAWING 051-091-01 50' BLM R.O.W. RESERVE �e G APPROX. LOCATION OF EXISTING 1986 BED TYPE DRAINFIELD. EXACT PERIMETER IS UNKNOWN. NEW CO'S AND MTS WERE INSTALLED AND ALL LINES JETTEDICLEANED. 2" OF LIQUID DEPTH IN BOTH MTS ON 4125!202, v O Q 2 o� V EXISTING BEDROOM HOUSE •.A. GARAGE tPPROX. LOCATION OF OLD 1978 DECOMMISSIONED DRAINFIELD r INSTALLED DOUBLE CLEANOUTS EDGE OF PAVEMENT— (OBL3 & DBL4) I H� 1 'NINSTALLEDIM-1530INFILTRAIOiTWO COMPARTMENT SEPTIC TANK WITH \� MANHOLE RISERS ON BOTH INLET AND OUTLET SIDE OF TANK FOR POSSIBLE FUTURE USE AS A STEP TANK. B \ \ A I B j INSTALLED FCO 14.0 19.5 i DOUBLE DBL1 31.1 28.7 CLEANOUTS DBL2 32.1 28.8 INSTALLED (DBL1 & DBL2) MH1 35.4 31.2 FOUNDATION 1 MH2 42.9 39.3 CLEANOUT 1 DBL3 41.9 40.6 (FCO) (� DBL4 41.5 40.9 ! y�� M71 41.1 68.2 I C01 41.6 69.2 CO2 43.1 68.0 ! CO3 49.4 73.1 / MT2 50.9 74.9 1 / NOTE: PIPE LOCATIONS ARE / SHOWN PER GEG SHOTS / TAKEN WITH LEICA DISTO / S910 LASER DISTANCE / METER. SWING -TIES TO / HOUSE CORNERS WERE GENERAT IN AUTOCAD. i GRAVEL DRIVEWAY --� NOTE: PER THE CONTRACTOR, THE OLD TANK WAS DECOMMISSIONED PER UPC ENGINEERING SALES - CONSULTING 3701 E. TUDOR ROAD. SURE 101 'ANCHORAGE- ALASKA • PHONE (907) 3376179 ' WEBSITE: wna.ganwsesung'kmerkV.wm PREPARED FOR: PHONE NUMBER PAGE NUMBER- UMBERC/O C/oARM SEPTIC SERVICES 907-688-9433 2 OF 3 PROJECTR.EGAL DESCRIPTION: DRAWN BY: T15N, R1 W, SECTION 8, LOT 1 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC TANK UPGRADE 4/26/2023 w Qz J w 5 m ' BLM R.O.W. I RESERVEOF ' IR 1, ..•••..... °e .i.'z .......... ,....... ......... �Vf6y A. Games �• C-793 LICENSE a��{�� LSS,�® 0� #AECC884 ffiRA® n Ln M a -I V M N O N 00 Ln 41 m 0 0 I I ri v @ V) E_ Ul W OL O £6'0££ M„ 00,60 o00N 3NV-I A83MOB w w O co h e �<L h• 3 o s• � Zq. 0• s U� } `o 60 N1 1 a Nx ys .. k � I li \' 110 L N v k x / X £6'0££ 3.0£,60«OOs 17107 Cb N 3A&.9S38 M'o'bW78,0.9 uj j C = @ J EE ca (�Lo(Om 0.a'c W f— 0) �! � R a) 06 Q N O () 0) U) 1 I I k� v L'99 Z'£9 O m v w 0 mc "« E c a) E O 0 = - E (� Q N O > Qi sem= � 0 > LL 0 N O 0 cu WrT c 'N v m � E VVll O > c c O LO c > a m 7 a 6 0O � 3 04 >„ R = 0 T N �?�0aj N N .O O O @ V) r m m m a C c 0 Q O aj m c � °Iz c rn a 3 cU @ L G @ O @L vi a) 00 J (n c 0 U .Q hD I -i C: .c w > @ @ In rn a) o a) 3 m on O>,cm tM M a� o @ 4 0 O NO Y O E 0 y � 0 E O 2 N m E a) N O N -� )0 0 N O) QI o 3 iL., 00 ¢ vi M CO Y -Oc r-0 0 0 ` >. u + ai > M �+ — 0 @ O N Z to ,�^ c6 tlA a) U- ILW U) I- c c O p J Lvp o o �o o Uc � U .00 �> o c Ny Uw0w 0 Z rn O F N �� aai V 0 A:—@Jv �Jf @a 3 oa Ea i� v 0 j cn o a co— > m m w 'a in O Y a I✓ 00 rt c �rn ONL0 = J V) >, N LnOO a1 T, Z c u 0 0 E .�; ate, N va a) oda N�UNa m J a� O 003 u u a L O m X 0 c v a) w Q OD = c u �m 3 Fes- U- U c •`� @ no ❑ 0 aN ®� CL OAwl C. > m Aa) Q @ c ® 00 Y "Ozs 'C ®�• U) N • Z z a) UN N O. I O � QJ —) 17 • HCl w E Of U• .0W @aOEo IC 71 /N 0 H W Q Q ®�t'�� j tVij C7 cli 6 v h N 3NV-I A83MOB w w O co h e �<L h• 3 o s• � Zq. 0• s U� } `o 60 N1 1 a Nx ys .. k � I li \' 110 L N v k x / X £6'0££ 3.0£,60«OOs 17107 Cb N 3A&.9S38 M'o'bW78,0.9 uj j C = @ J EE ca (�Lo(Om 0.a'c W f— 0) �! � R a) 06 Q N O () 0) U) 1 I I k� v L'99 Z'£9 O m v w 0 mc "« E c a) E O 0 = - E (� Q N O > Qi sem= � 0 > LL 0 N O 0 cu WrT c 'N v m � E VVll O > c c O LO c > a m 7 a 6 0O � 3 04 >„ R = 0 T N �?�0aj N N .O O O @ V) r m m m a C c 0 Q O aj m c � °Iz c rn a 3 cU @ L G @ O @L vi a) 00 J (n c 0 U .Q hD I -i C: .c w > @ @ In rn a) o a) 3 m on O>,cm tM M a� o @ 4 0 O NO Y O E 0 y � 0 E O 2 N m E a) N O N -� )0 0 N O) QI o 3 iL., 00 ¢ vi M CO Y -Oc r-0 0 0 ` >. u + ai > M �+ — 0 @ O N Z to ,�^ c6 tlA a) U- ILW U) I- c c O p J Lvp o o �o o Uc � U .00 �> o c Ny Uw0w 0 Z rn O F N �� aai V 0 A:—@Jv �Jf @a 3 oa Ea i� v 0 j cn o a co— > m m w 'a in O Y a I✓ 00 rt c �rn ONL0 = J V) >, N LnOO a1 T, Z c u 0 0 E .�; ate, N va a) oda N�UNa m J a� O 003 u u a L O m X 0 c v a) w Q OD = c u �m 3 Fes- U- U c •`� @ no ❑ 0 aN ®� CL OAwl C. > m Aa) Q @ c ® 00 Y "Ozs 'C ®�• U) N • Z z a) UN N O. I O � QJ —) 17 • HCl w E Of U• .0W @aOEo IC 71 /N 0 H W Q Q ®�t'�� j tVij C7 cli 6 v Municipality ®f Anchorage — Urp:rc tment P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 o Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver-#: OSV231024 COSA#: Permit#: PI D#: 051-091-01 Legal Description: T15N R1W SEC 8 LT 1 Engineer: Garness Engineering Group Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the private well has been approved. The approved separation distance is 95.0 feet. This waiver approval applies to the existing 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. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: vlZo Z Approved by: (/ti Name of Reviewer **** VARIAN C E/WAIVER REVIEW **** GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING - -t ,, . > >. May 19, 2023 Municipality of Anchorage 9 Development Service Department • • • �$ On -Site Water & Wastewater Program �:. • •••• •... 4700 Elmore Road % e r y A. Garners •: CE -7953 Anchorage, AK 99507 Ref: Waiver Request from Well to Drainfield for TI 5N, R1 W, Section 8, Lot 1 � 2 3 To whom it may concern: GGG `? U 4:V p. The existing 3 -bedroom house is served by private water and septic system. An emergency tank upgrade has recently been performed and new cleanouts and monitoring tubes were installed in the existing 1986 bed type drainfield as part of the septic upgrade. Per the contractor, the bottom of the new monitoring tubes was set 6 -inches below the invert of the distribution lines and after the new cleanouts were installed, the distribution lines in the drainfield were jetted and cleaned on 4/20/2023. We checked the liquid level in the new monitoring tubes on 4/25/2023 and found there to be 2" of liquid depth on both MT's. Based upon these measurements, the drainfield appears to be functioning within the design effective at this time. Based upon the location of the new CO's and MT's, and that the closest CO/MT are measuring right at 100 -feet from the well, it is believed that the south side of the drainfield is encroaching upon the 100 -foot well radius for this property. As can be seen on the attached record drawing for the septic tank upgrade, it appears that the assumed drainfield perimeter is encroaching approximately 5 -feet into the 100 -foot well radius. Based upon this assumption, we are requesting a 95 -foot waiver request from the well to the drainfield. The following are mitigating factors for the justification for this waiver: The bed type drainfield was installed in June of 1986, so this encroachment has existed for almost 37 - years. Several HAA's and/or COSA's have been approved for this property (1994, 2005, & 2015). The water samples for this property have had good bacteria results and the nitrate levels have ranged from 0.10 to 0.469 mg/L. We recently pulled new water samples from this well to confirm that there are no issues with water quality. No bacteria was detected, the nitrate level was ND. No well log could be found for this property; however, according to the previous HAA's/COSA, the well is greater than 63 - feet deep and the casing depth is greater than 40 -feet. Based upon the water quality history and that the encroachment has existed for over 36 -years with no known adverse effect on the well, it is our opinion that there is minimal risk with granting this waiver. 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 MUNICIPALITY OF ANCHORAGE �l,cnr On -Site Water & Wastewater Program No s,, PO Box 196650 4700 Elmore Road .- Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 V hftp://www.muni.org/onsite Department On -Site Wastewater Disposal System Permit Permit Number: OSP231053 Effective Date: 4/7/2023 Work Type: SepticTank Upgrade Expiration Date: 4/6/2024 Tax Code Number: 05109101000 Site Legal Address: T1 5N R1 W SEC 8 LT 1 G:1357 Site Mailing Address: 21128 BOWERY LN, Chugiak Owner: HOKKANEN PAUL E & MICHELLE R Lot Size in Sq Ft: 108900 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: - Issued By: V Date: ! Date: w -7102 MUMCIPAUTY OF ANCHORAR GE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-091-01 Property owner(s) PAUL & MICHELLE HOKKANEN C/O ARM SEPTIC SERIVCES Day phone 907-688-9433 Mailing address 21128 BOWERY LANE, CHUGIAK, AK 99567 Site address 21128 BOWERY LANE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) LOT 1 Legal description (Township, Range & Section) T15N, R1 W, SECTION 8 Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) TYPE OF DWELLING: Absorption Field ❑ Initial ❑ Single Family (SF) 0 Septic Tank Q Upgrade x pg (w/wo ADU) Holding Tank ❑ Renewal El Duplex (D) El ❑ Multiple Dwellings E]Privy (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: ZZ S Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Receipt Number: Permit No. 05F 7.3 / O,j' Waiver No. G:Oevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231053, Curtis Townsend, 04/07/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231053, Curtis Townsend, 04/07/23 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231053, Curtis Townsend, 04/07/23 MUNICIPALITY OF ANCHORAGE DEl .TMEN'r OF HEALTH AND HUMAN SER\ JS i Environmentnl Heallh Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SIFWAGE DISPOSAL SYSTEM AND/OR WELl. INSPECTION RI--PORT Nd. el Bedrooms TANKS SEPTIC [] HOLDING DISTANCES '~'~'----. TE SEPTIC ADSORPTION FROM ~ TANK FIELD WELL WELL /O z¢ / /~,;, / LOT LINE '~ 3-/ S / /~o FOUNDATION ',~5- 2) 7 ~ / ,~"- q TYPE OF SYSTEM []TRENCH ~ BED [] W. DRAIN [] OTHER original grade ~,~ F'r i '~ / P'~ FT ~] ~L ET ~ / ~ ~ff~ SQ FT ~ ~ ~ ~ ' FT PRIVATE REMARKS: [] OTHER (Identify) ~unicipal guidelines in nllncl on IIIis date: 72 Olg t3/eS) FT Scale: Ir) i r ed by LP, CC'~'~vse~'~fr~ermg Servicn~ Date Eagle River, Al( 99577 . , 694-5195 __ cellily that lids inspection was pedonned aecordinfl lo all DI~!]::'AR'I"MEIxfl .,F' ,'rll:,(~ I.. il'l AND Iii:NV I F~ONMEI',ITAI I d.), L[, 1 I. ON (' ' :' ' x ", .;' - :' :::' AK 995C) ;t. cM.,. L. STREET, Alli,Iltff,AM.-~ 264 '"4'720 AI:::'I:::'I.. I I];AlXf'I" :: V I NCEI'<[ F:' ,, GARVY ADDRES!ih: SR :1. BOX ~;:'687 CHI.,IGI Al<, AK ~79567 COIxI'I"AC]' PI-.IOI~IIE: 277-9582 I..Ef"iAI_ DES[?,R I I:::' ~ SIIBD I V I S I ON ~ ~':II..,M SMAI.,I-, TRACTB SEC T I.OT S I ZE ',', 2.5A 1.0]': :1, "(Al Ibl::. ~ I:1 Ut,I.. NA c e t' '!.. i t y 1, II ,:~ t..: I fo~tll )v the Mur~ic::i.l::)al:ity cif Anchl:;)l'ag~ (Iff[IA) and the Sta'Lc<~ c:)f Alaska,, 2~. :[ ~,,~:i:l.:t. :i. rH~i'[a]], l:,l"3t~ !~i¥~i~t6)l'll :i. 1"1 iFqi::CiCii~dai'H:::E) ,~d,'i.ln ail MOA i;::(::)l:;lt~i arid &u'H:J :i.r'l [:lt:)ll¥l:t.J.,t~rlc:E, w:ith t:l"i~,? de~:k(~r'l c:r':i.'l'.er':ia i:l[ Lhis :~..:,,, :1: w:i,].l a~:t1"16~176~ 'LI] a].]. * :(~ and ~'",.: .."~'t~. of Alaska i"t~.)[lu:[pC~llli:})l't[f~i il::)l~ 'LNc(- IF: A I..IF'r S]"AT]H]N 1,:~ IIq~T'I'AL_I...I~D :t:lq AN AREA IMJVI:I,~ I) BY MOA BUII._D.I. I It'~ I_,LDI.,...)~, TIIEN (:1.) Alxl EI...ECTF/I CAI., PERMI'I'( AIqD IlxtSI:::'IECTII]N MLIi~H' 131~: OB"I¥~INED~ (2) [ ~:r-.I::/.III,TS ,~ .... , ..... / .............. , ' ~ ............ ' :":','::" ,"",, ,..,) 'rHtE WH,.I. IIL) I ¥(IE Al I fd..RI.D WI'IHOI,.IT ;Alxl I::.L~I.~IF~.I.I.AI.,. ,[ll,.f,l::.CllOI,l I~1,,.,I 0~1, AND I:::..J:::.i.,ll~.l.l,,A, WORK MUS"I" BE DONE BY A ,.I,I.,LI I,.~,D l:.l..l:::.l., II ].I..I~N,, ~ ~ i ~ DA"I'E: s :~: C~N~a:) ........ ~...~ ............... ', ........ Al I I....,[[,( N I ,,Vrlql"Flxl] F:, '.}A:{VY ~ ,.,,.d I[.D iffy DA'TIi~: ~ , ' t AGLE RI'VISR ENGINEERING SI ,RVI¢_,ES '~i~ A ~ Leu Butera P.E. ~/~~ ~ P.O. Box 773294 lffi l Eagle Riw:r, Alaska 99577 ~li~~ ~ Telephone (907) 694-.5195 .__.....----__---------------------- May 27, 1986 Mr. Steve Merris Civil Engineer, On-site S}ervices Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99619 REF: Lot 1~ T16N~ R1W~ SCl?.8 Dear Mr. Morris: The enclosed site plan is submitted for issuance of on-site septic upgrade permit for! a 3 bedroom home on the above referenced lot. The plan as shown wi~ll require approval of 6' separation distance to lot line from one eerier of the bed. This should not cause any problems as there are no !septic systems adjacent and the road right of way is 50' wide due to t~e fact; that this let borders a section line. Because of this the septi'c system is actually setback gS' from the travelled read surface. 'ghe bottom of the bsd excavation will he lined with 1~" of sand to act ~s a filter above the natural gravel seil. The installation of 'this septic system will be in accordance with current Municipal guidelines. If there are any q~estions or if' additional informatien is required please feel free to contact me at 694-5195. Sincerely, Leu Butera, P.E. Encl: soil log site plan' specifications RIVER ENGINEERING SERVICES EAGLE i P.O. BOX 773294 EAGLE RIVER, ALASKA 99577 694-6195 LEGAL: Lot A. GENERAL 1. 2. 3. 4 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM 1, See. 8, T15N, R~W, SM The drawing and or site plan shall be a part of this specification. Ail materials and workmanship shall meet the requirements of the Anchorage Department of Health and State D.E.C.. Ail soil tests are a~visory to the design and are to be verified or modifiedl in the field by the engineer. All excavations and depths are advisory and are to be verified or modified in the fie].~ by 'the contractor to meet MOA, D.E.C require- It is the responsibi%ity of the owner to obtain all necessary permits or easements and to locate any adjacent multi-family Nells. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. DRAINFIELD 1, The tank outlet shall be uncovered and a PVC 3034 sewer line between · the tank and trench Shall be laid level so that the bottom of the bed is at an elevation above 4' depth. 2, The bottom of the bed shall be level, plus or minus 1.5", 3. The total depth of the excavation is not to exceed 5', the bed ia then to be backfilled with 12" of sand, then 6" of septic gravel before the perforate~ ].each pipe is laid, This is required due 'to the high permiability of the soil, Sand may be used from the excava- tion if approved by engineer. 4. The sand layer is to be compacted by hydraulic or mechanical compaction before placing septic gravel. 5, A lift station may be required if elevation of leach pipe is below 3.5' (the elevation below ground level at the position of the monitor tube). 6, Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent !is to be placed over the bed. 7. The area over the bed is to be finish graded to prevent pending of surface water runbff. 8. The septic tank and !leachfield must not be closer than 100 feet to any existing privatel well, 150' to any Class "C" well, or 200 feet to any community EAGLE RIVE ENGINEERING SERVIUES~i IN<::. P. O, Box 773294 EAGLE RIVER, ALASKA 99577 Phone 694-5195 SHEET NO CALCULATED BY CHECKED BY OF DATE. hereby cerUfy tImt I.'ha,.'e surveyed thO.~oilowJv, .._~ I ~...~.....~..~ ...................... ~___ Anehorag6 Iteco~ding Precinct. Alaska. and 'that [rnprovemenIs si[uated thereon, ore wilhln the ~roper( line8 nnd do no[ oyerl~p or ~.neroaeh on'the~pf'opert ng n I~aee t t ere . that mt we nefits: on. pror erty I~mg adjacent thereto er~c. roaeh on the prelms indi~:a~ec ~ereon. ~OIHt;It'F C. JOHNSON' :~;' ~'~,~',~; ~" ~:; .~y~:.~ I .... .,. ?re'h, lh,,,er, .... LEGAL DESCRIPTION:__~ ~- / MUNICIPALITY OF ANCHORAGE DEPARTMENT oF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ] SOILS LOG E] PERCOLATION TEST SLOPE SITE PLAN 10 11 12 13 14 15 16 17 18 19- 20- COMMENTS CE-6736 WAS GROUND WATER S ,.NCOUNTEREO? O F YES, AT WHAT Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE <~ ~-- (minutes/inch) ,TEST RUN BETWEEN ~' FT AND ~--- FT PERFORMED BY: 72-008 (6/79) Eagle Rivgr Enolnaarlnn P.O, BOX7732~41 Eagle River, AK 99577 694~1~§ CERTIFIED BY: ~/~ DATE: J~'~ \\ ~U,~ICIPALITY OF ANCHORAG 825 L Street -iAnchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME i T#hON~ I []NEW LEGAL DESCRIPTION Well I ~ Absorption rea Dwelling PERMIT NO. Manufacturer Liq. capacity in gallons Inside length Width Liqtdd depth ~ ~ ~ DISTANCE TO: Well ; Dwelling PERMIT NO. ~ Manufacturer Material Liquid capacity in gallons ~ D'STANCETO; //7%~ :J~¢~ Trench~d~ Distance betweon lines ~ ~ ~ N°' of lines / ~ ¢ inches --~~ ~ Top of tile to finish grade~'~ I Material beneath tile ~ ¢ inches Total'effective absorption area OTHER ~EMARKS 72-013 (Rev, 3/78) i~lL.IIl~'.l .I. C: ~ F'IFtL_ [[ I""T" IOF' I~ ~' ]I~IIRFIGIE PEPRRTHENT L H~RLTH AND ENVI~ONHENTAL .0TEOT~0N ~25 "L' STREET, ANOHORA~E, ~K. 9~5~ PERMIT NO. ( VRO~2V ) BRRR~r' MOORE BOHIER ¢ LFINE LOTi 8PPLICFINT L.OCATION LEGAL P.O. BGX 9.~,88 E. R. 99.5?? 694-9073: LOT SIZE ::L08000 SQLIF~RE FEET TYPE OF SOIL FIBSORB'¥ION S%...TEM: IS: DRFIINFIELD MR?4IMLIM NUMBER OF: BEDROOMS = }~ SOIL RATING THE REQUIRED SIZE OF THE SOIL ABSORPTION St-TEM (--,L~ FT?BF.:) = 85 THE LENGTH DIMENSION IS THE'" LENGTH (IN F"EET) OF THE TRENCH OR DRRINFIELI). THE DEPTH OF FI TRENCH OR PIT IS THE DISTFINCE BETNEEN THE SURFFIOE OF- THE GROUND 8ND THE: BOTTOM OF THE EXCHVFITION (IN FEET). TME GRRVEL DEF'TH IS THE MINIMUM DEPTM OF GRRVEL BETHEEN TH[-"- OUTFFILL PIPE RND THE BOTTOFI OF THE E>(CFIVFITION (IN FEET). PERMIT RPPL. ICRNT I-IFIS THE Rk,~f-ON..IBILI"[ 'r TO INFORM TtlI_. DEF'RRTMENT DURING THE IN~IRLLFITICN INSPECTIONS OF RNY ~,.IELL~ RDJRCENT TO TMIS PROPERT'¢ FIND TME [IUMEEF,. OF' kEmIDE[,ICE.~ THRT THE NELL H~LL_,Ek':'r""',;vE. BACKFILLING OP RMY c, ~ .- _,e:,TEM NITHOUT FINRL INSPECTION RND RPPROVFIL BY THI~; DEPRRTMENT HILL BE SUBJECT TO PRO~EC:LITION. MINIMUM DISTRNCE BETHEEN FI HELL RND RNY ON-SITE SENRGE DISPOSAL SYSTEM IS :LO~I FEET' FOR R PRIVRTE HELL.~ OR ~.50 TO 20~ FEET F'ROM R PUBLIC HELL DEPENDING LIPON THE TYPE OF PUBLIC HELL. OTHER REQI, J~REMENT~ MR"r' RPPI_M, SPECIFICRTIONS FIND CONSTRUCTION DIFIGRRMS RRE RV8~L8BLE TO ~NSLIRE PROPER INS~RL. LRTION, Z CERTIFY THRT l: I RM FAI'IILD:IR WITH THE I~'.EQI..IIREHENTS FOR ON--SITE SEWERS FIND HELLS RS SET FORTFI BY THE MUN~C~PRL~TY OF RNCHORRGE. 2: ] H~LL ~NSTRLL THE S'¢STEH ~N RCCORDRNCE H~TH THE CODES. g: ~ UNDERSTRND THRT THE ON-S~TE SENER SMS'TEN MFlM REQUIRE ENLRRGEHENT ~F' THE RESIDENCE ~S REHODELED TO ~NCL.~JDE MORE THRN ~ BEDROOMS. SUSNED:_gg.; . ;r ............ O ~ E GFC MENT CO. Russe# Ovster 694-2774 Soils ~' Foundations Performed for: Legal Description: ~epth 0 z6 ,_CHNICAL ~ DEVEL Bbx 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Earl Ellis SOIL LOG Land Developr~nt Name: /FJ-~_~,Pc/_. ,//4~,o/a6- _Tel. N0. ' ~/ 9~ Mailing Address: ~'~ ~a'~ 12~ ~.~=(~,~ ~ Pg~-Y~ / 2 ~ Z/a,e Yes / No If yes, what depth_=~2 Installation: Seepage Pit_._~ Drain Field. Ground Water Encountered: Proposed Comments' _C~[~,.,- ~4M_.?.~:~,b,e_ ez~, Performed by:<_-: ~-q~- GRE' '!R ANCHORAGE AREA BO Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 JGH NAME INSPECI'ION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION LEGAL DESCRIPTION SEPTIC TANK: ~ /'~ ~ /~ ~-///~ DISTANCE I:ROM WEL. L ~"'~ ~__ MANUFACTURER ]-.~;r~.~'.~ ,.~/4,~.~/ - MATERIAL_ INSIDE LENGTH INSIDE WIDTH__ LIQUID DEPTH -- COMPARTMENTS __LIQUID CAPACITY /~'~ GALLONS. SEEPAGE PIT: NUMBER OF PITS____ LINING MATERIAL DIAMETER ] __ CRIB SI~'E: .OR WIDTH___, DIAMETER BUILDING FOUNDATION___, NEAREST LOT LrNE__ LENGTH___, DEPTH DEPTH _ DISTANCE FROM: WELL TOTAl_ EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL.: Type /~; .~'~ ~'~ BUILDING FOUNDATION __ CONSTRUCTION_d~/~ ~:~-~ ~ NEAREST NEAREST LOT LINE SEWER LINE CESSPOOL OTHER SOU RCE,S APPROVED .... DISAPPBOVED I DISTANCES: PIPE MATERIAL: _ X~S/~ LOT SI.OPE: REMARKS: Form No, EQ-031 _ DEPTH SEPTIC --, TANK DIAGRAM OF SYSTEM DISTANCE FROM: SEEPAGE SYSTEM G.mA.A.B. GREATER ANCHORAGE AREA BORC)UGH DEPAI~TMENT OF ENVIRONMENTAL. QUALITY SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT SEEPAGE PIT MA[L. INg ADDRESS , DRAIN FIELD ., OTHER TO BE ]NSTALLED ~3y (~' FINAL INSPECTION: Z4 HOUR NOTICE REQUIRED, BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHOR TY WILL BE SUBJEC:T TO PROSECUTION. j/cc SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE , DRAIN FIELD -, DRAIN FIELD WELl_ TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK CAST IRON INTO AND OUT Of SEPTIC 'rANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC 'rANK AND SEEPAGE PIT CDNFOR~ TO E~~U~~~~NSTALLATION' DAtE /~? ¢ APPLICANT'S SIgNCTU R E ,,/~_ ~ ,:,,,. ,,,. o .~.-,.,. ,, I / ^ddre~s WOOD r, gON Loca't;ion: ]]o',';ory J,nt'v) 'to'-'-'- ?,i rcb'yood 'Poi;a] r):: !-i-,-,-'-, ";,qq- O0 Pr:ice sub:icc ~: c ~:m --,- 4u,~ ' ...... i.n.~, i.?,;',? ,':n:', ' n ~l.'v!;e ri.~.l. as outlined above. ] Sigl~ature___ . • Municipality of Anchorage ° On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-091-01 Expiration Date: a j 1. GENERAL INFORMATION Complete legal description T15N R1 W Section 8, Lot 1 Location (site address) 21128 Bowery Lane Chugiak, AK 99567 Current Property owner(s) Donald Keller & Brenda Jager Day phone Mailing address 21128 Bowery Lane Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [f Individual x❑ Individual Water Storage . ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: L/ -t4 U Yl mil , /'A > Date: /0 -93 • oVy5 COSA to be released to the engineer, unless otherwise req�sted by the engineer. COSA Fee $ S?� ` Waiver Fee $ Date of Payment la /'/�/� Date of Payment Receipt Number 631 yj Receipt Number COSA # 65G S( 5-7 cs Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea] affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Phone 522-7773 Date _10/10/2015 a r.? s' 49T 6. DSD SIGNATURE s' :.• •_ ti ®...... z..:ti,p�� System #1 Approved for bedrooms 0 A MICHAf(('' ' Ki RSON . x P System #2 Approved for bedroomsS, sf CE - 4381 Disapproved Pt 0 FO ...... • E. • 18 ROFESS{O�P�� Conditional approval for bedrooms, with the following stipuhilt1a�,�a�� By:� Original Certificate Date.`v yThe Mc Anchorage Development Services Division (DSD) issues Certificates of. On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work - 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA I,be sheet ! c If more than 1 septic system is on the tot: COSA Checklist # _of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: T1 5N R1 W Section 8 Lot 1 A. WELL DATA well type Private If A, B, or C provide PWSID # ,� V11Date completed 1974 Sanitary seal (Y/N) Y Total depth >63 ft. Cased to >40 ft FROM WELL LOG Date of test Static water level Well production WATER SAMPLE RESULTS ft. aM Coliform 0 colonies/100 mL Nitrate •469 mg/L Arsenic 6.09 ug/L Date of sample: 8/7/15 B.'SEPTIC/HOLDING TANK DATA TankType/Material Septic/Steel Parcel ID: 051-091-01 Well Log (Y/N) N Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 7/21/15 48.0 ft. 3.7 g.p.m. Collected by: And. Engineering Date installed 6/12/86 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) Date of pumping 3-25-15 Pumper JRs Pumping Y Y C. ABSORPTION FIELD DATA Date installed 6/12/86 Soil rating (g.p.d./ft2 or fftdrm) 125 SF/BDRM System type Bed Length 31.5' ft. Width 18 ft. Gravel below pipe •5 ft Total depth 7 ft. Eff. absorption area 344 fe ri Date of adequacy test 7/21 /15 Results Fluid depth in absorption field before test 5 in. Elapsed Time: 1'.,440 min. Final fluid depth 5 Any rejuvenation treatment (past 12 mo.) (Y/N & type) _ Monitoring tube Y Depression over field N Pass/Fail) Pass For 3 bedrooms Water added- 645 gal. New depth 6 in. in. Absorption rate , 450 g.p d If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: >100' Manhole/Access (YIN) in. High water alarm level at Meets alarm & circuit requirements? Septic tank/lift station on lot On adjacent lots Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer /septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: r Building foundation >5'Property line > Water main >1 Or Water service line >10' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: 2'** Property line Building foundation >10' Water Service line >10' Surface water_ >100' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS ""See Lot Line Waiver. Absorption field >51 Surface water >100, Water main N/A Driveway, parking/vehiclestorage >I Or G. ENGINEER'S CERTIFICATION 4 •OF q� I certify that t have determined through field inspections and Q�� ' 9� review of Municipal records that the above systems are in s conformance with MOA COSA guidelines in effect on this date. AYM Engineer's Printed Name Michael E. Anderson, P.E. s••'•• •••• h Date 10/10/2015 �� ;MICHAEL E. ANDERSON I. CE -4S 11 COSA brown sheet 10-10-12.doc 'S Municipality of Anchorage t�•` °�. • -� Development Services Department Building Safety Division e; On -Site Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519650 www.ct.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Expiration Date: -al- D 1. GENERAL INFORMATION Complete legal description TiT.rl ��iJ 8 .tor i Location (site addressor directions) xii-y a".3..��� W �.� �f j u&dk #OZ?' I Current Property owner(s) //.J.a- ?41=4v Day phone _x;rz - ooy2 Mailing address .t/,tis' 8arav ge sv,►s�.o� AG • 94.s� 3 Lending agency Day phone. Mailing address Real Estate Agent F 5 t3 Q Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 Eagle River Engineedng Setvlm Phone Well VFW IM1.1 Suite 2011 Address Eagle River. AK 99577 Engineer's Printed Name F x�/esc Date / OS CHRISTOPHER R S. DSD SIGNATURE ' Approved for _ bedrooms. �. Disapproved. tssrow Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rw. O1102) 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.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: _T/.Ti►J AFIAt/ zy-e_ -Tr— mer i Parcel ID: OS'/- 09/ —e i A. WELL DATA Well type If A. B, or C provide PWSID # _ Date completed N_, AOhh Sanitary seal &N) _yes VIM Total depth _L& ft. Cased to t40 ft. FROM WELL LOG NcP Q6mLL 404\ Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform _ colonies/100 ml. Arsenic: A-lIA mg./I. B. SEPTIC/HGbBfff6 TANK DATA ft. 9.P.m. Nitrate 6.1 mg./I. Date of sample: is io%y Well Log (Y& evo Wires properly protected (DN) ye's Casing height (above ground) in, AT INSPECTION /9 O -V .4 ft. 9— p.m- Other bacteria _Q,_ colonies/100 ml. Collectedby: G�ir Tank Type/Material v sei<- Date installed a/i2 /!G Tank size fame gal. ; . Number of Compartments _e�_ Cleanouts C94) v6s Foundation cleanout &'N) .y.Ly Depression over lank (Y/N) Wo High water alarm (`6) Date of pumping S/Gley Pumper_J-Zs s�✓.�P��„� C. ABSORPTION FIELD DATA Date installed 4*11jrAr4aL Soil rating (g,p.d Jii: or 0bdrm) �� System type Length 31.5- ft. Width /T ft. Gravel below pipe e. ft. Total depth 1._, ft. Eff. absorption area Sep P ft2 Monitoring tubeyes Depression over field do Date of adequacy test Result Fail) For 3 bedrooms Fluid depth in absorption field before test -V in. Water added�o gal. New depth—&_ in. Elapsed Time: ,fX -M6. Final fluid depth v tin. Absorption rate >= VX14 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y4!D& type) If yes, give date N/� D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at _ in. "Pump off" I t L/' % a er alarm level at in. Cycles tested Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot !e� Absorption field on lot ivo Public sewer main � ;S' Sewer /septic service line f?S On adjacent lots f ioo' On adjacent lots t ioo Public sewer manhole/cleanout -y' ' Holding tank too SEPARATION DISTANCES FROM SEPTIC/H6t&I41G TANK ON LOT TO: Building foundation Property line5 S Absorption field f/o ' Water main two ' Water service line 7410' Surface water t rvo' Wells on adjacent lots ,"" ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line S''� Building foundation g7' Water main 10/4' Water Service line t/e' Surface water t iev ' Driveway, parking/vehicle storage +110' Curtain drain t SO' Wells on adjacent lots tr oo' F. COMMENTS :Y -14!e LTn1E �2 G 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 effect on this date. Engineer's Printed Namei'z,-, % mm .r Date 1 Zge�u t HAA Fee 5 430 .(D Waiver Fee 5 _ Date of Payment –1-2—_ J Date of Payment Receipt Number Receipt Number (Rev. 12/01) w u;:f i �Sa � .d6�j /pOLv ifG'Y�Tt.!� � 0 I o.11,47 tJc Parcel I.D. # 1. ] MUNICIPALITY OF ANCHORAGE DEPAF~TME:NT OF HEALTH & HUMAN SERVICES Division of Environmental Services , On-Site Services Section p.O. Box~.196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPRO~/AL FOR A SINGLE FAMILY DWELLING ~ENERAL INFORMATION ! Oomplete legal description i Lot 1, T~5N R1W Section 8 HAA# HA iS'oc q Location (site address or dilrections) 21128 Bowery Lane, Chugiak, AZ< Property owner .vi~ce Ga HC 78 Box 2687, Chuglak, AT( Mailing address 99567 Day phone 688-3880 Lending agency BOA / Hides Benedict Mailing address. 2100 Nc/ gverq~een Pky, Hillsboro, OR Agent N/A Address Day phone 800-685-9814 X4153 97124 Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMSi 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·,,, ". ,..~., ~ . TYPE OF WASTI-'WATER DISPOSAL: ,-, Individual o6-site x ,,. ,, .~ . Ho d ng tan '" ' · ,' Community On-site . .,.~ ' Public sewer ,,, ,/ NOTE: If commumty wastewater system, provide written confirmation from State ADEC attesting to the legality' and status of system.' 72-025 (Rev, 1/91) Front MOA 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the vali'dafion date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address EngineeCs s~gnature DHHS SIGNATURE ~< Approved for ~ bedrooms. Phone 694-5195 Date. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date _/- Mun epartment of .ealth a.d Human Se,,,ioes {DHHSl issues Health Authority "Ap~Sro,~?l,rC, ertifi~e~,.b~Sed only upon the representations g yen n paragraph 5 above by an independent pi:0fes,siOhal .e, ngin~e~: registered n the State of Alaska. The DHHS does th s as a courtesy to purchasers of homes and thei~ie'nUmg institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~25 (Rev. I~1) Bsck MOA ~21 ~ Municipality of Anchorage Departlment of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A, Well Data Well type Log present (Y/N) Total depth Sanitary seal (Y/N) · ~/~/ /('//:,2 ~E'~ (~ Parcel I.D, 05/" O<~/ -(~/ If A, B, or '~,, attach ADEC letter. ADEC water system number ./v//C- Date completed ,-',~ 7 -/ Driller ~.*,,*r..,o,-¢.¢ Cased to /-//,* ' Casing height ~"¢-'// Wires properly protected (Y/N) ~"~ ~ FROM WE LL LOG Date of test , Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holdifT~ tank on lot Absorption field on lot g.p.m, AT INSPECTION /I -/~ .-,/~ ; On adjacent lots ; On adjacent lots Public sewer main Sewer service line ,~ / WATER SAMPLE RESULTS: Coliform '~ Date of sample: Public sewer manhole/cleanout Petroleum tank Nitrate O,/0 y~(~/£ Other bacteria ~?_~ Collected by: ~,X.l¢~ i>1~ B. SEPTIC/HOI;;DING TANK DATA Date installed Cleanouts (Y/N) High water alarm (Y/N) ~ank size ./~)(~ Compartments Foundation cleanout (Y/N) /¢ Depression (Y/N) ,/t//~ Alarm tested (Y/N) Date of pumping ~ 'q- I' ; Pumper , !/~. - SEPARATION DISTANCES FROM SEISTIC/H..O~c,D:I~G TANK T9' , Well(s) on lot /¢¢ / On ~djacenti lots ¢/~ / To prope~y line .~ / '~/~ / Sudace wateddrainage Foundation AbsorCtion field Water .to,rinse rvice line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C, LIFT STATION Date installed Size in gallons Vent (Y/N) "Pump on" level at High water alarm level ~ Meets MOA electrical codes (Y/N _.N.N.N.N.N.N.N.~/ SEPARATION DIST..ANC~ FROM LIFT STATION TO: WelI, L~.lotj On adjacent lots Manufacturer p off" Level at Cycles tested Surface water Date installed Length -~/' ¢ / Total absorption area Date of adequacy test D. ABSORPTION FIELD DATA Width Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil r~ing (GPD/F¢) /~' / Gravel thickness Cleanout present (Y/N) Results (pass/fail) /)/'/5.5 System type Total depth Depression over field (Y/N) for '~ Bedrooms After test ~'-" If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot To building foundation On adjacent lots "/ Surface water Curtain drain ¢/50'/'* ¢ ~,~5_~ "C" On adjacent lots ¢-//.)0 / Properly line To existing or abandoned system on lot Cutbank /~///) Water-m~'r/service line ~/~ / I Driveway, parking/vehicle storage area ~-/{~ E. ENGINEER'S CERTIFICATION -'~:~ : 'i" ~t"~t' .... I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in,eEebtorl.th¢' d~t.~ bights inspection. Signature ~~--'~ Engineer's Name Date ,~,,,~ ~//~' HAA Fee $. ~-~f-~ Date of Payment //~..,,~,~ '--- Receipt Number ~::~"~,~/~f-'5'r~',~'j Waiver Fee $ Date of Payment Receipt Number 72-026 (3~93)* Back Mt~NICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY ! 264-4720 Application Date June GENERAL INFORMATION (a) Legal Description (include lot, block subdivision, section, township, range) LOt; ~- Sec.8 T15N R1W Location (address or directions) ~ 1986 (b) Applicant Name Vincent Gar, vy _Telephone:Home n/a Business 277-9582 Applicant Address SRI Box ]268~ Cugiak~ AK 99567 (c) Applicant is (check one): Lending Ir}stitution [-I; Owner/builder [2~; Buyer []; Other [] (explain); (d) Lending Institution Home Sav~n~s And Loan Telephone Address 100~. E Bensod, Anchorage, Alaska (e) Rea~ Estate Company and Agent ;N/A Address Telephone (f) Mail the HAA to the following address: p~ckup by apjpl~cant TYPE OF RESIDENCE Single-Family [] Multi-Family [] Other Humber of Bedrooms 3 3. WATER SUPPLY Individual Well ~F'I Community [] Public [] Note: If community well system, must hav6 written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SI-.'WAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11i84) ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEAl:ICH, 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-sitb water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type o(structure indicated herein. I furlher verify that based on the information obtained from the Municipality of Anchorage fil~s and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm L~./~LF..~I¥~I~ENGtNEERING~ERViGE6 Telephone Address EAGLE RIVER~ AK 99577 ~/,/~. P. 0. BOX 773294 [)ate 694-51.95 D.E" APP.O ( Approvad for edrooms Approved ~ Disapproved _ ConditionaJ Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon ~he representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order fo satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality oi Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA Well Classification I~,UNICIPALITY OF ANCHORAGE (MOA) I-IIEAI~.T~I~C~,c/~I'HORITY APPROVAL (HAA) ~3¢f ¢¢~E-CK-IC. ST - FIE-'BRUARY 1984 ~ ~ ~ . ~ Le al Description· ~ I b~ If A, B, C, D.E.C. Approved (Y/N) Well Log Preseat (Y/N) /¢'/o I~ate Completed /~ ?'¢/ Yield Total Depth 'z'~O '/ I ¢. / Cased to ~ /-¢'" Depth of Grouting Static Water Level /~'" xC¢/"""JT~,,,'¢ ¢"~-~.";'"F _ PumpSetAt Casing Height Above Ground /~'~ i 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 /~ / ; On Adjoining Lots ~'/~'J")" · c~ To Nearest Edge of Absorption Field ~n Lot //~ · ; On Adjoining Lots x-/~.~o / To Nearest Public Sewer Line _ -//~/~, To Nearest Public Sewer Cleanout/Manhole _ /z."/¢/--~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~.c~'j, ~ ,-¢~¢¢..~.,~'; Date __ Water Sample Test Results .~4 .,¢~..r Comments ,'..~/c-~ ./~¢J ~'/V/- SEPTIC/HOLDING 'rANK DATA Date Installed. Standpipes (Y/N) Size , /¢~ No, of Compartments __ Air. tight Caps (Y/N) _ /v, Foundation Cleanout (Y/N) _ ~ -- Depression over Tank (Y/N) '4"/ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well '/~ ~'/ / To Property Line 0¢'~) / To Water Main/Service Line ¢~, - / Course ~c/''2~2 / Comments Page 1 of 2 72 026(11/84) Date Last Pumped ; for Temporary Holding Tank Permit (Y/N) To Building Foundation ¢'~- / To Disposal Field To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~:~'~-- Date Installed /~ Z'-~ Width of Field J~ ~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well -/'~ / To Building Foundation ,~ Lot 9d/ Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Water Main/Service Line '"/¢' '/ To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots "¢"-?~ / To Cutbank (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company ~,~'~-~ MOA No. Receipt No. ,'~. ~) Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Eagle River Engineering Sap/ices P, O, ~ox 773294 Eagle Rive~ AK 99577 694-5195 Seal INSPECTION APP~31NTMENTS TIME - TIME jMUN C PAL TY OF ANCtlORAGE MUNICIPALITY OF, ANCHORAGE DEPA~T~]~TOFH~ALTH~ENV RONMENTALPROTECTION DEPT. OF HEALTII & ~ 82B L Street - Anchorage, Alaska 99501 ENVIRONMENTAL PROTEC~ ON ENV~RONMENTALSANITATIONDIVISION JUl. 81981 ; ~ Telephone 264-4720 DIRECTIDNS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. ~ PROPERTY OWNER ~ PHONE Asbu~y C. Hoo~e, ~ ~ 688-3207 SR Box 924, Chugiak, 99567 ~OPERTY RESIDENT (If different from above)~ PHONE ~ BUYER ~ PHONE Vincent F. G~vvy 694~37~]. MAILING ADDRESS P. O. 3ox 1560~ Eagle River, AK 99577 ~ L~Nm~ INST~TUTmN PHONE National Ban~ o~ Alas~,, Attn: Shevvy Stevens 265~2882 ~A[ LING ADDRESS P.O. Box 600~ Anchovag~ AK 99510 ~ REALTOR/AGENT PHONE AREA, Inc.~ Realtors, :~yvna Johnston 694-9558 MAILING ADDRESS __ Box 249~ Eagle River, :~K 99577 5. LEGAL DESCRIPTION T15N RtW SEC 8, Lot 1 STREET LOCATION Bowery Lane.~'off North!Birchwood Loop ~'. TYPE OF RESIDENCE ~ NUMBER OF~BEDROOMS i [] One [] Four [~] SINGLE FAMILY ~ [] Two [] Five [] MULTIPLE FAMILY ~ ~ Three E] Six [] O~her 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY 8. SEWAGE DISPOSAL SYSTEM )NDIVIDUAL/ON-SITE** [] PUBLIC UTI LITY * ATTACH WELL LOG. A well log is required for all wells drilled since June '1975. For wells drilled prior to that date, give well depth (attach log if available,) 8 6 ~' ~' ?) 1978 YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST/3:CCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE [~!~ SINGLE FAMILY [] MULTIPLE FAMILY 2, WATER SUPPLY ~ INDIVIDUAL E~] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISPOSAL SYSTEM NUMBEROFBEDROOMS [] ' ONE ~' [~]--"THREE [] FIVE [] TWO [] FOUR [] SIX PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER [] OTHER []INDIVIDUAL/ON -SITE E]PUBLIC UTILITY Connection Verified []Septic Tank or E:]Holding Tank DATE INSTALLED__ Size: If Tank is homemade give dimensions: TYPE OF TANK TOTAL ABSORPTION A A .,' SOl LS RATING MANUFACTURER MATI~F~IAL 4. DISTANCESwELL/: .N I.~~TO: ? 'j .=c,~?' Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS DATE 72-010 (Rev. 6/79) /~" APPROVED FOR _~ . BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) []DISAPPROVED DAVIOA, SLENKAMP ROBERTA, SRAFER Asbury C. Moore 924 Cl~u G,:i.i'~k, Alaska Dear Flr. P]oore, 9967'7 MECHANICAL ENGINEER CIVIL ENGINEER 694-9055 694-2979 July ].8, 1981 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROI'ECTION JUL 2 Z 1981 RECEIVED Reference: Lot 1; Sectidn 8; T15N; R1W: SM An adJequacy test was performed on the system located on the referenced l}roperty as you requested. The septic tank was pumped and verifled co have a capacity oil ].0d0 gallons. The absorption trench was [:estcd by a continuous fZow of 551 gallons of water over a period of 2,1. hours with no measdrable rise in the water level in the sum[} ah the end of the trench. Ih can be concluded from ~this test that the waste water disposal ~V~Lem is currently adequate for the three 'bedroom residence located o~z I:h:is property. However, it cannot be guaranteed agaJ. nst subsequent !~:i.]ures. If we may be of further service, please do not hesitate to call. S[ncerely, ( ,...;// ;" ,, cc: )\rea Realty ,' ,'f';' !:',!,7'!.' :[ O N: Myrna JohnstOn !,4unici~:)alJty of Anchorage ~)_~)arL:ment of Heal'th and! Environmental Protection Alaska State Bank ,aL.Lonal Bank of Alaska SRB 1E6X EAGLE RIVER, ALASKA i MUNICIPALITY OF ANCFIORAGE DEPAP~TMEN~ OF HEALTH & ENVIRONMEN'rAL PROTECTION ENVI, RONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ;ERTIFICATE OF INSPECTION SEWER AND WATER FACILITIES 1, PROPERTY OWNER 2. LEGAL DESCRIPTION 3. TYPE DWELLING SINGLE FAMILY RESIDENCE MULTIPLE FAMILY RESIDENCE 4. WATER SUPPLY EZq COMMUNFFY/PUB LIC E23 OTHER (Describe) 5, SEWAGE DISPOSAL ] "~.~ INDIVIDUaL/ON-SITE E~] PUBLIC UTILITY L-'J HOL) NG:TA~lK(Maintensnce Required) DATE (z'"~--APPROVED FOR .. BEDROOMS CONDITIONAL APPROVAL (See Attached) DISAPPROVE° 72-014 (3/78) ,[~UNIC PALITY OF ANCH(:)RAGE- ' ) I)EPAFITMEN~f OF HEALTH & ENVIFIONMI:NTAL PROTECTION ~25 I. Street - Anchorage Alaska 99~01 ' REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAC LITIES DIRECTIONS: Complete all Darts on page 1, Incoq~lete re~ues~ will not be processed. ~lease allow ten (10) days for processing. J, PROP~TYOWNER ~ . PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from ~bove) ] MAI ~ ADDRES~ ' MAILING ADDRESS ' PHONE 4. REALTOR/AGENT MAILING ADDRESS 'l T~,~E E T LOCATI ON , ""YPE OF RESIDENCE I~] MULTIPLE FAMILY 7, WATER SUPPLY INDIVIDUAL' COMMUNI'TY ~ PUBLIC UTILITY 8, SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** PUBLIC UTILITY T / 5' '*If individual/on-site, give installation date If system is over two (2) Cears old an adequacy test is reouired p~, this Department, EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. [] Other_ ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled 3flor to that date, give well depth (attach log if available.) ',lUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~ Three ~ Six NOTE: THE INSPECTION FEE MUST AC~COMPANY 72-010(3/181 THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE I NSP E CT .~.~! ~ ~NSP ECTOR INSPECTOR DIRECTIONS: 1, TYPE OF RESIDENCE NUMBSR OF ~ SlNOLE FAMILY ~ ONE ~ THREE ~ FIVE U OTHER ~ MULTIPLE FAMILY ~ TWO ~ FOUR ~ SIX 2, WATER SUPPLY PER~IT NUMBER ~ INDIVIDUAL DEPT~ OF WELL ~ CO~UNITY DATE DRILLED ~ PUBLIC UTI LITY Connection Verified LOG RECEIVE~ 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER ~INDIVIDUAL/ON -SITE DATE INSTALLED ~PUBLIC UTILITY Connection Verified ~ - INSTALLER ~SeptJc Tank or ~ Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4, DISTANCESwELL TO: 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 CATE BY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) ' ~%~' ~ AR'FM~ . ~ HEALTH AND ENVi~ONMEN L PROTECTION {~)] ~ ' 825 L Street, Anchorage. AlasKa 99501 ~1: Time _ · ~.Q~_ ~: Time . ~,]~ p~ . ~3: Time ~,,~ Date 3-~;8 ~, ~ Date ~<~'75 C~L~s I)ate ~;D"7~ REQUEST FOR APPROVA~ OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution ReqUest: Alaska Statebank Mailing Address: 310 EAst Northern Lights Blvd. Phone: Property Owner: Peteri'J./Mary D. Jones Phone: 6811-3014 Mailing Address: Box 32 99577 Legal Description: T15~ R1W Section 8 Lot 1 See!directions on back o£ white sheet Single Family Residenca: (x) Number o£ Bedrooms: Three Multiple Family Res±de:~ce: ( ) Number o~ Bedrooms: ~ell System: Individudl ~ell (x) Community/Publ±c System ( ) Permit # ~epth of Well. 40' Well Log on File Construction i . Bacterial Analysis (x) Public utility ( ) ' 1 System: ~n-site System Sewage Dlsposa /.~'TQ~'~ ~o~, Permit # ~in s-bAlled Installer Septic Tank Size Absorption Area i Soils Rate Distances: Well to Septic Tank to Sewer Line i Nearest Lot line Manufacturer Material to Absorption Area Absorption Area to Nearest Lot Line /__ MUNICIPALITY OF ANCHORAGL , '/~'0 %E~ .//~.~ Department o~ Health and Environme. ntal Protection ~ ~~/ 825 L ~S~reet, Anchorage, Alaska 99501' '" ' ~quest for Approval of Individual Sewer and Water Facilities Property Owner: Mailing Address: 2;' Mailing Address: I Phone: o o Lending Inst]tu'tlon Mailing Address Realtor/Agent: Mailing Address: Legal Description: Street Location: Single Family Residence: (~) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedreoms: Water Supply:. *Individual Well If Individual Well, well depth If Community SystemI, name of system Sewage Disposal System: *~On-site System ~ (~ Publ ic/Co]~unity System Public On-site System, date of installation: System ( *NOTE: A well log is required on ALL wells drilled since 6/75. ** If on-site sewe[ system is ever two(2) years old, an adequacy test is required by this department. A fee of $25.00~must accompany each request before processing can be initiated. 3/77 —Fa r 6 I P F- lu• ,�3iretic v� oC Ccsgp eke 3 r�e�-ri Page Two Department ~of Health and Environmental Protection Request for Approvlal of Individual Sewer and Wa%er Facilities Legal Description: T15N RiW Section 8 Lot 1 Comments: Affadavit AttaChed: ( ) ~ Letter Attached: ( ) Approved: Disapproved:. '~~~;~ Date: Department Worksheet: "' ',~ A be held liable. a~o~ the ~e].I could only b,~ 'takun a~ an approval. Les N. Buchhol~ Joseph ~. ~lair GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Feb 20, 1974 Time of Inspection ll:OOpm Date of Inspection Feb 21, 1974 1. Approval requested by: Mailing Address 2. Property Owner Mailing Address: IREQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conventional ~ose~.O ~ Selective Real Phone: Ko Smith Phone: 68___8-2765 _ 3. Legal Description: Lot l, Sec_8 T15N _R1W~S_~I_ 4. Location: ~Of_Y_f_N Birchwood Loo~. 5. Type of facility to be inspected 6. Well Data: A. Type C. Construction 7. Sewage Disposal System: A. Installed C. Septic Tank: D. Seepage Pit: BowerJL_L~Jl_e___ Single No. of bedrooms _ 3 B. Depth D. Bacterial Analysis Sati~f'acteqmy---- B. Installer 1. Sizel 2. Manufacturer 1. Absorption Area 2. Material E. Disposal Field: Total Distances: A. Well to: Septic tank Nearest lot line ength of lines , Absorption area , Other contamination , Sewer Lines B. Foundation to septic tahk . , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages - Req,,~stifor Approval of Individual S~,~er & Water Facilities Legal Description Approval pending escrow of funds for installation of septic tank before July l, 1974 Comments Approva! Valid for one year from date signed Greater Anchorage APea Borough, Department of Environmental DIAGRAM OF SYSTEM Quality certify that the informatidn contained in this request for approval to be a true and accurate representation of t~e subject sewer and water facilities and these facilities are operating satisfactorily.i SIGNED EQ-034 (1/74) Date