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Home My WebLink AboutFISCHER BLK 1 LT 3B3Fischer Block 1 Lot 3B3 #015-292-23 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221108 PID Number: 015-292-23 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name JUSTIN LIBBY ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench R Bed ❑ Mound Site Address 5110 SPRUCE CREEK CIRCLE *ANCHORAGE, AK ❑ Other Phone Bedrooms Soil Rating Total depth from original grade INumberof 907-250-2561 3 *4.0 GPD/SF 6 MAX) Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 0.52 Ft. Subdivision Block Lot FISCHER; BLOCK 1, LOT 3133 Fill added above original grade SEE DWG. Ft. Gravel length 12 Ft. Township Range Section N/A Gravel width 12 Ft. Beds: Number of Lines 3 Distance between lines 4 Ft. SEPARATION DISTANCES 0 Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 144 Ft2 - -Ft. Well *50'+. *50'+ 5-0`. 25'+ TANK ❑ Septic © S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity GREER TANK 1500 Gal. Surface Water *50'+ *50'+ *50'+ Material Number of compartments Lot Line 5'+ **0'+ 5'+ NA PLASTIC 2 Foundation1 Q'+ 10'+ 10'+ LIFT STATION Manufacturer Capacity Remarks *AWWTS **WR#OSV221030 GREER TANK 500 Gal. Alarm location REMOTE MONITORING Electrical installed by Ca() Seo l C_, Installer PIPE MATERIAL House to tank p3034 Tank to D3034 drainfield A+ HOME SERVICES Drainfield D3034 Co/MTD3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 100.00 ft Inspection i5, dates: 2nd Location and description 3rd 4m FRONT DOOR THRESHOLD ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp o4�F �`��p D Conditional Approval: Date o o �� "� •!� �� O D ..' .. .. ' - ---� 0 - p � \A Gar ess:� CE— p Op��P, Septic System Approve Date / ••..�.�3. 2��• moo Note: th•s�approval does not include well permit requirements. #AEccseaD�p0000d�� kr-%cv uoiucu r o) 0 NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN PUTOCAD. FISCHER; BLOCK 1, LOT 364 \/ 'MT \ M OLD TRENCH WAS DECOMMISSIONED/FILLED WITH MOA FILTER SAND WITHIN 6' OF EXISTING BED I.. B 50' WELD RADIUS SAUNA / / O EXISTING 3 F O BEDROOM HOUSE MH ,SHED . \ y\ DECK i SPRUCE CREEK CIRCLE NEW DRAINFIELD DRAINFIELD INSULATED 4" THICK 4' WIDE ON I CENTER UNDER DRIVEWAY PER CONTRACTOR GENERAL LOCATION OF OLD LOG CRIB DECOMMISSIONED PER UPC PER CONTRACTOR /-NEW NS 00 TREATMENT POD 0�1 FISCHER; BLOCK 1. LOT 382 N 1500 GALLON HDPE GREER TANK; USED AS STEP TANK AND RE -CIRCULATION TANK FOR AWWTS `' / DF '44 iE.._:v....��".�.'..=s'S.e�ti._a. �isir..i�.i;�C.R.-L...-�a�f ,�S�:c�...FSeau�i3=.r :ir'.._-N.i_w/�}^ �2 �`�.�--3ilc� a::::x(5.-uE'u' �+-a .:._.�.^."ltl •`\ �T �,T �T �T � T *. •• Iii 1� S 1`�l I1`� 1�1 BJP' C �........ 4 ............. .............0 ENGINEERING g SALES � CONSULTING 3701 E. TUDOR ROAD. SUITE 101 -ANCHORAGE. ALASKA' PHONE (907) 337-6179 . W —tBSITE: Nvvv.gamessengineering.mm / •.....(.. ... .i ............. PREPARED FOR:PHONE NUMBER: PAGE NUMBER: ;/ Je ey A. GarIless Lu JUSTIN LIBBY 907-250-2561 2 OF 3 �#c'%�,.. CE 795 �_� PROJECT/LEGAL DESCRIPTION: DR BG. •,� �Fv� ? 1 ♦� FISCHER; BLOCK 1, LOT 363 1 � '"" P�' • TYPE OF WORK: DATE: LICENSE ��%FE L SEPTIC SYSTEM UPGRADE RECORD DRAWINGS 7/5/2022 # ICENS PERMIT NUMBER:R OSP221108DRAWING C R PARCEL ID NUMBER: 015-292-23 NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE GENERATED IN PUTOCAD. FISCHER; BLOCK 1, LOT 364 \/ 'MT \ M OLD TRENCH WAS DECOMMISSIONED/FILLED WITH MOA FILTER SAND WITHIN 6' OF EXISTING BED I.. B 50' WELD RADIUS SAUNA / / O EXISTING 3 F O BEDROOM HOUSE MH ,SHED . \ y\ DECK i SPRUCE CREEK CIRCLE NEW DRAINFIELD DRAINFIELD INSULATED 4" THICK 4' WIDE ON I CENTER UNDER DRIVEWAY PER CONTRACTOR GENERAL LOCATION OF OLD LOG CRIB DECOMMISSIONED PER UPC PER CONTRACTOR /-NEW NS 00 TREATMENT POD 0�1 FISCHER; BLOCK 1. LOT 382 N 1500 GALLON HDPE GREER TANK; USED AS STEP TANK AND RE -CIRCULATION TANK FOR AWWTS `' / DF '44 iE.._:v....��".�.'..=s'S.e�ti._a. �isir..i�.i;�C.R.-L...-�a�f ,�S�:c�...FSeau�i3=.r :ir'.._-N.i_w/�}^ �2 �`�.�--3ilc� a::::x(5.-uE'u' �+-a .:._.�.^."ltl •`\ �T �,T �T �T � T *. •• Iii 1� S 1`�l I1`� 1�1 BJP' C �........ 4 ............. .............0 ENGINEERING g SALES � CONSULTING 3701 E. TUDOR ROAD. SUITE 101 -ANCHORAGE. ALASKA' PHONE (907) 337-6179 . W —tBSITE: Nvvv.gamessengineering.mm / •.....(.. ... .i ............. PREPARED FOR:PHONE NUMBER: PAGE NUMBER: ;/ Je ey A. GarIless Lu JUSTIN LIBBY 907-250-2561 2 OF 3 �#c'%�,.. CE 795 �_� PROJECT/LEGAL DESCRIPTION: DR BG. •,� �Fv� ? 1 ♦� FISCHER; BLOCK 1, LOT 363 1 � '"" P�' • TYPE OF WORK: DATE: LICENSE ��%FE L SEPTIC SYSTEM UPGRADE RECORD DRAWINGS 7/5/2022 # ICENS MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road On -Site Wastewater Disposal System Permit Permit Number: OSP221108 Effective Date: Work Type: Septic Upgrade Expiration Date: Tax Code Number: 01529223000 Site Legal Address: F/SCHERBLN 1 L 383 G:2537 Site Mailing Address: 511OSPRUCE CREEK C|R.Anchorage Owner: UBBYJUSTIN CHRISTOPHER Lot Size in Sq Ft: Design Engineer: GARNESSENGINEERING GROUP LTD Total Bedrooms: This permit is for the construction of: 11531 R1 Disposal Field ZSeptic Tank ElHolding Tank El Privy El Private Well OWater Storage All umnstu/otkxn 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) . The wastewater `~~~ requires ^inspections during ^''^^'"^=a""''. The engineer shall notify the Development Services Department per AMC 15.S5.Provide notification bycalling (QO7)343'7QO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall baeither: a. Openedand Closed onthe same day, ur b. Covered, sealed, and heated tuprevent freezing Received Issued By 9 Municipality of Anchorage C,k� -- P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * VARIANCE/WAIVER REVIEW Waiver#: OSV221030 COSA#: Permit#:OSP221108 PID#: 015-292-23 Legal Description: FISCHER BILK 1 LT 3B3 Engineer: Garness Engineering Group 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 0.0 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. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: 23 ZZ Approved by: Name of Reviewgrr .......................................................... WOrl ■ ................ ■ . **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Development Services Department y. Phone: 907-343-7904 On -Site Water & Wastewater Section Fax.- 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 015-292-23 Property owner(s) JUSTIN & KATIE LIBBY Day phone 250-2561 Mailing address 5110 SPRUCE CREEK CIRCLE *ANCHORAGE, AK 99507 Site address 5110 SPRUCE CREEK CIRCLE *ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) FISCHER; BLOCK 1, LOT 3133 Legal -- Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: (Z all that apply) Absorption'Field ° F Initial ❑ Septic Tank ❑ Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signa ure of property owner or auth` ized agent) Permit/Rush Fees:15cl 5� Date of Payment: S_3- Z�Z2 Receipt Number: O l q6, 4 Permit No. _ 0_e,/922 / /01 Waiver Fees: 0225 Date of Payment: EZ1q1-,7 Receipt Number: D005 G Waiver No. 05 U? --Z- 1030 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Clie nt Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221108, Deb Wockenfuss, 05/23/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221108, Deb Wockenfuss, 05/23/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221108, Deb Wockenfuss, 05/23/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221108, Deb Wockenfuss, 05/23/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221108, Deb Wockenfuss, 05/23/22 aerial Test Reporlit Client: Gayness Engineering Group Ltd. 3701 East Tudor Rd. Anchorage, AK, 99507 Project: 2022 Testing Alaska Testlab - Anchorage 4040 8 Street, Suite 102 Anchorage, AK 99503 Phone: 907-205-1987 Fax: 907-782-4409 info@alaskatestiab.com Report No: MAT:22-0401-S01 Issue No: 1 Project Code: 220453 The results contained below pertain only to the items tested below. This report should not be reproduced, except in full, without the prlorwritlen approval of Alaska Testlab or the agency. CC: david Gamess Maria Kampsen Reviewed By: Maria E Kampsen Title: Senior Engineer Date: 4/12/2022 Sample Details Other Test Results Distribution 20 Sample ID 22-0401-S01 Description Method Result Limits Client Sample ID Fischer Blk. 1 L3B3 Group Symbol (based on visu"anual procedures) ASTM D 2488 SP General Location 8 Feet Group Name Poorly graded sand with gravel Method ASTM D6913 A Preparation Method 100 ___ Oven Dry _. Composite Sieving? Yes I I Separating Sieve(s) No. 4 Fractional Mass Retained (%) 0.00 90 Cu ASTM D2487 8.90 Cc 0.63 Date Tested 4/12/2022 Particle 100 Size 60 Distribution 20 MITI 6 Diameter 2 600 200 pm 100 Method: ASTM D6913 Drying By: Oven 50 Date Tested: 4/12/2022 I Tested By: John Platt 100 ___ _. i_ I I 90 i Sieve Size % Passing Limits ? 3in 100 80 2in 100 i 1 %, in 100 11 lin 95 70. 1/4in 89 to I I 'Wn 80 >, 60 ...._ .---- _.___ _._ .___ _ . __.__ _i _ _ _ ____.. _..__.. ._._-. __ 3/8in 74 ;a i No.4 61.4 No.10 45 a50 _.__ __.- .--_. _ _- _ _I. _ __ _. - ---.._ __.. ___ ___ __ __.. _ _ _ _.._. _ __ __ _ .. _ .._.. _. _ ., No.20 21 a) �___ No.40 7 40 -- ! IIII - - ._.. _. - No.60 3 { No.100 2 li No.200 2 20 10 _ - II - _ o Sieve Size 3" 2" V 1/2" #4 #10 #20 #40 #60 #100 #200 Comments" _ Sample Size Does Not Meet ASTM Requirements Soil Classification of Fines (4200) in Sieve Analyses Assumed Unless Verified by Additional Testing ATL M-aterial Test Report Client: Garness Engineering Group Ltd. Project Code: 220453 3701 East Tudor Rd. CC: david Gamess Anchorage, AK, 99507 Maria Kampsen Project: 2022 Testing Sample Details Sample ID 22 -0401 -SO2 Client Sample ID Fischer Blk. 1 1-3133 General Location 14 Feet Alaska Testlab - Anchorage 4040 B Street, Suite 102 Anchorage, AK 99503 _Phone: 907-205-1987_ Fax: 907-7824409 info@alaskatesUab,com Report No:iMAT:22-0401-S02 Issue No: 1. The results contained below pertain only to the items tested below. This reporl should not be reproduced, except In full, without the pdorwdllen approval of Alaska Tesllab or the agency. Reviewed By: Maria E Kampsen Title: Senior Engineer Date: 4/12/2022 Other Test Results Size so Description Method Result Limits Group Code ASTM D2487 ML Group Name Silt with sand Liquid Limit 0 Plasticity Index 0 Method ASTM D6913 A Preparation Method Oven Dry Composite Sieving? Yes Separating Sieve(s) No. 4 Fractional Mass Retained (%) 0.00 Cu ASTM D2487 CC Particle 100 Size so Distribution zo mm s Diameter z sao 200 Nm 100 Method: ASTM D6913 50 Drying By: Oven Date Tested: 4/12/2022 —I Tested By: John Platt i 100 90 - -.__. I -_-�. I ! _ _. _ _ __... Sieve Size % Passing Limits 3in 100 2in 100 1'/in 100 1 lin 99 70 _._ .__._ .. ------- --- -- _ . _ _ __. __ _ __ .. _ _ '/ain 98 E'/zin 97 f E �^ 60 ------ - I 3/8in 95 Q - No.4 90.3 No.10 88 m50 ._.__ ___ _ . __._. _._ ._-._- _ ---__- ... _ _-_ ____-_- _-.___ ..____ __. -_-._.._._ ._.-__ No.20 85 m No.40 83 40 ... _ ____ .._ ._ __ _ _ __. __ . ______._ -___ _-__ ______. ____.._..__!_ _.______._ -_._._ No.60 80 8 No.100 76 a30 No.200 71 . __ __-._ _ _ _._...- ._-_ _-__ -- ____. _... ___ _._.__ 10 -- ---- — - - - - - - -- - ---- -- - — --- — — — o___ _ l____.- .__ Sieve Size 3" 2" V 1/2" #4 #10 #20 #40 #60 #100 #200 Comments-, Soil Classification of Fines (4200) in Sieve Analyses Assumed unless Verified by Additional Testing No Plasticity Index Test Performed a Lot 364 _ COOP Cl . 1.5' LEMT-TO Lot 4C--2 10' UTILITY EASEMENT - E SAUNA SEPTIC PIPE GRAVEL' 1 LEVEL RESIDENCE WITH WALKOUT BASEMENT a. SHED, 'a. r0 'a• DECK WITH CARPORT j�BELOW Lot 11,531 s.f. rCHAIN-LINK FENCE GRAVED Co' ST' WELL 10 ' PRO CTIVE N PORCHT4.0' Lot 382 -WOODEN.FENCE r N 89-53145-W .• 5.00' } ' x t4 104fh AVENUE OTE: GRAVEL LOCATIONS ARE NAPPROXIMATE DUE TO SNOW COVER. MORTGAGE SURVEY X SCALE I" = 30' GRID SW 2537 Project No. 21-6991A1 pp 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang it H S S o C 1 a f e S, I n C. (907) 522-6476 Phone (907) 522-4625 Fax Q F A Professional Land Surveyors kenaiongsurvey.com d ....... jonothen@longsurvey.com �'� .•' I hereby certify that i have surveyed the following described property: LOT 363, BLOCK 1, FISCHER SUBDIVISION (Plat No. 70-170) Anchorage Recording District, Alaska, and that this Mortgage Location Survey Is a representation of the conditions that were found on the date the survey was performed. This survey does not constitute a boundary survey and is subject to any inaccuracies that a subsequent boundary survey may disclose. The information contained hereon shall not be used to establish any fence, structure, or other improvements. Dated this the r k Day of 0,22be)`z _L at Anchorage, Alaska It Is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plot. M.UNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS) MAINTENANCE. AND R-T.,PAIR. AGREEMENT. herein the "A(3REEMENT" made and entered into as of this 2— Day of of 20-.,?- 7.--, by and bet-%Accn herein Lhe"OWNER_" and the Municipality of Anchoraoe, herein the "N, 'Nic,11"ALITY". in accordance with Anchorage Municipal Code (ANIQ 15.65.365- In consideration of the mutual covenants contained herein, the parties to tills ALYreement at)ree as foliows: 1. Advanced WastewaterTreatment, Systems. The Municipali- ty, grants permission to the OwjlLr to utilize and operate an Advanced, Wastesvatcr Treatment Systern (AWWTS'), described as 0XVANI-Cl located at (le -al description) 5P,rVLC l Cc_t,� C, (AL 2. Maintenance. Repairs and Alterations. (Owner is required to read, understand and initial each section) <��Throuhout tile term of this Agreement- the Owner shall enter into a service agreement with an Aww,r,,-) service and maintenance provider approved by the klurucipality or the manuilictureCs representative. The AWWTS shall be maintained in a.satistactory condition capable of performing as designed and producing treated septic effluent in accordance with the. equipment's approval for operation in the \Municipality. It shall be the responsibility of the Owner during the tern) of this Agreement to pay for all repair(s), maintenance- adjustment(s), replacement costs. and inspection costs. This includes an annual maintenance fisc (typically $400 to S600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the inanullacturer's representative will inspect and make any necessary maintenance, —repairs or permitted alterations to the system. Owner acknowtedoes that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05118/2018) Page I of3 Owner acknowledges that the Municipality may request records of maintenance and repairs froill, the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.0310. O,,vncr agrees to grant tile Municipality reasonable access to test and inspect the AWWTS. TheiMunicipality will give at. least 24-hour notice. Owner agrees that any sale or transfier of title of tile property will not Occur without a nevv Certificate ol'On-Site Systems Approval. Owner agrees that the AWW-l',-)' installation and maintenance requirements as provided by the AIVNVI'S vendor/installer and approved by the Municipality are the aoverilim, I - - guidelines for the construction,, iiiaintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring S_ , of the AWWT, S asTequired by the AWWTS approval. 3_ Term. The term of this Agreet-fient ,hall begin on the date of approval by the Municipality to operate the installed s I ystcin, or upon transfer oftitle, and shall continue w-hile the AWW'fS is operational or until title is trans] -erred. 4. Nonwaiver. The failure ol"the Municipality atany time to enforce a provision of this Agreement shall in, no way constitute a waiver of(he provisions, nor in any Nvay affect the validity of the Agreement or any part hereof, or the right of tile Municipality thereafter to enfiorce every provision hereof. 5. Amendment. This Agrceinent shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to arnend, this agreement by either an unauthorized -representative or- unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court fior tile Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall opverri the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court ofcornpetent jurisdiction shall not invalidate the remaining provisions of tile Acyreernent. C� (rev. 05,118/2018) Page 2 ot'3 Z= 9 Date: 5-- 2- - 2 -Z-- print name) STATE OF ALASKA z Z )ss. I'll I RD JUDICIAL DISTRICT The foregoing instatment was acknoyvledged before me this day of 04?61 20U, by NOTARY PUBLIC FOR ALASKA.' My Conui-dssion expires: MUNICIPALITY! : By: (slgmature) ZL�(print name) (rev. 05/18.1-2018) Date: -z_ Title: Pate 3 of 3 NAMEg�_.� LOCATION SEPTIC TANK: DISTANCE FROM WELL — MUNICIPALITY OF ANCHORAGE Heal^~and Environmental Prote�n Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 VPe�:��PE INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADD C X,S le .YG- MANUFACTURER PHONE LEGAL DESCRIPTION—.4_3-C2 NUMBER OF MATF RIAL _—__ __ _COMPARTMENTS INSIDE LENGTH INSIOL WIDTH--_-, - , LIQUID DL -PTH ____ LIQUID CAPACITY GALLONS. TILE DRAIN FIELD: //AA / TOTAL LENGTH LG DISTANCE f"ROM WELL =C:Y_ FOUNDATION �Q NC AREST LOT LINE -_"__.--pF LINE _40� A of Lines DISTANCE BETWEEN LINES Jl'LA TRENCH WIIICTIZZ-4— IN. TOTAL EFFECTIVE ABSORPTION AREA / O SQ. 1 T. LENGTH OF EACH LINE AD ULPTII OF FILTERC� L/ DEPTH: TOP OF TILE TO FINISH GRADE _/ MATE RIAL BENEATH TILE —6_' *:!(413OVE TILE _,C_IN. SEEPAGE PIT: DIAMETER _OR WIDTH_, LENGTH_, DEPTH Log Crib _Rings_ Crib Size: DIAMETER__UEPTH_ DISTANCE FROM: WELL 70TA.L EFFECTIVE BUILDING FOUNDATION_, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well } Class Depth: Well istance To: Lot Line _ 1 Bldg: Sewer Line: i - Pipe Mater als: 9 of Bedrooms: I 1 Installer: Remarks: I i. I #t 4 DAT i ! i- 1. -i i , l ! v DAT f'7 U r-1 1 1-:;1 F r L— 1 l `r' 1J 1= Fi r-a l_;. H Cl Fc H ti lE /I � A(K. DEPHRIMENI U tHLlH HND ENV1RUNMENIHL Fr-�EIl1Uri I Bqua [C1L1 25 ' L' S 1 kEEI , HUH NCHHGE, HK. yvSU� • 27y-2511 ag t_1 r+l — L: 1 _.1' LE. L W L�— Fes: lJ 1=' 1-ii 1 wc:"L] F� 1=' 1=1a: M 1-11.�— PERM 11 NO. ( l ltt6U ) HPPLIUHfTl LUCKE EXC. BOX SRH 1121—L 544-2625 LUUHIIUN SHKUGE LK. LEUHL LUT 3B3 BLUCK 1 FISCHER SOUL). LUT SIZE llb:Sl SOUHkE FEET TYPE OF SOIL HBSURBILUN SYSIEPI IS: TRENCH MHXIMUM NUMBER OF BEDkUUP1S = 3 SU1L kH11NU (SO FI/BK)= TUU THE REUUIRED SIZE OF THE SU1L HBSUKPIIUN SYSILPI IS: L]LIJ-1"H= 1:2 L_Lr-aLi"1-H= Gk_% 1i►;;:F=1kfL=L L]LIJ-1"H= : THE LENGIH UIMENSIUN 1S THE LENGTH (1N FEET) OF THE IRENCH OR DP,HINFIELU. THE DEPIH OF H IREfUUH OR P11 1S THE DISIHNCE BETWEEN THE SURFACE OF THE LiRUUND HND 'THE BU11UM OF THE EXCHVHIIUN (1N FEET). THERE 1S NU SET W1DIH FUN TRENCHES. THE UKHVEL DEPIH 1S THE MINIMUM DEPIH OF URHVEL BETWEEN THE OUIFHLL PIPE HND THE BUIIUM OF THE EXCHVHIIU14 (1N FEET). I -"Cr Ir."t_iL FJL—Hr-+-o tj1—''1' 11.:_tr-d H PHCKHGE PLHNI PINY BE INSIHLLEU Hf THE PERMIIIEE'S UPTIUN SUBJECT TO THE •FOLLUWINU UUND111UNS: 1. ETT HEM. H L:LHSS 1 ON II f15F HPPKUVED PLHPJ I PINY HE 1 NS 1 HLLED. 2. H UUNIINUUUS MHINIENHr-4UE HGKEEPIENI 1S kEWU1kED. 1F H P1HINIENHNCE HGkEEPIENI 1S NOT KEPI CURRENT YOU MHY BE REOUIRED 10 ENLHRUE THE SOIL HBSOKPIIUr4 SYSIEM HNU/UR YOU MHY BE SU61JEU1 TU PROSECUTION. ---------------------------------------- --- `l,L4cl C ;�i: ] f{L c4LJ 1 1,;zLEL] --- BHCKF1LL1NG OF HNY SYSTEM 1411HUUT F1NHL Ir9' PEL'IIUrJ FIND HPPKUVHL BY [HIS DEPHKIMENI WILL BE SUBJECT TO PROSECUIIUN. M1N1MUP1 UISIHNCE BEIWEEN H WELL HNU HNY UN -SITE SEWHGE VISPOSHL SYSIEM 1S TUU FEET FUR H Pk1VHIL WELL ON 2UU FEET FUR H PUBLIC: WELL. UIHEk kEUU1kEP1EPJIS MHY HPPLY. SPECIFIC:HTIUNS HND CUNS'IRUCIlUN DIHGRHPIS NNE HVHILHBLE TO I14SURE PRUPEk INSIHLLHIlUfl. 11 ov�!r i l 1' 1=X1=' 1 1 t=om L>L�-C:L r'1Li: f=1,;:! ::I' -1L r 1 CEKIIFY IHHI 1: 1 HM FHMILIHP. WITH THE KELlU1KEP1Ef415 FUN UN -SITE SEI•JEKS FIND WELLS HS SEI FUKIH BY IHE P1UN1C1PHL11Y OF HNCHUKHUE. 2: 1 WILL 1NSIHLL THE SYSIEM 1N HCCUKUHrICE WITH THE UUDES. S: 1 UNDEKSIHMD IHH1 THE UN-STIE SEWER SYS1EN PINY REUU1KE ENLHRUEMENI IF THE RESIDENCE 1S REPIUDELED TO 1NUULUDE MUHL IHHrJ S BEDROOMS. S1UNL-D 1CHN1 LUCKS EXC. r ISSUED t:4'_ P_UH 1 E___L_= F Cfl�Q GRErrR ANCHORAGE AREA BOF'-*"JGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME AEDEA-C"I COW3r- MAILING ADDRESS /d0/ E 53PHONE 34/0. JV6 38' LOCATION SP/LULE &rd Gi,?dtr LEGAL DESCRIPTION .3 63, R&/ FiSef/E1e O SEPTIC TANK: DISTANCE / STg !t CILLI /�.0/1 NUMBER OF FROM WELL MANUFACTURER MATERIAL 9 COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH I IQUID CAPACITY X6.0 GALLONS. SEEPAGE PIT: NUMBER OF PITS DIAMETER OR WIDTH d' LENGTH! DEPTH /f LINING MATERIAL1s S [ � CRIB 512E: DIAMETER —DEPTH--L DISTANCE FROM: WELL /4"0 . µ / TOTAL EFFECTIVE BUILDING FOUNDATION � , NEAREST LOT LINE /2' . ABSORPTION AREA (WALL AREA) 39� SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE =NOid. CONSTRUCTION 6" ZJ'p/ttc0 DEPTH DISTANCE FROM: BUILDING FOUNDATION dO /t, LOT LINE NEAREST /[, SEWERST SEPTICLINE�f TANK //0 SEEPAG, SYSTEM /cc, /V6 CESSPOOL APPROVED DISTANCES: OTHER SOURCES t' DISAPPROVED INSTALLED BY: GcAue� E',ccAJ• PIPE MATERIAL: (?4fr SA-eA/ LOT SLOPE: REMARKS: Form No. EQ -031 REMARKS UIHUttMm Ur Kt 3 ROA,I 0 � N ir 1 Wept DATE -%-3- 7'r/ APPROVED 4� G.A.A.B. / I GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. 3330"Crr STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4591 / SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT 65LerA/J PEPERS04/ &4/JT MAILING ADDRESS /6f0/ E S'j� PHONE INSTALLATION LOCATION LEGAL DESCRIPTION - LoT 3f33 /J'LQG.c / /r/ SCA/ --7L 5'�„o INSTALLATION OF: SEPTIC TANK ✓ SEEPAGE PIT DRAIN FIELD OTHER TYPE AND SIZE OF FACILITY TO BE SERVED 3 .EPA, -t S,,Al;cLE x7i y FINANCED THROUGH TO BE INSTALLED BY /L• 6-< C'40' SOIL TEST RESULTS c NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED Su H 7'L R/T /2/X /3/ x b / Vo/d 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 / TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT � � DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL /S -/ SEPTIC TANK SEEPAGE PIT / DRAIN FIELD �J. aW- TO NEAREST LOT LINE. IJP WELL TO SEPTIC TANK /� / SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. /L/0 WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT SEPTIC TANK, /0-0 SEEPAGE PIT /ov/ DRAIN FIELD /may TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S 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 I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-96 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE '7 �� %!/ APPLICANT'S SIGNATURE FORM NO. EO -014 f ona zuCL•Ion E7csE .i'^% /ZX x.6, r " + "one test it worth • thousand opinlone 0020 TUDOR ROAD. ANCHORAOa. ALASKA 00007 • TeLerMowe 232-0472 :Performed For Eldon Pedderson Date Performed 4 -11 -?4 Lepal Description: Lot FziA Block,1 Subdivision r This Form Renorts Soils Log yes Percolation Test Oeoth Feet Soil Characteristics Overburden 3 Coarse: ravel.dlighily silty R Grad d..GP-GM +'ti(100) lu 7 -� ' A �. .. 10 Bottom of Test• Pi -t minus 10 ft.• Was..Cround Water Encountered? No If Yes, At what Depth? MM021 MTJP.Ifi �r•..��tttttttt��1• Readinq Date Gross Time Net Time Depth to H2O Net Oroo' R.rcolation Rate Hinute Proposed Insta ation: Seenace Pit' yes Drain Field Deoth of Inlet Depth To Bottom Of -Pit Or Trench V.TS: 10Q 'n,ftdrninn�r area renuired per hedroom tr^ hAArnnit er wacor table to minus 10 ft. "25't Performed ByData Certified By: Construction To. a onager Date: -4-11-74 r . r �1 . � .. • go+tRa aay.v' e ...r •'n r.t }y 4. e �` S 1 2"-, 'i.4' .,5,E?: i 't�+fd..zj•' iF DIULUNGI im I P. O. Box 4-1224 '�• 1310C Internat"I A rport Rad 4 ' ' (907) 274.4611 i _ ANCHORAGE, ALASKA 509 r ` f'�' nt DRILUNG LOG • i Poddrson Construction f Dom a Uae of Well 7LLocation (address of: Township, Range, Section, If known; or distance main roar z7: .L+ Lia Blk 3a Fishasr Sub, Our Rd b plat 6 2 264:e, �• Size of casing epth of Hole 75 feet Cased to feet ` r` _ Static water level 245 ft (abSo IY ow) land surface.: Fini of well (check one) open and t Screen ( ); Perforated ,(•:iIt �f, �` None R .I�kT+nlw Describe screen or perforation L _ f Well pumping test at V of drawdown from static ' Date of completion LL r ti ' Depth to feet from ground surface 0TO 2 r'.•' 2 -TOJ 8-ndy Cobt �Y7 To 8 • _� To ---IF ;..�; 1to TO 20C TO 21� 210 TO 215 'r ,o: 1K .. TO 2js6 . F 2 36 245TO 265 TO :. TO w TO (minute) for 1 tours with 100°1 ff WELL LOG ' . �» ..::-_;_• Give details of formations penetrated, size of material, color and hardness .Ips an ce . . . . . tlattld iRC . ` Ti Sand vo +A.. 11 Yr :ir=''`'`v��c r g =nail • Oravel t'•• silty •• ' .k;�n,:>' Clev Small Gratelt silty ;,amull Grovels o-ndy/silty. �wster saturated—no head Water Gravels slirht" anndy, Food saturation 3—CONTRACTOR CT) C�'J Y5�) V VJ rl- rl- 0 0 0') CY) (1) Cf) > 00 Ln N O N C'7 N ti 0 0 O MMi \'J N i N O7 N V J O Q) a_ M m (Y) J r J m w 2 CO LL O Q U U) a) J ti CD LO a 0 U C U Y W W U W d. LO m 70 cu (1) J W m 06Q z 0 W T- 0 0 m Q O c U C'7 x A E O 'a N O N N r m N 0 a) cu U a) U a) U) o`` 0 0 a N Q. O 3 U) L W O E a O ~ O O N O U N_ L C a) cm 1 C O N O c Q. C N _a •= O E p U).r o r N t E Q Cl) C O N O O v 3 m a) E � Q- c ',j w E c� OM V c CL p d N O O O_ Q. Q 0 E m N L Q O N 'a O N E V V •- � N cn O O 0 f4 = = O N U) Em Q ° O m A o N O 0 a) a N as L O U1 LO ow o >, C O. C O U) Q o Y > U LL O c Q U O a) 0 Q ZY VJ a) W O U Q O 2 U Q E- a 00 O -I--� U C2 C1 ca O CL U) N a CO N CO 1 C O ^O W C� U N Z C") ON � N I OLO LL T- Z 0 J Q Z v W 0 a T- O LO VJ Y W ca L- 0 O -r- L) U C C`7 Q m N O � U r � U � o U m U L � W L C) U) LO r c � 0 a � U In U a) -o -p t6 0 N O a O U U -j a) c O CL co —11 a� a� LL a� I N rte= ) _U L ate+ N a O �/.� 0 V/ a) = O a) _ L El 7 _0) O C Q c _ E N +U- Q U 3 U U C �+ H El a) N c g O aU E � E Li El❑ 2) O 3 c j �- + Q W Cl)El a UCf) O a) a� El E -a O � o El�' a) 04 A V — 0 Z O > p W m ❑� Elm U m O o oa cokv .L > Cn v o N IL a O (na� r ❑ ❑ ❑ Cn a o } ❑ a=i ui N tL W 0 ElEld � N U +� +' N pQ 'o ❑ u C O Cn U) ?� U)m J a) 0 A 2 w WElO W W w ~ f- N a) a N N N Y Z O N Q O U) co W LL a H a a� d H O O U N cr c y U) W W O ai W m O H H to Q Q > a) M m > � > cx N M L6 CO > W m 0 a� a� LL a� I N rte= 4.28 Forge Engineering 7/23/24 N/A N/A N/A N/A 2 Plastic Benjamin Schiller, P.E. (907) 522-7773 ARM Septic Services, LLC Maintenance Checklist: Advanced Treatment System Operational Checklist: Advanced Treatment System Legal Description: Street Address: 5& S 'CUL 4, ( C�-C.12. Service provided on: Date: 3 f- L-- -Ti^me: Service provided by: Company: 'tl�" _ Technician:4__,C--1n Date of last service: By: You Other. 1. Type of Aerocell Treatment System: Cat II -AeroCell Treatment System Cat III -AeroCell Treatment System 2. Conditions at media filter: acceptable ❑ Unacceptable a. Evaluate presence of odor within 10 ft of perimeter of system: None ❑ Mill ❑ Strong ❑ Chemical ❑ Sour b. Source of odor, if present: 3. Manhole Risers and Pipe Caps:Acceptable ❑ Unacceptable a. Cover/s intact: 'Yes ❑ Nit b. Method of securing cover: _? C (r— c. Insulation present on all lids? Yes ❑ No d. Any plumbing leaks or water intrusion: ❑ Yes V'No e. Surface water/infiltration into components: ❑ Yes K_1Ko 4. Venting/Air supply: Acceptable ❑ Unacceptable a. Air supply unit operating properly. 5,Yes ❑ No b. Venting appears operable. V Yes ❑ No 5. Media surface: (acceptable ❑ Unacceptable 1QNo a. Biomat on surface. ❑ Yes b. Uniform spray pattern. B -Yes ❑ No d. Ponding in/on media. ❑Yes ;�No e. Plugging/clogging of nozzles. ❑ Yes S No f. Media appears to be settling. ❑ Yes allo g. Appropriate maintenance performed. �s ❑ No h. Pest activity at surface. ❑ Yes L No 6. Effluent quality a. Effluent odor after passing through media filter:e b. Effluent color after passing through media filter: Clear ❑ Mild ❑ Strong ❑ Brown ❑ Black En/InNt{eY Wratr•rr 9eiuttana . 17933 Old Glenn Highway *Chugiak, AK 99567 office/fax: (907) 688-9433 Email: ARMServicesAK@outlook.com (PAGE 1 of 3) ARM Septic Services, LLC 7. Tasks for recirculating/discharge flows: Acceptable ❑ Unacceptable Q. If applicable, Jandy valve functioning, ❑ Yes ❑ No nN/A b. If applicable, Jandy Valve basin dry: ❑ Yes ❑ No N/A c. Cleaned collection system in Aerocell unit: ❑ Yes ❑ No Not Necessary d. Design recirculation ratio: 80 : 20 e. Actual recirculation ratio (Estimated): 6g : L70 8. Pump System: -Acceptable ❑Unacceptable a. Control panel in Auto: VYes ❑ No b. Timer settings IFS Panel (No Override timer): N -Yes ON: OFF: 2 n Override ON: Override OFF: /A c. Floats in correct placement: ❑ Yes ❑ No d. Floats working properly: ❑ Yes ❑ No e. High water alarm operational.- ❑ Yes ❑ No f. High water alarm count: g. Pump Run Counts: !$3 12 h. Pump Run Time: G(L- 6 -7 i. Float Error Counts: KL ❑ N/A j. Total Override Counts: ❑ N/A k. Effluent Filter serviced: DkYes ❑ No I. Tank lids secured after inspection: RYes ❑ No m. Weep hole functional: 137es ❑ No 9. Primary Tank: �Acoeptable ❑Unacceptable a. Sludge and scum level checked: L'Yes ❑ No b. Sludge/Scum levels: 1st: t V 2nd: (1c' 3rd: c. Tank needs to be pumped: ❑ Yes "4N0 d. Water softener backwash discharging on system? ❑ Yes ❑ No e. How many people live on the system?: 3 f. Tank lids/caps secured after inspection: Yes ❑ No g. Last Date Tank pumped: kkc( Z0L1111 10. Drainfield: a. Type of Drainfield (circle one): 63w 5 -wide Deep Trench b. Design Effective depth: G ' ch eet c. Checked Liquid Levels in Drainfield: RfYeS ❑ No MT#1 Liquid Level: 1 Inches MT42 Liquid Level: (/,6 Inches MT#3 Liquid Level: Inches MT#4 Liquid Level: (U Inches d. Is there any surfacing effluent?: ❑ Yes �-C�o 17933 Old Glenn Highway *Chugiak, AK 99567 office/fax: (907) 688-9433 Email: ARMServicesAK@outlook.com (PAGE 2 of 3) ARM Septic Services, LLC 11. Is the remote monitoring system functioning? (if no, describe in comments) ❑ Ye se a. Type of Monitoring system -.D bh-r�- k(�"- r b. Phone line working? ❑ Yes ❑ No kN/A 12. Does this system receive an advisory notice/warning? (if so, describe in comments) ❑Yes Nn -Io 13. Is the system in satisfactory condition/pass inspection? (if no, describe in comments) r�s ❑ No Other Comments: Z2 u Ce Service Provider: / Date: 1 17933 Olnn Highway *Chugiak, AK 99567 office/fax: (907) 68 -9433 Email: ARMServicesAKCoutlook.com (PAGE 3 of 3) v W 4. N II N O >, .0 q C., O ce -C rJ3 a ff+ U C cri d Q. a C, En OU 0 G JJ N C � � r N U v] a N ° �• Q' .. o C o o Q ,J ° o 6R ° pes c r ,, 3 d y > O V) G O %b0 b zj F �d M bA -o M4 C o p ro m ; > O U b a� b C, v 3 cd E5 Q O v U Cd cd E � Ln �: 4 - 0 Cd cd rll In(1)C 0 vi yU., 0 3Cd 0bn W Cd t cli °� ro b 3 d d d p U o N -fl . _ Cd V) N II N O >, .0 q C., O ce -C rJ3 a ff+ U C cri d Q. a C, En :3 G ° U > fd L." U v] a N ° �• Q' .. o C o o Q ,J ° o 6R ° pes c r ,, 3 d U m U U > O V) 79 Cd Oa o %b0 b zj F �d 6 9 Cd 12. U -o M4 C o p ro V] n > O Obi) cL y a� b C, EA cd CLC (+ .24 G r cn U Cd cd E � Ln �: 4 - 0 Cd cd rll In(1)C 0 vi yU., 0 3Cd 0bn W Cd t cli °� ro b 3 > ,rC., U c� p U o N -fl . _ Cd V) a � n N b U OU cd 3 O ro y O H O o. i-4 U cd y O 4•J O � 94 "tet' 00 O N 00 O G) L. Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the tine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS 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 AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this 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 Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 r • M a� cd Ca I 00 0 N 00 a 'n Qn 0 co b a� 1° b on b b H C cc - Q O w 0 00 0 N 00 a • '� Municipality of Anchorage On -Site Water and Wastewater Program _. (907) 343-7904 Certificate of On -Site Systems Approval Parcel I. D.015-292-23 1. GENERAL INFORMATION: Expiration Date: H-40 — 2Z Complete legal description FISCHER; BLOCK 1, LOT 3133 Location (site address) 5110 SPRUCE CREEK CIRCLE *ANCHORAGE AK Current Property owner(s) JUSTIN LIBBY Day phone 907- ZSb— 25161 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $-18-0 Waiver Fee $ Date of Payment <�y �Zu;'� Receipt Number Q),b y 6 6 COSA # 05C),1ISW Date of Payment Receipt Number Waiver # m, 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date:y 1 �� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and o�oov�0, industry practices. The reported results describe the condition of the system/s on the date/s of the o� V evaluation. Separation distances were measured to readily identifiable features. Hidden defects or o i��..• �'h encroachments may exist that were not identified during the evaluation. The operational life of all wells �� Q .• _ '•��:ri and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and �: � rJ workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and .""" .. """""" """• are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of • • • • • • the well or septic system. GEG makes no representation whether an alternative well or septic system '• r ss.: can be installed on the property in the event either of the current systems fail to perform adequately in ' . CE --957 the future. The content of this report is for the sole benefit of the person/party that retained GEG to id' perform the evaluation. Reliance upon the information provided in this report by any other person or^evparty S100d including subsequent property purchasers) is not authorized, nor will it confer any legal right 1L�if S whatsoever. #AECC884 6. DSD IGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: -Z 6 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other -04 Legal Description: FISCHER; BLOCK 1, LOT 3133 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 6/11/74 Total depth 265 ft Cased to 264 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 11/2/21 Static water level at beginning of test 231.9 ft. Comments � vim B. TANK DATA ��pslxz_ Age of tank(s) NE ea s Tank type/material P'Asrlc ��p ` `� Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping N/A D. ABSORPTION FIELD DATA Which system tested (date installed) 6/2022 ❑ ALL standpipes present per record drawing Total measured depth from grade 6.2 ft (max) Measured depth to pipe invert from grade 5.2 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective VZP Parcel ID: 015-292-23 Structure served by this system Well production at time of test 7.5+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No 19/coliform bacteria is Negative Nitrate L/. 21' mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Q_<rsenic less than MRL (ND) Collected by GEG Date of Sample 6/29/22 C. LIFT STATION ❑ Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: Adequacy test date N/A Results ❑✓ Pass For 3 bedrooms Fluid depth prior to test in Water added - gal New depth in Elapsed time - min ❑ Code -required soil cover over field Final fluid depth - in ❑ System presoaked Absorption rate 450+ and (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) Gallons introduced N/A gallons If yes, enter date Comments/Deficiencies: THIS IS A NEW DRAINFIELD AND STEP TANK. RECORD DRAWINGS WERE SUBMITTED WITH THE COSA COSA Checklist yellow sheet W E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' El *50'+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No *50'+ ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' ❑ Yes if No *50'+ ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft 0 Yes if No ft Yes if No ft Water Service Line > 10' Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' LE Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' _ El Yes if No ft Surface Water > 100' _ *50'+ El if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: ft Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ❑ Yes if No *50'+ ft Water Main > 10' Q Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' El*50'+ Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' El Yes if No ft Surface Water > 100' ❑ Yes if No *50'+ ft F. ENGINEER'S COMMENTS *AWWTS **WR#OSV221030 G. ENGINEER'S CERTIFICATION o� OF� o _ I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with p MOA COSA guidelines in effect on this date. Ver. . 9 J �Gor,} Ss: Qa E-79 3 e8 � o4��PrP�,. V�Z+� COSA Checklist yellow sheet 40 Pro f e s sio�°o #AECC884 400�000�d MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this ToDay of of 20 �4, by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants pennission to the Owner to utilize and operate an Advanced Wastewater Treatment System (.AWWTS), described as located at (legal description) Z33 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). A Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly :repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 3 E Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least/24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the constriction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. Term. The tern of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Lay. Any civil action arising from this 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 Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 OV S TATE-0-F-7tL-AS-1,tA1T, THIRD JUDICIAL DISTRICT ) ss. C) Date: ,.* %Lee The foregoing instrument was acknowledged before me this,,` day of : zh.;. 291 byL < < j a'i ilk„ NOTARY PUBLIC FOR A-L—A-SK77AP'? My Commission expires: MUNICIPALITY: By: (signature) (print name) (rev. 051118/2018) Date: U 16 `2Z Title: Page 3 of 3 Lot 4C--2 10' UTILITY EASEMENT - Z O 0 Lot 3B4 SEPTIC PIPES 590 + •0. 1.5 LEAN—TO f ,SAUNA y \ c BI -LEVEL RESIDENCE WITH WALKOUT o• BASEMENT 100' PROTECTIVE RADIUS 3'45"W 75.00' + 104th AVENUE --r- - - SPRUCE CREEK CIRCLE I PIPE /�� ' MANHOLES Cb• d.FENCE Lot 3B2 PLOT PLAN AS BUiLT X SCALE 1 " = 301 GRID SW 2537 Project No 22-46 DRi 11500 Daryl Avenue. Anchorage, Alaska 99515-3049 Lang & Associates, (n,c. (907) 522-6476 Phone (907) 522-4625 Fax *:'�0F Professional Land Surveyors kenOlangsurvey.com v Jonathan 0 langsu rvey.com I hereby certify that I have surveyed the following described property: LOT 3B3, BLOCK 1. FISCHER SUBDIVISION (PLAT No. 70-170) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold property except as indicated hereon. Dated this the _ �'L L� _ �� Day of _� r a, , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants. or restrictions which do not annear on the recorded subdivision plat. 49 —H ........... KENN H G. LA O o AS-520 . • ' Sz R ...... • Noo �04p °�sSIONAL `g4 Q�Opod4`� AECC963 � DECK WIT} CARPORT Lot 3133: _BELOW 11,531 s.f. rCHAIN—LINK FENCE I GRAVEL ..COV 100' PROTECTIVE RADIUS 3'45"W 75.00' + 104th AVENUE --r- - - SPRUCE CREEK CIRCLE I PIPE /�� ' MANHOLES Cb• d.FENCE Lot 3B2 PLOT PLAN AS BUiLT X SCALE 1 " = 301 GRID SW 2537 Project No 22-46 DRi 11500 Daryl Avenue. Anchorage, Alaska 99515-3049 Lang & Associates, (n,c. (907) 522-6476 Phone (907) 522-4625 Fax *:'�0F Professional Land Surveyors kenOlangsurvey.com v Jonathan 0 langsu rvey.com I hereby certify that I have surveyed the following described property: LOT 3B3, BLOCK 1. FISCHER SUBDIVISION (PLAT No. 70-170) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no Improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on sold property except as indicated hereon. Dated this the _ �'L L� _ �� Day of _� r a, , at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants. or restrictions which do not annear on the recorded subdivision plat. 49 —H ........... KENN H G. LA O o AS-520 . • ' Sz R ...... • Noo �04p °�sSIONAL `g4 Q�Opod4`� AECC963 DI Parcel I.D. 0 15-2 92-23 Municipality of Anchorage °` J On -Site Water and Wastewater Program = (907) 343-7904 , k Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Expiration Date: 11-2 ` ) a— L.3 Fischer, Block 1, Lot 3B3 Location (site address) 5110 Spruce Creek Circle, Anchorage, AK 99507 Current Property owner(s) John & Suzanne Tsoutsouvas Day phone 783-0309 Mailing address Real Estate Agent 5110 Spruce Creek Circle, Anchorage, AK 99507 2. :TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water Svstem ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: ��_ r?' ,•{ Date: COSA to be release0o the engineer, unless otherwise requested ._ _. bythe engineer. COSA Fee $ U— Waiver Fee $ Date of Payment '31 1 �� 13 Ct Date of Payment Receipt Number CA C) (a Receipt Number COSA# 05C l') 10 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson En Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIG%ATURE i/ System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Phone 522-7773 Date 8/10/2013 Conditional approval for bedrooms, with the following �F- OF A4gS,�4 49THe°7t� MICHAEL E. A''MERSON �? CE -4381 By / Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. - 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet f k c If more than 1 septic system is on the lot: COSA Checklist # Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Fischer, Block 1, Lot 3B3 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 6/11/74 Sanitary seal (YIN) Y Total depth 275 ft. Cased to 264 ft. FROM WELL LOG Date of test 6/11/1974 Static water level 245 Well production WATER SAMPLE RESULTS 7 Parcel ID: 015-202-23 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >18 in. AT INSPECTION 8/6/2013 ft. 238.4 ft. g.p.m. 3.1 g.p.m. Coliform 0 colonies/100 mL Nitrate 2.78 mg/L Arsenic N/D ug/L Date of sample: 7/30/13 B. SEPTIC/HOLDING TANK DATA Collected by: Anderson Engrg. Tank Type/Material Septic/Steel Date installed 7/3/1974 Tank size 1,000 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout (YIN) Y �vrDepression over tank (Y/N)) N High water alarm (Y/N) NN Date of pumping �` � ' �k� l> Pumper s i Z't ➢i t �i'", �� { PSYIr�(Y_ ( ) C. ABSORPTION FIELD DATA Date installed 7/3/74 Soil rating (g.p.d./ft2 or fie/bdrm) 110 SF/BDRM System type Crib/Trench Length 18(C) 20(T) ft. Width 14(C) 3(T) 6(C) 6(T) ft. Gravel below pipe ft. zoo (T) Total depth 10 ft. Elf. absorption area 384 (C) ft2 Monitoring tube Y Depression over field N Date of adequacy test 8/6/13 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 72/24 in. Water added 450 72/52 . gal. New depth in. Elapsed Time: 1,440 min. Final fluid depth 72/24 in. Absorption rate >= 450 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons "Pump off"level at in. Cycles tested Manhole/Access (Y/N) _ High water alarm level at Meets alarm &circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100 On adjacent lots 80 Absorption field on lot >100' On adjacent lots >100' Public sewer main N/A Public sewer manhole/cleanout _ Sewer /septic service line >25 Holding tank N/A Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >5, ' Water main >10' Water service line > 10 Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10, Water Service line >10' Surface water >100' Curtain drain None Noted Wells on adjacent lots >100' N/A Absorption field >5' Surface water >100' Water main N/A Driveway, parking/vehicle storage > 10' in. F. COMMENTS ***Waiver Dated 2/16/90 to Well on Adjacent Lot. Septic System Consists of 14'x 18' Crib and 20'x 3' Trench. Both More Than 35 Years Old. 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 COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 8/10/2013 COSA brown sheet 10-10-12.doc A : AMCIIAEL E. AND'R501d • W I`�j°•• CE -4381 a` eA -- Is e1 ` ei-PROF ESS10Ne4* w'ruAnchorage . .:.,.na��pal>ity of ge A b :.. ,,. Development Services Department Building Safety Division_}° On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage. ekus (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015492.23 HAA # 14 D A a / 2, 6 Expiration Date: % — 10 — O 2- 1. 1. GENERAL INFORMATION Complete legal description Lot 363 Block 1 Fischer SID Location (site address or directions) 5110 Spruce Creek Circle Current Property owner(s) Bart & Beth Theisen Day phone 258-8750 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 5110 Spruce Creek Cricle 99516 Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. (R". 7199) A C•r^"rr-aaC\IT A0.C 1\ICOC�TION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investiaation based on procedures outlined in the Health Authority Approval Guidelines for 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn Pannone Eno. Svc. Phone 272-8218 Address P.O. Box 102954, Anch, AK 99510 Engineer's Printed Name Steven R. Pannone. P.E. Date 4/6/2002 Engineers Comments: In conducting an adequacy test.1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DliHS Guidelines & Regulations. The reported results describe the performance or 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 ane septic systems depend on the local soil condition, ground water 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 or the evaluator of this systcm. All sstems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there arc no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate or how long the system will continue to meet the operational requirements of the ADEC or AIOA DIMS. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized nor will it confer any legal right whatsoever. 5. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: WATER AND Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: 942 �„ / l� 0— fi� Original Certificate Date: C5:; Expiration Date: Reissue Date: (Rw. t 1.89) Municipality of Anchorage A, • -� Development Services Department 0��'Ico Building Safety Division `"On -Site Water and Wastewater Program Y 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6150 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 383 BLOCK 1 FISCHER S(D Parcel I.D.: 015-292-23 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # _ Well Log Y Date completed 6111/1974 Sanitary seal Y Wires properly protected Y Total depth 275 ft Cased to 264 ft Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 611111974 4/512002 EncoJnfePeA. 157" �Q1 Static water level 245 ft 235 ftUftnh(eloset-r•t-�J%1d Well production 7 9 RM 2.5+ 9 R itw�th PN(x WATER SAMPLE RESULTS: Coliform _colonies/100 ml Nitrate ar mgll Other bacteria $ colonies/100 ml Date of sample: 4/5/2002 Collected by: Laura Pannone Arsenic mgll B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 7/311974 Tank size 1000 gal Number of Compartments 2 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm NIA Date of pumping 4/6/2002 Pumper NORTHLAND C. ABSORPTION FIELD DATA Date installed 7/3/1974 Soil rating (g.p.d.dt or fefbdrm) 110 System type CRIB/TRENCH Length 18120 ft Width 1413 ft Gravel below pipe 616 ft Total depth 10110 It Effective absorption area IM 240 fF Monitoring tube Y/Y Depression over field N Date of adequacy test 41512002 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 72/16 in Water added450 gal. New depth72149 in Elapsed Time: 1440 min Final fluid depth 72116 in Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date (Rev. 11199) ffl D. LIFT STATION Date installed Size in gallons NIA Manhole/Access 'Pump on' level at in"Pump off" levet at in High water alarm level at _ in Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 110' On adjacent lots 90• Absorption field on lot • 125 Public sewer main NIA Sewer /septic service line 90 On adjacent lots 100+ Public sewer manhole/cleanout N/A Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation 13 Property line 15 Absorption field 16 Water main N/A Water service line 25+ Surface water 100+ Drainage 100+ Wells on adjacent lots O• SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10' Building foundation 20 Water main NIA Water Service line 25+ Surface water 100+ Driveway, parking/vehicle storage 5 Curtain drain 100+ Wells on adjacent lots 90' F. COMMENTS ire L uuwG �.✓ rra - 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 HAA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone, P.E. Date 4-"2 HAA Fee $ 375`0 - " /S."R... e e Date of Payment 10/07- Receipt OZ Receipt Number q (Rev. 11199) Waiver Fee $ Date of Payment Receipt Number h :Steven Il. F'onnonez� 0i Nn. Cr. 8149 w 1 , C DervE 0 09 $p,eo cc aeseg GacLE �w 3oI %� °•� rr ti 3 GA�i}nR) ..' 4vY •,� V' �. oto. JIo, .o . I z_ Zr 11A* M4 a � LoT.3/33 NOJSE / k0 (�u°9'S3'45" 75,00' _�io4'� A✓6. _ �hP�. v 49t" N I vooxul 15.8035, _:e As -BUILT - No corners set Thte Burny rtk i to Dj IM l aoot,bg used tot of puspuse 4L ei ne et"It'.t�mlla--e' OMI;�dite sham a�► i i p L ror y at once ��nUb or eet- I lleregj OttiU tMt 1 Mrs autt M the tolloeinq acct ed property: j,-= �� _ Bat �-•� - w r imcm4mm svB�r��tvi s ras`c see%anae tecardiee Precinct. Maki. end. tMt_ M ne SM10 at we ecn an latC.lt t eto,ttbginoo massto itan or att. Property etaept as It MR. Ak 11515 MUNICIPALITY OFANCHOIIAGE ,.. -•:.. • DEPARTMENT OF HEALTH it HUMAN SERVICES Division of Environmental Services 1 1,,'- -Site -Site Services Section. P.O. Box 196650.. Anchorage, Alaska 99519-6650 3434744 ' CERTIFICATE OF HEALTH AUTHORITY 'APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# -- O�J�'Z�I�._�3..: HAA#—NAg401� 1. GENERAL INFORMATION Complete legat description 3 8 10 k 10 F rcb er .S /D Location (site address or directions) . sl to Spruce fretkc C,rcfe Propertyowner Ela,^e • f Dayphone '7e3-3ZVZ Mailing address ---Situ SprurP• 6-1et,- C„ti/e , �4��^, A -k 995-/0'r Lending agency "Of- gL ' ye Day phone S62 -2ref Mailing address y60 cii. 7 Tuo%r: 4:10(- A,,choce ag A -k 99So3 Agent 5kve- R"aofy,. f/lrl R¢al Efll*k Day phone'..273'-7262 Address H211 `6" St. AAchoraai,' Ak_99500 Unless otherwise requested, HAA will he held for pickup. 2. NUMBER OF BEDROOMS: 9 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- !� Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL - Individual = `• i rt 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. _ real (P«. wi) V, MOAM 5 STATEMENT OF INSPECTION BY ENGINEER, As certified by seal affixed hereto and as of the validation date shown below, I verity 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 adequateefor the number of bedrooms and type of stricture 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. NameofFrm >=laflo.e Trchnica/ Se.virL Phone 3yS—/355— Address 12130 Ec�+o Sf., fiRciiocagP, f}Gc 99S/� Engineer's signature Date Nacl 9. /99Y �OF A - r........................:.g SA M 1 " - �, �THEOD0RE F. MOORE • it ' V. � CE -3584 ,•'�: fit, -,_ 6. `. DHHS SIGNATURE �qwc - Approved for ? bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska.The DHHS does this as a courtesyto 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..' . r2kW WAN+) eat MOAm „.. Municipality of Anchorage MEM Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo f 3 0 3 6 /k I Fisch or S/p Parcel I.D. A. Well Data Weil type Pr.vu Ft If A. B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 6 / 7 Y Driller M - w Total depth 2'75' Cased to 26Y' Casing height 2 v ” Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Date of test Static water level Well flow Pump levell FROM WELL LOG 6- /it /7y 2'/S' AT INSPECTION 1t /61911 235 7 g.p.m. 7.2 t g.p.m. SEPARATION DISTANCES FROM WELL TO: > e 36' Septictholding tank on lot 110. ; On adjacent lots > too' Absorption field on lot 1251' ; On adjacent lots > ruo' Public sewer main N. A. Public sewer manhole/cleanout N..4• Sewer service line > 2S' - Petroleum tank > zs' WATER SAMPLE RESULTS: Coliform O col //00-1 Nitrate 1. 2 C, ey It Other bacteria r6^c evecr Aea Date of sample: /I / H / 9,Y Collected by: FYo/-ly. T.ch Suc. B. SEPTIC/HOLDING TANK DATA Date Installed 7/7Y Tank size lOoa ugal Compartments 2 Cieanouts (YIN) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (YIN) N. A. Alarm tested (YIN) N. A. Date of pumping to / /N /91/ Pumper Nor" fan of SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Weil(s) on lot Ito, On adjacent lots 90' )F- Foundation 13' c.&. To property line IS' Absorption field l6' Water main/service line > 2s' Surfacewater/drainage > too' 72-026(3W)•F=1 9 See 2/lE/9a Lower {ter 1.3/3y CI CONTINUED ON BACK PAGE C. LIFT STATION N. A. Date Installed Manufacturer Sae in gallons Manhole/Access (Y/N) Vent (Y/N) 'Pump on" level at "Pump off" Level at High water alarm level Cycles tested Meets MOA electrical codes (YM) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots - Surface water D. ABSORPTION FIELD DATA P,f Trrnr_4 12s" ' I C ' Date installed 7/ -1,Y 9/T7 Soil rating (GPD/1712) l uo cr'/rSdr"+ System type Seen• P, f + tre^c% Length I0 20' Width ry' 3' —Gravel thickness !E Total depth On adjacent lots Total absorption area 96Y * 220 0' Cleanout present (Y/N) Y 4rtACA Depression over field (Y/N) N Date of adequacy test 11 / 6 / 9 Y Results (passtfa1) Pa Sr for 3 Bedrooms Water level In absorption field before test 0" fre^ca Atter test 21" ^ ire^ch ^ f• Peroxide treatment (past 12 months) (YM) Alone known Of If yes, give date N.4 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 12s" On adjacent lots 9 0' *A Property line I C ' To building foundation 2 0' To existing or abandoned system on lot N• A • On adjacent lots > 30' Cutbank N. A • Water main/service line > 2s' Surface water > 100' Driveway, parkingtvehMe storage area T'F,enc b ap rf et u^der of rile Curtain drain None see^ See 2/t6/9otuowe�- fee 43Ca a/kl 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. <. a Signature s•••i. 4--6. tw2`35; 'a Engineer's Name Th eo elo -e r-te o -e ! J ................ THEODWE F. MOORE: Date Mvicee^+6r,- 9� 0-9Y } ';�•., CE -3502A m ♦ •.w •• • • Off•♦ HAA Fee $ 3 r/0 -c'w '/ Date of Payment tlll l9 1 - Receipt Number 00�87� 72026 (3W)• Bach Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Department of Health and Human Services tan Fant. 825 "L" Street morw P.O. Box 196650 Anchorage. Alaska 99519.6650 February 16, 1990 Bruce Corwin, P.E. Corwin and Associates 1000 East Dimond Boulevard Suite 205 Anchorage, Alaska 91515 Subject: Waiver Request for Lot 304 Block 1 Fischer Subdivision Waiver Request NWR890064, PID $015-292-22 Dear Mr. Corwin: The subject waiver has been amende9 as requested in your January 19, 1990 letter. The prior approval issued on November 1, 1989 waived the required 100 foot separation distances of Lot 3B4 Block 1 septic tank to well, 80 feet: Lot 3B4 Block 1 leachfield to well, 88 feet; Lot 384 Block well to Lot 3B3 Block 1 septic tank 80 feet; Lot 384 Block well to Lot 3B3 Bloct 1 leachfield, 90 feet. The amended approved waiver is far the proposed new septic tank separation distance to be installed 90 feet rather than 80 feet from the well on Lot 3B4 Block 1. This waiver approval applies to the proposed septic tank to well separation only. Any future upgrnde to either will require all separation distances be met or another approval from this office. If there are any further questions, please call this office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/ljm:06 Co ^ur ante, 4 J to SSmmiith, P.E. Program Manager On-site Services MUNICIPALANCHORAGE O DEPARTMENT HEALTH &HUMAN SERVICES of ( Division of Environmental Services��' On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. X �-�+ �� - A r%O -3 S HAA # It GENERAL INFORMATION Complete legal description LIT 383 BL.nck I F(scHFR 5Lr3DIV13I0Q Location (site address or directions) 5110 3PELICE CREEK CIRCLE Property owner SERRY BFRG t LYu I AND R5o t Day phone 346-41757 Mailing address 5110 50RLLCE ( E -F -k CIRCLE Lending agency SEA-rTLE HO2TGA6E Day phone .15 G *7 - 96- Z(o— Mailing address 560 EL 34 th AVE ANCF AK Agent 5nLD ray OWNER Day phone ABOVE- Address BOVE Address ABOVE Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-0251Rev.11911 From MOA121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or 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 SKIN CONSULTAfITS_Phone_a45---947 Address Engineer's signature 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments .Date h Au r, J swan C. CE -7604 .to PROFESS�ONP�� bedrooms, with the following stipulations: By:/��-.�/ Date C —2C-92 • The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-023(Pay. 1.91) Bach MOAM21 .. .� Municipality of Anchorage Jak Department of Health & Human Services low HEALTH AUTHORITY APPROVAL CHECKLIST QDEW Legal Description: Lat BB3 Block I F h r Parcel I.D. A. WELL DATA Well type PVT If A. B, or C, attach ADEC letter. ADEC water system number "A Log present (Y/N) N Date completed I I SU ne ' 74 - Driller M -W Dri I 1 i ag Total depth G 275 Casedto o 2641 Casing height I.R' Sanitary seal (Y/N) f Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTIONN MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Date of test I I June '74 7-24 -92 11 Static water level 245' 232' "u r' 10'1992 Well flow 7 g.p.m. 7.1 dV3 `UC E I V E D Pump level Not recarded Esbrna4e 2551 601 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Ito FT To TA1JK CLEAMOUT; On adjacent lots ©140 F•T TD CLE IT Absorption field on foto 130 FT TO CLEA1 000 ;On adjacent lots 155 FT TO r I EAWQ1 IT Public sewer main ' NH Public sewer manhole/cleanout Public sewer service line WATER SAMPLE RESULTS: Petroleum tank ' fJonn ob.SerVed Coliform 5aiisfad-12CU Nitrate O.98 nnsi Other bacteria Mang Date of sample: - - 724-92 Collected by: •5kUl COWSOItan _ B. SEPTIC/HOLDING TANK DATA Date installed 1974 Tank size 1000 Compartments dmknown Cleanouts (Y/N) Y 600) Foundation cleanout (Y/N) Y' ' Depression"(Y/N) N High water alarm (Y/N) NA Alarm tested (Y/N) 1.1A Date of pumping TSO -'i2 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: C Measurcd from cleanout .-1a Cleanout 3 Well(s)onlot O110� On adjacent lots 801st WalyeC Foundation-- 13� To property lineOl9- Absorption field IV Water main/service line WA 2 Surface water/drainage O Ao—r°rfOX f30ff 4o =d Ai}r i164tb4uC) 72-M (R". W91)from MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION NA Date installed Size in gallons Vent(Y/N) High water alarm level _ "Pump on" level at Manufacturer Manhole/Access (Y/N) ••Pup eft' eT vel at �cles tested Meets MOA electrical codes (Y/N) SEPARATION D E FROM LIFT STATION TO: n lot — D. ABSORPTION FIELD DATA On adjacent lots Surface water 3 Date installed pr+ mr4 Trench 1971 Soil rating 0100 SF/ddrm System type PIT I8X143QPIT 18x14 s Lengt T2EtJrµ -?n' Width TREOrj4 3' Gravel thickn3 PoT At il 6' Total depth Pt 13,7` TEMCb (0.2t Total absorption are(PQI i PIFTrrrl� Cleanouts present (Y/N) IN Depression over field (Y/N) 0 Date of adequacy test' 7-74 9 Results(pass/fail) rusf;m for bedrooms Peroxide treatment (past 12 months) (Y/N) Nrsn If yes, give date UA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: (-Meas red f}yyn CIeOttout to GlcOnoot� Well on lot O 130 On adjacent IotO��LI(�dt?r 3641 Property IlneO 151 To building foundation 31 To existing or abandoned system on lot NOW On adjacent lots 45' Cutbank QA Water main/service line WA Surface water W c91e 0b56yed Driveway, parking/vehicle storage area Z' Curtain drain Nar>e E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or contormed to all MOA and HAA guidelines In effect on the date of this inspection. © Frorn tucil Log. O'r 02 Scaled from s ey a.s-built cJ4W T-4.88 qPM "" Signature Engineer's Name - Sieve /%ns/ce7,---,7 k Date _6&V.97- /y�;arwn 3Q Tgken from MOA CIes11 ' CE' 604 s r fy HAA Fee S 1760"0' Waiver Fee: $' Date of Payment Date of Payment Receipt Number f �`3 3 — Receipt Number 72-M (Rw. 2N1)Book MOA 21 Saeu�s JUL 2 01988 GREEK C,/"K GL E LW80.00 I OA 5p 69 p?r Iv C 1/ Z-SsoRY i FitA.•fc //o.st �j I � 1 3S3ID 0►� OF 14, ' c' rr, MUNICIPALITY OF ANCHORAGE DEPARI MENT 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, Location (address or directions) sakaY Ols 2 92 2,3 X199- 09 Ua Application Date JJAIc Z3 198a range) r -m ty(Jwner- / _ n .� f I dt_y rVORNILPc KAI (b) met ��Telephone: Home 7_ mac? l �' Business Z77-95�� ApplicanUddress SSD IV -7tk lgue Sly t fe /6Sz RhA' AIS 991 0( (c) Applicant is (check one): Lending Institution [3ylp ; ; Owner/builderBuyer ❑ ; Other 13(explain); (d) Lending Institution Address (e) Real Estate Company and Agent ------ --- -- -- Address - Telephone (f) Mail the HAA to the following address: r.-, f/ SZZ - /-T Il Ar fiB�6 Telephone 2. TYPE OF RESIDENCE _ Single -Family Multi -Family ❑ Other Number of Bedrooms 7 3. WATER SUPPLY Individual Well, Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-025(11,64) S. 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 Firmnv r.11 A) Arrnc Telephone -SZZ - 7 It Addre Date t !r J. Corwin : � s Engineers Seal C&5283 �4'— . 6. DHEPAPPROVAL9L Approved for _� bedrooms by Date / -7 -14 -89 Approved X �� Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the 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 to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 / 7x -0n nveq MUNICIPALITY OF ANCHOR ^ f"d-) ENVIRONMENTAL SERVICES DIVIaION JUN 23 1968 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 RECEIVED 2644744 Legal Description: L nT 31 3 RL K / 14F A. WELL DATA Well Classification RC IVAT'e If A. B. C. D.C. Approved (Y/N) Well Log Present (Y/N) �— Date Completed � � x CAM Yield �• 4' hA 1 �'�( � - Total Depth -1,7 S Cased totem Depth of Grouting Q Static Water Level 2 2 S Pump Set At 2 5c)l 1 Casing Height Above Ground 2 Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot (� O ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot Ido -f- ; On Adjoining Lots Oki) +� To Nearest Public Sewer Line Z To Nearest Public Sewer Cleanout/Manhole 1 To Nearest Sewer Service Line on Lot Water Sample Collected by � 1Eice)( rrm ; Date A9 1,98 Water Sample Test Results SAT -II FAC_7Vf4 Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size L 000 4 K No. of Compartments 7 Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) Al Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) u/Temporary Holding Tank Permit (Y/N) L1 44 - Separation Distances from Septic/Holding Tank: r To Water -Supply Well X00 To Building Foundation /O r To Property Line )Sr I To Disposal Field 0 S t f To Water Main/Service Line Zf I t To Stream, Pond, Lake, or Major Drainage Course Ccmments`'k )��rJ rn Iia//er/ o� fo„frc �. shy Page 1 of 2 72 -CM IS v 8'861 From ' C. ABSORPTION FIELD DATA 1.1. ii474 1977 7 Soils Rating in Absorption Strata 100 5�lod„Type of System Design Date Installed PIf�1914' 7rea4-:/477 Length of Field 'PtT-►/P'X'14''1't-Li K1.-Z0� Width of Field Plr- /f 'X/9'� /rrec.( -'r 36" Depth of Field PIT-' // t T rre 1, • 101 Towl ?fr = 6Z4 Gravel Bed Thickness TeeA.e H - 6& Square Feet of Absorption Area T14 = 384 ; 71-eC-4 = Z42' Standpipes Present (Y/N) Y Depression over Field (Y/N) u Date of Last Adequacy Test 6.19/88 Results of Last Adequacy Test 5ATXFNcT0e4 Separation Distance from Absorption Field: To Water -Supply Well /OO & + To Property Line 714—W 7' %rr„c( /01 To Building Foundation T/+ -ZO't Ire. A -/0' r To Existing or Abandoned System on Lot U /A 1 t To Water Main/Service Line SO / To Stream/Pond/Lake/or Major Drainage Course _ / To Driveway, Parking Area. or Vehicle Storage Area d Comments -Y Rr .41 ,0, -Elle 456 ' /f D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at N High Water Alarm Level Tested for Electrical Codes (Y/N) Comments •" Check I certity tt Signed/ Receipt No. N %A On Adjoining Lots *' 2b t To Cutbank (if present) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Rating Alyainst HAA Request •• or conformed to all Aan HAA guidelines in effect on thedate of this inspection. Date y 3 1 ruc/MOA Date of Payment Amount: $ 7O Page 2 of 2 77.076 IS" 8'861 enc& Engineer's Seal M A LEGADESCRIPTION STREET LOCATION 11 k lTY OF A MUNICIPALITY OF ANCHORAGE DEPT. O. 1:'. ^ LT I & - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECT16NVIRONl: ENTAL i .. XLCTION .. • 825 L Street • Anehurepe. A4tke 99501 `? SINGLE FAMILY ENVIRONMENTAL ENGINEERING DIVISION APR 2 3 ❑ MULTIPLE FAMILY Tsilaphone 2844720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. IneomPleb "quiets will not be III, e I plee ANO"40 11m do"fpr pspcpWOg. 1. PROPERTY OWNER ((1'► PHONE COMMUNITY 5- MAILINGAQDRESS depth (attach log if available.) PROPERTY RESIDENT (if different from above) PHONE 2. BUYER If system is over two (2) yefirs oldadequacy test is required Q �l I 'u 6. ►- - a 3- MAI L NG ADDRESS »nt013/78) 43 2 v 0. LEND OINSTITUTION Aor - C_earz PHONE a MAILING ADDRESS 4. REAL 9 AGENT f� Pv G{(l% CL'k(e�,•u- PHONE a7a-urs MAILING ADDRESS A LEGADESCRIPTION STREET LOCATION 11 k S. TYPE OF RESIDENCE NUMBER OF BEDROOMS `? SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ MULTIPLE FAMILY El Two C3 Five Three ❑ Six 7. WATER SUPPLY INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975 r wells drilled prior to tha date, give well ❑ PUBLIC UTILITY depth (attach log if available.) S. SEWAGE DISPOSAL SYSTEM �- INDIVIDUAL/ON-SITE" "If individual/on-site, give installation date S7 QLN ❑ PUBLIC UTILITY If system is over two (2) yefirs oldadequacy test is required Q �l I by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REOUEST BEFORE PROCESSING CAN BE INITIATED. »nt013/78) )X,Pt: • " THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME IME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ 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 ❑Sept�iIc/^Tan1k6r ❑Holding Tank —.—._If Tank is homemade give dimensions: SOILS RATING S' TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL la - 4. DISTANCES WELL TO: Septic Folding Tank Absorption Arse Sower line Neaten Lot LiM Absorption Area to rearm Lot Li W$ S. COMMENTS APPROVED FOR J BEDROOMS ❑ CONDITIONAL APPROVAL (letter must a any certificate) L1(L�DISAPPROV ED DATE / —� 1 BV (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/781 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 016Uu J cue. J 46 121 Z 6,n 1. Lending Institution Request: `ie Alas eiv. Mailing Address: Phone: 2. Property Owner: Mailing Address: Jerry D./Bonnie G. Vanderhoff Phone: % Terri Huffman, Dynamic Realty 279-7611 3. Legal Description: Lot 3B3 Block 1 Fischer Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) 5. Well System: Permit # Construction 6. Number of Bedrooms: Three Number of Bedrooms: Individual Well (x) Depth of Well Sewage Disposal System: Permit # I Septic Tank Size Absorption Area Community/Public System ( ) 275' Well Log on File ( ) Bacterial Analysis On-site System pc) Public Utility ( ) talled 1974 Installer 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 CY01-114 4�c u 1w d iLb-L&/ � Cw)ut S DL( T 4 6glcv�t__ \, ��• ICIPALITY TME F HEALTH OF ANCHI .'6T AND ENVIRONMEN PROTECTION 5r L., Anchorage, Alaska 99501 • ,1 4 9"-2511, ext. 224 or 225 Date Received: July 19, 1977 #1: Time #2: Time �in� #3: Time Date l/_ ^ • is Date /1 6 q -1-1-j ,,,15 Date --Insp--- Insp Insp �n REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 016Uu J cue. J 46 121 Z 6,n 1. Lending Institution Request: `ie Alas eiv. Mailing Address: Phone: 2. Property Owner: Mailing Address: Jerry D./Bonnie G. Vanderhoff Phone: % Terri Huffman, Dynamic Realty 279-7611 3. Legal Description: Lot 3B3 Block 1 Fischer Subdivision 4: Single Family Residence: (x) Multiple Family Residence: ( ) 5. Well System: Permit # Construction 6. Number of Bedrooms: Three Number of Bedrooms: Individual Well (x) Depth of Well Sewage Disposal System: Permit # I Septic Tank Size Absorption Area Community/Public System ( ) 275' Well Log on File ( ) Bacterial Analysis On-site System pc) Public Utility ( ) talled 1974 Installer 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 CY01-114 4�c u 1w d iLb-L&/ � Cw)ut S DL( T 4 6glcv�t__ �i4UNICIPALITY OF ANCHORAGC1NU11.ILALITYCF6r. CFlcP.A3r. ,.�;*,.�-.. f_Ai. Gr' im'f1.1 t ,.. . _•`< ?'Department of° Fiealth'and-Environmental FfzotebEibn°��,cct;ON 1 825 71 Street; Anchorage, Alaska 99501 279-2511, c�t. 224, 225 JUL 19 1977 ast for Approval of Individual Sewer and Waf.6 /F$gil]l;tp,es (otimaiwl. 11 now PA c*6 town) 1. Property Owner: J,;,-rru D, a 1n.nn;o Q,\larxi rhoFF C/o Dyna�;c 'Renity, In(!- Ckr7 i HuffMan or Ken Calhoon) Mailing Address: i�F sol W. Nor+kern Ug6t•5 "bly4 Phone: )7'7.71,/t1 g9sg3 2. , Name of Buyer: unKnow n Mailing Address: Phone: 3. Lending Institution: unknaun ai this time. Mailing Address: Phone: 4. Realtor/Agent: Terri crKen Q0)0otl- D�,narY,ic,'Realtj/ Mailing Address: sal u). /VO(tjjern ighfs 't)ld. Phone: a7N•7c. 11 5. Legal Description: kot 3S3 'B►otX l Fischer G. Street Location: Single Family Resiue:nce: Multiple Family Residence: py vumDer oI Bearooms: 3 ( ) Number of Bedrooms: 7. Water Supply: *Individual well Dpi Public/Community System ( ) Zi5' -1�.n^ I If Individual Well, well depth kr¢-u c'��la If Community System, name of system 8. Sewage Disposal System: On-site System pG Public System ( ) If On-site System, date of installation: 19 714 b000 r3Olfbno *NOTE: A well log is required on ALL wells drilled since 6/75. . pp/ 3/77��/` op� !�k. r Page'�ao -- Department of Health and Environmental Protection Request for Approval of Individual Sewer and [later Facilities Legal Description: Wt 3S3 Block 1 riqcher SuMimis;on Comments: Affadavit Attached: ( ) Letter Attached: ( ) Approved: /7 Disapproved`: Department YTorksheet: 4&1� = 5 1 1�1 i I f 46-L/ 71.2 1 Date: l;7p -%% Date: 7 ii �- '�" • September 8, 1977 Jerry D. Vanderhoff • Terri Huffman Dynamic Realty 501 hest Northern Lights Boulevard Anchorage, Alaska 99503 Subject: Lot 3B81b&bcl 1 Fischer Subdivision This department recently conducted a percolation test on your sewer system. The test shows that it failed to meet the adequacy test for a three(3) bedroom single family residence. Before this department can send approval to the lending agency an upgradedof your sewer system will be required. The upgrade includes a twenty(20) foot trench connected to your existing seepage pit with six(6) foot of screened h - 2h inch gravel below a four(4) inch drain pipe. Prior to any construction, a permit must be obtained from this department. If there are any further questions, please contact this office at 264-4720. Sincerely, Robert C. Pratt, R.S. i+ SanitarAan 1 GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received Time of Inspection Date of Inspection /aA/71p, REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR -ctialJ , I. Approval requested by: Mailing Address: _ 66 1( /7i,P X o 1 Phone: 2. Property Owner: Phone: Mailing Address: 5 3. Legal Description: 3 /3 3 /s/., /��/ ,� t i 4. Location: _Sea�,at� �'he�c Cru Lr, 5. Type of facility to be inspected j4WA No. of bedrooms � 6. Well Data: A. Type C. Construction ax�ryl�nd 7. Sewage Disposal System: B. Depth 2 7 f' D. Bacterial Analysis r A. Installed 7- 3 B. Installer zye"?e v_ C. Septic Tank: 1. Size /Doo ,laQ 2. Manufacturer V X7' D. Seepage Pit: 1. Absorption Area ;U-/ 2. Material —r E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank /i0 f , Absorption area 130 Sewer Lines Nearest lot line /0 Other contamination — B. Foundation -to septic tank ).> Absorption area 30 C. Absorption area to nearest lot line 121 EQ -034 (1/74) Page 1 of two pages of •two pages"- Re st for,Approval of Individual rer & Water Facilities Description Comments Approved Zea'xcz,J Disapproved Date ApprovalkValid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM i certlry tnat the inrormation 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)