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Home My WebLink AboutWILLIAMSON BLK 1 LT 2Williamson Block 1 Lot 2 #015-073-07 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211473 PID Number: 015-073-07 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑ Upgrade JEREMY HINSHAW Site Address 5311 EAST 98TH AVENUE *ANCHORAGE, AK 99507 Phone Number of Bedrooms 907-351-1368 3 LEGAL DESCRIPTION Block Lot WILLIAMSON; BLOCK 1, LOT 2 rownship Range Section ABSORPTION FIELD ❑ Deep Trench Al Wide Trench ❑ Bed ❑ Mound ❑ Other Soil Rating Total depth from original grade *5.0 GPD/SF 6.38 MAX) Ft Depth to pipe invert from original grade Gravel depth beneath pipe SEE DWG. Ft. 0.52 Ft. Fill added above original grade Gravel length SEE DWG. Ft. 26.5 Ft. 3ravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES 5 Ft. ' - Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 125+ Ft2 1 - Well *50r+ *50r+ 25'+ TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity EXISTING Gal. Surface Water *50'+ ( *50++ Material �. Number of compartments Lot Line** 1 0'+ 1 0�+ I NA --"'/ FoundationI 10�+ 10�+ LIFT STATION Manufacturer Capacity Remarks *AWWTS **5'+ TO DECK POST INFILTRATOR 540 Ga Alarm location Electrical installed by REMOTE CAPSTONE PIPE MATERIAL House to tank EXISTIN drainfield Tank to Installer D3034 A+ HOME SERVICES Drainfield D3034 CO/MTD3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 100.00 ft Inspdection 15` 1/18/22 2nd 1/20/22 Location and description 31d 1/20/22 4`h 1/20/22 BOTTOM OF TRIM AT NW CORNER ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp t =1 oboo�p Conditional Approval: Date ooP�� ff: ' �IS,4�o �......./ .............:....� Je frey rness, Septic System �vr�-C,>� Approved �,C� _ Date �iE .�f.� Note: this approval does not include well permit requirements. aAEcc 44��00fesoo0Q� :v 05/02/18) PERMIT NUMBER: PARCEL ID NUMBER: OSP211323 RECORD DRAWING 015-073-07 A B DBL1 36.7 52.9 DBL2 37.7 53.6 FD 38.3 54.2 WILLIAMSON #1; BLOCK 1, LOT 15 MH1 39.0 58.8 _ VP1 26.1 51.4 Al 21.9 48.5 VP2 17.9 46.5 C01 15.0 44.3 MTI 13.3 43.1 CO2 26.4 34.4 APPROXIMATE LOCATION OF MT2 27.3 35.4 EXISTING LOG CRIB NOTE: PIPE LOCATIONS ARE SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO / S910 LASER DISTANCE METER. SWING -TIES TO HOUSE CORNERS WERE MEN( GENERATED IN AUTOCAD. 10 VS\oI epSE 0 \� NEW IM -540 INFILTRATOR SEPTIC 1 / TANK UTILIZED AS LIFT STATION F DBL1&2 EXISTING CONCRETE TANK MH1 0 STI MT 02 SHED NEW N3500 TREATMENT POD G A � PATIO � WILLIAMSON; BLOCK 1, LOT 3 GEG T NEW DRAINFIELDJ EXISTING 3 BEDROOM HOUSE \ 50' WELL RADIUS / SHED lks 1111111 7-77=7" , ,_ . m ._. . _. GROUP,;.....:... ............. .... .... ..., ENGINEERING�SAL€S�CONSULTING .,, � �. _,..,a 3701 E. TUDOR ROAD SUITE 101 - ANCHORAGE, ALASKAPHONE (907) 337-6179 - WEBSITE: w .gamessengineenng wm /( .......... . . PREPARED FOR: PHONE NUMBER: PAGE NUMBER:% - ire . i nesse•:• / JEREMY HINSHAW 907-351-1368 2 OF 3 �� ?�, E-7953 a PROJECT/LEGAL DESCRIPTION: DRAWN BY: •� • WILLIAMSON; BLOCK 1, LOT 2 D.J.G. �t� .. •''•pp'��tUJ�f�� 4W TYPE OF WORK: DATE: LICENSE t,4141k\siL`—�•� SEPTIC SYSTEM RECORD DRAWINGS 1/24/2022 #AECC884 TANK AND TREATMENT POD FROM CONCRETE SEPTIC DRAINFIELD IM -540 INFILTRATOR TANK - USED AS RE -CIRCULATION TANK COMMENDED FLOAT SETTINGS (FROM BOTTOM OF TANK) -OR-D E ;'JH WATER ALARM 4W LEVEL CUTOFF (ON/OFF) 28' z < 0 < U- 04 I? z 0 z cl) W > W W Q 0 ui < < Z LL z °°0 0 vi W u < IVJ _j Qt u- 0 wl o < w w **lMs OFA", AV # A Aw E-VATION OF BOTTOM OF 49i avjlsvwx*v�. 11 ##season** 0 .67 (GW AT 81.7 ON 1/18/22) A J f i 0 Atv *t�SA*ws� p�vi�*xvxv awns a 0 # e ff rey amess AV - AF CE7?5q ## z <1 4W AM*" AuMo6ftd 0"kt P-OROFESS fill so z < 0 < U- 04 I? z 0 z cl) W > W W Q 0 ui < < Z LL z °°0 0 vi W u < IVJ _j Qt u- 0 wl o < w w **lMs OFA", AV # A Aw E-VATION OF BOTTOM OF 49i avjlsvwx*v�. 11 ##season** 0 .67 (GW AT 81.7 ON 1/18/22) A J f i 0 Atv *t�SA*ws� p�vi�*xvxv awns a 0 # e ff rey amess AV - AF CE7?5q ## z <1 4W AM*" AuMo6ftd 0"kt P-OROFESS V� s SHANE A. HOLT..- LS-6914 OLT LS$914 a` 4 ooapr°Tesslona� 4qc �O�QQQa�o TNF INFCIRMA 370H HEREON IS FOR THE USE OF LENCMG WS?TFUnoNS.SPECtFIC&Ly TD SNdNANY CLWFLrCFS BETN@EN EMSRAG STRUCTURES AND PLA77F11 WT UNES N+AYYF EASENEVFS AND tS NOT TO BE USED FOR P05rWYING ADDOWNAL S TRUCTjMES- WPROVEAIENn, OR FENLELINES. EASE14ENT5 OF REOLIRD OR OTHER RfGHTS pF WAY, OR ANYaMTr NOT ON THE RECORD PLAT ARE NOT,%WWk HEREW UNLESS NOTED. NOTEPENCEUMES THA TAIAY APPEAR ON TW DRAM% ARE MOT FO BE uSED TD AETERMNE PROPERTY RHES OR POSITION ADOOPONAL IAHPROVEAIENT$ ANYPAVIK SHOWN NEREOM AU YEE APPRO7fWATE DUE T4] EXCESSIVE SNOWAMMi RICE. AS-SUILTSURVEY I" =20, NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVh PERFORMED A SUR VP OF 7HEFOLLOWING AESCReW PROPERTY SOT 2, 3LOCK 1• WXUAMSON SUB j PLAT 70.38) ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS WTVA TED MEREONARE WITHIN THEPROPERTY UNES AND NO VWLE ENCROACHMENTS E yf S T OTHER THAN NOTED. DATEOATANCHORAGEALASKA THIS 24 7H DAyOF J.ANUA.W • 2022 15187, F8 Ji;S� ]JP -26 HOI f L AND SUR%,FY1N6 9309GROVFR i RPWE AAVCHORAGE,AIC 4+_�•507 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program poBox 1mm50 4700 Elmore Road Anchorage, Alaska eea19-M6on pom"o: 904 Fax: (907) 343-7997 Permit Number: OSP211473 Work Type: Septic Upgrade Tax Code Number: 01507387000 Site Legal Address: WILLIAMSON BLK 1 LT 2 G:2437 Site Mailing Address: 5311EUOTHAVE, Anchorage Owner H|NSHAVVJEREMY L&TIFFANY R Design Engineer: GARNESSENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 11/3V2O21 11/3)/2022 2Disposal Field 2Septic Tank ElHolding Tank 0 Privy 11 Private Well OWater Storage All construction shall beinaccordance 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 (18AAC08) 3. The wastewater code requires inspections during the installation. The engineer shallnotify the Development Services Department per AMC 15.G5.Provide notification bycalling (907)343-7Q04(24/7' 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: n. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Special Provisions: 1)Analternative means and methods has been granted toutilize a CAT III application rate for the Ouonics � system based on the engineer's justifications and the fact that there is 2 ft separation between seasonal high � groundwater and bottom nfthe 2ftsand layer. double cleanout shall be provided downstream the existing concrete septic tank, as shown on the profile Issued By: Date-, 3 tZ.� :a ai.... �.s .'� ^�✓'3 .� 3 vxa `,3 '+�� f �Y .., 53 a F':s._' JR 5�.i '4 - Development Services Department Phone: 90 X34 3-79 On -Site Water & Wastewater Section Fa,:. 907-343-79 ON-SITE SEPTIC/VVELL PERMIT APPLICATION Parcel I.D. 015-073-07 Property owner(s) Jeremy & Tiffany Hinshaw Mailing address 5311 East 98th Avenue *Anchorage, AK Site address 5311 East 98th Avenue *Anchorage, AK Legal description (Sub'd., Block & Lot) Williamson; Block 1, Lot 2 Legal description (Township, Range & Section) Lot Size Sq. Ft. APPLICATION IS FOR (® all that apply) Absorption Field n Septic Tank Single Family (SF) 0 Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Day phone 907-351-1368 Number of Bedrooms 3 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) 0 (w/wo ADU) Upgrade Q D ❑ Duplex (D) Renewal El Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Jr� 5 Waiver Fees: Date of Payment:// llalh I Date of Payment: Receipt Number: 0 7 H 7 S (,= Receipt Number: Permit No. _ D SP A 1 1 y 7 3 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211473, Rebecca Carroll, 11/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211473, Rebecca Carroll, 11/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211473, Rebecca Carroll, 11/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211473, Rebecca Carroll, 11/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211473, Rebecca Carroll, 11/30/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211473, Rebecca Carroll, 11/30/21 o S66 w'3JY01Y Rnff! 3ArMU UYAQ-eW 6OV6 NZA8AgilS QNV7 Z70H r7oZ JO AVG r._ _ f 5fJ{t V,•i5Y'fV'3JVdpN7Ary15' 03100 C91ONNVHA �UP101S7X3 S1N3HH3vo8l5W ,TNWA ON ONV S3Hn A( K3Hwd 3H1. NIH1.W 3dVNG'3ff3N-! p31 WnDS 511J3iY3A07fdW13iBfSHI 3H11vril UF�V 'YN4ti N'1.',1al5fO 9fRONCJJ3tl:JYdGlCJN� 3�V$D HYAAONS 3MS53.3X3 p.A 3M 91 VWJXO ddVrM Ay1Y 7003d -;q NMOff '!%MVd ANY s1 AR03AOWPVO IVAY1 LMV NQl rOd.VV' S3MJ AId3dC19d 311093130 01 030 I:m 01 JCW Sar %W YM7 slrf f nG w3ddYAYN im 0mle jN3d 3iDN 03ION55377Nf M7393N NMAOH5 l(n 3W JVld&iM3!!3N! AO A ONABIN3 ANY 90A FM 4 WPM 9-V410 Ho 011p.730! do sjmaw vY 53N7137N2d M7 s11F371'3M1QNdYff's3kP71O7AY1s TM011000 9Wyoulsod 60:0 o35Y139Q1 ion :l"SfNau5Y.-7 sw" SRM? 407 cijlvld aw sgM7 ywve n4ui k3 n3--mmuw Tjofli .tiWMORS fu AIWY -fQ-WS SAMP4USNf`AVh7431 AO 3501391 Wodv 903939 WE 000' N3M! A193d{ bilj3u;do530 `3N7A1QMJ 391 i0 l �ppC>Qn4 ❑ AwAgfrS V 04004HW3AVPf IION) A-R.AgA Aa -q 3PJ4 f �guurss�f 4 31tl0 S IHI A35 SL3tMo] ON dpl)e _ - - - - a40a ,oz= „1 A3AHnsl71n,9-SV ❑ovF. J469-S� I]OH 'V 3NVHS A 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 V-1 Day of C of 20� by and between �1 1�► 4.nV �4ivks nq w __, 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 permission to the Owner to utilize and operate anAdvancedWastewater Treatment System (AWWTS), fl described as � ti cS u Ca ce located at (legal description) o, -5&P, V�1 L�- 2. Maintenance Repairs and Alterations. (Owner is required to read, understand and initial each section) t 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. Lr— 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). 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 drainfeld replacement. (rev. 05/18/2018) Page I of �J �� 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 maybe assessed in accordance with AMC 14.60.030. JM 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 (signature) Date: to, —Fganq li� (Print name) OF ALASKA )ss. THIRD JUDI�L DISTRICT The foregoing instrument 20, by NOTARY PUBLIC FOR ALASKA My Commission expires: before me this — day of MUNICIPALITY: /Y A By: (signature) 1(—(Print name) -Se-le AAHachrnent Tsar Notary Seal g 2- ! Date: If[ 1) 7,ZP-2( Title: CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189 Y�G.�wr A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California 1,, ) County of t wDmAo I ,, On QQ� rte—,( ,% � before me, � iLY �}-TY)Tu y TUV M. , Lw Date �" Here Insert Na and Title o th�s'ce' r personally appeared r\t—) lk Name(s)of Signer(s) who proved to me on the basis of satisfa-cMry evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. AMBER ABREU U COMM. # 2375739 (� •• ; NOTARY PUBLIC • CALIFORNIA SHASTA COUNTY C> COMM. EXPIRES SEP. 2I, 2025'` certify under PENALTY OF PERJURY unqer the laws of the State of California that the for in paragraph is true and correct. WITNESS my hand and official Signature Signature of Notary Public Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Do ument Title or Type of Document: 116 w�s� Document Date: a ` Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Na e: ElCorporate icer — Title(s): ❑ Partner — Fix ited ❑General ❑ Individual Attorney in Fact EJ❑ Trustee ardian or Conservator ❑ Other: Signer Is Representing: �-m ckj r4 e, Ko vaAri, S Number of Pages: P0_I r Signer's Name: ❑ Cor rate Officer — Title(s): 13 Partner ❑ Limited ❑ General ❑ Individual\ ❑ Attorney in Fact ❑ Trustee — Guardian or Conservator E) Other: ��sss Signer Is Representing: 02015 National Notary Association • www.NationalNotary.org • 1 -800 -US NOTA13Y (1-600-876-6827) Item #5907 GRE; 'TR ANCHORAGE AREA BOR IGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 ��pp INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAMEER/e l"(7E- I zscl-/ MAILING ADDRESS .$LV/ &x `7654 PHONE SCEW -6S 16 LOCATION. d . get Of -re 6/IteN LEGAL DESCRIPTION kr a <,zx / WL/e'/p�n.s,,J h SEPTIC TANK: DISTANCE FROM WELL /�'/ INSIDES LENGTH TheeTS A3nar3 .specs, P&t,aso CQf?&r *77TH '1 W/ ,.,STLtt /Celle Fnlecccpvv [�riErLES ORtikci": 21,o" /NLCT 310p 1( FRo.n A, oma'» NUMBER OF MANUFACTURER .4-67)C/?IAMB MATERIAL 1.D/1CieTC COMPARTMENTS ( INSIDE WIDTH '177 / / LIQUID DEPTH 5 LIQUID CAPACITY. 4 D GALLONS. SEEPAGE PIT: 1 NUMBER OF PITS 7 DIAMETER OR WIDTH /8 LENGTHDEPTH DEPTH /0 //,/ LINING MATERIAL °venth _ CRIB SIZE: DIAMETERXAJ DEPTH /6 DISTANCE FROM: WELL /00 BUILDING FOUNDATIION,50 NEAREST LOT LINE <)471 TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) -73. SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE -CAM/V. BUILDING CONSTRUCTION & Gia3//40 , eale.o( DEPTH cQ /6/ NEAREST FOUNDATION Jo '"f"" LOT LINE /0 CESSPOOL _ OTHER SOURCES APPROVED DISAPPROVED DISTANCE FROM: NEAREST I SEPTIC 7 SEEPAGE / SEWER LINE /O -( TANK /b0 i SYSTEM /00 REMARKS DISTANCES:a.s , hlLm INSTALLED BY• /)f p//C/JNT' �/17/ke PIPE MATERIAL•iaLea4 ///O%"V LOT SLOPE: C REMARKS: //02h1 SOLE [D✓Jt Form No. EQ.031 DIAGRAM OF SYSTEM / 2µ1 seoct- R 8.� fool --710 1 Aa a aotittar wefi DATE '//o / 7 ¥ APPROVED .L ' .R C. gaol-12vJ G.A.A.B. GREATER ANCHORAGE AREA BOROUGH DEPARTMENT or ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE:, ALASKA 99503 TELEPHONE 274-4561 ;.�/ , , /11 7/ SEWAGE DISPOSAL SYSTEM =- APPLICATION AND PERMIT PERMIT NO NAME OF APPLICANT .� e- ZS e/7 -�/O� MAILING ADDRESS 70 INSTALLATION LOCATION i SAY-? /6/ / PHONES%q &5% LEGAL DESCRIPTION g/ j', 6 ////nnogo, Si) r. INSTALLATION OF: SEPTIC TANK _ SEEPAGE PIT n DRAIN FIELD _, OTHER TYPE AND SIZE OF FACILITY TO BE SERVED J ✓) A/C • S//V9 /F /42-71/1/2/ /1/2/ /y //,I(u/(�� FINANCED THROUGH - TO BE INSTALLED BY ^ Sri - ' /iSelo c ."e�(tat_ SOIL TEST RESULTS � NOTE: THIS PERMIT ISNOT VALID WITHOUT SOIlr'FES'G_ COMPLETION DATE ANTICIPATED 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/000 4/i TYPE Z SEEPAGE AREA SIZE//)L�1/i.)/F TYPE MINIMUM DISTANCES. REQUIREMENTS deC / FOUNDATION TO SEPTIC TANK //,,^�� FOUNDATION TO SEEPAGE PIT (.gyp DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL + /.5 / / Y SEPTIC TANK SEEPAGE PIT ES-20DRAIN FIELD TO NEAREST LOT LINE. r WELL TO SEPTIC TANK _ /10 0 SEEPAGE PIT _./Ob DRAIN FIELD /O0 ALSO CONSIDER AREA WELLS. r WATER MAIN TO SEPTIC TANK /0 r SEEPAGE PIT /0 DRAIN FIELD le SEPTIC TANK. /QO . SEEPAGE PIT TO RIVER, LAKE. STREAM. tit e DRAIN FIELD /0 0 CAST IRON INTONA D OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATLON-SFEFT_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. OI LICENSED 1 SIGNER DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE. AREA BO eLjtR DESCRIBED SYSTEM 15 IN ACCORDANCE WITH SAID CODE. DATE .5/67`7% FORM NO. EO -016 APPLICANT'S SIGNATURE It NANCE: NO. 28-68 AND THAT THE ABOVE GREATER ANCHORAGE AREA BOROIJG' Department of Environmental Qua ,y 3330 "0" Street Anchorage, Alaska 99503 SOILS L G PEROLATION TEST Performed for ER/C Pot Z s c Date Performed 6/'2-'r/7`l Legal Description: L o 7— 0 Lo_cAL "Ai, /him so, c, 6ehiari tN Percolation test This form reports: Soils log Depth Feet 1- �„- ecJ .56O - 730 5 -- 6 - - sa ,,I9us %`/o /D (cion R Se eg,6e cvtae 1 9- 1i 30 Was ground water encountered?/t/Q If yes, at what depth? - SJOpe alit) � C r v Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate minute. Proposed 1nstal1anon: Seepage Pit Drain Fi e Id Urpth of Inlet 2 r _ Depth to t ottom of pi t or trench COI;PIENTS: /.3q_�y•- '� sievit (Aye 4:41---raze-4A-4-4e. i /` oght_ /U o 6 to li-rre-4_ o c,nd fcc -fie .ems Performed By: i _ Th q -t - _-Certified By:,!0a} %�.�p;v�v Date: (� 2517 EQ -040 (6/74) M -W DRILLING INC. P.O. BOX 10-378 ANCHORAGE. ALASKA 99511 PHONE 349-8535 NAME ADDRESS f-/4,17/fr J.:- 9. Y4 CITY LEGAL DESCRIPTION LEGAL OWNERS BANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEED OF TRUST HOME PHONE WORK PHONE INVOICE No 21 2 5 DATE CITY. MATERIALS UNIT PRICE AMOUNT TOTAL MATERIALS WELL NUMBER DIAMETER DEPTH STATIC LEVEL, GPM _42✓ eh PUMP MAKE H SETTING VOLTS asien, o4 Lao SERIAL NUMBER MODEL SCREEN LENGTH DRAWDOWN PHASE AMP RATE SLOT SIZE LINER/SCREEN DESCRIPTION OF WORK DATES ch coo/ aut ihfiuN R N 7g" y <<faal Sc 7 6,3 7 h',f 1� ,/7_3` All charges shall be paid in full within ten days unless other arrangements are made prior to drilling. The customer shall pay im terest at the rate of 11/2%o per month on any amount not paid within ten days. Failure to pay may result in a lien against the property. WO-KMAN r + r IN i I 1 OUT ' go LABOR HOURS : RATE e_e /570 J D 'I MATERIALS [FROM ABOVEI OTHER CHARGES CUSTOMER SIGNATURE PAY THIS AMOUNT --Ow/ J ✓ C% Municipality of Anchorage On -Site Water and Wastewater Program = (907) 343-7904 5A F E T T Certificate of On -Site Systems Approval Parcel I . D. 015-073-07 1. GENERAL INFORMATION: Expiration Date: 3 — I S Z (9 ZZ Complete legal description WILLIAMSON; BLOCK 1, LOT 2 Location (site address) 5311 EAST 98TH *ANCHORAGE AK Current Property owner(s) TIFFANY HINSHAW Day phone 907-351-1368 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 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: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �T�D + $� )_ 9 O Date of Payment 3/a D 21 Receipt Number 0 0 q 65 6 COSA # bSC 21 1 '111 Waiver Fee $ Date of Payment Receipt Number 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: 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: 1 2 Z/ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells 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 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 can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. (((ttf7Y 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for 3 bedrooms bedrooms bedrooms, with the Uu X-k1[,V \'r QTY OF =G ON-SI7 '�/eAECC884 i i C,So rte' WATER AND m � m WAST'-V"ATER Z:Z PROF.A 116fr stipula tons Jam` P vud p v aS1 ant itd 1/.2 ral A O22 -- Original Certificate Date: 3 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 __ COSA Checklist Legal Description: WILLIAMSON; BLOCK 1, LOT 2 If more than 1 septic system on lot: COSA Checklist # A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1974 (') Total depth 267 ft Cased to U N K ft 0 Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 9/18/21 Static water level at beginning of test 256.6 ft. Comments B. TANK DATA Age of tank(s) 47 years Tank type/material SEPTIC/CONS Measured operating fluid level in septic tank 60 0 Standpipes/foundation cleanout per record drawing Date of pumping 6/4/2021 D. ABSORPTION FIELD DATA Which system tested (date installed) NEW ❑■ ALL standpipes present per record drawing Total measured depth from grade 6.4 ft (max) Measured depth to pipe invert from grade 5.73 ft (min) ❑ N/A — pressurized field 0 Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 015-073-07 of Structure served by this system Well production at time of test 4.2 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes R No V Coliform bacteria is Negative Nitrate 0.57 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by GEG Date of Sample 9/10/21 C. LIFT STATION 0 Required maintenance completed Age of lift station NEW years Lift station material PLASTIC Comments: Adequacy test date - Results Q✓ Pass For 3 Fluid depth prior to test _ Water added " gal New depth in Elapsed time min bedrooms ID X Code -required soil cover over field Final fluid depth - in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) N/A If yes, enter date Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet 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' **50'+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft r7v Yes if No ft Neighboring Tank > 100' M Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No ft Absorption Field on Lot > 100' F-1 Yes if No **50'+ ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' Yes if No **50'+ ft Water Main > 10' Animal Containment > 50' F-11 Yes if No ft F-11 Yes if No ft ✓Q Yes if No ft Water Service Line > 10' Q Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' ❑✓ 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' Yes if No ft Surface Water > 100' E✓ Yes if No **50'+ ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Q Yes if No ft Private Wells > 100' Yes if No **50'+ ft Water Main > 10' Yes if No ft Community Wells > 200' ✓Q Yes if No ft Water Service Line > 10' Q 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' M Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No **50+ ft Water Service Line > 10' Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' Q Yes if No **50'+ ft F. ENGINEER'S COMMENTS *Assumed 100'+ from well on Williamson, Block 1, Lot 1 to log crib on subject lot **50'+ TO SEPTIC TANK AND NEW DRAINFIELD SERVED BY AWWTS - 100'+ TO "CONVENTIONAL" SEEPAGE PIT ON LOT 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. COSA Checklist yellow sheet �. �'•. CV -7953 #AECC884 Parcel I . D. 015-073-07 CoNJ� Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 0JV S A F r T Y Expiration Date: �3 ` / 5- Z d Z� 1. GENERAL INFORMATION: Complete legal description WILLIAMSON; BLOCK 1, LOT 2 Location (site address) 5311 EAST 98TH *ANCHORAGE, AK Current Property owner(s) TIFFANY HINSHAW Day phone 907-351-1368 Mailing address Real Estate Agent — Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 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 ❑ Waiver/Variance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ �2 �'o + .9� a 9 C) Date of Payment 2 (30202 I Receipt Number. Q Q Y 6 56 COSA# OS 21 1 '111 Waiver Fee $ Date of Payment Receipt Number Waiver # 0S6 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: 1 z .;3 Z/ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells 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 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 can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. Yt OF ��ECC884 G � bedrooms J- ON-SITE bedrooms WATER AND R' m WAST'=v 'ATER z PROC�F, bedrooms, with the follwii� stipula lonsA � �ii�.15�\�� er ness: • vj CIE 795 ILI do��pr0 f elssiona 6. DSD SIGNATURE System #1 Approved for System ##2 Approved for Disapproved Conditional approval for �— 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: WILLIAMSON; BLOCK 1, LOT 2 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1974 ") Total depth 267 ft Cased to UNK ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 9/18/21 Static water level at beginning of test 256.6 ft Comments B. TANK DATA Age of tank(s) 47 years Tank type/material Measured operating fluid level in septic tank 60 ❑ Standpipes/foundation cleanout per record drawing Date of pumping D. ABSORPTION FIELD DATA Parcel ID: 015-073-07 Structure served by this system Well production at time of test 4.2 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.57 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG Date of Sample 9/10/21 C. LIFT STATION ❑ Required maintenance Age of lift station Lift station materla� Which system tested (date installed) (5'74 Adequacy test date ** ❑ ALL standpipes present per record drawing Results ❑ Pass For 3 bedrooms Total measured depth from grade I 1 - 'L ft (max) Fluid depth prior to test ** in Measured depth to pipe invert from grade ft (min) Water added ** gal ❑ N/A — pressurized field ** ❑ Monitor tubes go to bottom of effective. If not, state New depth in ** depth into effective ' Elapsed time min ❑ Code -required soil cover over field Final fluid depth ** in ❑ System presoaked Absorption rate ** gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NIA date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies: "THIS IS A CONDITIONAL COSA - SEE APPROVED DESIGN IN MOA RECORDS COSA Checklist yellow sheet (IM 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' 0 Yes if No Community Sewer Manhole/Cleanout > 100' FJ Yes if No ft r 7v Yes if No ft Neighboring Tank > 100' Cj Yes if No ft Private Sewer/Septic Line > 25'[E] Yes if No ft Absorption Field on Lot > 100' [j Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft P-1 Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft P1 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: ft Community Wells > 200' Yes if No ft Absorption Field > 5' Rl Yes if No ft Private Wells > 100'✓[J` Yes if No ft Water Main > 10' M Yes if No ft Community Wells > 200' M Yes if No ft Water Service Line > 10' Q 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' [j Yes if No * ft Water Service Line > 10' M Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS 'Assumed 100'+ to well on Williamson, Block 1, Lot 1. New septic system will be a CAT 11 AWWTS. G. ENGINEER'S CERTIFICATION o� OF l certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with 4 T y* MOA COSA guidelines in effect on this date. . , .. . • , ... ....... • • • : _ r. ......... e y Gorne s. a CE -95 e `c COSA Checklist yellow sheet 0 a P �o\ o _ ofess!o a #AECC884 December 7, 2021 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Conditional COSA for Williamson; Block 1, Lot 2 To whom it may concern: The subject lot is served by a private well and septic system. The existing drainfield is in need of replacement. A design has been approved by the MOA and the owner has received three bids for the replacement. The bids are attached, and we are proposing to have the new septic system installed in January 2021, after closing of the sale. At this time, we are applying for a conditional COSA. Attached is the conditional-COSA paperwork. The existing drainfield is functional and should meet the needs of the new residents until the septic upgrade is performed. If you have any qugstions, please contact us at 337-6179. Thank you for your assistance. Garne°ssr .E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com 'R �i__ .... ...u8nics GARNESS a ENGINEERING GROUP9 Ltd ENGINEERING SALES CONSULTING xx December 7, 2021 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Conditional COSA for Williamson; Block 1, Lot 2 To whom it may concern: The subject lot is served by a private well and septic system. The existing drainfield is in need of replacement. A design has been approved by the MOA and the owner has received three bids for the replacement. The bids are attached, and we are proposing to have the new septic system installed in January 2021, after closing of the sale. At this time, we are applying for a conditional COSA. Attached is the conditional-COSA paperwork. The existing drainfield is functional and should meet the needs of the new residents until the septic upgrade is performed. If you have any qugstions, please contact us at 337-6179. Thank you for your assistance. Garne°ssr .E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREA,rMENTSYSTEY1 NMAINT FNANC E AND REPAIR AGREEMENT TI IIS iMAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and New Owner: entered into as of this V9 Day of _�)QvfmTR, of 20 Z , by and between Zachary Kirk & Deborah Stojak '^'�l1 ' w . 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 �!':ast:cya►ter "I'rs attrnent Sys€cuts. The Municipality grants permission to the Owner to utilize and operate anAdvancedWastewater Treatment System (AwWTS). described as vcv, c S a a - located at (legal description) _'. :►inten:encc, Repairsand Alterations. (Owner is required to read, understand and initial each section) o' 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 S 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 C)5 repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). 1)1�1 Owner agrees that only taintenance and repair personnel approved by the Municipality Sor the manulacturer's representative will inspect and make any necessary maintenatce, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential �0 -failure of the system, which could include sewage backup turd costly repairs or drtinfield replacement. (rev, 05/18/2018) Page I of t_ Owncr 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 AWW*FS ma} 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. {tL �^, 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. �. Amendment_ This Agreement shall only be amended by authorized representatives of die Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. .lurisdietion: 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. 'rhe 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 ONtFNER:- (signature) Date: TZ l �+lg 0; r (print name) STAT OF ALASKA ) ss. THIRD JUDI L DISTRICT ) The foregoing instrument Ncknowledged before me this _ day of 20 by NOTARY PUBLIC FOR AKA LASf for Notary Seca( My Commission expires: (%h1lne.r MUNI CIPALFr : _ � 1 By: ff tz;' , (signature) Date: i?ebeCC,R, di-ty ((! {print name) Title: r Buyer: Print Name: -6 � R � 2,� Date: (cp- F Buyer: By: \, / ' Print N me: LOC W)%41 r4D r Date: Pane 3 of 3 (rev. 05/18/3018) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT ) On this day, before n e thy u ]der igned Notary Public in and for said State, did personally appear (% . . f'( l/'/L l,�f'"110, ,� Sb)kho me known/proved to be the individual described in and wlio esecu ed the within and foregoing instrument, and acknowledged he/she signed the same as his/her free and voluntary act and deed, for the uses and purposes therein mentioned. Given under Illy bland. and official seal this g Ap111�IeI2 Public in nd or Alaska My commission expires: ✓»L�� day of ,, .4, }Cr.��/( '' 20.,'Z/ Municipality of Anchorage On -Site Water & Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-073-07 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent WILLIAMSON; BLOCK 1, LOT 2 Expiration Date: i 5311 E. 98TH AVENUE *ANCHORAGE, AK 99507 MARK FINA & LEAH CUYNO Day phone 317-9127 5311 E. 98TH AVENUE *ANCHORAGE, AK 99507 JIM STANDIFORD W/ REMAX DYNAMIC Day phone 244-3940 2. TYPE OF DWELLING: ▪ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System • 3 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer 1 111 ,- Received by: f �O` COSA to be released to the engineer, unless otherwise requested by the engineer. Date' COSA Fee $ $ q q0 .a) Date of Payment Receipt Number COSA # lc/1'1/r3 3su 3 /a6V Waiver Fee $ Date of Payment Receipt Number Waiver # 6. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date Lfit Lis bedrooms, with the following stipulations C`Cc°O e ��dro f es siotICX �Oopoo�a ON-SITE TIA TER ANG vo n .nrnSTEWATER o f ....— GRA!!s C PRO O JJlyl7j�i)) 3))7�1'IMot��~ By: /77 d 73?---7/— The N7unicipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations 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. ATTCHMENTS: Original Certificate Date: 6-2I /3 COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 41ro5) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: WILLIAMSON; BLOCK 1, LOT 2 Parcel ID: 015-073-07 A. WELL DATA *PER GEG INSPECTION **PER SURROUNDING WELL LOGS Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed PRE -1974 Total depth *258+ ft. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform •1/4colonies/100 ml. Arsenic: NO ug /L B. SEPTIC/HOLDING TANK DATA Tank Type/Material CONCRETE Sanitary seal (Y/N) YES Cased to **40+ ft. FROM WELL LOG NO WELL LOG ft. g. p. m. Well Log (Y/N) NO Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 3/30/13 255 ft. 6.0 g.p.m. o.4t 8 Nitrate mg./L. Collected by: GEG. Ltd Date of sample: 3/29/13 YES 12+ in. Date installed 9/10/74 Tank size 1200 gal. Number of Compartments 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) Date of pumping L%/ 1 / / 3 Pumper /14r /Qona (C,/ p LA.Cfl Ji riC:tJ C. ABSORPTION FIELD DATA Date installed 9/10/74 *BELOW EXISTING GRADE Soil rating (g.p.d./ft2or�(t/bdr3 130 N/A System type LOG CRIB Length 18 ft. Width 18 ft. Gravel below pipe 6 ft. Total depth *11.08 ft. Eff. absorption area 432 ft2 Monitoring tube YES Depression over field Date of adequacy test 3/30/13 Results (Pass/Fail) PASS Fluid depth in absorption field before test 47 in. Water added 485 gal NO For 3 bedrooms New depth ***68in Elapsed Time: 120 min. Final fluid depth 59 in. Absorption rate >= 450+ g.p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — ""t" ADeVC Fe? el- CRIB /r4vh_ner ECEJ s v 430,50 .nv ktt I int -o tci . AOh1%orfKL fM)of. Pitt D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons Manhole/Access (YM in "Pump off" level : High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic tank/lift station on lot Absorption field on lot Public sewer main 111' (TO CO) N/A Sewer /septic service line Animal containment areas 25'+ 50'+ On adjacent lots On adjacent lots 100'+ 100'+ Public sewer manhole/cleanout Holding tank N/A N/A Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main 5'+ N/A Property line Water service line 51+ Absorption field 101+ Surface water Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN F. COMMENTS 100'+ 5'+ 100'+ Building foundation 10'+ Water main N/A Surface water 1001+ Driveway, parking/vehicle storage Wells on adjacent lots 1001+ 10'+ G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Date 1+ 1 12 II? JEFFREY A. GARNESS (Rev.11/05) PROPOSE. MOPED ACM 6980Malar WINO =MO OSOILI NAO ILEDIIN YIMCI .M L -3 ti n= 300,00' L = 76.5'0 ' UNDER NO ORCUMSTANCES SHOULD AN AS -BUILT BE USED Fat coisisuaTesi DR FOR TSTA SURVEYOR TAKES RESPONSIBILITY FOR THE 70 BOUNDARY OR FENCE LSffS. LISTED DISTANCES PREVAIL OYER SCALING. REPRODUCTION MAY CAUSE ERRORS M SCALE THE SUR 2i11W. 7RANSACRDN ONLY AND ASSUMES FINANCIAL UABIUTY ONLY FOR THE COST Elf THE SURVEY. sumer ,O u nuioA1101 AS411.11.7 ❑ FNAL ST UCAA¢ As -BILI 0 PLOT PUN ... ASdaT ... LLT waxy .. • woman n A.1 -NN T ... AFO PICOP r SURVEY TYPE PLOT PLANS k LOT SURVEYS IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE THE ETOSTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. NO CTOm1! a,T SURVEY CERTIFICATION PLOT PL41 1 Mwl ..MJ Y.rt 1 Yw 04.1110.y Wi.1 the M M w'.was lona w NM /woe hush r yyy4 M w w W .wnwnaval Wm al int so FOUNDATION AYBML7 t :+.Y c .wa a-. MS., o* OM 1 Low P.r—n AH!{ +w M... a...... rM�'r. 1 w +..Mw — .. Wow. bus M m rw.ny .Ml ullr sanlea- FINAL STRUCNRE AS -SLAT L Poen cwr. a. Lahr spiry Plat I bra w.tn poll`An*k r w •army . r" n M.wW. w rs..a. r M..e r.. r....N+w .4I whewN.+.n: SYMBOLS • SETREBAR nit MANAGE 0 FUND WAR 1 MOOD FENCE C:20 merit FENCE NOD # 4d P lM ASPHALT CONCRETE MDCD DECK ONLY THOSE IMPROVEMENTS ABOVE GROUND ANO Ns1BL£ MU. BE ENDEAR, mirk VAIU.11, ETC.. ARE S IONN IN TIER APPROXIMATELOCA ON,O LY.LY. sNo MAY PREVENTSOME IMPROVEMENTS FROM WINO SEEN AND LOCATED. ALLDISTANCESARE RECORD UNLESS OTHERWISE NOTED. Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 842 E 12 ATE.At OF ANDIDRAOE, MAStA BINEN cm` 1 30' � SPMA Drown by Chead byc A1T i ST Thi.7001 R1J Mj,J Oats Dro•ns . AUSOSr 16, 2001 2437 W.O. LNd':Cr rl Sat LOT 2, BLOCK• 1, HILLIAASON SUBD. Roc tot SJ. Roc. Plot Flo No. Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-073-07 1. GENERAL INFORMATION r Complete legal description WILtAMSON, LOT 2 BLOCK 1 HAA# HR 0/014 a -S Expiration Date' / t' - / 3 - 0 I Location (site address or directions) 5311 E. 98TH AVE. *ANCHORAGE AK Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address EDGAR SMITH Day phone 346-2470 5311 E. 98TH AVE •ANCHORAGE AK Day phone RICK DAVIDS Day phone 272-6336 4130 CRANNOG ANCH. AK 99502 Unless otherwise requested, HAA will be held by DSD for pickup. 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 Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1,000.00 at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In 1170 Health AuthorityApproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system ls(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 furrier verily that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water suppty 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD, SUITE 2B • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWYVC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test and separation distances measured to readily identifiable features. The operational We of all wells and septic systems depend on the local soils condition, groundwatertevels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions we outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this reports for the sole benefit of the owner fisted above. Any rerlance upon or use of tlnls report by any other person or parry Is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE Approved for _ bedrooms. Disapproved. Date e/24 `J. ON-SITE WATER AND m� WASTEWATER Conditional approval for bedrooms, with the fllowing stipulations: tao;•• PROGRAM -1D"SVTSEVACO '%»>ur f1iV Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By7,4 (R.t. ruo) Manitenance Agreements Supplemental Engineer's Retort Other Original Certificate Date• O - /3- 0 Municipality of Anchorage Development Services Department Building Safety 0lvisbn On Site Water & Wastewater Program 4700 South Bream St P.O. Box 196650 Anchorage, AK 99519-6650 vww.ctanchorage ak us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: WIUArmSON, LOT 2 BLOCK 1 Parcel ID: 015-073-07 A. WELL DATA Well type PRIME If A. B, or C provide PWSIDII N/A Well Log (Y/N) NO Date completed 1974 OR BEFORE Sanitary seal (YM) YES Wires property protected (YIN) YES Total depth 275 ft, Cased to 40+ ft Casing height (above ground) 12 In. FROM WELL LOG AT INSPECTION Date of test UNK 8/6/01 Static water level UNK R 268 ft. Weil production UNK g p.m, 3.3 044111 - WATER SAM RESULTS: Coliform cotonlesM00 ml. Nitrate 41mgJL. Other bacteria c colonies/100 ml. Date of e: 8/7/01 Collected by: AWWC. INC. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 9/74 Tank size 1200 gat. Number of Compartments? Cleanouts (Y/N) YES FoundatIon cleanout (YM) YES Depression over tank (YIN) No High water atm (YIN) N/A Date of pumping 7/19/01 C. ABSORPTION FIELD DATA Date Installed a/74 Soil rating ..p.d . • fts/bdrm)130 System type LOG CRIB Length 18 - R Width 18 ft Gravel below pipe 6 rt. Total depth ».3 tt Elf. absorption area 432 ft` Month:ming tube YES Depression over field NO Date of adequacy test 8/6/01 Results (Pass Fall) PASS Fa 3 bedrooms Fluid depth In absorption field before test 21.5 In. Water added gal. New depth 37.51n. Elapsed Time: SE. min. Final fluid deplh36_251n. Absorption rate as 450+ g p4. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN K yes, give date — Pumper ROTO—ROOTER D. UFT STATION Date installed Size In gallons Manhole/ 'Pump on' level et_ in. 'Pump • n High water alarm level at In. Cycles tested Meets alarm & dreult requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank lift station on lot 100'+ Absorption geld on lot 111' TO C/0 On adjacent lots 100'+ On adjacent lots 1001+ Public sewer main N/A Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5'+ Absorption field 5'+ Water main NLA- Water service One 10'+ Surface water 100'+ Welts on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property fine 10'+ Building foundational O+ Water main N/A Water service One 101+ Surface water 1001+ Day. parldng/vehide storage 5'+ Curtain drain NONE KNOWN Wens on adjacent Tots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 tardy that I have determined through field inspections and review of Municipal records that the above systems ere h confcnnance with MOA HAA gulde!nes h effect an this date. Engineer's Printed Name JEFFREY A. GARNESS Date 8 21o/ HAA Fees 306.°° Date of Payment el ib I 0 f Receipt Number Bio air (R .12/00) Waiver Fee $ Date of Payment Receipt Number AUG -10-01 11:25 AM ROTO' -ROOTER 907 345 8284 P.01 Parcel I.D. # MUNICIPALITY OF ANCHORAGE • .. DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box, 196650 Anchorage Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR SINGLE FAMILY DWELLING /�U 015-073:-07 v ( HAA # W (A 4cke �� GENERAL INFORMATION Complete legal description Lot 2; Block 1; Williamson Subdivision Location (site address or directions) 5311 E. 98th Avenue v Anchorage, AK Property owner Susan Phillips Day phone Mailing address C/O Sun Properties 115 E. 11th Ave. ANchorage, AK 99501 Lending agency Day phone Mailing address Agent Rick Davids/ Sun Properties Day phone 272-'6336 2A-Z-6nq(> Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 XX 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. XX 72-025 (Rev. 1/91) Front MOA921 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 further verifythat 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 effe9ifirefieviitrepf, his inspection. Name of Firm Wastewater Corycul kw.Phone 337-6/79 1 Address Engineer's signature scrir. Alaska Water & .. Wastewater Consultants, Inc. Shall be PAID $ IC Z-5 at, or prior to, closing for the Engineering Services Provided: 6. DHHS SIGNATURE C/ Approved for THeEE bedrooms. Disapproved. By. Date Conditional approval for bedrooms, with the following stipulations: Additional Comments bz r,,eyi Date .5- x8-99 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/01) Back MOA 121 tECEIVEv Municipality of Anchorage MAY 27 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES muNiCwALITY OF ANCHORAGE Environmental Services DIVISIOnENVIRONMENTALSERVICES DIVISIO 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: 1 LL(l SOS L 2 Q 1 Parcel I.D.: D / S — 73 0 A. WELL DATA Well type PV 1 ' If A, B, or C, attach ADEC letter. ADEC water system number /1 Log present (Y/N) N Date completed 9/14- 02. gact aE Total depth r)--/ Cased to +0 t÷Casing height (above ground) IZ ', Sanitary seal (Y/N) �l FIS Wires properly protected (Y/N) -1/4/t _S FROM WELL LOG AT INSPECTIO Date of test N IA .h / 7 `T 9 Static water level 2-6s- Well production `h1 g.p.m. "2' 9 4- g.p.m. t / N>ax 0TLiOowtJ WATER SAMPLE RESULTS: Coliform Nitrate E'342- t<"P Other bacteria CI Date of sample: 5// 8/997 Collected by: /4-14k4 e/ /4 G • B. SEPTIC/HOLDING TANK DATA Date installed VII- Tank size ) 2-00 Number of Compartments 1 Cleanouts (Y/N) 1 Foundation cleanout (Y/N) 7 Depression (Y/N) NO High water alarm (Y/N) /U/r Date of Pumping 51/1/7/ Pumper r l 4- C. ABSORPTION FIELD DATA Date installed 9 /7 9' Soil rating (g.p.d./ft2 or ft2/bdrm) /3 ° System type Lo G- d t2 -ug le / / Length Width / Gravel thickness below pipe 6 Total depth H. 3 Effective absorption /3 432- v Monitoring Tube present (Y/N) y Depression over field (Y/N) Date of adequacy t2st 54/17 /` 9 Results (Pass/Fail) PSS For �, bedrooms Fluid depth in absorption field before test (in.); 37 Immediately after 64 gal. water added (in.): .57 Fluid depth t9 (ins) Minutes later: / 40 Absorption rate = 45 0'F/ g.p.d. Peroxide treatment (past 12 months) (Y/N) Ivor=vw If yes, give date l� 72-026 (Rev. 3/96)* * Fi LFJ) • S s— Co .//L-f��11NJz D. LIFT STATIQ` Date installed Size in gallop_ Manhole/Access (Y/N)�_�m�al at* "Pump off" level at* High waterrm .uel ar *Datum ----- Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / _ � l L7 Uzi CA) Absorption field on lot Public sewer rnain On adjacent lots (eO '1" (III C/O On adjacent lots 10014- kPublic sewer manhole/cleanout /fE Sewer /septic service line ?.5 + Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation _ �� Property line S — Absorption field / Water main/service line /3 •F Surface water/drainage yU0 Wells on adjacent Jots /00 '- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line /0 f- Building foundation t Surface water /004- Driveway, parking/vehicle storage area 50 f' i /O!F Water main/service line /0 Curtain drain N0.. jeDIAJ/✓ F. ENGINEER'S CERTIFICATION 1 certify that 1 have detgr ine in conformanc Signature j Engineer's Name I c,�1=Ff( j M• 6A-PvSS Date 5/2-6/ci9• Wells on adjacent lots fh Id inspections and review of Municipal uide Ines in effect on this date. HAA Fee' $ Date of Payment Receipt Number 2941,7 7-e) 72-026 (Rev. 3/96)* /b0 ostRatan ystems are is e+.°°. 4 goo :1 woa w� `Q itorrsb:tee Waiver Fee $ Date of Payment Receipt Number Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Road, Suite 2-11— Anchorage — Alaska 99504 Phone (907) 337-6179 — Fax (907) 338-3246 Consulting Engineers May 24, 1999 Susan Phillips c/o Sun Properties 115 East 11th Ave. Anchorage, Alaska 99501 Attn: Rick Davids Subject: Well & Septic System Inspection at Lot 2, Bk 1, Williamson S/D. Dear Ms. Phillips, Per the request of your agent, Rick Davids, Sun Properties, we performed adequacy tests on the subject well and septic system. The results of the field investigation and adequacy tests are summarized as follows: WELL: Prior to the start of the test (5/17/99) the static water level was 265 feet below the top of the casing (BTC). Over a period of 220 minutes, 641 gallons of water was pumped from the well (2.91 gallons per minute), during which time the liquid level in the casing dropped only one foot. Based upon this data it was concluded that the well exceeds the MOA requirement for a 3 bedroom house (.31 gallons per minute). SEPTIC SYSTEM ADEQUACY TIST: The drainfield is a log crib type system that was installed in September of 1974, making it approximately 25 years old. Per MOA records, the crib is 8' X 8' with an effective depth of 6 feet. Prior to the start of the test (5/17/99) the liquid depth was 37 inches deep (approximately 1/2 full). Over period of 220 minutes 641 gallons was introduced, causing the liquid level to rise 14 inches (45.8 gallons per inch). The recovery was monitored 140 minutes later and it was noted that the liquid level had dropped 2 inches, indicating approximately 91.6 gallons had been absorbed. Based upon this data, it was determined that the absorption capacity of the drainfield meets the MOA requirements for a 3 bedroom house (450 gallons per day). NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drain pipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), 1 of2 type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this well or septic system Upon our initial inspection there was a moderate depression noted over the crib area. It is unknown whether this settlement is associated with the initial installation, or an indication that the top of the crib is beginning to collapse. The property owner placed some fill over the area so as to eliminate the depression. The structural integrity of the crib is unknown. If you have any questio •lease contact me at 337-6179, or 244-9612. Jeffre! '. T ness, P.E., M.S. Presigent 2of2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I D # 6I5-013 —°7 1. GENERAL INFORMATION Complete legal description LoT HAAW\11)nL_R 1 2, BLk ( WILL)AMSon( SuS. Location (site address or directions) 5311 E. 98 4‘ AVE ANcfl. Ak 99516 Property owner SuSAr4 'PHILLIPS Mailing address SAME Day phone 346- IS 37 Lending agency FIRST NAT(oIAL BAN. 01- ANCA. Day phone 276.- 63 o G Mailing address Ra. f3ax I007ao1 4-nc%or7e A&c 99s -t6 Agent mi• R e'unc e ) Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (flov. 1/91) Front MOA 021 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm FLATTOP TEO SVCS Address I4S3o ECNo ST, Phone 34S- 13 -SS Engineer's signature 6. DHHS SIGNATURE \\ Approved for 3 bedrooms. Disapproved. By. J- %fit Date 8/ / 2/9 3 ,. t OAL b® b�•.°°... ;e ° tc.++.'+:i• 497N A •,k'r rd`-441--te-Lc. 971e4 is •. THEODORE F. MOORE ; Ri! Ova 11. CE - 3589 E>r ri Conditional approval for bedrooms, with the following stipulations: Additional Comments 044, LA ... Date (l ' CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 1121 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo -r 2, T3LK 1, WILL 'Anson( sus, Parcel I.D. A. Well Data Well type PRI v/TE If A, B, or C, attach ADEC letter. ADEC water system number N. A Log present (Y/N) N Date completed 917t/ orr BEFORE Driller Un Total depth 2 75' Cased to 2 y5 Sanitary seal (Y/N) y Wires properly protected (Y/N) y FROM WELL LOG AT INSPECTION X/9/93 Casing height 13 Date of test Static water level Well flow Pump levell 263 g.p.m. Y, 2 -t- g.p.m. > 26y' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 110 To (.0 . ; On adjacent lots > /oo' Absorption field on lot 111 to C.o. ; On adjacent lots >100' Public sewer main R,A • Public sewer manhole/cleanout N .A • Sewer service line -75' Petroleum tank Nome of SERvEA WATER SAMPLE RESULTS: Coliform 0 Date of sample: 7 /3o /9 3 B. SEPTIC/HOLDING TANK DATA Date installed 9itok Cleanouts (Y/N) 7 High water alarm (Y/N) Date of pumping N./-\• Nitrate 0,70„,9/L Other bacteria 0 Collected by: FLATTOP TECH SVCS Tank size 12 00 GAL Foundation cleanout (Y/N) i 6/13/93 Compartments I Depression (Y/N) Alarm tested (Y/N) N.A N Pumper Role." Roo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I Io' FR (.0. On adjacent lots > /00 Foundation 2 7 To property line 37 FRo„, c.o. Absorption field 20 Water main/service line ^ 75� Surface water/drainage > 100/ 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size 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 (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA i3o Fe45oRri Date installed q /lot 14 Soil rating (GPD/Ft2) 1.2 GPt) System type 5EEPMG PIT' Length I8' Width 18 Gravel thickness 6 i Total depth lo' Total absorption area 4 32 Cleanout present (Y/N) '/ Depression over field (Y/N) N Date of adequacy test 8/9b13 Results (pass/fail) _ P«sj for 3 Bedrooms Water level in absorption field before test 3/ " After test `i °l,5 " Peroxide treatment (past 12 months) (Y/N) NoNE KNowN If yes, give date N A . SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot III ` FRoN Co. On adjacent lots > /Do/ To building foundation `I2' FROM C.O. Property line 2R' FRon C•o. To existing or abandoned system on lot N A On adjacent lots > 40 ` Cutbank N .A , Water main/service line 1 75 Surface water .>100' Driveway, parking/vehicle storage area 5o ' Curtain drain NONE °BScgvED E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HM guidelines inrr�Rr(gof this inspection. 40,4+1,81 gg., rwl':'4qui �'?}k -gT O . THL000R2 r'-M!tOOUE ,. CE - 3509 : . 4 9�4% � F 'Cr 7 Signature ��.� C 2720 Engineer's Name 717eodor( r. Ho Date /4(- y l3 /99 3 V � HAA Fee$ 170 0O Waiver Fee $ Date of Payment l.J'Z� Date of Payment Receipt Number 2,5644 7 C75-67) Receipt Number 72-026 (3/93)' Back MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I D # `C f fl rfl \ HAA # W Q9nr> 1 (n 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; Block 1; Williamson Subdivision Location (address or directions) 5311 East 98th, Anchorage, Alaska (b) Property owner FIRST NATIONAL BANK OF ANCH{one : (home) Business Mailing Address Branch 30, P.O. Box 100720, Anchorage, Alaska 99510-0720 (c) Lending Institution ATTENTION: Brent Schlosstein Telephone 265-3529 Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here til, if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17034 Eagle River Loop Road. Suite 204 __Eagle RivenAlaska 99577 2. TYPE OF RESIDENCE Single -Family 20 Number of bedrooms 3 3. WATER SUPPLY Individual Well M Community ❑ Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE. DISPOSAL On-site L$ Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/80) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone 5 & $ ENGINEERING Address 17034 Eagle River Loop lioad )vc. Eagle River, Alaska 99577 Date 6. DHHS APPROVAL Approved for G��t</6/G _/-- ate Approved v Disapproved Conditional Terms of Conditional Approval /L1I'4/2- 6 1v%-292 i CAUTION'i The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/00) Back Page 2 of 2 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) NICIPALI[Yakgetthitt: FEBRUARY 1984 IRONMENTAL SERVICES 1/146 h744 APR 161990 RECEIVED Well Classification r1ALqJe FkM /tj If A, B, C, D.E.C. Approved (Y/N) Yield Total Depth 3S Cased to ' _ Depth of Grouting Static Water Level 25.7_151 Pump Set At ,Z' 3 Casing Height Above Ground 1 2 r Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) f Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot / / O • On Adjoining Lots / 00 1 -1 - Legal Description: ,Lat.2._y iOG/i C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field / `¢/81? Type of System Designee c?�, P)1- gr -(0-74 (�3 432# Length of Field Depth of Field ( Gravel Bed Thickness �9 Square Feet of Absortion Area Statndpipes Present (Y/N) Depression over Field (Y/N)� Date of Last Adequacy Test z{ - S ¶ 0 l/ Results of Last Adequacy Test £tR S fAc- t -f- oirN - 3 Zeal (rOOM� SEPARATION DISTANCE FROM ABSORPTION FIELD: rI To Water -Supply Well I II / To Property Line 2 S To Building Foundation 4-i To Existing or Abandoned System on Lot NrnW ; On Adjoining Lots 30 t To Water Main/Service Line / 0 4 To Cutback (if present) N/Pq To Stream, Pond, Lake, or Major Drainage Course A%(/1I i To Driveway, Parking Area, or Vehicle Storage Area S '/ Comments D. LIFT STATION Date Installed Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for N Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments "Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed s R s ENGINEERING 17034 Eagle River Loop Road No. 204 Company Date MOA No. CC- Receipt C Receipt No. Date of Payment Amount; $ 72-026 (Rev. 7/88) Back Receipt No Waiver Fee; $ Date of Payment Page 2 of 2 ,�>\CHEMICAL & GEOLOGICAL LABORATORIES O.FALASKA, INC. # �aa�i 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 -- FEDERAL TAX ID # 92.0040440 LABORn ANALYSIS REPORT BY SAMPLE for Work Order # 20920 Date Report Printed: APR 10 90 0 08:20 Client Sample ID:L2, B1; WILLIAMSON S/D PWSID :UA Collected APR 5 90 @ 16:00 hrs. Received APR 6 90 @ 12:30 hrs. Preserved with :AS REQUIRED Analysis Completed :APR 6 90 Laboratory Super( so STEPHEN C. Released By : G_ Special Instruct: EDE Chemlab Rof #: 900770 Lab Smpl ID: 1 Parameter Tested NITRATE -N Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY R.D.J. Matrix: WATER Result Units Client Name : S & S ENGR Client Acct : SNSENGP P.O.# NONE RECEIVED Req # Ordered By : R. SHAPER Send Reports to: 1)S & S ENGR 2) Method Allowable Limits 0.60 mg/1 EPA 353.2 10 1 Tests Performed ' See Special Instructions Above UA -Unavailable ND= None Detected " Seo Sample Remarks Above HA= Not Analyzed LT=Leas Than. GT. -Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEAL.TI-I AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION (a) i Application Date 7-50-e Legal Description (include lot, block, subdivision, section, township, range) /_D7 /- 5toe✓. / GAI/L[,&oaaf $f6/V/5/€'nl %IZ-n7 P`3t.J See.' Location (address or directions) 5C3// E. 98 - (b) Applicant Name ,5Rt/C4.o`/»ilT Telephone: Home -34 .-/!(.9 7-- Business 241: 63-07 Applicant Address A0. boy. 1/7.-062 ditie/(,_ /k• 9? 57) (c) Applicant is (check one): Lending Institution 0 ; Owner/builder 1 ; Buyer 0 ; Other 0 (explain) (d) Lending Institution (e) (f) Address Telephone Real Estate Company and Agent Address Telephone Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family)L Multi -Family 0 Other Number of Bedrooms 3. WATER SUPPLY Individual Well Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite`t Public 0 Community 0 Holding Tank 0 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 12-025 (11,04) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. i verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and frorn 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 ori the date of this inspection. II I ,Crelephone ��/ Name of Firm LL ClvauN{✓£NOj7'al. le/, Address /T e0 G.l 33' 7 �rcr'7 ' f fa%C/f lee Date 7- 30-`Y.' 6. DHEP APPR Approved fdf �\k ^411 -. bedrooms .1" Approved Disapproved Terms of Conditional Approval Engineers Seal a Date r Conditional STEP O 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 72-025 (11/04) A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Descriptio ' G 1 5 /z 3 eiJ Sid /7 MUNICIPALITY - DEPT. OF WITH & ENVIRONMENTAL PROTECTION ItIUI 3 160 RECEIVED 4,..biC»wu5ai 4 /lie Witt If A, B, C, D.E.C. Approved (Y/N) N/H Well Classification Completed' Yield W 1 Date Com9//o/iNW V` Well Log Present N) --- Total Depth 0-7'5- Cased to 2- 7 Depth of Grouting 44 0-7/ Pump Set At 2-7 Static Water Level ' Casing Height Above Ground Electrical Wiring in Conduit Y N) Depression Around Wellhead (Y Separation Distances from Well: To Septic/Holding Tank on Lot _ Sanitary Seal on Casing N) //Q/ To Nearest Edge of Absorption Field on Lot ////4 To Nearest Public Sewer Line �/ Cleanout/Manhole _ ill ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer // To Nearest Sewer Service Line on Lot 44 EdA/"l/ l • Date 7-&!o V$ ' Water Sample Collected by �5 '- Water Sample Test Results 52F'=trrd// `f" Comments 4- „" f 4 7E5T D/I-'M / •-Z� Y> c O tOe/( skguw>n.44:1 41017✓ B. SEPTIC/HOLDING TANK DATA Date Installed 7 `/6-711 Size /z -0O G No of Compartments StandpipesbY N) Air -tight Caps ON) Foundation Cleanoul(9N) a` ic'r- Depression over Tank (Y N) Date Last Pumped % / Pumping/Maintenance Contract on File (Y/N) ,4//4 ; for `(//, Holding Tank High -Water Alarm (Y/N) 44 Temporary Holding Tank Permit (Y/N) /1/1 / Separation Distances from Septic/Holding Tank: //0/ To Water -Supply Well To Property Line 37 / To Water Main/Service Line N1 Course �/I`j Comments To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage 33 33/ Page 1 of 2 72-026(11/84) LL %3/ W/LLIN-hSt J C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 17 /3o d -/G-71 /?/ Square Feet of Absorption Area Depression over Field (Y, Results of Last Adequacy Test Type of System Design Length of Field /Y / Depth of Field /0 iggP LaFy C2/4 Gravel Bed Thickness C , 75 Standpipes Present Y� Date of Last Adequacy Test Abeaa w4-Tt v/ 7-7(c PS Separation Distance from Absorption Field: /1/ To Water -Supply Well 7�// To Property Line �� To Building Foundation 1** To Existing or Abandoned System on Lot ///i ; On Adjoining Lots 5U (t - To Water Main/Service Line A//s To Cutbank (if present) /H To Stream/Pond/Lake/or Major Drainage Course ////9 To Driveway, Parking Area, or Vehicle Storage Area to 't' Comments D. LIFT STATION /A Date ed /V Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at _ "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for •umping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify thatInked, Deified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed n C t------ Date 7'-.3o-rc Company 4Ec5 MOA No Yc—O Receipt No. 3 si 9 -3 2 7 - 3/ _23•— ysci Date of Payment Amount: $ Page 2 of 2 72-026 (1/84) C. OF ip p4r) a ee'p Engineer's Seal oo�a'oo// Ca e,,.oMOD a v C. Pr4I, Jr, 50466 ALASKA Ci gkOn 1CfTRL corITROL ngineerinq & Enuironmental Studies 3RulccS, Inc. JULY 30 1985 BRUCE SCHOLTZ P.O. BOX 112069 ANCHORAGE ALASKA 99511 SELLER -SAME LEGAL:WILLIAMSON BLOCK 1 LOT 2 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -JULY 26 1985 BRUCE SCHOLTZ P.O. BOX 112069 ANCHORAGE ALASKA 99511 THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 432 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 676 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1200 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON JULY 29 1985 . FLOW TEST ON WELL WELL FLOW DATE -JULY 16 1985 A FLOW TEST WAS PERFORMEDIQN-THE WELL. 676 GALLONS OF WATER WAS PUMPED AT A RATE OF („4.2.,jGPM OVER A DURATION OF 3 HOURS. - THE DRAWDOWN WAS 3 'JWITH A RECOVERY TIME OF 30 MINUTES AND THE STATIC WATER LEVEL W<-271.05 FEET. THE WELL IS ADEQUATE FOR THIS! 3 "BEDROOM HOME.' go 0444 �t4,4v, 1200 West 33rd Avenue, Suite 13 • Anchorage. Alaska 99503 • (907( 561-5040 ALASKA ENVIRONN"NTAL CONTROL SERVICL , INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 JOB ,L z- D 1 Al/U//irr-Lw ./D SHEET NO. ,,,/ OF -IC C -f CALCULATED BY A, N//EA� DATE / -36 . CHECKED BYon DATE SCALE / N c 33 9: ?-4 N a R r N PAODTT 1€ti.s'In: f.Ym Mdi 0111; MUNICIPALITY OF ANCHOR ;E MUNiCIPMITY DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION D r1 C 0 - 'It N LL 199 a0 -I ))`E' � \\(( ,' l -PI L 4.:- 825 L Street - Anchorage, Alaska 99501 LNVIRUI Id i -1T • 9 ENVIRONMENT'ALENGINEERINGDIVISION I,t,;f- Telephone 264-4720 pD 1 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND S F:W I�`6i6,a DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.. PHONE 5,2 .: �j/ /�-_ �ul�^ �criU,�7 PHONE 1. PROP TV OIf9NEFtF - jJ J G' i�L�i�j Wi.7.icG-�� —�7s /(/p �6F/{�VS MAILI N _ lie/7 S_ 44 4:0 -l- iaa �A ,, q/AJ ZO/ /,��,/� V =am /' 4___, ---t= PROPERTY RESIDENT (If different from above) - 2. EEUYEE_-_�h 3 £. 1 l�Gr c�G'!/� yG/fir y fes' -: P110 E. 4/5-3/.54/ PHONE / r � MAILING A�RE55 /0 -Q(O9 7 99.5/1 , •J 3. LEND ��II INSTITUTION ( _- : MAILING ADDRESS _ 03 a &A �/ Ole,-,�- 2 ''yy/nn/��,�-�� `5. E PHONE/L�-r OE /'i - Y�a.�-. //�/�j '/ w/'-y� - 4. REA 'AGENT• } r Lao f� lit Cr-1,41.411•00/ k �1 3 t� , -1—��jf �py� MAI Li ESS -(/ a diY% O�.�ri// "r�9(G---J _ �f r _ / az1..1-5'sc�3�' 6, LEGADESCRIPTION - - - - • •p /__-_r� A?Aie kS0R9 STREETg PION. 24et-f-G ..Jre�J l - - �0 • r� 6, TYPE: OF RESIDENCE NUMBEI4 OF BLDROOMS N One ❑ Four ❑ Other___ SINGLE FAMILY • Two ❑ Five ❑ MULTIPLE FAMILYlUAi Three 0 Six 7, WATER SUPPLY-IInAlil NDIVIDUAL* * ATTACH WELL LOG, A well log is requiredforall wells drilled date, well IN COMMUNITY since June 1975, For wells drilled prior to that give 0 PUBLIC UTILITY depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM-- - .- • **If individual/on-site, give installation date/,4'I/ COL /975 JL INDIVIDUAL/ON-SITE" If system is aver two (2) years old an adequacy test is re uired 0 PUBLIC UTILITY by this Department. IC1-7)-1. NOTE: THEE INSI'ECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-01013/78) THIS SIDE FOR OFFICIAL USE ONLY - - INSPECTION APPOINTMENTS DATE RECEIVED - - TIME. TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OP BEDROOMS ❑ SINGLE FAMILY IN MULTIPLE FAMILY 0 ONE • THREE ■ FIVE • OTHER ■ TWO IN FOUR • SIX 2. WATER SUPPLY PERMIT NUMBER - 0 INDIVIDUAL ■ COMMUNITY DEPTH OF WELL ❑ PUBLIC UTILITY DATE DRILLED Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM IN INDIVIDUAL/ON -SITE PERMIT NUMBER IS PUBLIC UTILITY Connection Verified DATE INSTALLED ❑Septic Tank or • Holding Tank Size: If Tank INSTALLER is homemade give dimensions: SOILS RATING TYPEOFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - 5. COMMENTS 'PPROVEDFOR 3 BEDROOMS 0 CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Title) LEGAL DESCRIPTION • ALASKA CHUIROmCnTAL COMM sauces, Inc. Engineering & Environmental Studies :L1/4/81 1ST EQUIETY INC/LINDA SMITH 555 W NORTHERN LIGHTS BLVD— SUITE 201 ANCHORAGE AK 99503 SELLER — JOHN & SHIRLEY HORN BUYER— SUBDIVISION—WILLIAMSON BLOCK -1 LOT -2 ADEQUACY TEST FOR SEWER SYSTEM MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION NOV 1 0 1981 RECEIVED THE TYPE OF ABSORPTION SYSTEM IS A PIT WITH AN AREA OF 432 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 1200 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM HOME. THE SEPTIC TANK WAS PUMPED ON 9/15/81 . SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1200 ]:S ADEQUATE FOR THIS 3 BEDROOM HOUSE. F At "1`',n �'ka°a 0a awo° aao°o4h�'"{�0 „v elite o*149L o �pa0000/oo.-aa°.01oa 9,y;: o.o: Fy,� µ�IYonaau tli,fj w 4 1lr,,�rad PRM1 22174 �2Ql�C MOP fib 88�c" (SI'1'fi"°o ...bvao°O PX rC Y d1 �°,e4FESS>� 1220 Test 25th Auenue • Anchorage, Alaska 99503 • (907) 276-1361 3330 "C" 0SIP'1 I Time of Inspection __A; 3C) Date of Inspection n?r j.Cic),f) GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality Street, Anchorage, Alaska 99503 274-4561 Date Received 1.1-11 1cj fry Approval REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR requested by: Leda.iR j0-0.� Mailing Address: of nn I 2)?' 2. Property Owner: ,r(f.- 13,F la f Mailing Address: ' LI _L_o.ca. CWJ (-II )5 -)t Phone: 9`1L1- \ Phone: i:SVC &, 3. Legal Description: Py9 r N ox 1? 1 1 , l(D Q.noaso . 4. Location: 7' ijInck2 5. Type of facility to be inspected Ltyjo r, No. of bedrooms (Phs,00 6. Well Data: A. Type XlA�plIOP, \/ C. Construction/dory-u,.er), 7. Sewage Disposal System: ()L.Q\D. £0-w-4// e-tLeQ /775 A. Installed ___ Prctet�-/5 B. Installer B. Depth D. Bacterial Analysis 0, C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line 2. Material , Sewer Lines EQ -034 (1/74) Page 1 of two pages Page 2 of two pages - Rec at for Approval of Individual S ;r & Water Facilities Legal Description Ani' Nov 1 I 1 I_L_00in_ Comments Approved Disapproved _ Date /?-;7- App o K10Va1id for one year from date signed Greater Anchor a Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) c.. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 — 274-4561 IVO) REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: l— c nCMRO _ // VA Stc(ye FHA0 Property Owner: E/e <1 a c...4 (pro,/ .- / or.� Mailing Address: 52q-) C , 78"f:1, ,4 --pe Day Phone e 3. Name of Buyer: isci"9/ s VaSbh licif1( n CONV 7 Mailing Address: _____/Q/ nk/c 61i,) /J Day Phone Z7z - P7/9 7' 4. Name of Lending Institution: ghI�- o/ rC�`gs,'cc Mailing Address: 1501 tJ.OY f Ll7/,Js Phone 2-74 5. Name of Realtor or Agent: Lt/�t 1NL `` /// Y• tt, YS )tC / Lenure/ �ecf/��y� ac Mailing Address: go 2-5 C,1 F % 4 is Phone L"7 'Z �// ' GQ g3Zy 6. Legal Description. Location: 2- Ach C 004 d' &cb /gad 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: ild ekVt cc? Public Utility If Individual, number of dwellings presently served 7 If Individual, depth of well 267 9. Sewage Disposal System Type of System: No. Bdrms. Individual Public Utility Individual (on-site) _ If Individual, date of installation /979, - EQ -037 1104) 12br() Cp17 (Op'