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Home My WebLink AboutSUNNY BLK 2 LT 4Sunny Block 2 Lot 4 #015-242-71 Municipality of Anchorage Page 1 of 3 Development Services Department On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.snchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO30257 PID Number. 015.242-71 Steve Exelb and ShirleyEn Wastewater System: Upgrade AGba a. 11700 Trails End Road Anchorage, AK 99516 ABSORPTION FIELD 3 6.9444 ""Five 5°°"" Deep Trench LEGAL DESCRIPTION grlIctiii T««ow• 12 ,45 rapare Ft. Black tcx 81LbNlalal: D.PM lo PP OWan ka w"7a0.. Eiav«cl pN e«r«np . 2 .4 Sunny 2 Ft. 10 FE TowrWV: Raw llN FA WOW.W.. org.0 VW. Gra LWVM.. 0 to 2 Ft. 84 Fr. Well: Existing 3 «r... 1 oW.a. Ft. FL C4 dIoi,t n(Plwitk^a. C): T««D.pal: Ca.W W: abapwn«w p .W. Fr. FL 1,680 Fe ASTM 3034 PVC DN D«. DMMC'. SWIG W. W Lv N FL Cat's Eye Excavatio 7121.2312003 YW wms««. ca" Aa.»r,.I.«. TANK CPM FL Fl SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To From I Septic Tank Absorption Field Lift Station Holding Tank i rnvate SewcrLine Anchorage Tank Rm— 1,500 VIM >100' >100, WA WA >25' Steel Two (2) s..rnw.a >100' >100' WA WA LIFT STATION — NONE ON LOT Lot UW >5' >10, WA WA C.W Fa.Wlan >5' >10, WA WA gyp«'a M « in. wd.,D.a. I None Noted Mo0.1 zF"— Mp.Cam Frlan.d oy. BENCH MARK Existing Septlic I ank Pumped, Vushed, BaCkIlliedand lisuffiffDW— Garage Slab. 1DO.0 FL Engineer's Stamp �`P�� ate•. Inspections performed by: AH Dates: 1« 7121103 f 49th -71{ 2ne 7123103 Department of Health and Human Services approval ' S MICHAEL E. ANDERSON '� « .0 s Hn DE_„�,� •••�h��xEsslaN::• � Reviewed and approved by: Date: Municipality of Anchorage Page 2 of 3 _ DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SW030257 \'&' PID No. 015-242-71 0 Existing Yell A I BI C • St 24.5 23.3 Mt tt• 4S2 34.6 25.5 C4 75.5 67.6 ® H2 ti• Three aem,,.•_ M1 75.5 67.6 rH 1 os a ,gyp 9h�'y AS -BUILT PLAN �"-w LOT 4, BLOCK 2, SUNNY SUBDIVISION NOTE: Drawing Not Prepared From Surveyed As -Built. Locations May Not Be Exact. Existing Septic Tank Pumped, Crushed And Disposed. Existing Absorption Trench Abandoned In Place. Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT - 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SW030257 PID No. 015-242-71 US r f U 4 PROFILE AS -BU Style: 1' - 10' AEL E. ANDERSON No. CE- 391 .11 •'/• MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 8 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030257 Legal Description: rSUNNY BLK 2 LT 4 Date Issued: Jul 17, 2003 Expiration Date: Jul 16, 2004 Parcel ID: 015-242-71 Design Engineer: 0014 Anderson Engineering Site Address: 011700 HIDEAWAY TR Owner Name: Michelsohn Lot Size: 53145 SO. FT. Owner Address: 750 W. Dimond Blvd Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE. AK 99515 - This permit is for the construction of: Q Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By. Date: yff g Date: ��r ?LA -T Issued By � Municipality of Anchorage Development Services Department Building Safety Division e i On -Site Water and Wastewater Program s. .,. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ek.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 01 a y0 _�) I Permit Number $W Property owner(s)-Michelsohnand_Daughter Day phone 522-3375 Mailing address (1) 750-W-Dimond5oulevard_Anchorage. AK -99515 address (2) \ �� Tr Zip Code Legal description (Lot, Block & Sub'd.) 4.ot_4-Diock2.5unrly5ubdivieion Legal description (Section, Township & Range) Lot Size_JcrC) S Acres/Sq.Ft. Number of Bedrooms SJve_(5) THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: r Waiver Fees: Date of Payment: 1,1 I I n3 Date of Payment: Receipt Number: 1I N13 Receipt Number: (Rev. 12/00) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 522.6779 FAX July 9. 2003 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 2, Block 4, Sunny Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 2, Block 4, Sunny Subdivision intends to expand his three-bedroom home to include two additional bedrooms. We are therefore requesting a permit be issued for the construction of a new septic system to serve the five -bedroom home. The attached Site Plan and backup documentation identify the location and configuration of the new septic system and the parameters used in the design. Also identified on the plans are the location of the well on the lot and surrounding wells in the area, test holes, surface water and the septic systems on the surrounding lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test holes placed near the location of the proposed absorption trench indicated silty gravel with some sand and percolation rates approximating 31 to 60 minutes per inch. No groundwater was found during placement of the test holes, and none was noted during the monitoring period. We are therefore Proposing to place a new 1,500 -gallon septic tank and a 84' long x 3' wide x 10' effective depth absorption trench. The distributionellill lllaced 2' below tnsurface and the tn etth will be Sfcint flwill beplaced over septic tank and absorptonteho prevent freezing.. The ground surface on the lot slopes at varying grades from northeast to southwest. The absorption trench will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. All components of the new septic system will be constructed a minimum of 100' from the existing well on this lot and 100' from wells on surrounding lots. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells Lot 2, Block 4, Sunny July 9, 2003 Page Two in the area or those to be constructed in the future. 2. septicThe systems if in the area or those d as t be coil have no n tructed intherse futurePact on existing 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, s o Michael E. Anderson, P.E. Attachments .,;y q 49th MICHAEL E. ANDERSON No. CE -4381 ..s 5� 910 ��• ExlsUng o h Well ':: " r c N ;j H•. .L Throe 8edr 0 ` J o/ife TH2 and . 8'o Efreotve de c � Absorption Tre Depth cti1.5 Gall ptic k y o Abandon ,'1> TH 1 ExisUng •,• 0°A Trench e e L� NOTE: Remove and Properly Dispose �eZe FAsUng Septic Tank JJpd ,09 �0 yy95 SITE PLAN .,•.w •..,,, SCALE V e 50' . , ....._.....,, •j•�� t �.....J.. 49th .... ................... ......... rj. , ..I�1 4iC1NEL E.MCEN9O1 �I LOT 4, BLOCK 2, SUNNY SUBDIVISION �'•.� .. LOT 4, BLOCK 2, SUNNY SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom Home Deep Trench System Perc. Rate: 3160 MinJlnch 1,500 Gallon Septic Tank Application Rate: .45 GP pD/SF 10' Drainfield Rock 750 6 6.7 /.45 PDISFSF/LF (AglicaLF Trench length=1,66.7 SF Absorption Area THEREFORE: Construct a 84' Long x 3' Wide x 10' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 2' Below Original Ground Surface. Total Depth to be 12' Below Existing Ground. Maintain 100' Separation From Existing Well on Lot. Place ofcCoverto Prevent Freezinand a4 of Cover OverSepti cTnTrench or Provide Minimum 3' Natural Backfill 1'6" Geotedle Fabric 6- } 4' Perforated + PVC (Holes Down) Drainfieid Rock 3' i TYPICAL DEEP TRENCH 5tU i 1UP (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 10' Separation From Water Service Line. Minimum 100' Separation From Surface Water or Streams. Municipality of Anchorage � vr'io-P,iNICINE1y No. CE-4381E ANDERSON r+; Development Services Department `i+; Ne, -43er f ♦� 4700 South Bragaw Street Anchorage, AK 99519 6650 ��•.� SOILS LOG - PERCOLATION TEST�11,,,,�0 PERFORMED FOR: DATE PERFORMED: Township, Range, Section: LEGAL DESCRIPTION: L-P f Z^ SLOPE, SITE PLAN DEITH (FEET) ' jz 1 2 3 MJ 7 9 10 11 12 13 14 TS 16- 17- 18-. 6- 17-1s- 39. 20 COMMENTS WAS GROUND WATER ENCOUNTERED? �1 IF YES. AT WHAT DEPTH? �f ' plym b wxc Mer .I G . Groh Re2d;,9 Date 11m IV:1 1q:fy Net I DePth m Nn Tune ` Water ' DrOP f I-4.-1 S I . 7 6 (minuj,,wm h) PERC HOLE OIAMETER ` `y PERCOLATION RATE —I � ' TEST RUN BETWEEN S FT AND �` —F7 J� CERTIFY THAT THIS TEST WAS PERFORMED IN .. PERFORMED BY: �4" ` 1 ' ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE: sr Municipality of Anchorage MIDU'1T. E AN=ii;, Development Services Department �j�ci`• No. CE -4391 �' 4700 SoUlh Bragaw Street Anchorage, AK 99519-6650 41a' 1� & PMI SOILS LOG - PERCOLATION TEST� DATE PERFORMED: PERFORMED FOR: I IGII�I�1�"�DI7/Y V`�"' I2 "y C ,� L 15 tj Township, Range. Section: LEGAL DESCRIPTION: 1N� SLOPE. SITE PLAN 11 1 72 0 / ✓/ o 13 0 14 1s 16 L 0 17 p 18 19 20 O COMMENTS Cll GDJI WASGROUNOWATER ' ENCOUNTERED? IF YES. AT WHAT ' DEPTH? WPM w wsc AIW K..t.vn7 Gwzs ' ReaCdM gtO .T•.r•e r1 INei Dmth w NM I Time Waley OMP T%ri P.1 PERCOLATION PATE , (, ^" I.'^C+) PERC HOLE DIAMETER L • ` TEST RUN BETWEEN FT AND 8 FT - il. PERFORMED 6Y:, �/� 1 CERTIFY THAT THIS TEST WAS PFORMED IN /1 ll ER ACCOROANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE GREti ER ANCHORAGE AREA BOk JGH Department of Environmental Quality \` 3330 C Street Anchorage, Alaska 99503 %, INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM'-loC NAME-dOtl T11Ei MAILING ADDRESS 9.SO7 y�e14v. PHONE333-;33 /!. LOCATION <�W17 O��LEGAL DESCRIPTION AA1611,SIC/k, S5;'4 -2y / HO/Q/V &4V S///2 SEPTIC TANK: �a u 6Y DISTANCE�n NUMBER OF / FROM WELL '/I /4/ MANUFACTURER --- MATERIAL COMPARTMENTS / INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITYAOOO GALLONS. TILE DRAIN FIELD: l ' TOTAL LENGTH /J / DISTANCE FROM WELL � NFOUNDATION d t NEEAREST LOT LINE la f OF LINES %^� NUMBER OF LINES DISTANCE BETWEEN LINE$/A1_ TRENCH WIDTFi7; IN. TOTAL EFFECTIVE ABSORPTION AREA y�y SQ. FT. LENGTH OF EACH LINE I DEPTH OF FILTER / '/ DEPTH: TOP OF TILE TO FINISH GRADE y MATERIAL BENEATH TILE 4ftj ABOVE TILE 7 IN. WELL: TYPE_d01 11V CONSTRUCTION DEPTH DISTANCE FROM: BUILDING NEAREST NEAREST SEPTIC SEEPAGE FOUNDATION_, LOT LINE , SEWER LINE , TANK . SYSTEM , CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY: (fPLGV f F / SEWER LINE DEPTH: y PIPE MATERIAL: 44.5I' oo/V LOT SLOPE: DIAGRAM OF SYSTEM K FFF to �at7r�1 I REMARKS: D DATE/D /S_-T7APPROVED_A0 1,av{ G.A.A.B. Form E"32 r -x.'30 GREr=R ANCHORAGE AREA BOF' /Q - /7-%S O. j•• DEPARTMENT OF ENVIRONMENTAL QUALITY veRMl 3330 '•C•• STREET ANCHORAGE, ALASKA 999503 �y ' Iy7/, TELEPHONE 1 � UC/�/A SEWAGE DISPOSAL SYSTEM — APPLICATION ND PERvMIT NAME OF APPLICANT `T� . MAILING ADDRESSerr-4) / 'ooe'Z_r1V r� PHONE �.�/� n '��- c�Y fir. ip. INSTALLATION LOCATION ( LEGAL DESCRIPTION / ,I��' ��` • >� ��,�i'/ r e INSTALLATION OF; SEPTIC TANK — SEEPAGEPITT DRAIN FIELD OTHER % /J TYPE AND SIZE OF FACILITY TO BE SERVED �� / /�'��/-�•/��'I�,(`-",/�ys �L��.y,C/l'�`�� FINANCED THROUGH �7 TO BE INSTALLED BY SOIL TEST RESULTS A�Cr%li ..-eL�/�� NOTEI THIS PERMIT 13 NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED / 171' L't7 z✓c'Pa� G. c 'o�- .�3 .' 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 SEEPAGE AREA SIZ / TYPE- /jI- MINIMUM DISTANCES. REQUIREMENTS DIAGRAM OF SYSTEM FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PIT DRAIN FIELDS —X TO NEAREST LOT LINE. / / WELL TO SEPTIC TANK /O G SEEPAGE PIT / L7 / DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC /� SEEPAGE PIT /V DRAIN FIELD SEPTIC TANK. / SEEPAGE PIT DRAIN FIELD TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION S FEET INTO UNDISTURBED SOIL. — 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. - , a.w.A.a. OR LIC [NS[O DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.60 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. ��/^\J DATE / /'^ APPLICANT'S SIGNATURE / /'?[T�{t FORM NO. EQ -016 ' [// e ANCHORAGE M FAIRBANKS JUNEAU CONSULTANTS, INC. JUN 249 EAST 51ST AVENUE • P -O. !OX 9087 • ANCHORAGE, ALASKA 99302 • TELEPHONE 907.279-0480 • TELEX 090.33419 September 20, 1975 Hoe Unlimited 8040 Lake Otis Parkway Anchorage, Alaska R & M No. 562122 Re: Test Hole and Soil Log Report for Sanitary System NESS, SWC, Section 24, T12N, R3W, S.M. Gentlemen: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of September 19, 1975 and those procedures outlined in a letter dated July 15, 1975, by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within Section 24 for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 17.0 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. v— Wames neyr�,,.� Vice President JWR/jw xc: GAAB NO WATER TABLE 17.0' T.D. i Log represents Location of test hole Section 24 T12N, R2W. S.M. G Joe Bacon Property Log of test hole Anchorage, Alaska Consultants Inc. ANCHORAGE IAIRDANKS 'ALASKA JUNEAU mTE: 9-20-75 IBCALE 1"-3.0' IowN By WED IOHKO By WED IPROJ. NO- 562122 IOwo NO. A-Ol noon _ ' T.H. 1 9-19-75 0.0' Organics 1.0' Organic Silt, trace ' Sand s 2.5' s. Silt, trace sand (ML) 4.5' l Silty Sands (SM) L7 6.0' 4 Gravelly Sand �J trace Silt, (SP) , +;d ' 10.5' . 5 i Q'• f Sandy Gravel of trace Silt (GW) NO WATER TABLE 17.0' T.D. i Log represents Location of test hole Section 24 T12N, R2W. S.M. G Joe Bacon Property Log of test hole Anchorage, Alaska Consultants Inc. ANCHORAGE IAIRDANKS 'ALASKA JUNEAU mTE: 9-20-75 IBCALE 1"-3.0' IowN By WED IOHKO By WED IPROJ. NO- 562122 IOwo NO. A-Ol noon _ ? i' -^» „i'°?A'1Tf'^- M;%' 1_-71\GC ...` .......- .. .. . -' .. . __ _.. ,.-- .�'-.--...... 1 . - . -f M -W DRILLING, Inc. ' •�,ju„��( I 'V) P.O. Box, 4.1224 - 1310C International Airport Road (907) 274.4611 RECEIVED ANCHORAGE, ALASKA 99509 I ' w .{ i 1 DRILLING LOG i Well Owner Joc- .Bacon Use of Well nom I Location (address of: Township, Range, Section, if known; or distance main roar] } ,rA/y, % , TiaA'1�/3W, Size of casing 6 nepth of Hole 140 feet Cased to 140 feet w { Static water level +2O ft. (above) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation ?done Well pumping test at 20 gallons per (tid0Y) _(minute) for --!----hours with 100^' of drawdown from static level. j Notes Well flows O_ approx 10 GPM i Date of completion 10 ,J;wn� 76 i ! WELL LOG j Depth in feet from ground surface 0 Mn 2 l TO 15 __I5 TO 30 30 TO 58 Sfi TO 60 60 TO 137 13V TO 140 ` TO TO j TO TO TO TO TO TO Give details of formations penetrated, size of material, color and hardness Casing Stickup Silty Gravel .Sandy Gravel: viet & cAvinn -Cemented Gravel Modium Water GrAvelt 3 GPM, low ctntir• teynl ft. Cemented Gravelt rm,�11 WAter Gravels slivhtly spp!v, flowing nn�l� formation not bottomed out. N% WA U;-mfficd Gontracua Ccrtilicato Nus. 814 be 973 2 — STATE MUNICIPALITY OF ANCHORAGE Development Services Department \ ,� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-242-71-000 Expiration Date: Legal description SUNNY BLK 2 LT 4 Site address 11700 TRAIL'S END RD Anchorage AK 99507 Current property owner(s) STILLWATER BARBARA LIVING TRUS 5/9/2025 X The On-site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 11/7/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA ApprovaIjune 2022 MUNICIPALITY A Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 015-242-71 Complete legal description SUNNY; BLOCK 2, LOT 4 Location (site address) 11700 TRAILS END ROAD, ANCHORAGE, AK Current property owner(s) BARBARA STILLWATER 2. ON-SITE SYSTEMS SIZED FOR 5 BEDROOMS Day phone 907-230-2233 3. TYPE OF WATER SUPPLY: ■❑ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: A Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: FE -1 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 21 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed 0 Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ J� Date of Payment%012 q1Z_ `] COSA # S C" -Z- C/ / C/ C/ b Waiver Fee $ Date of Payment Waiver # 041- 1 01 �U1,214 COSA Applicalion_June 2022 COSA Checklist Legal Description: SUNNY; BLOCK 2, LOT 4 Parcel ID: 015-242-71 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA 9 Well log is filed with Onsite (or attached) Date drilled 1/19/1976 Total depth 140 ft Cased to 140 ft Q Sanitary seal is functioning correctly 0 Wires are properly protected Casing height (above ground)' in. Date of flow test for COSA 10/8/2024 Static water level at beginning of test ARTESIAN ft Comments B. TANK DATA Measured operating fluid level in septic tank *52" Date of pumping E>11 q/ 'V ❑ Required maintenance completed, if AWWTS Comments: *IN ST1 / 50.5" IN ST2 D. ABSORPTION FIELD DATA Which system tested (date installed) 7/23/2003 X ALL standpipes present per record drawing Total measured depth from grade 15.8 ft (max) Measured depth to pipe invert from grade 3.4 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. * ❑■ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Well production at time of test 3.5+ gpm Water storage tank volume N/A gallons WeIJ disinfected for coliform test? ❑ Yes ® No Coliform bacteria is Negative Nitrate�,4j mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Q-fiisenic less than MRL (ND) Collected by GEG, LTD. Date 10/8/2024 STATION ❑ Require Age of lift station Lift station mater com Adequacy test date 10/8/2024 Results Q Pass Fluid depth prior to test 010 in Water added 751 gal New fluid depth *6.5/0 in Elapsed time 135 min Final fluid depth "4.5/0 in Absorption rate 750+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) *120 in Effective depth used *010 in Effective depth remaining *120 in Comments/Deficiencies:*BASED UPON GEG ELEVATIONS SHOTS, BOTTOM OF MT1 IS 10.36' BELOW INVERT AND BOTTOM OF MT2 IS 10.21' BELOW INVERT. COSA Checklist June 2022 4�— 1 v) -4 712' E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' ❑i Yes if No ft E Yes if No ft Neighboring Tank > 100' no Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' g Yes if No ft Holding Tank > 100' R-1 Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' n Yes if No ft ❑i Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft Q Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' [E Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' Ful Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' M Yes if No ft Water Service Line > 10' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineerinq Group, LTD. (GEG) Phone 907-337-6179 Engineer's Printed Name Jeffrey A. Garness Date 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. distances to readily identifiable features. Hidden defects or encroachments may a O �� Separation were measured exist that were not identified during the evaluation. The operational life of all wells and septic systems depend levels (that may fluctuate qOp� O� . • ' S Q �( upon a variety of variables, including (but not limited to) soil conditions, groundwater the water usage of the family utilizing * L( T �* during the year), quality of construction (materials and workmanship), and the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not Q......:.. .... . • • • • • • - . • • .. • • !� 3uarantee 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;jidf - r A. Garne s.: The this is for the sole benefit of the that retained GEG UM ' adequately in the future. content of report person/party to perform the evaluation. Reliance upon the information provided in this report by any other person or party C _ (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. UCENSErofesslot' o0 Q000�" COSA Checklist June 2022 #AEC48M MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT +, `,; 1 907-343-7904 On -Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC241446 Subdivision: Sunny Block:2, Lot: 4 The septic tank for this property is 21 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $15,000 or more, not including engineering, surveying, MOA permitting fees or site restoration. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 015-242-71 1. GENERAL INFORMATION Complete legal description SUNNY BLOCK 2, LOT 4 Expiration Date: QST I oC . a a Location (site address) 11700 TRAIL'S END ROAD, ANCHORAGE, AK 99507 Current property owner(s) STEVEN EXELBY & SHIRLEY ENG Day phone Mailing address Real estate agent 11700 TRAIL'S END ROAD, ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55 Waiver Fee $ Date of Payment Date of Payment Receipt Number 5) rJ Receipt Number COSA # o SC 2a 1 �1, R I 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 06/15/2022 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the �11� system and maintenance. The operational life of all well and septic systems are subject to ~ � - - 4 these various and dynamic characteristics and are outside the control of the evaluator of the •� well and septic system. Therefore, any estimate of how long a system will function satisfactory �AgWP; • • • • • ' •!�9 �� discrepancies exist can be given b First Water Consulting& encroachments, deficiencies or * . TH ' 9* 6 or current or future occupants or guarantee that no unseen encroa ' , , , , , , , , , , , , , , , , , Ir 6. DSD SIGNATURE •'•' •"�" % Curtis Huffman V/ System #1 Approved for Jr bedrooms �r��F49, •,. CE128991 l�c� f/15/�2•'�� System #2 Approved for bedrooms iI,F�PROFESSON Disapproved Conditional approval for bedrooms, with the following stipulations: ur 111111((((((((( ON-SITE Z \NATE �,t TER Z pROG�\P �co BY P�TIc 1 �� C�G�Iu vt Original Certificate Date: 1a A0a a The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: SUNNY BLOCK 2, LOT 4 Parcel ID: 015-242-71 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA Well log is filed with Onsite (or attached) Date drilled 1/19/1976 Total depth 140 ft Cased to 140 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/14/22 Static water level at beginning of test ARTESIAN ft Well production at time of test 3.8+ gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 2.5 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date of Sample 6/14/22 Comments ARTESIAN WELL ASSUMED WATER PRODUCTION RESTRAINED BY PLUMBING / HOSE AT TEST. B. TANK DATA Age of tank(s) 19 years Tank type/material SEPTIC / STEEL Measured operating fluid level in septic tank 50” Standpipes/foundation cleanout per record drawing Date of pumping 6/14/22 C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 7/23/2003 ALL standpipes present per record drawing Total measured depth from grade 15.6 ft (max) Measured depth to pipe invert from grade 5.3 ft (min) N/A – pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective MOA IR SHOWS 10’ ED. ELEVATIONS SHOW 10.3’ED Code-required soil cover over field System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Adequacy test date 6/14/2022 Results Pass For 5 bedrooms Fluid depth prior to test 1 in Water added 750 gal New depth 9 in Elapsed time 1300 min Final fluid depth 1 in Absorption rate 750 gpd Any rejuvenation treatment (past 12 months) N If yes, enter date Comments/Deficiencies: MT/CO AT GRADE. SOUTHERN MT STAYED DRY. 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No *5+ ft Property Line > 5’ Yes if No ft Absorption Field > 5’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ 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 Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft If absorption field is under driveway comment below Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No F. ENGINEER’S COMMENTS *PER MOA CODE AT INSTALL. 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. 7/11/22 LOT 5 BLK 2 G 1� GRAVEL �Q WELL 0 CUNC SEPTIC ' • VENT TYP ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: SUNNY SUBDIVISION LOT 4 BLOCK 2 PLAT RI.17A LOT 4 BLK 2 PAVED D/W TRAILS END ROAD DECKS 9 p. 6.0 R=4.9' �QQ\� 6.2' �o,� .t.;� Q = FND 5/8" REBAR LOT 3 BLK 2 /OF SUR SURVEY CERTIFICATE. I John L. Schuller Have conducted a .00, O ,'v physical survey of this property as shown on this drawing and that the ,rr �. , • - .. - - - - • , 'e �'' • ' improvements situated hereon are within the property lines and no t1, . l .• .I # enchroachments exist other than noted. Under no circumstance shout , 49TH J �,,, any information on this drawing, be used for construction of fences, A0 * x �, ••� structures, improvements, or for establishing boundary lines. �.... , . � .. .. + .. ... . , . � � � p g ""` JVAi FA EXCLUSION NOTES: It is the owners responsibility to determine .� .:..,� ....................:..� .R. the existence of any easements covenants or restrictions which CD '•BHN L. SC�-IULLER.• e " LS -10408 do not appear on the recorded subdivision plat. /-�- ••N`' �,, • . , . • �� d 1831 Talkeetna Street WORK ORDER NUMBER: DATE: SCALE: E-MAIL: �O, ..�• . ' a Anchorage, Alaska 99508 JULY 9, 2022 1 =40 schuller®ak.net Ar, �� DRAWN BY: CHECKED BY GRID NUMBER: BON/PAM. , o fe `- Aw (907) 227--1455 office 2 JLS N W2740 220243 �,, s s e o no\ tea, �►��►'�'�' {907} 274--4992 fax n q'*o'P7 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH d HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 V,/J. 7 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) b157 - nv-/91/ (a) Legal Description (include lot, block, subdivision, section, township, range) L07- t_I I 9V_0 soNw SEC- PLY/ r 1AN,, .�?3 W( ' Location (address or directions) 11'7&0 { R-htt_S �>J� (b) Property Owner , 'gamut Telephone: Home ;%- it, 2p3 Business Mailing Address 11 l" T P -AILS eN0 (C) Lending Institution Nlovw&.a t4vJ145Q Telephone 27ui-6 1a0 1akCkIrPaAJO Mailing Address D -e -Ka -1 1 (d) Real Estate Company and Agent_ �-Pa a.�q "e-e'+cx ' Address 2(.00 Co V40e ✓ •t Telephone �-7(r- A")G (e) Mail the HAA to the followinc address: or: Check here if hold for pick up. List contact person and day phone number below. V S� Z7@ -39th 2. TYPE OF RESIDENCE Single -Family l�S, Number of Bedrooms 3. WATER SUPPLY Individual Well -\ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ¢i- Public ❑ Community ❑ Holding Tank ❑ Note± If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 77-078 lRw 8'881 Fronl 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 II Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm -Gt LLt t- � Telephone �77 ^3 9/.bAddress °2L 3 N e /� Date 0ci4 ''21 / 'if-7 -%9is. �• Engineer's Seal •. 0..22^� i 6. DHHS APPROVAL ,, ,e'"/�/ Approved for 3 bedrooms by C�' " Approved x Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 ».on iRw 8 661 sack n MUNt�tpP��P�s[� MUNICIPALITY OF ANCHORAGE (MOA) t h HEALTH AUTHORITY APPROVAL (HAA) Ft11t�C�. 2�y�� CHECKLIST -FEBRUARY 1984 �(,,� L• D 2644744 Legal Description: Lt7T �/ BIC QI 5o N N y s6;r_ ALI, '-IAP4, Fz�.W A. WELL DATA Well Classification ES If A. B, C, D.E.C. Approved (Y/N) VIA Well Log Present (Y/N) Y Date Completed I h9/ 76 Yield .209p„., Total Depth JqD Cased to MD Depth o1 Grouting N r> Hr.: Static Water Level 1` 0. "1(0u4# a;at,n Pump Set At V Nk*1cntM Casing Height Above Ground Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot - //n ; On Adjoining Lots fv 0 N F To Nearest Edge o1 Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line N 0n1 J;Z: To Nearest Public Sewer Cleanout/Manhole NoN£ To Nearest Sewer Service Line on Lot Water Sample Collected by C ; Date Water Sample Test Results (3 (• D t / , 1+,2 .+n /t Comments B. SEPTIC/HOLDING TANK DATA Date Installed Oc-t 2 7b Size ;oaa No. of Compartments DNS Standpipes (Y/N) 0Nr Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N)pieR7vireewt WORM fwesr Depression over Tank (Y/N) N Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ��A ; for Holding Tank High -Water Alarm (Y/N) Wa, Temporary Holding Tank Permit (Y/N) WAN Separation Distances from Septic/Holding Tank: To Water -Supply Well Ifo To Building Foundation U) To Property Line 50 r To Disposal Field To Water Main/Service Line / 0 To Stream, Pond, Lake, or Major Drainage Course aoo— 3oc� Comments Page 1 of 2 72-M tPry EV061 Front r'• C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /sem Type of System Design 7QENCH Date Installed 0 7 ,�> Length of Field 26 Width of Field 8ti y Depth of Field t Gravel Bed Thickness R Square Feet of Absorption Area yah Depression over Field (Y/N) N Results of Last Adequacy Test �« Separation Distance from Absorption Field: To Water -Supply Well �.Z7 To Building Foundation, Y Lot Standpipes Present(Y/N) 7 telo TT Date-oof Last Adegua-cy TTest "`h/R7 rte r /",P- T rsdaarf To Water Main/Service Line 7 to To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION N0 NS • , Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) • Comments To Property Line • 50 _To Existing or Abandoned System on On Adjoining Lots IVO NE To Cutbank (if present) N b NC 100•, - 300 l 3o' Dimensions Manhole/Access (Y/N) "Pump Off"Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA " Check Permitted Bedroom Rating Against HAA Request •' 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed rs Date t%&7 Company MOA No. Receipt No. Date of Payment Amount: $ /6 d �� x . �*`� ) „� Engineer's Seal 01 2225-E � ..: . 1971 1.-Y 1'•E 2i. iJJ Page 2 of 2 72.0261R" 8'861 Buk i i GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality ", ,.•>" 3330 "C" Street, Anchorage, Alaska 99503 274-4561 Date Received June 11, 1976 he �-Ilo•��- Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Conv. 1. Approval requested by: Thr First National Bank of Anchorage Mailing Address: Post Office Box 720, 99510 Phone: 279-4481 x 231 2. Property Owner: J. J. Bacon Phone: 349-3562/177-5686 Mailing Address: Post office Box 1335, 99510 3. Legal Description: .T12N R3W Portion of the NE; SW,4 S24 4. Location: See directions on back 5. Type of facility to be inspected single Family No. of bedrooms 2 6. Well Data: Individual A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On—site system A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Absorption area Sewer Lines Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page 1 of two pages • (^ AIUN:CIPAL'TY CF ANCHORAGE DEPT. CF H°_ALTH G MUNICIPALITY OF ANCHORAGE ENVMON,V.ENTAL r„ CTECTION DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561p J v 1 1 1976 REQUEST FOR APPROVAL OF !\ E C E I v D INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV XX 2. Property Owner: J. J. Bacon Mailing Address: P. 0. Box 1335, Anch. , Ak 99510 Day Phone 349-3562 or 277 5686 or home -344 1279 3. Name of Buyer: None -refinance Mailing Address: Day Phone 4. Name of Lending Institution: The First National Bank of Anchorage Mailing Address: P. 0. Box 720 Phone 279-4481 x 231 Anchorage, Alaska 99510 5. Name of Realtor or Agent: none Mailing Address: n/a Phone 6. Legal Description: Portion of the NEk, SWtt, S24, T12N, R3W., S.M. Location: Upper OMalley Road to Trails End. Take right on Trails end and go about 1/4 mile to where road swings to left. Continue on, on Trails End to end of road. 7. Type of Facility to be inspected: Single family residence No. Bdrms. 2 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation E0.037 (1/74) mailed 6/7/76 (do) Individual vrivate well one Individual (on-site) s, =taic system Page 2 of two Rages - Req 't for Approval of Individual S '?r & Water Facilities m - ' .legal'Description T12N R3W Portion of the NE4 SW4 S24 Comments Approved '4—> - Disapproved Date GtCClp Approval;Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED r EQ -034 (1/74) I,� Da to