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SELKREGG LT 5B
Selkreg!g Lot 5B #006-271-33 Sep_20.2022 03:09 PM Anchorage Well & Pump Service Inc 9072430742 #0532 P 1/ 1 MUNICIPALITY OF ANCHORAGE Development Services Department n Rhone: 907343-7904 On -Site Water & Wastewater Section _ Fax: 907-343-7987 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: 006 271 3 Date of Issue: - Legal Description Block Lot )Property Owner Name & Address: ARMSTRONG GLENN A & JULIANA K ELREGG 5B 2201 OTTER STREET ANCHORAGE, AK 99504 Pump Installation Date: 09 - i8 - 2022 Pump Intake Depth Below Top of Well Casing: 90 feet Pump Manufacturer's Name: STA -RITE Pump Model: 7P4H05231-0 Pump Size: • 5 hp Pitless Adapter Burial Depth: 10 feet Pitless Adapter Manufacturer's Name: MARTIN SON Pitless Adapter Installer. Well Disinfected Upon Completion? X Yes ❑ No Method of Disinfection: PELLETS Comments: Pump Installer Name: ANCHORAGE WELL & PUMP SERVICE Company: 7540 KING STREET ANCHORAGE, AK 99518 Mailing Address- � � 907-243-0740 State: Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report SWO80126 PID Number: 006-271-33 Permit Number. Name: Wastewater System: ❑ New ■ Upgrade SUSAN HORN Aa2201 ABSORPTION FIELD OTTER STREET a ANCHORAGE, AK Phone: No. of Bedrooms: 4 (] Deep Trench ■Shallow Trench OBee OMound OOther (907) 332-2201 Sell Roan¢ Told Dplh Irani angNol grz; LEGAL DESCRIPTION 1.2 GPD/S4 rt. 7.93 FL D.pth to PI" bolt" ham mgYM 9roo : Goal d.pth ll. "` pbw 3.02 dlock: Lot: Subdivision: — 58 SELKREGG 4.58 rL rL Township: Range: Section: — rill eddod eeow rlpbd yedc C.e..l M9U: 61 — — SEE DWG. rt. rL Groh wWth: NumW o/ IF.N Dbtard. e.l..w, An. WELL: []New ❑ Upgrade 5 I'Ll FL Go.erwtbn Nr t.. A.B.O. Told pop `v Co..d To (pmeyx) Total ee.orplkn or.s 526 PIP. melrld: D 3034/ F-810 rl FL So rL Drlir: \ 0.10 "od: 51011, watt L": YiNdlr. A+ HOMES Dol. MOW 9742-24/2008 rL TyePam, Set AL CO"eight Maw Ground: TANK Go. rL SEPARATION DISTANCES ■septic OHolding OS.T.E.P. 00ther To septic Absorption Lllt Holding uak/PMot. Y°""'°`ANCHORAGE TANK cope tyIn�m1250 Tank Field station Tank S..r Lhn rani 25'+ Petry: STEEL NwMr .1 earnparM.nlc 2 Well 100'+ 100'+ — — Surface water too'+ 100'+ — — — LIFT STATION Sa. H ea .. Ymulootrw: Lot Line 5'+ 10'+ — — — PwnP an I.ral e1: Pump el eL Iqh .elr dorm eL FoundaHDroin 5'+ 10'+ — — — Pu Ya. �: EbcaYd Ino,wt n. p.rlrmd er. Curtain NONE KNOWN BENCH MARK 2emcrks: OLD TANK WAS ABANDONED PER UPC t.eeatkn a,a p..rlplbn: TOP OF FCO A.r.ned V.I. 116..57 rL ENGINEER'S SEAL Inspections performed by: GEG, Ltd. Dates: 1st 9/22/2008 oo F �F. 2nd 9/23/2008 0 3rd 9/24/2008 off.• S�oO ov 0 Development Services Department Approval 9 0 •... • y ........�.. 0 •• •.... '••""'� Conditional approval: Dote: ••• '•.Je f A. rness: QO P Q� o 79$3 `�0p 4p eaeo0 goo Reviewed and approved by: Date, 0"� DOp profession o'er �04000�� (R.+. 4/De) PARCEL ID NUMBER: PERMIT NUMBER: —271-33 SWO80126 AS -BUILT DRAWING 006 _3 STI 31.46 63.45 ST2 38.73 69.10 DEILI 40.64 70.17 DBL2 41.60 70.65 DV 57.40 84.42 Col 97.15 103.78 MTI 95.19 102.57 CO2 87.56 132.33 1 MT2 190.10 1134.40 1 CO3 161.07 183.69 MT32 9.156 1 �3.!l 6 E04 61.83 120.28 MT4 62.64 120.50 I 5t* EXISTING 4 BEDROOM HOUSE 1 & NEW 1250 GALLON STEPIC TANK LOCATION ON DESIGN WAS APPROXIMATE T L T H� I ACCURATE OCAlION IS AS SHOWN ESERVE SITE 04 NEW DRAiNnEUD COLLEGE CATE T4 EAST #4; TRACT D 0T2 PERK :0 BENC t MT1 C A S PALE: V - 50, miIIIIIIIII& GARNESS ENGINEERING GROUP, Ltd. . I I CONSULTANTS & GENERAL CONTRACTORS M AM M N507 PREPARED FOR: PHONE NUMBER: PAGE UMBER: Go . r ess.:.... SUSAN HORN 332-2201 2 OF 3 J Iff e DRAWN BY: E— LEGAL DESCRIPTION: SELKREGG, LOT 5B K.D.M.p /Z TYPE OF WORK: DATE: 9/29/200 tofossto AS—BUILT DRAWING " 011051 PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: I SWO80126 066-271-33 TOP OF TANK AT INLET = 111.64 INVERT OF BUNG AT INLET = 110.98 ORIGINAL . 9E INSULATION FINAL GRADE = 115.29-115-30 ST1 ST2 �— TOP OF TANK / AT OUTLET — 111.61 NEW 1250 GALLON SEPTIC TANK FINAL GRADE 96.80-98.11 ELEVATION OF BOTTOM OF TEST HOLE • 81.03 (WATER 82.03) -INVERT OF BUNG AT OUTLET = 110.77 FABRIC INVERT OF PIPE 91.12 —BOTTOM OF TRENCH . 88.10 Iffm GARNESS ENGINEERING GROUP, m� _.. -- CONSULTANTS 8 GENERAL CONTRACTORS •�-••••�•-'•^••'^�• �' na t nua ■o.o. sua to • wo�au[. u� w.ar • wcrt (w>)sn-yin . ru Ib>!w-vw . �osm ....,e....y...w,w• PREPARED FOR: PHONE NUMBER: PACE NUMBER: "" ... SUSAN HORN 332-2201 3 OF 3 OQQ a ':� A. ess: vi LEGAL DESCRIPTION: DRAWN BY: 01 SELKREGG, LOT 58 K.D.M. DADo ��DOo���� T1PE OF WORK. 9/Z9/ZOO8 0 AS -BUILT PROFILE (Ra.. 01101 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jul 15, 2008 Expiration Date: Jul 15, 2009 Permit Number: SWO80126 Parcel ID: 006-271-33 Legal Description: SELKREGG LT 513 Design Engineer: 0855 GARNESS ENGINEERING GROUF Site Address: 002201 OTTER ST Owner Name: SUSAN HORN Lot Size: 116028 SO. FT. Owner Address: 2201 OTTER STREET Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99504 - This permit is for the construction of: M. 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: JEW/,; /%1111111111/LLL/L��G[v�— Date: 7 Date: �✓� � Municipality of Anchorage `\• --1 Development Services Department J Building Safety Division' On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. mo -'al 1— 53 Property owner(s) SUSAN HORN Day phone 332-2201 Mailing address 2201 OTTER STREET *ANCHORAGE. AK Site address Legal description (Sub'd, Block & Lot) SFLKROT 56 Legal description (Township, Section & Range) Lot Size //G, b -2S Sq.Ft. THIS APPLICATION IS FOR (Zall that apply): Absorption Field ❑ Septic Tank El Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Zip Code 99504 Number of Bedrooms THIS APPLICATION IS AN: Initial ❑ Upgrade El Renewal ❑ I 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. GARNESS ENGINEERING GROUP, Ltd. Permit/Rush Fees: K ('o , J V Date of Payment: 1102 Receipt Number: 115'l1 u (Rev. 11/05) Waiver Fees:1-7s.00 Date of Payment: '"II - 9 O $ Receipt Number: 671b Ahmicipality of Anchorage (Oct1. N,x IWVA) •.\nchoragm Alaslul V.619 QW) • 471N) Elmore INN `> �� I Illiee: ('M)71313-tiN11 • Flax: (!X)7) 34$-821N1 htlp://w���c.munLorq Mayor 31ark Begieh Development Services Department. July 15, 2008 Jeffrey Garncss, P.E. Garncss Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Subject: Waiver Request for Sclkregg, L513 Waiver Request WR#: 080046 Parcel ID # 006-271-33 SW080126 Dear Jeffrey Garncss, P.E.: c�oQOle nt..d� i Department Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Deb Wockenfuss Civil Engineer On -Site Water & Wastewater Program Conununity, Security, Prosperity Municipality of Anchorage Development Services Department C Building Safely Division On -Site Water and Wastewater Program 4700 Bragaw Strect P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#:080046 PID#:006-271-33 HA/Permit# SW080126 Date Received: July 15, 2008 Legal Description: Selkregg, 1,513 Engineer. Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Applicant: Susan Horn Waiver Requested: 5' Lot line waiver Criteria: Geology A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Points: a ..... .ommos..moss..........................moss.......................... Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: Date: 7115108 By: Deb Wockenfuss Name of Reviewer ......................................................................... Rec#: 75716 Amount: $175 Date Paid: 7/1512008 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS tw-' --sem July 7, 2008 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic System Upgrade for Selkregg Subdivision; Lot 5B, To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system is failed and needs to be replaced prior to sale of the house. We are proposing to install a new 1250 gallon septic tank and a 5 -wide trench type drainficld. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPHY: As can be seen on the attached design drawing the average topography below the drainfield is a 10+/- percent slope running approximately northwest/west to southeast/east. In short, there are no slope concerns. 5. LOT LINE NAIVER: We are requesting a 5 foot lot line waiver to the east lot line. There is no septic system within 10 feet of the lot line on tract D. We arc unaware of any adverse impacts with the granting of this waiver. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. P.E1, M.S. NOT9,Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507-1259 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: www.gamessenginecring.com COLLEGE GATE EAST /4; TRACT A / / / / / / / / / / / / / / / / / / / / / / / WETOR; LOT 3 / I / 1 / WETOR; LOT 4 1 I \ I AR — , SELKREGG; LOT 5A If 1 100' WELL I EXISTING 4 30% \ BEDROOM //\z \ HOUS / PL / `\(UETOR; LOT 7 � 1 \ / 1 tP K) / / WETOR; LOT 6 S LE: ® 1' - 100' / // COLLEGE GATE EAST /4; TRACT D / / PROPOSED MEPTIC ------------- PUBLIC WATR&SEWER] / / COLLEGE / GATE FAST , #4; TRACT F / LOT 58 LOT 59 GARNESS ENGINLLRING GROUP, Ltd. * ::4 CONSULTANTS d GENERAL CONTRACTORS •• •••••• •• �• . AI C TILCYI IIO1D. A/1[ 101 • 1MC10R.Y.0 Y [Y501 • [1rtIL 901}1) 'n • [.1Y CWYI& 32" • R - mow. Oww PREPARED FOR: PHONE NUMBER: PAGE NUMBER: • • • ••• •••• ......•••• SUSAN HORN 332-2201 1 OF1 ey A. orness: LEGAL DESCRIPTION: DRAWN BY: oO °P, �— 953 e� SELKREGG LOT 56 P•N•B 4�4 ° �•4!!���'' �ooG TYPE OF WORK: DATE: �Q4d ptofssslo oo�' SITE PLAN 6/12/08 (Rev 01A5) OF BEDROOMS:4 PER DAY (GPD): 600 ION RATES: 3.33 MIN./INCH D APPLICATION RATE -'I.2 DRAINTIELD SO.FT.: 500 MAXIMUM DEPTH:B FEET WIDTH: 5 FEET LENGTH:60 FEET M.OA APPROVED SAND FILTER: N/A EFFECTIVE:3 FEET REDUCTION FACTOR: 0.58 ACTUAL SQ.FT.: 517 J NOTE: THE CONTRACTOR SHALL HAVE THE PROPERTY LOT LINE, AND WELL RADIUS FLAGGED BY A REGISTERED I TO OBTAIN A COPY OF CONTACT CEG. BY PROCEEDING FORWARD \ LAND SURVEYOR PRIOR TO �WELLTHIS DRILLER, CONTRACTORANDLATION. THE ENGIN EER. \ CONSTRUCTION. PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIRCAnONS AND L/\ AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. I 100' WE RADIUS I EXISTING 1250 GALLON TANK TO BE PUMPED. CRUSHED. AND COMPLETELY ABANDONED PER UPC. \EXISTING ,TOS BEDROOM HOUSE \ PROPOSED 1250 GALLON TANK OLD TRENCH TO BE USED AS RESERVE SITE. / ZREQUESTING COLLEGE GATE EAST #4;TRACT E �iiffiR / / BENCH VALVE // / THjt / ko INSTALL DOUBLE / CLEANOUTS LABANDONED CRIB (1985) 11 INC jjjll�pll ARNESS ENGINEERING GROUP, Ltd. — CONSULTANTS& GENERAL CONTRACTORS•..••_•_�•^+�+•�-+�•••� Q •••••••••• ••••••••••• •'••• ]At L MCN NL0. NAC 101 MIOItORWT Mi MMO) A101[ (e0n1J) M a FM (Y°1).W " �C w.gsre.rnyne.Yq.an 0 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Q •••;•••• ••• •••••• .... SUSAN HORN 332-2201 1 OF 1 OO .Jet a A. arnes n _ .i LEGAL DESCRIPTION: DRAWN BY: VO�J E �F`p SELKREGG; LOT 5B P•N•B 71!}. 08 0°0 TYPE OF WORK: DATE: OQ01ro Te°a50oo� DESIGN FOR PROPOSED SEPTIC UPGRADE 7/7/2008 (Rev 01q ) GARNESS ENGINEERING GROUP, Ltd. .. I .. - CONSULTANTS 3 GENERAL CONTRACTORS ---��•��—� SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: 5ELKREGG; LUT DB PERFORMED FOR: SUSAN HORN DEPTH (feet) TEST HOLE 1 1 tea» ORGANICS/FILL 2 e>_» 3 Daae s 6 7 I 8 • NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/2/08 1 5:30 1 lye — 9 2 GM 10- %//% 6- 11 5:50 NNE 12- 2131415 • ..►sem.._ 13- IIIIIIIII 0 14- 5 6:10 15- 6' — 16- 161718 6:30 20 17- 6. 18— • • NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/2/08 1 5:30 1 6' 111111111 2 111191 20 %//% 6- 3 5:50 NNE 6' • ..►sem.._ 6:10 IIIIIIIII 0 6' 5 6:10 %//%Hit 6' — 6 6:30 20 0 6. DEPTH TO DATE GROUNDWATER 14' 7/2/08 Q' 7/9/08 7 11 ABANDONED PUBLIC WATE CRIB PUBLIC SEWER DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 7/2/08 1 5:30 — 6' — 2 5:50 20 0 6- 3 5:50 — 6' — 4 6:10 20 0 6' 5 6:10 — 6' — 6 6:30 20 0 6. 19 PERCOLATION RATE 3.33 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 6 FT. AND 7 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: ROB CAMBELL PERCOLATION TEST PERFORMED BY: DAVID GARNESS COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE:_7 q 0Y, FA 4 MUNICIPALITY OF ANCHORAGE HEALTH SER ESEnv DE FITMENTOF al Health Division sMAN lon C)C) (P 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES D OA N 2 TO FROM SEPTIC TANK ABSORPTION FIELD WELL Address WELL •� cam ..� �"!�t�- � i � I-= � Bedrooms Phones) Permit No. NJo. of � (} f =�.d_c5zc3, 19. L( "7 0 e r LOT LINE 73 �J'�.�; 5,C) / � (• LEGAL DESCRIPTION Lot Hj Block Subdivision U L) Ir= Ir _0 1 `.- FOUNDATION Township, Range, Section----�— AS-BUILT DIAGRAM (Show location of well. septic system, property Imes, foundation,p dnceway. ware, bodies, eta) TANKS LUT 5, VUETOR SEPTIC [I HOLDING Manulactmer Capacity in gallons /§MG1l�r�lle T-6a ILS I / 0 — R — Material ++ No. of Compartmeenntttss TYPE OF SYSTEM TRENCI-I ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom Irom � original grade r F Total depth from original grade l0 (2 F FT FII added above onginal grade 0,oi Gravel depth beneath pipe 7 S FT FT s rtT, _6rravel length Gravel width , �, FT 9 FT _ it MWTM 4- 13EDROOl o° �T"' RESIDENCE 0 lei" Total absorption area 16 SQ FT - Distance between lines FT Number of 1hne5 soo rating Pipe material (1 SQ FT _ 0-14 / ! Ci � MdM1T — 1950 564 STEELTMj[ Installer Date Inst 11 cl WELLS / �^ s^ ❑ PRIVATE ❑ OTHER (Identity) Classilmation IARC) � Total Depth Cased to FT FT �QQr EAST InslalleDale Installed: T14 13 15 — REMARKS: Scale: l J i t �R--Z7 = --_ E_NU7N5VID'9 SEAL - Inspections Perlormed by. -- - Date. r - . cerlily that this inspection was performed according to all Municipal and Slate guidelines in ellect an this dot / Date. Health Department Approval: — �� 72-013 (3/85) T 7 it F 0, 0 P 4 0 4 0 0 1: ueri F tnf flU, n vu ej ces 025 1 AM& P"ChDr6go. Wska 9001 x4own hili in ; I 1(.l Hli 1.1-og! ad,., Ldil Nr ! WIN �IwPl wy hlhom:l -,0', 1011.-,- -� f 561-15011, A1CHOR41E, AV 99501, -271 A rM i Wividon; NPOR Int; 5 Bloch NIA sychurk Y; 1uppyhy it'! ! togs: R no 30; AJ A AIR, or lavo J'hj- P, "! i-tz! EMU WK; K im JA Ow"M loop Qwwiiy. !!-5i.'; ilillof�.:, zspti, ma _ On Inam z romnartrank. Unpub to lop of 040v MR(s) t hif JIijF NPIW 0 Myl PEA FNWHf 1`Ii;'7',NJ,-,UH AF 1 14, : 1, 14 K Q Early I Anhui age WO wd the HOW 0 AWK 1 Al 11 W 0: 1 too ;,Jan in an ard,inup with 11 ! 404 onto and wistiow ,nd ir rumWora AR Ow dywqP rrijuri; of this pernk 1 i Nil 1 1 1 HKA Ind Stott a Alaska i; fop 'lie ocl:: :;JI:t . f!;iil on. wisting fwil, wastOWROP disposal system Of public WPM smium "I this x Y4 VdIvEn! a Pwany to: i iiii;: th! this muf it is Mid foF I whun of 4 Moms. i v15o undershand Ual the wanty of the Lola! is 4 bvdpoorni cn-i-d Rol DATH Permj,mber� S7�28� Date lssued: 1V/27/87 L/:ner Nane: DUANE HAYMANN Uwner Address: 22OO OTTER Sl, ANCH�RA8E, 0K Parcel ld: �(��~271-30 Lot Legal: Subdivision: V| Section: 23 |� Max 8edrooms: This Perm�t: / � �EPT�C TANK: M�:imum tota pti� iank must h�vo aL le�st 2/��mpari �eet requires insula�io� over tar NU![FY UHH5 P|�IOR L: 5 8iock: N/4 13N Range: 3W Da� Pho:e: 563-5500 I / LOT 5, VUET❑R a/ 2 R 0 M � i111I Iii 4—BEDROOM I11II' 1 1111111111 / RESIDENCE dl1I1] I1 111111 11 111111 G Sgg, 41 S �S° gyp, 01*e DRIVE o � o 300' EAST / 12 I 13 I 147 15 C❑LLEG GATE --IL CIPALITY OF ANCHORAGE C❑LLEGEGATE DRIVE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION INSTALLI 50' OF TRENCH 10' DEEP 7' OF ROCK SILTBARRIER 2-4' CLEAN OUTS 1-4' MONITOR 10l i 91987 RECEIVED 50 0 50 100 150 200 250 300 GRAPHIC SCALE 1' = 100' TOBBEN SPURKLAND P.E. LU I :J, VUETUR SEPTIC SYSTEM DESIGN 203 W. 15TH, AVENUE SEC, 23, T13N, R3W ANCHORAGE, ALASKA DATE, NOVEMBER 9, 1987 (907) 279-3916 DUANE HYMAN, 2200 OTTER STREET __ SHEET, 1/1 GRID, 1539 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LO(a — PERCOLATION TEST (ENGINEER'S SEAL) PERFORMED FOR: IV!'tR +4Y WN DATE PERFORMED: LEGAL DESCRIPTION:. dT I&Ii; rOR.,, Township, Range, Section: I I N t R.1 rwc 2.1- ,p A M ^ A '%"p @ SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10- 11 12 13- 14 15 16- 17- 18- 19- 20 - COMMENTS S t L .i' vA L, sAN>y S1 L"1 - WAS "1 - SOTio M e) Iw Aol.tr MUNICIPALITY OF ANCHOF DEP r, OF HEALTH & ENVIRONMENTAL PROTECT �10V J X987 RECEIVE WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT L DEPTH? _� O P E Depth to Water After hloniloringl �� gale: q �� G Reading Date Gross Time Net Time Depth to Water Net Drop 1 •Z•$"� o Ca I t 'I ' P 3 -3 )N 6P Vs r 40 P / '/ I/?-- f16 3 © PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER F TEST RUN BETWEEN FT AND a _ FT 1 PERFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STAT AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) e �^o� �rte,a- �T�fr IrD� IrD� 1' D Ir�� ---0203 W. 151h AVE "C" SUITE 203 � nLrFD3 �� �U �UU �(/V�VV9 Ol�u ANCHORAGE, ALASKA 99501 CONSULTING ENGINEER TELEPHONE: 007) 279-3916 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION DUANE HEYMAN OCTOBER 24, 2200 OTTER STREET FES ANCHORAGE, ALASKA, 99504 RECEIVED SUBJECT: Complaint of Malfunctioning Septic System q'lot 5, Vuetor Subdivision Dear Sir; 1985 Per your request I inspected the septic system at lot 5, Vuetor on October 16, 1985. Documents on file at the Municipal Department of Health and human Services shows that a 88 feet long trench was installed to serve your residence in July Of 1978. This trench was connected to the "old system" according to the file. However, what the "old system " consisted of was not mentioned. When I inspected the system I found two stand pipes. One was obviously connected to a seepage pit of some kind, log crib or concrete rings. The other pipe may identify the beginning of the trench. The first pipe was full of water, sewage, with a pool of sewage next to the pipe. The other pipe was dry.,,There was no indication as to where the other end of the trench might be. On October 21., I returned with a Case 680 backhoe. We succeeded in uncovering the section of sewage pipe that connected the trench to the "old system". We found that the old system consisted of a log crib and that the trench had been connected to the line running from the septic tank to the crib at a point ten feet upstream from the crib. The connection was accomplished with a "Y" thereby letting septic tank effluent flow to both the crib and the trench. When we exposed this "Y" and the line leading to the trench, we found this line completely blocked with sludge, resulting in all effluent going to the crib and none to the trench. We disconnected the pipe to the crib, installed a cleanout at that location and replaced the run of line to the trench. The attached sketch shows the configuration of the system. To prevent clogging of the line in the future, you may consider replacing the existing septic tank, which i understand is a one compartment tank. The required tank size for a four bedroom house is 1250 gallons. The amount of sludge found in the line may indicate that the existing bang is not large enough to handle the wastewater from your house. The pool of sewage around the crib had disappeared by the time the system had been repaired. ty '< Yours �obb n Spur cc L rry Montgomery, Department of Health. �O D �aG°��GiadQaD9 P020 2 ANCHORAGE, E"C" SUITE 203 ALASKA 99501 CONSULTING ENGINEER TELEPHONE: 1907) 279-3916 MUNI III OF ANCHORAGE DEPT. OFA ENVIRONMENTAL PROTECTION DUANE HEYMAN OCTOBER 24, 2200 OTTER STREET Fir ANCHORAGE, ALASKA, 99504 R V I EC SUBJECT: Complaint of Malfunctioning Septic System lot 5, Vuetor Subdivision Dear Sir; 1985 Per your request I inspected the septic system at lot 5, Vuetor on October 16, 1985. Documents on file at the Municipal Department of Health and Human Services shows that a 88 feet long trench was installed to serve your residence in July Of 1978. This trench was connected to the "old system" according to the file. However, what the "old system " consisted of was not mentioned. When I inspected the system I found two stand pipes. One was obviously connected to a seepage pit of some kind, log crib or concrete rings. The other pipe may identify the beginning of the trench. The first pipe was full of water, sewage, with a pool of sewage next to the pipe. The other pipe was dry. There was no indication as to where the other end of the trench might be. On October 21., I returned with a Case 680 backhoe. We succeeded in uncovering the section of sewage pipe that connected the trench to the "old system". We found that the old system consisted of a log crib and that the trench had been connected to the line running from the septic tank to the crib at a point ten feet upstream from the crib. The connection was accomplished with a "Y" thereby letting septic tank effluent flow to both the crib and the trench. When we exposed this "Y" and the line leading to the trench, we found this line completely blocked with sludge, resulting in all effluent going to the crib and none to the trench. We disconnected the pipe to the crib, installed a cleanout at that location and replaced the run of line to the trench. The attached sketch shows the configuration of the system. To prevent clogging of the line in the future, you may consider replacing the existing septic tank, which I understand is a one compartment tank. The required tank size for a four bedroom house is 1250 gallons. The amount of sludge found in the line may indicate that the existing tang is not large enough to handle the wastewater from your house. The pool of sewage around the crib had disappeared by the time the system had been repaired. Yours jobb n Spurkland c L rry Montgomery, Department of Health. -�'tA7aAG'Ei �NCLt>5ED ��S► DEIyG� �Po®L x � X S ori r: i �1J1c ONS cnw/PA2T MtNi L o`r 5 1 V ua,Nric HA -N vt,.L a.5, ! 9 35 J1/=50, Loa/T� �Os 5 Fr Wivt5 I r-amc" �' :r : ,. � Thi � , i •, t� >223 25, 1971 Q� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION Il ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage„ Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE p ❑NEWS �_ RADE MAILING ADDRESS LEGAL DESCRIPTION L- s 1z LOCATION NO. OF BEDROOMS Uy DISTANCE TO: Well Absorption area Dwelling PERMIT NO. a. Z LU Ia Manufacturer s Material No. of compartments N Liq. capacity in gallons IF HOMEMADE:Inside length Width Liquid depth O Z DISTANCE TO: Well Dwelling PERMIT NO. Z< 02< Manufacturer Material Liquid capacity in gallons 0 LU x DISTANCE TO: Well a Foundation Nearest lot line PER IN 53 I LU a Z PZ w No. of lines / Long t o e�h line Total I ' hyof lines fly -- Trench vyidtl-15 � � � Distance between lines P pcx Top of the to finish grade �t / Material beneath tile inches Total eff ti g4sorption area � J ot. LU Length Width s Depth - PERMIT NO. 4 F- a— IL 4' Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE T0: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. w w 9: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS — SOIL TEST RATING INSTALLER REMARKS- ev(17 o .pp-- APPROVED �DA�TjE LEGAL C '—/ ^2� — ' Irp 72-013 (Rev. 3178) TYPE OF' S'011- APSORF.TION DRAIWIEI_F,' MFI1'_!1lt-1UM NUMI'HIER OF BEDROOMS nr- .4 SOIL- RATING F*T./FtF.,.'1--. J.5(`.i I �) e Opfv� 1,1 k.-ji PA 1 C'*: 1 F'.1 X -i"11-fro C_'fi F--' 1�--n PA Ic" II -A 4�_ 1=9 C� Lo e D 1,0 THE DEPTH OF' FI TRENCH OR PIT I"; THE DIPSTANCE DEPARTMEN T OF fiffit ... TH AND EN %.I R 0 NN ENTAI_ PROFF.1' TIOtl '-V I -A F F-F-:-7'lr-4 K' FJ t-0 1 1511 HD e -A 7, 825 �L,` STREET: ANCHORFICIFE., AK. 995-0:1. AND [*FIE w -i -TOM OF THE-.' E'C:AVATION (IN F'EET). 264-4720 '60 A rK F.., LA F=,"p EF' F4 F V U X I PERNIT NO. 7805-3',t FiPF'L I GANT LAJAN':I-IEYI*'Ifftj 222,10 OTTER S'T 1�1,*-I:, 155813 L. 0 01 T.1 () N 2200 OTTEr-, sT L.F.'GAL.. 1_5 'v UE TOR S/D I -OT ST"","E TYPE OF' S'011- APSORF.TION DRAIWIEI_F,' MFI1'_!1lt-1UM NUMI'HIER OF BEDROOMS nr- .4 SOIL- RATING F*T./FtF.,.'1--. J.5(`.i THE RECAUIR.EC) OF' THE SOIL. ABSORPTION SYCITEM L_ FT. P-.1 17--a -1-1-1 = :E3 41 HD F, L_ PEN F)' 7" 11".."1 THE L-ENGTH F'I MENS TON IS THE I-ENGTH (IN F-EET;' OF THE TRENCH OR THE DEPTH OF' FI TRENCH OR PIT I"; THE DIPSTANCE BETWEEPI THI". SURFAC"E OF' THF.' GROUND FIND THE BOTTOM OF THE E;--:CAVATION '::IN FEE -,T''. '-V I -A F F-F-:-7'lr-4 K' FJ t-0 1 1511 HD e -A 7, THE GRAVEL. DEPTH IS THE MINIMUM DEPTH OF ORA',!rL7I-.-'ETWEEN THE OUTFALL. PIPF. AND [*FIE w -i -TOM OF THE-.' E'C:AVATION (IN F'EET). APPI-ICANT HAS THE RESPONSIBIL.ITY TO INFORM TH115 DEPAR.TMF..'NT DURING THF.. INS"FAL-1-fiTION INSPFC'TION_`5, OF ANY kIF"LL.S ADJACENT TO PROF'ERT'i-' NC` THE NUMBER OF' RESTIDENM_-'.-; THAT THE WEL.L WILA_ SERVE. �-2 I PA IF�o 1 C') F--'11 p_j I F..". C—'.' U. -A F';ACKF I 1_1 ING OF ANY SYSTEM WITHCIUT FTNAI_ M."zWECTION AND APPROVAI.. BIT, THll'::.; DEPARTMEN"I' WILA_ BE SUP.J'ECT TO PROSECUTIOhl. [If N2: f' C- UM l,,:.;TANCE BETWEEN A WELLOS' . AND ANY N—ITE SEWAGFF. -10(i) FEET FOR A PRIVATE WEL.L.; CSF. 1.54-1 TO 20CI FEET FROM A PURI -1.0 WEL-L. DEPENDING UPCIN THE TYPE OF* PUBI_Tc. WEL1.. C"I'M .1 ,".R REC!UIREMENTS MAY APPt-.Y. L--.PECfF'ICATfON1_-'.' ANC, C*ON,.-,TRUCTIOr.,I DIAGRANC AVAILABLE TO INSURE PROPER INSTAL-L.ATION. CA C_ vEi. rq F - F" -1- I C1F'F1'I.I',F*",0 Ti1m, jr.: I Ai"I IFY11"IfiI.IFIR WITH THE RECiUMEMENTS FOR ON-,TTE AND NFLA_S W�,-.; 5,F'T FORTH F,Y THF MUNICIPAL-ITY OF FINCHORFIGE. 2: 1 WIL.L. THE SY�-",TEM IN ACC'()RC1f1Nf*1'E WITH THE I UNDER'�-'TAND THAT THE 'SENER SY'C"TEM MAY F`.EQ1Y1RF' IF THF RF,1c_-*IDE.NCE IS. RE't-10DEL.EC- TO INCLAJI)E MORE THAI'l 4 I 13NED:. APPI ... ICANT DUANE. HE YKAN U4 t<'(j 1,A .1 Of )nAtmucidon gr -it -fe n None (tit is worth s showu7nd opinions" 2204 Cleveland Anchorage, Alaska 99503 Performed For Glacier Excavating Date Performed 6-23-78 _ Lenal description: Lot 5 Block SubdivisionVM�_Torr Subdivision This Form Renorts Soils Loq Yes Percolation Test_ tenth Feet Soil Characteristics _ FeaE K Reacii-sni t -- 2 -- Brown Silty Sandy Gravel _d — 6- 10 —10 — Bottom of Test Hole 12 -- 1d.- 16 — 1s _ 20— Was 0 -.- Was Ground Water Encountered? Yes If Yes, At what Depth? 8.5' s� o4 0 Is] 1►J�>la��f�:.— r Readinq Date Gross Time Net Time Depth to H2O Net Dron Percolation Rate Hinute Prnposed Ingta at on: "Seenaae neoth of Inlet V mVENTS: 150 Sq. Ft. drainage area Test Performed By Pit Drain Field N Dept o ottom Of Pit Or Trench et uilp.d par 1pd 0�1m 3a Data Certified BY: rTT. ��.,... Date: 6-23-78 '4 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l 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 . tinf&n4tion obtained from the Municipality of Anchorage (les 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 Finn 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, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines d 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. S. DSD SIGNATURE ye* Approved for bedrooms. Disapproved. Phone 337-6179 Date O e 5,3�rn �On�.1�.••.GE s�'� Conditional approval for bedrooms, with the }Mowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ON-SITE WATER AND .; WASTEWATER PROGRAM L/ By: 7 Original Certificate Date: 9-3 0-0$ (Rev. I M) Municipality of Anchorage Development Services Department Building Safety Division - On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SELKREGG, LOT 58 Parcel ID: 066,271-:33 A. WELL DATA *PER PREVIOUS APPROVED HAA 1997 Well type PRNATE If A, B, or C provide PWSID# N/A Well Log (Y/N) NO Date completed -1978 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Totaldepth '137 ft. Casedto '137 ft. FROM WELL LOG Date of test Static water level ft. Well production 9-p m. WATER SAMPLE RESULTS: Coliform _0 colonies/100 ml. Nitrate ND mg./L. Casing height (above ground) 12+ in. AT INSPECTION 3/14/2008 54 ft. 5.7 9.p -m. Other bacteria _0 colonies/100 ml. Arsenic: 10.5 ug./L. Date of sample: 9/12/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 9/22-24/2008 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping NEW Pumper, C. ABSORPTION FIELD DATA 11/17/1987 Date installed 9/22-24/08 Soil rating .p.d./f t /bdr 165/1.2 System type 5 -WIDE Length 53/61 ft. Width_ 5/5 ft. Gravel below pipe- 7.5/3.02 ft. •10.58/ 795 Total depth _10 ft. Eff. absorption area 526 ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test= in. Water added=gal. New depth=ln. Elapsed Time: = min. Final fluid depth= in. Absorption rate >= 600+ g,p,d. Any rejuvenation treatment (past 12 moa (YIN & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed 'Pump on" level at In. E. SEPARATION DISTANCES Size in gallons Manhole/Access "Pump off" level I . High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line P 10'+ Building foundation 10'+ Water main N/A " Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION ,.7..fif-``: t certify that I have determined through field inspections and �+VE ..... review of Municipal records that the above systems are inconformance with MOA COSA guidelines in effect on thisdate. • Jess;Engineer's Printed NameJEFFREY A. GARNESS\FQ 4 Date 9 29%0'8 W0Kfrofese}o�O\;� COSA Fee e o 7 S Date of Payment I a o Receipt Number 3 J 3 (Rev. »ros) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage .. • '� Development Services Department ° / Building Safety Division ` On -Site Water and Wastewater Program ' 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 080340 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 5B of Selkregg Subdivision. This inspection revealed an arsenic concentration of 10.5 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Information on arsenic is available from the On -Site Water and Wastewater Program website (www.muni.or onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. SGS Ref.# 1085001001 Client Name Gamcss Engineering Group, Ltd. Printed Datell'ime Project Name/# Sclkregg Collected Datdfime Client Sample ID Sclkregg Received Datefrime Alalria Drinking Water Technical Director P%N'SID 0 Samplc Remarks 09292008 8:24 09/122008 7:15 09/12/2008 16:15 Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Inil Metals by ICP/MS Arsenic 10.5 • 5.00 ug/L EP200.8 C (<10) 0923/08 0926/08 NRB Waters Department Total Nitretc/Nitrite-N ND 0.100 Microbiology Laboratory Colony Count 0 Total Coliform 0 Fecal Coliform 0 mg/L SM20 4500NO3-F D (<I0) coVl00mL SM209222B coVI00mL SM209222B col/100mL SM209222B A (<200) A (<I) A (<I) 0923/08 JDZ 09/12/08 DLC 09/12/08 DLC 09/12/08 DLC MUNICIPALITY OF ANCHORAGE • ^ DEPARTMENT OF HEALTH &HUMAN SERVICES &CIPALITYOF ANCHORAGE Division of Environmental Services MENTAL SERVICES On -Site Services Section DIVI510 N P.O. Box 196650 Anchorage, Alaska 99519-6650 MAY 2 7 1997 343-4744 R CERTIFICATE OF HEALTH AUTHORITY RECEIVED APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # - 0 0_C2 a- 7 I _ 3.3 HAA # 1. GENERAL INFORMATION Complete legal description Lot 5B Selkregg Subdivision Location (site address or directions) 2201 Otter Street f, Anchorage, AK Property owner" -"".,Sheila Selkregg Day phone 337-847A u,.L_. Mailing address 2201 Otter Street Anchorage, AK 99504 Lending -agency Day phone `•-Mailing address '• ` Agent ' John Blaine/ Coldwell Banker Day phone 561-8686 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX 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 XXX 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 _(Rev. 1/91) Front MOA#21 - 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. S & S ENGINEERING Name of Firm 17034, 6aslo Raver Loop Road No '204 Phone �g L/ - a 97 �J Address Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE Approved for 4 bedrooms. Disapproved. Date /17 /9 7 r RoeeR;r C:'ICGWAN r�r ti CE - 8891 ��*' A Conditional approval for bedrooms, with the following stipulations: Additional Comments By: (Z / �` Date 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-M(Ftw.1/91) Back MOAM21 MUNI Municipality of Anchorage ENVRONMENr Dlfi DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MAY 2 7 1997 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907)®343-4744 r1 Health Authority Approval Checklist RECEIVED Legal Description: )- 0 S e Z k n E G G- Parcel 1. D.: C) o 6, — D-7 f 3 -3 A. WELL DATA Well type OR � V a T 6- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Yo Date completednom` ` A ' ° C? 7 4 i Total depth 1 3 7 Cased to f 3 7 Casing height (above ground) Sanitary seal &N) V i S FROM WELL LOG Date of test Static water level Well production �� g.p.m• WATER SAMPLE RESULTS: Wires properly protected ON) AT INSPECTION S—/ --/q7 �r Y"�4 �. g.p.m. Coliform U Nitrate (9. Other bacteria U 9 (�S & S ENGINEERING ' Date of sample: lT Collected by: No. B. SEPTIC/HOLDING TANK DATA ( N Fo %�°.�4� c 0 vs�- g �n��Ea-t- 0 Ur ' t- -ska 99577 Date installed /3 /' 7 % R7 Tank size /;)- S` O Number of Compartments )- Cleanouts (9/N) Y49 --t Foundation cleanout ON) _ Y % ti Depression (Y k Date of Pumping C1 7 Pumper IA c J F. C. ABtOAP'TION FIELD DATA N O High water alarm (YIQ a Date installed 13 117 Soil rating (g.p.d./ft2 or L/bcfrrh System type Length S- 3 Width 'a - a Gravel thickness below pipe _ Total depth Effective absorption area 7 Z Monitoring Tube present ON) YE f Depression over field (YA&I ^ o Date of adequacy test S`/ 161 / 9 Results (Pass/Fail) 1'4 f f For _ bedrooms Fluid depth in absorption field before test (in.); f Immediately after ° 7gal. water added (in.): 7 Fluid depth G 9 (ins) Minutes later: 1 3 t' Absorption rate =. G 0 G f g p d. Peroxide treatment (past 12 months) (Y/N) WO r c K Noay If yes, give date N Yate s6; -S4 A,, /j c Lre, BNfc,A 0 T 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES Size in gallons "Pump on" level *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: - e f c holding tank on lot i° ° -- Absorption field on lot Public sewer main On adjacent lots On adjacent lots "Pump off" level at* Public sewer manhole/cleanout Sewer /septic service line S Lift station N SEPARATION DISTANCES FROM EPTIC7HOLDING TANK ON LOTTO: Foundation aZ S Property line '` Absorption field S_ 7L Water main/service line a �� Surface water/drainage / 6 0 t Wells on adjacent lots /0,., SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / a Building foundation ° } Water main/service line U Surface water /V 14 r poo Curtain drain Md Nr� k,�J o wi✓ F. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage areag U �` —Wells on adjacent lots O o I certify that I have determined thru field inspections and review of Municipal records tta�e,�79t�Ts are in conformance with MOA HAA guideli es in effect on this date. a; 4,1.- �""" �S Signature/t'�`✓% C'�!T „r�i�. '�7 Engineer's Name /` C) 'L% �a ✓�r.J / / T� ROBERT C: COW ` �4 Date S� r a (0 7 6E - 8801 ffr\ HAA Fee $ cy'2�v . vyt� Waiver Fee $ Date of Payment o /� % �� Date of Payment Receipt Number �XeL Receipt Number 72-026 (Rev. 3/96)* MAY -02-1997 13:21 CT&E ESI ANCHORAGE A1L. CT&@ Environmental Services Inc. CT&E ReU Client Name Project Name/# Client Sample ID Matrix Ordered By PWSID 972121002 S & S Ellgineeriug Sand Lake #2 & Seldregg L5B Scllue�-g Drinking Water 907 561 5301 P.05i05 Client PO# Printed Date/Time 0,5/02/97 09:44 Collected Date/Time 04/28/97 16:15 Received Date/Time 04/29/97 13:25 Technical Director: Stephen C. Ede Released By J40^,-- (f rw� Sample collected by: Bob C. CT&E Microbiology Drinking Water Program cerdfrcativrt status is provisional as of 4/8/97. Allowable Prep Parameter Results PWL Units Method Limits Date Nitrate -N 0.100 U 0.100 mg/L SM1a 4500•NO3F 10 Max Total Coliform 0 col/100mL SM18 92228 Analysis Date Init 04/30/97 JBL 04/Z9/97 RAM TOTAL P.05 MUNICIPALITY OF ANCHORAGE/� D U DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 5 t/yjz aSe-cr o13. T" 111N. (? 114/ Location (address or directions) .Uo-ea O iT �E t2 (b) Property Owner PuaH4- ONI Telephone: Home Business Mailing Addressg-t) C.) 7 r a Y?, (c) Lending Institution ,SAS V- S rk _ Telephone Mailing Address Li a e 0 4- (d) Real Estate Company and Agent 4 44 LelW � e' Address Telephone f C S (e) Mail the HAA to the followina address: or: Check here, if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well L� Community ElPublic 0 Note: If commu/nity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite I,d� Public ❑ Community ❑ 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 72-025 (Rev 8/861 Front 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 17 Telephone Address o� 3 6✓ lJ Date Engineer's Seal 5-E s' :A 1 r i 6. DHHS APPROVAL Approved for�R�&- 0-2 bedrooms by tate /U 261,%f1�7 Approved- Disapproved Terms of Conditional Approval Conditional 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 72-025 fBev aias) Back r �4N�pyS�MUNICIPALITY OF ANCHORAGE (MOA) ENS\FC���` H,0. JH AUTHORITY APPROVAL (HAA) HECKLIS -EBRUARY 1984 �\ N® 744 Legal Description: N'v'F T -O ra' A. WELL DATA Well Classification 9-e-- If A, B, C,D.E.C. Approved (Y/N) '_// X• r Well Log Present (Y/N) �� Date Completed 0t1"c'L-vl Yield 's ePM Total Depth13 ) Cased to 13 2 Depth of Grouting L\/�gN is Static Water Level ( 7,), Pump Set At /,2(9 Casing Height Above Ground / Chi Sanitary Seal on Casing (Y/N) / Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well To Septic/Holding Tank on Lot On Adjoining Lots �o- To Nearest Edge of Absorption Field on Lot !�� p ; On Adjoining Lots To Nearest Public Sewer Line U P To Nearest Public Sewer Cleanout/Manhole %�Ot�� To Nearest Sewer Service Line on Lot y U Water Sample Collected by { _ ; Date /0'3. 'S Water Sample Test Results ,f..� C' -Ca / N 0 Comments B. SEPTIC/HOLDING TANK DATA Date Installed f ` ` l �� Size No. of Compartments Standpipes (Y/N) t "'G0 Air -tight ,Caps (Y/N) Foundation Cleanout (Y/N) —� Depression over Tank (Y/N)Date Last Pumped Pumping/Maintenance Contract on File (Y/N)�/ for ty'&� Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) f'/b/I Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Building Foundation � -.-> To Disposal Field pl 0 To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course Comments Page 1 of 2 72-026 fRev 81861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �((j Type of System Design i 4 i Date Installed 7Z/ Length of Field Width of Field Ll Depth of Field y Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) �/)'(9U %� Depression over Field (Y/N) N Date of Last Adequacy Test i yM= Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well 1�2 0 To Property Line 5 Q To Building Foundation �P To Existing or Abandoned System on Lot 4116 ; On Adjoining Lots /Yo /y � To Water Main/Service Line > To Cutbank (if present) N 0 To Stream/Pond/Lake/or Major Drainage Course ly Irl L= tlUl1 ` f To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at N U �,/ b High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOOA and H9AA guidelines in effect on the date of this inspection. Signed i"el Date —`/,, r/ , 7/0 7 Company MOA No. Receipt No. �— �% Ul —UU 03 Date of Payment 11 -Zi- k 7 Amount: $ / () 0 i Page 2 of 2 72-026 (Rev 8/861 Back T Engineer's Seal F.;._ • � d�l��lS"a'Yd � �r ti •222.5 Ei ui•iF. �._�. i971, 5. 'LEGAL DESCRIPTION �- 5 V 7'G U�5- STREET LOCATION ` MUNICIPALITY OF ANCHORAGE 6. TYPE OF RESIDENCE - DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION SINGLE FAMILY - - - - - - - - - - - - - - 825 L Street - Anchorage;. Alaska 99509 -:- - - -. - - - - - -- - ❑ MULTIPLE- FAMILY ENVIRONMENTAL ENGINEERING DIVISION 7. WATER SUPPLY r-- Telephone 264-4720 * ATTACH WELL LOG. A well log is required for all wells drilled - COMMUNITY REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES PUBLIC UTILITY - - DIRECTIONS: Complete all parts on page 1. Incomplete. requests will not be processed. Please allow ten (10) days for processing, -- LQ INDIVIDUAL/ON-SITE** 1. PROPERTY OWNER - -- - - fij RS"b& —4113E�ry L-0 vcTr- PHONE - - ❑ PUBLIC UTILITY MAILING ADDRESS J-0 D D % 7` E tq ST- d PROPERTY RESIDENT (If different from above) PHONE 2. BUYER IqlVE �- Cd)edL n% PHONE d-1/3-ssgs MAILING ADDRESS pT rE2 ST. 3. LENDING' -INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT 006114&6 H5 PHONE d"77-1 5,5,3 _ MAILING ADDRESS a -o / c_ ST. �� � GlC !.d ITL- C,o /VC1 g 9 5. 'LEGAL DESCRIPTION �- 5 V 7'G U�5- STREET LOCATION ` -�- �-O 4 07-7`62 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS SINGLE FAMILY ❑ One l� Four El Other ,W ❑ Two ❑ Five - ❑ MULTIPLE- FAMILY ❑ Three ❑ ' Six 7. WATER SUPPLY r-- j9 INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled - COMMUNITY since June 1975. For wells drilled prior to that date, jive well PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM A60UT LtP6rcteLa LQ INDIVIDUAL/ON-SITE** **If individual/on-site, give installation date Ig61 . If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN13EINITIATED. 7g THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED . TIME TIME TIME DATE - DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL F I ` 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS E APPROVED FOR �_ BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) EJ DISAPPROVED DATE 11 - ZW to BY (Title) Z LEGAL DESCRIPTION - 72-010 (Rev. 3/78)