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Home My WebLink AboutFETROW LT 2Fetrow Lot 2 #051-221-58 On -Site Water System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP121185 Tax Code Number: 05122158000 Work Type: Well Upgrade Permit Effective Dates: July 17, 2012 to July 17, 2013 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: FETROW Site Legal Address: FETROW LT 2 G:1057 Owner/Address: FETROW LESLIE F & DOROTHY F C/O SANDRA K FRENCH PO BOX 671561 CHUGIAKAK 995671561 Site Mailing Address: 18305 OLD GLENN HWY, Chugiak Lot Size in Sq Ft: Total Bedrooms: This permit is for the construction of: 102694 N Disposal Field N Septic Tank N Holding Tank N Privy N Private Well Y 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued Bi MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 05 Property owner(s)Day phone �Z5 Mailing address Site address 46��)' Legal description (Sub'd., Block & Lot) FET9-o Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms THIS APPLICATION IS FOR: THIS APPLICATION IS AN: Q all that apply) Absorption Field ❑ Initial ❑ Septic Tank 17— Upgrade) Holding Tank Renewal ❑ Privy ❑ Private Well ❑ Water Storage _0 THIS APPLICATION INCLUDES A VARIANCE / WAIV R REQUEST FOR: 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. ( Ignature of property owner or authorized agent) . Permit/Rush y5Rush Fees: �O� ` alver Fees: Date of Payment: -� -i a Date of Payment: Receipt Number:_ Receipt Number: Permit No. _OSP �ajlRS Waiver No. G ABuildinglOn Site\Forms\Client Forms\Permit App_010411.doc (Rev. 1/11) .'ia &aw Plumbing' 8 !leafing, P.O. Box 774769 . Eagle River, Alaska 99577 907.696-2441 . Fax: 907-694-2441 1li�A y jdiL' e✓G f j-,45 774-47,e--' �7 y 1 '- 94WS6 z tv pXS� sE7P<4F 7X&A l Gno9l l� \ 6:-Xoelleo�� JUL-17-2012 10:35 FROM:K&L PLUMBING & HERTI 1-907-694-2441 TO:2497601 Jul -17-2012 11'07 AM Ferguson Enterprises 90 13769756 MAY -w0-2003 'tm 03127 PCI GREEK TANS( 5 NEGtfttgi I AX Nt? 1f3Ur4htibtltl8 4�. � FISC USA Formolovo L.69936V with w*wWwor 101t index 3.5 Dwwfy 0.930 A hexene Copolymer Unear tow Density PolYWhylend For ran ft Toys and ofte non-tenk Rotedonal moiding Appltrations Fornlolate L63935U mecca aA mquimmema of the U.S. Food and Drag AdminWmtion as specified in 21 CPR 1.77. I= covering safe use of polyolefin Altiolea intended for direct food *vntact. Typltsal Pmp"es of MIS AevWOP rental Qmde Filial DOoction Tcmpe t> m. °C at 66 psi ASTM D"S $4 13.S.C.R.. low [sepal ASTM £11693 >1000 hil. lmpwt MAO I&* Specimen ARM Std, 60 Ufa: S> eeimm . ARM Std. 196 F. W FornwleaoL MSU isfa0yheAtmod UVstewnud. ree raq.t+a.oathis docamatikmos.Jbmnfonye Tt"aoe.cwrnx.rte,�InaGrtaabo+�o,nsyyial,are.�cr>t >400.c ueam�xfasatlear.t ddwnkummamtubyamiroweKN" 11WOWd low RaL1%BO M 14001 iA'[31t7B,[JJ959Mta*.a, nt.:aennwue~a u.Y�ru "Jgmw ararn ra.e pr;Tua27o P.2/6 JUL-17-2012 10:36 FROM:K&L PLUMBING & HERTI 1-907-694-2441 T0:2497601 Jul -17-2012 1101 AM Ferguson [nterpriseS 9073168766 ru{r-eu-ewa [tin u3Ylt rn ulcetts. im 11 Vituimi hfUS N0. 1)74585808 P: 07 ttatkock Ibr -1&171 2MBSK wm%. w4w Von .(6311 MOM. 1{xxG a r kur IT ='d. CU(iTIPiCAl H 1a1U141DRR: 49D�l3 hLFI28718 iSSU13 nAT&' 1912elinmy 20.03 Yagc I of 1 lklsacd a1: 0voir:1'ank A' Woklinp - 3I N 1 Rk,•ric,k lJrhv XK 'MCI ttcllrtrt ltelatenCC. 2 U3eMIig021�" •' �liais iY (4 (rCdl�'tll(lt - ' .` . ,. f - cc�reYctluidp7e-Yamplcpafl �v.iCistu'mgc'1'klika(]W'=3pgPC:pilolla} -. Rove !recti invaad�,aled by UAdCfgtli(ri: CibAEttbiieg;Xna:di'Sn.prrw11�n31cc with flYC Standard(s) 711d164MA Otl t6is�crllticsl tei . -� : � • '. is : � : '� r " Strinllard(s)forgaloty: .AGiS[-1'NLS +ii(s l'd7. Aililf(jN1{CrruW'!a`,Y11�m lOMnH-tid:l�liLfavt% Ai Wil Ynal CilfptmYtlnad L xlc7taiy iiaitiet MAl4 ialY' WIRAmum l rwktet k dow AmPAtValt'rVolume --•' �:,',,,�'�ti.,:.;.Ktr�, � .rlX,�ri- . gp{>�p[nuxowJ�, VPAtC.f.SEprt({C.�"4n1µ ` e �$°Y Bo ' 4Ofily Ilu o ilfaduci4,baslfitlf. 1hS ri Fdssif ilGtrn.NLai7cin sbovW be considered or !icing cinrem,A, byUL,ig: GblYalhniaah`su y .., '171n 711.1,6.jlka 6. Aladin, kxinhx Y.ti, ut u' ijjply 'y'lllk r� allyl! K:l.ilC51[t11AN Gpl nhlrwlj; a t+NNrvi Ixaldwa {pqr FW ;1. 1(.11pXIXIM'.LL'�IM�11I11 t1Iwr.1dxwµ•1{MlX.li[gl•-IIIY Cik'�1.lftli ill l'nkx•�,n,•rlhv lF+.1�1i'{.Nh{.1(IO r1:YAlFi niti'�./1'T1/NP (llXxkM . i.kYlf:flj yl i.11i[alad rl. tin X{MXgLiNr l:1.1>fM1�iM'• • 1' - .. ...i. ,. 1!IYl;itncY. ''",�� .� 1�: -; It�withv.L•algjtU�r. ,��'Jr• /,,,��17t_., JZollltrilu,6 NYsruta �/ 7RltllaGnlkrivitrorr 1,1Atkwdsrd labIV.3 ifriet Mc. V. d&r nnw I.rf.,mnnwc Ing. P. 3/6 JUL-17-2012 10:36 FROM:K&L PLUMBING & HEATI 1-907-694-2441 TO:2497601 P.4/6 Jul -17-2012 1407 AM Ferg4o9n Lnterprisev 9v,4rym,00 MAY-2U-2UW 1Uk W:ll PH CWVX TANK b WELOIM FAX N0, 190746650.. P. 04 NSF Certified Product Ustin;s These Llatlatm areza lobi [19dnttd wThastda7, 7212 06, 5003 At 8.00 sx ustom standard rime, ne vlea eohot 1787 Iatt4mAtimai_ to ~Jxx tha status of "I YAst g, =abort afom, ar sake svggootlama. ANSONSFSTANDARD14 �. pinficS Ptping 9YSftM .CpMpe%nAy% and Rnlawd madais D114k bath far a 1110 04 28 gla -FORKOSA 1SLASTTCS CORPORATION, 'TEXAS 01 NANOSa Epm 01001 t00 31x2 QOICIUM, vx 77970 61+907-7060 I=t atz Po=v comm 7'h Drank. Maata, =a t'aat, caatlanaaa mtsto and 6ogr 11<tgalola awaiaL O1aaa3llostias sad aka Massa Daalas im perE+xassaa subur4 ve 6`41 11 5 .65a 11412 am 04390 1r auxifiea wRPbiala sea ganaain ,orWtasu ars idantifled by the aha 4hans fta. b.9rUm an •s! CattafuaWaa Ra.k. C.riJft.d ar9.a ol. ar �e naas. p1aM laaattan, ad tract. dasagaatlas M nha at la rho d9ftmol Watt - pobslale Mata• - 1p,t "4a1s atasial yl+,gl6faatlaM R4zd.Von d5ux D4n19uattan - parloa,m " Ot"Afted 0O 1120+ 7C 1120+ 1 IOa00}Lt7 400 13450 halm MI" V0 11201 I , n sac, 2Ma2 12262 2rrfRt P170f 11206 - 1 ±D1d f 2104 12454 AM D176f 1'r - x FORM ,N1 hm 1414+ sari[ D07p4 N 2, a ftw2.ema L6i54514— 315000 Am 91150 2. 4 ;ama5aaar 700293594 214a0D.lSM D32jm 4 1^' 41 4 sormlik" 700369502 2143005 ASM 5395o %atexiO aapllaa v$vI Mas/par 9tnndap4 61 haaith a2faata rqp;aaNmts W cutiftod xetarlals 4m4 asnada ia0tadta " oa anowpt lead basins an Al" tatetfl4aaian Patk. Certified aaariala ar pra4laata ago 1aaaWRlaa by tlr anaa[aaturss aoaa. plant 10490111, 40d ttad9 dao4v a%&aa as naoya in the effla.-ta% Watt mbqw cc ,abs! Os 7124! y pM-Mffwwx Alf :aaaaaing tips woo a oarmda Homo I AbM N.v I centarst mP I siw map I amr b I Nem I MQrla ,.,ti 4. 2401 MRs/MaaWaro Gd d1NP4a2i eabd�aaRCsnw 496,aHgNd.d Pap; , JUL-17-2012 10:36 FROM:K&L PLUMBING & HEATI 1-907-694-2441 TO:2497601 P.5/6 Jul -17-2012 1107 AM Ferguson �nterprt9t9 9073768766 nnr-eu-nuns Wt US;dd Vil GK&H T9XK S WELDING FAS[ N0. 190745MOO P. 05 aneamnnao.xuarw.xets o. O aeasn Direr. Wra..to tlAr:l: Mora. ua feur twn+rr ro neum nt NSMYi.iS�fitt+ NSR $rid Itm Oad:D�dam plantlw s.r,. Ww wd eorpwadq yre ►ouatulon is l4stin raw ejecttl6 V4 q gwlsoou1 . Spy O1MPLflCwtlA foo Om q idua uaea ave me L012CW. lreelwwtlaoe ler lal:ahla mmt i uwaa I, pipe R. altttaee S. 71pa a rittin" a, art somas and oft"age otber than plpe 9r ntttlede S. opaotal Ova app114ativne (ugnpreaeere ar tantnp 0: *all naming plpe/veVelinya Preipnetiana ftr mm-poeame ractr and Vnw rtret bigit A. eipa r. rittlnyq i• Pipe i llttlllge Seeedd wglt 6.- my d. CottlrWom Neste 1. coverage "twe d• arIL1. Magte end Voutr CowtLogmo Mote Wd &Mn ea" Dratane 9. CPtC4LW ■aatr Naket Vmw tbp D= button on y9nl' brew er to retnrn to p81r'■ Ltakinq .*W.M.'4sn yW JUL-17-2012 10:37 FROM:K&L PLUMBING & HEiTI 1-907-694-2441 TO:2497601 P.6/6 JUL-11-2002 THU iD,.36 an SRW TANK & WMIhG vim M7, lvwfgmwuo r, uc ._.--.-.__ _— .n.nF ,., .tw ,i cn 71 na-n-1 nF _ MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ONE r^� P�g NEW �� /V� 3J b I.i E__1 UPGRADE MAILING ADDRESS U �O K6 7oo,:�-ch `l _ c? ,5u `% LEGAL, SCq IPTION/ �jLL 645 ;/: !iI/lr/� !/Ole T /S )e> Gc� �71a4 s�� LOCATION NO. OF BED5q9MS U L DISTANCE TO: Well Absorptio�y / Dwelling �� / PE )OW T O. /� yH Manufacturer/r.1-,e f r' I No, of co parts Uq.c a rt alholos p IF HOMEMADE: Inside length Width Liquid depth - OUZ DISTANCE TO: Well D elling PERMIT NO. SZFQ- Manufacturer Material_ Liquid capacity in gallons w2 DISTANCE Well /� rj FoundatiP pq Nearest 1pt,line/ i PE u Z No. of lines/ Length a ch Ijne � Total len of ines � Trench w' th ,e Distance beoeeplanes P ? w o inches 7 I— Top of tile to fini grade Material beneath tile �� Gj Total effy�jve�eb�orp ' n area O inches G OCJ W Length Width Depth PERMIT NO. W n F w °- Type of crib Crib diameter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J Class//yy via Depth Driller Distance to lot line PERMIT NO. J W i DISTANCE TO: Buildingfoundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS '! pp V `. _ SOIL TESTR ING p INSTALL�F�j� /W L.L REMARKS 171 AFX(S71tVC 6405- D BC Od1FD CIT"13 167 -,Ilk f OF At ............ '��.�r� M'NICPALf O- L,�C GA- H & / a. • •••%•. s E I r APPROVED &109148INEt ERINC14 DATE LEGALOR13 19ep- 9riLil.% (RIVER. ALASKA '£S T#12a fis"979 4-0l5 lnev. 3//Sl fs' §; ' S ya�rC.Yy .1,; ja..,Yx �{ i`s �.q'WrS�ntcr h�xv.�u� S"'f tM12Pifi °D 1 TN ,AND ENV RONMENTAL .P EC ON ` i3'EET, ANCHORAGE, AK 99501 Y yap 264-$720 - 1'�I f NCl. 840915 eT ISSUED 10/29/84 �N LtCANT: DOUBLE M., -CONST. #)RESS'a P.O.. LOX 67005 tt CHUCaTAk, AN 99567 (JI%/LL /3E /2. FG72�G4 pNUTRCI' PHONE: 688-3113 .t �• aES7- 1& 477,44/ OAL DESCRIP: SUBDIVISION: NA LOT: 2 BLOCK. NA 17N TOWNSHIP# 15N R4166 1W SITE: 4A (SO. FT. OR ACRES) K BFTDO00MS • 3 ` tmd below are the options available to you in designing p • Y . g � g yaur .septic t . -Choose the option that best fits your site. q.,, ..... - - - - - - - --- - - - - - - - - < -' FZ F= h+B E31FlD W Tip FZ 9=k I M H 1C7 PIPE BOTTOM (FT.) 4.0 4, 0 4.0 L"DEPTH (FT.) 5.0 0.5 3.5 (, i{ PTH (FT.) 0 4.5 7.5: •: L W DTH (FT.) ' 2.5 - 14.0, L L66TH (FT. } 26.0 28.0 X8,0 { -i NAL :VijLUME (CU. YDS,) 13.3 14.6 20.8 SIZE (QQLS) 1,000.0 * 1,000.0 1$000.0 #x l Nt_r TN8 (SO. FT. /BR) 85 85 g5 i d MUST HAVE AT LEAST TWO COMPARTMENTS u.t - -- - - - - - - -- - - - - - - - - - - - - - - - - rti 'that. � � a Ia•am familiar with, the requirements for on-site sewers andwellssett �faith by 'the Municipality of Anchorage (MOA) and the State of Alaska. ' � , r� i �O 8rr l' n ewz tcf4e?$e rr§RrEi�tn£�r�" E if illi O�cFfii4( s and regulat'i ,,W111`adhere to all MOA and State of Alaska requirements for the -set -ba fC 4" distances from any existing well, wastewater disposal system or public 1 sewerage system an this or any adjatent or nearby lot. rA I;UhdePstand that this permit is valid for a maximum of 3 bedrooms and f arty.enlergement will require, an additional permit. " L T,, STA IDN IS INSTALLED. IN AN AREA COVERED BY MOA BUILDING CODESt 494`4) ANS tLECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED;., (2) AS-BUIL.TS•. Nd Lr APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORTf AND (3) THE TF,ICA;, K MUST BE DONE.BY:A LICENSED ELECTRICIAN. 14 r6 t--- _ DATE= 1iws, • - - SLE CONST. DATE: r. Z,ii PERFORMED FOR LEGAL 1 n. 2 3 G '7 v 4 a 5 � 6 6 7 v. .6 b 8 9 0 ,tl 10 J. G m � 12 (r / 13- 14- 15- 16- 17- 18- 19- 20 314151617181920 PERFORMED BY: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST L 2 G 144 iNbert A. 3hakr No. 1437-F N SLOPE el SOILS LOG ❑ PERCOLATION TEST fU,jDKTE PERFORMED: /O WAS GROUND WATERS ;1 ENCOUNTERED? 'Al L 0 P IF YES, AT WHAT E [r DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE /T (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFI DATE: (-ike,' _c /O fIG cam,!/ -1l/ /�/y. C/ ai�'�✓ �r� r .%1 i L rrri :sa BOX 2; 6 al -"e liver, A1asl.a A 113 ^ ^ A ^A A E>e 'r jt.._ A ., MUNICIPALITY OF ANCHORAGE --� A DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION FEB iu75 RECEIVED - A 'I / �f A A' u� }_ A I P A j /C 7' WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. A.D.L. No. la. Borough Subdivision Lor Block Ib. 1/4gtrs. - Section No. TownnsshipN Range E❑ Meridian .ftT1C}i -.., sj ;: —of_of—of- /� 1-6 S❑ S 01" Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: >�re Ralph Shipman �i Address: SR Box 31 Street Address -and Area of Well Location -49 .-nr 2. WELL LOG Feet Below Sur foes 4. WELL DEPTH: (final) 5.`DATE OF COMPLETION 100 1t. 8-4442 _ Material Type - Top Bottom D4 rt and: tf oulder$ -. 0 15 6. C] Cable tool j .Aotory C] Driven C] Dug 11 Auger ❑Jerred ❑Bored ❑Other: Greens toile lj 70 FraCt:t:@ 70 Pio 7.USE , Domestic ❑ Public Supply ❑.Industry E]- Irrigation ❑ Recharge ❑ Commerical isreenstone 0 100 - - 0 Test Well ❑ Other: S. CASING: ❑ Threaded XEkWelded - glom. b in. to 20 ft. Depth Weight 17 Ibs./ft. diam. in. fo_ft. Depth -Stickup fr. - .. 1PAL1T'f CF 9. FINISH OF WELL: 1 '. ...- EPI r n _ Type: �'3P. t7 TiA'f.P Dlometer: t1 Al [i SI ofMesh Size: Length: set between 1r. and ft. n G Backfilling - - Gravel Pack 10. STATIC WATER LEVEL: fr. .,o ❑ Above or ❑ Below fond surface .Date Equipment used: I I . PUMPING LEVEL below land surface and YIELD ft. atter -.hrs. Pumping g.p.m.- ft. after —hrs. pumping g.p.m. - - - 12.GROUTING Well Grouted: ❑ Yes ❑ No - Material: ❑ Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p.m. O Subm. ❑ Jet ❑ Centrificul ❑ Other 14.REMARKS: Bail tested at 1 GYM 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature _° ❑ F ❑ C This well was drilled under my jurisdiction and this report Is true to the best of my knowledge and belief; Magnuson Drilling AA 530.5 Registered Business Name Contract License Number P.O.Box 504 Eagle River, Ake Address: Signed L,,a ...(. r11 t.9 /�F�[.�/^C�a—.... Date: = Authorized Representative Form 02-WWR (11/81) - Copy Distribution: WHITE-Stoie DGGS, PINK -Driller, CANARY -Customer - - Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ei.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-221-- COSA# Q S 1. GENERAL INFORMATION Expiration Date: Complete legal description FETROW S/D; LOT 2 Location (site address) 18305 OLD GLENN HIGHWAY * CHUGIAK. AK * 99567 Current Property owner(s) Mailing address Lending agency Mailing address LESLIE & DOROTHY FETROW Day phone C/O AGENT Day phone Real Estate Agent DIANE SHEARER W/ KELLER WILLIAMS Day phone 696-6500 Mailing address 101 W. BENSON BLVD, #503 * ANCHORAGE, AK * 99507 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: to conducting this evaluation, GEG, LfD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system unde- the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational lire 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. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Phone 337-6179 Date �� oo�opp o OFA pop O* _H 0 ................ f G ness. G P C7 `O U4Pd r'ro f e s si00�o� ��44000�� ,%N- vg1OFA6 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist ins Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other 7 By: Original Certificate Date: — tRe��ivosi � ON-SITE WATER AND WASTEWATER PROGRAM Municipality of Anchorage �E , Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: FETROW die; LOT 2 Parcel ID: 051-221- j `3 r� A. WELL DATA *BEDROCK **SMALLONS OF WATER STORAGE INSTALLED IN HOUSE. Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 1/77 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 252 ft. Cased to *36 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 1/77 7/14/11 Static water level 22 ft. 48 ft. Well production 0.4 g,p.m. **0.22 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 2.02 mg./L. Collected by: GEG, Ltd. Arsenic: NO ug./L. Date of sample: 6/20/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 11 /10/84 Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 7/12/11 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA 'BELOW EXISTING GRADE Date installed 11/10/84 Soil rating (g.p.d./ft`or /bdrm 85 System type DEEP TRENCH Length 26 ft. Width 2.5 ft. Gravel below pipe 5 ft. Total depth *8.5 ft. Eff. absorption area 260 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 7/14/11 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 785 gal. New depth 2 in. Elapsed Time: 110 min. Final fluid depth 0 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons "Pump off" Manhole/Access water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/I'rft station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manurelanimal 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 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingtvehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION l codify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date -719(/2 COSA Fee S L `1 U Date of PaymentG!%l � Receipt Number G -7-a7c�C// 7 (Rev. 11/05) Waiver Fee Date of Payment Receipt Number JUL-9-2012 13;28 FROM:K&L PLUMBING & NEPTI 1-997-694-2441 G PRODUCT 211 K & L PLUMBING &. HEATING, INC. P.O. Box 774792,,. T0:6966505 C. V L.y JOB INVOICE 33054 i P.2/2 2 S.F. OLD GLENN HIGHWAY N 50039'43"E 454.88' 8' ARTERIAL LANDSCAPE ESMT. !STEM ,/ 8,", 194.9' b 06 to �O• �v EVTR7 wq Aouy NCHOR M b ao CO's •' Z?.0. /Q ��/"� RAMP WELL/ ELL GAZEBO N � `/ 3 { OLD POWER C POLE N e W M LIGHT POLE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5' DRAINAGE ESMT. N 50"38'48"E 463.55' UM, TED. � � OF A TO ENl'S, AV• JOT Tk. 49TH t *�� 'LAT. .................. "JO .... 40 DATA ........... FOR m Jeffery A Gaslaldi / iO� :� A. e�AV 40 KA ••�1iessionol V, A\1r*W•• rE. 1 "=30' rL l nv. FETROW 5 LO 102,1 b GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. t000 E. DOWLING RD., SUITE 8 ANCHORAGE, ALASKA 99507 PHONE 248-5454 GRID NW 1057 DATE 6/29/2012 I HEREBY CERTIFY THAT I HAVE SURVI PROPERTY DEPICTED ABOVE AND THA ENCROACHMENTS EXIST EXCEPT AS It IT IS THE RESPONSIBILITY OF THE OW DETERMINE THE EXISTENCE OF ANY E COVENANTS OR RESTRICTIONS WHICH APPEAR ON THE RECORDED SUBDIVIS UNDER NO CIRCUMSTANCES SHOULD HEREON BE USED FOR CONSTRUCTIO1 ESTABLISHING BOUNDARY OR FENCE ANCNnRAnF RrrnRniNn ❑I_RT irr *MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION •� ' APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Location (address or directions) (b) Applicants Applicants Address 7z) a a (c) Applicant is (check one) Lendiot3 Buyer = ; Other Q (explain); Application Date /— v O — 9 S ision, segtioq, tgwnsAip, range) 699-1-3113, - phone - Home Business Owner/builder ; (d) Lending Institution /frpi.J 0' Telephone AdcTrgss (e) Real Estate Co. & Agent Address IM 11/7 Telephone L (f) the HAA to the following address: 2. Type of Residence Single -Family Tszr Number of Bedrooms 3. Water Supply Multi -Family 3 Other (describe) 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] 5. Engineering Firm Providing Inspections Tests File Search, Data and As certified by my seal affixed hereto and as of the validation date shown below 1 verify that my investigation of this Health Authority Approval shows that the on-site water sapply and/or wastewater disposal system is safe, functional and adequate for the nunber of bedrooms and type of structure indicated herein.- I further verify that, based sa 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 regula- tions !a effect on the date of this inspection. Name of Firm M Address Date /- Telephone n�'•,� 1457 -L - 6. 457.i/ 6. DHEP Aporoval Approved for bedrooms �av: ,� ate CXJ Approved -- Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS- EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE U°PT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIROiVPhENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A_ WELL DATA Legal f FEB n5 T/_SN iC ! w Well Classificatio GZ _ If A, B, or C, D.YE.C. Approved(Y/N) Well Log Present (Yk Date,Complete�l J.gl.� %%% Yield Total Depth " cased to 36 Be�r� Depth of Grouting Static Water Level Z 1 Pump Set At It - Casing Height Above Ground C Z " Sanitary Seal on Casing ( ) Electrical Wiring in Conduit (Y Depression Around Wellhead (st Separation Distances from Well: To Septic/HTank on Lot ��a S r ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot '78 On Adjoining Lots L1 Af0/_"O To Nearest Public Sewer Line —10,U//4 To Nearest Public Sewer ' Cleanout/Manhole A}A To t4arest Sewer Service Line on Lot 'ZS 7A - Water Water Sample Collected By -75. 5; Date �z Water Sample Test Results c Comments 111�0 A-11 B. SEPTIC/ TANK DATA Date Instalie C3 _ Size No. of Canpartments Standpipes (Y Air -tight Caps (Y hN Foundat,io�j Cleanou (Y ) Depression over Tank {JZ Date Last /$Pumped Z P /� Pumping/Maintenance Contract on File ,{Y 111P ; for 1 Holding Tank High -Water Alarm (Y/[ ,� Temporary Holding Tank Permit (YA1,W Separation Distances fran Septics Tank: To Water -Supply Well /j�f To Building Foundation To Property Line 'Lo To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course "Pu O fit= Receipt # Date Paid: U Amount: (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Abscrpti n Strata kS_i�6i Type of System Design en_C [9 Date Installed l� �' ngth of Field Width of Field `j�� Depth of Field Gravel Bed Thickness a b Square Feet of Absorption Nea Z �® Standpipes Present (Y Depression over Field (71 Da of Last Adequacy Test h1 C� Results of Last Adequacy st %✓ !� ®� Separation Distance from Absorption Field: To Water -Supply Well % 7e To Property Lire zo To Building Foundation Z & r Terror Abandoned System on Lot 3.0 4- ; On Adjoining Lots 4V N '0 F c% To Water N&WService Line %C7 1F To Cutbank( if present) Ai YJ AJC To Stream/Pond/Lake/or Major Drainage Course AJ 0 N Offr To Driveway, Parking Area, or Vehicle Storage Area ZO f D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (YIN) "Pump On" Level at p f" Level at High Water Alarm Level at Vent (yLN) Tested for Pumping Cyc s ing Adequacy Test. gets MOA Electrical Codes(Y/N) Convents ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all M.A. HAA Guidelines in effect on the date of this inspection. Signed Date Company SRB 1 SK& CUT MOA No. PF9, 6 KBl/d5/s (Page 2 of 21 2-15-84 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date �kf VLL'' Z-),- (a) ' (a) Legal Description (include lot, block, subdivision, section, township, range) AA, 47'1�%Z a / 7 T/ 5 V IFD//cJ Location (address or directions) L- � GL€nJ (b) Applicants Name Applicants Address_ 2-72- lephone - Home Rnnina., (c) Applicant is (check one) Lending Institution Owner/builder Buyer � ; Other [-:::I (explain); ; (d) Lending Institution /l.1 0 moi/ Telephone Address (e) Real Estate Co. & Agenty_"n /L.t F Address Telephone AIL0 (f) Ma.44-the HAA to the following /address: J! _S t Z mlAE'E:'/i2 C 2. Type of Residence Single -Family Number of Bedrooms 3. Water Supply Individual Well Multi -Family Z_ Other (describe) Community M Public M Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests. File Search. nor. —A r..c,._._ 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 regula- tions in effect on the date of this inspection. Name of Firm53o 1157 Telephone i' Addreas ��. �i �' > T 22 Date AF ®r�� Ok- At It '•4 ttt (ENGINEER SEAL) 6. DHEP Approval a sr,«ior ec` 'n •. No. 1457-E , Approved .for `� bedrooms By + j(" It `j' ' 4 £ °' Approved Disapproved Conditional Terms of Conditional Approval C, C), o) %r/o9p /zO/?j/1JC TZCQ� F22G1 /.3E //v 5 7x, t.� CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT— ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE— MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE ISNOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-34 ........... ........... MUNICIPALITY OF ANCHORAGE (MOA) i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 A. WELL DATA Legal Description: !1J /43 l GI.J I S" /.tet Well Classification Prc j[JC k If A, B, or C, D.E.C. Approved(Y/N) %�— Well Log Presen ( Date Completed ;R''k � Yield s Total Depth %e70' Cased to 26 � 13 % Depth of Grouting Static Water Level .00 Pump Set At 4 Casing Height Above Ground .30 " Sanitary Seal on Casing (Y Electrical Wiring in Conduit (Y/ j Depression Around Wellhead W Separation Distances from 411: To Septic/`Hc� Tank on Lot /00 On Adjoining Lots /CSC To Nearest Edge of Absorption Field on On Adjoining Lots /00 To Nearest Pubis Sewer Line /0 Zr-l- To Nearest Public Sewer Cleancut/Manhole Al To Nearest Sewer Service Line on Lot c'SO Water Sample Collected By �/?Py/%�l Date //�Z �9Z Water Sample Test Results -7-15 L19C7'-1/0 Comments /Q 0 P B. SEPTIC/%'TANK DATA JV Date Installg4 GLt< Size / CT�o No. of Ccrnpartments u Standpipes (Y Air -tight Caps (Y'Foundation Cleanout 'g/ ) Depression over Tank (§7 Date Last P l/ Z7 9� Pumping/Maintenance Contract on File (Y//N) for Holding Tank High -Water Alarm (Y/N)L" 'i? Temporary Holding Tank Permit (Y/N)4 Separation. Distances from Septiclf Tank: ! To Water -Supply I,bll To Building Foundation c5_0 To Property Lire /CJ To Disposal Field CL 4 - To To Water 4ervice Line P7"—, To Stream, Pond, Lake, car Major Drainage Course 'kf 0 Comments f1�2 Tim/�s� Receipt # Date Paid: Amount: [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System resign 7�61C Aj Date Installed LA 4c Length of Field /..C - Width of Field go " Depth of Field 6t L -C_ Gravel Bed Thickness _ U VL Square Feet of Absorption/ �A1rea LL 6-C Standpipes Present (WI) Depression over Field (ZPDate of Last Adequacy Test // 2 Results of Last Adequacy L_A1Z.vk . 7�✓ BE' Separation Distance from Absorption Field: To touter -Supply TAb ll /L; � �� To Property Line /0 C� To Building Foundation cSL� �tL To Existing or Abandoned System on Lot 4' -�' h J F On Adjoining Lots 30 i,4 To Water Mar?/Service Line 5 1f To Cutbank(if To Stream/Pond/Lake/or Major Drainage Course A-' 0 AJ To Driveway, Parking Area, or vehicle Storage Area (,tCoicmients ��C� CQ e-,, s�cv¢Wa✓ /-Le n /Xi -a 7eld 4aIFA-,rlbF�-z 1"1TS„r NL'w 04JA.'c� Ceti D. LIFT STATION / eec<'L E.eL, Date installed Dimensions -rd ®:J �irvx Size in Gallons Manhole/Access (Y/N) _ "Ptunp On” Level at ifXesirVienq evel at _ High Water Alarm Level at nt (YM) _ Tested for i Cy Adequacy Test. Meets MOA Electrical Codes(YM) Comments ** Check Perm I certify that on the da of Signe Conga KBl/d5/s (Page 2 of 21 Bedroom Rating Against HAA Request ** I )fave checked, verified, or conformed to all MOA HAA Guidelines in. effect Date . MOA No. x , 2-15-84