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JAYNE'S PLACE LT 1
Jayne's Place Lot 1 #018-193-01 Municipality of Anchorage Page I of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW 85001 v PID Number: a I S 1 9 3 D Name: Wastewater System: ❑ New 25,Upgrade 6LbNN 4 NOLV(A ROI-VT Address: ABSORPTION FIELD Phone: No. of Bedrooms: Li Deep Trench ❑ Shallow Trench ❑ eed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: � �T O.$ GPD/Sq. . Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe I — T'AyNS S 1>LAtGE 3 Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: S �— • 5 Ft. Ft. Gravel width: Number of lines: Distance between lines: WELL: Exis-rl ,60 New ❑ Upgrade a. S Ft. ( — Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: AST 1�-% "P21VATIS I (-1(o Ft. I I%fa Ft. -i$O SO. Ft. 'F$10 h3 39 Driller: Date Drilled: Static Water Level: 1 Installer: Tw�eD 1C Date installed: �j-11-�1s {-CE SS �RILLt,JL Ca. 9-It,-91 IOrc Ft. Yield: Pump Set at: I Casing Height Above Ground: TANK 3 GPM VlIG Ft. I r* Ft. SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: 1aS0 From Tank Field Station Tank Sewer Lines NC({o�Er44;E TNK Well- IDa' (Soy — � a5�.t Material: �T>=EL Number of Compartments: a Surfac 00 -f- — — LIFT STATION Water 100+ — Lot 1Size Ll 7 in gallons: Manufacturer: Line a io t ��► –' _� "Pump on" level at: "Pump off' lev High water alarm at: Foundation aa' --' CurtainPump Make & Electrical Inspections performed by: Drain Nc�1.1 Krco N BENCH MARK Remarks: Location and Description: - -TOT ot= S-reP Cor+c2E7a) AT 9TA12uJjELL A-r 2L�AV Or- 1'IJ034F ($orMovn LAND(1U6) Assumed Elevation: EN L $� OF y,....q 5 & SS ENf IMMERINGt V `yi ; 9t 17034 Eagle River Loop Road No. 204 �...»° .. A �+ Inspections performed le River, Alaska 91577 Dates: 1st 2nd S ROBERT C. COWAN CE - 8801 Department of Health and H man Services approval ,r•'\ TF �.,, •<�,`' A Reviewed and approved by: ISId, Date: -26 72-013 (Rev. 9/91) MOA 25 Permit No. SW950010 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report LT1, JAYNE'S PLACE 01819301 Legal Description: PID No.: SCALE 1" = 72-013 A (1193) ' CO2 99.5' n 94.2'-I 1250 GAL S.T. GRADE` M'1'1nFi x-88.4' MIN I I r r DIVERTER VALVE INSTALLED -NEW 1250 A SEPTIC TA FCD h V� ROBERT C. COWAN i G"S CE - 8801 i ••�� LL PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES C P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950010 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:PRUITT GLENN A & NOLVIA B OWNER ADDRESS:2701 E 144TH AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01819301 LEGAL DESCRIPTION: JAYNE'S PLACE LT LOT SIZE: 49109 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 2/03/95 EXPIRATION DATE: 2/03/96 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 (24 HOURS) . 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS:�� J RECEIVED BY: DATE: 2✓ ISSUED BY: �L%GI' \` DATE: Z 3 �>` S& Febxuany 1, 1995 ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTHAUTHORITY APPROVALS MUNICIPALITY OF ANCHORAGE Department o6 Heatth and Human Sen.v.ieies P.O. Box 196650 SEWER &WATER Anchmage, AK 99519 MAIN EXTENSIONS REFERENCE: Lot 1; Jaynes Ptaee Subdivision SEWER&WATER Request you issue a permit t0 upgrade the dept c 6y,6tem &eAving the INSPECTION Sotm bed$oom hoaae on the stege a -need pnopeaty and i&sue a "Coed it iona.E" Heatth Autho& ty Apprcovat. An adequacy tett pe&4oued on the existing system gon Heatth AuthojLity ENGINEERING STUDIES Apprcovat purcposes Sound the abAorcption capacity og the exi,ti,ng system AND REPORTS to be inadequate. A eonditionat Heatth Authotu ty App,%ova2 is rcequested until the system can be uognaded by 15 June, 1995. A test hole was excavated and a perccotation test pen6onmed in the aAea WELCTION &FLOW o6 the p&opoi:Ed upgrade. The appxox.imate toea#,i.on o6 the test hole .0 OWTESTEST .located on the attached site pta.n. The monitoring tube within the test hote has been checked and bound to SITE PLANS be dry. Attached is the prcoposed upgrade design. We do not anticipate any advenhe e6t'ect6 on the ne-ighboning pnopent-ies by the .insta22at.ion os the ptopoaed septic system. Thence ane no ROADDESIGN point/ o6 contamination within the pto;_ n.�;ed weU radius which can be seen on the attached site plan. 16 you have any gc %.':-.ions, on %equiu additi.onae in�onmat%.cn bon your. SOILTEST rcev.iew, please contact us. S.ineercet y, PERCOLATION�� TEST /17/ont, ROBERT C. COWAN, P.E. RCC 1,v Ve STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 O AWG t/ irJ '• 'yj� O O UW; ] �! 7- f w to Cei > r J f <'� I: cy woo U i; F ��w O�PW Q r LU - f � x >y z O af Z Z h O . -a H i O F•6 O_ Omo�O ".0 UOa�i d'yrU aF Q tna E� W w N o0L`- a —F r W>- Z >- =am w(-) �_ Z MZ U I U O.z < O O LJ E�MQd C\lF mw Z Oo o F o O z a �� � J Iloll ¢� p 3i L, wZ VSO O ¢� r 07- c_ muj U> F � Z a w v a= La n ntw @ c1 a) (D Loo 2 Q rn Owe W cn z ' z P. CO O (n�JQwwQ0 �Nz o0mJ=i—'wU I �Of N ELTF- 0 O J Z O O U) U > E) co o � Y cn U LU U az J O V) �o w z z a Q -� Z Wir J 0 tovl o_ o Q o0L`- a —F z o Z >- =am w(-) �_ Z a \C V) OaOO I U O.z < O O LJ J ul I mw �g� � o 0 0 0 �I a o w Iloll J I r ww>- mh0 :�E �w2-z � I O `OOj � J nCk z m O n -Q(n owo �0( I cn z ' I P. (n�JQwwQ0 o0mJ=i—'wU I �Of I o Y �3a ,n><Z hI �� om 0'00IZ� o O cn m Q W o ~ aI V O FI � � 0 I 0 A181S L H O J w a � P-4 6NdWNON — — — — i so Ynvuiva 2 )Xrlizn .oi — P4 w-- ivisa zein of nim Sol 00 31vos NVJcOdn '09 = "I o0L`- d a \C V) OaOO I J ul I 0 0 0 �I I��. M Iloll J O `OOj � J IOW m O Q �0( I nim Sol 00 31vos NVJcOdn '09 = "I OU 000 W t -L ® F r, aaa . (xoox zimas) N a "9 (xoozi 2iaARS) r4 3AIJ,o3333 . L,_ 0 O N z a a x En o w z o pq m LO �DLO F n zww E " N ? E'P'wINW E.wz w w{ o m w CA � Q a) -c4 W zit* m w cn O Z O cj P4 _> O Y wU o pa FwWW w z U O P.WU U (n d. a, � M00400 Ea., a. W fxom4:m LL] p MFlW zM:304 0EQ P'+ zWa O- o o wCo Z J O � xP w N d' E-4 p Z Q w'tC') c c6� Q z z r. wiz pew a3 w rn o 0 ung wpa� 6Elw { ew 44( 3'1tlJS 'STN N01103S—X S&S nG ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. ON-SITE WASTEWATER VISPOSAL SYSTEM CIVILENGINEERS CONSTRUCTION PRACTICES (sol) 694-2949 FAX (907) 694-1211 and MATERIAL SPECIFICATIONS HEALTHAUTHORITY APPROVALS REFERENCE: Lot 1; Jaynes P.2aee GENERAL: SEWER&WATER MAIN EXTENSIONS 1. The scope o4 this ptoject incPudes the i,nstaE2ation o4 a 2eaeh4ietd tAench to serve the flout bedroom tes.idenee located on the ne4enenced pn.ope ty and excavation o6 the existing SEWER&WATER septic tank .to vet.cgy its.cntegt.cty. 14 the integtiity o4 the INSPECTION existing septic tank is poo,% the existing septic .tank is to be excavated, pumped, eicushed, and abandoned in ptaee and a new 1250 gallon septic tank .i"taZ2ed. ENGINEERING STUDIES 2. ConstAu.ction shaft be in -accotdance with the apptoved site plan AND REPORTS and design dtawings, Municipal pewit with any special provisions of conditions, and all appticabte State and Muni.eipat wastewater Disposal Regulations. WELLINSPECTION3. &FLOW TEST The contAactot shad be nes onsibte [of obtaining an neeessar i� ll g y y underground ut UAy locates. 4. Unless specf.4iea ty agreed otherwise, the ptopetty owner 6haU be responsible got flint grading areas subsequently deptessed SITE PLANS 4tom soi' settUng. 5. ContAactor4 installing wastewater di4posal systems must be eetti4ied by the Municipal HeaEth Department got system ROAD DESIGN instaelations. Ownet4 insta ting thew own systems must atso receive prior approval 4rom the Municipal HeaUh Depattment. SOILTEST SEPTIC TANK INSTALLATION: 1. A septic tank is to be eonstAucted by a certi4ied septic tank manu4ac tuh.et. Co"tAuction 4ha t include two 4" cteanouts 40t PERCOLATION TEST pumptng access. 2. The septic tank shat be sub4icientty bedded to prevent settling or shi4ti.ng o4 the tank. STRUCTURAL& MECHANICAL p� p/J 3. Att standpipes - on .the septic tank shaU extend a minimum o4 12 INSPECTIONS inches above 4inal grade. ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP - SUITE 204 - EAGLE RIVER, ALASKA 99577 Page Two Lot 1; Jaynes Ptaee JanuaAy 31, 1995 4. Septic tanks .ins#aUed with tens than 4' o4 covek shalt be .insulated. 5. A 6oundation eteanout shaft be .instatted one to hour beet 6rom the bui,td.ing 4oundation. In the .tine between the tank and the teaeh4.ietd there shah be two adjacent eteanouts (untess an e66.tuent pumping system exists within the septic tank). These eteanouts shalt be Located on undistuAbed soft not more than 10' 6rom the tank. The 6.Lrst eteanout, .in .tine, shalt be to clean toward the .teaeh6.ietd. The second cleanout shalt be to etean toward .the septic tank. 6. F.ina.t grading oven the septic tank shalt be such that a positive s.tope exists away 6rom the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed tAench to the dimensions shown on :the design. The bottom o4 the excavation shah be within 2 .inches o6 .tevet. I6 the sidewalts o6 the excavation become smeared, they must be rafted or scratched (roughed -up) be6ore gravet (sewer rock) p.tacement. 2. Once the gravel .is .inrstalted, the d.istAibution pipe is to be .instalted tevet with the per6orations 4aced downward. Gravet is then to be p.taced over the distlr ibution pipe to provide a minimum o6 2 inches o6 coven oven the pipe. 3. A silt bavUer must be .instatted between the 6.inat gravel .tayer and the native so.it back4iU. En6uxe the silt barrier covens the entire gravet sur6aee be6ore p.tacing baeh4.ilt. 4. Monitor tubes ,,hatt be o6 4our (4) inch diameter and .instatted approx.imatety .in the toeationv shown on the design. The portion o6 the monitoring tube extending through the gravet shaU be per4orated 44om the bottom o4 the tAeneh to the invent o4 the distAibution pipe. This is equdvatent to the eb4ecti.ve depth o6 the graven as noted on the design. 5. Back4.iU oven the 6-inat gravet .tayer must not be .teas than twenty -Jour 124) .inches. Insatation mus -,l be .instatted when the back4iu depth is .tens than tUAty-six (36) .inehea. The 4.in.ish grade oven the trench must be mounded to prevent the 4ormation o4 a depression a6ter sett ng. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed 6or .in6tat.tation must be eonstAueted by a Mun.iei,patty approved septic tank manu6acturer. Page Tha.ee Lot 1; Jaynes Ptaee JanuaAy 31, 1995 2. The 4ottowing pipe mateni.ats ane appnoved bon use .in septic system .insta,2tations .in the Municipat ty o4 Anchohage: Type oA Pape PeAf,oaated Sotid Cast IAon Yea Yea ASTM D3034 (PUC) Yea Yea ASTM F810 (HDPE) Yea No ASTM D2662 (ABS) Yea Yes Use o4 a type o4 pipe other than tilted above must be appnoved by the inspecting eng.ineen. 3. Insutation shatt be at teast 2" thick extAuded d ,%ect bun iat potystyAene (Dow Chem.ieat Company Sty)Lo4oam HI oA equat). 4. Septic tank intets and outlets shaU be flitted with wateAtight couptings (CauedeA, Eennco, on equal). 5. A penmeabte nontoxic sift baAA.ieA (Typan 3401, MiAa4.i 140/N, oA equat) must be .instatted between the 4.inae teaeh4.ietd gtaveb tayet and the native soil back4itt. G. Att teach4.tetd gAavet (sewer Hoch) shatt be 0.5"-2.5" seneened g1tave2 with tens than 3% passing the #200 sieve. 7. when hand .is being used as a 4.itteA matetiat, its gAadation speci4ications must eon4onm to cuAAent M.U.A. oA D.E.C. Aequiuments. INSPECTIONS: Typieatty there w tt be a minimum o4 thAee (3) inspections %equ ked duking the .iwsta tation o4 the wastewatea dizposat system. These .inspections Witt oecun as 4ottows : 1. The 4.inst .inspection must be conducted a4teA the excavation o4 ditches, pits, tAenehes, oA beds and be4one the .instc22ati.on o4 any gAave2. A septic tank may be set .in ptace, but may not be back4itted be4one this inspection. 2. The second .inspection must be conducted a4tea. the ptaeement o4 the sift baAurieA, gAavet, dist, ibution tines, standpipes, eteanouts, and .insutation, but be4one the ptaeement o4 any otheA backbit 2. Page Four Lot 1; Jaynes Ptaee January 31, 1995 3. The 4 nat .inspection is to occuA upon 4inat grading os the property. Osten there Witt be mare than these 3 .inspections required, edpeeiaUy with the .instaUation o5 muttipte trenched, sand 4itters, pressurized distribution %systems, etc. Thud, the .inspecting engineer .is to be contacted at teast 24 hours prior to the start o6 construction. l$ neeedsary, a pre -construction meeting wi U take ptace on-site. The .inspecting engineer wiU not coordinate, d fleet or eontrot .in any way the eontAaetor's activities. The owner shaU contract with the contAactor to persorm the wo,%k outlined .in these specisi ations and ptans and .in accordance with the attached M.U.A. petani.t. There will be no eontAaetuat aArangement existing between the contractor and S & S Engineering. S & S Engineering 6haU be the owner's rep tesenta Live and wiP.e .inspect the wo,%k as stated above to document the contractor's activities. P.inae acceptance os the contractor's work, nuts with the owner and the M.U.A. S & S Engineering shaU have no tiabitity to the owner or to others Son acts on om.iss.ionz os the contractor or any other. persons persorm.ing wo,%k on this project or the Sa.ituAe os the contractor to carry out the wo)tk in accordance with these construction documents. S & S Engineering's .inspecting engineer wiU not be respons.ibte San the construction means, methods, techniques, sequence, procedures or the sa4ety precautions incident to this project. CONTRACTOR/INSTALLER ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX(907)694-1211 PERFORMED FOR: GI -E t` -t �fbA 117. DATE PER LEGAL DESCRIPTION: (ADT ( , -'7AVfVj S PLAcE, Township, Range, Section: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS 61 ML _ OR(bflNtcS w/ UR.GAN+c SR -7, S WS � _ 0()"s -0()"s -Pr -'0 wl Ganv SLOPE SAV '<V SA -j0 Nv46 wir 5grn Ce`tuSizS, WAS GROUND WATER ENCOUNTERED? J9.0. N . IF YES, AT WHAT DEPTH? Depth to Water Alter Monitoring? PRY Date: No S L O P E X416 S— 3 ROBERT C. COWAN F 2 0'.' CE -8801 �? L DRI SITE PLAN h PERCOLATION RATE/3 (minutes/incch)PERC HOLE DIAMETER TEST RUN BETWEEN L, FT AND _ 'L FT S & S ENGINEERING I - /��- v CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: —TfU34 Eagle River Looq ACCORDANCE WITH A LUflWe-rMpa 01?4 a6I9I4@4 IN EFFECT ON THIS DATE. DATE: ; 72-008 (Rev. 4/65) 55577 wIM/ 1 K�����I h PERCOLATION RATE/3 (minutes/incch)PERC HOLE DIAMETER TEST RUN BETWEEN L, FT AND _ 'L FT S & S ENGINEERING I - /��- v CERTIFY THAT THIS TEST WAS PERFORMED IN PERFORMED BY: —TfU34 Eagle River Looq ACCORDANCE WITH A LUflWe-rMpa 01?4 a6I9I4@4 IN EFFECT ON THIS DATE. DATE: ; 72-008 (Rev. 4/65) 55577 MUNICIPALITY OF ANCHORAGE r� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ° ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND -AM WELL INSPECTION REPORT NAME MOx-lot PHONE �EW ❑ UPGRADE MAILING ADDRESS �--• "AA eox �4J LEGAL DESCRIPTION i L err- X11 S LOCATION o6ltog, 9A &W J)'J NO. OF BEDROOMS U DISTANCE TO: WeJI ��. BVI Absorption ea ee4Dwell ng PERMIT NO. _Y M z N I. Manufacturer t— e.V� Materia No, of compartments Liq. capacity irUallons IF HOMEMADE: Inside length Width Liquid depth _j (9z DISTANCE TO: ell Dwelling PERMIT NO. = Z Manuf 1�1er Materi Liquid capacit gallons = DISTANCE TO: Well �J Foundation Nearest lot line / � � PERMIT NO. !(�0�� (D (j Z w No. of lines Length of Total len f lTrench wifm P inches Distance between in e F To of the to finish rade P 9 Material beneath the P - Total effective abs tion ar S ip LU C7 Length Width Depth PERMIT N - Q F wa Type of crib Crib diameter Crib depth Total effective absorption area Lu D ANCE TO: Well 94ilding foundation Nearest lot line J ClasstN7)fvrpok;L_ Depth Driller Distance to lot line PERMIT NO. ®� W 3: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS ?V .-3d'7y 1'( SOIL TEST RATING INSTALLER REMARKS O It Pu S%r APPROVED - DATE LEGAL 31 rues 1Nev. 3//251 MAXIMUM NUMBER OF' BEDROOMS _ 1. SOIL RATING f*SQ FT.°'E:R)= 12 THE REQUIRED SIZE OF THE 'SOIL ABSORPTION SYSTEM 15: THE LENGTH DIMENSION IS THE LENGTH Ira FEET) OF' THE TRENCH OR C: RAIT'-JF'IEL..L':,. THE DEPTH OF A TRENCH CH OF' PIT IS* 'THE DI:= TFiNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E;>;CAVATI ON (IN FEE.T:j. THERE IS NO SET WIDTH FOR TRENCHES. THE 13RA,.E.L. DEPTH IS THE. MIt•lIt'll._Irq DEPTH OF GRAVEL, BETi!EEN THE OUTFALL PIPE AN[.,, THE B0770t'l OF THE... EXCAVATION I td FEET;. PERMIT APPLICAPIT HAS THE RESP fr•SiE:IL_ITY TO INFIRM THIS DEF'ARTMEtdT DURINi THE: 1r•STALLAT ION INSPECTIONS OF I'Ir'.I'T 14E:Lt._= ADJACENT TO THIS PROPERTY AND THE r._TI_IMBER OF RESIDENCES THAT` 'THE WELL klILL SERVE. BACKF71LLING OF' ANY 'SYSTEM WITHOUT" FINFIL.. INSPECTION AND APF'RO% AT_ BIT' T -H DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A 14ELLl- FIND ANYON--SITEEI,.lIGE DISPOSAL ','_;TEM 11- 11_ 0 FEET FOR A PRIVATE WELL.. OR :1.50 TO 200 FE'E'T FROM A PUBL. I C: WELL. DEPENDING UPON THE; 'TYPE OF' PUBLIC WEE_L. MINIMUM DISTANCE FR011 A PRIVATE t,.IELL TO A PRIVATE =EWER I. -INE IS 25 FEET AN[. - TO A COMMUNITY SEWER I... ME IS '7"5 FEET WELL L.OGS ARE REQUIRED ANID MUST BE RETURNED TO THE DE:F'FIE:' MEtI T W I TH I P•,I 30 DAYS OF 'T'HE WE'L-L. COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND COtl_;-rR ICTION DIAGRAMS ARE AVAILABLE TO i INSURE PROPER INSTAL ... L.FIT!Ot-.!. "F F; ° Ems.:'` CAE- lE= 9'°-1 z •. a T CERTIFY THAT 1: 1 Ari FAMILIAR WITH THE I='.E-QU I REMENT:_: FOR ON -S i TE n-:EldERS AND WEL [__S AS SET T FORTH BY THE r°A_ N I C I PAL. I T T OF ANCHORAr E. 2: 1 WILL_ I NST'AI-L THE. SYSTEM IN ACCORDAt,!C:E WITH THE CODE_. 1 UNDERSTAND THAT THE Card ---SITE SEWER 'S ,'`_:TEM MAY REQUIRE ENL—ARGEMEr,IT IF' THE: RESIDENCE IS REMODF-D-EE> TO INCLUDE MORE THAN 4 BEDROOMS. APPLICANT ME RL.E BEETER ISSUED BY__-c-elo _ ______.-__-___ ___ ._.___DAT.E_2-�_.�/ 2- V4. 0 DEPARTMENT C'-rfZ HEALTH Flr'aD ENVIRONMENTAL, PROTECTION 82F.; 'I._' STREET, ANC:HORFIGE: Ak;. 995F-11 264-4720 PET=MI T P-40. :: 810808 �� jSVYt` 6 AF'F'L1i-:FIrdT t1E:F:LE BEE'rEF SRA E":; 1546--P `1 5 - 87 c: L OCATIf_-1 #, ANC:H LEGP,t_ l...l 1/2 LOT 50 SEC:_:y: 12 r . tIOT SIZE 4940 0 SQUARE FEET ftopeseQr �rI - "�fplo .Vo " TYPE OF OIL. ABSORPTION EIS: TRENCH I MAXIMUM NUMBER OF' BEDROOMS _ 1. SOIL RATING f*SQ FT.°'E:R)= 12 THE REQUIRED SIZE OF THE 'SOIL ABSORPTION SYSTEM 15: THE LENGTH DIMENSION IS THE LENGTH Ira FEET) OF' THE TRENCH OR C: RAIT'-JF'IEL..L':,. THE DEPTH OF A TRENCH CH OF' PIT IS* 'THE DI:= TFiNCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E;>;CAVATI ON (IN FEE.T:j. THERE IS NO SET WIDTH FOR TRENCHES. THE 13RA,.E.L. DEPTH IS THE. MIt•lIt'll._Irq DEPTH OF GRAVEL, BETi!EEN THE OUTFALL PIPE AN[.,, THE B0770t'l OF THE... EXCAVATION I td FEET;. PERMIT APPLICAPIT HAS THE RESP fr•SiE:IL_ITY TO INFIRM THIS DEF'ARTMEtdT DURINi THE: 1r•STALLAT ION INSPECTIONS OF I'Ir'.I'T 14E:Lt._= ADJACENT TO THIS PROPERTY AND THE r._TI_IMBER OF RESIDENCES THAT` 'THE WELL klILL SERVE. BACKF71LLING OF' ANY 'SYSTEM WITHOUT" FINFIL.. INSPECTION AND APF'RO% AT_ BIT' T -H DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A 14ELLl- FIND ANYON--SITEEI,.lIGE DISPOSAL ','_;TEM 11- 11_ 0 FEET FOR A PRIVATE WELL.. OR :1.50 TO 200 FE'E'T FROM A PUBL. I C: WELL. DEPENDING UPON THE; 'TYPE OF' PUBLIC WEE_L. MINIMUM DISTANCE FR011 A PRIVATE t,.IELL TO A PRIVATE =EWER I. -INE IS 25 FEET AN[. - TO A COMMUNITY SEWER I... ME IS '7"5 FEET WELL L.OGS ARE REQUIRED ANID MUST BE RETURNED TO THE DE:F'FIE:' MEtI T W I TH I P•,I 30 DAYS OF 'T'HE WE'L-L. COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND COtl_;-rR ICTION DIAGRAMS ARE AVAILABLE TO i INSURE PROPER INSTAL ... L.FIT!Ot-.!. "F F; ° Ems.:'` CAE- lE= 9'°-1 z •. a T CERTIFY THAT 1: 1 Ari FAMILIAR WITH THE I='.E-QU I REMENT:_: FOR ON -S i TE n-:EldERS AND WEL [__S AS SET T FORTH BY THE r°A_ N I C I PAL. I T T OF ANCHORAr E. 2: 1 WILL_ I NST'AI-L THE. SYSTEM IN ACCORDAt,!C:E WITH THE CODE_. 1 UNDERSTAND THAT THE Card ---SITE SEWER 'S ,'`_:TEM MAY REQUIRE ENL—ARGEMEr,IT IF' THE: RESIDENCE IS REMODF-D-EE> TO INCLUDE MORE THAN 4 BEDROOMS. APPLICANT ME RL.E BEETER ISSUED BY__-c-elo _ ______.-__-___ ___ ._.___DAT.E_2-�_.�/ 2- V4. 0 • ` MUNICIPALITY OF ANCHORAGE • �:. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Stroet, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST SUILS LOG --7—H :# Z I_J PERCOLATION TEST PERFORMED FOR: Pier le- ,, �2eJln DATE PERFORMED: LEGAL DESCRIPTION: o E ty 7/ Ofz �J9'/✓/C C(7✓G� SLOPE SITE PLAN 1 ell I (( 'k jj�6k protuN St(�� a Ot ff I+I�yt 2 b Y gr0.Ve �Itt 54rL d P00r-`J 3 1 _ °`, gur 4 Cie 4 b 5 O 6 / 0 7 8 0 9 10 'b 11 12 , 31415 13- 14- 15 16 17 1s 1s 20 COMMENTS r�fj OSe < PERFORMED BY:_ 72-008 (6/79) tot, l a/ adec{ d W/ cobb�es OF Ae AS GROUND WATER S �a ria r COUNTERED? Alt) L /c _ ..,j C a`a ; l 1, ••• ,` P ;rr E it•••�••°oe..e•• •••eeuelt'o S. AT WHAT p�.... ° DEH? YYYA • o ooae ! r ° . o E-443 Ci fin �. `.✓ END f -FO LE r; q Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE 511y/ 1/144 .) (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED BY: W • f4-9,,,,, L�N!5 T ?E. DATE: Y' / 2-0 6 / 0 O M PERCOLATION RATE 511y/ 1/144 .) (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED BY: W • f4-9,,,,, L�N!5 T ?E. DATE: Y' / 2-0 6 / 0 O M RETURN TC, Division of Geological and G rsical Surveys (DGGS)_ 3001 Porcupine Drive (Tele.._:a: 277-6615) - Anchorage, Alaska 99501 -� W A T E R W E L L R E C O R D Drilling Company Name U.S.G.S. Local No. Drilling Permit No. STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES LOCATION OF WELL Please complete either la, lb, or lc. A.D.L. No. Ia. Borough _ Subdivision,Lot -..... . 18lock Ib. Fraction Section No. Township Range E/W Meridian lc. Distance and Direction from Road Intersections Street Address and Area of Well Location 3. OWNER OF WELL: Address: 2. WELL LOG Material Type Feet Below Surface Top Bottom 4. WELL DEPTH: (completed) 1 .'.. ft. Surface Elevation Date of Completion - 5. ❑ Cable tool ❑ Rotary ❑ Driven ❑ Dug ❑ Auger ❑ Jetted ❑ Bored ❑ Other: . •.., _ 6. USE: ❑Domestic _]Public Supply ❑ Industry ❑Irrigation ❑Recharge ❑Commercial []Test Well [—]Other: -`� ' >`•i%%• ! 7. CASING: E] Threaded ❑Welded x in. to 'i..%ft. Depth Weight !',• lbs/ft. in. to ft. Depth 8. FINISH OF WELL: Type: Diameter: Slot/Mesh Size: Length: Set between ft. and ft. Fittings: I , 9. STATIC WATER LEVEL: ft. ❑ Above ❑Below land surface Type of Measurement: 10. PUMPING LEVEL below land surface ft. after .hrs. pumping 9-P.M. ft. after hrs. pumping g.p,m. /-� c !CHORAG II. WELL HEAD COMPLETION: ❑ In Approved Pit ❑ Pitless Adapter inches above grade PAUNICIP 11-4 12. GROUTING: Well Grouted: Yes ❑ No Material: ❑Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g.p. Type: ❑ Submersible ❑ Reciprocating ❑ Jet ❑ Other: 14. REMARKS: 15. WATER WELL This well Address: CONTRACTOR'S CERTIFICATION: was drilled under my jurisdiction and this Registered Business Name report is true to the best of my knowledge and belief: Contract License Num er - Signed )� Form 07 -VUR %��:- C. '�'r Authorized Representative 1-. Date: • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 018-193-01 Expiration Date: 1. GENERAL INFORMATION: Complete legal description JAYNESS PLACE; LOT 1 Location (site address) 2701 E. 144TH *ANCHORAGE, AK 99516 Current Property owner(s) JUDITH MCCORMICK Day phone 250-7450 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: aC a; (\-N� 4 Fe vA Distance: P Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment 9 1 / / 9 Receipt Number Cj��') COSA# 6115 14 /g/ l Waiver Fee $ Date of Payment Receipt Number Waiver # `� Vl 0?1 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineelinq Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: .8 l30 l GI In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, with #AECC884 O p o� Ilo*i0�utt� ns: �^ >j ES OW � n _ BOriginal Certificate Date: S_ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advis ry Well Flow Advisory Others COSA blue sheet 10-10-12.doc COSA Checklist Legal Description: JAYNES'S PLACE; LOT 1 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 9/16/81 Total depth 176 ft Cased to 176 ft ❑ Sanitary seal is functioning correctly Al Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA $/5/19 Static water level at beginning of test 112.6 ft Comments B. TANK DATA Age of tank(s) 24 years Tank type/material STEEL Measured operating fluid level in septic tank 51 © Standpipes/foundation cleanout per record drawing Date of pumping t l Parcel ID: 018-193-01 Structure served by this system 1 Well production at time of test 4+ Um Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 0.426 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Al Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample $/5/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: N/A D. ABSORPTION FIELD DATA V Which system tested (date installed) 5/11/95 Adequacy test date $/5/19 ❑ ALL standpipes present per record drawing Results ED Pass For 4 bedrooms Total measured depth from grade 10.5 ft (max) Fluid depth prior to test 54 in Measured depth to pipe invert from grade *2.3+ ft (min) Water added 610 gal ❑ N/A — pressurized field 67 New depth in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 135 depth into effective "0.75 min ElCode-requiredsoil cover over field Final fluid depth 60 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) Gallons introduced N/A gallons If yes, enter date N/A Comments/Deficiencies: 'SEE EMAIL FROM OWNER DATED 8/14/19 "SOUTH MT- NORTH MT EXTENDS TO BOTTOM COSA Checklist yellow sheet From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' of W 6'j, L' •ro ez C£ o� Off• 33� if No E. SEPARATION DISTANCES S4 w'^�` Sia Property Line > 5'✓❑ From Private Well on Lot to: (Please enter distances if less than required or if community well) if No Septic Tank/Lift Station on Lot > 100' Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' Yes if No * ft E✓ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' [✓ Yes if No ft Absorption Field on Lot > 100'✓❑ Yes if No ft Holding Tank > 100' ✓❑ Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Animal Containment > 50'✓❑ Yes if No ft ✓❑ Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑ Yes if No ft E]Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' 0 Yes if No ft Property Line > 5'✓❑ C Yes if No ft Wells on Adjacent Lots: l Absorption Field > 5' Water Main > 10' Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10'✓Q ft Community Wells > 200' FZ1 Yes if No Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' Q✓ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' C] Yes if No *61 ft If absorption field is under driveway comment below J Property Line > 10'✓Q Yes if No ft Wells on Adjacent Lots: C l Water Main > 10' Q Yes if No ft Private Wells > 100' ❑✓ Yes if No ft , Water Service Line > 10' Yes if No ft Community Wells > 200' FZ1 Yes if No ft " I" Surface Water > 100' Q Yes if No ft IJ 1z 2 F. ENGINEER'S COMMENTS \J� 'R3 *SEE ATACHED WAIVER REQUEST. REPORTEDLY, THERE IS NO WATER OR SEWER SERVICE LINES TO THE GARAGE. RESEVE SITE WAS DRY UPON ARRIVAL AND STAYED DRY THROUOUT TEST. SUMP APEARS TO BE FUNCTIONAL. G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet #AECC884 Q-9 1 tPLIP1s�� � e Advanccd Treatment' Syster» r, ti„r GARNESS ENGINEERING GROUP, Ltd ” ._--------- ENGINEERING o SALES o CONSULTING: — August 14, 2019 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Jayne's Place; Lot 1- Waiver Drainfield to Foundation To whom it may concern: Per GEG inspection on 8/5/2019 it was noted that the existing drainfield cleanout is approximately 8 feet from the shop/garage foundation. Per MOA records, the drainfield is 2.5 feet wide. We request that your department issue a variance to alow the drainfield to be 6 feet from foundation. Attached is an as -built survey by Robert L. Farmer, PLS which shows the shop location. Also attached is a photograph showing the clean-out and the building. The shop/garage appears to have a slab on grade. Based upon this survey (7/2/2008), the encroachment has existed for at least 11 years. It is our belief there is minimal risk in approving this waiver, given the length of time the encroachment has existed without issues. Please call or emaA if you have any questions. 15 PSE., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com Municipality of Anchorage ' P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program trent ( I J J. fJ Department x x x x VARIANCE/WAIVER REVIEW x x x x Waiver#: OSV191079 COSA#:OSC191411 Permit#: PID#: 018-193-01 Legal Description: Jayness Place Lot 1 Engineer: GEG Applicant: McCormick 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 6 feet. This waiver approval applies to the Existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. Adjacent properties are not affected by this waiver. ...................................................... 0 0 0 0 X. .................. 1 Waiver is Granted: X Waiver is not Granted: Date: I Approved by: Name of Reviewer ..................................................... a 0 0 M N M ............ 0 0 0 ... 0 1 DEVELOPMENT SERVICES DEPARTMENT (` On -Site Water and Wastewater Section _ t www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval #OSC191411 Subdivision: Jayness Place Lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 24 years old. Typical replacement costs range from $6,000 to $9,000. 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 20 year old steel tank MAY look like. 14�?,F `.� `a� .h-.r.^a... • ��,,, n,„„.,`�;y;y Y�r,�a �1it��hgAdd e s 3 fox 19655 Aneho aged las�Ca` 9519 i 50 * Waivuii muni chit l_ Municipality of Anchorage �� ���`• Ory -�1 Development Services Department Building Safety Division L ,; On -Site Water and Wastewater Program 1J 4700 Elmore Road s P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. I - 13 b 1 COSA # 080'2/1 Expiration Date: /[q — 165 - O V 1. GENERAL INFORMATION Complete legal description Lot 1; Jayne's Place Subdivision Location (site address) 2701 East 144th Ave. Anchorage, AK 99516 Current Property owner(s) Stan Trekeit Mailing address Lending agency Mailing address Real Estate Agent Mailing Address PO Box 212349 Anchorage, AK 99521 Vicki Kass 517 W. 12th Anchorage, AK 99501 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well ✓❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 227.0267 Day phone Day phone 727.5555 TYPE OF WASTEWATER DISPOSAL: Individual On-site❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 sample results. (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 S 8 s Engineering Address 15661 S. Birchwood Loop R11. Chu k, AK 99567 Engineer's Printed Name 5. DSD SIGNATURE _Ae� Approved for —1/___ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Phone 6942979 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory 19//_ 0 I / / WA / (a« 1110) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 7—/6—OS- (R. —/6—OS- Municipality of Anchorage Development Services Department ` Building Safety Division ' K On -Site Water & Wastewater Program 4700 Elmore 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: LOT I iy �Y�� /g 1 C 1 iG� Parcel ID:'n i R^ 1 X13-01 A. WELLQ Well type iL')tV Date completed Total depth 110t. If A, B, or C provide PWSID # = Sanitary sea@) —)65S Cased to1 t6 ft. FROMEL LOG Date of test 9 a I Static water level .lid& m ' ft. Well production t -.-O 15.0 g.p.m. WATER SAMPLE RESULTS: k1 Coliform colonies/100 mL Nitrate ti lb mg/L Arsenic: D ug/L date of sample: 6A'/o6 B. SEPTIC/HOLDING TANK DATA Well LogON) N./Es Wires properly protected&) n Casing height (above ground) I Z + in. AT INSPECTION 6 1N oB r 10r;� fi. 5.17 g.p.m. Other bacteria 6 colonies/100 mL Collected by: 'Sq -S C"IAZ�I-lA1G Tank Type/Material Date installed S//ll S Tank size laSagal. Number of Compartments .'' 11 Cleanouts�/ 1) YES Foundation cleanout jl dhj Depression over t��an%%k (Y� /VO High ater alarm (Yt�_� Date of pumping —611 { �9 Pumper I V Or_T1+LfWb f u�11P/ C. ABSORPTION FIE D DATA,' Date installed J! �r Soil rating (g.p.d./ft2 r fe/bdrm) _� System type I ECt- 7eEx9Ci1 f r ' r Length 65 ft. Width o2. S ft. Gravel below pipe ft. r Total depth 8.3 ft. Eff. absorption area Monitor' tube E-1 Depression over field Date of adequacy test to liq r70 Resu s Pas ail) � For 4 bedrooms q U Fluid depth in absorption field before test in. Water added63�jal. New depth in. '1 Elapsed Time: min. Final fluid depth d In. Absorption rate >= 6� f g.p.d. Any rejuvenation treatment (past 12 mo.) (Y_11111� type) r'V O If yes, give date D. LIFT STATION N/fi Date installed Size in gallons _ `Pump on" level at _ in. 'Pump oft' level Datum vc es tested _ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1092 Absorption field on lot 160, Public sewer main N Sewer /septic service line a S t -f Animal containment areas r 664 Manhole/Access (Y/N) at Meets alar & circuit requirements? On adjacent lots /a% 4 / On adjacent lots /CO f_ Public sewer manhole/cleanout rilla Holding tank 0. r Manure/animal excrete storage areas /0(9 'A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation OQ Property line AM Absorption field Water main /J A Water service line �� + Surface water /Z)O r+ Wells on adjacent lots in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: I � t Property line Building foundation Jt- / 't Water main !o f r Water Service line !� Surface water �d 0 Driveway, parking/vehicle storage Curtain drain A* 0E KNc W Welts on adjacent lots ADO i F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that t have determined review of Municipal records W. conformance with MOA COS gL Engineer's Printed Name% Date G / 23 10 B COSA Fee $-- Date Date of Payment Receipt Number 0'J (Rev. 11105) h field inspections and above systems are in Waiver Fee $ Date of Payment Receipt Number i F •.MNIN MN. N twva J,�� j' i ,i SCS ReEN Client Name Project Name/N Client Sample ID %talrie Sample Remarks: 1082519001 S & S Engineering LI; Jaynes Place S/D LI; Jaynes Place S/D Drinking Water All Dates/rimes are Alaska Standard Time Printed Date/time 06/19/2008 14A9 Collected Date/Time 06/06/2008 14:45 Received Date/Time 06/06/2008 15:10 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results POL Units Method Contalnci ID Limits Date Date Init Metals by ICP/MS Hardness as CaCO3 ND Waters Department Total Nitratc/Nitrite-N ND Private Individual Analvsis Aluminum ND Antimony ND Arsenic ND Barium ND Cadmium ND Calcium ND Chromium ND Copper 24.6 Iron ND Lead 0.766 Magnesium 92.0 Manganese ND Chloride 1.19 Fluoride 0.104 Selenium ND Sodium 59200 Silver ND Thallium ND Sulfate 9.34 Zinc 5.03 G t9' 0.100 mg/L SM202340B D mg/L SM20 450ONO3-F 13 06/16/08 06/19/08 NRB 06/17/08 JDZ 20.0 ug/L EP200.8 D 06/16/08 06/19/08 NRB 1.00 ug/L EP200.8 D (<6) 06/16/08 06/19/08 NRB 5.00 ug/L EP200.8 D (<IO) 06/16/08 06/19/08 NRB 3.00 ug/L EP200.8 D (<2000) 06/16/08 06/19/08 NRB 0.500 ug/L EP200.8 D (<5) 06/16/08 06/19/08 NRB 500 ug/L EP200.8 D 06/16/08 06/19/08 NRB 2.00 ug/L EP200.8 D (<100) 06/16/08 06/19/08 NR13 1.00 ug/L EP200.8 D I<1300) 06/16/08 06/19/08 NRI3 250 ug/L EP200.8 D (<300) 06/16/08 06/19/08 NRB 0.200 ug/L EP200.8 D (<15) 06/16/08 06/19/08 NRB 50.0 ug/L EP200.8 D 06/16/08 06/19/08 NRB 1.00 ug/L EP200.8 D (<50) OCd16/08 06/19/08 NRB 0.100 mg/L EPA 300.0 C (<250) 06/12/08 06/13/08 LCP 0.100 mg/L EPA 300.0 C (<2) 06/12/08 06/13/08 LCP 5.00 ug/L EP200.8 D (<50) 06/16/08 06/19/08 NRB 500 ug/L EP200.8 D (<250000) 06/16/08 06/19/08 NRB 1.00 ug/L EP200.8 D (<I00) 06/16/08 06/19/08 NRB 1.00 ug/L EP200.8 D (<2) 06/16/08 06/19/08 NRB 0.100 mg/L EPA 300.0 C (<250) 06/12/08 06113/08 LCP 5.00 ug/L EP200.8 D (<5000) 06116/08 06119108 NRB ffm14 SITS Rrf.N Client Name Project lame/p Client Sample ID Matrix 1082519001 S & S Engineering LI; Jaynes Place SID Ll; Jaynes Place SID Drinking Nater All DateJfimes are Alaska Standard Time Printed Daten'ime 06/19/2008 14.49 Collected Daterrime 06/062008 14:45 Received Date?ime 00/00/2008 15:10 Technical Director Stephen C. Ede AIIoNable Prep Analysis Parameter Results POL Units Method Containa ID Limits Date Date [nit Private Individual Analysis Total Dissolved Solids Nickel 11003 Alkalinity CO3 Alkalinity OI I Alkalinity Conductivity pit Alkalinity Colony Count Total Coliform Fecal Coliform 150 10.0 mgt/. Sh120 2540C E (<500) 06/09108 EI IC ND 2.00 ug/L EP200.8 D (<I00) 06/16108 06/19/08 NRB 118 10.0 mg/L SM20 2320B E 06/06/08 EI IC ND 10.0 mg/L SM20 232011 1: 06/06/08 EI IC ND 10.0 mg/L SX120 2320B 1: 06/06/08 EI IC 248 1.00 umhos/cm SS12025101) E 06/06/08 SYII 7.65 0.100 pl1 units SM20 4500-11 B E (6.5.8.5) 06/06/08 EI IC 118 10.0 mg/L SM20 232011 E 06/06/08 EI IC 0 col/100ml- S%120 922211 A 06/06/08 DLC 0 col/100ml- SM20 9222B A (<I) 06/06/08 DLC 0 col/100ml- SN1209222B A 06/06/08 DLC 3IV0 SIH113S SU3N800 ON ll!ns-SV Z 101 M6ZE8 z 0 O SA N co w CA) 38 , E)dr nuanV L4"L '3 �— 00'99� M„09.69.68N 'NO3b3H NMOHS ION SUV 1V•Id 0302!0032! 3HI NO NMOHS 3SOHI NVH12l3HIO'CrdO038 d0 Sl.N3W3SV3 .0£ =„ L :31d0S CA) W LABII PGA 101 °� 4 ii S C) gem xeqd sr endwBn ::W..,^. I c z •\.ill• ;.jN i:�(, �A�:iT.'\ 0OZ93 FM WI F; N co MnS 3dw VN'dAw �/ �� Q8 OU'E 3 HO OZ ° s _!.�.'�.%�>tii+}:k I N VElOI w Q 00 \a� Ir ry. •y H00' ,.• x:74 , I � I 9MA; POO \` Ae"Allp I / PASO / I I loan Opdas p2� slum Opdas• I • • —B'SZ esnoy uae� USE I I io I I eBe�eO I speA opdas • � �d eweij tiolS L • o OZL Ole 'SZ I ------------------ ----- --J 1N3W3SV3 Alnun AL W'99L RZO.99.68S y z T I I � dL4 101 DLV 101 I I � 1 I I 'CIO DYNAMIC PROPERTIES 3111 "C" Stkiet Suite 100 Anchorage, V 99503 _ Day phone _ 7n 1mnTJLiJTTLQ ---- =3111-11C" Stxeet Suite`100 Anchorage O�_ T2-025 (RW. 1/91) Front MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Loi 1, TxyNea -P(-Ac L_ Parcell.D. 018193o1 A. Well Data Well type _RztvarE:If A, B, or C, attach ADEC letter. ADEC water system number — N/A -- Log present k�UN) V -=s Date completed q- /& - 9t Driller >rvss 1>rz/c�rNb Co, Total depth 17(o Cased to /-7G Casing height Sanitary sealON) /£s Wires properly protected &N) VES Date of test Static water level Well flow Pump levell FROM WELL LOG q- 1(0 -at ttt•, AT INSPECTION I • Is•95 106, t5 g.p.m. 3 v/k v/a SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 10 a , ; On adjacent lots Absorption field on lot 1,50, ; On adjacent lots Public sewer main -75 rt Public sewer manhole/cleanout Sewer service line a Petroleum tank N/,4 WATER SAMPLE RESULTS: Coliform O eoLcNtas� 100m- Nitrate Date of sample: i- 1:5-9s B. SEPTIC/HOLDING TANK DATA ay wG/L Collected by: m .E' Ru .p.m.3:0 c~— o� a C.0 ccs C=CD 0 �ro t ro _Other bacteria S t'S �NGINCFRiniv Date installed 5 - I t - 9 5 Tank size 1 a Sy GAS Compartments ;?_ Cleanouts ('N) - V'Es Foundation cleanoutN `/ES ((�') Depression (Y 1C1 NO High water alarm (YoNo — N/A - Alarm tested (Y9 N JC) — t -j /iE — Date of pumping N/A rtQN k- Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Ioo, fi On adjacent lots 1001 + To property line l01 -t Absorption field Surface water/drainage loo `+ Foundation (D'4 Water main/service line M 72-026(3/93)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE F D. ABSORPTION FIELD DATA Manufacturer Manhole/Access (Y/N) Cycles STATION TO: On adjacent lots "Pump off" Surface water Date installed G. l I • q S Soil rating (GPD/Ft) b . S System type Length t75 Width D•S Gravel thickness Total depth 9' Total absorption area -700 ' ` Cleanout present )N) Yds Depression over field (Y© NO Date of adequacy test t4 — "wc,,d syr>M Results (pass/fail) for Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y No If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I So To building foundation On adjacent lots 3q Surface water 100' f Driveway, parking/vehicle storage area 7S Curtain drain f""''E /' /I<NC. 'T -J On adjacent lots 10olt Property line To existing or abandoned system on lot Cutbank / + Water main/service line E. ENGINEER'S CERTIFICATION 9' I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature"� ` p 111c 2 T C . CO 6•J•9 Engineer's Name _ i ROBERT C. COWAN S--`�G'�� .` CE- Date E-Date / 4 1, HAA Fee $ Date of Payment Receipt Number 751 -WR 13/93)` Back Waiver Fee $ Date of Payment Receipt Number S& HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPO.SALSYSTEM DESIGN May 18, 1995 MUNICIPALITY OF ANCHORAGE Depaktment o$ Heatth and Human Se vices P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 1; Jaynes Ptace ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX (907) 694-1211 RECEIVED MAY 191995 Municipality uI knctnorage Dept. Health & Hurnan Services A Cond.iti.onat Heatth Authontiy Appnova2 (HAA) was i- hued on 2/3/95 Uon the %e4eaenced pnopenty. Att wo,%k %equited bon. the Conditi.onat HAA has been completed. Please .ilsue a bu Heatth Authority Appa.ova2 at th i,6 time. 14 you requite additi.onat .inbonmation, please contact u6. Sincerely, �� 1 Robert C. Cowan, P.E. RCC/gk 0 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE ;t DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ,. On-Site Services Section h " P.O. Box 196650 Anchorage, Alaska 99519-6650 - 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # - O/ 8 # H A q S ?n . .- Q Es[u..✓S a. A 1. -' GENERAL INFORMATION < '.Complete legal description Lot 1. -faun"- PP e Subdi,vd6ion .-.,Location (site address or directions) 2701 E. 144th Avenue Anchonaae AK Property owner Glenn Pnu,itt Day phone Mailing address CIO DYNAMIC PROPERTIES 73111 "C" S Aet Suite 100 Anchorage, AK 99503 Lending agency Day phone Mailing address Agent Ray 1)ahC/ DYNAMIC PROPERTIES 261-7636 Day phone Address 3111 "C" StAeet Suite 100 AnehoKage, AK 99503 - <, 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, _ t- 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 1 � f Community on-site h Public sewer NOTE. ' if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of _ -.- 72-M (Rev.1191) Front MOA e21 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 invest!qation 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. q - S & S ENGINEERINr Phone y - % 7 Name of Firm 17034 Eagle River Loop Rolad No. Address Eagle Engineer's signature Date ;L � l °/s~ REQUEST YOU ISSUE A CONDITIONAL HEALTH AUTHORITY APPROVAL.- SEPTIC UPGRADE WILL BE COMPLETED NO LATER THAN 15 JUNE, 1995 {7 "p ROBERT C. COWAN ._ JCE-8801 s'�'��+ 6. DHHS SIGNATURE ., ; �j� bedrooms. Approved for �a�}zti Pr�rC :>` Disapproved. _ Conditional approval for ` T bedrooms, with the following stipulations: � aPOS�n G��TTEwATER SiSTEi1 %O A?f Coasj'rFuc7-.E/) /9S PFRti�r sw93ooio /NO/ ArFS /'%DNE y TO "-,or;'.FScRola Ea %D ACCOMPG/SN S�1/'a E ,VF,y' e5*eg6j.FVsH�rL L 'No T .Btu !t'FL_�,4,5CQ Additional Comments uu7'11- AlkAL APPROu,44 /S S/G,vlcp` 13 Y TH/s 1ApPT. M P61?)hPiF 5 #h LL BF r o xy pZ E- 7'f d 13Y d o�s— By: - Date 2 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 Stateof Alaska. The DHHS does this, as acourtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage ® Department of Health and Human Services - HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L -r TAYIJES }Pt -Ac -E Parcel I.D. A. Well Data Well type PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number `/ Log present O/N) !F—S Date completed 11 16 $I Driller Total depth R61 Cased to 13,9 r Casing height 1 ' + Sanitary seal ON) FROM WELL LOG Date of test /CIS Static water level I!l Well flow i5 Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/heldin tank on lot /C Absorption field on lot 1? Public sewer main 7S / 4 - Sewer service line 2s' -t WATER SAMPLE RESULTS: Wires properly protected N) YEs On adjacent lots Public sewer manhole/cleanout /(J n ' + Petroleum tank N/�4 Coliform CO/aA Nitrate 0.29-A�IZ- Other bacteria GIS Date of sample: /%3195 Collected by: S S ENCIA) FEIL/NG B. SEPTIC/HAL-DIMG TANK DATA Date installed 6 AI 181 Tank size 12. SO Compartments Z. Cleanouts (DN) yts Foundation cleanout N) )/us: Depression (YO ;Ala High water alarm (Y& A) oJ /A Alarm tested (Y® No N.4 Date of pumping (1i[,zs Pumper l`tf 4>w5 SEPARATION DISTANCES FROM SEPTIC/HGLDWG TANK TO: Well(s) on lot (Od 4- On adjacent lots /Dy , -f- Foundation 16 L To property line /0 � Absorption field S�4- Water main/service line /6'.t - Surface water/drainage /Dc -f- cr'� W a Q= L4J 92< 72-026(3/93)•Front CONTINUED ON BACK PAGE AT INSPECTION y 1fie /gS r q /0(s Q 0 W I.P.M. g.p.m. e IJ/K a u V On adjacent lots /Oo '-A- On adjacent lots Public sewer manhole/cleanout /(J n ' + Petroleum tank N/�4 Coliform CO/aA Nitrate 0.29-A�IZ- Other bacteria GIS Date of sample: /%3195 Collected by: S S ENCIA) FEIL/NG B. SEPTIC/HAL-DIMG TANK DATA Date installed 6 AI 181 Tank size 12. SO Compartments Z. Cleanouts (DN) yts Foundation cleanout N) )/us: Depression (YO ;Ala High water alarm (Y& A) oJ /A Alarm tested (Y® No N.4 Date of pumping (1i[,zs Pumper l`tf 4>w5 SEPARATION DISTANCES FROM SEPTIC/HGLDWG TANK TO: Well(s) on lot (Od 4- On adjacent lots /Dy , -f- Foundation 16 L To property line /0 � Absorption field S�4- Water main/service line /6'.t - Surface water/drainage /Dc -f- cr'� W a Q= L4J 92< 72-026(3/93)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE Well on lot D. ABSORPTION FIELD DATA STATION TO: On adjacent lots Pump off" Level at Cycles tested Surface water 7-0 8(, 1NS'7IYL-6D Date installed r Y JuN:L 1 S� P°1'7- ' Soil rating (GPD/Ft2) o•00 System type PEE? T'ZENGh+ Length 6 A • S- / Width 2.S' Gravel thickness Total depth q Total absorption area � D .5 Cleanout present( N) Yes Depression over field (Ye(_ Date of adequacy test �J/4 6lew sYSrem Results (pass/fail) for Bedrooms Water level in absorption field before test After test Peroxide treatment (past 12 months /t%0 If yes, give da SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /cc) On adjacent lots /(Jd rd- Property line r To building foundation To existing or abandoned system on lot On adjacent lots iD Cutbank S0 i, Water main/service line Surface water /0Q r Driveway, parking/vehicle storage area Curtain drain AJONE KN6 WN E. ENGINEER'S CERTIFICATION l certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Signature Engineer's Name I ` b 1' �'2 7 C - Co ie� ✓ Date a ) / `I S— HAA Fee $ 0,00 F CM Date of Payment — �/�.S Receipt Number (0 5 (Y(y Z/ - 72-026 (3193)' BaCk Waiver Fee $ /a i Sp .1 of this inspection. -? "s ROOERT C. COWAN F 0 - cc - 8801 CL -8801 a •� •r e• FY tl � a•• a a((��a.a _ Date of Payment Receipt Number NC�a ' S 4 [11c 1� Waiver Fee $ /a i Sp .1 of this inspection. -? "s ROOERT C. COWAN F 0 - cc - 8801 CL -8801 a •� •r e• FY tl � a•• a a((��a.a _ Date of Payment Receipt Number Time APPLIC, JT FILLS OUT UPPER HAL Time Time ,",ONLY Property Gwner ,- , ,�� / Date Phone Mailing Address Inspector Zip Code Inspector Buyer Field Notes: f9 Address Zip Code Lending Institution e `� Phone Address (' 1� Zip Code ( ) DISAPPROVED Realty Co. & Agent �.;{ . -. I _ �, c. _; ; `��i, 7. , -... - y r' ; ., >: Wit-{- Phone DATE_ Address Zip Code<.. r Soils Rating _e- Well To Absorption Area c'7J ' I Description Septic Tank Size 12 S L} �2 Street Location Well to Tank et'o Type of Residence Q Single Family ❑ Multiple Family No. of Bedrooms= ❑ Other Water Supply Q individual ��j. "la Lo ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. log if ❑ Community For wells drilled prior to that date, give well depth (attach available). ❑ Public Utility Sewer Disposal .- Q Individual Year Individual Installed: t--I ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date nn \2'c� Inspector Inspector Inspector Insp or Field Notes: f9 MUNICIPALITY OF ANCHORAGE DEPT, OF I-I"t,L Tl i t: ENVIRONMsNTAL PRO -1l e `� RECEIVED. () APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE_ BY: Soils Rating Date Sewer Installed Well To Absorption Area c'7J ' Well Log Received Septic Tank Size 12 S L} �2 `Gg' Well to Tank et'o 72023 (3182( // of)oce-mbor 13, 1983 Sbetw:a Qe, Silk) )eeta t 1 Jaynes Sob. a «oval :or the intiN dual e a tem £acllities nest be granted until the folly it items have WAR, c pletea, ?he septic taaK n, i ea vim a receipt sow itted,t 0 t is d41 t at, .lease notify this depart eat fa< a ins ction whoa 9a mote\ Hioerepaneles have ea cor .tea, If theme ate any further questions. Please call U is office at 264-47-20. Sincerely, Jim Roberts »ssoclate fr:nvironrnontai Specialist JRloo/ /ce CC: Marston Real Estate Atte! Marty 21,E ett can ee£anis 2804 9, JorCmrn tights Anchor o, 99503 Time Time ie �a a Date Date Inspector Inspector Iinspector Comments Conditional Approval y Date Sewer Installed Permit No. Septic Tank Size 1A -:ip 3 ` S' 9^110 81or Holding Tank Size Soils Rating Well To Absorption Area Well Log Received P `i Well to Tank 0 .k- 1, 4 APPLICANT FILLS OUT LOWER HALF ONLY Property Owner F r/%jr ;- Phone Mailing Address C3j FG�-5 Buyer Address Lending Institution � ` Phone,; Address Realty Co. & Agent G? �„ Bi ii .T- n; d :_� j��%;, Phone Addresses Description Le al/ 9` 1 /moi l�C Street Location Typegf Residence DC7 Single Family ❑ Multiple Family No. of Bedrooms ❑ Other Water upply Individual ATTACH WELL LOG. A well log is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log if ❑ Public Utility available. SewagE Disposal ,.�fl Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. PENINSULA ENGINEERING 2820 'C' Street, Suite #3 Anchorage, Alaska 99503 276-4855 December 22, 1981 Graham Young Remax Properties 2702 Gambell, Suite #201 Anchorage, Alaska 99503 RE: Lot 1 Block 1 Jayne's Place Water Sample and Well and Septic Inspection Dear Mr. Young: As per your request, I have inspected the well and septic system installation on the above lot. The lab test results indicate that the well water is acceptable and the well is installed and capped in accordance with Municipal Standards. The septic tank and absorption system appear to be installed per Municipal specifications with all required standpipes above grade and sealed. The well is located in the front yard with the septic tank and absorption system located to the rear of the house. Sincere y, •r'i%�y I 4 Wayn enderson, P.E. WA:Zc—p Attachments: Water test results Rik eel At 9" a�°i9oo ;/6 o o o 4or<'a"�'�°�°O 41 9., 0{y00 gSoo coo 9