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SUMMIT ESTATES BLK 1 LT 6
Summit Block Lot 6 #015-072-24 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page,,/ of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: ¢:~, ~'~ -(0/ O ~ RID Number: 0 / ~ Name: ~~ 0U¢~rtW~,' WastewaterSystem: ~New ~Upgrade Address: ~ ~ ~ ~ ¢ ~ ~ ABSORPTION FIELD Phone: Number of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ther: Total Depth from original grade: BIock:l Lot:~ 5Subdivisi°n:o~¢¢~ ~t Depth to pipe bottom from o~ina~e:~o Ft. ~ravel depth beneath pipe:O~' O Ft. Township: Range: Scction: Fi~l added abeve ordinal 9rede: Gravel Length: Well: ~ New ~ Upg~ Grave, width: ~. O Ft. N~mber of/lines: I Distance~be~een lines:Ft. Classification (Private. A. B. C): ! To~ ~~ Cased to: TotaI absorption area: Pipe Material: Ddller: ~ Date Drilled: Static Water Level: Installer: ~ Date las, lied: ~/ 'Yield: / [ Pump S~t at: ~ Casin~ Height Above ~ .... SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. ~Other: T~o Septic Absorption Lift Holding >ublia/Private Manufa~urer: Gapaaity: Tank Field Station Tank Sewer Line I~ ~ ~ '~ ~ ~ ~, [ ~ O~ aa,. (~ ~ ~ Material: Number of Compa~ments: SudaceWater {¢ ~ [0~% ~ LIFT STATION Lot Line ,[ [,~ [Size;/ ~ O ~ Gal. Manufacturer:.pu&~:~al /~ ~ ~w~t~ :~m~t "Pu~p on" level at: /~ _¢~¢__ Pump Make&Model Electrical lnspe, tions,e~ormed by: Remarks: BENCH MARK ji Location and Description: i[ Assumed Elevation: C ond,t,onal Approval Date: ~ Reviewedandapproved~;~i;:~:'~J¢;:~?.f~}?/~X/~ Date: '5~;¢/"I/ Permit No. OSP 101057 PaDe 2 of 2 Municipolity of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 AnchoraDe, Alaska 99519-6650 Telephone: 54.3-4744 On-Site Wostewoter Disposol System ond/or Well Inspection Report Legal Description: LOT 6, BLK 1 SUMMIT ESTATES S/D PID No.: 015-072-24- GRND. PIPE MARK A B C ELEV. ELEV. C01 18 18 110 96 C02 72 40 94.34 88.2 TC01 8.3 50 92 TC02 87 54 91.86 C03 100 68 89 86 MT1 99 67 89 C04 80 54 88.5 86 /'-EXISTING WELL RADIUS SEPARATION ~ --'~ J ,--EXISTING FIELD ABANDONED ~ __/--LOT LINE WAIVER ~_- ~ -___~ / / f~'~----~-~-ELECTRICAL P~E~L ~ ', ~ ~~AD,ANTEX TANK AND POD / ~BENOH, ASSUME 100 / % / ~ EXISTING WELL ~ / - / - ~UILT / / STEEL ...... O ADVANTE .... ~% N.T.S. ~!% Municipality of Anchorage Anchora.qe, Alaska 99519-6650 · (907) 343-7904 · Fax {907) 343,7997 .h. ttp:/Iwww.muni.or.q/Onsite Development Services Department On-Site Water and Wastewater Proqram **** VARIANCE/WAIVER REVIEW **** WR#: OSP101058 HA#: Permit~: OSP101057 PID#: 015-072-24 Legal Description: Summit Estates, Block 1, Lot 6 Engineer: Mike N. Anderson Applicant: Steve Dumbrowski 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 1.0 foot. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: ...... 4/2/2011 Approved by:,,,~ ~ ~.~ Na~n ' · e of Reviewer Rec#: 132252 Amount: $200.00 Date Paid: 6/3/2010 **** VARIANCE/WAIVER REVIEW **** Permit Number: Tax Code Number: Work Type: On-Site Wastewater Disposal System Permit OSP101057 01507224000 Septic 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 Upgrade Permit Effective Dates: June 04, 2010 to June 04, 2011 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Subdivision: SUMMIT ESTATES Site LegaIAddress: SUMMIT ESTATES BLK 1 LT 6 G:2437 Owner/Address: DOMBROWSKI STEVEN 5541 E 97TH AVE ANCHORAGE AK 995070000 Site Mailing Address: 5541 E 97TH AVE, Anchorage Lot Size In Sq Ft: 13125 Total Bedrooms: 4 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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. Date: ~'/~ Date: (/'P/~/tfC Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 ,l11 e * www.muni.org/onsite ~ (907) 343-7904 , ON-SITE SEWERANELL PERMIT APPLICATION ', *- o.~/¢/~ ¢~' FOR A SINGLE FAMILY DWELLING /A/,% v'~ t , Parcel I.D, Ot~-O~,3'c3c! Property owner(s) Mailing address Site address ~, $ Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) Lot Size ~' Sq. Ft. 13/ t~ 5 Day phone ~ ~' ~' -~h ~, 6 .Zip Code Zip Code ~'~,~ ~3/,~ 1~ Lo4J~ Number of Bedrooms ~ THIS APPLICATION IS FOR ([5;~ all that apply): THIS APPLICATION IS AN: Absorption Field J~ Initial ~ Septic Tank ~' Upgrade ~ Holding Tank [] Renewal [] Priw [] Private Well [] Water Storage [] I certify that the above information is correct. I further certify that this application is being made for a Single Familia. nd is~o~applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: (Re~. 11105) Waiver Fees: ~.t")tO '~' ~'~.Y'~ Date of Payment: Receipt Number:. Michael N. Anderson, P.E. Civil/Structural Engineering & Construction 4661 Natrona Avenue Anchorage, Alaska 99516 Phone 345-3377 Fax 345-1391 June 2, 2010 Municipalities of Anchorage Departments of lleahh and tluman Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 Re: Summit Estates Blk 1, Lot 6 To Whom it may concern: Attached is an application for a replacement septic system permit on the referenced lot. The soils consisted of gray silty sands for the entire 14 foot depth with no water observed after the 7 day monitoring period. The perc rate was 2 minutes per inch at elevation 3 feet in the test hole. The neighboring lot to the north is vacant. The slopes are steep running north to south, starting with a flat driveway at 97'h then sloping down to the north property line, see plan. The proposed system will be an Advantex located at the toe (bottom) of the slope with the trench. From the site plan there is only one location to install a new septic system. Thc site plan is a copy from a recent survey asbuilt done last month, therefore it is accurate. The proposed drain field will be 8 feet maximum depth with 5 feet effective. The original system was a 3 bedroom system. The proposed new system is a 4 bedroom design. The reserve area will be to remove ami replace the proposed 20 foot trench, which should never be required if the system is maintained. The exist!ng 1250 gallon tank wilLbe.puml:~.d, and filled with concrete to avoid damaging the green house located d,rectly above..~ i,~.~..~' x~,~ ?~ This is also my request/fo[ a.~lot wai,,[er on t?~t s~de and a separation waiver between the new and old trenches. Due to the ex~tin~}vell~d the small lot size the separation distance between the existing and new trench cannot b~V'm'6e~e minimum separation of 10 feet or tv, ice the gravel depth. Justification for the waivers is we have no option except a holding tank or the Advantex system. A conventional system will not fit into the remaining area outside the well radius. None of the neighboring lots will be impacted by this new installation. If you have any question please call me at 727-8864. Michael N. Anderson, P.E. DESIGN CRFFE~IA: ~[?x~ ov~ 6~ GPB/~.O - 2~ SF 1.o _ 2~ SF/IO - 20' -3.o- ~ ~K (0 ~CH 8.0' DE~ sP 5.0' E~ -~.o. =.o. I o.I 20' LONO ~4 ~ ~ ~ ~PR~ ~ / BL~K 1 ~ ~OR~ HO~ ~ ~ / ~T 7 ~~ : ~ ~ . , ,, , .. ,,~_' ~2 ',. ~ ,, -EAST 9~n~ ~ ..... - ~ 2 ~ ~ 2 // ~ 2 ~8 L~7 ~ ~ 6 ~// ~3 ~ ~2 _ ~ ~ 2 ~K 2 ~ 2 ~K 2 BL~ 2 ~ 10 ~ 11 ~ 12 ~ 13 ~ 14 ~ -EAST 98TH AVENUE- Sept;c Des;gn Prepared for STEVE DOMBROWSKI SUMMIT ESTATES. BLOCK 1, LOT 6 Anchorage, ~aska ~**.,~ PHONE 545-5577 / FAX:545-1591 SCALE: 1'=100' 3. 'n-lE LLTi' 10' Or Ja.L:T PIPE ~ 11-1E TANK ~ BE $~( OR I~S~. 4. CL[ANOUrS 8~fE~N HOUSE AND TANK PER UPC. *- PROPOSl~ ADVANTEX /--TOE OF 114E SLOI:T., / PRO~I~qY UNE I -EAST g7TH AVENUE- , , Sept;c Oeslgn Prepared for SUMMIT ESTATES, BLOCK 1. LOT 6 . / ~ ... Anchorage, ~aska Michael N. Anderson, P.E. DATE: 6/4~010 a~UlCHAELN. ANDERSON~a 4661 NATRONA AVE. D~WN: D JR PHONE 545-5577 / FAX:545-1591 SCALE: 1'=30' Performed For: Legal Desc~ption: Municipality of Anchorage Development Sen/ices Department Building Safely Division On-Site Water' and Waslewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 v~vw ¢i anchorage ak us (907) 343.7904 Soils Log - Percolation Test S~ope 15- 16- 17- 18- 19- 20- COMMENTS ~ ~ ~ICHA~L N. A~DERSCN e~ ~ To.ship. Range, ~ion: Site Plan WAS GROUND WATER ENCOUNTERED? ~O $ IF YES. AT V~HAT DEPTH? L Reading Dale Gross Time Net Time Depth to Water Net Drop ~/~/,,~ ~'..~,.. /o~,~ ~,' ~-" ~, ,,- ~,'11 PERCOLATION RATE ~ (rn*nu~e,~s~o~) PERC HOLE DIAMETER TEST RUN BETWEEN~FT AND FT PERFORMED IN ACCORDANCE W~TH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~,/~.~r/~) Municipality of Anchorage 'Page J of 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 Permit Number: ~/9.~0~ PID Number: Marne: Wastewater System: [] New [] Upgrade Addcess:,.~.~t.//~__ff7¢~~.j A~&omF~ ~ ~¢rl4 ABSORPTION FIELD Phone: NO of Bedrooms: ~ ¢~_~ ~ : ~ Deep Trench B Shallow Trench B Bed ~Mound ~Other LEGAL D ESC R I PTI O N Sod Rating: Total Depth from original grade: GPD/Sq. Ft. LeE Block: Subdivision: Depth ~o pipe boltom from original grade: Gravel depth beneath pipe Township: I Range: I Section: Fill added above original grade: ! Gravel length: WELL: ~tS T O New O Upgrade Gravelwidth: Number of lines: Distance between lines: Et Ft. Classification (Private, A,8,C): Total Depth: Cased To: total absorption area: Pipe material: Yield:GPM IPump Set at: Ft. ICasing Height Ab°ye Gr°uno:Ft. TANK SEPARATION DISTANCES ~ s~,ti~ a Ho~di.~ U S.T.En Tank F~eld Slation T~nk Sewer Lines ~n ~ T~~ From Sur~c~ LIFT Water ~ Lot Size in gallons: I Manufacturer: Line ~0~ I "Pump on" level at: I "Pump off" level at: High water alarm at: Foundation j ~ I Curtain Pump Make & Model I Electrical Inspections performed by: Drein I Remarks: ~N ~f(~ p~ ~pp~o~,~ BENCH MARK ~ Location and Description: I Assumed Elevation: ENGINEER'S SEAL 2nd Department of He d Human rvices approval/ Reviewed and approved by: ~ Date: __[.~ ~ 72 013 (Rev. 9/91) MOA 25 PERMIT NO: SW930404 PAGE 2'OF 2 PID NO: 01507224 SWING TIES FROM: COR "A" COR "B" TO: C.O. '%" 21' 32' C.O. "D" 23' 38' EXISTING 38' LONG SOIL ABS. TRENCH W. 5' GRAVEL (EXACT ORIENTATION UNK.) WEL NEW 1250 GAL. SEPTIC TANK % ~ ~TBM EXISTING ~J/ 3- BDRM HOUSE ' EAST 97TH AVE ~ PLAN VIEW SCALE: 1" = 30' 1250 GALLON SEPTIC TANK INV CROSS - SECTION NO SCALE LOT 6, BLK. 1, SUMMIT ESTATES' SEPTIC SYSTEM UPGRADE AS-BUILT INSPECTION REPORT FLATTOP TECHNICAL SERvICEs J SCALEiAS-SHOWN 14530 ECHO STREET J DRAWN BY TFM ANCHORAGE, ALASKA 995 I6 OCTOB ER, 1993 PAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930404 DESIGN ENGINEER:FLATTOP TECHNICAL SERVICES OWNER NAME:DOMBROWSKI STEVEN OWNER ADDRESS:5541 E 97TH AVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 9/29/93 EXPIRATION DATE: PARCEL ID:01507224 LEGAL DESCRIPTION: SUMMIT ESTATES BLK 1 LT 6 1 OF 9/29/94 1 LOT SIZE: 13125 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS 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~~'-- RECEIVED BY~.~~~,~ ISSUED BY: HOUSE WELL~ () EXISTING 38' LONG SOIL ABS. TRENCH W. 5' GRAVEL EXISTING 1000 GAL FIBREGLASS SEPTIC TANK TO BE REPLACED WITH NEW 1250 GAL. STEEL SEPTIC TANK EXISTING 3- BDRM HOUSE WELL~X'%.% EAST 97TH AVENUE 20 0 20 40 NOTE: A WAIVER HAS ALREADY BEEN ISSUED ALLOWING THE EXISTING FIBREGLASS SEPTIC TANK TO BE LESS THAN 100 FEET FROM THE PRIVATE WELL ON THIS LOT. PER DISCUSSION WITH J. SMITH AT DHHS, IT IS UNDERSTOOD THAT THE REPLACEMENT 1250 GALLON TANK MAY BE INSTALLED IN THE SAME LOCATION, WITHOUT A NEW WAIVER BEING REQUIRED. FEET HOUSE SYSTEM LOT 6, BLOCK 1, SUMMIT EST. WELL AND SEPTIC SYST~E~M SITE PLAN . ANCHORAGE, ALASKA 99516 I SEPTEMBER, 1993 NOTE: THIS IS NOT A SURVEYED PLAT. ALL LOCATIONS SHOWN ARE APPROXIMATE. OGREA~..:Rw~NCHORAGE AREA Depart ment ;~3E0n~ir~el~ nta, Quality Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM · OCAT,ON LEGAL DESCR PT,ON? / SEPTIC TANK: DISTANCE INSIDE LENGTH A~ NUMBER OF MANUFACTURER~~ MATERI COMPARTMENTS ' INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY/~?~O GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL/~~) NUMBER OF LINES ABSORPTION AREA ~)' DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION //~1~ DISTANCE BETWEEN LINES SQ. FT. LE~NGTH OF EACH LINE / DEPTH OF FILTER Z7 MATERIAL BENEATH TILE TRENCH W,OTHS~,N. TOTAL EEFECT'VE '.,~ / ~./A BOVE TILE -'~ / IN. WELL:~ BUILDING FOUNDATION I CONSTRUCTION ~~ NEAREST NEAREST LOT LINE__ SEWER LINE DEPTH f SEPTIC SEEPAGE TANK , SYSTEM DISTANCE FROM: CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMARKS DISTANCES: INSTALLED BY:~/~~ ' SEWER LINE DEPTH: ~ f PIPE MATERIAL: REMARKS: DIAGRAM OF SYSTFM DATE //~¢'/~-?') AP PROVED/~ -~--~/~ GREATER ANChOrAgE ArEA BOrOUgh/~=~///~//,~ DEPARTMENT OF ENVIRONMENTAL I~UALITY (~ ,O ~ ~...O~/ 3330 "C" STREET ANCHORAGE, ALASKA 99503 ,', SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PER~IT / --~ NAME OF APPLICANT INSTALLATION OF: SEPTIC TANK ~/Og'J{'3 SEEPAGE PIT TYPE AND SIZE OF FACILITY TO BE SERVED ., DRAIN FIELD ~ OTHER FINANCED THROUGH COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT ~BOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINA~L INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. TYPE SEEPAGE AREA ~ / ~J TYPE [ MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT , DRAIN FIELD SEPTIC TANK TO SEEPAGE Pit WALL /~ i SEPTIC TANK , SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. Well TO SEPtiC TaNk ~ DRAIN F~ELD WATER MAIN TO SEPTIC TANK DRAIN FIELD /0t · SEEPAGE PIT ~/4:~_'} ~' ALSO CONSIDER AREA WELLS. _, SEEPAGE PIT ~/~ (~ SEPTIC TANK· ~(~r~ SEEPAGE PIT ~ (2~/~ DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSS]NC GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SO~L. 4 JNCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT F~TTED WITH AIRTIGHT REMOVABLE CAPS. CONFORM TO BOROUGH~_~_ ~~REGULATIONS .... RE DING INSTALLATION. OR I ' I DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE A~EA BOROUGH ORDINANCE NO. 28-6B AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. / /~ Performed Lenat This ~orm Renorts Soils Loq ~Am~ ~eoth Feet Soil Characteristics "One test is worth a thousand opinions" For ~L~Cie~' ~c~(}~ ~ate Performed ~,/9~ Qescrintion: Lot ¢ Block I Subdivision SU~m,I,,~~ ~'~C~X PercOlation Test Was Oround Water Encountered? I~ Yes, At what Depth? N--ti Readin~ Date Gross Time Net Time Depth to H20 Net Dron Percolation Rate Minute Pronosed Inst~llation: Seenaoe Pit ~.~_./ Drain Field De~th of Inlet Deoth ~o Bottom O~f Pit,Or Trench Test Performed By Data Certified ~:~~r~'S~ Well Owner DRILLING, INC. DRILLING LOG []se of We]~ Location (address of: Township, Range, Section, if known; or distance main road Size of casing Depth of Hole r.~. Z.. / feet Cased to ].02.7 feet Static water level ~! ] ft. (:fiKSlg.'.~) (below) land surface. Finish of well (check one) open end ( '.- ); Screen ( ); Perforated ( ). Describe screen or perforation ~I/A Well pumping test at ].2 gallons per (.'.~?~[) of drawdown from static level, (minute) fo~c hours with 100% ft. '1 Date of completion 7 ~ - / t '/ WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ~)c) Exi:~ ting Wall ~) TO TO 102 TO_ _TO TO__ TO- .TO TO_ _TO _TO TO_ TO TO TO. TO. 2 -- STATE IV1-W DRILLING, Inc. ~-J P.O. Box4-1224 · 1310C International Airport Road (907) 274-4611 ANCHORAGE, ALASKA 99509 DRILLING LOG Well Owner Hood Use of Well }'~)~' Location (address of: Township, Range, Section, if known; or distance main road i..oi; 6. Llk 1 Summit "'-' ...... '" ~ Size of tatung Static water level 55 Screen ( ); Describe screen or perforation Well pumping test at 6 gallons per of drawdown from static level ~Date of completiom 18 Oct ~ Depth of Hole _100 feet Casedto 94 feet ft. (~6¥~) (below) land surface. Finish of well (check one) Perforated ( )- (minute) for 1 hours with !00~;5 open end ( WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness :' ); ft. to NWWA Certified Conh'actor 2--STATE EPL,qws • Municipality of Anchorage On-Site Water and Wastewater Program ' (907) 343-7904 �' SA A ETY Certificate of On-Site Systems Approval Parcel I.D.015-072-24 Expiration Date: C - I 1. GENERAL INFORMATION: Complete legal description Summit Estate; Block 1, Lot 6 Location (site address) 5541 E.97'h Avenue*Anchorage,AK Current Property owner(s) Raymond Huot Day phone 907-444-3738 Mailing address Real Estate Agent Hunter Burton Day phone 907-630-4682 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for; Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 6-57) Waiver Fee $ Date of Payment 6-14211q Date of Payment Receipt Number Q4(aa(1CReceipt Number COSA# cSCIQ I/47 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: -<s ! 43 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 .00O000\, industry practices. The reported results describe the condition of the system/s on the date/s of the o ' OF A '°'% evaluation. Separation distances were measured to readily identifiable features. Hidden defects or ,`c .,...••..•.. .4 encroachments may exist that were not identified during the evaluation. The operational life of all wells O . 1.•••, �1n and septic systems depend upon a variety of variables, including but not limited to, soil conditions, D ►c'" • U groundwater levels (that may fluctuate during the year), quality of construction (materials and .`","-1.•• 9 H ....y,v0 workmanship), and the water usage of the family utilizing the system/s. These conditions can vary,and /Q•� '.... •• •• 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 ' .. .....0 the well or septic system. GEG makes no representation whether an alternative well or septic system 0 ...Jet.: . A. Gam e-s:' d can be installed on the property in the event either of the current systems fail to perform adequately in Uh 9� �95' e• _.�61 the future. The content of this report is for the sole benefit of the person/party that retained GEG to U s • `, • .�c 0 perform the evaluation. Reliance upon the information provided in this report by any other person or �G/ems • ... tG/ �0,••<Z7 o party (including subsequent property purchasers) is not authorized, nor will it confer any legal right %t\ 'f:'Pro(essionA\o whatsoever. � 000QQ�� 3FH)=E.lJ&64 6. DSD SIGNATURE ,oll(1t(Ilaf(� X. System #1 Approved for (( bedrooms �`��.��( OF Mic ' '04 1��. System #2 Approved for bedrooms V0 yo -S‘S Disapproved ON W AGER PN°R o Conditional approval for bedrooms, with the f iowln i iE 'n &z. co ))»/ s „,-N ti1 II _ By. 1 "`'� -(s Original Certificate Date: —Y'_(7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: Summit Estates; Block 1, Lot 6 Parcel ID: 015-072-24 If more than 1 septic system on lot: COSA Checklist# of Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Well production at time of test 4+ gpm Date drilled 7/1/77 Water storage tank volume N/A gallons Total depth 102 ft Well disinfected for coliform test? ❑Yes 0 No Cased to 102.7 ft 0 Coliform bacteria is Negative :1 Sanitary seal is functioning correctly Nitrate 4.92 mg/L ❑ Nitrate less than MRL (ND) X Wires are properly protected Arsenic ug/L X Arsenic less than MRL (ND) Casing height(above ground) 12+ in. Collected by G.'EG� Date of flow test for COSA 4/22/19 Date of Sample °228291'9 Static water level at beginning of test 79.1 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) 8!14/10 years ❑Q Required maintenance completed Tank type/material STEEL Age of lift station 9 years El Standpipes/foundation cleanout per record drawing Lift station material STEEL Date of pumping SEE MAINTENANCE REPORT Comments: Advantex System D. ABSORPTION FIELD DATA Which system tested (date installed) 8/14/10 Adequacy test date 4/22/19 4 ALL standpipes present per record drawing Results E Pass For 4 bedrooms Total measured depth from grade *7.8 ft(max) Fluid depth prior to test DRY in Measured depth to pipe invert from grade 2.25 ft(min) Water added 625 gal ❑ N/A— pressurized field New depth 1 in ❑ Monitor tubes go to bottom of drainfield. If not, state Ela sed time 25 min depth into effective 5.75 p CICode-requiredsoil cover over field Final fluid depth DRY in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A Any rejuvenation treatment(past 12 months) N/A N/A gallons If yes, enter date Comments/Deficiencies: AT MT COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' ❑Yes if No *50+ ft ❑✓ Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' EYes if No ft Absorption Field on Lot> 100' ElYes if No *50+ ft Holding Tank> 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment> 50' D Yes if No ft Q Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ❑,/ Yes if No ft EYes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' Ell Yes if No ft Surface Water> 100' EYes if No *50+ ft Property Line > 5' ✓❑Yes if No ft Driveway/Parking > 0' QYes if No, comment Absorption Field > 5' QYes if No ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' ❑Yes if No *50+ ft Water Service Line> 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ❑✓ Yes if No ft Driveway/Parking > 0' E Yes if No, comment Property Line > 10' ❑ Yes if No **1+ ft Wells on Adjacent Lots: Water Main > 10' 0Yes if No ft Private Wells > 100' EIYes if No *50+ ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑,/ Yes if No ft Surface Water> 100' ElYes if No *50+ ft F. ENGINEER'S COMMENTS *THIS IS AN ADVANTEX **WR#OSP101058 oQo600. \° G. ENGINEER'S CERTIFICATION OF ql'\4'N Qo,,` 4 I certify that I have determined through field inspections and review ' � •.i O ��?..• 4• :ll:: • 3 v of Municipal records that the above systems are in conformance with �� � is.. !�. * oD MOA COSA guidelines in effect on this date. �' Q 1 0 .•.J= f : Gar,ess. VOQ�1�fe,P •••�h .I.i'''c�,c,00 COSA Checklist yellow sheet V���ro f e s s�oo� #AECC884 �000� YYf i 4' S89.56'55"W 125.88' " (S89.59'00"W 125.00' R) x x—x- 10' UTILITY EASEMENT • SEPTIC VENTS (M') MH LOT 6 O O ' ADVANTEXO SLK POD otri O JO GREEN 2'x38' CANT HOUSE o W DECK 38.0' 71.9' `° OO – of W 0 tn O p0 O O 5.0' -o • d' N m O O 0 EXISTING -Io O 0 4 HOUSE 'z b O. Cl) " E z o 11.5' 5.5' DECK r AC `_ D/W ® Y O -o WELL 3 N d • WELL® U 0 0 0_ 26.0' 1 T N890 _+2,5,6:02:5,ffti,,,F\ - RETAINING WALL O 00 EAST 97TH AVENUE .NCHORAGE RECORDING DISTRICT,ALASKA OO =FND 5/8"REBAR SBUILT OF: 0 =FND REBAR W/YPC UMMIT ESTATES OT 6 BLK 1 PLAT P-628 AgtoO F``v\\ p,IAD SUR JRVEY CERTIFICATE:I,John L.Schuller,Have conducted a i iysical survey of this property as shown on this drawing and that the j `. •''''''''A Lq ,1 ptiAl' LAND 5,�� nprovements situated hereon arc within the property lines and no /���`•• 1_ s '� 'Ct.? �f -ichroachments exist other than noted.Under no circumstance should ' �j.• 49TH .1,-- \ �, '''74,o �r� ty information on this drawing be used for construction of fences, , * ' . * 4 1. uctures,improvements,or for establishing boundary lines. / GTI t-4 / C / o r CCLUSION NOTES:It is the owners responsibility to determine Cf1 !`' existence of any casements,covenants,or restrictions which ) ci1N L. SCHULLER. ��� •,,, not appear on the recorded subdivision plat. s IS-10408 2K ORDER NUMBER: OAIE SCALE C-r a 1831 Talkeetna Street JUNE 16. 2010 1"=20' ww•nQOokn•t 1 A 4'J ' ��� (`a i Anchorage, Alaska 99508 0—O1 7 DRAM BY:CHEMED en GRID Mamru 800x/DACE `�Arofessionot ��/ (907) 227-1455 office JLS 2437 1 001 41 �\N��`�+ (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and e4q/a- tered into as of this /1- Day of Mai of 20 /q , by and between .4 $Nt',I herein the "OWNER,"and the Municipality of _ • rev. � Anchorage,herein the "MUNIC 'ALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein,the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System(AWWTS), described as Aettu,t4eK located at(legal description) wi 4- es 4. Q. 554-1 C g1th A VJn(A-e , PACi).0{raqe , A K 1 O1 2. Maintenance,Repairs and Alterations. (J (Owner is required to read, understand and initial each section) r Throughout the term of this Agreement, the Owner shall enter into a service agreement_. 1(A) with an AWWTS service and maintenance provider approved by the Municipality or thel% manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. AD It shall be the responsibility of the Owner during the term of this Agreement to pay for all 6) repair(s), maintenance, adjustment(s), replacement costs,and inspection costs. This includes an annual maintenance fee (typically $400 to $600). MOOwner agrees that only maintenance and repair personnel approved by the Municipality , /C"-) or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. pt Owner acknowledges that regular maintenance of an AWWTS reduces the potential f0(4 failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 POwner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. T Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be r assessed m accordance with AMC 14.60.030. i?),,_ Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. !f A Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. 1 fig Owner agrees that the AWWTS installation and maintenance requirements as provided tPby the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system,or upon transfer of title,and shall continue.:=` while the AWWTS is operational or until title is transferred. „ 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this:' '. _ Agreement shall in no way constitute a waiver of the provisions,nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be' brought in the Superior Court for the Third Judicial District of the State of Alaska at ?. Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the y " parties under this Agreement. • 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent`' • jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 - - 1. 4 i ` O / / :Off /g---1114-) By. P. /i t A C (signature) Date: 2 ,,11.4,1,.;,... 20/? awli L '1 (print name) • STATE OF ALASKA ) :a., ) ss. THIRD JUDICIAL DISTRICT ) IA The foregoing instrument wa.1 ac owledged before me this 1St day of M‘, ° 20/1, by Aiti' < )i VJi t5 .�1 ,... er 0 Notary Public ..- NOT: •Y PUBLIC FORA KA I DYLAN C. CHAMBERLIN StatMy Commission expires: Il 1$IN--?-- °!Alaska My Commission Expinu Nov.18,2022 61111PIPRIPIIPIP1118011144111011”1”rismill-- • MUNICIPALITY: By: _ (signature) Date: (print name) Title: i i 1 (rev. 05/18/2018) Page 3 of.: 05/01/2019 11:25 Anchorage Tank (FAX)9072773715 P.0011001 04/09/2019 15:54 8686770 4PLUS PAGE es 04109/2019 1027 Anctiarage Tank Tim 277 3715 F.O011001 348 179 �4 0 No ■I I I I■ ■ ■l l U >II■■ SIX 11111111111 as I �l�� ti� - ■ II. 1111 II . 1111 1 lAIlrII RIP ■U 111 INImilml 1 ()\ ? ,u\Pt, �' °� ;: :::.:.n.,Es q° Field !• Antenance Rem AnchorageTank Annual Inspection 907-27213543 p,o,.nyowtwmm*1ml 9 Opaque Larry Bolus sll.naareor 5341 E.97th Ave,Anchorage AK 99518 (907)555456°.5 Ax spm m n lo os''V o Pod a PTV ANL N Duro a 1 Lasl l/v.vw, AX-124481 ` 410057 RT1.1120542 09/12/2018 Retrieve claM Info Measure Sludge/Scum nok 1a„ - sludos Spin 11,t Compvun6nt Ovtre � �1 I Prev'Out. Ganem Prrilov>t Raclrn r*tk+ 4 4 Timm,etttr.gv: 2nd Oomportment CUrrert Pro Curont Drevlo9I 1 Home to for sal! Thia is a COSA inspection inepoctUCtaan Adva^Tex Fitter boot clam Odor. /Normtd UPunpsnt l,attlr6larortrtcee 1/4 VJ b^' Perform Fieldm Field sapllrsyw. QBsat;ons Dams!! /Norms/ L CroowPod rom ,iry eo' Ae/y rfTU(1 b a NTUi) pH{6^9) no R.e1 tartdglns/Pondlnp, �Nono.tklor L bcoeaelve In1ek0 volt �,/ N 39 , ( 7 _ fnspao tOloef Dlaohargs Pwn %/ p stem clam 1 Inspool ' Odor 01 bampte RIsedud 0 Mom 0 0 "Noloal Z Musty Barth, ❑Mo`dr 504 sax Cl Puna r.i 0 Non.typ'ou/sugu, 0cabh.go 0 136r7oattaros L� otty mm In PVC' ❑Yea 2No Foran In tank Li Yes LIN* Inspeot/Servioo Other System Coruponbrtts Imp t Goan Ms p rNA Clean Check Control Penal tYndrefoonun Equlcnn6nt DI,prr,ad 1.441e..6/0rlM e+y.? dri — Roc1m Amps Discharge Ants Obborvotlont U 5•V1 f s,,,lbe-7 11 4dttloneJ 8orvives Rendered y�f ❑Cleennd textllo shoots? I_Replocad W co Ram Audlbloandvkualularm6 , CK 7Rept000dAissdOwItami? No torts(taisrnstry aYy) LTO; ii6No Parlor Used:W=Werrs ty,13-13BIsMo(f seen:pries s4loollonl Ineet+ct/aleen Pump btystem v1 B Item Number Do•drigtion hspoot CI6{n Runm.ldi`71 [ 1 Spike Buz 7 noel Corrie F ' MoAM, Final/Safety Ina ee11on Ron!) 'yl RSV tahfot:duda DORSO an 8lotubs'Feta.,. 4 fiManitold moor/tooted; rw ooted;Nth 171v.6 dod oenvoI prin.!mallvie Del gbtubs Puri 2Vsutt • (�{ J $ummaryntae mmendationra acatroutPMng Shcttor VdwX ....,.. [ 0 EyOkm poriarming;no 1.irmer sa'k'e!nNdW L Tcfk load,pumping /// 0Cn!lrora� ior Gommerrts — Q_ 4. +f' wA r liri A yc 1 Mgrut to pats,_ 9_______ Fax completed form to 1-86e-4G4.7404 Development Services Department · Building Safety Division On-Site Water and Wastewater Program ~,i~ll~ 4700 Elmore Street ~ ~ P.O. Box 196650 ..'~i.l~ ~t ~ Anchorage, AK 99519-6650 www. muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. (~('~'-O~?--~- Zq GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Day phone ,-~ (.,, Mailing address Lending agency Day phone Mailing address Real Estate Agent. Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMs: TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class ~ Public Water System Well TYPE OF WASTEWATER DISPOSAL: F~ 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 out!,~ed in the Certificate of On-Site Systems Approval Guidelines for this;application, shows that the on-s te war.er 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, lhe. 6n-site water~.,~ supply ~'nd/or ~as'tewater d sposal system is(are) in compliance with all applicable Municipal and State cedesi~ ordinances., and regulations in effect at the time of installation. bedrooms. DSD SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: $"'//~[/// (Rev. 11/05) Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type Date completed Total depth / If A, B, or C provide PWSID # / Well Log (Y/N) Y Sanitary seal (Y/N) ~" Wires properly protected (Y/N) ~ Cased to [c)~-~. Casing height (above ground) ~ in. Bm FROM WELL LOG Date of test /~//~ ~ Static water level /,Y'~ ft. Well production ~ ~ g.p.m. WATER SAMPLE RESULTS: Coliform '~_~ .colonies/lO0 mL Nitrate ~t¢~mg/L Arsenic: ._~_ ug/L d ate of sam pie: 'z~'Z~//// SEPTIC/HOLDING TANK DATA Tank Type/Material ~--~ J,-~c ( Tank size t ~oC~ gal. Number of Compartments __ Foundation cleanout (Y/N) '~' Date of pumping ~ Depression over tank (Y/N) A_( pumper ~ AT INSPECTION ft. g.p.m. Collected by: /'~ Date installed Cleanouts (Y/N) "7/ High water alarm (Y/N) Co ABSORPTION FIELD DATA Date installed %//~/~ - ~'/W' Soil rating (g.p.d./ft2 or ft2/bdrm) ~,('2 System type /~ ~b,~ ~'~'~ ! , ! Length 'Z D ft. Width ~, E) ft. Gravel below pipe Total depth ft. Eft. absorption area Z0o ft2 Monitoring tube "(' Depression over field Date of adequacy test ~ Results (Pass/Fail) ~ Fluid depth in absorption field before test ~ in. Water added ,,,'~al. Elapsed Time: ~"~min. Final fluid depth~'/ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) fro For/-(' bedrooms New depth,,,--~ in. ~ g.p.d. ~ If yes, give date 0 Z fi-),,../ WELL S89°56'55"W (S89'59'00"W 125.88' 125.00' R) 10' UTILITY EASEMENT LOT 6 BLK I WELL / 11.5' DECK VENTS (TYP) MH ADVANTEX POD X X 2'x38' CANT 38.0' LLJ LEI= "-- CD EXISTING '-' ' House o© Z Z AC O/W 26.0' 5.5' RETAINING WALL EAST 97TH AVENUE ~,NCHORAGE RECORDING DISTRICT, ALASKA ASBUILT OF: SUMMIT ESTATES LOT 6 BLK 1 PLAT P-628 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction offences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is thc owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: IDAIE: SCALE kndeng~k, net JUNE 16, 2010 J 1"=20' FRAt~I BYJO'IEC~ED 8,]GRID NUM~: 1 0--01 7 JLS 2437 100141 (~) = FND 5/8" REBAR 0 = FND REBAR W/YPC 10-13-00 08:51 FROB-CTE ENVI RON~IENTAL ~l~t~ CT&E Environmental Services Inc. 5610301 T-307 P.03/06 F-337 1006284002 TobbenSpurklandP,E. N/A Lt6 Bk 1Surnmit Estate Drinking Water Client PO# Pre-Paid Colis/NO3 CT&E Ref.# Printed Date/Time 10/12/2000 17:24 Client Name Callectetl Date/Time 10/09/2000 14:50 Project Name/# Received Date/Time 10/09/2000 16:48 Client Sample ID Technical Director,-,.,.,, Stephen C. Ede Matrix ~ ~ Ordered By Released t PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results PQL Units Method Limits Date Date Init Nila'ate-N 3.42 0.500 mg/L EPA 300.0 10max 10/09/00 SCL MUN,C,PA'ITYO, ANO.O"A E 2¢ DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL ~(~- O~'-~- I OF ON-S TE SEWER AND WATER FACILITY 264-4?44 Application Date February 18, 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 6; Block 1; Summit Estates Location (address or directions) East 97th Property Owner Alaska Housinq Telephone: Home Business Mailing Address (b) (c) (d) Lending Institution Mailing Address Telephone Real Estate Company and Agent 2001 REALTY/Ricky Doran Address 1345 West 9th Avenue, Anchorage, Alaska Telephone 276-2001 99501 (e) Mailthe HAAtothefollowinoaddress:or;Checkhere [],ifholdforpickup. Listcontactpersonand day phone numberbelow. S & S ENGINEERING/694-2979 17034 Eagle. River Loop Road, Suite 204 Eagle River, Alaska 99577 ordered by Ricky Doran TYPE OF RESIDENCE Single~Family ~ Number of Bedrooms 3 WATER SUPPLY Individual Well ~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. Page 1 of 2 72 025 fRay 81861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As cer[ified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone Address $ & S ENGINEERING Date 17034 Eagle RLver Loop Read DHHS APPROVAL Approved for _~ Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DH HS does th is as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page '2 of 2 72-025 IRev 8/86) Back ~,?, 5~..~: HEALTH AUTHORITY APPROVAL (HAA) ~+' -%~ 264-4744 qq~% Legal Description: ~ WELL DATA Well OlassJfication ~ ~k NJ ~ ~ b~, It A, B, G, D.E.G. Approved (Y/N) Well Log Present ~) y Date Com?ete~, ~ ~ ~' ~ - ~ ~ Yield Total Depth ~ ~/ Cased to ~ ~ Depth of Grouting Static Water Level ~ r Pump Set At Casing Height Above Ground [ ~ Sanitary Seal on Casing ~N) Electrical Wiring in ConduitS) ~ Depression Around Wellhead (Y~ Separation Distances from Well: ~ / To Septic/~ Tank on Lot ~ ~ ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line ~/~ To Nearest Public Sewer Clea~ouVManhole ~/~ To Nearest Sewer Service Line on Lot Water Sample Collected by ~ ~~ ~' ; Date Comments ~ ~ ~ ~/~ ~ ~ ~ B. SEPTIC/I~OL-DtNG TANK DATA No. of Compartments ,%/ Foundation Cleanout (Y/~ Date Last Pumped ~ ~ ~ ~ ~ ~------------------~ ~/,¢~ ; for Temporary Holding Tank Permit (Y/N) / To Building Foundation I ~ To D spo~a, :Fiel~ i : · ~ ' To Strb~i POnid: Lake or Major Drainage Date Installed \ _czP~ \<5-"3'~ Size Standpipes~/N) '~' Air-tight Caps (~N) Depression over Tank (Y~)) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) //'~ Separation Distances from S~l~t, ic/HoPJing Tank: To Water-Supply Well ~ "7 "~ I To Property Line .,~.~/I To Water Main/Service Line \ Page 1 of 2 72-026 (Rev 8/861 Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /"~--~--~ Date Installed \ C:> -- \'"~ Width of Field Square Feet of Absorption Area Depression over Field (Y/~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well Type of System Design Length of Field "'~¢~2) Depth of Field Gravel Bed Thickness Standpipes Present ~)N) Date of Last Adequacy Test To Building Foundation / Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments '¢ t.¢O .¢,..~ ~ To Property Line \ ,~/ To Existing or Abandoned System on ; On Adjoining Lots '~C;~ To Cutbank (if present) D. LIFT STATION Dimensions Manhole/Access (Y/N) "Pump On" Level at _ _~"-"-'~"~"~--~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for Pu~ing Adequacy Test. Electrical Codes (Y/N) Comments Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~.~,~4Gii.~EE~iNG--- Date Company ~11e, River, Alaska Receipt No. / ¢ ~ / 0 0 ~ / Date of Payment %~¢~/ Amount: $ / Page 2 of 2 72-026 fray 8/861 Back CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ANALYSIS REPORT BY ~AMPLE for Work Order # 5188 Date Report Printed: FEB 15 88 ~ 14:1{) Client Sample ID:LT 6 BLK 1 SUMMIT ~SID :UA Collected FEB 12 88 ~ 15:55 hrs. Received FEB 12 88 ~ 16:45 hrs. Preserved with :ICE Client Name: S & 8 ENGINEERING Client Acct: SNSENGP P.O.# NONE REC'D Deq # Ordered BF : R. 5CHAEPER Analysis Completed :FEB 15 88 Laboratory Supervisor :~TEPflEN C. EDE Released Dy 5end Reports to: 1)8 & 5 ENGINEERING 2) Special Instruct: Chemlab Ref #: 9099 Lab S~pl ID: T Matrix: Water Allowable Parameter Tested Result/Units Method Limits NITRATE-N 1.8 m~/I EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: COLLECTED BY J,P.M. I Tests Performed * See Special Instructions Above UA--Unavailable ND= None Detected ** gee 5an~Ple Remarks Above NA= Not Analyzed LT=Less Than, Gl'--Greater Than Tom Fink, Mayor uni ipality of Ancl Ora e Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 March 2, 1988 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop, Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 6 Block 1 Summit Estates Waiver Number WR88-009 Dear Mr. Shafer: Your request for waiver of the required 100 foot separation distance between a residential well and septic tank/absorption trench has been approved. This approval waives the required separation distance to 77 feet and 85 feet respectively. At this time there is not a problem with the low nitrate level in the well water. Other well samples taken in the surrounding area have the same nitrate level. Upon a field investigation by myself, I noted that the ground elevation difference between the well and the septic tank/absorption trench makes the well substantially higher than the septic system. As a result, if the septic system fails, any septage that may surface would flow away from the well. This waiver approval applies to the existing well to septic tank/absorption trench separation only. Any future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Daniel J. Roth Civil Engineer On-Site Services cc: Gus Andress, P.E., Manager On-Site Services/Water Quality Programs HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL iNSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT A. SHAFER February 19, 1988 CIVIL ENGINEER 694-2979 Municipality of Anchorage Department of Health and Human Services 825 L Street Anchorage, Alaska 99501 MUNICIPALIIY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL pROTECTIO~ FF_B 1 9 RECEIVED REFERENCE: Lot 6; Block 1; Summit Estates Request you issue the attached Health Authority Approval and grant a waiver for the horizontal separatiOn distances between the private Well and the septic tank and the leaChfield located on the referenCed property, ~a distance of 77 feet and 85 feet respectively. On February 6, 1988 the septic tank was uncovered. It was observed that the 4" cast iron sewer line leading from the house to the septic tank had settled near the tank. This line was repaired. Also observed was a cleanout on the septic tank which was sheared at the base causing a blocked entrance into the septic tank. This cleanout was repaired and extended above ground. Water tight couplings were placed on the inlet, outlet and cleanout serving the septic tank. The integrity j of the septic tank was verified. Also at this time the unused well located near the driveway was abandoned below grade. A risk analysis has been performed and it appears that no form of contamination of the well frOm this source is possible. Attached for your review are the following documents: A. Coliform and nitrate analysis of water taken from the well located on the referenced property. B. A plot plan showing relative distances between on-site wastewater disposal systems and wells. C. A profile of the site between the well and septic system. D. Risk analysis waiver worksheet. E. Well logs for the well serving the referenced property. F. A soils log done on the referenced property. 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 page two Lot 6; Block ii Summit Estates It is our opinion that the horizontal separation distances prescribed by 18AAC72.021 are not required in this case. If you r~ ~e additional information pleas? contact Roger/694-2979. %. SHAFERt P.E. 'L~ SCALE SCALE J ~ SCALE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES WAIVER REVIEW WORKSHEET DATE RECEIVED: ENGINEER: S & S ENGINEERING 17034 E~gl~ Ri~er LOOp Road NO. 204 Eagle River, Alaska 99577 CRITERIA: 1) Geology: Points: 2) 3) A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Specia% Conditions: WAIVER IS: granted, with conditions listed below: not granted for reasons listed below: DATE: BY: NAME _ ~ > DANTE RECEIVED ' INSPECTION APPOINTMENTS TIME TIME TI M I __~J.~.~~,~ ' DATE DATE AT CN~RONMENIAb ~U~CmAU~V OF A~CUORA~E 825 L Street Anchorage, Alaska 99501 ( RECEIVED Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts or~ page 1. Incomplete reques~ will not be processed. Please allow ten (10) days for processing. 1, PR ERTY OWNER ~ PHONE~ MAILING ADDRESS PROPERTY RESIDENT Jif different from above) PHONE I -- PHONE [2. BUYER MAILING ADDRESS 3, LENDING INSTITUTION ] PHONE I MAILING ADDRESS 4, ~ALTOR/AGENT MAILING ~DDR~SS 5. LEGAL DESCRIPTION SINGLE FAMILY NUMBER OF~BEDROOMS [] One ~' Four [] Other [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six 7. WATER SUPPLY ~ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled [] COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTILITY depth (attach log if available.) 8, SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY NOTE THE iNSPECTION FEE IV~IST ACCOMPANY EACH REQUEST BEFORE PROCESSIN N~BE INITIATED. -- ~ c~J_~-~'~~-~'~ ~ ^~ .._ ALASKA eFIUlROnmenTAL COIqTROL SeRUlCeS, IFIL ~nclJneer'incj 8 ~nuironmental Studies MUNICIPALITY OF ANCHORAGE DEPT. OF i L[;~ & ENVIROi'd4ENiAL i:,,C i ~C'i'ION A~J{~ 2~ ? 1980 RECEIVED 1220 LU~,sl 251Jl Auenue * J~ncJ~orag¢, Alaska e9503 * (907) 276-1361 ~~~_f.__E n_v_ i r ~o~n _me_ ~ _t a 1 Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 ....)\~ ~c~c~ ~ ~%/ a,'~)~0~~REU Date Received ,,- \/-F~ Time of Inspection ~',~-,,~,~]~ Date of Inspection ~-- Q EST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR Approval requested by: Mailing Address: 2. Property Owner: ~K~ (qc~t~F~ ,~-T~ Phone: Mailing Address: Legal Description: ~ {o Location: ~ ~ ~ Phone: ,5. Type of facility to be inspected J~,,w~ror~,~,,. No. of bedrooms ~no~ '6. Well Data: ~ A. Type I ,~),~l~,~,~. B. Depth C. Construction ~Ad~FJ~m-~C~~ D. Bacterial Analysis Sewage Dispose! System: ~]]~ ~L~..~ A. Installed \~c~ . B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank Nearest lot line , Absorption area , Other contamination , Sewer Lines B, Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ-034 (1/74) Page t of two pages _.Page 2 of two pages - Re.st for Appwoval bf ~ndividual .r :.r & Water Facilities ~[egal Description ~(~ Comments Approved Date Greater Anchorage Area Borough, Department of Environmental Quality ApprJval~alid for one year from date signed DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and ccurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 - 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO ~A~"¢¢~--~//' FHA CONY __ 2. Property Owner: /~-2~9 F~ J (~ F)/~-.% /~' Mailing Address: Day Phone Mailing Address: , ~--~-~ ~¢'-~)Day Phone 040, 5~/~)-~._~ 4. Name of Lending Institutien: Mailing Address: Name of Realtor or Agent: Mailing Address: Phone Phone 6. Legal Description: Location: 7. Type of Facility to be inspected: 8. Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served No. Bdrms. Individual ~ If Individual, depth of well Sewage Disposal System Type of System: If Individual, date of installation Public Utility Individual (on-site) EQ-037 (1/74)