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SPANISH HILLS LT 4
Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Aloskd 99519-6650 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW990265 PID Number: 017--151--04 Name:SAM MARCUM Wastewater System: [] New · Upgrade Address: 13341 CARITA ANCH. AK, 99516 *ABSORPTION FIELD Ph°ne:(907) 659--0408/659--7741 No. of eadrooms: 4 [] Deep Trench [] Shallow Trench · Bed [] Mound · Other LEGAL DESCRIPTION 2,0 0PD/S.. F~ *'7,0 rt. 4 - SPANISH HILLS 4.4 (MAX) ~ 0,6 FI, -- -- -- 0 -- 1.5 ~ rt, Ft. 450 Sa. rt. ASTM D-3034/F-810 rt. A+ HOME SERVICES 99 - 9/14/99 SEPARATION DISTANCES [] Septic [] Holding 'I S.T,E.".* · rom Tank Reid StoUon Tank S,w,r U,,, ANCHORAGE TANK 1500 Well 100'+ 100'+ 100'+ 25'+ STEEL 2 s.~oo~ ~oo'+ 1OD'+ ~00'+ - LIFT STATION W~ter LineL°t 1500, ANCHORAGE TANK/ORENCO PRODUCTS Foundation 5'+ 10% 5'+ -- - -- TIMER A(~TIVATED -~ 46" Dr(lin I I Remarks: * THIS IS AN INNOVATIVE RECIRCULATING BENCH MARK SEPTIC TANK (WITH A TRICKLE FILTER) AND UPFLOW FILTER CONCRETE SLAB OF GARAGE FLOOR SYSTEM (REACTEX SYSTEM). · * 2 FEET OF M,O.A. APPROVED SAND FILTER ADDED. 100,00 inspections performed by:. AWWC, INC. Dates: 1st. 9/lo/99 2nd 9/14/99 · Department of Health and Human Services approval '~E.~.'*..? · Reviewed and approved by: ~,/./~ ~,/ /~/, ,~. Date: c~-.2, ~-~]~/ PERMIT NuMBeR: 01 7-- 1 51 --0~ sw99o26 AS-BUILT DRAWING PAROE''D .U 6ER: -- INSULATION ~ UNDER DRIVEWAY ~ TH#2 mi/ FLOW DIVERTER (FB)--~ ~ . E~STINe ~ I . /o6~Y / ~ BEDROOM HOUSE TO REMAIN IN P~CE ~' NEW 1500 GALLON ~ / -[~__~_ 20.0_ - REClRCU~ SEPTIC / ~E 2~3 ~7.5 - C04 - 38,1 30,8 ~ C05 - 42,9 33,7 ~ .................................... MT1 - 33,4 30,8 MT2 - 41.6 33,5 6901 DEBARR ROAD, SUITE 2B, ANOHO~GE, AK, 9950, ~ PI4ONE= (907) 5~7-6179/F~= (907) ~8-~48 , SPANISH HILLS SUBDIVISION; LOT 4 {..-.[; .... AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ...... ~REP~EO FOR: PHONE NUMBER: SAM MARCUM (907) 569-0408/659-7741~' ''']''c~-~953 ,.," )AT[~9/27/99 9~WN BY: SCALE: PAGE: q~%~ ~ ......... K.D.W. 1 = 30' 2 OF 5 PERMIT NUMBER: PARCEL ID NUMBER: sw99o265 AS-BUILT DRAWING fOP ~.fANK m RN& ~ - ~I,6 (AVQ,) Af I~f ~,~ / ~'"' ~'~ ~'~ ~"~*d~ ~ ILelF"~7''~ INI.~T E . $~ .~~ OU[ET / u~w FROM ~CIE~A~ ~ . ~ 7,2" ~ P~NROCK~~ ~ =.:-i.~.,.:=)',.~L...~:~;~k.::::?'.L~s~?~:t:.&:~.~i::...~~ '.~?,?~"~t.?:~.;,~:,:[ ~,~p '1 P~?OM ~~ ~-~'~" '~ "~"~'~' ~.-'c~:':-'-' ~ ~;'~-~ ...:: ~ ~ASKA WATER & WAS~WA'~R CONS~T~S, ~C. 6901 DEBARR ROAD, SUITE 2B. ANCHO~GE, AK, 99504 ~HONE: (~07) ~Z-~JT~/~: (~0~) ~a-~ SPANISH HII. LS SUBDIVISION; LOT 4 . ~PE OF WORK: PROFILE AS-BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ' . .... :...~ SAM MARCUM (907) 569-0408/659-7741 ." K.D.W. N.T.S. ~ OF ~ MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 995'19-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 10, 1999 Expiration Date: Aug 09, 2000 Permit Number: SW990265 Legal Description: SPANISH HILLS LT 4 Design Engineer: 0041 AK Water & Wastewater Consulta Owner Name: Sam Marcum Owner Address: 13341 CARITA LANE ANCHORAGE , AK 99516-3713 Parcel ID: 017-151-04 Site Address: 013341 BUENA VISTA DR Lot Size: 49508 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepticTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AA072 ) and Drinking Water Regulations ( 18AACS0 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. ~[Io~ing special provisions. ~-~¢;eactex -~his permit is for a Reactex Wastewater Treatment System. '~tf~this~syS~tem is installed during the MOA testing period, a sampling contract must be obtained and samples taken according to the direction of the department. Alaska Water & Wastewater Consultants, Inc, 6901 DeBarr Road, Suite 2B ~ Anchorage, AK ~ 99504 (907) 337-6179 ~ Fax (907) 338-3246 Consulting Enginee~ s July 7, 1999 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Sewer Upgrade for Spanish Hills Subdivision, Lot 4 To whom it may concern: The existing 4 bedroom house is served by a private septic system and a private well. The existing drainfield was tested in March of 1999 and passed for 4 bedrooms. A site inspection performed 2 months later by the MOA found the septic system to be surcharged and in need of replacement before a Heath Authority Approval can be issued. Three test holes were performed on the reference property and the soils are summarized as follows. 1. SOILS: Test hole #1 was excavated on June 16, 1999 to a depth of 16 feet and no groundwater was encountered. The soil was primarily a ML material to a depth of 8 feet, where the soil transitioned to a GM material for the remaining depth of the test hole. Three perk tests were performed in test hole #1 and all three were found to be impermeable (see attached soil logs for percolation data). Test holes #2 and #3 were perfo~Tned on June 25, 1999 and again no groundwater was found. The soil below the organics in test hole #3 was similar to what was encountered in test hole #1 to a depth of 10.5 feet and the soil was also found to be impermeable. Upon the initial inspectiou of test hole #2, it looked to be the same as what was encountered in test holes #1 and #3. But when the perk tests were performed, they were found to perk at a rate of 14.1 min./inch at a depth of 3.5 feet and 40 min./in, at a depth of 8 feet. 2. TRENCH DESIGN: It is our opinion that clue to the limited area available, a Reactex system is the best option for the septic system upgrade. Based upon a visual assessment of the soils in test hole #2, a 1.5 gallon per day/ft2 application rate will be used. a. Percolation Rate: 40 minutes/inch b. Allowable Application Rate: 2.0 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Ama: 300 ft2 f. Total depth: 7 feet g. Effective Depth: 6 inches h. Reduction Factor = N/A i. Width: 15 feet j. Length: 30 feet k. Effective absorption ama = 450 ft2 (300 ft2+) 3. SURI ACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: The area where the proposed septic system is to go is virtually level. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179, or 244-9612. Thank you for your assistance. Sincereg ~ E., M.S. LOT 2, BLOCK 1 SEQUOIA ESTATES LOT 3, BLOCK 1 SEQUOIA ESTATES / LOT 9, BLOCK 1 SEQUOIA ESTATES LOT 2 f ~" SPANISH H~ / ~LOT 3 SPANISH H~LL S/D SEPTIC SYSTEM ~EE DESIGN, PAGE 2 OF 5) / LOT 4 ~'~ j SPANISH H~LL S/D '~- -- ~ LOT 5 SPANISH HILL S/D ALASI~ WATER AND WASTEWATER CONSULTANTS, INC. 8901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 337-61?g/FAX: (907) 338-3246 · -'OAL OESCRIPTION: SPANISH HILLS SUBDIVISION; LOT 4 ~'PE OF WORK: SITE PLAN PHONE NUMBER: (907) 659-0408/659-7741 SCALE:I ---- 100' PAOE: 1 OF 5 PREPARED FOR: SAM blARCUk4 DATE: 7/6/99 LOT 1 PALA'FERRA LOT 2 PALATERRA / / TH,#3 TH~I N~I,' ~~LC~ .... :...:.: ._.,:.-~ ~ ~ ~.=: ~ .~7:::-:::;:'~:-'~-~/:: --~ TO REMAIN IN P~CE ~ X X N ~ ~ Z GABON ~ ~ (SEE D~NL, PAGE 40I. 5) / - / < / / ~ ~) THE LINE UNDERN~TH THE DRIV.AY SHALL BE SCHEDULE PTIC ARFA~ ~~o Pvc w~m ." OF ~NSU~T~ON 4' W~gE W~m NO L~SS ~AN A[,AS~ ~AI~ AND ~AST[~A~ CO~S~,~ANTS, INC. DESIGN OF SEPTIC SYSTEB UPGRADE ~, ~.:...., ~ ;~e~ A.~ess.' PRE~AR~DsAM FOR:MARCUM PHONE(907)NUUBER:659_0408/659_7741 UO~.~.qh*~[ "'. C --7953 .'"'" DAT~:7/6/99 D~WN B*: JSOAL~: IPAGE: ' ~ OX A.C.G. 1 = ~0' 2 Of 5 FERNCO COUPLING ~ FLOW FROM FLOW FROM 4-" PV TRICKLE RLIER BACK -- , REClRCULATINO PUMP C~! TO SEPTIC TANK NLET I~~TO TRI.=CKUNO FILTER HOSE ~ INLET = OUTLET VARIES ! A R FLOW FROM r~ ~TR SITE :~AWt. SPACE TO -- H- CONFIGURATION% ~~TRICKLJNO F1LTER FERNCO TR~CKIJNG F1LTER > 4, x8' 4" PVC 6 PVC BACK TO HOUSE. i~k TANK SIZE PER GALLON TANKS FOR § BEDROOM ;~ ~[!~¥~.?:~;..:, ~ ORENCO 6901 DEBARR ROAD SUITE 2B, ANCHORAGE, AK, 99§04 PHONE~ (907) 337-6179/FAX: (907) 338-3246~,, ~,.-.,,v.,, PREPARED FOR: PHONE NUMBER: SAM MARCUM (907) 659-0408/659-7741 ~,!". L ..' .,~ - 68 INCHES DIAMETER C~ FROM S,T,E.P. TANK-~ I~ ~ w/~EC ~ ~COAL TAR PITCH & OF ~x8 BOARD ~~~ ~ COLLEC~ON PiPE ~ ~ ~ ~, ~(. ',?~:~5: ~; ~?~?~}~ ~}~ ~::~?~?~;:~:?~?~ ~ OUTLET ~ Dmsmmau~oN LINE. ~:~;:~;; .;~?~, (AS~G BLOCK PEA) ~; ;~'~::';'{;~;~ INLET SPANISH HILLS SUBDIVISION, LOT 4 _ ,.~.;'....~ PLAN AND PROFILE OF UPFLOW FILTER .. le PREPARED FOR: PHONE NUMBER: sA~ ~ARcu~ (~07) s5~-o40~/~ss-77~ '~d~'",.~. .'"~ J.L.M./a.c.G. N.T.S. 4 Of 5 -~~ o M~ ~ ' Mf o CO o Mf CO CO Mf o P~OFOSCP P~P '50' LON6 PY If' WI~ -/ PY 7' ~F', APP 2' ~ M,OA, APF'ROVCP 9ANP PIL.?¢~ MA'iCRI/~ ,ANt7 I' ~ O..~AN, WAbH~P .q~'vV~ IgJ~A]JqJ~OCK(6H ~LOWIN~IeO. Mf CO CO PINV~ 6~AP~ 0 MI' 6" OP PI~NNROCK B~N~A1TI PlSfRIPlJflON UIN~ 2' ~ ~ANP ?ROPIL VieW ALASKA. WATER AND WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B. ANCHORAGE, AK. 99504 PHONE: (907) 357-6179/FAX: (907) 338-324-6 .EGAL DESCRIPTION: SPANISH HILLS SUBDIVISION, LOT 4 PfPE OF WORK: DETAIL OF PROPOSED BED =REPAREO FOR: SAM MARCUM ~ATE:7/6/99 JD~WN BY:A.C.G. PHONE NUMBER: (907) 659-0408/659-7741 N.T.S, 5 OF 5 JSCALE: PAGE: ALASKA WATER & WASTEWATER CONSULTANTS~ INC. 6901 OEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504 PHONE (907) 337-6179 * FAX (907) 338-3246 [SOIL LOG - PERCOLATION TEST] LEGAL DESCRIPTION: PERFORMED FOR: DATE PERFORMED: SPANISH HILLS, LOT 4 SAM MARCUM 6/16/99 _ ORGANICS ML LOAMY & SIL~ ML VERY FINE SILT - MOIST AT TOP, NO GRAVEL, SOME SIDEWALL SMEARING I TEST HOLE PAGE 1 OF SOIL CLASSIFICATIONS ORG CL OL OH SC GM WFfH SOME SAND, ANGULAR ROCKS DEPTH TO DATE ;ROUNDWATER DRY 6/16/99 DRY 6/25/99 DATE READING CLOCK TIME 6/18/99 PERC, BOL WAS PRESO\KED 4+ HOI~RS PRIOR TO I'E!;TING NET TIME WATER LEVEl_ NET DROP (MINUTES READING (INCHES) PERCOLATION RATE TEST RUN BETWEEN 1.5 COHMENTS: PERCOLATION DATA ON THIS PAGE FOR UPPEI~BI~NC~ / ~,~ PERFORMED BY ALASKA WATER & WASTEWATER I, WAS PERFORMeD/IN ACCORDANCE WITH ALL THIS CATE. DATE: '?/71~ II 120+ (MIN,/INCH) PERC. HOLE DIA. _ FT. AND F-F. 6 (INCHES) '~/~;~' , CERTIFY THA1 N'II"CIP'~,~ICfBELINES IN EFFECT ON THIS ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504 PHONE (907) 337-6179 * FAX (907) 338-3246 [SOIL LOG - PERCOLA'¥10N TEST] LEGAL DESCRIPTION: PERFORMED FOR: DATE PERFORMED: SPANISH HILLS, LOT 4 SAM MARCUM 6/16/99 I TEST HOLE #1 I PAGE 2 OF 5 SOIL CLASSIFICATIONS OR HL CL OL MH CH OH SC DEPTH TO DATE GROUNDWATER SEE PAGE OF 5 SEE PAGE 1 OF 5 DATE READING CLOCK NET TIME WATER LEVEL. NET DROP TIME (MINUTES) READING (INCHES) COMMENTS: PERCOLATION RATE TEST RUN BETWEEN PERCOLATION DATA ON THIS PAGE FOR MIDI 110 (MIN./INCH) ERC. HOLE DIA. 3.0 FT. AND FT. )NLY. 6 (INCHES) PERFORMED BY ALASKA WATER & WASTEWATER THIS WAS PERFOR?E~ IN ACCORDANCE WITH ALL DATE. DATE: ~7/1 , CERTIFY THA-r DELINES IN EFFECT ON THIS ALASKA WATER & WASTEWATER CONSULTANTS, INC. ~ ©..F. A ~ ~ 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK, 99504 ..... [SOIL LOG - PERCOLATION TEST] LEGAL DESCRIPTION: SPANISH HILLS, LOT 4 l'£-:y !', ~'~'~' PERFORMED FOR: SAM MARCUM ~;~r~:..~'":'"'~ A ~d~'~e~ A. uarnes~,. A DATE PERFORMED: 6/16/99 ¢0~("4 /,:E-7955 ...' g~ 1~ PAOE 5 OF ~ '~%%~%~ SOIL C~SSIFICATIONS 2-- ~ '- sw UIIIIU NH 5-- "-*'~'~- sH~-~ OH SEE PAGE 1 OF 5 6-- ~ SC 7-- DEPTH TO DATE ~ GROUNDWATER 0 8-- SEE PAGE 1 OF ~ 10-- ~ -- ~ CLOCK NET TIHE WATER LEVEL NET DROP 11-- ~ DATE READING ~ TIHE (HINUTES) READING (INCHES) 12-- 6/1~/99 PERC. HOL WAS PRESC ,KED &+ HO' RS PRIOR TO TE~;TING 15-- 1 5',15 6" 17-- 19-- PERCOLATION RATE 120+ (HIN./INCH) ~ERC. HOLE DIA. ~_(INCHES) ./ COMMENTS: PERCO~TION DATA ON THIS PAGE FOR L.O~N~PE~3LE 'NLY. / / //// ~/ PERFORMED BY A~SKA WATER · WASTEWATER I, J , CERTI~ THAT T.,S WA. ~..~O.~... *CCO.~*.O~ W,.~ *.. s.*~.~.,O,~*. ~.,~,_,..S ,....~CT O....S DEPTH TO DATE GROUNDWATER SEE PAGE 1 OF 3 ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 20 * ANCHORAGE. Al<. 99504 PHONE (907) 337-6179 * F,~X (907) 338-3246 I SOIb LOG - PERCOLATION TEST] LEGAL DESCRIPTION: PERFORMED FOR: DATE PERFORMED: SPANISH HILLS, LOT 4 SAM MARCUM 6/25/99 FILL LOAM/ ORGANICS ML SMEARED SIDEWALLS ITEST HOLE PAGE 1 OF 2 SOIL CLASSIFICATIONS ORG ML CL OL HH CH OH SC ML W/ MORE GRIT DEPTH TO BATE GROUNDWATER DRY 6/25/99 DRY 7/2/99 6/18/99 PERC. HOI CLOCK NET TIME WATER LEVEL NET DROP TIHE (MINUTES READING (INCHES) 4+ HO~ RS PRIOR TO WAS PRESO 1 3:53 6" 2 4:23 3O 3 13/16" 2 3/16" ,.3 4:25 6" 4 4:55 30 3 7/8" 2 1/8" 5 4:56 6" 6 5:26 30 3 7/8" 2 1/8" PERCOLATION RATE 14.1 (MIN./INCH) --RC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3.~5 FTc. AND~. __FT. COMME, NTS: PERCOLATION DATA ON THIS PACE FOR UPPER/~ENCH//R?f qLY. PERFORMED BY A~SKA WATER ~ WASTEWATER I, %~P[ / k ~-- , CERTI~ THAT THIS WAS PERFORMeD/IN ACCORDANCE WITH ALL STATE CD/~ClPA~IDELINES IN EFFECT ON THIS // ALASKA WATER & WASTEWATER CONSULTANTS~ INC. 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504 PHONE (907) 337-6179 * FAX (907) 338-3246 I SOIL LOG -- PERCOLATION TESTJ LEGAL DESCRIPTION: SPANISH HILLS, LOT 4 PERFORMED FOR: SAM NiARCUM DATE PERFORMED: 6/25/99 I=s- HOLE #2I PAGE 2 OF 2 SOIL CI_ASSIFICATIONS ORG CL 41 L OL E~_~ OH SEE SC DEPTH TO DATE GROUNDWATER SEE PAGE 1 OF 2 PAGE 1 OF 2 DATE READINGI CLOCK I NET TIME I WATER LEVEL I NET DROP 1 3:55 6" 2 4:25 30 5 3/8" 5/8" 5 4:27 6" 4 4:57 30 5 1/4" 3/4" 5 4:58 6" 6 5:28 30 5 1/4" 3/4" PERCOLATION RATE 40 .(MIN./INCH) z/ ~ERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 8.0 F/AND.~ ~FT. COMMENTS: PERCOLATION DATA ON THIS PAGE FOR LOW;E/~Clc~ ~' ~7~E)~BC/yOLE~)LE ONLY. PERFORMED BY AlaSKA WATER & WASTEWATER I, ~N_~__~,,~ ~///~k.¢~. ~- , CERTIFY THAT THIS WAS PERFORM[ED/IN ACCORDANCE WITH ALL STATE ~/~1~ ~ NIOIPAL'~GUIDELINES IN EFFECT ON THIS DATE. DATE: '[["//?? / t' ALASKA WATER & WASTEWATER CONSULTANTS, INC..~.A~ ,.....,...::..t c~ ~o..©F' .'0']r}~h 6901 DEBARR ROAD, SUITE 26 * ANCHORAOE, AK. 99504 LEGAL DESCRIPTION:~SPANISH HILLS, LOT 4 ] I ~l,~..~ .... DATE PERFORMED: ~/25/09 u0~g:"g :E-V953 ..' ~OAU/ l T~Sr ~OCE ~3 ~ '~g:~7"t ............ ';~ DEPTH ~ ~.::~¢~ ORGANICS 2 ML SOIL C~SSIFICATIONS [~ITE PLAN] / k~/,'::~:~::;, GW ~ ORG 'L I": IO~LJ SM~RED & TIGHT ~&~E sc DEPTH TO DATE z GROUNDWATEE ~ OF EXISTINO SEPTIO DRY 7/2/90 LESS 7 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIHE (HINUTES) READING (INCHES) 6/18/99 PERC. HOL~ WAS PRESO ~KED 4+ HO[ RS PRIOR TO TE~TING 1 ~'.51 ~ 6" 120+ ~ (INCHES) PERCOLATION RATE (HIN./INCH) PERC. HOLE DIA. TEST RUN BETWEEN 2.0 FT. AND~ 2.5 FT. COMMENTS: THIS WAS PERFORMeD/IN ACCORDANCE WITH ALL STA~~ NICIPAL GUIDELINES IN EFFECT ON THIS ~A~. ~A~: ~/~/~ [ / ~ DEPTH TO DATE GROUNDWATE~ DRY 6/25/99 DRY 7/2/99 ~ROPERTY OWNER AGREEMENT FOR THE MAINTENANCE OF AN ON-SITE WASTEWATER DISPOSAL SYSTEM Thiz agreement, dated ~f//~ 199__~,, is made between the Municipality of Anchorage Department of Health and Hnmen Services (DHHS) and ~he propmw ow (s)of: This agreement is made for the purpose of maintaining an on-site wastewater disposal system on the subject property. The pro~rty owners agree to ~e following: Submit to the Municipality of Anchorage, on an mmual basis, au inspection and operation statement fi:om a registered professional engineer. This inspection and . operation statement slmll verify that the engineer.has inspected all effluent and air pumps, timers, a~d alarms, and that any deficiencies have been repaired and that the system is functioning as designed. (Si~ature) (Pfin~ Name) (Printed Name) ............................. Notarize Here ...................................... ......... d~FFbVT//t~f~//.~ //J~'~-(~Z,~///7 personally appeared befor(me, ,,~$~'?'~{//~ who iS pereonally known tO me ~... ,--..,...~ whose identity I proved on the basis of~~ ~ /~O I~ .~ whose identity I provdd on the bath/affi~ion of ~ ~ . ~ ~ ~ ., a credible witness of the above document, and he/she acknowledged that he/she signed ...... , -- ~ No~a~ Public ', ~y co~nission expires ~/~/~ Rick Mystrom, Mayor MmficipaHty of Anchorage eatm and Human c., Deloar rnen' of ' ' ' 825 'L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Dear ttomeowner/Prospective Buyer: The on-site wastewater disposal systern you are purchasing/installing is an "alternative" wastewater disposal system. This system, known as a "Recirculating/Upflow Filter Septic System", is undergoing testing within the Municipali .ty of Anchorage under the Alternative System section of the Wastewater Disposal Regulations (AMC 15.65). There are certain risks involved with the ownership of one of these systems: 1. The teclmology used in this system has been shown to be effective in other areas. 'The system is currently undergoing a two year testing period in Anchorage under the guidance of the Department of Health and Human Services (DITHS) and the State of Alaska Depm'tment of Environmental Conservation (ADEC) to determine its effectiveness in a subarctic environment. 2. The system for this proper¢' received a vertical separation distance waiver from both State of Alaska and Anchorage Municipal Codes ro ~'ound water. This waiver was granted due to the system's expected performance xvithin the site conditions on this property. I (we) certify that I (~ve) have read the above statements and am (are) aware of the risks outlined. I (we) also ceftin' that I (we) am (are) m the, process of purchasin¢ (property legal description/: (Purchaser Name)__ (Purchaser SignatUre) -- (Pugchaser Name) ............... Notarize Itere ................................................................ On this ___~ day of /~2~4~,'~'-L/- , /qF~fl ~ ~ [~/~rsonalZy appeared before me, who is personally knoxm to me , _ ~ whose ~den¢Sry I proved on the basSs of whose 5dentSty I proved on ~he oa~h/affSrmat~on of , a credible wSrness ro be the sSgner of the above document, and he/she acknowiedged that he/she s~gned ~... '..., ~ ~ ~ S -r~=. ~ ~ ~Notary Public My commission expires MUNICIPAI,ITY OF ANCHOR:,q (, V ...., ,_ , , . , SAFETY DIVISION 3500 EAST TUI~)R R~)..kl3. \ \; i I( I IN~PEE770NS: Voice t'90~ 563-3464 ~ ~ (90 3 .,' ~ ,-~': ? ~E: DUAl. L~, )'.1 ~ECT ~D~Ss., 13341 BUI' NA V~TA DR LO~' 4 BI.OCK: ,~L BDII .. ~PR OF ~ Wffire-ex~mfineatncx~ ~: .?e,:fiom ~ I)onot,,,..t.:,..; (' . · \t':')R If-IT'/ON: (907) 343.4211 PI:RM/T~IMBER: 99-9016 DA ~: 9/28/99 5:3~ PM .~ ~ PIIO~ ~2: -: ,:~ '.' ~.~ approved R~inspection? IlV~PECTOR: ...... WHI!N (.( RRIJCTIO. ); /IRE .4.: II3r i.'/ , I.'~'F ... DO NO?'RZ WD: i'. ,'t' . " ~ , il; l .X ~;PE(.'IION ~977 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF FIEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT . I [] UPGRADE ' e] Absorption area "' PERMIT NO. . ~, Manufacturer ~ Materla~. No. of compart,,e,,ts ~ ~ Liq. capacity in gallon~ Inside length Width Liquid depth [ ~,~O IF ROME~ADE: O ~ ~ Manufacturer Material Liquid capacity in gallons ~ Foundation Nearest Iotline/l~ [ -' PERMIT~O. N0, 0f lines Length 0f each llne T0tal le.gtt~ 0f lines Trench w~dth Distance between lines ~/~ ~ Top of til~ to finish grade I Material beneath tile / Total effective absorption area 7 ._. Length Width D0pth PERMIT NO. < ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest Ici line ~ DISTANCE TO: ~ Class Depth Driller Distance to lot linc PERMIT ~ Buildln9 foundation Sewer line Septic tank Ahsorption area(si ~ DISTANCE TO: QTHER APPROVED DATE LEGAL 72-013 (Rev. 3/78) ~'I-W DRILLING~ Inc. P.O. Box4-1224 · 1310C International Airport Road (907) 274-46] ] ANCHORAGE, ALASKA 99509 DRILl,lNG LOG Well Owner__ Wright Cons truction Use of Well Domes tic Location (address of: Township, Range, Section, if known; or distance main roack Lot 4 Spanish Hills Size of casing. 6" .Depth of Hole Static water level 99 ft. (~Yt]~ Screen ( ); Perforated ( Describe screen or perforation Well pumping test at_5 gallons per of drawdown from static level. 12/1/8o Date of completion 126 ~eet Cased to 125.8 feet (below) land surface. Finish of well (check one) open end ( xx ). N/A (minute) for 1 J~ours with 100% WI:LL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 .TO 2 Casing_s tickup 2 .TO O~Bnic s 3 .TO. ll TO 49 TO. 63 TO 78 TO. 84 TO 86 TO 103 _TO 121 TO TO TOw TO ); 3 11 49 63 78 84 86 103 121 125 Silty Sandy gravel Silty hard pan Silty claY SiIty hard pan Damp hard pan Silty hard pan Silty hard pan Sandy water ~rav.e] 1 -- CUSTOMER DEPFIRTt"IENT O~' HEFIL. TH FiND ENVIRONMENTFIL ~"'~'OTECTION 825 '"1. STREET., RNCHORRGE., FIK. I-'-I E b. L, f~'l I'-~ PERMIT NO. ( 800596 ) FtF'PL I CRN'r DICK WRI GFIT LOCFtT I ON CRRI TFI LRNE LEGRL I~0r~¢4 :.~',R~NI~H HI:i2b~ ; TVPE OF' SOIL RBSORPTION SYSTEf'I IS: NUMBER OF BEDROOMS = 4. 264-4720 SF..'.Ft BOX 25gl TRENCH SOIL RFITING (SQ FT/BR)= LOT SIZE 50000 SQI_IFIRE FEET 250 THE RE:)IIIRI'""D ::,I,:.E OF THE ...,Lilt_ HE,_,uRF1 ION :,,=TE:rl IS: THE LENGTH DIFIENSION IS TNE LE:NGTH <IN FEET) OF THE TRENCN OR QRRINF'IELD. THE DEPTH OF FI TRENCH OR PIT IS THE DISTRNCE BETWEEN THE SIJRFFICE OF THE GROUND RN[:, THE BOTTOM OF THE EXCRVRTION <IN FEET:). THERE IS ND SET WIDTH FOR TRENCHES. TFIE GRFIVEL. DEPTH IS THE MINIMUM DEPTH OF GRRVEL BETWEEN THE OUTFFIL. L PIPE RND THE BOTTOM OF THE E',,,',CRVRTION (IN FEET.'.',. PERMIT RPPLICRNT HRS ]'HE RESPONSIBILITY TO INFORM THI~ DEF'RRTHENT DURING THE INSTRLLRTION INSPECTIONS OF flNV WELLS R[:,JRCENT TO TFIIS PROPERT'¢ FIND THE NUMBER OF RESIDENCES THRT THE 1.4ELL WILL SERVE. ql- !..1,3 ,:-" 2 ::, .17 N"_---~;F"tE,2':I'" ;f. 0 !'-.! ~i; I:::tF.:E REG-:!L~ :~. F:EIZ:, BRCKFILLZNG OF' RN'¢ S'¢S'fEM WITHOUT FINRL INSPE(.'.'TION RND RPPROVRL B'¢ THIS DEPRRTMENT WILl_ BE SUBJECT TO F'ROSECUTION. HINIMUM DISTANCE BETWEEN R WELL RND RNV ON-SITE SENRGE DISF'OSRL S*r'STEM IS :t,00 FEET FOR R PRIVRTE b. IELI_ OR 150 TO 200 FEE]" FR. OM R PUBLIC WELL DEPENDING UPON TFIE TVPE OF PUBLIC NELL.. HINIMUM DISTRNCE FROM R PRIVRTE WELL TO Ft PRIVRTE SEWER LINE IS 25 FEET RNb TO n COMNUNITV SEI.4ER LINE I':; 75 FEET. WEI..L LOGS lIRE RE.F...~UIRED RND MUST BE RETURNED TO TNE DEPRRTMENT WITHIN 3.'0 DFIYS OF THE HELl_ COMPLETION. OTFIER REQLIIREHENTS MRV RPPL'¢. SPECIFICRTIONS RND CONSTRUCTION DIRGRRNS FIRE' Ft","RIt_RBLE TO INSURE PROPER INSTFtL. LRTION. F"EI¢;~:~"I ][ T E;-::P X F~E_-"Z:; E:~.,EIZ:EEI"-IE,:E:F.: 2=:::1L.. I CERTIF~¢ 'THRT '&: I BM FRMILIFIR WITH THE REQUIREMENTS FOR ON-SITE SEWERS aND WELLS RS SE]' FORTH 8~' THE MUNICIPRLITY OF RNCNORRGE. 2: I WILL INSTRLL THE SYSTEM IN RCCORDRNCE I.,.IITH THE CODES. ~:: I UNDERSTRND TFIRT THE OIq-~ITE SEWER SS'STEH MR'¢ REQUIRE ENLRRGEMENT IF ]"HE RESI[:,ENCE IS REMODELED TO INCLUDE MORE THRN 4 BEDROONS. S I GNEB~ .................................................... FIF'F'L I CFINT [:,I CK WRIGNT ~ LOT · ;: ....... :T 't ,.I L-:i .'-:'- '-;' ", t f-J~.:-,.l--{.-L.- I ~'!'. Cll'.~'.:.}; t::fJC~...'.E,:' ~;-:l!{f_,)l_.l May 11, 1978 ~77274 Dick Wright Star Route ADox 1585A Anchorage, Alaska 99507 Subject: ~ er~ni%, Expiration A pe_mlt ~ssuad by this departraent for well and/or on-site 8ewer installation on Lot. 4 ~!pan~ish Hills Subdivision has expired since the issue date exceeds one(l) year. In the event you still plan to install the well and/or on- site sewer system~ a new permit is required. The eriginal soil t~.st may be used to obtain a current permit. If the well has been drilled, a well lo~3 should be sent to this d~partment to document the installation date. ~f you have any questions regarding ~hs above matter~ please contact this offic~ imr~%ediately at 264-4720. Sincerely, Les N. Buchholz~ Senior Environmental opeclalist F:IEFH'I :[ T F:IF'F'I. )i CFINT I .OCI:;JT E ON I..E]]iFII. L,:I. '.E!;F'FrN :1: S H IJ]TI' E. ]i Z!Z 'i'"r'l::'lE [)l:= 'i~i(]l :[ L_ I:::II.;iIL;EiOI:i'.i:?IT ]: L-.II',,! E;'-r'E;'TEM ]; f!;: TI;d~:I",!CH I'IF'IX'~[HLJI"f I",IUI"'IE:EEI:;~'. ELF:' FE:EDF;'.EIOHf; ..... :t. THE; f;;:lS~(i:!lJi[t;il~l) Ei)]ZIE (ill::' 'I'HI!~'~ SOIl... I::II:EuE;CII:,U:::'"I ]l:Efl',,I ']:~;¥:::;TE:]"I THE I.iEI",IGTH I::;,II'IE:i'.,I'.:E;:I:(:II'.,i I:E; THE: L.,E:M(iFFH ,::i:t',! I::'E,E 'I'I~IE: THIE DI!i:F:'TI'I CIl::' f::l 'I"Fi'.I~]",ICHOI;~'. F:':I;'I" '1;~::; THE: I'):I;'.E;Tf:II",ICEi; 14 SI. It:;41:::FI[)I=: O1::: E~iI:E'.(]II. 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IE;H:D TI" I.E]",I(!iTI4 :[~iii; El',-;'. (:;I F'EET. ' }1 ti,,4t C]:~ ,.:] ;;;]t ~.,. :E li",4I E:I':Ii]I(I-: Z [ ,L, :[ I:'.1[i JIF H :!: I",1:1: I"II.]H I):t: f~;'l-I=lt',ll:]l!:~ r:iflETHE(E]'., Hlii:l .I.. FIIq[;, I:::IN'T' OI",I--S ;1: 'I'E E;E:I.'IFICili'( :l,i:!llZ. I I':Eli:'l' t':'Ol:;i'. I=1 I='I'?.]:VFITI~ OR ;:~'.EiEl F'Oli', FI I::'l. Jt31.. :[ I]: I.'ilEI.I.. l,ll'i:l_.l I..EIGE; I::II:;;'.E I:;:'.l~(;!l..l:t:l;i'.li}:l'i;' iI..IE;T Erie 'T'() TI'lIE I)I~:i:I;:'FII;ifI'HE~I",I"I'' H)'TI"I:!:i",I OF 'i'l'-Ili~: I.,.IL:]..I.. '; F '1:- ...I. 1: ' : J. .... ': I 1 .. I',I~..' I::11",1[;' C[:II",I?T'F;~:I.IC:I' ]: L."~i'hl~ ]: FII:iRFII'I:E; l::ll~i~:l~ I=l'v'l:=l/_' I..I::II31..IE T ~'~ I N'.51..II:,~:E: ..... 1:. - f I:1 ;1: NSTFtl .I ..1=1-1' T O1",1. ]; E:l'~l:;i'.'f'):F:'"¢ THI=IT :!.: ): Rid F:I=II'tiIi[..ZI:;:IR H i['I",L'I 'THE: I:i',I'!:(i:E..I;I:F.".EPIEI',ITF¢ F"E)R OI",I-S:['FE: SEI.qlEIR:E; Ftt",ID NEI..I '-"~; fi'.ii; SET I;:;'OFi'.TH E:"r' 'I'HFE I"II. JI",I:[C);F'I:rtl.];T"r' ElF: FiI",IE:HEII:~'.I::I(:iI~(. ;E:: i I.'.IZ[..I. ;[1",1'.¥'1'1::11..I-.. THI'Z :!:.;'-r'STI:::]'4 ZI",I I::IE::(';:EtI:;;:[)FII",t(]I~: 1.'.1);'i'1'~ THE :~:: ]; UI'41:>Er4STFtI",I[:' THFIT 'f'HIE I:~ll"4-SZ'l't:.; '-'~;IEI.'.IEF:~ S'¢S'I'IE]'t l'll:':l"r' F~:Ii:;6!IJ;[I:.~:E EI",!I..I~t;i'.GI(-;HEI"~'t' ]:F I;;:l'E:i::;Z[:qEl",l(i::,ri~ :['E; F::~!~ID[:,I':;I...Ii]) T(3 );IqCI.L.II],!E I"1[)1:;i:1ii': 'I'HI::IN 4 ..,:,:: F ~.. :~,::::~:~..rr''.. ''--._=~::~, ,. ~, ~, ~.,/~- 1::,~ j~,::,-rr ~ -, .... .'<'~'-- / / -") 9 MUNICIPALITY OF ANCHORAGE Development Services Department ',." �j Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 017-151-04 1. GENERAL INFORMATION Complete legal description SPANISH HILLS LT 4 Expiration Date: i ` T— Zd Z Location (site address) 13341 CARITA LN, ANCH AK Current property owner(s) GRACE DOBSON-COTTRELL Mailing address SAME Real estate agent 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: Private Well [] Water Storage ❑ Community Well ❑ Public Water System ❑ Waiver request for: Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Private Septic [I Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $--660 COX10 Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number COSA # 05C Z0 /5Y!3 Waiver # Distance: 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm MIKE N ANDERSON, P.E. Phone 727-8864 Address 4661 NATRONA AVE ANCH AK Engineer's Printed Name 6. DSD SIGNATURE MIKE N ANDERSON, P.E. Date 10-5-20 System #1 Approved for 4 �.... ...6.A. ....... bedrooms�...... ............ } r I �; • NilC AEL N. ANDERSON System #2 Approved for bedrooms 1.�,•., CE- 44'9 ,•�. ,, Disapproved l Fj l PRO f SSiu ` Conditional approval for bedrooms, with the following stipulaal��tl�iti� B Original Certificate Date: 02_1� 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. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other 2=L -,q V— Legal Description: SPANISH HILLS LT 4 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 12/1/80 Total depth 126 ft Cased to 125.8 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 24 in. Date of flow test for COSA 1012/20 Static water level at beginning of test 101 ft Comments B. TANK DATA Age of tank(s) 21 years Tank type/material Measured operating fluid level in septic tank ** ❑ Standpipes/foundation cleanout per record drawing Date of pumping SEPT 25 D. ABSORPTION FIELD DATA REACTEX SYSTEM W/2 FIELDS Which system tested (date installed) 9/10199 ❑ ALL standpipes present per record drawing Total measured depth from grade 4.6 ft (max) Measured depth to pipe invert from grade 4.1 ft (min) ❑ N/A —pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 017-151-04 Structure served by this system Well production at time of test 1.1 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes OR No ❑ Coliform bacteria is Negative Nitrate 0.243 mg/L ❑ Nitrate less than MRL (ND) Arsenic I ug/L ❑ Arsenic less than MRL (ND) Collected by M$/MNA Date of Sample 8/19/20 C. LIFT STATION ❑ Required maintenance completed Age of lift station 21 years Lift station material STEEL Comments: * steel septic tank (STEP) PRE-SET FLOAT LEVEL FOR REACTEX Adequacy test date 10/2/20 Results C]✓ Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 606+ gal New depth 1 in Elapsed time 1440 min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced 0 gallons If yes, enter date Comments/Deficiencies: VALVE WAS SWITCHED TO 1980 TRENCH. ALL OF THE PIPES IN BOTH SYSTEM HYDRO JETTED 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' 0 Yes Community Sewer Manhole/Cleanout > 100' ✓Q Yes if No ft ED Yes if No ft Neighboring Tank > 100' 21 Yes if No ft Private Sewer/Septic Line > 25'✓[] Yes if No ft Absorption Field on Lot > 100' Fj Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' 0 Yes if No ft Water Main > 10' Animal Containment > 50' Yes if No ft 7 Yes if No ft ❑✓ Yes if No ft Water Service Line > 10' Q Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' ✓(� Yes if No ft n Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: M Absorption Field > 5' if No Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' Q 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' I1 Yes if No ft If absorption field is under driveway comment below Property Line > 10' M Yes if No ft Wells on Adjacent Lots: Water Main > 10' M Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' n✓ Yes if No ft Surface Water > 100'✓Q Yes if No ft F. ENGINEER'S COMMENTS REACTEX SYSTEM WITH 2 FIELDS (1999 & 1980) 1999 BED TESTED ALL OF THE MT'S AND CO'S WERE REPLACED DUE TO DAMAGE. THE UPFLOW SAND FILTER (24") WAS REPLACED. NEW PUMPS AND FLOATS INSTALLED. G. ENGINEER'S CERTIFICATION 4 b_� Za �e. certify that I have determined through field inspections and review 4-i�l?`. • ' • ' ,`�' ^ ° �. of Municipal records that the above systems are in conformance with ,� •-' MOA COSA guidelines in effect on this date.. ; . •` .....• 14 •• MICHAEL N. AADLRSCN ¢��! rFA . • CE t 7 474 , CASA Checklist yellow sheet l p .'w MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this ?�-') Day of of 20 20 , by and between �JkV1,6' , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", 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 located at (legal description) 2. Maintenance, Repairs and Alterations. (O er is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory c ndition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, epairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Page 1 of 3 Z Owner acknowledges that the Municipality may request records of maintenance and /repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the /AWWTS. The Municipality will give at least 24-hour notice. er agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by 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 parties under this Agreement. 7. Severabilitv. 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 OWNER: BY (signature) Date: % " /-7—zv Z v (print name) STATE OF ALASKA } ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this .7 day of 20,,"7 by MUNICIPALITY: (signature) (print name) ..... ,%% P-( RI C/q O ' NO _ .F '�FALAS�P.'�oR�' F Ir`1 e$'Ma h fill Date: 10 (V-2 6 Title: (rev. 05/18/2018) Page 3 of 3 DEVELOPMENT SERVICES DEPARTMENT UU1 907-343-7904 On -Site Water and Wastewater Section_4 Fax: 343-7997 www.muni.org/onsite PROPERTY OWNER MAINTENANCE AGREEMENT ON-SITE WASTEWATER DISPOSAL SYSTEM This agreement, dated i i�c, 2020. is made between the Municipality of Anchorage Development Services/ On -Site and the property owners of l 53V % 4&_ l cid Cc This agreement is made for the purpose of maintaining an on-site wastewaterdisposalsystem on the subject property. The property owner(s) agree to the following: The property owner(s) will have an annual inspection of the system performed by a registered professional engineer. This inspection shall verify that all effluent and air pumps, timers, and alarms are functioning as designed. Any deficiencies shall be corrected and the engineer's statement that the system is functioning as designed shall be filed annually with the Development Services / On-site. Property Owner Name (Notarize Here) State of. It - Judicial District -;7, tl1t III111111!!!/II ""QP�piC1q Ods operty Owner Name t 0 deo ALAS�P 'ti�ry. 111111100"', On this 9- day of,&�� in the year C7edO before me, the undersigned notary public, personally appeared: 1AA0_L- a known to me to be the person(s) whose name(s) is/are subscribed to the within instrument ai?d acknowledged that he/she/they executed the same for the purposes therein contained. In yci wherSqrl her6unto set my hand and official seal. Notary Public (signature) (Notary's printed name) My commission expires: MUNICIPALITY of ANCHORAGE • Community Development Department • On -Site Water & Wastewater Program P: 907-343-7904 • F: 907-343-7997 • P.O. Box 196650 Anchorage, AK 99519-6650 . http://-;mw.muni.org Intermittent Dosing Sand Filter Maintenance Log Owners ./ � Street Address Phone Legal Desc, PID Septic Tank: _ -Sludge level winches •Pumping: required e no -Pumping completed es no Absorption Field: -Liquid level _inches IVIA •Flushing valves per approved design es 9 no -All flushing valves opened, distribution lines flushed, and flushing valves closed es no Lift station: -Pump basket cleaned e no •Biotube effluent filter cleaned Qes no -Timer float setting9J inches -High level float settinginches -Reference pointja �R�Se�__ -Pump on seconds -Pump off -minutes *Cumulative lifetime cycles_ *Operation satisfactory e no Air System: Nfp No' e •Air pump filter cleaned yts no *Date of latest install or rebuild Alarm System: *Cumulative run time_, > QR , 7 $ hours -Air pressure psi -Air system operation satisfactory not satisfactory -Dedicated electrical circuit es no -Audible and visual alarm inside dwelling es no -Float setting _inches -Alarm system operation sans acto not satisfacto ry Comments: 1 G,� .:5:..�............5....................v�i�-�?..........5l�-............................................... ........................................................... .......................................... ....... VNC ..................... �......... ......?,.. t)c, ...Qsa:M.gS l ......I.......... ................................................... ............... Maintenance Provider: Technicianr Company 1- _ L� CE Signature iDSF Maintenance Log_040313.doc Date of maintenance pct6v a6 Date�� S� Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 201549 Subdivision: Spanish Hills lot 4 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 21 years old. Typical replacement costs range from $8,000 to $11,000 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. Ip Mailing /address P Q Box�196650 *Anchorage, Alaska 99519 6650x* www muni or fi� ■ CA /,?/T /A NE & ± 2s�»�;3 ■ NCO 732" W7 w t ■ CA /,?/T /A NE & ± 2s�»�;3 ■ NCO 732" W7 w MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 017-151-04 1. GENFRAL INFORMATION Complete legal description HAA ~¢ Lot 4; Spanish Hills Location (site address or directions) Property owner Mailing address Anchorage, AK Sam Marcum Day phone 659-0408 13341 Carita Lane Anchorage, AK 99516 Lending agency Malng address ' Address Day phone Day phone '~4q-1 ?0N Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 4 TYPE OF WATER SUPPLY: XX Individual well ,..._. . Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: NOTE: xx Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~025 (Rev, 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinan.ces, and regulations in effe~j~/~e~ Name 'of Firm Wastew~ Address /~-~ Engineer's signature ~ - '- Alaska we~er.,& ' ~ Wastewater ConsUltants, inc. $ Shall be pAID /O ED at, or prior to, closing for the Engineering Services Provided, 6, DHHS SIGNATURE P'// A?proved for FO I//~ Disapproved. Conditional approval for 5~art~/[d bedrooms. p~,t his inspection. ~nt~ I~ Phone Jite 2B )504 bedrooms, with the following stipulations: Additional Comments D~te c]~ ~.. ~ ~ ~ ? 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 this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements, Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Roorn 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description:. A. WELL DATA Well type _ PEIVAYE Log present (Y/N) Total depth 126' Sanitary seal (Y/N) Health Authority Approval Checklist SPANISH HILLS S/D: LOT 4 _Parcel I.D.:_ 017-151-04. _ If A, B, or C, attacl) ADFC letter. ADEC water system number N/A Date of test Static water level Well production 5 WATER SAMPLE RESULTS: Coliforrn 0 Nitrate Date of sample:. 3/2~/99 lB. SF. PTIC/HOLDING TANK DATA Date installed ,/~/o,-~?~/,L Tank size _ 1 YES Date completed 12./1/80 Cased to_ 125.8' Casing height (above ground) YFS Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION 12/1 ./.q9 3/22/99 99' 102' g.p.m. 1.18 !._~4 m~/L Other bacteria __ Collected by: A.W.W.C.. INC. · Number of Compartments YES Foundation cleanout (Y/N). Date of Pumping NEW C. ABSORPTION FIELD DATA Date Installed ~/m./o~-o/~,./,~ _ Soil rating (g.p.d./fF or fF/bdrm) Depression (Y/N) _.J~L__ High water alarm (Y/N) _ Pumper - * THIS IS A EEACTEX WASTEWATER TREATMENT SYSTEM] ** 2.0 FEET OF M.B.A. APPROVED SAND FILTER WAS / ADDED BELOW THIS DEPTH. J *2.0 _ System type ? Cleanouts (Y/N).YES YES Length ,'~O' Width _ 15' _ Gravel thickness below pipe n:~' Total depth **4' (AVG..~_ Effective absorption area tk~n gq FT _ Monitoring Tube present (WN)~ Depression over field (Y/N) NO Date of adequacy test NFW Results (Pass/Fail) For ..--------Z-13~_ r~ms Fluid depth in absorption field before test (in.); Imme.d_~~-gal. water added (in.): ' Fluid depth_____ (m?) M~: Absorphon rate =,_ (,].p.d. .~-e~atment (past ]2 months) (Y/N). If yes, give date 72-026 (Rev. 3/96)* *BED D. LIFT STATION 9/10/99 - 9/14/99 Size in gallons TIMER "Pump on" level at* ACTIVATED *Datum BO'Fi'OM OF TANK Date installed Manhole/Access (Y/N) YES High water alarm level at* 46" Cycles tested NEW E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: * THIS IS A REACTEX WASTEWATER TREATMENT SYSTEM. 150 TIMER "Pump off" level at* ^CTIVATED 100'+ 100'+ Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Lift station 100'+ N/A 25'+ SEPARATION DISTANCES FROM SEPTIC/HOLDINGTANK ON LOTTO: Foundation fi'+ Property line ~,'+ Absorption field Water main/service line 10'+ Surface water/drainage 100'+ Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTIQN FIELD ON LOTTO: Property line Sudace water Curtain drain N/A 5'+ 100'+ 10'+ Building foundation 1 O' Water main/service line 10'+ 100'+ Driveway. parking/vehicle storage area 1 '+ NONE KNOWN Wells on adjacent lots 100'+ HAA Fee $. Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number F. ENGINEER'S -- . 1 CERTIFICATION ' lcertify that l h.a~e~/mij~ .~ field inspections andreviewof Municipalre~~t~emsare in conforma~ ~H~A /del/nas in effect on this date. Signature ( ~/~.~ ~ ~~ · MUHICIPALITY OF ANCHORAGE DEPARTMENT OF HEA ~.TH & HUMAN SERVICES O!~.Site Services Transmittal Sheet The attached paperwork has been reviewed and for the fGllowing reason(s): is being returned ___ Discrepancy in legal description and/or owner name. ___ Discrepancy in number of bedrooms. ___ Signature and/or stamp missing on Show measured distances to sewers/wells, curtain drains and streams within 200 feet of proposed system. ___Replacement disposal site not shown and/or tested. ___ Calculation error in design. Show locations of a].l soils, percolation or water table tests. ___ Proposed system too deep for soil test submitted. __ Topographic information missing or inadequate. ___ Narrative missing or inadequate. __ Additional soil/perc test needed. __ Sand filter requirements not satisfied. _ Water monitoring results missing or inadequate because __ Incomplete; missing. __Well log required. __ Water sample unacceptable ~because Please supply the necessary information and re-submit your request. Your cooperation is appreciated. Reviewer LEA VE THIS FORM A T'I'ACHED TO PAPERWORK /203-rev. 4/93 Alaska Water & Wastewater Consultants, Inc. March 27, 1999 6901 Debarr Road, Suite 2B~ Anchorage ~ Alaska 99504 Phone (907) 337-6179 ~ Fax (907) 338-3246 Consulting Engineers Sam Maremn 13341 Carita lane Anchorage, Alaska 99516 Subject: Well & Septic System Inspection at Lot 4, Spanish Hills S/D. Dear Mr. Marcum: Per your request, we performed adequacy tests on the subject well and septic system. The results of the field investigation and adequacy tests are summarized as follows: WELL: The static water level on 3/22/99 was 102 feet below the top of the casing (BTC). Over a period of 505 mhmtes, 670 gallons were pumped fi.om the well (1.22 gpm average). During the first 25 minutes of the test, 130 gallons were drawn fi'om the well and the level dropped 23+ feet, down to the pump, which then started to cavitate. The flow was then reduced to approximately 1.13 gpm for the next 480 minutes, during which time the level in the casing stabilized at 118 feet BTC. Eighteen hours later the level in the casing was checked and found to be 102 feet BTC (normal static level). Based npon this data it was determined that the capacity of the well exceeds the Municipal requirements for a 4 bedroom house (600 gallons per day). SEPTIC SYSTEM ADEQUACY TEST: The drainfield is a trench type system that was installed in October of 1980, making it approximately 18.5 years old. According to the M.O.A documents, it is 67 feet long, and has an effective depth (depth of drainrock below the drainpipe) of 108 inches, however, according to our field measurements the smnp only extends about 102 inches below the drainpipe invert. It is our understanding that the house had been vacant in the week prior to the adequacy test. Prior to the start oftbe test (2:05 PM) the sump had 66 inches of liquid in it (36 inches below the drainpipe invert). After introducing the first 158 gallons of water, the liquid level rose 13 inches (The flow was slowed down after introducing the first 130 gallons. See the well data). The next 172 gallons only caused a rise of 2 inches (water was 21 inches below the drainpipe invert). The next 370 gallons was introduced over a period of 285 minutes (starting at 5:45 PM), and then was inadvertently shut offby Jim Marcum at 10:30 PM. The liquid level in the sump at 12:00 PM (yes, it was midnight!) was essentially the same as it was at 5:45 PM, indicating that approximately 370 gallons had been absorbed between 5:45 PM and 12:00 midnight. Based upon this data, it was detem~ined that the absorption capacity of the drainfield meets the MOA requirements for a 4 bedroom house (600 gallons per day). NOTE: The adequacy of a septic system is influenced by numerous factors, including, but not limited to, seasonal surface water infiltration, groundwater variations, septic system maintenance (frequency of septic tank pumping, usage of biological additives), condition of drainpipe and pipe joints (which can be damaged by seismic activity and deteriorate with age), type of substances deposited in septic system (cigarette butts, sanitary napkins, misc. objects), and the amount of water being introduced on a continual basis. Consequently, the results of this adequacy test are only valid for the specific day of the test. Furthermore, because of the limited nature of this investigation, it is possible that there are hidden defects which may not have been detected. No warrantee is made regarding the future performance of this well or septic system WATER QUALITY: Water samples were taken and are being analyzed for nitrates and bacteria. As soon as the results are available we will have them fhxed to you. If you have any questio~s/~lease contact me at 337-6179. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 01 7-1 51 -04 \' 1. GENFRALINFORMATION Complete ~egal descriation Lot 4; Spanish Hills Location (site address or directions) Property owner Mailing address Sam Marcum 13341 Carita 13341 Carina Lane Anehoraqe, AK Day phone 659-0408 Lane Anchorage, AK 99516 Lending agency Mailir!g address Day phone Agent Kris Abegg/Paragon Properties Address Day phone_ 349-1200 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 4v XX If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site xx Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Ray, I/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastgwater 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~ Name of Firm ~~~SU~E 2B Address Engineer's signature ~ Alaska Water & .~ ~ ~ ,. Wastewater Consultant, Shall be PAID _~ or prior to, closing for the ' Engineering Se~ices Provide. 'f this inspection. Phone DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional comments By: Date 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 this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchor-'lge , DEPARTMENT OF HEALTH & HUMAN SERVICES APR 2.~ Environmental Services Division ,,~UN,C,PAt.,TY 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907)~L~AL SERWCES DIVISION Legel Description: A. WELL DATA Health Authority Approval Checldist Well type _¢,"; v~ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number [)ate completed I ~- / ~ / 60 Cased to 12.~. cg Casing height (above ground) ~'~' ' ~ Wires properly protected (Y/N) \/¢ ~ Date of test Static water level Well production FROM WELL LOG AT INSPECTION _ ~'~ g.p.m. I, I(~ g.p.m. WATER SAMPLE RESULTS: Coliform -~ Date of sample: ~/~/-// ¢/ ? Nitrate /, ¢J z/ n-i,,¢//_ Other bacteria --(~-" Collected by: /¢J5':/-'~ ~/¢7~,' ? ~¢¢~' ~/4.~,la~J~, -~-P¢-, B. SEPTIC/HOLDING TANK DATA Date instal[ed IO/~ /4~O Tank size Foundation cleanout (Y/N) __~/P~ Date of Pumping ~ / I~ /~ I ~ 5 0 Number of Compartments ~- Cleanouts (Y/N) %/~ Depression (Y/N) /V/° High water alarm (Y/N) - -- Pumper AW C. ABSORPT ON FIELD DATA Date installed J(~/I /~0 Soilrating (g.p,d,/f¢orft2/bdrm) ~.~O Systemtype ~f~ Length o-/~'/ .Width :~0'/ Gravel thickness below pipe ~/ _ Total depth Effective absorption area J"~'~) Monitoring Tube present (Y/N) Y Depression over field (Y/N) ./~// Date of adequacy test ~)/'~ ~/~' Results (Pass/Fail) ¢q5¢ For _ _bedrooms Fluid depth in absorption field before test (in.)', ~(¢ Immediately after (~'?Ogal. water added (in.): Fluid depth ~ (ins) Minutes ater: '~' Absorption rate = (¢OO 4- g,p,d. Peroxide treatment (past 12 months) (Y/N) /'vO If yes, give date 72-026 (Rev, 3/96)* Date installed'~"'"'"~ Size in gallons ~ Manhole/Access (Y/N) ~p off" level at* E. SEPARATION DISTANCES , ~ ~ SEPARATION DISTANCES FROM WELL oN I~OT T0: .... Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Water main/service line Property line Surface water /063 t ~.- Curtain drain F. ENGINEER'S CERTIFICATION SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: - Building foundation Driveway, parking/vehicle storage area Water main/service line 16 I certify that inconforma~ewi/h Signature ~,~ Engineer's; Na Date ~ Wells on adjacent lots this date, IOD ' ~'/. ~. 'ftems are HAA Fee $. ,'~ Date of Payment Receipt Number Waiver Fee $ Date of Payment · Receipt Number 72-026 (Rev. 3/96)* APPLIC NT FILLS OUT UPPER HAL bNLY Pr( oerty Ow ,er ."L)~;.,. _ ,~ e ..~ ~.~.~,0 Phone Buyer -~-~A ~-' ~- ~' ~/~ 6 -~ .t ..~ ~'~ '- Address ~ ~ (' 0 Zip Code Lending Institution ~ ~ Phone Address Zip Code ~" - ) ~ ~ ~.~..,~... Phone ,7, (¢'7 .P..,,..-,.. Type of Resl~noe Single Family '~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~Zlndividual A'rTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg tf available). ~ Public Utility Sewer Disposal ~ Public Utility ~ When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE PROCESSING CAN BE INITIATED. Time Time Time ~1 Time Date Inspirer Inspirer Ins%~tor ~D~ ~ Inspirer ~ Field Notes: [~ ~ MUNICIPALIW ~ ENVIROi J;. If,: A.: ,0, ECT on ,}? ~ 9 1982 RECEIVED (~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' 72.023 ' DA'rE RECEIVED INSPECTION __ APPOINTMENTS TIME ~__~ TIME T[I~IE / DATE DATE DATE ~SPEC'rOR INSPECTOR ~ INSPECTOR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 ~ ENVIRONMENTAl. SANITATION DIVISION Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts Ol) page 1. Incomplete requests wilt not be processed. Please allow ten (10) days for processing. MAILING ADDRESS Il ' PROPERTY RESIDENT (If different from above) ~ PHONE 2. BUYER PHONE MAILING ADDRESS ~ LENDING INSTITUTION PHONE MAILING A~DR SS ~. ~=E~AL DESCRIPTION 6. TYPE OF RESIDENCE NUMBER OF~BEDROOMS One ,,~. Four ~ SINGLE FAMILY [] Two [] Five [] MULTIPLE FAMILY [] Three [] Six [] Other 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 UTI LITY depth (attach log if evailable.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** /C~OU0 YEAR ON-SITE SYSTEM WAS INSTALLED. [] PUBLIC UTI LITY NOTE: THE[ INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY . 1, TYPE~F RESIDENCE NUMBER OF BEDROOMS ~J SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO E~-~"~-O U R [] SiX PERMIT NUMBER 2, WATER SUPPLY [~INDIVIDUAL DEPTH OF WELL E~] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3.~E A"GE DISPOSAL SYSTEM PERMIT NUMBER E~NDIVI DUAL/ON -SITE DATE INSTALLED []PUBLIC UTILITY Connection Verified INSTALLER []Septic Ta~nk or E~]Holding Tank Size: ] ~ If Tank is homemade SOl ES RATI~G~,~. give d'imensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tan~< Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Lille 5. COMMENTS EJ~"'APPROV ED FOR ~'~ BEDROOMS [] CONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY 72-010 (Rev. 6/79)