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GROLL BLK 1 LT 1
Groll Block 1 Lot 1 #050-521-39 Municipality of Anchorage Page I o! 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: ,,~ ~'/,,~ O ~"'" PID Number: O ~O - 5.~[.~- ~ ~ "'~': ~o~. ~.~c~ Wastewater System: D New ~Upgrade 77177 ABSORPTION FIELD Phone: I No. of Ben, ms: ~Oeep Trench O Shallow Trench O Bed D Mound ~ Other LEGAL DESCRIPTION s°~'"'~: I, ~ ~.o~ ~,. ~,-~ WELL: O New O Upgrade ~,=~,~i~t~: ~ ~t / V GPM ~ Ft. Ft. SEPARATION DISTANCES ~Septic O Holding ~ S.T.E.P. su,,~, t~,~ J,~ LIFT STATION "Pum~ on" level at: ~um~ off" level al: ~ High waler Remarks: BENCH MARK ENGINEER'S SEAL Inspections performed by: al~an~ H~ S~i S I ~ ,",. " Department of He an ce approva . ~."..-,.....' . .. Reviewed and approved by: ate: - - - ,~ ". , ZgZ ~$ :0189 £/~ :135H£ 000~ "6Z id$£ :31V0 17108 SV p~31SAS 311d3S 6£-I~£-0£0 # OId $~315d NHOI' I I ~'9 $71p~ OVO~ ,~3A18 $70Y$ 6//,9 770210 I }IO07fI I ,[07 88£000~S # lINS]d 916£-6L~ (Z06) 10£66 ~ 'HONY £nN]AY 'Nl£/ · £0~ ~ ON~'7~80d~ N]HHOI ! ! 0 ~ 6£-lg£-OGO ££f000~$ :ON llYtE]d 19108 S~ H31SXS ~Ild3S Sa$1$d iVHO£ OIIYfi]HO$ ~131D($ 011d35 770~D I XDOTE I gO7 I0~66 NV a6o~oq~uv '3'd ONVq~SndS N38aDi 00~0[ ~3?3~3HOSSV ~UVHHDN3~ -1 119 -~1~- 37V35 ON >lUO~ ~:~das ?06 000~ / w°~!u°N ~ ~nouoaiD ~.~ ..... ~,..~ ...~ >1~o~/ ~:~das .~o ~j ~ ii~k- £'££ / :/no uoaI3, uo!.,t opunoj ~ JaA03 ,£ / ,V~OJ aa,~as ,£ daaE ,£'~ 6uo7 ,£Z ap:A ,2 ~no uoa/j ~lUO~ ~:~das IO6 000~ :4~UaJl PJ°Pu°~s 51n0 uoal3 alqnoE ~ Jo~!uoN ~ m MUNICIPAU TY OF ANCHORA GE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 21, 2000 Expiration Date: Sep 21, 2001 Permit Number: SW000388 Legal Description: GROLL BLK 1 LT 1 Design Engineer: 0007 Tobben Spurkland, PE Owner Name: John Peters Owner Address: PO Box 771778 Eagle River, AK 99577-1778 Parcel ID: 050-521-39 Site Address: 025212 CRYSTAL CREEK DR Lot Size: 97923 SQ. FT. Total Bedrooms: 6 Permit Bedrooms: 6 This permit is for the construction of: [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] 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 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. Received By: '~'--"~ ~ Issued By: ?.E. 203 W 15th. Avenue, Suite 203 ANCliORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM UPGRADE DESIGN LOT 1 BLOCK 1 GROLL S/D JOHN PETERS Municipality of Anchorage Department of Health and Social Services 825 L Street Anchorage, Alaska 99501 August 18, 2000 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic ofthe septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: Ground Water 10.5 Ft Use Standard Trench Soil Rating. From Testhole 08/I.5/00 3 mia/in = 1.2 gal per sq.0dday No. of Bedrooms 6 Required Area per Bedroom: I$0/1.2 = 125 sq.ft. Total area required: 12.5 x 6 -- 750 sqft Bottom Rock At 6.5 feet Top Rock At 1.5 feet Rock Depth .5 feet Total Trench Length 750 / 10 = 7.5 ft. SYSTEM CONFIGURATION STANDARD TRENCIt TOTAL LENGTIt 75 FT TOTAL WIDTtl 2 FT TOTAL DEPTll 6.5 FT ROCK DEPTIt $ FI' COVER 3 FT SEPTIC TANK 2000 GAL The installation of this septic system will not prevent development of adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration ofsurface runoff will not result from this installation. N N--', ?'. . o ...... r~-~[ ................... ~2., ~...'T~ ~ 0 ~0 100 150 ~00 250 300 SC~LE~ U = 100 F~ TOBBEN SPURKLAND P.E. 205 · ISTH. AVENUE ANCH. AK. 99501 (~oz~ 2x~-~' LOI' I BI, OCK I GROLL $/D EAGLE RIVER ROAD MILE 6.2 JOHN PETERS PERMIT # S~O00XXX PID # YY II SEP~C SYSTEM DESIGN DATE: AU~ I~ 2000 SHEEh I/$GRID: SW 262 6ROOI~I.D~G %% -~ IYell EXIST TANK AND CRIB COVER $ FI' ~ o £5 50 75 100 1,~5 SCALE: 1' = 58 FT. TOBBEN SPURKLAND P.E. 2DJ kF t5m AVENUE ANCH. AK. 99501 (907) 279-J916 PERMIT # SWO00XXX LOT I BLOCk' I GROLL S/D EAGLE RIVER ROAD MILE 6.2 JOHN PETERS PID # YY J J SEPTIC SYSTEM DESIGN DATE: AUG. 18, 2000 SHEET: 2/J GRID: SkF 262 GROOIfl]~.DWG Monitor Double Clean Buts Lo / 20OO go( Septic tank Cleon Out Standard Trench: 2' V/de 75' Long 6.5' Deep tion Cleon out C(eonouts ~ 3' Cover 4' Hin Cover II ~i~:i~i~!~:~:[.~.~.~i~:~l~]~~ ~"-over Tank L NO ECALE ~ ~ It ~ENCH MARE AE2UMEP ELE~ JOO. OO $ILT BARRIEJ~-- 5 £~ of Septic Rock TOBBEN SPURKLAND P,E. 203 ~15~h Ave Anchoroge Ak 99501 LOT I BLOCK I GROLL SEPTIC SYSTEM SCHEMATIC JOHN P~T~'RS SEPTIC SYSTEH DES[GN DATE, AU~ l~ 2000 SHEET, rO~n' $~ £6£ PERMIT NO: P. LN. G£OOIOI$.DWG PERFORMED FOR: LEGAL DESCRIPTION: 3 4 5 6 ? 8. 9 10 11 12 13 14 15 16. 17. 18- 19- 20. DISCLAINFR' ~rnundwater Past and future presence trom these 'THai MunlclFallt¥ of Anchorage DEPARTMENT OF ~EALTH & HUMAN SERVICES 825 "L" Street, Am:horage. Alaska 99502-0650 SOILS LOG - PERCOLATION TEST DATE PERFORMED: ~'~ lb --&l-O L,, ,L t, ?, ~. x G,, Il Township, Range, Section: SLOPE SITE PLAN d e',.,., ,../ /./,/.,. : WASGROUNDWATER ENCOUNTERED~ IF YES, AT WHAT DEPTH~ E Depth Io Water Alter MonitoringS' Dale; Peadlng Dete Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE __ Immures/tach) PERC HOLE CIAMETER ~ TEST RUN BETWEEN FT AND FT conditinns indicated arR for the dates shown only. and/or depth of groundwater can not be predicted 0 D S ~'~ T, 10 ~1S . PERFORMED BY: ' , CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUll EL,NES IN EFFECT ON TH,S CATE. DATE: 72-008 (Rev. 4/85) Munlcil~allty o! Anchorage DEPARTMENT OF ~EALTH & HUMAN SERVICES 825 "L" Street, Am:horage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LEGAl. DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13- 147 15- 16- 17- 18- 19- 20- ~/~ ~_O LL Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Oeplh to Walef AIt~r I? Monilmin§? t~., S L o P SITE PLAN Feeding Detl Gro$1 Net Depth tO Net Time Time Water Drop FI4~ ,~./3'.o0 7~ ~ ~- $~,~ 7° i/:'~ ~ [0 I0 r~ 7~ / ~ ~o /oy~ 7~ ~ /o lo ~ o 7 F~ IO to PERCOLATION RATE .~ tmmuteumchJ PERO HOLE DIAMETER ~ TEST RUN EETWEEN ~/ FT AND ~ FT D[SCLA[HFR~ ~m~nd~t~ cnnd~i~n~ fndic~d a~e ~n~ ~he de~e~ shown only. Pas[ and future p~esence and/o~ dep[h of g~ound~a~e~ can no[ be p~edtc[ed trom these o~vaclons. PERFORMED BY: I ~ CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUll ELiNES iN EFFECT ON THiS OA~E. DATE: ~/~/0 ~ 72-~8 (R~. 4/~) GREAfER . ANCHORAGE AREA BOk, UGH ,- ' ·, (!~ "~'~/~:~ Department of Environmental Quality ~A?," ': ~' ;! 3330 C Street .... ! ]~ ?'~: Anchorage, Alaska 99503 ,' , , IN~PECTIO~N REPORT ON-51TE SEWagE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE ,/'~-,(,....} I ~ FROM WELL _'~2 '~ '-J-- INSIDE LENGTH MANUFACTURER.. ¢ -'~-E/~*- MATERIAL -_ ..... ~ .... COMPARTMENTS INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY~' : ,-[~(7'"GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE TOTAL LENGTH OF LINES NUMBER OF LINES_ [DISTANCE BETWEEN LINES __ TRENCH WIDTH__ IN. TOTAL EFFECTIVE ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER MATERIAl BENEATH TILE IN. ABOVE TILE IN. WELL: TYPE _ BUILDING FOUNDATION CESSPOOL APPROVED _CONST RUCTION NEAREST LOT LINE_ , OTIqER SOURCES DISAPPROVED NEAREST SEWER LINE DEPTH SEPTIC SEEPAGE , TANK , SYSTEM REMARKS DISTANCE FROM: DISTANCES: INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL' LOT SLOPE: REMARKS: DIAGRAM OF SYSTEM i.i~:i!] i'i fi-!: i..i::?-.G'TI4 [;:, :~ i'it:~]i'-,l:!i; :[ ()H )::i:: Ti 'i'l..llili: i)tEI:;:"iI.i !;::It::: t:::1 TI;i:!i:i:i'.,!E:i! 01:;:: I:':1:"t' [iil:;i:l]l li"41]:' I:::IF,i[:' 'il'iii!: I!',t])T'I [q'"l [11:: ! !lEi 'i'Hli]:;::iiii: '[:~!; i",1[) :~;l:i:'l' i.,t:[[:'ll't t:::OF;: 'I"I:';:IEi',I[:i'Ii::::i!;. ii'lti: (]ii:;;:l:;:l",,'t!!].. [:,I! ]::'"r H :1:I!:; Ti. il!!: I:::ti'.,fl:::, I'1...I! IFi:OT'I[)H EE:: lille E:;:.:;E:F:!',,,'I:::i'I ............................................... iF:-:::" !i::::li i!]:: il '~:::] rl::::::ti i[,~ lifE: if:::-:" li ... F:::Ii Ii '.-, !i '" '~[ ' !iii [i::::" ::ii] ~;']::li i!'-,.l/ ................................... FI F'Fl[::l.::]:::l[ii]!ill I:::'i..F:ii',i't i'"lt:::i'r' i!i',i:!: ]:h,l:ii;i't:::li.I iii:' I::['t' Tllli!: F:'[i:l:;:l"lZZ't'.'.Ei::/":ii; OF:"i Ii iii',! :!i;iii::iL]iii]]:] .'l'l ::1. iE];"I'Hi!i]:;i: t:::i !]:i.l:::i?i;:!ii; I I]1:,i :1: :I: i",! : ::; l:': FII:::'I:::'I:;?('I',/I~:[) I:::'l.l'::ll",!l' Hl:::!'r' ,.:. ?. I:::t [:[d",i )]i' h!l. ti]it:i:; i'"ii:::1 ]!7 I",l !'!i~l",tl:::lhlt]:l~ F:I[!it:;;:lil]!!]"'ili~'l",l'!' ]i' :!::; i:;;:!iii]l]:¢ I ]. i:;;:ii]]:'. ): [:: I:~ t"'ll:::t ]: I",! I':: ":'. t..::'c'..~:..I [ .1: ,::' v :::' q" ]J] :i}; .",il'Fi' l'::]i ]:::"i" []t .ll:;i'.j:;;:l[:i]",l'l '.¢"1 I J"l!:::l"r' I !',Iii: ];;:i:ii]]:¢..I ]i: I:;i:li:!::' 'i'i] I:i]",!l..!::l!:;;:(][[: 'i.-I1::-'., ?:i;['i ]] F:lt::i','i!;[)l:;i:l:::"T :!' [)i',i :::, ~' :::, I::.l I FiHI]:',-'"i]i:;:: '.r'l]i..I HF:i"r' I?,[:!: '::.;I F:',.'fFX]:T '1 II :'l'~'r'r:::; ::: '1 !'i' :i: I hereby certify that 1[ hav~2 stu:vtp, ed the £ol2owing Anchorage Rt~cord ~g Precinct, Aktska, and that the -,, inqprovemen{s situated thereon are ¥.'itifin the property ..,..7. "7;'~' linca lind do nol overlnD or encroach on thc property ,.""'' '..'. ' , :'. ' lying adjacent thcreto, that no improvement:¢ on prop- - , .~., ... ,,, ', . '~ errs' lying adjacent lhereto ' que:;tion and that there are 11o roadways, transmission ,... z., ~7 :, ,lines or oilier' visible r'nsements on sa d 1) 'o )ertv except .' ~'~ .. , . 'i~s indicated hereon. ' : ] SCAT. E: ., l%gistered b ~d S irveyor No 880.,LS .. ] 1 :z /~ z.., Box '15G 15a`gle It ye', Alaska, '~ ' " ~ Phone 694-~543 M-W DRILLING, INC. DRILklNG [.OG Bruce Groll Well Owner .................................................. Use of Well Location (address of: Township, Range, Section, if known; or distance main road / , ,~ ! / :/ , / . ,,/ ..,' ~lze of casing ........ Depth of Hole. ]:D2 feet Casedlo_ 60 .... feet Static water level___9_?_ ...... ft. Screen ( ); Perforated ( ~Dos(;ri}~p screeI1 or perforation Well pumping test at__6 .... gallons per (~ of drawdown from static lewd. (below) land surface. Finish of well (check one) open end ( ); 3" slots in last 5' of casing (minute) for_ .... ~ hours with Date of completion ....... E/_~/_Y1_ .................. W~LI. LOG Depth in fect from ground surface Give detaiJs of formations penetrated, size of material, color and hardness ..... _0_.~_.TO_' ~2~ ...... ~?bt.~.)-z_g.r:(~ye]z w~?_h_0&cas_L_9~3_a_)-- b. oL~l~ers ......... TO ......... TO ........ TO ............ .......... T© ........... TO ......... TO .TO, Boulder gravel with sJ]~y sand matrix _B[!Qr?2.cl5 _ _s_J_] l:_s_tgnq ~:n:~L/]:!it::e 1 --CUSTOMER 1MUHM " UTY OF HC AORA GE Development Services Department p p �_��= ��� Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-521-39 1. GENERAL INFORMATION Expiration Date: 67-2-S-22- Complete 7'23-2Z Complete legal description Groll Block 1 Lot 1 Location (site address) 25212 Crystal Creek Drive Current property owner(s) Lawrence & Margaret Fussner Day phone Mailing address 25212 Crystal Creek Drive, Eagle River, AK 99577 Real estate agent Day phone 2. TYPE OF DWELLING: ❑■ Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 6 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑■ Private Septic ❑■ Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: COSA Fee $ 55 O Waiver Fee $ Date of Payment . � - 13 - 2-2 Date of Payment Receipt Number 02- %'�-/-D Receipt Number COSA # 0 5 L a a 1), 9 5 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 06/10/22 6. DSD SIGNATURE System #1 Approved for & bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, F `t 4 ���llil law 49 TH :9 Ben)aWWSchiller �F, • CE 12592 • �`�i flF • . 06/10/22 • '�G�,� \ROFESSOW with the following stipulations: By r Original Certificate Date: - 2-3 2 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 X Septic System Advisory Well Flow Advisory COSA Checklist blue sheet Nitrate Advisory Arsenic Advisory Other S`ie2A.�,iE -Legal Description: Groll Block 1 Lot 1 - Parcel ID: 050-521-39 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA RE 5** Well log is filed with Onsite (or attached) Well production at time of test 0.gpm Date drilled 6/2/71 Water storage tank volume 1000** gallons Total depth 152 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to60 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate— mg/L ❑ Nitrate less than MRL (ND) RM Wires are properly protected Arsenic ug/L ❑ Arsenic less than MRL (ND) * Fore Engineering Casing height (above ground) in. Collected by g g 9 Date of flow test for COSA 6/7/22 Date of Sample 5/24/22 Static water level at beginning of test 139 ft. Comments *Met code at installation **Water storage installed in garage 4/2001 per municipal file B. TANK DATA Age of tank(s) 21 years Tank type/material SEPTIC/STEEL Measured operating fluid level in septic tank 48 ❑ Standpipes/foundation cleanout per record drawing Date of pumping 6/6/22 JR's Pumping D. ABSORPTION FIELD DATA Which system tested (date installed) 9/29/00 ❑ ALL standpipes present per record drawing Total measured depth from grade 12.2 ft (max) Measured depth to pipe invert from grade 7.0 ft (min) ❑ N/A — pressurized field Fmil Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked C. LIFT STATION red maintenance completed Age of lift staiRxa_„ years Lift station material Comments: Adequacy test date 6/22/21 Results Q✓ Pass For 6 bedrooms Fluid depth prior to test 0 in Water added 1000 gal New depth 0 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate '900 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N/A date of test) If yes, enter date NIA Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Yes Septic Tank/Lift Station on Lot > 100' ft Wells on Adjacent Lots: Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft dQ Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 25' 0✓ Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' M✓ Yes if No ft Neighboring Absorption Fields > 100' ft Community Wells > 200' Yes if No ft Animal Containment > 50' 0 Yes if No ft M Yes if No ft F. ENGINEER'S COMMENTS Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' MYes if No ft 0✓ 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' Yes if No ft Property Line > 5' Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' ❑✓ 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' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 0✓ Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100'✓Cj Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION AIF!9���� I certify that I have determined through field inspections and review ,,s of Municipal records that the above systems are in conformance with ili MOA COSAguidelines in effect on this date. Benjarr chiller 10' �Fq •. CE 12592 • c�� is�<c� • , 06/1 0/22 • \\2 ���F�pROFESSIO�P.� COSA Checklist yellow sheet �������� Septic 'Tank Advisory Certificate of On -Site Systems Approval #OSC 221275 Subdivision: Groll Block 1 lot 1 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks The septic tank for this COSA 1 property is 21 Vears old. A leaking septic tank maV be a source of contamination to the aquifer. Typical replacement costs range from $10,000 to $15,000 This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of a 16 -year-old septic tank in failure and should be replaced. x ,Mailing Address P Q Box 186650 *Anchorage, Alaska 99519 6650 *www muni org Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www. ci. anchorage. ak. us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC221275 During a recent COSA on-site inspection and test of the potable water supply well on Block 1, Lot 1 of Groll subdivision, the well's productivity was determined to be .5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 6 -bedroom residence is .62 gallons per minute. All parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. h Legend 1 F �\ Septic iW; Water Well LT, Tel. Pedestal I: Basket Ball Hoop Scale 1" = 50' \ LO "L ;., �� EDGE OF PAVEMENT qyL o `•• LE, Elec. Pedestal "'" Electric Meter Gas Meter CO Utility Pole CR Overhead Utilities /,/ Fence Line SHED ' �a. `> >. CO / \ Ste• `cam/ ` � \ � e '' t!.' .: �� / \ 61(2 I 1100 1 ui SHED Yet 0 \ `��/ \\ 846. \ \ LOT 2 ♦ I I g ♦ I0 25 50 100 Disclaimer \ The survey represents visible improvements and conditions at the time of the ♦ I I ���♦♦♦♦"", 11 t Scale in Feet desktop study. This document does not constitute a boundary survey and is I = �� O F A �,q III, subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to determine the existence of any ♦ — easements, covenants, or restriction which do no appear on the record plat. ` I 1 .9 F Under no circumstances should this document be used for construction or for \ p „ /� establishing a boundary or fence line. I p T General (Votes � �:� � � � � �ry� ; .............................; Pier ry gier (r 1. This document is created for the purpose of a single property �o rn �/ �' " • Ls- 12 o, zsz T / i� 06/23/2022 transaction and is subject to Federal Copyright Laws. 1 b /// �F J_ REO 2. Excepting for gross negligence, the liability for this survey shall not ♦ //j�FO PREPARED BY: exceed the cost of preparing ts 3. All measurements/setbacks re to theey. visual/apparent building footprint. \ t t t tARa,;i` ONA` .`` 9007-4W. 58th 60 66 VEV 4. All dimensions to property lines are plus/minus 0.1ft. DRAWN BY: SS CHECKED BY: PS ~ *. i.. MuniciP,ahty of,Anchorage":.,.',*' ' ((~'~ri~//~ , -* ,ii ' Devei6 "Sent se~iCes' Di~ a~ine'ht: '. '/¥ ;,, ~;~ .~* ~ ~: ~.'" :. :" ~: '" :':~" '" . ' :' ~:. ' P:0: ~'?~~Oe,'~ ~51~ ',' ~ , :".*: ".' :2": ,';" : *. :~ j..' ':::'. '" ~ .,. '., ~ :. *. ~. :.'.* .... : . :.:':.':.:;~:d.~Oe.a[~:*~'., ~ '~ .:; .,.. '..,., ATE HEAETH ...... "* -- ~ CERTIFIC OF ~AUTHORIT~Y.:APPROVAE - - , '" ::'FOR ~ siNGL~ FA~ICY,: DWEllING ' ' · . . ~ .-., ...: - .~ .:,* '~ * ,,; :.,' ~ : . ' .., ; .: ' ,.. .. ; ~. · .: .", "' '" " :*'~ * ~ *:0 -' Pa~l I.D. 050-521~39 ' ~ ' -': ' ':. ~*. ... ............ 1, GENE~LINFOR~ON : ~ , ~[m~on Date: ~: ~mplete legal des~p~on GROLL~ SUBD~SION;. LOT· 1~. BLOCK 1 L~on (sl~e ~ddm~ or dlm~ons) .25212, CR~AL CREEK. * ~GLE. R~ER;. AK '.: 99577 Current Property'ow~ler(s) - Mailing address · Lending agency,.: Mailing address Real Es~aie Agent Mailing address JOHN Ai~' D'EBBIE' pE:i'ERS '.'. * ' '.-.'. D~;y ph~e 694-453{/694-6822 25212 '(~I~Y~T~.!~ CRI~K '* F-.~GLE RIVER, AK 99577' ~ .i Day phone - .... : - · CONNIE HE"rTINC.,A w/ COLOWELL BANKER Day pho.n,e 696-7653/229-4783 10928 EAGLE,RIVER ROAD~ SUITE 115 * EAGLE RIVER~ AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 6 3. TYPE OFWATERSUPPLY.' Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAl.: Individual On-site [] Indivldual Holding tank [] [] Community On-site [] [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the reprassnta'Jons given In paragraph 5 by an independent professional civil engineer registered In the State of AJaska. Certificates of Health Authority Approval are required for the transfer of tiUe (except between spouses) for properties sewed by a single family on-site wastewatar disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority 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 less than 30 days old. (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 walls or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. Note:Alaska Water and Wastewatar Consultants, Inc. shall be pald SgOO:OO at, or prtor I to closing for the engineering services providec~. I 4o STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed he~eto and as of the validation date shown below, I redly that my investigation, based on procedures outlined In the Health Authority Approval Guidelines for this application, shows that the on-site.water supp~, and/or wastawstar disposal system Is(are) safe, functional and adequate for the number of bedrooms and ~ of strucZure indicated herein. I further verify that based on the Information obtained from the Munldpality 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, e .ffect at the. time of Insta. llation. Name of Firm ALASFA WATER & WASTEWATER CONSULTANTS. INC. .......Address 690i DEBARR ROAD. SUITE 2B * ANCHORAGE. AK 99504. Engtheer's Printed Name JEFFREY A. GARNESS. P.E. Phone 357-6179 Date Engineer's Comments: In c~ducting this evaluatton, AWWC, Inc. altempted to t:~ovide a thorough, conscian#ou$ engineering anaysls of the system in accordance wRh ADEO and MOA DSD Guidelines & Regulab'ons, The reported results desedbed the pertbrmance of the stem under the co~d~ons ~ncountored at ~he b'me of the test, and separation distances measured to readi~/ Identifiable features. The operet~onal life of all wells and eap#c systems depend on the Iocal soils condition, greundwator levels that may fluctuate during the year, and the water usage of the faml~, being served by the s~tem. These co~ditlan$ ~ outside the control of the evaluater of the system. Sagsfactoty test result3 do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or eneroachman~ AWWC, Inc, can therefore not provide an.v warranty o~ future estimate of how lang the s3~tom ~11 conb'nue to meat the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other paten or pa/ty ts not authorized, nor wfll It confer any legal right wha~esver. 5. DSD SIGNATURE !,,''/ Approved for ~ bedrooms. Disapproved. Conditional approval for __ ~." ON-SITE ':'~ ~"*: WATER AND : ~ t WASTEWATER .: · · '~ ; PRO · bedrooms, with the fllowmg sUpulatlons:.~ ~,,. GRAM Attachments: HAA Checldist Septic System Advisory Well Flow Advisory Manltenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: Municipality of Anchorage Development Services Department On-Site Wat~ & Wastewat~ Program P.O. BOX 196650 Anchorage, Al( 99519-6650 HEALTH AUTHORITY APPROVAL CHECKLIST LegalDescdpUon: A. WELLDATA We#type p~vA~ Oatecom~eted .6/2/71 Toteldopth **520 K GEOM. SUBDNISION; LOT 1~ BLOCK 1 Parcel ID: 050-521-59 *WELL DEEPENED ON 7/1984 AND ON 10/1989. **PER 1989 WELL LOG If A, B, or C provide I~NSIDft N/A WeU Log (YIN) YES Date of test Stel~ water leval Well production WATER SAMPLE RESULTS: Cased lo FROM WELL LOG *.10/11/1989 *.110 *'1.5 8o lt. Casl~ height (above ground) 12% In. ~ AT INSPECTION 4/11/2ool ft. U.K. ft. g.p.m. ***0.4 ,g.p.m. **'1000 GALLONS OF STORAGE INS~J_L~ ~N C, AE~E (4/2OO0. Coafotm 0 colonies/100 mi, Date of sample: 4./12/2001 B. SEPllC/HOLDINO TANK DATA Nitrate 0.5 regal.. Otherbacteda Collected by: AWWC~ INC. T;mk 'Pype/Materlal STEEL Ta~k size 2000 gal. Number of Compmlmente 2 Foundafloncleanout(y/N) YES Depmsslmovertm~(Y/N) NO 0 coionl~lO0 mi. Date of pumping NEW C. ABSORPTION FIELD DATA Date Installed Length 75 It. Date Installed 9/2000 C~mout~ (Y/N) YES High water alarm (Y/N) N/A Pumper LESS THAN 1 YEAR OLD ~ *~ 'R. IAN 1 YEAR OLD. 141' WA~ SO~ rating ~~/bdml) 1.2 Systemtype DEEP TRENCH Width Z.O It. Gravel below pipe ,5 lt. Total depth *8~-g.o ft. Eft. absorpl~m area 750 ~ Monlt~ lube YES Date of adequacy test **NEW Resu~ (Pass/Fall) - Fluid depth In abs~xpUon field before test - In. Water added - gal. Elapsed Time: - min. Final fluid depth - In. Any rejuvenation treatment (pa~ 12 mo.) (Y/N & Ospllisskxt over~id NO Fo~ 6 bedreor~ New depth - In. - g.p.d. SEPARATION DISTANCE~ SEPARATION DISTANCES FROM WELL. ON LOT TO: Septic tank/lift station on lot. 100'+ AbsorplJon field on lot 100'+ Public sewer main N/A Sewer/septic sen4ce fine 25% On adjacent Iote 100'+ On adjacent lots 100'+ Public sewer manl~ole/deanout N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5% Property line 5'+ AbserpUon field Water main N/A Water cervtce llne. 10'+ SUlTaCe Water. Wells on adjacent Iote 100'+ SEPARATION DISTANCE FROM ABSORPTION FIKI n ON LOT TO:. 5'+ 100'+ Prope~y line 10'+ Water sen~ce line 10'+ Cu.'rain drain NONE KNOWN Building foundation 1 o'+ Su~ace water 1 O0'+ Welb on adjacent Iot~ 1OO'+ Water main N/^ O~veway, paddngNeh~e storage §0'+ F. COMMENT~ O. ENGIN,EER'S CERTIFICATION l ce[~atlhave de~mL~ed through field ~spe~on, a~d rev/ew of Municipal recon~ that the above systems ". ' ~ance with MOA HAA guide[Inee In effect on thia date. EnglneefsPrintec~Na~ge dEFFREY A. C, ARNESS Date Date of Payment 5-1 - 1 eece[pt .um er ¥/¥?' Waiver Fee $ Date of Payment Receipt Number, 04ol7-01 14:52 FI~t~CT£ EKVI R~fl~NTAI ~sl~r~ CT&E Environmental ~ervices Iflc. 5615301 T-427 P.03/05 F-500 CT&E Ref.# Client Name Project Name/~ Client Sample ID Matrix Ordered ay Semplc Rcrn~k~: 1011822002 ~ Water & ',,Vastcwat ~i' Comultnnt.q ln~. NA C~oll S/D Lot I BIk: 1 Drinkin~ Wnt~ Client po~ Prluted Dnteffflme 04/17/2001 12:17 Cellected Dare, Time 04/12/2001 8:15 Rcc~ived DnteffFIme 04/13/2001 13:50 Stephen C. £de TechnlcMDirector, . . · . Limits Ds~ Ds~e Init Ni~ale.-N 0.$00 U 0.500 mS/L EPA 300.0 10hex 04/13101 SCL l~t.e ~:obt. ol. ogy Total Coliform 0 col/100mL SMI8922~B 04113/01 SKW 0§/10/2001 % 09:29 9075952403 Payment due on receipt of Invoice unless other ~Tlmgementa made. · Plum p~f by Inv~)k~ Ail ICCMml PIM Dui letlJ ~ (:;hMgMJ 1~ ~, THANK YOU. 05/10/20B1 09:29 9076%2403 BOYE:R TI~ & I~_l~S PAGE 03 BS-1E~-2~01 ~:58AM FR~ T~lu~Ht~IS~"'~'3_285_ Tn 19~769E2~az P.B1 ,ALA,~i~A 3OLDSTAR PLUI4BING AND HEAT1HG iNC. P.O. OOX 87135S WALR. LA, AK gg~'? ~ 3~-~6~ FAX gO'/' 373-3~$1 InYoice #: SERVICE INVOICE John 1" ~wr &Iii V~l~e ' 1 10,31 $10,31 1" ~VV'I' UniOn 1 6.5t $6.51 1" 3VV'T gO 3 1.59 $4.77 1" MIP x SWT Ad~pter I 2.63 32.63 1" x 3/4" Pitied Recfuc~ng Coupling I 3/4" ~ Union 2 3.68 $7.36 3~4" SWT Ball ¥&lv~ I 7,24 $7.24 3~4" MIP x SWT Adapter I 1.08 $1.08 3~4" FIP x SWT Adapter 1 1.3t $1.31 3~4" ~ 90 . 4 0 e8 S2.72 3/4- SVV'T Coupling ~ 2 0.4~ $0.90 11/4" PVC U~ion 1 6.90 $6.90 11/4" PVC Bail Valve 1 22e3 s2ze3 1 I/4" Pvc Cc, up~ng I 0.46 $0.46 11/4" Btam S~xing Check Valve 1 27.06 $27'.06 11/2" PVC Union 1 7.60 $7.60 6' 3 0utiet Extanaion Cord I 8.61 $8.61 3" Type C Screw,3 Per LB 1 3.50 $3.50 30 Amp Pow~, Relay and Du~t Cover 1 46.46 $46.46 4' x 8" ^lumlnum Flax Duct I 8.11 ~8.11 4' Vent Clamp 1 1.06 $1.06 4" 30 GA 90 DEC Galv. Elbow 1 4.1 $ $4.11 1/2HP ,~hallow Walt Jet Pump I 230.0~ $230.06 Nonvesco 300 Gallon VeCical Tank 3 427.45 $1.262.35 Non~esco 166 OaJlon V~tic=ai Tank I 303.75 $303.76 Electrlco Pun'~ Switch I 46.28 $46.28 Nonveeco 11/'Z' DBL Treaded Fitting 1 12..39 $12.39 11/4" C, alv. 90 I 2.~4 $2.94 Holddte Quick Strap 4 18.14 $72.56 e Oz. Pvc C~-nent I 3.20 $3.20 4 Oz. ,NI Ptz.p. C~:~"irner PU~le I 1.g8 $1.98 11/2" PVC Sllp Cap 1 0.54 $0.54 Z' x 11/'Z' PVC SPG x S Bua~tng I 0.95 $0.95 2"x 1114"$PG x g 8ustdng t 0.95 $0.95 11/2' x 3/4" $0 PVC $PG x TH 6u~ing I 4.46 H.46 Sub~tal Page I $2~146131 05/10/200! 89:29 9076902403 BOYER T[144 & F'ciEJ~ PAGE 04 WAULt. A. AK ~oT $/'e.2U* FAX SOT 373-3aet I~voice ~: 0~04 8-10.01 INVOICE I IJ~ He[Icl I' Part~ I~ee~..~otion Pfioe, Amount nce ~o~wem tor ~'g. 1 1/4" x I 1~ S~dard Bra~ Nixie I 0.91 $0.91 2' ~ ~P ~ 4 0.~ ~.~ 11~SxSxST. 5 1.10 ~ ~ S X S ~upit~ I 0.78 $0.78 2x4 8 FL D;led 5 6.~ ~2.~ : 2x6 8Ft, 1 10.~ InVOice Total' TOT~. P.02 -- ,/ APPLI(' NT FILLS OUT UPPER HAl ONL'Y Property Owner Phone . ,. ;, , ,' , ,. Zip Code Buyer _. Address ,, ', , , . ,. ,. Zip Code _ Lending Institution Phone, Address ,, . . Zip Code " · Phone Address ' - Zip Code Legal Description Street Location r, , , Type of Residence Single Family Multiple Family No. of Bedrooms ., / [] Olher : Water Supply individual ATTACH WELL LOG. A we{I Icg is required for all wells drilled since June 1975. ' Community For wells drilled prior to that date, give well depth (attach Icg if available), [] Public Utility Sewer Disposal · .~ Individual Year Individual Installed: Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Date Date Date Date Inspector Inspector Inspector Inspector Field Noles: MUNICIPALITY OF ANCFIORA~[ RECEIVED (~) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) D~SAP~OVE9 ( ) CONDITIONAL APPROVAL* Soils Bating Date ~wer Installed Well To Absorption Area Well Log Received ~ ~'. ~ . ~ Well to Tank Septic T~k Size / 2~ Y~ "ZJ 72-023 Time Inspector Time Date Comments Date Sewer Installed Soils Rating Permit No. Well To Absorption Area Well te Tank Conditional Approval ,qe Date Inspector Septic Tank Size Holding Tank Size Well Log Received 7 Property Owner Mailing Address Address Lending Institution APPLICANT FILLS OUT LOWER HALF ONLY ./..J/, h..% // Address Realty Co. & Agent Address Legal Description Street Location Phone ?77 Phone Phone Type. of.~esidence I~f'Single Family [] Multiple Family [] Other No, of Bedrooms Water ~S_upply I~ Individual [] Community [] Public UtIIi~ Sewa~g..,~Disposal ~ Individual [] Public Utility [] Holding Tank A'Fi'ACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach Icg If available.)~ Year Individual Installed: ___ ~/~ ,~ When Connected to Public Utility: NOTE: THE INSPECTION FEE I~UST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. EXCAVATION ROSERTA. SHAFER WORK Play 2, 1982 CIVIL ENGINEER 694-2979 John Walsh SR Box 216 Eagle River Road Eagle River, Alaska 99577 Dear Mr. Walsh, Reference: Lot 1: Block t~ G~oll S~bdivision A sewer system adequacy test was performed on the referenced property as you requested. The septic tank was pumped and verifeid to have a capacity of 1250 gallons. The seepage pit was charged with 500 gallons o~ter and'after a period of 24 hours 696 gallons had percolated out of the crib. It can be concluded from the above test that the waste water disposal system serving the ~f.o~u~rD~m~.residence located on this property is currently functioning adeaquately. However, the system cannot be guaranteed aQainst subsequent failures, Also, as referenced by the MunicJ. pality the well wires in the well were inspected and note~ to be in conduit as required. If we may be of further service, please do not hesitate to call. / cc: Trans-Americana Relocation Center Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA ~ATE RECEIVED INSPECTION APPOINTMENTS ( ,~Ti MF DATE INSPECTOR ~NSPEETO~ j MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE 825 L Street - Anchorage, Alaska 99501 (~) ENVIRONMENTAL SANITATION DIVISION jUt_ 8 1980 Telephone 264-4720 DIRECTIONS: Complete all parts on page 1, Incomplete requests will i]ot be processed. Please allow ten (10) days for processing. 1, PROPERTY OWNER PHONE B~uce/Aose G~o11 69~-9~2~ MAILING ADDRESS 315 9i9 C~eeA Aoa~, ~akeslAe, O~ego~ 97~49 PROPERTY RESIDENT (If different from above) PHONE 2, BUYER PHONE ~o~ H, Walsh 272-9802 MAILING ADDRESS 1800 ~o~th SaZem~ ~cbo~age 9950~ 3.'L~ND~NG INSTITUTION ~ PHONE Pi~st ~atio~aZ ~a~k o~ A~cho~age~276-6300 MAILING ADDRESS Post O~ice ~o~ 720 99510 4. REALTOR/AGENT [ PHONE Virginia ~oh~ieZd B A~ea Aealto~s~ 69~-9555 MAILING ADDRESS ~ost O~ice Box 249 99577 5. LEGAL DESCRIPTION Lot 1 Block 1 droll Subdivision STREET LOCATION Mile 6 Eagle River Road 6. TYPE OF RESIDENCE ~ SINGLE FAMILY [] MULTIPLE FAMILY 'JUMBER OF~BEDROOMS E] One ~[[~X Four E~ Two E] Five [] Three [] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTILITY * ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY 1977 YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [~] SINGLE FAMILY [] ONE [] THREE [] F~VE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2, WATER SUPPLY . [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [~]INDIVIDUAL/ON -SITE DATE iNSTALLED [~ PUBLIC UTILITY Connection Verified INSTALLER []Septic Tank or [] Holding Tank Size: I~-$-t~ If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCESwELL TO: Septic/Holding Tank Absorption Area ~ Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [][~] CONDITIONALDisAPPROVED APPROVAL (letter must., f~/..'~ .-~acc°mp/'an¥-¢~rtificate) PAR "[MEN 825 MUNIClPA!.!TY Or` ~\NCHORA6E 3F ttEALTH AND ENVIRONHI{NI, PF'.O'rECFION 7C SLuooL, Anchorac~r',, Alaska 99~0,1 ' ~0-' DaLe Receiw:cl: November 22, 1977 Time 9:30 a.m. lake 11-28-77 Monday Data DaLe Insp Pratt insp [nsp, ' ,lA% N~'. FACI L £'P_[ NS FOR A]?!~ROVAI, OF INDIV1DdAI, S/':WER AND ].. bending ln.qtit:ut.ion llequest: Alaska Bank of Conmlerce ' F---,4~'- 712 West 4th Avenue 99501 Phone: 279-5641 l:.'~a.J.]ing Ad.l~ c ..... _ Proparty Owner: William B./Rose Grolt Phone: 694-9421 Mailing Address: Star Route Box 216 99577 3 I,ega. 1 DcscrJpl, ion: Lot 1 Block 1 Groll Subdivision 4: Single Fami]_y Res i_danc:a: (x:~ Number of Bedrooms Four Mul'hiple I"amily Residence: ( ) Num}),.;r`- of Bedrooms 5. Well System: Individual Well (x) £:otmuuniky/Pubiic Sfst.em ( ) Pc)m~.i'L ![ Dap'th of Well 190' Well boq on Fi.l(.' ( ) Co~} s t:r u.c h ion Bacter/a'L Ana].5, sJ.s 6. Sewage Disposal Sys'kcm: On--si. La Sys'uem Publ'ic Ut_iii. fy ( ) l?ermit {~ '[ri s La ].J. ed 1977 Instal la- Abso:t:ptio]l Area .~ ......... Soils Rata M a t e r .i. a 1 7 Dist:ance:~: Well to ' ' ' ' · S(.I?'_i c Tank to Sewer.' L.i. ne Naa. rcs[' ]-,ok l[na Lo Nc:arest Lok to Absorpt-ien Area Abso¥'pt J_on Area Rc~ thc ..... For hpl)rov¢~l oJ: :Lnd]vJduaJ_ Sewer Legal Description: __~0~__.~ ~_OC_~ &_G.~O~_,~.p~di~_~i_9_~. Affadavi'h AthacNed: ~q I, etteu Attechefl: ( ) D.isapDro'vo(.... . : llake: Department; WorksNeck: i4UNICIPAI_ITY OF ANCHORA6 Dep~rh~ent oE Healt. h and Environmenha'l_ 825 L Shreet, Anchoraqe, Alaska 99501 2 6 4'- 4 7 2 0 , ~equest for Approval of Individual Sower and Water Pacilities /~q~.'~ Name of Buyer: Hailing Address: Phone: Hailing Address: _~'~__~2~ _~___.~. ~. ................................ Phone: Rea].tor/Agenh: HailJnq Address: PhoNe: Sinqle_ Fami]',/ ~R(,~'.~idc'nce: Multiple ]"amily Residence: {X~_.Number oJ: ]3edrooms: ..... ( ) Number o[ Bedroom.s: ,(_r Supp y: ' Ind.ividual We].I ( ~Pub.I ic/CommtntJty System ( ) IL' [nc]ividua]_ Well, we] 1 depth If Co~m~un;i. ty System, name of system Sewage Disposal System: *'lJn-sihc Syshem (~ Pub].ic Sys'hem ( ) If On-siteo: ...... ~ta,,~' ~" dale of Jnshal]atJ. ou: ~{~4~,_.~.¢__L~ ........ {~__Y *NOTE: A well log is required en Ali,l, wel].s drill, ed since 6/75~ ** If eh-site sewer system is over [-we(2) years old, an adequacy 'Lest is required by khis department. A fee ef $25.00 must accomNaxy each request beC'ere p~ecessing c~u', ))c JnJt~aLe'd. 3/77 Sa~itarian GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "c" Street, Anchorage, Alaska 99503 274-4561 Date Received m ~//~ ~ .. /'~/~./~ 0~,Time of Inspection / ~Ur REQUEST FOR APPROVAl. OF ~ INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: Mailing Address: , Phone: 2. Property Owner: . ~l APo (~L~I ~ Phone: 3. Legal Description: 5. Type of,facilitY to be inspected 6. Well Data: A. Type __J~u Y~ ~_L.~'. ~ C. Construction Sewage Disposal System: B. Depth I~C] . D. Bacterial Analysis ~ ~//,~9,~- ~'~.. A. Installed B. Installer C. Septic Tank: · D. Seepa'ge Pi.t: E. Disposal Field: 8. 'Distances: 1. Size 1. Absorption Area Total length of lines 2. Manufacturer 2. Material A. Well to: Septic tank , Absorption area , Sewer Lines Nearest lot line , Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot. line EQ-O34 (1/74) Page 1 of two pages Page 2 of two pages - Req Legal Description st for Approval of Individual E .~r & Water Facilities Comments Approved Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily, SIGNED Date EQ-034 (1/74) 1. Type of Inspection: 2. Property Owner: Mailing Address: Name of Buyer: Mailing Address: 4. Name of Lending Institution: Mailing Address: 5. Name of Realtor or Agent: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" Street, Anchorage, Alaska 99503 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES CMRO VA FHA CONV /--/'/ Day Phone Phone Mailing Address: Phone LegalDescription: _/~2-/'-' / /~//~' / Location:_ /~ ~' Type of Facility to be inspected: -~f~/'l~r Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well /,~0 ~ Bd s Individual Sewage Disposal System Type of System: If Individual, date of installation Public Utility EQ-037 (1/74} Individual (on-site)