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DICK'S LT 1
Dicks Lot 1 #015-242-38 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211208 PID Number: 015-242-38 Dwelling: ❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New R Upgrade Name Peter Davis & Linda Shepherd ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7600 Alatna Avenue, Anchorage, AK, 99507 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 223-2305 4 Existing GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Dicks 1 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well >100' N/A N/A N/A >25' TANK Septic El[:1ElS.T.E.P. Holding Other Manufacturer Greer Capacity 1250 Gal. Surface Water > 100' N/A N/A N/A Material Plastic Number of compartments 2 Lot Line >5' N/A N/A N/A NA Foundation >1 0, N/A N/A N/A LIFT STATION Manufacturer Capacity Gal. Remarks Tank replacement only Alarm location Electrical installed by PIPE MATERIAL House to tank D3034Tank to D3034 drainfield Installer Anderson Contracting & Environmental Septic Drainfield Existing CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 15t 7/2/21 Location and description dates: 2n Garage slab 3rd 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp F AJ Conditional Approval: Date �FQ, . • • ' ...... 49 71 �j Be njarrit9l,'3chiller •• CE 12592 • �`��'� '�� Septic System 7 �D Approved Date o 10?' est x/20/21 • . �' F�Fa )PROFESSIQ�P�'� ' Note: this approval does not include well permit requirements. � (Rev 05/02/18) Benjamin Schiller CE 12592R E GISTEREDPROFE S S I O N A LENGINEER1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND PERMIT # OSP211208 PID # 015-242-38 DICKS SUB, LOT 1 A B 2CO1 26.5 MH 28.0 SV 31.3 A B 2CO2 33.5 50.0 50.6 52.5 53.7 FEET 0 50 100 2CO1 ALATNA AVENUE 4-BDR M H O M E July 20, 2021 GALENA CIRCLESHED 10' UTILITY EASEMENTEXISTING WELL NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY EXISTING TANK REMOVED AND DISPOSED OF EXISTING ABSORPTION FIELD TO REMAIN IN SERVICE 2CO2 100' WELL RADIUS SEPTI C A R E A EXISTING WELL SV MH PLAN AS-BUILT PROFILE AS-BUILT (NO SCALE) 97.9 92.7 98.2 105.1FCOMH SV1250 GAL SEPTIC TANK 2CO97.7 Benjamin Schiller CE 12592 R E GISTEREDPROFE S S I O N A LENGINEERJuly 20, 2021 PERMIT # OSP211208 PID # 015-242-38 DICKS SUB, LOT 1 ALATNA AVENUE z tQ � 138.5' 10.3'x122' SHED Lot 4 W/ 5.0' DECK RETAINING G 10' UTILITY EASEMENTS I S 89'54'00°E 285.01' LR"'' 3�A O\ a Lot 1 >o� 12.3'x13.2' DECK 41,210 S.F. Lal So 2.2' CANT C-) � � I — 3y SPL\Z��NGE SWELL I (-) 94.9' o w. o Q 0 1S4 10.0'x22.0' DECK O Z La PIPES / WOSEPTIC ODEN WALKWAY 0 J N /PROTECTIVE WELL RADIUS ALL \C/ / MANHOLE -I , / 25.0' Lot 2 I PLOT PLAN ___ AS BUILT _X_ SCALE _1=_= 50__ GRID _ SW 2740Project No. _-__21_4441R1__-- 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone 00000pO0 Professional Land Surveyors (907) 5kenOlan92-46survey5 Fox2-46pF A��oa4 C� jonathanOlangsurvey.com I hereby certify that I have surveyed the following described property: LOT 1, DICK'S SUBDIVISION (PLAT No. 79-39) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. -KA Dated this the �'Day of Su' -------, _� =! at Anchorage, Alaska It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 4. 9TH . �* KEN• IAN. ar tA S- 202.•' gJ4G aR ado �4��OFFSSIONA� �o MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211208 Work Type: SepticTank Upgrade Tax Code Number: 01524238000 Site Legal Address: DICK'S LT 1 G:2740 Site Mailing Address: 7600 ALATNA AVE, Anchorage Owner: DAVIS PETER H 50% & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: % Dcpartinent 6/16/2021 6/16/2022 41210 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Veronica Pope GE 2021.06.16 Received By: 13:50:35 -08'00' Issued By:fii Date: / Date: tO d M MUNICIPALITY OF l_ d Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I. D. 015-242-38 Property owner(s) Peter Davis & Linda Shepherd Day phone 223-2305 Mailinq address 7600 Alatna Avenue, Anchorage, AK, 99507 Site address Same Legal description (Sub'd., Block & Lot) Dicks Sub, Lot 1 Legal description (Township, Range & Section) Lot Size 41,210 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo AD U) Septic Tank ❑X Upgrade ❑X Duplex ❑ (D) Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 22 — Waiver Fees: Date of Payment: (0 Date of Payment: Receipt Number: © 2 g b r7t Receipt Number: Permit No. �5P2 1120�b Waiver No. Permit App__- : ._..:c June 7, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 6/7/21 Subject: Dicks Sub, Lot 1 – Alatna Ave Septic system design Dear On-Site Services Engineer: The owner of the above lot has a septic tank that has reached the end of its expected life, so we are submitting this permit application for its replacement. The attached site plan identifies the location of the home as well as the wells and septic location. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. The new tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption fields. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211208, Rebecca Carroll, 06/16/21 Benjamin Schiller CE 12592R EGISTEREDPROFES S I O N ALENGINEER 1"=50' CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND DICKS SUB, LOT 1 FEET 0 50 100 2CO NOTE: NO SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. ALATNA AVENUE 4-BDRM HOME June 16, 2021 GALENA CIRCLESHED 10' UTILITY EASEMENTEXISTING WELL NEW 1250-GAL SEPTIC TANK w/ 20" MANWAY INSTALL DOUBLE CLEANOUTS BEFORE & AFTER TANK DECOMMISSION EXISTING TANK PER UPC EXISTING ABSORPTION FIELD TO REMAIN IN SERVICE 2CO 100' WELL RADIUS ≥5' SEPTI C AREA EXISTING WELL Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211208, Rebecca Carroll, 06/16/21 10!07/13 11:58AII ANCHORAGE WELL 6 PUNY 19072430742 p.02 Pump Installation Date: U? —/6 / ,7P Ptimp Intake Depth Below Tap of Well C41sin„:304— feet PLLTtip ':4iaBiUfaC2tlreY�51`l:tme: �i.�.yi,.� Pump Model: cs` M: ( 2_.... Pump Size l�hp Pltless ,Adapter Burial Depth: ( �, fret Pitless Adaptec' Yl anufactorer's Na rite: Pilless Adapter installarc— % Y4, Well Disinfected Upon C mnpletioa". Y¢s Fil No Method of Disinfcetitut: Comments; Anctlorage Pump & Wet1 Service Pump installer dame: 330 East 76th Avenue Anchorage, Alaska 99518 Phone: 907-243-0740 Pax: 907-243-0742 Attention: 'I:e pu p iostaflat shall prcw'sde a pump ms:ctliation logy to the [751:) w'sChi .id days ct PUMP irtst:dlatii)I1. ULil4 ItG so -fury t1iiV 1510~1 �Q� 3 i-GtIfW J'I CES Mork Saywh Pump Installation Log Weli Drilling Pert'lli Number; SW.,,,,—. Date of Issue: Parcel Identification ?lumber:_—._... Legal Descrit)008 Pra e ty Qwiter Name & Address: D f Ci Y Pump Installation Date: U? —/6 / ,7P Ptimp Intake Depth Below Tap of Well C41sin„:304— feet PLLTtip ':4iaBiUfaC2tlreY�51`l:tme: �i.�.yi,.� Pump Model: cs` M: ( 2_.... Pump Size l�hp Pltless ,Adapter Burial Depth: ( �, fret Pitless Adaptec' Yl anufactorer's Na rite: Pilless Adapter installarc— % Y4, Well Disinfected Upon C mnpletioa". Y¢s Fil No Method of Disinfcetitut: Comments; Anctlorage Pump & Wet1 Service Pump installer dame: 330 East 76th Avenue Anchorage, Alaska 99518 Phone: 907-243-0740 Pax: 907-243-0742 Attention: 'I:e pu p iostaflat shall prcw'sde a pump ms:ctliation logy to the [751:) w'sChi .id days ct PUMP irtst:dlatii)I1. '?--L49 t--Ild -A— MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 3 _ VNEW ❑ UPGRADE MAILING ADDRESS n /(/✓, LEGAL DESCRIPTION LOCATIO NO. OF BEDROOM 44 <* (� V Y Well DISTANCE TO: d loo Absorption area Dwelling PERMIT NO. ' �— 5 l03 Y _ LZ W Q h Manufacturer Material ^� No. of compartment t y Liq. r pacity in.gallons �6 Inside le Width Liquid depth IF HOMEMADE: Y JAZ DIST TO: a Dwelling PERMIT NO. = Z M acturer Material Liquid capacity in gallons D w= DISTANCE TO: WellFoundation ' _(7 -Id Nearest lot line PERMIT NO. u d3 -1 J LL Z F- Z w No. of lines Length of each line Total length of lin s Trench widt Distance between lines inches r) Q Q p11-1 Top of tile to finish grade Material beneath tile Total effective absorpti !� a%J inches ` V W C7 Length Width Depth PERMIT NO. QF- o, a w T of crib Crib diameter Crib depth Total effective ab ea 'L a DISTANCE TO: undation Nearest lot line J J ass Depth Driller Distance to lot line PERMIT NO. d W Building foundation DISTANCE TO: Sewer line Septic tank r Absorption area(s) r , OTHER PIPE MATERIALS kb 3 oy SOIL TEST RATING INSTA ER REMARKS �- r' C W � L APP OV DATE LEGAL 1l / --a /-I e I 72-013 (RebA/78) TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3/4- SOIL RATING (SQ FT/BR)= 140 THE REQUIRED THE SOIL ABSORPTIONM IS: ` mJ �*J � �� � 41 �oF. �����U_l E- EE F-�:`F��= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��Q U I Fc E: E--* EF_ F" -T 1 1 2! EF_ �C21 Cl "-- PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONSOF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. �t-_j 11-3 W_" 2: > �����������:F. " F-'- I= �������� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY,.---; OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=* FEE F-"- M I -T" U X F=" I F:; -'-"U "E-7. CNFEE 0 E: M E�-EFR! a --::L" ����� " I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES ] I UNDER5THNENLARGEMENT IF THE RESIDENCE 15 R-MiDELED TO IN UDE MORE THAN SIGNED:AP CANT Y-36 �~"^^ --- --,� ' DI CK W, GHT ^f �/ Irl LJ N? CD F7 F-1 r4 IC2 Vi ?"Fl 1-3 FE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PKOTECTION ' 825 'L' STREET, ANCHORAGE, HK. 99501 � 264-4720 L-A EE L_ L_ ��4 I---- r-4 —"a-. I -F EE ��L-J E=_ Fic" Fl* E=_ FR r-1 1 7 PERMIT NO. ( 781034 ) ` APPLICANT DICK WRIGHT SRH BOX 1585H 244 4214 LOCATION HTLHTNH/DICKS STREET LEGAL T12N R]W S24 SM LOT SIZE 41210 SQUARE FEET 00 TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3/4- SOIL RATING (SQ FT/BR)= 140 THE REQUIRED THE SOIL ABSORPTIONM IS: ` mJ �*J � �� � 41 �oF. �����U_l E- EE F-�:`F��= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). ��Q U I Fc E: E--* EF_ F" -T 1 1 2! EF_ �C21 Cl "-- PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONSOF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. �t-_j 11-3 W_" 2: > �����������:F. " F-'- I= �������� BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAY,.---; OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F=* FEE F-"- M I -T" U X F=" I F:; -'-"U "E-7. CNFEE 0 E: M E�-EFR! a --::L" ����� " I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES ] I UNDER5THNENLARGEMENT IF THE RESIDENCE 15 R-MiDELED TO IN UDE MORE THAN SIGNED:AP CANT Y-36 �~"^^ --- --,� ' DI CK W, GHT ^f �/ "+ 1 tW til lg' SOI Q5LQ r, 4 �r - !ry 14} MUNICIPALITY OF ANCHORAGE IJ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOi gTi1h 'TEST Pouch &650, Anchorage, Alaska 99502 276.2221 tr�Scla/,,��� �r SOILS LOG -- PERCOLATION TEST tr 1 NEIi1:00 -0 Ft1R ��� • �O, _ —. __.-� � DATE PERFORMED: r E ijSLOPE SITE PLAN /Q Of CPTH A Tf� �' ML• •�yra,r�sY coarst ' t , i } 0 1 y� �. _ " . sandy yrri✓� � i � ' - r. r f { { ' MM e /ray Sand � z I i i : fit}'- y h +� drys — WAS GROUND WA,TFRA&S ENCOUN"FEREt�? 2oro NM ri' �i IF YES. AT WHAT { r ' 13 ' % al si//y r�d and Q�d Sri y Reading Date Gross Net Depth tbe'. Time Water t?ft1t Time he/ow uboN/ 141 JWIA a6 Cpb��1b/eS ..r$" '�llth ;n1d 1"rivirorim.on" ot ,t I De) mit Of Ite I 276-229", Pe rfc)mied for l� I LepI De,cripLion A;k 56c, R2N, - 3.W This 'form reports: S (Y I I s I Pfrco'la'(Jw on L,t Depth Feet -00w cor-, 54 2 4 V% 7, v- 9 10 /o/ 0/)() :5;1-xy 12 - 113 - 14 - ------ 16'— Was ground water Cilcountered?I f it mIaL d(�Ah? - YE i(eading I)a to taros I )(,[)t.;l to IVIt(' 'C#Ple- iC AAW N -t 0 77 7 fi-p'r'c-olation rate Proposed i ns La I I a t im )ee Pit liepUl of Inlet Depth 6o' lJoLtom of 1) i 1, r trench COHMNIS: 40 d7 o;F& 01 ��.�/r,��ior, r a� !� ' h /�/ /%��/y yn Ih� ,rrn � o�c5 �a l�Q Perfurined ky: ,to'_.._ EQ 040 (6/74) ro 9 10 /o/ 0/)() :5;1-xy 12 - 113 - 14 - ------ 16'— Was ground water Cilcountered?I f it mIaL d(�Ah? - YE i(eading I)a to taros I )(,[)t.;l to IVIt(' 'C#Ple- iC AAW N -t 0 77 7 fi-p'r'c-olation rate Proposed i ns La I I a t im )ee Pit liepUl of Inlet Depth 6o' lJoLtom of 1) i 1, r trench COHMNIS: 40 d7 o;F& 01 ��.�/r,��ior, r a� !� ' h /�/ /%��/y yn Ih� ,rrn � o�c5 �a l�Q Perfurined ky: ,to'_.._ EQ 040 (6/74) ro ,Fhts ScoL-s -TZST W n s tio-l— C -M (10 Vo Y L L t -L M -W DRILLING, INC. DRILLING LOG Well Owner Use of Well Location (address of: Township, Range, Section,} if known; or distance main road C ) �-� r,. ' Size of casing Depth of Hole feet Cased to feet Static water leyel ft. ,below) land surface. Finish of well (check one) open end Screen Perforated Describe screen or perforation s r t=e=f o -'r a -i- i V.- J. A Well pumping test at gallons per ?Yftr) (minute) for hours with s is ft. of drawdown from static level. Date of completion l9 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness TO , C gmic Uasir TO TO Silty gra-xn�i TO Sandy v, t TO Uard. pIll i TO ' S o .' t j L wa ter e -1 �4p TO —TO- -TO— TO TO TO NAVVYA Coi-flfied Colltractor Ccrijf;c'Je No',,,. 614 Ck TO TO 3 — CONTRACTOR Municipality of Anchorage CCS ' Development Services Department Building Safety Division s, On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLINGt Q� Parcel I.D. 015-242-38 HAA# C_26a- 1. GENERAL INFORMATION Expiration Date: _fl)c Complete legal description DICKS SUBDNISION• LOT 1 Location (site address or directions) 7600 ALATNA AVENUE * ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address CLAY HIGHTOWER Day phone 677-3350 7600 ALATNA AVENUE * ANCHORAGE AK 99516 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 Day phone Day phone 3. "TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: - Individual Well -_. w Individual On-site --- Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Health Authority 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Phone Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any otherperson or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for _ Attachments: HAA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing 337-6179 Date ! 17-0 L04' L TY OF%r, ON-SITE �r°v _ WATERAND m, WASTE A ; _ 41E ' OTI DM ' _ Manitenance Agreements Supplemental Engineer's Reort Other By. t\ Q , Original Certificate Date: (Rev. 12101 municipauty or Ancnorage .`,". Development Services Department .2. ... n .:Building Safety Division " � .... W4dt1er ucC�(?ii1an (807n34oS�7ao3s9rr:ra7faegg9wee0aadwateSii_Kr_iu�3� s (�".w�..G."�.... .w .. ,. IFF lv/N. Well Log (Y/N) 7tJ Wires properly protected (Y/N) YES ,{ Casing vgheight (ab ove ground) 18+ in a[� ?, a W A. 1 Y dii i.. 011, f 'ty' F ml. Nitrate' 6.9 :,�_ucpmaawn wer tarlrc kTIN)w= rllgn waier, alarm (YIN) IN/ /A Pumper" MCDONALD'S PUMPING $'.�Y'a�3€*�i"�r....+„"+':�3tN�,.oww•" `";"`"�,.°.�,."v`"a'�`�'`�'ia:"4�.'�. t`ss�" `"�" loms Lin. .p.d. Date of Paymenl Receipt Number I fCirougfi field inspections antl .. - Q at the above systems are in twdelmes in effect on this date 5 Q of QQ y Gam sr ' p� JEFFREY A: GARNESS G -7953 mp Pofesslo°„jv—�� > �04000� Date of Paymenl Receipt Number 07-09-04 07`:09AM FROM -CUE ESI, SGS ENV SERVICES' _SGS.. 9075615301 T-994 P.02/03 F-068 Laboratory Analysis Report SGS Ref.# 1043835001 All Dates/Times are Alaska Standard Time Client Name Garness Engineering Group, Ltd. Printed Date/Time 07/08/2004 14:29 Project Name/# Dicks Lot 1 Collected Date/Time 06/30/2004 13:35 Client Sample ID Dicks Lot I Received Date/Time 07/01/2004 11:40 Matrix Drinking Water Technical Director Step e . Ede Released B Sample Remarks: AOo Ic Prep Analysis Parameter Results P L Q Units Method Container ID Lrmits Date Date Int Waters Department Nitrate -N 6.98 0.100 mg/L EPA 300.0 B (<=10) 07/01/04 IIB Microbiology Laboratory Total Coliform 0 coV100mL SM209222D - A (<=1) 07/01/04 DKC 0"UFnmmu,;�ema{Seri;:.n•; Ir„ 1 ubwtary Division ,200 West. Potter Dive, Anchmaye, AK 9951 B-1605 t(9071562-22430071561-5301 vawwsgsenvilonmenta nom Memhel of cho SGS Group {Socilt! Glnemle Qe Surveillance) 07/01/04 THU 08:21 FAX 9075014041 Sramek Hightower CPAs fa002 Ze"d ib1O1 H O d W s � a o Y/ 79 O y7j V� d� O y G� ✓` � O A. C N:E N d_ S• n • c a � v s e L '2 v C Z'p 4{ ti O � J a 'W/w� 9 p• u3 v G .2J � � tl P m 9 V yy � ry 3-13MID VN3'IVE) (a) ,11.911 3.00,£Oo00 N Gni -• .� W 09- nn �3 Rr O yi W �' � p N� cY 4i � •R_ ■1111 N W _ Zyti , 1 •6£ 1 Q 47 k`li �Y —__----- __-- _____—__ LN3WHSV3 K",IfLn .01 2 Ln N (1 Ri ; 0E 'Fe"d TTZT b89 Los S11Ma3NIhN3 STS TD:cT ]oZ-cT-f10N W O D � O 4 1 O � J Ln N (1 Ri ; 0E 'Fe"d TTZT b89 Los S11Ma3NIhN3 STS TD:cT ]oZ-cT-f10N MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel l:D.- 015--242-38 - - - - - -- - 1. GENERAL INFORMATION Complete legal description Dick's Lot 1 Location (site address) 7600 Alatna Ave Expiration Date: 6 ' s'v --2-2- 2. 2-Z Current property owner(s) Peter Davis & Linda Shepherd Day phone (907) 748-6391 Mailing address 7600 Alatna Ave, Anchorage, AK 99507 Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic Q 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 $ 550 Waiver Fee $ Date of Payment Date of Payment Receipt Number )-D Receipt Number COSA# 0 S C 1 0�� t 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 6/10/22 of •164gkhl *: 49 TH • * / 6. DSD IGNATURE / % System #1 Approved for _1 bedrooms '� Ben' . .. ...... . Ben)arr�rySchiller / System #2 Approved for bedrooms ����sfF9. • E125922 •����`��/ Disapproved 1�lFOPAVlCJJ. ' 4� Conditional approval for bedrooms, with the following stipulations: \\�����G\PA O/VC-1 1111A ti F Mrrl l'1/,gsr RAN 1 By: Original Certificate Date: _ 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Dick's Lot 1 Parcel ID: 015-242-38 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ❑ Well log is filed with Onsite (or attached) Well production at time of test 3.2 gpm Date drilled__ 5/30/1979 Waterstorage tankvolumeN/A -gallons Total depth 100 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 60.6 ft ❑ Coliform bacteria is Negative ❑ Sanitary seal is functioning correctly Nitrate 6.71 mg/L ❑ Nitrate less than MRL (ND) Al Wires are properly protected Arsenic ug/L n Arsenic less than MRL (ND) Casing height (above ground) 24+ in. Collected by Forge Engineering Date of flow test for COSA 5/11/22 Date of Sample 6/9/22 Static water level at beginning of test 30 ft. Comments B. TANK DATA Age of tank(s) `1 years Tank type/material SEPTIC/PLASTIC Measured operating fluid level in septic tank 58 ❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Which system tested (date installed) 11/2/1978 FOR ALL standpipes present per record drawing Total measured depth from grade 7.7 ft (max) Measured depth to pipe invert from grade 13.8 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 6.1 ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet C. LIFT STATION uired maintenance completed Age of lift sta years Lift station material Comments: Adequacy test date 5/11/22 Results Q Pass For 4 bedrooms Fluid depth prior to test 7 in Water added 776 gal New depth 41 in Elapsed time 1440 min Final fluid depth 3 in Absorption rate '600 gpd Any rejuvenation treatment (past 12 months) N/A If yes, enter date N/A 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' F/ Yes Community Sewer Manhole/Cleanout > 100' Q✓ Yes if No ft M Yes if No Neighboring Tank > 100' F/ Yes if No ft Private Sewer/Septic Line > 25' M Yes if No Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No Neighboring Absorption Fields > 100` Yes if No Animal Containment > 50' P✓ Yes if No Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' M,'Yes if No ft P/ Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' El Yes if No ft Surface Water > 100' ft ft ft ft _. ft [✓ Yes if No ft Property Line > 5'✓0 F/ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100'✓❑ Yes if No. Water Main > 10'✓Q F71 Yes if No ft Community Wells > 200'✓CJ Yes if No. 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' 21 Yes if No ft If absorption field is under driveway comment below Property Line > 10' F/ Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0✓ Yes if No ft Private Wells > 100' Water Service Line > 10' F71 Yes if No ft Community Wells > 200' Surface Water > 100'✓0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet ft ft �✓ Yes if No ft �✓ Yes if No ft l9 TH Benja chiller I �F� •. CE 12592 • c�`L�i �! ��T�� • • 8/31!22 • . *�w �Uk,- PROFESSION.� www.muni.org/onsite Nitrate Advisory Certificate of On -Site Systems Approval # OSC 221271 Subdivision: Dick's lot 1 A water sample revealed a nitrate concentration of 6.71 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. Mailing Address P O Box 196650 *Anchorage, Alaska`99519 6650 *www muni org From Northern Testing Laboratories, Inc. Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass rapidly into ground water wells. SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is in the form of ammonia or protein first, which through contact with oxygen and certain bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also result from the breakdown of organic matter buried in the soil. TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or three years but is associated with a potentially fatal infant disease called methemoglobinemia. In the digestive system of young children, nitrate converts to nitrite, which can pass through the intestinal wall into the blood stream. There it combines with the hemoglobin and interferes with the ability of the blood to carry oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The standard has been lowered from a previous level of 45 mg/L set by the US Public Health Service and the World Health Organization. TREATMENT: due to its solubility in water and negative ionic charge, filtration and other common home water treatment systems such as softening, or iron filtration does not readily remove nitrate. The best method for limiting nitrate in well water is source control. This can include avoiding overdosing of fertilizer near the well and maintaining good separation distances between septic tank leach fields and the well. A special anion exchange filter that contains a media with a strong affinity for negatively charged ions in water, or by a reverse osmosis treatment system or distillation can remove nitrate. TESTING: Nitrate analysis is usually done by one of the several "wet chemical" methods using a spectrophotometer to read the final color endpoint. Specific ion electrodes also can be used to detect the activity of nitrate in water. This laboratory uses several different wet chemical methods approved under the public water supply laboratory certification program. They also have test kits available, which the laboratory uses to perform an inexpensive "screening test", and with which the homeowner can monitor the change in nitrate levels from their well. They recommend comparing the test kit results against a certified analysis from the lab occasionally to verify the accuracy of the kit. We recommend using a specially prepared bottle that has been rinsed in hydrochloric acid for collecting samples. Mailing Address P O Box 196650 * Ancha�rage, "519;6650 *www mum org Municipality of Anchorage O • -� Development Services Department Building Safety Division On -Site Water and Wastewater Program s . 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ct.anchorage.ek.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-242-38 HAA# 4,40,4c) Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 1; Dicks Subdivision Location (site addressordirections) 7600 Alatna Ave. Anchorage Current Property owner(s) Herschel Knowles Dayphone271-5145 Mailing address 7600 Alstna Ave. Anrhora;e, AK 99507 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address % Unless otherwise requested, HAA will be held by DSD for pickup. �L, la >r._ 4�4 �o Z 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well :9 Individual On-site E9 Individual Water Storage ❑ Individual Holding lank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer - ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 5 by an Independent professional civil engineer registered in the Stale of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues 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.) Cerlificrates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined In the Health Authority 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 riles and from my Investigation and Inspection, the on-site water supply and/or wastewater disposal system Is(are) In compliance with ail applicable Municipal and State codes, ordinances, and regulations In effect at the time of installation. • Name of Firm S & S Engineering Phone 694-2979 Address 17034 N. Eagle River Loop Ste 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Dale f 4.50 Z COWAN 5. DSD SIGNATURE r hroeEaT c 'a CE -880101 Approved for bedrooms. •, Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory ```,`Q 4�ZYtOFq /, ON-SITE. 10 WATER AND ; rn WASTEWATER ; PROGRA&I X Maintenance Agreements Supplemental Engineer's Report Other (N.,v 12") Original Certificate Date: 9_ q C :2— Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L- O T I Q I C K -3 5/'0 Parcel ID: C I -r - A v 2 -3 P' A. WELL DATA Well type PBl v* rC If A, B, or C provide PWSID # = Date completed S�9T otv""'Sanitary sealo/N) Yt-f Total depth 3 3 7 g Cased to HO ft. FROM WELL LOG Date of test $ 9 7 Static water level a ft. Well production % • S 9 -p.m - WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate q. fA mg.A. Arsenic: 413I. Date of sample: B. SEPTICIHOLDING TANK DATA Well Log (ON) YOY Wires property protected j9N) Yc f Casing height (above ground) 11f in. AT INSPECTION gb002 36 a.r Tank Type9lAateAal -iter STC At t Tank oliO, SY! gal. Number of Compartments Foundation dpakout 04) �$ Depression over tank (YA© "0 Date of pumping - .� I l o pumper / S'14 c S C. ABSORPTION FIELD DATA , Date installed //I) 17 q Soil rating (g.p.d.W o 1 H O Length q B ft* Width 3 ft. Other bacteria Ft] g.p.m. O colonies/100 ml. Collected by:' a. 391SIOINCCRIHC 17p34 Eayte Rlwr LOOP Road No. 20i Eftw Rher, Ala" "577 Date Installed // l a /-71 Cleanouts 04) y4f r High water alarm (YIM ^' O System type iR c,r C H Gravel below pipe 6 ft. Total depth -L4 ft. Eff. absorption area S7 b fie Monitoring tube Yt f Depression over field N o Date of adequacy test T / /S/ o } Results P s ail)Pa ri For Y bedrooms / w 5A..O4t/ Fluid depth in absorption field before test Z in. Water added G )S gal. New depth d o in Elapsed Time: Go min. Final fluid depth a 6 in. Absorption rate >= b o O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NON L x N* w r/ It yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons 'Pump ofr level at _ in. Cvr:lpe tected SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Oft station on lot 11 3 Absorption field on lot )00,4 Public sewer main K 1,4 i Manhole/Aocess (Y/N) HlghalafT�i level at Meets alarm R circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout rV 1.4 Sewer /septic service line a.,.? •f' Holding tank N /A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 1 Building foundation O Property line S iA Absorption field S r � Water main Water service line u f Surface water l a O f Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 f Building foundation /0 1A Water main N 1.4 Water Service line � o "- Surface water l O o Driveway, parltinghrehide storage ) o f Curtain drain N o w 4- k ,✓*w1✓ Wells on adjacent lots a o 4 F. COMMENTS G. ENGINEER'S CERTIFICATION I certlly that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name R 0.RHEAT C. �o w�1.✓ Date 43/ x dO 7— HAA HAA Fee $ 3 7F. r Date of Payment 8� f ? lO 1 Receipt Number O a 4 S J-0 (Rev. 12100) Waiver Fee $ Date of Payment Receipt Number `�.assaarw.' ...q . .SIB• ..r In. AUG -14-02 05:57PM FROM -CUE ENVIRONIENTAL SRV G CUE Environmental Services Inc. 9075615301 T-772 P.03/07 F-188 CTRRReLp 1024946002 All Dates/Timesare Alaska Standard Tlme Client Name S & S Enginecting Printed DateMene 08/09/2002 15:48 Project Name/N Various Collected Date/Time 08/072002 12:00 Client Sample ID Lot 1 Dick's S/D Recelved DateMme 08/072002 13:15 Matrix Drinking Water Technical Directo StepheprVNEde Ordered By PWS1D 0 Released By Sample Remarks: Allocable Prep Analysis Parameter Results PQL Units Methal Limits Date Date Init Waters Department Nitrate -N 4.82 0.200 mg/L EPA 300.0 (<10) 08/08/02 PLW Microbiology Laboratory Total Coliform 0 col/IOOml. SM189222B (<1) 08/07/02 SBH 6£-6t 'ON 1Vld A109f1S S,N010 1 LOl 3l :�0 -••.A , TV 31V0 SV ZOi£Zi9 ,6'46 M ,cm 3.03.e3Cf g b / Otl010 c2 b r w 0 (N) ,£91,0£ 3.92,6£,69 S (d1U 53d1d-015 O O �Ild3g 7Ad .� �p TNM ONg 9*0 -d N3000M ,SO'dA1 O x-� j✓v3 ss %max .Y1MJ� r O S N ' ysl O e•M ?.5�0 qa bla ` c. ;A 0 00 071793 3.00,49,69 S I \ (21) ,10'99Z SIM 3nN3AV VNIVIV Irl ew .. Segs I D r 8 m.a z w D 8 n m ioaq PUD •patDD!puI— io pasoq Suo!tonal3 n mi ayt uo jooddD l j IDUOA00 `SLUBWBSDa )t PUD •SuO!jJaUUOD 10191 apDJe Ou!pl!nq of jo!id `iaplmq jo 'tua!lo Aq pap!Aoid UMoys IOU aio tDId stu9w9sD3 :S31ON # , o A -�- - :�0 -••.A , TV 31V0 SV ZOi£Zi9 ,6'46 M ,cm 3.03.e3Cf g b / Otl010 c2 b r w 0 (N) ,£91,0£ 3.92,6£,69 S (d1U 53d1d-015 O O �Ild3g 7Ad .� �p TNM ONg 9*0 -d N3000M ,SO'dA1 O x-� j✓v3 ss %max .Y1MJ� r O S N ' ysl O e•M ?.5�0 qa bla ` c. ;A 0 00 071793 3.00,49,69 S I \ (21) ,10'99Z SIM 3nN3AV VNIVIV Irl MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services} j ` DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # C. i � - � I- \ •q" -'"14 S' HAA # _ \ Qlnk L) 11 L 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) lvT LocatioliN i 4 ss fir directipus 4j ,• (b) Propetr8idht'ps.�y.., FLFS Mailing k&d,;dsS�� (c) Lending Institufioh Mailing Address (d) Real Estate Company and Agent Address Telephone $;et Z Telephone : (home) 7 f �357�'Business Z'71- si3y Telephone (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3 3. WATER SUPPLY Individual WelN4_ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site` Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmfQ Telephone Address �117,- I 331 Date 3.A-71- P 6. DHHS APPROVAL Approved for % bedrooms by C�ir�r �r Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS 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. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) MUNIC F ANCHORA HECKLIST - FEBRUARY 1984 SERVICES DIVISION 343-4744 ENVIRONMENTAL Legal Description: 407-1 94le I �51GKf mAR 2 9 1989-Tiz.-/ E.3�J A. WELL DATA Well Classification RECEIVED��,�� If A, B, C, D.E.C. Approved (Y/N) Well Log Present(Y N) Date Completed Sia- 79 Yield Total Depth /" Cased to —� Depth of Grouting —T Static Water Level 33.E Pump Set At Casing Height Above Ground / _/ Sanitary Seal on CasingON) Depression Around Wellhead (Yo Electrical Wiring in Conduit&N) SEPARATION DISTANCES FROM WELL: / To Septic/Holding Tank on Lot �� ; On Adjoining Lots ley To Nearest Edge of Absorption Field on Lot /0 d' ; On Adjoining Lots / To Nearest Public Sewer Line IJIA To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ZS AW /4- Water Sample Collected by A PJ14rAl;Date� Water Sample Test Results fl/ft_ '7-- "'6)'m A 7Zf-0 ; 3• / Comments 4G)RL4 nOd 72'17' /O--3- r7. B. SEPTIC/HOLDING TANK DATA Date Installed -417y' Size /7Sd No. of Compartments Standpipes Y/ I) Depression over Tank (Y& Air-tight Caps) Foundation CleanoutoN) Date Last Pumped Pumping/Maintenance Contact on File (Y/N); for Holding Ta h ar•larm (Y/N) W,47-- Temporary Holding Tank Permit (Y/N) SEPAR ' I ?I bill N14�3� M SEPTIC/HOLDING TANK: To `"'A '� p1 ' �. f� To Building Foundation To P pyrLine To Disposal Field a,,, �r r :� tlNf7iF�r7lY�:a•Rgnny;a: To eri yy ar rivice, • D t To Stream; 1?6nd, Lake or Mfcorbrainage Course v v Comments t K 72-026 (Rev. 7/88) Front Page 1 of 2 11 5' It - 45" / f - S/ L / B t �)I cKs C. ABSORPTION FIELD DATA .��` Soils Rating in Absorption Strata Type of System Design /�61 Date Installed 11-7--78' Width of Field 3 Length of Feld Depth of Field Gravel Bed Thickness Square Feet of Absortion Area 52 (a Statndpipes Presentcy)N) Depression over Field (19 Date of Last Adequacy Test Results of Last Adequacy Test /�' u�'7� SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well /00 /� To Property Line To Building Foundation /O �4- To Existing or Abandoned System on Lot ; On Adjoining Lots G -,�" To Water Main/Service Line 10 ,14- To Cutback (if present) All To Stream, Pond, Lake, or Major Drainage Course /d �4- _ To Driveway, Parking Area, or Vehicle Storage Area /0 Comments D. LIFT STATION 11_a' te Installed Dimensions Size in st Manhole/Access (Y/N) "Pump On" Level at" Pump Off" Level at High Water Alarm Level at Vent (Y/N) _ Tested for Meets MOA Electrical Codes (Y/N) Comments ""Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked inspection. Signed _ Company Pumping Cycles during Adequacy Test. verified, or conformed to all MOA and HAA guideli+�«'P-tfWt%*n the date of this Gt it • � Qf AJ �� SGS Date ����' ;.;� • + er's Seal MOA No. i •••• •`.. , Receipt No. 0-5 x/05/;1 Date of Payment -2!2 " X Amount: $ _ 17Q< 0-o 72-026 (Rev. 7/88) Back C. REID, '•� CE - 2251 .• s **sell 4P Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562 2343 FEDERAL TAX ID #i 92-0040440 LABORATORIES ANALYSIS REPORT BY SAMPLE for Work Order # 12300 Date Report Printed: MAR 27 89 @ 10:36 Client Sample ID:L1, B1, DICKS PWSID :UA Collected MAR 22 89 @ 14:30 hrs. Received MAR 22 89 @ 15:00 hrs. Preserved with :NONE Analysis Completed :MAR 24 89 Laboratory Supe v's r :STEPHEN C Released By �' Special Instruct: Chemlab Ref #: 4621 Lab Smpl ID: 3 Matrix: WATER Parameter Tested Result/Units NITRATE -N Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY A. WIEN. 3.1 mg/1 Client Name A E C S Client Acct AKECSRP P.O.# NONE REC D Req # Ordered By Send Reports to: 1)AECS 2) Allowable Method Limits EPA 353.2 10 1 Tests Performed See Special Instructions Above UA=Unavailable ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than � THwsm FOR-OFFICIAL USE ONL1 3 r ,� - DATE RSGEIUEd INSPECTIOWAPPOMITME11l t -TIFAE :TIME' TIIUIE bA'rl= , DATE_ DATIE M PELT-OW 7 SPECTOR FNS ECTOR _ DIR EGTI QNS: 1:. TYPE;OF RESIDENCE NUMBER dF �I QAi34�NIS ❑ I}VOLE=FAMILY L7 ONE ❑ THREE ❑ Fl. ❑ OTHER ❑ MULTIPLE FAMILY ❑ TWO ❑ FOUR= C] SIX - = WATER SUPPLY PERMIT NUMBER INDIVIDUAL bEP�'F�DFINELL ❑' COMMUNITY DATE_-DRILLED . ❑_ -PUBLIC UTILITY Connection Verified LOC_f€EGEIV $� SEWA�'3E ©hSP(i�AL-SYSTEM PERMIT NUMBER F IND}V16UAVON -SITE DATE-INSTAL ED �JkIC UTILITY �onneGtion Verified - INSTALLER CSe�tic-flan or © Holding Tanis Size /3 If Tank is homem.ede sO1LS RATING =lmensians: - - T t-0122:TANK _ MANUFACTUR-ER "TAL ABSORPTION AIR -A = MATERIAL ?l DISTANCE sap�i= oldi�rT�rrl� Al�acrrptio� Area Sewer Line eacest of Una WELL TO: -Absbr !D Area to=reearesFm Lina APPROVED ] �BE-0ROOMS ❑ COT4b-fTI6NAL APPROVAL={leder-must-accoro _ y certificate) DISAPPROVED BATE 7 (Thie) - LE0AL DESGRIPTFON 72-o1Q (Rev. 3/7S Cir 1 I -LD �-)AO Opptember 17, 1979 Dick Wright Star Route A Box 3791 Anchorage, Alaska 99507 SubjectLot I Dick's Subdivision Approval for your individual sewer and water facilities can not be granted until the following iter is have been completed: (1) A well log is submitted to this departr,.mnt. (2) The top of the well casing sealed with a sanitary seal so that it is water tight. (3) The depression or pit around the well casing needs to be filled with impervious type soil so that it slopes away from the well casing. (4) the water analysis report be delivered to this office xom Chem Lab, 5633 B Street, for our review. P ple leaee notify this department for a re -inspection when the noted descrepancies have been corrected. If there are any further questions, please contact this office at 264--4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/1jW CCI. Alaska Statebank 310 Past 1:1orthern Lights Boulevard 99503 Beth Holland Investor's Realty, Inc. 4241 B Street - Suite 204 99503