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MARIE ESTATES LT 4
(Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201440 PID Number: 051-111-37 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name HAROLD & LINDA LAWSON ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 24223 WHALEY AVENUE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating depth from original grade 3 GPD/SF JTotal Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Fill added above original grade Ft. Gravel length Ft. MARIE ESTATES 4 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'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation1 Q'+ LIFT STATION Manufacturer Capacity Gal. Remarks Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer JRS Drainfield CO/MT 3034. Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection15` 10/29/2020 �d 10/30/20 Location and description dates:2 3`d 4'h IBOTTOM OF SIDING ON-SITE WATER AND WASTEWATER SECTION APPROVAL OF A y Conditional Approval: Date TH " " " " " "' Curtis Huffman Septic System Ap roved - ,- Date 11-2--2-02-0 CE 128991 ,. ���®' FppROFESSION�`���� ���ESSOI I Note: this approval does not include well permit requirements. (Rev 05/02/18) PID: 051-111-37 PERMIT: OSP201440 A—C=25.6' B—C=12.8' A—D=28.4' B—D=13.7' A—E=33.3' B—E=16.0' A—F=35.8' B—F=17.6' EXISTING FIELD INSTALLED NEW 1000—GAL HDPE SEPTIC TANK 10' FROM FOUND & 5' TO EXISTING FIELD WITH NEW DFCO & DCO. LOT 4 100' WELL RADIUS 0 m MH I g DFCO 46.5' C BM C EXISTING 3BR HOUSE A 68.0' c) 11 DECK A �m r SCALE, 1' = 30 SEPTIC SECTION MARIE ESTATES LOT 4 PREPARED FOR: HAROLD & LINDA LAWSON 24223 WHALEY AVENUE CHUGIAK, AK 99567 FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK©gmail. com SCALE, NTS SUPPORT SERVICES: Aar, OF A ,, � F -1.1 -5 9 TH DATE: 10/30/2020 Zrtli-s" Huffman SURVEY: JLS� CE 128991�� 1 DRAWN: 10/30/202V SCALE: 1 " = 30' �FESSIO��' MUNICIPALITY OF ANCHORAGE On -Site Wat$r & Wastw water Program PO Box 1%650 4700 Elmore Raced AncharMe, Alaska 59519 50 Phme: M?) 344 -n44 Fast; (9W) 343.7997 Islip tiwwrr-arum,w!j1onaile On -Site Wastewater Disposal System Pertmilt Permit Number: OSP201440 Work Type: SepticTank Upgrade Tax Code Number: 05111 1370 0 Site Legal Address- MARIE ESTATES LT 4 G;1361 Silo Mafling Address: 24223 WMLEY AVE, Chujak Owner- LAWSON HAROLD L & UNDA J taesIan Engiineer; FIR T WATER CONSLILTING This permit is forth* conistructlon of; Effective Date; Expfratfon Data: Lot Size In Sq Ft; Total. Eedroorns: d 1 QIM2020 10x02021 49245 0 Disposal Field Rf 5epllic Tank ❑ H#ldlinq Tank ❑ Privy ❑ Private Well El Water 51prage All constructfon shall be in accordance with: 1- The attached approved design - 2. All requirements Specified in Anchorage Municipal rode Qh:Rpters 15,55 and 15,65 and the State of Alaska Wastewater Disp ose0 Regulations (1 AC72) and Onnking Water Regulalions (1 BAA 80) 3- The wastewater code requires Inspections during the instal[aticn. The angirwor shall notify the DOV pmant Seirvioes Dapartrrmnt per AMC 15,05, Prolvide riotlfca6on by calling (907) 343-7-904 (24f7)- 4. F turn October 15 to April 15, a suhsurfaco -sail abwrp6on zystem under construction d uring freezing wealher shall be elftr` a. Opened and Closed on the same day, or h- Covered, soaled, and heated to prevent freezing Recelved By: Date, 10/2112020 Issued By: Date: f MUNICIPALITY Development Services Department .; x On -Site Water & Wastewater Section Parcel I.D. 051-111-37 ON-SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) HAROLD & LINDA LAWSON Day phone 9072291593 Mailing address PO BOX 202681, ANCHORAGE, AK 99520 Site address 24223 WHALEY AVENUE, CHGUTAK, AK 99567 Legal description (Sub'd., Block & Lot) MARIE ESTATES LOT 4 Legal description (Township, Range & Section) Lot Size 49,245 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade Q Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A 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: 1,60,75 (-d V1 Waiver Fees: Date of Payment: 40167 y Date of Payment: Receipt Number: 40 016101 Receipt Number: Permit No. o5Pw/yy O Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350 -9566 / firstwaterAK@gmail.com October 15, 2020 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: MARIE ESTATES LOT 4 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. The lot and area are served by private wells. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201440, Deb Wockenfuss, 10/21/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201440, Deb Wockenfuss, 10/21/20 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 PHONE ~//~.~O ,~NEW MAILING ADDRESS ~'¢ DISTANCE TO: Well /~¢ Absorption area Dwelling ~oPERMITNO"~--~ ~ '7 ~ Manufacturer (~,~¢~¢.j~.? Material~.)Cff5& [ No, ofcompartments~_~ Liq. capacity in gallons Inside length Width Liquid depth IF HOMEMADE: ~ ~ DISTANCE TO: Well Dwelling PERMIT NO. O 2~ ~: Manufacturer Material Liquid capacity in gallons Q Well Foundation Nearest lot line PERMIT NO, u~ ~o DISTANCE TO: Total length of lines Trench .~_~dth> Distance between lines ~-I~' ~, ~_~ No. of lines/ Length of ea.~h ~.ne 3 ~_cf 4:.- inches ~ ~- Top of tile to finish grade / Material beneath tile Total effective absorption area Len§rh Width Depth PERMIT NO. ~ I- Type of crib Crib diameter Crib depth Total effectiue absorption area ~u Well Building foundation Nearest lot line ~ DISTANCE TO: _~ Class Depth Driller Distance to lot line PERMIT NO, u~ Building foundation Sewer line Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS f/ SOIL TEST RATING INSTALLER ,_,- REMARKS \ APPROVED DATE LEGAL 72-013 (Rev, 3/78) PE i:~:'!'"l ..T. T F:iF'F'L.:i; CFtF,!T SEVEF.:S(3N ! NC LOC:BT ]; O1'.,i PETEF-::S C.,q:E'E.[( L.EGF!t._ L4. HFIR]JE tESTRTES 'I"¢F'IE OF SOIL. FIBSORF'T'iON S"¢STEH ]£S:;; i"IF!X!HUH NUi"!E:I,~;F:: OF E:EDROO!'"tS .... 2-.' LOT S:; :[ ZE ,4-,::!.EtE'i,E'~ C-; .';!_ B.F'I,E FEET Tf4:I,.:,:NCH 'THE LENGTH r2',IP'IE!'.E~;tOi'.~ IS THE L.ENGTH (.'i.t'.,! FEET::, OF "I'IaE TRENCH OF: DRFI:[!'.,tFIEI..D. 'THE [:,EPTH OF R TRE.NC::.[-~ OR P:I:'F ]:S THE DItS"FRt'.,!I,'_':E E:ETI.,.!EEN 'T'.[-iE SLtF~:FFIC:E OF THE GRC!!.JND fiND '.['HE E~C~T'T'I.:I!',t OF' THE EXC;R',,,'F:!'FIOI'.~. ,::ZN FEE']"). "i"F!EF~:E :IS I'.,IO SET F.ItI:::,TH FOR TF?.ENCHES. THE C. iRR',,,'I,EL DE?TH. i:_.E; TH[-: HINII"IUH DE!::'TH OF' GF?fi',/EL E:E'!'.i,.IEE!'.,I THE OUTFFILL I::"[F'E RND ']"HE BOTTOH OF THE E'?.'iC:R',,,'I::tT:[ON ,::]:!'.,! F'E:ET:;,. F'EF:i','i i "i" RF'F'L .i Z:Fi~'.,i'i" HFIS T..-iE' F..:ES:;F'C~NS i E: i L :i: T"r' TO ! ,NFO.[;:H TH ]: S .F.,EF'FI~4:THEF,FF DLIF?. t NG THE iNS:;TF!t._LF!T]:F~N 'rNSF'ECTiL'm~'5 OF F!NY HE_I.._':2 FII)J'FiCENT TF~ THiS F'I.~:OF'E:F,:T'.'? FINE:, THE NUI"!BER OF: !-:.:ES Z DE:NCL::S "FIqFiT THE I.,.!ELL [,i ILL SERVE. ........... E:Fir':k;F:(LL.T!'..J.C'i CiF RN'T' .:,~ .:FtI:. ! !,.iITHC!UT F':[!qF!L T~,....,"-"P'FF'T'r -'~.~.. ,... , FINE:, FtF'PF.'C',.,'FII_ ~,-~:: ' THIS DE:F'FIRT."'!EH'.' !.,.t i L.L E:E: ':2L.IE:.J'iECT TO F'F: '..: :E;,E: .. T 1.: E N. i'"i:[N.T. HL.ii',I DiSTFiNC::E DETi4EEN R klEI~L I::ti'.,!D F!N"r' ON-::5ITE SE!.qRGE [."ISF'OSFIL. S'¥'L:;.,TEM iS:; :'t.L~,F3 FEET F'OF.! R F't:,?I',,,'FITE HELL OF'. :tDE~ TO 2E,Z'~ FEET FROt"! F:I F'UEC..trC !.,.!EL..L DEPEND!t",!G UF'ON THE T'¢I::'E OF F'UE~LtC; 14EL.L. HIN]:F!UH D.T. STRNCE F'I.;:OI"'! R PI;;:I',,,'FITE !.4ELL TO FI PF.:i',,,:RTE SE:kIEl,;'. LINE .IS 25 FEET 'T'O R E;E'.HHUi",!IT','r' SEt4EF: LINE .iT'_--.; '.,'"'!5 FEET. k!E!...L L..E~GS RF?.E REC!UIRED FIND i"IUST BE RE'T'LI?.!",iED TO THE DEF'FIF.:THENT !4ITi4:[N Z:E'~ DFIY'S OF THE FIELL CCff't.F:'LE'.[' .!: O!"L OTHE[';i: F?.ECiU..T.,£;~".I,EHEi'.4T:5 P1FI"?' FIF'PI,...'T'. SF'ECIF]:CFIT]:Ed",!S FIN[;' CEIN.S:;TF:LIE:T:[Oi",! r;,IFIGF..:FIHS .FIP.::E FI',/Fi!LF:iE~LE TO Zf.,!SI..IF4'.E PROPER ZI'-,is:;TFIL./..FITiOi~',I. T CEF:T I F"r' THFFF :L: i FIH F'i::iHI_'rFIE' i.,.!ITF! TL: F..E.:.L!zI-,~.Et !,_': '! F_. F:,'E' qI'.,I-SITE SE!.,.IERS FIi'.,IF:, F!EI.L'Z'; R:E; '~ET FORTH E?¢ THE i"!Ui'.4 :[ C t PFIL _T'T',¥, E!F FiNCHEIRFIGE. :;2; 2::: i f..ii'.,iC, E..':F.4iSTFIF,![) TFIFfT THE _-tt'.,t--.:~tTE S:Ei.,.!EP".: S'.?STEI"! PtFI"/ F'I::f::,I!Ip:'F' ..... ,_,.,~..,.,..,.~..,~'~]~ R~C"l:-':i',!'~ ........... iF 'T'HF' F~'E'.:; i [':,E:Zt'..i "Z E- :f S F:EHCd:::,FL. EI::, Tr'~ ! NCL. UDE i'.!CtF'.E TH,'::~N 2: E:EDF4'.OLqHS. J '1 E X/$ F-//',/ ~o 7, ?4 ,MUNICIPALITY OF ANCHORAGE DFPT C,': ','~' LT '. ?. ENVIROi,lh' :l',.>- · O L1- ON "As-Built" I hersb), certify ~hot a survey of the following described property and that tho jmprovomont~ situated thereon Ydlhln tho property Jlno~ and do'not overlap or encroach on t~o propo'rfy adjacent t'horofo~fhot no Improwmont~ on 'property lying adjacent thorolo encroach on tho prom[~o~ In question" and that thoro are no roodwoy~ trdn~ml~lon Ilno~ or other vlMble oo=omonf~ on ~old property except as Indicated Datod at Anchorago~Alask~ this ~C~) day of._~/~Y, /~ CONTRACTING ENGINEERS O, ASSOC, 212 E, International Airport ,Road ~??horo ~.,..~10.o..~.' 9oso~_ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG- PERCOLATION TEST PERFORMEDFOR: ~J~C-t.~t2--/~ ~.-'. /~:~-~/~_ 'EGALOESOR,FT,ON: /~d ~ ~/C /~7~/~S DATE PERFORMED: Lo/"~ SOILS LOG [] PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12-- 13 14- 15 16 17 18 19 2O COMMENTS PERFORMED BY: o~-) z-.-, ,4 . SLOPE / / LL WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND -- FT 72-008 (6/79) Rick Mystrom, Mayor MunicipaliW of Anchorage Department of Health and Human Services 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 January 17, 1995 Harold L. and Linda J. Lawson P.O. Box 202681 Anchorage, AK 99520-2681 Dear Mr. and Mrs. Lawson: During the fall of 1994, the On-Site Services Section of the Department of Health and Human Services conducted a review of on-site septic systems involved in the legal proceedings concerning Chuck Landers. Your property, Lot 4, Marie Estates Subdivision was involved in this review process. Following site visits and submittal of additional required information by the engineer on this project, Mr. Henry Wilson, P.E., your system was determined to be in compliance with applicable municipal codes. One of the additional submittals required for your system was a Certificate of Health Authority Approval for a Single F~mily Dwelling. I have included the original of this certificate and an additional copy for your files. The original blue copy of the certificate should be delivered to the lending institution which processes the mortgage on this property, for the existing original in their possession includes an invalid signature. All remaining paperwork (permit designs and/or as-built inspection reports) concerning your on-site septic system has been updated and is on file at the Department of Health and Human Services. Should you desire, you may obtain a copy of this paperwork for your files. If you have any further questions regarding this matter, please contact me at 343-4744. Sincerely, James Cross, P.E. Program Mm~ager On-Site Water Quality cc: Robert O. Baker, Ph.D., Acting Manager, Environmental Services Division HENRY WILSON 9601 BUDDY WERNER DR.: ANCHORAGE, AK 99516 (907) 346-2000 Constructing Engineers Engineers, surveyors CHARLES A. LANDERS HC83 BOX 192-A, MYRTLE DR. EAGLE RIVER, AK 99577 (907) 694-9098 July ~ 1994 Muncipality of Anchorage DHHS, On-Site Services Po Box 196650 Anchorage, AK, 99519 re: Lot 4 Marie Estates Subdivision Health authority apprvoal checklist and certificate Gentlemen: Please substitute the attached original signed reports for the reports originally submitted and processed, and remove the file copies and send to me at the above address. Henry H. Wilson, P.E. MUMCIPAUTY Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-111-37 1. GENERAL INFORMATION Complete legal description MARIE ESTATES LOT Expiration Date: ), - 3 - 202 I Location (site address) 24223 WHALEY AVENUE, CHUGIAK, AK 99567 Current property owner(s) HAROLD & LINDA LAWSON Mailing address Real estate agent PO BOX 202681, ANCHORAGE, AK 99520 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or. Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 3 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: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ � U50 (0 V /'0 Date of Payment 10130 /,2 0 A C7 Receipt Number. (09 O 3(04 COSA# QSCao 9607 Waiver Fee $ Date of Payment Receipt Number 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 FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/29/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the �`1\\\�\♦ system and maintenance. The operational life of all well and septic systems are subject to r` `l these various and dynamic characteristics and are outside the control of the evaluator of the P�ii ' •�^1�1 l well and septic system. Therefore, any estimate of how long a system will function satisfactory g,�_.. for current or future occupants or guarantee that no unseen encroachments, deficiencies or J discrepancies exist can be given by First Water Consulting & FWGS . / * . � lli ....•.* r ......... 6. DSD SIGNATURE r Curtis Huffman / System #1 Approved for bedrooms X411 '�, . •CE 128991 .����r� �i F�F�PROF/ SSIONP�'r System #2 Approved for bedrooms 1��ESSO. _ Disapproved Conditional approval for bedrooms, with the following stipulations: l ON-SITE �-VVA FF:P n ""IM)))})1111A,I -� 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 Legal Description: MARIE ESTATES LOT 4 Parcel ID: 051-111-37 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) Date drilled 5/25/1982 Total depth 177 ft Cased to 177 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 10/6/20 Static water level at beginning of test 154 ft. Well production at time of test 1.32 gpm Comments B. TANK DATA Age of tanks) NEW - 0 years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank NA ® Standpipes/foundation cleanout per record drawing Date of pumping NA — NEW TANK D. ABSORPTION FIELD DATA Which system tested (date installed) 5/22/1982 ® ALL standpipes present per record drawing Total measured depth from grade 7.3 ft (max) Measured depth to pipe invert from grade 4.8 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective 2.5' INTO THE 4' ED ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Water storage tank volume 300 gallons Well disinfected for coliform test? ❑ Yes ® Nc ® Coliform bacteria is Negative Nitrate 7.96 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by F�Wr° Date of Sample 10/15/2020 C. LIFT STATION ❑ Required maintenance completed Age of lift station _ years Lift station material Comments: Adequacy test date 10/6/2020 Results M Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 1200 gal New depth 1 in Elapsed time <1 min Final fluid depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) N If yes, enter date FWES 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' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® 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' ® 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' ® Yes if No ft Private Wells > 100' ® Yes if No —ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and review rr�T;• • •�� l� of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date.7H . ......... . Curtis Huffman ��¢ �'FC,•.CE 128991 •.��v� � P OFESSIO0-14�—� ft ft ft ft ft ft ft ft Nitrate Advisory Certificate of On -Site Systems Approval # OSC201607 Subdivision: Marie Estates Lot 4 A water sample revealed a nitrate concentration of 7.96 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. Marling Address P O Box:19ti65Q *Anchorage, Alaska 99519 6650 *www mum 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. and ),,3-VHM .-bL'L0C 3.,69.85e68S O 0 0 o .- Q 0 CK W Y� O O p 0 0 ,02 ,02 P`7 F- 0 LLC m [,� 1 G � }1 0) LO 0 � .1 ern" 0 m dam+ °'w F �+ PA 6R2 E12 ?mss a �01-- CD $0m o a, .. aZ G G w ? O � � •O ~ U � O W F cn q qq o� runO o w w a rn 0 z 2 \5 a_ :czeg_•® � o G cci � y v F �+ < M 04 NO aZ G G CQ O � � •O ~ U � O W i1, � N G N �3 z 2 m {a H In C% � „S-.,, 'U m • •" i~ � .O 13 OU N 0 8 J qH °o°o 00 N N� Foo a..0ID �, �a 0 �w o Z g w wH o- o y zz go M E" r' aTi Y o U���� p�� , N I a CD a• W C a c�i� o MUNICIPALITY OF ANCHORAGE ' . DEPARTMENT OF HEALTH &.HUMAN SERVICES_' Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE Of HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0~ III 7~q- HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: -~ TYPE OF WATER SUPPLY: Individual well Community well Public water X NOTE: w lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: If community well system, provide written confirmation from State ADEC attest- Public sewer If community wastewater system, )rovide written confirmation from State ADEC attesting to the legality and status of system. 72425 (Rev. 1/91 ) Front MOA #21 = STATEMENT OF INSPECTION BY ENGINEER AS certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance .with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection, : Name of Firm ~~'~_~ ~'~'~ Address Engineer's signature Phone bedrooms. DHHS SIGNATURE 'f-'"'"~App roved for .'~ Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of A~chorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer'registered in the State of Alaska. The 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. 1/91) Back MOA~ZI Municipality of Anchorage /~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT 'A- ~ ~-le E'5'~;~ Parcel I.D. O~'1 It ~ ~r A, Well Data Well type ~'~vc,~--e If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) OW-F, [-~ Date completed -/ //~ Driller Total depth ~-ff'~r' Cased to J'~' Casing height Sanitary seal (Y/N) FROM WELL LOG AT INSPECTION Date of test $_ ~<;'- ~z_ Io-~-- ~. Static water level Well flow g.p.m. .g.p.m. Pump level1 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot I I.~' Public sewer main Sewer service line WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: ~ 1~'/gc- B. SEPTIC/HOLDING TANK DATA Date installed ~'- 7_z- Tank size ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank 4--7..coI 3. ~ Other bacteria Collected by: I ooo Compartments Cleanouts (Y/N) High water alarm (Y/N) /'J P~ Date of pumping r,J~>,~ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Io~' On adjacent lots To property line 7o' Absorption field Surface water/drainage +t Foundation cleanout (Y/N) /'J Depression (Y/N) Alarm tested (Y/N) Pumper ;;::~' ~ P-~-¢, ¢,.3 Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) Manufacturer Manhole/Access (Y/N) . "Pump on" level at /'/ ~Level at High water alarm level ~%'~~sted Meets MOA electrical codes (Y/N) SEPARATION DISTAN~TATIQN TO: Well on I~~,~' On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed Length Total absorption area Date of adequacy test ~'- ~ Soil rating (GPD/FF) 85 ~ {'b~.,',-~,-, System type 'I-~'NcR Width z_.' Gravel thickness. Total depth ~:~_¢ .sC- Cleanout present (Y/N) "/ Depression over field (Y/N) ~-~ ~- ~'~ Results (pass/fail) ~,/¥s~ for '~ -- After test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) r-.J If yes, give date - Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ) ~ %' To building foundation On adjacent lots Surface water Curtain drain On adjacent lots Property line To existing or abandoned system on lot ~ ¢' Cutbank -~'o' Water main/service line ~o' Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidefines in effect on t~,~,~l.~.(e~f this*i~s.l~,ction. ~,~, .~ ',, ,*; .... ~t~ ~ ' ' ' Signature Date HAA Fee $ Date of Payment Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel i.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING /~ ~- HAA# 1. GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day phone Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well ~,. '~ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverifythat 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 alt Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of F~ Engineer's signature Date L1/. ~(¢% DHHS SIGNATURE /X/ Approved for Disapproved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The 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 (Rely. 1/91) 8ack MOA 1121 Legal Description: Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number , Date completed -7 I~L ~/2~//~f-Driller Su~-~vA~ Cased to /t~¢ar'' ' Casing height 7 Wires properl~protected (Y/N) Date of test Static water level Well flow Pump level FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main 4- ~o Sewer service line g.p.m. ; On adjacent lots -~oo ; On adjacent lots Public sewer manhole/cleanout +7_oo Petroleum tank WATER SAMPLE RESULTS: Coliform i,¢' Date of sample: IO/~/c)z" Nitrate B. SEPTIC/HOLDING TANK DATA Date installed Collected by: Other bacteria Tan k size I 0o~ Compartments Cleanouts (Y/N) High water alarm (Y/N) Date of pumping k)o,,./ kd 3- 7_. Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot Io~' To property line Surface water/drainage Foundation cleanout (Y/N) hJ Depression (Y/N) IV/:~ Alarm tested (Y/N) hr t~ On adjacent lots + loc)' Foundation lo' Absorption field Water main/service line 72-026 (Rev. 7/91) Front : ' CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) - "Pump on" level at ~. ~f" level at ~i~t sWl~l~ ~ael i~c~ iiec~i lc o d e s (y/N ).,~~£ ~tested __ SEPARATION~TATION TO: Well on ~ On adjacent lots Surface water D. ABSORP'rlON FIELD DATA Date installed ,~- ~7... Soil rating B~' <.,(¢/b~.¥,~ System type '~'~-L~'-~''4 Length. ~j Z. Width Gravel thickness Total depth. Total absorption area ~-~'~, 5~ Cleanouts present (Y/N) Depression over field (Y/N) /k) Date of adequacy test to - A~' -~-~ Results (pass/fail) ~¢$ for Peroxide treatment (past 12 months) (Y/N) bedrooms If yes, give date ' · SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Wellonlot ~ I~'~ To building foundation On adjacent lots + ~ Surface water -r-to.~ ~ On adjacent lots +~'~ °~ Property line To existing or abandoned system on lot N Cutbank + ~o' Water main/service line. 70' Driveway, parking/vehicle storage area Curtain drain E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date ofthis~in.spection. Signature Engineer's Name Date HAA Fee $ /'~_/"~ of Payment//"- ,eceipt,umber 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number "' " ~g '" DATE RECEIVED INSPECTION APPOINTI~ --NTS I DATE . INSPECTOR INSPE~OR INSPECTOR MUNICIPALITY OF ANCHORAGE ~UN~c~PAU~ OF ANCHO~AG~ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DF~T C~ ;,~ .~ T:, .~. 825 L Street - Anchorage, Alaska 99501 ~NVIR~O;4i,,'.~r, .A.; ,~, ~TIO~ ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 '~L; ~ 1982 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWE~I~I~?~ D DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be proce~ed. Please allow ten (10) days for processing. 1. PRO~TY OWNER ~ONE MAILINGA~S ~F~g~. -/ ~ ~ PROPERTY.(If dif[e~ent~ fro~a~ ~' PHONE ' PHONE MAILING ADD~ ESS / 5. LEGAL SC I TION 6, TYPE OF RESI~ENO~ FAMILY ~ MULTIPLE FAMILY NUMBER OF~BEDROOMS [] One [] Four , [] Two [] Five IJ~" 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 [~-.I N DI V I DUAL/O N-SITE** [] PUBLIC UTILITY 7C~YEAR ON-SITE SYSTEM WAS INSTALLED. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. January 27, 1983 Larry Severson General Delivery Lake Louise Junction Subject: Lot 4 Marie Estates Approval for the individual sewer and water facilities cannot ~~/~ granted until the following items have been completed: ~/~ A well log submitted to this offiCe for our files and . review. ~-;~ ..... ~ *-~eds to b~ submitted to this o Lo=ate and expose the cleanout to the seepag~ p~t and/or leaching area for our inspection. This is to insure the minimum distance requirements are met between the well and sewer system. ~ The permit for the installation of the on-site sewer system will expire December 31, 1983. We have not received the as-builts of the installation in this office. If a private engineer inspected the system, please send us the report for our files and review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. $ince re ly, Jim Roberts Associate Environmental Specialist JR43/p/EH LEGAL DESCRIPTION '/~ /~"///t.(t._"." ~,' / PERMIT NUMBER by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 ® TELEPHONE688-2759 DEPTH OF WELL / ' 'STATIC LEVEL OF WATER FT. /,,~'0 DRAW DOWN GALS. PER HR KIND OE CASING KIND'OF FORMATION: From. i5~ Ft. to From Ft. to.~ From...''~ Ft tO.., Frem~ Ft. to Ft. FromZ,,'~ Ft. to 3".2 Ft. ~om~5~3 From,.. From.] 7 & From._ From ..... From From F~I From,, From, From L Ft. Ft. Ft. Ft. tO_l , Ft._ Ft. to .. Ft. to Ft. Ft. to / 7d'~* Ft, Ft. to. Ft.. Ft. to.. Ft. to Ft. Ft. to . Ft. Ft. to Ft · Ft. to.. Ft.. Ft. to Ft. Ft. to Ft. From From From From From .... From_ From ~ From _ From From From_~ From From From From From___ Ft. to .Ft Ft. to__ Ft. Ft. to Ft. Ft. to . Ft Ft. to Ft ~UNICI,~,~,LITY OF AN~,HORAGF- Ft. to Ft. to__~ Ft Ft. ~o Ft. to ~Ft. Ft. ~o Ft. Ft. to__Ft. ~Ft. to~FL Ft. to Ft MISCL. INFORMATION: