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IL r.�ti1LI�4 All y 'a �.� ,' 3 tii� w �T `#. + *• ' f � (+ ` Vr "� r 1 1 4 i h`' * ' ' k y 4 r i#fir # k f r+ + � � .#} % t { " r # apt + 1 4 A�. # * p (i " i # ti b%,) • • i "r+ r a �i L '� t + i �s �4 *R�fir r 1 r 3i i e� • * 47• 'r,�l +' 4 4l y r _\ [ + �F'r#f�47,h� r` l{ a } fi # {- r±►• {^�+j +r►.. } + *}. j i4�r r� # F7 r it _ ._ s..f tr._ _4►;ir._ +.ir/H.tik ,�..t _ sra..tir_ +� r.�l .y.ti.tir� _ r �3itr�Frt�}+ J .# v�fYf#,� it 1 j• • + x_. 4 < ra mr" Z M!U :u -_w zi 1 6 Ic " M rn 0 Mm V o z o atm m < ;u �w - Z N -4O'Tl OWMMZE 0 ;v MM x >>M-'>- w -q �3 ;02: 021-iV =0 CZm =•MM wo wx o> fn — _q M (D Z, n:u x (4 -1 0 M o C') M X a4 _v > x F-- to z c Z;U;V_i(nm\mmr< r-O(J)Mrqm X, w co Oz F -4 C =Crlz Mm— C) MEW -i-q 0 OM zo WCA Z -4 07- M 0 G) CD ;u 10 0 ;u m CJS CD Ix P.O. t3OX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 26a.-4111 TO~,.~Y KNOWLES OEPARTMENT OF HEALTH & HUMAN SERVICES January i0, 1986 TO: Permit Applicant Subject: Permit # 850606 T15N R1W Section 30 Lot 102 A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1985. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system the original as-built inspection report(three part form) must be sent to this office for review and approval,and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Susan E. Oswalt Program Manager On-site Services SEO/ljw enc: Copy of Permit ~'ERM I T NG: DATE ISSUED: DEPARTMEh. FF ,--,F" HEAL. TH 825 L STREET, 850606 08 / 19/85 APPLICANT.~ CRAIG & NANCY WHITMORE ADDRESS: 69E. LAI<ERIDGE DRIVE EA '_".iLE R I VER, AK 995'77 [;)ON FAC] F'HONE: 688-3697 LEGAL DESCRIP: SUBDIVISION: NA LOT." 102 SECTIOH: 30 'TOWNSHIP: 15N RANGE: 1W L.OT SIZE: ~!;.~SA (GQ.FT, OR ACRES) BLOCK: NA 1: certi£y that: 1. I am ~amiliar with the *equirement. s £or on-sit.e sewers and wells as set Fopth by the Municipality o~ Anchorage (MOA) and the State ol Alaska. 2., I will instai1 the system zn accordance with ali MOA cooes and "egulations, and zn compliance with the des:i, gn criteria o~ thi~ permit. 3. I will adhere to all MOA and State e~' Alaska requirements for the set back distances From any existing well, wastewater disposal system or public sewerage sv'stem on this or any adjacent or nearby lot. AP~ L. ICANT: CRA 1SSOEO ~ ............ DATE:. 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 ~O~' ,~¢~b[ [~UPGRADE ' ~ Z Manufacturer O~~ No. of compartment~ "~ Liqp~b~all°ns IF HOME,DE: Inside length Width Liquid depth ~ . DiSTANCE TO: Well ~ , h Dwelling/ PERMIT,O. O Z ~ Manufacturer Material Liquid capacity in gallons D Well Foundation Nearest lot line PERMIT NO. ~ ~ No. of lines Lengt ea Total length of lines Trench width Distance between lines ~ inches ~ Top of tile to finish grade Material beneath tile Total effective absorption area inches ~ ~, Type of c~i~ Crib diameter Crib dept~_ / Total effective absorption area/~ ~ DISTANCE TO: Well/~t ~~ Buildlng~d~i~, ~ ~ ,earestlotline/o ~ j ~Class ~ De~th Driller Distance to lot line PERMIT NO. ~ DISTANCE TO: Building foundation Sewer line Septic tanE Absorption area(s) REMARKS I, .,,,,,-.. .... ,,, , .'~--~ Rev. 3/78) ~ · , ~;1UNICIPALITY OF ANCHORAGE'"'k ~ "~ Department' ~ Health and Environmenta~ ~rotection ~ 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * '~~~ , %~ ON-SITE SEWER PERMIT Applicant: [~ Mailing Address: ~ Location: ~ ~ ~ Phone Number: ~i-- y~ ~ Legal Description: C ~ ~ ~~ ~/~ot Size: ~ ~ ~ Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: /~ Holding Tank Maximum Number of Bedrooms: ~ Soil Rating(sq.ft/br) :/~/-- The Required Size of the Soil Absorption System Is: DEPTH LENGTH Z~) GRAVEL DEPTH WIDTH ~/ The length dimension is the length(in feet) of the trench or drainfield. The depth of a 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). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = I OOC~ALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 3L 1 9 8 1 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. tI c ' swP/024(1/ l) -- ~/s~stem in accordance with codes, i ~t~e on-site sewer system may require enlargement ~odeled to include more that 3 bedrgoms~--~ Date: 9 --ti--~l if ~ /~ MUNICIPALITY OF ANCHORAGE · DEPARTMENT OF HEALTH AND ENVI RONI~ENTAL PROTECTION 82§ L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG [] PERCOLATION TEST PERFORMED FOR: LE~ALDESOR,PT,ON: £?0~ S:~c ~o 'T-/~ SLOPE 2 3 4 5 8 9 /:7 / CATE PERFORMED: SITE PLAN 10 11 12 13 14 15 16 17 18 19 20 COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUND WATER ~//0 S ENCOUNTERED? L O P E IF YES, AT WHAT DEPTH? i Gross Net Depth to Net ~Reading Date Time Time Water Drop PERCOLATION RATE /~///h (minutes/inch) TEST RUN ~ETWE~N FT AND FT by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 t OWNER OF LAND ;'' �S '* ° f> `CJ �/ ► ter; ctl" DEPTH OF WELL —L tJ _ ADDRESS 5Lk'7 6 5 '-` 4AWsem �i�- =' '� V ATIC LEVEL OF WATER F' ll, ' i,� �..t � i w.. ' J� E� ,� <r � ! rJ of LEGAL DESCRIPTION DRAW DOWN FT. DATE. - Started "� '- I Ended ` GALS. PER HR PERMIT NUMBER KIND OF CASING i a X64 KIND OF FORMATION: FromFt. to a Ft. 4F gi1�-ZPQR12,e-I d From Ft. to Ft. From_Ft. to—,'S--Ft. '.-,Z4 G&AL TL 4U' 7- From' Ft. to Ft. From Ft. to-.S:,/—Ft. 6pe-g From Ft. to Ft. From Ft. to-,TI—Ft. UZ aG L-1 % 9-11 AN-Kom Ft. to Ft From Ft. to Ft. 00 From Ft. to Ft From%5_3 Ft. to__LCI_Ft. AABA*DC. k_ _ From Ft. to Ft.` From-/// Ft. to]..t,—Ft. ,k",® O tri� T&+e,4 �Pir ' Ft. to Ft. From Ft. to Ft. q,; P. ?/9E From Ft. to Ft. From Ft. to1-�4 Ft, %� From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From_ Ft. to Ft. From Ft. to Ft. — From—Ft. to Ft. — From Ft. to Ft. From to Ft. _Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. tt From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to ifelPAUTTef ANel 1E)RAGE W G MISCL.INFORMATION: ENVIRONMENTAL P.,..OTECTION t Z /t i ;. JA N 14 1982 RECEIVED NAME ��' - er2ifie) Drilli g og by DOC Co, dba SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS ~ LEGAL DESCRIPTION 7" /~" jo /t.,,-,~ DATE - Started ? ,/' ~" t Ended PERMIT NUMBER DEPTH OF WELL /.. ~,? O STATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR (, O KIND OF CASING ,5~ m,, r3,CJ~' KIND OF FORMATION: From, 7' Ft. to ';'( From ~2 Ft. to ':' From 5 ~'' Ft. to ~3-' / From '?/ Ft. to ?'~Y From Ft. to From-::'? Ft. to /!/ From ' / / Ft. to / ? ~"~ From.__Ft to Ft. From ,//'~" Ft. to/,fi c, Ft. From.__Ft. to Ft.. From__Ft. to Ft. From.__Ft. to Ft. From Ft. to Ft. From.__Ft. to Ft. From __Ft. to Ft. From Ft. to Ft. From__Ft. to Ft. 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 .Ft. to Ft. Ft. to.__Ft. .Ft. to Ft. Ft. to Ft. Ft. to.__Ft. Ft. to Ft. : : Ft..to Ft. Ft. to Ft.. Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to u~r'l. Or HEALTII & MISCL. INFORMATION: " ~7 // 7' '.~ ENVIRONMENTAL PROTECTION ~0 RECEIVED DRILLER'S NAME ~': ': · : -- MUNICIPALITY OF ANCHORAGE DEPT. OF HF-ALTM & ~:NVIRONMENTAL p,~:OTECTION PER. MIT NO. DEPFIRTMENT OF HEALTH AND EN'v'IRONMEN"FAI_ F't~:OTECTIOI'.,I :E:25 "L'" STREET., ANCI-4.0RAGE, BK. D950:t. 2~4-'4720 :BzL09 J. t9 ) BPPL..ICSNT LOCSTION !_EGBL D. CRRIG HHITTMORE T15N R±H SEC ~0 LOT ±02 SEE RBOVE SRR BOX 65 LOT SIZE 45000 SQURRE FEET NINIM[JM DISTANCE BE:THEEN R HELL RND AN"? ON-SITE SEHAGE E:,ISPOSAL S"r'STEM IS :180 FEET FOR R PRZVRTE HELL OR i50 TO 200 FEET FROM ~ PUBLIC HELL DEPENDING UPON THE T'¢PE OF PUBL. ZC HELL MINIMUM DISTRNCE FROM R PRIVRTE HELL TO R PRIVRTE SEHER LINE IS 25 FEET RN[:' 'TO R COMMUN~T'¢ SEHER LINE I~ 75 FEET. 1.4ELL LOGS PRE RE64tJIRED RND MUST BE RETLIRNED TO THE DEPRRTMENT I.,.IITHIN 3:8 DR'CS OF THE HELL COMF'LE]'~ON, OTHER REISiUIREMENTS MR'z' RPPL'¢. SPECIFZCRTZONS RND CONSTRUCTION DIRGRRMS PRE RVAZLRBLE TO INSURE PROPER INSTRLLATION. F" E F--: [--'i, I '"F E :>,: F' I f-~-: EZ 2~; [:, E C: E ["1 B E [;:-: Z--: ::L .. ::L _9...'E~-; ± I CERTIF"r' THAT ±: I AM FAMILIRR t.4ITN THE REQUIREMENTS FOR ON-SITE SEHERS RND HELLS FORTH B'T' THE MUNICIPALITY OF ANCHORRGE, 2: I HILL INSTALL ]'HE S"r'STEM IN ACCORDANCE HITH THE COB'ES. RS SE]' SIGNED: ........................................................ APPLICANT D. CRRIG HFIZTTMORE ~. z,z,_ b_¢ Br ........................................... DHTE V4. 0 Applicant: Location: Legal Description: -~(~ ~ t~J '5. ~O Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: ~-~,UNICIPALITY OF ANCHORAGE"-'~ Department ~ Health and Environmental. rotection 825 L Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL A-NF~5~u~!-s~ ~ PERMIT ~ C¢~i ~ ~J~ l~TKmOFCMailing Address: ~C~ f'~ ~'~ ~ Lot- Size: Seepage Bed: __ Holding Tank: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: (2) (3) S igne~t: DEPTH LENGTH · GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground an~ 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). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = GALLONS * * Permit applicant has ~the responsibility, to inform this department during the in~stallation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * i Backfilling of any system without final inspection and approval by this department i will be subject to prosecution. Minimum distanCe between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well ~o a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well Completion° Other requirements ~ay apply~ 'Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER $L 1 9 8 1 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. I will install the system in accordance with codes. I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bedrooms. Applicant SWP/024 (1/81) Issued by: Date: /""~--~ ~ - HUNICIPAb[TY OF ANCHORAGE. . The. le.ngth d[mel~ion is the length(~n f~ah) o~ th~ t.~en0b ~ep~h of a tre~n~h o~ pit is ~he. di-~tanCe b~twe~n ~h~ suc~ac~ of th~ g~ou~d~ ~ ~ REQUIRED ~3EPlqC(HOLDING) TANK $[Z~ -~ ............. GALLONS Pe~mL~ appJ. i~an~ ha~ the ~p0n~ibi/i~ to in~Or~ thi~ ' ' O~ an' wei~s adjacent tO~h~ of ~esid~nce~ that the w~ll ~;iJ.l sefve~ ' ' ~ ~ ~ TWO(2) iNSPeCTiONS AR~ R~QUIR~D Ba~k~ill~ of any ~yske~ w~tboB~ final i~apecb~on amd approva~ b~ is 25 f~ek and ho a co.unity ~ewe~ lina is 75 ~eet. We[~ %Og~ a~ rc~uir~l Other ~q~e~t~ may apply. ~0~i~ioabion~ and oonskruction ~ ~ ~ PSRM[I' ~XP[R~ DECEMBER 5L i 9 / �� 7 00 c S e x � A LO (N 0 CN �� C") 6 / / CL/ w 0 0 0 QO � co 0 cy� LO 0 / ƒ / � � LO G) � Y Q % > � � U W � D W � D_ � W � Q � W rl_ 0 CY) � \ / 2 / � � D Z � � � � Q :E C/) W � �► A / / k CY) 0 W § 0 / � 0 k Q ll A IZI, (N C:) C\, LO C\j � 2 f $ 2 e 3 ƒ .& M 0 \ ? / 0 a_ � � @ 0 E 0 -0 .0 c w kk 0 ° k O U $ = .§ 3 D $ .0 2 o§ : « � J 0 � U � f E es/ � j >+ oY 0 \ ' 3 0 0 � � e U)§ >cu° Cf M0 k 0 a)k 7cu7T 2 @ 3 � O k a C 0 k 0 (n ) 2 ° 2 ƒ § 2 2 � : } � A LO (N 0 CN �� C") 6 / / CL/ w 0 0 0 QO � co 0 cy� LO 0 / ƒ / � � LO G) � Y Q % > � � U W � D W � D_ � W � Q � W rl_ 0 CY) � \ / 2 / � � D Z � � � � Q :E C/) W � �► A / / k CY) 0 W § 0 / � 0 k Q ll A IZI, (N C:) C\, LO C\j � 2 f $ 2 e 3 ƒ .& M 0 \ ? 0 0 U) @ 0 E 0 -0 .0 c w kk 0 ° k O U $ = .§ 3 D $ .0 2 o§ : « J 0 ® = U E > j 0 \ ' 3 0 0 U)§ >cu° u M0 E � k 0 a)k 7cu7T 2 @ 3 � _ @ E ° 2 k a C 0 k 0 (n ) 2 ° 2 2 2 2 \ 0 a) x LLJ C: m Oil U LIL ICL mom z 0) CD M LL C) m a) 06 co (D E iz0 6 Al z LU a a. 0 co 0 0 CL 0 S- cl Al RAI U- nj NJ 69 - LL CO 0 C) U U) LL 0) CD 0 CO co to C14 :3 CO CL EL 0) C: 0 El 0) c =3 E E — r) 73 0 C/) (D >1 CN a) C/) Q) a 0 0) C: U) a) E > L- EEl 0 a) Q) (n 0) CL 0 m CL U) a (D -0 C: Q) 0 LL cu+ 2! CY) El w a- L- n U) F- (10 a) Q) O L a) 0)a) (1) C) M 0 2: L- C.) CN CD cu 0 co -0 LLI D M (D 0 CL a) C/) o - D 0 M 1 a'-) r -I 6. CL 0 CIO > r �c 0 w 0 0 CL U) M E LL0 DO El N 0 i El < LLj w E a) N CL uj 0 V5 > U) CO U) _0 _j U) (D 0 E] ❑r wWLU F- F- C0 a' M co z z O m LU U. 0 LL 0 F- a. C) cz CT L a j_- cl) LU LLJ P: 0 a. a. a. a) co 0 F- uj Cl) 0) < m (1) > r C-4 vi cF ui CO cox > w > m 0 RAI U- nj NJ 69 - LL CO 0 C) COSA Checklist Legal Description: WHITMORE LT 102-B Parcel ID: 05130326000 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system _ A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 911981 Total depth 120 ft Cased to 20.3 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 3/15/24 Static water level at beginning of test 7 ft. Comments B. TANK DATA Measured operating fluid level in septic tank na Date of pumping na ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) na ❑ ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficienci COSA Checklist June 2022 Well production at time of test 1.5 gpm Water storage tank volume0 gallons Well disinfected for coliform test? ❑ Yes ❑■ No ❑■ Coliform bacteria is Negative Nitrate 2.35 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L XArsenic less than MRL (ND) Collected by NRim Eng. Date 3/15/24 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date _ Results ❑ Pass Fluid depth prior to test Water added gal New fluid depth in Elapsed time min Final fluid depth in in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) Effective depth used in Effective depth remaining in in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' ❑ Yes if No ft Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft [E Yes if No ft ❑■ Yes if No ft Neighboring Tank > 100' ❑■ Yes if No ft Private Sewer/Septic Line > 25' ❑■ Yes if No ft Absorption Field on Lot > 100' ❑■ Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' F. ENGINEER'S COMMENTS Animal Containment > 50'■❑ Yes if No ft ❑■ Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' W Yes if No ft■ -1 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' ❑ Yes if No ft Tank to Property Line > 5' ❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' ❑ 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 tank or field is under driveway comment below F. ENGINEER'S COMMENTS AWWU Sewer (;. C:ERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Finn NorthRim Engineering Engineer's Printed Name Steve Eng COSA Checklist June 2022 Phony Datc 694-7028 4/17/24 TH r,�... , ... Steve Eng CE -6256 1z;Ff 4/T5/2 k+ --- - ------- -- ASBUILT SEWARD & I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE - FOLLOWING DESCRIBED PROPERTY: DATE - AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE E' (jsTENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: ANY DATA HEREON BE USED FOR CONs'rRycTiON OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN; v 11 • • 61 8 9 10 7 ...0te. t _ Municipality of Anch � :• : , A i1 i 'G`r.S l - On-Site Water and Wastewater Pr.• a �: 1 ' 2: . - (907) 343-7904 t.11 E • ° JUL 16 ZMb SaTY ti Certificate of On-Site Systems ° • *royal 9 051-303-26 nParcel I.D. Expiration`a e: /© 7-1-6 1. GENERAL INFORMATION Complete legal description Whitmore, Lot 102-B Location (site address) 14907 E. Lake Ridge Drive Eagle River, AK Current Property owner(s) Elizabeth Whitmore Day phone Mailing address P.O. Box 772251 , Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well LI Individual ❑ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer 0 WaiverNariance request for: Distance: Received by:42M ./�'���-19//9/0-e0 Date: 7//61// COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ 52S, Waiver Fee $ Date of Payment -3'11lele Date of Payment Receipt Number b2233D Receipt Number COSA# a OC l' [3 U(4 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Forge Engineering Phone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, PE Date 7/15/2018 F AL,1s‘ lel \*: 49 TH / �r�r/ 6. DSD SIGNATURE System #1 Approved for .3 bedrooms � Michael E.Anderson : V.-. 4381-E .•'��r System#2 Approved for bedrooms i11,\\"`b44 Disapproved Conditional approval for bedrooms, with the following stipulations: ON-SITE WATtR AND .-o WASTEWATER 4! PROGRAM / r Q , v� Original Certificate Date: 1 1 C I 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 : R ;•.• •f' • COSA blue sheet`. ', c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Whitmore, Lot-B Parcel ID: 051-303-26 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 9/1981 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 120 ft. Cased to 20.3 ft. Casing height (above ground) >12 in. FROM WELL LOG AT INSPECTION Date of test 9/1981 7/12/18 Static water level 3 ft. 8 ft. Well production 1 g.p.m. 1.4 g.p.m. WATER SAMPLE RESULTS: Coliform iflti colonies/100 mL Nitrate t\ID mg/L Arsenic 1Jb ug/L Date of sample: 7/io/i Collected by: I IA —A / a '.- i Colhi-forrn7/ 1 -1 / q B. SEPTIC/HOLDING TANK DATA Tank Type/Material AWWU Sewer System Date installed Tank size gal. Number of Compartments Cleanouts (Y/N) Foundation cleanout(Y/N) Depression over tank(Y/N) High water alarm (Y/N) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ft2/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area ft2 Monitoring tube Depression over field Date of adequacy test Results(Pass/Fail) For bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot NA On adjacent lots >100' Absorption field on lot NA On adjacent lots >100 Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25' Holding tank >75' Animal containment areas >50' Manure/animal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation AWWU Property line Absorption field Water main Water service line Surface water Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line AWWU Building foundation Water main Water Service line Surface water Driveway, parking/vehicle storage Curtain drain Wells on adjacent lots F. COMMENTS Property is served by AWWU Sewer System. G. ENGINEER'S CERTIFICATION ��OF. I certify that I have determined through field inspections and Ø ' 49 TH %\ •*' review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. A���` Michael E.Anderson . Michael E. Anderson, P.E. Engineer's Printed NameI�tPF'sr Tisk• . � c. Date 7/15/2018 `�l\���"`\O'A COSA brown sheet 10-10-12.doc