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HomeMy WebLinkAboutFIRE LAKE BLK 1 LT 6AFi re La kd Lot 6 Block •1IM051 361 32 (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: OSP261097 PID Number: 051-361-32 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name JOHN HATCH & CAROLYN SMITH ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 13812 KNOB HILL DRIVE, EAGLE RIVER ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot FIRE LAKE 1 6A 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 Sep Septic Absorption Holding !, Sewer Lift Station '; Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well 100+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding F-1Other Manufacturer GREER Capacity 1000 Gal. I Surface Water 100 + -- Material HDPE Number of compartments 2 Lot Line 104 NA Foundation 10'+ -- LIFT STATION Manufacturer Capacity Gal. Remarks Deep -burial septic tank. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tandre 3034 Installer JIM WHITTERS nfkeld -----__.._...-____ .......-_._-_-_ Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection15` 05/19/2026 05/20/26 Location and description 2�d - 3rd 4'h GARAGE CEMENT FLOOR 1 SLAB ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date A 1►�y' •���� .... . _ Septic System"' Approved-� Date Curtis Huffman .' ��'°F �° CE 128991 .• ;W ycslF _ • . 05/21 /26. . •'�C� [l%FOpROFESSIO�P�+ Note: this approval does not include well permit requirements. (Rev 05/02/18) EO EO EO EO EO EO EO EO PID:051-361-32 PERMIT:OSP261097 FIRST WATER CONSULTING FIRE LAKE BLOCK 1, LOT 6A LOT 8A - LOT 4A • w I 18.0' 24.0' C° 1 -STORY o x o I I UTILITY v, S 89059'30" E 198.53' 70.0' xx PEDESTALS (P DECK = 50' m x REBAR LT, I GRAVEL DRIVEWAY II zO,1 II (� LOT 6A O O oSEPTIC 0.822 ACreS Z OC STANDPIPES CoF: O I WELLCD _ - 71.5' r LOT 12A D m ill I SEPTIC,'' 00 m I MANHOLE v - Co m `� Z x SEE BUILDING O o I DETAIL o - 56.3' I I I A OD' x ODIOVERHEAD L?T X FENCE `X -XIX UTILI Lhr� --X- x 50' UTILITY N 89059'30" W 199.18' POLE I I LOT 8A till 5/2-D/Z(, .. ....... .. ...............� �'. B u Saliz �o LS -14837 J 4� 0 25' 50' r +i��ROFESSIONP\- AS -BUILT BUILDING DETAIL 1 = 30' " 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE LOT 6A, BLOCK 1, FIRE LAKE ALASKA SUBDIVISION RECORDED SUBDIVISION PLAT (67-3) ARE NOT SHOWN HEREON. ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEYAND THE IMPROVEMENTSAS DEPICTED HEREON EXISTAS IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SHOWN IN RELATION TO THE PROPERTY LINES. SURVEY MAY DISCLOSE. DATED THIS 20th DAY OF MAY, 2026, ATANCHORAGE, UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE ALASKA. USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT LLC HEIGHT, C.O.A. 122554 Land Surveying Services WWW.FIXEDHEIGHT.COM JOB # 26099 1 NO CORNERS SET THIS DATE I SCALE 1" = 50' 600 W 41st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 - '.CONCRETE • w .b 18.0' 24.0' C° 1 -STORY o x o FRAME N HOUSE 70.0' xx (P DECK = \m m x till 5/2-D/Z(, .. ....... .. ...............� �'. B u Saliz �o LS -14837 J 4� 0 25' 50' r +i��ROFESSIONP\- AS -BUILT BUILDING DETAIL 1 = 30' " 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE LOT 6A, BLOCK 1, FIRE LAKE ALASKA SUBDIVISION RECORDED SUBDIVISION PLAT (67-3) ARE NOT SHOWN HEREON. ANCHORAGE RECORDING DISTRICT, ALASKAAND THAT THIS DOCUMENT DOES NOT CONSTITUTE BOUNDARY SURVEYAND THE IMPROVEMENTSAS DEPICTED HEREON EXISTAS IS SUBJECT TO ANY INACCURACIES THATA SUBSEQUENT BOUNDARY SHOWN IN RELATION TO THE PROPERTY LINES. SURVEY MAY DISCLOSE. DATED THIS 20th DAY OF MAY, 2026, ATANCHORAGE, UNDER NO CIRCUMSTANCES SHOULD ANY OF THE DATA HEREON BE ALASKA. USED FOR CONSTRUCTION OF FENCES, IMPROVEMENTS, OR FOR ESTABLISHING PROPERTY BOUNDARIES. FIXED HEIGHT LLC HEIGHT, C.O.A. 122554 Land Surveying Services WWW.FIXEDHEIGHT.COM JOB # 26099 1 NO CORNERS SET THIS DATE I SCALE 1" = 50' 600 W 41st. Ave, Ste. C, Anchorage, AK 99503 907.290.8949 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program R}Box 19665O 47OUElmore Road Anchorage, Alaska 9g518-#050 Phone: 904 Fax: (9O7)34J-r887 http:8nmmw.muniorg/oneno On -Site Wastewater Disposal System Permit Permit Number: OSP281097 Work Type: GupUoTunkUpgradn Tax Code Number: 05136132000 Site Legal Address: FIRE LAKE 8LN 1LT 6A G:0453 Site Mailing Address: 13812KNOB HILL DR, Eagle River Owner: HATCH J(JHN H & Design Engineer: FIRST WATER CONSULTING This permit |wfor the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 5/14/2026 5/14/2027 Non -Public El Disposal Field Septic Tank Holding Tank n Privy El Water Well 11 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal codChapters 1555 and 1585 andth State ofAlaska Wastewater Disposal Regulations (1 8AAC72) and Drinking Water Regulations (1 8AAC80) -. The wastewater ---- requires inspections^during^the installation.^^The engineer shall notify the D",='"p'''=" Services Department per AMC 15.65. Coodinmtemjth On -Site staff regarding pnahanad method. 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Issued To: FIRST WATER CONSULTING Issued By: Curtis Townsend Date: 5/14/2026 5N4/2O26 3 MUNICIPALITY OF 'T "• �C T v.. Development Services Department , On -Site Water & Wastewater Section Parcel I.D. 051-361-32 ANCHORAGE ON -SITE SEPTIC/WELL PERMIT APPLICATION Phone: 907-343-7904 Property owner(s) JOHN HATCH & CAROLYN SMITH Day phone Mailing address 13812 KNOB HILL DRIVE, EAGLE RIVER, AK 99577 Site address 13812 KNOB HILL DRIVE, EAGLE RIVER, AK 99577 Legal description FIRE LAKE BLOCK 1, LOT 6A Number of Bedrooms 3 Engineering Firm FIRST WATER CONSULTING Building Permit Number Not Applicable ❑■ APPLICATION IS FOR: APPLICATION IS AN: (® all that apply) Disposal Field ❑ Initial ❑ Septic Tank El Upgrade 0 Holding Tank ❑ Renewal ❑ Privy ❑ Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: 2 Z Date of Payment: Permit No. Waiver Fees: Date of Payment: Waiver No. Distance: May 2025 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! May 14, 2026 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: FIRE LAKE BLOCK 1, LOT 6A 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 deep-burial HDPE tank per the attached design to serve the existing 3 -bedroom residence. We would recommend a 1500-gallon HDPE tank be installed for current functionality and future consideration or flexibility. No groundwater was noted in the MOA on-site file, but if groundwater is encountered during installation an epoxy coated steel septic tank or other action may be required. The lot and area are served by private water and any encroaching wells, easements, … must be staked prior to construction. 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 OSP261097, Curtis Townsend, 05/14/26 S H E D E A V E DECK 3BR HOUSE 70.0' 40 . 0 ' 28.0' 1 2 . 0 ' 18.0' 6. 0 ' 24.0' 22. 0 ' EO EO EO EO EO EO EO EO GRAVEL DRIVE LOT 4A LOT 12A LOT 6A LOT 14A 1 0 ' U T I L E S M T UTIL PEDESTALS FIRST WATER CONSULTING FIRE LAKE BLOCK 1, LOT 6A DESIGN DETAILS: NO WELLS WITHIN 100' OF PROPOSED SEPTIC TANK Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP261097, Curtis Townsend, 05/14/26 iz-tris Ihev. silts) 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 f1h PHONE NEW 4 Q�._ `ZIAq(� El UPGRADE MAILING ADDRESS LEGAL DESCRIPTION p li'._ "' 1 'c b,Vgtf.� LOCATION ` NO. OF BEDROOMS V _Y DISTANCE TO: Well '� Absorption area Dwelling PERMIT NO. 1 F- Z Manufacturer ��� Material No. of compartments 17, Liq.capacittyingallons IF HOMEMADE: Inside;e�gth Widtl� �� �q Liquid 'e h DISTANCE TO: Well Dwelling PERjMMIT NO. = z Manufacturer Material Liquid capacity in gallons = T DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. J LL z No. of lines Length of each line Total length of lines Trench width Distance between lines �Zw � inches H Top of tile to finish grade Material beneath tile Total effective absorption area O inches W Length I=T Width ip-T Depth c PERMIT NO. C7 Q I- R T e of crib Crib diameter Crib depth Total effective absorption area WR DISTANCE TO: Well Build fooundation Nearest lot line Class Depth Driller Distance to tIi e PERMIT NO. J W DISTANCE TO: Building foundation Sewer line Septic tank to Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER • r " r REMARKS l pI— bl � —✓� 0 14 11 q � SrD CM E �_ ILI ` •W'OL _SANK L%= iC !� > . 4. TOVED DATE LEGAL Ar V ( Av �Tz) �� -1 cx M i 1) A\ -, \ P� iz-tris Ihev. silts) E-4 E-4 E4 P E-( P E-4 &4 E4 E� 14 1-4 PK4 Pr4 114 rX4 P64 E-A: F4 P P E-4 E-4 E-4 E E-4 E4 E4 E4 E4 E4 E4 E4 E� E4 �T4 IX4 �T4 V.4 P4 fX4 rT4 rX4 �k rTW fZ4 rAl z m 04 • r4 iz 0 0 0 0 0 0 0 0 JO 9 9 9 9 9 9 9 9 9 9 9 9 fps1 " rjr4 rE4 W rZ4 [;4 W [Z4 f&4 04 w z MA ommm M V4 t 4p >= t:0i es :-- : • N 0 C) (D C) p E4 p E-4 E4 E4 D PI r-I C's :,Dr) E4 F--j Fra �T4 E-4 Z" rA4 rZI � [;4 rM4 FZ4 F34 rM4 5. 54 fr4 Q E-4 E4 z rn to !1-11 U-3 P-.�! 'l 1 ���­ "-.ry 9-D! 1=7 1=0 141 cl 00 f -AFT: 1=1 owl [EP.- DEPARTMENT(---WEALTH EP.-DEPHRTMENT qEHLTH AND ENVIRONMENTAJ TECTION 825 STREET, ANCHORAGE, AK. 95 --- 264-4720 -T �� m4 cj ^ CD rA__<3��� ���������� ������ �-� ~/8 ��� PERMIT NO. ( 780144 ) \ OLARS HPF" LICHNT DHRRELLCH��nN 8721 MIDLAND PL ------� 349 2446 ��- LOCATION EAGLE RIVER LEGAL L68 B1 FIRE LAKE S/D LOT SIZE 54000 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: �PF-7 FI,:" -F 11-4= -11.120 L.. E=L p4l IC -31 *-F H-1 F=r.��� 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). ������F.-- E> I!.-- L,=, -I- 1 10 ���� :E :Z E:-7. HE -_=u IL7-j 101 02i M=l J_���:-E_._- PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPAR ENT DURING THi INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROFiff-ITY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION iTA, F-1 UVAL il THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. 1,,lIl%lIrlUN DISTANCE BETWEEN A WELL AND ANY ON—SITE ;ZdAGE "IS OZFL SYSTIf 100 FEET FOR A PRIVATE WELL, OR 150 TO 200 FEET FROM A PUBLIC WELL DEPEN)INC W310 V E lY­ OF/pil OTHER REQUIREMENTS MAY APPLY. SPECIFICA_-Of I AND' EQ2' AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS ANC :LLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ' ]: I UNDERSTAND THAT THE ON—SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. ' SIGNED.- ` APPLICANT DHRRELL CARSON . - /'� ��-� / THE.. REQUIRED SIZE OF T1 -1'i--..• SOIL ABSORPTION _ Y;..}.EM 15: 1=0..:_ a n00 ­ :1.41% wool's 6...:u FA_ 1•-.1 =n•,=' F=7.. b _ 01 EEL �'=` s j—j = q=.0 THE LENGTH _ a -._a a m _f_ c _S, a E 9 a—_ _E.. r = '—n v F r E 0 =.—: E a=—? & -_r -- 9 c_.p F._. �'}-E!_: THE LENGTH (IN FEET) DEPARTMENT t,_t±—1"}L`i i"} }"'}`pit.! >_`'�'[[ .i !'�:t_tl'•;i'L=..•�..! r"iL i 10 '[f A TRENCH H 3-25 L_(l rREET, nNCHORAGE, RK. 99C BETWEEN THE SURFACE t–!CE OF THE GFs:t_t%iN_D AND D i HE BOTTOM OS= ` — n—i_— AL R„i_J17- 6 2_qiili:;it�, PERMIT NO. —Wit'_- 770985 ` TRENCHES. �:e �4..I-1 EES. _ !!`±E_L CARSON 8721 MIDLAND PL. Ai -*ICH :t _ !«''44 LOCATION E. R. L BE i•°• EEE THE OUTFALL !`1` AL._I_ i•`[Ih'`E LEGAL [ i.... t _ 1 , -• {'-; '7 ', . ...: FIRE LAKE =+r L: I LOT SIZE 54000 SQUARE FEET T`r`PE OF SOIL i=i':. S iRB T I. +_ N SYSTEM 15: `I'F:L",Nt:. H MAXIMUM 14}_( '7EiER OF i.-iEDI';t_tOMS = _ SOIL RATING ( SQ T/I;:R) = 100 0 THE.. REQUIRED SIZE OF T1 -1'i--..• SOIL ABSORPTION _ Y;..}.EM 15: 1=0..:_ a n00 ­ :1.41% wool's 6...:u FA_ 1•-.1 =n•,=' F=7.. b _ 01 EEL �'=` s j—j = q=.0 THE LENGTH D:t:M NSit_ N IS THE LENGTH (IN FEET) OF THE TFZE14CH OR = RA 1 i`•iF I E.LD. THE DEPTH OF A TRENCH H t_tR i-' i T 15 THE DISTANCE BETWEEN THE SURFACE t–!CE OF THE GFs:t_t%iN_D AND D i HE BOTTOM OS= THE EXCAVATION (IN ). FEET). THERE IS 1'[tt_t SET WIDTH FO ` TRENCHES. �:e �4..I-1 EES. THE GRAVEL DEPTH I S THE MINIMUM }'I I N I M M DEPTH H {_!}- GRAVEL L BE i•°• EEE THE OUTFALL !`1` AL._I_ i•`[Ih'`E AND THE BOTTOM OF THE EXCAVATION (I N FEET). §''_=_ :� r_.s e._3 �.. a -.. r•..._... !�__-� _—= L— n N �. g.= a p_. 04 laz 15 1 20t?,�=� _ ._- C_ r — �.. - a r. __ ti.._u i_ 4" _ 6 i G_,Er _ ca r/ q j 9 }-t PACKAGE }",[_.f' NT =' }�}; INSTALLED r��! . ! HE 'ESR ! it ' } N -t. fB _�E1._ ? 7 t_r THE FOLLOWING ..: t_iltl` OR --I! APPROVED � �. S�l 1.. E 3. T I-ItllR • } CLASS 1 t_if ; I ! Y�yS }i!='r[i�::t..t`:� ED !='L i('d T d'lt 1`:' _tE �NS T .LLEED. -. _ _ .�. i-A t_i L 11' t•-. ["- T:' C t-+- - a I' -"REQUIRED. 71-` s N ra '1`•,SiV.'' , . �• C•d 1. r•�1 _ . _ -ii I .ti rM,7 I-! _,-. _ a. t'.. 1.L i 1=.�'ti. P"{t._lf :EEI`I!_j ,i1'•41_1Ti�:(_ii� G` ` . _ !. L:L- t ' '1 !� �' V } }—It~i_�t_t('• P f It_e =•`'r_�t� .i't Pi'•IL�r''i_iR YOU MAY BE SUBJECT Lt T Tit r'r —' 'i. j".... r •S� 1 . _. BACKFILLING t_tl- A,—'_— ['•iNY SYSTEM WITHOUT FINAL It' SP -'E . I 1t_tS'":I AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. }_€TION. MINIMUM DI Tf`IN E BETWEEN A WELL AND flffli s I ir.4..-S I T L SEWAGE DISPOSAL ==Ir,_[T1= M 100 FEET FOR R A PRIVATE WELL OR LF_ 0 B=EET FOR R A PUBLIC WELL. I•a:.LL I_.iiGS t-fRi.� REQUIRED AND MUST BE RETURNED (E, _E}_: , i_t THE DEPARTMENT W.L : iIN 30 DAYS OF F THE WELL (_ i,:i_!f'1i=`I._} T I t,.tN. OTHER rE-tRL;EiF 1=rAPPLY. PEC I F t _HT I _jS AND CONSTRUCTION SIi —AARE AVAILP"IL_LE. TO It'd',►_}t''•:E f=`i::OPER INSTALLATION. @—" E�_ K-==`_ G -""T 1. n K=j ,; -C E I az=" i-= .`.. _• F-. iii':_: n. �. j-1 E=, !_._ FQ =1 ::._ _ =E... " _ 1 CERTIFY THAI .1. _ 1, . .. WITH ! ,_[ ON—SITE r _ r- - AND t �., - �"• .L t..1F1 s-f'i `iIL.I.Hi'='. :•'•(I T H `I'I-E REQUIREMENTS FO i_N i , _•r_WEh:S !I'•4D ;-°sr LL f=f_: SET F70FZTIA BY THE: tiU141I FIRL I "i-'•!! OF ANCHORAGE. HOi;;AGE. I WILL.. INSTALL THE SYSTEM IN ACCORDANCE WITH THE Ct_ii:::sES. .: •UNDERSTAND1 THAT_ ON—SITE _: SYSTEM M.r REQUIRE =d_:G,ET ,- TI••Ic.. RESIDENCE I'_.� REMODELED ELED Tt i INCLUDE Mt_tP::E i yi N _ `EL:)Rt_ _ t`I=. r3' tom, i H'SIGNEED: POW? K, A `F= L I t=:AINT E:'f-(Rt' ELL iw Ail%-'_[._tl',; CHNICAL & DEVEL M O ' Et E G E C ENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Soils Et Foundations Earl Ellis 688-2280 Land Development Performed for: Name: ---, '\-Z Tel. No. C'? - Mai I in g Address: Legal Description: e' - Depth (feet) Soil Characteristics 0- I 3- 4 5- -D 6- 7 8- 9,- 10- 11- 15 16 77" Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit Drain Field <S Comments: 'Z -<> Performed by: Date: :Z7 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 OSC261157 Parcel ID 051 -361-32 Expiration Date: 5/7/2027 Legal description FIRE LAKE BLK 1 LT 6A Site address 13812 KNOB HILL DR Current property owner(s) HATCH JOHN H & X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or conditions: No comments j j By: �Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, c Development Service Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's submittal. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory X Tank Age Advisory Arsenic Advisory Other 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 Application 1. GENERAL INFORMATION Parcel I.D. 051-361-32 Complete legal description FIRE LAKE BLOCK 1, LOT 6A Location (site address) 13812 KNOB HILL DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) JOHN HATCH & CAROLYN SMITH Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑E Private Well serving # 1 dwelling units ❑ Other Non-public well as regulated by MOA ❑ Water Storage ❑ Community Well or Public 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel 0 Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel or fiberglass older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ❑ Wide Trench X Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ l�' J Waiver Fee $ Date of Payment Date of Payment COSA # Waiver # COSA Application_Apr2025.doc COSA Checklist.docx COSA Checklist Legal Description: FIRE LAKE BLOCK 1 LOT 6A Parcel ID: 051-361-32 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 10/7/1977 Total depth 120 ft Cased to 120 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 24+ in. Date of flow test for COSA 5/7/26 Static water level at beginning of test 104 ft. Well production at time of test 4+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 6.79 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 5/7/26 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW TANK Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 5/25/1978 ALL standpipes present per record drawing Total measured depth from grade 11.4 ft (max) Measured depth to pipe invert from grade 5.4 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) 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) N If yes, enter date Adequacy test date 5/7/2026 Results Pass Fluid depth prior to test 37 in Water added 670 gal New fluid depth 57 in Elapsed time 1440 min Final fluid depth 36 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 72 in (MOA 6’ ED) Effective depth used 36 in (Final Fluid Depth) Effective depth (ED) remaining 36 in Comments/Deficiencies: COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Disposal Field on Lot > 100’ Yes if No ft Neighboring Disposal Fields > 100’ Yes if No ft Sewer Line/Main > 100’ Yes if No ft Sewer Manhole/Cleanout > 100’ Yes if No ft Sewer Service/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Disposal Field(s) on Lot to: (Please enter distances if less than required) Tank to Foundations > 10’ Yes if No ft Field to Foundation > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’. Yes if No ft Water Main/Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Wells > 100’ Yes if No *96 ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *MOA WAIVER – WR87-044 G. CERTIFICATION & 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 Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 5/21/2026 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 system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 5/21/26 Nitrate Advisory Certificate of On -Site Systems Approval # OSC261157 Subdivision: Fire Lake, Block: 1, Lot: 6A A water sample revealed a nitrate concentration of 6.79 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. Since nitrates are known to slowly increase, we recommend you monitor the water quality. 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. Q. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Nitrate Fact Sheet 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. 0. Box 196650 * Anchorage, Alaska 99519-6650 * www.muni.org Municipality of Anchorage • Development Services Department Building Safety Division - Y On -Site Water and Wastewater Program S A FE T Y 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 DWELLING Parcel 1. D. d,T ~ 3 6 3 HAA �-A 00. Expiration Date: 5 = O �- 1. GENERAL INFORMATION Complete legal description i— O j G,- 6i L a C X ( r,,V e 2- 4,k- E_ `x/10 Location'(site address or directions) 3 g k nco !3 �/ i �� ORi v� ►�,� �- +r P. icl�f� Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Day phone 13 31JL KN013 /1«L_ D4ivr ,�GL/� f2iy r�2� 4K C9 -t!-77 Day phone Day phone Mailing Address 7 Unless otherwise requested, HAA will beheld by DSD for pickup. - C ` C /q/ `f 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site] Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the 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 sample results. (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, 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 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 � & 5 ENGINEERING 17034 Eagle. RWe* Loop Road No- 2G.,j, Address `.axle River, Alaska 99577 Engineer's Printed Name I? o � k� C - C0 (fA e 5. DSD SIGNATURE 1/ Approved for 3 bedrooms. Disapproved. Phone GR 11 71 Date a /X/o y ROBERT C. COWAN } CE -8801 4 Conditional approval for bedrooms, with the following stipulations: Additional Comments Note: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be pe orm. to insure the weHs continued sui a Current nitrate concentration is 5.06 m maximum concentration is 10.0 m information on nitrates is avaflable from the n- 343-7904. Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: c2-" S_ (Rev. 01102) \ Municipality of Anchora e Development Services Department / Building Safety Division 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 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �C f (dLCaC-►� , l 1!—� I��� S/� Parcel ID: O� r — 36PH 2- A. A. WELL DATA Well type l� r If A, B, or C provide PWSID # Dare completed 421 Sanitary seal (YIN) Total depth 1. 10 ft. Cased to Tft. FROM WELL LOG Date of test Static water level ft. Wel! producrion . C) RIM WATER SAMPLE RESULTS: Coliform © colonies/100 ml. Nitrate S_ 06 mg./l. Arsenic: mg./l. Date of sample: !13 7`O`f B. SEPTICIFIOLDING TANK DATA Tank Type/Material Tank size 11lv. gal. Number of Compartments 71 VV ell Log (YIN) _.YCS Wires properly protected (YIN) y Casing height (above ground) 0't—in. AT INSPECTION /C4jft. 9.13 -m - Other bacteria 0 colonies/100 ml Collected by: S ! -16- l N Cr, /N1,— Date installed -7-6 Cleanouts (YIN) Foundation cleanot (YIN) _ l Depression over tank (YIN) /J High water alarm (YIN) Cu��scoc,) - � Date of pumping Pumper �) S C. ABSORPTION FIELD DATA Gate installed Soil rating (g.p.d./ftz o ftZ/bdr ) OQT System type�� Length i ?J' ft. Width ft. Gravel below pipe to ft. Total depth f (v ft. Eff. ab orption area `Zftz Monitoring tube Depression over field Al Date of adequacy test! J Results (Pass/Fail) 1 For _a bedrooms Fluid depth in absorption field before test G, in. Water added�y D gal New depth ) in. Elapsed Time: VO min. Final fluid depth/,,4 in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) A©/I%EASWWW — If yes, give date '—' D. LIFT STATION Date installed IV "Pump on" level a in. Datum E. SEPARATION DISTANCES Size in gallons "Pump off"level at in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? Septic tank i tin on lot / CC) i •t- On adjacent lots / C�© f r - Absorption field on lot f f�f- On adjacent lots+r- Public sewer main '� Public sewer manhole/cleanout /J StweeT /septic service line �i� f' Holding tank SEPARATION DISTANCES FROM SEPTIC/Uet6"G TANK ON LOT TO: I 6- (� Building foundation Property line �:;7 4- Absorption field_ Water main /U Water service line lot - Surface water /00 rr- Wells on adjacent lots I Or? SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main t Water Service line 1 O + Surface water10 V I ' ,( / 1 4- Driveway, parking/vehicle storage ! ©f-- Curtain drain ,VC/JC�1�%lh�N Wells on adjacent lots l� / w ,+t Ve F. COMMENTS Wk 37--og G. ENGINEER'S CERTIFICATION f , .-� ! certify 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. �+ . V� ` ^� ROBCRT C. COWAN r i4; Engineer's Printed Name IQ � �'� �1l�a% dti c- •. CE - 8801 , ti Date Z x w HAA Fee $ �7 �' Waiver Fee $ Date of Payment _ C' Date of Payment Receipt Number _ % 7 Receipt Number (Rev. 12/01) Municipality of Anchorage Recertification Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 Ok P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel aD: 051-361-32 1. GENERAL INFORMATION Complete legal description. HAA# HA000178 Expiration Date: Lot 6A, Block 1, Fire Lake Alaska S/D Location (site addressor directions) 13812 Knob Hill Current Propertyowner(s) Janet Garner Mailing address 13812 Knob Hill, Lending agency Mailing address Day phone Eagle River, AK 99577 Day phone Real Estate Agent Frank Irwin/Remax Anchorage Day phone Mailing Address 2600 Cordova Street Anchorage, AK 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 249-1338 257-0154 C1 /)J -/O TYPE OF WASTEWATER DISPOSAL: ® Individual On-site ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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 State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 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. 72-025 (Rev. 07!00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 17034 Eagle River Loot, Road No. 204 Phone iGgt '7 Address Eagle River, Alaska 99577 It i Engineer's Printed Name Robert C. Cowan 6. DHHS SIGNATURE L—� Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments Date -11/'//00 ��1ROBERT C. COWAN ti CE - 8801 r �t bedrooms, with the following stipulations. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: Expiration Date: / 2 / 5f— O 10 Reissue Date: 72-025 (Rev. 01/00)' 98? 694 1211 P.03/03 I-I~U ~,UI/U~ CT&E Her,# 100~4g6001 Client Name S & $ F-~gineerJng Pr~}eet Named# L6AB] F~Lk CUeflrSample~ LGABI ~eLk Matrix Drinking Wa[~ O~ered By P~JD Sample Remarks: Nilr~e-N ToToI Coliform Client PO# Prfltted Date/Time 09/1412000 13:08 Collected Date/Time 09/I2L2000 i 1:35 l'ieeeived Date/Time 09/1Z/2000 12:30 Techn~al Director 8~phen C. ~a~ Released B~~ M~hocl Limi;s .Dam Date lxlit 4.97 0,500 mg/L ]~PA 300.0 I 0 max 09112/00 SCL 2 OB, No Coli ceYlOOmI.. 5M18 9222B 09/12/00 TOTAL P. 83 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On -Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY- DWELLING Parcel I.D.(ZS) _ 5(JD 1 - 3 oZ 1. GENERAL INFORMATION HAA# YfOMFlf, Expiration Date: Complete legal description Lot 6A, Block 1, Fire LakeR=#=Z/D Location (site address or directions) 13812 Knob Hill Current Property owner(s) Janet Garner Mailing address 13812 Knob Hill, Eagle River, Ak Lending agency Mailing address Day phone 99577 Day phone 249-1338 Real Estate Agent Frank Irwin/Remax Anchorage Dayphone 257-0154 Mailing Address 2600 Cordova, Anchorage, Ak 99503 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site KI Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer _ . ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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 State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 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. 72-025 (Rev. 01/00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGINEERING Name of Firm 77044 F291le R',ver Loop Read No. 2G4 Phone Address Eagle River, Alaska 99577 Engineer's Printed Name R 66 6, 7- Co Date 6. DHHS SIGNATURE li' Approved for �_ bedrooms. Disapproved. GqI — a-/ 75 01 IkEER �F RCBURT 'C.. 'Cis"VVA-K CE 77�C ala............ Conditional approval for bedrooms, with the following stipulations. Note* The well for this property meets existing State and Municipal Codes. There are nitrates present. It is suggested that periodic testing be performed to insure the wells continued suitability. Current nitrate concentration is 6.52 mg/l. EPA maximum concentration is 10.0 mg/1. More information on nitrates is available from theOn-site Services Program, DHHS,`343-4744. Attachments: HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: - / 5-- 0 0 Expiration Date: ---1S =A A Reissue Date: 75-025 (Rev. 01/00)' 2%L.%_L_i V 6.-V MAY 0 4 2000 Municipality of Anchora%@NICIPALITY or DEPARTMENT OF HEALTH & HUMWSEh�(l0E-S'IC-FQ �i Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: LJ/ 61 .' / C� /. �12L' G�K�,garcel I.D.: A. WELL DATA 51-0 Well type IJ /1`14 7-6- If A, B, or C, attach ADEC letter. ADEC water system number Log presentyN) �L S Date completed /0/ / 7� Total depth ID Cased to / Zd Casing height (above ground) Sanitary seal ON) FROM WELL LOG �I Date of test /0 /7 / � T Static water level Zv i Well production WATER SAMPLE RESULTS: Wires properly protected"/N) C-5 AT INSPECTION g.p.m. g.p.m. Coliform 0 Nitrate ("• S- A Other bacteria 0 Date of sample: / / Collected by: S & S ENGINEERING B. SEPTIC/HOLDING TANK DATA Eavde River, " `` sfzz Date installed4 = 92 Tank size 1�!5� Number of Compartments Z Cleanouts�)N) Foundation cleanou (Y ) `6-5 Depression (Y/N) High water alarm (Y/N) Date of Pumping Zipumper 'S C. ABSORPTION FIELD DATA j Date installed Soil rating (g.p.d./ft2 or ftz/bdrm) X00 �I System type 0/2-%5) Length ! Width �1��/ Gravel thickness below pipe Total depth /0 Effective absorption area �/ Monitoring Tube present ®/N) ES Depression over field (Y,)) A/0 Date of adequacy test Results (Pass/Fail) //il S's For t4 6-1(_-- bedrooms / el Fluid depth in absorption field before test (in.); `-t Immediately after4IS:?gal. water added (in.): il Fluid depth !VZ (ins) Minutes later: Absorption rate = 45V g.p.d. Peroxide treatment (past 12 months) (Y/N) MQWJ 4d'tIAef yes, give date 72-026 (Rev. 3/96)'` D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* .; Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump off" level at* Septic/holding tank on lot Ad� r On adjacent lots Absorption field on lot r j On adjacent lots /Go t Public sewer main N/A Public sewer manhole/cleanout Sewer /septic service line Lift station /V A SEPARATION DISTANCES FROM SEPTIC/H �ON LOTTO FoundationProperty line Absorption field Water main/service line f Q Surface water/drainage 4077 Wells on adjacent lots SEPARAT ION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line �� / f Building foundation %� �� Water main/service line % r /- Surface water 0 0 Driveway, parking/vehicle storage area 6) ! t /�/0 n/&- %�r'VCya'/V Curtain drain Wells on adjacent lots F. ENGINEER'S CERTIFICATION l certify that l have determined thru field inspections and review of Municipal in conformance with MOAHAA guidelines in effect on this date. Signature Engineer's Name r `� �'e'T �� w� ✓ Date HAA Fee $ Date of Payment �T Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number .m '� i `'sem•` ROPERT C. COVVAN are MUNICIPALITY OF ANCHORAGE 0< DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date. :2/11,7h-7 1. _GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner �/"'_' - Telephone: Home (2%4� - c2022 Business _:�; 7Q - (,/ z y (c) Mailing Address Lending Institution ��P 0_'�_ lephone Mailing A,�A,. (d) Real Estal Address 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. S ENGINEERING 17034 92gle River Loep 110e d No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family X Number of Bedrooms 3. WATER SUPPLY Individual Well/[ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 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. Page 1 of 2 72-025 (Rev 8/861 Front 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 Firm S & S ENGINEERING Telephone��'�/ 17034 Eagle River Loop Road No. 204 Address Laala Rlusu! Alaska 99577 Date 6. DHHS APPROVAL Approved for Approved fAeleat 69 bedrooms by �^ Disapproved Conditional _ Terms of Conditional Approval CAUTION OF 4 AV • ° ° :'' .r T_- yDn/I mo '174 XOFc`SS140 Date S— !o — a 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. Page 2 of 2 72-025 Rev 8/86) Back C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �Cb�f� Type of System Design Date Installed Length of Field 13 Nnre[iT.1Nalm- [` Square Feet of Absorption Area Depression over Field (Y, V) Results of Last Adequacy Test 312 `, Depth of Field I ! Gravel Bed Thickness k�a — Standpipes Present d)N) Date of Last Adequacy Test Z2 8 7 Separation Distance from Absorption Field: , To Water -Supply � 1 S pp Y Well To Property Line � To Building Foundation �� To Existing or Abandoned System on Lot P ; On Adjoining Lots I To Water Main/Service Line To Cutbank (if present) F� er-- To Stream/Pond/Lake/or Major Drainage Course 00N*, To Driveway, Parking Area, or Vehicle Storage Area 2a Comments , P14- 10C--0ftX lh Ilse-e— wa..'v�r., D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and H A guidelines in effect on the date of this inspection. Signed& S ENGINEERING Date 2 % 17034 Eagle River ooP oa o. 204 ComEagib River-, Alaska 99577 MOA No. Receipt No. _ OO — Olj6 Date of Payment H -A- o e o Amount: $ R-) o -3 4 Page 2 of 2 72-026 (11/84) 426 ,I 9 d 0. � P'ewca ,a.n„�� ooe�eo A. ahcfw a s 1457 E -F August 10, 1987 P.O. L X 196650 ANCHORAGE, AL-ASKA 99519-6650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Robert A. Shafer, P.E. S&S Engineering 17034 Eagle River Loop Road #204 Eagle River, Alaska 99577 Subject: Lot 6A Block 1 Fire Lake Alaska Subdivision Waiver Request WR87-044 Dear Mr. Shafer: Your request for a waiver of the 100 foot separation required between the seepage pit on the subject lot and a private well located on the neighboring lot (Lot 12A Block 1 Fire Lake Alaska S/D) has been granted. The required distance has been waived to 96 feet. A letter of non -objection from the owner of the well on Lot 12A was written in 1978 at the time of the seepage pit installation. You have submitted a risk analysis to this department that indicates that there is no possibility of bacteriological contamination of the well from the encroaching seepage pit. You have shown that there are elevated background levels of nitrate levels in the area. It is unlikely that these elevated levels are the result of this single well -to -seepage pit encroachment. This waiver is valid for the existing seepage pit only. Should the pit require upgrade, the upgrade will be required to meet applicable setback standards. Sincerely, Stephen S. Morris Civil Engineer On-site Services cc Gus Andress, P.E. Manager, On-site and Water Quality Programs HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN ROBERT A. SHAFER CIVIL ENGINEER 694-2979 August 5, 1987 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AUG c) 1987 Municipality of Anchorage Department of Health and Human Services RECEIVED 825 L Street Anchorage, Alaska 99501 ATTENTION: Steve Morris REFERENCE: Lot 6A; Block 1; Firelake Alaska Subdivision This letter supplements information provided in our letter of July 25, 1987 request for waiver on the referenced property. Based upon our conversation concerning the high nitrate levels for the well on the referenced property and the adjoining property additional samples were taken within the immediate area. Copies of these analysis reports are provided for your information. As you can see by these reports the nitrate level in other wells in this area is also high. It is our opinion that these nitrate levels adequately establish background for the aquifer in this area and that granting a waiver as requested in our previous letter will not in any way contribute to these nitrate levels. If addi # information is required, please contact us. ss . SHAFER, P.E. SRB 196X EAGLE RIVER, ALASKA 99577 page two Lot 6A; Block 1; Fire Lake Alaska Subdivision July 25, 1987 It is our opinion that the horizontal separation distances prescribed by 18AAC72.021 are not required in this case. If you require additional information, please contact us. Sincerely, A. SHAFER, P.E. ss HEALTH AUTHORITY APPROVALS 2 July 25, 1987 ROBERT A. SHAFER IVIL ENGINEER 694.2979 Municipality of Anchorage Department of Health and Human Services 825 L Street SEWER &WATER Anchorage, Alaska 99501 MAIN EXTENSIONS REFERENCE: Lot 6A; Block 1; Firelake Alaska Subdivision Request you issue the attached Health Authority Approval and grant a SEWER WATER INSPECTION waiver for the horizontal separation distance between the see a e P it P seepage located on this property and a private well located on Lot 12A at a distance of 96 feet. Prior to the on-site wastewater disposal system being installed on Lot ENGINEERING STUDIES AND REPORTS 6A a waiver was granted by the Municipality of Anchorage for a horizontal separation distance of 96 feet. At that time the owner of the property on Lot 12A provided a letter of non -objection. WELL INSPECTION A risk analysis has been performed and it appears that no bacterialogical &FLOWTEST pollution is possible from this source. Attached for your review are the following documents: A. On-site wastewater disposal system inspection report for Lot SITE PLANS 12A showing a horizontal separation distance between his septic tank and his well of 78 feet (installed in 1970). B. A copy of the letter dated April 18, 1978 from the owner of Lot 12A stating his non -objection to the septic system on Lot ROAD DESIGN 6A. C. Copies of on-site wastewater disposal inspection reports, permits, well log and soil test for Lot 6A. These documents support SOIL TEST the existance of a previous waiver. D. Risk analysis waiver review work sheet. PERCOLATION E. Coliform and nitrate analysis of water taken from both wells TEST on Lots 6A and 12A. F. Flow test and well information for Lot 6A. STRUCTURAL& G. A plot plan showing relative distances between on-site wastewater MECHANICAL INSPECTIONS disposal systems and wells. ON SITE WASTE WATER DISPOSALSYSTEM DESIGN SRB 196X EAGLE RIVER, ALASKA 99577 D sn \ � Qq s X11 31VOS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES WAIVER REVIEW WORKSHEET DATE RECEIVED: LEGAL: to tu. � Av"l-SIVA ENGINEER: S & S ENGINEERING 17034.Eagle River Leap Road No. 204 Eagle River, Alaska 99577 APPLICANT: 2nnL' WAIVER REQUESTED: CRITERIA: 1) Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation 2) Special Conditions: 3) Other: Points: TOTAL: Pwbvil A. Shfx 1457.2 ih n t)oi, WAIVER IS: granted, with conditions listed below: not granted for reasons listed below: A 00- DATE: BY: NAME \ ?-r- S & S ENGINEERING 17034 Zagle River Loop Road No. 204 Eagle River, Alaska 99577 VIE \ ?-r- S & S ENGINEERING 17034 Zagle River Loop Road No. 204 Eagle River, Alaska 99577 ~ CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 3 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 ~ ...... ~.',,~;'~ FEDERAL TAX ID # 92-0040440 _CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. V ~o.^,o,,~;~'~ FEDERAL TAX ID # 92-0040440 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. FEDERAL TAX ID # 92-0040440 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 PROJECT: 17034 Eagle River Loop Road ROBERTA. SHAFER Eagle River, Alaska 99577 CIVIL ENGINEER 694-2979 DATE OF TEST: ~"~-'~.,t--~'"7 LOCATIONOFWELL(LegaIDescdption):~L.-c:>~ ~;,/~ ,~ ~ _~'\~_.~ ~ WELL DEPTH: i,,~.,~ / FT. CASING: ~'~ I -- - FT. SCREEN: STATIC WATER LEVEL (Top of Casing): __ \ 4~::',,~ I ~ FT. DATE: ~ - ~ CLOCK ELAPSED TIME SINCE TIME PUMPING STARTED/ DEPTH TO DRAWDOWN PUMPING STOPPED, MIN. WATER, FT. RECOVERY RATE, GPM REMARKS ~ 0 I u (swl) 0 0 Start ~ ac 3,5 __ 40 45 50 ~ ' 90 -- 120 (2 hours) 180 (3 hours) :~0~' 240 (4 hours) RECOVERY ~ ~ o 10 15 20 25 30 35 11/19/03 15:40 FAX 907 273 8440 ct PRUDENTIAL VISTA REAL ES Z001/001 X 94 Ile A -SUILT S I haiv surveyed the t NOY 'x dew1bed I ALpki - and tlk,;- the frnpmvt-. Mrs ed d-feim am wiliftin the propen y lines and do ncg ibev*to, encloach, per"',,. - Y on *am 77- X 94 Ile A -SUILT S I haiv surveyed the t NOY 'x dew1bed I ALpki - and tlk,;- the frnpmvt-. Mrs ed d-feim am wiliftin the propen y lines and do ncg ibev*to, encloach, per"',,. - Y on *am