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SST BLK 2 LT 4
Block 2 Lot 4 #015-082-21 Municipality of Anchorage a` Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW100001 PID Number: 015-082-21 Name: Andrew Or4en Wastewater System: ❑ New ® Upgrade Addreas: 9701 Homestead Trail, Anchorlage. AK 995116 ABSORPTION FIELD Phone: Numberof Bedrecros: ® Deep Trench D Shallow Trends D Bed D Mound D Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 0.8 GPDiFtz 11.$ Ft. Block Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 2 4 S.S.T. 2.1 Ft. 9.1 Ft. Township: Range: Secgon: Fill added above original grade: Gravel Length: 1.9-2.1 Ft. 53 Ft. Well: ❑ New ❑ Upgrade Gravel width: Number of linea: ET Men- lines: 2 Ft 1 I F t. Classification (Private, A, B. C): Total Depth:Cased to: Total absorption area: Pipe Material: Private - ExistingFI. Ft. 964 Fl Sch 40 & D3034 Driller: Date Drilled: Static Water Level: Installer: Dale Installed: Ft. Mike Anderson 1 01/30/2010 Yield: Pump Set at Casing Height Above Ground: TANK GPM FL Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: 7o Septic Absorption Lift Holding Dubliwpnvate Manufacturer: Capacity: From-'-,.Tank Field Station Tank Sewer Line Anchorage Tank 1500 Get. Well 1001+ 1001+ NA NA 251+ Material: Number of Compadments: Steel 2 surfacewater 100'+ 1001+ 1001+ NA LIFT STATION Lot Line 5'+ 101+ $'+ NA Size: Manufacturer. Gal. Foundation 5+ 101+ $+ NA 'Pump on' level at: "Pump orlevel at: High mater alarm at: in. in. in. Curtain Drain NA w 501+ NA NA Pump Make B Model Electrical Inspections performed by: Remarks: • None known BENCH MARK Existing septic tank abandoned in place per code and Location and Description: Garage slab floor existing absorption trench was connected with a diverter. Assumed Elevation: 100 FL Engineer's Stamp OF it 7 � # !r* Inspections by: ArcTerra Consulting, Inc. Dates: 1St performed 1/30/2010 - 2nd 1/30/2010 ` 3rd 02/23/2010 Development Services Department Approval Reviewed and approved by: Al l Date: 31/') \ SatDa AS—BUILT SYSTEM DETAILS/SITE PLAN Permit SW100001 S.S.T. SUBDIVISI❑N LOT 4, BLOCK 2 PID# 015-082-21 N89"56'S9,.'W .. 299.6/' REC & MEA / LOT 4 BLK 2 SHED NEW 1500 A GAL S .\ IVERTERCO i CO E DC vim✓ 60 TH09-1 F 61 9 __\` i 53' /CC `�<Q , PREPARED FORI �`y 1 ANDREW DRIEN N / * 49TH * 9701 HOMESTEAANCHORA E, AKD99516L 3 : FIELD BOOKS caNRuicD: 116 rya BOUNDARY: BOUNDARY DRAWN` BMW srAONc: STAKING \ CNEMm: KMD As9uar. JLS DATE: 03/12/20 9$101y= DWG. RM GRID: 2439 ACAD Nom: FILE JOB Nu.: 09-069 'Z 1 w cD .5' cn 30.0' Oi0o C 0) 4. �A = Fri O W NC 90 mz� G7 Bl 00' O SCALE, 1' = 30' VN s T 9..1V 1 %.5.10 NH SCALE, NTS +/2F SUING . 5 R' AK. 99577 _g75 99.5099.10 a 2 IB—C=48.5'g An!� NA—D=32.5'95.00 M (I Mn n FINAL GRADE B—D=51,2' & o TA—E=65,0' n rx vAawC B—E=75,2' y 1500 G L 90,80 SEPTIC EA—F=118.0' TANK SEWER ROCK �I B—F=112.0' 61 9 __\` i 53' /CC `�<Q , PREPARED FORI �`y 1 ANDREW DRIEN N / * 49TH * 9701 HOMESTEAANCHORA E, AKD99516L 3 : FIELD BOOKS caNRuicD: 116 rya BOUNDARY: BOUNDARY DRAWN` BMW srAONc: STAKING \ CNEMm: KMD As9uar. JLS DATE: 03/12/20 9$101y= DWG. RM GRID: 2439 ACAD Nom: FILE JOB Nu.: 09-069 'Z 1 w cD .5' cn 30.0' Oi0o C 0) 4. �A = Fri O W NC 90 mz� G7 Bl 00' O SCALE, 1' = 30' VN s T 9..1V 1 %.5.10 NH SCALE, NTS +/2F SUING . 5 R' AK. 99577 _g75 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW100001 Legal Description: SST BILK 2 LT 4 Design Engineer: 0070 ARC TERRA ENGINEERING & SU Owner Name: ANDREW ORIEN Owner Address: 9701 HOMESTEAD TRAIL ANCHORAGE, AK 99516-6532 /-30 -/0- ('' (d',c:) / oa Date Issued: Jan 20, 2010 Expiration Date: Jan 20, 2011 Parcel ID: 015-082-21 Site Address: 009701 HOMESTEAD TR Lot Size: 49499 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904(24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Received Issued By: Date:1z1 r0 Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I. D. 0 1!5; d g 2— 2 l Property owner(s) 402£w Ohi" Day phone Mailing address 1701 /ItNCSAaf,0 'IkPi 1iu / /i!� Zip Code Site address it Zip Code Legal description (Sub'd., Block & Lot) �, 5. 'T- 82- C Legal description (Township, Range & Section) Lot Size t��lq Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field V Septic Tank Holding Tank ❑ Privy Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 6 - THIS APPLICATION IS AN: Initial Upgrade Renewal I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. property owner or authorized agent) Permit/Rush Fees: a �24D. — Waiver Fees: Date of Payment: 1c, o Date of Payment: Receipt Number: 04557(, Receipt Number: (Rev. 11/05) ARC 1 ERRA CONSULTING, INC 212 E. 51"Ave, Anchorage, AK. 99503 ffice (907) 868-3791, Fax (907) 868-3793 January 11, 2010 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit - S.S.T. Block 2, Lot 4 The owner has requested we proceed forward to obtain a septic permit to upgrade the failed leachfield on the subject lot. The general slope of this lot is from east to west at a grade of approximately 1-7%. On November 21, 2009 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 5 -bedroom house. We propose to install one 53' long deep trench. Groundwater was not encountered during excavation or at monitoring. The property and adjacent lots are served by private wells as shown. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868-3792/FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duffus, Attachments: On -Site Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test Owner/ Contractor Specs 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 I WASTEWATER DISP❑SAL SYSTEM DETAILS S.S.T. SUBDIVISI❑N LOT 4 BLOCK 2 N89056'59"W 299.67' REC 8c MEA SHED LOT 4 s:. BILK 2 INSTALL FP 3� NEW �y 1500 30.0' ° •� CO C1 o D CO CO M T � a, TH09-1 \ 3� 0 M o i9 J ;;uX M N A P. _moi I 'Wo wlovr s' J� T. 0-2 10.0 T°G°A�ps K O EXI TIN C 0 S TI (!) 143' M T M 26 `'\, \ S Ul 00 'q • .a GREENHOUSE /W A.I.P. = ABANDON IN PLACE PER CODE FLAG WELL RADII PRI❑R TO C❑NSTRUCTI❑N Sca(e: 1'= 30' PAGE 2 OF 2 i OF 1, PREPARED FOR: Andrew Orien �RCTEjl / "1: '� ♦ 9701 Homestead Trail Anchorage, AK 99516 902-240-0970 by FlEID BOOKS COMP M ` 116 Boumwr BOUNDA nuwN: BMW r x /'�/Dq ti'QA' � sTmNa STAKING a�Ba� KMD ° •; Asear. JLS Bah 12/03/09 ...9 ! ` '•`a'N:351O�= owa Flee oras: 2439 S LN a u '101, C ND ACRD RLE FILE 'be N0.: 09-0V9 AK 99511-8) WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA S,S,T, SUBDIVISION LOT 4 BLOCK 2 °^w pw au.) w I w FLAG WELL RADII PRI❑R TO C❑NSTRUCTI❑N Scate: 1'= 100' DESIGN DETAILS PAGE 1 OF 2 5 BDRM X 150 GPD = 750 GPD 750 GPD/,8 GPD PER SQ. FT. (10 MIN/IN,)= 938 SQ. FT (938 / 2 x (9' GRAVEL) = 53 FT, TRENCH USE 1 TRENCH - 53' (L) X 2' (W) X 9' (D) Total depth of system Is 12' max from orlginal grade. Total depth of gravel below distribution pipe is 9' . NO PUBLIC WELLS WITHIN 200' DF PROPOSED SYSTEM. NOTES NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. 1. INSTALL NEW 1500 GAL & INSULATE TANK IF <4' COVER. NO SEPTIC SYSTEMS WITHIN OF PROPOSED TI WELL EXCEPT AS NOTED.. NOT 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM IF < 3' OF FILL. MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ. 3. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK. 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC... OF 1 PREPARED FOR: Andrew Orien gCTERA * : TH * 9701 Homestead Trail Anchorage, AK 99516 902-240-0970 ' TH M. S ,' CE— FIELD BOOKS muamen: g 6OUNDMY:BOUNDARy DRIAWN: BMW / snwND: STAKING 0"C"D: KMD ° •.,i ASDNILP. DATE " •w ESS108-AV JLS 12/03/09 ONG. FILE: ORm: 24392c qNn sv*I�4 l A 99571-8Tfb "a"° FILE: '10B "°' 09-069 ARCTERR . CONSUIMING, INC 212 E. 51" Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 SOILS PERCOLATION TES] Performed for: Andrew Orien Project: SST Block 2, Lot 4 TEST HOLE # TH 09-1 Depth SEE ATTACHED SITE PLAN 1-M,oRG/oL FOR HOLE LOCATION SM-sp w/ occ. boulders to 1' Silt decreasing w/ depth B.O.H. 19 - HOLE PRESOAKED 20- PRIOR TO TESTING Was Ground water encountered? NO What depth? NA Depth to water after monitoring? DRY Date? 11/30/09 Reading Date Gross Time Net Time Depth to Water Net Drop 1 11/21/09 1:00 6" - 2 1:30 30 min 2 15/16" 3 1/16" 3 * 1:31 6" 4 2:01 30 min 3" 3" 5 * 2:02 6" - 6 2:32 30 min 3" 3" 7 8 9 10 11 12 * Water Added Percolation Rate 10 (min/in) Perc Hole Diameter 6" Test Run Between 4.5 feet and 5.5 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. LOCATION OF WELL • • WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys (Please complete either la, Ib or lc.) Drilling Permit No. 870101 A.D.L. No. _. p1cDISTANCE Subdivision Lot Block 2 Ib. 1/4 qt rs. _of_of_of— Section No. TowashipNORange B❑ EQ W❑O Meridian DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 3. OWNER OF WELL: Address: Mr. Andrew Driet, 9701 Homestead TraU 2. WELL LOG Material Type Feet Below Surface Too Bottom 4. WELL„gEPTH: (final) ` }} 3. DATE OF COMPLETIgj / / J _ � - r'.%rd r m, LQ.. @ 2s 0 31 6, Q Coble tool E3RotorY ❑ Driven � Dug 1:1 Auger C] Jetted ❑ Bored Other: �h,,,p,�,U,77der fine, loose grovel !Of `"� " of till 31 48 - T. t �.F H Z49 04 7. USE: © Domestic C] Public Supply C] Industry ❑ Irrigation Recharge C] Commerical Test Well Other: )ray, saauly c1av CIL 767 silt, sand sti)f5., ivet %O dl,— °: F'?LNr ys�,p(j• - Sly C(L S. CASING: (] Threaded C] Welded diem.7 In. to '53 1t. Depth Weight 17 1be./ft. diem. in, to ft. Depth Stickup 215dVZ,it. S[C�"hi It Clf TBT .��1` t7C 92 9") Cl_:3IS2 ;:'AtET ^a1tiSZ t:;t% nUT'dvG. - r10! = 9. FINISH OF WELL: Type: or --ii lbottcrDiameter: SlotlMesh Size: Length: Set between ft. and it. Backfilling Gravel pack GN�RP 10. STATIC WATER LEVEL: 56 ft. 7 Date Above or © Below land surface - Equipment used: PP�1'(Y EPS,tN ) N Dti ` P j Zvi 1 1011 I1. PUMPING LEVEL below) apd surface and YIELD ft. after _hn. pumping_g.p,m. ft, after_hrs, pumping _g.p. M. - 12.GROUTING Well Grouted: D Yes Q No Material: C] Neat Cement ❑ Other: - 13. PUMP: (if available) HP Length of Drop Pipe ft. capacity g, p,m. - O Subm. Jet Centrifical Other 14.REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature F C This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief; - Registered Business Nome Contract License Number Address: Signed: Date: -7110/87 d Authorized Representative Form 02-WWR (11/81) Copy DistributioN WHITE - State DGGS, PINK - Drifter, CANARY- Customer Development Services Department Building Safety Division On-site Water & Waste -water Program 4700 Bragow Street P.O. Box 196650 Mark Begich ,Anchorage, Al' 99519-6650 Mayor wwwtMnl.orn/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW_ Parcel Identification Number: b1 G'CU' Date of Issue: Legal Description Property Owner Name & Address: a3-1 PF -Lu ORtc--hc �i L4 9('-70 F TR Pump Installation Date: 6-�2q Pump Intake Depth Below Top of Well Casing: 67& feet Pump Manufacturer's Name: Pump Model: Cr.) /;t, Pump Size g hp Pitless Adapter Burial Depth: / ® feet Pitless Adapter Manufacturer's Name: ov lei Pitless Adapter Installer: fi A Well Disinfected Upon Completion? RYes ❑ No Method of Disinfection: Comments: Pump Installer Name: A kJ -Ps b t ur-j ii y pie rti �a � Attention: The purnp installer shall provide a pump installation log to the DSD within 30 days of pump installation. PdMIT" NO: 1'E_ ISSUED: iPPL.. I CANT: iDDi ESS: UNTACT PHONE- EGAL DESCRIP; OT SIZEr DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION B25 L- STREET, ANCHORAGE, AK 99501 264-4120 L=B F*•1--- 10 1 ...Y-' F=: L.a.9 F -- L._ L_ F " E� F -A KI a -T- 87010:1. T-8701 i:I. 05.2:/87 ANDREW ORIEN 7901 HOMESTEAD TRAIL ' ANCHORAGE, AK 99516 344--1952 SUBDIVISION: S.S.T. LOT; 4 BLOC;„ 2 SECTION: 14 TOWNSHIP; 12N RANGEa 3W 49000 (SQ.F'T. OR ACRES certify that 1. 1 am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance= with the design criteria of this permit. =>. I will adhere to all MOA and State of Alaska requirements' for the set hack distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot.. IGNED DATE* PF'LICANTP ANDREW ORIE:N BSUG D DY7✓y�/J�J� --------------------- DAT t.: LPA 1111u1oaal. 4 1'^MI V, w • c�%�-3� � lv 30° L. 6J'twm a-7q-��oV �^,�6 'MOA q3 42©O pQ � a DATE 0/ -15 /-Or,5 N 89°56'59"w �� 346 - lzos 23-9-07 sHEow 9 SEPT/C . N cc ¢° LOT • - N / / tJ �f i /G4EENH0 E -1 / 299.65' N oArw�on/ N 890:55,59" w GOT 3 (0 V2- Lot 4�-Blocl Sbw/V%S/O/- An Recording Precinct, Alaska LOT SURVEY CERTIFICATION LEGEND I hereby certify that I have surveyed the property shown and described herecn,and ttx>t The Improvements situated thereon are within the prop- arty llnes and dont overlap or encroach on adjacent property and that no improvements on adjacent property overlap or encroach on the premises in question and that there are no roadways, utility lines or other visible Q5 = Bross copped alonument recovered o = Iron pipe and/or tebdr recovered a = 2x2 hub d tack recovered • = gra°x 3d' rebar set this survey easements on said property except as Indicated hereon. C. 65 1£1rL•3 « 1. R. Bu r Scale / ry_ Date Prepared by: R. L. BUTTON /5 —(57 8 % Reg/rlered Land Surveyor v / (907)279-6200 5/9 W. ElghM Ave. Anchorage, Alaska 9950/ Ref. F. B. No. r ... 15-P Property of: 1 ,.- — "/ / / , ' — I PIUCg1C1.Y111,1'1'y. UP [llVt... 11vLc[1U 1'a 11 h and r''nv;i.ronmcntal. Prot' ion �• Fourth Ploor Wost 825 L Street Anchorage, Alaska 99501 264-4720 % . -- _ INSPECTION REPORT ON-SITE SE✓✓ACE DISPOSAL SYSTEM nn '"� /, 7 _ r `:nf. n��Z'-'1�1N_'S_ _'._ MAI I- G ADURLS!�%_ �S! �• -�tT C�<?�.�t�sa_c1. ��� >r-IONE �( i -I- LLGAL �r L c n!P7!ON S,:.i'TIc TANK: Li?IAr4CE P(-Gf j NUMBER OF F I+.UL1 VJ L.I_L-..(UU-� •^.fJ.Uif.0 I URE R.SCJ__�2 .+C-C_IC, ._F•1AI iil. ;1.. _`_._.-_,COMPARTMENTS_ INi1.J F. L E N G T FI _._..____._____ INSIDE VII D T 11 __ LI Q 10 F)FP1,H ____._.__ LIQUID CAPACITY _GALLONS. f TOTAL LENGTH OUNOATION._/ ____. NEARLST LGt LINt._4j0_ OF LINE of Lines -( _..._..:-- DISTANCE 6L T'NECN �L If.ES _ '-__ TRENCH Yl LOTHZ IN. TOTAL EFFECTIVE FT. LF NGTII OF EACHLINE LA PTIi OF I' FILTER TOu: 1'ILL.. 70 I�!f;IS.th il CDE .� h.A(LJ?IA.L iiE^dEA7Ft TILE __� _-11`Jc ABOVE TILE --6—IN. SE.PACE P! f; U1:-',,.1EfER OR WIDTH__, LENC H_, DEPI-11 Log Crib Rings,, Crib Size: DIAMEI (!l -___L EPrH-_ DISTANCE FROM: WELL 10T?.L. EFFECTIVE NEAREST LOF LINE,_____ . ABSORPTION AREA (WALL AREA) - SQ. FT. . ell lass:)_u/L> • Depth: ell Distance To: Lot Line _ i i- lLlg Sewer Line: 'i -pe Materials: , �'f of Bedrooms: nstaller.: tfi�JZ�k�.orC ice! i ernarks:/'7ni7 n e I� T— ��, _ ^-- Z� W ab I � i G ' ' 1 i r rlaa —I L. I I i 7 (r It • i A-tm GREATER ANCHORAGE AREA BOROUGH q, do (Adylmf DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. I. 3330 "C" STREET ANCHORAGE, ALASKA 99503 p�'tlIgIlVl=luu� TELEPHONE 274-4561 1/p, /-)? SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT S-(g5p4L+hS C -[i ,7 MAILING ADDRESS :3Lq/o 'fpSf'WGOD Cc F PHONE ��J I INSTALLATION LOCATION LEGAL DESCRIPTION INSTALLATION OF: SEPTIC TANK SEEPAGE PIT DRAIN FIELD ,.OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH SOIL TEST RESULTS COMPLETION DATE ANTICIPATED TO BE INSTALLED BY NOTE: THIS PERMIT IS NOT VALID WITHOUT .SOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLIN+G OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE 6bO TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK , SEEPAGE PIT TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD WATER MAIN TO SEPTIC TANK DRAIN FIELD SEPTIC TANK. , SEEPAGE PIT TO RIVER, LAKE, STREAM. SEEPAGE AREA SIZE DRAIN FIELD DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. _. SEEPAGE PIT DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING STALLATION. G.A.A.B. OR LICENSED DESIGNER TYPE DIAGRAM OF SYSTEM 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM 15 IN ACCORDANCE WITH SAID CODE. DATE 1/ w r/' -)�? APPLICANT'S SIGNATURE_\�fyl FORM NO. EQ -016 &UNICIPALITY OF ANCHORAGE He and Environmental Prot4Wn Fourth Floor West 825 L Street Anchorage, Alaska 99501 264-4720 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYST NAM _ MAILING ADD RES o ���YCJ-) 'C_S{,��'°G_VO N E a X-1- �J �j,��^�� /j� Y�� L. L 6 :L S S.( f LOCATION Me����=—'-`"""-1- LEGAL L'ESC RIPTION __ SEPTIC TANK: DISTANCE Prof f NUMBER OF FROM WELL_ jha ( _ MANUFACTURER j�a_ M,ATERIAL1_'� 2,-1,.—COMPARTMEEN��TS INSIDE Lf�ENGTH �\^\ INSIDE WIDTH- - LIQUID DEPTH ___ LIQUID CAPACIT42--6 LLONS. T C iii ��i�n• , y � TOTAL LENGTH % DISTANCE FROM WELL _/Cd__ FOUNDATION"k�___NE�ry}�Fl��REST LOT LWE [Xf1 OF LINE Of Lines __(�-- DISTANCE BETWEEN LINES ___"_TRENCH WIDTHx_ IN. TOTAL EFFECTIVE ABSORPTIO,'J AREA _ SQ. FT. LENGTH OF EACH LINE - �I DEPTH OF FILTER Q� j DEPT! : TOP OF TILE TO FINISH GRADE (3 MATERIAL BENEATH TILE _u Zht ABOVE TILE IN, SEEPAGE PIT: -- --- ---------- ----- --- — DIAMETER OR WIDTH_, LENG'"H_, DEPTH Log Crib _Rings_ Crib Size:: DIAMETER__DEPFH_ DISTANCE FROM: WELL TOTAL. EFFECTIVE BUILDING FOUNDATION NEAREST LOT LINE ABSORPTION AREA (WALL AREA) SQ. FT. Well p' Class :orxJ, Depth: Well Distance To: Lot Line _ { Bldg: Sewer Line: j Pipe Materials: `, P_&.Zj,. I # of Bedrooms:y— Installer: �fL�%iporK %f1L� Remarks: D AT E7_-/3_-_L(APPR i D AT E7_-/3_-_L(APPR M -W DRILLING, INC. 1JUNiCIPALITY Or ANCHORAGE DEPT. C H ALTS l G e t - RIV ONcVEto^L I1'3TECTION �0 r DRILLING LOG ! E C E 1 V E D y Well Owner Stevens Construction Use of Well Dom, Location (address of: Township, Range, Section, if known; or distance main road Lot 4 Block 2 SST Subdivision, Anchorage Size of casing 6' Depth of He Static water level 50 ft. *abc Screen ( ); Perforated Describe screen or perforation Well pumping test at--jII—gallons of drawdown from static 14 1 Date of completion 9/15/77 - et /15/i% Depth in feet from ground surface O To 2 2 To 4 4 TO 55 55 To 65 65 To 85 85 TO 95 95 mn 101 TO TO - et Case'$ to --10--0- Lfeet )elow) land surface. Finish of well (check one)open end ( xx; (minute) for 1 hours with 100% x9 WELL LOG penetrated, size of material, color and hardness NV,/WA Certified Contract(& I y. 3 2—STATE' - I a .. DEPARTMENT HFHI TH HND ENVvIRONMRNTHt_��TEI Tllild�,✓WPLO �• ,TEFF I ANCHORAGE,U AFC a r 279-2511 vol- �� F •.N FV N _- F _ L Fos F .N F _w e Y N' N — ° T: N... ; f= &A FEE Fp' F=° F=: �' N-° -F- T FERMI T Nl+ 0 �1 li.y H-4AMYL (/� 1 5; 7� APPLICANT i HPdT c tFFH1-Y� i. Ut�;'T' -:;: 9.F�i Fa'= ttFi ii iD LOOP/T � C�^�r,-•#.`5 _AIX" � J�. l I)f_:HTTON HI:TIIF-.1 F. AI H..I_ "� I Fa-iHi... 1.4 BY T. SURD KOT T'F. 4.1.91 QUARE FEF'1- TYPE: OF SOIL_. AF'•:=S'IRRTTON ':'.STEM IS: TRENCH MAXTMUM NUMBER OF BEDROOMS 3 SOIL RATING(?Q FTIRR?= 175 THE. REQUIRED SITE OF THE SOIL ABSORPTION SYSTEM IS: F• . W=° W N -N -- 79 _'_F.. P-040413 N-"— _ Y.. W-" Y=F N-.: W._... 5_ a W=° 1 W -F — c=. THE t_F.1-46TH DIMENSION I'=• THE LENGTH CIN FEET) OF THE TRENCH OR: DRAINFIEl._D. THE DEPTH OF A TRENCH OR PIT 15 THE DISTANCE RETWFENITHE SURFACE OF THE AR0HND AND THE BOTTOM OF THE E. CAVALJON (T:N FEET) THERE I' : NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE t' TNTtIUM DEPTH OF GRAVEL_ BETWEEN THE OUTFRLL PIPE. AND THE BOTTOM OF THE EXCAVATION CIN FEET). F- F: 10 1,j F a- F-=° ITT go In FT.._ F=" -W- T' C-1 -W- k=1 P4 Fo 10, -F of F_- y_ 0 f:: -Y f --N (7:i Fi F__. F.__ CH r.4.. F=° R=s 1-_ F�1 Y =Y Y, � �.. F=° W._._ �Y F''.F 7'� e._ a �° �' x. f. Y �•'.6 H PACKAGE PLANT MAY PF. INSTALLED AT THE PORMtTiEF`S OPTION 'SUBJECT TO THE: EI_q.l._OWING CONDITIONS: A. EITHER H CLASS I OR IT NSF APPROVED PLANT'MAY BE INSTALLED. ALLED. 2. H CONT LNLOUS MHINTENHNC:F AGREEMENT •IS RIOUIR.'ED. IF H MAINTENANCE AGREEMENT 15 NOT KEPT CURRENT YOU MAY Be REQUIRED Ti i ENLARGE THE SOIL ABSORPTION SYSTEM AND/OR YOU MAY FF SUBJECT TO PROSECUTION. --------------------------------------- L°j 17.# C ..--° _. Y 1"410 F-" F-.. 07 IT T cm 04 _w F -N F' FEE N=' F-. e. a t 1 FzFE. F-� _. — _ BACKFTI.I.ING OF ANY ' YSTFN WITHOUT FINAL_ INSPECTION AND APPROVAL.. BY THIS DEPARTMENT WILL E.F, SUBJECT TO PROSECUTION. M T N T Mt1M DISTANCE BETWEFN H WELL AND ANY ON -S: T TF =.FWAGF_. DISPOSAL _ YST EM I'-• 100 FEET FOR H PRIVATE WELL OR PRO FEET FOR A PUBLIC WFL..I.... WELL 1.06. ARE REQUIRED AND MUST T FF RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WEL..L.. COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE RVRTt_AB E: TO INSURE PROPER INSTALLATION. F=" F71 F-' F-1 "F: -1 F77-: F=° Y lot I As Fa F-=' Y-_ _ F= F 1 F-= F=:: F--" -_ N._ . .X_ "=a .r I CERTIFY THAT 17 1 AM FAMILIAR WITH THE: REQUIREMENTS FOR ON-SITE 'SEWERS AND WELLS AS SFT FORTH B4' THE MUNICIPALITY TTY OF ANCHORAGE.. 2' I WIL._L... INSTALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. T UNDERSTAND THAT THE. ON-SITE `EWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IDENC E SIS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS, KJONEDA?..._t/ :�iS ---- _...------ HF'F'I..I� E3h{T ST�.itd._"T I: I-IEDB'r'.......w F 7 D • • :e• a0 Q P ( Municipality of Anchorage On-Site Water and Wastewater Program (907) 343-7904 5 6 7 : E T Y b, Certificate of On-Site Systems Approval Q lilt. Parcel I.D. 015-082-21 Expiration Date << ti !O` �cw, 1. GENERAL INFORMATION: 6 8 G 9 �' Complete legal description S.S.T; BLOCK 2, LOT 4 Location (site address) 9701 Homestead Trail*Anchorage,AK 99507 Current Property owner(s) Dale&Katie Shaw Day phone Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) • ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: / , Distance: Received by. 1 Date: b7, � l COSA to be released tot - : •in--r,unless of erwise requested by the engineer. COSA Fee $ 5 V Waiver Fee $ Date of Payment l t 12141$ Date of Payment Receipt Number O5143O4 Receipt Number COSA# OSL L8«f 3 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: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101-Anchorage,Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: IN )2 3/1 8 oo000O�� In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system oQOF A 4�d in accordance with theguidelines and regulations established bythe Municipality of Anchorage and 9 P Y 9 d�'C�.•' •.."• 4 C\�� industry practices. The reported results describe the condition of the system/s on the date/s of the Q P ' V 0A evaluation. Separation distances were measured to readily identifiable features. Hidden defects or �` • `t, - '•. �/ encroachments may exist that were not identified during the evaluation. The operational life of all wells 4 v TH . '•.*OO and septic systems depend upon a variety of variables, including but not limited to, soil conditions, l groundwater levels (that may fluctuate during the year), quality of construction (materials and QVA workmanship),and the water usage of the family utilizing the system/s. These conditions can vary,and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the Q ••Je. rf1 A. Gornoss.• system/s; therefore, GEG makes no warranty(express or implied) regarding the future performance of Qn; . /CE-7955 � the well or septic system. GEG makes no representation whether an alternative well or septic system U0'c I ) ��eQ can be installed on the property in the event either of the current systems fail to perform adequately in 04fe^ •'•t� 2 3 .1. oo the future. The content of this report is for the sole benefit of the person/party that retained GEG to �� O'prp{es5lon�oo perform the evaluation. Reliance upon the information provided in this report by any other person or ��00000�� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE System #1 Approved for LJ bedrooms System #2 Approved for bedrooms ��\\\ "I '-14fL., Disapproved SITE • ON- Conditional approval for bedrooms, with the followinZtip gl�AND g ::� WASTEWA�R YROGRN nA.v/INT SFR\I�LC� By: Original Certificate Date: I Q`� 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 .Nitrate Advg'o.ry-.:•- = Septic System Advisory Arsenic Advisory•`. . ..,.;.. Well Flow Advisory Other COSA blue sheet 10-10-12.doc • 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: S.S.T; BLOCK 2, LOT 4 Parcel ID: 015-082-21 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 7/10/87 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 98 ft. Cased to 98 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 7/10/87 11/14/18 Static water level 56 ft. 55.9 ft. Well production 6.5 g.p.m. 7.5+ g.p.m. WATER SAMPLE RESULTS: Coliform ND colonies/100 ml. Nitrate 6.75 mg./L. Collected by: GEG, Ltd. Arsenic: <5.0 ug./L. Date of sample: 11/8/18 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 1/3/10 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 11/20/18 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA `BELOW EXISTING GRADE AT MONITORING TUBE Date installed 1/3/10 Soil rating (•.p.d./ft'•r ft2/bdrm) 0.8 System type DEEP TRENCH Length 53 ft. Width 2 ft. Gravel below pipe 9.1 ft. Total depth *12.9+ ft. Eff. absorption area 964 ft2 Monitoring tube***YES Depression over field NO Date of adequacy test 11/14/18 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 60 in. Water added 1438 gal. New depth 73 in. Elapsed Time: 120 min. Final fluid depth 67 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) NO If yes, give date - -TESTED 2010 TRENCH ONLY -30 INCHES OF LIQUID IN 1977 TRENCH ON 11/14/18 **MT EXTENDS APPROXIMATELY 9.25 FEET BELOW THE INVERT OF THE LATERAL D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at .• wa er alarm level at in. - . •• Cycles tested Meets alarm &circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100+ 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'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 'S'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS *MET CODE AT TIME OF INSPECTION; NO DOCUMENTATION OF 1977 WELL DECOMMISSIONING IS ON FILE AT MOA 44lb:Wm iii ii � OF ! ''•, G. ENGINEER'S CERTIFICATION •'P;••••" • •.9.1. •• I certify that I have determined through field inspections and . 4, ' .. � • review • of Municipal records that the above systems are in , i conformance with MOA COSA guidelines in effect on this • •• date. ••0';• f _ • Corn..s;4, JEFFREY A.GARNESS •#IBJ'/• E-79 ••C�' a Engineer's Printed Name .♦,"F,• 1 Z i.€( Date ��i 2 ,//q '4 t 'ROFESS\11"\•4• ff LICENSE II\i" vi #AECC884 (Rev. 10/12/12) MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • (" 907-343-7904 On-Site Water and Wastewater Section I\ J Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC181613 Subdivision: SST, Block: 2, Lot: 4 A water sample revealed a nitrate concentration of 6.75 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P. 0. 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 I iPEACE N 89 56' 59" N 299.6 ,F,ce f • I i • I t 4 y• • �. i 1JI a-.. b v' tib, m 0 •TN ti1 w I •• Iy w Wi o .\* \ 1 •• r k W yi I y/ YJp t. ' �Jlf Onet t. GRAVEL LYtlVEWAY- ` 1- .. Pty- IF1oKR / / /?IMO I i ).... N 89 56. 59' 14 299.6,x..---- ---• I t 4 , 9 .....1., /•",t. . `` r LC 1 ,`\`'S I I I 1 pp��4pOO I oF4..�F.A�.gsut I AS BUiL.I SURVEY 1 30' 11, .VI) I1 NO CORNERS SET THIS DATE OGj.49 T 'iii i DO a . a 4 I I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY , SAW Ai /' 'i 6 OLOTF T4E BLOCK2,FOLLOWINGPROPERTY On • SH•ANE A HOLT �e4 OQ a • NEA.LS-6914 L yo�0� ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE Q1„ . i VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN vv ,OJ•ssion. `'c THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS ppp THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED. CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS DATED AT ANCHORAGE,ALASKA THIS _8 TH DAY OF NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. __NOVEMBER NOVEMBER 201$. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE • PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE ANCHORAGE,AK 99507 12607. FB 167-22. 193-26 345-5513 • Municipality of Anchorage =p #o On -Site Water and Wastewater Program < " (907) 343-7904 s , FE , r CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 015-082-21 1. GENERAL INFORMATION Expiration Date: Z — 2 y— l L' Complete legal description S.S.T. BLOCK 2 LOT 4 Location (site address) 9701 HOMESTEAD TRAIL ANCHORAGE AK 99507 Current Property owner(s) DAVID & MICHELLE ALLEN Day phone Mailing address Real Estate Agent 9701 HOMESTEAD TRAIL ANCHORAGE AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class_ Well Public Water System WaiverNariance request for: Received by: CASA to be released to the engineer, unless 5 Day phone S UBMIT -rA L JUL 1 7 2014 TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ requested by the engineer. Date: COSA Fee $ 62fo Waiver Fee $ Date of Payment ' 1 11►y v� Date of Payment Receipt Number oR'5?)0197 Receipt Number COSA # o S6' q 1331 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 Finn ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date _7/11/_14 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future ��►.�\ occupants or can ArcTerra guarantee that no unseen LS 1 encroachments, deficiencies or discrepancies exist OF A ��� � ZI'k 1 6. DSD SIGNATURE 0 The System #1 Approved for bedrooms. y KENNETH ".l°'1ee` S. sirs ��' �w System #2 Approved for bedrooms. ,,spa/��%�i 1'i5510:W' Disapproved. Conditional approval for bedrooms, with the following stipulations: Original Certificate Date: 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other f.OAA F6w aMmh �MM119 Arc. 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: S.S.T. BLOCK 2 LOT Parcel ID: 015.082-21 A. WELL DATA Well type PRV7 If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 7110/1987 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 98 ft. Cased to 98 ft. Casing height (above ground) 24+ in. FROM WELL LOG AT INSPECTION Date of test Static water level Well production 711011987 ft. g.p.m. WATER SAMPLE RESULTS: Coliform%i/-colonies/100 mL Nitrate le. mg/L Arsenic: mug/L Date of sample: 711012014 B. SEPTIC/HOLDING TANK DATA 7110114 Collected by: ARCTERRA Tank Type/Material SEPTIC / STEEL Date installed 1/312010 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N Date of pumping %/' t'% Pumper A C. ABSORPTION FIELD DATA Date installed 113012010 Soil rating (g.p.d./ft2 or ft2lbdrm) 0.8 System type DEEP TRENCH Length 53 ft. Width 2 ft. Gravel below pipe 9.1 ft. Total depth 13.6 ft. (Measured 7110/14) Eff. absorption area 964 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/1012014 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 35 in. Water added 810 gal. New depth 72 in. Elapsed Time: 1020 min. Final fluid depth 35 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _in. Datum E. SEPARATION DISTANCES WELL ON LOT TO: Size in gallons "Pump oft" level at _ in. Cycles tested Septic tankilift station on lot 1004 Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots Absorption field ono + On adjacent ots Public sewer main 751+ Sewer /septic service line 25'+ Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: Public sewer manholetcleanout 100'+ Holding tank Manure/animal excrete storage areas 100'+ Building foundation 5'+ Property line 5'+ Absorption field S'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 10'+ Water main Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+(NONEKNOWN) Wells on adjacent lots 1001+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 7111114 COSA brown sheet_10-10-12.doc OFA Z�, 1 44 A TH* 1+ IIENNETH M. DUF / / 7116 1 \�� SSiol i in. Municipality of Anchorage a , pa < Community Development Department Development Services Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 141337 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 4 of S.S.T. subdivision. This inspection revealed a nitrate concentration of 6.79 milligrams per liter (mg/L) was reported for the property's well water sample. 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. LOT 5 ANCHORAGE RECORDING DISTRICT ASBUILT OF: S.S.T. SUBDIVISION LOT 4, BLK 2 PLAT 77-152 SURVEY CERTIFICATE: I, Jahn L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER:DALE: — f—Mui FE9 8, 2010 1"=50' kndengBvk.net 1 O- 001 DRA N BM Hfl] D BY SB0 NU BEa: BOq(/Z. JLS 2439 100101 =FND 2 1/2" ALUMINUM MONUMENT ® = FND 5/8" REBAR 00, 49TH *I jJ fI A.. ...... ..fir,.... :JOHN L. SCHULLERr o r •• LS -10408 1k A0 �\.%essioncl �'! �y GRANDF D �O 212 East 51st Ave. Anchorage, Alaska 99503 (907) 227-1455 office (907) 888-3793 fax N89°56'59"W 299.67' REC &MEA x z SHED �J O x O 9.5' n 1n O ON FP 46SEPTIC.8' 00 ' C4 VENTS N 30.0' N Cn U1 �y Lr I .. ( TYP N ) •• a o z Y o (_n N nJ LOT 4 CO 4.0' " l y o y m m BLK 2C SX m N O IM N W O • • -1 COVERED N I Cz t -y �J W ENTRY M z 0.0 z % 00vv 0)39.8' w 00 r ` • rn (7 GREENHOUSES v COMMON GRAVEL D/W F- 89'56'5 "W N89'56'59 29 .81' (299.65' REC) 00 30' 30' 30' I N I LOT 3 � ANCHORAGE RECORDING DISTRICT ASBUILT OF: S.S.T. SUBDIVISION LOT 4, BLK 2 PLAT 77-152 SURVEY CERTIFICATE: I, Jahn L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER:DALE: — f—Mui FE9 8, 2010 1"=50' kndengBvk.net 1 O- 001 DRA N BM Hfl] D BY SB0 NU BEa: BOq(/Z. JLS 2439 100101 =FND 2 1/2" ALUMINUM MONUMENT ® = FND 5/8" REBAR 00, 49TH *I jJ fI A.. ...... ..fir,.... :JOHN L. SCHULLERr o r •• LS -10408 1k A0 �\.%essioncl �'! �y GRANDF D �O 212 East 51st Ave. Anchorage, Alaska 99503 (907) 227-1455 office (907) 888-3793 fax Municipality of Anchorage 1�1� ¢ Q'p04 QLD •; Development Services Department r Building Safety Division On -Site Water and Wastewater Program s A E r. 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-082-21 COSA # 1000-5-7 Expiration Date: / O 1. GENERAL INFORMATION Complete legal description S.S.T. BLOCK 2, LOT 4 Location (site address) 9701 HOMESTEAD TRAIL ANCHORAGE, AK 99516 Current Property owner(s) ANDREW ORIEN Day Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 9701 HOMESTEAD TRAIL, ANCHORAGE, AK 99516 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone 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 Onsite Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 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 ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 03/12/2010 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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, ArcTerra can not give any estimate of how long a :4%tirk system will function satisfactory for current or futureOF A rti occupants or can ArcTerra guarantee that no unseen U' 4 encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for �r bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: i-xatacnmems: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory_ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By 1�// nil Original Certificate Date: 3 " f w- /ic (Rev. 11705) Municipality of Anchorage • "` Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: S.S.T. BLOCK 2, LOT 4 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # _ Date completed 7110/198 Sanitary seal (Y/N) Y Total depth 98 ft. Cased to 98 ft. FROM WELL LOG Date of test 7/10/1987 Static water level 56 ft. Well production 6.5 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) Y Parcel ID: 015-082-21 Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 11/12/2009 7.73 9.p -m. Coliform 0 colonies/100mL Nitrate 6.17 mg/L Other bacteria 0 colonies/100 mL Arsenic: 5.00 U mg/I Date of sample: 02/23/2010 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 01/30/2010 Tank size 1500 gal. Number of Compartments 2 Cleanouts (YIN) )(Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping NA -new tank Pumper C. ABSORPTION FIELD DATA Date installed 01/30/2010 Soil rating (g.p.d./ft2 or ft2/bdrm) 0_8 System type Deep Trench Length 53 ft. Width 2 ft. Gravel below pipe 9.1 ft. Total depth 13.6 ft. (measured) Eff. absorption area 964 ft2 Monitoring tube Y Depression over field N Date of adequacy test NA - New System Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test— in. Water added_ gal. New depth _in. Elapsed Time: min. Final fluid depth _ in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) _If yes, give date _ IM D. LIFT STATION Date installed "Pump on" level at _in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off" level at _in. High water alarm level at _in. Cycles tested Meets alarm & circult requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 5W+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 301+ Water main 30'+ Water Service line 30'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 03/12/2010 COSA Fee $250.00 Date of Payment Receipt Number (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number If/ Municipality of Anchorage • "` Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Nitrate Advisory Certificate of On -Site Systems Approval # 100057 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block 2, Lot 4 of SST subdivision. This inspection revealed a nitrate concentration of 6.17 milligrams per liter (mg/L) was reported for the property's well water sample. 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. • J MUNICIPALITY OF ANCHORAGE I9 / 'S U o r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date q/7��`1 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) ter 4`. gLie- z 6s.7: 6-v&onl, Location (address or directions) '1901 A0&1'b3D T1QtNL /�nJ�tloRriG�L1�; r9�•� (b) Applicant Name D6771W DkluntlG Telephone: Home 34�G o7v2 Business 3Ny- /I t;2 Applicant Address 95.6-7 1. 5 [ f}NLf}024 6/ Sl��l gfs07� (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ;4 ; Other ❑ (explain); WGw 0;1U iAt(g CoAv714#C?&,4 (d) Lending Institution C0AfM9A1WWyf lypx 'tr Telephone RO 7` SZoe7 G 477 Address '�3loD( 5,77. (e) Real Estate Company and Agent NM Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Familyy;i Multi -Family ❑ Other Number of Bedrooms S 3. WATER SUPPLY Individual Well 94 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 ]2-025(11/84) • (re/ 10 SZO-ZL • Z to Z abed �jom s,ja9ui6u9 leuolssalad a41 ul suolsslwo ao siona aol alglsuodsaa lou sl a6eao4ouy 10 (1lledlolunA a41 panssl sl aleoy!Uao a aaolaq Lipp az (leue ao suolloadsui lonpuoo lou op d3HO to sa9/oldw3 sluawaimbei @leis pue 12aapal uleljao Alslles of japjo ul suollnlllsut 6ulpual aia41 pup sawo4 to siase4omd of (salinoo a se s141 S90P d3H0 941 e isely to alelS a4l ul PDA91s169J a9aul6u@ leuolssaloid luapuadapul up Ag anoge g gdei6eied ul uaA16 suolleluasoidaa a41 uodn 6lalos paseq salpollpJ83 Ipnaddy Al!jo4lnV 411L9H sanssl (d3HO) uogoalold 121u@wuOalnu3 PUB 4lleaH to luawliedad 96eao4ouy to /1JedlounW 941 lenaaddy Ieuo91PuoO ;o swja1 jeuolllPuoO panoaddeslO R— PanaddV 9120 ' (q swooapaq JOI Panoaddy. 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A. WELL DAT 1/c,0 Well Classification L M%JATV-, If A, B. C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed -�jiolez Yield 4,4W ",I Total Depth Cased to —Ito Depth of Grouting N/A Static Water Levely&/ Pump Set At 757 4 54 Casing Height Above Ground 21 -yo f Sanitary Seal on Casing (Y/N) YES. Electrical Wiring in Conduit (Y/N) YC—S Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot tnvt + ; On Adjoining Lots 1 tl® � To Nearest Edge of Absorption Field on Lot IeO� + On Adjoining Lots ! C) O + To Nearest Public Sewer Line N/A To Nearest Public Sewer Cleanout/Manhole 11ii /A To Nearest Sewer Service Line on Lot loot + Water Sample Collected by DOTiYu.D ; Date S's! g 7 Water Sample Test Results v cA L m NA.- N ! Comments T- (2a=SL1ta"S i) TTiT�ItL60 B. SEPTIC/HOLDING TANK DATA -4 - S -Ce_ Gout VM evL S. Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Size Air -tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped for Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage CourseCommentsLII a AUF"it4rl JJYf9WAL .� Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA/ Std �yvt j Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation I nt To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle S orage Area Comments �_e- - - • i5lwi D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present(Y/N) Date of Last Adequacy Test - To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) 0 Dimensions Manhole/Access (Y/N) - "Pump Off' Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Check Perritt B Broom Rating A ainst HAA Request ** Icertifyt t ech fid, ied, conformedtoall O ndHAAguidelinesineffectonthedateofthisinspection. Signed to 1 i/Ni G w Comp y J MOA No. 67- Z8,! Receipt No. /() i) J b o2_1 Date of Payment1Q6 0- s Amount: $�- Page 2 of 2 72-026 (11,84) t�: E-C_F_ �ZT1 �FlCAT l�( MUNICIPALITY OF ANCHORAGE 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 6e/7 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Gni �1 6VcQ 5 T SEF 7-1!2N r23iY/ Location (address or directions) / 970/ {i vue�YracY %Heti./ (b) Property Owner M,?_rc* L uyWcbl Telephi Mailing Addr�-0 Q - (c) Lending Institution mu -t "4 0 -- Mailing Address r✓ovt %/� * l.=0 Telephone Business (d) Real Estate Company and Agent •• // v>>- i I Lla4t"17 awcec �xcv Address Telephone i/ (e) Mail the HAA to the following address: or: Check hereA if hold for pick up. List contact person and day phone number below. 2. TYPE OF RESIDENCE Single -Family,,,/// t,B, Number of Bedrooms _ 3. WATER SUPPLY Individual Well Lit' 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 11 Holding Tank ElNote:mmunity 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 fRev Sias+ Front ryoeo (9M Iad) 940-U • 0 Z to d abed ')Jom S,JaaUlbua euolssaloJd aq1 u! suolss!wo Jo sJOJJa Jol alglsuodsaJ;ou si a6eJoyouy to A1!led!olunW aql panssl si aleolllJao e aJolaq elep azAjeue Jo suolloadsul;onpuoojou op SHHQ ;o sa@Ao!dw3 'sluawaJmbaJ alels pug !eJapal UIe1100 (;spies of JapJo ul suoln;Ilsw 6ulpua!J!aq; pue sawoq to sJam4cund ol/se4inoo use s!ylsaop SHHQ ayl Te se!ylo 01e1S ay1 UI paJalsibei Jaaul6ua jeuoissaloJd ;uapuadapu! ue Aq anogg 9 4dei6eied ul U8A!6 suo!;gluasaJdaJ aq; uodn 61uo paseq saleolp-Jao !enoJddy A;poq;ny g1!eaH sanss! (SHHQ) saa!AJaS uewnH pue ylleaH l0 luawlJeda(] a6eJoyouy to A;!ledlo!un!ry aq1 r . - ale(] leas s,Jaau16u3 NOI1f1VO euoIj!puoO lenoJddy !euollpuo(] to swJal panoJddes!(] panoJddy (q swooJpaq Jol panoJddy IVAOUddV SHHO '9 ale(] 1;71—c;l /�17 -z (�� ssaippv 9Il b lz auoyda!al wJ!d to awgN uolloadsul sig; to alep aql uo loalla ut suo!leln6aJ pue'saoueulpJo'sapoo a1e1S pue !ed!olun!nl le qpm eoueldwoo ui sl walsAs iesods!p Jalemalsem Jo/pue (!ddns Ja1eM alis-uo aql 'uo!loadsut pue u011e611sanu! AW woJl pug sa!g a6eJoyouy to /;lled!olunW ay1 wail paulelgo uo!lewolul ayl uo paseq ley; Al!JaA JaylJnl ! uiajaq paleo!pu; aJnlonAls to ad/1 pue swooJpaq to Jagwnu ay; Jol alenbape pue !euogounl'ales si walsAs lesods!p Jalemalsum Jo/pue A!ddns Ja12M 01!s-uo 9g11841 smog9 lenoJddy A;lJoglny 411eaH sly; to uo!;g6gsanu! AW ley; Al!JaA I 'mo!aq umoys alep uollep!IeA ay; to se pue olaJay paxlle !gas Aw Aq palnJaa sy NOI1VWUO3NI ONV VIVO `HC)HV3S 3IIj `S1S31 `SNO11O3dSN1 ONIOIA08d WHId ONI833NION3 '9 A. WELL DATA 0 0 MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY OF AlkAGMCMUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES&&MST - FEBRUARY 1984 264-4720 APR 61987 RECEIVED Legal Description: 1--6 t 4 _� 1< 2r S strC_ ry , ISM py-U% Well Classification V E�S If A, B, C, D.E.C. Approved (Y/N)� Well Log Present (Y/N) _ Date Completed �s/77 Yield Total Depth 1 O Cased to 1 O 1 Depth of Grouting Static Water Level 5 r7 Pump Set At Casing Height Above Ground , le Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit 'Y/N) _y/ Depression Around Wellhead [Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot > /t D ; On Adjoining Lots > To Nearest Edge of Absorption Field on Lot On Adjoining Lots > /®--C7 To Nearest Public Sewer Line N O ?,J LZ To Nearest Public Sewer Cleanout/Manhole N 0 N G To Nearest Sewer Service Line on Lot Water Sample Collected by 1 . S Date 3/3/ LE -7 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 111 'n Size 150-0 No. of Compartments T IV// 0 Standpipes (Y/N) OW!E Air -tight Caps (Y/N) Foundation Cleangut/(Y/N) Depression over Tank (Y/N) N Date Last Pumped 'V13 / 87 Pumping/Maintenance Contract on File (Y/N) WA ; for R6A Holding Tank High -Water Alarm (Y/N) NSA Temporary Holding Tank Permit (Y/N) 1��A Separation Distances from Septic/Holding Tank: To Water -Supply Well T I Up To Building Foundation ' L� To Property Line i'IQ 5 To Disposal Field R To Water Main/Service Line y 0 To Stream, Pond, Lake, or Major Drainage Course N ©1`1 EE - Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata %5 Type of System Design T LIyC h{ Date Installed 7�/7 7i Length of Field Width of Field 3 ( Depth of Field Gravel Bed Thickness Square Feet of Absorption Area / O� �% Standpipes Present (Y/N) To�-py Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test T a9g 1,5 r Fi ✓ e— rx ro o vvf S Separation Distance from Absorption Field: To Water -Supply Well - To Building Foundation To Property Line Q To Existing or Abandoned System on Lot O fel L On Adjoining Lots i 1,5-0 To Water Main/Service Line /D To Cutbank (if present) Iq o N � To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area p 2 L) Comments 0"e- ins e.¢ tit fia D. LIFT STATION N ONS Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at "' Check Permitted Bedroom Rating Against HAA Request "` Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ., I certify that I have checked, verif' d, or conformed to a I (u1QA and HAA guidelines in effect on the date of this inspection. Signed Date Company MOA No. Receipt No. U O O U S Date of Payment Amount: $ Page 2 of 2 72-026 (11184( OF a. t Engineer's Seal ONICIPALITY OF ANCHORAGE (111n. .&I 111 n. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date XGEGC1 A 'Z If 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L077 q. 6 1<0 Q1. s s -r- Stz-4 TlaNf 1�5 U// Location (address or directions) - �t701 140041MsTGAn TIZA►L. (b) Applicant Name (6L %iovt DAµKi;elephone: Home 3Yb— 3Y79 Business Applicant Address 9 %0 ( I.10rt-fES7EAl7 (c) Applicant is (check one): Lending Institution ❑ ; Owner/brilde�.❑ , Buyer 11; Other ❑ (explain); MF_2.2yL. L I C..mo+ (d) Lending Institution Address (e) Real Estate Company and Agent Address - Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Familyt/Multi-Family❑ Other Number of Bedrooms _ 5 3. WATER SUPPLY Telephone Individual Wel f�; Community El Public El Note: If commuunit'y 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 El Holding Tank ❑ Noterif/co`mmunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 n-025(11/84) 0 i 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. I_ -- 4 T A Name of Firm ' O �b G�' Cr0 y14101 I/ P Telephone Address ao3� 7 /` l ! w /1 Date ,�(i• 0••2225-E - t�'-{• JUN° 2S• t911 6. DHEP APPROVAL Approved for bedrooms b % ate Approved — X Disapproved Conditional Terms of Conditional Approval dhep CAUTION Seal The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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 (11/84) Wplilm �.���1k MUNICIPALITY OF ANCHORAGE (MOA) ENYIROI IN�Esm Piof&y ' HEALTH AUTHORITY APPROVAL (HAA) 28" CHECKLIST - FEBRUARY 1984 OR 264-4720 Legal Description: LO -A 4 # $K Za T�4tL.. SGL {Y T4'i1.1k T2.3vU A. WELL DATA Well Classification 71 CS If A, B, C, D.E.C. Approved (Y/N) NIA Well Log Present (Y/N) _Y _ Date Completed 911617-7 Yield 10lFm Total Depth 1 O ( Cased to 1 O l Depth of Grouting N C -4= Static Water Level 60 Pump Set At SOTTO M Casing Height Above Ground % la a Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) i Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 1 i►D On Adjoining Lots Y To Nearest Edge of Absorption Field on Lot On Adjoining Lots > ato To Nearest Public Sewer Line NoN& To Nearest Public Sewer Cleanout/Manhole F{ ON 1:3 To Nearest Sewer Service Line on Lot -*> t D Water Sample Collected by —T1 S - ; Date 31a-7lg6 Water Sample Test Results Comments B. SEPTIC/Pt&MW i6 TANK DATA Date Installed t1lt7177 Size 1 60 No. of Compartments TYPO Standpipes (Y/N) Y Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) IN Date Last Pumped S ? R5 Pumping/Maintenance Contract on File (Y/N) KlA ; for 14/11k Holding Tank High -Water Alarm (Y/N) NSA Temporary Holding Tank Permit (Y/N) WA Separation Distances from Septic/Holding Tank: To Water -Supply Well >110 To Building Foundation To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(l 1/84) To Disposal Field To Stream, Pond, Lake, or Major Drainage • C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field S Type of System Design I RaP4G H Length of Field 3 f 24 = (eg Depth of Field _ �r Gravel Bed Thickness B� Square Feet of Absorption Area OSL Li Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /0 4 To Building Foundation To Property Line To Existing or Abandoned System on Lot N b!4 G On Adjoining Lots i /&a To Water Main/Service Line 1 10 ' To Cutbank (if present) NONIE To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION NONE Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments M Dimensions Manhole/Access (Y/N) "Pump Off" Level at " Check Permitted Bedroom Rating Against HAA Request " Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, veriifie�d[,J/�r conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '^^ �' Date Company Receipt No. �i 7c/9 i Date of Payment ' &ITS —2 G Amount: $ e, Page 2 of 2 72-026 (11184) MOA No. Engineer's Seal 7 A� ": O2S1_ 0 ' J-24., Vy. -AL S .;111 ? ANP W : 7: x. �, -. ._ _ 1;:; National Bank of Alaska s Sherry Stephens MaLl? ldd =>s: Post Office Box 3-3859 99509 Phone: 279-2506,/20 ?. Proper t,. MUNICTP"' -TY of rlvc,HOR c 1 Michael D. Stephens r _? D F ,v �cr �r r 0 'CT, 0 yid&cess: b?� - 99501 1 Date Fteccei'e'=: November 8, 1977 3c q -LI _1-� - 11 Uo.-L LL_,aQ--1Z-(_iL-Lo l v-- i�.1,L. 1- _1111- C. U _-_ iui�. _-.. 7 A� ": O2S1_ 0 ' J-24., Vy. -AL S .;111 ? ANP W : 7: x. �, -. ._ _ 1;:; National Bank of Alaska s Sherry Stephens MaLl? ldd =>s: Post Office Box 3-3859 99509 Phone: 279-2506,/20 ?. Proper t,. Gor.:cs: Michael D. Stephens -Phcne: 349-2316 lailirg yid&cess: 1601 East 84th Court .. ,. Ltgal De ,c i-ptic;, : Lot 4 Block 2 SST Subdivision 4: Single r mi-ly iles.i once: (x) NX—it er of ;edroor,,: Five Aiult.; z 7 Pa " I Resp Jenice : ( ) Nt�.mber. of Bedrooms: r..., .ol1 100, Well. Loci on Pi -le {�) Cor.st� ctioz4V Analvsit ------- 6. --_6. Sewagc D spo al Sy ,tom: On-site Sy>tem (X) Public ti i. -;.y t ) Installed -_-19-77 _ 1 s�zlLer Sptic i'an,, Size ('�_� ? rnanufac urcrf2�2� 7+ sorption Area �� Soils .Rate S Maceriu]- � ��A.AAf..Q,1��<`-_G�t`✓-� �19N+'�i� 1 7. Di stanc s Ile!' _ t ,, pt e Tank -------__,—_ o °bsor ptic :_a�� to Se;,e,r Linz to Nearc:sl. Lot Lir;;; crest Lot line P Eor_pt Loll Ivrea n-4� .''bip • 0 JC -L tl _i:t 01, 'ind :v .r011.1C`llt8 i. i'rotec! ion In(ii v i-1na L Scciaer anr; w a, Legal Lot 4 Block 2 SST Subdivision C'- via —t-Af T _e- z SWA Af.fadavit ttachel: ) { Letter Attacnel: ( ) Approved: /7— Date Disapprcvcd: atc: Department Wnrh he st . MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA CONV XX 2. Property Owner: Michael D. Stephens, Stephens Construction Mailing Address: 1601 E. 84th Crt. Day Phone Anchorage, Alaska 99507 3. Name of Buyer: Wayne E. Stamper and Jean M. Stamper 3492316 Mailing Address: 3401 Perenosa Drive Day Phone: Her work- 272-5544 Anchorage, Alaska 9950? 4. Name of Lending Institution: Sherrie Stephens, National Bank of Alaska Mailing Address: P.O. Box 3-3859 Phr Anchorage, Alaska 99501 5. Name of Realtor or Agent: Marren Sanders, Dal] Real Mailing Address: 2700 E. Tudor Road Phone 6. Legal Description: Lot 4, Block 2, SST S/D Location: 000 Homestead Trail Anchorage, Alaska 99507 279-2506 Ext. 20 276-2400 7. Type of Facility to be Inspected: Single Family Residence No. Bdrms. 5 8. Water Supply Type of Supply: Public Utility Individual XX If Individual, number of dwellings presently served If Individual, depth of well 100 feet 9. Sewage Disposal System Type of System: Public Utility If Individual, date of installation 72-003(3/76) Unknown one Individual (on-site) XX