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HomeMy WebLinkAboutSEACLIFF BLK 2 LT 6AOnsite File Seacliff Block 2 Lot 6A #011-221-32 tnev =021 i8) Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 201129 PID Number: 011-221-32 r Dwelling: Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New R Upgrade Name Steven Ma#e ABSORPTION FIELD ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound site Address 9331 Shorcrest Drive ❑ 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. SubdivisionBlock � Lot Fill added above original grade Ft. Gravel length Ft. S ' `G ' i A-_ _0 -�� j Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic AbsorptionAbsorption Lift Station Holding Sewer Total absorption area Number of trenches , Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well I n/a A• TANK 9Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1000 Gal. Surface Water 1001+ Material Number of compartments Lot Line I 5'+ NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity I Remarks Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to3034Installer drainfield A+ Home Services Drainfield cO/MT3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 125.3 ft ection v, 4/5/21 Inspection Location and description 3rd 10/15/21 2'4/5/21 41 Bottom House Trim @ A ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: � Date �� pF A4 i' Fan^ons — — Septic System:. Approved I `' • c= 314 .;: , E�c` Date�a'=`«;f Note: this approval V I� tp`��'a'�- does not Inc ude wei) per it requirements. tnev =021 i8) -�iv�'iro-�nmv=D -+Z-0 v m DO; z CD Z • mTJ O O p � � D app C + r-xXm< O n N �p�� O ry o U) >oo cQzzocn=D Iv Om O z O m O cLn o� �m� v cn rn D D mm Op m mD Co !V a0 � D O cli A rr- m N N O U) � O 00 -P cl) Lo m M Z O v co rd —I E m a m Ln �. n ct,—u SHORE CREST DR.,/— — r n O m >p z r— O I— \ I o o. I 11I �� D s O I \, cn II ,, v o Tl I I I .. CC) �. . o C) I ' oI -i G7 D m m I D m T2 I m DCO D�1 I I ❑ ( D� m I O fi Di P -r o I o�l� o �< I Orr' DJ Oo D p� — — —Lf)— — — — — — F / :18 O p FrlO 10' Util Esmt p o _ _ r*mjo n - - — — OZ — — — - 101 Utit Esr-it — — — - V) D — m / � m / n m / z / I l FU NOTES: PANNONE ENG SVC LLC (C.I. 1088) REVISIONS DATE RECORD DRAWING P.O. BOX 1807 PALMER, AI( 99645 OFA�_ 10/15/2021 PHONE (907) 745-8200 FAX (907) 745-8201 �P• SCALE *:49M 1 ' = 40 SEACLIFF B2 L6A ••• •• .. ...•.. P.I.D. N221-32 DRAWN ACP STEVEN MACRAE -ti R. an.nope PERMIT N0. 9331 SHORECREST DR CE 8149 OSP201129 C1.0 ANCHORAGE, AK 99502 SHEET 2OF2 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Sox 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:Hwww.muni.org/onsite Permit Number: OSP201129 Work Type: SepticTank Upgrade Tax Code Number: 01122132000 Site Legal Address: SEACLIFF BLK 2 LT 6A G:2424 Site Mailing Address: 9331 SHORECREST DR, Anchorage Owner: MACRAE STEVEN R Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: it r? t 'S, IS Department 5/27/2020 5/27/2021 17103 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: ** The beginning of the field is to be located to ensure that the required 5' separation between the tank and field will be met. Received By: Issued By: Date: Date: 3 I MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 011-221-32 Property owner(s) STEVEN R MACRAE Day phone nAailinn nrirlracc 9331 SHORECREST DRIVE, ANCHORAGE AK 99502 .�'ItP afl(trPCC game _ Legal description (Sub'd., Block & Lot) SEACLIFF B2 L6A Legal description (Township, Range & Section) Lot Size 17,103 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: (N all that apply) Absorption Field ❑ Septic Tank Q Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) Q (w/wo ADU) Upgrade 10Duplex (D) ❑ Renewal ElDuplex Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is !in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: AA ho •-:w Date of Payment: V,2W26a_ Receipt Number: OaiV?G Permit No. (35P26[12 9 Permit App__- :- . Waiver Fees: _ Date of Payment: Receipt Number: Waiver No. COVID-19 25% DISCOUNT APPLIED Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201129, Deb Wockenfuss, 05/27/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201129, Deb Wockenfuss, 05/27/20 ~.., 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 PHONE [] UPGRADE NAME MAILING ADDRESS SF_. LEGAL DESCRIPTION LOCATION ell Absorption are~ ~ Z I Manufacturer m [Liq. c~pacity in gallons ~ ~¢ H~MEMADE: Inside length 0 ~ ~ I Manufacturer ~ ~ ¢ISTA~C~ TO: ~ Foundation ~ ~ ~ [ No of lines ~ I Length of ~ach ii'ne Total length of lines ~ ~ / Top of tile to finish grade~ / Material bene~ ~ez ~ [ Length Width Depth ~ . ~ ~ [ Type of crib Crib d~ameter Crib depth ~ ~ DISTANCE TO: ~ Well Building foundation ~ Class~ ~ 1 .J Depth Driller ~ Building foundation Sewer line ~ DISTANCE TO: ' Dwelling Material Width Material Nearest lot lin.~.i O / Trench width -'-~ ,~/~ inches inches NO. OF BEDROOMS No, of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT ~%~._O~2~ Distance between lines Total effective absorpti~_on area PERMIt- NO. / Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) PIPE MATERIALS OTHER SOl-~ T'E~T RATING INSTALLER REMARKS APPROVED DATE LEGAL T"r'F'I~ CIF: :BOIL F:I!.~'~::")F:'F"T'I":N T~E LENGTH E:,tf'IF'I"I'::T-lq T'::, "rq~: L.E:NGTH -"r~.j F:F'ET', OF' '~"4~'' TE'F.q'.i'~F.I F'!I:E: [::,F:F!Ii'md::!EI r'- THE DEPTH OF' I GF:OUNE:, FIN[> THE E~OT'T'CU"! OF THE EY.:L":F!',/FFF I ON ,:: I F,! FEET >. T H El R E I S !'-,I 2 S EL' T l,.! I [:, T H F' O F~: T F:!F.': N C H E S. THE: C~Fi:F{',,,'EL DEF'TH IS THE !',!I~,~.,.HLIr-! E:'=fF'"r"! OF Gi'~:F:A,,'EL E:E:"THEEN THE:. OLiTFF!LL F'iF'F2 iq. NE:, -I-'- . F'ER:h! i T F?PL. ! E:I~3h,FF HFIS THE ...............................................IFJ'qTFII I FITTFq'-,t 't't'.J':PI-:T'TTC!I'.,!S OF' F)(",I'~" !,iF !'q FI[)...TFIC:F2NT 'TO "FHt'S F:'F;?CF'F_::F."T? ,:hL m.- ......... ! ~"h".:'.'"' ..................i'dllhlE:F:l~' OF FiI~i:S!DE:NCF:ES 'THFF[' THE HE:EL. kit i ':'~:'F,r:..."~'",~. ~ ...........: '" ':':'TI [ 'r FI'3 OF F:IN'./ !:;'.,.'STF~:P! biT-!"'m .. ,..,l'--! Fi*'a,!.,ff ,u t ?-,t'::;PF'f":T T .............. q*.,l Fi.t'.4E:, FIF:'F'F~:(:ZI'v'FR_,:.~" ' .... .4 ~' ~; E,EF'F.F'T.'"I~:h."." t'!! I. L. F E/ :E;LIE',..ZrEE:T T :; F'F:OE';UZE:UT ! ON. H!NiHUH D]:L:;TFff.,ICE: BETHEEN FI HELL FIND FIN'Y ON--.SZTE SE. HF!GE: DISF'OSFtL 5?STEH IS iE,;El FEET FOR F! F'RI',,,'f~TE: HELL Of~'. ::LD$? TO ;2(~i FEE~T F?.OI"i FI F'I. rmlE:I...i~2: I.,.!E~LL. DEF'i~k:NDiNG UF'ON THE T'./F'E OF F'UBL. IC HELL. MiN!HLIH E:,!S"FFffqE:E F'fi;:OH F! F:'F~:!V~TTE HELL. 'T'O Fl PF'm!'v'FtTE SE:HER LINE iS ;25 FEET FiND TO F! (X]!"!h!LtF,~ i 'T"~' SEHEF: i... Z NE i S 7'~5 FEET. OTHEN: REgP. JIF:EHENTS !"!R'.? F!F!::'LV. SPECIF'iCFCrIONS RND CONSTF:LICTiC~N DIF~GEtRi',~S RF;:E lg',,,'F:)ILBDLE TO iNSURE PROPER: INSTFILLFFFI Of'mi. .....mr F:F'F,?f' ! F" ~' '~i ,'"lr"~ ~"""~' :i_' Z f:l!'"i F'I~,I"!ZLIFIF: .................. b.l'[TN THE F::EQL.I!?.FfHENTS F'!-I~'," ~ - ': 'r T :,, ,, · ....:~...._.-_...,':'~ :'~": FIND ,..~.L.~......,~'::' I : .I:i:~;. :[:'""~ ....., FCIF:TH E "? THE H. N ]' i '1: F'~L :r T'.,.' OF' ~:::m,lr' 2' i HILL. ]..'L::,,~" "r:,l ...... I "f'H~f ':'~"::TF?t. ,_ !N F~2:CDF:D~:~NC[:' .,ii'TH THE :" T ~']",F[q":TFN"~ THFtT THE~ -ff.,I--.': TTF~: Sf2141ZF~: '"" """TF'"t hli::l'~' ~:E(~lt..Ii~:E ~'~. ~ :~m"::l:'ht~:'~. T '[t::' TI-iF' ~'~:'= - [:,ENCE .. . .......... [ :IS F:EHOE:,EL. ED 'FO iNCLUE:,E i"iC~F:E THFff.4 ]~: PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3. 4 5 6 7 8 9 10 11 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L, Streot, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST DATE PERFORMED: SLOPE i:' / WAS GROUND WATER ENCOUNTERED? 12 13 IF YES, AT WHAT DEPTH? .......... [] PERCOLATION TEST SITE PLAN 14 15 16 17 18 19 20- COMMENTS PERFORMED BY; ~,~.;~ 72:008 (6/79) Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE TEST RUN BETWEEN DATE: f/ ? q/_ MUNMPAUTY OF ANCHORAGE Ui z. msµ, �� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section —Fax: 907-343-7997 Parcel I.D. 011-221-32 1 Certificate of On -Site Systems Appro Expiration GENERAL INFORMATION Complete legal description SeaCllff Block 2 Lot 6A Location (site address) 9331 Shorecrest Drive, Anchorage AK VOA -3 pmW -MoA 8 A0/22 Current property owner(s) Steve R. Macrae 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: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic j] Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System El Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 550 Waiver Fee $ Date of Payment _..'1 / & Z 0, Date of Payment Receipt Number U .� y 5 Receipt Number COSA # Os c), a A i 5 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. 6. DSD SIGNATURE Phone (907)745-8200 Date 2'O%al/ OF ALgq. n .. System #1 Approved for � bedrooms v� Steven _R. •Por .no^e System #2 Approved for C_ 1149 bedrooms �� %;•. Disapproved � Conditional approval for bedrooms, with the following stipulations: rrrr�ii cF(gNC �Q z ON' PND Z RO Qom; T l By: Original Certificate Date: L Ur' 1\,- \,-Clkvy r - The Municipality of Anchorage Development Services Division (DSD) iss es Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Seacliff Block 2 Lot 6A Parcel ID: 011-221-32 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system 1 A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Lot Supplied By Public Water System B. TANK DATA Age of tank(s) 1 years Tank type/material Measured operating fluid level in septic tank 4911 Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Deeep Tench Which system tested (date installed) 1981 Q ALL standpipes present per record drawing Total measured depth from grade 8 ft (max) Measured depth to pipe invert from grade 4 ft (min) N/A — pressurized field Monitor tubes go to bottom of effective. If not, state depth into effective A Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test gpm Water storage tank volume NSA gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L [:]Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 04/08/22 Results Q Pass For 3 bedrooms Fluid depth prior to test 0 in Water added 460 gal New depth 5 in Elapsed time 240 min Final fluid -depth 0 in Absorption rate 450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' [D Yes Community Sewer Manhole/Cleanout > 100' Yes if No ft M Yes if No ft Neighboring Tank > 100' ❑ Yes if No ft Private Sewer/Septic Line > 25' ❑ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No ft Holding Tank > 100' ❑ Yes if No ft Neighboring Absorption Fields > 100' Q Yes if No ft Water Main > 10' Animal Containment > 50' ❑ Yes if No ft ❑ Yes if No ft ✓V Yes if No ft Water Service Line > 10' IJ Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' ❑Yes if No ft ❑ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' [D Yes if No ft Surface Water > 100' Q Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' Q Yes if No ft Private Wells > 100' Q Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ✓V Yes if No ft Water Service Line > 10' IJ Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Il Yes if No ft If absorption field is under driveway comment below Property Line > 10' IV Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' 121 Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' [J Yes if No ft F. ENGINEER'S COMMENTS No Well / Lot Served By Public Water System G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and rei of Municipal records that the above systems are in conformance MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet if, 60' ROW :O Lot 7 _ r.....�.�. / '. LS- 176 •Y �� � 15 30 �� ID ��� p�OFESSIONAL�p�-� US SURVEY / NOTES ®������ FEET All dimensions shown are grid bearings and ground distances, record boundaries are per Plat No. 66-31 / 49th Star has conducted a physical survey of the property and all details shown on this Asbuilt Survey are correct. Under no ircumstances should -any data hereon be used -for establishment of property lines. It is the owners responsibility to determine the existence of any easements, covenants, or restrictions; no title research performed. AS BUILT SURVEY Power Pole LEGEND 49th Star Surveying L° G Lot 6A, Block 2, Tete -comm Pedestal PO Box 738 Girdwood, AK 99587-0738 Replat of Seadiff Subd., ® Septic System Clean out (907)891-6111 Anchorage, AK Q Septic Tank MH Jeremy@49thStarSurveying.com W.O. 2207 DATE: 4/4/22 Fence Municipality of Anchorage DeVelopment .Services Department Building Safety Division On-Site Water & Wastewater Program 470_0 B~agaw 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 FAIVllLY DWELLING Parcel i.D. 011-221-52 1. GENERAL INFORMATION Expiration Date: ~ ~ L-/, _ / ~... · Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address 2. NUMBER OF BEDROOMS: SEACLIFF; BLOCK 2~ LOT 6A 9551 SHORE CREST DRIVE *ANCHORAGE, AK 99502 ROBERT MANDZl Day phone C/O AGENT 9551 SHORE CREST DRIVE *ANCHORAGE, AK 99502 Day phone KATHY FERNANDEZ W,/ PRUDENTIAL· Day phone 275~7505 5801 CENTERFIELD DR #200 *ANCHORAGE, AK 99505 Unless otherwise requested, COSA will be held by DSD for pickup. 3i TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well [] Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class A Well · Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site 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 samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER o As cerfified by my seal affixed hereto and as of t,ffe validation date shov,;'~ 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 t,~e 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. Address 3701 E. TUBOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Pr nted Name JEFFREY A. GARNESS, P.E. Phone Date ,337-6179 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal fight whatsoever. DSD SIGNATURE Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory "' .... Advisow (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: ¢,"~-. - V'~ / / ' Municipality of Anchorage. Development Se ices 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 Legal Description: SEACLIFF; BLOCK 2, LOT 6A A. WELL DATA CHECKLIST Parcel ID: 011-221-,32 Well type COMMUNITY If A, B, or C provide PWSID# 210485 Well Log (Y/N) Date completed Sanitary seal (Y/N) Wires properly protecte~ Total depth ~ .ft. Cased to_ ~ft. Casing he__round)~__.in. FROM WELL LOG Date of test ~. ~ , ~ · ~TfoEr: SAMPL~ Nitrate mg2L. · Other bacteria colonies/lO0 mi. ~ ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments Foundation cleanout (Y/N) YES Date of pumping 1/24/2011 C. ABSORPTION FIELD DATA Date installed Length Total depth 2 Depression over tank (Y/N) NO Pumper, [*BELOW EXISTING GRADEI Soil rating (g.p.d./ft2o~ 1 O0 Width 3 ftl 5/17/82 38 ff. *8.0 ft. Eft. absorption area 304 Date installed 5/17/82 Cleanouts (Y/N) YES Highwater alarm (Y/N) N/A MCDONALDS PUMPING ft2 Monitoring tube YES Date of adequacy test *'1/25/2011 Results (Pass/Fail) PASS Fluid depth in absorption field before test DRY in. Water added 495 gal. Elapsed Time: 15 min. Final fluid depth 5.5 in. Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN **TRENCH WAS PRE-SOAKED WITH 2005 GALLONS ON 1/24/2011. System type TRENCH Gravel below pipe 4 .ft. Depression over field NO For 3 bedrooms New depth 7 in. 450+ g.p.d. If yes, give date - LIFT STATION Date installed "Pump on" level at in. Size in gallons "Pump off" level.~. Manhole/Access (Y/_~ ~ High water alarm level at in. ~ ~ Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Meets alarm & circuit requirements? COMMUNITY WELL On adjacent lots Absorption field on lot On adjacent lots ..-..- Public sewer main ~nout Sewer/septic service line .--------""' Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line. 10'+ Surface water. 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots. 200'+ Water main 10'+ Driveway, parking/vehicle storage 10'+ 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 P/inted~ Name JEFFREY A. GARNESS Date l/~//[t COSA Fees Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment, Receipt Number ~Ai~C] J_SB~OS~OHS MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMIFY DWELLING 011-221-32 HAA# (-~'~-\~.] GENERAL INFORMATION ' Complete'legal description l,ot 6A; Block 2; Seacliff Subdivision Location (site address or directions) 9331 Shorecrest Drive Anchorage, AK Property owner Mailing address Lending agency Mailing address Pat & Barbara Kelly 9331 Shorecrest Drive Day phone Anchorager AK Day phone 561-1766 Agent Linda Address Hopper/ Prudential Vista Day phone 273-7296 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: 3 xx If community well System, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA ~F21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature Alaska Water & Wa~tewater ConsCtan~ 6~0i DeBarr Road, Anchorage. AK Phone Date Alaska Water & Wastewater Consultanot~s, lrtc. Shall be PAID $ -70~ ~' at, or prior to, closing for the Engineerit'.,9 Services Provide& DHHS SIGNATURE ~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 72-025 (Rev. 1/91 ) Back MOA fi21 Municipality of Anchorage APR DEPARTMENT OF HEALTH & HUMAN SERVICES MUNICIPALITY OF AN~ Environmental Services Division t~NVIRONMENTALSERVI~ 825 L Street, Room 502 · Anchorage, Alaska 99501 · (gO7) 343-4744 Legal Description: Health Authority Approval Checklist ~/~ ~ ~'~ ~..,~-F- -q/Z) Parcel I.D.: ~1 J -~'~'~/ - ~-~ A. WELL DATA Well type ~.j~/~/~F~lf? Lo~(Y/N) ~/~- Date completed Total depth ~ Cased to I~/, B, or C, attach ADEC letter. ADEC water system number Casing height (above gro~ Sanitary seal (Y/N) ~ Wires properly ~N) FROM~CTION Dateoftest ~..~ - Static water level Well production g.p.m, g.p.m. Coliform Nitrate Other Date ~f~: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed ~ ir-+ lS ~ Tank size. ~/0OO Number of Compartments 0%. Cleanouts (~1).~ Foundation cleanout ~¢~) Y'~ Depression (Y,~ ~<> High water alarm (Y/I~ Date of Pumping c~t [~[c/~ Pumper C. ABSORPTION FIELD DATA Date installed ~J[ ~ / ~ Length ~ o '~-~. Width Soil rating (g.p.d,/ft~ or~/b..___drm)~ JO0 System type --~{LC~©iq ~.&,' ~' ' ~. Gravel thickness below pipe Total depth ~ ~ ~ Effective absorption area ~o~ Date of adequacy test ~l Fluid depth in absorption field before test (in.); Fluid depth ~/ (ins) Minutes later:. ~1 ~1~, Absorption rate = + ~.'~0 g.p.d. Peroxide treatment (past 12 months) (Y/~ Monitoring Tube present {~). ?~'~epression over field (Y~) Results (Pass/Fail) ~&~ For -'~7~ ~' bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Manhole/Access (y/~el at* High wat.~ *Datum----~ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main /'J//~ Sewer/septic service line On adjacent lots On adjacent lots "Pump off" level at* Public sewer manhole/cleanout Lift station /~..//,Z~ SEPARATION DISTANCES FROM SEPTIC/~ TANK ON LOTTO: Foundation 5 ~ Property line ~ '_,L ' Absorption field Water main/service line / 0 Surface water/drainage /~ '¢', Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line [ O ~ ~ Building foundation /~:) ''~ Water main/service line Surface water /0c) '/- Driveway, parking/vehicle storage area. Curtain drain ~',~0~ ~o~,~, Wells on adjacent lots c~-O© J~ ENGINEER'S CERTIFICATION I cerlify that ICve determ~i~edt, hru fiel~d ~spections and review in conforrnan~e with MO/~HA~ui~,eI~s, i~,_effecton this date. Signatu re //, \ ('~,I///,~, / HAAFee $ ~ .p;b Date of Payment z?/,/~'/?¢ Receipt Number /-~'7¢~'- ' '¢ Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* APPLIC.. )IT FILLS OUT UPPER HAL~ .ONLY Phone Property( ~wner Buyer Zip Code Lending Institution Phone Phone Realty Co. & A~nt /~//~ Zip Code Address Legal Description Z-- Type of Resi~nce Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply ~ Individual A~ACH WELL LOG. A w~l Icg is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach Icg if available). ~ Public Utility Sewer Disposal ~ Individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time C~, (-¥-,- , 6)C-~ ~ Date Date Date Date Inspector Inspector Inspector Inspector ENVI~ONM~;~'A.. ; .,O, 2CTION OCT 1 ~ 198~ RECEIVED ( ,~ ) APPROVED BEDROOM8 'OONDITION8 OF APPROVAL ( ) DISAPPROVED ( ) GONDITIONAL APPROVAL* 8oils ~ating Date ~wer Installed Well To ~sorptJon Area Well Log ~-- ~ '~ Well to Tank Septic T~k Size 72.023 (3182)