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HomeMy WebLinkAboutSCIMITAR #2 BLK 3 LT 13Scimitar #2 Block 3 Lot 13 #051-132-65 On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151245 Tax Code Number: 05113265000 Work Type: SepticTank Upgrade Permit Effective Dates: August 04, 2015 to August 03, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SCIMITAR #2 Site Legal Address: SCIMITAR 92 BLK 3 LT 13 G:1261 Owner/Address: BAXTER MATTHEW J & MEGAN A 20136 TULWAR DR CHUGIAK AK 995676357 Site Mailing Address: 20136 TULWAR DR, Chugiak Lot Size in Sq Ft: 43828 Total Bedrooms: 4 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received B� Issued By: 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. 051-132-65 Property owner(s) Matthew & Megan Baxter Day phone Mailing address 20136 Tulwar Drive, Chugiak, AK 99567 Site address 20136 Tulwar Drive Legal description (Sub'd., Block & Lot) Scimitar #2, Block 3, Lot 13 Legal description (Township, Range & Section) Lot Size 43,828 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ElRenewal F1Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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. property owner or Permit/Rush Fees: A15— Waiver Fees: Date of Payment: Date of Payment: Receipt Number: ®lli.l'Lq 4 Receipt Number: Permit No. OSP 16 I;lq ' Waiver No. Permit App__ : ::..,:c- Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@oanengak.com July 24, 2015 Subject: Scimitar #2, Block 3, Lot 13 Septic Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1500g Septic Tank to be issued for this property. The existing 1250g tank is collapsing and the pumper has been pulling rocks from the tank. It will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1500g septic tank at the owner's request that will be connected to the existing drain field. This lot and the surrounding lots are served by private wells. There are no wells within 100 feet of this system. 1. Upgrade Tank Design. a. See Sheet 1 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank. The proposed septic tank upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography is flat with slopes less than 1% in any direction within 100' of the system. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 WELL (E) \ W ��NN / LOT 14 W w�vl/ P/ \ /M� AA �y j J� \ O COLLAPSING 1500g SEPTIC TANK (E) DECOMMISSION PER CODE INSTALL i500g SEPTIC TANK (P) tS \ WITH DOUBLE CLEAN OUT \ / / OUS ` / V / HOUSE A EAP(E \/ (E) ��qr DRAIN FIELD (E \ ' / / \ LOT 13 \ WELL (E) O dG / • �J� �"V SEPTIC AREA (E) 12 \ / NOTES: C LL _���� Date TANK REPLACE PANNOaNE7 EN ANCHORAGE,CK 99510 ,� '��!OF'A4L, kk, 7/24/2015 PHONE (907) 272-8218 FAX (907) 272-8211 %g�p �9�+ Scale /........ .. / P.I.D. No SCIMITAR #2, BLOCK 3, LOT 13% 051-132-65 MATTHEW & MEGAN BAXTER Steven 8149 no. PERMIT 10. I c^C `1w OSPXXXXXX 20136 TULWAR DRIVE r PLAN CHUGIAK, AK 99567 ��lE�p�QS�Np�� Sheet \1xto l>\ 1 of 1 06/03/2010 16:49 9073449021 JRS SEPTIC PAGE 01 JRs PumpingInvoice • po Boxn3415 Eagle River, AK 99m Number. 31004 Order Num 31004 (907)694-6454 Date: 03 -Jun -2010 Serviced 02 -Jun -2010 P.O. Number. Manliest Job Description: 12508 61LLT0: 1p S & S Engineering 15861 South Birchwood Loop Chugiak, AK 99567 Tyler 20136 Tulwar Drive Chugiak, AK 99567 Quantity ServicaType Amount Tax Extension Septle Sery 1250K $185.00 No $185.00 Taxable Amount Tax Rate Tax Description Subtotal NonTaxed: $185.00 $0.00 0 $0.00 Subtotal Taxable: $0.00 Subtotal Tax: $0.00 Payment Terms Payment Adjustment Late Char>Je Net 30 $0.00 $0.00 $0.00 Please Pay: $186.00 Last Service 'O&r29 Aar t2S0g --SERV & BILL hnk levers normal+ tank good held drain good For your added convenlenm ve accept; American Express, Dicouer. We and WSW Card payments mer the phone. Aller b Days aoeeurd W be tumed 9m10 COLLECTIONS. $90.00 For NSF Cheeks RMmed Fram. S S S EngineeringPION"detach here and Mportion Munn the bottom whin your payment. 16861 Saar Bkctnvood Loop Chugiak. AK OM7 Order No. Invoice No. Dara Amount Due 31004 31004 03Jun-2010 $180.00 To: JRs Pumping PO Box 773415 Eagle River, AK 99577 Municipality of Anchorage Page _L_ of 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: �� ���1�� PID Number: USI 1 �2C��✓ Name:J; Q Wastewater System: ❑ New Upgrade Address: Arl6a,GF=r� EM�b55 v yJl o�`+L ABSORPTION FIELD Phone: No. of Be come: ❑ Deep Trench El Shallow Trench Bed El Mound 1:1 Other LEGAL DESCRIPTION Soil Rating: �9;, , -7 al tal Depth trout Qugingr e: /717 GPD/S .F. Lot: Block: Subdivision:{� Depth to pipe bottom from original gradfe: Gravel depth beneath pipe ( rr Ft. a. Ft. Township: Range: Section: Fill added above original gra: Gravel length: Ft. ^y Ft. WELL: ❑ New ❑ Upgrade Gravel width: /L Numb of lines: Distance beI een lines: /W, Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: 'f:e (p `�Q.r Ft. Ft. SQ. Ft. Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. t� Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ep IcIST Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufa�cctt//r r: _ Capacity in gallons Z From Tank Field Station Tank Sewer Lines 1��� ✓� Well I tr✓ Material: �! �,� Number of Compartments: Surface re — — — LIFT STATION Lot � � e� 1 �._ S allons: Manufacturer: Line !�'�✓ Foundation /� p ` � _ '- "Pump on" level at: "Pump off' High water alarm at: Curtain /C Pump Make &Model Electrical Inspections performed by: Drain Remarks: 3' 0 _W1,9 Ffiad IlLiII17L BENCH MARK 5!}NO �R/4VELr/-05 Location and Description: OASD SYSTEP t. Assumed Elevation: e IbbFt ENGINEER'S SEAL S & S ENGINEERING 17034 Eagle River Loop Road. Inspections performed by: l 9a 1st Eagle River, Alaska 99577 2nd • [i �.. 6u p .nV 6urd 1 A. h4iff.4 Department of Health and Human Services approval r. Reviewed and approved by: �����`+�-f' ���&Date: 72-013 (Rev. 9/91) MOA 25 i Permit No. SW930194 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Leqal Description: SCIMITAR SUBDIVISION ##3, BLOCK 3, LOT 13 PID No.:05113265 MT2C04 102.2' FINAL GRADE FILTER F BRIC SR �- 97.1' -• r` �; `�, -;.,A,-��. ",.: 96.6'I 3' SAND FILTER 93.6' D=. PIPES ]AID WITHIN SEWER ROCK S' UNDER & 27 OVER DIST. PIPES N.T.S. ♦ 88' NO WATER FOUND - A B - - - - - - - - - - - - C01 84.6'- 46.4' CO2 98.5 44.8' MT1 75' 31' 10' UTIL.ESMT. MT2 107' 57.2' NEW BED 3 co \ EXIST. 1500 GAL'_ SEPTIC TANK <MT2 MTI� FCO 24' CO3/ DBLE 0 DECK A Co B 4 BDRM HOUSE DECK DRIVE ENGINEEWA,'SE 72-013 A (Rev. 9/91) MOA 25 C:EC regulations (18 ACC 72.265: Table F, Note 2), require septic filter sand to meet slther Group A or Group $ specifications. The submitted sa nple .nets group 3 specifications. li YOU nave any questions, please do not hesitate to call. Sincerely, Mark Hansen .w MAR 311993 al:PARToViL -r CSF ENVIRONMENTAL (:GNSERVATIGN MIS DO i MARK HANSEN P.E. Cnnwhing Engineers Testing Lnborplory 11002 BOX 7387, PALMER, AK $9845 (907) 745.4723 a . Il/Iaroh 30. 1993 Quality Sand and Gravel, Inc. P.0, Box 1456 Palmer, AK 99645 Project: Sieve Analysis or' submitted sand Centlemen: 1 he following is the sieve analysis of the Sample submitted ^/21./93. Al --1,1 sown is the specification for the materiai indicated. Sieve cent Required for UEC septic filter sands Croup A Group 8 3/8"0 #40 #109 85-100 85- iQG Qercssing 9200 60-90 #404 0#60 0-15 #2001.4 0-5 0 -Coefficient. of Un3.1 -- 4 m.ax. Coefficient. of Cu0.96 - 1 171..1x. C:EC regulations (18 ACC 72.265: Table F, Note 2), require septic filter sand to meet slther Group A or Group $ specifications. The submitted sa nple .nets group 3 specifications. li YOU nave any questions, please do not hesitate to call. Sincerely, Mark Hansen .w MAR 311993 al:PARToViL -r CSF ENVIRONMENTAL (:GNSERVATIGN MIS DO i PAGE 1 OF 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930194 DESIGN ENGINEERS & S ENGINEERING OWNER NAME:HALL DAVID J & LORETTA H OWNER ADDRESS:AMERICAN EMBASSY BOX 315 FPO AE 09834 PARCEL ID:05113265 LEGAL DESCRIPTION: SCIMITAR #2 BLK 3 LT 13 LOT SIZE: 43828 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: L_ am _)- i3 -U) DATE ISSUED: 6/30/93 EXPIRATION DATE: 6/30/94 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 ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: A SAND FILTER LAYER OF NOT LESS THAN 4 FEET MUST BE INSTALLED. THE SAND USED IN THE FILTER LAYER MUST BE COARSE, UNIFORM AND CLEAN WITH LESS THAT 2% FINES PASSING A 200 MESH SIEVE. A SIEVE ANALYSIS MUST BE TAKEN ON a om `_-)s1 ) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 THE SAND USED, AND PROVIDED TO THE DEPARTMENT. C..) . RECEIVED B ISSUED BY: PAGE 2 OF 2 DATE: L ` ( f `3 DATE: /`/ 3 June 25, 1993 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 �nicipality of Anchorage HEALTH AUTHORITY EPARTMENT OF HEALTH AND HUMAN SERVICES APPROVALS TTENTION: Daniel N. Bolles 825 L Street Anchorage, Alaska 99501 SEWER&WATER n.. MAIN EXTENSIONS - [� EFERENCE: Scimitar Subdivision #7J, Blocks 1 Lot 13 SEWER &WATER INSPECTIONequest you issue a permit to upgrade the septic system erving the four bedroom residence on the referenced rooerty. ENGINEERING STUDIES n June 2, 1993, you sent a letter to Mr. and Mrs. Hall AND REPORTS informing them that the wastewater system serving the referenced property has been determined to be a source of ontamination to the potable aquifer serving adjacent roperties. Attached is the proposed upgrade design WELLINSPECxLOWTESTTION tilizing a two foot sand filter which will aid in the filtration of the sewage effluent. test hole was excavated and a percolation test performed in SITE PLANS he area of the proposed upgrade. On June 23, 1993, the existing septic tank was excavated and he outlet capped. The septic tank is now being used as a ROADDESIGN holding tank until such time as the proposed upgrade is omnleted. e do not anticipate any adverse effects on neighboring foperties by the installation of the proposed septic SOIL TEST parade. f you have any questions or require additional information or your renew, please contact us. PERCOLATION TEST STRUCTURAL & 11-� MECHANICALrt A. Shafer, P.E. INSPECTIONS ONSITE WASTE WATER DISPOSALSYSTEM DESIGN /LSU/lsu 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 w 0 Q Cr 0 CL 7) LEGAL SCIMITAR DRAWN L. S. ULSHER DESIGN CRITERIA: 4 BDRM = 600 GPD SOILS = 0.7 GPD/SQ. FT. (SAND FILTER) 600/0.7 = 857 SO. FT. REQUIRED BED: 6.5' DEEP INSTALL 2' SAND FILTER 6" GRAVEL OVER AND UNDER DIST. PIPES 24' X 36' OR EQUAL The proposed bed system with its 2' sand filter has been designed in accordance with M.O.A. Health Department criteria. The installation of this system will not guarantee that effluent or nitrates will not reach surrounding walla. However, we do not anticipate any adverse effects on neighboring properties. PALTER P RIC in L PIPES LAD) WITHN I ROCK, 6' UNDER OVER DISE. PIPES TT y S, DATE 6/7/93 -TS -HT _ -------------------- __ �J• 10' UTIL. ESMT. 36' CO T e�\ c OBl1 / Co 2\ C0 U � EXIST. TRENC GR.ws BED bECK 44 BDRM HOUSE 100' WELL RADIUS 1500 GAL SEPTIC TANK DRIVE r o Yd's lint+f •A4iV :U•u'S �� e{. a•e moo s.o,+am.^.aemmec ego e i � rde RF r �p� �� M� J f ��•+ 2' SAND FlLTERPROFILE II � N.T.S. PIPES LAD) WITHN I ROCK, 6' UNDER OVER DISE. PIPES TT y S, DATE 6/7/93 -TS -HT _ -------------------- __ �J• 10' UTIL. ESMT. 36' CO T e�\ c OBl1 / Co 2\ C0 U � EXIST. TRENC GR.ws BED bECK 44 BDRM HOUSE 100' WELL RADIUS 1500 GAL SEPTIC TANK DRIVE r o Yd's lint+f •A4iV :U•u'S �� e{. a•e moo s.o,+am.^.aemmec ego e i � rde RF r �p� �� M� J f ��•+ Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: DATE PER LEGAL DESCRIPTION:����L� Township, Range, Section: ;�E O� SLIU�I�Tp�^�µ""Z— SLOPE SITE PLAN r ----r ----- r --- T� 1 p a a 2 3 �o . 4- 5 O 6 y U 7 a' 8 a , 9 V 10 11 12 13 14 15 16 17 18 19 20 WAS GROUND WATER �� ENCOUNTERED? d IF YES, AT WHAT L o O DEPTH? P E J. Depth to Water After�� Monitoring? Dale: COMMENTS ==Mmm ... ��3l ► ' f�'e���7 AA WW � PERCOLATION RATE � (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN --"T AND ---L— FT S & S ENGINEERING I PERFORMEFAy34 age River Loop Road No. 904 ACCORDAff2SIWRl*dgJMIE5 9PS"UNICIPAL GUIDELINE 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE: ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: SCIMITAR SUBDIVISION #3, BLOCK 3, LOT 13 GENERAL: 1. The scope of this project includes the installation of an absorption bed to serve the four bedroom residence located on the referenced property. The existing leachfield is to be abandoned in place. 2. Construction shall be in accordance with the approved site plan and design drawings; Municipal permit with any special provisions or conditions; and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Page Two Scimitar Subdivision #3, Block 3, Lot 13 June 5, 1993 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. LEACHFIELD BED INSTALLATION: 1. Excavate the proposed Bed Area to the depth shown on the design. The bottom of the excavation shall be within 2 inches of level. If the bottom of the excavation becomes smeared, it must be raked or scratched (ruffed -up) before gravel or sand placement. 2. If a sand layer is required, place sand over entire excavation to the required depth shown on the design. The top of the sand layer must be within 2 inches of level. 3. Sewer rock shall be placed uniformly throughout the entire bed. Perforated distribution pipe must be installed level with perforations down. Gravel depth below the perforated pipe shall be a minimum of six (6) inches. Gravel depth above the perforated pipe shall be a minimum of two (2) inches. The total gravel depth throughout the entire bed shall be a minimum of twelve (12) inches. 4. The perforated distribution pipes must be no more than six feet apart. The distance between the outermost perforated distribution pipes and the sidewall of the absorption bed must be no more than three feet. 5. Silt barrier material must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. Page Four Scimitar Subdivision #3, Block 3, Lot 13 June 5, 1993 7. When sand is being used as a filter material, it's gradation specifications must conform to AMC 15.65.060D. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. Page Three Scimitar Subdivision #3, Block 3, Lot 13 June 5, 1993 6. Monitor tubes shall be of four (4) inch diameter and installed at the locations shown on the design. The portion of the monitor tube extending through the gravel depth shall be perforated six (6) inches below the bottom of the horizontal distribution lines. 7. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finished grade over the bed must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal) . 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. M7 HEALTHAUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN David and Loretta Hall AMERICAN EMBASSY PSC 451 P.O. Box 315 FPO AE 09834-5100 ROBERT SHAFER, P.E. ROGER SHAFER, P.E. June 25, 1993 CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 RECEIVED �. JUN 2 51993 Municipality of Anchorage Dept. Health & Human Services REFERENCE: Lot 13; Block 3; Scimitar Subdivision #2 Dear Mr. and Mrs. Hall, Reference your fax letter dated June 15, 1993. On June 23, 1993 the septic tank located on the referenced property was excavated and capped so it now functions as a holding tank. The tank was then pumped and left empty. In addition, the test hole was excavated and soil tests were performed to allow the completion of the design of the upgrade of the wastewater disposal system. The above work was completed per your request. It is my understanding that capping of the septic tank and pumping is not a cost to be born by Mr. Sullivan in this matter therefore a invoice is attached. For your information in Mr. Sullivan's interest we have completed the design and submitted plans to the Municipality of Anchorage, DEPT OF HEALTH AND HUMAN SERVICES for a permit. Prior to the actual construction it will be neccessary for you or Mr. Sullivan to provide us a copy of any agreement you have signed in affecting a solution in this matter. If we may be of further service, please contact us. Sinc IMT A. SHAFER, P.E. S/gk ENCLOSURES cc Bill Sullivan Bill McNafl7- Century 21 Alliance John Smith, Manager of On -Site Services DEPT OF HEALTH AND HUMAN SERV. 17034 NORTH EAGLE RIVER LOOP • SUITE 204 • EAGLE RIVER, ALASKA 99577 2 1.11 MUNICIPALITY OF ANCHORAGE 4- q ' V/�r �_., nF:PARTMFIVT nF NFAI TW Z CN\/IRMIR/MNITAI DDnTCrTJnni 72-UT3 Ilev. 3/78) ENVIRONMENTAL ENGINEERING DIVISION \\� 825 LStreet -Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME e o yew���, P Z NEW , J 1:1UPGRADE MAILING ADDRESS ,-' / f ox 9 76 (U%Uft LEGAL DESCRIPTION f ' - _S` i'��1'�- 5 ip LOCATION,—� S / /'J y�.� '- k N0. OF BEDR MS v Y DISTANCE TO: Well C ��� � Absorpt aro Dwelli g 4 � � PE71 � �6 wZ h Manufacturer Ma r No. of comp ents C– rn Liq. cgp i a(� IF HOMEMADE: Inside length Width- Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. Z OZ< Manufacturer Of IMaterial Liquid capacity in gallons w= DISTANCE TO: Well j / , /10 — Fo ation/ Nearer t link °'� ` PER T N � J u- z f. z W No. of lines j ( Length of Iine,l Total le tJ�f Kn#_' 3 Trench idb inches Distance be3�v ee - lines / X H Top of t,/fi*b grade l be tl� til Total effectiv absorption area inches Length Width Depth I PERMIT NO. LU 0 i a W Type of crib Crib dia e er ? Crib depth Total effective absorption area Lu DISTANCE TO: Well Building foundation Nearest lot line J Class ��- Degth�`• `,� Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area (s) OTHER PIPE MATERIALS - �.� S01 L TEST RATI 1\1115 i _ I NST ������+ oJ REMARKS jiJ 1 i T( i APPROVES / .F DATE LEGAL 72-UT3 Ilev. 3/78) [:'w:F AFr F I• Ir I`:l F' F!L T ? AND EN%J 1!"::OMIEN f -i?... f-"!�Ef=: t' J.0i`,f 264--4."2C Ci - '!r' "T - E' = P.."-11 EE' PER1111I T NO.111.(`1864 AF PL IC:ANT AI_` I'N WEA'•,.EC, :.: € r-`€_€,.,, „ : t:.€: -"=:r �,-..3:•:%-:_ _ _. �_F_A . ,... ,: .moi `� :.... i" u....F i-- LCC."PiTIt-€N TULLAIR. LEGAL LOT -123: BLK _ •=,CI M I TAF=: r._!E. LOT =, I -,E 4'7 t60 ;€;_ I I�€�-,c- , _ _ r T.T!PE OF' . C?II._ F;ESOF'PTIC€I'•-I T: TL:I'1 I'--: TR`rVNCF! T'11=I;:, I �'1LTY°T NUMBER€ -1F E FI:iF:°€-1C €PI= ..... ,I 'OIL, 4!1 € I T Y,ifa ' S`A I: T;?E _;�_, THE RECW I RED SIZE OF TFIE SOIL AF=i'_-,l-sRf T .T €-€Y '[ THE LENGTH C:'.TrlENSrCtY,f IS THE LENGTH 'IN FEET., O THF-- TE:Ef-dK:H €_TIT: Dr—*., 11.Y•IF=?cLl_`=. THE DEPTH OF' A TFT:ENC:Ff OF., PIT 117 T,.EE DISTANCE 8CT1•JEE•N THE-!_lKFA!:E OF THE GROUND AND THE EEC€ T 1'€_rel OF THE E`el.li`,H'y'A- r .ON 'fi riN F EF -.7). THERE IS Y•fit=€ SET WIDTH DTH F *OR TRENC"HIES. THE GRA'VET_.. DEPTH 1''. THE MINIMUM DEPTH (IF= GRAVEL. F€ETF:.TEEY,I THE €: LI T FALT_.. PIPE AND THE BOTTOM OF THE E ciri' PTiON (It-! FEET). PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM 'THIS f_. �EPAG:'.-CMEY•-IT TI TF I Y•: STAL.T..AT T OY•fi :T: NSF-'E•C"r ,_f O fi_, OF AY'd'T WELLS F ff.? j C-fC ENT T€;€ THIS F='F:OPE:F=:"F''i F=?Y,ID THE Y•fiLli•1F:ER OF RESIDENCES THAT THE W[ -`.LL WIL.L KEIT:'„E, BAC:F:;F I L L. r Y'fi€-� OF. ANY _,'7'_=•TE_M WITHOUT F= I Y•?HL IN'S "`E, :T 11"q-fi F'ND N� 'F=`F=:€::€`'r'AL. BY "F' . T ,7 DEPARTMENT WILL BE `--'lUB.,fEC:T TO PF":€_ SECr_IT I ON. Y'IIYd.iY`1LIF'i DISTAY•JCE BETWEEN A f..IFF_.L. AND t=iY•<Y C€Y.•I_... SITE :..EkIACF:I;''I ,Pt -i A ";'Tv:;`i I'. 100 FEET FOR A PFIVI-iTE bIELL. OR la wTO 200 Fr -.-.ET FROM H PI._IE;?_:F€:: !'.iELL. i;%L.'EYJt`'IYIii UPON THE l YPE= OF PUBLIC 14ELL. P1IY?IT°1T._IY1 C:'I:WTAPd(:€._ FF:CtF'1 A F`F:I`•,`FiTE: WELL TO A t'F=:I'.tItTE '=EI•'!Es Li aE 1 �!a FE:E F' l Y,I.=y TO Ii C:C€Y'tY'11_IY•fiIT,' SEWER L_IT`��IE I:= F=rE'T. WELL LOG—S".” ARE RE." I_ I RED ANW-% MUST BE RETURNED TO THE DEPARTY FENT f" WITHIN '-..0 DAYS YS OF THE WELL COMPLETION. OTHER REtuli_IIREMEY-ITS MAY APPLY- 'F',E(T:rFrC.rJT l]:=€N'": AND t_.€, Y,€,�-I-�;:,�_I�_...T_.r€.€T'd Y"'r 1€ F=: t'1E +=-E AVAILABLE TO INSURE RE PROPER I N:- TALLA-f I ON. C:ERTIF'=.' TIHF-Il I All Fr`rY'11'l..IFIF: F'.IrTH I'FTE. TT:Es:>!i_IIF:E�1E:YfiT: FOR C€Yy wIT::!FI•fFF; I=II';C' .TE:L.L.°E h'=; :tiLr. FORTH BY THE. Y'ILINI I sW I PAL I T`•r' OF ANCHORAGE. 2. 1 WILL. IY'fi'ETALL THE SYSTEM IN A(:::s-:s-sF:C'F=IY••CE Wlr-T THE CODc . - • r L!YJC.E;;:.-„TAYa D THAT THE: ON—'S I. TE �=�F: H .:; : R `T” 'rE[,l MAY REC*!U I RE r':r.TLAF:;€ E T'`IEY,TT T: F _I..I.- RESIDENCE 'C F=°E ; r DEYdC:E I:-; T=:L .Y'lOi;'E? ET . 'T"C€ I P•fiC:L!_I E MORE THAN BEDROOMS. APPL.1' C'- T t=li_`,' I Y,I S WEF:€',,, E F*' O & E ENC_AEERING & DEVELO:_.-HENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SOIL LOG 688-2280 Performed for: Name: 4"_ II AI ��� � Tel. No.--�) ZZ Mailing Address: �' % '76 1 �JIjS/6� �`�� 7 Legal Description: c-" ,-- 13 Depth (feet) 0 1 �� Z_ 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Soil Characteristics f5lC7- e-oluZS 'F_ _:7W/V'9 Vr /J�1c!�1� iSa ZX'_3 � Ground Water Encountered: Yes NoP-' If yes, what depth Proposed Installation: Seepage Pit— Drain Field Comments: Performed by: PLOT PLAN Al, cr PERC. TEST ®�q, ae®ec°oa a®s0 OF 414"'h- �a: �p C`76v4 f� 49:Em - m h,°o ae�e o�%ea°° a °°a °o/ape°n• Earl P. FIGS ' NO. 1745-E s 0 ca Date: i PLOT PLAN Al, cr PERC. TEST ®�q, ae®ec°oa a®s0 OF 414"'h- �a: �p C`76v4 f� 49:Em - m h,°o ae�e o�%ea°° a °°a °o/ape°n• Earl P. FIGS ' NO. 1745-E s 0 ca Date: OWNER OF LAND ADDRESS LEGAL DESCRIPTIO DATE. - Started PERMIT NUMBER KIND OF FORMATION: Tprtt*ftrb by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99567 • TELEPHONE 688.2759 Ended From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. _ From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: DEPTH OF WELL STATIC LEVEL OF WATER FT DRAW DOWN FT. GALS. PER HR KIND OF CASING From Ft. to Ft. From, Ft. to—Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to— Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft DRILLER'S NAME RECEIVED �by jAN 3 01992 Mynicipality of Anchorage Dept, Health & Human Services MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910243 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:SULLIVAN CHARLES W & OWNER ADDRESS:PO BOX 670272 CHUGIAK, AK 99567 PARCEL ID:05113265 LEGAL DESCRIPTION: SCIMITAR #2 BLK 3 LT 13 T15N, R1W, SEC 10, SM LOT SIZE: 43828 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED: 8/20/91 EXPIRATION DATE: 8/20/92 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: I RECEIVED BY: DATE:_ F'J12- ISSUED BY: ��' � DATE: azz�/_ � IAO IDUIL I %DUF\...'- I 0 IF fe, 1 .0 ye Pa Richard R Hankins, hereby certify that I have surveyad the following dlsscribed pr6perty: Lor /3, ilmir NO. z A ungcipa y ®'r Anchorage January 12, 1988 P.O. BC��96650 ANCHORAGE, ALASKA 99519-6650 (907)343-4200 TkMRWAX & Tom Fink, MAYOR DEPARTMENT OF HEALTH & HUMAN SERVICES Alaska Housing PO Box 101020 Anchorage, Alaska 99501 Subject: Lot 13 Block 3 Scimitar Subdivision #2 Permit #870026, On-site Well Permit A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1987. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report (three-part form) must be sent to this office for review and approval, and for documentation. Effective January 1, 1988, a new fee schedule is in effect. When re -applying for a new permit, the new fees are; $90.00 for an on-site sewer permit; $50.00 for a well permit; $140.00 for a combined sewer and well permit. If there are any further questions, please call this office at 343-4744. Sinc ely, Robert W. obinson — Program Manager On-site Services RWR/ljw enc: Copy of Permit ^^�«�I I�������if�� DEPARTMENT\�/ HEALTH AND ��NVIRONMENTA ~^ OTECTION �825 L STREET, ANCHORAGE, AK �64~4720 I .......... 1: ;l if'. PERMIT NO: 870026 DATE ISSUE�: 02/27/87 APPLICAN[: ALASKA HOUSING/ SULLIVAN WATER WELLS ADDRESS: P.O. BOX 10102O ANCHORAGE� AK 99501 CONTACT PHONE: 688~2510 LEGAL DESCRIP: �UBDIVISION: SCIMITAR #2 LOT: 13 BLOCK ���TION: 10 TOWNSHIP: 15N RANGE: : 3 LO� SIZE / : 43923 (SQ.FT. 1W OR ACRES> I certi�y that: 1. I amh�amiliar with the requirements [or �orz �y the Municipality on-site sewers andll we s as o{ Anchorage (MOA) and the set 2 . 1 will install the �ystem St t a e o� Alaska^ in accopdance with all MOA and in comPliance with the cooes design and 'e�ulations� criteria o� thi s 3. I will adhere to all MOA permit^ distances and State o{ Alask 'equirements �o' the [rom any existing well wastewatea , ' ozsposal set back sewerage system on this system or public or an y agjacent or nearby lot, SIGNED APPLICANT: A ��A *n�x b� 5ULLIVAN . ... ....... WATER / / / WELLS / ISSUED BY ......... c. AS BUILT NEV s I, Richard P. Hankins, hereby certify that 1 have surveyed the following described property. Lor 13, BLOCK .3 , 5C/M)7AR SUBD/V/S/ONS UNIT NO. 2 Anchorage Recording District, Alaska, and that no encroachments exist except as indicated hereon. 'C2 % I P .�° 4 M ewse.e.�as�o --Q-..wpow.oa-ovaaO... •_..• S Mc "Ofd P. %m um • ar NO. Std'000" Qe�� Of SO Al`���o 141% It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction or for establishing boundary or fence lines. Date : Drawn by: Pr®parod by 2 -20 -oz AW.- REGISTERED PROFESSIONAL . HAIANKIND NSURVEYOR Scale: Plot filing no: P.O. BOX 1105 -EAGLE RIVER,ALASKA 0 t7 &' TA. -/9® PH. 694.2371 99577 To:Becca Carroll 3/10/2021 Onsite Water and Wastewater Municipality of Anchorage Address: 20136 Tulwar Dr. Legal : SCIMITAR #2 BLK 3 LT 13 I’m writing this letter to clear up any confusion on the old decommissioned well on our property. When I purchased this property in July, 2010 it was communicated to us that the 6’’ Casing well drilled by Jay Williams in 1981 had been decommissioned. There is no visible evidence of this old well anywhere on the property. The decommission process was completed by Mr. Sullivan a previous owner in 1991. The current well that provides water for this property has an 8’’ Casing and was the one drilled by Sullivan in 1991. The well log supports this from the COSA when we purchased the property in 2010. I’m requesting that you update the file and remove the second well from active status on this property in your records. 400' deep well drilled 8/1991 by Sullivan, 8’’ Casing - SWL is 40'. well log is on page 25.- Active well 503' deep well drilled 9/1981 by Jay Williams, 6’’ Casing- SWL is 440'. well log is on page 31. Decommissioned. Sincerely Matt Baxter Property owner: 20136 Tulwar Drive Chugiak AK 99567           z H H Com"' d Z oil ITI OTJ ITI Oil ITI Oil ql It ITI tz � d d O z H H H H H H H H H H H H O O O O O O O O O O O O ti *m OTI OTI OM OTI � *21 �l H H H H .H ►-3 !-� H !� !� H y d OTJ 'TJ 'si '�7 '�1 `TJ 'TJ "r! 'TJ '�1 "l O!M 7d 7d 7d 7d 7d 7d 7d M PO M M 0 � 0 tr' p r OTJO �4DINCVH H H O O O O O O O O O O O O H � *my 0 y O n F� m m O ch X m N I m n D m r c c) � D y X Cl) D Ul V 0 C a� G7 co D 0 w� CDr- `� Dcn D O v_ 00 D 0 ;r, JA . 00 D N r cr) D cn D Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. COSA# OSC /(l jl%?Q Expiration Date: 9-7-10 1. GENERAL INFORMATION Complete legal description Lot 13; Block 3; Scimitar Subdivision M2 Location (site address) 20136TulwarChuglak,AK99567 Current Property owner(s) Erik sen Day phone 68"= Mailing address r e Lending agency Day phone Mailing address Real Estate Agent Shane Riley / Greadand Day phone 694-9125 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site❑ Individual Holding Tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of 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 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 S a s Engineering Address 15861 S. BirChwood Loop Rd. Chuglak, AK 99567 Engineer's Printed Name Roberta Shafer 5. DSD SIGNATURE Approved for Lbedrooms. Disapproved. Conditional approval for Phone 6942979 bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory _ Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By A • Original Certificate Date: 6— 7-1,o (R".. 1105) Municipality of Anchorage Development Services Department Building Safety Division ' On -Site Water & Wastewater Program 4700 Elmore 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: L 13 1311L 3 Sc�,A,%i 2— Parcel ID:_e)S 1 - y32 -6S =U(}d A. WELL DATA Well type _�6ucA± _ If A, B, or C provide PWSID # _ Date completed01 Sanitary seal (Y/N) Total depth -40-0ft. Cased to _�_Ift. FROM 7ELL LOG Date of test / Static water level �� V rr ft. Well production g.p.m. Well Log (Y/N) V Wires property protected (YM) Casing height (above ground) n. i AT INSPECT I N ft. WATER SAMPLE RESULTS: T i�eCCJQf� �- Coliformt/ colonies/100 mL Nitrate & Q mg/L Other bacteria colonies/100 mL Arsenic: N 1 ug/L date of sample: by --'5 LT B. SEPTIC/HOLDING TANK DATA Tank Type/Material 5� hL St e� I Date installed 161, V ( Tank size t5zo gal. Number of Compartments Z Cieanouts (Y/N) V Foundation cleanout (YIN) Depression over tank (Y/N) /✓ High water alarm (YIN) _Al Date of pumping 2 / V Pumper C. ABSORPTION FIELD DATA Date installed /3 01 3 Soil rating (g.p.d.lfe or eibdrm) System type �e V Length -20'0 ft. Width 2. ft. Gravel below p(pe 6. S ft. Total depth I ft. Eff. absorption areaZL ft2 Monitoring tube Depression over field A% Date of adequacy test i l O Results (Pass/Fail) 1 :For L.. bedrooms Fluid depth in absorption field before test 0 in. Water added'M gat. ii New depth in. Elapsed Time: f Z0 min. Final fluid depth 0 in. ' Absorption rate' >= II 0 V g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date II I, D. LIFT STATION Date installed Size in gallons 'Pump on' level at Lin. Pump off evel at= Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /o a ,f Absorption field on lot /,ov "> Public sewer main Sewer /septic service line 2 5-4 Animal containment areas 5-611 Manhole/Access (YIN) High water alarm level at Meets alar & circuit requirements? On adjacent lots /00 fl, On adjacent lots /Ud I-(- Public tPublic sewer manhole/cleanout I / Holding tank Al /— Manure/animal excrete storage areas _(V if- SEPARATION t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line 5—� Absorption field /t Water main /ell Water service line /0 N Surface water /60 Wells on adjacent lots /Gd If SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 Property tine /O / Building foundation (0 Water main /0 Lf Water Service line 10i( Surface water &01 f Drtveway, parking/vehicle storage _ Id Y Curtain drain mckle 4owr` Wells on adjacent lots 10 0 14 F. COMMENTS in. +Zo�aiccl .n �� _�c,. V5PCar are 6 IuO�.�llon wate� Sl rn�-iti: G. ENGINEER'S CERTIFICATION I certify that 1 have detormined-t review of Municipal records that conformance with MOA COSA guic Engineer's Date � /3Il /� v COSA Fee' $ 14 q n Date of Payment Receipt Number 23506 12 (Rev. 11/05) h field inspections and above Sys) rr /are Jn 7� ate! t04 - Waiver Fee $ •Vj_4AM� " w Date of Payment Receipt Number Municipality of Anchorage • ��/'/`J Development Services Department j Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchoragc.ak.us (907) 343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # 101070 During a recent COSA on-site inspection and test of the potable water supply well on Block 3, Lot 13 of Scimitar #2 subdivision, the well's productivity was determined to be 0.44 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.42 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Municipality of Anchorage Development Services Department Building Safety Division Onsite 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 FOR A SINGLE FAMILY DWELLING Parcel I.D. Irl - l3a &57 COSA# �D� 4tp 1. GENERAL INFORMATION Expiration Date: I 0—/ % — f7 % Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address SCIMITAR #2 SUBDIVISION, LOT 13, BLOCK 3 20136 TULWAR DRIVE ' CHUGAIK • AK 99567 SHARION do MICHAEL ULRICH Day phone 688-4517 20136 TULWAR DRNE * CHUGAIK 0 AK 99567 Day phone BOB RINK w/DYNAMIC PROPERTIES Day phone 261-7619 3111 'C' ST. * ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2.' NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ 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 engineers 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 riles 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS. P.E. Engineers Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, consciontious engineering analysis of the system in accordance with ADEC and MOA DSD Guidolinos & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, 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 wafer usage of the family being served by the system. These conditions are outside the control of the evaluator of the systom. 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 right whatsoever. 5. DSD SIGNATURE v Approved for bedrooms. Disapproved. Phone 337-6179 Date 7 17 - Conditional approval for bedrooms, with the fllowing stipulations: Attachments: v COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other •. ONSITE WATERAND •; WASTEWATER PROGRAM By: v Original Certificate Date: _^ 17- D 7 ol". I IMS) Municipality of Anchorage Development Services Department Budding Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 190650 Anchorage. AK 99519.WW www.muni.oroonsite (907)343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: SCIMITAR N2 SUBDIVISION, LOT 13, BLOCK 3 Parcel ID: OS A. WELL DATA '68 FEET TO BEDROCK easr.'Mmo�) Well type SATE If A, 8, or C provide PWSID# N/A Well Log (YM) YES Date completed 8/1991 Sanitary seal (YM) YES Wires properly protected (Y/N) YES Total depth 400 ft. Cased to •68 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 8/1991 6/26/2007 Static water level 40 ft. 226 ft. Well production 3 g,p.m. 0.42 g.p.m. WATER SAMPLE RESULTS: <h - Coliform 0 colonies/100 mi. NltrateQ,0&mgJL. Other bacteria ALC�_colonies/100 ml. Arsenic: b-10-ug./L. Date of sample: 6/25/2007 Conected by: GEG Ltd. B. SEPTIWHOLDING TANK DATA Tank Type/Material STEEL Date Installed 10/1/1981 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/28/2007 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA Date installed 7/15/1993 Soil rating .p.d. ft'/bdnn) 0_7 System type BED Length 36 ft. Wkith 24 ft. Gravel below pipe 0.5 ft. Total depth *_ft. Eff. absorption area864 ft' Monitoring tube YES Depression over field NO Date of adequacy test 6/26/2007 Results (Pass/Fa6) PASS For 4 bedrooms Fluid depth in absorption field before test"3 in. Water added 785 gal. New depth '+3 in. Elapsed Time: U min. Final fluid depth'=3 in. Absorption rate » 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N S type) NONE KNOWN If yes, give date — ►• THE SECOND MT REMAINED DRY THROUGHOUT TEST D. LIFT STATION Date installed Size in gallons 'Pump on" level at _In. "Pump ofr le_gLat'--irr' E. SEPARATION DISTANCES Manhole/Access water alar level at in. Cycles tested Meets alar 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankllift station on lot 100'+ On adjacent lots t 00'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Sewer /septic service line 25"+ Animal containment areas 50'+ Public sewer manhole/cleanout N/A Holding tank N/A 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 N/A 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 N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that i have determined through field inspections and i review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed/Z Name JEFFREY A. GARNESS a Date -7ti /0 2 COSA Fee S 30.00 Date of Payment �7' Receipt Number `/(, '$ 3 (Rev. 11!05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage • "� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 070246 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 3, Lot 13 of Scimitar #2 subdivision, the well's productivity was determined to be 0.42 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.42 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. Municipality of Anchorage 40) Development Services Departinent Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-132-65 1. GENERAL INFORMATION HAA # 03= 0 Expiration Date: 11 /9- 0.3 _ Complete legal description Lot 11; Rln(,k 1- Seimitar SrnhdiviSion #2 Location (site address or directions) 9.Q116 T„ 1 wn r nr Current Propertyowner(s) Celeste Kinser Mailing.address Lending agency Mailing address Day phone 688-7793 _ Day phone Real Estate Agent Pete Farris / Dynamic Day phone 9,29-1637 Mailing Address 311 ' G' st . Ste, 100 AItSAK 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 7WZ, J?,-� T b f l0-3 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: ' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Ek Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from. my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S riiyggrinry riwna�g4-�q79 - Address 17034 N. Eagle River Loop Ste. 204 Eagle River, AK 99577 Engineer's Printed Name Robert C. Cowan Date //3/0-5 OF S. DSD SIGNATURE �Ij�a ROBERT 8801 �//``� Approved for _ bedrooms. iii t`�pRCi Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments WASTEWATER : . PROGRAM Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Lt% Original Certificate Date: D? (Rev. 01/02) Municipality of Anchorage ' Development Services Department Building Safety Division On -Siete Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LOT l3 2 Parcel ID: OS/ - 137,-65' A. WELL. DATA Well type Lt% Date completed ?A/8 Total depth 1Uft. If A, B, or C provide PWSID # Well Log (YIN) Sanitary seal (Y/N) Wires properly protected (YIN) y Cased to �- Casing height (above ground) r g in. FROM WELL LOG AT INSPECTION Date of test41114V /40 1 0103 N HJI�� Static water level 4-4o ft ft. Well production Q. 33 �T g.p.m. O.Sty g.p.m. WATER SAMPLE RESULTS: Coliform D cotonies/100 ml. Nitrate 0. 1 mg./l. Other bacteria 0 colontes/100 ml. Arsenic: mg.11. Date of sample: �0 3 Collected by: V!; 6u6 /nl(r- B. SEPTICIHOLDING TANK DATA Tank Type/material E Pr((.- / T;FjL Date installed 1 O ( ,7 i Tank size L o gat. Number of Compartments 2` Cleanotits (YIN) y Foundation cleanout (YIN) Depression over tank (YIN) A High water alarm (YIN) A Date of pumping 2 D Pumper l S C. ABSORPTION FIELD DATA Date installed -7/i,4�j Soil rating (g.p.d./fe or ft2/bdrm) (2L2 System type 450 Lengthft. Width 24 ft. Gravel below pipe Ot ft. Total depth R Eff. absorption area8.<4ft? Monitoring tube Depression over field N Date of adequacy test 03 Results (Pass/Fail) For A bedrooms Fluid depth in absorption field before test 0 in. Water added gal. New depth in. E'.apsed Time: f00 min. Final 9uid decth �i in. Absorption rate >= (00 g.p.d. Any re;uvenation treatment (past 12 mo.) (YIN 3 type) Al If yes, c,ve nate D. LIFT STATION Date installed N 'Pump on" level at Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) 'Pump ofr level at _ in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: t Septic tank/lift zt n on lot ! �� / 'f Absorption field on lot f'� /'A' Public sewer main IV Spw r /septic service line lis On adjacent lots /CC It, On adjacent lots 40© Public sewer manhole/cleanout AJ /4 Holding tank ti IA - HAA-_ SEPARATION DISTANCES FROM SEPTIC/HQLBMG TANK ON LOT TO: Building foundation S Property line f' Absorption field Water main N A- Water service line t 0 (,r Surface water l 00 rT i� Wells on adjacent lots _(L SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: / Property line 10 If /- 1Building foundation 10 (4- Water main N ,4 Water Service line 10 /T- Surface water _ J_QQ '-r Driveway, parkinghrehide storage Curtain drain/JP&&/%IDn/,tf Wells on adjacent lots /-Q '-t-- F. COMMENTSOr- At G. ENGINEER'S CERTIFICATION d •':.szS. Y V :J. I certify that I have determined through field inspections and i review of Municipal records that the above systems are in �• Q Ro� C conformance with MOA HAA guidelines in effect on this date. ��v p°8&T •;. ��- Engineer's Printed Name/�t''t `T C� i'��'� �'f�' :: �•'";iti .t Date 4� 3 HAA Fee $ -7 s ' Waiver Fee S Date of Payment $ by IO 3 Date of Payment Receipt Number (Rev. 12101) oy01gS. Receipt Number Municipality of Anchorage .11 • Development Services Department ° BuildingSafetyDivision a. ... On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Health Authority Approval # 030410 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 3, Lot 13 of Scimitar #2 subdivision, the well's productivity was determined to be 0.56 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is 0.42 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. IEAVIl A111110111Y AM'nOVAI s SEwrnawAlEn W111tXIE115"Is stwEn s wAtE n 111srrct1c11 EI 101 E trivia STMIES a1onErtlros WEII 111SPEC11011 A Flow list 511E n A11s 110AOnESICA BOR TEST TEST situctunAL s MECIIAT ICAL rlsrrctlolls 011511E WASIEWAIEn r1SM)SALSYSIEM 111s1CJl WELL RECOVERY TEST DATA CLIENT:G1 WELL LOCATION TEST DATE: WELL DEPTII: _ CASING DEPTII: TES,j PROCEDURE: 1) Draw water down to pump. 2) Shut pump on 15.60 min. -record tittle / 3 v5 -record meter reading 3) Tum pump on. drawdown. a) Slut pmtlp oil. 1t A. -record lime -record meter reading 5) Calculate gal./1n111. recovery. ES ASA; START TIME: 3; 133f 5G1MIfk-d- TESTED BY: e �— WELL DRILLER: A- DATE DRILLED: / ?tV 5" M11SC IA A; Casing Ilelgllt: Satlllary Seal? Wires In Condull? Grading O.K.?m Ptlp Deptll: Samples Taken? Date: 110DER( C. COWArt, P.E. InODEIII A. SI IArER, P.E. CIVIL EIIGOIEEDS (007) 604-2070 rax(907)691.1211 _ STATIC WATER LEVEL: N A2.4'J� METER GAL./MIN. f�/� TRIAL PUMP 11 TIME 11 OFF / 3 v5 S2Z 9�G to.(,//f = 1 ON 3'fiO 1t A. O. 57(57(OFF OFF_ 3 V4 15W,15W,s�. 1, 1• a / " /D• ! 2 ON OFF 1 :3g —I 134- OFF- b r• !� / /q.= 3 ON / !) y� M 1 •+ OFF 14 Q 2— OFF I1 tt �f �d• T /9 4 ON OFF f � l �- k tr I A Z I 5 2 .3 00.45 oi OFF 6 ON OFF RESULTS; WELL CURRENILY OkODUCES: ae So FLOW RATE NOT GIIARANTttD--SUBSEQl1ENT VARIATIONS • CAN OCCUR. LIA144f, � 9a 60 /2�U�-A31.� �2o/S ,Q�9/AvGS �F 7`d 0z$s rW-K c r10 vs �,v Av&Z L, Lf sEO � t70,14 Mill I EAGI E IINTII l OOP • S1111E 204 • EAGI.L Il1VEII. AI ASKA!rt577 JUL-17-03 THU 01:53 PH Dynamic properties AS FAX N0, P. 05 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE, FOLLOWING DESCRIBED PROPERTYi el z,ed'V7Z oM. � DATE, AND THAT NO ENaiOACHMENTS KR EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDI EASEMENTS, COVENANTS, OR RESTRICTIONS iyw/26/ WHICH DO NOT APPEAR ON THE RECORDED SUB01- VISION PMT. UNDER NO CIRCUMSTANCES SHOULD FB` ANY .DAA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR • ESTABLISHING BOUND- DRAWN, ARY LINES. ep,wpvf� OF At � �TH� .•'9*� V. Non. Mak S.w.•d = • �S' /��•. LS -6918 w •' MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section CrATs P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # til l'DZ iO� HAA # i �� IXC `` 11 1. GENERAL INFORMATION Complete legal description L l 3 t> 3 Sc� v� r lot{z_ 5's� Z Location (site address or directions) ZD Is L- �y L\..A Pte- fly. Property owner Mailing address Lending agency xt,L Day phone Day phone Mailing address Agent ��� b�� �i11 ��s�kf� Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: �1 3. TYPE OF WATER SUPPLY: Individual well x Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 M 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. S & S ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone �' N - -�-9 7 f Eagle River, Alaska 99577 Address Engineer's signature 6. DHHS SIGNATURE V Approved for F0 U R bedrooms. Disapproved. Conditional approval for Additional Comments In Date Rte:; E OF q •� RCHRT C. COWAN ••f•C a �i,\•ti CE - 8801 bedrooms, with the following stipulations: Date /Z- (�''79 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 W21 •� RCHRT C. COWAN ••f•C a �i,\•ti CE - 8801 bedrooms, with the following stipulations: Date /Z- (�''79 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 W21 pre Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVIC �t Environmental Services Division �� 825 L Street, Room 502 • Anchorage, Alaska 99501 •.4(907) 343-4744 Health Authority Approval Checklist Legal Description: Parcel I.D.: d `-1132�p5- A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present O/N) Date completed g '911 Total depth �oo Cased to LM' Casing height (above ground) �Zd Sanitary seal "�N) Wires properly protected &/N) FROM WELL LOG AT INSPECTION Date of test � �9 I ' ' >M q - 5 � 1111 i � Static water level `f 2�3 OW" 4,T) 'tJ 4, oana� J JQ"U l.D GM7; Well production �JCo.D _g,P4R- 33,0 919. WATER SAMPLE RESULTS: Coliformy Date of sample: Io B. SEPTIC/HOLDING TANK DATA Nitrate b .21 -S Other bacteria 0 Collected by: S� SR-: Date installed 1`l V k Tank size 1'5'0 O Number of Compartments Z Cleanouts ON) -V_ Foundation cleanout O/N) 4 — Depression (YQ rJ High water alarm (Y/N) t3IPa Date of` Pumping S '9 S Pumper ;�2 Pomp, fofi C. ABSORPTION FIELD DATA Date installed -7'I —GI3 Soil rating (g.p.d./ft2 or ft2/bdrm) b,% System type i Length U Width Z l I Gravel thickness below pipe Total depth �/a' Effective absorption area �Monitoring Tube present &l)_�t_ Depression over field (Yo IJ Date of adequacy test $, I �%1 � Result Pa ail) P" c, For bedrooms Fluid depth in absorption field before test (in.); 6 1 Immediately after4°o gal. water added (in.): 6 Fluid depth fes_ (ins) Minutes later: 0 Absorption rate = L 200 g.p.d. Peroxide treatment (past 12 months) (YO Pb�J d- 11-00 0 J If yes, give date 0 `A- 72-026 (Rev. 3/96)` D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION, DISTANCES Size in gallons "Pump on" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot I o 0 Absorption field on lot loo k Public sewer main On adjacent lots I b o L �- On adjacent lots Public sewer manhole/cleanout l 1 - Sewer /septic service line Lift station 0 !k SEPARATION DISTANCES FROM SEPTIC/HOLDING II rTANK ON LOT TO: Foundation LA k Property line 7?,.- Absorption field S� y c � f� Water main/service line to Surface water/drainage /,16 Wells on adjacent lots /� 6 It SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: t Property line 12-5, Building foundation 15-( Surface water ('Z o �k Curtain drain F. ENGINEER'S CERTIFICATION Water main/service line 1' Driveway, parking/vehicle storage area Wells on adjacent lots I certify that l have determined thru field inspections and review of Municipal records in conformance with MOA �fHAA q�delin in effect on this date. 0 Signature ,� �-� .+ �T Engineer's Name d 1'3 C, Co wA� p •� Date 8/3 HAA Fee $ (� 610 a e1 Date of Payment fJ G� Z C7 y Receipt Number �d 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number �k gag Y are ` KF16GfK1 L, (,UVVAN d�IZ- MUNICIPA £IIY OF ANCHORAGE M e z o e& 2 D o z 23y WELL VISORY EEALTH A eORITY _ 22ovaa x9. ceviae a =sc=at 2eait5 'uo«ity Apprcval on -sive izasectica and test of G+ potable W tee supply weal on Lot Block 3 of /Cl/Al Ta A # :2, Subdivision, t' -e we 11'3 g=oaecticity s deter -mined to be Q437 gallon: ger \f=ete. 25e afaU 11 p:oaact«mi«y =ems izea by this Department ;'AMC 13.55{ £a= a be3zoom residence is D. 2 aall=zs Per ziaste. sltwoois the :c5ject well cur—n--1v exce-ds G. minim m >e<=i=emezt, z_1 re=ties d - co=os=sea are aari:eJ tEzt 1»e =»Daae«:so c=eaci©y oz t5- -- f�'LI ate. :©«»=tics oz «oe-=sit±ca: ; :a zees :c,z as washing ca=2 ash z=ero awns «_: . _des i -,.a y >e =ems mzo=y meat be F, az«ea to a:� ,Dries §: the=:awe=s Seal©© tEo=:ty g==sz1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES M Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# �: 41 —\:2,.';)- In HAA# £}9�(,(}�j� 1. GENERAL INFORMATION Complete legal description Lot 13: B. Qck 3• Scim,i.teh #2 Location (site address or directions) 20136 Tuan Chugiak, AK 99567 L' hrinLo.o Property owner Sutt i.van Day phone 688-2759 Mailing address P.O. Box 670272 ugia , Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & 5 ENGINEERING Phone Address 17034 Eagle River Loop Road No. 72014- 9 577 Engineer's signature Date 6. DHHS SIGNATURE Approved for le ` - bedrooms. Disapproved. Conditional approval for Additional Comments By: bedrooms, with the following stipulations: Date 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. Municipality of Anchorage • +i Department of Health &Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lc�'r �_2;> f�X-IL_5 SC Parcel I.D. �a2V�`J sem• 2 A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number A Log present (3:1N) Date completed a-�_\\ Driller Total depth Cased to 1.05 Casing height Sanitary seal &N) Date, of test Static water level Well flow Pump level Wires properly protected ON) FROM WELL LOG AT INSPECTION _ N (38or+�y�- c C n Va v � R T A > C ru; i o� on SEPARATION DISTANCES FROM WELL TO: Z Septic/holding tank on lot t> c7 �+ ; On adjacent lots bo , Absorption field on lot \ o o ; On adjacent lots Public sewer main Ips Public sewer manhole/cleanout�� Sewer service line t -t- ZS t -�- Petroleum tank WATER SAMPLE RES'JA LTS: C -,>C-,>. M Coliform t0c'^ Nitrate � �r j 9 vle Other bacteria g n 6, i` S & S ENGINEERING Date of sample: 2- % Collected by:17034 aye River Loop Road No. 204 Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed �� `� Tank size \'5-0 o Compartments — Cleanouts &N) Foundation cleanout (' N) Depression11(Yvr High water alarm (Y& 4 Alarm tested (Y/N) A Al Z VA Date of pumping 3 ' - Pumper �� GESS 7O olr SEPARATION DIS ANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot \ r->ot k On adjacent lots \dt'\ Foundation To property line—1 o t k Absorption field S + Water main/service line— \ b,} Surface water/drainage \ bot 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Manufacturer Manhole/Access (Y/N) "Pump on" level at /Pump off' level at Meets MOA electrical codes SEPARATJqb4-DTSTANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Cycles tested Surface water (01/lPi! _ Date installed `b\ Soil rating �5 �I�IZ System type 7ae-,�(�6 Length 45t Width 4bu c� Gravel thickness 9" Total depth � \ Total absorption area ��4 Cleanouts present &N) Depression over field (Ya Date of adequacy test Z - Results djas fail) PPcSS for roJtZ- bedrooms Peroxide treatment (past 12 months) (Ya If yes, give date D SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot \ L To building foundation \ >r On adjacent lots \�, Property line L2 I+_ To existib d d ng or an one system on lot e\ �- On adjacent lots Cutbank !>- Water main/service line Aa � Surface water \ �� \ Driveway,g g parkin /vehicle storage area Curtain drain I G. E. ENGINEER'S CERTIFICATION I certify that t have checked, verified, or conformed to all MOA and HAA guidelines in effect pn ffi&d4t#,of this inspection. ., . L va rM � cr C1 1170M L agile River Loop Road No. 204 o C6J Signature ��c�l�i'ivek, AIa�IFa9957T �` �C� � ; f'"� t :it"eo eoo�lc ger, 3n �ece n:;Ua�uaao:+%e_�. ,;�1 Engineer's Name Date '_�D - 2 -'�13 HAA Fee $ Waiver Fee: $ Date of Payment Date of Payment Receipt Number V qjjz�;-_3 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 ,4 . A � HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER& WATER INSPECTION 2 2 ENGINEERING STUDIES AND REPORTS WELL INSPECTION 8 FLOW TEST SITE PLANS I I ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN WELL FLOW TEST DATA Page Ia42 ROBERT SHAFER, P.E. ROGER SHAFER. P.E. CIVIL ENGINEERS (907) 694-2979 FAX 694 1211 CLIENT: DATE OF TEST: 2-2Lo-�s LOCATION OF WELL (Legal Description) : k nT- \'15' 'P %_y_ 3 Sc.A M1 r p.•�S�o "Z WELL DEPTH: 40e' CASING DEPTH: LAI TESTED BY: R r.:A DATE DRILLING COMPLETED: i�)-0\\ DRILLER: TRST DATA! CLOCK TIME DEPTH TO WATER DRAWDOWN PUMPING RATE(GPM) REMARKS b ,tiba 5CA I swl — '�2P S1 kA 1" 3.`t k) y— JY_ — 4 (y OF 1` ZuF Z MISC. DATA: CASING N coNTs� SANITARY SEAL: WIRES IN CONDUIT?i GRADING O.K.?: BACTERIA & NITRATE S LES COLLECTED: RESULTS: WELL CURRENTLY PRODUCES GPM WITH A DRAWDOWN FLAW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCURI 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 1A A,. HEALTH AUTHORITY APPROVALS SEWER d WATER MAIN EXTENSIONS SEWER d WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION 8 FLOW TEST SITE PLANS I i ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSVSTEM DESIGN -O Page 2 of 2 WELL RECOVERY TEST DATA ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVILENGINEERS (9071694.2979 FAX 694-1211 CLIENT: (_ 'Pet-- Y.Pq„s' PUMP WELL LOCATION (legal): GAL./MIN. TEST DATE: TESTED BY: WELL DEPTH: WELL DRILLER: CASING DEPTH: DATE DRILLED: TEST PROCEDURE: MISC. DATA: 1) Draw water down to pump. Casing Height: 2) Shut pump off 15-60 min. Sanitary Seal?: -record time Wires in Conduit?: 22 '. It -record meter reading Grading O.K.?: 3) Turn pump on. Drawdown. Pump Depth: 4) Shut pump off. Samples Taken?: -record time Date: C1 4:12 , -record meter reading OFF 5) Calculate gal./min. recovery. TEST DATA: START TIME: STATIC WATER LEVEL: OFF TRIAL PUMP TIME METER GAL./MIN. 1 OFF 461 to 11 ON OFF ori �1blo:� 2 OFF a o C\ b ON OFF 22 '. It C1 3 OFF C> 4c1 (,PA ON OFF 'L� '. v b C1 4:12 , 4 OFF 0�' C> 0 CNA -I- OFF 1 0� O cIi 5 OFF � 1 6112 OLN --� -- OFF 'Lp,C7�i q `TbP 1"koY RESULTS: WELLr CURRENTLY'PRODUCES: ACN CaP a FLOW RATE NOT GUARANTEED --SUBSEQUENT VARIATIONS CAN OCCUR! 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577