HomeMy WebLinkAboutMOUNTAINSIDE VILLAGE BLK 3 LT 1 Onsite File
Mountainside Village
Block 3
Lot 1
PIb# 020472 - 20
The 1985 4 bedroom bed may not be tested for a
future COSA .
Municipality of Anchorage
• On-Site Water and Wastewater Program • (907) 343-7904 Page of
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191200 PID Number: 020-172-20
Dwelling: ® Single Family (SF) [' Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ® Upgrade
Name:
MICHAEL & ALICIA COOK ABSORPTION FIELD - EXISTING
Address ® Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
17521 STEAMBOAT DRIVE, ANCH., AK 99516 ❑ Other
Phone Number of Bedrooms Soil Rating Total depth from original grade
5 1.2 GPD/SF 8 Ft.
LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe
Subdivision Block Lot 2 Ft. 6 Ft.
MOUNTAINSIDE VILLAGE 3 1 Fill added above original grade Gravel length
Township Range Section VARIES 1.41-1.75 Ft. (2 x 26'L) 52 Ft.
Gravel width Beds:Number of Lines Distance between lines
SEPARATION DISTANCES 3 Ft. Ft.
Lift Station Holding Sewer Total absorption area Number of trenches Dist.between trenches
To. Septic Absorption
From Tank Field Tank Line 624 Ft' 2 12 Ft.
I
Well 100'+ 100'+ NA NA NA TANK ® Septic ❑S.T.E.P. ❑ Holding ❑Other
Manufacturer Capacity
Surface Water 100'+ 100'+ NA NA INFILTRATOR 1530 Gal.
Material Number of compartments
Lot Line 5'+ 10'+ NA NA PLASTIC 2
NA
Foundation 10'+ 10'+ NA NA LIFT STATION
Manufacturer Capacity
Gal.
Curtain Drain NA *NA NA NA
Pump on level at Pump off level at High water alarm at
Remarks Existing septic tank decommissioned
per UPC. in. in in.
Pump make and model Electrical Inspections performed by
PIPE MATERIAL House to tank 3034 Tank to 3034
Installer A+ drainfield
Drainfield 3034 co/MT 3034
Inspector FWCS / MNA BENCH MARK (Assumed elevation) 100 ft
Inspection
2
r' 6/12/19 ,d 6/12/2019 Location and description
dates:
3'° 6/13/19 4'" 6/13/19 BOTTOM OF SIDING
COMMUNITY DEVELOPMENT DEPARTMENT APPROVALN.N\
i
i <s, ........... ��
am �1
Conditional Approval: Date l "". .1-
.r L�9 TH /\ fir
# MICHAEL N. ANDERSON.'
1 No. CE 9489 •G��/
Air
�`�.
�-' 2-1 -(q
� ` FESSIOTI�1
Approved L NA____ `� Date
\\`_411P'
Inspection Report_9-1-12.doc
Permit No. OSP191200
MOUNTAINSIDE VILLAGE BLOCK 3, LOT 1
PID No.: 020-172-20
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51es) o exp MHØ ?%.4
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' .01 o Sii c ..o DIVCOs ,fMTCO1 "/
+ o''• PL R :%, 1 EXISTING
'.�. 114.4 co �i�i,1 5BR—HOUSE _
• HMT
COt MT
y \ F TH19-1
cs, . L_
SCALE! 1' = 30' 0 I
A-C=38.9' fFCO MT MN f CO C0\ `MT UT\ /CO
B-C=27.895.91 L[ C{94.19 FINAL GRADE 94.1
A-D=42.0" /22'1G"
oc
B-D=22.6' INSULATION 9119 11
1— FILTER FABRICORIG. GRADE
A-E=72.0' 0.0
oRG/a
B—E=46.0' 91 1.537-GALLON 9,.,s \\)o.4.4 90' 1'0
PLASTIC TANK SEWER
ROCK
A-F=90.8' (*agm
B-F=60.0' CO MT kg co 9�20.7
A-G=86.7' FINAL GRADE cFl91.95
LTER FABRIC r:/ QSOG
B-G=63.5' SEPTIC SECTION
54
5/25/19 78.04
SEWER ROCK
A-H=98.2' SCALE: NTS 88.54 1.0 GRND.WTR.
)L2_.5474.54 BOH
B-H=69.6'
MOUNTAINSIDE VILLAGE BLOCK 3, LOT 1 i., OF A
PREPARED FOR: Or ,(V
s+
MICHAEL & ALICIA COOK /*49TH!\ A
17521 STEAMBOAT DRIVE, ANCH., AK 99516
Michael N. Anderson, P.E. MICHAEL N. ANDERS N/
DATE: 6/19/2019c�,, No. CE 9488 /
4661 Natrone Ave. DRAWN: BMW 1 `�;p� 6/19/19 e�
Anchorage, Alaska 99516 t �O
FESSIOt1-
(907)727 8864/FAX: (907)345 1391 SCALE: 1" = 50' �``_11P..
.iS lit
Municipality of Anchorage
a11'�Ili��.
apart enf
P.O. Box 196650 • 4700 Elmore Road
Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997
http://www.muni.orq/Onsite
Development.Services Department
On-Site Water and Wastewater Section
**** VARIANCE/WAIVER REVIEW ****
Waiver#: OSV191044 COSA#: OSC191237 Permit#: OSP191200
PID#: 020-172-20
Legal Description: Mountainside Village Block 3 Lot 1
Engineer: Mike N. Anderson
Applicant: Michael & Alicia Cook
•
Your request for a waiver of the required 5.0 feet horizontal separation from the septic tank to
the absorption field has been approved. The approved separation distance is 3.0 feet. See
engineer's waiver request for justification
This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site
wastewater disposal system will require all separation distances be met or another approval from
this department.
Waiver is Granted: X Waiver is not Granted:
Date: 6/21 I Approved by: Nee..e.A._
Name of Reviewer
**** VARIANCE/WAIVER REVIEW ****
Michael N. Anderson, P.E.
CiviUStructural Engineering and Construction
4661 Natrona Ave. Anchorage,Alaska 99516
Phone 345-3377/Fax 345-1391
June 20, 2019
Municipalities of Anchorage
On-Site Water&Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
LEGAL: MOUNTAINSIDE VILLAGE BLOCK 3, LOT 1
Due to the tight site constraints (creek surface water & retaining wall), it appears the newly
installed IM-1530 Infiltrator plastic septic tank was installed approximately 4-5' from the
existing bed and we are requesting a wavier from tank to field of 3' at this time. The septic tank
material is plastic, the bed is down slope from the tank and a septic tank monitoring tube was
installed at construction. We believe these items justify the waiver and that the reduced
separation will have no adverse effect. Please contact Brent M. Western or me if you have any
questions.
Sincerely,
inklay(///1/11
Michael N. Anderson, P.E.
Support Services
Brent M.Western Flist Water
907-440-4601 �CUNSIIIfING SIHVICFS
C .1 MII IP.i NAi IIWRIII
Sisi9RlA PlRN YIYI
•
�,P��,TY // /161
N
MUNICIPALITY OF ANCHORAGE e„t
On-Site Water&Wastewater Program ,t.•
J � 1 rts-
PO Box 196650 4700 Elmore Road `” `� t ,.:. .
Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997
http:/lwww.muni.org/onsite
.:" Deparumen t
On-Site Wastewater Disposal System Permit
Permit Number: OSP191200 Effective Date: 6/6/2019
Work Type: Septic Upgrade Expiration Date: 6/5/2020
Tax Code Number: 02017220000
Site Legal Address: MOUNTAINSIDE VILLAGE BLK 3 LT 1 G:3439
Site Mailing Address: 17521 STEAMBOAT DR, Anchorage
Owner: COOK MICHAEL R & ALICIA N Lot Size in Sq Ft: 77307
Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 5
This permit is for the construction of:
•
El Disposal Field E l Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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
6/6/19
Received By: Date:
Issued By: Date: 641/"(/�
EPLRA/S
MUNICIPALITY OF ANCHORAGE
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section \ Fax: 907-343-7997
ON-SITE SEPTIC/WELL PERMIT APPLICATION
Parcel I.D. 020-172-20
Property owner(s) MICHAEL & ALICIA COOK Day phone 9074448822
Mailing address 17521 STEAMBOAT DRIVE, ANCHORAGE, AK 99516
Site address 17521 STEAMBOAT DRIVE, ANCHORAGE, AK 99516
Legal description (Sub'd., Block & Lot) MOUNTAINSIDE VILLAGE B3, L1
Legal description (Township, Range & Section)
Lot Size 77,307 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING:
(®all that apply)
Absorption Field 0 Initial ❑ Single Family (SF) n
(w/wo ADU)
Septic Tank H Upgrade Duplex (D) ❑
Holding Tank [ Renewal ❑
Multiple Dwellings ❑
Privy ] (SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A 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: 5e16.-
Waiver Fees:
Date of Payment: "l t ti0t Date of Payment:
Receipt Number: 6.22(0$0 Receipt Number:
Permit No. DS PN j D_DU Waiver No.
G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345 -3377 / Fax 345 -1391
Support Services
Brent M. Western
907-440-4601
May 27, 2019
Municipalities of Anchorage
Departments of Health and Human Services
P.O. Box 196650
Anchorage, Alaska 99519-6650
Fax 249-7847
RE: SEPTIC SYSTEM UPGRADE PERMIT
LEGAL: MOUNTAINSIDE VILLAGE BLOCK 3, LOT 1
The septic field has failed and we request a septic permit to upgrade the system on the above
referenced lot. Attached you will find the test hole results, which the design is based on. We
propose that a 53 long deep trench be installed along with a new IM-1530 Infiltrator tank.
The slopes are generally 13-18% at the proposed trench location. The lot and area is served by
private water systems and the design will not impact any of the neighboring properties. Please
contact Brent M. Western or me if you have any questions.
Sincerely,
Michael N. Anderson, P.E.
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191200, Deb Wockenfuss, 06/06/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191200, Deb Wockenfuss, 06/06/19
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191200, Deb Wockenfuss, 06/06/19
Michael N. Anderson, P.E.
Civil/Structural Engineering and Construction
4661 Natrona Ave. Anchorage, Alaska 99516
Phone 345 -3377 Fax 345 -1391
SOILS LOG - PERCOLATION TEST
LEGAL DESCRIPTION: MOUNTAINSIDE VILLAGE B3, L1
PERFORMED BY: FWCS / MNA - I MIKE N. ANDERSON CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT
ON THIS DATE. DATE: 5/27/19
5/27/19
DEPTH
FEET
OG
SOILS
1
ORG/OL
2
3
4
5
6
7
8
GM-gp
9
10
11
12
13
Silt / moisture
increasing @ 13
14
15
16
17
BOH
18
19
20
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
5/25/19 10 min 6 3 4/16
6 3 5/16
6 3 5/16
6 3 3/16
6 3 4/16
6 3 3/16
PERCOLATION RATE 3 (MIN / INCH)
TEST RUN BEWTWEEN 5 & 6 FT
PERC HOLE DIAMETER 6
PRE-SOAKED PRIOR TO TEST & ALL READINGS TO
THE 1/16TH.
GROUND WATER ENCOUNTERED: YES
IF YES, AT WHAT DEPTH: 15
DEPTH TO WATER AT MONITORING: 12.5
DATE: 5/25/19
TESTHOLE # 19-1 DATE PERFORMED: 5/16/2019
SEE SITE PLAN FOR SLOPE & LOCATION
COMMENTS:
VERIFY GROUNDWATER MT
AT TIME OF CONSTRUCTION
PERFORMED FOR: MICHAEL COOK
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191200, Deb Wockenfuss, 06/06/19
11
y;'y
MUNICIPALITY OF ANCHORAGE
11 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEtRING DIVISION
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME
PHONE
2y� /3$ ❑UPGRADE
MAI LING ADDRESS
g y 3 1 A., fLije skck.le Ano/'-! A y9 Y70
LEGAL DESCy,RIPTION
%�u<<�fru+•r -ii� V:llr (-v 1' i i3 f;x /c. 4 �c</t i// 1Vlz 3 �:.,°'
LOCATION // t—
NO. OF BEDROOMS �..
O Y
Well Absorption area 6
DISTANCE TO: (D �f�,
Dwelling J a
PERMIT NO. 7-'G L .
o
w
Manufacturer �rC
(S
Material
�r p�tiQ
No. of compartments
Liq. capacit in gall"ins Inside length
rf�}� �/ IF HOMEMADE:
Width
Liquid depth
�Oz
DISTANCE TO: Well Dwelling
PERMIT NO.
= z rQ
Manufacturer Material
Liquid capacity in gallons
Lu
DISTANCE TO: Well / �� Foundation > Nearestlotline
3 b 6,.,e
PERMIT NO
8 B . o z
u Z
Il �za
No. of lines Lengt of each Iii� Total length of lines O ,Trench width
v r�
.i
Distance between lines 6 ;
oy-
Top of tile to finish gradefr _ & t Material beneath the / u�ekas
inches
Total effective absorpt on area
�
w
O
Length Width Depth
�j -, 47 :✓"
PERMIT NO.
C7
Q F
w n:
Type of crib Crib diameter Crib depth Total effective absorption
�
area
y
DISTANCE TO:
Well.
Building foundation
Nearest lot line
j
Class
kfe)/ d
Depth /
Drill
Distance to lot line
PERMIT NO.
w
DISTANCE TO:
Building foundation
Sewer line
septic tank
Absorption area(s)
OTHER
IS
PIPE MATERIALS
3C>3 c i
SOI L TEST RATING
%/ -+- -'� a / J�
INSTALLER[
/\l /,",-
el,f c,' E7i, d"S_
REMARKS
n. t d Z
fi11�4
9
.T
New �: � r �� ` n
e>• �e
1
-Aiti So .1 wca Prf/cr
/'�
ef'n tr ii, /'q. t 4�✓'e
Y
hv" /etez Kc ill OC4'I M JZ) '2:�
n
1
PA I 1
7
APPROVED DATE LEGAL
J e
72-013 (Rev. 31781
I
1201 PRI m ST. 99515 ANcnonAc�Ev ALASKA
344-7714
SIX INCH WATER WELL DRILLED
OUT TO THE DEPTH OF 255 40
DRILLED AT THE RATE OF 823-00 PER FOOT. Cho -W -e- P"- 250 A "46
PROPERTY OWNER
LOCATION OF WELL
-1381
t. / BU. 3 Sub.
.aeteii Vl.t
DRILLER BeAnte Clave off. Ranpa-tt D&tttlJ4 LTonko
WELL LOG:
0----17' StJtt t 4and* 9A"el, with 4eve zat 4maU boutde".Rua- �I analtup
17---28' A congtomZAate o.. broken be&wa mate ,%" R H11V3d A lydI
�t:m,0li7Nv ao I,1nvaIDIN(lw -
28---49' Bedrock. Seve&aZ broken a&Ra4.:1 St" -L caput¢ dttven .to ae�Awal at 49 A.
49--250' R vee haul 4edZn.e� bedrock.. Ro watelt Vi-eld 4how4n.¢ untU 185 .to 189
ane gPm. gtanual -type nock- Rew wate�t gteid of 2 1/2 gM 4haw.tnq. at 243 .to
248 A. A ponouo 4pe vat z be tA2agy bedrock. Tota.L wateh pnoduct,ioa of. 3 1/2 gflZ-
Water necave,t4 come4 back. up to 4"�ac.e Level. 3/4 Monae SubrAeA4ihte PUMA 41Loutd
be dn4tat)ed about 20 A. ag battant-
Co,A- o.,f UiLung: $23.00 pet A- X 250 4: 85750.00
aci aclbt .;,Za .,A2 coat. oz 4e,t ap C.a.x.
COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF $5.750000
THANK YOU VERY MUCH.
BERNIE CLAUS OF RAMPART DRILLING WORKS
DATE a.LJ4 29th' 1985
SERVICE CHARGE OF T%a% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS,
,gip.
an a tq I E C F-= n- 0<_ �- �"`�,., _� I ff r"alF�Ed... F �,l l• t � r* s1F_ CO
DEPOWWF IT -`NT
25 L' -STREET; ; AMCHORME ,' AI': n'19501—
PERMKT NO: 850027
DATE IS�SLJEDI, 02101/85'',
l-F-ICANT;.. :DAVE Lt THOMAS
ADDRESS: -8
9
57iu'HitEYS J_hLE _
...,.;.
.',
ANCHORAGE, AK 99 O
CONTACT f-'Ffi7NC': 248-1181,
LEGAL DEES`CRIPF '.:.$3 � ��' . k 1 �r a
�SECTTON, 1:1 � TOWN Tre 11N
LOT SITE,' 71707 CSQ. FT. OR 'ACI"ES} .:
MAX BEDROOMS. 4
Listedbelow are'thW'optii_)nes Available to you'S designik% your septic:
system. Chao -e the option that best f.i.t.s your sits.,
DEPTH TO PIPE BOTTOM (FTA 7.,:; xtt 1 X;"
GRAVEL. DgPTI ! (C=T,) ^. 0 (o
TOTAL DEPTH ii (F"T') 3.5
GRAVEL. WIDTH (FT.) °i Cr ^�
C FiA ICL i E NOTI) +� T 179 ) (.i t M (/y y-
r
GRAVEL VOLUME YD.. 'r I1°ff`�$ IB,lia_1...d« q
is
TANK SIZE tCA1S) f 250 � ���Pco
SOILRr1TI4110 f:atn;f T. /SE) 1�-, 1� �
DEPT( TO PIPE BOTTOM < 2.0 FT. COVER
DEPTH TO P1:PL- BOTTOM < 3.54yZ REOUZBES -TNSULATDN
w4 DEPTH TO PIPE E. BOTTOM `: A -0 7T. MAY F 1GUIREA L r f STAT:f6t�1
GRAVEL LENGTH > 75 1=T, ' REQUIRES MULTIPLE RUNS YNOT EY,C:E=C.X3I P jC t'T: a CFW)
K TANK`MUST7HAVE:-AT LEAST 'rwn n,r4(fAR'mt-Nr,
r
1 certify that:
1. I am:: familiarf4tiliar with,the 7GC.uirem?nt,a for on—site sewers and wells as -•e't..
forth by the Muni;ipa.lity o�' -Anchar ge "CMOA) and''f:i-re State of Al k
r.._., I L•J Z:T. I, 7.n'mta17. the system 7.n Accordance wi't.!', all A'IC{r•: Ir i7ci t -':i and regulations,
And in compliance with the design Criteria of this permit..
=y
,:i. :1 will adhere t. o' CYL ). MPA and:... State {lf ,AEa!a i': <-:t „r`eqU 1.1 i^mVrl'%. s f(:.i i'... i.h<_ let llus_i<'..
dint:a,,eg from any ekisti.ng wKil wastrawaterdisposal system or J::7I.blir_
' ewerage `+may+=stem po this or any/ ad,j. cent_ or nearby lot.
4 I u^de:'>tand that this -permit -s valid ror a, maximum'6P A L•r-ornomss'`&cl
any enlarg&mant will r6qus.;6 an additional. permit:,
,.s
THEN (1) AN
WIL,I_. NO'F BE
ELECTRICAL. '
S TONED
I r PQRTa _ AND- 1 ) THE
DATES �
I_, THOMAS
DATEii
,
• Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR`._ M eW-ir�jjN__ F -IC DATE PERFORMED: �f /
LEGAL DESCRIPTION:�pU4Tlsi+T15+� � lia5 �I .E DTownship, Range, Section: fie,. I t T It a li2t,�
EET
1 + OL 6+-c�p,NrC 40+'1
'
z GWL
3
4
5
6
7
8
9
10
it
12
13
14
15
16
17
18
19
20-
COMMENTS
0-
COMMENTS
WAS GROUND WATER
ENCOUNTERED? 40
S
.. L' IF YES, AT WHAT L
DEPTH? O
P
E
Depth to Water After
Monitoring? Date:
JI It FLAN
37— (G aro
Reading Date Gross
Time
mom
Depth to
Water
Net
Drop
3) '75-7
mom
/001
0
-P-?- -4
OEMIVIEN
�1NUMMNo
0011
�����
1q
3 bo
lozq
!0
2qo
,ry
UO
id
n3 A
U
/0
60
■NN
No�
37— (G aro
Reading Date Gross
Time
Net
Time
Depth to
Water
Net
Drop
3) '75-7
30D
/001
0
-P-?- -4
13
1q
3 bo
lozq
!0
2qo
,ry
UO
n3 A
U
/0
60
PERC&LATION RATELI !U9 E�
(mini-uteslinch) P RC HOLE DIAMETER
G
TEST RU�v BETWEEN FT AND 31L—FT
J PERFORMED BV %�a.�� /+`!Od`% f'$ tl2.� �L.��,c�,�. �Gy�fi+,` _ ..
I {may CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4;85)
1.°I o r t 4 I e Ie t 11_ I -r °w_® F= F=i r-4 e tl .'s t� iF ®'3 FE yl e
DEPARTMENT HEALTH AN ENS' rPON f4ENITHL OTEC TI v � L' `rTREET: FiN'FO i� RAAE ' AN'.. �a5C,1 , 0>7
264-4720,_
WELL FINCA I TE _ E4 If=1*: F:n°1=FRh1 I -T
PERMIT NO. c: cR42t_r ,}
APPLICANT KRIS Hr ISA 2115 COTTONWOOD 274-6•978
LOCATION _,STEAMBOAT
LEGAL L 1" ? TiT:` '= I'DE ',? ILLAGE LOT ' SIZE S1-74000 "SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM 'IS: DRHIN`FIELU
MAXIMUM NUMBER OF BEDROOMS 4 'SOIL RATING �SQ FT1BR ti- 287
THE REQUIRED SIZE OF THE SOIL ABSORPTIONd SYSTEM IS: _
/ dF=F T—r 1 -1 S�r_ziF;Nf=l 0E=9 E-eFF1' .r
THE LENGTH DIMENSIONd IS THE LENGTH (IN FEET) OF THE TRENCH OR DR:AINFIELD.
THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION <(IN FEET).
T"E 'T FR t< "4_-" t:- I E� T I-1 I =. 15:. C --r O C-71 F'E E T :
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN'THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET)
1 E ®=t e_1 I �� E C� =. E 1=' T I =�, T �Y t,# d•=` ,:. ,� 2 � � _ �'� �'-=e � �(L L %r t,l'�
PERMIT APPLICANT HAS THE RESFONdSiEILITY TO INdFORM THIS`DEPARTMENdT DURING "THE
INSTALLATION INSPECTIONaS OF ANY WELLS ADJACENT TO THIS` PROPERTY ANCA THE
NUMBER OF RESIDENdCES THAT THE WELL WILL SERVE. _.
MINIMUM DISTANIC:E BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM I
100 FEET FOR A PRIVATE WELL OR 150 'Till 200' FEET FROM A PUBLIC. -„'WELL DFPENDINaG
UPON THE TYPE OF PUBLIC WELL:
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND' CONSTRUC:TIONd DIAORAM`E ARE
AVAILABLE TO INSURE PROPER IYdSTALLATION.
1=' F= F_ rl I 'lf" E <: F' I t E E::::: E'PTE: E F;-:° . � L _ s;, _. —
I CERTIFY THAT
1.: I AN FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS ANC} WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE 'SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SY''TEM MAY REQUIRE ENLARGEMENT IF' THE'
RESIDENCE IS REMODELED TO' Ibb"LUDE MORE THAN 4'EEP..6OMS:`
SIGNED:' ----
- :----------
APP' A 4TnYRI_ HAS,R
ISSUEDBY_ B�?-ice/------------- a 5 -
-----C HTE-- --=�----_ 14. Ei
I N = P`E4=:?' I C.) P-4 . F=l f=.1='
.®`V9_9 I F^EEy
BACKFILLING OF
ANY
'SYSTEM WITHOUT FINAL INSPECTION ANG
APPR? (VAL` 5'7 THIS
DEPARTMENT WILL
BE
SUBJECT TO PR:OSECUTICiN:`""
MINIMUM DISTANIC:E BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM I
100 FEET FOR A PRIVATE WELL OR 150 'Till 200' FEET FROM A PUBLIC. -„'WELL DFPENDINaG
UPON THE TYPE OF PUBLIC WELL:
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 20 DAYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND' CONSTRUC:TIONd DIAORAM`E ARE
AVAILABLE TO INSURE PROPER IYdSTALLATION.
1=' F= F_ rl I 'lf" E <: F' I t E E::::: E'PTE: E F;-:° . � L _ s;, _. —
I CERTIFY THAT
1.: I AN FAMILIAR. WITH THE REQUIREMENTS FOR ON-SITE SEWERS ANC} WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
I WILL INSTALL THE 'SYSTEM IN ACCORDANCE WITH THE CODES.
3: I UNDERSTAND THAT THE ON-SITE SEWER SY''TEM MAY REQUIRE ENLARGEMENT IF' THE'
RESIDENCE IS REMODELED TO' Ibb"LUDE MORE THAN 4'EEP..6OMS:`
SIGNED:' ----
- :----------
APP' A 4TnYRI_ HAS,R
ISSUEDBY_ B�?-ice/------------- a 5 -
-----C HTE-- --=�----_ 14. Ei
too"% SOILS LOG
MUNICIPALITY OF ANCHORAGE PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
1, 1 11 TEST
ns L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: K S Hvsc, DATE PERFORMED: 5 18 83
LEGAL DESCRIPTION: M+- SI'Ae '*)ilX= Q 3 L Sec 33T,4111,17 -3w MON 11-63 OZy-
SLOPE SITE PLAN
#F S.1%
ee
2-
3- np
V JL
7-
'
-
13'
4.
4.
15-
16-
1 17-
1 18 -
1 19.
1 20-
6,,.n 5;lt
occasf�-� 5.N \
oim) wo 5'."kal s4j
1'�
rel WAS GROUND WATER S
(c; v\ 1r, ENCOUNTERED?' vio L
0
P
E
IF YES, AT WHAT
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
5/20
2 Iff
Sz
Z44
30
.28
•2q
244
311
30
39
to
-5'6
3LtLi
'30
- 46t
RATE
PERFORMED BY: C61"w �Ca,r ls-n 1'ns CERTIFIED BY: DATE:-
2 o E 2 sAcciS
• ALASKA 610ROIl nTAL COnTROL ZuiCCS, InC.
Engincerinq & Enuironmtatal Studies
PERCOLATION TEST DATA SHEET
CLIENT Kri S Fi BSc, DATE
ADDRESS
ZIP CODE
LEGAL LOCATION M+
TOTAL DEPTH OF HOLE ft.
ZONE TESTED �� /i Z ft TO f ft
READING #
CLOCK TIME
NET TIME
DEPTH TO
DATUM
NET DROP
RATE (min/in)
Z5�
—
2rs
3p
2, i3
3
—
Zyb
L ' 31
y3
�v?
'il
t
n
-5r
3 3r'
OF q ,%
3
Ar
y�:: •
'•• s
•'' '� 1/
FINAL PERCOLATION RATE
PERFORMED BY 9ev1
2
T,t 1 G,/OJ,-n1
S1,-fzf 2
........................
Leroy C. Reid Jr.
R �,?ROFES5I�N��r®
4--0wt t/ -L -N y , �_ 1
2 6 3 ,2 3 -Y-
$ 1200 West 33rd Aume. Sui h.P• Anchoragi Alaska 99503. (907) 276-1361
EPLRAIS
MUNICIPALITY OF ANCHORAGE
64);\)
Development Services Department
Phone: 907-343-7904
On-Site Water & Wastewater Section ` Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 020-172-20 Expiration Date:
1. GENERAL INFORMATION
Complete legal description MOUNTAINSIDE VILLAGE BLOCK 3, LOT 1
Location (site address) 17521 STEAMBOAT DRIVE,ANCHORAGE, AK 99516 —
Current property owner(s) MICHAEL&ALICIA COOK Day phone
Mailing address 17521 STEAMBOAT DRIVE, ANCHORAGEAK99516
Real estate agent Day phone
2. TYPE OF DWELLING:
❑ Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well ® Private Septic
Water Storage Holding Tank ❑
Community Well ❑ Community ❑
Public Water System- CI/ ❑ Public Sewer
7-0-elk,
Waiver request for: l0� K TD FLei Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ a► $� _ Waiver Fee $ _ 2 5
Date of Payment 40l ri1 i! Date of Payment 6/92 1/1
Receipt Number 3'-61 ,L10 Receipt Number 03 9 7 J..!
COSA# 5&C19I a39" Waiver# 0 5 V 0L0-1
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. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm ANDERSON CONSTRUCTION &ENGINEERING Phone 345-3377
Address 4661 SHOSHONI DRIVE,ANCHORAGE,AK 99516
Engineer's Printed Name MICHAEL N.ANDERSON,PE Date 6/14/2019
Comments:This investigation was completed in compliance with MOA guidelines,regulations, :4 `
and best industry practices/methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested.The flow and absorption rates may change4% Or Az \
due to subsurface conditions that may not be observed from the surface,changes in land use, • ....
local soil characteristics,groundwater levels that may fluctuate during the year,quality of Tc 1
construction(workmanship&materials),the water usage of the family being served by the C2 � h
system and maintenance. The operational life of all well and septic systems are subject to / * ;•/� 9 TH * /
these l an and dynamic eanyies and are how o the control of the evaluator ois the /�—r��'��
well and septic system. Therefore, estimate of how long a system will function satisfactory
for current or future occupants or guarantee that no unseen encroachments,deficiencies or
discrepancies exist can be given by FWPS and Anderson Construction&Engineering. ..MICHAEL N. ANDERSON
No. CE 9489 .. j
6. DSD IGNATURE \ .•• 6/1.4/1.9-•• . '/
System #1 Approved for t �ssto6N'
S
y pp bedrooms�� �1\;16:46:41..
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms, with the following stipulation
§,:„,
O "((firrfo �
i4,_y%.
W E SI TE o
WASTE ANU m^
WATR
P
mo RocRAM 0
.".1%
f„ISE RV CSS
")))))))))" )S
By: 1 (,/1. c: C.LC Original Certificate Date: Co _ 1 t
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA)based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA Checklist blue sheet
COSA Checklist
Legal Description: MOUNTAINSIDE VILLAGE BLOCK 3, LOT 1 Parcel ID: 020-172-20
If more than 1 septic system on lot: COSA Checklist#_of_ Structure served by this system
A. WELL DATA
® Well log is filed with Onsite (or attached) Water storage tank volume NA gallons
Date drilled 7/29/1985 Well disinfected for coliform test? ❑ Yes ® No
Total depth 250 ft ® Coliform bacteria is Negative
Cased to 49 ft Nitrate 2.94 mg/L 0 Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly Arsenic ug/L ® Arsenic less than MRL (ND)
Wires are properly protected
Fwf.s
Casing height (above ground) 18+ in. Collected by
Date of flow test for COSA 5/13/2019 Date of Sample 5/30/2019
Static water level at beginning of test Artesian Plug ft.
Well production at time of test 5.5+ gpm
Comments
B. TANK DATA—6/13/2019 - NEW AA. 15 30 C. LIFT STATION -NA
Age of tank(s) 0 years ❑ Required maintenance completed
Tank type/material SEPTIC /PLASTIC Age of lift station years
Measured operating fluid level in septic tank Lift station material
® Standpipes/foundation cleanout per record drawing Comments:
Date of pumping NA—NEW TANK
D. ABSORPTION FIELD DATA—2 X 26'L x 3'W x 6'ED—1.2 GPD/SF = 624 SF
Which system tested (date installed) 6/13/19 INSTALLED Adequacy test date NA - NEW SYSTEM
® ALL standpipes present per record drawing Results ❑Pass For_bedrooms
Total measured depth from grade 9+ft (max) Fluid depth prior to test in
Measured depth to pipe invert from grade 3+ft(min) Water added gal
❑ N/A—pressurized field
New depth in
® Monitor tubes go to bottom of effective. If not, state Elapsed time min
depth into effective
® Code-required soil cover over field Final fluid depth in
❑ System presoaked Absorption rate _gpd
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) N
date of test)
Gallons introduced gallons If yes, enter date
Comments/Deficiencies: rv4
rs
COSA Checklist copy.docx
E. SEPARATION DISTANCES— Per MOA record docs&observations 5117119.
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100'
® Yes if No ft ® Yes if No ft
Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft
Absorption Field on Lot> 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment> 50' ® Yes if No_ ft
® Yes if No ft
Manure/Animal Excreta Storage > 100'
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' ® Yes if No ft Wells on Adjacent Lots:
Property Line > 5' ® Yes if No ft Private Wells> 100' ® Yes if No ft
Absorption Field > 5' ® Yes if No ft
Water Main > 10' ® Yes if No ft
Community Wells > 200' ® Yes if No ft
Water Service Line > 10' Z Yes if No ft
If septic tank is under driveway comment below
Surface Water> 100' ® Yes if No ft
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below
Property Line> 10' Z Yes if No _ft Wells on Adjacent Lots:
Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ft
Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No ft
Surface Water> 100' ® Yes if No ft
F. ENGINEER'S COMMENTS
•
Albi:gh.N.Nu
z;\
r idly.� �F.....
G. ENGINEER'S CERTIFICATION ,�, '• ' . .rf1
I certify that I have determined through field inspections and review 11*'49TH"" .. * t
of Municipal records that the above systems are in conformance .
with MOA COSA guidelines in effect on this date.
MICHAEL N. ANDERSON.
No. CE 9469 /
COSA Checklist copy.docx 11\.... l9.1.9.
y#G�
per,,•_.... .
TRACT A
�J/P0, 20'SLOPE EASEMENT FOR
‹) TEMPORARY TURNAROUND
ti
50'CREEK MAINTENANCE EASEMENT
c...)4,, 47P
OOH /\ SS8°\' .- CENTERED ON CREEK THREAD
/ QO 25.0'z. ?4
\. 0
///:? p5 �. EXISTING CENTERLINE
�� 293 / OF CREEK
/ p. �"k?20, ��. N
/ ° 0 6 SSP \\ / \• ��
Et SSP -" EXISTING S�
�. a HOUSE 00,
0 ' ` I: SEE DETAIL •'.--___.
c4 93 3 25.0' `— 6
7—" 'P7
O % ROCK RETAINING _ __ 7, \
z ¢•GWALL S27°36'00"W 50.00'
LOT 2 `
P ,
LOT 1
7 SHED
-4. LOT 9
a
2B1 4
STY 05 pp^\N
LOT 8
�cti
4
‹,.0.04 ,‘‘.„ 92,
OF AC'''4
,c��'49TH iN �00 EXISTING
I • p `� HOUSE �ti`i'
CDiy. '� o
O°
STEVEN CALLAG-IAN 60 )Co' ,6• 6. 60,
Q4s, LS-12034 ..°p ,\c
OQPC1.9./.2,P,f g
rOjessionot,,.. K. 60.
%O�0000�o
?22 ryIV
NOTE:
THIS DRAWING SHALL NOT BE MODIFIED FOR USE
AS A PLOT PLAN WITHOUT THE EXPRESSED
WRITTEN CONSENT OF LCG LANTECH. HOUSE DETAIL
SCALE:1"=20'
ORDERED BY: BRENT WESTERN PARCEL#: 020-172-20-000 SURVEY CERT CATION LCO LANTECH INC HAS CONDUCTEDA VHYSICAL SURVEY OF
THE PROPERTY AS SHOWN ON THIS DRAWING AND CERTIFIES THAT THE
- IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO
LEGAL DESCRIPTION: ADDRESS: VISIBLE OR APPARENT ENCROACHMENTS EXIST OTHER THAN NOTED CR SHOWN.
AS-BUILT 17521 STEAMBOAT DR.
EXCLUSIONARY NOTE IT IS THE OWNERS RESPONSIBILITY TO DETERMINE THE
EXISTENCE OF ANY EASEMENTS.COVENANTS.RESTRICTIONS OR RIGHT-OF-WAY
LOT 1, BLOCK 3,
TAKINGS IAMICH DO NOT APPEAR ON THE RECORDED SUBDNISION PLAT UNDER NO
CIRCUMSTANCES SHOULD FOR
MOUNTAINSIDE VILLAGE ESTABLISHING PROPERTY LINES OR FOR PLOT.PLANY DATA HEREON BEE PD URPOSES CONSTRUCTION.FOR
250 EI Street LEGEND OverNong _ia
SEPTIC STANDPIPE •(x)SSP
Anchorage.Alaska 99301 \\wood oee!r Concrete•.
SEPTIC MANHOLE owl • _
• ''"JI.
�-�
WATER WELL FENCE X ;� -rick PPtli•
Surrey Department DRAWN DATE: 6/19/2019 ; WORK ORDER:19034
Phone 562-5291
Y�h Inc Mainline DRAWN BY: ADS PLAT: 79-177
�" �� Phone 243-8985 CHECKED BY: SC 1 GRID: SW3439
an.GLitectu4e• engirkee t ng•etewerying. AE:CC 668
SCALE: 1"=60' FB/PG:814/33 REF:2004L193A
Municipality of anchorage
-� Development Services Department -
Building Safety Division
On -Site Water & Wastewater Program
4700 B
P.O. Boxox 19 196650650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLINGA �/
Parcel I.D. 0%-0' l7Z-ZO COSA# HA O (0 11
1. GENERAL INFORMATION Expiration Date: D - 13 - 019
Complete legal description MOUNTAINSIDE VILLAGE: BLOCK 3. LOT 1
Location (site address) 17521 STEAMBOAT DRIVE "ANCHORAGE. AK 99516
Current Property owner(s) MARTY FOOT & VICKIE O'BRIAN Day phone
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
17521 STEAMBOAT DRIVE 'ANCHORAGE. AK 99516
Day phone
250-3485
JULIE ERICKSON W/ PRUDENTIAL Day phone 242-9282
3801 CENTERPOINT DRIVE #200 *ANCHORAGE, AK 99503
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
0
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 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 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. Phone 337-6179
Address 3701 E. TUDOR ROAD. SURE 101 . ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date E fa D 9
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough, ocOF �Q
conscientious engineering analysis of the system In accordance with ADEC and MOA poo q �Q
DSD Guidelines 8 Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the lest, and separation Q
distances measured to readily identifiable features. The operational lite of all wells and P" C')
septic systems depend on the local soils condition, groundwater levels that may Q• • • • • •?• • • • • • • • . • • • •p
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 • .. • �. �r • • • • • • • • • • • • • • •Q
results do not guarantee future performance of the system, nor do they guarantee that OQ 11Y mess.- QQ
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide Q1 C 7 53 `ROS
any warranty or future estimate of how long the system will continue to meet the OQ i�/'• 13 �o.9 vav
operational requirements of the ADEC or MOA DSD. The content of this report is for OQq°oprofe�g.o0oo=
the sole benefit of the owner listed above. Any reliance upon or use of this report by any Opp , 0
otherperson or party is not authorized, nor will it confer any legal right whatsoever, l ;
Y oF��ryc
S. DSD SIGNATURE
J�:•
Approved for bedrooms. ON-SITE
��`� : 1/JATER AND
Disapproved. WASTEWATER
PROGRAM '
Conditional approval for bedrooms, with the fllowing stipulations:%O ' , ••• ����
'rrll)I11))
Attachments: /
COSA Checklist (/ Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: Original Certificate Date: .� 13 — 0ej
(Rm 11N51
Municipality of Anchorage
Development Services Department _ _ ''_•
Building Safety Division
On -Site Water & Wastewater Program '
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
�
Legal Description: MOUNTAINSIDE VILLAGE S/D: BLOCK 3, LOT 1 Parcel ID: 020 �/ 7a *-_o
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES
Date completed 7/29/1985 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES
Total depth 250 ft. Cased to 49 'ft. Casing height (above ground) 12+ in.
Date of test
Static water level
FROM WELL LOG
7/29/1985
SURFACE LEVEL ft.
AT INSPECTION
5/1/09
24 ft.
Well production 3.5 __g P.M. 6.85 g,p,m,
WATER SAMPLE RESULTS:
Coliform 10 colonies/100 ml. Nitrate I. (O mg./L. Other bacteria O colonies/100 ml.
Arsenic:0.1Z sug./L. Date of sample: 7 3 uu 9 Collected by: GEG Ltd.
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/STEEL Date installed 8/1/1985
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 5/1/09 Pumper MCDONALD'S PUMPING
C. ABSORPTION FIELD DATA ow wsnNc cRA
Date installed 8/1/1995 Soil rating (g.p.d./ft'o /bdr 217 System type BED
Length 57 ft. 'Width 24 ft. Gravel below pipe 0.5 ft.
Total depth *3 92 ft. Eff. absorption area 1368 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 5/1/09 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test* DRYin. Water added 685 gal. New depth 6 in.
Elapsed Time: 120 min. Final fluid depth DRY in. Absorption rate >= 600+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
"USED MT1 FOR ADEQUACY TEST. THERE WAS 10" OF LIQUID IN MT2 PRIOR TO TEST, THE
LIQUID LEVEL IN THIS MONITORING TUBE DID NOT CHANGE THROUGH THE COURSE OF THE TEST
AND NO LIQUID WAS VISIBLE IN ANY CLEANOUT THROUGH OUT THE TEST.
D. LIFT STATION
Date installed
"Pump on" level at in.
E. SEPARATION DISTANCES
Size In gallons
'Pump off"
Manhole/Access
water alarm level at
Cycles tested Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/cleanout N/A
Holding tank
Animal containment areas 50'+ Manurelanimal 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
s 94'
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 rQ o 9 T �e
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date. O fr A. Gorn s.:
Engineer's Printed Name JEFFREY A. GARNESS QO 4 s C FG
4i /
Date n O71Prof Ol Siote4o
COSA Fee a 4 4 0 ou
Date of Payment s 111 D i
Receipt Number oti�7 7777
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
W.
Z
LOT 2
e
qo
NI
rn
o.
6j
TRACT A
LOT 1
.251.14
15 00 W
LOT 8
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gl+yigGll. Dr.y-
, •ti^•'•., LS -10792 :•ti
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AUGUST 31. 2001 ADDED / SEPTIC CIEANCUTS
LEGEND: SE ENO
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UN
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.
ENIXN'ERS
WT6�
AS -BUILT OF: LU pvsvwlot 4� -
561-6522968 ,
LOT 1, BLOCK 3,
MOUNTAINSIDE VILLAGE
SUBD
991.!77
86.66 96•911 $g.78 p6.8Y
0 0 0 0
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ANALYTICA
GROUP
Gamess Engineering Group, Ltd.
Attn: Jody GEG, Ltd.
3701 E Tudor Road, Suite 101
Anchorage, AK 99507
907-337-6179
Fax: 907-338-3246
Client Sample ID: Mountainside Village
Sampling Location: 44-W G3 L.
Client Project: Private Well Testing
Sample Matrix: Aqueous
COC #:
PWS#:
Residual Chlorine:
Comments:
Lab#: A0904072-OIA
SP-Analytica, Inc. -Anchorage
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date:
4212009
Receipt Date:
4n2009
Sample Date:
4nn009
Sample Time:
2:00:OOPM
Collected By:
KM
Flat! Definitions:
MRL = Method Reporting Limit
MCL= Maximum Contaminant Limit
B = Present also in Method Blank
H = Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = Lost to Dilution
r• = RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
4500-NO3E (Aqueous) - Nitrate+Nitrite pres Test was conducted by: Analytica - Anchorage
Nitrate -Nitrite as Nitrogen 1.60 mgtL 1.3 /0 4/1620()9 4/162009 JQ
Lab#: A0904072-0IB
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
9223B -PA (Aqueous) - Coliforms in DW Test was conducted by: Analytica - Anchorage
E. Coli Pass PASSIFAIL 1.0 1 4/72009 4/72009 DL
Total Coliform Pass PASS/FAIL 1.0 1 4n/2009 4!1/2009 DL
Lab#: A0904072 -OIC
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
2330B (Aqueous) - Langelier Index Test was conducted by: Analytica - Anchorage
Langelicr Index/Corrosivity -0.18 C Units -1.0 4/17/2009 4/17/2009 JQ
2320B/2320B (Aqueous) -Total Alkalinity Test was conducted by: Analytica - Anchorage
Alkalinity, Total 82.5 mg/L 4.0 2320B 4/132009 4/13/2009 JQ
CaCO3
4500 -11 -B/4500 -H -B (Aqueous) - pH
Page 3 of 5
Test was conducted by: Analytica - Anchorage
ANALYTICA
CROUP
Gamess Engineering Group, Ltd.
Ann: Jody GEG, Ltd.
3701 E Tudor Road, Suite 101
Anchorage, AK 99507
907-337-6179
Fax: 907-338-3246
Client Sample ID:
Mountainside Village
Sampling Location:
BItJ t3 3 L I
Client Project:
Private Well Testing
Sample Matrix:
Aqueous
COC #:
KSI
PWS#:
Test was conducted by. Ana7ytica - Anchorage
Residual Chlorine:
pH
Comments:
4500-11-64x72009 4!72009 IQ
SP-Analytica, Inc. -Anchorage
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907-258-2155
Fax: 907-258-6634
Report Date:
4212009
Receipt Date:
4/72009
Sample Date:
4!72009
Sample Time:
2:OO:OOPM
Collected By:
KSI
Flamm Definitions:
MRL = Method Reporting Limit
MCL = Maximum Contaminant Limit
B = Present also in Method Blank
H = Exceeds Regulatory Limit
M = Matrix Interference
J = Estimated Value
D = L.ost to Dilution
•• = RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Analysis Method
Prep Prep Analysis
Parameter Result
Units
Flags MRL
MCL Method Date Date Analyst
4500 -H -B/4500 -H -B (Aqueous) - pH
Test was conducted by. Ana7ytica - Anchorage
pH 7.9
pH
0.0
4500-11-64x72009 4!72009 IQ
2540W540C (Aqueous) - TDS
Test was conducted by: Ana7ytica - Anchorage
Total Dissolved Solids 126
mg/L
20
Soo 2540C 4/132009 4/132009 JQ
Lab#: A0904072-0ID
Analysis Method
Prep Prep Analysis
Parameter Result
Units
Flags MRL
MCL Method Date Date Analyst
2340132340B (Aqueous) - Total Hardness
Test was conducted by: Anafytica - Thornton
Hardness, Total 100
mg/L
1.0
2340B 4/152009 4/152009 RM
2(10.7200.7 (Aqueous) - Family Well Water III
Test was conducted by: Anafytica - Thornton
Calcium 32.7
mg/L
0.10
200.7 4/142009 4/142009 RM
Iron 0.0814
mg/L
0.050
0.3 200.7 4/142009 4/142009 RM
Magnesium 5.64
mg/L
0.10
200.7 4/142009 4/142009 RM
Manganese <MRL
mg/L
0.0100
0.05 200.7 4/142009 4/142009 RM
Sodium 3.99
mg/L
3.0
200.7 4/142009 4/142009 RM
200.8200.8 (Aqueous) - Family Well Water (All
Test was conducted by: Ana7ytica - 77iornton
Arsenic 0.225
ug/L
0.15
JO 200.8 4/142009 4/142009 GY
Page 4 of 5
ANALYTICA
GROUP
Gamess Engineering Group, Ltd.
Attn: Jody GEG, Ltd.
3701 E Tudor Road, Suite 101
Anchorage, AK 99507
907-337-6179
Fax: 907-338-3246
Client Sample ID: Mountainside Villa e
Sampling Location: Ell 1A-
Client Project: Private Well Testing
Sample Matrix: Aqueous
COC #:
PWS#:
Residual Chlorine:
Comments:
Lab#: A0904072 -02A
Sample Conunent: Mountainside Village
SP-Analytica, Inc. -Anchorage
4307 Arctic Blvd.
Anchorage, AK 99503
Phone: 907.258.2155
Fax: 907-258-6634
Report Date:
4212009
Receipt Date:
4/72009
Sample Date:
4/72009
Sample Time:
2:00:OOPM
Collected By:
KM
Flae Definitions:
MRL = Method Reporting Limit
MCL= Maximum Contaminant Limit
B = Present also in Method Blank
It = Exceeds Regulatory Limit
M = Matrix Interference
1= Estimated Value
D = Lost to Dilution
** = RL higher than MCL; target not detected
TNC = Too Numerous to Count - result rejected
CF = Confluent Growth - result rejected
TCNG = Turbid Culture No Growth - rejected
Analysis Method Prep Prep Analysis
Parameter Result Units Flags MRL MCL Method Date Date Analyst
00.82W.8 (Aqueous) - Pb Cu Flush Test was conducted by. Analytica - 771omton
Copper 242 ug/L 0.10 1300 200.8 4/152009 4/152009 GY
Lead 6.84 ug/L 0.10 15 200.8 4/152009 4/152009 GY
Page 5 of 5
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water & Wastewater Program
4700 South Bragaw, St.
P.O. Box 196650 Anchorage, AK 99519-6650`
www.d.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 020-172-20 HAA# ki 1) 0 r ��
1. GENERAL INFORMATION Expiration Date: I
Complete legal description MOCJNTAI'r�SI`D'E'yIL"(AGE SUBDIV 510BLOCK
Location (site address or directions) 17521 STEAMBOAT DRIVE
Current Property owner(s) FRANK LEMON Day phone 247-6564
Mailing address
Lending agency
Mailing address
17521 STEAMBOAT DRIVE
Real Estate Agent
Mailing address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
Individual Well
.
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
B
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority
Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer
of title (except between spouses) 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 less than 30 days old. (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 isnot 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, 1 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. 1 further verify that based on the
information obtained from the Municipality of Anchorage tiles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 26 * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, AWWC, Inc. 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. AWWC, Inc. 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
_1Z Approved for 4 bedrooms.
Disapproved.
Phone 337-6179
Date tO O )
Conditional approval for bedrooms, with the flowing stipulations:
ON SITE "
WATER AND
PROGRADE
Attachments:
HAA Checklist Manitenance Agreements
Supplemental Engineer's Reort
Septic System Advisory
Well Flow Advisory Other
Original Certificate Date:
By:
(Rev.'I=0)
munic
Developer
orl. prpvi e
Sanitani caval`/V/A3\�YFS"' `
y
O
,fJd x
LLC i^VI ITT "
_ ole/A
sem" in.
in. High water alarm level at
w`FSLa"3.,x uhl.r..A"M. bsr>.a
ROM WELL ON TOT TO:� R
1'00+ On adjkentlots` ...,.._.,. 7
C7
z.lraa";;;':;t i?1 ea'w`-';t,.,,,,•e:x,
Property line + Absorptinonjfield
Water service, 'line�10 + Surface water 100 +
5'+
r�
and
��..
spections
items are in p" D
ct on this date D .. .. ....
fr Go ess
GRS Q 7953 O�
A
e
4 ey o fes510� o�
4iuN.x:"w� Pr"+i..b�ro...yE
Y Je
Waiver Fee
Date of Payment
Receipt Number
Oct -04-2001 08:17am From -B P +970-247-6825 T-112 P.001/004 F-009
Date: October 4, 2001
From: Frank L. Lemon
Tel. (970) 247-6864
Fax: (970) 247-6825
To: Jeff Crarness
Alaska Water and wastewater Consultants
Tel. (907) 337-6179
Fax: (907) 338-3246
Pages: Cover + 3
Subject: Well and Septic System Test Report letter from Steve Panone performed on the
17521 Steamboat Drive well — Frank and Jackie Lemon's property.
Jeff,
Following this cover please find the letter describing the well flow rate that you need.
Thanks
Frank Lemon
Oct -04-2001 08:17am From -S P +970-247-6825
WWI c WHf 9ypNC � bilC
I+CNE No. :272 sale
Pannone EnglnemiV S'erV1Ces, LLC
September 5, 200I
U.B.In�pect aWt Laskey
s
3650 Coarwd ParkWq Suite 100
Chantilly, VA 201$I.3Ia9
subject: 17521 Steamboat Sgrin„s
Job No.lOSOSSD
Well S. SOPO; 89etem inspection
Dear Ms. LUckey:
T-112 P-002/004 F-009
7133293MM P. ".?
Sep- M 2001 e9:15PM P2
Ras'ka, 99510
PasiilotlC Estgsneerisig Seivicea (1'E8);firmed a well acid
and tela $t rhe abyve � 1ayP�rb' 1Wx your mgtiest dated. Aui;ust i6 ap�p�1. � Mica
�'�+ show tha�� Ges dfeiiitl+t, while the we>J worldag rdegtitately, Tru
is a detailed de
QT as wall as test ptacedurev sod the htvestJga, wblah will p3ovlda bacic�„fo�
gid
itOer'ngnd test
ofthe sjMM w we yet 15, 2001 to parfo:m an adequacy
tigatioa and test of the
MO o,AtIchorthataparbaot the
ns of DevdopmaAt Seepiy it the t Section (1�OAJ. The
Au + ggloae Par, minute sad gybed iYPa septic Samd b artasisa wclj that was able to produce
gUat of 198&. ay vrith a 1,260 -gallon aegtio tank inetailed in
Teslas Mutasy. rad Ptoeed e
AM kic t e ctedmr the Owner of3lot arui aesdoged fora Lest on �1dgj,. �un 17) Z0Q1 At 11:00
tttor and The hair'owaa wJf0 seeded to be at the boUse to jet our tsch W la into a pact.
t(Me.locked i'onoed yard canlgining d,�, A PU "chnL-
time. * ba was up one home whM the jgn arrived at the property at the sabeduled
lstiinute� bscbre leaving the tkuyawrJo sulived. we waited !or apProrrimately 30
iba• another fob.
contacted
23, 20Oaz1nWhen the pthe Owner of this ve and afte, he as ltlspeetion for Thursday Auguet
gates to the kneed arca. The dogs do� arrived oa sift, the Owners wife �s them and OWiled the
eleea-outs and two omni xu'o to allow us to penbrm the teat We found seven
10 inches and 24 tttlxs conn to this bed system. rhe two monitor cubes sjaowed
the mquitrnd amount per ASO paras. h, put 300 &%now of water into the eysteta (half of
and %* jYtcbas in the 1"aw uawsJ. The eco l Pose two inches is the mwftr tube
pipos of the field. The test was halted at thia poiaL The p8a
tah3Ce the 0hn,� issditated to the Owner that the 1�� needed to come Out and look at this sys�eal,
would be xV to was yip i� the lateral PiPes, Rhe technician informed the Owner that I
discoveredthe FgY aticxnooa to look at the
the creek was locamd only 99 lkec ft orp the dswat em� In addition the teehA lciaa
eeparatton distance unless ward), ain$e1d (the
MGA reiluiree t 00406t
The Owner raquested that old bfcrjQ aids ptunpiag corse GUt to his property' and pump hie
�r
Oct 04-2001 08:17am From -S P +870-247-6825 T-112 P.003/004 F-009
FRfIq : PA%Nj)NE ENG SW PhiONE Np, 272 ezae 703293%570 P.04/07
sem,, es 20131 09:26pM p3Ma, Margaret Luckey
2 SVt=ber 5, 2001
FbVftPbc tan$ and drain ,field On Fr'd1%y August 24, 2001, which they did.
I asrivad at the PmPWW on
that the �tla cask oras Pum pry and r a4, sao7 1" s�ppeo�asey s:oo rr�.
PU=Ped. I sound ten iue and seven lncbe* evidence of the %1d 1>avlag P I lbatad
raquosted that I check ft $eld for level and fns tfie in tlue trvo monatos tubes. Tl,.�6n Owner
GPM
i ®d a survey using a hand level. The * ivey a boa d thatUW= the r tatetal
n ancbcs uigmvel under the latecnl
a half inch in mosr Cans, with a Pape and tbmt the la %tad hau to
milt bis =Ord doo=ents 5� moi° Muu1 of one inch Out OafjeeveL � �r cam' level (whbin
recordnted us
waiver docuaaMta were not an filo with t ���� the house is SePtetetbar of 1999, Tkese
betweS$egua4' Y Hca �tthe crerk10 aysteMUL Me and showed the W -U= Passied an
that tl�c coq 3escttsd a
ted to L A Owner that sluice he Dumped the "ptie
L=k =d OcId that it
�chedtgor work Y Detfe�med and that ft would z to e0yast the sYaaem. We
2001, luta to repua to the house to Perform the tsar ass ltdonday August 27,
on M1=dO August 27 2001 two
ppned, F1sat PE9,s
to amfm= the retest and . things ba techaiaaA a
ked. Tbc technician sled OM d Haat ao one was borne. The +sd at rhe psoger4Y
another job. The aPpsmamately 30 aainutea ai: rho per b�tbta o the ceC area was
celled sae to request Haat T mat hc+ppeaed was that Mr. cnp„aui P'loaes otyaur�Co�m to
COnt$Cropd the l;aelocatiatt Abe 7 the teetiLtg of tj]ihS �}'atEia. T(3C ownex �d
teChtuciau performs test t comactut throe that he was no eoatltirufahle witht having
'Wa
�JO ednead�y Au$uat a9, zo01. Owwaer sad scltstiuled the nest on
PES arslved on site at the scbeduled taasa and was tet into the fenced ansa. We found tine septic
tank 18 3400 *were Tb' redry W m t 4016o0and six inches oiI%Wd .in the fields tauzIdOnttt g11,es
II Tho lataral
'=, I toed the Water l3�ris of watt's ilrOan the well int%* the drain Field. We
r �Ws rashes as 6 ap the tno niter tubes. lateral PIPM and ibe
% pipe latergi rosWatgr e three ar raoa with tba addition of the vrattank �es. T�hee�els in
the u two check the wa�� le a°S mtattu 7 9ettmMed the owner t6et I wild serum
PDOAS n to Myra, tp thrddrr OrWn d hours, Them � = ufts tthe `�n absorb Iso
\q a deptls Pis, thew
aftrUveb
S the T%=3 obae August 30% I rsttuncd to this
TMimS 3UV acdan*, The water depth � fes' I checked inch
&wish
oilag 8ato{y 300 gallons of ovate:). The Ped Ona itieli is 24 Owsaeg
dry' and brio loads of disbes, a* well as the owner wed ma ibis wife did three load*
meow code bad allowa forthese things and a a' few showers. I ftf %wd e�
�bmpect the Veto= the foIlovslag
i rgturnad trs the pr aperV oaa August
hscro
levh ya ai , with t he pw� o l� a0e0I�&Pte' t 7:00 aaa. I checked the water
%sad that thebaL
ho ted thewkad ti Vteos v=� ag erste,
dyu'e= was '� t3aUona to a4 boyars.
Oct -04-2001 08:18am From -B P
FRCM : PAWME ENG SUC
Ms. Margaret Luckey
Pap
September 5, 2001
COGGIOdow
+970-247-6825
PR>Z NO. : M 8218
T-112 P.004/004 F-009
7032931579) P. 05,07
4P. 26 2083 89:17FM P6
This aePrIC- 9Yst= dove a0e meat the code cad
4xttof Dmva1 oP tronal TNWMO=b ofthe M.,dpatity of
f dtis PMP meets sbs MO SPS u+eats for a Snnr.� SOOtim fr fftr (4) bednuam hc, a well
eontaip rw 6aotQri� attd 1.82 rqO ofnitrates. ase tde watervrna tested and
Inof$yP�he eaao8 an *a' �=>& vide a'th4l0ugh, conacientiow e+rgineeril� avalysis of rho
31"" g rv"h OA CWd lrt R%Ul ti0as. Thm
Ygm nndcr the conditions wowftmd at the time o?the Ws d ` mi stParteW esdmscrtbe tqe clysis mance
readily identifiable .The operational life 4rFaU wells and 39Paration distances measured to
waditioq, ground watee levels that may flucpratco Systems deycnd on the local soil
served by tete system These conditions ani outside uftthe *6 year, zmd the wow �p of ft family �B
ofthis report
la for dse sok benefit of tha outs apt the rags control ofthe ayslvator oftws system. The aacroat
Whatsoever, Or we
af,O rePOrt by sihY outer Person a part' is not roMW rized nor0lIds�er . ny reliance
Y Sal right
Pleasee contact ,ore ar 272-8218 or 227.3522 if you have any gtaeatioaa.
sincerely,
0:\>�0tlrarrsROir-9A}rBtpIDV:LLnG&.001.00C —-- —
3
...ern..
3
SOS- Coe
9141
C dd 9
5. STATEME?
ien'in
slues Health Authority
ve by an,indepen&nt
to purchasers of homes
Aoyees of DHHS do not
00
Municipality of Anchorage SEP 10 1999
DEPARTMENT OF F{EALTH & HUMAN SE'RVICEyFMUINIarv.mOFA ,
EnvironmentalServices Division,.` EWMIONMENrAi.seevI
825 L Street, Room 50� •anchorage, Alaska 99501, (907) 343 474'
1.
ea u orl y app ora hec'c�si
carp wni � i � ;Parcel I �::
a „�.�:` �, .ry .�... �,.. ..•. -y°- .t�.p -us °v'tiy -`� � Skf ;.�rxt i`4
aern � '� � � � '� Date completed 9 85"
d Cased to 49' Casing height (abode ground) 12 +
sea Wires properly protected (Y/
x�
29 85 mea.,.:
tg
e5 $/25I�99
der leve. � R
m.
P e
samp e:�- s Coilected by: '
A 4�
to ed �1 5 " an srze um er oC�`ompartrnerns � C eano�s
wn c eanop , - egression � ig wa era arm � N
umping 2 um er 'A+ Ii0 C
. _ �, '� ` n � !ALL,.QLEAN-0Ui5 WERE'D'RY". THROUGJ{00T THE 7E5,f
to I t 85 " foil rating g p..%ftz or rmj 1 System type e`"�
Width 4' �� � Gravel thiokness belQiv-pipe � � r'6 �To a deg �" "` 54'
a, sor ion a ea t3 ondonng u epresen epressio over ie
an
or oo s
� eq�racy es ° 25 99 Resutfs Pas ' ail �'$ bedrooms
p n a ,Sorg ion ie befo,e . es n.); . •s o mine ate y aft& 000 gal wafer added (m) US 73 s
Mum
"'D (ins mutes a er sorp ion ra a
reatme pa mont s / I if yes give date
- r
ma'x�� rRffl& ` � i
.rntrs ta'tS`mm�;W""� st ..i»;7" s:-'c_�*u"�•sa'.,
Srzervma to p
°Pu eve] at' N Pum off' level at
:-.
'Datum
Public sewer
+ I iN atatinn w/„
0
NUNS KNUWN
evens on aajaceni iots ivy T'
i a de a fi
d inspections and review of Municipal rec h tems are
with A r idel nes in effect on this date.
JEFFREY A.
GARNESS ... r ..
�e.
—7853O�U77
�O
a•
fe^•�•
... .....• oAe�..
$ P}'t
¢OGY.^�. Aw n�,:. 4���
as`�N ✓ n.. ... Yta��
de,*�+U.+n.;"N�°.�'[u^.".�!'i;��°^M' S x�,u""i,€'titx t ,Y ��;
<�
Waiver Fee $ �2t�
4 .V#Yr°'1dA .• ..+—en..w... .. a....+u m»..uw.rm.. �.rvN.-.m s:.
Date of Payment
-r�✓t�
`J
�1����
Receipt Number %%
�. �evivyy;
A. 47a£er"'�'a�Ie
B. Soil` 5o prion
C.'Permeability�
D .' "Water'" fiaSTe" Grath"ent
E. Horizontal Separation
TOTAt
a
-. •> ALG -23-1999 a9 57 TOP REMAN AGENTS
907 276 1524 P.01
6
20' SLOPE EASEMENT FOR
4
50' CREEK MAINTENANCE EASEMENT
CENTERED ON CREEK THREAD
EXISTING CENTERLINE
�e
nO
SE nb' L II
1%t6A
W000 RETAINING
WALLS
LC? 1
2�1�a
S 3
o5 p0r w
7:� 49TH •'•�
. a
nneth LDreyer-' o`
sr•'• LS -8202 ✓' �oj0
W*r
iortoeeeo en - "CLUSION NOTES: R is the ewnerS' responsibtlRy� to tletarm'ne LEGEND: SET F,'ND
C A R O L. E3 l,.,1 'T { the existence of any ememerts covenants or res ctions s(a•Re w/CARrS� s/e• Re Q
with
which do net appear an the r4corJo 0vbdiAaian plot NOTE �d gy N NON. yy, MONUMENY
y or HUD & TACK C
/VAX PRnPFRT FS tlndv ne tiraumetoneM alloula ary dotn Hereon ba usee t
... .......... . __
NOHOW ccnetruction or for establiehinq property lines.
r
SURVEY CERTIPICf chi:this LANTECH
cpwty
moonphysical survey Of this plODerty C
drawing 9nd that the improvemen
LAINIZIFIR SURV YO 5-PLANNERS-EVCINEERS AS -BUILT OF-; LECAL I
440 WEST BENSON 41V0. #103 (fax) 561-6628] ^�/
ANCHORAGE, ALASKA 995C3 (907) 562�N719m!'M177
5297 LOT 1 BLOCK
WgRx ORDER NUN ER: WII:
wax'.. fIL 27, 1998f=60' MOUNTAINSIDE
99-t" 437A°"" av:cxtaco aD. L 3439
WOOD OECxS-
STANDPIPES-
3,
VILLAGE SUBD
Municipality of Anchorage
Department of Health and Human Services
825 "L" Street
Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
http://www.ci.anchorage.ak.us
September 17, 1999
Jeff Garness, PE
Alaska Water & Wastewater Consultants, Inc.
6901 De Barr Road, Suite 213
Anchorage, Alaska 99504
Subject: Waiver Request for Lot 1 Block 3 Mountainside Village Subdivision
Waiver Request #WR990070
Parcel ID #020-172-20
HA990458
Dear Mr Garness:
Your request for a waiver of the required 100 feet horizontal separation from the
absorption field to surface water has been approved. The approved separation distance is
94 feet.
This waiver approval applies to the existing absorption field to surface water separation
only. Any future upgrade to the on-site wastewater disposal system will require all
separation distances be met or another approval from this department.
If there are any further concerns or questions regarding this waiver, please call our office
at 343-4744.
Sincerely,
a;;/- � r --;Ir
Daniel J. Roth
Civil Engineer
On -Site Water Quality Program
Alaska Water & Wastewater Consultants, Inc.
6901 Debarr Rd., Suite 2B - Anchorage — Alaska 99504
Phone (907) 337-6179 — Fax (907) 335-3246
September 8, 1999
Municipality of Anchorage
Department of Health & Human Services
On -Site Services Section
Attn: Dan Roth
P.O. Box 196650
Anchorage, Alaska 99519-6650
REFERENCE: Waiver of Separation Distance from Septic Absorption Field to Surface
Water for Lot 1; Block 3; Mountainside Village
Dear Mr. Roth,
The referenced property has a 4 bedroom house served by a private well and private septic
system. During our recent well and septic evaluation for purposes of obtaining a Health Authority
Approval, we determined the separation distance between the leachfield and the creek is only 97
feet to the cleanout located at the northwest end of the bed (approximately 94.5 feet to the edge
of the bed).
Request you issue a waiver for the separation distance from the leachfield to the creek to 94 feet.
Enclosed is an asbuilt survey, site plan and a topography drawing of the property. Given the fact
that any surfacing effluent will run perpendicular to the slope contours, it can be assumed that the
wastewater would flow at a path almost directly north. Such a path would be over 100 feet
before effluent reached the creek. The ground from the trench to the creek is moderately
vegetated, and would provide some filtration should effluent surface. In order to reach the creek,
surfacing effluent would have to cross the driveway, alerting the homeowner to the problem
Based upon my evaluation of the site, and the potential risk for contamination, it is my
recommendation that the separation distance from the trench to the surface water be waived from
100 feet to 94 feet.
If you have any
JAG/gd
tse contact us at 337-6179. Thank you for your assistance.
-
-
-
TRACT B
CAA
C^�&
VLOT 2, BLOCK 3
MOUNTAINSIDE VILLAGE S/D
\ LOT 9, BLOCK 3
y \ MOUNTAINSIDE VILLAGE S/D
MW
Uy'
�7 \ LOT 8, BLOCK 3
MOUNTAINSIDE VILLAGE S/D
mw \MN
o
� LOT 7, BLOCK 3 ,---'
MOUNTAINSIDE VILLAGE S/D \ \ k,OUNT�NSIDf VILLAGE
ALASKA WATER AND WASTEWATER CONSULTANTS, INC. 0000�000
6901 DEBARR ROAD. SUITE 2B. ANCHORAGE, AK. 99504 p 440
PHONE: (907) 337-6179/FAX: (907) 338-3246 .
LEGAL DESCRIPTION:
•.� O
MOUNTAINSIDE VILLAGE SUBDIVISION; LOT 1, BLOCK 3 * -
TYPE OF WORK: .... ,.
SITE PLAN
TONI TADOLINI (907) 263-3720/7458684 �Q�{''•,
E: DRAWN BY: SCALE: PAGE: D�Oaa P�ofesslo�o\��o
9/8/99 K.D.W. 1 = 100 1 OF 1 �Z"&=�
`HUG -23-1999 09:57 TOP REMPk AGENTS 987 276 1584 P.O!
O
r�0%
SLOPE EASEMENT FOR
50' CREEK MAINTENANCE EASEMENT
CENTERED ON CREEK THREAD
.2o,
r �g
EXISTING CENTERLINE
OF CREEK
t
r
`tttt O EXISTING
t O HOUSE 1b' i tt
tvr
6 t
CP tt B3 3 ry WOOD RETAINING �
t WALlS �\
2 1 O
45
�t1
9
O. u+tt
L07 1
I
M w
5 �3ot0o
8..��.� �--
nna
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9a�s US—b202 ;' i��
tre rc�,
�.i•iu•mui•riri•1•u•vri�r•i�
4earooms.
6 E
cowing supuiations.
mAaq
ter"dis osal
Repairs 4to be
i
4GF
r APR..1.7 199
ipality of Anchorage
=„ HEALTH & HUMAN SERVICES
nantal Qarvlrac nivicinn
'i� f•ttVM VVCLL LVIa FSI Irvar�vl IVIS
w
�a'ur�e -e- �uitGdG �
qr ":4 'ti `^Y• #' S" M#H HY^ di` 'W.u+•5: Tb'MY'yp""o-vip4N+kpS'^b`,^lkl
a2.+�5a+Y:".
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win��//
GlJe�/s�w�
Nitrate-N� z Other bacteria
>.y�i �Ij
7 Collected by: vu
AN'�ATX
27 NM
f/N) 11Depression High water alarm (Y/N)
�imr?s'��'�ww3�.'S.•"T�'v�TM�'r'C,wn9'�W�umznFr a-xnreu..kz�¢�j�
/0 9G Pumper f serdlGe-5
�� Soihratmg (g p d /ft2 or ft%bdrm) 2! 7 System type � �
.'aCw ��� .,�w�,, na, Y-. .� a ,• :ger .f �R ,�"Ta.r. � � •_ r..�. _,• /
_KVidth Z �/ Gravel thtci�ness below pipe � Total depth sy
�a n,�£,v w -"`3s. a�--n'r+ PEXxEs*3•�i. "`s"'�`p�y'`". ,�a x....ai `�fiR""YI"'.'.... .�. ., x x, s "'Y",q
re a . ��z Monitoring Tube presenepression over fiield'(Y/N) may_
�7 Results (Pass/Fa l) has 5 For bedrooms
�97
�''s:�'� � s.... ����� 1:��. `7J � � f... ...liad.h• eRst �/)YS nil umic� orlrinAfin A • �S
G IfIVI ELI IJ`P kIA IIV)
Size in gallons
/N) "Pump on" level at* "Pump off" level at*
vel at* *Datum
rANCES
A%10ES'FNO,OWELL0N'LOT T11 O
KND ENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
April 16, 1997
Municipality of Anchorage
Dept. of Health & Human Services
On -Site Services Section
P. O. Box 196650
Anchorage, Alaska 99519-6650
Subject: Mountainside Village Block 3, Lot 1
Gentlemen:
Following a request from the owner, we conducted an adequacy test on the existing
septic system for the subject property. We found several deficiencies with the system, as
delineated in the attached report, which must be repaired to meet municipal
requirements for the issuance of a HAA. However, we are requesting a Conditional
Health Authority Approval (CHAA) be issued at this time.
Due to the site conditions of this property and access to it, I recommended escrowing
the necessary funds for construction pending completion of the repairs in the spring or
as soon as the frost has left the ground. The existing septic system, although not in
compliance with municipal regulations, is operational, does not pose a safety or health
risk to the public and should meet the needs of the owners until repairs to the system
can be completed in the spring.
If you have any questions, please contact me at 696-6111/FAX 696-8111.
Respectfully submitted,
XHD Engineering
M. Duffus P.E.I�
Kenneth
.:i
attachments: KND Septic Adequacy Report
MOA Health Authority Checklist
MDENGINEERING
20441 PTARMIGAN BLVD.
EAGLE RIVER, AK 99577-8736
SEPTIC SYSTEM ADEQUACY TEST
Date:
April 5,1997
Legal:
Mountainside Village, Block 3, Lot 1
Location:
17540 Steamboat Drive, Anchorage, AK
Owner:
Robert Allen
Address:
Residence: 4 bedroom single family
Well: On-site single family
Septic System: Record Source:
Tank Size:
Absorption System:
Absorption Area:
Gravel Under Pipe:
Soil Rating:
Installation Date:
Waivers Granted:
Previous Inspection Date(s)
MOA/ DHHS
1250 gallons
Bed
1224 Sq. Ft.
Rec - 6" /Fnd-12"
217 Sq.Ft. /Bdrm. or 21 min. /inch
8/1/85
None
8/89,9/92
Last Pumping (Date/Service): 6/18/96, A+ Services
Date this Test: 3/27/97
Test Procedure: The system was inspected and measurements were taken of the various
components. The system was covered with approximately 18" of snow and the owner
had exposed 2 monitoring tubes and the 2 tank cleanouts. The tank was not pumped at
the time of inspection. There were no cleanouts found in the field. Elevation shots were
taken of the ground, top of pipe, and the bottom of the monitoring tubes.
Approximately 8" of effluent was found in the center monitoring tube and the outside
tube was dry. The tank has approximately 6' of cover and the cover over the field varies
from 1' to 3'.
Over 600 gallons of water from the hose bib on the west side of the house were injected
into the system through the center monitoring tube. The water level in the tank
remained stable while the water in the center monitoring tube rose to 9.5" and the
outside monitoring tube rose to 7.25". The maximum levels began to drop off prior to
the end of the test. Following cessation of water flow to the system, the water levels in
the monitoring tubes continued to drop. After 24 hours the water had dropped to its
pre-test levels. _
Due to the discrepancies in the water levels between the two monitoring tubes and the
lack of cleanouts, we recommended that the system be excavated to determine the level
of effluent in the field in relationship to the pipes. Three holes were excavated mi the
field. Hole #1 was dug adjacent to the tank, Hole #2 adjacent to the center monitoring
SEPTIC SYSTEM ADEQUACY TEST
Mountainside Village, Block 3, Lot 1
April 5,1997
page 2 of 2
tube and Hole #3 adjacent to the outside monitoring tube. The pipe elevations at all
three locations were approximately the same. Effluent was found approximately 34"
below the lateral pipe at the center monitoring tube with no effluent at the outside
monitoring tube. The southeast lateral was crushed and had been for some time,
thereby inhibiting the distribution of effluent in the field. There was fabric over the
system at Hole #1 and #2 but no insulation. There was 4" of insulation at Hole #3 but no
fabric. A grass root mat was forming within the gravel around the pipes in Hole #3.
Due to the amount of frozen material excavated and the lack of adequate ground cover
it appears reasonable to assume that a portion of the field may be frozen thereby
creating the water level differences between the two monitoring tubes. In addition,
significant quantities of solids were found in some of the pipes.
Test Results: Although the system absorbed the required water the following items
should be corrected to bring this system into compliance with code.
1) Repair the crushed lateral.
2) Install cleanouts as illustrated on the inspection report.
3) Install post tank cleanouts.
4) Provide additional fill sufficient to provide a minimum of 2' of soil over the system in
all places. In areas with less than 4' of cover insulation should be installed.
To insure proper operation of the system in the future we are also recommending that
the following be accomplished at the same time.
• Install cleanouts at the end and beginning of all laterals and hydrojet the laterals to
remove all solids.
• Remove root mats around pipes as necessary to prevent future clogging, and backfill
with gravel as required.
• All disturbed areas should be re -insulated and have fabric installed in accordance
with municipal specifications.
Once the above deficiencies are addressed this system will meet the minimum code
requirements of the Municipality of Anchorage, Department of Health and Human
Services, On-site Section and a Health Authority Certificate can be applied for and
issued. �>
Note: The operational life of all septic systems depends on the local soil conditions,
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 this septic system. Therefore, we can not give any estimate'of how loAg
this system will function satisfactorily for current or future occuparfts All septic
systems ultimately fail. Some systems last 15-20 years, others fail afterC
less than 5
y :
years. -.
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES y�
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 I.D. # f-lfAr� - 1 i a - HAA # LI
1. GENERAL INFORMATION
Complete legal description I 'r 1 i31 oc k 3 Mc tO t <<.Ks ( de Vi I iay.e
Location (site address or directions) 1 J I.( SfeNw h ,« } Avtck� dare AY
Property owner I
�� } (5V00S Day phone (ti15)
Mailing address 1� J. l ' x �i I% Pest a dei^� C4 9 4 v 6 0
Lending agency /v1 n ^ f nn ca i Day phone
Mailing address 12% \A/ )= fr we 0-d h« �e sa'f'e. 12 y Aoci, Ai: 99lo3
Agent 1' (3it,d)e++ �17a�wtct uc Yr�fa. Day phone 3LIS ZoZo
Address I' 0 Bo,x 11 31 o /4vtcko•'ay6 99J"1S-
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 9
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 X
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 MOA421
Ra VON yoeg (t6/l '�OH)SZPZL
�l M S Jaauibuo Ieuolssa;ad ayl ui suoissiwo ao saaja ao; alq!suodsai
;ou s! a6e�oyouy ;o �llled.oluny� ayl panssi sl also.;lllao a ajo;aq a;Ep azlleue jo suo.;oadsu! ;onpuoo
IOU op SHHO to sealoldw3 •sluawai.nbai alels pue.ejapa; u.EUao /gsiles oljapao ui suo!;nl!lsu! 6ulpual J1ayl pue
sawoy;osieseyoindol(selinooeses.ylsaopSHH4agl'ENselV;oale;Say;u.paialsi6aiaaau.6ueleuolsseloid
;uapuadepui ue (q anogE g ydea6e.led ui u9n16 suolleluesa.ldej ay; uodn (luo paseq sale01;.u90 IenoiddV
Al!joylnV glleaH sonssi (SHH4) sao.na96 uewnH pue y;leaH;o luawliedeo a6woyouV;o F(1!led.olunyq ayl
C -O ale(]
moPindlls 6uimollo; ayl y;!nn 'swoojpaq
26 i2 b als(]
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3unIVNJIS SHHQ '9
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auogd J N '2 wJ.J !o awEN
uol;oadsu! slyl;o a;up ay; uo loa;ya uj suo.leln6ai pue 'saoueulpio
'sapoo alelS pue iedlolunN lie yl!m aouelldwoo u. si WOWS lesodslp aalumelsem Jo/pue Alddns
aalem ails-uo ayl'uoiloadsul pue uoile6llsanul Aw Ova; pue sal!; ebejogouy;o Al!ledlolunW ay;
wa; paulelgo uollew.lo;ui ay; uo paseq;eyl �uan.layun; ! •ulaaay paleolpui ainlonils;o ad/1 pue
swoapaq;o jegwnu ay; jo; alunbape pue leuolloun; 'a;es si walsAs lesodslp ja;emalsem ao/pue
lddns as;um al!s-uo ag; ley, snnogs uolleolldde lenoaddV (luoglnV g;leaH slgl;o UOIIE611Sanu!
!w lEgl (;!Jan I 'Molaq uanoys a;ep uol;ep!len agl;o se pue olaaaq paxige leas !w Aq pa!;!laao sV
H33NION3 AS N01103dSNl d0 LN3W3.LVJ S 'S
Municipality of Anchorage
Department of Health .& Human Services
HEALTH. AUTHORITY APPROVAL CHECKLIST
Legal Description: �� r 1 131 k 3 /yw",A ft'yg de V4 Parcel I D.
A. WELL DATA
Well type il^rvotiJ-t If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Datecompleted , 29 AL cS Driller 2u!r o2 ti�
Total depth
Sanitary seal(Y/N)
B. SEPTIC/HOLDING TANK, DATA
Date installed f A Tank size I Z 5 O G«. l Compartments Z
Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) Al
High water alarm, (Y/N)
"`/A Alarm tested (Y/N) M`A
Date of pumping 3 I Ait tr 9 Z Pumper A+ Home S e"tc¢ (
SEPARATION DISTANCES ,FROM rSEPTIC/HOLDING TANK TO.
Well(s) on lot —On adjacent lots I d O 4- Foundation 2 8
Topro"pertyline NO Absorptionfield 6 Water main/service line
Surface water/drainage I JO 4--
72-Q26 (Rev. 7/91) Front CONTINUED ON BACK PAGE
FROM WELL LOG
AT INSPECTION
Date of test
9 J +� f w S
Z f3 Awa 9 Z
0Z
Pae
$�vFNce vl
SNrface
�;
cn
Static water level
a U
1r'S'f
rnc�
Well flow
3 72 g.p.m. 3 S g.p.m.
ry
�¢co MKte nded - 230s
r,�o+ tilrsr� i2
rM
`®
>
Pump level
.rM
SEPARATION DISTANCES FRO11M WELL TO,
-
Septic/holding tank on
lot f ° '
Onadjacent lots f o }
o `"
L,
Absorption field on lot
1 2
; On adjacent lots
I
Public sewer main
Public sewer manhole/cleanout IV 006
Sewer service line
!U c rI�-
Petroleum tank
WATER SAMPLE RESULTS:
Coliform
Nitrate U' 9
�� Ck Other bacteria
v m
s
}F
Date of sample: 2 6
Au G 92-
Collected by: c2 P
B. SEPTIC/HOLDING TANK, DATA
Date installed f A Tank size I Z 5 O G«. l Compartments Z
Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) Al
High water alarm, (Y/N)
"`/A Alarm tested (Y/N) M`A
Date of pumping 3 I Ait tr 9 Z Pumper A+ Home S e"tc¢ (
SEPARATION DISTANCES ,FROM rSEPTIC/HOLDING TANK TO.
Well(s) on lot —On adjacent lots I d O 4- Foundation 2 8
Topro"pertyline NO Absorptionfield 6 Water main/service line
Surface water/drainage I JO 4--
72-Q26 (Rev. 7/91) Front CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed Manufacturer
Size in gallons Manhole/Access (Y/N)
Vent (Y/N) "Pump on" level at' "Pump off" level at
High water alarm level
Cycles tested
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot On adjacent lots Surface water
D. ABSORPTION PIELD DATA
Date installed l !ay.G $ Soil rating `� �� (rP �/w I- s tem t e 13E d
— ' yF Ys YP
Length S I Width - Z `! ' Gravel thickness Total depth r
Total absorption area 1 2.2 `1 S F
Cleanouts present (Y/N) �
Depr@ssiorl over field (Y/N) N Date of adequacy test __Z 3 AM(T 9
Results (pass/fail) i�055 for L'
bedrooms
Peroxide
AInC/eM,�tr�ye2a'(tmt nms) 1(.Y1a/cNOr) 1R N u c% d If yes, udrat +
/o w IV //I.�st 12 uMa
vIca anJ
SEPARATMO�TIONDO: -
eoaFFIELTrQniYx�k:A..�
pian
Well on lot 129 adjacent lots t U0 4-/ Property line y v '
To building foundation 3 S To existing or abandoned system on lot IV 0 w e
On adjacent lots I���' Cutbank$- Water main/service line Iy'ae
Surface water 1 v 0 -t-'
Curtain drain IV vi e
E. ENGINEER'S CERTIFICATION
Driveway, parking/vehicle storage area
i
1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature Y1k1�1
Engineer's Name (Yl
Date �I Z1/ J1i
HAA Fee $
Waiver Fee: $
Date of Payment `z y "' Z Date,of Payment
Receipt Number 1-6/0716 C�lo % Receipt Number
72-026 (Rev. 3/91)Back MOA 21 /
1
ARCTIC SLOPE CONSULTING GROUP, INC.
Engineers • Architects . Scientists • Surveyors
30, 0n—, ArinVe M<nera9eNae4a 99318—]0}
TelvPaane: (907) 349-S, to rax: (907) 349-413
WELL LOG
LOCATION:
Subdivision: Movsvt f",,vx.s3 de V, t L
Lot:
Block: 3
Client's Name: V,ck: _ 131x4 ei�-
r
Address: R 0, 13 o x' 11 3 10 2 -
TESTER: C ✓,L C-,IOR12
Initial Reading on Meter: 671 S`},,j
DATE: 31 A AGr 7z
DRAW
DOWN
TIME
GPM
GALLONS
VOLUME
GALLONS
TOTAL
FIELD MONITOR
LEVEL
METER
READING
0'
r0 3v
2.11 of wafcv-
515q ls—
ro
Po;
4,Y 0
6.
67 r
211
_22j-
6d
6 0
24,0
91.37
31`
'44
2,33
3J`,J
1 z G,S,
3"
2 $y
30
3, 4o
SL
1,5
4"
S 335"
1i:rf
7
Lig, (2
2 z 64-
1"
YMLI
1. rJ2
a0
3,'t
yl,0
2
4 "
S
I r
3,4
2.0
9.
Li
s'491-
1
i2 : 30
3. L .
52.
3 31
40
SS -3
l : u d3,13
56.0
L, 9 v,
4'1
5- 6'-t
1,5r
I f
S^2, 0
4
tt"
S, C] 0 0
t 30
-z
Lt 3, 0
5
4°
s
4 13
62, J
'-1
4'
^$v �
10' 00vN
24 AJAG
NOTES: I est iae
Production Rate: i 3, 0 GPM
2
id WV 0k4, h7 le✓e I Yec
24 -Hour Capacity >600 Gallons
MUNICIPALITY OF ANCHORAGE"
• '- Department of Health & Human Services M -
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
Parcel I.D. # _l - AL) HAA # 0 P�SL
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include lot, block, subdivision, section, township, range)
1, ou_!��ainside ��rflaq� Scc/C?.
/_ C, Block
Location (address or directions)
l7Soo S-tec�_t�ilDef�cz_t /)rive ,I�Lu/c/
(b) Property owner Ve I hO M a S Telephone: (home) _1r C—Business
Mailing Address 5--1- C S-�L(' LZ 6 cD r.
(c) Lending Institution Telephone
Mailing Address
(d) Real Estate Company and Agent /
Address
Telephone —
(e) Mail the HAA to the following address: (or check here Of hold for pickup.)
List contact person and day phone number below:
2 L i
2. TYPE OF RESIDENCE
Single -Family d Number of bedrooms
3. WATER SUPPLY _
Individual Well Oma!/ Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE 13,1SO"OSAL
On-site 0' Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025(Rev. 7/88) Page 1 of 2
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this
Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe,
functional .and adequate for the number of bedrooms and type of structure indicated herein. I further verify that
based on the information obtained from the Municipality of Anchorage files and from my investigation and
inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and
State codes, ordinances, and regulations in effect on the date of this inspection.
CC �W I Yl A S S 0 C. Tele hone S� Z � 3!/
Name of Firm p
Address IOCCJ E. Dirvtonc1 %' Iycl. -15eL .ZC.S
Date u t S f v 1252
6. DHHS APPROVAL
Approved for bedrooms Date
Approved --_—Disapproved Conditional
Terms of Conditionals Approvali—
ineer's Seal
.i+,in#CLre`.-""s;;.�.
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval
cerificated 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 orderto 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. ]/88) Back Page 2 of 2
MUNICIPALITY OF ANCHORAGE (MOA)
MUNiCI.....*iOIAQHealth Authority Approval (HAA)
DNIS1pNCHECKLIST FEBRUARY 1984
ENVI�NMONTs343-47d'4 `_,
AUG 15 1y�a�9 Legal Description: _KAQt,_ntc6n5i�le U o j� 0.q e-
RGCLG� V ED�a 1J10Gk
A. WELL DATA
Well Classification P r i k ea_le/ If A, B, C, D.E.C. Approved (Y/N)
Well Log Present (Y/N) _� Date Cornpieted 7 , 5 Yield 4 q a
Total Depth 255 Cased to ` Depth of Grouting _- n/eL-
Static Water Level 1 be_IO w a ram! a pump Set At L(r kh O W h i
Casing Height Above Ground 2 Sanitary Seal on Casing (Y/N) `7 -
Electrical Wiring in Conduit (Y/N) % Depression Around Wellhead (Y/N)
SEPARATION DISTANCES FROM WELL:
To Septic/Holding Tank on Lot 10 2_' / ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot l f3 On Adjoining Lots /00,+
To Nearest Public Sewer Line h��= ToN/earest Public Sewer Cleanout /Ma nhole
To Nearest Sewer Service Line on Lot
Water Sample Collected by �J L i n r Aq ki ;Date— 8/8/<92
Water Sample Test Results
Comments
B. SEPTIC/HOLDING TANK DATA
Date Installed 1 85 Size17- SO No. of Compartments Z -�
Standpipes (Y/N) %/ Air -tight Caps (Y/N) y Foundation Cleanout (Y/N)
Depression over Tank (Y/N) ti Date Last Pumped>'t`O {1
Pumping/Maintenance Contact on File (Y/N) nl'5L for ex -
Holding Tank High -Water Alarm (Y/N) h Temporary Holding Tank Permit (Y N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
To Water -Supply Well 102- To Building Foundation 18
i
To Property Line D i To Disposal Field
To Water Main/Service Line C/ "--
To Stream, Pond, Lake or Major Drainage Course r a_
Comments
72-026 (Rev.7/88) Front Page 1 of 2
C. ABSORPTION FIELD DATA G
Soils Rating in Absorption Strata 2 17 /6 r Type of System Design /3 C ci
Date Installed 8/ G' S Length of Field 51
z
Width of Field Z`t Depth of Field
�ravelThickness
Square Feet of Absortion Area Statndpipes Present (Y/N) y
Depression over Field (Y/N) Date of Last Adequacy Test
Results of Last Adequacy Test S C(tt' Sf6LCf'C f J
SEPARATION DISTANCE FROM ABSORPTION FIELD:
To Water -Supply Well Ile? To Property Line
To Building Foundation �34( To Existing or Abandoned System on
Lot G— 1 On Adjoining Lots ) 00 't
To Water Main/Service Line � To Cutback (if present)
To Stream, Pond, Lake, or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area f G f
Comments
C
LITATION ^�
L�
Date Installe
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
"Check PerVt d Bed
I certify thai l vp chi
Signed
Date
MOA No.
Dimensions
Manhole/Access(Y/N)
"Pump Off" Level at
Vent(Y/N)
Pumping Cycles during Adequacy Test.
Rating Against HAA Request"
ve rfied, or conformed to all MOA
2-(.
Receipt No. Receipt No. —
�>
Date of Payment / 0 /�L^, K Waiver Fee: $ —
Amount: $ / �6 vy Date.of Payment
72-026 (Bev. vea) Back Page 2 of 2
the date of this
Engineer's Seal
'� LA80RAYORIES \` rCVC„AL. 1AA 1Q # 92.0040440 J A
' ANALYSIS REPORT BY SIMPLE "for Work Order # 15679
Date sport Px
V,inta3t pUG 10`84 @19:39
ClientSample ZD:IBHEv4kLii $kn& (15740 STEAMBOAT) Client Name CORWIN & ASSOC
PWSID DA ` Client Acct CORWINP
Collected AUG 8 89 8 1100 hso. P.Q.A NONE REC*D
Received AUG 8 89 S 14:15 his, Req #
Preserved with :AS REQUIRED Ordered By
Analysis Completed :AUG 9 89 Sand Reports for
Laboratory Supervisor :STEPHEN CA�DE 1)CORWI9 8 ASSOC
Released By : �;t/
. r -s-^-' 2)
........ ..... .I .................... y...: ...... '.....ob.....a...".fi iw.r....r.tiraw''i. " . {
Special HOLD FOR 4106 UP
Instruct:
Chemlab Ref t; 6876 Lab Smp1 ID: 1 Matrix: WATER
Sample"" ROUTINE SAMPLE ,
Remarks: SAMPLE COLLECTED BY E.L.
Allowable
Result/Units Metbod Limits
i 2 mg/l EPA 353.2
10
---- -------------
I Tests. Performed` 'See Special Instructions Above UA -Unavailable
ND- None Detected " See Sample Romarks Above
NA. Not Analyzed ` LS -Lass Than, GT-Gseatar Then
---- -------------
I Tests. Performed` 'See Special Instructions Above UA -Unavailable
ND- None Detected " See Sample Romarks Above
NA. Not Analyzed ` LS -Lass Than, GT-Gseatar Then