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Home My WebLink AboutTHOMAS L BOYLE BLK 1 LT 1BThomas L 0 Boyle Block 1 Lot 1 B #015-282-32 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW960VV0 PID Number: 0/5-282-3z New Io�pKAD Ml1cl.e(( Wastewater System: ❑ New ><Upgrade Addfess l/G y GJa Ht, S1. A.,eti. 'pito ABSORPTION FIELD Phone: No. of Bedrooms: 3 gDeepTrench O Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: Z- Total Depth from original grade: r B.9 GPID/Sq Ft Lot:��JJ Block: �Srurbdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe /.O / A$l 4l . 4?e LL -3,411 Ft S FI. Township: Range: Section: Fill added above original grade: Gravel length: 33 Ft. Ft. ❑New ❑Upgrade Gravel width: 2— Numberoflnes: DetrtebetweenanerWELL• FtVM FI. Classification (Private. A.S.C): Total Depth: Cased To: Total absorption area: Pipe material: D3o3 r/ Fi. Ft. 60. Ft. ic /D Driller.. ~ ate Drilled: Static water Level: installer. Date Install 1(IS Ft. v..l S i 4-4L yield:'odmp Set at: Casing Height Above Ground: TANK PM Ft. Ft. SEPARATION DISTANCES Xseptic ❑Holding 0S.T.E.P. To Sepik: ADaorplien Lm Holding Pubitemrivate Manufacturer. ./ T.e� Capacity In gallons: 4660From Tank Field Station Tank Sewer Ones /vy Welh 10014 /OO r f — -., I Z S► Material: STEL L- Number of Compartments: 2 Surfac Water /oo'f /oe'� — — t� LIFT STATION Lot /D 1 — — L Size In gallons: Manufacturer. Line /Orf Foundation /a /f /O�f — — — "Pump on" level at: "Pu ' bust at: High water alarm at: Curtain /OD,F /�aef — — Pump Mat Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: N (� co.,,ri of a,o C' k � kaulf d�✓G Assumed Elevation: /00 ENGINEER'S SEAL OF At .4111i �Q .••''w....... S i 9TH Inspections performed by: mud ENdih«%Dates: lst//"��'�S of "� •••• ••«• :•*• 2nd //-i9- 9$ 9z ..«........ :... Kenneth M. D f CE 16 �i �'F Department of Health and Human Services approval �., ,.•'��00 251 Reviewed and approved by: Q�t7u� Date: Z 8 ; pROFSSIONA��— ESI 2-013 (Rev. a/et) MOA 26 AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW980440 B❑YLE S/D. LOT 1B, BLOCK 1 PID#015-282-32 � I I i LOT 1A SEPTIC I I I I I I VWML 0 K LST 1B TH #98 D: A -C=24.3' FIELD BOOKS COuR wo: S B -C=40.8' -1 IN A -D=27. 13 11/30/' B -D=42.1' 2734 ACROFaC:98145.DWG "NO: A -E=34.5' o B-E= d A -F=38.338.3' / B -F=28.2' I / FIELD BOOKS COuR wo: 3 BDRM BWNDARv: J Sourfe 0RAm" KMD STAMN@ J. Sourfe aMEM SFD A5 UILT` J. Sourfe BATE` 11/30/' F 2734 ACROFaC:98145.DWG "NO: VOLL 0 S.T. l I FINISH GRADE nn 93.3 2' INSUL. BOARD FILTER FABRIC 000 GAL SEPTIC 90.3 TANK SEWER ROCK or aLgs'' 49TH I ' KENNETH IAD / � - CE -7118 ?�7Ale �1'ESSlO�py �� 33' PREPARED FOR: BRAD MITCHELL 11641 WAGNER STREET ANCHORAGE, AK 99507 (907) 892-4923 FIELD BOOKS COuR wo: BWNDARv: J Sourfe 0RAm" KMD STAMN@ J. Sourfe aMEM KMD A5 UILT` J. Sourfe BATE` 11/30/' 0w. ME. MB: 2734 ACROFaC:98145.DWG "NO: 98145 aff SCALE: 1' = 50' SCALE, NTS e VARIES T 0.5' 5.8' 1 B.M.-NAIL IN PLANTER. ELEV=102.97 EMU) ENGINEERING 20441 PTARMIGAN BLVD.' EAGLE RIVER, AK 09577-0730 III/FAX (907)696-8111 MUNICIPALITY OFANCHORAGE Department or Health and Human Services On -Site Services Program 825 L Street, Room 502 ' L —till - Qk% P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 aP,M ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Nov 13, 1998 Expiration Date: Nov 13, 1999 Permit Number: SW980440 Parcel ID: 015-282-32 Legal Description: THOMAS L BOYLE BLK 1 LT 1 B Design Engineer. 0070 KND Engineering Site Address: 011641 CANGE ST Owner Name: Brad Mitchell Lot Size: 49497 SO. FT. Owner Address: 11641 Wagner Street Total Bedrooms: 3 Permit Bedrooms: 3 Anchorage , AK 99507 - This permit is for the construction of: ❑✓ Disposal Field Z Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 engineer must notify DHHS at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-4744 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: ' Date: l� p 'C. Date: 3 I J111C��D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 November 10, 1998 RECEIVED Municipality of Anchorage NOV 12 1998 Dept. of Health & Human Services Mu"ucipality Of Anchorage On -Site Services Section Uept. Health & Human Services P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Upgrade Sewer Permit — Boyle S/D, Lot 1B, Block 1 Gentlemen: At the request of the owners, on October 31, 1998, we excavated one testhole for the subject property to upgrade the existing system, which was identified as in failure after completion of an adequacy test. We installed a monitoring tube with our testhole. The results of this test and water monitoring are attached. We propose to install a 2' wide deep trench while retaining the existing field for use in the future. The testhole registered no water during excavation or upon monitoring. The existing tank will be excavated and its integrity verified. Additional fill will be provided over the system as required. This lot is relatively flat and slopes to the west away from the existing field and the house at approximately 5-7. There are no public or private wells within 100' of our proposed system location except as noted. There is neither surface water within 100' nor any known curtain drains within 50'. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, IKTHD Engineering Kenneth M. Duff E. attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Tests WASTEWATER DISP❑SAL B❑YLE S/D. SYSTEM DETAILS/SITE LOT 1B, BLOCK 1 PLAN NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' Or PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. i 4� or aL4s 1, 9TH *+0 KENNETH M. S CE -71 6 4 Ar \ �FESSION)'4 � DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/1.2 GPD PER SO. FT. (1.1 MIN/IN.)= 375 SO. FT 375/(2'(W) X 6'(D)) (6' GRAVEL) = 31.25 FT. TRENCH USE 1 TRENCH - 32'(L) X 2' (W) X 6'(D) Total depth of system Is 9.0' from original grade. Total depth of gravel below distribution pipe is 6.0' NOTES: 1. CONTRACTOR TO EXCAVATE 8 VERIFY TANK INTEGRITY. IF REQUIRED, CONTRACTOR TO INSTALL 1000 GALLON SEPTIC TANK. INSULATE TANK IF (4' COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK. 4. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJCENT PREPARED FOR: BRAD MITCHELL 11641 WAGNER STREET ANCHORAGE, AK 99507 (907) 692-4923 FIELD BOOKS COMPVTED: BOUNDARY: j. Sroufe DRAM KMD STAKING J. Sroufe CHECKED: KMD hB `X'T. J. Sroufe DATE 11/8/ UBO. FILE: MD: 2734 ACRD FRE: 98145.DWG '1°B NP: 98145 Scale: 1'= 100' PAGE 1 OF 2 LLIX! LU) ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 6-8111 KD WASTEWATER DISP❑SAL SYSTEM DETAILS B❑YLE S/D, LOT 1B, BLOCK 1 0 3I G FIELD SE is EXI T 1000 GAL S.T. co I STALL DIVERTER/C❑'S PRO ❑SED P IMAR MTWC❑ OF AL9S 1, * 49TH *+0 KENNETH X eus / CE -711 b \FESSIO'0 AW \Zz ftl 4011 PREPARED FOR: BRAD MITCHELL 11641 WAGNER STREET ANCHORAGE, AK 99507 (907) 892-4923 FIELD BOOKS Ca KTE0: Ma DAFtr: J Sroufe DRAM: KM STURRG: J. Sroufe oMED: KMD Mseunr. J. Sroufe °"N; 11/8/ 0M . 11M MID: 2734 AM ME: 98145.DWG ' NO: 98145 SED FI SYSTE 5-7% Scale: 1'= 20' PAGE 2 OF 2 M�lll IU) ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-11736 —6111 —8111 KNLul ENGINEERING 24141 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS LOG - PERCOLATION TEST Performed for: Brad Mitchell Date Performed: 10/31/98 Legal Description: Boyle Blk 1 Lot IB TEST HOLE 9 9M 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16 - 2- 3- 4- 5- 6- 7- 8- 910- 1112- 131415- 16 17 18 19 •20 DRG rootmat SP/SM- reddish brown Sample taken SP/Sw B.O.H. SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water aftermonitorine? DRY Date 11/7/98 Reading Date Gross Time Net Time Depth to Water Net Drop 1 10/31 1.05 - 6- 2 1:10 5 min 0 5" 3 1:11 - 6- 4 1:16 5 min 0 5" 5 1:17 - 6" - 6 1:22 5 min 0 5- 7 • Water Added Comments: Soil sample taken for lab analysis Percolation Rate <_(min/in) PercHole Diamelcr__T__ Test Run Between 4 feet and 5 feet 1, Kenneth h1. Duffus, certify that this test was performed in accordance with all State and Municipal guidehn,�> ii: effect on this date: r ' MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION I` ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE 2MEW 34i-�z6 ❑UPGRADE MAILING ADDRESS 0 3 eu +4 LEGAL DESCRIPTION 6 LOCATION NO. OF BEDROOMS W 44wav— 3 D DISTANCE TO: WellI O Absorption area I 6 Dwelling PERMIT NOn �Q' v 77 ;:z Manufacturer , /� Material No. of com artments WQ ~ Yi N Liq. capacity in gallons �0 IF HOMEMADE: Inside length Width Liquid depth bY DISTANCE TO: Well Dwelling PERMIT NO. JOZ Material Liquid in _? f Manufacturer capacity gallons O DISTANCE TO: Well ' Z� • Foundation •-7 9 Nearestlotline /•Tr O� PERMIT NO. 8 30 W = / J W Z No, of lines Length of each line Total length of lines Trench width Distance between lines z W r p r &Inches H Top of tile to finish grades Material beneath tile pper�,, sr Total effective absorption area 1 p 41'�••- Q QJ Inches SR Length Width Depth PERMIT NO. W <I.. Type of crib Crib d er Crib tlepth Total effective absorption area W� w Well Building foundation Ne ine DISTAN J s Depth ' ACJ O Driller Distance to lot bne PERMIT NO. y 301 J V Wy Building foundation Sewer line Septic tank r r Absorption area107 DISTANCE TO: OTHER PIPE MATERIALS s AND CAS -r I Bons SOIL TEST RATING INS 5Q Fi INSTALLER /�. 8 REMARKS NK. " If -%P3 Ay % <t ArT '••S' •••• •• • • ••. DEPt. CF Hcf. Tt A ENVIROW.A_ ml T 64 - ,� • [DWAgD • RIAGR � D JUL 1" •r CE -3016 J ti APPHOVEDs • 17 DATE EGAL •P�C C ®fa r>•. •••• L zY� 72-013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE Department f `Health and Environmentai",rotection 825 L Street, Anchorage, AK. 94501 (/ 264-4720 * * * I'1 HANDWRITTEN PERMIT Permit # R`'9,510 `i WELL AND ON-SITE SEWER PERMIT _ 995/ Applicant: hDm F- r Mailing Address: RD /3 6-Y 3-5/6/ Location: Phone Number: 3 (/ 9• J c" A G Legal Description: L -I t3 61 /3Lot Size: Type of Soil Absorption System Is: Trench: Y_ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br) / ';L '1� The Required Size of the Soil Absorption System Is:' DEPTH !I LENGTH 2"7 . GRAVEL DEPTH _ _L _ WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ 0_Z)0 GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * ' * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending 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 this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I unders hat the on-site sewer system may require enlargement if t2her s dence is remodeled to include more that 3 bedrooms. Signe3: Issued by:� �a Applicant Date: 3h�c) 3 SWP/024(1/81) WELL L Date Drilledi 4/28/88 Static Water Level 120 feet Drax Down' NA feet Tyre Material Drilledi 0 feet to 20 sand gravel 20 to 45 Rravel 45 to 55 sand 55 to 100 clay 100 to r, Gallons Per Minute 10 Total Feet of Casing 180 144 cemented hardpan 144 to 165 sand and Rravel Ik CPM 165 to 180 rocky cla,• 180 to 185.sand and Rravel aquifer IOGRPI Hefty Drilling S.R.A. Box 1553 H Anchorage.Alaska 99507 MUNICIPALITY OF ANCHORAGE DEPT. OF H`- LTH " ENVIR0ti7,A`_NTAL PROTECTION OCT 19 RECEIVED 0 4NCHORAGE FI RONNIENTAL PROTECTION a 99501 2G4.4720 LATION TEST PERFORMED FOR: T f -•I 4. FIM DATE PERFORM LEGAL 1 2 3 4 5- 6- 7 8 9 10- 1 2 0 12 .• Vim 13 ' 14 - 15• 16• 17 18 19 20 COMM IN, SOILS LOG ❑ PERCOLATION TEST Lcl' fA I F %q IR •- �i-:r.k ( �� l.0 R k: -ft! -c: I � f SLOPE SITE PLAN '— Ci HN,GJ �•.! 511 tiit� Cs�i , cA CT MIL) LT P4V- C L. 4�T V) f--jn1c OF A < T P. Rol ph a. uke I •. Q Fq. •s. WAS GROUND WATER S ENCOUNTERED? I Q L 0 P IF YES, AT WHAT E DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop �C r�% '• a :. �..� `\-,wtL,).m�,aPERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT I PERFORMED 11Y112 Exst International Airport Rd. CERTIFIED BY: DATE: Suite 204 r u _ a!1l \ ,,( xiiL' • i t Sia l l� ,( p Iii \ e+• 2 v ' V'. 3 tjl •1:� r �.. wi t ltl, `.� l f' Y h eI YI I'>.i�>(�ill: .i •.� J ♦,.., ' + YL;w ♦-. r��w :Ii:• , b T`t y. 'iul_rr/it '�7 :.�✓� _^ [uf1' �y 1 ✓ n, i I � ✓ ( 1 114/' , ' i. �'' f . � - ,.: f - , • 04g. O i, II _ .r' C %" ♦ i•;:.. O _ ,.r; :,c �l. .1.. !);>..! �J:•J: J�:_•yV ~ Parcel I.D, 015-282-32 Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Expiration Date: ZI 1. GENERAL INFORMATION Complete legal description Thomas L. Boyle, Block 1, Lot 1 B Location (site address) 11641 Wagner St. Current Property owner(s) Paul & Georgia Stiefel Mailing address 11641 Wagner St. Real Estate Agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System U Public Sewer ❑ Waiver/Variance request for: Received by:. -- y: - �, r Date:�� COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5ro��i/0 Date of Payment Receipt Number COSA # anoL/ l Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE 1/ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone (907) 272-8218 Date 1/27/2014 bedrooms, with the following stipulations: i By: Original Certificate Date: —� 3 Theci 't An aDevelopment 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 COSAblue sheet r - ., c If more than 1 septic system is on the lot: COSA Checklist # -L_of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Thomas L. Boyle, Block 1, Lot 1 B Parcel ID: 0 15-282-32 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 4/28/1983 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 180 ft. Cased to 180 ft. Casing height (above ground) 18+ in. FROM WELL LOG AT INSPECTION Date of test 4/28/1983 1/24/2014 Static water level 120 ft Well production 10 g,p,m, WATER SAMPLE RESULTS: 95 3.3+ ft. i'" Coliform colonies/100 mL Nitrate AJ0 mg/L y Arsenic WD ug/L Dateofsample: V)&/a,W Collected by: q5 B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 11/19/1998 Tank size 1,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 71I $/t3 Pumper 4+A1o.Me C. ABSORPTION FIELD DATA Date installed 5/7/1983 Soil rating (g.p.d./ft2 or f?/bdrm) 125 SF/BR System type Deep Trench Length 30 ft. Width 2 ft. Gravel below pipe 6.7 ft. Total depth 11 ft. Eff. absorption area 400 ftz Monitoring tube Y Depression over field N Date of adequacy test 1/24/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 452 gal. New depth 1 in. Elapsed Time: 150 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at E. SEPARATION DISTANCES Cycles tested WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) _ in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone Date 1/27/2014 COSA brown sheet 10-10-12.doo Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. Municipality of Anchorage Development Services Department Building Safety Division Y 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. 015.282.32 HAA # Ilk' Expiration Date: g - / — n 2- 1. GENERAL INFORMATION 1. Complete legal description Thomas L. Boyle, Block 1. Lot 16 Location (site address or directions) 11641 Wagner St. Anchorage, AK 99516 Current Property owner(s) Brad & Lonita Wainwright Day phone 345-8801 Mailing address 11641 Wagner SL. Anchorage, AK 99516 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: 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 ❑ 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_KND ENGINEERING, INC. Phone _(907) 696.6111 Address _20441 Ptarmigan Blvd., Eagle River, AK 99577 Engineer's Printed Namq Kenneth M. Duffus Date 05/20/02 5. DSD SIG TURE . Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other By: ��/ IV. /scii Original Certificate Date: Municipality of Anchorage , Development Services Department s Building Safety Division • ' On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA we" type VdM If A, B, or C provide PWSID # Date completed 4= Sanitary seal (YIN) T Total depth 18S ft. Cased to 180 ft. FROM WELL LOG Date of test 4128189 Static water level 120' ft. Well production 10 g.p.m WATER SAMPLE RESULTS: Coliform _I—colonles/100 mi. Nitrate 0,200 mg./I. Arsenic: _M mgA. Date of sample: 5114102 B. SEPTICIHOLDING TANK DATA Well Log (YM) Wires property protected (Y/N) Y Casing height (above ground) 180 AT INSPECTION 99 ft. 7+ g.p.m. Other bacteria 3 colonies/100 ml. Tank Type/Material Septic 1 Steel Date installed 11119198 Tank size 1000 gal. Number of Compartments 2 Cleanouts (YM) Y Foundation deanout (YM) X_pepression over tank (YIN) H_High water alarm (YIN) NA Date of pumping 518192 Pumper McDonalds C. ABSORPTION FIELD DATA Date installed 11f19198 Sob rating (g.p.d./fe or fe/bdrm) Lj System type Deep Trench Length 33 ft. Width 2 ft. Gravel below pipe S.8 ft. Total depth LH ft. Eff. absorption area 975+ fe Monitoring tube Y Depression over field H Date of adequacy test 5M4102 Results (Pass/Fail) Pass For bedrooms Fluid depth in absorption field before test Q in. Water added JU gal. New depthW in. Elapsed Time: 14fi min. Final fluid depth IJ in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Data Installed NA Size in gallons Manhole/Access (Y/N) "Pump on' level at _In. 'Pump off" level at _ in.High water alarm level at In, Datum Cycles tested Meets alarm b circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot 100'+ On adjacent lots 1001+ Absorption field on lot 1001+ On adjacent lots 1001+ Public sewer main 75'+ Public sewer manhole/cleanout 1001+ Sewer /septic service line 25'+ Holding tank 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation _51+ Property line Q+ Absorption field 51+ Water main 10'+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 104 Surface water 1001+ Driveway, partdnghrehicle storage 25'+ Curtain drain 50'+ Wells on adjacent lots '+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the adore systems are in conformance with MOA HAA guidelines in effect on this date. �' '' +'•"'•• Engineer's Printed Name Kenneth M. Duffus t�Oti.� Date 05/20102 �1,FU AOF»•SIOHP�o�40� HAA Fee $375.00 Waiver Fee $ Data of Payment 05/20/2002 Date of Payment Receipt Number 19 7 3 Receipt Number, (Rev.1001) MAY -17-02 04:53PM FR0M-CUE ENVIRONIENTAL SRV G CUE Environmental Servicea Inc. CUE Ref.# Client Name Project NameJM Client Sample ID hlatris Ordered By PWSID Sample Remarks: 1022560001 KND Engineering Boyle Bl, LIB Boyle BI, LIB Drinking Water 0 9075615301 T-892 P.02/03 F-352 All DatesITImes are Alaska Standard Tlme Printed Date/13me 05/16/2002 14:29 Collected Date/Clme 05/14/2002 12:00 Received Datemme 05/14/2002 13:00 Technical Director Stephe Ede Released By ��,w Allowable Prep . Amlysia Parameter Results PQL Units Method Limits Date Date [nit Haters Department Nitrate -N 0.200 U 0.200 mg/L EPA 300.0 (<10) 05/15/02 JDT Microbiology Laboratory Total Coliform 0 a r- cot/100ml. SM199222D (<1) 05/14102 KAP NAY -17-02 04:54PN FROM -CUE ENVIRONIENTAL SRV 9075815301 T-892 P.03/03 F-352 /�I ME Environmental Services Inc. j Laboratory Division riarrrrrr�rrrrrrri'rrrsr. 200 W. Potter Drive Drinking Water Analysis Report for Total Coliform Bacteria Anchorage, AK 69516.1605 Tet: (907) 662.2343 READ INSTRUCTIONS ON REYERSE SIDE BEFORE COLLECTING SAMPLE Fax: 1907 561.5301 MUST BE COMPLETED BY WATER SUPPLIER I TUBE COMPLETED BY LABORATORY 17 PUBLIC WATER SYSTEM I.D.If Its? PRIVATE WATER SYSTEM r Send Resuhs O Send Involve aA. ,',✓A �dGlt)f�t/tJb-?.yG itJpfrrr qo SGA- 1-7—W .. oy loe"—yv crD . EACn,E tZltrErt- �'k _ `�S�7 ry yr gym, O Send Reruhs O Send larolce Iua..lY,u SAMPLE DATE: 0 5 Month SAMPLE TYPE: XRoutine Mw6 SAcee D Repeat Sample (for routine sample with lab ref. no. ) O Special Purpose SAMPLE LOCATION adytz air LI)3 EE m Day Year H. Analysis shows this Water SAMPLE to be: K" Satisfactory O Unsatisfactory O Sample over 30 hours old, results may be unreliable O Sample too long in transit; sample should not be over.'*Vhours old at examination to indicate reliable results. Please send new sample via special de iv ,, mai//l. Date Received Time Received I�D� Analysts Began (sl Analytical Method: embrane Filter MMO-MUG 0 Number of colonies/100 tnl. Result* Analyst 1022560 ,1A Treated Wate. Untreated Water Time Collected ODA% Collected By M A/ riew hats EM _ Anch Fbks Jun ❑ Fated Date: Time Client notified of unsatisfactory results: 11 Phoned Date: Spoke with Time: Fazed BACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Collform / E Coli Membrane Filter. Direct Count ( J Colonles/100 ml TWC-ra.n...,T.C.... Verification: LTB BGB COLIFIRM on . ofhi 1.,..e Fecal Coliform Confirmation Final Membrane FI er Results Coliform/100 ml c Reported By �---tyste U% Time h OC -10 bra Comments: (� WSMMember of the 605 Group (Societe Ginerale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND, MIC4IGAN, MISSOURI. NEW JERSEY, OHIO, WEST VIRGIN o . Q ytl� yYcr . ii�• W+ 1 w `a 5 00'07'50' E 164.95 r S ----------- 61,2.' _ys -:gad - uGi� �g33L�ga wm^ laiaui'yif & y5 -fip.L$ cot 001' as a,10 0 1 a` YVF °gs s.e �z�0'01 orm x a ?ems. ESD y VKb�E �g(jo.S ` toz"+'_ :... — 27.7 g a30`-j3j8eb$6 1_D r a is f'9Z 27.9 LCMTO n 2 �_i b ynS Visas o E'D ` ~O m m J Z e �.. V7 e ® t >;a D 5§ L) p (n ' ^ v\ O .' 1 m W. lY m w �„�, O e1% p . � 161.95 W to x z � - N 00'07'17' W z ,p r C m W P WAGNER STREET Z P p MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services an 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.# DIS- 2SZ-32' "-\ HAA 1Y�\S,"" 1. GENERAL INFORMATION Complete legal description 7/'•"*�r L. $orQ S/y r1GK / Gr //j Location (site address or directions) //"P' y' /Jai nf. Sf , e1nr-/r • , AK Property owner ia,W kile,tirll Day phone 90-7 S9z - y9z3 Mailing address /16gl lt)acnr. s4. Aie4..y. Qe 9S5"67 Lending agency Mailing address Agent Address _ Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 ; 3. TYPE OF WATER SUPPLY: Individual well 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 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-M( .1/91) Front MOA 12/ 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 III 0S+ hef, ;,"r Phone Address /?:,-rte Ak i9 S77 —C-73% Engineer's signature Date 12 -off -10 6. DHHS SIGNATURE JApproved for 1 bedrooms. Disapproved. Conditional approval for Additional Comments M 1UTlr �. ••m•....-. y� FC K9nnC 7 0 bedrooms, with the following stipulations: Date /-Z-Z.96 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. resMW. +m> 8. MOA CM RECEIVED Municipality of Anchorage DEC 01 1998 DEPARTMENT OF HEALTH &HUMAN SERVICES�ncnvAul r of Environmental Services Division LL��lvuLs�vnces 825 L Street, Room 502 • Anchorage, Alaska 99501 • (90r3a3-a744 Health Authority Approval Checklist Legal Descriptio,: IdAvIdS Z. 96YI6 S/lb 0 *81-141 &T/3 Parcel I.D.: OI S- 262— 3Z A. WELL DATA Weli type fr v ✓��f' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Data completed Total de �6f r Cased to /Sd r rt depth Casing height (above ground) Sanitary a" (YM) Y Wires properly protected (Y/N) 7 FROM WELL LOCI AT INSPECTION Date of test Static water level Well production /0 g.p.m. if '19 g.p.m. iLE- Vv.. 41-`�ta W�a_� WsaTpw►st�2 fo+.S.��o--%, Sl. c-. WATER SAMPLE RESULTS: Coliform Nitrate 114RL- Other bacteria D Date of sample: 11-2q-10 Collected by: KA) D B. SEPTIGHOLDING TANK DATA Date Installed /1-0-10' Tank size Number of Compartments 2 Cleanouts (Y/N)_� Foundation deanout (Y/N) I- Depression (Y/N) N High water alarm (Y/N) N/h Date of Pumping Pumper M ABSORPTION FIELD DATA Date installed //- / I - ! $ Soil rating (g.p dAV or ft=/bdrm) 2_ System type .Zl t5� Length 73 r Width Z r Gravel thickness below pipe Total depth g• 9 Y Effective absorption area 37 S of Monitoring Tube present (YIN)—Y-- Depression over field (YM) 14/ Data of adequacy test Results (Pass/Fail) For Fluid depLinabsor"pdon Geld before test On.); Int er gal. water added On.):Fluid dep(hrs) MI r. Absorption ratePenzddent (past 12 months) (Y/N) fl yes, give date 72-028 (Rev. SW D. LIFT STATION Date installed Manhole/Access (Y/N) — High water alarm level at* _ Cycles tested E. SEPARATION DISTANCES 'Pump on" 'Datum Size in gallons 'Pump off' level at' SEPARATION DISTANCES FROM WELL ON LOT TO: Septiciholding tank on lot /D 0 r i On adjacent lots 1661+ Absorption field on kri /00 �t On adjacentlots /Od + Public sewer main N) A kzor -t- \ ) Public sewer manhole/cleanout NIA "oo� r Sewer /septic service line 2 S r Lift myon N/ A SEPARATION DISTANCES FROM SEPTICMOLDING TANK ON LOT TO: Foundation l0 1r Property line / 0 i f, Absorption field Water main/service line /L1+ Surface water/drainage hoc Wells on adjacent kfls SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1061 -t- Property oor-!- Property One 161+ Building foundation /d /a' Water main/service line /Oi} Surface water / Dolt Driveway, paridng/vehide storage area / G o - Curtain drain 106 1+ Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have detemdned thm field hupections end review of Municipal in confomunce wfih MOA HAAguidelhres in effect on dds date. Signature Engineer's Name F�NNBTLi a�iirl Data la -0 /— 9 HAA Fee $ sn • ED Date of Payment / -z- Receipt Receipt Number Gi Z`� �– �7I 23 / 72-028 (Rev. "6)' Waiver Fee $ Date of Payment Receipt Number CE 104 rt C -T 7 Alaska Water & !Wastewater Consultants, Inca 7320 East Chesttr Heights Circle —Aaehorage - Al:trka 99504 Phone (907) 3376179 - Fax (907) 338-1216 I )d October 7,1998 Brad Mtchell C/O Remak Properties Attn: Peggy French 26M Cordova St., Suite 100 Anchorage, AK 99503 REFERENCE Lot 16; Bloch 1; Boyles Subdivision DearMr. Mitchell, Per your request we performed a well flow test and a septic adequacy test at the referenced property on October 5, 1998 for purposes of obtaining a Health Authority Approval (HAA). The results of our investigation are surnmarized as follows: A. WEI.14 On the day of our tett (1015/09)liw tiatic•waicf-kv&hl-tG-c «&";"'a> 413 L lino 1�a uw tt.: �(j (Jj tlnr.en »n:• tr n and lne rrOw Stirred 011 NII. BS1l9ll LLYULL V W ALMAWo3 CfW-%4r v r V. ii s.�i� 7..•... waL.rnnrj1ldM thl;t t114 Wog Qrfi$!? ion is a�Prezimtie 8.49 g�llons;+c*aniaute _�Yith ;< 33 fL drawdown. The well flow Production meets Municipality or, Ancnomge (nava) minimum flow requirements for a three bedroom dwelling, which is .31 gallons per minute. It should be noted that seasonal fluctuations In the well production can occur, and that timme performance is not guaranteed. B. SEPTIC: Per Municipal records the on-site wastewater disposal system was installed inMa . 1983 and consists of a 1p0l0�0Lpgallon septic tank followed by a trench 30 R. long, 1t).S 1{ deep, wrta an CUM"' --r— 01 OV - found the system to be 10 & deep and the monitoring tube in the leachfield had I 1 inches of liquid in it prior to adding water. A total of 1187 gallons of water was introduced to ti:e end of the lea&lidd. During 4&04 additka A• smt to the AmMeld. y9er was o0servea Oatac1118 IIIW Wo **Vu.. w..., Lw.wJ..p +� �'�•� _ __...... a •. r. �.� .. the property 26 hourr lAtr. After adding only 160 OLIant of-Wme?, baeiang lino the sepdc tiaic i 1"veld als8�t e014d ihnt liquid levels •in •thr_nrlrtic raw4 AmAnaoi river U �1t rGa�n itu � . • 6A on our findings) it was detttmined a tU o m r rn wlNl•tlr*Irnt nm: u1 rMM etatA nffailure. It must be uoaraded prior to receiving a Municipal HAA. � '00A r•yaw 9z — 1f9z3 �aoec ?9Z—�z7 7� Time APPLIC.:4T• FILLS OUT UPPER HAL~ONLY Time Property Ow:Tr _ I lv✓Y� Time Phone �y- 7uJ Mailing Address Zip Code o Date , Inspector Inspector Buyer Inspector LL)�ol:�s . Inspec Address = Zip Code MUNIcIPALITY OF ANOIORAGE Lending Institution ` \ r ;� 1) Phone Address Realty Co. d Agent carr- C. 0' Phone Address Zip Code Legal Description / f� Q (ock-- `7 Street Location (/V u)Z ( ) CONDITIONAL APPROVAL' Type of Residence 1;1Single Family DATE ❑ Multiple Family No. of Bedrooms ❑ Other Solis Rating Dale Sewer Installed Well To Absorption Area Water Supply �'Tndividual Well Log Received (/ ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community 7— lirZ —,s4lil For welts drilled prior to that date, give well depth (attach log If available). ❑ Public Utility Sewer Disposal ' �'] �3 ndivldual Year Individual Installed: ❑ Public Utility When Connected to Public Utility ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date , Inspector Inspector Inspector LL)�ol:�s . Inspec Field Notes:'C)K (k>CQ.Q MUNIcIPALITY OF ANOIORAGE CEPT. OF H`.P t: t„V P's'" RO ENVIROtiA=NTAL PROTECTION carr- C. 0' OCT 19 RECEIVED (, ) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: yr C5 Solis Rating Dale Sewer Installed Well To Absorption Area Well Log Received (/ Tank Slxe 7— lirZ —,s4lil Well to Tank If 0 0Septic 12O 3 I