No preview available
HomeMy WebLinkAboutNEWTON LT 1Newton Lot 1 #051-144-15 Municipality of Anchorage ; Development Services Department -- Building Safety Division On -Site Water and Wastewater Program. 4700 S. Bragaw St P.O. Box 196650 Anchorage• AK 99519-6650 f www-cl anchorageak.us (907) 343.7904 Page I Of3 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: Sl,b iyo- — t�s�–J!!!! ,,// // PID Number. 7 7_ d S�?A4vn 4 YVIne LLQ Wastewater System: ❑New Upgrade ° llp Phar: 6 Vt ABSORPTION FIELD 85 A Nenc«aee«oal.: � y,,, U need rro�dl 0 Pee_ T,6.0 a Bed 0 M"W o oew. LEGAL DESCRIPTION $a1 RawV. Tar new ado &.Dawam: Dedtn b DTe Odom horn OI'% dgrw Fade: Grw dedtn arse Pa: Tawnaup: Seroan Ft. F fe added atrq dnOrW Dade: ,�, Dow Large: Well: ❑ NewGq ' S Ft. Fi ❑Upgrade ewCe: Rvnw a w.e: Oebnppee.Ndler Cusvna°m (Pogo. A a. Ck Tda Dade: Ft• Fl iaa auadrgdt arae: (/�' 7 P lana: ^,f%J OrYlar. One Om W: FL FL Sv •7�f1/ �) 'J uds waa Yiad: Pdne Set al: FL /ANY N 1 % // / / /•fes/Q J a00H Glaar: Wu Ft. at. TANK SEPARATION DISTANCES ❑ septic Q Holding❑r S.T.E.P.To Septicon Uf[3 Other Tank Holdingub5vprivateFStation Tank Sewer Line tv'Oa.It t uaenr: S � ..//,� t G O ✓1C/G l e Nin°°r of cdrvanm.nr: Burra«wa«�V_ .r �W/ LIFT STATION Lot Lee D a ^/ % Fdwraudt 7N /5 Kqn wai« ««mal: N A /7 . Curran ora, { VO n� v10 "Makaa FJaeKal YndK DMdniea Or m. Ramada: L BENCH MARK Ft. Inspections performed by: 17034 Eagle River Loop Rud, No. 204 . Dates: 1R) Development Services Department Approval, �s/o s N T ` ROBERT C. COWAN a^C,� CE -8801 Reviewed and approved by ' la 13 W1 Date:`���rj�.4Y� ,tlt .- • PERMIT ND. SWO30407 PACE 2 OF 3 DEPARTMENT uOr HEALTH ANDhHUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION 6650hon: 343-4744 ON-SITE WASTEWATER DISPOSAL SSYSTEM e, Alaska 1AND/OR e1WELLeINSPECTION REPORT LEGAL LOT 1, NEWTON S/D P.I.D. N0. O51_tee_Ic PERMIT N0. SWO30407 PACE 3 OF 3 DEPARTMENTUOFIPHEATH ANDhHUMAN SERVICES P0. Box 196650 ENVIRONMENTAL SERVICES D'''�IppVISION hon: 343-4744 ON—SITE WASTEWATER DISPOSAL SYSTEM 1AND/OR 9-6650 0 P1WELLe INSPECTION REPORT LEGAL LOT 1, NEWTON S/D P.I.D. N0. 057—tdn_la MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519.6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030407 Legal Description: NEWTON LT —1 - Design Engineer: 0003 S & S Engineering Owner Name: Shawn & Honnen McLeod Owner Address: PO BOX 671671 CHUGIAK , AK 99567-2364 11-r-0 3 /: 00 ".1Li:oo Date Issued: Sep 30, 2003 Expiration Date: Sep 29, 2004 Parcel ID: 051-144-15 Site Address: 022043 KAREN AVE Lot Size: 11700 SO. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of. ❑D Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Private Weil ❑ El Water Storage All construction must be in accordance with: I. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By. Date: 71,70103 Date: % 3 0)3 Muli icipality, bf Anchorage • �) Development Services Department �•''� " -, / Building Safely Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ek.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. d 5 1 " I A -k — 15 Permit Number SW 30407 SAA 0 tJ Z. McLEoD Property owner(s) Vk O N N 6 tl M c _e <) D Day phone Mailing address (1) P . o . B me U IkD } 1 Mailing address (2)_ C \V-%4 ak A I wilCA Zip Code 99 S to v � 1 Legal description (Lot, Block & Sub'd.) LO'}' :.. N E W -% o t1 i Legal description (Section, Township & Range) l v Ati kVM Lot Size 11. '�-o �Acfw Sq.FI. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above Information is correct. I tUrther certify, that this application is being made for a Single Family Dwelling and Is In accordance with applicable Municipal Codes. (oignazure or property owner or authorized agent) 17034 Eagle River Loop Road, No. 204 Eagle River, Alaska 99577 Permit Fees: 1/ 0d - o.. Date of Payment: cj / } S- /0 7 Receipt Number: 19 (Rev. 12/oo) Waiver tees: bate ot f Payment: Receipt Number: (,60. `I /a -s-/0 3 yk;t ;Lo/ NEALTHALrrmmry APPACNAL3 sEWEA&WATER W W ERTEMIM6 SEWER& WATER NSPECTION ENGINEERNOSTDDIES ANDREPMS WELL"crioN C FLOW TEST SITE PLANS WILTEST PERCOLATION TEST STMXTURALa ►ECIvw-AL PaPECTIONS ONSITE WASTEWATER OMP084SYSTDA DESIGN September 16, 2003 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 1, Newton Subdivision ROBERTC. COWAN. PE ROSERTA. SHAFER, PE CMLENGINEERS (907)694.2979 FAX (907) 694.1211 It is requested that you issue a permit to upgrade a septic system to serve the existing four bedroom dwelling on the referenced property. Two test holes were excavated and percolation tests were performed on 8/16/85 & 10/26/02. The approximate locations of the test holes are located on the attached site plan. At the time of excavation ground water was not encountered, and after monitoring 'the test holes for seven days they were found to be dry, as shown on the attached soils logs. We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerely, Vbert ? RCC/bj j Enclosure 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 Performed For: / Legal Description: G Depth 5- 6- 7- .0 Municipality of Anchorage Development Services Department eugdmg Safety Division On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519b650 www d anchorace.ak.us "7)343-7004 Soils Log - Percolation Test 7 4C- C-0 o T / /✓� n/ rb.� s /' Y1:SGP.oLrIDY1ATER /I /O U ENCCUMZ-7.07 � V S IFYES•ATV%ATDEPTIr! �� L O D<plS to Yhler Alter p klonhoring7 E p, ROBERT C. COWAN CE -6301 t �' ....... _ ••�. Ji" -,j Dale Pedortned: 1!0 2G• Il rlan r -- Reading Date Gross Time Net Time Depth to Water Net Drcp 10 o s 6- 3 1 0 1 0 14 10 l ro 10 PZ:t::c1L4TIC1I PME - 1 I - t-1^��n l FERC F.CLE OW.I=TER (L TEST F.L•N SINE°N C2 FT ANO FT COMMENTS PERFORIMED BY: Lj rJ6lN��izl Nl—. I CERTIFY THAT THIS TE ST WAS PEP.FOR?,IED IN ACCO :.NCE WITH ALL STATE ASD LIUNICIPAL GUIDELINES IN EFFcCT ON THIS DATE. DATE: 20 0 3 • ` \.J K SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION 926 L. Street, Anchorage, Alaska 99901 264.4720 TEST SOILS LOG — PERCOLATION TEST PERFORMED FOR: `�Nc'%f /J ftre CO)s •Mq c�'r ns- DATE PERFORMED: fIZYG /,I5 - LEGAL DESCRIPTION: /O f ( Newfo.. S4 Ze,✓ 7'/,y N /c /W 're C F V.Ayr,H. SLOPE SITE PLAN egg-ANrc 7opf•/I 1a Date VP ff,1. 15-*:a3uD Depth to Water Net Drop ���~• moi. -'LS 17 ����ILiI Louis A. Culera (r.'. • CC -6736 W 20 v art aat�• y. PEA6ALATION RATE o ��Q✓C. (miwhMelinclaL_ TEST RUN BETWEEN FT AND /5. FT COMMENTStt�g roA '".Aa 4yQ �/. yryre.e., r;.t q,z(e N >< 7` Iva t.•( -OT i16,(✓. Lfi.+. CKS s � wr� �'r �� 'S '/ r i , PERFORMED BY:------ E4oAv#F_F"flag j,,vkS__CERTIFIEO BY: a 7'cCi]-to DATE: .7/tS p F. 0. hex 773291 E201111 (liver, AK 99571 7z-ooe 14/791 694.5195 WAS GROUND WATER ENCOUNTERED? - Vol IF YES, AT WHAT DEPTH? .- -Prr Flooding Date Gross Time Time Depth to Water Net Drop ■I ����ILiI '■ .- -Prr Flooding Date Gross Time Time Depth to Water Net Drop ROBERT C. COWAN, P.E CML ENGINEERS (907)694-2979 FAX (907) 694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM HEALTH4RHOTRY APPROVKS CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS SEWERSWATER M4NEXTENSIONS REFERENCE: Lot 1, Newton Subdivision September 4, 2003 SEWERS WATER INSPECTION GENERAL: 1. The scope of this project includes the verification or replacement of the ETR7NEMINGSn1pES existing 1250 gallon septic tank and installation of - a - new trench to ANDREPORTS upgrade the septic system at the residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design "UMPECTIM drawings, Municipal permit with any special provisions or conditions, and all SFLOWTEsr applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground SITE PLANS utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible ROADDESIGN for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing SM TEST their own systems must also receive prior approval from the Municipal Health Department. rERC«ATMN SEPTIC TANK INSTALLATION: TEST 1. A septic tank is to be constructed by a certified septic tank manufacturer. �S Construction shall include two 4" cleanouts for pumping access. Wa INSPECTIONS 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. ONSITE WASTEWATER OSPCGKSYSTEM DESIGN 17094 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RNER, ALASKA 99s77 Page 2 Lot 1, Newton SID September 4, 2003 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 fl. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 fl. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCHIDRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression afler settling. Page 3 Lot 1, Newton SID September 4, 2003 MIN11IUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pip Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mira£ 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: Page 4 Lot 1, Newton 31D September 4, 2003 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to cant' out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTORANSTALLER Municipality of Anchorage Mark Begich, Mayor Buildi11g Safety Dhisioll P.O. Box 196650 • 4700 Braga«• Strcct Anchorage, Alaska 99519.6650 • (907) 343-8301• Fax (907) 343.81-00 I'ttP://%ms"w.muni.org 9/26/2003 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, AK 99516 Subject: Waiver Request for Alpine Terrace Block 3 Lot 1 Waiver Request flWR030084 Parcel ID 4015-243-10 Dear Ted Moore: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is o� 1..0 feet. This waiver approval applies to the existing absorption field to property line 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 343-7904. Sincerely, '//- ' R'7 Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: 030083 PID#:051-144-15 HAM Date Received: 9126103 Legal Description: Newton Lot 1 Engineer: S & S Enaineerina 17034 North Eaale River Loon Ste 204 Applicant: Shawn & Hennen McLeod Permit#:5--��'�' m-1 Waiver Requested: 2 foot separation distance from the Trench and the West Lot Llne of the Property Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: Waiver is not Granted: List Conditions or Reasons for above: Sr" r EvG� &kie s L EaE2 air— Date: F Date: 9/ --7- /V 3 By: VII AI Name of Reviewer .......... on........................, Rec#: 42201 Amount: $150.00 Date Paid: 9/2612003 S& WALTHALITHOR Y APPROVALS SEWER 6 WATER ►LNNEXTENSIONS SEWER & WATER INSPECTION ENGINEERINGSTLAIES ANO REPORTS WELL INFECTION t FLOWTEST SITEPNS ROAnOESIGN S0R TEST PERCOLATION TEST STRUCTURAL& WCIwaCAL INSPECTIONS ONSITE WASTEWATER OtSPOSALSYSTEM DESIGN ROBERT C. COWAN, P.E CML ENGINEERS (907)694.2979 September 18, 2003 FAx(907)694-1211 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, Alaska 99519 REFERENCE: Lot 1, Newton Subdivision Request you grant the following waiver for the existing four bedroom house on the referenced property: a waiver for the separation distance from the proposed trench and the west lot line of the above referenced property at two feet. The mitigating factors involved which support the issuance of the waiver is as follows: The existing drainfield crib is saturated and an alternate system needs to be installed for the existing four bedroom house. 2. Existing well radii on the above referenced property and surrounding properties limit the area in which a new wastewater system can be installed to an extremely small area on the south end of the above referenced lot. 3. There is insufficient space to install a new drainfield without the requested waiver. We, therefore recommend a waiver for the separation distance between the proposed trench and the west lot line at two feet. We do not anticipate any adverse effects on the neighboring properties by the granting of this waiver. If you have any questions, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/jhm 17034 NORTH EAGLE RNER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION ` 825 L Street • Anchorage, Alaska 99501 Telephone 264-0720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE n Lc VA - �PP+r/e%� li %Y'fJu7 sONEW pyUPGRADE MAILING ADDRESS SR l — 13ox 0-2s,7 of rc-.c...rtic/ C-4 i<!r LEGAL DESCRIPTION Lit / AJe.,.✓ro.., T/SN iC LOCATION NO.OF BEDROOMS DISTANCE TO: Well / 6..✓ 70 Absorption area / Dwelling / �' PERMLT NO. D Y Aixer R. ♦ /DO O., ,T 1-ZManufacturer C/r FJNr'�' Material fc No. of compartments N~ CO.sc re Liq, capacity in gallons /3 So IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. -102 Oz Manulacturer Material Liquid capacity in gallons DISTANCET0: Well /0d t Foundation / Nearest lot line PERMIT N0. , = Z No. of lines / Length of each line Total length of lines Trench wid / Distance Ixty+een lines 1- Top of the to finish grade / Material beneath tile Nehe! Total eff live absorption area FY" s6 Length Width Depth PERMIT NO. W 0 i /- to d Type of crib Crib diameter Crib depth Total effective absorption area a DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. J DISTANCE T0: Building foundation Sewer line Septic tank Absorption area(s) OTHER we / PIPE MATERIALS si %v..e.! P. vc . .3 ✓ z � � 79 SOIL TEST RATING INSTALLER REMARKS 0 -- a v .�. ..:,^fed M 770 CJ CZ -67'36 fir" �L`�OFESSIO'�?P� s .r APPROVED /DATE LEGAL ��� k'/�S- Lot s..6 � /Vew7a/✓ ./. 7[-013 (Hev. 317B) ANCIIORAGEI /--�l1UHealthLInd OF ironmenta. / Department �f Health and Environments. Protection Pouch 6-650, Anchorage, AK 99502 n w� 264-4720 On-site Sewer/Ww*sr Permit HANDWRITTEN Permit No: Scm g!a>So10 / iPG2//-Z_�E Date Issued:�- /(e -FAQ /� Applicant: l 4t'te- C '604-7c"z- 6 10�7�77A,4 Address: !P 0,, / Sy / E ./C. , //� Legal Description: S/D: NEte)i-_DDa/ Lot: / Block: I iy Section: / Township: /S'y Range: / to Lot Size: d• 2-74 (Sq. Ft. or Acres) Lot Location: Max Bedrooms: Listed below ar t e options available to you in designing system. Choose the option that best fits your site. ----------------------------------------------------------- Depth to pipe bottom(ft.) Gravel depth (ft.) Total depth (ft.) Gravel width (ft.) Gravel length (ft.) Tank size (gal.) Soil rating (sq. ft./br) TRENCH BED y o/ s' O > '7- -rFr 2.S � 8s' your septic W. DRAI ** Gravel length 75 feet requires multiple runs (not exceeding 75 feet eacl ** Tank must have at least two compartments ---------------------------------------------------------------------------- I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage(MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for the maximum number of bedroc stated above, and any enlargement or modification will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, TIIE1 (1) AN ELECTRI,L PERMIT AND INSPECTION MUST BE OBTAINED;'(2) AS-BUILTS WILL NOT BE APPROV p WITHOUT AD/ ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL W K MUST BE dN& A A LICENSED ELECTRICIAN. SIGNED: Applican DATE: ISSUED B Y : '� l_5�11yt �t DATE: SWP/024 rev.1/85 F- /6- PSS r SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 82S L. Street, Anchorage, Alaska 99501 2641720 TEST \ SOILS LOG — PERCOLATION TEST PERFORMED FOR: 617 &f `-k /-� a rr• �Cn. �rS c.isr_^s' DATE PERFORMED: /G , LEGAL DESCRIPTION: Lot / /Ver.✓f•r S4 6e,✓ 1v /a /w re r- 2- 3- 4,- 5- 6- 7 234 -567 8 9� .�'•' 10 ..o 11 D. 12 `.d 13 oie GAW4 TPr.d Gw 5 •..�.! r,.�(1 14- 4 Date Gross Time is - 15- Depth to Water r �. r, c u � •a PEF606AilON RATE O (rwiwuta.Fiwch)_ 16 TEST RUN BETWEEN .� � . `.� PTT e, r % r%+ a; ....... .... �c Fr r r t�i2 PERFORMED BY: CERTIFIED Louis A. Culera DATE: 51111KAL +� �• CE -6736 Eaple River. AK !"577 FA SLOPE r. WAS GROUND WATER ENCOUNTERED? _IJO IF YES, AT WHAT DEPTH? r Reading Date Gross Time Net Time Depth to Water Net Drop PEF606AilON RATE O (rwiwuta.Fiwch)_ TEST RUN BETWEEN FT AND /T. FT COMMENTSihCcrc;A 7£ i *A, •.. e?P;yr-G-c•.ce_ r%+ o{ 47 Arv, Lt. cce �c Fr r r t�i2 PERFORMED BY: CERTIFIED BY: '65� ?zr DATE: 51111KAL /. 0. Mz 773214 Eaple River. AK !"577 20 .I I U v ��r�a�--.o 0040'dp J f S,-��Q�C. PEF606AilON RATE O (rwiwuta.Fiwch)_ TEST RUN BETWEEN FT AND /T. FT COMMENTSihCcrc;A 7£ i *A, •.. e?P;yr-G-c•.ce_ r%+ o{ 47 Arv, Lt. cce �c Fr r r t�i2 PERFORMED BY: CERTIFIED BY: '65� ?zr DATE: 51111KAL /. 0. Mz 773214 Eaple River. AK !"577 72-008 (6/79) 694-5195 r Sy SZ.v . / .f Y' 4n Y�Ytsl P.r.S ;4iw� fy as 1 dec/rve..n eu�•o: fJtr u A rr + fK Gri�/n5 4,p }� �H r.. fys �C �•. -3�2� �... rS _ 7f-4 i. K %+ri J '� A lT G f % l� �7'►++- --e-e . William It. Newton rental property Township 15, section 9, lot 1 of lot 115. Water well for domestic use. Drilled in March 1969. Size of casing ---- 6" steel. Depth of hole 991. Cased to 99'. Finished well open-endo Stdtic water level below ground --- 89'. Well pumped at rate of 10 gal per min. for 24 hour,.. No aw dotvn. Depth in feet from surface: 0' to 18' gr,vel 18' to 47' Hard pan 471 to 52' sand & clay 521 to 641 Dort clay 64' to 961 hard pan 96' to 9816" water bearing sand & gravel 98'6" to 99' Coarse gravel (Nater bearing) L � n'kn a SEPTIC TANK: DISTANCE FROM ZR ANCHORAGE AREA BOROUGH HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 2.1-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM �1� 11/ i L.iu'-7ir 410 LIQUID CAPACITY � �) GALLONS. INSIDE LENGTH INSIDE SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITSOUTSIDE LINING MATERIAL I NEAREST LOT LINE TILE DRAIN FIELD: t1,W a7: HONE NUMBER OF AM I OR WIDT/H/� IENGTH ��EPTH--- . DISTANCE FROM WELL /!� / , BUILDING' FOUNDATION, TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) a R9 O SO. FT. 70TAL LENGTH DISTANCE FROM WELL , FOUNDATION , NEAREST LOT LINE , OF LINES NUMBER OF LINES DISTANCE BETWEEN LINES TRENCH WIDTH IN. TOTAL EFFECTIVE ABSORPTION AREA SO. FT. LENGTH OF EACH LINE DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE WELL: TYPE DY -11110a DISTANCE FROM zj-9 1 WATER DEP%TH/f�. BUILDING FOUNDATION.�L % SAMPLE NEAREST NEARELOT LINE o-�`S / , SEWERS LINE_S7ANKSEPTIC 7� / , SYSTEMSEEPAGE //,,//'' OTHER �. .__!(L.L, CESSPOOL , SOURCES_ DIAGRAM OF SYSTEM DISTANCES: DATE 4� I I I.. I 7 -i.I I GAAB-UD•2 GREATE) tNCHORAGE AREA JROUGH •' ' IIEALTII DEPARTMENT 327 Eagle St. Anchorage, Alaska 99501 279.2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT Case No. /z NAME OF APPLICANT � _ �N.+ i MAILING ADDRESS HONNO. RESIDENCE ADDRESS �^ LOCATION OF INSTALLATION ` LEGAL DESCRIPTION_— �G 9 APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PIT �, DRAIN FIELD , OTHER TO SERVE THE FOLLOWING FACILITY FINANCED THROUGH TO BE INSTALLED BY_ PERCOLATION TEST RESULTS jrilANTICIPATED DATE OF CO BELOW TO BE FILLED OUT BY HEALTH DEPARTMENT • J, THIS IS TO SERVE AS PERMIT TO INSTALL A AS DESCRIBED BELOW. SIZE OF UNIT TO E SERVED . SEPTIC TANK SIZE 75n TYPE al SEEPAGE AREA 2 $8i7 TYPE m DIAGRAM OF SYSTEM Q)'8y4 Q,,,c-6 DISTANCES: N11V Ac Authority I certify that I am familiar with the requirements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the above described system is in accordance with said code. DATE `S� APPLICANTS SIGNATURE, Municipality of Anchorage 1 Development Services Department Building Safety Division On Site Water Wastewater Program B 4700 ragaw Street /r) P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. COSA# QVDAq&l 1. GENERAL INFORMATION Expiration Date: 10 124 0(9 Complete legal description NEWTON SUBDIVISION: LOT 1 Location (site address) 22043 KAREN AVENUE • CHUGIAK, AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address SHAWN do HONNEN McLEOD Day phone P.O. BOX 671671 • CHUGIAK, AK 99567 Day phone 688-8456 Real Estate Agent DAR WALDEN w/REMAX PROPERTIES Day phone 257-0409 Mailing address 110 W. 38th SUITE 100 • 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 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Welt ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system fs(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, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 7 S V6 Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provido 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. S. DSD SIt;NATURE 7 Approved for — bedrooms. Disapproved. Conditional approval for bedrooms, with the flowing Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory `\lttctE AN $ • �NSRP �R Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other By: t – ,-- &), Original Certificate Date: In. I'M Municipality of Anchorage ' Development Services Department Buildup Safety Division On -Site Water 6 Wastewater Program 4700 Bragaw Street P.O. Boz 196650 Anchorage, AK 99519.6650 www.muni.org/onsib (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: NEWTON SUBDIVISION: LOT 1 Parcel ID: A. WELL DATA ' WELL DeePt7rM 3/30/2000 Well type FWAn If A, B, or C provide PWSID# N/A Date completed 3/1969 Sanitary seal (Y/N) YES Total depth *178 ft, Cased to 177.3 R. FROM WELL LOG Data of test 3/1969-3/30/2000 Static water level 89 ft. Well production 10-4 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 6/13/2006 99 R. 5.4 g.p.m. Coliform 0 colonies/100 ml. Nitrate ND mgJL. Other bacteria 0 colonies/100 mi. Arsenic: ND ug./L. Date of sample: 6/13/2006 Collected by: • GEG Ltd. B. SEPTIC/HOLDING TANK DATA 'FOUNDATION CLEANOUT INSIDE FOUNDATION Tank Type/Material SEPTIC/CONCRETE Date Installed 6/1969 Tank size 1250 gal. Number of Compartments 1 Cteanouts (YIN) YES Foundation deanout (YM) 'YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/22/2006 Pumper JR's PUMPING C. ABSORPTION FIELD DATA Date Installed 11/5/2003 Soil rating .p.d. ftWdrm) 1_2 Length 48 ft. Width 3 ft. System type DEEP TRENCH Gravel below pipe 7 ft. Total depth 010.9 ft. Eff. absorption area572 R' Monitoring tube "YES Depression over field NO Data of adequacy test 6/13/2006 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 4 M. Water added 705 gal. New depth 12 in. Elapsed Time: 330 min. Final fluiddepth 4 in. Absorption rate >-- 600+ g,p,d, Any rejuvenation treatment (past 12 moi (YM & type) NONE KNOWN If yes, give date — "MONTTERING TUBE ON EAST SIDE OF OLD TRENCH NOT FOUND D. LIFT STATION Date installed "Pump on" level at _in. Datum E. SEPARATION DISTANCES Size in gallons "Pump High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Iift station on lot *69 Absorption field on lot too '+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots "'80' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line "2. Building foundation 10'+ Water main 10'+ Water service line t 0'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ COMMENTS *SEPTIC TANK INSTALLED IN JUNE OF 1969. 40#WR030084 *••SEE ATTACHED WAIVER REQUEST G. ENGINEER'S CERTIFICATION I certily that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidednes in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date -719/a6 COSA Fee i Waiver Fee E Date of Payment 7 D (a Date of Payment Receipt Number (') L a DU Receipt Number (Rsv. 11105) NEWTON COURT- --N E39 571 E. 90.00 DWELL 12 •o to ANCHORAGE RECdipNG DISTRICT. ALASKA AND THAT THE NFOiAWTON HEREON IS FOR THE USE OF LENDING NSTTTLRIONS SPECIFICALLY TO SNOW ANY CONNCTS BETWEEN O PL "ISTING STM.CTURES MD PLATTED LOT LINES OR EASEMENTS MO IS NOT TO SE USED FOR POSRONING ADOITIONAL WITHIN THE WOPERTY LINES ANDNOWBIBLE STRUCTURES OR FENCELNES ENCRO�LIMENTS OUST OTHER TWIN NOTED. N O NOTE AHYFENCELNESSNOVMMELO MDAPPRONMATELYAHOA WTTOSEUBEDTODETERMNEPROPERTYLINES 0 ❑ TEL 26&5614 Q FITwAL•wAr T'l C] W 13 3 17 2 STORY o O OFRAME SLOG. = N R m ❑ TIP • p N aD.D � Rp L DECK S � 1 ` f y • O � w < -------------------- T D•MTLFTY K111WT. N 69 57' E 90.00 0000�4p� o pF q 4� 0 .... .. i?9 TH Qa 4—* .•:'�di ) .1 SHANE A. HOLT: j KAREN AVENUEdO�n,'e' L96B,4 ^000` AS-BULT SURVEY (NO CORNERS SET THIS DATE) 1'-W I WREBY CERTIFY THAT I NAVE PERFORMED A MORTGAGEES NWECTON Of THE FO CwW DESCRIBEOWOFERTY LOT 1, NEKTON we. ANCHORAGE RECdipNG DISTRICT. ALASKA AND THAT THE NFOiAWTON HEREON IS FOR THE USE OF LENDING NSTTTLRIONS SPECIFICALLY TO SNOW ANY CONNCTS BETWEEN TE VISIBLE NPRO WNTSNTWTED THEREON ARE PL "ISTING STM.CTURES MD PLATTED LOT LINES OR EASEMENTS MO IS NOT TO SE USED FOR POSRONING ADOITIONAL WITHIN THE WOPERTY LINES ANDNOWBIBLE STRUCTURES OR FENCELNES ENCRO�LIMENTS OUST OTHER TWIN NOTED. EASEMENTS OF RECORD. OTHER T THOSESHDWN ON THE RECORDED RAT. ARE NOT SHOWN HEREON ILRIESS•O WD) DATEDATANCHORAGE. AIAWUTNISJITN_ NOTE AHYFENCELNESSNOVMMELO MDAPPRONMATELYAHOA WTTOSEUBEDTODETERMNEPROPERTYLINES DAYOF ,ANE 2006. NOLT LAND SR -NW iLOIN. Ff5 T2&?2 CRL mSTRUCTURES TEL 26&5614 ANY PAVING NEI VAI WY BE AFPR0X0 TE DUE TO SHOW CONOTTONS 0 06/27/2006 09:14 9073449821 f■ i■ ■r ■r JRs Pumping PO Box 773415 Faille River, AK 99577 (907) 694-8434 BIIIina Information Gamess Engineering Group 3701 E Tudor Road Suite 101 Anchorage, AK 99507 (907) 337-6179 Meagan & Kris Job Site Information Benny 22043 Karen Ave Chugiak, AK 99587 (907)337-6179 Additional Location Comments Beige w/Green Trim Pipes @ Front yard septic C left side of home Inside fence Service Type Septic Service 15K Show -up Fee Due to Dogs 00/20 JRS SEPTIC Job Description: 10009 P.O. Number: Tome: Net 30 Salearep: Map Boric: Cross Streets: Job Commants: Kadla Steffes Street PAGE 01 Service Agreement Number. 020179 Order Date: 19 -Jun -2006 Service Date: 22 -Jun -2006 12:00 Technician: Gene Tu S:: 0 Job Type: Repeat Map Odd: 35 - - 11/07/2003 10009 p and checked tank solids - BF 2 X's Diagram: S'%Qiaar_ ssQt79_bmo H IL City Price Each Tax? 1 $135.00 No 1 $50.00 No Gallons Planned: 1000 Gal. Actual: Hose Length: Double Tank: O Pump System: O Baffles Inlet: O Baffles Outlet: O Extension Actual $135.00 $50.00 NonTaxoWTotal Taxable Total Tax Total Grand Total Eatimaled Charges: $185.00 $0.00 $3.00 $185.00 Actual Chargee: Customs agrees b the bans and condtoons shown, THIS IS A BINDING AGREEMENT. Signature end Tula or customs, Roprosentati m Date Accepted by JRs Pumping Date Accepted For your added convenience we, accept Ammican Evress, Dlcover, Visa and Mester Card payments over the phone, After 30 D" accounts will be turned over to collections. $25.00 For NSF Chocks Resumed. NMI SGS Refit 1063011001 All Dates/Times are Alaska Standard Time Client Name Garness Engineering Group, Ltd. Printed Date/Time 06/232006 9:19 Project Name/# Lot I Nasvton SD Collected Date/Time 06/122006 14:20 Client Sample ID Lot I Newton SD Received Date/Time 06/132006 11:44 Matrix Drinking Nater Technical Director Stephen C. Ede Sample Remarks: ND 20.0 ug/L EP200.8 C 06/14/06 06/16/06 SCL Antimony ND 1.00 Allowable Prep Analysis Parameter Results PQL Units hlettwd Container ID Limits Date Date lnit Nitrate -N ND 0.100 mg/L EPA 353.2 D 06/13/06 ALR Nitrite -N ND 0.100 mg/L EPA 353.2 D 06/13/06 ALR Metals Department I lardness as CaCO3 30.8 5.00 mg/L SM20 234011 C 06/14/06 06/16/06 SCL Private Individual Analvsis Aluminum ND 20.0 ug/L EP200.8 C 06/14/06 06/16/06 SCL Antimony ND 1.00 ug/L EP200.8 C (<6) 06/14/06 06/16/06 SCL Arsenic ND 5.00 ug/L EP200.8 C (<10) 06/14/06 06/16/06 SCL Barium ND 3.00 ug(L EP200.8 C (<2000) 06/14/06 06/16/06 SCL Cadmium ND 0.500 ug/L EP200.8 C (<5) 06/14/06 06/16/06 SCL Calcium 5270 500 ug/L EP200.8 C 06/14/06 06/16/06 SCL Chromium ND 1.00 ug/L EP200.8 C (<I00) 06/14/06 06/16/06 SCL Copper 1.20 1.00 ug/L EP200.8 C (<1300) 06/14/06 06/16/06 SCL Iron ND 250 ug/L EP200.8 C (<300) 06/14/06 06/16/06 SCL Lead ND 0.200 ug/L EP200.8 C (<15) 06114/06 06/16/06 SCL Magnesium 4290 50.0 ug/L EP200.8 C 06/14/06 06/16/06 SCL Manganese 2.22 1.00 ug/L EP200.8 C (<50) 06/14/06 06/16/06 SCL Phosphorus ND 200 ug(L EP200.8 C 06/14/06 06/16/06 SCL Chloride 3.68 0.100 mg/L EPA 300.0 D (<250) 06/16/06 06/16/06 DSII Fluoride ND 0.100 mg/L EPA 300.0 R (<2) 06/16/06 06/16/06 DSII Potassium ND 500 ug/L EP200.8 C 06/14/06 06/16/06 SCL Selenium ND 5.00 ug/L EP200.8 C (<50) 06/14/06 06116/06 SCL Sodium 30300 500 ug/L EP200.8 C (<250000) 06/14/06 06/16/06 SCL Silicon 5390 200 ug/L EP200.8 C 06/14/06 06/16/06 SCL Silver ND 1.00 ug/L EP200.8 C (<100) 06/14/06 06/16/06 SCL Thallium ND 1.00 ug/L EP200.8 C (<2) 06/14/06 06/16/06 SCL Sulfate 11.7 0.100 mg/L EPA 300.0 D (<250) 06/16/06 06/16/06 DSI I SGS RcEN 1063011001 Client Name Gamcss Engineering Group, Ltd. Project Name/# Lot 1 Nc%%Ion SD Client Sample ID Lot 1 Newlon SD Matrix Drinking Water All Dates rimes are Alaska Standard Time Printed Date rime 06232006 9:19 Collected Date2'ime 06/122006 14:20 Received Date/time 06/132006 11:44 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units hicthod Container ID Limits Date Datc snit Private Individual Analvaia Total Dissolved Solids 140 Zinc ND Nickel ND I ICO3 Alkalinity 100 CO3 Alkalinity ND 011 Alkalinity ND Conductivity 230 PI I 8.48 Alkalinity 104 Total Coliform 0 10.0 mg/L SM202540C D (<500) 06/14/06 PLW 5.00 ug/L EP200.8 C (<5000) 06/14/06 06/16/06 SCL 2.00 ug/L EP200.8 C (<I00) 06/14106 06/16/06 SCL 20.0 mg/L SM202320B D 0620106 PLW 20.0 mg/L SM202320O D 0620106 PLW 20.0 mg/L SM202320B D 0620/06 PLW 1.00 umhos/cm SM2025100 D 06/13/06 KP 0.100 pl I units EPA 150.1 D (6.5-8.5) 06/13/06 KP 20.0 mg/L SM202320O D 0620106 PLW col/100ml. S%12092220 A (<I) 06/13/06 TLF snoSGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM IDS '�fZIFUNATE WATER SYSTEM Send Rem S_11= SAMPLE COLLECTION: Date: Q -3 6J �GO awa a" V. ❑ Send Reaulls SAMPLE TYPE Transported to Lab By. ❑ Same a3 collector Other. TO BE COMPLETED BY LABORATORY Sample Receivinn: Date: Time: Delivery Method: Received By. Comments: Baeteriolonieal Water Analysis Record: Anaysls Began: i // 31010 /AiA6 Analyst: `T1- Analytical Method: Membrane Filter MMO-MUG (P/A) Reported By: bpoWn ❑Sample,o 30ho rs DId: ResWa may be untenable For Remote Laca%" 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Fax 907.561-5301 Lab Ref NM t�osaop11ry-VV AMA1� (ISend Invoke. Pl�outine ❑ Treated Water ❑ Repeat Sample Untreated Water (refer to lab no. 1 ❑ Special Purpose ❑ RUSH SAMPLE Phone #: Fax #: MMO-MUG (PIA) RESULTS: Total Conform: E. Coe: MEMBRANE FILTER RESULTS: DIMCI CDunt CoWAWOOML Veditadm ro. nt AOEC: ANC FBK NN ine: Sent to alant Phoned Q Faxed Q DatarMa' Spokewtlh: rr arm • LTB' SGB d-6atisfactory r,.,0.. { EG ❑ Unsatlsfactory _— rxre•r»a».v.+re.r Datomme: — /G '06 _�G: r o u•oo«a.dw Fomt # FW -0053 12/17/03 \Wsesimsol"V GroupData\Put5c\D000MENTIFORMSIappmedlCoO Form 121703.tds a•°a :?7 MADS F�Nu�N Gq atw W. SAMPLE COLLECTION: Date: Q -3 6J �GO awa a" V. ❑ Send Reaulls SAMPLE TYPE Transported to Lab By. ❑ Same a3 collector Other. TO BE COMPLETED BY LABORATORY Sample Receivinn: Date: Time: Delivery Method: Received By. Comments: Baeteriolonieal Water Analysis Record: Anaysls Began: i // 31010 /AiA6 Analyst: `T1- Analytical Method: Membrane Filter MMO-MUG (P/A) Reported By: bpoWn ❑Sample,o 30ho rs DId: ResWa may be untenable For Remote Laca%" 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-562-2343 Fax 907.561-5301 Lab Ref NM t�osaop11ry-VV AMA1� (ISend Invoke. Pl�outine ❑ Treated Water ❑ Repeat Sample Untreated Water (refer to lab no. 1 ❑ Special Purpose ❑ RUSH SAMPLE Phone #: Fax #: MMO-MUG (PIA) RESULTS: Total Conform: E. Coe: MEMBRANE FILTER RESULTS: DIMCI CDunt CoWAWOOML Veditadm ro. nt AOEC: ANC FBK NN ine: Sent to alant Phoned Q Faxed Q DatarMa' Spokewtlh: rr arm • LTB' SGB d-6atisfactory r,.,0.. { EG ❑ Unsatlsfactory _— rxre•r»a».v.+re.r Datomme: — /G '06 _�G: r o u•oo«a.dw Fomt # FW -0053 12/17/03 \Wsesimsol"V GroupData\Put5c\D000MENTIFORMSIappmedlCoO Form 121703.tds O Mayor Mark Begich YlunicipaUty of Anchorage M). lkix VC650 • Atnchnrnge, Alaska • Telephone (i1(7) 343.8301 • Fax (!1)7) 343-Klm 471M)1lml;.nc SInc1 • Atnchnmgc, Alaska!MI,i117 July 12, 2006 mim.muni.org Building Safety Diiosion Jeffrey Garness, P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Subject: Waiver Request for Newton S/D Lot I Waiver Request WR#: 060030 Parcel ID # 051-144-I5 IIA060292 Dear Jeffrey Garness, P.E.: Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 80 foot horizontal separation distance waiver from well on Newton S/D Lot 2 and septic tank on Newton S/D Lot 1. This waiver approval applies to the existing septic tank to private well 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 343-7904. Sincerely, 0 odall -nginccr On -Site Water & Wastewater Program Community, ty, Security, Prosperity , e C� LK State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3,1985) Waiver Request for: Newton S/D Lot 1 ParcelID#: 051-144-15 Waiver Request Number WR#: 060030 Waiver Requested: 80 foot horizontal separation distance waiver from well on Newton SID Lot 2 and septic tank on Newton S/D Lot 1 Engineer: Jeffrey Gamess, P.E. IIA060292 SeDtic Tank Data The septic tank was installed in 1969 and the well was installed in 1981. The well has encroached the septic tank for over 20 years and the water samples are with -in municipal standards. The approximate septic tank depth is 10 feet below ground surface. Well Data The well is 178 feet deep with the casing approximately the same depth. Water samples show nitrates, coliform, other bacteria to be with -in municipal standards. Municipality of Anchorage \\ Development Services Department 1 Building Safety Division On -Site Water and Wastewater Program 4700 Bmgaw Street P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchoragc.ak.us (907)343-7904 Waiver Review Worksheet WR#:060030 PION; 051-144-15 HA/Permit# IIA060292 Date Received: July 12, 2006 Legal Description: Newton S/D Lot 1 Engineer: Jeffrey Garness,P.E. Garness Engineering Group 3701 E. Tudor Road, Suite 101 Anchorage, AK 99507 Applicant: Shawn McLeod Waiver Requested: 80 foot horizontal separation distance waiver from well on Newton S/D Lot 2 and septic tank on Newton SID Lot 1 Criteria: Geology Points: A. Water Table 7.36 B. Soil Sorption 3.24 C. Permeability 2.39 D. Water Table Gradient 2.00 E. Horizontal Separation 2'2 Total: . _ ...17.190 .......................................................................... Waiver is Granted: X Waiver is not Granted: List Conditions or Reasons for above: Date:/117 /06 By: Joe Goodall Name of Reviewer Rec#: Amount: $QQO Date Paid: 7/12/2006 State of Alaska: Separation Distance Waiver Guidelines for S.C.R.O. (State of Alaska Memorandum to District Office Engineers dated January 3,1985) Waiver Request for: Newton SID Lot 1 - ParcellD#: 051-144-15 j Waiver Request Number WR#: 060030 Waiver Requested: 80 foot horizontal separation distance waiver from well on Newton SID Lot 2 and septic tank on Newton SID Lot 1 Engineer: Jeffrey Gamess, P.E. IIA060292 Water Table Points ,," Depth of well: 178 7.36 Depth of septic system: 10 168 Distance from the bottom Point Clean Gravel of the system to the highest Value 1 water table In feet 1.5 Sand w/ Small Amt of Clay 0 0 8 1 17 2 24 3 30 4 40 5 85 6 100 7 290 8 1000 9 10 • Straight line Interpolation Is permitted between any two values Soil Sorbtion Points 3.24 Soil Type I Point Value Clean Gravel 0 Fractured Rock 1 Course Clean Sand 1.5 Sand w/ Small Amt of Clay 2.5 Silt 3.5 Clay and Sand Equal 4.5 Clay 6 42 168,2.5 +[ 68, 23 6 + f 31 l 68 + ( 68,4.5 + f 1fi8, , + [ 168, + r 12 13.5 168 + [ 168, 0 0.6 + 0.8 + 0.2 + 0.3 1.3 + 0.1 + 0 + 0 *Use the predominant soil type but values can be averaged for a mixture Permeability Soil Type Point Value Clay(will channel) 0 Silt and Sandy Clay 2 Clayey Sand 3 Fine Sand 1.5 Sandy Gravel 1 Fractured Rock 0.9 Course Sand (30 grit) 0.4 Clean Gravel 0 Points ois 2.39 42 Ll 68, 3 + 23 168. 3 + ( 681 .9 + ( 16281 2 +� 48 68j 3 +r 112G81 .9 + 168, 1 + f 168 J, 1 0.75 +0.41 +0.17 + 0.14 0.86 + 0.06 + 0.00 + 0.00 'Use the predominant soil type but values can be averaged for a mixture Gradient �� -30% 0.3 Separation -20% 0.7 slopes toward well -10% 1.2 J} 25 -5% 2 1 0% 2.91- Oat 5% 4.51 5 10% 6 slopes away from well 60% 7 'If the gradient Is unknown, assume the worst case Horizontal Horizontal Point Separation Value In Feet 0 0 25 0.7 50 1 75 2 100 3 150 5 200 6 300 7 Points 2.00 Points ait 2.2 "Linear Interpolation between two point value Is acceptable. Horizontally means straight line distance to the well not the contaminate travel distance to water table which may be greater. Conclusion: Grant Waiver Total Points: 17.190; GARNESS ENGINEERING GROUP, Ltd. •� CONSULTANTS & GENERAL CONTRACTORS July 5, 2006 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request for Newton Subdivision; Lot 1 The existing 4 bedroom house is served by a private well and septic system. On 6/13/06 a site visit was done in order to obtain a COSA. During the site visit the separation distance was measured from the septic tank on Lot 1, Newton Subdivision to the well on Lot 2, Newton Subdivision and was found to be 80 feet. Based upon our conversation with your department a waiver is required. We request you grant an 80 foot separation distance waiver from the well on Lot 2 to the septic tank on the referenced property. The septic tank was installed on 6/1969, and the well on Lot 2 was drilled in approximately 1981. Since the septic tank was installed prior to the well on Lot 2, the owner of Lot 2 is responsible for paying the waiver fee. The following items are justification for the waiver: • There is a drainage ditch between our septic tank and the well on lot 2, and if the tank was to overflow, it appears that it could not run towards the well head. • The location of the septic system is in a very visible area so that if any effluent was to surface, it would be noticed and the problem corrected. The other path of contamination is subsurface migration of wastewater should the tank begin to leak. Recent water sample results for the well on Lot 2 indicated nitrate levels to be non- detectable and coliform bacteria results to be 0. Attached are well logs from surrounding properties. The depths range from 86 to 440 feet. The static water levels range from 40-100 feet below grade. The aquifer is confined below layers of silty clay, clay, and silt that have prevented untreated effluent from reaching the aquifer. This encroachment has existed for 25 years with no adverse impact. Based upon the aforementioned facts, it appears that there is minimal risk associated with the granting 80 foot separation distance waiver. If you have aJ* puestions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 3383246' Website: gamessengineering.com NEWTON S/D; LOT 5 / I / \ J \ NEWTONS/D; \ LOT 6 \ \ I 11 NEWTON COURT \ I00' I \ WECL R40IUS I \ \NEWTON S/D: \ \ LOT 2/EXISTING \ EXISTING SEPTIC BEDROOM HOUSE : •+ \ \ SYSTEM KAREN AVENUE \ YE: Y 0 1' � 40• \ \ 1 \ I I\ 11 / I BIRCHW / COMMUNITY CHURCH (NO CONCERN) / I I% GARNESS ENGINEERING GROUP, Ltd. p * ` H •;y CONSULTANTS & GENERAL CONTRACTORS •• "I [ T ma ° 101 . IMOMY.0 m ONO1 . A (M1pn1 lT . rm PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ••••• • ......••• SHAWN & HONNEN MCLEOD 688-8456 1 OF 1 QQ p t e rness:• LEGAL DESCRIPTION: DRAWN BY: O ° ' . CI -79 3 e, NEWTON SUBDIVISION. LOT 1 B.F.M. e4,� Oio(.°� oqo TYPE OF WORK: 40 SCALE DRAWING FOR WAIVER REQUEST 6/20/2006 d Prolesslotl& �oOOO��Oo jKft. ulM. ) ♦Well Owner. _ ♦ Lega1 DescrlpZ Job No.: 01-129 Pennit No.: N/A (�( M -W trilling, Inc. ♦P.O.Box 1l0378#Anchoroge,AK 99511• •907-345-4000. 907-345-3287 Fax• Deepening Groundwater WeUAs-Built & Lop Brent ♦Use of Well: Domestic Construction ♦flak Depth: 182' Casing Size. 6" ♦cased re. 173.011 ♦Materlat: A 53 Steel ♦ Dr81 Method. Air rotary _ Perf. Down -hole ♦WeflConrp/erlon- Open end _Screen Perforated X Method: Wheel ♦Screen/Perforalfas descrVkm: 1"X '/." slot perforations,8 per foot: 160' to 170' ♦GpourNoles. 2 sacks- bentonite No. 8 granules ♦ Well Development. Method: Air surge Noses: ♦Stark water kvd (SR2) 99 (above) (below) lop ofeasing (700. ♦ Weayle/d test at 2 gallons per ndaute (GPMy ) for 10 hours with 60' ofdrrwdown(DD)fromstatic level (SWL). *Method.- Submeniblepump ♦ Date of completion: 09 March 2001 Well Lnv • Pump Install• Depth to feet from top orcman& Detalls of formations penetrated, sift of material, colorand hardness. 0 TO 100 Existing well 100 TO 108 Sand vel: dam 108 TO 121 Silty clay 121 TO 155 Small vel: silty/sandy 155 TO 170 Cobble gravel. silty/sandy, dam 170 TO 182 Bedrock: brown -gray shale TO TO TO TO TO TO 0on—C TO TO TO ed-Gontraetor certificate No's. 814 & 973 TO iln-W DRILLING, Inc. 2 5/7V% Job No. 00-130 P.O. Box 110378. 10930 Old SewW Highway (907) 349-0535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner M/H Sark Portnier U$e of Well Dom Location (address of: Township, Range, Section, if known; or distance main road L1 of L115. Secn 9. T15N, lh3ld. S.H. Q\\..) 22043 Karen Drive. Chu Riak "rj; .:TO 1� SuBD Size of casing 6 nepth of Hole 178 feet Cased to 177.3 feet Static water levet 100 ft. (skaa) (below) land surface. Finish of well (check one) open end ( X ); Screen ( ); Perforated ( X ). Describe glgpMperforation ky Rhnt perfa aperex 174 to 177invnerR Rrat PTOs/1 Well pumping test stdgallons per (lour# (minute) for 2 Ihours wits, 61 ft of drawdown from static level. Date of completion 'An Har 2 n n n WELL LOG Depth in feet from ground surface Give detalls of formations penetrated, size of material, color and hardness _0_T0__Z_ Casing Stirknn 2 100 Existing Well 100,1O 110 Clay: brn, sticky, silty, gravelly 110 TO 130 Silt: brn, clayey/sticky 130• TO 150 A/A: sandy (fine) 150 To 156 Small Gravels blue grey, silty/clayey-sticky 156 1.O 158 Vater Gravels small. fine sandAvilt. dirty 158 11`0 _175 Gravelly Sand: clayey. vet/so.upy 175 TO 178 Small Water Gravel: sandy/silty, dirty but cleaned up TO angular pebbles --could be weathered TO surface of bedrock, gray black LA 00 TO TO 1 TO t TO1 " y 1—CUSTOMER Ap l 1 . by A & L DRILLING COMPANY BOX 87, EAGLE RIVER, ALASKA 99577 • TELEPHONE 894.2588 •'r I' • �r :' i,' i . "_ .. OWNER OF LAND t,(M iyF 000004-4(J DEPTH OF WELL ADDRESS /0 0 A'r: Z IL1 F Q STATIC LEVEL OF WATER FT. LEGAL DESCRIPTION �a i S rUE uTa ��SUgO DRAW DOWN FT. S DATE .Startcd lel 761 77 Endcd !.�— GALS. PER IIR PER111T NUMBER 7 %� KIND OF CASING D KIND OF FORMATION: From F Ft. to1_Ft. `ilHtd It A tilvC4 From Ft. to Ft. From 10Ft. toSZ,4 Ft. ezH r d fZa lix a From Ft. to Ft. From Ft. to ,5_a' Ft. dPnrAr4V e'4,4y From Ft. to—Ft.— oFl.From FromFt. to_�L-I_Ft. &Q r From Ft. to Ft From-7,1._.FL to75' Ft. r0101y t Aelf''rr' From Ft to Fl From*/S' Ft. to �ij___Ft. S79A-70 116419✓GC From Ft. to Ft. From IT Ft. to c(9 Ft. 4 ✓ W 6 ed 0* o From Ft. to Ft. From19_Ft. to_jk(a_Ft. S14W4 6R4✓Ec dl u%ArE'l-'From Ft: to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft.' From Ft. to Fl. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to FL From Ft. to FL From Ft. to Ft. From Ft. AIISCL. INFORMATION: )Ov.+-t/) )'a .3F. 004/4c60 /o/ r f Ro io ro/ . 0'a C.4Si.dG DRILLER'S NAME ' '"- ' A' BOY 1.3QSOe STAIZ llamrk: A AIVCIIOnAGE, ALASKA 99.502 34.1-7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 440 7eet. DRILLED AT THE RATE OF 825.00 PER FOOT. Cha4ge {.a.t 400 A onty. PROPERTY OWNER 4k. & fibt4 Shaun & Laua Roatchan 694-5039 263-4238 LOCATION OF WELL SITE B'k sub. DRILLER BeyUe CCatu a,. Rampatt D2444b9 004,U WELL LOG: 0 18' SZt ty. 4andV clay. wtth 35% g�uw4 dn. the PAxatton 18----45` RatdpaA. A ceAeAt&d 44au" 45----66' A wet clay. w4.th a 4artdµ jUne q taV" at. 65 IU, 1letV. 4tt4 Xa&4 at. 66----90' R btue clav wLtll. thin a tW4 of. tt a .sand. Wei matcA," De&µ 4ttt*. 90---107' Conglonetate. A Waken wck mater" Some good gAtw . Ro wate't. pu4en.t. 107-440' BeAock. A 4ed ta&Ua ty..toa. fla wateA 4howtng. an* where along unttt 365 Itt. T.ta&cUon, p tied .to be 3/4 941- Wate�t to that a4= •ta out olt a patou4 .type matettal. Leve .than 1/2 V9 4n"ea4e .inn p.taducttan ltu 400 A. flew Watet gteld at 424 .to 432 .fit 44 a gtatut.tat & po.taaa type matetlat. At. teaat 1/2 gAW 4AOtea4e In ptoductton. Tota -Wates yield o� 90 gatton4 pet hoot. Th44 Wetl may. at4o .aWLre Wtth. U4e .to avet 100 gaLlana pet hour du ting 4oae aan.th4 of- .the Vaal.. At4o the V.teld alit dcctea4e dwting. dt.let Un" al- .the Vxat. Wat.ea .level t4 flack U.p .to wLtJl.tn 40 Leet of. .the 4tu14ce 4n. a 24 hou-t time {.tatrte. Ovet 600 ga tano o� wate2 dn. AmrAue an A&U AzcovetV. 1.6 gaLton4 pet Oat .LI A"ew.e. Che Ro"e SUt%ZWttr a TUmp 4hould be trw.tatted .to 400 {i & .toweled .to wLthla 20 /t oA .the botkom 4 needad. 94 maµ be 4tU*-444- 4 .the pump .Lo pU,t .to etoae to 440 4. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. Co4.t o f D4ttt4nq.: 125.00 pet A..t "4 400 A. 110, 000.00 12, 500 pa.td faa uh 3oth., 84 WRITE CHECK PAYABLE TO RAMPART DRILLING WORy FpRI,THE SUM OF--57,$�n P� We Suaaant"d quat t # & quant.Ltµ an .tht4 Welt. l J THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING W RKS DATE Qi Ach 30th, 1984 SERVICE CHARGE OF IY.% PER MONTH WILL SE ASSESSED ON PAST DUE ACCOUNTS. SCS Ref.M 1063219001 All Dates/rimes are Alaska Standard Time Client Name Garness Engineering Group, Ltd. Printed Date/rime 06/24/2006 11:11 Project Name/W Newton Lot l Collated Date/rime 06/19/2006 8:05 Client Sample ID Nctston Lot l Received Date/time 06/19/2006 11:15 Matrix Drinking Water Technical Director Stephen C. Ede Sample Remarks: 353.2 -The NIS for NO2 failed to meet QC criteria. The batch LCS is within QC limits. Allowable Prep Analysis Pammocr Results PQL Units Method Container ID Limits Date Date lnit Waters Department Nitratc•N ND Microbiology Laboratory Total Coliform 0 0.100 mg/L EPA 353.2 D (<10) 06/19/06 ALR col/IOOmL Sh12092220 A (<1) 06/19/06 TLF MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. # -Q 61- l411- l h HAA # R0 Lt Mol 1. GENERAL INFORMATION Complete legal description Lot rl; Newton Subdivision. . Location (site address or directions) 22043 Karen Avenue Chug.iak, AK 99567 Property owner Robut and Debbie Spahn Day phone 688-6572 Mailing address 22043 Kaaen Avenue Chug.iak, AK 99567 Lending agency Day phone Mailing address Agent ---Snook S.tittnen /CENTURY 21 COLONIAL Day phone 696-6572 Address 11901 Bu.6$nea6 BCvd. Suite 103 EagCe Riven, AK 99577 Unless otherwise requested. HAA will be held for DickuD. 2. . NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water P-57 NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Nw.1/91) Front MOA121 S. 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 . Address Engineer's signature 17034 Eagle No. 204 6. DHHS SIGNATURE - Approved for ? bedrooms. 0 Disapproved. Conditional approval for Additional Comments Phone Date 2—Zo_g C/� bedrooms, with the following stipulations: 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. raaxs (ro .1A1) ekt A10A m ® Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lor I E\Xrr>A Sln Parcel I.D. A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number M AA. Log presentO/N) Date completed 3-x^ Driller J1r— Nitrate Total depth ct �I t Cased to cl `t t Casing height Z-It�1�i , 1 .q �5 ¢ Sanitary seal (@N) S G S ENGINEERING Wires properly protectedeVN) %/ FROM WELL LOG AT INSPECTION gG Date of test 3 ' Lon 2 - 1 q - �l � 0 Static water levet Well flow 1 g.p.m. 3.3 + g•p•m• Pump levell JK— OGF lerr,TTz .t G N P. Si SEPARATION DISTANCES FROM WELL TO: Q o Septictholding tank on lot 7c>%; On adjacent lots Z Absorption field on lot oo ; On adjacent lots 1103 Public sewer main l ~ P � Public sewer manhole/cleanout 1` Sewer service line ,� I -J5 1k Petroleum tank 17-5 WATER SAMPLE RESULTS: Coliform 0 Nitrate Z;',e>L- Other bacteria Date of sample: Z-It�1�i , 1 .q �5 ¢ Collected by: S G S ENGINEERING B. SEPTICIHOLDING TANK DATA lips . Lei;.. kiwe LOOP Noad No. 204 Cagle River, Alaska 59577 Date installed Lp - 3 - V, Tank size % Compartments Cleanouts (9/N) 1 Foundation cleanout (Y© Depression (Y� High water alarm (Ya 13 Alarm tested (YIN). Date of pumping -4,14- 93 Pumper S f- . C'P_ ssf eo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot -7c, On adjacent lots loot Foundation 61 To property line % Absorption field 3 9 Water main/service line Surface water/drainage %C>C> 72-WO(M3)•Front CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size in gallons Vent(Y/N) High water alarm level Manufacturer Manhole/Access (Y/N) 'Pump on' level Meets MOA electrical codes (YIN) SEPARATION on lot D. ABSORPTION FIELD DATA LIFT STATION TO: at adjacent lots Surface water Date Installed - S Loal 0L.2p—Soilrating(GPD/Ft2) t3S 84 System type CA& 17-",ta Length 4� Width /a' s' r G ravel thickness L' 3,S Total depth /0 7,rr Total absorption area 9 w Cleanout present (M)_Depression over field (Y®j I Date of adequacy test -2- /4-1 - Results Jlgii 'fail) AAS -5 for 3 Bedrooms Water level In absorption field before test 31. L/ D After test 37 , '/ D ~ Peroxide treatment (past 12 months) AeJe- �! `d d If yes, give date el s SEPARATION DISTANCE FROM ABSORPTION FIELD TO: t Well on lot /o o ' On adjacent lots / oal Property line / r To building foundation / o To existing or abandoned system on lot 'u A On adjacent lots3o r Cutbank �` R Water main/service line /0 Surface water ba '4- Driveway, parking/vehicle storage area S r F4 Curtain drain ~ w E. ENGINEER'S CERTIFICATION 1 certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the fIatq of this inspection. Signa Engin Date HAA Fee $ ✓' 00 Date of Payment -:7- Receipt Receipt Number i a Y % 72-026 ("3)' Back Waiver Fee $ Date of Payment Receipt Number Commercial Testing & Engineering Co. A , Environmental Laboratory Services REPORT of ANALYSIS 5633 B Street CT&E Ref.* :94.0652-5 Anchorage, AK 99518.1600 Client Sample ID :L1 NEWTON S/D Tel: (907) 562-2343 Matrix :WATER Fax: (907) 561.5301 Client Name :S & S ENGINEERING WORK Order :75758 Ordered By :R. SHAFER Printed Date :02/14/94 @ 15:46 hrs Project Name Collected Date :02/09/94 @ 13:30 hrs Project# Received Date :02/10/94 @ 15:45 hrs PWSID :UA Technical Director :S C. EDE Released By : ��e, V/ -- Sample Remarks: ROUTINE SAMPLE COLLECTED BY: RAY. Parameter Nitrate -N QC Allowable Ext. Anal Results Qual Units Method Limits Date Date Init 5.86 mg/L EPA 353.2/300.0 10 02/14 LLH ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than A D = Secondary dilution. GT = Greater Than ��1�6ia7 LL Member of the SGS Group (Socik0i GdnArale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA. COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA Municipalit3, of Anchorage !� Department of,Health and Human,Services Division of Environmental Services 'r On -Site Services Section)825'"L' Street >' Room 5021 P.O. Box196650'Anchorage,;AK°99519-6650 + !' ... www.ci.a6ch6rag6.6k us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY•APPROVAL FOR A SINGLE FAMIL MVELLING .I:. ' ^ .I. Parcel 1. D.' CI I - i q N - l 5 HAA# Expiration Date:. f, 1. GENERAL INFORMATION Complete legal description Lot 1, Newton Subdivision Location (site address or directions) 22043 Karen Avenue Current Propertyowner(s) Mark Portenier Day phone 688-26691• Mailingaddress PO Box 672364, Chugiak, AK 99567 - Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by:�>� �- 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ® Individual On-site El ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The Municipality of Anchorage Department of Health and Human Services (DHHS) 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) on -properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 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. 72-025 (Rev. 01x00)' 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 Health Authority Approval Guidelines for the Health Authority Approval application show 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 verity 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. 1.3 Name of Firm S & 5 ENGINEERING - - Phone 601 y ' a -j 7 % Eagle River Loop Road N0.204 Address Eagle Rt..or IAl„ka-49577 Y Engineer's Printed Name Robert C. Cowan. P.E. _Date DHHS SIGNATURE �� Approved for I+ bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory 01 0 -Pk ROCERr C. COWAN �I L10 CE -Z80101 I t�; , • V . It Ly41 bedrooms, with the following stipulations. Maintenance Agreements Supplemental Engineer's Report Other ON-SITE WASTEWATER PROGRAM By: Original Certificate Date: Y-2-2-0/ Expiration Date: -7 " 2 i- O 1 Reissue Date: 75.025 (Rev. 07100)' Municipality of Anchorage • "' Development Services Department V f i Building Safety Division ' On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L AIL4 Al V2 Parcel ID: O S / - ryy -r S- A. WELL DATA Well type AWE- If A, B, or C provide PWSID # = Date completed �4r 13 OD Sanitary seal (YM) ZI'S Total depth ,---�O—ft. Cased to 40 R. FROM WELL LOG Date of test O �� Static water level /�% ft. Well production 490 g.p.m. WATER SAMPLE RESULTS: Well Log (YM) --f WWas properly protected (YIN) C3 Casing height (above ground) �_in. AT INSPECTION 3% i'ofo 9— p.m- Coliform 0 colonies/100 ml. Nitrate 0—V mg. 410cteria 0 colonies/100 ml. Date of sample: S/! 9 Collected by: 17034 Eeg3 a River Lecp Rcad Flo. 20s Eagle r, ,j, B. SEPTIC/HOLDING TANK DATA Tank Type/Material ilmz' / coyerx*Date installed �0 3 6 Tank size /Z6D gal. Number of Compartments Cleanouts (Y/N) 1/E•S Foundation cleanout (YM) A's Depression over tank (YIN) /k O High water alarm (Y/N) /NS t96 Date of pumping [7 / Pumper �A N / 17} Q Y C. ABSORPTION FIELD DATA Date InstallediSoil rating (g.p.dJW or /bdrm System type d2 rl Length !2T{� ft Width 1 ft. Gravel below pipe 3.5 ft. r Total depth Eff. absorption area 3ALoft' Monitoring tube )�a Depression over field AJ 0 Date of adequacy test Results (Pass/Fail) �S For A bedrooms Fluid depth in absorption fielcjbefore test in. Water added gal. New depthZgin. Elapsed Time: a y ( Final fluid depth (0 in. Absorption rate >= 6000_ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) New6 AVIWN If yes, give date D. LIFT STATION Data installed Size in gallons "Pump on" level at "Pump ofr level at _ in. Datum Cydes tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankiliRsiaBon on lot 6:7_ Absorption field on lot / 00 10 - Public sewer main r Sewer/septic service line 25 Manhole/Access (Y/N) High water alarm level at in. Meets alarm 8 circuit requirements? On adjacent lots /06) / 'p- - On - On adjacent lots /b 0 �'t- Public sewer manhole/cleanout /t A Holding tankNA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1514- Property line 15 � Absorption field 5 Water main A4 Z6Water service line / V- Surface water X00 r i Wells on adjacent lots )00+- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r � Property line Building foundation /0 f' Water main r Water Service line 0 '� Surface water /00 r F Driveway, paddng/vehide storage Curtain drain 1L2Y BVZlCA1 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 above systems are lo y conformance with MOA HAA guldellnes in effect on this date. i %" ,//�� A S RcfEpAplltJwAN f Engineer's Printed Name l� 0/jeRT C' dwA-J a-6301 ;;�•, Date HAA Fee $ 300.0- Waiver Fee $ _ Date of Payment 3/,30/01 Date of Payment Receipt Number o o ) 3.r y Receipt Number (Rev. 12100) MUNICIPALITY CF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES �t 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. # QraI - 111 L11 -1e) 1. GENERAL INFORMATION Complete legal description Location (site address or directions) HAA # 1J 13� 9 1(I-1 a'a Lot 1; Newton Subdivision; 22043 Ka,%en Avenue Property owner N If R N111-938832-203 Day phone Lending agency Day phone Mailing address Agent Sue Haven ASSOCIATED BROKERS, INC. Day phone 563-3333 Address 640 West 36th Avenue Suite One, Anchotaae, Ak. 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX 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 )R". 1/91) FOM MOA 021 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & 5 ENGINFERING - Phone 17034 Eagle River Loop Road No. 204 Address Engineer's signature 6. DHHS SIGNATURE Approved for T�3 bedrooms. Disapproved. Conditional approval for Date 10- 1 — 91 :r� v 6ERJ. AFER P.E. ' i Fop •,� ,• F�'r (l,`XPRi� �1�~P~` bedrooms, with the following stipulations: KAdditional Comr V: The well for this property meets existing State and Municipal Codes. There are nitrates present. It is Sugg--`-' "-` a nPriodi i -PS inq be performed to insure the wells continued suitability. Nitrate concentration is 5.0 mg/1. EPA maxi- - - ra -- JS 10 0 m9/1 M Date 16-3-q) 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 purchasersof 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. 7V=IR«.1/911 erx MOAn1 • �, Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST N Legal Description: -LOr \ Ea1-coA 'sic Parcel I.D. CS/—/441(— 1-5- A. S A. WELL DATA Well type -P(Lw Arra If A, B. or C, attach ADEC letter. ADEC water system number ^\�A Log present Date completed 3- L04\ Driller uK- Totaldepth 99 Casedto CAok Casing height tZ�� Sanitary seal 6)N) Wires properly protected ON) FROM WELL LOG, Date of test 5 uct Static water level g9 Well flow 10.0 9•p -m• Pump level \11rw -I' ooy 6Sf-tM .f SEPARATION. DISTANCES FROM WELL TO: ATINSPECTION MUNICIPAUTYOFANOiORAGE ENVIRONMENTAL SERVICES DIVISION 926 . OCT 2 1991 ,5,'`' + RE'CEIVED ��Tr1,.1 '1 � oGF3dc'raM Septic/holding tank on lot �� ; On adjacent lots Absorption field on lot ► 0o" ; On adjacent lots 100 ` Public sewer main n Public sewer manhole/cleanout .1 Sewer service line 25 sl Petroleum tank 2S t} WATER SAMPLE RESULTS: Coliform d GO1^��oo�Q Nitrate - S• D M��Q Other bacteria - do E S & S ENGINEERING Date of sample: fl -1:2-011 t `1 -'5-�►\ Collected by: 1 • XIVW Loop Road EagleRlver,Alaska99577 B. SEPTIC/HOLDING TANK DATA Date installed 'U S - l0`1 Tank size l25n Compartments Cleanouts O/N) Foundation cleanout (Y& Depression (`QFC) rJ High water alarm (Y& Alarm tested (Y/N) "1'a Date of pumping - '\ - °i \ Pumper :Sl-. CSV SsfooL- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot 70� On adjacent lots 10 � Foundation $ To property line14- Absoiptionfield 3q' Watermain/service line le�� Surface water/drainage t w" 72026 (Rev. 7M) From CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size In gallons Vent (Y/N) "Pump on" level at _ High water alarm level - Manufacturer— Manhole/Access anufacturer_Manhole/Access (Y/N) Cycles tested off' level at Meets MOA electrical codes SEPARATIQD � STANCE FROM LIFTSTATION TO: Weft on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA ) Date installed 16-20-95 Soil rating 455')P/u- System type -� = )'S' 1-g"Z4 Length �-� 11 , Width 'V ' S1 Gravel thickness Y 3•S k Total depth 10, •S 1...•; Total absorption area Z>3s� Cleanouts present (SYN) 7 Depression over,field (Y/1% Date of adequacy test CI -S -`1 1 Results as tail) P"S for bedrooms Peroxide treatment (past 12 months) (YA -+(a tiE ✓ 3LJAI If yes, give date ^j!a ' SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot look;" Onadjacentlots too" Propertyline (It To building foundation tot } To existing or abandoned system on lot "(Ia On adjacent lots qtr Cutbank A Water main/service line If) kr Surface water 1 rx-> µ Driveway, parking/vehicle storage area 15 k+ Curtain drain .�1A J4i1A33;11J:�3 7. 2 2 _ E. ENGINEER'S CERTIFICATIOM'rt :r I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effe `raj ��g of this Inspection. I OF A( X Signature! S & S ENGINEERING Lagle Rbv&r Loop Road No. 204 Engineer's Name Eagle River, Alaska 99S77 Date DU HAA Fee $ — -f % l Date of Payment Receipt Number T 72-M(Rw. 3N1)Swk MOA 21 1 - Waiver Fee: $ Date of Payment — Receipt Number _ CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING 6 ENGINEERING CO. 5633 8 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 ANALYSIS WORT 11 SAY.?LE for NOREorderl 37982 Data Report Printed: Sv.? 13 91 4 09:51 Client Sample ID:L1 NEWTON S/D Client Name :S 6 S ENGINEERING PWSID :UA i------------------------------•-----.....---.-....-----.-----.--..-..--.-.__---------------- VOL AROP.ATIC/UNSAT ORGANICS Client Aeet :SNSENG? Collected SEP 3 91 4 15:15 hrs. - BPO 1 PO 1 NONE RECEIVED Received SEP 4 91 1 IS:00 tire. Req t Preserved with :AS RECUTAED ND(1.0) Ordered ly :R. SWER Analvels Conrle,ted :SEP 6 91 Laboratory Siporvlsor :STEPHEN C. ED! R slats ed By Cbemlab Ref 1: 914579 Lab SmDl ID: 1 Matrix: WATER Send Reports to: 03 6 S UMNSERING 2) Parameter Tested I Result Units Method i------------------------------•-----.....---.-....-----.-----.--..-..--.-.__---------------- VOL AROP.ATIC/UNSAT ORGANICS n/a n/a EPA 503.1 BENZENE ND(1.0) ppb EP1503.1 r BAOMOBEfRLNE ND(1.0) ppb EP1503.1 n-BUTTLBENZENE ND(1.0) ppb EPAS03.1 _ sac-BUTTLBENZENS ND(I.0) ppb EPAS03.1 tort-11ITTLBENZENE ND(1.0) ppb EPA503.1 CHLCROBENZENE ND(1.0) ' ppb EPA503.1 2-CALCROTOLUENE ND(1.0) ppb EPAS03.1 4-CAL09OTOLIIENL ND(I.0) ppb EPA503.1 1,2-DICULOROBENZLNE ND(1.0) ppb LPAS03.1 1.3 -DICK OROBENZENE ND(1.0) ppb EPA503.1 1.4-DICHIOROBUMNE ND(1.0) ppb EPA503.1 , LTHTLBENZENE ND(I.0) ppb LPA 501.1 HEXACHLOP.OBU'.ADIENE ND(1.0) ppb EPA503.1 ISOPROPILBENZLNE ND(I.0) ppb EPA503.1 • 4-ISOPROPTLTOLUENE ND(1.0) ppb LPA503.1- NAPHTHALENE ND(1.0) , ppb EPA503.1 { r.-PROPILBENZENS ND(I.0) ppb EPA503.1 ' STTRe.N? ND(1.0) ppb EPAS03.1 TETRACHLOROETHYLENE ND(1.0) ppb EPA5031 TOLUENE ND(1.0) ppb EPA503.1 1.2,3-72ICHLOR08ENZ19! _ NO(1.0) '. ppb E?A503.1 i 1.2.4-TRTCRLORO1LS"ENE ND(1.0) ppb EPAS03.1 TRICHIORCETHTLE4E ND(1.0) ppb EPAS03.1 1.2.4-TRTMETHTLBENZENE - 91)(1.0) ppb EPA503.1 1.3,5-TRIMETRYLBENZENE HD(I.0) ppb ` EPA503.1 a-XTLENE ND(1.0) ppb EPA503.1 m 6 p XTLENE ND(1.0) ppb EPA503.1 Allowable Limits n/a r�I%S MS Member of the SGS Group (Socidtt6 Undrale de Surveillance) 1 n n + MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date�C�jr 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot I Newton Subdv., T15N, R1W, Section 9 Location (address or directions) ,ren Lane Chugiak (b) ApplcantNameDlavis—Bennett Telephone: Home 376-1232 Business 694-8307 Applicant Address SR1—Box 2787 Birchwood, Chuctiak, Ak. 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderr) ;Buyer ❑ ;Other ❑ (explain); (d) Lending Institution Home Savings and Loan Telephone 176-1520 Address P.0 -B 874510, Wasilla AK. 99687 Gerri Galloway (e) Real Estate Company and Agent NZA Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Familyj) Multi -Family❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Q Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 r2-025411.54) A , 5. ENGINEERING FIRM PROVIDINC'SPECTIONS, TESTS, FILE SEARCH, DA1'tND INFORMATION As certified by myseat 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 o1 bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Telephone { Address / EAGLE RIVER ENGINEERING SERVICES Date _ 'u6CS PLE RIVER, AK tl9blf .R$OX 773294 t E94-5115 6. DHEP APPROVA Approved for X 0 I • bedrooms by Approved Disapproved Terms of Conditional Approval -OF A "I 4 .. , .. ,. ,yi •••••• «•"�t ineer's Seal •. Louf. A. 1100 : 4, �'i Y • • CI -6136 ••t• ,c) n� Conditional CAUTION I The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Page 2 of 2 72 -WS (I V14) µdNICIPALtTY OF AtJCH�RAIac MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH L4 �Ikpt.WtENTAI PROTECTION HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1884 AUG 21 iJ 284-4720 Legal Description: �"r It/�w�r.✓ S� 6o/r. Rf CE1V [D 7/1'74/ / If Sem . S A. WELL DATA Well Classification Poe/ r/A7-F If A, B. C, D.E.C. Approved (YIN) /1114 / rt Well Log Present (YIN) _V Date Completed 3 /6 5 Yield Total Depth `!`} " Cased to 95 Depth of Grouting y14 Static Water Level ?a Pump Set At '!g" *r4 r .. Casing Height Above Ground Sanitary Seal on Casing (YIN) - i Electrical Wiring in Conduit (YIN) y Depression Around Wellhead (YIN) N Separation Distances from Well To Septic/Holding Tank on Lot 70 �; A/4✓ 1'qs5) ;On Adjoining Lots To Nearest Edge of Absorption Field on Lot * ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole Nva To Nearest Sewer Service Line on Lot a S Water Sample Collected by E^�'n°�- ; Date SJ T! If r Water Sample Test Results z� Comments B. SEPTIC/HOLDING TANK DATA Date Installed !0 i Size /'� So No. of Compartments Standpipes (YIN) %y Air -tight Caps (YIN) %� Foundation Cleanout (YIN) N Depression over Tank (YIN)A.1Date Last Pumped T";r iiPJ Pumping/Maintenance Contract on File (YIN) ��1114 —;for Holding Tank High -Water Alarm (YIN) Temporary Holding Tank Permit (YIN) y�4 Separation Distances from Septic/Holding Tank To Water -Supply Well %a {il To Building Foundation 8 To Property Line ~ 30 r To Disposal Field — 410 ri To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course /yo.ve Comments Page 1 of 2 72-026(11;64) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �S �B'e Type of System Design See,gS� Datelnstalled _2985 Length of Field /� r i r , Width of Field s Depth of Field Gravel Bed Thickness 3 �� Square Feet of Absorption Area SS- 46 Standpipes Present(Y/N) Depression over Field (Y/N) Date of Last Adequacy Test i n- r - Results of Last Adequacy Test S 7�,f 7tv�a.o I.-& -e T�A Separation Distance from Absorption Field: To Water -Supply Well /00 .0- To Property Line �� r To Building Foundation Lot 1911 To Existing or Abandoned System on On Adjoining Lots Amod;- _�? o 7, To Water Main/Service Line /O )'- To Cutbank (if present) tiz To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area. or Vehicle Storage Area Comments SYS Q r <.,&W S.. t. J {c,<f,. {y' 3 GJc../.-c..... /%"'•C -%.�y.�l� �Oi% C,t.lt^r /S 6 � �e.., f•d..TR1J�Q/rh:• aQ.� 9r�G.� D. LIFT STATION A/ Date Installed Size in Gallons "Pump On" Level at — High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) _ "Pump Off' Level at •• Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOAand HAA guidelines in effect on the date of this inspection. Signed Date ?/ a dfsS Company ��' F•f MOA No. S'T — J Cx— Receipt No.OF A-�52�4� ++t 11, 1 Date of Payment `�� ��' g o �P;: •, s 0 Amount: $ `5 •L)b0 * !49TH •*�� Engineer's Seal Page 2 of 2 72026 111,84) Louis A. Eutera CE -6736 Tirrr Time ne Date Date Date Inspector Inspector Inspector Comments n Conditional Approval c Date Sewer Installed Permit No. Septic Tank Size Holding Tank Size Salts Rating Well To Absorption Area Well Log Received Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY Property Owner Phone Mailing Address SL't j3ll>< �7SZ C�lltClp.,�. E�j�'GZ2�� Buyer Address Lending Institution11 Phone Address-PLA4"-J E(QnC4-' a',rj PCil Realty Co. 6 Agent — Phone Address Legal Descriptlon vL U" , Street Location .KJ r pit C.. 1 C Type I Residence Single Family 3 O Multiple Family No. of Bedrooms Cl Other WatSupply Yn Individual t0'/ jro )CI–IS ATTACH WELL LOG. A well log Is required for all wells drilled since June ❑ Community 1975. For wells drilled prior to that date, give well depth (attach log If O Public Utility available. Sewre Disposal , ?J Individual Year Individual Installed: O Public Utility When Connected to Public Utlllty ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. r'� r EXCAVATION ROBERT A. SHAFER A WORK CIVIL ENGINEER 694-4979 March 16, 1982 MUNICIPALITY OF ANCHORAGE C`_PT. CF HIALT4 & ENVIR )NUSZNTA: P,�OFECFICN Chambers Construction Company 0152 ATTENTION: Susie Brown SRI Box 2782 North Birchwood RECEIVED Ch6giak, Alaska 99567 Dear Ms. Brown, Reference: Lot 1; Newton Subdivision A sewer system adequacy test was performed on the system located on the referenced property as you requested. The septic tank was pumped and verified to have a capacity of 1250 gallons. The two seepage pits were tested by charging the systems with approximately 1250 gallons of water and after a period of 24 hours all the water which had been added to the cribs had percolated out. It can be concluded from this test that the waste water disposal systemfserving the three bedroom residence located on this property 4s -currently functioning adequately. However, the system cannot be guaranteed against subsequent failure. If we may be of further assistance, please do not hesitate to call. bincereiy, R�O ERCT . SHAF R, P E. BRA'S/ss _ _ J cc: First National Bank of Anchorage Parkway Branch Municipality of Anchorage Department of Health and Environmental Protection SRS 196X EAGLE RIVER. ALASKA March 9, 1902 Chris and Karen Drown Sit 1 Dox 2702 Chugiak, AK 99567 Subject: Lot 1 Newton Subdivision �Y G Approval for the individual sewer and water facilities cannot be granted until the following items have been completed: • The top of the well casing sealed with a sanitary seal so that it is water tight. • The water analysis report needs to be submitted to this office from the Chem Lab, 5633 D Street, for our review. • The septic tank pumped with a receipt submitted to this department. • An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this office for our review. Please notify this department for a reinspection when the noted discrepancies have been corrected. If there are any further questions, please call this office at 264-4720. Enclosure RP55/p/Efi Sincerely, r RoberO C. Pratt Associate Environmental Specialist . 4 MUNICIPALITY OF ANCHORAGE DEPT. OF NEA a + DEPARTMENT OF HEALTH ® ENVIRONMENTAL PROTECYIOEPoONMENTAL FGOTCCTIOH STR ET OCATION 05 L Swan - Andaareye, AWee 99501 6 TV E OF RESIDENCE NOV 619 ENVIRONMENTAL ENGINEERING DIVISION SINGLE FAMILY Telephone 2644720 RECEIVED �t.t REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all ports on pope 1. Ineonwiste requests, will not be pracewed. Ploose allow ten (lol dovs for processing. 1. PROPERTY DINNER PHONE at COMMUNITY I MAILING A DRESS depth (attach log if available.) PROP757Y RESIDENT (U ferent from above) H E "If individual/on-sits, give installation date If system is over two (2) years old an adequacy test is required 2. BUYER by this Department. PHONE + 8 (LING AD ESS Sk , NOIN T ION PHONE MAIL NG AOOR 99 4. R sl/AOENTPHONE MAILING DRESS S. LE ! IPTION STR ET OCATION 6 TV E OF RESIDENCE NUMSER ❑ One ❑ Four ❑ Other SINGLE FAMILY 0 Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7, WATER UPPLY INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) E. SEWAGE DISPOSAL SYSTEM AINDIVIDUAL/ON-SITE" "If individual/on-sits, give installation date If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. „ 7a THIS SIDE FOR OFFICIAL USE ONLY J _ INSPECTION APPOINTMENTS DATE RECEIVED - TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER DF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 2 WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED ..,. .. * SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED �^6� I ALLER SOILS RATING ❑Septic Tank or ❑ Holding Tank Size: IXo If Tank is homemade give dimensions: TYPE OF TANK 0_'ra_mQ Kv MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic Holding Took Absorption Arm ina rrt Lot Lim Abwrption Arr to IMarest Lot Lina S. COMMENTS APPROVED FOR _�� BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE - II -^4 BY (Title) LEGAL DESCRIPTION 1"lu IMV. 3//01 Steven A. Johnson & Associates P.O. Box 76, Anchorage, AK 99567 688-3085 (BATA SHEET - SEEPAGE PIT Test:Perf --i-d ,for• ( _ : %;onnie Tallman; ; _ --_ "I ' Date Started 10/28/78 Legal;Description_ Number ofll Bedrooms_ (1-) -Te st--Volume-(Tt Da I •• able 1 Lot Il Newton Sub. Pumper Rent -A -ran (1100ga7 Tank Pumped -tYes Yes fio _-3----bedrooms.-x- 150-gal/Bedroom, _ 4,50._ -gal 2 x TV. 2 x 450 ga = 900 gal Time at beginning of pumping (Tp) 1550 Gallons '(in)l ! ; .( mg :.. (in):. Q(�n) (ga /in) —o -: 3 •o - ; o:o; 0.0 . ,. 0.0 o.o...: 2• -- 72.0.:: 3.0... 59.0 .. -- _ 7710._0. _ _:.. 20:0- 200 }; ,;3 .o,!; .:. q.o.. 33.0 ;:400 r'i .13 90; p 600 ,3 •0. 800 ,, i3 .o 9.0 33.0 -Reae9007 } 1 00 1400 11600 _ -3800,-._ . .:......_ (2):: System 'capacity (SC), _. 200 gallon gal/in SP {3)• Sure volume (SV) 0.4 ! V = 0.4 .450 gall = 180 �gal 0) Fluid level drop ( FL) I - -1 - --- l- - --- f 200 1+ -- - TJ6'g-aZ .2UU-'ga l (fable '2 T "(min) T '(min) a T (min) SP (in) ASP (in) iASP (in) 0 .:.: :. 30.':: ,:,0.0... 11.0.. ,o. - --- 30 - - - - • . . ... ... ... ....... i ... ..:'.: -ULLL _S'iir.*g,e apacity._( C.)1 _ _8V- L min -- - _-. Day II T24 - 1515'' SP24 = '88.0: in. (6) ` Flui. Lost-CSC x i(p P24 SP ). : ' .... . . i 102Q_.gal/day -- - (7) P.er olation R to bdrm drms }i . ....... i ililji 1 ! i, .. -Sur a Capacit i(XC) _ 1 :1 gal/mrn per, olation R1te'i(PR) 10 galday/bdrm ~- j } I. d �9, op M Slane te en A -I Johnso i -