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MOUNTAINSIDE VILLAGE BLK 3 LT 5
Mountainside Village Block 3 Lot 5 #020-172-24 Municipality of Anchorage Page of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 0 Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 82109 t7 PID Number: Oho — 17Z— 2L1 Name: i••t ► Wastewater System: New ❑ Y Upgrade .r1; N Address: la , \r lNoo. ABSORPTION FIELD Phone: 127g 1— — of Bedrooms: 3 &/Deeip Trench ❑ Shallow Trench 0 Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original rade: 1415 GPD/Sq Ft. f Lot: Block: tt Subdivision,/ INSaCYi V. tt Depth to pipe bottom from orlginat grade: Gravel depth beneath pipe JN Ftl Ft. 7 Ft. Township: Range: Section: Fill added above original grade: Gravel length: Ft. 36 Ft. ,,�./�� WELL: tgJNeW ❑ Upgrade •Ft. Gravel width: Number of lines: Distance between lines: CtassinCatlon (Private, A,B,C): TotalDepth: Cased To: r' t/3 Ft. Z WW [ FL Total absorption area: t� SQ.Ft �� Ft. Pipe material: p 30 3V s{w.alrI Oral Drilled: 11 Star( Water Level: installer. UNlw&`16 Date InsV lNedDate 1 r G r7 Z N FL v, tot, %igs Yield: /Pump Set at: Be#"22 Casing height Above Ground: TANK GPM F,. F,. SEPARATION DISTANCES septic ❑Holding ❑S.T.E.P. To septic Abwryaon Lin Holding Putilliviivivats Manufacturer. Capacity In gallons: From Tank Field Station Tank Sewer Linn Welt Welt' /05 ( / aO N��S %/ Nfi I �n�) i Material: Material: Number of Compartments: Number of Compartments: Waters 6 owz O BS f fZ✓e: LIFT STATION Lot p_V 50 } i N/ I•( + 1 Size In gallons: Manufacture r. Line CJ(/ :J � Foundation lfJ7 y p t f N�Y ),/ "Pump on" level at: `Pump ore' level at: High water alarm at: CurtainPump Drain 0 t-4 O 13 '12✓K Make B Model Electrical Inspections performed by: Remarks: BENCH MARK 1 i h H5S ' �, Location and Description: ��eor Y'�- eM cam It Assumed Elevation: / r t%Aj101NEt:RV SEAL w A �a 4 �04�Uw...•��JW °• a, ..... F1% ., �� .I'l s Inspections performed by: '� [Y Dates: 1s 9 2nd 4LCn5?V•k;:snd *•a Department of Healffi and Human Services approval � CE- \�c&LL;io,t Reviewed and approved by: Date:—30—>���'°' . "'. t... wv,) MVA (i I II I I I � I I 25 49th No. CE -2225 Tb'ell / SWINGT/ES: AC 43 TT / BC 57.5 TANK CO / AD 51.5 B BD 67.5 DOUBLE COS A£ 91.5 BE 110 TRENCH CO BENCH YAR A �— ;0 C f / / 100 , •,•125 150 / f'=50 FT / -_ D � / 'VDD"" '�" "`""" ' c��LOT 5, BLOCK 3, MOUNTAINSIDE VILLAGE SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE ANCH. AK. 99501 17801 STEAMBOAT DR1Vf DATE: SEPT. 24, 1996 lc��) z7c-3415 JOHN WESTPHAL SHEET: QA GRID: 3439 � / 1 ' / 1 I II I I I � I I 25 49th No. CE -2225 Tb'ell / SWINGT/ES: AC 43 TT / BC 57.5 TANK CO / AD 51.5 B BD 67.5 DOUBLE COS A£ 91.5 BE 110 TRENCH CO BENCH YAR A �— ;0 C f / / 100 , •,•125 150 / f'=50 FT / -_ D � / 'VDD"" '�" "`""" ' c��LOT 5, BLOCK 3, MOUNTAINSIDE VILLAGE SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE ANCH. AK. 99501 17801 STEAMBOAT DR1Vf DATE: SEPT. 24, 1996 lc��) z7c-3415 JOHN WESTPHAL SHEET: QA GRID: 3439 THIS SYSTEM WAS INSTALLED IN 198J. A PERMO WAS 087A'NED, BUT AN INSPECTION REPORT WAS NOT EKED WITH THE HCALDT DEPARTMENT. THIS AS8U/LT IS BASED ON INFORMATION FROM THE PERMIT AND FIELD INSPCCAONS CONDUCTED IN 1996. PRIMARY TRENCH ,0 Monitor Clean Out Standard Trench f PER PERMIT AND FIELD INSPECTION 2' V;de 36' Long 11' Deep 7' Sewer rock 4' Cover Cleanouts Monitor 8391 96.91 --� 11 80.71 NO SCALE 6 1I � 49th _ IBEN SPURKLAND No. [E-2225 •, lcYIFESS 85.48 1 81.15 1000 got septic tank BENCH MARK. GARAGE FLOOR ASSUMED ELEV. 100.00 �0-3""`"'"" r'`' LOT 5, BLOCK 3 A/OUNTALYS/DE VILLAGE SEPTIC SYSTEM AS BUILT Anchorage orage Ave SEPTIC SYSTEM SCHEMATIC DATE Anchornge Ak 99501 SEPT. 24, 1996 11 SHEET- ,f/.A GRID= 34.18 , MIJtJ I C I 1 r_�L I TY DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 264-4720 4 -JELL nrJE> OtJ-SITE SEWER PERM I T PERMIT NO. C 821090 > APPLICANT MARY. T JOHPJSON 2481 BELMONT DR 278-1551 LOCATION LEGAL LS 83 MOUNTAINSIDE VILLAGE LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I5: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSO FT/BR>= 165 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: J>FE: F'_r 11 LE"C3-r 3iS C3RF=jVE:L_ E>EF}TJ-F= 7 THE LENGTH DIMENSION IS THE LENGTH CIN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT I5 THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). RE'MU I REP SEF}T I C TF=l tJJC S I zE= 1000 0nL_L_0t4S PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. --- TWO C 2 > I "SF ECT I OtJS RRE FZE:QU I REE> --- BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. PERM I T EXF} I RES J7ECEMEER 31.. I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IPJ ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: APPLICANT AND WELLS AS SET ENLARGEMENT IF THE ISSUEDBY ---- -------- DATE-- U �Z _ ` V4 0 ---------- -------- -� �+ O SOILS LOG MUNICIPALITY OF ANCHORAGE : r DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 925 1. Stntl, Anchorage. Alaska 99501 2641720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: TDH/t/t D 11f DATE PERFORMED: 1d�9/g Z LEGAL DESCRIPTION: LOT' OE —PT M SLOPE SITE PLAN (FEET) I I I I I 1 ML 2 3 1EN..E.. Gross Time Net Time Depth to Water LOG of 4 / – i 09,410 90 GM �FiPCu�A74o.t/ 5 NUMENNEVAM MEMENEWAME '00/ T 6 Rr'A;.-r'2 7 To To rEsr /jv.e. ✓G SO7L Lo G /1 TT/9C/iFU, t3 6oG 9 Afr4a 'o 10 11 WASGROUNDWATER S ENCOUNTERED? �� O P 12 IF YES. AT WHAT E 13 DEPTH? 14 15 16 17 18 19 .E 1EN..E.. Gross Time Net Time Depth to Water ....,,.... / / – i 09,410 90 MENNENNOME PMPP s NUMENNEVAM MEMENEWAME 3 11 , o . 7,;1 / •• t- or 57 g/! 3 'V741 rima. Reading Date Gross Time Net Time Depth to Water Net Drop / / – i 09,410 90 'f� � 4AeT s 3 11 , o . 7,;1 / •• 6 " 3D 50 6 /y 20 U PERCOLATION RATE tminutesrnch) TEST RUN BETWEEN FT AND ! '/5' FT COMMENTS PERFORMED BY: 44 WA2K Hol GI/J/i CERTIFIED BY: DATE: 72-009 (67791 F�GGI�L A n ( �) Alaska Testlab 4040 "B" Street Anchorage, Alaska 99502 Mark Johnson 4040 "B" Street Anchorage, Alaska 99503 n Phone (907) 278-ISSI (Telecopier (907) 272-5742 May 25, 1982 W.O. AA00001 Grid: 3439 Re: Percolation Test Lot 5, Block 3 Mountainside Village Subdivision Sir: We performed a percolation test on the above referenced lot on October 16, 1980. The test hole was drilled at the location shown on Figure 1 by Denali Drilling, Inc., using a continuous flight auger mounted on a Nodwell carrier. The test hole log is shown on the attached test boring log. The percolation test was performed after the hole had been saturated for 24 hours. The soils consist of layered Silt (ML) and Gravel (GM), (Test Boring Log, Lot 5, Block 3). The percolation zone consists of the silty gravel layer which extends from a depth of 5.0 feet to ll.o feet. The percolation rate for this soil was observed to be 5.0 minutes/inch. No ground water level was observed during exploration. We trust this report meets your present needs. Approved: p n_ � Q Melvin R. Nichols, P.E. Manager MIi: kf. Sincerely, ALASKA TTESTTLLA,D /1"'V-0 1r'� L Mark Holum Geotechnical Engineer "L QF At `! .• S NIP.• W .4 MP.. 4..F. y + Melvin R. Nkhols Na. 4113E ,�•{ ,♦A ;, fiMr. ;. Zi_ ����� ': .•••'+',�::! ;'.(j:ri ••^'.+ / .•• .•�+r ..••_ y•• t '' � "y' , � f r.'� r" Jy � //�` ♦ ♦ t �, .� JE • 1•rE /•r r ,: I� ''•'. -•'••. :: til`\ c a°:„, •/.,'_ ""`/ •`�� POt .�:�i;'';•i '.. - • � r. •J n _ ''fir! O. �':_', • •.' . :::, . is a i.' �••' � \' :/.. i$. :. - :. : ' / % �`� -•'- •- 2 • r� e` , ' I . 1� Ora, •• • T � .Y�' _ • .+'•+�',•+'i ;: \.• a 1• "'. ��• `�. :.:/ ./\� /� .: lj i•. Yid/. ••�. i. .',y`•:i:.••' ICA • r:; � ,�/ 1 '' , MOUNTfuNSloe vrttAf.E orncotlmon/ T!•ST �. Figure 7 ` ; +• •, ATL ALASKA TESTLAB n �Alaska Testlab 4040 "It" Street Anchorage, Alaska 99503 W Phone (907) 278-ISSI October 12, 1982 W.O. $A00001 Grid: 3439 Mark Johnson 4040 "B" Street Anchorage, Alaska 99503 Re: Percolation Test, Lot 5, Block 3 Mountainside Village Subdivision Sir: Dk (Telecopier (907) 272-57421 On October 9, 1982, Mark Holum, engineer with Alaska Testlab performed a percolation test on the above referenced lot. The test hole was excavated at the location shown on Figure A and is 30 feet west of the 16 foot deep test boring. The diameter of the percolation test pit was 1 foot and it extends 5.5 feet below grade. Soil conditions are shown on Figure A, and consist of a surface layer of 4 feet of silt (ML) with occasional gravel and an underlying layer of silty gravel (GM). The percolation zone consists of soil classified as GM. This zone was observed to extend from depths of 5 to 11.0 feet. The test pit was excavated, cleaned of debris, and saturated for 24 hours prior to testing. The test pit was refilled to a depth of 1 foot and the drop in water level was observed at 10 minute intervals. The observed percolation rate was 10 minutes per inch. No ground water level was observed during testing. Please call if you require additional information. p�q� Gf A qac Sincerely, P.....N.N.y •• IV ti yN % ► : TII �`1 }, «01 ALASKA TESTLAB Approved: A/ r... .. .. f.....t... 0 .C��L R. Mark Hanen, `•� ' • i'CE 4753 ♦ ! sc S /0 6 �NAt �v Mark Holum >♦t41N� MH:KBW:kf Geotechnical Engineer Block 3 - Lot 5 Date: 10/16/80 Mountainside Village Logged By: O.M. batch W.O. #A19551 Depth in Feet From To Soil Description 0.0' - 3.0' Brown Sandy Gravelly Silt (ML) with some peat, moist, surf, medium plasticity, (fill). 3.0' - 5.0' Brown Sandy Gravelly Silt (ML), moist to wet, stiff, medium plasticity. 5.0' - 11.0' Brown Siltv Sandv Gravel (G.M) with occasional cobbles, moist, medium dense to dense,.sub- rounded particles to 6"+. 11.0' - 16.0' Brown Sandy Gravelly Silt (HL) dry, hard, NP. Bottom of Test Hole: Frost Lire: Free Water Level: Sample Depth 1 5.0' 2 10.0' 3 15.0' 16.0' None Observed None Observed Type of Sample Grab Grab Grab Unified Soil Classification. GM GM .. .•! Remarks: Refer to Sheets 1-3 for Unified Soil Classification explanation. Figure 6 A T L ALASKA TESTLAB f^ (1 �a 1 �7 Hui, T:aS ■+ D S ilia??•,�a3'i7::� 4 L; sa a i J 1 lii- a' 3 a—t3 1. 7 3. •i�—i?j:y Eti7 at 4 t E 41{? •3 aaw3 �'a z 1 Y i; i41 t3a 43s i. a$f •2 as .1L' a� ��g i1i B.ii � ai �irx:4 nw<4¢ tdIL eC� 3!Lii F!:^33?t r a a i if -ta �a—c is s �3 0 ?a;iri?3T;=; •g. �I�a ATL ALASKA TESTLAB i I .I 11 I i II I I i ] �a . • .3iT s'•a`3 t . S �tl IIII ; � � III III I I 1 i � r` f I�'��1.111,1I?a51111 o 3 � II i II I)I'llil9 3a • � � �? eo f � 33 t: Ilj o� II.. .'i I 1111 � .ri IIII IIII l it 531 d 5 { iEj I ?;3 s a ,.ar.. P..P S S R R ='+ ' x'ws'»'No cil •wll,ray r K•r<v7's'1 YS.•w wn aTwlwww,■ w•+f•1 ^!+1^". r. Mw lrJ wwn. bu rw a=[ .N Yww M1•V^a^.nyl• Jp JnwwJ wMa.dn wwwl rwll a.w Mlyd lanJ•.w.d .n •+JnwP P+1 W....n..wnal +P b.prT w rw. ,.n o,J wN 13;:2.13 :3. �'.f:i?3-■g S j--illsY:_ :t°L :1=- y•-:�.■ y.2 23-;i =S -3 1E�i.. ed1L D: i 6 ( aSSi27e 3i •i, wt.lY•3 .a]=T <SL�i 32:4et Sit: S=` • 2 :i -c 7�-_Et; a4£: �1 Si�14+ 's;Ii- .7:7a■a'i •a:■Sj ;� i. E� ?a. z .{C.�t._ 7�1� :� i• � u w - 31 QL i- i L3 � a •i ,:� O. as ae : a ' e :� '3 � 3a L4 'yi 7F as 71 ft { d• gg; is i•7 2f 3 .r�. 73 •J a -a e. '± _a 3. e• I 4 is _ ° + - ias is wf 4 _f f �17' E I Y O IL 4� ! .1 L• p `a y � a3 i = r 2; I a■ Si ;� a TL �� - 2 a ?� a� is 53 '•i aR 55 = �i .. .. ;i =i a 31 ev ii ■3 ii 3 ��' ,�! �F r w z ;i 1's t• �� !a ]• -: is 3 .iZ 1L -� �i( iL �2� i6 i '"'}3 2'• �� a lii �6 a:3 i< Y� ."P.i �i ,4_ 1 ,rna.gJ .Mw.q.l rg 3 L i PwYrnq Y+•.N.0 J � Mi"wsy, OS olwn w�rr ,m �•AM Y^w ±u..°. ��2 .WlrmJ ,J.I. r•,.Ma � _ �.rl 3 2 i 3 .•Yl ua^I.'w ..Y~,I.w .•.ww.l i �' sw.wrlN�y.�yi.uw wm..l^P.y.aY..wN .i y� PO SaYq,V'w.,.:M .,Pm n. MaP. w.rw N1 ^N NL yvn ,.w. =OL'wN.N. dnl a.n M.n W:'aN.•V. w Iwnwr M IPy •^J� .n.la y,w w lnuwr M N.Y..V. ,.°N I Mm 1w.Jrn.l Mw twulwd �a 1 �7 Hui, T:aS ■+ D S ilia??•,�a3'i7::� 4 L; sa a i J 1 lii- a' 3 a—t3 1. 7 3. •i�—i?j:y Eti7 at 4 t E 41{? •3 aaw3 �'a z 1 Y i; i41 t3a 43s i. a$f •2 as .1L' a� ��g i1i B.ii � ai �irx:4 nw<4¢ tdIL eC� 3!Lii F!:^33?t r a a i if -ta �a—c is s �3 0 ?a;iri?3T;=; •g. �I�a ATL ALASKA TESTLAB f .art Na!o Loo — Description Guido The sod descriptions shown on the 4rgs are the beet estimate of the wsi's characteristics at the time of field examination and as such do not achieve the tecnioa of a laboratory testing procedure. If the log incWcs soils samples, :t.ose samples weave an independent textural elauifreation in the laboratory to verify the field examination. The logs often include the following items: Rgth Interval — usually shown to 0.1 foot, within that sone no srgnt-(,'ant— c2nge in soil type was observed through drill action, direct observation or sampling. Frost Classification — NFS. Fl, F2, F3, F4, see "Sod Classification Chart" �� Texture of Soil — An engineering classification of the soils by particle ;sir an proportion, Re "Soil Classification Chart", note the prop,.rtwus are approximate and modifications to the soil group due to stratification, inclusions and ehnrges it, properties are included. Moisture Content - this is a qualitative measure: 12, aro ter little apparent surface moisture, !dam . moisture forma portion of color, less than plastic limit, wet, no free water, often soft, if cohesive soil, saturated, free water may be squeezed out, if a free draining soil; ddatent at natural moisture content, if a nonplastic silt or fine sand. (The moisture content is further defrnedby reference to Pl, LW. NP, MTvor dilatency.) Densitv — refers to moreor-less non -cohesive soils, such as sand gravel matures with or without a fine fraction, derived from drilling action andlor sample data: usually described as: very loom, loose, medium dense, very dense. Central intent is to portray earthwork characteristics. Stiffness — refers to moreor-less cohesive soils and fine grained silts of tie c(ay-silt groups. Derived from drill action and/or sample data. Very soft, soft, stiff, very stiff and hard are commonly used terms. Particle size — The largest particle recovered by the split spoon Is 1.318". Sc1by tube 3", auger nights (minute man) 2 Auger (lights (8 -So hollow stern) 6"-8". Larger particles are described indirectly by action of the dro:ing and are referred to as eolbles. 3" to 8", or boulders 8"4. Therefore when reviewing the gradation sheets, if any, the drscriptior. on the hole log must be considered for ancindication of target particles. unified Soil Classification — This is a two letter code. See unified .. Claisi sf cation shrcitet r Wither definition. In some eases AASHO and/or FAA soil classifications may be shown as well as the unified. Atterberg Limits — useful for fine grained and other plastic soils. Pl; natural moisture content believed to be less than plastic limit Pit; natural moisture content believed to be between pFattic and liquid limits Lwr; natural moisture content believed to be greater than liquid limit Np; uon•pbstic, useful as a modifying description of some silty rnaQrials. Ditate.r_� — is the ability of water to migrate tu the surface of e saturn<dd or nearly saturated sod sample when vibrated or jolted — used as ♦n aid to determine if a fine grained soil is a slightly or non•platie sot or a volcanic ash. Rock nour — finely ground sod that is not plastic but otherwise appears Untr al a to a clayey silt. Organic Content — usually described as Peat. PT, sometimes includes imine parsec es such as wood, coal, etc. as a modifier to an inorganic soil. Quantity described as; trace, or an estimate of volume, or, in sax of all organic, — as Peat. This may include tundra, muskeg and bog material. Muck — a modifier used to describe very soft, scmiorganic deposits uival!y oeeuring below a peat deposit. Amorphus peat — organic particles nearly or fully disintegrated. Fibrous Peat — organic particles moreor-less intact. Bottom of Testhole — includes last simple interval. From Line — seasonal frost depth asdeseribed by drilling action andlor samples at the time of drilling. Frozen Cround — other than frost line, described by samples, usually ineludesctrption of ice content, oftei will include medified unified Classification for frozen soils — this is a special use related to permafrost studies. Free Water Level — The free water level noted during drilling. This is not necessarily the static water t.:ole at the time of drilling or at other seasons. Static water table determination in other.than very permeable soils requires observation wells or picaometer installations, used only an Special cases. Blow 6" — The number of blows of a 143 we jet free falling 30" to advance a 2" split spoon 6"; she number of blows for a 12" advance is, by definition, the standard penetration. dab — natural moisture content of the soil sample, usua0y first p<rformed on clean sands or gravels below the water table. ,•pe ofS_a_m�l�e — 9ip, «(era to 2" split spoon driven into the soil by 140 pound weight, a disturbed sample, .1, thin will tube, "Shelby" used to obtain und'uturbed samples of fine grained soil, ' ,G. "grab" disturbed sample from .ager Cpthts or wall of teench. S,,, cut sample, undisturbed sample front wall of trench. Dry Strength — a useful indicator of a soil's clayey fraction, N•Nnspe. L•Low,M•Mediun, l l nsligh Cr_ oup — The samples are placed into sp parrndv similar groups Lased on m fir and texture and are arbitrarily assigned a group letter. Fortier disturbed tests including Atterberg Limlrs, grain site, moisture deputy relationslsip, etc. may be performed on the group and ate alwmed to reflect the general disrwbed chanctesittics of the sails aoipoed sea the grpup. This is an important phase of the soil analysis and is card to stendudiu the various quathative determinations and to reduce the number of quantitative tests necessary to detctihe the soil mass. (qD ALASKA TESTLAB w SOIL CLASSIFICATION CHART N1 AYEYCLAYE' OR\ /OR fY / \ I / SI Y SAND SANDY GRAVEL R GRAVEL 0 10 20 30 40 50 60 70 80 40 100 GRAVEL (+n4 SCREEN) % BY WEIGHT NONFROST SUSCEPTIBLE SOILS ARE INORGANIC SOILS CONTAINING LESS THAN 3`/n FINER THAN 0.02 mm. GROUPS OF FROST -SUSCEPTIBLE SOILS: Fl GRAVELLY SOILS CONTAINING BETWEEN 3 AND 20% FINER THAN 0.02 mm. F2 SANDY SOILS CONTAINING ULTWCEN 3 AND 15010 FINER THAN 0.02 mm. F3 a. GRAVELLY SOILS CONTAINING MORE Tt1AN 20% FINER THAN 0.02 mm. AND SANDY SOILS (EXCEPT FINE SILTY, SANDS) CONTAINING MORE THAN 15% FINER THAN 0.02 mm. b. CLAYS WITH PLASTICITY INDEXLS OF MORE THAN 12. EXCEPT VARVED CLAYS. F4 a. ALL SILTS INCLUDING SANDY SIL TS. b. FINE SILTY SANDS CONTAINING MORE TI IAN 15`/o FINER THAN 0.02 mm. C. LEAN CLAYS WITH PLASTICITY jjl i)L':<ES OI" I_ES$ THAN 12. d. VARVED CLAYS. ATL ALASKA TESTLAB APPLICNT FILLS OUT UPPER HAI'"•,ONLY Property Owner AZ r- -T • 1 A N S U �J Time Phone Mailing Address Zlp Code Buyer r Address Zip Code Lending Institution NJME Sn�� N� S Date Phone Address Zip Code Really Co. d Agent Phone Address Zip Code Inspector Legal Description C<. C) RI•IG. -a, ALT Oji cip V e t_ t n-1 'e- Street Locatlon Inspector Type of Residence 6�ngle Family ❑ Multiple Family No. of Bedrooms ❑ Other Water Sypply XI Q CI 5�36Z1L c�r ndividual / ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community��/ For wells trilled prior to that date, give well depth (attach log if available). ❑ Public Utlllly Sewer Disposal C-l'n'dlviduaf Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank DISAPPFIOVED CONDITIONAL APPROVAL* NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.. Alnnri-., fl„ni- ^—r— Time Time Time Time r Date Date Date p Inspector Inspector Inspector Inspector Field Notes: v lY Q� ✓�_ �/. _ / �^7 MUNICIPALITY OF ANCHORAGE f EPt. OF Q CI 5�36Z1L c�r ENVIRO.' •M:NTAL Pkai:CIION L o 4-r- NOV 2 9 I'..... RECEIVED ( I APPROVED BEDROOMS *CONDITIONS OF APPROVAL DISAPPFIOVED CONDITIONAL APPROVAL* K�-- ( 1 DATE Z 6 -BY: Cie> r LQ -Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size T--._ �.t...+..+-.•.+s. +r, -...,.rte... -� �.Z.�.......-.r.e---�--fr^Rr-.-�.-�a+w....^,.c-a +•vw..; _-+--•e - CHEMICAL & GE 10-\ LABORATORIES (' ALASKA, INC TELEPHONE (907) 5622343 ANCHORAGE INDUSTRIAL CENTER .� 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER- . A WATER SYSTEM: I.D. NO. t' O H n/S a �✓ IR Water System Name Phone No. r" w; Mailing Address 6 'y I City 1 j. Stab•^ f ',I Zq Code fil .0 SAMPLE DATE: MELTT D Lvow CdJ f , SAMPLE TYPE: (�^ ❑'Check Sample (for routine sample with tab ref. no. I ❑ Treated Water`` O Special Purpose ❑ Untreated Water - � SAMPLE�. P�^» {: �. ;w��. ..:� •..., _,.::. .a NO. LOCATION < , .' r "Time Collected. Calected By fl l.�-,�R w..r ,t' "E A c { TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: satisfactory ❑ Unsatisfactory ❑ Sample too long in transit: sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. -} Date Received s, Time Received Analytical Method: ❑ Fermentation Tube 6'Membrane Filter 4 L ab ` Ref;. No. Result* Analyst ED �`A'T:Noo, eo�a.ue,/l0a nw.�a llo of vwiur pon"oni ..•• -- - - - - • • - aa9w (sl - BACTERIOLOGICAL WATER ANALYSIS RECORD ' • • - Rev. 1979 Date Colleded source READ INSTRUCTIONS dU R«Nwe Time Re Gleed BEFORE A.M. DJs. Lab. No. 1Dml I O.lml ' EMS 9rom 24 hourt, Broth 49 hours, COLLECTING SAMPLE Multiple Tube Report, 10ml Tub" PoNtNe/TUW 16ml Portio~ s"mills" Filter. Dlr«t count Collbrm/looml Verltkatlon, LTB 960 Final Membrane Filter Results C061tonn/160ml .. . Reported BY— , r/. _ Data Tana- 9.m. a \ \ \ \ \ \ /\�\� \ \ \ \ \ \ } } } \ \ \ `\ Lw / � � -� j ( V4 k \ / o ) � 9z dt C4 w � 0 C4 0 C4 8{ 2} V. a 74 Q \ \ \ \ \ \ /\�\� \ \ \ \ \ \ } } } \ \ \ `\ Lw / � � -� j V4 \ / � 74 Q \ \ \ \ \ \ \ \ \ \ \ \ } } } \ \ \ Lw 74 Q � 9z000s 00 m Z ty M > rn a < W z G) 7 GI 0 0 Municipality of Anchorage n On -Site Water & Wastewater Program _ (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 020-172-24 ExpiratioZ *14 1. GENERAL INFORMATION '3Petchen StUilgr Complete legal description MOUNTAINSIDE VILLAGE S/D; BLOCK 3, LOT 5 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 17801 STEAMBOAT DRIVE, ANCHORAGE, AK, 99516 JEFFREY KIM Day phone 17801 STEAMBOAT DRIVE, ANCHORAGE, AK, 99516 JAMIE HARVEY W/ JACK WHITE Day phone 2. TYPE OF DWELLING: E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System WaiverNariance request for: N/A 3 223-8374 227-1059 Received by: Date: /"/Z"V,// y COSA to be released to the engineer, unless otherwise requested by the engineer. Distance: - COSA Fee $ TYPE OF WASTEWATER DISPOSAL: Waiver Fee $ Individual On-site I I ! z/ I I L/ ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ Received by: Date: /"/Z"V,// y COSA to be released to the engineer, unless otherwise requested by the engineer. Distance: - COSA Fee $ aq1-fib Waiver Fee $ Date of Payment I I ! z/ I I L/ Date of Payment Receipt Number Q 45-15-36Receipt Number COSA# W1144060 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. /further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 *ANCHORAGE, AK, 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, U0.. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidefines & 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 readrly identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the ovmerlisted 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. 6. DSD SIGNATURE System #1 Approved for bedrooms. Phone 337-6179 Date System #2 Approved for bedrooms. D(F t�f(+�f�r'/( Disapproved. �'n Conditional approval for bedrooms, with the following s !P ionsoN-SITE cm �s ,,.ursFR AND .02 Original Certificate Date: The lel dnicipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other fp inrnno� If more than 1 septic system is on the lot: COSA Checklist # _of_ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: A. WELL DATA MOUNTAINSIDE VILLAGE S/D; BLOCK 3, LOT 5 Parcel ID: 020-172-24 Well type PRIVATE If A, B, or C provide PWSID# NIA Well Log (YIN) YES Date completed 11/17/1982 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 293 ft. Cased to BEDROCK ft. Casing height (above ground) 12+ in. Date of test Static water level FROM WELL LOG 11/17/1982 UNKNOWN ft. Well production 1 n WATER SAMPLE RESULTS: AT INSPECTION 4- ef ft f -9 a —g -P.M. Coliform 0 colonies/100 ml. Nitrate 2.24 mg./L. Collected by: GEG, Ltd. Arsenic: ND ug./L. Date of sample: 10/29/2014 B. SEPTIC/HOLDING TANK DATA 'IN CRAWLSPACE Tank Type/Material SEPTIC/STEEL Date installed UNK Tank size 1000 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) 'YES Depression over tank (YIN) NOHigh water alarm (YIN) NIA Date of pumping _� Pumper /�` G Vryy2 a�// i�t / N jN?10�� �Gwl Le C. ABSORPTION FIELD DATA BELOW EXISTING GRADE ?s Oee/ franL� Date installed UNK Soil rating (g.p.d./ffor /bdrm 165 System type -ml( Length 36 ft. Width 2 ft. Gravel below pipe 7 ft. Total depth '13.7 ft. Eff. absorption area 504 ft2 Monitoring tube YES Depression over field NO Date of adequacy test 10/26/2014 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 1110 gal. New depth 49.5 in. Elapsed Time: 159 min. Final fluid depth1�.5 in. Absorption rate >= 450+ g,p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date 4vuSE W?S V�.z ' �'z ! do rZ+ P2ioz ao "c 4S _4jr D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump of level at we er alarm level at in. Cycles tested Meets alarm & circuit requirements9 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ On adjacent lots 1001+ Absorption field on lot 100'+ On adjacent lots 1001+ Public sewer main Sewer /septic service lips 25'+ Animal containment areas 501+ Public sewer manhole/cleanout WA Holding tank 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 NIA Water service line 101+ Surface water 100'+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main NIA Water service line 10'+ Surfacewater 100'+ Driveway, parking/vehicle storage ADJACENT TO Curtain drain NONE KNOWN Wells on adjacent lots too,+ F. COMMENTS "PER PREVIOUS HAA DOCUMENTATION. G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date 1t)11/1Y' (Rev. 10/12112) Municipality of Anchorage o hG • '� Development Services Department a Building Safety Division S A E r Y On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 020-172-24 COSA# 1. GENERAL INFORMATION Expiration Date: a C Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MOUNTAINSIDE VILLAGE; BLOCK 3 LOT 5 17801 STEAMBOAT DRIVE *ANCHORAGE AK 99516 AUDUN & SUSANNA MIKKELSON Day phone C/O AGENT 17801 STEAMBOAT DRIVE *ANCHORAGE AK 99516 Day phone BETHANY STAMPER W/COLDWELL BANKER Day phone 360-2455 401 E NORTHERN LIGHTS AVE #100 *ANCHORAGE AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 337-6179 Date d V 1 6 1 t Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, ADEC MOA opo F oopo� conscientious engineering analysis of the system in accordance with and described the the moo` DSD Guidelines & Regulations. The reported results performance of the the time of the test, and separation P S'�QOO system unde.- conditions encountered at distances measured to readily identifiable features. The operational life of all wells and QD septic stems depend on the local soils condition, groundwater levels that may p Y P 9 y Q....:.. .. • • • • • • • • • • • • . • • • • .. 0 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 . .. QO • .. • • • • • . • • • • • • • • Q y A. Garn ess. there are no hidden defects or encroachments. GEG, LTD. can therefore not provide to the Q 9� ' . �4 sfe CE— 953 �� Q j C�? any warranty or future estimate of how long the system will continue meet • . operational requirements of the ADEC or MOA DSD. The content of this report is for a pyopp�o 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. r �Y OF 5. DSD SIGNATURE ` Z Approved for bedrooms. ON-SITE v _� WATER AND K- 419t'ASTEWATER Disapproved. PROGRAM Conditional approval for bedrooms, with the following stipulations: ��� �•, .'� '� �� ,moo.••.. ••' p0: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory C.� Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Rev. 11/05) Municipality of Anchorage �V • Development Services Department Building Safety Division ; A; q'T V On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MOUNTAINSIDE VILLAGE; BLOCK 3, LOT 5 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Date completed _L1/L7/82 Sanitary seal (Y/N) YES Total depth 293 ft. Cased to BEDROCK ft. FROM WELL LOG Parcel ID: 020-172-24 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 10/7/11 Date of test 11 /17/82 Static water level UNK ft. 45 ft. Well production 1 —g -P.M. 3.17 g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate` mg./L. Collected by: GEG, Ltd. Arsenic: 1'*' Q ug./L. Date of sample: 10 7 11 �j t C/I i/i B. SEPTIC/HOLDING TANK DATA *IN CRAWLSPACE Tank Type/Material SEPTC/STEEL Date installed UNK Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Pum � � � D,��S I p er Date of pumping C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed UNK Soil rating (g.p.d./ft2or 2/bdrm 165 System type TRENCH Length ft. Width 2 ft. Gravel below pipe 7 ft. X36 `�"* ia� Z� 504 ft2 Monitoring Total depth h5�2@'ft. Eff. absorption area 9 tube YES Depression over field NO Date of adequacy test **10/7/11 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 9.5 in. Water added 990 gal. New depth 52.5 in. Elapsed Time: 120 min. Final fluid depth 31.5 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date — **2000 GALLON PRE—SOAK ON 10/6/11. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump ofP' levelHigh water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank 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 N/A Water service line 10'+ Surface water. 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER PREVIOUSLY ISSUED HAA. EXACT DISTANCE IS UNABLE TO BE DETERMINED. aao�oo004 G. ENGINEER'S CERTIFICATION o �F I certify that I have determined through field inspections and p 4 TH �� Q review of Municipal records that the above systems are in 0 ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' conformance with MOA COSA guidelines in effect on this Q date. ,J e Garne s;' Engineer's Printed Name JEFFREY A. GARNESS Q�o4, — g Date I 4411�04ed U*** * '°rofessior o ��0000d�� COSA Fee $ 14 1 D Date of Payment I U Com► �� Receipt Number C) LA C� (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division „ On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D._Lam. ' ! — / COSA# Q 510'3 1 S 1. GENERAL INFORMATION Expiration Date: 0 t% 9 Complete legal description MOUNTAINSIDE VILLAGE: BLOCK 3, LOT 5 Location (site address) 17801 STEAMBOAT DRIVE *ANCHORAGE. AK 99516 Current Property owner(s) Mailing address Lending agency Mailing address WILLIAM JOBUSH do HSU HORACE Day phone 17801 STEAMBOAT DRIVE 'ANCHORAGE, AK 99516 Day phone 748-0745 Real Estate Agent KATHERINE DEHOOP W/ EXIT REALTY Day phone 230-8522 Mailing address 19132 TRAILBAY DRIVE *EAGLE RrVER. AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional 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 avid/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Finn GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 . ANCHORAGE, AK 99507 Engineers Printed Name JEFFREY A. GARNESS. P.E. Engineers 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 d Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE (/ Approved for '3 bedrooms. Phone 337-6179 Date —1-9 ►G Oct Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: Attachments: / COSA Checklisty Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Report Nitrate Advisory Other By: (R.v. 11105) aoQ�;(D F ON-SITE ••• Gt WATER AND WASTEWATER PROGRAM O � � Original Certificate Date: q —11!) 0 --� Municipality of Anchorage • -�1 Development Services Department _Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MOUNTAINSIDE VILLAGE: BLOCK 3, LOT 5 Parcel ID: 0.2- 10L - A. - A. WELL DATA Well type PRNATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 11/17/82 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 293 ft. Cased to BEDROCK ft. Casing height (above ground) 12+ in. F(iOM WELL LOG AT INSPECTION Date of test 11/17/82 7/31/09 Static water level UNK ft, 52 ft, Well production 1 g.p.m. 2.2 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.5 mgJL. Other bacteria 0 colonies/100 ml. Arsenic: ND ug./L. Date of sample: 7/31/09 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA •IN CRAWLSPACE. Tank Type/Material SETPIC/STEEL Date installed Tank size 1000 gal. Number of Compartments 3 Cleanouts (YIN) YES Foundation cleanout (YIN) *YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 8/13/2009 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GEST Date Installed UNKNOWN Soil rating (g.p.d.lfeo /bd 185 System type TRENCH Length 36 ft. Width 2 ft. Gravel below pipe 7 ft. Total depth • 13.25 ft. Eff. absorption area 504 ft' Monitoring tube YES Depression over field NO Date of adequacy test 7/31/09 Results (Pass/Fail) PASS For -3 Fluid depth in absorption field before test DRY in. Water added 455 gal New depth 32 in. Elapsed Time: 295 min. Final fluid depth 4 in. Absorption rate >= • 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date D. LIFT STATION Date Installed Size In gallons Manhole/Access (Y/N 'Pump on" level at in. 'Pump off leve High water alarm level at ln. Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A 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 N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPTIC TANK IS OUT OF THE PATH OF VEHICLE TRAVEL. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS HAA. EXACT DISTANCE UNABLE G. ENGINEER'S CERTIFICATION o OF ZV I certify that I have determined through field inspections and Q e 49 review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. 0.... .. a JGar ess: Engineer's Printed Name JEFFREY A. GARNE55 QQ j . E(�— `F r e �o Date �prof ..elo0to COSH Fee $yw Waiver Fee $ Data of Payment /���0 Date of Payment Receipt Number QLA 5 -9 1q Receipt Number (Rev. 11105) V all ■:w NORTHLAND PUMPING SERVICE, INC. Your Professional Septic Pumping Service Company 7501 E. 140thAvcnue ANCHORAGE, ALASKA 99516 (907)344-7146 • FAX (907) 858-6770 To William Joebush 17901 Steamboat Drive Anchorage, Air 99516 Te4Ms'. AFLUS "�' PAGE: 01 DATE P.O.* August n, 2009 19804 Pump Septic $1w00 Ordered by: Garness Engineering A 's 4'2009" rate increase began Aug- 2009 148-0745 10/01100 gallons, 2 standpipe; Tank loca ed in lower driveway 40' from front of house next to driveway ,OAS Ov- ?,of.'/'z, Ie'2 ikt'go�on HI'R '� TD PAJ 6AT 1- 60T ftU,C t r" c_t_e VL4T j3;fV4;iD ,p, o 61010 ��Pallons _ Holding Tank ❑ PROBLEM AREA -CALL FOR MORE INFORMATION X Septic Standpipes El NEEDSTO BE DONE AGAIN IN 6 MONTHS Good Shape Sludge ❑ ❑ buildup on bottom ❑ Floater on top ITirt�e "' ❑ Jim cap missing or ❑ Cut standpipe to V above ground ❑ Needs Septictrine _ Leach Area II s needs replacing Lot 6 Lot 4 c Cr 25 ,49 f 00 O 4L an P-- Oa UpN o LOT 5 L'i ; 4: O oLA o rn WELL © 30' A� �} � � V 2 , fyP i EXISTING `��1r / ti'' Nom• M O HOUSE ! /j J v > � � 107.2 00 ry� O D 4 r 11 � ,. nM Q00000pp 2 Septic Standpipes OF qt o . ........ ,9S'40 L 3 Septic Standpipe `•90J 49-TH m 2 Septic Standpipes ... � '•, nt o. offman: a Q S-9020 �4 eajO� �u• ./ i „tfo0 ' �OpOoo�o ' � W Q ;' 00 Sv O N, o gyp- p % W—r /' O a; >. ; a� �Q� HOUSE DETAIL r ;'= GJ SCALE: 1"=30' Z .4 30 l� Z IN'11 H 00 i �p L� ' Qy c° N } J .p. Do; , . .gyp. J rj.., EXISTING eJP HOUSE `?0.00 "I r 2, r� 1„ NOTE: THIS DRAWING IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN WITHOUT THE EXPRESSED WRITTEN CONSENT OF LANTECH. Legal Description: AS—BUILT ordered By William Jobush Lot 5, Block 3, legend: septic Standpipe (D Mountainside Village Subdivision Water Well Qn Wood Dack SURVEY CERTIFICATION: hos conducted o physical sunray the hisLANTECHdraw and certifiesthatthat Me ,n property as shown on this thmenemenb he proing shoaled thereon we within the properly INea and no enaoochmenis eeNl Arm mriteoctl oMer than noted. EXCLUSIONARY NOTE: It Is the owners responsibility to determine the LAND dt CONSTRUCTION SURVEYORS—PLANNERS—ENGINEERS existence of any easements. covanonts, restrictions or right—of—way takings which do not appear on the recorded subdMslon plot. Under 440 West Benson Boulevard, Suite 200 Phone: 562-5291 no circumstances should any data hereon be used for construction, Anchorage. Alaska 99503 Fax: 561-6626 for establishing property lines, or for plot—wan purposes. Plat: 79-177 Grid: 3439 Date: Aug 20, 2009 Drown BY. CB Work order: 2009—L-126 Ref: 05—L-74 FB/PG: 753/4 scate:1"=50 Checked By. APH EEI Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 , Llio. Anchorage, AK 99519-6650^ www.muni.org/onsite JIYU/� (907) 343-7904 kz, G' CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 'v•i.t'j•j Parcel I.D. 1. GENERAL INFORMATION COSA # n pny q I Expiration Date: _19 — ;Z 9 — 0 Complete legal description 7, yon i„9�us,a�y,�.,��- sP • .r �Locdtlon Xsite address) �76oiS'rcraypor oe ,4ueyouee ,q� q��� Cuqrent f,roperty owners) v G��.v Cswoy Day phone Mailing address Lending agency Mailing address Real Estate Agent Day phone Day phone Mailing Address Unless otherwise requested, COSA will be held by DSO for pickup. m&04, 2. NUMBER OF BEDROOMS: 3 440-1120(o 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well QT Individual On-site [.-r Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer �egistered-in-th—e-State ofA as a. erGficaTes of D-n:sit-e-SWems-Approva are regwre or ti -e -Trans er o title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address 9Ba6c7 .r%enxl �i�-crt C�� G•��`��r AK Engineer's Printed Name Oowca as •7��� 5. DSD SIGNATURE L,""� Approved for 3 bedrooms. Disapproved. Conditional approval for Additional Comments Attachments: COSA Checklist X Phone,{9077 416-1,a7j Date • �� • d 4 it . w bedrooms, with the following stipulations: Arsenic Advisory CIN -SITE :�� WATER AND t^= INAPT.PA=P; _ PROGRAM Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By lv Original Certificate Date: 9 - .Z g' O 6 (RW. 11)05) Municipality of Anchorage ' Development Services Department ° Building Safety Division On -Site Water & Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST �1 Legal Description: !oc� MVIA"IeLings �c Parcel ID: 020 _I A. WELL DATA Vi lla5 s/D Well type ! finel - rw Date completed -'��.0 Total depth 9X- ft. Date of test Static water level Well production If A, B, or C provide PWSID # _ Sanitary seal (Y/N) X Well Log (Y/N) y Wires property protected (Y/N) _Y_ 1t * Cased to _ ft. //,. b7 ' Casing height (above ground) U n. FROM WELL LOG / WATER SAMPLE RESULTS: Coliform �0 colonies/100 mL Arsenic: YJQ mg/1 B. SEPTICIHOLDING TANK DATA Nitrate 1,30 mg/L Date of sample: ya AT INSPECTION Si y ft. 2. / g.p.m. Other bacteria colonies/100 mL Collected by: .c .,E,rr.JX ±!y Tank Type/Material "WrzO Es'L, Date installed /4f f Tank size /oae gal. Number of Compartments z Cleanouts (Y/N) Y at Foundation cleanout (Y/N) Y, Depression over tank (Y/N) High water alarm (Y/N) 1.0 Date of pumping 2�a/oG Pumper A"-'W,—JG.%c/O f'✓ •+v� uGS�cd�cs C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ftz or ft /bdrm) /E 5 System type �xexY�J Length 9L ft. Width ft. Gravel below pipe* • • 7 ft. Total depth _/,; ft. Eft. absorption area -ro Monitoring tube r Depression over field N Date of adequacy test JV"'Oba- Results (Pass/Fail) t5AK_f � ( ) For _9,_ bedrooms Fluid depth in absorption field before test 8 in. Water addedsiA'gal. New depth gr0-in. Elapsed Time: S14 min. Final fluid depth :�24n. Absorption rate >= 49(f',v g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) A) If yes, give date "`' D. LIFT STATION Size in gallons 'Pump on" level at —in. Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ioS"5,3x, Absorption field on lot Public sewer main N1� Sewer /septic service line Animal containment areas .40 _4Fx Manhole/Access (Y/N) level at Meets alarm d ril On adjacent lots /p a On adjacent lots ioo yry Public sewer manhole/cleanout Holding tank Azj w Manure/animal excrete storage areas /B© 4/ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 4/40 'W Property line /0 441 Absorption field ✓ref Water main N�.� Water service line 2i'W Surface water /V o Wells on adjacent lots O`A4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /,o s Building foundation8 6 tFi< Water main 'JZ.Q Water Service line fi Surfacewater IQ4917--yl- Driveway. parkirgivehicle storage'��'s``r�� Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and bI. review of Municipal records that the above systems are in t ,. conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name lulu! r'.rCE✓t�Y ��f,�+j, /4� (fir. �.��• ov Date '��._ •. _ _.�� COSA Fee 3 W I / Date of Payment 66 pa Receipt Number (Rev. I IM5) Waiver Fee $ Date of Payment Receipt Number P_ouSlas_T.JCenlcv 9$OG E Nonh star Gircic,�almer Iaska49G4 (9071746-1 September 9, 2006 Mr. Jeff Poet Municipality of Anchorage On-site Services 4700 S. Bragaw Street Anchorage, Alaska Re: Re -issuance of COSA certificate Lot 5, Block 3, Mountainside Village 17801 Steamboat Dr., Anchorage, Alaska Property Owner: David Gowdy Dear Jeff. On March 17, 2005, our office conducted a septic and well adequacy test on the above property. The owner is now being transferred and the house is listed for sale. An inspection of the property was made on September 7, 2006, to make measurements and visually observe the property to insure that nothing had changed since the original March 17, 2005, adequacy test. Water samples were collected at that time. We are requesting issuance of a new certificate of On-site Systems approval. The fluid depth in the absorption field on March 17, 2005 was 8"; the fluid depth on September 7, 2006, was measured at 18". The effective depth of the sewer rock is 7 feet, so there appears to be adequate absorption area left in the leach field. Inspection of the well determined that the wires are still properly protected. If anything else is required, please contact me at (907) 746-1073 or 243-5372. Sincerely, V Douglas T. Kenley, P.E Municipality of Anchorage • Development Services Department, Building Safety Division On -Site Water and Wastewater Program ° 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. HAA #_ 0. Expiration Date: % — 13 1. GENERAL INFORMATION Complete legal description _Lmf S, g/ack 3, /"7ou n %v, >%/.yae Location (site address or directions) 79o/ /fir. kl9s74, Current Property owner(s) Day phone 97'/ Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well IE Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The *Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm De&e A-9 s 7: Aifn /e,a Phone r17.4 7_) -1 /d 73 Address 9964 /10// Engineer's Printed Name Dain+/gas 74' /5oe'-/7 Date � • qtr' �i s. �r e. °F• a �4 gyp• •��t�. 5. DSD SIGNATURE '/rZ''•. X8118 —J,.� Approved for 3 bedrooms. l Disapproved. Conditional approval for bedrooms, with the following stipulations Additional Comments Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory o, r: ON-SITE WASTEWATER i���0,� • •' • GAS Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: (Re, Onvz( Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 198850 Anchorage, AK 99519.6650 www.ci.anchorege.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: —e' 1'/ocle3 /4/o,wn4/1/'11RQIi ParceIID: A. WELL DATA Well type Afc if A. B. or C provide PWSID # _ Date completed �� �7/fZ Sanitary seal (YM) Total depth _L%'2 ft. Cased to / 3 R 1 b, t 7 FROM WELL LOG Date of test//Y/7/f g Static water level ft. Well production / g.p,m, WATER SAMPLE RESULTS: Coliform —:L—colonies/loo mi. Nitrate 9•3%Z mg./i. Arsenic: -'1- mg./1. Date of sample: 3 /7103' B. SEPTIC/HOLDING TANK DATA Tank Type/Material }gaol: r - s /ic / Well Log (YIN) Y Wires property protected (Y/N) / Casing height (above ground) 3�_in. AT INSPECTION 31/71OS S/ y ft. '.7./ 9— p.m- Other bacteria B- colonies/100 ml. Collected by: _f%n le Date installed /9s'3 Tank size lvee gal. Number of Compartments .Z Cleanouts (Y/N) _V X Foundation cleanout (YIN) _.X_ Depression over hank (Y/N) / High water alarm (Y/N) Al 4 Date of pumping ///flox Pumper /Y�ith/'yn P�rnoing Scry r C. ABSORPTION FIELD DATA A'0 Date installed _ = /11 Soil rating (g.p.d./ftz or( /t'• r System type .frcn c fi Length ? G R Width ft. Gravel below pipe 7 It. Total depth /3 ft. Eff. absorption area Xcy fe Monitoring tube --y-,_ Depression over field N Date of adequacy test 3 /7/P�r Results (Pass/Fail) e4 s s For 3 bedrooms Fluid depth in absorption fleld before test 8 in. Water added ,£ 4 gal. New depth_ in. Elapsed Time: 16 min. Final fluid depth JA in. Absorption rate >= //So g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 'Pump on' level at _ in. E. SEPARATION DISTANCES Size in gallons 'Pump otr level Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/[ft station on lot/la.> n,4 r fo,c T dr K Absorption field on lot /-149' Public sewer main /f/�h' Sewer /septic service line a7Sf " Manhole/Access (Y/N) at in. Meeb alarm & circuit requirements? On adjacent lots On adjacent lots / °O Public sewer manhole/cleanout 414 Holding tank ?f"f SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation S/�O / ' Property line /0 r Absorption field S' Water main /1'�N Water service line Surface water Wells on adjacent lots 40 C f SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /D t Building foundation fO t " Water main Water Service line a 5 f ' Surface water Driveway. parkinglvehide storage Alin n t fo /Vo,.e X C:on i Curtain drain ro ex 157, Wells on adjacent lots F. COMMENTS #ndoCn e/eirn/e'r1" /oer>edi'nrhe ek07"' ata` /JGG[.r enf4A,,o7 {,re-�nir$done on rhe Sc/Slee in/�j9G. Ae.e;4ee +„` �; lg. 3siYia .�.✓,c LTwr.�,✓c w•.o 'P.tkrGer>� NY vcrro.+lc.,/ ..,,•• �1 G. ENGINEER'S CERTIFICATION ,�P• 1 car* that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. �, re . • s Engineer's Printed Name Doa a Aqz -/- filen CE � Date %) �):'i• 1• C+dB+'��? HAA Fee $ 14* -40 Date of Payment 411110,6- Receipt 1111OSReceipt Number (Rev. 12101) '1 Waiver Fee $ Date of Payment Receipt Number W A it 0 N 0 ac n 5 O 6 29� a9' o O Z 0, LOT 5 EXISTING HOUSE �1M n I I , , , , , , , ' 3 , , 2 % J y N , a28 - oonC Ap OF At N 49TH �.�.....:.. Q a Michael L. Jokela : a OQ s LS -7839 .a i ey�Q v14 -00, Oo/eaalanat o= FA SCALE 1"=30' NOTE: THIS DRAYRNC IS NOT TO BE MODIFIED FOR USE AS A PLOT PLAN. q « W, W bT't t determine 1"1EwE0 e1 EXCLUSION NOTES. It is the owners response y 0 the existence of any easements. covenants, or restrictions 5/5'RB W/CAP@ 5/8' RBO A U D R E Y MASON Which do not appear On the recorded subdivision plot. NOTE: 3,25' ALMON. Q MONUMENT40 with RE/MAX OF EAGLE RIVER Under no circumstances should any data hereon be used for HUB k TACK El ««« ConatNction Or far establishing property lines. FENCE- —X— X — SURVEY CERTIFICATION: LANTECH has conducted a OVERHANG- phasingl survey of this property as shown on WOOD DECKS - there- drawing and that Improvements situatederic !here CONCRETE - on are within property lines and n0 N1crOOah— pr ASPHALT— E� he menta exist other than noted. GRAVETICL- -ffWdW=r=h — A S— B U I L T O F: LEGAL DESCRIPTION: PIPES- WATER WATER LAN &CONSTRUCTION SURVEYORS -PLANNERS -ENGINEERS 440 WEST EALASKA NSON Lw LOT 5, BLOCK 3, ANCHORAGE, 9503 (907) 562-5291 WORK ORDER NUMBER: APRIL 1, ZOOSTE".SO FrAT 79 117 MOUNTAINSIDE VILLAGE SUBDIVISION "��' W. 2005REIr. }g0. R� 93568 MUNICIPALITY OF ANCHORAGE JAL DEPARTMENT OF HEALTH & 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 I.D. # 0 20 - 17 2 - 2 If 1. GENERAL INFORMATION HAA# A1;Yh1C--, , '_) Complete legal description 'Let Sy Qloctc 3y f-zc' ,7 /w•'-P7sidc 1411ccy� mit Location (site address or directions) 17601 Sfz�am be of Drove Property owner _LG`r,�nl : ( `k1 L 1 Day phone.— y�7E Mailing address 3131 R 1-.715- Lending i1 Lending agency Mailing Day phone Agent- C' ten Ifoush%�7 - Dall Reath, Dayphone 2*76-16133 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site ✓� Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rw.1/91) F,"t MOAN21 . 5. STATEMENT -OF INSPECTION BY ,ENGINEER_ As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S¢p f;c stcr fe.., A G tp(( Qf - S a / f Cont t'r'uc f wq dcrcur. e� he ti on Name of Firm_F�o Techno'col qev Vices phone LVE- 13471— Address 19-5'30 Echo S,4. fl-nc,4orczUe_._/)k 99516 Engineer's signature 5E '7� Date &0 wt 2/, 1996 6. DHHS SIGNATURE Approved for -3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: Date • The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-0254R".1/91) B.c. MOA Qt Municipality of Anchorage AUG 2 81996 DEPARTMENT OF HEALTH &HUMAN SERVICES Environmental Services Division Y G 825'L" Street, Room 502 • Anchorage, Alaska 995010 (907) 3434 Health Authority Approval Checklist Legal Description: !.6 8*3 mow n Iamstdl WLON s parcel I.D.: U ZO -1 T 2 - Z y A. WELL DATA Well type Pmt ✓a I -e If A, B, or C. attach ADEC letter. ADEC water system number Log present (1'rM Y Date completed it 11-11 b 2 Total depth 2 `i 2' Cased to 13 ' Casing height (above ground) 3 ' Sanitary seal (Y" Y - Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test it /17 / OF B / 16 / 96 Static water level Well production / R.P.M. WATER SAMPLE RESULTS: s1 2.0 Coliform 0 M //c+0 m.¢ Nitrate 1.30 nu. /-C Otherbacteria NOOK nee- /Te Date of sample: 8 / r6 / 96' Collected by: r19f HwP %c!t S✓ e *11L SEFTIC/HOI.DING TANK DAT W "'06 104 20c %` rr/io' h fu"no( I" ,F, /e & uNNJ \\ 7%tt cw 4r4lee» of Mr newslcwj4e pyo Oys�sPters tb eyr.p t •%N►1 t� Ml p er,-z // Date installed '-x / 9B1 Tank _l _ _ _ y_ Number of Compartments �_ Cleanouts (Y/1�_)~ Foundation cleanom (YIN) =It Depression (Y/N) _t High water alarm (Y" N. J, Dam of Pumping B/r 6 !>iG Pumper-Vj "acf *C. ABSORPTION FIELD DATA See Av& t,sno(v SPhe 7-44'r l" Date installed '-'c i 91 b Soil raring ig p.d./fl= or !t2/bdrm) ISS- 0' System type Treo c 6c 6 ungmLx3_��� Width — Gravel thiclmess below pipe 7 Total depth 1 ' ! /► tK l *Effecrive absorption areaSOY Monitoring Tube present(Y" Y Depression over field (Y/N) M Date of adequacy test 8/1!!96 Results (Pass/Fail)Psi For 3 bedrooms Fluid depth is absorption field before test (in.); D Immediately dtmg$4Pgai. water added (in.): SO. S Fluid depth K (ins.) Minutes later: r 1 Y Absorption rate - > H4 -V p.d. Peroxide treatment (past 12 months) (Y/N) None i %ouo. i If yes, give date N. A. D. LQTSTATION N.A. ManholdAaas (Y/N) High water alarm level at* �' E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum "Pump W level at - SEPARATION DISTANCES FROM WELL ON LOT TO: Septidholding tank on lot JOS' iy C. o. ; Oo a4jaceot lots 1 too ' Absorption field on lot -%* t E.O' ' ; On adjacent lots ? t lro ' Public sower main r4. A. Public sewer manhole/cleanout N . A•. Sewer /septic service line 2 S" Lift station N. R. SEPARATION DISTANCES FROM SEPTIGHOLDINO TANK ON LOT TO: Building foundation N 3 ' Property line > ro' Absorption field sa S ' Water maidsavix line ro' Surface water/drainage > /40' Wells on agjaxnt lots � r e✓o' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 5r9' + Property Lime 210' Water maidservix line 10 ' Surface water > t CnD' Driveway, parhingrvehicle stomp atm /Fif i ac� f Curtain drain None Seen Wells on uljaxnt lots > t e-10-' F. ENGINEEIL'S CERTIFICATION ^_r- 1 certify that 1 have determined thro field inspections mrd review ofMimicipal recor&f"JW Ab Ut in conformance with MOA HAA guidelines in effect on this date. 'e' _ Engincer's Name Th e4ir& rY F Muvrr lt8febclu&SeaLHae: ,s Date A44"t- el r9945r r+i' '.•''••..... .• �',;': ;; HAA Fee $ 3tSb • Cf' Date of Payment gLzg1Ts Receipt Number AF�d-2-- Ll y / Rev. 9/95 OSS: haawk.doc Waiver Fee S Date of Payment Reocipt Number T.SPURKLAND P.E. 203 W. 15th. AVE. SUITE 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 Municipality of Anchorage Department of flealth and Social Services 8201 Street Anchorage, Alaska 99501 Subject: 11AA Lot 5, Block 3, Mountainside Village 17901 Steamboat Drive Gentlemen; August27,1996 RECEIVED AUG 28 1996 Municipality of Anchorage Dept. Health 8. Human Services We are submitting an HAA for this property. A file search at DHHS revealed that a permit was issued for the installation of a well and a septic system in 1982 and reissued in 1983. An As Built report was not submitted; this system therefore is "undocumented". On 8n196 witnessed Acreage System exposing the tank and the beginning and end of the trench. One standpipe to the tank was located and the outline of the trench could be traced adjacent to the driveway. The total length of the trench was found to be 36 feet. The top of the trench was found at 4 to 5 feet below the present surface, and the bottom 7 feet below that. No trench cleanouts or monitors were found. Acreage System proceeded to install a cleanout between the tank and the foundation, watertight couplings on the tank, new tank cleanouts, double cleanouts after tank, and a monitor and trench cleanout at end of trench. The displaced sewerrock was replaced with new rock. The tank was insulated with 2 inches of insulation. Flattop Technical Services performed the well and septic test. Yours T. Sp 'land P.E.