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HIGHLAND HILLS #2 BLK 2 LT 9
Highland Hills #i Block 2 Lot 9 #050-382-40 Municipality of Anchorage •�- •� Development Services Department Building Safety Division :a On -Site Water 8 Wastewater Program. 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.d.anchorage.ak.us (907) 343.7904 Page 1 of 3 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SW040457 PID Number. 050-382-40 Norma: NUTTY Wastewater System: ❑ New ■ Upgrade Address: 6121 HIGHLAND ROAD a EAGLE RIVER, AK. 99577 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 622-4848 3 Deep Trench Shallow Trench Deed DMound DOther LEGAL DESCRIPTION W0.8 6T0/Sry n Tam t.ak r� 7 (MAX) n Block: Lot: Subdivision: ,y. Z brevet fa pipe boot Dam' palm arvw en wwu asprpm 4+ 2 9 HIGHLAND HILLS SEE DWG. n n Township: Range: section: — — — n ell.a assts e,--- ream DWG. G w W Wipe 60 n SEE n Or" wwft Iherier of Aw bee...t 6nm WELL: ❑ New ❑ Upgrade 5 n 1 law — n ` pea Te1d te.w rm"m"aa0 T" etwarpamt ewm 600+ ►be D 3034/ F-810 Dram' �X\5 tial. tkuwm m. n Made wet' L"Sh '"`PAUL CHERVAN Dale bt6/4/2005 Tyle: pww comp titre ACew owwte c-cos-(xcgH TANK RPM n n SEPARATION DISTANCES oseptic ClHolding osT.F-PP..r r wm'wa`�1ef X�S���NG To Form Septic Tank Abi rVon Field Uft station t= Torek /hAwU Well — 1000+ — — 25'+ Waerbk tMener d amigmbtwilm Surface Water - too'+ - - - LIFT STATION Lot Una — 10'+ — — — A» In pswwt NOM.,tmer. an I,.* It H4h VOW aim m et Foundation — 10'+ — — — pene, teeb esww sapeelbrn Wow" W Curtain Drain NONE KNOW BENCH MARK Remarks: EXISTING SEPTIC TANK VERIFIED TO BE OF GOOD INTEGRITY ON 6/4/2005 TOP OF GARAGE SLAB r 100.00 n wars o { A�: qs4 *�. Inspections performed by: GEG, Ltd.Dates: 1st 6/4/2005 :. .. .... 2nd 6/4/2005 3rd • A. Go ess.: Development pervices Department Approval e E—e _Reviewed " R e'viewedand approved by: Date: 9hn�Op*'P•ofeeeto^O��c I I�40ooa� pip. Wol) w040457 AS -BUILT DRAWING P050-382-40 ` 1 � 1 I 1 1 I 1 I 1 I 1 1 1 1 � I I I I I I i l�!�l.11l`l GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS.�� =I c emA, '" ' w barb 's ..........►.• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JIM NUTTY (907) 622-4848 2 OF 3 LEON. DESCRIFDON: DRAWN BY: HIGHLAND HILLS SUBDIVISION: LOT 9. BLOCK 2. R.A.L. DATE: TYPE OF WORK: 8/24/2( AS—BUILT FOR NEW DRAINFIELD I I I 1 1 I NEW DRNNFIEID T11 11 1 11 111 �!,� 1� TTN/t1 lut2 MUMN SEPnc TANK (VERIFlED TO BE OF ON oCg/2005) Rrt o% -i'�Sm ..... ........ rey amess: C�-79 3 r' •` C01 98.8 1107.6 MT1 97.6 1106.0 "`:!; >• CO2 114.0 92.7 'j. MT2 113.4 92.9 t •,: FD 80.9 69.4 l�!�l.11l`l GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS.�� =I c emA, '" ' w barb 's ..........►.• PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JIM NUTTY (907) 622-4848 2 OF 3 LEON. DESCRIFDON: DRAWN BY: HIGHLAND HILLS SUBDIVISION: LOT 9. BLOCK 2. R.A.L. DATE: TYPE OF WORK: 8/24/2( AS—BUILT FOR NEW DRAINFIELD I I I 1 1 I NEW DRNNFIEID T11 11 1 11 111 �!,� 1� TTN/t1 lut2 MUMN SEPnc TANK (VERIFlED TO BE OF ON oCg/2005) Rrt o% -i'�Sm ..... ........ rey amess: C�-79 3 r' •` PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: - SW040457 050-382-40 ORIGINAL GRADE . 81.19 O HIGHEST POIN RELATIVE ELEVATION OF BOTTOM OF TEST HOLE O 68.69 (TEST HOLE DRY) -FINAL GRADE - 81.74-82.56 FABRIC INVERT OF PIPE - 78.21 (AVG.) )TTOM OF TRENCH - 74.15 (AVG.) GARNESS RNGINRRRING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS =I L TIOM IIMR YIC 101 • MCMD" L MI • NM (IO/AiM " PREPARED FOR: PHONE NUMBER: PACE NUMBER: JIM NUTTY (907) 622-4848 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: HIGHLAND HILLS SUBDIVISION; LOT 9. BLOCK 2. R.A.L. TYPE OF WORK: DATE. AS -BUILT FOR NEW DRAINFIELD 8/24/2( (11". O1N5) wl�@ y 'dc me9s.� CE 793 V. 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 Initial Date Issued: Oct 26, 2004 Expiration Date: Oct 26, 2005 Permit Number: SWO40457 Parcel ID: 050-38240 Legal Description:tHiGHLAND HILLS #2 BLK 2 LT 9 Design Engineer: 0855 Gamess Engineering Group, LTD Site Address: 006121 HILAND RD Owner Name: JIM NUTTY Lot Size: 76537 SO. FT. Owner Address: 6121 HILAND ROAD Total Bedrooms: 3 Permit Bedrooms: 3 EAGLE RIVER, AK 99577-0000 This permit is for the construction of: ❑/ Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify 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 dosed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Date:,K-)Z2,7Lok Issued B _ 7 1 - Date: /0 r Municipality of Anchorage • Development Services Departmenti'� Building Safety Division Onsite Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. tb- 38a -4o Permit Number Property owner(s) JIM NUTTY Day phone 622-4848 Mailing address (1) 6121 HILAND ROAD • EAGLE RIVER, AK Mailing address (2) Zip Code 99577 Legal description (Lot, Block & Sub'd.) LOT 9. BLOCK 2: HIGHLAND HILLS SUBDIVISION Legal description (Section, Township & Range) N/A Lot Sizer(a�, ✓�=Acres/Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade E THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit Fees: Date of Payment: 10 1 �2 110 Receipt Number: 059q 1 Waiver Date of Payment: Receipt Number: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS o October 20, 2004 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Upgrade for highland hills Subdivision; Lot 9, Block 2, To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The septic system is currently in the state of failure and needs to be replaced. We are proposing to install the alternate drainfield identified in SRS engineering's 1996 design. The existing 1000 gallon septic tank is to be excavated and the integrity verified. If of poor integrity a new 1000 gallon septic tank will be installed. A confirmation test hole was dug to confirm the soils and groundwater conditions. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that an application rate of 0.8 gallons/day/ft' should be used. 2. TRENCH DESIGN: a. Percolation Rate: 6-15 (visually) minutes/inch. 4 min/inch per S&S eng. testhole b. Proposed Application Rate: 0.8 gallons/day/ft' c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 563 ft= f. Total Depth: 6 feet (maximum) g. Effective Depth: 4 feet (minimum) It. Width: 5 feet i. Reduction Factor: .50 j. Minimum Length: 57+ feet long k. Effective absorption area = 570 ft' 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246 * Website: gamessengineering.com 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. TOPOGRAPIIY: The average slope in the area is approximately 5 to 10 percent running west to east. In short, there are no slope concerns. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you ave any questions, please contact us at 337-6179. Thank you for your assistance. R .E., M.S. NOTE. A one soil log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507 Ph: (907) 337-6179 0 Fax: (907) 338-3246 • Website: gamessengineering.com •: iso::+..•,ti�;' EXISTING 1000 GALLON SEPTIC TANK. TO BE EXCAVATED AND INTEGRITY VERIFIED. IF OF POOR .• .•. y. •y INTEGRITY A NEW 1000 GALLON SEPTIC TANK WILL BE INSTALLED. 1 goo, POST 1 y BED, HOL 11 EXISTING WELL � 1 1 NOTE: THE CONTRACTOR SHALL HAVE THE SOUTH LOT LINE FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS 6 FEET DEEP MAXIMUM BY S FEET WIDE BY 57 FEET LONG. ADD 4 FEET OF CLEAN, WASHED SEWER DRAINROCK. —I EXISTING DRAINFIELD / IS TO BE USED AS A S&S ENC. TH/1— '::. \ GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS& GENERAL CONTRACTORS 1161 F TUOna PMAI [11IT9 101 • AN. WnQAU AK oosm • P me (onnS17.M1no • FAX (907)1V9.1746 JIM NUTTY Te"Sfm•Pj1 10/21/2004 LAWN BY: C.J.G. ALL: 1 " = 40' 622-4848 1 1 OF 1 HIGHLAND HILLS SUBDIVISION; LOT 9, BLOCK 2, E OF WORK: DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE STALL FLOW DNERTER L—INSTALL DOUBLE / CLEANOUTS • .. .a ........................... J r A. orness:' 0 7 3 i� i, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825"L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: 10Ny L1.f S T k1V K.V DATE Loi rl BLOCK 2 - LEGAL DESCRIPTION! -14 1(-;/ `A..r D {f r c.a- S */)Township, Range, Section: DEPTH SLOPE SITE PLAN 1 iFiE Tt O fLL C ,. Ub 2 h a,Fttas< 3 6!� :c3 4 c r� .'c I G -M is-t2A4R L d ANO 6 •'"" , C'L 473� SrL.7- 6- F11Xrv, S' 7 .r( 9 1v't to - it l:. 12` 13 ^v ' Q.. V. ly 14 Dpq a.30.91, 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? N O 5 IF YES. AT WHAT L O DEPTH? P E Depth to Water Atter pRy S�$/q S Monitoring? Date: 20t_jPERCOLATION RATE (mmutevmch) PERC HOLE DIAMETER TESTRUNBETWEEN 3"r FTAND S— FI COMMENTS `9VG �SO vTW<e.A et CON Tj 4+e•7"0n! • J*L/TNd L4 SO/LJ C 6.1c 14 o ONJIr! 'S L/Ti/C SYj 74 f'9., needing Date Grose Time Not Depth to Time Water Not Drop a,Fttas< Y 1f RJ' :c3 S .'c I I , C'L or, PERFORMED BY: S-& S EpN4CWN96RING — I -"44, 4A01,1 CERTIFY THAI THIS 7ES7 WAS PERFORMED IN ACCORDANCE INTIMA IN EFFECT ON Tf IIS DATE. DATE: 72•00e in" 695) 6491 River, Alaska 99577 OF °gyp GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS S GENERAL CONTRACTORS 0* ' • T) stoi c twox tro•o, sui[ toi • wtc•wwcC M. auaot • nwic: (W?W7-6170 • rw+: trot 3246 • rrtssnc prn•.riq+».iry.oan SOIL LOG - PERCOLATION TEST ... .... . .............. LEGAL DESCRIPTION: HIGHLAND HILLS SUBDIVISION; LOT 9, BLOCK 2, O a ••. f ess: .i PERFORMED FOR: JIM NUTTY DATE: 10/7/2004 QD�ti -7953 •' `FG DEPTH =__= ORGANICS 4p0o"ptc/essloao��o ( ) TEST HOLE � �OODoo� 1 LOAM 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 16 DEPTH TO GROUNDWATER •' Imm JIM DRY - 111111m 33011191VZZA OF", uum • IIIIIIIII !q9t - %//% X1111151 I�.>�e • DEPTH TO GROUNDWATER DATE DRY 10/7/2004 DRY 0/14/200 SEE ATTACHED SITE PLAN DATE IREADINGI CT MEK I (MINUTES) NET TIME I WATER READING LEVELI (INCHES) N 19� PERCOLATION RATE _ (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN FT. AND FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORMED BY: ❑ NO PERFORMED BY GEC, Ltd. 1, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: zo LVIOLoe Municipality of Anchorage Page t of Z DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: Sud RbO10$ PID Number: 0A50 --zRz - 4o Nam: Soa�q �o Wastewater System: I$ New ❑ Y Upgrade o - c oIJ AdP.O. e-.r.)e 77t1,_4'7 EA - - l?%VC l Ar e�s'T ABSORPTION FIELD Phone: _ (mal Li y 3 S I No. of Bedrooms: ❑Dee Trench P olt Shallow Trench O Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Z Total Depth from original grade: • GPD/So Ft rve Lot: Block: Subdivision: 11 Z Depth to pipe bottom hom original grade: Gravel depth beneath pipe H16HILAt4n BILL,.* .Zr Ft �Fa Ft Township: Range:_ Section: Fill added above original grade: Gravel length:Jf, I _ -Z•S Ft Ft. WELL* 111f New 13 Upgrade Gnivel width: Number of lines: ( Daunce bmreen lines: Ft. Ft. Classdication (Private. A.B.C): Pit Total Depth: Cased To: Total absorption area: Pipe material: AStFQ O+w� y 'l A E ZLO Ft. LO. S Ft. y0O SO. Ft. O Driller. SL)LA.IJA14 w%7te LI' Date Grilled: 8 SWIC Water L"el: Installer. �yrp 4Y&" Date Installed: 100 Ft. Rait. %-15`1G Yield: 6 Pump Set at: Ca ng tlelght ADM Grand: TANK GPM u. K.. Ft. 2'4 Ft. SEPARATION DISTANCES OLSeptic ❑Holding ❑S.T.E.P. To Saptc Absorption Litt Noloing bI1NPdvate Manufacturer. Capacity In gallons: From Tank Fiew station Tank Satyr Linn a Welt !4061+ loo+ — _ 1 ZS -F Material: STEEL_ Number of Compartments: Surface Water fool+ 1661+ — — LIFT STATION Lot1 v4 1 - - —. Size In gallons: Manufacturer. Line Foundation C4 1 7 j f to .�, "Pump on' level at: el at: = High water alarm at Curtain l�cni� krJc 1J Pump M ooel Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: '156N1 = &, t t G ' 00'r_3A oft oAl E - SlOk; F Assumed Elevation: !IACori 100-40 ..........�gs.�11t) S A S RNGINRRRING -1-117-51' w. ,.. Inspections performed by: 11034 Riffireir toor Need, NeARIPS:1St . j 1..,...:.... licaliffie 8apfaRiver, Alaska "577 2nd 7-1s-96 ROBERT C. COWAN i4C llttJ�Fi_ CE -8801 I Department of He Ith a u Services approva + w t�iii����_:i�y. Reviewed and approved b . Date: qn y� 72-017(11". SAI) MOA 25 V Permit No. SW960105 2 2 Page of _ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 a Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report LOT 9, BLOCK 2, HIGHLAND HILL S/D UNIT#2 Legal Description: PID No.: 050-382-40 T2d13 A (Wv. MI) MOA 25 F / SWINC-TIE MFJSUREMENTS A N\ B 20.0' 34.0' j DONE BY AS -D ILT SURVEY / DRAWN BY: WI M D. FLEMIN STI58.5' 70.5' i 64.0' FBL 76.0' 66.0' 78.0' / I C01 71.5' I 95.0' r� 92.5' MT1 70.0' CO2 79.5' 1 78.0' 1 o MT2 80.5' 79.0' 1 1 1 S Bee 19)k L TIC TANK ALT. S TE 11� 1 N 1 B Con 1 11 1 I 1 1 1 1 11 0 C S, O 1 C i1 -G IL 1 ^ 70 CO 1 o NEW TRE CH t 1111 RA = 00. NEVA' � 1YE 1 � 1 1 S ALE 1' - 40' 1 11 F NAL GRADE 1 f2 C0? STI ST2 B4.2• ,�. r V IN ULATION gg C0 79.'J k9R i!�C�'�J �'' • tk moi! EW 80.2' 1000 CAL 'i � ROBERT'C. CO'AAN••• f .+ / . . c TiNK 61•f I = 75.8' MT2 a 75.7' Q801 /t+t NO ITER FOUND '.r �'Z-•'�✓ lF�;'•.C�' iifvllFp //7"ar/qc, T2d13 A (Wv. MI) MOA 25 F Nou. 4 '96 11:42 SOUTH FORK CONST TEL 907-694-1122 P. 1 tikh'�'.1-96 SAT 10:40 An *VLLIVAN WATER WELLS 686 2739444444444444 P.01 .r wrfitird Drilling Eug by OOC Co. ttw SULLIVAN WATER. WELLS P.O. BOX$109tMONVOIA&ALASKAMINT • TILFPHONI1414-41`641 O OWNER OF LANDy dy 0IS • .-]AfJ;el ADDRESS LEGALDESCRIPTIO.,N DATE -Started Ended _SL PERMIT NUMBER KIND OF FOR.NATION: From. 0_ F1. to A Ft. c tr f"J c, J, 4w? Fwm-a—ft.to-4yy_Ft. FromAtFt.to.pµA�FLC+�Ar `r�NOX�(I/ur�V ,J r From. 8+ C1 Ft. to� Ft. Xd&Q I" it Cot L6F DEPTII Of HELL FI rromjb_5_� Ft. toLIitAf r A0 Fa.m__"Ft. to 5T>,Tj LVEL OF WATER Fr. u c 141(( A. �rrroom_,_-_ Frutnll�� Ft -to rnrc Fl._J3ad&c& !Y/i4d ���From Ft.ln FI• DRAW DOhN FT. Ft. [���,/rrom Fru.n f2[Q}�Fl.lo/+��`I''_FL_.(an,, �OC� 'Q o`4'— ►rom Ft to GALS. PER HR Fro.n1-!1._Ft.IoJ�Ft..�,1C'.4.SC - From ft. to FI. ' / b•�_,— From 4 6'e�rom st.to Ft. ri_Fc.to.6�+K[1i�.F1.J+/7��� From!�.iFt.IOY �v FL _7L�f�eG� ��6 rom�_Ft to 1. KIND OFCASI\C Ft. - - Ft. From Fl. to Ft. From Ft. to Ft. From FI. to F{. From Ft. to Ft From Fl. to Ft. from Filo Ft From to-LR2-FL agEazetJIC 6&lfy F 1 ro FI rromjb_5_� Ft. toLIitAf r A0 Fa.m__"Ft. to Ft. From .0_Ft-to1,d,PFt. t"t6dAQQC_ i(Z 'Y rt to Ft. �rrroom_,_-_ Frutnll�� Ft -to rnrc Fl._J3ad&c& !Y/i4d ���From Ft.ln FI• FromjL_:r_FL /O_L,{L_Ft,..plS,:Qzwl- gjAY Ft. to Ft. [���,/rrom Fru.n f2[Q}�Fl.lo/+��`I''_FL_.(an,, �OC� 'Q o`4'— ►rom Ft to FI, . Fro.n1-!1._Ft.IoJ�Ft..�,1C'.4.SC - From ft. to FI. ' / b•�_,— From 4 6'e�rom st.to Ft. ri_Fc.to.6�+K[1i�.F1.J+/7��� From!�.iFt.IOY �v FL _7L�f�eG� ��6 rom�_Ft to 1. From Ft• to ft. �e&'1a1pj Sa ff"eli FY mq Ft to Ft. Ln. lEd�s� Jn,ciG From.. Ln. to FI k [09GK. rom7 Ft. to Ft. From Fl. to Ft. From Ft. to Ft. Ftorn Ft. to Ft. From—F1.40—Ir b— " f t A / C D — MISCL. INFORMATION: -131996 u O I (e II 7-0 rel4 6 �� CSI n1Fi rnunNipality of A ansrage .-A Dept-Health&Hum i�, (^� f DRILLFR75 NAME �1� PARCEL: 050-382-40-000-97 CARD: 01 OF O1 RESIDENTIAL VACANT LAND STATUS: RENUMBERED TO/FROM: - - - - 1 ------ =----------------------------------------------------------------------- JANKE PHYLLIS L HIGHLAND HILLS #2 BLK 2 LT 9 PO BOX 770567 0 EAGLE RIVER AK 99577 0567 SITE ------------------------------------------------------------------------------ LOT SIZE: 76,537 ---DATE CHANGED--- ----DEED CHANGED ---- ZONE : R6 OWNER : 05/17/96 BOOK : 2922 PAGE: 0972 TAX DIST: 010 ADDRESS: 00/00/00 DATE : 05/09/96 GRID HRA # 000000 PLAT : 740014 NOTES ----------------------------------ASSESSMENT HISTORY -------------------------- --- LAND-- --BUILDING- ---TOTAL--- FINAL VALUE 1994: 34,100 0 34,100 FINAL VALUE 1995: 12,000 0 12,000 --EXEMPTION--- FINAL VALUE 1996: 40,200 0 40,200 -----TYPE----- EXEMPT VALUE 1996: 0 0 0 STATE EXEMPT 1996: 0 -COMM COUNCIL - FINAL VALUE 1996: 40,200 SOUTH FORK E. R Date: 7-15-91C ROBERT C. COWAN, P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907)694-2979 FAX(907)694.1211 RECEIVED HEALnNAurHOwn APPROVALS JUL 161996 Municipality of Anchorage DeptMunicipality otgnchora P(. SEWERSWATER DEPARTMENT OF HEALTH AND HUMAN SERVICES e h & Human Ser ices MANMENSIONS 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 SEWERS WATER INSPECTION REFERENCE: (.oT 41 B1 .N IG 2 1416"LA•10 A" .S/O Valr*2- ENGINEERINGSTUDIES ANDREPORTS The septic inspections for the referenced P P property were performed on 7-12-9t and 7-tr-n Prior to submitting the On-site Wastewater Disposal System and/or Well Inspection Report we are waiting for the FDOADA*I*104 to be WELLNSPECTION &FLOW TEST completed. If we may be of further service please contact us. SITE,w,S Sincerely, '��•VA/I�/v' ROAD DESIGN Robert C. Cowan, P.E. SOILTEST PERCOLATION TEST STRUCTURALS MECHANICAL INSPECTIONS; ONSITE WASTEWATER DISPOS&SYSTEM DESIGN 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE is%so DEPARTMENT OF HEALTH AND HUMAN SERVICES I� P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 21 o y-\ ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT I -C\ Lo PERMIT NUMBER:SW960105 DATE ISSUED: 6/06/96 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 6/06/97 OWNER NAME:JANKE PHYLLIS & OWNER ADDRESS:P.O. BOX 770567 EAGLE RIVER, ALASKA 99577 PARCEL ID:05038240 LEGAL DESCRIPTION: HIGHLAND HILLS #2 BLK 2 LT 9 LOT SIZE: 76537 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: ,y//A ///J /�f �n RECEIVED BY: �^' . v�'t/'`" DATE: 4 ISSUED BY �l\ DATE: NEALTHAVTHORITY APPROVALS SEWERS WATER MAIN EXTENSIONS SEWER 8 WATER INSPECTION ENGINEERINGSTUgES AND REPORTS WELL INSPECTION 8 FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL 8 MECHANICAL 14PECTIM ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN nG May 6, 1996 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 9, Block 2, Highland Hills SID ROBERT C. COWAN. P.E. ROBERTA. SHAFER, P.E. CML ENGINEERS (907) 694-2979 FAX(907)694-1211 Unit 82 Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. A test hole was excavated and percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered in the test hole and after seven day gorund water monitoring, the monitoring tube within the test hole was found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. There are no points of contamination within the proposed well radius which can be seen on the attached site plan. If you require additional information, please contact us. Sincerely, ?W4<7 Robert C. RCC/gk Enclosure Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER. ALASKA 99577 1 = 60, I SITE PLAN rn Z!> o -� n C ��' � z z o ST � y T a G;SN �t D rn O G V K Jx � Z O 0 'L G 9� z O 7 °2J DESIGN ::E -0m0 ;o L4Ln O1 �3 A(n WC O O a) lTJ zy c�'_ nrri �yo� H 0 �p O~O �r0('1 r" -0 NII rn zzc z Z ~ mrN -n rn WNA�i Ln Dj0 -40 0 U �_ O yr�,p O y (n0 o�mv QRONvCz] Oo0o'' zip z II rb in AD W><w y�c v O 9 -4 m�A=m LA z� CT 'n• nN"m(m�COZ] 1+1 0_-zm v Cc+ zom(At�ANN q m m n M z Vi \ \ z Z 0 1d30 .0 ------------f Y�� A\ (,vmmKmz 7 0 s ---- \ O m O� N AO M>=z o= -�a+;Z ¢r- 0=!> O o z Z nlava 7 ux .00 I 13�tl>!0 ONtLSIX3 ?p, p fpT p� z z 3 BDRM r z Ino O - T a my D rn O n-00co p � Z O D ° z O L7 N D Mlr O 1 r O 0 v f n x 0 m D r Ni WEALTH AUTHORITY APPROVALS SEWER & WATER MAINEXTEHSIONS SEWERSWATER INSPECTION ENGINEERINGSTUDIES AND REPORTS WELLI SPECTION 8 FLOW TEST SREPLANS ROADDESIGN SOIL TEST PERCOLATION TEST STRUCTURALS MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSALSVSTEM DESIGN ROBERTC. COWAN, P.E. ROBERTA. SHAFER. P.E. ON-SITE WASTEWATER DISPOSAL SYSTEM CIVILENGINEERS CONSTRUCTION PRACTICES FAX(99a-2907)s944-- 1211 and FAX (907) MATERIAL SPECIFICATIONS Lot 9, Block 2, Highland Hills S/D Unit #2 May 3, 1996 1. The scope of this project includes the installation of a 1000 gallon septic tank and five foot wide drainfield to serve the proposed three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. C TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP • SURE 204 • EAGLE RIVER, ALASKA 99577 Page Two Lot 9, Block 2, Highland Hills S/D Unit $2 May 3, 1996 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD 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. Page Three Lot 9, Block 2, Highland Hills S/D Unit 82 May 3, 1996 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 after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Tvpe of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 14014, 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 38 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. Page Four Lot 9, Block 21 Highland Hills S/D Unit $2 May 3, 1996 Typically there will be a minimum of three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. 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. Page Five Lot 9, Block 2, Highland Hills S/D Unit $2 May 3, 1996 S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/INSTALLER n Municlpallty of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMEDFOR: PNyCL( S ` Zjy K1' DATE PE L-3 7-'1 BLdc'iG Z LEGAL DESCRIPTION: e -L- S 0) Township, Range, Section: "lip H SLOPE SITE PLAN 1 L HETI O /L4R N r c S 2- 3 3 L 4 + 4- 6- 7 6 7 r• v• 8- 9 9 lvt 10- 12- 1 3 01213 ^ y 14 15 16 17 18 19 5 trrM (y2AtaL/JA0-'o S (L.7— II1)(rv4i- S DW a-3o.gc. WAS GROUND WATER *rO ENCOUNTERED? S IF YES, AT WHAT L O DEPTH? p E Depth to Water Alter Do 8/$/As— Monitorinp7 One: Reading Data Gross Time Net Depth to Time Water Net Drop aSOAIc 1,7-9,7q —j - O /'f Itj 4-75- r, O 1r 03 .1s" 20 { UPERCOLATION RATE (mmutevincn) PERC HOLE DIAMETER s ,• TEST RUN BETWEEN 3. r FT AND FT COMMENTS pVG S y-f9`I AK CCN S'7 A -c-7.10 '*Ad Lt Soit.) Fd,t A.v CNJtr4L C.4 ;-I SYS 7h.a. PERFORMED BY: S at S IRRWIND ERS• 1 CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WL� 'STIlT�71V IIWapFNOYd"jryDRES IN EFFECT ON THIS DATE. DATE: "gas Ri"r, Alaska 99577 72-008(Rev. 4,85) - Parcel I.D. 050-382-40 4 $� Municipality of Anchorage ' On -Site Water and Wastewater Program e rx (907) 343-7904 s E Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Complete legal description Highland Hills #2, Block 2, Lot 9 Location (site address) 6121 Hlland Rd. Current Property owner(s) Daniel & Krystal Alicie Mailing address Real Estate Agent Day phone _ 6121 Hiland Rd. Eagle River, AK 99577 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well I] Individual I] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance Received by: COSA to be released to the unless otherwise requested by the engineer. COSA Fee $ 6240— Date 240—Date of Payment %ta 11:5 - Receipt 1SReceipt Number 0 C(55 � COSA# 0--pQ15-1210 Date: W 12 Z O I S Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sale benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272=8218 Address P.O. Box 100217, Anchorage Ak. 995100 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Date 6//2015 Conditional approval for bedrooms, with the following stipulations: By: ' si/ �'�' l Original Certificate Date`. The nici of orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represen tions given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheM f .e 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: Highland Hills #2, Block 2, Lot 9 A. WELL DATA Well type Private If A, B, or C provide PWSID # _ Date completed 8/1996 Sanitary seal (YIN) Y Total depth 260 ft. Cased to 60.5 ft FROM WELL LOG Date of test 8/1996 Static water level 100 Well production 6 WATER SAMPLE RESULTS: ft. g.p.m. Parcel ID: 050-382-40 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 6/2/209.5 5.1 Coliform ice& colonies/100 mL Nitrate �`• I mg/L Arsenic (0.05 ug/L Date of sample: 6/2/2015 Collected by: PES B. SEPTIC/HOLDING TANK DATA ft. Tank Type/Material Septic/Steel Date installed 7/15/1996 Tank size 1,000 gal Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5/27/2015 Pumper JR's Pumping C. ABSORPTION FIELD DAT S O $ 9 v y} 2Db 2 2 yg GPD/SF Shallow Trench Date installed Soil rating (g.p.d./ft or ft /bdrm) System type Length A(r 6 O ft. Width 5 ft. Gravel below pipe 4 ft. (pDa Total depth 8,5 ft. Eff. absorption area 4ea fe Monitoring tube Y Depression over field N Date of adequacy test 6/2/2015 Results (Pass/Fail) PASS For 3_ bedrooms Fluid depth in absorption field before test 12 in. Water added 452 gal. New depth 14 in. Elapsed Time: 100 min. Final fluid depth 12 in. Any rejuvenation treatment (past 12 mo.) (YIN & type) NO Absorption rate >= 450+ g.p.d. If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at E. SEPARATION DISTANCES WELL ON LOT TO: Cycles.tested Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 50+ SEPTIC/HOLDING TANK ON LOT TO Manhole/Access (YIN) in. High water alarm level at Meets alarm & circuit requirements? _ On adjacent lots 100+ On adjacent lots 10Q+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10 + Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 110+ Curtain drain 50+ Wells on adjacent lots 100+ F: COMMENTS 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 Steven R.. Pannone Date 6/4/2015 COSA canary sheet_2-6-15.doc in. £PuWS MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On-Site Systems Approval Q� Parcel I.D. 050-382-40 Expiration Date: 6,— 2 `Q–11 / 1. GENERAL INFORMATION Complete legal description Highland Hills #2 B2 L9 Location (site address) 6121 Hiland Road Current property owner(s) Jason & Jennifer Taylor Day phone Mailing address 6121 Hiland Road Eagle River, AK 99577 Real estate agent Day phone 2. TYPE OF DWELLING: 0 Single Family(w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ O5D Waiver Fee $ Date of Payment 3/2&if 9 Date of Payment Receipt Number 0256a9 Receipt Number COSA# £'3 . /q/o3 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein.I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes,ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations. The reported results describe 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 soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system.All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance,nor can we estimate remaining life of the system.The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date / ?03 2. ,-.��t�`\\ . -...OF qk�S�t'r 6. DSD S GNATURE * �V� �iik, *,� System#1 Approved for bedrooms ' te,•an P•Yinor.cel 6;c.,. CE °149 \,i/ System#2 Approved for bedrooms ��'" • 1:• LJ Disapproved <<\�� e` Conditional approval for bedrooms, with the following stipulations: �• ON-SITE t) WATER AND Pil WASTEWATER o • PROGRAM QA g' By:______T ___‘... .::-,-._.a._0Original Certificate Date: 3 -Z7'!7 The Municipality of Anchorage Development Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other�ow�[ y zz.gri COSA Checklist blue sheet COSA Checklist Legal Description: Highland Hills#2 B2 L9 Parcel ID: 050-382-40 If more than'I septic system on lot: COSA Checklist# of Structure served by this system 1 A. WELL DATA ■❑Well log is filed with Onsite(or attached) Well production at time of test 5.03 gpm Date drilled 8/96 Water storage tank volume n/a gallons Total depth 260 ft Well disinfected for coliform test? ❑Yes ❑✓ No Cased to 60.6 ft Ui Coliform bacteria is Negative ❑� Sanitary seal is functioning correctly Nitrate 1.89 mg/L ❑ Nitrate less than MRL(ND) El Wires are properly protected Arsenic ND ug/L IDArsenic less than MRL(ND) Casing height(above ground) 18+ in. Collected by PES Date of flow test for COSA 3/8/19 Date of Sample 3/15/19 Static water level at beginning of test 106.7 ft Comments B. TANK DATA C. LIFT STATION Age of tank(s) 23 years ❑ Required maintenance completed Tank type/material ° ' Age of lift station years Measured operating fluid level in septic tank 48" Lift station material ❑� Standpipes/foundation cleanout per record drawing Comments: Date of pumping D. ABSORPTION FIELD DATA 1996 6/4/2005 Which system tested (date installed) 6/4/05 Adequacy test date 3/8119 111 ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 8.0 ft(max) Fluid depth prior to test 30 in Measured depth to pipe invert from grade 4.5 ft(min) Water added 450 gal ❑ N/A—pressurized field New depth 35 in Q Monitor tubes go to bottom of effective. If not, state Elapsed time 100 min depth into effective D Code-required soil cover over field Final fluid depth 32 in ❑ Absorption rate >450 gpd System presoaked (Required if vacant for greater than 30 days prior to Any rejuvenation treatment(past 12 months) date of test) Gallons introduced gallons If yes, enter date Comments/Deficiencies:-PES recommends switching flow diverter valve to other trench. COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot> 100' Community Sewer Manhole/Cleanout> 100' p Yes if No ft 0 Yes if No ft Neighboring Tank> 100' 0 Yes if No ft Private Sewer/Septic Line>25'El Yes if No ft Absorption Field on Lot> 100' 0✓ Yes if No ft Holding Tank> 100' 0 Yes if No ft Neighboring Absorption Fields> 100' Animal Containment> 50' 0✓ Yes if No ft ❑✓ Yes if No ft Manure/Animal Excreta Storage> 100' Community Sewer Main > 75' 0✓ Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations> 10' ✓l Yes if No ft Surface Water> 100' ❑✓ Yes if No ft Property Line> 5' p Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' El Yes if No ft Private Wells> 100' ID Yes if No ft • Water Main > 10' El Yes if No ft Community Wells>200' 0 Yes if No ft Water Service Line> 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells> 100' EI Yes if No ft Water Service Line> 10' 0 Yes if No ft Community Wells>200' 0 Yes if No ft Surface Water> 100' ✓❑ Yes if No ft F. ENGINEER'S COMMENTS 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 */49Th j\ .* MOA COSA guidelines in effect on this date. •••• •• • f63 '• •$seven ..-annoRe :� CE 8149 •::; COSA Checklist yellow sheet MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT • r 907-343-7904 l On-Site Water and Wastewater Section \ j Fax: 343-7997 www.muni.org/onsite —/ Septic Tank Advisory Certificate of On-Site Systems Approval # 0SC191085 Subdivision: Highland Hills #2 Block:2, Lot: 9 Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for this property is 23 years old. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 20 year old steel tank MAY look like. x --• ) ,,,,i- ti ,yam i t, 1C7 y Y - ..I.. , A. ilk - ° j•�[1 r� 1 � y il 0 w b , _ °a`" - " , iiiiiiiiiii6a Mailing Address: P. 0. Box 196650 * Anchorage,Alaska 99519-6650 *www.muni.org .1 Rs Pumping Invoice PO l t(\ 77141i 341 i'a:tic Rive!,, AK 99577..;•11 19)(171( -6-1j.I BILL TO: 19948 JOB SITE Jason Taylor Jason 6121 Hiland Road 6121 Hiland Road Eagle River, AK 99577 Eagle River, AK 99577 Invoice Number: 50217 Invoice Date: 25-Feb-2019 Order Num: 50217 Serviced 22-Feb-2019 Manifest P.O. Number: Job Description: 1000g Quantity ServiceType Amount ; Tax 1 Septic Sery 1000K $285.00 No Subtotal NonTaxed: $285.00 Subtotal Taxed: $0.00 © 0 % $0.00 Tax: $0.00 Subtotal: $285.00 Payment Adjustment Late Charge +/- Payment/Charge: $0.00 $0.00 $0.00 $0.00 Please Pay: $285.00 f! Payment Terms: Net 30 1G� woic i � Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-382-40 Expiration Date: a / 1. GENERAL INFORMATION Complete legal description HIGHLAND HILLS S/D #2 BLOCK 2 LOT 9 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: 6121 HILAND ROAD, EAGLE RIVER, AK, 99577 JAMES NUTTY Day phone 952-2013 6121 HILAND ROAD, EAGLE RIVER, AK, 99577 E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 00 Q Date of Payment Receipt Number /}snq OJ t to COSA # 11G31593 Waiver Fee $ _ Date of Paymen, Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of fhe system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life ofall welts 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 ofhow 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. 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved. Conditional approval for bedrooms. bedrooms. bedrooms, with the following Phone 337-6179 Date I lb l L f3 oo6000� QF.A p� Qin i 9 .. ••.�* .. �O. ..... ........... P '.J fr ss,. P795 4 11112•1.3c�oo �QP��� OF �i J ON-SITE Ms- WATER P'�ER o^ moo_ WASTE__ eA S%J -I. Original Certificate Date: L D"unicipality or Anchorage Develop, stmt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State Of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineet's work. 7. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev. 11105) 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 HILAND HILLS S/D #2; BLOCK 2, LOT 9 *BEDROCK ® 51 Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 8/1996 Sanitary seal (YIN) YES Total depth 207 ft. Cased to *60.5 ft, FROM WELL LOG Date of test 8/1996 Static water level 100 ft. Parcel ID: 050-382-40 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 5/9/2013 94 ft. Well production 6 g,p,m, 5.11+ 9.p -m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate' 54ng./L. Collected by: GEG, Ltd. Arsenic: N (Dug./L. Date of sample: 5/9/2013 B. SEPTICIHOLDING TANK DATA f )1/5/13 Tank Type/Material SEPTIC/STEEL Tank size 1000 gal. Number of Compartments ? Foundation cleanout (Y/N) YES Depression over tank (YIN) NO Date of pumping u Pumper c: 1` le C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE 7/12-11/3/1996 1.2 Date installed 6/4/2005 Soil rating .p.d./ rft'/bdrm) o_B Date installed 7/12-7/15/1996 Cleanouts (Y/N) YES High water alarm (Y/N) YES OLD TRENCH/NEW TRENCH System type TRENCH/TRENCH Length 40/60 ft. Width 5/5 ft. Gravel below pipe 4/4+ ft. Total depth * i6A -r O ft. Eff. absorption area s oft2 Monitoring tube YES Depression over field NO Date of adequacy test **5/9/2013 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 34/33 in. Water added 455 gal. New depth 42/41 in. Elapsed Time: 120 min. Final fluid depth 40/39 in. Absorption rate >= 450+ g,p,d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date **TESTED 2005 TRENCH ONLY. THREE (3) INCHES OF LIQUID IN 1995 TRENCH AT TIME OF INSPECTION. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump off" level at a er alarm level at Cycles tested Meets alarm & 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,+/100,+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank 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 . -Ti> f+ Building foundation 10'+/10'+ Water main N/A Water service line 10'+/10'+ Surfacewater 100'+/100'+ Driveway, parking/vehicle storage 10'+ 10'+ Curtain drain NONE KNOWN Wells on adjacent Iotsl00'+/100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION l certify that ! have determined through field inspections and review of Municipal records that the above systems are to conformance with MOA COSA guidelines in effect on this date. Engineer's P'nI d%Name JEFFREY A. GARNESS Date 111Z/� (Rev. 11/05) �f f� A..... rn ss:... Chain link fence N t O 1 o_ 1 O 1 1 OG 8.8— deck o We9 Lot 9 L �L ° 1700 Lot 10 s° °� 10' Utility Easement 19 S o� Le i Shed I I I <e Shed I I I 3°p011I Unsubdivided N� Lot 8 OF AQ�� r 49rt'h' *!i 00 00 Fred WaIatka s �� sa 3255 - S SCALE: 1"= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. S & S BE AS -BUILT NO CORNERS SET THIS DATE Municipality of Anchorage Development Services Department Building Safety Division i On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-382-40 HAA ##U1�D/o yy�o Expiration Date: — 2 7- -n 1 GENERAL INFORMATION Complete legaldesaiption Lot 9, Block 2, Highland Hills #2 Location(siteaddressordirections) Mile 4, Hiland Road Current Property owners) Sam Cohen Dayphone 694-6552 Mailing address HC 85 Box 9750, Eagle River, AK 99577 Lending'agency Day phone Mailing address Real Estate Agent Day phone Mailing Address /J Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑x Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage 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. S A S ENGINEERING Name of Firm 17deFgr Qrwrl.oepRoasllds,'!Oh Phone G`f y ->y 7 7 Address Eagle River, Alaska 99577 Engineer's Printed Name Robert r. _ rns7nn , P G Date / rY/o / 3L L -e \ ROBERT C. COWAN f 5. DSD SIGNATURE I'�c� • CE -8801 ; �`', Approved for _ bedrooms. +++elf• `-.. ''•`' J Disapproved. •1a\,r�� Conditional approval for bedrooms, with the following stipulations: ONSITE LT W -TER AND • r11 Additional Comments ; ER Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other gy;Original Certificate Date: R ' 2%- 0/ lRb. R'C01 Municipality of Anchorage .. ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak.us (907)343-79W HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lx Arccs s/3 Parcel ID: OS -0 — 3' L yo A. WELL DATA Well type Rw+-rt if A, B, or C provide PWSID # = Well Log a/N) Ye J Date completed S/94 Sanitary seal (pN)Lo 3 Wires properly protected O/N) Y4! Total depth 2(i0 ft. Cased to bL I ft. FROM WELL LOG Date of test _ c/o) 4 Static water level ) 0 O R. Well production 6 9— P.m-WATER SAMPLE RESULTS: Coliform O colonies/100 M. Date of sample: 4 t S- l 0 1 B. SEPTIC1HOLDING TANK DATA Nitrate I.S3 mg.A. Casing height (above ground) / 3 f in. AT INSPECTION T/ r/o/ ITS rt. G .'I 9 - p.m - Other bacteria G colonies/100 ml. Collected by: S i S ENGINEERING 17034 Eagle RIW LOOP 1111001111 NO- 29 Eagle River, Aloka 99577 Tank Type/Material 51X; i c /J 74 4 t Date installed -7/1319c Tank size 00 0 get. Number of Compartments CleanoutsOft4) Yf l Foundation cieanout (SIN) Yt S Depression over tank (Y/r,Q ! 0 High water alarm (YI9 r n Date of pumping i s° 0/ Pumper 1 R s C. ABSORPTION FIELD DATA Date installed 7//SA6 Soil rating g..d. orft'A>drm) 1=a Length' Hol ft. Width '5— ft. .S Hot"0 .%.0 System type TR4. C,04 Gravel below pipe "i ft. Total depth i & R. Eff. absorption area 6100 ft' Monitoring tubeY41 Depression over Reid N o Date of adequacy test T/ S/ 0 / Results 1as ail) Pe f-1 For 3 bedrooms Fluid depth in absorption field before test ) �� ln. Water added±t 7gal. New depttr� � % In. i a Elapsed Times SSmin. Final fluid depth / "o in. Absorption rate >= YS -0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N Gp.{ KNONr✓ If yes, give date — D. LIFT STATION Date installed Size in gallons "Pump on" level at _ In. "Pump ofr Datum E. SEPARATrON DISTANCES tested (YM) ,-� in. High water alarm level at SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot /0 0 Absorption field on lot j DO I t Public sewer main N R Sewer /septic service line Meets alarm & circuit requirements? On adjacent lots On adjacent lots in. Public sewer manhole/cleanout A11A Holding tank �) /A SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: If ' S Building foundation S� y Properly line zry _ Absorption field water main Water service line /0 t Surface water. 0014 , Wells on adjacent lots f U 0 '4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 7 6 ' Building foundation 6 6 ' Water main t) A q 0 i 100 �f Driveway, parkingtvehide storage SD '� Water Service line Surface water r Curtain drain NONE KNyW"i Wens on adjacent lots -100 � F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through Reid inspections and 4t/ l" ' review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. p - COWAN Engineer's Printed Name aQER T C • O wA�✓ ''0 • CE -8801AP Date HAA Fee $ '300. u Date of Payment % 6. •i- A° r Receipt Number O 0 °I D 3 `• (Rev. 17!00) Waiver Fee $ Date of Payment Receipt Number 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. l f urtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is In compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S 8 S ENGINEERING Phone 6 g 1[ —Xq 7q 17034 Eagle River Loop Road No. 204 Address Eagle River'Qsk. 995=0 - Engineer's signature 6. DHHS SIGNATURE ' L ,�� Approved for L��'?)bedrooms. Disapproved. Conditional approval for Additional Comments Date cc-eeol 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. n-025 m.+.IM) B+ k MOA rn ,.�-_,..... _�__._._-.....,,...... ,......-e. _..�...__�.�. . - AMINICIVAIiTY OF MICNOitAGE ENVW4f&1EWAL SERVICES DIVISION Municipality of Anchorage NOV 1 1996 DEPARTMENT OF HEALTH & HUMAN SERVICES C �, C' C Environmental Services Division RECEIVE 825 L Street, Room 502 • Anchorage, Alaska 99501 a (907) 343-4744 Health Authority Approval Checklist Legal Description: LOT q gLocK Z hlf iAk P.10 Parcel l.D.: 050 -• 387-- 40 A. WELL DATA WII-a5 S/D !tom Well type f AI VArrE It A, B, or C, attach ADEC letter. ADEC water system number Log present &N) A S Date completed 81.4 Total depth 2601 I Cased to ". S I Casing height (above ground) 2 + Sanitary seal &N) `itcs Wires property pvotectedoN) Y& S Date of test Static water level Well production FROM ELL LOCI A (� WATER SAMPLE RESULTS: /001 0 AT INSPECTION E� 9. P.M. g.p.m. Coliform O Nitrate I . 4 Z Other bacteria Date of sample: I I - 4 -'I; Collected by: 5 & S ENGINEERING --T7=4 "gig xiwr toop ReW, its 204 B. SEPTIC/HOLDING TANK DATA Eey1e River, Alaska 99577 Date Installed -7 -1 S -41 Tank size 10 0 n Number of Compartments Z Cleanouts i9N)A5 Foundation cleanout (21N) qr;S Depression (Y#9 f -Jo High water alarm (YS) NO Date of Pumping 146 s ..1 Pumper C. ABSORPTION FIELD DATA Date installed -7''15-1f. Soil rating p.d or ft'lbdrm) • Z System type Length ' " 0 Widtti'"'�tS I Gravel thickness below pipe 4 r Total depth Effective absorption area 1'f0e Monitoring Tube present ®'N)_Y&-, Depression over field (Ye tJo Date of adequacy test r= 03 Results (PassJFall) .— For 3 bedrooms Fluid depth in absorption Held before Last (in.); � Immediately attar -=gal. water added (in.): Fluid depth (ins) Minutes later: Absorption rete = Permdde treatment (past 12 months) (YM) If yes, give date 72-0213 (Rev. 9/913)• D. UFT STATION Data Installed Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES "Pump 'Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons "Pump off" level at' rUiWholdlng tank on lot 1001 t On adjacent lots look 'f Absorption field on lot 1401 4 On adjacent lots 10o i 'f Public sewer main /j !A Public sewer manhole%leanout/I 1d 1A, Sewer /septic service line ZS It Lift station A A SEPARATION DISTANCES FROM S%Eff—uiOLDING TANK ON LOT TO: Foundation 54 � Property line g, Absorption field 6 Water main/service line 10 I{ Surface wateddrainage f ea 1 (- Wells on adjacent lots t Oo 14 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: � r Property line L Building foundation U. Water main/service line le I t Surface water 10014, Driveway, parking/vehicle storage area 5 I:' Curtain drain 0/0, Wells on adjacent lots 1061 4 F. ENGINEER'S CERTIFICATION I cerW that I have determined thru field inspections and review of Murddpal records ihAA in contommances;V H1�4 ,911nes in effect on Ihis date. Signature _- Lam/ G//��>�� s I Engineers Name /�� B �.2r �:. ©+�.f� d Data COWAN HAA Fee $ B '!f:' Date of Payment /,, h,5 74 l Receipt Number 72-026 (Rev. 3/96)' Waiver Fee $ Date of Payment Receipt Number L