HomeMy WebLinkAboutOUR MOUNTAIN BLK 2 LT 3Our Mountain Block 2 Lot 3 #051-111-63 kmev uoiuu 10) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP231227 PID Number: 051-111-63 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name STEVEN & DIANE WALL ABSORPTION FIELD - EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 20628 EDWARD CIRCLE, CHUGIAK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot OUR MOUNTAIN 2 3 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ft2 Ft. Well 100'+ __ 25'+ TANK ® Septic ❑ S.T.E.P. E] Holding El Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ __ NA Foundation 101+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated & reconnected to existing septic. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer JRS drainfield Drainfield CO/MT 3034. Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 15` 8/10/23 Z ,8/11/23 Location and description 3rd 4 th TOP OF MH RISER ON-SITE WATER AND WASTEWATER SECTION APPROVAL _ 0.0OF A Conditional Approval: Date �!�Q•, • W- 0{ .... ..... ......... 1 • • • Curtis Huffman Septic System Approved -I i �� •.��I Date �2 CE 128991 �1 ��'lF-• 8/15/23 .. •vii lPx. PROFESSION-. Note: this approval does not include well permit requirements. \OF11mO kmev uoiuu 10) t j I 10' UTILITY 25.0' EASEMENT 1 1 1 f W 40 I 4 MANHOLE- Lin) 1 O � z � o 3t 4 I m CP 3' U,� o61 ` wELL S � �C 1000 o . DECK - 2.0'x4.8' CANT Lot 2 N 89'59'11"E 302.24' [-�-1 6.0'x16.5' SHED SEPTIG PIPES Lot 3 57,243 S. F. 43.2' STORY RESIDENCE i, W/ WALKOl1T BSMT. ---t4,3.2 5.5'06.0' DECK J 'C g 84'57'24"W( ) 287.74 / S 84'57'42"5N(R) Lot 4 33' SECTION LINE EASEMENT I PLOT PLAN ___ AS BUILT _X_ SCALE _ 1" = 50' GRID _ NW 1361 Project No. 23-322A2 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates inc. (907) 522-6476 Phone ken®longsurvey.com --qs � Professional Land Surveyor s jonathonOlongsurvey.com OF AL trovis®langsurvey.com 'Qs o'W, I hereby certify that I have surveyed the following described property: /co •• :9 LOT 3, BLOCK 2, OUR MOUNTAIN SUBDIVISION (PLAT No. 77-17) *: •49TH * �� Anchorage Recording District, Alaska, and that the improvements situated thereon are • • • • • • • • • • • • • • • • • • • I within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed• • • premises and that there are no roadways, transmission lines or other visible ��•�••• KENNETH G. LANG , o easements on said property except as Indicated hereon. Fc�� • No 5[202 Dated this the �� Day of at Anchorage, Alaska AW It — �li �OFE551QNAL��' 4 It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 PID:051-111-63 PERMIT:OSP231227 FIRST WATER CONSULTING OUR MOUNTAIN BLOCK 2, LOT 3 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231227 Work Type: SepticTank Upgrade Tax Code Number: 05111163000 Site Legal Address: OUR MOUNTAIN BLK 2 LT 3 G:1361 Site Mailing Address: 20628 EDWARD CIR, Chugiak Owner: WALL STEVEN W & DIANE N Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date: No i U � Department Lot Size in Sq Ft: Total Bedrooms: 8/1/2023 7/31/2024 57243 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing SSS 7 j Received By: n Date: p Issued By: _ Date: 3 MUNICIPALITY OF ANCHORAGE Development Services Department,� t57 „ Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-111-63 Property owner(s) STEVEN & DIANE WALL Day phone Mailing address 20628 EDWARD CIRCLE CHUGIAK, AK 99567 Site address 20628 EDWARD CIRCLE CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) OUR MOUNTAIN BLOCK 2 LOT 3 Legal description (Township, Range & Section) Lot Size 57,243 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) El (w/wo ADU) Septic Tank 0 Upgrade Q El (D) Holding Tank El Renewal Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 2 2 Waiver Fees: Date of Payment: 2 b 20 ?_3 Date of Payment: Receipt Number: 61 At L / Z Receipt Number: Permit No. OS F 13 1 q- -L Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com ! !! July 21, 2023 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: OUR MOUNTAIN BLOCK 2, LOT3 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1000-gallon HDPE tank per the attached design to serve the existing 3-bedroom residence. We would recommend a 1500-gallon HDPE tank be installed for future consideration or flexibility. However, groundwater was noted in the MOA on-site file at 8-10’ and if groundwater is encountered during installation an epoxy coated steel septic tank may be required and is very likely to be installed. The lot and area are served by private water. The design will not impact any of the neighboring properties. A final as-built survey will be completed after installation with all septic pipes located. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231227, Curtis Townsend, 08/01/23 FIRST WATER CONSULTING OUR MOUNTAIN BLOCK 2, LOT 3 DESIGN DETAILS: NO PRIVATE WELLS WITHIN 100' OF PROPOSED SEPTIC TANK. AREA SERVED BY PRIVATE WATER. NO SEPARATION ISSUES OBSERVED. STAKE WELL RADIUS & OTHER REQUIRED SETBACKS PRIOR TO CONSTRUCTION. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231227, Curtis Townsend, 08/01/23 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division OS 825 "L• Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Nemo DISTANCES 0 Iw TO SEPTIC ABSORPTION Addrebf FROM TANK FIELD WELL rilo WELL \ Gto a 10 Phonate) Permn No. N o. of Badrooms "1rV5 -'1?�S 09 oo(0'6 3 LOT LINE loth- I �0 Lew.oeacalmon Lot 3 B,Mk 1 Z Subdvlawn t FOUNDATION 'y� F 4 Township. Range. section Tb AS-BUILT DIAGRAM (Snow location of wail. septic system, propeny linea, toundatim. an,vewar. water boa». etc.) TANKS ArSEPTIC ❑ HOLDING manulactuithawy In gallons Cap\ v�'X T Z'sis 000 Matenal No. of Compartment, Z , 3 TYPE OF SYSTEM ❑ TRENCH ❑ BED .erW. DRAIN ❑ OTHER Depen to pipe bottom both ongmal Tow Oepm Irom original grade y, , h� grade 7 FT (O FT IT I I Fla added above orlg,nal grace Gravai Capin beneath pops D FT 3 FT ITS .11- m5fl Gavel length Gravel wnOm 4' FT S FT •i Tow abeorption area Dlsla l between Ynea . t !+ i SO FT 1� FT i r Number of lines Sod rating Pipe malerW I 2co SO FT 5 instate, -09 Date Installed I c� q WELLS -�rPRIVATE ❑ OTHER (Iden01v1 Glawtitabon (AB.C) TOW Depth Oaaad m IrIPtJloJb-L. \2 FT 2 FT Inewler Dale metal" 'SO I.w\Jb•+ 1 S a1 see swes REMARKS: l A Z Scala: 1 O Tr med by: f kalG all,,`Q� ' ,.,� 7s:,• /� * 7 •' " °' f/ . int' 1 Dale. r A.ta.rt A. u% a: R 5 ENGINEERING I tally MA is leu wu peTlwmed &=ding to all River Loop Road o. 2(YT �••.� NIP. 14574 4l Ir �g� qa�Eoaulgelele B Munidp e: �`a,,,'•. ••' 4si tit.'l.dr„•_....•t'S'b�d°r EEE aglK(�er.Ii� .!y. ZhLL vFeSS10 �kn health Daparlmenl Approval: Date: 72-013(3185) DOC CO. Ebb SULLIVAN WATER WELLS P.O. BOX 670272,CHUGIAK,ALASKA 99567• TELEPHONE 688-2759 I '•1� / OWNER OF aLAND JOE 6' it L DEPTH OF %KLLL l°t 7 / .C. i ADDREI SS id- aX C71447 CNA Sn 6& g9S67ST \TIC LL\'EL OF %,':,TER FT. //3 LEGAL DESCRIPTION Z J 6'(4d DRAW DOWN FT. I ,rte DATE. • Started Ended S P GALS- PER IIR PERMIT NUMBER KIND OF FORMATION: { / From —0Ft. toC2Ft. l"ASrn/6 �fTiSKtI _ FromCRFt. to 3 Ft. n uf! Q JA From j_Ft. to071Ft. 1/01Y C<Ai f trieddv Fromc2l Ft. tol? Ft. 11471 .ideVt)__ Fromgf—Ft.to_17 v/<� From r7Ft. to _Ft. CL 11 y t't4�EL_ From.-i5a"Ft.to--13 FL 11toje ctti-r From -73 Ft. toLD 7 Ft. 134 0vuA) C a YY From Ft. to Ft. 6tCR�c� From JD:7 Ft. to //LFt. ='•AY 4,eda94 1 From„IIFl. to Ft. CnaQ<6: From�ppFLtol;J_�Ft. JRo+a 6R4wS& 424M i From Ft. to Ft. � I Yt t7 From1��3.._Ft.to��r Ft. W'ti y 'r4'JO 914✓t:” From Ft. to Ft. w F T From jas Ft. to_jaLFt. SA'JQ 6,t*✓F_c s From Ft. to Ft. WA7164 KIND OF CASING 4 �:O� From Ft. to Ft. From FI. to Ft. From Ft. to Ft. From Ft. to Ft ' From Ft. to i Ft From Ft. to Ft. ' Froin -Fl. to Ft. From Ft. to Ft. From Ft. to Ft. From Fl. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. ` From Ft. to-Ft.- From-Ft. oFt:FromFt. to -Ft. From Ft. to Ft ' DRILLER'S NAME M U N I C: I P A L I T Y O F A N C H O R A G E Department of Health & Human Services 825 L Street, Anchorage, Alaska 99501 343-4720 O N- S I T E S E W E R u W E L L P E R M I T Permit Number: 890068 Upgrade -S-Lt% '�- -7 QO to Date Issued: 05/02/89 Engineer Designed Owner Name: JOE GRILL Day Phone: Owner Address: P.O. BOX 671467 694-2979 ANCHORAGE, AK 99567 Parcel Id: 051-111-63 Lot Legal: Subdivision:;OUR MOUNTAIN SURD. Lot: 3 Block:•2 Section: 10 Township: 15N Range: 1W Lot Size 57150 (sq.ft. or acres) Max Bedrooms: This Permit: 2 Total Capacity: 3 SEPTIC TANK: Minimum total septic tank capacity: 1,000 gallons. Each septic tank- must have at least 2 compartments. Depth to top of septic tank(s) < 4.0 feet requires insulation over tank(s). WELL: Log must be submitted to Municipality of Anchorage Department of Health and Human Services within 30 days of well completion. INFORM D.H.H.S. PRIOR TO INSPECTIONS BY ENGINEER, IF AFTER OFFICE HOUR CALL 343-4681 AND LEAVE A MESSAGE. CONSTRUCT PER ENGINEERS ATTACHED APPROVED DESIGN. PHIS PERMIT EXPIRES 1/31/89 AND VALID FOR A SINGLE FAMILY HOME. I CERTIFY THAT: 1. I am familiar with the requirements for on-site sewers and wells as set Forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back: distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 2 bedrooms. I also understand that the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit. Signed: � ^' ^ DATE: (Owner) J�GR LL ---1 a -d ------ ------------------- Issued By: DATE -09 ---------- ---- p J W J 4i z� `1 �\ a�• J J Municipality o1 Anchorage DEPARTMENT OF HEALTH 8 HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR:. 1bC--L'L— DATE PER LEGAL DESCR �r C4rl COMMENTS WASGROUNDWATER ENCOUNTERED? S IF VES, AT WHAT L DEPTH? C P E Depth to Water Atter Monitoring? 1 d Date: �m PERCOLATION RATE --1- 4 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN cT AND 415' FT PERFORMED S`L S ENGtlyea:rc"— I %G34 Eeg ! tYM E�{t�� CERTIFY THAT IS TES WAS PERFORMED IN ACCORDANCE W IT:~�A5i1p1iAMMICIPAL GUIDELI EFFECT ON THIS DATE. DATE: Z 724= iRev. 485) \ If" MUNICIPALITY OF ANCHORAGE ^' DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264A720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME _ PHONE E"EW 1z -. L vyy-(„1(L I/ ❑UPGRADE MAILING ADDR SS £l1fil-41�% DFC''7IF l�/� v vSG LEGAL DESCRIPTION .S/ LOCATION NO. BEDROOMS �3 Well / Absorption area Dwelling PERMIT NO. DISTANCE TO: r DY 6.2 ;70 PZ 2Q Manulxturer � Material No. of compartments W H 1 � L h Liq. cap41y in gallons IF OMEMADE: Inside length Width Liquid depth _ d le DISTANCE TO: Well Dwelling PERMIT NO. JVz _ — Manufacturer Material Liquid capacity in gallons DISTANCE TO: / Wel-f Foundation, Nearest lot line ' PERMIT N O W GD -^- le s P,20'IF� � Z Z No. of lines Length of each line Total length of lines Trench width Distance between lines F E w Z C/ r / isse/ses 0/ Top of file to finish Material beneath the f grade Total effectiven absor ti area Ineoe Length Width Depth PERMIT NO. W (7 i F- Type of crib Crib diameter Crib depth Total effective absorption area W 1 H DISTANCE TO: Well Building foundation Nearest lot line Depth Driller Distance to lot line PERMIT O. / i DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER b PIPE MATERIALS SOIL TEST R TING /ai_ INSTALLER uat I,t,rs SI I�f REMARKS Ott •p..,._ hF !k ; tl ( tj f S APPROVED DATE LEGAL / f 2 - 72-013 (Rev. 3/78) (j / / 'Th 1 •l IJ r-4 I I-- I F' Fi L I T V Ce F Fi r -a i::: H Cl F: Fi r; E DEPARTMENT/1 HEALTH AND EFJVIROtJPlENTAL/- OTECTIOPJ 825 ' _ STREET, ANCHORAGE, AY. 9— 01 254-4720 I,IELLL— F1rAL` r_�t�— ITE EEL�IER FEFr'1 I T PERMIT NO. C 820483 ) APPLICANT JOSEPH GRILL LOCATION LEGAL L 3 E 2 OUV.MOUNTAIN Se'D TYPE OF SOIL ABSORPTION SYSTEM IS MAXIMUM NUMBER OF BEDROOM'S = 3 GENERAL DELIVERY CHUGIAY, 99557 349-6264 LOT SIZE 20000 SQUARE FEET SOIL RATING (SG? FT/ER)= J?� THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: CHEF T -r LLEr-JC3—r I t 13F?9=I'v'EL CNEF:'—r THE LENGTH DIMENSION IS THE LENGTH CIH FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OP. PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIH FEET). THERE IS NO SET WIDTH FOP TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (I1-1 FEET). F:EGe1_1 I REGI DEFT I C TF-lr4K E I ?E= 1r IDID- CiRLLOt JE 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. --- T1,1sZo < f—a ? I r-dEFECT I r_,r4l — F1F2E REG!L1 I F?EQ -- 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 OP 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 1/) 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 DIAGRAM'S APE AVAILABLE TO INSURE PROPER INSTALLATION. _ d FEF_r-1 I T EX, F=' I FE: GxECEMFEF{ =-3 s 154 2 \S SIGNED APPLICANT JOSEPH GRILL ISSUEDEY tCSLutl�t uA`�L ---DATE—L U- 62L ----- }xlts+4. 0 I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON—SITE SEWED SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED APPLICANT JOSEPH GRILL ISSUEDEY tCSLutl�t uA`�L ---DATE—L U- 62L ----- }xlts+4. 0 MUNICIPALITY OF ANCHORAGE •Departmento"''f Health and Environmenta^4rotection 825 Street, Anchorage, AK. j9501 264-4720 Permit # * * * HANDWRITTEN PERMIT * * * 4�?s^7 WELL AND;W ON-SITE SEWER PERMIT / % / Applicant: G l I Mailing Address: 7a I dLcl— LJ�-�.cS, Location: ekv� Phone Number: .3 g7 Ga %Y Legal Description: 1-3 8-.;kou'r, M11. S , Lot Size: l• 6 a C Type of Soil Absorption System Is: Trench: X Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) �11f7 The Required Size of the Soil Absorption System Is:' DEPTH % -� LENGTH 6 GRAVEL DEPTH _(1_ WIDTH n 0 The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ 16e GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * *.* TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection and approval by this departmen will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper.installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 2 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that 3 bed Signe3: i1 Issued by: A pli ant Date: SWP/024(1/81) • r %�1 TPS 7/Z1�76 bLk oR9 brzwv� si 2Oc-(S 3� /� c o 63 FS 13 u bRwv� ciE sa�}g,.rz( w/i2c Sc Sor,n2 co�LES TiZ� �ViC�f (_rj jL o • 0 'FSW C6t� v MS�7`lo�Fl 1 .° J ' ��•ne •'�llryrn.. st✓ LQ 4e . c� .�• (,a�etza,L� clr5�o��1,ucR.�g .o.G G •, 0 LIR b11nt�NT}atnl SLkzID, �LO BORING LOGS SCEIIt:, 3� ALLACE. EN6lNEER,IyC- 4839 'TAMPA 0;:A CiRGLE Awannhr_tr V do � 'C` -� •�., , LC in LU= h 1 I i !_ b j 3 a 3 c 3 4 1 it LL I = 2 ? 2 1 k LL 2 Z 7 tZ f Fw-• _� i 0 o7 7 — oYt In Lr - a ON Int tll v' rI' Lu \ U� q j _ I Aj cn rj rJ o3 cc 21 Cn ujm \_ to t- 5 of �� Ct {� �+t` 07 h M CC in , d I (1 2 .In X11 , Q lc4r) to iAi — I 2 u7 N N 61 dr,- �� c� n I j Is lob_ 4] r�`-y � 'rte _� ri If � o � g •✓1 .ffJ CO 19 l v %0 v V N _ LL LQ 1i V , tn v ', Q , Q !i n W O i m 1 a- c� s •J�� 1" \i... LIN CE) i Yj i W ` M 3 .wl. w �. ~ N N N M N N N N u. 2 rn m M L-A r( QIOlAle- 41 C-. (M4 -N1 t JR SOILS LOG MUNICIPALITY OF ANCHORAGE O PERCOLATION (�!]it DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST I'1 a r 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 'Y_ OS[PILI �!�/CC DATE PERFORMED:�O�f/6•Z LEGAL DESCRIPTION: ,[jhr 3 16""4K 0010110'-".Jr.V/d SUBZ1tYSI&I 1 rewrlroP &/c 2 :.' r 21,00 ear �iLgCta S� ✓4�S 3 %0.-? /?1 -if ���'cC Cctivt d' � ,S(tf- i✓ECC 4'.E'A06a .?A7(./C� �`SiFk►cC --=a %d 8 9 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? CS IF YES, AT WHAT �+/ DEPTH? 0 Reading a�' Lj P- rSae<Y f',Cd O<rA rt'.P,c'G'C'tS 5 Time Time 6 d - &4 feeev coda • .:,E. 44INJ �,.. TEST RUN BETWEEN FT AND FT 8 9 10 11 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? CS IF YES, AT WHAT �+/ DEPTH? 0 Reading Date GrossNet Depth to Net Time Time Water Drop • .:,E. 44INJ (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS rAl T.�'GC ,'S"ezeAl p Y',f06/GA. o 2-114A/r FE // rA/ '.X- -',s' /d n/ ff o; rd o ,0 4'_ 24-d or '10 PERFORMED BY: CERTIFIED BY:�� C. DATE: r CLe� rt 110 s• LO ue C. to Yet ,�00 i Opp r...NAv 20 -I I . ` .. _ — 111 PERCOLATION RAT; �/i� (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS rAl T.�'GC ,'S"ezeAl d?O�,t!�jc'[d L.//i1i.1/ XFMH j co.i�/ Y',f06/GA. o 2-114A/r FE // rA/ '.X- -',s' /d n/ ff o; rd o ,0 4'_ 24-d PERFORMED BY: CERTIFIED BY:�� C. DATE: 72-006 (6/79) W - • i . .1 , J MUNICIPALITY OF ANCHORAGE Q Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-111-63 Certificate of On -Site Systems Approval Expiration Date: l Legal description OUR MOUNTAIN BLK 2 LT 3 Site address 20628 EDWARD CIR Chugiak AK Current property owner(s) STEVEN & DIANE WALL X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: 1 By: Original Certificate Date: This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 MUNICIPALITY OF ANCHORAGE 0 Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 _ man= ,[, oq.•o' � Certificate of On -Site Systems Approval Application P 1. GENERAL INFORMATION Parcel I.D. 051-1 Complete legal description OUR MOUNTAIN BLOCK 2 LOT 3 Location (site address) 20628 EDWARD CIRCLE CHUGIAK, ALASKA 99567 Current property owner(s) STEVEN & DIANE WALL Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age _NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 5-50 Waiver Fee $ Date of Payment 2 Date of Payment COSA # _05C?--; Waiver # COSA Application 2022.doc COSA Checklist copy.docx COSA Checklist Legal Description: OUR MOUNTAIN BLOCK 2 LOT 3 Parcel ID: 051-111-63 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled May 1989 Total depth 127 ft Cased to 40+ ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/11/23 Static water level at beginning of test 118 ft. Well production at time of test 4.4 gpm Water storage tank volume NA gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 7/11 23 & 8/1/2023 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NEW Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA – (Per MOA files Upper 3’ ED 1989 / Lower 1’ ED 1982 2 Trenches) Which system tested (date installed) 5/23/89 & 11/1/82 ALL standpipes present per record drawing Total measured depth from grade 7 / 4+ ft (max) Measured depth to pipe invert from grade 4.3 / 3.3+ ft min N/A – pressurized field. Per record drawings, field is insulated. 1982 Field Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective 2.76’ (1989 Field) Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced 2000+ gallons 7/10/23 date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 7/11/23 Results Pass Fluid depth prior to test 2 / 2 & 1 in (2 LOWER TRENCHES) Water added 1000 gal New fluid depth 31 / 5 & 4 in Elapsed time 1440 min Final fluid depth 0 / 0 & 0 in Absorption rate 450+ gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 36 / 12 in Effective depth used 3 / 0 & 0 in (Missing ED + Final Fluid Depth) Effective depth (ED) remaining 33 / 12 & 12 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots & appears approximately 0.24’ ED of upper 1989 trench is missing. These 2 absorption fields installed in 1989 & 1982 are connected together per MOA file. COSA Checklist copy.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 8/15/23 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 8/15/23 APPLI"XNT FILLS OUT UPPER HAS= ONLY Pnlperty Owner/ QG !.(/tIn_. l/��iiLl`LGIi Phone J�� 1 Mailing Address //-.`Q, (Or{ 3 �S r/�-���Zlp Code 9 S!p % ,�/- S Buyer /�1p' Address "/" ' Zip Code Lending Institution ��(/j -G'!/!�t-�i ,�,,���,� Phone LA✓ G Address Zip Code 9 Sa3 -�n.SG Realty Co. d Agent Phone Address Zip Code Legal Description Street Location fel4y04.r.yl Type of Residence Single Family �7 ❑ Multiple Family No. of Bedroorm ❑ Other Watel Supply ( ) DISAPPROVED Individual ATTACH ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log If available). ❑ Public Utility DATE S6 Ser Disposal " Individual Year Individual installed: Public Utility When Connected to Public Utility: ❑ Holding Tank " NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector inspector Inspector Inspector Field Notes: / ( - I APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( I CONDITIONAL APPROVAL' DATE S6 Br: Soils Rating Date Se er Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 10aj naa iran \ Municipality of Anchorage Development Services Department :' '+' `• Building Safety Division` On -Site Water and Wastewater Program .. ,. 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING J�(� j' Parcel l.D. r�`1— �<<��3 COSA # 696915 Expiration Date: / o — 1. GENERAL INFORMATION Complete legal description Lot 3$; Block 2; Our Mountain Subdivision Location (site address) . " `d`ward Cir. Chugiak, AK 99567 Current Property owner(s) Andrea Sears Day phone 227-7626 Mailing address Sam Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well R1 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding Tank ❑ Community On-site ❑ 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 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 s a s Engineering Phone 694-2979 Address 15861 S. Birchwood Loo Ch k, A 9 6 Engineer's Printed Name Date 5. DSD SIGNATURE _jZ Approved for _ bedrooms. Disapproved. Conditional approval for bedrooms, with the Attachments: COSA Checklist X Arsenic Advisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: r Original Certificate Date:_ -7— Jl— 9< )R. 1tM) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST /�%�R7 Legal Description: h/ r''�' �J�� /!!a'WPO Wb Parcel ID: A. WELL DATA Well type i IIV%i7r— If A, B, or C provide PWSID # � Well LogaN) Date completed L-5 t1/ Sanitary seaaN)\11e0s Wires properly protected)) , n Total depth Io> ft. Cased to 0 f ft. Casing height (above ground) !& f in. FROM WELL LOG AT INSPECT ON Date of test&9 �y Static water level Well production 9 P•m• $o 9 -p -m - WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate �,U D mg/L Other bacteria colonies/100 mL Arsenic: 'i4 D' ug/L date of sample:h Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Date installed 4- tt — Tank size !0 'gel. Number of Compartments v Cleanouts(WN) � � Foundation cleanou(?NDepression over tank (Y4V _�k High water alarm (Y/tg).._ Date of pumping CK9 06 Pumper C. ABSORPTION FIELD DATA _ Date installed / / 9 �' Soil rating (g.p.d./fe o ft2/bdrm OTCO System type Length 7S5 ft. Width S r ft. Gravel below pipe Total depth _1 ftl Eff. absorption area'�_f? Monitoring tube Depression over field Date of adequacy testa DQE Resul (Pas 3^ ail) For _5Lbedrooms o n Fluid depth in absorption field before test %i in. Water addedgal. New depth in. Elapsed Time: iso min. Final fluid depth Lo_ in. Absorption rate >= '4GO + g P•d• Any rejuvenation treatment (past 12 mo.) (YO type) Q0 If yes, give date D. LIFT STATION N/Fl Date installed 'Pump on" level at _ in. Datum E. SEPARATION DISTANCES Size in gallons Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift ron lot /oc 4' r Absorption field on lot /m "f Public sewer main A.)LA r Sewer /septic service line o2s i r Animal containment areas $� f High water alarm level at Meets alarm & circuit requirements? On adjacent lots /CO l4- r On adjacent lots /66 +- Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas (Cts rA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r I ( Building foundation $ 'F' Property line 5''F' Absorption field 5 /- / r Water main AD. K1 Water service line F Surface water (GY1) r Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /D I * Building foundation /0 r'I- Water main ti%� r Water Service line 10 + Surface water, 100 14- Driveway, parking/vehicle storage S Curtain drain AVC6 KrLY V Wells on adjacent lots _ /fb I F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determh review of Municipal records conformance with MOA COSI Engineer's Printed Name Date COSA Fee $ q30 Date of Payment 7 6°o Receipt Number 47 y4D (Rev. 11/05) h field inspections and above systems areywin Waiver Fee $ Date of Payment Receipt Number 6.n A. Md. H1 Upa V �r t�I �PRaR aa•n AOII .Aiq .R.Ot Z N ti 2s! � 0 V589' S9'//"W .3612.24'' o f c.aF Q / �,Jt irouu I ►` N Rc so.es• \ a,�t� j I �9 I O � ivttc � R; Vol LL - ►8 al' "� 287. 74' A' SWAN ' �`���� , Prepared by CO""1C/70N • E of ' �. Robert E. Johns, Jr. & Assoc. MOT PLAN.• D •, , P,.•• "' Professional Land Surveyors 1e e+ w .� •w •�•.F a.... •w •r 1 �. G BRINK M y •.,rYr r W •. YI r••r. ANCHORAGE, ALASKA BBSO{ •�.�M MYMYM MPr M P+++~ •••• p• 49th •• •// Soule: 1 tr = G 0 1 ksc Lot S.F. Rea Plat Flo No. �....•' . .. FOUNDATION AS -BUILT ��/ • ••••• •• / Date S.ry yet r Drown Dy CA•oked Dy. i.. , i • 11-11-0� REJ REJ •.rr Y e+w r er ROBERT E.. NS JR. ��. r ow..•.• r. r.... / / • - Oats Drawn: e1 A.':. 4121-S ::l,.�a� 11-11-05 1361 5-372 FINAL STRUCTURE AS -BURT �� •! ,✓• oa Legal DseaWtion: ....r.....�r+«..•.r0P. 44 vA o1 • Lot 3, Block 2 ���i,F"'M° i•••• our Mountain subdivision LOT IPAM T SURVEY TYPE SYMBOLS ❑ PDIMDATIOM /S -BUTT • SET REBAR !T' DRAINAGE ASPHALT ❑ IWN 11RYCR1IIL Ae-MRT O FOUND RFRAR a _0- WOOD FENCE CONCRETE ❑ PIOT PIAN ... AS-BIIET ... LOT "VEY ... mPtwx y00 ASSUMED EIEV. METAL FF'NCE PLDT PLANS t LOT SURVEYS NOTE IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER. PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE CONSTRUCTION. TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHGWN. FENCES. WELLS. SEPTIC CLEANE OUTS, SIDEWALKS, DRIVEWAYS. TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS. COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. AL.L. DISTANCES UNDER NO CIRCUMSTANCES SHOULD AN AS -BURT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESP N9DUU FOR PTHE INITIAL REVAIL OVER NSACTICN REPRODUCTION ASSUMES C FINANCIAL LIABILITY IN SCALLY � THE COST OF THE SURVEY. 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.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING a t O s• ee� Parcell.D. 051-111-63 HAA# Expiration Date: 1. GENERAL INFORMATION Complete legal description 1,0c 3; Blork 9.- Qur Mnunt-nin ¢n1.Aiyiainn Location (site address or directions) 9Q678 Edward Cir ral-]a giver, AK 99577 Current Property owner(s) Tanya S Peter Dickinson Dayphone 688-0899 Mailing address same Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 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 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 S b S Engineering IPhone 694-2979 Address 17034 N. Eap,le River Lp Ste. 204 F.ap,le River, AK 99577 Engineer's Printed Name R0r34'ar C- cowRAd Date 1r l �y�os QF �)Ln ROBERT C. COWAN IW 5. DSD SIGNATURE ylftcl,y CE -8801 f J Approved for bedrooms. +tz `v�:�s:i;;;` ia,� Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:AtOriginal Certificate Date:IVIS P0115 ..(Rw. 01101) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA Well type4r2W+4TE Date completed _qo Total depth N-7 ft. A 051-1(1- to3 If A, B, or C provide PWSID # = Well LogY�I J) ��ES Sanitary seal fSi�J) �S Wires properly protected Cased to LLOIft. Casing height (above ground) l �+ in. FROM WELL LOG Date of test ri a Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 ml. Nitrate n -I mg./I. Arsenic: mg./I. Date of sample: l /OS B. SEPTIC/HOLDING TANK DATA Tank Type/MaterialS L PPS1 Tank size loco gal. Number of Compartments a AT INSPECTION 11 3 05 (1 ft. S70,2) g.p.m. Other bacteria O colonies/100 ml. S & S ENGINEERING Collected by:Rivet Loop ft d Nc. Eagle River, Alaska 99577 Date installed it I 1 q2- Cleanouts&) 6-5 Foundation cleanoutbY J) _JLA Depression over tank (Ye 1JQ High water alarm (Yd) & Date of pumping 10 I -LI Joe, Pumper �`� ►iN�g C. ABSORPTION FIELD DATA Date installed 5 NO Soil rating (g.p.d./ft2 ft2/bdrm) 7,00 System type T✓ �^� 11 Length 4q# r 3 1 ft. Width S ft. Gravel below pipe 1 s 3 ft. Total depth .5!L� ft. Eft. absorption area '� n_ft2 Monitoring 7tube E'3 Depression over field 00 Date of adequacy test 11.0OS Results ass/F ) r�� For 3 bedrooms Fluid depth in absorption field before test Z in. Water added gal. New depth 20" in. Elapsed Time: LV min. Final fluid depth E in. Absorption rate >= y 50 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y6k type) ND If yes, give date — D. LIFT STATION PJ A Date installed "Pump on" level at _ in. E. SEPARATION DISTANCES Size in gallons at _ in. High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tang on lot r rr) Absorption field on lot (on r� Public sewer main 0 A Sewer /septic service line ,{ On adjacent lots r4 i� On adjacent lots/ DC's Public sewer manhole/cleanout u I JA Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5 r r Property line S r� Absorption field S r + r Water main I Water service line )n + Surface water I D© d Wells on adjacent lots (/on in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: f Property line 10 I ; Building foundation f0 f Water main A) 114 r / r Water Service line l0 * Surface water too 1" Driveway, parking/vehicte storage r Curtain drain AxW6 1Cn7t�wll) Wells on adjacent lots ICX'D'� F. COMMENTS It if "C) ... T G. ENGINEER'S CERTIFICATION �` I certify that I have determined through field inspections and review of Municipal records that the above systems are in S., ....... . conformance with MOA HAA guidelines in effect on this date. a'i MOW E."LowAN C:-8801 Engineer's Printed Name�h JW'*J +sfit FV'. Date HAA Fee $ 3 D • vv Waiver Fee $ _ Date of Payment 07 L '7049 Date of Payment Receipt Number 11 / S—A S' 1/u Receipt Number (Rev. 12101) 11-11-05:16:59 ; ;907 661 6301 9 2/ 2 SG$ SGS Ref. #: 1057510 Client Name: S SS Engineering Project Name: Our Mountain SID, L3.82 Client Semple ID: Our Mountain SID, L3,82 Metrix: Drinking Water PWSID SGS Environmental Services Inc 200 W. Potter Drive Anchorage, AK 99518 Tel: (907) 562-2343 Fax: (907) 561-5301 All dates/limes are Alaska Standard Time Printed DateMme: 11/11/05 15:20 Collected Datefrime: 11/08/05 14:30 ReceNed Datelr'ane: 11/08105 16:32 Technical Director. /<<t ehen E� Released Anowabte Prep Analysis Parameter Results PDL Units Method Limits Date Date Init Bacteria 0 OB 9222B 11/06/05 1Vosms tf Nltrate N.D. 0.10 mgAg EPA 300.0 10.00 11/09f05 11/00/05 azs Y OttRRCT T RRfwle e(1•AQ .� ■RAY tYl•IO i •IRAN ernACI `v • O oI 0 I I I AP= SO•ee• 1 L X5.21341 Raa.oe• L r+B.BB' 2 5890 S9'//"W 342.24' C.O. Prepared by SURV� CERIMCAMON .�����r„ �.•�� of 'a off., PLOT PUN 164, , ,.•••”"••••• ♦ Professional Land Survey ors I ••.• YliwkrY •++we Msw.R at 431 1700 BRINK DR. ANCI!ORACE, ALASKA 99504 w w.�.w MNw Nr«•w Na. ,� NCtCSE T�f Rea lot S.F. 430 Iww'.N M N �•r �� A•" •.w :' 49t N8`64%.'r 7 42„E W 287. 7.4' PLOT PLANS k LOT SURVEYS Mme. IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS. SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWAYS. TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUPDIVISION PLAT. ALL DISTANCES ARF PFCnnp LIN, = UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPON5BRITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. IDISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Prepared by SURV� CERIMCAMON .�����r„ �.•�� of 'a Robert E. Johns, Jr. & Assoc. PLOT PUN 164, , ,.•••”"••••• ♦ Professional Land Survey ors I ••.• YliwkrY •++we Msw.R ♦. 1700 BRINK DR. ANCI!ORACE, ALASKA 99504 w w.�.w MNw Nr«•w Na. t �. kale: 1 N e 609 Rea lot S.F. Rea Plal Fle NO. Iww'.N M N �•r �� A•" •.w :' 49t l.....' .., .. . . ..,.� Date Surveyed: 11-11-05 Drown Dy. REJ Cnecked Dy. REJ FOUNDATION AS -BUILT Le.Mtc ave. e. M+rwwY •+II / / ..........� ..... ....... DBE J •�.: Gia: W.O. M e�r 1 o �I Date Drown: 11-11-05 1361 5-372 +�•��+� 4121 S eRM Legal Deecnption: FINAL STRUCTURE AS -BUILT ar+A O. M+r w.w wrl ♦ fe''••., •,.•' haat ♦ • L er.rL •ti MAn4 w YMN MI'�I r W e .......... D +!♦♦iare����•���• Lot 3, Block 2 Our Mountain .Subdivision N.r NMr.. ❑ Lor "VEY SURVEY TYPE SYMBOLS ❑ FOUNDATION AS-SULT • SET REBAR DRAINAGE ASPHALT ❑ RNAL C111UC11XK AS -BUILT O FOUND REBAR q.-py WOOD FENCE CONCRCTE ❑ MAT PLAN ... AS-eULT ... LOT SURVEY ... 7OP00RAPNY 60-020 ASSUMED ELEV. .N ll METAL FENCE wm .r . yryc eretWODrRnC,1AS-11AMT PLOT PLANS k LOT SURVEYS Mme. IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISBLE WILL BE CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE SHOWN. FENCES. WELLS. SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWAYS. TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. WHICH DO NOT APPEAR ON THE RECORDED SUPDIVISION PLAT. ALL DISTANCES ARF PFCnnp LIN, = UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABUSHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPON5BRITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY. IDISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. Municipality of Anchorage • Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET To: Bob Cowan Legal description: Our Mountain Block 2 Lot 3 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. ❑ Additional soils Information needed. _ ❑ Water monitoring results inadequate. _ ❑ Discrepancy in information submitted. ❑ Topographic information missing or inadequate. ® Incomplete; missing Survey scales less than 100 feet seoaation distance well to M.T. ❑ Incomplete; missing ❑ Additional adequacy test information needed. ❑ Water sample unacceptable. _ ❑ Measured/proposed distances/dimensions missing. ❑ Locations of all soils, percolation and water monitoring tests not shown. ❑ Proposed system too deep for soils information submitted. ❑ Well log required. ❑ Omission in narrative. _ ❑ Insufficient fill over tank or field._ ❑ Other. Name of reviewer: Jeff Date: 11/17/2005 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHED TO THE PAPERWORK Municipality of Anchorage • -- Development Services Department Building Safety Division ve i On -Site Water and Wastewater Program ` 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enr-horage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING n Parcel I.D. o s t — pt t — (63 HAA # Expiration Date: 1..GENERAL: INFORMATION - Complete'legaldescnption Lot 3; Block 2; Our Mountain SID Location (site'address or directions) Current Propertyowiher(s) Clara Mailing address 20628 Edward circle Eagle River. AK 99577 Torrison Dayphone 688-0667 20628 Edward Circle Eagle River, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. /L., 70�i0/o 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 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. Name of Firm S & S ENGINEERING 03 ageIver oop Roa No. 204 Address Eagle River. Alaska 99577 - Engineer's Printed Name ROZICAi C. C0k111---' Phone 6'7Y-21777 Date 10/a/01 S �..t.�..^.✓�i -... COWAN 5. DSD SIGNATURE I, R08ERT C Approved for 3 bedrooms. t $"''"j Disapproved. aa+� Conditional approval for bedrooms, with the following stipulations: J • ON-SITE • ••:� � VVA Rte. m Additional Comments WASTRUATEp o' PROGRAM .iii' !p �'•... • • •' �Q����• �lJ/)U1111r��1 Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date: / 0 ' 3 ' O (Rev. IZIM) Municipality of Anchorage • Development Services Department Building Safety Division On -She Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Andwrage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Legal HEALTH AUTHORITY APPROVAL CHECKLIST A. WELL DATA Well type of V4l?.,— Date c ompletedIfrg i Total depth ft. If A, B, or C provide PWSID # =� Sanitary seal (Y/N) Ae f �. Cased to �ft. FROM WELL LOG Date of test /.qq— Static water level 117" 13 - ft. Well production g.p.m. WATER SAMPLE RESULTS: eea�e+ Parcel ID: GSI - Ill -6 3 Well Log (YIN) _ Wires property protected (Y/N) J� Casing height (above ground) / 8 + in. AT INSPECTION -=JP 10 ) ft. 5. Z g P.M. Coliform O colonies/100 ml. Nitrate 0- 5- mg -A. Other bacteria 0 oolonies/100 ml. Date of sample: ( Collected by: B. SEPTIC/NOLDING TANK DATA Tank TypeMtaterial L— Date installed Tank size' gal. Number of Compartments y-- Cleanouts (Y/N) Foundation cleanout (YIN) � Depression over tankalarm(Y/N) N High water alar(YIN) CN Date of pumping t% f Pumper &P4 ITS -y C. ABSORPTION Date installed 457-1q M r Soil rating (g.p.d./ft= o fP/bd J*1" System type 30 Length ft. Width S ft. Gravel below pipe 3 ft. Total depth H. Etf. abs tion area Monitoring tube Depression over field Date of adequacy test a 30 Results (Pass/Fad) P^-.% For 3 bedrooms Fluid depth in absorption field before test &- in. Water add Amal. New depth Z f in. Elapsed Time: 4imin. Final fluid depth IL in. 1 Absorption rate >= � g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) /V D If yes, give date D. LIFT STATION Data installed "Pump on" level at Datum Size in gallons In. 'Pump off" level at _ in. E. SEPARATION DISTANCES Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: / Septic tenklltft on on lot /00 f Absorption field on lot / D 0 r fi Public sewer main r Sr /septic service line Manhole/Access (YM) High water alarm level at Meets alarm 8 dreuit requirements? On adjacent lots 00 I I - On adjacent lots /00 '~' Public sewer manhole/cleanout Holding tank .4v AA' SEPARATION DISTANCES FROM SEPTICMOLDING TANK ON LOT TO: J/ /t— Building foundation S / Properly line _r Absorption field / / f Water main N Lt� Water service line 10 Surface water CODO Wells on adjacent lots l00 /r in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line D Building foundation /Q '� Water main N Water Service line��/©� �� / Surface water 100 1�Driveway, parking/vehide storage Curtain drainA6w& LL. wy Wells on adjacent lots 1,Mt1 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 HAA /guidednes in effect on this date. Engineer's Printed Name®Viµ . Date /a / a d o I HAA Fee $ 3 Oct• Waiver Fee $ Date of Payment /c/a /,o I Date of Payment Receipt Number 0/ o 13 6 Receipt Number (Rev. 12/00) . SEP -28-01 17:28 FR011-CUE ENVIRONIENTAL SRV G CTAE Environmental Services Inc. is,t rrrrrrrrrrrrrrrirr� 9075615301 T-957 P.01/03 F-338 CUE ROLN 1016427001 Client POa Client Name S & S Engineering Printed Date rime 09/2812001 13:44 ProjectNamNq L3, 32, Our Nita S/D Collected DateMme 09/2112001 13:00 Client Sample ID L3, 32, Our Mm S/D Received Date rime 09/21/2001 16:23 Matrix Drinking Water Technical Director Stephen C. Ede Ordered By PWSr0 Released By Sample Remarks: Allowable Prep Analyse Parameter Results PQL Uma Method Limits Date Date Init Waters Department Nitrate -N 0.500 U 0.500 mg/L EPA 300.0 (<10) 0922/01 SCL Microbiology Laboratory Total Coliform 0 col/100m1 SM1892228 (<1j 0921/01 KAP F W MUNICIPALITY OFANCHORAGE • ~r DEPARTMENT OF HEALTH 8 HUMAN SERVICES M>; Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. # 1. GENERAL INFORMATION Complete legal description Lot 3; B4och 2; Oun Mountain Subdivision; Location (site address or directions) 20628 Edward C.i.ac2e Property owner UichaeL b Debohah 0)tki4zelualzi. Day phone 688-4146 Lending agency Mailing address Day phone Agent �$etei�PHH/HOVEQUITI Day phone 510-246- 6545 AddressP. 0. Box 4039 oncoa onnca 94524-4039 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water (Ixn-cL ooh 3 XX NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 22-025)R".1/91) Front MOAY21 S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Phone ENGINEERING Address 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Engineer's signature 6. DHHS SIGNATURE 4- Approved for bedrooms. Disapproved. M Date No. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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 thei r 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. 72425In«. +A» e•ot MOAR21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-013SLIV2 Q7+r Nloor3rov3%�oparcel l.D. A. WELL DATA Well type 20-"JAII— If A. B, or C, attach ADEC letter. ADEC water system number P46. Log present PN) y Date completed Driller S OLAu JM l Total depth 12^11 Casedto 1291 Casingheight A2r* Sanitary seal ON) - - U Wires properly protected (6'.YN) P411CIPAI ITY CIC ANCHORAGE ENVIRONMENTAL SERVICES DIVISION FROM WELL LOG AT INSPECTION I t.R 0 3 1992 Date of test Static water level t t3L t 1'f -RECEIVED Well flow 43.0 g.p.m. 5 �� g.p.m. Pump level UIL y� SEPARATION DISTANCES FROM WELL TO: , Septic/holding tank on lot k Cxol ; On adjacent lots Absorption field on lot tfl4.1 ; On adjacent lots t Public sewer main '�� Public sewer manhole/cleanout Sewer service line r Petroleum tank WATER SAMPLE RESULTS: Coliform __1;� c o..�l 0�"A . Nitrate P1 r? Other bacteria AOar_ �ZV �cty Date of sample: Collected by: S&S ENGINEERING 17034 age River Loop Roeil No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date Installed Iaz Tank size \goo &np-Ae Compartments Z Cleanouts ®/N) V Foundation cleanout P/N) y Depression (Yo tJ High water alarm (Y O) Alarm tested (Y/N) A Date of pumping `i -ill Pumper Tg-. �SSPeo� SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well (a) on lot 106 � On adjacent lots 1001 } Foundation Z41 Topropertyline 101 Absorption I ield 101 Water main/service line 1O1} Surface water/drainage t o C 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date Installed Size in gallons Vent(Y/N) High water alarm level —Manufacturer — Manhole/Access (Y/N) "Pump on" level at = 4�r Meets MOA electrical codes SEPARA on lot FROM LIFT STATION TO: D. ABSORPTION FIELD DATA On adjacent lots Cycles tested p off' level at Surface water Dateinstalled 5'9-62' Soil rating -\15' - 7 -CAP(- System type DR +�1 dFlsivyt s Length lt�1t �i11 Width 1 Gravel thickness �, `• S1 Totaldepth Total absorption area �1 i�l Tc�'Pti Cieanouts present/N) - Depression over field (Y/0 Date of adequacy test 3' Z' 2 - Results Results a5a fail) for TAarr� r5) bedrooms Peroxide treatment (past 12 months) (Y&) r%° -1f, W -P -Jo l lJ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot to2t On adjacent lots tDr." Propertyline tot To building foundation 4S 1 To 1existing or abandoned system on lot �0_ On adjacent lots '�' �L Cutbank- '1`/_' Water main/service line tcU'r Surface water t Driveway, parking/vehicle storage area Vol N' Curtain drain a� 0.1,ri2:Ai )D 9c5L nnr ,i i.._.4..., � i... fc..... .? 1,10% t .- - E. ENGINEER'StERTIFICATION. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 4 S 8 S ENGINEERING -W OF A1,4%%, P Aw •%. -I. Ih 17034 Eagle River Loop Road No. 204 0, y'�. • ) .+ .17 yea Signature Fa;lP Rivas. A1..1.2 04577 p* i •� + p �9?k % •N•N. Engineers Name �• +' Date82. 15 l.F L1++ 1• :s Z 4 yb,'',.tiy►y"' JZ HAA Fee $ Waiver Fee: $ Date of Payment Date of Payment Receipt Number Receipt Number 72-M(Aw. 9/91)axk MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 ANALISIS RESULTS for INVOICE 1 51469 Chomlab Ref.t 92.0757 Saspla 1 5 Matriz; NATER Client Sample ID : L7 12 OUR MOUNTAIN S/D PWSID : U1 Collected : PER 26 92 l 15:55 bre. Received : PPR 27 92 4 12:15 hre. Preserved with : 13 REQUIRED Analysis Completed : 118 28 92 Laboratory SuperTisor • SIEPHEN C. EDE Released By : C Com[/ Client Name :S 6 S ENGINEERING Client Acct :SNSENGP IPOt Rsgt Ordered /y :R. SHAPER Send Reports to: 1)S i S ENGINEERING 2) POI :NONE RECEIVED .................................................................................................................................... Parameter Results Unite Nsthod Allowable Limits NITRATE -N Sample ROUTINE SAMPLE COLLECIED IT: RAI. Remarks: ND(0.10) n7/1 EPA 5S3.2 10 .................................................................................................................................... 1 Tuts Performed See Special Instructions Above 01.Onatailable ND- None Detected " See Sample Remarks Above NA- Not Analyzed LT -Leu Than. GI -Greater Than rTN C^e7 Member of the SGS Group (SocI616 GdnArale de Surveillance) MUNICIPALITY OF ANCHORAGE • �� Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # DS ifl3 HAA # 1--414 89 D / PJ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner .Tne Gr; 11 Telephone: (home) s71-7251; Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Tack um; re r„-/ T.nri r•rosder Address .• Telephone 694-5500 (e) Mail the HAA to the following address: (or check here e, if hold for pick up.) List contact person and day phone number below: S b S ENGINEERING 17034 Esole River Loop Rad Ne 4�d Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family CX Number of bedrooms a- 3. WATER SUPPLY Individual Well P Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-siteO Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72.025 IR". 7M) Page 1 of 2 Z 10 Z e6ed Mote (991L '"10 %MEL -Tom s,jaau!6ua !euopsajad ayl Ut suo!ss!woJo siajajolalq!suodsal lou s! 96eiogouV 1oAl!led!o!unW ay1•panss! sl aleolpliaoe elolaq elep azA!eueio suo!loadsul lonpuoo tou op SHHO to saaAo!dw3 •sluawaiinbal alels pue lelapal u!euao Als!les of japio u! suo!lnl!lsu! 6u!pual rayl pue sawoq 10 slasepind of Asalmoo a se SIM saop SHHO aUl TNSVIV to elelS 84i U! paJals169i jaau!6ua leuoissalad luapuadapu! ue Aq anoge 5 ydei6eied u! uaA16 suoileluesaidai ey1 uodn Aluo paseq paleolluao lenaddV Al!joglny ylleaH sonss! (SHH(3) sao!AieS uewnH pus ylleaH loluawlleda0 a6eioyouV 1oAl!led!o!unyl ayl .'NOLLt1V0 lenaddV Ieuo!l!puo0lo sui!al !eUoll!pUo'J panoiddes!O panaddV �z— a1e0 Aq swoojpaq sol panaddV IVAOUddV SHHO '9 B j--5 bOZ oN Pao dLZ966 eIselV •JaA!a G!be3 ONIS33NION3 S 8 S Z auoydalal GWO ssajppV wJ1310 eweN •uo!loadsu! s!yl 10 alep ayl uo 1oa11a ui suo!leln6ai pue 'saousu!PIO 'sapoo alelS pue !edlolunyy lie yl!m eoue!!dwoo ui si walsAs lesods!p jalemelsem Jo/pue A!ddns jalem ells-uo eyl'uolloodsu! PUL uo!1e611sanui Aw wojl pue sal!; e6eloyouV 10 Al!ledlo!unw eyl woj1 pauielgo uo!lewJolui eyl uo paseq Im Al!J*aA i'aylinl I -u!ajay paleo!pu! ainlongs 10 adAI Pus swoalpaq to aagwnu eyl sol alenbope pue leuo!lounl 'ales si walsAs lesodsip ialemalsem jo/pue A!ddns jalem ells-uo ow lugl smogs !eno.(ddV AluoUlnV ylleaH s114110 uo!le6!lsanui Aw leyl AluaA I'mo!aq umoys alep uo!1ep!!enayl to se pus oia�ay pax!lle leas Aw Aq pa!l!11ao sy NOIIVWHOdNI ONV V1V0'H021V3S 3llj'S1S31'SNO1103dSNl °JNIOIAOHd WHId DNIH33NIJN3 'S • .. MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval (HAA) 'C1PAL ry &HECKLIST - FEBRUARY 1984 ' JN""ItNTAL sE. Vices AG$43-4744 _es c:vrsLON Legal Description:._J.+'y 'AY 1 IS88 A. WELL DATA RECEI V D Well Classification ot-t- If A, B. C, D.E.C. Approved (Y/N)/g Well Log Present �N) _Date Completed S� I Yield '1'80 61 Irk to 00 Total Depth Cased to Depth of Grouting Static Water Level t'� r Pump, Set At �- N Casing Height Above Ground Sanitary Seal on Casing MN) Electrical Wiring in ConduitON) Depression Around Wellhead (Ydl)> t___3 SEPARATION DISTANCES FROM WELL: ) To Septic/Holding Tank on Lot 1 00 ; On Adjoining Lots 1 To Nearest Edge of Absorption Field on Lot 1 C=nj ; On Adjoining Lots To Nearest Public Sewer Line 0 " To Nearest Public Sewer Cleanout/Manhole r To Nearest Sewer Service Line on Lot + 2S Water Sample Collected by �4 i 4�� Date Water Sample Test Results` Commentse2F-TZxtlEa-+ Def3ve J- B. SEPTIC/HOLDING TANK DATA Date Installed "Jed- Size I Ctx2_No. of Compartments Z- Standpipeso/N) Air -tight Caps(�RN) V Foundation Cleanoutt(VN) Depression over Tank (YILT ►J ate Last Pumped 'Or- V9 Pumping/Maintenance Contact on File (Y/N) !, ; for Holding Tank High -Water Alarm (Y/N) a P Temporary Holding Tank Permit (Y/N) a b SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation To Property Line o (' To Disposal Field Z o �- To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comme6cSSPe:1�L_ -'Fdt-1PkF - 72-M (Rev. VN) Frwl Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �'t S� ?� ��� Type of System Design Date Installed ��-1-P1L ?t S'�1-59 Length of Field 4r -7r Width of Field Depth of Field Gravel Bed Thickness f 3 Square Feet of Absortion Area 17� fT�� Statndpipes Present 07N) `/ Depression over Field (YtT eJ Date of Last Adequacy Test a -u -5`j .Results of Last Adequacy Test a�Ix f VT W SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well IoZI To Property Line 10) To Building FoundatioP ' " - • To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line �� 1y To Cutback (if present) a To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ton } Comments D. LIFT STATION N /� Size in "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) — .Pump Off' Level at -.-- Vent (Y/N) tuVent(Y/N) _ Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" certify that I have checked, verified, or conformed to all MOA and HAA guidelines in Inspection. Signed 5 & 5 ENGINEERING Company 7034 Eagle River Loop Road No. 204 P y ate R}wrr /kt ka 99577 Date MOA No. C l 4�`� 3 Receipt No. �S - ���SGcJ� Receipt No. — Date of Payment '� _ ��� a / Waiver Fee: $ _ Amount: $ elt=lp- �%��� Date of Payment 72-M (R". 7/88) Back Page 2 of 2 ar!»rt A. thwim W. W7•f �� P:Jc�;S1CtiP� a of thJ'A •7 ;n AA. .AN, CHEMICAL & GEOLOGICAL LABORATORIES OFALASKA, INC. r - r 5693 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FEDERAL TAX ID N 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order 1 13271 Date Report Printed: NAY 12 89 4 11:46 Client Sample ID:L3, 12, OUR MIN PWSID :UA Collected MAY 11 89 4 10:20 hrs. Received MAY 11 89 1 15:00 his. Preserved with :AS REQUIRED Analysis Completed :MAY 12 89 Laboratory Super or S EPREN C. EDE Released By Special VERI TURBID SAMPLE. Instruct: Chemlab Ref 1: 5250 Lab Smpl ID: 1 Parameter Tested NITRATE -N Sample SAMPLE COLLECTED BY RJS. Remarks: Client Name : S 6 S ENCR Client Acct : SNSENCP P.0.1 NONE REC D Req 1 Ordered By : RJS Send Reports to: 1)3 6 S ENCR 2) Matti:: WATER Allowable Result/Units Method Limits --------------------------------------------------------- ND(0.10) mg/l EPA 353.2 10 ............................................................................................. 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected " See Sample Remarks Above NA. Not Analyzed LT -Lase Than, CT -Greater Than