HomeMy WebLinkAboutPETERS GATE BLK 2 LT 3Peters Gate Block 2 Lot 3 #051-541-13 Municipality of Anchorage On -Site Water and Wastewater Program • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151181 PID Number: 051-541-13 Dwelling: E Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New E Upgrade Name: PAMELA IVERSON ABSORPTION FIELD ❑ Deep Trench E Shallow Trench ❑ Bed ❑ Mound Address 24948 SIERRA MESA CIR., Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 1.2 GPD/SF 6 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 2 Ft. Gravel depth beneath pipe 4 Ft. Subdivision Block Lot PETERS GATE 2 3 Fill added above original grade Varies 1.35 — 1.40 Ft. Gravel length 38 Ft. Township Range Section Gravel width 5 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 380 Ft2 1 -- Ft. Well 100+ 100'+ 100'+ NA NA TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity I 1000 Gal. Surface water 100'+ 100'+ 100'+ NA Material STEEL Number of compartments 2 Lot Line 5'+ 5'+ NA NA Foundation 5'+ 10'+ 5 + NA LIFT STATION Manufacturer Capacity Gal. Curtain Drain NA *50'+ NA NA Remarks *None known. Existing tank Pump on level at in. Pump off level at in. High water alarm at in. decommissioned per code. S.T. insulated Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer JR9 Drainfield 3034 CO/MT 3034 Inspector ARCTERRA BENCHMARK (Assumed elevation) 100 ft Inspeection V 8/21/15 8/21/15 Location and description ction 2"d 308/21/15 a"' 8/31/15 Bottom of siding - shed COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engin OF All Conditional Approval: Date j ` */49TH*+ c --- / , KE:VNE1'H N `sa ry A / Approved 6% Date eer's Stam Inspection Report_9-1-12.doc A -C=39.0' s B -C=41.5' A -D=44.0' IS—L=4bJ' N A -E=47.5' B -E=55.5' m A -F=49.0' a —17=575' A-6=85.5' A -G=85.5' B -G=92.0' A -H=87.0' u B -H=95.5' AS -BUILT SYSTEM DETAILS/SITE PLAN Permit OSP151181 C) PETERS GATE SUBD LOT 3 BLK 2 PID# 051-541-13 NE_ WATER SETBACK SCALE, 1' = 30' S 89°57'45" E 235.00' 03.3 103.2 99.3 FINAL GRADE 99,40 f 0 rc �- fRTFR FA9fIL_ 1000 GAL y SEPTIC 96.0096.00 4 TANK SEWER ROCK 11 OF AL,4 �1 � 4 TH� i I` KENNE U I CE 118 .' yY4 / 1 `tea \ '%oms10NA 38' PREPARED FOR: PAMELA IVERSON 24948 SIERRA MESA CIRCLE Chugiak, AK 99567 907-240-0182 FIELD BOOKS cwpuTm.. A BWNDARY: N/A WAM: C) STAKING N/A m1 - KMD o� DAA' 9/1/15 Dft FILE \ D NW1262 ACRD n�' FILE I 'ADB N°` m INSTALLED NEW 1000—GAL S.T WITH C CO OST—TANK COs v CO & ERTER nNZ O_ COs M O RTER � B REQ. SE ACKS STAK BY RLS In ik r CONST. TH15-1 Z M WATER SETBACK SCALE, 1' = 30' S 89°57'45" E 235.00' 03.3 103.2 99.3 FINAL GRADE 99,40 f 0 rc �- fRTFR FA9fIL_ 1000 GAL y SEPTIC 96.0096.00 4 TANK SEWER ROCK 11 OF AL,4 �1 � 4 TH� i I` KENNE U I CE 118 .' yY4 / 1 `tea \ '%oms10NA 38' PREPARED FOR: PAMELA IVERSON 24948 SIERRA MESA CIRCLE Chugiak, AK 99567 907-240-0182 FIELD BOOKS cwpuTm.. BWNDARY: N/A WAM: BMW STAKING N/A m1 - KMD A UILTO JLS DAA' 9/1/15 Dft FILE GMD: NW1262 ACRD n�' FILE I 'ADB N°` 15-155 KA' 1 84A0 M SCALE, NTS GARNESS ENGINEERING GROUP, Ltd x, ._, CIVIL & ENVIRONMENTAL ENGINEERS _-_. May 27, 2015 (REVISED) Pamela Iverson 24948 Sierra Mesa Circle Chugiak AK, 99557 Reference. Peters Gate; Block 2, Lot 3 — 24948 Sierra Mesa Circle — Septic System Evaluation and Proposal for Upgrade. Ms. Iverson, Per your request, we performed a site visit to complete a well and septic system adequacy test, for the purpose of obtaining a Certificate of Onsite Systems Approval (COSA) from the Municipality of Anchorage. Our findings are summarized as follows. WELL 1tLOW TEST: On the day of our test (Sit 5/15) the static water level was 209 feet below die top of the casing. Eight -hundred and thirty (830) gallons were pumped from the well at an average flow rate of 4.00 gallons per minute (GPM) which resulted in a maximum drawdown of only 14 feet. Based upon this data, and deducting the 250 gallons of water storage in the house (volume is per the owner) it can be concluded that the well will continuously produce at least 2.75 gallons per minute, which exceeds the Municipal requirements for a 3 bedroom house (0.31 gallons per minute). WATER SAMPLE RESULTS: Water samples were taken on 5/15/15 and submitted to a state certified laboratory. The results indicated no bacteria and ND (non -detect) for Arsenic and Nitrates. SEPTIC SYSTEM: The septic system consists of a 1,000 gallon septic tank and a deep trench type drainfsid. Can 5115!2015, the drainfieid was inspected and found to be surcharged (over full) and was not able to be tested for its functionality. Based upon this data, it was determined that the drainfield is currently in a surcharged/failed state, and does not meet the MOA absorption requirement of 450 gallons per day (GPD). Although the system may continue to be functional, a new septic system will need to be designed and installed prior to transferring tide on the house. . . The fallowing is a summary of the engineering costs associated with upgrading the septic system. • Services to date for the records research, septic inspection & evaluation, well test, water samples; and preparation of this report: $950.00 • Excavation of test hole: $600 to $750.00 (excavator change, plus 15% mark-up). • Soils Analysis, percolation test and groundwater monitoring for test hole: $700.00 • Engineering services to design the septic system: $94#0.00*. This is based upon a conventional gravity now septic system with no waivers to property lines, surface waters, or nearby wells. We will need an up to date and current as -built survey of the property, 3701 fast Tudor Road, Suite 101 * Anchomp, Alaska 99507-1259 Phone: (907) 337.8179 * Fax (907) 338.3248 * Website: www.garnessengineeiing.com om Municipality of Anchorage cent s Separtmehnt Development Services Division; On -Site Water and Wastewater Program ****' VARIANCE/WAIVER REVIEW **** Waiver#:OSV151071 COSA#: Permit#:OSP151181 PID#: 051-541-13 Legal Description: Peters Gate, Block 2, Lot 3 Engineer:. ArcTerra Applicant: Pamela Iverson Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. F1 Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property:' ❑ Adjacent propertiesarenot affected by this waiver. Waiver is Granted: X Waiver is riot Granted: Date: iQ Approved by: M%of Reviewer o �F cTER,, "� § ARCTERRA CONSULTING, INC ' R 212 E. 51' Ave, Anchorage, AK. 99503 q o " ' STING ,r0office (907) 868-3791, Fax (907) 868-3793 N WeF. v.�reSG°l June 26, 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: LOT LINE WAIVER — PETERS GATE BLK 2, LOT 3 �l.Lql/s osv 15'lo-7! 05/-5VI-/3 2_6 4` _ V+ 61a-7st Per the recent attached as -built survey dated 6/1/15 by John L Schuller, LS -- the existing septic field is within the required 10' separation distance to the lot line. The measured distance is approximately 8' from property line to the monitoring tube and we are therefore requesting a waiver to 5' to lot line at this time. We are installing a new leach field that will be at least 10' from the property line and installing a diverter valve between the two leach fields to prolong the life of the system. The old system has been in operation since 1985 with no known issues and we do not expect there to be any adverse effect on the adjacent lot. If you have any questions, please contact me at 868-3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Kenneth M. Duffus, P.E. Attachments: As built Survey N H 0 a LOT 6 7j. W UU-U1jUU W 230.00 O M SIERRA MESA CIRCLE 0 M ORDING DISTRICT, ALASKA SB OF: OO = FND 5/8" REBAR PETERS GATE SUB IVISION LOT $3 BLOCK424 PLA 200531 —__— SURVEY CERTIFICATE: !2 . Schuller, Have conducted a physical s ey of tl t e as shown on this drawing and that the tents hereon are within the property lines and no enchroachm is a hereon noted. Under no circumstance should any inform ai n this drawing be used for construction of fences, structures, improvements, or for establishing boundary limes. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 15-015 tefflmpitaas M JLS NW1262 1 1501 �OF 446 �.............. *. 49� W ............. .... L.�SCHULLER o PAS -10408 �m�'27. I 0 F 0 a �45 0� LAR rFP�✓' 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151181 Tax Code Number: 05154113000 Work Type: Septic Upgrade Permit Effective Dates: June 29, 2015 to June 28, 2016 Design Engineer: ARC TERRA CONSULTING INC Subdivision: PETERS GATE Site Legal Address: PETERS GATE BLK 2 LT 3 G:1262 Owner/Address: IVERSON PAMELA J PO BOX 670737 CHUGIAKAK 995670737 Site Mailing Address: 24948 SIERRA MESA CIR, Chugiak Lot Size in Sq Ft: 54014 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I. D. 051-541-13 PAMELAJ IVERSON SUM-i TTAL JUIv i 7 nD15 Property owner(s) Day phone Mailing address PO BOX 670737, CHUGIAK, AK 99567 Site address 24948 SIERRA MESA CIRCLE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) PETERS GATE BLOCK 2, LOT 3 Legal description (Township, Range & Section) Lot Size 54014 Sa. Ft. Number of Bedrooms 9&L94#3008%tullet APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Single Family Absorption Field Initial ❑ (SF) Upgrade (w/wo ADU) Septic Tank ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: i Distance: 5� I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. or authorizeci agent) Permit/Rush Fees: .5(09 Date of Payment: (&II i'G( 5 Receipt Number: 0116061?b Permit No. MP1511 g/ Permit App_*1-12.doc Waiver Fees: dls,— Date of Payment: a9�CS� Receipt Number: Waiver No. di V 0 ?,"cTERR,q }c ARC 1m ERRA � ♦ X z = CONSULTING, INC V s 212 E. 51" Ave, Anchorage, AK. 99503 o Office( \ / 907\I 868-3791, Fax (907\ 868-3793 eRiy��NyY1Li�Nn,SS �� June 15, 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit — Peters Gate Block 2, Lot 3 It has been determined that the absorption field of the subject property is saturated. Subsequently, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system. The general slope of this lot is from east to west at a grade of approximately 13- 18% over the septic area. On June 6, 2015 a testhole was performed to investigate soils and groundwater. The results of this test are attached for your review. The proposed upgrade will serve the existing 3 -bedroom house. We propose to install one 5 -Wide 38' long trench. Groundwater was not encountered at excavation but was at 13' at monitoring. The property and adjacent lots are served by private water. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 868- 3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. 4PLeKenneth M. Duffus,.. Attachments: On -Site Sewer Application Wastewater Absorption System Details/ Site Plan Soils Log/ Percolation Test 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA PETERS GATE SUBD LOT 3 BLK 2 - FLAG PROPERTY LINES WELL RADII & EASEMENTS PRIOR TO CONSTRUCTION NO SLOPES >25% WITHIN 100' OF PROPOSED SYSTEM r NO PUBLIC WELLS WITHIN 200. OF m PROPOSED SYSTEM. y NO PRIVATE WELLS WITHIN 200' OF m PROPOSED SYSTEM EXCEPT AS NOTED. r NO SEPTIC SYSTEMS WITHIN 200' OF I PROPOSED WELL EXCEPT AS NOTED, I). D S CE- 1 ,At / `\SSIO�= O DESIGN DETAILS ScaLeI 1'= 100 3 BDRM X 150 GPD = 450 GPD PAGE 1 OF 2 450 GPD/1.2 GPD PER SQ, FT, = 375 SQ, FT (375 / 5 x ,50 RF (4' GRAVEL) = 38 FT, TRENCH USE 1 TRENCH - 38' (L) X 5' (W) X 4' (ED) Total depth of system is 6' max from original grade. Total depth of gravel below distrlbutlon pipe Is 4' NOTESI 1. VERIFY OR INSTALL 1000 GAL & INSULATE TANK IF <4' COVER. 2, INSULATE TRENCH WITH 2' HD BURIAL FOAM IF < 3' OF FILL. MIN. 2' FILL WITH INSULATION, >3' COVER NO INSUL REQ, 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK, 4, CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS EASEMENTS, PROPERTY LINES, ETC - PREPARED FOR; PAMELA IVERSON 24948 SIERRA MESA CIRCLE Chuglak, AK 99567 907-240-0182 FIELD BOOKS BOUNDARY: BOUNC STAIGNG: STAKIP ASBUILT. JLS DND. M ADAD Fl"'FILE COMPUTED: DRArm: BMW a'EcaD' KMD DATE` 6/15/1: GRID: NW1262 JOB N°: 15-155 REI •�dGi WASTEWATER DISP❑SAL SYSTEM DETAILS PETERS GATE SUBD LOT 3 BLK 2 Q � ZZ 0 FCO 0 o� � D < m r rn 0 CONNEC TO EXISTI S.T & 13,18% 13,18 WATER SETBACK S 89057'45" E CONNECT TO EXISTING S.T INS -% L 2 POST -TAN COS & DIVERT Ac; 13,18% TH15-1 T o MT FLAG PROPERTY LINES WELL RADII & EASEMENTS PRI❑R TO CONSTRUCTION �-ft OF 1 PREPARED FOR: PAMELA IVERSON 24948 SIERRA MESA CIRCLE * 4 Tx�/ Chugiak, AK 99567 907-240-0182 FIELD BOOKS cmpum: CE -711 ,rvq A4 OWNOARI'80UNDARY °PANT: BMW Ao, STAKING: STAKING wEC . KMD / A uu. JLS DATE 6/15/15 FESSIOTI= DWG. rne: wo: NW1262 ACM FILE:JOB No.: 15-155 FILE 235.00 Scale; 1'= 20' PAGE 2 OF 2 'P1yF�ULTING • 3e A' AK. 99577'$ QsRcTERR9 A ARftERRA CONSULTING, INC 212 E. 51" Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 SOILS PERCOLATION TEST Performed for: Pamela Iverson Date Performed: 06/06/15 Project: Peters Gate 112, L3 TEST HOLE 8 TH 15-1 Depth Org/OL SP/gp/gm-sm mod dense, trace of silt, wl cobbles to P 14-a"'t _. B.O.H. - mosit 15- 16- 17- 18- 19- 20- � CH QF AL� A,,,. KF,NM1E'rn M.0 / 7] 16 '0' m err>sio t� i SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO What depth? NA Depth to water after monitoring? 13' Date? 6/16/2015 Reading Date Gross Time Net Time Depth of Water Net Drop 1 6/6/15 1:00 6" - 2 1:10 10 min 6/16" 4 9116" 3 * 1:11 6" 4 1:21 10 min 8/16" 4 7/16" 5 * 1:22 6" - 6 1:32 10 min 8/16" 4 4/16" 7 * 1:33 6" - 8 1:43 10 min 10/16" 4 4/16" 9 * 1:44 6" - 10 1:54 10 min 9/16" 4 3/16" 11 * 1:55 6" - 12 2:05 10 min 9/16" 4 3/16" * Water Added Percolation Rate 2A (min/in) Pere Hole Diameter 6" Test Run Between 5 feet and 6 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. j 72413 (Rev. 7/78) � 1 1 MUNICIPALITY OF ANCHORAGE �� DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION \, 1*0 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONEEW ML , mer -LI X14- ❑ UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. BEDROOMS 3 Well Absorption area Dwellirtq PERMI NO O DISTANCE TO: Y d Q Manulxturer �j� Mat eli No. of compartments Z ai I. GR C:�C � .7 rn Liq, c p iallons J IF HOMEMADE: Inside length Width �— Liquid depth -1 Z DISTANCE TO: Well Dwelling PERMIT NO. D _ H Manufacturer Material Liquid capacity in1W llons O DISTANCE T0: Well Found�yyp� i Nearest lot loner PEHM W l D7 J J W No, of lines Length of ea rte Total•leng yf 11'res r Trench wits Distance betweer„jn F = / L nches Q Top finish Material beneath Total cc of the to gra �. / lila affective absorption area p } inches Length Width pDepth PERMIT NO. W Q 1— Type of crib Crib diameter Crib depth Total effective absorption area W 1 _ Well Building foundation Nearest lot line DISTANCE TO: J ClassC e th / /r L Driller Distance to lot line PERMIT NO. J J /V W r+ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER ^ PIPE MATERIA !J I RATING SOIL TEST ff INSTALLER CotiJ L G S sT. Y VEMARKS 1JORA v ° P S -1"0 C -o ' u f 1 OF 44 MSart A. SMM• ' �� "J, :• Ko. 1457-F :•rrt FFSS%I" APPROVED SRU IC01. DATE AL �J E RIVER, ALA-KI,�.57r PH. t E: �/AE -237J 72413 (Rev. 7/78) 08/31/2005 09:13 6882259 SULLIVAN PAGE 01/01 Tatifirb Drilling Rfxg by DOC Co. ae, SULLIVAN WATER WELLS P.O. SOX 670277, CHUOIAK, ALASKA 66667 • TELEPHONE 606.2759 OWNER OF ITKLAND j / S 4¢ JOEO t t j pp ADDRESS f_ 40 4, 7- ,�� 6a C 6/J dr,4� LEGAL DESCRIPTION Io"i 3 MAC r3 P,9-7EAS ' DATE - Sorted Ended PERMIT NUMBER DEPTH OF WELL 4'0 6 STATIC LEVEL OF WATER FT. to DRAW DOWN FT GALS. PER HR 30 KIND OF CASING is l 6,0 KIND OF FORMATION:: � From D Ft. to�dc_Ft. C% t 1'rj Jf, UWI� .. Ftom Ft. to—Ft. From.%$_Ft. to -9-3 _M FL AAZWQC Ie K Fronl Ft. to Ft. From++�1 3�5>_FLtoD�_�FL_ /4f4,jC ,MACK f�e*!j From Ft. to Ft. FrOM21%GLFt. to -12r -Ft. AMO&.9 AkAQ 4QAF9;4rom FL to Ft From—Ft. Fl. to Ft. J QJ,4r, From, Et. to Ft From.3a5�:Ft.to3rS-FL 60424fer-k '64AGK F��rg¢o�cm Fl. to Ft. Ft.C1/�DL' Ftom.,, 4-CFt. to� �i a Ace4c/r. 4-'Frpm pt. tyj—Ft. From Ft. to Ft. alp d sp q From FL to Ft. Fwm273_Ft. to uo Ff (-0,4 g C k B,619CA From Ft. to Ft. From Ft. to Ft. From Ft. 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 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. to Ft MISCL. INFORMATION: DRILLF.R'S NAME L I rmWATER WELL RECORD • ` STATE OF ALASKA • DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either Is, to ar Ic.) A.D.L. No. PI la. Borough P`VbCI talon Lot Block le. 1/e ql to. Section No. Township N❑ Range E❑ Meridian anchorage Nte 3 2 _er_er_er_ a❑ w❑ Ie. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS S. OWNER OF WELL: )dyers & Flyers Address:.O.Box 670351 Soot Address end Area of Well Location Ch•�.akp ?.k 99567 Y. WELL LOG Feet eer lace el e• W �EPTH: (11.01) S. DATE OF COMPLETION 1`7 . fl. JL — 5 — `35 Materiel Type Top Bottom Fe2t 0 6�n B, ❑Cable tool flRotory ❑Driven ❑Due Eravol & SAnd 6 38 ❑ Auger ❑ Jetted ❑ Bored ❑ Other t rook black 38 !10 7.USE: Q Domestic []Public Supply ❑ Industry rook prey 0 1010 ❑ Irrigation ❑ Recharge ❑ Commerical rock white water 00 ?l ❑ Test well ❑ Omer: rock Prey !20 128 B. CASING: ❑ Threaded Q Welded rock are crerisis -w iter 128 1t, dlom._in. to_ ft. Depth Weight lee./a. rock rzrev w:_ter 1400 192 diem. In. loft. Depth Stickup ft. g. FINISH OF WELLt Type: Diomety: L— � � I r:.v 1s.:... :•nglh: Set bel.soo ft. and ft. Boekflllleg gravel pack 1 10. STATIC WATER LEVEL: 60 ft. 4 ❑ Above or Below land surface Date Equipment used: 11. PUMPING LEVEL bele. lend surface end YIELD 190 ft. offer 1 Ms. pumping I I.P.M. l lT OcPT cNT A1. PQ it. offer mare. pumping-O.P.M. •. EtyV1. f IY.GROUTINO Well grouted: ❑ Yes IS No 11 :J Material: ❑ Neat cement ❑ Other: V 13. PUMP, (If available) HP Length of Drop Pipe ft. capacity G.P.M. ❑ Sabm. ❑ dot ❑ Cotrllical ❑ Other I/.REMARKS: la. WATER WELL CONTRACTORS CERTIFICATION: IS. Water Temperature �• ❑ F ❑ C This well was drilled under my Jutfedlolloe and this report is Ira to the best of my knowledge and belief; Gene Skyles Well D#4ing A 16951 ' P.O_.egistered Business Name Conlroct License Number Address: PBox 671473 Chugiakt . 99567 signed: % s Date• iE1_i� 'Z di d S� AWhorlied Repres tw " Ferro 02-WWR (II/dl) Copy Distribution: WHITE- State D6GS, PINK •Orlller. CANMY•Cuslemu PI la. Borough P`VbCI talon Lot Block le. 1/e ql to. Section No. Township N❑ Range E❑ Meridian anchorage Nte 3 2 _er_er_er_ a❑ w❑ Ie. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS S. OWNER OF WELL: )dyers & Flyers Address:.O.Box 670351 Soot Address end Area of Well Location Ch•�.akp ?.k 99567 Y. WELL LOG Feet eer lace el e• W �EPTH: (11.01) S. DATE OF COMPLETION 1`7 . fl. JL — 5 — `35 Materiel Type Top Bottom Fe2t 0 6�n B, ❑Cable tool flRotory ❑Driven ❑Due Eravol & SAnd 6 38 ❑ Auger ❑ Jetted ❑ Bored ❑ Other t rook black 38 !10 7.USE: Q Domestic []Public Supply ❑ Industry rook prey 0 1010 ❑ Irrigation ❑ Recharge ❑ Commerical rock white water 00 ?l ❑ Test well ❑ Omer: rock Prey !20 128 B. CASING: ❑ Threaded Q Welded rock are crerisis -w iter 128 1t, dlom._in. to_ ft. Depth Weight lee./a. rock rzrev w:_ter 1400 192 diem. In. loft. Depth Stickup ft. g. FINISH OF WELLt Type: Diomety: L— � � I r:.v 1s.:... :•nglh: Set bel.soo ft. and ft. Boekflllleg gravel pack 1 10. STATIC WATER LEVEL: 60 ft. 4 ❑ Above or Below land surface Date Equipment used: 11. PUMPING LEVEL bele. lend surface end YIELD 190 ft. offer 1 Ms. pumping I I.P.M. l lT OcPT cNT A1. PQ it. offer mare. pumping-O.P.M. •. EtyV1. f IY.GROUTINO Well grouted: ❑ Yes IS No 11 :J Material: ❑ Neat cement ❑ Other: V 13. PUMP, (If available) HP Length of Drop Pipe ft. capacity G.P.M. ❑ Sabm. ❑ dot ❑ Cotrllical ❑ Other I/.REMARKS: la. WATER WELL CONTRACTORS CERTIFICATION: IS. Water Temperature �• ❑ F ❑ C This well was drilled under my Jutfedlolloe and this report is Ira to the best of my knowledge and belief; Gene Skyles Well D#4ing A 16951 ' P.O_.egistered Business Name Conlroct License Number Address: PBox 671473 Chugiakt . 99567 signed: % s Date• iE1_i� 'Z di d S� AWhorlied Repres tw " Ferro 02-WWR (II/dl) Copy Distribution: WHITE- State SOILS LOG MUNICIPALITY OF ANCHORAGE (• r iDEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TESTOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 -- SOILS LOG — PERCOLATION TEST PERFORMED FOR: q 64 -es C ST. DATE PERFORMED: 4-7-zf - 8S LEGAL DESCRIPTION: t,�t•�r (3L. -Vi- Z FE -7 iYZf 6A-i'lt SI(i SLOPE SITE PLAN 1 J t•• r 2 3 4- 5- 6- 7 5 6 Jr/ L7 � �4 8- 11 919- lo - 0 11 12 13 14 15 16 17 18 19 GP L/4HT 5/�T kla�re(!r S S �+ WASGROUNDWATER S ENCOUNTERED? L 0 P IF YES, AT WHAT f E DEPTH? �L7 4-2A -fi6 OF AZ v7 t!c 4u #"d A. Shefu! •• ir. No. 1117.E ta'''i Reading Date Gross Time Net Time Depth to Water Net Drop 20 PERCOLATION RATE r (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS 1 ! STF"L PERFORMED BY: .4 %: VIGINE=RIK 1 CERTIFIE DA GR9 196)( o.•�LE RIVER. ALASM V77 PH. 694-2WO 72-008 (6/79)--'------ • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 k 5 A CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-541-13 1. GENERAL INFORMATION Complete legal description PETERS GATE BLOCK 2, LOT 3 Expiration Date: __' Location (site address) 24948 SIERRA MESA CIRCLE, CHUGIAK AK 99567 Current Property owner(s) PAMELA J. IVERSON Day phone Mailing address Real Estate Agent POBOX670737 CHUGIAK AK99567 2. TYPE OF DWELLING: 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 Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Receive -a' by: e —724 COSA to be released to the engineer, unless Date: COSA Fee $_, a�o� S __ Waiver Fee $ Date of Payment Receipt Number 054 F$t� COSA# 05C-15-15-1 / Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 9/1/15 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system.. 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, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseenf Or A encroachments, deficiencies or discrepancies exist. 'Ar�`�v AZ )III, , 6. DSD SIGNATURE _4eo� System #1 Approved for —3 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for KFr\ETH .. li FUS � 71i8 tl'z 01 1 RosesstoN'� .Age ► bedrooms, with the following By: Original Certificate Date: Q % � f1—=F The icip y rfoGrage Development Services Division (DSD) issues Certificates of Onsite 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 COSA blue sheet_10.10.12.dw 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: PETERS GATE BLOCK 2, LOT 3 Parcel ID: 051-541.13 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Date completed 711995 (Deepened) Sanitary seal (Y/N) Y Total depth 400 ft. Cased to 93 ft. FROM WELL LOG Date of test 712005 Static water level 183 ft. Well production 0.5 9— p.m- WATER SAMPLE RESULTS: I/ Coliform colonies/100 mL Nitrate P,17,9 mg/L Arsenic: Alb_ug/L Date of sample: 813112015 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping NA- NEW TANK Pumper C. ABSORPTION FIELD DATA Well Log (Y/N) Wires properly protected (Y/N) Y Casing height (above ground) 18+ in. AT INSPECTION - PER GEG, LTD. 5115115 ft. Collected by: ARCTERRA Date installed 8/21/2015 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 8/21/2015 Soil rating (g.p.d./ft2 or ftz/bdrm) 1.2 System type SHALLOW TRENCH Length 38 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 7_4 ft. Eff. absorption area 380 ftZ Monitoring tube Y Depression over field N Date of adequacy test NA - NEW SYSTEM Results (Pass/Fail) _ For _ bedrooms Fluid depth in absorption field before test _ in. Water added_ gal New depth_ in. Elapsed Time: — min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 151+ Sewer /septic service line 251+ Animal containment areas 501+ SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots 1004 On adjacent lots 1004 Public sewer manholelcleanout 100'+ Holding tank 100'+ Manurelanimal excrete storage areas 100'+ Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ ABSORPTION FIELD ON LOT TO: Property line ;fw mI evsuilding foundation 10'+ Water main 101+ Water Service line 10'+ Surface water. 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 504(NONE KNOWN) Wells on adjacent lots 1001+ F. COMMENTS Well flow performed by Gayness Engineedng Group, LTD (see attached report) 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 KENNETH M. DUFFUS Date 9/1/2015 COSA canary sheet,2-6-15.doc in. -}et!v10( 1;I ..: H O a LOT 6 0 0 M SIERRA MESA CIRCLE ANCHORAGE RECORDING DISTRICT, ALASKA ASRUELT OF: PETERS GATE SUBDIVISION LOT 3 BLOCK 2 PLAT 74-146 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey ofthis property as shown on this drawing and that the improvements situated hereon are within the property lines and no encbroachments exist other than noted. Under no circurnstance should anyntformation on this drawing be used for construction of fences, structures; improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 15-015 wLS JLS I M NW1282 O = FND 5/8" REBAR ..OF A01 L�s�i �; • 4 TH I it 4 SOHN L. SCHULLER.- �w LS -104Q8 ami 0 H O a N> rRv� x a % �' r U1 � ` v 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax CNRr 5 r,JcV_1> Municipality of Anchorage -� Development Services Department Building Safety Division ' Onsite Water and Wastewater Program s • . r 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. Off/ - -1qI - / 3 COSA # %l n%U? Expiration Date: / (1 - O (� 1. GENERAL INFORMATION Complete legal description -V�GLci[2 Ger t- 0;� X-3 aec'L Location (site address) 14 q yP �I tA,1rA Current Property owners) tkar e Day phone -793- 3Da.-y Mailing address P.D. Box ln"1 /S��- (Auaialc= AK '795'4-7 Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA wX be held by DSD for pickup. 2. NUMBER OF BEDROOMS: S 3. TYPE OF WATER SUPPLY: Individual Well ell Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site 2, 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 Onsite 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, 1 verify that my Investigation, based on procedures outlined In the Certificate of Onsite 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 Eagle River Engineering Services Phone (09 y - 5- IU42 I VFW ME,ue Address FnqIp Rivpr AK 99577 Engineer's Printed Name Chraa*17ev e. b000d Date .42 110106 5. DSD SIGNATURE Approved for �� bedrooms. Disapproved. Conditional approval for bedrooms, with the following CE103 77 Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other BY i�Zl /40a -et Original Certificate Date: Municipality of Anchorage s•, • Development Services Department Building Safety Division ` On -Site Water & Wastewater Program ' 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/ortsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 3 Legal Description: /��fln�f CSG �vf pK B/oCk�,�ParcelID: Olt1- EY 1 -13 A. WELL DATA * W tGl_ Det D 7/`1� Well type RLVO& If A, B, or C provide PWSID # _ Well Log (Y)N) Date completed ]�95 Sanitary seal (91N) L&d- Wires properly protected UY N) Total depth_ft Cased to _13—ft. Casing height (above ground) _(Rin. FROM WELL LOG Date of test -71o5 Static water level 1 83 ft. Well production 5 9 -P.M. WATER SAMPLE RESULTS: Coliform . colonies/100 mL Nitrate •SN(o mg/L Arsenic: _Alk mgA Date of sample: �Z/o 4?6 )/037/04 B. SEPTICIHOLDING TANK DATA Tank Type/Material tvi,'c 544"Lz AT INSPECTION 8/;LS/oS 3.3 g.p.m. Other bacteria O colonies/100 mL Collected by: r_ aw.ice 4 ,,,.;n.i Date installed 5'/3/ / 95 Tank size 1 OOU gal. Number of Compartments _;_ CleanoutsON) VA:a= Foundation cleanout (9N) (" Depression over tank (YO 71,& High water alarm (YA) "!'Lo Date of pumping 9 1-71O5 Pumper C. ABSORPTION FIELD DATA Date installed f 11 105- Soil rating (g.p.d.W o Podrm //0 System type Sha//aoJ *Ind, Length 3-7 ft. Width 5- ft. Gravel below pipe a ft. Total depth 5 ft. Eff. absorption area 11!�:fe Monitoring tube. JdjA_ Depression over field PIC Date of adequacy test Results Pas ail) _4?adg4_ For 3 bedrooms Fluid depth in absorption field before test ,?S_ In. Water added_&J!RQ gal. New depth_3± in. Elapsed Time: min. Final fluid depth .25_ in. Absorption rate >= HS O g.p.d. Any rejuvenation treatment (past 12 mo.) (Y(&)& type) 'nope- kneiA7n If yes, give date ri le D. LIFT STATION Date installed Size in gallons 'Pump on' level at _ in. 'Pump off' levy Datum Cycles tested _ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot +100' Absorption field on lot _ t 100 ' Public sewer main t —15 Sewer /septic service line ray ' Animal containment areas - 100' Iftanhle/Access water alarm level at in. Meets alarm & circuit requirements? On adjacent lots _ 4 100 On adjacent lots t 100 ' Public sewer manhole/cleanout r 100 ' Holding tank t 100 ' Manure/animal excrete storage areas 1-/00, SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation -r5 ' property line v6 ' Absorption field t 5 ' Water main + 10 1 Water service line t /0' Surface water t 100 Wells on adjacent lots + 00' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line -r 10' Building foundation +10' Water main r 10' Water Service line t 10' Surface water +1100, Driveway, parkinglvehicle storage f-10 ' Curtain drain t•So ' Wells on adjacent lots t 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 COSH guidelines in effect on this date. Engineer's Printed Name rllri S%ol,trr ,Cg. aLand Date .;? / 10 /0(0 COSA Fee $ i-1 30 Date of Payment? rr.IDI; Receipt Number (Rev. 11/05) ouu Waiver Fee $ Date of Payment Receipt Number -7-7 ----------- + Itfl- 'x F� ri -9 IN np• - �j '?C 7 A, 43 07 A BUILT-'"- A -hereEl ilelt;fy that I ha vl� su desicil4d.- z L c 7 Anao�p -Rvo�l,drdrmie6ji.precj,c,lska,-andh ove. np4f E �A overlap or enatc thmewitla the property lines and do not Pro PeftY fYIng icljicent thereto, thmt�,. ­00-imPrO.VevwrWonpvopaty - I YO d in tj a jacent thereto encroach i nand I MAhere are 4oadws Pco133,0 Mt."Anakated-h.. :cn .-PTO MUNICIPALITY OF ANCHORAGE �S 1 J 4//7 DEPARTMENT OF HEALTH & HUMAN SERVICES O DIVISION OF ENVIRONMENTAL SERVICES Ary CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY H87-0576 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7 Block 2'Peters Gate Subdivision (T15N R1W Section 14) Location (address or directions) Sierra Mesa Cr. (b) Property Owner A.H.F.C. Telephone: Home Business Mailing Address 235 East 8th Avenue, Anchorage 99501 (c) Lending Institution lst National Bank of Anc4pgollaRe Mailing Address Eagle River Alaska 99577 (d) Real Estate Company and Agent Linda Malone, Re /Max Address 16600 Centerfield Drive #201, Eagle River, Alaska 99577 Telephone 694-4200 (e) Mail the HAA to the following address! or: Check here ®Xif hold for pick up. List contact person and day phone number below. S & S Engineering 17034 Eagle River Loop Road #204 Eagle River, Alaska 99577 2.. TYPE OF RESIDENCE Single -Family GYx Number of Bedrooms three(3) 3. WATER SUPPLY Individual Well ME Community O Public O Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite EK Public ❑ Community O Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 77-075 M" nasi Rom f^ n 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S Engineering Telephone 694-2979 Address 17034 Eagle River Loop Road 9204 Eagle River, Alaska 99577 Date November 21 1987 Engineer's Seal NOTE: The mound system approved and installed on this lot was designed for the sand fill layer and not the accepting soils. It appears to be functioning adequately at this time. 6. DHHS APPROVAL / r Approved for three (3) bedrooms by ( ��eDate -D _ecember 1, 1987 ApprovedXXXXXXXXXXXX Disapproved Terms of Conditional Approval Conditional C8Liiii16111 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. Page 2 of 2 . 720251R, 8.861 e.,oww n _ CIPAITY OF ANCHORAGE (1161110�p MUNICIPA 5EQ µ� Nta% ALUTHORITY APPROVAL (HAA) EW9-0NM- CHECKLIST - FEBRUARY 1984 NOV 2 3 1987 264-4720 Legal Des iption: LOT 7 dik-Z _ECEIVED P/10 A. WELL DATA R Well Classification IOtAjirn'_5'-� -_ If A. B. C, D.E.C. Approved (Y/N) ir.,%b- Well Log Present (VN) N/ Date Completed 7 1"7 — S3 Yield C26 Total Depth JO -b Cased to 20 Depth of Grouting Static Water Level ��y1 -� ���� Io � Pump Set At 21� �o Casing Height Above Ground 3e-3 Sanitary Seal on Casing (9N) Electrical Wiring in Conduit(tY N)y _Depression Around Wellhead (YAP Separation Distances from Well: 1 To Septic/PloldinAp-Tank on Lot On Adjoining Lots r 1 To Nearest Edge of Absorption Field r' qT of t'� : On Adjoining Lots 1 =� To Nearest Public Sewer Line p To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 115 ('- Water Sample Collected by Water Sample Test Results Comments A� 4' 41-e-1�i%I.g> T�yff NrG� 31, G�1-%S �cC k.k�-.,A— -- o—a> -.ti cnt3 B. SEPTIC/i40k84H4H'TANK DATA Date Installed _ Size I Q22 No. of Compartments Z Standpipes (Y)N) _ )z Air -tight CapsdgN) Foundation Cleanoutow) Depression over Tank (Y, l�j *-I Date Last Pumped Pumping/Maintenance Contract on File (Y/N) t� : for �- Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) P Separation Distances from SepticAdoWi lg Tank: I To Water -Supply Well 11 To Property Line %C> t '1 To Building Foundation Sd I To Disposal Field S To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course I r7--> A - Comments Page 1 of 2 72-026(11/64( C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z-S� ¢�� Type of System Design Date Installed 7 -21 - 133 Length of Field 3S r Width of Field Depth of Field 15- Gravel Bed Thickness O tt (Pre, �_ t.� '�g1c .:r ) Square Feet of Absorption Area 103fl Standpipes Presents 1) y Depression over Field (Y69- -----t_3 Date of Last Adequacy Test \O— 8— FS -1 Results of Last Adequacy Test Separation Distance from Absorption Field:l To Water -Supply Well ( 13I To Property Line To Building Foundation Lot ; On Adjoining Lots To Water Main/Service Line - I o 1-4' To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course I c o I-ar To Driveway, Parking Area, or Vehicle Storage Area t O -4, — To Existing or Abandoned System on Comments D. LIFT STATION / A Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at — Tested for Electrical Codes (Y/N) Comments — Dimensions Manhole/Access (Y/N) _ "Pump Off' Level at Vent(Y/N) '• Check Permitted Bedroom Rating Against HAA Request •• Cycles during Adequacy Test. Meets MOA I certify that I have ch ��d, verified, or conformed to all OA a d HAA guidelines in effect on the date of this inspection. Signe8 S ENGINEE�teING va div sr 5a+ Real No-204)ate ComXft%RMr.Alaska "577 MOA No. w R\ r �� Receipt No. 02 —� 0/-ao/3 P �P ,.«... .d Nil$ . Date of Payment 3 — P/ Amount: $ /U !� �' • s I r 7 O : )Wl A. Shelrr ..J ICa. 1447-G i Page 2 of 2 72-016 (11,64) ^ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CCRTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY t 264-4720 / Application Date So 0 -pis' 1. GENERAL INFORMATION (a) Legal Description (include lot. block, subdivision, section, township, range) S J1d2'G 3 GL -It'. —z— C= C= Location (address or directions) (b) Applicant Name ►`^��£-Telephone: Home �-� w Business Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/buildeyM- Buyer ❑ ; Other ❑ (explain); (d) Lending Institution XAO /-IF Telephone (e) Address Real Estate Company and Agent Address Telephone (f) �t e HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Multi-Famil ❑ Other Number of Bedrooms O A -r 3. WATER SUPPLY Individual Welt Community ❑ Public ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite C6 Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11,8+1 Page 1 of 2 n r 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below. I verity that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name I_TrR7 Date 6. DHEP Approved for Approved Terms of Conditional Approval by F�� / Conditional CAUTION Date The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264.4720 MONICWAUn OF AW0110111illiM DWT. OF hTALTA 4 D4VNKX*4-WAL PROTEC(IOH JUN 2 4 its A. WELL DATA Well Classification S , fl�• If A. B. C, D.E.C. Approved (Y/N) /J & Lv' Well Log Present ) Date Completed - - 5,5 Yields- 6 tO\� Total Depth Iq 2 Cased to Depth of Grouting Static Water Level —(�f) Pump Set At ) qc--> N Casing Height Above Ground 3(o Sanitary Seal on Casing4:VN) Electrical Wiring in Conduit 04) Separation Distances from Well: Depression Around Wellhead (Y/ t0j To Septic/HtriWwgTank on Lot \ C>S I On Adjoining Lots \ C_Dri� 'ir- To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots 1 To Nearest Public Sewer Line �A To Nearest Public Sewer p� Cleanout/Manhole - A To Nearest Sewer Service Line on Lot -l4.) Water Sample Collected by s S E4XG I IQC3E-r 114)(n Date LO-19- Water o-ld-Water Sample Test Results Ste, S�nesT,,,r� Comments L_ B. SEPTIGHeiBIN TANK DATA Date Installed I (Skzg:> No. of Compartments —Z__ Standpipes&N) Air -tight Caps &) Foundation Cleanout®N) Depression over Tank (Y© Date Last Pumped AJ Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) A Temporary Holding Tank Permit (Y/N) N Separation Distances from Septic/NaLding..Tank: To Water -Supply Well \ OS t To Property Line \ d f To Water.Mwn/Service Line fp�o I.+ Course Comments To Building Foundation To Disposal Field 3ytog4S 47,ot-_� Pagel of 2 (o a-y-gj 72-026(11/84) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata A 2!f5 Type of System Design 13 KI Date Installed 5—( \'$S Length of Field 44+% Width of Field �On Depth of Field (C .!S Gravel Bed Thickness 3 Square Feet of Absorption Area ��S'� Standpipes PresenION) Depression over Field (Y/© Dptf Results of Last Adequacy Test /n of Last Adequacy Test &, tJg w L---- Separation Distance from Absorption Field: t � To Water -Supply Well I (oTo Property Line To Building Foundation 57D To Exiting or Abandoned System on r Lot LA ; On Adjoining Lots S10 4 - To Water M"/Service Line gD t To Cutbank (if present) tJ To Stream/Pond/Lake/or Major Drainage Course "1 A To Driveway. Parking Area. or Vehicle Storage Area r7 ":� t; Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Electrical Codes (Y/N) Comments Check Permitted Bedroom Rating Against HAA Request .. Pumping Cycles during Adequacy Test. Meets MOA 1 certify that I have checked. verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S ru ` F`!^! iE¢�iiit i Date SRO 100x ci0 f A Company Lr „ F nr a`�1— "T—�n°srF— MOA No. `(t, 0 1L4 1 ..... :4 2371 Oki Receipt No. _ tcuXin Date of Payment Amount: $ — Page 2 of 2 72-026 111, 84) iEn�!n�f it+l6�lrs• �. • pyorf A. Shah' kW.% 'qF .......... �$+� %,NLl�F E'S o�`��