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Home My WebLink AboutHENKINS BLK 5 LT 3AOnsite File Henkins Block 5 Lot 3A #051-291-20 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 1 ON -SITE WASTEWATER INSPECTION REPORT Permit Number: OSP 241042 PID Number: 051 291 20 Dwelling: ❑■ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New X Upgrade Name WHITE ABSORPTION FIELD El Deep Trench El Wide Trench El Bed El Mound Site Address 15823 Alderberry ❑ 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 HENKINS B5 L3A 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 - _ _ _ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water +100 — _ _ Material Number of compartments Lot Line +10 - - - NA POLY 2 Foundation +10 _ _ _ LIFT STATION Manufacturer Capacity Remarks TANK REPLACEMENT ONLY. Gal. OLD TANK HAULED OFF, BED VERIFIED +5' FROM TANK Alarm location Electrical installed by Installer PIPE MATERIAL House to tank ABS Tank to 3034 drainfield JRs Drainfield EXIST CO/MT3034 Inspector C&M ENGINEERING BENCH MARK (Assumed elevation) 100 ft Inspection 15` 3/28/24 2nd 3/29/24 Location and description 3rd 4th BOTTOM OF SIDING ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp `� OF A4.q l� Conditional Approval: Date .: AMW . .cS�,�. �� j CO •:9 i.. .... .��..r r • Septic System Approved Dat� 3 Za2 `� r >+HARLES G BALZARI�II ��)�F�' CE-13854 .•��`�� Note: this approval does not include well permit requiremen s. PROFESSION 3/10 2 trcev voivu 1 a/ CHARLES G BALZARINI CE-13854R E G I S TEREDPROFE S S I O N A L E N GINEER 4/1/24 1" - 50' / /v LOT 2 ANCHOR BLOCK 50 v / UGT & OHE + UTILITY NATURAL 'KPOLE TYP GASH �5/8" REBAR W/ PLASTIC CAP PLO O> p J RIVE I .0. / lj 2j ' WELL /`RETAINING /^ro ^ 0 2a.s' e.a•o WALL TYP 1 SHED CARPORT CONCRETE FOUNDATION EASEMENT — _ 100 _N1Eu% 47,613 S89'37'04"E E. HENKINS RD. 292.15'(M) 292.10'(M) LEGEND: (C)=CALCULATED DATA (M)=MEASURED DATA (R)=RECORD DATA PER PLAT ohu=OVERHEAD UTILITIES UG=UNDERGROUND TELECOMMUNICATION OHE=OVERHEAD ELECTRIC TYP=TYPICAL LOT '7 * II N89'46'22"W 196.69'(R) 11 1196.71'(C) S 4" PLASTIC SHED PIPE TYP 66't 3 N c° LOT 5 o% 0- 3A Ov z ui S.F. 3 1/4" ALUMINUM MONUMENT TYP FENCE NOTES: 1. EXCEPTING FOR GROSS NEGLIGENCE, THE LIABILITY FOR THIS SURVEY SHALL NOT EXCEED THE COST OF PREPARING THIS SURVEY. 2. THIS SURVEY REPRESENTS VISIBLE IMPROVEMENTS & CONDITIONS ON THE DATE OF SURVEY. 3. THIS DOCUMENT DOES NOT CONSTITUTE A BOUNDARY SURVEY & IS SUBJECT TO ANY INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY DISCLOSE. 4. THIS SURVEY PERFORMED FOR KHRIS WHITE & CRAIG WANGRUD,IT SHOULD ONLY BE USED FOR A SINGLE PROPERTY TRANSACTION EXCLUSION NOTE: 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. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. 1 -'^-- KAI FARMER SURVEYING AS-BU #12646 9131 E. FRONTAGE RD. PALMER, ALASKA 99645 PH: (907)745-0222 rsurvevina.com www.farmersw PAGE 1 of -1 FB: 24-01 I HEREBY CERTIFY THAT A MORTGAGE INSPECTION WAS PERFORMED UNDER MY DIRECTION ON THE FOLLOWING DESCRIBED PROPERTY: HENKINS SUBDIVISION RSB., BLOCK 5, LOT 3A, PLAT No. 2019-109, ANCHORAGE RECORDING DISTRICT, ANCHORAGE, ALASKA. SURVEYED ON THE 29th OF MARCH, 2024. 02024 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241042 Work Type: SepticTank Upgrade Tax Code Number: 05129120000 Site Legal Address: HENKINS BLK 5 LT 3A G:0755 Site Mailing Address: 15823 ALDERBERRY LN, Eagle River Owner: WHITE KHRIS Design Engineer: C&M ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: �0 V Ueparcnienc Lot Size in Sq Ft: Total Bedrooms: 3/27/2024 3/27/2025 47613 ❑ 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 Special Provisions: Prior to installing the tank, locate the edge of the bed in order to ensure that the required Ii separation from the tank is met. Issued By: Date: Date: Z 719 3 U H C PD A L TY 0 F H C H 0 RA G c Development Services Department p P / Phone: 907-343-7904 On -Site Water &Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051 291 20 Property owner(s) White Mailing address Site address 15823 Alderberry Day phone Legal description (Sub°d., Block & Lot) Henkins B5 L3A Legal description (Township, Range & Section) Lot Size 47,613 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑ Septic Tank ❑ Upgrade Q (w/wo AD U) Holding Tank ❑ Renewal ❑ Duplex (D) ❑ Privy ❑ Multiple Dwellings ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: NONE Distance: NA I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C&M ENGINEERING (Signature of property owner or authorized agent) Permit/Rush Fees: -# 360 Waiver Fees: Date of Payment: Receipt Number: Permit No.Ic>�I2— Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 RE: Proposed Septic System for Henkins B5 L3A Dear Reviewer, The above referenced property is currently served by an older septic system with a leaking tank that needs to be replaced immediately. We are requesting an expedited review of this application. Our review of available documentation and field investigation show that this project will not adversely impact any nearby Wells, Wastewater disposal systems, replacement disposal sites, or drainage flowing onto and off of the subject property. As shown on the plan, the tank will be greater than 10’ from the house foundation. The tank will be of MOA approved construction. The tank must be covered with a minimum of 2” moa approved insulation and 3’ of cover or a minimum of 4’ of cover without insulation. The repair must be performed by a moa certified installer in accordance with MOA requirements. If groundwater is encountered during excavation of the tank hole, an alternate tank type may be required. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leach field, well, and other applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini@gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE 3/23/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241042, Deb Wockenfuss, 03/27/24 CHARLES G BALZARINI CE-13854REGISTEREDPROFESSION A L E N GINEER 3/23/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241042, Deb Wockenfuss, 03/27/24 TC .Z V96 t M..ZS.ZOo00 N .t0 h 01 9-- /V ZN ry w 0 d - N z Y z x a I W I- Y Y t - to 0 ZUf t� OZ >.Ow t aQZ-��tOn�-Zoe x 00 N Q Q�}= O V Z V — (f)m J V O D to Z 0 0 u w dam' N oZ Q r MI.L. LLJ LCD wwwom01-W 3C Vno z D �' M Z ZO0�= ZZLA 0 LLJ O tr0 v V) LL, ZtL,tn Z 00 1. Y L.LJ V1 Ij in Z V) J l.i 0 Z o z Z a- i� Z W 0 oz G Q o W m _ N z N OL .Z V96 t M..ZS.ZOo00 N .t0 h 01 9-- /V ZN ry w 0 d - N z Y z x a I W I- Y �OWO�QQL6. Z O. OCE t - to 0 ZUf t� OZ >.Ow t aQZ-��tOn�-Zoe x N Q Q�}= O V Z V I-��3D=Crti �WLL.0Zfntn�� t�_n V O D to Z 0 0 u OI'�I}. 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C9cca Q0 x I+� 0 0- O Z I CD Q w g cxi 3 0 ao 4 N `a MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. / 7"' MUNICIPALITY OF ANCHORAGE I>1'5q 8 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264.4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE EW C,BB 3y3 0 UPGRADE MAILING ADDRESS LEGAL DESCRIPTION, - LOCATION NO. OF BEDROOMS DISTANCE TO: Wella area Dwelling PERMIT NO. !/ O Y ;:z Manufacturer Material al No. of compartments W _ / _ Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth .�.. 032 DISTANCE TO: Well Dwelling PERMIT NO. _. 4 Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well -� Foundation _ •� Nearest lot brie PERMIT No. of lines Lengthof ch ine Total length of Imes Trench width Distance between Ines , f Inches Top of the to finish grade Material beneath the�� Total effective absorDuon ere ✓ inches Length Width Depth PERMIT NO. W U f- Type of crib Crib diameter Crib depth Total effective absorption area W� DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption steals) OTHER PIPE MATERIALS FVC, i SOIL TEST RATING s A _C -V INSTALLER REMARKS I C APPROVED DATE LEGAL i I / h I 72-013 (Rev. 3/78) .1 MUNICIPALITY OF ANCHORAGE k_ Department—", Health and Environmenta"'?rotection 825. Street, Anchorage, AK.' __4501 264-4720 Permit # Ssl�ll� * * * HANDWRITTEN PERMIT f WELL AND/OR ON-SITE SEWER PERMIT Applicant: J(> [� �l- Mailing Address: / A eve 6Q L/ Location: Phone Number: 449_JL 4 Legal Description: /O T y _ 17`�/%l S •Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) 1S0' The Required Size of the Soil Absorption System Is: DEPTH 2 • S LENGTH CeS— .GRAVEL DEPTH 61.1 WIDTH 3 O 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 _ 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 departure: will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fe< 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 3 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 tha bedrooms. Signedth i�l��. Issued by: Applicant Date:var SWP/024(1/81) C� If 'Lc, DIJQ,e 7z:;/�' OF J,erlia, PERFORMED LEGAL DESCR MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 89501 264-4720 SOILS LOG — PERCOLATION TEST SOILS ) Gross Time i Overburden 1 (MLi 2 "3 of 6C (UP) 150 5QFT/bDRM 4Tn CML) 5 _A•.Fi• :�;:: • i(aP) 150 SgFT.�L30RM 62pNj26153) 7 ';'.: 0(814183).*� 8 0 10- SOILS LOG ❑ PERCOLATION TEST DATE PERFORMED: L-iJ� 83 11 WASGROUNDWATERY.0s L ENCOUNTERED? 0 12 P IFYES, AT WHAT / 0 C l_ E 13 1 — i 14- is- 16- 17- 18- 19 - 201 4151617181920 COMME PERFORMED Reading Date Gross Time Net Time Depth to Water Not Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT CERTIFIED 72-008 (6/79) / DATE:O —Cj `_-/ (907) 243.2282 KENJOHNSON 0 01 L.-jP rt" l V WATER WELL DRILLING PUMP SALES & SERVICE 30 YEARS ALASKA DRILLING John ;loore P.O. Box. 4-604 Anchorage, Alaska 99$09 Re; Water well Lott'' Blk- 5 Heinks Subd. WATER WELL LOG 0ftto2ft Fill r'^� 3163 LINDEN DRIVE ANCHORAGE, ALASKA 99502 September 24, 1933 2 ft to 6 ft Organics ( peat ) 6 ft to 27 ft Same with some fine gravel 27 ft to 34 ft Sand and brown silt 34 ft to 40 ft Course gravel and gray silt 40 ft to 41 ft Boulder ( weeps h-20 ) 41 ft to 44 ft- Clean Ided- sand& .gravel Water bearing 4 GPM Static 6 ft from surface Drawdown to 38 ft: good recovery Bottom stable MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-291-20 Certificate of On -Site Systems Approval Expiration Date: -2- Legal description HENKINS BILK 5 LT 3A Site address 15823 ALDERBERRY LN Eagle River AK Current property owner(s) WHITE X The On -site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 4/3/2024 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 Ofll '! Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051 291 20 Complete legal description Henkins B5 L3A Location (site address) 15823 Alderberry Current property owner(s) Whlte 2. ON -SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 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: N Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel X Plastic ❑ Concrete ❑ Fiberglass Age 0 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS❑ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: none 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 $ s 0 o Waiver Fee $ Date of Payment (/-/,/ '-/ COSA # OSC "Z y I r) Date of Payment Waiver # COSA Application_ June 2022 COSA Checklist Legal Description: HENKINS BLOCK 5 LOT 3A Parcel ID: 051 291 08 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system 1 A. WELL DATA ■❑ Well log is filed with Onsite (or attached) Date drilled 9/24/83 Total depth 44 Cased to LINK ft ❑ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) +12 in. Date of flow test for COSA 3/6/24,3/7/24 Well production at time of test +1.5 gpm ft Water storage tank volume NA gallons Static water level at beginning of test 17.5 ft. Comments B. TANK DATA Measured operating fluid level in septic tank NA Date of pumping NA NEW ❑ Required maintenance completed, if AWWTS Comments: new tank D. ABSORPTION FIELD DATA Which system tested (date installed) 5/1/84 ❑E ALL standpipes present per record drawing Total measured depth from grade 4•2 ft (max) Measured depth to pipe invert from grade NA ft (min) ❑ N/A — pressurized field. ❑■ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 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 3/7/24 date Any rejuvenation treatment (past 12 months) NA If yes, enter date NA Well disinfected for coliform test? ❑ Yes ❑■ No X Coliform bacteria is Negative Nitrate 1.98 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑■ Arsenic less than MRL (ND) Collected by C.BALZARINI Date 3/06/24 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date 3/7/24 Results [O]Pass— Fluid depth prior to test Water added 450 ga New fluid depth 0.5 Elapsed time 10 Final fluid depth 0 0 in I in min in Absorption rate 450 gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 6 in Effective depth used 0 in Effective depth remaining 6 in Comments/Deficiencies: NO CLEANOUT IN FIELD TO VERIFY DEPTH TO INVERT COSA Checklist June 2022 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' Community Sewer Manhole/Cleanout > 100' Fol Yes if No ft [-E-1 Yes if No ft Neighboring Tank > 100' ❑® Yes if No ft Private Sewer/Septic Line > 25' nE Yes if No ft Absorption Field on Lot > 100' FuTI Yes if No ft Holding Tank > 100' Q Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' 0 Yes if No ft R Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' R Yes if No ftnm 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' 0 Yes if No ft Surface Water > 100' 0 Yes if No_ Tank to Property Line > 5' no Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' Fm] Yes if No ft Private Wells > 100' FE-1 Yes if No Water Main > 10' 0 Yes if No ft Community Wells > 200' 0 Yes if No _ Water Service Line > 10' FETI Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS SURFACE WATER OBSERVED ON LOT, BUT WELL OVER 100-FT FROM ALL SEPTIC COMPONENTS. INSPECTION OCCURED DURING WINTER. ft ft a'i 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 C&M ENGINEERING Engineer's Printed Name CHARLES BALZARINI, PE COSA Checklist June 2022 Phone 907-854-5558 Date 3/30/24 es. " ti¢1 t)��"yy ��,,;�yT^'SCC'1S �.±±yyy p3H��T»�[ T IL pr:aE 1 T Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program �� 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D._051-291-08 COSA# o(DDh,�l Expiration Date: G — 13-0(a 1. GENERAL INFORMATION Complete legal description 14ENKINS RLOCK 5, LOT 3 Current Property owner(s) BRANDON & RF6 r .A S RVIN Day phone Mailing address Lending agency Mailing address Day phone Real Estate Agent _ KATHY GERACI Day phone 242-5276 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 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 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. Engineer's Printed Name KENNETH M. DIIFFIIS Date 03/07/2006 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, KND can not give any estimate of how long a OF A �t system will function satisfactory for current or future �p��.•••'••••��•9 11 occupants or can KND guarantee that no unseenS'¢91/ encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Jz� Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checidist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ON-SITE m= WASTEWATER By: /0'6'—�' Original Certificate Date: Municipality of Anchorage • Development Services Department •� Building Safety Division On -Site Water 8 Wastewater Program • 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID 0 Date completed 9/24/1983 Sanitary seal (Y/N) Y Total depth _4—ft. Cased to _4_ft. FROM WELL LOG Date of test 912411983 Static water level 6 ft. Well production 4 9 - p.m -WATER SAMPLE RESULTS: _ Well Log (YIN) Y Wires properly protected (Y/N) Y—_ Casing height (above ground) 36 In. AT INSPECTION 1 B ft. 1.83 g.p.m. Conform _Q_colonies/100mL Nitrate 3.13 mg/L Other bacteria _0_ colonies/100 mL Arsenic: _0_mg/I Date of sample: 2/21-22/2006 Collected by: KND Engineering, Inc B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Data Installed 5/1/1984 Tank size 1000 gal. Number of Compartments Z Cleanouts(Y/N) Y Foundation cteanout(Y/N) M Depression over tank(Y/N) N High water alarm (YIN) ,)Date of pumping 2/21/06 Pumper J R's C. ABSORPTION FIELD DATA Date installed 5/1/1984 Soil rating (g.p.d./ft? or ftp/bdrm) 150 System type jkd Length 11 ft. Width jj_ft. Gravel below pipe O.5 ft. Total dep& 2.5-4.5 ft. Eff. absorption area.50_fe Monitoring tube Y Date of adequacy test 2/21/06 Fluid depth in absorption field before test Q, in. Depression over field )y Results (Pass/Fail) Pass For 3__ bedrooms Water added 450 gal. New depth 1.5 in. Elapsed Time: &S min. Final fluid depth.Q in. Absorption rate >=450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) N_If yes, give date ----- D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on' level at_in. 'Pump off level at in. High water alarm level at in. Datum Cycles tested Meets alarm 8 circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+_ Absorption field on lot 100'+ Public sewer main 75'+ Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 10 0'+ On adjacent lots 100'+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10 ' + Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parkingtvehide storage1 0'+ Curtain drain 50'+ Wells on adjacent lots1 00'+ F. COMMENTS *FCO inside foundation G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and P «..&F= 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 �� `9 �'•►��d:.•''�F�r ti; pRt)fESS40�'Pi Date 03/07/2006 COSA Fee 5430.00 Waiver Fee E _ Date of Payment ? a I04 Date of Payment Receipt Number -11 AA Receipt Number. (Rev. I Ift) N 2,5-10, e _ L ' P4 i 67,a 57 w Ry.is.:J,vf AS -BUILT I hereby certify that I have/surveyed the following described property: r r_1 L/j c" "C i•%- ��ro,� 310+213=N—P.lwt!M, Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this ± day of. ROBERT C. JOHNSON. 'lcr4-, SCALE: Registered Land Surveyor No. 80 -LS 1" o Ird' Hug Dow -6W -Eagle River, Alaska ?"'ri Phone (907) 694-2543 SCS RcEM Client Name Project NamelN Client Sample ID Matrix PWSID Sample Remarks: 1060833001 KND Engineering flenkins B5 L3 Hcnkins B5 L3 Drinking Water 0 All Dates/rimes are Alaska Standard Time Printed Date/Time 03/07/2006 14:06 Collected Date/time 02/21/2006 15:00 Received Date/time 02/21/2006 15:37 Technical Director Stephen C. Ede Parameter Results PQL Units Medved ContainerlD Allowable Limits Prep Analysis Date Date [nit Nitrite -N ND 0.100 mg/L EPA 353.2 B 02/22/06 JC Nitrate -N 3.13 0.100 mg/L EPA 353.2 B 021=06 JC Metals Department Hardness as CaCO3 103 5.00 mg/L SM20 2340B C 0223/06 0223/06 SCL Private Individual Analysis Aluminum 31.8 20.0 ug/L EP200.8 C 0223/06 0223/06 SCL Antimony ND 1.00 ug/L EP200.8 C (<--6) 0223/06 0223/06 SCL Arsenic ND 5.00 ug/L EP200.8 C (r--10) 0223/06 0223/06 SCL Barium 14.7 3.00 ug/L EP200.8 C (<-2000) 0223/06 0223/06 SCL Cadmium ND 0.500 ug/L EP200.8 C (<=5) 0223/06 0223/06 SCL Calcium 32500 500 ug/L EP200.8 C 0223/06 0223/06 SCL Chromium 1.32 1.00 ug/L EP200.8 C (100) 0223/06 0223/06 SCL Copper 147 1.00 ug/L EP200.8 C (<=1300) 0223/06 0223/06 SCL Iron 296 250 ug/L EP200.8 C («300) 0223/06 0223/06 SCL Lead 0.280 0.200 ug/L EP200.8 C (<=15) 0223/06 0223/06 SCL Magnesium 5420 50.0 ug/L EP200.8 C 0223/06 0223/06 SCL Manganese 3.60 1.00 ug/L EP200.8 C (<=50) 0223/06 0223/06 SCL Phosphorus ND 200 ug/L EP200.8 C 0223/06 0223/06 SCL Fluoride ND 0.100 mg/L EPA 300.0 B (<=2) 0228/06 DSII Chloride 1.54 0.100 mg/L EPA 300.0 B (<=250) 0228/06 DSI I Potassium 509 500 ug/L EP200.8 C 0223/06 0223/06 SCL Selenium ND 5.00 ug/L EP200.8 C (<=50) 0223/06 0223/06 SCL Sodium 2090 500 ug/L EP200.8 C (<=250000) 0223/06 0223/06 SCL Silicon 5690 200 ug(L EP200.8 C 0223/06 03/06/06 TK Silver ND 1.00 ug/L EP200.8 C (<=100) 0223/06 0223/06 SCL Thallium ND 1.00 ug/L EP200.8 C («L) 0223/06 0223/06 SCL Sulfate 10.6 0.100 mg/L EPA 300.0 B (<-250) 0228/06 DSI I Page 2 of 7 FFJ M14 SGS Ref.N Client name Project name/# Client Sample ID Matrix M'SID 1060833001 KND Engineering Henkins f)5 U flcnkins U5 U Drinking Water 0 All Dates/Times are Alaska Standard Time Printed Date/Time 03/07/2006 14:06 Collected Date/Time 02/212006 15:00 Received Date/Time 02212006 15:37 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Medved ContainerlD Limits Date Date Init Private Individual Analysis Zinc 25.0 5.00 ug/L EP200.8 C (<=5000) 0223/06 0223/06 SCL Nickel ND 2.00 ug/L EP200.8 C (100) 0223/06 0223/06 SCL Total Coliform 0 COVIOOmL SM209222D A (c=1) 0221/06 DPT Page 3 of 7 J SCS Rera 1060833002 Client Name KND Engineering Project Name/# I►enkins D5 L3 Client Sample ID I►enkins H5 L3 Back Side Spigot Matrix Drinking Water PWSID 0 Sample Remarks: All Dates rimes are Alaska Standard Time Printed Date rime 03/07/2006 14:06 Collected Date/time 02/22/2006 13:34 Received Date rime 02/222006 14:36 Technical Director Stephen C. Ede Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date [nit Private Individual Analvain Total Dissolved Solids 121 HCO3 Alkalinity 98.0 CO3 Alkalinity ND 011 Alkalinity ND Conductivity 230 pI I 7.60 Alkalinity 98.0 10.0 mg/L SM202540C A (<=500) 02/27/06 KP 20.0 mg/L SM202320B A 03/01/06 PLW 20.0 mg/L SM202320B A 03/01/06 PLW 20.0 mg/L SM202320B A 03/01/06 PLW 1.00 umhos/cm SN12025106 A 03/01/06 KP 0.100 pli units EPA 150.1 A (6.5-8.5) 0222/06 AZS 20.0 mg(L SN1202320B A 03/01/06 PLW Page 4 of 7 Municipality of Anchorage Department of Health and Human Services Division of Environmental Services ! Onsite Services Section 825 L Street Room 502 ! i. P.O. Box .196650 Anchorage, AK 99519-6650 ; www.ci.anchorage.ak.us r . (907)343-47447 CERTIFICATE'OFHEALTH'AUTHORITY-APPROVAL . FOR,A`SINGLE FAMILYDWELLING Parcel I.D. 051-291-08 , HAA#'ISCX��(D Expiration Date �' 1.' GENERAL-INFORMATiON; r' Complete legal description Henkiris Sub L 3 B 5 k 'Location (site addressor directions)::" 15823'Alderberiy:6hunita AK .. Current Property owners)`��l/tA �Y ! A A? 17%--&.o. ne P0;6yx.7.70`/: `cZ_a!2 �fy�Jt ' c `Wailing a ------- Lending agency ,` Day phone" - Mailing' address Real Estate Agent Kathy Geraci Day phone 694-9125 Mailing Address,- Unless_otheiwise requested 'HAA will be held by DHHS for icku HAA lcked u b p_ . R ... _p.... , p . y 2 : NUMBER•OF BEDROOMS 3 iLS.� t 3' 'TYPE OF.WATER SUPPLY. TYPE OF WASTEWATER bISPOSAL '• ,,`. 1 :' Indrvldual Well ® Individual On Site , Individual WaterStorage ❑ ` Indniidual Holding tank ❑ Community Class Well ❑ Community On Site ❑ �,'. Public Water System , ❑ Public Sewer ? , `❑ •." �� The Municipality of Anchorage Department of Health and Human Services (DHHS) Issues Certificates of Healttr" Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer. of title (except between spouses) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also Issues HAAs upon request to home owners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue f6r properties served by a private or Class C well and may be reissued with new water sample results less than 30 days; old.lCertificates are valid for one year for properties served by Class A or 6 -wells or public water system: The Municipality of Anchorage is no( responsible for errors or omissions in the professional engineer's work.: `- 5. STATEMENT OF INSPECTION BY ENGINEER r As certified by my seal affixed hereto.and as of the validation date shown below,9 verify, that -my investigation based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval ;; c application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on- site water supply and/or wastewater disposal system Is in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation Name of Firm USNDFngmeering' Phone _sg6-61 •t 11 Address 20ee1 Ptarmigan Faalp River *AK9g577 Engineer's Printed Name Kenneth nuffus Date R1241oo t Ilk. r 1 OF9 .4L ' / * 49 _ *. D 3: 6 DHHS SIGNATURE. /1 CE 911 j Approved for 3 bedrooms. , 1;Fj• PftftssioNw, dW Disapprove Conditional approval for bedrooms, with the following stipulations:' i Additional Comments m1 j.I •. - Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow AdvisoryOther .By Original Certificate Date: 9 j'9 0 0 Expiration Date: a — b b Reissue Date: (R«. nm) Municipality of Anchorage E C E I V E • "` Department of Health and Human Services Division of Environmental Services On -Site Services Section 8251.' Street Room 502 SEP 0 5 2000 P.O. Box 196650 Anchorage, AK 99519-6650 www907)343-4 e.ak.us MUNICIPALITY OF ANCHORAGE (907) 4744 ENVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Honking Sub. L3 B5 Parcel I.D.: 051.291-08 A. WELL DATA Well typerip vats If A, B, or C provide PWSID # Date completed 9/24/1983 Sanitary seal Y Total depth 44 it Cased to 44 it FROM WELL LOG Date of test 9/24/1983 Static water level 6 It Well production 4 g.p.m WATER SAMPLE RESULTS: Coliform C9 colonies/100 ml Date of sample: $ 3 > 6D B. SEPTIC/HOLDING TANK DATA Well Log Y Wires property protected Y Casing height (above ground) 36 in. AT INSPECTION 8/17/2000 r1l 9 -p.m Nitrate ?.q5 mgfl Other bacteria 0 colonies/100 ml Collected by: ,'Wd &r jjee.,; C Tank Type/Material Steel Date installed 5/111984 Tank size 1000 gat Number of Compartments 2 Cieanouts y Foundation cleanout y Depression over tank n High water alarm na Date of pumping 5 o 11 ° DO Pumper JR's C. ABSORPTION FIELD DATA Date installed PS / 5L4— Soil rating (g.p.d./ft2 or ftl/bdrm)150 System type bed Length 18 it Width 28 It Gravel below pipe 0.5 it Total depth 2.5&4.5 ft Effective absorption area 504 ft2 Monitoring tube y Depression over field n Date of adequacy test 8 ° I °6D Results (Pass/Fail) pass For 3 bedrooms Fluid depth in absorption field before test tU in Water added450 gal. New depthB in. Elapsed Time: 60 min Final fluid depth dnf in Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) n If yes, give date (Rev. 11/99) D. LIFT STATION Date installed 1 a 1 0 Size in gallons 'Pump on' level at — Datum. Cycles tested E. SEPARATION DISTANCES in High water alarm level at _ in Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanklliftstation on lot 115' On adjacent lots 100'+ Absorption field on lot 1+15'+ Public sewer main en Sewer /septic service line 100'+ On adjacent lots 10n'+ Public sewer manhole/cleanout na Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 1A' Property line dS' Absorption field In' Water main +n'+ Water service line 10'+ Surface water 100'+ Drainage 40n'+ Wells on adjacent lots +00'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1A' Building foundation +A' Water main 120' Water Service line 120'+ Surface water +0n'+ Driveway, parking/vehicle storage 15%'+ Curtain drain 100'+ Wells on adjacent lots Inn'+ F. COMMENTS i �5F '9S G. ENGINEER'S CERTIFICATION AfQ !f91 1 certify that I have determined through field inspections and ........ .................:.......... review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. 0 s ce-�u/ Engineer's Printed Name KAnneth -Dr'au&1 Date h+essio�a HAA Fee $� U Date of Payment Receipt Number��—�J (Rev. 11/99) Waiver Fee $ Date of Payment Receipt Number MUNICIPALANCHORAGE DEPARTMENT OF HEALTH 8 HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# ()e _ =1- ng, HAA# V,1f1`1'�na�� 1. GENERAL INFORMATION Complete legal description Location (site address or directions) fS87. 3 A_De�e l�Gi.4X � ftp' Property owner Cay PZ+.171-n/ Day phone 69Z-70-02 Mailing address fSrpZ3 /�DexBzxAy 04yalA±&' Ar— 99az7 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 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 k 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. 72an(n«.1A1) Fr l MOA921 u.row me civ -U)uou -)poo saaou!6ua Ieuolssa;old etll u! suo!ss!wo Jo s1ono Jo; elq!suodsoi IOU s! obelogouV ;o Al!led!o!unyq a41 'ponssi sl oleo!pliao a alo;oq elep azAleue Jo suo!loodsul lonpuoo IOU op SHHO;O saaAoldw3 •sluawoJlnbei alels pue Ielapa; U101103 A;s!les of Jap10 u! suollnl!;su! 6u!pual J!ayi pue sawoy;o slaseyolnd of AsolJnoo a se s!41 saop SHH(3ay1 •L'MselV;O a;elS eyl u! palals!6a1 Jaau!6ua Ieuo!ssa;ad luopuadapul ue Ag anoge S ydel6eJed ul u8A!6 suolleluesaldal oyl uodn Aluo paseq saleO1;!1JaC) IenaddV Al!Jo4lnv ylleaH sanss! (SHH(l) SaD!AJOS uewnH pue 41leaH;o luawlledap e6elogouV;o p!led!o!unlry ey1 NUI111VJ :suollelnd!ls 6u!mollo; eyl y1!m 'Swoalpaq t.� sluawwo0 Ieuol3!pPV J0; IA01dde q IEU E •penoJddes!Q •swooJpeq Jo; panoJddV G BUn.LVNJIS SHHO einleu6lssiaaul6u3 ros66 s�sn "AeI 3 Ssa1PPV -IS.uleuoa 0tzoz lie- IPA9 0004d -WdUO ed'lfPlAeO UJJIj;0GLUUN •uo!loadsul s!yl;o elep eyl uo loal;a u! suo!lelnBeu pue'sooueu!p10 'sapoo e1elS pue led!o!unW Ile yAm eouelldwoo u! sl walsAs Iesods!p Jalemalsem Jo/pue Alddns Jalem ells-uo 841'uopoadsul pue uo!1e61lsanUl Aw wcul pue salt; e6eloyouV;o Al!Ied!o!un" etll woJ; pau!elgo uo!lewJo;u! ayl uo paseq leyl A!!JaAJaylJn} I •u!a1a4 poleo!pul eJnlonJls;o ed/4 pue swooJpaq;o Jagwnu eyl Jo; elenbape pue Ieuolloun;'3;es sl welsAs lesodslp Jalemalsem Jo/pue Alddns Jalem ells-uo eyl 1ey1 smogs uopeolldde IenoJddV Al!JoylnV 411eaH s!yl 10 Uo!1e61lsanU! Aw leyl A;!Jan l'M018q UMoyS 8lep UOIlepIIEA 04110 Se pUe 010134 paXl;;e IeaS Aw Aq palplJao sv R '9 H33NIJN3 AS NO11O3dSN1 dO LN3W31V.LS 'S Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: liar 7:� 6Lr-5- Parcel I.D. 6A-111VIU5 115. A. Well Data Well type ekel Lth1_15' If A, B. or C, attach ADEC letter. ADEC water system number �y Log present (YM) Date completed L �3 Driller � S L�ynt�'hJY Total depth Cased to` Casing height 7 `� Sanitary seal (YM) y Wires property protected (Y/N) FROM WELL LOG AT INSPECTION Date of test %f �y1�3 S�Lc s3 2 o < I Static water level Well flow 4 g.p.m. 3, / g.p.m. o o Pump levell 4.K G N w o� SEPARATION DISTANCES FROM WELL TO: Q 0 Septictholding tank on lot //S ; On adjacent lots Absorption field on lot //S t ; On adjacent lots / CPO t - Public sewer main W Public sewer manhole/cleanout Sewer service line ( vo Petroleum tank wome WATER SAMPLE RESULTS: Coliform Nitrate 0'37 Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date Installed. 5 f X/4�/ Tank size oDC7 Compartments Z Cleanouts (YM) v Foundation cleanout (Y/N) s/rfeo� Depression (YM) High water alarm (Y/N) ��R Alarm tested (Y/N) Date of pumping !�/2�lr� Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot n On adjacent lots Foundation f To property lines / Absorption field `O r Water main/service line 1/0 14" Surface water/drainage lyo - rnme tysal• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed NM Manufacturer Size in gallons Manhole/Access (Y/N) Vent (YM) High water alarm level 'Pump on' level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA 'Pump off' Level at Cycles tested Surface water Date installed �� Soil rating (GPD/FF) /;Z s/5'� System type Length •18' Width Z$ Gravel thickness 4�e Total depth -2X2- vL f1�4- guar Total absorption area :5;Y Cleanout present (Y/N) Depression over field (Y/N) . /✓ Date of adequacy test _r14 e 93 Results (pass/fail) 4te for 3 Bedrooms Water level in absorption field before test Ao A-,,6After test �oNVT Peroxide treatment (past 12 months) (Y/N) /t// If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot //St' On adjacent lots /oo f' Property line To building foundation let.- To existing or abandoned system on lot /,/Ov-- On adjacent lots 12D Cutbank N�Water main/service line / Zo t Surface water /OD,A Driveway, parking/vehicle storage area !�/O (- Curtain drain wcN� �Hw� E. ENGINEER'S CERTIFICATION I certify that/ have checked, verified, or conbormed to all MOA and HAA guidelines in effect on the date of this inspection. David R. Dayton P.E. 2021QDonalarSt. Ch Jak, Alaska 99 7 s • ..r `� Signature Engineer's Name _ U -ca /� � �Y"�� . Zn j c,�,w R. tl ,"J ! 4 Date/'� 3 �, e'� ••, • `�:� r a 4 f� �..,»...•• .� Ems.' HAA Fee $ l 72` OZD Date of Payment 6 —z-9 3J Receipt Number Za 7c%(r r z/ �r 72-028 (3199)' Back Waiver Fee $ Date of Payment Receipt Number .. __. �AS•BUILT, .. '. j hereby certify that I have surveyed the foL'owi6g described proporlY:•..Ir.i�..-•s.+¢JJ(4�iEC`�_,�s$___.-.,.--._—�—_ ti Anchorage Reowding Precinct, Alaska,'*" that "fie improve- ' .•.+ " - masts esdusni thereon are within the property lines and do •t ' ' •Y ti. not overlap or encroach on the property lying adjacent there- ,•: �,., i _ .' to, that no Improvements on property lying adjacent thereto - encroach on the premises In question .and Lhat there are no • • • . ... ,h„f,�; roadways, transmission lines or other visible easements on 'said indicated property except as hereon., - .. Dated at Eagle River, Alaska - - 1 ... 7.. ' .: ... - "� this -2 day oL M.r.V y.19 res_ ... ItODEhT C.JO2lti ."SON 3"e.P'f•} _ SCALE: Regic'ered Land Surveyor No 806 -US ! I"_kelp 0X TirewoWEagle River, Alaska, - _ .. Tse , Phone (907) 694-2543.. - D. R. DAYTON, P.E., R.L.S. Chugiak, Alaska 99567 20210 Donalar WELL FLOW TEST Legal Description: Lot 3, Block 5, Henkins Subdivision Date of test: May 26, 1993 Well Depth: 44 ft. Casing Depth: 44 ft. Static Water Level: 9.5 ft. Driller: Ken's Company Requirements: 3 bedroom - 450 gallons per day (907) Mx'=2 696-2417 Test: The well was pumped through an outside hose bib while monitoring volume, time and drawdown. Results: The well produced 450 gallons in 2 hr. 33 min. Maximum drawdown was 6.6 ft. which was fully recovered within 15 min. after pumping was stopped. The well is currently producing adequately for a 3 bedroom home.. D. R. DAYTON, P.E., R.L.S. 20210 Donalar Chugiak, Alaska 99567 ADEQUACY TEST Legal Description: Lot 3, Block 5, Henkins Subdivision Date of Test: May 26, 1993 Septic Tank: 1, 000 gallon, 2 compartment, steel tank Absorbtion System: 18' x 32' bed Soils: 150 sq. ft. per bedroom Requirements: 3 Bedrooms - 450 gallons per day Test; Water was injected into the absorbtion bed while monitoring volume, time, and liquid level in the bed. (907) MNMS 696-2417 Results: The bed accepted the required 450 gallons with no rise in the liquid level in the bed. The absorbtion system is currently functioning adequately for a 3 bedroom home. r' -VU L Dkmo= Rte. `...,T` ,'i2 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services tr • 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. # tj:r / 291 Od HAA # 09'q — c) 1 (OCO 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, ra >< 3 Location (address or directions) Fy (b) Property owner /—��L��t, Telephone Mailing Address (home)�_Business ` 'bPO4P (c) Lending Institution �Jf� Telephone Mailing Address (d) Real Estate Company and Agent Address T2�_'/e n� g;/-- Lderl fe Telephone [o-�¢ — 4 (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: ALle--i& See el<z�e. 2. TYPE OF RESIDENCE Single-Familyx Number of bedrooms 3. WATER SUPPLY Individual Well 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-site 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. 72-035 JR.. 1/881 Page 1 of 2 M �.!..a�.r•w•:,r..:+r':.,..r :: <-..... r.......<.....r r..- v.-...snw-�.w.u..........�............r-+..-...-.............,.._..i..........<..........�...,..... .......,.. �........ _.... ....... Z jo Z abed 3110l"ll »u) szo-zc •Niom s,iaau!6ua leuo!ssajad a4l u! suolss!wojos:oijajoj olq!suodsai lou si a6eioyouV jo Apled!ownW all•panss! sl aleo!j!uao a ajojagejepezA!euejo suoljoadsul1onpuoojou op SHHO to saaAoldw3 •sluawa:!nba: ajels pup 1pjapal u!euao Als!les oljapio u! suo!lnl!lsu! 6u!pual j!ayl pup sawoy jo s:aseywnd of Asal:noo a se s!yl saop SHHO all TXsplV jo alelS ayi u! pa:als!6ai iaau!6ua eeuo!ssajad luepuedapu! up Aq anoge g ydeiSsied ui uaA!6 suo!leluasa:da: ell uodn Aluo paseq paleo!pjao IpnaddyAjuoylnV yl!eaHsanss! (SHHO) sao!AIaS uewnH pueylleaH joluawliedaO a6ejoyouV joAl!Ied!o!uny4 all NOI1nVo IenaddV leuo!1!puo0 jo swial !�euo!1!p,�ujo`0 panaddes!O panaddy eO a{/i+ // i'0� �%° Aq swoapaq £ �oj panaddy 68-// / el IVAOHddV SHHO *9 leas s,Jaau!6u3 : ccss F' ' : Vu -03 O/ GIVO x7ssa�PPV 0,,77- /f —Z�i$ euoydalal ?rJ . ,,.�/� w:!jjoeweN •uo!loadsu! s!yl to elep 6yl uo laalle u! suo!3 InBei pue 'saoupu!pjo 'sapoo alelS pue led!o!unyq Iee tyl!m eoue!Idwoo ui st walsAs lesods!p jalemalsem Jo/pue Alddns jalem alis-uo eyl'uolloadsu! pue uo!le6!Isanu! Aw waj pue sail a6e:oyouV jo Aj!Ied!o!unV4 at41 wal pau!elgo uo!lewjojul ell uo paseq lell Aj!IaA jayljnj I •u!aay paln!pu! ainlonuls jo adAl pue swoapaq jo jagwnu all jol elenbape pue Ieuollounj 'ales s! waisAs Iesods!p immalsem jo/pue Alddns jajem el!s-uo all Ima smogs IenaddV Al!joylnV ylleaH s!yllo uo!1p6ilSaAQi Aw jell AjuaA I'molaq umoyS alep uo!lep!IeA all to se pue olaiay pax!lje leas Aw Aq paggiao sV f7011VWFIO:INl CNV V1VC'140EIV3S 3lid'S1S31'SNO1103dSNl VNIMAOHd Wllld JNIV33NIJN3 'S MUNICIPALITY OF ANCHORAGE (MOA) N, • -� r o AN: Hedttfi Authority Approval (HAA) EN1'I� ASE ""C `UCHECKLIST - FEBRUARY 1984 343-4744 l i�39 Legal Description: RECEIVED �f_3 ��, A. WELL DATA 1 u1 //7 Well Classification _ Ph ✓ L If A. B. C, D.E.C. Approved (Y/N)'= 04:: Well Log Present (Y/N) Date Completed 9/?Yield wns Total De th p Cased to _,42a!� Depth of Grouting Static Water Level fid• s Pump Set At `lh<2oLVYJ Casing Height Above Ground 2. 3 Sanitary Seal on Casin Y/N) Electrical Wiring in Conduit (Y/N) j Depression Around' lellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot �l s ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots _71420 To Nearest Public Sewer Line 1,f1,4 -:,To Nearest Public Sewer Cleanout/Manhole N/i4 To Nearest Sewer Service Line on Lot BOO, Water Sample Collected by P Coru4t i Dat Water Sample Test Results / t Comments Aell x�ee de eon 5 aeeel 4/�emm 7v 20, s /It S M d7 B. SEPTIC/HOLDING TANK DATA r Date Installed �Size No. of Compartments �/ 2 Standpipes (Y/N) _L—Air-tight Caps (Y/N) oundation f Depression over Tank (Y/N) N Date ya umped Pumping/Maintenance Contact on File (Y/N) MIA - Holding Tank High -Water Alarm (Y/N) � Temporary Holding Tank Permit (Y/N) '0U1,4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well ll5 / To Building Foundation /¢ To Property Line 45 / To Disposal Field �x To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rn. 7M) FWt Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �50 Type of System Design Date Installed Length of Field 28 / X Width of Field �B / Depth of Field 41 Gravel Bed Thickness 6W 2C Square Feet of Absortion Area 504- ;W1 Statndpipes Present (Y/N) Depression over Field (Y/N) N r Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well ��✓� �� To Property Line �2 / To Building Foundation—To Existing or Abandoned System on Lot z2/ A"' ; On Adjoining Lots 20 /-30' To Water Main/Service Line 74 To Cutback (if present) 1 To Stream, Pond, Lake, or Major Drainage Course ld0 / Aa To Driveway, Parking Area, or Vehicle Comments /U0 M e //"I v 11!-70 6g,9L t2 D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes Comments "Check certify that Inspection. / Signed __!1 Company _S Dimensions Manhole/Access Bedroom Ratrng Against HAA Request" Date z V /f:�f 1- ir MOA No. erit�- ;?15- Receipt /S Level at Vent (YIN) or conformed to all MOA and HAA AL Receipt No. 0 5-y20U/3 x/(99 7 Date of Payment i -/0,-(K/ Amount: $ 170-M Pumping Cycles during Adequacy Test. on the date of this *1 . A Engineer's Seal - V oFA :�.. o..,.•• a �� Q" a^, [r Ror,,,''N''yf� Receipt No. Waiver Fee: $ Date of Payment 72-M (Rev. vea) Beck Page 2 of 2 r1 n MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIFO*1ENTAL HEALTH DEPARPIEPTP OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR ^HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date %%T.L /j 5'Y. (a) Legal Description (include lot, block, subdivision, section, township, rarge) M - (b) (b) Applicants Nam? Ji/,, iL/oc•rc Tblephorel5`s-YSSS Applicants Address (c) Applicant is (check �oro) Lending Institution Q; o.rner/builder ; Buyer [::::I; Other F -=--F (explain); rfr- • (d) Lending Institution Telephone Address (e) Real Estate Co. 6 Agent Address Telephone 2. Type of Fbsidence Single -Family M Multi -Family Q Number of Bedroom 3. Eater Supply Individual 1-11 [2:1 Community other (describe) Public Note: If cStmunity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedroom specified in this HAA (%N) 4. Sewago Disposal Onsite M Public r::l Community Folding Tank Q Is the wastewater disposal system adequate for the rLm ber of bedrooms X'Y�N) [Page 1 of 21 2-15-84 5. Engineering Firm Providing Inspections, 'Tests, Data and Information I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date__5 Name of Firm C S1 �, Te lephc -n 5 /- Sr Y D Address__ /2oo I1 i�,l 5.;4Of AIL,��l� ...... Signed by _ /%3u/�-ratr �'ik 95lZl� :`r^'� .••' �, '•..; �-a!!I Date — 7 0 : r, - : � 1 �.... • ••lN, •u 00 / ? ...... • 1 �. roy (ENGINEER SEAL) �� • o. 4251•E ' 'i, f� `tT� •• .•• r��•,. 6.DHEP Approval Approved for bedrecrm Approved [El: Disapproved Terms of Conditional Approval YA1 f� i B1' z-zzQ C Date c i Conditional The Municipality of Anchorage [apartment of Health and Envircramntal Protection does not guarantee thn continuod satisfactory parformnco of thn water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in tho State of Alaska, the water supply and wastewater disposal system is safe and func- ticnal for the number of bedrooms and type of structure indicated. (CHEF SEAL) 7. Mail HAA to the following address: J [ " r'a KB2/d5/s [Page 2 of 2] 2-15-84 A. WELL DATA ►AWOPALM OF ANCHORAGE DEPT. OF HEALTH & ' n ENVIRONMENTAL PROTECTION MCNICIPA= OF ANCHORAGE (MOA) MAY 151984 HEALTH ALMIORITY APPROVAL ( HAA) RECEIVED CHECKLIST - FEBRUARY 1984 Legal 'Description: lot 3 Q/•e�S ,��J/ *CA Ci l r 5i4 Well Classification YC,ve If A, B, Cr C. D.E.C. Approved(Y/N) Well Log Present Li22) Date CciVIeted 2:24±3. Yield Total Depth Y}Z Cased to y `/ Depth of Grouting Static Water Level l -F¢- Pump Set At Casing Height Above Ground Z.3/ Sanitary Seal on Casing 'N) Electrical Wiring in Conduit I N) Depression Around Wellhead (Y Separation Distances from Well: I / To Septic/Holding Tank on Lot % s� 3 On Adjoining Lots /00 To Nearest Edge of Absorption Field on Lot ,> IDo ; On Adjoining Lets >/oO To Nearest Public Sewer Line !LVA To Nearest Public Se%mr Cleancut/Manhole !+/IA To Nearest Sewer Service Line or. Lot N/q Water Sample Collected By Datey- water Sample Test Results Cas nts B. SEPTIC/HOLDING TANK DATA 'Date Installed I�!� /( Size My315 No. of Compartments c� Standpipes ) Air -tight Caps N) Faundatior. Cleanout Y( N) Depression over Tank (Y Date Last Pumped Nom Pumping/Maintenance Contract on File (yjgp for Holding Tank High -Water Alarm (YX)N/, Temporary Holding Tank Permit (YIN)Al-'l Separation Distances from Septic/HQlding Tark: l To Water -Supply Vbll +s•�� t' To Building Foundation (I.�Property Line /2l To Disposal Field ,X'KC 9/ o Water Main/Service Lire To Stream, Pond, Lake, or Major Drainage Ccurse /Urnp - Comments (Page 1 of 2) 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /S—O Type of System Design /�o c✓ Date Installed Length of Field Z$ / Width of Field Depth of Field y� Gravel Bed Thickness 6 �� Square Feet of Absorption Area 5-01/ Standpipes Present &N) Depression over Field (Y Date of Last Adequacy Test N/A Results of Last Adequacy 7bst Ov/4 Separation Distance from Abscrptfon Field: To Water -Supply Well / 3Z / To Property Line !Z/ To Building Foundation 7 zo I To Existing or Abandoned System on Lot AI /A On Adjoining Lots To Water Mair,/Service Line N/$ To Cutbank(if present) 1,114 To stream/Pond/Cake/cr Major Drainage Course Ai A To Driveway, Parking Area, cc Vehicle Storage Area- Caments D. LIFT STATION Date Installed �� Dimensions DV�� Size in Gallons Manhole/Access (YM) "Pump On" Level at "Pup Off" Level at High Water Alarm level at Tested for Electrical Codes(YM) Ccenents Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MDA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. Signed Date _ e'Y pFbe Al. Is Coapany i4L� �S �. [ MOA No. Y/ -O -Z fENG...•,•�3�lirl :64 1, oy C. Rad, k. [Pa 2 of. 21 M.• 223 e • - '•• •. .