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HomeMy WebLinkAboutGREAT LAND ESTATES #3 BLK 6 LT 2trent Land Estates #3 Block 6 Lot 2 #051-133-02 Municipality of Anchorage Development Services Department Building Safety Divisiono t Onsite Water 8 Wastewater Program. 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519.6650 www.cl.anchorage.sk.us (907) 343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO10211 PID Number. 051-133-02 Name: DEBBIE WOODY Wastewater System: [I New ■ Upgrade Y Address: P.O. Box 670685 * CHUGIAK, AK 99567 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 694-5656 3 ❑Deep Trench ❑Shallow Trench NBed DMound Dother LEGAL DESCRIPTION 501 Rd"` 0.7 '`"l Depth /ram °• 5.0 cm/sq. n — in. Lot. Block: Subdivision: Depth to pb bott m fnn adpinei peck Craw depth b.n.nth pipw 2 6 GREATLAND ESTATES #3 1.0 — 2.5 rL 0.57 n Township: Range: Section: A oee.e dww onp.w Ve craw kevuc — — — 1.0-2.5 rL 46 n WELL: El ❑ Upgrade craw .14th: 15 limber of iuc 3 Diet'e . het~ ens 4.5 n pt Gb..irceaenPrk.* A&C . Tocol cows T. on eo: Told aEwpera Py. mat~ D 3034/ F-810 n In. 690 so. n Mehr: °ata D,Yad: EX\\N Stade Mdr Lw : ke t . CCC CONSTRUCTION Dula MW.G 7/19-24/2001 n Pump set C"ng height ADow tom: TANK CPY n R SEPARATION DISTANCES ■septic (3 Holding 0S.T.E.P. ❑Other To Septic Ab so Bon Tdt Uft Holding bpe/Prtrat. Mmadaeluw: PREMIER PLASTIC Capodb in eosa 1000 From Tank F station Tank s..w uhw Well 100'+ 100'+ — — 25'+� PLASTIC w a 2 Surface water too'+ 100'+ — — — LIFT STATION Lot Line 5'+ 10'+ — — — sig In 9� Foundation 5'+ 10'+ — — — on l.w at: as "h eater o at: Curtain Drain NONE KNOWN ►urw tide.. a.ctrled anp.otlarw pwfarm.d der• Remarks: *2.02 FEET OF M.O.A. APPROVED SAND BENCH MARK location and Dwonpb FILTER ADDED. DOOR THRESHOLD ON BACK SLIDING DOOR THE EXISTING SEPTIC TANK WAS COMPLETELY REMOVED. "d°eAU°n 100.00 n urDe+efns WAL 0.00�4pp %S 0 aQoop�� v0 Inspections performed by: AWWC, INC. Dates: 1st 7/19/2001 0 * D ...... ............. 2nd -3rd 7/20-24/01 0 0 0 4th 7/25/2001 DO ', e r A. Camess 0000-.,s'•. Department of Health and Human Servi es pproval • 7953••: c4`rPv� o Reviewed and approved b . Date: PP Y'� 4p�00000'°"a (Rig. 12/00) PERMIT NUMBER: AS-BUILT DRAWING PARCEL NUMBER: SW010211 051-11 33-02 1 � CREE WA Y�;-�-i NOTE: ALL ND AREAS WITHIN THE 100 FOOT RADIUS OF THE I ' NEW SEPTIC SYSTEM WERE FILLED IN. L J ETG O BEUS D AS A f RESERVE SITE. NEW DRNNiIELD t p \ I A n �► A BSTI 47.8 62.5 99�, ST2 0.4 5. d L1 4. 0. NEW 1000 CALLON 'PREMIER PLASTIC' DFD .4 I.B INSTALLED (FD) DBL7 \ SEPTIC TANK O1 --63-6— --TQ-.T—DBL2 g _74-5— Z-0-2— 66. 0O3 1.5 79.2 \ C04 1.8 9.9 \ MTI MT2 2.5 82.2 M1 1 bz. 69.5 MT4 1 94.9 1 65.5 — — — — — — — — — — — — — — — — — — — — — — — — — — — — - 33• SECTION EASMENT NOTE: THE EXISTINGSEPTIC TANK WAS CREEK ROAD COMPLETELY REMOVED. DA 7/25/2001 o q� F 4�V DRAWN BY: J.L.M. �-� RAI.ASKA IVNTI?R & «7ASTIZATI:R O�� . 1••' y*OpQ E CONSULTANTS, INC.' 1" = 40� ••• •• •••••• •.••• (U 6901 DERARR ROAD, WTI! 2R'ANCNORAGE. M 99506. P~(907),337l179• FAX 907)336-0266 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: DEBBIE WOODY 694-5656/272-25251 2 OF 3 QQ ' Je r amess; Q •• 7953 0�4�,^' LEGAL DESCRIPTION: GREATLAND ESTATES SUBDIVISION #3: LOT 2, BLOCK 6, •., :' �q�o� 4��440006 TYPE OF WORK: AS—BUILT OF SEPTIC SYSTEM UPGRADE ��60 PER"RNU1AS—BUILT DRAWING PARCELro NUMBER SW010211 051-133-0202 FINAL GRADE - 97.1+ TOP OF TANK AT TOP OF TANK AT INLET - 94.01 OUTLET 94.05 r- INSULATION n___/ INVERT OF BUNG - AT INLET - 92.94 ORIGINAL GRADE 92.78— (LOWEST POINT) 0.57 FEET OF 2.02 FEET OF FIL NEW 1000 GALLON "PREMIER PLASTIC SEPTIC TANK FINAL GRADE FILTER FABRIC INVERT OF BUNG AT OUTLET - 92.72 INVERT OF DISTRIBUTION LINES m 91.87 (AVERAGE) BOTTOM OF SAND FILTER 89.28 (AVERAGE) 5, WIPE 7 ALASKA NNIXMM & WASTEINIXI'LR CONSULTANTS. INC. ,...w..,,".I. A. " DEBBIE WOODY 694-5656/272-2525 LEGAL DESCRIPTION: GREATLAND ESTATES SUBDIVISION #3; LOT 2, BLOCK 6, TYPE OF WORK: PROFILE AS -BUILT OF SEPTIC SYSTEM UPGRADE J.L.M. ORIGINAL GRADE 94.28 (HIGHEST POINT) IP OF SAND FILTER / )TTOM OF DRAINROCK 91.30 (AVERAGE) N.T.S. p NUMBER:VA 3 OF 3 -1 it 8991 Permit Number: SWO10211 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Jun 27, 2001 Expiration Date: Jun 27, 2002 Parcel ID: 051-133-02 Legal Description: GREAT LAND ESTATES #3 BLK 6 LT 2 . Design Engineer: 0041 AK Water & Wastewater Consultarr Site Address: 023334 CREEK RD Owner Name: Debbie Woody Lot Size: 91912 SO. FT. Owner Address: PO BOX 670685 Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567-0685 This permit is for the construction of: ❑ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: Date: 4 — 2 7-01 Municipality of Anchorage Development Services Department Building Safety Division OnSKe Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.onchorage.akus (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. b S- I - l33- c�Z Permit Number Property owneqs) DEBBIE WOODY Day phone 689-6464 Mailing address (1) SITE_ A531 -f GruV-R.l. Mailing address (2) 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK Z1p Code 99577 #3 Legal description (Lot, Block & Sub'd.) LOT 2. BLOCK 6: GREATLAND ESTATES SUBDMSION Legal description (Section, Township & Range) N ZA Lot Size `f7 '*�1 Acres/Sq.FL Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuz7J ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and Is In accordance with applicable Municipal codes. ALASKA WATER & WASTEWATER CONSULTANTS, INC. (Signature of prepefty owner or authorized ageno Permit Fees: $ 3i? 0 • ov Date of Payment 15101 Receipt Number. 6q(og Waiver Fees* Date of Payment Receipt Number. ALASKA WATER & WASTEWATER �^�^�-•-v CONSULTANTS, INC. June 11,2001 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic Design for Lot 2, Block 6, Greatland Estates Subdivision #3 To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing septic system is in a state of failure and needs to be upgraded. A test hole was excavated southwest of the existing septic system. The proposed septic system will be designed around the 30 foot radius of test hole #1. We are proposing that a 1000 gallon septic tank and a bed type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: See the attached logs which shows the soil classifications, groundwater monitoring and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 0.7 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Allowable Application Rate: 0.7 gallons/day/R2 c. Number of Bedrooms: 3 d. Design Flow: 450 gallons per day e. Minimum Absorption Area: 643 ft2 f. Total Depth: 5.0 feet (maximum) g. Effective Depth: 0.5 feet h. Width: 15 feet i. Reduction Factor: N/A j. Minimum Length: 45 feet long k. Effective absorption area = 675 ft2 6901 Debarr Road, Suite 213 * Anchorage, AK 99504 Ph: (907) 337-6179 * Far: (907) 338-3246 * Website: akwwc.com 3. SURFACE WATERS: There is some ponding of water to the west of the proposed bed. Any ponding within 100 feet of the proposed septic system will be filled prior to construction 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography of this property is a 1 to 5 percent running from approximately northeast to southwest; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact me at 337-6179. Thank you for your assistance. M.S. NOTE: Attached is a site plan drawing, a design drawing, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akwwc.com Oay�C1�44� �� �?O wO I 1 I LOT S, BLOCK S; GREATLAND ESTATES S/D /3 1 -_L CREEK W, I I EKISTING LJ SEPTIC SYSTEM 1 .----------t------ ------- ------------------- PROPOSED SEPTIC UPGRADE (SEE DESIGN PACE 2 OF 2) CREEK ROAD ALL SUCH AREAS ARE TO BE FILLED. LOT 1, BLOCK 1; SLEEPY HOLLOW S/D 02 LOT 2, BLOCK 1; SLEEPY HOLLOW S/D /2 ALASKA «TATER & WASTEIVATER CONSULTANTS, INC. 6001 DF9ARR ROAD. SUTE 29 • ANCHORAGE. AK 9950. • PHONE (901)557-0179 • FAX (907)356-526 DEBBY WOODY 694-5656/272-2525 LEGAL DESCRIPTION: GREATLAND ESTATES SUBDIVISION #3: LOT 2. BLOCK 6, TYPE OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE J.L.M. E_ goo' c:... E NUMBER: �S 1 OF 2 GBLOCK 5: ESTATES S/D J3 LOT 3, BLOCK 1: SLEEPY HOLLOW S/D /2 e CK KAY LJ I 1 I 1 I I I �r� THIS AREA HAS I 1 1 SOME E NOTE) 1 1 1 11 �-SL 1 1 1 1 W \ I \ L / EXISTING DRAINFIELD TO BE USED AS / RESERVE SITE. A EXISTING SEPTIC TANK ED AT 1 1 / BE 1 I j � /7NOTE: INSTALL FLOW PROPOSED 7000 GALLON - _ _DNERTER.SEPTIC TANK (SEE NOTE) ANY N PROPOSED DRAINnELD UPGRADE\ATER IN THE 100 EXCAVATE A TRENCH THAT IS S.0 FEET DEEP MAXIMUM BY 15 FOOT RADIUS OF THE FEET WIDE BY 45 FEET LONG. PROPOSED DRAINFIELD ADD 2.0 FEET OF M.OA APPROVED NEEDS TO BE FILLED IN SAND FILTER. AND ADD 0.5 FEET PRIOR TO CONSTRUCTION OF CLEAN. WASHED SEWER DRAINROCK. • — — — — — — — — — — — — — — — — — — — — — — — — — — — — WILL NEED TO BE RAISED. IF IS UNABLE TO BE OBTAINED. A a I nu c T c o TAMK Wu I uevr 1 33' SECTION EASMENT CREEK ROAD 1 6/6/2001 ALASKA RATER S WASTEMVATER CONSULTANTS, INC. 6001 DEBARR ROAD. SUTF ED • AN[HORACF. AA 4V504 • PHONE (007)377-6179 • FAX (407)33832G! REPARED FOR: PHONE NUMBER: DEBBY WOODY 694-5656/272-2525 GREATLAND ESTATES SUBDIVISION #3; LOT 2, BLOCK 6, DESIGN OF SEPTIC SYSTEM UPGRADE C.J.G. 1 " 40' NUMBER: 2 OF 2o t7953 .....$$ .. Q004 � •,• � 11w��• CO40� ALASKA «TATER & VVASTENAWTER CONSULTANTS, INC. LEGAL DESCRIPTION: OREATLAND ESTATES SUBDIVISION 13: LOT 2, BLOCK 6, PERFORMED FOR: DEBBY WOODY DATE: 4/27/2001 DEPTH __ (fee 0 EE J_ ORGANICS ITEST . HOLE 1 1 �7�• 2 SOIL CLASSIFICATIONS •�?:5;0: GW zzz= ORG SM/ML �';; GP ML 3 GM CL q GC OL • ° ° SW MH SP •.. ?<.•: SM : OH 6 SC ::''•�: 8 9 10 11 12 13 14 15 16 17 18 DEPTH TO DATE GROUNDWATER 8.0' 5/23/01 8.0' 6/6/01 i� EXISTING-� j ! SEPTIC SYSTEM i ED 1 L A�\ SITE PLAN 1 100' DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 5 GP���NS OF O�e�O 5 QER• 19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6" (INCHES) 20 TEST RUN BETWEEN 4.5 FT. AND 5.0 FT. COMMENTS: PERC—HOLE WAS PRE—SOAKED FOR 4+ HOURS PERFORMED BY ALASKA WATER do WASTEWATER I, JEFFREY A. GARNESS, CERTIFY THAT THIS VPS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: _� MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME C ..l. PHONE >—d-NEW 65F (a9Q1'!y7 ❑UPGRADE MAILING ADDRESS�� LEGAL DESCRIPTION Lt Q/%r 6 6-� c eT/o.,�/ F� ik rfe.r #3 /SN R / c✓ S<< /z7 LOCATION Pe.,/crr G-r.G/r NO. OF BEDROOMS 3 DISTANCE TO: Well / Absorption area Dwelling / PERMIT NO. DY .5— z ManulxturerG2 c'E' Material S7>let / No. of compartr5,enls .-i ns Liq. capacityina IF HOMEMADE: Inside length Width Liquid depth dOZ DISTANCE TO: Well Dwelling PERMIT NO. S? Manufacturer Material Liquid capacity in gallons O= -� DISTANCE TO: Well OO / "r / Foundation �O Nearest lot lines PERMIT NO, g yOs/J> W a z No. of lines Length of each+ e&:( Total length of4w .s Bs• 'Fre+rtri width Distance between lines � i w ' 3Sr r Ls.k( / 7 wepes 3 e f Top of tile to finish grade / Material beneath the Total effective absorption 9[eaR� D .3.0 rr< / ; 7. inches 'y'" 'JJ Length 0 Width Depth - PERMIT NO. W Qo H W 1 Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J i DISTANCE TO: Building foundation Sewer line Septic tank Absorption steals) OTHER PIPE MATERIALS ,p.z SOI L �ST RATING INSTALLER REMARKS / / 7 X 3 �-.. AVx- O 1 �t : uitE 25, 1971 �<�i : jls' ....• \ V %VCONAL= � l � APPROVED ;D/TE LEGAL fi L t z 'emr 6 6:YrA 72-013 (Rev. 3/78) mum I C I F=`AL- I TY OF Ah3CH0FzAGE. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 ON—S I TE SEWER $¢ WELL- PERM I T PERMIT NO: 840518 DATE ISSUED: 06/28/84 APPLICANT: STRATA, INC ADDRESS: SR BOX 18 EAGLE RIVER, AP: 99577 CONTACT PHONE: 688-4949 LEGAL DESCRIP: SUBDIVISION: GREATLAND ESTATES #3 LOT: 2 BLOCK: 6 SECTION: 10 TOWNSHIP: 15N RANGE: 1W LOT SIZE: 2.11A (SQ.FT. OR ACRES) LOT LOCATION: ,CREEP: ROAD MAX BEDROOMS: ,3 Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. B E I>' �R A I N ---� DEPTH TO PIPE BOTTOM (FT.) 3.5 ** 3.0 ** GRAVEL DEPTH (FT.) 0.5 1.0 TOTAL DEPTH (FT.) 4.0 4.0 GRAVEL WIDTH (FT.) 17.0 5.0 GRAVEL LENGTH (FT.) 34.0 66.0 GRAVEL VOLUME (CU.YDS.) 21.4 18.3 TANK SIZE (GALS) 10000.0 ** 1,000.0 ** SOIL RATING (SQ.FT./BR) 125 125 *+� DEPTH TO PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION ** DEPTH.TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A LIFT STATION +�* TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - - - - - - - - - - - - - - - - - - - I certify that: 1. I am familiar with the requirements, for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and.regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent.or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; -AND (3) THE ELECTRICAL WORK. MUST DONE BY A LICENSED ELECTRICIAN. SIGNED �� --- -- DATE:/ ��� APPLICANT: TRATA, INC / ISSUED BY----- DATE / -------------------------------- --�/� Q`---- i i r. n. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 1' 825 L• Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST SOILS LOG $(/-oS/i� O PERCOLATION TEST PERFORMED FOR: StY'.. 'f'e. X., c . DATE PERFORMED: 4151.7,01-F L 0 t 1 6/!C' 6 LEGAL DESCRIPTION: d7re, �' Lg ,.e/ �'S 7`41,-j- #3 /5 �� y�- /� / L!% DEPTHOlCG RNrSLOPE SITE PLAN C 1 2 3 4 5 t .6 7 8 9 10 11 12 13 14 15 16 17 18 19 SY.•.d �' G7.«c/ GP OF Al 1k It 4S i *• 49TH ►=ir_U%WrAv#.,nffIMIX 0 2225-E JUNE 25, 1971 �y 70ilAL e WAS GROUND WATERS ENCOUNTERED? e'f L 0 Rud. P IF YES. AT WHAT p �E DEPTH? O Reading Date Gross Net Depth to Net /.2 S- �j/rnr Time Time Water Drop RATE /pv,1 .TEST RUN BETWEEN FT AND FT OFp �/ry soe rGi/.e'-tT rrj,'sve� c/ a Co✓�Gr fiver 6.:1 G.rrfs p ,�J�'iO�i'-sr'r+G 6 PERFORMED BY: CERTIFIED BY: !/ DATE: J C •� O 20 Iul vis-41 PE 4eetAZ40N /.2 S- �j/rnr RATE (minutes/inch) .TEST RUN BETWEEN FT AND FT pp � COMMENTS /"`-7'ru� soe rGi/.e'-tT rrj,'sve� c/ a Co✓�Gr fiver 6.:1 G.rrfs p ,�J�'iO�i'-sr'r+G 6 PERFORMED BY: CERTIFIED BY: !/ DATE: J 72-008 (6)79) LOCATION OF WELL (Please compIsl• sltMr so, la or Ic.) n WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 9 Geophysical Surveys Drilling Permit No. A.D.L. No. laBorough 9ebdlelelen Lot Block I►. 1/4 site. Section No. TooMhlpN� Range E❑ Meridian ' V BEAT LAND ANCW ESTA E'tl—ef_ef_ot� S0 W❑ Ic. DISTANCE AND OIRECTIOI,'P ROM ROAD INTERSECTION! S. OWNER OF WELL: VN IT 3 Aear•..: I q14�� S r RVAL) Street Addle*@ and Area of Wall Location ANC(4 O' E. WELL LOG FSttrfoe• eer Bolo. d. WELL DEPTH: (final) S. DATE OF COMPLETION 140 ft. jj_ - j✓nr- �� Material Type Top Bottom r G. ❑ Cable reel [3.90101Y ❑ Drlvn ❑ Dug ❑ Auger ❑Jolted ❑ Bored ❑ other: ` ly15 12 y 7. USE: © Domeolia ❑ Politic Supply ❑ Industry ❑Irrigation ❑Recharge ❑Commensal ❑ Tool Well ❑ Other•. of •r •s 7 Ir II ItWET 9. CASING: C] Threaded [3 Welded at*.._6 1.. to 1 3Q ft. Depth Wight �_ Ihe./ ft. lo_ ft. Depth Stickup_ ft. ki N1929. 9. FINISH OF WELLI CUT. Oh ON —Type' _ Olamnen - - — . Slat/Mpeh also: Length: a•r bn..en rt. and it. Backfilling Gravel past c 'ff F. r% 10. STATIC WATER LEVEL:11!9' If. I it ❑ Above or ❑ Belaw land surface Date Equipment used: 'Snit ' II. PUMPING LEVEL bolo. land surface and YIELD 13$fl. after2. Me, pumpinp��g,p. m. —ft alter hie. pumping IE.GROUTING Well Grouted: ❑ Yes CE40 Material: ❑ Neat Cement ❑ Other: Ia. PUMP: (If available) NP r r Length of Drop Pipe ft, capacity g.p.m. ❑ Subm. • ❑ Jet ❑ Cenlriflcal ❑ Other Id,REMARKS: AIR LIFT Pvnp(N0 16. WATER WELL CONTRACTORS CERTIFICATION: -' IS. Water Temperature • ❑ F 0 This .ell .as drilled under my jurisdiction Sad this *poll Is true to the ban of my zno.ledge and belief; 3/.1 u LaAILL(NG d- 1076 D Registered Business Name , contract Llceasa Number Address: 1 � Signed: G�� Lf �FEt.�� Dote: �Authorized Pepreaealatie• 01 Form 0E•WWR(11/61) COPY Distribution: WNITE•SIo1a DGOS,PINK-D,illot, CANARY-COstnmor MUNICIPALITY OF ANCHORAGE Development Services Department Phone 907-343-7904 On -Site Water & Wastewater Section Fax. 907-343-7997 Parcel I.D. 051-133-02 Certificate of On -Site Systems Approval Expiration Date: Legal description GREAT LANDESTATES #3 BLK 6 LT 2 Site address 19658 CREEK WAY Current property owner(s) BURKE AUDREY S & SHAWN D 5/22/2025 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 9/20/2024 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 Absorption Field Advisory Tank Age Advisory Other IP-Hcv rc;dlll Well Flow Advisory Nitrate Advisory Arsenic Advisory -t-a1< COSA ApprovaLJune 2022 MUNICIPALITY OF x .. Development Services Department \� On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-133-02 Complete legal description Great LandEstates #3 Block 6 Lot 2 Location (site address) 19658 Creek Way Current property owner(s) Shawn D & Audrey Burke 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: M Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ❑■ Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel Q Plastic ❑ Concrete ❑ Fiberglass Age 22 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS FNJ Bed ❑ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ -650 Waiver Fee $ Date of Payment Z 7� y Date of Payment COSA # ��� G2 �t 12. Z O Waiver # COSA Application_June 2022 COSA Checklist_June 2022 COSA Checklist Legal Description: Parcel ID: If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank Date of pumping Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) ALL standpipes present per record drawing Total measured depth from grade ft (max) Measured depth to pipe invert from grade 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 gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Adequacy test date Results Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) in Effective depth used in Effective depth remaining in Comments/Deficiencies: 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’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F.ENGINEER’S COMMENTS G.CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC & MOA guidelines and regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this system. All systems eventually fail, and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore, we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Phone Engineer’s Printed Name Date Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O.Box 1807, Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Greatland Estates #3, Block 6, Lot 2 Septic Tank Information The subject lot is currently served by a conventional on-site system installed on 07/19/2001 to 07/24/2001. This system consists of a two compartment 1000-gallon Premier Plastics septic tank followed by a conventional bed absorption field. PES was contracted by the owner to perform a well and septic adequacy test in accordance with MoA regulations to obtain a COSA for the sale of the property. Liquid levels within the septic tank were measured and found to vary only (+/-) one-inch between the first and second compartment indicating minimal settlement along the tank. PES collected readings of the septic tank’s fluid operating level within the second compartment of the tank as follows: • 05/22/2024 – (Fluid level observed at 2.5 inches below top of tank) (During Flow test) Septic tank pumped 05/31/2024 (Per pump receipt 1000-gallons was pumped) • 08/09/2024 – (Fluid level observed at 1.0 inches below top of tank) (Checked per MoA request) • 08/21/2024 – Fluid level observed at 2.5 inches below top of tank) (Checked per MoA request) The outlying measurement as observed on 08/09/2024 was collected by a different member of PES as the levels observed on 05/22/24 & 08/21/2024. With similar operation levels, an additional measurement of the true depth of fluid within the second compartment of the tank was collected on 08/21/2024 and found to be only 39.5 inches. This operating depth does not align with any model of Premier Plastics tank manufactured by Premier Plastics. The observed ‘high’ fluid operating level may in-part be due to the static load of soil exerted over the top of the septic tank in which has caused creep deformation of the plastic material. This deformation will result in an overall lower surge capacity of the tank; and at certain times may cause the drain lines pre-tank to hydraulically load in order to produce outflow. Despite any deformation in which has occurred, it is the opinion of this office that the subject septic tank appears to be in sound operating condition and is suitable to operate for its intended use. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, Steven R. Pannone, P.E. F. ASCE Owner/Civil Engineer 20 September 2024 C R E E K W A Y CREEK ROAD 8000 KING STREET ANCHORAGE, AK 99518 Phone (907) 344-5990 Fax (800) 761-8502 C3 Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519650 L www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS A ROVAL FOR A SINGLE FAMILY DWELLING per-133-D�- 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address cosAu O�b�S"' Expiration Date: _ �O GREATLAND EST. #3: LOT 2. BLOCK 6. 19658 CREEK WAY ' CHUGIAK. AK 99567 WALTER DAMIAN J & JEANNE M Day phone c/o AGENT Day phone EVA LOKEN w/PRUDENTIAL VISTA Day phone 689-6476 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily Identsable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate owing the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the solo benefit of the owner listed above. Any reliance upon or use of this report by any other person orpartyIs not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE lof� Approved for 3 bedrooms. Disapproved. Conditional approval for Phone 337-6179 Date 6 SA bedrooms, with the allowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements o; PROGRAM ii tyT\\\ Supplemental Engineer's Reort 11yy�}}}111I I Other By: z/ � r� Original Certificate Date: Cp — 9 — 01 67 In. "Mt Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water b Wastewater Program ` 47W Bragew Street P.O. Box 196650 Anchorage, AK 995198850 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: GREATLAND EST, N3: LOT 2. BLOCK S. Parcel ID: 05-1 -13 3-01 A. WELL DATA Well type PMVATE N A, B, or C provide PWSID# N/A Date completed 6/12/1984 Sanitary seal (Y/N) YES Total depth 140 ft. Cased to 139 ft. FROM WELL LOG Date of test 6/12/1984 Static water level 115 ft. Well production 10 — 9 -p.m -WATER SAMPLE RESULTS: Coliform _ 0 oolonies/100 ml. Nitrate J.ff mgJL. Well Log (Y/N) YES Wires property protected (Y/N) YES Casing height (above ground) 12+ in. AT INSPECTION 5/23/2006 122 ft. 5.9 g.p.m. Other bacteria Q colonies/100 ml. Arsenic: -dA-ug./L. Date of sample: 5/23/2006 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material PREMIER PLASTIC Date installed 7/24/2001 Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Cleanouts (Y/N) YES High water alarm (Y/N) N/A Date of pumping 10/22/2005 Pumper JRs PUMPING C. ABSORPTION FIELD DATA 7/3/1984 125 Date k atafled 34 19-24/2001 Soil rating .p.d. 1 _ 0_7 System We BED Length 45 ft. Width 15 ft. Gravel below pipe 0.5 ft. 4.0 578 Total depth 13-5-44 ft. Elf. absorption am 690 ft' Monitoring tube YES Depression over Heli NO Date of adequacy test 5/23/2006 Results (Pass/Fag) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 539 gal. New depth 0 in. Elapsed Time: 0 min. Final flub depth 0 In. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) NONE KNOWN If yes, give date - • TESTED THE BED SYSTEM INSTALLED IN 2001 D. LIFT STATION Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Iifi station on lot 100 + On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/deanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: Building foundation 5'+ Property One 5'+ Absorption field Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property Ane 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkinglvehide storage 10'+ Curtain drain 50'+ Wells on adjacent lots 1002+ F. COMMENTS G. ENGINEER'S CERTIFICATION AVAI�,...... I earthy that I have determined through ileal inspections and review of Munfdpat records that the above systems are in conformance with MOA COSA guidelines in effect on this date. r y ss.:... Engineer's Printed Name JEFFREY A. GARNESS 7 Date 6��u6f • . 6b . �c. d pref...bnd COSA Fee 1 Waiver Fee E Date of Payment ��QY Date of Payment Receipt Number /4010 Receipt Number (Rev. 1 Ims) Municipality of Anchorage Development Services Department Bu(Iding Safety Division =: � � - On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.d.enchorage.ek us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING'/ H Parcel I.D. 051-133-02 HAA# 4 O / b -5 9 C7 1. GENERAL INFORMATION Complete legal description Expiration Date: /0 — 2 7-0 1 Location (site address or directions) 19658 CREEK WAY • CHUGIAK, AK. Current Property owners) DEBBIE WOODY Day phone 694-5656 Mailing address Lending agency Mailing address Real Estate Agent Mailing address P.O. BOX 670685 ' CHUGIAK, AK 99567 Day phone EVA LOKEN w/ PRUDENTIAL VISTA Day phone 689-6476 16635 CENTERFIELD DRIVE • EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site I® Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. Note. Alaska Water and Wastewater Consultants, Inc. shall be paid $ 3j 3Y'G at, or prior to closing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health AuthorityApproval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system Islam) 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-slte water supply and/or wastewater disposal system ls(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Finn ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, AWWC, Ina attempted to provide a thorough, consclentious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines Q Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test and separation distances measured to readily identiflable features. The operational fife of all wells and septic systems depend on the tical soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for V79 sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE f/ Approved for 3 Disapproved. Conditional approval for Attachments: HAA Checidist Septic System Advisory Well Flow Advisory bedrooms. Phone 337-6179 Date bedrooms, with the fllowing stipulations: Manitenance Agreements Supplemental Engineer's Reort Other JN • ON-SITE WATER AND •; WASTEWATER '. • PROGRAM F�•— By: �� Original Certificate Date: (Rr.12=) Municipality of Anchorage . ' Development Services Department o , Building Safegr Division On -Sits water & Wastewater Program 4700 South Bragew SR P.O. Box 1966ti0 Anchorage, AK 99579-6b0 wwwxLsnchorsgeAk.us (997) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description. GREATLAND ESTATES S/D N3: LOT 2, BLOCK 6, Parcel ID: 051-133-02 A. WELL DATA Weti type 3 "WATE B A. B, or C provide PWSID# N/A Date completed 6/12/84 Sanitary seal (YIN)_M Total depth 140 R Cased to 139 & FROM WELL LOO Date of test 6/12/1984 Static water level 115 fL Well production 10 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) YES Wines properly protected (YIN) YES Casing height (above ground) 24+ in, AT INSPECTION 7/23/2001 122 fL 5.5 g.p.m, Cotilorm • 0 colonies/100 mi. Nitrate 1.55 mgA. Other bacteria 0 colonles/100 ml. Data of sample. 7/23/2001 Collected by: AWWC. INC. S. SEPTIC/HOLDING TANK DATA Tank Type/Material PREMIER PLASTIC Date installed 7/24/2001 Tank sine .1000 gel. Number of Compartments 2 Cieanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (YM) N/A Date of pumping NEW Pumper C. ABSORPTION FIELD DATA • F M.OA APPROM SAND FP -TM BUM 70T& D—ERT7K Data installed 7/19-24/2001 Sal rating .pA felbdrm) 0_7 System type BED Length 46 R. Width 15 fL Gravel below pipe 0.5 fL Total depth •3-A-4-0 R. Eff. absorption area 690 R` Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fall) - For 3 bedrooms Fluid depth in absorption field before test = in. Water added =gal. New depth =in. Elapsed Time: = min. Final fluid depth = In. Absorption rate as - g.p d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) - If yes, give date - D. LIFT STATION Data installed Size in gaflone "Pump or? level at n. E. SEPARATION DISTANCES High water alarm level at k►. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/Oft station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent k1b 100'+ On adjacent kris 100'+ Public sewer manhde/deanout N/A Sewer h)epdo service One 25'+ Holding tank NIA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption Held 5'+ Water main N/A Water service One 100+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO. Property One 10'+ Building foundation 10'+ Water main N/A Water service line 100+ Surface water 100'+ Driveway, parking/vehide storage 50'+ Curtain drain NONE KNOWN Wells on adjacent lots -1-00—'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through Weld Inspections and * ; 13 A ;:'# review of Mun/dpal records that the above systems are in ..."' aonlbrmance wide MOA HAA guldeWnes In effect on bVs date. r A. as'q Engineer's Printed Name JEFFREY A. GARNESS �y •, 7953 0/ Data /, �dP�ot sw�`d': � HAA Fee S 320-60 Date of Payment 7.1 a celO j Waiver Fee $ Date of payment Receipt Number 7 7UI Recelpt Number M". 12m) 06-02-06 16:36 FROM-Pudential Jack White Earle River 9076896499 T-652 P.002/003 F-630 06-02-06 16:36 FROM-Pudentlal Jack White Eaole River TIFY THAT I HAVE SURVEYED THE -ESCRIBED PROPERTY, ENCROACHMENTS EXIST EXCEPT AS r IS THE RESPONSIBILITY OF THE ERMINE THE EXISTENCE OF ANY AVENANTS, OR RESTRICTIONS APPEAR ON THE RECORDED SUBDI- UNDER NO CIRCUMSTANCES SHOULD EON BE USED FOR CONSTRUCTION ES, OR FOR ESTABLISHING BOUND - 9076896499 T-652 P-003/003 F-830 J �1 SEWARD & ASSOCIATES LAND SURVEYING 6! D DATE y�l��':::1e a GRID: ..... ..:.. Dum. m L-•nd FIB: ff �:•. is-egle E'a A�o'D�^skYuti* .� DRAWN, n r, MUNICIPALITY OF ANCHORAGE 0f / 3302 DEPARTMENT OF HEALTH d HUMAN SERVICES I DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�� OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date August 6, 1987 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; Block 6; Greatland Estates #� Location (address or directions) On Creek Road in Peters Creek (b) Property Owner Theisen Telephone: Home Business Mailing Address (c) Lending Institution Alaska Pacific Mortgage Telephone Mailing Address (d) Real Estate Company and Agent JACK WHITE COMPANY/Lynda Banner Address P.O. Box 771699, Eagle River, Alaska 99577 Telephone 694-5500 (e) Mail the HAA to the followina address: or: Check here LX if hold for pick up. List contact person and day phone number below. S & S ENGINEERING - 694-2979 17034 Eagle River Loop Road, Suite 204 Eagle River, Alaska 99577 Ordered by Lynda Banner 2. TYPE OF RESIDENCE Single-Familygi Number of Bedrooms - 3. WATER SUPPLY Individual Well (KK Community ❑ Public ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite `F 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. Page 1 of 2 noas IR-. 81861 ROM 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 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 No's— Telephone 17034 Eaglo R! Y" LOOP Rced Address Date 6. DHHS APPROVAL Approved for " _-3 edrooms by4"^ Date 9- 2-9-E 7- Approved �I Disapproved Conditional Terms of Conditional Approval CAUTION 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 is -ms 1aa. a 861 B.oh n MUNICIPALITY OF ANCHORAGE (MOA) MUNICIPALITY CF ANCHOH;F,ALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIVISICCtiECKLIST - FEBRUARY 1984 264-4744 AUG 2 01987 Legal Description: Lc,,- L RL -A /a i�ReR`/�-ARID ✓~•S%' A. WELL DATA RECEIVED Well Classification S• F If A, B, C, D.E.C. Approved (Y/N) N/A Well Log Present &N) Date Completed Yield —it•o to EM t Total Depth / y01 Cased to /35. S Depth of Grouting Static Water Level 11 %:3' Pump Set At t' • �< - Casing Height Above Ground yJ Sanitary Seal on Casing&N) Electrical Wiring in Conduit ()N) Separation Distances from Well: Depression Around Wellhead (Y& To Septic/Hold ng Tank on Lot /0O'4- ; On Adjoining Lots To Nearest Edge of Absorption Field on I,ot 1001-f' ; On Adjoining Lots To Nearest Public Sewer Line "IIA To Nearest Public Sewer t Cleanout/Manhole ry To Nearest Sewer Service Line on Lot Z f Water Sample Collected by 4a -S &4 ^ AiEr•1 I&IL. ; Date S-11- B 1 Water Sample Test Results SA'Zc j=AcR29./ C;X- drnC4•'•L'S d- A-^^ Comments \JF_LL_Ft_uW Fort- 41 .5. B. SEPTIC/H9E:BFNG TANK DATA Date Installed Size /00P No. of Compartments Z Standpipes (YO Air -tight Caps (Y/� Foundation Cleanout&) Depression over Tank (Y& Date Date Last Pumped c -/3 ��_: Pumping/Maintenance Contract on File (Y/N) ~/(A ; for �— Holding Tank High -Water Alarm (Y/N) K'ZA Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Helding Tank: To Water -Supply Well /JCX05t4 To Building Foundation To Property Line 101 f To Disposal Field To Water Main/ServiceL' a X04 To Stream, Pond, Lake, or Major Drainage CoursejA r� Comments ' J� r S C r= SSA,:C4- �N�rP�ti!(� 5"" B9I-OZ L Page 1of2 72-M IRw 8'P61 Front C. ABSORPTION FIELD DATA Soils Rating In Absorption Strata —) Z 5 dlgam Type of System Design r Date Installed - 3 ^8 y Length of Field fit% r i Width of Field ) Depth of Field y b Gravel Bed Thickness en. f / Square Feet of Absorption Area 5 8 Standpipes Present (ktN) Depression over Field (Yo Date of Last Adequacy Test Results of Last Adequacy Test S /t^r ��/`� Vy�`� �2 cj Q 2 - Separation Distance from Absorption Field: To Water -Supply Well Or7' 4 To Property Line r.,4 "-I To Building Foundation To Existing or Abandoned System on Lot "1,4- ; On Adjoining Lots -3o/'f To Water Main/Service Line yOr 4 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course ^11i4 To Driveway, Parking Area, or Vehicle Storage Area /Pt>/ 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 Tested for Electrical Codes (Y/N) — Comments •• Check Permitted Bedroom Rating Against HAA Request •• Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOAand IJAA guidelines ineffect onthe date ofthis inspection. SignedS & S ENGINEERING - Date 8 Com 17034 Eagle River Loop Road No. MOA No. � pVAId_Riwr,-Alaske "M A -Od Uai/ F Q Receipt No. -- P • . till., Date of Payment p �a IWO ~•,'y Amount: $ / D O s It j. „• ne eal ti � O a • �••ww.3>^ Page 2 of 2 71.026 IAPv 8'861 Back N i A. $lltk v t1o. 1137-1 h � M MICIPALITY OF ANCHORAGE ', DIVISION OF ENVIRO MNUAL HEA:78 DEPARTK--NT OF HEALTH AND ENVIRO:,'iZ.%MQ APPLICATION FOR HEALTH AUTHORITY APPROVAL 1. General Information ApplicatIm ��''J-'�D�/ (a) Legal Description (inQlude loth blogk,'"bdivision, sectt�6 township, r"e); / � F<, Cr/Pi�.�/lr n c! L.A4 Air Location (address or directions) LO� 0 4 �� /N el kl e k iti (b) Applicants Name C, V s% Telephone - Ho a Buafnesa Applicants Address���Jl/�� �QSSI �GL• (c) Applicant is (check one) Lending Institution ; 0 ner/builder�; Buyer � ; Other � (explain); (d) Lending Institution ' /[/ 0 /J r Telephone Address (e) Real Estate Co. S Agent Address Telephone (f) .5:pl/the HAA to the following address: 2. Type of Residence Single -Family Multi -Family other (describe) 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 the legality and status. 4. Sewage Disposal Onsite Public E=1 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. [Page 1 of 21 5. Eng'. n Firm Providing I ts, File Search, As certified by my seal affixed hereto and as of the validation date shown belo*' verify that my investigation of this Health Authority Approval shows that the oti water supply and/or wastewater disposal system is safe, functional and adequate lot the number of bedrooms and type of structure indicated herein. I further verify thy; based on the information obtained from the Municipality of Anchorage files and fro t; investigation and inspection, the on—site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula— tions in effect on the date of this inspection. Name of Firm M Address Date Telephone (ENGINEER SEAL), 6. DHEP Approval +�� No^ >u7p ?f Approved for bedrooms By�_�T_���~�_,� Approved —IyNr Disapproved Conditional Terms of Conditional Approval CAUTION ,THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT— ATICNS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE D'1EP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE— MENTS. EMPLOYEES OF DEEP CO 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 n C. ABSORPTICN FIELD DATA Soils Rating in Absorption Strata 06 d'6) Type of System Design Date Installed Lergth of Field 3 Width of Field Depth of Field z. Gravel Bed Thickness c, Square Feet of Absorption Area S% 8 Standpipes Present Kiat') Depression. over Field (#A Date of Last Adequacy Test !iC't✓ c• Results of Last Adequacy lost Aj 'e z -J Separation Distance from Absorption Field: To Water -Supply Well /Do eo�- To Property Line /d V To Building Foundation 4/ .0 To Existing or Abandoned System on Lot N / /a ; On Adjoinirg Lots (A N PC 0 To Water N&VVService Line -�D -�z To Cutbank(ifpresent) A-) 14 To Stream/Pord/Lake/cr Major Drainage Course /=J14 To Driveway, Parking Area, or Vehicle Storage Area /Gb Comrents dJv .0 OF D. LIFT STATION Date Installed Dimensions Size in Gallons nhole/Access (Y/N) "Rump On" Level at Off" Level at High Water Alarm Level at Vent (YM) Tested for Pumping Cycles during Adequacy Test. Meets MDA Electrical Ccdes(Y/N) Car nts " Check' Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MCA HA1�jpti�l�es in effect on the date of this irspection. A. Signed $ 3 £ E`JatNEEBC;ii Date /D / r `i�4'• •f '~'¢9*�f6 Company ji;,OLE PtVEB. ALA8KA Q.7t MOP. No. 9 —Tp1. 604 Q07D KBl/d5/s (Page 2 of 21 •••r /rb.A A. S. 2-15-84 A. WELL DATA B. MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION OCT 19 lope. RECEIVED Well Classificati moi!/ If A, B, or C, D.E.//C. Approved(Y/N) Well Log Presen ( Date Conpleted VU/J 6'L% Yield '`s Total Depth d Cased to 3 % Depth of Grouting Static Water Level/.S Rupp Set At u �C Casing Height Above Ground 2 (o LI Sanitary Seal on Casing (Y Electrical Wiring in Conduit(Y Depression Around Wellhead ( ) Separation Distances from Well: 1 To Septic/Haod*M Tank on Lot /d Z ; On Adjoining Lots(/,1V061 To Nearest Edge of Absorption Field on Lot / fi0 On Adjoining Lots G//NOF c% To Nearest-Pabiia'Sewer Lire 'eq �I'i To Nearest Public Sewer Cleancut/Manhole iv I ii TO Nearest Sewer Service Line Lot �v A Water Sample Collected By„S'-, S i.Inee/ ; Dai Water Sample Vest Results 51111 l 5 I—elc zyr�j Cements /.-f-0 ^-f IF SEPTICS TANK DATA Date Installed Size 4ly 2No. of Crnpartmerts 2 Standpipes ) Air -tight Caps ) Foundation Cleancut Y i Depression over Tank (8 Date Last Pumped fL�o C -i Pumping/Maintenance Contract on File (Y )Ar, /1- ; for 'V /'f. Holding Tank High -Water Alarm (YM) W Tlemporary Holding Tank Permit (Y/N)"Xi Separation Distances from Septic/Holding Tank: i To Water -Supply Wall /O 2 To Building Foundations To Property Line 10.,4- To Disposal Field /-7 '1 To Water ft-tim/Service Lim To Stream, Pond, Lake, ar Major Drainage Course N p .1 [r Comlents ,Ut, "6 c. 3 v —) [Page 1 of 21 tb 161 L 2-15-84