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Home My WebLink AboutMCKINLEY VIEW ESTATES BLK 2 LT 2McKinl y View sta Block 2 Lot 2 #0§1-792-06 Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191358 PID Number: 051-792-06 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name MICHAEL W. KASKEY ABSORPTION FIELD -EXISTING ❑ Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 22433 CENTURION DRIVE, CHUGIAK, AK ❑ 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 Fill added above original grade Ft. Gravel length Ft. McKIN LEY VIEW ESTATES 2 2 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 Ft' Ft. Well 200'+ -- 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1000 Gal. Surface Water 100'+ -- Material HDPE Number of compartments 2 Lot Line 10'+ -- NA Foundation 10'+ __ LIFT STATION Manufacturer Capacity Gal. Remarks Tank insulated. Alarm location Electrical installed by Tankto RIPE MATERIAL House to tank 3034 3034 Installer NORTHERN EXCAVATION drainf eld Drainfield CO/MT 3034. Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspection 1M 8/23/19 nd 10/10/19 Location and description 3`d 4`" DOOR SILL ON-SITE WATER AND WASTEWATER SECTION APPROVAL r Conditional Approval: Date ��Q►,••' . TH �.. Curtis Huff• • Huffman F` •. CE 128991 eptic rovedste APp Date/ d.2 ��'f'lF •. 12/17/20')0•`��Aw Note: this approval does not include well permit requirements. ��,��•�` kNev uoiuzriu/ ANCHORAGE RECORDING DISTRICT, ALASKA riMa l-1 u i"IE114A McKINLEY VIEW ESTATES SUBDIVISION LOT 2 BLOCK 2 PLAT 82-225 SURVEY CERTIFICATE. 1, John L. Schuller. Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Linder no circumstance should any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMaER: SCALE t�avuc 6, 2019 sr1"=30' 1 E -W 19-073 oruw av rano mm nu�arrs soak JLS NW1459 190164 0 = FN❑ 518" REBAR °F • ALS �r * 49MI ........... m '%JQr IN L. SCHULLER: • c w� LS -10408 a �' °fessionQ� rx—x�x~x�x� J K LOT 3 BLK 2 —x—X— LAXV ta t7 1831 Talkeatna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNI IPALITY OF ANCH0RAGE O n l to Water & Wa stewater Program PC Box 199650 47W Elmo a Road ! -chord Ala+kt 9951 M&% Phor�'-: W) 343-7904 Fac M7) 343.79W h1tp:?ivrwru-rn1ure.org�anr rfe On -Site Wastewater Disposal System Pt It Permit Numl r; OSPIg1:�50 Work Type, SeptieTank UpgraWc laa. Cu UL-Nuiii1ier. -05179204000 Sltc L-ogal Addross; MCKINLEY VI EV, ESTATES E3 LK .2 LT 2 O;1459 Site Mailing Address: 22433 CENTURION DR, Chugiak Owner: KASKEY MICHAEL W Design Engineer: ANDERSON CONSTRUCTION & ESI C IN E EFS I N G This permit as for the Construction of: Effective Date: Expiration Data: Lot Sita in Sq Ft: Total Bedrooms: 8119=19 811 St2020 20024 ❑ Disposal Field Q 'Septic Tank 0 Holding Tan% ❑ Povy ❑ PdvateWei I Q VVgiter Storage All ccriwructlan G 1121 be In accordarice with. 1- The attached approved -design- 2- All requirements specified in Anchorage Munidpal code Chapters 15-55 and 15-$5 end Vhe State of AlasKa. VV:3stewater Disposal RegulAtiorm (18AAC72)and Drinking Vater Reg ulaiions (18AACK) 3_ Tl i d w;j%Li�vu K1L-i i-Wv i Vg uA V,.0 it I bP10L lk+i i� 4tui it i!g L I re a 1% W110OU1 1, Tl re eI lg a lees sh1u 11 r Mi ly u ie U evulupruerht ervices De parirrlent per AMC 15,65. Provide noilfi cati on by ca Iling f 907) 343-7904 (24f7). 4_ F ra m Ociabe r 15 to Apri 1 15, a subsu rface sail absorpti on system under con31 nuctlorr duNng freezing weather shall t]e either: a_ Opened and Closed iDn the same day, or b. Covered, sealed, and heated 10 prevent freezing 8119f1 9 Received By: Dete: Issued By: Date; sh MUNICIPALITY OF ANCHORAGE �i Development Services Department ri Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-792-06 Property owner(s) MICHAEL KASKEY Day phone 9074060767 Mailing address 22433 CENTURION DRIVE, CHUGIAK, AK 99567 Site address 22433 CENTURION DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) MCKINLEY VIEW ESTATES B2, L2 Legal description (Township, Range & Section) Lot Size 20,024 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo AD U) Septic Tank ® Upgrade RX (D) ❑ Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. FWCS - BRENT WESTERN (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: (� (<i� Date of Payment: Receipt Number: (� aLl7q_t) Receipt Number: Permit No. Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Michael N. Anderson, P.E. Civil/Structural Engineering and Construction 4661 Natrona Ave. Anchorage, Alaska 99516 Phone 345 -3377 / Fax 345 -1391 Support Services Brent M. Western 907-440-4601 August 12, 2019 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: McKINLEY VIEW ESTATES BLOCK 2, LOT 2 To whom it may concern: The owner has requested we proceed forward to obtain a septic permit to upgrade the aged septic tank on the subject lot. The proposed upgrade will serve the existing 3- bedroom house. The lot and area is served by public water and this upgrade will not impact any of the neighboring properties due to the lot layout. Please contact Brent M. Western or me if you have any questions. Sincerely, Michael N. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191358, Rebecca Carroll, 08/19/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191358, Rebecca Carroll, 08/19/19 Municipality of Anchorage Page / of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~O 9~ ~O/.~ PIDNumber: Name: ~-,~,~ Wastewater System: D New ~pgrade ~ ~ ~/~ ~/~ ABSORPTION FIELD P~one; ~. /~~No. of S.~ms:~ ~pTrench ~ Shallow Trench ~Bed =Mound LEGAL DESCRIPTION so...,,.~. ~ 5 ~.o~s~ ~, SEPARATION DISTANCES ~Se,~, a Ho~,.., a s.t.~.,. Sudace w.t., ~1oo ' ~ N/A LI~ STATION LOt Size in gallons: [ Line ~/~ ' Remarks: ~ ~/ ~/~z$~ ~ZF[ BENCHMARK Inspections pedo~ed by: ~ Dates: 1st Depadment of Health and Human Se~ices approvat Reviewed and approved by: ~, .~ ~ Oate: ~-~-~ Permit No. ·S~/960013 Page ·2 of 2 · Municipelity of Anchorege DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorege, Alosko 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legol Description: ·MCKINLEY VIE~/ EST. LOT 2, BLK 2 PID No.: · 051-792-06 S~/ING TIES= A - C = 91.3 B - C = 71.1 A - D = $2.2 B - D = 51.7 A - E = 27.5 B - E = 2B.1 UTIL & DRNG EASEMENT C VALVE EXIST. SEPT! ELEVATIONS ~. Top ~- rou.~Arlo. CL[A<UF SCALE 1%40' 4/11/98 ENGINEER'S SEAL '.'-..% PAGE I OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960013 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES OWNER NAME:NEACE SEAN H & DANA K OWNER ADDRESS:P.O. BOX 671565 CHUGIAK, AK. 99567 PARCEL ID:05179206 LEGAL DESCRIPTION: ~MCKINLEY VIEW ESTATES BLK 2 LT 2 LOT SIZE: 20024 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 1/24/96 EXPIRATION DATE: 1/24/97 !: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: VERIFY THAT THE EXISTING 1000 GALLON SEPTIC TANK IS SOUND AND IS SUITABLE FOR CONTINUED USE OR REPLACE WITH A NEW 1000 GALLON TANK. RECEIVED BY: septic +30' no weLL - public w~ce? supply S Bg'SB'25' 84.03 no well - public wote~ supply VA sep~;c / g - TEST HOLE ~ - BULL RUN DIVERSION V. · - MONITOR TUBE , * o - SEWER CL~NOUT NO SURFACE WATER +100 PROPOSED L~CHFIELD NO KNOWN CURTAIN DRAINS [--]- EX~ST~NG LEACHF~ELD EASEUENT WELL/SEPTIC SITE PLAN LEGAL: MCKINLEY VIEW EAGLE RIVER ENGINEERING P.O. Box 778~4 EAGLE RIVER, AK. ~577 (907) 694-5~95 FgX: (907) 694-3297 Louis Butera, P.E. Registered Civil Engineer January l7, 1996 Jim Cross, P.E. Manager, On-Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: McKinley View Estates Lot 2, Block 2 Narrative & Permit Application Dear Mr. Cross: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The surrounding lots are large, allowing sufficient room for septic sites. This is the replacement system for this lot. The original is retained with a diversion valve. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to public well service which eliminated well protective radii. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. XG:\WPDOCS\ 1996\96-001A.NAR P.O. Box 77329.1 · Eagle River, Alaska 99577 · Telephone (907} 694-5195 ° Fax (907} 694-3297 SPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM LEGAL: McKinley View Estates Lot 2, Block 2 01/17/96 1. The septic plan is for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessar~ permits or easements and to locate any adjacent multi-family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. 9. Any remaining open test hole excavations shall be filled. 1. Septic tank shall be retained, undisturbed, with Bull Run diversion valve and additional cleanouts installed. 1. The ~'ench is to follow the natural land contour to maintain uniform total depth of the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5'. 3. The total depth of the trench excavation is not to exceed 8' at any point. 4. The effluent line be connected to the existing after tank line with a Bull Run type diversion valve. 5. The trench gravel is to be covered with typar fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 3' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class 'C' well, or 200 feet to any community well. RECOMMENDED LEACHFIEID DIMENSIONS: TOTAL DEPTH = 8' GRAVEL DEPTH -- 6' under pipe, 2' over pipe TRENCtl LENGTH = 85' TRENCtl WIDTH = 3' SOIL RATING = 0.45 GPD/ft: BEDROOM CAPACITY = 3 SEPTIC TANK = 1,000 gallon existing tank T~venty-four (24) hours notice required for all inspections. G:\WPDOCS\ 1996\96-001A.$PC Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Aiaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFOR'~EDFO.: /.~ ~-C~Vl /Je~C¢ DATE"E.FORMEO: LEC^LDESCR,.T,ON: l~',.1¢7 ~)~¢.) E~+' Township. Range. Section: ~..2 t0 11 12 13 14 15 16 17 18 19 20 I Z & PERCOt SLOPE SITE PLAN \ II/11111 ~WATER /JO ~NTERED? ~N RATE '~ 2 (minutes/tach) PERC HOLE DIAMETER TEST RUN BETWEEN '~ FT AND ~ FT IJII , / I,_/I I [,~-I I I ~. I' ILl I-~/I I/1 I I I Ixl.l~l I/I \~ if Reading Date Cross Net Del3th to Net Time Time Water Drop 3 " l: ~ I ~ COMMENTS PERFORMED BY: ~' t"/r I ~ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATF- 72-008 (Rev, 4~85) EAGLE RIVER *~ ENGINEERING SERVICES S.E~NO. Or P.O. Box 773294 EAGLE RIVER, AK 99577 C*LCUt~TEt~S~ ~^TE (907) 694-5195 CHECKED BY. DATE · ,:~..-' '" '~tcuanley View Estates Lot -2, Block 2 ................................ : ................ 01/17196 : .... :. Single Family Three Bedroom Dwelling _: ........................................................................... · ' i~3BR'x 15ogpd '= 450gpd .... i ....... : ................ : .........: .................. : .................. ..- ~: :..i ...!' : ........ .... i .Soil perc rate = .. 32 min/inch =: 0.45 gpd/ft:, application rate for trench ,..:......: . .;_ ..: .... ' ':, 'Absoi'ption ~re,4're~i~ii~d -'2. 45oi) 0.~,~ '= 'i~'00o ft~ ......... i "*i ............ · ! Gravel depth ..= 6'.*(8' total depth) !_Trench length = 1,000 ft2. ! 212' = 83' .... : ............. OPTION ! : : ..... :"! .... or 5' :wide drainfield with 4'-gravel depth,-7'.total depth ........... 1,000 ft2. ! 5 .x 0.5 reduction factor. =: 100' length ..................... i® · . ~,.'~ OF 44. -%! ~-..) ~ · ~ I ~-BU~ . _. . ,~-- ~, ~ . t I I h~eby ~tt~ thai [.ha~ ~ey~ the following d~b '." ,o,,,,.,,,,,,"''""" .... .., ..t. · .' ..,. ~ t, II~Op~;~';~e~ J mentl situated thereon are wit~ ~e property lln~ and , . .~. . .. .,. -~-r~oo.-~ I not or.lap o~ e~oa~ ~ ~ ~p~ty lyln~ odJo~nt ~ ".- C . · r.' ~ ' . :' .~ ~-~'~ J to, that no ~vemen~ on p~pe~y lytngidJicent~e, · <. ~t.s L: ~ ~'. ~ .~ .' [ ~oa~ on ~e prem~ In qu~Uon ~d ~at the~ are ~ · -- ~ '. :...,..:.-t,.~ --~ ~.. , ? · I ~dwnys, ~sion l~ ~ o~er visible ense~nb t -. ~ .... ~... ~ .~;~.. :. ~ ~,r~ ~r,~ *,,, *'',o ~ JDated at ~gle ~v~, Alas~ . '¢~' ' "~ " " ' .. · ' ' ~ ~'~ 4~;-t ~ S~ .... ~ I ", ,; '-.' ' '- ." I z- = ~ ~ .' ~,,,e. ~_~ VALVE ~ E~¢~, I / rx~s~. ~ 2 ] / ~,ooo GAL ~ ~=: / S~TIC~r ~ ~ ~ HUUSE , ~ - TEST HOLE ~ - BULL RUN DIVERSION V. · - ~ON~TOR TUBE o - SEWER CL~NOUT KEYBOX ~ ' ~ PROPOSED LEACHFNELD NO SURFACE WATER +100 NO KNOWN CURTAIN DRAINS r ]- EX~STNNC L~CHFNELD EASEMENT WELL/SEPTIC SITE, PLAN LEGAL: MCKINLEY VIEW ESTATES LOT 2 BLK 2 OWNER: N/A ~?..- .... ~osg ~-oo~l D~[: o~/~7/9~I sclc[ ~"=~o' P.O. Box 778~4 EAGL~ RIVER, AK. ~577 (~07) G~4-51~S FAX: (~07) G~4-8~7 , ~ MUNICIPALITY OF ANCHORAGE ~ DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROT~:CTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE.._, MAILING ADDRESS LEGAL DESCRIPTION L2_~ LOCATION DISTANCE TO: Liq, capac ty in ga Ions ~ ~%? <~ C~) IF HOMEMADE: DISTANCE TO: Well WeJi DISTANCE TO: No. of lines ~ Length of eac,~O Top of tile to finish grade Length Width Type of crib Crib diameter Well DISTANCE TO: ~.lass Depth DISTANCE TO: Building foundation OTHER PIPE MATERIALS pOC. IInslde length . Dwelling Foundation Total length of lines,. Material beneath tile Depth SOIL TEST RATING ~o ~,/~ .~/~ INSTALLER REMARKS APPROVED DATE / Dwelhng // M a t e~_~l~ ~.(~ W dth ~ Material Nearestlothne /~. Trench w?~Jth ~.-~-/~inches NO. OF BEDROOMS PERMIT NO. ~-._ / o'~. ~ NO. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. ~7.~ ~ PERMIT NO. Crib depth Total ef fecti~e absorption area Building foundation Nearest lot line Driller Distance to lot line PERMIT NO. Sewer line Septic tank Absorption 8rea(s) LEGAL 72-013 (Rev. 3~78) PERMIT NO. MUhi I C I~'~AL I TY OF ANCH~-~RAGE DEPARTMENT' 'HEALTH AND ENVIRONMENTAL' ~OTECTION 825 'L' STREET, ANCHORAGE, AK. 9950i 264-4~28 WELL AND 014--S I TE SEWER PERM I T ( 821085 ) APPLICANT BILL GROUSE ~S&S ENGINEERING SRB 196X 995? ~94-2979 LOCATION LEGAL L2B2 MCKINLEY VIEW ESTATES LOT SIZE ~99~9 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: ~ ~_~ MAXIMUM NUMBER OF BEDROOMS SOIL RATING <SQ FT?BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= ~: LE~GTH= '~ GRAVEL DEPTH= 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). THE TRENCH WIDTH IS 2~. 000 FEET. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEM THE OUTFRLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). REQU I RED SEPT I ¢ Ti=Ir~F~--. S I ZE= '1000 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. Tt-iO (2 > I hlSPECT IONS ARE REQU I RED BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN R WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM R PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM R PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO R COMMUNITY SEWER LINE IS ?5 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN ~0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I CERTIFY THAT l: I RM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS RS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ~ BEDROOMS. RPPLI C~NT B I L~'USE[ / / ISSUED BY_~_ E ..... ~ V4. 0 O & E ENG'~.NEERING & DEVELO, iVlENT CO. Box 90. Davis St.. Eagle River. Alaska 99577 694-2774 or 688-2280 Ruuell Oyate~ Earl EIII, 694-2774 SOIL LOG 688-2280 Depth (fe~) 8oll Characladetlca 0 1__ 2__ 3 4__ 5__ 7__ 8__ 10 11 12 13 PLOT PLAN PERC. TEST 14__ 15 16 Ground Water'Encountered: Yes.__ Proposed Installation: Comments: No ~/ If yes. what depth Seepage Pit Drain Field Performed by: .,~,,.r./~ ?'. /~' '"//" Date: 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 Parcel I.D. o5~--792-o6 1. GENERAL INFORMATION Complete legal description Expiration Date: McKinley View Estates, Block 2 Lot 2 Location (site address) 22433 Centurion Drive, Chugiak, AK 99567 Current Property owner(s) Thomas G. Mugford, Jr. Day phone Mailing address 22433 Centurion Drive, Chugiak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Peggy Pepper French/ReMax Day phone 242-6121 Mailing Address 11o W, ~8th Avenue, #1OO, Anchorage, AK 995oR · , ~i 'v ~' Unless,otherwisb~requested, GOSA will be held by DSD £or pickup. 2~ ,NUMBER,OF B~OOMS: 3 3.. 'ryPE ,OF WATER sUPPLY: TYPE OF WASTEWATER DISPOSAL: IndMdual'Well .~ [] Individual On-site Indivi,du, al.Water Storage [] Individual Holding Tank COmmunity Class A Well [] Community On-site Public Water System [] Public Sewer r-1 The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation· Name of Firm Pannone Engineering Services, LLC Phone 272-82z8 Address P.O. Box 1OO217, Anchorage, AK 99qlo Engineer's Printed Name Steven R. Pannone, P.E. Date 7/7/~1 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & 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. leThveel~Pt;~tim°an;lflliufcetu°aft~lld~Vr~Inl; ~hed;;ap~i;ns~s[l~em;ad;pend on thee local soil condition, ground water ~n. ....... ... . . .. , er usage of the family bein~ served bv the s,,st~-, ,~ ;~ ~q~ ..c~ cunumons are outside me control of the evalu~*~ ~r.~: .......... V ~ ~ ..... _~2'~F' .................... satisfacto,~, test .... ~,~ A ........ ~ ....... 1.~ DybtiTllJ.. ~'MI systems eventually fail and ~ ~ ..'" l . .7 ,,~ou~[~ uu nut guarantee Iuture pertormance of the svstem nor '~ *~- ........... ",:' x-,/~ there are no hidden defects or encroachments PES can th~r~£c, .... *~ "- uu racy guarame~e mat ~' '~."' 49 ~ ~ '". performance nor ~ive an,, est; ..... c~._. , ' _. --: ...... :~-~ nm provide any warranty for Iuture ~....,.-',~. ~, v ---,~ mnuw tong me system will continue tn meat tho ...... ' , ,~ k,. ~,,)'"~,~'"""~ .............. · - ............ upcratlonal ~ ~ -- reqmrements of the MOA DSD. The content of this report is for the sole benefit of the owner listed x: ......... abo~ve. Any, reh,an, ce. upa? or use of this report by any other person or Dartv is not anthnri~.,t ...... ;,, :, conmranyiegainghtwhatsoever. _ ..................... .~... ao. CE 8149 d for ._'~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 'y ~ / ¢ .- / / Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box lg6650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: McKinley View Estates~ Block 2 Lot 2 Parcel ID: o~;a-7q2-o6 A. WELL DATA Well type _A If A, B, or C provide PWSID # ==o697 Well Log (Y/N) ~~ f. ~aa~ite~oSea/ (Y/N~. Wires properlY_casing heir) · Date of test ~'-..~ ~ Static water level.,~~ ~ ft. Well production J ~ \ g.p.m.~ ~ g.p.m. Co~ .. colonies/100 mL Nitrate ~mg/L _ ~ .... A~enic: , ug/I Date of sample: Collected by: ~ B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer Steel Date installed ~=1=.61~98~ in. Tank size ~ooo gal. Foundation cleanout (Y/N) Y Number of Compartments _2 Depression over tank (Y/N) N Cleanouts (Y/N) Y High water alarm (Y/N) N/A Date of pumping ~, 7/6/~o~a C. ABSORPTION FIELD DATA Pumper JR's.Pumpinq Date installed ,.Inlaqq6 Soil rating (g.p.d./~ or ft2/bdrm) o.4,i System type Deep Trench Length 52/z~o Total depth 8/=.2 ft. ft. Width ~1] Eft. absorption area ~ooo ft2 ft. Gravel below pipe 6/6 Monitoring tube Y Depression over field N Date of adequacy test ?17/=o==. Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test ~.~.1o in. Water added/+ge gal. New depth~/do in. Elapsed Time: _o min. Final fluid depth A~lo in. Absorption rate >= ~.~;o+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION nstalled "Pump at, in. Datum E. SEPARATION DISTANCI SEPARATION DISTANCES FROM WEL Size in gallons "Pump off" level at ...... Cycles test~l TO: in. Manhole/Access High level at alarm & circuit requirements? in. Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer line containment areas )n adjacent lots On ~nt lots Public sewer Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation xo+ Property line, xo+ Absorption field 17' Water main 2~;+ Water service line 4o+ Surface water Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~o+ Water Service line 40+ Curtain drain. None Known COMMENTS Building foundation, 20+ Surface water =oo+ Wells on adjacent lots 2oo+ Water main ~o+ Driveway, parking/vehicle storage I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. .... ~-" Rigid Insulation over S2' Trench. Diverter valve should be switched every year or two. f~- J~'~o~ ~: ~ ENGINEER'S CERTIFICATION ..~ _~. A/'~ ~~...~ ...... ~ .................. ~.~ ~,~Steven R. Ponnone]~, ~..~% No. CE 8149 ,,*~ Engineer's Printed Name Steven R. Pannone, P.E. Date COSA Fee $ Date of Payment Receipt Number. (Rev. 11/05) 7hl2oll Waiver Fee $ Date of Payment Receipt Number il'Rs Pumping PO Bo× 77341 $ Eagle River, AK 99577 (907) 694-6454 Br'~in..g. Information Tom Mugford 22433 Centurion Drive Chugiak, AK 99567 (907) 688.0792 1~ Information .... Tom 22433 Centurion Drive Chugiak, AK 99567 (907) 888-0792 267-6700 Additional Location Comments Dl,.gram; Light Blue ranch - W/~s ( 1/2 acre Lot) septic ~ hack of home Job Description: P.O. Number:. Terms: Salasrep: Map Book: Cross Streets: Job Comments: 1000g Net 30 Kadia Oberg Road Service Agreement Number: 033759 Order Date: 01.Jul-2011 Service Date: 05-Jub2011 Technician: Dan Tax %: 0 Job Type: Repeat Map Grid: 2,1 - - Last Service *09/04/2009' pumped & checked tank 1000g Gallons Planned: 1000 Gal. Actual: -- Hose Length: 3 Double Tank: [] .,,_=., Pump System: [] Baffles Inlet: [] Baffles Outlet: [] Service Type Qty Price Each SepticServ 1000K 1 $1 Tax? Extension Actual No $185.00 NonTaxable Total Taxable Total Tax Total Grand Total Estimated Charges: $185.00 $0.00 $0.00 $1B5.00 Actual Charges; Customer agreee to thQ terms and ~onditlona ~h~wn. THIS IS A BINDING AGREEMENT. ,S. tg~atuj'e and Title of Customer Representative Accepted by ORe Pur ~plng - Date For your added ~onven ~nce ~ a~ept; Dlcover, Visa and Mas~er Card pelonis over the A~r30 Days account ,viii be turned over Io COLLECTIONS, $30.00 ~or NSF Checks Returned. 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. J')~-I- "~ '~ COSA# Dt~)~J~ Expiration Date: '7- '~ - O '7 1. GENERAL INFORMATION Complete legal description Lot 2 Block 2 McKinley View Estates Location (site address) . 22433 Centurion Drive, Chu.qiak, AK 99567 Current Property owner(s) Mailing address Lending agency Mailing address Scott & Heather Huff ,1035 Redoubt Drive, Kenai, AK 99611 Day phone 335-1491 · Day phone Real Estate Agent . P~qy French/ReMax Day phone 242-6121 Mailing Address 110 W. 38· Ave., Ste. 100, Anchoraqe, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBEROF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System [] [] [] [] TYPE OF WASTEWATER DISPOSAL: Individual On-site [] Individual Holding Tank [] Community On-site [] Public sewer [] The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties sewed by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certitificates of On-Site Systems Approval ara valid for 90 days from the date of issue for properrtes 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 wastawater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further vedfy that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Pannone En.qineerinq Se~ces,'LLC Phone 272-8218 Address P.O. Box 102954, Anchoraqe, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date. Engineers Comments: In conducting an adcquamJ test, I attempt to provide a thorough, conscientious engineering analysis of thc system in accordance with MOA DSD Guidelines & Regulations. Thc rcported results dcscribe thc performance ortho systcra undo' thc conditions ~ncountered at the time of the test, and s~amtion distances measur~ to readily identifiable features. The operational life of all wells and septic s3~lcms depond on the local soil condition, ground wato' levels that may fluctuate during thc year, and thc water usage of the family being served by thc system. These conditions are outside the control ofthe evaluator ofthis system. All systems eventually fail and satisfactory test results do not guarantee future performance of thc s'~'t em, nor do th~ guarantee that there are no hidden defects or encroachments. PES ran therefore not provide any warranty for future performance nor give any estimate of how long the s~sturn will continue Io meet the operational requirements of the MOA DSD. The content of thls report is for thc 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 v'"' Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 1 X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building ~afety Division On. ire Water & Waste~ater Program 4700 Brai]aw Street P.O. 8ox 196650 Anchorage, AK 99519-6650 www. munLorg/onslte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal De.piton: Lot2BIockZMcKinleYVlew_F__,~__. Parcel A. WELL DATA Well type A IfA, B, otC provide PVVSID # ZI0697 Well Log (Y/N) _ .~~ Sanitary ~eel (Y/N) Wires properly Total depl~ ~ Cased to -- .~fL Cas~t)ov~ ground) in. F~LOG //~/ ///~['~NSPECTION ~.. __:~ies/1. mL ~wit~of sample:mg/L B. SEFTIC/HOLDING TANK DATA Tank Type/Material Tankmze 1000 gal. FoundaUon cManout (Y/N) Y Date of pumping ABSORP11ON FIELD DATA Number of Gompem~ent~ ~ Depression aver tank (Y/N) N Pumper San~rv Pum~q C~anoute (Y/N) y High water alarm (Y/N) NIA Dateinstel~Ki4/~lg~l SollratJng (g.p.d./ft~or~/bclrm)~l,4~ Systemtype DeeDTmnch Leng~ 52J40 fL Width :~ fL Gravel below pipe ~ fL Total depth ?~/11.~ fL Eft. abeorl~on area 1000 ~ Monitoring tape Y Depression over fleid N Date of adequacy test ~/1 ~'~ Resulte (Pass/Fall) .,~lsl For}bedrooms Fluid dept~ in absorption field before test 37~ in. Water adclad4/3 gal. New depth4~l4 in. Elapsed Time: 1440 min. Final fluid depttt ~ in. AI3so~ptidn ram >- ~ g.p.d. A~y rojuvenalion trealment (pest 12 mo.) (Y/N &type) 1~9 If yes, give date O. UFT STATION Date installed 'Pump on" level at in, Datum E..:I~.~.AI~A~ TIO N DISTAN C ES S'EP~TIGIN DISTANCES FROM WELL ON LOT TO; Septic tenk/liff~ .rd 0~~ Abeoq:~on field on lot ~._.~.~__~_~//'~ On adjacent lots SEP/~ATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Manhole/Ac4'ess (Y/N) High water alarm level at Meels alarm & circuil requirements?. in. Building foundation 11) Property line 4~' Absorption field Water main Water service Dine Surface water Wells on adjacent lots 200* SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 11~ Building foundation ~ Water main Water Service line 25~ Surface water 1~0. Drh~,my, pafldng~ehicte Curtain drain Hone Observed Wells on edjacent kits 200t. G. ENGINEER'S CERTIFICATION COMMENTS I ~ ~at I ha~ de~i~ ~w ~ Mun~l ~a ~at ~a~ ~ MOA ~ gullies E~in~s Pd~ Name ~n ~ ~nnone. P.E Da~ CO,SA Fee $ Date of Payment Receipt Number (Rev, 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www. ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-792-06 HAA # H ./~. Expiration Date: 1. GENERAL INFORMATION n'3oo'-13 3 -I..-z- Complete legal description . Lot 2 Block 2 McKinley View Estates Location (site address or directions) .. 22433 Centurion Drive~ Chuqlak, AK 99567 Current Property owner(s). Mailing address Lending agency Mailing address Kevin Greqory Day phone.230-7364 22433 Centurion Drive, Chuqiak! AK 99567 Day phone. :;~,';¢,:~-'~;'c,.'~ Agent . U.S. Inspect/Evens Duclalr Day phone .703-293-1529 Mai~ing Address .. 3650 Concorde Pkwy~ Ste. 100~ Chantllly~ VA 20151-1129 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class A Well Public Water System TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] [] Individual Holding tank [] [] Community On-site [] [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HA.&) 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. DSD also issues HAAs upon request to home owners. 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 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. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation based on procedures outlined in the Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe. functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspect[on, 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 Pannone En,q. Svc. Phone. Address P.O. Box 102954~ Anch, AK 99510 Engineer's Printed Name Steven R. Pannone, P.E. Date L'x"'jc~ Engineers Comments' In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analys~s of the system m accordance wtth MOA DSD Guldehncs & Regulatlons. Thc reported results describe thc performance of the system under the condmons encountered at thc time of 4,, thc test, and separation distances measured to readily identifiable features The operational hfc of all ~ dO.:*' wells and septic systems depend on the local sod condmon, ground water levels that may fluctuate m. ~ during the year, and thc water usage of the family being served by the s~stcm. These conditions are ~ ~ outsidethccontrolofthcevaluatorofthissystcm- Ails/stems eventually fadandsat~sfactorytest resuhs ~. ~~ ....... do not g~arantec future performance of the system, nor do they guarantee that there are no h~dden defect or encroachments. PES can therefore not provide any warranty for future performance nor give any ~ ~ cst mate of how ong the system will continue to meet thc operational ~qutremen s of thc ADEC or ~ C~/_'~,, MOA DSD. Thc content ofth~s report ts for the sole benefit of thc owner listed above. Aay rehance upon e~"Jf~"'~";"'~c~ ~.~- ...... or use of th~s report by any other person or party ts not authorized nor wdl tt confer any legal right ~ 6. DSD SIGNATURE ~ Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ~..:. wATEF, At,ID Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Expiration Date: X ~- .' WASTE'~A, Ai,-r*, .; : ~. . c.~A~1 Maintenance Agreements Supplemental Engineer's Repoa Other Original Certificate Date: ~ --/.3..,- 0 ,.~ Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.cLanchorege,ak,us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 2 Block 2 McKinley View Eatal~es A. WELL DATA Parcel I.D.:. 051-792-06 Well type Class A If A, B, or C provide PWSID # 210697 Well Log Data compl~ Sanitary seal Wi~rotectad Total depth"',,,, ft Cased to ft CastngJ3eigl~t (above ground) ""~ WELL LOG , ~PECT;ON - Stalk: water level , ~ ff Wall production ,.--'""/ g. p .~'d¥,,~ g.p.m WATER SAM~ ~ _Col~ colonias/100 mi Nitrate mg/I '~.~teria ,E~ta of sample: Collected by:. ~ e. SEPTIC/HOLDING TANK DATA colonies/100 mi Tank Type/Material Oreer Ste~l Date installed ~ Tank size 100~1 gal Number of Compartments 2 Cleenouts Y Foundation cleanout Y Depression over tank N High water alarm NI~ Date of pumping ?J2112003 Pumper Sanitary Pumoq~ C. ABSORPTION FIELD DATA Date installed 4/511996 Soil rating (g.p.d./ff2 or ft2/bdrm) ~,4[i System type Deed Trench Length 52/40 fl Width ~1~1 ft Gravel below pipe .1~/6 ft Total depth 7.811'1.8 ft Effective absorption area 1000 ft2 Monitoring tube .~ Depression over field N Date of adequacy test 2/281200~1 Results (Pass/Fail) p~ For ~ bedrooms Fluid depth in absorption field bef~e test a~l~ In Water added470 gal. New depth[12(~ in. Elapsed Time: 144~ rain Final fluid depth 4512 in Absorption rate >= 45{~- g.p.d. Any rejuvenation trealment (past 12 mo.) (YiN & type). N9 If yes, give dale (Rev. 11/99) 'Pump on" level at in P,~mp'-off" level at in Datum J Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LO~ Septic tan~ift station on lot ~:~f'adjacent lots Absorption field on lot , ,/~[~JOn ad;acent lots Public sewer main Y Public sewer manhole/cleanout Sewer/septic servi~ Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Manhole/Access High water alarm level at in Meets alarm & circuit requirements? Building foundation 10' Property line 45' Water main ~.~- Water service line 40' Drainage 10{)+ Wells on adjacent lots 20{1+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field 17' Surface water 199+ Property line tI~N. Building foundation Water Service line 41~,- Surface water Curtain drain None Observed Wells on adjacent lots 200+ F. COMMENTS Water main. Driveway, parking/vehicle storage 2" Rioid Insul over 52' Tren. ch. Diverler Valve In~olace to switch belween trenche..~&%'~r~a~ad, svstem. G. ENGINEER S CERTIFICATION ~r~'- .... -';~'--'~ review of Municipal ~o~s that the a~ve systems a~ In ~.....4 ........ ~.~..; ......... ~.....~ con~o~anco ~ MOA H~ _. Engin~r s Print~ Name Steven R. Pannone, P,E. Date ~ 3 Date of Pa~ent % I ~{ I O % Dale Of Pa~ent R~eipt Numar --~'& I 0 R~ipt Numar (Rev. 11~) *' . '~'hereby certify that I have s[~r~by~'the following Anchorage Recording Precinct, Alaska~ end that the improve- ments situated thereon are within the property ]tees and do ~ot overlap or eneroach on the property lying adjacent there- to. that no improvement~ on property lying adjacent thereto - encroach on the prernL~e~ In question and that there ate no . . roadways, transmission lines or other visible ea~emente on .. laid propert7 except as indicated hereon. ' ~-.. Dated at Eagle River, Alaska · ,. ~OBERT C. 301INSON '~/ SCALE: Registered Lancl Surveyor No; 1' = ~ ~.~ I . Bo,~ 45~, Eagle River, Alaska Phone ¢907) 69.i-2543 legal Locaton(steaddressordrectons) ~', ~:" :,, = .... . .-. - · .: .~ .. Property owner ~p~n & ~nn Neace ........ - ~.,-, Dayphone 6~q 5195 ~q . ~ :,.~ .~ ~ Address .................. t..-~ ~ ............... :"'. , ;: .~, ': Unless othe~tse requested, HAA :2.~/~ NUMB.ER OF BEDROOMS: ,.' , 3' ' ,',e.,, 3. '-TYPE OF WATER SUPPLY: =. ' ~' .,~' .-.~ ,.: . . . ' ,.*~ ,.;,.-~'. .'. · ;,~ . ,' ..... ..u,v,uum ~,~,. :. .'.' i i~ ~..OTE: , .... .... ~, ,. Hold ng tank~.,,. ~"~ ~:.," c'.'~-~ ~': On-site.,, ~ ': ~ :'. ~ OTE~~' 5. STATEMENT OF INSPECTION BY. ENGINEER;,!,,* As certihed by my seal affixed hereto and as of the validation date shown below, I verify that y investigation of this Health Authority Approval applica, tion shows =t. hat the on-site water supply and/or wastewater disposal system is ~afe, functional and adequate.for the number of bedrooms and type of structure Indicated herein. I further veri!y that based on.the information obtained from the Municipality of Anchorage files and from my investigation a~d inspection the on-site water supply and/or wastewater disposal system is In,compliance ~'ith all Municipal and State codes, ordinances, and regulations In effect d~ tl~ *date (~f thi~ ir sP ti0 ; Name of Firm Ea~].e PJ. ver En(3~.nee~/ncJ Se~'V.{ces ......... Phone 694-5].95 Address p~o. I~× 773294. gaole River,·~ 99577 .... Engineer's signature .~_~~ Date x,-,.~_ ,,.~- ~-~ DHHS SIGNATURE ~ Approved for * Disapproved. Conditional approval for · Additional Comments --~he. Mu..~Lcil~_llty of A. ~l~'~orage Department o! Health and ,Human Services (DHHS) Issues Health Authority "***~ptSroval C~rqficate~.Bbs~d only upon the representations given' in p~r~gr~ph 5 above by an independent professional engineer feglstered In the State of Alaska. The DHHS does thls as ,~ courtesy to purchasers of homes and ih~e ~*' e'nd ng~t tut ons n order tosat stycerta n feders and state requ*r~ments. Emp oyees of DHHSdo not cond~:t*inspectl~ns or analyze data before a certificate Is issued. ,The Municipality of Anchorage is not responsible for errors or omissions In the professional engin~r's work '; ~ ~* .~ ~ Municipality of Anchorage ./ DEPARTMENT OF HEALTH & HUMAN SERVICES . . Environmental Services Division 825 L Street, Room 502 · Anchorage. Alaska 99501· (907) 343-4744 Health Authority/~oprovaJ Checklist A. W~I.I- DATA Well type Well pmdu~on ~ WJE~~~: NiUat~ &p.m. g.p.m. B. SEPTI~G TANK DATA Foundation ci~nnout C. ABSORFI'ION [~'1~'.n DATA Dastard ~ ?;~ ~) Grm~ thickness below pipe ~/ To~aldepth oc/ Fluid depth in absml~on ~ besom t~st (m.); m~ v. Ln~r STATION ~/~ High wa~r aian~ le~i al* / *D~mm 'Pump off' level si* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO:. Public ~ smzion SBPARATION DISTANCES FROM Sbyl'IC/H(H~ING TANK ON LOT TO: B~l~ roundado- /,~ ' · ~PARATION DISTANCE FROM ABSORFIlON I',~, n ON LOT TO: W~v~ F~ S Da~c of Pa~, l~ggip~ Nuu~x~' Rev. 8/95 OSS: baa.wi.doc MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date ,.~u.n~.. 24, 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a} Legal Description (include lot, block, subdivision, section, township, range) Lo,~. 2; 8~,ocb. 2; ~.(cKZt~,e.~/ I/Zee Location (address or directions) (b) Property Owner Mailing Address (c) Lending Instit,;tion :...'Mailing Adc~r~s~' Telephone: Home Business #27~479 · c, Telephone (d) · .ReaI Estate Company, and'Agent Address ' 4105 Tudo~ C~ O~ve~ A~cho¢~,~ ~ 9950J Telephone" ' (e) Mail the HAA to the follow(ha address: or: Check here ~, if hold for pick up. List contact pemon and day phone number below. S ~ S ENGZNEERZNG/694-2979 17034 E~g~ R,[.u~. Loop go~d, Su.,i.t~ 204 E~g&e RZve. r, A,t,a.6~z.a. 99577 O~d~.,~ed bv 8ob M~n TYPE OF RESIDENCE Single-Family ~] Number of Bedrooms. WATER SUPPLY Individual Wellr'l Communityr-I Public,~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,~[~ Public 1'3 Community I-I Holding Tank I'1 Note; If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 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~s 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 flies 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 Address Date Telephone / DHHS APPROVAL Approved for ~edrooms by Approved ~'/~ Disapproved Terms of Conditional Approval Conditional 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 englneer's work. Page 2 of 2 ~JNICIPALITY OF AN~HO~GE MUNICIPALITY OF ANCHORAGE (MOA) ,IVIRONMENTAL SERVICES DIVISION HEALTH AUTHORITY APPROVAL (NAA) " 129 1988 RECEIVED WELL DATA CHECKLIST - FEBRUARY 1984 264-4744 Legal Descr[pt_iqrl: Well Classification' Well Log Present (Y/N) Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from WeB: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments ?.~'~'~ · · '~ If A, B, C, D.E.C. Approveq~TN) · Date Completed Yield Depth of Grouting Pump Set At' ' Sanitary Seal on Casing (Y/N) Depression Around WeIIhead (Y/N) ,..~ I_/.~,~,t..,._ ; On Adjoining Lots "?--'~'c:~"'~r' ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot ; Date B. SEPTIC/HOL-EHN~ TANK DATA Size Date Installed Standpipes {~N) y Air-tight Caps~N) Depression over Tank (Y~ Pumping/Maintenance Contract on File (Y/N)t.~ Holding Tank High-Water Alarm (Y/N) . /~"~ Separation Distances from Septic~o~ank: To Water-Supply Well '""~¢=' 14'' TO Property Line To Water ,Main/Sen4ce Line _ .'. Course ...... :.;.: ....... No. of Compartments "~ Foundation Cleanout (~1) Last Pumped 1~/~~'ate ; for Temporary Holding Tank Permit (Y/N) · 'ro Building Foundation To Disposal Field To Stream. Pond, Lake, or Major Drainage Page 1 of 2 .... _- ",'" ' ' ,." -I ',i C. ,ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~'~" / Width of Field , . . Square Feet of Absorption Area Depression over Field (Y/~:~ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot To Water Main/Service Line Type of System Design Length of Field '~.."'~ Depth of Field ~' Gravel Bed Thickness Standpipes Presentd~)N) Date of Last Adequacy Test . ~ ~ To Property Line ~. ~ t To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments ; On Adjoining Lots To Cutbank (if present) To Existing or Abandoned System on i Dimensions Manhole/Access (Y/N) Pump On Leve~__ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for ' " ~es durin~ Adequacy ~'est. Meets MOA Electrical Codes (Y/N) ' ~ ' Comments. . i Chec'k Permitted Bedroom Rating Against HAA Request °* ' ~ I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in'effect on the date of this inspection. Signed / Date .-~/"~-- ~"/~r~ ~" S & S ENGINEERING ~ Comp~~tv~~, ~A No. ~-- ~ ~ Page 2 of 2 · --.-, ~ ~ E~lle RIv~, Alflka ~577...--~ Receipt No. Date of Payment Amount: $ MUNICIPALITY OF ANO"IORAG~ ENVIRONMENTAL SERVICES DIVISION ,,, 129 1988 RECEIVED STEVE COWPER, GOVERNOR P.s~o .: __~__/o__££2 ..... Tn blhom It May Concern: a¢¢ordinq to the record~ on rile in thi~ office, th~ __~_4~j__~.~_/_~_;~,/ ~"/~_~rr/.__..~/~.~,~.,7'_~/~_--J_~ ...... Uater System is in compliance ~ith the ~tare o? Alaska Drin~'jnq Mater Requlations. Sincerely. Environmental Field O?ficer Date Date Date Comments Conditional Approval JViUN[CIPALITY OF ANCHOIU~GE ENVtR 3, ~;, .t,, A.: .,O, ~CTION 5 ~ C 1 6 1982 RECEIVED Date Sewer Install~ ~& ~l~ Permit No. q.~ [ ~ Septic Tan~ Size ~,. ~ ,[~ Holding Tank Size ~olls Rating Well To Absorption Area Well Log Recelv~ Well to Tank APPLICANT FILLS OUT LOWER HALF ONLY ~ Phone Address Address Legal Description ~7~ ~1~.1 ~1 ~ ~t~ Street Location Type~ Residence ~: 'Single Family ~ Multiple Family No. of Bedrooms ~ ~lndividual A~ACH WELL LOG. A we~l log Is requlr~ for all wells drill~ since June ~mmunity 1975. For wells drilled prior to that date, give well depth (attach log [3 Public Utility available.) Sewa~ Disposal ~ndlvidua~ Year Individual InstallS: ~ ~ O Public Utility When ~nnected to Public Utility; ~ Holdln~ Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY ~CH REQUEST BEFORE PROCESSING CAN BE INITIATED.