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TONJESS ESTATES BLK 2 LT 10
ss� Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191100 PID Number: 051-831-03 ❑ New ❑✓ Upgrade Name: TYRONE ROWSE ABSORPTION FIELD Dee ❑ p Trench El Shallow Trench FI Bed ❑ Mound Address 24997 SCHAFF DR, CHUGIAK AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 1.2 GPD/SF 12.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.0 Ft. Gravel depth beneath pipe 6.O Ft. Subdivision Block Lot TONJESS ESTATES 2 10 Fill added above original grade 0.0 Ft. Gravel length 42.0 FL Township Range Section Gravel width 2.5Ft. 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 504 Ft2 1 Ft. well 106.4 100+ N/A N/A N/A TANK p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 500 Gal. Surface water 100.0+ 100.0+ N/A N/A Material Number of compartments Lot Line 15.6 5.0+ N/A N/A STEEL 1 NA I Foundation 10.0+ } 10.0+ N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50.0+ 50.0+ N/A N/A Gal. Remarks CHANGE ORDER &WAIVER FOR FIELD Pump on level at in. Pump off level at in. High water alarm at in. CHANGES TO FIELD AND LOT LINE SEPARATION "LOCATED UNDOCUMENTED AND IMPROPERLY Pump make and model Electrical Inspections performed by ABANDONED WELL ON L11 TO THE SOUTH Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield JR'S SEPTIC Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 397ft Inspection 151 05/06/19 dates: 2"d 05/06/19 Location and description 3`d 05/15/19 4'" THRESHOLD FRONT DOOR COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp .. �L� Conditional Approval: Date 1< ,® .. ..... �jtteven PanrioRe � Approved Date CE 8-14�� 11 IaNcwvlI RC'JVI l_ I -I' 14..000 W U G G G U 4 W G G G G G 4 m m m m m m t0 �D t0 �O �O t0 000000000 0 0000 NO GROUNDWATER 26APR2019 NOTES: RECORD DRAWING I DRAWN I JRL I SITE PLAN m-tc)mv-y -u�c)0..`.=Op oO 1c: CD f D O m -F . r �t 09 cpm m -1 prrx � m � z O C rl Fn 0 In M I Dx �(n c�=�zZ=1 m - D DO -��>0cziW0_i -{ 0 0 f *1 C O I I Lng 0 - Z z (n �O WA m 0 m i O Z �m p 0 m D r 02 00 n Em O D Ul rZ-' cD77D(n DD - Z �PC mOO CnppIL, -DmrO�-10m CD(n D Z D D< D x Om OOD - mz7 m 70 _ ;l Z m .. O cn y cn OM Ono. Ln0 C7 00) r-;0>7, �cn �°a,cn �o r ;u-0 - DO < rnm �z mO D DO m D C7 D \ < = U1� Zp p O _t Q my N O (n x p Frl m D � O D11»-1Z-0� C-OmDp� U) MF �z �m D-(7TW cj� z-<MD�tnmz 00-iDND-<G1 =QUO.. �Om 0 N) p er () T1 0 T1 m 0 0 --j zL' n m fTl = U) p 0 —I G) O m cf) D >� /z D O � ."00 Ln oo0 0 Lf) (A 9 < o \ \ *�. ". O 0 z- I I I I / \\ O I / o�rm- \�\U zz O r I I I N\\ 0 r N\ -- M ----1 r9 C7 r m o chit w 0)D PANNONE ENG SVC LLC P.O. BOX 1807 PALMER, AK 9645 PHONE (907) 745-8200 FAX (907) 745- TONJESS ESTATES B2 1-10 TYRONE ROWSE 24997 SCHAFF DRIVE CHUGIAK, AK 99567 RFA�c� OF- �P40 TH "fiteven R. ann e �;. CE 8149 1, REVISIONS uAit 05/15/2019 1" = 60' P.I.D. NO 051-831-03 2 OF 2 Municipality ®i Anchorage ` �`��•' l)epartntent P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Department On -Site Water and Wastewater Section * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV191032 COSA#: Permit#:OSP191100 PID#: 051-831-03 Legal Description: Tonless Estates Block 2 Lot 10 Engineer: Pannone Engineerinq Services Applicant: Tyrone Rowse Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. See engineer's waiver request for justifications. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ................................................■.............................t Waiver is Granted: X Waiver is not Granted: Date: S 21 % Y Approved b / p Name of Reviewer ............................................... ■ ............................. ■ t **** VARIAN C E/WAIVER REVIEW **** Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com May 15, 2019 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street P 0 Box 196650 Anchorage, Alaska 99519-6650 Subject: TONJESS ESTATES B2 L10 Lot Line Waiver Request Ladies and Gentlemen: We request a waiver to five foot (5') to the lot -line from the drain field. Due to obstacles the homeowner wished to leave alone and the surrounding terrain, the only location remaining for the field is along the south lot line. Granting this waiver is not likely to affect the health and safety of this lot or the surrounding lots now or in the future. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, 4o,®,oea$ R 4 of AS°o ,u X Steven R. Pannone • CE 8149 0 /�q 4 Steven R. Pannone, P.E. Owner/Civil Engineer Anchora'e Mailing: P.O. Box 1002.17, Andhorage, AK 99510-0211" Palmer Maining: P.O. Box 1807, Paimer, AK 99645 Teleohone: !907" 754-8200 FAX: (0107) 754-8201. OsV191011 S 25 5/ 21') l R 'Pn oy94 CIO 0 7y 4 Xl ASBUILT—NO CORNERS SET THIS DATE. , zo .. SE[IARD & ASSOCIATES LAND I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE: z' - -- -_ FOLLOWING DESCRIBED PROPERTY: 4� A4 DATE: o AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 9z //� v INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS A/ k1 WHICH DO NOT APPEAR ON THE RECORDED SUBDI— VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: Duane Mark Seward s—�—�,6 ANY DATA HEREON BE USED FOR CONSTRUCTION cjs OF FENCENESLINES, OR FOR ESTABLISHING BOUND- DRAWN: ARY LI. MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSPI91100 Work Type: Septic Upgrade Tax Code Number: 05183103000 Site Legal Address: TONJESS ESTATES BLK 2 LT 10 6:1462 Site Mailing Address: 24997 SCHAFF DR, Chugiak Owner: ROWSE TYRONE R & JULIE A Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 'S I)cypartIII ell t 4/29/2019 4/28/2020 50486 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: t 9V//j_ Issued By: fz;, at'zev Date: d Date: / 4 P\\\, us P4 MUMCIPAUTY OF ANCHORAGE Community Development Department ter. Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-831-03 Property owner(s) TYRONE ROWSE Mailing address 24997 SCHAFF DRIVE Site address 24997 SCHAFF DRIVE Day phone Legal description (Sub'd., Block & Lot) TONJESS ESTATES B2 L10 Legal description (Township, Range & Section) Lot Size 50,486 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: (® all that apply) APPLICATION IS AN: TYPE OF DWELLING: Absorption Field Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade x pg (w/wo ADU) Holding Tank 1:1Renewal ElDuplex ❑ (D) ❑ Multiple Dwellings ElPrivy (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: or_q�5_ Waiver Fees: Date of Payment: q f I Date of Payment: Receipt Number: 050 19A Receipt Number: Permit No. 0 3 A l q 1100 Waiver No. Permit App__- : :'_. c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191100, Rebecca Carroll, 04/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191100, Rebecca Carroll, 04/29/19 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191100, Rebecca Carroll, 04/29/19 E-MAILED j3aL-rA r z -I`1 7 / ► 9 Inspection Report_1-1-12.doc Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181398 PID Number: 051-831-03 ❑ New ✓❑ Upgrade Name: TYRONE ROWSE ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 24997 SCHAFF DRIVE MOther Phone Number of Bedrooms Soil Rating I olal 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 TONJESS ESTATES 2 10Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line Ft' Ft. Well 106.4 N/A N/A N/A 110.0 TANK EI Septic ElS.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHRORAGETANK Capacity 1000Gal. Surface water 100+ N/A N/A N/A Material STEEL Number of compartments 2 Lot Line 15.7 N/A N/A N/A NA Foundation 12.4 N/A N/A N/A LIFT STATION Manufacturer Capacity Gal. Curtain Drain 50+ N/A N/A N/A Pump on level at Pump off lev High water alarm al Remarks in. in. in. Pump mak model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer JR'S SEPTIC SERVICES Drainfield CO/MT 3034 Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assumed elevation) 395,0ft Inspection151 11/19/18 11/20/18 11 /20/18 and description tes: 2" SE BOTTOM HOUSE TRIM 3'd 12/12/18 41h COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ' TH f % "Steven' •'�onnone' IIJJ i'^ Approved Date 8149W s Zj _.�CJL(',CR Inspection Report_1-1-12.doc \/ 370 \1 � /- 375 .380 3135J —390 .P / z •�. C> I v/yj,f f O � ' r /�`` ty�l l 395 € I /lrL v\Yd 3 BDR \ \ SFD CRA€N FIELD (E) REMOVED SEPTIC TANK E106.4 l �� r TI PER MOA CODE �€ 1 o ..� f, S?C�•' i �� I CC3� 1^JELL E ! l• f f I 1 INSTALL 1000a SEPTIC TANK / \ 1 W/ DCO AFTER. INSTALLED DCO BEFORE i — w — w A B DC 1 17.7 16.9 DC2 17.9 I 19.6 T1 18.9 23.9 T2 22.0 29.1 DC3 29.7 311.3 DCk 28.9 28.9 — w — w — WATER LINE WELL RADIUS — SS — SS — NEW SEPTIC ABBREVIATIONS TH TEST HOLE (P) PROPOSED (E) EXISTING CO CLEAN OUT NO. MT MONITOR TUBE NO. TYP TYPICAL / �z ��� Z \ WELL E ti wo o 0 z z o- GU (J J NOTES: I i3 ENG C, LLC Date RECORD DRAWING C i ANCH t a . 12%17/18 P.O. 80X 102954 ANCHORAGE, AK 99510 .,•••"` PHONE (907) 272-8218 FAX (907) 272-8211 ••'•,.� Scale 1" = 50' ... .. . ..... P.I.D. NO TONJESS ESTATES 82 L10 51-831-03 TYRONE ROWSE •• le • *p lw U; PERMIT NO. DRAVv'N ACP 24997 SCHAFF DRIVE CE 8149...- OSP181398 SITE PLAN CHUGIAK, AK 99567 Sheet 2OF2 NZ ASBUILT-NO CORNERS SET THIS DATE. SMARD & ASSOCIATES LAND SURVEYING 688-4566 SCALE: DATE: 4 T ti GRID: Duano Mark Seward FB-* �T,, % LS — Ar 41 DRAWN; MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program pOBox 1966o 4700 Elmore Road Anchorage, Alaska 9951S'00oO Phone: e04 Fax: (9O7)343r997 Permit Number: DSP181398 Work Type: SeptoTankUpQnode Tax Code Number: 05183103000 Site Legal Address: TONJES5ESTATES BLK 2LT 10 G:1462 Site Mailing Address: 24897SCHAFFDR, Chugiak Owner: R[)VVSETYRONE R&JULIE A Design Engineer: PANNONEENGINEERING SERVICES This permit isfor the construction of: AMI-EM11IMMMI V; Lot Size in Sq Ft: aN 01, %pop )e pa rtment 11/8/2018 11/G/2010 1771 Disposal Field 2 Septic Tank El Holding Tank El Privy 1771 Private Well El Water Storage All construction shall beinaccordance 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 (18AAC8O) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65.Provide notification bycalling (SO7)343-7SO4(24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall beeither: o. Opened and Closed onthe same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: rd EPNS MUNICIPALITY OF ANCHORAGE Community Development Department t Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-831-03 Property owner(s) TYRONE ROWSE Mailing address 24997 SCHAFF DRIVE Site address 24997 SCHAFF DRIVE Day phone Legal description (Sub'd., Block & Lot) TONJESS ESTATES 132 L10 Legal description (Township, Range & Section) Lot Size 50,486 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank RUpgrade ❑x (D) El Holding Tank ❑ Renewal ElDuplex Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: Receipt Number: Permit No. J6 P ! $1 V Permit App_, -:- :'-.-'c, Waiver Fees: Date of Payment: Receipt Number: _ Waiver No. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181398, Rebecca Carroll, 11/06/18 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181398, Rebecca Carroll, 11/06/18 r`. MUNICIPALITY OF ANCHORAGE DEPARTMENTPROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT prioNE NAME W Witty MAILING ADDRESS ,A��,� ,AV' c)9503 21oZ Ci »�tixll `�} At LEGAL DESCRIPTION Lok tO bits 2_ LOCATION VY o. cr Wa ~ Es4e, ks i%+b 2"19 -G514- k1 N EW ❑ UPGRADE e»c.. Lu C4 i s.t-r.-Ff Pc 1 Well DISTANCE TO: NOT 1fl Manufacturer Cyr cr."- Lig. capacity in gallons I IOW IF HOMEMADE: • JVZ 1 1 -- DISTANCE TO: Well Manufacturer O J= Wla _0 LL - 2 W 1 -Res crO Well DISTANCE TO: No. of lines Length of each line Absorption area Inside length Dwelling Foundation Total length of lines 30, Dwelling NOT iN MaterialSlat teeI Width Material Nearest lot line 12-0 Trench width /O inches NO. OF BEDROOMS 3 PERMIT NO. B2-09 OS No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons P E HM ITIJ,LO985 Distance between lines Top of tile to finish grade Ar W 0 Qt— W N Length Width Type of crib Crib diameter DISTANCE TO: Well J W Gass Depth DISTANCE TO: Building foundation OTHER Material beneath tile Depth Crib depth Building foundation Driller Sewer line PIPE MATERIALS �lel,ti� inches Total effective absorption area 460 fl` PERMIT NO. Total effective absorption area Nearest lot line Distance to lot line Septic tank PERMIT NO. Absorption area(s) SOIL TEST RATING 146 -R-1- / bcctrvvr+' INSTALLER 7 t i p EKw4A 1•i REMARKS APPROVED Il. sect 12-7.1 Ser-rAp tr Dt~ DATE LEGAL //� /c eve Ss k.$l?As- 0710 zs/i/c 7 . 72-013 (Rev. 3/78) • • 1' �p ih Drilling ?log DOC Co. doa SULLIVAN WATER WELLS P. O. BOK 272, CHUGIAK, ALASKA 59567 • TELEPHONE 688-2759 OWNER OF LAND /'4C t Lrl R % err wS' i DEI'EIl OF WELL APO 1. ADDRESS lass. 11 • �si<el 49:6 5 STATIC LEVEL OF WATER FT. SJ LEGAL DESCRIPTION_4- /o . ,S-tC3.r •;‘" Jt DATF. - Started PERMIT NUMBER Ended DRAW DOWN FT GALS. PER IIR KIND OF CASING cry 600 KIND OF FORMATION: From_O Ft. to u2 From Ft. to it From_(_Q_Ft From t_Ft to 59 From Ft.to From .1-21 'Ft to / 7 From-[.0Fl. to / 7/ Ft._1?.Eii'/3'• ali.^> From Ft SL91%)0 t G4A✓,sh From Ft to Ft. Ft. Ccr/J' E l,C4c1-AL _ Front Ft to Ft Ft 544a ICAC04.0c G 6.' /From Ft to Ft Ft /14/SCO From Ft to Ft Ft. [3i500eOG is From Fl. to Ft. Ft ___ tQ.lnck' .6.001Cdai From Ft to Ft. Ft.to Ft. L From Ft.to - Ft. / d C �"' From FromfG—Ft.to Jib Ft ;2a.eiaCK Sjcj From Ft. to From Ft.to From Ft to From Ft.to From Ft to From Ft to • From Ft: to' -. From Ft to From Ft to Ft. Ft. From Ft. to Ft Ft. From Ft to Ft Ft. From Ft.to Ft. Ft. From . .. Ft to Ft Ft. From Ft to Ft Ft. From Ft. to" Ft. Ft. From Frio Ft. -. Ft. From Ft to Ft MISCL.INFORMATION: t" 'rc r'r- t " ceirnoc • ,t .t_: DRILLER'S NAME r MUC.t I C Ie^PL I TY OF PJNCE. )RFIGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, 6NCHOR0GE, AK. 99501 2 O N— S I T E SEWE R PERM I T PERMIT NO. < 820985 > 2702 GAMBELL ST 99503 APPLICRNT STEVEN WHALEY LOCATION L JDLOT SIZE 999999 LEGAL TOP SS ESTATES 010 12 (1 �-K J So. �S TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUFI NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 145 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEPTH= 12 LENGTH= 2SORPVEL DEPTH= S THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION <IN FEET). THERE I5 NO SET WIDTH FOR TRENCHES. THGRAVEL DEPTH IS THE EXMMINIMUM DEPTH F OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE E0TDOOF REG!U I RE6 SEPTIC TFINFY SIZE= 1000 GFILLONS PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE ILAIINSPECTIONS ONST FHAANY YEWEWELLS LILADJACENACENT TO THIS PROPERTY AND THE UMBER OF RESIDENCES TWO <27 INSPECTIONS FIRE REIQU I RED --- BACKFILLING ANY WITHOUT OUTSFFINAL NAIOINSPECTION AND APPROVAL BY THIS DEPARTMENT WIFLBE SUBJECT TO 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 A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE I5 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. OTUIEMAY AINSTALLATION. SPECIFI ATIONS AND CONSTRUCTION DIAGRAMS ARE HIRRREQTO INNTSEPROPER PERMIT E}{F} I RES DECEMBEFZ 1s'82 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SETI CERTIFY THAT 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 3 BEDROOMS. 3( O. nrtF 279-0574 SQUARE FEET SIGNED: APPLICANT ISSUED BY EVEN WHALEY DATE -_2/ t V,) = S G -D _ 3 / rb - !1C c4. 0(E lJ • /1 ICJ SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: 5 t --y> V Q (,l1 tG.) Q y LEGAL DESCRIPTION: TON .5E55 EST ATG$ 1 2 3 4 5 / 6 7 \A 8 9 10 12 FPTE lL 4 r ¢, 1? • GP SF/.(A.1N o v- ltiN+>�J a.C. '6 • -• 13 • ; ��P1m MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Parcel I.D. 051-831-03 Certificate of On -Site Systems Approval Expiration Date:.W o v .23 Q 0 f Complete legal description Tonjess Estates B2 L1 Q Location (site address) 24997 Schaff Dr, Chuglak, AK 99567 Current property owner(s) Tyrone Rowse Day phone Mailing address Real estate agent 2. TYPE OF DWELLING: El Single Family (w/wo ADU) El Duplex n Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well Q Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received �, �/.�°' Date: COSA to be released to the engineer, unless othenvise requested by the engineer. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA 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. Reliance on this report by another person is at their own risk. Pannone Engineering Services LLC highly recommends buyers hire their own engineer to evaluate this report. Name of Firm Pannone Engineering Services Phone (907) 745-8200 Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R. Pannone P.E. Date OF AkqS���� 6. DSD SIGNATURE : • • �� System #1 Approved for bedrooms �� ' _:tniren ro-il;•o I:te System #2 Approved for bedrooms �,1 =t ��js . Disapproved jNN®i��® Conditional approval for bedrooms, with the following stipulations: Or' By: (i Gi q Y Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Tonjess Estates B2 L10 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 10/82 Total depth 180 ft Cased to 61.6 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 10/18/18 Static water level at beginning of test 73.5 ft. Comments B. TANK DATA Age of tank(s) 0 years Tank type/material Steel Measured operating fluid level in septic tank ❑ Standpipes/foundation cleanout per record drawing Date of pumping New D. ABSORPTION FIELD DATA Which system tested (date installed) 04/2019 S❑ ALL standpipes present per record drawing Total measured depth from grade 12 ft (max) Measured depth to pipe invert from grade 6 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-831-03 Structure served by this system Well production at time of test 1.7 gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑✓ No ❑ Coliform bacteria is Negative Nitrate 2.79 mg/L ❑ Nitrate less than MRL (ND) Arsenic ND ug/L ❑ Arsenic less than MRL (ND) Collected by PES Date of Sample 08/08/19 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date New Results 1JPass For 4 bedrooms Fluid depth prior to test 0 in Water added 0 gal New depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ❑✓ Yes Community Sewer Manhole/Cleanout > 100' M✓ Yes if No ft ✓M Yes if No ft Neighboring Tank > 100' [771 Yes if No ft Private Sewer/Septic Line > 25' F71 Yes if No ft Absorption Field on Lot > 100' Q✓ Yes if No ft Holding Tank > 100' R Yes if No ft Neighboring Absorption Fields > 100' Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft M✓ Yes if No ft Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' 0 Yes if No ft R✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ®✓ Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: 0 Absorption Field > 5' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' ✓1 Yes if No ft Community Wells > 200' Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' (]✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 5 ft Wells on Adjacent Lots: Water Main > 10' 0 Yes if No ft Private Wells > 100' Yes if No Water Service Line > 10' FV -1 Yes if No ft Community Wells > 200' 0 Yes if No Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS Waiver on file G. ENGINEER'S CERTIFICATION� OF mac.' .I I certify that l have determined through field inspections and review p of Municipal records that the above systems are in conformance with MOA COSA TFI guidelines in effect on this date.Aw COSA Checklist yellow sheet ft ft Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 4 r Certificate of On -Site Systems Approval Parcel I.D. 051-831-03 Expiration Date: �j 1. GENERAL INFORMATION Complete legal description Tonjess Est, B2 Ll 0 Location (site address) 24997 Schaff Dr. Chugiak, AK 99567 Current Property owner(s) Tyrone Rowse Day phone Mailing address 24997 Schaff -Dr. Chugiak, AK 99567 Real Estate Agent 2. TYPE OF DWELLING: nx Single Family (w/wo ADU) 171 Duplex El Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual nX Individual Water Storage ❑ Holding Tank 171 Community Class Well El Community 171 Public Water System 171 Public Sewer 171 WaiverNariance request for: - Distance: _- -- ------ _37-11-- 7-7— Received by: Date: 7 COSA to be released to the engineer, unless otherwise requested by the engineer. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, 1 attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA 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 Pannone Engineering Services LLC Address P.O. Box 1807 Palmer, AK 99645 Engineer's Printed Name Steven R Pannone Phone (907) 745-8200 Date L CZE OF :4C, 6. DSD SIGNATURE *•.... System #1 Approved for bedrooms : S even . 06nnone •' System #2 Approved for bedrooms 9-,. CE -8149.1 Disapproved ,l A�OFE5S1ci.�'r Conditional approval for bedrooms, with the following stipulations: Rte, -n YL I +VA-) 'k,� c, L} - l0 Q_ C� +-a 0 M 110 � � . 1 1� e- t ko . tko cVta +n +kC S;.i S--kPt (AD'1 11 �Jc>„ye { a b e LJ l_00 ;` CIV -SITE R tl,TE-R IQ j \A1AgTFWATER =� PROGRAM G� 000_0_�Meu BY ^ ��?�-t� Q Ori inal Certificate Date: Original l I � The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet—f .. Legal Description: TOD|eSS Est. B2 L10 A. WELL DATA Well type Private |fA.B.orCprovide PVVS|D# Date completed 10/82 Sanitary seal (Y/N) Y Total depth 180 ft Cased to 61 6 ft. FROM WELL LOG 1/1��� DDatecf�et D ~ Static water level 575 Well production 1 on _.5 WATER SAMPLE RESULTS: Em Coliform N8Q —|onies/100mL Nitrate 2.87 mg/L Arsenic ND ug/L Dateofsample: 10/18/18 B. SEPTICXHOLDUVGTANK DATA TankTypo/yWoteha| S8Dfir/Sf88l Tank size 1000 gal. Number ofCompartments 2 Foundation cleanout (Y7N) \/ Depression over tank (Y7N) KJ Date ofpumping NEW Pumper _ C.ABSORPTION FIELD DATA Kmore than I septic system isonthe lot: COSAChacNiot#101__ Structure served bythis system 1____ 051-831-03' Pa��|D� � W�L��N_____ Wires properly protected (Y/N) \' Casing height (above ground) 18 in. AT INSPECTION 10/1A/18 73� . ft. 1.7 9 -P -M - Collected by: PES Date installed 11��0/18 od '^-�' C|eanouts (YYN) / High water alarm (Y/N) N/A Date installed 9/27/87 Soil rating (g.p.d/ft2m82 /b m)145 System type T[8DCh Length 30 �� VW���'�� ft. Gmvebe�wpipe � ft. Total depth 12 ft. Ef[absorption area 480 fe Monitoring tube \/ Depression over field Kj Date ofadequacy test 10/18/18 Renu|to(Pasa/Fai|) Pu�� For � bedrooms Fluid depth in absorption field before test 42 in. Water added go|. Newdepth64 in. Elapsed Time: 160 Final fluid depth 58 Absorption rate >= 600+ __A.p.d . Any rejuvenation treatment (past 12mn.)(YYN&type) KJOO8 KDOVVD |fyes, give date ____� D. LIFT STATION Date installed "Pump on" level eiin. "Pump off"Ievel at in. Datum WELL ON LOT TO: __ Size ingallons Cycles tested Septic tank/lift station on lot 100'f Absorption field onlot 100'f Public sewer main 75'f Sewer /septic service line 25'f Animal containment areas 50.+ Manhu|e/Acoeao(Y/N) High water alarm level at in. Meets alarm &circuit requirements?_______ 1��'f Dna�a�mt��____ Onadjacent lots 100'+ Public sewer manhole/cleanout 1004 Holding tank 100'f Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK DNLOT TO: Building foundation 12'4' Property line 154' Absorption field �5 1f Water main 25'f Water service line 10'f Surface water 100'+ Wells on adjacenlots 1004 ABSORPTION FIELD ON LOT TO: Property line 10'f Building foundation 10'+ Water main 10'f 1' VVo�rSom�aUno ^~O + Surface water 100'f Driveway, parking/vehicle storage 104' Curtain drain None Known Wells on adjacent lots 100'f F. COMMENTS Field iSabout 60%used. G. ENGINEER'S CERTIFICATION / certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COS4guidelines /neffect onthis date. Engineer's Printed Name Steven R. p8DDODe. P.E. Date coSA canary sheet_2-6'15.mm --- W.-Uga ... . Pan�������������� ������°�������°���� �������=�°��«� LLC none ~�~"��°"~~~~~"°"^�� °�^~" �u~~~�= ��~^ Steven R.Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com 4 January 2019 Municipality ofAnchorage Development Services Department On -Site Water & Wastewater Program 478UElmore Road POBox 28665O Anchorage, Alaska 995l9'66SO Subject: TonjessEstates 82L10 COSA Approval Ladies and Gentlemen: We request a COSA approval on the above mentioned property. The Onsite system was designed for a three bedroom house. The house was built as a three bedroom house and then expanded to four bedrooms. The Onsite system has been in operation for 32 years and is currently about 60 percent used. PES conducted an adequacy investigation on 10/18/2018 and added 600 gallons into the system. The water levels rose 22 inches, and then immediately began to a drop when the water was turned off (most likely the 22 inch rise was caused by hydraulic head from water being introduced into the system.) On average a 4 bedroom house will have 5 people living in il with an average waste water production of 50 gallons per day per person for a total of 250 gallons per day. We request a COSA approval for 3 bedroom/ 600gallons per day. When the current onsite system fails it will be replaced with an onsite system designed for 4 bedrooms. Granting this approval will not affect the health and safety of this lot or the surrounding lots now or in the future. If you have any questions or concerns, please contact me at 907.745.8200. Simcereky, Steven K.Pannone, P.E. Owner/Civi|Engineer 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 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING 051-831-d3 1. GENERAL INFORMATION Complete legal description COSA# 0$n n Expiration Date: 1' t' - 2 a - 0 O TONJESS ESTATES, BLOCK 2, LOT 10 Location (site address) 24997 SCHAFF DRIVE * CHUGIAK, AK 99567 Current Property' owner(s) RICK TURNER Day phone 688-0711 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 24997 SCHAFF DRIVE • CHUGIAK, AK 99567 Day phone MARGARET BILLENGER w/PRUDENTIAL Day phone 689-6464 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: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank O Community On-site ❑ Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 axed hereto and as of the validation date shown below, 1 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 GARNESS ENGINEERING GROUP. Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: 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 it Regulations. The reported results described the performance of the system under the conditions encountered et 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 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 perfomrance 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 wilt continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Ls for the 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. Date 9 )i6 /o 8 5. DSD SIGNATURE Approved for , bedrooms. Disapproved. Conditional approval for bedrooms, with the Mowing stipulations: ti; WATER AND : WASTEWATER PROGRAM :e. • i��• ,,,..• // 1)xl\ 0)\ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineers Reort Other Original Certificate Date* g - 2 a.- 03 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST �1 Legal Description: TONJESS ESTATES, BLOCK 2, LOT 10 Parcel ID: D; 0-g 3 1 - 03 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A, Well Log (Y/N) YES Date completed 10/1982 Sanitary seal (Y/N) YES Total depth 180 ft Cased to 61.6 ft. Wires properly protected (Y/N) YES Casing height (above ground) 18 in FROM WELL LOG AT INSPECTION Date of test 10/1982 8/6/2008 Static water level 57.5 ft. 97 ft. Well production 1.5 g p.m. 0.625 g.p m. WATER SAMPLE RESULTS: Coliform . 0 colonies/100 ml. Nitrate. &(o mg./L. Other bacteria n colonies/100 mi. Arsenic: AI ug./L. Date of sample: 7/31/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA "CLEANOUT IN CRAWL SPACE Tank Type/Material SEPTIC/STEEL Date installed 9/27/1987 Tank size 1000 gal. Number of Compartments 3 Cleanouts.(Y/N) YES High water alarm (YIN) N/A JR'S PUMPING Foundation cleanout (Y/N) 'YES Depression over tank (Y/N) NO Date of pumping 8/8/2008 Pumper C. ABSORPTION FIELD DATA Date installed 9/27/1987 Soil rating (g.p.d./ft'o t /bdr) 145 System type TRENCH Length 30 ft. Width 2.5 ft Gravel below pipe 8 ft. Total depth "10.08 ft. Eff. absorption area 480 ft' Monitoring tube YES : Depression over field NO Date of adequacy test 8/6/2008 `Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test **61 In. Water added 500 gal. • . New depth "'65 In. Elapsed Time• 120 min. Final fluid depth 51 In • Absorption rate >= 450+ g.p.d. f OELOW EXISTING GRADE Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — "15.5 INCHES BELOW THE INVERT "1.5 INCHES BELOW THE INVERT D. LIFT STATION Date installed "Pump on" level at in Datu E. SEPARATION DISTANCES Size in gallons "Pump off" leve Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main - 100'+ 100'+ N/A Manhole/Access (Y/N High water alarm level at in. Meets alarm & circuit requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 251+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent Tots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main Water service line 10'+ Surface water 1001+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS N/A Driveway, parking/vehicle storage 10'+ G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this dale. Engineer's Printed Name JEFFREY A. GARNESS Date K 1 t kijOk3 COSA Fee $Seillber 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 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Nater Well Advisory Health Authority Approval # 080290 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 2, Lot 10 of Tonjess Estates subdivision, the well's productivity was determined to be 0.625 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.41 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. ••••—••••.. •I.In •MILL!% +C07 351104 7-564 P.002/002 F-436 • SBUILT-140 CORNERS SET THIS DATE. HEREBY CERTIFY THAT 1 HAVE SURVEYED THE RlOWING DESCRIBED PROPERTY: ro-4n'Sr er O7a-J .e.02-64; ar: t • D THAT NO ENCROACHMENTS EXIST EXCEPT AS DICATED. IT IS THE RESPONSIBILITY OF THE 'HER 1D DETERMINE THE EXISTENCE OF ANY SEMENTS,COVENANTS, OR RESTRICTIONS IICH DO NOT APPEAR ON THE RECORDED SUBDI- tION PLAT. UNDER 140 CIRCUMSTANCES SHOtRD Y DATA HEREON BE USED FOR CONSTRUCTION •FENCE LINES, OR FOR ESTABLISHING BOUND - :Y LINES. • SEWARD & ASSOCIATES LAND SURVEYING 688:4566 SCALE: /-So DATE' Per/P/:::" GRID: .. /Weenc = DRAWN: • `RtOF A • Oven. /Ank i n / .# titc L.5 ••6911!1 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OS/ M/ 0 3 HAA # 0 7 0 2 6 7 Expiration Date: 9 - / 7 - 0 Li. 1. GENERAL INFORMATION Complete legal description Y oy,Pss .a �. Location (site address or directions) a4579,zc5<.vAfF I�P Current Property owner(sy9 iz#c sl T.tet v,F 5:44.4.4.4444) Day phone n Mailing address T4' p �,,.-f ��Y9e .4� 995-0sz Day phone Lending agency Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System0 .LSI 0 0 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank 0 Community On-site ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm, s-2/ Tivec{ Ec a%w-fes,* s Phone O9y .T/9.5— Address /6tY/ gSS9 MO./ A.•ku.c Mc'n alt 99-e" 7 Engineer's Printed Name 6iS1,1'n roj'sce-.a- . ' Gz/�do Date O/ 5. DSD SIGNATURE l71--- Approved for 3 bedrooms. Disapproved. Conditional approval for R WOOD CE10187 e. bedrooms, with the following stipulations: • Additional Comments �, :• ON -Sir • Cr - X : WATER AND • r II C • , 11. • PROGRAM *MTh MI • Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory BY •)/19. IA/ rere4— (Rev. 01/02) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 4 — / 7- 0 4- • Legal Description: A. WELL DATA Well type / 'j tre If A, 8, or C provide PWSID # _ I ell Log ON) Date completed /c4Yt2 Sanitary sealcj94) 1/.oro Wires properly protecteceN) )/.0'.3 Total depth , depth /2170 ft. Cased to ra/l:ft. Casing height (above ground) a/ in. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST %.e/5 -F -5 FarAxe- ,4io R 2 Parcel ID:Pn6"/ — 8'5/ -o3 FROM WELL LOG Date of test A072911Z Static water level T ft. Well production /.,�' g.p.m. WATER SAMPLE RESULTS: Coliform t7 colonies/100 ml. Nitrate 2.2Y Arsenic: N/A- mg./I. Date of sample: X//l/p'j BSEPTICII TANK DATA 0 AT INSPECTION eoy /6/ ft. O.0 / g.p.m. Other bacteria 4' colonies/100 ml. Collected by: C &E 5 Tank Type/Material 4=✓EFa.e.. Date installed e1���,' r3 Tank size' /ego' gal. Number of Compartments X Cleanouts&N) yr, Foundation cleanout! !))4 Depression over tank (Y5 Nd High water alarm (Y80) 40 Date of pumping tS ^i — Or Pumper C. ABSORPTION FIELD DATA@ Date installed %/rl/rp Soil rating (g.p.d./ft2 Length 30 - ft. Width "DtIMPC? K Z±t System type ?.eg•, ctA1 ft. Gravel below pipe $ ft. Total depthJy (j. Eff. absorption area `reft2 Monitoring tube 1 Depression over field _iJ0 Date of adequacy test 0//z/,,ber Resulta-as 7f ail) Fluid depth in absorption field before test nr-Jin Water added 4Wgal. Elapsed Time: no min. Final fluid depth .grin. Absorption rate For bedrooms New depthil•5n. >= Ys g.p.d. Any rejuvenation treatment (past 12 mo.) (1eiype) if/O.cJ, n If yes, give date ""X� D. LIFT STATION Date installed Size in gallons 'Pump on' level at _ in. 'Pump off" $t•"_ in. Datum ycles tested '. SEPARATION DISTANCES° SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot //.3 1 On adjacent lots On adjacent Tots o e/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? Absorption field on lot Public sewer main Sewer /septic service line in. Public sewer manhole/cleanout Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation (0 ' Property line ter/ Water main f/O ' Water service line /'V Wells on adjacent lots redo 1. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line is/e, Absorption field Surface water Building foundation /2 ' Water main 'f'/O1 - Surface water /i00 Driveway, parking/vehicle storage Curtain drain /O O Wells on adjacent lots 7700 Alowls .Ca- m.1 F. COMMENTS 0 P Rfloeb5 ,WATLAtLE 04 AS-Buiti ofCWTevt. raFoRt%I4T 0frAtnitro FRor\ P12gtjrovtS tt&iia64,,cttickni leoVkC, G. ENGINEER'S CERTIFICATION !certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name CTinS TaPtfi`2 R. k!aob Date 67/e/oci 45,3-4 HAA Fee $ &tt /fro Date of PaymentWfrivi Receipt Number S7$cc 1.n. (Rev. 12/01) U Waiver Fee $ Date of Payment Receipt Number 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.ci.anchorage.ak.us (907) 343-7904 Water Well Advisory Health Authority Approval # 040267 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Block 2, Lot 10 of Tonjess Estates subdivision, the well's productivity was determined to be 0.61 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.31 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. •win un41LLA +907 35214T4 T-564 P.002/302 F-436 SBUILT-NO CORNERS SET THIS DATE. 4EREBY CERTIFY .THAT 1 HAVE SURVEYED THE 'LLOWING DESCRIBED PROPERTY, remetres _ Ctzrp - _ for, a'.r:.j • D THAT No ENHMENTsDICATED. IT IIS THES ESPONSSICBILITY tsT OF DccEpT E 'NER TO DETERMINE THE EXISTENCE OF ANY SEMENTS,COVENANTS, OR RESTRICTIONS ITCH DO NOT APPEAR ON THE RECORDED SUBD(- 61ON PLAT. UNDER NO CIRCUMSTANCES SHOULD Y DATA HEREON BE USCTION FENCE LINES, OR FOR ESTABFoR LISHING BOUND - LINES. SCALD SEWARD & ASSOCIATES LAND SURVEYING 688-4566 /-So; DATE; P7/9/2 z GRID, ..vw446L 3z -W DRAWN: �P�� ars*.* 1:.Rtg * . THA. •.;�,�,'� • r �� *Ferrer . • ouuw M..k k.wrd • •. 134.0978 C. i • Municipality: of Anchorage Development Seivices Department • Building Safety Division On -Site Water & Wastewater Program ' 4700 South Bragaw SL Ra Box 196650 Anchorage, AK 99519-6650 www. d.an chorage.akus Gorrlrnc»aaxn+eo( Y5 • - j ; (907) 343-7904'. ;' , ' Parcel I.D. on (�/146i.v 4 into l oa• sa CERTIFICATE :OFtHEALTH ,AUTHORITYAPPROVAL" FOR A SINGLE 'FAMILY DWELLING 051 $31 a3 04-7 432 11 GENERAL INFORMATION Complete legal p P g description TONJESS • ESTATE; !LOT 10, BLOCK = 2 Location (site address or directions) .: 24997' SCHAFF DRIVE EAGLE RIVER, AK , 9577 Current Property owner(s) JENNIE :SMITH is . Mailing address Lending agency Mailing address Real Estate Agent Mailing address Day phone .. RESIDENTIAL MTG. "' Day phone 222-8805 ATTN: ° ESCROW DEPT. DEBBIE JENKINS ' ' *222-5561' *222-8897 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage • Community Class 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 (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 clays from the date of Issue for properties served by a private or Class C well and may be reissued with new water sample results Tess than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 'Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $635.00 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 verily that my Investigation, based on procedures outlined In the Health AuthodtyApproval 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 stricture 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 • ALASKA WATER & WASTEWATER CONSULTANTS. INC. phone 337-6179 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, AW1NC, Ina attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines & 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 Identifiable features. The operational life of all wells and septic systems depend on tho local 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 systom. 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 operailonal requirements of the ADEC or MOA DSD. The content of this report Ls for the sole benefit of the owner listed above. Any reliance upon or use of thls report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. / Conditional approval for / I N t t Un r tnek;71; na 1 c p'pro1/a l Date . Garness; C 7953 ....• : . Q ,..• �oqv 0'Prore ssior`3 �04000� 1/4\QP��I�F AN, �S :J • ON-SITE y m= : WATER AND bedrooms, with the flowing stipulations: WASTEWATERPROGRAM • ▪ O • •• ▪ J01fi"il/ SENr)1Cxjl �P p/n,e.CS 'th-e— C.. n es ;titivta/ 0-7r (o -l4-01 0 rpLOIia� Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Ray. 12m) Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date. 7 - / 7 - O 1 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cI.anchorege.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: TONJESS ESTATES S/D; LOT 10, BLOCK 2, Parcel ID: 051-831-03 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/1982 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 180 ft. Cased to 61.6 ft Casing height (above ground) 12+ In FROM WELL LOG AT INSPECTION Date of test 1 0/1 982 5/15/01 Static water levet 57.5' ft. 99' ft Well production 1.5 g p m •0.7 g.p m •S&5 ENGINEERING WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate 2.86 mg/L. Other bacteria 0 colonies/100 ml. Date of sample* 5/10/01 Collected by: •S&S ENGINEERING B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date Installed 9/27/87 Tank size 1000 gal Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N)YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 5/16/01 Pumper SANITARY C. ABSORPTION FIELD DATA Date Installed 9/27/87 Soil rating (g.p.dJft'o4 //bbdrrr )145 System type TRENCH Length 30 ft. Width 2.5 ft. Gravel below pipe 8 ft. Total depth Date of adequacy test 6/28/01 Results (Pass/Fall) PASS For 3bedrooms Fluid depth In absorption field before test 2 in. Water added 11300 gal. New depth 35 In. Elapsed Time: 350 mina Final fluid depth32 In. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) TERRALIFT If yes, give date 5/25/01 12 ft. Eff. absorption area 480 ft' Monitoring tube YES Depression over field NO D. LIFT STATION Date Installed Size In gallons Manhole/ 'Pump on' level at In. 'Pump off" High water alarm level at In Datu • Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots Absorption field on lot '-'f( 1001+ Assumed On adjacent lots Public sewer main N/A Public sewer manholelcleanout N/A Sewer /septic service Zine 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 51+ 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 line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parkingNehlcle storage 101+ SFS&- A. -t --a. &1/41(2 3.457 100'+ 100'+ Curtain drain NONE KNOWN F. COMMENTS G. ENGINEER'S CERTIFICATION Wells on adjacent lots 100'+ 1 certify that 1 have determined through field inspections and review of Munidpal records that the above systems are In conformance with MOA HAA guidelines In effect on this date. Engineer's P7ted ame '713 a/ Date JEFFREY A. GARNESS C 953 Oeup 4 o ��OO0000b HAA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number Receipt Number (Rev. 12/00) MUNICIPALITY OF ANCHORAGE MEMORANDUM WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO. D/D Q'32. During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot /0 Block '- of TOt/O-E5/ Are Subdivision, the well's productivity was determined to be e).7 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 bedroom residence is _0, 3 gallons • per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. ASBUILT-NO CORNERS iET`THIS-BATE. • • • .. • :.• gARD &'•ASSOCIATESLAND SARVEYING 6884566 I HEREBY CERTIFY -THAT .I HAVE SURVEYED THE' FOLLOWING • DESCRIBED PROPERTY: AND 'THAT NO ENCROACHMENTS EXIST DCCEPT'AS INDICATED. IT 1S THE RESPONSIBILITY OF• THE OWNER TO DETERMINE THE .EXISTENCE OFNANY • EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH. DO NOT APPEAR ON THE RECORDED. SUBDI- VISION PLAT. UNDER N0 CIRCUMSTANCES.'SPfl D ANY DATA HEREON BE USED•FOR CONSTRUCTION • OFFENCE LINES, OR FOR ESTABLISHING'BOUND-. ARY LINES. Y DATE: • 979/PL GRID: • • • . .NWly6L Fat . DRAWN:`:: • :` • r .LS 16918 e • • Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# u/-ifli Oag Parcel1.D. 1551— 5r31- D3 1. GENERAL INFORMATION Expiration Date: 53 -IS- D/ Complete legal description Lot 10, Block 2, Tonjess Estates Subdivision Location (site address or directions) 24997 Schaff Drive Current Property owner(s) Janice Snyder Day phone Mailing address Lending agency Day phone Mailing address 24997 Schaff 688-7345 Drive. Chupiak. AK 99567 Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 —)11- 2 4_ c /trio y TYPE OF WASTEWATER DISPOSAL: 0 Individual On-site ❑ ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ Public Sewer 0 1. e .tcs _ < < r... .,fefi. 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 we!! 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 cr omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 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. S & $ ENGINEERING Name of Firm 17034 Eagle River Loop Road No. 204 Phone Ga % -a 9 7q Address Eaglet River, Alaska 99577 Engineer's Printed NameRobert C. Cowan, P.E. Date �6i$/0 CON0,T/6,4pc. NRH ,r4 RE.a✓tsrf0 7-0 RE•,.oki Fog_ Se»n HaEa. c Rt.7ErT 30 DAy?tit TERRA Llicr REJ✓vt,Vn7ioA- O� r / 5. DSD SIGNATURE Approved for Disapproved. Conditional approval for $20.000 00 rn he put in thin nffira hng givan fipnl bedrooms. crNGINE e4 .t YST MP r 9 YROBERT C. COWAN / e: 5 S1e0 •.‘ CE -8801 .40:4- "41, :.- ++t ttZ‘, FlOfLrp1+�`tio �/ L�ZZ ts� 3 bedrooms, with the following stipulations: escrow. Money to eszrnw shall not ha ralnagarl ,,ntil approval if 11'� to gaprAr cycr.,m is 1'cEjuredr it shall be complete by 8-15-01. Additional Comments \tttk\i'l0F 4" J` • ON-SfTE •Gl `X: WATER AND T"a WAS1EWATtK • PROGRAM • Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory PC BY: itv (Rev. 12C0) �/. /_D- " Maintenance Agreements Supplemental Engineer's Report Other • Original Certificate Date: G - /t '© / Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1. -Ori 0;faLOGIL 2;f O.-1 7SS Parcel ID: Sip A. WELL DATA Well type 17/L( Vice If A, B, or C provide PWSID # Date completed JQ Z Sanitary seal (Y/N) Total depth /pt% ft. Cased to 4uSft. FROM WELL LOG Date of test lO/f}2 Static water level 57. ' ft. Well production / • S g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate Z. mg./I. Date of sample: S j/O / d / Collected by: B. SEPTIC/HOLDING TANK DATA Well Log N) es Wires properly protected (Y/N) AS Casing height (above ground) /L In. AT INSPECTION q/ /TO/ 99 ft. D-9 g.p.m. Other bacteria D colonies/100 ml. c z c rni�tuccmn ^. 17034 Eagle River Loop Road No. 204 /_ Eagle River. AL: rha 99577 Tank Type/Material 4,1 IL / Date installed 9/67 Tank size /0100 gal. Number of Compartments Cleanouts (Y/N) 76C Foundation cleanou to ) 14 Depression over tank (YIN) Ai° High water alarm (YIN) ^v/A Date of pumping J /t /O/ Pumper iriii/ 1114 1 C. ABSORPTION FIELD DATA Date installed 4 Soil rating (g.p.d. ft2 ftZ/bd ) M System type T n/C. Al Length 30 ft. Width -. 7 ft. . Gravel below pipe 8 ft. Total depth /?i ft. Eff. absorption areaeUift2 Monitoring tube Date of adequacy test '51/510 / Results (Pass/Fail) Fluid depth in absorption field before test _ in. Water added gal. Depression over field 410 For 3 bedrooms New depth_ in. Elapsed Time: _ min. Final fluid depth _ in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.)RN & type) i -eI-L /P- If yes, give date g/ZS O/ 72 gti 1,/Fr 612.570 / . !! o V6 ?are sT� �1 ,9t ‘-n/Ci/Nteen. /NCr C// 6/0-8/12/• D. LIFT STATION Date installed Size in gallons "Pump on" level at in. 'Pump off" level at _ in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: /f Septic tanMrift•,tatlun on lot / 00 On adjacent lots /00 r Absorption field on lot / 00 II- On adjacent lots / 00 r Public sewer main N / Q Public sewer manhole/cleanout A/ /A- A Manhole/Access (WN) High water alarm level at Meets alarm & circuit requirements? In. $swf/septic service line � /'- Holding tank SEPARATION DISTANCES FROM SEPTIC/FjOLGING TANK ON LOT TO: Building foundation S d' Property line S 14.- / Water main Ala Water service line / O +' Surface water eilWells on adjacent lots /OD r •r' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Absorption field S i f Property line /0 r 4- Building foundation /O f /00 14 - Water main 'V 1/ / D r Water Service line /O *' Surface water / 0 0 r Driveway, parking/vehicle storage T Curtain drain /VD/Vie— /4.1111 1/Wells on adjacent lots /0 0 't F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. /1458€.er C. ee1.44n/ 6/C/0/ Engineer's Printed Name Date 1� r % R&.I�AMP COWAN f� j . v I1 g • CE -(3801 �« f 11 lc" .,4. At.-).......,. tt 1 ft O F...........•••; ,„'.,, �VECJJt7 4 HAA Fee $ Y J 3 oo. Date of Payment Receipt Number (Rev. 12/00) C /n/of 00 SGS'/ Waiver Fee $ Date of Payment Receipt Number Parcel I D M MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING (A _0 ;t -(]3 1. GENERAL INFORMATION Complete legal description HAA ti 1a ilk Q 1'4n (14) Lot 10; Block 2; Toniess Estates Location (site address or directions) 2497 Schaff Property owner Terry Walton Day phone 688-6248 Mailing address Chugiak, Alaska 99567 Lending agency Day phone Mailing address Agent ASSOCIATES RELOCATION c/o Jeanette Griggs Day phone 344-0501 REALTY CENTER, INC. Address8400 Hart -ill RnnA Anrhnrnge. Alaaka 44507 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 4 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer X% NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 IRev. 191) From 1,10* 921 VA vow W.9 (16/1 'MU) Sitrt! •>IJoM sJaau!6ua Ieuo!ssa;ad eqf u! suo!ss!wo Jo sioina io; elq!suodsw lou s! e6ejogouy ;o Al!led!o!uny4 0141 •panss! s! eleo!ppaa e eio;eq mei ezAleue Jo suogoadsul lonpuoo lou op SHHO;o saaAoldug •swawannba ems pue papa; u!eyao A;sues of lappo u! suo!fnmsu! 6u!pual (10141 pue sewoy;o siasegomd of Asaunoo e se 0!143 scop SHHO eyl tIsely;o e1MMS 0141 u! paJals! 6ai laau!6ua leuo!ssa;oid wapuadapu! ue Aq enoge 9 gdejbeied u! uan!6 suo!leluesaidaJ 0141 uodn Apo paseq.saleo!;!va0 !muddy AlP041 y 42180H sans! (SHHO) sao!nies uewnli pue y1!eaH;o wewvedaa ebejogouy;0 A!Ied!o!unvl 0141 N011fldo swawwo0 Ieuol3!ppy :suo!lelnd!1s 6u!Moilo; 0141 t1!M 'swoapaq es,:orS,1,t to •0N •^�'; 313dv rw o01:1 GOON 1011 i ...;..».»AI1._ so iner *le Ib:• .yr . Is 0000 ttPr JO -Lb -1212 ew0 Jo; lenadde leuo!1!puo0 •panoJddesl0 •swoapeq Jo; panaddy —7- 3Hf1J.VNOIS SHHO 's euoyd LLS66 Elan 'J•nla •1603 we. ;GNI peox dool J•nlx •lee3 btCLL ON11133NION3 S 8 S emleu6!s s.Jaau!6u3 ssappy uu! j to eweN •uo!loadsu! 0!141;o Esup 0141 uo bane u! suollelnSa pue'saoueu!pJo 'sapoo ems pue Ied!o!unlry He yl!M eoue!!dwoo u! s! walsAs Iesods!p JaleMelseM Jo/pue Alddns Ja1eM ells-uo 0141'uouoadsu! pue uolle6!lsanu! Aw was pus sap; e6eloyouy;o A4!Ied!o!unyN 0111 was pau!elgo uo!lewJolu! eys uo paseq mut AsianMayl•m; ! *want" poiso!pu! elnlonlls;o edAl pue swoapeq 40 Jagwnu 0141 Jo; elenbape pue lsuo!foun;'a;es s! walsAs Iesods!p JawMalseM.o/pue Aiddns Jal2M al!s-u0 eyl 3ey1 smogs uo!leo!Idde lenaddy A1uoginy 1411291-1 s!141 ;o uope6!lsanu! Aw lets Alcan l'Molag umous elep °o!1ep!len eyl;0 se pus many pax!;;e leas Aw Aq pa!;!Pao sy H33NION3 AEI NO1103dSNI d0 1N3W31y1S 'S Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lair 1 O e'u4-.2104 A. WELL DATA Well type YC-' V rv1 If A, B, or C, attach ADEC letter. Log presentN) Date completed Total depth , SO Cased to Sanitary seal P/N) Date of test Static water level Well flow Pump level T FROM WELL LOG %o-32 Sit le 14 9D. o UK SEPARATION DISTANCES FROM WELL TO: t Septic/holding tank on lot 1091 Absorption field on lot 1 0D } Public sewer main Parcel 1 D ADEC water system number JIB lo- Si Driller c'''1%.#1.- A.4. tO 11 41" Casing height Wires properly protected 4N) t*P4 grptint 1214" AT INSPECTION (y -29-9Z 1/41 Or • On adjacent Tots • On adjacent Tots t cot Public sewer manhole/cleanout Petroleum tank 4- 14 - Sewer service line 2S 14� WATER SAMPLE RESULTS: 4 O wise,..$2 Coliform Date of sample: 1-9-9y B. SEPTIC/HOLDING TANK DATA Date installed `1 ' 21- 61- Nitrate Cleanouts &'N) High water alarm (Y LI Collected by Other bacteria A1GAV-ie S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank size l o0o Compartments 7 - Foundation Foundation cleanout ON) _'Depression (Y5) r-) Alarm tested (Y/N) ri/A Date of pumping 1 0 - 1 o - c11 Pumper T2 .Ga4 .sl r Lo40'1-042 /AI 4eAvJL-srALE SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 10 9 1 On adjacent lots )o0 jr Foundation 101 k To property line 1D 1 Absorption field Surface water/drainage 1 0 01 72-026 (Rev. 7/91) Front Lot Watermain/service line 10'4 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size In gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes SEPARATIO• a TANCE FROM LIFT STATION TO: I W on lot On adjacent lots ' Surface water D. ABSORPTION FIELD DATA - Date installed" '7-1'S� Soil rating 144System type T-+S�a Length 3°1 Width ° Gravel thickness 6 k Total depth 1-z-' :Total absorption area 46i.4 Cleanouts present (F)'N) y 'Depression over field (Y/ 1 Date of adequacy test (_J Results, ail) P�-s for '-etf-tt- (3) bedrooms Peroxide treatment (past 12 months) (Y0 Ade._ s' do e.1 Al If yes, give date ,-1/A. SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1ve14- On adjacent lots L°c>eA Property line 1D%*To building foundation \ 6 e } To existing or abandoned system on lot ...IL On adjacent lots -15 t4. Cutbank `S )4Watermain/service line 10I t3 4- Surface water ) 00 Driveway, parking/vehicle storage area '�° t^ Curtain drain a%A• E. ENGINEER'S CERTIFICATION '''t .1 I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspechn. J 5 & 5 ENGINEERING i 74 .. 'QF *SO;;S 11 17034 Eagle River Loop Road No.204 • �'••,y 4 Signature R : {eEa7lc River, Alaska 99577 %r 49�``Sy # M..N. .N • NW.N., Engineer's Name ••..• • • N •N g .9 -Z( -q2 •' I� R E •SHAFER: woe Date ., : tir �s:No. 8215' ',tee. 4121.•„.;•. • _ .•'r• �vr �_ tkv4VoFES o -. -27�9Z HAA Fee $ / 7 0 Date of Payment Receipt Number 72-026 (RN. 3/91) Back MOA 21 (a 0 7—e2(7 7 os *065 Waiver Fee- $ Date of Payment Receipt Number WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO /Pi ,2 0405 During a recent Health Authority Approval on-site inspection and test of the potable water supply well on Lot /0 Block 2 of TONTESS EST -Pi -ES Subdivision, the well's productivity was determined to be .7S gallons per minute. The minimum well productivity required by this department (AMC 15.55) for a 3 bedroom residence is .3/ gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of noncritical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Health Authority Approval. ri l�or 1C> VAN- Z "(1) elms eser, F t_l Ft...o t l T es -r d —rp, - — �°—?1-....9 2 -'fi M E—.. --_4') 11:ot>s 85 __ l c 1... _._1 a 1 9 C - -TO- PbNP Zs'. `t l., Art - 11_. 9 n. 1'1_..9 ..1 z. _.-1 le L71, mt.J J• 1 1: c cnrM - qui . Gr4 `i Ono - GFS &IPA 11..6 ,Nt4 11.1 4Act- 1 v.3 Gm.- tett; I 1t+r•l $ 8 5 ENGINEERING 17034 Eagle River Loop Road Neil $1 Eagleltiver—Alaika 99577 Parcel I D # MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Or/- F3 / -o3 HAA # —tel o o 7 7Y4 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision. section, township, range) Lot 10; lock 2; Tonjeaa Eatated Location (address or directions) 24997 Sha4j( Dni.ve, ChugLah (b) Property owner Lew.ia J. Aiken Telephone : (home) 688-9957 Business 694-4070 Mailing Address HC 79 Box 6426 Churaak, Ata4ka 99567 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent Re/Max off Eagte Riven Attn: Vinginia Kohlfietd Address Telephone (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: 5 & 5 ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family ❑x Number of bedrooms 3 7- 3. WATER SUPPLY Individual Well ax Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site CU Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (A.v. 7/88) Page 1 of 2 C. ABSORPTION FIELD DATA a Soils Rating in Absorption Strata /14 5 0/8 j7 Type of System Design _! KIS &G:1 Date Installed C1 —2 — g 7 Length of Field 30 ' Width of Field 3o �� Depth of Field • 1 2 Gravel Bed Thickness `a a Square Feet of Absortion Area '-i 80 # Statndpipes Present (Y/N) Depression over Field (Y/N) ►J r Date of Last Adequacy Test Results of Last Adequacy Test 5A 1i T i S Ac.tor1 3 P ed4-oo M SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / o0++ To Property Line To Building Foundation Z 0 t Lot NA To Water Main/Service Line • On Adjoining Lots To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 30 t Comments 1 (0-2®-50 104 To Existing or Abandoned System on .10 it To Cutback (if present)' n)/A N�A D. LIFT STATION Date Installed - Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments "Check Permitted Bedroom Rating Against HAA Request" I certify that 1 have checked, verified, or conformed to all MOA and HAA inspection. Signed Company Date MOA No. EN aInEtR)NV 17034 Eagle River Loop Read Nv. Eagle R/er, AI,:y�2 r9 9577 C 0'03 Receipt No. Date of Payment 7 -5 C� Amount $ l ) 0 dU 72-026 (Rev. 7/88) Back guidelines in wig? O'a •+• a II Wirt. 'F des)kC is 1 T • ......»• ..... girIL-11 fM>"rTs, do ; .•4b Receipt No Waiver Fee* $ Date of Payment Page 2 of 2 11111 ..: ie; 11.40•..4.0.4..• CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS RLPOP.T EY SAMPLE for Work Order 125076 Date Report Printed: JUL 6 90 1 1C:21 Client Sample ID:Ll0 12 IONJESS :STATES S/D PWSID :OA Collected UN 2/ 90 4 1y:05j hrs. Received 0-4-t his. Preserved with :AS REQUIRED Analysis Completed :JUL 4 90 Laboratory Supertteo,:STEPHEN C. EDE - E.Tiiiid�y Client Nene : S L S ENGINEERING Client Acet : SNSENGP P.0.t NONE RECEIVED Req 1 Ordered Ey : R. SEALER Send Reports to: 1)S i S ENGINEERING Special Instruct: Chemlab Ref 1: 902153 Lab Smpl ID: 3 Parameter Tested Matrix: NAIL/ Result Unita Allowable Eethod Limits NITRATE -I Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED EI R. RYAN. - 2.0S y/1 EPA 353.2 10 1 Tests Performed ND- None Detected N1- Not Analyzed ' Sae Special Instructions Above " See Sample Reaaras Above LT -Leu Than, GT -Greeter Than UA -Unavailable • e r 1 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5883 B Street Anchorage, Alaska 99518 •.Drinking Water Analysis Report for Total oliform Bacteria t TELEPHONE (907) 582-2343 TO BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D./ PRIVATE WATER SYSTEM Name Mailing Address Phone No. S SS ENGINEERING I1DJ4 Egle River Loop Rood No. 204 ENI* River, Alaska ,,577 CIty SAMPLE DATE: i 1 IoM Mo. 2qState l3� Day SAMPLE TYPE: led Routine L? Check Sample (for routine sample with lab ref no. 0 Special Purpose Zip Code Year ❑ Treated Water ❑ Untreated Water SAMPLE Time P40. LOCATION Collected 1 1 Lit t o161nC/Cp irCticeSsE,44*ts i los 21 • ) 3I 4I 1 51 Collected By f TO BE COMPLETED BY LABORATORY Anal s shows this Water SAMPLE to be: Satisfactory ❑ Unsatisfactory ❑ Sample too long In transit; sample should not be over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mall. Date Received Le -25-`-o Time Received 1325 Analytical Method: Membrane Filter i • No. of colonies/100 ml. Lab Ref. No. Result• 902153 ■r. III ■ ■■ Analyst READ INSTRUCTIONS BEFORE COLLECTING SAMPLE BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter. Direct Count Conform/100m1 Vedfkation: LT8 BOB Final Membrane Filter Results Conform/100ml Reported By Date -4,--s:, -7,3 Time: TNTC = Too Numberous To Count OB = Other Bacteria PART Ola: or Two `tf:' Rto4A1 MICR TO FOLLOW a T. •m 4. Ir Pak r-. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 09 s 1. GENERAL INFORMATION (a) Legal D cription (include lot. block. subdivision. section, township, range) tit /0 dz % .1 Location (address or directions) (b) Applicant Name-'/pnfrt./ tri-L4fr.✓ Telephone: Home at -XS 5;1 Business S.Tc -3760 Applicant Address CRa Box l si-6, (t.., -4 1 9$3 –4-7 (c) Applicant is (check one): Lending Institution 0 ; Owner/builder; Buyer 0 ; Other 0 (explain). (d) Lending Institution C?C .27/401 cc/ J Telephone Address (e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: 5&Srata/leering SRB 196x (f) tog Miver, Alaska 99577 2. TYPE OF RESIDENCE Single -Family a Multi -Family 0 Other Number of Bedrooms L.? 3. WATER SUPPLY Individual WellAi Community 0 Public 0 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 0 Community 0 Holding Tank 0 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 72-025 (1144) r r- 1. 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 tiles 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 Telephone Address S 8 S Engineering SRB 196x Date _E,j{s.a ,A7aj;,QQS77 6. DHEP APPROV_) Approved for bedrooms by 1— 11 — 431.9 Date %/ !/ 6 Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions In order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 111/64) • A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOM, HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ACME K -1ST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION Legal Description LST t o et c. "2 - IAN IAN 2 01986 RECEIVED Strr, oases t' r If A, B, C, D.E.C. Approved (Y/N) Well Log PresentO/N) Date Completed 10 -82 Yield • S CriP64 4 - Total Depth l SOF Cased to tot1 43 It7 • Depth of Grouting Static Water Level 'S 1011 Pump Set At 0%14 -- Sanitary Seal on Casing (SYN) Electrical Wiring in Conduit (EON) Depression Around Wellhead (Y/1' Separation Distances from Well: To Septic/Fielding Tank on Lot Casing Height Above Ground _7-zr" 1o4 To Nearest Edge of Absorption Field onof To Nearest Public Sewer Line tA Cleanout/Manhole 1A To Nearest Sewer Service Line on Lot ? C 14" Water Sample Collected by S h S C - I,J:11-WG • Date 1-1 to — Su - Water Sample Test Results SA- TlSV)--e-oran....) Comments 1t'� tn/�L ✓i�in rE-sr 51-k, &o T1/,_4 t-JfL. m ptoo xo /^J rtxC..-f-ss o, • See Pi" - termor • On Adjoining Lots t 001"r • On Adjoining Lots 1 can Jr To Nearest Public Sewer B. SEPTIC/HOtDTFTG TANK DATA Date Installed 41- 2-1- tin- Size l t3o.- No of Compartments Z Standpipes4)/N) (Yi ^ Air -tight Caps N) Foundation Cleanout (Y/LQ Depression over Tank (Y/0 Date Last Pumped 1 -1 to - S Ee Pumping/Maintenance Contract on File (Y/N)j /�` • for IJ Holding Tank High -Water Alarm (Y/N) �! p Temporary Holding Tank Permit (Y/N) /A Separation Distances from Septic/Hafding Tank: To Water -Supply Well 1 o ' To Building Foundation ti, r 1 To Property Line 1 0- To Disposal Field It, r To Water Main/Service Line 1 o e+ To Stream, Pond, Lake, or Major Drainage Course •J /P Comments Page 1 o12 72-024111;841 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field 41-2-'1 `SZ 4'5-* I (334-- Type of System Design —112-a)c—N 3D r Length of Field Depth of Field t2� Gravel Bed Thickness Square Feet of Absorption Area 1-kto Standpipes Present (57.11N) Depression over Field (Y93) Date of Last Adequacy Test Results of Last Adequacy Test SATS V-7,--ciro'`j Separation Distance from Absorption Field: To Water -Supply Well V o0 To Building Foundation J P Lot To Water Main/Service Line ?.-c, } 1--tIO--BIo To Property Line t a I-4— To Existing or Abandoned System on or1' loa' . On Adjoining Lots To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Cutbar)!c (if present) A ra D. LIFT STATION Date Installed Dimensions Size in Gallons Ma hole/Access (Y/N) "Pump On" Level at� 'PPump Off" Level at A-' High Water Alarm Level at 1�(, Vent (Y/N) Tested for /� Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check 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. l -1'I -etc Signed S & S Engineering SKB 196x CompanyEactt" ai»^r, shts.v.t.99577 MOA No Receipt No. S-10 Ll aS Date of Payment Amount* $ to S •Ob Date Page 2 of 2 72-026 01,84) SS oo 3 APPLICANT FILLS OUT UPPER HA(' ONLY ! c Zip Code q j687 Phone 376 7-73z, Property Owner ��-*�uCe— -J./ /7// *jading Address P.O. /3051C// 40/.."7.:51',--44: Buyer' Address Zip Code Lending Institution 4�AAY tic__ Zip Code 7,,/`177 Phone /q / .n -1a �P'sn-/'.l/4 Aar, Address .5-7?, ... 9X/Cfeerre9e7 E Realty Co. & Agenthone I I .ii Address 21p Code ,, ✓i Inspector MImnrt Legal Description Xa- 701 �G. "Co< z- 72:74-16363S E67247t5 Street Location Type, Residence 29 Single Family ❑ Multiple Family No. of Bedrooms I 'r Pt ii i/ O Other W ter Supply Individual O Community O Public UtilityL' � /// , ATTACH WELL LOG. A well,.fag Is required for all wells drilled since June 1975. For wells trilled prior to Iha( date, give welt flep(b (attach log II available). _ '�f/ Y; (I 4' - S,ewir Disposal X Individual ❑ Public Utility / ❑ Holding Tank I ( .� � // Year Indio intoned. J! /%O When ectad to Public Utility. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time em, AQC C an o Date Date Date Date 1-`4 ..Cs.3Cu_c� Inspector Inspector Inspector MImnrt Inspect° A' ITV C- •No Field Notes: �t�, ` p /-/y p� c\ ca.( P6!_I y`y t� I biro Li) d 1��1G-r5J t'lnc�kr_ 0 • .A ci OC- r- \- CnP< \.0-1...t_. 1• o lCao Ci D. °T• cc I - ;. • A . ENYIRJ U: ;L:A_ ..u._LTtON 1 N 1 9 IS RECEIVED .- i f f2a --.. [Y. `lkJ/A. c".4,ll 4/ • ( ) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL DATE _E •- 'CONDITIONS OF APPROVAL B Sons Rating / S % Date Sewer Installed —Z le 7 - p 2- Well To Absorption Area Well to Tank Well Log Received Septic Tank Size /0 Q o