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EKLUND #1 BLK 5 LT 1
Eklund #1 Block 5 Lot 1 #050-541- 1 1 Municipality of Anchorage "° < Development Services Department Building Safety Division s. .. On -Site Water and Wastewater Program, 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW030190 PID Number: 050-541-11 Name: Karen Wastewater System: ® New ❑ Upgrade Address: 7040 Feray Cir.. Anchorache, All 99507 ABSORPTION FIELD Phone: 349-7312 Number of Bedrooms: {^ Deep Trench /Shallow Trench Q Bed ❑ Mound p Other: LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 0.8 GPD/Ft' 6.0 Ft. Block: Lot: Subdivision: Depth 0 pipe bottom from original grade: Gravel depth beneath pipe: 5 1 Eklund #1 2.0 Ft. 4.0 Ft. Township: Range: Section: Fill added above original grade: Grew]Length: 1.2 Ft. 42 Ft. Well: ® New ❑ Upgrade Gravel width: Numberoflines: Distance between lines: 5.0 Ft. 1 NA Ft. Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: Private 65 Ft. 64 FL 375 Fe Sch40 & D3034 OrilMr. Data Drilled: Static Water Level: Installer: Date Installed: Sullivan 9/5/03 22 Ft. Mike Curry.1/26/04 Yield: Pump Set at: Casing Height Above Ground: TANK 12 GPM unkn Ft. 2 Ft. SEPARATION DISTANCES ® Septic ❑ Holding ® S.T.E.P. ❑ other: To Septic Absorption Lift Holding Public/PrivatE Manufacturer apaclty: From Tank Field Station Tank Sewer Line Anchorage Tank 1250 Go]. Well 100'+ 100'+ NA NA 25'+ Material: Number of Compartments: Steel 2 Surface Water 100'+ 100'+ NA NA LIFT STATION Lot Line 5'+ 3' NA NA ize: 1250 Gel. anu a urer: Orenco Foundation 5'+ 10'+ NA NA 'Pump on" level at: "Pump OH' level at: High water alarm at 44" in. 42" in. 48" in. Curtain Drain NA *50'+ NA NA Pump Make B Model Electrical Inspections performed by: Franklin 2445 0117 Rising Son Remarks: *none known BENCH MARK Location and Description: Field insulated Bottom of siding Assumed Elevation: 100 Ft. Engineer's Stamp AC1 tee •.. ®•;.�e® J. Inspections performed by: KIND Engineering, —In Dates: 1 But 1/15/04 N . L 0 god 1/26 01 s ••••• •.... Development Serv'c s Department Ap royals 1+21)Oy �,;••KennCE 7176uf ate% Reviewed and approved by: ate: fQ� �Fp•'•• ...••°"••���o� (Rc, lV00) 0 ,o 40 A -C= 7.9' B -C= 32.2' A -D=17.9' IB -D= 39.3' A-E= 54.3' B-E= 50.6' A -F= 37.5' B -F=12.0' AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW030190 EKLUND #1, BLOCK 5, LOT 1 PID#050-541-11 20' SLOPE CONSTRUCTION MAINTENANCE EASEMENT/ 1 PANTHER ©oup SCALES 1' = 50' Imp �. �F A -Z4 \ Air `�, /* 9� *, KENNET D S r' CE -711 i 1 ` P40FESSIOt./ L 420• PREPARED FOR. SCALE, NTS se.4 KAREN J. CAFMEYER 7040 FERGY CIR. ANCHORAGE, AK 99507 <907) 349-7312 FIELD BOOKS WAPUTM: BOUNDARY: NA ORAn": �G. � V M) ENGINEERING STAIOND: NA CNECKE@ KMD 20441 PTARMIGAN BLVD. ASSULT.. NA DATE: 31 04 EAGLE RIVER, AK 99577-8736 DwD. ME Ca D: SE0602 ACAD FLL 03037.DWG "" 03037 (907)696-6111/FAX (907)696-8111 Feb 05 04 12:42p Troy Davis HM 9073579395 Rising son Electric Inc. 907 622 6777 02/05/04 01i14P P.001 February 5, 2004 Troy Davis Homes 1451 E. Parks Hwy - Ste. #207 Wasilla, AK 99654 FAX #(907) 357-9395 Re: Lot 1 Block 5 Eklund Subdivision To Whom It May Concern: -wising on gfectric, Inc. ll�Q16 \\//ooJ1anJ Drive goefe River, AK 99577 (907) 622.6777 The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, n Kevin S. Hornbuckle, Owner Administration License Number 1284 Specialty Contractor License Number 27285 p.2 Feb 05 04 02:55p 01/01/1999 00:61 Vj Trod Davis HM 9073579395 p,2 6662259 SULLIVAN PAGE 01 �3rtlttnq y ooc co.'".' SULLIVAN WATER, WELLS P.O. DOX 670272, CHUGIAK, ALASKA 88567 a TELEPHONE 688-2750 OWNER OF LAND:-rx o A ADDRESS: LEGAL DESCRIPTION: r J ✓►1 l34 V. S" ,4;,'i r DATE: —CfI S /" ':Z PERMIT NUMBER; D 3a i a c7 Date of Issue -16 . TAX IDENTIFICATION NUMBER: 05-0 - sq I Is well located at approved permit location? !j -y< Q No Method of Wiling: 4-+81rr-0tary U cable tool Depth of well: �! Casing Type S'`+�Wall Thickness inches Diameter__ A 11 Inches, depth 6�1—feet Liner Type; —00 1 a •. V= Casing Stickup Above Ground: a feet Static Water Level: __ Beet Recover Rate: -a -gpm Method of Testing: �14J Q Wall Intake Opening Type: ,n end :1 open hole J Screened: Start feet Stopped feet 'J Perforations Start feet St ped feet Grout Type; a. Volume �(aC df Depth: from b feet to feet Well Disinfected Upon Completion? (HYrs U No Method of Disinfection: C_ s1[.. -Ag ....I.i 4,-6 ?0j14,'jj . Comments: _ C4J'J6 'fr!C/K J S: _ c �,3 d� � �•• L'71 i 1 f Driller's Name ATTENTION: It is the responsibility of the property owner to submit a copy of the well tog to the proper authority. Municipality of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. KND ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 11 /FAX (907)696-8111 February 9, 2004 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 RE: SEWER PERMIT/ LOT LINE WAIVER — EKLUND #1, BLOCK 5, LOT 1 Gentlemen: The septic system was constructed within 10 feet of the property line (see attached survey). The system is still located within the test hole radius and we do not expect there to be any adverse effect on adjacent lots by the location of this system. We are therefore requesting a waiver to 3.0 feet to lot line at this time. If you have any questions, please contact me at 696-6111 /FAX 696-8111. Respectfully submitted, KND Engineering, Inc. Attachments: As -built Survey Inspection Report HAA w/ waters Well Log Electrician Letter 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.anchomge.ak.us (907)343-7904 Waiver Review Worksheet WR#: 040007 PID#:050-541-11 HA#:040039 Permit#: 030190 Date Received: 2/11/04 Legal Description: Exlund #1 Block 5. Lot 1 Engineer: KND Engineering 20441 Ptarmigan Blvd. Eagle River, Ak. 99577 Applicant: Karen Cafinever Waiver Requested: 3 feet separation distance absorption field to property line Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: Waiver Is not Granted. List Conditions or Reasons for above: Date: _02 1 a " By: ___ 96Z 4�haDWof Reviewer ............................................................■..............■■. Rec#: 2-11-04 Amount: $175.00 Date Paid: 2-11-04 2/12/2004 Municipality of Anchorage Mark Begich, Blttyor Building Safety Di«ision P.O. Box 196650 - 4700 Bragaw Street Ancltorttgc, Alttska 99519-6650 - (907) 343.8301- Fax (907) 343-8200 littl)://%,.,%%-w.iyititti.org Ken Duffus KND Engineering 20441 Ptarmigan Blvd. Eagle River, Ak 99577 Subject: Waiver Request for Eklund #1 Block 5 Lot 1 Waiver Request #WR040007 Parcel ID #050-541-11 HA#040039 WR# 030190 Dear Engineer: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to property line has been approved. The approved separation distance is 3.0 feet. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeffrey W. Poet Engineering Technician On -Site Water & Wastewater Program 2 e ry) MUNICIPALITY OF ANCHORAGEii J n� Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW030190 Legal Description;- Eklund #1;Block'5'Lot'1 Design Engineer: 0070 KND Engineering Owner Name: Karen Calfineyer Owner Address: 7040 Fergy Circle Anchorage , AK 99507 - Date Issued: Jun 16, 2003 Expiration Date: Jun 15, 2004 Parcel ID: 050-541-11 Site Address: Unknown Lot Size: 41984 SQ. FT. Total Bedrooms: 2 Permit Bedrooms: 2 This permit is for the construction of. ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By:!,�/ " Date: Y l9 U_3 Date: �° �� *;_ Municipality of Anchorage Development Services Department �� " "I`'Building Safety Division On -Site Water and Wastewater Program 4700 South Bra aw St. "' • P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW Property owner(s) Karen Calfineyer Day phone _349-7312 Mailing address 1) 71 1 FergyAnchorage,-AK 1 Mailing address (2) Zip Code Legal description (Lot, Block & Sub d.) Eklund #1,5, Li Legal description (Section, Township & Range) Lot Size LA N L] Acres/Sq.Ft. THIS APPLICATION IS FOR: Number of Bedrooms 2 Sewer Only ❑ Well Only ❑ Sewer and Well ® Water Storage [] Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. re of property owner or authorized agent) Permit Fees:i S,S-D Waiver Fees: Date of Payment: ook/03 Date of Payment: Receipt Number: 0 36 920 r-� Receipt Number: (Rev. 12/00) 1 V D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 June 11, 2003 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: New septic/well permit — Eklund #1 Block 5, Lot 1 Gentlemen: The owner has requested we proceed forward to obtain a septic permit on the subject lot. On June 18, 2002 one testhole was performed by S&S Engineering for the proposed system. The results of this test are attached. The general slope of this lot is from north to south at a grade of approximately 15-25+%. We have designed our system utilizing the existing testhole that was excavated for the proposed 2 -bedroom house. The lot will be served by an individual well located on the southeastern portion of the lot. We propose to install one 5' wide shallow trench. Water was not encountered during the excavation, but was measured at 11' during monitoring on May 1, 2003. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, Ki"iD Engineering, Inc. enne s, P.E. Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Test Excavators/Owners Specs WELL & WASTEWATER DISP❑SAL SYSTEM DETAILS/SITE PLA EKLUND #1, BLOCK 5, LOT 1 10' Utll Esmt K 1 3 �2 Slope Const 4 lloia -ant o / 2 \ SE nC AL SITE FLAG PL \ES.MT A.,�.,, °— 10' Utll Esnt — Es 11 , VACANT �0 wanes i .:, ' 4 aglaa Yr \ 1 m \ \ ANTHE f 11 DESIGN DETAILS 2 BDRM X 150 GPD = 300 GPD 300 GPD/0.8 GPD PER SQ. FT. (8.6 MIN/IN.)= 375 SQ. FT (375/5'(W)) X .5CRF) (4.0' GRAVEL) = 37.5 FT. TRENCH USE 1 TRENCH - 38 (L) X 5' (W) X 4.0'(D) Total depth of system is 6.0' from original grade. Total depth of gravel below distribution pipe is 4.0' . PRESSURIZED DISTRIBUTI❑N SYSTEM HOLE SPACING DESIGN 1. RESIDUAL HEAD = 5' 2. HOLE SIZE = 3/16' = 1.00 GAL. PER HOLE @ 30 PSI 3. 30 GALS (PUMP DELIVERY)/1.00 GALS./HOLE = 30 HOLES 4. 38 LF LATERAL/30 HOLES = 1.27' SPACING PER HOLE NO PUBLIC WELLS WITHIN 200. OF 5. ALL HOLES SHALL HAVE CAPS INSTALLED PER MANUFACTURES SPECS. PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' DF PROPOSED WELL EXCEPT AS NOTED. Adir OF\ i►��. rte. .4,�� 1 r* TH :...-� CE -7 6 1 \ Pj?0Pzss1o'0" AW N❑TESI 1. USE 1250 GAL S.T.E.P. TANK, INSULATE IF <4' OF COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS, LOT LINES, FOUNDATI❑NS AND ALL OTHER SETBACKS. PREPARED FOR: KAREN CALFMEYER 7040 FERGY CIR. ANCHORAGE, AK 99507 (907) 349-7312 FlELD BOOKS COMPUTED. BOUNDARY: N A DRANK: STAKING: NA CHECKED: KI ASBUILT. NA OATS 6 DNC. FILE: CRIO: cl ACAD FILE: 03037.DWGI JOB N 03037 Scale= 1'= 100' PAGE 1 OF 2 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 96-6111/FAX (907)696-8111 WASTEWATER DISPOSAL SYSTEM DETAILS EKLUND #1, BLOCK S, LOT 1 \ �\ S&S 6/18/02 K N D W4 IE I-3 �p POSED 125 25' S.T.E.P. TACV FC Illy s eco 10' PROPOSED 2 BDRM HOUSE PREPARED F❑Rt KAREN CALFMEYER 7040 FERGY CIR. ANCHORAGE, AK 99507 (907) 349-7312 . FIELD BOOKS COMPUTED: BOUNDARY: N A DRAW V STAIGNG: NA CHECKED: KMO ASBUILT: NA DATE: 6/10/ D"c- nLE: aaD: SE060 ACRD FLE: 03037.OWG JOB No.: 03037 12' Scalet 1'= 20' PAGE 2 OF 2 L45dV LW ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 MLinicipality of Ahchorage �y ,iENGINEER SE Lj N�, Development Services Department Building Safety Division •; ; ;� .a.tr On -Site Water and Wastewater Program _•_ «.. ............ ... 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 ►r -� C www.ci.anchorage.ak.us r ROBERT C. COWAN i4, (907)343-7904 rj� f�� .9E-.$801 •�i��A; Soils Log - Percolation Test Performed For: i��-L�� Cid-�M��-72� Dale Performed: 07, Legal Description: C.� f / ; l.-OG/G�'; ur1,/Q Depth 1- D to GROUNDWATER J „ ENCOUNTERED? 11y 2- • s. TT •tJ E Depth to Water After 0 P �. 4 Date: 5- ..0 3d 3 a 7- -8- D 8- O cr 9- 9- 30 10- 10-11- 3 YZ! 37z �r -0 11- O 12- 2-13-O• 13- 01. 14- 15- 16- 17- 18- 19- 20 - COMMENTS 02G�-=I KGs I v I WAS 6014 Site Plan ®mmmmmmmmm ®®®E■■■■■ M®®®®®®E�� Reading D to GROUNDWATER J „ ENCOUNTERED? 11y Net Time Depth to Water s. IF YES, AT WHAT DEPTH? E Depth to Water After 0 P Monitoring? E Date: 6014 Site Plan ®mmmmmmmmm ®®®E■■■■■ M®®®®®®E�� Reading D to Gross Time Net Time Depth to Water Net Drop QC�O ✓ O 3 A O 3d 3 a a D V O cr 30 3 YZ! 37z �r O y PERCOLATION RATE . (minuleynch) t - PERC HOLE DIAMETER TEST RUN BETWEEN ' FT AND _. FT- PERFORMED T_ PERFORMED BY: G I PERFORMED IN ACC DANCE WITH ALL STATE AND MUNICIPAL CERTIFY THAT THIS TEST WAS IN EFFECT ON THIS DATE. DATE: KND ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 7 (907) 696-6111 /FAX (907) 696-8111 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES AND MATERIAL SPECIFICATIONS LEGAL DESCRIPTION: EKLUND #1, BLOCK 5, LOT 1 GENERAL: 1. The scope of this project includes the installation of a septic tank and/or drainfield to serve a single-family residence on the referenced property as delineated on the attached Municipality of Anchorage (MOA) permit and site plan. 2. Construction shall be in accordance with the approved site plan and design drawings; MOA permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. KND Engineering, Inc (KND) assumes no responsibility of the accuracy of the as -built survey provided by the owner or owner's representative. 4. The owner or contractor is responsible to notify the engineer of any discrepancies noted on the design plans or drawings prior to commencing work. These discrepancies could be, but not limited to, possible encroachments, surface water, varying soils, unplatted easements, types or use of dwellings on or adjacent to property, nearby public wells, etc. 5. The contractor shall be responsible for locating any necessary underground utilities, easements, property lines and surface water. The owner and/or contractor shall ensure, if deemed appropriate, that a registered land surveyor prior to construction flags all setbacks. 6. The contractor shall be responsible for verifying all pertinent separation distances and component layout. 7. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. 8. The MOA Development Services Department On -Site Water & Wastewater Program must certify contractors installing wastewater disposal systems. Owners installing their own systems must also receive prior approval from said MOA Department. SEPTIC TANK / HOLDING TANK / LIFT STATION INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded with proper material and compacting to prevent damaging, settling or shifting of the tank. 3. All standpipes on the septic tank shall extend a minimum of 12 inches above the final grade. 4. Septic tanks installed with less than 4 foot of cover shall be insulated. The contractor will ensure that the fill over the tank does not exceed the burial depth rating. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 feet from the tank. The second cleanout, in line, shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. Page 1 of 3 Reference: Eklund #1, 135, L1 Date: 06/11/03 Page: 2 of 3 7. All H.D.P.E. tanks shall have a vertical length of 4 -inch perforated drainpipe besides the tank extending to the bottom of the tank to above grade to monitor ground water. 8. All tanks shall be anchored when there is not enough adequate soil cover to resist buoyancy forces in high -groundwater areas. 9. All holding tanks and lift stations shall have an audible and visual alarm inside the residence. 10. All lift stations shall be wired in compliance with the Uniform Electrical Code and all MOA guidelines. 11. The contractor shall remove the old tank, or abandon it in compliance with the Uniform Plumbing Code. The contractor is solely responsible for the abandonment procedure. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavaction become smeared, they must be raked or scratched (roughed -up) before gravel (sewer rock) placement. 2. Once the sewer rock is installed, the distribution pipe is installed level with the perforations facing downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitoring tubes shall be four- (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation of a depression after settling. 6. All advanced technology waste water disposal systems (Advantex, Biocycle, Intermittent Dosing Sand Filter, etc...) shall be constructed, installed, maintained and monitored per manufacturer's specifications and MOA requirements. MINIMUM MATERIAL SPECIFICATIONS: 1. A MOA approved septic tank manufacturer must construct any septic tank proposed for installation. 2. The following pipe materials are MOA approved for use in septic system installations: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with less than 3% passing the #200 sieve. If deemed necessary, a sieve analysis should be performed. 7. When sand is being used as a filter material, its gradation specification must conform to current MOA or DEC requirements. Reference: Eklund #1, 135, L1 Date: 06/11/03 Page: 3 of 3 INSPECTIONS: Typically there will be three (3) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the sewer rock, distribution lines, standpipes, and cleanouts, but before the placement of the silt barrier, insulation, or any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required, especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. The inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre -construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractor's activities. The owner shall contract with the contractor to perform the work outlined in these specifications and attached plans and in accordance with the attached MOA permit. All materials, components, and construction practices shall comply with the MOA's and the State of Alaska's latest ordinances, regulations, or policies regarding wells and septic systems. The failure of the inspecting engineer to notice a material or construction non-compliance does not relieve the contractor of his/her responsibility to correct such deficiency. There will be no contractual arrangement existing between the contractor and KND Engineering, Inc. KND shall be the owner's representative and will inspect the work as stated above to document the contractor's activities. Final acceptance of the contractor's work rests with the owner and the MOA. KND shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. KND's inspecting engineer will not be responsible for the construction means, methods, and techniques, sequence, procedures or the safety precautions incident to this project. BY PROCEEDING FORWARD WITH THE INSTALLATION OF THE WATER AND/OR WASTEWATER SYSTEM (S), THE PROPERTY OWNER, CONTRACTOR, AND WELL DRILLER ACKNOWLEDGES HAVING READ AND ACCEPTED THESE SPECIFICATIONS. Owner: Contractor: Driller: NOTE: PRIOR TO CONSTRUCTION -- THE CONTRACTOR SHALL HAVE THE LOT LINE & 25' SLOPE EASMENT FLAGGED BY A REGIESTERED LAND SURVEYOR. MUNICIPALITY Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-541-11 1. GENERAL INFORMATION Complete legal description EKLUND #1 BLOCK 5, LOT 1 Expiration Date: / " / S -zo zi( Location (site address) 4401 UPPER KOGRU DRIVE, EAGLE RIVER, AK 99577 Current property owner(s) THOMAS E GAULKE Day phone Mailing address Real estate agent 4401 UPPER KOGRU DRIVE, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 2 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distan Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ q 1a' 50 cvy I b-1 I ) Date of Payment 9�LZ/ZO Z0 Receipt NumberIj COSA# OSC2©1 51 (o Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 9/19/2020 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to . these various and dynamic characteristics and are outside the control of the evaluator of the welPand septic system. -Therefore; any -estimate -of how -long -a system will function satisfactory— for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & f % 6. DSD SIGNATURE System #1 Approved for 2- bedrooms System #2 Approved for bedrooms Disapproved ••,9 1 • Curtis Huffman • . • • . �Fc •. CE 128991 ��il\w�pROF SSONP��c�`,.� Conditional approval for bedrooms, with the following stipulations: ..iirtiflrrf— B : lti Original Certificate Date: -0 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: EKLUND #1 BLOCK 5 LOT 1 Parcel ID: 050-541-11 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ® Well log is filed with Onsite (or attached) Date drilled 9/5/2003 Total depth 65 ft Cased to 64 ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 9/17/2020 Static water level at beginning of test 19 ft. Well production at time of test 3.8 gpm Comments B. TANK DATA Age of tank(s) 16 years Tank type/material STEP / STEEL Measured operating fluid level in septic tank *44" ® Standpipes/foundation cleanout per record drawing Date of pumping 9/1/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 1/26/2004 ® ALL standpipes present per record drawing Total measured depth from grade 7_1 ft (max) Measured depth to pipe invert from grade ft (min) ® N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Structure served by this system Water storage tank volume NA gallons Well disinfected for coliform test? ® Yes ❑ No ® Coliform bacteria is Negative Nitrate 0.226 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) NES Collected by = & SULLIVAN Date of Sample 9/17/2020 & 9/24/2020 C. LIFT STATION ® Required maintenance completed Age of lift station 16 years Lift station material STEEL Comments: *Float levels. Maintenance report attached. Adequacy test date 9/17/2020 Results N Pass For 2bedrooms Fluid depth prior to test 21 in Water added 400 gal New depth 29 in Elapsed time 1400 min ® Code -required soil cover over field w/ insulation. Final fluid depth 21 in ❑ System presoaked Absorption rate 300 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) Gallons introduced gallons If yes, enter date W Comments/Deficiencies: FIELD OPERATING IN THE MID-RANGE OF THE 4' ED. F`S `. <r 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 if No 5+ Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No ft Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No ft Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No ft Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ft ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 5+ ft Surface Water > 100' ® Yes if No. Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No _ Water Service Line > 10' ® 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 *3 ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No _ ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS *MOA WAIVER. G. ENGINEER'S CERTIFICATION / certify that l 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. 'NowAdw law .. . ....t:..�: .. ... .. Curtis Huffman ¢� ��c�s.• CE 128991 �. ���� ROFEssIdN�`��� 10 ft ft ® Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval Parcel I.D. 1. GENE Expiration Date: �a; d �'`jtl'�a �tlp�al,descrtptio ! u q0 I [% y t•P�nriPifi°v'ii�T9her(sl«' �'� 1' f� � LLIs C/i-� !Gk'_ ^F • X� a' <.. v v 5C/ L,4,t/ ab96®YW_. 2. TYPE OF DWELLING: [) Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: J5--ff Day phone A P y /3j3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by' / Date: COSA to be reieasc w the engineer, undess otherwise requested by the engineer. COSA Fee $ ff /� Waiver Fee $ Date of Payment �6 CJl6�a Date of Payment Receipt Number Receipt Number COSA# oeD (P I()u Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm CfM E �G s✓� c l�� t/(� Address 2,q55 Leo .ppp ptc,, K A Engineer's Printed Name (Yr',CL E5 6. DSD SIGNATURE 2 System #1 Approved for 2 bedrooms System #2 Approved for _ bedrooms Disapproved Phone 0"_055'4_5''569' Conditional approval for bedrooms, with the following stipulations: o r.TEWATER PROC-RAM 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 blue sheet ! - : c If more than 1 septic system is on the lot: COSA Checklist # _j—of I Structure served by this system I Certificate of On -Site Systems Approval Checklist Legal Description: L kLy/V D I-OC'k 5 Parcel ID: (950- W/ - A. WELL DATA Well type FPN6T,: If A, B, or C provide PWSID # I WA Well Log 0/N) Date completed q1Y10 5 Sanitary seal (PN) 2L5 Wires properly protected (P/N)YS Total depth ft.65 Cased to 14ft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test `�lj/t�7j /A 3/16 Static water level Well production f 2� 9.p -m. _ _ 9.p -m. WATER SAMPLE RESULTS: Coliform Nc'� colonies/100 mL Nitrate 04, mg/L Arsenic N > ug/L Date of sample: Ila r{/l Collected by: Cr (jf�L hRSM3 B. SEPTICIHOLDING TANK DATA rr C Tank TypeNat�re-rial % �Date installed Tank size i gal. Number of Compartments Cleanouts&TYN) XC� FoundationcleanoutLO)N)Depression over tank (Y/fn/N High water alarm 5 Date of pumping /l9fl i�j /T Pumper C. ABSORPTION FIELD DATA Date install c�« Soil rating (g.p.d./ft? 2 m) System type %d�LGoc✓ jun C�( Len ) 3 Width ft. Gravel below pipe ft. T�pt f %sorlption area ft2 Monitoring tube la Depression over field 1VO b {e ofaNL�t(U�C4'tA5"t °'F�� � b Results ( ass Fail) f15S For bedrooms .....� til b9*,"l3 f° fore test 0_ in. Water added gal. ` New depth - -q— in. ;� EI 2 irpe: � � . C min. Final fluid depth _ in. Absorption rate >_ �i� g.p.d. Any rej!' � m�e'nt (past 12 mo.) (YO& type) P49/Vii 1h14/N4/A If yes,.give date M!f}. D. LIFT STATION Date installed 0%0 Size in gallons 252 "Pump on level at 14 - in. "Pump off' level at a in. Datum i OrTOM c9F 113 — Cycles tested a 9 E. ',SEPARATION STANCES WELL ON LOT TO: - Manhole/Access OI) L2--� 5 I High water alarm level at 4— in. Meets alarm & circuit requirements? -;5 Septic tank/lift station on lot 4 1&v On adjacent lots UCCP Absorption field on lot t 6X-9 _ On adjacent lots i toe, Public sewer main 4. Public sewer manhole/cleanout (!9� Sewer /septic servlcg_;line 1 S Holding tank 1 7 S Animal containment areas -F [bt9 Manure/animal excrete storage areas 4100 a SEPTIC/HOLDINd-TANK OW.TTO: Building foundation Property line Absorption field S Water main -4 (c9 Water service line Surface water i C� Wells on adjacent lots 'E to ABSORPTION FIELD ON LOT TO:. Property line 3 Building foundation f' l4� Water main 4 to Water Service line Surface water 'F 1l90 ' Driveway, parkingivehide storage 'has Curtain drain —+ 50 Wells on adjacent lots, ± /00 ` F. COMMENTS G&ac�t 2�cp -FO t407( L -1W E fZ &4A V7-rb Tae : 'WR l g0W7 G:: ENGINEER'S CERTIFICATION t certify that I have determined through field inspections and review of Municipal records that the above systems are- in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name 044RL-&5 134/ 2A1 3 Z Date U1q, 5190 U-, COSA yellow sheet_2-6-15.doc 4 � j.• y / O I v c I it. Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-541-11 1. GENERAL INFORMATION Complete legal description Eklund #1 Block 5 Lot 1 fi Expiration Date: /o —S) - 13 Location (site address) 4401 Upper Kogru Drive Eagle River AK Current Property owner(s) CAFMEYER KAREN Day phone 240-0385 Mailing address same Real Estate Agent Susan Bickman Day phone 240-0385 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class C Well Public Water System Received by: 2 TYPE OF WASTEWATER DISPOSAL: ® Individual ❑ Holding Tank ❑ ❑ Community ❑ ❑ Public Sewer ❑ Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ " l 1 O' Date of Payment �Ji13 Receipt Number 0 559�" COSA# Obc1313SO Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm NorthRim Engineering Phone 694-7025 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng 6. DSD SIGNATURE S t #1A df oZ b d Date 7/22/2013 �}, gQeasc°e la f z fy76 9T { ys em pprove or e rooms. System #2 Approved forbedrooms. V0-,',° s°°f'E f �_! Disapproved. Conditional approval for bedrooms, with the following stipulation's;:. ' By: / v t Original Certificate Date: - S The Muni Ipalirofenchoage Devlopment 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_9-1-12.doc If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: )5/<'LrJN 6 '� i Q S L / Parcel ID: O SO- 54 1- A. WELL DATA Well type P_ If A, B, or C provide PWSID # Well Log (Y!N) V - Date completed S/03 Sanitary seal (YIN) Wires properly protected (Y/N) _ Total depth -AL-5ft. Cased to _!�Lft. Casing height (above ground) ?171 in. FROM WELL LOG AT INSPECTION Date of test 9 S G3 7 /g Static water level ZZ ft Z( ft Well production 12 g,p.m. g.p.m. WATER SAMPLE RESULTS: Coliform C colonies/100 mL Nitrate C. 157 mg/L L,_ -� { Arsenic KL)ti _Ug/L Date of sample: 74 /? Collected by: Z✓ ' "' eK�,� B. SEPTICIHOLDING TANK DATA Tank Type/Material S E_P /S7GEL Dateinstalled Tank size 12 5o gal. Number of Compartments 2 Cleanouts (Y/N) Foundation cleanout (Y/N)/_�Y Depression over tank (iiNj N High water alarm (YIN-, Mea Date of pumping 5! nl ! r 3 Pumper "S C. ABSORPTION FIELD DATA Date installed J 2�0Ll Soil rating (g.p.d./ft orftz/bdrm) o• System type %r,Ack Length ft. Width J ft. Gravel below pipe_ ft Total depth _ ft Eff. absorption area 3-Z_'5ft2 Monitoring tube - Depression over field _ V Date of adequacy test 7 Results (Pass/Fail) GsJ For Z bedrooms Fluid depth in absorption field before test 6 in. Water added° gal. New depth �. in. Elapsed Time: 3 t7 min. Final fluid depth in. Absorption rate >=6o t g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) I 11 If yes, give date D. LIFT STATION Date installed 11t5-1Jq Size in gallons /0-50 ?rEp Manhole/Access (YIN) "Pump on" level at 144 in. "Pump ofr level at q2- in. High water alarm level at in. Datum O- O M Cycles tested 3 Meets alarm & circuit requirements? _ E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot yac / 7L Absorption field on lot /66 `'f Public sewer main NA Sewer /septic service line 25 �t Animal containment areas YO -f' On adjacent lots ! a G F On adjacent lots /o a Public sewer manhole/cleanout NR Holding tank �fA Manurelanimal excrete storage areas /0' SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5-'-e- Property line 614- Absorption field 5 -14 - Water 4 - Water main Al,* Water service line / 0 `� . Surface water / 00 Wells on adjacent lots / 00 �r ABSORPTION FIELD ON LOT TO: Property line 3 �+ Building foundation �� Water main N� Water Service line �� Surfacewater FD O `F Driveway, parking/vehicle storage /O `t Curtain drain ✓'/(C' Wells on adjacent lots / O o F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that t have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name cS 71�,kjr Date COSA brown sheer_10-10-12.doc �mo 0 41 1 / O. Ix A r r" •► r1i 1 I ,Mit- 3.96,IIrOtl9 AM i 1 I � 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. 050-541-11 1. .GENERAL INFORMATION HAA# d L7L b(93q Expiration Date: •S— 0 L 11 Z I DIVA 0101.141141111111 IN) _1111111 Location (site address or directions) NHN Panther Driv _,�aF r _ Rover, AK 99577 Current Property owner(s) Karen Cafineyer Day phone R4A-7312 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 7040 Feray Cir., Anchorage. AK 99507 Unless otherwise requested, HAA will be held by DSD for pickup. Day phone Day phone 2. NUMBER OF BEDROOMS: Z 3. TYPE OF WATER SUPPLY. TYPE OF WASTEWATER DISPOSAL: ' Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding tank Community Class Well ❑ Community On-site Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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. i MunicipalitYof Anchorage g Development Services Department _{ Building Safety Division (' • On -Site Water &Wastewater Program . ; ° I ° * • 4700 South Bragaw St. is I 'P.O. Box 196650 Anchorage, AK 99519-6650 ' www.ci.anchorage.ak.us �! r' '(907) 343-7904 it HEALTH AUTHORITY APPROVAL CHECKLIST Legal �Descnption: EKLUND #1, BLOCK 5, LOT 1 Parcel ID: 050-541* -1 1 A. WELL' DATA Well type Private If A, B,'or C provide PWSID # Well Log (Y/N) Y Date; completed9/5/03 Sanitary seal -(Y/N) Y Wires properly protected (Y/NM Total depth' 65 ft. Cased to +i ft. Casing height (above ground'_ i''' i FROM WELL LOG �'' AT INSPECTION Date of test 9/5/2003 Static water level 22 ft. - ft• Well production 1 2 g,p,m g.p.m. WATER SAMPLE RESULTS: I; Coliform 0 col6nies/100 ml. Nitrate 0.100 -mg./I. Other bacteria 4- colonies/100 ml. Arsenic:'mg./I.' ,Datelof sample:, 2/5/04 & 1/27/04 ' Collected by: KND B. SEPTIC/HOLDING TANK DATA TankI (Type%Material Se tR is STEP) / Steel (Anch, Tank) Date ns tall 1/15/2004 Tank size 11 I!° 1250 gal. Number of Compartments 2 Cleanout s (Y/N) Y• Foun,dation'cleanout (Y/N) Y—jDepression'over,tank (Y/N) N High water alarm (Y/N) Y -Dateof pumping NA - NEW TANK Pumper C. ABSORPTION FIELD DATA r Date installed 1 /26/04 Soil rating (g.p.d./ft2 or ftZ/bdrm)-M System type Trench Length 42 ft. Width 5 ft I Gravel below pipe 4 ft:i Total ;depthi6 ft: Eff. absorption area 375 ft2 Monitoring tube Y ' Depression over field N Date jof adequacy test NA, -NEW SYSTEM !+ LResults (Pass/Fail) Pass For 2 7 bedrooms . Fluid' epth;in absorption field before'test I' s in. Water added gal. 'New depth in. Elapsed Time min. Final fluid depth in. Absorption !rate' g.p.d. I Any, rejuvenation treatment (past 12 mo) (Y/N &' type) If yes, give date I c 01-30-04 04:19PM FROM -CUE ESI, SGS ENV SERVICES SGS Ref.# 1040493001 Client Name KND Engineering Project Name/# Eklund #1 I.1, B5 Client Sample ID Eklund #] Ll, B5 Alatrix Drinking Water Sample Remarks: 9075615301 T-235 P.02/03 F-243 All Dates/Times are Alaska Standard Time Printed Date/Time 01/30/2004 12:43 Collected Date/Time 01/27/2004 15:45 Received Date/Time 01/27/2004 16:45 Technical Director i� Stephr Ede Released/ Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Nitrate -N 0.100 U 0.100 Microbiology Laboratory Total Coliform 96 OB, No Coli mg/L EPA 300.0 B (<=10) 01/27/04 JJB col/100mL SM18 9222B A (<=I) 01/27/04 DKC