HomeMy WebLinkAboutEAGLEBROOK BLK 1 LT 14c)�� -Sao-a3
Municipality of Anchorage Page l of Z.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 0 Telephone: 343-4744
On - Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ®a ® PID Number: / 7 ® /Z of � _
Name: Wastewater Systems® ❑ New ❑ Upgrade
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Address: TI
ON FIELD
Phone: No. of Bedrooms: ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mo ❑ Other
LEGAL DESCRIPTION
Soil Rating: Total Depth f original grade:
GPD/S. Ft.
Lot: Block: Subdivision: Depth to pipe bottom from original grade: Grjdepth beneath pipe
I ®
r _�. LIFT
STATION
v..
Pump Make I Electrical Inspections performed by:
72-013 (1/91) MOA 25
6A(�"r-1394014
Ft
Ft,
Township: Range: Section:
Fill added above original grade:
Gravel length:
Ft.
Ft.
WELL: WNew
❑ Upgrade
Gravel depth:
Number of lines: Distance between lines:
Ft.
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorp area:
Pipe material:
g Ft.
' t D Ft.
SO. Ft.
Driller:
Date D filled::
D
Static Water Level:
k11. Ft.
Inst r:
Date installed:
Yield:
Pump Set at:
I
Casing Height Above Ground:
T ANK
.0 GPM
Ft.
Ft.
SEPARATION DISTANCES❑Septic
_
❑HoldingS.
T. E.P.
To
Septic Absorption
Lift Holding Public/Private
Manufacturer:
Capacity in gallons:
From
Tank Field
Station Tank Sower Linos
Well
Material:
Number of Compartments:
r _�. LIFT
STATION
v..
Pump Make I Electrical Inspections performed by:
72-013 (1/91) MOA 25
Permit N®. — qvc I (, S Page ®f Z-
72-013 A (2/91) MOA 25
il
11 iiiiiiiiiiji ME
.�2 k "
1201 Ramona St. 9951.E ANCHORAGEv ALA99H.4
DRILLED AT THE RATE OF
OWNERPROPERTY V _ -
Anch. 925Q8
LOCATION OF r -
DRILLER ------ Perni® au5 of F'am part
0 ®22e Silt sand material. 10 fine ravel®
22 ® 66' Coarse gravel with 45% clay binder®
6� - 94' ilardp$n. P cemented gravel.
9-4-=-1061 Silty Sand�Lwater_�earjng_f�n� rayeL.
106 110' Q0. d water bearing coarse rav®1: This Y1e11 is duc n 1 m m
60 feet ®ff bettom' Poth aUanity �f quality is very good. Ouantfty ®f water
is over 20 -gym "1® feet off bottoms ;e --to C.Q
be installed. at the sixty ft® .level® Soine fine sand is in the water formation
Q pumping from a higher level will stRbilize & keep weight on the water
aqui, fe,r.
This Well paid for in full by Fiff Perry 8®2290.
JU14 2 9 1991
IVluraicipaliiy ct ,Aiich0rago
Dept, Health & Hurf= Services
C®5i INCLUDES ALL, LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM o -------------
THANK
— ®®'®WTHANK YOU VERY MUCH,
13 1 L,41J ®F AftT DRI L, NO ORKS
DATE_ Sept 1 � 199J
0 p I Ya% PER MONTH WJ1.L BE ASSESSED ON PAST DUE ACCOUNT&
i
C:) t ®1— 1,A \ - q,<-2
° - ` ' � x !� Ti ° t� T� i W' f a ;fit
ro, � , , .os„ ..0 . t ..., ., ,a.., ssx,. A ,a.� �
v
1201 R -am onaAgun F o i OR`Y R n X , ,;x A a4 ., A S : n. 6,.
344-17714
SIX INCH WATER WELL DRILLED ---------- OUT TO THE DEPTH OF 110 feet.
DRILLED AT THE RATE OF "23°00 PER FOOT. Steel casing seated to 110 ft.
PROPERTY OWNER r. "`rs. Biff perry 1}11 Vac Innes St. Anch. 99508
LOCATION OF WELL SITE ? t. / r -1-k. / Sub. �cirsled.^oor�
DRILLER µernie Claus of Pampart trilling Works.
I' L
0 - 22' Silty sandy material. 10c:,,fine gravel.
22 - 66' Coarse gravel with 450; clay_ binder.
Y
6 d1,�1r"i�."t`W>�.`,S5�9WcEms
68 - 94 r?ardoan. A cemented gravel.
94 - 106' Silty sandy water bearing fine gravel.
106 - 1101 ('rood water bearing coarse gravel: This Well is_oroducinp_i_5-gpm
60 feet off bottom! pothguanity quality is verb good® uantity of water
is over 20-gnm 10 feet off bottom. 'Se __.p 12 horse submersible cumc
be installed at the sixty ft. level. Solve fine sand is in the water formation
0. pum-ping from a higher level will stabilize , keep ,veight on the water
aquifer.
This Well paid for in full by 7iif Ferry 8-22-90.
WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF
THANK YOU VERY MUCH. V
B IE= CLAU�OF ART DRILLING ORKS
DATE Sent 1 , 1 caa�
SERVICE CHARGE OF 1%a% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS.
A M
READ THIS COMPLETELY BEFORE INSTALLATION
The RED JACKET submersible motor is designed to pump
potable water at temperatures up to 90° F. For applications
where the units will be pumping other liquids or water at higher
temperatures, the factory should be consulted before making
the installation. Failure to do so will void the warranty.
NOTE: Installation procedures may vary between states.
Refer to your state water well code for proper Installation
regulations. Refer to your local electrical code for proper
wiring procedures.
a'
The RED JACKET submersible unit is designed to give long,
trouble free service. Experience has indicated that little or no
attention is necessary once a submersible unit has been
properly installed. Many service calls on submersible units
have been due to an improper installation. For this reason, we
strongly recommend following the outline provided, paying
particular attention to the precautions noted when installing the
unit.
The majority of service calls on submersible units are electri-
cal in nature. ALL RED JACKET submersible units are thor-
oughlytested throughoutthe manufacturing process for electri-
cal continuity and resistance to avoid any possible need for
service. In the unlikely event that electrical problems do occur,
a complete electrical testing procedure is included in this
manual for your use or use by a qualified technician of your
choice.
This motor is for deep well applications and should not be
used in surface water such as lakes, rivers or swimming pools
where physical contact with the unit or water may cause
electrical shock. The motorframe should always be grounded
when performing electrical tests.
Fill in this information and keep this book in a safe place. The
technical information about your submersible pump will be
found etched on the unit.
Have you selected the right size pump?
Several important factors must be considered when selecting
a submersible pump:
1. You must compare the capacity of your well to produce
water to the pumping capacity of the pump you have
selected. If the pump you selected pumps water faster
than your well can produce it, it could result in pump failure
due to dry pumping. Contact your local well driller or State
water well department for information on well capabilities
in your area.
2. Be sure that your well has at least a 4" inside diameter to
accommodate your RED JACKET submersible pump. If
you encounter a smaller well, contact your local well driller
for information regarding enlarging or redrilling a well of
adequate size.
3. Will your pump provide the capacity of water needed in
gallons per minute (GPM) necessary to satisfy your water
needs? REDJACKET submersible pumps are available in
1/3 -11 /2 horsepower ratings to satisfy most water needs.
What will you need?
Now that you have selected the right size RED JACKET
submersible pump to satisfy your water needs, checkto be sure
you have all the necessary pipe, wire and accessories needed
to complete your installation.
1. If you are replacing a jet pump or small -to -medium size
submersible using plastic pipe, it can normally be pulled
out of the well by hand. In case the pump orjet being pulled
is installed on steel pipe or is otherwise too heavy to be
pulled up by one or two men, a tripod with a block -and -
tackle or other lifting device should be used for easy, safe
removal from the well.
2. Once the old equipment has been removed, be sure to
cover the well to prevent any debris or other contamination
from entering the well.
WARNING: Before removing existing equipment from
your well, be sure to disconnect the power at the
source. Be sure power has been removed from the
control box on submersible units using a control box.
Pre -Installation Check. Whenever possible, the equip-
ment should be checked and the splice made before being
taken out to the installation. This will often save hours and
dollars for the installer.
A. Never pick up the pump or motor by the wire leads.
B. Inspect the equipment visually for any damage.
C. Check the pump and motor nameplates to be sure they
are correct.
/— / — Lag /e hi^001
Part No. 051-210 5/90
Z --
Always give this information whenever it is necessary to
ti
contact your dealer or the factory.
Model No.
H. P. f Volts `' Cycles LD _
o '
Amps: L L SSG' _ L
.
Date of in9tallafion 2 /� i 3/J
ry
Well Depth 1 l ® ft. Pump set at Z ft.
Static Level ft. Draw Downft. at --L5 _GPM
_— �j
Have you selected the right size pump?
Several important factors must be considered when selecting
a submersible pump:
1. You must compare the capacity of your well to produce
water to the pumping capacity of the pump you have
selected. If the pump you selected pumps water faster
than your well can produce it, it could result in pump failure
due to dry pumping. Contact your local well driller or State
water well department for information on well capabilities
in your area.
2. Be sure that your well has at least a 4" inside diameter to
accommodate your RED JACKET submersible pump. If
you encounter a smaller well, contact your local well driller
for information regarding enlarging or redrilling a well of
adequate size.
3. Will your pump provide the capacity of water needed in
gallons per minute (GPM) necessary to satisfy your water
needs? REDJACKET submersible pumps are available in
1/3 -11 /2 horsepower ratings to satisfy most water needs.
What will you need?
Now that you have selected the right size RED JACKET
submersible pump to satisfy your water needs, checkto be sure
you have all the necessary pipe, wire and accessories needed
to complete your installation.
1. If you are replacing a jet pump or small -to -medium size
submersible using plastic pipe, it can normally be pulled
out of the well by hand. In case the pump orjet being pulled
is installed on steel pipe or is otherwise too heavy to be
pulled up by one or two men, a tripod with a block -and -
tackle or other lifting device should be used for easy, safe
removal from the well.
2. Once the old equipment has been removed, be sure to
cover the well to prevent any debris or other contamination
from entering the well.
WARNING: Before removing existing equipment from
your well, be sure to disconnect the power at the
source. Be sure power has been removed from the
control box on submersible units using a control box.
Pre -Installation Check. Whenever possible, the equip-
ment should be checked and the splice made before being
taken out to the installation. This will often save hours and
dollars for the installer.
A. Never pick up the pump or motor by the wire leads.
B. Inspect the equipment visually for any damage.
C. Check the pump and motor nameplates to be sure they
are correct.
/— / — Lag /e hi^001
Part No. 051-210 5/90
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Name
11
Phone(s)
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Environmental Health Division
825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
P- DISTANCES
TO SEPTIC ABSORPTION
FROM TANK FIELD WELL
Lot I Block .
Township, Range, Section
R
No.
No. of Bedrooms
`4
WELL
NUT
-
LOT LINE
I t
G 1
:RIPYIOPI
TYPE OF SYSTEM
FOUNDATION
Depth to pipe bottom from -
Total depth Irom original grade
r 4
AS -BUILT DIAGRAM (Show location of well, septic sy:
driveway. water bodies, eto)
SEPTIC ❑ HOLDING
Manufacturer Jam±
Capacity in gallons
Materia
No. of Compartments
TYPE OF SYSTEM
[]TRENCH BED ❑ W. DRAIN L❑ OTHER
Depth to pipe bottom from -
Total depth Irom original grade
original grade
FT
Fill added above original grade
Gravel depth beneath pipe
FT
0 l
r
_
Gravel length
Gravel width
40 FT
FT
Total absorption area
Distance between lines
C" SOFT
FT
Number of lines
Soil rating
Pipe material
® SQ FT
G
In taller
Date Installed
�9
�j p�
III
of 3 f WELLS
❑ PRIVATE ❑ OTHER (identify)
IM
Installer
N'
Date Installed:
REMARKS:
property lines, foundation,
0
1 I Scale: NT E,J�IB9�ER'$$'rF L
"' �irispections Pertor ed
Date®
I certify that this inspection was peliormed according to all I .
t
Municipal and Slate guidelines in ellect on this dale:
Health Department Approval:Date:
7o n�z rvnst
|1UN1C1PHLITY OF ANCHORAGE
Department of Health & Human Services
825 L Street, Anchorage, Alaska 99501 343
ON~BITE SEWER & WELL PERMIT
Permit Number: 900168
Date lssued: 06/22/90 Engzneer Uesigned
Owner Name: STANLEY to JANICE PERRY
Owner Address: 4111 MAC INNE1�
ANCHORAGEr AK 99508
Parcel Id: 017~121�23
Lot Legal: Subdivision: EAGLEBI'M QK
Section: 35 7ovim ship:
Lot Size or acres)
Max Bedrooms: This Permit: 4 Total
I
Lot: 1 Block: 1
12N Range: 3W
Capacity: 4
='~°b P.,rv
^\IS Q�
Day Phone:
562�4655
SEPlIC TANK: Minimum total septic tank capacity: 1v250 gallons" Each septic
tank must have at least is compartments" Depth to top of septic tank(s) < 4,0
�eet requires insulat. zoil over tank(s),
WELL: Log must be submitted to Municipality of Anchorage DepartmenL o{ Health
and Human Services within 30 days of well completion,
INSTALL PER ENGlNEERS ATTACHEQ PLANS, NOTIFY DHHS PRIOR TD EACH
1NSPECTION" A LIFl STATION REQUIRES AN ELECTRICAL PERMIT FROM
PUBLIC WORKS" THIS PERMIT IS ISSUED FOR THE PLANNED 4 BEDROOM
SlNGLE FAMILY DWELLING ONLY AND EXPIRES ON 12/31/90"
I CERTIFY THAT:
1. I am [amiliar w:th the requirements i o r, on�site sewers and wells as set
iorth by the Municipality of Anchorage (MO(A) and the State of Alaska.
2 I oil ll inat. a1I the system in accordance with all MOA codes and regulatzons,
and in compliance with the design criteria of this permit"
3. I will adhere to all MOA and State of Alaska requirements for the set back
distances rom any existing wel1, wastewater disposal system or publzc
sewerage system on WAS or any adjacent or, nearby lot.
4. I underst at th ermii is valid {op a maximum of 4 bedrooms" I
a1so unde d th capacity of the total system is 4 bedrooms and
any (0nlarn�f��1 )t wi uire an addiLi(Orion l permit" ,
Sigr'ed:
(Owner)
Issued By:
.... .... ... ..... �..... ..
ANICE PERRY ~
DATE:
DATE:
4 ,8dr; 'mss X /50 z7 yza' m so/ /,s X A 5
37,5 ?
la Cfl_
���P✓elGpe�
P 50 2 ¢i-
/Jn ve ;
� LDT/ a®
� i /a5o9al�ns'r �
LUT 2 75rCZ
L > 70�
MUNICIPALITY OF ANCHORAGE
OF IiEALTPi
DEPT.
ENVIRONMENTAL PROTECTION
°J 2219 at, deve6.1eol
I
NOTE-
All linens" ns And Locations Must Be Field Verified Prior To Construction
ER SYSTEM LOCATION PLAN
wT OLD" sueoivls;oH
n r
SECTION/ T�OWNSHIP/RANGE �j
35 / / ��
SCALED@@ NOTE®
Tt,e Accuracy Or Location OC Exisiting And
4, Proposed Property Comers, wells, and Septic
��. r ,``i ° DRAWN BY- q� ®® Systems indicated Ss Not Exact. Dimensions
r Nna®R'�'� (J s/C.s indicated stave Been Determined 6y Use OC Cloth
Tape and/or eup[cipal. stecords, And Not ®y
+x ,.d,-.�--M^•. �w>. "�" . T Surveying Techniques
PREPARED FORS
DATE, �///8r/ ® SHEET OF
W,(Inicipality of Anchorage
®� �( DEP ARTMENT OF HEALTH & HUMAN
825 -L" Street, Anchorage, Alaska 995
SOILS LOG — PERCOLATION
PERFORMEO FOR: R✓/�� �� -
LEGAL DESCRIPTION: Zo/---
oePrR
LEeT�
2 /
3 Slit/
4-
6-
7-
A G7
fl
9 (iY," '
,Vic
n p
U
Township, Range,
SLOPE
�2a
SITE_ PLAN
WAS GROUNDWATER - /gyp v
10
ENCOUNTERED?
S
11® L
IF YES, AT WHAT O
DEPTH? P
12 Depth W Ylater Mh r ?
13 Man tntiag? pate S
14 Reading Date Gross Net Depth to Net
Tune Time Water Drop
MUNICIPALITY OF ANIMRAGE
15 DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
is
'JUN 2 21990
17
RECEIVED
18
19
2O
PERCOLATION RATE
TEST RUN BET4W-EN.
COMMENTS
PERFORMED BY: CJ/ /its= "✓ ' �r `��
ACCORDANCE WITH ALL STATE, AND MUNICIPAL.
72-008 (Rev. 4/85)
(mlmneslireeh) PERC HOLE DIAMETER
=T AND FT —1
TERTIFY THAT T ISS TEST WAS PERFORMED IN
THIS DATE OA
- -pi ceo ne
2.
® Four- LJroom house 4'"
18)(50' = g00"q.b-r iOtCA Lt'4-er
5 cLu C' S p S S
— .C� e
£
Rd
War. \p0 � f�i� p�opoSed
30'
Well
! H. v
P Sty. d , / ❑ T o
bL' rc e l W L
LJ2-�fri 1 I Z
k r r 1l 7f0 POSP� II
Cru J. COPWI❑ )
SEWER SYSTEM LOCATION PLAN
d
�i5� LI
LOT BLOCK �^ g SUBDIVISION
I I Cct lv brook -
r^' SECTION/TOWNSHIP/RANGE
`� Sa 35 TION P,
SCALE, .r NOTE,
YF6E ACCURACY OF LOCATION OF EXISTING
( % , PROPERTYCORNERS, WELLS, AND SEPTIC
DRAWN BY, SYSTEMS INDICATED IS NOT EXACT.
DIMENSIONS INDICATED HAVE BEEN
. NORTHMawr® a�
`.) ) DETERMINED BY USE OF CLOTH TAPE AND
WR Wa•0n. .�' n • .�.:..n ..: .':.. ..:.. ..n •':. .: ...n..
NOT BY SURVEYING TECHNIQUES.
• W, 1 �. CF•::d 9j PREPARED FOR,
.
i
e
2A Feb. 198°3
,DATE' SKEET of
`(ENG NEER'S SEAL)
�t
Municipality of Anchorage
® DEPARTMENT OF HEALTH & HUMAN SERVICES
825 "L" Street, Anchorage, Alaska 99502-0650 „ _- J. C
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: DATE PERFORMED: 3 Lac _,,.r._nl�/986
LEGAL DESCRIPTION:__�QQ/ Township, Range, Section: T12N A
f� SLOPE SITE PLAN
�5,
--
2
IF YES, AT WHAT
0 0
b
3
0
O®'
4-
® 0
0
16OS7 5
�+
Depth to to Water Alter
e G
so bee-,
Monitoring?
Date:
8
Na® p 9
a5f;o6g1p
11
j)V 12
6ND
13
3 SCJ
14-
4151617
15-
16-
17
P= s
o
18
7
?I
JJ
9
19-
m
20
20
CoP ) bUO&I
wP q ra v�-1
VisAaa.l�y r��ea �+
Lm
GM brow r\) 4^ icy
q -ra v el
GM- bye 6;4
WAS GROUND WATER
'i ENCOUNTERED?
S
O �1 D %
P
E
d
a
raa�� :0C 60s00a, m ,I
0
C J.®Corwin
C 52 3 ` F,
POFE.SS
Re I Date I Gross I Net I Depth to I Nor
Time Time Water op
PERCOLATION RATE
TEST R"BETWEE
(® t
(minutes/inch) PERC HOLE DIAMETER
=T AND FT
G ,
n -F ►tea sn.k4- C�Idrn
a
PERFORMED BY: 1AS A 1 Ca UQ Q� I ( — a ERTIFY THAT TPiI TEST WA9 PEhF� A'm--Eb IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES EFFEC O/ THIS DATE. DATE: / ��
72-008 (Rev. 4/85)
Y 0,
IF YES, AT WHAT
DEPTH?
7 _
2Y
�+
Depth to to Water Alter
5
Monitoring?
Date:
raa�� :0C 60s00a, m ,I
0
C J.®Corwin
C 52 3 ` F,
POFE.SS
Re I Date I Gross I Net I Depth to I Nor
Time Time Water op
PERCOLATION RATE
TEST R"BETWEE
(® t
(minutes/inch) PERC HOLE DIAMETER
=T AND FT
G ,
n -F ►tea sn.k4- C�Idrn
a
PERFORMED BY: 1AS A 1 Ca UQ Q� I ( — a ERTIFY THAT TPiI TEST WA9 PEhF� A'm--Eb IN
ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES EFFEC O/ THIS DATE. DATE: / ��
72-008 (Rev. 4/85)
Y 0,
0a
Op 0
& associates,inc.
Consulting Engineers
P.O. Box 230608 a Anchorage, Alaska 99523-0608 a (907) 279-8866 a FAX: (907) 279-2882
June 7, 1990
Mr. Dan Bowles
Municipality of Anchorage
Department of Health and Human Services
OnSite Services
825 L Street, 5th Floor
Anchorage, Alaska 99501
SUBJECT: WATER MONITORING EAGLEBROOK SUBDIVISION
Dear Dan:
In accordance with our conversation, we have been informed that
Acreage Systems, Inc. has repaired the curtain drain bordering
the east side of Eaglebrook Subdivision, Lot 1, Block 1. We
monitored the water elevation at two locations on June 6, 1990
and found the water to between 7 and 8 feet below the surface.
Even though the water levels are now deeper than our original
monitoring, we don not recommend that the original design we
submitted be altered and ask that the permit be issued for the
sewer system as we had originally designed.
Should you have any further questions or need any additional
information, please let us know.
W
& AS ;OC TES, INC.
. Corwin, P.E.
MUNICIPALITY OF ANICHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
W,
-1 17 ,
C6
0 fj
MT
AY7
6 -Al
Parcel I.D. 017-121-23
Municipality of Anc
Onsite Water and Wastewater
(907) 343-7904
Certificate of On -Site Systems
1. GENERAL INFORMATION
L 2 2 2016
Expiration Date: j 2 -
Complete legal description Eaglebrook, Block 1, Lot 1
Location (site address) 14800 Northfield Drive Anchorage, AK 99516
Current Property owner(s) Stanley & Janice Perry
Day phone 444-2852
Mailing address 14800 Northfield Drive Anchorage, AK 99516
Real Estate Agent Day phone
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Four
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
M
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request
Received by: Date: /N
COSA to be released to the engin r unless otherwise requested by the engineer. -
COSA Fee
Date of Payment
Receipt Number
COSA #
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
a
5. STATEMENT OF WSRECTION 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 Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
6. DSD SIGNATURE
System #1 Approved for bedrooms
System #2 Approved for bedrooms
Disapproved
Conditional approval for bedrooms,
te. 7/14/2016
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s O MICR 4,E. ,A{,SUERSON
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with the following stipulations:
Original Certificate Date: '1 —/ 2
v
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.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet;' 1: c
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: Eaglebrook, Block 1, Lot 1 Parcel ID: 017-121-23
A. WELL DATA
Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y
Date completed 8/22/90 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y
Total depth 110 ft. Cased to 110 ft. Casing height (above ground) >12 in.
FROM WELL LOG
Date of test 8/22/90
Static water level UNK ft
Well production 20 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate ND mg/L
Arsenic ND ug/L Date of sample: 6/21/16
AT INSPECTION
6/18//2016
20
ft.
5.2
9 -
p.m -
Collected by: And. Engineering
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel Date installed 7/18/90
Tank size 1,250 gal. Number of Compartments 2 Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping Pumper T4 AKS
C. ABSORPTION FIELD DATA
Date installed 7/18/90 Soil rating (g.p.d./ft2 or a/bdrm) 150 SFISDRM System type Bed
Length 40 ft. Width 24 ft. Gravel below pipe .5 ft.
Total depth 4 ft. Eff. absorption area 960 a Monitoring tube Y Depression over field N
Date of adequacy test 6/18/16 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 710 gal. New depth 0 in.
Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= 600 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date installed
"Pump on" level at in.
Datum
E. SEPARATION DISTANCES
Size in gallons_
'Pump off' level at
Cycles tested _
WELL ON LOT TO:
Septic tank/lift station on lot >100'
Absorption field on lot >100,
Public sewer main >75'
Sewer /septic service line >25'
Animal containment areas >50'
SEPTIC/HOLDING TANK ON LOT TO:
>5' >5'
Manhole/Access (Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots
>100'
>100'
Public sewer manhole/cleanout >100,
Holding tank >75'
Manure/animal excrete storage areas >100,
Building foundation Property line
Water main >10, Water service line >10
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOTTO:
Property I!ne >10' Building foundation >10'
Water Service line > Surfacewater >100
Curtain drain None Noted Wells on adjacent lots >100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION
t 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 Michael E. Anderson, P.E.
Date 7/14/2016
COSA brown sheet 10-10-12.doc
Absorption field >51
Surface water >100,
Water main >10,
Driveway, parking/vehicle storage > 10'
t
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, William+ S. Smithe.°°moo
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.0 / hereby certify that on accurate survey of the
V following described property -
L o -r
- — rr qr
was mode on and that the
improvements situated thereon are withln the
property /inee and do not onrr/ap or encroach
on the property lying adjacent thereto, that no
improvaoenfsan property /ying aQ/bceat tbereto
encroach on the premises In question and that
there are no roodways, tronsmisslon /lues cr other
visible easements on said property except as
indicated hereon. t2 /�
Dated of Anchorage, Alaska thJ�_day, of
PREPAR£O FOR 0414-1,
j14 L-SNo. ¢/075
ORWN BY•' MSS OATS: If//4/q/: SCALE: / N So SHEETNO. / of / GEODETIC TECHNOLOGY
CHOO BY; Mie WLt Na •'. FB. NO. ,y//sem GR/O SURVEYING SERV/CES
2601 Turnagain ,Parkway
AS'BU/LT Anchorage,', Alaska 99503
L07-1 3000.GL / 24 8-3390
Ef%LGE.��dO.0 '5//Bb.
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.
MUNICIPALITY OF ANCHORAGE
® `H DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # is 1 ®1 — I Z 1 Z3
Complete legal description o i
C_ -AG -tom 13ILO 0K
Location (site address or directions) t 4-86p U 1LIyt-
Property owner 4 _v—
® � Day phone 3 4J --L 121
Mailing address 14800 t7 IL 1=i e.A
Lending agency Day phone
Mailing address
Agent Day phone
/_TGU i
Unless otherwise requested, HAA will be held for pickup.
2, NUMBER OF BEDROOMS:
Individual well
Community well
Public water
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
Individual on-site
Holding tank
Community on-site
Public sewer
NOTE: If community wastewater system, provide written confirmation from State A®EC
attesting to the legality and status of system.
72-025 (Rev. 1/91) front MOA N21
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 application shows that the on-site water supply
and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms
and type of structure indicated herein. I furtherverify that based on the information obtained from
the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is in compliance with all Municipal and State codes,
ordinances, and regulations in effect on the date of this inspection.
Name of Firm V N I6-1 N 1^J Phone .3 S�� ®.._
Address 940 I t, 6's C-17
Engineer's signature
MWE
0
®zoo. ®O..'6.daupT.•®
0 Robert E. knief wx
:o Pio. 4149 - E
� ���C4SJleTel`rgi
6, DHHS SIGNATURE
__�L Approved for bedrooms.
Conditional approval for
Additional Comments
M
iLITIC
Date 6-24-11
bedrooms, with the following stipulations:
Date 7�/— ZZ
The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority
Approval Certificates based only upon the representations given in paragraph 5 above by an independent
professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes
and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not
conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not
responsible for errors or omissions in the professional engineer's work.
72-025 (Rev. 1/91) Back MOA k21
rotiMunicipality of • . • ' a
Department of Health & Human Services
HEALTH AUTHORITY APPROVALCHECKLIST T 4i��'
Legal Description: Lor ` Blow l Parcel I.D. ® 11 ® 121"2.3
Lj=A 12-0611L 149 &s® A. a e eml
A. WELL DATA
1
Well type If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed Driller
Total depth 9 d Cased to -Casing height 9
Sanitary seal (Y/N) � Wires properly protected (Y/N) ®D�p
Date of test
Static water level
Well flow
Pump level
FROM WELL LOG
??__q0
WK -
g.p.m.
(0 O
d �
Septic/holding tank on lot 1 S7 On adjacent lots
Absorption field on lot ; On adjacent lotsm�
Public sewer main PJ 1A Public sewer manhole/cleanout PST 1A
Public sewer service line QIA Petroleum tank PP ON % tet®
Coliform —____ c® Nitrate Other bacteria �.
Date of sample:g7II Collected s0/Jy7
B. SEPTIC/HOLDING TANK DATA
77�
Date installed 4 93110 Tank size 1 Compartments
Cleanouts(Y/N)
Foundation cleanout (Y/N)
Depression (Y/N)
High water alarm (Y/N) Alarm tested (Y/N)
Date of pumping
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
P
Well on lot € SooOn adjacent lots �� Foundations
To property line_ Absorption field Water main/service line
Surface water/drainage /04
72-026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
"Pump on" level at
Meets MOA electrical codes (Y/N)
Mal
— Manufacturer
Manhole/Access (Y/N)
mp off" level at
Cycles tested
On adjacent lots
Surface water
Date installed ___ __ :T— 18 —9 0 -_ Soil rating — L System type
Length 4-0 Width 2-+ Gravel thickness -Total depth 4
Total absorption area — - Cleanouts present (Y/N) ev
Depression over field (Y/N) Date of adequacy test --X) ®Fl y AJu�Slvrw�
Results (pass/fail)
Peroxide treatment (past 12 months) (Y/N)
If yes, give date
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot adjacent lots
Property line_
0
To
ine—
To building foundation To existing or abandoned system on lot
On adjacent lots
Surface water
Curtain drain AJ
Water main/service line
Driveway, parking/vehicle storage area
bedrooms
I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
A�tq,jl
Signature
%
%
Engineers Name L;t�T
Date Robert E. Knsef®1
No. 4149. E N &W
2
HAA Fee $ FION CO
Date of Payment
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
r
M
NORTHERN TESTING LABORATURIE69
FAIRBANKS, ALASKA 99709 (907) 45&3115 , FAX 466,3125
3330 INDUSTRIAL WAY (®07) 977-637®a FAX 274-9645
2545 FAIRBANKS STREET AHCHOFIAGE,ALASKA 20603
acreage systema, Inc.
601 fie Noetheen Lto, Blvd., ,#343
4nchorage » 99503-2811
our Lab is
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sample Matrixi
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DL Stated LA Re@Ult
Regulatory Min.
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x Below Detection Limit
zotimated Value
Date
M'PChod Parameter Units Reault Flag Analysed
mW®®-- °--®��.@ a®r__m-®_ ®__�aw�_Yp. _w® PP «tea.--
EPA 300.0_®__Nitrate-N-------_ - mg/l 0.5 D 05/31/91
LL
Repoeted jy% William N. 9-mVhan
Rneh®rage operations Manager
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NORTHERN TEST11
21011AIIRgAANKS STREET
600 UNIVERSITY PLAZA yyEyr, SUITE A ANCh10aAGe, AL4,SKA 89503
FAIRaANI(9, KA 907�d77.837®•EAX274®645
%7�g116 ® PAX47k647
rfn�ln l, yC011form
TIJ OE COMPLET'Eo BY CLIENT - Bacteria
0 PUBLIC WATER SYStg
PRIVATE WATER SYSTEM
ACREAGE SYSTEMS, INC.
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