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BOB WELLS BLK 2 LT 1A
Bob Wells Block 2 Lot 1 #067 - 042 - 09 On -Site Water and/or Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP161176 Tax Code Number: 06704209000 Work Type: SepticTank Upgrade Permit Effective Dates: July 14, 2016 to July 14, 2017 Design Engineer: ARC TERRA CONSULTING INC Subdivision: BOB WELLS Site Legal Address: BOB WELLS BLK 2 LT 1A G:0363 Owner/Address: CRIPE SEAN & SARAH 26016 EAGLE RIVER RD EAGLE RIVER AK 995779692 Site Mailing Address: 26016 EAGLE RIVER RD, Eagle River Lot Size in Sq Ft: 28469 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: %/ X / Date: (da -r4 By: Ai' -r4 / / Date: MUNICIPALITY OF ANCHOR Community Development Department Development Services Division On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 067-042-09 Sean & Sarah Cripe Property owner(s) Day phone Mailing address 26016 Eagle River Rd, Eagle River, AK 99577 Site address 26016 Eagle River Rd, Eagle River, AK 99577 Legal description (Sub'd., Block & Lot) BOB WELLS BLK 2 LOT 1A Legal description (Township, Range & Section) Lot Size 28,469 Sq. Ft. Number of Bedrooms 3 APPLICATION I5 FOR: (EI all that apply) Absorption Field ❑ Septic Tank 2] Holding Tank ❑ Privy Private Well Water Storage APPLICATION IS AN: Initial Upgrade Renewal 0 0 TYPE OF DWELLING: Single Family (SF) (w/wo ADU) Duplex (D) Multiple Dwellings (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE /WAIVER REQUEST FOR: 0 0 Distance. I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. c� �w (Signature of prope r' .�1! er or/authorized agent) Permit/Rush Fees: 216— Date 6— Date of Payment: G/Z9/ i% Receipt Number: G t 3s aG Permit No. ©Sr! rn (l 7 Co Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. b.k cTER,,q m \ ARC 1 ERRA CONSULTING, INC 212 E. 51s` Ave, Anchorage, AK. 99503 Office (907) 868-3791, Fax (907) 868-3793 June 24, 2016 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Septic Tank Upgrade Permit — Bob Wells Blk 2 Lot lA The owner has requested we proceed forward to obtain a septic permit to upgrade the failed septic tank on the subject lot. We propose to decommission the existing 1978 1000 -gallon septic tank and install a new 1250 -gallon septic tank to serve the existing 3 -bedroom house. For your information, attached is a diagram of this proposed tank upgrade. The tank will be placed further south away from the foundation as much as possible. The lot and adjacent lots are served by private wells and there are no wells or surface water within 100' of the proposed tank. We do not expect there to be any adverse effect on adjacent lots by the development of this tank. If you have any questions, please contact me at 868-3791 / FAX 868-3793. Respectfully submitted, ArcTerra Consulting, Inc. Dea Duffus Owner's Representative Attachments: On -Site Sewer Application Upgrade Sketch WC° 01s- 20441 PTARMIGAN BLVD • EAGLE RIVER, AK 99577-8736 • PH (907) 868-3791 • FAX (907) 868-3793 ro)1 m�o,� Q,5 q4 ezin 2016 SEPTIC TANK UPGRADE: Decommission existing septic tank per code & install new 1250 -gallon septic tank and two post -tank cleanouts per code, maintaining 5'+ from foundation & existing field, and 10' + from waterline. 3o7.31 ass..4s-cJ et ,..Ln aI y -s7-or NOTES 1. No wells on adjoining lots are within 100' of proposed tank placement. Na Pubic,ocUs welibn r6vos�6 p 2. No surface water noted within ta-ir� 100' of proposed tank placement. AS -BUILT 1 hereby certify that i have surveyed the following described • propt7ty. Lo7- /+ P/s'e:-k t ar Bye tv-e•-1 /s Full Andtorge etirdingredncand that the improve - asks, ments re withinthe �enand do not or encoach on the property adjacent1ydgthereto, thatno improvements onpproperty adjacenttheretoenroscon the premises to pueston and that there are no roadways, trensmisalon tines or other visile easements on said property except as Indicated hereon. Dated at Eagle River, Alaska this fr ti' day of t-jrs....v I9 7 ROBERT' C.IOHNOSN X 1SCi�LE Registered Land Surveyor No. ii80-TeS Box 77-0456, Eagle River, Alaska 99577 phone (907) 694-7543 ec 41-' MUNICIPALITY OF ANCHORAGE (I DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME Q. -URI -Es -- .9 t4 PHONE 4se, -..ziocta NEW ■ UPGRADE MAILING ADDRESS Q (� .0 . CJ ©)C CA TA VAC I. -E \U6R, LEGAL DESCRIPTIONQ0-n L x O-2 Oo� V36LLs S� LOCATION ��' O'er S(/.4s-t-S(/.4s-t-\` M C \ \*.1't47... QD e� C ,Y .. CZOA1i NO. OF BEDROOMS SEPTIC TANK DISTANCE TO: Well Absorption area X. 0 1 Dwelling w S PERMIT NO. ..1 110 (p 1,2 Manufacturer Material No. of compartments Z Liq. capacity in gallons \boo IF HOMEMADE: Inside length % 1 t A Width N 14 Liquid depth I A c Y —03 Z DISTANCE TO: Well ` Dwelling PERMIT NO. 2 ? < Manufacturer N Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well I.47 Foundation 2, Nearest lot line PERMIT NO. 1643(321L, No. of lines \ Length of each Total length of lines 0► Trench width inches Distance between lines 1 A Top of tile to finish grade �� 4\ Q Material beneath tile `t (p 0 inches Total effective absorption area 40e SEEPAGE PIT Length Width Depth PERMIT NO. ` Type of crib , f\Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line W ass ` r►0 \r)O Depth Driller Distance to lot line PERMIT NO. I DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS NL is" -RATING \c42.1 P -Th\ `3©3q- , S 0 SOI EST V-6tt �5 co 1 `N� INSTALLER 3034 S� W REMARKS Attty 30' w 1 4•" 1, Z� ita 3634 VV-, 1 M N I 44 P D np . Yv r 1,5 etL j►VED DATE LEGAL iiirk , ci6S\,1_,3,2,3 —.v.. .\s\ -k% 72-013 (Rev. 3/78) MKINICIk^FR... ay' FOINICI-IN���� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, HK 99501 RD`5/) 264-4720 /�-7� //~'.~ /u _____ ___ ___ ____ __,,__` �_��� ����� ������ ��—��n� ������� �~��x^o�o 4/»es_ PERMIT NO. ( 780622 ) APPLICANT CHARLES FERRIN LOCATION EAGLE RIVER RD LEGAL Li B2 BOB WELLS 5/D PO BOX 927 EAGLE RIVER 688 2690 LOT SIZE 24800 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 135 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: DEE.F"TI-1= ILO �E.:NM-1A= 37,4 cauF-11-4-1= 67; THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. 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 IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FiflaIQUIFREEED, �Fir4K !SialE:= 1.010,10 cino_l_or-47E5 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ___ -FWD <2> INITIONE; BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM HPUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL- WELL ELLWELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTHLLHTIM CAIECMOU:F.: ft.E4�� I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDRO8MS. SIGNED:_ ISSUED APPLICANT CHARLES FERRIN 0 & E GEG ECHNI CAL Ft DEVELJPMENT CO. Russell Oyster 694-2774 Soils Et Foundations Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Ellis 688-2280 Land Development Performed for: Name: /%2 Ci- , eie,e/N Tel. No. 188-s Mailing Address: 2 92.!, 4s ` � .tic ftr7.7 Legal Description: '-E r Depth (feet) Soil Characteristics 0 1 2 3 `Y -�o,D G / c W! Z' -7- O, a #‘)/4. , E 7'S' 1, ap-- m 14:;41 A).017 azei 6 A- 7 8 9. 11 12 13 14 15 16 e.AD364.-E . j%= Pa ci Lis £ ? /YI it.1u 3-/idc44 35 Scze (:20n7rbelA E/�6L6' G"Zi U te- %&dA4 Ground Water Encountered: Yes No '` If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: 354- r 22 3& Performed by: Date: u4.7 (:// 197 MUNICIPALITY OF ANCI-FORAGE DEPT. OF N`AL7N & QIIrtI(Irb MENTAL ,� by j p% 41979 A & I, DRILLING COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 . TELEPHONE 694-2588 OWNER OF LAND (,//f?/LFQ, 'JA EIV ADDRESS R L. E= LEGAL DESCRIPTION 267- 1 bjk :"-)(d DATE - Started /u '- .� Ended % c - 7 (�- PERMIT NUMBER 71 0 C° a DEPTH OF WELL RECEIVED STATIC LEVEL OF WATER FT ? 416,-W DOWN FT GALS. PER HR KIND OF CASING ,10 ;gni-) KIND OF FORMATION: From Cf Ft to 1 Ft O (..+/eZ d a Q 06-1^-1 From Ft to Ft From 1Ft to / S- Ft. e 4-itr' 6 Q ni� FG. -,,FFrrom th1 Ft. to Ft. From i .I� Ft to b 7 Ft C14- !r r 4- b 'Q-4., `4. From Ft. to Ft From t �% Ft. to 777 Ft s�v� d 6 2 ✓r_ C 4-- ��T Fro n Ft. to Ft From Ft to Ft From Ft to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft. From Ft to Ft. From Ft to Ft From Ft to Ft. From Ft to Ft From Ft. to Ft From Ft to Ft From Ft to Ft From Ft to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft to Ft From Ft to Ft MISCL. INFORMATION: DRILLER'S NAME Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 067-042-09 Expiration Date: 9 - (. - / 1. GENERAL INFORMATION Complete legal description BOB WELLS BLOCK2, LOT 1A Location (site address) 26016 EAGLE RIVER ROAD, EAGLE RIVER, AK 99577 Current Property owner(s) IVARS STOLCERS & ANDRA SILGAILIS Day phone Mailing address 26016 EAGLE RIVER ROAD, EAGLE RIVER, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Z Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: COSA to be released to the engineer, unless se requested by the engineer. Date:620 -/5 COSA Fee $ 5VVo Waiver Fee $ Date of Payment gig /15 Date of Payment Receipt Number oaRyac-, Receipt Number COSA# 05C1512' In Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER sli Certi� 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. 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 inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. 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 well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. Date 6/18/15 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulatio <20. it OIFf i f fr�� C iii WATER ANDrt, ▪ WASTEWAT ' o - PrROCRAM By: 1)50F'usslON�' //(4 dKT- "')))»»))))'' Original Certificate Date: io - 2 The Mun pal , of nchorage 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_10.10-12.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: BOB WELLS BLOCK 2, LOT 1A Parcel ID: 067-042-09 A. WELL DATA Well type PRVT If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 10/26/78 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 70 ft. Cased to 40+ (PERMOADOCS) ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/26/1978 6111/15 Static water level 40 ft. 38 ft. Well production 12 g.p.m. 2.8 g.p.m. WATER SAMPLE RESULTS: Neil eil colonies/100 mL Nitrate 486 mg/L Arsenic: Nt ug/L Date of sample: 6/11/15 B. SEPTIC/HOLDING TANK DATA Collected by: ARCTERRA Tank Type/Material SEPTIC / STEEL Date installed 11/15/1978 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 6111/15 Pumper JRs C. ABSORPTION FIELD DATA Date installed 1111511978 Soil rating (g.p.d./ft2 or ft2/bdrm) 135 System type DEEP TRENCH Length 34 ft. Width 3 ft. Grave( below pipe 6 ft. Total depth 8.4* ft. (Measured 1130/14) Eff. absorption area 408 ft2 Monitoring tube Y Depression over field N Date of adequacy test 6/11/15 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 20 in. Water added 450 gal. New depth 28 in. Elapsed Time: 1440 min. Final fluid depth 19 in. Absorption rate >= 450 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) 14 If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" levet at _ in. "Pump off' level at _ in. High water alarm level at Datum Cycles tested Meets alarm & circuit requirements? in. E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 25'+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation <5' (See MOA Docs) Property line 5'+ Absorption field 5'+ Water main 10'+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 101+ Surface water 100'+ Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I 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 KENNETH M. DUFFUS Date 6118115 COSA canary sheet 2-6-95:doc Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 067-042-09 1. GENERAL INFORMATION COSA# Oscta 1210 Expiration Date: Complete legal description BOB WELLS; BLOCK 2, LOT 1A Location (site address) 26016 EAGLE RIVER ROAD *EAGLE RIVER, AK 99577 Current Property owner(s) KAYDA NICHOLS Day phone 273-5277 Mailing address 26016 EAGLE RIVER ROAD *EAGLE RIVER, AK 99577 Lending agency Day phone Mailing address Real Estate Agent TERRY GOSE W/ REMAX Day phone Mailing address Unless otherwise. requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well . Individual On-site Il Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 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 & Regulations. The reported results described the performance of the system untie.- 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 soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. • 5. DSD SIGNATURE V Approved for 3 bedrooms. Disapproved. Conditional approval for Date ("Hirt i Q VA VA mess.. C 79 P^ . b..ffl2.. oco4 Ec P�ofessiono O�000�� \Q,1j�`OF (��q0(r gON-SITE WATER AND ` bedrooms, with the following stipulations"; WASTEWATER E. y PROGRAM �� •� SQ )))))))))»e. � JN\c° \\ Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Adviso By: (Rev. 11/05) l./ zzi 79e- x' 1 Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: BOB WELLS; BLOCK 2, LOT 1A A. WELL DATA *PER SURROUNDING WELL LOGS Parcel ID: 067-042-09 Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 10/26/78 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 70 ft. Cased to *40+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/26/78 5/8/12 Static water level 40 ft. 35 ft Well production 12 g.p.m. 2.96 g p.m. WATER SAMPLE RESULTS: Coliform0 colonies/100 m1. Nitrate°.Dtgmg./L. Collected by: GEG Ltd Arsenic:) A �O ug./L. Date of sample: 5/8/12 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 1 1 /15/78 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping (o/11)1)- Pumper c ' 5 Pl.Lrl%oirt GJ C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 11/15/78 Soil rating (g.p.d./ft or2/bdr)135 System type DEEP TRENCH Length 34 ft Width 3 ft. Gravel below pipe 6 ft Total depth *8.50 ft. Eff. absorption area 408 ft2 Monitoring tube YES Date of adequacy test 5/8/12 Fluid depth in absorption field before test Results (Pass/Fail) PASS 22 in. Water added790 gal. Depression over field NO For 3 bedrooms New depth 36 in. Elapsed Time: 120 min. Final fluid depth 26 in. Absorption rate >= 450+ g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE If yes, give date - D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off" level Datu E. SEPARATION DISTANCES Manhole/Access (Y/N High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot Public sewer main 100'+ N/A Sewer /septic service line 251+ Animal containment areas 50'+ On adjacent lots On adjacent Tots Public sewer manhole/cleanout Holding tank 100'+ 100'+ N/A N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation * Property line Water main N/A Water service line 5+ Absorption field 5+ 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 N/A Water service line 10'+ Surface water 1 00'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *SEPTIC TANK C/0 IS 6'+/— FROM HOUSE. SEPARATION DISTANCE FROM TANK CORNER TO THE FOUNDATION IS UNKNOWN WITHOUT EXPOSING THE SEPTIC TANK. 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 COSA guidelines in effect on this date. Engineer's Printeci Name JEFFREY A. GARNESS Date 42/I1142- COSA Fee $ `t Q Date of Payment Co f r 2 /i' Receipt Number (Rev. 11/05) G 85550-, Waiver Fee $ Date of Payment Receipt Number r •al f ;, 4t' A n � • "r¢ r8 • 72 Sr. +.,...c_I- ? 1 )te•-e kr ro' �filify iFSert`t, 307.31 Task c'o is b141 g'From hou2e 0 fl.Lti %Q >M "Tl From 6..04<iikmt1c uA(a1w A L, %\oufi e'-Cc.tre$+4'n • OF Aar :9 $# 49ti1 (`,�14 k A r• .•N•.•.... W.•.N,.M .e. .e • 0 75444.:44t., ct4t E,t,iA-hYn a gpi .. • M...•YN./....dos •.... N j Robert C.Johason Pell Fe df a °. ▪ NO.t3GS ;".'�•;v t�•vi cJ e 'he S —r7— A5: M-61 C. AS -BUILT 1 hereby certify that 1 have surveyed the following desaibed property. Lei- / e it k 2. Pob f SvLc/ S�e.IzrAct L3, Tlrf,tlip1w 1574, Anchorage Recording Precinct, Alaska, and that the improve• tnents situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Improvements on property lying adjacent thereto encroach on the premises In question and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated at Eagle River, Alaska this f5—=1 t,yof Mrav 1907 ROBERT C. JOHNSON Wc'-+', SCALE: Registered Land Surveyor No1'880-LS 1^ - Ara r Box 77-0456, Eagle Rivet, Alaska 99577 Phone (907) 694-2543 3 BEDROOM HOUSE SLAB ON GRADE FOUNDATION TANK DRAINFIELD HOUSE SLAB ON GRADE FOUNDATION TOP OF SLAB ELE. 94.83 (SHOT BY GEG) WOOD RETAINING WALL */� 10" ASSUMED et - F LOCATION OF TANK IN RELATION TO FOUNDATION DOES NOT PUT TANK AT RISK OF BEARING LOAD FROM HOUSE 1 "=20" UNKNOWN WIDTH 3.3'+ TOP OF TANK ELE. 93.525 (CALC) SEPTIC TANK BOTTOM OF TANK ELE. 88.65 (SHOT BY GEG) 060 GARNESS ENGINFERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS =e: 701 E TUDOR ROAD. SURE 101 • ANCHOMGE. AK 99507 • PHONE (907)337-6179 • FAX (907)338-3266 * WEBSITE www.gamevengl eR g.cam PREPARED FOR: KAYDA NICHOLS PHONE NUMBER: 907-354-7088 PAGE NUMBER: 1 OF 1 LEGAL DESCRIPTION: BOB WELLS S/D; BLOCK 2, LOT 1A TYPE OF WORK: CROSS SECTION OF TANK DRAWN BY: A.J.G. D arnessr D b !3: Ecod o o ppp�. 21, DATE: �� �ofessio�o 6/21/2012 �OO000�� (Rev. 01/05) 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. 06,7 Oe/Z 09 HAA# t75OAik3 Expiration Date: 1— 9 - O S 1. GENERAL INFORMATION Complete legal description - btiet- tet- , Vs 1-t • get 02 - Location (site address oridirections) a 6 0/6 P to - ,C4/44.- e. . Current Property owner(s) Foy f � c/urw. Crolcefirr/ Day phone (077- 30-2-1 Mailing address ztp0/!o Er_ ;Oily? p t , Pettit. (,ver 4k 99577 Lending agency Frsf 4 -titian 77,Uc- Day phone 491/- I4/56 Mailing address Pater_- Ali✓ -u Age B"€d 6&nn hit AK 99577 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 System Er 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 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. 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. Eagle River Engineering Services 10421 VUW fid., Suite 201 Eagle River, AK 99577 Name of Firm Address Engineer's Printed Name Cite STopNE1' ti'. [Web 5. DSD SIGNATURE ✓ Approved for 3 bedrooms. Disapproved. Conditional approval for By: Phone 69H-5795 bedrooms, with the following stipulations: Additional Comments tf ri OF a /e • j ON-SITE •: • WATER AND ; m- WASTEWATER PROGRAM• : z ib/)ii»»Iit Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other (Rev 01/02) Original Certificate Date: IQ — 9- US 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 • Legal Description: 166 G(%G(4-. hof fs4- Parcel ID: t%'7- 04; - Oq A. WELL DATA Well type Tnllividca, If A, B, or C provide PWSID # _ Well Log ON) Date completed 4/14./7/ Sanitary seal ON) U- Wires properly protected QN) c Total depth 6'7 Cased to (09•S' ft. Casing height (above ground) !.a- in. FROM WELL LOG AT INSPECTION Date of test /0/a G/7,r SJ G/c5 Static water level 'J0 ft. q3 ft. Well production i.'- g.p.m. S 5- g.p.m. WATER SAMPLE RESULTS: Coliform fel colonies/100 ml. Nitrate .GS/ mg./I. Other bacteria 1 colonies/100 ml. Arsenic: n/a mg./I. Date of sample: 57/21115 Collected by: L 4A/.4o- Bic wcc.+--i B. SEPTIC/HOLDING TANK DATA Tank Type/Material C77--c-c4- / , pa, Date installed (/ f / 5J7d' Tank size /i WO gal. Number of Compartments .2- Cleanouts (YEN) (#C4 -- Foundation Foundation cleanout (9N) Depression over tank (Y/�I NZc- High water alarm (Y1S 'i2e- Date of pumping si2//OS- C. ABSORPTION FIELD DATA Pumper c1E 's RGLI'vlfyc j Date installed 11 /1517F Soil rating (g.p.d./ft2 orlft2/bdrml 135 System type `%n-cL Length 3Y ft. Width .9 ft. Gravel below pipe Co ft. Total depth - /O , ft. Eff. absorption area d08' ft2 Monitoring tube L f c4._ Depression over field ` r Date of adequacy test 5- 1/41- Results s ail) _a For 3 bedrooms Fluid depth in absorption field before test 1/5 in. Water added 145--0 gal. New depth 49.5in. Elapsed Time: 75 min. Final fluid depth N5 in. Absorption rate >= 1150 g.p.d. Any rejuvenation treatment (past 12 mo.) (YS& type) `728— If yes, give date n la D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on' level at _ in. "Pump off" level at in.L)f(High ire_ Datum ycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main r -t-W0' Sewer /septic service line er alarm level at in. Meets alarm & circuit requirements? On adjacent lots On adjacent lots tico' -f /00' Public sewer manhole/cleanout 1 /5 ' Holding tank SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Water main + / 0 5' Property line ji2L Water service line Wells on adjacent tots -4 / 00' tl0' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ' Si' Building foundation 1-7 Water Service line -r' /0' Surface water t/00' Curtain drain 1-50' Wells on adjacent lots t 100 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. Engineer's Printed Name Chrivf0Plw.. ,2. Date (c/7 /QS HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) (41 f Ica/ Absorption field Surface water -t (UQ' -7 ' f/oO' Water main 'r10 Driveway, parking/vehicle storage .23' Waiver Fee $ Date of Payment Receipt Number r 307.31 RA $.4 d 41 Cot de. •f:c el 5-- 17— a 5: n AS -BUILT 1 hereby certify that I have surveyed the following described property. f_o7- 1 e/.re:k 2.r Rob w.0_1/s Se�.�ron. L3,7-1* A ;IP ILL.) r$M, Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or enaoach on the property lying adjacent thereto, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. Dated at Eagle River, Alaska this f -S �' day of Nil"' 19 q= ROBERT C. JOHNSON %lcn..5 SCALE: Registered Land Surveyor No.4180.LS 1" - r Box 77-0456, Eagle River, Alaska 99577 Phone (907) 694-2543 06/03/2005 11:55 9073449621 JRs Pumping PO Box 773415 Eagle River, AK 99577 (907) 694-6454, JRS SEPTIC dining IMonnetlon _ .I Ever Enp'niertng • Job Description: 1250g 10421 VFW Rd SN 201 Eagle River. AK 09577 (907)694.5195 P.O. Number. Terms: Net30 Salting): 14kole Map Bode: Job Sate Information —j Cres Streets: Log Cabin Circle Stephanie - J- June Croxlord(home owner Job Comments: LeaChecked service pumpedd �n level; normal. BF 2x. Outflow c/o has 26016 Eagle River Road sludge build-up. Recommend letting. In$cw Me clear. PAGE 02 Service Agreement Number: Order Date: SeMea Dat.. Technician: 016796 27 -May -2005 31 -May -2005 12:00 em Tony Job Type Repeat Map Grid: 134- - Eads River, AK 99567 (907) 694-5195 Tax Percent: Service Type Qty Price Each x 2 Men Tax Extension Actual Contractor Job 1 3140.00 No No 6140.00 Additional Locet$on Comments: Red -cedar. ranch style wl rs on house & maw. no dogs. White hailer M front of house, paved dw w/ turnaround Woe - sleep dw. 4bdnn septic In back to the East w/ green caps - use gate to access pipes. Diagram: c/o • Tank • _ e Gate • e/o 11 Gallons Planned: 1250 EagleL.—•— Gallons Actual: Hose Length: Double Tank: [1 Pump System: F%I Bares Inlet Li Baffles Outlet n _ Eagle 1 Estimated Charges: Actual Charges: Nontaxable Total 5140.00 Taxable Total 60.00 Tax Total $0.00 Grand Total $140.00 Customer egress to the terms end conditions printed on the back. THIS ISA BINDING AGREEMENT. Signature and TIIM of Customer Representative Delo ACapled by JR -1 Pumping Date Accepted For your added conveNence we accept' American Express, Dlcover. Visa and Master Card payments over the phone. error %A nave armims wul be turned over to collections. 525.00 For NSF Checks Returned. MUNICIPALITY OF ANCHORAGE 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. # 067-042-07 1. GENERAL INFORMATION Complete legal description HAA# Lot 1, Block 2, BoB Wells Subdivision Location (site address or directions) 2601 6 Eagle River Road Property owner Dennis Long Day phone 696-1557 Mailing address 26016 Eagle River Rd. Lending agency None Day phone Mailing address Agent NnnP Day phone Address 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 `+ XXX 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 XXX NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 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 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 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Anderson Engineering Phone 563-7155 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's signature MPJ Date Z/0A 7 6. DHHS SIGNATURE By. Y Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72.025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage LE C E I V E D DEPARTMENT OF HEALTH & HUMAN SERVIC Environmental Services Division `i% 34.9 t97 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 4 Municipality of Anchorage Dept. Health & Human Services Health Authority Approval Checklist Legal Description: Lot 1 Block 2, Bob Wells S/tParcel I.D.: 067-042-07 A. WELL DATA Well type Individual If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed Jan 4 , 1 979 Total depth 69 ' 9" Cased to 69' 9" Casing height (above ground) 15" Sanitary seal (Y/N) Y Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test 1/4/79 7/7/97 Static water level 40 ' 36.9 Well production 1 2 g.pm. g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate .81 mg/L Date of sample: 7/7/97 Collected by: Other bacteria Stuart Gilbert B. SEPTIC/HOLDING TANK DATA Date installed 1 1/15/78 Tank size 1 , 000 Number of Compartments 2 Cleanouts (Y/N) Y (1 ) Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N Date of Pumping 5/15/97 C. ABSORPTION FIELD DATA Pumper J.R. Eagle River Date installed 11 /15/78 Soil rating '(g.p.d./ft2 or ft2/bdrm) 135 System type trench Length 34 ' Width 36" Gravel thickness below pipe 6 ' 0l'' Effective absorption area 408 Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 7/7/97 Results (Pass/Fail) Pass For 3 BR bedrooms Fluid depth in absorption field before test (in.); 1" Immediately after 705 gal. water added (in.) 37" 21 hrs Fluid depth 21.5'' (ins) Minutes later: Absorption rate = 583 g.p.d. 1,260 mi N Total depth 10 Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* If yes, give date D. LIFT STATION None on Lot Date installed None Size in gallons Manhole/Access (Y/N) "Pump on" level at* "Pump off" level at* High water alarm level at* *Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 140 ' On adjacent Tots GT 1 5 0 Absorption field on lot GT 140 ' On adjacent lots (T 150 Public sewer main None Public sewer manhole/cleanout None Sewer /septic service line GT 50 ' Lift station None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation GT15' Property line 39' Absorption field 7 Water main/service line GT 50Surface water/drainage Nnna Wells on adjacent lots GT 1 50' observed SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 20 ' Building foundation GT 20Water main/service line GT 50' Surface water None observed Driveway, parking/vehicle storage area GT 50' Curtain drain No evidence Wells on adjacent Tots GT 1 50' F. ENGINEER'S CERTIFICATION I certify that 1 have determined thru field inspections and review of Municipal records t o ms are in conformance with MOA HAA guidelines in effect on this date. Signature E Engineer's Name /4i GOA- &. 410aITJO" Date 7617/9 7 HAA Fee $ 3ifi, lU Date of Payment Receipt Number ncqcV 1 D �� 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MEMORANDUM DATE: July 31, 1997 TO: Jim Cross, MOA- DHHS /� FROM: Mike Anderson, P.E. Ea SUBJECT: Lot 1, Block 2, Bob Wells Subdivision Septic System Adequacy Test RECEIVED JUL 30 1997 Municipality of Anchorage Dept. Health & Human Services A septic system adequacy test was performed on the absorption trench serving the three bedroom home on the subject lot on July 7, 1997. The house had been occupied by a large family, but 7 weeks prior to the test all but one member of the family had left. The system was therefore underutilized for at least 7 weeks. In addition the tank was pumped on May 15, and all sewage emanating from the house had yet to refill the tank. No effluent had flowed into the trench for nearly 2 months. The water level in the trench on the day of the test was only 1" above the bottom. Water was introduced into the trench at a rate of 7 gallons per minute. The water level in the trench rose to 25.5" after 295 gallons. An additional 405 gallons raised the water elevation to 37". The trench was then allowed to recover. One hour later the water elevation in the trench had dropped to 30" indicating 310 gallons of water had been absorbed in only one hour. After 21 hours the level had dropped to 21.5" indicating nearly 510 gallons of the water had been absorbed. The trench therefore absorbed more than the required 450 gallons over a 24 hour period. It is apparent from the test that the working level of the trench was above 20" from the bottom. The lack of use over the previous 7 weeks had lowered the water level in the trench below the working level. It is obvious, however, the trench is capable of absorbing more than 450 gallons of water per day. A copy of the field report is enclosed for your use. Please let me know if you have further questions. MUNICIPALITY OFANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES, 'Division of Environmental Services On-Site;Services.Section, P.O.' Box 196650 :A Anchorage, Alaska' 9951A-6650 ' 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING I.D. # f�1171— E�L1— cr1 GENERAL INFORMATIOtN ' f' • 5 Iii �YF , Complete legal description ocation (site address or directions !roperty owner penny Can9 Day Phone 696-]557 a(iing address HC ;83, Bax ]794 Eag'�e Riven, AK 94577 "' end(ng+agency �Day.phone 1ail(ng address Da e o n `geRt� • ": Y P..h )TE: If community wellsystem, provide .written confirmation from State ADEC attest -f': ing to the legalitydand status of system. PE OF WASTEWATER DISPOSAL ,= individualnon site, Holding tank Ywt x s ,tIl t, trM ft�4.: Community op-site ' f Public sewer Y )TE ' If community, wastewater system,provide written confirmation' from State AD attesting to: the legality and statusiof system ' 72-025 (Rev.1/91) Front MOA H21 _' 5. STATEMENT OF .INSPECTION BY ENGINEER As certified date shown below, I verify that investigation of thisHealth Authority Approval application shows that the on-site water t.er .suPPly and/ordisposal , wastewater system is safe, functionaland adequate for the number of bedrooms and type of structure indicated herein I further verity that biiSeddn:the information obtained from the Municipality of Anchoragi!leiendfrbrii vestgation and ,4e317 compliance with allinspection, the on-site wate supply and/or wastewater disposal system Municipal and State codes, , 'ordinances, and regulations 17 eff eOnine'date',ot this inspection Name of Firm '''" ' Phone Address /261 Engineer's signature Date 2 2 -94' CAUTION 71 ..=rhe Municiplity of Andhorage Department of Health and Human Services (DHHS) issues Health Authority •Approval Ceitificates,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 *21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 5L -v-- Z c 3 ltJ. Parcel I.D. A. Well Data WelltYP? e 2.- 1 pc -T17.--- If A, B, or C, attach ADEC letter. ADEC water system number 4.\ Log present&N) �( Date completed k -c. - -L. -18 Driller A A Total depth 6\N Cased to L -`I G1 to Casing height \ 1 - Sanitary seal ON) Wires properly protected 01) FROM WELL LOG AT INSPECTION r Date of test 10 2 -"16 q - -"I4 70 0 n TI m Static water level 4 Q I ( (1 D Well flow 1 I-. b g.p.m. 4, 1, g_p, rn < o Pump levels OIL— Go t'f'1 4.0m _ -A o C7 < SEPARATION DISTANCES FROM WELL TO: o c Septic/holding tank on lot 1 �o ` ; On adjacent lots 1 0 d Absorption field on lot 1 o' ; On adjacent lots 1 0,z=. k Public sewer main Public sewer manhole/cleanout ^.A Sewer service line 1 Petroleum tank WATER SAMPLE RESULTS: Coliform C7 Nitrate d' Other bacteria O Date of sample: 4- 7- 91 B. SEPTIC/HOLDING TANK DATA Collected by: Date installed \ \ - '1 'b Tank size \ a v Compartments 1- Cleanouts bN) ' Foundation cleanout `N) y Depressi n (Y41))9 r� High water alarm Y Alarm tested (Y/N) �� Date of pumping 1, ZS _el 3 Pumper Ste. Cess Pod SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 1 �k On adjacent lots t a Foundation 5 To property line 1,n °r Absorption field i Water main/service line 1 Surface water/drainage 1 0 0 l' 72-026 (3193)' Front 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" Le High water alarm level Cycles Meets MOA electrical codes (Y/N) SEPARATION DISTAN n lot D. ABSORPTION FIELD DATA Date installed M LIFT STATION TO: On adjacent lots Surface water Soil rating (GPD/Ft2) \ o°• System type - rte Length - '• Width 3 Gravel thickness Le' Total depth I o Total absorption area 40 (614' Cleanout present ON) y Depression over field (Y Date of adequacy .test A" - Q -9 4 Result AarT ail) Water level in absorption field before test "2? l..o'` After test 3"111 L Peroxide treatment (past 12 months) (Y(6 1-1,0 k•-rg- 1n0 , If yes, give date AL �rc�s for Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 1e) c7 On adjacent Tots 1 c,oProperty line I Ar - To building foundation 1 a ' ITo existing or abandoned system on lot '� \,, On adjacent Tots �n 1 Cutbank °�6 Water main/service line 10' k Surface water 1 t> a 14- Driveway, parking/vehicle storage area '15 I Curtain drain 'A\ Nc E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of This inspection. Signature Engineer's Name Date /ki eeri r t1 41/ 2-1 Date of Payment 9—/ 2 —-V‘ Date of Payment Receipt Number ,Q,5-6/ (3 '7 t) Receipt Number 72-026 (3/93)' Back 670 77_5 P a 9.6? --/y. ,tior• 4 • JV1UIN .frtNLII 1 VI MUNICIPALITY OF ANCHORAGE DEPT `" • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC MI'4OrJ' 'I /. 825 L Street - Anchorage, Alaska 99501 1,1•41.1.M1,, IV.. I' " TION cam] . C�)F;,us 1— I V E D J�1c'' la 4 F—' 2 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 RE C E REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests�will not be processed. Please allow ten (101 days for processing. 1. PROPER !t., e...5e.e-,,l `) ff� (�/. ,.9 MAILING ADDRESS 8. SEWAGE DISPOSAL SYSTEM j **If individual/on-site, give installation date 7G . PROPERTY RESIDENT (If different from above) PHONE 2. BUYER aPHONE �/ otAI L1lV� /.74\ DRESS "..... e Cae.!--1744-- $4114,/- //,'? 'Ll:::', 76-- 1:'/Z/e,fre 4.,"</3 /2 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTO ACa€f / �i�C- �p ' ��a PHONE MAILING ADDRESS td%7ZIL4 ' 5. LEGAL f R/TION �Zec.C— L 16 A lfC/ 5 elid' // ,54'/' ST T O TIO/ 4_. \kOZf J� dW? aWd,e Q (�� �[: 6. TYPE OF RESIDENCE NUMBER OF BEDROOMS_...... III One NI Four In Other Ar SINGLE FAMILY ❑ Two ❑ Five El MULTIPLE FAMILY f Three ■ Six 7. WATER SUPPLY ,jam INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled El COMMUNITY since June 1975. For wells drilled prior to that date, give well ■ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM j **If individual/on-site, give installation date 7G . INDIVIDUAL/ON-SITE** If system is over two (2) years old an adequacy test is required ■ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010(3/78) 79 THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DATE RECEIVED TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ OTHER • FIVE ❑ SIX ■ FOUR 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS [P— APPROVED FOR 3 BEDROOMS e certificate) ❑ CONDITIONAL APPROVAL (letter must accompany ❑ DISAPPROVED DATE 3-S BY (Title) PGe LEGAL DESCRIPTION 72-010 (Rev. 3/78)