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NORTH SLOPE #1 BLK 4 LT 6
North Slope I Block 4 Lot 6 #050-511-06 Inspection Report_1-1-12.doc Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:/Avww.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP161025 PID Number: 050-511-06 ❑ New ❑✓ Upgrade Name: Richard & Ruth Degraaff ABSORPTION FIELD ❑ Deep Trench []Shallow Trench E] Bed E] Mound Address 30827 Kuparuk Ave. Eagle River, AK 99577 ❑ Other Phone Number of Bedrooms. Soil Rating _ Total depth from original grade 3 GPD/SF Ft LEGAL DESCRIPTION Depth to pipe invert from original grade Ft, Gravel depth beneath pipe Ft. Subdivision Block Lot North Slope #1 4 6 Fill added above original grade Ft. Gravel length - Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. behveen trenches From Tank Field Tank Line Ft2 Ft. Well 113.5 N/A NA N/A 95,2 TANK [D Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1,250GaI. Surface Water 100+ N/A NA N/A Material Number of compartments Lot Line 20.3 N/A NA N/A Steel 2 NA Foundation 18.6 NIA NA NIA LIFT STATION Manufacturer _ Capacity - - Curtain Drain 50+ N/A N/A N/A Gal. Remarks � - Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer - - PIPE MATERIAL Housetotank 3034 Tankto drainfeld 3034 JR's Septic Drainfield 3W CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspection 1` 5/25/2016 Location and description 2"° 3,d 4t Top of Finished Floor COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date ,........ . seven F�. �on•no(ae Appro<�ya2 DateLS Inspection Report_1-1-12.doc SPECIAL PROVISIONS TO SPECIFICATIONS ALL CONSTRUCTION WAS INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON-SITE WASTEWATER. DISPOSAL SYSTEMS. - 2. SCOPE OF WORK: INSTALLED NEW 1,000g SEPTIC TANK AND DECOMMISSIONED EXISTING TANK PER CODE. OU V U /\• z� 1012 l \�, 7\�gSfMfNr s5.a TANK NEW SEPTIC - \ / WELL (E) LOT 6 3BRHOUSE ' / (E) INSTALLED NEW 1,2509 SEPTIC TANK T1 \ (y FC ((E) T2 / DC �w—W W/ DRIVEWAY DECOMISSIONED- 1000g SEPTIC TANK PER CODE \ DRAJN FIELD (E) - kUPgRU SEPTIC AREA (E) .. \ 5 A B - AA T1 .33.3 23.4 DESIGN PARAMETERS ABBREVIATIONS INSTALLED NEW TANK LEGEND -FC FOUNDATION CLEAN OUT N0. BEDROOM: 3 T# - TANK CLEAN OUT NO. TANK SIZE: 1-,250g - W WATER LINE/ - C# CLEAN OUT NO. - WELL RADIUS DCO- DOUBLE CLEAN OUT USED: NEW 1,250g SEPTIC TANK SS — NEW SEPTIC OG ORIGINAL GRADE - E EXISTING .NOTES: PAMN EN SVC, PDQ, BOX ANC AK _���� \\ 1�1 Date 7/26/2016 RECORD DRAWING 1j010217 ANCHORAGE, 9�0 ,� '�F!�F'A`.' _ fr PHONE (907) 272-8218 FAX (907) 272-8211 %y�p. Scale DRAWN BY: .*�r 1"=50' - NJC .. .. " - J.D. NO NORTH SLOPE #1, BLOCK 4, LOT 6 .. ...... .. .... / 050-511-06 RICHARD & RUTH DEGRAAFF Steven R. Ponnone PERMIT NO. 30827 KUPARUK AVENUE� �s CE 8149 ..�/ +1`1��� OSP161025 PLAN EAGLE RIVER, AK 99577 � 0 Sheet S= 2 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: OSP161025 Tax Code Number: 05051106000 Work Type: SepticTank Upgrade Permit Effective Dates: February 12, 2016 to February 11, 2017 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: NORTH SLOPE #1 Site Legal Address: NORTH SLOPE #1 BILK 4 LT 6 G:0703 Owner/Address: DEGRAAFF RICHARD & RUTH 30827 KUPARIK AVE EAGLE RIVER AK 995779713 Site Mailing Address: 30827 KUPARUK AVE, Eagle River Lot Size in Sq Ft: 43260 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: Date: )1 ' 640r� Issued By: Date: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Division QD On -Site Water & Wastewater Program Phone: 907 Fax: 907 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 050-511-06 Property owner(s) Richard & Ruth DeGraaff Day phone Mnilina address 30827 Kuparik Avenue, Eagle River, AK 99577 Site address 30827 Kuparik Avenue Legal description (Sub'd., Block & Lot) North Slope #1, Block 4, Lot 6 Legal description (Township, Range & Section) Lot Size 43,260 - Sq. Ft. Number of Bedrooms 3 T-9 al FEB a 2016 { Id APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) o Septic Tank Q Upgrade 0 Duplex Duplex ❑ Holding Tank ❑ Renewal F-1 Dwellings ❑ Privy ❑ (SF and/or D) Private Well 0 Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: PLk �J Waiver Fees: Date of Payment: ';k 1lo I (o f1-. Date of Payment: Receipt Number: 0'5 Receipt Number: Permit No. l0 to IS Waiver No. Permit App_ :-1L.a- Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: stevePi3anen¢ak.com February 9, 2016 Subject: North Slope #1, Block 4, Lot 6 Septic Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 10008 septic tank to be issued for.this property. The existing 1000g tank is collapsing. It will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1000 septic tank that will be connected to the existing drain field. This lot and the surrounding lots are served by private wells. There are no wells within 100 feet of this system. 1. Upgrade Tank Design. a. See Sheet 1 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank. The proposed septic tank upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes from north to south at approximately 20% in the vicinity of the tank. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 SPECIAL PROVISIONS TO SPECIFICATIONS ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. SCOPE OF WORK: INSTALL NEW 1,000g SEPTIC TANK AND DECOMMISSION EXISTING TANK PER CODE. 3 \\AS w \ \y£NT 3 WELL (E) LOT 6 HOUR 3$12 per pE/, HOUSE / y, (E) COLLAPSING 1000g SEPTIC TANK (E) Sl DECOMMISSION PER CODE AND INSTALL 1000g SEPTIC TANK (P) W� W�NI { WITH DOUBLE CLEAN OUT �P oo� � 5 \ kNp\VeNJ£. DESIGN PARAMETERS INSTALL NEW TANK NO.BEDROOM:3 , TANK SIZE: 1,000g USE: NEW 1,000g SEPTIC TANK NOTES: TANK REPLACE DRAWN BY: DRM PLAN DRAIN FIELD (E) LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC TSEPTIC AREA (E) M _M ABBREVIATIONS FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. DCO _ DOUBLE CLEAN OUT OG ORIGINAL GRADE E EXISTING PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 NORTH SLOPE #1, BLOCK 4, LOT 6 ' RICHARD & RUTH DEGRAAFF 30827 KUPARUK AVENUE EAGLE RIVER, AK 99577 OF.?C X11 /29/2016 F¢ �s�9,+) Scale 050-511-06 81 1 OF 1 �� / MUNICIPALITY OF ANCHORAGE �1 / p 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 PHONE ❑ NEW ; I . �,-/ k',Z_ 9 7 _19. UPGRADE MAI LIN.DRESS 5 S ��cti,�C S/ %>GK v . LEGAL DESCRIPTION n LOCATION 11:10 Iz NO. OF BEDROOMS Well Absorption area Dwelling PERMIT NO. DISTANCE TO: F_ a Manufacturer ��., J Material N p,1co a' �1. �f� f`k�i?� & LU I... / Liq. capacity in gallons IF HOMEMADE: Inside length Width d'de`pi '" - Oz DISTANCE TO: Well Dwelling PERT qb. 02 Q 2 F Manufacturer Material Liquid capacity in gallons _s,a €" e Well Foundation Nearest lot line P E RV LFF kQ._ J LL z No. of lines Length of each Val length of lines Trench width Distance between lines Z w inches 1Ix. Top of tile to finish grade __y/ Material beneath tile Total eiks.1ime a on area p-- inches w Length! Width % Det lid%// f (j PE T. fj I a- Type of crib Crib diameter Crib depth Total of ctive absorption area�1 � j _,Y�Tfi w V+ A DISTANCE TO: Well �+^� / Buildingyirytigh Nearest lot line �® i Ci t�7 Cla D _ Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER t PIPE MATERIALS 71 546 C SOIL TEST R' ING Ar �' a � INSTALLER Cf? CkCe&e/e REMARKS ILm 10 1*49 A. SheIV # 32T o�fsy APPROV--ED.- aSPID 196X DATE LE L t-s'41M RVER, ALASKA 'Ha57'! -i All /fes.... 71-io1 ! , ^ PERMIT NO: DATE ISSUED: APPLICANT: AQDRESS: ^ ' ` �F::' ����Ile ��IEED E-,:- DEPARTMENT OF HEALTH AND EVIRONMENTAL PROTECTION ~ 825 L STREET, ANCHORAGE, AK 99501 264-4720 CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: 84O81Ell UPGRADE 09/25/84 PETER JARRATT ENGINEERING EAGLE RIVER, AK 99577 694~2979 SUBDIVISION: NORTH SLOPE LOT: 6 BLOCK: 4 SECTION: 32 TOWNSHIP: 14N RANGE: 1E 40000 <SQ^FT. OR ACRES) certify that: 1" I am familiar, with the requirements for on-site sewers and wells as set forth by the MunicipaliAc ty o� Anchorage (110A)ao OA> nd the State 4 Alaska. 2" I will install the system ir� accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit, 3" I will adhere to all MOA and State o� Alaska requirements �or the set back distances 11rom any existing weastewater disposal system or public sewerage system on this or any adjacent or nearby lot" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES� THEN (1) AN ELECT�I PERMIT AND INSPECTIQN MUST BE OBTAINED; (2) AS�8UILTS WILL NOT BE APP THOUT AN LECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORk��UST ��� [���,E��A LICENSED ELECTRICIAN. SIGNED AF PI JARRATT ISSUED BY DATE: , DATE: - PERFORMED LEGAL DESCRIPTION DEPTH (1pt 61-n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST loelej(� 1 j, �L CGZdI! L 2 w 6.� 4 4", 5 . a 8 9- Z nism m, WE ZMANNINEE■■ ENEREMEN 10 ENEINEEN■EE i .'MINE'0oss- \MISININEENNE MAMMON NN■NE►�i�1�i ■t1■■Nr■■■M 11 ■NEN■EN/NN ■■N■NNN■■■ 12 ■■NN■N■■■■ 13- 14- 'wG 15- 5 16- 1617 17 8 18- 1920 19- 20- COMMENTS l..'� PERFORMED BY: • +, •� 1.� NO. 1457-[ •'+ ,l�'J Op 72-008 (6/79) -- "" NONE NOON ■IMEN ■NE■ ■SIN■E OMEN ■NNE NONE ■■NN ■■■■ SOILS LOG ❑ PERCOLATION TEST DATE PERFORMED: WAS GROUND WATER S ENCOUNTERED? _ GGG L O / P IF YES, AT WHAT Q% E DEPTH? (� 10,11 nism m, WE ZMANNINEE■■ ENEREMEN ME ENEINEEN■EE i .'MINE'0oss- \MISININEENNE MAMMON NN■NE►�i�1�i ■t1■■Nr■■■M 01 ■NEN■EN/NN ■■N■NNN■■■ ■■NN■N■■■■ Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE /& M_ (minutes/inch) TEST RUN BE WEEN FT AND FT Metyl7-0�f�� � ���e--® dee,;ilk), CERTIFIED BY: DATE: utYa'S Hkbh4 � . GRE ANCHORAGE AREA M11 Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME l�L'k`� MAILING ADDRESS J /�� 6" ICJ,/j/P/) PHONE LOCATION LEGAL DESCRIPTION SEPTIC TANK: DISTANCE NUMBER OF FROM WELL /X6 MANUFACTURERj'4yi k. MATERIAL �� �A� / COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITYA'f'L�GALLONS. TILE DRAIN FIELD: 1 DISTANCE FROM WELL ` � FOUNDATION "i/� NEAREST LOT LINE �l' TOTAL LENGTH LINS NUMBER OF LINES % DISTANCE BETWEEN LINES TRENCH WIDTH— IN. TOTAL EFFECTIVE ABSORPTION AREA �''(�l� SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER /// J DEPTH: TOP OF TILE TO FINISH GRADE _MATERIAL BENEATH TILE a 141 ABOVE TILEIN. WELL: TYPE /-�iil-t%' 1,r CONSTRUCTION BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL , OTHER SOURCES APPROVED DISAPPROVED DISTANCES:�� INSTALLED BY:��"�i.i "/ 'r'GJ' "✓a SEWER LINE DEPTH: / PIPEMATERIAL: // LOT SLOPE: REMARKS: Form EQ -032 DEPTH DISTANCE FROM: NEAREST SEPTIC SEEPAGE SEWER LINE . TANK . SYSTEM_ REMARKS DIAGRAM OF SYSTEM DATE •� APPROVED G.A.A.B. uu J �h I�M�'M NAME OF APPLICANT INSTALLATION LOCATION LEGAL DESCRIPTION GREAT ANCHORAGE AREA BOF i DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK SEEPAGE ING ADDRESS ISI PERMIT -NO. PHONE TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTAL LLED BY� f �® SOIL TEST RESULTS LTs 9 fl • NOTE: THIS PERMIT IS NOT}VALI WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE 100 TYPE MINIMUM DISTANCES, REQUIREMENTS -/ FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT SEPTIC TANK TO SEEPAGE PIT WALL DRAIN FIELD sT - SEPTIC TANK SEEPAGE PIT DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ' ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD SEPTIC TANK, SEEPAGE PIT DRAIN FIELD TO RIVER, LAKE, STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULA mr_nen�w�r_ :wicrnt I .rinv v OR NSED DESIGNER '0[- TYPE _ DIAGRAM OF SYSTEM lur'l-, Uz 6U� I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH'ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. i DATE APPLICANT'S SIGNATURE "_� �F�a_ l`°7tt FORM NO. EQ -016 �—�-- i -- — -- - 4--- — — lur'l-, Uz 6U� I CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH'ORDINANCE NO. 28.68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. i DATE APPLICANT'S SIGNATURE "_� �F�a_ l`°7tt FORM NO. EQ -016 UKLAILK ANUHUKAUL AKLA UUKU1 „ artment of Environmental Qu,,. 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST Performed forC% 1_ Legal Description: This form reports: Soils log Depth Feet 3 4- / 6 7 - 14 - Was ground water encountered? Date Performed - 7� ercolation test A/C) If yes, at what depth? 10 Reading Date Gross Time Net Time Depth to Water Net Drop Percoiation rate minuLe. Proposed installat o� n: Seepage Pit Drain Field i)epth of Inlet Depth to bottom of pit or trench Zig CU(4P?EtdTS :�'_- _6 Performed Q�–�✓��c �;-��--,�—��- Certified Q __,_._____�__-------_-date: ------- EQ-040 (6/74) Parcel I.D. 050-511-06 T/17/14 Municipality of Anchor On -Site Water and Wastewater Progrs (907)343-7904 Certificate of On -Site Systems Ap 1. GENERAL INFORMATION a a 7o � JUL z 7 2016 �6 3 Expiration Date: �2^� Complete legal description North Slope #1, Block 4, Lot 6 Location (site address) 30827 Kuparuk Ave. Current Property owner(s) Richard & Ruth Degraaff Day phone Mailing address 30827 Kuparuk Ave. Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING. Fx] 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 7 Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ . 6 Waiver Fee $ _ Date of Payment Date of Payment Receipt Number Receipt Number, COSA # Waiver # 5. STATEMENT OF INSPECTION OY EAFER As cerfified by my seal affixed hereto and as of the:validatforNA6 shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite Systems Approval "Guidelines "for this application, shows that the on-site water supply and/or wastewater disposal system is (are)oafe, func4.o and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information Q taine?d' fro a Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater dispossystem is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations -.-The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of this *system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone (907)272-8218 Date 7/26/2016 Seven tinnone CE -8149° Si the following stipulations: Certificate Date: Z' 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 COSAbluesheet E l., c If more than I septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: North Slope #1, Block 4, Lot 6 Parcel ID: 050-511-06 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N Date completed UnknownSanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 40+ ft. Cased to unknown ft Casing Height (above ground) 18+ in. FROM:WELL LOG AT INSPECTIQN Date of test Unknown 9/16/2014 Static water level Unknown ft. Well production Unknown 9 -P.M. WATER SAMPLE RESULTS: Coliform Qwies/100 mL Nitrate mg/L Arsenic ug/L _ Date of sample: l tt B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Tank sie 1,250 gal. Number of Compartments 2 Foundation cleanout (YIN) Y Depression over tank (Y/N) N Date of pumping New. Pumper N/A 29 ft 4.7+ g.p.m. Collected -by: PES Date installed 5/25/2016 Cleanouts (Y/N) Y High water alarm (YIN) N C. ABSORPTION FIELD DATA 9/28/1984 z 125 SF/BR Bed Date installed Soil rating (g.p.d.fft orftz/bdrm) System type Length 32120 ft. Width 12 ft. Gravel Below pipe 0'5 ft Total depth 3,5 #t. Eff. absorption area 624 ftz Monitoring tube Y Depression over field. N' x ,Q/16/2014 Pass Date of adequacy ted Results (Pass/Fail) For bedrooms Fluid depth in absorption field before test 0 in, Water added 460 gal. New depth 6 in. Elapsed Time: 180min: Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' levet at in. High water alarm level at in. Datum Cycles tested Meets alarm & cireuit requirements? 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 _?5+ Holding tank 1 DO+ Animal containment areas 50+ Manure/animal excrete 'storage areas. 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 1.0+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Weljs on adjacent lots 100+ F. COMMENTS Weare now requesting an unconditional COSA. See attached record dra% S� I6Ca t�� dV(1 Tib �� i Sy tl� Ove O` ;D?/Q�2 G. ENGINEER'S CERTIFICATION I certify that / 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 Steven Pannone Date 7/26/2016. COSA canary sheet_2-6-15.doc I LOT 7 0 O Q <V 41 N N N Z LOT 13 569°3 y0 Z/tilitY F�SE� 2p6 00 9 well LOT 6 deck '\J en S60�3038,, \UF'q�,(f -)06100 SCALE: V= 40' AC �,. 49th ' y j 0 0: �.' . Fred Walatka • ff / srF • 3255 - S �e.. �OFESSIOtN� � '� EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON: THE RECORDED PLAT ARE NOT SHOWN HEREON. Fb 15-15, pg 36 BE LOT b 3.g ' x 12'Firewood Storage Encroaches GD' N CJ RECERTIFIED8.02-16 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I -have performed a Mo agee's in edion of the following describad prop erty.• NORTH" -SLOPE SUBDIVISION ADDITION No:1 Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying. adjacent thereto, that no improvements on the 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 Anchorage, Alaska - this 18th day of February , 2016 FRED WALATKA & ASSOCIATES Engineers and Surveyors (907-248-1666) Parcel I.D. 050-511-06 2uSf/ Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Location (site address) Expiration Date: North Slope #1, Block 4, Lot 6 30827 Kuparuk Ave. Current Property owner(s) Richard & Ruth Degraaff Day phone Mailing address Real Estate Agent 30827 Kuparuk Ave. Eagle River, AK 99577 2. TYPE OF DWELLING: 7 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well F71 Individual F-71 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received Date: 2Z COSA to be released to the engineer, unless otherwise requested by the engineer. r CID COSA Fee $ �1 f t V7 Waiver Fee $ Date of Payment a/� llh Date of Payment Receipt Number 0g6jdG 1p Receipt Number 1 rr �p COSA # �C� P �b� 19�VV0 4A/aiver # 5. STATEMENT OF INSPECTION BY ENGINEER--. As certified by my seal affixed hereto and as of the validation date shotIf vrg belool Medi 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, ordinang.es,%nd regulations in effect at the time of installation. % In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system irykrg[&rtjpe with MoA COSA guidelines and regulations. The reported results describe the performance of the system under the conditions encountic .a0hVime of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend -on iBelocal soil condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These p"bnditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for — In , bedrooms bedrooms Date 2/1/2016 bedrooms, with the following f By. _1 k* J, � �\ 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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAbluesheel r -- ., .. i If more than 1 septic system is on the Tot: COSA Checklist # I of 4 Structure served by this system Certificate of On -Site Systems Approval Checklist - - Legal Description: North Slope #1, Block 4, Lot 6 Parcel ID:050-511-06 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N Date completed Unknown Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y 40+ Unknown 1 8+ _ Total depth ft. Cased to ft.' Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test Unknown 9/16/2014 Static water level Well production Unknown Unknown ft. 9 - p.m - WATER SAMPLE RESULTS: Coliform -colonies/100 mL Nitrate IL)b mg/L Arsenic IV r> ug/L Date of sample: I a71a-ot 49 29 4.7+ Collected by: PES ft. g.p:m. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 7/23/1975 Tank size 1,000 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 oZ f % -Pumper :%LAS *01-' � i C. ABSORPTION FIELD DATA- Date ATADate installed 9/28/1984. Soil rating (g.p.d./ft2 or fe/bdrm) 125 SF/BR System type Sed Length 32120 ft. Width 12' ft. Gravel below pipe 0.5 -ft. - Total depth 'T; ft. Eff. absorptionf: area 624 fe Monitoring tube 'Y . Depression over field.N' Date of adequacy test 9/16/2014 Results (Pass/Fail) Pass For 3_bedrooms Fluid depth in absorption field before test 0 in. Water added 460 gal. New,depth 6 in. Elapsed Time: 180 min. Final fluid depth 0 in. Absorption rate >= 460+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date 0 D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ 00+ - On adjacent lots 100+- Absorption field on lot 100+ A On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanouf 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+ Property line 5+ Absorption field 5+ - Water main 10+ Water service -line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: - Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certffij that t have determined through field inspections and review of Municipal records that the above systems aft in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven Pannone Date 2/112016 COSA canary sheet 2-6-15.doc To whom it may concern: RE: 30827 Kuparuk Ave, Eagle River, AK Alaska USA Mortgage Company (AUMC) recognizes that the septic tank on the above referenced property must be replaced as a condition to lend on this property. AUMC will escrow sufficient funds at closing, so that this may be replaced in the spring at a lower cost than during the winter. AUMC intends to escrow double (2x) the highest bid we have received. The amount of this bid is $6,250, and the amount we intend to escrow is $12,500. Any remaining balance after replacement will not be released until a final COSA is issued on this septic tank. Sincerely, J Jeffrey Stanford P.O. Box 196850 • Anchorage, Alaska 99519-6850 Phone (907) 563-3033 • (800) 737-3033 outside Anchorage • Fax (907) 261-3401 • www.alaskausamortgage.com Alaska USA Mortgage Company, a member of the Alaska USA family of financial service companies Pannone Engineering Services Lac Steven R. Pannone, Principal Registered Professiona"Mgineer E-mail: steveCaoanengak.com February 22, 2016 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Rd. _ P. O. Box 196650 Anchorage, Alaska 99519 Subject: North Slope No. 1, Block 4, Lot 6 Conditional COSA Request Ladies and Gentlemen: I am writing to request a conditional COSA he issued for this property to accommodate its sale closing tomorrow. A permit was issued to construct an upgraded septic tank, however due to time constraints and winter weather the tank cannot be installed before the sale. 1.5 times the highest bid for the installation of the system ($9,375) has been placed into escrow. 1. COSA. The Owner is in the process of selling this property. The existing system was located and inspected. The system was tested for operation and was found that it could accept the required 150 gallons per bedroom per day (450 gpd). The septic pumper noted that the tank baffle had collapsed and indicated the tank needs replacing. The intent is to install an upgraded septic tank by July 31, 2015. This system will not affect the health or welfare of anyone on this lot or the surroynding lots. If you have anyquestions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer . Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 O M 690LOT 13 338„�' -fe gni -)06.00 We;fa O a0 LOT 6 deck 30,3 \C1Aqi�v 206 0 p \.Al/FNU� OF AC S s ��. 49th � •.�r9 �� 00 y ...... J 9x 3255 - S a4' ,: SCALE: V= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON. Fb 16-15, pg 36 BE o �4 LOT 5 cDof� tCl $9 ' x 12'Firewood SV s 00 Storage Encroaches O' o \ M AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mort ages 's ins action of the following described property: B - - 8 , NORTH SLOPE SUBDIt/iSl N A DIT10N'N�. 1 Anchorage Recording Precinct, Alaska, and that the Improvements situated thereon are within the property fines and do not overlap or encroach on the pmperlylying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. --- Dated at Anchorage, Alaska this 18th day of February , 2016 FRED WALATKA & ASSOCIATES Engineers and Surveyors (907-248-1666) MUNICIPALITY OF ANCHORAGE 4 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 7— // 8�I' 1. GENERAL INFORMATION (a) Legal Description (include loot, block, subdivision, secti n, township, range) fl dress or directions) L/i4-// O (b) Applicant Name ��`��� �� '� Telephone: Home 7 Business,—��� ' 1-5 - ApplicantAddres s 06% ��'°aF—s— / Z�6-/ /2 /,� Jys (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); (d) Lending Jnstitution /7on.sf S� �/i�tllo� Telephone 2 �1 Z — /y�5_1 Address (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the �&S'EWVNEERING 5$ B 7nAX RIVER,& 2. TYPE OF RESIDENCE Single -Family, Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY s Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING._rSPECTIONS, TESTS, FILE SEARCH, DA'I�_,1ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 S & S E'riO1GTelephone 6 f Z� Z Address SR B 196X JUL Date EAGLE RIVER AK 99577 J lu 4 r A.:+2, �+ o o �✓ �� LR v��C®ya�•Ba'b'�as 6. DHEP APPROVAL Approved for edrooms by dfyL/Date ./ . Approved �� Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72.025 (11/84) ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) " ` 6 19 86 - CHECKLIST - FEBRUARY 1984 )�w 264-4720 / R� 1� C E I V E D Legal Description: 4 Z3`r �I// ��'`�A ,� A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present 0) Date Completed 2%�� ��% Yield <� �` 4' Total Depth _�_ Cased to �¢ Depth of Grouting i Static Water Level —%3 Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit A! NM Separation Distances from Well: Sanitary Seal on Casing Y 1K — Depression Around Wellhead{'P& To Septic/Holding Tank on Lot %DD / ;On Adjoining Lots lj To Nearest Edge of Absorption Field on�ot U ; On Adjoining Lots To Nearest Public Sewer Line ��" To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Loft 5� Water Sample Collected by t� " 5 6�,-F6 Date Water Sample Test Results Comments IM, B. SEPTIC/"^' 11 TANK DATA C -5- B. .S Date Installed Size ado J No. of Compartments Standpipes&W Air -tight Caps�AyrFoundation Clea Depression over TankkY* Date Last Pumped -' Pumping/Maintenance Contract on File (Y/N) for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /y'J { To Building Foundation To Property Line .50 j y To Disposal Field �•� 'G E. To Stream, Pond, Lake, or Major Drainage To Water-PAewr/Service Line �= 1 9 Course CommentsIrk t�- L4/a5 �??CSC Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /Z �! Type of System Design Date Installed '"��� Length of Field J . r Width of Field �" / Depth of Field >� ,f Gravel Bed Thickness (� _ Square Feet of Absorption Area �DU/r Standpipes PresentON) Depression over Field j Date of Last Adequacy Test Results of Last Adequacy Test _ Separation Distance from Absorption Field: t To Water -Supply Well //SCS / To Property Line �D To Building Foundation S-3/ To Existing or Abandoned System on Lot / To Water-Maim/Service Line �:a a To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments 5f -,l &4/01.1 D. LIFT STATION On Adjoining Lots To Cutbank (if pres) f `` /1.17. � h A i,L)h of Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for IV14, Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S ENGINEERING Date ,JUI 1 4 1988 Company SR B 196X MOA No. �S 3 EAGLE RIVER AK 99577 Receipt No. qr'j `{'-I Date of Payment -7 V 1 �7— O� �� •" •�••••• va•e9 e���o� ' Amount: $ r, s En S�al�v �� Page 2 of 2 72-026 (11/84) ,/ Ebert A. Sh�4w t t� a•.• tom. i•t,57.6 •v°•�`F �ti p OFFt MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date / (a) Legal Description (include lot, block, subdivision, section, township, range) Telephone (f) Mail the HAA to the following address: 2. ape of Residence Single -Family P4 Number of Bedrooms Multi -Family Other (describe) 3. Water Supply' Individual WellEm Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Location (address or directions) /2oAD o�� �ff6LE /'/�!2 ,plJfl� 11U/�fh2u/� /� T rrel� Telephone - Tome Business (b) Applicants Name Applicants Address (c) Applicant is (check one) Lending'Institution• �T� owner/builder ; Buyer ; Other[ (explain); (d) .. Lending Institution " ° �". �`<'- '� Telephone Address 4, (e) Real Estate Co. & Agents i Address Telephone (f) Mail the HAA to the following address: 2. ape of Residence Single -Family P4 Number of Bedrooms Multi -Family Other (describe) 3. Water Supply' Individual WellEm Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Fgj Community Holding Tank Note: If community well system, must have written confirmation from the State /department of Environmental Conservation attesting to the legality and status. V [Page 1 of 21 i 5.1')Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of'bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage 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 regula- tions in effect on the date of this inspection. Name of FiTelephone5-7c/ -,5-0 `/ a Address ckora UC Q- -1 I S d-�!> — DateOf ® ------ `��3.4 9 •���•••° °sae ® 00r OON. 06�00OMN•° ij 6 . DHEP Approval ". C. Reld. �� . No. 2251-9�. , Approved for bedrooms �� �Fp-•°°°•••� to Approved Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE. IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 (Page 2 of 21 7-19-84 ✓ MUNICIPALITY 0- ^r,GE DEPT. OF f: MUNICIPALITY OF ANCHORAGE (MOA) ENVIP.ONIIAENTALr;e.-•- !?N HEALTH AUTHORITY APPROVAL (HAA) AD 1 CHECKLIST - FEBRUARY 1984 Legal Description: A. TALL DATA t Well Classification LeiV/�7-:, If A, B, or C, D.E.C. Approved(Y/N) n; 4 Q L ell Log Present Y � Date Completed J,/�z/�y�o�n1 Yield ,5 :4Q,,, ` 4r /I-. otal Depth Cased to Depth of Grouting ti; /,I - Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing(Y ) �'V Eiectrical Wiring in Conduit (Y ) Depression Around Wellhead ( /N) /!� Separation Distances from 4L-11: To Septic/Holding Tank on Lot %/Ci On Adjoining Lots t/vfj Cl/ To Nearest Edge of Absorption Field on Lot / ; On Adjoining Lots .f-/Oo s To Nearest Public Sewer Line ,U !t To Nearest Public Sewer Cleancut/Manhole L�'4- To Nearest Sewer Service Line on Lot NI✓� Water Sample Collected By oe Date $b, d, AI/ Water Sample Test Results 151-M T14C rok V Comments Y. SJ alta V , (, 5-1 S B. SEPTIC/HOLDING TANK DATA Date Installed Size UL © No. of CcanpartmentsAN / Standpipes Y ) Air -tight Caps Y ) Foundation Cleanout Y ) Depression over Tank (Y Date Last Pumped 14m kj rn Pumping/Maintenance Contract on File (YM) A) for 1 Holding Tank High -Water Alarm (YM) U _ Temporary Holding Tank Permit (YM) U ,- Separation Distances from Septic/Holding Tank: To Water -Supply Well +11o, To Building Foundation i To Property Line + i& To Disposal Field j To Water Main/Service Line -1To Stream, Pond, Lake, or Major Drainage Course DDS Commentsy_ YY�V iuu n R/�h1u titi�� Vt yr D`r"a p L#V) �"� v l of i k t r u »� 6A -hi L6 0 L42= (� ( //�uL� 0 �� •� (Page 1 of 21 �`__ "! 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata _2 2 5' Type of System Design •22 " Date InstalledS Length of Field (pQ r Width of Field bw" Depth of Field C• 5 Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present Y ) Depression over Field (Y } Date of Last Adequacy Test Results of Last Adequacy Zest l L_ U- Separation Distance from Absorption Field% To Water -Supply 'Kbll Aw / zo / To Property Line /p To Building Foundation ,g5 --/V To Existing or Abandoned System on LOn Adjoining Lots * 300 /..� To Water Main/Service Line 1- 3r5 /)�'_ To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course 1- /00 To Driveway, Parking Area, or- Vehicle Storage Area -7/ _;L11` / Comments�IIIAiJWtQi(/ D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes Comments Dine ns ions at Vent (YM) ng Cycles during Adequacy Zest. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all on the date of this inspection. Signed L ' u1V)VV Date Company dilLc MOA No/. KBl/d5/s vw n%�ti�.���. �� Cv D '�/az ✓tJ (Page 2 of 21 MOA HAA Guidelines in effect RS •air p a%a:ao .0eow e. Q ee 4 sone% ane. •s na ap d Le C. Reid, Jr, s, 7 ©Qo�iPJ oo. 2251•E , p a 2-1584 ALASKA 6MIROW11TAL conTnoL OWNS, Inc. 6n9ineerinq & 6nuironmental Studies September 27, 1984 Department of Health and Environmental Protection 825 L Street Anchorage, Alaska 99501 Attn: Keith Bandt Legal: Lot 6 Block 4 North Slope Subdivision Well Flow Test on Single Family Residence Dear Keith: A flow test was performed on the well at the above property on August 16, 1984. Over 450 gallons of water was pumped at a rate of 5.9 gpm. I consider this well adequate for domestic useage in this 3 bedroom house. Please contact me if you have any questions. Sincerely, wen Turner nironmental Scientist Appr 1200 West 33rd Auenue, Suite 6 • Anchorage, Alaska 99503 • (907) 561-5040 ALASKA MUIROnMenTRL COnTROL SCRuCCS, InC. 6ngineerinq & enuironmental Studies OCT 19 1984 PETER JARRETT 207 E NORTHERN LTS ANCHORAGE AK 99503 SELLER — STANLEY & KATHY BARRETT BUYER — SUBDIVISION — NORTH SLOPE #1 BLOCK — 4 LOT — 6 ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 660 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 1 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 2 GALLONS. THE SYSTEM IS UNACCEPTABLE BECAUSE THE SURGE CAPACITY IS LESS THAN 75 GALLONS. THE SYSTEM IS NOT CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. FLOW TEST ON WELL THE WELL FLOW RATE WAS 5.9 GPM FOR 1.5 HOURS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUW OF 1000 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. ppqq v t� y o iO4kOvvv •svxv p A�.O nO. �l I�1/.y♦� oy C. Ret , Jr. `ae No. 2251.E 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (901) 561-5040 . - DATE RECIVED INSPECTION APPOINTMENTS 4, Lot 6 TIME TIME G TIME (4 -wheel drive required) = LTJ iJ 7 1 DATE DATE DATE ❑ Two ❑ Five ❑ MULTIPLE FAMILY ® Three ❑ Six INSPECTOR INSPECTOR, jj;;"-// INSPECTOR MUNICIPALITY OF ANCHORAGE �''�'Ir DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTE�C WkiPALITY OF ANCHORAGE 825 L Street Anchorage, Alaska 99501 - DEPT. OF HEALTH & - ENVIRONMENTAL PROTECTION ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 PEAR 1311981 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SPE FPF711f DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER ❑ PUBLIC UTILITY PHONE David Batts 694-2668 MAILING ADDRESS S R Box 1453F, Eagle River, AK 99577 PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE Stanley L. $ Kathleen B. Barrett MAILING ADDRESS Out of State 3. LENDING INSTITUTION PHONE National Bank of Alaska 265-2882 MAILING ADDRESS P. 0. Box 600, Anchorage, AK 99510 4. REALTOR/AGENT PHONE AREA, Inc. Realtors/Myrna Johnston 694-9555 MAILING ADDRESS P. 0. Box 249, Eagle River, AK 99577 5. LEGAL DESCRIPTION North Slope #1 Blk 4, Lot 6 STREET LOCATION NHN Kuparuk Avenue (4 -wheel drive required) 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other ® SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ® Three ❑ Six 7. WATER SUPPLY ® INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTI LITY depth (attach log if available.) 47 f t . 8. SEWAGE DISPOSAL SYSTEM K7 INDIVIDUAL/ON-SITE** 1975 YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79)� �C_ ut 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY I 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 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 J� INSTALLER r �i ❑Septic ``Tank or ❑ Holding Tank Size: O 0 If Tank is homemade V give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL ✓^2�WYi 4. DISTANCES WELL TO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS lam' APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE `` B�' ' , I• �(/�//J��.� 72-010 (Rev. 6/79) y 825 "i.." STREP E ANCHORAGE, /t,LASKA 99501 (907) 264-4111 GFORc,rA.sul_uVAN, 'VIA YOR 0FPARTNi1-R=.T0 F IAEALTH , N1)ENViRONMENTALPROTECTI0N March 25, 1981, David Batts Star Route Box 1453F Eagle River, Alaska 99577 Subject: Lot 6 Block 4 North Slope Subdivision #1. Approval for the individual sewer_ and water facilities cannot be granted until the following items have been completed: (1) The water analysis report needs to be delivered to this office from, the Chem Lab, 5633 B Street, for our review. (2) The septic tank pumped with a receipt submitted to this department. (3) An adequacy test needs to be performed on the existing leaching area. This test will determine if the system is adequate according to National Standards. A listing of private firms performing the test is enclosed. This report needs to be submitted to this department forour review, (4) A four(4) inch cast iron standpipe needs to be installed to thL leaching area. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw cc: Myrna Johnst-o„ National. Bank of Alaska Area Inc. Realtors Pouch 7-025 995.1.0 Post Office Box 249 99577 Area Realty ATTENTION: Myrna Johnston P.O. Box 249 Eagle River, Alaska 99577 Dear Ms. Johnston, DAVID A. SLENKAMP MECHANICAL ENGINEER 694-9055 March 29, 1981 Reference: Lot 6; Block 4; North Slope Subdivision #l: David Batt property ROBERT A. SHAFER CIVIL ENGINEER 694-2979 A sewer system adequacy test was performed on the system located on the referenced property. The septic tank was pumped and verified to have a capacity of 1000 gallons. The absorption trench imas'tested by a continuous flow of 646 gallons of water over a period of 24 hours with no adverse effect on the system. The clean out for the septic tank and at the beginning of the absorption trench and the sump at the end of the trench were repaired with the installation of new pipe by the owner prior to commencing the above test. It can be concluded from this test that the septic system (septic tank and absorption trench) is currently functioning adequately for the three bedroom residence located on this property. If we may be of further assistance, please do not hesitate to call. Sincer , R BERT A, SHAFER,P S/ss cc: National Rank of Alaska Municipality of Anchorage Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA �47nC'FOCA4£ apt C o PG N GREA ERGE AREA ROUGH Department of Environmen 1 Quality 3330 C Street, Anchorage, Alaska 99503 274-4561 (� n- t,Lo ,L -u -LD CJ\ Date Received pctober 29, 1976 Time of Inspectior Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & 14ATER FACILITIES FOR Conv. 1. Approval requested by: First National BAnk of Anchorage Mailing Address: Post Office Box 720 Phone: 279-4481 x 483 2. Property Owner: David E & Shirley M. Batt Phone: 272-1531 Mailing Address: Star Route Box 1453 Eagle River 99577 3. Legal Description: Lot 6 Block 4 North Slope Subdivision 4. Location: 5. Type of facility to be inspected Single Family No. of bedrooms 6. Well Data: Individual A. Type B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: On-site system S'D , /fo- A. Installed /Q7� B. Installer 9Qnn�,�%yl. C. Septic Tank: 1. Size ,nnn 2. Manufacturer D. Seepage Pit: 1. Absorption Area lolo� �.1 2. Material E. Disposal Field: Total length of lines Ion I 8. Distances: A. Well to: Septic tank Absorption area IIn'g, Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Page l of two pages Page 2 of two pages - Re st for Approval of Individual er & Water Facilities m 4egdl Description Lot 6 Block 4 North Slope Subdivision Comments Approved Disapproved Date Approvali.Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM 1 VV[ L'11J VIIGV wfI IIIIVIIIIU41V11 111 YIIIJ 14ti MY -r rl v. .. -. - lu accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF ENVIRONMENTAL QUALITY DEPT. OF HEALTH & 3330 "C Street, Anchorage, Alaska 99503 — 274-4561 ENVIRONMENTAL PROTECTION REQUEST FOR APPROVAL OF OCT 2 91976 INDIVIDUAL SEWER and WATER FACILITIES RECEIVED 1. Type of Inspection: CMRO VA FHA CONV X 2. Property Owner: David E. & Shirley M. Batt Mailing Address: Star Rte Box 1453 F Eagle River Day Phone 272-1531 3. Name of Buyer: None Mailing Address: N/A Day Phone 4. Name of Lending Institution: First National Bank of Anchorage Mailing Address: P.O. Box 720 Anchorage, AK 99510 Phone 279-4481 ext. 483 5. Name of Realtor or Agent: Mailing Address: 6. Legal Description: Lot 6, Blk 4, North Slone S/D Location: Eagle River, Alaska 99577 Phone 7. Type of Facility to be inspected: iindpr construction single family No. Bdrms. 2 S. Water Supply Type of Supply: Public Utility Individual X If Individual, number of dwellings presently served 9 If Individual, depth of well Sewage Disposal System Type of Syslan: Public Utility If Individual, date of installation Eo 037 (1174) Individual (on-site)