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HomeMy WebLinkAboutMCKINLEY VIEW ESTATES BLK 2 LT 6E(Acts4n 64LO lot.a. a k\cOSIt:gAo J • Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number SIA) 96OYS2. PID Number DS/- 792.-/D Name: fa�1 # CLQ®yje G-��d�e� Wastewater System: iiiNew ,Upgrade Address:22- Y7 Cerrtgv/a.G, DR C'�ac4y1g1�, `f ABSORPTION FIELD Phone: No. of Bedrooms: 3 0 Deep Trench Shallow Trench 0 Bed 0 Mound 0 Other LEGAL DESCRIPTION Soil Rating. A, r (/ W GPD/Sq. Ft. Total Depth from original grade:/ -/ . qq Lot: Block: Subdivision:Depth NACiKinlel Subdivision:. 'S]-, to pipe bottom from original grade: /.y0 Ft. Gravel depth beneath pipe 3 Ft. Township: Range: Section: Fill added above original grade: /, l0 3 r Ft. Gravel length: 9-1 z Ft. WELL: ❑ New ❑ Upgrad© Gravel width:5 Ft. Number of lines: Distance between lines: Ft. Classification (Private, A,B,C): j/ Total Dept < Ft. Cased To: Ft. Total absorption area: --a sa SO. Ft. Pipe material: 'p "?p3 ci f" f5/ O Driller: IAA N' CP Date Drilled: Static Water Level: Ft. Installer: U5 k�t45.S cm L.✓t`i. Date installed: �+Pp� /2-00-5e Yield:_----'"-- GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES FrSeptic 0 Holding 0 S.T.E.P. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Lines Manufacturer: 4OL t-1 . 1 AA,K. Capacity in gallons: 100c- Number of Compartments: 2 Well- 2004 2®D� { - P Material: S-r E[_ SurfacWater lop 1f- /0014- — -- UFT STATION Lot/ Line /� /� — Size in gallons:`Manufacturer: Foundation o Fy 4 "Pump on" level at: "Pu " level at: High water alarm at: Curtain/ Drain p�f /Obl _ __ Pump Make el Elec rical Inspections performed by: Remarks: n1 D klaowel eu.- 1r/ eirdiA BENCH MARK Location and Description: ��7J )J Bo /1/254-2,- o{ deck. S //vW4.7 0.1 cel-t-i e.i -l- p4.12l. Assumed Elevation: Jo o Ft ENGINEER'S SEAL .y OFlet � J v .> r �,. J � =� '4 (J9 P41 p E.• qt�, �z u� 4 ,•y p AA 4F ye, //( ) ' Ali,( inspections performed by: eN D C115/.0P7/pili Dates: 1st '2-°/-/0 2nd/2-off-96 i2-10- Ye Department of Health and Human Services approval �AI, i, .%)•_46,12 Reviewed and approved by: j/4"ie , /`% /k9 Date: i 72-013 (Rev. 9/91) MOA 25 AS-3UILT SYSTEM ]ETAILS/SITE DLA\ McKINLEY VIEW ESTATES S/D, BLOCK 2, LOT 6 TD LOT 5 Permit SW980065 PID#050-571-22 TOP OF SLOP 20' Drng Esmt- N84°49'00"E ------- f PRI ARY SYST TH #98-1 E O co TH 8-2 SEPTIC DIVERTED MT RESERV XI STING RED SYSTEA CM'S 1000 GAL LOT 6 SEPTIC SC E 1" = 50'/ A -C=25.5' B -C=21,4' A -D=28.2' B -D=24.9' A -E=46.6' B -E=64.5' A -F=133.3' B -F=137,0' 099,76-) 4" SOLID FROM HOUSE ONITOR TUBE 96,10-) H FINISHED�GRADE 95,38 w 'A• ' 0 0 zw E • � FILTER FABRIC 1090 GAL SEPTIC TANK 95,411 95,16 ." of JL4 ,41 11* 9 TFI /\ *# --) / KENNETH M. DD a ICA CE -711 _ ,w 1ii 4 c'��� / /Ale A� // ����'~ \ 4'40FESSIO-AS' Nik`__t .\C92,31D SEWER ROCK 89,2 9227 C89,26DN 87.2' PREPARED FOR: PAUL & CHERYL GARDNER 22479 CENTURIAN DRIVE CHUGIAK, AK 99567 (907) 688-0225 SCALE NTS VARIES 30' 77,75� 000 FIELD 800KS COMPUTED BOUNDARY: JOHNSON DRAWN: KMD STAKING: JOHNSON CHECKED: K M D ASBUIL.T: JOHNSON DATE: 12/10/98 s�! D) ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-3736 DWG. FILE: GRID: N W1 459 ACAD FILE: 98114.DWG JOB No.: 98114 (907)696-6111/FAX (907)696-8111 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW980452 Legal Description: MCKINLEY VIEW ESTATES BLK 2 LT 6 Design Engineer: 0070 KND Engineering Owner Name: Paul Gardener Owner Address: 22479 Centurian Drive Chugiak , AK 99567 - This permit is for the construction of: Disposal Field ✓ Septic Tank Holding Tank 1 C_ .."411'1'. ) Date Issued: Nov 20, 1998 Expiration Date: Nov 20, 1999 Parcel ID: 051-792-10 Site Address: 022479 CENTURION DR Lot Size: 31826 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By>, Issued By: Date: �r ,l6 Date: //' 2O--? KN D ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 November 10, 1998 Municipality of Anchorage Dept. of Health & Human Services On -Site Services Section P. O. Box 196650 Anchorage, Alaska 99519-6650 Subject: Upgrade Sewer Permit - McKinley View Estates S/D, Tort 2, Biotic 6 Gentlemen: At the request of the owners, on November 2, 1998, we excavated two testholes for the subject property to upgrade the existing system, which was identified as in failure by the owner. We installed a monitoring tubes with both testholes. The results of these tests and water monitoring are attached. We propose to install a 5' wide shallow trench while retaining the existing field for use in the future. The testhole registered no water during excavation or upon monitoring. The existing tank will be excavated and its integrity verified. Additional fill will be provided over the system as required. This lot is relatively flat and slopes to the northwest away from the existing field and the house at approximately 5-7%. A slope in excess of 25% is along the property line but in excess of 50 feet away from the proposed field. There are no public or private wells within 100' of our proposed system location except as noted. There is neither surface water within 100' nor any known curtain drains within 50'. We do not expect that there will be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, MIND Engineering Kenneth M. Duffus, attachments: On -Site Well and Sewer Application Wastewater Absorption System Details/Site Plan Soils Log/Percolation Tests WASTEWAT-P DISPOSAL SYSTEV DETAILS/SITE SLA\ McKINLEY VIEW ESTATES S/D, BLOCK 2, LOT 6 KN tlt Esl LOT 14 LOT 13 LOT 11 LOT 12 Q9 / 12/ / / 9;/ // / e° f. t / // d// / // / / w/ / / / 4,/ / X / r/ LOT 21 4198-1 ° -. OMTa _EXISTING BED LOT 4 i LOT 8 / / / / / LOT 18 LOT 9 ALL LOTS SERVED BY COMMUNITY WATER NO PUBLIC WELLS WITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE WELLS WITHIN 200' OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS WITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. OFAz A. _ W1 *49TH IKENNETH M. DU '26 CE -7116 ,Wa d 10R0FESSI00, DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/.6 GPD PER SQ, FT, (5,93 MIN/IN„ADJ, TO 16 MIN/IN)= 750 80. FT (750/5'(W) ) X .58(RF)) (3' GRAVEL) = 87,0 FT, TRENCH USE 1 TRENCH - 87(L) X 5' (W) X 3'(D) Total depth of system is 4.5' from original grade. Total depth of gravel below distribution pipe is 3,0' NOTES: 1, CONTRACTOR TO EXCAVATE 8, VERIFY TANK INTEGRITY. IF REQUIRED, CONTRACTOR TO INSTALL 1000 GALLON SEPTIC TANK, INSULATE TANK IF <4' COVER, 2. INSULATE TRENCH WITH 2” HD BURIAL FOAM, 3, CONTRACTOR WILL ENSURE MAXIMUM 2% SLOPE INTO SEPTIC TANK, 4, CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS & SEPTICS. PREPARED FOR PAUL 8, CHERYL GARDNER 22479 CENTURIAN DRIVE CHUGIAK, AK 99567 (907) 688-0225 Scale: 1"= 100' PAGE 1 OF 2 FIELD BOOKS COMPUTED: BOUNDARY: JOHNSON DRAWN: KMD STAKING: JOHNSON CHECKED: KM D ASBUILT: JOHNSON DWG. OLE: DATE: 11/10 /98 N W1459 GRID: ACAD FILE: 98114.DWG JOB 00.: 98114 END ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-0111 K D WASTEWATER ]ISP -SAL SYSTEM iETAILS McKINLEY VIEW ESTATES S/D, BL❑CK 2, L❑T 6 ' * 49TH * KENNETH M. FUS CE -711. wa ►� 0 »ROFESSI01yAl PREPARED F❑R: PAUL & CHERYL GARDNER 22479 CENTURIAN DRIVE CHUGIAK, AK 99567 (907) 688-0225 Scale: 1"= 20' PAGE 2 ❑F 2 FIELD BOOKS COMPUTED: BOUNDARY JOHNSON DRAWN. KMD STAKING: JOHNSON ASBUILT: JOHNSON DWG. FILE: CHECKED: KM D DATE 11 /1098 GRID: NW1459 MHO ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ACRD FILE 98114.DWG JOE No.: 98114 (907)696-6111/FAX (907)696-8111 ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS LOG - PERCOLATION TEST Performed for: Paul Gardener Date Performed: Legal Description: McKinley View Est. Blk 2. Lot 6 TEST HOLE # Depth (Feet) 17- 18- 19- 20- ORG- reddish brown rootmat GP- brown, loose, some silt GM- increase silt w/ depth Silt clods on bottom Slight smearing on walls B.O.H. .4.17.7 •:1144 \> U 491H • • ‘KENNETH M. D • - . CE 7116 '111114 ..... 11/2/98 98-1 SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO What depth? N/ A Depth to water after monitoring? d/OAJE Date 11-2o-78 Reading Date Gross Time Net Time Depth to Water Net Drop 1 11/2/98 9:05 - 7 1/2" - 2 9:15 10 min 5 5/8" 1 7/8" 3 * 9:16 - 71/2" - 4 9:26 10 min 5 4/8" 2" 5 * 9:27 - 7 1/2" 6 9:37 10 min 5 4/8" 2" 7 9:38 - 7 1/2" - 8 9:48 10min 5 5/8" 1 7/8" 9 * 9:49 - 7 1/2" - 10 9:59 10 min 5 5/8" 1 7/8" 11 * 10:00 - 7 1/2" 12 10:10 10min 5 5/8" 1 7/8" * Water Added Percolation Rate 5.9 (min/in) Pere Hole Diameter 6" Test Run Between 4 feet and 5 feet Comments: Adjust perc rate to 15-30 min/ inch due to soil conditions 1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. }VD) ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 SOILS LOG - PERCOLATION TEST Performed for: Paul Gardener Date Performed: Legal Description: McKinley View Est. Blk 2. Lot 6 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20 - GP/GM- reddish, some silt GP- some silt GM- increase density w/ depth Cobbles to 8" B.O.H. TEST HOLE It II T : : 749 B • �31, 0 :KENNETH M.US: 4/� ♦ %' CE 711 • rya. e i '''''..4:5111:254w 11/2/98 98-2 SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO What depth? N/ A Depth to water after monitoring? Date Reading Date Gross Time Net Time Depth to Water Net Drop 1 11/2/98 10:05 - 7 1/2" - 2 10:15 10 min 5 5/8" 1 7/8" 3 * 10:16 - 7 1/2" - 4 10:26 10 min 5 5/8" 1 7/8" 5 10:27 - 7 1/2" - 6 10:37 10 min 5 5/8" 1 7/8" 7 10:38 - 7 1/2" - 8 10:48 10 min 511/16" 113/16" 9 10:49 - 7 1/2" - 10 10:59 10 min 5 5/8" 1 7/8" 11 * 11:00 - 7 1/2" - 12 11:10 10min 5 5/8" 1 7/8" * Water Added Percolation Rate 5.9 (min/in) Perc Hole Diameter 6" Test Run Between 4 feet and 5 feet Comments: Adjust Rerc rate to 15-30 min/inch due to soil conditions 1, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. MUNICIPALITY OF ANCHORAGE 72/013 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ►( 1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME—� y y�� yy j/ PHONE UPGRADE MAILING ADDRESS LEGAL DESCRIPTION - d / 6 az_ //"7c l(//t. L ((/- ,, Vic:..' LOCATION„, _ &' `/i 2 /116 `ft)Z, = /.r” 7-,e, :i 41101;-1 NO. OF BEDROOMS--- .." SEPTIC TANK DISTANCE TO: ,- WeI / `j 6" "9 Ab rption ares . Dwelling p ( � PERMIT NO. "`C ,/ Manufacturer s Ma efial No. of compartment Liq. capacity n allons- o' - „1> ,P IF HOMEMADE: Inside length Width -.__.---...,. Liquid depth 6 Y -J0Z ®� Q a r DISTANCE TO: Well Dwellings PERMIT NO. Manufacturer G'd Material Liquid capacity in gallons TI LE DRAINFIELD TRENCH DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. No. of lines Length,of ach I Total length of lines Trench width inches Distance between lines Top of tile to finish grade Material beneath tile inches Total effective absorption area SEEPAGE PIT Length Width _ Det- 1 t a PERMIT NO e'- Type of crib 4 Crib diameter Crib depth Total„ ffecCive a S0�gti.on aY DISTANCE TO: Well / - Buildirr founc4tlg1 — •�0--- Nearest lot lin¢ (74, /CJ J w � Class Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: }���'') Building foundat' n Sewer line Septic tank Absorption area(s) OTHER "j'" PIPE MATERIALS At r SOIL TEST RATING 1IIIIEWiN`.�f �C jet . i 1Q c be) INSTALLER ---. - C: a r )er:-)ee-// REMARKS /57) ✓ A 0/2. :477711(/9 047/9 go e /?/f= .. (s C� � l0 f � e"ru / 13 -.) F - to �Y �W� Z �Pj } ) I �//1� //wry! , `. r 4 t /.-✓IVP ��fl FJ i� ei ��.t E - .. C K' 9 d 1, n -_�. - ir, , '' 4--`-,) l , APPRbVEP DATE LEGAL o / 3Mt-MI ()3 a% GAC.U4 Ai lVI (Rev. 3/7g) MUNICIPALITY OF ANCHORAGE Department -f Health and Environmenta' Protection 825 Street, Anchorage, AK. 9501 264-4720 * * HANDWRITTEN PERMIT * * Permit # , L AND/0 -ON-SITE SEWER PERMIT,- Applicant: Mailing Address �° Wel//‘w Location: Legal Description: `_. //kl�r27 (l Ztl Lot Size: Type of Soil Absorption System Is: Phone Number: Trench: Drainfield: Seepage Bed: Maximum Number of Bedrooms: 3,5 DEPTH Holding Tank: Soil Rating(sq.ft/br) The Required Size of the Soil Absorption System Is: Ci " C(�V� LENGTH L5 GRAVEL DEPTHb601"" L' WIDTH </ The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There 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). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ /two GALLONS * * 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. * ".* TWO(2) INSPECTIONS ARE REQUIRED * ** 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 a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will `'-ns.all the sy, em in accordance with codes. (3) I underst that -hr on-site sewer system may require enlargement if thee/resij = ash- odeled to include more that 3 bedrooms Signed: Date: SWP/024(1/81) c AlaigbkE R:77ia4 aft ;de Al .5/ /7y cl�cy elfeu; / 104, l�r�y h-IuC /JV.SL/JgT. PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG O PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: 6 f:? :57/ 2 ,4-1 661 -YM( Cr- Z16717 -51/t /56 c)/Z. 57 /Afer° 10 12 13 14 15 16 17 18 19 20 E PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 14' COMMENTS Y7 9 -r" 11111.11111 El El MEM ading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN (minutes/inch) FT AND — FT PERFORMED BY: . 4 e 72-008 (6/79) • . • :31.44.X.,Y1V • • Ji CERT! F I D yr/A r DATE:7-2--d-"J Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 051-792-10 Expiration Date: 5-2 v `L 8 1. GENERAL INFORMATION Complete legal description McKinley View Estates S/D Blk 2, lot 6 Location (site address) 22479 Centuria Dr, Chuaiak, AK Current Property owner(s) Carol R. Milo Schierholz Day phone Mailing address 22479 Centurian Dr, Chugiak, AK Real Estate Agent Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ;K. Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: EMS Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number 2c t s Z-( COSA# O5c/6/2 y/ Date: 1' Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 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 MIKE N ANDERSON, P.E. Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE 6. DSD SIGNATURE System #1 Approved for _5 bedrooms. System #2 Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: wt o sc iv`.r, fv .ice low . S --45.4 i e (.0( CNA c I S e 046,1„,,,c -de'" -Arulo intaAk VG JD •P L d Cod -0 C) V' Phone 727-8864 Date 06/16/16 ICi-.AAL NI. Ar:DrRSCNN Cc/)- 9469 tel 14 a -Agri \c."R "' (OFgecyy r� ON-SITE ��.. WATER AND m Y: ---------__ ( { WAST W Bw X ��t Original Certifier; Dt o 0o \\ � VJ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site SysJty�s Approval ((CQ6SSAAi\based only upon the representations given in paragraph 5 by an independent professional civil engineer registered iliEStE e' 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 1010-12. doe 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: McKinley View Estates S/D Blk 2, lot 6 Parcel ID: 051-792-10 A. WELL DATA Well type A If A, B, or C provide PWSID # #210697 Well Log (YIN) Date completed Sanitary seal (YIN) _ Wires properly protected (Y/N) _ Total depth _ft. Cased to ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Arsenic: ug/L Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Date installed 12/111998 Tank size 1000 gal. Foundation cleanout (Y/N) Y Date of pumping 11-5.15 Number of Compartments 2 Depression over tank (Y/N) N Pumper Sanitary Pumpers Cleanouts (Y/N) Y High water alarm (Y/N) NA C. ABSORPTION FIELD DATA —1985 SYSTEM TESTED tate installed 12110/1998 Length 87.2 ft. Total depth 62 ft: Date of adepiaaby,test 5/20/2016 Soil rating (o.p.d./ft2 or ft2/bdrm) 0.6 System type WIDE TRENCH Width 5 ft. Gravel below pipe 3.0 ft. Eff. absorption area 750 ft2 Monitoring tube Y Depression over field N Results (Pass/Fail) PASS For 3 bedrooms Fluid depth.iri alasorption field before test 12 in. Water added 450+ gal. New depth 17 in. Elapsed Time: 1050+ min. Final fluid depth 11 in. Absorption rate >= 500+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) UNKNOWN If yes, give date 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 Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas 5'+ Absorption field 5'+ Water main 100'+ Water service line 101+ Wells on adjacent lots 2001+ ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 1_0'+ Water Service line 10'+ Surface water 100'+ Curtain drain 50'+ (None Known) Wells on adjacent lots 200'+ F. COMMENTS * MEASURED AT THE END OF THE TRENCH/MT G. ENGINEER'S CERTIFICATION Surface water 100'+ Water main 101+ Driveway, parking/vehicle storage 10'+ I certify that f 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 MIKE N. ANDERSON, PE Date 06/16/2016 COSA canary sheet_2-6-15.doc .-4:?•• OF ;431 .1.84-1 0 h•• i, •� it*:* 49. ity. MICHAEL N. AND ERSON: 9469 OFESSIO • // �1 1 N ,! / 0 12/ c,-yss: o ) ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS -EXIST tXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR -CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE= SEWARD & ASSOCIATES LAND SURVEYING', 694-0829 DATE. GRID: DRAWN, Parcel I D # 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 4'51-792 -J 1. GENERAL INFORMATION Complete legal description M 6/ HAA# At. View es!i/ 32 i Lof�o Location (site address or directions) 22 (--/ 7 9 Ce,,474✓iqh l�✓»/ C14u5i/k / AK Property owner Pa/itiCie-y/ -d/tier Day phone Mailing address 22 y"7`) Ce -7174--;4 ✓, � Z:44/,57 -4`i /4/4 56 ,7 Lending agency Day phone Mailing address Agent 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 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 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 KA/7� �h�iheP�iv,� Phone 696- ZP /// Address 2- °an fro/. /£GSI ev -1 4lK %95 7 % — � </!I LJ Date / Z l ( 98 Engineer's signature "? 6. DHH S SIGNATURE Approved for ({1 ; bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: `%G I .1 i `-�_ C /(1• 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 u21 RECEIVED Municipality of Anchorage DEC 11 19 DEPARTMENT OF HEALTH & HUMAN SERVICES MUNICIPALITY OF A Environmental Services Division ENVIRONMENrALSERVI 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: A le 0) ES4 _ -321, 1-64- (49 A. WELL DATA Well type A Log present (Y/N) Total depth Cased to asing height (above ground) Sanitary seal (Y/N) Wires properly protected (Y/N) AT INSPECTION Parcel I.D.: 05 1 792_-1 0 If A, B, or C, attach ADEC letter. ADEC water system number Date completed Date of test Static water level Well production g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate FROM WELL LOG g.p.m. her bacteria Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Date installed /2 a l - 9e Tank size // 000 Number of Compartments Foundation cleanout (Y/N) Depression (Y/N) ! \/ High water alarm (Y/N) Date of Pumping Pumper C. ABSORPTION FIELD DATA Date installed 12�() - 8 Soil rating (g.p.d./ft2 or ft2/bdrm) A Go System type 5 e /low 7:"..1‘/G Length g7. 2 Width 5. Gravel thickness below pipe 3. Total depth Z Effective absorption area 750 d fi Monitoring Tube present (Y/N) "1 Depression over field (Y/N) Cleanouts (YIN) 1 Date of adequacy test Results (Pass/Fail) For Fluid depth in absorption field before test (in.); Immedi. ergal. water added (in.): Fluid depth (ins) Minut- - . Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)* bedrooms D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level - * "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 On adjacent lots Absorption field on lot On ad' - . - ots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation /0 / Property line '0 Absorption field / Water main/service line /U i� Surface water/drainage /00 //- Wells on adjacent lots -2 D0 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: /6 / f Building foundation /D Water main/service line �d /D t Driveway, parking/vehicle storage area /d / 4 - Property line Surface water � Curtain drain /00' 4- Wells on adjacent Tots 76D -i- F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal in conformance wit MOA HAAguidelines in effect on this date. Signature Engineer's Name records the io s ems are 4„,-te:walvtlftoi .. :„,..s9a"Q 47(E to cfl G' Vp /� / / /'/' ROiA 9080 v; O /e Iff%!'I e �f I (J G11"-I'/.(S �a. .a�aaesysv. se'�sq br'10 V:1 a/ �•a .e. („);,, Ke(u tM i.. rt7f f% c f Date /Z — I 1 HAA Fee $ (17) ' / 2 Date of Payment //� Receipt Number 4 (` 6 7 72-026 (Rev, 3/96)* N pry Waiver Fee $ Date of Payment Receipt Number NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE 8005 SCHOON STREET FAIRBANKS. ALASKA 99701 ANCHORAGE. ALASKA 99518 (907)456-3116 • FAX 456-3125 (907)349-1000 • FAX 349-1016 KND Engineering 20441 Ptarmigan Blvd. Eagle River, AK 99577-3736 Attn: Ken Dufus Client ID: Client Project #: Source: NTL Lab#: Sample Matrix: Comments: Preuss Subdivision L9, B6 Hose Bib, N. Side of House A154578 Water Report Date: 3/30/98 Date Arrived: 3/18/98 Sample Date: 3/18/98 Sample Time: 10:30 Collected By: Ken ** Legend ** MRL MCL B E M H D = Method Report Level = Max. Contaminant Levet = Present In Method Blank = Estimated Value = Matrix Interference = Above MCL = Lost To Dilution Method Parameter Units Result Date Date MRL Prepared Analyzed SM 4500 E Nitrate -N 447 Repot d By: Jorma K. Kuusist Chemistry Supervisor mg/L 5.32 2.50 3/26/98