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HomeMy WebLinkAboutSPRING BROOK VISTA #1 BLK 3 LT 6Spring Brook Vista #1 Block 3 Lot 6 #050-091-07 GRED, I ER ANCHORAGE AREA BORuUGH 5 Department of Environmental Quality P 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME _FCAM9�£�__— MAILING ADDRESS —13-0—A `i�`�a— ! _(ZIVf /2 _ PHONE LOCATION Y tido LEGAL DESCRIPTION 1 arca &1k",_ } SEPTIC TANK: DISTANCE ���)) nOF FROM WEL , 4W AM�`�MANUFACTURER7\ Ot)l�ll i, NUMBER M MATERIAL �w�` _COMPARTMENTS_ INSIDE LENGTH INSIDE WIDTH __LIQUID DEPTH _LIQUID CAPACITY IaUo GALLONS. SEEPAGE PIT: NUMBER OF PITS ( DIAMETER _ OR WIDTH I ! LENGTH f _�-I DEPTH �d LINING MATERIALIL-2dh CRIB SIZE: DIAME'TER_DEPTH DISTANCE FROM: WELL TOTAL EFFECTIVE j BUILDING FOUNDATION-, NEAREST LOT LINE ABSORPTION AREA (WALL AREA) s.b __SQ, FT. ADDITIONAL ABSORPTION WELL: TYPE (-i0M10�1AV CONSTRUCTION__ BUILDING NEAREST NEAREST FOUNDATION. -,LOT LINE SEWER LINE _, CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMA DISTANCES: INSTALLED BY: PIPE MATERIAL: C1 wCL r��, LOT SLOPE REMARKS: Sir m- C� i Form No. FO.031 DEPTH SEPTIC TANK_ DIAGRAM OF SYSTEM DATE 4' I 001 )`h. APPROVED DISTANCE FROM: SEEPAGE SYSTEM G.A.A.B. NAME OF APPLICANT INSTALLATION LOCATION L/_ LEGAL DESCRIPTION . GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 SEWAGE DISPOSAL SYSTEM - APPLICATION AND PERMIT PERMIT NO. MAILING ADDRESS^PHONE Utdige_ I INSTALLATION OF: SEPTIC TANK 1 ()-' °i C� SEEPAGE PIT DRAIN F'ELD , OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS I �� "K'�y , -C� NOTE: THIS PERMIT IS NOT VALID 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 1.0�- 0 TYPE "���'� �� �X � �) SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS DIAGRAM OF SYSTEM -1 FOUNDATION TO SEPTIC TANK f FOUNDATION TO SEEPAGE PIT r DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK SEEPAGE PITT DRAIN FIELD TO NEAREST LOT LINE, WELL TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT 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 REGULATIONS GA ING INSTALLATION. -2, (/-' 4#� G,A,A.B. OR LICENSE% DESIGNER I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.88 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE `"L" % �, /s APPLICANT'S SIGNATURE FORM NO.� -016 �J _j 1 _.1_-� I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.88 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. DATE `"L" % �, /s APPLICANT'S SIGNATURE FORM NO.� -016 Performed for--Kftw-cUi Legal Description: 1_ not This form reports: So71s GREATER ANCHORAGL AR[A BOROL Department of Environmental Quaiity 3330 "C" Street Anchorage, Alaska 99503 SOILS LOG - PEROLATION TEST Depth Feet 4 y (v�r7 C�GP,aN c�Rl4vci—) WE (, ;Y S-- 2- / 6 � (44 to Performed rcolation test 9 y ---- 10 - Deuse Grey (eogoe//ys o 11 - oF,4� CML) 'pP 12 - 13 - Was ground water encountered?Va___ If yes, at what depth? Reading Date Gross Time Net Time Depth to Water Net Drop Percolation rate nnnuLe. _T_....__.�._--- Drain Field Proposed iristal1J-15n: Secpagc Pit Dopth of Inlet Depth to bottom of pit or tree h C0ITIENTS: Ncoy"oil?`���c, Performed Qy: +195 _._Certified f3Y:�-T�.,._� ____.-__. e ��-- EQ-040 (6/74) • '� Municipality of anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS Parcel I.D. 050-091-07 Expiration Date: 1. GENERAL INFORMATION Complete legal description SPRING BROOK VISTA #1 BLOCK 3, LOT 6 Location (site address) 12239 EAST PRINCE OF PEACE DRIVE EAGLE RIVER AK 99577 Current Property owner(s) MICHAEL J. MIKULA JR Day phone Mailing address Real Estate Agent JUL 12 2015 I� 12239 EAST PRINCE OF PEACE DRIVE EAGLE RIVER AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _ Well ❑ Community ❑ Public Water System ® Public Sewer ❑ WaiverNariance request for: Distance: COSA to be released to the engineer, unless othey0e/Auested by the engineer. COSA Fee 10 Date of Payment /rJlr� Receipt Number Qq(j0_ '_b COSA# 04L(WZ05 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, b� edures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, sfiows a 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 Date 717116 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 O A f encroachments, deficiencies or discrepancies exist. 1��'. ,r k 6. DSD SIGNATURE' System #1 Approved for bedrooms. B /b'Allf System #2 Approved for bedrooms.4 Disapproved. Conditional approval for bedrooms, with the following stipulations: By --r f tP g Original Certificate Dater S C The Municipality of Anchorage Development Services Division (DSD) issues Certificates of Onsite Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet id10.12.dm If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Chedklist Legal Description: A. WELL DATA - PUBLIC WATER Well type Date completed _ Total depth _ft. Date of test Static water level Well production WATER SAMPLE F Coliform colonii Arsenic: 4) If A, B, or C/(N) Sanitary se Cased to FROM WELL FIN mL Nitrate _mg/L Date of sample: B. SEPTICIHOLDING TANK DATA Tank TypelMatenal SEPTIC I CONCRETE Tank size 1250 gal. Number of Compartments 2 Parcel ID: 050-091.07 # _ Well Log (YIN) Foundation cleanout (YIN) Y Depression over tank (YIN) N Date of pumping 3 3.7{ G Pumper JRs C. ABSORPTION FIELD DATA Date installed 6/2011975 Soil rating (g.p.d. a or6;;�85 Length 12 ft. Width12 ft. Total depth 10:7 ft. (Measured 7/5116) 'Eff. absorption area 2"s Wires properly protected (Y:/--in. Casing height (above group AT INSPECTION ft. 9 - p.m - by: Date installed 6/20/1975 Cleanouts (YIN) High water alarm (YIN) N System type SEEPAGE PIT Gravel below pipe 6 ft. Monitoring tube Y Depression over field N Date of adequacy test 715!2016 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth4n.absorptibnfield before test L in. Water added /algal. New depth 58 in. Elapsed Time: 115V min. Final fluid depth -'Ib in. Absorption rate >= 450+ g.p.d. Any rejuvenation" treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES - PUBLIC WATER 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: Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas Building foundation 5'+ Property line 54 Absorption field 54 Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 2004 ABSORPTION FIELD ON LOT TO: Property line 104 Building foundation 10'+ Water main 104 Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 104 Curtain drain 50'+(NONEKNOWN) Wells on adjacent tots 2004 F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS Date 71712016 COSA brown sheet_10-10-12.doc in. • '� Municipality of Anchorage $ On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-091-07 1. GENERAL INFORMATION Expiration Date: I _3 - /,-6- Complete .S Complete legal description SPRING BROOK VISTA #1 BLOCK 3 LOT 6 Location (site address) 12239 EAST PRINCE OF PEACE DRIVE EAGLE RIVER AK 99577 Current Property owner(s) LAURA M. STRAUSS Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 21903 42ND PL W, MOUNTLAKE TER WA 98043 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class _ Well Public Water System WaiverNariance request for: Received by: COSA to be released to the engineer, unless 3 Day phone TYPE OF WASTEWATER DISPOSAL: ❑ Individual ❑ Holding Tank ❑ ❑ Community ❑ ® Public Sewer ❑ by the engineer. Date: 60 COSA Fee $ qQd ' Waiver Fee $ Date of Payment 6_l140113 Date of Payment Receipt Number 6b-6-qa2 Receipt Number. COSA#— Q S (_131145 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD„ EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 5/15/13 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.i occupants or can ArcTerra guarantee that no unseen (*'Air Ilk encroachments, deficiencies or discrepancies exist. 6. DSD SIGNATURE %PdrMli It ]4 -! C a �/' System #1 Approved for bedrooms. System #2 Approved for bedrooms. ` sSSn Disapproved. Conditional approval for bedrooms, with the following stipulations: 5 .2© By: Original Certificate Date: p13 The Mu pal ty 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 COSAbalesheet 10-10-12.d c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: SPRING BROOK VISTA#1 BLOCK 3 LOT 6 Parcel ID: 050.091.07 A. WELL DATA — PUBLIC WATER Well type If A, B, or C provide PWSID # _ Well Log (YIN) Date completed Sanitary seal (Y/N) Y Wires properly protected (Y/N) Total depth _ft. Cased to _ft. Casing height (above ground) _in. 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: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC 1 CONCRETE Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (YIN) N Date of pumping 511312013 Pumper JRs C. ABSORPTION FIELD DATA Collected by: Date installed 612011975 Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed 612011975 Soil rating (g.p.d./ftz or felbdrm) 85 System type SEEPAGE PIT Length 12 ft. Width 12 ft. Gravel below pipe 6 ft. Total depth 10.7 ft. (Measured 1/25/13) Eff. absorption area 288 ftZ Monitoring tube Y Depression over field N Date of adequacy test 5113113 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 51 in. Water added 900 gal. New depth 55 in. Elapsed Time: 1200 min. Final fluid depth 50 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at _ in. Datum Size in gallons "Pump off' level at _ in. Cycles tested E. SEPARATION DISTANCES - PUBLIC WATER WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Manhole/Access (YIN) High water alarm level at Meets alarm & circuit requirements? On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 54 Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main 104 Water Service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOWN) Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of determined through field inspections and review of Municipal records that inspections and review of Municipal records that the above systems are in Municipal records that the above systems are in conformance with MOA above systems are in conformance with MOA COSA guidelines in effect on conformance with MOA COSA guidelines in effect on this date. COSA guidelines in effect on this date. on this date. Engineer's Printed Name KENNETH M. DUFFUS Date COSA brown sheet 10-10-12.doc in. cIJ Municipality of Anchorage O -Development Services Department Building Safety Division 00* 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 ALIi HORmy, APPROVAL _ FOR A SINGLE FAMILY DWELLING Parcel I.D. V E009 [07- 1. D7 1. GENERAL INFORMATION HAA # 014 Expiration Date: Complete legal description G PRiA)G, i3 LOCK Vj�ST4 #1 3Uc 3, L % Location (site address or directions) 122-39 E - PRRO&E i�>2 Current Property owner(s) 11?0S5 KI -c90678 -R Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Po Box &70,'01 F612 AN) s I A K 2 9 70 $ Day phone clog ySS- $ _,ay Unless otherwise requested, HAA will be held by DSD for pickup. Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:, TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ .Community Class Well ❑ Community On-site ❑ Public Water System Er, 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. Municipality of Anchorage Development Services Department ; *F. 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 i Legal Description: SPRriJk 13ao9 K V1LSTh- ' / gLK 3 • Li 6 Parcel ID: d S b&cl %O? - A. WELL DATA Well type If A, B, or C provide PWSID # Well Log (Y/N) ti 14' Date completed Sanitary seal (Y/N) Wires properly protected (Y/N) Total depth ft. Cased to ft.. Casing height (aboveground) in. FROM WELL LOG AT INSPECTION Date of test IUk Static water level ft. - ft, Well production — g.p�.m. g.p.m. WATER SAMPLE RESULTS: ° i Coliform` > — colonies/100 ml. Nitrate' mg./l: Other bacteria — colonies/100 ml. Date of sample: r =Collected by: B. SEPT" C/H #"A TANK DATA to Tie/Material __ OIC A L-7� ('/cGawDiK6� Date installed _ 61Zn 7S Tank size gal. :; :Number of Compartments -2,L Cleanouts (Y/N) Foundation cleanout (Y/N) J. Depression over tank (Y/N) All High water alarm (Y/N) ' vll/ Date of pumping ! �Z91� ,y Pumper t ? S C. ABSORPTION FIELD DATA ,S ; :Date installed ZZ4 'Soil rating (4. r'ft2/bdrm) � Systemtype-6tX9 4l P.%T Length / 2 ft. Width 7? ft. Gravel below pipe ft. I .r, Total depth /1.3 ea ft. Eff. absorption ar: Z9ft2 Monitoring tube 5 : ! Depression over field ti p Date of adequacy test 0= iResults (Pass/ai}j ��i45 For bedrooms Fluid depth in absorption field before test l° in. i Water added-gl0gal.' { : New depth SO in. ElapsedlTime: 7_� NsrSrf. Final fluiddepth in.. Absorption Irate g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) VC9 ; If yes, give date JAN -28-2004 11:26 PM COLD.KEY.REAL.ESTATE 907 336 1133 JAN -20-04 WED 16:84 HOLT LAND GURYEY 1073455513 IA TW D1Ilo- � 1 ` V. v _ ~ 1 6TAmb PrPE5 .� r e 57•57'813'Iw 64.291 [IN[I PAWLV I ►MIw[ Mdump � r r � r r., r .. �' � r ■1•�q .....fA�=-1 Ad wtN.tf, 1 N 4 a•�11T gK� �3n.Dd FOR EAC DAEM 9 Of RBCOOO, OTHEA THAW tW SS SHOWN ON TIE RICOROrO PLAT, AM NCT SHOWN IIE!AEOKNNI,F. S S INDICA NOIC ANY FFMCELMS MCMN ARE LO ;ATEO APPROXMAATCI.YAN1 APP NOT TO K tmD TO MTEF04INC PROPERTY L1NE8 ORIOCAT3BTRUCTUAE9. ANY PAVINU 61 K" NAY w APPR+J uATF DUE TO BNUW CONDITIONS. P. 02 P.OI z N a m N o,6 acbab By CMUS UoobPI Q 1/3o/oy G6r1Tbb7 avonl NOT[ NO. 4 pN PLAT•1=-i 49 N INTATROI • d0 7930T CABCIM9NT Al IN wHium TM[ LOT traNRQ NE V2 PRCHISNT90 rROM aurrlNu f� ANY OUT DCAb OR ORF[OTIVE y rmc[o AMC FROM Fcar"AMINO A AIVV ICItnAVATI11N. 41-ILM 1UPPM 1 NO CMNC"- 1r.T TRIO DATE) 1'880 I HfAnY CSRTA'Y THAT 1 HAVE PERFOIIMEO A M041OAGIM1 0rsP1CT1ON OF TMf POMOWING OS6CI0sic PAOPEILTT. LOT 0, [LOCK S, SPRINO.ROCK; VISTA NO. 1 ANC40RA0I PCCORDINO OIQTRICT, ALASKA AND TRAY THF V1819L! IMPROVtMSMS RITUATP.O THEREON Aft 1MT111N TNI PAOHeRTY LIM.2 AND N7 VISISLE INCROACWPM IXIST OYMgIL THIN NOTCO. DATED AT ANCHORAGE, ALACKA TTK[ 26711 VOP JAHUARr 2001 — NOIT lAiiD cunvsrW3t1. Pslbls.SS T'fl. saf.saly Municipality of Anchorage J 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. C5 V -v-/ I - 0-7 HAA: f 40'P'0 E'q9 Expiration Date: 7- 30-03 1. GENERAL INFORMATION , t ) Complete legal description oSprt rig F-�(bCi; V 15+'0-- �(j�v Location (site address or directions) 1� E. J9/1 y(CL d -C P.GGLGL. Current Property owner ( s) (7Loll) 011"50 ri Day phone (04 &-(ooU9 Mailing address �� �q (� • �� I ✓1C 2. �� Q�Q-� a - Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, NAA will be held by DSD forpickup. 2. NUMBER OF BEDROOMS: —3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Weil ❑ Community On-site ❑ Public Water System 19 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 5 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 less than 30 days old. (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. 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 Eagle River Engineering �ervicea Phone (nq °f—SI qi5 Address Y.O. Bo: 773294, Eagle Riyaa,AK99577-3294 Engineer's Printed Name L rn LC a!} . 1�' u B y Ll Date 7-3- d _)� + Louis A.sutera 5. DSD SIGNATURE �a � 1� CUM Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: `f/. / — ct/ Original Certificate Date: —7-30-0.2— (It". '3O-02 (0.n. IZWI 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.cl.andxwage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:Spf;nOJ greok Vi5tx"%46f6/ Nocl(3 Parcel ID: USO -091-07 A. WELL DATA Public JWQtele Well'�pe _ If A, B, or C provide PWSID # _ Well Log (Y/N) Date Comoted _ Total depth Date of test Static water level Well production Sanitary seal (YM) _ Cased to ft. FROM WELL LOG WATER SAMPLE RESULTS: ft. Wires properly protected (Y/N) Casing height (above ground) In. AT INSPECTION ii# Coliform colonies/100 mi. Nitre mg.fl. Other bacteria colonies/100 ml. Date of sample: Collected : B. SEPTICIHOLDING TANK DATA Tank Type/MaterialLo.v ere Ae- K/eNElkr Date installed 02017-5- Tank /20/75Tank size ton a gal. Number of Compartments Cleanout( (Y/N) Ya.5 Foundation cleanout (Y/N) k,f_ Depression over tank (Y/N) AQ High water alarm (Y/N) A/0 Date of pumping % 2 -ma- Pumper f fe l Y0*—rj"'S C. ABSORPTION FIELD DATA Date installed 040/75 Soil rating (g.p.d./ft2 or ft'/bdnn) ffi.-Sq,ff, System type P i f Length 12. ft. Width 12.1 ft. Gravel below pipe ft. Total depth I1.3 r ft. Eff. absorption area 2 8 8 ft= Monitoring tube 1& 5 Depression over field jV 6_ Date of adequacy test 613 / 0 2 Results (Pass/Fail) is AS For 3 bedrooms Fluid depth in absorption field before test LjY- in. Water added;%31gal. New depth,tD_ in. Elapsed Time: 1W Db min. Final fluid depth 4S *• 'in. Absorption rate >= 1-14-d g.p.d. Any rejuvenation (past 12 mo.) (Y/N & type) IAM If yes, give date D. t'T STATION /j/p j i f f Stq t I Q n. Date in Iled Size in gallons Manhole/Access (Y/N) "Pump on" vel at _ In. "Pump off level at _ in. High water alarm level at in. Datum Cycles tested Meets alarm b dreuk requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: No wg It o n /of. Septic tank/lift station on lot N/R On adjacent lots t 10 0 / Absorption field on lot N/R On adjacent lots t 100 Public sewer main N/A Public sewer manhole/deanout ASM Sewer /septic service line NAR Holding tank A/1B SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: / Building foundation' t S ' Property line t 10 / Absorption field 2 2 Water main +161 Water service line +10 Surface water 10 0 / Weiss on adjacent lots 4100 / SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line t i 0 r Building foundation +25' Water main +101 Water Service line 1101 Surface water t 100 / Driveway, parkinglvehide storage +2S' Curtain drain #110 Wells on adjacent lots t 10 0 r F. COMMENTS G. ENGINEER'S CERTIFICATION N.'tI;• O� F lL,fIP �ti i certify that I have determined through field inspections and ;;: * �q97!! review of Municipal records that the above systems are in...>T �.--...... conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name LOG1S A. itrkfePQ � Date 00102 HAA Fee $' JU Waiver Fee $ Date of Payment �- sZ 2 - �� Date of Payment Receipt Number 3 D 9s Receipt Number (Rev. 12/00) Eagle River Engineering Services P.O. Bos 7 73294 Ea;la Rivcr..W 99577.3294 (907) 694.5195 tel (907) 693-3297 fav SEPTIC ADEQUACY TEST REPORT TEST DATE: 6!3%02 LEGAL: Spring Brook Vista 1" 1, Lot 6. Block 3 LOCATION: Eagl: Ricer RESIDENCE: Single Family. 3 Bedrooms - WATER SYSTEM: Public Water SEPTIC SYSTEM: From (Slunicipal) Records Tank: 1,000 Gallons Absorption System: Pit Type INSTALLATION DATE: 6; 20/75 ' INSTALLED ABSORPTION AREA: 233 Square Feet ORIGINAL SOIL RATING: 35 Sq. Ft. (From Original Soil Log/Estimated) TEST PROCEDURE SEPTIC: The leachfield was charged with water from the community water system at an acera_:e rate of 6.3 GPNI for a total of 2.430 gallons. The septic tank and pit liquid levels were monitored referencing a measurement below the top of the standpipe. During the test, water was added through the pit cleanout tube and the pit water level was monitored as water was added and then absorbed into the surrounding soil. The water level in the septic tank did not rise after the addition of 2.430 gallons of water showing that the pit had accepted the entire amount. A total rise in liquid level in the pit was recorded as 30.5". Measurements were taken of the pit level, at 10 minute intervals and after 24 hours with a satisfactory return in liquid level. The monitoring indicates the septic system will accept the required 150 gallons per day of effluent. per bedroom, which is the required absorption rate for Municipal approval. TEST RESULTS The septic system soil absorption rate meets the requirements of the Municipality of Anchorage for a 3 bedroom sin -le family residence as of the day the system was tested. lF %\?c noted rhit thg JcptM ,ank has a Zoog a=•nI KErrctl. Y.WEp rc r :•i rr :a., P a:E 1 of _ soWitivd ,,,at .nvr the top Ahich Mill 114111IL: CXtensivo puu1piu'- and FU53ibl% cxca%ation to In addition the after tank cleanout has a good deal of sludge inside it indicating that the baffle may be missing from the concrete tank. It is not uncommon for a concrete tank baffle to rust out and then there is little solids separation to the Ieachtield. Thie acpt;c tank t01 have to be pump d to meet IMOA upprova -" recommend excavating to allow througgh pumping of the tank and the tank baffle/separator should be inspected at this time. Assessment of existing subsurface conditions by the inspecting engineer is limited to information obtained from the available monitoring tubes and Municipal record search. We do not guarantee the validity or quality of subsurface tests and inspections performed by the original inspecting engineer or authority. This report is limited to absorption rate testing and surface separation measurements as currently required by the Municipality of Anchorage. The operational life and the matter of compliance with State and Municipal codes, for all water and septic systems depends on the local soil conditions. groundwater levels that may not be observed from the surface without additional testing water usage of the homes being ser% d by the system, and the detail of required testing procedure. Septic systems expire with use and future environmental concerns may require more extensive testing, which could render the pit unusable. This is true of all septic s}stems. There is no guarantee that septic s}stem tested sill meet the requirements for approval in the future. The test data and investigation of existing conditions is provided to our client for submittal to the Municipality Health Department for their review and approval. Any concerns with this test report should be discussed with the testing engineer. If it is requested we will submit the report directly to the Municipality. :]O0:'O]-Qt9SEPTICO%LYADEo rEST REPLDOC P\GE Z Oft P.O. BOX 777511-.IAGLE RMk ALASKA 99577 VAR PAGE ! DRIVER &' INVOICE (QLQ DATE OF SERVICE TIME ODAkk . t5OWW9� ❑ Pump Septic Tank w/up to 3 Backwashes Pump Holding Tank ❑ Extra Time / Backwashes Required 1Z1 JR's recommends your next pumping in I �. Ar AUTO ❑ We will call or send a reminder at that time. ❑ Standpipe(s) needs repair; missing / crimped / broken / no caps ❑ Only one standpipe ori septic tank ❑ Tank.appears to be /oao gallons/ crib leach 1 Last Pump qW&A G # of gallons ❑ Other r/117 C/V n 1�* 70i'n ble- Quantity Description Amount 125c Gallons Pumped - Septic System $ G% Extra Time / Backwashes Other: - ' Total Amount Due: $ `"j;{" -- Payment Terms: 30 days from invoice date -1.5% per month late fee $25 charge for all returned NSF checks •i� FA— rr" nrlr c„«. /lI P r i -r ice PIiELtMtMARY 1 hcrpby t'M'tilY that I have aurveyid the tillowini - �• .. _ _ -^__/ desoribal PrnJmri 'sv!�= 40. a •.c••••� AmhorngeRrcvirJJng{1�rccn Atuk ndthat"."i:ptra ' " •' •� '. '� a thwed improvempnis, as pis Thereon b the build•y t '.. / •�• ��` _ r.% "rdl be vvilhin the prn s ' •� �': • no r nlpro em�nthean nY no, h•InK a Ijarem theretta. Ilia pn n pro rly tYhf ■ ,.�•il !',•,ara �;77%(,' M•F•a - - rr arh on the prrmieps 1pnc K djnant Ib.•rA, • ml uwdwnv.+. IranRmissior{ Ines tion and that th.•rr• nr - P •hl:'J, l• •. o-.•nts nn aniJ profrerly except as hld eor ler ated, hrrrrrible 4 •are •._•'.•. - 1)atcvt nl F.fgly Itiver• Ala•N■ - /Z. �.•.. ry' , .. Ibir I =ir day Iv:7 't'ALF.: 11011F:ItT C, jr)IINSC)N X, q.^ 1 ': ,!1F4<Iaf..It 1d.ol :nlvr 'nl �. .'7 w . r Ji{. F,,..y I7rlrr. AIa.yF /try f