HomeMy WebLinkAboutFALLING WATER BLK 3 LT 2lli*ng Water
Block 3
Lot 2
#050-772-08
Municipality of Anchorage
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Community Development Department �L�i®1�®aa�e"j1' 'o
On -Site Water & Wastewater Program
4700 Elmore St. • P.O.
Box 196650 Anchorage, AK 99519-6650 • hftp://www.muni.org/onsite • (907)343-7904 l`3
ON-SITE WASTEWATER INSPECTION REPORT AUG 86 2016
Permit Number: OSP161162
PID Number: 050-772-08 ❑ New ■ Upgrade
Name:
ABSORPTION FIELD
JOHN BUNN
❑ Deep Trench ❑ Shallow Trench ❑ Bed ound
Address
3016 MISTY MOUNTAIN ROAD, EAGLE RIVER, AK 99577
❑ Other
son Rating
Total Depth v odgtaat de:
Phone:
No. of Bedrooms:
720-227-4424
2
ovnsa. B
FI
LEGAL DESCRIPTION
Depth to Plot, invert pard choralgrade
Gaye otneeneatnpipe .
Ft.
Subdivision:
Block: Lot:
Fal added above ongtnal grade. �
ca Vel length:
FALLING WATER
3 2
��9 Fi
F1.
OWOS Ip: anger
Section:
Gravel width:
am. la.r.11lnee:
Distance Wraddn toes:
FL
Ft.
SEPARATIONDISTANCES
Total abaorp ale..
Namber, of licaches
D6L balween trenches
TO
Septic
Absorption
Lift
Holding
Pubt"Fail
From
Tank
Field
Station
Tank
sewer Linee
SO. FL
FL
well
100'+
-
-
25'+
TANK N Septic ❑ S.T.E.P. ❑Holding El Other
Mawlacturec
INFILTRATOR SYSTEMS
capacity'.
1000 cat.
Surface water
100'+
z
-
-
Modell
N„mber oropad'Ider.
Lot Line
5'+
-
-
N/A
PLASTIC
2
Foundation
51+
LIFT STATION
Curtain Drain
NONE KNOWN
Manmaaurer
c y'
Gal.
Remarks: ` OWNER I NST ALL WITH THE HELP OF JR'S EXCAVATION
-Pump car lenacTHbwater
=CT�Wt
aland ac
OLD SEPTIC TANK WAS DECOMMISSIONED PER UPC PER OWNER/JR'S.
Pump Make B Model
Elduncet lnspecone pedomred by:
PIPE MATERIAL
House to tank EXISTING Tank to D3034
drainfield
Installer *OWNER
Drainfield EXISTING CO/MT D3034
Inspector GEG, Ltd.
BENCH MARK (Assumed elevation)
100.00 Ft.
Inspection
Location and Deacnpgpp.
Dates: 1St 6/20/2016
2nd -
3rd -
4th
BOTTOM OF SIDING BY FCO
ENGINEER'S SEAL
Community Development Department Approval
�.•• 0F IO
Conditional approval:
Date:
= ; ' �/ *#
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tt .....
��.JTF:IIYYII CE-79T��
Approved:
Date: 1 �d �2D1 7
ftFES;,..•�••
LICENSE
#ACENSE
OS 1661162 RECORD DRAWING
EXISTING WELL
'.•p
GROUP, Ltd
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CIVIL & ENVIRONMENTAL ENGINEERS
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE,
AK 99507 • PHONE (907) 0376179' FAX (907) 338 3246 • WEBSITE: www 9emessen9ineenn9 com
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PAGE NUMBER '.
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14 • .4...
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In I
GRAVEL DRIVE
a
Lu
BLOCK 3, LOT 2
J.L.M.
TYPE OF WORK:
•.
DATE:
RECORD DRAWING OF SEPTIC TANK UPGRADE
•
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4.
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4.
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EXISTING
2BEDROOM
HOUSE
4..
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CID
9
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\ _____ --
\ sTi NEW 1000 GALLON
'\ INFILTRATOR
SEPTIC TANK
A B
cRle FCO 127 16.1
STI 319 316
ST2 36.6 35.5
DBL1 40.1 39A
EXISTING SEEPAGE PIT DBL2 39.5 39.5
CRIB 529 54.3
PARCEL ID NUMBER:
050-772-08
/
/
GARNESS
ENGINEERING
GROUP, Ltd
CIVIL & ENVIRONMENTAL ENGINEERS
3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE,
AK 99507 • PHONE (907) 0376179' FAX (907) 338 3246 • WEBSITE: www 9emessen9ineenn9 com
PREPARED FOR:
PH ONE NUM BER:
PAGE NUMBER '.
JOHN BUNN
720-227-4424
2 OF 3
PROJECT/LEGAL DESCRIPTION:
DRAWN BY.
FALLING WATER SID,
BLOCK 3, LOT 2
J.L.M.
TYPE OF WORK:
DATE:
RECORD DRAWING OF SEPTIC TANK UPGRADE
6/28/2016
V=20'
p...........,.,,,�
LICEN SE �,,"S`�� �•
#AECC884
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PERMIT NUMBED: PARCEL ID NUMBER:
OSP161162 RECORD DRAWING 050-772-08
NOTE: TANK WAS INSTALLED
BY HOMEOWENR WITH THE
HELP OF JR'S EXCAVATION
TC
INVERT
(OUTLET
= 92 25
TWO COMPARTMENT
INFILTRATOR TANK
GARNESS ENGINEERING GROUP, Ltd If
3701 ETUDOR ROAD, SUITE 101 'ANCHORAGE AN 99507 -PHONE (907)337-8179'FAX(907) 3383246 -WEBSITE: w gdm¢54¢tlgi0¢¢
PREPARED FOR:
PHONE NUMBER:
PAGE NUMBER:
JOHN BUNN
720-227-4424
3 OF 3
PROJECT/LEGAL DESCRIPTION:
DRAWN BY:
FALLING WATER S/D; BLOCK 3, LOT 2
J.L.M.
TYPE OF WORK:
DATE:
RECORD DRAWING OF SEPTIC TANK UPGRADE
6/28/2016
O� CE . G�4ness:e Q
JJ'•., •
��i pROFESS��P:•�
LICENSE 1r41%"„'k��
#AECC884
See reverse for requirements/remarks.
I have read and understand troth sides of this permit. i agree to the terms and conditions; and I certify that all work will comply with federal, state,
and municipal codes and regul ns and the provisions of this permit.
Signature: Date: ����
,-Hent Set
A , MUNICIPALITY OF ANCHORAGE ,
Development Services Department
Right of Way Section
epartment
ENCROACHMENT PERMIT R192323
THIS AGREEMENT, made this 9th day of September, 2019, by and between JOHN CODY
BUNN and their, heirs, administrators, and assigns, hereinafter called "PERMITTEE", and the
Municipality of Anchorage, a municipal corporation organized and existing under its Charter and the
laws of the State of Alaska, hereinafter called the "PERMITTER".
WITNESSETH:
WHEREAS, PERMITTEE is the owner of the following described real property:
FALLING WATER SUBDIVISION, BLOCK 3, LOT 2, according to the official
records thereof, on file in the office of the District Recorder, Anchorage Recording
District, Alaska, and;
WHEREAS, PERMITTER owns and/or maintains the real property more particularly
described as follows:
The TWENTY FOOT UTILITY EASEMENT, immediately_ along. -to. the west
boundary of PERMITTEES property as shown on Plat No. 78-10, on file in the office
of the District Recorder, Anchorage Recording District, Alaska, and;
WHEREAS, PERMITTEE has placed a septic seepage pit upon the referenced real property
which encroaches 3-0 feet upon the PERMITTER'S 20 -0 -foot Utility Easement.
NOW, THEREFORE, it is mutually agreed between the parties hereto that:
I. The PERMITTER, acting through the Director of Development Services -
Department, hereby grants to the PERMITTEE the privilege of allowing a septic
seepage pit to encroach 3-0 feet upon the PERMITTER'S 20,M.tijity E6semen4l'.
as shown on "Attachment A," included herewith.
2. The PERMITTEE agrees forever to indemnify, defend, save and hold harmless,
the Municipality, its officers and employees, fromany and all lawsuits, claims or .
actions brought to any person for or on account of damage to property or' injury, ,
disease, illness or death of persons, including all eosts'and expenses incident
thereto, arising wholly or in part from or in connection with the existence of; `
alterations, . maintenance, " repair, renewal, reconstruction, operation, use or
removal of the encroaching septic seepage "pit, as placed" upon- the
PERMITTER'S 20-0 foot Utility Easement.
3. The PERMITTEE shall not assign or transfer any of the rights granted herein to
another individual or company without first notifying and securing the approval
of the Director of Development Services Department.
4. This Agreement and Permit grants PERMITTEE no interest in PERMITTER'S
real property whatsoever, except only the encroachment rights described herein.
5. The PERMITTER reserves the right to revoke this permit upon twenty (20) days
written notice to the PERMITTEE. The PERMITTEE agrees upon such notice
of revocation, to move said encroachment(s) from the 20-0 feet Utility Easement
in which it is placed. Should the PERMITTEE refuse or fail to comply with said
written notice, the PERMITTER may, without further notice to the
PERMITTEE, remove or cause to be removed the encroachment(s), and the
PERMITTEE hereby agrees to reimburse the PERMITTER for all costs
incidental to the removal thereof.
In addition to the mutual promises heretofore made, the PERMITTEE has paid the PERMITTER a
one-time permit application fee of $120.00. The PERMITTER hereby waives the annual fee of
$315.00.
IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seal the day
and year first hereinabove written.
GRANTEE: GRANTOR: MUNICIPALITY OF ANCHORAGE
Jo unn, Owner tack L. Frost; Jr.
Right of Way Supervisor
�p�pSiYPflg`o CARLOS DAVID ARAGONES
NOTARY PUBLIC STATE OF TEXAS
MY COMM. EXP. 02/25!2023
9�OF�Py NOTARY ID 12995481-5
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY that on this 9th day of September, 2019, before me, the undersigned, a
Notary Public in and for the State of Alaska, duly commissioned and sworn as such, personally
appeared Jack L. Frost, Jr., known to me to be the Right of Way Supervisor for the Municipality of
Anchorage, Alaska, .who executed the foregoing instrument, and he acknowledged to me that he
executed said instrument as the free and voluntary act and deed of said corporation for the uses and
purposes therein mentioned, and that he was authorized to execute said instrument.
WITNESS my hand and official seal on the day and year first above written.
CA -
NOTARY PUBLIC i and fortstta"'
My Commission E. ires:
STATE OF ALASKA )
) ss.
THIRD JUDICIAL DISTRICT )
THIS IS TO CERTIFY that on this 49 day of Se , 2019, before
me, the undersigned, a Notary Public in and for the Slate of Alaska, duly commissioned and sworn as
such, personally appeared 106 (IA-. �tk n t , known to me to be the
individual(s) named herein who executed the foregoing instrument, and (s)he acknowledged that (s)he
did so freely and voluntarily for the used and purposes therein mentioned, and on oath stated that (s)
he was authorized to execute said instrument.
WITNESS my hand and official seal on the day and year first above written.
/.1 Z ') // — r
�ot�vauB� CARLOS DAVID ARAGONES
* * NOTARY PUBLIC STATE OF TEXAS
MY COMM. EXP. 02/25/2023
OF �Py NOTARY ID 12995481-5
OTARY PUBLIC ' and for Alaska
My Commission pines: OZ I i 2S ZO 23
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:
OSP161162
Tax Code Number:
05077208000
Work Type:
SepticTank Upgrade
Permit Effective Dates: June 16, 2016 to June 16, 2017
Design Engineer:
GARNESS ENGINEERING GROUP LTD
Subdivision:
FALLING WATER
Site Legal Address: FALLING WATER BLK 3 LT 2 G:0804
Owner/Address: BUNN JOHN CODY
3016 MISTY MOUNTAIN ROAD EAGLE RIVER AK 995779766
Site Mailing Address: 3016 MISTY MOUNTAIN RD, Eagle River
This permit is for the construction of:
Lot Size in Sq Ft:
Total Bedrooms:
N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage
51127
2
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.
Receive
Issued
I
MUNICIPALITY OF
Community Development Department
Development Services
On -Site Water & Wastewater Program
ANCHORAGE
Mayor Dan su"I
SI)SO On -Site Sewer/Well Permit
For A Single Family D1
Parcel I.D. 050-772-08
LUSH!
JUN 16 2016
3 l0Pm
907-343-7904
907- 343-7997
WeA
Property owner(s) JOHN BUNN Day phone 720-227-4424
Mailing address 3016 MISTY MOUNTAIN ROAD *EAGLE RIVER AK
Site address 3016 MISTY MOUNTAIN ROAD *EAGLE RIVER, AK
Legal description (Sub'd, Block & Lot) FALLING WATER; BLOCK 3, LOT 2
Legal description (Township, Section & Range)
Lot Size
Sq.Ft. Number of Bedrooms
2
MUNICIPALITY OF
Community Development Department
Development Services
On -Site Water & Wastewater Program
ANCHORAGE
Mayor Dan su"I
SI)SO On -Site Sewer/Well Permit
For A Single Family D1
Parcel I.D. 050-772-08
LUSH!
JUN 16 2016
3 l0Pm
907-343-7904
907- 343-7997
WeA
Property owner(s) JOHN BUNN Day phone 720-227-4424
Mailing address 3016 MISTY MOUNTAIN ROAD *EAGLE RIVER AK
Site address 3016 MISTY MOUNTAIN ROAD *EAGLE RIVER, AK
Legal description (Sub'd, Block & Lot) FALLING WATER; BLOCK 3, LOT 2
Legal description (Township, Section & Range)
Lot Size
Sq.Ft. Number of Bedrooms
2
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DEWELLING:
(Mall that apply)
Absorption Field
Fl❑
Initial
Single Family (SF)
❑
Septic Tank
®
Upgrade ®
(w/wo ADU)
Renewal ❑
Duplex (D)
Holding Tank
❑
Multiple Dwellings
❑
Privy
❑
(SF and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal codes.
GARNESS ENGINEERING GROUP, Ltd.
(Signature of property owner or authorized agent)
Permit/Rush Fees:11015f
f Waiver Fees: _
Date of Payment: b Date of Payment:
Receipt Number: 03�3°Z Receipt Number:
Permit No. 0S. el Waiver No.
(Rev. 01/11)
June 15, 2016
Municipality of Anchorage
Development Service Department
On -Site Water & Wastewater Program
4700 Elmore Road
Anchorage, AK 99507
Ref: Proposed Septic Tank Upgrade for Falling Water; Block 3, Lot 2
To whom it may concern:
LT 14111111111111111111
0
sOil
The existing 2 bedroom house is served by a private well and septic system. The septic
tank is in a state of failure and needs to be upgraded. We are proposing to
decommission the existing septic tank per UPC, and install a new 1000 gallon HDPE
septic tank.
We are unaware of any adverse impacts this installation would have on adjacent wells
or septic systems. If you have any questions, please contact us at 337-6179. Thank
you for your assigtance.
P. E., M. S.
3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259
Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com
J
10' Util. Esm \ \ iA
N
C�
\ 9 ZF �Op. \ ' \
750
\ \ I �CZ
,.e
\� \INSTALL DBL w •'":.•.
C/0'S PRE GRAVEL DRIVE." / \
& POST
TANK
XI
LEAHY; LOT 4 \ \ \ \ N 'e'. ,' ••y:; • `.. r'•'•. / I---
\ \ \ \ I'EzTIN
I ••'.•r. / I F --H
APPROXIMATE \ \ \ BEDROOM /
LOCATION OF 100' I HOUSE
WELL RADIUS
\I /
\ \ ROODOED I
7 GALLON
M2 GREER
PLASTIC
GEG, Ltd. HAS A d PAGE SPECIFICATION TANK. OLD
LETTER THAT PERTAINS TO THIS DESIGN. O TANK TO BE
TO OBTAIN A COPY OF THE LETTER DECOMMISSIONED
CONTACT GEG. BY PROCEEDING FORWARD PER UPC.
WITH THIS INSTALLATION, THE ENGINEER,
WELL DRILLER, CONTRACTOR AND
PROPERTY OWNER AGREE THAT THEY I FALLING WATER;
HAVE READ THESE SPECIFICATIONS AND \ EXISTING BLOCK 2, LOT 4
AGREE TO ACCEPT THE TERMS AND \ I SEEPAGE PIT NO CONCERNS
CONDITIONS OUTLINED.
NOTE: THE CONTRACTOR SHALL \
HAVE THE WEST LOT LINE, \
UTILITY EASEMENT AND ALL 15' Util Esmt FALLNG WATER;
WELL RADII FLAGGED BY A \ BLOC 2, LOT 3
REGISTERED LAND SURVEYOR NO ONCERNS
PRIOR TO CONSTRUCTION. \ I
GARNESS ENGINEERING GROUP, Ltd "
= CIVIL & ENVIRONMENTAL ENGINEERS=
3701E NOOK ROAD, S M 101 • ANCHORAGE, M 99507 • PHONE ( 337-6179 • FM 907) 336-3246 MEBSIIE 9ameeaan I H win
'REPARED FOR PHONE NUMBER PAGE NUMBER
JOHN BUNN 720-227-4424 1 OF 1
.EGAL DESCRIPTION: DRAWN BY:
FALLING WATER; BLOCK 3, LOT 2 PNB
YPE OF WORK: DATE:
SEPTIC TANK DESIGN UPGRADE 6/15/16
e�-
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MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
On -Site Water & Wastewater Program Fax: 907-343-7997
Septic System Owner -installer Agreement
A real estate property owner (Owner) may install their own septic system.
The department may issue an approval for a homeowner to perform work on a conventional
(not AWWTS) on-site wastewater disposal system to serve that individual's owner -occupied,
single-family or duplex home if the homeowner satisfies and agrees to the following
requirements.
The property owner and excavation equipment operator may perform work on no more than
one owner installed project in a 12 -month period.
As owner of (legal description) / ✓1 agree the
following items are true and accurate.
My experience installing septic systems is as follows.
2. The name of the excavation equipment operator is. l kt,,ZL�
3. There will not be compensation for installation services rendered.
4. 1 will be actively involved with the septic system installation at all times.
5. The name of the inspecting engineer is
6. 1 agree to discuss the following items. with the inspecting engineer:
a. Permit design criteria and specifications.
b. Inspection requirements set forth in AMC 15.65.150.
c. 2 -hour minimum advance notice given to the On-site Water & Wastewater
Program for all required municipal inspections.
7. 1 agree any changes I make to the items listed above will require a new approval before
performing work.
I agree to have the project -specific On-site Wastewater Disposal System Permit available
at the construction site for the duration of all related work.
Owner's printed name: , )(gk,n lei a
Owner's signature: Date: —& c try- i'
Septic System Owner Installer Agreement_Feb2015.doc
72,0 2z-7 qllyy
MUNICIPALITY OF ANCHORAGE
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
/�lC
�9_v_-913
❑ UPGRADE
_
MAILING ADDRESS
2 R T, 19 O
LEGAL DESCRIPTION
/4 ,3 FL//, (- /o
LOCATION r
e, ee
NO. OF BEDROOMS
fill
DISTANCE TO:
Well
Absorption area
Dwellin
PERMIT NO.
8
U Y
W
T
OQ
I-_ Z
UJ
Manufacturer
Mater' I ,,((
/� / [L
No. of compartments
Liq. rapacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
Y
0z
DISTANCE TO:
Dwelling
PERMIT NO.
J
Z
2
Manufacturer Material
Liquid capacity in gallons
C
w=
DISTANCE TO:
We
Foundation Ne t line
PERMIT NO.
J LL Z
No. of lines
Length of ach line
Total lengt es Trench width
Distance between lines
F cc
inches
¢ F
Top of tile to finish grade
Material beneath tile
Total effective absorption area
e
inches
LU
Length ,
Width
Depth /0 t
PERMIT NO. / OD b
G�
a< —
Type of�crib
('
Crib diameter 'J t
Crib depth
Total effective absorption area
wa
T
WWell
rn
DISTANCE TO:
IV
Buildin u dation
Nearest lot line
/01
V�
Clas
Depth
Driller
Distance to lot line
PERMIT NO.
J
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
(L
SOIL TEST RATING
CC
�J^
INSTALLER
\ F
—
REMARKS
ve IV Co _/
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owvwwcham Aplr ,/
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APPROVED DATE LEGAL
0, , (3-/6-7
I` -i Mu". 0/ to)
���T������ �� ��������U."
DEPHRTMENT OF HEALTH HND ENVIRONMENTHL PROTECTION
825 /L' STREET/ HNCHORHGE. HK99501
264-4720
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11. 4 F,.::— IL ...... II. f-1 PA ��.."o T P.
PERMIT NO. ( 790078 )
HPPLICHNT BRAD DICKEY SR RT BOX 161] EHGLE RIVER 694 92]9
LOCHTION PO 1)RIVE' OFT E. R. RD
LEGHL L2 B] FHI LING WHTER LOT SIZE 51000 SQUHRE FEET
TYPE OF SOIL HBSORBTION TRENCH
MHXIMUM NUMBER OF BEDROOMS � � SOIL RHTING (SQ FT/BR)�
THE REQUIRED SIZE OF THE SOIL HBSORPTION SYSTEM IS�
������� �� �����^
THE LENGTH DIMENSION IS THE L�NGTH (IN FEET) �F THE T�ENCH OR DRHINFIELD
THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE 8ETWEEN THE SURFHCE OF TH�
GROUND HND THE BOTTOM OF THE EXCHVHTION (IN FEET)l
THERE IS NO SET WIDT` FOR TRENCHES
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE
HND THE BOTTOM OF THE EXCHVHTION (IN FEET)
jj����- - ".:������� ����7J. 0: ,4 1 ....... 11���
PERMIT HPPLICANT HHS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
IN:TRLLHTION INSPECTIONS OF ANY WELLS ADJACENT Ti THIS HND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE
�_� IF T r�
BHCKFlLLING OF HNY SYSTEM WITHOUT FINAL INSPECTION HND HPPROVHL BY THIS
DEPHRTM�NT
WILL. B� TO PROSECUTION.
MINIMUM DI�T�NCE BETWEEN H WELL HNE, ANY Cit.k-SITE S�WHGE DISPOS�L SYSTEM I�
100 FEET F::*OR H PRIVATE WELL.; OR
150 TO 200 FEET F�OM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL
WELL LOGS HRE REQUIRED HND D.PST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS
OF THE WE'LL COMPLETION.
OTHER REQUIREMENT� MHY HPPI PECIFICHTIONS RND CONSTRUCTION DIHGRHDS HRE
HVHILHB LE TO INSURE PR8PER INSTHLLHTION�
�j^
I CERTIFY THHT
1� I AN �HMIL�HR WITH THE REQUIREMEWTS FOR ONSITE SEWERS HND WELLS ASSET
FORTH B; THE MUNICIPHLITY OF HNCHORHGE.
2� I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES
]� I UNDERSTHND THHT THE ON—SITE SEWER SYSTEM M8� REQUIRE ENLHRGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS
'
ISSUED GY __^.__DHTE _
YI2
0 £t E GEOi Box
CHNIICAL1e&ef/DEVEU 'MENT CO.
RivAlaska 99577
694-2774 or 688-2280
Russel' Oyster Earl Ellis
694-2774 SOIL LOG 688-2280
Soils Et Foundations Land Development
Performed for: Name: Tel. No.
Mailing Address:
Legal Description:
Depth (feet) Soil Characteristics
0
1
2
3
4
0
I
10
11
12
13 n
14 • �
n
15 a to
16 U�A
Ground Water Encountered: Yes-- No—,— If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by: Date:
5
i-
-.
7
8
0
I
10
11
12
13 n
14 • �
n
15 a to
16 U�A
Ground Water Encountered: Yes-- No—,— If yes, what depth
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by: Date:
14,
S. v, cA-U i NN t. -
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• Municipality of Anchorag
On -Site Water and Wastewater Program °" AUG 2 7 2019<'
(907) 343-7904 g , F E T�
CERTIFICATE OF ON-SITE SYSTEMS AP �
8
Parcel I.D. 050-772-08 Expiration Date: C I O, CQ, 01
1. GENERAL INFORMATION
Complete legal description Falling Water Block 3 Lot 2
Location (site address) 3016 Misty Mountain Road
Current Property owner(s) John Cody Bunn Day phone
Mailing address 3016 Misty Mountain Road, Eagle River, AK 99577
Real Estate Agent Lc. h i tx Day phone -3 3 72-
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
F-1 Duplex
Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
❑
Community Class _Well
❑
Public Water System
❑
WaiverNariance request for:
TYPE OF WASTEWATER DISPOSAL:
Individual
Holding Tank
❑
Community
❑
Public Sewer
❑
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ ?TG Waiver Fee $
Date of Payment �1a�'(�Q Date of Payment
Receipt Number"1�i� Receipt Number
COSA # Q�� ILI 146 1 Waiver #
Distance:
5. STATEMENT OF INSPECTION BY ENGINEER �" R
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 696-6111
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 8/23/19
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 OF a j� \
encroachments, deficiencies or discrepancies exist. 0, , , S; 1
4.J Tj��-K
6. DSD SIGNATURE ��'
` KE. METH �f. D FUS
System #1 Approved for L5 bedrooms. ` „
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
=� WASTFWATFR Z_
J PROGRAM
�•N
JI SFA
By: RL� Original Certificate Date: I b
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
Well Flow Advisory
COSA blue sheet 10-10-12.doc
Arsenic Advisory`';
Other
COSA Checklist
Legal Description: Falling Water 133 L2
If more than 1 septic system on lot: COSA Checklist # of
A. WELL DATA
11111111 Well log is filed with Onsite (or attached)
Date drilled 9/21/79
Total depth 118 ft
Cased to 117.6 ft
Sanitary seal is functioning correctly
Wires are properly protected
Casing height (above ground) in.
Date of flow test for COSA 8/15/19
Static water level at beginning of test 97 ft.
Comments
B. TANK DATA
Age of tank(s) 3 years
Tank type/material Plastic
Measured operating fluid level in septic tank 50
FS Standpipes/foundation cleanout per record drawing
Date of pumping 8/24/19
D. ABSORPTION FIELD DATA
Which system tested (date installed)5/16/79
ALL standpipes present per record drawing
Total measured depth from grade 9.1 ft (max)
Measured depth to pipe invert from grade 5 ft (min)
❑ N/A — pressurized field
Monitor tubes go to bottom of effective. If not, state
depth into effective 4. 1
Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
COSA Checklist yellow sheet
Parcel ID: 050-772-08
Structure served by this system 1
Well production at time of test 3.5 gpm
Water storage tank volume gallons
Well disinfected for coliform test? ❑ Yes Nc
11 Coliform bacteria is Negative
Nitrate 0.813 mg/L ❑ Nitrate less than MRL (ND)
Arsenic ug/L 11 Arsenic less than MRL (ND)
Collected by Arcterra Consulting
Date of Sample 8/15/19
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Comments:
Adequacy test date 8/15/19
Results Z Pass For 3 bedrooms
Fluid depth prior to test 0 in
Water added 450 gal
New depth 18 in
Elapsed time 132 min
Final fluid depth 0 in
Absorption rate 450+ gpd
Any rejuvenation treatment (past 12 months)
If yes, enter date
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes if No ft
Wells on Adjacent Lots:
Community Sewer Manhole/Cleanout > 100'
® Yes
if No
ft
m Yes
if No
Neighboring Tank > 100' ® Yes
if No
ft
Private Sewer/Septic Line > 25' m Yes
if No
Absorption Field on Lot > 100' ® Yes
if No
ft
Holding Tank > 100' ® Yes
if No
Neighboring Absorption Fields > 100'
Surface Water > 100'
® Yes
Animal Containment > 50' ® Yes
if No
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' ® Yes
if No
ft
® Yes
if No
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' ® Yes if No ft Surface Water > 100'
ft
ft
ft
ft
ft
® Yes if No ft
Property Line > 5'
® Yes if No ft
Wells on Adjacent Lots:
Absorption Field > 5'
® Yes if No ft
Private Wells > 100' ® Yes if No _
Water Main > 10'
® Yes if No ft
Community Wells > 200' ® Yes if No _
Water Service Line > 10'
® Yes if No ft
If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10'
Yes
if No
ft
If absorption field is under driveway comment below
Property Line > 10'
® Yes
if No
ft
Wells on Adjacent Lots:
Water Main > 10'
® Yes
if No
ft
Private Wells > 100' ® Yes if No
Water Service Line > 10'
® Yes
if No
ft
Community Wells > 200' ® Yes if No
Surface Water > 100'
® Yes
if No
ft
F. ENGINEER'S 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.
COSA Checklist yellow sheet
+�! ' V .......
Ar•
CE jjj t
�+♦�R�.�'�� ESQ ��'.+
li,
ft
ft
I
0
HOUSE UL I HIL N00°0
LENGTH
247.50
106.74
'47"W 565.10
\ z
\ 00
\ NO
O
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/ 20 UTILITY EASEMENT' N
/ cr 00
S11CP
n ::E /
n f S
0\
CANb�°28'28"E 194.31
' c�
0 /
"
Date Scale
8/29/2019 111=401
BOBBYF. BURNETT Grid
2941 Carriage Drive SE 0804 AS -BUILT
Anchorage, Alaska 99507 Drawn by Field Book
(907) 350-5541
BFB ASB2019
MISTY MOUNTAIN ROAD
GRAPHIC SCALE. • 1 Inch = 40 Feet
20 0 20 40 80
/
Legal Description
CURVE CHART
NO
DELTA RADIUS
Q
39'23'28" 360.00
Q
81'32'24" 75.00
HOUSE UL I HIL N00°0
LENGTH
247.50
106.74
'47"W 565.10
\ z
\ 00
\ NO
O
, I N N IJL.J
/ 20 UTILITY EASEMENT' N
/ cr 00
S11CP
n ::E /
n f S
0\
CANb�°28'28"E 194.31
' c�
0 /
"
Date Scale
8/29/2019 111=401
BOBBYF. BURNETT Grid
2941 Carriage Drive SE 0804 AS -BUILT
Anchorage, Alaska 99507 Drawn by Field Book
(907) 350-5541
BFB ASB2019
MISTY MOUNTAIN ROAD
GRAPHIC SCALE. • 1 Inch = 40 Feet
20 0 20 40 80
/
Legal Description
I hereby certify that the property described hereon has been surveyed
by me, or at my direction, and that the improvements situated thereon
LOT 2 BLOCK 3
are within the property lines and do not overlap or encroach on the
FALLING WATER
property lying adjacent thereto unless otherwise shown. That no
SUBDIVISION
improvements on the property lying adjacent thereto encroach on the
premises in question and that there are no roadways, transmission
PLAT # 78-10
lines or other easements on said property except as shown.
__`N
���"• •ter 1
BOBBY F. BURNErr /
Is -6464 /
Adir
��`�� '
Municipality of Anchorage „$
On -Site Water & Wastewater Program
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 050-772-08 Expiration Date: '
1. GENERAL INFORMATION
Complete legal description FALLING WATER S/D; BLOCK 3, LOT 2
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
3016 MISTY MOUNTAIN ROAD, ANCHORAGE, AK, 99577
JOSEPH & SALLY SCHULZ Day phone C/O AGENT
3016 MISTY MOUNTAIN ROAD, ANCHORAGE, AK, 99577
LISA HUSTON W/ EAGLE RIVER REALTY Day phone
2. TYPE OF DWELLING:
Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 2
4. TYPE OF WATER SUPPLY:
441-5375
TYPE OF WASTEWATER DISPOSAL:
Individual Well
I
Individual On-site
0
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by: /./"
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ L� c�6
Date of Payment
Receipt Number
COSA #
Date:i
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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineers Comments:
In conducting this evaluation, GEG, LtD_ attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system 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 soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being sowed by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSO. The content of this report Is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
_System #1 Approved for
System #2 Approved for
Disapproved.
Conditional approval for
0
a bedrooms.
bedrooms.
bedrooms, with the following
Phone
337-6179
Date t- 4j
fir............ s;v0
'. ft
y rness,
i. Cqq 71.53
SOF Alv (i//i
\�Q 01
ON-SITE
WATER AND
WASTEWATER
Original Certificate Date: Lb - .�2_ f' /�
The t[yrrucip kn'chorage Develop,emf 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.
7. ATTCHMENTS:
COSA Checklist Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
(Rev. 11105)
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: FALLING WATER S/D; BLOCK 3, LOT 2 Parcel ID: 050-772-08
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A
Date completed 9/21/1979 Sanitary seal (Y/N) YES
Total depth 118 ft. Cased to 117.6 ft.
FROM WELL LOG
Date of test 9/21/1979
Static water level 105 ft.
Well Log (Y/N) YES
Wires properly protected (Y/N) YES
Casing height (above ground) 12+ in.
AT INSPECTION
6/1/2013
97
Well production 10 g.p.m. 2.88+ g,p,m,
WATER SAMPLE RESULTS: SS
Coliform (3 colonies/100 ml. Nitrate Sq ing./L. Collected by: GEG, Ltd.
Arsenic: 1XJ ug./L. Date of sample: -to/-s
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/PLASTIC (SUNSET) Date installed 5/16/1979
Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO1 High
hhjwater alarm (Y/N) N/A
Date of pumping��_ Pumper Oh C- h,2 / t.cir s ,
C. ABSORPTION FIELD DATA BELOW EXISTING GRAD
Date installed 5/16/1979 Soil rating (g.p.d./Wor /bdrm 85
Length 11 ft. Width 11 ft.
System type
SEEPAGE PIT
Gravel below pipe 6 ft.
Total depth *9.6 ft. Eff. absorption area 264 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 6/l/2013 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 31 in. Water added 455 gal. New depth 31 in.
Elapsed Time: = min. Final fluid depth 31 in. Absorption rate >_ **450+ g,p,d.
Any rejuvenation treatment (past 12 mo.) (YIN & type)
NONE KNOWN
If yes, give date
**SEPTIC SYSTEM ORIGINALLY SIZED FOR 3 BEDROOMS. TESTED FOR 3 BEDROOMS, BUT RESIDENCE
IS ONLY 2 BEDROOMS.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at wa er alarm level at - in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots
Public sewer main
Sewer /septic service line 25'+
100'+
Public sewer manhole/cleanout N/A
Holding tank
Animal containment areas 50'+ Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
1 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 Print%d N�me JEFFREY A. GARNESS
Date 6/�5//�
(Rev. 11/05)
C-753
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Ott BaIdN6 R�M4�
9fiA. &XWM62WAC1f
BREAK LINE
SEE DETAIL
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AAAI r.4'b.
Break Line
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PLOT PLANS & LOT SURVEYS
�
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TD
TO VERIFY PROPOSED BUILDING GRADE RELATIVE
ONLY THOSE IMPROVEMENTS ABOVE GROUND
WILL BECONSTRUCTION,
FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
:At40ISIBLE
SHOWN. FENCES. WELLS, SEP'RC CLEANOUT$, SKS, DRIVEWAYS,TO
ETC., ARE SHOWN IN THEIR APPROXIMATE LOC,
EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
I x
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
-
ALL DISTANCES FARE RECORD UNLESS VASE NOTED,
SURVEY CERT0CATION
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UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USER FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE UNE$
( THE SURtiSYCR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL. LIABILITY ONLY FOR THE COST OF THE SURVEY,
I USTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE
FWSORKY SURVEY TYPE
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PLOT PLANS & LOT SURVEYS
NOTE;
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TD
TO VERIFY PROPOSED BUILDING GRADE RELATIVE
ONLY THOSE IMPROVEMENTS ABOVE GROUND
WILL BECONSTRUCTION,
FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
:At40ISIBLE
SHOWN. FENCES. WELLS, SEP'RC CLEANOUT$, SKS, DRIVEWAYS,TO
ETC., ARE SHOWN IN THEIR APPROXIMATE LOC,
EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
ONLY, SNOWTHE
MAY PREVENT SOME IMPROVEMENTS FROM BEINANO LOCATED
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
-
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SURVEY CERT0CATION
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ANCHORAGE. ALASKA
swia», aI tawn.onv axw aan
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Grid,.
d, SE 804
W.O.
1198
FtrtAl SERUCTURE AS -WILT
two. -e G +aM.,
� miy
ff rq •..,
Legal Description: BLOCK
LOT 2 BLOCK 3
s t.. otos vtar »w i
•• .. 5�i`1
bf
faY[RN. M tM. M6 awt i M
VWeuilTnb 4�N ueWu
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a
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Falling Water Sub.
En
SGS Ref.#
1103448001
Client Name
Pannone Eng. Srv.
Project Name/#
Falling WaterBk3,Lt2
Client Sample ID
Falling Water Bk3,Lt2
Matrix
Drinking Water
Sample Remarks:
Printed Date rime 07/20/2010 15:32
Collected Date/Time 07/14/2010 14:15
Received Date/Time 07/14/2010 15:10
Technical Director Stephen C. Ede
Parameter
Results
LOQ
Units
Method Container ID
Allowable
Limits
Prep Analysis
Dale Date
lnit
Metals by ICP/MS
Arsenic
ND
5.00
ug/L
EP200.8
C
(<10)
07/16/10 07/19/10
KDC
Waters Department
Total Nitrate/Nitrite-N
0.594
0.100
mg/L
SM20 4500NO3-F
B
(<10)
07/15/10
AYC
Microbiology Laboratory
E. Coli
Negative
I
100mL
SM20 9223B
A
07/14/10
DLC
Total Coliform
Negative
1
100mL
SM209223B
A
07/14/10
DLC
Municipality of Anchorage
• Development Services Department C�
Building Safety Division x
On -Site Water and Wastewater Program
4700 Bragaw Street S A Y
P.O. Box 196650 I A
Anchorage, AK 99519-6650 !
www.muni.org/onsite y �: Zvi
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-772-o8 COSA #_6 (' ,
Expiration Date: _ -7— 7-°_
1. GENERAL INFORMATION
Complete legal description Falling Water S/D Block 3 Lot z
Location (site address) io16 Misty Mountain Road, Eagle River, AK 99577
Current Property owner(s) James Dietzmann Day phone
Mailing address
Lending agency
Mailing address
-4o16 Misty Mountain Road, Eagle River, AK qql; 7
Day phone
Real Estate Agent Raney Hardman/ReMax of Eagle River Day phone 440-7257
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
Individual Well ED
Individual Water Storage ❑
Community Class Well ❑
Public Water System ❑
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank ❑
Community On-site ❑
Public Sewer ❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the 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 Pannone Engineering Services, LLC Phone 272-8218
Address P.O. Box 100217, Anchorage AK 99510
Engineer's Printed Name _Steven R. Pannone, P.E. Date 4/4/2-011
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & 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. .'"`�i,
The operational life of all wells and septic systems depend on the local soil condition, ground water l ��� OF "'�
levels that may fluctuate during the year, and the water usage of the family being served by the system. ••�P. . •••.....
These conditions are outside the control of the evaluator of this system. All systems eventually fail and 1 C)
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that A 4 rH •�. ��
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future .....t ••• ••••• ••• ................
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed ��_iP:Steven R. Pannone; i
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it �� �� '•., No. CE 8149 �� a
confer any legal right whatsoever.
5. DSD SIGNATURE��.••
Approved for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
VMSTEWATER
iPRONIGRAM
''dtt�'�..\\
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitrate Advisory Other
By: tom,, l G Original Certificate Date:
(Rev. 11/05 f�
Municipality of Anchorage
• Development Services Department
Building Safety Division,
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Failing Water SID Block 3 Lot 2 Parcel I D: 050-772-08
A. WELL DATA
Well type P
If A, B, or C provide PWSID #
Date completed 9/iSh2`979 Sanitary seal (Y/N) Y
Total depth 118 ft. Cased to _&U.5_ft.
FROM WELL LOG
Date of test 9115/1979
Static water level 101 ft.
Well production 10 g.p.m.
WATER SAMPLE RESULTS:
Coliform -Nig—colonies/1 00 mL Nitrate 0.522 mg/L
Arsenic: ND ug/I Date of sample: 2 2oi1
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 12 in.
AT INSPECTION
7/1412010
99 ft.
3.3 9 -p.m.
Collected by: Pannone Engineering
Tank Type/Material Sunset Plastic Date installed 516/1970
Tank size l000 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/A
Date of pumping 7/1S/2o10 Pumper Ass Pumping
C. ABSORPTION FIELD DATA
Date installed 51611929 Soil rating (g.p.d./ftp or ft2/bdrm) 8i System type Pit
Length 11 ft. Width 11 ft. Gravel below pipe 6 ft.
Total depth 9 ft. Eff. absorption area ak& Monitoring tube Y Depression over field N
Date of adequacy test 7114/2o10 Results (Pass/Fail) Pass For 2 bedrooms
Fluid depth in absorption field before test 2Z in. Water added3oo gal. New depth2z in.
Elapsed Time: o min. Final fluid depth 2Z in., Absorption rate >= 300+ 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
Datum
Size in gallons
in. "Pump off' level at in.
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot loo+
Absorption field on lot loo+
Public sewer main NIA
Sewer /septic service line 25+
Manhole/Access (Y/N) _
High water alarm level at
Meets alarm & circuit requirements?
On adjacent lots loo+
On adjacent lots loo+
Public sewer manhole/cleanout NIA
Holding tank 75+
Animal containment areas loo+ Manure/animal excrete storage areas loo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 1o+ Property line 1o+
Absorption field 5+
Water main NIA Water service line 25+ Surface water loo+
Wells on adjacent lots loo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line so+ Building foundation 1o+ Water main N/A
Water Service line 25+ Surface water loo+ Driveway, parking/vehicle storage 20+
Curtain drain None Known Wells on adjacent lots loo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION 44?='
I certify that / have determined through field inspections and � o•° '•:�'
review of Municipal records that the above systems are in Aff m
conformance with MOA COSA guidelines in effect on this date.
....... ...... .... ..............
%Steven R. Pannone;
Engineer's Printed Name Steven R. Pannone, P.E. No. CE 8149
Date •...............•••' •••'
� e�Ess�c�. •
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
in.
SGS Ref.#
1111117001
Client Name
Pannone Eng. Srv.
Project Name/#
FALLING WATER BLOCK 3 LOT 2
Client Sample ID
FALLING WATER BLOCK 3 LOT 2
Matrix
Drinking Water
Printed Date/Time
Collected Date/Time
Received Date/Time
Technical Director
04/04/2011 10:00
03/29/2011 10:10
03/29/2011 11:00
Stephen C. Ede
Sample Remarks:
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Waters Department
Total Nitrate/Nitrite-N 0.522 0.100 mg/L SM20 450ONO3-F B (<10) 04/01/11 AYC
Microbiology Laboratory
E. Coli Negative 1 100mL SM20 9223B A 03/29/11 DLC
Total Coliform Negative 1 100mL SM20 9223B A 03/29/11 DLC
E`�
Municipality of Anchorage ' � Ld`
• '� Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street 5 A E T Y
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _050-ZZz-og COSA # (i �C
1. GENERAL INFORMATION Expiration Date:
Complete legal description Falling Water S/D Block � Lot 2
Location (site address) -4o16 Misty Mountain Road Ea le River, AK gg577
Current Property owner(s) James Dietzmann Day phone
Mailing address :16 Misty Mountain Road Eagle River, AK 89577
Lending agency Day phone
Mailing address
Real Estate Agent _Raney Hardman/ReMax of Eagle River Day phone 440-7257
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
2
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_WaterSystem-Public-sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the 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 _Pannone Engineering Services, LLC
Phone 272-8218
Address P.O. Box zoo2i7 Anchorage, AK gg5zo
Engineer's Printed Name Steven R. Pannone P.E.
Date
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & 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•••7_
levels that fluctuate
0F q� ���,
may during the year, and the water usage of the family being served by the system.
.•`P •.• ••........ .gS �1
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
49 rH
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
••••r� ••
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
�•k?\'� ••n R. • •Pannone: •••
�;Steve'/`ui
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it�1�
J �.,. No. CE 814 9
confer any legal right whatsoever.
�:•
5. DSD SIGNATURE..........
Approved
for bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
Y 0K.'. �,, f
• WATER AN =.
e
PRODWA
TER
o
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
y - Original Certificate Date.
(Rev. 11/05) "�
Municipality of An,
Development Services Department
Building Safety Division
On -Site. Water & Wastewater Program
4700 Bragaw Street
P.O Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Fa ft water S/D Block 3 Lot 2 Parcel ID:_o50-772-08
A. WELL DATA
Well type P If A, B, or C provide PWSID #
Date completed 9&SLi979 Sanitary seal (Y/N) _Y
Total depth 118 ft. Cased to 217.5_ft.
FROM WELL LOG
Date of test 9 is/1979
Static water level 109 ft
Well production 10 g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL NitrateQ,,6C'4mg/L
Arsenic: ug/I Date of sample: 1 2olo
B. SEPTIC/HOLDING TANK DATA
Well Log (Y/N) Y
Wires properly protected (YIN) Y
Casing height (above ground) 12 in.
AT INSPECTION
7/14/2010
44 ft.
3.3 g.p.m.
Other bacteria colonies/100 mL
Collected by: Laura Pannone
Tank Type/Material Sunset Plastic Date installed 5/16/1979
Tank size l000 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/A
Date of pumping 7hg/2oso Pumper _JR's Pumoina
C. ABSORPTION FIELD DATA
Date installed5&_6&M9_Soil rating (g.p.d./ft2 or ft2/bdrm) Sr System type Pit
Length 11 ft. Width 11 ft. Gravel below pipe 6 ft.
Total depth g ft. Eff. absorption area afi&ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/14/2o1a Results (Pass/Fail) Pass For 2 bedrooms
Fluid depth in absorption field before test 27 in. Water added oo .gal. New depth2Z in.
Elapsed Time: o min. Final fluid depth 2Z in. Absorption rate >= 3oo+
g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date
D. LIFT STATION
Date installed Size
"Pump on" level at in
Datum
E. SEPARATION DISTANCES
"Pun
Cycle
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ioo+
Absorption field on lot ioo+
Public sewer main N/A
Sewer /septic service line 25+
Animal containment areas ioo+
Manhole/Access (Y/N)
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots ioo+
On adjacent lots ioo+
Public sewer manhole/cleanout N/A
Holding tank _25+
Manure/animal excrete storage areas ioo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation io+ Property line io+ Absorption field
Water main NIA Water service line 25+ Surface water ioo+
Wells on adjacent lots ioo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 1o+ Building foundation io+ Water main N/A
Water Service line i5+ Surface water ioo+ Driveway, parking/vehicle storage zo+
Curtain drain None Known Wells on adjacent lots ioo+
F. COMMENTS
G. ENGINEER'S CERTIFICATION ••� O�
/•�`PCE;...........�
I certify that / have determined through held inspections and • • '•`9
review of Municipal records that the above systems are in Z 49TH ••..'�;
conformance -with MOA COSA guidelines in effect on this date.
.... �...... ...............
Engineer's Printed Name Steven R. Pannone, P.E. Steven R. Pannone:
��'� s•• No. CE 8149 A
Date
/ria '•.•••. ....••••°
COSA Fee
Date of Payment J�/ /y
Receipt Number
(Rev. 11/05)
Waiver Fee $
Date, of Payment
Receipt Number
P"Por
EUV- A"WW I vv
zchwo c"met
MCNT EMLOW Breva
ME B"NG
WEAA WLANO "AM
BREAK LINE,"
SEE DETAIL
NOTE
Break Line
E NOT SHOWN
I
UNDER NO CIRCUMSTANCES S+!IOULD AN &S -BUILT BE USED FOR CONSTRUCTION OR FOR CSTAKISHIN'G80"UNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LIABILITY ONLY FOR THE COST OF THE SURVEY.
LISTED DISTANCES PREVAIL OVER, SCALING, REPRODUCTION MAY CAUSE ERRORS IN SCALE,
SURVEY TYPE SYMBOLS
FOUNbATION AS -BUILT
SET REBAR
INAL STRDRZINA(i
FUCTUP1 AS -8114A A SPHALT
PLOT PLAN -IB
, ASUILT LOT SURVEY ... tOPOURAPHY b FOUND RESAR WOOD FENCE CONCRETE
AS -BUILT NQ -BUILT CORNERS SET METAL FENCE r)Fry
_A5
(g�) ASSUMED ELEV.
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
'HE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHCH 00 NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
SURVE' CERTIFICATION
PLOT PLAN
t #W*y cartity that i haa phyakdy omm*yod
g!
the Idt &~ sw ldnaft.4 iwo6m end that I
106" WMI w astliblishod 'A .4 tho ICK edm4ft
0 0hp- on.. tta pi- and t. itto "st Of My
w,e.ftdql «W �*Oft* an d1rftw.',m* h" OW
t
FWNDA11ON AS -BUILT
1, R.DWA E. ,.krona. *_ hwoy Wiry thal I
hove vwNrfk'W an Ag-oult—
0�daijo- to Chit 1. -a ..'
dIMWftkM* ON ilfan.Va an
arc Chao 404 r. �90ER - GHN
wv_ 01h.'Aw
FINAL STRUCTURE AS -BUILT
ftbt E jo96c 'v. 40'may CM'tit), that I
1p .1.• 4L
an Aa
Al thio wt wd t"t 19 wo 11�0 . . ........
do.406am. m so— ft"
art t.4 d .0 *.Jvt w'"" #1
'14%
.wbe
ONLY THOSE IMPROVEMENTS ABOVE GROUND: AND VISIBLE WILL BE
SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAY -S,
ETC,, ARE SHOWN IN THEIR APPROXIMATE. LOCATION, ONLY, SNOW
MAY PREVENT SOME IMPROVEMENTS rRIOM SEMtC SEEN AND LOCATED,
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTE3_
I
Robert E. Jdns, Jr, &_- Asc,
Professionai Land Surveyors
842 E. 12 AVE.
ANCHORAGE, ALASKA 99$01
scalc 1 tt 50' Rm Lot S,F. c, Plat F -Te NT.
Dote surveyed: 7/16/10 cked Gd by-
_J�77 S W `fi�e'
L F01%
Dote Ornian: 7�-rid; S' /20/10 E 804 1198
E;9.1 _Dn.riptlom,
LOT 2 BLOCK 3
Falling Water Sub.
SGS Ref.#
1103448001
Client Name
Pannone Eng. Srv.
Project Name/#
Falling Water Bk3,Lt2
Client Sample ID
Falling Water Bk3,Lt2
Matrix
Drinking Water
Sample Remarks:
Parameter
Metals by ICP/MS
Arsenic
Waters Department
Total Nitrate/Nitrite-N
Microbiology Laboratory
E. Coli
Total Coliform
Results LOQ
ND 5.00
0.594 0.100
Negative 1
Negative 1
Printed Date/Time
07/20/2010 15:32
Collected Date/Time
07/14/2010 14:15
Received Date/Time
07/14/2010 15:10
Technical Director
Stephen C. Ede
Allowable Prep Analysis
Units Method Container ID Limits Date Date Init
ug/L
EP200.8
C
(<10)
07/16/10 07/19/10
KDC
mg/L
SM20 450ONO3-F
B
(<10)
07/15/10
AYC
100mL SM20 9223B A
100mL SM20 9223B A
07/14/10 DLC
07/14/10 DLC
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519.6650
www.cl.anchorage.ek.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-772-08 HAAtt_14A 01004 /
1. GENERAL INFORMATION Expiration Date: _S— �S ^ 0/
Complete legal description FALLING WATER SUBDIVISION; LOT 2 BLOCK 3
Location (site address or directions) 3016 MISTY MOUNTAIN ROAD EAGLE RIVER AK 99577
Current Property owner(s) KEN BRAZ Day phone 696-1282
Mailing address c/o CAROL BUTLER w/ REMAX
Lending agency Day phone
Mailing address
Real Estate Agent REMAX PROPERTIES/CAROL BUTLER Day phone 257-0161
Mailing address 2600 CORDOVA STREET ANCHORAGE, AK 99503
Unless otherwise requested, NAA will be held by DSD forplckup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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.
Note: Alaska Water and Wastewater Consultants, Inc. shall be pald $1,110.00 at, or prior
to closing for the engineering services provided.
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 AuthorityApproval Guidelines for this application,
shows that the on-site water supplyandlor 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 ofAnchorage riles 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC.
Address 6901 DEBARR ROAD, SUITE 28 * ANCHORAGE, AK 99504
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
in conducting this evaluation, AMM, Inc. attempted to provide a thorough,
conscientious engineering analysis of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the lest and separation
distances measured to readily Idontifable features. The operational Eta of all wells and
septic systems depend on the local sats condtion, groundwater levels that may
fluctuate during the year, and the water usage of the family, being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. AV=, Inc. can therefore not provide
any warranty or future estimate of how long the system will continue to moot the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole bonerit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will It confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
Phone 337-6179
Date
xxxx Conditional approval for 2 bedrooms, with the tllowing stipulations:
$500.00 shall be put in escrow to have the septic tank pumped by a certified pumper
at the earliest possible date no later than May 15, 2001. Money in escrow shall
not be released until this ollice has given tinal fullapproval of this ea t
TF
c
Attachments:
HAA Checklist
Septic System Advisory
Well Flow Advisory
Manitenance Agreements
Supplemental Engineer's Reort
Other
By: Original Certificate Date: 2 —14-01
(RW. 17!00)
D. LIFT STATION
Date installed
'Pump on• level at--Jn.
E. SEPARATION DISTANCES
Sits in gallons
High water alarm level at in.
Cycles Meets alarm S circuit requirements?_
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tanklliR station on lot 100'+
Absorption Heid on lot 100'+
Public sewer main N/A
On adjacent lots 1000+
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Sewer /septic service one 25'+ Holding tank N/A
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation 5'+ Property one 5'+ Absorption field 5'+
Water main 10'+ Water service one 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property one 10'+ Building foundation 10'+ Water male► t o'+
Water service one 10'+ Surface water 100'+ Driveway. parking/Vehide storage 50'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
0. ENGINEER'S CERTIFICATION
I cet* that I have determined through Neld 6rspewons and
review Of Munk 4W records that the above systems are M
contbrmance with MOA HAA guldellnes In elfed on this date.
Engineer's Printed NaJpp"11e JEFFREY A GARNESS
Date 2/8
010
HAA Fee S 3r��
Date of Payment/0/
Recelpt Number
(PAY. 12MM
Waiver Fee S
Date of Payment
Receipt Number
Municipality of Anchorage . .
• Development Services Department
Building Sarety DMelon
On -Sb Water & Wastewater Program
4700 South Bragew SL
P.O. Box 196850 Anchorage, AK 99519 -MM
www.cl.anGarage ak us
(907) 343-7M
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: FALLING WATER S/D• LOT 2. BLOCK 3. Parcel ID: 050-772-08
A. WELL DATA
Well type PRIVATE If A. B. or C provide PWSID# N A Wen Log (Y/N) YES
Date completed 9/21/79 Sanitary seal (YAC YES Wires Property Protected (Y/N) YES
Total depth 118 fL Cased to 117.6 fL Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 9/21/79 1/26/01
Static water level 105 ft. 101 ft.
Well 3.42 production 10 g.p.m. 9•P•m.
WATER SAMPLE RESULTS:
Conform colonles/100 ml. Nitrate r mg.A . Other bacterta..Lcolonies(100 ml.
Date of sample: 2/8/2001 Collected by: AWWC. INC.
B. SEPTICIHOLDING TANK DATA
Tank Type/MaterialPLASTIC (SUNS Data instaned 5/16/79
Tank size 1000 gal. Number of Compartments 2 Cteanouts (YIN) YES
Foundation cleanout (Y/N)YES Depression over tank (Y/N) NO High water alar (Y/N) N/A
Date of pumping
Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA REMEBREMM
Date installed5/1s� Son rating (g.p.d.Wior41�85 System type -- SEEPAGE PIT
Length 11 fL WkM 11 A. Gravel below pipe --I—ft.
Total depth 1 o fL EB. absorption area 264 R' Monitoring tube YES Depression over field NO
Data of adequacy test 1/26/01 Results (Pass/Fall) PASS Fort bedrooms
Fluid depth in absorption field before test 17L In. Water added 666 gal, New depth32. In.
Elapsed Time: 30 min. Final fluid depth-L7:.in. Absorption rate >= 300+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date –
02-13-01 07:03 FROM -CTE ENVIRONKNTAI 5615301
CTBE Environmental Services Inc.
CT&E Ref.#
1010647001
Client Name
AK Water& Wastewater Consultants Inc.
Project Name/#
FaUin¢ Water SID Lot 2 Blk 3
Client Sample ID
Falling Water S/D Lot 2 Blk 3
Matrix
Drinking Water
Ordered By
PWSID
0
T-815 P.02/03 F-115
Client PO#
Printed Date rime
Collected Date rime
Recelved Dste/rlme
Technical Director
Released By "
.41
02/12/2001 16:42
02/082001 9:00
02/082001 10:20
Stephen C. Ede
Sample Remarks: -- - --
Allowable Rep Analysis
Pamm�a Results _ PQL Unita Meiliod Limits Date n,1.Init
Waters Department
Nitrate -N
Microbiology Laboratory
Total Coliform
0.500 U 0.500 mglL EPA 300.0
0 eoU100ml. SMI892228
10 max 02/08/01 SCL
02/08/UI SKW
01-13-01 07:04
LTA
FROM -CTE ENVIRONIENTAL
5615301
ME Environmental Services Inc.
Laboratory Diviti77.r___.
T-815 P.03/03 F-115
st\
U liform Bacteria a 200 W. Potter Drive
DrinkingWater Anal R Anchorage. AK 99518.1605
YSIS Tel: 1907) 562-2343
READ INSTR UCT/ONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax: (907) 561-5301
MUST BE
Q PUBLIC WATER SYSTEM I.D.N
PRIVATE WATER SYSTEM
Q Send Results Q Send leveler
Music .7 Inc.
D Send Results 4' I'aAor1nrouvr'Z% Cir
...M. �..waztzmafe,1.:.. •L. t ...I..nur....e
'1 - nFF-1 h.
r7—
SAMPLE
r
SAMPLE DATE: m
Month Day Year
SAMPLE TYPE:
TO BE COMPLETED BY LABORATORY
An ysis shows this Water SAMPLE to be:
Satisfactory
Q Unsatisfactory
Q Sample over 30 hours old, results may
be unreliable
Q Sample too long in transit; sample should
not be oveaftours old at examination
to indicate.reliable results. Please send
new sample via speci elivery mail.
Date Received Of?
Time Received /07-Q1
Analysis Beg:tn /7-30
Analytical Method: Membrane Filter
D MO -MUG
'Nnies/IOO ml.
I tj 10647 Result* Analyst
Q Routine Q Treated Water
Q Repeat Sample (for routine sample Untreated Water
with lab ref. no. )
Q Special Purpose
Time Collected
SAMPLE LOCATION *Collected By
rk.Ye hon
Sent to A.D.E.C.
O "
Anch Fbks Jen o
Fazed
Date: Time: pp
Client notified ofwtsit(Fafectncy results:
Phoned Spoke with azed
Date: Time.
BACTERIOLOGICAL WATER ANALYSIS RECORD
atMO-MUG Result: Total Coliform / E-Cali
Membrane Filter: Direct Count f/ Colonies/100 ml
Verincatlon: LTB BGB COLIFIRM
Fecal Coliform Confirmation
Final Membrane Filter Results � Collform/100
Reported By!=�� Date /9 61 Time C 53S _ hn
Comments: I I
rvrC- r» N..r....r Toe...,
ua-a•..a.n.,..
1*13 7a Member of the 6GSGroup (SociatiiGeneraledoSurveillance)
-.----._.-..... ...............,.e.. r wnoutA rl ARlnA ItNOIS MARYLAND. MICHIGAN. MISSOURI. NEW JERSEY. OHIO, WEST VIRGINIA
r
Municipality of Anchorage ti1�
(� Development Services Department �•:
Building Safety Division
\— OnSite Water & Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 995196650
www.cl.anchorage.ek.us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 050-772-6S HAA#XA010041
1. GENERAL INFORMATION Expiration Date:.r – /4 – 0/
Complete legal description FALLING WATER SUBDIVISION: LOT 2. BLOCK 3.
Location (site address or directions) 3016 MISTY MOUNTAIN ROAD EAGLE RIVER, AK 99577
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
KEN BRAZ Day phone 696-1282
c/o CAROL BUTLER w/ REMAX
Day phone
REMAX PROPERTIES/CAROL BUTLER Day phone 257-0161
2600 CORDOVA STREET ANCHORAGE, AK 99503
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 2
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
®
individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Welt
❑
Community On-site
❑
Public Water System
❑
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 Gila (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, l 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/orwastewater 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 (les and from my Investigation and Inspection, the
on-site water supply and/or wastewater disposal system ls(are) In compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of Installation.
Name of Finn ALASKA WATER do WASTEWATER CONSULTANTS. INC.
Address 6901 DEBARR ROAD, SUITE 28 • ANCHORAGE. AK 99504
Engineer's Printed Name JEFFREY A. GARNESS. P.E.
Engineers Comments:
In conducting this evaluation, AKNVC, Inc, attempted to provide a thorough,
consdenttous engineering analysls of the system In accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test and separation
distances measured to readily idondfiabfe features. The operational fife of all wells and
septic systems depend on Me local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the famlybeing served by the system.
These conditions are outside the conbd of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or enaoachments. AK%V, inc. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report Is for
the sole benefit of the owner fisted above. Any reliance upon or use of this report by any
other person or party is not authorized, nor willlt confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 2 bedrooms.
Disapproved.
Phone 337-6179
Date z t'6 o/
4
�o�op00
f `.7� ./...00!
Conditional approval for bedrooms, with the filowing stipulations:
Attachments:
HAA Checklist �_ Manitenance Agreements
Septic System Advisory Supplemental Engineers Reort
Well Flow Advisory Other
A. ess;
—7953 `F
..... '*IC A
ON-SITE .
WATER AND
WASTEWATER
PROGRAM
By:Original Certificate Date: 2 — /4 — O/
Mw. 12M)
Municipality of Anchorage ,
' Developmen1�.
t�Servicess Departmentsulling Solely ;
WM
O"ne water.&. �WastewaterryP�(am
47W SWy, Bragaw SL
P.O. Banc 196650 Anchorape, AK 99519650
www.d.anchorage.ak.us
(907)943-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: FALLING WATER S/D: LOT 2. BLOCK 3 Parcel ID: 050-772-08
A. WELL DATA
Wen type PRIVATE If A, S. or C provide PWSI0# N/A
Data completed 9/21/79 San" seat (Y/N) YES
Total depth 118 R Cased to 117.6 fL
FROM WELL LOG
Data of test 9/21/79
Static water level 105 fl,
Wen production 10 g,P,m,
WATER SAMPLE RESULTS:
Well Log (Y/N) YES
WIM PmPerly Protected (YM) YES
Casing height (above ground) 12+ in.
AT INSPECTION
1/26/01
101 fl
3.42 g.p.m.
Conform 0 colonies11100 mi. Nitrate 0.5 mgA. Other bacteria 0 colonles/100 ml.
Date of sample: 2/8/2001 Collected by. AWWC. INC.
B. SEPTICJNOLDING TANK DATA
Tank Type/Material PLASTIC (SUNSET) Data installed 5/16/79
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) No Fngh water alar (Y/N) N/A
Data of pumping 7-115 101 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 5/18/79 Son rating (g.p dAllor(Ij!Ej�O 85 System type -SEEPAGE PIT
Length 11 n, WIC 11 ft. Gravel below pipe 6 It.
Total depth —j2--1 Ell. absorption area 264 fe Monitoring tube YES Depression over field NO
Date of adequacy test 1/26/01 Results (Pass/Fan) PASS For 2 bedrooms
Fluid depth In absorption field before test 117' In. Water added 666 gal, New depth32" in.
Elapsed Time: 30 min. Final fluid depth _L71 In. Absorption rate >= 300+
p.p.d.
Any re)uvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
D. LIFT STATION
Date installed Size in gallons
"Pump on' level at n.
E. SEPARATION DISTANCES
High water alarm level at in.
Cycles rued Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tankllift station on lot 100'+
Absorption field on lot 100'+
Public sewer main N/A
Sewer /septic service line 25'+
On adjacent lots 100'+
On adjacent lots 100'+
Public sewer manhole/deanout N/A
Holding tank N/A
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
5'+
Property One 5'+
Absorption told
5'+
Water main
10'+
Water service One 10'+
Surface water
100'+
Driveway, parldngNehlde storage 50'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property One
10'+
Building foundation
t 0'+
Water main 10'+
Water service One
10'+
Surface water
100'+
Driveway, parldngNehlde storage 50'+
Curtain drain NONE KNOWN Welts on adjacent lots—M'+—
F.
ots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
i certify that I have determined through told inspections and e
review orMuni(pat records that the above systems are In
conformance with MOA HAA guidelines M effed on this date.
e fro A. i
Engineer's N e JEFFREY A GARNESS —7953 �S
Date 7, !b/O1 Os^sdptctsssw�dfS
HAA Fee $
Date of Payment
Waiver Fee
Date of Payment
Receipt Number Receipt Number
FW. 12=)
8. LEGAL DESGRIP ION 2 !�
DATE RECEIVED
INSPECTION APPOINTMENTS
Pk, e-e�
TIME
TI E
TIME
Qm
Two ❑ Five
DATE
( ,
DATE
DA7-E
INSPECT
INSPECTOR
INSPECTOR
MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH &
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT ECTI ONENVIRONMENTAL PROTECTION
828 L Street - Anchorage, Alaska 99801
•
ENVIRONMENTAL SANITATION DIVISION SEC 1 t• 1979
Telephone 264.4720 RR EE [[�� FF �� vv
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERIf CTtTt1P5E D
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. PROPERTY OWNER A-���
e
PHONE
Z3
MAILING ADDRESS
PROPERTY RES115ENT If�djfferentrom�ove) /�
,.4S147
P E'�
2. BU ERPHONE
MAIJN03 ADDRESS s
O S�
r
3. LENDING INSTITUTION /1O
�V
PHONE
Q
MAILI ADDR SS
G. 5-1, 'e
4. REALTOR/AGENT
�, 0,ae�PV T� w Ce
P ONE
MAILINGAD ESS /
Lo e. C/' e-
8. LEGAL DESGRIP ION 2 !�
STREET OC ION
Pk, e-e�
6. TYPE OF RESIDENCE
NU ER OF,BEDROOMS
SINGLE FAMILY1:1One
E]Four [DOther
Two ❑ Five
❑ MULTIPLE FAMILY
❑ Three ❑ Six
7. WATEJR SUPPLY
INDIVIDUAL"
ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
INDIVIDUAL/ON-SITE"
iOMOl 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) 90
THIS SIDE FOR OFFICIAL USt ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE ❑ THREE ❑ FIVE ❑ OTHER
❑ TWO ❑ 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
INSTALLER
❑Septic Tank or ❑Holding Tank
Size: ?CWD If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
31' APPROVED FOR ` BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE
... I
BY
72-010 (Rev. 6/79)