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HomeMy WebLinkAboutVERN HAIK LT 2Vern Hal*k Lot 2 #051-061-80 (Rev ub/u2/i d) Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211246 PID Number: 051-061-80' Dwelling: ❑W Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Upgrade Name James Delks ABSORPTION FIELD ❑ Deep Trench Wide Trench ❑ Bed ❑ Mound Site Address 24640 Chugiak Drive, Chugiak, AK 99567 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade (907) 317-8842 4 1.0 GPD/SF 4.8/4.7 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 4.2/4.3 Ft. Gravel depth beneath pipe 0.5/0.5 Ft. Subdivision Block Lot Vern Haik 2 Fill added above original grade -(0.5)/0.6 Ft. Gravel length 2 @ 60 Ft. Township Range Section Gravel width 5.0 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches 2 Dist. between trenches >6 From Tank Field Tank Line 600 Ft2 Ft. Well N/A N/A N/A N/A >25' TANK 0 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Capacity Existing Gal. Surface Water N/A >100' N/A N/A Material Number of compartments Lot Line N/A >10' N/A N/A NA Foundation N/A >10' N/A N/A L STATION Manufacturer Capacity Remarks Septic tank is existing Gal. Alarm location Electric Iled by PIPE MATERIAL House to tank Existin Tank to g drainfield D3034 Installer Hiland Excavation Drainfield D3034 CO/MTD3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 15t 7/5/21 7/6/21 Location and description dates: 2nd Threshold of lower sliding door Yd 7/8/21 4th ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date '�� ' ''9t0� �TH •*� '• / Septic System BenjariiLry5chiller �� ���; CE 12592�`��® Approved' 1 In.• — pp Date �dh , C 7�l G "� •. $���F9F�p�OFESSIONA�`c��/12/21 o. Note: this approval does not include well permit requirements. (Rev ub/u2/i d) VE RN HAIK SUB, LOT 2 PERMIT # OSP211246 PID # 051-061-80 EXISTING 1250 -GAL SEPTIC TANK-- LOT\1; 2 - 60' LONG x 5' WIDE, 0.5' EFFECTIVE DEPTH ABSORPTION TRENCHES LOT 12 *I. ik i NG ;:��or- f4 . . . . �:-,4* 9 mi .... . ....... . .Benjja i Schiller C E 2592 rA" �Iy 16. 2021 'ORO C4UGIAK--D-RI-V--E-.. 15'T&E EASEMENT LOT 2 30' UTILITY EASEMENT 4-8DRM HOME O F 2CO SH MT2 CO2* col 0 'a FS FS MT1 ,�MTT4 TH1 C04 CO3 M T 3 fJ CHAIN LINK FENCE Z— iA�, E EASEMENT KEEP EXISTING TRENCH FOR FUTURE USE LOT 5 Zr I 0 PLAN AS -BUILT 0 50 100 111101 ME 'FEET 111=50' LEGEND CO -CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE FD - FLOW DIVERTER VALVE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE VERN HAIK SUB, LOT 2 PERMIT # OSP211246 PID # 051-061-80 NORTH TRENCH 97.0 FINISH GRADE 96.5 ORIGINAL GRADE 92.2-- U-r..Il .... .. . DRAINFIELD ROCK —10�-92.2 91.7 qr MOA APPROVED FILTER SAND T'— 91.7 89.5 60, 89.5 SOUTH TRENCH 96.3 FINISH GRADE 96.7 ORIGINAL GRADE n 1 1 p 92.5-- DRAINFIELD ROCK 92.5 92.0 -- MOA APPROVED FILTER SAND 92.0 89.7 89.7 60' GROUNDWATER @ 83.7 7/12/21 82.7 PROFILE AS -BUILT (NO SCALE) 497H .......... ... Benja 'n Schiller CE 12592 MY 16. 2021 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 J^ http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211246 Work Type: Septic Upgrade Tax Code Number: 05106180000 Site Legal Address: VERN HAIK LT 2 G:1461 Site Mailing Address: 24640 CHUGIAK DR, Chugiak Owner: DELKS JAMES Design Engineer: FORGE ENGINEERING This permit is for the construction of: Q Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms: »11nr S' De 1) rtment v 7/1/2021 7/1/2022 32900 ❑ Private Well ❑ Water Storage 4 All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing pecial Provisions: A test hole shall be provided prior to construction of the drainfield to confirm separations to impermeables and seasonal high groundwater, as well as to confirm percolation rate. Construction may proceed at your own risk prior to 7 -day groundwater monitoring. If results require a design change, construction shall stop pending Onsite review and approval of a change order. Please submit results with the inspection report (or change order, if required). nn ,�� � 1 ; D r d� � r�v� � se �l cl,�.•� -I- a s o � 15 ,�I2+ < I � How s p l � f -{-e,- r�u re_ �I � r l o r V 'I/blzo�l Received By: f / Date - Issued By: Date: 7/1 0, On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-061-80 Property owner(s) James DelkS Day phone Mailing address 24640 Chugiak Drive, Chugiak, AK 99567 Site address Same Legal description (Sub'd., Block & Lot) Vern Haik Sub, Lot 2 Legal description (Township, Range & Section) Lot Size 32,900 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) ❑x (w/wo AD U) Septic Tank ElUpgrade ❑x Duplex (D) ElHolding Tank ElRenewal ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: 5 ` Waiver Fees: Date of Payment: % © Date of Payment: Receipt Number: ©d a 1 Receipt Number: Permit No. d S P.2 f T� y b Waiver No. Permit App_::- ::-..:c June 25, 2021 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 6/25/21 Subject: Vern Haik Sub, Lot 2 New septic system Dear On-Site Services Engineer: The septic system on the above lot has failed, although the existing septic tank is a replacement that was installed in 2012. Therefore, we are submitting this permit application for a new absorption trench. The ground surface on the lot is mildly sloped, and is fairly flat in the area where the trench is located. Drainage arrows are shown on the site plan showing the grade and direction of flow. Stormwater drainage will not impact this septic system. The new trench will be constructed parallel to the slope as much as possible. This property, as well as neighboring properties, is service by a community water system. There are no wells within 100’ of the property lines. The water line is in the front of the home, close to the road, and does not impact the location of the trench at all. Please refer to the attached plan for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211246, Rebecca Carroll, 07/01/21 EXISTING 1250 -GAL SEPTIC TANK— i 1` L 0 T `1 �0 t w 2X60'LONGx5'WIDE,0. EFFECTIVE DEPT ABSORPTION TRENCHE MAINTAIN 6' SEPARATIO E NGINE[RI NG ®or .. •. Benja I�;Fc��TFA• CE i Schiller so zoz , •��C��,i ®® lde�PROIESSIONP�..® C H -GIA-K--E) RIVE., co 1� 1 i �� 15' T&E EASEMENT LOT 2 30' UTILITY EASEMENT / INSTALL LLLL FL`- r 'r } 4-BDRM HOME / DIVERTER VALVE i % g OT 5 SHEDMT CO ---- CO MT 9T H H N (`�CHAIN LINK FENCE KEEP EXISTING � TRENCH FOR FUTURE USE 10/�fZA1NAGE EASE ENT LOT 3 '�' -'DCT 4-- — NdTE: I / NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE LEGEND PROPOSED SEPTIC SYSTEM CO -CLEANOUT NO EXISTING WELLS- THIS AND PROPERTIES ARE ON A COMMUNITY 2CO - DOUBLE CLEANOUT WELL SYSTEM FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE 0 50 100 MH - MANHOLE him ME �m 7morl FEET MT - MONITORING TUBE SV - SEPTIC VENT 1"=50' TH - TEST HOLE VE RN HAI K SUB, LOT 2, (10 DESIGN FACTORS: SYSTEM REQUIREMENTS: 600 GPD PEAK FLOW 5 -WIDE TRENCH SYSTEM PERK RATE: <1 MIN/IN 1250 -GAL SEPTIC TANK (EXISTING) APPLICATION RATE: 1.0 GPD/SF 600 GPD / 1.0 GPD/SF / 5' WIDE (* 0.5' DEEP = 1.0) = 120 LF TRENCH REQUIRED (120 LF SPECIFIED) BOTTOM OF TRENCH: 4' BELOW GRADE FLOW LINE ELEVATION: 3.5' BELOW GRADE TOP OF TRENCH: 0.5' ABOVE GRADE N. 3' 6" 1 611 '610 _ r; .c; 2 ^. . 5' 4" PERFORATED PVC (HOLES DOWN) DRAINFIELD ROCK 2' MOA -APPROVED SAND TYPICAL TRENCH SECTION (NO SCALE) NOTES: 1. GRADE AREA OVER TRENCH TO DRAIN AWAY 2. PROVIDE 3' OF COVER OVER TRENCHES AND 4' OVER SEPTIC TANK, OR 2' WITH 2" OF INSULATION 3. CHECK GROUNDWATER AT TIME OF CONSTRUCTION. IF LEVEL IS HIGHER THAN PREVIOUSLY OBSERVED, CALL ENGINEER IMMEDIATELY 'lk�-'49 Schiller • .' . . CE 52592 .2111 `t 9�a�PR0 FESSIO;P .a Colt 1 SOILS LOG AND PERCOLATION TEST E H G I H E E R I H G LEGAL DESCRIPTION: VERN HAIK SUB, LOT 2 PERFORMED FOR: JAMES DELKS DATE: 7/5/21 PROJECT No.: PARCELID#: 051-061-80 TECHNICIAN: J. MILLETTE DEPTH TEST HOLE 1 (feet) 2 3 4 5 6 _ 7 8 9 10 11 ,I < 12 13 G@ 14- 15----1 16 17 18 19 20 COMMENTS: • .� GW: SANDY GRAVEL W/ SOME SILT GW/GP: SANDY GRAVEL WITH COBBLES SLOPE WAS GROUND WATER ENCOUNTERED'? NO IF YES @ WHAT DEPTH? - DEPTH TO WATER AFTER MONITORING: DATE OF MONITORING: - L p E DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) 7/5 1 9:31 <1 016 /6-106 616 2 9:32 <1 016 / 616 616 3 9:33 <1 016 / 616 616 4 9:34 <1 016 /6-106 616 5 9:35 <1 016 /616 616 6 9:36 <1 016 / 66 616 PERCOLATION RATE: <1 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 3.5 FT. and 4.5 FT. CHUGIAK DRIVE FND. N0. 5 — -1 x w 76. /t9 SURVEY ORDERED BY: DAR WALDEN @ KELLER WILLIAMS 1.22.2016 THE INFORMATION HEREON IS FOR THE USE OF LENDIN6INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY V = 30' NO CORNERS SET THIS DATE OF A 49 TH� SHANE A. HOLT .' LS -6914 0` Da a o �ArOfessioW Lo ��40000`i I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 2, VERN HAIK SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _25TH DAY OF _JANUARY , 2016. HOLT LAND SURVEYING 600 HIGHVIEW DRIVE ANCHORAGE,AK 99515 345-5513 Municipality of Anchorage Community Development Department Page 1 of 3 Onsite Water & Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 a http1Avww.muni.org/onsite • (907)343-7904 ONSITE WASTEWATER INSPECTION REPORT Permit Number: OSP 121054 PID Number: 051-061-80 ❑ New ®Upgrade Name: MELISSA & ROBERT JONES ABSORPTION FIELD Address: ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 24640 CHUGIAK DRIVE *CHUGIAK, AK 99567 ❑ Other Phone: No, of Bedrooms: Soil Robng: I Tocol Depth from original grade: / C/O AGENT 4 LEGAL DESCRIPTION Subdivision: Block: Lot: VERN HAIK _ 2 owns Ip: ange: ec Ion: SEPARATION DISTANCES TO Septic Absorption Lift Holding public/Pn Depth to pipe invert from original grade: Gravel depth FL nll added above original grade: I Drove,natF Total width: From Tank Field Station Tank Sewer Lines Well 200'+ EXISTING — — 25'+ TANK El Septi Surface Water 100'+ EXISTING — — N/A Manufacturer: GREER Lot Line 5'+ EXISTING — _ Material: STEEL Foundation 5'+ EXISTING — — LIFT STATION Curtain Drain 11 NONE KNOWN Manufacturer. Remarks: OLD TANK WAS FILLED WITH GRAVEL/DRAINROCK. 'pomp °" level at: P Installer Pump Make Number of ❑ S.T.E.P. ❑Hol perfomned by: ea: Uietance between lin Oist. between trench ing ❑ Other 1250 G merits: 2 PIPE MATERIAL House to tank D3034 Tank to D3034 drainfield WILCO CONTRACTORS Drainfield EXISTING CO/MT EXISTING Inspector GEG, Ltd. BENCH MARK (Assumed elevation) Inspection 100.00 Ft. Dates: 1st 4/18/12 2nd — Location and Description: 3rd — 4th — BOTTOM OF SIDING AT SE CORNER OF HOUSE ENGINEENB SEAL Community Development Department Approval I�0600� Conditional approval: Date: E_A. Gar ess.• e`G ' ee a -e �_. / w Da PERMIT NUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: — OSP121054 051-061-80 DAWN Lane A B ST1 42.53 10.80 15' Elec & — Telecom Esmt - — — — — ST2 49.72 13.63 DBLI 52.00 15.22 DBL2 52.12 14.44 ',WATERLINE LOCATION PER m 1986 INSPECTION REPORT. n EXISTING 4 BEDROOM HOUSE A NEW 1250 GALLON J "�y SEPTIC TANK, Dk 1&2 E STING DRAINFIELD NOTE: ALL SURROUNDING PROPERTIES ARE SERVED BY A COMMUNITY WATER 1.. = 30. SYSTEM. O� o�� .... ....v�o GARNESS ENGINEERING GROUP, Ltd. *:-'4 T� CONSULTANTS & GENERAL CONTRACTORS _ ...... ... . .. ............ 3701 E. MOOR ROM. SURE 101 * MCHOMa. M 99507 • PH (907)337-8179 • FM (907)3M 46 MOSRE: wwwg ma n&M dnq.9 PREPARED FOR: PHONE NUMBER: - PAGE NUMBER: •• ....... ........... MELISSA & ROBERT JONES C/O AGENT 2 OF 3p e A. rness. LEGAL DESCRIPTION: DRAWN BY: Qn 9; CE VERN HAIK LOT 2 PNB V�406 LG Fq�1Z ��AoG "a TYPE OF WORK: DATE:ofessior°oma AS—BUILT DRAWING 4/19/12 o On -Site Wastewater Disposal 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: OSP121054 Tax Code Number: 05106180000 Work Type: Septic Upgrade Permit Effective Dates: April 17, 2012 to April 17, 2013 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: VERN HAIK Site Legal Address: VERN HAIK LT 2 G:1461 Owner/Address: JONES MELLISA A & ROBERT C 24640 CHUGIAK DR CHUGIAK AK 995675763 Site Mailing Address: 24640 CHUGIAK DR, Chugiak This permit is for the construction of: '09-/Z @ q'©O Lot Size in Sq Ft: 32900 Total Bedrooms: 4 N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Receiv Issued Municipality of Ancho P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907)343-7904 0 Fax (907)343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program inept S �0 P 4 1 N Department **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP121055f COSA#: Permit#:OSP121054 PID#: 051-061-80 Legal Description: Vern Haik Lot 2 Engineer: Garness Engineering Group Applicant: Melissa R Robert Jones Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the foundation has been approved. The approved separation distance is 6 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property - 0 Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Reviewer .....................................Mason.. ...........................smog. Rec#: 09043G Amount: $200.00 Date Paid: 4/17/2012 **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Seryices Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 051-061-80 Propertyowner(s) MELISSA & ROBERT JONES Dayphone C/0 AGENT Mailing address 66 CYPRESS TRAIL *LAKELAND, GA 31635 Siteaddress 24640 CHUGIAK DRIVE *CHUGIAK AK 99567 Legal description (Sub'd, Block & Lot ) VERN HAIK S/D• LOT 2 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 4 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (®all that apply) Initial ❑ Absorption Field ❑ Upgrade Septic Tank ❑ Holding Tank ❑ Renewal Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: .(' tII ` l' t Waiver Fees: Date of Payment: ti j j' 1 1Date of Payment: r Receipt Number: / 01'0 61136- Receipt Number: Permit No C>Pia (C,5 -q Waiver No. C)Shl�(o'�S_ (Rev. 01/11) April 16, 2012 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Tank Upgrade for Vern Haik Lot 2; To whom it may concern: The existing 4 bedroom house is served by a community well and a private septic system. The home has had an addition added to it that encroaches within a foot of the existing 1250 gallon septic tank. Due to the encroachment the septic tank serving the home needs to be relocated to meet the required separation distance. We are proposing to fill the existing 1250 gallon steel septic tank with drainrock or gravel and replace it with a new 1250 gallon septic tank at the location shown on the attached drawing. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any que ions, please contact us at 337-6179. Thank you for your assistance. Sincerely, d M.S. NOTE: Attached area design drawing and G.E.G. Ltd 7 page construction specification letter. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessenginee'ing.com GARNESS ENGINEERING GROUP, Ltd. r CONSULTANTS & GENERAL CONTRACTORS; , April 16, 2012 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Waiver Request from Foundation to Existing Drainfield for Vern Haik Lot 2; To whom it may concern: The existing house had an addition added onto it that encroaches onto the existing drainfeild. We are requesting your department grant a 6 foot waiver from the foundation to the existing drainfield. The justifications for this 4@4er are as follows; P WCVe0 par -J& • The foundation is a slab on grade so there is no potential for effluent from the drainfield to migrate laterally into a basement or crawl space. • It is our understanding that the addition was added in 1997 which indicates that the encroachment has existed for 15 years with no apparent signs of impact. In short there is minimal risk associated with the grating of this waiver. If you have any questions, please contact us at 337-6172. Thank you for your assistance. M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengincering.com DAWN Lane SEPTIC TANK UPGRADE DESIGN 15' Elec & Telecom Esmt LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND EXISTING 4 BEDROOM HOUSE DECK PROPOSED 1250 SEPTIC TANK. WATERLINE LOCATION PER 1986 INSPECTION REPORT. EXISTING 1250 GALLON SEPTIC TANK TO BE PUMPED AND FILLED WITH GRAVEL. CLEANOUTS NOTE: ALL SURROUNDING PROPERTIES ARE SERVED BY A COMMUNITY WATER SYSTEM. GWARNESS ENGINEERING GROUP, Ltd_ -- CONSULTANTS & GENERAL CONTRACTORS .. 3701 E. TUDOR ROAD. SURE 101 • PNCHOWE. AR 99507 • PHONE (907)337-6179 I FM (907)338-3246 • WEBSITE: www.gam ssanglm ong.wm PREPARED FOR:PHONE NUMBER: PAGE NUMBER: MELISSA & ROBERT JONES C/O AGENT 1 OF 1 LEGAL DESCRIPTION: DRAWN BY: VERN HAIK S/D LOT 2 PNB TYPE OF WORK: DATE: PROPOSED SEPTIC TANK UPGRADE 4/16/12 OF fur.—ia . 'Oro f e s sio��� FERMINUMBER: AS—BUILT DRAWING PARCEL ID NUMBER: OSP - OSP121054 051-061-80 TOP OF TANK AT INLET = 94.08 INVERT OF BUNG AT INLET = 93.66 FINAL GRADE = 99.47-99.69 ST1 ST2 TOP OF TANK AT OUTLET = 93.89 NEW 1250 GALLON SEPTIC TANK 10' MAX BURIAL DEPTH —INVERT OF BUNG AT OUTLET = 93.12 GARNESS ENGINEERING GROUP, Ltd. ... CONSULTANTS & GENERAL. CONTRACTORS 3701 E. 1000R ROAD, SUITE 101 * ANCHORBCE, AI( 99507 • PHONE (907)337-6179 I FM (907)335-3246 WEBSITE rw.gomaeeang neetlng.cam PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MELISSA & ROBERT JONES C/O AGENT 3 OF 3 5' LEGAL DESCRIPTION: DRAWN BY: 4Op 9 VERN HAIK LOT 2 PNB p� TYPE OF WORK: DATE: PROFILE AS—BUILT DRAWING 4/19/12 ey ness: CE -7953 �� Eo MUNICIPALITY OF ANCHORAGE DE ITMENT OF HEALTH AND HUMAN SERI cS Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES TO SEPTIC ABSORPTION . WELL I f-� `oMsi Address S�-S TANK TANK FIELD WELL Zoo {--E- v C GI r�¢� N` Sel3lSL L.rZ, Phone(s) Permit No. No. of Bedrooms Lo -2_ D LOT LINE , /0��, '4 - LEGAL DESCRIPTION Lot Block Subdivision - Z P -W FOUNDATION if 199 r 5 Township, Range, Section AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation. /' 115 G driveway, water bodies, etc.) TANKS Cf,YSEPTIC El HOLDING - - - -. Manufacturer Capacity in gallons 611 fL43 GjZ. D Material No. of Compartments Sl c^C�L. Z co �•K rt -Y TYPE OF SYSTEM ❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Naw If Depth to pipe bottom from Total depth from original grade Ile P rL original grade FT / (� FT HB S R K Fill added above original grade Gravel depth beneath pipe - j FT FT ce r ' sr Gravel length Gravel width • L FT r FT �e TH 01 LT Total absorption area Distance between lines 5,= r %R rG SLO SO FTJ H 1A FT Lr o Number of lines Sod rating Pipe material r If a SOFT A -Si M J3D3 Installer Date Installed Nt V ' -ONS- !c9 -3r- WELLS ❑ PRIVATE OTHER (Identifv) classification (A,B.C) Total Depth Cased to FT FT kbriiirbul i U Installei Date Installed. REMARKS: 4 t .p Scale: /if ^.gor .� N¢(WE Inspections Performed by: s, ' JPS c��`. �••... �•° c� Date. .� tl of • �'' r S & S ENGINEERING I certify that this inspect' nQwas performed according to all ` �+ A. $# �V .°o this date l o 457_f �F'y '•e. Municipal anPRAguideMAeffect on EAGLE RIVER, 99577 ,.•'��d�;,f $'+�°�'noFEssio���,� •' Health Department Approval: Date: 72-013 (3/85) M tJ N1 I (--][ 3:-1-~y- (D F =. i=h FIA C-- f=1 10 FEE DEPARTMENT �. HEALTH AND ENVIRONMENTAL �ROTECTION . ` 825 L STREET, ANCHORAGE, AK 99501 264-4720 PERMIT NO: 860396 . DATE ISSUED: 10/21/86 � APPLICANT: PAUL MYERS CONST. ADDRESS: % S&S ESNGJNEERING ' EAGLE RIVER, AK 99577 CONTACT PHONE: 694-2979 . LEGAL DESCRIP: SUBDIVISION: VERN HAIK LOT: 2 SECTION: 3 TOWNSHIP: 15N RANGE: 1W LOT SIZE: .32900 (SQ.FT. OR ACRES) MA% BEDROOMS: 4 Listed below are the options available to you in designing system. Choose the option that.best [its your site. . -K-I=C F=- UNIK-- VA ]E:K—= ID DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 GRAVEL DEPTH (FT.) 6.0 0.5 TOTAL DEPTH (FT.) 10.0 4.5 GRAVEL WIDTH (FT.) 2.5 20.0 GRAVEL LENGTH (FT.) 42.0 . 38.0 GRAVEL VOLUME (CU.YDS.) 25.3 28.2 TANK SIZE (GALS) 1,250.0 ** 1,250.0 ** SOIL RATING (SQ.FT./BR) 125 125 BLOCK: NA your septic __________ 114 - 13 r -7c 9!!.N IL�� 4.0 3.5 7.5 5.0 54.0 40.0 1,250.0 ** 125 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ I certify that:* .1. I am familiar with therequirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in -compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater'disposal system or public ' sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum Of 4 bedrooms and any enlargement will require an additional permit. ' IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRIC AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE AppMOVREPORT; AND (3) THE SIGNED DATE: � APPLICANT: L 111 IRS 0 'T. ~ ISSUED BY DATE: ___02��~�__ « ' . Municipality of Anchorage 0 • '` DEPARTMENT OF HEALTH & HUMAN SERVICES °°• ���~•• • •• 825 "L" Street, Anchorage, Alaska 99502-0650 .• •......••••••rir SOILS LOG — PERCOLATION TEST W. t 4d7•Ie I 74bwd A. - •. �.� %Q*; ESSVP�°1" PERFORMED FOR: P`A YeZ,C D/J S/`iLClUYG1.! DATE PERFORME . V f3�o LEGAL DESCRIPTION:_ Lo% XG�hJ �{•�41ic. S�) Township, Range, Section: 1 IsN, &>_ I DEPTH SLOPE SITE PLAN 1 Of E EZ) L- a. O P—' &Ar.91[. S 2 v � 3 a ' L-XPrt>ab S Arub5 •+i- C.IC-AvcL 4 p W I'r-/-! 1'SO4Lbd1L Q.0 130 S 5 0 6 r' o 7 O ' ;0 8 Qop•' 9 1 : P WAS GROUND WATER - ENCOUNTERED? %� b 11 S /IF YES, L V M AT WHAT O 12 DEPTH? = E 13 14- 15- 16- 17- 18- 19- 20- COMMENTS 4151617181920COMMENTS _ /3orm^4 OF No" Depth to Water After Monitoring? Nv'146: Date:lo-MO-B� PERCOLATION RATE _(1--utes/inch) PERC HOLE DIAMETER �— TEST RUN BETWEEN AND FT PERFORME%RY$ j*RL/ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDAN�IGLIe/ WWE�PC0 AL GUIDELI �IEFFECT ON THIS DATE. DATE: -.It/- 72-008 (Rev. 4/85) 1� Y • SCALE L oT Z WA-lelZ 5Y574 - W ff.L fat f{OO,LC� uA r 'U v a 0 m n I f � 1 s CO to � c. I 11 1N -real I I P • is :.a✓ � '� �• i'► 1C I 11 I SMT dw 1 1 II • c.o A�, . 51 TE I�r=SuZVL I L oT Z WA-lelZ 5Y574 - W ff.L fat f{OO,LC� uA r ' l� v a 0 m v v 4 I f � 1 s 0 � ,�'• P • is :.a✓ � '� �• i'► 1C dw S & S ENGINEERING SR B 196X C(iiAPUTATION SHEET EAGLE RIVER, AK 99577 SUBJECT: DATE: SHEET OF BY CKD L_ c:,r.-,- G Vta ?_ Q llw<i Ic iz 7 7. _17 .11 if L.J L L jk. T j7- Lail* 7 4_7 ---.--- - � :..:�:".-.:_. • — _' � fieJ.oz's:c.P�l•ISrI a • N690"135'E 39.�GB'/McoJ•1 (NB9°J4:i0E S9i'Rec.P11SA1 33.0 00' _ 243.23 f� JJ4 Of _ :0t I E C — .s �/5'Elre.6 Telecom. ttnlJ.� '• � � � p � Te/i omm nica/iOn 1:x30' �• /�J �+ IW a � � EJtntJ. � I N ^t4 n �p to n v a 32 900 SF / VAr-ANI ti 0. 75 Ac. E 0 V , -D. -•7-A C. e n 44 l�0 (; A Cry" i / % �, -ry uro�noge Eamtt. % 44 Re ti `� Fnd � ReDor J 0 ti SiWG,,- "t line &I'11til Ac $r �i J b 4TP/ourrr. fJrn `�• �o zi' 3tio 12 i.0 3 �..• �� �� '� 95441 SF v wfft o °o ! i 4 cdel Ac. ti h tJ Z ?7.5.111;1.6 Te%can. '• `' eNi��EtTT'� �. _ �.52,7•�7L' — .� _ .._, eaTts.— — — o � � bA ,35.Fi 3 NB9°S?'3S"E NB9°S?'35"E v tc 0 /� y'?�orn 3j—155.�b�/�c7. 5.•Tele—com n—rca—i-n/3fo0m.2t3J.v7tIt' h ' 4q MI. �n / % ti 11 0 22, 796 SF h b 3?, 207 SF e h 34, 627 SF 4i 0. SZ Ac. ^ t 29, 986 SFoti &174 Ac, FI o 0. 75Ac. o u o° 0.69 Ac. n/otecarx/.rolniwr 3io `'�'SW Gr L0 % k 4 Pit. E/utno Heights SS, ud AW. 4 ;.pr 0.GA6 10'e4ttetcoe h 15183' "j0' �liII 30'U/)i/.ay Ts/ecein. E'o _N Sd37 ,*;at ee $04,/A b line / a o /56.90' .zes OS"?E0. c1 o = I1 jj.o0' N69•SG37'E 593.77' (Meas{ (NB9•SS'tS E f93.e 'Rec. P7? 114) (N69 65 57P f.93.6; Wee. *0-015A) NO9 146 ;i7"E X. 00WMI) N99.56 ;i7'E 33 00'lMro a/ (NB97S'?3 E 3j 00'Rer.P7Z /14I TN (.►09.55'75 E 3d 00'Rec' P7I• II ! �-. � J33!•S 11 h VH cor' vFsPa? X3o AI.P�lyh .r I ,I no Po;nl 144.1 er JQ> �I rEAO N09 *55J a iJ t Q c` it L li'V A J i 19 S UO ti h% .. �, 4 1 % ` ti `3 v Lo[S t!i(r�D�V�I.vPc1� E /0 S are O 14 GL*(vC t B9'17.1G"E /j10.0'Rec• P7?•/BG) • I / /QOAD (NB9'S5'30E G39.G7'Ree.P7t•114) • NB9•SS'JO"E !°59.87'(Prop.l •'t •--- .f .. 0"E IGd9.4B'(Prop.J /NB9°SS :i0'E 1638.70%LK. P?/SES — � --�' �, bearings ($ource: PZ15E) , TAX_CERTIFICATION ` _ —SUR""—CEVITIFICATE 1 Eagle River Engin'eerihg,',,Sbrv1q6S 11940 Business Blvd, Suite :#205"'.' 5195 P.O. Box 773294 4,694 ) Eagle River. Ak. 99577: Fax'694-3297 Legal:,-,,- Meter Reading Monitor Level Well Level Tank Level -41 0 wner:. Remarks -7 aq C�& I U 11..75 z njAye rime YA Meter Reading Monitor Level Well Level Tank Level GPM PSI Remarks -7 aq C�& I U 11..75 z njAye . (I1A ON 0 I'l. L: 14) ?�qo 7 t, o 25 3:7-�) '7A4 007 bD 31 0G0 31-719 41 21; 1 Z(,c> 44-S S. 1 3 L t) 44.7s- 41 71 214) 4 Y 0 q yzli- 3 31 �I*-V4A OTC e!!�= A -Orr ro je- F I- e, Ve 40 1: I MUNICIPALITY OF ANCHORAGE ��� iZ tli4 Development Services Department - Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-061-80 Expiration Date: 7-- 9 _,20 z 1. GENERAL INFORMATION Complete legal description Vern H a i k Sub, Lot 2 Location (site address) 24640 Chugiak Drive, Chugiak, AK 99567 Current property owner(s) James DelkS Day phone (907) 317-8842 Mailing address Real estate agent 24640 Chugiak Drive, Chugiak, AK 99567 2. TYPE OF DWELLING: ❑E Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic Water Storage ❑ Holding Tank ❑ Community Well Q Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ j cD Waiver Fee $ Date of Payment 7f�Date of Payment Receipt Number C.32ZHD Receipt Number COSA # 05C)_ 1 A 3 3 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. I acknowledge that On=Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller, P.E. Date 7/12/21 0F Aq�'lO� 49 TM s__ •* r 6. DSD SIGNATURE . a System #1 Approved for bedrooms { Beni am�nj5-hiller / System #2 Approved for bedrooms ���1�i% • 0;1252; • •�����'�� Disapproved itl�\\\ isi � Conditional approval for bedrooms, with the following stipulations: i�rsF � (14ilif���(i i� 5; J ;t Ji , SAiT RER Original Certificate Date: 7—I%-2./ The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: Vern Haik Sub, Lot 2 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Wel filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test ft. Comments Community well B. TANK DATA Age of tank(s) 9 years Tank type/material Septic / Steel Measured operating fluid level in septic tank 50 © Standpipes/foundation cleanout per record drawing Date of pumping 3/26/21 D. ABSORPTION FIELD DATA 5 -Wide Trench System Which system tested (date installed) 7/$/21 W ALL standpipes present per record drawing Total measured depth from grade 5.3/4.3 ft (max) Measured depth to pipe invert from grade 4.8 / 3.8 ft (min) ❑ N/A — pressurized field lJq_1 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: COSA Checklist yellow sheet Parcel ID: 051-061-80 Structure served by this system Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ N ❑ Coliform bacteria is Negative ate mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample IFT STATION ❑ Requir aintenance completed Age of lift station years Lift station material Comments. - Ad test date Resu [J Pass For bedrooms Fluid depth for to test in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate 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) 7 Yes Septic Tank/Lift Station on Lot > 100' ft N/A Community Sewer Manhole/Cleanout > 100' N/A Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑ Yes if No N/A ft Private Sewer/Septic Line > 25' ❑ Yes if No N/A ft Absorption Field on Lot > 100' ❑ Yes if No N/A ft Holding Tank > 100' ❑ Yes if No N/A ft Neighboring Absorption Fields > 100' ✓0 Yes if No N/A Animal Containment > 50' ❑ Yes if No N/A ft ❑ Yes if No ft Community Sewer Main > 75' [1 Yes if No N/A ft Manure/Animal Excreta Storage > 100' ❑ Yes if No N/A ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 7 Yes if No ft Surface Water > 100' Yes if No. Property Line > 5' ✓l Yes if No ft Wells on Adjacent Lots: ✓l Absorption Field > 5' E✓ Yes if No ft Private Wells > 100' © Yes if No Water Main > 10'✓❑ ft Yes if No ft Community Wells > 200' ✓0 Yes if No Water Service Line > 10' ✓0 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' E✓ Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' ✓l Yes if No ft Private Wells > 100' ®✓ Yes if No Water Service Line > 10' ✓0 Yes if No ft Community Wells > 200' 0✓ Yes if No Surface Water > 100'✓] Yes if No ft F. ENGINEER'S COMMENTS A�tN, G. ENGINEER'S CERTIFICATION®F�J��� I certify that I have determined through field inspections and review � TM •��� 49 of Municipal records that the above systems are in conformance with , .. , , • MOA COSA guidelines in effect on this date. 0 • Benja chiller �� �Fc • CE 125927/12/21 Aw COSA Checklist yellow sheet ft ft ft ft ft ern:. weal ,�F:[ . :.J. REc --- --- - --- - -- CHUG.IAK DRIVE - THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS: AND I5 NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THI5 DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES ORP05ITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS-13UlL I SUIZVLY I" = 3U' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 2, VERN HAIK SUB. ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS _12 TH DAY OF JULY , 2021. FB HOLT LAND SURVEYING g3og GROVER DRIVE ANCHORAGE,AK 99507 907.223.8615 • Municipality of Anchorage t:rfr`o On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcell.D. 051-061-80 1. GENERAL INFORMATION Complete legal description VERN HAIK LOT 2 Expiration Date: I `a?- ('� --(2 Location (site address) 24640 CHUGIAK DRIVE, CHUGIAK, AK 99567 Current Property owner(s) TRAVIS JON & CHRISTINE A. PASSMORE Day phone Mailing address Real Estate Agent 24640 CHUGIAK DRIVE, CHUGIAK, AK 99567 2. TYPE OF•DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual Individual Water Storage ❑ Holding Tank ❑ Community Class A Well ® Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: Date: ! Z9 i COSA to be released ngineer, unless otherwise requested by the engineer. COSA Fee $ �J`o Date of Payment Receipt Number COSA# 05C10V' 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS 1/27/16 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 �v,a system will function satisfactory for current or future% �� o - ALS , occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. � � 4-O,Ttl r 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved. Conditional approval for ?� KENNEL . DUVVS bedrooms. crT 16 � o 1,17 / bedrooms. bedrooms, with the following stipulations: WATER AND Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10-10-12.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 Checklist Legal Description: VERN HAIK LOT 2 Parcel ID: 051-061.80 A. WELL DATA — CLASS A Well type A If A, B, or C provide PWSID # 211431 Well Log (Y/N) 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. 9.p -m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Arsenic: _ ug/L Nitrate _mg/L Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC / STEEL Tank size 1250 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Dateo'lpumplhg ' 1126/16' �PumpeF'-JRs C. ABSORPTION FIELD DATA Date installed 11/2/1986 Soil rating (g.p.d./ft2 or ft2/bdrm) 130 Length 40 ft. Width 3 ft Total depth 13.4 ft. (Measured 1/27/16) Eff. absorption area 560 ft2 Collected by: Date installed 4118.1912012 Cleanouts(Y/N) High water alarm (YIN) N System type DEEP TRENCH Gravel below pipe 7 ft. Monitoring tube Y Depressionover field N Date of adequacy test 1/26/2016 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth.in absorption field before test 56 in. Elapsed Time: 1320 min. Final fluid depth 58 in. Any rejuvenatiori•tfeatmeol(past 12 mo.) (YIN & type) _ Water added 1170 gal. New depth 15 in. Absorption rate >= 600+ g.p.d. 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 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 5'+ Water main 10'+ Water service line 101+ Surface water 10Q'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 6'(2002 MOA Waiver issued) Water main 104 Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 10'+ Curtain drain 50'+ (NONE KNOwN) Wells on adjacent lots 2001+ F. COMMENTS in. 4 -week vacant system presoaked prior to testing. EA'1 t'M1WtP SHgo t A" 91i4Aom7 i Ao .v e -r Aoloww G. ENGINEER'S CERTIFICATION l 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.AUFFUS Date W7116 .COSA canary sheet 2-e-15.doe Parcel I. D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and 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 FOR A SINGLE FAMILY DWELLING 051-061-80 1. GENERAL INFORMATION Complete legal description Vern Haik, Lot 2 COSA# O5C(911(? Expiration Date: — a o Location (site address) 2460 Chugiak Drive Chugiak, AK 99567 Current Property owner(s) Meiiisa and Robert Jones Mailing address Lending agency Mailing address Real Estate Agent 2460 Chugiak Drive Chugiak, AK 99567 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. .NUMBER OF BEDROOMS: Four (4) Day phone Day phone Day phone 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Weil. ❑ Individual On-site ✓❑ lndividual:Water Storage ❑ Individual Holding Tank ❑ :community Class A Well ❑ Community On-site El Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. _ Date 4/19/2012 OF Ak� • d' * ' •49 ► 01 A : MICHAEL E. ANOFRSON W i 5. DSD SIGNATURE �I.•. CE -4381 _Approved for �_ bedrooms �,,� i vaE®SA,4* o.44♦ Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By(�Q r t Original Certificate Date: T o� (Rev 11M) 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: Lot 2, Vern Haik A. WELL DATA Well type Class A If A, B, or C provide PWSID # 211431 Date completed _ Sanitary seal (Y/N) Total depth ft. Cased to ft. FROM WELL LOG Date of test Parcel ID: 051-061-80 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) in. AT INSPECTION Static water level ft. ft. Well production g.p.m. g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate mg/L Other bacteria colonies/100 mL Arsenic: _ mg/I Date of sample: _ Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septiclsteei Date installed 4118-1912012 Tank size 1,250 gal. Number of Compartments Two Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping New Constmotion Pumper C. ABSORPTION FIELD DATA Date installed 11286 Soil rating (g.p.d./ft2 or ft2/bdrm)130 SFIBDRM System type Deep Trench Length 40 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth 13.5 ft. Eff. absorption area 560 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4110112 Results (Pass/Fail) Pass For a bedrooms Fluid depth in absorption field before test 44 in. Water added 612 gal. New depth 53 in. Elapsed Time: 1,440 min. Final fluid depth 44 in. Absorption rate >= 600 g.p.d, Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off' level at _ in. High water alarm level at in. Datum Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot On adjacent lots Absorption field on lot On adjacent lots Public sewer main Public sewer manhole/cleanout Sewer /septic service line Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5 Absorption field >5' Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >200' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line t0' Building foundation >10' Water main >10' Water Service line >10' Surface water >100' Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >200' F. COMMENTS: fi g G. ENGINEER'S CERTIFICATION LJ�P'•• 10. I cern that t have determined through field inspections and ' * 49n ••.•• * 0 review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. � � :Mlcrina. E n°rtdexsoN Engineer's Printed Name Michael E. Anderson, P.E. jf ; CE`4381 a �9•. yd9-ra;r•��� Date 4/19/2012 $�9��PROEESSIO�a 4:41' COSA Fee $ QQ6 -a' Date of Payment ct1at5/12 Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number m 0 k n. �� 1, REVISED 1/11/91 A55UILT-NU GURNER5 St t I H13 UAI t. S5hw h' 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE, FOLLOWING DESCRIBED PROPERTY: 1"=30' Vern Haik Subd.,Lot 2 DATE: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS 4-30-90 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRID: EASEMENTS, COVENANTS, OR RESTRICTIONS NW 1461 WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FB: ANY DATA HEREON BE USED FOR CONSTRUCTION 12-8 OF FENCE LINES, OR FOR ESTABLISHING BDUND- DRAWN, ARY LINES. DMS CJ 4 OF At�� Ar?- '''•r •.s v � w Municipality of Anchorage • '�1 Development Services Department Building Safety Division On-Site Water& Wastewater Program 4700 B ox 19 650 / P.O. Box 196650 Anchorage, AK 9951"650 650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-061-60 COSA# / d [) d % 7 1. GENERAL INFORMATION Expiration Date: H — /—f' Complete legal description VERN HAIK S/D: LOT 2 Location (site address) 24640 CHUGIAK DRIVE • CHUGIAK. AK • 99567 Current Property owner(s) KARI & ANGIE ZAGLAUER Day phone 688-8661 Mailing address Lending agency Mailing address Real Estate Agent Mailing address 24640 CHUGIAK DRIVE " CHUGIAK. AK * 99567 Day phone SALLY CARMAN W/ CENTURY 21 NORTH HOMES Day phone 227-0506 400 W. TUDOR RD. 0440 • ANCHORAGE, AK • 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class A Well 0 Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of Issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat 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 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 GARNESS ENGINEERING GROUP, Ltd. I Phone 337-6179 Address •3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date � 3__0 ko Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 8 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory lost results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will It confer any legal right whatsoever. 5. DSD SIGNATURE 1/ Approved for _V_ bedrooms. Disapproved. Conditional approval for bedrooms, with the filowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other P ` ON SITE •:� WATERAND m_ WASTEWATER : `- ; PROGRAM '))))))111 By; 04 Original Certificate Date: (Rn. IVD5) Municipality of Anchorage 0 • Development Services Department Building Safety Division On -Site Water i£ 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: VERN HAIK S/D: LOT 2 Parcel ID: O-1— 0 U i— 000' A. WELL DATA Well typecoMMUNRY to B, or C provide PWSID# 211431 Well Log (YIN) Date completed Sanitary seal (YIN)_ Wires properly protected (YIN Total depth ft. Cased to ft. Casing height (ab round) in. FROM WELL LOG AT 1 CTION Date of test Static water level ft. ft. Well production g.p.m. g.p.m. _ ... WATER SAMPLE RES Coliform colonies/100 mi. Nitrate mg./L. Other bacteria colonies/100 ml. enic: ug./L. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 11/2/1985 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 3/17/10 Pumper SANITARY PUMPERS C. ABSORPTION FIELD DATA I -BELOW EXISTING GRADE Date installed 11/2/1986 Soil rating (g.p.d./ft°o /bd 130 System type TRENCH Length 40 ft. Width 3 ft. Gravel below pipe 7 ft. Total depth •13.5 ft. Eff. absorption area 560 ft' Monitoring tube YES Depression over field NO Date of adequacy test 3/18/2010 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 58 in. Water added' 1730 gal. New depth 71n. Elapsed Time:"= min. Final fluid depth"?2 in. Absorption rate >= "600+ g,p,d, Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — "1730 GALLONS INTRODUCED. THE LAST 1450 GALLONS CAUSED NO RISE IN LIQUID LEVEL. TRENCH ABSORBED 1450 GALLONS DURING FINAL 236 MINUTES. NO RECOVERY READING NECCESARY. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off Ievei High water alarm level at Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service On adjacent On adjacent lots Holding tank COMMUNITY ;WELL manhole/cleanout Am containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 5'+ Water main 10'+ Water service line 100+ Surface water 100'+ Wells on adjacent lots 200'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main '10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle�storage' 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 200'+ F. COMMENTS G. ENGINEER'S CERTIFICATION o ...•• I certify that 1 have determined through field inspections and . a o review of Municipal records that the above systems are in 0 conformance with MOA COSA guidelines in effect on this ; i• date. Q '•.J ey Corn ss,- p Engineer's Printed Name JEFFREY A. CARNESS QQ yr CE 279 \��0, �Q'e. 3/.3v ./a�,- Date 30/y0 04�d Prof ass, 1,0\ COSA Fee $ L/ c7 Waiver Fee $ Dale of Payment 3 " 1 y Date of Payment Receipt Number Q _� 0 Receipt Number (Rev. 11/05) E - - �;T ASBUILT-NO CORNERS SET THIS DATE. SEakRr b ass I HEREBY CERTIFY THAT I HAVE'SURVEYED THk SCALE, FOLLOWING DESCRIBED PROPERTY;*-., 1"=3a' Fern rack Sub3..Lot 2 DATE& AND THAT NO ENCROA.^,HMENTS EXIST EXCEPT AS 4-30-90 INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY GRIDi EASEMENTS, COVENANTS, OR RESTRICTIONS V4 1461 WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO'CIRCUMSTANCES SHOULD FB+ ANY DATA HEREON BE USED FOR CONSTRUCTION 12-8 OF -FENCE LIMES, OR FUR' ESTABLISHING _80UND- • DR ~ ARY LINES. �•. DMS RTES L. ND r -4 ..ti 'e C54, /L --� Municipality of Anchorage •" Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE-FAMILY DWELLING Parcel I.D. 051-061-80 1. GENERAL INFORMATION HAA # f `A C U::� Expiration Date: -6--- - O Complete legal description Lot -24 -u-rn Haik Subdivision Location (site address or directions) 24640 Chugiak Dr. Current Property owner(s) Mark Anderson Day phone 907-374-7 o3 Mailing address Lending agency Mailing address Real Estate Agent 935 Windflower Ln. Fairbanks. AK 99712 Day phone Kathi Olmstead Dayphone_6oL_/._y00- Mailing Address 16600 Centerfield Dr. E201 �Eagli�!River, AK 99577 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well ❑ Individual Water Storage ❑ Community Class A Well EX Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site QK Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Heafth 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 Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 67- 2 116-'W 1�1A- 'S Parcel ID: eK-1 -06/ -460 A. WELL DATA DMJAI ,11431 Well type A LWW jtV J& , or C provide PWSID # � Well Log (YIN) Date completed Sanitary seal (Y/N) Total depth ftCas to ft FROM LOG Date of test Static water level ft Well production 9•P•m• WATER SAMPLE ESULTS: Coliform colonies/100 ml. Nitrate mg./l. Arsenic: mg.A. Date of sample: B. SEPTIC/HOLDING TANK DATA Tank Type/Material 7((- i Ey Tank size gal Number of Compartments 2 Wires properly protected (YIN) Casing height (above bund) in. AT INSPECTIO ft. g.p.m. ther bacteria colonies/100 ml. Collected by: Date installed 11 2 Cleanodts&/N) Foundation cleanout 6/N) Depression over tank (Yo ,J High water alarm (Y/O /V Date of pumpingPumper C. ABSORPTION FIELD DATA Date installed !/ Soil rating (g.p.d./ftz Length 40 ft Width -i h• System type /26- i/6'?Y Gravel below pipe IX Total depth _13 ft. Eff. absorption area ,�Z Monitoring tube `� Depression over field Date of adequacy test 2 / f% - Results (Pass/Fail) —AS-5- For 14 bedrooms Fluid depth in abscrption field before test SZ,in. Water added 61jaal. New depth j& in. Elapsed 5me0 min. Final fluid depth STSG in. Absorption rate >= OlJ c.p.d. :[c� Any rejuvenation treatment (Fast .2 mo.) (YIN &type) /I/r�t/����t%0W'P if , es, mve date Municipality of Anchorage O 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. DS 1- o G 1- S o _ HAA # M9 0 Expiration Date: 9 - / 3 - PA 7. GENERAL INFORMATION Complete legal description Lot .2'; Vern !,Haile S /D Location (site address or directions) 24640 Chugiak Dr. Chugiak AIC 99567 Current Property owner(s) Greg Hawthorne Day phone 688-7578 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address P.O.Box 670545 Chugiak, AK 99567 Day phone Day phone Unless otherwise requested, HAA will be held by DSD for pickup. V&Z ��',— S- /0 I 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site 12 Individual Water Storage ❑ Individual Holding tank ❑ Community Class WellX❑ 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. Municipality' of Anchorage • Development Services Department " *A. ;Building Safety Division On -Site Water &Wastewater Program 11114760 South Bragaw St. i P.O. Box 196650 Anchorage, AK 99519-6650 wrww.ci.anchorage.ak.us J!(907)'343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST;; Legal Description: Ld i '` V ��^� Phc< S�� � � Parcel ID: 0-6'1- D G /- 8 ti r. I , A. WELL"DATA I L C 9r� r� vN r y 'll" �,�1�¢-7 /d. - �� q ✓ w,4, t ,c Well type If A, B, or.1C provide PWSID # Well Log (Y/ " Date,completed Sanitary seal (Y/N) Wires pr y protected (Y/N) {,I , ' ` asin height aboveground)in. Total depthr ft. Cased to ft 9 g( FROM WELL LOG AT INSPECTION: Date of test , i II I I 41 I , I ft. � static water, 'level II � I ' i (_',,: • ,I 11 f 11 I I I I ill t I, i, s' Well production' m a�� i' g.p.m. g.p. WATER SAMPLE R LTS: ;i Coliform colonies/100 ml: ' Nitrate 11 ' mg./I. Other, bacteria colonies/100 ml. 9 Date ' ample: .II'ICollected by B. SEPTIC/HOLDING TANK DATA i Tank�Type/Material SEP�i 1w1IS r �,� 1.l''i r11 Date installed �.l ,,r�� .�• '• .V' i. � i Pi i ! '_� it !�'. :' '� � � I '�.. � �r ? Tank size i► o ' gal:„, Number of Compartments '�--� Cleanouts (I)` Yf J ” i I 1 f I , f Foundation' cleariout�) YrI Depressllllion over tank (Y�j ;N J High water alarm (Y& N .a „ •'t,! i. � �• 'iY' f ,� I, Date ofpumping/,10�011Pumper SS/ ,ti'r . '� i... i�'•i . .�� 'I �,', �" Ii I'. I. I�j I'�I, ! C ABSORP tTION FIELD DATA i Date instaltled 11 $ L (' Soil rating (g p.d./ft? or ft�Ibdrm ') 3 � ! � � i System type � 7 ��� � r ;..,I , •,.. � ,'� �' II I`r I I!� 1 el.r I � i I Ii it � � � � • Length {� Iftt lu !Width"'� jl 3 �'� ('° ft Gravel below pipe % ft. I (I I I i1 I I I F i. I 2 s N Sb t I a I Monitoring tube D' res i ft M Y e s o over field area, n r a e Total de tti � 15 ft.?,' ft: Eff.'absorption�'I ILS P '� g � 1'P € Date of adequacy test III Ig�1 o�0 1 I I�Resulis Pas' Fail) �! ss s; i j For 'f bedrooms i. y� 11. :I � I I ti{n"Id before'test r a� incl WateraddedblS� al. ! New depth in. Fluid de thin abso o fie 9 P P rP Elapsed Time: `f 3 "mini I Final fluiddepttiS,Sya�in Absorption rate >= Ga g.p.d. � 1,lII I � ij 'll � `II '• '/ j 'I �' ! i r�N61v� '', �� 1 � `r Any, rejuvenation treat rent (past 12 mo.) (Y/N 8� type) klelo',�� If yes, give date I 1 ' , i MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D. # C)_'� X - Flo k - p'o HAA # "2\ 9 C� (\ \ —4)(\ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Vern Haik Subdv. Lot 2 T15N, R1W, Sec. 3 Location (address or directions) NHN Chugiak Drive (b) Property owner H.U.D. Properties Telephone: (home) Business 271-4342 Mailing Address 222 W 8th Ave (Box N-64) , Anchorage, Ak. 99813 (c) Lending Institution N/A Telephone Mailing Address (d) Real Estate Company and Agent Assocaited Brokers / Sandy H-ielmsted Address 640 W 36th Ave, Suite 1, Anchorage, Ak 99503 Telephone (907) 563-3333 (e) Mail the HAA to the following address: (or check here IN, if hold for pick up.) List contact person and day phone number below: Pickup by Engineer 2. TYPE OF RESIDENCE Single -Family 29 Number of bedrooms 4 3. WATER SUPPLY Individual Well ❑ Community M Public ❑ Note: If community. well system, must have written confirmation from.the State Department of Environmental Conservation'attesting to th legality'and status. 4. SEWAGE DISPOSAL., On-site El Public ❑ Community 0 Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 MUNICIPALITY OF ANCHORAGE (MOA) Health Authority Approval.(HAA) FEBRUARY 1984 ' 3434744 LL Legal Description: mat iye.N I< Q' `�� ..... Tis •2 A. WELL DAT . Well Classification % Y'�'"' If A, B. C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of.Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot ;'On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed �SF6 Size ,5 - -No. of Compartments at Standpipes (Y/N) „Y Air -tight Caps (Y/N) f' Foundation Cleanout (Y/N) y Depression over Tank (Y/N) i✓ Date Last Pumped %O T �e � Pumping/Maintenance Contact on File (Y/N). ^��� ;for Holding Tank High' -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK:' PP �-alay� To Water -Supply Well I To Building Foundation,' To Property Line To Disposal Field To Water Main/Service Line } y° To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 STEVE COWPER, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE WESTERN DISTRICT OFFICE 563-6775 3601 C STREET, SUITE 322 ANCHORAGE, ALASKA 99503 April 20, 1990 FOR: EAGLE RIVER ENGINEERING ATTN: LOU BUTERA P11SID: 1211431 According to the records on file in this office, the Lot 2. Vern Hail: Subdivision, Dawn Water Co. Eater System is in compliance with the State of Alaska Drinking THater Regulations. Sincerely, Richard Sundet Environmental Field Officer RS:bas MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date December 23, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2; Vern Haik Subdivision Location (address or directions) (b) Applicant Name Arlene Myers Telephone: Home 688-2985 Business 688-4508 Applicant Address P.O._Box 670351, Chulgiak, Alaska 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer ❑ ; Other O (explain); (d) Lending Institution HnmA Say; nga nnA Loan Telephone AddressAn_oh�P.• Alaska (e) Real Estate Company and Agent Wi Ga Tnup-g mnntGaT/_Nn� Stahl A)z Address Ch-hugiakI Alaska HH Telephone (f) %& The HAA to the following address: c F GINEERTNG —SR13 196X River-, Alaska 9.Qg7� 2. TYPE OF RESIDENCE 'r Single -Family 8X Multi -Family ❑ Other Number of Bedrooms 4 3. WATER SUPPLY Individual Well ❑ Community O Public Rk Dawn Water System Note: If community well system, must havewritten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite a ' PublicEl Community ❑ Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 1 �r 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. l further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Fir,ISm ENGINEERING Telephone /�-4���17 f Address Date AK 99577 low �sN • N 1190+••• y•+ y o�ineer' '•ti"i� +� = .--,.Z.x.+. �, • F,%6wi A. o .• '. Ma 1'M57•� ' a' � PA 0 6. DHEP APPROVAL —,3/ Q/ Approved for /f% bedrooms by �^ Date.�� Oha Approved Disapproved Conditional Terms of Conditional Approval ON f�tll� eP CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/04) r�ao-G- M oOHo-,ttNRYgIPALITY OF ANCHORAGE (MOA), �. �, V4� ALTH AUTHORITY APPROVAL (HAA) 4afipE CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: Z A. WELL DATA oc Well Classification A , If A, B, C, D.E.C. Approved/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level _ Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Depression Around Wellhead (Y/N) To Septic/Hetding Tank on Lot Zoe 'E" ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot LOP 1+ ; On Adjoining Lots — To Nearest Public Sewer Line Cleanout/Manhole — To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results Comments B. SEPTIC/H9tVMG TANK DATA Date Installed 10 -3t -E- Size 124570 No. of Compartments Z Standpipes (9N) Air -tight Caps (VN) Foundation Cleanout PN) Depression over Tank (Y/& Date Last Pumped New Pumping/Maintenance Contract on File (Y/N) ; for '— Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/f4ak M Tank: 1 To Water -Supply Well ZvD �� To Building Foundation b To Property Line To Disposal Field s To Water Main/Service Line /0 /4- To Stream, Pond, Lake, or Major Drainage Course A �/ D D 14- Comments f Comments Page 1 of 2 72-026(11/84) BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION Telephone: I907J Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 274-2533 ANCHORAGE, ALASKA 99501 DATE: 12-29-86 PWS I.D.# 211431 To Whom it May Concern: According to records on file in this office the DAWN -WATER COMPANY Water System is in compliance with the State Drinking Water Regulations Sincerely, Michael P. Lewis Environmental Engineer