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CHANDELLE ACRES LT 29
Chandelle Acres Lot 29 #051-822-08 Municipality of Anchorage Page 1 of 3 Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number:-SW636342 fNuAtim-NN, J1 et %) — +ler Plb Number: 051-822-08 Name: MM&M Contracting, Inc. Wastewater System: New Address: P.O. Box 670495 Chugiak, AK 99567 ABSORPTION FIELD Phone: Number of Bedrooms: 688-1236 Four (4) Deep Trench LEGAL DESCRIPTION Soil Rating: .45 GPD/Ft' Total Depth from original grade: 12 Ft. Block: Lot: Subdivision: 29 Chandelle Acres Depth to pipe bottom from original grade: 3 Ft. Gravel depth beneath pipe: 9 Ft. Township: Range: Section: Rlt added above original grade: 1.3 Ft. Gravel Length: 80 Ft. Well: New Gravel width: 3 Ft. Number of lines: i 1 Distance between lines: Ft. Classification (Private, A, B. C): Private Total Depth: 143 Ft. Cased to• 142 Ft. Total absorption area:. 1,440 Ft2 Pipe Material: ASTM 3034 PVC Driller: Sullivan Water Wells Date Drilled: 12/19/03 Static Water Level: 108 R. Installer: MM&M Contracting, Inc. Date Installed: 11121.1211103 Yield: 15 GPM Pump Set at: Ft. Casing F eight Above Ground: 2 Ft. TANK SEPARATION DISTANCES o septic ■ Holding ❑ S.T.E.P. ❑ Other: To From Septic Tank Absorption Field Lift Station Holding Tank 'ublic/Private Sewer Line Manufacturer: Anchorage Tank Capacity in Gallons: 1,250 well >100' >100' NIA N/A >25' Material: Steel Number of Compartments: Two (2) Surface Water >100' >100' NIA NIA LIFT STATION — NONE ON LOT Lot Line >5' >10' N/A NIA Size: Gal. Manufacturer: Foundation >5' >1 U' NIA N/A Pump on level at: in. 'Pump off level at: in. High water alarm at: M. Curtain Drain None Noted Pump Make & Model Electrical Inspections performed by: Remarks: BENCH MARK Location and Description: Basement Slab - - Assumed Elevation: 100.0 Ft. Engineer's i �• if2., 4th MICHAEL E ice••. NO. CE Stamp •�1 • s �" ANDERSON ` '� -4381 •• ff Inspections performed by: T.L. Kimbrouqh Dates: 1st. 11/21/03 2"d 12/01/0300,70„-A• Department of Health and Human Services approval Reviewed and approved by: Date: 71c29/6y .1♦TF,'••. -•.mac,: �j...PRO ����''..- Municipality of Anchorage Page 2 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SW030366 PID No. 051-822-08 N O F- O O O 2 205.78 29 A B 1,250 Gallon Septic Tank S1 S2 C3 M1 C4 62.0 54.4 48.3 41.3 41.6 37.6 32.0 29.4 71.7 72.8 at 1 S2 /re C3 est TH 1 BasDooement Pallo r East S,de Four Bedroom Home 10' Utility Easement 0 TH 2 M1 C4 0 Wel c 0) E d 10 N D) 0 O 205.58 Chandelle Drive AS -BUILT PLAN SCALE,1"=40' LOT 29, CHANDELLE ACRES SUBDIVISION sir C")\> A �•1. 4: 49th i IsAC� .S MICHAEL E. ANDERSON g •�-fp No. CE4381 I F •., NU PROF. E sSkOt'ee Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Legal Description: SW030366 PID No. 051-822-08 Page 3 of 3 TBM = 100.00' cr BASEMENT SLAB 9.17' N 94.53' N U IU 4.10 r-1 2' Insul. 92.46' 92.0' i r- 1250eptic TGalanlonk 1.85 95.95' 0.56' 75.0 80' (Trench Length) 81,65' PROFILE AS -BUILT Scale. 1" = 20' 0.59' ser • N84100'00'W 170.00 CHANDELLE AC N89]58'58'W 57094 8410 WEST 570.78 79-190 10'81111Es m1105.58 10x15 UG Esmt 179.28 S89158'08' AREA PLAN SCALE 1" = 100' ROM':'COUNTRY REALTY OWNER OF LAND ADDRESS: LEGAL DESCRIPTION C f+! 4.v id 54 C E. AC iZ F S �5 r 5 DATE: / / r `7l t! 3 PERMIT NUMBEFk n 3 e 3 (c C Date of iss ie -1_ TAX tDEhfr FICATION NUMBER: n s i - - Or Is wee located at approved permit location? 14 1(e,, CI No Method of DrilItg: &ter rotary LI Cattle tool Depth of wee: / a easing Type & / FC eyyalu Thickness G 5-0 Diameter inches. depth /y ,1 Liner Type: Casing Stickup Above Gnwnct Static Water Levet i° F Recover Rate l < gpm Method of Testing: 4 2 - Well Intake Opening Type: O-e�enn end U open hole ;.t Screened; Stat feet Stopped Perioratirns Start feet Stop Cr /4/ 10 Grout Atom om Jar;044.). z Depth: from 0 feet: to alp teat Well Disinfected Upon Completion? toles a No Method of Diction 444 ] o PHONE NO. : 9076881238 Jul. 22 2004 09:42RM P1 (lCer.ftteb fritting tog by DOC CO. dba SULLIVAN WATER WELLS y 9P.O. BOX 870272, CHUGIAK, ALASKA 99567 •• 7)l1 ,7 A� [�:).Q %Ri g i%•= IMREt{OI.EDATA S/CeA43., SaJ0 42 it *etc- cri<T i �CcvA"� 54-.%19 64 k--‘ ith4 feet ea4Sr. Comments: Dnller's Name tITENTKON:1t is the responsibility of the property owner to submit a copy of the well fog to the proper authority. Municipality tf Anchorage: Department of Health & Human Services andfor Department of Environmental Conservation. MatSu Borough: )apartment of Environmental Conservation. it MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT Initial Permit Number: SW030366 Legal Description: Chandelle Acres Lof29" Design Engineer: 0088 Anderson Construction & Eng'g Owner Name: MM & M Contracting Owner Address: P.O. Box 670495 Chugiak , AK 99567 - This permit is for the construction of: I✓1 Disposal Field III Septic Tank f Holding Tank v (p3' 2: p 1-n, Date Issued: Sep 09, 2003 Expiration Date: Sep 08, 2004 Parcel ID: 051-822-08 Site Address: Unknown Lot Size: 51149 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 2I / /03 ^ fAid. CMLLFO L5a,6T//F4p TeEA'ch' To 77 , /E Oucc}] ?7tE J-Rf ur-1. REPnr-( fkf /0 ' vo!Az4/ To Received By: Issued By: t, 44,4/0(z_ Date- `x'42—O3 Date: 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 Legal description (Lot, Block & Sub'd) www.cLanchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel 1 D — SL2 —&� Permit Number SW 01 0366 Property owner(s) MM&M Contracting Day phone 6&&-1236 Mailing address (1) P 0 Box 670495 Chugiak AK i�. 9`95677 n & ar g address (2);2.36W.5 C 4� &t cb ({ i . (r� c'lf"' lip Code 'i &A' I of 29 Chandelle Acres Subdivision Legal description address Township & Range) Lot Size� I 1 `1 q Acres q.Ft. Number of Bedrooms Four (4) THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub 0 Swimming Pool 9 Therapy Pool 9 9 Well Only Water Storage Jacuzzi Water Softening Unit 0 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. (Signature of property owner or authorized agent) Permit Fees: 3' 55() Date of Payment: R I7 103 Receipt Number: i-li'j)i y Cf (Rev. 12/00) Waiver Fees: Date of Payment: Receipt Number: AND ER50VEN1Io P.O. BOX 240773 ANCHORAGE, AK 99324 522-7773,„ August 28, 2003 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 29, Chandelle Acres Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The owner of Lot 29, Chandelle Subdivision intends to construct a four-bedroom home on the lot. We are therefore requesting a permit be issued for the construction of a well and septic system to serve the new home. The attached Site Plan and backup documentation identify the location and configuration of the new well and proposed septic system. Also identified on the plans are the locations of the well and septic systems on the adjacent properties. Drainage arrows are shown indicating the current patterns. The drainage patterns will be maintained after construction. The test holes placed on the lot indicated silty sand with varying amounts of gravel in the area of the new absorption trench and alternate site. The percolation rate for this material is between 14 and 40 minutes per inch. No groundwater was found during placement of the test holes and none has been noted during the monitoring period. We are therefore proposing to place a new 1,250 -gallon septic tank and a 67' long by 3' wide by 10' effective depth absorption trench to treat the effluent generated in the house. The elevation of the distribution line in the absorption trench will be 3' below the surface and the total depth will be 13'. The ground surface on the lot slopes at steep grades from south to north off the existing road. It then flattens at the base of the slope and proceeds to the north where the new septic system and house will be placed. The trench will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. The new septic system will be constructed a minimum of 100' from the proposed well on the lot and the existing wells on the adjacent lots. It will also be constructed a minimum of Lot 29, Chandelle Acres Subdivision August 28, 2003 Page Two 100' from any surface water in the area. If the system is constructed in accordance with our design the following statements apply: 1. The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments 125.00 N84700'oow 17o.00 NOOIOT1OWN 1324.00 P311 89158'5870.$8410 WEST 0.78 79-190 195.00 205.78 29 AREA MAP SCALE 1" =100' 4 - 6T Long x 3Wide x 10' Effective Depth Absorption Trench • • TI-1 1 TH 2 205.58 Chandelle Drive LOT 29, CHANDELLE ACRES SUBDIVISION LOT 29, CHANDELLE ACRES SUBDIVISION SYSTEM REQUIREMENTS: Deep Trench System 1,250 Gallon Septic Tank 10' Drainfield Rock DESIGN FACTORS: Four Bedroom Home Perc. Rate: 14 - 40 Min./Inch Application Rate: .45 GPD/SF 600 GPD/.45 GPD/SF (Application Rate) = 1,333 SF Absorption Area 1,333 SF/20 SF/LF = 66.7 LF Trench Length THEREFORE: Construct a 67' Long x 3' Wide x 10' Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 3' Below Original Ground Surface. Total Depth to be 113' Below Existing Ground. Maintain 100' Separation From Well on Lot and in the Area. Place 2' of Direct Bury Insulation and 2' of Fill Over Absorption Trench or Provide Minimum 3' of Cover to Prevent Freezing. 4' of Cover Over Septic Tank. 2'6" 6" 10'0' Natural Backfill 3' I I Geotextile Fabric 4" Perforated PVC (Holes Down) Drainfield Rock TYPICAL DEEP TRENCH SECTION .•aoF (NO SCALE) • NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Well on the Lot. j Minimum 100' Separation From Surface Water or Streams. • • • MIDI GAEL E. ANDERSON •n ;„,. No. CE-4381_er 2 3 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT/ON-SITE WATER AND WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG -PERCOLATION TEST PROJECT #: M0355 PERFORMED FOR: PAUL MYERS / MM&M CONSTRUCTION LEGAL DESCRIPTION' 4- 5 6 —. 7- 8- 9 10 11- 12 13- 14- 15- 16- 17 18 COMMENTS' LOT 29, CHANDELLE SUBD. TEST HOLE # 1 OG - RED - BROWNISH SILTY SANDS W/ GRAVELS DAMP GRAVEL -SAND -SILT MIXTURE - MEDIUM DESITY / GM WAS GROUNDWATER ENCOUNTERED? IF YES, WHAT DEPTHS DATE PERFORMED' 8/8/2003 SLOPE NO DEPTH OF WATER None AFTER MONITORING. ?� MICHAEL E. ANDERSON .` 47: O • . :"rp%.• No. CE -4311 BOH - 19' DATE' 8/28/2003 s 0 P E SITE PLAN See Site Plan READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP Start 8/8/03 12:05 12" 1 12:35 30 2.25" Recharge 12:35 12" 2 13:05 30 2.125" Recharge 13:05 12" 3 13:35 30 2.125" PERC RATE: 14.1 MIN./INCH PERC. HOLE DIAMETER' 6,• TEST RUN BETWEEN 4.5 FT AND 5.5 FT NO IMPERMEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST TEST PERFORMED BY: T.L. KIMBROUGH I, MICHAEL E. ANDERSON CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 8/28/2003 2 3 4 MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT/ON-SITE WATER AND WASTEWATER PROGRAM 4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 SOILS LOG - PERCOLATION TEST PROJECT #: M0355 PERFORMED FOR: PAUL MYERS / MM&M CONSTRUCTION LEGAL DESCRIPTION' 5- 6 -• . 4 LOT 29. CHANDELLE SUBD. TEST HOLE # OG - RED - BROWNISH SILTY SANDS W/ GRAVELS 7 -..a •:• DAMP GRAVEL -SAND -SILT MIXTURE - MEDIUM DESITY / GM E « WAS GROUNDWATER 9 - ENCOUNTERED? 10 II - 12 13- 14- 15- 16 . 17- 18 7- 18 COMMENTS' IF YES, WHAT DEPTH DEPTH OF WATER AFTER MONITORING. DATE - 1♦ a 49th .:c : ••. r...... •P• �r MICHAEL •E. ANDERSON : W i W• BOH•♦ 4j`•. No. CE -4381 JVI=I f'' "•••.................•• ZA4O DATE PERFORMED' 8/8/2003 SLOPE 0% NO None 8/28/2003 L 0 P E SITE PLAN SEE FUTURE ASBUILT N READING DATE GROSS TIME NET TIME DEPTH OF WATER NET DROP Start 8/8/03 12:10 12" 1 12:40 30 0.875" Recharge 12:40 12" 2 13:10 30 0.75" Recharge 13:10 12" 3 13:40 30 0.75" PERC RATE: 40 MIN./INCH PERC. HOLE DIAMETER' 6" TEST RUN BETWEEN 4.5 FT AND 5.5 FT NO IMPERMEABLES ENCOUNTERED / HOLE PRESOAKED PRIOR TO TEST TEST PERFORMED BY: T.L. KIMBROUGH I, MICHAEL E. ANDERSON CERTIFY THAT THS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 8/28/2003 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 29, CHANDELLE ACRES SUBDIVISION GENERAL: 1. The scope of this project includes the procurement and placement of a new 1,250 -gallon septic tank at the location shown on the site plan. Work also includes the construction of a new absorption trench 67' long by 3' wide by 10' effective depth also at the location shown on the Site Plan. The total depth of the trench will be 13' below existing ground and the distribution pipe will be placed at 3' below the surface. All components of the new absorption trench and septic tank must be constructed a minimum of 100' from any surface water and 100' from the well on this and adjacent lots. A minimum of 4' of cover is required over the septic tank and 3' over the absorption trench. In lieu of cover 2" of direct bury insulation and 2' of cover may be placed. 2. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor is also responsible to assure the separation distance from wells in the area is maintained. The engineer will accept no responsibility for Contractor errors. 4. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. SEPTIC TANK INSTALLATION 1. A new 1,250 -gallon septic tank must be procured from a certified septic tank manufacturer. Lot 29, Chandelle Acres Subdivision August 28, 2003 Page 2 of 3 2. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 3. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 4. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. 6. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drainfield. 7. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. The Contractor is solely responsible to assure these separation distances are met. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to •Lot 29, Chandelle Acres Subdivision, August 28, 2003 Page 3 of 3 placement of the rock. All pockets of unacceptable materials must be removed and replaced. MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Fernco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections must be completed during the construction of the septic system. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. His measurements must include verification that the proper separation distances have been met. A certified surveyed as -built may also be required to assure the proper separation distances are met from wells in the area. MUNICIPALITY OF ANCHORAGE Development Services Department p P Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-822-08 Legal description CHANDELLE ACRES LT 29 Site address 23925 Chandelle Dr Chugiak Expiration Date: Z 3 Current property owner(s) Andrew Severns The On-site system(s) is/are approved for bedrooms dt i" Conditional approval fore_4�bedrooms, with the following stipulations: Comments or advisories: septic tank pumping is prepaid. ARM Septic Services will visit the property spring 2023 to pump the 1250 gallon septic tank. 14/u - ARM Septic Services 907.688.;9433 V-3 , / 23 n M Original Certificate Date: 4/14/2023 cl� This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval_June 2022 MUNIUPAUTY OF ANCHORAGE Development Services Department s Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-822-08 Complete legal description CHANDELLE ACRES; LOT 29 Location (site address) 23925 CHANDELLE DRIVE *CHUGIAK, AK Current property owner(s) ANDREW SEVERNS 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS Day phone 3. TYPE OF WATER SUPPLY: X Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic ❑ Private Septic serving 2 dwelling units -❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: 0 Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 19 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed FW� Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ _ 5 5() // /Waiver Fee $ _ Date of Payment _ 'r-1/ ? �- Date of Payment COSA # n1_� Waiver # COSA ApplicaUon_June 2022 COSA Checklist Legal Description: CHANDELLE ACRES JZe; 1,-1s� 4 /IV123 Parcel ID: 051-822-08 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑■ Well log is filed with Onsite (or attached) Date drilled 12/19/2003 Total depth 142 ft Cased to 142 ft ❑■ Sanitary seal is functioning correctly ❑■ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 3/17/2023 Static water level at beginning of test 103.5 ft Comments Well production at time of test 6.8 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes 1011 No X Coliform bacteria is Negative Nitrate 2.91 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L 0 Arsenic less than MRL (ND) Collected by utU Date 3/17/2023 B. TANK DATA C. LIFT STATION Measured operating fluid level in septic tank 51 ❑ Required maintl Date of pumping .5f3�/2823 p`'''�' CO 313 11-20 -Z3 Age of lift station ❑ Required maintenance completed, if AWWTS Lift statio aterial Comments: 'SCHEDULED TO BE PUMPED - SEE ATTACHED RECEIPT C ents: D. ABSORPTION FIELD DATA Which system tested (date installed) 11/21/2003 ❑■ ALL standpipes present per record drawing Total measured depth from grade 15 ft (max) Measured depth to pipe invert from grade 7.6 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 7.1 ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced N/A gallons date Any rejuvenation treatment (past 12 months) - If yes, enter date - years Adequacy test date 3/17/2023 Results 0 Pass Fluid depth prior to test 33 in Water added 616 gal Nvw fluid depth, 37 in / Elapsed time ou min incl fluid depth �33i Absorption rate 600+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) 108 in Effective depth used 54.75 i Effective depth remaining 53.25 inj Comments/Deficiencies: M -r A^ i br- 1-44 Y-4, t, COSA Checklist June 2022 V- 112 c4 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' n Yes if No ft no Yes if No ft Neighboring Tank > 100' R Yes if No ft Private Sewer/Septic Line > 25' QYes if No ft Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' [C Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft i Yes if No ft _Manure/Animal E_x_cretaStorage > 100' Community Sewer Main > 75' Yes if No ff QYes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' [E Yes if No ft Surface Water > 100' Yes if No ft Tank to Property Line > 5' 0° Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' 0 Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' Water Service Line > 10' 0 Yes if No ft F!] Yes if No ft Community Wells > 200' 0 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS *WATER LINE WAS PROFESSIONALLY LOCATED. LOCATION OF CLEANOUT TO WATER LINE LOCATE WAS 12.5' (PICTURES ATTACHED). ATTACHED IS A ROUGH SKETCH OF THE WATER LINE LOCATION. IT IS ASSUMED THAT THE WATER LINE IS 10'+ BASED UPON THE 2023 LOCATE AND THE 2016 COSA SIGNED BY THE ENGINEER STATING 101+ G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Garness Engineering Group, LTD. (GEG) Phone Engineer's Printed Name Jeffrey A. Garness Date In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 907-337-6179 OF.4 J fTr y arness_ VCE ;7953 O�Oif�P •._.��I�j.���Ao LICENSE�QGQfessi f, #AECCB84 �DO�oOo� a r4 v -. O N. 'M ,`� �•L„, r r _�f � ~� I fitoL=fes at13 rs I Cf4A61t>F +I erehy crrfify that 1 hav� surveyed -the f OWW ng 'descss cl L c+- ►� �-�f�' Vic: � ►'c� �.d,.�. Ain horage J�eco djng. Alasi:a,. ar►d:that �u►pe. a rznpros meats shat iti ttttre+�n are ithhitk t y: s and`ia tsut ovedap•or-eNicro i or�.iiae petty !Y ec js� Ibe�etu, khat rx3 improven��nts on !}+u►q adjacent t to on the in .premises questi and that Etre a=re o roadwaya, transtttission'tines d; ether i viable easements on id propetiy. except as inc ted hereon] t# Dented at -River,. Ala"I . � �'F.ag1e . = i i- day of . r � R ER'i' C. JOFti�t SCALESON` . R 61t :. : istered i.and. s�ey t�Fu: •BB'tl+k:S.. ... ,. -d 5fi. Eeglt`Rivet,. 6' a 53579• no (OMAQC5t9 A" Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 051-822-08 Expiration Date: 1 – 1. GENERAL INFORMATION Complete legal description Chandelle Acres, Lot 29 Location (site address) 23925 Chandelle Drive Chugiak, AK 99567 Current Property owner(s) Andrew & Justine Rockey Day phone 612-839-0870 Mailing address P.O. Box 670152 Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: O Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Four 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well El Individual LI Individual Water Storage El Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ C26 — Waiver Fee $ Date of Payment . G ' (% Date of Payment Receipt Number Q) S 436 Receipt Number COSA# OCL' l 11/4 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 Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Phone 522-7773 Date 9/26/2016 0:.1a*2:41k� OF,ACt6# 247107 , � " sem®, dO+ 0410?, It, MI6-Ilc iF; P.IN;OERSONp 6# y. GE•4331 . • ®/hit 79 FES®04� �$ bedrooms, with the following stipulations: A\�t(tOF (/to� ... J ON crrr WATER AND 1111: Jo WASTEWATER oZ_ PROGRAM By: AA, -.A Er-rrdZaattn Original Certificate Date: 10 ^ CH 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 COSAblue sheet f '- 1. c If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Chandelle Acres, Lot 29 A. WELL DATA Well type Private If A, B, or C provide PWSID # Date completed 12/29/03 Sanitary seal (WN) Total depth 143 ftCased to 142 ft FROM WELL LOG Date of test 12/19/03 Static water level 108 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 2.52 mg/L Arsenic ND ug/L Date of sample: 9/12/16 Parcel ID: 051-822-08 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) AT INSPECTION 9/11/16 111 5.0 ft. g.p.m. >18 Collected by: Anderson Engrg. in. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed Tank size 1,250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 6/2/16 Pumper Sanitary Pumpers 11/21/03 C. ABSORPTION FIELD DATA Date installed 12/1/03 80 Total depth 13 ft. Length ft. Soil rating (g.p.d./ft2 or ft2/bdrm) .45 GPD/SF 3 1,440 ft2 Width Eff. absorption area Date of adequacy test 9111 /16 Fluid depth in absorption field before test 24 System type Deep Trench ft. Gravel below pipe 9 ft. Monitoring tube 2 Depression over field Results (Pass/Fail) Pass For 4 bedrooms in. Water added 630 Elapsed Time: 120 min. Final fluid depth 24 Any rejuvenation treatment (past 12 mo.) (Y/N & type) gal. New depth 29•5 in. in. Absorption rate >= 600 N If yes, give date g.p.d. D. LIFT STATION Date installed "Pump on" level at in. "Pump off" level at Datum Cycles tested Size in gallons E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main >75' Sewer /septic service line Animal containment areas >50' >25' SEPTIC/HOLDING TANK ON LOTTO: in. Manhole/Access (Y/N) High water alarm level at in. Meets alarm & circuit requirements? On adjacent Tots >100' On adjacent lots >100' >100' Public sewer manhole/cleanout Holding tank >75' Manure/animal excrete storage areas >100' ' Building foundation >5 Property line >5 Absorption field >5 Water main >10' Water service line >10' Surface water >100' Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: O e Property line >1 Building foundation > 10 Water main Water Service line > 0 Surface water >100 Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS Driveway, parking/vehicle storage > G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that theabove systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 9/26/2016 COSA brown sheet 10-10-12.doo s Oa,* MICHAEL E. ANDERSON e w CE -4381 :44 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 Parcel I . D. 051-822-08 COSA# C(G' (3�' Expiration Date: / c' 1. GENERAL INFORMATION Complete legal description Lot 29, Chandelle Acres Subdivision Location (site address) 23925 Chandelle Drive Chugiak, AK 99567 Current Property owner(s) Arleen Myers Day phone 688-1236 Mailing address Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four (4) 23925 Chandelle Drive Chugiak, AK 99567 3. TYPE OF WATER SUPPLY: Individual Well 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 furtherverify 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 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 5. DSD SIGNATURE !."' Approved for 1-1.. bedrooms. Disapproved. Conditional approval for By: Phone 522-7773 Date 9/21C21°- � r1441 00, • 49 $6 : MICHAEL E. ANDERSON #• S.% •.�• CE - 4381 •.•��2`".play bedrooms, with the following stipulations: WASTEWATER a • rl_rf -'r ASA • Jrr ctr).• • •'cc) J�fJ/,-, HENT )FV\C,� • Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 0-y 0 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 29, Chandelle Acres Subdivision A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Date completed 12/29/03 Sanitary seal (Y/N) Y Wires properly protected (Y/N) 1' Total depth 143 ft. Cased to 142 ft. Casing height (above ground) >24 in. FROM WELL LOG AT INSPECTION Date of test 12/19/2003 9/19/2010 Static water level 108 ft. 113.7 ft. Parcel ID: 051-822-08 Well production 15 g.p.m. 5.2 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 1.89 mg/L Other bacteria 0 colonies/100 mL Arsenic: ___ mg/I Date of sample: 9/19/10 Collected by: M. Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material SePtic/steei Date installed 11/21/03 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 9/13/10 Pumper JRs Pumping C. ABSORPTION FIELD DATA Date installed 12/1/03 Soil rating (g.p.d./ft2 or ft2/bdrm) .45 SPD/sFSystem type Deep Trench Length 80 ft. Width 3 ft. Gravel below pipe 9 ft. Total depth 13 ft. Eff. absorption area 1,440 ft2 Monitoring tube Y Depression over field N Date of adequacy test 9/19/2010 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test o in. Water added 1,250 gal. New depth 16.5 in. Elapsed Time: 840 min. Final fluid depth o in. Absorption rate >= 600 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump ofd level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main N/A Sewer /septic service line >25' Animal containment areas >50' Manhole/Access (Y/N) High water alarm level at in Meets alarm & circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas >100' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line >5' Water main N/A Absorption field >5' 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 Service line >10' Surface water >100' Water main >10' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS: I certify that I have determined through field inspections and review of Municipal records that the above systems am in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 9/28/2010 4�;�s�s11�%, fit. -'44 i1 ' ;' 4918 i\ 0 G. ENGINEER'S CERTIFICATIONIII vow • I*St• • ; P4381 : „ ,; oto .•T. -2—10.���,`r pa COSA Fee $ Date of Payment c g ( d 03bri(y Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ROM : COUNTRY REALTY PHONE NO. : 9076881238 Jul. 28 2004 12:06PM P1 Z .5-, 7.17 wg's; OF4i • 41111 Ac ...oaten" e If ArAte. 7.'S ii - , *N... 0* 49th it • ••••••••• OS* 111....** v. Ap 1 Robert C. Johnson fax:, s. • aw 9,4 NO.830-S % irtgest ... .-0:6," %%•.* -0%,..iin„PM, t\ --•-we - z AS -BUILT i rpheperertyby,certify.. L.0 .tthat21,fr have surveyed the following described p aha n• ti-e-tl -4». Ac;r7.7-c - .1'; 54.4 .d , I.. 1- ts-M). f3 1: ii-' 1 s'ri . • '' . „ . . .. . , AnchOrage Recording Pietzinct, -AlaSki, and' that the i'2hPtt.o?'e- i:ctents situated thereon are within the property lines, and do not • ovetiap or en'croach on the Papery lyrug adjacent thereto; that . no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements nn said property except as indicated hereon. Dated at Eagle River, Alaska .. - this. 2 -ITT 4-1-T de. iof -...1-1-.0.‘ y zoo Wt. : ROBERT C. JOHNSON .. . SCALE: Registered Land Surveyor -No. • " tt el ' Box 77-0456, Eagle River, ,Alaska2,99577 AS -BUILT rsify that l hav, surveyed the :Following describs chorage Recording K rt, Alaska,and ,that the improve- ments situated thereon are ithin the property lines and do not averlap•or•enicroach on the mroperty lying adjacent thereto, that no improvements on pro lying adjacent thereto encroach on the premises in quesh+, and that there are no roadways, transmission lines or, other visible easements on said property except as indicated hereon. Dated at Eagle River,. Alaska thus2-� `" "' day of -ILA' �' ROBERT C. JOINS©N GALE: Re istered Land. Survey. ;¢ :y 77-0456, Eagle River, ne (9x7) 694-2543 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 HAA # 6363 Parcel I.D. M1.822.08 1. GENERAL INFORMATION Complete legal description Lot 29, Chandelle Acres ea_ Expiration. Date: liyerTaC041/ Location (site address or directions) 23925 Chandelle Drive Current Property owner(s) Mailing address P.O. Box 670495 Chugiak, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: Four(4) MM&M Contracting Day phone 688.1236 3. TYPE OF WATER SUPPLY: Individual Well 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 Health Authority Approval (HAA) based only upon the 'representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for, 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample' results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown. below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 disposalsystem 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 Address P.O. Box 240773 Anchorage, AK 99524 Phone 522.7773 Engineer's Printed Name Michael E. Anderson, P.E. Date 7/26/2004 5. DSD SIGNATURE Approved for Disapproved. By: '1 bedrooms. •pfaaa4 • O 1 1. j MCHAEL E. ANDERSON ♦• j,•. No. CE -4391 ♦yPESS,•'•c Conditional approval for bedrooms, with the following stipulations: Additional Comments \\1`P�\�YtO � C J=•Q ON-SITEGi: -%z:Z• WAIEKANu :11 WASTEWATER ; t PROGRAM O`. Q• • ^'•.T.• • 3yo ;se 1111111A� Attachments: HAA Checklist X Maintenance Agreements �( • Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other (Rev. 12/00) A� ••,..h 1 11 J� 0 Original Certificate Date: 'j/c?9/1 q un$cipaht of Ane p y orage Development Services Department Building Safety Division Or Site Water & Wastewater Program O ox4700 South Bragaw St. 9 6`65 l Hca ro age, AK 99519-6660 n ,,ra ci anchorage ak us t9o7r 34"3""7904 EALTH AUTHORITY APPROVAL CHECKLIST Le9 l �f ision rn ,_.v .ur Wr,�hK'......,art: Legal escnp ion. o 29 Chan el a cies 5uba vision Parcel fb 09 ) Jell type rivate ( =, or pray' •eP a e topplei1 ani pry sea ol depth t43 ff "" G`ase tb 13'f=52248 Well Log ires property protected (Y" Casing eig"fit (above ground) 4 in co onies 160' m rru;;.,me.:,ua Jl trate i. mq./I col Hies/100.rn • bate of sample �C/libDI:Ar Tank'type atena Septic! ee a ,�e an size . ' gal. umber o i"Com'parmenfs 2 "��"z;'e,Y. .�-51� ..... .xvia`w,y:* t. Y' ..k..,�t"e'-.�7` '.r 3"S�`.;s..c a we*:•'::: Via.>.: Fountta on ceanout egression over an ig wa era arm i) \ yy} "644n..'rYh '. My. � .a� i Nk;. � "•+' 'Y ✓]:'�[<a :N.y�ru"i4r ate o pumping Pumper ewions ruction " ;�. .. A +. ;S `- *j•,,. I : ` ''..k..- a'r'.;run'."k:a'.��'rY�`;YE4&? fes,5 . a e ms a led 2�b oil ra ng (g.p.d /ff2 or ft2lbc)rm) .4 / ys em fype ueeP l Tench M"r�: engt�� u h 3 ff Gravel below pipe 9 w:: i•^' ty-s"a3 a"v' .4A. otat.ep 1 a•sorption area 0 ft t oni onng uu e j uepression over field I - a rebs v .sawrcrsxr:.'rn.sr m. .a..+4+..rula:+ w *.,. w4r+>' �' x. « Lx M' t -as i„ -m. t +� 1 °^.«m7 S nw yz?` %u'Se ha avh - v h a e o a eequacy es f `esults (Pass%Paif) For bedrooms in ? v?d•. Y m.L'Wry a s. i b �`�'s£�✓Cv 4Y, t .uen"1,eM..+ 2rcsia.aAwm ,,v .,.+y p y ,..,t`i^kx', *;:n - +,^3 s< t,. "'r .t .a r r*, Tae w did de th in a sorption ie. before test • ink �ker added gal,flew depth m • .,✓:i ,eO„' i f h <i.:"+ "'dT`,:"rx - n..�, ''t: n"h ' "'x" dt. *Ktw' M ' - ? A.r✓-4,,,,,,,n:',1�.':c .. a. �?#y,; r�•'Td`a, Iapsecf ime min nal flava depth n sorption rate > g p tl .%y''-ate 8" W'„.�'t 4, •h.k,'"`r'..„gy.^?��Sa n' fe�uvenation treatment (past 12 mo.)' l /fY` type) N If yes give date D. LIFT STATION. Date installed Size in gallons "Pump on" level at in. "Pump off' level at i Datum Cycles tested .' . E. SEPARATIONDIS`TANCES SEPARATION`DISTANCES`FROVIWELL` OI' LOTTO: Septic tank/lift station on lot >100` Absorption field on lot >100' Public sewer main NIA Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? m. On adjacent lots >1b0' On adjacent lots >100 Public sewer manhole/cleanout NIA Sewer /septic service line >25' Holding tank NIA SEPARATION DISTANCES PROI(MIMSEPflC7HOLTA-O"`'ThRON`I;07'TO: '"` Building foundation >5' Property line >5' Absorption field>5'' Water main NIA Water service line >10' Surface water >100' Wells on adjacent Tots >100' SEPARATION DISTANCE FROM ABSORPTIONFIELD; ON LOTTO Property line •>10' Building foundation ......... . Water Service tine >10' Surface water >100'' Driveway, parking//vehicie storage >25'" r, Curtain drain None Noted Welis on adjacent lots•>100 .`„ ' F. COMMENTS"�" . >10' Water main >10' G. ENGINEER'S CERTIFICATION SOFA / certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Michael E. Anderson, P.E. Date 7/26/2004 • • \MICHAEL E. ANDERSON :fit •e 1 No. CE -4381 f-ESs0+-1.� HAA Fee $ f %M, Date of Payment Rebeipf'Number "M S5 55 (Rev. 12700)' Waiver Fee $ Date of Payment Receipt Number