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Home My WebLink AboutTHOMSON LT 7Thomson Lot 7 #067-041-07 Municipality of Anchorage On -Site YVater and Waste%later Program - (907) 343-7904 Page Of ON-SITEITUASTELAM, TER INMRPECTION REPORT Permit N umber: OSPI61243 PID Number: 067-0411-07 Y rIUJ�_-UL. L_j Nt-,W !M UfJqfdUt� Name: Daniel and Barbara ® ABSORPTION FIELD ,[Address E] Deep Trench El Shallow Trench gMBed [IMound 1 1,7025 lemens Circle Eagle River, AK 99577 Eli Other _Numbero ,Phone "on a2'f7Bdrom, Soil Rating Total depth from original grade I133 GPDISF! Ftj IDepth to pipe invert. from original grade Gravel depth beneath pipe Subdivision Block Lot 0, Ft. 1 -4 3 Ft. .5 Thomson 7 iq, I 11 1 added above original grade Gravel length I Fownship Range 'section 1 1 Ft.j 38 F L Gravel width Beds: Number of Lines Distance between lines 11 N' IJI*, 1 PNft,=* Ft. I Ftj Toi Septic Total absorption area 'Number of trenches Dist. between trenches I Absorption Lift Station Holding Sew I I Tank I Fil ed I Tank L2ine t From 570 F Ft.. Well ' A ITANK EW:. Septic [21 S.T.E.P. [I Holding [I Other NA >1 00 1; NNA >25' jManufac�turer Capacity NA Asting Gala Surface Water NA >1 00' NA 1 - Lot Line 1 NA I >10' NA NIA I ILIFT STATION Foundation NA >11U 1 NA NA Manufacturer Capacity Curtain Drain None Noted Pump on level at (Pump off level at High vivater alarm rzcrrrarnarx!3uflu auz:;QrP'1I(xj UUU aria p1ping in. _qompletely_L(�rniqved from site. Contaminat�d in.1 in. I Material replaced with MOA approved sand. jPump i� ake and model Electrical Inspections performed by ATankto UERIAL House to tank Lar Installer drainfield Rm ce Martin Grainfield F81 0 rp�_7 Inspector W . Roberts BENCH MARK (Assumed elevation) 00.0 it _j Inspection 10/4/16 nd 11-ocation and description da 2 Conditional Approval:Date AW 0. A" -i 49 q__ '0 4381-E 11-23-2Q ppilroved Date )013 r tit Tnspe"On _po' Municipality of Anchorage Page 2 of 3 DEVEOPMENT SERVICES DEPARTMENT PID NO: 067-041-07 4700 South Bragaw Street Anchorage, AK 99519-6655 - 343-7904 Permit Number: OSP161243 THOMSON SUBDIVISION LOT 7 NOTE: tO Existing Septic Tank Verified Suitable for Continued Use. Old Absorption Bed and Contaminated Material Removed From Site. si 14Y 22Z S2 15.T 275 0 2CO2 17.1' 41H 2CO3 48.a 64.r ID TRACT A -3—A Existing Well CHARLICE SUB. Existing Well FCO S1 OTHI S2 2C01 Drawing not completed �qv from Surveyor As Built. Locations are not exact. Al MICHAEL E. ANDERSON No. CE -4391 LEGEND S1 — Septic Vent C3 — Clean Out M1 — Monitor Tube ` TH — Test Hole S&S TH.—S&S EnQn - � . |�Mc�e Municipality of Anchorage DEVEOPIrIENT SERVICES DEPARTMENT 4700 Bmore Road Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: OSPI61243 M Gallon Septic Tank EXISTING Page 3 of 3 PID No067-041-07 M MUM D R C-11), -1c I L E AC'::')" B LT No Scale 49th M No, CE -4381 < 2v 4v '4i�,OUFESSVT'�5'V 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: OSP161243 Tax Code Number: 06704107000 Work Type: Septic Upgrade Permit Effective Dates: September 01, 2016 to September 01, 2017 Design Engineer: ANDERSON ENGINEERING Subdivision: THOMSON Site Legal Address: THOMSON LT 7 G:0363 Owner/Address: BRANDVOLD BARBARA S & DANIEL J 7025 CLEMENS CIR EAGLE RIVER AK 995779611 Site Mailing Address: 7025 CLEMENS CIR, Eagle River This permit is for the construction of: Lot Size in Sq Ft: Total Bedrooms: ,p C 11 pal tnient 42626 Y Disposal Field N 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. Special Provisions: An additional perk test is required prior to construction. Received Issued By: Date: Date: / �� Municipality ®i Anchorage P.O. Box 196650 0 4700 Elmore Road Anchorage. Alaska 99519-6650 0 (907) 343-7904 s Fax (907) 343-7g97 Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV161105 COSA#: Permit#:OSP161243 PID#: 067-041-07 Legal Description: Thomson Lot 7 Engineer: Anderson Engineering Applicant: Daniel and Barbara Brandvold Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 20.0 feet. This waiver approval applies to the proposed 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. ® Adjacent properties are not affected by this waiver. ..............................................................................1 Waiver is Granted: X Waiver is not Granted: Date: [� Approved by: Name of Reviewer ............................................................ ................1 **** VARIANCE/WAIVER REVIEW **** MUNICIPALITY OF Community Development Department Development Services Division ct On -Site Water & Wastewater Program ANCHORAGERUSH! RUSH! ON-SITE SEWER/WELL PERMIT APPLICATIOfi a 40f-^J2y6 2015 Parcell.D. 067-041 07 Viz; Property owner(s) Daniel & Barbara Brandvold Day phone MA5-0L _ Mailing address 7025 Clemens Circle Eagle River, AK 99577 Site address Same Legal description (Sub'd., Block & Lot) Thomson, Lot 7 Legal description (Township, Range & Section) Lot Size 42,626 Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field ❑X Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms Three APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑x (w/wo ADU) Upgrade NDuplex (D) F-1Renewal F1 Multiple Dwellings ❑ (SF and/or D) 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) M�fid /5 Permit/Rush Fees: $.zi.d03c/%% Waiver Fees: Z Date of Payment: SP— ?—If _46 Date of Payment: 5 Receipt Number: O yd 0 3 G Receipt Number: C) J G Permit No. U��6/Z7�2 Waiver No. OS V Permit App_` 1�._c. ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) August 26, 2016 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99519-6650 Subject: Lot 7, Thomson Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The septic system on Lot 7, Thomson Subdivision has failed and must be replaced. We are therefore requesting a permit be issued for the reconstruction of the septic system to accommodate the three-bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the existing and proposed septic systems. The existing Septic Tank will be exposed and inspected and verified suitable for reuse. If it is found to be defective it will be replaced with a new 1,000 gallon tank. No conflicts exist between the proposed septic system and the wells and septic systems on this or adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The surface area of the lot which is available for the septic system upgrade is limited by the steep slopes in the back of the lot and the placement of the well. The only suitable place is the same location as the existing absorption bed. The existing bed will be demolished including all pipe, drainfield rock and contaminated soil. The materials will be either hauled from the site of buried on the property more than 100' from the existing wells in the area. The excavated area will then be backfilled with MOA approved coarse sand. The new absorption bed will be constructed atop the sandat the same elevation as the existing bed. &+ le/ A5,4 The test holes placed on the lot in the past and the test hole recently placed all indicated gravel with sand with some silt (GW/GM). Groundwater was found in the original test hole placed in 1990 at 8'. No groundwater was found in the recent test hole and none has developed in the past monitoring period. The subdivision has developed since the original test hole was placed and drainage improvements have been made. This may account for the lack of groundwater in the area. The percolation rate in the accepting soils was determined to be 4.8 minutes per inch. We have designed the new absorption bed with an application rate of .8 gallons per day per square foot. We are proposing to place a 38' long by 15' wide absorption bed with a .5' Lot 7, Thomson August 25, 2016 Page Two effective depth. The total depth of the bed will be the same as the existing bed. The distribution line will be 3.5' below the surface or at the same elevation as the existing bed. A minimum of 3' of cover will be placed over the absorption bed and 4' over the septic tank. The ground surface on the lot slopes to the southwest in the area of the absorption trench at a grade of 5%. A cut slope begins 20' from the edge of the bed and slopes at a 2:1 to the dry ditch below. A slope waiver is included with this permit application. The bed will be placed in the same location parallel to the contours of the ground where it has functioned well for 26 years. 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 49 �.....5. ...ry......... a .. I ♦ %�.. ................ .................. q..T• ♦♦ MICHAEL E. ANDERSON.' ♦�� '.. Dln rr-a3ni _S i THOMSON SUBDIVISION LOT 7 17,955 S.F. �I LEGEND Iml Verify Integrity of Existing Septic Tank for I o Continued Use. Remove Old Absorption Bed and Contaminated Material in its h Entirety. Replace all Contamination to 4' Mme° Below Grade. Construct new 15' Wide x B 38' Lang Absorption Bed. Al3 LOT 6 - ---------- =ry I m o ---------- 10 o Ib TRACT A -3—A CHARLICE SUB. Existing Well i '� ' ® No Conflicts with Existing Well ', Well on This Tract. \® Well is >150' from Thr1ee Bedroom Lot Line. Home i "s v ' i rco Sv CO sv zco NOTE: No Surface Water Within 100' of the Tei°`O\ i Proposed Septic System. �; ' . S 49th LEGEND ........ �........... . ...,:.. s 0 t� % LOT SV — Septic Vent ....... I...'::.`....s.............:` :a--"� CO — Clean Out MICHAEL E. ANDERSON.: R�a NO Conflicts with \ MT — Monitor Tube ♦ C 4 TH — Test Hole ♦ J :, No. CE -4381 ?tip Well on This Lot. g •��Fp z f,: «'�F�� SITE PLAN S&S TH — Tet Holeneering S44 1AYA ES`��••• SCALE 1" = 50' LOT 7, THOMSON SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS Three Bedroom Home Shallow Bed System Perc. Rate: 1-5 Min./Inch Verify Existing 1,000 Gallon Septic Tank Application Rate: .8 GPD/SF 4' Total Depth Drainfield Rock .5' Effective Depth 3 Bedrooms X150 SF/Bedroom/.8 GPD/SF(Application Rate) = 562.5 SF Absorption Area 562.5 SF/15 LF (Width) = 37.5 LF Bed Length THEREFORE: Remove the Existing Bed Including Piping and All Contaminated Soil. Backfill with Clean Coarse Sand to the 4' Level Below Existing Ground orto the Same Depth as the Existing Bed. Construct a 38' Long x 15' Wide Absorption Bed as Detailed Below. Distribution Line to be Placed at 3.5' Below the Existing Ground Surface or at the Same Depth as the Existing Bed. Place 3' of Cover Over Distribution Line. Place Topsoil and Revegetate Exposed Surfaces. Maintain 100' From Existing Well on Lot. Place Topsoil and Revegetate Exposed Surface and Slopes Natural Backfill 3.0' Geotextile Fabric 5' O O O . 5' Drainfield Rock Remove All Contaminated Soil to In Situ SP Material Below 4" PVC Replace with MOA Approved Clean Coarse Sand Limits of Contamination to be Determined in Field Underlying SP NOTE: New Absorption Bed to be Constructed at Same Depth as the Existing Bed. 2.5' 5' 5' TYPICAL BED SECTION (NO SCALE) NOTE: Grade Area Surrounding Bed to Drain Away. Minimum 6' Separation From Bedrock. i Minimum 4' Separation From Groundwater. i Minimum 100' Separation From Wells in the Area. Minimum 100' Separation From Surface Water or Streams. Minimum 10' Separation From Water Service Line. 2.5' ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 FAX August 29, 2016 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 7, Thomson Subdivision Absorption Bed to Slope Waiver Dear Onsite Services Engineer: Lot 7, Thomson Subdivision has limited area for construction of a septic system due to steep slopes to the back of the lot and the placement of the well. The only suitable area is at the location of the existing absorption bed. The edge of the bed is 20' from a ditch back slope. This back slope is approximately 2:1 extending down to a dry ditch along Clemens Circle. We are therefore applying for a waiver allowing placement of the absorption bed at its current location where it has functioned for 27 years. The existing absorption bed is in a failed state and no trace of leaking effluent has been noted on the exposed cut slope since it was constructed. The imaginary 25% slope from the edge of the bed and 2.5' above the flow line does not daylight. The soil encountered in the test holes is clean well graded sand (SM/SW) which is very good for the absorption of septic effluent. Most of the effluent absorption will be down with little or no migration of effluent to occur toward the steep slope. We hereby request the waiver be issued allowing the bed to be constructed 20' from a break in grade greater than 25%. Sincerely, Michael E. Anderson, P.E. L th „ MICHAEL E. ANDERSON NO. CE 4381 Attachment MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 1,700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-0050 DEPTH (feet) I 2 3 4 5 6 7 8 9 IV II I I SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: LOT 7, THOMSON SUBDIVISION PERFORMED FOR: ROYCE MARTIN DATE: 7/15/16 PROJECT No.: PARCEL ID#: TECHNICIAN: W. ROBERTS TEST HOLE # OB/OG d s. SILTY GRAVEL WITH SAND � a GM e e BOH SLOPE SEE SITE PLAN WAS GROUND WATER ENCOUNTERED? NO IF YES @ WHAT DEPTH? S DEPTH OF WATER AFTER MONITORING NONE O SEE SITE PLAN DATE OF MONITORING: 8/1/16 r DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DEPTH TO WATER (INCHES) NET DROP (INCHES) 7/15 TEST HOLE PRESOAKED PRIOR TO TESTING: I 10:40 .75" 2 11:10 30 7.00" 6.25" 3 11:11 88" 4 11:40 30 7.13" 6.25" 5 1:41 .75" 6 12:11 30 7.00" 6.25" PERCOLATION RATE: 4.8 (MIN/INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN: 2.0 FT. and 3.0 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. TEST PERFORMED BY VETECH ENGINEERING TECHNICAL SERVICE. I, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS nATc. 8/26/16 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES " Environmental Health Division 067 -oil -07 825 "L" Street, Anchorage, Alaska 99502, Telephone 2644720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES TO SEPTIC ABSORPTION AFROM TANK FIELD WELL • t Permit No. No. of Bedrooms WELL 1 CiL LEGAL DESCRIPTION LOT LINE Blockwbayyvo.— f FOUNDATION ansa. Ssctron AS -BUILT DIAGRAM (Snow f«aeon of wee, "Put; system, propeny ones. found, dmewaY. water Dodles etc) TANKS <SEPTIC ❑ HOLDING • . I Cap—ty m gaeons TYPE OF SYSTEM ❑ TRENCH .�ED ❑ W. DRAIN ❑ OTHER spin to pPe bottom from y Total depth Iron, apmm gra« roma grace a added above Gngma grade I Gravel depth beneath pipe --'25 FT 145 res Owancs between Imes S�osp FT ,S 501 Weng Pipe marmot ZSSO FT L Dae mnalrod q s 0 WELLS PRIVATE ❑ OTHER (Identity) p \ Tota DePtn Casso to FT REMARKS: a I e'. Inspections PeAo / d by: Date: 5— 11--1 o 17034 Eagle River Loop Road No. 204 evtlty pia Ibis inspection wu pedwired wording to all Eagle River, Alaska MuNdpal and Stae pllidelim In oiled on this doe: !Nash Department Approval: Date: 72-013 (3/95) L •--ENGINEER'S SEAL H %j - •k :a w a- ..ai•s�w..i..• s Nobert A. 3MFa• a� No. I�J7d • e§�: l '� .e• i„y 1.1 U IJ 1 L I P A L 1 T Y 0 17 A N C H O R A G E Department of Health & Human Services 825 L Street, Anchorage, Alaska 99001 343-A=*+ 11,7yy /yds/ O N- S I T E S E W E R 8< W E L L F E R M I T Permit Number: 900089 Stj-.�aL�ao89 Date ISSUed: 05/01/90 Engineer Designed Owner Name: JOANNE OOONEN Owner Address: 1101 CORDOVA ST #429 ANCHORAGE, AK 99501 Parcel Id: 067-041-07 Lot Legal: Subdivision: Section: 23 Lot Size 42626 (sq.ft Max Dedrooms: This; Permit: Day Phone: 274-0428 THOMSON Lot: 7 Dlock.: - Township: 14N Range: IW or acres) 3 Total SEPTIC TANK:: Minimum total septic tank tank must have at least 2 compartments f e.eL requires insulation over, tank(s). Capacity: 3 capacity: 1,000 gallons. -Each septic Depth to top of septic tank(s) < 4.0 WELL: Log must be. submitted to Municipality of Anchorage Department of Health and Human Services within 30 days of well completion. INSTALL PER ENGINEERS APPROVED PLANS. NOTIFY DHHS OF ANY DESIGN CHANGES NECESSARY AND PRIOR TO EACH INSPECTION. VERIFY WATER LEVELS PRIOR TO C:ONS'TRUCTION. THIS PERMIT IS ISSUED FOR THE f"LANNED 3 DORM. SINGLE FAMILY DWELLING ONLY AND EXPIRES 12/31/90 I CER (IFY THAI: I. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. 1 will install the system in accordance with all MOA codes and regulations, grid in compliance with the design criteria of this permit. a'. 1 willadhere to all MOA and State of Alaska requirements for the set back: distance=, 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 3 bedrooms. I also ernderstand thaL the capacity of the total system is 3 bedrooms and any enlargement will require an additional permit. Eigned: DATE: � -------------- -- (Owner ) JOANNE DOONEM=/J �� - _----------_-_ DALE: ' ' �te`vo:�yocn 2!Cµ1. Municipality of Anchorage •..:. DEPARTMENT OF HEALTH & HUMAN SERVICES 825 `L" Street, Anchorage, Alaska 99502-0650 Ili 6, SOILS LOG — PERCOLATION TEST Ia n% ltrs T r !� :, •orE3,la�,ti PERFORMED FOR:—DATE PERFORMED: LEGAL DESCRIPTION: �.o� 'i�-iGY'lSeti_1 Township. Range, Section: 2- 3 n� 5 o iO' 6- 7- 8- 9- 10- 11 78 9 1011 12- 13- 14- 15- 16- 17- 18- 191 213141516171819 20 COMMENTS Em ING SLOPE WAS WATER ENCOUNTERED? IF YES, AT WHAT f DEPTH) 8 Depth to Water Alter e Monitoring) � Da1C'1 •'�— e0 PLAN PERCOLATION RATE (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT 17034 Eagle River Loop Road No�,2tY✓ PERFORMED BY: —Eagle-Rivet'-Alaska-DDS77 /� Y CERTIFY THAT T IS TES WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL /� EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/65) , •i ---- -- PERCOLATION RATE (minutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT 17034 Eagle River Loop Road No�,2tY✓ PERFORMED BY: —Eagle-Rivet'-Alaska-DDS77 /� Y CERTIFY THAT T IS TES WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDEL /� EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/65) , •i � • T _ P1LJV4I C I QVIL I TY OF FA Cl+"A FRF C3 EE: , DEPARTMENTHEALTH AND ENVIRONMENTAL ¢OTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 26'4-4720 WELL F"EsKPF I T PERMIT N0. C 830483 � APPLICANT ROBERT K BOYER 1795 EAGLE RIVER, RD 99577 694-9403 LOCATION! EAGLE RIVER LEGAL . L7 THOMSON LOT SIZE 999999 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F-aFRM I T EXF} I FRES~ vECEMEBEFR 1s=lv? I CERTIFY THAT 1: I AM FAMILIAR, WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. SIGNED: APPLICANT ROBERT K BOYER ISSUED BY__ __----------DATE---- ��J V4.0 Tntifirb 43riiiing �[u- O0C Co. 00' SULLIVAN WATER WELLS P.O. BOX 670272, CHUGIAK, ALASKA 99587 • TELEPHONE 6882759 OWNER OF LAND_cus i-_13'"J'J �3pti1Cn� ADDRESS //Dl C.,RQ]JA --FP4.)cl fi,,Jcq LEGAL DESCRIPTION 431' 7 Th/O�+t PJ OBJ DATE. • Started s f J Ended / PERMIT NUMBER DEPTH OF HELL h'7 TC y''S'-'4-LITIC LEVELOF HATER FT. /S DRAW DOWN FT GALS. PER HR 30 D O KIND OF CASING KIND OF FORMATION: From Ft. toFt. CASA -j< SI fC-KJP From Ft. to FI. From �`�' Ft. to 9 Ft. Q JC Q AV w Froin -Ft. to Ft. FromFt. to a Ft. ` 5/4 c From Ft. to Ft. From Ft. to' F Ft.y �'�1 ('� _ From Ft. to Ft From —2 Ft. to -7(P Ft. � r� i From Ft. to Ft From 24 Ft. to_Ft. 1?4 UC C'L A� From Ft. to Ft. From.:�F_Ft. to_!E�Ft. CI -111' /? (�,eAJS �_ From Ft. to Ft. From eF` I rf1"��% ( �Qfi AcG r From Ft. to Ft. �_Ft. to I Ft. MISCL. INFORMATION: MAY 304990 RECEIVED DRILLER'S NAME ��` C From Ft. to Ft. _ From Ft. to Ft. From Ft. to Ft. From Ft. Io Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. toMWCIPAEnY_OFJINCHORAGe DEPT. OF HEALTH d From Ft. to Ft. From Ft. toENVlkONFAENTAL4RORC_rjOP) MISCL. INFORMATION: MAY 304990 RECEIVED DRILLER'S NAME Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parceli.D. 067-041-07 COSA# OSC!"a13R�i Expiration Date: 1. GENERAL INFORMATION Complete legal description THOMSON LOT 7 Location (site address) 7025 CLEMONS CIRCLE, EAGLE RIVER, AK 99577 Current Property owner(s) ARTHUR & TRINNETTE KOENIG Day phone Mailing address 7025 CLEMONS CIRCLE, EAGLE RIVER, AK 99577 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: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 ARCTERRA CONSULTING, INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Name KENNETH M. DUFFUS Date 08/28/2012 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIG ATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: IJVJH %.A1UUK]1bL n Hrsenic Havisory Septic System Advisory Maintenance Agreements Well Flow Advisory Supplemental Engineer's Report Nitrate Advisory Other By: / Original Certificate Date: (Rev.,,,�5)/ Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: THOMSON LOT 7 Parcel ID: 067-041-07 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Date completed 5/1990 Sanitary seal (Y/N) Y Total depth 101 ft. Cased to 101 ft. FROM WELL LOG Date of test 5/1990 Static water level 25 ft. Well production So 9 - p.m -WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 12+ in. AT INSPECTION 8h6/2012 ft. 7.75 g.p.m. Coliform NEG colonies/100mL Nitrate 0.471 mg/L Arsenic: ND mg/I Date of sample: 8/16/12 Collected by: ArcTerra B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5111L199 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 71712 Pumper JR's C. ABSORPTION FIELD DATA Date installed 5 1 990 Soil rating (g.p.d./ft2 or ftz/bdrm) 125 System type Bed Length 38 ft. Width 15 ft. Gravel below pipe 0.5 ft. Total depth 5 ft. (Measured 8/17/12) Eff. absorption area 570 ft Monitoring tube Y Depression over field N Date of adequacy test 8/17/2012 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth 3 in. Elapsed Time: 85 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at _in. High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 100'+ Public sewer main 751+ Sewer /septic service line 251+ Animal containment areas '50'+ On adjacent lots On adjacent lots Public sewer manhole/cleanout 1001+ Holding tank 1001+ Manure/animal excrete storage areas lo0r+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 51+ Property line 51+ Absorption field 51+ Water main 101+ Water service line 101+ Surface water 1001+ Wells on adjacent lots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main Water Service line 101+ Surface water 1001+ Driveway, parking/vehicle storage 101+ Curtain drain 50'+ (None Known) Wells on adjacent lots 1o0'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETHM. DUFFUS Date COSA Fee $490.00 I Date of Payment? aal la C Receipt Number 005N (Rev. 11 /05) Waiver Fee $ Date of Payment Receipt Number �v Municipality of Anchora • -�1 Development Services Depa 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 ge rtment 1 �G-iSSµanc� CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FO-rR/ A SINGLE FAMILY DWELLING ,t Parcel I.D.062 -041- 64 COSA# t �1�(, 6Q-I/� 5 1. GENERAL INFORMATION Expiration Date: / - 1 - 01 Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address THOMSON LOT 7 7025 CLEMONS CIRCLE, EAGLE RNER AK SHANNON WANGEN Day phone 7025 CLEMONS CIRCLE EAGLE RIVER AK, 99577 Day phone ED ERICKSON W/ PRUDENTIAL JACK WHITE Day phone 227-5275 16635 CENTERFIELD DRIVE EAGLE RIVER AK, 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 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 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 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 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. Phone Address 3701 E. TUDOR ROAD, SUITE 101 . ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the 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 test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA 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 fight whatsoever. 5. DSD SIGNATURE / Approved for bedrooms. Disapproved. 337-6179 Date Z 8 Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory y Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By:// // (�. Original Certificate Date: (RM. 111, 11105')//' VYr1J I LMAI CR PROGRAM Municipality of Anchorage Development Services Department Building Safety Division s 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: THOMSON LOT 7 Parcel 0:067-071- 07 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 5/1990 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 101 ft. Cased to 100.58 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 5/1990 4/8/2008 Static water level 25 ft. 37 ft. Well production 50 -9 -P.M. 7.5 -9 -P.M. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 1.05 mg./L. Other bacteria 0 colonies/100 ml. Arsenic: ND ug./L. „Date of sample: 9/15/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 5/11/1990 Tank size' 1000 gal. Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (YIN) NO High water alarm (Y/N) N/A Date of pumping 4/8/2008 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GRAM Date installed 5/11/1990 Soil rating (g.p.d./Wo /ted 125 System type BED Length 38 ft. Width t5 ft. Gravel below pipe 0.5 ft. Total depth •4 ft. Eff. absorption area 570 ft' Monitoring tube YES Depression over field NO Date of adequacy lest 4/8/2008 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY in. Water added 757 gal New depth 7 in. Elapsed Time: 540 min. Final fluid depth DRY in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump off' level High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 50+ Property line 50+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway. parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field Inspections and review of Municipal records that the above systems are In conformance with MOA COSA guidelines In effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date �112C, 09 COSA Fee S Waiver Fee $ Date of Payment Receipt Number (Rev. 11105) Date of Payment Receipt Number Municipality of Anchorage • Development Services Department / Building Safety Division On -Site Water S Wastewater Program 4700 Bragaw Street P.O. Box 196650 pp Anchorage, AK 99519-6650 / (jfG� �,b 1zW www.muni.org/onsite / (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. U p fl - Dy i - Dq COSA# � 1. GENERAL INFORMATION Expiration Date: 7 J-7- (J R — I Complete legal description THOMSON LOT 7 Location (site address) 7025 CLEMONS CIRCLE, EAGLE RIVER AK Current Property owner(s) SHANNON WANGEN Day phone Mailing address 7025 CLEMONS CIRCLE, EAGLE RIVER AK, 99577 Lending agency Day phone Mailing address Real Estate Agent ED ERICKSON W/ PRUDENTIAL JACK WHITE Day phone 227-5275 Mailing address 16635 CENTERFIELD DRIVE EAGLE RIVER AK 99577 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well n Individual On-site E Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of 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 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 Onsite Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 ' ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. 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 test, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outsido the control of the evaluator of tho system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA 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 Approved for bedrooms. Disapproved. Phone 337-6179 Date �` 1/5 /08 f � Conditional approval for bedrooms, with the fllowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory t./ Arsenic Advisory Maintenance Agreements Supplemental Engineer's Reort Other �ess o °tlllfftryr/r/ \SY OFgN/ii�� K Qp ••....• cy o ON-SITE WATER AND = m" WASTEWATER PROGRAM - --� '�TTT1I1 By: ��—(�1 Original Certificate Date: 4—/ 7— In 0 (R".11105) I 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: THOMSON LOT 7 Parcel ID:0 G 7-01/1- 07 A. WELL DATA Well type PWATE If A. B, or C provide PWSID# N/A Date completed 5/1990 Sanitary seal (YIN) YES Total depth 101 ft. Cased to 100.58 ft, FROM WELL LOG Well Log (YIN) YES Wires properly protected (YIN) YES Casing height (above ground) 12+ in. AT INSPECTION Date of test 5/1990 4/8/2008 Static water level 25 (t. 37 ft Well production 50 g,p,m, 7.5 —9 -P.M. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate l .33 mg./L. Other bacteria_colonies/100 mi. Arsenic. �O g./L, Date of sample: 4/8/2008 Collected by: GEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 5/11/1990 Tank size 1000 gal. Number of Compartments 3 Cleanouts (YIN) YES Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) N/A Date of pumping 4/8/2008 Pumper JR'S PUMPING C. ABSORPTION FIELD DATA taeiow ExisnNc caAo� Date installed 5/11 /19901 Soil rating (g.p.d./ft'o t /bdr 125 System type BED Length 38 ft. Width 15 ft. Gravel below pipe 0.5 g, Total depth _oft. Eff. absorption area 570 ' Monitoring tube YES Depression over field NO ft Date of adequacy test 4/8/2008 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test DRY In, Water added 757 gal. New depth 7 in. Elapsed Time: 540 min. Final fluid depth DRY in. Absorption rate >= 450+ P g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) NONE KNOWN If yes, give date — D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on" level at In. "Pump off" level I I High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ ' Public sewer main N/A On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 50+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this 0 date. J r y ess- Engineer's Printed Name JEFFREY A. GARNESS CE -795 08 45:1 Date �oreaa}o� a COSA Fee S 412, v • U U Date of Payment—� /6/ (32? Receipt Number 17084-3 (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number ��f/gi✓iE �ONCh�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 ••aea •4rre Y t i s• ar♦ CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D._ati'/ o7 HAA# 05pl7�� Expiration Date: in 1. GENERAL INFORMATION Complete legal description 7-w v" _"'PA l -,e r - Location (site address or directions) e.2 I- EH6C1S Cif, Current Property owner(s) G1,��. v c L�wrnsLcvi k/..,xav Day phone G9a - 3519 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 77D1' .'i' /•LlNN__�J .,4r. Fermi! .yrs -t A.0 99.Ti� a Day phone 'F'e-0mA's Day phone l9y- yreD Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Individual On-site 0 ❑ 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 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. 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 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 Z;r,3- e .L?'• ireX55 Phone Address i/F•J Arai Engineer's Printed Name 7 Aolmp S. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the follo) Date 3 16 1 &5— ON-SITE • c+ Additional Comments�cpig�m WASTEWATER is! Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By. �.,/ /! Original Certificate Date: (Rev. 01102) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196850 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L dsySe eJ Ar- P�-" Parcel ID: 4V6 7 ®y/ e ?I A. WELL DATA Well type Date completed —[90 Total depth /is:Lft. Date of test ' Static water Level Well production If A, B, or C provide PWSID # _ Well Log6N) 1/" . Sanitary seal 45%) Wires properly protected *I)yrs Cased to .Ms's' ft. FROM WELL LOG .ff�o S© g.p.m. WATER SAMPLE RESULTS: Coliform _—oolonies/100 ml. Arsenic: mg./I. B. �G TANK DATA Tank TYP154a e -11 Nitrate p /O mg./I. Date of sample: ,(2 /Q2./Oy Casing height (above ground) _g?Lin. AT INSPECTION 9/3 /40 -Y' l.. / f 9— p.m- Other bacteria_( /� 001onies/10g0 ml. Collected by: b Yig& ..I IV Date installed jr-- // -7D Tank size /es y gal. Number of Compartments Z Cleanoutse�ft) V&a Foundation cleanouttl) -,VRy Depression over tank (Yd),M0 High water alarm (Yo .v/q Date of pumping IO Pumper TR'3 'Pa'y^vO C. ABSORPTION FIELD DATA Date installed -i/- O Soil rating System type :g ed Length 3 $ ft. Width rs— ft. "AF below pipe O.T ft. Total depth 4' Y ft. Eff. absorption area T+so fe Monitoring tube � �Depression over field .v v Date of adequacy test om/ D /i r Results4ajMVFail) P.r as For 3 bedrooms Fluid depth in absorption field before test ef in. Water added�'�0 gal. New depth.! 3 in. Elapsed Time: -YA min. Final fluid depth —A in. Absorption rate >= yrro g.p.d. Any rejuvenation treatment (past 12 mo.) (Y&U type) AAOR/„f If yes, give date ��A D. LIFT STATION Date installed 'Pump on' level at _in. Datum E. SEPARATION DISTANCES Size in gallons G 'Pump o at _ in. Cycles tested MIn—hole/Access (Y/N) _ High water alarm level at Meets alar & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankilift station on lot //s' ' On adjacent lots t /vat, Absorption field on lot /m 9 ' On adjacent lots r/04 ' Public sewer main t ;#s' Public sewer manhole/cleanout lir Sewer /septic service line t A6-1 Holding tank t /od ' SEPARATION DISTANCES FROM TANK ON LOT TO: Building foundation // Property line '%i , Absorption field 17 - Water xWater main t i0' Water service line t i oSurface water tido' Wells on adjacent lots t .100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line al -I Building foundation oT ' Water main 4 io ' Water Service line ;.-o' Surface water Driveway, parkinplvehide storage' Curtain drain t" . Wells on adjacent lots tyd-An' ,V06W A&VO& i F. COMMENTS G. ENGINEER'S CERTIFICATION `?r I certify that I 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. ? CHWTOPH R R Engineer's Printed Name �.e/.sr ,JV",e .�P, l4AO , Date 3/01 4!6— HAA /D14o6— HAA Fee $ A/W /• OD Date of PaymentO Receipt Number (pyay-"0 (Rev. 12101) 'rl''f Waiver Fee $ _ Date of Payment Receipt Number in. _U) im R4: i� W pt n v I -w CSV • G" Fi�i+l N Co. r � PJ•• • �J%`. MENS CSR B? ow , , , , , , a , � U � j AA1jI , ,77rr A , , , , , , , , , , , , 1 , , , , , , , , , , , V p/ � ' '�j app � � P• •P• v 7 w i N - O Ll g onao p' o q � , • �,a" P Ai� �O I •p fit O if 4 • it + A� ]O _ 4 K o . C ; S•_ /-ate ��,ri 1ppUpUp 4 Rth LU o N MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICE$ ` Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage; Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # HAA # -ice 9 �Olo tl�l 1. GENERAL INFORMATION Complete legal description Gcr > T en iro cJ .S..so.ds.o �J Location (site address or directions) _L 7 Lear. so.v r �.eccr /i-� -Z-- Property owner ewer 0,e J. b Day phone Eft — Ho49 Mailing address- Ale- 8.4' - i%rf,2 Lending agency Day phone Mailing address Agent Day phone Address --- � Unless otherwise requested, HAA will be held for pickup. 2.1 NUMBER OF BEDROOMS -� 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water _. -... ... • NOTE: If community well system, provide written confirmation from State ADEC Ing to the legality and status of system attest - -77 4 -TYPE OF WASTEWATER DISPOSAL %7., Individual on site 't T 1 Holding tank r �; `I -; t Community on-site . - � :. � r .;b � �:, 'illy •• � � \'� Public sewer.-!. NOTE • , If community wastewater system; provide written confirmation fro State ADEC, attesting to the legalityand status of system -e; m - _ . '_'.y 71-073(WvAN1) hart MOA Ill 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that my ?' investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone Tfb - (02 �3 Name of Firm _ Address Date Engineer's signature OF A/e�l�� Uti CE 8176 i a_ 6. DHHS SIGNATURE \\\�a��• Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments ,d.........•.4. -a 9d - Date c't'The AiluniCipality of��cthorage Department of Health and Human Services (DHHS) issues Health Authority - r'�p royal �eNtieafes.based only upon the representations given in paragraph'5 above by an Independent ,''prd(epsiorjal engineer registered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes . grid their ending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not :conduct.1 -.I ... tions or analyze data before a certificate Is Issued.`The'Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. t ':riga M.,. w�j bock wwm Municipality of Anchorage „rll�1, Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Parcel I.D. A. Well Data Well type If A. B. or C, attach ADEC letter. ADEC water system number 'J�A Log present (Y/N) Y Date completed -f� ✓ "?3;F49 Driller Total depth 0 7 � Cased to /oc Casing height .Z Sanitary seal (YM) i Wires properly protected (Y/N) i Date of test FROM WELL LOG AT INSPECTION A/ -4Y 0,990 Static water level • z SrFf Well flow SO — 9 -p.m -Pump levell 1J1A SEPARATION DISTANCES FROM WELL TO: .fled /9 �99� �,LFr rn z o .�G .S g.p.m. !•nr7 ro C Septiclhotding tank on lot "09 1� Fi ; On adjacent lots Absorption field on lot / 0 t e ; On adjacent lots rn C � o < S' H G /es0 Public sewer main 'UZq Public sewer manhole/cleanout Nl.9 Sewer service line Bo',Fi Petroleum tank 'JI.W WATER SAMPLE RESULTS: Coliform 29' Nitrate `�' 9 9 `�4�� Other bacteria G Date of sample: %lOrJ /E / foy Collected by: w B. SEPTIC/HOLDING TANK DATA Date installed Ma � ii, /940 Tank size /p 0O �'°� Compartments Z' Cleanouts (YM) Foundation cleanout (YM) Y Depression (Y/N) ti High water alarm (YIN) '�/A Alarm tested (YM) Date of pumping 9 t 9 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /0f * Fi On adjacent lots i00 +�/ Foundation To property line S6 • s<< Absorption field /Ai i Water maiNservice line y0 �Ff Surface water/drainage _ _ _ '�/19 72-M MA'F m CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) 'Pump on" level at High water alarm level Meets MOA electrical codes (YIN) P1.4 SEPARATION DISTA M LIFT STATION TO: 'Pump n lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed '440 y / / /990 Soil rating (GPD/Ft) /1.0— System type Bio Length -IBFi Width /SF}. Gravel thickness �z Total depth Total absorption area S7o A/ 't Cleanout present (Y/N) Y Depression over field (Y/N) ti Date of adequacy test ''�Ot! /e / P!W Results (pass/tail) .oArs for Bedrooms Water level in absorption field before test / ��/ After test Z i Peroxide treatment (past 12 months) (Y/N) If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / 0 2 V. Al On adjacent lots /ooI AV Property line Ao-- To building foundation -L I? To existing or abandoned system on lot Al) On adjacent lots /0O FA Cutbank yo « Water main/service line Surface water 'J1%1 Driveway, parking/vehicle storage area Curtain drain A-1' 4 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of Oils inspection. Signature \ (C II Engineers Nam ) x T r �I r.. . r-�'t` � Date It 2i �f�l J� HAA Fee $ r/n% Douglas T. Kenley Civil Engineer State of Alaska C.E. 8176 HUSTON.XLS SEPTIC SYSTEM ADEQUACY TEST Legal Description Les 7 7un.itonJ �✓s Applicant 4"0-,r ar ✓, A<o ✓r.�7 Date of Test itlo.� �B iy9� SYSTEM DATA Tank Volume /000 pg� Number of Bedrooms Absorption system sr� Number -of 8e eerfls /viGA lo..,J.0 Ao sr Absorption required (1.5 ely.vow) TIME FLOW .. TEST DATA VOL.COMMENTS .. MEMO ��crnri�trt��e►p��rm��i■�s 97'"M WMA System Passed ✓ Sysytem Failed Comments Fj V, Page 1 ON uJ6it. ,Sfoii�v �.fsrss� ,�6eo✓aty .Ps.4v/,u�.s Fi.✓.�NLO �d�T