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HomeMy WebLinkAboutMOUNTAIN SHADOWS BLK 1 LT 9Onsite File Mountain Shadows Block 1 Lot 9 #017-401-09 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: _______________ Date of Issue: ____-____-____ Parcel Identification Number: ____-____-____ Legal Description Block Lot Property Owner Name & Address: Pump Installation Date: _____-_____-_____ Pump Intake Depth Below Top of Well Casing: __________ feet Pump Manufacturer’s Name: ___________________________ Pump Model: _____________________________________ Pump Size: ____________hp Pitless Adapter Burial Depth: _________ feet Pitless Adapter Manufacturer’s Name: _________________________ Pitless Adapter Installer: ____________________________ Well Disinfected Upon Completion? XX Yes No Method of Disinfection: _____________________________ Comments: Pump Installer Name: __________________________________ Company: ___________________________________________ Mailing Address: ______________________________________ City: ___________________ State: __________Zip: _________ Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221088 PID Number: 017-401-09 Dwelling: ■❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑1 Upgrade Name TOM REALE ABSORPTION FIELD NORTH/SOUTH ❑ Deep Trench ❑M Wide Trench ❑ Bed ❑ Mound Site Address 12931 MICHAEL ROAD *ANCHORAGE, AK ❑ Other Phone Number of Bedrooms Soil Rating JTotal depth from original grade 907-223-3965 3 1.2 GPD/SF 7.18 & 7.33 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 4.03 & 4.02 Ft. Subdivision Block Lot MOUNTAIN SHADOWS; BLOCK 1, LOT 9 Fill added above original grade SEE DWG. Ft. Gravel length 35 & 35 Ft. Township Range Section N/A Gravel width 5 & 5 Ft. Beds: Number of Lines - Distance between lines - Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches _ _ From Tank Field Tank Line 700 _ Ft2.2.. - 8'+ Ft. Well 100,+ 100,+25�+ J TANK XSeptic [IS.T.E.P. El Holding [I Other Manufacturer Capacity GREER TANK 1500 Gal. Surface Water 100'+ 100,+ Material Number of compartments Lot Line 110,+_10,+ NA HDPE 2 Foundation 110,+ 10,+ LIFT STATION Manufacturer Capacity Remarks Gal. Electrical installed by Alarm location PIPE MATERIAL House to tank D3034 Tankto D3034 Installer A+ HOME SERVICES Drainfield D3034 CO/MTD3034 Inspector GEG AND MOA BENCH MARK (Assumed elevation) 100.00 ft Inspectiones: 15` 4/25/22 4/26/22 Location and description 2nd 3'd 4/26/22 41h 4/26/22 BOTTOM OF TRIM AT SOUTH CORNER OF HOUSE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Stamp �o6oOp Conditional Approval: Date OF 4 .......•_.. ....... ••......... Septic S stem ..... a 0 fey . Car rre� s:' t-1-/ Approve , Date 5 �/D ' CE -53 4� �P /- -a I - Note: this approval does not include well permit requirements. aneccea4�D000oo���o (Rev 05/02/18) 0 PERMIT NUMBER: OSP221088 TOP OF TANK AT INTLET = 91.77 INVERT OF BUNG AT INLET = 91.1 ORIGINAL GRADE AT HIGHEST POINT = 93.60, GEG 2022 T.H. NORTH. TOP OF MH = 98.11 i— FINAL GRADE = 97.02-97.52 MH NEW 1500 GALLON H.D.P.E. GREER SEPTIC TANK RATED FOR 10' BURIAL FINAL GRADE = 94.35-95.18 FILTER FABRIC ORIGINAL GRADE AT HIGHEST POINT = 92.60 TOP OF TANK AT OUTLET = 91.75 PARCEL ID NUMBER: 017-401-09 INVERT OF BUNG AT OUTLET = 90.89 SOUTH FINAL GRADE = 93.43-93.93 GEG 2022 T.H. QF of U .. 4 ....... ....... d4i .. ..... 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, AK 99507 -PHONE (907) 337-6179' FAX (907) 338.3246' WEBSITE. www.gamessenginee6ng.com •S ••• ...............•,•• S .... ... ..y..•o PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ®(� : J rey Aar SS r TOM REALE 907-223-3965 3 OF 3 ®� J,' ;.. C 795 •' _"A PROJECT/LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN SHADOWS; BLOCK 1, LOT 9 D.J.G........."''�••�, o® TYPE OF WORK: DATE: A � SEPTIC SYSTEM PROFILE RECORD DRAWING 4/28/22 #ECC894 PERMIT OSP221088 RECORD DRAWING PARCEL ID NUMBER: 017-401-09 IN / \ WELL RADII AND LOT LINES WERE \PROFESSIONALLY SURVEYED \ PRIOR TO CONSTRUCTION �01�5 1p0 V`1E1'� I \ I SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO 5910 LASER DISTANCE METER. SWING -TIES TO - HOUSE CORNERS WERE GENERATEp I(y AUTOCAD. I \y 'L 0 Q 0 w d U wo- EXISTING r HOUSE A .• c�tJ A�` � - \ NEW DRAINFIEI (UNDEVELOPED) DBL1&2--\ I I I'D NG FCO / NEW 1500 GALLON / HDPE GREER TANK JMH1 ASSUMED LOCATION OF OLD ST1 DRAINFIELD LEFT IN PLACE \ 1 FOR FUTURE USE EAST 130TH AVENUE - - - - - - - - - - - - - - - - - N SCALE: _ ENGINEERING,,SALES�CONSULTING 3701E TUDOR ROAD, SUITE 101 'ANCHORAGE, AK 99507 -PHONE (907) 337.6179 -FAX (907) 336-3246 - WE8SITE mra gone—lo .,6.g.-. PREPARED FOR PHONE NUMBER: PAGE NUMBER. TOM REALE 907-223-3965 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: MOUNTAIN SHADOWS; BLOCK 1, LOT 9 D.J.G. TYPE OF WORK: DATE: ,._ SEPTIC SYSTEM RECORD DRAWINGS 4/29/2022 At 49 0 0♦ .e. t2 .............•..... Je f AGarness w ._r • E 93 � o '2','.7�c�®moi p..� LICENSEa ��®� #AECC884 1, URN ESS ENGINEERING GROIJP, Ltd roCe l` :..< •fi <.::.; ENGINEERING, SALES v CONSULTING _ r a v.atsst:a :rrtie::rr�oeAt April 28, 2022 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Mountain Shadows; Block 1, Lot 9 - Lot line waiver for 1983 drainfield to south lot line To whom it may concern: Per the survey provided to use by Shane Holt, PLS, the 1983 drainfield is approximately 5 feet form the south lot line. We are requesting that your department issue a variance for drainfield to lot line down to 5 f t.„ ustificaLions for granting this waiver is as follows: • This enchroachement has existing for the life of the system (approximately 39 years) • The drainfield is adjacent to East 130th Avenue and does not prevent the development of an adjacent lot. • The drainfield does not encroach upon an adjacent well. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for' your assistance. .E., M.S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Website: www.garnessengineering.com Municipality of Anchorage S l n Ucparnnenr P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver-#: OSV221026 PID#: 017-401-09 Permit#: OSP221088 Legal Description: Mountain Shadows Block 1 Lot 9 Engineer: GEG Applicant: Tom Reale Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the lot line has been approved. The approved separation distance is 5 feet. This waiver approval applies to the Existing 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. ...................................... 0 0 W R K K 0 N E ..... 0 0.. 0 E .................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: " 2 d'L2 Approved b _ CI V eco Name of ReviewerG�"� ............................................................................. **** VARIAN C E/WAIVER REVIEW **** EAST130TH A VENUE_ �9.; 49 TH* u o N� SHANE A. HOLT G 1p P LS -6914 v 4 �n�°fessional \"o'er' THE iNFORNAT ION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND 1$ NOT TO BE USED FDR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FEN ELI NES. EASEMENTS OF REC ORD,OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT ARE NOT SHOWN HEREON( AN INDICATED) NOTE: FENC`ELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTYLINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. THE SURVEYDATA ON T1115 DRAVIING IS PREPARED FOR THE OWNER OFRECORD ONLY. ANYCOPYING, OR UAL/ZING THE DATA HEREON IiPROHIBITED UNDER COPYRI6NT LAW AS-BU/LT SURVEY 7 " = 30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 9 BLOCK] I111OUN LAIN SHADOWS SUB ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS 57 DAY OF ANY , 2022 NCLT_AND SURi_YVG 9309GROVFR DR MF AVCHO.:AGE.AK 9)507 ^d-8615 MUNICIPALITY OF ANCHORAGE ocnt On -Site Water & Wastewater Program 0 PO Box 196650 4700 Elmore Road M Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://Www.muni.org/onsite '*CHO K 0, Dej)at-tment On -Site Wastewater Disposal System Permit Permit Number: OSP221088 Effective Date: 4/21/2022 Work Type: Septic Upgrade Expiration Date: 4/21/2023 Tax Code Number: 01740109000 Site Legal Address: MOUNTAIN SHADOWS BLK 1 LT 9 G:2841 Site Mailing Address: 12931 MICHAEL RD, Anchorage Owner: REALE THOMAS G & ELAINE 0 Lot Size in Sq Ft: 27081 Design Engineer: GARNESS ENGINEERING GROUP LTD Total Bedrooms: 3 This permit is for the construction of: Disposal Field 0 Septic Tank 01-1olding Tank 0 Privy El Private Well 11 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code -requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Date: )-// I a 2 Date: 4/42 1L'202� MUMCIPALITY OF ANCHORAGE ,rte Development Services Department Phone. 907-343-7904 On -Site Water 4 Wastewater Section Fax: 907-343-7997 ON-SITE SEPTICIWELL PERMIT APPLICATION Parcel I.D. 017-401-09 Property owner(s) TOM REALE Day phone 907-345-6980 Mailing address 12931 MICHAEL ROAD *ANCHORAGE, AK 99516 Site address 12931 MICHAEL ROAD *ANCHORAGE, AK 99516 Legal description (Sub'd., Block & Lot) MOUNTAIN SHADOWS; BLOCK 1, LOT 9 Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field E] Initial ❑ Single Family (SF) 0 Septic Tank Q Upgrade 0 (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D) El Privy El Multiple Multiple Dwellings ❑ and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: ,#)5 is Waiver Fees: Date of Payment: y a a a Date of Payment: Receipt Number: 9 G Receipt Number: Permit No. 056OZZ 10 5g Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient FormsTermit Application.doc HE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221088, Rebecca Carroll, 04/21/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221088, Rebecca Carroll, 04/21/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221088, Rebecca Carroll, 04/21/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221088, Rebecca Carroll, 04/21/22 EAST 130TH AVENUE �Q.�OF At ° SHANE A. HOLT G LS -6914 ,` d /( T,,-. /Vi? 4PPFAli ON it-r'lS L 0 ON T; IL PE(<ORD PLA i AS -BUIL T SURVEY f " = .30' ©4 NO CORNERS SET THIS DATE QrO�essional X,ao %QO1oo:11 I HEREBY CERTIFY THAT I HAVE ORPIED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOTS BLOCK] MOUIVTAliV,5H,'IDOWSSUB. THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/aR EASEMENTS; AND Is VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN NOT TO BE USED FOR POSITIONING AQDITIONAL STRucTUREs, IMPROVEMENTS, OR FENCELINES. THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EASEMENTS OF RECORD, OR ANY LEGAL ENTITY, OTHER THAN THOSE APPEARING ON THE RECORD PLAT EXIST OTHER THAN NOTED. ARE NT SHOWN HEREON( UNLESS INDICATED) DATED AT ANCHORAGE,ALASKA THIS 9 rH DAY OF NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE 4IAA' H , 2022 PROPERTY LINES 0R PO SIT i ON ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. OL A 9L , ✓'.'vC TNf SUFVEY L!S FA GN THIRD 'VANG;s PR AR'0 FOR 7NF Ov'JNFK R CFRO,4U ONC Y. 7 fJ �bFi f I,: AnFCGPr5IJ 0PR ITT(TZ/VCTHE047A1ir/JlSPRGY/EITEOUIJDERC-CPlR,6NTIAWFAVF, fiK1i`Ui MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI LING ADDRESS ~-E GA L DESCRIPTION Lei c/ lY/o , I /"If, LOCATION FO,,/ DISTANCE TO: / /~' Z I Manufacturer A /~1 -- .... I' / 2~0 I Iv m~,wEMADE'. ~ ~ IWell .~Z DISTANCE TO: oz~ i ~E--~ I Manufacturer DISTANCE TO: We"I4;' No. of lines3 Lengt, of each line.~ , Top of tile to finish grade ' Length T~-e~oo f crib DISTANCE TO: Absorption area /0 Dwelling ~,~_ ,, Mataria'57etd / Inside length ~ Wdt~ ,~ Dwelling Foundation ~-..~ / Total length of/l~,~s, Material beneath tile IMateria] Nearest lot line /~..~ · Trench width I~'~ 40' inches NO. OF BEDROOMS3 No. of compartments 2 Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO./, . Distance between lines Total effective absorption area Width Depth PERMIT NO. Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot Iioe Depth Driller Distance to lot line PERMIT NO. Building foundation Sewer line Septic tank Absorption area(s) OTHER SOIL TEST RATING 15'o INSTALLER REMARKS APPROVED DATE LEGAL ........ 72-013 (Rev, Department: Permit ~ Cdp Applicant MUNICIPALITY OF ANCHORAGE /"': f Health and Environmenta Protection 825 m Street, Anchorage, AK. 99501 264-4720 * * * HANDWRITTEN PERMIT * * * WELL AND~ON-SITE SEWER PERMIT I/~/~'-/c"~ Mailing Address, /~4 / /'~/~,J,// /¢~4 ~-/ ~¢~,f Location: /¢d¢¢/~/~.~. ~..~¢3.¢ .~ / ~T-?_ Phone Number: ,~3'/~ ¢~¢ Legal Description:-~¢~2 .~/~ -~ .~ ~ Lot Size: ~ / ~ Type of Soil ~sorption System Is: ~y~/ ~/~-~ ~,~ Trench: Drainfield: Seepage Bed: /'Holding Tank Maximum Number of Bedrooms: ~ Soil ~ating(sq.ft/br) ~ '57 DEPTH The Required Size of the Soil Absorption System Is: LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(~$ TANK SIZE = ld¢ ¢ GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. 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 this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 m * * * 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 codes. (3) I understand that the on-site sewer system may require enlar/~?ment if the residence is r~modeled to include more that/~,bedroom~~ S igne~/~,~ ~/~~~ Issued by: ~.~3~/~~- ~ ~ Date: ~,,, z ~,' ,~ SWP/024(1/81) ALASKA ENVIRONMENTAL CONTROL SERVIC[ INC. 1220 West 25th Avenue Suite B ANCHORAGE, ALASKA 99503 276-1361 279.2917 JOB SHEET NO. CALCULATED BY CHECKED BY SCALE Of DATE_ DATE Z' ALASKA BllUIROnmelqTAL COF1TI OL SE!I L]IC S, 1IGC. ~nqir, eerinq 8 I~nuironmcnlul %tudics May 2, 1983 Paul Palmer 41i E 36th Avenue Anchorage, Alaska 99503 Dear Mr. Palmer: Mountain Shadows Subdivision Lot 9, 10, 11. All 3 lot's did not percolate at an intermediate depth which would be required for a septic system of a trench design. Test holes were redone with a post hole digger 1 foot below the OL layer on Lot's 9, 10, and 11. The percolation tests were done at these depths because original test holes showed increasing tightness of silt and gravel with depth, and did not perc. These lots can accept a septic system but it must be of a shallow surface design (mound system.) This letter and drawing are rough draft of a conventional trench system and that of a mound system on each lot. They are not the final engineered design but a draft to use for cost estimates of mound versus trench. Sincer?ly, ~/~f~ . ' Pete S~pala Civil Engineer 1200 [Ucst 33rd Auenue. Suile B · Anchorc~%e. Alosko 9~.~03 · [007) 276 t361 ALASKA PERCOLATION TEST DATA SHEET ADDRESS ZIP CODE TOTAL DEPTH OF HOLE ff. ZONE TESTED ~ ft TO ~ '/?_ ft READING # CLOCK TIME NET TIME DEPTH TO NET DROP ~RATE (min/in) DATUM i5': O~ ......................... / O /O / ~dS'- lO? I. of 1.1,95~ I. O~$- .. /. o¢5~ lDO , ,oq FINAL PERCOLATION RATE __.(min/in) 1200 U},'st 33,'d Au¢.quL Sm,P,#* A.chorog¢. AIQsb 99503 ~' (907) 276-1361 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTFCTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O SLOPE SITE PLAN t IF YES, AT WHAT .-I DEPTH? ,/7 Gross Net Depth to Net Reading Date Time Time Water Drop , ,.~. /~. (..¢ . . /',. ~' lc /~ . M,,~ ,'(, ~>~ , ~// 72-008 (6/79) · e t~(~ //' (.7.~' PERCOLATION RATE / / /'''~ ~, 4_~t/!· ,'(mlnutes'/i~o~) ' :" ~X AND ~ FT TEST RUN~EEN · ..,. //__~' ( ~-~-: /. CERTIFIED BY: DATE: - - rvI-W DRILLING, Inc. P.O. Box 10-378 ,, 10300 Old Seward Highway (907) 349-8535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner ?:?/?~i :.,?)LFI UseofWe]l Location (address of: Township, Range, Section, if known; or distance main road ,~ ~1~.~ ;~ :-'; Size of casing 6~ Depth of Hole Static water level 23 ft. (~l]~/,'~ Screen ( ); Perforated ( 3fl6 feet Cased to 20~ feet (below) land surface. Finish of well (check one) open end ( ~,×v~ ); ). Describe screen or perforation Well pumping test at. ~,~ gallons per of drawdown from static level. Date of completion ..L.d.y Z0, (minute) for ] hours with ] fi0.; ,_ft. WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness ,, ~: TO C;o. sin,.% st:Lc]cfm TO 15 TO 't .o I~-0 TO 366 TO TO TO TO TO TO TO TO ___TO ___TO __TO '2raV be,,:h 'gch. 814 3--CONTRACTOR Municipality of Anchorage On -Site Water and Wastewater Program J (907) 343-7904 G 5 ; F E , "Y Certificate of On -Site Systems Approval -Parcel I.D.017-401-09 ? �o _ 2 Expiration Date: 1. GENERAL INFORMATION: Complete legal description Mountain Shadows; Block 1 Lot 9 Location (site address) 12931 Michael Road *Anchorage AK Current Property owner(s) Tom Reale Day phone 907-223-3965 Mailing address Real Estate Agent 2. TYPE OF DWELLING: M Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) - - -Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual lZ Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $_2 i5 C) Date of Payment Receipt Number 03 3 Z 2 c�: COSA# 11 E3--- Date: Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineerinq Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101 -Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: �t Z[ 7,2- In Z 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. 6. CSD SIGNATURE System #1 Approved for bedrooms It I bedrooms s��G�pALITy l/riiir _ bedrooms, with the following ai la�ok�N S/TF �o r � AF STR'�Nrr7 :Z System #2 Approved for Disapproved Conditional approval for / \ �. . r- TL' 'r fr-A. Goriessr CE— -? i #AECC884 VIUL Original Certificate Date: .2 �Z Z 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other �J Checklist ,egal Description: MOUNTAIN SHADOWS; BLOCK 1, LOT 9 Parcel ID: 017-401-09 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA r ❑ Well log is filed with Onsite (or attached) Well production at time of test 1.7 gpm Date drilled 7/20/83 Water storage tank volume N/A gallons Total depth 366 ft Well disinfected for coliform test? ❑ Yes ❑ No Cased to 20.4 ft _ ❑Coliform bacteria is Negative On Sanitary seal is functioning correctly Nitrate G:.E1 4 r�"i`'g/L ❑ Nitrate less than MRL (ND) ❑ Wires are properly protected Arsenic ug/L WArsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by GEG Date of flow test for COSA 4/27/22 Date of Sample 4/21/22 Static water level at beginning of test 18.5 ft. Comments B. TANK DATA C. LIFT STATION Age of tank(s) NEW years ❑ Required maintenance Tank type/material SFP CmDP{ Age of lift station Measured operating fluid level in septic tank Lift station mat ❑ Standpipes/foundation cleanout per record drawing Comme Date of pumping N/A D. ABSORPTION FIELD DATA Which system tested (date installed) 2022 Adequacy test date NEW ❑ ALL standpipes present per record drawing Results [D Pass For 3 bedrooms Total measured depth from grade ft (max) Fluid depth prior to test in Measured depth to pipe invert from grade 3.9/4.14 ft (min) Water added - gal ❑ N/A — pressurized field New depth in ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Elapsed time - min FOR Code -required soil cover over field Final fluid depth - in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) date of test) Gallons introduced NIA gallons _ If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' 0 Yes Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft 0 Yes if No ft Neighboring Tank > 100' Yes if No ft Private Sewer/Septic Line > 260 Yes if No ft Absorption Field on Lot > 100' Yes if No ft Holding Tank > 100' E Yes if No ft Neighboring Absorption Fields > 100' 0 Yes if No ft Water Main > 10' Animal Containment > 50' ❑✓ Yes if No ft 21 Yes if No ft [D Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' 0 Yes if No ft [D Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' [] Yes if No ft Property Line > 5' R1 Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' 0 Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' [D Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' Q Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' El Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' Yes if No ft F. ENGINEER'S COMMENTS SEE ATTACHED WAIVER REQUEST FOR 1983 DRA-fl'qFELU AND S=H-L-= N- G. ENGINEER'S CERTIFICATION I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet • I MW LIN •f � i'1rA ... JGo ness: CE— \c�G � 0 rofession o� #AECC884 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~.~, Telephone: Home Business ~?/~ (c) Applicant is (check one): kenOin~ lnst~tution ~: Owner/builOer ~: Buyer ~; Othor~ (explain): (d) Lending Institution ..~¢'./~¢;.r'~_'~"~..¢¢~ Address _~ ¢' ' (e) Real Estate Company and Agent Telephone ~ (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family..~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Wel~ Community [-] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite/~ Public [] Community [] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 [11,84) ENGINEERING FIRM PROVIDIN~ INSPECTIONS, TESTS, FILE SEARCH, DA~,~ AN[) INFORMATION ' As certified by my seal affixed hereto and as of the validation date shown below, [ verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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. Name of F~r~~,J ~ Telephone ~-~ ~ DHEP APPROV '~,~ ~-~~'/'~ ~'~-'~'~::~'~-.~ Approved ~ Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) WELL DATA MUNIClPALiTM H~J~I~JI~j~EY OF ANCHORAGE (MOA) DEPT. OFH~AUTHORITY APPROVAL (HAA) ENVIRONMENTAL ~IST ' FEBRUARY 1984 264-4720 1986 JiZb Legal Description: ~ Well Classification /~¢-~/¢/¢ Well Log Present (Y/N) Total Depth ~" J~'~_/~C'ased Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: If A, B, C, D.E.C. Approved (Y/N) Date Completed .'~-- ¢"¢' - ,~,-~ Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot /'¢~' ~ ; On Adjoining Lots ,/~o ''/'' To Nearest Edge of Absorption Field on Lot ~_.¢G.o "'" ; On Adjoining Lots ./o'¢' To Nearest Public Sewer Line _ /~'~ To Nearest Public Sewer Cleanout/Manhole ~ To Nearest Sewer Service Line on Lot . Water Sample Collected by ~"¢~"'~ ; Date '72'¢4'"z'~~ Water Sample Test Results ?/~'~o ..-~-~'~/ Comments B. SEPTIC/HOLDING TANK DATA Date Installed.-~'6'¢~¢''~ Standpipes (Y/N) / Air-tight Gaps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contract on File (Y/N) ~.~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well _ ./¢~'~* To Property Line -~"-~' To Water Main/Service Line _ Course Size -/'~¢'~'~ No. of Compartments / Foundation Cleanout (Y/N) /~'" Date Last Pumped ../¢/- ~;"2~'- ; for Temporary Holding Tank Permit (Y/N) To Building Foundation '/~""~ / To Disposal Field /'~ /' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-02611//84) MU~I~)!PALIIY OF AN EPT. OF CHORAG~ ENVIRon. ..... HEALTH ,~. '~r~ PROTECTioN RECEIVED C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ;:¢- ~-¢,¢"- ~?'~ Width of Field /,¢¢ / Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well ,~,¢-.~ '''~ To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Length of Field .¢2,¢, ~- Depth of Field ~"-~ .~..~ Gravel Bed Thickness o.,.¢" Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line. To Existing or Abandoned System on ; On Adjoining Lots ~'¢0 '-~ To Cutbank (if present) .,"~/,~ Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t h at...~//~..~y, ver~, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed/'-~/~y~--~~ Date Company/'~/-/'/~C'~,,,~,'d .,~'~'~ MOA No. Page 2 of 2 72-026 (I 1/84) BEVAN ENGINEERING Approved Well & Septic Engineers I"h..u"~i c:i pal. i, ty o,F Anchorage Depar'l:ment'. o~ Health & IE:nv:i.r'onmental I::'r'crhec:t::i. on 82L] "L.." Street ~nchor'age~ ~:l. asl.::a 9D51~1 Re. :: SBA, Health Author:[t'.y Approval (HAA) App:l. icat. ion I_o'1': 9 BI I.:: 1 Ngun'hain Sh~clows Subd. P.O. Box 119852 Anchorage, AK 99511 (907) 522-1383 (907) 258-05~4 ~Uiv"ct~Lmr O ~ ~_ DEPT r~- A/X/CHop,_ L p,~OTEc,110~i RECEIV -D Gert ~',: ], ~me:n :: :OLIi'":i.I"K:] 'l:l'le per":[od ~:l"U:.)m November 17 to :[)ec:e. mber' f;J:3, 1986 wK? perfor'm~cJ researc:l'l,, site invest,~ga~:ior'i~ well, 'Flo~ 't:e~st:Lng and absorpt:i, on fi~].d f. es'l::~riD i:)ursuarrh '1':[.~ I...le. alt:l"l Aut'.l-lor:i.'by Approval on the) abov(e i ~-.f~,.¥ (.,,.nc, ..d lcrh, We I]er'for~med a we)].]. .flow tes'l: and .found the well. pr-oduc'l:.:i, or~ to be 1.,5 ga].].ons pe.r' m:i, nut.~: (gpm). This exc:e, eds t'.h(~:: r"eqt.c[r'~'~d ~ ..... :,.t.z.~ ~::}[.)nl 'for" a .]; bedroom hofne:. We · kook a water' saml:)].e for Cc)l:i..f~r'm ar'lalysis and the r-esu].t.~ were negative. IAle p(.:~r'forillR~,d afl i~d[:H::ll,.h':~cy t~'~st 01] t:h~ septi~ system and ch~r[.er'mir~ecl that it'. al::~sor'bed at a rate o.f '7~Z2Z~,.~- gal].ort~ per day (gpd). This exceeds tine 4.51Zl gpd r"e~c~u:i, recl .t:or a 3 I:)ech'"c:)om home, T'he ~iep'kic: t. anl.:: Nas pumped amd the volume ver-i.fied to be 1..::,Jl,~ gal ].or'l~, 'To clur" I.::nclwledqe a].l o.f t:he ir'vformation r'e.~ques'hecl on t.l"uB HAA Che:ck].:i.s'l': and Applic:at:ior~ has I:Jeen asse:.~mb].ecl. We are) SLd:Jmi'l:t:Lng this c:lat~.~ '1:o you for' your' i'"~v:i, ew, I::'lea:~.i[:,~ c:cn'd':ac:'h us if we (::ar~ prc~v:i.c:le ~l'l'/ a(::Iclit:Lol]al S:i, nl::er'el y., ~ At t acl'lmerrhs ." HAA App ]. :i. cat i clr] HAA Checl.::l ist f~ew~r As-bu:[ 1 t: Or':i, gina], Soils Investiga't:ion Wel 1 I_cn;] Total Coli,form Analysis Septic Tank Pumping receipt cc: SBA APPLIC %IT FILLS OUT UPPER HAl_ ONLY P,operly Ownm Phone Gordon Wolfe Mailing Addrese ]:,2.4~y 'l[',~q.l~.~ ~1 ~_chorage; Ak: zip Code 9q~0Z1' 3SIT-4tIR4 Buyer Robert J. and. Anna Young Address Zip Code Lending Institution United Bank Alaska Phone Address (645 G Street, Anchorage Ak.) ZipCode 99501 ~76-1911 Really Co. & Agent Loan Dept. located 3201 C St.Calais B£dg. 9~T503 Phone Address Zip Code Legal Description Lot 9, B l, Mb. Shadow:~ Sub° Street Loceti0~ 130th & Michael Rd., Anchorage, Ak. ._ Type of Residence C'~ Single Family ~,, Mulliple Family No. of Bedrooms ~ ~ Other Water Supply [~{;Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~] Public Utility Attached. __ Sewer Disposal In¢lividua[ Year Individual Installed: ~ Cj [~ ."{ ~ Public Utility When Connected to Public Utility: O~:~2 · ~ ~.,,~Ho__ ding Tanl~,~'", , __ 6" NQTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: MUNICIPALITY OF ANCHORAGI~ PEPT. OF H~A. LTH (~ppRovED BEDROOMS ', ~ 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPFIOVAL' Boils ~ating Date ~wer Installed Well TO ~sorption Area / ALASKA e ,ulRO[lmdlTAL COI1TROL October 27, 1983 Municipality of Anchorage Department of Health & Environmental Protection 825 L. Street Anchorage, Ak. 99501 Re: Health Authority On October 20, 1983 our company collected a water sample from the house located on Lot 9 Block 1 Mountain Shadows Subdivision. The property owner is Ken Boyer. The water analysis was satisfactory. A copy of the report is attached. The well is located 100+ feet from the septic tank and 100+ feet from the ].each field. The electrical wires are encased in conduit. Ali the standpipes are capped. The well casing stands over 1 foot above ground and has a sanitary seal. 1200 ~Uesl 33rd Auenu¢, Sui~ B · Anchoraq¢, Alaska 9s503 · (907) 276-1361 ALASKA E I dlROI FTleI TAL COF1TROL SeRuiC S, IIqC. ~nqinecrinq $ ~nuironm¢~laJ January 11, 1984 Department of Health & Environmental Protection 825 L. Street Anchorage, Alaska 99501 Attn: Cory Willis Dear Cory: Here are the copies of the percolation tests we did on lots i0 and 11, block 1, of Mountain Shadows Subdivision. Lot 9 had a visual soils rating of 150 sq.ft./bedroom in the excavated area. Lot 11 had been over excavated so we perced the bottom of the bed and then had 3 ft of sand brought in to bring the bed to 4 feet above groundwater. The way the lots were cleared ~qde it appear that we were deeper than planned. However, we found that the excavator used building excavation dirt to fill around the holes. The soils were much better than what we found earlier with the augers. I hope this answers your questions. Sincerely, 1200 LUesl 33rd J~uenu¢, 5uile [~ ,* Anchoraqe, Alaska 99503 · (907) 276-1361