The URL can be used to link to this page

Home My WebLink AboutMILE HI #1 BLK 10 LT 2 Municipality of Anchorage Page J of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~.~bJ~'-/o~>.'~l PID Number: O~'o - ~o[ - ~ Name: ~Ol~ ~O~q Wastewater System: ~ New ~ Upgrade '~ *~N,~u~ ~ ~.,M ~ ABSORPTION FIELD I No. of Bedrooms: ~ Deep Trench ~ Shallow Trench ~ Bed D Mound D Other Total Dept~ from ordinal grade: LEGAL DESCRIPTION ~oi,~,~,: O.¢ o~/sq.~, ff- Subdiv~ion: Depth to pipe bottom from original grade: Gravel depth beneath pipe Lot: ~ Block: ~0 ~i>~-I~l ~ I G~ Ft. Ft. Township: .~ Range: ~ Section: Fill added aboveo{ original.._ ~ ~ Igrade: Ft. Gravel(~length:~o.. ~ '~ ~01 '~O~ Gravel width: Number of lines: Distance be~eenlines: WELL: ~' New D Upgrade ~ Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: ~'T~ ~I~A~ ~0 Ft. ~O'~ Ft. ~00 SO. Ft. ~O Driller:~¢l~ ~ ~ DateDHl[ed: Static Water Level: In, al]er: Date installed: Yield: Pump Set at: Casing Height Above Ground: I. ~ ~ U.K. ~t. ~ ~. TANK SEPARATION ~ISTANCES ~ Septic ~ Ho~ai~g ~ S.T.~.P. TO Septic ! Absorption Li~ Holding ~ublic/Pdvate~ Man~acturer: Capacity in ga~lo~s: From Ta.~ Fie~a Station Tank S~w~Lin~, ~C~, ~ I O O O Number of Compa~ments: Su~ace Water jO~l+ tm~+ ~ ~ ~ LIFT STATION Foundation ~ I I O I .~ ~ ~ "Pump on" level at: ~" ' : High water alarm at: Remarks: :~ ~0AiqE~ , [~o~-rE~ BENCH MARK Location and Description2 ~ Assumed Elevation: Inspections pedormed by: S&SENGINEERING Dates: 1st Io--I.-~ ::; ~~ ~gle Eive~, Alaska ~9577 ~ ~ , '.~. C~ ~n Department of Health and Human Se~ices approval '"' Reviewed and approved by: ~~ C Date: [IW' 7 '~ 72-013 (Rev. 9/91) MOA 25 PERMIT NO. SW970331 PAGE 2 OF 2 Municip, o, Lifl: oF' Anchor'o, Qe DIE?ARTHENT OF HEALTH AND HUFfAN SERVICES FNVIRONHIENTAL SERVICES DIVISION P.O. Box 196650 oAnchorage, ALask~ 99519-6650 · TeLephone: 343-4744 ON=S~TE WASTEWATER DOSPOSAL SYSTEH AND/OR WELL INSPECTION REPORT LEGAL LOT 2, BLOCK 10, MILE-HI SUBDIVISION #1 P.LD. NO. 050--201--44 WELL BROWNIE DRIVE ! A B FCO 22.0' 5.0' C01 28.0' 5.5' ST1 ,50.0' 7.5' ST2 54.5' 14.0' DBL1 56.0' 15.5' DBL2 57.0' 17.0' FD 55.0' 25.0' C02 21.5' 12.0' C05 57.0' 46.0' MT1 55.5' 44.5' C04 14.0' 24.0' 005 54.0' 50.5' MT2 21.0' 28.5' N~-w 1000 GAL. SEPTIC TANK-- BDRM HOUSE LOT 2 ST1 100 5S'T2> FINAL GRADE C02 = 100.8' ~--'C04 = I00.4' C03 = 100N~ = 101.7' FINAL GRADE-~ C02 C04 ;05 MT2 NEW lO00 GAL SEPTIC .5' TANK C04 = -- C05 = = 91.6 C02 = 95.7' C03 = MT1 = TRENCHES · NO WATER FOUND 85.5' B.O.H. SITE · . ~'~ ·: ,. ,.:.~,', , ... ..,,,_ ,. ...... ..,:... DOG Co. dba ' SULLIVAN_ ;: .: :,.:..=..... ~ .,;.~.WATER'.WELL~cr ~.f ~:~ :'"' ' Mun oipah[y, ct O~NEROF ~ND.. ~Eo~zL ~-"~ $ORE HOLE DATA' '' .]''. '..~:i,"'?.~ ~"~ '. . ,~ '' '.'?~ ,}..'??L ~,..'~2 : ',u:'" . " , ...... PER~IT,.'NUMBER~'70~,~I .. Date of Issue ,.. ...... ;:' .~" :. ':']" b' "'~ " ': · ' t ' ;. ' : T~ ~,i'B O E.~'TI'FiOATI'O N NUMBER Is We)~.l~¢'ated at approved permit location? , ~s a No Method 0f Drilling:. ~aw ~ cable tool ,, Ca~Jl]g~e~WallTh{cknm". (,,g~ . ..inches Diameter, '~ d .In~hes, depth '~ ~ /'/' ...'.._feet ~yp~,, ~' :'~ .,. :.. , LI~ .... .'P~ing, ievel:J ;feet a~er, h~. pa~ing gpm 'Wgll'lptage Opening Ty~e: ~ Open End' ~q~ Hole O' "' ''~ ....... ,,.~eet &cree,n~d; , sta~ ~ , feet ~:8tqppe, ~ R&.~oratlo~s Sta~ leet Stopped'. [eet D~p[b: free--feet, to ~ . . .~eet Pq~'p ~qtake Depth: , ..~_. feet Pu~bSize, ' hp Brand Name-, A.'[T. ENIION; It is the.r.esponslbility of .t, ho p..rpperfy owner to submit e copy of tho w~ll · ~.f.. A.~{qh.~m~te .'D.'e'pa~tmegt,0[ Health & HU~eh Sei'vice~ and/or De~admont of Envlr~'hfi~ent~ 'Consei~at,o6J MatSU Rick Mystrom, Mayor M miCipaliW of Anchorage DePartment of Health and Human Services 625 "L" Street P.O, Box 196650 Anchorage, Alaska 99519-6650 November 14, 1997 Robert C. Cowan, PE S&S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, AK 99577 Subject: Waiver. Request forLLot 2 Block 10 Mile Hi Subdivision #1 Waiver Request #WR970070 , PID #050-201-44, SW970331 Dear Mr. Cowan; Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 5 feet from the new trenches to the east property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, Donna C. Mears Civil Engineer I On-site Services ljw #7 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~ WR970070 PID# 050-201-44 HA# Permit # SW970331 Date Received: OeDob~,R4~?1997 Legal Description: Lot 2 Block 10 Mile Hi Subdivision #1 Engineer: Robert C. Cowan, P.E., S & S Engineerin~ 17034 Eagt~ River Loop Road, 'Suite 204, Eagle River, Alaska Applicant: James D. Pr, ide?, 99577 Waiver Requested: Lot line waiver of 5 foot from the new trenches and alternate site to the east property line. Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: Special Conditions: 3. Other: Waiver is Granted: Waiver is NOT Granted: List Conditions or Reasons for above: Date: By: Na~o~ev~ewer~, /3~ / Rec #: #03270/4268 Amount: $ 115.00 Date Paid: October 24, 1997 ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER&WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ONSITE WASTEWATER DISPOSAL SYSTEM DESIGN October 22, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.O. Box 196650 Anchorage, Alaska 99519-6650 REFERENCE: Lot 2, Block 10, Mile High Subdivision Addn. #1 Request you grant a 5 foot lot line waiver from the new trenches and alternate site to the east property line of the referenced property. We do not anticipate any adverse effects on neighboring wells, septic systems, or drainage patterns by the granting of this lot line waiver. If we may be of further service please contact us. Sincerely, Robert C. Cowan, P.E. 17034 NORTH EAGLE RIVER LOOP ° SUITE 204 o EAGLE RIVER, ALASKA 99577 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMJ~N SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PAGE 1 OF 1 PERMIT NUMBER:SW970331 DATE ISSUED: 9/24/97 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 9/24/98 OWNER NAME:PRICE JA/~ES D OWNER ADDRESS:JOHN HOLLAWAY 7437 HENNINES WAY, ANCHORAGE, AK 99504 PARCEL ID:05020144 LEGAL DESCRIPTION: MILE-HI #1 BLK 10 LT 2 LOT SIZE: 45106 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: PROPOSED TRENCHES MAY NOT BE LOCATED LESS THAN 35 FEET FROM A CHANGE IN SLOPE OF >25%_ ./ ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ONSITE W.~STEWATER OISPO~AL SYSTEM DESIGN September 15, 1997 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 2, Block 10, iV[de-Hi Subdivision No. 1 Request you issue a permit to drill a well and install a septic system to serve the proposed three bedroom house on the referenced property. Also request you issue a waiver for 35 feet to a slope that exceeds 25%. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. The monitoring tubenvithin the test holesha~been checked and found to be dry. This property has enough area for a future septic upgrade which can be seen on the attached site plan. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. If you require additional information, please contact us. Sincere, ly, Robert C. Cowan, P.E. RCC/mg Enclosure MUNICIPALITY OF ANCHORAGE ENVlI~;)NMENTAL SF. RVICF_.5 DIVISION 8EP 1 6 1991 RECEIVED 17034 NORTH EAGLE RIVER LOOP "SUITE 204 · EAGLE RIVER, ALASKA 99577 , 't'¢ = 50' SITE-PLAN SCALE / / DESIGN o / / z~ o PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 'L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST DATE PERFORMED~I LEGAL DESCRIPTION:~'T' ~ ~L k:: /0 ~3 / U,~ ~j~ / Township, Range, Section: 1 2 3 4 7 8 12 t3~ 17 18 19 20 COMMENTS SLOPE WAS GROUND WATER ~ (~) ENCOUNTERED? s L IF YES, AT WHAT ~ O DEPTH? p E SITE PLAN Depth to Water After Moniloring? ~),.,t. ~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~' ~ ~ ~ ?3¢ -- t PERCOLATION RATE ~] O (minutes/inch) PERC HOLE DIAMETER ..~ ~. ~t- TEST RUN BETWEEN ~, FT AND ~- $- FT S & S ENGINEERING PERFORMED BY: 1~'C=~ .~._~;m..~V3~ I___..~ o~.R .......... M~ ~ I . CERTIFY THAT THiS TEST WAS PERFORMED IN ACCORDANCE W~"~~PAL GUIDELINES IN EFFECT ON THIS DATE. DATE: ~ //~ / ~ 7 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL DESCRIPTION: 3 7 t~ L 8 9 10- 11 12 13 14 15 16 17 18 19 20- COMMENTS Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST ~1c¢ //¢c/-/-,~/Township, Range, Section: SLOPE WAS GROUND WATER ENCOUNTERED? ~ 0 S IF YES, AT WHAT ~ ~) DEPTH? p E SITE PLAN Deplh to Water After /)~¢y Monitorino? Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~a,~ ~,~ I:~e '~0 ~'~ 1~/~'' I PERCOLATION RATE "~ O (minutes/inch) PERC HOLE DIAMETER __ TEST RUN BETWEEN ~ FT AND ~~ '~ FT PERFORMED BY: , I CERTIFY THAT, THIS TEST WAS PERFORMED IN 1/U~4 Eagle R~ver Loop Road No, 204 ACCORDANCE WITEaajI~ a~Al, a~ksaL,~$g~AL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) ROBERT C. COWAN, P.E. HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS. SEWER&WATER INSPECTION ENGINEERINGSTUDIES ANDREPORTS WELL INSPECTION & FLOWTEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 REFERENCE: Lot 2, Block 10, Mile-Hi Subdivision No. 1 September 15, 1997 GENERAL: The scope of this project includes the installation of a 1000 gallon septic tank and two five foot wide drainfields to serve the proposed three bedroom residence for the referenced property. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The contractor shall be responsible for obtaining any necessary underground utility locates. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. On all leachfield mound systems, the property owner shall be responsible for ensuring a satisfactory vegetation growth over the mounded area. Contractors installing wastewater disposal systems must be certified by the Municipal Health Department for system installations. Owners installing their own systems must also receive prior approval from the Municipal Health Department. SEPTIC TANK INSTAIJ~ATION: 1. A septic rank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. 2. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 3. All. standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 Page Two Lot 2, Block 10, Mile-Hi Subdivision No. 1 September 15, 1997 4. Septic tanks installed with less than 4 fi. of cover shall be insulated. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. l~om the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second deanout shall be to clean toward the septic tank. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCH/DRAINFIELD INSTALLATION: Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed-up) before gravel (sewer rock) placement. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill: Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shovm on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The finish grade over the trench must be mounded to prevent the formation ora depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. 3my septic tank proposed for installation must be constructed by a Municipally approved septic tank ~nanufacturer. Page Three Lot 2, Block 10, Mile-Hi SubdMsion No. 1 September 15, 1997 The following pipe materials are approved for use in septic system installations in the Mnnicipality of Anchorage: _Type of Pipe Perforated Solid Cast Iron Yes Yes ^STM D3034 (PVC) Yes Yes ASTM F810 (HDPE) Yes No ASTM D2662 (ABS) Yes Yes Use ora type of pipe other than listed above must be approved by the inspecting engineer. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam HI or equal). Septic tank inlets emd outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leackfleld gravel layer and/he native soil backfill. All leachfield gravel (sewer rock) shall be 0.?'-2.5" screened gravel with less than 3% passing the #200 sieve. When sand is being used as a filter material, ks gradation specifications must conform to current M.O.A. or D.E.C. requkements, 'which ever applies. INSPECTIONS: Typically there will be a minimum of three 0) inspections required during the installation of the wastewater disposal system. These inspections will occur as follows: The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. The second inspection must be conducq:ed after the placeme~t of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property~ Page Four Lot 2, Block 10, Mile-Hi Subdivision No. 1 September 15, 1997 Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre- construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A_ permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owners representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons perfomfing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident to this project. CONTRACTOR/OWNER M1try i)T) • • J 'A�, & � U' •! r}{ Municipality of Anchorage - °� � On-Site Water and Wastewater Program a MA ) 7 ZQr 1,611 i (907) 343-7904 Sow, Sip.. c �h Certificate of On-Site Systems Approval Ol 6 s L Parcel I.D. 050-201-44 Expiration Date: -! - - 11 1. GENERAL INFORMATION Complete legal description Mile Hi #1 Block 10 Lot 2 Location (site address) 22222 Brownie Drive Current Property owner(s) Hollaway, John & Sylvia Day phone Mailing address 22222 Brownie Drive Eagle River, AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual CI Individual Water Storage ❑ Holding Tank ❑ Community Class Well El Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received lc �. _I .h I� /L„, / Date: q l 7/7-. COSA to be released to the engineer,unless otherwise request/`.y the engineer. COSA Fee $ E - Waiver Fee $ Date of Payment 5111 111 Date of Payment Receipt Number 0.q03-1 C� Receipt Number COSA# 04411 II Or Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my teal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate ofn-Site.'S ms Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (a e's"aonal and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtaine rom 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. In conducting an a �ttempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regu a I orted results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water 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 this system, All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 5/16/2017 ALN j*: gh osvC049- i�,_ • *9 6. DSD SIGNATURE jxj_ " '`400\ System #1 Approved for 3 bedrooms Steveti R, •annone . rif System #2 Approved for bedrooms OA 4)3 CE-8149 �e Disapproved � ��OFESiA Conditional approval for bedrooms, with the following stipulations: ON-SITE WATER AND • \AiASTE NATER PROGRAM 1 t {; w`Q-4, e t tivi By: - c"v‘.- b "— ( Original Certificate Date: g-1 7 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA b:ue sheet ( - If more than 1 septic system is on the lot: COSA Checklist # 1 of Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description Mile Hi #1 Block 10 Lot 2 Parcel ID: 050-201-44 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 9/25/1997 Sanitary seal (Y/N) Y Wires properly protected (YIN) Y Total depth 220 ft. Cased to 40.6 ft. Casing height (above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 9/25/1997 10/26/2016 Static water level 78 ft. 86 ft. Well production 1 .4 g p.m 3.8 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 0.722 mg/L Arsenic ND ug/L Date of sample- 5/10/2017 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 10/2/1997 Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping 8/5/2016Pumper Sanitary Pumpers C. ABSORPTION FIELD DATA Date installed 10/2/1997 Soil rating (g p.d /ft2 or ft2/bdrm) 0.6 GPD/SF System type Deep Trench Length 80 ft. Width 5 ft. Gravel below pipe 4 ft. Total depth 6 ft. Eff. absorption area 800 ft2 Monitoring tube Y Depression over field N Date of adequacy test 10/26/2016 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 32/0 in. Water added 450 gal_ New depth 33/0 in Elapsed Time 120 min. Final fluid depth 32/0 in Absorption rate >= 450+ g.p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 51* Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS *Waiver on file #WR970070 G. ENGINEER'S CERTIFICATION OF. qtgAki I certify that I have determined through field inspections and /Ay, p. �I— ..:v # review of Municipal records that the above systems are in /*; .!�ItAu. \ •*�0 conformance with MOA COSA guidelines in effect on this date. �'� � Engineer's Printed Name Steven Pannone ,+ Sievers i.'�nririorie. •; Date 5/16/2017 6j q•• CE-8149 • .1 COSA canary sheet_2-6-15.doc / °' L / '� I �_ LOT 1 / if/ A,, 08 r. h l(�-x 8 a / / Power / Pole // / /III 1- ry�a ‹711 cy-L.0 / / AnchorJ +_' / z I ,�� LOT 2 %. ../ , ,./ BLOCK 10 / /) / i ! / ,o I, / ,e' / / ! , / .,„, c). , 1.,` if 411 / i i n* I 21 / C" / /! f 3v l 1 / / / & / / / / / / / I 0.21.9/ / • / I / / / "�faiI / I ." / I -lir I / / V / ,—Wood Deck I I I ! . / / / Lower Level I i I I / / / ^f/// 1 1 I 1 1 / ,_._---.•:" ...' --Wood Sundenk 1 1 1 I Wood R.-1i! d 'tl�e-,e�`'�I/l tipper Level I 1 1. F.,,,:._ % 1 c,0 ___11 I I 1 ! / / ? Al�'t-- 1 0.4=��,3 I ,/ / 1 / n L A i . / � // / t1 -"4":1--- —7 l._evil Wnnri 1.II ` 11�?I 11 Frame Residenne I i I Wood Sundeck 11 i`?�1 _ _ bi W / / Upper Level_ it. "r-C;1 ,9" � C— rruw rvtI" I I / r"------ Covered Wire ,,,,, r 11 ASF. % ' 01 tx / / Fence — /. 'Nsi, I 5.6--- A / Jo. I _1.0• 4 * I r ,1 �` / . '/� tri 7-1 � --4' Cantilever Ii,_, /v Q. 1/ I` /- Att L. ,A tilt, .1 n I e, / �. r,ltu\.,,G•.1 ,•v�� / Woodl-chod �..�. ' /c+P_n_s� // 0 1' '-ch.,..d. .coo li,o^ �' • / I Nn Form 1 4fl, g ` 1.4-� yy '•� ^ I x.; t ' / 0 . o� = If "I1I b, gas//"..--_-------, as /".� �,. ./ / //8� r 1 "—Wire Fence 1 CD l \ '".,f •i t/ , ✓/o , / / \ • 1 ../..-"S.2-4-1.`,v,{ / A \--Wood • Fence i / 9o.s. 1"1- 1/ v I ® 6-C9. / -----'.----....,,.......:;.;:/ / Q Na' `�o' —,..ser rlk'c �IyN j • , � / I ^, F0) 1� / plastic Sided ��` N fr; / Green House ---mor,„._ . Mli� ,..., __, • (No Foundation) '�. ii. ! �� 1 mow r '�. 1 1• - 5/8 Rebar / '"" J LOT 3 I I , / / SCAT F : 1 " = 30' 0' 15' 30' 60' NOTE: PREPARED FOR: Dimensions are measured to the wood trim. JOHN & SYLVIA HOLLAWAY I hereby certify that an accurate survey of the following described n rnnprty, '``�.wezt A l iii T [IF '9/..4.10: ,.. /� '__J U lJ I I �� _ r, �,11 c_ I ciIIo fln/IeIr i hn_') � ";•'' A-'•• J� 1,.! �V I II I V I•&I V.1 `♦ V iV, c2%•. __. ' ••V••9 ' • was made on May 22, 2017 and that the improvements DWN. I DATE i GRID N. # " 4916 P ' :"Vii, situated thereon are within the property lines and do not overlap or .i¢P 16/3/2017 (NW 58 encroach on the property lying adjacent thereto, that no I I e _ I:; K,a..t,,t,.,,,,_,. . improvements on the property lying adjacent thereto encroach on FILE NO. I F.B.2016/20171 JOB NO. - ": ...145 the premises in question and that there are no roadways, tc, No. 3143-S�.•' ..• r ' 17QR I P(,_ 19 11706 "• ' •.•.• •.• �„ transmission lines or other visible easements on said property except I I �, qs ••••••• 4 as indicated hereon. Easements other than those shown on the A, fLii ‘*k4 tSYN�� " record plat may not appear on this drawing. KA RA BEL! V JK(JF1— C 6103/20,7 Anchorage Alaska, this 3rd day of JU11e 2017. SUS VE ! '! I G (yU7) aa7-sasa w ,_^ V/ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING o5o-2o1-,. . GENERAL INFORMATION Complete legal description Lot 2~ Block 10; Mile High Subdivision #1 Location (site address or directions) Property owner Mailing address Lending agency Mailing address NHN Brownie Drive Eaqle River, AK Di~ot~ll Construction Day phone p.o. Box 770210 Eaqle River, AK 99577 Day phone 694-5797 Agent Address Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickuP. 3 NOTE: Individual well XXX Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: XXX Individual on-site Holding tank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72~)25 (Rev. 1/91) Front MOA#21 o STATEMENT OF iNSPECTION BY ENGINEER As certified by myseal affixed hereto and as of the validation date shown below, I 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. Name of Firm s & s ENGINEERING 'I~'u;~4. Ea~le River Loop Road No. 204 - Phone. ~ c~ ~ _ ¢% c) '7 ~ Address Ea~ Engineer's signature ~//~"~'+. ~,~...,___ Date D-"/T/'/~/'¢)' o¢ DHHSSIGNATURE '// Approved for Disapproved. Conditional approval for bedrooms. L bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their let]ding institutions in order to satisfy certain federal and state requirements. Employees of DHHS 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. 72-025 (Rev. 1/91) Back MOA I~NVlRONMENTAL SERVICES DIVISION Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 3 Health Authority Approval Checklist Legal Description: L~,~ ~ tO pI~L..G HK-'~F} 5ID'l:l') Parcel I.D.: A. WELL DATA Well type PI~, ~'~,"~'~'- Log present(~) Total depth ?_~O / Sanitary seal'N) IfA, B, or C, attach ADEC letter. ADEC water system number atecom., te Cased to '~0 1 ~ II Casing height (above ground) Date of test Static water level Well production FROM WELL LOG J · "~ g.p.m. WATER SAMPLE RESULTS: Wires properly protected AT INSPECTION Coliform O Nitrate Date of sample: ~. J ~ ~ !~'~'~ Collected by: B, SEPTIC/HOLDING TANK DATA Date installed j b !'Z,!~ Tank size !/.~OO ~0~\ Number of Compartments __ Foundation cleanout LJ~IN) ~ ~:,,4, Depression (Y,{~ ~ (~ 0 Date of Pumping· 1,~ ~.V3 Pumper Other bacteria g.p.m. S & S ENGINEERING 17034 E~I,=, I~iv,,? I__~,~_ ~ ~_~ H~. 2~ Eagle River, Alaska 995~ ~-- Cleanouts (,.'~N) High water alarm (Y/N) / C. ABSORPTION FIELD DATA Length ~ (~. z~ ~ Width Soil rating ~ or ft2/bdrm) 0,(.o Systemtype ~ Gravel thickness below pipe ~r-I Total depth Effective absorption area ~oF) Pr+z` Monitoring Tube present,N) ~E,(~ Depression over field (Y/~ ~O Date of adequacy test .1~ ~..I Results (Pass/Fail) ~F~O For ',,.] E.~J bedrooms Fluid depth in absorption field before test (in.); Fluid depth ~f~J (ins) Minutes later: ~',,/ Peroxide treatment (Past 12 months) (Y/N) l~ 72-026 (Rev. 3/96)* Immediately after 'I,/~J gal. water added (in.): ~J~.',d Absorption rate = ~J~ g.p.d. yes, give date l'~lR If D. LIF~ ~ N~~~~ Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons elat* "Pump off" level at* *DatumS'""" ~~, SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot [ OO~ '¥ On adjacent tots Absorption field on lot ~OD~Jr On adjacent lots Public sewer main ~.,~ ~+ Sewer/septic service line ?--~' ~ ~ Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation Property line I I)~ Jr Absorption field Water main/service line hO¢4' Surface water/drainage, iGC ~ ')- Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line ~,~ ! Building foundation ! Surface water Ic~o T Curtain drain I Water main/service line Driveway, parking/vehicle storage area I'~ON ~- IZ-~to~ Wells on adjacent lots 1 E¢O~ ~ ENGINEER'S CERTIFICATION ~ W~v~-~_ --~,p--~-¢~o (w ~ '~ ~ 7 co 7 0 '~ I ceRify that l ha'va ~ete~mined t~ru field inspections and review of Municipal reco~ ~,~,abo~s are in conformance w~i~cM/~ gu~/~es in effect o/~ this date. Signature ~//~¢ ¢- ~/'~--- ' Engineer's Name //~)~E/¢7-- L'". CO~ Date ~ /I ~ / ~ ~ HAA Fee $ ~ ~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number S AND S ENGINEERING PAGE 03 CT&E ESI ANCHORAGE 90?$615301 P,03/03 ZI~ T&E Environmental Servioes In=, ,rinking Water Analysis Report for. Total Colifo~ Bacteria ~4D AV~T~ZON~ ON ~E~E SIDE aEFO~E COALg~[NG ~[PLE Tel; (~7) 862.1343 O aY WA~R SUPPLIER c] pUBLiC WATI~R, SY~TIEM XPRIVAT[ WATSR SYSTEM lib r~T, aG,"- ) B80 48 j.~"' D FEB-~6-1~98 10:~9 CT&E E~I ANCWORAG~ ,~ OT&E Envimnm~ntal$~Ioe~ln,, PAGE 82 9~75815301 P.O2/OJ 980748001 L2 BIO Milo HI S/D 1 L~ n~O Mile RI S/D l Dri~ Wite~ POL Uflft$ Nitrste-~ TO~O[ ¢~Lffgrm 0 0.100 mg/L coL/lO,rtL EPA 300.0 lO