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F & R BLK 1 LT 1
F&R Block 1 Lot 1 #060 - 331 - 07 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221320 PID Number: 060-331-07 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name QUINN MEEHAN ABSORPTION FIELD 0 Deep Trench ❑ Wide Trench ❑ Bed ❑ Mound Site Address 7779 HILAND ROAD, EAGLE RIVER, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 808-394-7940 3 1.2 GPD/SF SEE DWG. Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 5 Ft. Subdivision Block Lot F & R 1 1 Fill added above original grade SEE DWG. Ft. Gravel length 41 Ft. Township Range Section - - Gravel width 3 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 410 Ft2 - -Ft. Well 100'+ 100'.}. - - 25'+ TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer INFILTRATOR SYSTEM, INC. Capacity 1060 Gal. Surface Water 100'.+- 100'+ _ _ Material Number of compartments Lot Line 51+ 10'+ - - NA PLASTIC 2 Foundation 10'+ 10'+ _ _ LIl-^"CATION = �' Manufacturer Capacity Remarks Gal. Alarm location Electricai„,�= Iled by Installer PIPE MATERIAL House to tank D3034 Tankto D3034 PRECISION GENERAL CONTRACTORS Drainfield D3034 CO/MTD3034 Inspector GEG CONSULTANT, JODY MAUS BENCH MARK (Assumed elevation) 98.99 ft Inspdectio 15` 8/31/2022 9/1/2022 Location and description 2�d 3rd 9/2/2022 41h - TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineers Sump Conditional Approval: Date .... .. . N . v �: �H t -•.-� 4 0 D Septic System 40 � :J f Y � Approved-----." —t,— Date Q 9. E-795 p `0 Note: this approval does not include well permit requirements. 4?�°�oOoo���o #necc kmuv uu/u!J Io) r'�J PERMIT NUMBER:RECORD C p p �' fl, PARCEL ID NUMBER: RE OSP221320 CORD DR 1VVING 060-331-07 THE OLD DRAINFIELD WAS PERMANENTLY DECOMMISSIONED AND THE OLDS I DECOMMISSIONED PER UPC PER THE CONTRACTOR -- ���� ------- 15'UTIL.ESMT. �\ /--- �c`------ ----- \ \ NEW DRAINFIELD INSTALLED DOUBLE CLEANOUTS (DBL1 & DBL2) CL STREAM I NEW IM -1060 INFILTRATOR ___�-� coz 1 PLASTIC SEPTIC TANK i - � . Cp3 I SN#� ST 7 100' zi FOUNDATION V o ` .... r ;CLEANOUT (FCO) l f A 8 FISTING i; �� FCO 31.5 13.1 / ROOM (J� C01 45.6 57.3 3-BHOdtySE CULVERT ICY MH 83.8 1100.2 . r , 1 I 1- t eL DSIV i \ GM — — I TOTE: PIPE LOCATIONS ARE r SHOWN PER GEG SHOTS TAKEN WITH LEICA DISTO gyED S910 LASER DISTANCE METER. SWING -TIES TO i HOUSE CORNERS WERE f GE ERATED IN AUTOCA4. i NOTE: THE 100 -FOOT WELL RADIUS AND !� f THE 100 -FOOT SETBACK TO THE STREAM WERE STAKED BY A REGISTERED LAND SURVEYOR DURING CONSTRUCTION. HILAND ROAD a 1'=40' /--CULVERT - y r .......... q.9... ....d .�,� -... :... ENGINEERING, SALES � CONSULTING � - �-�_ �. _ . � / • � � 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, ALASKA- PHONE (907) 337.6179' WEBSITE. www.gamossanginoarirg com p....;::. .� .. u.... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ®� •� r y A Ga eSS � s QUINN MEEHAN 808-394-7940 2 OF 3 �0 J,'••, C -795 ' _Z"A PROJECTILEGAL DESCRIPTION: DRAWN BY: ®`�' •.• . 13 z z•' � � F& R S/D; BLOCK1, LOT 1 J.L.M. 0 Fp•• ••••... TYPE OF WORK: DATE- LICENSE 8®���®E®�®® �® RECORD DRAWING FOR SEPTIC SYSTEM UPGRADE 9/612022 # LICENSE 4 alA �i © r -- PERP2NUMBER: RECORD DRAWING PARCEL 1NUMBER: OSP221320 060-331-07 TOP OF MANHOLE = 98.99 (FINAL GRADE ST1 H \ = 97.77-98.29 m TOP OF TANK @ INLET = 94.48 - INVERT OF PIPE / @ INLET= 93.99—/ TOP OF TANK @ OUTLET = 94.48 ------2" OF INSULATION PER CONTRACTOR INVERT OF PIPE @ OUTLET = 93.66 IM -1060 INFILTRATOR PLASTIC SEPTIC TANK MTI CO3 0z MT2 CORIGINAL GRADE FINAL GRADE = 93.50-94.50 = 93.99-9F d7 TEST HOLE #1 .TER FABRIC -INVERT OF PIPE = 88.50 -BOTTOM OF Ao TRENCH = 83.50 GwN1 . �- c".-.--- 0,4 RELATIVE ELEVATION OF BOTTOM OF TEST HOLE (NO GROUNDWATER) = 77 .® . .OF dOg O�iaaaaaa ••••. „ .• dd i i AV i a .....49 .........}..... .:....ao ENGINEERING - SALES, CONSULTING --: 9 . = 10 3701 E. TUDOR ROAD, SUITE 101 -ANCHORAGE, ALASKA' PHONE (907) 337.6179- WE8SITE• www.gammongineering.00m 0 ... .. . .............. .........., PREPARED FOR: PHONE NUMBER: PAGE NUMBER: Cn : r y . Garn SS :'mss Q; is QUINN MEEHAN 808-394-7940 3 OF 3 d®G'� CE -7 = ® `f' s PROJECT/LEGAL DESCRIPTION: DRAWN BY: ® '•. o F & R S/D; BLOCK1, LOT 1 J.L.M.�® �•p �'"�''��yP�oFp TYPE OF WORK: DATE: LICENSE ° ° ° d ®S�®.�®o® RECORD DRAWING FOR SEPTIC SYSTEM UPGRADE 9/6/2022 #AECC884 [:Lt::7vIS/ in Ln N N N O N to Q\1 O O h m M a 0 co W n Q W O W J J I k \ I \ co cn \ N 00 rn 3 , L6 \ "j N cO I j M 64.6 £3 L N W 56.6 Z 7i� I � � I LO lwsa •iun st 00"SZZ M.6£.Zl o00N A377d,OZ \ 9107 ©9nS VG 107 98.9 LO O O N 3 to a y d I U Y Q J� Y41 CL aJ -� C O y C u C > LL O a) CL Y j y U a> > y � U Y O i Y i Y U � u +' + w to 0 00 E- c C m y � O m f CL 7 c m y mx _c « n. o y CL y m O> > O T O c 7 m m a CL 2 O m m m w m N U to C O m 4 ::rnam m m a m c m o y � d c m m y m a5E C m E m o co N -6 :1 L°y',D,E:6 OF -w U� rcVMV' m m � c > w E m m E � � U CL m E O n C m y o 0 d y C c 3 c mp m c > Q c y Z�•, � m Q y O m U m@� m � m C, N w `o y'S or or O m L m y m C f- m M 7 v O m N a 4 y w O m mcc am c - vos O N L h M C m U C y > t m o m U C C m O m E o r a y p U 2L�y cn J CU J a C Q Z > o CD m o o h rwQ•c� m m E y m m at m pY Y C U UU (0 O > m m O y Z v U w O f0 V N C U y F O C X L U m Vi ao E E (U E v Q h N 3 A v tn N C: O 00 vH Ln 01 0) m Y E to C o Q U vi m2 Q � CU t CU u c Ua=E J w O O J vw u to � O > V1, >� c Q D i L 00 .-i c N Ln p0 41LD 4 c `r 3 LL ttDD cn ��,•' '`R CD N y6I . N • Z O t1..• �toa.. y I N O 00'9ZZ g.Lt.£OROOs n / / z qz, x / CO am csco N �.: U j 11• �° = x / z•tit lul a t / cc �2Lo co / d' x I k \ I \ co cn \ N 00 rn 3 , L6 \ "j N cO I j M 64.6 £3 L N W 56.6 Z 7i� I � � I LO lwsa •iun st 00"SZZ M.6£.Zl o00N A377d,OZ \ 9107 ©9nS VG 107 98.9 LO O O N 3 to a y d I U Y Q J� Y41 CL aJ -� C O y C u C > LL O a) CL Y j y U a> > y � U Y O i Y i Y U � u +' + w to 0 00 E- c C m y � O m f CL 7 c m y mx _c « n. o y CL y m O> > O T O c 7 m m a CL 2 O m m m w m N U to C O m 4 ::rnam m m a m c m o y � d c m m y m a5E C m E m o co N -6 :1 L°y',D,E:6 OF -w U� rcVMV' m m � c > w E m m E � � U CL m E O n C m y o 0 d y C c 3 c mp m c > Q c y Z�•, � m Q y O m U m@� m � m C, N w `o y'S or or O m L m y m C f- m M 7 v O m N a 4 y w O m mcc am c - vos O N L h M C m U C y > t m o m U C C m O m E o r a y p U 2L�y cn J CU J a C Q Z > o CD m o o h rwQ•c� m m E y m m at m pY Y C U UU (0 O > m m O y Z v U w O f0 V N C U y F O C X L U m Vi ao E E (U E v Q h N 3 A v tn N C: O 00 vH Ln 01 0) m Y E to C o Q U vi m2 Q � CU t CU u c Ua=E J w O O J vw u to � O > V1, >� c Q D i L 00 .-i c N Ln p0 41LD 4 c `r 3 LL ttDD cn ��,•' '`R CD N y6I . N • Z O t1..• �toa.. y MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program poBox 1y66s 4moElmore Road Anchorage, Alaska yoo19-6nuo po '7904 pax: (907)343-7997 Permit Number: OSP221320 Work Type: Septic Upgrade Tex Code Number: 06033107000 Site Legal Address: F&RBLK 1 L 1 8:0255 Site Mailing Address: 7770H|LANORD, Eagle River Owner: K4EEHANQUINN P Design Engineer: GARNEG8ENGINEERING GROUP LTD This permit imfor the construction of: ZDisposal Field ZSeptic Tank [] Holding Tank 0Phvy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/10/2022 8/10/2023 []Private Well [] Water Storage All construction shall beinaccordance with: 1. The attached approved design. 2.All requirements specified inAnchorage Municipal code Chapters 1555 and15G5 andUh State ofAlaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) -. The wastewater ~`~` requires^inspections^during"the installation."The engineer shall" notify theue,empmox Oopvioea 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 beeither: a. Opened and Closed onthe same day, or b. Covered, sealed, and heated toprevent freezing Received B) Issued By: 3 Development Services Department _ Phone 907-343-7904 On -Site Wafter & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 060-331-07 Property owner(s) QUINN MEEHAN Day phone 808-394-7940 Mailing address 7779 HILAND ROAD, EAGLE RIVER, AK 99577 Site address 7779 HILAND ROAD, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) F & R S/D; BLOCK 1 Legal description (Township, Range & Section) LOT 1 Lot Size Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) [] (w/wo AD U) Septic Tank Fx] Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF 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: 0. 5 t235-7 Waiver Fees: Date of Payment: Receipt Number: Permit No. _OS P22132 0 Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewatefforms\Client FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221320, Deb Wockenfuss, 08/10/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221320, Deb Wockenfuss, 08/10/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221320, Deb Wockenfuss, 08/10/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221320, Deb Wockenfuss, 08/10/22 MUNICIPALITY OF ANCHORAGE - ` (i' 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 ^y AK V �ZIA Wfi �: of-7Ia PHONE yi to EWknuDfA� UPGRADE .: MAILING ADDRESS 1 I LEGAL DESCRIPTION CEA Sn �i�5" :�- A- R.- Gln (14-z. hDL 4 LOCATION NO.BEDROOMS SEPTIC TANK DISTANCE TO: Well [ r0° Absor tion aria Dwelling ( �� Mater i e C -.I PERM 6666 No. of comartments Manufacturers Liq. cagecy�ty ir��ga Ions `tibio IF HOMEMADE: Inside length Width Liquid epth o J0Z O Z cr 1-1— DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well C.- ,�d0� Foundatio I Total length liner Nearest lot I ( Trench u the (�y inchese PERMIT N(�^ �/ % / X�(J(�7 (p�j Distance bets ee es No. of lines I Length'515h line ( Top of tile to finish grade Material beneath tile dinches. Total effe ve rption area - SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J W Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER N 1, t0 a. 9 Li- PIPE MATERIALS 17-• 303 eli pot__ SOIL TESTING" !" - ,5 I ii�Il INSTALLE?! , */:� ? 7 C //Io/rstr�. ---4",.----4",.-TV, �MJ�JB. REMARKS v3 X....,-..., .,.... ,,y , APP VED ,. DATEE�A I )../..'--- I 72-013 (Rev. 3/78) ��J I 1:0-.Y E-0E2.IT��F- ,������������� _ � mm DEPARTMENT �P HEALTH AND ENVIRONMENTHL:� R8TECTION 8r5 STREET, HN�HORHG�/ H� ����� � - /'l� �--��' �� 264�4720 `/h//^�\/����'�.J ��-- �� �� .� ' 8r5 STREET, HN�HORHG�/ H� ����� - � /'l� �~- 264�4720 `/h//�\(� � , / PERMIT Na/ ��n��� � �m��/�� ' ��'^' '`, . "�puv, ' � r HPPLICHN7 LOCATION LEGAL L1 F & R S/D LO/ SIZE 999999 SQUARE FEET � / :/l/.1) • MHXIMUm NUMB,R OF BEDROGMSOIL RATING (SQ FT/BR)- 90 RONALD AND GLORIA NARRIic'4046 20TH 99503 TYPE OF SOIL ABSORPTION SYSTEM IS. TRENCH THE RPQUIRED SIZE OF THE SUIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BuTTOM OF THF EXCAVATION (IN FEET) THERE IS NO SET NIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF !HE EXCAVATION (IN FEET). h .... E'• N. 1. F0 V-A 11--14 !1:::71; �-t1 0110rNI :E2"T 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 Wilt_ SERVE. �„a 7:4, 11,41:s F- i= I: [c -i4 r-41 - FP IIRA=. P1=' F71 g0EEP, BACKFILLING OF ANY SYSTEM WITHOUT FIMH| INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION MINIMUM DISTANCE BETNEEN H WELL AND ANY ON~SITL SEWAGE DISPOSAL SYSTEM IS 10u FI -FT FOR H PRIVHT- WELL OR 150 TD 200 FEET FROM H PUBLIC NEL! DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DIS|HNCE FROM H PRIVATE MEI...! TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL !OGS ARF REQUIRED AND MUST BF RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLEFION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTH!!A1ION r 0D�07:117P4-11EBFP.:IFB �����:2P' I CERTIFY THAT 1: HM FAMILIAR WITH THE REQUIREMENTS FOR ON SITE SEHERS AND WELLS As SFT FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WI!{ INSTHU... THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERS!HND THAT THE ON-SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED�~. APPLICANT / RONALD AND GLORIA NHRRICK ISSUED BY_�l -l:2g1DHTE~~~�77_ V40 PERFORMED FOR: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6650, Anchorage, Alaska 99602 276-2221 SOILS LOG — PERCOLATION TEST 7-3A)LEGAL:DESCRIPTION: L-A c ha("JtSt , 7E IST 19 ,FF . Bte , �,.�- cY'� ra5is 71 � - Bre slty ,law GIr•.p L.'s( 9 MIME_—fjlk CM— a1,44. - tier) 5-// 13-.arv, S0,61,1 SSI -tires 14- 15- 16- 17- 18- 19- 20 - COMMENTS SLOPE Sandy tevc-1 Laya„cot - LF,osr.- , CIS»p (r.MTeI ( yirodeci I rG „ Caw T.N. ASOILS LOG LI PERCOLATION TEST DATE PERFORMED: ..71,/ Its �o / �7 K- ND WATER A I S N UNTERED? ' `r 0 L O IF YES, AT WHAT DEPTH? I F-1 SITE PLAN ,Ace,cx s ro a d Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN FT AND (minutes/inch) FT PERFORMED BY: �J�1 t c' F7.y lfey• I CERTIFIED DATE:4y /$ r7 -2y i ,• (/ 72-008 (7/76) S4998UEC 061978 C C� ()/l (-139 G� 0 DAAJ r TrAifirh Eiriltitt; /Cog by DOCSULLIVAN WATERCdWELLS P. 0. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND . ADDRESS A:. 6 ) : u / LEGAL DESCRIPTION f‘. DATE - Started 'I/ Ended DEPTH OF WELL / STATIC LEVEL OF WATER FT DRAW DOWN FT GALS. PER HR PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From (,) Ft. to 6 Ft. .___L_‘,,,c1•••;;-'14Ft to __".<3.......",.?Al z::,‘ --I From Ft From (.,, Ft. to,... Ft. ‘1,410,,i9 .°4 ii:Ase,4 , 4 41, From Ft. to Ft From Ft to_ Ft. C4.41-er .--n I it - 9- ;.? From Ft. to Ft. From .?, ) Ft. to `C4 i Ft. '-= 4. ; 41- C., 041r.4 =..i• :::(:,.... From Ft. to Ft From 1/ Ft. to `5/.,:; Ft ,,e, -::::,<,..e .',-. ?L. ,,‹ From Ft to Ft ( From I' -e' Ft. to e A.:',1 Ft. .,',5'e2.,'-' d 4- .4 ' eid, 44-,' r' z From Ft to Ft From Ft. to Ft. c.),(..) (..,P44-0' From Ft. to Ft. From '76 Ft. to / 3 b Ft. .,/,37sz---,.o!,,i,e.../i- / =6--).„).4,./J-Z From Ft to Ft. From I 4-) (> Ft. to / .' 4- Ft 41?/..:-7.e.1?,e.-)t- 4:. '-3 '."° From Ft. to 04-' Ft. From Ft. to Ft A<'4.: 7 ,,,,, ..--r.s- ./ 0 t; "*".'+' From Ft. to Ft. From Ft to From / i' t' Ft to/'V Ft /-,'.'' 7.1 t';' .. '',=' ' — Ft Ft ./.':..i.',...',4r*V 4rom From/ 4 Y' Ft to_ti tr•Z..) lji'-',/1.-:'''1-r" "-Ft to_ Ft From_ Ft. to Ft. ';.) (...;.A4 From Ft to Ft. From Ft to Ft From Ft to Ft From Ft. to Ft. From Ft. to—MUNICRUTY---Of—ANCHOBAC;E From From Ft. to Ft. Ft. to DFPT C" 1— • I.T, 9, ENVIRTAtt-,- A A. 1—) '', TION From Ft to Ft. From Ft to Ft, M1SCL. INFORMATION: 4 - RECEIVED DRILLER'S NAME /1-e• Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 060-331-07 Legal description F&R Block 1 Lot 1 Site address 7779 Hiland Rd Current property owner(s) Quuinn Expiration Date: 12-13-22 X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: i 77:BYOriginal Certificate Date: 9-13-22 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval—June 2022 MUNICIPALITY OF Development Services Department On -Site Water & Wastewater Section Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 060-331-07 Complete legal description F & R SID; BLOCK 1, LOT 1 Location (site address) 7779 HILAND ROAD, EAGLE RIVER, AK 99577 Current property owner(s) QUINN MEEHAN Day phone 808-394-7940 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: 9 Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑■ Plastic ❑ Concrete ❑ Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed a Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $� +1 (50"'* = i _ Waiver Fee $ Date of Payment �� ►�12 a= C� D 5�8- Date of Payment COSA # , ,1 `-iso/ Waiver # COSA Appllcation June 2022 ,-A Legal Description: F & R; BLOCK 1, LOT 1 I'2I!S; v► S&o ri►f,t'�6 Parcel ID: 060-331-07 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA 1i ❑ Well log is filed wit bOnsite (or attached) Well production at time of test 1.6+ gpm Date drilled 8/1,99, Total depth 160 ft Water storage tank volume N/A gallons Cased to 45 ft Well disinfected for coliform test? ❑ Yes ❑ No ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 7/29/2022 Static water level at beginning of test 42.1 ft Comments B. TANK DATA Measured operating fluid level in septic tank NEW Date of pumping NEW ❑ Required maintenance completed, if AWWTS Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 8/31-9/2/22 ❑ ALL standpipes present per record drawing Total measured depth from grade 11.9 ft(max) Measured depth to pipe invert from grade 5.5 ft(min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. ❑ Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced _gallons date Any rejuvenation treatment (past 12 months) N/A If yes, enter date Comments/Deficiencies: COSA Checklist June 2022 n Coliform bacteria is Negative Nitrate 2.39 mg/L ElNitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GARNESS ENGINEERING GROUP Date 8/1/2022 STATION ❑ Require Age of lift station Lift station rnaWr com Adequacy test date NEW Results o Pass Fluid depth prior to test NEW in Water added NEW gal New fluid depth NEW in Elapsed time NEW min Final fluid depth NEW in Absorption rate 450+ gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) NEW in Effective depth used NEW in Effective depth remaining NEW in E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' 0 Yes if No Community Sewer Manhole/Cleanout > 100' ❑i Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ❑i Yes if No ft Private Sewer/Septic Line > 25' Q Yes if No ft Absorption Field on Lot > 100' E Yes if No ft Holding Tank > 100' ❑■ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' Q Yes if No ft Q Yes if No ft ft If tank or field is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' 0 Yes if No ft Tank to Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' © Yes if No ft Private Wells > 100' Yes if No ft Water Main > 10' © Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' R Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Gamess Engineering Group, LTD. (GEG) Phone Engineer's Printed Name Jeffrey A. Garness Date _ In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including (but not limited to) soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regardin, the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. COSA Checklist June 2022 907-337-6179 o6000O OF.�J 0�.. .. H *.:..... ....... � .. ................. ..� e.re, s: � o LICENSEE P"ofessk°' o NAECC884 ��OpoOo� PO S Municipality of Anchorage Development Services Department :'�17) Building Safely Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 b fi Anchorage, AK 99519-6650ll ^ /, www.muni.org/onsite fib [,� (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING` A n /' Parcel I.D. (76o- 20 i I - n7 COSA# 01 LI7 1. GENERAL INFORMATION Expiration Date: 9/3/09 Complete legal description F & R SUBDIVISION. LOT 1, BLOCK 1 Location (site address) 7779 HILAND ROAD * EAGLE RIVER, AK 99577 Current Property owner(s) JENNIFER WELLS Day phone 952-8406 Mailing address PO BOX 964 " KENAI, AK 99611 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. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 3 TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank ❑ Community On-site ❑ Public Sewer • ❑ ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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 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 Finn GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD. SUITE 101 * ANCHORAGE. AK 99507 Engineers 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 It 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 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 if confer any legal right whatsoever. 5. DSD SIGNATURE Approved for 3 bedrooms Date 41 5101 * • 00 • a ... .Q Disapproved. Conditional approval for bedrooms, with the fllowing stipulations: ` o • -0 Or ...0. , ' ON-SITE= J . ' WATER AND : 7-2 WASTEWATER : Attachments: COSA Checklist Septic System Advisory Well Flow Advisory nitrate Advisory�Ivvivv�D By: 4G t— (Rev. m oos) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other o• Original Certificate Date' A. Municipality of Anchorage Development Services Department, Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orgfonsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: WELL DATA Well type PRIVATE Date completed F & R SUBDIVISION, LOT 1, BLOCK 1 Parcel ID: 060-33).07 If A, B, or C provide PWSID# N/A 8/1982 Sanitary seal (Y/N) YES Total depth 160 ft. Date of test Static water level Well production Cased to 45 ft. FROM WELL LOG 8/1982 WATER SAMPLE RESULTS: 45 ft. 1.5 g p m Well Log (WN) YES Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 4/15/2009 48 ft. 1.4 g p m YES 18 in. Coliform 0 colonies/100 ml. Nitrate -1•a a mg./L. Other bacteria 0 colonies/100 ml. Arsenic: 5. 1 ug IL Date of sample. 4/16/2009 Collected by CEG Ltd. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1000 gal. SEPTIC/STEEL Number of Compartments 2 Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO Date of pumping 10/10/2008 Pumper C. ABSORPTION FIELD DATA Date installed 8/14/1982 Cleanouts (YIN) YES High water alarm (Y/N) JR'S PUMPING N/A HBELOW EXISTING GRADE Date installed 8/14/1982 Soil rating (g.p.dJft'or t /bdr90 Length 30 ft. Width 3 ft. System type TRENCH Gravel below pipe 5 ft. Total depth *9.42 ft. Eff. absorption area 270 ft' Monitoring tube YES Depression over field NO Date of adequacy test 4/15/2009 Results (Pass/Fail) PASS Fluid depth in absorption field before test 14 in. Water added 460 gal. For 3 bedrooms New depth 32 in Elapsed Time: 900 min. Final fluid depth 14 In. Absorption rate >= 450+ 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 (Y/N "Pump on level at In "Pump off" level . High water alarm level at in. Datu Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic tank/lift station on lot Absorption field on lot Public sewer main 100'+ N/A Sewer /septic service line Animal containment areas 25'+ 50'+ On adjacent Tots On adjacent Tots 100'+ 100'+ Public sewer manhole/cleanout Holding tank N/A N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water "100'+ Wells on adjacent Tots 1001+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water *1001+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *PER OUR SITE INSPECTION ON 4/15/2009 THERE WAS NO SURFACE WATER SEEN RUNNING IN THE DRAINAGE DITCH G. ENGINEER'S CERTIFICATION 1 certify that 1 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 Date Side 9 JEFFREY A. GARNESS nes/ 0 E-7953 4) d Pio f;8310 °� o '4000000��� COSAFee$ /O'er / Date of Payment '�/z 7 / 07 Receipt Number / 20770 70 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number 0 ti ti I 1 .97 09:04 REi1Yix OF Eit1itr- c'n .r tlo. a^• linrirY t- • • I 1 I I .��ii.4ur�a✓ ,y1‘,357.yB ea -dr :ter- era c,f- ASBUILT-NO CORNERS SET THIS DATE. tre4.- - -- .a' -- f' LtzSEWARD & ASSOCIATESLAND MIMIC 688-4566 • 1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: Lot 1, Block 1 P d 1 SuMdIvizio AND NO criLicuAottEHTB EXIST INDICATED. IT 1 MRESPDNSIBIU� THE owNER TD DETERMINE THE EXISTENCE OF ANY EASD,cNTS, SNAR ON OR RESTRICTIONS WHICH DO VISION PLAT. UNDER HO cmcumsEaucts wino ANY DATA HEREON BE USED FOR COIdSTRIC ION OF FENCE LINES, OR FOR ESTABLISHING, BOUND. ARY LINES. Parcel ID #i RE.c.`n e 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA# v C 1. GENERAL INFORMATION Complete legal description °' /. C'� /7 Fa 52/-0:27"%is.o cJ Location (site address or directions) '`�'� z / '7/;L� ,4✓s.e.9 9 9,5 7 7 Property owner �� � �� r,� At. Day phone Mailing address Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well 3 Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer 3 NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 7121 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 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 Firml�o���r T ��t l Phone (9'67) 74IC i071 Address 99‘m 6; .�r,a•47i Engineer's signature Date •?-0.99 _ 4 aC.) Ito 404: •J , * /,I COUGGE 81 6ENI EY.' 6. DHHS SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By !----;‘t4—ti /Q// - Date 1- 2 7-- ? ? CAUTION 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 lending 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 021 RECEIVED Municipality of Anchorage JAN 2 0 1999 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division MUNICIPALITY OF ANLrI 825 L Street, Room 502 • Anchorage, Alaska 99501• (90�+S4ASERVICES o Health Authority Approval Checklist Legal Description: 4.0' 7- /, .49< o c cs j .c8• ..2/er>, A. WELL DATA Well type !t.¢'v-'' If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) y Date completed 7/4.6 ' Total depth i6 OAL' Cased to 4f6F>. Casing height (above ground) /6'.J - Sanitary seal (Y/N) y Wires properly protected (Y/N) i FROM WELL LOG AT INSPECTION /9'99 Parcel I.D.: Date of test Static water level Well production �16fd. WATER SAMPLE RESULTS: Coliform Date of sample: '999 B. SEPTIC/HOLDING TANK DATA /• g.p.m. Nitrate z • z / Other bacteria Collected by: fro 2 A.JL y Date installed /'S//siZ Tank size ' ' 4'41 -Number of Compartments ti Cleanouts (Y/N) Y t3) Foundation cleanout (Y/N) Y Date of Pumping 1,4/9.6' Depression (Y/N) ' High water alarm (Y/N) Pumper 11/2s .74-°.`--6"°i.04 C. ABSORPTION FIELD DATA Date installed 83/1//®Z- Soil rating (g.p.d./ft2 or ft2/bdrm) 44) Length .9 / Width 3 9 Gravel thickness below pipe 5-6 Total depth //' Sum clZduAlse Effective absorption area -..2 Monitoring Tube present (Y/N) Y Depression over field (Y/N) N Date of adequacy test ./,QA--? / /999 Results (Pass/Fail) .�-q�f For .i bedrooms System type 7.7020, Fluid depth in absorption field before test (in.); Fluid depth 17- (ins) Minutes later: "CA- Immediately afterri ' gal. water added (in.): -014' ' Absorption rate = g.p.d. 30 Peroxide treatment (past 12 months) (Y/N) If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump o.9" level at* High water alarm level at* *Datum E. SEPARATION DISTANCES o " level at* SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /01a ,..71, On adjacent lots gab *i4i1- Absorption field on lot /3 ?F? . On adjacent lots /oe `� . Public sewer main 'U/� Public sewer manhole/cleanout '1)/4 Sewer /septic service line Z� �� Lift station A)/47 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation zy1 �� Property line .99FL Absorption field _93/4,1 Water main/service line ,ZS" `F/ Surface water/drainage la o'F-/ Wells on adjacent lots /gam 1461. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1‘,'f Building foundation 63F� • Water main/service line 4-6 «• Surface water /FJo' /. ,(Jo .ce"49& 4414(J Curtain drain ro Epi 6 Driveway, parking/vehicle storage area /oa F/ F. ENGINEER'S CERTIFICATION Wells on adjacent lots im, I certify that I have determined thru field inspections and review of Municipal rest the • ove *kips are in conformance with MOAT HAA guidelines in effect on this date. . � ' 9 i 0*6.49 ;�� •.*' Signature �'" �Q" /..: ......... i irk':; t Engineer's Name �ou�z vs' T. 7 7'• Date I ' .9°) 6-,.AEy po HAA Fee $ ©- Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* 03z -6p (&7 P) Date of Payment Receipt Number Parcel I.D. # 06® MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Ssrvices Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING �9/— 7 HAA# (Ac1.Vi['�i)� 1. GENERAL INFORMATION Complete legal description Lor ! ®moo f" /,SU,orvsrJidsia,LJ Location (site address or directions) 79.0-77 Property owner cZe•—/A, F.4e,o.,1.t Day phone e96—i>7�F-PX Bax Mailing address f/9z040j E,gac .� `���, /-1,L 99x"77 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. 4. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank , Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC. attesting to the legality and status of system. , 72-025 (Rev. 1/91) Front MOA 921 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 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 Dov0InT• jCe (` Phonea-0 7`{c�-(tr73 Address 19 La J Engineer's signature I ' / 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Date LY:i Conditional approval for 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 lending 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) Beck MOA 4021 Municipality of Anchorage I DEPARTMENT OF HEALTH & HUMAN SERVI C Environmental Services Division 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907M434Z0)97 Municipality of Anchorage Health Authority Approval Checklisjept. Health & Human Services Legal Description: L-er / B1.oa,e / /0 ' ' A. WELL DATA Parcel I.D.: 060-.W8/- 07 Well type i'qe• 7-4*- If A, B, or C, attach ADEC letter. ADEC water system number Log present (YIN) ) Date completed '9ue. '9' Total depth /6'F' Cased to 4/4-,-c71-. Casing height (above ground) /6'"f• Sanitary seal (Y/N) ' Wires properly protected (Y/N) Y FROM WELL LOG AT INSPECTION Date of test nuc, /9'60.2., /J -e.. • z.// / 4096 Static water level y5 -F7`• 4' • / I7' Well production /. S` g.p.m. /• 9 g.p.m. WATER SAMPLE RESULTS: Coliform dz Nitrate - `fit Other bacteria Date of sample: -Z 4'47 1.".5-e.,�0 /99,d Collected by: F,eEo 442 ''.cJz. y B. SEPTIC/HOLDING TANK DATA Date installed Bim`//ri'x. Tank size '4049 494• Number of Compartments - Cleanouts (Y/N) % Foundation cleanout (Y/N) Y Depression (YIN) Al High water alarm (YIN) �l''� Date of Pumping Z�3�96 C. ABSORPTION FIELD DATA Date installed gl'+'/9z. Pumper Soil rating (g.p.d./ft2 or ft2/bdrm) 9° System type -77-"-'71 Length _fOF7z. Width -1Ff Gravel thickness below pipe =.4-.71'. Total depth //F7L. mes:rei 'r Effective absorption area -270 moi` 2Monitoring Tube present (Y/N) y Depression over field (Y/N) 4-1 Date of adequacy test ' - j / 994' Results (Pass/Fail) ,4-e-sS For bedrooms Fluid depth in absorption field before test (in.); // Immediately after 2.gal. water added (in.): 3.2 //✓. Fluid depth az' (ins) Minutes later: y.' Absorption rate = / d g.p.d. Peroxide treatment (past 12 months) (Y/N) 'V If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" le el at* A High water alarm level at* *Datum es ed E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot / 0 A-74 On adjacent lots /De tff Absorption field on lot / .,' 9/‘iL On adjacent lots /Oo '`F71 Public sewer main '�1.9 Public sewer manhole/cleanout A7,9 Sewer /septic service line -es 1-« Lift station //4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation Z4/ -7�-` Property line l'5714-74 Absorption field -,./Af Water main/service line -Zs fQSurface water/drainage /oo 7d -A-71 Wells on adjacent lots /do 74.71 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Z6 /z -.P4 Building foundation 6.iF74 Water main/service line did '''F72 Surface water /o 0 fFf Driveway, parking/vehicle storage area zoo. —/ 4)&'46 "2•4>ou-4._l Curtain drain Ta ‘')e/sr- F. ENGINEER'S CERTIFICATION Wells on adjacent Tots I certify that I have determined thru field inspections and review of Municipal records �ieorov s are in conformance withIN1OA HAA guidel� es in effect on this date. *, .,. � • 3.. '4) T 1 d.1ti 1 ; *d Signature Engineer's Name Date IP/7/9 `7 / ��Bc-,yl cJ ,1S' T r'NLEY ,� i;jt ° CEB176 HAA Fee $ LSU ' OU Waiver Fee $ Date of Payment Receipt Number U acLAs1 g 98 72-026 (Rev. 3/96)* Date of Payment Receipt Number 11.1.41••••••• PI 1� r SBtJ1LT�Nfi CORn� r THIS -A1 SEWAPD & ASSOCIATES LAND SURVEYING 633-4566 ilrREi9Y CERTIFY .THAT - ' s Yr E4 TME1LL0WING DESCRIBED PROPERTY TiNOCCOD D T• ENCROACHMENTS E,X1ST -SCC ;PT AS A!CAT'ED. IT 13 THE RESPONSI$ILI TY )F THE 'NEP TO DETERMINE THE EXISTENCE Oi ANY SEMENTS, COVENANTS, OR RE$TF ICI ONS IICM DO NOT APPEAR ON THE RECOR )q) SWS01. 55I0N PLAT. UNDER NO CIRCUMSTAA CE: SHOULD FOR CONS TRI. DTION t=EN E LINE;OR OR FOR 1NG SC JND- r LINES. nwrimma SCALE: " DATEI 7/21/92 ARID: SW255 Par 30.35 DRAWNI DMS • y,4912 At •• Oven. M,k Sww.,rd '' A •.. LS "691$ ,.•• Asr iktt • aaa�a' &\i'a 3119H3 JO XHW/3d t;S:EE 9E, 60 D3:I r MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date i (a) Legal Description (include lot, block, subdivision, section, township, range) /-74 / !4/- / / . /' S'41 ,/t/, Location (address or directions) S.. tx /Z- /r , /-i, >a. a ./ 'Pe/ (b) Applicants Namelk Etet/,t, 14,1 kin,' Telephone - How, easiness n Applicants Address / z=r 7 7? /`c.} z- f3 rf r f/4- i!fn (c) Applicant is (check one) Lending Institution 11 ; Owner/builder In ; Buyer ; Other (explain); (d) Lending Institution Address (e) Real Estate Co. & Agent Telephone r 7'.� Address /OCA tr dn,3 Telephone 39r 0.D y 3 (f) Mail the HAA to the following address: 7/; -*r .14). 2. Type of Residence Single -Family 1 Multi -Family Other (describe) rd y Number of Bedrooms 3. Water Supply - Individual Well Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community Holding Tank Q 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] ers 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 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 regula- tions in effect on the date of this inspection. Name of Firm -Sp a rer/.r../.F Telephone -.2 2, -3Sir Address "4)3 t-✓ /5— 7 L/.,e-/r r ' 9 5 P- e / Date 8172r/541 l' tt Or• 'q ! (ENGINEER SEAL) 6. DHEP Approval /� � ' 9;--/o-s � Approved for 3 bedrooms By fCl.��-.� �IJaG'a.�('ii�`�•17ate �J�, Approved X Disapproved Conditional. `�'__ `" 49TH ..•s r, ^� t 2225 -E i ' ' JUNE 25, 1971 • Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS 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 REQUIRE- MENTS. EMPLOYEES OF DIIEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY 07 ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. t RR4/ej/D18 (Page 2 of 2] (DHEP SEAL) 7-19-84 • A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SEP 8 1984 RECEIVED Legal Description: t / f Su .b , .B/!- / Well Classification ,Pr've,i-e If A, B, cs C, D.E.C. Approved(Y/N) Well Log Present (Y/N) / Total Depth /60 / Cased Static Water Level 9 3 " Date Corlileted Yield 90 6)0/7- to ,ny to `VS Depth of Grouting /vdne, Casing Height Above Ground ai/ Pump Set At ✓5-1- 9sri, Electrical Wiring in Conduit (Y/N) / Separation Distances from Well: To Septic/Holding Tank on Lot /06- / ; On Adjoining Lots /or) Y - Sanitary Seal on Casing (Y/N) %/ Depression Around Wellhead (Y/N) I%/ To Nearest Edge of Absorption Field on Lot /e9,94— ; On Adjoining Lots /00-1- To °dam To Nearest Public Sewer Line /P/ -e. To Nearest Public Sewer Cleancut/Manhole Water Sample Collected By .t;751•7 ; Date Water Sample Test Results 5- 5, 74. IS r41t or/ I/! To Nearest Sewer Service Line on Lot 40" %7lY1 Comments B. SEPTIC/HOLDING TANK DATA Date Installed fi7,/Z Size /d'O 6 / No. of Compartments Standpipes (Y/N) ,Y Air -tight Caps (Y/N) / Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) ,V Date -Last Pumped 101111011k q- / ° - Pumping/Maintenance Contract on File (Y/N) /v ; for Holding Tank High -Water Alarm (Y/N) DVA- Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well /494. To Property Line /0 4 - To Water Main/Service Line /- Course Course 4//4 To Building Foundation To Disposal Field .76-- To s To Stream, Pond, Lake, cr Major Drainage Contents o/'4' e... e ,r fs e opt /h4.._. .00 »,C S lq o' [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA eh Soils Rating in Absorption Strata /L3 Type of System Design tre' Date Installed 51/4,-- Length of Field 30 Width of Field 3 4" '' Depth of Field ' /// Gravel Bed Thickness 60 Square Feet of Absorption Area 74 46 Standpipes Present (Y/N) Depression over Field (Y/N) N Date of Last Adequacy Test &//-7/6-9 Results of Last Adequacy Test 54t.J4=-A.7 Separation Distance from Absorption Field: To Water -Supply Well /fie' To Property Line /4 74- To `To Building Foundation :3/ / To Existing or Abandoned System on Lot /yam- ; On Adjoining Lots ":30 To Water Main/Service Line /o t To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course 4j4 To Driveway, Parking Area, or Vehicle Storage Area /o .- Comments /fr,- t f<oa�, , See cvara,+ er. -1' D. LIFT STATION 40. Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked on the date of is inspecti Signed , .... 1 Company verified, or conformed to all MOA HAA Guidelines in effect KB1/d5/s [Page 2 of 2] Date 3//? I MOA No. gl7Sl-0(( 2-15-84 • APPLI(^`NT FILLS OUT UPPER HA:_ ONLY Property Owner k,,, t) 3 ; 1 Cl j 1 i -i \/V/�) K (t` k...., Zip Code .� t� cC) "-' Mailing Address / l) y iii 1/11 %1 non i14' e /jc Phone '). 1 - kr,-/e9 (:)..,,i)1'.:-. jG Buyer-- YYI /-i h.. ,) E //-a A.) i'�. t} VV f -i 0/4 Address - /7O j'1 11 �' �'�S '1— 1 (:) Cr ate Zip Code r:=„ f'j/> r 1 Lending Institution Iiu Inc w'.-5 Lcq AJ ' f -9c) ''r>E: Feciet! .4 C. 535 D, `-3d r ' + Address i-3,,y.^,`s i„,yJ''r N 0 1 -1 -'4 -Meer) 14- <, 0 sf Zip Code Phone„; -.2.2..../ [7/ �;? ” —// 2_ Realty -Go: -&-Agent- Address Zip Code Phone Legal Description L._ c..7-1- 1 if) it 1 F 5 k - L) loC(c - • S 10,-,-.) Street Location_ - ._. .. - Type of Residence ,4Q Single Family _ O Multiple Family No. of Bedrooms -\ ❑ Other Water Supply X. Individual G gni_ o to to ❑ Community II ❑ Public Utility I oI, ll ale. h.a!`i ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal g Individual Q AC)Lcdo�_ ❑ Public Utility1 L�S�- l L/ _rri� ❑ Holding Tank �. o Year Individual Installed: 7t p When Connected to Public Utility Inspector NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Tim Time ---1 l , �?._QC Time / c;t,,1S1A Au0 Date jf e \ Date -\ Date Inspector In .> t. Inspector Inspector Field Notes: Cfi lJ ��� Q�P /y C ``Ab MUNIC PALITY OFA CH.RAGE DFPT C° ENVIR.Ji Ji.:f ,. ^ . .i),::t.iION RECEIVED ( ) APPROVED BEDROOMS ( ) DISAPPROVED ( 7) CONDITIONAL APPROVAL' DATE % L .- 2 ► l _'�Jy' - n r�S.6CONDJrf10 _~_ "a'[ ✓ f//YQ tt �y 4114-)Ak.e J et, , ... 1 / c Jn / J vigil I/,--'-5 --i_e OFA QV ✓G „�Q .._/J ..._ t BY:'t,iL�A7f c.- 1 ` Soils Rating Date Sewer Installed e_ Well To Absorption Area .0 Cb v Well to Tank '4-) ©0 ell Log Received Septic Tank Size ((De) 72.023(3/82)