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HomeMy WebLinkAboutFIREWEED HILL BLK 1 LT 5Fireweed Hill Block 1 Lot 5 #015=w271-27 Municipality of Anchorage Development Services Department " Building Safely Division \ On -Site Water 8 Wastewater Program, 4700 Bragaw St. -- P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907) 343-7904 Page 1 of 3 Onsite Wastewater Disposal System and/or Well Inspection Report Permit Number. SW100013 PID Number. 015-271-27 Name: JAMES ROBERTS Wastewater System: ❑ New ■ Upgrade Address: 3241 MICHIGAN AVENUE 'ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 522-5485 4 O Deep Trench ■ Shallow Trench O Bed Cl Mound 0Other LEGAL DESCRIPTION $a ft": 5 Tota Depth /rwn odginal ,roes 6 cvD/sa. ft. n Block: Let: Subdivision: Depth to yip. boawn hem orloinal grade: G,wN depth bwooth pipe. 1 5 FIREWEED HILLS 2.91 n 3.09 n Township: Range: Section: IM added abo OtVnd graft G'°"I lwoh: - - - SEE DWG. n. 15 n. WELL: ❑ New ❑ Upgrade G,oeel width: 5 Mwntw of Ines: 1 Dielane. W. Ta.e: — rt pt. Cbwefcation Pmate, A.B.0 : TOW Cooed To:(KNOCK) Total aeearpaon ana: 129 Pyo r w w.. 3034/ F-810/SCH 40 s,, so. TLD oat. aead: sloth wmw Lav : n.taYr: GEG oat. krt 4/2-6/10 R Pump Sm ALcae+ho ""t A cna dl TANK cPu n n SEPARATION DISTANCES 0Septic 0Holding ■S.T.E.P. 0other• TO Septic Absorption Litt Holding k/Prhgte Ywedaclwr: GREER Capaaav In tpeorw: 1500 ;ram Tank field Station Tank sww Lsr.e Well 100'+ 100'+ — — 25'+ Yotwrl: STEEL Y,e of aanpwt w: 2 Surface water 100'+ 100'+ - - - LIFT STATION Lot line 5'+ 0•1'+ - - - 9n In gaear: 1500 Ywwfaatww: GREER 0UANICS Pwnp an lw a at: V an I at "h .1wal Wm at: Foundation 5'+ 10'+ — — — TIMER TIMER 1 44" Pump Yaks a Yoe./: Erctncd Inp«+ione p.rlw W. Curtain Drain NO KNOWN P—TE-30-1 M.O.A. Remarks: *THIS IS A OUANICS AEROCELL SYSTEM. BENCH MARK Locotlan and Dnalptkn: "WAIVER #100006. BOTTOM OF TRIM IN NE CORNER OF HOUSE OLD TANK WAS PUMPED, CRUSHED, & COMPLETELY Ervwian: 100.00 ABANDONED PER UPC. Tt GEG Ltd- Inspections performed by: . Dates: 1st 4/2/10 EYGIREER'3 ZEAL aoo�op4p� 10 3rd 4/6/10 o :'9 r O� Development Services Department Approval ¢ : �,T Conditional approval: Date: . .•. •, r y.. roes... O Q� CFS7953 .•' �a�G� 04 e� 1.6tG'oAd Opp°/'ra,g„1a'r,0o by: Date: 167-J 0 Reviewed and approved (R«. 4/0I) OpoOoo�� r NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW1 - SW100013 015-271-27 `SEPTIC � EXISTING D AS A RESEF 100' WELL 100' WELL RADIUS MICHIGAN PO( 1.2 TH 02 R� TO BE USED IN50� O GARNLSS ENGINEERING GROUP, Ltd. CONSULTANTS S GENERAL CONTRACTORS •� •-••- •---- 3n1 L TDM I,ow. wrt 101 • ANNORIfL. M M 7 . w (W7W7�In • to (907) Ml • 1 11[ w..dsa...r...Fo«• PREPARED FOR: PHONE NUMBER: PACE NUMBER: JAMES ROBERTS 522-5485 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: FIREWEED, BLOCK 1, LOT 5 PNB TYPE OF WORK: DATE: ASBUILT DRAWING 4/14/2, (R. 01/05) 0 A B COI 45.02 30.29 STI 46.00 31.19 MH 56.65 41.77 POD1 52.94 39.54 PGD2 50.72 37.56 JV 49.34 35.25 FD 46.05 32.40 CO2 44.41 31.42 MT1 38.36 26.70 CO3 36.71 28.81 0 _ ti Z9 m CD ^0 N:O c_ to ti Oz 40 ( y OJ W co \ m L � 00, O DO cn i $ oo Lnc�c> mmZ v DvrrI z m x X I 3 PC) + +m x o w r C 0" so 'I Z A N • A Cm y -C 0 V Y �2 zbn0 r (A mz C D MO � z � n � — A z 7 o z L < 0 A 0 m rn 'u (� 19.1 ti S N 0 00 D UC �O z + Qp CD 1 o� =rmr O� 1 N y r 1 O C O �I .O Ln 00 r GP 'n vNID e U] ODA . z a o N 0 -� V WWm ±' mr0 drill C) .Z1 �F 00 �F .............S�ppO ..... DATE: DRAWN BY: .. 4/14/10 PNB CAL DESCRIPTION: /� »� Q j f • y q, • • • rness - •..O FIREWEED HILLS BLOCK 1, LOT 5 GARNESS ENGINEERING GROUP, Ltd. 0 TYPE OF WORK: +� CCN3ULTANTS&GERERALCONTFACTOF3 p Jf AS—BUILT OF QUANICS AEROCELL SYSTEM ..,c ., n,.,,,�1..,,,,. °,ou,.,..»,°•n..n».,�..,..ss °&Pt fe ID'�Fov PREPARED FOR: PHONE NUMBER: __F3 A(,E; �Q4O4Op0OO��o JAMES ROBERTS 522-5485 3 OF 3 &Il 'U It -iI;bj n SC"s'"-ss _r,_i r,ecr ing I-CUii_ i_LY Inspection Report MWinicipality of Anchorage, Building Safety Division 4700 Elmore Road INSPECTION: VOCE (907) 343-8300, FAX ,9'907)249-777"7 - wmew.m.irti.org $f;% aMO Andy Company Address 1089, 0 `1VAI..NUT CIR Gr1d 3W2153 Subdivision F"!� EMEED HU Work Deacrtption [rstafi Ht stalson hock up iriap. performed/Prepaid 0 10 Pi�rnflt Teir.hoici n N,011SA, 'Ahk il7.l ENE 3. Comments OF Diroodons euply marrsri�gs plea Inspection Type E1evtnca'-,Rcj1Ua Electric l Comments (for 'irtspe wase only', Parmit 4 ICJ -6,979 Inspection Data 20 -Apr -201 0 AM Dison 982-26,90 LOT 6 SKI TR rile Inspector - Data MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Mar 24, 2010 Expiration Date: Mar 24, 2011 Permit Number: SW100013 Parcel ID: 015-271-27 Legal Description: FIREWEED HILL BLK 1 LT 5 Design Engineer: 0855 GARNESS ENGINEERING GROUF Site Address: Owner Name: JAMES ROBERTS Lot Size: 12604 SO. FT. Owner Address: 3241 MICHIGAN AVENUE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-1448 This permit is for the construction of: ❑V Disposal Field ❑,/ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907)343-7904(24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Waiver #100006 allows the drainfield to be within 1 foot of the property line. EXPOSED EXISTING AND PROPOSED PIPES UNDER DRIVEWAYS AND PARKING AREAS SHALL BE INSULATED. Received By: Issued By./ YL1 1'IL'% /l(�ti1/Lti'G� v! Date: ?j ? S O Date:2k Z �/Q Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage. Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http:llwww.m un I.org/Onsite Development Services Department Onsite Water and Wastewater Program mrgr No r" o, Department **** VARIANCE/WAIVER REVIEW **** WR#: 100006 HA#:_ Permit#: 100013 PID#: 015.271-27 Legal Description: Fireweed Hill B1 L5 Engineer. GEG Applicant James Roberts Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................................................... Waiver Is Granted: X Waiver Is not Grant Date: 31242010 Approved by v' Y/! Name of Revi wer ............................................ m.seem........................... Rec#: 074660 Amount: $200 Dale Paid: 2116110 **** VARIANCE/WAIVER REVIEW **** Municipality of Anchorage 0*P1 Development Services Department Building Safety Division ° On -Site Water & Wastewater Program 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. O/J - ?7 i "27 Property owner(s) JAMES ROBERTS Day phone 522-5485 • .•• • '� 111FAT0 I III MUR MeOR '. Site address Zip Code 99516 K;t Legal description (Sub'd, Block & Lot) FIREWEED: BLOCK 1. LOT 5 Legal description (Township, Section & Range) N/A Lot Size 12., 60 L( Sq.Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 4 THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. AA—, Permit/Rush Fees:53n Date of Payment: L U Receipt Number: 07 6 (Rev. 11/05) Waiver Fees: Oy Date of Payment:.- rL f U Receipt Number: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS February 15, 2010 Municipality of Anchorage Development Service Department On -Site Water R Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Upgrade for Fireweed Hills Subdivision; Block 1, Lot 5. To whom it may concern: The existing 4 bedroom house is served by private well and septic system. The septic system is in a state of failure and needs to be upgraded. We are proposing that a new 1500 gallon S.T.E.P tank, a Quanics Aerocell unit and a 5 -wide trench type dminfield be installed. On 1/28/2010, one test hole was excavated on the property and no groundwater was encountered to the depth of 12 feet. The perk hole was pre-soaked and the absorption rate was determined to be 13.33 minutes/inch between 4 to 5 feet. The drainfield will be designed around the 30 foot radius of this test hole. Given the original septic system on the property was sized for 3 bedrooms and the house is actually has 4 bedrooms, reserve drainfield sites has been established. As can be seen on the attached design drawing, we have provided two alternate drainfield sites. In order to install these alternate sites, the original drainfield must be completely abandoned. The existing septic tank is to be pumped and completely removed and the area is to be filled with clean gravel material. The contractor must compact as necessary to avoid settling of piping around the tank. Comments regarding the design are summarized as follows: 1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 4. LOT LINE WAIVER REQUEST: We are requesting that a 1 foot lot line waiver be granted from the east property line to the proposed and alternate drainfield sites. We are unaware of any adverse effects this lot line waiver would have on adjacent properties. 5. TOPOGRAPHY: As can be seen on the attached design drawing, the average topography in the area of the proposed upgrade is a 8% running approximately east to west on east half. There are no slopes greater than 25 percent within 50 feet of the proposed upgrade. In short there are no slope concerns. 3701 E. Tudor Road, Suite 101 ' Anchorage, AK 99507-1259 Ph: (907) 337-6179 • Fax: (907) 338-3246 0 Website: www.gamesscngincering.com We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. , P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507-1259 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: www.gamcssenginecring.com / FIREWEE��4LI BLOCK 1. LOj I I ILLU 1 I I. ' 11Ld W BLOCK 1, LOT 7A SEPTIC SYSTEM \� N FIREWEED NR BLOCK 1, LO ---J \ 0 �ARLAD VVf i i / C'MALLEY ROAD I -1� I FIREWEED IBLOCK 1. I J Lam\✓ O 1 \ 1 1 I 1 I I I I 1 ' FIREWEED HILL. I BLOCK 1, LOT 7A I -1� I FIREWEED IBLOCK 1. I J Lam\✓ O 1 \ 1 1 I 1 I I I I 1 SITES T12N R3W SEC21 LOT 9 N2 WELL LOCATED ON NORTHEAST END OF LOT. NO CONCERNS. `' `I\ I PROPOSED SEPTIC SYSTEM FIREWEED HILL / \ . �, (SEE DESIGN. PACE 2 OF 3) 47J LOCK 1. LOT/3 /FIREWEED HILL. \ I I BLOCK 1. LOT 4 \1 I 100' WELL R1.D 1 I i CROSBY LOT 9A \-VICHIGAN SRT EE~T x7 RADIUS I X00• WELL CROSBY LOT 98\\ / FIREWEED HILL \ / / BLOCK 2. LOT 1l� FIREWEED HILL. / / q BLOCK 2. LOT FIREWEED HILL. 1 ILOCK 2. LOT 1 1 L -J I FIREWEED HI L. BLOCK 2. LO �� , 1 too' WELL ns po --�--� F — — — — —— —— --------------- \---------- \ I I WELL ON LOT 2. \ BLOCK 2 AL50 \ I I SERVES LOT 1. / I \ I I BLOCK 2 / ooaoppp0 � OF q�gS��o, GARNESS ENGINEERING GROUP, Ltd. p;?. 4 CONSULTANTS A GENERAL CONTRACTORS . V' M1 [. T100R el>•0. LIR 101 . uRwOWG[. M w v . w.o+[ (corm? -am • In 1107 .L-"" RIMIE ... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: y•A.••••FnC55'••• JAMES ROBERTS 522-5485 1 OF 3 Q -P ' LEGAL DESCRIPTION: DRAWN BY; Ow FIREWEED HILLS SUBDIVISION; BLOCK 1. LOT 5 Iaprotesl&W 0\ J.L.M. ��sp'2�.1y'IR•''��ooG TYPE OF WORK: DAIL: 40QOOpp�QOop� SITE PLAN FOR SEPTIC SYSTEM UPGRADE 1 2/15/2010 (Rev. 01)05) EXISTING SEPTIC SYSTEM -- J SITES T12N R3W SEC21 LOT 9 N2 WELL LOCATED ON NORTHEAST END OF LOT. NO CONCERNS. `' `I\ I PROPOSED SEPTIC SYSTEM FIREWEED HILL / \ . �, (SEE DESIGN. PACE 2 OF 3) 47J LOCK 1. LOT/3 /FIREWEED HILL. \ I I BLOCK 1. LOT 4 \1 I 100' WELL R1.D 1 I i CROSBY LOT 9A \-VICHIGAN SRT EE~T x7 RADIUS I X00• WELL CROSBY LOT 98\\ / FIREWEED HILL \ / / BLOCK 2. LOT 1l� FIREWEED HILL. / / q BLOCK 2. LOT FIREWEED HILL. 1 ILOCK 2. LOT 1 1 L -J I FIREWEED HI L. BLOCK 2. LO �� , 1 too' WELL ns po --�--� F — — — — —— —— --------------- \---------- \ I I WELL ON LOT 2. \ BLOCK 2 AL50 \ I I SERVES LOT 1. / I \ I I BLOCK 2 / ooaoppp0 � OF q�gS��o, GARNESS ENGINEERING GROUP, Ltd. p;?. 4 CONSULTANTS A GENERAL CONTRACTORS . V' M1 [. T100R el>•0. LIR 101 . uRwOWG[. M w v . w.o+[ (corm? -am • In 1107 .L-"" RIMIE ... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: y•A.••••FnC55'••• JAMES ROBERTS 522-5485 1 OF 3 Q -P ' LEGAL DESCRIPTION: DRAWN BY; Ow FIREWEED HILLS SUBDIVISION; BLOCK 1. LOT 5 Iaprotesl&W 0\ J.L.M. ��sp'2�.1y'IR•''��ooG TYPE OF WORK: DAIL: 40QOOpp�QOop� SITE PLAN FOR SEPTIC SYSTEM UPGRADE 1 2/15/2010 (Rev. 01)05) NUMBER OF BEDROOMS: GALLONS PER DAY (CPD): 600 PERCOLATION RATE/S: 13.33 ALLOWABLE APPLICATION RATE: S MINIMUM GRAINFIELD SO.FT.: 120 MAXIMUM DEPTH: 6 FEET MAX. WIDTH: 3 FEET LENGTH: 15 FEET EFFECTIVE: 3 FEET REDUCTION FACTOR: 0.58 ACTUAL SOTT.: 129 /• EXISTING DRAINFIELD TO BE /-EXISTING USED AS RESERVED SITE. PROPOSED 650 AEROCEL \ UNIT ANO JANDY VALVE / ALTERNATE SITE /2. EXISTING DRUNFIELO IS REQUIRED TO BE COMPLETELY ABANDONED ;20' • 2.5' X 3' OF EFFECTIVE • 120 SO.FT.) INTO � G LINE GLG. LIG. HAS A 7 PALL 5PLCRICAIION- • PROPOSED 1500 GALLON S.T.E.P. TANK LETTER THAT PERTAINS TO THIS DESIGN. • TO OBTAIN A COPY OF THE LETTER - �4.� •- TERNATE SITE /1. EXISTING DRWlflELD IS FORWARD CONTACT CEG. BY PRON. ,�. •e --I REOUIRED TO BE COMPLETELY ABANDONED THE WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND 1•\ � L I (12' A S' • 4' OF EFFECTIVE - 120 SO.FT.) PROPERTY OWNER AGREE THAT THEY 1 •-\ ,�, •.. HAVE READ THESE SPECIFICATIONS AND • e 1L L H# a �y I AGREE TO ACCEPT THE TERMS AND ' •• CONDITIONS OUTLINED NOTE: THE CONTRACTOR SHALL HAVE THE EAST LOT LINE, AND ALL WELL RADII FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. \ INSTALL FLOW DIRECTOR EXISTING SEPTIC TANK TO BE PUMPED \p AND REMOVED COMPLETELY. AREA TO BE FILLED WITH CLEAN GRAVEL PROPOSED 5' WIDE BY �S \ 15' LONG QRMNFIELD EXISTING �Z II A "OUSE 1 DOT LOT UNE WAIVER REQUEST Ll I \ I RA 1 100' WELL RADIUSI I U I I ICHIGAN STREET/ 5 E GARNESS ENGINEERING GROUP, Ltd. p°O;'?• H �ll CONSULTANTS i GENERAL CONTRACTORS •"" ' • • "' •"' • • • •' �'. >Nl L R100. 11040. 1,AI[ 101 • YC„gYL(. AK 10I001 • h (101)0.17-1111 • FN (907"-01.1 • K m �w.pwwp.w`y m� PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ......••• ......•••• JAMES ROBERTS 522-5485 2 OF 3 Ire C rness: LEGAL DESCRIPTION: DRAWN BY: PQOy • • CE -7 53 :� FIREWEED HILLS SUBDIVISION, BLOCK 1, LOT 5 J.L.M. OQTs� 'Z�.IS �I•a' oQoG TYPE OF WORK: DATE: Y°o4pO�rofessooOa� DESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE 2/15/2010 (Rw. OCAS) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 3 GENERAL CONTRACTORS -- __- --+ SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: FIRLWELO HILLS; tlLUOK 1, LUI D PERFORMED FOR: JAMES ROBERTS DEPTH ____ ORGANICS (feet) ==:= TEST HOLE 1 1 t 1 1 1 1 1 1 1 GM eIl��I�[.���IIeI►6 DATE DRY 1/28/10 DRY 2/4/10 / Y,,•SERTIC % I'IIIItII L��•� ----- U U 1������ 30 ����i 2 1/4- rM, 2:05 NNE • — 4 III'IIII 30 3 3/4' 4"5 2 1/4- 5 2:35 lilt 6- — 6 3:05 30 DEPTH TO_ GROUNDWATR DATE DRY 1/28/10 DRY 2/4/10 / Y,,•SERTIC % —I ,`P.�•ur /.qs� 1010 J'•.J Gorness: I� E -79 T3 ' :e' \Zflo f esil000a/ / \ FIREWEED HILL \�J�LL+ K 1, LOT 6 NET TIME (MINUTES) /it NET DROP (INCHES) 1/29/10 1 / Y,,•SERTIC % —I L��•� ----- U U ' 30 3 3/4- 2 1/4- 3 2:05 — 6' — 4 2:35 30 3 3/4' 4"5 2 1/4- 5 2:35 — 6- — 6 3:05 30 • e 2 1/4' \ � REWEED L. 41AL CK 1, LOT 4 - _ 4g I 100' WELL RtQh / -;416S;C ♦ ' ' }� ♦ i� 100 DATE READING CLOCK TIME NET TIME (MINUTES) WATER LEVEL READING NET DROP (INCHES) 1/29/10 1 1:35 — 6- — 2 2:05 30 3 3/4- 2 1/4- 3 2:05 — 6' — 4 2:35 30 3 3/4' 4"5 2 1/4- 5 2:35 — 6- — 6 3:05 30 3 3/4- 2 1/4' 19� PERCOLATION RATE 13.33 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4 FT. AND 5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: N YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ANDREW CRAY COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERfORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: Z vChn A O � O Z y0 Oe Z S nw <_f_ 00 A n > C r w m O� cm O r A g t� O O n Zy c Gt 1 mN ,�„F OZA O Qi A 2 I mN ' y v (tC'' ''Om yN .ZIDm O v 1 I y N z f ii y I 00 mlr 2 mm -Z< ,� N mo ' o z N C �1 m O r v U O m D O i O z Cl Zml 2 CE" o g m A y +��mm 0 z O O N m s '"' t^ O + FfA C r0 ti 'O tom., 22 V K > y n n O N A A 2 C O Dom v Z mOm m O O z O m Z CO 1 C m Os< N m Az mmm Nyp 'A0 ti� �� s o O" Ai O A p A CW NA OC Zr_ o -< Cm yy N y ti t ZZ m O A tti�tt y 00 �zf AyyN < z t•t< zo mo mz -uz iimm zo gyma CAm <m t^O A5 zr Zy O m- .l• _ CO 0 0 M2 C m � 'N N pr m 0 A • O 3' OF z EFFECTIVE I o A - Z A T C r m N / c ti m o m rliO m o�06�40��4 r--6 FEET DEEP MAX. e GATE: RAWN BY: �.... ... . ....... ........ 2/15/2010 J.L.M. O LEGAL DESCRIPTION: •• ••••••••• .......... FIREWEED HILLS S/D; BLOCK 1, LOT 5 Y" - v T Y nesse O TYPE DE WORK: GARI�ESS ENGINEERING GROUP, Ltd. 1 a c �s�g3 DESIGN OF QUANICS AEROCELE SYSTEM CCNSULTANiStGENERALGON7FACIOFS ZISII".•�govo >"I t \en bG = x. /.OewOl.. ,net wot ron Y.-•.�Mr. ron u, H.• . ��•• w. r.�.ywr,�, ♦ ` C_o PREPARED FOR. PHONE NUMBER: PAGE: 4404p fessilo JAMES ROBERTS 1 522-5485 1 3 OF 3 M..nicipality of Anchorage MEMORANDUM DATE: December 11, 1986 TO: File FROM: D.N. Bolles, On-site staff 411<jr SUBJECT: Lot 5 Block 1 Fireweed Hills Subdivision On July 16,1986 this office recieved an as -built for a well and septic constructed on the subject lot on October 24, 1986 under permit #840788. Due to concern over the close proxcimity of neighboring systems an infield investigation was pursued with the following discrepancies noted: 1) A driveway had been constucted over a portion of the absorbtion trench, 2) a clean-out designated on the as -built, at the easterly extremity of the trench, was not present. On July 22, 1986 Mr. Kiatchuck, of AECS, was notified of the discepancies. At that time he stated that a HAA had been completed which explained those items. To date this office has not recieved a HAA on the subject lot. Therefor this as -built is being accepted as correct with the understanding that these dscepancies occured after installation and were beyond the control of the engineer. As to the driscrepancies themselves these will have to be addressed prior to issuance of an approved HAA. DNB/db 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 PHONE P<NEW - - � LJ UPGRADE S _ C 4-S TQM --Ns2.M-C - - - - ----- - - w_"" 0 MAILING ADDRESS •rR k} Sup Tc-----1� )C 1I0n A �-E__ l LEGAL DESCRIPTION -L64s-__3_ _HttI_T 12�__ rV 3_w _ 5,:c-- 'ZI LOCATIONv u NO. OF BEDROOMS Al 1 G 1' 1 Cr Wel Absorption area DISTANCE TO: g Dwelling PERMITNO. 4-G v -__10.6 - -- IZQ('dSEp ,7 Materi I _ rEc -- No. of comp menu p --- F- 2 Manufacturer N C 1-1 _ --- - -- G L-- — - -- Licl. rapacity in gallons © 0 IF HOMEMADE: Inside length Width Liquid depth Y DISTANCE TO: Well Dwelling PERMIT NO. J�2 0-F Manufacturer Material - Liquid capacity in gallons J = Well f DISTANCE TO: Fo i ation Nearest lot line PAN PER fT NO. k -o 7& � u z _Lu No of lines Length of each li r _019as&_n _ _ _ Total k ngth f1y t s Trench wilt 1 Distance, l between ines F. Top of tile, to finish grade � r Material beneath rile r ToIa,efface e absolp F area Length Width Depth PERMIT NO. ul a. H as w Typn of crib Cnh di ureter Crib depth Total effective absorption area y DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line. PERMIT NO. J pie)VA-16 Building foundation Sewer line Septic tan l< r Absorption areas) 1 1 1 1 DISTANCE TO: OTHER _— _ � _loovl — — PIPE MATERIALS a -- -- -- - SOIL TEST RATING pp-- rj- L Ci 7 t INSTALLER �n_ _SJT CC>_9 P, REMARKS t7f U , 16 A/ CS_ -UE__ _T/%N_�,But G41 1U�iL�b1i---<5 oe-r •rloENe j+'_m odl- 5 T R 4 1 um- to ra _t�� I T Lid I I I APEROyED DATE LEGAL -,5- L4J C- /O/Ztf/e4t LK- 23 ( I"t1P� Lea.-gl, Hit_0-5 r12,u 3 Sh,C L /z -uta Ittev. 3/R6I u M U Phi I J: F� C) IP" PA C",': R -A C3 F;,�, r.. -N C='p El_�': - DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION - 825 L STREET, ANCHDRAGE9 AK 99501 264 .... 4720 ���..... ��1 -T- E=..,��WE�7'k_. IL_ IP FEE F -RPI I� PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: 840788 09/17/84 ALASKA CUSTOM HOMES 804TH E. 15TH. SUITE #3 ANCHORAGE, AK 99503 276-0288 LEGAL DESCRIP: SUBDIVISION; FIRE WEED HILLS SECTION: 21 TOWNSHIP: 12N LOT SIZE: 12600 (SQ°FT. OR ACRES) MAX BEDROOMS: 3 Listed below are the options available to system. Choose the option that best fits ' 7"IFZ [HE". V4 C= VA DEPTH TO PIPE BOTTOM (FT.) 4.0 GRAVEL DEPTH (FT.) 7.0 TOTAL DEPTH (FT.) 11,0 GRAVEL WIDTH (FT.) 2.5 GRAVEL LENGTH (FT.) 62.0 GRAVEL VOLUME (CU.YDS.) 43.1 TANK SIZE (GALS) 1,000^O ** SOIL RATING (GQ"FT./BR) 287 LOT: 5 RANGE: 3W you in designing YOU[' site. ---~-~-^ ]�FEE: 13 4.0 0.5 4"5 24.0 47"0 41.8 1,000.0 ** 250 BLOCK: 1 your septic *� GRAVEL LENGTH > 75 FT° REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) ** TANK MUST HAVE Al" LEAST TWO COMPARTMENTS I certify that: 1^ I am familiar with the requirements for onsite sewers and wells as set forth by the Municipality of* Anchorage (MOA) and the State of' Alaska. 2° I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances From any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4" Anyn(A fj q����a1e��a�i��i�e�����tasa��l��o��� fte�iMI.-Opum o[ 3 bedrooms and IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS�BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED ~ DATE: ___~?2__���__^�_�-�_~�����__ APPLICANT ALAS ISSUED BY DATE: _��_ ^^ MUNICIPALITY OF ANCHORAGE Department f Health and Environmenta Protection 825 Street, Anchorage, AK. 9501 ci 264-4720 # # # HANDWRITTEN PERMIT # # # Permit # ON-SITE SEWER PERMIT Applicant: J/� �1 �� Q/i 1�_6 L C-1. Mailing Address: Z'�(!> u Location: Phone Number: Legal Description: `� ✓�/ ��c�-e_Q��(.QQ Lot Size: Type of Soil Absorption System Is: Trench: X Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br)_ J 'W7 a {� The Required Size of the Soil Absorption System Is: DEPTH L—_ LENGTH Ll . GRAVEL DEPTH I 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(HOLDING) TANK SIZE _ 1(k)D U 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 3 3 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 enlargement if the r side qe is remgdel�d to include more that 3 bedrooms. SigneZl: Issued by: L- -c 01plicant . Date: _ C _�_6_> - SWP/024(1/81) XSOILS LOG MUNICIPALITY OF ANCHORAGE ���� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION X PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: LANDMARK IDESIG N \X1 A\/ HA\/ 111119e/ LEGAL DESCRIPTION: Loi S IM -ex K 1 F: LEGAL W E tE �J �' I LLS �1 . — _ .. SLOPE SITE PLAN 2 iCl SAnloy, SILTY Sit FrILL 3 S Icy, SO6440ty 4 GQAVFL 5 / � a 6 7 8 t , wai L,401 4a4 L 10 ---1 - WAS GROUND WATER ENCOUNTERED? 12 IF YES, AT WHAT DEPTH? 13 14 15 16 17 18 OF A'i lx%, No 19 - SL O P E Reading Date Gross Time Net Time Depth to Water Net Drop 1 00 1 7 r . �1 .... op I q .... 71S40 20 v 510so 0 hf: go •50 20- 49th J 1in�,� •� PERCOLATION RATE 6J �('(minutes/inch) I. N 2225-E ,?"Cr TEST RUN BETWEEN .�L. FT AND FT COMMENTS �I� n, 1 NE 25. 1971 PERFORMED BY: 72-008 (6/79) DATE: 6% 041-01 a A SMS9r� o SOILS LOO MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION 7 EST 825 L. Stroet, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:_ LANDMARK "DcSIG N DATE PERF-OHMED:__ �__I I .I LEGAL DESCRIPTION:__ c7LL_5 P�\,c)-c <�;____—� .r...A� c i SLOPE SITE PLAN z /,�,% SAcNDy, SILTY FILL 3 O Ity, SOWAC(y n GQAVa L 5 OGCQ.L 46.4 py Y.CDJ 4 6 8 J 10 11 1 vM WAS LNCOUNOTtEREU?ATF_fi 1n L O 1' ! `1 IF YES, AT WHAT . Dlke q� l DEPTH? 14 Date Gross Time Net Time Depth to Water 4 . .I . •. 15 apt ....... . . 16 .E JUNE ; S, L)/117 p— ti 18- 8 - �w OF - 19 .. 1 a Reading Date Gross Time Net Time Depth to Water Net Drop •,� apt p— AAP----- - '��a•��• - - • a e2/O Y2 .5 v s: 161 2 vo 3o 7� 20 : 49H25 PERCOLATION RAT E 30��� (minutes/inch) N -E TEST RUN BETWEEN .�L. FT AND FTCOMMENTS 71 lit, t PERFORMED BY: �� ` CERTIFIED BY: DATE: ., 72-008 (6/79) It is the responsibility of +,e owner or builder, prior to construction, to YE fy proposed build- i:,g.grade relative to finished grade and utilities connections, and to determine the existence .of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. 0 El 0 . � I �e" n� E'ar I 130.03 9 Za_ EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. PROPOSED CONSTRUCTION PLAN (CERTIFIED PLOT PLAN) I. JA 3 0 Ald7--,E ZONED: ELEVATIONS ARE BASED UPON'oO!&iww Wloa•ea► p n ,&.,(q o- N e far L.► i'L !o $lac�t LEGS EXIST ELEVS . ® BRABB CAP MON11MENTr—�,PROP1 Et til- LOT SURVEY CERTI FI CATION o IRON PIPE 9 STEEL PIN — DRAINAGE ARROW LOT 5- BLOCK ❑ SURVEY HUB EA TACK `:•:! ANCHORAGE RECORDING DISTRICT REVISIONS DATE BY PREPARED BY: DOWLING .a, -ASSOCIATES.Residenbe`'oth; 804 EAST 15th Ave; Sulte `•2 pRC1�OSED .CONSTRUCTION ONLY;' ANCHORAGE, ALASKA 99501' DATE: /d .5rp y BY: SCALE: / ki,` 3 pr W0'&'el c�3 (. RB. '.�l' f+O -��/ GRID: 'z 6 Municipal, iy of Anchorage POUC i-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #: 840772 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 5 Block 1 Fireweed Hill Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. if a private engineer inspected the installation of the on-site sewer system, the original as• -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Bandt, Supe visor Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 ...........�....�....�......m-.+a.,..<�.n..nwmr��w-NeN.1R!Mt7".ry1lP'^'f•,��^T'e.TyARR+en ..� .a....nnw..—�.-..n"-. .._. _....__.. .. .. ..._ Isi 6 1 D A;7111_`NT JF HE ALTH AN, ENVIg0-01vk,TAL PF OT =CT IN f! 25L �7R5ETr AN CAO aK 9r) �U1 �. ?t4-472 CN - SITE ;EiEa ry6LL _R''.IT PERMIT NO: 84;77? DATE ISSJE: ?/11l4 AP?LICANT: 4L5SKA CUSTOM a�'^.. 'J LD=_- AD)PSS: 30 15TH SUIT!.: ITI -- -- - - A#CH:)nAG:r Ac v4S�-l1 CONTACT PHJNE: _'76-5331 - EaA1. GAS{?ip: S1i;"<cyIVicl�,'.N: FlPF W_cr} 44ILi --^T: 5 P! OCK: 1 SECT I0 - 1'J�-I TO'1NSH?P; 12'r RaP,'r 71' - LOT SIZE. (S').FT. CR ACacy) SAA "jEDk"JjS ; LIJT�- - DBr"L)W A-?ETk* 0:T.LV: AVHILAE"S LE i, 0� IN DIGNING YOUR SEDT_IC 3Y-STrm, CHt OOSTHY 3PTION THAT --?E iT F ITa OUR SIT= d d. igATV - - - - - - - - - - - - - - - - - - TRE.NCH -0r?T-H- TG P-1 Pr--0TTvM {tT,) 4.0 4.iu 4.-) GRAVEL DEPTH (FT.) TOTAL CEP7i (FT.) I 4 11 7.5 - �R�I-VEL 4�iDTH �fT.) GRAVEL l NJTH (FT.) ! F, ,:) 4 at.O * jRAVrL VOLJ�_ (CJ.YDS.) 4" 1 TkN-K 7bIZ-t {{7ALi) r i'`;.3 « 1 ; .1 +* .J.i1 r,r SOIL AT IN; (S'..FT�/;R) �P7 rf(/ _ + bftVi�lE_ L£VG-TH > 1 F' T. a ;UIk=S "4ULTI�L \? U:S {VET Fx£E`Dil;i ** TAN< 'IL5T hA.V :n T L{=AST T,C CO'AP.APT'I �1Tg - - - - - - - - - -�!- - - - - - - - - - - -4 - - - - - - - - - - - I CFkTAP'Y ,THAT: 1 . I Al '-A IT'L. I ITy TN F TR 75 FT. EAC tail_ - r.hTS FOG 0 rr7WFP, AND 'BELLS AS SET #BkTH IF TMP- 4FaN1,ClPALITY 0r A.. HOPA(3;: (M -)A) ANC, TH= STATF Of ALASKA. wILLt.,INITjALL TH: SY'i Yf IN dC ^,2D4nCE 'dIT4 ALL `"Cz. CODE', AND QEGULATI31 A.ND I`�'y�� LI fvON k'ITHrTh �t'y1JN CRIT ^IA :7F TaIS > ^MIT. - 1 �,iL� A,CTI T3 ALL 110-A A TAS OF ALASKA �«UiREM'�ITS F'P Tf SET Halt DASTANCE5 fRO 1 ANY -XI„ i F '47LLr WAST, ;t AT .1 I::Pt,SA,L SYS7F:4 0« PUBLIC S iv =FAGr Ni,Y`$T._0V THIS^: NY ADJACE';T OR NF4P3Y L:T. I AJ�JrF _STkN6 TKAT T4I P 4M -T I 3 VA+_I) F0? A aAXTMUA {3f 7 aEDROO'AS AND ANY f.VLA.R:itIK 14T W LL ? ,1J'; A'J AJDITIJ?IAS 11 - ISA LIFT-S-TAT10S TvSTALL N ArRFA C 0 V F Y ±•:DA RIJILDInit, CODES,, THcN (li AN ELECTRICAL F,:4111T .AtvD I4%,3P�CTT?hi 1,1 1' ='F 01T4I°dEDi (Z) AS—'3UILTS WILL NOT &F AP?R)V::D 'WIT14OUT }"N FL=CTFTCAL INCDF" TION PFPORT; AND (1) THE L- L-TH_'tAl- sc 1 Ll L;_ 4JYE #-Y A LItC1iSFD EL=CT;lCIAM. a 1'.N?_D DATA:: AP?LICANT: ALASKA CU5TON H3°'_ ,UTLDcRc---- - - - ------------------ -IsSUSD P_�Y (Q2t� D T_: 9/ ------------------------------------- ------ -n----- ut* Municipality of AnchorageAr On -Site Water and Wastewater Program ,�O N� (907) 343-7904 Certificate of On -Site Systems Approva Parcel I.D. 015-271-27 1. GENERAL INFORMATION: Expiration Date: l — T^Z-/ Complete legal description FIREWEED HILL; BLOCK 1, LOT 5 Location (site address) 10890 Walnut Circle *Anchorage Current Property owner(s) Hannah & Quillan Ruf Day phone 830-6380 Mailing address Real Estate Agent 2. TYPE OF DWELLING: © 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 Individual Water Storage ❑ Holding Tank ❑ Community Class_Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment l0 /3Z 22� Date of Payment Receipt Number ©7 01 Receipt Number COSA #�S � 2 1 1 3 ©S 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 Engineering 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: 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. DSD SIGNATURE _ System #1 Approved for 3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, 0 F ......... .. .. ...... ........ J rrVy A. G—,rr-?ess: j9_ CE -7 53Vp ,f 4�\,rofesslo06Qo #AECC884 (rorr�i W04/.with the folfowinipu �,Q TF 0in qN Original Certificate Date: (r 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 _X11^ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: FIREWEED HILL; BLOCK 1, LOT 5 Parcel ID: 015-271-27 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA ® Well log is filed with Onsite (or attached) Well production at time of test 6.0+ 9 p Date drilled 10/8/84 Water storage tank volume N/A gallons Total depth 221 ft Well disinfected for coliform test? ❑ Yes © No Cased to •UNKNOWN ft Coliform bacteria is Negative Q Sanitary seal is functioning correctly Nitrate mg/L] Nitrate less than MRL (ND) ® Wires are properly protected Arsenic ug/LArsenic less than MRL (ND) Casing height (above ground) 18+ in. Collected by GEG, LTD. Date of flow test for COSA 5/25/21 Date of Sample 5/25/21 Static water level at beginning of test 131.4 ft. Comments *ILLEGIBLE ON SCANNED WELL LOG IN MOA ONLINE RECORDS B. TANK DATA Age of tank(s) 11 years STENSTEE; Tank type/material Z Measured operating fluid level in septic tank 48•• ® Standpipes/foundation cleanout per record drawing i U Date of pumping SEE ARM SERVICES MAINTENANCE HISTORY �r C. LIFT STATION ❑ Required maintenance completed Age of lift station 11 years Lift station material STEEL Comments: QUANICS = D. ABSORPTION FIELD DATA 1984 TRENCH Which system tested (date installed) 70124J84 Adequacy test date 5/25/21 r F11-1 ALL standpipes present per record drawing Results ❑Pass For 3 bedrooms �--~- Total measured depth from grade 9.83 ft (max) Fluid depth prior to test 39 in Measured depth to pipe invert from grade 5.75 ft (min) Water added 472 gal ❑ N/A — pressurized field New depth **48 in ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time 120 min depth into effective S°°-405 © Code -required soil cover over field Final fluid depth 43 in © System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) *1747 Gallons introduced gallons If yes, enter date N/A Comments/Deficiencies, 1984 TRENCH FULL AFTER PRESOAK ON 5125121 -WATER LEVEL 1' BELOW INVERT. (2010 TRENCH DRY UPON ARRIVAL- NIT EXTENDS 2.91'BELOW INVERT) 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' ❑✓ Yes **50'+ Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' ❑✓ Yes if No ft Absorption Field on Lot > 100' ❑ Yes if No **50+ ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ✓❑ Yes if No ft [71 Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Q Yes if No ft Q Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No **50+ ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: ❑✓ Yes Absorption Field > 5' ❑ Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' ❑✓ 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' ❑✓ Yes if No ft If absorption field is under driveway comment below Property Line? 10' ❑ Yes if No *1 ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' ❑✓ Yes if No Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑7 Yes if No Surface Water> 100' ❑ Yes if No **50+ ft F. ENGINEER'S COMMENTS // WR#100006 "'AWWTS (..MEASURED 6'8" FROM FIRST COMPARTMENT OF S.T.E.P. TANK TO BEGINNING OF 2010 TRENCH. SEPERATION MAY BE LESS THAN 5'; HOWEVER, BOTTOM OF TRENCH IS HIGHER THAN TOP OF TANK - NO CONCERNS. 1984 TRENCH EXTENDS BELOW DRIVEWAY. THIS WAS ACCEPTED IN 2010. G. ENGINEER'S CERTIFICATION l certify that / have determined through field inspections and review Qom? \' of Municipal records that the above systems are in conformance with �Q/ 4 MOA COSA guidelines in effect on this date. %' COSA Checklist yellow sheet Jer, e A. Gor as,' �c G e\`er ' • ��Z.. ,i r. •' �� O y0� ,_ro f essioao #AECC884 ft ft MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this 2,9 Day of tAp,,4 of 20`2,1 , by and between gt a� t (AA t—LI AMS,,. , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 1 u Al Ir - located at (legal description) 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18.2018) Page 2 of 3 OWNER: By: _ �, - --_ (signature) f.4-1(-�i _......._f_1...1-� (Print name) STATE OF ALASKA ) ) ss. THIRD JUDICIAL DISTRICT } Date: 2Q -2-j The foregoing instrument was acknowledged before me this ono day of 1 20,3by Da\S�_S n'i _. VATS C9 MAOKA NOTARY PUBLIC FOR ALASKA My Commission expires: MUNICIPALITY: By: "� L—E-� {signature) (print name) Date: (..D _g Title: (rev. 05x'18(2018) Page 3 of 3 ARM Septic Services, LLC Maintenance Checklist., Advanced Treatment System T-06- �Ijji Operational Checklist: Advanced Treatment Systern F Legal Description: Street Address: AYE:-�r'C ��r:,,(✓r (,rf Service provided on: Dater//7,.;% Time: 1 OV -._`ti Service provided by: Company: hi'ic�`i'� Employee: ``' =1 ,V) y Date of last service: �,J'_./ % By: (,,'You Other: 1. Type of Aerocell Treatment System: Cat II -AeroCell Treatment System Cat III - AeroCell Treatment System 2. Conditions at media filter: L%Acceptable Ll Unacceptable a. Evaluate presence of odor within 10 It of perimeter of system: Norr �' Mild ❑ Strong ❑ Chemical ❑ Sour b. Source of odor, if present: 3. Manhole Risers and Pipe Caps: LAcceptable ❑ Unacceptable a. Cover/s intact: -E-7es ❑ No r; b. Method of securing cover: c. insulation present on all lids?`42"Yes ! l No d. Any plumbing leaks or water intrusion: ❑ Yes E �!'No e. Surface waterlinfiltration into components: L� Yes Li No 4. Venting/Air supply: Acceptable ❑ Unacceptable a. Air supply unit operating properly. Yes (_ No b. Venting appears operable. , " Yes ❑ No 5. Media surface:'E-Acceptable ❑ Unacceptable a. Biomat on surface. ❑ Yes `�.; No b. Uniform spray pattern. Yes ❑ No d. Ponding in/on media. ❑Yes Ej-No e. Plugging/clogging of nozzles. ❑ Yes 2q -No f. Media appears to be settling. ❑ Yes L'5' --No g. Appropriate maintenance performed. ---2-Yes ❑ No h. Pest activity at surface. ❑ Yes E --No 6. Effluent quality a. Effluent odor after passing through media filter: -None ID Mild ❑ t_�Strong b. Effluent color after passing through media filter:' Clear ❑ Brown ❑ Black 17933 0ld Glenn Highway `Chugiak, AK 99567 office/fax: (907) 688.9433 Email: ARMServicesAKCouttook.com (PAGE 1 of 3) ARM Septic Services; LLC 7. Tasks for recirculating/discharge flows: L�4-Acceplable D Unacceplable 9. Primary Tank: nAcceptable ❑Unacceptable a. a. If applicable, Jandy valve functioning: `J -Yes it No C' N/A Sludge/Scum levels: 1 st: < ' 2nd: `'f r 3rd: b. If applicable, Jandy Valve basin dry: L Yes�� No Ll NIA No c. Cleaned collection system in Aerocell unit: L Yes Ci No i `Not Necessary e. d. Design recirculation ratio: 80 : 20 Tank lids/caps secured after inspection: N"?es ❑ No e. Actual recirculation ratio (Estimated): Last Date Tank pumped: 7 - 2 z - `LE! 8. Pump System: L,A:cceptable ❑Unacceptable a. Control panel in Auto: 1 Yes 1 No b. Timer settings IFS Panel (No Override timer): i ; Yes ON: OFF:—i'7,;.t.,cr."_ Override ON: 2., ^ Override OFF:=''1 'Y' ❑ NIA c. Floats in correct placement: �-Y—es ❑ No d. Floats working properly: Yes C No e. High water alarm operational: � +Yes ❑ No f. High water alarrn count: g. Pump Run Counts: h. Pump Run Time: _ _ i. Float Enor Counts: q N/A j. Total Override Counts: N/A k. Effluent Filter serviced: Yes ❑No I. Tank lids secured after inspection: C Yes ❑ No m. Weep hole functional: �es ❑ Ne 9. Primary Tank: nAcceptable ❑Unacceptable a. Sludge and scum level checked: © Yes No b. Sludge/Scum levels: 1 st: < ' 2nd: `'f r 3rd: _❑ /N/A , c. Tank needs to be pumped: ❑Yes No d. Water softener backwash discharging on system? i ' Yes No e. How many people five on the system?: I,IG-L(6: f) - (�'.. f. Tank lids/caps secured after inspection: N"?es ❑ No g. Last Date Tank pumped: 7 - 2 z - `LE! 10. Drainfield: a. Type of Drainfield (circle one): Bed 5 -wide Deep Trench b. Design Effective depth: _ inches/feet c. Checked Liquid Levels in Drainfield: Yes ❑ No MT#1 Liquid Level: Inches MT#2 Liquid Level: Inches MT#3 Liquid Level: Inches MT#4 Liquid Level: Inches d. Is there any surfacing effluent?: ❑ Yes E. --N o 17933 Old Glenn Highway `Chugiak, AK 99567 office/fax: (907) 688-9433 Email: ARMServicesAK@outtook.com (PAGE 2 of 3) ARM Septic Services, Y [C ' 11./sthe remote monitoring system functioning? (if no, describe incomments) t=�`' []woa. Type of Monitoring systern,b. Phone line working? Yes No N/A � iz,Does tmosystemreceive pnadvisory noUxe/wa,ninQ?(if so, describe incomments) LJYes '�/-mO 1x.|othe system insatisfactory condition/pass inspection? (if no, describe incnmmonu,)4��^ea F-1 NO Other Comments: CN Service Prov 17933 Otcl GLe in 1-11 h ay 'Chugiak, AK 99567 office/fax: (907) 608'9433 Email: 4RMSorvices4K@outkmkzom (PAGE 3 o/3) ` • • Municipality of Anchor ._�� a 9 'o '' •-` On-Site Water and Wastewater Pro. u ^• '`4°4 `6 (907) 343-7904 N y`jail snferY n ),; Certificate of On-Site Systems •royal Parcel I.D. 015-271-27 Expiration:. $ .L. 0)�' `� 1. GENERAL INFORMATION Complete legal description Fireweed Hill Block 1 Lot 5 Location (site address) 10890 Walnut Cir Amanda&Nicholas Petumenos/Timothy Petumenos Current Property owner(s) Day phone Mailing address 10890 Walnut Cir. Anchorage, AK 99516 Real Estate Agent Chris Swires Day phone (907) 338-8292 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for:*Absorption field to property line separation (WR#100006) 1 .0' Distance: Received by: (,/ f '1 4 /111 Date: 1-17q/4 COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ Waiver Fee $ Date of Payment -(0-0 Date of Payment Receipt Number opl IA) Receipt Number COSA# C t 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 Forge EngineeringPhone (907) 522-7773 Address PO Box 240773 Anchorage, AK 99524 Engineer's Printed Name Benjamin Schiller, PE Date 3/30/18 IP',.., I 6. DSD SIGNATURE f• • —Pi' 1.-( /' 9 XSystem #1 Approved for bedrooms rj �;. Ben;.► in Schiller :<� System #2 Approved for bedrooms �#,06)..:.. c {c .'r �.or Disapproved lio\�Nw'``��-� Conditional approval for bedrooms, with the following stipulations: Q �`� OF Mfr, ON-SITE 0ra Z WATER AND - 0 \NAS A EWA TCR o: crk PROGRAM /04 • ih�h/T C`p\I``GG� By: 7 �_ Original Certificate Date: I –Cis I 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 blue sheet r '. c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Fireweed Hill Block 1 Lot 5 Parcel ID: 015-271-27 A. WELL DATA *Original well log is illegible, info taken from other COSA paperwork on file Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Date completed 10/8/84 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 221 ft. Cased to 40+ ft. Casing height(above ground) 24 in. FROM WELL LOG AT INSPECTION Date of test 10/8/84 3/26/18 Static water level 100 ft113 ft Well production 15 gpm 4.6 g p m WATER SAMPLE RESULTS: Coliform Neg colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 3/23/18 Collected by: Forge Eng B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEP/Steel Date installed 4/02/10 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Pumper ARM Services Maint Agreement Date of pumping 4/2/18 C. ABSORPTION FIELD DATA Date installed 4/02/10 Soil rating (g.p.d./ft2 or ft2/bdrm) 5.0 System type 5 Wide Length 15 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 8.5 ft. Eff. absorption area 129 ft2 Monitoring tube Y Depression over field N Date of adequacy test 3/26/18 Pass For 4 bedrooms Fluid depth in absorption field before test in. Water added 600 gal. New depth 1 .5 in. Elapsed Time: 1440 min. Final fluid depth 0 in. Absorption rate >= 600 g p d N Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed 4/02/10 Size in gallons 1500/44 Manhole/Access (Y/N) Y "Pump on" level at Timer in. "Pump off' level at Timer in. High water alarm level at 44 in. Datum Bottom of tank 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 >75' Animal containment areas >50' Manure/animal excrete storage areas 100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line >5 Absorption field >5 >100' Water main 10 Water service line 10 Surface water Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line '0' Building foundation 10' Water main 10' Water Service line 10Surface water 100 Driveway, parking/vehicle storage Curtain drain None Noted Wells on adjacent lots �100' F. COMMENTS *Waiver for 1.0' separation of absorption field and property line (WR#100006) G. ENGINEER'S CERTIFICATION .... oF ...1.0.1.146‘.\‘‘‘ I certify that I have determined through field inspections and ����P:•••• **.t.";40A review of Municipal records that the above systems are in *:• • • .n,l :* conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Benjamin Schiller, PE •••• / •• / •• Benja, Schiller Date 3/30/18 # • 2 92 ,,,,i ,, COSA brown sheet 10-10-12.doc ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY/ OF ANCHORAGE� D AND � GtA /9 G,"t c{ yd-`1110C. �i L(1 THIS MAINTENANCE AND REPAIR AGREEMENT made and entered into as of this ,�j, 614-Day of 401-.4.-1 of 20 18, by and between//`i1r1 L//1. ""6041.411.(1,"e. herein the'`OWNER,"and the Municipality of Anchorage. herein the "MUNICIPALITY." In consideration of the mutual covenants contained herein,the parties to this Maintenance and Repair Agreement agree as follows: I. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS),described as QUANICS AEROCELL located at (legal description). FIREWEED HILL, BLOCK 1 LOT 5 2. Definitions. Alteration. Any change to the design or function of an AWWTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Certificate of On-Site Systems Approval (COSA). An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with Anchorage Municipal Code(hereinafter, "AMC') 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. Permit. An On-Site Wastewater Disposal Permit as required by AMC 15.65 to construct and operate an AWWTS. 3. Term. The term of this Maintenance and Repair Agreement shall begin on the date of approval by the Municipality to operate the installed system or issuance of a COSA, and shall continue while the AWWTS is in use or is operational or until the property is sold or title is transferred by the owner and a new COSA is issued to the new owner or transferee of the property. 4. Alterations, Installation and Removal of Additional Equipment. Prior to performing any alterations to an AWWTS, the owner agrees to obtain an On-site Wastewater Disposal Permit from the Municipality in accordance with AMC 15.65. 5. Maintenance and Repairs. A. Throughout the term of this Maintenance and Repair Agreement. the Owner shall maintain their A W WTS in a satisfactory condition capable of producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. The owner shall enter into a service agreement with an A WWTS service and maintenance provider approved by the municipality and the manufacturer of the AWWTS for the entire term of the A WWTS. In addition, it shall be the responsibility of the Owner during the term of this Maintenance and Repair Agreement.and any renewals thereof, at the owner's sole expense. to pay for any and all: (l) repair(s), (2) maintenance.(3)adjustment(s), (4)replacement costs, and (5) inspection costs. B. Owner agrees to comply with all applicable ordinance, laws, regulations, rules and orders for the AWWTS. C. Upon request by the Municipality, the owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system. When a record of maintenance is documented and maintained by the system vendor,the owner agrees to allow the Municipality access to this information. D. Owner acknowledges that the line for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60 for improper discharge. E. Owner agrees that only maintenance and repair personnel approved by the Municipality will inspect and make any necessary maintenance, repairs or permitted alterations to the system. F. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. G. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On-Site Systems Approval. H. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the construction.maintenance and repair of the Owner's AWWTS. 6. Nonwaiver. The failure of either party at any time to enforce a provision of this Maintenance and Repair Agreement shall in no way constitute a waiver of the provisions. nor in any way affect the validity of the Maintenance and Repair Agreement or any part hereof,or the right of such party thereafter to enforce each and every provision hereof. 7. Amendment. A. This Maintenance and Repair Agreement shall only be amended, modified or changed by a writing,executed by authorized representatives of the parties, with the same formality that this Maintenance and Repair Agreement was executed with, and such writing shall he attached to this Maintenance and Repair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this agreement,the only authorized representatives of the parties are: a. Owner:4/9 in aid GA; rlac,&2 C. 4.6 b. Municipality: Director.Community Development or designated authority C. Any attempt to amend, modify,or change this contract by either an unauthorized representative or unauthorized means shall be void. 8. Jurisdiction: Choice of Law. Any civil action arising from this Maintenance and Repair Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the panics under this Maintenance and Repair Agreement. 9. Severability. Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Main •nance an epair Agreement. OWNER: (2- c..-_ By: %X (signature) Date:7 /..T A.Ex-\nc4'. \• (print name) STATE OF ALASKA ) )ss. THIRD JUDICIAL DISTRICT ) The foregoii:igfinstrurnent wacn vied,ged beforeme thi��'dtfog; 2p/S , by r-rrruth Utei as bi- -- ff `4,LZH A. .. N RY PUBLIC FOR ALASKA til.f... A ht4A :-...5:-"1"- i •LNOTARX �` My Commission expires: a -2---C---t ,, 14)17,(,lfftil4t;t11 '`. MUNICIPALITY: By: v"'N. - (signature) Date: '(--9 -1e (print name) Title: Municipality of Anchorage Development Services Department u Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street S " E T Y P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/ohsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 015-271-27 COSA# c)SC 1\1q-�5 Expiration Date: 1. GENERAL INFORMATION Complete legal description FIREWEED HILL BLOCK 1 LOT 5 Location (site address) 10890 WALNUT CIRCLE ANCHORAGE AK 99515 Current Property owner(s) ALEXANDER S. DUNCAN Day Mailing address Lending agency- „ Mailing address Real Estate Agent Mailing Address 10890 WALNUT CIRCLE ANCHORAGE AK 99515 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 (TESTED FOR 4) 3. TYPE OF WATER SUPPLY: Individual Well ' individual Water Storage ❑ Community Class . Well ❑ Public Water System ❑ Day phone Day TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, .•. "' ordinances, and regulations in effect at the time of installation. Name of Firm ARCTERRA CONSULTING. INC. Phone 868-3792 Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577 Engineer's Printed Narne KENNETH M. DUFFUS Date 11/11/11 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational fife of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future , occupants or can ArcTerra guarantee that no unseen s encroachments, deficiencies or discrepancies existky� 5. DSD SIGNATURE �✓SApproved for _ _ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory PROGRAM Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Q-- ___- Original Certificate ra=ate:___/' 1-�_l Municipality of Anchorage • '� Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: FIREWEED HILL BLOCK 1, LOT 5 Parcel ID: 015-271-27 11 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # Date completed 10/8/19 Sanitary seal (Y/N) Y Total depth 221 ft. Cased to 40+ ft. FROM WELL LOG Date of test 10/8/1984 Static water level 100 ft. Well production 15 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) 24 in. AT INSPECTION 11/2/2011 ft. 5.16 g.p.m. Coliform NEG colonies/100ml- Nitrate ND mg/L Arsenic: ND mg/I Date of sample: 11/02/11 Collected by: ArcTerra B. SEPTICIHOLDING TANK DATA Tank Type/Material STEP/STEEL Date installed 2 2010 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (YM) Y Date of pumping *10/21/2011 Pumper Around the Clock Pumping C. ABSORPTION FIELD DATA Date installed 4/2/2010 Soil rating (g.p.d./ft2 or le/bdrm) 5.0 System type Ouanics-5-Wide Length 15 ft. Width 5 ft. Gravel below pipe 3.09 ft. Total depth 7.15 ft. (Measured 11/2/11) Eff. absorption area 129 ft? Monitoring tube Y Date of adequacy test _11J2/2011 Depression over field N Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 610 gal. New depth 2.4 in. Elapsed Time: 30 min. Final fluid depth 0 in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed 4 /2112010 Size in gallons 1500 44 Manhole/Access (YIN) Y "Pump on" level at Timer in. "Pump off"level at Timer in. High water alarm level at 44 in. Datum Bottom of Tank Cycles tested 2 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 1001+ Public sewer main 751+ Public sewer manhole/cleanout 100'+ Sewer /septic service line 251+ Holding tank 100'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 51+ Absorption field 51+ Water main 101+ Water service line 10'+ Surface water 1004 Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 11+ (WR#100006) Building foundation 10'+ Water main 10'+ Water Service line 10'+ Surface water 1001+ Driveway, parking/vehide storage 1('+ Curtain drain 5o'+ (None Known) Wells on adjacent lots 10o'+ F. COMMENTS *,._...._a .0 G. ENGINEER'S CERTIFICATION ­71. ," '�► Ilk I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name KENNETH M. DUFFUS j Date 11/11/2011►- `r COSA Fee $490.00 pp Date of Payment )y'a 11 y Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-271-27 COSA# 1000 q % 1. GENERAL INFORMATION Expiration Date: Q Complete legal description FIREWEED HILLS BLOCK 1. LOT 5 Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address 3241 MICHIGAN AVENUE 'ANCHORAGE. AK 99516 JAMES ROBERTS Day phone 522-5485 3241 MICHIGAN AVENUE 'ANCHORAGE. AK 99516 Day phone Real Estate Agent DIME OWENS W/ KELLER WILLIAMS Day phone 360-795-0559 Mailing address 101 W. BENSON BLVD. SUITE 503•ANCHORAGE, AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seals fixed hereto and as of the validation date shown below, t verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guit(efines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functionat'and adequate for'the number of bedrooms and type of structure indicated herein. I further verify that based tfn the i k information obtained from the Municipality of Anchorage riles and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SURE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the lost, and separation distances measured to readily Identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefir of the owner listed above. Any reliance upon or use of this report by any other person or party Is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE _Z Approved for ___�L bedrooms. Disapproved. Phone 337-6179 Date a t 6 1c, Conditional approval for bedrooms, with the filowing stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other PROGRAM By:_�//�. �L/. Original Certificate Date: (Rev. 11105) Municipality of Anchorage 0 • Development Services Department' Building Safety Division On -Site Water & Wastewater Program �. 4700 Bragaw Street P.O. Box 196650 w� nchorage, AK 99519-6650 P w (907) 343.7 onsite (907) 343.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: FIREWEED HILLS BLOCK 1, LOT 5 Parcel to: 015-271-27 A. WELL DATA Well type PRNATE If A, B, or C provide PWSIDN N/A Well Log (Y/N) Y Date completed 10/8/1984 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 221 ft. Cased to 40'+ ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/8/1984 12/29/09 Static water level 100 ft. 133 ft. Well production 15 g,p•m. 4.83' g,p•m, WATER SAMPLE RESULTS: Coliform _0 colonies/100 ml. Nitrate <0.1 mg./L. Other bacteria 0_colonies/100 ml. Arsenic: <5 ug./L. Date of sample: 3/30/10 Collected by: GEG Ltd. B..SEPTIC/HOLDING TANK DATA OUANICS AEROCELL SYSTEM Tank Type/Material STEP/STEEL Date installed 4/2-6/10 Tank size 1500 gal Number of Compartments E Cleanouts (Y/N) YES Foundation cleanout (Y/N) Y Depression over tank (Y/N) NO High water alarm (YIN) YES Date of pumping NEW Pumper C. ABSORPTION FIELD DATA -BELOW FlNAL GRADE Date installed 4/2-6/10 Soil rating (g.p.ddftorjIbd 5 System type 5 -WIDE Length 15 ft. Width 5 ft. Gravel below pipe 3.09 ft. Total depth 7.25 ft. Eff. absorption area 1129 ft' Monitoring tube YES Depression over field NO Date of adequacy test ' NEW Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test in. Water added =gal. New depth =in. • Elapsed Time: = min. Final fluid depth= in. Absorption rate >= 600+ g.p,d• Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - D. LIFT STATION Date installed 4/2-6/10 Size In gallons 1500 Manhole/Access (Y/N) YES "Pump on" level at TIMER In. "Pump off" level at TIMER in. High water alarm level at 44" In. Datum BOTTOM OF TANK Cycles tested NEW Meets alarm & circuit requirements? YES E. 9EPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer /septic service line 25'+ Animal containment areas 50'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Holding tank N/A Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line * 1'+ Building foundation 10'+ Water main N/A Water service line 106+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent tots 100'+ F. COMMENTS *WR#100006 G. ENGINEER'S CERTIFICATIONoC�C. `!.'...! • v I certify that i have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this 0 0 date. DO '•.J y Go ess; O Engineers Printed Name JEFFREY A. GARNESS Q �. ,e�CE—J9 N14 Date uJlLlto r^ �� dP,o(essio�d\ I �440000�� COSA Fee $. „. Waiver Fee $ Date of Payment N-11-10 Date of Payment Receipt Number %.r A'4/ 6.— Receipt Number (Rev. 11105) . mw v.~ss w e N.C. OOCNCII LOT TA &LOOK I j/ O • M S 89034'5011E 89.601(MEAS.) FNw N°.�wauw WEST 90.03 ( RECORD) °Oi"AfO� I NEW roCmON/ /OImON 10 Yi1Llly E.SENENi I e I 1 ulFNE Q, W rte`,,: I Fo / O O IL C3 l7 � o•� ° _ 1 eFar I � I• e 0 N N c �I W D O 61NGlEHODS yl i FRAME HOUSE 22,7 N Z ( LT O 0 A' a ri N I n I PNO. IHELP POCTONA N 89°32'1 1DW 90.961 ( MEAS.) WEST 90.03 ( RECORD) j� 4FM1i MfNr11GCG1YM Yl M.yR1 /NN. N.C.CONNE L BOO °°IENLIE aOT OF q �aoor rl .: .491N .............................. N°LT: P o'ru wwl"r`,.Y.i�n....'..1ir., i"`f"f"•"r"r"e�"�':.'De'o".o:D •I..YE 1L. ,. usal• .u`.D'Wr:c"�`D.".�. Y.D.r�e.ea.e„..w. .rorYY wo.w.o.nD..e.oD.w, o•Ro er Ycw.Y .wom N _ • .WMtleOffODOM.rwwrlvl.OMrArf fCPROMr Yeflr4Nueiffo..W Y..6C.RP .�n VM �Yer pJOi` .e 1n.�e ✓ .OYruY 10uRD W.OrwTrYpMrCfgY WOrOYRfr/Ifsf.rr.M. W�RY.r. 1MY� � wr.w� YnMr Wr Y MW1wR M NYlrtttllW 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 Parcel I.D. # 1. GENERAL INFORMATION Complete legal description Lot 5; B.2o ck 1; Fikeweed H.i U Subdivd sion; Location (site address or directions) 3241 Michigan Avenue Property owner Sonya Cathoun Day phone 349-2597 Mailing address P 0 Bax 110062 Anchorage„ Ataska 99511-0062 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS. 3 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX 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 #21 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 Phone Address 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Engineer's signature Date THE CONDITIONS OF THE HEALTH AUTHORITY APPROVAL ISSUED FEBRUARY 20, 1992 HAVE BEEN MITT. 6. DHHS SIGNATURE Approved for Disapproved. !� bedrooms. Conditional approval for Additional Comments By: lurk bedrooms, with the following stipulations: Date l 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 k21 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 Parcel I.D. # �� �'' �� 1 �� HAA # Q (V!,_�r, 1 CYX 1. GENERAL INFORMATION Complete legal description Lot 5; Btock 1; Fixeweed H.iU Subdivi,6ion Location (site address or directions) 3241 Michigan Avenue Property owner Sonya Cathoun Day phone 349-2597 Mailing address P.U.Box 110062 Anchorage, Ata.6ha 99511-0062 Lending agency Day phone Mailing address Agent Day phone Ad d ress Unless otherwise requested, HAA will beheld for pickup. 2. NUMBER OF BEDROOMS, 3 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX 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 #21 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING17034 Eagle Kjver Locp7- Phone Address Sagle River, Alaska 99577 Engineer's signature Date 2,-1 S "12. RECOMMEND APPROVAL ON THE CONDITION THE �e CLEANOUT ON THE EASTERN END OF THE SEPTIC (� s0 aA;�4 LEACHFIELD IS LOCATED AND REPAIRED: AND THAT !�AV �1 'a�m$,� INSULATION IS PLACED OVER THAT PORTION OF THE LEACHFIELD UNDER THE DRIVEWAY. ® .00 OF as*• Yq r9� t�nt� RO ER J SHAFER �u^ No. 215 too. 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for At aw bedrooms, /with the following stipulations: Additional Comments M %tITIC Date 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 021 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: LS1K , FIRewEar_) Au Sh Parcel I.D. 6l5 -ZP-Z Z A. WELL DATA Well type IIWP-_Ira If A, B, or C, attach ADEC letter. ADEC water system number N111 Log present &N) YES Date completed 10/6/S4 Driller SoE: 6i1=L^RorusK �211.1t�"r4 CO, Total depth a Q t Cased to �I r J Casing height ay "+ Sanitary seal N/N) yes Wires properly protected &N) YaS Date of test Static water level Well flow Pump level FROM WELL LOG IUlolB`i 160 r 15 9 -p.m SEPARATION DISTANCES FROM WELL TO: r Septic/holding tank on lot /00i On adjacent lots /00 Absorption field on lot 166'4- _ ; On adjacent lots X60 Public sewer main N/A Public sewer manhole/cleanout _A Sewer service line 80 �_ Petroleum tank WATER SAMPLE RESULTS: Coliform 0 Nitrate mg/J_ Other bacteria d Date of sample: 1 II1'g2 Collected by: S � S EN&iN&,&o/uc, B. SEPTIC/HOLDING TANK DATA Date installed �OylgY Tank size /D00 Gia"c-- Compartments 2 Cleanouts (9/N) Foundation cleanout")yEs Depression (Y/6) f0a High water alarm (Y/6) NZA Alarm tested (Y/© /,J/,4 Date of pumping _ aAAc 2 Pumper R70[A*,0 wwl/N4______ _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots Foundation To property line -Absorption field 8 Water main/service line a5 + Surface water/drainage I fi 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE M AT INSPECTION oz 10ki2. 11'7, r 00 S CO g.p.%.- �; z ui m O z On adjacent lots /00 Absorption field on lot 166'4- _ ; On adjacent lots X60 Public sewer main N/A Public sewer manhole/cleanout _A Sewer service line 80 �_ Petroleum tank WATER SAMPLE RESULTS: Coliform 0 Nitrate mg/J_ Other bacteria d Date of sample: 1 II1'g2 Collected by: S � S EN&iN&,&o/uc, B. SEPTIC/HOLDING TANK DATA Date installed �OylgY Tank size /D00 Gia"c-- Compartments 2 Cleanouts (9/N) Foundation cleanout")yEs Depression (Y/6) f0a High water alarm (Y/6) NZA Alarm tested (Y/© /,J/,4 Date of pumping _ aAAc 2 Pumper R70[A*,0 wwl/N4______ _ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot On adjacent lots Foundation To property line -Absorption field 8 Water main/service line a5 + Surface water/drainage I fi 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE LIFT STATION fJ Date ins d �t Size in gallons Vent (Y/N) High water alarm level "Pump Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DIST FROM LIFT STATION TO: NIA - Wel D. ABSORPTION FIELD DATA On adjacent lots ,,,__Pump off" level at Cycles tested Surface water Date installed �D'�y'��f Soil rating}F� System type 7RENC41 Length 602 Width 37 Gravel thickness 2 Total depth Total absorption area g6$ Sl— Cleanouts present (_i'N) Y&s Depression over field (Y/19 IUo Date of adequacy test all 1 192-- Results 2 Results (pass/fail) n' for 3 Peroxide treatment (past 12 months) (Y/6.J' 1 bNis kNowN If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot �UO r+ On adjacent lots -2.1-� Property line bedrooms 32, PF R. rNcp, i2+roaT. 32 To building foundation a5 To existing or abandoned system on lot A)/� On adjacent lots Cutbank NZ Water main/service line �5 Surface water )60'Pr I/ Driveway, parking/vehicle storage area QIZIUEL(�ft UUi f TR AW Curtain drain NnN�. Krjow,./ n(a UNDER STkPW V7ioij 7.1447 71*_ j?GI T1oN oP T2r,N1GH E. ENGINEER'S CERTIFICATION LkNoit. pwuSw.o-y IS ANO 7_147 114E MISSING CO. is Locg1&21A p OoL I1VrrAu.eogy END UT- TONCM. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect oi,gly date of this inspection. �• (y`l? t. S tk S ENGINEERING Signature 17034 Eagle River Loop Road No 204 Eagle River, Alaska 99577 Engineer's Name Date 2, 1 8 -!1-2 HAA Fee $ I7d� Waiver Fee: $ Date of Payment 0� - 1 � 2 Receipt Number 1S 72-026 (Rev. 3/91) Back MOA 21 Date of Payment Receipt Number