HomeMy WebLinkAboutASPEN RIDGE BLK 1 LT 4Aspen Ridge Block 1 Lot 4 #017-093-04 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201178 Work Type: SepticTank Upgrade Tax Code Number: 01709304000 Site Legal Address: ASPEN RIDGE BLK 1 LT 4 G:3039 Site Mailing Address: 6600 ASPEN RIDGE CIR, Anchorage Owner: HANSON FRANCIS PAUL & Design Engineer: FORGE ENGINEERING This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: enr o c ^ Department 6/18/2020 6/18/2021 51904 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Aj /J Issued By: r Date: ��la!dZ Date: / 4 MUNICIPALITY OF ANCHORAGE r. Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERM/ELL PERMIT APPLICATION Parcel I.D. 017-093-04 Property owner(s) Francis Hanson & Sarah Teaford Day phone Mailing address 6600 Aspen Ridge Circle Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Aspen Ridge, Block 1, Lot 4 Legal description (Township, Range & Section) Lot Size 51,904 Sq. Ft. Number of Bedrooms Four (4) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Waiver Fees: Date of Payment: to 11-tI uw Date of. Payment: Receipt Number: Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade 0 Duplex ❑ (D) Holding Tank ❑ Renewal ❑ MNltiple Dwellings ❑ Privy ❑ F (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. COVID-l9 Permit App_-'-:•;-.,�c2570 DISCOUNT APPLIED Ii 'r 4 (Signature of property owner or authorized agent) Permit/Rush Fees: 225 ��2�� Waiver Fees: Date of Payment: to 11-tI uw Date of. Payment: Receipt Number: Receipt Number: Permit No. 05P 761 N19 Waiver No. COVID-l9 Permit App_-'-:•;-.,�c2570 DISCOUNT APPLIED Ii 'r 4 PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) June 16, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: Aspen Ridge, Block 1, Lot 4 – 6600 Aspen Ridge Circle Well and Septic System Design Dear On-Site Services Engineer: The septic tank on the subject property has passed its useful life and must be replaced. We are submitting this application for a permit to construct a new septic tank. The attached site plan identifies the location of the home and the proposed and existing septic tank sites. No conflicts exist between this proposed tank location and any other well or septic system, whether on this lot or adjacent lots. The new septic tank will be placed near the same location as the existing tank. Storm water drainage will not impact this site. Wells on this and adjacent lots are shown. The new tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption trench. No surface water is within 100’. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. 6/16/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201178, Rebecca Carroll, 06/18/20 10050 0 FEET 1"=50'4-BDRM HOMENOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND ASPEN RIDGE, BLOCK 1, LOT 4 6/16/2020 SHED EXISTING WELL1,250 GALLON SEPTIC TANK w/20" MANWAY EXISTING ABSORPTION TRENCH TO REMAIN IN SERVICE. DECOMMISSION EXISTING 1,250 GALLON SEPTIC TANK PER MOA CODE. MH SV 2CO Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201178, Rebecca Carroll, 06/18/20 72.013 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE �.5 4 S -S v b , DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 3 tf. n5 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAMEC6L PHONE NEW �.114 4X — ❑UPGRADE MAILING AD RESS LEGAL DESCR)PTION25 A� LOCATION ' NO. OF BFDROOMS Well Absorptio area Dwelling l . PERMIT NO. v DISTANCE TO: 5 Y HZ Manufacturer Mater' No. of co partments Wreps Liq. c ac' 'n gallons IF HOMEMADE:NA. Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. Jaz O Z Material Liquid in < Manufacturer capacity gallons O Well Foundation r Near st In � Line PER T NO. 63n -j= W DISTANCE TO: a�j J LL Z No. of lines Length as �ine Total len g o irJes Trench width �� Distance t can lines Z W M= inches , Top of tile to finish grade , at Material benetile Total effective _absorption area O rr inches Length Width Depth PERMIT NO. W a a F Type of crib Crib diameter Crib depth Total effective absorption area Lu W y Well Building foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: • OTHER PIPE MATERIALS r y, Q G D303 C SOIL TEST RATING IfRi Y' 1-:11J3 INS ALLER A r RE ARKS v— V G r > ;e_ N C Z f CO e h JOHN E. SWANSON; i APPROVE OFESSIO ®V DATE LEGAL 72.013 (Rev. 3/78) WELL LOG Date Drilleds Static Water Level 60 feet Draw Down T,' / A feet Type Material Drilleds 0 feet to Gallons Per Minute Total Feet of Casing 155 50 foe' to an —rnlrpl at 60 ft, `10 Feet to 150 C.r'Im('--!--r'rI 1-1"Tdn.-Ir 150 fest, to ?1jn Pqi:--cic to from 60 ft. to 7r) ft-, to Hefty Drilling S.R.A. Box 1553 H Anchorage ,Alaska 99507 V '714 YOIZIO '�Ov N4�01 -YO OIY�4l/)db�j,W AO IV T t Ii A!� n nn T? 1 rI 1A 1_I r -.i I lL-- I �'" hal L I T' °•a•" 17-1 F=' 1=1 t-4 $::-1--" -i F_' 1 ='1 C F= DEPARTMENT HEALTH AND ENVIRONMENTAL ROTECT I ON 825 'L" STREET, ANCHORAGE, AK _ 9501 � �:E,4-4 r 2 0 14 F= 1_ _ I H 14 E> a=e t-4 —!F. . I ?" Imo: '=• F= L4 F: F: F' F=-: F_. r-1 I i PERMIT NO. 830355 cr f APPLICANT PYRAMID EXCAVATING 7125 OLD SEG' ARD HWY 349-6561 LOCATION LEGAL LOT 4 ASPEN RIDGE .UB LOT SIZE 999999 9 =,i"1UARE FEET TYPE OF SOIL ABSORPTION SYSTEM I S . TRENCH MAXIMUM NUMBER OF BEDROOMS _ .. SOIL RATING ;ice! FTS• BR ) =• 21 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM I S. : THE LENGTH DIMENSION I S THE LENGTH (IN FEET) OF THE TRENCH OR DRA I NF I ELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (I til FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION (IN FEET). ir' F=" Q 1._I I F;-= E E " = EE F=' -V I r. -- 'i' n N l-=:: -. I 2-E: = 1 0 0 0 0 �.'..1 L._. L ._ t--# r-4 PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM SRM THIS DEPARTMENT DURING THE INSTALLATION INS,PECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. -- ..._ — _,I.. A-4 f--# < 2 > I 0 4 0w F " E. A......- ..f.. 1Q N:F. 1"1 F Z E= FR IEC-A 1..._I I F;;: F. E-° --- BACKFILLING ....,........-..._.BAS.. KFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND AF'FF:i=iVAL BY THIS DEPARTMENT WILL BE SUBJECT Ti i PROSECUTION. MINIMUM DISTAC•aCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL S`T STEM Is 10 0 FEET FOR A PRIVATE WELL OR :150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC: WELL. MINIMUM DIS,TANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS, OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F="EE l-' M I i" EE X F=" I fes' F= =.- E-• FE r. =- E M e= E: F-' 2- - _. -L =-=4 I CERTIFY THAT :1: I AN FAMILIAR WITH THE REQUIREMENTS FOR ON–=ITE SEWERS, AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES : I UNDERSTAND THAT THE ON --SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. r.I GNEA..__ ___. W _-------------- _______ L 8 ,= 8. 5- G -A_ APPLICANT PYRAM EXC:AVTING S= MUNICIPALITY OF ANCHORAGE Department f Health and Environmenta Protection 825 u Street, Anchorage, AK. 99501 264-4720 # # # HANDWRITTEN PERMIT # # Permit # Ai[]iCJa WELL ANDhP ON-SITE SEWER PERMIT 9V S6� Applicant eo C) � �?Mailing Address: S lnq r�Q� 3%19_ Location: Phone Number: c 7 Legal Description: L y" A-5 Pe /1 el 2 e Lot Size: Type of Soil Absorption System Is: Trench: Drainfield: X _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms:_ Soil Rating(sq.ft/br) �� 7 64 The Required Size of the Soil Absorption System Is: DEPTH 17, LENGTH % 1_f-�D GRAVEL DEPTH 3 WIDTH 5 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 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 residence is remodeled to include more that,X bedrooms. S igne2l:,ate �7' �i:- Issued by: -Y LAisant f Date: CS SWP/024(1/81) SAMkk 7125 OLD SEWARD HWY. & ENGINEERS. INC. ANCHORAGE, ALASKA 99503 S 349-6561 SUIS LU(; I'f_i ;01.A I MN I F.S 1 3 �GcXc-0 0IAA_ I'I�ItI f)IfMLI) 1OIf � 'f/�D �^�a�%Q-�I n linll 1'11111H1M1:1/ SI_ I � SITE I'LnN _ 1 2 3 4 5 6 7 8 9 10 11 12 1;1 14 15 16 17 18 19 20 COMMENTS / /- 3S At . 3r , I-- S.5' G M .8. �'— 1Z/, jAV -460,0,001 4hR t X6 12 000 10/)7) ILA tw /_4eJo s�eai WAS GROUND WATER S T ENCOUNTERED LL / I DEPTH ►r Reading Date Gross Time Net Time Depth to Water Net Drop ILA tw /_4eJo s�eai PERCOLATION RATE �O (minutes/inch) TEST RUN BETWEEN � FT AND FT t/O/N�M CE14TIFIED UY DATE: WAS GROUND WATER S T ENCOUNTERED LL / P IF YES, AT WHAT E /vl DEPTH ►r Reading Date Gross Time Net Time Depth to Water Net Drop owl z off_ - � PERCOLATION RATE �O (minutes/inch) TEST RUN BETWEEN � FT AND FT t/O/N�M CE14TIFIED UY DATE: (ii89 /0• o, _ X71 (S Municipality of Anchorage ., a;., 1On-Site Water and Wastewater Program ij' (907) 343-7904 Q- 1 L018 n 6 ti Certificate of On-Site Systems Approval c. << cu o` . 8 L 9 . 017-093-04 ` l7 `l �Parcel I.D. Expiration 1. GENERAL INFORMATION Complete legal description Aspen Ridge Block 1 Lot 4 Location (site address) 6600 Aspen Ridge Cir. Current Property owner(s) Brooks Chandler& Mary Chandler-Gardner Day phone Mailing address 6600 Aspen Ridge Cir. Anchorage, AK 99516 Real Estate Agent Day phone 2. TYPE OF DWELLING: Li 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 E Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: a� = t Received b -1 rh a_I ., 1 ., — Date: /ill R COSA to be released to the engineer,unless otherwise requested by t e engineer. COSA Fee $ LS i' co- Waiver Fee $ 1 Date of Payment t f il,`) Date of Payment Receipt Number 656.4gr Receipt Number COSA# 0CC-1B I ZG`r2-- 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. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 5/9/2018 �c OF A(,q kkk 6. DSD S\icIGNATURE �•••• • p \ •* System#1 Approved for L/ bedrooms j ' 46 •Steven H.'Pannone• / System#2 Approved for bedrooms ��� 9s, CE-8149 i.,/ Disapproved 1kk\\PROFESS -0,SS Conditional approval for bedrooms, with the following stipulations: IS c iri C 4- t' 3 S.---- PotI (9 )0(_______ L. - i U x, r62 a), c .cS r' 't c (^ 26yvms OLD ��-\\ OF Aivci c�Q • . ON-SITE �<. 3 WATER AND z. o WASTEWATER o PROGRAM 1 /BY t".-,_ —Original W 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 If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Aspen Ridge Block 1 Lot 4 Parcel ID:017-093-04 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 5/12/1983 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 240 ft. Cased to 155 ftCasing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 5/12/1983 4/13/2018 Static water level 60 ft. 51 .7 ft. 4.6 Well production 1 g.p.m. g.p.m. WATER SAMPLEjjRESULTS: n ��--L� Coliform 1'a'1 colonies/100 mL Nitrate ; 0 mfg/`L Arsenic NV ug/L Date of sample: i�f v Collected by: PF S B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5/12/1983 Tank size 1,250gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N Date of pumping 10/30/2017 Pumper Northland Pumping C. ABSORPTION FIELD DATA Date installed 5/12/1983 Soil rating (g.p.d./ft2 or ft2/bdrm) 213 SF/BR System type Deep Trench Length 88 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 7.3* ft. Eff. absorption area 1,320 ft2 Monitoring tube Y Depression over field N Date of adequacy test 4/13/2018Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 32.5 in. Water added 600 gal. New depth 32.5** in. Elapsed Time: 90 min. Final fluid depth 32'5** in. Absorption rate >= 600+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS Survey on file. *Monitor tube does not reach to bottom 2.7 feet of field. **Water level assumed to be just under bottom of monitor tube. G. ENGINEER'S CERTIFICATION .,�~��F�\\ I certify that I have determined through field inspections and woj:- •� review of Municipal records that the above systems are in 0*'. • 1- j *�f9 conformance with MOA COSA guidelines in effect on this date. 1••••VIP� • •••• / Engineer's Printed Name Steven Pannone 0••:Sieveri W. 06ririori :•' 5/9/2018 6 CE-8149 ..,�/ Date 9I / •• %%..•• COSA canary sheet_2-6-15.doc MUNICIPALITY O_ F ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT i • •• ''1' 907-343-7904 On-Site Water and Wastewater Section Fax: 343-7997 www.muni.org/onsite Septic Tank Advisory Certificate of On-Site Systems Approval # OSC181202 Subdivision: Aspen Ridge Block:1, Lot: 4 The septic tank for this property is 35 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. :" )4t 1%1' i, aTififc'f,;:.., ' — , • • , le, tr- a ` ','�. K �ins. y?"Y ae btry S Y .} V ' fir,. y ' e !; � A Vja Y �A X44 r Mailing Address: P.0. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org Municipality of Anchorage Development Services Department Building Safety Division \ _ y On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. _ _ N q -v93 -D1-4 COSA# Mog()7� Expiration Date: 1. GENERAL INFORMATION Complete legal description Lot 4; Block t; Aspen Ridge Subdivision Location (site address) 6600 Aspen Ridge Cir. Anchorage, AK Current Property owner(s) Marcnia Biaszak Day phone 244-8584 Mailing address saIle Lending agency Day phone Mailing address Real Estate Agent Kathryn Donahue Day phone 562.6464 Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site❑ Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S a s Engineering Address 15861 S. Birchwood Loop Chu '6k, 9567 Engineer's Printed Name 5. DSD SIGNATURE _y/f Approved for q bedrooms. Disapproved. Phone 694"2979 Date ZS C7 3 Conditional approval for bedrooms, with the following stipulations: M ON-SITE-- Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Nitrate Advisory Other ey: '119' 1 'ff1tM (RM 11005) Original Certificate Date: r k Municipality of Anchorage \+ • Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore 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: T JCGrK 1 � H . EL 6r_ `r D Parcel ID: 017 -Mg -O i A. WELL DATA Well type i fly If A. B, or C provide PWSID #= Well Lo&Y J) Date completed 4'133 Sanitary seal (/) ses Wires properly protecte (rCN) (to, Total depth-240—ft. Cased to 15$ ft. Casing height (above ground) If+ in. FROM WELL LOG Date of test .511 dt3-5 r Static water level ti� ft. Well production 1• g.p.m. WATER SAMPLE RESULTS: Coliform -0-Colonies/100 mL Nitrate )�J] mg/L .Arsenic: 4 ug/L date of sample:Olce6 AT INSPECTION � Da • 9.p -m. Other bacteria O colonies/100 mL Collected by: L,4- J G&XJJ1U(MXXp B. SEPTIC/HOLDING TANK DATA Q Tank Type/Material S>✓ IG. Date installed S IZ• 3 Tank size 1950 gal. Number of Compartments a Cleanout<Fm) Foundation cleanout®Pl) Depression over /ntank (Y IVO P- High water alarm (Y� /�� Date of pumping f Ob Pumper 4f- Yh-ES&•ILLS C. ABSORPTION FIELD DATA Date installed 5Ll Z v3 Soil rating (g.p.d./ftz ielbd 13 System type—T—REX" Length ft. Width $ ft. Gravel below pipe %' ft. Total depth ft. Eff. absorption area Left2 Monitorin tube , Depression over field to Date of adequacy test - Resut (Pas /Fail) )GS For-4—bedrooms ,� u Fluid depth in absorption field before test C� in. Water added gat. New depth in. r� Elapsed Time: 160 min. Final fluid depth (Q_ in.Absorption rate >= Cto+ g.p.d. 11 Any rejuvenation treatment (past 12 mo.) (Y& type) JO If yes, give date _ D. LIFT STATION 01A Date installed Size in gallons "Pump on' level at _in. 'Pump o lai= Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 1 Septic tank/lift station on lot 100 fi Absorption field on lot /00 "' Public sewer main VIn Sewer /septic service line aS r4 - Animal containment areas 50,+ High water alarm level at Meets alarm & circuit requirements? On adjacent lots we �- On adjacent lots 100 4 Public sewer manhole/cleanout] A - VA Holding tank 2l Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: r r t Building foundation `� f Property line $ F Absorption field S Water main _ Water service line /0 + Surface water /G) Wells on adjacent lots IQ0 I+ - in. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: % Property line 1D + k Building foundation (O 4 Water main � / r ) Water Service line /d / Surface water. /do f Driveway, parking/vehicle storage /O + Curtain drain UOV6 KIVGYLIU Wells on adjacent lots /00 r'r F. COMMENTS Ftow eArr- A7oT�yHPI� QED-sat�seBu cIr U&nTUoA7S cam) c-)ctOQ. G. ENGINEER'S CERTIFICATION I certify that I have determined review of Municipal records T conformance with MOA COSA gt Engineer's Pri Date �1 COSA Fee $_ Date of Payment Receipt Number (Rev. 11/05) h field inspections and above sysfeims are in Y�� �•.G _� Waiver Fee $ Date of Payment Receipt Number Cor 5 1102 197-r- 10 97.6.c✓....- 100—pR'N6� " -I— T M4SONAAY R.W.g I �1 WI MPrlC spa -COT 3 lD=TELE �'ELECr ESithT. Lot 4 , Block . Aspen Ridgy alLlivision Anchorage Recording District, Alaska (8Z'/,95) LOT SURVEY CERTIFICATION I Iw.by Witty that move evrvoyed the property sawn end deoerlbed hater, and that the Impraeewts situated thereon as •lthln the prop - .ay un.. " do not ce.rlep or baKeoh an adjacent property end that no I n "ay.arlHe an edioteat property wodap or Increase on the pnmtwo In accetloo and that In" are so roadways, uttdly lift. or other vidblo oae.nents on said property@adopt on Indlealed hereon. Scale /„ 50t Date o © �0'5 /5-G23 Ret 3039 1 F.B. No. 0:5-037 OF L L Button MI 192 Qnwmsato of a other how Mow ota.n on the plot of record are not shers on hovn ra value. OlotherwiseneLd.d. LEGEND 0 Bross or Aluminum capped monument recovered O Iron pipe and/or tabor. recovered. 0 2 x 2 hub 6 tack recovered 0 5/8' x $0" rebor set this survey ---II— Fence L16o (Approx. Location) Prepared by: R. L. BUTTON Registered Land Swveyw (907)279-6200 $/9 W. Eighth Ave. Anc%rage A/aska9ZO/ Property of: ;ebbe/-1 B/as,Z,aA MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICES_ s, .t 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 l.D.# 1-0�(3-0� _HAA#, NAg404:730 1. GENERAL INFORMATION Complete legal description Lot 4; Btock 1; Aspen Ridge Subdivi6t.on Location (site address or directions) 6600 A4pen Ridge Anchorage, AK Property owner Lanny and Lucie Di.6bnow Day phone 564=6332 Mailing address P•0. Box 110527 Anchorage, AK 99511 Lending agency Day phone Mailing address { Agent Beth Vmmon/ SIMPSON •CO Day phone 345-1020. ' 12350 Indu,6tny Ulan Anchorage;` AK 99515 'Address z v 4i zx_ Unless otherwise requested, HAA will be held for pickup. 2 NUMBER OF BEDROOMS. 4 +` fh f 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If communi well s stem ` ty y ,provide written confirmation from State ADEC attest mg to the legality and status of system. 4 TYPE OF WASTEWATER DISPOSAL:1.+y' Individual on-site',;,.XXX ' ►,' ,, a ' C� ••i xR r Holding tank Community on site '� ',i t 7` _ �ir r: , Public sewer !ti FA kt31. ,., t• T'. 9y J-'.+ ♦ t � }}1F ..,s,.vZ ,_wj' r,x. --•-+••` ��` k,�i'wtr.�x �xr_ .--,`� ;- r.l , E.!',,si,�i��l� x' �a '��f ' TE:,- If community wastewater system, provide written confirmation from State attesting to the legality and status of system :3 ' Y, jj`a'kx i '�. 4. ''" h��y�A,. z "ai'Alj 2 1 4 i h<�'x' 'tM-025(Rev 1/91 Front MOAN21 • �,r�'�}��„a r un i .s 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. S& S ENGINEERING Name of Firm Phone b `� Address Eagle River, Alaska 99577 Engineer's signature Date- // l,. l R y a~ OF ^ Q 4 � .• 1 �nawwas,u .• aaaaa as rias .-.ccei' tia�F9S ROBERT C. COWANIIa•t CE - 8801 6. DHHS SIGNATUREa;d pRaFrss���i�'��''� Additional Comments A� ' Date .. x II • d :P=CAUTION .�_ ti?he Municrpality of`A ichorage Department of Health and Human Services (DHHS) issues Health Authority . ,,,Approval Certificat4s based only upon the representations given in paragraph 5 above by an independent proiessroMl enj 4eeregistered in the State of Alaska. The DHHS does this as a courtesyto purchasers of homes and higli 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 omiss)ons in the professional engineer's M-0?5 (Pfau 1/91) MOAN21 BW* �. �R6����Kfi, i *' •+ to Municipality of Anchorage .� Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo7- l3�uc.00 / }s� �Parcel I. D. A. Well Data Well type Pr v 4 %f If A, B, or C, attach ADEC letter. ADEC water system number Log present 1&/N) i Date completed. S^ 2 3 Driller Ii if- F r Y D v? r L u ,ti G Total depth "X-10 Cased to ! S ­Casing height Sanitary seal (Y(''N) iy Wires properly protected (Q)/N) y Date of test Static water level Well flow Pump levell FROM WELL LOG r J,:z,/ir3 60 i AT INSPECTION rm a'z / g.p.m. y g.ff." ?, SEPARATION DISTANCES FROM WELL TO: Septic/#eleli— tank on lot Absorption field on lot Public sewer main Sewer service line Jul /+q s- 0 WATER SAMPLE RESULTS: Coliform D Nitrate 311 '^� �� Other bacteria p 11 I I s l `r `l Collected b -S S, s Date of sample: y: B. SEPTIC/WOt ffMTANK DATA a t ,n (.-INi ¢ PeI V(r Date installed S / ) z h 8' 3 Tank size / S-0 Compartments Cleanouts (DN) Y Foundation cleanout &N) y Depression (Y/&I High water alarm (Y/N) N /q Alarm tested (Y/N) N 1A Date of pumping i� 11 l `)'i Pumper w0/Lr H LJ9,,'-o Pu M,06NC SfAVI z SEPARATION DISTANCES FROM SEPTIC/HeL4W46 TANK TO: r � Well(s) on lot 00 On adjacent lots 10 r � / To property line G + Absorption field Surface water/drainage 72-026 (3/93)" Front Foundation a s - Water main/service line CONTINUED ON BACK PAGE ® -' w 17b v rn S co � � / r" G o c On adjacent lots /00 N On adjacent lots ) 0 0 Public sewer manhole/cleanout '� %A Petroleum tank 'V0,� p-- G, ,10 L "J WATER SAMPLE RESULTS: Coliform D Nitrate 311 '^� �� Other bacteria p 11 I I s l `r `l Collected b -S S, s Date of sample: y: B. SEPTIC/WOt ffMTANK DATA a t ,n (.-INi ¢ PeI V(r Date installed S / ) z h 8' 3 Tank size / S-0 Compartments Cleanouts (DN) Y Foundation cleanout &N) y Depression (Y/&I High water alarm (Y/N) N /q Alarm tested (Y/N) N 1A Date of pumping i� 11 l `)'i Pumper w0/Lr H LJ9,,'-o Pu M,06NC SfAVI z SEPARATION DISTANCES FROM SEPTIC/HeL4W46 TANK TO: r � Well(s) on lot 00 On adjacent lots 10 r � / To property line G + Absorption field Surface water/drainage 72-026 (3/93)" Front Foundation a s - Water main/service line CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DIST Well on LIFT STATION TO: On adjacent lots Manufacturer Manhole/Access (Y "Pump off" Level at Cycles tested D. ABSORPTION FIELD DATA Date installed S_ /) ;L / 3 Soil rating (GPD/Ftz) Surface water ;c rZ B 1 3 System type 7- R k N c y Length 5 Width 3 Gravel thickness 1-3 Total depth /0 Total absorption area / C S` 6 Cleanout present (Y/@1 N Depression over field (Y9 tV Date of adequacy test 11 / + S^ / R y Results (pass/fail) PA S S for Bedrooms Water level in absorption field before test 0 After test a Peroxide treatment (past 12 months) (YA H O- C K 0 w r) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ) o c To building foundation On adjacent lots S`0 r f On adjacent lots i for �f If yes, give date Property line 3 f To existing or abandoned system on lot _ Cutbank 1 0 o /y Water main/service line Surface water /00 -i- Curtain drain N 0 N# K �^' 41 w r/ E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area 1 certify that l have checked, verified, or conformed to all MOA and HAA guidelines in Signature Engineer's Name K o d f ,2 T Co w 4.1/ Date // / )_o >/q y c -C HAA Fee $ �-;4D b Waiver Fee $ Date of Payment ` G Date of Payment Receipt Number / % Receipt Number 72-026 (3/93)" Back 3 da4oilhis inspection. Commercial Testing & Engineering Co. L Environmental Laboratory Services SINCE 1908 CT&E Ref. 94.5800-5 LABORATORY ANALYSIS REPORT Client Sample ID L4 BLKl ASPEN RIDGE S/D Matrix WATER Client Name S & S ENGINEERING WORK Order 10873 Allowable Ext. Ordered By R.J.S. Printed Date 11/21/94 @ 12:16 hrs. Project Name Collected Date 11/15/94 @ 14:00 hrs. Project,'# Received Date 11/15/94 @ 14:30 hrs. PWSID UA Technical Director STEPHEN C. EDE Released B% Sample Remarks: ROUTINE SAMPLE COLLECTED BY: S.S. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -------------------------------------------------------------------------------------------------------------------- Ni:.rate-N 2.39 D mg/L EPA 353.2/300.0 10 11/18/94 MCE * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed 91 = Undetected, Reported value is the practical quantification limit. LT = Less Than a) = Secondary dilution. GT = Greater Than cv u 5633 B Street, Anchorage, AK 99518-1600 — Tel: (907) 562-2343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA 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. # 017-093-04 HAA # HA920148 1. GENERAL INFORMATION Complete legal description Lot 4 Block 1 Aspen Ridge Subdivision Location (site address or directions) 6600 Aspen Ridge Circle Anchorage, Alaska Property owner Mailing address Michael Armstrong Day phone Arlington, New Jersey Lending agency Day phone _ AAnilinn gHrlracc Agent RoseAnn Alexander % Coldwell Area Barl2F,Wph(MW. Address 4105 Tudor Centre Drive, Anchorage, Alaska Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Four (4 ) 3. TYPE OF WATER SUPPLY: Individual well xxx Community well Public water 561-2488 99503 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 xxx 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 Engineerin Phone 694-2979 Address 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 Engineer's signature This is a duplicate original from DHHS files. The copy of the origninal Certificate is on file with DHHS if there are any questions. The original has been misplaced. 6. DHHS SIGNATURE xxx Approved for four (4) bedrooms. Disapproved. Conditional approval for Additional Comments Date bedrooms, with the following stipulations: By; 9,344 my= Date March 18, 1992 4l1Tlr 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 #21 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES T 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. # C1n -(n3 — I LA HAA # k�Qo�a®�'A 1. GENERAL INFORMATION Complete legal description Lot 4; Btock l; Aspen Ridge Subdiv.i6ion; Location (site address or directions) 6600 A6pen Ridge Citccee Property owner M.ichae_ Atcmstkonq Day phone Mailing address Atc.P.%ng,*an, New 1en�sey Lending agency Day phone Mailing address Agent Raze -Ann A.Poxandu C01 12WFI I AREA RANKER -INC. Day phone 561--2488 4105 Tudotc Centtze D, i.ve Address Awph,94age, AZ"ka 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 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 A By: 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 Phone Address 17034 Eagle River Loop Road No. 204 ac7 a wer, as a 9577 Engineer's signature DHHS SIGNATURE Approved for bedrooms. Disapproved. Date gM'�' 9 F�4ry�Y 1 Conditional approval for bedrooms, with the following stipulations: Additional Comments Date 3 i8 y2 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 #21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Loa '-/ I &K 1, /FSA' IcrDG€ /p Parcel I.D. A. WELL DATA Well type �ktuA:?tz If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) yds Date completed Driller4->=7V U121LQ/UC_ Total depth a4C , Cased to 15c�, r Casing height I,� 11+ Sanitary seal 6)N) Y—ES Wires properly protected (ON) FROM WELL LOG AT INSPECTION Date of test .5"12- 8 3 3- 5- 2 MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Static water level 60 51 Well flowU 9 1992 g.p.m. 3�0 g.p.m. Pump level Ulc 190t RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 100r + ; On adjacent lots Absorption field on lot 100'+ ; On adjacent lots Public sewer main A) A Public sewer manhole/cleanout Sewer service line rJ0 '� Petroleum tank NO WATER SAMPLE RESULTS: Coliform 0 Nitrate o1 0 � Other bacteria Date of sample: oZ J aC 1i 2 Collected by G B. SEPTIC/HOLDING TANK DATA Date installed 5I 1Z4 83 Tank size 1;�So GA'L Compartments oZ Cleanouts &N) ES Foundation cleanout &N)yES Depression (Y/1 High water alarm (Y6 N A Alarm tested (Y/G rJ Date of pumping 3 L y 1 `1 z Pumper t1 t NOAAE. SI -R rc.F.S SEPARATION DISTANCES FROM SEPTIC/ fNG TANK TO: Well(s) on lot /Oy,'f On adjacent lots _ /DO rf 1 Foundation �5 To property line LID '4' —Absorption field S Water main/service line SO Surface water/drainage 1�0 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION A Date ' lied Size in gallons Vent (Y/N) "Pum " level at Manufacturer Manhole/Access (Y/N) High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DIST E FROM LIFT STATION TO: Well o On adjacent lots D. ABSORPTION FIELD DATA "Pump off" level at Cycles tested Surface water . Date installed 5—jLU Soil rating 21`Z�l SF�!$IZ System type TIZEA N ! 11 / ! Length 88 Width Gravel thickness 6 Total depth 10 Total absorption area lob Sr Cleanouts present (Y/O roo i Depression over field (Y/l l %yb Date of adequacy test Results (pass/fail) PASS for �% bedrooms Peroxide treatment (past 12 months) (Y/ I Q'T ��wu If yes, give date r1J A SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot loo t On adjacent lots f Od I Property line_ To building foundation 10'4- To existing or abandoned system on lot On adjacent lots so 1+- Cutbank /00l4- Water main/service line Surface water 100'+ Driveway, parking/vehicle storage area Curtain drain NuIS& �Nowto E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. � OF S & S ENGINEERING ,F,g�"�A'�eas��scec��";_ Signature 17034 Eagle River Loop Road No. 204 go? Co ®& Cade River, Alaska 99577 �� �� , i;' ;� ; r Engineer's Name sc aaxa�a m Wasai Date 1.lik':7My,;c uh6AFEFt m 4 e_J t1i HAA Fee $ r %& Date of Payment � 3 9-9 v Receipt Number 3 5 0 3 L? S 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 4 ur LABORATORY CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. k 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 Client Sample ID L4 B1 ASPEN RIDGE S/D PWSID UA Collected FEB 26 92 6 18:00 hre. Received FEB 27 92 4 12:15 hrs. Preserved With AS REQUIRED Analysis Completed FEB 28 92 Laboratory Supe rvieo S PHEN C. EEDEE Released By : G G/ ANALYSIS RESULTS for INVOICE # 51469 Chemiab Ref.# 92.0757 Sample # 7 Matrix: WATER Client Name :S & S ENGINEERING Client Acct :SNSENGP BPO# Req# Ordered By :R. SHAFER Send Reports to: 1)3 & S ENGINEERING 2) PO# :NONE RECEIVED .................................................................................................................................... Parameter Results Units Method Allowable Limits ------------------------------------------------------------------------------------------------------------------------------------ NITRATE-N 2.0 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BI: J.W. Remarks: .................................................................................................................................... 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected "" See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than ANN SGS Member of the SGS Group (Soci4t6 GBnArale de Surveillance) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date A =� (a) Legal Description (include lot, block subdivision, section, township, range) u T' 4:2c" 1-1 .2-C -=,i j Q ��Czz . Location (address or directions) v ?-7(a 36 38 (b) Applicants Name je:ayt ��/rJ 5.C'�✓ Telephone - Home Business Applicants Address (c) Applicant is (check one) Lending Institution ; Owner/builder[; Buyer �[; Other E::l (explain); (d) Lending Institution 4elephone 2-2r, Q: � Address (e) Real Estate Co. & Agent����� Address Telephone (f) Mail the HAA to the following address ! --S / E=, 7k,`r z� fit.► �t : /� f 2. Type of Residence Single -Family r_5;ZT Multi -Family Other (describe) Number of Bedrooms 1 3. Water Supply Individual Well 5z Community M 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 O.nsiteF5;�7T Public Community Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 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 Telephone 'I- (Q Z Address Date z L ���;✓ °e`•�� AW COD (ENGINEER SEAL)•°•�° °°•®°°°`'°• '°°"®•® ®,� �Y c Vf eo0•°eee o' THOMAS R. MSTH ee M9 6. DHEP Approval �� I °°°° 2248--E ,' n eOeeO•eee°� q 4 4 Approved for bedrooms By Approved Disapproved Conditional \ f CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIO* 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 DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 21 7-19-84 lPage 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating -in Absorption Strata �- .� Type of System Designry Date .Installed Length of Field, Width of Field �; " Depth of Fielcj/� Gravel Bed Thickness . %2, Square Feet of Absorption Area Standpipes Present WN) y�S Depression over Field (YIN) A�,a Date of Last Adequacy Test %wQ Results of Last Adequacy 'lest "-" Separation Distance from Absorption Field: i To Water -Supply Well To Property Line To Building Foundation To Existing cr Abandoned System Cn Lot A1,,4 ; on Adjoining Lots Z-0— <--) e le To Water Main/Service Line A-114 To Cutbank(if present) A -lo..-# To Stream/Pond/Lake/cr Major Drainage Course To Driveway, Parking Area, Cr Vehicle Stcrage Area Cant nts D. LIFT STATION- ; Date Installed Dimensions Size in Gallons Manhole/Access (YM) „Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes(YM) Comments Check Permitted Bedrocm Rating Against HAA Request ** I certify that I have checked, verified, cr conformed to all MOA HAA �' sin effect on the date of this inspection. , f' J Signed Date 2 ��e • •'e" Carly _ ����--r4 MOA I3o. t� .. pfd, ..:e.> RBl/d5/s THOMAS R. SMITH i # X1.7 �¢ •' 2248-E �� �O•0000000'•� [Page 2 of 21 2-15-84