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HomeMy WebLinkAboutATELIER #1 BLK 2 LT 5AAtelier #1 Block 2 Lot 5A #041-031-45 PERMIT NUMBER: PARCEL ID NUMBER: OSP131461 AS -BUILT DRAWING 041-031-45 A B C ST117.53 49.46 27.91 MH MH 24.66 56.27 20.70 / POD1 22.22 54.38 23.35 OPGD2 26.61 58.76 22.49 / \ CO1 26.26 57.96 78.98 F.D. 27.22 58.94 18.10 :`r• MT7 86.16 10 72.45 - ..4RIVEWAY g•:,,: ,. \\ \ MT2 82.02 95.74.74 71.47 _�-�---�-----`- CO2 96.62 109.13 84.93 Imo\ LOCATION OF MT4 95.87 108.01 84.91 CURTAIN DRAIN, PER OWNER �. CO3 93.07 104.14 84.44 I I J` ,...J SCALE: MT3 92.10 103.15 83.60 SHOP �`' /;. 7 700' 1 _ \ TH#1 NEW DRAINFI ID ,,11,, 3 1:•, i LJ ��OS \ \ MTOOCO33 I� /�.Y D NEW 1500 T2 \ 4- y`.D„Pi:Nis GALLON F..•1� II II MT u L1l STEP TANK FLOW DIVER R VALVE 01 �-:.:'..+:•p :.•: e. �`� I -�� Ho l I Pi FC.. • EXISTING 4 BEDROOM \ ,.P2 HOUSE ATILIER #1; BLOCK 2, LOT 6A / �\ / EXISTING 1994 TRENCH 7 , ATELIER#1; BLOCK 2, LOT 4 GAR_NESS ENGINEERING GROUP, Ltd - -= CIVIL & ENVIRONMENTAL ENGINEERS,- . 3701 E WD RW, SN@ 101 . MILIIORMY. Olc 99507 . aunuc loon sv_awe . oo .e,.n ... ._. PREPARED FOR: MIKE MCINTIRE LEGAL DESCRIPTION: ATELIER #1; B TYPE OF WORK LOCK 2, LOT 5A AS -BUILT DRAWING PHONE NUMBER: PAGE NUMBER: 907 240-1102 2 OF 3 DRAWN BY: DJG DATE: 11/12/ 4#4IIIIIIII4YAA E %xvill, Ca PERMIT NUMBER: PARCEL ID NUMBER: OSP131461 AS -BUILT DRAWING 041-031-45 FINAL GRADE = 98.01-98.82 ADVANTEX 24" INSULATED AX20 POD RISER TOP OF TANK AT OUTLET = 94.44 INSULATION TOP OF TANK AT INLET =94.36 / TOPSOIL & SEEDING Yom%WILL BE DONE IN THE SPRING OFF __ _ ....................... ________________ _ _ _ _ 2015. INVERT OF BUNG AT INLET = 93.76 1500 GALLON STEP TANK i L ORIGINAL GRADE @ INSULATION HIGHEST POINT=81.32 FINAL GRADE FILTER FABRIC =83.71-83.99 r SAND TOP OF SAND = 80.32 15' LONG -RELATIVE ELEVATION OF BOTTOM OF TESTHOLE _ = 66.32 ( GROUNDWATER @ 75.32) GARNESS ENGINEERING GROUP, Ltd +- - -•- -�= CIVIL & ENVIRONMENTAL ENGINEERS = --+ - 3701ETUDOR ROPO, 3V TE 101' ANCHORAGE AK 99507' PHONE Pan 337E139'E (90] 330 WEB w.w�.q res5cg�'ma®com PREPARED FOR PHONE NUMBER PAGE NUMBER MIKE MCINTIRE 240-1102 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: # ATELIER #1; BLOCK 2, LOT 5A DJG #4 TYPE OF WORK: DATE: SEPTIC SYSTEM AS -BUILT 11/12/2014 INVERT OF DISTRIBUTION LINE _ 80.82 (AVG) BOTTOM OF BED =78.32 (AVG.) APPLICATION NO. Municipality of Anchorage � Community Development Department - Development Services Divisione°'r P.O. Box 196650 - Anchorage, Alaska 99519-6650 - 4700 Elmore Road r6, Info and Help: (907) 343-8211 INSPECTION: Voice: (907) 343-8300 Fax (907) 249-7777 er/ r Inspection Report - Electrical RETROE141535 Permit Type: Electrical Res Master/Standalone Permit PYp - F 1 OA Notes: Please eall Devin 20 min prior to inspection 907:6Q28893 Requested by: Devin rafeedie Schedule Date:10/22/2014 907.688.2751 Devin@capstoneelctricak.com PreferenewAM Inspection #: 326047 Address of Project: 6931 MONTAGNE CIR Parcel: 04103145000 Legal: ATELIER #1 BILK 2 LT 5A G:2142 Description of Work: Installing lift station controls and power. Contacts onC tractor (907)602-8893 CAPSTONE ELECTRIC, LLC' 22356 WHISPERING BIRCH DR. Inspector Comments: P Inspector: 1 i ('� {� Date:Ir-2 ZZ. 7?, A� On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 .Permit Number: OSP131461 Tax Code Number: 04103145000 Work Type: Septic Permit Effective Dates: December 18, 2013 to December 18, 2014 Design Engineer: GARNESS Subdivision: ATELIER #1 GROUP LTD Site Legal Address: ATELIER #1 BLK 2 LT 5A G:2142 Owner/Address: MCINTIRE MICHAEL L & BARBARA L 6931 MONTAGUE CIR ANCHORAGE AK 995071230 Site Mailing Address: 6931 MONTAGNE CIR, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 74052 Total Bedrooms: 4 N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Permit includes waiver OSP 131004 allowing the existing absorption field to be 8 feet from the south and west property lines and the proposed absorption field to be parallel with the ground slope. Received Issued By MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Fax: 907- 343-7997 On -Site Water & Wastewater Program Mayor Dan Sullivan On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. 041-031-45 Propertyowner(s) MIKE MCINTIRE Day phone 240-1102 Mailing address 6931 MONTAGNE CIRCLE, ANCHORAGE, AK, 99507 Site address 6931 MONTAGNE CIRCLE, ANCHORAGE, AK, 99507 Legal description (Sub'd, Block & Lot ) ATELIER S/D #1; BLOCK 2, LOT 5A Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: ( fall that apply) Absorption Field Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Sq.Ft. Number of Bedrooms 4 APPLICATION IS AN: TYPE OF DEWELLING: Initial ❑ Single Family (SF) Upgrade ❑ (w/wo ADU) Renewal Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) 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. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: 15" renew a( Waiver Fees: Date of Payment: No 'ZW Date of Payment: Receipt Number: Receipt Number: Permit No. DSP 1314%1 Waiver No (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS amm December 13, 2013 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Upgrade for Atelier #1; Block 2, Lot 5A; To whom it may concern: A septic permit was issued for the subject property on 2/4/2013 (OSP131003). The permit is about to expire and no components of the system have been installed. We are requesting that you re -issue the permit. There have been no changes to the proposed septic system installation or installations to surrounding properties. If you have any questions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com On -Site Wastewater Disposal System Permit Permit Number: OSP131003 Tax Code Number: 04103145000 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: Septic Upgrade Permit Effective Dates: February 04, 2013 to February 04, 2014 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: ATELIER #1 Site Legal Address: ATELIER #1 BLK 2 LT 5A G:2142 Owner/Address: MCINTIRE MICHAEL L & BARBARA L 6931 MONTAGUE CIR ANCHORAGE AK 995071230 Site Mailing Address: 6931 MONTAGNE CIR, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 74052 Total Bedrooms: 4 N Privy N Private Well N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Permit includes waiver OSP131004 allowing the existing absorption field to be 8 feet from the south and west property lines and the proposed absorption field to be parallel with the ground slope. Received Issued By: Municipality of Anchorage Development Services Division On -Site Water and Wastewater Program Sti'n `Deparent **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP131004 COSA#: Permit#:OSP131003f PID#: 041-031-45 Legal Description: Atelier 91. Block 2. Lot 5A Engineer: Garness Engineering Group Applicant: Mike Mcintire Your request for a waiver of the required 10 feet horizontal separation from the existing absorption field to the property line has been approved. The approved separation distance is 8 feet. Your request for a waiver allowing the proposed absorption field to be parallel with the ground slope has been approved. This waiver approval applies to the proposed and existing absorption fields as described above only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ® Existing absorption field has been in place since 1994. The affected adjacent property owner(s) have not been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ❑ Adjacent properties are not affected by this waiver. ............................................................................... Waiver is Granted: X Waiver is not Granted: Date: Approved by: Name of Reviewer Rae#: 02073G Amount: $200.00 Date Paid: 1/22/2013 **** VARIANCEIWAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On -Site Water & Wastewater Program Mayor Dan Sullivan Phone: 907-343-7904 Fax: 907- 343-7997 On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel l.D. C441-D,� 1-ys Property owner(s) MIKE MCINTIRE Day phone 240-1102 Mailing address 6931 MONTAGNE CIRCLE *ANCHORAGE, AK 99507 s�L 'LQ_ Site address 6931 MONTAGNE CIRCLE *ANCHORAGE, AK 99507 d�O Date of Payment: Legal description (Sub'd, Block & Lot ) ATELIER #1; BLOCK 2, LOT 5A Date of Payment: ( fa Legal description (Township, Section & Range) N �3 C -7 -Receipt Number: Lot Size Sq. Ft. Number of Bedrooms 4 /y Permit No. f)Sr)�ICD3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DEWELLING: (Pall that apply) Initial ❑ Single Family (SF) Absorption Field ® Upgrade ® (w/wo ADU) Septic Tank ®Renewal Duplex (D) F-1Holding ❑ F-1 Tank MultipleDwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: EXISTING DRAINFIELD TO LOT LINE Distance: 8 FEET certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/RushFees: s�L 'LQ_ Waiver Fees: d�O Date of Payment: 1 as 13 Date of Payment: ( fa Receipt Number: N �3 C -7 -Receipt Number: oa0 � /y Permit No. f)Sr)�ICD3 Waiver No._OSPGIOOq (Rev. 01/11) January 8, 2013 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Proposed Septic Upgrade for Atelier #1; Block 2, Lot 5A; To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The existing septic system is in a state of failure and needs to be upgraded. We are proposing to install a Quartics Aerocell CAT III treatment system on this property which includes the installation of a 1500 gallon S.T.E.P. tank and bed type drainfield. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of this test hole. 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. TOPOGRAPHY: As can be seen on the attached design drawing the topography around the drainfield is 5-10% running southeast to northwest. In short, there are no slope concerns. 5. WAIVER FOR PROPOSED DRAINFIELD PARALLEL TO SLOPES: Due to site constraints, we are requesting your department issue a waiver to allow for the installation of the proposed drainfield to be non -parallel with the contours. The difference in elevation from one end to the other will be 1.5 feet. In short there is minimal risk associated with the granting of this waiver. 6. WAIVER FROM PROPERTY LINE TO EXISTING DRAINFIELD: The existing 1994 drainfield was installed to close to the west and southwest property lines. We are proposing to install a new drainfield with a flow diverter to still utilize the existing drainfield. We are requesting a 8 foot waiver to both property lines. There is no septic system within 10 feet of the drainfield on Lot 4. 3701 E. Tudor Road, Suite 101 *Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.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. Sincerely, P.E., M.S. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com \ATELIER #1; BLOCK 2, LOT 6!/ ATELIER #1; BLOCK 2, LOT \ \ / I / I — ATELIER #1; \ / / ,BLOCK 3, LOT 1 V \ \ A �l VVC i i / \I ATELIER; BIrOCK 2, LOT 4 11 I\ / 1 1 I I 1 1 I 1 I I I I \ 1 ! \ 1 1 rftETIIC / / 1 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 8. GENERAL CONTRACTORS 3701 E. MDOR ROM, SURE 101 • ANCHORME, AN 99507 • PHONE (907)337-8179 • FM (907)338-3245 1 W SRE: www.9ame wglnednq.coi PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MIKE MCINTIRE 240-1102 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: ATELIER #1; BLOCK 2, LOT 5A PNB TYPE OF WORK: DATE: SITE PLAN 7/17/12 LOT 5, LOCK 1; ELIER S/D (VACANT) I LOT 6, BLOCK 1; ATELIER S/D \ — ' LOT 7, BLOCK 1; ATELIER S/D '14,44v A'. tess:, ea Z. k \ 64PCPj'� F'DRAIN ! OUTFALL / \ATELIER #1; BLOCK 2, LOT 6!/ ATELIER #1; BLOCK 2, LOT \ \ / I / I — ATELIER #1; \ / / ,BLOCK 3, LOT 1 V \ \ A �l VVC i i / \I ATELIER; BIrOCK 2, LOT 4 11 I\ / 1 1 I I 1 1 I 1 I I I I \ 1 ! \ 1 1 rftETIIC / / 1 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 8. GENERAL CONTRACTORS 3701 E. MDOR ROM, SURE 101 • ANCHORME, AN 99507 • PHONE (907)337-8179 • FM (907)338-3245 1 W SRE: www.9ame wglnednq.coi PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MIKE MCINTIRE 240-1102 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: ATELIER #1; BLOCK 2, LOT 5A PNB TYPE OF WORK: DATE: SITE PLAN 7/17/12 LOT 5, LOCK 1; ELIER S/D (VACANT) I LOT 6, BLOCK 1; ATELIER S/D \ — ' LOT 7, BLOCK 1; ATELIER S/D '14,44v A'. tess:, ea Z. / \ATELIER #1; BLOCK 2, LOT 6!/ ATELIER #1; BLOCK 2, LOT \ \ / I / I — ATELIER #1; \ / / ,BLOCK 3, LOT 1 V \ \ A �l VVC i i / \I ATELIER; BIrOCK 2, LOT 4 11 I\ / 1 1 I I 1 1 I 1 I I I I \ 1 ! \ 1 1 rftETIIC / / 1 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 8. GENERAL CONTRACTORS 3701 E. MDOR ROM, SURE 101 • ANCHORME, AN 99507 • PHONE (907)337-8179 • FM (907)338-3245 1 W SRE: www.9ame wglnednq.coi PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MIKE MCINTIRE 240-1102 1 OF 2 LEGAL DESCRIPTION: DRAWN BY: ATELIER #1; BLOCK 2, LOT 5A PNB TYPE OF WORK: DATE: SITE PLAN 7/17/12 LOT 5, LOCK 1; ELIER S/D (VACANT) I LOT 6, BLOCK 1; ATELIER S/D \ — ' LOT 7, BLOCK 1; ATELIER S/D '14,44v A'. tess:, ea Z. NUMBER OF BEDROOMS: 4 GALLONS PER DAY (GPD): 600 PERCOLATION RATE/S: 22.50 PROPOSED APPLICATION RATE: 4.0 MINIMUM DRAINFIELD SQ.FT.: 150 MAXIMUM DEPTH OF EXCAVATION: 3 FEET WIDTH: 10 FEET LENGTH: 15 FEET M.O.A. APPROVED SAND FILTER: 2 FEET EFFECTIVE: 0.5 FEET ACTUAL SQ.FT.: 150 LETTER THAT PERTAINS TO THIS DESIGN. TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND /CURTP DRAIN / ,/ \ ' v4� S �O GARAGE s \ \ TH#1 \ S i \ � I \ os \ C C MT�jj \ � U MTI 2 of 2 e A. G 55.' LEGAL DESCRIPTION: ATELIER #1; BLOCK 2, LOT SA TOE OF SLOPE /CURTP DRAIN / ,/ \ ' v4� EXISTING TOP OF SLOPE 1` / ATELIER #1; BLOCK 2, LOT 6A >nt� PROPOSED DRAINFIELD IS qC 100' + FROM CURTAIN DRAIN � /MHSY� OUTFALL. OUTFALL WAS INSPECTED AND NO WATER ssD WAS FLOWING. AEROCELI / car / III UNIT PROPOSE 00 GALLON STEP TANK WIT ANIC' CONTROLS 1 100' SET BACK- -r—d� Y EXI \ ING SEPTIC TANK TO /� • � 9 I BF�DECOMMISSIONED PE CSN � c�P WELL RADIUS N GROUP, GARAGE H 7* EXISTING TOP OF SLOPE 1` / ATELIER #1; BLOCK 2, LOT 6A >nt� PROPOSED DRAINFIELD IS qC 100' + FROM CURTAIN DRAIN � /MHSY� OUTFALL. OUTFALL WAS INSPECTED AND NO WATER ssD WAS FLOWING. AEROCELI / car / III UNIT PROPOSE 00 GALLON STEP TANK WIT ANIC' CONTROLS 1 100' SET BACK- -r—d� Y EXI \ ING SEPTIC TANK TO /� • � 9 I BF�DECOMMISSIONED PE CSN � c�P WELL RADIUS N ExlsnNc 4 BEDROOM HOUSE I I I I I I I I I I I I I I 1 I I I I I y� I I l h � GARNESS ENG[NEERING GROUP, H 7* .. cOxsuLrnxrs a• GENERAL coNrRaerorxs j7� 3701 E TUDOR PND, SIIfIE 101 • ANCHORAGE, OH 99507 •PHONE (907)O.t)-81]9 • FM (90038-]118 UPC. / I PREPARED FOR: PHONE NUMBER: � � I 2 of 2 e A. G 55.' LEGAL DESCRIPTION: ATELIER #1; BLOCK 2, LOT SA DRAWN BY; PNB'l.(Z.S3i I —I�- DATE. 12/10/12 4�4444OQQOpo ExlsnNc 4 BEDROOM HOUSE I I I I I I I I I I I I I I 1 I I I I I y� I I l h � GARNESS ENG[NEERING GROUP, H 7* .. cOxsuLrnxrs a• GENERAL coNrRaerorxs 3701 E TUDOR PND, SIIfIE 101 • ANCHORAGE, OH 99507 •PHONE (907)O.t)-81]9 • FM (90038-]118 • NEBSRE 9 aaen9 neeM9.eom a PREPARED FOR: PHONE NUMBER: PAGE NUMBER. � MIKE MCINTIRE 240-1102 2 of 2 e A. G 55.' LEGAL DESCRIPTION: ATELIER #1; BLOCK 2, LOT SA DRAWN BY; PNB'l.(Z.S3i 1"7Eo� TYPE OF WORK: DATE. 12/10/12 4�4444OQQOpo SEPTIC DESIGN UPGRADE (Rev. 01/05) GARNESS ENGINEERING GROUP, Ltd, ... .... .... CONSULTANTS & GENERAL CONTRACTORS SOIL LOG — PERCOLATION TEST LEGAL DESCRIPTION: ATELIER N1 BLOCK 2, LOT 5A PERFORMED FOR: MIKE MICINTIRE DAT DEPTH ---- (feet) TEST HOLE #1 1 � ORGANICS/FILL 7/12 19� PERCOLATION RATE 22.50 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3.5 FT. AND 4.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: PERCOLATION RESULTS ARE WITHIN 1/16TH OF AN INCH PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ER ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 1 17 9113 SOIL CLASSIFICATIONS b.' l 3 GP ML GMCL 4 GC OL SW MH 5 • : SP CH SIM %.' OH 6 Sc SEE ATTACHED SITE PLAN 7 DEPTH TO DATE GROUNDWATER 6 GM HEAVY SEEPS 0 11' WS 9/17/12 6' 9/24/12 9 7' 10/29/1 S® " = Loo' 10 CLOCK NET TIME WATER LEVEL NET DROP 11 DATE READING TIME (MINUTES) READING (INCHES) 9/17/12 1 11:17 — 6.00" — 12 2 11:47 30 5.50" 0.50" 13 3 11:47 — 6.00" — 4 12:17 30 5.25" 0.75" 14 5 12:17 — 6.00" — 6 12:47 30 5.25" 0.75" 15 7 12:47 — 6.00" — B.O.H. 8 1:17 30 5.25" 0.75" 16 17 18 19� PERCOLATION RATE 22.50 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 3.5 FT. AND 4.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: ROB CAMPBELL PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: PERCOLATION RESULTS ARE WITHIN 1/16TH OF AN INCH PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ER ORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 1 17 9113 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: �L�� �'1Z1 Li`l PID Number: Name: G�M.�6CG L , �iC.J Ti �2t Wastewater System: New ❑ Upgrade Address: ABSORPTION FIELD Phone: X711, _ .rip®g No. of Bedrooms: 2"Deep Trench ❑Shallow Trench ❑Bed ❑Mound ❑Other LEGAL DESCRIPTION Soil Rating: 6 Total Depth from original grade: /d f GPD/Sq. Ft. Lot: Block: l Subdivision: it Depth to pipe bottom from original grade: d E Gravel depth beneath pipe �„ X, �� •2 / e0_1.'i�'� . 4l Ft. 'eFt. Township: Range: Section: Fill added bove or' incl Gravel length: c 8 Adm' Ft. Ft. WELLff New El Upgrade • Gravel width: Number f lines: Distancry��ween lines: NN Ft. Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: I� / /Xd Ft. //.f Ft. SQ. Ft. Driller: Date Drilled: Static Water Level: Ft. Installer: Date installed: Yield:-4—Pump Set at: Casin Height Above Ground: TANK GPM Ft. .Z I" IDC SEPARATION DISTANCES Cdseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift HoldingPublic/Private Manufacturer: 'r Capacity in gallons: /irI" From Tank Field Station Tank Sewer Lines I,& a i/dAe-4.- i r4"A*_�- 0 Well, /�S" / / f / �✓/� ��� /20 / Material: Number of Cgmpartments: Surface/os / �O3 �Q l / i/a LIFT STATION Water .4 Lot�G AJJI �A / Size in gallons: Manufacturer: Line Foundation /x/ ��/� �I � it i/A ,L)"Pump on" level at: IT off" level at: High water alarm at: Curtain J/� �ti/A �t%/� �/� Pump Mak el Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: Assumed Elevation: /100 Ftmo ENGIA,�L OF A Inspections performed by: Dates: 1st 'r�'s 9 %z '" `' '• 1.. �" • 2nd '�,Jj"AGorT. KNLEY: Department of Health Wd Human S vices approval `�'�°'" CE 0476 •'• 4/,o,­ Reviewed and approved by: Date: Date: 72-013 (Rev. 9/91) MOA 25 Alaska How-Ye1llYorn's Driilllina 122411 AM1on Anchorage, Alaska 99515 'Nell Orrner [907 345-441 ? Me Intire, Mikb �. � A A332� Location Of Well PERMIT 0 SW940071 CI 4 oorl I 9 -or ugh Subdivision La# E�lock Section No Tewnship N Range E W _850 Sa � Merdian Anohorage Atelier 5�4 1 � seepago from 55' - 98' S - Well Log !'t. Belour Surface Material Tope Top Bottom fern silty loam 0 0 _ brn silty gravel, damp Q 261, seep CI 40' Statin 'dater hart! pan _850 Sa � 55 silty gravel, hardpan lonses whobblsrs 55 seepago from 55' - 98' 48 gray sillty hardpan, dry 98 108 � brown cemented gravel, cobbler _ _ 108 1 d8 140 150 bodro,zk, seepage /tap of rook perforateed/ Perf-Hawk moohanioai perforator i en C, -X 08+ holes 3 1 C�" x 1 " betwe .•- dovalnpPd with air 68'-95' __ Woll producing 5gpm, and will ~probably increase/pumping - — —.— �4" linea will be installvd fron•, 113' to 150' betvre setting pump Well Depth (ft) Date of Completion 150 4122/94 Drilling Method Use rotary dcrflastiL. Casing Type i welded Diameter (in.) Depth (ft.) Weight (ibs/ft) G to 1 113 1 to Finish of ~fell T9 pe diameter perforate Statin 'dater Level Level (ft.) Date 23' to basing 4122194 Pumping I..fYel Below T of ii (ft.) After (hr -s) Put Grouting Yes ( Matprial No Pump H.P. Capacity Type C� submersible Setting (ft) _ Remarks _ well producing 5 gprn, but probably will inorcaoe with pumping is well wss drilled under my juri.diotion and this report is true to the best of my knowl#dge and belief. Authorized RePr viivntitivo Date VornylL. Nowell MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW940071 DESIGN ENGINEER:DOUGLAS T. KENLEY, P.E. OWNER NAME:MCINTIRE MICHAEL OWNER ADDRESS:1713 THUNDERBIRD PLACE ANCHORAGE, ALASKA 99508 PARCEL ID:04103145 LEGAL DESCRIPTION: ATELIER #1 BLK 2 LT LOT SIZE: 74052 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 Aw DATE ISSUED: 4/13/94 EXPIRATION DATE: 4/13/95 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 1.5.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST:' BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE DATE: 13 114 Douglas T. Kenle.v, P.E. HC01 Box 6034. Palmer, Alaska 99645 (907) 746-1073 March 19, 1994 Mr. Mike McIntire Lot 5A, Block 2, Atelier Subdivision Addition #1 Anchorage, Alaska PERCOLATION TEST RESULTS AND GENERAL SITE INVESTIGATION REPORT on February 12, 1994, the above -referenced 74.136 square foot site was inspected in conjunction with soil perk tests being performed for application and approval for the installation of an on-site waste water disposal system. The site is located at the intersection of Atelier Drive and Montagne Drive in Anchorage, Alaska. The system is being installed to serve a new four- bedroom home scheduled for construction in the spring of 1994. The septic tank will be a 1,250 gallon tank. The site is on the southwesterly side of Montagne Drive with a slope ranging from approximately 20 to 3% in the east -west direction and 8% to 10o in the south -north direction. The immediate area that has been selected for the waste water disposal system has an average slope of 6-7%. The site is moderately treed with birch, spruce and alders. It appears that there are no obstructions that would prevent surface water runoff. According to the present owner, the drainage ditch running through the property is dry most of the year. on-site observation and physical survey shows that there are no water wells nor private waste water disposal systems within a 100' radius of the proposed. system. No surface water was observed at the time of the inspection, and it appears that there is no potential for contamination of adjacent water wells or streams. Two percolation tests were taken at the site to assess the adequacy of subsurface soils to accommodate both the primai::y and replacement on-site waste water disposal system. The results of this test are attached to this report. Mr. Mike McIntire March 19, 1994 Page. 2 The test site had adequate percolation rate to support the proposed four-bedroom residence. Subsurface soils were found to be sand with some gravel overlain by 12" of surface organics. The percolation rate for both test holes was found to be 30 minutes per inch. If there should. be any questions concerning the percolation rate or characteristics of the site, please call me at (907) 746-1073. Sincerely, Douglas T. Kenley P.E. PE#8176 e49e1y 'e6a1040uy 0 0 uOlslnlpgng jelIGIV 'Z 119 'V9 40-1 30N30IS38 381INIOW 3AIW 'NW i U Permit No. Page 6 of 6 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: LOT 5 A 8 L K 2 A- F L I ER S I) BO AD 0I! 4iA- PID No.: �rl4 . 1 'T H H6' .)- 9 a P T t C_ i., bb' i� y"SaweR ;a. I.70 NC 72-013 A (2/91) MOA 25 TP* 11 e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST� T• Kenley cP •• 0 CE -8176 4C aw PERFORMED FOR: M R �,l I (� to M 4INT I R E DATE PERFORME�:� ,} 38 Lo-r SA OLkz LEGAL DESCRIPTION: A`rC-LI ER $ IJBN AODW, 1 Township, Range, Section: SLOPE SITE PLAN DEPTH (FEET) ORGANICS 14 1 _ . C2 •r 49?►± 2 •r 3- 4 4 ` ' �a o' v' 6- 7 7 8 0 o_ a or 9- 10- 11 10 •11 D. D r � 12 4 13- 14 * o C% 15 • 16 17 18 19 20 COMMENTS 91NNDY JILT W1 $ome GRp+V CL '_ WAT'ER TA6LE $c)TTOM OF I4OLC WAS GROUND WATER ENCOUNTERED? YE S S IF YES, AT WHAT / L I4.S D DEPTH? P E Depth to Water After 19 Monitoring? Dale 2 al 4 Gross Depth Water PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN H FT AND 5.5 FT PERFORMED BY: DOUGLA$ Ktwla'y I -' CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: F ' F 72-008 (Rev. 4/85) T P Z M �`,,. •�,•.......,�� Municipality of Anchorage DEPARTMENT e► � ... ............ 66 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 � % else 66.41 :e1�tiaao SOILS LOG — PERCOLATION TEST 0;••e'cu CE-81Kenley : PERFORMED FOR: M R. MI i w s M A Zvi T I R E DATE PERFORME�:�a:' +' 4 Lor 5 A 13 LK z LEGAL DESCRIPTION: ATELIER SuBN AyoN Township, Range, Section: SLOPE SITE PLAN (FEET) 1 w Q , 2 3 a ,,b 4 ` •o 5 6 e- p 7 a. 8 9 �D 10-- 12- 13- 14- 15- 16 0•12 13 14 15 16 17 18 19 ORGANICS SP.Nl)'( SILT LN/ SOME GRAN9L BOTTOM OF 140L5 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? &I- Depth to Water After Monitoring? N A Datc z' 9 4 S L P E 14 0Za1 Q, 20 � PERCOLATION RATE 3 2— (minutes/inch) PERC HOLE DIAMETER 6 TEST RUN BETWEEN H FT AND E;-5*—FT COMMENTS PERFORMED BY: DOUGLAS Ktt 11~EY ACCORDANCE WITH ALL,STATE AND. MUNICIPAL GUIDELINES IN 72-008 (Rev. 4/85) IFY THAT THIS TEST WAS PERFORMED IN THIS DATE. DA ES 2 S t S 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: ATELIER #1; BLOCK 2, LOT 5A Parcel ID: 041-031-45 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 4/22/1994 Sanitary seal (Y/N) YES Total depth 150 ft. Date of test Static water level Well production Cased to 113 ft. FROM WELL LOG 4/22/1994 5 Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 18+ in. AT INSPECTION 10/28/2014 24 ft. g.p.m. 2.02 g.p.m. WATER SAMPLE RESULTS: Coliform 0 . colonies/100 ml. Nitrate _L' 31 mg./L. Collected by: GEG. Ltd Arsenic: V0 ug,/L. Date of sample: 10/30/2014 B. SEPTIC/HOLDING TANK DATA Tank Type/Material _ SEPTIC/STEEL Tank size 1500 gal. Number of Compartments 2 Foundation cleanout (YIN) YES Depression over tank (Y/N) NO Date of pumping NEW Date installed 10/2/2014 Cleanouts (Y/N) YES High water alarm (Y/N) YES C. ABSORPTION FIELD DATA *BELOW FINAL GRADE Date installed 10/2/2014 Soil rating (g.p.d./112or /bdr 4System type MOUND Length 15 ft. Width 10 ft. Gravel below pipe 0.5 ft. Total depth *3.4 ft. Eff. absorption area 150 ft2 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+ P g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — D. LIFT STATION Date installed 10/2/2014 Size in gallons 1500 Manhole/Access (YM) YES "Pump on" level at_Tj ALt in. "Pump ofr level at'rllA!�Rin. High water alar level at 58 in. Datum BOTTOM OF TANK Cycles tested 3 Meets alar & circuit requirements? YES 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'+ Public sewer main N/A Sewer /septic service line 25'+ On adjacent lots Public sewer manholetcleanout N/A Holding tank N/A Animal containment areas 50'+ 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 *10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain F. COMMENTS 40'+ Wells on adjacent lots 100'+ *1994 TRENCH IS 8' FROM PROPERTY LINE (OSP131004) G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineers Printed Name JEFFREY A. GARNESS Date Il ItItIy (Rev. 11/05) ��"� °Sj-°gyp n �' ` :C N Z ( P m '�i = d D � A = s ❑ Sda�' c L D�n�R _ rn ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT BETWEEN MUNICIPALITY OF ANCHORAGE AND THIS MAINTENANCE ANI}REPAIR AGREEMENT made and entered into as of this JeDay of NOWM ber of 20 I q, by and between L&'C& LAiA�rA, herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY." in consideration ofthe mutual covenants contained herein, the parties to this Maintenance and Repair Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as &aUr1n 4C4 loomed At (legal description). Att:,1; tI -*l rS D Z- 2. Definitions Alteration. Any change to the design or function of an A W WTS 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 ofan 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 omner and a nc%ti COSH is issued to the new owner or iransteree of the proper[}'. 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 AWWTS in a satisfactory condition capable of'producing treated septic effluent in accordance with the equipment's approval for operation in the Municipalit). The owner shall enter into a service aereementxith an AWWTS service and mainbeaance grMdder nouroved by the municipality and the manufacturer of the A WWTS for the entire term of the AW WTS. 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 pal' for any and all: (7) 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 AW WTS. 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 ftne for failing to maintain and repair an A W WTS 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 A W WTS installation and maintenance requirements as provided by the AWWrfS vendor/installer and approved by the Municipality are the governing guidelines for the construction, maintenance and repair ofthe Owner's A W WTS. 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 %%i[h• and such t+riting shall be augched Io this Maintenance and Rcpair Agreement as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions ofthis agreement, the only authorized representatives of the parties are: a. Owner: Love4o, L.1 rpr-4 b. Municipality: Director, Commwtity 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. c 8♦ Juriadietion: Ckolee 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 parties under this Maintenance and Repair Agreement. 9. sm . Any provisions of this Maintenance and Repair Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Maintenance and Repair Agreement. OWNER; By: (signature) Date: Ir I a114 KE4'OA L. %�j�/� T (print name) STATE OF ALASKA ) THIRDJUDIOAL DISTRICT ) _ The#orWing instrument waskn� edged before me this l a I/C day of A/OM l')(iN,' �DL.by iOVt.1'�a L. K v� Nfty puat Al blic NOT Y UBLIC FOR ALASKA d,A. WEST oU My C tssion expires: aJl o� l� w conMnbt8la° 9D- - MUNI) E AMITY: By: /sign&=) Date: (print name) Title: L---ryI - i= MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES_ Division of Environmental Services 1( 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. # 31, 4-5— HAA # HA C? �LO SSS_ 1. GENERAL INFORMATION Complete legal description de ,Z '*,,/ Location (site address or directions) -� q�� �%®�•►�4ti G�i•C�a� g9SOB ,4.yGvo���GE ,�•!i c.•I.4a�� G . ®moo •tetve,q Z . Property owner_ M a t'.ur..c •�.� Day phone e7V - yc" Mailing address 'y'•1 7Z/1AA04W1C P/,,y mac. • .�.✓C.NoiC.466',Q Qq�-o,B Lending agency .tJ�r�o.tJ,4L B.Q.tl,�C Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADECattest- ing to the legality and status of system. ' 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site ,1 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 MOA821 /� / S. 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 y7 ' eo" Address oX- Engineer's signature cV 2- Date 9 y 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. OF Z . • A.*;,.'. GOU S L KENLE `%�• CE 8176 Conditional approval for bedrooms, with the following stipulations: Additional Comments B4,�Date CAUTION The Mu nicipality'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 orderto 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 -WS (Pw.1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L J--4 B'`1 'Z '�r�� ��,�. Parcel I.D. A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed Wim, ZZ, Z r i I I e r 414Ei010— /LL /AI Total depth /%4"b6f Cased to / ljr' Cf- Casing height Sanitary seal (Y/N) Y Wires properly protected (Y/N) y FROM WELL LOG Date of test Static water level T, ne . Well flow ; 9 -P.M. Pump levels 414J eA/muJA1 SEPARATION DISTANCES FROM WELL TO: AT INSPECTION 9p � ll'i'1 ca Septic/holding tank on lot / / 6"'4-1 ; On adjacent lots Absorption field on lot / /T -;On adjacent lots /da Public sewer main A11.9 Public sewer manhole/cleanout ��r9 Sewer service line •Zo F� Petroleum tank �� d WATER SAMPLE RESULTS: Coliform Nitrate l• `7l Other bacteria Date of sample: S�yr 9, / 9 qh% Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Tank size /.e.10 Gi4L_ - Compartments .Z Cleanouts (Y/N) Y, Foundation cleanout (Y/N) y Depression (Y/N) A..) High water alarm (Y/N) '��� Alarm tested (Y/N) '�'IV Date of pumping , okz Pumper --- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot 14- On adjacent lots a ��� Foundation �x F� To property line y� / Absorption field 3� / Water main/service line Surface water/drainage 72-026 (3=)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DIST lot D. ABSORPTION FIELD DATA LIFT STATION TO: On adjacent lots M Manhole/Access (Y/N) Date installed M,oY X / / P9.Z Soil rating (GPD/Ft2) Length 811 " Width Total absorption area _f/ "Pump off#. Surface water System type -VA—Zo ✓d A./ Gravel thickness .t Total depth Cleanout present (Y/N) y Depression over field (Y/N) A.1� Date of adequacy test A,)Av,,J �s�sr"��'! Results (pass/fail) for Water level in absorption field before test 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO: test yes, give date Well on lot / f * ,O� On adjacent lots / 30 1, "."f Property line To building foundation 2 I/ To existing or abandoned system on lot N54 On adjacent lots /V 0 '` f i Cutbank N1.n Water main/service line -ire/.9 Surface water i o� '� Lt . Driveway, parking/vehicle storage area 8F1� Curtain drain E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in e%; (of this inspection. F iii 111 °�. • ,••� 4� 7,i . ooA n.g T ,� Signature (�� ;.....;, Engineer's Name A P.� • Dov LIQ, 7 1<ENLEY •�,Q A ,i. f` & Date D • I'� • Gl �-I �4,,;• CE 8176 HAA Fee $ 300 , ° a Date of Payment ��1� IL-7' q —I Receipt Number 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number Commercial Testing & Engineering Co. �Jzet,L Environmental Laboratory Services �iiwiiiiiiiiiiiiiiiiii►i.�i�.iiiiw'i►�ii�e�� SINCE 1908 LABORATORY ANALYSIS REPORT CT&ERef.# 94.4385-1 Client Sample ID LOT 5A BK 2 ATELIER Matrix WATER Client Name DOUGLAS KENLEY,P.E. WORK Order 81741 Ordered By Printed Date 08/30/94 @ 15:37 hrs. Project Name Collected Date 08/27/94 @10:57 hrs. Project# Received Date 08/27/94 @11:35 hrs. PWSID UA Technical Director STEPHEN C. EDE Released By: ------------------------------------------------------------------------------------------ Sample Remarks: ROUTINE SAMPLE COLLECTED BY: F.W.K. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -------------------------------------------------------------------------------------------- Nitrate-N 1.4 mg/L EPA 353.2/300.0 10 08/29/94 DJS * See Special Instructions Above UA = Unavailable * * See Sample Remarks Above NA =Not Analyzed U=Undetected, Reported value is the practical quantification limit. LT=Less Than D = Secondary dilution. GT= Greater Than 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 COMMERCIAL TESTING & ENGINEERING CO ENVIRONMENTAL LABORATORY SERVICES .. Drinking Water Analysis Report for Total Coliform Bacteria5633 0 STREET READ AK 99518 INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE ANCTOR (907) 562.2343 FAX: (907) 561.5301 MUST BE CUMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. # t z 'RIVATE WATER SYSTEM end Results ❑ Send Invoice �! � Water systan Naneconpany:Nz - contact M-1: Direct Count (a Colonies/100 ml ax i um�ber Access Verification: LTB BGB COLIFIRM Sa._ •� oce ❑ Send Results ❑ Send Invoice om?any Name Conaet nun: nt Acarms c1y Stam Zp Co - SAMPLE DATE: Fl—of?] [ -1-71 ? : Month Day Year SAMPLE TYPE: R' -Routine ❑ Repeat Sample (for routine sample with lab ref. no. � ❑ Special Purpose ,_TC) b SAMPLE LOCATION q o 440'0 ✓tri x&'. 'e ❑ Treated Water ❑ Untreated Water Time Collected Collected By Please Print TO BE COMPLETED 13Y LABORATORY Ana/lysis shows this Water SAMPLE to be: C� Satisfactory ❑ Unsatisfactory Cl Sample over 30 hours old, results may be unreliabi-' ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special delivery ail(. Date Received 2 `� Time Received Analysis Began -z 1 G Analytical Method: ❑ Membrane Filter ❑ MMO-MUG * Number of colonies/100 ml. Lab Ref. No. Result* Analyst I Sent to A.D.E.C. Anc Fbks Jun ❑ Faxed Date: ��_ Time: CIient notified of unsatisfactory results: ❑ ❑ Phoned Spoke Aith Faxed Date: Time: BACTERIOLOGICAL WATER AN\TALYSIS RECORD M1410-14TUGResult: Total Coliform Membrane Filter: �! � E. Colip, �S � �, y � tn� �rj Direct Count (a Colonies/100 ml Verification: LTB BGB COLIFIRM rn7C=Too,N'urnrousToCoum Fecal Coliform Confirmation Final Membrane Filter Results Y Collform/100 ml Reported By, (,(,� �Q24Pba � Date I Z�'qy — Time—D � 6 -) hrs Comments: �T7�—'J— SGS Member of the SGS Group (Societe Generale de Surveillance) .• OB = 00-v Baena ENV1RONt"EN T AL SERVICES IN ALASKA. COLORADO. UTAH. ILLINOIS. OHIO. h4ARYLAND. WEST VIRGINIA. NEW JERSEY. SOUTH CAROLINA - Commercial Testing & Engineering Co. y A� Environmental Laboratory Services S. CE 190a 5633 B Street Anchorage, AK 99518-1600 Drinking Water Analysisp Re ort for Total Coliform Bacteria Tel: (907) 562-2343 Drinking Fax: (907) 561-5301 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER ❑ PUBLIC WATER SYSTEM I.D. B" PRIVATE WATER SYSTEM Send Results � ❑ end Invoice '�Icr 0�pzoacl-4f I •' ���G�� Gator Sy-t='N=.J mpany.'we contact twine .1-7741 F ones um er Z!u'a AOA ax: um er Matt g Adwm C,ty smte P e ❑ Send Results ❑ Send Invoice ompany N— Conmct t e Mamng A dress Qty State Lp Code SAMPLE DATE:rn _T /j� Month Day Year SAMPLE TYPE: ❑ /Routine ❑ Treated Water *,"'Repeat Sample (or routine le ❑ Untreated Water with lab ref. no. » ❑ Special Purpose Time Collected SAMPLE LOCATION Collected By o y,9iy Plcase Print TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: -4/ Satisfactoy ❑ Unsatisfactory ❑ Sample over 30 hours old, results may be unreliable ❑ Sample too long in transit; sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample via special dgeh ' ry mail. Date Received 1 Time Received a Analysis Began Analytical Method: ie Membrane Filter ❑ MMO-MUG * Number of colonies/100 ml. Lab Ref. No. Result* Analyst 409 .91 Sent to A.D.E.C. Anch) Fbls Jun ❑ Faxed Date: a4 Time: Client notified of unsatisfactory results: ❑ ❑ Phoned Spoke with Faxed Date: Time: 13ACTERIOLOGICAL WATER ANALYSIS RECORD MMO-MUG Result: Total Coliform E Coli Membrane Filter: Direct Count i Colonies/100 ml Verification: LTB BGB COLIFIRM Fecal Coliform Confirmation Final Membrane Filter Results f "� 77 , iColiform/100 ml Reported By to �� Z �— Time 1 Q �� hrs Comments: TNTC — Too Numoous To Count OB - Otho Bacreaia v Member of the SGS Group (Soci6t6 Gerikale de Surveillance) ENVIRONMENTAL FACILITIES IN ALASKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA