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
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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)
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LOT 6,
BLOCK 1;
ATELIER S/D
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ATELIER S/D
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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
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LOT 7,
BLOCK 1;
ATELIER S/D
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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
\
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LOT 7,
BLOCK 1;
ATELIER S/D
'14,44v A'. tess:,
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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
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LEGAL DESCRIPTION:
ATELIER #1; BLOCK 2, LOT SA
TOE OF SLOPE
/CURTP
DRAIN
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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
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UNIT
PROPOSE 00 GALLON
STEP TANK WIT ANIC'
CONTROLS
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BF�DECOMMISSIONED PE
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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
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UNIT
PROPOSE 00 GALLON
STEP TANK WIT ANIC'
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BF�DECOMMISSIONED PE
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3701 E TUDOR PND, SIIfIE 101 • ANCHORAGE, OH 99507 •PHONE (907)O.t)-81]9 • FM (90038-]118
UPC. /
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PREPARED FOR: PHONE NUMBER:
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LEGAL DESCRIPTION:
ATELIER #1; BLOCK 2, LOT SA
DRAWN BY;
PNB'l.(Z.S3i
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DATE.
12/10/12
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PREPARED FOR: PHONE NUMBER:
PAGE NUMBER.
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MIKE MCINTIRE 240-1102
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LEGAL DESCRIPTION:
ATELIER #1; BLOCK 2, LOT SA
DRAWN BY;
PNB'l.(Z.S3i
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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 •'
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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