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HomeMy WebLinkAboutBARCLAY CITY LT 3Onsite File Barclay City Lot 3 #050-441-31 The 1985 drainfield cannot be reconnected due to concerns that it is in groundwater and its proximity to the 2020 drainfield. Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201294 PID Number: 050-441-31 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name JEFF AND ROBERTA PULL ABSORPTION FIELD El Deep Trench ©Wide Trench ❑Bed El Mound Site Address 33563 CUMULUS ROAD, EAGLE RIVER, AK 99577 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 230-9472 3 1.2 GPD/SF SEE DWG. Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Ft. Gravel depth beneath pipe 0.57-0.58 Ft. Subdivision Block Lot BARCLAY CITY - 3 Fill added above original grade SEE DWG. FL Gravel length 80 (2 @ 40') Ft. Township Range Section - - - Gravel width 5 Ft. Beds: Number of Lines - Distance between lines - Ft. SEPARATION DISTANCES To Septic AbsorptionHolding Lift Station Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 400 Ftz 2 8 Ft. Well 100-} 100+ - ! - 125+ TANK ❑ Septic [IS.T.E.P. El Holding El Other Manufacturer G R E E R TA N K Capacity 1000 Gal. Surface Water 100+ 100+ _ _ Material PLASTIC/HDPE Number of compartments 2 Lot Line 10+ 110+ - - NA Foundation 10+ 10+ _ _ LIFT STATION I rer Capacity Gal. Alarm location installed by Remarks PIPE MATERIAL House to tank Tank to D3034 drainfield D3034 Installer NORTHERN EXCAVATION Drainfield D3034 co/MTD3034 BENCH MARK (Assumed elevation) 100.00 ft inspector JODY MAUS, GARNESS ENGINEERING Inspectes:tion X51 9/21/20 9/22/20 Location and description 2na are 9/22/20 4119/22/20 - - - - - ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date ...� ... .... f Septic Syste _P /� Approved Date. `fess: CE -7953' `p0 �o��c,�o Note: this approval does not include well permit requirements. P #AEcces��Dooposlo�,��� (rcev uwu2iib) K NUMBER: PARCEL NUMBER: OSP2029RECORD DRAWING 050-441-31 ' : p BARCLAY CITY; LOT 2 i At a 1A%- AtC F - w 2 w w a2 EXISTING z 3 -BEDROOM HOUSE Lu C) a En I 100' WELL RADIUS U EXISTING WELL C3 C3 / o A I B I C-1 FCO 25.2 10.4 MH 33.9 27.0 STI 38.5 27.7 DBL1 42.3 27.7 DBL2 43.0 27.2 FD 59.3 29.5 52.5 C01 76.3 50.5 74.4 MT1 72.2 1 46.3 70.5 CO2 57.1 23.0 37.3 MT2 59.4 25.6 40.7 CO3 86.6 57.2 77.4 MT3 83.4 53.8 74.1 C04 69.5 35.4 43.0 MT4 72.2 38.1 47.2 DRAINFIELDS / BARCLAY CITY; LOT 4 INSTALLED FLOW DIVIDER (FD) - EXISTING DRAINFIELD ABANDONED IN PLACE INSTALLED DOUBLE CLEANOUTS (DBL1 & DBL2) NEW 1000 GALLON GREER HDPE PLASTIC SEPTIC TANK STING FOUNDATION CLEANOUT (FCO) , 1 r. -� .- �'w s ENGINEERING SALES CONSULTING 3701 E TUDOR ROAD, SUITE 101 'ANCHORAGE. AK 99507 'PHONE (907) 337-6179' FAX (907)33&3246 ' WEBSITE: wa N.gamessenginecring.c PREPARED FOR: PHONE NUMBER: PAGE NUMBER: JEFF PULL CO AGENT 2 OF 3 PROJECT&EGAL DESCRIPTION: DRAWN BY: BARCLAY CITY, LOT 3 J.L.M. TYPE OF WORK: DATE: RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 10/5/2020 N SCALE: 1"=40' NOTE: THE OLD SEPTIC TANK WAS DECOMMISSIONED PER UPC PER THE CONTRACTOR ,6:%0:10kuIt$$ Q` 4Ar Aw ��� AN .. ..... � .......... 0 n 01 �® �'.AW •�(J-i#ftey A. Ganess '� �I LICENSE AV OFESLICENSEvxArp, #AECC884 / IN PERMIOSP 201294 T NUMBER: RECORD DRAWING RAWING FINAL GRADE ST1 TOP OF MH LID = 99.29 � — 98.6-99.1 MH TOP OF TANK @ INLET= 93.17— INVERT OF BUNG @ INLET = 92.50 NEW 1000 GALLON GREER HDPE SEPTIC TANK LOWER TRENCH 2" OF INSULATION INSTALLED MT3 CO3 ON THE 24' OF SOUTHWEST END MT4 C04 FINAL GRADE OF TRENCH PER CONTRACTOR = 93.00.94.03 FILTER FABRIC 2" OF INSULATION INSTALLED ORIGINAL GRADE ON THE 24' OF SOUTHWEST END @HIGHEST POINT OF TRENCH PER CONTRACTOR FILTER FABRIC— 1 TOP OF FILTER SAND = 90.41 - ti 2.0.2.1' OF M.O.A. '�`.;. TOP OF FILTER r, APPROVED SAND `- INVERT OF SAND 89.51 �`r... FILTER PIPE 90.09 MAXIMUM EXCAVATION DEPTH = RELATIVE ELEVATION OF GRO 87.41-87.51 RELATIVE ELEVATION TO DAM RELATIVE ELEVATIC TOP OF TANK @ OUTLET = 92.92 •INVERT OF BUNG @ OUTLET= 92.26 UPPER TRENCH MT1 C01 PARCEL ID NUMBER: 050-441-31 :INAL GRADE = 94.16.95.31 -ORIGINALGRADE Cod HIGHEST POINT = 94.41 2.0-2.1' OF M.O.A. APPROVED SANDINVERT OF FILTER: i PIPE = 90.98 5' MAXIMUM ft'f-t91 DEPTH = 88.31.88.41 = b6.41 hUK UNMEK I KENCH / 62.51 FUK LOWER TRENCH = 86.41 FOR UPPER TRENCH /85.51 FOR LOWER TRENCH = 78.41 FOR UPPER TRENCH 177.51 FOR i OWER TRFAICI- Aw � �•; �.. �- AR ENS I EE IN G � q _ ' 4................ ENGINEERING SALES= CONSULTING � �l7-17.s.•...3701E. TUDOR ROAD, SUITE 101 ANCHORAGE, AK 99507-PHONE(907)337-6179-FAX(907)33&3246VVEBSITE www.gamessengineedng com .{� 'i �`v�°Fr+t �( PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ®� '; y A. Gaf(18SS••.� � 11 JEFF PULL CO AGENT 3 OF 3���iJ; t: CE PROJECT/LEGAL DESCRIPTION: DRAWN BY: BARCLAY CITY, LOT 3 J.L.M. OF� "' ••. •.•' TYPE OF WORK:ROFESS\ DATE: LICENSE ��® RECORD DRAWING OF SEPTIC SYSTEM UPGRADE 10/5/2020 9AECC884 / MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite Ort -Site Wastewater Disposal System Permit Permit Number: OSP201294 Work Type: Septic Upgrade Tax Code Number: 05044131000 Site Legal Address: BARCLAY CITY LT 3 G:1206 Site Mailing Address: 33563 CUMULUS RD, Eagle River Owner: PULL JEFF R & ROBERTA A Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms �i»ent tea_ Depa i'trnen t 8/13/2020 8/13/2021 100624 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shalt be in accordance with: 1 _ The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The 1985 drainfield shall be abandoned in place and cannot be reconnected due to concerns that it is in groundwater and its proximity to the proposed drainfield. Received By: Issued By: Date: Date: �O�d 1,10UNICIPAL'ITY oF ANCHORAGE Development Services Department Phone: 907-343-7904 Fax: On -Site Water & Wastevijater Section Fax, 907-343-799/ ON-SITE SEPTICAIVELL PERMIT APPLICATION Parcel I.D. 050-441-31 Property owner(s) JEFFREY AND ROBERTA PULL Day phone 230-9472 Mailing address 33563 CUMULUS ROAD, EAGLE RIVER, AK 99577 Site address 33563 CUMULUS ROAD, EAGLE RIVER, AK 99577 Legal description (Sub'd., Block & Lot) BARCLAY CITY, LOT 3 Legal description (Township, R 7 ge & Section) Lot Size Sq. Ft.. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field � Initial 0 Single Family (SF) (w/wo ADU) Septic Tank FXFI Upgrade RX Duplex (D) Holding Tank R Renewal Multiple Dwellings Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: q �, �,V66V Waiver Fees: Date of Payment: qla090 Date of Payment: Receipt Number: 656,q 76 Receipt Number: Permit No. Os CZ0 I )_� q Waiver No. G:Tevelopment Services\Building SafetyNOn Site Water and WastewaterTorms\Client FormsTen-nit Application.doc IN r is z r, a � t 10 101RARA 101 3 X1 I July 29, 2020 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201294, Rebecca Carroll, 08/13/20 uanics ikeroCeff Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic System Upgrade for Barclay City S/D; Lot 3 To whom it may concern: The existing 3 -bedroom house is served by private well and septic system. The existing septic system was originally designed for a 3 -bedroom house and consists of a 1000 -gallon steel septic tank followed by a deep trench type drainfield. The drainfield is in a state of failure. The septic system must be upgraded in order to obtain a COSA. A test hole has recently been excavated on the property in the area of the proposed septic upgrade. We are proposing that a new 1000 -gallon HDPE Greer tank and dual 5 -wide trench type drainfields be installed within the 30 -foot radius of the test hole shown on the site plan and design drawing. Comments regarding the design are summarized as follows: 9. SOILS: A soil log which shows the soil classification, percolation test and groundwater monitoring is attached. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATERS: There are no surface water concerns. 4. TOPOGRAPHY: Attached is a MOA Contour map which shows the topography in the area. The topography slopes generally southeast to northwest at a 20 to 35% slope, with the average slope ranging less than 25% in the area of the proposed drainfields. No slopes greater than 46% were observed within 100 feet downgradient of the proposed septic system. In order to meet the steep slope disposal field requirements in regards to the effective being less than 36 inches below existing grade, we are proposing the drainfield be excavated a maximum of 6 feet deep at any point (on the uphill side of the drainfields) and then 2 feet of MOA filter sand be installed. This will ensure downward migration of effluent. Also, according to the steep slope disposal fields section of the ordinance, natural vegetation within 50 feet downgradient of the disposal field shall remain undisturbed, or the exposed slope shall be stabilized with erosion control vegetation or an approved equal prior to final operational approval. There are driveways (unvegetated) downgradient of the proposed disposal fields; however, the driveway areas to be stable with no indication of erosion or instability noted during our site visits. We would also like to note that the existing drainfield is in a surcharged condition and there is no indication of daylighting effluent downgradient of the existing drainfield. We have discussed the slope issues with Rebecca Carrol in your department and it was her opinion that a waiver would not be 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com Page 2 of 2 required, given that the existing slopes appear to be stable and that there is no indication of daylighting effluent from the existing surcharged drainfield. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If yu have any questions, please contact us at 337-6179. Thank you for your assistance. 11 3effrea�rw�, P. E., M.S. Presi 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www. garnessengineering.com Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201294, Rebecca Carroll, 08/13/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201294, Rebecca Carroll, 08/13/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201294, Rebecca Carroll, 08/13/20 SGS Ref.# Printed Date/Time 07/22/2020 10:18 Collected Date/Time 07/13/2020 8:23 Received Date/Time 07/13/2020 14:25 Technical Director Stephen C. Ede 1203350001 Client Name Gayness Engineering Group, Ltd (GEG) Project Name/# Barclay City, Lot 3 Client Sample ID Barclay City, Lot 3 Matrix Drinking Water Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 B (<10) 07/15/20 07/21/20 ACF Waters Department Total Nitrate/Nitrite-N 1.32 0.200 mg/L SM21 450ONO3-F C (<10) 07/14/20 EWW Microbiology Laboratory E. Coli Negative 1 100mL SM21 9223B A 07/13/20 A.L Total Coliform Negative 1 100mL SM21 9223B A 07/13/20 AI I MuNIcIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ( ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT LEGAL DESCRIPTION LOCATION NO. OF BEOROOMS We ~ A~orpt on area PE~~ ~ ~ Manufacture~ ~'~ Liq. capacity in gallons ,~ , ,~.~ .... ~ Inside length Liquid depth  DISTAN ET Dwglling Well PERMIT NO. I c o: ~./. ~ Manufacturer '- Ir~ Material Liquid capacity in gallons Well ~ ~ No. oflines / LengthSe~:~ I Zotall~ngtho~es f ~ ~ VZ inches ~ ~ Top of toe to fi~s~grede ~ Materia, beneath tile Total effective absorptio~ inches Length Width Depth PERMIT ~ ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line ~ DISTANCE TO: Class / _ Depth Driller Distance to lot line PERMIT NO. ~ ~ DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PiPE MATERIALS REMARKS APPROVED ~ J ~ J~JlN~i~ ~ATE LEGAL 72-013 (Rev. 3/78) .................... Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: 2 3 5 6 7 8 9 10 11 -'--'- 12 13 14 15 16 17 18 19 WAS GROUND WATER ENCOUNTERED? S L. IF YES, AT WHAT . O DEPTH? p E Depth to Water Alter Monitering? Date: Gross Net Depth to Net Reading Date Time Time Water Drop _/ / PERCOLATION RATE minute Yinc PERC HOLE DIAMETER TEST RUN BETWEEN N FT COMMENTS PERFORMED BY: . . SRB 196,Y /~//./~__.~...~c...~ CERTIFY THAT T/HIS TEST V~'AS PERFORMED ACCORDANCE WITH ALL ~,~,:,~,~r~-i~,llClPAL GUIDELI ~l,~,~'~ EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) IN -MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOl LS LOG [] PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3 5 6 7 8 9 10 11 12 13~ 14 15 16 17 18 19 2O ~berl A. She~er ~' ~ No. 1457-1~ DATE PERFORMED: ~'"c~/'/" 8 SLOPE ENCOUNTERED? O P E IF YES, AT WHAT DEPTH? /5' -/%~,~ ~'Z/~' ~_~ ~ SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop ,, / PERCOLATION RATE / ~' (minutes/inch) TEST RUN BETWEEN FT AND ~ FT COMMENTS PERFORMED 72-008 (6/79} G Q V • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s .� : E T,Y.. Certificate of On -Site Systems Approval Parcel I.D. 050-441-31 1. GENERAL INFORMATION: Complete legal description BARCLAY CITY S/D; LOT 3 Expiration Date: 2 "2 0 'Z -o Location (site address) 33563 CUMULUS ROAD, EAGLE RIVER, AK 99577 Current Property owner(s) JEFFREY AND ROBERTA PULL Day phone 230-9472 Mailing address Real Estate Agent 33563 CUMULUS ROAD, EAGLE RIVER, AK 99577 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $, Date of Payment Waiver Fee $ Date of Payment Receipt Number a 600 1 G Receipt Number COSA # 05 C � D A 6 �q Waiver # C_ 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: tt"d� 1 In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. DSD SIGNATURE System #1 Approved for bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, ��� $ 1 '•� of v7% .... .......... �f)F y`A,Gorness, CE -7953— ' f e s sio�°oo #AECC884 with the follow'*tipul l[TE WATER AND B ' Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory COSA blue sheet_10.10-12.doc Nitrate Advisory Arsenic Advisory Other i Legal Description: BARCLAY CITY S/D; LOT 3 If more than 1 septic system on lot: COSA Checklist # 1 of 1 A. WELL DATA * ❑ Well log is filed with Onsite (or attached) Date drilled 9/17/85 Total depth *215 ft Cased to *215 ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 713/20 Parcel ID: 050-441-31 Structure served by this system 1 Well production at time of test 4.0 gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 1.32 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG,LTD. Date of Sample 7113/20 Static water level at beginning of test 190 ft. Comments *PER 1998 HAA. WELL LOG MAY BE IN MOA HARD FILE. B. TANK DATA >station N Age of tank(S) NEW years ntenance com Tank type/material P�asTic yeMeasured operating fluid level in septic tank NEW ial❑ Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA DUAL 5-WIDES Which system tested (date installed) 9121-22n° Adequacy test date NEW ❑ ALL standpipes present per record drawing Results ❑ Pass For 3 bedrooms Total measured depth from grade * ft (max) Fluid depth prior, to test NEW in Measured depth to pipe invert from grade * ft (min) Water added NEW gal ❑ N/A —pressurized field NEW New depth In ❑ Monitor tubes go to bottom of effective. If not, state Elapsed time NEW min depth into effective ❑ Code -required soil cover over field Final fluid depth NEW in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: `SEE ATTACHED RECORD DRAWINGS COSA Checklist yellow sheet Any rejuvenation treatment (past 12 months) NIA If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Fl� Yes Community Sewer Manhole/Cleanout > 100' rv7 Yes if No ft (7,/ Yes if No ft Neighboring Tank > 100' C] Yes if No ft Private Sewer/Septic Line > 25' Yes if No ft Absorption Field on Lot > 100' Rl Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' [71 Yes if No ft Water Main > 10' Animal Containment > 50' Yes if No ft 0 Yes if No ft 0 Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway Community Sewer Main > 75' D Yes if No ft ❑✓ Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Fl� Yes if No ft Surface Water > 100' Yes if No ft Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots: Q Absorption Field > 5' Fv� Yes if No ft Private Wells > 100' [71 Yes if No ft Water Main > 10' [] Yes if No ft . Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' [) Yes if No ft If absorption field is under driveway comment below Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Fv� Yes if No ft Community Wells > 200' Yes if No ft Surface Water > 100' El Yes if No ft F. ENGINEER'S COMMENTS 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 COSA guidelines in effect on this date. COSA Checklist yellow sheet f CE -7953 r #AECC884 mo-> ui > 0 c m mm>-Uozr., 0 Pi 0 7lu Ap r9ri ch C) < x z -v m 0 Ow rtimz — MM z 0 X :u Fri X- 0 \�I, m 0 w o o mm zpa:xr- 1 0 00 M M ril GO CAM –4-N x 0 X X C/) 0 U) z 'u> mzx-qu)m m< 0 z M U)z cn :— Z ;UPI C-) ............ ........ .... .... ..... .. < G) 0 C) < Co 0 -TI m Eu > S c/) 0 z T CA X ril cF V 4 I -V I c5 R - Cl) CD t=j f = i lk .. .. ...... .... C: r7 3 N Nor ON Im MUNICIPALITY Of ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING -- . . GENERAL INFORMATION Complete legal description Lot 3, Barclay~S/D Location (site address or directions) Eagle River Road (Extension) Property owner Mailing address Lending agency Mailing address Joe & Renee' Curro PO Box 771214, Eaqle River, AK 99577 Day phone 694-8077 Day phone Agent Sharon Minsch/Remax Address '16600 Centerfield Dr., Suite 201, Day phone 694-4200 Eagle River, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: e NOTE: Individual well xxx Community well Public water If community well system, provide written confirmation from State ADEC attest- lng to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: xxx If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. $ & S ENGINEERING Phone ~ Name of Firm ~-,,,.,A ........ ....... ~,~ r~,ver Loop Eoad No. 204 Eagle River, Alaska 99577 Address Engineer's signature '?~,~,! ~/ "~ycT-~------ Date DHHS SIGNATURE b," Approved for Disapproved. -T/"I/~ E E bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(Rev. 1/91) Back MOAIC21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type h~l ~/~'T~--, Log present ~N) y~ Total depth ~[-/.~ ,/ Sanitary seal (~)'N) 'd ~- .~ Date of test Static water level Well production Health Authority Approval Checklist /~_.~.~'~ ~ ~ -~'~t'/~. Parcel I.D.: / If A, B, or C, attach ADEC letter. ADEC water system number Casing height (above ground) Date completed / Cased to ~/~-' FROM WELL LOG g.p.m. Wires properly protected ~_.~) Ye 5 AT INSPECTION /¢7 g.p.m. WATER SAMPLE RESULTS: Coliform Date of sample: Nitrate Collected by: SEPTIC/HOLDING TANK DATA Date installed ~-.2_~" c~-~'~Tank size Foundation cleanout (Y/~ Date of Pumping //~ ~.~Zr/" F/ Pumper Other bacteria ~,&,! $ & S ENGINEERING Eagle River, Alaska ~577 Number of Compartments ,~ Cleanouts (Y/N)_7~ Depression (Y~) /~ High water alarm (Y/N) /~J/~c C. ABSORPTION FIELD DATA Date installed ~'~,~ ~'-~ ~;:~-~'-'~ Soil rating (g.p.d./fF or fF/bdrm) Length ~.~ ~-' / Width ,.~ Gravel thickness below pipe Effective absorption area Z.~ ~)'--~ Monitoring Tube present ~/N)_~ Depression over field (Y/~ Date of adequacy test /~'-,~- F,P~ Results (Pass/Fail) /5/:].~_~ For Fluid depth in absorption field before test (in.); Fluid depth (ins) Minutes later: Peroxide treatment (past 12 months) (Y/N) System type Total depth' .~ '/ after_~_~gal. (in.): Immediately water added Absorption rate = N ~o + .g.p.d. If yes, give date - bedrooms 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles teste.~ J Size in gallons ~-,.  "Pump off" level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot //~--~ / Public sewer main Sewer/septic service line On adjacent lots //~ On adjacent lots /~ ~ '/- Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation l ~ ? Property line /~ ~L. Absorption field ~ Water main/service line /~,/'~r- Surface water/drainage /£~-h Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line //'(~ Surface water /C Curtain drain Building foundation ///~/~ Water main/service line Driveway, parking/vehicle storage area Wells on adjacent lots //~' HAA Fee $. ' ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal recor~l~a~i~(~)~ems are in conformance with MOA HA,4~ guide '.~nes in effect on this date. ~ign~ture EngineefsName ~0~-'~, ~-Ob~M . . ., Date of Payment//~ Receipt Number Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* ,~t~_.' CT&E Environmental Services Inc. CT&E Ref.# 985992001 Client Name S & S Engineering Project Name/# N/A Client Sample ID Lt 3 Barclay S/D Matrix Drinking Water Ordered By PWSID Sample Remarks: Client PO// Printed Date/Time 10/15/98 22:05 Collected Date/Time 10/14/98 10:50 Received Date/Time 10/14/98 14:00 Technical Director: Stephen C. Ede Released B~~.~L4~ ~ Paraneter ResuLts PGL Units Neth~ AtLouebte Prep AnaLysis Limits Date Date Init Total CoLiform Nitrste-N 0~/100 #L, HO COLI 0.964 0.100 mg/L S#18 9222B 10/14/98 KAP EPA 300.0 10 max 10/14/98 10/14/98 GCP