HomeMy WebLinkAboutBERNARD BLK 2 LT G-2Bernard
Block 2
Lot G-2
#060 - 321 - 08
MUNICIPALITY OF ANCHORAGE
On -Site Water & Wastewater Program
PO Box 196650 4700 Elmore Road
Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997
http://www.muni.org/onsite
On -Site Wastewater Disposal System Permit
Permit Number: OSP231186
Work Type: SepticTank Upgrade
Tax Code Number: 06032108000
Site Legal Address: BERNARD BLK 2 LT G-2 G:0254
Site Mailing Address: 19005 ELNORA LN, Eagle River
Owner: MCDONALD ADAM & ERIKA
Design Engineer: FORGE ENGINEERING
This permit is for the construction of:
Effective Date:
Expiration Date:
relent S
�' rG
O.r
Department
Lot Size in Sq Ft:
Total Bedrooms:
7/14/2023
7/13/2024
63864
❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction shall be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
. Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By:
Date:
Date:
3
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 060-321-08
Property owner(s) Adam McDonald
Mailing address 19005 Elnora Lane, Eagle River, AK 99577
Site address 19005 Elnora Lane
Day phone (907) 717-7815
Legal description (Sub'd., Block & Lot) Bernard Sub, Block 2 Lot G-2
Legal description (Township, Range & Section)
Lot Size 63,864 Sq. Ft. Number of Bedrooms 3
APPLICATION IS FOR:
APPLICATION IS AN:
TYPE OF DWELLING:
(® all that apply)
Absorption Field
❑
Initial ❑
Single Family (SF) ❑X
(w/wo ADU)
Septic Tank
[AUpgrade
❑X
(D) EJ
Holding Tank
❑
RenewalDuplex
❑
Multiple
Multiple Dwellings ❑
Privy
F]
and/or D)
Private Well
❑
Water Storage
❑
THIS APPLICATION
INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit/Rush Fees: I ?_ �— Waiver Fees:
Date of Payment: 7AA�j
Receipt Number: O 70 gct.0
Permit No. DSP Z .3 / 151
Permit App_::- ::'-.,:c
Date of Payment:
Receipt Number:
Waiver No.
June 28, 2023
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
Subject: Bernard Block 2 Lot G-2 - 19005 Elnora Lane
Septic Tank Replacement
Dear On-Site Services Engineer:
The owner of the above lot has a septic tank that has reached its end of useful life, so we are
submitting this permit application for its replacement. The attached site plan identifies the location
of the home as well as the wells and septic location. No conflicts exist between this proposed
system and any other wells or septic system, whether on this lot or adjacent lots. Although the
building has 3 bedrooms, at the homeowner’s request we are upsizing to a 1250-gallon tank.
The new septic tank will be a minimum of 100’ from all wells and surface water. Please refer to
the attached plan for the septic design. If this design is followed, there will be no adverse impacts
to adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231186, Curtis Townsend, 07/14/23
//
//
//
//
CO - CLEANOUT
2CO - DOUBLE CLEANOUT
FCO - FOUNDATION CLEANOUT
FD - FLOW DIVERTER VALVE
MH - MANHOLE
MT - MONITORING TUBE
SV - SEPTIC VENT
TH - TEST HOLE
LEGEND
1"=50'
3-BDRM HOME
CARPORT
FCO
BERNARD SUBDIVISION, BLOCK 2 LOT G-2
FEET
0 50 100Benjamin Schiller
CE 12592REGISTEREDPROFESSIONA L E N GINEER
ELNORA
L
A
N
E
6/28/23
SEPTIC PLAN
SHED
DECK
COOP
PUBLIC USE EASEMENT
DOC# 2007-078820-0 A.R.D.
25' DRAINAGE & STREAM
EASEMENT PLAT 81-245 A.R.D.
DECOMMISSION
TANK PER UPC
NEW 1,250-GAL SEPTIC TANK
PROVIDE FOUNDATION CLEANOUT OR
DOUBLE CLEANOUT BEFORE TANK
ENSURE 5' SEPARATON FROM DECK AND 10'
FROM FOUNDATION
EXISTING TRENCH TO
REMAIN IN SERVICE
2CO
SHED
EXISTING WELL
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP231186, Curtis Townsend, 07/14/23
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03/15/2006 10:22 9784186053
GOD PEOPLE
Certitieb OraYting log
by
•
DOC CO. dba '
SULLIVAN WATER WELLS
P.O. BOX 670272, CHUGIAK. ALASKA 99567 •TELEPHONE 638-275 •
9
PAL
. f It�jj%f�Kt:.A. •
• (L F. Jactc AOC. C. �'riLiC�f$%Y BORE HOLE DATA
ADDRESS'
LEGAL DESCRIPTION: R;r,e J)t,vj /34/d; <J (4 -rt
DATE -;-1/102 tint
PERMT NUMBER: CAC -41-2 Date of Issue --S.
TAX IDEN11FICAIION NUMBER: 060 - .742i - toe -
Is well located at approved permit location? -terO No
Method of Drilling: it rotary 0 cable tool
Depth of well. qO
Casing Type Crh .4 Wall Thickness o:).52 -) inches
Diameter 6 inches, depth Q 5 feet
Liner Type: /tom 41.3 E
Casing Stickup Above Ground: g. •
Static Water Levet: 4J
•
Recover Rate: L—gpm
Method of Testing: !¢/ fs.
Well Intake Opening Type: 0 open end a n hole
O Screened: Start feet Stopped feet
0 Perforations Start feet, topped feet
2.=_.tnC 4h V Volume '" 4C
Grout Type: / 1:.., t -
feet
feet
Depth: from Ca
feet, to i; tr" • feet
Well Disinfected Upon Completion? Q_Yes 0 No
Method of Disinfection. 0.44. 0 ewe 5-644.7;./..
Comments:
DEPTH
Pion, To
a
a.
/
A
12
to:
i?-
'
4=
4a}
!b0
c•
/7:2-
t.2`/7)
/751
IPSkik'
.3m
) 70
a. /
,'fl
)At
In
3' S
3 3'9
PAGE 02
doFri,,,) S7-rcc.JP •
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Drilier's Name fil:x.a L,_._----
ATTENTION: It Is the responsibility of the property owner to submit a Copy of the well fog to the proper authority. Municipality
of Anchorage: Department of Health & Human Services and/or Department of Environmental Conservation. Matsu Borough:
Department of Environmental Conservation.
,wflPPpr.26. 205 N,
19:40A
•
•
•
ram
Mark Ecgich
Moyer
Gayness Engineering Group, Ltd.
J.., sU.., Veit.
901-6138-254;'2916 P. 2 r. 1
Development Services Department
Building Safety Division
On -Site Water a Wastewater Program
4700 Brogaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
L'w'.rnunl eraLensia
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: (2 pcj/a,
Parcel Identification Number:p -32L-1,2k
Date of Issuc• ! O,6
Legal Description
Black
Z
Pump nsta at on Date: - - l76
Pump Intake Depth Below Top of Well Casing 335--
Lot
33 '
Lot
Pump Manufacturer's Name tai..i
Pump Model: _ Q
Pump Size 1_hp
Pitless Adapter Burial Depth: 10 feet
Piticss Adapter Manufacturer's Name:
Piticss Adapter installer:
L"rre ezc n a C a
Weil Disinfected Upon Co,npletion? »'fes U No
Method of Disinfection: el y.),
Comments:
Pump Installer Name:
Company:
Property Owner Name 8: Address:
kcn,vck: Moct
Eleir gra
Mailing Address: /" DLjic 27O/77
City: / .. i State: /d.�_Zip: ri�7
m
feet
AItau don: The pump installer shall provide a pump installation log to DSD within 30 days of pump installation.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water 8 Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Permit Number: SW060012
Legal Description: BERNARD BLK 2 LT G-2
Design Engineer: 0000 None Required
Owner Name: KENRICK MOCK & KHRISTY PARKER
Owner Address: 19005 ELNORA LANE
EAGLE RIVER . AK 99577 -
Date Issued: Jan 31, 2006
Expiration Date: Jan 31, 2007
Parcel ID: 060-321-08
Site Address: 019005 ELNORA LN
Lot Size: 63864 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank 0 Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
-THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55.
PLEASE SEE THE ATTACHED SHEET 'PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM'. IT IS
THE BURDEN OF THE PROPERTY OWNER TO DETERMINE THAT THE PROPOSED WELL WILL NOT HAVE
ANY ADVERSE IMPACTS ON ADJASCENT WELLS OR SEPTIC SYSTEMS AND DETERMINE ANY EXISTING
WASTEWATER PERMITS EFFECT THE LOCATION OF THE PROPOSED WELL. IF THERE ARE ANY
QUESTIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT
907-343-7904.
Received By: 16I1"4'f/ t'n C-
Date•
3/
Issued By: ( (► Date: I l3 i (0o
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel LD, D. 060 321 08 OBa=Fe
Property owner(s) Kenrick Mock & Khristy Parker
Mailing address 19005 Elnora Lane, Eagle River
Site address 19005 Elnora Lane, Eagle River
Legal description (Sub'd., Block & Lot) Bemard Blk 2 Lt G-2
go} --694-H015
Day phone 907-786-1956
Zip Code 99577
Zip Code 99577
Legal description (Township, Range & Section)
Lot Size 63864 Sq. Ft.
THIS APPLICATION IS FOR (® all that apply):
Absorption Field ❑
Septic Tank ❑
Holding Tank 0
Privy 0
Private Well
Water Storage 0
Number of Bedrooms 3
THIS APPLICATION IS AN:
Initial
Upgrade
Renewal
0
0
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
*114,GL / i t
(Signature of property owner or authorized agent)
Permit/Rush Fees: /'7 S Waiver Fees:
Date of Payment: --—'1 -0 GDate of Payment:
Receipt Number: 7S 9 7 n/A Receipt Number:
(Rev. 11105) y�
• 1—.2K-06
I CI DOS Glnor'c1 LurE I S Currtni-ki on
Com0V4ne-1 wel) . We wmia lit 10
Gkril\%11 pr;bru4R w -t l l Ana ;mega -10
ScoANC G7 'Proal +4 c&nmun( 7 w4n9er-
Si5lem
441LUct Kick
areAX •er• 9/41/ /��171i
ASBUILT
I HEREBY CERTIFY •THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
flr4 0 s7,4 Zara -z, .4.1-; z•
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SEWARD & ASSOCIATES LAND SURVEYING 694-0829
SCALE:
so'
DATE:
s/yam
GRID:
• 4/ zsf/
FB:By/e
DRAWN:
.Or11
at C4F flt lb
r,`P .......
,
G�!v
Duan* Mark Sward
�1�•'• LS -6918 : csS
� MUNICIPALITY OF ANCHORAGE
// y,E\ DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
_ I (1 ENVIRONMENTAL ENGINEERING DIVISION
\\ `- 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
NAME jj��
b 1i1 - bei..(.(..oAA
PHONE
6,y4_.3C7,2q
L[�NFW
❑UPGRADE
MAILING ADDRESS
8011 02 3Li e'eoce.
LEGAL DESCRIPTION
L G.-.2 Q ..2 ,gena-,e.ci
LOCATION
NO. OF BEDROOMS
SEPTIC
TANK
DISTANCE TO:
ell +2001
Well
�uy�
Absorption ar a
g 1�� l
Delling /
wgo
Material ��
Ste
PERMIT NO.
8a067
No. of compartments
Manufacturer n�£�
Liq. rapacity in allons
IF HOMEMADE:
Inside length
Width
Liquid depth
--�_
/060
o Y
-ICZ
0Z <
1
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Manufacturer
Material
Liquid capacity in gallons
TILE
GRAINFIELD
TRENCH
DISTANCE TO:
31/YI/?�/l •/
CGl��7�-
+.20v�
Foundation /
Nearest lot line /C /
PERMIT NO.
9620
a 0 a '7
No. of lines )
/
Length of each I
5Ye`'
e
Total length of lines
5-6, '
Material beneath tile /
Depth
Trench width
-^-34, inches
inches
Distance between lines
Total effective absorp�n area
.5/5/
PERMIT NO.
Top of tile to finish grade
Length
(
---3 (62_
Width
SEEPAGE
PIT
Type of crib
Crib diameter
Crib depth
Total effective absorption
area
DISTANCE TO:
Well
Building foundation
Nearest lot line
-r
Iii
C ss /
2rnet-cl`
Depth
Driller
Distance t4 lot line
PERMIT NO.
v�j,
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
PIPE MATERIALS
b -3o34
N
r0.
SOIL TEST RATING
/35�
l9/
INSTALLER
bF — D �.c t_Cc A
4
Qt
061llltllt,'(lti(ii
Sv
/i'C
—
a
Is'El
bolo
REMARKS
6
1)
�a
tti
,,�
PD
PAS
APPROVED DATE LEGAL
/1)&7/7 /%��%�y /,/b 2-'
72-013 (Rev. 3/78)
1. ND LT~I_ "T' "-r" CP F;7. F:1 Gi�
DEPARTMENT HEALTH AND ENVIRONMENTAL r'ROTECTION
825 'L' STREET, HNCHORHGE, AK. 99501
264-4720
Cff r-4 Er. EFE .1 E.: FR.' F"'" E.: IR ri -T
| PERMIT N1 ( 820267 )
APPLICANT DEAN-DELUCIH
LOCATION ELENORH ST
LEGAL LQ2 B2 BERNARD
//�
BOX 234 ER 694-342'
LOT SIZE 63864 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH
MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 135
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM 15:
IDEIP'T11-11= K_���,40-114-11=
E>EDPTIF-0=
^�
THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIEM
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
FimEcluirREAD s;EL7F-1-1c.: �nrAK rs;I:zu= AJorwl oFia_t_uor,u55
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE
�WD <:;2> �r4S4="EFJC-1-10r-47FiR:EE FREEICIOL.EIRJET>
BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION.HND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS
100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND
TO A COMMUNITY SEWER LINE IS 75 FEET.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER INSTHLLHTIM
���M1.-IF ���1.�1P--E; ��OFEMBE-1".F.*.
I CERTIFY THAT
1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF HNCHORHGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES,
3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDRQOMS.
HPPLICIT DEAN-DELUCIH
ISSUED BY
Y4.0
0 & tN VEERING & DEVELOP" At.O.
JX 90, Davis St., Eagle River, Alaska 99577
694-2774 or 688-2280
Russell Oyster
694-2774 SOIL LOG
Performed for: Name.
Earl Ellis
688-2280
Tel. No )7(-'
Mailing Address. 'T /� Ae6I6)T'E E//cy44 // , 4X • 9%.''7,7
Legal Description:
Depth (feet) Soll Characteristics
0
1
2
�4
5
6
.54/vim ,,
..
i
10
11
12
`13 ;
14
15
16
J ,E'E- P1-4
Fvr Z o C4 ria .✓
*49'Y 10
o �j
o/ r• .i. ... el o r .
I Earl P. Ellis %,,,4:7140/
p.0 g,, a NO. 1745-E Co%
II h F�!r•r c.
. -
9
rr. nrre•o•,
Ground Water Encountered: Yes 1-''r No If yes, what depth
%
.. • �8%ic0
PLOT PLAN
PERC. TEST
Proposed Installation: Seepage Pit Drain Field
Comments:
Performed by:
/ 4 A- (: "4,„2_,
Date'
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 060-321-08
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Real Estate Agent
BERNARD S/D; BLOCK 2, LOT G-2
Expiration Date:
19005 ELNORA LANE, EAGLE RIVER, AK 99577
GUY AND DEBRA FERENCY Day phone 388-9303
19005 ELNORA LANE, EAGLE RIVER, AK 99577
2. TYPE OF DWELLING:
II Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
waiverNariance request f
Received by:
COSA to be released to the engi
A
r
'r u olherw :quested by the engineer.
Day phone
TYPE OF WASTEWATER DISPOSAL:
• Individual On-site II
O Individual Holding tank 0
O Community On-site 0
O Public Sewer 0
Distance:
elIZs//s
COSA Fee $
Date of Payment
Receipt Number
61123/15-
COSA #
123/r5-
COSA# 65C1515-59
Waiver Fee $
Date of Payment
Receipt N jmber
Waiver #
6. 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,
sho yrs that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for: tife'ntiinber 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.
Address 3701 E. TUDOR ROAD, SUITE 101 'ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG provided an engineering evaluation of the well and/or sego system in accordance wph /he
guidelines and regulations established by the Muniabality of Anchorage and industry practices. The reported results describe the
cnnddion of /he systemis on the deters of the evaluation. Separation distances were measured to readi&ridentifiable features..
Hidden defects or encroachments may exist that were not identified during the evaluatkn. The operational life of all wells antiseptic
systems depend on a varietyof varrabks including, but notgmfed to, sod conditions, groundwater levels (that may fluctuate during
the year), qualtyofconstruction (materials and workmanship), and the water usage of the tamiyutilzingthe systemic These
conditions can vary, and are outside the denim/ of GEG. Satisfactory test results do not guarantee future performance of the
system/s; therefore, GEG makes no warranty (express orimptied).regarding the future performance of the well orseptic system.
GEG makes no representation whether an alternative well or septic system can be installed on the property in the event elmerofthe
current systems fail. The content of this report is for the sok benefit of the person/partywho retained GEG. Reliance upon the
• information provided in this report by any other person or party, incluoingbut not limited to subsequent proper'purchasers, isnot
authorized. In short, GEG disavows any legal duyta anyone other than the person/party who paid for this report.
6. DSD SIGNATURE IG
System #1 Approved for 3- bedrooms.
System #2 Approved for bedrooms.
Disapproved.
Conditional approval for
Phone 337-6179
Date o l ;'�j
ra, J- e• •. Garrn%-ss &u i
G
%cp.), •• ••i E ..J• `cam i I
E-si ON-SITE �0
WATER AND "
lEe
WASTEWATER z^
ern PROGRAM
bedrooms, with the following stipulations:
By: �1 /4/ Original Certificate Date:
The "nisi, F7„/A Deverop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
c./
Nitrate Advisory
Arsenic Advisory
Other
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: BERNARD 5/D; BLOCK 2, LOT G-2 Parcel ID: 060-321-08
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# NA Well Log (Y/N) YES
Date completed 2/21/2006 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 340 ft. Cased to 44 ft Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 2/21/2006 9/17/2015
Static water level 55 ft. 30 ft.
Well production 3.0 g p m 4.3 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: THETA ENS/& ENG
Arsenic: ND ug./L. Date of sample: 9/10/2015
B. SEPTIC/HOLDING TANK DATA *INSIDE CRAWLSPACE
Tank Type/Material SEPTIC/STEEL
Date installed 6/8/1982
Tank size 1000 gal. Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (YIN) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping 11/11/2014 Pumper JR'S PUMPING SERVICE
C. ABSORPTION FIELD DATA
('BELOW EXISTING GRADE TO BOTTOM OF MT
Date installed 6/8/1982 Soil rating (g.p.d./ftor
135 System type TRENCH
Length 56 ft Width 3 ft Gravel below pipe 4 ft.
Total depth *6.45 ft Eff. absorption area 448 ft2 Monitoring tube **YES
Date of adequacy test 9/17/2015 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 15.5 in Water added 609 gal.
Elapsed Time: 955 min. Final fluid depth 18 in
Depression over field NO
For 3 bedrooms
New depth ***26 in.
Absorption rate >= 450+ g.p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
**MT ONLY EXTENDS 36 INCHES BELOW THE INVERT
***THE LAST 477 GALLONS INTRODUCED CAUSED NO RISE IN THE LIQUID DEPTH
D. LIFT STATION
Date installed
"Pump on" level at
Size in gallons
in. "Pump off' level at
Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
1001+
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
100'+
N/A
Sewer /septic service line 25'+
Animal containment areas 50'+
Manhole/Access (Y/N)
wa er alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots 1001+
Public sewer manhole/cleanout N/A
Holding tank N/A
Manure/animal excrete storage areas 100'+
100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+
Water main N/A
Property line 5'+ Absorption field 5'+
Water service line 10'+
Wells on adjacent lots 100'+ PVT/200'+ PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 101+
Water service line 10'+
Curtain drain NONE KNOWN
F. COMMENTS
POST TANK CLEANOUT IS PRESENT, BUT FLUSH WITH GRADE
Surface water 100'+
Building foundation 10'+ Water main N/A
Surface water 100'+ Driveway, parking/vehicle storage 10'+
Wells on adjacent Iots100'+ PVT/200'+ PUBLIC
G. ENGINEER'S CERTIFICATION
certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Print d Nae
Date 177 /7
(Rev. 10/12/12)
JEFFREY A. GARNESS
Municipality of Anchorage
On -Site Water & Wastewater Program
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
Parcel I.D. 060-321-08
1. GENERAL INFORMATION
Expiration Date: a/q/)3
Complete legal description BERNARD S/0; BLOCK 2, LOT G-2
Location (site address) 19005 ELNORA LANE *EAGLE RIVER, AK 99577
Current Property owner(s) HARRY & PAM STYANER
Mailing address
Real Estate Agent
Day phone 694-2205
19005 ELNORA LANE *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:
4. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
3
Day phone
OK --o rcle0.5e -i° Ve" t'
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
❑ Individual Holding tank
❑ Community On-site
❑ Public Sewer
•
❑❑
Received bye
COSA to be released to the engineer, unless otherwise requested by the engineer.
Date:
)/ /
COSA Fee $ 1Rb
Date of Payment ► i 1 g d a `) ea
Receipt Number 61Qf°\ G
COSA #
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. 1 further verify that based on the
information obtained from the Municipality of Anchorage files and from my investigation and inspection, the
on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal
and State codes, ordinances, and regulations in effect at the time of installation.
Name of Firm
Address
GARNESS ENGINEERING GROUP, Ltd.
3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date
Phone 337-6179
Engineer's Comments:
In conducting thisevaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily identifiablefeatures. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
✓ System #1 Approved for 3 bedrooms.
System #2 Approved for bedrooms.
Disapproved.
ess.
CE 79153 m`,01
aprofessio�°oma
��040000�
LOW( ff01/4
istorf
Z
ON-SITE
WATER AND
STEWATER o^
bGRAM
Conditional approval for bedrooms, with the followirig�gpula
�cs's
The Municipality or Anchorage Develop,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations 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. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
By: aeil/ W fr
(Rev. 11105)
Nitrate Advisory
Arsenic Advisory
Other
Original Certificate Date: 1 1/q7 2
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: BERNARD S/D; BLOCK 2, LOT G-2
A. WELL DATA
Well type PRIVATE
Parcel ID: 060-321-08
If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 2/21/2006 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 340 ft. Cased to 44 ft. Casing height (above ground) 18+ in.
FROM WELL LOG AT INSPECTION
Date of test 2/21/2006 9/28/2012
Static water level 55 ft. 29 ft.
Well production 3.0 g.p.m. 5.9 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 ml. Nitrate'. IF mg./L. Collected by: GFG. Ltd
Arsenic: t Oug./L. Date of sample: 1 0/ 1/ i).
B. SEPTIC/HOLDING TANK DATA *INSIDE CRAWLSPACE
Tank Type/Material SEPTIC/STEEL Date installed 6/8/1982
Tank size 1000 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A
Date of pumping I. D i t I t 01- Pumper V 12' S St p -i- «-
C. ABSORPTION FIELD DATA *BELOW EXISTING GRAD T' SoTTsn cap nT sF*
Date installed 6/8/1982 Soil rating (g.p.d./ft2orCbdri 135 System type TRENCH
Length 56 ft. Width 3 ft. Gravel below pipe 4 ft
Total depth *6.45 ft. Eff. absorption area 448 ft2 Monitoring tube **YES Depression over field NO
Date of adequacy test 9/28/12 Results (Pass/Fail) PASS
Fluid depth in absorption field before test 16 in. Water added 7211 gal.
For 3 bedrooms
New depth 24 in.
Elapsed Time: 120 min. Final fluid depth 16 in. Absorption rate >= 450+ g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date —
**MONITORING TUBE ONLY EXTENDS 36 INCHES BELOW INVERT.
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N
"Pump on" level at in "Pump off' level - High water alarm level at in
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
100'+
Septic tank/lift station on lot
Absorption field on lot
Public sewer main
N/A
100'+
On adjacent lots
On adjacent Tots 100'+
Public sewer manhole/cleanout N/A
Sewer /septic service line 25'+ 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'+PVT/200'+PUBLIC
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation
Water service line 10'+
Curtain drain
F. COMMENTS
101+ Water main N/A
Surface water 100'+ Driveway, parking/vehicle storage 101+
NONE KNOWN Wells on adjacent lots 100'+PVT/200'+PUBLIC
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems am in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date /I ) 6 i/2
(Rev. 11/05)
+the 1o0ta11c'ri kji the stfucture(;)a:,
shown 911 thi3, ''ec,Ord drawing
o-kkkilt,n/ -6
011withyTiti�21,AMC.
as //
a
EAi/`yc.47,22,a4/
y�c�li,.�fc -5:0a _52
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED' SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF' FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
>
SEWARD & ASSOCIATES LAND SURVEYING 694-0829
Parcel I.D.
Municipality of Anchorage
Development Services Department
' Building Safety Division
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
.FOR A SINGLE FAMILY DWELLING
(Yd)-3�1 bv6 cosA# old) 14 1
1. GENERAL INFORMATION
Complete legal description
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing address
Expiration Date: 7 . Qi - o (n
BERNARD SUBDIVISION; LOT G2, BLOCK 2,
19005 ELNORA LANE • EAGLE RIVER. AK 99577
KENRICK MOCK Day phone 694-4945
19005 ELNORA LANE • EAGLE RIVER. AK 99577
Day phone
Day phone
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class Well
Public Water System
•
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding tank
Community On-site
Public Sewer
a
The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered In the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer
of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or
water supply system. DSD also Issues COSAs upon request to homeowners. Certificates of On -Site Systems
Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may
be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, 1 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
Address
GARNESS ENGINEERING GROUP. Ltd.
3701 E. TUDOR ROAD. SUITE 101 • ANCHORAGE, AK 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, LtD. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the limo of the test, and separation
distances measured to readily identifiable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluates of the system. Satisfactory test
results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty a future estimate of how long the system will continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. My reliance upon or use of this report by any
other person or party Is not authorized, nor will it confer any legal right whatsoever.
5. DSD SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for
Phone 337-6179
Date 14I3/o6
bedrooms, with the Wowing stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By:
Mw 111151
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Reort
Other
\`,,,lttos(0F rrift
>10
ON-SfTE : M
: WATER AND
WASTEWATER ; -
• PROGRAM : 4
a.
in, 00
Original Certificate Date: T-.2 S - 0 G
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water & Wastewater Program
4700 Bragew Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.ory/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description. BERNARD SUBDIVISION; LOT G2, BLOCK 2, Parcel ID: 0 Co 0 - 3 1 / - 08
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 2/21 /2006 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 340 ft. Cased to 44 ft. Casing height (above ground) 18+ in.
FROM WELL LOG
Date of test 2/21/2006
Static water level 55ft. _ *IC\ ft.
Well production 3 g p m - N g p m
WATER SAMPLE RESULTS:
Conform 0 colonies/100 ml. Nitrate N/n mgJL. Other bacteria 0 colonies/100 ml.
Arsenic: SIL ug./L. Date of sample- 3/16/2006 Collected by
B. SEPTIC/HOLDING TANK DATA *INSIDE CRAWLSPACE
Tank Type/Matertal STEEL
AT INSPECTION
GEG, Ltd.
Date installed 6/8/1982
Tank size 1000 gal Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) "YES Depression over tank (Y/N) NO
Date of pumping
5/16/2005
Pumper
High water alarm (Y/N)
JR'S PUMPING
N/A
C. ABSORPTION FIELD DATA tuagy_goisstmocnisarnmstuaej
Date installed a/e/taa2 Soil rating (g.p.d./ft2ora 135 System type TRENCH
Length 56 ft. Width 3 ft. Gravel below pipe 4 ft.
Total depth •8.3 ft. Eff. absorption area 448 ft' Monitoring tube YES Depression over field NO
Date of adequacy test 12/28/2005 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 14.5 in Water added 600 gal New depth 35.5 in
Elapsed Time: 315 min. Final fluid depth 16 in.
Absorption rate >= 450+ g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date —
*MONITORING TUBE ONLY EXTENDS 34.5 INCHES BELOW INVERT,
D. LIFT STATION
Date installed
"Pump on" level at in.
Datu
Size in gallons Manhole/
"Pump off" . _ n High water alarm level at in.
Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
100'+
Septic tankAift station on lot
Absorption field on lot
Public sewer main
100'+
100'+
Sewer /septic service line
Animal containment areas
25'+
50'+
On adjacent lots
On adjacent lots
100'+
100'+
Public sewer manhole/deanout
100'+
Holding tank N/A
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation
Water main
5'+ Property fine 5'+ Absorption field
10'+
Water service line 10'+ Surface water
Wets on adjacent lots 100'+/200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+
Water service line
Curtain drain
F. COMMENTS
10'+
50'+
G. ENGINEER'S CERTIFICATION
Building foundation 10'+
Water main
100'+
5'+
100'+
10'+
Surface water 100'+ Driveway, part ing/vehide storage
Wells on adjacent lots 100'+/200'+
1 certify that 1 have determined through field inspections and
review of Municipal records that the above systems am in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name
Date 4/3/0'
JEFFREY A. GARNESS
10'+
79 3
o /flip
COSA Fee $
L b .cD
Date of Payment
Receipt Number
(Rev. 11/05)
1
412o I0
t
Waiver Fee $
Date of Payment
Receipt Number
SCS Ref.N
Client Name
Project Name/p
Client Sample ID
Matrix
1061286001
Gamcss Engineering Group, Ltd.
Bernard SD Lot 6-2 Bk 2
Bernard SD Lot 6-2 Bk 2
Drinking Water
All Dates/Times are Alaska Standard Time
Printed Date/Time 03/242006 9:51
Collected Date/Time 03/16/2006 8:30
Receired Date/Time 03/162006 14:29
Technical Director Stephen C. Ede
Sample Remarks:
Parameter
Results
POL
Units Method
Metals by ICY/MS
Arsenic
Waters Department
Nitrate -N
Microbiology Laboratory
Total Coliform
ND
ND
0
5.00 ug/L EP200.8
0.100 mg/L EPA 353.2
co1/100mL SM20922213
Allowable Prep Analysis
Container ID Limits Date Date !nit
C (<.10) 03/22/06 03/22/06 SCL
B (<=10) 03/16/06 1C
A (<=1) 03/16/06 DPT
03/27/2006 14:22 9073449821 JRS SEPTIC
JRs Pumping
PO Box 773415
Eagle River, AK 99577
(907) 694-6454
Blllino Information
Kenrick Mock
19005 Elnora Lane
Eagle River, AK 99577
(907) 694.4945
Job Site Information
Kenrick
19005 Elnora Lane
Eagle River, AK 99577
. (907)694-4945
Additional Location Comments Diprwn:
3rd dw on your left - Brown house w/
ft's on post, 2 dogs will be Inside,
fenced
yard but will be open.
Pipes in back yard and visible.
Service Type
Septic Service 15K
Job Descrlpuan: 1000g
P.O. Number.
Tama: Net 30
Salserep:
Map Book:
Cross Streets:
Job Comments:
Qty Price Each
1 $125.00
Nikole
Hiland Rd
PAGE 02
Service Agreement
Number:
Order Date:
Service Date:
Technician:
016819
11 -May -2005
16 -May -2005 12:0
Dave
Tax %: 0
Job Type: Repeat
Meq Grld: 128- -
Last service 08/12/03 1000g
Pumped tank - heavy solids, BF Ix.
Tax?
No
Gallons Planned: 1000
Gal. Actual:
Hose Length: 3.5
Double Tank: 0
Pump System: 2
Baffles Inlet: 0
Baffles Outlet: 0
Extension Actual
$125.00
NonTaxable Total
Estimated Charges: 5125.00
Actual Chayes:
Taxable Total
$0.00
Tu Total
60.00
Grand Total
5125.00
Customer agrees to the tarts end candldons printed on the back. THIS ISA BINDING AGREEMENT.
Signature and Tide of Customer Representative
Data
Accepted by JRs Pumping Deter Accepted
For your added convenience we accept; American Express, Dicovar, Visa and Master Card payments over the phone.
After 30 Days accounts wtit be turned over to collections. *25.00 For NSF Checks Returned.
k
\yam` . -- --
a?E-4-,4ag;t ' /0/c�
ASBUILT
121
SEWARD & ASSOCIATES LAND SURVEYING 694-0629
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY:
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TO DETERMINE THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI
VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD
ANY DATA HEREON BE USED' FOR CONSTRUCTION
OF FENCE LINES, OR FOR ESTABLISHING BOUND-
ARY LINES.
SCALE!
/ -G 3"-c•/
-DATE
GRID:
•SGi ZSf�
FB:
ey/.9
DRAWN:
••:491 Th1 •"74
0
•
.
e
T.T
o,,..,. Mut Seward
�+,• 1S-6918
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
��pp�
Parcel I D # 060-321-08 HAA # / T'/ 0006 9
1. GENERAL INFORMATION
Complete legal description
Lot G-2; Block 2; Bernard Subdivision
Location (site address or directions) Elanora Lane
Eagle River, AK
Property owner James Kinn & Margaret Beattie Day phone
696-6187
Mailing address P•o• Box 770945 Eagle River, AK
Lending agency Day phone
Mailing address
Agent Eva Loken/Prudential Vista Day phone 689-6464
Address 16635 Centerfield Drive Eagle River, AK
Unless otherwise requested, HAA will be held for pickup.
3
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
14.
xx
NOTE: If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
Individual on-site
Holding tank
Community on-site
Public sewer
XX
NOTE: If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72-025 (Rev. 1/91) Front MOA 4t21
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 dispoW rvici n ,gmpliance with all Municipal and State codes,
ordinances, and regulations i effect o the d •f this inspection.
wastewater on s, 37�� 7�
Name of Firm D�rr ' • .q/� 2B Phone
Address 17
i/
Engineer's signature / %,- O Date
Alaska Wats &
Wastewater Consultants, Inc.
Shall be PAID $ —700—
or prior to, closing for the
Engineering 3 rviGe4 provided, _.
at,
6. DHHS SIGNATURE
Approved for 3 bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
By.
2 -co 0
Additional Comments
Date )-420- O O
CAUTION
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 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 engineers work.
72-025 (Rev. 1/91) Back MOA #21
RECEIVED
Municipality of Anchorage JAN 18 2000
DEPARTMENT OF HEALTH & HUMAN SERVICESFnunAuY OFANGHURAGE
Environmental Services Division - 'viu )NMENTALSERVICES DIVI.
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description:RFRNARn SIIRnIVISION• I OT G-2. MOCK 2 Parcel I.D.: 060-321-08
A. WELL DATA
Well type CLASS "A"
If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Date completed
Total depth Cased to
Sanitary seal (Y/N
820267
FROM WELL LOG
asing height (above ground)
Wires properly protected (Y/N)
AT INSPECTION
Date of test
Static water level
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform Nitrate
Date of sample:
Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 6/R7 Tank size 1000 Number of Compartments 2 Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES (IN HOUSE) Depression (Y/N) NO High water alarm (Y/N) N/A
Date of Pumping 1/12/2000 Pumper JR'S PUMPING
C. ABSORPTION FIELD DATA
Date installed 6/R2
* SEE ATTACHED SEPTIC ADEQUACY TEST DATA SHEET
Soil rating (g.p.d./ft2 or ft2/bdrm) 135 System type
TRENCH
Length 56' Width 3' Gravel thickness below pipe 4' Total depth 7' — 7.5'
Effective absorption area 448 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO
Date of adequacy test 1/12/2000 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test (in.); DRY Immediately after 601 gal. water added (in.): *10"
Fluid depth N/A (ins) Minutes later: N/A Absorption rate = 450+ g.p.d.
Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date —
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed
Manhole/Access (Y/N) "Pum vel at* "Pump off" level at*
High water alarm level at *Datum
Cycl- ed
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
Public sewer main
Sewer /se. ' ice line Lift station
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Foundation 5'+ Property line 5'+ Absorption field 5'+
Water main/service line *10'+ Surface water/drainage 100'+ Wells on adjacent lots 200'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main/service line *10'+
Surface water 100'+ Driveway, parking/vehicle storage area 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 200'+
Size in gallon
UNC
On adjacent lots
W
adjacent lots
Public sewer manhole/cleanout
F. ENGINEER'S CERTIFICATION
* PER PREVIOUS HM.
UNABLE TO FIELD VERIFY.
I certify that 1 h.. •. -t J inei G- field inspections and review of Municipal recor_
in conformah. elines in effect on this date. p'
Signature
u�LI =�
Engineer's Nam-/ F JEF 'EY A. GARNESS
Date l/i740op
oo600p0;\
i'/•r
00
0.
•. 7953 der
ms are
•
y0O0
HAA Fee $ �J (76 `
Date of Payment
Waiver Fee $
Date of Payment
Receipt Number S7/ 7 (3 7 ) Receipt Number
72-026 (Rev. 3/96)*
ALASKA WATER 6- WASTEWATER
iSaMint. .: CONSULTANTS, INC. *;s% Sas.,.....". saxis`atzsaztiaav-'u'ssmn;smKassrs
SRPTIC ADEQUACY TEST DATA
LEGAL DESCRIPTION:
STREET ADDRESS:
ICI. NT: MAR.& At&T
Lisrt.Al;gm
•�1-p.rd a a.A
gEA'IT,
NUMBER OF BEDROOM: 3
S/0 Lot c -2�
LP,1.1 C
SONE NUMBER: 271 -64 II Ca x7. 144)
Scocic 2
rog6-6187
GALLONS PER DAY NEEDED: '/S 0
SEPTIC: *SEE H.A.A. SITE VISIT CHECKLIST* DATE OF TEST:
FIELD MEASUREMENTS:
TOP OF MT/SUMP TO BOTTOM: 5g ti (MT1) / / T2)
TOP OF MT/SUMP TO DISTRIBUTION LINE: *Lfo`I (MT1) /
STICK-UP OF MT/SUMP:,; ;d'- t2° (MT1) / n1 /tt (MT2)
TOP OF MT/SUMP TO LIQUID LEVEL: occ' Cas" MT1) / 4 //. (MT2)
Puz.. 1 NSPe'-Ttwa
geea27*
n! / OT 2)
TIME
METER
READING
NUMBER OF
GALLONS
SEPTIC TANK
LIQUID LEVEL
MT /SUMP
LIQUID LEVEL
RISE (+) /
FALL(-)
2:Z'{
1g9Z3
Par4Pge.p
OK'f 88"
—^
Z:34
Zoo1$
RS
Z8"
.{-1611
Z_SO
3016`I
/61/2`I,G
7511
6 to°Tim.
3 •_2o
2.011S66
287/533
78"
`u`t
`
1:27
ZoSz`f
6R/c.o1
7011
j / i
— SToef 9
aov.l
RESULTS:
X : PASSED ABSORBED ifSo+ GALLONS IN .53 MINUTES ( 4Co+ GPD)
: FAILED - SEE ATTACHED LETTER
Comments:
Signature: Date:
6901 Debarr Road, Suite 2-B * Anchorage, Alaska 99504 * Ph: (907) 337-6179 * Fax: (907) 338-3246 * awws@alaska.net
,erOgt
si
V
•
r rN/ OYO I -
9 . s. o oSi
No.41W4 ,;• �r I
40%,
AEGENQ.._
th+ay mammal recovered
• Iron pips and/or robe recovered
O Vega 3O" calor set this survey
PREPARED FOR! F^//19A
DARN an wst PAM 7/07 SCALE+ /'= soy
tor 4.-/
/ hereby certify that on commit &Inv a/ /he
to/lowing described , properly..
Lo TQ -2, Seocr. Z/ BdrAPA4te,Y 1e.e.
was mode on V/yr%p', and MOW*
Improvements s/taated thernn ,ore +rl1AM the
property tinea and do not overlap cr moron*
on Me properly O*g od/ooent thereto . fto1 'no
Improvements on property /y/n0 'gd/oceat Menlo
encroach ai the prem/ass /n aunt/on and . that
there ere no rooalrgys, transmission tines a' other
v/e/b/s easements an sold properly except Of
tnd/cotsd hereon.
Acted of Anchorites, Alasto, Ihl dcy, Pf
E2 Ise
trob-
CHCK0 a./.< WI NR
FANO 32
SNEETNO. / of/
GR%D 2,54
AS -BUIL T
LOT4-2 a«` 2
n rn,14 n A r-r/oA
mZ L..2 Na 11/075"
PREPAREO BY.
CORW/N Q ASSOC/AYES
1000 E. DIMOND ILVA,?
SUITE 205
ANCHORAGE, ALASKA 99315
(9071522 -ISP
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information
Application Date
(a) Legal D crron (include lot, N.oc�k b¢Iivis section, township, range)
Location f(�dd ess or "dir ons) Ce d Vii` -r,/' 001,0 A-(
(b) Applicants Name \h g- QA ./
Telephone — Home Business
Applicants Address
(c) Applicant is (check one) Lending Institution
Buyer ; Other (explain);
(d) Lending Institution
Address
; Owner/builder ;
Telephone
(e) Real Estate Co. & Agent
Address
Telephone
4_0( Breva ,Sa .r %r
7,v 0
(f) all the HAA to the following address:
a a E ENGINEERING.
SFIBX
1�L 14p111 R A�ttLASK ' �„7,�
. ?I1. 3J4-29 9
2. Type of Residence
Single—Family
Number of Bedrooms
3. Water Supply
Individual Well
Multi—Family
Other (describe)
ie04,,j lurk/
Community Public
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite
Public
Community
Holding Tank
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
the number of bedrooms and type of structure indicated herein. I further verify that,
based on the information obtained from the Municipality of Anchorage files and from my
investigation and inspection, the on-site water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm
8 &C ENG1 EE�1 tz
S.nB 196X •
Address '��_ tv1P,R, ALASKA. •`£5577
' PH. tY04-2370
Date l Z— 2.� -'`ef
6. DHEP Approval
uri°1/1
Approved for JJ#z 1 bedrooms By Date
(ENGINEER SEAL)
Aebort A. Shafer ,1
,'� No. 1657-E
Sd°ac. •c oaf°a FF .afD
P110 ESS\C)\\"
Approved Disapproved Conditional
Terms of Conditional Approval
dy
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER. TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2]
7-19-84
A. WELL DATA
MUNICIPALITY OF ANCHORAGE (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST FEBRUARY 1984
Lega Description:
€Ie 1'v th-lt 0
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
DEC 201984
RECEIVED
2 1 2
Well Classification _^r If B, or C, D.E.C. Approved(Y/e)
Well Log Present (Y/N) Date Completed Yield
Total Depth
Static Water Level
Cased to Depth of Grouting °
Pump Set At
Casing Height Above Ground Sanitary Seal on Casing (Y/N)
Electrical Wiring in Conduit (Y/N)
Depression Around Wellhead (Y/N)
Separation Distances from Well:
To Septic/4-Wank on Lot e..99.O On Adjoining Lots
To Nearest Edge of Absorption Field on Lotto On Adjoining Lots
To Nearest Public Sewer Line To Nearest Public Sewer
Cleanout/Manhole To Nearest Sewer Service Line on Lot
Water Sample Collected By
Water Sample Test Results /
Comments
Date
1 c
B. SEPTIC/a TANK DTA
Date Installed 0'2- Size 000 No. of Compartments
Standpipes (Y Air -tight Caps ) Foundation Cleanou
Depression over Tank (, Date Last Pumped JO, Y—
Pumping/Maintenance Contract on File
for
Holding Tank High -Water Alarm (Y , 4- Temporary Holding Tank Permit *Ai 14
Separation DistancesfromSeptic/NZdipg Tank:
To Water -Supply Wall Z70) To Building Foundation / 6/
To Property Line �C) To Disposal Field 8 ;42, /
To Water i/Service Line f- To Stream, Pond, Lake, or Major Drainage
Course N U raF
Comments Ai Co
Receipt # 1S
Date Paid: la
Amount : L15,
[Page 1 of 2]
2-15-84
C. ABSORPTION FIELD DATA
Soils Ratingin Absorption Strata AKS -76(
T of System Design %enc
P Type Y g 4
Length of Field —6
Date Installed b if 2 -
Width of Field 3 6
Square Feet of Absorption ea
Depression over Field f4Y
Results of Last Adequacy st .►•f `I4
Depth of Field
7 /2 -
Gravel Bed Thickness
412
Standpipes Present
Date of Last Adequacy Test Vie" /' Z
Separation Distance from Absorption Field:
To Water -Supply Well 2' 0 ---
To Property Line /
To Building Foundation 3 2- 71.- / To Existing or Abandoned System cn
Lott' ; On Adjoining Lots 'O
To Water lea/Service Line ,5 e"-- To Cutbarrk(if present)
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Continents AAD
/tJ 19 /JJ
rSV /
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Dinensions
Manhole/Access (Y/N)
11
Off" Level at
Vent (Y/N)
Tested for Pumping Cycles during Adequacy Test.
Electrical Codes(Y/N)
Comments
Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified,
on the date of this inspection.
Signed i` �ABa� B CIINt Date a- 20R
Company pH 2978 110571 MOA No.
or conformed to all MOA HAA Gui
KB1 /d5/s
[Page 2 of 21
2-15-84
(\L1 fX
N,N H 10V
DEPT. OF ENVIRONMENTAL CONSERVATION /
ANCHORAGE/WESTERN DISTRICT OFFICE
437 "E" STREET, SUITE 303
ANCHORAGE, ALASKA 99501
DATE: 46. /?, /Q/I9;
PWS I.0.# /A 754'
BILL SHEFFIELD, GOVERNOR
Telephone: (907)
Address:
274-2533
To Whom it May Concern:
According to records on file in this office the
04,04. 4 6.4.44: Water System is in compliance -with the State Drinking
Water Regulations
Sincerely,
1
