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HomeMy WebLinkAboutHUNDRED HILLS 1ST ADDITION BLK 5 LT 11Municipality of Anchorage Page )of 3 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: SW °110.31-17 PID Number. 9 — \U1 \ _. Ln Name: �';n, Wastewater System: A New ❑ Upgrade .I�u�Pley Address: Po Pox 67I1087 AK a�56� ABSORPTION FIELD a Deep Trench ❑ Shallow Trench 0 Bed 0 Mound 0 Other ,ci,I�,nk Phone: No. ofedrooms: LEGAL DESCRIPTIONS Soil Rating: 1,2 GPD/Sq; Ft. Depth to pipe bottom from original grade: Ft Fill added ab"oovv/e original grade: 0-5 Ft. Total Depth from original grade: IO ht . Gravel depth beneath pipe Ft Gravel length. L/5 Ft. Lot: 11 Block: �Vt'tR Sub ivis;otps I I ����, Township: Range: , • , I A,V + Section: 2.1 __TI2A WELL: A)/A 0 New 0 Upgrade Gravel width: Ft. Number of lines: I Dist ebetweenline: WA Classification (Private, A,B,C): Total Depth: Ft. Cased To: Ft. Total absorption area: 500 SQ. FL Pipe material: ip 11� pc,4. PVC, Driller: Date Drilled: Static Water Level: Ft. Installer: OWnc r Date installed: IoIDi2.JCl1 Yield: GPM Pump Set at: Fl. Casing Height Above Ground: Ft. TANK SEPARATION DISTANCES 0 Septic 0 Holding 0 S.T.E.P. To From Septic Tank N/A Absorption Field NSA Lift Station NIA Holding Tank NIA Public/Private Sewer Lines N /A Manufacturer: s A Nora5r, Jank Material: Sted Capacity in gallons: 1750 Number of Compartments: 2. Well' Surface Water 500,4 5.op/,- NIA Nf miA LIFT STATION Ail/ Lot/ Line / ' U / zh V Nrl /A A, i !v `i /vA Size in gallons: Manufacturer: Foundation 53/ / `,D /1%r� NIA N1A "Pumpon" level at: "Pumpoff" level at: High water alarm at: g Curtain Drain NIA N j p N/ A rl N/A i'tA NIA Pump Make & Model Elec rical Inspections performed by: Remarks: '"I"h� pe c.i5e.d, Well OC.Ai ;On BENCH MARK n is MO /1- eee,n -n)e, ser;r.. "tank, ltntA Location and Description: of concre..SIiia Arik'Corner of Trp '� drat`nif,ei locAi,ori5- 17ovse. Assumed Elevation: IoO.Oo Ft. ENGIN F,,,l' EAL \� s�.P ti:- uo li i, ? I. t„ Curtis A. ;Ging - 1 `�, ' ; "-�'y' ,, `''' ��®;k ,Q014' ' f dollo� ' Dates:lst to (a, -) Inspections performed by. S �n 2nd )0j12+11 Department of Heath and Human Services approval Reviewed and approved by, q41 �� Date. -3-7-79 72-013 (Rev. 9/91) MOA 25 V) • s • y '. c- ^:tsa 1 i t8 ••ti "Ddoi go Ai 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:SW970347 DESIGN ENGINEER:CURTIS KING, P.E. OWNER NAME:DUDLEY JAMES EUGENE OWNER ADDRESS:PO BOX 671687 CHUGIAK, ALASKA 99567 PARCEL ID:07819116 LEGAL DESCRIPTION: HUNDRED HILLS 1ST ADDITION BLK 5 LT 11 LOT SIZE: 110852 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: \D \11 PAGE 1 OF 1 \ij-\2 l DATE ISSUED:10/01/97 EXPIRATION DATE:10/01/98 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 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: MAXIMUM BURIAL DEPTH OF THE ABSORPTION TRENCH SHALL BE 10.5 FEET FROM GROUNDVEL. 'e, RECEIVED BY: ISSUED BY: DATE: //- DATE: f- DATE: /O " / j/ /7C/9C�fr MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW970347 DESIGN ENGINEER:CURTIS KING, P.E. OWNER NAME:DUDLEY JAMES EUGENE OWNER ADDRESS:P.O. BOX 671687 CHUGIAK, ALASKA 99567 PARCEL ID:07819116 LEGAL DESCRIPTION: HUNDRED HILLS 1ST ADDITION BLK 5 LT 11 LOT SIZE: 110852 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: PAGE 1 OF 1 DATE ISSUED:10/01/97 EXPIRATION DATE:10/01/98 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY 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 -S 5. THE FOLLOWING SPECIAL PROVISIONS. PERMIT) SPECIAL PROVISIONS: MAXIMUM U -DEPTH OF THE ABSORPTION TRENCH SHALL BE 10.5 FEET FROM GROUND LEVEL. a7,4„/ RECEIVED BY: ISSUED BY: )0(2) 1 v L v lJ DATE: / `�� co„;;A NOTE:ELEVATIONS ARE ASSUMED DATUM_ • Q 'tH ro›OxroH ro(nZH t+1biZC70H • tzint+jxlfn ZHx1HH O HHt1jOx Z:n0�nL1 H to H O ;d xn HZLTJ tijo <CnCn c�r�Hro ro r� Z x1 0 rtlZr7HxZ oncn O • Z H H H 7JH0'TJHtrJ CJtn HOH rj c1ZZr (-LOthH H M1 1-3 cn • tsjxo1< aJt• TjZC7c0 t7 C1l H tTJ F+] H• x1WPc) HH Vl H D Kj x HnHt71-cr� O Hxt1 z01-ci roZtJZOZ r fn X 17 ro LTJ H O ;d HECnCCf) HLTJHC75ti nz xnHb7to tri d C H H O 0 tir ro d r7 oZ G)z PROPOSED CONSTRUCTION PLAN HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: /i- M, sl4LY GcaTi/B/.(!S • 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: SEWARD & ASSOCIATES LAND SURVEYING 694-0829 DATE: 1//yls GRID: cu./ // Jo FB: sz-70 DRAWN: A f y,* TH• j// Deno Merk Soward 0 • LS -6918 yw�a Owner: Jim Dudley Legal Description: Lot 11, Block 5, Hundred Hills Subd., Addn. 1 A. General Overview 1. The septic system is designed for a four (4) bedroom single family residence only. 2. The attached drawings, site plan, and percolation test logs shall be part of this specification. 3. All materials and workmanship shall meet the Municipality of Anchorage (MOA) Department of Health and Human Services requirements. 4. All soils tests are advisory to the design and are to be verified or modified in the field by the engineer. Upon completion of the excavation, soil conditions present in the walls and floor of the deep trench should be logged. If the drainfield is constructed outside of the 30 ft radius circumferencing test hole (TH) #1 and TH#2 then one (1) additional 16.5 ft test pit shall be excavated and one (1) additional percolation test performed approximately 6 ft below grade. One (1) additional 16.5 ft soils test hole (TH#3) shall be excavated and one (1) percolation test shall be performed, in the middle of the proposed reserve drainfield, at approximately 6 ft below grade. 5. TH#1 was excavated on 4/28/95 and was used for the design of the original disapproved septic system, submitted to the MOA on 12/6/95. The disapproved septic design is attached along with MOAs On -Site Services Transmittal Sheet with comments. 6. All excavations and depths are advisory and are to be verified or modified in the field by the contractor to meet MOA requirements. 7. It is the responsibility of the engineer to locate any adjacent wells. 8. The installation and excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 9. It is prudent that a surveyor locate the nearest lot line position and location of any easements. 10. Inspection of on-site waste disposal system installations are required, and shall be in accordance with the Municipality of Anchorage Waste Water Disposal ;Regulations Section 15.65.150. The first inspection must ,be conducted after the excavation of ditches and before Any gravel is placed. At this time the construction (nater1als will be verified by the engineer. The second inspection must be conducted after the placement of —,gravel, distribution line, monitoring tube, and ,c.'='cleanouts but before the � placement of any other backfill. The engineer will be on site for the placement of the remaining backfill and silt barrier. 11. The lot is large, over 2 acres with vacant lots on each side. Development of this lot will not effect any other development areas. 12. The lot is located at the toe of a hillside and all drainage flows downhill from the proposed well and drainfields. The proposed well is approximately 20+ ft higher in elevation than the proposed drainfields. 13. The nearest surface drainage is 500+ ft away from the lot. 14. This septic system design consists of; three (3) pages of specifications, two (2) percolation test forms, and four (4) pages of drawings. B. Proposed Septic Tank 1. The septic tank shall be constructed out of steel and contain two compartments. 2. The septic tank shall have a capacity of 1,250 gallons. C. Proposed Drainfield (Deep Trench) 1. The bottom of the trench shall be level, plus or minus 1.5 inches. 2. The drainfield pipe will be laid over a minimum of 6 ft of gravel bed with an additional 6 inch layer of gravel installed to provide a minimum of 2 inches of gravel over the drainfield pipe. 3. Piping materials used for drainfield installation shall be 4 inch diameter ASTM P3034 pipe or approved MOA pipe. All pipe must be labeled with the ASTM designation on the side or show proof of ASTM equivalency. 4. Gravel backfill material shall be 3/4 inches to 3 inches screened rock diameter with less than 3% passing #200 sieve residual. 5. The drainfield pipe in the trench shall be connected to the line going into the septic tank as shown in the attached drawing. 6. A silt barrier or approved non-toxic geosynthetic fabric will be placed between the final gravel layer and the native soil/backfill. 7. The fill over the trench shall be graded to prevent ponding of the surface water. 8. One (1) cleanout shall be placed at each end of the proposed drainfield. Two (2) cleanouts shall be placed between the septic tank and the proposed drainfield. One '>,)(1) foundation cleanout shall be within 3 ft of the '-house. One (1) monitoring tube shall be placed in the r. ,roposed draifield and shall extend to the bottom of the �aupo e,e; :grainfield. The tops of all cleanouts and the monitoring "'tube shall extend above grade. All cleanouts and cue4IsA.L4Ai \;monitoring tube are depicted in the attached drawings. ( - , v , t: 0OFk . 1'St� D. Recommended Drainfield and Reserve Drainfield Dimensions 1. Septic System Sizing - 4 bedrooms. 2. Percolation Rate - 0.085 min./inch, average of Pero Test #1 and #2 located in TH#2. 3. MOA Soil Application Rate - 1.2 gpd/sf. 4. Absorption area - 4 bedrooms * 150 gpd/bedroom = 600 gpd. 5. 600 gpd/1.2 gpd/sf = 500 sf. 6. Length of Deep Trench Absorption Field. 500 sf/6 ft/2 sides = 41.66 ft (use 42 for length of trench). 7. The accepting soil stratum is a poorly graded sand with gravel (GP) with a percolation rate which is faster than one minute per inch. However, a sand filter layer is not required due to the native sand content in the accepting soil stratum. E. Minimum Separation Distances 1. The drainfields shall be a minimum distance of 75 ft from the top of the western slope. 2. The drainfields shall be a minimum distance of 10 ft from any property lines. 3. The proposed drainfield shall be a minimum of 12 ft from the proposed reserve drainfield. 4. The proposed well is 150+ ft from the drainfield. 5. The septic tank shall be a minimum distance of 5 ft from the house foundation. 6. The drainfields shall be a minimum distance of 5 ft from the septic tank. F. Insulation Requirements 1. The septic tank and proposed drainfields shall not be placed underneath the main driveway/parking area; however, the non -perforated connecting pipes will have to be placed underneath the driveway/parking area. 2. All the connecting pipes and septic tank shall have 1 inch of blue board placed over the top of them. Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST 2.c la (�rESSV ' PERFORMED FOR: Jim batty DATE PERFORMED: ,S/%)74E7 LEGAL DESCRIPTION: L/i, As" ffvndre« N,fls SUbdAMATownship, Range, Section: S 10 11 12 13 14 15 16 DEPTH (FEET) U,0 U 0 (2 C U ,0, 0, 0 'o Poorly r4vleG sAn4w, 9,rAvc1(GP) - brown ;ski rgrcy Eu ra(Arere4 s meG ` �vn, /;o CiGnSe. P g07rvk, 5/ Fmnisf SLOPE WAS GROUND WATER ive) ENCOUNTERED? /V('t IF YES, AT WHAT DEPTH? S L O P E Depth to Water Mer Monitoring? One- Oat • 5%261#17 17 G7m' gk11C�AVA"�'ian ff No 9rov004(vAler cor4,0dere�t' 18 19 20 2 Tz SITE PLAN w N Reading Date Gross Time Net Time LSCC.) Depth to Water Net Drop 5,/2)f170;II) 5'7'.;rn y,r / 3./02. 3'2 lu reMi 3" 2 3,6,2 2"r i'7 reFUf y'/ 3 3.1,5 3,, 1u re,F;If 3i/ y s. OV 2." 1'' rdiII vi 5 s.&s 3,. 1" PERCOLATION RATE 0,O'7 TEST RUN BETWEEN (minutes/inch) PERC HOLE DIAMETER FT AND (0 FT COMMENTS Pere.-rts-f'1�z T/JZ, 1,64vferseefetP cumyle�Gly 411)ayarfr, I'Je, Gvlc. w0C /'Lv,'CL F://e4 Lv, i& )2'/ 1 11 1- . Aert-orrne PERFORMED BY A ,4175 �d r CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE a-✓�Vl e% I /c/97 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: J)r 'Daley LENGINEERSNO11 ; ` / `l D ,0GyJ011,ryocoy cooe0000 Curtly A. King DATE PERFORMED: .\ LEGAL DESCRIPTION: An (,.j SI,'A Township, Range, Section: Aa n , Pm- SAnd w li r�r4ve-161?) '6) " prawn 0)1 r9., it, / ihajpA, to /I e r se n croX, 5 / —mo isZ 17 EicAVA+,,n No grovdwAf1er en[4,w.l red SLOPE WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L 0 P E Depth to Water ger Monitoring? Dale' t Sec ,21, Tl2.N, 1231.0 SITE PLAN N TN 11 oilSce 9,4 flow Reading Date Gross Time Ne TimegeL., Depth to Water Net Drop 5/2471.71F;11) I/; SS1 m 5„5,� zit,/ 3 // s” / ,I 1 reFi II 2- 5,75 //l 1 // re i I 1 ,/ i/ 3 6.87 3" I'/ ref I I I s" 4l 5. /5. c;,, /i Pi re.Fa)I '1/' S 7.1,5" 3" /u PERCOLATION RATE 0.10 (minutes/inch) PERC HOLE DIAMETER ZO TEST RUN BETWEEN -7 FT AND J. FT COMMENTS Pere. Test 24l - l)2 . 4r/nfer seeped completely y aP7?-e,--1 h,. hale wai,4,101 JZ// P (" (relln'I C°/•� �jiCn pP cw/4t • WAS '.rCGr PERFORMED BY. $-t, - 01 . - A' .,. (,-'1277s ketA ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE 72-008 (Rev. 4/85) CERTIFY THAT THIS TEST WAS PERFORMED IN DATE lla f���z c i /e/97 3 ) F,? -z \-\ , p-ir;la 1:i'. A) ----. ; ), • 0---.. -.. 1- --'' / --7 ,..< ., k.- ▪ , (6 ' <„) - fir',4.7/3 _ / 0 Af S1, " 6 67 "FT \ \ •• -•<„•:, , co- 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 Parcel I.D. 078-191-16 1. GENERAL INFORMATION cosA# 05 C I ( t Expiration Date: 6 3 ` /1 Complete legal description HUNDRED HILLS #1; BLOCK 5, LOT 11 Location (site address) 445 WOLF DRIVE EAGLE RIVER, AK 99577 Current Property owner(s) JOEL WAGNER Day phone 206-599-9111 Mailing address 445 WOLF DRIVE EAGLE RIVER, AK 99577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well II Individual On-site Ill Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water 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. CERTIFI Legal Description: A. WELL DATA Well type PRIVATE Date completed Total depth 141 Date of test 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 CATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST HUNDRED HILLS #1; BLOCK 5, LOT 11 Parcel ID: 078-191-16 6/9/99 Static water level Well production WATER SAMPLE RESULTS: If A, B, or C provide PWSID# N/A Sanitary seal•(Y/N) YES ft. Cased to 141 ft. Well Log (Y/N) YES Wires properly protected (Y/N) YES Casing height (above ground) 24+ FROM WELL LOG AT INSPECTION 6/9/99 2/17/11 70 ft. Coliform Arsenic• A/O ug./L. B. SEPTIC/HOLDING TANK DATA 20 g.p.m. colonies/100 ml. NitrateO• I'1 (mg./L. Date of sample: 2/16/11 (DOUBLE C/O's PRIOR TO TANK. Date installed Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Foundation cleanout (Y/ Date of pumping 11/// a G/ 78 ft. 3.4 g.p.m. Other bacteria 0 Collected by: in. colonies/100 ml. GEG, Ltd 10/12/97 Number of Compartments 2 Cleanouts (Y/N) YES ES Depression over tank (Y/N) NO High water alarm (Y/N) Pumper 3-12 S RA rncpi C. ABSORPTION FIELD DATA Date installed 10/12/97 Length 45 ft. *BELOW EXISTING GRADE Soil rating (g.p.d./ft2or tZ/bdrrr 1.2 Width 3 ft. N/A System type DEEP TRENCH Gravel below pipe 6 ft. Total depth *7.9 ft. Eff. absorption area 500 ft` Monitoring tube YES Date of adequacy test 2/17/11 Results (Pass/Fail) PASS Depression over field NO For 3 bedrooms Fluid depth in absorption field before test 6 in. Water added**605gaI. New depth 10 in. Elapsed Time: 155 min. Final fluid depth 9 in. Absorption rate >= 450+ g.p.d. An re'uvenation treatment ast 12 mo.) (Y/N & type) NONE KNOWN **LAST 360 GALLONS INTRODUCED ONLY CAUSED LIQUID RISE OF ONE (1) INCH. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N High water alarm level at in. Cycles tested Meets alarm & circuit requirements? "Pump on" level at in. "Pump off' level Datu E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: 100'+ Septic tank/lift station on lot Absorption field on lot Public sewer main 100'+ N/A Sewer /septic service line 25/4- Animal 5'+Animal containment areas 50'+ On adjacent Tots On adjacent lots Public sewer manhole/cleanout Holding tank 100'+ 100'+ N/A N/A Manure/animal excrete storage areas 1001+ 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 Tots 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 NONE KNOWN F. COMMENTS Wells on adjacent lots 100'+ 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. Engineer's Printed Name JEFFREY A. GARNESS Date 2121///I COSA Fee $ I / d Date of Payment 1 0 1 i Receipt Number 519 @r (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number SGS SCS Ref.# Client Name Project Name/# Client Sample ID Matrix PWSID 1110543001 Gayness Engineering Group, Ltd Hundred Hills B5,L11 Hundred Hills B5,L11 Drinking Water 0 Printed Date/Time Collected Date/Time Received Date/Time Technical Director 02/24/2011 13:52 02/16/2011 9:00 02/16/2011 15:40 Stephen C. Ede Sample Remarks: Parameter Results LOQ Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department ND Total Nitrate/Nitrite-N 0.146 Microbiology Laboratory Colony Count Fecal Coliform Total Coliform 0 0 0 5.00 ug/L EP200.8 C (<10) 02/17/11 02/23/11 NRB 0.100 mg/L SM20 4500NO3-F B (<10) co1/100mL SM20 9222B col/100mL SM20 9222B col/100mL SM20 9222B A A A (<200) (<1) (<1) 02/19/11 AYC 02/16/11 DLC 02/16/11 DLC 02/16/11 DLC ;las Puny, ping vtf, 9977 Heather 8, Joel i.,Al.sgner 44S W Drkfe Eag River, AK ':4g577 (07) e:04-5949 J*1-"6.n5cri:,n1c.,1. P.0 1,41rrther Tet,h1.6.; sp job Ilt,rrimerr:S•, tretw... )rrot; $1te li!ttarM'ttiorl - Joel 445 Wo4f Dry's 5.agie River, AK c.).n..77 (907 094-594S Addilionei Location Comments'. JPS SEPT IC; Net 30 Karia Hiiand Roed 'Lest Sery Unknown Ditatacrt: etlivritIca.pas.trrird 5-Mtri uiland Rosci - Onty Log home On Left NEED -DRAWING Circular DW - use First DN si.;in. Post 3-Bdrrn Septic g front of Home laPA, 000So/ Servioe Type Septic Sery Qty e Each 1 $.2ZO.D0 Tax? NO ........abdappowantoyeet.012010111 a Of hmsl /+Xgii.....g os v... SW 604.0•,.......11 Estimated C NionTaixzblo Total $230 00 _ , ae,,rvice Agreerne.nt Number 032769 Ore r IS -Ian -7011 Service Det&: 1. -Jan -7011 120 Technicer: Mike Job Typo: Repeat Map, Ggid. 1,59. - GeHOne. Pierined: Gal. Actual: Texabie Total $0,00 1250 Hose Lq.:p.gth: Double Tank: L.] Pump System: 2 Baffles net: Baffles Ouiuq. Extension Act.r..446 $230,DO Tax TOM' $0.00 Grand Total S2$0.00 skowai carg Custornv arz„ree. the 'err* ard com60.griii howen THS ;.5 A FolNoiNci AGESVAE-.71,47. Stgnetae Eter411i0 CLalornerfrIttnresentaive amonzomaeutic.i.......ordmtow ,..o.epeti toy JR.. lu;roir!..c4 / •,,h7);,»r a'zi`a,ed .zOrrvetiertoe.../. t:i.ockr•JY; \32. trIn ,.,t1nyart.E. ,Areseersod....0........exana•04.11M rjge Ler ( r.3:ttr ZInttzutturnejdLEC1L4i'tn.fj() For NSF Returntrri. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 078-191-16 1. GENERAL INFORMATION HAA# � (72C00 Expiration Date: s/ '1(02_ Complete legal description HUNDRED HILLS SUBDIVISION #1; LOT 11, BLOCK 5, Location (site address or directions) WOLF DRIVE * EAGLE RIVER (HILAND), AK Current Property owner(s) JOEL WAGNER Day phone 830-9152 Mailing address P.O. BOX 670344 * CHUGIAK, AK 99567 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ■ Individual On-site Individual Water Storage 0 Individual Holding tank 0 Community Class Well 0 Community On-site 0 Public Water System 0 Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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. Note: Alaska Water and Wastewater Consultants, Inc. shall be paid S at, or prior to closing for the engineering services provided. 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 Health Authority 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 ALASKA WATER & WASTEWATER CONSULTANTS, INC. Address 6901 DEBARR ROAD, SUITE 28 * ANCHORAGE, AK 99504 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: in conducting this evaluation, AKWWC, Inc. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSO 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 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 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. AKWWC, Inc. 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. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory By: (Rev. fly Phone 337-6179 Date 17-17)0 2_ 1t((((((((ff(re- bedrooms, (ri • �11 OFA bedrooms, with the fllowing stiptlla�itjYis' •• qp ;-- ON-SITE G�' .� . A1C' • r• rt WASTEWATER : 'rROGRAt.l . �•, .' Qom.: :, .�., •. .• Lf<. r0 \N v'ENT SE�`�� Manitenance Agreements Supplemental Engineer's Reort Other Original Certificate Date: /Z/U/L Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: HUNDRED HILLS S/D #1: LOT 11, BLOCK 5, Parcel ID: 078-191-16 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (WN) YES Date completed 6/9/1999 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 141 ft.Cased to 141 ft. Casing height (above ground) 36+ in. FROM WELL LOG AT INSPECTION Date of test 6/9/1999 11/13/2002 Static water level 70 ft. 72 ft. Well production 20 g.p.m. 8.8 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 0.60 mg./L. Other bacteria 10 colonies/100 mi. Arsenic: N/A mg./L. Date of sample:11 /13/2002 Collected by: AKWWC, INC. B. SEPTIC/HOLDING TANK DATA TankType/Material STEEL Date installed 10/11-12/1997 Tank size 1250 gal Number of Compartments 2 Cleanouts (WN) YES Foundation cleanout (YIN) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 11/21/2002 Pumper CHUGACH PUMPING C. ABSORPTION FIELD DATA *BELOW OUSTING GRADE Date installed 10/it -12/1997 Soil rating • .p.d ' • r ftybdrm) 1.22 System type TRENCH Length 45 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 98.7--9.7 ft. Eff. absorption area 500 ft= Monitoring tube YES Date of adequacy test 11/13/2002 Results (Pass/Fall) PASS Fluid depth in absorption field before test 0 in. Water added 641 gal. Depression over field NO For 3 bedrooms New depth 1.5 in. Elapsed lime: 5 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Accen (YIN) "Pump on" level at in. "Pump off` I » l at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1008+ On adjacent lots Absorption field on lot 100'+ On adjacent Tots 100'+ 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A 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 1 O'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems we in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed N me JEFFREY A. GARNESS Date [Z/zJo7. HAA Fee $ W Waiver Fee $ to of Payment 1 7.1. A Z' Date of Payment Receipt Number ©2 4/ -NS Receipt Number (Rev. 12101) Certi fieb rifting ij by DOC Co. Ob. SULLIVAN WATER WELLS P.O. BOX 870272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2789 OWNER OF LAND J1ECEL Con1Sr DEPTH ADDRESS 1 r /Sox 67//69 Com, //ft From To _EGAL DESCRIPTION /44,44A60 N/143 / (% ADD fiti' s I o7 // 02 4 orJE4 ,e�ra� •,► BORE HOLE DATA PERMIT NUMBER 99 O 117 Date of Issue - 3 -i, 4 TAX INDENTIFICATION NUMBER e)7? - Is well located at approved permit location? Method of Drilling: Depth of well: /4 / Casing Type .(?ter_ Wall Thickness Diameter , // inches, depth Liner Type: ij # JE Casing Stickup Above Ground: oZ Static Water Level (from ground level): 70 rotary /4 1 / e. b er 0 N 90 Q cable tool 4t?5' tot /3a Inches feet feet feet Pumping level: feet after hrs. pumping gpm Recover Rate: o}D qpm Method of Testing: Well Intake Opening Type: open End 0 Open Hole Screened; Start feet Stopped Q Perforations Start feet Stopped 10 Grout Type: /564-041T C141 Volume 4130L/12 Depth: from 0 Pump Intake Depth: Pump Size feet, to hp Brand Name Well Disinfected Upon Completion? Method of Disinfection: C stir eke., Comments: p/9rt 7/4/ Wee% ❑ No So PIM D feet feet feet feet r�• ll .'' IMAY 1 9 2C31,tt • ATTENTION: It is the responsibility of the property own^r to submit copy of the well log to the proper authority. Municipality of Anchorage: Department of Health & Hurfan Services and/or Department of Environmental Conservation. MatSu Borough: Department of Environmental Conservation. 43!81 Si0-1SANG 6RAJC.c. hie146;14-,) 14 r M f)( q'S ?e16;14-,) / o l So1-4 d} (-4.4 ✓e c. 134 6.4 Af 1 z 6,44 RECEIVED APR 10 2000 Munic:patity ut Anchorage Dept. Health A Human Rorvicoo P ii -t9-02: 5:O5PM; CT&E Ret# Client Name Project Name/# Client Sample ID Matrh PWSID Sample Remarks: Parameter CT&E Environmental Services Inc. 1. n 1027855001 AK Water & Wastewater Consultants Inc. Lot 11 Bik 5 Hundred Hills #1 Lot 11, BM 5 Hundred Hills #1 Drinking Water 0 Waters Department Nitrate.N Microbiology Laboratory Total Coliform S r. d. Results :907 5615301 1V 2/ 3 All Dates/Times are Alaska Standard Time Printed Date/1'ime 11/19/2002 15:02 Collected Date/ITme 11/13/2002 16:05 Received Date/Time 11/14/2002 12:30 Technical Direct Stephen C. Ede Releas PQL Units Method Allowable Prep Limits Date 0.600 U 0.600 mg/L EPA 300.0 (<=10) 10 OB, No Coli Analysis Date Init 11/14/02 JS coVl00mL SM18 92228 (<=1) 11/14/02 KAP 11-19-02; 5:O5PM; ;907 5615301 # 3/ 3 CT&E Environmental Services Inc. Laboratory Division rri� el>Y¢araesramorAreaa+as►Errsev. sa+alcove t asre�vro® moAvanna $® • 200 W. Potter Drive . Drinking Water Analysis Report for Total Coliform BacteriaAnchorage• AK 99518-1605 Tel: (907) 562-2343 READ INSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE . Fax: (907) 561-5301 MUST BE COMPLETED BY WATER SUPPLIER TO BE COMPLETED BY LABORATORY O PUBLIC WATER SYSTEM LD:11 PRIVATE WATER SYSTEM X Send Results VC Sent! Invoice Y_t c_A 1 N4. Wua £yaeaN Mr.e C104/ 337- 61711 Phone Nufn6er Mahn Addrcu. Car O Send Results 1] Send Involve Comp..y Nm. 1•4114nx Addnu Coq SAMPLE DATE: 8ef• Gtitu4 355• Cavaa..m. Of 6-7) 33 8-3tri't For Number Sbre Zrp Cod. 1I; Month Cauau ..,n Stag Zrp Cod. Ida! Day O z1 Year • SAMPLE TYPE: lf, Routine O Treated Water O Repeat Sample (for routine sample )itt: Untreated Water with lab ref. no. ) D Special Purpose An lysis shows this Water SAMPLE to be: Satisfactory o Unsatisfactory O Sample over 30 hours old, results may be unreliable O Sample too long in transit; sample should • not be over3lti)hours old at examination to indicate reliable results. Please send new sample via special delivery mail. 11-1 K—o2 Date Received Time Received Analysts Began l (Du Analytical Method: embrane Filter MMO-MUG 1027855 t) ml. Result* Analyst 7 Cele 0 Sent to A-D.E.C. Anch Fbks Jun Faxed Date: Time: Time Collected Client notified of unsatisfactory results: SAMPLE LOCATION • Collected By 0 Phoned • Spoke with _1 of ni $1.C. 5. 14Utitttteo PILL( .5/94.1 100,5' 3W MA vs Date: • /tours i06. t 11, -e a 61 IS Flare Ma BACTERIOLOGICAL WATER ANALYSIS RECORD Comments: MMO-MUG Result: Total Coliform ^(�_ (� E Co!! Membrane Filter: Direct Count l� x-11., U.),. Colonies/100 ml Verification: LTB BGB COLIFIRM Fecal Coliform Confirmation Final Membrane Filter •alt`s'`cj Coliform/100 mi `—Date lc tit," ime (hrs Time: Reported By • Faxed • TNTC a Too Numerous To Como OB - Other Bacteria Ef.7S Member of the SGS Group (Societe Generale de Surveillance) ENVIRONMENTAL FACILMES IN ALASKA, CALIFORNIA, FLORIDA. ILLINOIS, MARYLAND. MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA p• NOV-22-02 11132 AM HEATHER WAGNER 9076945949 P.01 ASBUTtI• • SEWARD & ASSOCIATES LAND SURVEYING 1 HEREBY CERTIFY THAT 1 HAVE SURVEYED THE SCALE FOLLOWING DESCRIBED PROPERTY: �T-'�� .sole .i.vielrj l Ates !L4y //, BSN. S • AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE O INER 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. 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