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Home My WebLink AboutMOUNTAIN MANOR BLK 1 LT 4Mountain Manor Block 1 Lot 4 #050-671-23 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 NAME L PHONE NEW (yq 7 / ❑ UPGRADE MAILING ADDRESS-. 0, 7 075 LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS 3 Well % Absor tjon area Dwell' gf PERMIT NO. Uy DISTANCE TO: F Z Manufacturer Mat real No. 112-r partments aQ En ~ capacity in gallons Liq, �SQ__ IF HOMEMADE: Inside length th Liquid depth Well Dwelling PERMIT NO. �02 DISTANCE TO: DISTANCE — 04 Manufacturer Material Liquid capacity in gallons S H ❑ w = DISTANCE TO: Well / DO Foundatio " �% Near e t of Ijrte PE I !2 jLL Z No. of lines __+ oh line Total lent ofi lines Trench width inches Distance between lines Z w ~ Q F In Top of the to finish grade / Material beneath tile / 3.3.225 -inches Total effective absorption area / ❑ Length Width Depth PER IT NO. W 0 a H Type of crib Crib diameter Crib depth Total effective absor tion area P ° w W Well Building foundation Nearest lot line rn DISTANCE TO: " Class Depth Driller Distance to lot line PEI g � C J J iN (( J W Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: c5 Gi 040t OTHER I PIPE MATERIALS V3O SOIL TEST RATING Al o INSTALLER R ARKS A 3 33 R F a elai(tj Id EL— _ /L. t APPROVED ,,�/J/l/�� 7 ��, '" DAy,TE ,J L'EEGpAL �� p /�wpm D 641vF1 R 0 rq-J 14 79 V N � V TH NN l?ayM'AFW F�WAHLVA 825 -L' STREET.- ANCHORAGE., AK. 99501 264-4720 ID N:F. I -F- FE T E: W E: FR U F- t3 FR " L�m l= F::F= F;R! M I -r PERMIT NO. < 800201 ) DATE OF ISSUE 61080 c; 01 F=lm ke WARNING - DUE TO CHANGING REQUIREMENTS THIS PRINTOUT MAY NOT BE AN EXACT COPY OF THE ORIGIONAL PERMIT APPLICANT CHARLES DOWRICK RT 2 BOX 7327 LOCATION STILLWATER DR LEGAL L4 81'--MOUNTfn NMANOR - LOT SIZE 43670 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/BR)= 280 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: Cti F= Fz-r " = rte_ 5 L_ 1= " 0 -r H 1.4 0 FR f=V V E: L_ E> 1= F:D-r 3:_ !ry THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A 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). FZ FE 171 LJ 31 F� E: E> :S FE FD -r 11G -r F:•l N K <-:; I ZE= :JL -510 C3 F41 L k"--1 r4 — — — -r L-4 L3 < :2 > I r -4:E; F=lm FE IC"r 10 r4" -S F=l FRE FZ F= r_Z9 U I FR E: [> --- BACKFILLING BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND 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 WELL1 OR 150 TO 200 FEET FOR A 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. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY - SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION F=' FE F? r-1 11 -r E: X F:z* I IR 1="-=:; E> E= iG r=- r-1 0 I=- FZ ER 0 I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND TIPT THE ON-SITE SEWS SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE I"t 5EL TC!lAtCLUDE MORE THAN 4 BEDROOMS. SIGNED:-- ---------- ISSUED BY___`_'_ INSPECTION H WELL INSP DOWR I ORY - SEr E 1 0 0 L LOG DATE No W eW Oro f----f- SEWER 2 0 0 DRILLER _14 ch cN__-_L �TEC?ION - �|u�\ o DEPHRT?1FNT � ��EHiTH AMD ENVIR3NMFRlH| 825 '|. �TREFT. HNC11ORHGE. 9L 264-4728 ��;�� ) /�'^� �� ST �E �� PERMIT NO ( 78�251 ) *!�, 4(u�� /yL0Y\ LOCHTIGN MT ��@U� �/» � i0T 5IZE @ SQUF)RE FEET LEG6L L4 B1 MT MHNOR S/� TYPE OF S0IL HBSORBTION SYSTE"! ISTRENCH MHXIMUM 141... OF BEDROOMS = � SOIL RHTIHG (SQ FT/BR)� 100 TME REQUIRED SIZE OF THE SOIL HBSQRPTION SYSTE� IS� PTY FT poll -T- 1- 1� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) 0F THE TRENCH OR DRHINFIELD� THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE RETWEEN THE SURFHCE OF THE GROUND HND THE �OTTOM OF THE EXCHYHTII'D N (lN FEET) THERE IS NO SET WIDTH FOR TRENCHES�TH BET!�EEN THE OUTFH!L PIPE THE GRHVEL DEPTH IS THE MINIMUM DEr DF GRRyEL HND THE BOTTOM OF THE EXCHYHT1ON (IN FEET) ST 1: 20H- HPPLlCHNT HAS THE RESPONSIBlLITY TO INFORH 4-H 14 DEPHRTMEM*i DURING T�F PERMIT INSTHLLHTION INSPECTIONS OF HMY WELLS HDJHCENT TO THIS PROPERTY AND THE NUMRER OF RESIDENCES THAI THE WELL NILL SERVE X In 113711 --s ��'C�: 1, 1: 17, 10 VS swu IT? RR Fit VET (it U � 1: 1"n il�� On `�~~ BHCKFILLMCI OF HNY S9S1E1 HITHOUT FINAL INTPECTION HNT" HPPRGVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTI8N. MIFAIMUM DISTANCE GETNEEN H WELL HND MAY ON~SlTE SEWAGE DISPUSHL SYSTEM IS 100 F�ET F8R H PRIVHTE NELL/CORELL DEpENING UpOM THE TYPE OF P�B| 150 TO 200 FEET FROM H PUBLi N -�� IC WELL. |ETURNED TO THE �EPHRTMENT WITHIH WELL LOGS ARE REQUIRED HND MUST �c R ]8 DRYS OF THE NELL COMPLET�ONHppLy SpECIFICAT! yNS HND CONSTRUCTION DlHGRHMS OTHER REQUIREMENT� MH� HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION. to" 17K M M : C W QXR :1 15014757 171 Q 117 WFE P-1 150 Q FQ Y S, 1"VS, I CERTIFYHTHHTAR WITH THE REQUIREMENTS FOR DN -SITE SEHERS its) WELLn 1� T HR F51�� HS SET FORTH BY THE MUNICIPHLITY OF 19PUHQRHGE. 2 I HILL INSTALL THE SYSTEM IN NI[H THE CODES 7� � UNDER5THND THAT THE ON- SITE SEWER SYSTEM MHY REQU]RE ENLHRGEMFNT IF T�E R�5�DENCE IS REMODELED TO INCLUDE MORE THHN 3 BEDROOMR SIGNED�_ �PPLIC9�T DUHCRN MCLEOD 0 & E GEOTECHNICAL & DEVEI OPMENT CO. Box 90, Davis St., Eagle River, Alaska 99571 694-2774 or 688-2280 Russe# Oyster 694-27t SOIL LOG 6M -22806M-2280280 fad Ellis Soils Q Foundations Land Development Performed for: Name: Z)ycrTel. No. Mailing Address: Re9, 6vk- '%9c <��,r�. ,E�ic.%�, erl•�r. V05r4R77 Legal Description: I vr- !/. e�'C/e /, ; �I,,�,+�r,�i�✓ %�clo� �<J.�;.� Depth (feet) Soil Characteristics 0 2 3 4 5/��, 7 10 11 �j�'� [rk'�(l[`LC�;' .�'�"a/�1�� f��f_-A�� C•a��.Io��O �71.. CL,E/PiN e/�OClS,�• '�/�s•Cti 12 13 14 15 16 Ground Water Encountered: Yes No i! If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: � 7 Performed by:[eft Date: e ?f� This well is producing —gallons c- water per hour. Set pump @- — feet. INVOICE NVOICE NO. MOON DRILLING FORMATION IN FT. CABIN FORMATION IN FT. IN FT 101 DATE SR BOX 668, BOGARD RD. 102 YOUR P. O. NUMBER PALMER, ALASKA 99645 —202-- 2oa s 104 TELEPHONE 745-4071 4 106 TERMS 5 SALESMAN Lot Blk Sub WELL LOG 8 DEPTHDEPTH CABIN FORMATION DEPTH CABIN FORMATION IN FT. CABIN FORMATION IN FT. IN FT 101 201 1 102 -2-- los —202-- 2oa s 104 204 4 106 205 5 106 206 8 107 20T T 108 208 8 109 209 9 llo 230 10 111 213 11 112 212 12 113 23a 1a 11a 21a 14 116 216 18 118 216 18 117217 17 118 218 18 119 219 19120 220 0 123 221 1122 222 2a 12a 223— 28 124 224 24 126 226 26 128 228 28 187 227 27 126 228 28 12B 229 29 130 230 so 131— —231- 231lag282 132-282 a2 13s 23s 98 134 234 84 136 238 86 138 236 88 337 237 aT 13a 238 VE ae 199 239 99 140 240 40141 241 41 lag 242 a2 143 24a 48 144--244 44 146 246 46 248 48148 147 247 47 148 248 48 149 248 49 160 280 50 161 261 61 162 262 52 163 253 68 164 — 254 4 64 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section �` `' Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-671-23 1. GENERAL INFORMATION Expiration Date: �' Z.0— ZZ Complete legal description MOUNTAIN MANOR BLK 1 LT 4 Location (site address) 18536 Stillwater Drive Eagle River Current property owner(s) BISTODEAU BRADLEY & MARCI Mailing address Real estate agent 2. TYPE OF DWELLING: AK 99577 Day phone 18536 Stillwater Drive Eagle River AK 99577 Wendy Bringhurst El Single Family (w/ �bAD:UD) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone 907.854.1236 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well El Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Jc- 5 O Waiver Fee $ Date of Payment _ q I 1 3 I 020 )_ Date of Payment Receipt Number 6 0 � 3 Rb Receipt Number COSA # _ 0 S C c?,� i f L% � 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. 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Phone 907.406.1058 Address 19162 Mountain Rd Chugiak AK 99567 Engineer's Printed Name Curtis Townsend, PE Date//Z Z,_�2Z �*......y. f �� 6. DSD SIGNATURE '. System #1 Approved for bedrooms ..►. f •••k SST'A' p r3s L. TgqvmsePPd System #2 Approved for bedrooms �'O, t`CE 119x`1 -Disapproved Conditional approval for bedrooms, with the following stipulations: 'Y tOF�(( ,_ I-.� J UN - I. WATER AND c r Jm WAST' -.v TATER J1 f l JJ� By: —' Original Certificate Date: L/ "z o -zz 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 X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: MOUNTAIN MANOR BLK 1 LT 4 If more than 9 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1978 Total depth 95 ft Cased to 40 ft ❑ Sanitary seal is functioning correctly OR Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 2/7,2022 Static water level at beginning of test 53 ft. Comments B. TANK DATA Age of tank(s) 44 years Tank type/material septic fiberglaSS Measured operating fluid level in septic tank 50 ❑ Standpipes/foundation cleanout per record drawing Date of pumping Jan 24, 2022 D. ABSORPTION FIELD DATA Which system tested (date installed) 1980 ❑ ALL standpipes present per record drawing Total measured depth from grade 10.6 ft (max) Measured depth to pipe invert from grade 7.1 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 050-671-23 Structure served by this system Well production at time of test 6 gpm Water storage tank volume 0 gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 2.81 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L OR Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 3/2912022 C. LIFT STATION ❑ Required maintenance ( Age of lift stationy Lift station materia C • Adequacy test date 217/2022 Results M Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 600 gal New depth 27 in Elapsed time 1300 min ❑ Code -required soil cover over field Final fluid depth 0 in ❑ System presoaked Absorption rate 600 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) no date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: FCO, tank CO, beginning of field CO and end of trench sump are all present COSA Checklist yellow sheet 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' .✓[�, Yes Community Sewer Manhole/Cleanout > 100' Q Yes if No ft (7✓ Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25'71 Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighbofing Absorption Fields > 100' Yes if No Animal Containment > 50' 0 Yes if No ft 21 Yes if No ft if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' Yes if No ft 0 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 8 ft Surface Water > 100' Q✓ Yes if No ft Property Line > 5'✓C1 .✓[�, Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' 0 Yes if No ft Private Wells > 100' ✓❑ Yes if No _ Water Main? 10'. . Q Yes if No ft _ Community Wells > 200' ✓] Yes if No _ Water Service Line > 10' 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' ✓v Yes if No ft Wells on Adjacent Lots: Water Main > 10' Q Yes if No ft Private Wells > 100' ❑ Yes if No 91 Water Service Line > 10' Yes if No ft Community Wells > 200' Yes if No Surface Water > 100' ✓0 Yes if No ft F. ENGINEER'S COMMENTS tank met separation requirements from foundation at time of install absorption field to well waiver WR910028 G. ENGINEER'S CERTIFICATION l 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 :L'¢`,' C�p ............ ... "I's i ' wr. "Z . . Nis. c 1 t' A ' v�:U sm FES5kt1'k!a 4F im ft ft III ft Y'K I z' W o . d _-A _g -d v a AS -BUILT l V t I hereby certify that I have surveyed the following described property: Anchorage Recording Precinct, Alaska, and that the I improvements situated thereon are within the property 1 lines and do not overlap or encroach on the property r lying adjacent thereto, that no improvements on prop- I erty lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission + limes or other visible easements on said property except as indicated hereon. Dated. at Eagle River, Alaska this__?_ 'a_day of 19 F ROBERT C. JOI-INSOl\ M - SCALE: r.esistered Land Surveyor No. 880 -LS j I" =-p� Box 456, Eagle River, Alaska Phone 694-2543 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program s x E s V 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. 050-671-23 COSA # d S U a.1 of 19 Expiration Date: ! " 1 R 1 1. GENERAL INFORMATION Complete legal description Mountain Manor Block 1 Lot 4 Location (site address) 18536 Stillwater Drive, Eagle River, AK 99577 Current Property owner(s) Meredith Mark & Patricia Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: XI - 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone 854-1091 Day phone Day phone 854-1091 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank ❑ Community On-site ❑ 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 sample results. (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, 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724, Eagle River Engineer's Printed Name Steve Eng Date 6/13/2012 Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well ase s are subject to these various and dynamic characteristics and are outside the control of themes evaluator of the well and septic system. y .G` ;��"w°� K 5. DSD SIGNATURE4YV End ERG / st'` S:avaa . L0 Approved for bedrooms. ��¢�%r »» xs 6256 Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: a �P/ Original Certificate Date: (Rev. 11105) 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 CHECKLIST Legal Description: Mountain Manor, Block 1 Lot 4 Parcel ID: 050-671-23 A. WELL DATA - Public Water Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed 3/11/78 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 95 ft. Cased to 40+ ft. Casing height (above ground) 18 in. FROM WELL LOG AT INSPECTION Date of test 3/11!78 - - 61.13112 Static water level unk ft.. 47.2 ft. Well production unk 9.p -m. 7+ g.p.m. WATER SAMPLE RESULTS: Coliform Pass colonies/100mL Nitrate 1.49 mg/L 'Arsenic: 0.277 ug/I Date of sample: 5/31/12 Collected by: nr B. SEPTIC/HOLDING TANK DATA Tank Type/Material Sunset/Glass Date installed 8/14178 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N_. Date of pumping 5/22/12 Pumper-UR's C. ABSORPTION FIELD DATA Date installed 8/14/78 Soil rating (g.p.d./ftp or ft2/bdrm)100 System type trench Length 59 ft. Width 2.5 ft. Gravel below pipe 3_5 ft. Total depth 7.5+ ft. Eff. absorption area 413 ftz Monitoring tube Y Depression over field N Date of adequacy test 6113112 Results (Pass/Fail) Pass For 3 bedrooms Fluid.depth in absorption field before test 0 in. Water added 450 gal.,New depth 0 in. Elapsed Time; 30 min. Final fluid depth 0 , in. Absorption rate > 450 g,p.d Any rejuvenation treatment (past 12 mo.) (Y/N & type) unknown If yes, give date = D. LIFT STATION Date installed na Size in gallons na Manhole/Access (YIN) na "Pump ori" level at na in. "Pump off' level at na in. High water alarm level at na in. Datum na Cycles tested na Meets alarm & circuit requirements? na E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main NA Sewer /septic service line 25'+ On adjacent lots 100'+ On adjacent lots 91'+ * Public sewer manhole/cleanout NA Holding tank na Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 10'+ Absorption field 5'+ Water main na Water service line 1d+ Surfacewater 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main na Water Service line 10'+ Surface water. 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain n/a Wells on adjacent lots 91'+ F. COMMENTS G. ENGINEER'S CERTIFICATION orCo .•'� 10* �9iii 1 1 certify that I have determined through field inspections and �. x review of Municipal records that the above systems are in i. conformance with MOA COSA guidelines in effect on this date. 9 x Steven W. En®.. r' A?, Engineer's Printed Name Steve End PE 4256r ya s Date 6/13/2012pPrtlFrr.`"*`f COSA Fee $490.00 - Waiver Fee $ Date of Payment ia�(�f'.2 -Date of Paymeni Receipt Number Receipt Number (Rev. 11f05).. - - Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 wwW.cLanchorage.ak'us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY AppROVAL FOR A SINGLE FAMILY DWELLING HAA#~ Parcel I.O--~ S'o - G -/I -"~c~O '3 Expiration Date:__ 1, GENERAL INFORMATION ~Manor subdivision CompletelegaldesCfipti°n Lot___~_~4 18536 stillwater Drive Location (site address or directions) Current Property owner(s) Vicki & George Robert siter Day phone 696-4013 18536 stillwater Drive, Eagle River, AK 99577 Malting address Day phone _ 2. NUMBER oF BEDROOMS: 3. TYPE OF wATER suPPLY: ~] ~ndividuat We~t ~ ~ ~ Individual Holding Tank [~ Individual Water Storage Community On-site Community Class ~ell ~] ~] Lending agency Mailing address Real Estate Agent ~~ista/Crai Bennett Dayphone 689-6472 MailingAddress_16635 Centerfjeld ' HAApickedupby' ~ for pickup. ' ~¢/o o Unless otherwise requested, HAA will be held by DHHS 4 TYPE OF wASTEWATER DisPOSAL: individual On-site Public Sewer Public Water System (DHHS) issueS Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent The Municipality of Anchorage Department of Health and Human Services professional dvil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site system. DHHS also issues HAAs upon request to home owners. and/or water supply of issue for properties served by wastewater disposal . . , , ~.,- valid for 90 days from the da,!~e,~ ~han 30 days old. Certificates .... - ..... ~ Health Authority Appro Cert ~ u,~u~ v, _ ~.~ .,.~oc,,~n w~u~ nu,~ or a public water system. The MunidpalitY a private or Class C well and may uu are valid for one year for properties served by Class Act B wells f Anchorage is not responsible for errors or omissions in the professional engineer's work. 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 Health Authority Approval Guidelines for the Health Authority Approval application show that the On-site Water SUpply and/or wastewater disposa system is Safe, functional and adequate for the number of bedrooms and type of structure ndicated herein. I further Verify that based on ir?ormation Obtained from the Municipality of Anchorage files and from my investigation and inspect on the on- S~te water SUpply and/or wastewater disposal system is in Compliance with all apPlicable Municipal and Stalle Codes, ordinances, and regulations in effect at the time of installation. Name of Firm S & S ENGINEERING ~a le?.iver LDo-RoadNo, 2 Engineer'sr~- . , . , ~, ..... ~_~ 7 - ~9 ),7 ~r'ntedName~_~ ~_ ' ~' ~ %,-" /'....~, '~' ~'.,t Jr' ............ :'~ DHHSSIGNATURE Approved for ~ bedrooms. Disapproved. Conditional approval for ~ bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory ~-_ Well Flow Advisory gy:~ Expiration Da/e:~ - / - 0 o Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: Reissue Date: RECEIVED Municipality of Anchorage JVJA¥ DEPARTMENT Of HEALTH & HUMAN SERVIC/~ c PAL z¥ OFANCHOl Environmenta Services Division 'VIRONMENTALSERVICE$ 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Legal Description: A. WELL DATA Well type /~ Log presen~N) Total depth Sanitary seal Health Authority Approval Checklist Ij /&~'/~ /L'/'~/D'-/~ ParcelI.D.: ¢'/)~--~)- ~'~--/ '-~ ,~ IfA, B, or C, attach ADEC letter. ADEC water system number "---- Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform Date of sample: SEPTIC/HOLDING TANK DATA Date completed Cased to 40 FROM WELL LOG / Casing height (above ground) Wires properly protected ~)N) AT INSPECTION g.p.m. -'~7~', 0 g.p.m. Nitrate Collected by: Other bacteria S & S ENGINEERING Eagle River, Al~sEa 9~577 Dateinstafled ~.~/~L-//7~ Tanksize /~,,~'""~ Foundation cleanout. ~IN) Date of Pumping %/~-~[ ~Pumper Number of Compartments _ A/O High water alarm (Y/N) ~-' Cleanouts~N),~-~ / C. ABSORPTION FIELD DATA . . Date installed Soil rating (g.p.d./fF or fF/bdrm)/~ System type Length ';~'~ ~ //~ / ~/idth .~6/ Gravel thickness below pipe ~ ~ /~ Total depth / ,m ...... Effective absorption area4tSMonitoring Tubepresont~,~Depressionovorfield(Y~ Date of adeq~acy test (/~/~ Results(Pass,~) ~ For ~ ~ bedrooms , / Fluid depth in absorption field before test (in.); ~ Immediately affer~gal, water added (in.): Fluid depth (ins) Minutes later: ~ Absorption rate = g.p,d. Peroxide treatment (past 12 months) (YIN) ~/~f yes, give dato 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Manhole/Access (Y/N) ~i~E~tee;t~ldarm level a,~/~ ' Size in gallons "Pump on" level at* *Datum "Pump off" level at* E. SEPARATION DISTANCES Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line SEPARATION DISTANCES FROM WELL ON LOT TO: /O(~ J'/- On adjacent lots /'OO / ~ On adjacent lots /A Public sewer manhole/cleanout / Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation ~' '~ Property line ~-- ~ Absorption field / Water main/service line /0 '/- Surface w~er/drainage /~ :~-Wells on adjacent lots SEPARATION DISTANCEFROM ABSOFIPTION FIELD ON LOT TO: Property line /0 //" Surface water /~)O /''~- Curtain drain /'~/~' ,~'/' ~"- Building foundation /~ ~"/"- Water main/service line ~/~ ~/' Driveway, parking/vehicle storage area ~J'"~d~'''f-,~ ~ Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certif~ in conformance with M/OA~_A~A gside/ines~p effect on this date. Signature "~ ~. ~ ' Engineer's Name ~'~)~'¢-~"- ~-' ~ ~o~4~ Date ~"~/3 //O O CE-880] HAA Fee $ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 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 Parcel I.D. # CJ --')O - LOD -era 1. GENERAL INFORMATION HAA # IA f- 'AIC I LD Complete legal description Lot 4; 'Bloch 1;' Mountain Manon.Subdivtis.i,on Location (site address or directions) 18536 SfifUwaten Eagle Raven, Ala-6ka Property owner Harvey and Sandy Wetch Day phone 696-4001 Mailing address 18536 StiUwaten, Eagle Raven, Alaska 99577 Lending agency Mailing address Agent Naomi, FuP.!'en/ VISTA REAL ESTATE Day phone Day phone Address 3000 C StAeet, Suite 101 Anchorage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 \' 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 562-6464 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 XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front 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 furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 17034 Eagle River Loop Address Engineer's signature 6. DHHS SIGNATURE Approved for 3 Disapproved. Conditional approval for Additional Comments M bedrooms. 411TIC Phone Date 3— Z3-7-3 A. tA u�* nay a* e Jr'., 10 •k:t..,.::':. bedrooms, with the following stipulations: Date 3- 31-2Y 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 engineer's work. Legal Description Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 1,Vr 4 &V- 1 Maw VAAJ�0 -��cel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) Date completed b Driller VAOD4 Total depth CVS Cased to 40 \ + Casing height \ ,a4r- Sanitary seal (DN) J Wires properly protected a/N) Date of test Static water level Well flow Pump level FROM WELL LOG J JV__ AT INSPECTION SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot iL->ovr ; On adjacent lots Absorption field on lot I loo ; On adjacent lots Public sewer main �`�' Public sewer manhole/cleanout Sewer service line 2S \� Petroleum tank WATER SAMPLE RESULTS: Coliform d Nitrate 1 2� Q• Other bacteria t. oc> ✓ Date of sample: �' ' t "�3 Collected by: S & 5 ENGINEERING 17034 Eagle Kiver Eagle River, Alaska 99577 B. SEPTIC/HOLDING TANK DATA Date installed `a ' kA -16 Tank size IZ–SD Compartments Z Cleanouts O'N) �4 Foundation cleanout&N) Depression (Y® High water alarm (Y,% r� Alarm tested Date of pumping Pumper _ ��, 6-6-s3 Pao '— SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot 100 t On adjacent lots I Ln' C> k+- Foundation S To property line \o" � Absorption field log Water main/service line 0 Surface water/drainage too ti - 72 -026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level 'Pump on" level at Meets MOA electrical codes (Y Manufacturer Manhole/Access (Y/N) SEPARATIO�L8f9TANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots ump off' level at Cycles tested Surface water _ Date installed g'i4 -1 Soil rating 1rx�`b/($R- System type TREa(--A Length `l Width 3o Gravel thickness Total depth 1e, 41 Total absorption area Cleanouts present (Y/N) Depression over field (Y&) �A Dto of adequacy test S - 22 _g t Results (pass/fail) PA-Pe.for F�6 L3 e- (-*) bedrooms Peroxide treatment (past 12 months) ()(/ 1 410A'i, 4t�-m% , 0� If yes, give date ()r� Q-�c� J ��(a L k 3yvP . PAPP"�IA.� SEPARA ION DISTANCE FROM ABSORPTION FIELD TO: t Well on lot 1(> 0 L�- On adjacent lots Ck Property line ) o t+ To building foundation 1 e k To (existing or abandoned system on lot A\>, On adjacent lots '�? t + Cutbank tl`A, Water main/service line 1 b % + Surface water 1 0o t } Driveway, parking/vehicle storage area -3.01 } urtain drain SLA. E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on�t epf this inspection. S & 5 ENGINEERING Signature 17034 Eagle -River Loop Road No. 204; Engineer's N�i le River, Alaska 99577 �� j4. V L 1_ E 1 vL e• 3 - 23 —93 �w�1 n.1Zrry,��r,� r Date , HAA Fee $ 7D , tw) Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number tiA t CHEMICAL & GEOLGGIiGAL I.+ABORATORY , A DIVISION OF COMMEAC1AL TESTING & ENGINEERING 04 :�we�ron. 6833 U STPELT ANCNORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 5615301 Chemlab Rof,d :93,1131-1.. REPORT of ANAMI5 Client Sample ID :L4 11 MTN. HANot matrix NATER Client Name is A B ENCINEERINC Ordered By :RAY Projsot Nem - PKoiectl< PN9ID :UA ripple ROUTINE RANFIE C06L67ED BY+ RAI Rematke: Collected :03/16/93 f 13:00 tire, Received :03/19/93 4 15:55 hre. W011 Order :64212 Report Completed :03/22/93 Tschnteal Director STEDE Released "` QC Allowable Extract Analysis Parameter R.eults Qur,l Unite method ---------------------------------------------- Limits Date Cats Init RITRATI-N 1:29 NO EPA 353.2/300,0 _------------------................ 10 03/22/93 LLH ........... .... ...i.. .......... I �p�osel�InetructlfonR'Abore�',k'�S ,, .�,. air r I. ..................................... .................. N k UA: unarailablel --- rh. NA, Not Analyxsd NY, S cal,WAnti£ication limit. Me tear Clgi MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES M} 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 Parcel I.D.# nom-L�`l�-HAA# OA"�C1'1a 1. GENERAL INFORMATION Co��nnpletp legal description Lot 4; Btock 1; Mountain ManoK SubcL'vtibtion Location (site address or directions) 18536 Stittwaten. D)i.ve Property owner David L. 9 Man.cia Outcatt Day phone Mailing address Lending agency Day phone Mailing address Agent Iiis Boking TARGET INC. — Day phone 694-2388 ` • • - frll%.Ll M1roBe m"golf•I•�w[Weewww c. fed A 2. NUMBER OF BEDROOMS: __ 4 IN 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. 3 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water, supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Engineer's signature 777.3.^, Fa;:ie River Loop Road No. Earle River, Alaska 99577 DHHS SIGNATURE -,0,' Approved for bedrooms. Disapproved. Conditional approval for Additional Comments Phone Date _ r A b� 1 � , p i3G I�TM.R�'.L S• bedrooms, with the following stipulations: Date �f 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 engineer's work. 72-025 (Rev. 1/91) Back MOA #21 Municipality of Anchorage W111991 Department of Health & Human Services ENSERVICES DIVISION HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-o''c'+ AIG- 1 I')oenlrar,.4 dAi4ofi-Parcel I.D. RECEIVED A. WELL DATA Well typeQ>Z"J'6<r6 If A, B, or C, attach ADEC letter. ADEC water system number ','A, Log present ON) Date completed 3 - II -'I b Driller 1'Aanni Total depth 145 r Cased to 401 Casing height Sanitary seal (5N) J Wires properly protected 2YN) J Date of test Static water level Well flow Pump level FROM WELL LOG Uv: ANIg.p.m. V \4 - SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot N�� r AT INSPECTION 15 - 27- -ct I 5-7, g.p.m. v I< ; On adjacent lots k }- Absorption field on lot IUco1. ; On adjacent lots I C>C:)1� Public sewer main SIA Public sewer manhole/cleanout it, Public sewer service line �I� Petroleum tank 245 �} WATER SAMPLE RESULTS: Coliform 'd /100 ^4 Nitrate 3 MY/� Other bacteria /Iot�� Date of sample: Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SEPTIC/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed 0- i'q -79, Tank size I2c;;-6 Compartments Cleanouts (9/N) Foundation cleanout &N) High water alarm (Y& /J Alarm tested (Y/N) Date of pumping 5-Z3-91 J.2• GEszw 0 (- pomei.iw SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot , 001+ On adjacent lots ►- lnb1 L Depression (Y,(!y. IJ 11.)l. Foundation To property line ID, Absorption field LF Water main/service line Surface water/drainage Loa 1 } 72-026(Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical i "Pump on" level at — Manufacturer Manhole/Access (Y/N) p off' level at Cycles tested SEPARAT�STANCE FROM LIFT STATION TO: on lot D. ABSORPTION FIELD DATA On adjacent lots Surface water Date installed cl?,' 14 --7 f5 Soil rating X05: P i-., System type 1�0`rJCA Length SC Width 3i7 Gravel thickness 3•S Total depth 7.S �+ Total absorption area _f! 3 0 Cleanouts present O/N) V Depression over field (Y& Date of adequacy test -5--7-7. Results as ail) PASS for �J&- (40 bedrooms Peroxide treatment (past 12 months) (YCf lv JK If yes, give date rqk SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ►V)C>%+ On adjacent lots -K els, Property line Ib 4 - To building foundation Io, On adjacent lots _.5v Cutbank To existing or abandoned system on lot 'I�4 alp' Water main/service line I n } Surface water I o% 1} Driveway, parking/vehicle storage area Curtain drain r3lA ar�.a to - (o - $Ci E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & 5 EN HE17..1'.fNG Signature 77034 r a0 a IW a o. 204 , 's y Engineer'sNameEa le River, Alaska 99577 ..snRa< Date rye `.g ,•• - h �. _tit i�' :Ik1- HAA Fee $ ��_ Waiver Fee: $ _ Date of Payment Date of Payment 1 ( J Receipt Number Receipt Number 79-nI A /Fov 3/011 Rork 1,1l1A 91 Municipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 December 3, 1991 David R. Dayton, P. E. HC 78 Box 1026 Chugiak, Alaska 99567 Subject: Waiver Request for Lot 5 Block 1 Mountain Manor S/D Waiver Request #WR910028, PID #050-671-24 Dear Mr. Dayton: A Your request for waiver of the required 100 foot horizontal separation of a septic system to a private well has been approved. The approved separation distance is 91 feet from the well on Lot 5 to the septic on Lot 4. This waiver approval applies to the existing septic system to well separation only: Any -future upgrade to either will require all separation distances be met or another approval from this department. Sincerely, Concur: Daniel J. Roth Civil Engineer On-site Services ljm:#6 ohn Smith, P.E. Program Manager On-site Services i r Tom Fink, Mayor Municipality of Anchorage 410k, Department of Health and Human S 825 "L" Stre P.O. Box 196650 Anchorag fR • T DTP TT X49 482 076 RECEIPT FOR CERTIFIED MAIL RETURN RECEIP n ^NPF COVERAGE PROVIDED June 13, 1991 Mr. Wesley Severson 18600 Stillwater Dr. Eagle River, AK 99577 NOTICE OF VIOLATION Subject: Well drilled on Lot 5, Dear Mr. Severson: It has come to the attention of serving the subject property dol distance of 100 Ft. required by wastewater system on Lot 4 Blk drilled on June 5/6, 1989, 11 y on Lot 4 was constructed. Corr o that you either obtain a waiver a and wastewater system, or redri 9 from neighboring wastewater syr F M m Correction of this violation m c or legal proceedings may be in z prompt attention to this matte m Our phone number is 343-4744. Incl v Sincerely, 4v//"/1_1 /CSL Daniel N. Bolles On-site Services cc: John Smith, P.E S&S Engineering D. L. Outcalt db/151 SENDER: Com ESTED Q Put Plete items 1, 2, 3 and 4, 3 r ut YWr address in the ••RETURN 70•• s 4i g r silo. Failure to do this will r P°C0 on the barn/M nern� to You. The return P went this card from y'Z7 y me o} the recei t fN will r del -Y For additional delivered to antl oof 1577 t- available. Consult ees the foNowin the dote o1 for Postm C services ars swrkets) reCuested, aster for teas end check boat (es) I t • 13,10how to whom. d,..a , Program Manager, On-site Services CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WORKorder# 34135 Date Report Printed: MAY 13 91 @ 18:55 Client Sample ID:L4 B1. MOUNTAIN MANOR Client Name :S G S ENGINEERING PWSID :UA Client Acct :SNSENGP Collected MAY 10 91 @ 09:45 hrs. BPO # PO # NONE RECEIVED Received MAY 10 91 @ 13:50 hrs. Req # Preserved with :AS REQUIRED Ordered By :R. SHAFER Analysis Completed :MAY 13 91 Send Reports to: Laboratory Supervie r : TEPHEN C. EDE 1)S & S ENGINEERING Released Bye- U' 2) .................................................................................................................................... Chemlab Ref #: 911944 Lab Smpl ID: 3 Matrix: WATER Parameter Tested Result Unite --------------------------------------------------------------------- NITRATE-N 1.3 mg/l Sample ROUTINE SAMPLE COLLECTED BY: RAY. Remarks: Allowable Method Limits ------------------------------ EPA 353.2 10 .............................................................................................................. 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected "' See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WOREorder# 34135 Date Report Printed: MAY 13 91 Q 18:56 Client Sample ID:L4 B1. MOUNTAIN MANOR Client Name :S & S ENGINEERING PWSID :UA Client Acct :SNSENGP Collected MAY 10 91 # 09:45 hrs. BPO # PO # NONE RECEIVED Received MAY 10 91 0 13:50 hrs. Req # Preserved with :AS REQUIRED Ordered By :R. SHAFER Analysis Completed :MAY 11 91 Send Reports to: Laboratory Supe vivo TEPHEN C. EDE 1)3 & 3 ENGINEERING Released By G Cj / 2) �................................................................................................ Chemlab Ref #: 911944 Lab Smpl ID: 4 Parameter Tested ----------------------------------------------------- TOTAL COLIFORM Sample ROUTINE SAMPLE COLLECTED BY: RAY Remarks: Matrix: WATER Allowable Result Unita Method Limits ------------------------------------------------------- 0 col/100 ml ................................................................ ................ 1 Testa Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than i r.11 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 3 41f? h 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) - L- 9/�T��I/lci� o� S/n Location (address or directions) Real Estate Company and Aaent /„07bte h4, � ;K Peluekj--. Nui 3. WATER SUPPLY Individual Well Community D Public D 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 D Community D Holding Tank D 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 72-025 (11184) c.�crr Telephone Home �ZZ' Bus! .eic tutlon D �# ,Owner/buiider.� y � Op.,,'.Other❑ fie) 9-st r� �� i�yv">tt .•. _�eT¢,a 1.1k Y'+� u��S`W Telephone +' ' fjLy, 7f /„07bte h4, � ;K Peluekj--. Nui 3. WATER SUPPLY Individual Well Community D Public D 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 D Community D Holding Tank D 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 72-025 (11184) 5 ENGINEERING FIRM PROVIDING As certified b INSPECTIO Y mY seal affixed hereto and NS' TESTS, FILE SEARCH � t Authoritygpproval shows that the on- as of the validation date shown belo DATA AND INF for the number site watersu INFORM from the of bedroomsandt PPIYand/orwastewaterdis I verif Municipalit type of structure indicated herein. 1 further verify that based o investigation wastewater dis Y of Anchors Posal system is safe, functgi na and adequate posal s 9e files and from quate Health the date of this ins tion. is in co m my investi y n the information obtained inspection. mPliance with all Munici gation and ins Name of Firm Pal and State codes action, the on-site "ter supply and/or ordinances, and regulations in effect on Address S regulation Date Telephone Ee�► °oyer Alaska 9957P The Muncipality of AnchorageCAUTION Approval certificates based Department of engineer re solely upon Health and Environ registered in the P the representations mental Protection institutions in order to satisfy ly Alaska. given in (DHEP analyze The DHEP does this as paragraph 5 above b i issues Health Authority Y data before a Y certain federal and state re a CourtesyY an rode professional en certificate is issued, The quirements. Em to Purchasers of Pendent professional engineer work. Munici Plo ees homes and their lending pality of Anchorage y of DHEP do not conduct inspections page 2 of 2 9e is not responsible for p ctions or rz-ozs (11,94) errors or omissions in the MUNICIPALITY OF ANCHORAGE (MOH) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: LZ>7" K A/K / AdrN. M,4 -A(62 A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present4 l r_,, 034*Depth `5 � t I '� $ Yield Total Depth 9S f Cased of Grouting LAK - Static Water Level (BC]' Pump Set At L. Casing Height Above Ground — Electrical Wiring in Conduit (�y w t% 4 - Sanitary Seal on Casing( q__ Depression Around Wellhead (-YdQ Separation Distances from Well: To Septic/Holding Tank on Lot �d� ; On Adjoining Lots 1 n� t To Nearest Edge of Absorption Field on Lot L bcvt- ;On Adjoining Lots nG To Nearest Public Sewer Line To Nearest Public Sewer } Cleanout/Manhole To Nearest Sewer Service Line on Lot 7� Water Sample Collected by S`+� 5 L6�N fpockVG ; Date Water Sample Test Results 5i+-7-1 5 P4A-e 6 K. Y Comments B. SEPTIC/HOLDING TANK DATA Date Installed 6 -1q -7g Size /Z5-0 No. of Compartments Z' Standpipe( Mq)_ Air -tight Caps Foundation Cleanout Depression over Tank era Date Last Pumped �� s Pumping/Maintenance Contract on File (Y/N) ;for t Holding Tank High -Water Alarm (Y/N) ~ Temporary Holding Tank Permit Separation Distances from Septic/Holding Tank: To Water -Supply Well (-DO '~ To Building Foundation 8 To Property Line I C) k ~ To Disposal Field La % To Water Main/Service Line Zk;�+d- f- To Stream, Pond, Lake, or Major Drainage Cou Comment= Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Inn L>t< Type of System Design l 7tL .C.i-p Date Installed C �- i t-{ -1-7 f, Length of Field 14 is( Width of Field Zr ti Square Feet of Absorption Area Depression over Field Depth of Field --I L i Gravel Bed Thickness 3 z 3oi Standpipes Present (Y6) Date of Last Adequacy Test Results of Last Adequacy Test Sh'T is�✓tC�9 Separation Distance from Absorption Field: To Water -Supply I b0 t PP Y Well To Property Line U.a 1 To Building Foundation hr Lot V - ; On Adjoining Lots i� To Water Main/Service Line a To Cutb �rtk To Stream/Pond/Lake/or Major Drainage Course To Driveway, P rking Area, or Vehicle Storage Area 40 Cments 'h as tom. -- rr o17- bAJLc./ D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) To Existing or Abandoned System on 3b t- 4 - (if present) t� Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed S & S Engineering Date 2 — ! 'f G SRB 196x Company Eagle River, Alaska 99577 MOA No. £S5_—< -b3 (f /•• ••Rhe Receipt No. S 1 `�i• y••R'��i �® Date of Payment a �co LOIS' 3 �09e0 Amount: $ V./ J C I!Y /, i.r M1 � � Shaffer a 4a Mu tA57 ,*k; r a• nnom/ Page 2 of 2 72-026 (11/84) 5. LEGAL DESCRIPTION DATE RECEIVED �%2OA INSPECTION APPOINTM NTS 8. TYPE OFRESIDENCE NUMBER OF,BEDROOMS TIME TIME TIME ❑ Two ❑ Five DATE DATE _��5 DATE INSPECTOR INSPECTOR i�- INSPECT R 41— since June 1975. For wells drilled prior to that date, give well MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH 8e ENVIRONMENTALPROT�PALITY OF 825 L Street - Anchorage, Alaska 99501 DEPT. OF ANCHORAGE " .A E i I I & B. SEWAGE DISPOSAL SYSTEM ;L i ICIcCTION YEAR ON-SITE SYSTEM WAS INSTALLED. ENVIRONMENT ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 MAR 1 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE 11�►1[I� DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10)days for processing. 1. PROPERTYOWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) ,/— PHONE 2. BUYER // PHONE MAILING ADDRESS 3. LENDING INSTITUTI PHONE LING ADDRESS 4. REAL OR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION _ Q % �'% �%2OA STREET LOCATION S 71 7vPi , 8. TYPE OFRESIDENCE NUMBER OF,BEDROOMS ❑ One 0 Four ❑ Other ® SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY W INDIVIDUAL* *ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM T5< INDIVIDUAL/ON-SITE** YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) d -O ,Y'_'" 47 UO�a�' oV 'Al7 vo nin In— nlia% THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ OTHER ❑ FOUR ❑ SIX 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED O 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑ Holding Tank Size: )� If Tank is homemade give dimensions: SOILS RATING O Q TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL Tp: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Loot Line 5. COMMENTS 1 r ❑ APPROVED FOR BEDROOMS EQ ---CONDITIONAL APPROVAL (letter must accompany certificate) ElDISAPPROVED DATE 3 -,) - fir/lb� BY VC vo nin In— nlia% TO/�G R M b:1S SUBJECT Li DATE X1 MESSAGE REPLY ,41'11-P 51GNED a Y l 4uz:� Redifyrm® 4S 471 r� --4:v -J, ,�� gy SEND PARTS 1 AND 3 WITH CARBON INTACT - PART 3 WILL BE RETURNED WITH REPLY. DATE /,4/ yo POLY PAN (50 SETS) 0 471