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HomeMy WebLinkAboutMOUNTAIN MANOR BLK 2 LT 1Mountain Mano lock 2 Lot 050-67! -20 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 PHONE I [] NEW ~o~;~ "~/"~'(~I [] UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION {/~//~ ] Well x AbsorPtion area I DISTANCE TO: I I~1 ' ~ I/ I ~ Z ] Manufacturer ~ Liq, capacity in gallons Inside ength '/~0 , IF HOME'DE: ~ ~ DISTANCE TO: Well Dwelling ~ ~ Manufacturer D I Well ~ ~ Z ~ No, of lines ~ ~ Length of each line Total length of lines ~ ~ Top of tile to finish grade~ ~ Material beneath tile ~ ~ngth Width Depth ~ ~~ We~~ Building foundatio~ ~' [ DISTANCE TO: ~Cl~s Depth Driller Dwellln~,~ Material IWidth Material Nearestlo~eg Trench width inches NO. OF BEDROOMS PERMIT NO. ~'7~ ? 7~ No. of compartments Liquid depth PERMIT NO, Liquid capacity in gallons PERMIT NO. ~:~ ~ inches PERMIT NO. Total effective absorption area Nearest lot line Distance between lines Total effective absorption area Distance to lot line PERMIT NO. Septic tank Absorption area(s) OTHER PIPE MATERIALS ~y~ 4'~P,~r¢',; PFc. ~f~ P/pzE SOIL TEST RATING INSTALLER REMARKS DATE LEGAL (I"inufnO ln-W-ns ern by A & 1, DRff LUNG COMPANY BOX 97, EAGLE RIVER, ALASKA 99577 o TELEPHONE 694-2588 OWNER OF LAND DEPTH OF WELL ADDRESS -=! '" STATIC LEVEL OF WATER FT LEGAL DESCRIPTION - ,17jQ v -u 7,0-t) 1V D6UAW DOWN FT. 4L DATE - Started , a— Ended "�"dr GALS. PER HR C� r, PERMIT NUMBER 1 -7 0 KIND OF CASING - KIND OF FORMATION: From Ft. to Ft. ? J E'e /5 Eve '04E('',/ From Ft. to Ft. From Ft. to Ft. S19*ud t- 4,elf ✓Fe- From Ft. to Ft. From Ft. to Ft. Ft. to Ft. From Ft. to Ft. From Ft. to Y' Ft. e Lr�l % From Ft. to Ft, From Ft. to Ft. </97e / �� <� '` From Ft. to Ft. From Ft. to =- , i Ft. cle kiL i f� �C'sftJEG From Ft. to Ft. From Ft. to _/j -Ft. %7i4!{,1 Y0/94 -J From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to , • Ft. fill—,46!0 /1 /9�1�r C '>' � £'From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: i:W From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. DRILLER'S NAME l.::'EF;ffq I "r' NO. R I I.::Hi::iF?.[)I.]:FII."IE I.;.~CIN t';i!(]1 F::t [;, S I.EN[:, L::L iE:;;;i: MI.]Lli'.,H"I.qIN MFII'.,IOF:: E;,-."L":, L.CFI" S I ZE TYI:::'I.E C'I.:: SC)IL F:IE::.'_:;I.]RE:'T'IC)N S'.r":'.':;"r'E]'q IS: fREN..H MI:::tF:;]~t'"ILII'"t NI...tI','IE:E]:~: CIF' IE:EE[:,f~:I.]OM'.:5 = 'q. :.L SOIL. TI-lIE I.;.:Ei]:¢...I I I~:EE[:, S I ZE OF "I"I--IE: E 3 1 I_ FIBSI.]I.RF'"f'I I.:iN ':'~'T'S"I"EM I S · "lq.qlE l...I.':'i:i'..tG"f'H [:, I h'IE:I'.,IE; I CIl'.,I I L""i; 'THE L.E:t'.,IGTH ':.' I N FE:E"r' ;:, O1.: "lq-~lE "t"F?.ENCFt [)R DF;;:F:I I I",t1:::' I EL.E:,. THE: [:,E:F'TH I.]F FI "f'F?.I,.:.'.'N[::H I,]R F'IT IS:, THE [.',t:iSTFIi',ICE BE:'t'!-,.IE:EI'-,t THE:: SUI;?F::'I.:ICE C)F: THE Ciil.;::OI..Jt'-,l[:, FIl'.,ll::, THE BI.]TTOH O1,:: 'T'HE E::XCR',/FFf' .T ON < .T.N F'EE:T>. 'T'HEI,;?.E I S NI,] SET I.,.t I. [::,TI.4 F'OI'~: 'T'F.'rENCHES:;. 'l"HEi: GF.:F:I',/EL [:,EF'TH IE; TFII,E I"IINIMI.JH DEPTH OF GF.:F:t'v'EL BI.ETHE:EN THE C)IJTI::'I:::II...I.... I.::']:F'I.E FIND THE E:OTTI,:d"I C)I,:: THE EXCI.::I',,,'I,:ITION ,::IN FEET::,. F'I::tl,]I.(f::tGE F'L.I.:INT hIRY BE ]:I'.,tSTFtLLE[:, A"F THE F:'I,ERMI"FTEE'":.E; I.:~F"TIC)I",I :51.JEi;.]'E[::"I.' 'T'I.]I THE: FOLL. OHI NG Cl.:dq[:, I T IONS: :1.. l.ii:]:'T'l'..IEl,;?. I::1 CL. FIS':";:; I OF.: I I 1'.4SF' F:IPI.:'F.".O',,,'EI.::, F:'I,...FIi'.,IT I"'II=IY E:I.E I I'.,tSTI.:II....t._E[:,. 2. FI CI,:)I'.,tT I 1'41..lOLlS I."IFI I i'.,I'T'ENFII'.,II,:;E F:IGI.REE:I'"IENT I I.::IGI;;:E'EHIE:I'.,H" IS I'.,IOT I-'::EF:'T CURF.'.ENT '~.'l.)l.J Ft[ii:fE;CII,~'.PT]:I.]I'-,I SYSTEM I::1t'.,1[;,/O1.;.': YOU t¥1FtY t"'11 N I MiJH D I E;'I"I,::II'.,IC:E: EEi.".'T'HI,EE:I",t I,:t HEL..L. I:::11'.,1[:, Fti'.,IY OI",I-.S ITE SELktFtC.:iE D I :E;I'"'Of'~;RI_ :.'.=.i'.r'S't"Ei]'"l t S :t.(iln;ili F:EET I.::'O1,;i: F:t F:'I,;.'.IVt"::Fi"IE HELJ.. OF.: 2C'~O FEET FOR I.:1 F'I,]BL..IE: I.,.E:I....I ..... t.,.IEL..L.I....I.]Er. L5 F:tRl,ii: !RI,~::[;:II,JII:;.:E[:, I.:IND MI,JE;T BE RETI.JI.a'.NEE:, TO THE [:,EPRR'I.'HEI'.4T I.,iITHIN ]:;0 I::,I:::IYS C)I.::' 'T'HI,E: HE:L.L CI.)MPL.E:TION. C:I't"I,..IEI.;;'. l.~:Eg!l,] I I.~:I,EME]'.,ITS I"'IFIY RI,:'PL.Y. SPEC; I F I CFIT IONS IqN[:, CONS"I"Fi:UCT I O1'.,I [:, Z FII..iil.;~:I.::IHS F:II.RE I.:1',,,'i.::11 [...I:::II!!i:I....E: 'T'O I N':'SUI;?.E I:'F;.:OF'EFi: I N'.:.i;TF:II_I._FIT I [)i'.4. t CI,EI:~;'.T I I'::Y "I.'HR'T' ::L: :[ l.:ff"t I:::'RMILIFII'R I.,.!]:'t'l"l 't"HI'~: RE:I,';!UIF?.EME]",IT'.F.; F'OR OBI-*:SITE SEt4EI';i:S F:II"41]:' 1.4EL. I...E!; F:l:i.::; F'C~I,;i:'I"H B"r' THE: I"ILIN I E: I PAl... I TY OF FINCI,qL31,;?.Ft['JiE 2: I 1.,.11L.L.. I NS"I"F:IL..I.... THE: S"r'S'I"EM I N FII.::COF.:I,)FII",IC:E 1.4 1 'T'H THE: CO[:'I::'!:S. :J:: I L.tN[:,EI.;:E;TF:IN[:' THI::FI" 'T'HE ON-:E;ITE: E;EHER :..E;Y:STEH I"i.i'::¢¥' F.'.E(;'41.]tF.'.E E:I'-,II...I,::IF;:CilEME]",H" Il.:' THE I.RES :i. I.;:'ENC:I.!~ I S I'RI.EMOI'.':'EL. EE:' TO I NCt...I'J[:'E I'"II']F?.E: THFtN 4 BE:DROOHEi;. :i.:.'. :i: ................................................................ / I,:: ::'l::q_ I. E:F:II'.4T F:'. I CHFIB.'.I) C::I:::IHE:Fi:C:d'.,I ,,_._~- -~ ,~ ,~ ~-.~",,'1 ~¢-' ~0 - ,~' "'/~ 0 Er E GEO Russe# Oyster 694-2774 Soils ~ Foundations Performed for: Legal Description: Depth (feet) o 2 Hame: Hatltn9 Address: Soll .CHNICAL 8 DEVEL Box 90, Davis St,, Eagle River, Alaska 99577 694-2774 or 688-2280 SO~L LO,G Characteristic~ 'MENT CO. Earl Ellis 688-2280 Land Development Tel. NO. 8 10 12 rC, *:,,%- 13, Ground Water Encountered: Yes No Proposed Installation: Seepage Pit__ Comments: ~-'~- < -~--~'~ <,~, ~-~ '/ If yes, what depth~ Drain Field Performed by: Date: \q~ -' ~ ~ '7') d I-- OTT Am 0')1 ` r - ♦' J M M a) 06 U) C: ,� E S� O a) v) 00 C6 Ilki N O N Lrk N > 6 0 Q 0 0- O Q + U) (Lf E Q w U` N I_ 0 H-- 0 U N U o O CDN CO O O m U IL ti LO O O7 Q W LLl J Q W W J U U 0 w U) Q 00 00 U) U) a) c� m U) 0 0 a) O Q Q m C) c`a U) U) a O O C O I- X U) E.- 0 O a Q) \I v O (N 00 r C'7 ai m a) U a) U c LM O 8 a L 0 U) %Y O > O O -0 U . Q '> > o Q U LL c 'a) L U) Z Q 0 0 IL 0 cn a) CL V N 1C M CL V •� O 3 ) L N in O E a O O -a O U U O N O t L c N O 0 O N N O Q 41 C An _Q U E E N + c a 0) +_' i °' 0 L U) r- O 00 3 a) a) L a •�; > O C M cu !Z a) -a C o L O sZ sZ Ea) Q L E CD U)in U m 41 � % j ch = a. M o L O Cn O C v Q U (/) .0 H N U) E �, V) E > a) ai cm O t L) C Q -0 -0 Q InO O 0O 41 N m L CL L U) o CLa-inO N O t u C Q a L 0 U) %Y O > O O -0 U . Q '> > o Q U LL c 'a) L U) Z Q 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 Application 1. GENERAL INFORMATION Parcel I.D. 050-671-20 Complete legal description Mountain Manor Block 2 Lot 1 Location (site address) 18816 Road's End Circle, Anchorage, Eagle River, AK 99577 Current property owner(s) Joseph L@Stina Day phone (907) 854-2302 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ❑■ Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: X Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ❑ Plastic ❑ Concrete ❑■ Fiberglass Age 45 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑■ Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ 5 Waiver Fee $ Date of Payment 2,4 Z Lf Date of Payment COSA # o -S C 2 `� i�J 5 q Waiver # COSA Application—June 2022 10 E a) _U CL O U CD U c C Z Oco C QE a I- zi LL U m / ,7-0 C L O C V O LO > � r Y � U C I\ Q X � W c a a cv m m Cn C d 'Q >� o E a) CY) U a- -0 N v 7 co C Q N a) Ln ID (n C y (9 E � C n 'n. E O E o C p CT a) a) @ E E a) ❑ ❑ U N a) O Z ❑ U) c W z Z 00 O N J rK v I� m 'O d N t 00 N_ Ci O o a) � O c c L p N AN ° 0 o -0 LO N Cl.. ca o U 'L N I to p Z O ~ > m N U C. LL O 00 NC� Z Q , O U R Z❑ O D W r� a) E o > o U U Q O N O J cn o C O ~O a -o E E O Q C O a) m "O 2 V U 0 O LL ON N a R E c'7 � \ c— o o c o d 0 m N L c c () O O o v N U N 3 O 0 Co aci � a� o A U Z Q U ❑ a) _U CL O U CD U c C Z Oco C QE a I- zi LL U m / ,7-0 C L O C V O LO > � r Y � U C I\ Q X � W c a a cv m m Cn C d 'Q >� o E a) CY) U a- -0 N v 7 co C Q N a) Ln ID (n C y (9 E � C n 'n. E O E o C p CT a) a) @ E E a) ❑ ❑ U N a) c U) c W E 00 O N _ X v I� m 'O d N t 00 N_ C-) v� O Q L •� L I N AN ° 0 cp o -0 A N 00 � ca a) O I N C O ~ C U a) p C LL O 00 > o U) , L � o U Q O L O a) r� a) a) 3 U Q O N Q cn o fl o ~O a -o ,;Zt. O Q O O N fn O QCA O a) Oo ❑ ,C (D O � O J J p J u 0) 0 —4- W a) ti c () WCL LL m C o O N 3 O _ Co Q❑ o A U Q a) _U CL O U CD U c C Z Oco C QE a I- zi LL U m / ,7-0 C L O C V O LO > � r Y � U C I\ Q X � W c a a cv m m Cn C d 'Q >� o E a) CY) U a- -0 N v 7 co C Q N a) Ln ID (n C y (9 E � C n 'n. E O E o C p CT a) a) @ E E a) ❑ ❑ U N a) c U) c W E C) O N Q X CN m 'O d p CO 00 N_ � v� A I •� c •� N I a) Ln E cp L n a O O O 00 � ca LO IL() I 'O N O ~ � co a L LL @ > a , L � o ca C O O L O a) r� a) a) 3 a ca Q L z w LL * a) 01 (D U) c W E 'a O N Q X 'D 00 m 'O d p CO cn � E E A I ti 0) E N I N cp L n a L a L Q a) O -0 \ CA 3 C`7 'O N ❑ W � co a n Q LL @ > a , L � o O ° Q c Q a) U C E a u, Z W L C > O O 0 fn O QCA L a) Q ❑ ,C (D cE � >c I CJ O O_ p J u 0) 0 a) � WCL LL O N 3 O _ Co a o 0 -.—ca 0 O a a ? - U' U) 0- c E 0- a I -,c L c ❑ a I Cc) Q) cn N L M v>i J E Z d c a -C J a m N ca El O 6 3: 0 FO- 2 ❑ * a) 01 (D U) c W E 'a O N Q W 'D 00 m 'O d p CO cn � E E A I iL v n E a) Z I N cp L n a L a L Q a) O -0 a) '0 > > N ❑ W U U U W n Q LL W W > * a) O N E 'a Q L O Z I 'O a) � Z c o O I C: E _\ 'O :Z - C N O N U) > N L � o ° Q aa) N co M C O Z a) C > E c voi o m ai ca Q •� C 'C U � � a) CJ O O_ C CO O O -ate _ Co CD OC O C ChCO ? C) U) 0- c N I CD ❑ Q U � U a1 U X M U N >, IC" G > a) fn E O M T U) O cc U O m 4 U) Cc "" L G _0 O L O CO U rn cc W E U E C N 0) U T U) 0 F--. V O O 0 Benjamin Schiller, P.E. (907) 522-7773 Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and 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. o5o-67z-2o 1. GENERAL INFORMATION Complete legal description Mountain Manor, Block 2, Lot · Expiration Date: -/o Location (site address) ~88z6 Roads End Cir. Eagle River Current Property owner(s) Ethann & Donald Oldham Day phone Mailing address Lending agency Day phone Mailing address Real Estate Agent Raney Hardman - Remax of Eagle River Day phone 44o-7257 Mailing Address Unlessother~v~'se requested, COSA will be held by DSD for pickup. 2. ,.:NUMBER OF 'BEDROOMS: /+ 3. TYPE OF WATER;~UPpLy: 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 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 M~unicipality of Anchorage files and from my investigation and inspection,~he on-s te water supply and/or wast~ater disposal system is(are) in compliance w th all applicable Municipal'abe~' StaLe codes, ordinances ~ahd r~gulations in effect at the time of installation "" ~"?':' Name of Firm Pannone Engineering Services, LLC Phone 27=-82:t8 Address P.O. Box zoo2z7, Anchorage, AK 9_qSzo Engineer's Printed Name Steven R. Pannone, P.E. Dat~ Engineers Comments: [~ conducting an adequacy test, [ attempt to provide a thorough, conscientious engineerin~ analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe.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 soil condition, ground water 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 this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. PES can therefore not provide any warranty for future performance nor give any estimate of how long the system will continue to meet the operational requirements of the 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 L]L bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 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 O.F ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: MoUntain Manor Block 2, Lot=. A. WELL DATA Parcel ID: o5o-67=.-2o Well type Private Date completed Total depth 78 fL IfA, B, or C provide PWSID # Sanitary seal (Y/N) Y Cased to .zro ft. FROM WELL LOG Well Log (Y/N) Y Wires propedy protected (Y/N) Y Casing height (above ground) =.2 AT INSPECTION in, Date of test Static water level Well production WATER SAMPLE .RESULTS: Coliform Ne§ colonies/lO0 mL Arsenic: __~,e-'og/I SEPTIC/HOLDING TANK DATA ft. ~' I~'- g.p.m. D¢-.-'"I Nitrate Date of sample: 81612o=.o 81~1',o=.o ~.5 ff- 5.5+ g.p.m. Otherbacteda Ne§ colonies/100mL Collected by: '. Pannone En§ineerin9 Tank Type/Material Fiber~liass Tank ~ze- =.2~o gal Number of Compartments _= Fbundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping <~/~//~g:~IC) Pumper JR's Septic ABSORPTION-FIELD DATA Date installed Cleanouts (Y/N) Y High water alarm (Y/N) N Date installed ~t=.~_1=.978 Length ~=. ft. Width 2.5 Total depth =._Ao fL Eft. absorption area 5=.0 ~ Date of adequacy test 81~el2o=.o Results (Pess/Fail) __ Fluid depth in absorption field before test ~in. Elapsed Time: 6..~o min. Final fluid depth 28 in. Any rejuvenation treatment (pest 12 mo.) (YiN & type) N Soil rating (g.p.d./ft2 or ~/bdrm) xs~iSF/BR ft Monitoring tube Y Pass System type Deep Trench Gravel below pipe Depression over field N For ~, bedrooms Water. addedaaE gal. Absorption rate If yes, give date New depth3.Q in. g,p.d. LIFT STATION Date installed "Pump on" level at Datum Size in gallonS in. "Pump off" level at ~ in. CyCles tested E. SEPARATION DISTANCES 'Property line ~o+ Water Service line Curtain drain 50+ COMMENTS Manhole/Access (Y/N) High water alarm level at Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ~.m.+ Absorption field on lot Public sewer main 75+ Sewer/septic service line 25+ Animal containment areas 50+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation zo+ Property line ~o+ Water main ~.o+ Water service line 2~+ Wells on adjacent lots ~.oo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation ~o+ · ~+ Surface water ~oo+ Wells on adjacent lots ~.oo+ On adjacent lots =oo+ On adjacent lots ~.oo+ Public sewer manhole/cleanout ~.oo+ Holding tank ~oo+ Manure/animal excrete storage areas Absorption field 5+ Surface water ~.oo+ loo+ Water main 75+ Driveway, parking/vehicle storage ~.o+ in. COSA Fee $ /~' Date of Payment Receipt Number (Rev. 11105) ENGINEER'S CERTIFICATION --~.~.,~,r,,,,.,..A~ .Ce, ~, 4-~' ~_- ~ - cerc~y mat I have determined through field inspections and rewew of Municipal records that the above s stems are ~n , F% .. comormance w~th MOA COSA guidelines in effect on this date. '~,~,~m., ............. ,..,, Engineer's Pnnted Name Steven R. Pannone, P.E. '. '~'~;'-'~,' waiver Fee $ 2. Date of Payment Receipt Nurhber SGS Ref.# 1104030001 Client Name Pannone Eng. Srv. Printed Date/Time 08/18/2010 8:30 Project Name/# Mountain Manor B2,L1 Collected Date/Time 08/06/2010 11:30 Client Sample ID Mountain Manor B2,LI Received Date/Time 08/06/2010 15:00 Matrix Drinking Water Technical Director Stel}hen C. Ede Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 08/13/10 08/16/10 NRB Waters Department Total Nitrate/Nitrite-N 4.20 0.100 ' mg/L SM20 4500NO3-F B (<10) 08/09/10 AYC Microbiolog~ Laboratory E. Coli Total Coliform Negative I 100mL SM20 9223B A 08/06/10 DLC Negative I 100mL SM20 9223B A 08/06/10 DLC ~ ~ ~ SURVEY T~E ~ ~ ~T PLOT PLAN5 .... ~ Prepared by _ 3Rs Pumping PO Box 773415 Eagle River, AK 99577 (907) 6 94-6454 B~ing Information Ethann Oldham Po Box 773486 Eagle River, AK 99577-3488 (907) 242-0337 [J..0. ,,!~,.,~[t.e. !n form atl-o n Ethann 18816 Roads End Circle Eagle River, AK 99577 (907) 242-0377 Additional Location Comments Diagram: Cedar home w/large garage on comer of Inspiration & Roads End Circle 4-Bdrm septic on east side of house by swing set and wood pile Job Description: P,O, Number: Terms: Salesrep: Map Book: Cross Streets: 1250g ' Net 30 Dawn-Dawn Jamie Drive Service Agreement Number: 031608 Order Date: 05.Aug-2010 Service Date: 09.Aug-2010 12:0 Technician: Mike Tax %: 0 Job Type: Repeat Map Grid: 87 - - Job Comments: Last Service '10/09/2006' 1250g --------SERVICE - & - BILL .... tank normal back flushed 2 times=clean clean out bent or broken - need repair S:\Diagrams\1650e.bmo Gallons Planned: 1250 Gal, Actual: , Hose Length: Double Tank: [] ._.._ Pump System: [] Baffles Inlet: [] ..__ Babies Outlet: [] Service Type Qty Price Each Septic Serv 1250K 1 $0.00 Tax? No NonTaxable Total Taxable Total Estimated Charges: Actual Charges: Customer agrees to the terms and oonditlons shown. THIS I$ A BINDING AGREEMENT. Extension Actual $0.00 Tax Total Grand Total Signature and Title of Customer Representative -Date Accepted by JRs Pumping -Date Accepted For your added convenience we accept; American Express, Dicover, Visa and Master Card payments over the phone. After 30 Days account will be ttJrned over to COLLECTIONS, $30,00 For NSF ChecKS Eeturned. JRs Pumping PO Box 773415 Eagle River, Al( 99577 (907) 694-6454 ~n!3 Information Ethann Oldham Po Box 773486 Eagle River, AK 99577-3486 (907) 242-0337 [.Job Site Information Ethann 18816 Roads End Circle Eagle River, AK 99577 (907) 242-0377 Job Description: 1250g P,O, Number: Terms: Net 30 Salesrep: Karlla Map Book: Cross Streets: Jamie Drive Service Agreement Number; 031843 Order Date: 11-Aug-2010 Service Date; 30-Aug-2010 12:0 Technician: Mike Tax %: 0 Job Type: Repeat Map Grid: 87 - - Job Comments: Last Serv '08/09/2010' 1250g SERVICE - &. BILL .... :Pumped mud & dirt from C/O C/O - cleared Additional Location Comments 4-Bdrm - Cedar home w/large garage Corner of Inspiration & Roads End Circle Septic on east side of house by swing set and wood pile Diagram: S:\Dia~zrams\16508,bm= lH Gallons Planned: 1250 Gal. Actual: .,, Hose Length: 1.5 Double Tank: [] Pump System: [] Baffles Inlet: [] Baffles Outlet: [] Service'Type Service - Fee Qty Price Each Tax? I $0.00 No Extension Actual $o.o0 Estimated Charges: NonTaxable Total Taxable Total Tax Total Orand Total Actual Charges; Customer agrees to the terms and conditions shown, THIS IS A BINDING AGREEMENT, Signature and Title of Customer Representative Date Accepted by JRa Pumping -Date Accepted For your added convenience we accept; American Express, Dlcover. Viaa and Master Card payments over the phone. After 30 Days account will be turned over to COLLECTIONS. $30.00 For NSF Checks Returned. 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 June 6, 1986 Application Date GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Block 2; Mountain Manor Location (address or directions) 694-9890 688-2141 APplicant Name Don Bernard Telephone: Home Business Applicant Address P.O. Box 771141, Eagle River, Alaska 99577 (b) (c) Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain); (d) Lending Institution _ First Federal Address Anchorage, Alaska (e) Rea~ Estate Company and Agent none Telephone Address Telephone (f) ~tdhe HAA to the followingaddress: S & S Enqineerinq SRB 196X Eaqle River, Alaska 99577 TYPE OF RESIDENCE Single-Family ~ Multi-Family [] Number of I~edrooms 4 Other WATER SUPPLY Individual Well ~ 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. 72-025 (11/84) Page 1 of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DA'I ~ AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my inves:.igation 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 furthe,r 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 ail Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of F~r~ S [:NC. INI;I:R!NG Telephone '~ ~ ~'~'~-~ ~'~ '~ Address SE B 196X Date EAGLE RIVER, AK 99577 JUN I 6 I986 "-' ~' '-"J"~'l l " ' '~ Approved for Z~''~')g~'~. bedrooms by'.' .¢., ? ¢(::.4_.- -r_~ ¢., ~....~ Date Approved ,F Disapproved Conditi°nAi Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations 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 requirements. 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. Page 2 of 2 72-025 n 1/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION I b 1986': RECEIVED WELL DATA Well Classification Well Log Present~J~" Total Depth ,',','7~ ' '7/* Cased to Static Water Level ~Z/~ · Casing Height Above Ground Electrical Wiring in Conduit ~)''~ Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot / Z. / To Nearest Public Sewer Line Cleanout/Manhole If A, B, C, D.E.C. Approved (Y/N) Date Completed ~-/~''' ~"'~::~ Yield Depth of Grouting -- Pump Set At ~-~-- · Sanitary Seal on Casing ~ Depression Around Wellhead ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on Lot water sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed ~'~/~'..~7~;~ Size Standpipes ~ Air-tight Caps~/,N')' Depression over Tank ~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well /':::::) /' / To Property Line /'~ · ~ To Water-MefrlTService Line ~ · /~"~ No. of Compartments ~- Foundation Cleanout ~'/N~_ Date Last Pumped ~, ~,c//~ '"¢"//~ ; for "--- Temporary Holding Tank Permit (Y/N) Course To Building Foundation To Disposal Field //' To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~--L /~ .. '7~ Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Type of System Design Length of Field -%""~-' ' Depth of Field "7 ! ravel Bed Thickness ,-~ ,~.. O Standpipes Present ,~¢~1~ Date of Last Adequacy Test ~-%'"~ Lot To WaterMci,,-/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~.~ ~-- To Cutbank (if present) Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions M¢ole/Access (Y/N) ., .//'./"Pump Off" Level at /'¢', ,~ Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t hat~l~l~errel~[~r~r~or conformed to all MOA and NAA guidelines in effect on the date of this inspection. Signed SRB 196X Date JUhJ ! O ;986 Company EAGLE RIVER, AK 99577M0A No. ,~!FJ'---o c~ _? Receipt NO. Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) · MUNICIPALITY O,' i~'qCHOR.~Dff . MUNICIPALITY OF ANCHORAGE DEPT. O,- ( DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION IEUVIR©Ntv',EN]AL W. Of ECTION ~ · 826 L Street - Anchorage, Alaska 99501 ~b ENVIRONMENTAL ENGINEERING DIVISION ~'- Tele~one 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS= Complete all parts on page 1. In=omplete reques~ will not be proceed. Please allow ten {10) days for processing. 1. PROPERTY OWNE~ ~ ~ ~ PHONE MAILINGADDRES~ ~ _ ,~ ~ / ~ PROPERTY RESIDENT {If ~ff~ent fro~ above). / /// ', PHONE 2, BUYER /' - ' PHON~ MAILING ADDRESS ~J~ ~TM /'' / ~'- I PHONE 4, REALTOR/AGENT ~ , ~ ..... MAILING ADDRESS ~ --/) .~ ' -~- , - I~-7 ' // v - - - LEG.~,L D ESCRI P?~ / .,~/) ' ///¥-, / TYPE OF RESIDENCE/' ' ~ SINGLE FAMILY ~ MULTIPLE FAMILY 7. WATER SUPPLY ..,{~. I NDIVI DUAL* --i COMMUNITY --I PUBLIC UTI LITY 8. SEWAGE DISPOSAL SYSTEM ~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY [] Other NUMBER OF BEDROOMS [] One [] Four [] Two [] Five ~ Three [] Six * ATTACH WELL LOG. A well Icg is required for all wells drilled since June 1975. For wells drilled prior to that date, give wel depth {attach Icg if available.) **If individual/on-site, give installation date ~q-'~,"~. . If system is over two (2) years old an adequacy test is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME CATE DATE CATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: ' 1, TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED ,~) 3. SEWAGE'DISPOSAL SYSTEM PERMIT NUMBER [] I NDIVI DUAL/ON -SITE DATE' INSTALLED []PUBLIC UTILITY ~",~ ~ Connection Verified INSTALLER [--]Septi~f~ank or [] Holding Tank Size: / If Tank is homemade SOILS RATING give dimensions: I ~ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL Absorption Area to nearest Lot Line 5. COMMENTS '" A"PROVEDFOR 3 BEDROOMS/q [] CONDITIONAL APPROVAL (letter must accfmp~ny certificate) LEGAL DESCRIPTION 72-010 (Rev, 3/78) January 5, 1978 Richard Cameron Star Route Box 367 ~agle River, Alaska 99577 Subject: Lot 1 Block 2 Mountain Manor Subdivision Permit 9770970 A permit issued by this department for well and/or sewer system has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation date. If there are any further questions, please contact this office at 264-4720. Sincerely, Health and Environmental Protection Sewer and Water Section