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HomeMy WebLinkAboutPARK HILLS #1 BLK 3 LT 1Park Hills #1 Block 3 Lot 1 #017-142-21 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201079 PID Number: 071-142-21 Dwelling: ❑® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Al Upgrade Name KELLY PERRY ABSORPTION FIELD Site Address ❑ Deep Trench ❑ Wide Trench [I Bed ound 14730 Park Hills Drive ❑ other Phone Number of Bedrooms Soil Rating JTotal depth original grade 229-7613 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe Invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. PARK HILLS #1 3 1 Fill added above original gr a Gravel length Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding I Sewer Total orption area Number of trenches Dist. between trenches From I Tank Field I Lift Station I Tank Line Ft2 Ft. Well 1001 -}-TANK 9Septic ❑ S.T.E.P. EDHolding I—]Other Manufacturer Capacity Surface Water *60' GREER TANK 1000 Gat, Material Number of compartments Lot Line5 �+ 1 I i NA HDPE 2 Foundation 10'+ LIFT STATION Manufacturer Capacity Remarks OLD TANK DECOMMISSIONED PER UPC Gal. PER CONTRACTOR `WR910003 Alarm location Electrical installed by PIPE MATERIAL House to tank D3034 Tank to D3034 Installer drainfield WILCO EXCAVATION Drainfield D20341EYIsTINc Co/MTD3034 Inspector DAVID GARNESS P.E. & TIM ECKLUND BENCH MARK (Assumed elevation) 99.14 ft Inspection t 2 5/9/20 - Location and description nU TO _ _--- -� 41h _ TOP OF MH ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp ,c OF'� Conditional Approval: Date o l' 1'/ •.'�%SLpi 491 Trlr{ Septic DateApprov(a � 0 Note: this approval does not include well permit requirements. �e��ip�orz,sU4��• 9 ECC884 (Rev 05/02/16) PERMIT NUMBER: OSP201079 RECORD DRAWING PARCEL ID NUMBER, 017-142-21 A _:F2 IZ 21 �8 STI 33.7 26 PD8MH 1 3 L 1 34.8 2 8.2 a2 ::z - L2 Da _T4 7 8,8 E a) "SWING TIES" WERE TAKEN cu FROM SURVEY BY ELIZABETH WALATKA, PLS (ATTACHED) I w w Lu W O,os WEA NEW 1.000 GALLON GREER TANK APPROXIMATE LOCATION OF EXISTING GRAINFIELD; EXACT LOCATION OF DRAINFIELD IS UNKNOWN, EXISTINGn BEGINNING 09 DRAINFIFLD WAS NOT LOCATED DURING INSTALLATION TO AVOID DAMAGING/KILLING HOUSE A LARGE SPRUCE TREE (DISCUSSED WITH TIM ECKLUND DURING INSTALLATION). FFROM TANK 60' CREEK OFFSET FROM WAS EXPOSED TO ENSURE ADEQUATE SEPERATION F • SURVEY; PHYSICALLY MEASURED 60'+ DURING INSTALLATION WITH MOA INSPECTOR TIM ECKLUND - m 0 S WOODHAVEN AVENUE) i & :'•.' STREAM E w Lu Lli I L0 c/) LU w Ly ,T SCALE: '6SI'lslu OF%t ¢m'GA RNIE"SSS REN OG"INE""IN 5 u Ltd . .. .......... r_l Im " "n" r 6/ T UJENGINEERING- SALES CONSULTING 0 0 3101 r RROA:) StPTE 101 'AKFLACZ'. A1(94"" PHO'r-1_907) 3)7'6174 -PAX ?W)3%6 -32-'A "AESSITE ..... ... . . . ...... I.......' .......... PREPARED FOR: 0* b-, PHONE NUMBER: PAGE NUMBER: # *. A. Garnesh Q KELLY PERRY 907-229-7613 2 OF 3 0 % SQA LEGAL DESCRIPTIOM CE -7 5T - DRAWN BY; lw PARK HILLS #1-, BLOCK 3, LOT 1 D.J.G. TYPE OF WORK: 64 . ....... 4W DATE. LICENSE SEPTIC TANK RECORD DRAWINGS 11 & 611/2020 #AECC884 "likulkV& PER;hi'i WU1079 RECORD DRAWING I N G PARCEL 4 NUMBER: OSP20107 9 071-142-21 r TOP OF NA;t FINAL L GRADE = 99.03.99.2 MN �5T2 TOP OF TANK AT INTLET = 95.12 TOP OF TANK AT OUTLET = 95.09 NEW 1000 INVERT OF RUNG AT INLET = 94,50 GALLON H.D.P.E. INVERT OF BUNG AT CUTLET = 9:,25 SEPTIC TANK ®1 l . m �t,SSIE�II�3 OT T71111 Inc(;: . ENGINEERING -SALES <CONSULTING ... i Ws....,... a731 E i t COA ROA:}, Jtl:Tf �C t ' PrfCHOSFCc, pv, •J:.A7 ` at10NE (^0:1 ]77 Q179' tNL iA7i J]tlSaS ` V:E95ITZ. www ......rvs,........ . f PREPARED FOR: PHONE NUMBER.: a?AGE NUMB'cR:�m A, G2tnB55 LO is t KELLY PERRY 907-229-7613 3 OF 3 CE -7951 :'te m LEGAL DESCRIPTION: DRAWN BY; ',/ `� C� o PARK HILLS #1: BLOCK 3, LOT 1 E.D.W TYPE OF':VORK: DATE: ECC �apkodYS"® ®o SEPTIC TANK PROFILE 5/21/20 #A84 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201079 Work Type: SepticTank Upgrade Tax Code Number: 01714221000 Site Legal Address: PARK HILLS #1 BLK 3 LT 1 G:3037 Site Mailing Address: 14730 PARK HILLS DR, Anchorage Owner: PERRY KELLY R Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: fteplitmLnt 5/6/2020 5/6/2021 43566 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either.- a. ither:a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: During construction, separations from surface water to the new septic tank and existing drainfield will be confirmed. if separations granted by WR910003 are still being maintaineo, the waiver will be re- issued for the new tank. If separations are found to be less than granted distances, anew waiver will be required prior to inspection report approval. Received B) Issued By: Date: 2, u Date: �/ a 0 ' C) Ti MUNICIPALITY OF ANCHORAGE Community Development Department Development Services Phone: 907-343-7904 On -Site Water & Wastewater Program Fax: 907- 343-7997 Mayor Dan Sumvan On -Site Sewer/Well Permit Application Parcel I.D. 017-142-21 1 For A Single Family Dwelling Property owner(s) KELLY PERRY Day phone 907-229-7613 Mailing address 14730 PARK HILLS DRIVE *ANCHORAGE, AK Site address 14730 PARK HILLS DRIVE *ANCHORAGE, AK Legal description (Sub'd, Block & Lot) PARK HILLS #1; BLOCK 3, LOT 1 Legal description (Township, Section & Range) Lot Size Sq.Ft. Number of Bedrooms 3 APPLICATION IS FOR: ( ®all that apply) APPLICATION IS AN: TYPE OF DEWELLING: Absorption Field ❑ Initial ❑ Single Family (SF) Septic Tank ® Upgrade ® (w/wo ADU) Holding Tank 0Multiple Renewal [] Duplex (D) ❑ Dwellings ElPrivy [� (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: SEPTIC TANK TO SURFACE WATERS0 Distance: -FEET 1 certify that the above information is correct. applicable Municipal codes., GARNESS ENGINEERINia GROUP, Ltd. (Signature of property owner or'�authorized agent) I further certify that this is in accordance with Permit/Rush Fees: a�I ,�/I! (v� - waiver Fees: _ Date of Payment:_ �lat gl aU Date of Payment: Receipt Number: 0(zq'�15 Receipt Number: Permit No. . d �9 Waiver No. COV ID -19 :25% DISCOUNT APPLIED (Rev. 01/11) 1t Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201079, Rebecca Carroll, 05/06/20 GARNESS ENGINEERING GROUP, Ltd • ..001KNE� ENGINEERING SALES CONSULTING May 6, 2020 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Proposed Septic Tank Upgrade for Park Hills #1; Block 3, Lot 1 To whom it may concern: The subject lot is served by a private well and septic system. Per MOA records, the existing septic tank is approximately 30 years old. Per MOA memorandum, a septic tank of this age should be physically inspected and/or replaced prior to COSA approval. Based upon this fact, we are proposing to replace the septic tank We are proposing to decommission the existing septic tank per UPC and install a new 1000 -gallon HDPE Greer tank rated for 10' burial. We are also requesting that the existing waiver from tank to surface water be re -issued (60 -foot waiver). Per GEG inspection, there are surface waters 55 feet from the existing tank. Given that the beginning of the field is not delineated with a clean out, we may be able to maintain the existing separation distance of 60 feet to surface waters, however, the existing drainfield waiver may also need to be amended (after the beginning of the field is located). if necessary, a waiver amendment will be applied for with the inspection report (for the tank and/or drainfield). Justification for reissuing the existing waiver is as follows: The existing tank has likely encroached upon the surface water to the east for the life of the system. The existing tank is steel, the new tank is HDPE. In short, the new tank wilt be an improvement on the existing system. The driveway is located between the tank and surface waters. If effluent were to overflow, it would be evident to the homeowner and corrective action taken. See attached design drawings for tank location and other MOA requirements. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any quegtions, please contact us at 337-6179. Thank you for your assistance. Sinceirely) r V J04 AI ness PSE., M.S. President 3701 East Tudor Road, Suite 101 ' Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 ' Fax: (907) 338-3246 ' Website: www.garnessergineering.com Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPI LANCE —110'WEI L RADIUS 0 � 1 a' PARK HILLS #1' BL90K3, LOT 2 � � / BIRCH TREE ESTATES; / BLOCK 1, LOT 21 1 t PARK HILLS #2; 1,100' WELL RADIUS I BLOCK 2, LOT 15 / BIRCH TREE ES`rA/ BLOC", LOT 377/ _�� 12SDr.g9 f i "r as / 100' WEI RAQIW \ PARK HILLS #2; 11 0, BLOCK 2, LOT 16 \ \WOODHAVEN AVENUE r 1 FOREST RIDGE; BLOCK 1, LOT 1B O l� FOREST RIDGE; BLOCK 1, LOTZ --I-- LU _I— ' : 1 \ m / PARK HILLS #1; \\ BLOCK 2, LOT 13 \ 1 0'V Y \ -•PAP BLOCK 2, LOT 14 i LL RADIUS N / SCALE: 1"=100' ENGINEERING SALES CONSULTING 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507' PHOJ�E (907) 337-6179' FAX (907) 338-3248' WEBSITE: www.gamessengineering.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: KELLY PERRY 907-229-7613 1 OF 2 PROJECT/LEGAL DESCRIPTION: DRAWN BY: PARK HILLS #1; BLOCK 3, LOT 1 D.J.G. TYPE OF WORK: DATE: � SEPTIC SYSTEM DESIGN UPGRADE 4/22/2020 �I.��.D...'..;... ...... 0 ................ 00 A. e 15 s C AV ,0 CE J��F It PROFESS\O�P�•• LICENSE �Nrvimkz ***� #AECC884 / 05/06x/20 GEG, LId. HAS AN 8 PAGE SPECIFICATION LETTER THAT PERTAINS TO THIS DESIGN. BY PROCEEDING FORWARD WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND PROPERTY OWNER AGREE THAT THEY HAVE READ THESE SPECIFICATIONS AND AGREE TO ACCEPT THE TERMS AND CONDITIONS OUTLINED. f I E N 1 T') ;5 _ rarna9e \ �,`4_� Easement �`'z�nase Easernenl ` v;ELL RA l \ EXISTING 3 BEDROOM HOUSE WOODHAVEN AVENUE INSTALL CLEANOUT AT BBEEGI�NNING_ OF THE GRAINFIELD TO DELINEATE THE BEGINNING OF THE DRAINFIELD I I / I -- LU LU LU W Of LLl LU c RI E 0W W CO ASSUMED LOCATION OF EXISTING GRAINFIELD PER MOA RECORDS Municipality of Anchorage On-site Water and Wastewater (3SP201OT9, Rebecca Carroll, NOTE: THE CONTRACTOR SHALL HAVE ALL WELL RADII SHOWN AND SURFACE WATER SETBACKS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION, , , I t , APPROXEMATE LOCATION OF CREEK; PER 1990 SURVEY IN MOA RECO RD(ATTACHED)PERFORMED I BY WILLIAM FLEMIING, LS y ' i , 4 ° 4 s / , x , l � I — PROPOSED 1,000 GALLON HDPE GREER TANK RATED FOR 10' BURIAL. INSTALL DOUBLE CLEANOUTS BEFORE AND AFTER TANK. EXISTING 'TANK TO BE DECOMMISSIONED PER UPC r EXISTING 60' WAIVER TO BE MAINTAINTEO, !F / 6C' SEPERATION CANNOT BE OBTAINED DURING CONSTRUCTION A WAIVER'JJILL BE APPLIED FOR WITH THE RECORD DRAWINGS I f S I I y f SURFACE WATER TO THi EAST 1S NOT SHOWN ON SURVEY, APPROXIMATE LOCATION OF PONDED SURFACE WATER. PRIOR TO CREEK. WAIVER AMENDMENT WILL BE REOUESTED WITH RECORD DRAWINGS IF NEEDED A I �. * � 49 * 10 r � *" e A G ess , Ar C 7903 r LIC NSE+f 0�M�SS\0 `••;• ECC 84 ol GARNESS ENGINEERING GROUP, Lt ENGINEERING SALES CONSULTING _ 3,OT E TUUaR ROAD. SUITE IDi • PNC.-CRP.GE, nx 99507 • PHOtYF (907) 737-6173 • FAX 196�'I JJ6 7246 'N, 3SITE.—.W-sserg�neeg,g cans PREPARED FOR PHONE NUMBER: i PAGE NUMBER KELLY PERRY 907-229-7613 2 OF 2 PROJECTLEGAL DESCRIPTION. DRAWN BY PARK HILLS #1; BLOCK 3. LOT 1 D.J.G. TYPE OF WORK. DATE. �, DESIGN OF SEPTIC TANK UPGRADE 4/2712020 * � 49 * 10 r � *" e A G ess , Ar C 7903 r LIC NSE+f 0�M�SS\0 `••;• ECC 84 ol �1 N _ SCALE 1" = 40' i * � 49 * 10 r � *" e A G ess , Ar C 7903 r LIC NSE+f 0�M�SS\0 `••;• ECC 84 ol / MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION y ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME -/ /_ lntl_wC� PHONE )`7�...5' NEW UPGRADE `.� is ` ! MAILING ADDRESS /0De ')- z l LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS r, _Y- DISTANCE T0: II [ Absorption area v i Dwelling I a�C7 ' U ed PERMIT NO. .� _ ,� 2P n / J` M< Q Manufacturer Material No. of compartments LU — S:6- Z W Liq. capacity in gallons 7)O CJ IF HOMEMADE: Inside length Width- Liquid depth �— ] 0z DISTANCE TO: Well I Dwelling PERMIT NO. _j 2 < Manufacturer Material Liquid capacity in gallons 0 w = DISTANCE TO: II Foundation /�j Us.¢Gj Nearest lot line r 0 PERMIT NO. > >t lG C7 J LL Z 2 L No. of lines Lengt of each line Total lengtA of lines Trench width Distance between lines F / g��1e inches ' cc F.- Top of tile to finish grade � Material beneath tile Total effective absor tion area P 0 J inches 0 Length Width Depth PERMIT NO. w C7 41.- aE: w Type of crib Crib diameter Crib depth Total effective absorption area m DISTANCE TO: Well Building foundation Nearest lot line Cl ssDet VCC Driller Distance to lot line PERMIT NO. 4C), LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption areas) OTHER - %kf4 �✓ 4. L\!cv " PIPE MATERIALS a SOI L TEST�7RATING INSTALLER REMARKS �L)f�l'I `rCJL Cf Ul��� l�t i 6 , Ls (61 ) bu r� P. C> 2 i0 ' O(VOI)l t Ln iz_ 4c_ fi k L Jk C.) '4- ( 1 APPROVED DATE LEGAL ) i2-0js Ifsev. s//u) (�,j la®x 1,369v SvrAn H®tirrE A ANCUOIRA019, ALASKA 99502 344-7'714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 140 �e DRILLED AT THE RATE OF ,23600 PER FOOT. PROPERTY OWNER Cn-a 7 7e eA 34.5-3821 ?.0. ' 10-224.7 90511 -rf,1012:2 3RC> LOCATION OF WELL S ScLbe DRILLER (3yin b? Clfl b4 of WELL LOG: o----18 , .S,(,(.f.,u, aAeve! , 25/ b t d eA e 18---681 (-ac rAe Seven -)[,?,a L drauJ—d A. 68- -- f:LoJz.dq(7.n. Cenertted c,�rrvet. 05----•1')6' S.i lhu. Toru „- Urea, C-tml,a 1095 ;° ne gJLrve (-® 126--14,01 ate,�z cowme lura evL rev rzn- n�rrcve L Danz_ 137-140 Pe -et. Ue,(d �howi 15 G.!r'i( urtifh. 78 #a 314, Ralme. S«b. %ura/, lih.cu,'-d be Zmh-tiled 10 to 15 tee t lrattam, 00 pv,c f aaa X 140 P,e ' : 33220a 00 j ~J� 1 ry 1 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID D LLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM F `�3.z2o� nc THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE (Zana 2nrJe 1 82 SERVICE CHARGE O F 7%z% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. C, F=- n r -J 8::- 1-. n DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 `L" STREET, ANCHORAGE, AK. 9950.1 264-4720 1_�1 IM L_ ff-- " E=-: FZ- F= FE V< rl X -J�jj. PERMIT NO. 82-1047 ln-q-SQ APPLICANT ALMOND INC PO BOX 10-2249 345-ZB81 LOCATION LEGAL LIB3 PARK HILLS #1 LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 245 4"oop^- THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM Iq- C- w� I r'4 F=F'_r"— . F=- - F=j 0%0 E: I E.. F=. 1_1 1=a. 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). -IF " F= -ir 1;--_o F= " rl--1=1 1_4 I r -A _r F=F=F=-r- THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL-8ETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). F;; -"F= G"! U 11:;,:* U C -s fS; U !F-' -T I � -r n " K —'-. I =- U = -1 C-5 C-1 iP-i u::j po i L Cl" PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. FRE=_: Rf 6:;:! U IF_ E: 'F=E - 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 WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. I MINIMUM DISTANCE FROM A PRIVATE WELL Ti 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. I OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. U--F=C-E=ME-E=F;? 7c -1 , : A L "-=; 9 � .2 1 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 THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. 113 SIGNED: ---------------------------------------- APPLICANT ALMOND INC 1-7 X 6 1 ISSUED BY_� V4. 0 5,115 -- s1h) t T21FIE UIF 1 --5- lJ ON W; -S TFOH E;� : DRri T P!,F cij'' U 0 '7%3 P 3 --1 T i ,s rel -,•F T 15 119F MAIM EN FS -1 H,- SU H�- T-RISHAS OR P 1 -T 1 0 L .5� f -'s J0 ON SE Ti P - b7 fs r F - -T- 1-0 E3 a 511 W 4 W 1 Ell 1 05, to, hot Ey- ET W TOO MAYS. EXE15TIll Ell TFAT MENUIVUN CO Th EM URWEEIL Z� TIWEGENI rIBF- OMIT- - iIL L P i �--, t� �M �- ON < E N PE EK F --V St FIV M T- t W low in 4 to. 55 1 21 Es, �D M&L 'ATRY"HAT Trip r n" -ro TV! i vKhArsh rile -101 low" -Y spir) me Ec U `U, 1 E�2 z 1 X p 3 - 3, fA j? A 71, Zc r - t Aw ST a Fqc K 1711.1 1 Eve A for WONIFS BY THIS It mnl, r n ANY Pl 1 12? 10ND HF! ecNiw7 -�f� J" T�) 7�flop 61C�i-WESN fi AND ANY CDN',-,:�f-FF IOE14MCNE 1110 FINT FQF: A FOR-TVATE W0, -L ch un re 201) ANT FFRUI R P-IrPt—W P;1ejr.Vr rc-, xM- <t- Tn tlj?h V2 05 HAT FiND TUM 10) Yo L)EP,K.� ;W I T11 � N _AA- OmPf";, MIPY �,- Y. FIESSIFTS 1 0- ED FT: VA N AM F-HPULAM WIM �HF RfFQ--jT'A N -U5 FOR --�Z'misn *QN.D WcF-J-5 Fr� -5, r MY? FF FIV 'FFK' r� ;- 0 1 MU. ACTIVE TSTF ROOM !It- NH, i`N -011 PF SE�W4jHk JAMA! -Ms 14 -To Muka: mogn swarm WAKE toy L AS -H T, Pf MID U 14 F (OP! P H? fz� T 025 Az STAN;nz 14!- 99 �! 0 Pa 10 KA all PY 5,115 -- s1h) t T21FIE UIF 1 --5- lJ ON W; -S TFOH E;� : DRri T P!,F cij'' U 0 '7%3 P 3 --1 T i ,s rel -,•F T 15 119F MAIM EN FS -1 H,- SU H�- T-RISHAS OR P 1 -T 1 0 L .5� f -'s J0 ON SE Ti P - b7 fs r F - -T- 1-0 E3 a 511 W 4 W 1 Ell 1 05, to, hot Ey- ET W TOO MAYS. EXE15TIll Ell TFAT MENUIVUN CO Th EM URWEEIL Z� TIWEGENI rIBF- OMIT- - iIL L P i �--, t� �M �- ON < E N PE EK F --V St FIV M T- t W low in 4 to. 55 1 21 Es, �D M&L 'ATRY"HAT Trip r n" -ro TV! i vKhArsh rile -101 low" -Y spir) me Ec U `U, 1 E�2 z 1 X p 3 - 3, fA j? A 71, Zc r - t Aw ST a Fqc K 1711.1 1 Eve A for WONIFS BY THIS It mnl, r n ANY Pl 1 12? 10ND HF! ecNiw7 -�f� J" T�) 7�flop 61C�i-WESN fi AND ANY CDN',-,:�f-FF IOE14MCNE 1110 FINT FQF: A FOR-TVATE W0, -L ch un re 201) ANT FFRUI R P-IrPt—W P;1ejr.Vr rc-, xM- <t- Tn tlj?h V2 05 HAT FiND TUM 10) Yo L)EP,K.� ;W I T11 � N _AA- OmPf";, MIPY �,- Y. FIESSIFTS 1 0- ED FT: VA N AM F-HPULAM WIM �HF RfFQ--jT'A N -U5 FOR --�Z'misn *QN.D WcF-J-5 Fr� -5, r MY? FF FIV 'FFK' r� ;- 0 1 MU. ACTIVE TSTF ROOM !It- NH, i`N -011 PF SE�W4jHk JAMA! -Ms 14 -To Muka: mogn WAKE toy L AS 1 ..... / MUNICIPALITY OF ANCHORAGE---' �-/. 6 3 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION O PERCOLATION TEST 825 L Street, Anchorage, Alaska 99501 264-4720 - SOILS LOG — PERCOLATION TEST PERFORMED FOR: PAr K HILLS 5,L4K4fY151 r5" DATE PERFORMED: 3- 29 S Z LEGAL DESCRIPTION_ : 7 -L -Sr No Le 4 1 q 12' 4 rorn SrA t4. £ Ar 220' SLOPE SITE PLAN DEPTH te" NumuS 1 -+=r•oZEN Tp Z' l� 2- 3 20 SW41 5- 5.5 sit-ry grAVEt. y SANo erbtJN, SI191T+ly mO13T tiArt:l 0RtLt-ir1C) 51L:�4 grAvft,L-v SAAJO , r3rawrd4 S1143K*1%) Mot ST r Awd 0r.1. Cobble S WAS GROUND WATER - - S ENCOUNTERED? No L O P IF YES, AT WHAT t7�7I T -r. E DEPTH? tI - Reading 1 5- Gross Time Net Time 67 6- Net Drop 7 Z o ;} 0 3 5 +V/ S 8 3_. - __- ----- 9 __ +S _-- -. 3�_ b�i�__ 37 10 j 8 1/1 12 t� 13 — - 14 :+5 -'/4- 4 15 16 17 18 19 20 SW41 5- 5.5 sit-ry grAVEt. y SANo erbtJN, SI191T+ly mO13T tiArt:l 0RtLt-ir1C) 51L:�4 grAvft,L-v SAAJO , r3rawrd4 S1143K*1%) Mot ST r Awd 0r.1. Cobble S WAS GROUND WATER - - S ENCOUNTERED? No L O P IF YES, AT WHAT t7�7I T -r. E DEPTH? tI - Reading 1 Date Gross Time Net Time Depth to Water Net Drop Z o ;} 0 3 5 +V/ l3//' 3_. - __- ----- C35__-.- __ +S _-- -. 3�_ b�i�__ 37 __._ 61+/f.__ 8/6 j 8 1/1 8/144. — - 4:50 :+5 -'/4- 4 9h� 'TQ PERCOLATION RATE a % (minutes/inch) TEST RUN BETWEEN3 FT AND 4 FT COMMENTS L6 QrAyF&, or [obblC 40- t•y- 1104/= x6hErx in+APr L,)..\" (-LMOVC8 "5'IArJCIa �P S=IN 3y2" r�bc�C a�o�cnt0 PERFORMED BY: CERTIFIED BY: DATE: »_rtna rfin9t 35 40,164 SF • (� _—�� �. __....v��.i �/�a��©� `ate \ 0.97fac-'`"r _ � _-�0. �,a��r,¢"c•Oc.P.� � _ - fes'" "' � �• .. 2- ,S. at ox, � z'0` re.s E/ec. G'snt�{ �' r�•�'r�' x„ /jam' �' _ �_ I �.- �172•b°3 �� 6ipffrcx, loc4fion of'0,,\` J ISI' p . /OI'Cre k SJdc of L,91 Line for 5}1sfe*.53 (leteJlofo.u"� I I ��f 4 1.15 Ac. ry l Wil EXia% /`Crook Moint m?. �' b/b 3® C1 % \ I / 10' re%, SENTDiv i C/o Ac. j I 133, 03 s h: 0.1' , 5.06 Au. 30 V h �---'�,�, --- ` to tum 1 �> 41, 224 9F 6 c1� 33) SE a �I 0.99 Ac. � 1.11 Ac a o I 15, -fold. eleC. Eerr,/ 4 v MUNICIPALITY OF ANCHORAGE' 0 PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: AIASfcA, FX ANeAT:l wq _ DATE PERFORMED: IO - 11 - A? - LEGAL DESCRIPTION: r. ihU.S Suh�f ✓f5f Dal LoT I RIK 3 SLOPE SITE PLAN DEPTH (FEET) , 1 • O - 1 . S 1 0QAN9E- eRowfJ SILT SAPJD, TRACC 9ravEt, 2 some orgAmic-5 pre5e&rr -ro Z' N IK 3 4 9 6 7 Sntl2-7.5 51L -7y c)rAVEwy 5AP,10 g grey wo BrLowf.) M015*• Dews& � 9 10 ,` more cjrAtJg4- 4tuo Sl+ghtl %eSS SttT % WAS GROUND WATER 11 CL+ 10 ENCOUNTERED? 12 13d 150,43 14,o-fy,5� 14 S f 1 y 5A+ J o y g r Av E L- SMOWf.l, mOfjT 15- 16 T -D `tY�i�t�LsEA -Co 17- 1 ?6S F1 18 19 S tJ nL O P E IF YES, AT WHAT DEPTH? Reading Gross Net 9 at Date Time Depth to Water Net Drop JIF '► % o. 4 54 -Ewe 20 PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT COMMENTS -rh2Qe WO 'Free v3A7@Q who.E C49a 00, t+t�f.ld ��Q WAS Ia5-L�Ited a f to -u- RZ ArJo eF,ecKEd`el.�� lto-t��� o nP was dem +0 15. S r PERFORMED BY "��`� '�" `'��N-4='��-' CERTIFIED BY: J WI-�Stin�i3 DATE: �O �� 72-008 (6179) Gt $V • Municipality of Anchorage°*}4'`� On -Site Water and Wastewater Program - (907) 343-7904 s f T Certificate of On -Site, Systems Approval Parcel I.D. 017-142-21 Expiration Date: -Z-2(9ZC) 1. GENERAL INFORMATION: Complete legal description PARK HILLS #1' BLOCK 3 LOT 1 Location (site address) 14730 Park Hills Drive "Anchorage Current Property owner(s) Kelly Perry Day phone 229-7613 Mailing address Real Estate Agent 2. TYPE OF DWELLING: Z Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSH Fee $ g ©� (v(o D Waiver Fee $ Date of Payment Z" 2020 Date of Payment Receipt Number 07 S Receipt Number COSA# 0SG .2-012— 23 Waiver# al 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: !, Il Z o In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the o C) evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational lire of all wells\. and septic systems depend upon a variety of variables, including but not limited to, soil conditions, 0,?, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and ""' •' • • • . ' • •' • . ). •' . are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system �, ey 'A 'c. ness:' can be installed on the property in the event either of the current systems fail to perform adequately in O�q9, •?1 E i the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or PCaroress,o"°� party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 DSD SIGNATURE i��� System #1 Approved for bedrooms \p 9W YOFa,�"t��/� System #2 Approved for bedrooms Disapproved®N�S1TE oWA TER ARID m �_ Conditional approval for bedrooms, with the followings a t i ST - ;`ATE PR6 , A R o By: 1ti. C=�Q� Original Certificate Date: 6 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 Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other (V.I CCA Checklist Legal Description: PARK HILLS #1; BLOCK 3, LOT 1 Parcel ID: 071-142-21 If more than 1 septic system on lot: COSA Checklist# 1 of 1 Structure served by this system 1 A. WELL DATA [0-1 Well log is filed with Onsite (or attached) Date drilled 1112182 Total depth 140 ft Cased to 140 ft Al Sanitary seal is functioning correctly W Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 4/10/20 Static water level at beginning of test 42.1 ft. Comments B. TANK DATA Age of tank(s) NEW years Tank type/material "'° pE Measured operating fluid level in septic tank NEW (jn� Standpipes/foundation cleanout per record drawing Date of pumping NEW D. ABSORPTION FIELD DATA Well production at time of test 6.1+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L 0 Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by GEG, LTD. Date of Sample 4110120 C. LIFT STATION ❑ Required maintenance c Age of lift station years Lift station m lal Comm s: NIA leted Which system tested (date installed) 1QJ13182 Adequacy test date 4/10120 ® ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade *9,25 ft (max) Fluid depth prior to test 2 in Measured depth to pipe invert from grade ***6.9 ft (ruin) Water added 738 gal ❑ N/A — pressurized field New depth 5 in © Monitor tubes go to bottom of effective. If not, state Elapsed time 120 min depth into effective '2.4 3 ©Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NONE date of test) N/A Gallons introduced gallons If yes, enter date N/A Comments/Deficiencies: 'DRIVEN MONITORING TUBE "AT MONrrORING TUBE "'CLEANOUT AT END OF TRENCH 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' ✓❑ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' F-11 Yes if No ft Private Sewer/Septic Line > 25'El Yes if No It Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' 0 Yes if No ft Neighboring Absorption Fields > 100' F✓❑ ❑✓ Yes if No It Water Main > ',0' Animal Containment > 50' ❑✓ Yes if No ft Yes if No ft ✓v Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' ✓❑ Yes if No ft ✓1 Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No *60 fl Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: ❑✓ Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100' ❑✓ Yes if No It Water Main > ',0' ❑✓ Yes if No ft Community Wells > 200' ✓v Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No ft If absorption field is under driveway comment below Property Line > 10'✓❑ Yes if No ft Wells on Adjacent Lots: Water Main > 10' ❑✓ Yes if No ft Private Wells > 100' El Yes if No ft Water Service Line > 10' I❑ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' ❑ Yes if No *68 ft F. ENGINEER'S COMMENTS *WR#910003 G. ENGINEER'S CERTIFICATION �4 OF I certify that l have determined through field inspections and review of Municipal records that the above systems are in conformance withT' MOA COSA guidelines in effect on this date. , • . , _ , ,� , , , , , , , , , , • , , , f.r. v .:...a.. ess,.* CE -7. 53 z COSA Checklist yellow sheet r a 0 �� 0fessi0 c� #AECC684 8488M 0J If IN SCALE: 1 "= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON UNLESS OTHERWISE NOTED LU 30 w �No, z sr 00 wi 2 0 (D Of W W !tiN\\\X1 �F OF & � 1 49th 9 �/ 00 t�j 0' ,:'Elizabeth L. Wpldtkb: i Of " .8035 - LS ei • . •a06J.r lit XXX 1 - ( - Recertified 05127/2020 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagees inspection in accordance with ASPLS Standards of the following described property: Lot 1. Block 3, Park Hills Sub :Sion Addition No 1 Anchorage Recording District, Alaska, and (hat Rte improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways. transmission lines or other visible easements on said property except as indic tted hereon. Dated at Anchorage. Alaska this 7th day of April , 2020. FRED VJALATKA & ASSOCIATES, L.L.C. En in r of FB 20.1, pg 36-37 8 64 MC 1 907-246.1666 9 ee s an urveyors This drawing is a representation of conditions found at the time the mongage location survey was performed. This document does not constitute a boundary survey and is subject to any inawurecies that a subsequent boundary survey may disclose. The Information contained on this dtowing shall not be used to establish any fence. structure Or other improvements. This dravting shall only be used for a single proparty transaction. Use of Otis drawing by the original client or by others at a later dale without the consent of Eilzabeth L. Walatka is a violation of Federal Copyright lour. Unless gross negiigance is discovered, the liabiilty extent of the preparer is limited to the amount of fees collected for services in preparation of this product. I Lot 2 I i I S 89°09'40" E 166.57 I Lot 21 I 30 72.5 Drainagesa ementpralnage Lt1 I Eaemof >_ 0 o c o —� to — `— m I I /yell 00 fl— U) J w o J Lot 37 W � m o I retaining wall chain link fence i \deck\ Lot 1 = io Q ( D o \ 0 z Iasphalt:' ': o -1-47.6 �\ I2.201 WF�aRe 0. C - ry c`•> 57- .O ' \ 2.5 CH OF( O 'coir clean out i3 i 2.0 H WOODHAVE AVENU ivtanholeZi I o EI I LU O i Stream c W I �r m I P T I septic Z � I vent I (typ)\g 0J If IN SCALE: 1 "= 40' EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT ARE NOT SHOWN HEREON UNLESS OTHERWISE NOTED LU 30 w �No, z sr 00 wi 2 0 (D Of W W !tiN\\\X1 �F OF & � 1 49th 9 �/ 00 t�j 0' ,:'Elizabeth L. Wpldtkb: i Of " .8035 - LS ei • . •a06J.r lit XXX 1 - ( - Recertified 05127/2020 AS -BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagees inspection in accordance with ASPLS Standards of the following described property: Lot 1. Block 3, Park Hills Sub :Sion Addition No 1 Anchorage Recording District, Alaska, and (hat Rte improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways. transmission lines or other visible easements on said property except as indic tted hereon. Dated at Anchorage. Alaska this 7th day of April , 2020. FRED VJALATKA & ASSOCIATES, L.L.C. En in r of FB 20.1, pg 36-37 8 64 MC 1 907-246.1666 9 ee s an urveyors This drawing is a representation of conditions found at the time the mongage location survey was performed. This document does not constitute a boundary survey and is subject to any inawurecies that a subsequent boundary survey may disclose. The Information contained on this dtowing shall not be used to establish any fence. structure Or other improvements. This dravting shall only be used for a single proparty transaction. Use of Otis drawing by the original client or by others at a later dale without the consent of Eilzabeth L. Walatka is a violation of Federal Copyright lour. Unless gross negiigance is discovered, the liabiilty extent of the preparer is limited to the amount of fees collected for services in preparation of this product. • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 s CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel l.D.017-142-21 1. GENERAL INFORMATION Expiration Date: 8 '2 % - /S Complete legal description PARK HILLS S/D #1 BLOCK 3. LOT 1 Location (site address) 14730 Park Hills Dr, Anchorage AK 99516 Current Property owner(s) Dave & Barabara Vralsted Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: 14730 Park Hills Dr, Anchorage, AK 99516 ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class _Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Distance: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: "-/ 2/lam COSA Fee $ �j?� ' 1- 3�S�a ' 0 66 Waiver Fee $ Date of Payment 5-)W16- Date of Payment Receipt Number 0�9 55t� Receipt Number COSA# 055 5 1�3� Waiver# VT 5. STATEMENT OF INACTION BYGINE 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 ARCTERRA CONSULTING, INC. Phone 868-3791 Address 20441 PTARMIGAN BLVD., EAGLE RIVER AK 99577 Engineer's Printed Name _KENNETH M. DUFFUS 5/21/15 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 and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen - encroachments, deficiencies or discrepancies exist. OF AL /'t c�T 'rl ee 6. DSD SIGNATURE System #1 Approved for —,�3 bedrooms. System #2 Approved for bedrooms. Disapproved. �V Conditional approval for bedrooms, with the following stiprrions- ON-SITE WATER AND PROGRAM By: Original Certificate Date: -.:�-L 1~1,5- Thenchora u ' 'ao rH p ge 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 responsiblefor errors or omissions in the. professional engineers work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 10.10-12.dw If more than 1 septic system is on the lot: COSA Checklist # of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: PARK HILLS S/D #1 BLOCK 3. LOT 1 Parcel ID: 017-142-21 A. WELL DATA Well type private If A, B, or C provide PWSID Well Log (Y/N) Y Date completed 1112182 Sanitary seal (YIN) Y Total depth 140 ft. Cased to 140 ft. FROM WELL LOG Date of test 11/2/82 Static water level 78 ft. Well production 15 9 -p.m. WATER SAMPLE RESULTS: Wires properly protected (Y/N) Y Casing height (above ground) 12 in. AT INSPECTION 4130115 80 ft. Coliform Nea colonies/100 mL Nitrate ND mg/L Arsenic: ND ug/L Date of sample: 515115 Collected by:MNA B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC 1 STEEL Tank size 1000 gal. Number of Compartments 2 Foundation cleanout (Y/N) Y Depression over tank (Y/N) N Date of pumping 5.20.2015 Pumper McDonald C. ABSORPTION FIELD DATA 9.13 -m - Date installed 10.13.1982 Cleanouts (Y/N) High water alarm (Y/N) N Date installed 10-13.1982 Soil rating (g.p.d./ft2 or fe/bdrm) 245 System type 5 WIDE TRENCH Length 87 ft. Width 5 ft. Gravel below pipe 3 ft. Total depth 7 ft. Eff. absorption area 750 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/14/2015 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth 0 in. Elapsed Time: 900 min. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Absorption rate >= 450+ g.p.d. If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN) "Pump on" level at in. "Pump off"level at in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES —CLASS A WATER SYSTEM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 1004 Public sewer main NA Sewer/septic service line 50'+ On adjacent lots 1004 On adjacent lots 100'+ Public sewer manhole/cleanout NA Holding tank NA Animal containment areas 1004 Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 54 Property line 51+ Absorption field 5'+ Water main 104 Water service tine 104 Surface water 60' WAIVER Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 104 Water Service line 101+ Surface water 68' WIAVER Driveway, parking/vehicle storage 104 Curtain drain 50'+ (None Known) Wells on adjacent lots 1004 F. COMMENTS The small open water spots located within 68' of the leach field and 60' from the tank have been filled by the MOA to meet original 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 hMeAh N � Iz� A Date�a /// r COSA canary sheet 26-15.doc E? - PF `qk\ E AZA . � � e 1Mn ssins�' i MUNICIPALITY OF ANCHORAGE • T Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES - 343-4744 CERTIFICATE OF IN FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D.# D1`1 -lqlq-aHAA# gQ�AInc.)1C) 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1; Block 3; Park Hills Subdivision #1 Location (address or directions) 14730 Park Hills Drive, Anchorage, Alaska (b) Property owner Jim & Yvonne Louthan Telephone : (home) 345-5178 Business Mailing Address 14730 Park Hills Drive, Anchorage, Alaska (c) Lending Institution Key Bank of Alaska Telephone Mailing Address (d) Real Estate Company and Agent JACK WHITE COMPANY/Kay England Address 32QI C, Strppt, suite 1.00, Anchorage, Alaska 99503 Telephone (e) Mail the HAA to the following address: (or check here 0, if hold for pick up.) List contact person and day phone number below: S S ENGINEERING/694-2979 170-44 Eaale River Loop Road, Suite 204 Resale River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family [A Number of bedrooms 'R 3. WATER SUPPLY Individual Well 0 Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site IR 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 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & S E1VG11fEcR:NG Telephone Address 17034 Eagle River Loop RnnA ., Date �7 � / 1 1Engeer's Seal =_.X° 6. DHHS APPROVAL Approved for 3 bedrooms by �/ Date Approved /\ -Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) j uRA ,,HECKLIST - FEBRUARY 1984 — ;LNIAL SERVICES DIVISION 343-4744 Legal Description: JAN o 71991 �i} L_ , L,L�_s 4-1 A. WELL DATA C I ' ED Well Classification��1 J1 DJ 4-A If A, B, C, D.E.C. Approved (Y/N) a Well Log PresentC N) S—Date Completed �� �� Yield -7," AFM --t— Total 'rTotal Depth _l_'S 2 Cased to �—Depth of Grouting i Static Water Level 42 Pump Set At I Casing Height Above Ground 12- -"- Sanitary Seal on Casing (I) Electrical Wiring in ConduiQMN) Depression Around Wellhead (Y� r 1l SEPARATION DISTANCES FROM WELL: r ( To Septic/Holding Tank on Lot On Adjoining Lots i C� To Nearest Edge of Absorption Field n Lot `rLo ; On Adjoining Lots 1 To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service L)ne on Lot Si 12 ; Water Sample Collected by I Date Water Sample Test Results�- Comments B. SEPTIC/HOLDING�DATA Date Installed 1cy_2' Size No. of Compartments .-Standpipes j J) T—Air-tight Caps/N) Foundation Cleanout") Depression over Tank (Y4P ate Last Pumped l,0 — Pumping/Maintenance Contact on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) 1a Temporary Holding Tank Permit (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well To Building Foundation 7A To Property Line I To Disposal Field 4— To Water Main/Service Line 1� To Stream, Pond, Lake or Major Drainage Course Comm ►rl�n�- G)r "�!%S �J�'1�1► ��i 72-026 (Rev. vas) Fro, Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design�%`t t�tT Date Installed �r 1 Length of Field I � Width of Field95- Depth of Field 'I Gravel Bed Thickness 0� Square Feet of Absortion Area 1` ��b Statndpipes Present(DN) Depression over Field (YLV N Date of Last Adequacy Test v7--- I Results of Last Adequacy Test5���1��^-`-1 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well -To Property Line i To Building Foundat4onl Jfl To Existing or Abandoned System on Lot r1 I ; On Adjoining Lots�� i To Water Main/Service Line o k To Cutback (if present) To Stream, Pond, Lake, or Major Drainag� e Course gr i To Driveway, Parking Area, o1 �ehicle Storage Are Comments >�- � V���✓�� D. LIFT STATION Date Instd Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) - "Pump Off' Level at Vent (Y/N) ing Cycles during Adequacy Test. "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 & i tL� � ,� ���t is ' Company. - h 99jY7 �, Enginoer's`�eal Date r MOA No. Fez �-� ..... Z. L L(14 Receipt No. t t ( l C . Receipt No. z Date of Payment 1- �l-` Waiver Fee: $ S0IU.L)C�) Amount: $ Date of Payment -1'-Ot 72-026 (Rev. 7/88) Back Page 2 of 2 I N N' I /66,,.S77 .N I '•° Z� � iv ,x 90 O ml I Sh — —i AO fll I 0 O C Si v Y IN I i D s s • 00 ae p r s o� s i 3 IIZOILZ ' ai 0 o• Z �. v► 0 m • • m Se 00 w O .moi M AL % i a s a �..3�v : :,(� :L'•�•. Fit' Z 47 ` m \ L a i CL o ma; urs r r RI j`I r �i `� c'° • nom+ • o v '. 3 • st + D -� 2 �1 w 3 o. 3 0' '• r �. °mss o ,: :ay toN Q NG O i o e ? M e< v a(e�aw_�•..• �'i O 7C m ae W • _oz oa on Mr 0 ."rsy. 00 0 f9 W Q ? n: o e=• v O n N + • o �_ IL fi � c e y r • � + � _ KIODD_.N<[VE� AVE......_.. o� zm om 3a m m 30 ml I Sh — —i AO fll I 0 O C Si v Y IN I i D s s • 00 ae p r s o� s i 3 IIZOILZ ' ai 0 o• Z �. v► 0 m • • m Se 00 w O .moi M AL % i a s a �..3�v : :,(� :L'•�•. Fit' Z 47 ` m \ L a i CL o ma; urs r r RI j`I r �i `� c'° • nom+ • o v '. 3 • st + D -� 2 �1 w 3 o. 3 0' '• r �. °mss o ,: :ay toN Q NG O i o e ? M e< v a(e�aw_�•..• �'i O 7C m ae W • _oz oa on Mr 0 ."rsy. 00 0 f9 W Q ? n: o e=• v O n N + • o �_ IL fi � c e y r • � + � _ th Municipality ®f Anchorage } j Department of Health and Human Services1h5 -- 825 "L" Street Tom Fink, Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 January 10, 1991 Robert A. Shafer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 1 Block 3 Park Hills S/D #1 Waiver Request #WR910003, HA910010, PID #017-142-21 Dear Mr. Shafer: Your request for a waiver of the required 100 foot horizontal separation of an absorption field/septic tank to a stream has been approved. The approved separation is 68 feet and 60 feet respectively. This waiver approval applies to the existing disposal system to stream only. Any future upgrade to the system will require all separation distances be met or another approval from this department. S' cerely, Con r: Daniel J. Roth n Smi Civil Engineer rogram On-site Services On-site DJR/ljm Services Janua&y 7, 1991 ROBERT SHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694-1211 ... ,URAUE SERVICES DIVISION HEALTH AUTHORITY APPROVALS 9 Municipatity o4 Ancho&age -JAI"] 0 7 1991 DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Strseet�'� SEWER &WATER P.O. Box 196650 l Anchonage, Atas ka 99519-6650 L„�� `�q���pL MAIN EXTENSIONS REFERENCE: Lot l; Btock 3; Patk H.ittz Subdivision #1; Request you .issue the attached Heatth Autho,%ity App&ovat and g&ant a SEWER &WATER wai.ven 4ors the sepa&tion distances between the septic system and a INSPECTION smatt steam both Located on the 4e4e&eneed p&opersty. The septic tank .is Located apprsoximatety 60 4t. 6&om .the strseam white the teach6ietd .is toeated app&ox.imatety 68 6t. 6&om the strseam. ENGINEERINGSTUDIES This rse nest -comes subsequent to ou& Deeembe& 24, 1990 tetters which AND REPORTSORIS R L, Oak youA ” ctaszi6icati on" o6 the st)Leam. On January 3, 1991 Dan Botta 4rsom yours o44.ice .in6orsmed us the strseam .is to be eo"ide&ed a s1146ace waters soursee and .the %equi&ed separsation distance to the septic system .is 100 4t. WELL INSPECTION &FLOW TEST Attached 4o& yours rseview is an annotated as-bu,itt 6ukvey o4 the prsope&ty showing the st)team toeation. We have added the components o4 the septic system, and some etevation data to the dAawCng. SITE PLANS As Mated .in ours tetteA o6 Decembers 24, 1990, the septic system was tnstatted in 1982. On the inspection &epo&t .is noted a "taw a&ea, standing waters." Appa&entty the wateA was m.inimat enough 6o& the .inspeetoA to not considers this a suA6ace waters soursce at that time. ROAD DESIGN Other. than because o6 the m.indmat size o6 the cheek we fleet these separsation distances should be grsanted due to the existence o6 a smatt rsetaining watt and driveway between the septic system and e&eek. P&.iors SOILTEST to contaminating the ersee.k., sewage ove&6tow woutd have to t&avet across the di iveway. Sewage trsavetting across the dti-veway woutd be qu.ickty observed and &emediat steps woutd be taken p&.io& to contamination o4 the e&eek. PERCOLATION TEST 14 you have any questions o& tequ i&e addit.ionat .in6onmation bon you& rseview, please contact us. S.ince&ety, STRUCTURAL& MECHANICAL INSPECTIONS - `- ,' RU13 A. SHAFER, P.E. RJ7S/ m ONSITE WASTEWATER DISPOSALSYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 V t /f .r O ! / &Z 3 /'H 'W///L 1 S sum w �vFR /iFQuFsr Altvjw li-R�/aola V _ K E JVD �O f F/�OM S E1°T/C L/1�e TG S o fe4u r -- flFTE/►' /� S/TF_ VISIT-- Oy -/�V _9_` 9� TME FaeLvu_��l -- A1J°i9ws l'o 1wIF�p _S_�P F. eE J•vcs �✓ -- - - -M EL T- 71_0 I G_GS/-QES o fC�D_IJ__r"ft E _5_FE1 S_7WE RE�i_ -L o 4i-. - -- 5_EPr�c T��' o�Q p . l.�. FiFL `--- I - — WduLd /`7oST_L /4 jam! P /yT0 T/f� HOUJF. =---- I, Al T Td - t? 5,f .E --D1? / v G- Y —L- Al -C 1.vis �� T U.- o c, to , , TtR_ is G TF /Y 611? E ��� u NT/ �_ / T ISI / �J�tZLEr��� � E ST/P Ems- •tet, — of Q_U-I���LGrn. w lytelle,6 c rS EAG-�7"!�✓�%�'/� _TI�� -- "I ��PvGRe!7/0 �aY Freon- A1J°i9ws l'o 1wIF�p _S_�P F. eE J•vcs �✓ -- - - -M EL T- 71_0 I G_GS/-QES o fC�D_IJ__r"ft E _5_FE1 S_7WE RE�i_ -L o 4i-. - -- 5_EPr�c T��' o�Q p . l.�. FiFL `--- I - — WduLd /`7oST_L /4 jam! P /yT0 T/f� HOUJF. 0 4,EOVIVER•A/ 17034 Eagle River Loop Road Eagle River, Alaska 99577 ROBERT A. SHAFER CIVIL ENGINEER 694.2979 PROJECT: W H T: T/-- C -OM A A N Y DATE OF TEST: ( Z- 12 -teta LOCATION OFWELL (Legal Description): Lof � (nc_ Z PA( ( 1;11 j f,.6 �1 T WELL DEPTH: FT. CASING: 14 Q 'FT. -- SCREEN: DATE DRILLING COMPLETED: ` Z - Z_ DRILLER: ( "C�i Apt Lrt�iinJ!Lk STATIC WATER LEVEL (Top of Casing): 2 FT. DATE: TIMEK ELAPSED TIME I PUMPING DT NI WA I WATER, FT. I DEPTH TO DRE O ERY I I RATE, G M PUMPING I REMARKS STOPP 0 I 0 10 15 20 25 30 35 40 45 50 55 60(1 hour) Start (—Ir) 150 180 (3 hours) +Y . 210 f� 240 (4 hours) p RECOVERY E t 0 0 5: 15 k. 20 25 30 Comments: 1 kW e l l p,r` o j L)c e s #L� M i N (nA L) M o f 7. P Subsequent Variatiorlf Can ®scar OV er A 14 k ou u' (p e d' t o j APPLI( NT FILLS OUT UPPER HA: ONLY "Loperty Owner`&M dh d _ M C " J " Phone Mailing Address ,r, o 9a f Zip Code Buyer Date Address Zip Code Lending Institution�iCS%LZ y17k �� / / ! Inspector Phone Address c 1 Zip Code Inspector Realty Co. & Agent RN �Y L, _ p Phone Address -- '� �� s�' J - r } r. �,, Zip Code ��� '� �' �� Legal Description 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Street Location co - BY: P—( /IA Type of Residence Soils Rating Date Sewer Installed Single Family .l- Well Log Received Septic Tank Size ❑ Multiple Family No. of Bedrooms_ Well to Tank ❑ Other Water Supply A Individual ATTACH WELL LOG. A well log is required fon all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal A Individual Year Individual Installed: - ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date - Date Date Date Io Inspector Inspector Inspector Inspector �,,q Field Notes: i ( `z) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' 3a DATE f —3a BY: P—( /IA Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72-023 (3182) MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date _ Oct. 15, 1984 _ (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 1 Block 3. Park Hills, Suhdivisinn 41 Location (address or directions) 1 Park Hills Drive (b) Applicants Name John J. & Joan L. Wernsdorfer Telephone - Home345-7590 Business Applicants Address 1 Park H_L_a1LaDrivP (c) Applicant is (check one) Lending Institution Owner/builder ; Buyer El ; Other [:::I (explain); (d) Lending Institution 1st National Bank-AncchQra2u Telephone 270_6300 ry Address Trust Department (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: John J. & Joan L. Wernsdorfer P.O. Box 111512 _ Anchorage, Alaska 99511 2. Type of Residence Single -Family 4 ^ -t Multi -Family Other (describe Number of Bedrooms 3 3. [dater Supply Individual Well! " 1 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 EU Public E:] Community [-_:::I Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 2] 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that, based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system ,is in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Ocean Technology. Ltd Telephone 248-3888 Address 2502 W Northern Lights Blvd. Anchorage. Alaska Date October 15, 1984tx h DTH �elT} oo°s_s- •s aemae°sases Y,P, (ENGINEER SEAL) ®` 6. DHEP Approval Approved for bedrooms Approved Disapproved Terms of Conditional Approval ® ase..•.... . Bcauya:' CE - 3995 <'Q i By „ Date k�t�JfESSi��t. Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR LRALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page .2 of 21 7-19-84 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION, HEALTH AUTHORITY APPROVAL (HAA) OCT 1 %4 CHECKLIST - FEBRUARY 1984 RECEIVED, Legal Description: ����,r�;~,;- t;r -'', A. WELL DATA Well Classification If A, B, or Cr D.E.C. Approved(Y/N) Well Log Present (Y/N) Date Completed Yield a. Z;awp Total Depth Z6� Cased to Depth of Grouting SIN Static Water Level l� ° Pump Set At &dZ,,,f/{���t1�J Casing Height Above Ground ,2.6--/ Sanitary Seal on Casing (YM)k//-, Electrical Wiring in Conduit (Y/N) &..e Impression Around F7ellhead (Y/N) A)6-) Separation Distances from Well: To Septic/Holding Tank on Lot /nn s On Adjoining Lots 1�4' To Nearest Edge of Absorption Field on Lot 1-Y4 ° On Adjoining Lots To Nearest Public Sewer Line d01i To Nearest Public Sewer Cleanout/Manhole _/�1� f To Nearest Sewer Service Line on Lot Water Sample Collected By Date /� - // - Del Water Sample Test Results COmnents B. SEPTIC/HOLDING TANK DATA Date Installed /,0-/3-�'2� Size 1d66 / e, No. of Corrpartments 1 Standpipas (Y/N) A% Air -tight Caps (Y/N) /r°' Foundation Cleanout (Y/N) V(,,-`-` Depression over Tank (Y/N) Alt) Date Last Pumped /6A/d?��p Pumping/Maintenance Contract on File (Y/N) ` ; for Holding Tank High -Water Alarm (Y/N),4/11;� Temporary Holding Tank Permit (Y/N) / j/ Separation Distanoas from Septic/Holding Tank: To Water -Supply Infill /ej� To Building Foundation 2,Q To Property Line �"6 ' dy To Disposal Field /6 To Water Mair./Service Line (sj' To Stream, Pond, Lake, or Major Drainage Course Z2 Comrents Receipt # ?DL 19 is C> Date Paid: Amount: L4S,c)C) [Page 1 of 21 2-15-84_ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata/ �`' SFr 5r;,; Type of System Design Date Installed /Q /j1 -g h Length of Field Width of Field Depth of Field j Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (YM) d/Z3 Date of Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply 4\b11 //1!5- ' To Property Line /yr''' To Building Foundation To Existing or Abandoned System cn Lot A/ l� ; On Adjoining Lots /00 To Water Main/Service Line ' `- To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area ComiTnnts D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Com arts Dimensions Manhole/Access (Y/N "Pump Off" Level at Vent (Y/1N) Pumping Cycles during Adequacy Test, rets MOA Cneck Permitted Bedrocm Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelires in effect on the datA f this reinspection. Signed L+'_ Date �� �S" B¢ - Company UC�� k 7c,�/r/o Lo a CTD MOA No. 63&¢ KBI /d5/s [Page 2 of 2j AV 0) ° •• ` �9 Fy 9TIl d a Patrick A. Beaugar CE -3995 v �� 2-15-84 /0:/7 /o /r�ry excess �qpc r�r /p 30 /D r/.Pr1 610 �a ;r- r°a"Q64> S�f�rtc a /C� C1,44 - LT S7T3r/G �evec iiv Adsc2GriD� = p. 00 ' az- rorilAd- tff rord4 '/z O A. Jr 14»a4 RISC, Aweiia /G -// -Bq DO , 64-efe GL's f // DS (.�G Municipality of Anchorage � afta Department of Health and Human Services C I6 Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 January 7, 1991 Robert A. Shafer, P.E. 17034 Eagle River Loop, Suite 204 Eagle River, AK 99577 Subject: Lot 1, Blk 3, Park Hills #1 Dear Mr. Shafer; In response to your letter of Dec. 24, 1990, a site visit to the subject lot was made on January 3., 1991. Our findings were that there does appear to be a persistent.source. of surface water entering onto Lot 1 through the existing culverts under Park Hills Dr. An exact determination of the flow and location of any resultant stream cannot be made at this time. Further investigation will be necessary after break-up. If you have need of further clarification please contact our office. Si/nnccerely, Daniel N. Bolles On-site Services cc: John Smith, P.E., Program Manager, On-site Services /139 M 1; ` Deeemben. 24, 1990 ROBERTSHAFER, P.E. ROGERSHAFER CIVIL ENGINEERS (907) 694-2979 FAX 694.1211 HEALTH AUTHORITY APPROVALS Mun.ic.ipat.i.ty o4 Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L Street P.U. Box 196650 SEWER&WATER Anchorage, Ataska 99519-6650 MAIN EXTENSIONS REFERENCE: Lot 1; Btock 3; Patk H.Ltts Subdivision #1; Request you pengow a site visit to aid .in the deteam,ination og the SEWER &WATER existence o4 a su&4ace water. soun.ce. INSPECTION The septic system was .instatted on the pnopen#y in Dctoben, 1982. On the .inspection nepont .is noted a "tow area, standing water.." This .is appnox-imatety 80 it. bnom the septa teach5.ietd. Attached you wctt ENGI N EERING STUDI ES blind an az-buitt survey. On this as-buitt we have had the surveyor AND REPORTS tocate .The drainage eounse Leading 4nom a eutven# under the naad and acnoss the pnopenty. At this time, there exists onty .ice with no 4tow.ing water. It appears this area is meant onty 4on pe4iodic sungace nun -o66 white the neat drainage easement .is tocated acnoss .the north WELL INSPECTION &FLOW TEST end o6 the dn-iveway as shown on the as-bu,itt. As can be seen bnom .the as-bu.itt, the ct"zi4ication ob this "cheek" .ins c&iticat due to .its pn.ox-im.ity to the septic system. SITE PLANS Ij you have any questions, on wish us to accompany you on the site visit, ptease contact us. S.incen y, ROAD DESIGN i i / SOILTEST ERT A. SHAFER, P.E. R S/gm MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION PERCOLATION TEST 6 11,03 C919 RECEIVED STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 90 W 5.89�CJ911U., /66,57 \ O Dm m �` N42_O 6 g'b�' N '.o •.v •C A s _ G D — --1 r I t► o E: 1 rq 2 � I h 90 rn r' On M a o o e 0 a•eIL Uc fDUO_ N�► llEnl It l� Ian zn n 1 l� •_ �_' o p 30 _ G D — --1 r I t► o E: 1 rq 2 � I h 90 rn r' On M a o o e 0 a•eIL Z n i o� •_ �_' o p y ame 0 > 30 a •> ca o 6L �° 'p co 0•• "o� • w p - v 9 c' ni 'go, � v a r,•a �sZe�7' -31 _M 3 p% e O w o 40 0 v06 ' � N(•+d••e6oa� 'O y p w � • • � p � n �. O y • 6 C n= p p O =• w C ` n 1 0 f >> y •i �+, w• •• o 3 v -� n � ~ Y w MUNICIPALITY OF DEPT. OF HE, ENVIRONMENTAL �Q Glace✓coavdz ori Lor 11 9K-7) Pt R K MUS a u a t). 7Q1bo 4,6b'), as It„lr 1 -fir - J 4v� Ell, .5 4 777-- 7, f J Ell, 4