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SUE TAWN ESTATE #2 BLK 1 LT 3
Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number:.OSP241277 PID Number: 051-471-25 Dwelling: H Single Family (SF) n with ADU El Duplex (D) F1 Two Single Family Project: n New N Upgrade Name RICKY & BRENDA MANN ABSORPTION FIELD - EXISTING ❑ Deep Trench El Wide Trench n Bed n Mound Site Address 23434 CREEK ROAD, CHUGIAK EJ Other PhoneBedrooms Soil Rating Total depth from original grade = 4 GPD/SFI Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot SUE TAWN ESTATE #2 1 3 Fill added above original grade Ft. Gravel length Fit, Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To! i� Septic C Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Fl?- Ft. Well 1100,+ 1 2r0'+ TANK 2 Septic El S.T.E.P. F-1 Holding F-1 Other Manufacturer GREER Capacity 1250 Gal, Surface Water 100 Material HDPE Number of compartments 2 Lot Line 10'+ 1 NA Foundation 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks Deep-burial HDPE tank. Alarm location Electrical installed by Installer PCN PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Drainfield CO/MT 3034 Inspector FWCS BENCH MARK (Assumed elevation) 100 ft Inspectios 1119/11/24 9/12/24 Location and description date2'�J 3rd 4" TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL Conditional Approval: Date Aaw AW01 TH .. . .... . ......... Septic System $0 Curtis Huffman Approved A!,Z Date -0. CE 128991 Awl' 16/24 .9,; PROFESSO -0- Note: this app*vXaI does not include well permit requirements. (Rev 05/02118) PID:051-471-25 PERMIT:OSP241277 FIRST WATER CONSULTING SUE TAWN ESTATE #2 B1, L3 \FFA � \qy CREEK ROAD Ct N 90'00'00"E Lot 4 10' DRAINAGE EASEMENTS Lot 5 PLOT PLAN AS BUILT X SCALE 1 " = 60 GRID NW 1 160__ Project No. ___ J24_247ZAl _ P.O. Box 210005 6M� yN LangLan& Associatesinc. Anchorage, Alaska 99521-0005 �, `joo��p��4 "t1 (907) 522-6476 0 F A 04 Professional Land Surveyors kn0lansurveyurvey.com ken®langsurvey.com I hereby certify that I have surveyed the following described property: C� : H , LOT 3, BLOCK 1, SUE TAWN ESTATE — ADDITION NO. 2 (PLAT 76-268) .. ..... ... .... ......... Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a V representation of the conditions that were found on the date the survey was performed. Q This survey does not constitute a boundary survey and is subject to any inaccuracies JO . . A . C.. LANG .: or that a subsequent boundary suryey may disclose. The information contained hereon shall<"�,Q not be used to establish any fence, structure, or other improvements. Q J� 9<4�A '' .LS -9944.•' S 4O ,� � y , >-4; at Anchorage, Alaska 0 d Dated this the ?J Day of s ' l_�— �_--- `---- p� OBOE dao fSSI0NA4 0 It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 o N I Ii N ..ya. A 1 STORY .400Y 6 RESIDENCE ti ° 86.7' WALKOUT SyOp N w/ BSMT. 4.3 N Lot 2 L, = VC ti 82.6 26.2. N 9.5'x20.0' 3 r� M 1.3' CANT N' LEAN—TO 72'6 6.6 SEPTIC MANHOLE p 328• SEPTIC PIPES o Z 14.5'x15.0' 2.0'x13.5' CANT DECK 1.5'x6.7' CANT / DECK w/ RETAINING WALL STORAGE \ / BELOW DECK Lot 3 1 1.94 Acres P RG�EG� I WELL I \ '24"W S 89' 285.00' Lot / Lot 6 i / ISI ISI Lot 4 10' DRAINAGE EASEMENTS Lot 5 PLOT PLAN AS BUILT X SCALE 1 " = 60 GRID NW 1 160__ Project No. ___ J24_247ZAl _ P.O. Box 210005 6M� yN LangLan& Associatesinc. Anchorage, Alaska 99521-0005 �, `joo��p��4 "t1 (907) 522-6476 0 F A 04 Professional Land Surveyors kn0lansurveyurvey.com ken®langsurvey.com I hereby certify that I have surveyed the following described property: C� : H , LOT 3, BLOCK 1, SUE TAWN ESTATE — ADDITION NO. 2 (PLAT 76-268) .. ..... ... .... ......... Anchorage Recording District, Alaska, and that this Mortgage Location Survey is a V representation of the conditions that were found on the date the survey was performed. Q This survey does not constitute a boundary survey and is subject to any inaccuracies JO . . A . C.. LANG .: or that a subsequent boundary suryey may disclose. The information contained hereon shall<"�,Q not be used to establish any fence, structure, or other improvements. Q J� 9<4�A '' .LS -9944.•' S 4O ,� � y , >-4; at Anchorage, Alaska 0 d Dated this the ?J Day of s ' l_�— �_--- `---- p� OBOE dao fSSI0NA4 0 It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. State of Alaska AECC963 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241277 Work Type: SepticTank Upgrade Tax Code Number: 05147125000 Site Legal Address: SUE TAWN ESTATE #2 BLK 1 LT 3 G:1160 Site Mailing Address: 23434 CREEK RD, Chugiak Owner: MANN RICKEY L & BRENDA L Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: 9/6/2024 9/6/2025 84542 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: TO F- L,/C— Date: Issued By: Date: -?� z rd ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-471-25 Property owner(s) RICKEY& BRENDA MANN Day phone Mailing address 568 PHILIP DRVE, LINCOLN, AL 35096 Site address 23434 CREEK ROAD, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) SUE TAWN ESTATE #2 B1, L3 Legal description (Township, Range & Section) Lot Size I Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial F] Single Family (SF) Fx] (w/wo ADU) Septic Tank El Upgrade RX Duplex (D) ❑ Holding Tank El Renewal EJ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well El Water Storage EJ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Z_ Waiver Fees: Date of Payment: Date of Payment: Receipt Number: Permit No. U-S Receipt Number: Waiver No. GAIDevelopment Services\Building Safety\On Site Water and WastewaterTorms\Client FormsTermit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / FirstWaterAK@gmail.com ! !! August 26, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC TANK UPGRADE PERMIT LEGAL: SUE TAWN ESTATE #2 BLOCK 1, LOT 3 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank on the above referenced lot. We propose to install a 1250-gallon HDPE tank per the attached design to serve the existing 4-bedroom residence. A 1500-gallon septic tank may be considered for current functionality and future consideration or flexibility. Groundwater was noted in the MOA on-site file at 8’ below grade and if groundwater is encountered during installation that may affect this septic tank upgrade, an epoxy coated steel septic tank, the tank may need to be anchored for buoyancy measures and / or other actions may be required. The lot and area are served by private water and any encroaching wells, easements, … must be staked prior to construction. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241277, Curtis Townsend, 09/06/24 FIRST WATER CONSULTING SUE TAWN ESTATE #2 B1, L3 DESIGN DETAILS: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241277, Curtis Townsend, 09/06/24 ('~' 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 LEGAL DESCRIPTION PHONE E~NEW LOCATION DISTANCE TO: IWell I Abs°rpti°n are~ ~ L q., IF HOMEMADE: Inside length DISTAN( Well Dwelling PERMIT NO. ]lions DISTANCE TO: No. of Top of tile to finish grad~::~ Length Width Foundation Material beneath tile Nearest Trench width .ERM,T No.~DO ~5 lines PERMIT NO. Type of cr Class Depth Driller Building foundation Sewer line DISTANCE TO: bsorption area Nearest lot line Distance to lot line PERMIT NO'~o~O~_C Absorpt on area(s) OTHER PIPE MATERIALS SO] L TEST RATI N G INSTALLER ~EMARKS AR[:tR4~VED / ! DATE~ i,Li ~GAL 72-0~ ;~¢e v. 3/781 LOT SIZE 84000 SQUFIRE FEET NF t ELD SOIL. RFIT I NG LEGRL L3 B± SUE'f'RHN ~$2 T'¢PE OF SOIL. RBSORPTION SYSTEM IS: i'4F!XIh'IUM NUMBER OF E:EDROCIMS .... ¢ ,:: 9,;Q FT,-"BR) = THE REQUIRED SIZE OF TPIE SOIL F!E:SORPT!ON SV:.:;TF::H Ii;: THE LENGTH D!PtENSION IS :'FIE LENGTH '::IN FEET) OF' 'THE TRENCH OR DRRINFIEL[:'. THE DEPTH OF R TRENCH OR PIT' IS THE DtSTRNCE BE!'HEEN THE SU.RFRCE OF THE EiREII_IND Ri"~[Z:, THE E~OTTOM P~F ]"tiE E:qC:R',,,'RTION~ ':: IN FEET). ~_ THE GRRVEL. DEPTH I:F.; THE MINIMUM DEPTH OF GP. RVEL BE'f].,.!EEN THE OUTFFILL PIF'E FIND THE BOTTOM OF THE EXC:FIVRTION <IN F'EET). ~m'..~, FIF'F'L!CFfl'-~,T Lb:, THE RESF'ON'}];IE~!LI'"9 TO !NFC~RM 1H!.=, [:,EF'FIRTMENT ':,I!r~'iNG THE I. IEL_:, FF, fRr':ENT ]]3 THIS F'P~F'E~'T'9 FIND THE ......... i N_,h ~._. !LN_, RN'¢ · INqTFII I FITZOf - ':'-' ...... .':' OF I ¢' BIL.IME~ER Cfi: RESIDENCES THRT THE HELL i,,tlL.L. SERVE. _P.-F!CKFILLING OF R1'4"¢ S¥SI"EH 1.4ITHOU¥ F'ZNRL INSPECT:ION RND F:IPPROVFIL E?¢ THIS DEPFIRTHENT I-4ZLL E~E SUBJECT TO PR,'Z)SECUTION. MINIMUM [:,iSTRNCE BETHEEN FI WELL RND RN, Y ON-'LEITE SE.WRGE [:,!SPOSRL SYSTEH IS :£00 FEE]' FOR F! PRI'¢FITE HELL OR ZOO TO 200 FEET FF-..'OM R PUBLIC HELL DEF'ENC, ING UPON THE T'¢PE OF PUBLIC HELL. MINIMUM DIS"i"RNCE F:F:.'OM R F'RIVFITE HELL TO FI PRI',,,'RTE SEHEF:: LINE t'}] 25 FEET' TO Fl COMMUNIT'¢ '-:;EHER LINE IS 75 FEE]". FFTHER REQUIREMENTS MF:I'¢ EtPF'L'¢. 5.;F'E:CIFiCF!TICdqS FINE) EOi',I':-;TPLCTIF$,t DiFP_--;RF!HS FIRE FP,,'RILFIBLE TO INSURE F'ROPER INSTF~LLF~T:[ON. I CERTIF"? THRT i: i RM FF[MILIRR NITH THE REQU!REHENTS FOR ON-SITE SE!4ERS FIND HELLS R:F., SET FORTH B"r' 'THE MUi'.,!ICIPRLITV OF' F¢.~,CHORRGE. 2: I WILL INSTFILL THE S"r'STEM !h,I RCCORDF!NCE !.,~iTH THE CODES. Z.':: ! UNDERSTF~ND 'rHRT THE ON-SITE SEHER SYSTEM MR'9 REQUIRE ENLFIRGEMENT IF' THE RESIC, E.'.,!CE IS REMCK)ELE[:, TO iNCLLIE:,E MiRE THRN 4 EEC, F']'?IS. r F!PF'LIC~NT GFIR"¢ _~. EETT? HiCKLiNG ! SSI.JEC, E:¥. ....... ¢.~:.....-.==x ....... '-'--.q ................ :~-=-.-- ...... ~ ........ -.--? { - MUNICIPALITY OF'ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST ~ SOILS LOG [] PERCOLATION TEST SLOPE CATE PERFORMED: SITE PLAN 11 13- 14- 15 16 17 18 19 20- COMMENTS PERFORMED BY: WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? 72-008 ~6/79) Reading Date Gross Net Depth to Net Time Time Water Drop 1 PERCOLATION RATE /~//~ (minutes/inch) TEST RUN BETWEEN FT AND -- FT CERTIFIED ~ " Fr'LZL. dN r LOCFIT Z ON L. EGRL. GRtT'Y,-."BETT'¢ H ........ L INL:i L ~ E, fL =,LIE TFLb.li',! '~,.'T' LOT SiZE 8,:!.Eli3E~ S6J. U61RE F:EET MINIMLIH DISTRNCE E,'ETHEE:N FI 14ELL END F:INY ON-SITE SE,HFS, GE DISPOSRL E.;YSTEH IS 2LOEt FEET FOR FI PRI',,,'RTE H_ELL OI:E~ ::LEiE~ TO 2E~!D FEE]' FROM R PL.IDLIC HELL [;,EF'ENDINEi L!PON THE TAr'F'E OF PUE:LiF: HELL. MINIMUM DIE;TFINCE FROH FI PF~I',,"FI'FE I4ELL TO R PRI'v'RTE SEHER LINE IE; 25 FEET END ]"0 R COMI"IUNIT~?' SEHER LINE tS 75 FEET. HELL LOGS ERE RE6!U!RED Rh!D MUST BE RETURNED TO THE DEF'FIRTHENT I.'.!ITHIN ]:E~ E-"Ff¢S OF THE HELL E:OHF't. ETION. OTHER RE~;!UIREMENT'S MR'¢ RPPL'¢. :.E;F'EC!FICRT!ONE; END CONS]"RUCTION DIRGRFIHS F~RE F¢',"RIL,~BLE: TO INSURE PROPER ]:NSTRLLRTtON. ! CERT I F'T' THRT .................'1: i 61i't FRt"IlLIF~R'. I.,E[TH THE R'E'::' 'rR'EHFt'.I'TC; FOR ON-'r:;TTE .:,EI4E:R:, FIND HEL. LS H._,=':' SET FORTH E,~ 'T~21E MUNIC)]F'FILIT'.? OF MNL:HuRHbiE. 2: I !4ILL INS"I'FILI.._ THE ._,~_,rErl IN RC:CORE:,F¢.,!CE H.[ Fh THE CODES. :5 I GNED: RF'F'L ! CENT GFIR'¢,-,'E:ETT¥' H I CKL I NG ISSUE[:, -P., '?_ "/'4. El ~ MUNICIPALITY Of ANCHORAGE Departmen~ ~f Health and Environment{ Protection '~ 825~ Street, Anchorage, AK. ~9501 264-4720 * * * HANDWRITTEN PERMIT * * * Permit ~ WELL AN~TE S,"WE'-F% PERMIT , Applicant: /~C~ V ~-J/ '~ {~-e (~Mailing Address: ~ Location: Phone Nu~er: . ~ Legal Description: L~_~ / ~ ~ ~Lot Size: Type of Soil ~sorption System Is: Trench: Dra ~ld: See~d: Holding Tank: Max~ N~e~~ of BeQr~ms. soi~atlng (sq. ft/br) .... The Re~d~ Size of the S~o~tion System Is:~ DEPTH .LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = ...... GALLONS * * 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. * *.* TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departmen~ will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fee- for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation, * * * PERMIT EXPIRES DECEMBER 31, 1 9 $ 2 * * * I certify that: (!) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may r~quire enlargement if the residence is remodeled to inc'lude more that~bedrooms. Date: , _ SWP/024 (1/Sl) e 'ifie hy Doc co. SULLIVAN WATER WELLS P. O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND ADDRESS - '-~"f~ LEGAL DESCRIPTION DATE - Sta~ed ~ ~ PE~IT NUMBER Ended DEPTH OF WELL /~> '~/' ':~ ~ATIC LEVEL OF WATER FT. DRAW DOWN FT. GALS. PER HR ~,-~ ~ KIND OF CASING ~ ~' fi)/d KIND OF FORMATION: From C? _Ft. to '::~' Ft. ~.') ..... ~'~-(~c~-d~'~c~~''~d From From From ~ Ft. to Ft. ~ ~ ~ f From.~ From .... C_ ~( ~ .&~ From From ~ Ft. to .Ft. From /L94) Ft. to o , Ft. From ~Ft. to Ft.. From ~_Ft. to Ft. From From From__.Ft. to Ft. From __ From Ft. to_ From__.Ft. to Ft, From Ft.' From From Ft. to Ft, From__ From__.Ft. to Ft, From__ From Ft. to Ft. From__ From _Ft. to Ft. From__ From Ft. to Ft. From Ft. to Ft. Ft. to Ft. Ft. to Ft. Ft. to Ft, Ft. to__.Ft Ft. to Ft: Ft. to__.Ft _ Ft. to__.Ft. Ft. to Ft.. Ft. to__ Ft._ Ft. to Ft. Ft. to. Ft. .Ft. to Ft. .Ft. to Ft._ Ft. to__ Ft. .Ft. to__ Ft. Ft. to Ft. MISCL. INFORMATION: DRILLER'S NAME ~,~._ ~' , ., -.__ Parcel I.D. 051-471-25 Certificate of On -Site Systems Approval Expiration Date: Legal description SUE TAWN ESTATE #2 BILK 1 LT 3 Site address 23434 CREEK RD Current property owner(s) MANN RICKEY L & BRENDA L X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for Comments or advisories: By: 8/21/2025 bedrooms, with the following stipulations: Original Certificate Date: 9/18/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other See attached waiver COSA ApprovaIjune 2022 Development Services Department On -Site Water & Wastewater Section ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 051-471-25 Complete legal description SUE TAWN ESTATE #2 BLOCK 1 LOT 3 Location (site address) 23434 CREEK ROAD, CHUGIAK, ALASKA 99567 Current property owner(s) RICKEY & BRENDA MANN — Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: 0 Private Well M Private Well serving 2 dwelling units R Private Well serving 3+ dwelling units El Community Well or Public F1 Water Storage 4. TYPE OF WASTEWATER DISPOSAL: Z Private Septic n Private Septic serving 2 dwelling units El Holding Tank R Community Septic or Public Sewer 5. SEPTIC TANK: R Steel Z Plastic R Concrete R Fiberglass Age NEW - See advisory if steel older than 20 years 6. ABSORPTION FIELD: F-1 AWWTS EJ Bed F-1 Deep Trench Z Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: Z 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 $ Waiver Fee $ 232 Date of Payment q11 7,Z Date of Payment COSA # 2 3 Waiver # 03 V z q 10.51 COSA Appkation.doc COSA Checklist.docx COSA Checklist Legal Description: SUE TAWN ESTATE #2 BLOCK 1 LOT 3 Parcel ID: 051-571-25 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled June 1982 Total depth 108 ft Cased to 108 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18+ in. Date of flow test for COSA 8/21/2024 Static water level at beginning of test 90 ft. Well production at time of test 6.7 gpm Water storage tank volume NONE gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 2.24 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 8/21/2024 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank NA* Date of pumping NA* Required maintenance completed, if AWWTS Comments: *NEW TANK C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 6/14/82 ALL standpipes present per record drawing Total measured depth from existing grade *5.5 ft (max) Measured depth to pipe invert from grade 3.1 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 8/21/24 Results Pass Fluid depth prior to test 2 in Water added 600 gal New fluid depth 15 in Elapsed time 1440 min Final fluid depth 0 in Absorption rate 600 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 24 in (MOA 2’ ED) Effective depth used 0 in (Final Fluid Depth) Effective depth (ED) remaining 24 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots, observations, MOA record documents & appears approximate with 2’+ ED. *Lower end of field with a MT – most of the trench has 3-4’+ of cover. The 10-15’ end portion of the trench has less than 3’ of cover with only 2.6’ of cover above the top of the lateral pipe at the sump. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No *0.5’ ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS *Apparent separation field to shop – Waiver requested with this COSA submittal. New tank is 10’+ from foundations. G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 9/12/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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 in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 09/12/24 Municipality of Anchorage � Uepartmrnt r`. P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 0 (907) 343-7904 0 Fax (907) 343-7997 http://www.muni.org/Onsite eves . end Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV241051 COSA#: Permit#:OSP241277 PID#: 051-471-25 Legal Description: SUE TAWN ESTATE #2 BILK 1 LT 3 Engineer: First Water Consulting Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the foundation has been approved. The approved separation distance is 0.5 feet. See the engineer's justification letter. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: / V Approved by:l�1 Name of Rev1 er .....................................................■..,y.r(....................� **** VARIAN C E/WAIVER REVIEW **** 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com September 16, 2024 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SUE TAWN ESTATE #2 B1, L3 – EXISTING FIELD TO FOUNDATION WAIVER Due to limited site constraints, the existing aged steel tank was removed, properly decommissioned and a new 1250-gallon deep-burial HDPE septic tank installed in the same general location. Per the septic tank upgrade permit the existing field was located to verify 5’ separation to the newly installed septic tank and a field cleanout was installed to the start of the trench. It was discovered with this COSA & tank upgrade process that the existing septic field is within 10’ of the existing shop foundation, along or under a small parking area and has existed for the past 30+ years without any known issues or adverse impacts along with past approved COSAs and observations. We therefore request granting of this waiver of shop foundation to field of 0.5’. Granting of this waiver is justified because there have been no known or observed adverse impacts for 30+ years of any effluent interaction to the foundation. The MOA has approved the existing inspection report and subsequent COSA/HAAs of this property. This appears to be the closest portion of the 5’-wide- trench to the foundation slab. The slab foundation is the detached shop-garage with no living area impacts. The field invert is approximately 3’+ below the bottom of this foundation garage floor area. The area has good compactable soils. There has been no known settling or point load issues, and the porosity of the soils indicate minimal if any lateral migration. We believe that separation is adequate to prevent any potential damage to the building or drain field per record documents and visual observations. We are unaware of any adverse impacts this waiver would have to the existing drain field or foundation. Given this justification, we respectfully request a 0.5’ existing field to foundation waiver be granted at this time & without any required MOA waiver fee. Granting of this waiver will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. c c� ca CD m` CO U >, 0] N Ncr- U_ U Cl N [!J A C c� Ca L L CU W A ca E -C o U m 3 o ca ca Lo c Q ti A E rn :3 ° V U U E 0 - cc U CL= cr @ )C� LD Y N �o E m CD M Cf) o, E � 6 @)I U � [4 N Va c E eq cu ` 04 d- co -L o r O U- O V D OJ L L -oU�-C >% E C o C ai ca 2 a) J } LL E m U 'L cu Do E .1 O L 3 i U i [G O D LL❑U}r D r N c c� ca CD m` CO U >, 0] N Ncr- U_ 618910 • • • Municipality of Anchorage ti' 1Q ; On-Site Water and Wastewater Program MAN" �`" (907) 343-7904 a MAY 17 , f E 36 4c ti Certificate of On-Site Systems Approval << "� 0/ g 9 i,9 Parcel I.D. 051-471 -25 Expiration Date: [ -2_1 7 1. GENERAL INFORMATION Complete legal description Sue Tawn Estate #2 Block 1 Lot 3 Location (site address) 23434 Creek Road Current Property owner(s) Gregory & Tamy Stevenson Day phone Mailing address PO Box 641032 Chugiak, AK 99567 Real Estate Agent Day phone 2. TYPE OF DWELLING: CI Single Family (wlwo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual [] Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: i Received by. . <<�/, �;d AI 0/2// COSA to be released to the engineer,unless othe e requested by the en• eer. COSA Fee $ 50.E Waiver Fee $ Date of Payment 5`l X211 " Date of Payment Receipt Number 0.31 6�06 Receipt Number COSA# 856171178 0gWaiver# 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MoA COSA guidelines and 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.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 5/17/2017 of ALj k 6. DSD SIGNATURE +Afth‘ ���" System #1 Approved for L( bedrooms •S{even s none • �� �. CE-8149 System #2 Approved for bedrooms s•• Disapproved >> �NOEESS100 Conditional approval for bedrooms, with the following stipulations: &ICC Arvilc. 'e•-• -3 7 yearK. v, ;-6.e lAeo,4 c_iy‘,4 oceoQi II 343 --7 0q ON-SITE yG_ WATER AND 5' VVASTEWATER PROGRAM c"; By: �/� Original Certificate Date: (p-2--t 7 The Municipality of Anchorage Deveopment Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet E - If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description Sue Tawn Estate #2 Block 1 Lot 3 Parcel ID. 051-471-25 A. WELL DATA Well type Private If A. B. or C provide PWSID # Well Log (YIN) Y Date completed 6/1982 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 108 ft. Cased to 1 08 ft Casing height (above ground) 24+ in FROM WELL LOG AT INSPECTION Date of test 6/1982 5/3/2017 Static water level 88 ft 96.5 ft. Well production 6.0 gpm Ti g p m WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2.68 mg/L Arsenic ND ug/L Date of sample. 5/10/2017 Collected by PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 6/14/1982 Tank size 1 500 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N)r Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 5 f pp�0, Pumper SR's Septic 1 C. ABSORPTION FIELD DATA `�I v vtf lte♦C�'' Date installed 6/14/1982 Soil rating (g p.d./ft2 or ft2/bdrm) 125 GPD/SF System type Length 72 ft. Width 5 ft. Gravel below pipe 2 ft. Total depth 6 ft. Eff. absorption area 514 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/3/201 7 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in Water added 600 gal New depth 0 in. Elapsed Time: 120 min. Final fluid depth 0 in. Absorption rate >= 6004 g p.d. N Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes. give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "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 WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main 75+ Public sewer manhole/cleanout 100+ Sewer/septic service line 25+ Holding tank 100+ Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ . Surface water 100+ Driveway, parking/vehicle storage 10+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION OF AL kkl I certify that 1 have determined through field inspections and 'skQ;••• 4 •9:4-90 review of Municipal records that the above systems are in �4r ' • .. i` -...v. t♦r conformance with MOA COSH9 uidelines in effect on this date. % •••• •• ..VW4I Engineer's Printed Name Steven Pannone %":'S ev R."innone• A - Date 5/17/2017 o.: . CE-8149 /kiwi k�i,�/ OFES9l`0•\+•~ \\�� COSA canary sheet_2-6-15 doc N •"��._-S a ikq CREEK ROAD o r7 • N 90'00'00"E 285'60' M' — • : .. • N SEPTIC PIPE 1 STORY 4RIVEWAY RESIDENCE ry^�z•J °so ai w/ WALKOUT • D`' ',9 o 86.7' N BS MT. •3' N w 82.6' 26. t z46.. Lot 2 1.3' CANT M 9.5'x20.0'LEA0M Lot 4 ID 72 fi 33 6 6' N PIPSEES CHAIN—LINK o /O 14.5'x15.0' �L"� ♦►' 2.0'x13.5' CANT DOG RUN o Z DECK Al� 1.5'x6.7' CANT 0 / DECK w/ RETAINING WALL STORAGE / BELOW DECK R--,,IE.. '''.---..\---10' DRAINAGE f Lot 3 9RC). C �� I 1.94 Acres EASEMENTS WELL f S 89'1'24"W 285.00' — __\,- -- ....._ ..... / ...... \ / Lot / Lot 6 Lot 5 PLOT PLAN AS BUILT —X SCALE 1" = 60' GRID NW 1160 Project No. 17-099/A1 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates , inc . (907) 522-6476 Phone Q4app�� (907) 522-4625 Fax o© 0 F A CIN Professional Land Surveyors kenOlangsurvey.com c§5::. JonathanOlangsurvey.com OOP S�QOO I hereby certify that I have surveyed the following described property: 0� ' �'' LOT 3, BLOCK 1, SUE TAWN ESTATE — ADDITION No. 2 (PLAT 76-268) *: 49TH �� .-��,Q0 Anchorage Recording District, Alaska, and that the Improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that Q no Improvements on the property lying adjacent thereto encroach on the surveyed 0•�• •I(ENNETH•G. •LANG• ;•.•.� premises and that there are no roadways, transmission lines or other visible 4 0 0 easements on said property except as indicated hereon. L� O s, �l �j Dated this the 1 .1-1-1 Dayof i,�.'.feu 2D l 1 at Anchorage, Alaska 044��� •S-52• '? O�' O , ---f_. 9 Q AR N 1 s%0 OFFssioNg.•,--- It is the responsibility of the owner to determine the existence of any easements, DOppOo�" covenants, or restrictions which do not appear on the recorded subdivision plat. AECC963 May 24, 2017 To Whom It May Concern, The leach field at 23434 Creek Road, Chugiak Alaska in the SueTawn Subdivision has had no know issues since our purchase of the property in 1998. Additionally, no vehicles drive or park on the leach field. Very Respectfully, Greg St on ffOlBox 671032 Chugiak AK 99567 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING *~'~/-- ~ ~" NAA# 1. GENERAL INFORMATION Complete legal description Lot 3; Bloc~ 1; Sue Town Estates #2; Location (site address or directions) 23434 Creek Road Property owner Mailing address ~an Harris Day phone 2322 Sou~h Monna St. Morton Grove, Ill. 61550 Lending agency Mailing address Day phone Agent A1 RomaSz~ski RE/MAX OF .EAGLE RIVER Day phone 694-4200 Address 16600 Ce~t~rfi~d D~ve #210 Eagle River, Alask~ 99577 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well xx / Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the ~,alidation date shown below, 1 verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Phone E/~ ¢¢"¢-~' Name of Firm ~;.'0,;.'.. ~,~:~ ['.,w:' L-'~.i.- r , 5~gle River, Alasl:~ Address Engineer's signature DHHS SIGNATURE Approved for ~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments ? - ~ Date I r · ~'/ The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to 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. MUnicipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~o-¢ '=2 ¢c*,.¢-~ ~o¢-~'~<¢~[ ~--5~ A, WELL DATA / Well type ~J,~-~---- ~lfA, B, or C, attach ADEC letter. Log present (~/N) "/ Date completed Total depth /D~ ' ¢"~ Cased to Sanitary seal'N) y FROM WELL LOG Date of test Static water level Well flow Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Public sewer Service line Parcel I.D. ADEC water system number ~'~' Casing height Wires properly protected ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank WATER SAMPLE RESULTS: Coliform ~ ~' ~/~o~ ~-d-~ Nitrate Date of sample: '-/~ / 0 ~'~ / '- ~,¢ ¢~%'/~.. ,~ Collected by: B. SEPTIC/HOLDING TANK DATA Date installed Cleanouts ~N) High water alarm (Y~ Date of pumping '~ Other bacteria S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Tank size / ~--~ Compartments 7.- Foundation cleanout (Y~:) ./~ Depression (Y/~ Alarm tested (Y/N) Foundation Water main/serwce line SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~ U¢~1 ~ ~ On adjacent 10ts Topropertyline ~'7~C>' ~-~ Absorptionfield Surface water/drainage loc> 72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at High water alarm level Meets MOA electrical codes SEPAR~ROM LIFT STATION TO: Wel~on lot On adjacent lots Manhole/Access (Y/N) ~ Cycles tested Surface water D. ABSORPTION FIELD DATA Date installed L~ ~ I~ ~ ~ 7-~ Length '~' ~ Width_ Total absorption area -~/ Depression over field (Y~ Results~Tfail) Peroxide treatment (past 12 months) (Y/~ Soil rating Gravel thickness ~ Total depth System type _Z~'/~/'~/ bedrooms Cleanouts present.N) Date of adequacy test for If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I I ~ ~ c On adjacent lots ~ oc:~ ' ~ Property line ~c> ~ ~ To building foundation ~ c:;,' & To existing or abandoned system on lot ~ ),~, On adjacent lots '"~Z:;>' ~ /'~ } Cutbank ~ Water main/service line ~ ' % Surface water 10 ~ '~ Driveway, parking/vehicle storage area ~" ~ Curtain drain "'J//~ E. ENGi'NEE~'s CERT FiCATION I certify that I have checked, verified, or conformed to afl MOA and HAA guide/ines in effect on the date of this inspection, Signature Date HAA Fee $ Date of Payment Receipt Number (t-o 72~028 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date January 6, 1988 GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) LOT 3 BLOCK 1 SUE TAWN ESTATES ~2 Location (address or directions) (b) Property Owner A.H.F.C. Telephone: Home Business Mailing Address (c) Lending institution Mailing Address. Telephone (d) RealEstate Company and Agent RE/NAX - A1 Romaszewski Address 16600 Centerfield drive ~201 Eaqle River, Ak. Telephone 694-4200 99577 (e) Mail the HAA to the followino address: or: Check here [~[. if hold for pick up. List contact person and day phone number below. S & S ENGINEERING 17034 F. agie RLver Loop koad No. 204 Ea_~le River. Alaska 9957".'/ TYPE OF RESIDENCE Single-Family ~ Number of Bedrooms 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. SEWAGE DISPOSAL Onsite~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page I of 2 72 025 (Rev 8/861 Fronl 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, Date Name of Firm Telephone Address $ & $ ENGINEERING 17034 Eagle Ri~=~ L~,;p .... ,,,, i~..~? c_~cl~, I~lver~ Alaska 99577 Approved for Approved z.'/~'4~ Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services /DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to 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. Page 2 of 2 72-o25 IRev 8/86) Back MUNICIPALITY OF ANCHORAGE (MOA) MuNiCIPALItY OF AHCHEI~H AUTHORITY APPROVAL (HAA) ENV~R©NMENTAL SERVICES DIVIS~ECKLIST - FEBRUARY 1984 264-4744 ' :~('II 1 Z~ !1~ O 8 Legal D..escription: ~ 0,,, R E C E I V E D Well Classification ~.~J ~'-~,¢'~-- If A, B, C, D.E~C. Approved (Y/N) Well Log Present ON) Date Completed ~ ~"~ Yield Total Depth _ ~ ~1 Cased to \.¢P {~ f Depth of Grouting -'-"----' Static Water Level _ Casing Height Above Ground Electrical Wiring in Conduit (~?N) Separation Distances from Well: To Septic/i ioldi~Tank on Lot To Nearest Edge of Absorption Field on/~ot To Nearest Public Sewer Line Pump Set At ~[L---., Sanitary Seal on Casing (~N) Depression Around Wellhead (Y/~, I [ t,~ ; On Adjoining Lots ~ ~ I~_ ~.[z~ I ; On Adjoining Lots \ ¢2~ IA~ To Nearest Public Sewer Cleanout/Manhole. To Nearest Sewer Service Line on Lot \"7~.c> I;;~ _ Water Sample Collected by ~ '~ ~-~ ~"-~:~¢~ ¢.bG_; Date ~,--'"~ ~4~ B. SEPTIC/HOL-'CI,~G TANK DATA Date Installed ~ -'tz~¢-~:~'~S ze \ ~-O_~) No. of Compartments Standpipes ¢~[~N) '~/ _ Air-tight Caps (:[~N) _ Depression over Tank (Y/~ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) r~/~ Separation Distances from Septic/l~Tank: TO Water-Supply Well To Property Line To Water Main/Service Line __ Course \ ~tE;:::>t "~ Comments "'// Foundation Cleanout (Y/d~) ~ Date Last Pumped \--~ ~ 'i~ /~- ; for Temporary Holding Tank Permit (Y/N) ~/'~ To Building Foundation TO Disposa Field "': ~ To Stream, Pond, Lake, Or Major Drainage Page 1 of 2 72 026 fRev 8/861 Front C. ABSORPTION FIELD DATA To Water-Supply Well To Building Foundation Lot _ To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Soils Rating in Absorption Strata Date Installed ~- \ ~ ~ ~::/"/'~' Length of Field ~ ')--.~ Width of Field ~" ~ Depth of Field ~,~ Gravel Bed Thickness Square Feet of Absorption Area ~ \,Cf- "~ Standpipes Present (~) Depression over Field (Y~)_ ~ __ Date of Last Adequacy Test __~. Results of Last Adequacy Test ~//5'"~1"'~~ ~ Separation Distance from Absorption Field: \ Lc:c~'J '~ To Property Line To Existing or Abandoned System on t ; On Adjoining Lots '""~'D~ "~:21"~ TO Cutbank /if present) ~//~ / Type of System Design Comments D. LIFT STATION ~ /,,~ Size in Gallon~ "Pump On" Level High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) ~..~Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Bequest ** I certify that I have checked, verified, or conformed to all MOA and H. AA guidelines in effect on the date of this inspection. Si~g~e~EN6]NEBI~NL6~ R~-~I---- Date // C~agleR[verL P ~No. 2~ MOANo. Eagle River~ Alaska 99577 ~ ~ O / O O ~ Receipt NO. Date of Payment Page 2 of 2 72 026 fRev 8/861 Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTrFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date GENERAL INFORMATION IMUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3 Block 1, Sue Tawn Estate'#2 Anchorage Location (address or directions) Mountain Road, Chugiak Area Recording District (b) Property Owner Machonne Forsi Telephone:Home 688-4409 Business 694-8700 Mailing Address 11823 01d Glenn Hwy, Suite 107 Eaqle River, Ak 99577 (c) Lending Institution Ak Conti nental Ban k Telephone 562-0880 Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the followin(~ address: or: Check here ~, if hold for pick up. List contact person and day phone number below. Machonne Forsi 694-8700 TYPE OF RESIDENCE Single-Family Number of Bedrooms WATER SUPPLY Individual Well7~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. SEWAGE DISPOSAL Onsite,~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 fRev 8/861 Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and es 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 flies 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 ~¢-~--~'/~'/ ~"¢/~.~ ~ ~7"/-S Telephone Address ¢~0 ~ ~¢¢-/"~/ ~ Approved for + bedrooms by / / Approved ~. Disapproved Conditional Terms of Conditional Approval Date ~/- .2 CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of ho mas and their lending institutions in order to 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. Page 2 of 2 72-025 fRev 8/861 Back WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4744 Legal Description: ~(/~' 'TAbJtJ I~-~1'/'~ ':~7-'' Well Classification '~kJ~T~- If A, B, C, D.E.C. Approved (Y/n) Well Log Present (Y/N) N/~ Date C, ompleted -~/~'~' Yield Total Depth ~ ~ 0 Cased to ~o~) Depth of Grouting Static Water Level ~ Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot l~c~ ~ ; On Adjoining Lots To Nearest Public Sewer Line ~Ot,.l(~ F~.ES~I' 'f' 100~ - To Nearest Public Sewer ~ ~ +100 CleanouVManhole kiOSk' gP~¢56td~ ~- od To Nearest Sewer Service Line on Lot Water Sample Collected by '"l~o ~01~1 ; Date Water Sample Test Results ~'~l'l~O~V' Comments ~' R-rT~-~ *~) bJ~,C, T~'~"" A~tO I~¢~T~, ~/~r'~¢U~' B. SEPTIC/HOLDING TANK DATA Date Installed (~/f~¢' Size {~ ~'OO,~C~ I No, of Compartments Standpipes (Y/N) ~¢~ ~,~') Air-tight Caps (Y/N) ~ _ Foundation Cleanout (Y/N) Depression over Tank (Y/N) ~0 _ Dat~ Las{ Pumped Pumping/Maintenance Contract on File (Y/N) ~ ; for Holding Tank High~Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water-Supply Well To Froperty Line To Water Main/Service Line Course Temporary Holding Tank Permit (Y/N) To Building Foundation _ 2.~' / TO Disposal Field ~ / To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026 IRev 8186/ Fro~t C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed '~/~ '~' Width of Field -~ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot *~'J0[,J ~' ~,E~,{'~' /¢D'Er~ Type of System Design Length of Field '"~'% / Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test . ,,ORA ltd /p-,/0'7 ' ' To Property Line To Existing or Abandoned System on ; On Adjoining Lots TO Water Main/Service Line '~ ~ ~ To Cutbank (if present) f4Op~- ~',~J,J-~'" To Stream/Pond/Lake/or Major Drainage Course __~0~d ~ ~(2~/~1' To Driveway, Parking Area, or Vehicle Storage Area ~O ~ Comments ~, /sr~T"f'/~J''{6'O IIJSf)E0-'~O~5 ~E'¢OI2'~-' LIFT~T~TIO N Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/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 that I)~ave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~(',~/~ ~¢2~- Date Company ,'~, ~-~ ¢~ MOA No. Receipt No. /~b (~ ./ Date of Payment Amount: $ /O0 ~ Page 2 of 2 72 026 fRev 81861 APPLI . NT FILLS OUT UPPER HA,. ONLY Phone Realty Co.& A~nt } ' ~ ' Phone Typ~ of Residence Single Family [] Other Water Supply Community [] Public Utility Sewer Disposal Public Utility [~ Holding Tank ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to th~,t date, give well depth (attach log if available). Year Individual Installed: ./ When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector ( ~.~1 ) APPROVED BEDROOMS *CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Y-"('~ ~ ~ ~.~.. Well to Tank Septic Tank Size 72.023 (3/8~)