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SKYLINE VIEW BLK 2 LT 10
5 kyl i*ne View Block 2 Lot 10 #051-192-17 UBMITA u,>pccum, nupui i_ yr Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http:/Avww.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSPI31268 PID Number: 051-192-17 ❑ New ❑✓ Upgrade Name: Diana & David Martinez ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 19374 Starflower Circle ❑ Other Phone Number of Bedrooms Sol[ Rating Total depth from original grade 3 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Subdivision Block Lot Skyline View 2 10 Ft. Fill added above original grade Grave length Township Range Section Ft. Ft. Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches I From Tank Field Tank Line Ftp Ft. Well 100.0 (E) N/A NIA 80.1 TANK ❑p Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1 1000Gal. Surface water 100+ (E) N/A N/A Material Number of compartments Lot Line 34.6 (E) N/A N/A Steel 2 NA Foundation21.2 (E) N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A Gal. Remarks Tank replace only. Pump on level at in. Pump of level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tankto drainfeld 3034 JR's Septic Pumping Drainfield CofMT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection o g/13/ t 13 Location and description dates: 2"a 3`tl 46 Top of Deck COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date 1H/ .teven . '�annomee 2 CE � Approved Date"Y u,>pccum, nupui i_ 7 /.,/ SEPTIC AREA `t .44 6 SEPTIC AREA WELL (E) 10' UTIL ESMT \ DRAIN FIELD (E) DCO _-- SEPTIC AREA SEPTIC AREA 5.0 M' COLLAPSED 1000g SEPTIC TANK 1 Zi I ABANDONED PER CODE \ I T2 INSTALLED NEW1000g SEPTIC TANK LOT 10 T1 / W/ DCO / CC A °� \ h B 3BR HOUSE SEPTIC AREA 100.0 \ WELL (E) '< SEPTIC AREA I WELL (E): 2 // I I cS I 9 WELL (E) STARFLOWER Fo o'o wo 1ELL (E) CIR / 3 z� z z lz ¢�W / 3 LLOV U U OU G Z 96A 92.0 81.8 S� NEW 10008 SEPTIC TANK NOTES: RECORD DRAWING PANNONE ENG SVC, LLC Date ,��OF q�gS`l1 12/30/13 P.O. BOX 100217 ANCHORAGE, AK 99510 .: PHONE (907) 272-8218 FAX (907) 272-8211gy+) Scale 49TH *// 1"=50' �..... .. ..:.. � NO SKYLINE VIEW, BLOCK 2, LOT 10 P.I.D..I.D. NO Steven' :'Pan'none' DIANA &DAVID MARTINEZ2-17 / SPERMIT NO. . CE 8149 �� 19374 STARFLOWER CIRCLE � c, OSP131268 PLAN CHUGIAK, AK 99567><�R2pFES50NP Sheet l�\�0 ��'� 2 OF 2 T7 4 T2 4 VABJ DCO 8 DV (E) 2 M1 (E) 6 M2 (E) 3 WELL (E) (E) 7 /.,/ SEPTIC AREA `t .44 6 SEPTIC AREA WELL (E) 10' UTIL ESMT \ DRAIN FIELD (E) DCO _-- SEPTIC AREA SEPTIC AREA 5.0 M' COLLAPSED 1000g SEPTIC TANK 1 Zi I ABANDONED PER CODE \ I T2 INSTALLED NEW1000g SEPTIC TANK LOT 10 T1 / W/ DCO / CC A °� \ h B 3BR HOUSE SEPTIC AREA 100.0 \ WELL (E) '< SEPTIC AREA I WELL (E): 2 // I I cS I 9 WELL (E) STARFLOWER Fo o'o wo 1ELL (E) CIR / 3 z� z z lz ¢�W / 3 LLOV U U OU G Z 96A 92.0 81.8 S� NEW 10008 SEPTIC TANK NOTES: RECORD DRAWING PANNONE ENG SVC, LLC Date ,��OF q�gS`l1 12/30/13 P.O. BOX 100217 ANCHORAGE, AK 99510 .: PHONE (907) 272-8218 FAX (907) 272-8211gy+) Scale 49TH *// 1"=50' �..... .. ..:.. � NO SKYLINE VIEW, BLOCK 2, LOT 10 P.I.D..I.D. NO Steven' :'Pan'none' DIANA &DAVID MARTINEZ2-17 / SPERMIT NO. . CE 8149 �� 19374 STARFLOWER CIRCLE � c, OSP131268 PLAN CHUGIAK, AK 99567><�R2pFES50NP Sheet l�\�0 ��'� 2 OF 2 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP131268 Tax Code Number: 05119217000 Work Type: Septic Permit Effective Dates: August 16, 2013 to August 16, 2014 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SKYLINE VIEW Site Legal Address: SKYLINE VIEW BLK 2 LT 10 G:1159 Owner/Address: MARTINEZ DIANA L & DAVID C PO BOX 672388 CHUGIAKAK 995672388 Site Mailing Address: 19374 STARFLOWER CIR, Chugiak Lot Size in Sq Ft: 13942 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: �` n_� Date: �l6 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-192-17 Property owner(s) Diana & David Martinez Mailing address P.O. Box 672388, Chugiak, AK 99567 Site address 19374 Starflower Cir Day phone Legal description (Sub'd., Block & Lot) Skyline View, Block 2, Lot 10 Legal description (Township, Range & Section) Lot Size 13,942 Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field ❑ Septic Tank ❑X Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑X (w/wo ADU) Upgrade [ADuplex (D) ❑ Renewal ElMultiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / 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: r1M Date of Payment: _ ?LIN!2115 Receipt Number: O11`�51aC, Permit No. Permit App_: Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@paneneak.com August 9, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Skyline View, Block 2, Lot 10 Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon septic tank be issued for this lot. The proposed system will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a three-bedroom house and is operating adequately for three bedrooms. The existing 1000 gallon septic tank has collapsed. The existing 1000 gallon tank will be abandoned per code. This lot is served by a private well that is over 100' from the septic system. The surrounding lots are also served by private wells that are over 100' from this system.. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 10 slopes from south to north at approximately 5% in the area of the tank replacement. The proposed installation will be located in the central portion of the lot next to the existing septic tank and absorption system. Mailing: P.Q. Box 100217, Anchorage, AK 9959.0-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 1/2 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 77 \ -Z/ t- Lt WELL (E) E) 3: 3ZF IS WELL (E) E) F SEPTIC AREA SEPTIC AREA P REA 4- 10' UTIL ESMT DRAIN FIELD (E) SEPTIC AREA SEPTIC AREA 5.0 LOT 10 g SEPTIC AREA AA Al 313R HOUSE 100.2 (E) �j :;F WELL (E SEPTIC AREA/ f/ I � 92 WELL (E) 3 3 STARFLOWER I g WELL (E) tL CIR 3 / WELLI(E) W W_� W NOTES: �NG SVC, UIC Date 8�9�13TANK REPLACEP.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 /�Cqp �y+(r �...... .. .... 'R"Pannone'%PERMIT PF.•. CE 8149 .;4?j �#c, `l>N........ Scale 1„=50' SKYLINE VIEW, BLOCK 2, LOT 10 DIANA &DAVID MARTINEZte've'n 19374 STARFLOWER CIRCLE P.I.D. NO 51-192-17 NO. OSPXXXXXX PLAN CHUGIAK, AK 99567 Sheet \\ ��` 1e0F i MUNICIPALITY OF ANCHORAGE �. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ':�>L_r=F- PHONE ❑ NEW CErrmmZ_y 2-I ER L ,�cj I154PGRADE MAILING ADDRESS CIO SSS �-Nc,cf�liz�r2lni� S2t� l�l�k �JZ, �t � LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS SEC- Well Absorption area Dwelling PERMIT NO. DISTANCE TO: Uy 1- � Manufacturer Material No. of compartments ��� 6 Liq. rapacity in gallons I F HOMEMADE: Inside length Width Liquid depth ® Y DISTANCE TO: Well Dwelling PERMIT NO. J __ Oz H Manufacturer Material Liquid capacity in gallons i�T DISTANCE TO: Well �bOt� Foundation d— Z� Nearest lot line ,� JD PERMIT NO. p 85-ofi& 4 Z No. of lines Length of each line Total length of lines Trench width _ Distance between lines �1A F cc - ` i 2-61 inches t F- Top of tile to finish grade Material beneath tile Tot effecttiiveabsorption area onarea —_�es, /� inches 12- Length Width Depth PERMIT NO. ui f7 4 I-- a. a: W Type of crib Crib diameter Crib depth Total effective absorption area vi DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J - W DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS T!ye_ 3y SOIL TEST RATING n; C(�J INSTALLER _ � M r_ 7-rWD G l REMARKS J/ i �ti$r Y i�ep• t n llp� a..�e o •.'1L a yA + a614borl M. Shafer e">cQ �. N1,C — APPROVE D TE LEGAL��Iy, �g+}� S`RFi�I gx�lp�N(�t �yy ,roc AIASKl� �IJJI� ZD �L'I�ti IVE_A g /Z-U13 IHev. 3/75)_-,' I pit - /2 -U1 3 it- PERMIT NO: DATE ISSUED: APPLICAN1": ADDRESS: CONTACT PHONE: ��0 IFR, G 3, ll::*":�, DEPARTMENT OF HEALTH AND ENVIRONMENT PROTECTION 825 L STR�ET, ANCHORAGE, AK 99501 264-4720 85O416 07/17/85 % S&S F"NGINEER TWEED EXCAVATING SRB 196.-X EAGLE RIVER, AK 99577 694~'979 LEGAL DESCRIP: SUBDIVISION; GKYLINE VIEW SECTION: 16 TQWNSHIP: 15N LOT SIZE: 12060 (SQ,FT. OR ACRES) MAX BEDROOMS: 3 F u:�) Lj,:, s<3R-��t LOT: 10 BLOCK: 2 RANGE": 1W Listed below are the options available to you in dc�signing yoHr cieptic system" Choose the ootion that best your site" -T' F-�7. F. -HE PA 0 V-1 E�% VE .1-3 11.4~ 13 Ph 1, gh. 11 DEPTHTO BOTTOM T. 4.0 4"0 4,0 GRAVEL DEPTH (FT.) 6.0 0"5 3.5 TOTAEPTH (FT^) 10"0 4,5 7"5 GRAVEL WIDTH (FT") 2,5 14"0 5.O GRAVEL LENGTH (FT^) 22"0 21: 28"0 GRAVEL VOLUME (CU"YDS") 13.3 14"6 20"8 TANK SIZE QGALS> 1,000"0 1,00O"0 ** SOIL RAT JNG MCL FT"/BR) 85 85 85 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS I certif,y that: 1" I am �amili�r wit� the requirem�nto �oP on~site sewers and as oet foPth by Mun0.c1pality of, (MDA) �nd thv State of' Al�ska. 2" I will install the system in with all MOA codes �nd regulations, and in compliance with the design criteriaof' this permit" 3" I will adhere to all MOA and State of A1aska require�ents �or th*� set back dislances any existing wellv ystem or public sewerage system on this or any adjacent or nearby lot" 4" I understandthat thig pepmit is valid for a maxim�m of 3 bedrooms and any enlargement will require an additional permit" . IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOH BUILDING CODES, THEN (1) A I PE N MUST BE'OBTAINED; (2) AG~BUILTG WILL NOT B INSPECTION REPORT; AND (3) THE �LECTHICAL ELECTRICIAN" SIGNED DATE: Vx INEER TWEED EXCAVATING ISSUED BY DATE: �\..\-1 SOILS LOG ��. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 �� 1 SOILS LOG — PERCOLATION TEST PERFORMED FOR:DATE PERFORMED:J� v / ` LEGAL DESCRIPTION: pQ � / SLOPE S TE PLA ( lay 2 9LTy 5A/J9 3 4 5 6 9 Go h /t s /z��G� 10 v , 11 WAS GROUND WATER S ENCOUNTERED? L O P 12 — IF. -,,YES, AT WHAT E DE(TH? 13 - P Reading Date Gross Time 14r Depth to Water Net Drop J S�6� ti Qyx a8 Q 16 " T., fih zfar c 17 S fl t, 18 19- 9 ,Reading Date Gross Time Net -rime Depth to Water Net Drop J S�6� ti Qyx a8 20 PERCOLATION RATE _(minutes/inch) TEST RUN BETWEEN - — GN b\ FT COMMENTS I X7 ;~'dQIfVE ERI�UCi 1G ER, ALASKA Mit PERFORMED BY: :PN. 0.0"174 CERTIFIED 72-008 (6/79) GREE%, ER ANCHORAGE AREA HOh.,UGH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME / n–ZLEGAL ING ADDRESS i�_c1�©LC.�,�~�Zeex' H0�p Cr�$r o7SLOCATION f GLMJDESCRIPTION SEPTIC TANK: DISTANCE Q I UMBER OF FROM WELL � MANUFACTURER �� MATERIAL COMPARTMENTS - INSIDE LENGTH _INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY( `) QLLONS. TILE DRAIN FIELD: � / TOTAL LENGTH DISTANCE FROM WELL �Q� /FOUNDATION / k[`-% _NEAREST LOT LINE_ Q (//_'OF LINES NUMBER OF LINES_ DISTANCE BETWEEN LINES _—TRENCH WIDTH"" IN. TOTAL EFFECTIVE ABSORPTION AREA Oq � � SQ. FT.LENGTH OF EACH LINE � f DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE 41 MATERIAL BENEATH TILE ?�IN. ABOVE TILE w WELL: TYPEJ_C•-AC CONSTRUCTION BUILDING FOUNDATION CESSPOOL G•••0PIM7 DISTANCES: INSTALLED BY: NEAREST LOT LINE OTHER SOURCES DISAPPROVED �/ I I SEWER LINE DEPTH: —��5h PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ -032 NEAREST SEPTIC SEWER LINE , TANK_ REMARKS DEPTH SEEPAGE SYSTEM– DISTANCE FROM: DIAGRAM 01= SYSTEM O - . ,PRI(x DATE WAPPR0VED r% a G.A.A. B. SUM //�. UUUKWE X wo Too L.1:Why 1:1 F7 Vol P41 C Cp it! Not IS IT� T DEPHRTMENT OF H ND ENVIRONMENTHL PROTECTI�N�L/r^/ /� VIP � 6~222i br � PERMIT NO ( 76917 ) HPPLICHNT'Ej, jU^ PO8OX ]51 CHUGIR �/� LOCHTION COLUMBIN LEGRL L10 BLK 2 SKYLINE VIEW S/D LOT SIZE 22000\SQURRE FEh� TYPE OF SOIL HBSORBTION SYSTEM IS� TRENCH MHXIMUM NUMBER OF BEDROOMS � ] SOIL RHTING (SQ FT/BR)z 85 THE REQUIRED SIZE OF THE SOIL H8SORPTION SYSTEM IS� �IH 141 oil -1 - 1-0 YR. too VIA IT! 07 Inv kip U., ����11� � Q SEE Q k -0 X FA? Kip ED,, YES IT 1100' , E A: 11, 1=1 Rho K YK;; . K: ::A !F�::o 11 5- .. 11:�� �)I�� �II..'11 (DI �:::11 :I[r -11- X 1:1 R41 YES FH 162 kip Q Kip Gs L A III F2 h?p ov-�, BHCKFILLING OF HNY SYSTEM WITHT FINHL INSPECTION HND HPPROVHL BY THIS DEPHRTMENT WILL BE SUBJECT TO PROSECUTION MINIMUM DISTRNCE BETWEEN R WELL HND HNY ON~SITE SEWHGE DISPOSHL SYSTEM IS 100 FEET FOR H PRIVHTE WFLL OR 200 FEET FOR H ['d WELL WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPHRTMENT WITHIN ]0 DHYS OF THE WELL COMPLETION SPECIFICHTIONS HND CONSTRUCTION DIHGRRMS HRE HVHILHBLE TO INSURE PROPER INSTHLLHTION 11 At: jj::::�: - C�:Il (DI P.-.11 I CERTIFY THHT 1� I HM FHMILIHR WITH THE REQUIREMENTS FOR ON�SITE SEWERS RND WELLS HS SET FORTH BY THE MI -ITA ICIPAL ITY OF ANCHORAGE. 2� I WILL INSTHLL THE SYSTEM IN HCCORDHNCE WITH THE CODES ]� I UNDERSTHND THHT THE ON~SITE SEWER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS SIGNED Jr L // / yv 0 Ef E GEL ECHNI CAL Ef DEVE_.JPMENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster Earl Ellis 694-2774 SO I L LIG 688-2280 Soils Et Foundations Land Development Performed for: Name: Tel. No. Mailing Address: Legal Description: Depth (feet) Soil Characteristics 0 1 `y 3 4 5- 6- 7 7 9. I 10 j 11 12 13 14 15 16 Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit Drain Field_ Comments: Performed by: Date: - J h,i 4 rveli is p`roducing gallons of water per hour.. " Set pump @ feet. INVOICE r ILLING INVOICE NO ): _ a. DATE SR `60X 668, K*ARD RD. " .1 ' PALMER, ��ALASKA 44645 r f YOUR P. o. NVMaER .. , � �P' TF#ONE 745`4071 �. , J ,��w/ TERMS ,....:;,_.Sub. WE'LL SALESMAN 'LOG INFTH T,` 0A8IN,. 1FORMATIO1 DEPTH tCASIN IN FT. FORMATION DRe1j CABIN FORMATION tr FT 1' --7f 101 201 ; 9-T 7r 102 ✓" ,�"- 202 $ - �. 108 _.,_. 8 4 104 Z 106 , 205 ._. ". �_ r sem,. $ 106 208 - a 107 207 - 208 $ 108209- 209 to _. .. ,110 10 210 :, 11 • 11z k 211 $ 112 12 212- 218 218 14 _114— .. 214 .:. .� 116 216 9 77 1 17 ,. . , ..., 118 218 < 17 117 217 1$ 118 218 , A - , 219 . O ' � ^ ""� 2q 220 1 121 221 122 — 222 8 123-228 � �64 it4 F m° :. :' 1 Z4 r 224 226 .,3 27 227 228 9 129 229----�-- 777 4 9 230 ssa 228 4:.184 ' 1aa d :T 185 285 t> $188 7�7 286 7 18? 237— d(4 ld$ P 280 t40 289 40 240. 41 •. 141 , $41 42 142 242 4d 4 148--248 c 44 x 1 44 244- 45-7 1146 -- 246 146 47 1 Al 1117,7777—,147 _ 247 7 248 4$ 149148 249 fi 60 250 .j> �.,.. $2 .. 161 25T 522— �` -252— 252 y' 6$ j 168 2sa .y 64 164 " 254 j: 4i6 lbb 265 jib l6R q--256- 256 6$ 156 258- 268 e ` 69 9- 159 168 , 266 6q ., " 160 leo 61 ' 181 261 62 162 262 6d 189 288 204- 84s6587 67- -266- 267 T 69 r-"" 189 268 ,-. ?0 _ 170 ' 268 270 S x _ _ 271 .: 72.— 1717 272 a t' 777 94 '.4,. 174 274 : 76 i 176 275 74 • 176 278 t 77 177 277 j � 7d 178 278 79 _ .�.:.; 80 -a's'h 180 28Q c 8} r,d9 162-282- 282 288 t r t# d 84, da A4 i 284 d6 86 � 285 s ` d7� 287 291288 lee 289 9 4' 190 AUX 290 j 92 ' 192 291 282 °t $4. 94 19{ _ _. _ t f 288 r4 „ 05L 186 284 N -... 15 =19'7�.., 295 ;� •, . J ee —267— 86 .. $d, 108 168 298 10 200 296 " - PI+FASE PAY FRAM THIS INVOICE f% (? �% •i Fant AMOUN r�.1 + r ; 9 MUNICIPALITY OF ANCHORAGE Development Services Department'�l Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 051-192-17 1. GENERAL INFORMATION Complete legal description Expiration Date: 14 - Z-0ZI SKYLINE VIEW BLK 2 LT 10 Location (site address) 19374 Starflower Cir Chugiak Current property owner(s) Mailing address Real estate agent MARTINEZ DIANA & DAVID PO Box 521604 Big Lake 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone _ AK 99652 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well 0 Private Septic F Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: tank to well, field to lot line Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. Date: Distance:97.3', 3.9' COSA Fee $_ -P I Z, jrO COV !D Waiver Fee $ S$.5 CO UID Date of Payment Receipt Number D a�`ioD COSA # 05G 2 01,55'6 Date of Payment Receipt Number Waiver # 0S 02.01062, 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Eklutna Engineering, LLC Phone 907.406.1058 Address 19162 Mountain Rd Chugiak AK 99567 a Engineer's Printed Name Curtis Townsend, PE Date ' C1 IJ o 2-:i 6. DSD SIGNATURE System #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms OF A , qS� 4®TH T--���� ....... ........ eaeee ty' CE I Flo PRO `, bedrooms, with the following stipulations: work �-c� \4,0 ! B �- Original Certificate Date: I o — I 1`7 — 2d The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory_ Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet Legal Description: SKYLINE VIEW BLK 2 LT 10 If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled 1977 Total depth 202 ft Cased to 202 ft Al Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) ' 12 in. Date of flow test for COSA 8/23/2020 Parcel ID: 051-192-17 Structure served by this system Well production at time of test 3.9 gpm Water storage tank volume—0— gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate 15.5 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑ Arsenic less than MRL (ND) Collected by Curtis Townsend Date of Sample 8/2312020 Static water level at beginning of test 74 ft. Comments well was scoped, hole found in casing at 17'. 4" liner was installed. nitrates tested 2nd time. B. TANK DATA Age of tank(s) 7 years Tank type/material septic Steel Measured operating fluid level in septic tank 51 ❑ Standpipes/foundation cleanout per record drawing Date of pumping Aug 31, 2020 D. ABSORPTION FIELD DATA Which system tested (date installed) 1977/1985 ❑ ALL standpipes present per record drawing Total measured depth from grade 6.678.8 ft (max) Measured depth to pipe invert from grade 4.2/4.3' ft (min) ❑ N/A – pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 2.4'/4.5 C. LIFT STATION ❑ Required maintenance comp Age of lift station y Lift station material Comment Adequacy test date 8/23/2020 Results Q Pass For 3 bedrooms Fluid depth prior to test 0/0 in Water added 4,342 gal New depth 0/0 in Elapsed time 0 - min ❑ Code -required soil cover over field Final fluid depth 0/0 in ❑ System presoaked Absorption rate ' 450 gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) _ date of test) Gallons introduced 2000 gallons If yes, enter date Comments/Deficiencies: water didn't present itself in the MT of the 1985 trench or the sump of the 1977 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' 97.3 Community Sewer Manhole/Cleanout > 100' ❑ Yes if No ft ❑✓ Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' F✓ Yes if No ft Absorption Field on Lot > 100' ❑✓ Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft Neighboring Absorption Fields > 100' Private Wells > 100' 0 Yes if No ft Animal Containment > 50' Yes if No ft ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' n Yes Manure/Animal Excreta Storage > 100' ft Community Sewer Main > 75' ❑✓ Yes if No ft M 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 ft Property Line > 5' /1 Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' Fv� Yes if No ft Private Wells > 100' 0 Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Water Service Line > 10' n Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ✓❑ Yes if No ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No 3.9 ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100' 0 Yes if No ft F. ENGINEER'S COMMENTS seeking waiver for the reduced separation distances G. ENGINEER'S CERTIFICATION l certify that ! have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet 6F A Tt;; .............. L 7 ....:.... . Date ° �;•�4 No. c ,-PRO EN011 EERS) Nitrate Advisory Certificate of On -Site Systems Approval # OSC201556 Subdivision: Skyline View Block 2 lot 10 A water sample revealed a nitrate concentration of 15.5 milligrams per liter (mg/Q. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. a � �, x Mailing /�tl�ress P O� Box 196650-* Anchorage, Alaska 99519 6650 * witiw muni org ASBUILT m I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. - I SE74ARD & ASSOCIATES LAND SURVEYING 694-082 SCALE: F A4 DATE: GRID: FB: Duane Mark: or LS - 6 8 Ar -7,9 • AT IZI vhlwwlt� DRAWN: -hh° Mun' d alky of Anchorage +fir I�r. .�1)rpartmenr P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 ® (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV201063 COSA#:OSC201556 Permit#: PID#: 051-192-17 Legal Description: SKYLINE VIEW BLK 2 LT 10 Engineer: Eklutna Engineering Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 97.0 feet. In addition, the field is approved to remain 3 feet from the property line This waiver approval applies to the existing septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ■............................................. ■ ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: 0 / Approved by: Name of Review **** VARIAN C E/WAIVER REVIEW **** Eklutna Engineering, LLC curtistownsend@gmail.com October 9, 2020 Subject: SKYLINE VIEW BLK 2 LT 10 Septic Tank to Well and field to lot line Waiver Request OSC201556 OSV201063 During a COSA inspection in September 2020, it was discovered that the septic tank on the subject property was 97.3' away from the water well. It was also discovered that the 1977 field is 3.9' away from the eastern property line. I am requesting a waiver for the reduced separation distances. The following justifications are provided for your consideration. Septic Tank to Well Justification The well on lot 10 was drilled to a depth of 202' in 1977. The static water level was at 74' in September 2020. Starting at a depth of 17' is a layer of hardpan. Water was found at 23', 35', 45' and 75'. When the well was drilled the casing was perforated at 34', 43, 71' and 82'. This hardpan alternates with other layers to the bottom of the well. The ground level at the water well is at higher elevation than the septic tank on the subject property. Should sewage overflow the septic tank, it would drain away from the western neighbor's well. Nitrate concentration was tested in August 2020 and found at a concentration of 16 mg/L. The well casing was scoped and a large hole was found at 17'. The well casing was sleeved with a 4" liner and bentonite was placed from just below the pitless to a depth of 54' depth. An additional nitrate sample was collected within a week of this repair and it tested at a concentration of 15.5 mg/L. The nitrate concentration reduced and it is expected that with time, the nitrate levels will further decrease. The septic tank is new as of 2013. Normal water levels are exhibited in the tank which means the tank is not leaking. Field to Property Line Justification The field in the northeast corner of lot 10 was installed in 1977. The sump for this field is 3.9' away from the eastern property line. The effective depth of this field is 6. Lot 11, to the east has a field located in the northwest corner of this lot. It was installed in 1977 and has an effective depth of 5'. The sump of this field is 22' away from the sump on lot 10. The distance between these two fields is at least twice the effective depth of either trench. Lot 11 has room to construct any future upgraded trench. For the above reasons, we request that the waiver be granted for the current situation. Sincerely, Curtis L. Townsend, P.E. eaoa as wee ............ ao®oa 'L'o ncJ 9��� • No. CE 1904' P.O. Box 670269 Chugiak, AK 99567 P: (907) 688-2759 F: (907) 688-2259 TO: Marina/ Curtis Townsend 19374 Starflower Circle Chugiak, AK 99567 Camera Inspection Report Date: 9-4-20 Large hole found at 17'. This is most likely the source of the high nitrates. 4" Liner was installed and bentonite placed with tremie tube to insure placement from bottom to top. MUNICIPALITY OF ANCHORAGE -7 ' L� • "� DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # C6 - 1c1 Q - 1-1 HAA # 1,, Q' L\ n Q °l 1. GENERAL INFORMATION Complete legal description Lot 10; Block 2; Skytine View Subd%vtiation Location (site address or directions) 19374 Stakcjtowen Ci)tcte Property owner Jim Kincaid Day phone 488-1793 Mailing address P.U. Box 80129 Faikbank6 AK 99708 Lending agency Mailing addres Day phone Agent Ratph Nobnega/ VISTA REAL ESTATE Day phone Address 4241 "B" S.ineet Ancholcage, AK 99503 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 562-6464 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rov.1/91) Front MOAN21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address 17034 Eagle Engineer's signature 6. DHHS SIGNATURE 2 Approved for / Disapproved. Conditional approval for Additional Comments Loop Road 204 bedrooms. Phone Date r bedrooms, with the following stipulations: State and Municipal Codes. There are nitrates present. It is suggested that a periodic testing ea«o-insure t, i�el_]-s con--.fnued suitab' ty. Nitrate concentration is 7.4 mg/l. EPA �I]�t loll i 111q/1. Via% ORMEN S���I'%l NLITIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 72-025 (Rev. 1/91) Back MOA #21 ® Municipality of Anchorage AiL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: -r- 10 L_ ?, S u,� e- Parcel I.D. \ (E�A SD A. Well Data Well type If A, B, or C, attach ADEC letter. ADEC water system number 46- Log present&N) Date completed a A S- 77 Driller Y'l o o� Total depth Zo z Cased to _/,6 ) b' f Casing height /;'- Sanitary seal CY)N) Wires properly protected CVN)� B. SEPTIC/HOLDING TANK DATA Date installed t 57q Tank size /0O0 Compartments 2 Cleanouts (TN) Foundation cleanout (y6N) s� Depression (YCN) High water alarm (Y/D&) Alarm tested (Y/N) Date of pumping - f3 -5 Pumper .754 Ge-�,rJ/eo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot _ i 9 5- ( On adjacent lots 44- 99 Foundation S/ F To property line /o t4- Absorption field S' Water main/service line k SI urface water/drainage lv a i 'A - \A \A 0C\,((Gp L kA - !i5 ' toe-"ro-p Ort AtiT.c-�T- iJfv5 t72((Le5o 72-026(3=)•Front /' / F 90 9-I�- ''F�,� (f-lrs /./J tt,�v CONTINUED ON BACK PAGE 0 e-rF. 1-, 7- FROM WELL LOG AT INSPECTION o Date of test --2 sem- -77 S -94- Q 0 Static water level y I/- 7 ¢ ¢ > Cp LU Well flow .� g.p.m. �• [ g.p.m. o � d , Pump levell i U!� a P- LLJ SEPARATION DISTANCES FROM WELL TO: Z 0LAC Septic/holding tank on lot `1S ; On adjacent lots 100 Absorption field on lot / oo ; On adjacent lots J/ Public sewer main Public sewer manhole/cleanout _ 2S (� S wer Sservice line Petroleum tank I" U -la - t3s WATER SAMPLE RESULTS: Coliform a Nitrate 114 OcI l , Other bacteria � Date of sample: - 3 -9 2f Collected by: S4 S (moi B. SEPTIC/HOLDING TANK DATA Date installed t 57q Tank size /0O0 Compartments 2 Cleanouts (TN) Foundation cleanout (y6N) s� Depression (YCN) High water alarm (Y/D&) Alarm tested (Y/N) Date of pumping - f3 -5 Pumper .754 Ge-�,rJ/eo SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot _ i 9 5- ( On adjacent lots 44- 99 Foundation S/ F To property line /o t4- Absorption field S' Water main/service line k SI urface water/drainage lv a i 'A - \A \A 0C\,((Gp L kA - !i5 ' toe-"ro-p Ort AtiT.c-�T- iJfv5 t72((Le5o 72-026(3=)•Front /' / F 90 9-I�- ''F�,� (f-lrs /./J tt,�v CONTINUED ON BACK PAGE 0 e-rF. 1-, 7- C. LIFT STATION Date installed Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE D. ABSORPTION FIELD DATA Manhole/Access (Y/N) Cycles STATION TO: On adjacent lots "Pump off" Level Surface water Date installed t S� Soil rating (GPD/Ft2) S S ��• System type T/L� Length -?3 a elf _Width _ 3 ' �,s Gravel thickness �' Total depth /19 i6 Total absorption area ,S88 i 7a�rALt— Cleanout present( N) Depression over field (Y¢!) Date of adequacy test— t -'6—i *f- Results,(j9D/fail) 7 6vxss for 3 Bedrooms Water level in absorption field before test 01 b ✓ After test 6 ° Peroxide treatment (past 12 months) (YO 11- 11- N If yes, give date ^�h SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /a o ' On adjacent lots /0;2- r _Property line /o' To building foundation l o To existing or abandoned system on lot L On adjacent lots -3 Cutbank `� Water main/service line /O _ Surface water lob � � Driveway, parking/vehicle storage area Sv'; Curtain drain '� 4 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified r confo ed to all MOA and HAA guidelines in effect o e dat of this, inspection. 7 Signature Engineer's Name 17 E 0 ' er oop Road No. 204 Date G HAA Fee $— Waiver Fee $ Date of Payment Date of Payment Receipt Number ��0 i� % k' Receipt Number 72-026 (3/93)' Back MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHOF117Y APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION I (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name`�_n_J_ _ Telephone: Home — �__ Business `v c/ ? 3 Applicant Address eoX �� �✓��_-� x.1_7 ___ — (c) Applicant ischeck one): Lending Institution El; Owner/builder E] ; Buyer E] ; Other5e(explain); (d) Lending Institutionr7�--AP "C Telephone Address (e) Real Estate Company and Agent ___J» 6-" Address Telephone— / L-0 (f) f6tait the HAA to the following address: 2. TYPE OF RESIDENCE Single-Familyo- Multi -Family El Other Number of Bedrooms _-3- 3. ._-3 3. WATER SUPPLY Individual Well Community E7 Public E7 i "7 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. OnsitA Public D Community 11 Holding Tank El 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 12-025(11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FIDE 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 Address Telephone -- Date 0-P 8e;,a ec .S'' ,57-C-6.7 <C(ce, d reV �F- yr-� C o {! J I t ! �. S`e"la -re C . lel niuF C. PJ. 6. DHEP APPROVAL, Approved for �z)bedrooms by Approved — /` Disapproved Terms of Conditional Approval Conditional CAUTION 'pogo j • F. r{i i, 4090 '"gineer s��e'ci1�-+ Pa tori A. Shafw No. 7487•- � boo `-D go Oa ve Va° pR01:r S�lt�i F Date 'rhe Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending Institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025111/84) N0 -0-W G G\Q OF �P eRpj� �NJO�oNM�N �,�GJ o ®e MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST -FEBRUARY 1984 /J M L 264-4720 — �— Legal De cription: L- ! O B 2 _fit �G.✓ !r/L7 6i 1 A! W :5' !7 A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield Total Depth Cased to Depth of Grouting Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on CasinON )�S Electrical Wiring in Condui (Y/ ) E S Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample "fest Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes (Y/N) Depression over Tank (Y/N) Size ; On Adjoining Lots On Adjoining Lots _ To Nearest Public Sewer To Nearest Sewer Service Line on Lot Date Co�,O/e See d X17 ///-i4 Air -tight Caps (Y/N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well To Property Line To Water Main/Service Line Course No. of Compartments 611 14p, s - Foundation Cleanout (Y/N) Date Last Pumped ;for Temporary Holding Tank Permit (Y/N) To Building Foundation - To [Disposal Field I To Stream, Pond, Lake, or Major Drainage Comments- ff="9a 4F: /F 71G TSg A./ 4,f, Lu '+. � P_ Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 8S //�T Type of System Design 2 0 G N Date Installed .% LZ O lej r < � Length of Field �- 6 C. I Width of Field 3 � Depth of Field i0 Square Feet of Absorption Area Depression over Field (Y(9_ Results of Last Adequacy Test 3/2 Gravel Bed Thickness 72- " — Standpipes Presen(Y ) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well /QD r -/- To Property Line To Building Foundation 30 f To Existing or Abandoned System on Lot 0 — ; On Adjoining Lots To Water Main/Service Line /0 To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course /J 0 -,/ To Driveway, Parking Area, or Vehicle Storage Area Comments 7 -"IJ Zr "tJ t-it7�rwt, D Q FXId'7/�� X7-, v_ - D. LIFT STATION Date Installed Size in Gallons Dimensions Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) L — Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date 7 �Z.&S- $RD !9133€ --7 CompaY,t�t� ti�pp11�FR_A1A�L�IjA�/�Bq9(K(]�i>I 9rJ57i MOA No. SS UO _ 3 K.` A� '�uq�� V0. OWN!) - E7,F�a{�Atl ea96eao Ya�V t Receipt No. Date of Payment A771 ', e ik 4 �� �AFi� 9 OC99a 0 Amount: $ ��' Page 2 of 2 72-026 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH Lo CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY Q l J 264-4720 0 Application Date June 1l+, 1985 _ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 10, Bk 2, Skyline View Subd.; Sec. 16, T15N, RIM, S.K. Location (address or directions) NI -1N Columbine ( Chugach id{) (b) Applicant Name Fed. Nai;ioal Mortf;age hT p9ione: Home NSA' Business 6942300 Applicant Address c/o Century 21 Sleeper, Attn: Jeanne Mandell, P.O. 130x 2117,7 Eaagle River 1 l J ! ( --- (c) Applicant is (check one): Lending Institution U; Owner/builder 0 ; Buyer © ; Other © (explain); Fed. National Mortgage Assn. 694-2300 (d) I -ending Institution ___ _— — Telephone Address cjo Century 21 Sleeper, Attn; Jeanne Mandell, P.O. Box 21.17, Ea . -le River, AK (e) Real Estate Company and Agent Century 21 Sleeper, Attn: Jeanne Mandell Address 9-- Address P.O. Box. 21.17, Plaza 7 {/606, Eagle River AK 99577 Telephone 6q4-2300 — — -- — -- (f) Mail the HAA to the following address: Hold for pickup 2. TYPE OF RESIDENCE Single -Family Iii: Multi -Family E) Other Number of Bedrooms Three 3. WATER SUPPLY Individual Well ID Community 0 Public 0 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 0 Public E Community E) Holding Tank 0 Note: If community well system, must have written confirmation from the Slate Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11 e4) A 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 Alaska Soi:L Te.st:ing & Engineering 561 71�5� Telephone T s— Address _6.100 A street, Anchorage, AK 99502 Date 6`.L4 -8y Note upgrade requi.rements'. 6. DHEP APPROVA Approved for �'_ bedrooms by Approved Termp of Conditional Approvals _ "sem" L fZ1eGi U-1'1�--`�-CAS--�� •-zr��J �) i_p Gam.,, J} �,� Conditional Seal Date _ ) CAUTION The Municipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 A. WELL DATA Well Classification Private MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HOPICIPALITY OF ANCHORAGIz DITT, OF HEALTH & CHECKLIST - FEBRUARY 1984 C•NVIRONMENTAL PROTECTION 264-4720 Lot: 1CZ,;; �C 1241 ine View Subd. ; Legal Description: Sec. 1.6, T15N RIM S.M. RECEIVED If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Y Date Completed _ 2—�5-77 Yield 3 gpm (Ref. Comm. _t) 202 ft. 202 (Ref. N/A CBepthA Total Depth Cased to Grouting Static Water Level 74 ft. Pump Set At 195 ft. Casing Height Above Ground 14 inches Sanitary Seal on Casing (Y/N) N Requires Upgrade Electrical Wiring in Conduit (Y/N) N Requires Upgrarfepression Around Wellhead (Y/N) N Separation Distances from Well: To Septic/Holding Tank on Lot 95' Ref. ADEC Waiver atta&�efidjoining Lots 123 ft. To Nearest Edge of Absorption Field on Lot 1-05 ft. ; On Adjoining Lots .123 ft. To Nearest Public Sewer Line 1.00+ ft. To Nearest Public Sewer Cleanout/Manhole 100+ ft. To Nearest Sewer Service Line on Lot 30+ ft. Water Sample Collected by "'lark Holum, P.L. ; Date 6-6-85 Water Sample Test Results Satisfactory Comments 1) Well yield confirmed at 450 gal/day per 4 hour drawdown test 6-5-85. 2)Perforated casing at 34', 431, 71' & 821. Ref. ADEC waiver attached. 3) Well seal & conduit requires repair. SEPTIC/MOLDING TANK DATA Date Installed 7-27-77 Size 1000 gal. No. of Compartments 2 _ Standpipes (Y/N) Y Air -tight Caps (Y/N) N Ref Comm 1<oundation Cleanout (Y/N) y Depression over Tank (Y/N) N Date Last Pumped 6--6-85 Pumping/Maintenance Contract on File (Y/N) N/A ; for Holding Tank High -Water Alarm (Y/N) N/A Temporary Holding Tank Permit (Y/N) N/A; Separation Distances from Septic/Holding Tank To Water -Supply Well 97' Ref. Comm 2 To Property Line 20 ft. To Water Main/Service Line 10+ ft. Course 100+ ft. Comments Page 1 of 2 72-026(11/84) To Building Foundation 10+ ft. To Disposal Field 10+ ft. To Stream, Pond, Lake, or Major Drainage 1)Septic tank cap requires repair 2) Refer ADEC waiver for separation distance C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed 7-27-V7 Width of Field 23 -ft' 85 ft2/bdrrn (Soil. ioit,pe of System Design — Length of Field 23 ft - 36 inches Depth of Field _ 10 ft. Gravel Bed Thickness 6 ft. Deep trench Square Feet of Absorption Area 276 ft2 Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test 6/5m-9/85 Results of Last Adequacy Test _Unsatisfactory for 3 bdrrn house. Absorption rate is approx. Separation Distance from Absorption Field: 300 gafday. Absorption trench to be replaced. To Water -Supply Well 105 ft. To Property Line — 3 ft (Trecnh to be replaced) To Building Foundation 20+ f t. To Existing or Abandoned System on Lot N/A — ; On Adjoining Lots 23 ft. To Water Main/Service Line 20+ ft. To Cutbank (if present) __ N/A To Stream/Pond/Lake/or Major Drainage Course 100+ ft. To Driveway, Parking Area, or Vehicle Storage Area 20 ft. Comments laxisting trench to be replaced due to inadequate capacity. D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments N/A 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 Request ** I certify that II have the ke ver d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed _///��GJ�Date 6-14-85 CompanyAk Soil Testing & EngrIVIOA No. ST 85-260 Receipt No. Date of Payment Amount: $ Page 2 of 2 72-026 (11184) Conclusion: The absorption rate of the trench is ap which is unsatisfactory for the t Performed by: Mark Holum, P.L. 6T 85--26o gal./day, r r o,� s e t' t, MARK HOLUM CE 5734 ,'. "OFE$1^.•t� smFi illi ALASKA SOIL TESTING AND ENGINEERING 6100 A Street, Anchorage, Alaska 99502 (907) 561-7453 hn(J `IICIPALIrY Or ANCI; CkAG D[P1'. OP HLACfii li F' IYiIiON,vJE,Nif',L PdCf[CTION Adequacy Test Location: Lot 10, }3k 2, Skyline View Subd. f j/ [Y C `type. Septic Tank and Trench ^ ±. I V pJ Address: Columbine St., Chugach Client: Century 21, Sleeper Date Time ttivantity of Depth Below Depth Below Grade Slater Added to Grade of hater of Water Level Trench bevel in '.french in Septic Tank (Gal.) (In.) (In.) 6-5-85 1.1:26 am 0 61. 1/2-(0106truct- 59 3/4 11:46 35 50 1./2 ed C.o.) 59 1/2 1.:00 pm 147 " 59 3/4 2:00 232 3:00 331 50 3/8 3,50 450 4:00 " 6-6-85 1.:15 Pm11 57 3/4 4:10 0 58 58 3/4 4:25 45o 50.1/2 " 4:31 1000 50 3/4 " 4:47 " 51 1-/2 " 6-7-85 2:32 pm " 64— (Obstruct- 11.1 (Pumped tank) 6--8-85 8:54 am 0 it ed (:.O.) IT 9:24 400 50 1./2 " 9:30 750 49 1/2 It Q: 36 17.00 it " 9:45 1400 3 " 9:53 44 " 10:13 " 44 1/4 " 1.1.:40 n 1+5 1/1-1 n 2:12 pm " 46 1./8 " 5:�7 46 7/8 T 9:02 47 1/2 " 6-9-•85 10:13 am " 48 3/8 " Comments: The trench standpipe is obstructed by sludge at a depth of approximately 60 inches. The septic: system was notin use for approximately three months prior to testing. Conclusion: The absorption rate of the trench is ap which is unsatisfactory for the t Performed by: Mark Holum, P.L. 6T 85--26o gal./day, r r o,� s e t' t, MARK HOLUM CE 5734 ,'. "OFE$1^.•t� smFi MISS ALASKA SOIL TESTING AND ENGINEERING 6100 A Street, Anchorage, Alaska 99502 (907) 561-7453 June 1.4 , 1985 Municipality of Anchorage Department of Health and Environmental. Protection Division of Environmental health 825 L Street Anchorage, iUE 99501- Subject: Applicatio for Conditional Approval Gentlemen: PAUNIC1PALITY OF A;VCIIOk /I;cO P7. rOF HEALTH jjwal nrne,�FAL pR,, 'R1 CI ION :(J. 19'� Lot 10, Block 2, Skyline View Subdivision (Chugach, AK) Attached please find a request for a conditional approval for the subject property. Items which are currently deficient and which require upgrading include: 1) Absorption trench; 2) Well Seal; j) Septic tank cap. A waiver has been granted my ADEC for the well and the septic tank location. A copy of the waiver is attached. A conditional approval is requested. since the house is currently unoccupied and is owned by an out-of-state financ-Lal :institution. The conditional approval is intended to document: those items which need upgrading and to allow the financial institution to select the most efficient method of upgrading the deficiencies. Please call if I may provide adaitional. information. Very truly yours, ALASKA 601L TESTING AND ENGBEE RING Mark Holum, P.E. Manager 1 BILL SHEFFIELD, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION / ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 June 14, 1985 Iv1UfyICIPAi.IiY OF ANCIIORHGL DEPT. OF HEALR-f rff`/IRONMENi��,� PRCrEC77O1v Alaska Soil Testing & Engineering 6100 "A" Street ( i 1981 Anchorage, Alaska 99502 ff SUBJECT: Waiver Horizontal Separation between IJell and Septic C V Tank, Lot 10, Block 2, Skyline Subdivision, Eagle River, Alaska (8521 -WA -182) Dear Sir: The Department has reviewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 95 feet on the subject property for a 3 bedroom single family residence only. However, the proposed work on the absorption will need to be reviewed by the Municipality, Department of Health and Evironmental Protection. Sincerely, L teven Eng. District Engineer SWE/msm Time APPLIC NT PILLS OUT UPPER HAL ONLY Prope,ty-Owner ("�� ., �.., /% _ - ; i./�;., / Phone Date Inspector Inspector Mailing Address/�(:� c' i� -->.�i --! 'f�., Zip Code Field Notes: C. Gh '0 Buyer iJy.l:./ -'j _ x /541 ., .,...,,, Address Address 'CONDITIONS OF APPROVAL Zip Code ( ) DISAPPROVED Lending Institution �.`:! �q ,�. �;. �„ /�,,..,, / ( ) CONDITIONAL APPROVAL' DATE BY: Phone Soils RatingDate Sewer Installed Well To Absorption Area Well Log Received Address _. _ �, �- �, _ _ / Zip Code , Well to Tank Realty Co. & Agent Phone Address Zip Code Legal Description-r_y.._- �•z� /l(J ;� /,,•% ,2 .i:� L� /:,.c (�.� ,:� .�",• /, [�. a-�,�%i<:J Street Location (:"-,,... �_ "-... �. �- ZC. Type of Residence Single Family ❑ Multiple Family No. of Bedrooms__ ❑ Other Water Supply 6� Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. �j Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal Individual Year Individual Installed: Public Utility When Connected to Public Utility: ❑ Holding 'rank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Dale Date Date Inspector Inspector Inspoctor Inspector Field Notes: C. Gh '0 AUG 2 9 1983 Q� G %tiG x /541 ., .,...,,, (3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Ellvi 10: I,,, ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE BY: Soils RatingDate Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size ' -_ Well to Tank 72023 PW) 5. LEGAL DESCRIPTIO DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME r SINGLE FAMILY ❑ Two ❑ Five DATE �j DATE DATE 7I Xl INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR INSPECTO INSPECTOR depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM nF ANCHOP.AGC ,6 INDIVIDUAL/ON-SITE**YEAR iFlRhllTV OF HEJH & MUNICIPALITY OF ANCHORAGE HEALTH & ENVIRONMENTAL PROTECTION ppIl��lVV��RgDppEPNNT. MFNTAL pIOf-CTION DEPARTMENT OF 825 L Street - Anchorage, Alaska 99501 MICR 2 7 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264.4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE MAILING A KESSAz /J�/o ��� �/�!�L� iC./�/XCJ PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILI G ADDR S o 5 -el- w 3. LENDING INSTITUTION , P//HH/ONE MAILING /ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTIO 722 STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ One ❑ Four ❑ Other SINGLE FAMILY ❑ Two ❑ Five ❑ MULTIPLE FAMILY Three ❑ Six 7. WATER SUPPLY Xl INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM ,6 INDIVIDUAL/ON-SITE**YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. a1 17 72-010 (Rev. 0/79) V I .�J 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY NUMBER OF BEDROOMS 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY ❑ ONE ❑ TWO ❑ THREE ❑ FIVE ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified _ PERMIT NUMBER DATE INSTALLED INSTALLER SOILS RATING ❑Septic Tank or ❑ Holding Tank Size: ICW If Tank is homemade give dimensions: _ TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELL TO: Septic/Holding Tank A sorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line - 5. COMMENTS APPROVED FOR � BEDROOMS L (letter musLaccoy ificate) EJ DISAPPROVED ❑ CONDITIONAL Ajt3V DATE .�J 72-010 (Rev. 6/79)