HomeMy WebLinkAboutOVERLOOK ESTATES BLK 2 LT 4Overlook
states
lock 2
Lot 4
068-041
-10
Municipality of Anchorage Page
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: ~L~ °l ~:~ .~Jr'7 PID Number: ~ ~O~ I Ic~.
~leme: Wastewater System: ~New ~ Upgrade
~: ~ ABSORPTION FIELD
No. of Bedrooms: ~eepTrench ~ Shallow Trench ~ Bed ~ Mound ~ Other
Soil Rating: ] ~ ~ Total Depth from original grade:
LEGAL DESCRIPTION ~.~s~.
Subdivision: Depth to pipe bottom from original grade: Gravel dept~eneath pipe
WELL: ~ New ~ Upgrade Gravel~ ~[~f~ ~ Ft. ~ ] ~ ~ Ft.
Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material:
P~mp 8et al: C~in~ Hei~hl Above Ground:
~ Material: ~umber of ~omps~ment~:
Surface
Lot ' I ~/~ V/~ ~Z'~I Size in gallons: IManufacturer:
Drain
BENCH MARK
Locetion and Description:
Assumed Elevation:
Reviewed and approved by: ate:
72-O13 (1/91) MOA 25
Pern~i~ No. ~Y~-~ ~/~/~7 Page '/ of_
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 ·~ Anchorage, Alaska 99519-6650 · Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: .
PID No.:
LBT 3
BLBCK ~
VACANT
32' LI
1000 G^~
TANK
LBT 4
SLBCK ~
HDUS£
VACANT
SI'B(
- ]}RI VE'w'AY
K 2
SCALE~II' = 60'
~ ! ~'""~....~"~' Sa" ~ i [] - TEST HOLE
ELEVATIDNS
(NOT TO,SCALE)
~ TABLE LE~[L
72-013 A (2/91) MOA 25
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
P.O. BOX 196650, 825 "L" STREET, ROOM 502
ANCHORAGE, ALASKA 99519-6650
PAGE 1 OF
ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW910147
DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES
OWNER NAME:EAGLE VENTURES
OWNER ADDRESS:PO BOX 7718228
EAGLE RIVER, AK 99577
DATE ISSUED: 6/11/91
EXPIRATION DATE: 6/11/92
PARCEL ID:06804110
LEGAL DESCRIPTION: OVERLOOK ESTATES BLK 2 LT 4
SEC 25, T14N, R1W, SM
LOT SIZE: 52762 (SQ. FT.)
NUMBER OF BEDROOMS: 3 THIS PERMIT: 3
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD / WELL SYSTEM
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 FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED BY:
ISSUED BY:
6-34-?/
Louis Butera, P.E.
Registered Civil Engineer
June 5, 1991
John Smith, P.E.
Manager, On-Site Services
Municipality of Anchorage
P.O. Box 196650
Anchorage, AK 99519
Re: Lot 4, Block 2, Overlook Estates
Dear Mr. Smith,
The proposed septic upgrade will have very limited impact On adjacent properties for the
following reasons:
Reserve space is adequate, due to soil absorption capacity.
adequate, ground water is not a problem.
4. Drainage will not be effected by septic system installation.
If you have any questions please call our office at 694-5195.
The area has large lots allowing sufficient room for septic sites.
Immediate neighboring lots do not have septic systems or wells in place.
Soils are very
Sincerely,
Louis Butera, P.E.
P.O. Box 773294 · Eagle River, Alaska 99577 · Te}ephone (907) 694-5195 · Fax (907) 694-3297
EAGLE RIVER
ENGINEERING SERVICES
P. O. Box 773294
EAGLE RIVER, ALASKA 99577
Phone 694-5195
SHEET NO.
CALCULATED BY
CHECKED BY--
SCALE_
OF /
DATE___
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
PERFORMED FOR: ~_~e_
LEGAL DESCRIPTION:
DATE PERFORMED: ~'~/,cr'/?'i,
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
SLOPE SITE PLAN
17
18
19
20-
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DEPTH?
COMMENTS
Gross Net Depth to Net
Reading Date Time Time Water Drop
/ ~/~/~' ~;~ '~ ~.~ ~ '- ~ ~ <"
5- 0'/*/9, :~ .' 5' / //, / ,--,,,, a ' - 3 '-'~-" ~
PERCOLATION RATE ~ ~ (minutes/inch)
TEST RUN BETWEEN
FT AND ~ FT
PERFORMED BY:
72-008 (6179)
Eagle River Engineering Servic0s
P. 0. u0x 173294
Eagle Rive~ Al( 99577
694-5195
CERTIFIED BY:
DATE:
sPECIFICATIONS FOR ON-SITE SEPTIC SYSTEM
LEGAL: LOT 4, BLOCK 2, OVERLOOK ESTATES
A. GENERAL
The well and septic plan are for a single family residence only.
The drawing and or site plan shall be a part of this specification.
All materials and workmanship shall meet the Anchorage Department of Health
and State Department of Environmental Conservation requirements.
All soil tests are advisory to the design and are to be verified or modified in the
field by the engineer.
All excavations and depths are advisory and are to he verified or modified in the
field by the contractor to meet Municipality of Anchorage, Department of
Environmental Conservation requirements.
It is the responsibility of the owner to obtain all necessary permits or easements
and to locate any adjacent multi-family wells.
The excavation is to be exactly in the area shown on the site plan, any deviation
requires engineer approval.
It is always recommended that a surveyor locate the nearest lot line position and
the location of any easements.
B. Trench
1. The trench is to follow the natural land contour to maintain uniform total depth
of the trench bottom.
2. The bottom of the trench shall be level, plus or minus 1.5".
3. The total depth of the trench excavation is not to exceed 10' at any point.
4. The trench gravel is to be covered with typar fabric material.
5. Soil or combination of soil and extruded board insulation to a depth of 3' or
equivalent is to be placed over the leachfield.
6. The area over the trench is to be finish graded to prevent ponding of surface water
runoff.
8. The septic tank and leachfield must not be closer than 100' to any existing private
well, 150' to any Class "C" well, or 200 feet to any community well.
RECOMMENDED LEACI-IFIELD DIMENSIONS:
TOTAL DEPTH = 10' GRAVEL DEPTH = 6" TRENCH LENGTH = 31.25'
TRENCH WIDTH = 3' SOIL RATING = 1.2 GPD/FT2 BEDROOM CAPACITY = 3
SEPTIC TANK SIZE = 1,000 GALLONS
Twenty-four (24) hours required for all inspections.~,%.~,, ,.
~'~ '-" '
~ .... ~ 89° 49' 57~ E
139~89~
LBT 3 ~ LEIT 4
BL~CK ~ ~ BLBCK ~
~ ~ VACANT
/ ~ '~- ~/,o0~ ...... ~ . I
/ ~ ~ ~ e - MONITOR TUBE
k. ~ ....~UN~ h~,, ~ -~ - WELL
NO KNOWN CURTAIN DRAINS EASEMEN
S E PT I C S IT E P LA N
LEGAL: LOT 4, BLOCK 2, OVERLOOK ESTATES
OWNER' EAGLE VENTURES
~ONTRACTOR: N/A
JOB ~ 91-057~ DATE: 06/05/91~ SCALE 1" = 60'
P.O. ~o~ 773294 ·
EAGLE RIVER, AK. 99577
(907) 694-5195 FAX: (907) 694-3297
LEGAL DESCl;
PL4NS
MUNICIPALITY OF ANCHORAGE
•
y �4
Development Services Department Phone: 907-343-7904
On-Site Water & Wastewater Section Fax: 907-343-7997
Certificate of On-Site Systems Approval
Parcel I.D. 068-041-10 Expiration Date: `—� ( ��
1. GENERAL INFORMATION
Complete legal description Overlook Estates, Block 2, Lot 4
Location (site address) 27427 Paramount Drive Eagle River, AK
Current property owner(s) Timothy & Mary Coe Day phone (203) 583-2203
Mailing address 27427 Paramount Drive, Eagle River, AK 99577
Real estate agent Steve Sharp Day phone (907) 891-3454
2. TYPE OF DWELLING:
H Single Family (w/wo ADU)
LJ Duplex
Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Private Well 0 Private Septic
Water Storage Holding Tank n
Community Well Community n
Public Water System LJ Public Sewer E
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ SSOII Waiver Fee $
Date of Payment (o[14l tq Date of Payment
Receipt Number 04153f02 D Receipt Number
COSA# Q 5 C tQ t23f Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based
on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On-Site staff may visit the site to verify the information submitted.
Name of Firm Forge Engineering Phone 907-522-7773
Address 1399 W. 34th Ave Suite 101, Anchorage AK 99503
Engineer's Printed Name Michael E. Anderson, P.E. Date 6/13/19
+!PA *, ...."N;;1���;•i
6. DSD SIGNATURE i' '� Npir 11Nre •
X. System #1 Approved for 3 bedrooms ���',s MICHAEL E ANDERSON.
♦. -cr,�'... Na. CE-4381 s'•_=
System #2 Approved for bedrooms •� rF ,,,,.........6i13/19 .0° '•
,. ..
Disapproved
••(4),%.,
+.e.tu�ES;;u i
Conditional approval for bedrooms, with the following stipulations:
lk l�.�TY(OFrr�I(
`� ON-SITF r),
WATER
AND mr
'�P,RpEWA rER o
GRAM
r0 6`�
Q ,.
ii
�) f l l l '1Vt '
))))
j"'
�fy; �7
t.-.- �___�G Original Certificate Date: (p-2- l---1
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 1 a-vt- � AO(th.CO7
COSA Checklist blue sheet
COSA Checklist
Legal Description: Overlook Estates Block 2 Lot 4 Parcel ID: 068-041-10
If more than 1 septic system on lot: COSA Checklist# of Structure served by this system
A. WELL DATA
❑■ Well log is filed with Onsite (or attached) Well production at time of test 7.5 gpm
Date drilled 6/91 Water storage tank volume NA gallons
Total depth 150 ft Well disinfected for coliform test? ❑ Yes % No
Cased to 124.8 ft ❑ Coliform bacteria is Negative
❑ Sanitary seal is functioning correctly Nitrate 3.23 mg/L ❑ Nitrate less than MRL (ND)
❑Wires are properly protected Arsenic ug/L ❑■ Arsenic less than MRL (ND)
Casing height(above ground) —24* in. Collected by Forge Engineering
Date of flow test for COSA 6/10/19 Date of Sample 6/11/19
Static water level at beginning of test 86 ft.
Comments Well casing is in a island planters box.It is flush with the soils,but the box is about 24"above grade.Approved previously.
B. TANK DATA C. LIFT STATION
Age of tank(s) 28 years ❑ Required maintenance completed
Tank type/material Septic/Steel Age of lift station years
Measured operating fluid level in septic tank 51.5 Lift station material
El Standpipes/foundation cleanout per record drawing Comments:
Date of pumping 6/19/19 JRs Septic Pumping
D. ABSORPTION FIELD DATA Deep Trench
Which system tested (date installed) 6/24/91 Adequacy test date 6/10/19
❑ALL standpipes present per record drawing Results ['Pass For 3 bedrooms
Total measured depth from grade 13.3 ft(max) Fluid depth prior to test 0 in
Measured depth to pipe invert from grade 6.7 ft(min) Water added 1,216 gal
El N/A—pressurized field
New depth in
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective Elapsed time 160 min
ElCode-requiredsoil cover over field Final fluid depth 0 in
Absorption rate >450 gpd
❑ System presoaked
(Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) None
date of test) If yes, enter date
Gallons introduced gallons
Comments/Deficiencies:
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' Community Sewer Manhole/Cleanout> 100'
0 Yes if No ft p✓ Yes if No ft
Neighboring Tank > 100' 0✓ Yes if No ft Private Sewer/Septic Line >25' 0✓ Yes if No ft
Absorption Field on Lot> 100' ✓�Yes if No ft Holding Tank > 100' ❑✓ Yes if No ft
Neighboring Absorption Fields > 100' Animal Containment>50' 0 Yes if No ft
✓0 Yes if No ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75' 0 Yes if No ft 0 Yes if No ft
From Septic/Holding Tank on Lot to: (Please enter distances if less than required)
Building Foundations > 10' 0 Yes if No ft Surface Water> 100' 0 Yes if No ft
Property Line > 5' 0 Yes if No ft Wells on Adjacent Lots:
Absorption Field > 5' 0✓ Yes if No ft Private Wells > 100' 0 Yes if No ft
Water Main > 10' ✓0 Yes if No ft Community Wells > 200' 0 Yes if No ft
Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below
From Absorption Field on Lot to: (Please enter distances if less than required)
Building Foundation > 10' p✓ Yes if No ft If absorption field is under driveway comment below
Property Line > 10' 0 Yes if No ft Wells on Adjacent Lots:
Water Main > 10' 0 Yes if No ft Private Wells > 100' ElYes if No ft
Water Service Line > 10' 0 Yes if No ft Community Wells> 200' 12 Yes if No ft
Surface Water> 100' 0 Yes if No ft
F. ENGINEER'S COMMENTS
G. ENGINEER'S CERTIFICATION ..4voi OF Alii_
I certify that/have determined through field inspections and review ��'` . �.....•...;q�q •�.
6') yy1
of Municipal records that the above systems are in conformance with :•
MOA COSAguidelines in effect on this date. •
i 4s 49th \"0,0
`�n MICHAEL E. ANDERSON• :
�.u. 6�,. No. CE-4381 ;•�'_=
♦ v, ••.. 6/1 4/1 9 �c� •
COSA Checklist yellow sheet ♦�4��p� P� ��
.� ROFESSt 44.
MUNICIPALITY OF ANCHORAGE
•
DEVELOPMENT SERVICES DEPARTMENT • �"r 907-343-7904
On-Site Water and Wastewater Section f Fax: 343-7997
www.muni.org/onsite
Septic Tank Advisory
Certificate of On-Site Systems Approval #0SC191236
Subdivision: Overlook Estates BIk 2 Lot 4
Starting at 20 years of age the MOA issues Advisory's for steel septic tanks. The septic tank for
this property is 28 years old. Typical replacement costs range from $6,000 to $9,000.
This advisory must be attached to all copies of the subject Certificate of On-Site Systems
Approval.
This is an example of what the metal of a 20 year old steel tank MAY look like.
- 1':
r- 111" ,,,
,T r` i,,, -
w •e] ".. ) • sem . . -
ar . ,.,i -4
•
v,,,tii is g
a M 1
y .
E ,1.. AL ti.
M.
r n
Mailing Address: P.O. Box 196650*Anchorage,Alaska 99519-6650 *www.muni.org
9949'57'.4'3999
4
•
•
•
... .....
•
t� 2
Tf •
--•„.r-7-111E1
• t__
3IIL
•
j
fl I "r of ��Qa
cLQ _D_ S1-P
_.-. j C/ TH
..-..._...__._._._AAAA—
gs .49 -
/ y
$OQ
SHANE HOLT
/+s A
V .
,e.,....... '
n•A
Y 'o, upl•2.4"
_1
Vi
D4yr, _ AS-BUILT SURVEY 1"=30'
NO CONN'ERS SE'11-IS OATS
HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY
OF THE FOLLOWING DESCRIBED PROPERTY
ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE
VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN
THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS
ra nroRM.rle..a<o.IS'or 1.1 AUE er 133013c I•STITUTIOns se<CIrIccLLX TR sm.AN. EH IST OTHER THAN NOTED.
Nr L1Cri HTNLEN LXlirIn,STRUCTURES ARD.L.TTED LIT LINES 0.0,EASEMENTS,ANO IS DATED AT ANCHORAGE,ALASKA THIS DAY OF
voT TO D< OIR POS1T1 oru4 ADDITIONAL STRUCTURES.I0PR•VEn[VS,op rE SCELI0[S.
"SEMEN.
0u•r RE...•T x.x..o:E VU
PRILC•N TxE NE..0,0.AAE LeT S.eNN �. 2019
Avec.1 WILLIS IN DIELE.,T
NOTE: rCNC[LINES THAT APPEAL On T.IS DRAYS.ARE n0 TO BE USED TO DETERNRE
PROPERTY LI0R
0 POSITION ADDITIOYAL I0PROVEME
ANT PAVIRF S03.e YNHERE.MAY RE APPROXIMATE IUE TO TO EXCESSIVE 111011 A0D/OR ICE•
Noir 000 DRI
9309YING
GROVES0 O VE
ANCHORAGEµ909'99501 /
3.545,3 /
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. o68-oz+:~-:~o
GENERAL INFORMATION
Complete legal description
COSA #
Expiration Date:
Overlook Estates Block 2, Lot 4
Location (site address) 27427 Paramount Drive, Eagle River
Current Property owner(s) Leroy and Beverly Sires
Mailing address
Lending agency
Mailing address
Real Estate Agent Keller Williams ! Craig Bennett
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS:
TYPE .OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class __
Public Water System
Well
Day phone
Day phone
Day phone
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site
[] Individual Holding Tank
[] Community On-site
[] Public Sewer
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results, (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Pannone Engineering Services, LLC Phone 272-82:1.8
Address P.O. Box 1.oo2:1.7, Anchorage, AK 9qS:to
Engineer's Printed Name Steven R. Pannone, P.E. Date ~/5/2ozo
Engineers Comments: in conducting an adequacy test, ! attempt to pro¥ide a thorough, conscientious engineedug analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
5. DSD SIGNATURE
~ Approved for ~' bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
× " /LI
By:
(Rev. 11/0,5~
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
on-site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
· Legal Description:
WELL DATA
Well type Private
Date completed
Total depth 3.~o ft.
Overlook Estates Block 2, Lot ~
IfA, B, or C provide PWSID # ~
Sanitary seal (Y/N) Y
Cased to 3.2~ ft.
FROM WELL LOG
Date of test 61xh.99~
Static water level 80
Well production ~
WATER SAMPLE RESULTS:
Coliform Neg colonies/100mL
Arsenic: ND ug/I
SEPTIC/HOLDING TANK DATA
Tank Type/Material Steel
Tank size xooo gal.
Foundation cleanout (Y/N) Y
Parcel ID: o68-0~.1-'~o
g.p.m.
Nitrate 2.2zr mg/L
Date of sample:
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) 3.8
AT INSPECTION
3.ol2612o=.o
8~ ft.
6.0 g.p.m.
in.
Other bacteria Neg colonies/100 mL
Collected by: Pannone Engineering
Date inStalled
Number of Compartments _= Cleanouts (Y/N) Y
Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 912ql2o~o Pump_~r JRs Pumping
C. ABSORPTION'FIELD DATA
Date installed 61~13.~9~ Soil rating (g.p.d./ff2 or ft2/bdrm) =.2GPDISF
Length, 32 ff. Width 3
Total depth 8-9 ff. Eft. absorption area ~8~r ~
Date of adequacy test =.ol2612o=.o Results (Pass/Fail) __
Fluid depth in absorption field before test _o. in.
Elapsed Time: 7o min. Final fluid depth g in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N
Monitoring tube Y
Pass
System type Deep Trench
Gravel below pipe 6 ft.
Depression over field N
For 3, bedrooms
Water addedzrS~ gal. New depths_5 in.
Absorption rate >= ~r~o+ g.p.d.
If yes, give date
D. LIFT STATION
Date installed
"Pump On" level at ~ in.
Datum
E. SEPARATION DISTANCES
Property line ~.o+
Water Service line
Curtain drain 50+
F. COMMENTS
Size in gallons
"Pump off" level at ~
Cycles tested
in.
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot
Absorption field on lot zz9
Public sewer main 75+
Sewer/septic service line 25+
Animal containment areas 50+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation -,o Property line zo+
Water main zo+ Water service line 25+
Wells on adjacent lots zoo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation zo+
Surface water ~oo+
Wells on adjacent lots ~oo.
On adjacent lots zoo+
On adjacent lots zoo+
Public sewer manhole/cleanout zoo+
Holding tank zoo+
Manure/animal excrete storage areas
Absorption field 5+
Surface water zoo+
loo+
Water main 75+
Driveway, parking/vehicle storage =o+
in.
G. ENGINEER'S CERTIFICATION
.....
I certify that I have determined through field tnspections and
review of Municipal records that the above systems are in
· : . ~.....~,m.;'A~...-Z~.~. ...... ~....a......~_
conformance with MOA COSA guidelines in effect on this date. ~~_.~
Engineer's 'Printed Name Steven R. Pannone, P.E. --
Date /~ ~,/~?.,...~"' "~'~ .~"~_,~,~., ~.~'~'~
COSA Fee $~
Date of Payment
Receipt Number
(Rev. 11/05)
//_>
Waiver Fee $
Date of Payment
Receipt Number
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On-Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
Parcel I.D. #
06804110
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
NAA #
GENERAL INFORMATION
Complete legal description
Overlook Estates, Lot 4, Block 2
T14N R1W Sec.25
Location (site address or directions) NUN Paramount Drive, Eagle River
Property owner E~g]~ v~nh~-¢~ Day phone 694:~9661
Mailing address P.O. Box 771822, Eagle River, AK 9957?
Lending agency N/A
Mailing address
Day phone
Agent
Ad dress
N/A Day phone
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
Unless otherwise requested, HAA will be held for pickup.
3
NOTE:
Individual well
Community well
Public water
If community well system, provide written confirmation from State ADEC attest-
ing to the legality and status of system.
4. TYPE OF WASTEWATER DISPOSAL:
NOTE:
x
Individual on-site
Holding tank
Community on-site
Public sewer
If community wastewater system, provide written confirmation from State ADEC
attesting to the legality and status of system.
72~325 (Rev. 1/91) Front MOA #21
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 verifythat 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 Eagle River Engineering Services Phone 694-5195
Address P.O. Box 773294, Eagle River, AK 99577
Engineer's signature
Date
DHHS SIGNATURE
,/~/_... Approved for .~..,~.~) bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Additional Comments
By:
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.
72-025 (Rev. 1/91) Back MOA#21
Municipality of Anchorage
Department of Health & Human Services
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: ~k'~'£/..~O/:' F'.57:; Z.¢7-~ _/~'/-~,~ Parcel I.D.
A. WELL DATA
Well type .Pl~h/,,I.7'~, If A, B, or C, attach ADEC letter. ADEC water system number
Log present (Y/N) Y Date completed 0(~/9/ Driller
Total depth /~ ~ Cased to /,ZZ,/. ~ J Casing height
Sanitary seal (Y/N) Y wires properly protected (Y/N)
FROM WELL LOG
Date of test
Static water level ~'~
Well flow .~'.
Pump level 1,b~l/d/~/Dl~/,J
SEPARATION DISTANCES FROM WELL TO:
Septic/holding tank on lot /D~' ~
Absorption field on lot //~ ~
Public sewer main ,,4,//.~
Public sewer service line ~//,~
g.p.m.
AT INSPECTION
-
; On adjacent lots /~D ~',~
; On adjacent lots /E~D" '/
Public sewer manhole/cleanout /'//-~
Petroleum tank
WATER SAMPLE RESULTS:
Coliform ~ Nitrate
Date of sample: 02'/Z~/
Collected by:
Other bacteria ~
./
E:./v~/,~/~-~-,~
B. SEPTIC/HOLDING TANK DATA
Date installed (0~/~./-t/
Cleanouts (Y/N)
High water alarm (Y/N)
Date of pumping
Tank size ~ ¢¢0 ~,¢Z Compartments ~-,
Foundation cleanout (Y/N) Y Depression (Y/N) /V
Alarm tested (Y/N)
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO:
Well(s) on lot //~Z/ ' On adjacent lots /(~ / ¢'
To property line ~/-
Surface water/drainage
Absorption field
Foundation
Water main/service line
72-0~6 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE
C. LIFT STATION
Date installed
Size in gallons
Vent (Y/N)
High water alarm level
Meets MOA electrical codes (Y/N)
SEPARATION DISTANCE FROM LIFT STATION TO:
Well on lot
D, ABSORPTION FIELD DATA
Date installed
Length .'~ ~-. ~ Width
Total absorption area
Depression over field (Y/N)
Results (pass/fail) /P.4 ._<; ~
Peroxide treatment (past 12 months) (Y/N) ,/'CD
~ Manufacturer
cess (Y/N)
"Pump on" level at "Pump off" level at
Cycle ~o,~~
On adjacent lots Surfa ~~
Soil rating /, ~. ~,O///-~. z System type
Gravel thickness [¢ v Total depth
Cleanouts present (Y/N)
Date of adequacy test
for -~
SEPARATION DISTANCE FROM ABSORPTION FIELD TO:
Well on lot //c) J On adjacent lots //¢~ '~ ¢
Y
If yes, give date ./(4'//-~
/
bedrooms
Property line ~/' .~ ¢
To building foundation
On adjacent lots
Surface water
Curtain drain ~//,4
To existing or abandoned system on lot .A,//~
Cutbank /g//.,¢ Water main/service line /V//¢
Driveway, parking/vehicle storage area :~ o° ~
E, ENGINEER'S CERTIFICATION
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signature
Engineer's Name
Date
HAA Fee $ /~,7~,
Date of Payment ,2/~','~/~./
Receipt Number
Waiver Fee: $
Date of Payment
Receipt Number
72-026 (Rev. 3/91) Back MOA 21