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HomeMy WebLinkAboutKENAI VIEW LT 2Kenai View Lot 2 #018-332-05 May 12 22 10:42p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE o�lr a l Development Services Department ��- J Phone: 907-343-7904 On -Site Water & Wastewater Section% Fax: 907-343-7997 Pump Installation Log Well Drilling Permit Number: Parcel Identification Number.. 018-332 05 Date of Issue: - - Legal Description Block Lot Property Owner Name & Address: JENNINGS SUSAN P KENAI VIEW 2 3421 TIESZEN AVENUE ANCHORAGE, AK 99516 Pump Installation Date: os - ii _ 2c22 155 Pump Intake Depth Below Top of Well Casing: feet RED JACKET Pump Manufaetirer's Name- 8S 1 2 Pump Model: Pump Size: "" hp Pitless Adapter Burial Depth: 12 feet Pitless Adapter Manufacturer's Name: MARTINSON Pitless Adapter Installer: Well Disinfected (Upon Completion? ,Yes ❑ No Method of Disinfection: PELLETS I Comments: I Pump Installer Name: _ Company: Mailing Address: ANCHORAGE WELL & PUMP SERVICE 7640 KING STREET ANCHORAGE, AK 99518 907-243-0740 State Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. Municipality of Anchorage Community Development Department Page 1 of 1 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP151092 PID Number: 018-332-05 ❑ New ❑ Upgrade Name: #Caren Bollinger ABSORPTION FIELD ❑ Deep Trench El Shallow Trench 21 Bed ❑✓ Mound Address 3421 Tieszen Ave. Anchorage, AK ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 165GPD/SF 3.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3 Ft. Gravel depth beneath pipe 0.5Ft. Subdivision Block Lot Kenai View 2 Fill added above original grade 0 Ft Gravel length 30 Ft Township Range Section Gravel width. 18Ft. Beds: Number of Lines 4 Distance between lines 4Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area - Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 540 = Ft N/A N/A Ft, Well 150+ 150+ 150+ N/A N/A TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Existing Capacity Gal. Surface Water 100+ 100+ 100+ N/A Material Number of compartments Lot Line 5+ 10+ 5+ N/A NA Foundation 5+ 10+ 5+ N/A LIFT STATION Manufacturer Capacity Curtain Drain NIA N/A N/A I N/A Existing Gal. Remarks2" of rigid insulation over field. Pump on level at in. Pump off level at in. High water alarm at in. Repaired existing field due to piping being extremely out of level. Original bed found to be 30'x18'. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank3034 Tank to drainfield 3034 Installer A+ Home Services Drainfleld 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCHMARK (Assumed elevation) 100ft Inspectionr _ 1 7/9/2015 7/9/2015 Location and description dates: 2� East Door Threshhold 3rd 7/10/2015 4'" COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp j Conditional Approval: Date .. *' 49 TM ;* � ` teve*nrESon*riorae­� .E 8149 ./ Ctj Approved r Date R Inspection Repori!X-1-12.doe A B \ ` � I M1 19.4 28.0 M2 36.9 42.0 M3 38.0 20.6 \ M M4 47.9 35.0 � / CLASS "C" WELL�� NORTHEAST CORNER L/ -� OF LOT J ` -' NO WELLS w/I 200" RADIUS EXCEPT AS NOTED DORA AVE R-"UN0EUE PED) r WELL (E) �� s I \ - �� WELL I �\ I (E) I � l 38R OUSE e REPAJRED EXISTING 18'x30BED c 'LATTERAL LINES WERE NOT (3 LEVEL AND WERE REPLACED J , TH1 WITH 1 }" 0 PIPE HOLES 30" ,1 \ © l .000g —M3 ml ON CENTER. , SEPTIC TANK (E) _ TH84 M / cl) 55 O 77 /SEPTIC -- M4 ` AREA--11�: M2 IAX-\ W _ SEPTIC AREA W LINE EXITING LIFT STATION _ W--- FIELD LOCATED COMPLETELY DISCONNECTED. CURTAIN DRAIN REPAIRED AND REPLACED PER ` 3, TIESZENA CODE. WELL (E) ���� �\ WELL (E) �Y t X , 1 a� � 1 i ` IV W� NOTES:PANNONE ENG SVC, LLC OF AC til 8i7/2015 RECORD DRAWING P.O. BOX 100217 ANCHORAGE, AK 99510 J C�•' qs �j �y*j�l Scale PHONE (907) 272-8218 FAX (907) 272-8211 *�Plie49 TM 50 %""' ' "' P.LD. NO KENAI VIEW LOT 2 < 018-332-05 KAREN BOLLINGER 3421 TIESZEN AVENUE Steven R. Gan ne j PFc� CE 8149 .. fir// _ +�`liF4 PERMIT NO. OSP151092 DRAWN NJC Sheet PLAN ANCHORAGE, AK 99524 gOfES56NP �+r �� "�� 2OF3 a o 0 1,000 g SEPTIC TANK (E) NOTES: DRAWN I NJC DESIGN DETAILS 1.25"P PIPE 5' O.C. TYPICAL W/ 0.125" DRILLED HOLES 30" O.C. NEW DRAIN ROCK 6" ABOVE f+ PIPE INV w -w- 2' RIGID INSULATION m m FILTER FABRIC ........ DRAIN ROCK 0 z oo II m PERMIT NO. CE +iltj� SECTION w w m zRIGID INSULATION m a FILTER FABRIC 1.25"0 PIPE 5' O.C. TYPICAL W/ o a 0.125" DRILLED HOLES 30" O.C. (P) o DRAIN ROCK 6" ABOVE 0 PIPE INV DRAIN ROCK1 ` ` 3,39 SLOPE PROFILE PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 KENAI VIEW LOT 2 KAREN BOLLINGER 3421 TIESZEN AVENUE ANCHORAGE, AK 99524 8/7/2015 AP''•�9 f+ Scale *:t}9 TH •.*�/ - NTS ..... ........ .. . NO 018-332-05 Steven R. Pannone PERMIT NO. CE +iltj� 8149 OSP151092. ........ �-r Sheet 3 OF 3 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: OSP151092 Tax Code Number: 01833205000 Work Type: Septic Upgrade Permit Effective Dates: May 15, 2015 to May 14, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: KENAI VIEW Site Legal Address: KENAI VIEW LT 2 G:3135 Owner/Address: BOLLINGER KAREN S PO BOX 240272 ANCHORAGE AK 995240272 Site Mailing Address: 3421 TIESZEN AVE, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy All construction must be in accordance with: Lot Size in Sq Ft: 12000 Total Bedrooms: 3 N Private Well N Water Storage 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: sI <�1 Zoos Issued By: �.�✓��� ` — Date:!:: �s Municipality of Anchora cent S; �� P L f a y Department ** VARIANCE/WAIVER REVIEW **** Waiver#: SV151038 COSA#: _ Permit#:OSPIS1092 PID#: 018,332-05 Legal Description: Kenai View Lot 2 Engineer: Pannorte Engineering Services - Applicant: Karen Bollinge The proposed bed exceeds the 15 foot maximum width. The bed is approved to be 28 feet wide. See the engineer's letter. This waiver approval applies to the proposed bed only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. D,The affected adjacent property owner(s) have been .given a 7 day notice regarding this waiver. ❑'Notarized letter(s) of nonobjection have been received from the owner(s) of the affected adjacent property.. _ Adjacent properties are not affected by this waiver. Waiver is Granted: X Waiver is not Granted: Date: 5 ALI/5 Approved by:. c Name of RevieW.r **** VARIANCEMAIVER REVIEW:**** MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program SUBMITTAL ANCHORAGE 111111015 ANDREW EARP Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 018-332-05 Property owner(s) Karen Bollinger Mailing address 3421 Tieszen Avenue, Anchorage, AK 99524 Site address 3421 Tieszen Avenue, Anchorage, AK 99524 Legal description (Sub'd., Block & Lot) KENAI VIEW L2 Legal description (Township, Range & Section) Lot Size 12000 Sq. Ft. APPLICATION IS FOR: (® all that apply) Absorption Field ❑X Septic Tank ❑X Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Day phone None Available Number of Bedrooms 3 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑X (w/wo ADU) Upgrade ❑x Duplex (D) ❑ Renewal ❑ Multiple 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. of property owner or Permit/Rush Fees: 471611 ' Date of Payment: 413#4111's Receipt Number: Irl 135 Permit No. 6 S P 15 1092 Permit App_' ::..mac. Waiver Fees: -PZ 15 Date of Payment: E /�5 Receipt Number: 00666G Waiver No. 0 5(! /5/03 P Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@paneneak.com 14 May 2015 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: KENAI VIEW L2 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to install an upgrade septic system be issued for this property. The proposed systems will serve an existing three (3) bedroom house. Currently the existing field is in failure. The existing 10008 septic tank will be replaced with a 1250g S.T.E.P. tank. The existing field will be removed and replaced by a twenty-eight foot (28') by thirty-three foot (33') bed absorption system. This lot is served by a Class -C community well. The surrounding lots are also served by private wells. There are no wells within 100' of this system. Soils. S&S Engineering performed a test hole January of 1984 at the original grade at that time and Pannone Engineering performed one test hole on this lot in April of 2015, and groundwater was monitored for at least seven days. The test hole monitor tube was dry after the seven day monitoring period. It is my opinion, based on the results of the soils tests and overall soils appearance; an application rate of 0.5 gallon/day/square feet should be used for a conventional wastewater system. 1. Soil Absorption System Design. a. See Sheet 2 of the design package. A waiver is required for the proposed bed dimensions. Due to constraints in positioning the field (caused by Lot 1 encroaching upon Lot 2's pre - designated reserve field area by installing a curtain drain) to comply with current distance separations a change of dimension from 15' wide to 28' wide is required. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. There is a curtain drain on Lot 1 that is 50'± from the proposed field. 3. Topography: The proposed drain field is located on the southern portion of the lot. The surrounding topography generally slopes from northeast to southwest at approximately 4%. There is an approximately 23% grade slope on the last 8'± leading to the southern and western property line. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 4. Waiver Requests: We would like to request separation distance waivers for the following: Bed Dimensions: Request a waiver on bed dimensions. Due to constraints in positioning the required field the dimensions need to be 28'W x 331. The existing septic on Lot 2 had a reserve field area to the west of the current drain field. The neighbor on Lot 1 obtained approval from the MOA to install a curtain drain on the eastern portion of Lot -1 which thereby compromised the pre -planned reserve area for the septic on Lot 22. In addition to maintaining specified separation distances to the property line, the foundation and neighboring water wells a drain field of the prescribed width of 15' is not feasible. The install contractor is aware and will (and is able to) comply with.special install requirements of the field to not degrade the condition of the site during install. S. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 N\ IAI M�1 �Al 1 \ ` is 12 XASS "C" WELL ` NO WELLS W�I 200' RADIUS EXCEPT AS NOTED DORA AVE R.0 W-(1jNDEV PED) o `\ 1 s WELL (EJ A I I WELL (E) \ I � C 38R m OUSE W C 8 oa Jj 2 ✓TH1 LJ 1250g S.T.E.P. RO EXISTING 18'x42' BED ©_ TANK (P) DRAIN FIELD P REMOVE 1000g 1 Tj4 28'x33' x 0.5'ED x 4.0'TD \ M ASEPTIC TANK (E) 1 1.25'0 PIPE 5' O.C. TYPICAL W/ M-� - 1. . ` - \ .� 0.125" DRILLED HOLES 30" O.C. (P) I \� o �� ABANDON LIFT STATION (E) X28,9 �\tttttt -ADO 0.5'± TO ACCOUNT FOR z PER MOA CODE n BIOMAT REMOVAL SEPTIC AREA—mow ,(j 50.1 SEPTIC AREA�W W W --__ \ _ i-- FIELD LOCATED FV (P) Q END OF CURTAIN DRAIN EACH LINE , sz TTIESZEN A i1 WELL (E) WELL (E) � \ I 1 , p W-� NOTES: PAM N �-.7�7 LLC .���� \\ Date FOR CONSTRUCTION P.O BOX 11010217 ANC ANCHORAGE, 995 0 r �c .�F Q�gS1+l�' 05/14/15 PHONE (907) 272-8218 FAX (907) 272-8211 /�g�Q �9�) Scale .... .. :.. P.I.D. NO KENAI VIEW LOT 2 /018-332-05 KAREN BOLLINGER Steven . Po'nnoBe j PERMIT NO. DRAWN JRL PF. •. CE 8149 ,�e� OSP151092 3421 TIESZEN AVENUE �) ,s .• �i PLAN ANCHORAGE, AK 99524 lel e o ssioNP� Sheet 3 i\\\\ s SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS. 3. SCOPE OF WORK: INSTALL NEW 1250 GAL S.T.E.P. TANK AND REMOVE AND REPLACE EXISTING SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS NOT ENCOUNTERED BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN 6.NY OF THE EXCAVATIONS LESS THAN 15 FILET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. m 0 r2INSULATION I rFILTER FABRIC Ir1.25"0 PIPE 5' O.C. TYPICAL W/ o cmcn.w ro.nr r..no o r�0.125" DRILLED HOLES 30" O.C. (P) 'o a 1250 g S.T.E.P. TANK (P) DESIGN PARAMETERS DRAIN ROCK LEVEL FROM TEST HOLE BY NGINEERING ON 1/27/84 PRIMARY/RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (750 gpd) TANK SIZE: 1250g S.T.E.P. TANK PERC RATE — 12.1 MPI SOIL RATING: 0.5 GPD/SF AREA ROD: 900 SF SYS. TYPE: BED 0.5'ED USE: 28' WIDE X 33' LONG TOTAL AREA: 900 SF NOTES: 0.5' ED, 4.0' TD DRAWN I JRL I DESIGN DETAILS SECTION DRAIN ROCK 6" ABOVE PIPE INV i 1T ADD 0.5't SAND TO ACCOUNT FOR BIOMAT REMOVAL w w m � 2" INSULATION m ¢ FILTER FABRIC ¢ 1.25"0 PIPE 5' O.C. TYPICAL W/ 0 0.125" DRILLED HOLES 30" O.C. (P) z : `DRAIN ROCK 6" ABOVE f DRAIN (SCALE 1"=10) PROFILE LEGEND W WATER LINE/ WELL RADIUS — SS NEW SEPTIC PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 KENAI VIEW LOT 2 KAREN BOLLINGER 3421 TIESZEN AVENUE ANCHORAGE, AK 99524 23.3 % SCOPE T ABBREVIATIONS Cu COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE N0. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BEG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE ��\\ De —'OF AGgslosat/o7/15 Scale . II NTS. n R..Pannome' j PERMIT N0. CE 8149�� OSP15ms2 Sheet `ROFESSIONP�� 2 OF 3 TEST HOLE 1 ORGANICS 1 2 WATER NETTIME LEVEL NET DROP MPI SANDYGRAVEL GM WITH SILT READING 10 BOH NO GROUNDWATER (FILL) 3 -- 5.185 --- a 2 13:31 30 MIN 8.000 2.815 10.66 DATE PERFORMED: 04/14/2015 SILTY SANDY 5 GM/SM GRAVEL (FILL) 6 SOILS LOG - PERCOLATION TEST SLOPE WAS GROUND WATER 7 OR ORGANICS ENCOUNTERED? -N IF YES, AT WHAT 8 DEPTH? airE)V-Y DEPTH TO WATER AFTER MONITORING? 0 GM/SM SILTY SANDY DATE: 04/22/2015 GRAVEL ,-TH 1 4 G TH84 ' SLOPE TH X 3 13:32 --- 5.185 --- 4 14:02 30 MIN 7.667 2.482 12.09 5 14:03 --- 5.185 --- 6 1433 30 MIN 7.664 1 2.479 1 12.10 PEROLATION RATE 12.10 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3.0 FT AND 4.0 FT COMMENTS: Test hole excavated by A+ Home Services. Prec hole was presoaked. Test run for two hours. Last 3 readings reported. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL�G7U�IIDL7I�NEES IIN.7�EFFECT TON THE DATE OF THIS TEST. NOTES: Ptil\1\O E ENG JYC1 LLCk�i Date � �F gC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 r (....•.• gstl� 05/07/15 PHONE (907) 272-8218 FAX (907) 272-8211 %g�P �yf+ Scale NTS �...... . .... ..... P.I.D. NO KENAI VIEW LOT 2/ 018-332-05 KAREN BOLLINGER / Steven R- annoRe j PERMIT N0. DRAWN JRL PFc� CE 8149 ,\ r 3421 TIESZEN AVENUE (+ � OSPI51092 SOILS LOG ANCHORAGE, AK 99524 �tp'' p� Sheet 1` �70FE$Sl0`�� 3 OF 3 READING DATE aLOC IMEK WATER NETTIME LEVEL NET DROP MPI READING 10 BOH NO GROUNDWATER 1 04/14/15 13:01 -- 5.185 --- 2 13:31 30 MIN 8.000 2.815 10.66 DATE PERFORMED: 04/14/2015 3 13:32 --- 5.185 --- 4 14:02 30 MIN 7.667 2.482 12.09 5 14:03 --- 5.185 --- 6 1433 30 MIN 7.664 1 2.479 1 12.10 PEROLATION RATE 12.10 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 3.0 FT AND 4.0 FT COMMENTS: Test hole excavated by A+ Home Services. Prec hole was presoaked. Test run for two hours. Last 3 readings reported. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL�G7U�IIDL7I�NEES IIN.7�EFFECT TON THE DATE OF THIS TEST. NOTES: Ptil\1\O E ENG JYC1 LLCk�i Date � �F gC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 r (....•.• gstl� 05/07/15 PHONE (907) 272-8218 FAX (907) 272-8211 %g�P �yf+ Scale NTS �...... . .... ..... P.I.D. NO KENAI VIEW LOT 2/ 018-332-05 KAREN BOLLINGER / Steven R- annoRe j PERMIT N0. DRAWN JRL PFc� CE 8149 ,\ r 3421 TIESZEN AVENUE (+ � OSPI51092 SOILS LOG ANCHORAGE, AK 99524 �tp'' p� Sheet 1` �70FE$Sl0`�� 3 OF 3 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 CL -1 I PHONE - �. W ❑ UPGRADE MAILINGa ESS /o S -S nlG1N PGi LEGAL DESCRIPTION C LOCATION ® ly /dL� NO. OF BEDROOMS Uy DISTANCE TO: ,V IJb (� Absorptions r�a G E ✓ Dwelling /5- � PERMx & P 2Manufacturer „� Mat No. of compartments a. LU w Li c c gallons IF HOMEMADE: Inside length Width Liquid depth G�Z JO DISTANCE TO: Well N welling PERMIT NO. z QManufacturer = F Material Liquid capacity in gallons p Well Foundation Nearest lot line PERMIT NO. �= w ANCE DISTTO: j LL Z No. of lines Length of each line otal length of lines Trench width Distance between lines 2 w inches F - cc F- Top of tile to. finish grade Material beneath tile Total effective absorption area G inches Lu Length !/n / Width p / Depth C7 a 4 Type ofy Crib diameter Crib depth 4 Total effective a rp are w m rn Well BuiIdin fo tgion Nearest lot line / DISTANCE TO: p y J Class- Depth Driller t ce t lot in7Z ZF Lu DISTANCE TO: BlJilsli g f(ry4aU.an ewer 'ne /J `I eptic tank C or�ti rea(s) OTHER N PIPE MATERIALS� i- p Y SOIL TEST RATING 1.'1 E?�3T1✓� S7�J"� INSTA ER,y�qq p�'''x If V REMARKS-- eA . �O a ..� Y ala u �'iw . jj I R1bfA ,A..ft*tt'r .` • a S 4 APPR VED'j DATE LEGA ORB 196X - SIV.ER, ALASKA L n -ma (14ev_s/78) DEPARTMENT OF' HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET.'ANCHORAGE, AK 99501 264-4720 PERMIT NO: : E.44r 04-- ENGINEERED DESIGN DATE ISSUED: 03/1''r'84 AF'FL ICANT: CLIFF HEW I TT IAC: DRE SE, : C/O S&S ENGINEERING, SRB 196 EAGLE RIVER,Al---f 99577 CONTACT PHONE: f. -----q4--2..:7,79 ;LEGAL. DESCRIP: SUBDIVISION: KENAI VIEW LCAT: u BLOCK: N/A SECTION: C_ TOWNSHIP: :12N RANGE: 3W LOT SIZE: ;12000 W i !. FT. CSF' ARES I CERTIFY THAT: 1. I ANI FAMILIAR WITH THE REQUIREMENTSFOR ON --SITE SEWERS AND WELLS AS SET FORTH BY THE MUNd I C I PAL... I TY CSF` ANCHORAGE (NOA'.) AND THE . STHTE OF ALASKA. 2. I WILL INSTALL STALL THE SYSTEM IN ACCORDANCE WITH ALL HOA CODES AND REGULATIONS.- AND EG iLATIC NS.AND IN COMPLIANCE WITH THE DESIGN CRITERIA,OF THIS PERMIT C I W I L L ADHERE TO AL.L. MOA AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES FROM AN•d`,'` EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR. PUBLIC SEWER RGE SYSTEM ON THIS OR ANY ADJACENT CENdT CSF:: NEARBY LOT. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA ,BUILDING aaCODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE ben—A I NdED; ( 2) AS—BU I LTS WILL NOT BE -'F'F'F'- v ' D 14ITHOl-J - _AN EL.EC'TRICAL IN SPECTIONd REPORT., AND (3) THE ELECTRICAL ; -' R ' N'1!_I I;i , = EY' A I+=E.N SED ELECTRICIAN. . S I GNdEc; L -'ATE : ✓�3''� AF'F'LI! Nd -'.-IFF HEWITT ISSUED C.','JliFDATE: _� 3 0 Department Health and Hnvironmentarotection 825 Street, Anchorage, AK. 501 SSS 264-4720 3 WANDWRITTEN PERMIT Permit # D WELL AND/OR ON-SITE SEWER PERMIT r Applicant: �I-IFF &W/ %i Mailing Address: / S �S Location: e �� A `SPS 7 7 Phone Number 7-- �,�e a'3 Tia At R 3 w Legal Description: L a �EiYf}z �%/Flil% S�L7 Lot Size: /aZ600 7q Type of Soil Absorption System Is: Z/(41&,?W.Jf 6"> 0ES164V—M0(Jn/1> SYS'1Z'17A . W,6 Trench: Drainfield .Seepage Bed: Holding Tank:' dES/fit/. Maximum Number of Bedrooms: 3 Soil Rating(sq.ft/br) 57 The Required Size of the Soil Absorption 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 s adjacent to this property and the number of residences that the well will se e. # # TWO(2) INSPEC IONS ARE REQUIRED # Backfilling of anysystem_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 feet for a private well or 150 to 200 feet from 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 8--A-* I certify that: (1) 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 and s and that the on-site sewer system may require enlargement if the es' s remora ed to include more that .3.b dr oms-. Signed:Z A /A , , , Issued by: "713`aant ;3 --/3 F 3 Date: SWP/024 (1/sl) /. Tna CGS000, CJ SOI LS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264.4720 SOILS LOG — PERCOLATION TEST PERFORMED FQR: L G I F - �ty /? 7 - DATE PERFORMED: LEGAL DESCRIPTION:/ ` r'Fco g,o P� SLOPE SITE PLAN (LET.) ®>fGr All 6 141Z1 3 ( 4 S ✓/ r, �� 5 �r 6 7 1 ISS A - ' 8- 9 9 / 10 C/ GSC' 11 12. � J(2. 13 � \1 .. 14 15 Date low 1'� 164 Depth to Water "040."t w���� AV � 17 .• 1k A 18 yq ... ......at... Robert A. Shofar 19 Jj%s No. 1457.E ..- ` 0,0 -.ago". +=: 20 ' COMM AS GROUND WATERr^ L NCOUNTERED? .J O P IF YES, AT WHAT E DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 1k A f10 ' ,o A " //;30 A 3D `rte PERCOLATION RATE C/ minutes/inch) At TEST RUN BETWEEN FT AND FT /1 PERFORMED BY: �'�- AI' CERTIFIE ALASKA �'H, 5942979 09377 72-008 (6/79) -- -_. DATE: STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION f3? CONSTRUCTION AND OPERATION CERTIFICATE ALA�� for PUBLIC WATER SYSTEMS. A,._ APPROVAL TO-CONSTRUCT Plans for the construction or modification of L-01Z S1�L SSC 20 (33 1 l L N 13 �3 LJ ams. l ct public water system,located in C�JWISE Alaska, submitted in accordance with 18 AAC?80.1.00 by )0 l _ . S i�r��i2 have been reviewed and are l approved. ❑ conditionally approved (see attached conditions). At�� y'1 t BY..,. TITLE DAT If construction has not started within two years of the approval date, this certificate is void and new plains and specifications-must be submitted for review and approval before construction. _- B. 'APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Date C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the public water system was completed on (date). The system is hereby granted interim approval to operate for 90 days following the completion date. BY TITLE DATE As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY TITLE DATE DISTRIBUTION: 1. WHITE ENGINEER (Complete Section C) -- -, 2. YELLOW - WATER SYSTEM FILE (Complete Section C) - 3. PINK • ENGINEER/MUNI-BOROUGH (Complete Section C) 18-0407 (Rev. 11/831 4. GOLDENROD - MUNI-BOROUGH (Complete Section A) LOCATION OF WELL (Please complete either lo, Ib or to.) E031 Borough Ike Subdivision Lot BlockA4 . li d w R WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOD RES Division of Geologicol a Geophysicol Surveys Drilling Permit No. A _ n I N„ 1/a airs. P Section No. Township No Range E0 Meridian -4}.of.o}— hrs. pumping g.p.m. sp WO F] Yes ® No Ic. I DISIVINCE AND DIRECTION FROM ROAD INTERSECTIONS Street Address and Area of Well Location 2. WELL LOG Material Tree o, VWNtrr Vr WELL; r t n Address: I I . PUMPING LEVEL below land surface and YIELD ,i��G,r,,,I hP Surfac4, Feet. BelaBottom 1' WELL D€PTH: (final) 5. DATE OF COMPLETION Top hrs. pumping g.p.m. 6, ❑Coble tool ®Rotary 0Driven 0 Dug Auger ❑Jetted OBored 0 Other: 12.GROUTING Well Grouted: F] Yes ® No 7. USE: ® Domettlo 0 Public Supply ❑ Industry O Irrigation O Recharge 0 Commerical 0 Test We A-- •- Other: s C] Other: CASING: Threaded F1 Welded p gt De fh Wet ht � ! Ips./tt. in. to ft. Depth Stickup ;,� ft. *9. C FINISH _OF WELL: Type: � C. Y' �.:..a, ' . t j Diameter• Slot/Meeh Slze: Length; Ser between !% ft. and r+�5 }t. Backfilling Gravel pack V) Length of Drop Pipe AN HEALT f \Cry`��T, 10� STATIC WATER LEVEL: -(F ft. C3Above or C}7Below and rsur}ace Date Equipment used :C= �f'c-. f�A'�i 8 14. REMARKS: s I I . PUMPING LEVEL below land surface and YIELD ft. after hrs, pumping g.p.m. ft, offer hrs. pumping g.p.m. 12.GROUTING Well Grouted: F] Yes ® No Material: ❑ Neat Cement C] Other: 13, PUMP: (if available) HP C V) Length of Drop Pipe it. capacity q. p.m. ai O Subm. Q Jet O Centriticol O Other r a n o_ 14. REMARKS: Z 0 16. WATER WELL CONTRACTOR'S CERTIFICATION: 15. Water Temperature -a 0 F - C This well was drilled undermy jurisdiction and this report is true to the best of my knowledge and belief; /VtndYc Dr�l(;n} .lac. Registered sllne'7ss Name Contract License Number Address: r( O f )OX 'q /.N5 a1 I!, ��%h� t f �:x. A `/ � Y 7 Signed : zed Representative Date: �K - r-)() Form 02-WWR (11/81) Copy Distribution: WHITE - State OGGS, PINK - Driller, CANARY- Customer bC49 4V E::- Ml Fin W? r '., ADEOUACYTEST WATER AND SEWER INSPECTION WELL INSPECTIONS AND FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST_ ON SITE WASTE WATER DISPOSAL SYSTEM DESIGN EXCAVATION WORK 0 0 March 5, 1984 Department of Environmental Conservation ATTENTION: Bruce Erickson 437 E Street Anchorage, Alaska 99501 Dear Mr, Erickson, ROBERT A. SHAFER CIVIL ENGINEER 694-2979 REFERENCE: Lot 213; Si; Section 33; T12N7 R3W; Seward Meridian Request a certificate to construct Class C well on Lot 213 as located on the attached drawing. It is proposed that this Class C well will eventually provide water to residences constructed on Lot 213 and to the residence to be constructed on Lot 2 of the Kenai View Subdivision. If we may be of further service, please do not hesitate to contact u s . ,l'1 Since RAS/ss A. SHAFER, P.E. SRB 196X EAGLE RIVER, ALASKA 99577 1 EASEMENT AND COMMUNITY WELL AGREEMENT ST This Agreement is made this ��— day of �yZ 6,�e, 1984 between JEAN ROYSTON, a single woman, and HARRY DAVID C IN; and MARY JO COMINS, husband and wife. WHEREAS, Royston is the owner of that certain parcel o] real property more specifically described as follows: Lot Two (2), Kenai View Subdivision, Anchorage Recording District, Third Judicial District, State of Alaska. WHEREAS, the Comins are the owners of that certai parcel of real property more specifically described as follows: The Southern one-half (1/2) of Lot 213, Section 33, Township 12 North, Range 3 West, Seward Meridian, Anchorage Recording District, Third Judicial District, State of Alaska. WHEREAS Royston desires to construct a well facili upon the property owned by Comins, which may be used for t benefit of both parcels, and WHEREAS the parties desire to enter into an agreemen for the joint construction and use of said well for the benefi of both parcels, IT IS THEREFORE AGREED: 1. Easement. The Comins hereby grant to Royston a easement both subsurface and surface for the purpose o constructing and maintaining a community well facility wit respect to the property owned by the Comins. With respect t said easement, Comins covenant to Royston that they will no engage in any activity with respect to said property which woul constitute a violation of any applicable federal, state or lova laws or regulations with respect to Royston's construction anc -- operation -of said well- fac-i_li ty,,. 2. Cost of Construction. Royston agrees to construct the subject well facility in a reasonably workmanlike manner. Royston shall be responsible for all costs of construction and in addition, upon request, shall supply Comins with releases signed by the contractors supplying work or materials with respect to g a v Z O o LLJ Z LU CO _1 a J ^ W v m the well waiving all statutory lien rights. Said facility shal have the capability of supplying the reasonable residential wate needs to two single family dwellings. Subsequent to constructio and prior to actual use by the Comins lot of the well, any cost; of repair and maintaining said well facility shall be borne b, Royston. Subsequent to actual use by the Comins lot of the well, all costs of repair and maintenance shall be borne equally. Notwithstanding the above, if any damage is due to the negligence of any person who uses or has used the well facility pursuant to authority of either of it parties herein, said party grantin such authority shall be liable for such damages. 3. Management. Until such time as real propert improvements are constructed on the lot owned by Comins, whic would utilize the subject well facility, the management of sai facility shall be vested in Royston. Pursuant to said managemen authority, Royston may carry out all repairs, maintenance and al other discretionary and non -discretionary functions with respec to said facility. Upon the construction of improvements upon th lot owned by Comins, said management shall be shared equall between Royston and Comins, or the then owner of the Comins' property. 4. Binding Effect. This agreement shall be bindin upon the parties hereto, their respective heirs, executors administrators and assigns. 5. Effective Term. This agreement shall constitute a easement and covenant to run with all of the aforesaid describe land, and shall be binding upon the parties hereto and all othe persons and parties claiming through said parties herein, and fo: the benefit of and limitation upon all future owners of said Ian( and prem sesi this conveyance a`nd `-a reement --being- deli -Tied fo 9� _ _. the purposes of assuring the availability and quality of watez with respect to both parcels described herein. Notwithstandinc the above at any time subsequent to the execution of this agreement Royston (or the then owner of legal interest in th Royston lot) may deliver to Comins (or the then owner of th 1 g a C6 m t RM 0 -ds 3 `• M 62 p0, r-8 wg� J W W { m i { Comins lot) a notice (in recordable form) of her intent t abandon the well facility, upon such abandonment Royston' obligation to contribute to the maintenance of the well pursuan to this agreement shall cease as will the easements granted b Comins herein. 6. Location of Well- Comins shall have the right t accept or reject proposed locations for the actual well facility, provided however that the right of Royston to drill a well in an particular location may not be reasonably withheld by Comins. 411 Ha ry id Comins n Royston 4� a y JO mins 112 ALASKA HOUSING FINANCE CORPORATION By Title Donald �(• Elliott Controller ACKNOWLEDGMENT STATE OF ALASKA ) )ss. THIRD JUDICIAL DISTRICT ) T e foregoing instrument was acknowledged before me this day of February, 1984 _�/ n Roys n. 7� ota Pu laic for laska y c m ission expires: O Q ACKNOWLEDGMENT STATE OF ALASKA )ss. THIRD JUDICIAL DISTRICT ) The foregoing instrument--..acknow edged efor�e � me thisday of F bru y r 19 4� by H� ry ��avi Comi r N tary bli, or Alaska M com si n.expires: D ACKNOWLEDGMENT STATE OF ALASKA ass. THIRD JUDICIAL DISTRICT ) % he foregoing instru t was ackn wledged before me this %ay of February, 19 4, by ry Jo mins. _.�. of P is for -Alaska My mission expires: / a i ACKNOWLEDGMENT STATE OF ALASKA )ss. THIRD JUDICIAL DISTRICT ) 21st The foregoing instrument was acknowledged before this day of February, 1984, by Donald V. Elliott , for a ss on behalf of the PEL AL S A HOUSING FINANCE CORPDRP IW 13-EaseCW Notary Pu lic for Alask My commission expires. 0 SIG-r,�I k. T Ibr G�1�It L -LIE-% am pass. i �1I -r> TiE�SZE�N Utir�Z FuTVR� fZta+ala`, -To d a N 0 III 20l 'I 20� L 3 I m a.�olzP'not�l 31 waT�Iz L6,1EL - �6-r 3o M u�_ /01 ���Ia,I �I��� S��r��Islo�•l �� i E:F,� IF, 1 1 qe�p '. l Svc -rte LI . - _ -+ 6 pass. i �1I -r> TiE�SZE�N Utir�Z FuTVR� fZta+ala`, -To d a N 0 III 20l 'I 20� L 3 I m a.�olzP'not�l 31 waT�Iz L6,1EL - �6-r 3o M u�_ /01 ���Ia,I �I��� S��r��Islo�•l �� i E:F,� IF, 1 1 qe�p '. l Svc -rte LI . - _ Parcel I.D. 018-332-05 GS �G Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 sneer. Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Location (site address) Kenai View, Lot 2 3421 Tieszen Ave. Current Property owner(s) Karen Bollinger Mailing address PO Box 240272 Expiration Date: f % - / 0 - /_) Day phone Real Estate Agent Day phone 2. TYPE OF DWELLING: Rx Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ix Individual F. Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance re uest for: Distance: Received by:Date: �) �a 2O COSA to be released t t, le engineer, unless otherwise requested by the engineer. COSA Fee $ 5? -G Date of Payment 04 h57 Receipt Number Ci% COSA# ©5C►51412 Waiver Fee $ Date of Payment Receipt Number 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. In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MDA 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 7J21/2015 6. DSD SIGNATURE ^ _Ae___1System #1 Approved for bedrooms -t t Slsven .'f�annone !# * CE -8149 i System #2 Approved for bedrooms 4d \� Disapproved }�{t' Conditional approval for bedrooms, with the following stipulations: By: Original Certificate Date: The cip A- Drage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represents Ions 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 ° ., c If more than 1 septic system is on the lot: COSA Checklist # + of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Kenai View, Lot 2 Parcel ID: 018-332-05 A. WELL DATA Well type Class 'C' If A, B, or C provide PWSID # Date completed 8/2/1984 Sanitary seal (Y/N) Y Total depth 140 ft. Cased to 140 ft Date of test Static water level Well production FROM WELL LOG 8/2/1984 a ft. - Unknown g.p.m. Well Log (Y/N) N Wires properly protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 7/7/2015 67 ft. 1.5 9 - p.m - WATER SAMPLE RESULTS: Coliform 2�colonies/100 mL Nitrate OZ46 mg/L Arsenic 2 ug/L Date of sample: Collected by:� B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date instal)ed 6/22/1984 Tank size 1,000 gal. Number of Compaftments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (Y/N) N r Date of pumping %iZ Pumper A C. ABSORPTION FIELD DATA 6/22/1984 2 165 SF/BR Mounded Bed Date installed.. Soil rating (g.p.d./ft or ftz/bdrm) System type Length �0 ft.. Width 18 ft. Gravel below pipe 0.5 ft. 'f ' syd Total depth %i R ft. Eff. absorption area ftz Monitoring tube Y Depression over field N Date of adequacy test 7/10/2015 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 500 gal. New depth 0 - in. Elapsed Time: 10 min. Final fluid depth 0 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed 6/22/1984 "Pump on" level at 42 in. Datum Bottom of Tank E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line Animal containment areas Size in gallons 500 "Pump off"level at 40 Cycles tested 4 Manhole/Access (Y/N) Yes in. High water alarm level at 45 in. Meets alarm & circuit requirements? Yes On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 110+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 150+ Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 10+ F. COMMENTS Over 500 gallons of water storage: in crawlspace (4 holding tanks) G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems. are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name Steven R. Pannone - Date 7/21/2015 COSA canary sheet 2.6-15.doc Municipality of Anchorage x Community Development Department Development Services Division 5 q E r On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 Arsenic Advisory Certificate of On -Site Systems Approval # 151412 A Certificate of On -Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 2 of Kenai View Subdivision. This inspection revealed an arsenic concentration of 17.7 micrograms per liter (ug/L) for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 ug/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. Information on arsenic is available from the On -Site Water and Wastewater Program website (=.muni.org/onsite) or at 343-7904. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. M Found 5/8" Rebar Power Pole DORA AVENUE T O 3 T a w 0 co c j E a E E - E N N { N O N Ci nlO W M W I S89"39'00"E �I i O M Found 5/8" Rebar 0 M TIESZEN AVENUE NOTE: Distances are measured to the wood trim. I hereby certify that an accurate survey of the following described property: KENAI VIEW SUBDIVISION (P-649) LOT 2 was made on July 29, 2015 and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Easements other than those shown on the record plat may not appear on this drawing. Anchorage Alaska, this 31st day of July 2015. 0 to Pole N I SCALE 1 " = 20' 0' 1 D' 20' 40' �- 18'9—� 8.1 : o Wood Fence I M N N NI 19.4'= __-12.3' Wood iw Wood Wood Shed 12.5" r Deck 0 Shed No Foundation LD 1.2' Chain Link Fence 11.8' 1—Level I - ,,)Wood Frame I 12.3' Residence ry w Wood on ConcreteO 0 0 0 _ Steps Block N Metal o LOT 1 o Foundation Roofed N\�o 0 00 0 Carport -- o N LOT 3 Z X24_3- .0' 29.6' LOT 2 =' Gravel Clean Out Driveway (typ) N C Wood Fence Lift Station i Man Hole _- 0 M TIESZEN AVENUE NOTE: Distances are measured to the wood trim. I hereby certify that an accurate survey of the following described property: KENAI VIEW SUBDIVISION (P-649) LOT 2 was made on July 29, 2015 and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Easements other than those shown on the record plat may not appear on this drawing. Anchorage Alaska, this 31st day of July 2015. 0 to Pole N I SCALE 1 " = 20' 0' 1 D' 20' 40' 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description L o +- Z V/1&w Location (site address or directions) 3 9 Z 1 I'J# c e rvfp of t�o✓u. aH._ n l 1L Se1✓a�d - f-f✓a ] Property owner Tow►aa� S>t•doN s Day phone 4 S - s3 69 Mailing address Re x y S2 Lf Ak Fgj-f t Lending agency Gr't, A40V-1 CL91e Day phone Z77'��`l�f Mailing address i ZI ✓?_ UAL e, t4L 1 2-0 Avic:k. #1 k '71 Agent L✓e.rvc�n rrosse+- Day phone Su aSdNr Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: Z 3. TYPE OF WATER SUPPLY: U1e11 on atIyuce.vA+- Individual well v&z vtf- [-v +' Community well Public water 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 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 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 A S G U t V%C Phone 3 ti 9 -Sf Address Engineer's signature 6. DHHS SIGNATURE Approved for Disapproved. 7i bedrooms. Date Conditional approval for bedrooms, with the following stipulations: Additional CommentsATFACH6D.- WC -7W10 Po,7t es Co c& JV61L JOH'(�L fir' Date 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 M E M O R A N D U M DATE: October 16, 1992 TO: All Parties Concerned FROM: John Smith, P.E. , Manager, On-site Services sVvk SUBJECT: Health Authority Approval - Lot 2 Kenai View The subject property is served by a well located on adjacent Lot 213. A recorded agreement allows both Lot 2 Kenai View and Lot 213 to use the well. Lot 213 is not currently developed. At such time that Lot 213 desires to use the well, the wellrs wiLot ll become a Community Class "C" well and the property 2 Kenai View and Lot 213 will be required to obtain a "Certificate to Operate" from the Alaska Department of Environmental Conservation. This will require that all adjacent wastewater disposal systems be at least 150 feet from the well or that a waiver be obtained from the Alaska Department of Environmental Conservation to allow a lesser separation distance. Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: j<ev�a. �i'eu/ �"Oi 2 Parcel I.D. A. WELL DATA Well type hr� t�o� k� If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) /V Date completedg 4-1 Driller Allm Total depth i ?_0 F Cased to, '") U a' F i Casing height I Sanitary seal (Y/N) i Wires properly protected (Y/N) Y m � z FROM WELL LOG AT INSPECTION z Date of test N % I Ayt`!r , `9 Z rrl ri _"1 O Static water level t Well flow N �/} g.p:m. '� I g.p.mrn v Pump°level /V�/� in rn 0 Z SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 1 00 i r} On adjacent lots 1 00 } F _F Absorption field on lot I"00 " ; On adjacent lots too +-F i- Public sewer main Public sewer'manhole/cleanout Public sewer service line Petroleum tank WATER SAMPLE RESULTS: Coliform Nitrate Le,u f'p„ del•echea 1'"`' 10ther bacteria Date of sample: lo AK U 4 - Collected by: roc 60PP B. SEPTIC/HOLDING TANK DATA Date installed z 3'NN 9'2— Tank size 1000 Ga I Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) y Depression (Y/N) N High water alarm (Y/N) M Alarm tested (Y/N) A.1YA Date of pumping Lam► AIA G 9 Z SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s)onlot ��d On adjacent lots /vv I- Foundation i3 To property line 1 'y ` Absorption field Z ` Water main/service Tine Nar C Surface water/drainage t d 0 n-026(Rev.3/s7)Front Mon 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Z 7- T(Aiv 2; `{ Manufacturer (/tvtkv%owv� x 3 DEC -p Size in gallons S7_ lF�o i- ±150aaoll Manhole/Access (Y/N) Y Vent (Y/N) hr "Pump on" level at Z !'�zFT "Pump off' level at 7 - High High water alarm level Cycles tested 3 Meets MOA electrical) codes (Y/N) Y \/ISNONIIN I/eJiCI'GG( �l�v� N� Gro u.v%dwa%c✓- �s leuk�4y %wfo L,41� St'ahluN SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot 100+- D. vv} D. ABSORPTION FIELD DATA On adjacent lots t ° v Surface water 1004 - Date installed 2Z A w U Y 4 Soil rating 0,40 "">/sa/aystem type M OIAK d_ Length Width Gravel thickness U, S Total depth " I ani 3%' Total absorption area 7 S6 S F Cleanouts present (Y/N) Depression over field (Y/N) lei Date of adequacy test f y A tt;r 92 - Results Z Results (pass/fail) PcaS3 for Peroxide treatment (past 12 months) (Y/N) Af SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot IV V+- On adjacent lots I v d F rwv If yes, give date Property line Z To building foundation 201 To existing or abandoned system on lot �%+^ 5 - On adjacent lots IS Cutbank ff(;N L- Water main/service line Nv n c_. Surface water 10 U r- Driveway, parking/vehicle storage area Curtain drain /V* f, t - E. ENGINEER'S CERTIFICATION SI bedrooms I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date"of this inspection. J) Signature 04414A ' t n trEngineer's Name .,Date l � Care . Meu3� 4��Q 353 PROFESSO"P1' d HAA Fee $ /7e Waiver Fee: $ Date of Payment , Date of Payment Receipt Number `/off Receipt Number 72-026 (Rev. 3/91) Back MOA 21 NORTHERN TESTING LABORATORIES, INC. 3330 INDUSTRIAL AVENUE FAIRBANKS, ALASKA 99701 .(907) 456-3116 • FAX 456-3125 2505 FAIRBANKS STREET ANCHORAGE, ALASKA 99503 (907) 277.8378 • FAX 274-9645 Arctic Slope Consulting Group 301 Danner Avenue, Suite 200 Anchorage AK 99518 Attn: Ken Ackerman Our Lab #: A119623 Location/Project: - Your Sample ID: Lot 2 Kenai View Sample Matrix: Water Comments: Method Parameter EPA 353.3 Nitrate -N Reported By: Susan C. Tif tal Microbiology Supervisor Report Date: 08/13/92 �l Au992 9N Date Arrived: 08/11/92 Date Sampled: 08/10/92 R'EC E I V E D ry Time Sampled: 1515 ASHG w Collected By: EG MDL = Method Detection Limit Flag Definitions B = Below Regulatory Min. H = Above Regulatory Max. E = Below Detection Limit Estimated Value Units Result Flag --------------------------- mg/l <MDL PRGJ # !/I10 0G76',033 ��OUNT �` ,0f PROJ __ ____ -y�/__ AMOL NT _,r„__ �PPROVA!-S PMS_ pm,_,_ Date MDL Analyzed 0.1 08/11/92 SSaA�pHT F(Lyy Jy $"qrS A FUO- Np A+ HOME SERVICES, INC 15900 Francesca Drive Anchorage, Alaska 99516 345-1890 or 345-2444 CUSTOMER Artie -;lope Consulting Group • 301 Danner Anchorage, Alaska 99518 Block Lot DATE DESCRIPTION F!14Z92 unp, Septic Tank x x rt -S1 towards Potter INVUIct tt % T TOTAL AMOUNT _ , Gallons '� p Leach Area Holding Tank _Standpipes 5 3 Septic Time ❑ PROBLEM AREA—CALL FOR MORE INFORMATION ❑ NEEDS TO BE DONE AGAIN IN 8 MONTHS ❑ Floater on top -0Good Shape R. Sludge buildup on bottom 4 im cap missing or ❑Cut standpipe to 1' above ground ❑Needs Septictrine needs replacing FUSTOMER COPY — KEEP FOR YOUR RECORDS —PLEASE PAY FROM THIS INVOICE— AXRCT�ICSLOE204S� ULTING GROUP, INC.Engineers •Archcts •Scientists •Surveyors DATE: I y Aim— 4 Z 301 Donner Avenue Anchorage, Alaako 99518-3035 Telephone: (907) 349-5148 Fax: (907) 349-4213 WELL LOG LOCATION: Subdivision: K Lot: 2 Block: Client's Name: Address: TESTER: Initial Reading on Meter: NOTES: 24 -Hour Capacity Gallons Production Rate:%% vim— GPM MUNICIPALITY OF ANCHORAGE • Department.of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR. HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. #\�- 33 - HAA # t_lCOn Q i$ 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 2: Kenai. View Subdiv-izion Location (address or directions) 3 2-1 ? 1e'5zWAJ (b) Property owner HUD Telephone: (home) Business Mailing Address #111-032-336 (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent ASSOCIATED BRQKERS/Sandu Address 640 West 36th Avenue Anehonage Ata,6ka 99503 — .:, Telephone 563-3333 � *. .. �:� . • .., (e) Mail the HAA to the following address: (or check hereo if hold for pick up.) List contact person and day phone number below: S 9 S ENGINEERING1694-2979 - Eap a Riven A2ah a 99577 2. TYPE OF RESIDENCE Single -Family ❑ Number of bedrooms �- 3. WATER SUPPLY Individual Well IV< Community Public ❑ Note: if community well system, must have written confirmation from the State Department of. Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-siteKX Public Community ❑. Holding Tank ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION ' As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of FirmTelephone 5 & S E Road No. 2U4 Address 17034 Eagle Rivar Loop Eagle ver, 4 Date `�/l B /g / 6. DHHS APPROVAL Approved forTo l bedrooms by -'- _ ("-*- Date S Fg Approved X Disapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • +� Ith Authori.Rty Approval (HAA) of PN4 O' WLIST = FEO'UARY 1984 M�N�pw�N�P4gER���Es� 343-4744. `N�`RpNM Legal Description: A. WELL DATA Well Classification `� �w `� r''L- If A„ B, C, D.E.C. Approved (Y/N) a A Well Log PresentON) Date Completed 8�a� Yield Total Depth 012 Cased to �—Depth of Grouting Static Water Level y Pump Set At i�-- Casing Height Above Ground 2 Sanitary Seal on CasingDll) Electrical Wiring in Cionduit4pN) Depression Around Wellhead (Y SEPARATION. DISTANCES FROM WELL: :,r To Septic/Holding Tank on Lot 41" ' On Adjoining Lots 1 �d To Nearest Edge of Absorption Fief on Lot �` Pl n 0-K; On Adjoining Lots ''— To Nearest Public Sewer tine p To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot 2-� 4 - Water Sample Collected by, Water Sample Test Results — Comments B. S grJ6 Wi 1,s 01 Date ^Ile _e Size I bVQ No. of Compartments _ Standpipes ON) Air -tight Caps (DN) Foundation.Clea � -- I`j to Last Pued m Depression over Tank (Y ! p d Pumping/Maintenance Contact on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) %4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: _To Water Supply Well s° 4— To Building Foundation i To Property-4ine / a ' To Disposal Field 20 To Water Main/Service Line 30 �4— To Stream, Pond.,Lake or Major Drainage Course Comments '"'lfi �%- ✓ 1 C -S 72-028 (Rev. 7/88) Front Page.1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Str —�L�v �P,�- Type of System Design aUL)Q1?P Date Installed Length of Field 4Z r Width of Field �8, Depth of Field _ oJbJp,v>) Gravel Bed Thickness f� Square Feet of Absortion Area � � Statndpipes PresentON) T Depression over Field (Y/&V Date of Last Adequacy Test LB " 89 Results of Last Adequacy Test 3 31A SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well .57- r4, + To Property Line 1� To Building Foundation Z-5 To Existing or Abandoned System on Lot N N, � r On Adjoining Lots 4" _ r To Water Main/Service Line To Cutback (if present) r To Stream, Pond, Lake, or Major Drainage Course _r C� p 4- To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION L L a Date Installed Dimensions �� P/A. CrJ[-✓>� Size in Gallons Z Manhole/Access((WN) y r "Pump On" Level atti 3J/Z fr ump Off" Level at 1 High Water Alarm Level at '` `f" fJ00r Vent¢PN) Tested for 12 Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes,09N) — 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 o.f. t, ,j4 . inspection. � Signed 3 & 5 ENGINEERINU `�'�G a Company 17034 Eagle River Loop Road No. 204 Eagle Ry'ger, lask- 09577 Date J l �1 MOA No. C e Receipt No. 0-5 2✓ ` /Z� c� Date of Payment Amount: $ 170• Receipt No. _ Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 ,bawt A. Uwkw a 40N VOOGI OMiOd V�rp pROFESS10i"°► ;G 1 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. ` 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 \y FEDERAL TAX ID # 92-0040440 ANALYSIS, REPORT BY SAMPLE fox Work Oxdex # 12990 Date Report Printed: MAY 2 89 # 16:34 i Client Sample ID:L2, EENAI VIEW Client Name S & S ENGR PWSID :UA Client Acct SNSENGP Collected APR 28 89 6 13:45 hrs. P.O:# NONE REC D Received APR 28 89 0 15:30 hrs. Req # Preserved with :AS REQUIRED Ordered By RJS Analysis Completed :APR 28 89 Send Reports to: !1)S Laboratory Supexvior EPHEN C. EDE & 3 ENGR I 2) Released By ......... ... ............................. .... ............ ........ I.............. ................ i Special ,j :i Instruct: l Chemlab Ref #: 5067 Lab Smpl ID: 5 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits ------------------------------------------------ NITRATE -N ;r - ND(0.1) mg/l EPA 353.2 10 Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RJS: ..... -............................................................................................... 1 Tests' Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES )� / CERTIFICATE OF INSPECTION FOR HEALTH, AUTHORITY APPROVAL 3`V�td OF ON-SITE SEWER AND WATER FACILITY 264-4744 d/� Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lo 7' Z- &64dg �/AegA,41 ✓146,j -TZ-AJ a lj sez33 (b) (c) (d) Real`! Telephone 7,0—. /7/7 (e) Mail the HAA to the following address: or: Check her if hold for pick up. List contact emon and da phone nu ber below. , 2. TYPE OF RESIDENCE Single -Family r Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. , SEWAGE DISPOSAL Onsite( Public ❑ Community ❑ Holding Tank ❑ ' Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. . Page 1 of 2 72-025 (Rev 8ie6) Font 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 Approvsl 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 �'- s Telephone Address /"& � Date is I / 6. DHHS APPROVAL 9) `/ Approved for 7WQ () bedrooms by Date ��AP 1� rl � Approved _ 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 72-025 (Rev 8/861 Back r_= L I = WMI —t 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 72-025 (Rev 8/861 Back A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) pAUNICIPALI� OE ANCHORAGE HEALTH AUTHORITY APPROVAL (HAA) EtyVIRONMENTAL SERVICES DIVISION CHECKLIST 720 VARY 1984 AUG 2 61988 Legal Description: 407� 7-- T'^) S O lP :332-a�r 30r_ -'?3. Well Classification If A. B, C, D.E.C. A proved (Y/N) Well Log Present YY 1) Date Completed �Yield Total Depth / l Cased to a Depth of Grouting �f Static Water Level GS Pump Set At Casing Height Above Ground '- (Y Sanitary Seal on Casin N) Electrical Wiring in Conduit&N) Depression Around Wellhead (Y N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots %� f To Nearest Edge of Absorption Field on Lot fore f ; On Adjoining Lots ` To Nearest Public Sewer Line, ��� To Nearest Public Sewer Cleanout/Manhole. ��� To Nearest Sewer Service ine on Lot Water Sample Collected by /}e'c3 fi'/0J ; Date Water Sample Test Results CT `�- /J/7,?A' E5 49 Comments 40A�a� fimj _i'Sr 7-13-"e - Ai a4- "eAfA ol 4o7 - sEr_- '?3. k B. SEPTIC/HOLDING TANK DATA Date Installed �'Lz- Size /10'0-0 No. of Compartments Standpipes (Y ) Air -tight Caps/(Y/N) Foundation Cleanou l (Y ) Depression over Tank (Yaw Date Last Pumped 7'13 P5 -r A3I'5 Pumping/Maintenance Contract on File (Y/N) �/� -;for AX Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N)_ Separation Distances from Septic/Holding Tank: To Water -Supply Well OoU f To -Building Foundation %S r To Property Line To Disposal Field To Water Main/Service Line %O To Stream, Pond, Lake, or Major Drainage Course �� t Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 6� Type of System Design; `e4414A Date Installed �'�Z 'S� Length of Field 4Z_ Widthof Field Square Feet of Absorption Area Depression over Field (` /N — Results of Last Adequacy Test Depth of Field h M.1/D ,ravel Bed Thickness 0';5� 756 / Standpipes Presen (Y ) Date of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well �� /� To Property Line /a'` To Building Foundation Lot ��r+ i To Water Main/Service Line /� f To Stream/Pond/Lake/or Major Drainage Course To Existing or Abandoned System on On Adjoining Lots Z-0 To Cutbank (if present) A /Qb r f To Driveway, Parking Area, or Vehicle Storage Area 400 01/4?4- 6457D Comments D. LIFT STATION Date Installed (.0-W47 Dimensions -3 Dg4 Size in Gallons jo Manhole/Access Y)N) 00 "Pump On" Level at 7 "Pump Off' Level at L High Water Alarm Level at �dVent (Y N Tested for 4AAF Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes©N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h the ked, v iffied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Date �' � .mge,v�ga Company �5 MOA No. 6�'7 � ®F �`''A'"Y � �✓ � � � n� • • Receipt No. y ��': e w 4 Date of Payment Z� � 0000* •.••• •••m• • Amount: 112-0 00 0 041000 4010*46" 7 ` • OY C. BEID, J e `��`,,•. CE - 2251 �•`.. ' Page 2 of 2 +�4kh, 72-026 (11/84) mCHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. /1174 --ON 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FEDERAL TAX ID N 92-0040440 LABORATORIES ANALYSIS REPORT BY SAMPLE fox Work Order # 8667 Date Report Printed: AUG 22 88 @ 12:56 Client Sample ID:EENAI VIEW TIESZEN ST. Client Name AECS PWSID :UA Client Acct ; AEECSRP Collected AUG 18 88 @ 15:50 his. P.O.# NONE REC'D Received AUG 18 88 @ 16:30 his. Req # Preserved with :4 DEG. C Ordered By : A. WEIN Analysis Completed :AUG 19 88 Send Reports to: Laboratory Supervisor :STEPHEN C. E�DE/ 1)AECS 9 Released By : G. i/ 2) Special Instruct: Chemlab Ref #: 2279 Lab Smp1 ID: 1 Matrix: WATER Allowable Parameter Tested Result/Units Method Limits ----------------------------------------------------------------------------------------------------------- NITRATE-N 0.49 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY A. WEIN .......................................'............... I Tests Performed See Special Instructions Above IIA -Unavailable ND— None Detected " See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than THE ELECTRIC DOCTOR, INC. WE MAKE HOUSE CALLS " 1207 W. 47TH ANCHORAGE, AK. 99503 (907) 561-2225 ALASKA LIC. #AA9148 Marston Property Management Ref: Lot 2 Kenai View Sub. 3421 Tieszen Anchorage, Alaska Lift Station check out August 4, 1988 I have inspected the lift station in question and ran the system through it's cycle. The pump ran when called for and shut down automatically when finished. The high water alarm was tested and is working. I have no additional information on this system as to construction date or the like. Robert De Loach, Electrical admin ator State of Alaska. Lic. # AA516 Ajv Y� -� MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Descrieti on (include lot, block, tip/ �1/I� s Location (address or directions) Application Date e bdivision, section, township, range) f -VArR the HAA to the following address: —j 1456 r --RING 144 QqW -- a Family Multi -Family Other (describe) of Bedrooms ual Well Community Public f, `community well system, must have written confirmation from the State' ent of Environmental Conservation attesting to the legality and statuit. i�a Public Community Holding Tank s'�4Y COMUni.ty well system, must have written confirmation from the; State; ant of Environmental Conservation attesting to the legality and st8tu +� J r, 5.19919leEing Firm Providing Inspections, Tests, file Search, Data and Information ,,A4i, Aertifiedd my seal affixed hereto and as of the validation date shown below, I f v�iiify that my investigation of this Health Authority Approval shows that the on-site r E_ anter supply and/or wastewater disposal system is safe, functional and adequate for number of bedrooms and type of structure indicated herein.- I further verify that,, r ased on the information obtained from the Municipality of Anchorage files and from my r�#1atigatioa and inspection, the on-site water supply and/or wastewater disposal, System is in compliance with all Municipal and State codes, ordinances, and regula- ""�.tidns in effect on the date of this inspection. h $� s E'dC1NEERiIVC z ;�tame of Firm Telephone_. 'LE RIVER, ALAS u y; e.a a«and PH. 694.2979 flr Date ®F AC A. Sha%r Aptroval 4�¢ °s too. 1457 roved for �°j� bedroo �P40F�E roved b'` Disapproved �e no - 'of Conditional Approval t � - AL PROT'ECTIOt�[ MUNICIPALITY OF ANCHORAGE (MOA)- HEALTH MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST 4F4EBRUARY 1984 // X E I�/ E D Legal Des ription: S b Y4�10 Z/114A ���,P 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 Casing (Y/N) Electrical Wiring in Condui(Y/ ) �� S Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by ; Date Water Sample Test Results q Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size No. of Com artments Standpipes (Y/N) Air -tight Caps (Y/N) Foundation Cleahout (Y/N Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contract on (Y/N) ;for Holding Tank High -Water Alarm (Y/N)--Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding f To Water -Supply Well To B ' ng Foundation To Property Line To Disposal Fi To:Water Main/Se 'ce Line Cours comments Page 1 of 2 72-026(11/84) To Stream, nd, Lake, or Major Drainage C. ABSORPTION FIFLD DATA Wis; Rating in Abso=tion Strata — Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Squire Feet of Abs on Area Stand pip resent (Y/N) Depression over Field (Y/N) Dat Last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well o Property Line To Building Foundation To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Servi Line To Cutbank (if present) To Stream/P /Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION s"e,,o ���/� lzQ� a Date Installed Dimension Size in Gallons Manhole/Access (Y/N) . "Pump On" Level at "Pump Off" Level at High Water Alarm Level at t (Y /N) _ 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 M A an HAA guidelines in effect on the date of this inspection. Signed Date S Compyt; SRB 196X MOA No. PH. 694-2979 .►�'�� Receipt No. OF Date of Payment �: y� •"•;�` Amount: $ 10 *; 00 • •A. ....� I i e_.• ".�•. •Y.SN .J 1 in •. Na 1487-E ; • +` Page 2 of 2 t,';c •._ r`r► 72-026 (11/84) ""MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information (a) Legal Descriptio C2 6 Application Date /Ze 2 ,�2� 1Y Y (include lot block, subdivision, section, township, range) Location (address or directions) (b) Applicants NameJLPOK POtj „j'TO AJ Telephone — Home — 60'2-0 Business Applicants Address -2V-S'- 7 14-J 2-7 _)?� A}4 1G N • / f! R_ (c) Applicant is (check one) Lending Institution ; Owner/builder; Buyer = ; Other E::l (explain); (d) Lending Institution i'E/� &,e,/d7J`{ejTelephone Ad3w,sa �Wti eA �. (e) Real Estate Co. & Agent Address Telephone AID 4- (f) IftAt the HAA to the following address: eg LA E4 WEE"ma RAR 1ARS Af. RIVER.AkA 2. Type of Residence Single—Family Multi—Family Other (describe) Number of Bedrooms 3. Water Supply Individual Well Community = Public = Note: If community well system, must have written confirmation from the State Department, of Environmental Conservation attesting to the legality and status. 4. Sew O a to 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 21 5. 'Engineering Firm Providing Inspections, Testsj 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 =-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regula— tions in effect on.the date of this inspection. Name of Gre0LA Da "`j , 6. DHEP Approval' Aged forbedrooms d Disapproved Telephone .. 0F. AL .tl....:,.y. NG �� shofar ; 4L+ �� V1.o . No. 1457•@ a1 �V� et ®�yr pRO FE5S���a.'� By Date Approve Conditional X Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT— ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERID. IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE— MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 7-19-84 [Page 2 of 21 ( TE PL OF HEALTH & �•� NTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) 'DEC HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 RECEIVED Loc. ori �' 2 A. WELL DATA e-4 Legal Description: Z = N✓� ! VI aLAJ Well Classification l()a If A, B, cr C. D.E.C. Approved(Y/N) Well Log Present (Y Date Completed Yie Total Depth c►� Cased to /40Depth of Grouting �-- Static Water Level J - f Pump Set At Lt Casing Height Above Ground �Sanitary Seal on Casing (Y Electrical Wiring in Conduit ( Depression Around Wellhead (VAg Separation Distances from Well: To Septic/Rabdilag Tank on Lot f✓ D N E On Adjoining Lots /5D 4 - To Nearest Edge of Absorption Field on Lot kO +Jr On Adjoining Lots /Sr To Nearest Public Sewer Line /V 0 A To Nearest Public Sewer Cleanout/Manhole /y1A_ To Nearest Sewer Service Line on Lot Water Sample Collected By J sti IS G�n." Date Water Sample Test Results `n re S NW0*r c. Comments GyE L e_ /.S Pb B Gt/i G CL, Airr C % N )Cr47 leer fly Arc. ,F4 ee . tat t2 E r � fJF(57 u C dW O M I -r 4-07- AIFZ - B. SE ICS TANKDAT Date Installed �//d— size ©t9 _ No. of Compartments Z Standpipes Air -tight Cap (/#)' Foundation Cleanout (Y ) Depression over Tank (4 Date Last Pumped` Pumping/Maintenance Contract on File (k/44- ; for Holding Tank High -Water Alarm ( ) Temporary Holding Tank Permit ( ?� Separation Distances from Septics Tanks % To Water -Supply Well .,)O t✓C7 To Building Foundation As- To sTo Property Line /a oe To Disposal Field 20 To Water Z/Service Line .�'� 14-- To Stream, Pond, Lake, cr Major Drainage Course D OJ 46 Comments // ✓� t✓� h %1 e et lJK G Z l Receipt # 1550 Date Paid: Amount: a [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Designft"Ad 1� Date Installed r'f Length of Field 4e iw Width of Field Zz r Depth of Field !�} Gravel Bed Thickness Square Feet of Absorption AreaStandpipes Present(Y ) Depression over Field Date of Last Adequacy Test x, Results of Last Adequacy Test Separation Distance fr Absorption Field4, To Water -Supply Wall /%.1/ %.1�/4- To Property Line /O To Building Foundation 2� To Existing or Abandoned System cn Lot /J /,j ; On Adjoining Lots F0 To Water 46virvlService Line Yb 70e- To Cutbank (if present) AJ 0 4.J IF To Stream/Pond/Lake/or Major Drainage Course o AJ 2° To Driveway, Parking Area, or Vehicle Storage Area Conanents * G✓C✓' U '^ G- o % Z / 3 D. LIFT STATION Date Installed tg 2 Dimensions >-b t A / 4 Size in Gallons _ Manhole/Access (Y ) "Pump Ori" Level at +� "Pump Off" Leve at �- High Water. Alarm Level at 42 E /A.)4 05'7' Vent Ot Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical ** Check Permitted Bedrom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. (-- -�.• �� ---I SignedCUgiWEfiIN Date Company ! t;AU A OR& ALASKA '00M MOA No. KB1/d5/s [Page 2 of 21 2-15-84