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MCKINLEY VIEW ESTATES BLK 3 LT 10
McKinley V Estates Block 3 Lot 10 iew #051-792-28 UBMJTTA 4700 Permit Number Community Elmore St. • P.O. Box 196650 ON-SITE OSP131 197 Municipality Development On -Site Water & Wastewater Anchorage, AK 99519-6650 WASTEWATER PID Number: of Anchorage Department Program • http://www.muni.org/onslte INSPECTION REPORT 051-792-28 JUL 3 • (907)343-7904 ❑ New 0 2013 Page 1 of 3 r_/ Upgrade Name: SUSAN RALEIGH ABSORPTION FIELD • Shallow Trench • Bed 0 Mound Address: 21433 BARON DRIVE *CHUGIAK, AK 99567 0 Deep Trench • Other Phone: No. of Bedrooms: 688-1159 3 Sod Rating: GPD/Sq. Ft. Total Depth from original grade: Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade: Ft Gravel depth beneath : •e: Ft. Subdivision: Block: Lot: MCKINLEY VIEW ESTATES 3 10 Fill added above original grade: Gra - -ngth: Ft. township: _ Nange: — section: _ Gravel width: \\....\G CAS " Beds Number of Fries Distance between lines: "' SEPARATION DISTANCES Total absarpt.- area' SQ. Ft. Number of trenches: Wet between trenches: Ft. To From Septic Tank Absorption Feld Lift Station Holding Tank Public/Private Sewer Lines Well 1001+ EXISTING — — 25'+ TANK ® Septic 0 S.T.E.P. ■Holding • Other Surface Water 100'+ EXISTING — — N/A Manufacturer: ANCHORAGE Capacity: 1250 cal. Lot Line 51+ EXISTING — — Material: STEEL Number of compartments: 2 Foundation 5'+ EXISTING — — LIFT STATION Curtain Drain Manufocturen Capacity: Gal. NONE KNOWN Remarks: OLD TANK WAS DECOMMISSIONED PER UPC Pump ono level as Pump off' level at Hi r alarm at LARGER TANK WAS INSTALLED PER REQUEST OF OWNER. Pump Make d: Mode ctrical Inspections performed by: PIPE MATERIAL House to Drainfield tank D3034 Tank to drainfield CO/MT D3034 Installer WHITTERS EXISTING EXISTING Inspector GEG, Ltd. BENCH MARK (Assumed elevation) 100.00 Fe Inspection Dates: 1st 3rd 7/16/13 2nd — Location and Description: BOTTOM OF TRIM SIDING ON SW CORNER OF HOUSE — 4th — Community Conditional approval: Development Department Approval Date: ENGINEE SEAL oo� op�4 o 4 P. • ' f . G . CE— yp o •••• b rofes0 r N QO aVAA Hess;' 0 -' vp ao,, Approve . 01/1/14 Date. /(th Q Q a PERMIT NUMBER: OSP131197 AS -BUILT DRAWING PARCEL ID NUMBER' 051-792-28 A B ST1 28.97 8.54 ST2 31.85 16.13 DBL1 25.79 4.90 DBL2 27.12 5.71 DBL3 32.71 19.37 DBL4 31.31 19.20 FCO 21.58 2.74 MCKINLEY VIEW ESTATES; TRACT W COMMUNITY WELL/ LOCATED ON PROPERTY / t / r MCKINLEY VIEW ESTATES; BLOCK 2, LOT 22 / PUBUC WATER f / / LOCATION OF WATER SERVICE LINE WAS PROFESSIONALLY LOCATED ON 7/8/13. / / / // / GLENN VIEW ESTATES WEST #1; /./ BLOCK 2, LOT 24 / / / / PUBLIC WATER /.� // meq/ EXISTING 3 BEDROOM HOUSE FCO / ST11BL &2� n� NEW 7699' T2 GALLON SEPTIC EXISTING TANK DRAINFIELD DBL 3&4 MCKINLEY VIEW ESTATES; BLOCK 3, LOT 9 PUBLIC WATER GLENN VIEW ESTATES WEST #1; BLOCK 2, LOT 23 PUBLIC WATER GARNESS ENGINEERING GROUP, Ltd. -•- v,v, u =.y CONSULTANTS & GENERAL CONTRACTORS we 701 E TUDOR ROAD. SURE 101 • M`CHORAGE. AW 99507 • PHONE (907)337-6179 • FAX (907)338-3246 • WEBSITE: ,m.9amweny9pMnµcom PREPARED FOR: SUSAN RALEIGH PHONE NUMBER: 688-1159 PAGE NUMBER: 2 OF 3 LEGAL DESCRIPTION: MCKINLEY VIEW ESTATES; BLOCK 3, LOT 10 DRAWN BY: PNB TYPE OF WORK: AS—BUILT DRAWING DATE: 7/19/13 GLENN VIEW ESTATES WEST #1; BLOCK 2, LOT 2 PUBLIC WATER SCALE: 1"= 40' •'*L& C%' X000 4p Q f - A. Garn ssr 0 009.', 'E79 '/fO �F2-4 l� 2:45'cl d Pr� f 1000\ c7 V (Rev. 01105) PERMIT NUMBER: OSP131197 AS -BUILT DRAWING PARCEL ID NUMBER: 051-792-28 ST1 FINAL GRADE = 99.28-99.38 ST2 TOP OF TANK TOP OF TANK AT INLET = 95.21 �I__ AT OUTLET = 95.21 INVERT OF BUNG AT INLET = 94.56 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 8 GENERAL CONTRACTORS 3701E TUDOR ROAD, SURE 101 • ANCHORAGE Al( 99507 • PHONE (907)337-6179 • FAX (907)330-3149 • MEB911E wwn'.9amnrngIrm S9.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: SUSAN RALEIGH 830-9560 LEGAL DESCRIPTION: MOUNTAIN VALLEY ESTATES; BLOCK 2, LOT 10 TYPE OF WORK: PROFILE AS -BUILT DRAWING (Rev. 01105) 3 OF 3 DRAWN BY: PNB DATE: 7/19/13 INVERT OF BUNG AT OUTLET = 94.41 ess: «& i/i4.13 v,pro fession OO000�� On -Site Wastewater Disposal System Permit Permit Number: OSP131197 Tax Code Number: 05179228000 Work Type: Septic Permit Effective Dates: July 15, 2013 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 to July 15, 2014 Design Engineer: GARNESS ENGINEERING GROUP LTD Subdivision: MCKINLEYVIEW ESTATES Site Legal Address: MCKINLEY VIEW ESTATES BLK 3 LT 10 G:1459 Owner/Address: RALEIGH SUSAN L PO BOX 672037 CHUGIAK AK 995672037 Site Mailing Address: 21433 BARON DR, Chugiak Lot Size in Sq Ft: 20026 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: r Date: Sr/3 Date: 7 MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On -Site Water & Wastewater Program Mayor Dan Sullivan Phone: 907-343-7904 Fax: 907- 343-7997 On -Site Sewer/Well Permit Application For A Single Family Dwelling Parcel I.D. oSI-14Aa- 3 Property owner(s) DAVID BUTTS Day phone 688-1159 Mailing address 21433 BARON DRIVE *CHUGIAK, AK 99567 Site address 21433 BARON DRIVE *CHUGIAK, AK 99567 Legal description (Sub'd, Block & Lot) MCKINLEY VIEW ESTATES; BLOCK 3, LOT 10 Legal description (Township, Section & Range) Lot Size APPLICATION IS FOR: (Nall that apply) Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage Sq.Ft. Number of Bedrooms 3 APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: N/A TYPE OF DEWELLING: Single Family (SF) (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance — I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Permit/Rush Fees: aCo — Waiver Fees: Date of Payment: 7l f t I! Date of Payment: Receipt Number: 0 `4?'G Receipt Number Waiver No. Permit No. CM9 II et 1 (Rev. 01/11) GARNESS ENGINEERING GROUP, Ltd. July 1, 2013 CONSULTANTS & GENERAL CONTRACTORS Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Rd. P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic Tank Upgrade for McKinley View Estates; Block 3, Lot 10 To whom it may concern: The existing three (3) bedroom house on the referenced property is served by public water and a private septic tank. Per the homeowners request he would like to upgrade the existing septic tank. We are proposing to replace the existing septic tank with a new 1000 gallon septic tank. We are unaware if any adverse impacts this installation may have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. Jeffrey Preside ess, P. . M.S. NOTE: Attached is a site plan drawing, a design drawing, one soil log, which are all part of the design package for this septic system. (Contact G.E.G. Ltd. for 7 page construction specification letter.) 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.com MCKINLEY VIEW ESTATES; TRACT W COMMUNITY WELL / LOCATED ON PROPERTY / GLENN VIEW ESTATES WEST #1; BLOCK 2, LOT 24 PUBLIC WATER MCKINLEY VIEW ESTATES; BLOCK 2,/ LOT 22 PUBLIC WATER / LOCATION OF WATER SERVICE UNE WAS PROFESSIONALLY LOCATED ON 7/8/13. EXISTING 1000 GALLON SEPTIC TANK TO BE DECOMMISSIONED PER UPC PUBLIC WATER ST1 \ \ PROPOSED GLENN VIEW ESTATES WEST #1; BLOCK 2, LOT 22 PUBLIC WATER EXISTING DRAINFIELD SCALE: MCKINLEY MCKINLEY VIEW ESTATES; BLOCK 3, LOT 9 PUBUC WATER GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS.. 3701 E. TUDOR ROOD. SUITE 101 • ANCHORAG.E. AK 99507 • PHONE (907)337-6179 • FAX (907)336-3246 • WEBSITE: w..9amw.engn PREPARED FOR: DAVID BUTTS PHONE NUMBER: PAGE NUMBER: 688-1159 1 OF 1 LEGAL DESCRIPTION: MCKINLEY VIEW ESTATES; BLOCK 3, LOT 10 TYPE OF WORK: SEPTIC TANK UPGRADE DESIGN (Rev. 01/05) DRAWN BY: PNB DATE: 7/1/13 MUNICIPALITY OF ANCHORAGE i/:a flr_� ", \ DEPARTMENT OF HEALTH St ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 254-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OIC WELL INSPECTION REPORT NAME ys PHONE 6< l""�:,J: 6 IL-NEIN ❑UPGRADE MAILING ADDRESS—,-., / LEGAL DESCRIPTION ? pp-- a1 " 1� q]9 / Y W LOCATION i NO. OF BEDROOMS SEPTIC TANK DISTANCE TO: Well �e-ttfiu,_ Absorption area Dwelling 9 PERMIT NO. Manufacturer �i1 Material No. of compartments Liq. capacit',y_iin gallons - (_: IF HOMEMADE: Inside length Width Liquid depth O z 02 Q s - r dfi DISTANCE TO: D Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons TILE DRAINFIELD TRENCH DISTANCE TO: Well Foundation Nearest lot line PERMIT NO. No. of lines / Length of each line Total length of lines a' Trench width - Distance between lines Top of tile to finish grade 9 Q Maters eneath tile g es Total effective pFa�tbsor tion area SEEPAGE PIT Length Width Depth PERMIT NO. Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J W Class Depth Driller Distance to lot line PERMIT NO. DISTANCE TO: Building foundation Sewer line Septic tank Absorption areals) OTHER ---- - - - Ph a°M-C? OA V. A. PIPE MATERIALS SOIL TEST RATING INSTALLER ,.A, C..� .tom REMARKS f a a II. 711—'11— i id APP9_QyED DATE LEGAL "Nit/ y? 72-013 (Rev. 3/78) P1 1]..3 r4 IC I if=" -11."Le CD FE. IFITA C.:3-11117orR FUCT� DEPARTMENT [ HEALTH AND ENVIRONMENTAL . ITECTION 825 /L' STREET/ ANCHORAGE, AK 99501 264-4720 PERMIT NO. ( 830059 ) APPLICANT STEVEN SKHGGS CONST PO BOX [) CHU8IHK 99567 688~2831 LOCATION SOIL AVERAGED • LEGAL L10 B] MCKINLEY VIEW ESTATES LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 147 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: fiLe li___EDVAK-EiF1F11-11= :3;7' CGRFIVIEEO___ CAFEIP-IF11-11= � THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H 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). ii-Tn=4701 I FnEE ������ INV< 1::S; I: 2E1E: == 711....11-3C.EN �I__ ii".4 f.; PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION'INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. MI1401 w::;722> u.-HIFR.TE 0"-���1.113:FAEC. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTHLLHTIOR �XF.R":111REE!E; I CERTIFY THAT i: I HM FAMILIAR WITH THE REQUIREMENTS FOR 8N -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE • 2: I iJfLL DTHE SYSTEM IN ACCORDANCE WITH THE CODS. ]: I UNDER ND THAT HE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE REMODEL]INCLUDE MORE THAN 3 BEDROOMS. PPLICANT ISSUED BY__/_ /� / .}) ��x��|t/�__DATE V4. el Russell Oyster 694-2774 0 & E ENG„JEERING & DEVELOI- MEM- CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Ellis 688-2280 Performed for: Name• �/ffl/c � /46-/9A/f2 P i/E-1-e?P, 7EAI % Tel. No F—.,41`'�c� Mailing Address. `` z . "e)}(., 5'i o E E 41,,t,0,, 99S- -7 Legal Description: Le,/ Depth (feet) /U, 81- CIC 1.//67 IN L 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Soil Characteristics / 6i2,4 V -(i- b" E/A/L_MI (fl :4 . MSSG s / '/e)`/: r P c=.4 de V, Le_' % i tf# 57m a/Cli D ua r .a --r L) f /7/ r Ground Water Encountered: Yes No If yes, what depth Proposed Installation: Seepage Pit Drain Field Comments: PLOT PLAN Ai PERC. TEST 22,2 Earl P. Ellis : t-'../ e. J i. • ' it 0 FESS t1P� Performed by: �). (.7‘_) ,� �" (.) / ( Date. 5`/74 c a� • Municipality of Anchorage _P, _ rT On -Site Water and Wastewater Program a (907) 343-7904s a r Y Certificate of On -Site Systems Approval Parcel I.D. 051-792-28 1. GENERAL INFORMATION: Expiration Date: 10 -2q- Z O Z O r Complete legal description MCKINLEY VIEW ESTATES: BLOCK 3, LOT 10 Location (site address) 21433 BARON DRIVE, CHUGIAK, AK 99567 Current Property owner(s) DAVID BUTTS Day phone 480-336-3486 Mailing address Real Estate Agent 21433 BARON DRIVE, CHUGIAK, AK 99567 ANGIE FERRIS Day phone 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System c TYPE OF WASTEWATER DISPOSAL: ❑ Individual ❑ Holding Tank ' ❑ ❑ Community ❑ ® Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 55b 1 L1 IZsb Waiver Fee $ Date of Payment ��� l o�v� Date of Payment Receipt Number On(426 Receipt Number COSA # 05(22619-30 Waiver # COVID-19 25:7o DISCOUNT APPLIED 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are). in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group, Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road, Suite 101- Anchorage, Alaska 99507 , Engineer's Printed Name: Jeffrey A. Garness Date: C= 41 ? o In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. #AECC884 6. DSD SIGNATURE _"< System #1 Approved for 3 bedroomsIPAt j,)- � System #2 Approved for 1. Disapproved Conditional approval for bedrooms _ bedrooms, with the following st�it�tiot G,r'9�� �;Z � Vi[l •I 1 Original Certificate Date: � - l e a, The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of;Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_10-10-12.doc (A COSA ..c, Legal Description: MCKINLEY VIEW ESTATES; BLOCK 3, LOT 10 Parcel ID: 051-792-28 If more than 1 septic system on lot: COSA Checklist # 1 of 1 Structure served by this system PUBLIC WATER SYSTEM l LL DATA ❑ Well log I ' d with Onsite (or attached) Well production at time of test m Date drilled Water storage tank volu g;allonsTotai depth ft Well disinfect coliform test? Yes ❑ No Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for C Static wate at beginning of test ft. menu orm bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Ars ' _ ug/L ❑ Arsenic less than MRL (ND) Collected by -�, Date of Sample B. TANK DATA IFT STATION Age of tank(s) 7 years ❑ Requir aintenance co Tank type/material STEEL Age of lift station ye Measured operating fluid level in septic tank 49'75 Lift station material ❑ Standpipes/foundation cleanout per record drawing Comments Date of pumping 10/24/2019 D. ABSORPTION FIELD DATA DEEP TRENCH Which system tested (date installed) 2114/83 Adequacy test date 12"2119 ❑ ALL standpipes present per record drawing Results ❑✓ Pass For 3 bedrooms Total measured depth from grade 10 ft (max) Fluid depth prior to test *24 in Measured depth to pipe invert from grade 5.2 ft (min) Water added *863 gal ❑ N/A — pressurized field New depth *53 in ❑ Monitor tubes go to bottom of effective. If not, state '4.8' *195 Elapsed time min depth into effective © Code -required soil cover over field Final fluid depth '30.25 in F71 System presoaked Absorption rate 450+ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) *YES date of test) N/A Gallons introduced gallons If yes, enter date X11/1719 Comments/Deficiencies: 'SEE ATTACHED REPORT DATED 1/3/2020. NOTE: 33" OF LIQUID LEVEL IN MT FOR DRAINFIELD ON 6/12/20. COSA Checklist yellow sheet E. SEPARATION DISTANCES PUBLIC WATER SYSTEM FrOTit� vate Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Sta I t> 100' Community Sewer Manhole/Clea r:r#s"100' es if No ft Neighboring Tank > 100' Ye if No ft Absorption Field on Lot > 100' ❑ Yes if No —114 Neighboring `Absorption Fields > �,. U Yes if No ft Main > 75' ❑ Yes if No ft Yes �erlSe`ptic-Line�>2570 if No ft Priva Yes if No ft Ffakii Tam nk > 100' ❑Yes if No ft Animal Containme _ ❑ Yes if No ft Manure/Animal Excreta Storage > ft ❑Yes if o ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No ft Surface Water > 100' F Yes if No ft Property Line > 5' Q Yes if No ft Wells on Adjacent Lots: Wells on Adjacent Lots: Absorption Field > 5' F�, Yes if No ft Private Wells > 100' Fv-1 Yes if No ft Water Main > 10' D Yes if No ft Community Wells > 200' Q Yes if No ft Water Service Line > 10' Fv1 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' 21 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' Yes if No ft Water Service Line > 10' ❑ Yes if No ft Community Wells > 200' Q Yes if No ft Surface Water > 100' Q Yes if No ft F. ENGINEER'S COMMENTS '`5'+ - MET SEPRATION DISTANCE AT TIME OF INSTALLATION. *'`APPROXIMATELY 10' PER WATER SERVICE LINE LOCATE PERFORMED IN 2013 FOR SEPTIC TANK UPGRADE. GEG, LTD. DID NOT HIRE COMPANY THAT PERFORMED THE WATER SERVICE LINE LOCATE. G. ENGINEER'S CERTIFICATION Qoo*��040 I certify that l have determined through field inspections and review D of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date.* • ; .l . g='='. s :s V ,;Jd'f�e'y A. lSorness; r O�� �P . • 1r� f f 2r? . ' A 4G COSA Checklist yellow sheet 4oe A o Ec d rofession a� #AECC884 GARNESS ENGINEERING GROUP, Ltd z..p.;,_....c,. ENGINEERING- SALES -CONSULTINGza�_xa Advanced ?"rrabnen*System. January 3, 2020 David Butts 21433 Barron Drive Chugiak, AK 99567 Ref: Septic Adequacy Test for McKinley View Estates S/D; Block 3, Lot 10 To whom it may concern: The referenced property has a 3-bebroom residence on it that is served by public water and a private septic system. The septic system consists of a 1,250 -gallon septic tank (installed on 7/16/2013) and a deep trench type drainfield (installed on 2/14/1983). According to the 1983 inspection report, the deep trench is 39 feet long by 3 feet wide and has 6 feet of effective. It was our understanding that the drainfield was terralifted on 11/7/2019 by Alaska Statewide Terralift. On 12/12/2019, we went to your property to perform a septic adequacy test on the drainfield. Upon arrival we took measurement of the drainfield and found the sump (monitoring tube) extended only 57.5" (4.8') below the invert of the distribution line. This would indicate that the sump does not extend to the bottom of the drainfield or is partially filled with dirt, sludge, etc. Prior to adding" water to the drainfield, we found the sump to have 24" of liquid level in it (33.5" below the invert of tfie distribution line). A total of 863 gallons of water was then introduced to the sump which caused a liquid level rise to 53" (4.5" below the invert of the distribution line). Water was then stopped from being introduced into the drainfield and it was allowed to recover for 195 minutes. At the end of the 195 -minute recovery period, the liquid depth was 30.25" (27.25" below the invert of the distribution line), a drop of 22.75". Based upon this recovery reading, it is calculated that there drainfield absorbed approximately 677 gallon in a 195 -minute recovery period. Based upon this septic adequacy test, the drainfield met the absorption rate for a 3 - bedroom house (450 gallons per day) and is eligible for a MOA Certificate of Onsite System Approval (COSA). The septic testing adequacy test data is good for 2 -years; however, prior to applying for a COSA, we will be required to check liquid levels in the drainfield to verify the liquid level is still operating below the invert of the distribution line. While onsite, we also noted the liquid levels in the septic tank (as required to obtain a COSA) and found there to be 49.75" of liquid depth in the first compartment of the septic tank and 50.25" of liquid depth in the second compartment of the septic tank. This indicates that the operating liquid level in the septic tank was normal on the day of our test. When you are ready to apply for a COSA, or if you have any questions, please contact us at 337- 6-1-7 Thank you f0 your business. Sin Jeffrey 1,:,%a.cness, P. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179' Fax: (907) 338-3246 * Website: www.garnessengineering.com 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 HAA # bi �1 I'q.b LAI) Parcel I.D. # cl — 1 ° - 1. GENERAL INFORMATION Complete legal description Thor /° /94,9e Location (site address or directions) ��y33 C,4Lu4,4, 4/- Property j-Property owner (--„--"9"o /5;f,e-4/71 /V6:1-4172:1) 4'1 Day phone 6,911- 53Z-3 Mailing address Ro•"9°x 67/72 2,,i -e-14 /4W-- /4- j9.s.77 Lending agency Day phone Mailing address Agent 4es-4/ /141-50i1 — 47-7747`/C z-oleg470 Day phone 6Y- 200 Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well x Public water 3 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 021 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 ori -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. avid R. Dayton P.E. Name of Firm ': ?210 Donalar St. '.,ruiak, Alaska 99567 Address ,( Engineer's signature �• ,' Date /,9'''Z— Phone 6%lv ,7f% uu o•n�r .• A . n. nrsirtaa • r;- { ' ' ,.�ROF SSlGN •e• 6. DHHS SIGNATURE �' Approved for a��•t C3) bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: By: Additional Comments Date /d "" to ' 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. 72-025 (Rev. 1/91) Back MOA 521 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING C fl(6is fnro-arb Parcel I.D. o.r/ fn. 2r 1. GENERAL INFORMATION HAA# 05 0W2_ Expiration Date: t s 1+— 0 6 Completeiegai description 'VG .. y Location (site address or directions) ?/y33 ate 0,e Current Property owner(s) T„L,a1 p1 /lain s Day phone an-- lo9 e Mailing address ,`'' /moo Aex ..f.22 neer ��4ro yQ,: 9'1 -.2:- Lendingligency Day phone Mailing address Real Estate Agent ni.c/ 414•.F Day phone /ZSR —O//r Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS:_ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 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 Health Authority Approval (HM) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 vasupply d i orr 9s0 days fromem. DSD also issues the date of issue for propertprt to homeowners. operties served by a private ertificates or Class Cfwelland mlth ay be eissuediare 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 Health Authority 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 Eagle River Engineering Setivi09S Address Eagle River. AK 99577 Engineer's Printed Name /'., .sm ¶r,o YE.0 ,e /c'eeo 5. DSD SIGNATURE < VApproved for 3 bedrooms. Disapproved. Conditional approval for Phone C9'1- (T/hr bedrooms, with the following stipulations: Additional Comments kk ttxOFrrrri; 41:•• --- "...4"d • WATER WASTEWATER : PROGRAM • ��Q) Cis- ). Attachments: HAA Checklist X Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other / (Rev. 01/02) P0 -671 -- Original Certificate Date: 1 - 4 D5— Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: � - t4' 'ce�y �irti� �s j Parcel ID: a /- P .% ' A. WELL DATA Well type Rlrsi,r___ If A, B, or C provide PWSID # Well Log (YIN) Date completed _ Sanitary seal (Y/N) _ Wires properly protected (Y/' Total depth ft. Cased to ft. Casing height (a ground) in. FROM WELL LOGAT I CTION ' v a3 Date of test Static water level Well production WATER SAMPLE RESULT ft. g.p.m. Coliform onies/100 mi. Nitrate mg./I. Other bacteria colonies/100 ml. Ars mg./I. Date of sample: Collected by: B. SEPTIC/HOLDING TANK DATA Tank Type/Material S ee.t. Date installed 5Ay/rt'3 Tank size /vest, gal. Number of Compartments Z Cleanouts&N) yt.r Foundation cleanoutOYN) S" Depression over tank (Y& ed o High water alarm (Y6) tel//i4 Date of pumping/S//7/4c/ Pumper Tag PvyPivG- C. ABSORPTION FIELD DATA Date installed .. /yyr3 Soil rating (g.p.d./ft2 or Ldrr. La System type reisr'csf Length 07 ft. Width ft. Gravel below pipe !z ft. Total depth /4 ft. Eff. absorption area veer ft' Monitoring tube YDS Depression over field .vD Date of adequacy test /.2//a/dr Resu Pass/ ail) For 3 bedrooms Fluid depth in absorption field before testf•Sn. Water added 4'COgal. New depthnn. Elapsed Time: Z�/ Final fluid depth fiiSin. Absorption rate >= rTD g.p.d. Any rejuvenation treatment (past 12 mo.) (' type) „er./.9.4.-w If yes, give date �f/9° Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at _ in. "Pump off'An A/Pr igh water alarm level at a - Meets alarm & circuit requirements? Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic ieeitfYe SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S Property line .25" i' -0-41x6'°-v in. On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Water main t/t� Water service line Wells on adjacent lots ♦/do' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /.f' Building foundation /.SWater main t/. Water Service line ?to' Surface water */OO' Driveway, parking/vehicle storage Wells on adjacent lots t/r9D Absorption field Surface water S, t /vD ' i'Curtain drain tTD * NBmern F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Naarne �rr,e sratsrurre /C wdev Date i Z l /01 «1' • CHRISTOPHER R. WQOO ceio3ai • 7, HAA Fee $ Date of Payment Receipt Number (Rev. 12/01) 0.00 3,Voy lajzo Waiver Fee $ Date of Payment Receipt Number ray s=/s ASBUILT-NO CORNERS SET THIS DATE. 1 HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE •EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA UCTION OF FENCE LINES, OR FOBE R ESTABLISHFOR ING BOUND- ARY LINES. SEWARD SCALE: DATE: 7/ z GRID: .riw /ysy FB: -Ft- 77 DRAWN: 49/71 & ASSOCIATES LAND SURVEYING 68 4 Ffiti%_ Ale". f • • so • Duane Mark Sow,rd , I a 4566 •�j • LS -6918 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Zor �U G� 6 Parcel I D 79:)- A. -2 A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed Driller Total depth Cased to Casing height Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION • c r, Z • 45 r't'�i tV m O -n Date of test Static water level Well flow Pump level gpm r t� m Z ril • cn o G) Z SEPARATION DISTANCES FROM WELL TO: Septic/Ig tank on lot 200 '71- ; On adjacent lots 2r9-0 / Absorption field on lot ,, /ZOO f" ; On adjacent lots �`)7/. Public sewer main 4GA/6-- Public sewer manhole/cleanout � A/A/c5. ti® Sewer service line //lzF" Petroleum tank /t/oA✓� WATER SAMPLE RESULTS: Coliform "'�I Nitrate Other bacteria Date of sample: Collected by: B. SEPTIC/HOLDEMIG'TANK DATA Date installed Tank size /6700 Cleanouts (Y/N) Y High water alarm (Y/N) Date of pumping Foundation cleanout (Y/N) N/4- O'ct 4-, 19 91 Compartments Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES//FROM SEPTIC/1-1411G TANK TO: Well(s) on lot Ao'✓0- On adjacent lots /Vi; A,/4F- To property line Absorption field 9 Surface water/drainage /lGot/t /Of/x1 /o9 4//2 A( 1/04.11t4,... Foundation Water main/service line /O 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in I:i:iIIons Manhole/Access (Y/N) — _ _ Vent (Y/ N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA f(Dat1`(-- Date e installed /g,.. On adjacent lots Surface water Soil rating �Y7S��eiSystem type _ ee'vc"5" Length , Width �� / Gravel thickness ' Total depth _ __/0 r Total ab:;orption area e Cleanouts present (Y/N) _ Y. Depression over field (Y/N) / —A/ Date of adequacy test 50'74 <'2_/l�Y�_ Results (pass/fail) vfor _ _ __ bedrooms Peroxide: treatment (past 12 months) (Y/N) ___ /yawn) A/.�w ✓ If yes, give date SI PAI L .TION DISTANCE FROM ABSORPTION FIELD TO: Well (>n kit ( On adjacent lots /9' Property line To building foundation '/ /'`,> To existing or abandoned system on lot _ Xici'e�.✓ Ori adjaront lots � v = ISNow,J Cutbank Ifo^ Water main/service line___ Surface i,l r ater ,, //Ol2 i' Driveway, parking/vehicle storage area Curtain drain Vail b /�lvuld E. ENGI fl I[R'SS CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. ,vm'46 *w ve"y David R. Dayton P.E. C.Q"TW "46x° Mf 20210 Donatar St. Y Signatrire ;,a iak,AAI ^, Engineers Name _ Date YRPR.4•'M.wweaa.yer: RNA! . 1 f•u`.> 0 f264;14-1 R. Dayton a /t 1•�PJ ee Nab. 22115 - „.04.0 a p> (-, HAA Foe $ ' Date of Paym:'nt /': ? rj (..) 1/7 s - Receipt Numbor 72-026 (Rev. 3/91)19,1,9; MOA 21 Waiver Fee: $ ._ Date of Payment Receipt Number D. R. DAYTON, P.E., R.L.S. `'x`x o"aw` Chugiak, Alaska 99567 (907) 20210 Donalar Street September 30, 1992 ADEQUACY TEST Legal Description: Lot 10, Blk 3, McKinley View Estates Date of Test: September 29, 1992 Absorbtion System: 39' x 6' effective depth trench Septic Tank: 1000 gallon, 2 compartment, steel tank Soils Rating: 147 sq. ft. per bedroom Design Flow: 3 Bedroom - 450 gallons per day WON 696-2417 Test: 480 gallons of water were injected into the absorbtion trench in 60 minutes. Float level measurements were taken at 10 minute intervals with a total rise in 60 minutes of 23". Float level measurements were taken at 15 minute intervals fo 90 minutes after water injection was stopped. The results were plotted on a grapg of time versus gallons absorbed. Results: The graphical plot showed a 24 hour absorbtion of 600+ gallons. Conclusion: The absorbtion system is currently functioning adequately for a 3 bedroom home. // ®lky�DAP9�faep Oa 0 W16D <sY�fs L.F t` +rt ® David R. Driyton ; • Et% a" . i.6, R4. 220.5•E uv i1' PNOFESSISO"O. WALTER J. NICKEL, GOVERNOR DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99515 October 1, 1992 Mr. David Dayton 20210 Donalar Chugiak, Alaska 99567 SUBJECT: McKinley View Estates Class "A" Public Water System, PWSID 210697 Dear Mr. Dayton: (907) 349-7755 I have completed a review of this office's files concerning the monitoring status of the above -referenced Class "A" Public Water System and found the following: 1. The last satisfactory Total Coliform Bacteria Sample results was submitted to this Department on August 7, 1992. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 2. The last inorganic Chemical Contaminants Sample results were submitted to this Department on February 4, 1991. This does meet the provisions of 18 AAC 80.200(a), of the State Drinking Water Regulations. 3. The last Radioactive Contaminants Sample results were submitted to the Department on June 10, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. 4. The last Organic Chemical Contaminants/Volatile Organic Chemicals were submitted to this Department on June 23, 1992. This does meet the provisions of 18 AAC 80.200(a), State Drinking Water Regulations. Issuance of this letter does not imply that the above -referenced Class "A" Public Water System is in compliance with other provisions of the State Drinking Regulations. If you have any questions on the above information, please do not hesitate to contact this office at 349-7755. Sincerely, Michael Lu Environmental Eng. Asst. II MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL k4,'-} - I �� OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal escription (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property Owner F/l�f, 4 , Telephone: Home Business Mailing Address �yJ (c) Lending Institution �i/w��- /7 � . 't-&� Mailing Address ! C/'',1 -i/ ��f ,�Q��,�� a�c/�� je (d) Real Estate Company and Agent (2e,./0 G10 c,-/ ,����� Y Address / ,i). /7 //7 7� 2 y i CALL) / ��`'S_?% Telephone lO 99-- V%-oo / (e) Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. Telephone S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 2. TYPE OF RESIDENCE Single -Family Number of Bedrooms 3. WATER SUPPLY Individual Well 0 Community 0 Public f% Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. y 77 a'?, 1Vat e. 4. SEWAGE DISPOSAL Onsite Public 0 Community 0 Holding Tank 0 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 8/861 Front 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. S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Name of Firm Address Date Telephone e '6L-297 6. DHHS APPROVAL Approved for '"'C -t) bedrooms by 2v-���__4"" UU Q ^ '' Date Approved Disapproved Terms of Conditional Approval Conditional 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 P10 PO oRv14S MU�1GD1v`g1O MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) 0NVtV'dt CHECKLIST - FEBRUARY 1984 gpck )i 0 264-4720 Legal Description' A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (9/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 Conduit (Y/N) 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 e --Cd { ; 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 T-st Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed 2-'%`/-S3 Size /c=.®O No. of Compartments G - Standpipes 60N) Air -tight Caps Depression over Tank (Y Pumping/Maintenance Contract on File (Y/N) )si/A Holding Tank High -Water Alarm (Y/N) N/4 Separation Distances from Septic/Holding Tank: To Water -Supply Well z -OC> To Property Line /01-4 Foundation CleanoutSN) Date Last Pumped 1//03 - ; for N/A Temporary Holding Tank Permit (Y/N) To Building Foundation .S r N/4 To Disposal Field 6 To Water Main/Service Line !®f To Stream, Pond, Lake, or Major Drainage Course Comments tq,4 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata /LITril/ 6/L Type of System Design %/276A-/LIV Date Installed Width of Field /17/-33 Length of Field 39 Depth of Field Gravel Bed Thickness foi toy Square Feet of Absorption Area i!/v B cl' Standpipes Present/N) Depression over Field (Y N� Date of Last , Adequacy^Test Vil/e T A A. Results of Last Adequacy Test , $5��"-( e-� - 3 , ,e___ Separation Distance from Absorption Field: To Water -Supply Well a G o 1 -F To Property Line 1O y z To Il3uilding Foundation L 0 — To Existing or Abandoned System on I of 1`174A ; On Adjoining Lots — 2 1-1 To Water Main/Service Line /o z -F To Cutbank (if present) N/4 To Stream/Pond/Lake/or Major Drainage Course _ *-f IA To Driveway, Parking Area, or Vehicle Storage Area �O r Comments D. LIFT STATION Date Installed __ Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at _ J "Pump Off" Level at High Water Alarm Level at Vent (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 MOA and HAA guidelines in effect on the date of this inspection. S 5 ENGINEERING J/3/� 7 Signed17 gd_Na ��ate / Comppole River, Alaska 99577 0 MOA No. ?%—`-° Receipt No 1 U O/ 6 f C) Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) STEVE COWPER, GOVERNOR DEPT. OF ENV12CONMEN'TAL CO1®1SERVVAT Telephone: (907) Address: ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 DATE: 4-8-87 PWS I.D.# 210697 274-2533 To Whom it May Concern: According to records on file in this office the b4CIQNLEY VIEW S/D Water Regulations Water System is in compliance with the State Drinking Sincerely, aures C. Allen., RS --- Regional Sanitarian Supervisor APPLIC NT FILLS OUT UPPER HAI ONLY -, Property Owner( ' t) A 12 L. i''''.- ', \ c).1' )(2 0 ..."' ' "I'Vn V, K C-: (T) -.,.. ' Mailing Address r ( ) (.11)6',, -.•; :-) :-.1 1.- A (7 i (;.- r , t)(.` r. .' , Zip Code ri,l)ti,. - -(/ Phone C 7 -2 -,,?,-..r.) ., , Buyer i'4::_?I'li-jr-- -:',' C) 6 i' ) 'St 11.,, -IC i::: elly,4 Address 7 1 11 / ( Ai e -,' i,-./.. 0--t-• /1 ,., ,,..•.. . .. ,,,,,/, c / r (2 1 Zip Code -).•-, , Lending Institution r: i (!,...„,i.- iv 717 ..., -.6 mil ,,,,.._ 6,,,,,,,v: c•-•,/,,: A/,',,,,, i 0 4-,, ifk,r. 1-2/) i"!., '-f '72. <::. Address ( .411'FA ; 1-- /42i / • 7-7) T.(' ('-':. // P Zip Code (le-„l'S ('', i Phone )'A , , _ ...____ _ Realty Co. & Agent k.ry'; A y / l:AC ,i r A? I de I- Address i- c i.',.)7:),:. 4-I c; . .,-. (: „t_ r- / LK: r ZipCode// 7 2 Phone 7-- i . Legal Description ) _ ,,,,,,"1-- t ;1,, ca,L._ c'i,,,,',„ ri-k, ,., .--,„/ , „. , , 1,,,,, c , , ,, I r...:••• -,,...-t.,.., r_ . "-- 7 '- • - '"'" -.-.=, 1 , , Street Location 1.,) -I , t--.- .-1:,)( 0 ;, ti) 12),k) i ' V (3) Type of Residence _.,>E1 Single Family E Multiple Family No. of Bedrooms„-) Inspector El Other Water Supply 17 Individual ,l,k: Community 111 Public Utility ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal Individual lil Public Utility C11 Holding Tank Year Individual Installed: ! When Connected to Public Utility: IA 1,....1-i AY 20 193 M8 "Municipality t)t ?i.-:,* : ,, NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date / .6426 -'.-7tiato Inspector Inspector Inspector Inspector Field Notes: (ilte--4 IA 1,....1-i AY 20 193 M8 "Municipality t)t ?i.-:,* : ,, ( ( ) ( ) DATE BY: - APPROVED BEDROOMS e ,.., DISAPPROVED CONDITIONAL APPROVAL*, (-C-3 tt--(4r.-3 " -CONDITIONS OF APPROVAL Environinanial iifi,Nter.' i Soils Rating Date Sewer Installed -2.1g--- Well To Absorption Area Well to Tank Well Log Received Septic Tank Size (6k)() 72.023 (3/82)