No preview available
HomeMy WebLinkAboutHIGH HOME BLK 1 LT 1I II { { t` ID So - 3a►- 59 Municipality of Anchorage On -Site Water and Wastewater Section - (907) 343-7904 Page of ON -SITE WASTEWATER INSPECTION REPORT Permit Number OSP241145 PID Number: 050-321-59 Dwelling: 0 Single Family (SF) M with ADU [:1 Duplex (D) [I Two Single Family Project: [] New 0 Upgrade Name John & Heather Deloney ABSORPTION FIELD Deep Trench M Wide Trench M Bed Ej Mound Site Address 1870 Upper McCrary 0 Other Phone Number of Bedrooms Soil Rating depth from original grade 15 0.8 GPD/SF ITotal 14.76 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 6.76 Ft. Gravel depth beneath pipe 8.0 Ft, Subdivision Block Lot High Home 1 1 Fill added above original grade 0.68 - 1.24 Ft. Gravel length 59 Ft. Township Range Section Gravel width 3 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES Toj Septic Absorption Lift Station � Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field i T Line 944 Ft2 1 Ft. Well 1001+ 1001+ 25'-r TANK 0 Septic El S,T E.P. F-1 Holding [I Other Manufacturer Greer Capacity 1500Gal. Surface Water 1 1001+ 1001+ Material Number of compartments Lot Line 101+ 101+ NA Plastic Foundation 10'* 101+ �TATION Manufacturer Capacity Gal. Remarks * Field verified 10'foundation to tank. Field verified 5'sepAration of tank to existing trench. Alarm location Electri ailed by Tankto PIPE MATERIAL House to tank D3034 drainfield D3034 Installer JR's Drainfield D3034 CO/MT D3034 Inspector Arcterra Consulting BENCH MARK (Assumed elevation) 100 ft Inspection ist 8/15/24 2nd 8/16/24 dates: Location and description Td 8/16/24 41h 8/17/24 Bottom of door frame ON -SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 1*11 71* "Llit"I'll" 1P 44 Conditional Approval: Date ♦10 Septic System Approved Date KENNETH Mt. CE 711 AW 9 t�ll " 4t411 Note: this approval does not include well permit requirementl. ESSk (Rev 05/02/18) 5 o .['GTERR' r� AKcTrKKA a CONSULTING, INC ti 20441 Ptarmigan, Eagle River,AK 99577 Office (907) 696-6111, Fax (907) 868-3793 �FYYF "�1',71HG _�yL LB' OFAL�,k� K, R'ln KENN'ETH i bL1 r= / AW SOILS PERCOLATION TEST \ Lys"� Performed for: John & Heather Deloney Date Performed: 8/15/24 Project: High Home Block 1 Lot 1 TEST HOLE # TH-2 Depth (Feet) 1- 0' - 3'6" Org 2- with brown silt 3- 4- - Pere Bench #1 @4' 5- 3'6" - 22' GM 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- 21- 22- B.O.H. 22' SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? No What depth? NA Depth to water after monitoring? Date (Depth below grade) Reading Date Gross Time Net Time Depth to Water Net Drop 1 5/8/24 11:00 3 4/16" 2 11:30 30 Min 5 14/16" 2 10/16" 3 * 11:30 3 4/16" 4 12:00 30 Min 5 14/16" 2 10/16" 5 * 12:00 3 4/16" 6 12:30 30 Min 5 14/16" 2 10/16" 7 8 9 10 11 12 * Water Added Percolation Rate 11.4 (min/in) Perc Hole Diameter 6 " Test Run Between 4 feet and 4.5 feet *Pere test from TH - 1 I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. NbY_b/'bb__W 132.63' ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HIGH HOME SUBDIVISION LOT I BLOCK I PLAT 73-243 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouli any infonnation on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners, responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DALE: SCALE: E—MAIL: OCT 30, 2024 1 --= 40' schullerok*gmcil.com 24-030-3 DRAWN BY. ICHECKED B�'; MD NUMBER: B001<TPAGE: JLS NW0254 240330 00 = FND 5/8" REBAR AMW AW OF AZ AW ;or 49TH * .-* .................... . ......... ?A CD •.J HN L. SCHULLER-* 0 LS-10408 �tro f . essionc\ Alw low IS 4UP, 1, D_ • A 'P GG 7f 4 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP241145 Work Type: Septic Upgrade Tax Code Number: 05032159000 Site Legal Address: HIGH HOME BLK 1 LT 1 G:0254 Site Mailing Address: 18710 UPPER MC CRARY RD, Eagle River Owner: DELONEY HEATHER K & JOHN H Design Engineer: ARC TERRA CONSULTING INC This permit is for the construction of: Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: r. D(parI)nnt 7/1 /2024 7/1 /2025 34867 2 Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Test hole to be dug to minimum 20.5' to verify soils prior to construction septic field. See note 5 on page 1 of 3. Received By: /' % Date: Issued By: Date: 5 MUNICIPALITY O,F Development Services Department On -Site Water & Wastewater Section ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-321-59 Property owner(s) John & Heather Deloney Day phone Mailing address 18710 Upper McCrary Rd. Eagle River Site address 18710 Upper McCrary Rd. Eagle River Legal description (Sub'd., Block & Lot) High Home Block 1 Lot 1 Legal description (Township, Range & Section) Lot Size 34,867 Sq. Ft. Number of Bedrooms 5 Phone: 907-343-7904 Fax: 907-343-7997 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) X❑ (w/wo ADU) Septic Tank M Upgrade IR Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Trench to slope greater that 25% Distance: 0' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. Dea Duffus (Signature of property owner or authorized agent) Permit/Rush Fees: Sq Date of Payment: Receipt Number: 00Z(O(r Permit No. dSp 2 `( I l `f5 Waiver Fees: Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\FormsUient Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241145, Curtis Townsend, 07/01/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241145, Curtis Townsend, 07/01/24 A TRCERR A A TRCERR A C O NSULT I N G ,I N C . Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241145, Curtis Townsend, 07/01/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241145, Curtis Townsend, 07/01/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241145, Curtis Townsend, 07/01/24 A4CCI� 4R y �.,.R04 D N by _b /- bb.. W 1 ,52. 6,5" ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: HIGH HOME SUBDIVISION LOT 1 BLOCK 1 PLAT 73-243 SURVEY CERTIFICATE: I, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing and that the improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shoul4 any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary limes. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCALE. E-MAL APRIL 29, 2024 11?= 30' schullerckOgmail.cam 24--030 DRAWN BY: CHECKED BY GRID NUMBER: BOOK/PAGE: JLS NW0254 240139 * == FND 5/8" REBAR AW 1••' 4 �H K ® . . . • . . . . . • ♦ . . . • . • . . • • • ; • • • a • • . TU^ ` 'Z ?A t �•.JOHN L. SCHULLER.• 0 A0 a + • • • ��� ems' 1831 Talkeetna Street • g '4 : ,erg �` Anchora e, Alaska 99508 o'p �� �� ry fe Q; ��GW ,(907) 227-1455 office (907) 274--4992 fax q 4-7rc- 3 M Mark Segich Mayor Pump Installation Log Well Drilling Permit Number: SW Date of Issuer Parcel Identification Number: Legal Description 4 16-3 o A4 Pump Installation Date: C6/Y/P- Pump Intake Depth Below Top of Well Casing: 300eet Pump Manufacturer's Name: zF1P—/ek0- Pump Model: /Poe Pump Size hp Pitless Adapter Burial Depth: feet Pitless Adapter Manufacturer's Name: pideS3 lastaflerl NIA' /ell Disinifected Upon CornplefloiY." F] rTD Method of Disinfection: Comments: Pump Instiflel. -Name., Property Owner Name & Address: l3perT mcs*e- 184-11) blppeR PeC12A2Yf Faye, PwAap, Attention: . The Ownp installer shall provide a pump installation tog to the DSD within 30 days of pump installation. Municipality of Anchorage Page of_� DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: _-_ SW F30Z�Zr? PID Number: ASO - a32/ _59 Name: Ss�Ly/�q �o� 1�,a u Wastewater System: D�New ❑ Upgrade Address: r ABSORPTION FIELD i Phone: Ycl rN No. of Bedrooms: - Xbeep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: q Total Depth from original grade: D, 0 GPD/Sq. Ft. 17 Lot: Block: ubdivlsion, r Depth to pipe bottom from original grade: Gravel depth beneath pipe Township: /1 Range: Section: Fill added above ori Inat grade: � Gravel length: FL Fl. • WELL: New ❑ Upgrade _ Gravel AaCM: WIDT Number of lines: Distancce�b tween lines: _q Ft. / Y Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: O Pipe material. �f Ft. -30 Ft. %7SQ. Ft.?©37 Driller: /11-12/NE Date prill� : /,9/3019 3 Static Water Level: 8.3 Installer: Date installed: Ft. Yield:Pump Z Set a�jC Casing Height Above Ground: TANK GPM -r Fl. FI. SEPARATION DISTANCES Xseptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lilt Holding Pub"/Private Manufacturer: ";41y4 Capacity in gallons: From Tank Field Station Tank Sewer Lines /19/(r11/ / 200 Well / Z v /�? / 127 ,c//� N �{`i �j / Material: J Number of[ Compartments: J li Surface N14 LIFT STATION ///,4 _ ---- Lot 2 / Size in gallons: Manufacturer: Line Foundation /. / l / /n/� ^ ' "Pump on" level at: "Pump off' level at: High water alarm at: Curtainv(i/'� Pump Make & Model Electrical Inspections performed by: Drain / Remarks: BENCH MARK Location and Description: 6()�O II` S/ /,y1-- 7r 2<Q+k Assumed Elevation: /00119 ENGINEER'S SEAL y'• f E �• �� �� ° e 1"t� Y4 °�•. rw'see Yt Inspections �g�GI9`F fr i/ � 6� eP ptr dYl e•=.a performed by: Dates: 1s =.°•e..ar,e° 2nd 211219"k a1<r �� .,,•z . `'''AAAs Department of Heal t and Hut Services aper vat Reviewed and approved by: `- �tij� Date: Permit No. SW ��7-1? Page _e_ 2—_ of 7i Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: #IG,H HO&C- 40-r / 16445L J PID No.: OjO-3Z-1-59 � MccRA o \ R \D M 10' urk � -r fASEHfNT WELL 3¢ q� a 0 0 0 VACANT LOT A 1500 GAL HOUSE TANK ry LOT 2 SWINGS .'w WELL AC 24'b D G AD 33.1 +101� B AE 53.9 }s>, BC 44.3 E BD 64.1 BE 24.6 V W SCALE 1" = 50' • - MONITOR TUBE o - SEWER CLEANOUT OLD ROAD BED -0— _ WELL LEACHFIELD — — - EASEMENT ENGINEER'S SEAL OF N 0527'% W ' C;�� J ELEVATIONS BOT. SIDING 2 REAR BAY VIN . 49TH (NOT TO SCALE) ASSUMED "C' 100.00' O' 00 10 2' ADDED FLL GG,Reour"o �� c LOUIS A. BUTERA =�W� LEVEL R 93.5' �CE-6736 0 t2 NO GVT 7ss 1, PROF NPS w� 9<.6' TANK 4.3' 91.7' 91.7' I1` ESSI� '� 72013 A (Rev. 9/91) MOA 25 SEP -13-94 TUE 9 707 Fv �SWC/1nLf)-X P_ 01 STATE OF A AZKA DEPARTMENT OF NATURAL. RESOURCES DIVISION OF WATER WATER WELL RECORD LOCATION OF WELI eosouam su WON LOT SLOCK sEGMN DTRs smnm Tovrt mp PANGE nmaootN iq ®N ❑E f Qs ow LOCATIOWSKETCH: WELL OWNER: DEPTHS MEASURW FROM:Ikasing top ❑ground surface WELL DEPTH: DATE OF COMPLETION Depth of holo: it Depth of casing: ^� ft ��% 3.0 1 f BOREHOLE DATA: Depth Material Type and Color From To DEPTH TO STATIC WATER LEVEL. .5 • It below Stop of casing C3 ground Surface Date: /� � �'Q ► 9�., METHOD OF DRILLING: ,flair rotary ❑ cable tool p other -9 — u5E Op WELL: fgdomestic 0 irrigation ❑ monitor M public supply 0 other ��— CASING STICK-UP: _1t. Diam: in, tozeft Casing t'": in, to Zalt �LrI WELL INTAKE OPENING TYPE: 0 open end 0 screoned perforated 2 open hole Depths of openings: to —ft SCREEN 'TYPE: _ Diam: In. SroUMesh size: Length:_„ it GRAVEL PACK TYPE:._ Volume used: a Depth to trop: GROUT TYPO: Volume: �, Depth: from ft to ft - DEVELOPMENT METHOD: Duration: e h r PUMPtNG LEVEL AND YIELD: ,( ft after _res, hrs pW npirp,.9 --0Pm PUMP INTAKE 00"; ; ft Horsepower _� WELL. DISINFEC7tn UPON COMPLETION? 0 YES Cl NO CONTRACTOR INFORMATION: REMARKSe 11 hep stAie 6u5inesS N me � PLEASE MAIL WRITE COPY OF LOG,TO: /to. DNRIDIVISION OF WATER $�gnature o�onzea espro mvv Oate PO BOX 772118 ggOle RIVER AK 271fi PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES,1, `J P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930428 DATE ISSUED:10/14/93 DESIGN ENGINEER:EAGLE RIVER ENGINEERING SERVICES EXPIRATION DATE:10/14/94 OWNER NAME:DUTTON SYLVIA KAY OWNER ADDRESS:P.O. BOX 772468 EAGLE RIVER, AK 99577 PARCEL ID:05032159 LEGAL DESCRIPTION: HIGH HOME BLK 1 LT 1 LOT SIZE: 34867 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PR RECEIVED B ISSUED BY: DATE: fy b'3 DATE: _ Louis Butera, P.E. Registered Civil Engineer October 8, 1993 John Smith, P.E. Manager, On -Site Services Municipality of Anchorage P.O. Box 196650 Anchorage, AK 99519 Re: High Horne, Lot 1, Block 1 Narrative Dear Mr. Smith: The proposed septic upgrade will have very limited impact on adjacent properties for the following reasons: 1. The area has large lots allowing sufficient room for septic sites. 2. Immediate neighboring septic systems are all +30' distance. 3. Reserve space is adequate, due to absorption capacity. 4. Drainage will not be affected and is not a major consideration in our design. If you have any questions please call our office at 694-5195. Sincerely, Louis Butera, P.E. /1993/93-064A.NAR PO Rnv 7719W . Penlo A1,A_ 00577 . 9},1....6,...,, 10011 Con CM: - c.... mnm cnn onno EAGLE RIVER ENGINEERING SERVICES P.O. Box 773294 EAGLE RIVER, AK 99577 (907) 694.5195 ,,,q High Home Lot 1, Block 1 SI IEET NO. OF CALCULATED BY L. B. DATE 10/08/93 CHECKED BY DATE SCALE Five Bedroom Single Family Residence 5 BR = 750 gpd Soil rating = 10 min/inch = 0.8 application rate (trench) 750 gpd _ 0.8 = 938 square feet absorptionarea Trench Dimensions: Gravel depth = 10' Length = 938 - 20 — 47' Width = 3' ;� G9A4,01 j�� rr•��!O e � 7g u n �FO oo'oo pa ♦ oanvi ea^• aaae Y O• Look C --6735 N� 0 F I sS5 \1993\93-064A.CAL MOD UN7d!-I ISb;H SIwLl 2.15 1 ICMP:dIn .mNt.G'0'mFbrsOIUIIoOf*I VlpllE 1OFL FRIF 1 n 225 WO SPECIFICATIONS FOR ON-SITE SEP'T'IC SYSTEM LEGAL: LOT 1, BLOCK 1, HIGH HOME A. GENERAL 1. The well and septic plan are for a single family residence only. 2. The drawing and or site plan shall be a part of this specification. 3. All materials and workmanship shall meet the Anchorage Department of Health & Human Services requirements. 4. All soil tests are advisory to the design and are to be verified or modified in the field by the engineer. 5. All excavations and depths are advisory and are to be verified in the field by the contractor to meet Municipality of Anchorage requirements. 6. It is the responsibility of the owner to obtain all necessary permits or easements and to locate any adjacent multi -family wells. 7. The excavation is to be exactly in the area shown on the site plan, any deviation requires engineer approval. 8. It is always recommended that a surveyor locate the nearest lot line position and the location of any easements. B. TRENCH 1. The trench is to follow the natural land contour to maintain uniform total depth of' the trench bottom. 2. The bottom of the trench shall be level, plus or minus 1.5". 3. The total depth of the trench excavation is not to exceed 12' at any point. 5. The trench gravel is to be covered with filter fabric material. 6. Soil or combination of soil and extruded board insulation to a depth of 4' or equivalent is to be placed over the leachfield. 7. The area over the trench is to be finish graded to prevent ponding of surface water runoff. 8. The septic tank and leachfield must not be closer than 100' to any existing private well, 150' to any Class "C" well, or 200 feet to any community well. RECOMMENDED LEACH -FIELD DIMENSIONS:: TOTAL DEPTH = 12' � r—y GRAVEL DEPTH = 10' TRENCH LENGTHr��5ey TRENCH WIDTH = 3' SOIL RATING = 0.PD T22 BEDROOM CAPACITY = 5 SEPTIC TANK SIZE = 1,50GALLONS r Twenty-four (24) hours notice required for all inspections. \1993\93-064A.SPC VACANT LOT N �,Upp McclyAR v NO CONFLICTING WELLS +100' B — TEST HOLE • = MONITOR TUBE o SEWER CLEANOUT NO SURFACE WATER +100' -0 - WELL NO KNOWN CURTAIN DRAINS PROPOSED LEACHFIELD— — — EASEMENT WELL cSc SEPT _IC SITE PLAN LEGAL: LOT 1, BLOCK -1 HIGH HOME OWNER: N/A _ CONTRACTOR: JOHN C. HAGMEIER CO., INC. JOB 93 064[ DATE: 10/08/93 SCALE 1' = 50' EAGLE, RIVER ENGINE'E'RING SERVICES P.O. Dox 773294 EAGLE RIVER, AIS. 99577 (907) 694--5195 FAX: (907) 694-3297 OF 4� W P een^A0090p� Fy P o'\ enc 4& 9pflB ay,; Do y, iti 7ooeo• /ep •aD�wweo.�._ Done o6Dsgemgc- oo..e.o��e one g G�4e Louis A. Bviora � � �CE-6736 �-o �eq• q®ggq���(j 6 %Q0FESS1 (ENGINEER'S SEAL) Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:/}l/iGhl�/E/� DATE PERFORMED: O9L,S?IV3 _ LEGAL DESCRIPTION: rll67Hf//J/4C L01- ,(?�/G % Township, Range, Section: 7--/5`N fl�/w SCC, b T SLOPE SITE PLAN BKowN 5/t -f 2 -- 3 4 q. 5 �O 6- 7 7 O 8 O 9- 10- 11 10 11 12 d e7 13- 6--- � 3 C�� VfX/65, SA/,IpY, 67&411GL1-Y 5/LT /t Tl Utgv�LLy SAND VE,rzy DEnrSC 541tfE if 5 Z''17' WAS GROUND WATER ENCOUNTERED? NO 5.4/f,� '4r /, , S (fir12y IF YES, AT WHAT L DEPTH? 0 E 14 Depth to Net Water(!N) Drop /N ti -5�r/0 o/r� 15 E -y It1® °�pO °C°Tp.j CJ 16 .47 4 o" %'!-i ee apQ� t 900 Waa �o 17 ��< ro0 opaan apo ae oao .. R: 18 >T`� Looe A. [?vt;,re ° , a 19 n p or= v 20 COMMENTS Depth to Water Aller Monitoring? Date: O F' -3;- Reading Date Gross Net Reading Time Time — Depth to Net Water(!N) Drop /N ti -5�r/0 o/r� MIN" l!r 03;,y9 PERCOLATION RATE (mmules/inch) PERC HOLE DIAMETER 6 „ TEST RUN BETWEEN �— FT AND % —FT PERFORMED BY: j�7- /L C-- I �� CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) 0*Municipality of Anchorage DEPARTMENT OF HEALTH R HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502.-0650 SOILS LOG — PERCOLATION TEST ^ 'ev .. O"2V oo`(ENGINLF�R'S'&EAL)",j� 00600. .AC £Oq S7D :�.�•" �. �a A to e Louis A. Butzra oe n CF -6735 ou PERFORMED FOR: N4C;Af E/L DATE PERFORMED: O9 LEGAL DESCRIPTION: T'l�N'tIOME LOT /. 4L1� / Township, Range, Section: T/yr t/ k9/W IST SLOPE SITE PLAN 1 2 -1--- O 13 14- 16- 17 4 1617 t O 18 0F96HNlC- 13,COWN/ 5/6f, 02l,�9Nl(� VAljlGS, SJ91qDy (a2AVELLY 5/1-T S/LI-Y 6--r,eAVELL / S/)/ly VCR'/ UC/VSC /V60/v/11 1)4�Ll aE 19 20 COMMENTS _ 7"H —5196 Reading Date Gross Time WAS GROUND WATER ENCOUNTERED? No S IF YES, AT WHAT L D PTH? /�� /9 P V��y LI %TLS S1 Lr A n A CC7 P Depth to Waler Aller ',9NDY 4121ACL Monitoring? Date: _ /V60/v/11 1)4�Ll aE 19 20 COMMENTS _ 7"H —5196 Reading Date Gross Time Net Time Depth to Water(//,)) Net Drop /N /3 09 DRY 3 ql os Lf _ 58 19 /N 13 /9 / 5 15 3f_ 9 0 3e r v /l� l C)/ /`/ 3Z / o / y q7 / 1 5 PERCOLATION RATE ' b (mmules/inch) PERC HOLE DIAMETER TEST RUN BETWEEN 6 FT AND _ FT PERFORMED BY: %�i -� I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: Z'-'ZZe/5-3 72-008 (Rev. 4/135) MUNICIPALITY OF ANCHORAGE Development Services Department \� Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax: 907-343-7997 Parcel I.D. 050-321-59 Certificate of On -Site Systems Approval Expiration Date: Legal description HIGH HOME BLK 1 LT 1 Site address 18710 UPPER MC CRARY RD Eagle River AK Current property owner(s) DELONEY 8/15/2025 X The On -site system(s) is/are approved for 5 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 9/10/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA Approval —June 2022 WUNICIPALITY OF ANCHORAGE R05H Development Services Department Phone:907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-321-59 Complete legal description High Home Block I Lot I Location (site address) 1871OUpper McCrary Current property owner(s) John & Heather Deloney Day phone 2. ON -SITE SYSTEMS SIZED FOR 5 BEDROOMS 3. TYPE OF WATER SUPPLY: 2 Private Well E] Private Well serving 2 dwelling units R Private Well serving 3+ dwelling units R Community Well or Public Fj Water Storage 4. TYPE OF WASTEWATER DISPOSAL: 0 Private Septic R Private Septic serving 2 dwelling units M Holding Tank R Community Septic or Public Sewer 5. SEPTIC TANK: FI Steel V Plastic ❑ Concrete F Fiberglass Age New - See advisory if steel older than 20 years 6. ABSORPTION FIELD: 0 AWWTS F-1 Bed V Deep Trench F-1 Wide Trench El Seepage Pit Waiver request for: Expedited review requested: 0 Distance: By applying for this entitlement, this property is subject to inspection by municipal On -site staff to verify the accuracy of the information provided. COSA Fee $ P, � Q /(513 Date of Payment . C/z:�A�'-y COSA # 0 5 C 13 -3 -2- Waiver Fee $ Date of Payment Waiver # COSA Application —June 2022 COSA Checklist Legal Description: High Home Block 1 Lot 1 Parcel ID: 050-321-59 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ❑./ Well log is filed with Onsite (or attached) Date drilled 10/30/93 Total depth 348 ft Cased to 30 ft 0 Sanitary seal is functioning correctly ❑✓ Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 8/16/24 Static water level at beginning of test 95 ft. Comments B. TANK DATA Measured operating fluid level in septic tank New Date of pumping ❑ Required maintenance completed, ifAWWTS Comments: New install 8/15/24 D. ABSORPTION FIELD DATA Which system tested (date installed) 8/16/24 ❑ ALL standpipes present per record drawing Total measured depth from grade 16 ft (max) Measured depth to pipe invert from grade 7.44 ft (min) ❑ N/A — pressurized field. ❑ Per record drawings, field is insulated. 0 Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies Well production at time of test 2 gpm Water storage tank volume None gallons Well disinfected for coliform test? ❑ Yes ❑✓ No [K] Coliform bacteria is Negative Nitrate mg/L] Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by Arcterra Consulting Date 8/16/24 T STATION ❑ Require t� Age of lift station Lift station material Comments: ce completed Adequacy test date Results ❑ Pass Fluid depth prior to test in Water added gal New fluid depth in Elapsed time min Final fluid depth in Absorption rate gpd FIELD STATUS — POST RECOVERY Effective depth (per record drawings) Effective depth used in Effective depth remaining in 96 in COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' Community Sewer Manhole/Cleanout > 100' ✓❑ Yes if No ft 0 Yes if No ft Neighboring Tank > 100' ❑✓ Yes if No ft Private Sewer/Septic Line > 25' © Yes if No ft Absorption Field on Lot > 100' ✓❑ Yes if No ft Holding Tank > 100' ✓❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' ✓❑ Yes if No ft 0 Yes if No _ ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' 0 Yes if No ft © Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' J❑ Yes if No ft Surface Water > 100' ✓❑ Yes if No ft Tank to Property Line > 5' ✓❑ Yes if No ft Wells on Adjacent Lots: Field to Property Line > 10' R Yes if No ft Private Wells > 100' ✓❑ Yes if No ft Water Main > 10' 0 Yes if No ft Community Wells > 200' © Yes if No ft Water Service Line > 10' 21 Yes if No ft If tank or field is under driveway comment below F. ENGINEER'S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines, indicates that the on -site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date e Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. +`*f��" The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The 4- O flow and absorption rates may change due to subsurface conditions that may not be observed from the 4; surface, changes inland use, local soil characteristics, groundwater levels that may fluctuate during the year r {7 `� and the water usage of the family being served by the system. The operational life of all well and septic ■ * �� systems are subject to these various and dynamic characteristics and are outside the control of the evaluator or 4g m of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will A function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen KiwgiTH 4, r encroachments, deficiencies or discrepancies exist. uFFUS� I.JN � �t 1 COSA Checklist -June 2022 +rkkkks �i� ~ • Municipality of Anchorage u5 6 7 8 3 70 °`_ eV -to_ On-Site Water&Wastewater Program a abbiv (907) 343-7904 0 s a E . a AUL 1 3 201 CERTIFICATE OF ON-SITE SYSTEMS if'�'OVAL ti 6gLg �'� Parcel I.D. 050-321-59 Expiration Date: 10-2-S"-- I 1. GENERAL INFORMATION Complete legal description HIGH HOME; BLOCK 1, LOT 1 Location (site address) 18710 UPPER MCCRARY ROAD*EAGLE RIVER,AK 99577 Current Property owner(s) BRETT MCBRYDE Day phone 748-8877 Mailing address 18710 UPPER MCCRARY ROAD*EAGLE RIVER,AK 99577 Real Estate Agent Day phone 2. TYPE OF DWELLING: II Single Family (w/wo ADU) ❑ Duplex E Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well U Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariancerequest for.. N/A Distance: - n V _ Received by:( / Date: V2 s//7 COSA to be released to the e/nee less otherwise requested by the engineer. COSA Fee$ a(p —f Waiver Fee$ Date of Payment '7 l I`{ l i Date of Payment Receipt Number Receipt Number COSA# DSCI'l 12.gc/ Waiver# i 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. Phone 337-6179 Address 3701 E.TUDOR ROAD, SUITE 101 *ANCHORAGE,AK, 99507 JEFFREY A. GARNESS, P.E. 7/1/2/77- Engineer's /1/Z//7' Engineer's Printed Name Date Engineer's Comments: in conducting this evaluation,GEG provided an engineering evaluation of the well and/or septic system in accordance with the .rr101�1%.�, guidelines and regulations established by the Municipality of Anchorage and industry practices.The reported results describe the •*- OF 44♦ condition of the system/s on the dates of the evaluation.Separation distances were measured to readily identifiable features. :•A_\ •••• • (� �♦ Hidden defects or encroachments may exist that were not identified during the evaluation.The operational life of all wells and septic 4: /J._., V ♦• systems depend on a variety of variables including,but not limited to,soil conditions,groundwater levels(that may fluctuate during ••`) ••• It the year),quality of construction(materials and workmanship),and the water usage of the family utilizing the systems.These ; 'i * �. conditions can vary,and are outside the control of GEG.Satisfactory test results do not guarantee future performance of the „I`• • • 1• systems;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 (14 ,,,, r1� % current systems fail.The content of this report is for the sole benefit of the person/party who retained GEG.Reliance upon the /---�-�/ 1 rness / information provided in this report by any other person or party,including but not limited to subsequent property purchasers,is not ,#.‘"'•-t 0 •y =Lv: authorized.in short,GEG disavows any legal duty to anyone other than the person/party who paid for this report. C 79 3 a 6. DSD SIGNATURE .+ PROFESS����•-' LICENSE ,1Ri,1„`�..4 #AECC884 />( System#1 Approved for bedrooms. System #2 Approved for bedrooms. \11Y0= Disapproved. -\QI�— -4i1,�: Conditional approval for bedrooms, with the following stipylkk�ns: ON-S/T- WATER AND n1 WflSTEV /\y ER z - PROGRAA4 . '-9n . •Sri ,\.„;-• c-. ,‘ L / — By `�. (—' 0 Original Certificate Date: 7-- 2S ^1^7 The Municipality or Anchorage Develop,emt Services Division(DSD)issues Certificates of On-Site Systems Approval(COSA)based only upon the represenatations 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. ATTCHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other rRnv 1N17/171 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: HIGH HOME; LOT 1,BLOCK 1 Parcel ID: 050-321-59 A. WELL DATA *CASED TO BEDROCK Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 10/30/93 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 348 ft. Cased to *30 ft. Casing height(above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/30/93 10/26/16 Static water level 83 ft. 101 ft. Well production 2 g.p.m. 1.95+ g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate ND mg./L. Collected by: GEG, Ltd. Arsenic: <5 ug./L. Date of sample: 6/21/17 B. SEPTIC/HOLDING TANK DATA 23 YEAR OLD STEEL SEPTIC TANK MAY BE APPROACHING THE END OF ITS USEFUL LIFE Tank Type/Material STEEL Date installed 8/18/94 Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/20/17 Pumper JR's PUMPING C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE OF MT Date installed 8/18/94 Soil rating (i.p.d. or ft2/bdrm) 0.8 System type TRENCH Length 47 ft. Width 3 ft. Gravel below pipe 10 ft. Total depth 15.1+ ft. Eff. absorption area 940 ft2 Monitoring tube **YES Depression over field NO Date of adequacy test 10/26/16 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 63 in. Water added 758 gal. New depth 65 in. Elapsed Time: 12 min. Final fluid depth 63 in. Absorption rate >= 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date - -MT ON WEST SIDE OF TRENCH GOES 9 FEET INTO EFFECTIVE DEPTH. -MT ON EAST SIDE OF TRENCH WAS NOT FOUND. . l , D. LIFT STATION Date installed Size in gallons Manhole/Access(YIN) "Pump on"level at in. "Pump off"level at wa er alarm level at in. -- Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100'+ Absorption field on lot 100'+ -- On adjacent lots 100'+ Public sewer main 75+ Public •sewer manhole/cleanout '100'+ Sewer/septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS DRAINFIELD IS 12 FEET FROM SLOPES GREATER THAN 25%-NO DAYLIGHTING OBSERVED visas aIg h 4�. � 4� 'f G. ENGINEER'S CERTIFICATION .!4:. ,- r b ,• ' +fl.` s ii 1 certify that I have determined through field inspections and ° 4: I, �i` ! review of Municipal records that the above systems are in 0 conformance with MOA COSA guidelines in effect on this — 1'I' ..."" 't• date. !.�';. Je :y . ness a Engineer's Printed Name JEFFREY A.GARNESS _joy.... • — 95 .. �r Date /-112..//1 �' � FESSt Y 44 LICENSE 1111aaaaaaS *AECC884 (Rev. 10/12/12) Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On-Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: COSA#: OSC171294 Permit#: PID#: 050-321-59 Legal Description: High Home Block 1 Lot 1 Engineer: Pannone Engineering Services Applicant: Garness Your request for a waiver of the required 50 feet horizontal separation from the absorption field to the excessive slope has been approved. The approved separation distance is 12 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. This waiver does not apply to alternate field ❑ 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: Approved by: Name of Reviewer **** VARIANCEIWAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE 0* DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services t 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. # 050--321-59 HAA it ' /Afj) _2��> 1 1. GENERAL. INFORMATION Complete legal description Lot 1; Block 1; High Home Subdivision Location (site address or directions) 1 871 0 Upper McCrary Eagle River, AK Property owner Sylvia Dutton Day phone 337-9201 Mailing address C/O Fortune Properties 2525 "C" Street Anchorage, AK Lending agency Day phone Mailing address Agent Margaret Goche/ Fortune Properties Dayphone_ 337-9201 Address — Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 421 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. Alaska Water & Wastewater Name of Firm Considtants, Ime. _ Phone 3 f 7 Address 7320 Last Chester Hts. Circle Engineer's signature 09504 101-2,199 Date INC- #//ComFes- c�1�,f=��1aU StCF� Pte' �rzJ-" (NVoIC� S_UL�-�1�rTJ� T-0 PV TV 6. DHHS SIGNATURE _le`� Approved for VE bedrooms. Disapproved. Conditional approval for Additional Comments W 1l1TIC Y) effrey . Garness 7953 ®�®E ®® bedrooms, with the following stipulations: Date /0- G- 9R 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 ;I Municipality of Anchorage OCT � DEPARTMENT OF HEALTH & HUMAN SERVICES 0* Environmental Services Division iv ulourr+ui r ur AlxY 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34,yI4 t4NrAl SH Health Authority Approval Checklist Legal Description: LOT I, f3LOGK �. NiGu Moat€ ��D Parcell.D.: 060"3Z1— A. WELL DATA n Well type PKWATE= If A, B, or C, attach ADEC letter. ADEC water system number 1� R Log present O/N) YES Date completed /0%o/13. Total depth 3143 Cased to 30'60 e-a"`"t)Casing height (above ground) Sanitary seal (9N) FROM WELL LOG Date of test _ 10�30/93 Static water level a31 Well production _ g,p.m. WATER SAMPLE RESULTS: Wires properly protected (ON) AT INSPECTION ! �zzS `18 is lj- — YES Coliform' Nitrate �N� v►2q/L Other bacteria Z _ le: q�a8�98 WAS-AsKP, wa-raA_ Date ofsam P Collected by: ASrewArdn. 4:::_�m4Suurgrro'rs ►Nc . B. SEPTIC/HOLDING TANK DATA Date installed f3 18=�_ Tank size 1500 Number of Compartments Z _ Cleanouts 6)N) Y&§ Foundation cleanout (9N) YF -s Depression (YeD I,io High water alarm (Y/t-V_ No Date of Pumping Y2S q S Pumper . K gum pirJ C. ABSORPTION FIELD DATA Date installed O 1$ ` q —Soil rating (.p.d./ oH*bdm) 0. S _ System type _ �T SS tj -I4 Length 'f7 Width 3 Gravel thickness below pipe 101 _ Total depth yY 1f Effective absorption area q4© Monitoring Tube present (Y/N)`fEs Depression over field (YQ do Date of adequacy test _6z5 `►$ Results 5)/w PAss For 5 bedrooms Fluid depth in absorption field before test (in.); 19" Immediately after 76 gal. water added (in.): q4f " u Fluid depth 3a (ins) Minutes later: Z� Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Yty NONE I<kbvjrJ If yes, give date 72-026 (Rev. 3/96)' D. LIFT STATION 0 /,p, Date Manhole/Access (Y/N) High water alarm level. E. SEPARATION DISTANCES "Pu "Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 1001+ Absorption field on lot Public sewer main Sewer /septic service line /00 0 Size in gallons On adjacent lots On adjacent lots "Pump off" level at' Public sewer manhole/cleanout Lift station rJ nl /A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: 1 I Foundation S4 -Property line f o I 'f Absorption field 6 -!- Surface water/drainage 1 odf -1- Wells on adjacent lots 1 001 Water main/service line 10 t+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: f Property line 10 Building foundation I U F Water main/service line i h 1+ i Surface water 1001 t Driveway, parking/vehicle storage area So Curtain drain Nat -c krl6u)r1 Wells on adjacent lots loolt x Pere 105,PEcr?C)rJ RcPn2f ,��,�®�� F. ENGINEER'S CERTIFICATION 1/12'� or "A I I certify that l in conforman inspections and review of ,s in effect on this date. Signature t ff , ',,- A. Engineer's Name Date Z HAA Fee $ y ()—d` 67) Date of Payment Receipt Number Z/ 72-026 (Rev. 3/96)' a Waiver Fee $ Date of Payment Receipt Number E-7953 •ee a RO.FESSt�N�`� are CTM l;nvlronmental Servicee Inc. . .s.�n,�zirarr�-®sasw,s�y C'l uERet'.# 985603001 Client PO# Clr'ent :Name ,kK wAter & Wastewater Consultants Inc, Printed iDette/Time 10/02/98 09:59 Project Name/# Lt 1 011( 1 High Dome SID Collected Date/Time 09/28/98 08:45 Client sm"ple I -P Outside Hese Dib Received Date/Tittle 09/28/98 13;45 Matrix Drinking Water Technical Dfineetort Stephen C, Ede Ordered By PwSYD 0 [toleanecl ...�...._.�.��..._...� . alLerinble Prep Annlvsis Psrnmeter,e_�er ....m� Results POLE Units MLthedLimit5 Unite Onte ]nit natal Coliform v cal/i00mL SM18 92220 09/28/98 KAP Nitrate .v 0.iG� 0.100 mg/L EPA 300.0 10 max 09/28/98 09/28/98 GCP iii 171 A 7x-11 rMl- i (AC MUNICIPALITY OF ANCHORAGE I r j • 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 q Parcel I.D. # 050-321-59 HAA # A -1 �' 4' 1. GENERAL INFORMATION Complete legal description Hiqh Home Lot 1 Block 1 Location (site address or directions) 18710 Upper McCrary Road, Eagle River Property owner Sylvia Kay Dutton Day phone 248-6789 msq Mailing address P'O•BOx 772468, Eagle River, AK 99577 Lending agency NSA Day phone Mailing address Agent N/A Day phone Address .Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 5 3. TYPE OF WATER SUPPLY: Individual well x Community well Public water NOTE: If community well system, provide written confirmation from State AD EC attest- ing to the legality and status of system. 4. TYPE OF,WASTEWATER DISPOSAL: Individual on-site x 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. ' z: 72-025(89Y.1/91) Front MOA M21 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 invest!gation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Eagle River Enginering Services Phone 694-5195 ' Address P.O. Box 77329,, Eagle River, AK 99577 Engineer's signature 6. DHHS SIGNATURE �A df bd By: Date ................ C" Louis A. Bulcra- '- k7.f0 CE -6735 pprove or a rooms. Disapproved. Conditional approval for ` ' bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage,is not responsible for errors or omissions in the professional engineers work. 72-025 (Rev. 1,91) Back MOA #21 - Municipality of Anchorage Department of Health and Human Services t HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: f//(aH #ONC, Parcel I.D. 050 - 341-S9 A. Well Data a-rl I Well type AeIV/3TE If A, B, or C, attach ADEC letter. ADEC water system number &1A Log present (Y/N) YES Date completed 1013D%93 Driller _,P/NF Total depth Sanitary seal (Y/N) Date of test Static water level 3L�sl V ?,r5 Cased to 30 Casing height FROM WELL LOG /0,Z9 3 83/ Wires properly protected (Y/N) Well flow Z g.p.rn. Pump levell 3Lf 9 SEPARATION DISTANCES FROM WELL TO: Septic/tag tank on lot Absorption field on lot AT INSPFCTInKl On adjacent lots - 45 On On adjacent lots 74/00 Public sewer main /,1A Public sewer manhole/cleanout A/1A Sewer service line 2I? Petroleum tank Jj0Pn267,A-/7: WATER SAMPLE RESULTS: Coliform 10 Nitrate 0. // /' & I L Other bacteria Date of sample: D 91/0 �9y Collected by: _LN 3/NCF_ /? 13. SEPTICINNING TANK DATA Date installed 9� Tank size /SOO Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) Aa High water alarm (Y/N) /V1A Alarm tested (Y/N) A/1/4 Date of pumping /`11A - /1,160 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /.3Z On adjacent lots f/OD 1 Foundation b / To property line Absorption field / Water main/serviee line o75 / Surface water/drainage 72-026(3/93)*Front CONTINUED ON BACK PAGE r�n oz rl m p. M. 17-171 m C „ X11 o G , C n� 7 - On On adjacent lots 74/00 Public sewer main /,1A Public sewer manhole/cleanout A/1A Sewer service line 2I? Petroleum tank Jj0Pn267,A-/7: WATER SAMPLE RESULTS: Coliform 10 Nitrate 0. // /' & I L Other bacteria Date of sample: D 91/0 �9y Collected by: _LN 3/NCF_ /? 13. SEPTICINNING TANK DATA Date installed 9� Tank size /SOO Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) Aa High water alarm (Y/N) /V1A Alarm tested (Y/N) A/1/4 Date of pumping /`11A - /1,160 Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /.3Z On adjacent lots f/OD 1 Foundation b / To property line Absorption field / Water main/serviee line o75 / Surface water/drainage 72-026(3/93)*Front CONTINUED ON BACK PAGE C. LIFT STATION NIA Date installed Size in gallons -- Vent (Y/N) allonsVent(Y/N) High water alarm level Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANel2 - FROM LIFT STATION TO: Well D. ABSORPTION FIELD DATA rer /N) "Pump off" Level at Cycles tested On adjacent lots Surface water Date installed O&�/ 7194i Soil rating (GPD/Ft') 01 f System type 4 T�ENCf/ Length Z/ Width , Gravel thickness Total depth 2 r 9 Z -/D �/` Total absorption area Cleanout present (Y/N) `/ES Depression over field (Y/N) Date of adequacy tesy1y /S/EGJ Results (pass/fail) P /qss for S Bedrooms Water level in absorption field before test NZ4 After test N/A Peroxide treatment (past 12 months) (Y/N) A/IA If yes, give date NIA SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /V2 , On adjacent lots f/O10 / Property line To building foundation To existing or abandoned system on lot /V1A On adjacent lots 30 Cutbank 1Y 1A Water maWservice line 50 Surface water NIA Driveway, parking/vehicle storage area 50 Curtain drain �Vnlkll= &PAeCNT E. ENGINEER'S CERTIFICATION 1 certify that / have checked, verified, or conformed to all MOA and HAA guidelines in effect on the ddte;,Qf this inspection. Signature s Engineer's Name GDU/S E�12R4� Date /�5 `� •, t11, �.0 u a, co oca °;,,�.�c,Yw HAA Fee$1 NO `� Waiver Fee $ Date of Payment �1— /71—& c� /) Date of Payment Receipt Number Gq ?-3 66 �a / Receipt Number. �n nnc Tamm, o.,w Commercial Testing & Engineering CO. t IL Nltratc-N UA=tJnav:ulablc See Special lnstm-tionu Abovc NA =Not Anslyzed s� S"SMnpleRejm&ptAbuve L'1'-Leea'lhan U =Uud tectod, Reportedvalue is the practical gteuttificalion 1 imik. (•iT ^ aeftterThan 1) = Secondary d I"P. 5633 t3 Street, Anohor*ge. AK 99618-1600 — Tel. (907) 582 -2343 Fax: (9071 5615301 v __ _— — --• --- — �- _ ._ Arvin m;Av _iactsEY. aHio. UTAH, WEST vIRGMIA gnvironnlentsl Laboratory Servicas L,ABORATf7RY ANALYSIS REPORT C'I'&,F,Ra1.# 94,4597.1 Client Sample 113 IDGfi HOME 111 Motrlx WATER WONI{Order 82025 l:lieutName EAf;i.E Ri`11?Rp,NO1NEERING PrintcxiDate 09/12/94 ltrs. fhd¢edHy L'okkectedDate 09108194 [u311:00 lu�s- ProjcaKNama kCecoivedDate 09!081')4 (�13;ri5 hra. Projcctd yWSID ITA Technica117ircctar Sl'L'►'1D.sN C. EDP 9ampfeRemarka: ROS)TINEgAMI'I.ECL7I.T.EC'1'FDBY:CH. �~ � Allowable MLAo:d Itesulte (dual Vnits Mek) od Limits Dote Dale Init Pauamcier � �L3PA _____ _ 10 09109/94 CMR -- 353.21300.0