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HomeMy WebLinkAboutHIGHLAND TERRACE #5 TR 1-Dm 0 0 tiighland Terrace - - --------- w "0"' 050�31 1�26 `\ MUNICIPALITY OF ANCHORAGE went On-Site Water&Wastewater Program _o PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,� r, httpa/www.muni.org/onsite . 11 �hCHOPPGO On-Site Wastewater Disposal System Permit Permit Number: OSP181220 Effective Date: 7/26/2018 Work Type: SepticTank Upgrade Expiration Date: 7/26/2019 Tax Code Number: 05031126000 Site Legal Address: HIGHLAND TERRACE#5 TR 1-D G:0155 Site Mailing Address: 10828 STEEPLE DR, Eagle River Owner: VAN ARSDALE MARK & KIMBERLY Lot Size in Sq Ft: 49505 Design Engineer: C & M Engineering Total Bedrooms: 4 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank ❑ Holding Tank 0 Privy 0 Private Well 0 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 Received B . Date: 7/42 7/13 3 411/ 7/Issued By: ,�� (/�. ,.• �� Date: /� ePtitat MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 050-311-26 Property owner(s) Mark and Kimberly Van Arsdale Day phone 782-6020 Mailing address Site address 10828 Steeple Drive Legal description (Sub'd., Block & Lot) Highland Terrace #5 Tr 1-D Legal description (Township, Range & Section) Lot Size 49505 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial Single Family (SF) ❑ (w/wo ADU) Septic Tank ❑ Upgrade Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: none Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (6, - (Signature of property owner or authorized agent) Permit/Rush Fees: Waiver Fees: Date of Payment: 77t (g Date of Payment: Receipt Number: �Qo1 S5b Receipt Number: Permit No. ecc 'lb lgZ Waiver No. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181220, Deb Vlbckerduss, 07/26/18 C&M ENGINEERING SERVICES Ph: 907-854-5558 Municipality of Anchorage Onsite Water & Wastewater Program 4700 Elmore Rd Anchorage, Ak 99507 6/27/2018 RE: Proposed Septic System Upgrade for Heritage Park #5 Tract 1-D Dear Reviewer, The above referenced property is currently served by a 4 bedroom septic system installed in the 1980s. The 1250 gallon steel tank has failed and is in need of immediate replacement. We are proposing that the existing tank be replaced with a new 1250 or 1500 gallon tank constructed and installed in accordance with MOA requirements. The tank shall be covered with a minimum of 2" moa approved insulation and 3' of cover. The repair shall be performed by a moa certified installer in accordance with MOA requirements. The engineer will inspect the tank before backfilling. Repair of the proposed system will not negatively impact adjacent lots. Upon completion of the installation, a record drawing will be submitted showing the location of the new tank, leachfield, well, andother applicable features. Thank you for your time in reviewing this permit request. Please do not hesitate to contact me at 907-854- 5558 or by email cgbalzarini6a gmail.com with any questions or concerns. Sincerely, Charles Balzarini, PE �1�-X P� of A�4, .. ... .. CHARLES G BALZARINI �����•. CE -13854 .•��`�� �` ROFEWS 0O �� HIGHLAND TERRACE #5 TRACT 1—A I / OTE: CONTRACTOR TO INSTALL TANK IN ACCORDANCE WITH MANUFACTURER RECOMMENDATIONS FOR BEDDING AND BURIAL DEPTH. INSULATION IS REQUIRED FOR TANKS WITH 4' OR LESS OF COVER. A MOA APPROVED POLYETHYLENE TANK IS RECOMENDED. ALL WORKSHALL BE COMPLETED BY A MOA CERTIFIED INSTALLER, IN ACCORDANCE WITH MOA REQUIREMENTS. SEPARATION DISTANCE NOTES: THE PROPOSED SEPTIC TANK IS GREATER THAN: / 100' FROM ANY PRIVATE WELLS 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER 10' TO ANY PROPERTY LINE OR FOUNDATION 970, O I I \ REPLACE EXIST TANK 1 WITH NEW 1250 ' GAL TANK. DEMOLISH OLD TANK PER MOA REQUIREMENTS \ � \ 7 OPTIONAL: 70 \ G S REPLACE EXISTING \< SEWER LINE AND FOUNDATION CLEANOUT. <\pq \ FqS 07 l EXISTING L \ ---_4 BEDROOM HOME FENCE— \\ \ APPROX LOCATION OF EXISTINGa 1 \ DRAINFIELDS HIGHLAND TERRACE #5 � TRACT 1—E \ APPROX, SEPTIC AREA / p'0iz nt / O q 7GS of Anchorage and Wastewater ■■ 00 (f) W U W L0 N Lr) L0 Z_ LO W LLJ 00 0 O Z 0) W U Z J EL H Z W 2 W U J W Y Z H HIGHLAND TERRACE #5 \ TRACT 1—D \ APPROX. 100' NEIGHBORING WELL RADIUS HIGHLAND TERRACE #5 \ NEW AFTER TRACT 1-8 TANK CLEANOUTS \ \ REPLACE 90 WITH (2) 45'S 1 I NOTIFY OWNER AND ENGINEER IF PIPE APPEARS TO BE PLUGGED I I I / OTE: CONTRACTOR TO INSTALL TANK IN ACCORDANCE WITH MANUFACTURER RECOMMENDATIONS FOR BEDDING AND BURIAL DEPTH. INSULATION IS REQUIRED FOR TANKS WITH 4' OR LESS OF COVER. A MOA APPROVED POLYETHYLENE TANK IS RECOMENDED. ALL WORKSHALL BE COMPLETED BY A MOA CERTIFIED INSTALLER, IN ACCORDANCE WITH MOA REQUIREMENTS. SEPARATION DISTANCE NOTES: THE PROPOSED SEPTIC TANK IS GREATER THAN: / 100' FROM ANY PRIVATE WELLS 200' FROM ANY PUBLIC WELLS 100' FROM ANY SURFACE WATER 10' TO ANY PROPERTY LINE OR FOUNDATION 970, O I I \ REPLACE EXIST TANK 1 WITH NEW 1250 ' GAL TANK. DEMOLISH OLD TANK PER MOA REQUIREMENTS \ � \ 7 OPTIONAL: 70 \ G S REPLACE EXISTING \< SEWER LINE AND FOUNDATION CLEANOUT. <\pq \ FqS 07 l EXISTING L \ ---_4 BEDROOM HOME FENCE— \\ \ APPROX LOCATION OF EXISTINGa 1 \ DRAINFIELDS HIGHLAND TERRACE #5 � TRACT 1—E \ APPROX, SEPTIC AREA / p'0iz nt / O q 7GS of Anchorage and Wastewater ■■ 00 (f) W U W L0 N Lr) L0 Z_ LO W LLJ 00 0 O Z 0) W U Z J EL H Z W 2 W U J W Y Z H f MUNICIPALITY OF ANCHORAGE 1 DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM ANEW/OR WELL. INSPECTION REPORT NAMEPHONEE r � f . .; � NEW .. /' . ❑ i1PGRADE MAILING AIDDRESS LEGAL DESCRIPTION LOCATION NO. OF BED OOMS ,r=37 DISTANCE TO: Well Ga Absor do re „,t_ v._ Dwelling r, PER prr„L. z LU No. of cojnpartment Manufacturer M r Liq. ,a?c�l Ions IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. hManufacturer Material Liquid capacity in gallons DISTANCE TO: Wellf ( Foundatipon j. Near egt line% PERMP No. of lines Le/ .0i e h t Tota Ieng f Ii Trench -dth �r Distance be tiny !- € inches L I_ To o • tiletto fish grade ld er1 bene47f- e r Total effective absorption area °” - f �. inches Le gth Width Depth PERMIT NO. w C9 Q F- < w Type of crib Crib di;/;de/ Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line a Class _ Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER -7, �11 AM PIPE MATERIALS. SOIL TEST RATI NG 3 INSTAL E C 1 RE ARKS a dt f/P sy 'L i mcwS,..�- G.+'.. 07 ,r=37 IB 1�0,y y f 72,f 3 Rev.3 8) , Cgrr (filrb 43ritt !R F by F DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUG IAK, ALASKA 99567 9 TELEPHONE 688-2759 OWNER OF LAND a Y ' ,- 11�' 4A i'-� � _ DEPTH OF WELL ADDRESS STATIC LEVEL OF WATER FT. r d LEGAL DESCRIPTION / DRAW DOWN FT. DATE - Started Ended GALS. PER HR PERMIT NUMBER KIND OF CASING KIND OF FORMATION: From Ft. to Ft. From Ft. to Ft. Fi om Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. rl %� From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. { ' f' - -no From Ft. to Ft. From Ft. to Ft. ` From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. 1=�� =- ','' �= - From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. .- ` From Ft. to Ft. From Ft. to Ft. _1 ` ` "" From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. p �^ LIT J ANCHORAGE From Ft. to Ft. From Ft. to �'EP OF t ENV RO IN,%i'-' j \\ I_( 1 / G L MISCL. INFORMATION: ;° a RECEIVED DRILLER'S NAME THE REQUIRED SIZE OF THE SOIL.. ABSORPTION SYSTEM IS: K-0000"700— 0 U71 1-1= H=7 r=,; Ii ° FA ° ° L. n= THE LENGTH DIMENSION :I _, THE LENGTH (IN FEET) OF THE TRENCH i R DRA I N•dF I ELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND !ND AN'dD THE BOTTOM M CIF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FCR TRENCHES. THE GRAVEL DEPTH IS THE: MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (I N'd FEET). l I E0 li70_ fi N TR IO E -p = is h -T- l II_: -Ti FA P4 (I- i = :�L - =': 0i ate; fi=fi 9 a �n r" - PERMIT APPLICANT HAS THE RESPONSIBILITY TO I INFORM THIS DEPARTMENT DURING THE INSTALLATION IN• SPEI TICINd` OF ANY WELLS S A[: _IA ENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. P._,:_1 l08 ""_ _ ° 1 9-4 °E , 1=" E: 5-- !! 1 ILII 1--4 low F�—:' i1~ N 1--1 E=7 E-° BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AN' D APPROVAL BY THIS DEPARTMENT 1•,.I:ILL BE S!_ BjEC T TO PROSECUTION. MINIMUM DISTHI''•iCE BETWEEN A WELL AND AN•.!'T ON—SITE SEWAGE DISPOSAL S STEM I i'•_il•_i FEET FOR A PRIVATE WELL OR 150 0 TCI � ?0 0 FEET FROM A PUBLIC WELL DEPEND I I' 1 UPON THE TYPE OF PUBLIC: WELL. MINIMUM iISTANC:E FROM A PRIVATE WELL TO A PRIVATE SEWER LINE I S ._E FEET AND TO A C:CII lfclUI'•d I TY _EWER LINE I S 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN _ 0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS N'11—!Y APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ! RE AVAILABLE TO INSURE PROPER INSTALLATION. F _" E un--__ 1--y h 7- E071-0"' -Ii IL =y 1� N_- Ii f two Ire �= l „ :lL "--g R =-- 1 CERTIFY THAT 1.: I AM FAMILIAR WITH THE REQUIREMENTS FOR CIN•=!—_,ITE SEWERS AND WELLS AS _,ET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL STALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. : I UNDERSTAND DERSTAN• D TH ! i THE ON—SITE SEWER SYSTEM N''I1=!'•i REQUIRE ENLARGEMENT AGEMENT I F THE RESIDENCE IS REMODELED TO 1 IN•41_LURE MORE THAN 4 BEDROOMS. SIGNED: ---•-- . ----- t !PP :ANTI CREW CONSTRUCT I I_IN,I 1=`u 1L11" -moi -fi CE- .-I� 1011. 1 _F_ 9" II3 F 1-1! 1:' „g IfT -1- '5L r° L 7 R7 -i Fl- l-DEI='ARTMENT DEPARTMENTur- HEALTH AND ENVIRONMENTAL r R l T E1= T I I, N �� 25 'L' ' .- ! FEET, ANCHORAGE, AK. 9"950'i 264-4720 yVWV// () 'i Il_ f _ 1'—I! 1:: „( `t! n U3 144'— ". 1 7— E _� E0 r A EE 11-_R" 1=" � r'-_` 1-» li _ 2( PERMIT NO. ( 830443 ) APPLICANT CREW CONSTRUCTION SLE,.=; E. 56TH ANCHORAGE, ALASKA 561-1792 L. O C! T I 01`•J '-To Q Q cZ c LEGAL TRACT i -D HIGHLAND Tom'_ ,, =. ADD LOT SIZE '?99999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I S : TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING (SQ FT/C,R) = 23S, THE REQUIRED SIZE OF THE SOIL.. ABSORPTION SYSTEM IS: K-0000"700— 0 U71 1-1= H=7 r=,; Ii ° FA ° ° L. n= THE LENGTH DIMENSION :I _, THE LENGTH (IN FEET) OF THE TRENCH i R DRA I N•dF I ELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND !ND AN'dD THE BOTTOM M CIF THE EXCAVATION (IN FEET). THERE IS NO SET WIDTH FCR TRENCHES. THE GRAVEL DEPTH IS THE: MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (I N'd FEET). l I E0 li70_ fi N TR IO E -p = is h -T- l II_: -Ti FA P4 (I- i = :�L - =': 0i ate; fi=fi 9 a �n r" - PERMIT APPLICANT HAS THE RESPONSIBILITY TO I INFORM THIS DEPARTMENT DURING THE INSTALLATION IN• SPEI TICINd` OF ANY WELLS S A[: _IA ENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. P._,:_1 l08 ""_ _ ° 1 9-4 °E , 1=" E: 5-- !! 1 ILII 1--4 low F�—:' i1~ N 1--1 E=7 E-° BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AN' D APPROVAL BY THIS DEPARTMENT 1•,.I:ILL BE S!_ BjEC T TO PROSECUTION. MINIMUM DISTHI''•iCE BETWEEN A WELL AND AN•.!'T ON—SITE SEWAGE DISPOSAL S STEM I i'•_il•_i FEET FOR A PRIVATE WELL OR 150 0 TCI � ?0 0 FEET FROM A PUBLIC WELL DEPEND I I' 1 UPON THE TYPE OF PUBLIC: WELL. MINIMUM iISTANC:E FROM A PRIVATE WELL TO A PRIVATE SEWER LINE I S ._E FEET AND TO A C:CII lfclUI'•d I TY _EWER LINE I S 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN _ 0 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS N'11—!Y APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ! RE AVAILABLE TO INSURE PROPER INSTALLATION. F _" E un--__ 1--y h 7- E071-0"' -Ii IL =y 1� N_- Ii f two Ire �= l „ :lL "--g R =-- 1 CERTIFY THAT 1.: I AM FAMILIAR WITH THE REQUIREMENTS FOR CIN•=!—_,ITE SEWERS AND WELLS AS _,ET FORTH BY THE MUNICIPALITY OF ANCHORAGE. I WILL INSTALL STALL. THE SYSTEM IN ACCORDANCE WITH THE CODES. : I UNDERSTAND DERSTAN• D TH ! i THE ON—SITE SEWER SYSTEM N''I1=!'•i REQUIRE ENLARGEMENT AGEMENT I F THE RESIDENCE IS REMODELED TO 1 IN•41_LURE MORE THAN 4 BEDROOMS. SIGNED: ---•-- . ----- t !PP :ANTI CREW CONSTRUCT I I_IN,I .0 wIl r` ROMA `IRf, . �'ECT) ON `fir. ANCROE0 AK 'ell PRO 41 —S.1w .W &443 J Mn CA X44STRUC7 I CUM _17921 165 E. 11561H AMC-RMAGE, ALASY, 1564 "I R -T I -D filCiMAUD U RR.Off. E 5954-0,99 SLIFRZ FEET OF � TJC ' E :� SOIL SCS R ` ' � w , k �� THE NM OR MP - I' . DEPTH A TRENCH OR PE015` =E -V EN THE SALIRFRVE CIF Ifit fAMM MID THE VOTTM OF IRE XCA N " . IS NO ' T MID19 FIR' ' 'ES. -OW4VEL DEPTH THE U DEPTH OF riRRAML ViETWEEN THE Mr-frALL PIPE W, IME RMTOM OF THE E W TIOFEE ' , ' -i :' = .- ff APPLICM-7 Ham» ` _ Ul 30FOP&I THIS E,,ff'f&lMf4TDURING . = IllLLA " INSPECTIMS Y KLLS , " CZMT TV IRIS PROPERTY MV THE UV RESIDENCES. IMRT THE WELL 1411-L KILLING WILL f O K0C.fTl . LrM �' Y _EM ,EET MR R M+ 'E MELL CIR 150 70 2fAe FEET FRE44 fl PLINK NELL DEPEI-91-ING VT CtF Fmuc NELL. kwi oiscamm Fri . .= f4E_ 5EMIER LINE IS. 25 FFETY AM, 5ftWk LINE M n -FEET. JLOGAS GT BE RETVRf&b 70 TfE rl.EPf4R7M9Nl WITHIN 3@ Asa WELL c r . . *4 FAMILIARAtil M HEQ * -S MPS KID WELLSR Z BV 'THE tVNJC;JPRLITY M AHS "'. 'tt4AT 7HE M -5-21E SZWER 51YSIEM MAY' REVVIM ENLARSEMEM IF THE S COELED TO INCLUDE WERE7M-4E OM55 - �U4`.``wpN e �� �� ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: U� l? {' DATE PERFORMED: LEGAL DESCRIPTION: �l2 �7J /-� �� /��C�b'i'7�1r7 %Z%L( � S/1 %4bb �DEPTH SLOPE SITE PLAN Sig-T;oTFI T F zr s�Nr�y ©�(�✓�i,��c� ��. 2 3 4- 6- 6 0- 8 u 9- 0, 10 11 12 0, 13 J C L'4ye✓Y G e vCL- 2 3'y 'ole,cr 14 Date Gross Net Depth to Net 5 15- Time Time Water Drop 16- a ® oo 17 17 �-- / 18- / .Aeri A. Shofler 19 ; % tNo. 14�>-E d < 'v 20 7 � CO h,,J00000P�0'�Gy.��S L]V `OFESSIOt+A4 .3 1 Iv � COMMENTS PERFORMED BY -5J S 72-008 (6/79) WAS GROUND WATER /�/� L ENCOUNTERED? /// O P IF YES, AT WHAT E DEPTH? LY — a Reading Date Gross Net Depth to Net Time Time Water Drop a ® oo -- �-- / / Z� .,Z> ya3 JAI 7t 1� 7 .3 L•; SO �' Iv � L(- 3, 23 t; X33 e, 8 O �. PERCOLATION RATE Z 7 (minutes/inch) / 9 TEST RUN BETWEEN FT AND -7 FjT /t CERTIFIED DATE: • Municipality of Anchorage Onsite Water and Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 050-311-26 Expiration Date: -7-1-10 1. GENERAL INFORMATION I -p Complete legal description _HIGHLAND TERRACE #5, TRACT D Location (site address) _10828 STEEPLE DR, EAGLE RIVER Current Property owner(s) _DAL & KITTY CHEEK Day phone Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage ❑ Community Class A Well Public Water System ❑ WaiverNariance request for: TYPE OF Individual Holding Tank Community Public Sewer Day phone T I Received 4 .!¢ - G'w ryer Date: %/ l/l „?Ciao COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Gi2� Date of Payment Receipt Number COSA # OS G 181 33 Waiver Fee $ _ Date of Payment Receipt Number Waiver # S. 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 MIKE N ANDERSON, P.E.Phone Address 4661 NATRONA AVE. Engineer's Printed Name MIKE N ANDERSON, PE Date Q 6. DSD SIGNATURE System #1 Approved for bedrooms. P CP� �f i,•. System #2 Approved for bedrooms. 8 •'I'�%t/ ,. Disapproved. Conditional approval for —L bedrooms, with the following stipulations: W r"" By: — r ` �� Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other oombiu....1 m-io-fzmc 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: HIGHLAND TERRACE #5, TRACT D _ Parcel ID: 050-311-26 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # _ Well Log (Y/N) Y Date completed -6-6-83— Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 280 fL Cased to 20.3 ft. Casing height (above ground) 20" _ FROM WELL LOG AT INSPECTION Date of test 6.6.83 3-15-18 Static water level 173 ft. 195 ft. Well production 0.75 g.p.m. 0.5' g.p.m. WATER SAMPLE RESULTS Coliformcolonies/100 mL Nitrate (, 0 Zmg/L Arsenic: _'&ug/L Date of sample: 48my Collected by: 3/"(fi `e B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 6.19.83 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) Date of pumping " Pumper TANK TO BE REPLACED_ C. ABSORPTION FIELD DATA Date installed 6.19.83 Soil rating (SF/BEDROOM) 239 System type DEEP TRENCH Length 83 ft. Width 2.5 ft. Gravel below pipe 6.6 ft. Total depth 12.14.5 ft. Eff. absorption area 996 fe Monitoring tube Y Depression over field N Date of adequacy test 3.15-2018 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 48 in. Water added 600+ a]. new depth 61 in. Elapsed Time: 1350 min. Final fluid depth 47 in. Absorption rate >= _600_g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date 0 D. LIFTSTATION Date installed "Pump on" level at _ in. Datum Size in gallons Manhole/Access (YIN) "Pump off' level at _ in.High water alarm level at —in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES Building foundation WELL ON LOT TO: Water main 100'+ Septic tank/lift station on lot 100+' On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main 200'+ Public sewer manhole/cleanout 200'+ Sewer /septic service line 25'+ Holding tank 100'+ Animal containment areas 1004 Manure/animal excrete storage areas 1001+ SEPTIC TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5' Water main 1001+ Water service line 501+ Surface water 100'+ Wells on adjacent lots 200'+ ABSORPTION FIELD ON LOT TO Property line 10'+ Building foundation 10 Water main 100'+ Water Service line 101+ Surfacewater 1001+ Driveway, parking/vehicle storage 50'+ Curtain drain 50'+INone know) Wells on adjacent lots 200'+ F. COMMENTS `HOLDING TANK INSIDE THE HOUSE CRAWLSPACE. "EXISTING TANK WILL BE REPLACED AFTER CLOSING. G. ENGINEER'S CERTIFICATION T•P1E OF q(q�� 1 certify that 1 have determined through ne/d inspections and i h,•••••• •• s t 1 i review of Municipal records that the above systems are in /�*:49TH* .••9 conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name MIKE N. ANDERSON PE�•�et ,wCHAEL• • • • • •...• . •• _ N. ANDARSCN :.R COSA canary sheet 26-15.doc I 9 hSJilll Cl' h/ e ......xed IRe IOIIOW d ranRnd Ane—aM IXI g Pr -I e4 n1. it aYN tMl the mppve, menti dm.LLd that within the pmpertY Ime aM do not ,varap a ennro ch nn the properly lying adjacent thaw to lhet no enImvn proy lying aditat theetop Vumlion end Net there are na rpeduap, LLanamloian Ilnee ur miter vi.Ibie enaemeote en veld propoU vxM( m indicated herenn. Uatrd nt Eegle Aivep Aaika aoszRr JtlHN50N =`-I SGLE RegisteredLandill, AIur rte All to I^ BOx 4Nc Eagle River, dlaek. i'hpne. ('ML 6462540 Municipality of Anchorage Community Development Department On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http Hwww.muni.org/onsite • (907) 343-7904 Well Decommissioning Log Legal Address: �/ f� Subdivision diva (.ed 1i'uvaero ¢�lock_Lot_ T R Section Lot_ On-site Water & Wastewater Program certified contractor pert000irg the well decommissioning: Name: 1� C, f G � �� '9w K C . Signature: Company'. Mt kGJ A n �.rr 4/oAr £ncrr Well decommissioning datey/�G, i! M110hod ofdecommiasioning: AMC 15.55.0601-1 a.❑ b. [_1 c.N Location: Use the space belowto provide a drawing of the property showing the follovAng items', • North arow • Decommissioned well, • Other water vreIls on the property, • Two separate swing -tie distances for each well shown on the dmwfng, Note: The evmg-tie distances shall be measured from either permanent structures or the property comers. �69SM m'yyrJnt alfll• W e—_ ahe/6<rn4. `�uJti r rhfs was Nor t w�//� pry /4,reI, GAGommunily Developmenc0evelopment Ser iceekBuilding Safety\On Site Water and Wastewate6Forms\Client FonnsoNell Decommisioning Randoc Municipality of Anchorage • '� Development Services Department ; Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907)343-7904 Water Well Advisory Certificate of On -Site Systems Approval (COSA) # OSC181133 During a recent COSA on-site inspection and test of the potable water supply well on Block , Lot Tract 1-D of Highland Terrace #5 subdivision, the well's productivity was determined to be .5 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 4 -bedroom residence is .42 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Mike Anderson From: Darcy Ellingboe [dellingboe@alyeskatitle.com] Sent: Thursday, April 5, 2018 10:13 AM To: Mike Anderson Cc: cheekk@mtaonline.net Subject: 57655/Cheek to Van Arsdale: 10828 Steeple Drive, Eagle River, AK Hi Mike, Please note that we will not be releasing the Escrow Holdback funds for payment until MOA certification/confirmation is received. Let me know if you need anything else. Thanks so much Q Darcy Ellingboe Escrow Officer Alyeska Title Guaranty Agency 11823 Old Glenn Highway #118 Eagle River, AK 99577 Direct 907.622.2850 Fax 907.622.2843 delli noboe(a)alveskatitle.com Licensed Assistant: Kristina Palmer kpalmerg)alveskatitle.com/907-622-2844 Thank you for choosing Alyeska Title, we appreciate your business! A-Al�r.,q.wcM Underwritten by: The information contained in m attached to this a -mail is COEFIDENTUL and/or PNWILEGED. This a -mail is intended to be reviewed by the individual it is addressed to only. If the reader of this e-mail is not the intended recipient, please be advised that any review, dissemination, disclosure or copying of this e-mail or the information contained in or attached to, is prohibited. If you have received this e-mail in error, please notify the sender immediately and delete the e-mail from your system, without retaining any copies. Thank you. M MUNICIPALITY OF ANCHORAGE AAA DEPARTMENT OF HEALTH & HUMAN SERVICES I - Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343-4744 FAIZIN: (r 050-311-26 HAA# UP '(7) _J:�) Complete legal description HIGHLAND TERRACE SUBDIVISION #5: TRACT Z' I - Q Location (site address or directions) 10828 STEEPLE DRIVE Property owner ROB HAYES Day phone JON 694-6877 Mailing address 10828 STEEPLE DRIVE EAGLE RIVER, ALASKA 99577 931M Agent BARBARA CRITTENOEN w/ PRUDENTIAL VISTA Day phone (907) 689-6464 Address 16635 CENTERFIELD DRIVE. SUITE 103 EAGLE RIVER, AK 99577 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. Individual on-site XXX Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC ing to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Water and Wastewater Consultants, Inc. shall be paid $1000.00 at, or prior to, closing for the engineering services provided. As certified bymyseal affixed hereto and as ofthe validation date shown below, |verify that my investigation ofthis Health Authodty 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 vedfy that based on the information obtained from the Municipality of Anchorage files and from myinvestigation endi |yand/or wastewater disposal system is in compliance with all KuniuipState oodea, ondinenceo, and regulations in effect onthe date of this inspection. Address 6901 DEBARR ROAD, SUITE 213 ANCHO RAGE, ALASKA 99504 Engineer's Signatur U, Date 2, In conducting this evaluation, AWWC, Inclattem to provide a thorough, conscientious engineering analysis of the system in accordance Mth AE H Guidelines & Regulations. The reported results described the performance of the system under the conditions countered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, ground water levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactoty test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. AWWC, Inc. can therefore not provide any warranty for future estimate of how long the system will continue to meet the operational requirements of the ADEC or MCA DHHS. ...... The content of this report is for the sole benefit of the owner listed above. Any rty is not authorized, reliance upon or use of this report by any other person or pa nor will it confer any legal right whatsoever. Tr A. ess: 6. DHHS SIGNATURE Approved for bedrooms Conditional approval for bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authodty 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 2nalyze 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. 1191)Back MOA #2nComputer Version Kt(-� I VED APR 2 5 2000 Municipality of Anchorage MUNUPALOry 2,' :. DEPARTMENT OF HEALTH & HUMAN SERV]Qk� ,L Environmental Services Division 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 Legal Description: HIGHLAND TERRACE #5; TRACT D Parcel I.D.: # 050-311-26 �M PRIVATE_ If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) YES Date completed 6/6/83 Total depth 280' Cased to 20.3' (TO BEDROCK) casing height (above ground) 18"+ Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES FROM WELL LOG AT INSPECTION Date of test 6/6/83 4/13/2000 Static water level 173' 194' Well production 0.75 g -p -m- 0.46 9 -p.m - WATER SAMPLE RESU7S: I Coliform Nitrate nel. - -Other bacteria Date of sample: Collected by: A.W.W.C., INC. Date installed 6/19/83 Tank size 1250 GAL. -Number of Compartments 2 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Depression (Y/N) NO High water alarm (Y/N) N/A Date of Pumping 4/13/00 Pumper JR'S PUMPING Date installed 6/19/83 Soil rating (g.p.d./fl:2 or ft2/bdrm) 239 Fr/BDRM System type TRENCH Length 83' —Width 2.5' —Gravel thickness below pipe 61 Total depth 12' – 14.5' Effective absorption area 996 SQ FT Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test 4/13/2000 Results (Pass/Fail) PASS — For 4 — Bedrooms 14> 7 7 �5 (0 7 .,5 Fluid depth in absorption field before test (in.); 40.5" Immediately after @11W gal. water added (in.): XW Fluid depth 42.5" (ins) Minutes later: 1070 —Absorption rate = 600+ Peroxide treatment (past 12 months) (Y/N) NONE KNOWN If yes, give date ----- 72-026 ---- 72-026 (Rev. 3/96)" Computer Version Manhole/Access (Y/N) High water alarm Size level at* "Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25'+ Lift station N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5'+ — Property line 5'+ Absorption field 5'+ Water main/service line 10'+ —Surface water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCES FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ —Water main/service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage area 10,+ Curtain drain NONE KNOWN —Wells on adjacent lots 100,+ F. ENGINEER'S CERTIF1 TI OF certify that I have t ld inspections and review e ru e of Municipal record t4,' dove tems are in conformance.. --7 .0, with MOA guide affect this date. C/) . . .. ..... ...... Signature — ffl Engineers Nampl JEFFREY A. GARNESS ere A. rrsess;' 7953 Date 7— f e s HAA Fee $ Date of Payment ) Receipt Number 11-�� _14, Z Z, 7 6,37 72-026 (Rev. 3196)* Computer Version Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE ,MEMORANDU-MI WATER WELL ADVISORY HEALTH AUTHORITY APPROVAL NO.- 0 00/� 3 During a recent Health Authority Amproval cn-s4te -Jns-C)ecticn and test of tl,e potable water sup -Q-1 v well on -Ero-to T/�,-} C -T Block Of IIIC-111-ANO 79R...e,.;O'-5-Suba---,-vi-s4Lon, the well's productivity was de-termn-'ned to be 0, *4 gallons per minute. The minimum well productivJiLty required by this DeDa--me-- (AM C 1S ..5? f c r a bedroom residence is 0.A1.2- canons per mi ---,--.e . A I -thoug h, the sub j ec t we' 1 currentiv exceeds this min -JMum --ecu -i-remen t , ail parties concerned are adv-* see` that ire Production capacit-v of the well- may fluctuate. Restriction 0-ncr-critic-ml, ,-;ater uses such as wash 4 r a cars and lawns and carders may -'-;e required. This a,-:' vi Scry mus-- he -attached to all copies c= the ec t He a I th ,�"�')C D- F Time APPLIC �\1, n F0LLS OUT UPPER HAL ONLY Property Owner t'j+�( ��E.�i[J /!�,)(4"d' Phone Mailing Address j�j,j ��( S�t� .ice Zip Code Date Buyer _L Date Address Zip Code Lending Institution A ', �-A '[ t� •� %�— Phone Address ,Z t' Oj1�a1� L��� �$ Zip Code Inspector Realty Co. i£ Agent Phone Address Zip Code Lo 'S Legal Description s�J.t'.! CL'a Street Location Type of Residence Single Family H_i`.LTf-I ❑ Multiple Family No. of Bedrooms_ ❑ Other �ae�2 Water Supply OCT �? a� INC� Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community l . For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility ( ) DISAPPROVED Sewer Disposal Individual Year Individual Installed: ?L '❑ Public Utility When Connected to Public Utility: ❑ Holding Tank DATE NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. ,�"�')C D- F Time Time Time Time Date Date Date Date c,--2 Inspector Inspector Inspector Inspector Lo 'S Field Notes: 14R�„� S ujS4'.+N� t ( Qsi.s S6wh s�J.t'.! CL'a MUNICIPALITY OF ANCHORAGE DEPT. OF �l.cr{, b H_i`.LTf-I -�—d C—R- ENVIROI\,/_NTAL 1 � PROTECTION �ae�2 OCT �? a� INC� Z � Vt�o t d � 9' �'®�lJ .La) APPROVED BEDROOMS CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' C5 —a R DATE BY: zml S Soils Ratinng� Date Sewer Installed Well To Absorption Area Well Log Received ✓ -- ( Well to Tank Septic Tank Size 72023 (3182)