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Home My WebLink AboutBOULDER SPRINGS LT 30oulder · prongs Lot 30 015-161 -59 Municipality of Anchorage Community Development Department Page On-Site Water and Wastewater Program 4700 Elmore St. · P.O. Box 196650 Anchorage, AK 99519-6650 · http://www.muni.org/onsite · (907) 343-7904 ON-SITE WATER AND WASTEWATER INSPECTION REPORT Permit Number: OSP111049 PID Number: 015-161-59 Name: WASTEWATER SYSTEM [~ New [] Upgrade Kevin Brownsberger ABSORPTION FIELD Address [~ Deep Trench [~ Shallow Trench ~-I Bed E~ Mound 11061 Boulder Circle, Anchorage, AK [--] Other Phone Number of Bedrooms Soil Rating ITotal depth from original grade 333-7512 752 3 5.0 GPD/SFI Removal of organics only Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade IGravel depth beneath pipe Subdivision Block Lot See Drawing Ft. Gravel 0.5 Ft. Boulder Springs 30 Fill added above original grade length Township Range Section See Drawing Ft.I 20 Ft. - - - Gravel width I Beds: Number of Lines I Distance between lines WELL (from logs/tests) E~] New [~ Upgrade 5 Ft. Number - Dist. - Ft. Classification (Private, A, B, C) Total Depth Cased to Total absorption area of trenches between trenches Existing - Ft. - Ft. 1 O0 Ft2 I - Ft. Driller DateDritled Static Water Level TANK i~septic ~]S.T.E.P. [~Holding DOther - - - Ft. Manufacturer ICapacity Yield Pump set at Casing height above ground Greer I 1500 Gal. - GPM - Ft. - Ft.iMaterial iNumber of compartments Water quality testing Coliform __ Co1/100mL Steel 2 LIFT STATION Arsenic ___ug/L Nitrates - mg/L i Manufacturer I Capacity SEPARATION DISTANCES Quanics/Greer I 1500 Gal. To Septic Absorption Lift Station Holding Sewer ~Pump on level at Pump off level at High water alarm at From Tank Field Tank Line Well 100'+ 100'+ 100'+ 25'+ Timer in.I Timer in.I 46" in. Surface Water 100'+ 100'+ 100'+ ,Pump make and model IElectrical Inspections performed by Lot Line 5'+ 10'+ 5'+ NA P-SE-41T M.O.A. Foundation 5'+ 10'+ 5'+ I :PIPE MATERIAL D3034/FS10/Sch 40 Curtain Drain N/A N/A N/A N/A BENCH MARK Assumed elevation 107.76 Remarks: Location and description Bottom of window siding, near control panel Note: This is a Quanics/Aerocell system Installer Wilco Contractors Inspection 1" 5/4/2011 dates: Inspector GEG, Ltd. 2nd 5/4/2011 .~',x ~ ....... COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL "~ ~ ' Conditional Approval: Date i'! ~"~:TJ'' ~~"::' ...... ~'"¢n"'"' ~:'.'":-'~; .......... -'~" ' _l}ia~'~!"P" re~,~'/~'~h e fig a rn ess ~, j :. /:::. ~.:g/._*d' ...:."e',a, \\Geg 1 \geg )ER SPRINGS\LOT 30\Inspection Report Form.doc PERMIT NUMBER: AS BLTI]--, DRAWING PARCELID NUMBER: OSP1 1 1049 - 015-161-59 ~co21.916.8 - PRE,*0.96 57.03 ST1 41.66 57.60 75.50 Ac,1 57.9o 72.73 ~0.~ X / I AC~ 60.2~ 7S.20 92.~S ~ I I / 001 63.86 79.17 96.71 ~ NOTE OLD HOLDING TANK MT1 64.96 79.77 97.~0 ~ I WAS PUMPED AND ~ C02 79.17 98.37 116.00 ~ ; REMOVED FROM THE ~ ' / MT2 7761 97.3~ 114.99 GEG TH 1 2002 PROPERS. N~ ~Nn~LD -,~/ ~ OROUNDWATER ~ ~' I NEW 1500 GALLON "~ST1 ~ ~ ~¢~ J/ ~ ~ ~ ~ ~ ~ ~ / / ' c/o / ~ ~ 5 ~ / /~ ~ t ~ / I ~ SE~VES ~ ~ I , ~ x WELL SERVES ' X ~ ~1" ~/4o' ~ ~ OF A'~ ~ .', : ~;,~ CON'ULTANTS ' 'ENERAL CONTRACTORS ?~... :., .... ~ ~Ue r~y A Gern~ KEV N BROWNSBERGER I 907-353-7521 I 20~ S,,~ ,,~ ?:~ BOULDER SPRINGS LOT 30 A.J.G. ~q~ ~:~:~ AS-BUILT DRAWING OF NEW SEPTIC SYSTEM 5/27/2011 (Rev. 01/05) PERMIT NUMBER:AS BUILT DRAWINGPARCELID NUMBER: OSP111049 - 015-161-59 FINAL GRADE= TOP OF TANK INLY= 95.5~ ~ TO DRAINFIELD/ AEROCELL 2" INSU~TION .............. ~'~" I - RECIRCU~TING ~ ~ ~ LINE FROM ~ L - AEROCELL ........... ~ TOP OF TANK MOUND WAS TOPSOILED SEEDED ~ ~ ~ FINAL GRADE = ~ / 99.42-100.54 FILTER FABRIC ~ ~/ ~ :: ~ - ~ ~ ORIGINAL GRADE ~ :o = 95.2 / ~~:; APPROVED ??~S'::~ ~ / TOP OF SAND ~ '~ ~A~n F LT~P ~2t:-~;',t , ~ OF TESTHOLE = 85.17 ~ (o.ou.~WA~E~ ~ ~.~ GA:R.N :ESS ENGINEERING G~ROU':P, :Ltd. [fg;'"'Z.9/L~ CO~SU~TAUTS ~ ~U~L CO~Z~CVO~S ~: ~' ':' :'' ~ elf e A G~rn~ss KEVIN BROWNSBERGER 907-333-7521 I 3 OF 3 ~'g"../~ PROFILE AS BUILT OF NEW SEPTIC SYSTEM 5/27/2011 (Rev. 01/05) Municipality of Anchorage Community Development Department - Development Services Division P.O. Box 196650 - Anchorage, Alaska 99519-6650 - 4700 Elmore Road Info and Help: (907) 343-8211 INSPECTION: Voice: (907) 343-8300 Fax (907) 249-7777 Inspection Report- EleCtrical ApprLICATION NO. RE,ROE111123 Master/Standalone Permit Permit Type: Electrical NOte~: permit iS n §ep§c panek Call when.done. :kenny 227-1812. this*is for Under:ground 'and final. Requested by: kenny 227-1812 eei1954@gmail.com 'Address of Preject: - 11061 BOULDER CIR Res SChedule Date:05/09/2011 Preference:AM Inspection #: 127281 Parcel: r 01-516~159000 Legal': ' BO.ULDERSPRINGSLT 30'G:264I' DeScriptkm of~ork: -Se'p~tic~s~S~em ~le~trib'apgj~, Contacts Owner Contractor (907)272-4591 Inspector :Comments:' ' BROWNSBERGER KEVIN J ED'S ELECTRIC INC P.O. BOX 210767 £ Inspector: Date: Permit Number: OSPl11049 Tax Code Number: 01516159000 Work Type: Septic Permit Effective Dates: May 03, 2011 Design Engineer: Subdivision: On-Site Wastewater Disposal System 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 Upgrade to May 02, 2012 GARNESS ENGINEERING GROUP LTD BOULDER SPRINGS Permit Site Legal Address: BOULDER SPRINGS LT 30 G:2641 Owner/Address: BROWNSBERGER KEVIN J 11061 BOULDER CIRCLE ANCHORAGE AK 995076445 Site Mailing Address: 11061 BOULDER ClR, Anchorage Lot Size in Sq Ft: 16637 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y SepticTank 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 a..n~Ciose_o~the same day. ,,~B¢. Go~er'~e~d, sealed, and he----' '-:'¢~"- -ate.~(te-preVe-~n~t-f~ezi,g,.,..~-~ ~ ~ (' Special Provisions: The well in the easement must be addressed prior to final approval for the "/ ~.~pleted septic system. _.~ Received Issued By: Date: MUNICIPALITY OF ANCHORAGE Community Development Department Development Services On-Site Water & Wastewater Program i .. On-Site Sewer/VVell Permit Application For A Single Family Dwelling Parcel I.D. 015-161-59 Property owner(s) KEVIN BROWNSBERGER Mailing address 11061 BOULDER CIRCLE *ANCHORAGE, AK 99516 Phone: 907-343-7904 Fax: 907- 343-7997 Day phone 535-7521 Site address 11061 BOULDER CIRCLE *ANCHORAGE, AK 99516 Legal description (Sub'd, Block & Lot ) Legal description (Township, Section & Range) BOULDER SPRINGS LOT 30 Lot Size Sq. Ft. Number of Bedrooms 5 THIS N/A THIS APPLICATION IS FOR: ( [] all that apply) Absorption Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage [] THIS APPLICATION IS AN: Initial [] Upgrade [] Renewal [] APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: I certify that the above information is correct I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. (Signature of property owner or authorized agent) Fees: Waiver Fees: Date of Payment: Receipt Number: Permit No. ~ Date of Payment: Receipt Number: Waiver No. (Rev, 01/11) GARN'ESS ENGINEERING GiROUP, CONSULTANTS & GENERAL CONTRACTORS Ltd. May 2, 2011 Municipality of Anchorage Development Service Department On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650, Anchorage, Ak 99519-6650 (907) 343-7904 Ref: Proposed Septic System for Lot 30; Boulder Springs Subdivision To whom it may concern: The existing 3 bedroom house is served by a private well and holding tank. There was a permit originally granted in October 2002 (permit # SW020382) to install an Advantex system. At this time we are proposing to modify the design and install a Quanics Aerocell treatment system on this property which includes the installation of a 1500 gallon S.T.E.P. tank and a 5-wide trench type drainfield. Attached are a site plan and a design drawing showing the proposed septic system. One test hole was excavated on the property. The drainfield will be designed around the 30 foot radius of the test hole. On May 2, 2011 we monitored the groundwater level and found it to be 4 feet below grade. Our design will be based upon a seasonal high water reading of 4 feet below grade. Comments regarding the design are summarized as follows: 1. SOILS: See the attached logs which show the soil classifications, groundwater monitoring, and the percolation test results. 2. DRAINFIELD DESIGN: See attached design drawing for drainfield specifications. 3. SURFACE WATER: According to Toben Spurklands drawing dated November 9, 1993 which is on record at the M.O.A., there was a spring north/northeast of the septic system. We performed two different site visits in 2002 and a recent site visit in 2011 and did not find any indication of a spring. In short there are no surface water concerns within 100 feet of the proposed septic system. running approximately east to west. In short, there are no slope concerns. We are unaw¢ of any adverse impacts this installation would have on adjacent wells or septic systems. you have a~y//c/ue~ons, please contact us at 337-6179. Thank you for your assistance. ~J~rnei,ely,~1]"'/1 P.E., M.S.Pres~/~ NOT~E.'VAttached is, ~ are : 's a s'te plan drawing, a design drawing, two detail drawings, and two soil logs, which all part of the design package for this septic system. (Contact G.E. G. Ltd. for 7page construction specification letter.) TOPOGRAPHY: The average topography in the area of the proposed drainfield is a 20%-25% slope If 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com ~ MOOSE RUN LOT ,7, I I ~ MOOSE .UN ,OT 5 I I ~ I I / ," x ..._._... I I / / / I, ~ ~ ~ X LOT 29 ~ / / / MOOSE RUN LOT ' ' ~ '~ ......... ~ ~ ~ ~,~:~.,.._~ ~ ' I~ ~ '~~LL ~. I~~ ~" = ~oo .... - / ~ I / I I I ~"~ ', ' GARNESS ENGINEERING CONSULTANTS & GENERAL CONTRACTORS ~~ 71't'~''~''': .... BOULDER SPRINGS LOT aO PNB SITE PLAN 4/29/2011 (Rev. 01/05) \ \ I / / / DESIGN CRITERIA: NOTE: THE CONTRACTOR NUMBER OF BEDROOMS: 3 I ~ SHALL HAVE THE ~ST & I GALLONS PER DAY (GPD): 450I WEST LOT LINES, AND ALL I PERCOLATION RATE/S: 1.9 WELL RADII F~GGED BY A PROPOSED APPUCATION RATE: 5.0 [ REGISTERED ~ND SURV~OR I I ALLOWABLE APPLICATION RATE: 6.O PRIOR TO CONSTRUCTION. MINIMUM DRAINFIELD SQ.~.: 90 DRAINFIELD DESIGN: I I LENGTH: 20' ~ ' WIDTH: 5' BOULDER SPRINGS S/D' LOT 29 M.O.A. APPROVED SAND FILTER: 2.0' ~ EFFECTIVE: 0.5' N ' ' REDUCTION FACTOR: N/A o ~ fIpROPOSED DRAINFIELD , L~ER THAT PERTAINS TO THIS DESIGN. - / N ~/ / AEROCELL TO OBTAIN A COPY OF THE L~ER ~ / L /,~ / UNIT I I CONTACT GEG. BY PROCEEDING FORWARD ~ /~Q~ '~ WITH THIS INSTAL~TION, THE ENGINEER, ~ / ,~~ ~= ................. I WELL DRILLER, CONTRACTOR AND ~ / NI~/I~.~ N / '~'~ ~'~ ',~ I I/ AGREE TO ACCEPT THE TERMS AND '~ F m~.,n.T.~,~ ~.T..R.~n ~ ~~ / / ~ = PROPOSED 1500 GALLON STEP I ...... ~ ............... ~,.~~ ~ ~.~ . / I ~ =~ ~ / ~ EXISTING HOL lNG TANK ~ ~ ~ N / N ~OBEN SPURK~ND TH I/ =o .~ -~co, ,SSlO..~- ~~ ~ / X ~ ~o~.~w~=. ~ ~. 7 / / / I _ ... ~-..:~ GARNESS ENGINEERING GROUP, Ltd. 4~~ CONSULTANTS & GENERAL CONTRACTORS BOULDER SPRINGS LOT SO PNB SEPTIC SYSTEM DESIGN UPGRADE 4/13/11 (Rev. 01/05) ..... GARNESS EN'GI'NEERING GROUP, Ltd. ". CONSULTANTS & GENERAL CONTRACTORS t .................... t~OIL LOG - PERCOLATION TESTI ~ LEGAL DESCRIPTION: BOULDER SPRINGS S/D~ LOT 30~ -~ ~~ . ~ DEPTH ~ (f~e~ORGANICS TEST NOLE ~ SOIl C~SSIFICATIONS ~ ] i i II ~IIJ~TIGM/SM w/ ~;~¢~;:t; GW ~ 0NG ~j x~ ..................... 4--] ~ ~ ' , SOME ML t~-~;.'~'::'-:'% GP ~h , ~ LOT 29; BOULDER , I / 0~ gL , ~ ~ SPRINGS S/D ] GO OL ~ +h ~ SW ~H 0 TH~I ~ ~EXISTING ~ ~HOLDING ~/' / ~ II~l~+I~lcL LENSES SM OH I THROUGHOUT I Z, 7~f~tSTARTING DEPTH TO I ~' ,,/ , ' -" x AT 7' GROUNDWATER DATE I ~1 // SEEPS ¢ 7' T0 10' 9/5/2002 I ~ I/I ~ ~ / ~ ~ ' ~ I 4.5' 9/6/2002 I O iii ~/ / . 5.25' 9/12/02 _~ 11 DATE READING CLOCK NET Tt~E WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 12 9/6/2002 1 1:46 - 6,, _ 2 1:56 10 1/4" 5 3/4" 13 5 1:56 - 6,, _ 4 2:06 10 1/2" 5 1/2" 14 5 2:06 - 6,, _ 6 2:16 10 1/2" 5 1/2" 15 7 2:16 - 6,, _ 16 8 2:26 10 5/4" 5 1/4" 9 2:26 - 6,, _ 17 10 2:36 10 5/4" 5 1/4" 11 2:36 - 6,, _ 18 12 2:46 10 5/4" 5 1/4" 19 PERCOLATION RATE 1.9 (NIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 1.0 FT. AND 2.0 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ~ YES ~ NO SOILS LOGGED BY: JODY MAUS PERCOLATION TEST PERFORHED BY: ZACHARIAH GALL CONNENTS: PERFORMED BY AKWWC, INC. I, JEFFREY A. GARNESS, CERTI~ THAT THIS WA~ P~RFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: DEPTH TO GROUNDWATER DATE SEEPS @ 7' TO 10' 9/5/2002 4.5' 9/6/2002 3.25' 9/12/02 4' 5/2/11 UPGRADE ~ J- J 0m ~ c~ ~ I o< Z~ ZO ~ ~ ~,~o z . ~o I~ ~ ~ . .. mm ~ ' I ., o ~o ~m ~ ~0 ~ I m~ o ~ ~ /mm z E b ~ 'k ~ ~/~ z ~ ~ c Z .;.:~ ,~ /~.:..,} ,, .q~ ~ ~ ..:.~:':; .%%;-'.k, ,.., ... ~ C :'...:,': '?.t.,~,'.¥".:','t, ~'$"'~~ > ;.. %.:~'. ,r.-;,' ::. ~ f ..';." ~. ':" ';:': :""~':~ :;:";":~ ~' o .-. · r .:,.: %: ,,t :.., ',. :.:'.. t~ ~ ~ 0 0 C Z o LEGAL DESCRIPTION: ~ ..: BOULDER SPRINGS LOT 30 GARNE. SS~;~filNEERi~6 Gh0:¢v' L d] o0 DESIGN OF OUANICS AErOCELL SYSTEM KEVIN BROWNSBERGER 907-555-7521 ~[~ress~O~ ~J REPAIR AGREEMENT M[~MOR,-',,NDUNt OF UNDERSTANDING BETWEEN MUN'[CIP.~,ITY OF ~&NCHORAGE THIS MEMO'}C,'-kNDUM OF UNDERSI'ANDING made and entered into as of ~h~s ............ ~ .......................... -. ,~ : .& ...................... herein the "OVv~ER,' and thc Murdc~rali:ty of Anchorage, heroin the "MUNICIPALITY?' la consideration of~e mutual covenants contained hereim the panics to th. is Memorandum of Un&rstm~ding agree as follows: i. ADVANCED WASTEWATER TREATMENT SYSTEMS. Munidpality grants ~.<.missi.o.n to Owner to atiiize and o~rate an Advanced W~tewater Treatmem System (AWWTS), described as (~5~.~!i~J~_.5...~ce ~.. located 2. A. Alteration..Aay change to the design or i~nction ot:~ AWW'['S that !.acludes the installa6on or removal or,my pa~s:, components or pieces not h,cluded in ~he original c. onsm~ctkm permit and desiga. Prior to per'fom6~,g ~y alteralions to an A WWTS lhe owaer must obtain a Wastewa'ter DisV)sal. System Constmctioa Permit fi'om the Mu~,.icipality p~u~nt to Anchorage Mu.nieiPal C0de (hereby. at, eL "AMC'") f3. Certifi~:t~ of (}a*S~i'e Sys'te~ns ApP.mvaL A.n apFoval by the Mtmkipality of existing water a~d wastewater dis~sa.1 systems give.ri at fl~e lime of prol~%, sale and title trans.tkr it~ accordar~.ce with AMC 15.65. These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AWWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On-Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit. An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On-Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of (D ($ ~ .00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. shall co~1 nme wh ~le. t:heA W W ~ S system .~ m ~s~ or op~m~.~o:nal o~ u~ ~.t.l~he pr~per~y .is sold or title is transtb'rred by owner and a new certifi~a'te of On,S~le gpproval is issued ~.he ~ew owner or trans~ree of fl~e prope~y, ~ol to make mV attemlions, removal of p~s or additions to the AWWTS without a t...onstruct~on Perm~'~ fron'~ ~he Municipality. 6. :Ma~..ntenance and R~lmirs. A. ThroughouI lhe tem~ of ~h:is Memorandum of'U'ndetstaading, the Owner shall mai.~t,fin AW ~ TS in good repair, In addilion, it shall be fl~e responsibili'ty of the Owner during ~e tem~ of INs Memorandum of Ua:derslm~ding, ~d any exlmmions or renew~ls thereot; al fJ~e om>.er's sole expenm, m pay fi'~r any m~d. all: (!)repaiffs); (2) maiakmance. {3) a~iustm.en't(s}, {4j mplacemem co~s. at~d (5)inspection costs. F'u~her, Owner agrees to comply wi:It all applicable ordlnm~ce, !aws~ regalations, .rules and orders ~br the AWWTS. B, Owne~ agrees to t>rovide the ~ Mum~.~pah~ a written schedule ofrou:tine nav~ bce.a ,. erlorm~.d on t'l~e system pursuant to Ihe mai. atetxance ~d repairs WBich ' · l:erms m~d co~ditions conlained ia the Owaer's A t ~,q. S Oi~rating pcrmiL This schedule shall ~ subm~ed to the Municipality a~ually u~n ~he reaewal of the C. Owr~er ack~owledges flint fl~e fine scliedule AW W 1. S ~=r=. c~,t~d in AMC. 1:4 60 M~lficipa~ii:y will b~spect gad ma~ a~y a~essa.ry main~.enaace, repai.~s or parmkted all~alions to the system. E. Ow~er agrees to gram tM Munlcipatily reasonable access to test a~d insect the AWWTS cl~i124 ho~rs wri~e~ notice. F. Owner agrees ,l~at any m~ie or traastkr of fide of the property will not occur withoul' a new Certificate of On-Site Systems Approval G. O~er agrees thai the mlevam provisions of the stai~da~ s~cification guidebook for AWWTS is the governing pmthssional guidelii~es ibv fl~e construction, maintenance and repair of the O~er's AW%~N'S. 7. Non~'aiver. The ~ilure of either paay at any time to e.a~bi'ce a provision of this Memorm~dmn of Understanding shall in no way reinstitute a waiver of the provisions, nor ii~ any way effect the Yaiidi. ty of the Memoraadum ofi3nderstaading or any pail hereoE or the rigt~l of such parc thereafter to enR>rce each and every provision t~emo'L 8. Amet~dmenl, A:. This Men:torah&lin of Unde~sta:~.ding shall only be ame~Med, modified or changed by a. writing, executed by authorized representatives of ~e parties, with the same tbrmality of ~fis Memorandum of Undemtm~ding was exec't~ted and such writi~g shall t~ at~ached to this Memorandum of Undersiaading as an amendment. B. l:':'or iP.e purposes o£aW anendment modification or change to the leans a~d conditions of this contract, ihe ol~ly authorized represen':.afives of th~, parties are: Anchorage: C. Any attcmpl Io a.mei~d., modify, or change this contract by either au unauthorized representative or 'unauthorized means shall be void. 9. 3urisitictioa: C._ho~ee of [,aa'. Any civil action arising from this Memorandum of Understanding shall L~ brought in ~hg Superior Court for the Thi~rd Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights obligations of the panics ureter this Memorandmn of Understaa. ding. I 0. Se,¥erabilit~% Any provisions of'&is Memoraad~m~ of Understanding decreed it~val:id by a court ofcompelent jurisdiction shall, not irp~:alidale: thc ~cmaining provisions of the Memorm~&m~ of Ut~derstandlng. .............. 7']'77 /'~' / ,' ' STATE OF ALASKA TH1RD JLIDIC.1AL DlSTRICT Title: Date: Tb.e fbregoing., instrument was acknOvledged 'bel%re hie this _~ ....... day of. ..................... Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION ' P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-site Wastewater Disposal System and/or Well Inspection Report ~,m,: ~~.~, ~/~ ~ Wastewater System: D New ~pgrade Address: --" / 1/0 ~ / ~o ~/~ ~ ~ ABSORPTION FIELD Phone: ~ No. of Bedrooms: ~ ~ Deep Trench ~ Shallow Trench ~ Bed ~ Mound ~ Other LEGAL DESCRI PTIO N so, Rating: Total Depth from original grade: GPD/Sq. Lot: ~ -- Block: ,~ /~ Subdivis'on:~ Depth topipebottomfromoriginalgrade: Gravel depthbeneathpipe Town~hlp: J Range: J Section:t -- Fill added above original grade: Gravel length: I I Ft. Ft. WELL: D New D Upgrade arave~ depth: Number of lines: J Distance between lines: Ft.J Ft. Classification(Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. SQ. Ft. Driller: Date Drilled: Static Water Level: Yield: J Pump Set at: J c.~ing Height Above Ground'. GPMj Ft.~ .~. TANK SEPARATION DISTANCES ~ Septic ~olding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines ~~ ~~ Well J~ Material: ~ ~ Number of Compartments: Surface Water ~/~ LIFT STATION Lot Size in gallons: ~ Manufacturer: Line Foundation "Pump on" level at: "Pump off" level at: ~ High water alarm at: I Curtain Drain I ~/~ Pump Make & M°del I Electrical Jnspecti°ns Ped°rmed bY: Remarks: BENCH MARK Inspoctions porformod by: Dates: 1st i ~ Department of Heath and H~an Services appr~va~ Reviewed and approved ~- Date: ~ '~, *" 72-013 (1/91) MOA 25 8t.1 \89,~ \ SP£ING 8~..3 87,6 8~6 91,1 91.9 I x G'~ 8~.4 87.4 90,7 9~ 94,4 / 8~,8 88.3 90.3 91,4 9~,I 96,0 , - 90~ I 15 0 15 30 45 60/ 75 0~.6 09.3 91.4 9p. 9 96,~ 99,5 101.5 ~CAL~ ]' = ~0 PT// ~~ Tes~hote GROUND ELEV 94,3 GROU~WATER ~ 4 FT / EXIST, SEPT1~ ~ ¢ "~ X "' 'OUND ELEV 99 / / it Class C TOS~E~ SPU~KL~Nn P,E, LOI 30 ~OUL~ER SPRINGS S/D SEPtiC SvS~E, ~S~U~L7 803 W 15TH, ~VENUE DATE, Nov, ~ i9~3 ANCH, AK, 9950~ SEC, ~4, TlPO ~3~ c~nT) P7~-~16 ALEX COM~S SHEET, 2/3 GRID, P641 1" X I0' CONDUIT ' -- RAIN CAP TYPICAL/ I' GAL VAN1ZEB III1% TO ALARM'PANEL /--- C~ULDER COUPLINSIII[ -N O' ~ I PFC COND,U, IT. · ., ~ II MERCURY SWITCH FLDAT S TANgA££ £000 GAL. HZ]L~ING TANK GREER {IR ANCHORAGE TANK TOBBEN SPURKLAND P.E, LOt 30 BOULDER SPRINGS S/D SEPTIC SYSTEM 6151 ~, 9IMDN9 BLV3. 1106' BOULDER CIR BATE,SEPT. ~ 1993 tq~ . ~.-~o~. A~LEN CDM~S SHEET, 3/3 GRID, 8641 / unicipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 December 14, 1993 Tobben Spurkland, P.E. 203 W. 15th Ave. Anchorage, AK 99501 Re: Lot 30, Boulder Springs Permit No. SW 930434 Dear Mr. Spurkland: On October 14, 1993, this office issued the subject permit for the installation of a 2,000 gallon holding tank. In accordance with your September 29, 1993 letter, the holding tank permit was issued because a conventional soil absorption system could not be installed due to the presence of a shallow groundwater table and several surface water springs. Based on this information, it is obvious that the existing crib system is discharging into the shallow groundwater table. This is a violation of both state and municipal wastewater ~isposal regulations. The as-built inspection report, which you submitted on November 17, 1993, indicates that the holding tank was installed down flow of the failed log crib system and that the log crib system is still in service. Please be advised this office will not approve the continued use of a log crib system that is discharging wastewater effluent to the shallow groundwater table. Please take necessary measures to ensure that the log crib is properly abandoned and that the holding tank is operating in a water tight condition. This work must be completed no later than January 31, 1994. Sincerely, Services cc: Allen Combs PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW930434 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:COMBS ALLEN C & ESTHER M OWNER ADDRESS:Il061 BOULDER CIR ANCHORAGE AK 99516 DATE ISSUED:10/14/93 EXPIRATION DATE:10/14/94 PARCEL ID:01516159 LEGAL DESCRIPTION: BOULDER SPRINGS LT 30 LOT SIZE: 16637 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: HOLDING TANK 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 (iSAAC80). 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 PROVISIONS: RECEIVED BY: W. DIMOND i~LVD, ANCHORAGE~ ALASKA 995i)2~-59(14 f907) 279--39~6 Piun i~ ;: i pa ~ J ty o~,~: Ar~ch~)r-age l)iv'~s~.~)n ~'~ Envi~"~)nmentai Health Departme~:: ~3~ Health and Soc.iai Services A~'~ct~:)ra~e~ Aiaska 9950~ S~_~bjec't::: F'e.~--~l~.t ¥~]r LoL 30 [~ouider' Springs Gent Iemen; W~ ;ar"e a, ppl-,.;ing ~cCr' a pier-mit. [:c; install a hc~ic[i, ng tank p~-~perty, the ex~st:~nc4 system does not meet HAA reqLl:~Feil]el~t a thre~] bedroo~'~ l~ou~e and mus~. be replaced. Standa~'d s~orp'tJor~ sys'[.ems are not suitable due to grour~dw~te~,' and s[~ve~'al. ~ur~ac,:e springs. The residence 'J~s c:L~rr'en'~ly occupied by a cou pi~e. ~her~ is ~o ind,~,c:at:ic~n c~ sur'~acing waste wa'[er c~r c~ver~'tow :From [:.[]e existing system. l"l"~e c~'~e,~' h~:_~pes that the h[~ldingtank ~ittl be ~,'::~c~r~, pendin~ app~-~r)val (_~.~ tt~e [}r~?ncc~ sand LO? 14 LOT £?C~ LOT i % SCALD i' = i~ FT, TB~EN SPURKLAN~ P,E, LDT 38 ~DULBE~ 2P~ING2 2/B SEPTIC SYgTEN ~ES~GN ~03 W 15TH, AVENUE ANCH, AK, 99501 2EC, ~4, H~N ~3~ ~TE, AU6, g 1~93 ~n7~ ~7~-~16 ALEX CDN~ gHEET, I/3 G~, ~64I o~,8 88,3 90.3 91,4 ~,I 96,0 ~ 15 0 15 30 45 60/ 75 90' 8~,6 89,3 91.4 9p, 9 96,~99,5 101,5 ~CbL[ ]': 30 FT / / I ~ GROUNG~ATER $ 4 FT X / TO~EN SPURKLAND P,E, LOT 30 3OULDEP SPPINGS S/9 SEPTZC SYS~EN DESIGN 803 ~ ]STH, ~VENUE ~NCH, ~K, 9950t SEC, 24 TI2N R3~ DATE, SEPT, 2~, l~93 (~A7} 27~-2916 ALEX CBM3S SHEET, 2/3 GRID 2641 I" X i0' CONDUIT R:::pC::c:~7ICAL/ i'GALVANIZEDL4~FT, OFCDVER£VER TANK STANDARD ~000 GAL, HOLDING TANK GREER DR ANCHORAGE TANK P,E, LOT 30 ~DULDER SPRINGS S/D SEPTIC SYSTEM DESIGN BLV~, I106' 8DUL~ER CIR DATE,SEPT, 99~0B-3904 A~LEN CDM~S S~EET, 3/3 GRID, 8641 W. DIMOND BLVD. ANCHORAGE, ALASKA 99502-3904 (907) 279-3916 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 I Street Ap. chorage~ Alaska 99501 Sub j ecl: Septic: System Permit Lot 30 Boulder Springs S/D September 6, t993 RECEIVED SEP 9 195,3 Dept. Heaiti~ & Human Services Gent. [ emen; :[ am requesting your assistance in providing a satisYactory onsite waste water dispose1 system for lot 30~ Bouider Springs S/D. This subdivision was created prior' to i972. A communi~:y waterweli was installed in 1972. Only lots 29. 30, and 31 has been de- veloped. Lot 3i has a residential well, while lots 29 and 30 ar'e served by the well or-~ lot 30. These two houses were co~structed in t972 when the separation distances between the well and the sept'ic system were 80 feet to septic kanks and 120 feet to drain- ~ields. The septi,,: system on lot 30 has failed and a replacement must f oun d. b~ With the present separat :i on distance of 150 feet. ~ there i~ a very limited area available for a septic system. To complicate the si. tuat:fon, groundwater is at: shallow depth with surface seepage in places. (Springs) Ast. ar~dard septzc system ('_"an not be installed on this lot w~.thout s~bstantial waivers to the required well separation. Ar~. "Orenco Sap. d FittL=r" can be instal].ed~ however final of the effluent needs to be addressed. disposai I have tentatively indicated the physical sizes of the o~: an C~renco system. The size of the absorption trench may be larger 'i:har~ required, i used a percolation rate of 7.5 ~T~ir~/i. nch and used .......~,J/. c)~ the reqt,ired area. Please rev:iew t:his submittal and lee me know if this is a viable SOlLd'::iori at this time. A more specific and detailed design will be -~:)rthcom'ir~g Jf i:his concept is approved. LOT ]4 LBT ~7~. LOT ] I SCALU 1' = 100 FE TBBBEN SPURKLAND P,E, LOT SO BDULBER SPRINGS S/B SEPTIC SYSTE. aoa w ~sm, AVENUE ANCH, AK, 99501 SEC, 24, TI2N RS~ DATE, AU6, g 199S ~anT~ ~7q-~m~ ALEX CDMBS SHEET, 1/3 GRID, ~64I , / GROUNGWATER P 4 FT~ ~ Tes~hoke GROUND ELEV TDBBEN SPURKLAND P,E, 203 W 15TH, AVENUE ANCH, AK, 99501 LOT $0 BllULI~ER SPRINGS SEC. 24, TI2N ALEX £DMB$ SEPTIC SYSTEM DESIGN DATE, OUL 1, I393 SHEET, 2/3 GRIB, 2641 GAAB-HD-I GR[ ~R ANCHORAGE AREA BOROU' DEP~nrMENT OF ENVIRONMENTAL O. UALIT'~ 3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME ~ ¢"',~/-'~/~":": LOCATION MAILING ADDRESS PHON E~-----' SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY_ /'"'~ ~) ~ GALLONS. NUMBER OF MATERIAL _,r -fi~-.,.~:::~-,~.. COMPARTMENTS INSIDE LENGTH ,-'"'~' INSIDE WIDTH ~"'"-- LIQUID DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER OF PITS_ ,/ OUTSIDE DIAMETER ~ OR WIDTH /,"~ , LENGTH /' ~ , DEPTH "~'~' / LINING MATERIAL ,,,~ ~-~'~'/--<~./'=~'"~-~'~'~'(~'-'~- DISTANCE FROM WELL /'~,.'~-z':"..-''',~g-.~,~'-'~''~ , BUILDING FOUNDATION-,~,,~,~-"¢.. NEAREST LOT LINE_~c-.,,~::=~-"" TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: DISTANCE FROM WELL_ f~'-'---Tqmg'C~DATION ~"'-"'".~__ ,NEAREST LOT LINE NUMBER.-'OF LIN ~..B.,$'5~_~ ~T DISTANCE BETWEEN LINES RENCH WIDTH ABSOI~'ON AREA SQ. FT. LENGTH OF EACH LINE x,,,_ . DEPTH: TOP OF TILE TO FINISH GRADE DEPTH OF FILTER MATERIAL BENEATH TILE TOTAL LENGTH , OF LINES IN. TOTAL EFFECTIVE IN. ABOVE TILE W E L L: '"~"¢~-"~"--'*'~' ~ TYPE e,~.,,~'"L-'-~'~:=' DEPTH NEAREST SEPTIC / SEEPAGE LOT LINE / SEWER LINE ~"~" , TANK SYSTEM DISTANCE FROM WATER BUILDING FOUNDATION.~ SAMPLE CESSPOOL '--"-' NEAREST OTHER ~ , SOURCES,~ DIAGRAM OF SYSIEM DISTANCES: APPROVED G.A.A.B. (};RE:A"] EH ANCHORAGE: ARE:A BORr,,.;._,GH DEPARTMENT OF ENVIRONMENTAL QUALITY 3500 TUDOR ROAD POUCH 6-65'O ANCHORAGE, ALASKA 995'02 TELEPHONE 279-8686 SEWAGE DISPOSAL SYSTEM,,- APPLICATION AND PERMIT INSTALLATION LOCATION INSTALLATION Of: SEPTIC TANK ~ SEEPAGE PIT ~ , DRAIN FIELD OTHEr TYPE AND SIZE OF FACILITY tO be SERVED -~ ~ '~)1~ ~ ! ~/ ~/~/~ FINANCED ThrOUgh TO BE INSTALLED BY SOIL TEST RESULTS ,~ ~ · ~ --'~'~ COMPLETION DATE ANTICIPATED ' /i~' ~ ~ ' O H~AgTU DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE TYPE SEEPAGE AREA SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK ~) sePTiC TANK TO SEEPAGE PIT WALL ,9' SEPTIC TANK , SEEPAGe PIT TO NEAREST LOT Line. i WELL TO sePtiC TANK DRAIN FIELD DRAIN FIELD /L/~ ' , DRAIN FielD SEEPAge Pit /L/~~ ALSO CONSIDER AREA WELLS. t WATEr MAin TO SEPTIC TANK /E2 , SEEPAGE Pit I Drain FIELD TO RIVEr, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET into UNDISTURBED SOIL. 4 INCH DIAMETEr CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH Airtight REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. DIAGRAM OF SYSTEM I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE N~O. 28-68 AND THAT THE ABOVE dESCRIbED SYSTEM iS in AccorDanCE With said ¢OD~...~ ~-- ~// ~/ log OF BO~ING NO. co ~ SOil DESCRIPTION mm -gm n SUR, [Ll~V.; /'~'50 , ......... 1 ~m ,ScS , ' . .,. .~.~..~ , . "~,0 '/.'"'""~ -3E ----- ~ / , L C.~MPLETION'~ I~,PTH: ~.~ I~ Ii I DEPTH TO 'WATER: DATE: ' : ' DATE: ALASKA G£OLOOICAL CONSULTANT~ ~,ON~UI.,T IN G G£OI. OOI,~TI, LOG OF BORING NO. ~. m ~ SOIL DESCRIPTION .~ / SUR. ~LEV.: ..... c~ ~ /~ , ~ ,.. .:~.., . ,. j . ~ ] .,: . ', ~MPLETION PTH: ' TO WATER DATE. J ' ' , , i , , , DATE: ALASKA O£OLOOICAL CONSULTANTI, GON~J&,TINQ ~,~'OI. OglSTI, ...TYPE BORING:, HoLLol. x3 5'7 'E I, } .'~.u.c ~' [q ~X~ION: .2-0 7- ] t~-' . .... ' ~ m ~ S~ll DESCRIPTION,. '" ou>° ~ ~- ~=~ ~'~ <~mo=~ ~ I · , ~ : [ ~MPL~IION ~TH: .... D~IH TO WATER: DATE: DATE: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & W@stewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 w~rw.muni.org/onsite (907) 343-7904 CERTIFICATE OF 0N-SITE SYSTEMS APPROVAL FOR A SINGLE FAIVIILY DWELLING Parcel I.D. 015-161-59 1. GENERAL INFORMATION Expiration Date: ~" / /--'// Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address BOULDER SPRINGS LOT 30 11061 BOULDER CIRCLE *ANCHORAGE, AK NANCY MAGNUSON Dayphone C/O AGENT 11061 BOULDER CIRCLE *ANCHORAGE, AK Day phone BRIAN BODERICK W/ PRUDENTIAL Day phone 563-5500 5801 CENTERPOINT DR. #200 *ANCHORAGE~ AK 99503 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site [] Individual Water Storage [] Individual Holding tank · Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (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. STATEMENT OF iNSPECTiON BY ENGINEER As certified by my seal affixed hereto and as of the vafidation 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 *.he 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 i,,~stigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with afl applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 5701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Phone 557-6179 Date Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The rePorted results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater 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. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for ~-~ bedrooms, with the following stipulations: 7' Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Original Certificate Date: r~ '" //'~ / / Municipality of Anchorage Development ServiceS Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Legal Description: WELL DATA Well type PRIVATE Date completed Total depth 145 5/29/95 ff. BOULDER SPRINGS LOT 30 If A, B, or C provid, e PWSID# N/A Sanitary seal (Y/N) YES Cased to. 61 ft. FROM WELL LOG Date of test 5/29/95 Static water level 21 ft. Well production 1.6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Nitrate 2.75 mg./L. Arsenic: ND ug./L. Date of sample: 1/28/11 CHECKLIST Parcel 'ID: 015-161-59 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 6/2/10 24 .ft. 5.3 g.p.m. YES YES 12+ in. Other bacteria 0 colonies/100 mi. Collected by: GEG, Ltd *TO BE B. SEPTIC/HOLDING TANK DATA Tank Type/Material HOLDING/S ~' EEL Tank size 2000 gal. Numberof Compartments 1 Foundation cleanout (Y/N) *NO Date of pumping C. ABSORPTION FIELD DATA INSTALLED SPRING OF 2011. Date installed Cleanouts (Y/N) Depression over tank (Y/N) NO Pumper 10/23/93 YES High water alarm (Y/N) YES HOLDING TANK Date installed Soil rating (g.p.d./ft2or ft2/bdrm) System type Length .ft. Width ft. Gravel below i~i3~/ ft. Total depth ft. Eft. absorption area ft2 Monitoring tube_,-..---'-'"'~epression over field Date of adequacy test Resul~ P~3seCF~-~~ For~bedrooms Fluid depth in absorption field be~ in. Water added__gal. New depth /., Elapsed Time: J _min""~~l fluid depth in. Absorption rate >=m__ g.p.d. ~eatment (past 12 mo.) (Y/N & type) · If yes, give date D. LIFT STATION Date installed "Pump on" level at,__ in. Size in gallons Manhole/Access (Y/_~ ~ "Pump off" leve~igh water alarm level at Cycles tested, Meets alarm & circuit requirements~ SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot N/A Absorption field on lot N/A Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas. 50'+ in. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank 75'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 75'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Absorption field Surface water. HOLDING TANK Property line Water service line COMMENTS N/A 100'+ Building foundation. Water main Surface water __ ' y, parking/vehicle storage Wells on adjacent lots G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed.Name JEFFREY A. GARNESS Date "~/ llC// I COSA Fee Waiver Fee $ Date of Payment ~ /'~ / / ~ Date of Payment Receipt Number ~ ~/~l ~ Receipt Number (Rev. 11/05) GAR N'ESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS June 9, 2010 Nancy Magnuson 11061 Boulder Loop, Anchorage, AK, 99516 c/o Jerry Dewhurst w/Remax Prope~ies REFERENCE: Boulder Springs Subdivision, Lot 30; 15711; 11061 Boulder Loop, Anchorage, AK, 99516 Ms. Magnuson, The subject property is served by a private well and holding tank. Per the request of Kris Magnuson, we inspected the well and holding tank which serves the subject property for the purpose of obtaining a C.O.S.A. (Certificate of On-Site Septic Approval). A site visit was performed on 6/2/2010. Our findings are summarized as follows: WELL: The well on the property is sixty-five (65) feet deep. At the start of our test, the static water level was twenty-four (24) feet below the top of casing (BTC). Four hundred sixty gallons (460) were pumped from the well over a period of eighty-five (85) minutes, resulting in a maximum drawdown of thirty-seven (37) feet. Based upon the testing data, the well produces at least 5.3 gallons per minute (GPM). WATER QUALITY: Water samples were pulled on 6/2/2010 and delivered to a state certified lab to be analyzed for arsenic nitrates and bacteria. When we receive the results, we will forward them to you. HOLDING TANK: The septic system consists of a 2000 gallon holding tank. During our site visit, two deficiencies were noted: · No foundation cleanout was present. This cleanout must be installed prior to C.O.S.A. approval. · No high water alarm exists inside the house. An interior alarm must be installed prior to C.O.S.A -"~ approval. We recommend that you contact A+ Home Services (907-345-2444) to make these repairs. The following is a summary of costs accrued by this project so far: · Services to date for well and septic evaluation, water sampling and preparation of this report: $850.00 If you have any~u~slions, please contact us at 337-6179. "~ Sincerely,/ t Jeffrey A; S. Presi~entf 3701 E. Tudor Road, Suite I01 * Anchorage, Alaska 99507-1259 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.gamessengineering.com SGS Reft# 1110306001 Client Name Gamess Engineering Group, Ltd Printed Date/Time 02/03/2011 8:40 Project Name/# Boulder Springs L30 Collected Date/Time 01/2§/2011 11:30 Client Sample ID Boulder Springs L30 Received Date/Time 01/28/2011 12:22 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 Sample Remarks: Allowable Prep Analysis Parameter Results LOQ Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 02/01/1 I 02/01/I 1 NRB Waters Department Total Nitrate/Nitrite-N 2.73 0.100 mg/L SM20 4500NO3-F B (<10) 02/02/1 I AYC Microbiology Laboratory E. Coli Negative I 100mL SM20 9223B A 01/27/11 SDP Total Coliform Negative 1 100mL SM20 9223B A 01/27/11 SDP 25 LLI :;3 0 o rn o ! o Z / LOT 28 LOT 30 1.0 OH ~ 8084B LOT 29 Notes: 1. The 15' Utilty easement and the 40' 80' and 120' radius setback lines were plotted by scaling the dimensions from the origin plat (Plat No. 72-109). Said plat has no dimensions to accurately locate the easement or setback lines. 2. Ddveway location is approximate due to snow and 0 n- 30 ~...~N=120'00 o seepage pits - / No sewers,septic tanks SCALE: 1"-- 40' _.-r', ....... .~'1 ' -...,. , I ~ w.,"49 TH ~ '~ /~ -, Fred Wala~k~ :~ /%~-. ~0, 325~-s ..~ · ~SEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED P~T ARE NOT SHOWN HEREON. Lante~ BE AS-BUILT NO CORNERS SET THIS DATE I hereby certify that I have performed a Mortgagee's inspection of the following described proper[y:.. LOT 30, BOULDER SPRINGS SUBDIVISION Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not ovedap or encroach on the property lying adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Anchorage, Alaska this 5th day of February ,2011 FRED WALATKA & ASSOCIATES Engineers and Surveyors (907-248-1666) Feb.lO, 2011 4'32PM Garness Enaineerina Group, Ltd, No.0464 P. 1 . Residential Anchorage, Atasl~a 99503-4049 (907) 222-8~00 phone (907) 222-880I fax l-flSfi-357-2707 toll free *,'~x'w.residemialmtg. eom February 10, 2011 RE: 11061 Boulder Circle, Anchorage, AK 99507 To Whom It May Concern, Residential Mortgage, LLC has received two bids proposing to excavate and install double cleanout for the above mentioned property. Residential has agreed to use the higher bid of $1300 from A+ Home Services and hold it in an escrow account that we will manage. We wilt be holding two times that arno~mt ($2600) plus an additional $150 Re-Inspection fee in an escrow account. A copy of both bids has been attached for your review. Plea~se note that these bids do not include landscaping. Please contact me with any questions you may have. Mortgage Loan Processor AK# 199727 Residential Mortgage, LLC (907)646-8761 (907)646-8741 hx 11061 Boulder Ckde A+ HOME SERVICES, INC. 7501 E. 140th Avenue Anchora§e, Alaska 99516 (907) 345-1890 · Fax (907) 868-6770 '*~c~c'E~arness Engbeerh~g : 677-4570 Oct_ 25, 2010 JOB NAME Springs A+ Home Services, Inc. appreciate~ the opp~i~ to bid on the follow~g ~cope or, work. To ~cavate and b~tall a double cleanout b tro~ oft~k $1300 To move aI~m h~sir./e by Ltyon have my questions er c~cerm office at the number l~ed above. We by the Locate Call C~at~r or settlem~t, l~e a site vkit, plebe do not he'ac ~o call our Au[Ye NOTE: Th;$ pror~o.saJ may be d)~ion~ ~re sariCac)op/and ~r~ hereby accepted. You are ~ulhonzed to dO Si ~atur ] 1~ ' ' ....... "' ' ' ' ,adeasosJ, n~dabov, . ~ GARNESS ENGINEERING GROUP, Ltd. 3701 E. Tudor Rd. Suite 101 Anchorage, AK 99507-t259 Phone: (907) 337-6179 Fax: (e07) 33:8-3246 Construction Bid Document# 721 Date: 2/9/11 Client: Prudential Jack White C/O Brian Broderick 3801 Centerpoint Dr. Ct 200 Anchorage, Ak 99503 Project: Brian Broderick Description Qty Rate Total: ) Install foundation clean out 1,000.00 1,000.00 Boulder Springs; L30:11061 Boulder Circle By signing below, the ctient agrees to the p~'oposed work and has read GEG's 7 page specification '~,~rm in~.h~...Ic,~l ,~,;+k +kc, design pscksg8. ~ ~'~' '; .... ':-~ ........................ , ,,~ ,~,,uw. ~~pp,u~ to the above estimate unless othe~ise noted: 1. All import of fill and export of trees, soil, debris, etc. will be billed out at an additional charge. 2. Estimate does not innluH~ fnp~r~il & seeding, o~,4/ .............. Signature: Date: (Total: $1,000.00 ) Feb 04 02/04/11 2011 8:34PM ISRRCS PUMPIMG TIBBETTS Isaacs Pumping Service 90?56254?3 p.1 Type Date Num P. O, # Magnuson,Nancy Invoice Payment Invoice Payment Invoice Feyment Invoice Payment Invoice Invoice Invoice Paymenl Paymenl Invoice Payment 4124/2009 14241 5/11/2009 4020 6/1012909 14477 6/23/2009 4039 8120/2009 14816 9/16/2009 4180 10/13~2009 15099 10122/2009 4215 11/30/2009 15674 5124t2010 15848 6124/2010 15989 6/28t2010 3706 7/7/2010 3715 8/30/2010 16207 11t6/2010 3793 4/22t09 6t9109 8/18/09 10/12109 correctbn 5122110 6/23fl O' 8/19110 P~el CUSTOMER · 750'1 E. 1.40th Avenue Anchorage, Ataska 99516 3923 pmmd ~ Block Lot DATE 02-02-11 DESCRIPTION In~iall holding tani~ aiai~a insiae:,.ho~,,,e at. ,,lJ.0bl Boulder Circle 333-7521 ,.'. TOTAL AMOUNT $I75.0, Gallons _ _ Septic ~ Leach Area ~ Holding Tank ~ Standpipes [] PROBLEM AREA ~ CALL FOR MORE INFORMATION [] NEEDS TO BE DONE AGAIN IN 6 MONTHS ~ Good Shape [] Sludge buildup on bottom ~-~ Jim cap missing or [] Cut standpipe to 1' above ground needs replacing Time [] Floater on top ~ Needs Septictrine Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.Oi. Box 196650. Anchorage? AK 99519-6650 vvww.muni.org/0nSite (907) 343-7904 CERTIFICATE OF 0N-SITE SYSTEHS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-161-59 1. GENERAL INFORMATION COSA# / ! ! 0 2 Expiration Date: ~ -,/O -// Complete legal description BOULDER SPRINGS LOT 30 Location (site address) 11061 BOULDER CIRCLE *ANCHORAGE, AK Current Property owner(s) KEVIN BROWNSBERGER Day phone 555-7521 Mailing address 11061 BOULDER CIRCLE *ANCHORAGE, AK Lending agency Day phone Mailing address Real Estate Agent .......~ ~,...~./_..~ ,~ ,"L:' '~' .?.. ~n~ ~:-~. * ,' ' Ma~il' address '. ' ~ :Utiless: O:therw/de requested, COSA will be held by DSD for pickup. 2.:.:.NUMBER'-" OF BEDROOMS: 3 3..TY~EPF WATER SUPPLY: Day phone TYpE OF WASTEWATER DISPOSAL: Individual Well · Individ ual On-site · Individual Water Storage ~] Individ ual Holding tank [] Community Class Well [] Community On-site [] Public Water System [] Public Sewer [] I The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems App oval are vahd for 90 days from the date of ~ss'ue for properbes served by a private o[ Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to0ne 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 professior~al 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 t~at my investigation, based on procedures Outlined in the Certificate of On-Site Systems Approval Guidelines for this application, 'shows t,~at 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 f-om 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 357-6179 Address 5701 E. TUDOR ROAD, 'SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date Engineer's Comments': In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineefing analysis of the system in accordance with ADEO and MOA DSD Guidelines & Regulations. The reported results described the performance of the system underthe conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater 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. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that · there are no hidden defects or encroachments. GEG, LTD. can therefore not provide ' any warranty or future, estimate of ho~.long t/~e sy~tem will continue to meet tt~e operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal fight whatsoever. DSD SIGNATURE ~ Approved for _~,~ bedroomS. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory (Rev. 11/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other ,/~-~~ Original Certificate Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 (]ERTIFICATE OF ON-SITE SYSTEMS APPROVAL (]HECKLIST Legal Description: BOULDER SPRIN(;S LOT 50 A. WELL DATA Parcel ID: 015-161-59 Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES Date completed 5/29/95 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth 145 ft. Cased to 61 .ft. Casing height (above ground) FROM WELL LOG AT INSPECTION Date of test 5/29/95 6/2/10 Static water level 21 .ft. 24 ft. Well production 1,6 g.p.m. 5,3 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ND ug,/L, SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size 1500 gal. Nitrate 2,73 mg./L. Collected by: GE(;, Ltd. Date of sample: 1/28/11 STEP/STEEL Number of Compartments 12+ in. 2 QUANICS AEROCELL UNIT Date installed 5/4/1 1 Cleanouts (Y/N) YES Foundation cleanout (Y/N) YES Date of pumping NEW ABSORPTION FIELD DATA Date installed 5/'4/11 Length 20 ft. Total depth *4.24 ft. Eft. absorption area 100 ft2 High water alarm (Y/N) Date of adequacy test NEW YES Depression over tank (Y/N) NO Pumper. I *BELOW FINAL GRADE ] rating (g,p.d,/ft2o~ 5.0 System type Soil TRENCH Width 5 ft. Gravel below pipe 0.5 .ft. Monitoring tube YES Depression over field NO Results(Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test - in. Elapsed Time: - min. Final fluid depth - Any rejuvenation treatment (past 12 mo.) (Y/N & type) Water added - gal. New depth - in. in. Absorption rate >= 450+ g.p.d. NONE KNOWN If yes, give date - D. LIFT STATION Date installed "Pump on" level at.~jn. E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons Manhole/Access ~ ~ "Pump off" leve_l_AL--.----inT'-~-. High water alarm level at Cycles tested Meets alarm & circuit requirements? 100'+ Septic tank/lift station on lot Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25'+ Animal containment areas 50'+ .in. On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank 75'+ N/A Manure/animal excrete storage areas 100'+ Building foundation Water main Wells on adjacent lots SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: 5'+ Property line 5'+ N/A Water service line, 10'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots. 100'+ Absorption field 5'+ Surface water, 100'+ Water main N/A Driveway, parking/vehicle storage 10'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date COSA Fee $ ~ Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number LOT 28 25' LOT 29 ~;1/2" Vent ~ RADIUS = 120' NO PITS ~2 Aero cell.~ SEEPAGE (Dia.=2.25') Lift Station (~'(Dia=2.25') 2 Cleanouts --'" NOTE:'~-rHE 15' UTILITY EASEMENT IS /.-~ PLOTTED IN ITS SCALED LOCATION, / THE PLAT Of RECORD HAS NO DIMENSIONS TO ACCURATELY LOCATE Panel / /./ LOT 30 Electric THE EASEMENT. ///JcO ~ / ' "~ r-- N EXISTING / x ~ CIRCLE . × SEPTIC T AN S · J~ R DISPOSAL FIELDS. .~%~ ~ ~IS DRA~NG ~ALL NOT BE MODIRED FOR USE AS A PLOT PLAN ~OUT ~E EXPRESSED ~I~N CONSENT OF LAN~. Legal Oeacrlptlen: Lot 50, Boulder Springs Subdivision Jl Ordered By: Porn Brownsberger AS-BUILT Legend: aeonout co . Septic Standpipe Water Well ~ , Fence --X--X-- SURVEY CERTIFICATION: LAN3ECH has conduCted o physical survey of the property am shown an this drawing and certifies that the ~mprovements situated thereon ere within the property lines and no encroachments exist Other then EXCLU~ONARY NO'i~ It I~ the owners' responsibility to determine the exM[ence of =ny easements, covenants, restrictlon~ or rlght-of-woy toklnga which do not appear on t~e recorded aubdMs~on plat. Under no circumstances shOUld any data hereon be ueed for construct on, for estabiishlng property llnee, or for plot-plan purpose~. ~d: 2641 [:)at= June g, 2011 Orown e~: PL 'Ref: 96-L-566 & 11-LH'48 Scale: i"=~0' Checked By. JMZ LAND & CONSTRUCTION SURVEYORS-PLANNERS-ENGINEERS 440 West Benson Boulevard, Suite 200 Phone: 562-5291 Anchorage, Alosko 99505 Fax: 561-6626 mot: 72-109 & 71-279 Wo~ 0~,~. 2011-L-088 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 015-161-59 HAA# 1. GENERAL INFORMATION' Complete legal description Lot 30; Boulder Sprinqs Subdivision Location (site address or directions) 11061 Boulder Circle Anchorage, AK Property owner Mailing address Lending agency Mailing address Agent Kathi Address Allen Combs 11061 Boulder Circle Day phone 346-3006 Anchorage, AK 99516 Day phone Fernandez/ Vista Real Estate Day phone 562-6464 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of syStem. 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. XXX 72-025 (Rev. 1/91) Front MOA ~21 STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S & S ENGINEERING 17034 Eagle River Loop Road No. 204 Add ress Ea~jle River, Alaska 99577 Engineer's signature -~,--~ Phone Date DHHS SIGNATURE Approved for 2 Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments By: The Municipality of Ar~chorage 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% work. 72-025 (Rev. 1/91) Back MOA ~1 MUNICIPALITY OF ANCHOP, AGE ENVIRONMENTAL ,SERVICES DIVISION Municipality of Anchorage SEP 0,5 1996~~ DEPARTMENT OF HEALTH & HUMAN SERVICES R E C E J VE Environmental Services Division 825 L Street, Room 502 · Anchorage, Alaska 99501 ° (907) 343-4744 Health Authority Approval Checklist LegalDescription:Z,e~- ~'o ~e,,~.~o4.~ ,~/'~'"'¢~' $/~ ParcelI.D.: 01,.?'-- )~,1- ,,c-~ A. WELL DATA Well type C L~ rS ~ ,~otc R~?aevt,~ 6'td & Log present (~N) ' ¥~- $ Date completed ~'- / a- ~ / ~/5- Total depth Cased to _~above ground) Sanitary seal (Y/N) ' ~_/"'~'~'- Wires properly protected (Y/N) AT INSPECTION Date of test ,,~'~' ~'~' ~'"'"* Static~ W~'~d.uction g.p.m. C ~ IfA, B, orC, attach ADEC letter. ADEOwet~number ~3.1- g.p.m. WATER SAMPLE RESULTS: Coliform O Nitrate Date of sample: ~' / ~ ~ / ~/(- B. SEPTIC/HOLDING TANK DATA''~ Collected by: Other bacteria S & S ENGINEERING Eagle Ri,ver, Alaska 99577 Date installedT/7,z ~ '°/~t~ Tank size~e°~ ~' 3,0,o Number of Compartments r-- Cleanouts (~N) YE -,(' Foundation cle,anopt. (~/1~ /v O Depression (Y~j~ Date of,~'~pJng ~/~°/q',''G. Pumper ~o~o C. ABOORPTIONFIELDDATA '~ ~ ,~ oo~ Date installed Soil rating (g.p.d./~ Length __ .Width ':~. __ Gravel thickness below pipe ~depth __ EffectiVe absorption area , . Monitoring lube present (WN)_~epression over field (Y/N) . Date of adequacy test ~ __ Re~~ For __ ~ __ bedrooms Fluid depth in absorption field be~ . Immedistely after gal. water added (in.): _ D. LIFT STATION Date installed Size in ga~'~ Manhole/Access (Y/N) "Pum~ "Pump off" level at* High water alarm level at* *Datum cyc! E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: ! / Foundation -~' '/- Property line ..C"/- Absorption field ,~, Water main/service line ;3 ~'/'/- ~ Surface water/drainage /c~o -~ Wells on adjacent lots ! /oo -/- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line ' ~ ~:' ~' ~ 'i~Uilding foundation Surface water "' ; ' ~ '~'. ~' '~ ' _~cle storage area Cu~i~,~~~~ Wells on adjacent lots ENGINEER'S CERTIFICATION I certify that/have determined thru field inspections and review of Municipal record~~,~, ~.s in conformance w~/~DJ H~ gu~nes in e ff ect on this date. Engineers Name ~~ ~ are HAA Fee $ Date of Payment Receipt Number ~--~/7 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 09/04/96 12:03 CT&E ESI ANCHORAGE ~ 9076941211 N0.033 Q03 CT&E Environmental Services Inc. laboratory Division 200 W. Potter Drive Anchorage, AK 99518-1605 Tel: (907) 562-2343 Fax: (907) 561-5301 CT&E Ref.# Client Name Project Name/# Client Sample ID Matrix Ordered By 964241001 $ & S Engineering Lot 30 Boulder Spfiags $/D Lot 30 Boulder Springs $/D Dri~ng Water 0 Sample Remarks: Client PO# Printed Date/Time 09104/96 09:33 Collected Date/Time 08130196 11:.30 Received D~teJThne 08/30/96 17:00 Technical Director: Stephen C. Ede At [owabte Prep Anatysie Method L~mit~ 0ate Date Init Nitrite-N 0.100U 0,100 mg/L EPA $53.Z 08/31/96 NItrate-~ t.$~ 0.100 mg/L EPA 3~3.~ 08731/96 Total Cotifom 0 0 co[/100mL $M18 9ZZZ~ 08/30/96 TAV ~~ Member of tho 8GS Group {Soci6t~ G6n4rale de Sun;eillance) ENVIRONMENTAL FACILITIES IN At. ASKA, CALIFORNIA. FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI. NEW JERSEY, OHIO. WEST VIRGINIA AUG--~O--~ 11:59 AM ANCH PHYSICAL THERAPY 90? 2?7 1923 P.02 ( STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES :' '-' DIVISION OF MINING & WATER MGMT · , WATER WELL RECORD · "~'.ATW..~I OF WELL ,,,, , , [~ I"~ M ~t~ LO ~~,~ t~p ~gro~ s~ace ~ D~H: DATE OF COMPlaN ......... ~- ~ ----'-- ' ' ~of~e:~ it UCPLHOL.~ ~TA: · Depth ~pth of casin~ft ~te, i~l I~ ~r~ Color From To_ . ~ . DE~H TO ~ATIC WATER ~: · * '-' -' , ** ' ' Date: ~ M~HOD OF ORILLING: **~ air ro~a~ ~ cable t~l -- ~~/, - .................... ~ USE OF W~L: ~ dome~ic D irrigation ~ mo~tor ~......../~:~ ~ / ~ ~ ~ p~i~ SUpply 0 other ~ ~''~ CASCO STICK,P: .~ ft. Diem: G in. to~ / it W~L INTAKE OPTING TYPE: ~ o~n end ~ screened ~~,.~.- - ..> , - , ~ ',~ ~/ ~ .... . ...... .. ~ SCR~N TYPE: G~V~ PACK TYPE: ..,: ,,, _ o p,. ,o ,o;: .... Oep~: from . .... ~ ~,, , . O~O~ M~HOD: "~ PUMP~G L~EL AND~LD: ~ /~ ltafter . ~ ,, ~s pumping~gp~ ~ .... ~ --~ t PUMP ~TAKE DEPTH: [ ~ DISINFECT~ UPON COMPL~ION~ CONTRACTOR INFORMAl It fl:. .REMARKS: ,'-Ct ~-.' ,-~.,/~-~-*' ~ '~~-~ '~l$~St~ '~t~Name .... ~/ ~ ~ .... . ~ ~r PLEASE ~AIL WHITE COPY OF LOG TO: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE Of HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 01,~ I~,l ~ 1. GENERAL INFORMATION Corn plete legal description Location (site address or directions) Property owner Mailing address ALLEN C-¢¢-,1'F.,5 Dayphone Z~c/G- ~oc~ Lending agency Mailing address. Day phone Agent Day phone Address e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status"of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev, 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and'inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirm I--"~/o~ .--~>~-rV'-._Lo..~.L¢ '-~- -~ Phone Add tess ~ o Engineer's signature approval for bedrooms. bedrooms, Sm DHHS SIGNATURE ~Approved for Disapproved. Conditional Date l lltq lq~ with the following stipulations: Additional Comments By: The Municipality of ~,nchorage 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 repistered 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 tr~'/, 1/e" ' ' '~ MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lo~ 30, I"~O01,,~FL- q'~(~/NG~ Parcel I.D. A. Well Data Well type ~_ Log present (Y/N) Total depth Sanitary seal (Y/N) If A, B, or C, attach ADEC letter. ADEC water system number Date completed Driller Cased to Casing height FROM WELL LOG Date of test Static water level Well flow Pump level1 SEPARATION DISTANCES FROM WELL TO: Wires properly protected (Y/N) AT INSPECTION .g.p.m. g.p.m. Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line q5 ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /~ WATER SAMPLE RESULTS: Coliform Date of sample: It~ z Nitrate /--//. 7 / Other bacteria Collected by: '~-'~-' --~ B. SEPTIC/HOLDING TANK DATA Date installed [ ~'7 ~//~,.-~ Cleanouts (Y/N) 7 Foundation cleanout (Y/N) High water alarm ( Date of pumping Tank size l~o 4 ,,0..o--~.o Compartments ~L -/- ] /~,] Depression (Y/N) Alarm tested (Y/N) I Pumper ~ -~ / SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ?~- //7--o To property line ~> / L~ Surface water/drainage On adjacent lots ~//~"~ Absorption field ~ ~ Foundation ~/~-~ Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION ~///~ Date installed Manufacturer Size in gallons Vent (Y/N) "Pump on" level at Manhole/Access (Y/N) "Pump off" Level at High water alarm level Meets MOA electrical codes (Y/N) Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Length ! ~ Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Width Cleanout present (Y/N) Results (pass/fail) Soil rating (GPD/FF) ~ / "7Gravel thickness Systemtype ~/~./ ~ ~ Total depth c~ Depression over field (Y/N) for [ After test /--//--% If yes, give date r,.! Bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot I To building foundation On adjacent lots ~ 3-0 Cutbank Surface water Curtain drain '/~ o On adjacent lots ~'7[/,,~- Property line To existing or abandoned system on lot N/~, Water main/service line Driveway, parking/vehicle storage area ~ (-~ E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidefines in eff. ecfon the date °fthis inspection. Engineer's Name . - p~¢-~l.~,~? ~-'- Date II HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back Waiver Fee $ Date of Payment Receipt Number '" ENVIRONMENTAL LABORATORY SERVICES ENGINEERING CO. S,NCE,.O. REPORT Of ANALYSIS Chemlab Ref.~ :93.6:140-.-5 Cliertt Sample ID :L30 BOULDER SPRINGS Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :TOBBEN SPURKLAND, P.E. Ordered By :TOBBEN SPURKLAND Project Name : Project~ : PWSID :UA WORK Ordar :73192 Report Completed : 11/16/93 Collected :]_.l/17./93 ~? 15:15 hrs. Received :1.1/12/93 @ 16:10 hrs. Technical D i r e ct o r: /~ ,_t~~~ ~_ STEPHEN. C. EDE Released By : Sample Remarks: ROUTINE SAMPLE COLLECTED BY: T.S. QC Allowable E×t. Anal Parameter Results Qual Units Method Limits Date Date Init Nitrate-N 4.71 m.g/L EPA 35B. 2/300 ~.0 1.0 11/15 1-.L~l * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U ~= Undetected, Reported value is the practical, quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than Member of the SGS Group (Socibt6 G~n6rale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA Municipality of Anchorage OFFICE OF THE MAYOR P.O. BOX 196650 ANCI tORAGL', AI.ASKA 9!)519-(i650 TELEPtlONE: (907) 343-4431 FAX: (907) 272-1991 Torn Fink, Mayor June 3, 1994 Mr. Allen C. Combs 11061 Boulder Circle Anchorage, Alaska 99516 Dear Mr. Combs: Thank you for your letter of May 9 regarding the problems you are having obtaining a Health Authority Approval on your property at 11061 Boulder Circle. According to Department of Health and Human Services (DHHS) records, no application was submitted from your engineer, Mr. Tobben Spurkland, for a sand filter system to be installed at 11061 Boulder Circle. Although DHHS did permit a very limited number of innovative sand filter systems for evaluation during 1993, your property was not submitted for consideration under this program. However, you were issued a permit to install a holding tank on your property on October 14, 1993. This permit stated that construction done under the permit must comply with all applicable Municipal and State regulations. It did not make any statements regarding the condition of your existing system. Your engineer, Mr. Tobben Spurkland, chose to install the holding tank downstream of your existing septic tank and crib system. This arrangement is generally acceptable if the existing system meets all regulations but is not functioning adequately for the load it is receiving. However, in the case of your existing system, not all regulations were in compliance. The depth of your existing crib is shown to be 8 feet on DHHS as-built drawings dated July 3, 1972. The as-built report submitted by Mr. Spurkland following the installation of your holding tank shows ground water at your crib location to be at a depth of approximately 6 feet. Current Anchorage Municipal Code (Section 15.65.060.A.2.b) states that the required separation between the bottom of a disposal field (your crib) and the ground water table must be a minimum of 4 feet. DHHS notified Mr. Spurkland that it would not approve the continued use of a log crib system that discharged Wastewater effluent to the Mr. Allen C. Combs June 3, 1994 Page 2 shallow groundwater table. You were mailed a copy of this letter, dated December 14, 1993. If your holding tank is still connected downstream of your crib, it is in violation of Anchorage Municipal Code, and DHHS will be unable to issue a Health Authority Approval on your property. I would also like to inform you that DHHS is currently accepting proposals from engineers for the installation of 10 additional sand filter systems during this construction season. These additional systems will be installed under a test program to further determine the efficiency of sand filters in Anchorage's environment. These proposals have been requested to be submitted by June 13, 1994. From the review of your property's records at DHHS it appears that your property might be a good candidate for one of these systems. If you have any comments or questions regarding this matter, please contact James Cross, a Civil Engineer with DHHS, On-Site Services section, at 343-4744. Sincerely, Tom Fink, Mayor cc: Helen D. Beirne, Ph.D., Director, Department of Health & Human Services Robert O. Baker, Ph.D., Acting Manager, Environmental Services Division 05-2~-94 09'05 AM FROM MAY May 9, 1994 Allen C. Combs 11061 Boulder Circle Anchorage, Alaska 99516 PO1fO6 Honorab~Mayor TomFink City ofAnchora~e P. O. Box 1966~0 Anohorag~AK 99519 In April 1992 we purohased a home at 11061 Boulder Circle that needed extrusive remodeling to brin$ it up to standards. We re~ a constmotion loan/rom North Rim Bank to purdue the house and we did all the.needed repairs out-of-po~et ($100,000). The following year in March we contacte6. ~i~inee~ Tobin Spurkland (P.E.), a~ requested thai he do a perk test. He la~' said t.h~t'it dirt not pass the perk test. He then dr~ up a plan for tt nt~v sand ~ter system an~ Submittal it to the Muni Department of Health and Human S~rvicos. The depanm, nt subsequently iriibrmed us that they had reje~'ted the system. I m~t with Helen Beime, Director of the Depanmant of Health and Human Services, and uked what remedy we could purslie to e, orreot this problem. She said that if we installed a holdin8 tank beyond the crib with an alarm system that this would be ~ceptable. It would serve to catch a~y_e~x~ cess liquids from the crib. I pa~sed this information bark to Tobin Spurkland who then drew up the needed do~monts for the system, reoomraended by Ms. Beime, to submit to the Health Department. The deparunent issued a permit to complete the work sped/it'd in the dooumottts. The work wu oompleted in September 1993. In De0ember 1993, we rer, eived a letter from $ohn Smith, P.E., of the Health Department who stated we were in violation of polluting the ground water. I met with Mr. Smith and Hgen Beime to try to resolve this matter. Thtir verbatim re~ponse was, "Your engineer, T, Spurkla~ should have 'ttnown b~tter' than to ~ d~igned a system lil~ this. "' My predicament is that our Cnlitn~r designed the system and your people in the Department of Health and Human Services approved the syst~rt and issued tl~ .~rrnk m haw the wnrk comp!et_ed ~nly to ]~t~ di~.nptove their own ~.nproval acti'on. 05-2?-94 09:05 AM FROM MAY 0 P02/06 I would appr~-ia~e anyggn8 you could do ~o resol~ this situation a~ i~ is holdi~ up my ~ and th~ ira,rest re~ has e. ominu~l to inor~aa~ by 2.1/2% whi~ has cost us comid~'ably more money b~ause of'this de[ay. I will be happy to talk with you or ~o m~-t with you To respond to any questions you may have. My number is 244-9493 (cSlul~r) or 346-3006 (home). Stllo~r~ly, All~n C. Combs DEPT. OF ENVIRONMENTAL CONSERVATION TONY KNOWLE$, OOVERNOR ANCHORAGE/WESTERN DISTRICT OFFICE 800 E. DIMOND BLVD., SUITE 3-470 ANCHORAGE, ALASKA 99503 Mr. Allen C. Combs 11061 Boulder Circle Anchorage, Alaska 99516 May 23, 1995 (907) 349-7755 RECEIVED MAY 3 0 1995 Mu~iC~pality of Anchorage Dept, Health & Human Services Subject: Lot 30, Boulder Springs Subdivision, Proposed Class C Public Water System, Anchorage, Alaska, ADEC Project Number 9521-DW-130-126 Review Dear Mr. Combs: This letter is in response to your May 10, 1995 submittal in which you requested approval to install a source well for a Class C Public Water System that will provide potable water to your home and the Bed & Breakfast that you operate. I have reviewed the submitted information and have the following comments: It appears that the proposed location for the source well will meet the current State Drinking Water Regulations and guidelines. Therefore, in accordance with State Drinking Water Regulations, 18 AAC 80, construction approval to install the proposed source well and water distribution system is being granted. A Construction Certificate, constituting this approval is enclosed. Prior to serving water to the public, the following items will need to be provided to this office for review and, if appropriate, issuance of a final -operation certificate. 1. A copy of the well log and well yield test results will need to be submitted to this office. 2. The longitude and latitude of the well will need to be submitted to this office. Written verification, under the stamp of a Professional Engineer (P.E.), that the new source well meets all provisions of 18 AAC 80.015 (b) will need to be submitted to this office. 4. Analytical results for total coliform bacteria and nitrates (as nitrogen) will need to be submitted to this office. Mr. Allen C. Combs 2 May 23, 1995 Calculations showing the capability of the water system source well to meet minimum water consumption needs and the criteria for water demand calculations will need to be submitted to this office under the stamp of a P.E. 6. Engineering as-buiits plans detailing the water system will need to be submitted to this office. Verification that only lead-free pipe, flux, and solder were used during the construction of the water system will need to be submitted under the stamp of a P.E. This approval does not imply the granting of any additional authorizations, nor obligate any state, federal, .or local regulatory body to grant required authorizations. In February, 1993 the State adopted regulations requiring fees for plan reviews when a public drinking water system is modified. The installation of a new source well is a modification. The fee required for this project is $200. The fee invoice (invoice number 101511) is enclosed. Thank you for your cooperation and coordination with this Department. This approval letter does not cover any upgrade to the existing wastewater disposal system. If the wastewater disposal system is upgraded, the existing waiver will become invalid and the minimum separation distance of 150 feet between the new source well and the new wastewater disposal system will need to be meet. If you have any questions, please do not hesitate to contact me. Sincerely, Keven K. Kleweno, P.E. District Engineer KKK/pt Enclosures: As Stated cc: Jim CrOss, P.E., MOA/DHHS, w/o Enc. Municipality of Anchorage REQUEST FOR VOUCHER CHECK FROM: Health & Human Services (DEPARTMENT) TO: MUNICIPAL CONTROLLER DATE: May 25, 1995 R 37482 THIS SECTION FOR ACCOUNTS PAYABLE USE ONLY REFERENCE NO. INVOICE DATE INVOICE NO. CHECK NO. CHECK DATE PREP APPR 1. REQUEST THAT A MUNICIPALITY OF ANCHORAGE CHECK BE ISSUED TO: Name Esther M. Combs 11061 Boulder Circle Address Anchorage, Alaska 99516 2. THISPAYMENTISFORTHEFOLLOWING(SUBSTANTIATIONATTACHED): Applicant applied for a well permit on a "bread & breakfast" facility making the well permit from ADEC not the MOA. only. Please refund the following. 5-3-95, however, this property will be I this commercial property and must obtain~ The MOA handles single family dwellingI Lot 30 Boulder Springs S/D I 3. DISPOSITION OF CHECK: (1) ~IVlAIL TO PAYEE (2) [] MAILTO PAYEE W/ATTACHMENT (3) [3 NOTIFY PAYEE TO PICK UP IN TREASURY AUTHORIZED USE ONLY (6) i--I NOTIFY DEPARTMENT EMPLOYEE WHEN CHECK IS READY IN FINANCE Name: Name: Org. No.: Phone No.: __- Phone No.: 4. ACCOUNTS TO BE CHARGED: ITEM ENTER ALL POSITIONS OF ACCOUNTING DISTRIBUTION NO. DESCRIPTION Oq; ICC Acer/Obi Task Opt Cost Ctr. WAJWO AMOUNT i 12o oo 1 ~62.1 ];,e:rrrJ. .~57 ~ · 5. TOTAL AMOUNT OF CHECK ~ 12000 6. SIGNATURES ~;~I_L~ ~L.~:3~ 343--4744 Employee & Phone No. Approving Authority 7. INSTRUCTIONS a. To be used only when payment cannot be made by purchase order, travel expense report, travel authorization or petty cash. b. Must be approved by department head unless approval authority is delegated in accordance with Policy and Procedure 24-7. c. Retain carbon copy for your file. 40-001 (Rev. 2/91) MOA #15 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services On-Site Sewer/Well Permit Application NOTE: Application must be filled out completely SI N G LE FAMI LY DWELLI N G Property Owner Name /~ ~"/~' ~ ~ ~"~ (~..~ Mailing Address //~ / ~ ~ ~~ ~/~ Legal Description -~ ~ ~ ~ ~ ~/~ ~ Lot Block Parcel Identification Number Day Phone ~..:~ Zip Code Subdivision [~ ~ LO ~:3"~ Section Township Range Lot Size / _~.) ¢-~ ¢ Acres/Sc!. Ft Inspections will be conducted by: RECEIVED Number of Bedrooms: ,J~ Approved Engineering Firm ~.~L.~ IC~'~ '~"~ ~ ~-~'~r~u"~'~, Municipality (permit fee include~l~A¥ ~1995 Does your house contain any of the following: Hot Tub, Swimming Pool, Therapy Pool, J,a.,c~'{IDJcJpalJt¥ of Anchorage Human 8ervice~ or Water Softener Unit? If yes, which one? . This application is for: Sewer Only Sewer and Well __ Sewer Upgrade __ Well Only I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and in accordance with applicable Municipal codes. 72-012 IRev 10/86) Receipt # Property Owner/Well Driller ~'~ ~"'C~"~ .;~"~ Permit# ' Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Services Division Telephone: 343-4744 ON-SITE SERVICES FEE DOCUMENTATION Date Paid: '~'~/..~"'-- Name ~:~y.~~me ~, hec~-o ~ Mailing/f/~ ~/Address: (0~.~_~ d~ OS-- Legal Description(s~~,..~ ~ Permit Number: 00858 Type of Payment: (Indicate Amount Paid) .l,?althj Authority: Excavator Permit: Sewer & Well Permit: Engineer Permit: Well Permit: Sewer Permit: Copy Request: 72-034 (Rev. 10/87) Pumper Permit: Well Driller Permit: Tank Manufacturer: (Waste Treatment) DISTRIBUTION: WHITE--MASTER WAIVERS: Lot Line: Well to Tank: Well to Field Field to Surface Water Tank to Surface Water FILE CANARY--PROGRAM FILE 8t,1 \ 8~.~ \ e~.~ e~,~ ~ ~.~ ~,~ I , , / I 1~ 8 , 15 30 4~ 60/ I ~ 6ROU~ATER ~ 4 FT ~ X. .. T~3EN' 'SPURKLANO P,E, L~{~,~O'BOUL$E~ SPBINGS S/D s~p~c s~s~. ~S~U~LT e09 ~ mTn, nV~NU~ ANCH, AK, 99501 SEC. ~4, TZ~N ~3~ DATE, NOV, ~ 1993 ~nT~ ?7~-~q~ :,. ALEX CgM~S SHEET, 2/3 GRID, 2641 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALT' CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION Application Date (a) Legal Description (include lot, blocJ(, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ;*~,w~'* Fd.~'c(, * ~J Applicant Address Telephone: Home '~'~- ~ 2 ~ ?~ Business (c) Applicant is (check one): Lending Institution [] · Owner/builder J~; Buyer [] ' Other [] (explain); (d) Lending Institution Telephone Address (e) Real Estate Company and Agent Address (f) Telephone Mail the HAA to the following address: TYPE OF RESIDENCE Single-Family~ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well [] Community,J~r' Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. -4. SEWAGE DISPOSAL OnsiteJ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 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. NameofFirm fA,-J-CK~'~/,~,qc~-- ~.~F Telephone _ Address ~/,~ ¢) ~ Date ~/~ /~ ~ WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom per day and that certified laboratory tests showed no presence of coliform bacteria in a sample of that water. No warantee or certification is expressed or implied concerning the long term adequacy or safety of the water supply. ON-SITE SEWAGE DISPOSAL SYSTEM NOTE: This Health Authority Approval inspection merely certifies that the subject on-site sewage disposal system accepted at least 150 gallons of water per bedroom per day as determined by methods approved by the Municipality of Anchorage Department of Health and Human Services. No warantee or certification is expressed or implied concerning the long term adequacy of the on-site sewage disposal system. Construction data reported on buried system components is from MOA files and was not verified during this inspection. Approved for'---~ ¢ bedrooms b K~ate Approved /..---""'--- Disapproved Oonditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 Ol/84) MUNICIPALITY OF ANCHORAGE (MOA) CHECKLIST- FEBRUARY 1984 264-4720 Legal DescriptioJ~ ~~" BBIB d lS WELL DATA ~V'aOI.ONV =10 ~~ W II la smflcatlon ~~- ~ e C s" ' . ~ IfA, B,C,D.E.C. Approved(Y/N) Well Log Present (Y/N) ~ Date Completed ~/~' ~ Yield Total Depth ~/ Cased to ~ / . Depth of Grouting Static Water Level ~ / Pump Set At Casing Height Above Ground ~ ~~ Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) Electrical Wiring in Conduit (Y/N) N~:~ Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments .~,~ ~/4 · On Adjoining Lots /~:)~' · ' On Adjoining Lots To Nearest Public Sewer To Nearest Sewer Service Line on ;Date 0' ~ B. SEPTIC/HOLDING TANK DATA Date installed Standpipes (Y/N) V~-----~ Depression over Tank (Y/N) ~) Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) ~_7 Separation Distances from Septic/Holding Tank: To Water-Supply Well //~:::)~-~ / To Property Line ~:)~ '~' To Water Main/Service Line Course Size /~)~:~:)~.~--No, of Compartments / Air-tight Caps (Y/N) Y~.% Foundation Cleanout (Y/N) Date Last Pumped ~-~'"¢~-" 'for Temporary Holding'Tank Permit (Y/N) To Building Foundation To Disposal Field ~ To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test\ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~ .-~ Separation Distance from Absorption Field: To Water-Supply Well ,/~ / To Building Foundation Lot ,~~--- To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line o To Existing or Abandoned System on ; On Adjoining Lots ~ / To Cutbank (if present) Comments LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify t hat~fl~.c h/c k~d,/~erifi~/~or conformed to all MOA and HAA guidelines in effect on the date of this inSpection. Signed ./~ ~/P~~ Date jO/ Co m pa n y '-'AJ¢',"/'rQ ;,"'~, ,¢-: E,',,,, r' MOANo. ' ' Receipt No. (_,eC:~:~ I -'" ~:b,O~ ~. Date of Payment OI, Amount: $ Page 2 of 2 72-026 (11/84) 4.1n i m W vMv of h mil Jion n, ldeMIty J ~ ~ W h da~h fthid~i M the kNaM~: ] / / ~/ / ~ * NHAWTHORNE-ENGINEERING '712'7 OLD SEWARD HIGHWAY ANCHORAGE, ALASKA 99502 907-344-,471 I ~344-1551' A B C I CHECK ONE O~ MORE C~I Simple too 1onO tn t~instt. IJ~RE SAMPLE MAS COLLECTED SIGNATURE) ~YP~ OF (CHECK ONLY ONE THZS COLUNN) [~I'~MZNICZNG MATER vP'CHECK TREATMENT f~Xld SOURCE MATER I-! NEW CONSTRUCTZ~ OR REPAZRS C3 OTHeR(Specify),, ]CS THZS ~LE A CHECK ~LE TO A PREVIOUS NON-CONFO~ZNG ~LE? C] YES , ~ PR[VZOIJS COLLECTZON DATE: CHLORINATED FXLTERED C]UNTREATED OR OTHER Smliple should not be over 30 hours. O Smq)le r~cetved too late tn Neek [~ Not tn pPoper container ~] Leaked out I-I Znsufftctent tnformtton provided. Please r~ad Instructions on form. C) Other (specify) RECEIVED FROH RECEIVED RY DATE ANALYTICAL HETHOD: [~IEMBNANE FILTER r-I FERMENTATION TUBE Date &Ttme Started Date &Ttme "ANALYSZS i~I~IJE$~LD (IF OTHER TNA# TOTAL COLZFORIq) LABORAT.OALY~RI~SULTS SEND ~E ND ZIP CODE t_l Other Bacterta NAp[ I'1 Test unsuitable because: BACTERIOLOGICAL IMTER ANALYSTS RECORD FOR LAB USE ONLY !~ TOTAL COLIFORJqS --] FECAL COLZFORXS I--] OTHER I-1 Confluent GPowth I-1 TNTC SATISFACTORY i~ ".SATZSFACTOnY [3 Membrane Ftlter: Dtrect Count Verification: LTB Final M~mbrane Filter Results Reported By ,, BGB Date Time .,, Coliform/lOOml Coltform/lOOml A.M. P.M. REAO SAHPLE COLLECTION INSTRUCTIONS ON BACK OF FORH ANCHORAGE. Y'~IEST£RN DISTRICT OFFICE 437 'E' STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 September 4, 1986 Hr, Luduig Ferche 11061 Boulder Circle Anchorage, Alaska 99316 SUBJECT) Lot 30, BOULDER SPRINGS SUBDIVISION Anchorage, Alaska 8721-FA-031 Dear Mr. Ferche) The Department has revieued the Engineer As-built plans for th~ subject project. Final approval is hereby given for the ~ater system and the "Certificate to Operate" is attached. Approval ~or the private septic system may be obtained through the Municipality of Anchorage. Any future expansion of the subject project ui11 require additional approval ~rom this o~ficeo Sincerely, S~even~. Eng, PE DistriCt Engineer SWE:pkk ENCLOSURE STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS APPROVAL TO CONSTRUCT Plans for the construction or modification of in by public water system located ., Alaska, submitted in accordance With 18 AAC 80.100 [] approved. [] conditionally approved (see attached conditions). have been reviewed and are BY TITLE DATE If construction has not started :..;.'~ two years of the approval date, this certificate is void and new plans and specifications must be submitte(3 iv, r,'--",,-,w and approval before construction. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Date C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the ~ /:~,':~, '--.- ' ' ' ~ water system was completed on granted interim approval to operate for 90 days following the completion date. (date). The system is hereby BY TITLE DATE As-built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. , .....- Z~''~:~ ~.~ :: :' '~' ".' ".1 .. "~.; BY ~" TITLE DATE 18-0407 (Rev. 11/83) DISTRIBUTION: 1, WHITE · ENGINEER (Complete Section C) 2~ YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEER/MUNI-BOROUGH (Complete Section C) 4. GOLDENROD - MUNI-BOROUGH (Complete Section A) -. ..... ? · .,. . - - MUN1CIPALITYOF ANCHORAGE DEPARTMENTOF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street -Anchorage, AlaSka 99501 ~~~// 'ENVIRoNMENTAL EN Gi NEE RtNG 'DIVISION ~ Telephone 264-4720 ~ , REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONE= Complete all parts on page 1. Incomplete reques~ will not beproc~ed. Please allow ten {t 0)-daysfor proc~sing. ~7_P~'P~W ow~ . ~ , .... ' I PHONE PMOPEffi~Y ~81DENT Ill d ffer~nt~rom ~bove] ..... .' ' ' - ~ PHONE MA~U~GADD~ES~ ' ' ' ' . ~ ' .... LENmNe mST~TUT~O~ ~ PHONE MAIL;NG ADDREES ..... ~ , .I ' . REALTOR/AGENT , · I PHONE MAIMNGADDRESS - ' ~ - ~ . _' _' [] COMMUNITY since EEWAOE I NDI VI DUAL/ON-SITE~* [] PUBLIC UTI LITY If system i= 'NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH F 72~1~0(3/78) ~ sINGLE FAMILY r-I On, [] Twd [] MULTIPLE FAMILY I~ INDIVIDUAL* *ATTACl er wells drilled · give well quired TIME DATE INSPECTOR DIRECTIONS; THIS SIDE FOR OFFICI~AL USE.ONLY INSPECTION APPO I NTM ENTS TIME DATE INSPECTOR DATE RECEIVED TIME DATE .. INSPECTOR 1. TYPE OF RESIDENCE [] SINGLE FAMILY [] MULTIPLE FAMILY 2. WATER SUPPLY [] INDIVIDUAL [] COMMUNITY [] PUBLIC UTILITY Connection Verified 3. SEWAGE DISP.OSA'L SYSTEM [] INDIVIDUAL/ON -SITE []PUBLICUTI LITY Connection Verified E~"ptic Tank or [] Holding Tank Size: /~..~O If Tank is homemade give dimensions: TYP~ TOTAL ABSORPTION AREA 4. DISTANCES WELL TO: Absorption Area to nearest Lot Line NUMBER OF BEDROOMS [] ONE --I THREE [] FIVE [] [] TWO [] FOUR [] SiX PERMIT NUMBER OTHER DEPTH OF WELL DATE DRILLED LOG RECEIVED PERMIT NUMBER DATE INSTALLED INSTALLER SOl LS RATING MANUFACTU~R. ~ MATERIAL ~ -- ~ Septic/Holding Tank IAbsorption Area ISewer Line Nearest LotrLine 5. COMMENTS [~'""DI SAPP ROVE D DATE LEGAL DESCRIPTION APPROVED FOR BEDROOMS CONDITIONAL APPROVAL (letter must accompany certificate) 72-010 (Rev. 3/78) July 10, 1978 J. Joseph Kintz % Michele Billmeyer Century 21 Properties Unlimited 300 ~.~est 36th Avenue Anchorage, Alaska 99503 Subject: Lot 30 Boulder Springs Subdivision Before this department can approve your request for a~proval on the sewer and water facilities, several items will nevi to be completed. (1) The property must be surveyed and staked so that we may determine whether the sewer systumcan be upgraded or replaced. (2) The stand pipe to the seepage area must be exposed. (3) After the stand pipe is exposed, a percolation test must be performed to see how well the system is functioning. If there are any further questions,ppl&ase cona~ct this office at 264-4720. Sincere ly, Robert C. Pratt, R.S. Sanitarian RCP/lJh GREATER ANCHORAGE AREA BOROUGH 3330 ,,C,, Department of Environmental Quality Street, Anchorage, Alaska 99503 274-4561 Date Received August 9, 197~ Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF Conv. 1. Approval requested by: Escrow Comp. any Mailing Address: Phone: 2. Property Owner: Ludwiq Ferche Phone: 344-9881 Mailing Address: Post Office Box 4-1732 3. Legal Description: Lot 30 Boulder Springs Subdivision 4. Location: Stroqanof Drive 5. Type of facility to be inspected . 6. Well Data: Individual - serving two A. Type C. Construction 7. Sewage Disposal System: A. Installed 1972 C. Septic Tank: 1. D. Seepage Pit: 1. E. Disposal Field: Total length of lines Single Fam~'ly B. Depth No. of bedrooms 3 D. Bacterial Analysis On-site system B. Instal ]er Si ze 2. Manufacturer Absorption Area 2. Material ,,/¢,~'"'"'~'/,~se"wer Li nes Absorption area , Other contamination , Absorption area Distances: ~AA .~1 {~o~.' ~epti c tank Nearest lot line B. Foundation to septic tank C. Absorption area to nearest lot line EQ-034 (1/74) Page 1 of two pages Page 2 of two pages Re ;t for Approval of Individual ~r & Water Facilities Legal Description Lot 30 Boulder Sprin~s Subdivision " i Approved Approval Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAMOF SYSTEM I certify that the information contained in this request for approval to be a true and accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ-034 (1/74) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 2510 East Tudor Road, Anchorage, Alaska 99504 276-2221 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: CMRO VA FHA 2. Property Owner: Mailing Address: CONV / f~~/7~ Day Phone: .'~ 3. Name of Buyer: /p~ Mailing Address: ~,,~'~ ~' 4. Name of Lending Institution: Mailing Address: ~ ~ 5. Name of Realtor or Agent: Mailing Address: ~~ Legal Description: Location' Type of Facility to be Inspected: Water Supply Type of Supply: Public Utility If Individual, number of dwellings presently served If Individual, depth of well , Individual Sewage Disposal System Type of System: Public Utility If Individual, date of installation Individual (on-site) 72-003(3/76) 176 F1 upp~ RO~tp 161 175 182 DeArmoun Road Area Reference Map-P14