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STONEHILL BLK 1 LT 2
Stone Hill Block 1 Lot 2 #060 - 342 - 02 . Municipality of Anchorage '---, 1 ,t 1_ Development Services Department Building Safety Division �: - On-Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 Page' www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW090152 PID Number 060-342-02 of 3 """\ BEN HINZE Wastewater System: o❑ New • Upgrade Address 19868 EAST STONEHILL DR., EAGLE RIVER, AK. 99577 ABSORPTION FIELD Prone Numbers Bedrooms 0 Deep Trench el shone Trench O Bed 0 Mound 0 purr LEGAL DESCRIPTION Sod Rating 0.6 GPD/Flt Toa Depth from °rano! grade 5.0' Ft Back 1 Lot 2 Swdnuoon Deto pope halon from original grade Deed' to 1.5' Ft. Gravel Mph beneath ppe 3.5' Ft Townamp Senile Sedan F» added above anginal grade 2.7' FI. Gravel Length 8212 © 41') FI. Well: ■New ❑Upgfad Gravel wean 5.0' Ft. Number a Wes 2 Dunce res between 10.0' FI Cbaedaalan (Private. A B. C) EXISTING PRIVATE ToDean Ft Cased a Ft Thudabsoroan wetsPpe 750 Fe Melena ASTM3034/ABS/F810PVC prnbr Das Owed Stabs War Leval rt Installerpara DOUG GREY EXCAVATION Instated 9/24/09 Yield GPM Pump Sar- FI. Camp anti Above Grund FI. TANK SEPARATION DISTANCES -. Septic D Holding D S.T.E.P. 0 Other. To From Septic Tank Absorption Field Lift Station Hold Tank 'uDIiUPnvate Sewer Line MrWxtur GREER Capaar 1000 cel We 100'+ 100'+ 25'+ Material H.D.P.E. Number ol Compartments 2 Sutaown 100'+ 1oo'« LIFT STATION Lo 5•« 10'+ 5ue sue N/A Gal Mrkladur Foundation 5'+ 10'+ 'Pump of lata at 'Pump Or . a In Non war arm el in Curran Drsn NONE KNOWN Penp Make . ...i Ebcfraal ln•prtane penrrrod by Remarks BENCH MARK Coulon and Description RIGHT SIDE OF DOOR, TOP OF DECK Assumed Sermon 100.0' FL • S&S Engineering Inspections performed by: 15551 S Blrrhwnnd I p Pr1 Dates: 1st 9/24/09 lb p 1 iOF � ./ r;� �• 9 149 >k\ Chuglak, Alaska 99567 2nd 9/25/09 Development Services Department Approval,!• Conditional Approval Date: • M \a • ••N�NyNM ats N► lista ! i 411, � ) ES Its` O f � I /1/4?-4-/I Reviewed and approved by: j/q `V • / e-�l Date: a- - / 0 (Rn amel C/ //��� PERMIT NO SW090152 PAGE Yo? OF /3 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: (907) 343-7904 • www.ci.anchorage.ak.u• ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR- LEGAL LOT 2; BLOCK 1; STONEHILL S/D P.I.D. NO. 060-342-02 MT CO NEW SHALLOW TRENCHES LINE UNDER DRIVEWAY INSULATED W/4" OLUEBOARD. I )BL2 �\ 2 G� �� \LOTSEPTIC 4 cAREA. NEW GREER 1000 tc\ O_ \ GALLON HDPE Ln SEPTIC TANK ( 5,-A\ ' EN.I�,"� 11:TA11P artyla• .4441.41) A' • 9 .A \* PERMIT NO SW090152 PACE / 3 Or ,2'3 Municipality of Anchorage DEVELOPMENT SERVICES DEPARTMENT - BUILDING SAFETY DIVISION ON-SITE WATER AND WASTEWATER PROGRAM, 4700 BRAGAW STREET P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: (907) 343-7904 • www.ci.anchorage.ak.u! ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPOR' LEGAL LOT 2; BLOCK 1; STONEHILL S/D P.I.D. No. 060-342-02 FINAL GRADE ST1 A B ST2 /- GRADE = 97.9' _FCO 15.2 --- TMT 49.7 77.0' ST1 49.1' 78.8' --- TANK 70940E 4.7�� 2" INSULATION DBLU592_54 57.6 --- 001 120.4' - 122.8' INTLET = 94.3'- / NEW 1000 \OUTLET = 94 1' MT1 122.1' - 124.q' GALLON GREER 1 CO2 113.9' - 99.2 HDPE MT2 112.1' - 97.5', CO3SEPTIC TANK 177.0' - 124.3 MT3 C04 123.9 - 123.0'104.6' MT4 )25.9' --- 106 2' C05 79 75.3' --- )\IT1CO2 MT2 ORIGINAL C01= 80.0' GRADE = 77.3' I CO2= 80.1' ..I ranacxs „ ,,,, .111 MT1= 72.3' )\iT3 C04 MT4 2" INSULATION C01= 75.8' CO2= 75.8' '-MT2= 72.3' MT3= 69.8' 1111 CO3= 78.5' C04= 78.0' z .- ORIGINAL IMO CO3=R7D5' = 74.8' s WATER FOUND AT 65.8' 63.8' B.O.I-I. N-MT4= 69.8' N. T. S. MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL. SYSTEM PERMIT Upgrade Permit Number: SW090152 Legal Description: STONEHILL BLK 1 LT 2 Design Engineer: 0003 S & S ENGINEERING Owner Name: BEN HINZE Owner Address: 19868 EAST STONEHILL DRIVE EAGLE RIVER , AK 99577 - Date Issued: Aug 14, 2009 Expiration Date: Aug 14, 2010 Parcel ID. 060-342-02 Site Address: Lot Size: 0 SQ. FT. Total Bedrooms: 0 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued B Date: 1P 746-1 Date: 509fri Municipality of Anchorage Development Services Department Building Safety Division • On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, Alaska 99507 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. (%0-1,y2-02 Property owner(s) Ben Hinze Mailing address 19868 EAST STONEHILL DRIVE. EAGLE RIVER. AK. Site address "SAME' Legal description (Sub'd., Block & Lot) STONE HILL S/D, BLOCK 1, LOT 2 Day phone 360-7964 Zip Code 99577 Zip Code Legal description (Township, Range & Section) Lot Size Sq. Ft. THIS APPLICATION IS FOR (® all that apply): 0 Absorption Field Septic Tank Holding Tank Privy Private Well Water Storage I certify that the above infor Single Family Dwellin ion is cor 's in accor Number of Bedrooms 3 THIS APPLICATION IS AN: Initial Upgrade Renewal 0 ect. I further certify that this application is being made for a nce with applicable Municipal Codes. (Signature of prop- • •wner ized agent) Permit/Rush Fees: Date of Payment: Receipt Number. 01 23 c Receipt Number: (Rev. 11/05) // Waiver Fees: Date of Payment: S&S Engzneening WEALTH AUTHORITY APPROVALS SEWERS WATER IAN EXTENSIONS SEWER & WATER INSPECTCN ENG'NEERING STUDIES ANO REPORTS WEU INSPECTION .FLOW TEST STE PWS ROAD DESCH SOIL TEST PERCOLATION TEST STRUCTNRmLS Ik wWICAL NSPecno S ONSITE WASTEWATER WPCSAL SYSTEM OESION ROBERT C. COWAN CIVIL ENGINEERING PN: 907-6942979 FAX: 907-694-1211 August 7, 2009 MUNICIPALITY OF ANCHORAGE Development Services Department P.O. Box 196650 Anchorage, AK 99519 REFERENCE: Lot 2, Block 1, Stone Hill Subdivision It is requested that you issue a permit to install a new shallow trench and 1000 gallon septic tank septic system to serve the existing three bedroom house on the referenced property. A test hole was excavated and a percolation test performed. The approximate location of the test hole is located on the attached site plan. At the time of excavation (7/2/2009) water was found at 9.0'. After seven days of monitoring, ground water was found at 10' 4". We do not anticipate any adverse effects on neighboring wells, septic systems, reserve areas or drainage patterns by the installation of the proposed septic system. The construction of this system will not prevent any future development on any of the adjacent properties. If you require additional information, please contact us. Sincerel yn . Shafer, P.E. Enclosure 15861 S. Birchwood Loop Road - Chuglak, Alaska 99567 ............J.lisidalamai.., Peilormed For: Legal Description: 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- Municipality of Anchorage Development Services Department Building Safely Division On -Site Water and Wastewater Program 4700 South Bragaw SI. P.O. Box 196650 Anchorage, AK 99519.6650 www.muni.org/onsilo (907) 343-7904 Soils Log - Percolation Test �,0 flttnzE Ler (2;7S1 cT'*- /) SIZAVIAL Yownship• Range, Section: Slo e Dale Perto med: Oeplh (Feet) }-oPA7!>AJttS am COMMENTS oH WAS GROUND WATER ENCOUNTERED? IF YES. At WHAT DEPTH? Depth to Watar *Rim • r p Monitoring? / E L O Date: Site Plan cJ Sti P_g N Reading daspAetb Date Gross Tine Net Time Depth to Waler Net Drop >/6�I 31/4" 30 30 4/7/ " 1,0" 31/4'l 30 60 N %4,'r -7/R" 3'�" 30 qD Lf 3/ " 1 % t' 31/4" 30 /2.0 'f le holt VA/" 50 160 two 1 . Da. PERCOLATION RATE TEST RUN BETWEEN esswevese FT PERC HOLE DIAMETER FT I PERFORMED BY: PERFORMED IN ACCORDANCE WITH ALL STATE AND P a FY THAT THIS TEST WAS IN EFFECT ON THIS DATE. DATE: S&S EngineeRmg HEALTH AUTHORITY APPROVALS SEWERS WATER MAN EXTENSIONS SEWER WATER INSPECTION OJUNEERINOSTupES ANO REPORTS WELL INSPECTION &PLOMTEST SITE PWS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS CN SITE WASTEWATER DISPCSALSYSTEM OESION ROBERT C. COWAN CIVIL ENGINEERING PH: 907-694-2979 FAX: 907694-1211 ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION PRACTICES and MATERIAL SPECIFICATIONS REFERENCE: Lot 2; Block 1; Stone Hill S/D August 7, 2009 GENERAL: 1. The scope of this project includes the installation of a new 1000 gallon IIDPE septic tank and new shallow septic trenches to serve the existing three bedroom residence located on the referenced property. 2. Construction shall be in accordance with the approved site plan and design drawings, Municipal permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. 3. The contractor shall be responsible for obtaining any necessary underground utility locates. 4. Unless specifically agreed otherwise, the property owner shall be responsible for final grading areas subsequently depressed from soil settling. 5. Contractors installing wastewater disposal systems must be certified by the Municipal Development Services Department or ADEC if required, for system installations. Owners installing their own systems must also receive prior approval from the respective agency. SEPTIC TANK INSTALLATION: 1. A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. All HDPE septic tanks are required to have a 4" monitoring pipe installed next to the tank extending to the bottom of the tank. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. 15861 S. Birchwood Loop Road - Chugiak, Alaska 99567 Page 2 Lot 2; Block 1; Stone Hill Subdivision August 7, 2009 3. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. 4. Septic tanks installed with less than 4 ft. of cover shall be insulated. All IIDPE septic tanks are required to be covered with a minimum of' 2" direct burial insulation, and a maximum of 4 feet of cover. 5. A foundation cleanout shall be installed one to four feet from the building foundation. In the line between the tank and the leachfield there shall be two adjacent cleanouts (unless an effluent pumping system exists within the septic tank). These cleanouts shall be located on undisturbed soil not more than 10 ft. from the tank. The first cleanout, in line, shall be to clean toward the leachfield. The second cleanout shall be to clean toward the septic tank. 6. Final grading over the septic tank shall be such that a positive slope exists away from the septic tank. ABSORPTION TRENCIUDRAINFIELD INSTALLATION: 1. Excavate the proposed trench to the dimensions shown on the design. The bottom of the excavation shall be within 2 inches of level. If the sidewalls of the excavation become smeared, they must be raked or scratched (ruffed -up) before gravel (sewer rock) placement. 2. Once the gravel is installed, the distribution pipe is to be installed level with the perforations faced downward. Gravel is then to be placed over the distribution pipe to provide a minimum of 2 inches of cover over the pipe. 3. A silt barrier must be installed between the final gravel layer and the native soil backfill. Ensure the silt barrier covers the entire gravel surface before placing backfill. 4. Monitor tubes shall be of four (4) inch diameter, installed approximately in the locations shown on the design, and extend a minimum of 12 inches above final grade. The portion of the monitoring tube extending through the gravel shall be perforated from the bottom of the trench to the invert of the distribution pipe. This is equivalent to the effective depth of the gravel as noted on the design. 5. Backfill over the final gravel layer must not be less than twenty-four (24) inches. Insulation must be installed when the backfill depth is less than thirty-six (36) inches. The Page 3 Lot 2; Block 1; Stone Hill Subdivision August 7, 2009 finish grade over the trench must be mounded to prevent the formation of a depression after settling. MINIMUM MATERIAL SPECIFICATIONS: 1. Any septic tank proposed for installation must be constructed by a Municipal approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Type of Pipe Perforated Solid Cast Iron Yes Yes ASTM D3034 (PVC) Yes Yes ASTM F810 (IIDPE) Yes No ASTM D2662 (ABS) Yes Yes Use of a type of pipe other than listed above must be approved by the inspecting engineer. 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Company Styrofoam 111 or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable nontoxic silt barrier (Typar 3401, Mirafi 140N, or equal) must be installed between the final leachfield gravel layer and the native soil backfill. 6. All leachfield gravel (sewer rock) shall be 0.5"-2.5" screened gravel with gess than 3% passing the #200 sieve. 7. When sand is being used as a filter material, its gradation specifications must conform to current M.O.A. or D.E.C. requirements, which ever requirement applies. INSPECTIONS: Page 4 Lot 2; Block 1; Stone Hill Subdivision August 7, 2009 Typically there will be a minimum of three (3) inspcctions required during the installation of the wastewater disposal system. These inspections will occur as follows: 1. The first inspection must be conducted after the excavation of ditches, pits, trenches, or beds and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled before this inspection. 2. The second inspection must be conducted after the placement of the silt barrier, gravel, distribution lines, standpipes, cleanouts, and insulation, but before the placement of any other backfill. 3. The final inspection is to occur upon final grading of the property. Often there will be more than these 3 inspections required. Especially with the installation of multiple trenches, sand filters, pressurized distribution systems, etc. Thus, the inspecting engineer is to be contacted at least 24 hours prior to the start of construction. If necessary, a pre - construction meeting will take place on-site. The inspecting engineer will not coordinate, direct or control in any way the contractors activities. The owner shall contract with the contractor to perform the work outlined in these specifications and plans and in accordance with the attached M.O.A. permit. There will be no contractual arrangement existing between the contractor and S & S Engineering. S & S Engineering shall be the owner's representative and will inspect the work as stated above to document the contractors activities. Final acceptance of the contractors work rests with the owner and the M.O.A. S & S Engineering shall have no liability to the owner or to others for acts or omissions of the contractor or any other persons performing work on this project or the failure of the contractor to carry out the work in accordance with these construction documents. S & S Engineering's inspecting engineer will not be responsible for the construction means, methods, techniques, sequence, procedures or the safety precautions incident 10 this project. CONTRACTOR / INSTALLER ED MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME //�/ p'.1 -1-1.„,t JJ �-c,t ✓,.. C..Ofl S g.",-, PHONE 67t r7//7 [JEW • UPGRADE MAILING ADDRESS r pp a. 9 / oar 77 -3 -Zc 6f 47-,s/e. -e.--e:-fr. cj 55-7J LEGAL DESCRIPTION Lt- a_ S 70ne, A, %/ i /'/ i✓ /' / 1.A.) sic / 9 LOCATION Sar, 2'2. -/corms — /1.11,-M vie/ .Or, NO. OF BEDROOMS 3 SEPTIC TANK DISTANCE TO: Well /OD •t Absorption area - /7 ! Dwelling I S5 PERMIT NO. - L/U SS/ Manufacturer G.,-.. Material 3 le 1 No. of compartments Liq. capacity in gallons /b ov IF HOMEMADE: Inside length Width Liquid depth a 2 OC7z I z < DISTANCE TO: Well Dwelling PERMIT NO. Manufacturer Material Liquid capacity in gallons qq ` 2 F a 1. 0 DISTANCE TO: Well ,le /®l7 Foundation I '7 Nearest lot lined /p PERMIT NO. S tioe6—/ No. of lines a Length of each line 1 RIP Total length of lines r 3 /•n es z 31-/ Tanwidth r'Stc.0 ao r iwelaac Distance between lines i,. r a• sett — S S Top of tile to finish grade l ' / `T Material beneath tile 6 �G -r inches Total effectiv��orrpptior0,are� `fa •' w QType a. ti ength Width Depth PERMIT NO. of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line j w Class p✓t da Depth I �� 1 Driller Distance to lot line PERMIT NO. .8_,..,„,p,--/ DISTANCE TO: Building foundation 7p t Sewer line 7.s� Septic tank /bGy Absorption areas) LCD* OTHER PIPE MATERIALS dl -y �n0 n ✓c , �'.� ©rat.@. ete SOIL TEST FIATING /alit'=. 281: �IH,1'r Wt._ INSTALLER • OI 'e@h Cs..h tt 41-,,,-,lothREMARKS & \Kt: e'': 9.' .4(,gstelt ��' IN -a etc - '• 9 d� t1� Ylon c co pt•vrell OP it}Z re t4 NK .! sr• n,.9+Ji g t `a 9 E ', •I n. • •2 2.2 ta �' N E 25, 1971 : F v�� I L.,i.e.- APPROVED DATE LEGAL I ofu/g/- Lf 2 STbniSHi -[._ %q 72-013 (Rev. 3/78) 1011-1/ ' PERMIT NO: DATE 'ISSUED„ Th E"1 ELj 11M :IC iC:`.:]C U_" ';; IL-- i -r " e IJ E_" ir72';1Ih49 E II -#'CJ EC 6713E3 EE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PFROTECTION 025 L STREET, ANCHORAGE, AK 99501. 264--4720 C1$"J--S 1 'T 1.8IE R 1 F: d =C ..,: LP-11IE:.'t_L_ LLE" FE C -`,.•E'" 840051 10/05/84 , APPLICANTt DEAN CONSTRUCTION ADDRESSt C/O )30X 773294 EAGLE RIVER, AK 99577 CONTACT PHONEt 694-9117 LEGAL DESCRIP8 SUBDIVISION: STONEHILL SECTION; 19 TOWNSHIP; :t4N LOT SIZE: 47057 (S0.1=T. OR ACRES) LOT LOCATION: HILAND DRIVE MAX BEDROOMS: LOTS 2 RANGE: 1W BLOCK: NA Listed below are the options available to you in design:inq your septic, system. Choose.the option that best fits your site. :4"=c EF: t :) ;Ln! ". O FZ I "a :JC II`.1i DEPTH TO PIPE BOTTOM (FT.) 4.0- 4'.0 GRAVEL DEPTH (PT.) 0.3 1.0 TOTAL DEPTH (FT.) 4.5 5.0 GRAVEL WIDTH (PT.) 17.0 5.0 GRAVEL. LENGTH (PT.) ' 34.0 66.0 GRAVEL VOLUME (CU. YDS.) 21.5 18.4 TANK SIZE (GALS) 1.,000.0 .**..1.,00.0 **- SOIL *SOIL- RATING (SELF"T. /BR) 125 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS 125 I certify 't.ha1't 1. I am familiar with the requirements for an -site sewers and wells as set forth by the Municipality of Anchanage (MOA) and the State of Alaska. I will install. the system in accordance. s: 1 2. acrr,r^;tncet. with all MOA codes am -I regulations, and in compliance with the design criteria of this permit. 3. .0 will adhere 'C.o a1.1 MOA and State of Alaska'requirements for the set back - distances from any existing well, wastewater disposal. sy St.r_xm ar public: sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of -. bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED -IN AN. AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL. PERMIT•AND INSPECTION MIDST BE OBTAINED1; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT AND (3) THE ELECTRICAL WORK: MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED APPL:T.CPd\ITP: ISSUED BY DEAN CONSTRU %CTION uv L�20-4--rar DATE DATE;;(0 S cct 41 PERFORMED FOR rT1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST LEGAL DESCRIPTION: L—* .2 DATE PERFORMED: SOILS LOG 8yo��l ❑ PERCOLATION TEST T/1171/ !2)t. sec CS/ / p 5- ¢S jA.14 to J'.0 2e._ '3/4 Vs -t /vrA 4 10 Gm 11 x four of 12 13 14 5 16' 17 18 19 20 COMMENTS 5,4„.1t CJ go t- Tc.s t hole SLOPE 0 7.I w WAS GROUND WATER ,ENCOUNTERED? IF YES, ATWHAT DEPTH? SITE PLAN a=1 Hr tett ho e °7a Reading Date Gross Time Ne Time Depth to Water Net Drop Jib Ka PEREOtrr/ON RATE TEST RUN BETWEEN FT AND incer FT PERFORMED BY: 72-008 (6/79) Sup CERTIFIED BY: rs. DATE: ° 5/6 (lnfiftrb Brining lug by DOC Co. dba SULLIVAN WATER. WELLS P. O. BOX272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 ) /? DEPTH OF WELL /�` O )WNER OF LAND fin n .<S O� i�•-J WDRESS r A /20 A / 3 65-\ ;3,-.e /� mk ATIC LEVEL OF WATER FT / r .EGAL DESCRIPTION_ L t 7 To "' mDRAW DOWN FT L f I )ATE - Started /U! Ended /371:-.44 GALS. PER HR Co O 'ERMIT NUMBER / KIND OF CASING G a /) QND OF FORMATION: 7rom L) Ft. to_l_Ft. - j4 ")10 4 4'-4 c C 14 JA d fro n Ft to Ft -rom Ft. to Ft j C I.A 7' From Ft to Ft. From /a . Ft to 7r Ft !3 e-4.,{ 0 4 /c From Ft to Ft From 7S Ft. to E / Ft '3C 07l 7s �� "`J From Ft. to Ft From Ft. to Ft / v (/,,1 From Ft to Ft From _-> / Ft. to ! d o Ft. 0 From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. - From Ft. to Ft. From Ft. to Ft From Ft to Ft. From Ft to Ft. From Ft. to From Ft. to Ft. From Ft to t. t. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft to Ft. From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. - From Ft. to Ft. From Ft. to Ft From - Ft. to Ft 1 vIISCI-INORMATION: ((- / 4 // G " 0-1` DRILLER'S NAME 12...-4-1 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section—' Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 060-342-02-000 Expiration Date: 10/1/2025 Legal description STONEHILL BLK 1 LT 2 Site address 19868 STONEHILL DR Eagle River AK 99577 Current property owner(s) MARCELLUS ERIC L & LYNETTA X The On-site system(s) is/are approved for 3 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: By: Original Certificate Date: 10/28/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory Arsenic Advisory Other COSA ApprovaIjune 2022 MUNICIPALITY OF ANCHORAGE Development Services Department _ Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 060-342-02 Complete legal description STONEHILL BLOCK 1 LOT 2 Location (site address) 19868 STONEHILL DRIVE, EAGLE RIVER, ALASKA 99577 Current property owner(s) MARCELLUS ERIC & LYNETTA Day phone 2. ON-SITE SYSTEMS SIZED FOR 3 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: ❑ Steel ® Plastic ❑ Concrete ❑ Fiberglass Age 15 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ❑ Deep Trench ® Wide Trench ❑ Seepage Pit Waiver request for: Distance: Expedited review requested: ❑ By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ ~ U Date of Payment �� 7 Z L COSA # V L Ly1 Waiver Fee $ Date of Payment Waiver # COSA Application.doc COSA Checklist.docx COSA Checklist Legal Description: STONEHILL BLOCK 1 LOT 2 Parcel ID: 060-342-02 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system ____ A. WELL DATA Well log is filed with Onsite (or attached) Date drilled OCT 1984 Total depth 120 ft Cased to 18 ft Sanitary seal is functioning correctly Wires are properly protected Casing height (above ground) 18 in. Date of flow test for COSA 10/1/24 Static water level at beginning of test 16 ft. Well production at time of test 4.5+ gpm Water storage tank volume None gallons Well disinfected for coliform test? Yes No Coliform bacteria is Negative Nitrate 2.74 mg/L Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Date 10/1/24 Comments __________________________________________________________________________________ B. TANK DATA Measured operating fluid level in septic tank 48” Date of pumping 10/1/24 Required maintenance completed, if AWWTS Comments: C. LIFT STATION Required maintenance completed Age of lift station years Lift station material Comments: D. ABSORPTION FIELD DATA Which system tested (date installed) 9/24/09 ALL standpipes present per record drawing* Total measured depth from existing grade 8.7 ft (max) Measured depth to pipe invert from grade 4.2 ft (min) N/A – pressurized field. Per record drawings, field is insulated. Monitor tubes (MT) go to bottom of effective. (ED) If not, state depth into effective Presoaked required if (Required if house vacant or field not used for more than 30 days prior to date of test) Gallons introduced gallons date Any rejuvenation treatment (past 12 months) N If yes, enter date Adequacy test date 10/1/24 Results Pass (North / South Trenches) Fluid depth prior to test 3 / 16 in Water added 460 gal New fluid depth 9 / 21 in Elapsed time 1440 min Final fluid depth 0 / 14 in Absorption rate 450 gpd FIELD STATUS – POST RECOVERY Effective depth (per record drawings) 42 in (MOA 3.5’ ED) Effective depth used 0 / 14 in (Final Fluid Depth) Effective depth (ED) remaining 42 / 28 in Comments/Deficiencies: Approximate total measured depths from existing grade. ED per elevation measured shots, visual observations, MOA records & appears approximate. *Could not locate the missing south trench eastern pipes. COSA Checklist.docx E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100’ Yes if No ft Neighboring Tank > 100’ Yes if No ft Absorption Field on Lot > 100’ Yes if No ft Neighboring Absorption Fields > 100’ Yes if No ft Community Sewer Main > 75’ Yes if No ft Community Sewer Manhole/Cleanout > 100’ Yes if No ft Private Sewer/Septic Line > 25’ Yes if No ft Holding Tank > 100’ Yes if No ft Animal Containment > 50’ Yes if No ft Manure/Animal Excreta Storage > 100’ Yes if No ft N/A – Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10’ Yes if No ft Tank to Property Line > 5’ Yes if No ft Field to Property Line > 10’ Yes if No ft Water Main > 10’ Yes if No ft Water Service Line > 10’ Yes if No ft Surface Water > 100’ Yes if No ft Wells on Adjacent Lots: Private Wells > 100’ Yes if No ft Community Wells > 200’ Yes if No ft If tank or field is under driveway comment below F. ENGINEER’S COMMENTS G. CERTIFICATION & STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Engineer’s Printed Name CURTIS HUFFMAN, PE Date 10/24/2024 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes in land use, local soil characteristics, groundwater levels that may fluctuate during the year, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, any or NO estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & 10/24/24 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O(00149 -002 1. GENERAL INFORMATION Complete legal description Lot 2; Block 1; Stonehdl Subdivision Location (site address) 19868 East Stonehill Dr. Current Property owner(s) Be" Hinze Mailing address same COSA # 1()OOr2 LI 51.3— JO Expiration Date: Day phone 622-1014 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 ❑ Individual Holding Tank 0 ❑ Community On-site ❑ O Public Sewer 0 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system Is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm s & s Engineering Address 15861 S. Birchwood Loop Chugiak, AK 99567 Phone 6942979 Engineer's Printed Name Robed Sharer Date 5. D7NATURE 1� Approved for , " bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: 1 2 or N M •M A• MISS KS 140.4 / f Amonssraw CRY ©F•. QP.,..... et/ ON-SITE ••'• Cz !: WATER AND ; mn: • PROGRAM • Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Pit FO"2 1 Original Certificate Date: , . — 3-/0 (Rev 11A5) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LTd' tsCK rl/ S7eg26HIek Legal Description: A. WELtz..DATATh Well type _IV/TTE', Date completed /0/S`f Total depth /420 'ft. Parcel ID: r 0-3r{a -Oa If A, B, or C provide PWSID # = Well LoaN) Sanitary sealJJ) Wires properly protect Cased to /8 ft. Casing height (above ground) I i fin. FROM WELL LOG Date of test /OM Static water level /5 ft. Web production WATER SAMPLE RESULTS: Coliform OD colonies/100 mL Nitrate 3.41 mg/L Arsenic: 5_O ug/L date of sample: lb -t/ p B. SEPTIC/HOLDING TANK DATA r Smartt/f4-.D.tP.E. /0 g.p.m. Tank Type/Material AT INSPECTION r�at�o /g ft 44 6 ,0 g.p.m. Other bacteria 0 colonies/100 mL Collected by: S4 -S ecticrireaz Date installed 9 /24,7 Tank size /at gal. Number of Compartments o2 Cleanout jaVCS it Foundation cleanoutj�Y ICS fCS Depression over tank (Y It �O Date of pumping — N/R Pumper --NEIL 'TTiteIC— High water alarm (Ye) MO C. ABSORPTION FIELD_ DATA Date Installed Length 89gr 9)t. Total depth 7. ft. Soil rating Width r ft2/bdrm) 04, 6 ft. Eff. absorption area 750ft2 Date of adequacy test 1 /7-/b0 Resul Fluid depth in absorption field before test (9x in. Water added 552 gal. 1( Elapsed Time: (Jr min. Final fluid depth 0 in. NiAny rejuvenation treatment (past 12 mo.) (`S type) N( 0 System type 51-16/rn_o f (excites Gravel below pipe 3.5 ft. Monitorin tube ICS Depression over field 1\10 ail) For bedrooms New deptharr in. Absorption rate >= Nsa at g.p.d. If yes, give date D. LIFT STATION p. /19 Date installed Size In gallons Manhole/Acc 'Pump on' level at _ in 'Pump off Ie - _ in. High water alarm level at in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot /CD '/ On adjacent Tots r Absorption field on lot to, '4- On adjacent Tots Public sewer main n1iR Sewer /septic service line S + Animal containment areas JVD t SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation de, Property line 5 'f /Co 4- Public sewer manhole/cleanout Holding tank NIR Manure/animal excrete storage areas /GO NIR Absorption field 5 4 Water main N Water service line /0 'A' Surface water Wells on adjacent Tots / OZ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /0 1" Building foundation a 9 'f" Water main Al / " , Water Service line In 't- Surface water /CO ^` Driveway, parking/vehicle storage cP r+ Curtain drain /JorciE KVAW Welts on adjacent lots /GY7 F. COMMENTS 1i7ii« Flap "ReirItltb ?up -a' a ?uOmB Nan- euwentt�-r g(seszacc1- vitem-Tu hs G ENGINEER'S CERTIFICATION 1 certify that l have deterrnined'gh field inspections and Flex C f}�.raasc •,• r review of Municipal records that ab ve ys ar n ri ''jam conformance with MOA COSA/Ejui li/ies irjeffct s d te. • 4.. Engineer's PrinteName Date / COSA Fee $ Date of Payment Receipt Number (Rev. 11/05) g,FTE !2; Na't • Waiver Fee $ Date of Payment Receipt Number SGS, SGS Refit Client Name Project Name/0 Client Sample ID Matrix 1100229001 S & S Engineering L2,131 Stonchill S/D L2,131 Stonchill S/D Drinking Water Printed Date/time Collected Date/Time Received Date/time Technical Director 01272010 11:45 01/21/2010 14:00 01212010 15:50 Stephen C. Ede Sample Remarks: Parameter Results LOO Units Method Allowable Prep Analysis Container ID Limits Date Date Init Metals by ICP/MS Arsenic Waters Department Total Nitrate/Nitritc-N Microbiology Laboratory Colony Count Total Coliform Fecal Coliform 5.00 U 5.00 ug/L EP200.8 C (<10) 01/22/10 01/25/10 NRB 3.41 0.100 mg/L SM204500NO3-F 13 (<10) 0 0 0 col/I00mL SM2092220 col/100mL SM20 922213 col/100mL SM209222D A A A (<200) (<1) (<1) 01/25/10 RIF 01/22/10 SDP 01/22/10 SDP 01/22/10 SDI' sra v64 '4( ,OPser A -fl reS9t' - iyo,oa Ant- atres,Op sl-fl/7.-c4JJ-V • ff, g �P�c+�ficrZ't.v , /s/6Y ASBUILT-NO CORNERS SET THIS DATE. y�y e ra-i"" .w C SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: xrz /eW !L Sd6Q !07l att. / AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE: /.wyo DATE GRID: FB' DRAWN: fy::t4/l��✓f�ti'� �� Dian* Med Saw*, • y�•. LS -A B .`g' „Pie:Thra« '• tor, ,...+••• Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 f zgos� CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. O G O— 3 q2o 2 HAA# 050 /.7-3 Expiration Date: . 1 0 -CLI - O 5 RL. 0c k / Lara s;0 euggitt PRw✓e. 1. GENERAL INFORMATION Completelegal description' STvA/E /-t/LL Location (site address or -directions) / 9 ria F. Current Property owner(s) Mailing address Lending agency Mailing address Day phone Day phone Real Estate Agent Mailing Address FR V/S//9 o, 4ed Lr_,t/v62 Unless otherwise requested, HAA will be held by DSD for pickup. 4 t44 Ls Me." -Ai Day phone cen (4/7C- -- 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 2 3) TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank Community On-site Public Sewer far The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also Issues HAAs upon request to homeowners. Certificates of Health Authority 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 sample results. (Certificates may be reissued for a period of up ‘o 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 engineers work. 4. STATEMENT OF INSPECTION BY ENGINEER . As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection. the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Nn' 1" gist �,�� Phone ,c yi 732CP Date 7/1? //CS r• ; edi•44.4 . Address / 7r237 JSP,+ Engineer's Printed Name IEV. EXJ ( • 1 . • 5. DSD SIGNATURE ✓ Approved for 3 bedrooms. Disapproved. Conditional approval for SCO •;91 • 9 ct Steven W g 1d w l,:e` PE 6256 •d 1i rEsso_ •••o-0 bedrooms, with the following stipulations: Additional Comments `G,QP.\ ... Advel ; Z ONS ". . WATER AND • mz : WASTEWATtH PROGRAM . .• A%S e ......•' Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory a9* w -rwr (Rev. 01,02) Maintenance Agreements • Supplemental Engineer's Report Other Original Certificate Date: 7 -2-1-05- Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6550 www.cianchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: STONE. U/L! .Cid LC> r Z 5z. t Parcel Ib: D +o 0 - 3 4.x.-0 A. WELL. DATA Well type P If A, B, or C provide PWSID # _ Well Log (Y/N) y' Date completed kill* Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth /2o ft. Cased to /tSif . Casing height (above ground) / i in. f FROM WELL LOG AT INSPECTION Date of test /13/Ay 3/(Pio s Static water level / 5 ft. / 0 ft. Well production / 0 g.p.m. C S g.p.m. 4 - WATER SAMPLE RESULTS: Coliform , (D colonies/100 mi. Nitrate 0. ( 2 mg./I. Other bacteria 0 colonies/100 ml. Arsenic: — mg./I. Date of sample: Z/f8,0 5 Collected by: Af4digfr's-. LI) B. SEPTIC/HOLDING TANK DATA Tank Type/Material GE ethe / STEEL Date installed ('G/Pq Tank size,,/Qpti gal.:. .• Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N)` Y Depression over taa7, nkk (Y/N) A/ High water alarm (Y/N) .4.04 Date of pumping •ff fA/�SY..t' Pumper E.:r C. ABSORPTION FIELD DATA Date installed • /4/14 ; Soil rating jg.dtR°'or ft2/bdrm) /2 S System type /3E00 Length•31.e.ft' ' Width 2 Q ft. Gravel below pipe 0 S ft. Total depth L_ Sft. Eff. absorption area ‘4P-Oft2 Monitoring tube Y Depression over field it/ Date of adequacy test 2/11/05 Results (Pass/Fail) PA ss For 3 bedrooms Fluid depth in absorption field before test _(_ in. Water addedf{SOgal.'/" New depth 3 in. Elapsed Time: €Amin. Final fluid depth 0 in. Absorption rate >= (•{' 50 g.p.d. -*- Any rejuvenation treatment (past 12 mo.) (Y/N & type) pC(k If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT Septic tank/lift station on lot //40 r ,F Absorption field on lot /00 it. Size in gallons anhole/Access (YIN) "Pump off° level at _ in. High water alarm level at Cycles tested Meets alarm & circuit requi Public sewer main Ai/4 5,+— Sewer /septic service line 'ate +t` Holding tank Aff/A TO: On adjacent lots /00'44 - On adjacent lots /0 0 `4• Public sewer manhole/cleanout Nit SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation L/0 r f' Property line 201# Absorption field 3 Water main Ai 0 Water service line .S0 rir Surface water A3 C/ r'r' Wells on adjacent lots /00 ii• SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line /01r Water Service line 5 0 rfi Curtain drain &'Atk. F. COMMENTS Building foundation 20 'f' Water main N, 4 Surface water /O0 r1' Driveway, parking/vehicle storage S r+ Wells on adjacent lots /00 �r 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 HAA guidelines in effect on this date. Engineer's Printed Name S rove CnI C Date 3/dQ105- HAA Fee $ t4'jO -ED walskgreive PqE ee ..A oqS� I r~"49 FIle et - tig ea/ ...nit • a Date of Payment 30110C Receipt Number US SVC Vi.^ (Rev. 12/01) •••••••• •• ��% w+�^^ ; ovf of ,1A • r `�%CROFEsst00a givectsior Waiver Fee $ Date of Payment Receipt Number Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. /DO - SOP- Dei HAA# 0501P.? Expiration Date: 7- 1- 0 .6- 1. 1. GENERAL INFORMATION Complete legal description S7O fsfEla. C. Location (site address or directions) /49'(:P6', 5/1, Lar 2 &Lee k 5. sror./_ fila D%. Current Property owner(s) Cfo rim to fcEel Day phone G t? C4' 7C Mailing address Lending agency Day phone Mailing address Real Estate Agent Mailing Address .: L "J Day phone €n. 4'7C t;c6 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site • Individual Holding tank 0 Community On-site 0 Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given In paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority 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 sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of Installation. Name of Firm Xfa 't4 Evnt `C-„ Address / 70237 &o.cr a,,)— Engineer's Printed Name SPIE 47%fC Phone C%4/— 7026' Date 3Lo?.*� V A � �'\"��••.M•• l.Q 11 T 12 % Steven W. EnO' ' ,"S 5. DSD SIGNATURE ' � .•• PE 6254 se ',',v 17 Approved for 3 bedrooms. �I*R. •' .0.F. Fs.; Disapproved. Conditional approval for bedrooms, with the following stipulations: <kkpY`0 two, •- : •. �.e Additional Comments S ON-SITE S E `�- WATER AND ; �^ Y : WASTEWATER : moo. PRAORAM : • Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Bylitty Pcs-Ot— (Rev. 01/02) Maintenance Agreements Supplemental Engineer's Report Other Original Certificate Date: 1+ — /— 0 3 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.clanchoragesk.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST F_ WVs/8 LAor z 8Z. (, Parcel ID: D 0 - 3 11-.2.-011-.2.-02 Legal Description: Sed AI A. WELL DATA Well type P Date completed Ad (/ Total depth 12a ft. Date of test If A, B, or C provide PWSID # Sanitary seal (YIN) Y Cased to /tgft. FROM WELL LOG %y Static water level / S ft. Well production / 0 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate O. i F mg./I. Other bacteria 0 colonies/100 ml. Arsenic: mg ./I. Date of sample: ?MPS' Collected by: /%1'449Z'* f't f 8. SEPTIC/HOLDING TANK DMA Tank Type/Material G2tt / Sr c. Date installed l G/PL, Tank • e Maid gal Number of Compartments 2 Well Log (Y/N) 1Wires properly protected (YIN) Y Casing height (above ground) / 2 in.'s AT INSPECTION 3711110S /!3 ft. b, S g.p.m. 4- an size'. Cleanouts (Y/N) y Foundation cleanaut (Y/N) \/ Depression over tank (YIN)( N High water alarm (Y/N) /i//i¢ Date of pumping" 9///0S Pumper 27E. S C. ABSORPTION FIELD DATA Date installed • / G d Soil rating .4rdor ft2lbdrm) /2 S System type 25D / �{ ; ift Length 3t ft r' Width 2 p ft. Gravel below pipe in r ft. Total depth 4. Sft. Eff. absorption area t<left2 Monitoring tube Y Date of adequacy test 3/1870 f Results (Pass/Fail) PA St Fluid depth in absorption field before test 0 in. Water added/4-0gal Depression over field /(/ For 3 bedrooms New depth 3 in. Elapsed Time: CQmin. Final fluid depth 0 in. Absorption rate >_ So g.p.d. -E- lf FIf yes, give date Any rejuvenation treatment (past 12 mo.) (WN & type) pwit D. LIFT STATION Date installed Size in gallons "Pump on" level at m "Pump off" level at _ Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot pier ?- Absorption field on lot /00 if Public sewer main NM anhole/Access (Y/N) in. / High water alarm level at Meets alarm & circuit requi On adjacent lots On adjacent lots /0 0 el- Public f in. Public sewer manhole/cleanout Sewer /septic service line I It Holding tank ,v/4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Nfr Building foundation 1./0 11- Property line 201# Absorption field S i Water main Ir (et Water service line SO 47` Wells on adjacent lots /00 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / d r , f Building foundation 20 f Water main NA Water Service line 5 Q re Surface water Surface water AO 0' fit' /4a rr Curtain drain i/Atk. Wells on adjacent Tots /00 't' F. COMMENTS Driveway, parking/vehicle storage s 14- G. + 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 HM guidelines in effect on this date. Engineer's Printed Name S rgve 046‘ Date 3/d9/OS HAA Fee $ 4 .CD •Pt • /. • Ysts4 ✓s sen vvGEn r " ta �seam ►E 6236 & j Date of Payment 31aq ?oS Receipt Number t06 38/, V„^ (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number ..57-44/�i5,/CLC,, ,Qfse Seecs/sus/f' ASBUILT-NO CORNERS SET THIS DATE. ti>y" SEWARD & ASSOCIATES LAND SURVEYING 694-0829 I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: rro fi07r*2 sk4er for a 4- / AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. SCALE: DATE: GRID: FB: DRAWN: p6:4011wa‘` `��ct pF A(,9�e' ,7 • • �i • DaeSeward LS -6918 t ... A71 1 %Iva lots \{ . 2SCr; ...:Cwt..: CS Rel.tl hent Name 'roiect Nantc/P hent Sample ID Isiria WSID 1051456001 NcrthRim Engineering Various StoneH:II 1? Bl Drink inn Water 0 • .. t500• - e 411 DatesTirncs arc Alaska Standard Time Printed Date/Time 03,25/2005 6:38 Collected Datdllme Received Date/Time Technical Director 03/182005 9:00 03/18/2005 11:35 Stephen C. Ede satple Re:tasks. aamctcr Results POL Allowable Pop Analysis Cniu Method Cuounucr ID L:mils Date Dale ini atom Copartmont Nitrate•N iorobicloav ' aboratory Tota: Cchtottet 0.180 9 0.10U mg,:. EISA 300.3 B (<a101 03':3:05 CP N cot':'Mhr.L 9222B A (Call 03/1845 T .l 5—Go 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 .n .12AO-na` HAA# 1=Ualq4(101"1 GENERAL INFORMATION. Complete legal description .. ' r1 ”:5r,,1 hLot 2, =82och 1, Stonekge'Subd.i.v.io.Lon Location (site addressor directions) NHN 'Stone:k t DWave Property owner Jamie MLtLeh: Day phone 694-7148 Mailing address 9245 Wand Road Eagle Riven. AK 99577 Lending agency ` Day phone Mailing address Agent Day phone Address Unless otherwise, requested, HAA will be held for p'cku� p. 2. NUMBER OF BEDROOMS: 3 N 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. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on -cite 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 . STATEMENT OF INSPE., PION BY. ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, l verify that investigation of this Health Authority Approval application shows that the on-site water st(ply'>` and/or wastewater disposal system is safe, functional and adequate for the number of bedroms and type of structure indicated herein.1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investisation and inspection, the on-site water supply and/or wastewater disposal system isin compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection.. Name of Firm Phone (0 t977 Address 17034 Engle River 1. Eagle River, Mac Engineers signature" d f' Ori i ShNkt ( ' No..1457.1./ ' " °tato DHHS SIGNATURE �Cif�O�v1.� X Approved for 3 bedrooms, Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments Date CAUTION The Municibality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates; based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct' inspections or, analyze data before, a certificate is. issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Roy. 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot' 2 �� - 1 Sro l�rt. > s (p Parcel I.D. A. Well Data II Well type Pg --k.1 ort If A, B, or C, attach ADEC letter. ADEC water system number '`P - Log present ON) Total depth Sanitary seal jN) Date of test Static water level Well flow Pump levell \2� ' Cased to 1 '5', 4t -'t n9-- Casing height Iz + Date completed ID s 1t Driller SJ\--1/4-a.lrn� FROM WELL LOG 10-811- 1s Wires properly protected 6..;N) AT INSPECTION -iv-'S4rn p. -o g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line I t0 JlL TR7 n g.p.m. 0 ; On adjacent lots 1 0 0 1- 1o0 ; On adjacent lots ern C0 cD .A loo rk Public sewer manhole/cleanout WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: -at --clic' B. SEPTIC/HOLDING TANK DATA Date installed (ID - s �t Cleanouts OYN) High water alarm (Y& rk Petroleum tank LS \.51.0 Tank size Collected by: 4- Other bacteria O S & $ ENGINEERING 17034 Eagle River Lamp R. Eagle River, Alaska 99577 Compartments 2 Foundation cleanout &N) Y Depression (Y/ Alarm tested (Y/N) A(°A Date of pumping 3 -9 - 9 t Pumper r Osseo o L SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot To property line On adjacent lots 4 10 / Absorption field Surface water/drainage 72-026 (3/93)' Front /D� /7' Foundation SS "-- Water Water main/service line 70 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) "Pump on" level at offLevel at SEPARATION D E FROM LIFT STATION TO: ell on lot On adjacent lots ycles tested Surface water D. ABSORPTION FIELD DATA Date installed 10 -eb 4 Soil rating (GPD/Ft2) l 2-C /&L System type ' -- e.-. Length 334 1 Width 7-0 ' Gravel thickness 01S- ' Total depth 4 ,C Total absorption area toe 6'b Cleanout present(9/N) j' Depression over field (YWM -1 Date of adequacy test 3- / o - If Results ass fail) /14-s3 for 3 Bedrooms N Water level in absorption field before test O After test 0 Peroxide treatment (past 12 months) (161:) /10,-1,1::: i'-° ad If yes, give date ''/lam SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 12)8 V On adjacent lots /n v 1 Property line / 0 t To building foundation 7e)/ To existing or abandoned system on lot On adjacent lots%� 1x Cutbank /A- Water main/service line /o Surface water / o //4"Driveway, parking/vehicle storage area /0 1 Curtain drain '`y/h E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HM guidelines in effect on,the: date of this inspection. Signature S & S ENGINFF 17034 Eagle River Engineer's Naggl Date p and No. 204 T HAA Fee$ /YD ec%L) Date of Payment <, —/ Receipt Number ci) S7 3 O C ) 72-026 (3193)' Back Z&_ Waiver Fee $ Date of Payment Receipt Number s Sm.E o a Commercial Testing lit Engineering Co. Environmental Laboratory Services mssssssae must« rnrsisssssssfssa LABORATORY ANALYSIS REPORT CT&ERef.ti 94.10193 Client Sample TO LOT2 STONEI-lILLS'D Matrix WATER Client Name Ordered 13y I'rojectNama Project# PWSrD S & 5 ENGINEERING R. SHAFER 11A Sample Remarks: ROU11Nl.t SAMPI.RCOT.I.EC'I'BT) BY: RAY. WORK Order 76463 Printed Dade 03/14/94 @ 13:14 hes. Collected Dat e 03/09/94 @ 16:00 hrs. Receivedlh'de 03/10/94 (u111:45 hrs, Technical Director STEPHEN C.E+DE ef� Released By: �^' . OC Allowable Exl. Anal Parameter Results Qual Units Method Limits Dale Date Inil Nitrate -N L96 mg/1. EPA 353.2/300.0 10 03/11/94 CMR ------------- " See Special instructions Above "* See Sample Remarks Above t l = t In t'Ctected, Repotted value is the practical (Tivinti iication linil. `-s D= Secondary dilution. UA a Unavailable NA=Not Analyzed LT=Less Than GT = &eater Than 5633 B Street, Anchorage, AK 99518-1000 -- Tel: (907) 562-2343 Fax: (907) 561 -6301 ENVIRONMENTAL FACILITIES IN AIJSKA, COLORADO, FLORIDA, ILLINOIS, MARYLAND, NEW JERSEY, OHIO, UTAH, WEST VIRGINIA M MUNICIPALITY OF ANCHORAGE Th DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH i—,¢I_o I CJS CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application DateSeptember 3, 1986 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot2 Stonehill Location (address or directions) Eagle River (b) Applicant Name Miller — RoissierTelephone: Home 694-7148 Business N/A Applicant Address P.O. Box 770249 Eagle River. Alaska 99577 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ® ; Buyer 0 ; Other 0 (explain); (d) Lending Institution Northl and Mortgage Telephone 694-7872 Address (e) Real Estate Company and Agent N/A Address N/A Telephone N/A (f) Mail the HAA to the following address: pickup by engineer 2. TYPE OF RESIDENCE Single -Family El Multi -Family 0 Other Number of Bedrooms 3 3. WATER SUPPLY Individual Well ® Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ® Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) -1 �'Th 5. ENGINEERING FIRM PROVIDIN.. INSPECTIONS, TESTS, FILE SEARCH, DA..4 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. 1 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 Telephone - Address .. 6 SERVICES Date 7/4a/s-t EAGLE RIVER,: AK 99577 P. 0. 11169( 773294 994-5195 6. DHEP APPROVAL . (5 Approved for ��6/�`I bedrooms by Approved ✓ Disapproved Terms of Conditional Approval btV faat c4 s°y°64s 9 4 'z 79 V0 -"K f Engineeo 0 r Seal a°f°p°°meoo°°°°vao°°000 . o(1 ° Louis A. 6otera� C2-6736 V -5H-0 i p -,.SS101` i C. Conditiona Date 7//>/b 1i ,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 (11/84) A. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION SEP 11 1986 RECEIVED WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description' 7/4/ N /EVw Sec /i F -a If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) % Date Completed /41/49.9 Total Depth /ao Cased to /'-/-Y f&dn^'tDepth of Grouting N//4 Static Water Level S-/° iv „ Pump Set At 126717"-- Yield 2e77"-- Yield 7 S GP" 7r,r N� Casing Height Above Ground ao Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Separation Distances from Well: Y Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot t"• On Adjoining Lots /`d To Nearest Edge of Absorption Field on Lot N/c To Nearest Public Sewer Line *MO •• On Adjoining Lots *die • To Nearest Public Sewer Cleanout/Manhole h'/`r Water Sample Collected by Erik fee '41 E..,Si.,iee"^'f To Nearest Sewer Service Line on Lot 9/v/P c • Date Water Sample Test Results SF ti✓ zrt Comments B. SEPTIC/HOLDING TANK DATA Date Installed /6/1&-`/ Size /Oov 54/ No of Compartments Standpipes (Y/N) X' Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) 7 Depression over Tank (Y/N) N Date Last Pumped o:v/}f- .-_ /nent4s el;,, 44 -Le. , sil Pumping/Maintenance Contract on File (Y/N)�� ; for l✓/4 Holding Tank High -Water Alarm (Y/N) h/�4 Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: / To Water -Supply Well f/° as. To Building Foundation .53- To Property Line }/O' To Disposal Field /7/ To Water Main/Service Line f/a / To Stream, Pond, Lake, or Major Drainage Course N1/4 Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed /6/er Width of Fietcf- ' a /2 S 41,6w Type of System Design Length of Field 34' Depth of Field 41-s— Gravel Bed Thickness e„ Square Feet of Absorption Area G ge, Standpipes Present (Y/N) / Depression over Field (Y/N) Results of Last Adequacy Test /1/4 Separation Distance from Absorption Field: To Water -Supply Well SOU To Property Line 1/42 To Building Foundation 70 To Existing or Abandoned System on Lot �/� • On Adjoining Lots 7—Se Date of Last Adequacy Test 7^ To Water Main/Service Line L" ' To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments N4/4 70 D. LIFT STATION 0/ Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off' Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that Ihav/checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed /L 3 / � Date ST acs Company --/"5. Receipt Receipt No. MOA No. 400 / 030 0- ? -7/ -162 L.7? -7/-167 Date of Payment Amount. $ Page 2 of 2 72-026 (11/84) 6; UCS 4 -_-Th O(- ill . `Sp 9 40010 0 OO 0. "48 r. !� °° �0? A ° Sk ° 9Tt- G t°Ei°id�eer's Seal o°o fa m'n •r .y. L. o.e os000p000 peso. a oeo n.o •o ®cc�go vE ® Louis A. Bolero 41 1 Sj,S. CE -6736 e° t® • MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 7/12/85 (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 2 Block 1 STONEHILL SUBDIVISION %/ yN 2 / v� Sec /9 Location (address or directions) NHN Stonehill Drive Eagle River, AK 99577 (b) Applicants Name ROBERT DEAN Applicants Address 694 9117 Same Telephone ` Home Business S R BOX 9352 Eagle River, AK 99577 (c) Applicant is (check one) Lending Institution ; Owner/builder XX f ; BuyerF-7; Other El (explain); (d) Lending Institution ALASKA MUTUAL BANK Telephone 694 9571 (e) Address P. 0. Box 771068 Eagle River, AK 99577 Real Estate Co. & Agent Jack White Address Eagle River Branch Telephone 694 5500 (f) Mail the HAA to the following address: ROBERT DEAN S R BOX 9352 Eagle River, AK 9 ' 2. Type of Residence Single -Family a Multi -Family FT Other (describe) Number of Bedrooms 3 3. Water Supply Individual Well XXX Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. Sewage Disposal Onsite Public Community 71 Holding Tank FT 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] 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 regula- tions in effect on the date of this inspection. 4.1 EAGLESVEaf iG f3EfRING SERVICES =Name of Firm Address P. 0. BOX 773294 6943195 Date_ 4r (ENGINEER SEAL) Telephone rt .030 o oar: o°c e. , Lcuis n. Boars CE -U366. DHEP Approval Jj, o E . 4 a ggJAC er Approved for /rpt <E4 bedrooms By !h QR d 0}Dfi c i 9 'dr.C. Approved X Disapproved Terms of Conditional Approval Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER 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 REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A. CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL. ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) JUL 16 MS CHECKLIST - FEBRUARY 1984 264-4720 'L ° t a f /.4- STo-,e h' 7/ RECEIVED Legal Description. Std°. 7 /WnJ ie./ w Sec /9 f A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) /1/-24 Well Log Present (Y/N) / Date Completed Alfret Total Depth /'a° / Cased to It '(ed °4epth of Grouting NA Yield d o e 6'/1 N• Static Water Level / 5 Pump Set At !a° %t n..r Casing Height Above Ground c'4 n Sanitary Seal or Casing (Y/N) Electrical Wiring in Conduit (Y/N) Y v Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot QUO t .. • On Adjoining Lots /Lca 7' "" To Nearest Edge of Absorption Field on Lot le" ' ; On Adjoining Lots /do To Nearest Public Sewer Line yOY.e_ To Nearest Public Sewer Cleanout/Manhole /t n- To Nearest Sewer Service Line on Lot a S Water Sample Collected by 0.125/.,e -e ; Date 7/12/&f - Water Sample Test Results S•4 tY r t._ 7twj v Comments 1 B. SEPTIC/HOLDING TANK DATA Date Installed /:Vet/ Size /a°0 No of Compartments Standpipes (Y/N) Y N Air -tight Caps-(Y/N) )' N Foundation Cleanout (Y/N) Depression over Tank (Y/N) N N Date Last Pumped We Cant r -w"° *tan, Pumping/Maintenance Contract on File (Y/N) �� • for Holding Tank High -Water Alarm (Y/N) 44 Temporary Holding Tank Permit (Y/N) ti� Separation Distances from Septic/Holding Tank: To Water -Supply Well /°U } - To Building Foundation To Property Line /4 1 To Disposal Field g /9 63' To Water Main/Service Line /v 1 To Stream, Pond, Lake, or Major Drainage Course IVD''=- Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata • 2 S Type of System Design Date Installed 19 `// Oct. Width of Field `2 $ Length of Field Depth of Field J � S'G3 ao Gravel Bed Thickness 6 Y Square Feet of Absorption Area Standpipes Present (Y/N) Depression over Field (Y/N) Results of Last Adequacy Test Ne w Date of Last Adequacy Test New Cvxr7� Cen—s *re Separation Distance from Absorption Field: To Water -Supply Well JO2771 To Property Line /O / To Building Foundation 70 To Existing or Abandoned System on Lot /f]on)t • On Adjoining Lots 30 / t To Water Main/Service Line /0 To Cutbank (if present) /2'4 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments /r/ah ie D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed % u«r+ Date 7/' r/pJr- Company G`/e. Err • MOA No 5 T m2 s j-- - ©f ALAN r7 `9y polo° ° o ° 11.: > •o..v °. .. u.00.. eee.�' 0 Receipt No. 2JA ?...55 Date of Paymentn - \j' 5 Amount: $ AS C/1> Page 2 of 2 72-026 111/84) Engineer's Seal