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HomeMy WebLinkAboutSTOCKHAUSEN LT 145tockhau P. rl Lot :[4 ! -062 -2:! 10/21/2022 Municipality of Anchorage . P.O. Box 196650 ® 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 ® Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Proqram * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV221071 COSA#: PID#: 051-062-21 Legal Description: Stockhausen Lt 14 Engineer: First Water Consulting Permit#: OSP221305 Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 5.0 feet. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: / L'-) 2 ( Z Approved by: L� r Name of Reviewer **** VARIANCE/WAIVER REVIEW **** MUHMP ie UTY OF AHCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-062-21 Property owner(s) MITCHELL & KRISTEN PERKINS Mailing address PO BOX 672234, CHUGIAK, AK 99567 Day phone Site address 21424 GINGER LEE DRIVE, CHUGIAK, AK 99567 Legal description (Sub'd., Block & Lot) STOCKHAUSEN LOT 14 Legal description (Township, Range & Section) Lot Size 20,908 Sq. Ft. Number of Bedrooms y APPLICATION IS FOR: (® all that apply) Absorption Field N Septic TankX❑ X❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN Initial ❑ Upgrade X❑ Renewal ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: TYPE OF DWELLING: Single Family (SF) X❑ (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: t,2 5 -t 4 37a Waiver Fees: Date of Payment: �/3�� ��-? /0ZSOZ� Date of Payment: Receipt Number: �b 30 i Ll gQ027 y Receipt Number: Permit No. 0510221305 Waiver No. 0b\/22.10 71 GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com October 14, 2022 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT W/ WAIVER LEGAL: STOCKHAUSEN LOT 14 The owner has requested that we obtain a septic permit to upgrade the existing aged steel septic tank and augment the existing field from 3BR to 5BR on the above referenced lot. We propose to install a 1500-gallon HDPE tank and extend the currently existing dry leach field with a 5BR reserve to make this 5BR septic system per the attached design. A testhole was conducted recently and the results are attached with this submittal. We respectively request a 5’ property line (PL) to new field waiver be granted with this submittal. Granting of this waiver is justified since this area is along the ROW, does not interfere with the ROW or adjacent properties wells or septic systems, the proposed septic field is more than 30’++ to any other septic systems, the proposed septic field will be outside any well radii, the separations will be staked prior to construction and there has been no known issues. The lot and area are served by private wells and a public well towards the south. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221305, Deb Wockenfuss, 10/21/22 FIRST WATER CONSULTING DESIGN CALCS: NO PRIVATE WELLS WITHIN 100' OR PUBLIC WELLS OF WITHIN 200' OF PROPOSED SEPTIC SYSTEM. NO SLOPES >25% WITHIN 50' OF PROPOSED FIELD. STOCKHAUSEN LT 14 -- FOR RESERVE USED 4GPD/SF SOIL RATE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221305, Deb Wockenfuss, 10/21/22 FIRST WATER CONSULTING STOCKHAUSEN LT 14 DESIGN DETAILS: NO PRIVATE WELLS WITHIN 100' OR PUBLIC WELLS FROM 200' OF PROPOSED SEPTIC SYSTEM.ADJ SEPTIC AREA RLS / SURVEYOR TO STAKE WELL RADII, PL, SEPARATIONS... PRIOR TO CONSTRUCTION. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221305, Deb Wockenfuss, 10/21/22 3030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL : FROSTAD LOT 1 PERFORMED BY: FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 10/13/2022 DEPTH FEET OG SOILS 1 2 ORG/OL 3 4 5 6 GM – W/ 2’+ BOULDERS 7 8 9 10 EXISTING FIELD 11 12 13 14 15 16 17 BOH 18 19 20 Reading Date Gross Time Net Time Depth to Water Net Drop 10/11/22 10 min 6” 2 7/16” “ 6” 2 6/16” “ 6” 2 6/16” “ 6” 2 6/16” “ 6” 2 5/16” “ 6” 2 5/16” PERCOLATION RATE 4.3 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6” PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: 14.5’ DATE: 10/13/22 TESTHOLE # 22-1 DATE PERFORMED: 10/6/22 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: EXCAVATED 6’ BELOW EXISTING FIELD. SOIL WAS SURPRISINGLY DRY AT EX. VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: MITCH PERKINS 10/13/22 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221305, Deb Wockenfuss, 10/21/22 www.sullivanwaterwells.com Pump Installation Log Well Drilling Permit Number: SW Date of Issue Parcel Identification Number: Legal Description Property Owner Name & Address Stockhausen Lot 14 Mitch Perkins 21424 Ginger Lee Drive Eagle River, AK 99577 Pump Installation Date: 4/11/20 Pump Intake Depth Below Top of Well Casing: 71 feet Pump manufacturer’s Name: F&W Pump Model: 4F11P05301S Pump Size: 1/2 hp Pitless Adapter Burial Depth: 6 feet Pitless Adapter Installer: Unknown Disinfected Upon Completion? yes no Method of Disinfection: Chlorine 50 PPM Comments: Pitless Manufacturer: Unknown Pump Installers Name: Sullivan Water Wells Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. ~NICIPALITY OF ANCHORAGE/~'--~ ~ea . and Environmental Prote Jn Fourth Floor West 825 L Street Anchorage, Alaska 99501 279-2511, x 224, 225 INSPECTION REPORT ON--SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL_ MANUFACTURER MATERIAL _ INSIDE LENGTH INSIDE WIDqH_ LIQUID DEPTH NUMBER OF --~ COMPARTMENTS LIQUID CAPACITY/(:2~y~) GALLONS. TILE DRAIN FIELD: DISTANCE FROM WELL FOUNOATION~ ,~... I % of Lines DISTANCE BETWEEN LINES ABSORPTION AREA __ ~C¢-O _ SQ. FT. LENGTH OF EACH LINE DEPTIt OF FILTER ~! DEPTIh TOP OF TILE lO FINISH GRADE MATERIAL BENEATH TILE__. TOTAL LENGTH ~ ~ NEAREST LOT LINE. OF LINE TRENCH WIDTH.~"--O~ IN. TOTAL EFFECTIVE __IN. ABOVE TILE p~ ,v IN. "----- SEEPAGE PIT: Log Crib Rings BUILDING FOUNDATION DIAMETER _ OR WIDTH , LENGTH__, DEPTH Cri~ Si~e: DIAMETER ..... DEPPlt_ . DISTANCE FROM: WELL TOTAL EFFECTIVE _, NEAREST LOT LINE__ ABSORPTION AREA (WALL lEA) SQ. FT. Well Class: Depth: Well Distance To: Lot Line Bldg: Sewer Line: __ Pipe Materials: % of Bedrooms: Installer: Remarks: DATE ,,,ED h L$ON WELL DRILLla,S 1305 W, 45TH STREET ANCHORAGE, ALASKA 99503 !F ;. PHONE 272-9343 DRILLING LOG Well Owner j~k,\ ~, kN ~ ~c ~ t't~.4~ ~.e~ ~ Use of V~ell Location (address of: Township, Range, Section, if known; or distance main road ~el[e/u~ F~ Size of casing to Depth of Hole ~ Li feet Cased to ~ ~ feet Static water level L~ ac ft. (above) be~) land surface. Finish of well (check one) open end ( ); Screen ( ); Perforated ( Describe screen or perforation ~~ % ~4o~) ~-e~, (5. ~o~, C~ t~ ~4 · Well pumping test at ~ gallons per (hour) ~ for ~ hours witb ~ ft. of drawdown from static level. Date of completion_ WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness O' TO TO ~ .TO_ .TO_ .TO_ .TO .TO_ .TO. .TO_ .TO_ .TO_ .TO DEPARTMENT 0/LJ4EAL-IH HNI) ENVIRONNENTAL FE[.Ilil NO. ,:: 7766~5 ) ' flPPLZ~HNT AUBERT J. RE. If. B_X ~J,,4.¢ qR '~TJ..~ ~n~ L.OCRT [ ON 'LEGRL LOT i4 S-I'OC:KRKUSEN SUBD. I,..OT SiZE 2]~:000 SQUARE FEET IYPE OF SOIL RBSORBTiON SYSTEM IS: TRENCH MAX]fqUM NUMBER OF BEDROOMS = ]¢ SOIL RR]'ZNG (Sl].! FTPBR)= %48 ]'HE REQUIRED SIZE OF THE SOIL. ABSORPTION SYSTEM THE I..ENGTH DIMENSION iS THE LENGTH (iN FEET) OF THE 'fRE:NCH OR DRRINFZELD. THE DEPTH OF A TR. ENCH OR PIT ZS THE DZS]"RNCE BETWEEN THE SORFRCE OF THE L~ROUND AND THE BO'TTO~ OF THE EXCAVATION (IN FEET). ]HERE iS NO SET L,llD'l"H FOR TRENCHES. THE GRAVEL DEP]'H ZS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFBLL PIPE AND THE BOTTON OF THE EXE:RVRTION (tN FEET). F" R C: l-=::: ~ g.C~ E F" [_ Fl~"~.t T' Cg P' qf' ]] R PACKAGE PLANT MAY BE INSTALLED AT THE PERMITTEE"5 OPTION SUBJECT 'fO THE FOLLOWING C:ONDI'IZONS: &. EITHER A CLASS I OR ~ NSF APPROVED PLANT MAV BE INSTALLED. 2, R CONTINUOUS MAINTENANCE AGREEIdE:NT IS RE6]UIRED. IF A MAINTENANCE RGREEMENT tS NOT KEPT CURRENT YOU MR9 BE REQUIRED TO ENLARGE THE SOIl.. RBSORF'TION SVSI'EM RND,~OR 90U MR9 8E SUBJECT l'O PROSECUTION. 8FiCKFiLLiNG OF RNY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY '['HIS I)EPARTNENT WILt. 8E SUBJECT TO PROSECUTION. · MINIHUM DISTANCE BETWEEN A WELL. AND ANY ON-SITE SEWAGE DISPCISAL SYSTEM IS d.O[i!~ FEEf FOR A PRIVATE WELL OR FIEf8 FEET FOR R PUBLIC WEL. L WELL LOGS ARE RE~UIRED AND MUST BE RETURNED TO I"HE DEPRRTMENT WITHIN ~:~ DRYS OF THE WEi_L COMPt..ETION. OI'HER REQUIREMENTS HAY AF:'PLY. SPECIFICATIONS AND CONSI'RUCTION DIRGRRMS ARE W,z'RILABLE TO INSORE PROPER INSTALLATION. I CER'FIFY THAT J.: IRM FAMILIAR WI]'H THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. '-2~': I WILL INSTALl._ ]'HE SYSTEM IN ACCORDANCE WITH THE CODES. ]$: I UNDERSTFIND THAT ]"HE ON-SITE SEWER SYSTEM MAY RE~;!UIRE ENLRRGEMEN'I' IF ]"HE RESIDENCE IS REMODELED ]0 iNCLUDE MORE THAN ~ BEDROOMS. 0 8-,E GECO. ,:CHNICAL 8- DEVEL ,.;MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Soils ~ Foundations Performed for: SOIL LOG Name: /~/b~ x,~, ~/~> Tel. Ho. Hailing Address:£o~ ///--~ Legal Description: Depth (feet), Soil Characteristic~ Earl Ellis 688-2280 Land Development 6 8 11, 12-, 16 Ground Water Encountered: Yes Proposed Installation: Seepage Pit Comments: No ~/ If yes, what depth Drain Field Performed b ' y. ~Oate: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw.Stre~t. P.O. Box 196650 Anchorage, AK 99519-6650 ~ii'. www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEHS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-062-21 1. GENERAL INFORMATION COSA# ~C/~/2 ~ Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address STOCKHAUSEN LOT 14 21424 GINGER LEE DRIVE * CHUGIAK, AK * 99567 JEFFREY COOK 21424 GINGER LEE DRIVE Day phone * CHUGIAK, AK * 99567 Day phone 229-2765 JAY OSBORNE W/ PRUDENTIAL' Day phone 345-4663 3801 CENTERPOINT DR, #200 * ANCHORAGE, AK * 99505 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 5 '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. 4. STATEMENT OF INSPECTION BY ENGINEER 'As certified by my seat affixed hereto and as o, L,,e va,,uoaun d~,~ s,,~,~,,, b~,,,~,, t ..... y ,,,o, my investigation, based on procedures outlined in the Certificate of Qn. 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 t,~e 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 557-6179 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 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. DSD SIGNATURE ~J Approved for ~'~ Disapproved. Conditional approval for ~ I ~ASTEWATER , bedrooms, with the following stipulations:~ %. PROG~M .' ~. ~ A,,achmems. COSA Checklist Septic System Advisory Well Flow Advisory I~llLl QL~;~ /"~.1 v IS~l y (Rev. ~ ~/05) Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report u[ner Original Certificate DaCe:__~/: ",'~ - / 0 B= Municipality of AnChorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 9951'9-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Legal DescriPtion: STOCKHAUSEN LOT 14 WELL DATA Well type PRIVATE Date completed Total depth 84 8/25/77 ff. If A, B, or C provide PWSID# N/A Sanitary seal (Y/N) YES Cased to 23 ft. FROM WELL LOG Date of test 8/25/77 Static water level 54 Well production 8 WATER SAMPLE RESULTS: Coliform 0 celOnies/100 mi. .ft. g.p.m. Nitrate 5.53 rog.IL, CHECKLIST Parcel ID: 051-062-21 Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 10/19/2010 62 .ff. 4.8 g.p.m. YES YES 12+ in. Other bacteria 0 colonies/100 mi. Arsenic: ND ug./L. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL/SEPTIC Tank size 1000 gal. Number of Compartments 2 Foundation cleanout~(y/N) YES Date of pumping 10/9/10 ABSORPTION FIELD DATA Date installed' ' 8/29/77 Length 46 ff. Date of sample:l 0/18/2010 Collected by: GEG Ltd. Date installed 8/29/77 Cleanouts (Y/N) YES Depression over tank (Y/N) NO Pumper. I'BELOW EXISTING GRADEI Soil rating (g.p.d./ft2o~. 140 Width 4 ft. High water alarm (Y/N) N/A JR'S PUMPING System type TRENCH Gravel below pipe 5 ft. Total depth *9.8.3 ft. Eft. absorption area 460 ft2 Monitoring tube YES Depression over field NO Date of adequacy test. 10/19/10 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 11 in. Water added 450 gal. New depth 26 in. Elapsed Time: 1 60 min. Final fluid depth 22 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date N/A LIFT STATION Date installed "Pump on" level at in. Size in gallons Manhole/Access (Y_.y.~) ~ "Pump off" level a.~igh water alarm level at .in. E. SEPARATION DISTANCES Cycles tested. Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: 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'+ 100'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 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 100'+,/150'+ Absorption field, Surface water 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN Building foundation. 10'+ Water main N`/A Surface water 100'+ Driveway, parking/vehicle storage Wells on adjacent lots 100'+`/150'+ 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 Il> /7.~/~D COSA Fee $ ~ Date of Payment Receipt Number (Rev. 11/0§) Waiver Fee $ Date of Payment, Receipt Number, Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 Nitrate Advisory Certificate of On-Site Systems Approval # 101275 A Certificate of On-Site Systems Approval inspection and test of potable water was recently conducted on the well water supply on Block , Lot 14 of Stockhausen subdivision. This inspection revealed a nitrate concentration of 5.53 milligrams per liter (mg/L) was reported for the property's well water sample. The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On- Site Systems Approval. II ASBUILT CERTIFICATION I HEREBY CERTIFY TNAT I HAVE SURVEYED THE SHOWN PROPERTY AND THAT NO ENCROACHMENTS EXIST EXCEPTr. AS II~DE:;AZED. ') ~ MIC~,~EL -S.~K~It-t LER,' LS 'h. I' = 40' I0-25'201i DRAWN 9Y MK LLC ALASKA CONSTRUCTION SURVEYS, 414-1 B STREET, STE 205 ANCHORAGE, ALASKA 99505 34-4--5505 (EAST 283,13) ,. EXCLUSION IT IS THE RESPONS1BItJTY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCE.' SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. Asbuil[ Lot 14 Stockhausen Subdivision SW1/4 S 3, T15N, RIW, S.M. FOR Jeffrey Cook 10/20/20~0 09~39 9073~9821 JRs Pumping PO Box 773415 Eagle ~iver~AK 99577 (907)694-6454 Jeff Cook 21424 Ginger Lee Drive Chugiak, AK 99567 (907) 688-1117 Jeff 21424 Ginger Lee Drive Chugack, AK 99567 (907) 688-1117 Additional LoCation Comments: Diagram: 1 St house on right - on corner w/#'s -- Two - story beige w/matron Trim Septic on right side when facing house. JRS SEPTIC PAGE Job Description: P.O. Number; Terms: Salesrep: Map Book: Cross Streets: Job Comments: 1000g .~.;\Diagrams~20132.bmp Service Agreement Number: 032324 Order Date: 08-0ct-2010 Service Date: 09-Oct-2010 12:00 Technician: Dan Net 30 Tax %: 0 Dawn-Dawn Job Type: Repeat Map Grid: 22 Old Glenn Hwy ~-I:~' Service ......... ;~) 7/06/2'~-~'-7-;-' **SERVICE & BILL* ;tank evels normal back flushed 1 time ............. Gallons Planned: 1000 lO00g Gal. Actual: .... Hose Length: Double Tank: ~ ,..,...__ Pump System: (~ Baffles Inlet: [] ~ Baffles Outlet: [] ~ Service Type Qty Septic Serv IO00K 1 Price Each Tax? Extension Actual $185.00 No $185.00 NonTaxable Total Taxable Total Tax Tolal Grand To~l Estimated Charges: $185.00 $0.00 $0.00 $185.00 Actual Charges: Customer agrees to the terms end conditions shown. THIS IS A BINDING AGREEMENT. /, /Signat~ a!~ltle of Custom For your added ¢onveni)~'ce After 30 Days accoun~wlll I~t .(r Representative -- ' / and Master 'Card payments over the phone. Jrned over to COLLECTIONS. $30,00 For NSF Checks Returned. Parcel I.D. # 1. 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 ,~: ~ ·: ', ~, ~' '~ GENERAL INFORMATION . Complete legal description Stockhausen, Lot 14 Location (site address or directi0ns) CERT F CATE OF HEALTH AU'~HORITY APPROVAL FC F{'A~SINGLE FAMILY' DWELLING 21424 Ginger Aee Road, Chugiak Property owner William& ~irginia Harris Mailing address' 21424Ginger Lee Road, Chugiak, AK Day phone 6RR-0656 99567 Lending agency City Mortgage/Jeanie Day phone 696-0701 · Mailing addres Agent '~ Address Don McKenzie Real Estate/Teresa Rcm~a~ phone .Eaqle River, AK 99577 Unless otherwise requested, HAA will be held 'for pickup. 2. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual Well Community ~vell Public water well syst m p id itten'~o'nfi~r~tion NOTE: If community e ,rov e wr lng to the legal~ty and~t~tus'of system: 4~ TYPE OF WASTEWATER DISPOSAL: individual on-site Holdihg t~nk '" ~94-9035 5, NOTE: from State ADEC attest~ - Community on-site Pubhc sewer ~f community Wa~tewater System; provide Written confirmation from state'A~)~ ~ attesting to the legali~y'~nd Status'~)f sysf~fi~. 72-025 (Rav. 1191) Front MOA ~21 STATEMENT OF INSPECTION BY: ENGiNEER .r ~ 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 mves.t~ation and inspection the on-site water' supply and/or wastewater disposal system isin 'compliance Witl~ all Municipal and State codes, ordinances, and regulations in'effect on the date of this inspection. Name of Firm Eaqle River Enqineerinq Services Phone 694-5195 . :Addres~ p.o. P~ 775294. ~agl~ River. AT( 99577' Engineer's signature _ Y~ Date 3//-27/5'~ J DHHS SIGNATURE /~ Approved for Disapproved. Conditional approval for bedrooms. bedrooms, with the' following stipulations: Additional Comments By: Date The Mun c pality of Anchorage Depa~trnent 0f Health and Human Services (DHHS) issues Health AuthoritY APproval Certificates based only Upon the representations given;in paragraph 5,ab0ve by an independent professional engineer registered in the'State of Alaska, The DH HS doesthis'as'a courtesy to purchasers of hO, mes and their lending institutions in order to satisfy Certain federal and state requirementS; EmPl6yees of DHHs d6'n0t conduct inspections or analyze data bef0re a certificate is issued. The Municipality of AnChorage is not responsible for errors or Omissions in the professional engineer's workl . Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ~?-~,,ZYf/u~E,,V /,07'/¢ 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 0¢/~ '~/'7 ? Driller ~/L/,,$O/'./ Cased to ~/~ ~ '~" Casing height 7'0 ~/~ Wires properly protected (Y/N) Date of test Static water level Well flow Pump level1 FROM WELL LOG AT INSPECTION ¢ g.p.m. ~ ~'' ¢ g.p.m. SEPARATION DISTANCES FROM WELL TO: Septic/hehCrncj' tank on lot / ~0 / Absorption field on lot / ~ ~ / Public sewer main /"//~ Sewer service line //~2 ~ .; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank o WATER SAMPLE RESULTS: Coliform SA'rI5,~.'~E';ro,'& 'r' Date of sample: '~ ,] ~ ~ Nitrate Collected by: Other bacteria $~T/SFAcT'o/~ ~' S, SEPTIC/HOLDING TANK DATA Date installed ~ ~',/~ ~ Tank size ,/~)~ Compartments Cleanouts (Y/N) )/~<, Foundation cleanout (Y/N) ~/~ _~ Depression (Y/N) High water a.larm (Y/N) ,/'/,/~ Alarm tested (Y/N) ,/"///~ Date of pumping "~ ,')>-¢//'~W Pumper ,._~'~ ~5 SEPARATION DISTANCES FROM SEPTIC/ ...... ~ TANK TO: , Well(s) on lot / ~,0 On adjacent lots To property line Z./~ ' Absorption field Surface water/drainage -/"//..)0 / Foundation '~ / Water mei~/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION /"J/~ Date installed Size in gallons Vent (Y/N) "Pu~ High water alarm level Meets MOA electrical codes~N) SEPARATION D,ST^CCE FROM STATION ~.~Man~facturer ole/Access (Y/N)_ "Pump off" Level at Cycles tested Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed Length /¢(~ J Width Total absorption area Date of adequacy test Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) Soil rating (GPD/Ft2) /¢(2/;ff JZ~,~ System type ,l/ J Gravel thickness ~ ~ Total depth Cleanout present (Y/N) )/E 5 Depression over field (Y/N) ~-/o Results (pass/fail) /cE $ $ for ~ Bedrooms '70,75" After test ?o :7 ~ ~' /Y/~ If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ~ c~ / To building foundation On adjacent lots ¢' '¢ O' Surface water ¢/00' Curtain drain /',//~ On adjacent lots -¢ /O o ' Property line ~ ~ ' To existing or abandoned system on lot Cutbank /~//,~ Water maiR/service line Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION Date HAA Fee $ Date of Payment Receipt Number 72-026 (3/93)* Back I certify that I have checked, verified, or conformed to all MOA and HAA guidelines tn effect, o~;,tt~'8. ~,~t~, o~tb./s inspection. Signature ~~ Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL /~' l,~"] - ~),/~--'~,~ OF ON-SITE SEWER AND WATER FACILITY 264-4?20 GENERAL INFORMATION (a) Application Date ~CH 6; ;tq87 Legal Description (include lot, block, subdivision, section, township, range) STOC~IAUSBN: Lot Location (address or directions) GZNC, ER LEE ROAD: Past apartmeDts to the right to _~reen with white house (b) Applicant Name f?R,E WAf,KR, R Telephone: Home N/A Business 694-4200 Applicant Address P.O. BOX 772849, ~¢,G~ RZV~R, AL~SYv& 99577 (c) Applicant is (check one): Lending Institution []; Owner/builder []; Buyer []; Other [] (explain); RRAT, F, SmA'PR A~F(N~P (d) Lending institution Af~TZC t~%UERA~ CR~DZT T~ZON Telephone 265-6250 Address P.O_ POX 100~60; ANCHORAGE; AI,ASKA c~gRlO (e) Real Estate Company and Agent f,~,F, WAT,fCRR ; RF,./IVfAX OF I~,AC, f,F, RTVR, R Address P,O, P~¥ 772Rb, 9; RAC, T,F, RT~rR, R; Af,A,~I(A 9957? Telephone (f} Mail the HAA to the following address: rT~ RR. PTf~]~ ITP R¥ TYPE OF RESIDENCE Single-Family [~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY Individual Well;[~ Community [] Public [] Note: If corn munity well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite [~ Public [] Community [] Holding Tank [] Note: If corn munity well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (~ 1184) Page 1 of 2 ENGINEERING FIRM PROVIDll ~NSPECTIONS, TESTS, FILE SEARCH, D. , AND INFORMATION As certified by my seal affixed hereto and as of the vafidation 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. Name of Firm JEAGLE RIVER ~qGINF~gJ:L~NG S~VZCE Telephone (901) 694-5195 Address P.O. ~OX 77,3294, EAOLE RIVER, ALASKA 99577-3294 Date March 6, 1987 ,ineer's Seal Approyed '}(~r" ~' -~ bedrooms by Approved ,~' Disapproved Terms of Conditional Approyal Conditional 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) P, EC£1V£D MUNICIPALITY OF ANCHORAGE (MOA} HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: ~-~ /~/ WELL DATA Well Classification ,/P'4~/~/4 Well Log Present (Y/N) ,-~ Date Completed ~'/ Total Depth ~:~' / Cased to ~--~'o~/¢ ';'/,~'~Depth of Grouting Static Water Level ~-2 ' Casing Height Above Ground ~ / Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) -'~/.~ ' Yield :~'~ ~'~ ~ ~ Pump Set At ~:>/ / Sanitary Seal on Casing (Y/N) .~/' Depression Around Wellhead (Y/N) ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot ,/.2..s" / ; On Adjoining Lots '//~ / To Nearest Public Sewer Line /t/,~ To Nearest Public Sewer Cleanout/Manhole 2'>'J4' To Nearest Sewer Service Line on Lot Water Sample Test Results ~'~ B. SEPTIC/HOLDING TANK DATA Date installed ~__//2 ? Standpipes (Y/N) .,.v' Depression over Tank (Y/N) ,4/ Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic/Holding Tank: TO Water-Supply Well //~ / To Property Line /'vz~' / To Water Main/Service Line ~',5- / Course v'/~ ,.P ~ Size '/~"~)~<~'~ / No. of Compartments Air-tight Caps (Y/N) ,J/ 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 I of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed ~//??. Width of Field Z¢¢/ Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test ~'/;~'.r~ ~, Separation Distance from Absorption Field: To Water-Supply Well .Z.~..~-' To Building Foundation .~-¢¢ / Lot TO Water Main/Service Line Type of System Design Length of Field x~/'~' / Depth of Field .~/' Gravel Bed Thickness '5-/ Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line .~¢ / To Existing or Abandoned System on ; On Adjoining Lots ~-¢~ / To Cutbank (if present) ~_./~' To Stream/Pond/Lake/or Major Drainage Course '~-/~'~ To Driveway, Parking Area, or Vehicle Storage Area Comments D, 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 that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed '~7~'~;~;:::~ Date ,.~//¢/~ Company /---'~/~'/(~'~"~- MOA No. Receipt No. ./O ¢-~ / 00/~'~ Date of Payment .'~'/~ '~ Amount: $ ./~/_) ~ Engineer's Seal Page 2 of 2 72-026 (1 ~/84) Eagle River Engineering Services P. 0, Box 7732g,1 Eagle River, AK 99577 694-§195 EAGLE RIVER ENGINEERING SERVICES P.O. BOX ~73294 EAGLE RIVER, ALASKA 99577 WELL AND SEPTIC ADEQUACY TEST REPORT TEST DATE: LEGAL: LOCATION: RESIDENCE: PUMP YIELD: WELL YIELD: WATER SYSTEM: SEPTIC SYSTEM: March 4, 1987 Stockhausen: Lot 14 Chugiak, Alaska Single Family, 3 Bedrooms 5.6 Gallons per Minute +5.6 Gallons per Minute Private Well From Municipal Records Tank: 1000 Gallons Absorption System: Trench Type INSTALLATION DATE: 1977 INSTALLED ABSORPTION AREA: ORIGINAL SOIL RATING: 460 Sq. Ft. 140 from original soil long report. TEST PROCEDURE: The leachfield was filled with water from the onsite well at an average rate of 5.6 GPM for 120 minutes. At that time, the well had delivered 660 gallons with 4' of drawdown from a static level of §7'. The septic tank and leachfield sump water levels were monitored referencing a measurement below the top of the standpipes. During the test, water was added through the trench/cleanout tube and the sump water level was monitored as water was added and then absorbed into the surrounding soil. The water level in the septic tank did not rise after the first addition of 660 gallons of water showing that the leach trench absorbed the full amount of water. Measurements were taken of the trench sump water level, with return to original starting level within 10 minutes after the finish of the test. The monitoring indicates the septic system will accept the required 150 gallons per day of effluent, per bedroom, which is the required absorption rate for Municipal approval. TEST RESULTS: The well flow rate and septic system absorption rate meets 'the requirements of the Municipality of Anchorage for a three bedroom single family residence as of the day the system was tested. Assessment of existing subsurface conditions by the inspecting engineer is limited to information obtained from the available monitoring tubes and Municipal record search. Well and Septic Adequacy Test Report (Con't) Page We do not guarantee the validity or quality of subsurface tests and inspections preformed by the original inspecting engineer or authority. This report is limited to absorption rate testing and surface separation measurements and does not verify the integrity of the piping for the water supply or waste water system. The operational life~ and the matter of compliance with State and Municipal codes, for all water and septic systems depends on the local soil conditions, groundwater levels that may not be observed from the surface without additional testing, water usage of the homes being served by the system, and the detail of required testing procedure. There is no guarantee that the well and septic system tested will meet the requirements for approval in the future. Any concerns with this test report should be discussed with the testing engineer. It should be noted that the well log on record with the Municipality of Anchorage shows a 6" casing being drilled and driven to 23'. At this level an open hole was drilled and then lined with a 4" steel liner. Municipal code calls for a 40' minimum casing depth unless the casing is seated in a bedrock surface. From the well log presented, a rock shelf was encountered at a depth of 20'5" to 33', then a large rock was penetrated to an unknown depth with sand and gravel thereafter. The suitability of this rock shelf and rock as a protective layer is solely dependent on the well drillers judgement and accuracy of his log. This would be true for any drilled well. The protection offered by the 4" liner is dependent on how far the liner extends into the original cased portion of the well. The liner for this well extends to within 116" of the ground surface. The static water level of 57' and the absence of a shallow ground water table as evidenced by the soil log would indicate that this well is obtaining its water supply from the perforated depth of 72-84'. In this case, under current conditions, the intention of the Municipal code would be accomplished. The owner should be aware that the liner situation exists, and that an assessment of the integrity of this well is based on ground water table elevations existing at this time. X ?~--~MUNICIPALITY OF ANCHORAGF~--.~, ~c~L~ /X DEPAR'TM$ ;OF HEALTH AND ENVIRONMEN )PROTECTION / ~ ' 82~ L Street, Anchoraa~, Ala~'K~' 99501 ~ ~ 264-4720 -~ ~ Da~e Received: January 18~ 1978 #1: Time I~ ~%~> D n~ #2: Time #3: Time Date /_~/_U~. /, ~f Date Date Insp ~, ~. Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES' Lending Institution Request: United Bank Alaska % Debbie Border Mailing Address: 645 G Street 99501 Phone: 276-1911/210 Property Owner: Hubert Reid Mailing Address: Star Route Box 1352 99567 Phone: 688~3197 Legal Description: Lot 14 Stockhausen Subdivision Single Family Residence: ~ ) Multiple Family Residence: ( ) Well System: Individual well Permit # ~ Construction Number of Bedrooms: Three Number of Bedrooms: ~ Community/Public System ( ) Depth of Well 86' Well Log on File Bacterial Analysis Sewage Disposal System: On-site System ( ~ Public utility ( ) Permit # ~q~ni~(^ Installed 1977 Installe~ Septic Tank Size ~ ~o~%. Manufacturer ~. Absorption Area ~.qf>~ Soils Rate ~ Material ~,~. . 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line Two .. Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 14 Stockhousen Subdivision Comments: Affadavit Attached: Approved: ~_ Disapproved: Letter Attached: ) Date: Date: Department Worksheet: REALTORS REQUEST FOR APRROVAL OF INDIVIDUAL SEWER & WATER FACILITIES Type of Inspection: CMRO VA FHA CONV Xx Property Owner: Mailing Address: Hubert Reid S. R. Box 1352 Chugiak, AK. 99567 DayPh0ne 688-3197 Name of Buyer: William J. Dennison Mailing Name of Mailing Name of Mailing 5750 Glenn Hwy Sp. ~3 Address: Anchorage, AK Day Phone 333-9155 Lending Institution: United Bank Alaska - Attn: Debbie Bordez 645 G. Street Address: Anchorage, AK - 99501 Phone 276-1911 (Ext.210) Realtor or Agent: Myrna Johnston or Hank Warren P. O. Box 249 Address: Eagle River, AK 99577 Phone 694-9555 Legal Description: Stockhausen Lot 14 New Glenn Hwy to Peters Creek - turn left at top of Location: hill then iramediate right to get on Old Highway. Turn l~road to right past Bernie's Bar, House is first one on right (Green in color) 7. Type of Facility to be inspected: Single Family 8. Water Supply Type of Supply: Public Utility __ Individual __ If Individual, number of dwellings presently served If Individual, depth of well 86' 9. Sewage Disposal System Type of System: Public Utility __ If Individual, date of installation: No. Bdrms. 3 X 1 Individual (on-site) X DEPl. OF HEALiH EI~VI~ONM~]N~AL P~O] ..... AREA, INC. REALTORS [] Anchorage "C" St. Office 3300 C Street [] East Anchorage [] Eagle River Eastgate Office Pa r k ~t ~:C)ff ,(~. 5437 E. Northern Lights P.O. ~2~9