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SUNSET HILLS BLK B LT 15
Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP201056 PID Number: 018-201-26 Dwelling: W Single Family (SF) EJ with ADU ❑ Duplex (D) ❑ Two Single Family Project: R New Jfl Upgrade Name ERIC KRETSCHMER ABSORPTION FIELD E]Deep Trench E]Wide Trench 9Bed []Mound Site Address 244--9F_A,R,-MAaU.N-_R0AD 'ANCHORAGE, AK El Other Phone Number of Bedrooms Soil Rating Total depth from original grade 907-306-6367 13 4.0 GPDISFI SEE DWG. (REBUILD) Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade SEE DWG. Fl, Gravel depth beneath pipe 0.52 Ft. Subdivision Block Lot SUNSET HILLS: BLOCK B, LOT 15 Fill added above original grade SEE DWG. FL Gravel length 21 Ft. Township Range Section N/A Gravel width 7 FL Beds: Number of Lines 2 Distance betmeen lines 3 Ft. SEPARATION DISTANCES Toi Septic !Absorption Holding Sewer Total absorption area of trenches Dist. between trenches From Tank Field Lift Station Tank Line 147 Ft2 INumber Ft. well 50'+ TANK E) Septic 0 S.T.E.P. 0 Holding El Other Manufacturer Capacity Surface Water •50'+ I Gall Material Number o mpariments Lot Line j I 151+ INA Foundation 01+ 10' f LIFT STATION Manufacturer Capacity Gal. _ Remarks 'CAT 11 AWWTS Alarm loc i Electrical installed by to PIPE MATERIAL House to tank EXISTII`�b Tank drainfield D3034 Installer ARM SEPTIC SERVICES Drainfield D3034 CO/MT D3034 inspector DAVID GARNESS, PE BENCH MARK (Assumed elevation) 100.00 ft Inspection4/1512020 Location and description dates: 2'd 0' FRONT DOOR THRESHOLD ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp F Conditional Approval: Date 6) t/ <4 Septic System Approved Date Note: this approval does not include well permit requiremens Cry 1 01, ECC8 4 kmuv volu// i 0) PERMIT NUMBER: OSP201056 RECORD D RAW I N G PARCEL ID NUMBER: 018-201-26 A B C C01 105.8 84.1 87.6 \ CO2 104.2 83.4 87.5 MT1 93.5 67.4 69.6 MT2 90.0 MT3 106.6 65.4 84.5 68.7 87.9 _ DEAJ�MOUN ROAD MT4 1103.0 1 82.6 87.0 - - - - - - - - - - - - - �0\US J5 O� - - - - - - - - - - ��" EXISTING 3 BEDROOM EXISITNG FCO m HOUSE / C 1� � • •r . EXISTING TANK, DRAINFIELD AND AEROCELL POD .'M T1 NEW DRAINFIELD MTJ T3 I HANNAH'S COURT / T—----------r-----------�—--r-------- — I I I I N SCALE: / I 1"=40' GARNESS ENGINEERING GROUP, Ltd ENGINEERING SALES CONSULTING 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 -PHONE (907) 337-6179 -FAX (907) 339-3246 • WEBSITE: —ga—s—gineenng.com PREPARED FOR: PHONE NUMBER: PAGE NUMBER: ERIC KRETSCHMER 907-306-6367 2 OF 3 LEGAL DESCRIPTION: DRAWN BY: SUNSET HILLS; BLOCK B, LOT 15 D.J.G. TYPE OF WORK: DATE: ,.- SEPTIC SYSTEM RECORD DRAWINGS 4/17/2020 WOODEN FENCE DEARMOUN ROAD N 89'5900"E 100.00' 0) _ o i 6.8'x7.7' DECK w/ WELL BELOW 10 1 26.0' ----- 13.0'x15.0' DECK 1 STORY a6 m RESIDENCE w/ RETAINING WALLS Z `'4 WALKOUT BSMT. 12.7' .. 1:0'k20.9' 0 m 19.5 40.6' �� m CANT- '. O O — — 14.4 GRAVEL :.: _O Lot 16A 0Ln O m I� 0 o Lot 14 SEPTIC PIPES 0 Lot 15 MANHOLES 15.000 S.F. N POST & RAIL FENCE r . POST & RAIL FENCE SEPTIC PIPES .ucorc—oma—oma—oma orc'— —ore oa— —02 S 89'59'00"W 100.00' HANNAH'S COURT -------------- I I ---- I Lot 20 I I Lot 21 I I Lot 22 PLOT PLAN ___ AS BUILT _X_ SCALE _ 1=M40' GRID _ 5W 3033— Project No. 20-1241R2 ___ 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lana & Associatesinc. (907) 522-6476 Phone �/ (907) 522-4625 Fax ��ooODOQ4O� Professional Land S u rve ors kenOlangsurvey.com v OF A � �p y jonathanOlongsurvey.com I hereby certify that I have surveyed the following described property: LOT 15, BLOCK B, SUNSET HILLS SUBDIVISION (PLAT No. P-228) Anchorage Recording District, Alaska, and that the improvements situated thereon are within the property lines and do not encroach onto the property adjacent thereto, that no improvements on the property lying adjacent thereto encroach on the surveyed premises and that there are no roadways, transmission lines or other visible easements on said property except as Indicated hereon. - k) Dated this the _, __�' �� at Anchorage, Alaska --� --- Day of __ -=��_� �-------- It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. ,* 49TH y*l ............. ... . ........... KEN ETH G. o LS -5202.. SJR 4pp�R�Ff5510NA1• � �� AECC963 MUNICIPALITY OF ANCHORAGE Onsite Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519.6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http:l/www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP201056 Work Type: Septic Upgrade Tax Code Number: 01820126000 Site Legal Address: SUNSET HILLS BLK B LT 15 3:3033 Site Mailing Address: 2130 De Armoun RD, Anchorage Owner: KRETSCHMER ERIC J & Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: 0 Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Effective Date: Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 4/10/2020 4/10/2021 15000 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2.All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By' �) Issued By: Date: l�o Date: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201056, Rebecca Carroll, 04/10/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201056, Rebecca Carroll, 04/10/20 MUNICIPALITY OF ANCHORAGE DEPA.T.E.T HEALTH A.D HU.A" SE"V'OES Environmental Health Division 825 "L' Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAl. SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES ~,ddress )~ ¢' ~ ~ TO SEPTIC ABSO,P'rlON WELL F~O~ ~ TANK FIELD Phone(s) Permi, NO. ' ' ~o. ~f B~d ogres fWELL (0 O,_/. LEGAl- DESCRIPTION Township, R~nge, Section ~2 ~l ', /-~.3 ¢~ ', ~ -% ~ driveway.AS'BUILt DIAGRA~ (ShowloCatlOn olwell, sepncsystem, properlyhnos, loundabOn.w~tor boOms, etc.) ] TANK'S ~ SEPTIC capaciWmgam'o~sU HOLDING/ 913~ ~ T~E~,.~ ~ BED ~ W, D~ E~ OT~E~ii Dep/I, top,pebotlomlrom Total de,th from original gr'de t/ 3 ~[q ?~_ FT Gravel lenglh I -1~ Z FT ~.~1 FT ( / ~ ~ SQFT ~ FT I ' WELL~ ~ PRIVATE ~ OTHER (Identlfv) 1- FT! REMARKS: I~ctions Pe~ormed by:. 17034 ga~le River Loop Road No. 204 ~ cedily ~at Ibis inspe~10n was pedormed according 10 ~11 ' · 72-013 (3/85) HUD ANCHORAGE 98~ PO~ U.S, Depa~¢nent of Housing and Urban Development Anchorage Office, Region X 222W. 8th Avenue, #64 Anchoruge, AK 99513-7537 Mr. Robert 8chaffer~ P.E. s & S En$ineering 17034 Eagle River Loop Road Suite 204 Easle River~ AK 99577 Dear Mr. 8barfer: Subject; 2130 DeArmoun Read, Anchorage, Alaska 99515 FHA Case Number 111-042305-703 The subject property has been converted to a two bedroom single family residence and will be marketed as such by the U,S, Department of Housing and Urban Development (HUD). Please proceed with the leachfield upgrade. Conside~ing the property has been held off the market since it was conveyed to HUD in June, we would like the completion of this upgrade as soon as possible. If you have any questions, please contact Vivian Gayton at 271-4342. Sincerely, ~aul O. Johnson~ Chief Property Disposi~ion/ Loan Management ~3vos LEGAL DESCRIPTION: 2 3 4 7 8 9- 10- 13- 14- 15- 16 17 18 19 20 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? s L IF YES, AT WHAT O DEPTH? p E ~3epth to Waler A~ler __?'/~ Monllorlng? ~ Gross Net Depth to Net Date 'rlme Time Water Drop IN U.S. Department of Housing and Urban Development Anchorage Office, Region X 222 W. 8th Avenue, #64 Anchorage, AK 99513-7537 Mr. Robert Shaffer, P.E. S & S Engineering 17034 Eagle River Loop Road Suite 204 Eagle River, AK 99577 Dear Mr. Shaffer: Subject: 2130 DeArmoun Road, Anchorage, Alaska 99515 FHA Case Number 111-042305-703 The subject property has been converted to a single family residence and will be marketed as such by the U.S. Department of Housing and Urban Development (HUD). Please proceed with the leachfield upgrade. Considering the property has been held off the market since it was conveyed to HUD in June, we would like the completion of this upgrade as soon as possible. If you have any questions, please contact Vivian Gayton at 271-4342. Sincerely, ~ Fau O. Jo nson, o e ~- Property Disposition/ Single Family Loan Management Branch GAAB-HO I GR'~'TER ANCHORAGE AREA BOROI' 'H HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM SEPTIC TANK: DISTANCE FROM WELL LIQUID CAPACITY /7 J"'~ GALLONS. MAILING ". · c~'T~./~ ~ PHONE ADDRESS ~~ ~O~/ . . . LEGAL DESCRIPTION lZ?'r MATERIAL OO~V"(-~4~z'~ ? ~: INSIDE LENGTH ~7 L NUMBER OF OC~-~ ~ COMPARTMENTS ! INSIDE WIDTH ~ / DEPTHLIQUID SEEPAGE SYSTEM: SEEPAGE PIT: NUMBER GE P~TS~/OUTSIDE DIAMETER LINING MATERIAl NEAREST LOT LINE --' OR WIDTH . DISTANCE FROM WELL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) · BUILDING FOUNDATION z/~ z~ sq. ET. TILE DRAIN FIELD: ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE FOUNDATION ., NEAREST E. ~E)cs--rX~q c E BET S / SQ. FT. LENGTH OF EACH LINE TOTAL LENGTH OF LINES DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE DLE WELL: TYPE~/(.,j_ ~7/~ DEPTH /~r~<~' i LOT LINE ~¢~ t NEAREST /, I SEPTIC _, SEWER LINE__ ~- k] TANK DISTANCE FROM , BUILDING FOUNDATION. I~'~ (;, / SEEPAGE , SYSTEM WATER ~ SAMPLE_ , NEAREST OTHER , SOURCES · CESSPOOL DIAGRAM OF SYSTEM DISTANCES: ~ '= 7~,~ DATE GREATE~ 327 Eagle St. ANCHORAGE AREA. ,{)ROUGH HEAl,TH DEPARTMENT Anchorage, Alaska 99501 2,79-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT ~-: MAILING ADDRESS ~'~"~--/~'~.~' PHONE NO. LEGAL DESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK_ b'"'~, SEEPAGE PIT. L"'/, DRAIN FIELD. __, OTHER TO SERVE THE FOLLOWING FACILITY. ~ ~-~'¢~ /~f.,c¢.,.,.~¢_ ~ ¢~,/¢¢%¢ ~Z~CT//z.~¢¢' FINANCED THROUGH ,"'""~"¢'~/ TO BE INSTAL LED BY_~d~-__~ PERCOLATION TEST RESULTS ANTICIPATEO DATE OF COMPLETION BELOW TO BE FIt. LED OUT BY HEALTH DEPARTMENT THIS IS TO SERVE AS gA.. DISTANCES: .. SEPTIC TANK SIZE AS DESCmEO ,ELOW. SIZE OF UNIT.TOBE SERVED--~ /~ TYPE ~ SEEPAGE AREA ~ ~ '~_TYPE DIAGRA~ OF SYSTEM Health Authority certify that I am familiar with the requkements of Greater Anchorage Area Borough Ordinance No. 28-68 and that the GATE above described system is in accordance with said code. GREATER ANCHORAGE AREA BORO!JGH HEALTtt DEPARTHENT 327 EAGLE STREET ANCHORAGE, ALASKA 9gs01 · .' ~Date Performed__ This Form Retook'ts Depth . . p ~- SOi.l Characterks~lcs Location Sketch Was Ground Water Ii: Yes~ At What Deli, th~_-~ Reading Date Depth To H20 Dpain '~' t le].d Net Drop Proposed Installat*on, Seepage Pit Depth Of Inlet jI !)ep~-h-j~-~"~'it ,Or '!'renc~--~'[7 'rest Performed By:~ ......... %'U Sff ,EPL14R1S a� • Municipality of Anchorage On -Site Water and Wastewater Program - (907) 343-7904 T Certificate of On -Site Systems Approval Parcel I. D.018-201-26 1. GENERAL INFORMATION: Expiration Date: Complete legal description Sunset Hills Block B. Lot 15 Location (site address) 'Anchorage AK Current Property owner(s) Eric Kretschmer Day phone 907-360-6367 Mailing address Real Estate Agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: Date: COSA to be released to the engineer. unless otherwise requested by the engineer. 01)v tL) r-)[4; carp COSA Fee $ I /— � �� a-60 Date of Payment Ll 1261 z �zo Receipt Number 6a2toa(2 COSA # 0 J.5 6:zo 11 Waiver Fee $ Date of Payment Receipt Number Waiver # S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm: Garness Engineering Group. Ltd (GEG) Phone: 907-337-6179 Address: 3701 East Tudor Road Suite 101- Anchorage Alaska 99507 Engineer's Printed Name: Jeffrey A. Garness Date: 4 % t Jr. conducting this evaluation, GEG provided an engineering evaluation of the well andlor septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the system/s, on the datets of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or a ! . • t, "' encroachments may exist that were not identified during the evaluation, The operational life of all wells r',• rr.' •' t ) ' .'3.c=�4. and septic systems depend upon a variety of variables, including but not limited to, soil conditions, r% r groundwater levels (that may fluctuate Burin the � g year), quality of construction (materials and ? . t workmanship), and the water usage of the family utilizing the systemts, These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the system/s; therefore, GEG makes no warranty (express or implied) regarding the future performance of �r,• •�-�-• • • • • •�•�'•• • the well or septic system, GEG snakes no representation whether an alternative well or septic system �'� �t # �Y�• � r �=`s' can be installed on the property in the event either of the current systems fail to perform adequately in {! ' 1�� the future. The content of this repos is for the sole benefit of the person/party that retained GEG to In 1j perform the evaluation. Reliance upon the information provided in this report by any other person or t I ". =t' i` t•�,r '�� } party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever., 6. DSD SIGNATURE #AECC884 LL System #1 Approved for 3 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms�Or « � I i, bedrooms, with the following stil Vons:014-SkT r h j S - \N P p,Nt i G - Jf''�i • SVR By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 7. ATTACHMENTS: COSA Checklist Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist Legal Description: SUNSET HILLS; BLOCK B; LOT 15 If more than 1 septic system on lot: COSA Checklist #_of A. WELL DATA ❑ Well log is filed with Onsite (or attached) Date drilled "66(?) Total depth ;98 2+ ft Cased to UKNOWN ft F1111 Sanitary seal is functioning correctly Q Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA Off Static water level at beginning of test 95.2 ft. Comments *WELL TEST B. TANK DATA Age of tank(s) 5 years Tank type/material 5"' Measured operating fluid level in septic tank N/A H Standpipestfoundation cleanout per record drawing Date of pumping 4/17/2020 D. ABSORPTION FIELD DATA Which system tested (date installed) NEW © ALL standpipes present per record drawing Total measured depth from grade 6.93 It (max) Measured depth to pipe invert from grade 4.91 ft (min) ❑ N/A— pressurized field N Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 018-201-26 Structure served by this system Well production at time of test 8.6+ ,-qpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes ® No K Coliform bacteria is Negative Nitrate 2.66 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑U Arsenic less than MRL (ND) Collected by GARNESS ENGINEER GROUP, LTD. Date of Sample V112020 C. LIFT STATION N Required maintenance completed Age of lift station 5 years Lift station material HDPE Comments: SEE ATTACHED QUANICS MAINTENANCE BY ARM SEPTIC SERVICES Adequacy test date N/A Results [DPass For 3 bedrooms Fluid depth prior to test - in Water added = gal New depth in Elapsed time = min Q Code -required soil cover over field Final fluid depth _ in ❑ System presoaked Absorption rate _ gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) NIA date of test) Gallons introduced NIP` gallons If yes, enter date Comments/Deficiencies: COSA Checklist yellow sheet 0 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' Q✓ Yes ❑ Yes ,50,+ if No _ It Neighboring Tank > 100' Yes if No_ ft Absorption Field on Lot > 100' 0 Yes if No R50'+ ft Neighboring Absorption Fields > 100' Wells on Adjacent Lots: U1 Yes if No ft Community Sewer Main > 75' M✓ Yes if No _ ft Community Sewer Manhole/Cleanout > 100' QYes ifNo_ft Private Sewer/Septic Line >260 Yes if No ft Holding Tank ? 1 DO' P Yes if No ft Animal Containment > 50' ❑✓ Yes if No ft Manure/Animal Excreta Storage > 100' nYes K No _ ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' Q✓ Yes if No—ft —ft Surface Water > 100' ❑ Yes if No •50+ ft Property Line > 5' ❑✓ Yes if No—ft Wells on Adjacent Lots: Wells on Adjacent Lots: ✓❑ Yes Absorption Field > 5' Q✓ Yes if No_ ft Private Wells > 100' ❑ Yes if No '50'+ ft Water Main > 10' ❑✓ Yes if No—ft ❑ Yes Community Wells > 200' 0 Yes if No _ ft Water Service Line > 10' ❑D Yes if No—ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' 0 Yes if No —ft If absorption field is under driveway comment below Property Line > 10' ❑ Yes if No *5'+ It Wells on Adjacent Lots: Water Main > 10' ✓❑ Yes if No_ ft Private Wells > 100' ❑ Yes if No*50+ ft Water Service Line > 10' ❑D Yes if No _ ft Community Wells ? 200' Yes if No _ ft Surface Water> 100' ❑ Yes if No'5�+ ft F. ENGINEER'S COMMENTS *CAT II ADVANCED WASTEWATE TREATMENT G. ENGINEER'S CERTIFICATION l certify that 1 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. CCSA Checklist yellow sheet NAECC884 rness;' CE— 1 ARM Services, LLC Maintenance Checklist Advanced Treatment System Operational Checklist: Advanced Treatment System Legal Description: Er2nA L (4:0,21 Street Address: 1 t `8 ) f )a v n L e C} Service provided on: Date:"S/AryligTime: Service provided by: Company: .A' 96 _ %an.fa,+t Employee: Date of last service: Vo l fq By; You Other: 1. Type of Aerocele Treatment System: L_KCat II -AeroCell Treatment System C Cat III -AeroCell Treatment System 2. Conditions at media filter: C�ceptable 0 Unacceptable a. Evaluate presence of odor within 10 It of perimeter of system: �0 e �. Mild `Di Strong ❑ chemical C Sour b. Source of odor, if present 3. Manhole Risers and Pipe Caps: acceptable Unacceptable a Covens intact t✓ Yes ❑ No b. Method of securing cover:,„ c. Any Plumbing leaks or water intrusion: ❑ Yes d. Surface waterrinfiltralion into components:1 C Yes .l 0 4. Venting/Airsupply: Ee'gcceptable Unacceptable a. Air supply unit operating properly, CYes Li No b Venting appears operable. &Yes ❑ No 5. Media surface: '=rAoceptable �.J Unacceptable a. Biomat on surface. Yes 2-No b Uniform spray p y pattern. 'fes ❑ No d. Ponding in/on media - .� Yes " �No e Plugging/clogging of nozzles; J Yes 'f_�rfyo f Media appears to be settling. ❑ Yes LJ No g Appropriate maintenance performed. Lames Li No h. Pest activity at surface. 0 Yes. LJ -No r W t ; ;v"C) vOa -box V t Uu�& 4ACkj. 6. Effluent quality a. Effluent odor after passing through media filter Ya Mild Strong b Effluent color after passing through media filter: ZZ Clear C Brown ❑ Black 24738 Chugiak Drive'Chugiak, AK 99567 Ph: (907) 317-9433 of (907) 688.9433 Email: ARM5ervicesAKC+nutIook.c ARM Services, LLC; 7. Tasks for recirculating/discharge Flows: C�imeptable Unacceptable a. If applicable, Jandy valve functioning: ❑ Yes b, if applicable, Jandy Valve basin dry: ❑ Yes ❑ No C Cleaned collection system in.Aerocell unit u Yes QNo d. Design recirculation ratio: 80 : 20. e. Actual recirculation ratio (Estimated): S. Pump System: 2`Aoceptable E3 Unacceptable a. Control panel in Auto: No b. Timer settings ON: 9 cin OFF: .I Z_ V uK Override ON. _ rZ-t(&,(A_ Override OFF: c. Floats in correct placement:C es ❑ No d High water alarm operational: [des 13 No e. High water alarm count: q`,� f Pump run time: '/ 5-:q— —.3 g. Pump run counts: 14, '390 h. Effluent Filter serviced; ZYes i. Tank lids secured after inspection: 2_�es L Weep hole functional: 2<es 9,. Primary Tank: 13 Acceptable g.�nacceptable a. Sludge and scum level checked: 9 Yes b. Tank needs to be pumped (Wes C. Tank lids/caps secured after inspection: �aSes d. Last Date Tank pumped: 10. Drainfield: C No l No No 0 No G`l`N/A J" N/A Not Necessary EXTRAS: -Type of Monitoring System: Sergi tf .L r -Remote monitoring working?: Yn- -Phone line working? Ve,S N/A u No Sludge/Scum levels: E d !$ f 1 No Type of Drainfield (circle one): Bed wide ) Deep Trench Design Effective depth:. 0,1' inch Checked Liquid Levels in Drainfield: �1 Yes L No MT#1 Liquid Level: 1'5—_ Inches MT#2 Liquid Level: 15 Inches MT#3 Liquid Level: Inches MT#4 Liquid Level Inches Is there any surfacing effluent: ❑ Yes Q16o 11. Is the system in satisfactory condition, and does it pass inspection? _ Yes at LAO Other Comments: # �rs,>.:•�ie(r! 1'Gtt`^1 ff'_+,i�l to,:LJ �i'i`, i.,r� Service Provider: 24738 Chugiak DOve'Chugiak, AK 99567 Ph: (907) 317-9433,office/fax:, (907) 688-9433 Email: ARMServicesAK�outlook.com PAGE z _ t M L. 7r. ;a �� 'f.F14 Ivy 2� tl st 7 d F 'A Owner acknowledges that the Municipality may request records of maintenance and repairs from the manufacturer's representative or maintenance provider. Y Owner acknowledges that the fine for failing to maintain and repair an AWWTS may be assessed in accordance with AMC 14.60.030. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS. The Municipality will give at least 24-hour notice. Owner agrees that any sale or transfer of title of the property will not occur without a new Certificate of On -Site Systems Approval. Owner agrees that the AWWTS installation and maintenance requirements as provided by the AWWTS vendor/installer and approved by the Municipality are the governing guidelines for the constriction, maintenance and repair of the Owner's AWWTS. Owner agrees to maintain remote monitoring of the AWWTS as required by the AWWTS approval. 3. Term. The term of this Agreement shall begin on the date of approval by the Municipality to operate the installed system, or upon transfer of title, and shall continue while the AWWTS is operational or until title is transferred. 4. Nonwaiver. The failure of the Municipality at any time to enforce a provision of this Agreement shall in no way constitute a waiver of the provisions, nor in any way affect the validity of the Agreement or any part hereof, or the right of the Municipality thereafter to enforce every provision hereof. 5. Amendment. This Agreement shall only be amended by authorized representatives of the Owner and Municipality. Any attempt to amend this agreement by either an unauthorized representative or unauthorized means shall be void. 6. Jurisdiction: Choice of Law. Any civil action arising from this Agreement shall be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the rights and obligations of the parties under this Agreement. 7. Severability. Any provisions of this Agreement decreed invalid by a court of competent jurisdiction shall not invalidate the remaining provisions of the Agreement. (rev. 05/18/2018) Page 2 of 3 MUNICIPALITY OF ANCHORAGE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT THIS MAINTENANCE AND REPAIR AGREEMENT, herein the "AGREEMENT" made and entered into as of this c?p - Day of 6�,f i ( of 2020 , by and between G1W mess , herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPALITY", in accordance with Anchorage Municipal Code (AMC) 15.65.365. In consideration of the mutual covenants contained herein, the parties to this Agreement agree as follows: 1. Advanced Wastewater Treatment Systems. The Municipality grants permission to the Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as 6) LLQr„ Cs located at (legal description) �- ,c,'h ��� 1 r L 15 3g �, R 1 Manns C+ - Ahcil" , A14, gl7S1 S 2. Maintenance, Repairs and Alterations. (Owner is required to read, understand and initial each section) Throughout the term of this Agreement, the Owner shall enter into a service agreement with an AWWTS service and maintenance provider approved by the Municipality or the manufacturer's representative. The AWWTS shall be maintained in a satisfactory condition capable of performing as designed and producing treated septic effluent in accordance with the equipment's approval for operation in the Municipality. It shall be the responsibility of the Owner during the term of this Agreement to pay for all repair(s), maintenance, adjustment(s), replacement costs, and inspection costs. This includes an annual maintenance fee (typically $400 to $600). Owner agrees that only maintenance and repair personnel approved by the Municipality or the manufacturer's representative will inspect and make any necessary maintenance, repairs or permitted alterations to the system. Owner acknowledges that regular maintenance of an AWWTS reduces the potential failure of the system, which could include sewage backup and costly repairs or drainfield replacement. (rev. 05/18/2018) Pagel of 3 OWNER: By: �-.r . `' v� (signa(Lire) (1)r111t flame) STATE OF ALASKA ) ss. THIRD JUDICIAL DISTRICT ) Date: q I Z-,, z.() Zt, The foregoing instrument was acknowledged before me this _6_ 20 -7n , bye', a _ N TARY PUBLIC tOR ALASKA My Commission expires: zaz 3 MUNICIPALITY: By: L° -O � `ZJI o' (signature) Re -IL e 'ca- (f ro &_(print name) da -y of _A -p Z Date: Y a 616 Title: 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 1, GENERAL INFORMATION Complete legal description Lot 15; Block B; Sunset Hills Subdivision Location (site address or directions) 2130 Dearmount Anchorage, Alaska Property owner Mailing address HUD ~111-042-305-703 Day phone Lending agency Mailing address Day phone__ Agent Sandy/ASSOCIATED BROKERS Day phon,b ~ 563-3333 Address 640 west 36th Avenue, Anchoraqe, Alaska 99503 Unless otherwise requested, HAA will be held for pickup. ' NUMBER OF BEDROOMS: 2 TYPE OF WATER SUPPLY: individual well .xxx Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4, TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5, STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information ol~tained from the Municipality of Anchorage flies and from my investigation and inspection, the on-site water supply and/or wastewate.r disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date o¢ this inspection. Name of Firm Address 17034 Eagle River Loop Road No. EagJe River, Alaska ~527 Engineer's signature Phone DHHS sIGNATuRE %_ i', ^ppror d for Disappr_0ved. bedrooms. Conditional approval for bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their Fending 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. Municipality of Anchorage .~ Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. WELL DATA We I type _'~,4,~\k/'/'"/F~ If A, B. or C. attach ADEC letter. Log present(Y,~j~ ParcelI.D. ADEC water system number /~/~ Date completed '~' Cased to ~/..eL Casing height /~, I/j_ Wires properly protected2~N) Total depth Sanitary seal,N) FROM WELL LOG Date of test Static water level Well flow / g.p.m. Pump level SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on Public sewer main __ Public sewer service line AT INSPECTION ; On adjacent lots / ; On adjacent lots Public sewer manhole/cleanout __ Petroleum tank WA'¥ER SAMPLE RESUL/TS: Coliform ~ ¢*"'~'/¢~%P.,~'/ Nitrate Date of sample: ~ ~::~/ Collected by: Other bacteria B. SEPTIC/HOLDING TANK DATA Date installed //'~¢¢:~ '~O Tank size / / ~' ~',/~, Cleanouts ~N) High water alarm (Y/N) Date of pumping Compartments Depression (Y~j~ Alarm tested (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK l'O: Well(s) on lot ~¢,C~f 6~)7~',,~ On adjacent lots To property line ~ ~ ~ Absorption field Surface water/drainage \ ~( ~- 1 ~;;'Of~ Foundation Water main/service line 72 026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Manufacturer Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at "Pump off" level at High water alarm level Cycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Length '~-'~ Width Total absorption area Depression over field (YO Results (pass/fail) Peroxide treatment (past 12 months) (Y4:~¢;~;:> Soil rating ~Z.~¢-~/~ System type Gravel thickness ~" .Total depth Cleanouts presentd~N) Date of adequacy test for ~- bedrooms rf yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ( ~1 On adjacent lots ~, ~:~:~ 1 ~ Property line To building foundation (¢~¢" To existing or abandoned system on lot On adjacent lots ,'2~ ~F- Cutbank ~-~L~d~ Water main/service line Surface water /, ~;;(::~t2¢ Driveway, parking/vehicle storage area Curtain drain t~,,~t-,~ ~ , E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effec~ o.(f,thc.~t~¢~o.f this inspection. S & S ENGINEERING o ~ ,..: ;:;,' ,,;~- '¢ Signature 17034 Eagle Ri,v~ ¢ ..... .~ . - Ea~l~: f~iver, AlasEa ¢¢577 Engineer's Name ~ HAA Fee $_ /¢~ ~:¢~ Date of Payment ~¢'/.~¢/¢// Receipt Number _/¢,~ -~ (/'///¢~¢ -/) Waiver Fee: $ Date of Payment Receipt Number 72-026 {Rev. 3/91) Back MOA 2I MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLIN .¢-.* Parcel I.D. # (~";\.~- ~t,:~,'-:~ -¢:~(c, HAA# '~'~'~'*- .... "'~0' 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 15; B~ock "B"; Sunset Hills Subdivision; Location (address or directions) 2130 De Armoun Road (b) Property owner Mailing Address (c) Lending Institution Mailing Address H.U.D. #042305-703 605 W~t 4th Avenue Telephone:(home) Anchoraqe~ Ak. 99501 Telephone Business (d) Real Estate Company and Agent Address_~01AAs~L~ ~¢"~ z.¢bt,...~ ~. 99518 Telephone 344-8492 (e) Mail the HAA to the following address: (or check here [~if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING ] 7034 Ea_ale River Loop Road Nh. _904 Eagle River~ Alaska 9957/ 2. TYPE OF RESIDENCE Single-Family E~x Number of bedrooms 3, WATER SUPPLY Individual Well [2~z. Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site FJ~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDIHG ml,b~EL, i ~O~',tS, TESTS, FILE SEARCH, b~T~ ANL) 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 cf 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 Telephone ~¢¢~ Z ~ ~ Address Date 6. DHHS APPROVAl.. Approved for ~- Approved -~ Disapproved Conditional Terrr~s of Conditiona! Approval The Mun icipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work, 72-025 (Rev. 7/88) Back Page 2 of 2 _x2'~'"'x MUNICIPALITY OF ANCHORAGE (MOA) U~.~OF ^NCH~iiih Authority Approval (HAA) V~r. L4,~J/HEALTH &C-H~CKLIST - FEBRUARY 1984 ENVI~]~C~i'AL PROTEC~OJ'.,I"' 0£C i gg0 RECEIVED 343-4744 Legal Description: ~o~ /~' ~,©~ ~" "~'"~" i A. WELL DATA Wee C assifioation I In. 11 Well Log Present (Y/N) ~ Date Completed ~¢~- I~' '~ ~ Total Depth / ~_.z~' ~ Cased to _~g"/ Depth of Grouting ~ Static Water Level ~' ~ Pump Set At Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line If A, B, C, D.F.C. Approved (Y/N) Yield ~?~. ~_. ~Di~A Sanitary Seal on Casing (Y/N) Depression Around Wellhead (Y/N) ; On Adjoining Lots /0(2 '/' ; On Adjoining Lots lO0 "/' To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot ~ ~ ¢ B. SEPTIC/HOLDING TANK DATA Date Installed ~/ -,~O-~OSize _~OO~w) No. of Compartments Standpipes (Y/N) f~ Air-tight Caps (Y/N) Depression over Tank (Y/N) Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SEPARATION DISTANCES FROM SEPTIC/HOLDING 'rANK: To Water-Supply Well '~ ~ To Property Line To Water Main/Service Line Foundation Cleanout (Y/N) /J o Date Last Pumped ~'~ ~ /l~/ - ~/ ~ tk)/IA ;for /~/~q Temporary Holding Tank Permit (Y/N) ~)/~ To Building Foundation -'~ ~, To Disposal Field .~ O To Stream, Pond, Lake or Major Drainage Course Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,/'.~. ~" ~/l~f;~ Type of System Design "7--~:~/,..) ~ ~'~ Date Installed [ I - ~D -- ~ O Length of Field Z Width of Field ~ Depth of Field / O Gravel Bed Thickness [o. Square Feet of Absortion Area ~_ (o 8 ¢ Statndpipes Present (Y/N) Depression over Field (Y/N) /~ ~ . Date of Last Adequacy Test Results of Last Adequacy Test /~A (//~ ~ ,, j-~ SEPARATION DISTANCE FROM ABSORPTION FIELD: t / To Water-Supply Well / ©o ~ To Property Line ./0 To Building Foundation /n ~ To Existing or Abandoned System on Lot -;~O -/- ; On Adjoining Lots _'_'_'_'_'_'_'_'_'~ O To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To C/utback (if present) D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments "~ Dimensions Manhole/Access (Y/N) ~'~ "Pump Off" Level at %'~%.~/~','/~ Vent (Y/N) Pumping Cycles during Adequacy Test. **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. $ & $ ENGiNE~R",NG Sig ed Company Eagle River, Alaska 99577 Date /~ ~'~ MOA No. Receipt No. Date of Payment Amount: 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET · ANCHORAGE, ALASKA 99518 · TELEPHONE (907) 562-2343 FEDERAL TAX I,D. #92-0040440 ANALYSIS SEPORT BY SAI~PLN fez Woxk Ozdez # 30507 Date Heport P~lnted: DEC d 90 @ 10:45 Client Sample ID:LIS S "B" SUNSET HILLS S/D ?WSID Collected HOV 30 90 @ 15:30 hrs. Heceived NOV 30 90 ~ 17:00 hrs. PxeseKved with :AS HNQUIHED Client Name : S ~ S NHGIHERHIHG Client Aoot : SHSENGP P,O.# NONE RECEIVED Heq $ O~dozed By : g. SHAFES Analyule Completed :DEC 3 90 Send ~epozts to: Laboratory Supezffi;o! ,'8~B?HEH C. RDE I)S & S EHGINRESIHG ~eleaeed By : ~j_~ 2) Special Instruct: Chemlab Eel #: 905053 Lab 5mpl ID: 1 Matzix: WATER Allowable ?aKametar Teated ~esult Units Method Limits HITSATE-N 1,1 l~/1 EPA 353.2 LO Semple ROUYINE SAHPLE. Sema~ks: SAMPLE COLLECTED BY R.D.J. Tests Pe~fozmed ' Sea Special Instzuctions Above UA-Unavailable Hone Detected "See Sample Remazke Above Not Analyzed LT-Le~ Than, GT-Gzeater Tlmn TELEPHONE (907) 562~2343 5633 B Street ',i ~.~,~..~-~;' Anchorage, Alaska 99518 Report for Total Goliform Bacteria Drinking Water Analysis TO BE COMPLETED By WATER SUPPLIER ~/PRIVATE WATER SYSTEM ~ Mailing Address Phone No. $ & S ENGINEERING ] ~'u;f4 Eagle River Loop ~On~ Eagle River, Alaska City State SAM.LE DATE: 75¢-1 Mo. DayYear Zip Code SAMPLE TYPE: ~' Routine [] Check Sample (for routine sample with lab ref, no, [] Special Purpose _) [] Treated Water [] Untreated Water SAMPLE Time Cogected NO. LOCATION . Collected By 31 I "1 I Date Received Time Received Analytical Method: TO Bi-' COMPLETED BY LABORATORY sYatiS shows this Water SAMPLE to be: isfactory [] Unsatisfactory [] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mai]. Membrane Filter No. of colonies/100 mi. Lab Ref, No. Result* L Analyst A.D.E.C. BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Membrane Filter:. Direct Count TNTC = Too Numberous To Count OB -- Other Bacteria Coliform/100 mi Verification: LTB. BGB Final Membrane Filter Results Repot[ed By ~- Time: Collformll00 mi a.m. PART ONE (])F TWO REMAINDER TO FOLLOW MUNICIPALITY OF ANCHORAGE ' DIVISION OF ENVIRONMENTAL HEALfH DP~ARTME5[£ OF I~AL%]{ AND ENVIRONMENTAL PRUI:EC~ION : APPLICATION FOR HF~%LTH At~£HORITY APPROVAL CERTIFICATE !'.~% I.. ~.~}~le~__~jfn__f_o~tion Appl.xcatlon Date ._ !-~i- (a) U,~al Desc~igtoion (include lot, block, subdlvlslo~n,~s~..c~tion, t~.~ LOcation (add,ess o~ directions) ' (c) hppliqant is (che~ om) ~nding Institution [~; ~ql~r~uil~r ~; Telephone.,__ e T_yf~e___o_~f Residence Single-Family ~ Multi-Family N~r of ~dr~ '~3 Other (describe) Wate)z Individual Well [__~----~ Co~nunit:y ~ Public Note: If co{~nity ~].1 system, must hav~ written cxDnfi~mation fr~an the State Depa_~tm~nt of Environmental Conservation attesting to the legai[ty and status. Is the ~11 adequate fo~ the nur~er of bedroom~ specified in this HAA--(_Y-/~-..)-._Z_ Sewage Dis osal the wastewater dis~sa], system adequate f~ the ~iu~r of ~dr~ns _~_._~ ....... [Page 1 of 2] i~ ~' i 5. Enatnee~in~ Firm P£ovidi.n_q Ins_~_ctions, Tests, Data and In I ~tify ~at I have ~cked, ~ifted, ~ ~nf~d to all ~A e~:feet on tm~te/~.fbm~ ~.gs~ tion. Date (ENGINEER SEAL) C it :o al : .... Date The Municipality of Anchorage Dopa~tm~nt of H~a3.th and Environm~,ntal Protection dc~s not guarantee the continued satisfactory psrformance of t~m water supply and/or the wastewate~ disposal system. ~3.l~is approval indicates that, as of the validation date shown above, based on the data and infc~nnation ft~nished ky an epxjirmer registered in the State of Alaska, the water supply and wastewater disposal, system is safe and funo- tional fo~ the numbe]: of be, drccmm and type of structure indicated. ( E~{EP SEAL) 7. Mail the HAA to the follc3~ing address: KB2/dS/s [Page 2 of 2] 2-15-84 ~UNIClPALI17 OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION H~.ALTH ~JTHORITY APPROVAL (HAA) gui 2 0 1g~4 CHECKLIST - FEBRUARY 1984 .... :REC IVFD Legal De.scrzptmon. Well Classification dll/~:. If A, B, c~ C, D.E.C. Approved(Y/N) , Well Log P~esent (Y/N)/~d Date Completed .///f/~'~/~/~/ _ Yield Total Depth_ /~ ~ Cased to ~/~//://d/.13~/ _ Depth of G~outing..//~/~,/d~¢~/~/ Static Wate~ Level/~/n~/~?f~/~/ . . Pump Set At_/V~/~,4/~'/?//~ Casing Height Above G~ound /~ ~ Sanitary Seal on Casing (Y/N) Electrical Wi~ing in Conduit (Y/N) ~ Depression A~ound Wellhead (Y/N)//~_~; Separation Distances f~cm Well: To Septic/Holding Tank on Lot ~ ~ / ~,~ ; On Adjoining Lots /~ To Nearest Edge of Absorption Field on Lot ~ /~; On Adjoining Lots /(%.(~ To Nearest Public Sew~ Line ~-~ ?~ To Nearest Public Sewer Cleancut/~hole ~)~' ~ ' ''' .l- - ~.': TO Nearest Sew~ Service Line on Lot . WateF Sample Collected By /, ~/~Y/>?/~/~/// ; Date ~ ~/~ ~ ~ ~/ Wate~ Sample Test Results B. SEPTIC/HOLDING TANK DATA Date Installed/-/...~')-.~?() Size /.~:~3~...? ~?//- No. of C~,~a~tments . ( Standpipes .(Y/N) ~/:~ _Ai~.-tight Caps '(Y/N) i/~ . Foundation Cleanout (.Y/N)~VdQ Dep~ession.ove~ Tank (Y/N) ~/~)__ Date Last Pu~oed ~-/~ ~/ Pumping/Malntenance Contract on File (Y/N)~//// ; fo~ /~//~ Holding Tank Hlgh-Wate~ Alarm (Y/N)/(/:/ Temporary Ho(d~ng Tank Permit (Y_~__~/~,/_ Separation DiStances f~om Septic/Hol'~ing Tank: To Water-SupPly Well To P~ope~ty Line _~ / To Wate~ Main/Service Line co. se TO Building Foundation ~' To Disposal Field //~ / To' S~eam, Pond, Lake, c~ Major D~ainage Comments [P~ge 1 of 2] 2-15-84 Ce ABSORPTION FIELD DATA Soils Rating in Absorption Strata ////~ /;///,?~?~/~ Type Date Installed //~ Width of Field Square Feet of Absorption A~ea Depression over Field (Y/N) z~/69 Results of Last Adequacy Test of System Design ~'~ Length of Field /~ Depth of Field ~ ' Gravel Bed Thickness standpipes P~esent IY/N) Date of Last Adequacy Test ~/-/?-~/ Separation Distance f~cm Absorption Field: To Water-Supply Well /~ / To P~operty Line ~ To Building Foundation '~ ' To Existing Or Abandoned System cn not~/~///~ ~9 ; On Adjoining Lots .~/ ~- To Water Main/Service Line ~ ~ To Cutbank(if present) To Stream/Pond/Lake/Or Major D~ainage Course /~//~] To D~iveway, Parking Area, or Vehicle Storage Area /~ w~ Coa,~ents Date Installed Size in Gallons "Pump On" Level at High Water AlarmLevel at Tested fo~ Electrical Codes(Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Co~ents ** Check Permitted Bedrocm Rating Against HAA ~sque. st I certify that I have checked, verified, or confo~a~d to all MOA HAA Guidelines in effect Signed, KB1/dL/s Date 7/~ /c64- MOA No. ~3 [Page 2 of 2] ~"-. CE - 4369 2-15-84 RILL SHEFFIELD, GOVERNOR D~PT. Ot~ ENIVI[RONMENTAL CONSERVATllON SOUTHCENTRAL REGIONAL OFFICE 437 "E" STREET, SUITE 200 ANCHORAGE, ALASKA 99501 274-2533 August 7, 1984 Neil Hawthorn Hawthorn Engineering 7127 Old Seward Highway Anchorage, AK 99502 SUBJECT: Lot 15, Block B, Sunset Hills S/D Dear Mr. Hawthorn: ~L~i.~ OF ANCHORAGE ~i~¥~©I~I~[NIAL PROTECTION AUG ? 1984 RECEIVED The department has reviewed the waiver request for the subject property and finds that no waiver is necessary for a single family home on the property because it meets the requirements of Title 7, Alaska Admin- istrative Code, Subchapter 2, Paragraph 312 which was in effect at the time the system was constructed. Since the system has worked and continues to work with out major repair or modification it can be approved under the Administrative Code in effect when it was construc- ted. Sincerely, District Engineer BEE/dd HEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report fei' Total Coliform Bacteria ;/, . ."~. TO BE COMPI. ETED BY WATER SUPPLIER ~ / ~TER SYSTEM: (' See h on beck Water System Name I.D. NO. ~ ~1~. ~/ .~ / / Phone No. City State Zip Co(k) Mo. Day Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no.__ [] Special Purpose 0 Treated Water [] Untreated Water SAMPLE NO. LOCATION Time Collected Collected By J /~70 BE COMPLETED BY LABORATORY /Asnalysis shows this Water SAMPLE to be: atisfactory [] Unsatisfactory [~] Sample too long in transit; sample should not be over 30 hours old at examination to indicate reliable results. Please send new sample via special delivery mail. Date Received Time Received / Analytical Method: [] Fermentation Tube /4~ Membrane Filter Lab Fief. No. Result* Analyst l-l'q l-lq Iq-I 06.1220 (b) Rev. 1983 BACTERIOLOGICAL WATER ANALYSIS RECORD READ INSTRUC'I'IONS BEFORE COLLECTING SAMPLE Membraee Filter: Direct Count Verification: LTB BGB, Final Membrane Filter Results Time: _ TNTC = Too Numerous To Count Collformll00ml __ Collformll00ml c© ~QU~$T FO~A??~O~^L INDIVIDUAL SEWAGE AND WATER FACILITIES ' out in Tri licate) ~. Mame of pesson reques~n~ ap~?oval~ Numb~ ~,~ ~edrooms in house Wat~. AnalyslS: a. BactgY.~ ~ ] b. Detergent a. '~ 7pe . Distance from well to closest existing or proposed: 1. Sewer line 2. Septic tank . 3. Seepage Area Cesspool' 5. Property Line 0-0 ' 6. Other sources of possible contamination, i.e., creeks, lakes, houses, barn, drainage ditch, etc. ~ ............ · Sewage disposal system. a. Age of system~~~ b, Septic tank capaelty~ln gallons ~ c. Name of septic tank manufacturer 1. If "home made" shgw ~ia[ram on~reverse~side of thls~=orm. Disposal fzel~"o~ ~e'~d'~ ~I% size a~d type ............................ 1, Distance to property .lln~ ~ to house foundation ~.. Percolation Tes~ f. Percolation Test performed by "~. []se the reverse .side of this form to show diaEram, Dia[~ram should include ' %he foJlowJn[, lnfo~natxon p~operty lines;.well location, house location, ;~,-~l,~c tank ].ocation, disposal area location, location of percolation test a~,d d~.ection of ground slope. 9. The ~ r,,-~n~,~m on this form is true and correct to the best of my knowledge. SiEn~~llcant Date Si?ned TO BE FILLED OUT BY HEALTH DEPART ;ENI PE~SONNE___~L '£he ebove described sanitary facilities are hereby apl>roved, subject to the Conditions: The above described sanitary facilities are disapproved for the following ...... .... _ App.'oval is valid for one yee~ following the date of approval. CPJ:cw ~arch 11, DT0 Alaska 995(12 your Jlouse im l)~At~mun l!oa,:l ~qarch 4, 1970 and 1, l'he cessl)ool t.s too close to tho I,,'oll, h~ on!or for yml to receive C~IRa hous~n?, ai~pvm, al for tho lll)art~:t~t il~ tho bm~en~ent of your ],a~se, the s~e~' and ~tater oa a soil ~'~if~b l;e~'i,issto, .[or rental £ro~ this oil':kc t~, here!'~y ~;lven t~lease call if you have any q,estion~,~ ¢50, I1Ct~Clli]llI tho MOil test or l.,tttallatt, o~ of 1;hu se~;or syst~e.a The later .qanq~le that was suk,~tttod ~!ret'~ yoor v:etl turned out .lt,q.:rn ce: REQUEST FOR APPROVAL OF INDIVIDUAL SEvAGE AND WATER FACILITIES (Fill out in Triplicate) Water AnalF~is: a, Bact~r.{ al b, Der emgent " ~ ? :) e. Casin~ ~' ~ ~1 / d, Distance from well to closest existing om proposed 1, Sewer lin~ 2 eptlc . S ' 3, Seepage Area ~ q. Cesspool' ~ ....... 5. 6. Property L lne_L%~L~_' Other sources of possible contamlnetion~ i.e.~ creeks, lakes, ouses, b d i d' h apn ~ ranage itch Sew~!:e d~sposa], system, b, eptzc tank capacity in galjons//(2z''~ , S ' e. Name of septic tank manufaotu~e~ 1. If "home made" show dlasram on reverse side of this form. d.' Disposal field oP se ...... 1, blst ' . .~hce ~o property l~n~ Y' +~ ~ .......... ~:,/ ' f, Percolation Test performed by ..... -------~--- --~~ ....... Use ~he reverse ,side of this form to show dia£ram. Diagram should mnelude house location l;he fo]lo' Jn_~ ]nform~t$or. p~ope~ty l~.nes~.well location, -~.~l.~-~c tank tocatlon, disposal area locat~on~ location of percolation test~ a~,d d]~.ectio~ of ground ~lope, Tke ~nf,,,,~o~ ~m o~ ~his f:orm is true and correct to the best of my knowledSe. Date SiFne TO BE FILLED OU'F BY_~HEALT}{ DErART~!ENT PERSONNEL The above described sanitary facilities are hereby approved~ subject to the r ltow~ng The above described sanlt~'ry facilities are dlsspproved for the following S~g i~, · . .... D ,~/, App,.oval is/valid fo~ one year followln8 the date of approval. CPJ: cw