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STUCKAGAIN HEIGHTS BLK 2 LT 4C
tuckagain 'D Heights Block 2 Lot 4C #041-021-06 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151220 Tax Code Number: 04102106000 Work Type: Septic Upgrade Permit Effective Dates: July 23, 2015 to July 22, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: STUCKAGAIN HEIGHTS Site Legal Address: STUCKAGAIN HEIGHTS BLK 2 LT 4C G:2043 Owner/Address: PANNONE ENGINEERING SERVICE PO BOX 100217 ANCHORAGE AK 99510 Site Mailing Address: 9930 NEARPOINT DR, Anchorage Lot Size in Sq Ft: 87144 Total Bedrooms: 5 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received 0?41ulS Issued By:� 1�i2i�/ Date: • Z ✓`� MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fa On-Site Water & Wastewater Program SILRMAi ON-SITE SEWER/WELL PERMIT APPLICATION JUL 131 2015 L C) (P Gretchen Stuller Parcel I.D. 041-021 X Property owner(s) Gregory & Leslie Schweiger Day phone Mailing address 9930 Near Point Drive, Anchorage, AK 99507 Site address 9930 Near Point Drive Legal description (Sub'd., Block & Lot) Stuckagain Heights, Block 2, Lot 4C Legal description (Township, Range & Section) Lot Size 87,144 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q ADU) Septic Tank IMUpgrade FX(w/wo Duplex (D) ElHolding Tank E]Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. of property owner or authorized Permit/Rush Fees: `4 a16j ei Waiver Fees: Date of Payment: –+115115 — Date of Payment: Receipt Number: C54Receipt Number: Permit No. SSP (5120 Waiver No. Permit App__- :::.._c: Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveR@oaneneak.com July 9, 2015 Subject: Stuckagain Heights, Block 2, Lot 4C Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1500g Septic Tank to be issued for this property. The existing 1500g plastic tank will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1500g septic tank that will be connected to the existing drain field. This lot and the surrounding lots are served by private wells, with the lot to the north being served by a community well. The well on this lot is over 100' from this system. There are no wells within 200 feet of this system on the surrounding lots. 1. Upgrade Tank Design. a. See Sheet 1 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank. The proposed septic tank upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes from the east to the west at approximately 10% in the area of the septic system. The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 %AREA SEPTIC AREA \ �O• \ 1OX30 ANCHOR ESMT E DRAIN FIELD (E) ZJlq 1500g SEPTIC TANK (E) DECOMMISSION PER CODE 4C <S �P 1500g SEPTIC TANK (P) WITH DOUBLE CLEAN OUT 58P HOUSE (E) 2 � VdELL (E) �^l OR��F WELL ANDSEPTICW OVER 200' FROM \ PROPOSED SEPTIC \ NOTES: PANNONE ENG SVC, LLC TANK REPLACE P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 STUCKAGAIN HEIGHTS, BLOCK 2, LOT 4C GREGORY & LESLIE SCHWEIGER 9930 NEARPOINT DRIVE PLAN ANCHORAGE, AK 99507 WELL AND SEPTIC OVER 200' FROM PROPOSED SEPTIC Steven R. Pannone CE 8149 cs� 7/9/2015 Scale 1"=50' '.ILD - NO Nl-021-06 'ERMIT NO. 15PXXXXXX Sheet 1 OF 1 MUNICIPALITY OF ANCHORAGE Heap T and Environmental Protea `on �� Fourth Floor West w 825 L Street Anchorage, Alaska 99501 279--2511, x 224, 225 _ INSPECTION REPORT Ca_N-SITF, SEWAGE DISPOSAL SYSTEM _ r• NAME-�=5 ('-v-"��-._ MAILING ADDRESS. _. �_�� _�._ I�'11 PHONE 2a LOCATION SCOL-Acc_��{�ln _LEGAL DESCRIPTION ���,"' SEPTIC TANK: DISTANCE Ir� r NUMBER OF l FROM WELL ,— MANUFACTURER_ � : TI.0.S�4k/\TERIAL.!-L_ --'"._-_COMPARTMENTS_ INSIDE LENGTH--^ WIDTH ~_._ LIQUID DEPTH TILE DRAIN FIELD: Llleep����\ + i DISTANCE FROM WELL (00 t _-FOUNDATION=`tCD &----NEAREST LOT LINE LIQUID CAPACITY ts'oo GALLONS. I TOTAL LENGTH !� a J_} -_OF LINE q } Of Lines __. _-_ DISTANCE BETWEEN LINES _N_ P'' TRENCH WIDTVL `p IN. TOTAL EFFECTIVE _ `-t ` I ABSORPTION AREA __ �J _O Cl_____ SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER DEPTH: TOP OF TILE TO FINISH GRADE __4 - _. MATERIAL BENEATH TILE_ _� a IN. ABOVE TILE ;2 IN. SEEPAGE PIT: DIAMETER ---- OR WIDTH-- LENGTH--, DEPTH----. Log Crib _Rings_ Crib Size: DIAMETER _-_-DEPTH_—DISTANCE FROM: WELL— TOTAL ELL -TOTAL EFFECTIVE BUILDING FOUNDATION_. , NEAREST LOT LINE---- . ABSORPTION AREA (WALL. AREA) SQ. FT. Well i Class }�_ Depth: _:3 Well Distance To: Lot Line (pI Bldg:�bt Sewer Line: p `- Pipe Materials: # of Bedrooms: Installer: �Pnc�a Remarks: S, , ( G n of DnTE APPROVED --- ---_l _tI jI.'II� - +- I- � I , I DnTE APPROVED --- II;6C)a L1 a; orYl 1"'11-11' 4 I iD 1=-91"-A 1-.1- 7114_ m=a 1_i W'l%S�/-�7 DEPARTMENT �r HEALTH AND E % I fr:ONMEdTAL" fRf_ll -T I ON / / Mn 1 -825 'L.' STREET, ANCHORAGE.: AK. 99501. 79-2511. - LA Ew 1__ L FA 14 E> 1_ hi —"S 1 -F FE K x:1:.16+.14': 1=-° 1 __ Fv' 1 1 I I PERMIT NO. f 77.116 APPLICANT ERNE'ST G SLOAN 6027 EAST 10TH AVE 5657 LOCATION STUCKAGAIN LEGAL L4C B2 STLICKAGAIN LOT SIZE 87120 SQUARE FEET TYPE OF :OIL ABSORETION SYSTEM I =• : TRENCH MAXIMUM NUMBER OF BEDROOMS = 5 _OIL RATING (SO FT.'BR?= 90 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 1_:°1=1 -F VA = E3 1._ 1=1 A Ca i 1-1= _$ e_.. C3Ivy FA %/ 10 1._.. 1_-° F" 1 1 1 -- THE LENGTH DIMENSION IS. THE LENGTH ':IN .FEET~ OF THE TRENCH OR DRAINFIE.LD. THE DEPTH OF A TRENCH OR PIT IS, THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). THERE I_ NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH I`_+ THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFALL_ PIPE. AND THE BOTTOM OF THE EXCAVATION (IN FEET). Fv_ECAL Y I FQEE> nEmn-rmcco Te=18mE-=' :C 'F . _ :A._..=:a®=bu -7_' w ID < I E a Ss F' 1 Y 11D P -A e FA F R E FR E=1:_-01._ a I FQ F_ o BACK F I LL i NG OF ANY SYSTEM WITHOUT FINAL. INSPECTION AF' D APPROVAL BY THIS DEPARTMENT WILL E0._ SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISFOSAL. SYSTEM Is 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC: WELL. WELL LOG=: ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F w E FT 1 I I -OF 2-r° 1-11_ I E° F= u3 FT C3 6A E be E FA F Q IF= F4_ C 11""A :1. 5N 5v 1._1 F _ I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SEf FORTH BY THE MUNICIPAL.IT'•r OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE _EWER SYSTEM MAY REQUIRE: ENLARGEMENT IF THF..: RESIDENCE IS REMODELED TO INCLUDE MORE THAN 5 BEDROOM'S. SIGNED:40491 r y -------------------- APPLICANT ERNEST G 5L_OAN ISSUED By LOU Ui- /eS1 uulnrvv Begun� J Hole No. —�` ' 13^ YOjviii V. Lounsbury e Associo;>� Comp Z2/e�ld �- Sheet — Va Engineers — Surveyors To/al Depth rclNO 13 -2G -L. Anchr>roge, .Alaska w Name STu��AC-Aihi 1?E16NTS- �-cT4 G'BIy-Z tion odused URo'7T Qy Slc�tioc TPENC' I`�C Party f2% ('e Geologisl O VC''(c.AST CLO F TN i o/ Z Ground Water Table Depth in ft u t %rte-•�D_ Time Dole Ser npting DESCRIPTION Loco/ion Notes E Diagram: Soi/ type, color, texture, estimated particle size, a v m a sompler driving notes,IOCATi�N IMAP' depths circulation lost, p@ notes on drilling ease, - b bits used, etc. - - �i� o E Vegetation: g "TA L-%,. S ('2U.C�-- c `t31 I•c-In O - t 2I �' oG et.5 O": i 5 — G_ -C, h e:$!- - - M�P e �ear� �PP�eI �cynses �r!I�. �rav .e ms . 9� _ /O - `s1rC�PS 14 /5 1-1 -1711 5rffIP(-e 18 i ' I /„i„- ... ,.,, , r -r,., c.,,,.[.. .��P •aden n?%b9 :.� �/,;ndard P.ce;rc;on .i�r:p/Fr ✓ir�en :•i% C/b; humrcAr .. 3J,�.r1,0~ BERME CC AU Q RAM ART DRILLIN9,, ORKS,i' rr y*ta f` DATE may 11, 1991 SERVICE CHARGE 0F IVi% PER MONTH WILL BE ASSESSED- ON PA ST _DUEACCOUNTS. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910087 DESIGN ENGINEER:DUMMY COMPANY OWNER NAME:SLOAN ERNEST & KATHERINE OWNER ADDRESS:9930 NEAR POINT ANCHORAGE, ALASKA 99507 PARCEL ID:04102106 LEGAL DESCRIPTION: STUCKAGAIN HEIGHTS BLK 4C LOT SIZE: 87120 (SQ. FT.) NUMBER OF BEDROOMS: 5 THIS PERMIT: 5 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 2 LT PAGE 1 OF 1 DATE ISSUED: 5/08/91 EXPIRATION DATE: 5/08/92 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: DATE: s-Ar�i/ DATE: - ANCHORAom, AILASIKA 344-7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF 128 A. DRILLED AT THE RATE OF $20.00 PER FOOT. ChaAge At 100 A ant6 PROPERTY OWNER ft. & M4. Pete & xath.y. S.toan & fa, D2. 337-9705 REPT. HEALTH & LOCATION OF WELL SITE 4C B 4 Stuck 2 Sub z ggq"AplOF AngnQ-g-c�Adivision DRILLER Be4n e Ug" a4 Ramatuut Niy kA SEs' WELL LOG: c� RuxUAa,ty. ( Back-up WeU D�r.Ued to �uppLestent & canes itute a �Le�re�iue oeconda.�G7eU» 0----161 S.uty, gcuwet 30°1 cCa.% bindet 16---37' Come WveL. R dad.nwte�iicet Ue�ey. i tt l&l 4.i,Lt in eonmatian. 10/0 �d.�tid. 37--128' Bed,eock. R .Dealt-aeta=Ap i nock. Uel i4 GLe. wet maty aat at thz am ip i ert t o� bedaock. Haureve�e at -pwt 42--46 .fit mate✓? .in, a rywrurGi to mate, L .ind.Le u 3/4 gra product i.on. 45 BPH. Thin ate -a4 4 cywiui Ue matetLmL Pwn 78 .to 83 �t y i e ld fact ,,Gaut 1/2 gpfil. P2oduct+.on Aon 84 to 87 4 in a good p,0&04 i tlp Of- C&"ttad Line hock. Th,i4 a&ea 4hOU14 1 1/2 9Plll Nate t QLe&. Uehy.. ttUe new mate t y ie.,d an down .to 128 A. Thd4 IJeU -!4 pnaducenry 150 .to 160 gaGtono pet howL & ohouLd at4a axAea4e, aamemhat math uae. 1.6 goAt 4 pet A 4A heoehue. About 150 gaLLom 4taad-bIP heuewe. Water ,Levet 44 )rack up, on .PULL 2e.coveAuy .to mina ia, about 40 ft 4 4u&e ace. Cart o� J)& U ince: $20.00 peh A. X 100 A. orU4: $2000.00 Tura Thouoand Doi aA4. Ro addit{an.at ca4t. Tht4 WeU mao paid fah an TUL.L by. Pete tFF . We,U d&tV ed & paid fah .the tht&d creek a�,n.e g,, 19 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAILT G. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM----------------- THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE R'uyt,4;t 6.th, 1984 SERVICE CHARGE OF IY2% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. r., I PERMIT TI02 DATE ISSUED: APPLICIANTo ADDRESS: (CONTACT PHONE: LEGAL_ DESCR I P e ILOT SIZE; DEPARTMENT OF HEALTH AND ENVIRONMENTAL. PROTECTION 025 L STREET, ANCHORAGE, AK 99501 264-472o -4722 PA -..__ YE: x 1- IF: W I:_: L._ p.--- F" IE= rte: F:-0 IC '-T 09/20/84 ERNEST SL-OAN 9930 NEAR PT DR. ANCHORAGE, Elle: 99507 261-2372 SUBDIVISION: STUCKAGAIN HEIGHTS LOTv /4C; SECTION: 6 I TOIaNSHIPs 12N RANGE^ 2W 2A (SQ.FT. OR ACRES) BLOCK: 1 certify that: 1.. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOW and the State of Alaska. . I -will. install the system in accordance with all MOA codas and regulations,, and in compliance with the design criteria of this permit. . I will adhere to all MOA and State of Alaska requirements for the seet ba.cla: distances from any existing well., wastewater disposal system or public sewerage system on this or any adjacent or nearby lot.... SIGNED DATEe _ -- ---- -- - 9./ �.l ... APPLICANT; ERNES'T SL_OAN ISSUED BY DATE. Ea _ ---------_ _ _ . _ _--�_----- --. _------_- ___ _- ------ -- g©---. 0 11b, J U�) 40.0 0 e -m Q e.: 0v.e� Om � C�-• 4: a . a.: va•• p rrri 4. o CVI0 mAil t'i CA 1 r � �_ � • _ �_ :. o ; � � a; ..�• a -per � �I 70 a: n$ m• 3 s e i ca m ® x •'a n z CA CD ® N N m M O M y � r A mCO m nm i U 0 N L C o Q L �G e -m Q e.: 0v.e� Om � C�-• 4: a . a.: va•• p rrri 4. o CVI0 mAil t'i CA 1 r � �_ � • _ �_ :. o ; � � a; ..�• a -per � �I 70 a: n$ m• 3 s e i ca m ® x •'a n z CA CD ® N N m M O M y � r A mCO m nm i U 0 N s A 741- c 41 -z O U, \s� J oq/ d 0 ti i��•4*k :� ?��%•• .. tv ,. � .� it nn._ . _ � o s s. -� .• .C.C. - - b� o� L ,��f \ 4 � M ti •�� >a4 13 IOX S no 4 QN ,o so in . \�Q V 'p < -n�i o \\ z G7 i nlop-TN n1 r o sm voocR� *o-IM04 N� O m 11�I � • r w b O� v Q \ D p / n o s s � 'p '� •p• PI ♦ rr z 11 1'0 4MAV i �•� aa�+p—co ~Q�• • •'�P\('` vi 'T) x:0 N_ i/1 N r 1� v o i w< b' ' Y 0��..' •lam ••� ( 111 03* Pf C Q m 7t r ..o C r o '� • .`•. r w %� 3 : �S ' Q T 'n D .•� fOi� I� o► o q = i e (¢g_.: t�nl o • G C 1 ro m m �lN w <rs����e �R: vim• • ���\ >Dr RI o ch N" n : 4'13 . ••/\✓ r 1 w r- m Ls w a p v AF p w w�e L�Pe� 0c NxM 2 .�m Q co 14 m O 7I� y G < � c a w D o ssa' ' i v 4~ N m = Yl ohT�E 6 � ® Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 Certificate of On -Site Systems Approval Parcel I.D. 041-021-06 1. GENERAL INFORMATION: Expiration Datej —2- G _Zy ZZ Complete legal description STUCKAGAIN HEIGHTS; BLOCK 2, LOT 4C Location (site address) 9930 Nearpoint Drive *Anchorage Current Property owner(s) Leslie Schweiger Day phone 952-7020 Mailing address Real Estate Agent 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual IK 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. COSA Fee $SCJ Waiver Fee $ _ Date of Payment % A A I Date of Payment Receipt Number (:)16 Q 1 G Receipt Number COSA # 03C,2_11650 Waiver # 41 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, 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: 0 /145 r In conducting this evaluation, GEG provided an engineering evaluation of the well and/or 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 date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend upon a variety of variables, including but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. 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 the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail to perform adequately in the future. The content of this report is for the sole benefit of the person/party that retained GEG to perform the evaluation. Reliance upon the information provided in this report by any other person or party (including subsequent property purchasers) is not authorized, nor will it confer any legal right whatsoever. 6. D D SIGNATURE System #1 Approved for __�L bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms bedrooms, with the #AECC884 NLITY 6F6/iii 0A1 do v <in I u �� VA r-_ m^ 44 o .mac \\,\1 Original Certificate Date: l ©Z (q, - Z/ 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 - AI t COSH Checklist Legal Description: STUCKAGAIN HEIGHTS; BLOCK 2, LOT 4C If more than 1 septic system on lot: COSA Checklist # of A. WELL DATA W Well log is filed with Onsite (or attached) Date drilled 5/11191 Total depth 195 ft Cased to 42 ft Sanitary seas is functioning correctly 101 Wires are properly protected Casing height (above ground) t $ t in. Date of flow test for COSA 9/23/21 Static water level at beginning of test 40.7 ft. Comments B. TANK DATA Age of tank(s) 5 years Tank type/material SEKICISTEE Measured operating fluid level in septic tank 49" Standpipes/foundation, cleanout per record drawing Date of pumping 4/28/21 1 D. ABSORPTION FIELD DATA DEEP TRENCH Which systern tested (date installed) 1977 F01 ALL standpipes present per record drawing Total measured depth from grade 8.83 ft (max) Measured depth to pipe invert from grade *2.83 ft (min) ❑ N/A — pressurized field n Monitor tubes go to bottom of effective. If not, state depth into effective ❑ Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced N/A gallons Comments/Deficiencies: 'SEE EMAIL FROM OWNER REGARDING FREEZING COSA Checklist yellow sheet Parcel ID: 041-021-06 Structure served by this system Well production at time of test 1.4+ gpm Water storage tank volume N/A gallons Well disinfected for coliform test? ❑ Yes 0 No R Coliform bacteria is Negative Nitrate 4.14 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ❑® Arsenic less than MRL (ND) Collected by GEG, LTD Date of Sample 9/23/21 C. LIFT STATION ❑ Required maintenance mpleted Age of lift station years Lift station erial Com ts: N/A Adequacy test date 9/23/21 Results ❑J Pass For 4 bedrooms Fluid depth prior to test 0 in Water added 607 gal New depth 0 in Elapsed time 0 min Final fluid depth 0 in Absorption rate 600+ gpd Any rejuvenation treatment (past 12 months) NONE If yes, enter date N/A Qv 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' 0 Yes Community Sewer Manhole/Cleanout > 100' 0 Yes if No ft 0 Yes if No it Neighboring Tank > 100' M✓ Yes if No ft Private Sewer/Septic Line > 25' 0 Yes if No fit Absorption Field on Lot > 100' 0 Yes if No ft Holding Tank > 100' Yes if No ft Neighboring Absorption Fields > 100' ✓/ Yes if No ft Water Main > 10'✓Q Animal Containment > 50' 0 Yes if No ft 0 Yes if No ft 0 Yes if No ft Water Service Line > 10' 0 Yes if No Manure/Animal Excreta Storage > 100' If septic tank is under driveway comment below Community Sewer Main > 75' 0 Yes if No ft Yes if No ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100'1 Yes if No ft Property Line > 5' Yes Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' if No Yes if No ft Private Wells > 100' ✓/ Yes if No ft Water Main > 10'✓Q ft Yes if No ft Community Wells > 200' 0 Yes if No ft Water Service Line > 10' 0 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 . ft Wells on Adjacent Lots: Water Main > 10'✓� Yes if No ft Private Wells - 100' Yes if No ft Water Service Line > 10' Yes if No ft Community Wells > 200' 0 Yes if No ft Surface Water > '100' 0 Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION l 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. COSA Checklist yellow sheet 01 0 F �.� _ ... ................ Je 'r `{j Carnes, 9, -E-795-3___1 Z s �cfi Pr ofess-vol_"\—:E #AECC8BA Erik Widger From: Leslieanne Schweiger <ladingers@gmail.com> Sent: Monday, October 11, 2021 4:08 PM To: Erik Widger Subject: Schweiger COSA information To whom it may concern, The 2nd well that was non functional and was decommissioned during dirt excavation to bring lot up to grade in 2015. We have not had any freezing issues with the septic system. Thank you, Greg and LeslieAnn Schweiger 4-roc:,V-0,&A�d 14-9T � I t L 4 4 Legal Address: Subdivision Stuckagain Heights Block 2 Lot 4C T R Section Lot On-site Water & Wastewater Section certified contractor performing the well decommissioning: Name: Gary Witt Company: GLW Enterprises, LLC Signature: E W , 1 M Well decommissioning date Summer 2015 Method of decommissioning: AMC 15.55.060L1 a. ❑ b. ❑ c. ❑ Location: Use the space below to provide a drawing of the property showing the following items: • North arrow • Decommissioned well location • Location of other water wells on the property • Two separate swing -tie distances for each well shown on the drawing Note: The swing -tie distances shall be measured from either permanent structures or the property corners. The well was decommissioned using betonite to fill the tank and then capped by welding a lid on. G:\Development Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Well Decommisioninq form.doc NEAR POINT KNOLL, BLOCK � earporn nve 3 Story Wood Frame House GRAVEL With Attached 4 Car Garage DRIVEWAY ' G i 4/ S, ` 00. 8p, b/$A 2ND STORY WOOD DECK) rW t \ \ DECOMMISSIONED \ WELL NEAR POINT LOT IB -2 Legend ' Electric Meter 5' Septic ® Found YPC Gas Meter d' Over Head Utilities 0 Found Rebar �T_\ Tel. Pedestal CTL Telephone Pole E,Elec. Pedestal O Concrete Bollard Water Well EJ Stone Tiles Stone Retaining Wall \ � •oo \ LE \ L \\ LT �\ \\ 0 / NEAR POINT \ LOT General dotes 1. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. Dimensions to property lines are plus/minus 0.1ft. 2. This document is created by Frontier Surveys for the purpose of an as -built survey for Lew Ulmer, only. 3. This document is based on Plat No. 74-249 1 I 1 II =42.14 'Q=20.00 OF At Illlt Disclaimer Q� 1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary 4 H j survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to detennine the existence of any easements, covenants, or restriction r I t which do no appear on the record plat. Under no circumstances should this document be used for .. .. .. .... ....,....� construction or for establishing a boundary or fence line. ......... A Heq M. Stfagfer i NO. IS -9812 -••; 0 25 50 100 ��/lc�s�••, to/os/2oz1 F9 45 Scale in Feet tfIIPIES*S`0NA` %% � LOT 4C, BLOCK 2 STUCKAGAIN HEIGHTS SUBDIVISION ANCHORAGE RECORDING DISTRICT, THIRD JUDICIAL DISTRICT CONTAINING: 87,144 Sq. FL +/- (RECORD) RECORD PLAT: 74-249 ANCHORAGE RECORDING DISTRICT PREPARED BY: ONTIER FRONTIER SURVEYS, LLC 650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518 I DRAWN BY: 1S I DATE: 10/06/2021 I DRAWING ID: 21-737 LOT13 LOT 5 0 P n EA S �`V Q 90' x 30' ANCHOR \ P� ticb tl h ry EASEMENT \ i Si Tx 7' O�0 ry x6 r �'S' ��vSi(i t SHED o° o° Lot 4C, Block 2 ' S' °°ja°�' Stuckagain Heights Subdivision 87,144 Sq. Ft. +A 9930 earporn nve 3 Story Wood Frame House GRAVEL With Attached 4 Car Garage DRIVEWAY ' G i 4/ S, ` 00. 8p, b/$A 2ND STORY WOOD DECK) rW t \ \ DECOMMISSIONED \ WELL NEAR POINT LOT IB -2 Legend ' Electric Meter 5' Septic ® Found YPC Gas Meter d' Over Head Utilities 0 Found Rebar �T_\ Tel. Pedestal CTL Telephone Pole E,Elec. Pedestal O Concrete Bollard Water Well EJ Stone Tiles Stone Retaining Wall \ � •oo \ LE \ L \\ LT �\ \\ 0 / NEAR POINT \ LOT General dotes 1. Excepting for gross negligence, the liability for this survey shall not exceed the cost of preparing this survey. Dimensions to property lines are plus/minus 0.1ft. 2. This document is created by Frontier Surveys for the purpose of an as -built survey for Lew Ulmer, only. 3. This document is based on Plat No. 74-249 1 I 1 II =42.14 'Q=20.00 OF At Illlt Disclaimer Q� 1. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvements and conditions at the time of the survey. This document does not constitute a boundary 4 H j survey and is subject to any inaccuracies that a subsequent boundary survey may reveal. It is the responsibility of the Owner to detennine the existence of any easements, covenants, or restriction r I t which do no appear on the record plat. Under no circumstances should this document be used for .. .. .. .... ....,....� construction or for establishing a boundary or fence line. ......... A Heq M. Stfagfer i NO. IS -9812 -••; 0 25 50 100 ��/lc�s�••, to/os/2oz1 F9 45 Scale in Feet tfIIPIES*S`0NA` %% � LOT 4C, BLOCK 2 STUCKAGAIN HEIGHTS SUBDIVISION ANCHORAGE RECORDING DISTRICT, THIRD JUDICIAL DISTRICT CONTAINING: 87,144 Sq. FL +/- (RECORD) RECORD PLAT: 74-249 ANCHORAGE RECORDING DISTRICT PREPARED BY: ONTIER FRONTIER SURVEYS, LLC 650 W. 58th AVE. SUITE E, ANCHORAGE, AK 99518 I DRAWN BY: 1S I DATE: 10/06/2021 I DRAWING ID: 21-737 p 6 • Municipality of A Q age On Water and WastewQ11- r a'n (907) 343-790. JAN 3 1 , t Certificate of On -Site Systems Approval Parcel I.D. 041-021-06 Expiration Date:? 1. GENERAL INFORMATION Complete legal description Stuckagain Heights, Block 2, Lot 4C Location (site address) 9930 Nearpoint Dr. Current Property owner(s) Pete & Katherine Sloan Day phone Mailing address Real Estate Agent 9930 Nearpoint Dr. 2. TYPE OF DWELLING: Fx] Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 5 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fx] Individual it Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received bV /' /1 CSL r l it h�C�/�1� — Date: / � COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 61p� Waiver Fee $ _ Date of Payment % A )L/ (� Date of Payment Receipt Number O£,(5 -47i6 Receipt Number COSA # 0SC17 /Ua';" Waiver # 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, 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 Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone 6. DSD SIGNATURE System #1 Approved for . £3 bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for Date 1/7/2014 bedrooms, with the following stipulations: By Original Certificate Date: -'� The Municip5lity-6f-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. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r If more than 1 septic system is on the lot: COSA Checklist # _Lof 2 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: Stuckagain Heights, Block 2, Lot 4C Parcel ID: 041-021-06 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (YIN) Y Date completed June 1984 Sanitary seal (YIN) Y Wires properly protected (YIN) Y Total depth 128 ft. Cased to 37 ft. Casing height (above ground) 18+ FROM WELL LOG Date of test June 1984 Static water level 40 ft. Well production 2.5 g.p.m. WATER SAMPLE RESULTS: AT INSPECTION 1/6/2014 38 ft. 1 g.p.m. Coliform /ti1?g colonies/100 mL Nitrate 7 mg/L Arsenic I�J t> ug/L Date of sample: /)-c t Collected by: PSS B. SEPTICIHOLDING TANK DATA Tank Type/Material Date installed Tank size gal. Number of Compartments_ Cleanouts (Y/N) Foundation cleanout (YIN) _ Depression over tank (YIN) _ High water alarm (YIN) Date of pumping Pumper C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2 or ftz/bdrm) System type Length ft. Width ft. Gravel below pipe ft. Total depth ft. Eff. absorption area fl? Monitoring tube _ Depression over field _ Date of adequacy test Results (Pass/Fail) For. bedrooms Fluid depth in absorption field before test in. Water added gal. New depth in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at in. Datum Size in gallons "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line Water main Water service line Wells on adjacent lots ABSORPTION FIELD ON LOT TO: Property line Building foundation _ Water Service line Surface water Curtain drain Wells on adjacent lots F. COMMENTS G. ENGINEER'S CERTIFICATION Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100 I certify that t 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 Steven R. Pannone Date 1/8/2014 COSA brown sheet 10.10-12.doc Absorption field Surface water Water main Driveway, parking/vehicle storage in. If more than 1 septic system is on the lot: COSA Checklist# of 2 Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: Stuckagain Heights, Block 2, Lot 4C Parcel 113: 041-021-06 A. WELL DATA Well type Private If A, B. or C provide PWSID # Well Log (Y/N) Y Date completed 5/11/1991 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 195 ft. Cased to 42 ft. Casing height (above ground) 18+ in. FROM WELL LOG Date of test 5/11/1991 Static water level 45 Well production 3 i711 AT INSPECTION 1/6/2013 41 g.p.m. 0_6 WATER SAMPLE RESULTS: Coliform "fie _colonies/100 mL Nitrate -5.-7q mg/L Arsenic 1U D ug/L Date of sample: 61�,o l Collected by: 7 /i B. SEPTIC/HOLDING TANK DATA FIN g.p.m. Tank Type/Material Septic/Fiberglass Date installed 1977 Tank size 1,500 gal. Number of Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over t/ank (Y/N) N /High water alarm (Y/N) N Date of pumping (��9�I �� Pumper i`f { Fla e > ems✓+c_ fS C. ABSORPTION FIELD DATA Date installed 1977 Soil rating (g.p.d./ftZ or ftz/bdrm) 90 SF/BR System type Deep Trench Length 49 ft. Width 3 ft. Gravel below pipe 6 ft. Total depth 8 ft. Eff. absorption area 588 ftZ Monitoring tube Y Depression over field N Date of adequacy test 1/6/2014 Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test 0 in. Water added 810 gal. New depth 5 in. Elapsed Time: 340 min. Final fluid depth 0 in. Absorption rate , 750+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) No If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ Absorption field on lot 100+ Public sewer main 75+ Sewer /septic service line 25+ Animal containment areas 100+ Manhole/Access (Y/N) _ High water alarm level at Meets alarm & circuit requirements? On adjacent lots 100+ On adjacent lots 100+ Public sewer manhole/cleanout 100+ Holding tank 100+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Water main 10+ Water service line 10+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10+ Surface water 100+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS G. ENGINEER'S CERTIFICATION / certify that t 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 Steven R. Pannone Date 1/7/2014 COSA brown sheet 10-10-12.doc Absorption field 5+ Surface water 100+ Water main 10+ Driveway, parking/vehicle storage 110+ in. WS1- QUILT F 87,144 s. F SA7 UMV DISH i Ccs hs location of the structure(s)es f / shown on this record drawing 1 'I SQ'X 30 ESMT.QR SEAR, 1� q: S. P.'s • e WELD. •WELL e "at 4C , Block 2 �Sfuckoyain He!q&3 Anchorage Recording Distric rAloska (74-249) SURVEY CERTIFICATION I WOW amity that thaw aurwyod the property shown and 404"rlbtd hOnaa, We that the fmprowwaate eltuattd fhertoe on witMO tea prop. Orly Unsound doom overlap or enoreaoh an adjoomt praVwty and that no Improve"de on odjaemd propwty ovtdop or mmooh an the pnmlue N pwetlon and NO Ihro art no roodw9y#- utletY Wuw, w other ylal9lt Oottwents on Sold property eea4pt a Irdlaotod harton. 3 LEVEL IT `CF 304 two R. L. Burson o 15.1192 Scale C� Date �j Prepared by: R. L. Burrow © 07-09"/G OM279-62A� 51PWD9hthAe�nobwaQ®aAtcska3A5O! Ref. 2043 F. B. No. 4.9 ` 27 Propsrfy of; . Pe! e Sloal% `k�`�t♦��� r:aswitate of mord attar Than thaw Wwwa on fhe plat of record art not Sham harooh UNIONS, Otherwilo acted. 07-©y. LEGEND 0 Bract or Aluminum capped motwment recovered O Iron pipe uWar rebar recovered. 13 2 x 2 hub t3 tach recovered i 5/3"x34"rebar set this survey s Fence Line (Approx. Location) Scale C� Date �j Prepared by: R. L. Burrow © 07-09"/G OM279-62A� 51PWD9hthAe�nobwaQ®aAtcska3A5O! Ref. 2043 F. B. No. 4.9 ` 27 Propsrfy of; . Pe! e Sloal% _ .,SAt�eu.,"de Srmrcd .. Pump CR S¢RvlCE1 *LLC RESIDENTIAL • Co.lmunGIAL • EMEnGENCY LIGENSEL) - BOND[D • INSURED JOHN NETHERTON B.O. BOX 110496 OFFICE: (907) 346-9355 ANCHORAGE, AK 99611 This report is in regards to the property at Stuckagain Heights Blk 2 lot 4C. This propert has three wells on site. Two of the wells are currently in use. Neither of the wells are high producing water sources. For this reason the two wells are operable and the combined amount of production has shown to be enough to feed the property's needs. The third well on this property shows on the as built to be on the right of way by one foot four inches. For this reason and the lack of use, a decommission of this well has been ordered by the municipality. %-, Upon inspection of the site we found that the well ordered to be decommissioned is extremely close to another well currently in use at the property. For this reason normal methods of decommission are not viable at this time as the concrete, bentonite slurry or chips being used will cause fluids from the decommissioned well to seep through the formation and ultimately choke of the water supply to the operable well. Through an agreement with the Municipality Division of Onsite Water and Waste Water a alternative method of decommission will be implemented on this property. The decommissioning will overcome obstacles. 1, AAROW PUMP & WELL will dig down through use of an excavator to the pitless adapter depth. At that time the water line and pitless shall be disconnected. A water tight plug will be installed below the pitless depth. Bentonite chips will be applied above the plug. And the well will be cut off and buried at a depth to meet code. Through this process we will prevent any contaminants from entering the well or through use. 2 Through this process the well will be cleared and create an unobstructed right of way easement. 3 Through this process we shall cause no disturbance to the current formation supplying water to the adjacent well. Work will be completed 2/5/2014 ,? z r J� MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES O Division of Environmental Services On -Site Services Section On P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # �u -�� - �� HAA # 1. GENERAL INFORMATION Complete legal description Lot 4C; Btock 2; S#uckagain Heights Subdivision Location (site address or directions) 9930 Neat Property owner EKnu t Pete Stoan Day phone 261-4123 Mailing address 9930 Nona Pn,intt Anchanago, Abn a 99507 Lending agency Day phone Mailing address Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well XX 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 XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA N21 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 furtherverify 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 Phone Address 17034 Ea�1e River Loon Road No, 204 Eagle River, Engineer's signature 6. DHHS SIGNATURE Approved for ii v bedrooms. Disapproved. Conditional approval for Additional Comments 0 U Date bedrooms, with the following stipulations: Date�4 �z 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 lending institutions in orderto 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. 1/91) Back MOA k21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description:6�gyain�Parcel I.D. A. WELL DATA Well type / J4 If A, B, or C, attach ADEC letter. ADEC water system number d Log present (Y/N) Date comple g t - ` Driller (TMn.4rf h( u Total depth Cased to u o be r asing height (Z f Sanitary seal (Y/N) Date of test Static water level Well flow Pump level Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION 4:; 1661 o AVW 3 g.p.m. g.p.m. �,/1 / NOISIAM S3JIAMS 1V1N3WN`1NIAN3 U Com' y,., -_ " A I.Jw, rJr mvq SEPARATION DISTANCES FROM WELL TO: / r/FoeA4A-7_) oi✓ 61 ✓Ez\l r-OjG 9I; c_- J V✓Eu- r>�ILLED F-6� lo Gtr1/_5/4siey" l;�� j -/b-9/ Folz DA-iA o °L Z V✓£tiLS. Septic/holding tank on lot DO t ; On adjacent lots ( DL) /t Absorption field on lot I ( nD t ; On adjacent lots (�O Public sewer main "JJ A Public sewer manhole/cleanout u� Public sewer service line Petroleum tank 1,.2 O A) r- R�)0GJ A) WATER SAMPLE RESULTS: Coliform-ti�l'�✓V�] Nitrate / Other bacteria Z d 0 Date of sample: l (y' q Collected by: �s `F rtica= /a2L 3 vv'EiL5 CoilnlEL--i�� /NTo R�5w&,x:6. B. SEPTIC/HOLDING TANK DATA �5CI5_ A5-)3J)L-7- SJ2&r-1 rog k4Eu -L,�,c -s Date installed Compartments Z Cleanouts (Y/N) Foundation cleanout (Y/N) te-- Depression (Y/N) tJ High water alarm (Y/N) NIA Alarm tested (Y/N) 1A Date of pumping (- - CI' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: i r / Well(s)onlot (DO t On adjacent lots I oo f Foundation— / oundation / � r To property line (D t Absorption field (0 Water main/service line i Surface water/drainage (n0 t 72-026 (Rev. 3/911 Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) "Pu on" level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATI( Well on lot D. ABSORPTION FIELD DATA On adjacent Manufacturer Manhole/Access(Y/N) "Pump off" level at Cycles tested TO: I ots, Surface water _ Date installed T� Soil rating n0115 1�r System type R-eiJC.A Length 4 �l Width 3 (Q Gravel thickness (0 Total depth Total absorption area _:S-8 f Cleanouts present (Y/N) 14 Depression over field (Y/N) A) Date of adequacy test Cl j Results (pass/fail) U14 S S for bedrooms Peroxide treatment (past 12 months) (Y/N) N/l� If yes, give date 0 I w SEPARATION DISTANCE FROM ABSORPTION FIELD TO: r i Well on lot C20 % On adjacent lots .100 'F Property line To building foundation 10 f To existing or abandoned system on lot /,J W On adjacent lots 30 f Cutbank AJ Water main/service line / f r Surface water Curtain drain tiIIA E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the Signature ara!V1 e_itlNl. J�J 4 L� a jle River Loots Road No. 204 Engineer's Narn(Lagia lzlvor, Alas 99577 Date �q HAA Fee $ 1-70 ( Date of Payment Receipt Number �0 77 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number 0 of this inspection. CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING sneoanrowY ` 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS REPORT BY SAMPLE for WORKorder# 34257 Date Report Printed: MAY 17 91 @ 16:16 Client Sample ID:L4 "C" B2 STUCKAGAIN HEIGHTS S/D Client Name :S & S ENGINEERING PWSID :UA Client Acct :SNSENGP Collected MAY 1.4 91 @ 19:20 hts. BPO # PO # NONE RECEIVED Received MAY 15 91 E 14:45 .his. .. Rey Preserved with :AS REQUIRED Ordered By .:R. SHAFER Analysis Completed ;MAY 17 91 Send Reports to: Laboratory Supervisor_ :STEPHEN/ -C. EEDDE 1)S C& S ENGINEERING Released BY .�j Chemlab Ref #: 912023 Lab Smpl. ID: 3 Matrix: WATER _ Allowable Parameter: Tested Result Units Method Limits ------------ -----------------------------------------------------------------------------------`--- NITRATE-N 2.9 mg/l EPA 353.2 10 _ .Sample ROUTINE SAMPLE COLLECTED BY: R.U.J. Remarks: _....__.....e=_.«_.,_...a.,.................—._..........,_,a e� 1 Tests Perf oared :See Special Instructions Above UA=Unavailable- - ND- None Detected ".See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT-Greatef Than O MUNICIPALITY OF ANCHORAGE `0 • Department of Health & Human Services 41, DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. If C, LA 1 -- (--Q\ — It r HAA # is �`) ) Ll!an 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4C • Btock 2 • S.tuckagain Heighta -Subdivision; Location (address or directions) 9930 Nean o.int Dni.ve (b) Property owner EAneat SQoan Telephone: (home) 337-9705 Business 261-4123 Mailing Address 9930 Neaapoin-t Dkive Anchorage Ak. 99507 (c) Lending Institution Mailing Address (d) Real Estate Company and Agent Address Telephone Telephone (e) Mail the HAA to the following address: (or check here Wxif hold for pick up.) List contact person and day phone number below: 17034 Eagle River Loop Road No. 204 g River, -- 2. TYPE OF RESIDENCE Single -Family rix Number of bedrooms S 3. WATER SUPPLY Individual Well EXx 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-siteXN Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 Z to 9 abed Y -Oa (ea)L �-H) M -U •Naom s,aaaul6ua leuoissaload aql ui suolsslwoao saoaaaaol elglsuodsaa lou sl 96eaogouy to A;IledlolunW eql •panssl sl aleollllaao a aaolaq elep azAleueao suopedsul lonpuoo lou op SHH(]10 saaAoldw3 sluewaalnbaa a;els pue leaapal ulelaao Alslles olaapao ul suollnlllsul bulpual alagl pue sewoq to saasegoand of Asolanoo a se slql saop SHH(] agl 'uMsely Io OWLS aql ul paaalslbaa aaaul6ua leuolssaload luapuedepul ue Aq anoge 9 gdea6eaed ul u9AI6 suolleluesaadaa aq; uodn Aluo paseq paleolllaao lenoaddy Allaoginy 44leaH sonss! (SHH(l) saolAJaS uewnH pue glleaH to luawlaeda(] 96eaogouy to A;Ijedlolunyq aql : ,Iva leuolllpuoo - Ienoaddy leuollipuoo to swaal panoaddesl(]—_ panoaddy Aq swooapaq aol panoaddy IVAOUddV SHHO OIL'(] LL56G'- 1'cltl'aanl� sseappy G euogdela Ar1Nia2e1;!8��I1`cdhEOLI to aweN ,uolloedsul slgl;o alep agl uo loelle uI suollelnbei pue 'seoueulpao 'sopoo alelS pue ledlolunlry lie gllm aouelldwoo uI sl walsAs lesodslp aalemalsem ao/pue Alddns aalem ails-uo aql 'uolloadsul pue uolle6llsanul Aw woal pus sail; a6eaogouy Io A;IledlolunW egl woal paulelgo uollewaolul aql uo paseq le4l AlueA aaglanl I -ulaaaq peleolpul aanlonals Io adAl pue swooapaq to aagwnu eql aol alenbape pus' leuollounl 'ales sl welsAs lesodslp aalemalsem ao/pue Alddns aalsm ells-uo aq; leg; smoqs lenoaddy AllaoginV 4lleaH Slglto u0lle6llsenul Aw ley;AIIaaA l'moleq umogs alep uollepllenagi;o se pus olaaaq paxll;e leasAw Aq paiplaao sy NOIIVWHOdNI (INV VlVO'HONV3S 3-1Id'S1S31'SN01103dSNl ONIOIAOad WHId ONIli33NION3 '9 MUNICIPALITY OF ANCHORAGE (MOA) • ),,/,,Health Authority Approval (HAA) avICLB oIvls CKLIST - FEBRUARY 1984 343-4744 ,r JAN 161991 Legal Description: �y A. WELL DATA R C r 1 V� D Well Classification -'tj1 /r FA to to If A, B, C, D.E.C. Approved (Y/N)'�A_ Well Log Present (Y/N) . 4—Date Completed (p -E341 Yield / Total Depth ���11 Cased to 1 ru epth of Grouting �— Static Water Level Casing Height Above Ground — Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: Pump Set At 'f Sanitary Seal on Casing (Y/N) — Depression Around Wellhead (Y/N) To Septic/Holding Tank on Lot It 'f ; On Adjoining Lots / (?o ' To Nearest Edge of Absorption Field on Lot / t ; On Adjoining Lots / () o t To Nearest Public Sewer Line �tS t To Nearest Public Sewer Cleanout/Manhole 100 t f To Nearest Sewer Service Line on Lot Z`� / t Nbv`i-k W_J `aoU l � WE (� Water Sample Collected byJ S dJGJJeeJJ <A) ;Date E -`T Water Sample Test Results yAT'6TAC-1 o0 `F - Comments B. SEPTIC/HOLDING TANK DATA Date Installed 101:tjsize i ! ov No. of Compartments 2 Standpipes (Y/N) _ 4 Air -tight Caps (Y/N) Foundation Cleanout (Y/N) _ t Depression over Tank (Y/N) h I Date Last Pumped - q Pumping/Maintenance Contact on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) __qA Temporary Holding Tank Permit (Y/N) A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well / 10 - To Building Foundation r To Property Line -/ n % To Disposal Field i To Water Main/Service Line to f i To Stream, Pond, Lake or Major Drainage Course /1 ( no t Comments uum�Cl l� Na MP 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA / Soils Rating in Absorption Strata Type of System Design T ZCA)C� Date Installed /Ci _:� 7 Length of Field <{ CJ Width of Field 3 % Depth of Field r Gravel Bed Thickness �n Square Feet of Absortion Area P B A Statndpipes Present (Y/N) y Depression over Field (Y/N) _ Results of Last Adequacy Test Date of Last Adequacy Test — Z — C/ I. _ `�- la , J n. , AA SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / on f To Property Line To Building Foundation 10 f To Existing or Abandoned System on Lot /J'ZAA ; On Adjoining Lots z O f To Water Main/Service Line To Cutback (if present) 7 To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area 2 0 Comments 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) "Check Permitted Bedroom Rating Against HAA Request" "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect;Qn,, inspection. Signed 5 5 €'NGINKYRING r 17034 Fa0 c Rival . e, _ , Companyf a01e fLtvFr Alaska 99577 r Date /TT/ MOA No. G/G— c7 0,3 e Receipt No. aaya���1LS Date of Payment Amount: $ 72-026 (Rev. 7180) Back Receipt No. _ Waiver Fee: $ Date of Payment Page 2 of 2 Q, )e date of this ' N D�nMDFGfNpF j proms _D°4� CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. s o f�eoe.rosii �r 5633 B STREET • ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 30682 Date Report Printed: DEC 11 90 @ 16:15 Client Sample ID:L4.'C",B2 STUCEAGAIN HEIGHTS S/D Client Name S & S ENGINEERING PWSID :UA - Client Acet SNSENGP Collected DEC 6 90 @ 12:10 hrs. P.O.# NONE RECEIVED Received DEC 7 90 @ 13:10 hrs. Req # Preserved with -:AS REQUIRED. Ordered By : R. SHATER Analysis Completed :DEC 10 90 Send Reports to: Laboratory Supervisor_:STEPAEN C. EDE 1)S & S ENGINEERING Released By �n`/Cl//i / 2) Special Instruct: Chemlab Ref 1: 905140 Lab Smpl ID: 1 Matrix: WATER Parameter Tested NITRATE -N Sample ROUTINE SAMPLE. Remarks: SAMPLE COLLECTED BY RDJ. Allowable Result Units Method Limits ------------------------------------------------ 2.4 mg/1 EPA 353.2 10 _ "=1 Tests Performed See =Special InstructionsAbove e= UA=Unavailable ND. None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT=Greater Than f� O� `te za4C, _ ueowoowmn CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET n ANCHORAGE, ALASKA 99518 e TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 31141 Date Report Printed: JAN it 91 @ 13:49 Client Sample ID:L4 "C" STUCK AGAIN HEIGHTS S/D N. WELL PWSID :UA Collected JAN 4 91 @ 13:30 hrs. Received JAN 4 91 @ 14:20 hrs. Preserved with :AS REQUIRED Analysis Completed :JAN 8 91 Laboratory Supervisor TEP EN C. EDE Released By Chemlab Ref #:/910036 Lab Smpl ID: i Parameter Tested NITRATE -N Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY; R.D.J. Matrix: WATER Result Units 2.3 mq/l (� eF.MeFDfryQF l 0 J 4 G Client Name S & S ENGINEERING Client Acct SNSENGP BPO # PO # NONE RECEIVED Req # Ordered By : R. SHAFER Send Reports to: 1)S & S ENGINEERING 2) Allowable Method Limits ---'----------------------- EPA 353.2 10 1 Tests Performed UA=Unavailable See Special Instructions Above ND= None Detected See Sample Remarks Above NA= Not Analyzed LT=Less Than, GT -Greater Than n. 17034 Eagle River Loop Road Eagle River, Alaska 99577 14 =NrorRX ROBERT A. SHAFER CIVIL ENGINEER 6942979 PROJECT: 4 Q �� I' s� O p t — DATE OF TEST: J Z —4T ( g Description): Lig-_—i LOCATION OF WELL Le al Destrl tion : o N 0 WELLDEPTH: Z. FT. CASING: • t7. SCREEN: DATE DRILLING COMPLETED: C, — e DRILLER: I� I tIA,,t ti II I/J�i STATIC WATER LEVEL (fop of Casing): 4 FT. DATE: ( _2=171 CLOCK TIME ELAPSED TIME SINCE PUMPING STARTED/ STOPPED, MIN. DEPTH TO. DRAWDOWNI WATER, FT. RECOVERY PUMPING RATE,OPM REMARKS OD 0 n (swl) 0 0 Start 1 � � 5 -- 0 10 15 93 _ Zo 20 - ...._. { 25 440 2.0 30 35 2. p 40 Z _ 45 p 50 ( _ 55 00 60 (1 hour) 90 iv o0 120 (2 hours) 1502,�``"• �� -•� __ IS 180 (3 hours) �. 210 ! . Z i ! b0 240 (4 hours)�� I RECOVERY t 0 0 7 - r ' a � v �_ — 15 20 i I 25 30 I I 35 rirJW IS not Comments: � f I AA OUe-Ir SubsequentVariations WE qp Can Occur. IGUr^ �Gvd C