HomeMy WebLinkAboutUNDERMOUNTAIN ESTATES LT 6Undermountain
Estates
Lot 6
#050-481-08
Municipality of Anchorage Page of
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: SW 940 370 PID Number: 050 4191 -08
Name:
Wastewater System: >,New ❑ Upgrade
yi20` /
Address:
9 /070Y4, C011lc IF95&7
ABSORPTION FIELD
Phone:
�a-M
Si95
No. of Bedrooms:
p Deep Trench Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth f//original grade:
0 GPD/Sq.Ft
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
�fiplrAam OUNl
7 Ft.
Ft.
Township:
Range: J 1
Section: r
Fill added above original grade:
Gravel length:
7,5--
0—/ Ft.
Ft.
WELL: Ci'New ❑ Upgrade
Gravel depth'
Al H
Number of lines:
Distance between lines:
FL
Ft.
Claset lccation (Private, A,B,C):
rF)Vi
Tot
Total Depth:
Cased To:
Total absorption area:
Pipe ateriel:
m
/ Fi
300 Ft.
45CO Ft.
%SOSC. Ft.
�i fiSTM
Driller:
Date Dr (led:
Static Water Level:
Installer:
Date installed:
AFY
5 GUI/
ff S
Ft.
Cts /S
3/=7 - 91/3 -
Yield:Pump
&I
t:
Set at:
1
Casing Height Above Ground:
12
TANK
I• GPM
Ft.
.111121 Ft.
SEPARATION
DISTANCES
y18eptic ❑ Holding ❑ S.T.E.P.
To
septic
Absorption
Lift
Holding
Pnvate
Manufacturer.
Capacity in gallons:
From
Tank
Field
Station
Tank
Sewer Lines
/y/✓C/7. Tgi✓rr
Well
f/00
t'/�//f✓,
r/I
97/
Material:
S>
Number of Compartments:
Watee
elm
!'/00
LIFT STATION
fIGrJ/
N,4
Loty
f/D
-
l8
Size in gallons:
Manufacturer:
Line
/�'
Foundation
15
/O
1(11A
"Pump on" level at: "Pum vel at:
High water alarm at:
Curtain
Pump Meka&
Electrical Inspections performed by:
Drain
>
Remarks:,Sb�,t e 7-, Ic, f iie� /�,j,s-
BENCH MARK
Location and Description:
L✓4d Lo.=+',rvu �..rj- .r rc (+�yc cr+c(�
O� � G S/
p�
-Assumed Fvleti0�
/
ENGINEER'S SEAL
ce�� a•< o at'7 r.b
-
�l CF� E i ei•` G% t�
S j
Inspections performed by: r/ZES Dates: ls 9 57,--
Fae ea sa9ua�.......
io °eer.aca• ti
2nd 9S
�.
•• •,
,f�
01 louia Ae Bulerin
Department of He Ith an u Services approval
Reviewed and approved b : Date:
72-013 (1/91) MOA25
Permit No. SW940320 Page 2 of 2
Municipality of Anchorage
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Legal Description: UNDERMOUNTAIN LOT 6 PID No.: 060-481-08
S Sg
D \ S
$ 5X,5 )RFNCH E
SWING TIES, 6 C
A -C = 33.8 �zsa cAL
B -C = 42,7 TANK
A -D = 87.1
B -D = 95.7 S<OPE HSE
A-E = 31.8b' M 8RE FOUNDATION
B-E = 57.0 °2`b 4 B DRIVE �P
WELL _
100•
MONITOR TUBE
SEWER CLEANOUT
¢ - WELL
LEACHFIELO
— - EASEMENT
SCALE 1" — 60'
111/07/95
ELEVATI❑NS
(NOT TO SCALE) TOP OF WELL CASING
V As..MEn ELEV = 100.00 482, 8' f ENGINEER'S SEAL
0000Op��
ORIGINAL
FINISH GROUND ��'`:`✓ •.,•< !I 440
LEVEL AT: -7J`
ELEV AVG FINISH
97.8
96.8 ELEV 98.1 = a���P \• -P 49TH TH �0
+3 Na GWT �..-..:..... ...............
TANK T 79.8 •• •. ••
9L2 1.0 90.8 90.8 C•. •LOUIS A. BUTERA,�
CE -6736 �O
MTI 86.8
MT2 86.8 44 FDpRpFESS\ONPo�
0
��O0000��
Tom Fink,'- -
Mayor P.O. Box 196650 Anchorage Alaska 99519=
ENGINEER BULLETIN 90-4
July 30, 1990
To: Engineers Designing and Inspecting On-site Wastewater
Disposal Systems
Subject: Construction Inspections and As -built Submittals
Construction inspections by the design engineer are essential to
ensuring that an on-site wastewater disposal system is
constructed in accordance with the permitted design. Equally
important is the accurate preparation and documentation of all
as -built information which is submitted to this office
subsequent to construction completion.
Although AMC 15.65 - Wastewater Disposal Regulations does not
require that DHHS be notified in advance of construction
inspections, we do encourage engineers to follow a practice of
notif in this office of all antics ated construction
znEpP�*ions. Advance notification allows our staff to
efficiently conduct periodic field inspections of newly
constructed systems and provides a convenient opportunity for
the engineer to discuss any field design changes which may be
necessary due to unexpected site conditions. At your request
our staff is available to meet at the construction site to
discuss and resolve specific design/construction issues.
Most field design
the telephone
proposed field
the permitted
writing and in
changes which
variance must
construction.
changes can and will be approved verbally over
or on location during a site inspection. However,
design changes, which significantly departer from
design, must be requested by
he advance of construction. All field design
would normally require a specific waiver or
also be requested and approved in advance of
As -built submittals which indicate that a system has not been
installed in accordance with the permitted design or which
inaccurately depict the actual installation of a system will not
be approved.
If you have any questions please contact our office at 343-4744.
Sincerely,
n Smith P.E.
rogram Manager, On-site Services
cc: Lee Browning, P.E., Manager, Environmental Services
Kids Are Our Future
ter i it Britting ruvg
by
MC Co_ ooe
SULLIVAN WATER WELLS
P.O- B0X$Tow,CHUGIAK, ALASKA BBW • TELEPHONPOB-2762
OWNER OF LAND /� C.�J5
ADDRESS 16o '2106`i- E 2
LEGAL DESCRIPTION' -,ST 6 U.aOXA 'w0jAr1 --
DATE • Started Ended
PERMIT NUMBER
KIND OF FORMATION:
From e_Ft. toa Ft. C-1AFl�J6 .5'r'C+Y�f10
From 'A. Ft. t 7 -.-Fk A aw &'ed ".J
From-7—Ft, to 321r Ft.
From_a�p� Ft. tjS -Ft. `�/f�Al�i�.j��.4���� l••�tit�rL
From��,.s+—�Ft. to-T(D Ft.!t
FromFt.toFt. �fiiili®CSG tnnilPc=-
Fromfrr ,3_Ft.lo
From —Ft. to!
From./_Zyy'-J--���� Ft. u_Ft,.,.�ia"�r
FromdyD Fk to_�,].FI. 9 L! aC
FrorAiJ 4 --Ft. to,IMFt.
Frmq�Fkt��Ft.
From oa7tf Ft. to _3 00 Ft.
From Ft.
From Ft. to Ft.
Froth Ft. to Ft.
Flom Ft. to Ft.
MISCL. INFORMATION:
Sri To r`i"t_ 6 41 c AS`J6
DEPTH OF WELL '700
STATIC LEVEL OF WATER FT.AFS �r710
DRAW DOWN FT.
GALS. PER HR / r.----�------
KIND OF CASING 1E d
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft.
From Ft. to Ft,
From._. Ft. I^
From Ft. to
From Ft. to �� Ft.
Vlkr4- CY ,_n 3vi7, ol
rom Ft. to F.
From
Ft. toO
To
$
Co.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft.
From
Ft. to
Ft-
Po t'" brand la c transmittal memo 7671
#of pages O
To
Fr m )
Co.
Co.
Dept.
Pho
Fax -"'cam. A g
Fax #
DRILLEWS NAME
Municipality of Anchorage
• Department of Health and Human. Services
625 "L" Street
Rick Mystrom, P.O. Box 196650 Anchorage, Alaska 99519-6650
Mayor
343-4744
August 29, 1995
Preston S Peppers
PO Box 771064
Eagle River, Alaska 99577 1064
Subject: Lot 6 Undermountain Estates Subdivision
Permit #SW940320, PID #050-481-08
The subject permit, issued August 29, 1994 by this office for a
single family well and/or on-site wastewater system, has
expired as of August 29, 1995.
A new permit must be obtained from this office for a well
and/or on-site wastewater system NOT installed by the
expiration date.
If you have drilled the well, a well log must be sent to
this office for documentation of the installation and to
close the permit.
If a licensed Professional Engineer has inspected the
installation of the on-site wastewater system, the original
as -built inspection report must be sent to this office for
review, approval and documentation. All inspection reports
must be submitted within 30 days of construction completion.
When applying for a new permit, the fees are: $320.00 for an
on-site wastewater permit; $120.00 for a well permit and
$440.00 for a combined on-site wastewater and well permit.
If you have any questions, please call this office at 343-4744.
Yinerely,
s Cross, P.E.
ram Manager
On-site Services
enc: Copy of Permit
cc: Mary Dayton
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 AND WASTEWATER DISPOSAL SYSTEM PERMIT
PERMIT NUMBER:SW940320
DESIGN ENGINEER:DAVID R. DAYTON, P.E.
OWNER NAME:RIEDNER CAROL J
OWNER ADDRESS:P.O. BOX 670867
CHUGIAK, AK 99567
PARCEL ID:05048108
LEGAL DESCRIPTION: UNDERMOUNTAIN ESTATES LT 6
LOT SIZE: 94406 (SQ. FT.)
NUMBER OF BEDROOMS: 4 THIS PERMIT: 4
THIS PERMIT IS FOR THE CONTRUCTION OF:
DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM
ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH:
PAGE 1 OF 1
DATE ISSUED: 8/29/94
EXPIRATION DATE: 8/29/95
0l -1Q
�'n0
1. THE ATTACHED APPROVED DESIGN.
2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS
15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL
REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80).
3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS
PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY
CALLING 343-4744 (24 HOURS) .
4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL
ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING
WEATHER MUST BE EITHER:
A. OPENED AND CLOSED ON THE SAME DAY
B. COVERED, SEALED AND HEATED TO PREVENT FREEZING
5. THE FOLLOWING SPECIAL PROVISIONS.
SPECIAL PROVISIONS:
RECEIVED B
ISSUED BY:
a�'o
c1- 15 -OS
DATE:- O - 31- - 9 V
DATE:
f
9 Municipality of Anchorage
DEPARTMENT OF HEALTH 8, HUMAN SERVICES
825 " U' Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: IZ62'��' DATE PER
/
LEGAL DESCRIPTION: '"s+' Township Range, Section:
SLOPE
(FEET) Olee, ¢NAGS 4l S—A*Oi3
1
'Jtc-'fes/ s�A cS1�,
2 %
4 Z
5 Sacr'y 3/wjo
6 wlocchs,t��r+t
Go�gt85
7
1*1
I7
- WASr:RntiNn WATER -i
10 ENCOUNTERED? ND
�.._...__ - S
11---' - IF YES, AT WHAT p
DEPTH? P
12, E
Depth to Water After
13 . Monitoring? ` 107UQ, Date: 81
14
5'
16
17
18
19
or -104'3•
� e t
ritiA'rd ? G:%J%41r i I:
/L/W
PLAN
Reading Ra 0Gross
3
Time
Net
Time
Depth to
Water
Net
Drop
- s3
30
3
ZY-32f
- 30
Q
3zr., 3=L
3o
a 2
20
PERCOLATION RATE 1Z (minutes/inch) PERC HOLE DIAMETER
TEST RUN BETWEEN 5 FT AND Co FT
COMMENTS
20210 Donaiar St.
C ugiak, Alaska 99567
PERFORMED BY: IA CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85) - / '
a� Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
825"L" Street, Anchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST ;
PERFORMED FOR: ,fi��(L� 7"'T� L'n' DATE PER
Section:
LEGAL
1•
2-
2y -
3-
4-
5-
6
7
8
9
10
11
12
13
14
15
16
17
19
20
COMMENTS
W
VT-Zq n oto
-fiOLA .
SLOPE
WAS GROUND WATER
ENCOUNTERED? �
S
L
IFYES,ATWHAT 0
DEPTH? P
E
Depth to Water After v/'2/n'/
Monitoring? Date: �
5 SEAL)
s At
SITE PLAN
Reading
Gross
D to Time
Net
Time
Depth to
Water
Net
Drop
2` y
7-39y �4-2��
ZZ"'
0-6'
6`
278 . 2s=
/f
o — YYy
Y%y
j
Zs� —30?
/0
0- 3 yp3
S/b
Sze _3as
/o
0
PERCOLATION RATE; (minutes/inch) PERC HOLE DIAMETER 60
TEST RUN BETWEEN 6 FT AND Cv FT
WaYla K. a on .
PERFORMED BY: 202110 Donalar St- •gg I_ CERTIFY THAT THIS TEST WAS PERFORMED IN
.01
ACCORDANCE WITH ALL SKATE AiJDf MUNICI PAL7GUIDELINES IN EFFECT ON THIS DATE. DATE:
72-008 (Rev. 4/85)
f
D. R DAYTON, P.E., R.L.S.
20210 Donalar Chugiak, Alaska 99567 1907) 696-2417
July 14. 1994
Lot 6, Undermountain Estates
The proposed septic and well system will serve a 4 BR home oA a large
lot. (2114 acres). The lot slopes from North to South at 22% on thelnorthern
portion, steepening to 25%+ on the southern portion.
The system is located greater than 50 ft from the grade bre , parallel
to the countours.
The system will not interfere with wells or septic systems op neighboring
lots. There will be no measurable impact on reserved areas or on drainage.
i
i
BB/AB/96 16:13 CT2.E ESI ANCHORAGE � 907 694 3297 NO.564 1703
KI
ME Rei',#
Client Name
Projeet Nana/#
Client Sample M
Matrix
ordered By
MID
Perarnatef
Nitrate -N
Nitrite•N
Total Goliferm
CT&E Environmental Services Inc,
Laboratory Division
963511001
Eagle River Engineering
1ladennounlain Lb
Undennonntain, L6
Drinking Water
200 M Potter Drive
Anctw*age, AK 99610.16015
Tei: (907) 562.2343
Fax:(007) 561-6301
Client POA
Printed Pale/Time
Collected DattMme
Reeved DatelTime
Technical Director
Released By
08/08/96 13:22
0810519610:45
08/05/96 12:00
ALIO+ bte PreP Anal Ysis
RasuLts PUL Uni tO Methte T"od Limits _ Date Dait
0.133 0.100 0911- EPA 353.2
0.1000 0.700 m0/L EPA 353.2
0 0 Col/1004 SM18 92228
C0106196 £M8
08/01/96 EMB
00/05/96 TAV
�i
Menrlwr of tha SGS Group (Soci6tA Ganefala da Survaillanm)
N. MI880UMI, NEW JEMSEY, OHIO, WEST VIRGINIA
ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGA
OB/09/96 16:14 CUE ESI RNCHnRRGE + 907 694 3297
ND.564 PO4
AL CT&E Environmental Services Inc.
Laboratory Division rarPm���®�rr��®mio���®�d������•vgg®�revs�ere+s�r.
Drinking Water Analysis Report for Total Coliform Bacteriarive
a00h4;e Omer D 98518-7605
NERD INSTRUCTIONS ONREYERSESIDEBEFORECOLLECTING SAMPLE Tel-
ex:907)5 2-2343
307
in PUBLIC WATER SYSTEM I.D. k
',V6 PRIYATt WATER SYSTEM
-a
❑ Send,Qerulty ❑ Send Invoice
u
•m¢A w
„ aW
P
❑ $end R¢saltr ❑ Send Avoicr
ry a
SAMPLE RATE:
Month
SAMPLE TYPE:
Routine
❑ Repeat Sample (for routine sumPle
with lab ref. no.
❑ Special Purpose
SAMPLE LOCATION
❑ummCnts:
07 IdJ.9
Day Year
❑ Treated Water
Untreated Water
Time Collected
Collected By
LF
Picot Prim
Analysis shows this Water SAMPLE to be:
'I/ Satisfactory
❑ Unsatisfactory
❑ Samplt over 90 hours old, results may
be unreliable
❑ Sample too long in transit; sample should
not be over Ott hours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received
Time Received li�p
Analysis Began � F
Analytical Method:Mona MUGilter
" Number of colonies/100 ml.
r 4t. �rgg
nj�r h/.. '^� Ra%utt" An yst
96,3511]
fiy
`.V a WJ1E .a®..r_
I Jj t�
$cnfto AA7.D.E.C. Adeh - Fbks Jun Foxed Dew
client notified of unsatisfactory results:
El
i'ho ed .-.-. Spokc witlt Foxed
HACTERIOLOGiCAL WATER ANALYSIS REC010
MM❑ -MUG Result: Total Coliform R Coll �
Membrane Filter: Direct Count . 0 Colonies/100 ml
Verification: LTB ��. BOB COLIFIRM�
Fecal Coliform Conlirmation
Finsi Membrane Filter Results p� Caltibrm/100 m1
Reported By fir'' "" Dote 6 �-%G-- Time Jou hrs
mvrc-rw+N.mc roC nn
,,a 'fmonanvlc
Mambo, at the SGS Grnupl$ociete Undrale de Sumoilianeel
n�neuA rat isr,egln mnninA nnninm naeavi nein nn�rvin An. u+eCnnm i+cu+ +cecw nuin �aieST aIIR(=1t,in
PNI/14fla�na[nr •. r..-..�+vc ins .__
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907) 343-7904
Parcel I.D. 050-481-08
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Expiration Date: R I S -
Complete legal description Undermountain Estates, Lot 6
Location (site address) 24637 O'Riedner Road Eagle River, AK 99577
Current Property owner(s) Kelly & Carol Hepler Day phone
Mailing address P.O. Box 772605 Eagle River, AK 99577
Real Estate Agent
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: Four
Day phone
4. TYPE OF WATER SUPPLY:
Datei
TYPE OF WASTEWATER DISPOSAL:
Individual Well
R
Individual
Date of Payment
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑ -
Community
El
Public Water System
❑
'"Public Sewer
❑
WaiverNariance request for:
Distance:
Received by: `�✓L�- f-�
Datei
COSA to be released to the engineer, unless olherMse requestedbythe engineer.
COSA Fee $ - 5a%,
',Waiver Fee $
Date of Payment _y5 �1 IT_
Date of Payment
Receipt Number 10 b3 19 4 a
Receipt Number
COSA# DAJ5�a�5
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
Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name
Michael E. Anderson, P.E. Date 519/
i
a �r:AW
4
918_ .
6. DSD SIGNATURE �a> :7)awoeasoN : � o
_System #1 Approved for bedrooms B s'., S%104381
System
Approved for _bedrooms �4f 111jd�ae e
Disapproved
Conditional approval for bedrooms, with the following stipulations:
By:
Original Certificate Date: J /'�—
The uni alit f rage 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 Stale of Alasko. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineers work.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
- Well Flow.Advisory Other
CASA blue sheet r '- 1,. c
If more than 1 septic system is on the lot:
COSA Checklist #
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: Undermountain Estates, Lot 6
A. WELL DATA
Well type Private
Date completed 8/95
Total depth 300 ft
Date of test
Static water level
If A, B, or C provide PWSID #
Sanitary seal (Y/N) Y
Cased to >40 ft.
FROM WELL LOG
8/95
120
ft.
Well production 1.4 g.p.m.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 1.08 mg/L
Arsenic ND ug/L Date of sample: 3120/15
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic/Steel
Tanksize 1,250 gal.
Number of Compartments 2
Parcel ID: 050481-08
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
4/16/15
122 ft.
1.4 g.p.m.
Collected by: Anderson Engrg.
Date installed 8195
Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (YIN) N
Date of pumping 17 " 17- VV Pumper fXS _PV MPI 0 Gr
C. ABSORPTION FIELD DATA
Date installed 8/95 Soil.rating (g.p.d./ft` or fe/bdrm) •8 GPD/SF System type 5' Wide
Length 75. ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 12 ft. Eff. absorption area 750 flz Monitoring tube Y Depression over field N
Date of adequacy test 3/22115 Results (Pass/Fall) Pass For 4 bedrooms
Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 2.5 in.
Elapsed Time: 1,440 min. Final fluid depth 0 in. Absorption rate >= 600 g p d
Any rejuvenation treatment (past 12 mo.) (YM & type) N
If yes, give date
D. LIFT STATION No Add On Manhole - Gravity Flow to Absorption Trench.
Date installed Size in gallons Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm & circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
>100' On adjacent lots >100,
Septic tankflift station on lot 1
>100' On adjacent lots >100'
Absorption field on lot j
Public sewer main
>100' Public sewer manhole/cleanout >100'
Sewer /septic service line >25 Holding tank ' >75>75',
Animal containment areas
>50' Manurelanimal excrete storage areas >100'
SEPTICIHOLDING TANK ON LOT TO:
Building foundation >51 Property line >5 Absorption field >51
Water main
>10' Water service line >10' Surface water >100,
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10, Building foundation >10' Water main N/A
Water Service Zine >10 Surface water >100' Driveway, parkinglvehiclestorage >10
None Noted >100'
Curtain drain Wells on adjacent lots
F. COMMENTS
Well was Hydrofracturod on'4116115. Well Production Increased to 1.4 GPM.
G. ENGINEER'S CERTIFICATION
I 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.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 5/9/2015
COSA brown sheet 10-10-12.doe
.. .......• .
MICHAEL E. ANDERSON •Q--
#A CE 4381
AVt,l; `�ROFESSIO�w�►�
WATERWELL - TEST PUMP REPORT
Conducted by Anchorage Well & Pumo Service
330 E 76th Avenue. Anchotwe AK 995; 8-2840
Ph: (907) 243-6740 Fax: (907) 243-0742
Owner Information
owner ff��f r2
Address:
'Well Locaticn:
Well Information
Total Depth:
Depth of Casing:
Static Water Level:
Casing Size:
Screen Diameter:
Screen Si0i:
Screened From:
StaticWater Level: Screened To:
,Max Drawdown: Remarks:
Air Line Depth:
Average Discharge:
PUMP CN Time: Date:
PUMP CFF Time: V Date
Elapsed Waller Level Flowmeter Flow GPM 1, Comments
Time Feet
I Meters
GALLONS PUT41PED PRIOR TO TEST=4160(617-618)
fn«-
--�
_ _ I _
- _.:
i-
,,-.LLC:NS PUMPED=
--
—_'NE_L TEST YIELD=
I
l'd Z17LOEbZ-L06 SdMH d9b:Z0 41, LO
LOT 7
\ ryh
rR6Hc\��7"7
Qir�J`I • 9 49
10' UNDER �/ \
GROUND
UTILITY \
EASEMENT
(TYP) CO �r
h4
S,1v
CHIMNEY
Mh
2 2nd
2
CANT
\
FLOOR
THREE STORY
[UPPER
DECK
FRAME HOUSE
.7
NOTES:
(SEE DETAIL)
1. SEE PLAT
LOT 6
-^- �
32.6'X 8'
ADJ. CAMPER W/
Op O COSpyROC1C 7 ` ` �' Z80p"•F 48y.78 . DECK & LEANTO\
3pLATNp jaERSUDg, (0)461esfxf% 8.1.'X6.2'
738 ADJ.SHEDD
Op b C 4 SLO
Np_ 3 PlAr SCfjYO DER SU
DETAIL (NOT TO SCALE) 7p 158 °B 4.4t
ENCROA-
,a\. CHMENT
C0 U/�
2'X5.7'
S,1v
CHIMNEY
t
CANT
�h
12.2'X30'
7�&
[UPPER
3.T—
DECK
.7
NOTES:
METER POLE
1. SEE PLAT
NOTES
COVERED PORCH
WISTEPS
ELECTRIC METER
METER
LEGEND
SATELITE DISH
FOUND 5/8' REBAR
❑
POST
®
WELL
O
SEPTIC PIPES
®
METER POLE
(R)
RECORD PER PLAT
(M)
MEASURED VALUE
-r
GUYWIRE
APPROXIMATE
2tl' EXISTING
-J. • •
PUBLIC
USE
EASEMENT
(SEE PLAT)
I
t
t
,maw��///� [r��]/�j(V/ 0 847 W. Evergreen Ave. Palmer,Alaska 99645
aw v Phone (907)745-1110
I HEREBY CERTIFYTHAT I HAVE SURVEYED THE FOLLOWING
DESCRIBED PROPERTY: LOT 6 UNDERMOUNTAIN
ESTATES SUBDIVISION. PLAT NO. 66.353
ANCHORAGE RECORDING DISTRICT, AND THERE ARE NO
ENCROACHMENTS VISIBLE AT THE TIME OF THIS SURVEY,
EXCEPT AS INDICATED.
DATED THIS -29H -DAY OF MAR, 20 15 AT EAGLE RIVER,
ALASKA. IT IS THE RESPONSIBILITY OF THE OWNERS OR
BUILDERS TO DETERMINE THE EXISTENCE OF ANY EASEMENTS,
COVENANTS OR RESTRICTIONS WHICH DO NOTAPPEAR
ON THE RECORDED SUBDIVISION PLAT. UNDER NO
CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR
CONSTRUCTION OR ESTABLISHING BOUNDARY OR FENCE LINES.
THIS IS NOTA LOT CORNER SURVEY.
I JOB NO. 16065 (CLIENT IFIELD BOOK/PG(S). 270!5,8,8 f
PLAN IASBUILT X
Tmverss PC
HW I 1"
13W 130,
TOP CUT BANK
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel I.D. # 050-481-08
1. GENERAL INFORMATION
Complete legal description
Undeimountain Lot 6
Location (site address or directions)
NHN O'Reidner Road, Eagle River
HAA # — 1� 1c) i,• C_ _S I `�
Property owner Scott Peppers Day phone 694-9681
Mailing address _2_0_ Pnx 77064 Eagle River Ak 99577
Lending agency KeyBank/Cindy Jobe Day phone 564-0257
Mailing address 2809 C Street Anchorage, AY 99503
Agent
Address
Day phone
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 4
3. TYPE OF WATER SUPPLY:
Individual well x
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:
!ndividual on-site X
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. 1/911 Front MOA Y l
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 Eagle River Engineering Services Phone
694-5195
Address P.O.
Box 773294
Eagle River AK 99577
Engineer's signature
Date ! ��
��-
6. DHHS SIGNATURE
Approved for
Disapproved.
Conditional approval for
Additional Comments
..,fY ........
bedrooms.
bedrooms, with the following stipulations:
%IJTIC
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 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)Rw.1/91) Back MOAN21
0
Municipality of Anchorage
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division
825"L" Street, Room 502 • Anchorage, Alaska 995010 (907) 343-4744
Health Authority Approval Checklist
Legal Description: f/�/,,,'&N
C0(ZN'%4!/� Parcell.D.: 050 +91-0e
A. WELL DATA !NT (P
Well type POI ✓ATa If A, B, or C, attach ADEC letter. ADEC water system number
Log present (YRS Yes Date completed OY 95
Total depth '?00 7,
,� Cased to �� Casing height (above ground)
Sanitary seal (YIN) y i s Wires properly protected (YRS
Date of test
Static water level
Well production
FROM WELL LOG
p��9f
WATER SAMPLE RESULTS:
Coliform
AT INSPECTION
Nitrate 01133 M614- Other bacteria jt�','—
m
Date of sample: 0Y10s�9[o Collected by: 4_61946�s
,
B. SEPTIC/1104A)f \iG TANK DATA
Date installed Q 4r%� Tank size 25/� Number of compartments 4 Cleanouts (YN Yes
Foundation cleanout (Y/N) yX5 Depression (YRS A19 High water alarm (Y/N) 1V1'4
Date of Pumping 1441 Pumper
C. ABSORPTION FIELD DATA
Date installed S� Soil rating (g.p.d.&2 erflZPodrm) C9f System type 7/2 NC/f
Length Wid7th Gravel thickness below pipe Total depth /
l/
Effective absorption area monitoring Monitoring Tube present(Y/I� Depression over field (Y/N)Date of adequacy test / W Results (Pass/Fail) P'45'5 For IT bedrooms
Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in):
Fluid depth (ins.) Minutes later: Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N) i— If yes, give date
m
c:
O'
im
c
g 1
cp-
a
rntipyC
r�
Nitrate 01133 M614- Other bacteria jt�','—
m
Date of sample: 0Y10s�9[o Collected by: 4_61946�s
,
B. SEPTIC/1104A)f \iG TANK DATA
Date installed Q 4r%� Tank size 25/� Number of compartments 4 Cleanouts (YN Yes
Foundation cleanout (Y/N) yX5 Depression (YRS A19 High water alarm (Y/N) 1V1'4
Date of Pumping 1441 Pumper
C. ABSORPTION FIELD DATA
Date installed S� Soil rating (g.p.d.&2 erflZPodrm) C9f System type 7/2 NC/f
Length Wid7th Gravel thickness below pipe Total depth /
l/
Effective absorption area monitoring Monitoring Tube present(Y/I� Depression over field (Y/N)Date of adequacy test / W Results (Pass/Fail) P'45'5 For IT bedrooms
Fluid depth in absorption field before test (in.); Immediately after_ gal. water added (in):
Fluid depth (ins.) Minutes later: Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (Y/N) i— If yes, give date
D. LIFT STATION p q
Date installed
Manhole/Access (Y/N)
High water alarm level
E. SEPARATION DISTANCES
Size in
level at* "Pump off' level at*
*Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot �-/Do / ; On adjacent lots 1 --loo /
Absorption field on lot /-/00 I ; On adjacent lots fU O
Public sewer main Public sewer manhole/cleanout I t
t
Sewer /septic service line 7i S Lift station
SEPARATION DISTANCES FROM SEPTIC/HQLPWG TANK ON LOT TO:
Building foundation / Property line NO l Absorption field t
Water.}ttairdservice line '/ Z � Surface water/drainage Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation �- 117 / Property Line L_Water.n am/service line
/ t
Surface water 't-100 Driveway, parking/vehicle storage area / _ / S
Curtain drain NA,0PA9i5,&1T Wells on adjacent lots
F. ENGINEER'S CERTIFICATION
t
I certify that I have determined thru field inspections and review of Municipal rgcords fN'above-'.(y�stenrs are
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name Z -O UI S hU7✓//I?n4gmn�hi>>Sea"e
ouiR
a
A. Nu ora
Date3> 9G�4 J
•[94B
HAA Fee
Date of Payment
Receipt Number _ c� Z!Z 7
Rev. 8/95 OSS: haa.wk.doc
Waiver Fee $
Date of Payment
Receipt Number