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HomeMy WebLinkAboutT15N R1W SEC 18 LT 72AT15N R1W SEC 18 Lot 72A #051 -172 - 48 • • Municipality of Anchorage Development Services Department ;, s e - Building Safety Division ° S. Bragaw St. On-Site Water and Wastewater Program, 4700 P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.cI.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PID Number: 051-172-48 Permit Number: SW040449 Name: Cevin L Gilleland Wastewater System: • New IN Upgrade Addresser Birchwood L000 Chuaiak. AK. 99567 ABSORPTION FIELD 19136 Phone: Number of Bedrooms: 6RR-36RR 3 o Deep Trench 0 Shallow Trench 0 Bed 0 Mound r ether: LEGAL DESCRIPTION Son Rating: GPO/Fe Total Depth from • . al grade: Ft. Block: Lot subdMalon: 72A Depth to pipe bottom from original grade: d,Ft. Gravel , ... beneath pipe: Ft. Townahlp: Range: Section: 15N 1W 1841 FIN added above original grade: OXY Ft. Gravel Length: Ft. Well: ■New CI Upgrade Gravel width: Li.\t7 v Ft. Number of lines: Distance between linea: Ft. Classification (Private, A, B. C): Private Total Depth: Cased to: 69 Ft. 68 Ft. Total absorption a - . F9 Pipe Material: Griner: Sullivan10/25/1439 Date Draed: Static Water Level: Fl. Install- Date Installed: Yield: 20 GPM Pump Set at Coring H ight Above Ground: unknown Ft2 Ft. TANK V �/ ./� SEPARATION DISTANCES 0 Septic 0 Holding 0 S.T.E.P. �j IS I ■ Other. To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Line Manufacturer Lapa"h'' Gal. Well 100'+ 100'+ NA NA 25'+ Material: Number of Compartments: Surface Water 100'+ 100'+ NA NA LIFT STATION Lot Line S'+ 10'+ NA NA Sae: Gal. Manufacturer. "Pump High Foundation 51+ 10'+ NA NA 'Pump on' level at: in. off level at: In. water alarm at In. Curtain Dram NA *501+ NA NA Pump Make 8 Model Electrical Inspections perfored by: Remarks: *none known BENCH MARK Previous existing well Location and Descnption: decommissioned Assumed Elevation: 100 Ft. _End\�tamP rikv--0.OFaq MgS�fI el Engineering. Inc.Dates:1st10/25/04 i *i49L . , %, ei' a "'"""' y s Inspections performed by: MD�,� 2nd map,1 » s iiv, Kenneth jag 1lit Development Services Department Approval O p� Date: -1.2. - WE 'CA . CE (. r!�, 4 f t -10 .9, • OFESSICit'4t - Reviewed and approved y: 'rj/� • (Rev. )2n10) Oj ‘\�N`�Oli AS -BUILT WELL DETAILS SEWARD MERIDIAN, T15N, R1W, SEC 18, NE 1/4, LOT 72A Permit SW040449 PID# 051-172-48 BECKY LAN E 10' Util Esrnt Chain Inc fence Q Q SEPTIC CO 100' WELL RAI$IUS (NEW) SEPTIC 100' WELL RADIUS (EXISTING) SCALE: 1' = 40' A -C= 37.5' B -C= 52' fir';, CF. AL. c *;L // gig %/ OPEss1061A• 03096w2asb.dwg PREPARED FOR: CEVIN GILLELAND 19136 BIRCHW00D LOOP CHUGIAK, AK. 99567 (907) 688-3688 FIELD BOOKS COMPUTED: BOUNDARY•. — DNA' WAC STAMM — CHEMED: KMD ASBULT: DWG. ?LE JOHNSON DA1C 11/09/04 1*! ID ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 OND: NW1155 *CAD RLE: 03096W2ASB.DWG JOB N6: 03096 (907)698-6111/FAX (907)696-8111 (tCertitteb flitting tog oocco.dba SIJLLIVAN WATER WELLS PA. 80X E702M. CMJGIAK. M.ASK�► ta567 ' -. WINER oFWIDr CtJi.-J Gitcr`blear - DEPTH . USDFESS: won .EGAL OP3E:Tr 2si9 `/ PERieff NUMBER 1,4o449 Date ofie*erb -2-$ TAX ,,, NUMBElt 05 t - „a -- 41' Is well located at aapoted location? C.3%/Cs No Method of Milting: rotary U table tool Depth *dwelt A Casing Type SThSt. wall Thickness ' atS inches Diameter 6 inches. depth feet tlrherType /d Oa1IL= Csisirg Stickup Ab mGra & feet Static Water Levet � 9' feet Recover Rate Spm Method of Testing itit woo Intake openhXI Type end n open hole :1 Saeerhed; . Start feet StoPPtid feet U Perforations Start feet grad feet Groot Type: W"aT•,fr.?L Itr ne j„icdt' Depth: from F'`0 feet.to 22,8 feed Wel Disktected upon Ootnpte kXY? » Et No Method afr CS tot- r, CZPp,�t Commits 0 ,,t Cn w+G n- c cJ/ 4 ; ssurf `i' 4a.v.t ca fir' 3 3 r L.:1 S'A...10 3 3 S►/ 9t Y SALA 1 64.11,r'' 4 1 ' 3,4.00 6/€BJC.L. —WA E' 5.3 S7 6S N42 © S (,9 t*ua u.147:6A /1444 "404 Mat Name lifTEN /Ott it is the responsibiity of the property owner to subma a copy of ecwehe ll o onmenoal the grope ar ai uthoriy. M unicipafity e: t An Department of Health & Human Services and/or DeparineM u Borough: rtrnent of Environmental Conservation. 10-18-04; 3:42PM; SGS Ref.# 1046515001 Client Name KND Engineering Project Name/# T15N, RI W, See 18, NEI/4, L72A Client Sample ID T15N, R1W, See 18, NEI/4, L72A Matrix Drinking Water Sample Remarks: ;907 5615301 # 2/ 2 All Dates/Times are Alaska Standard Time Printed Date/Time 10/18/2004 15:36 Collected Date/Time 10/04/2004 14:00 Received Date/Time 10/04/2 04 14:55 Technical Director Ste C. Ede Released y� Allowable Prep Analysis Parameter Results PQL Units Method Container ID Limits Date Date Init Waters Department Nitrate -N 10.2 * 0.100 mg/L EPA 300.0 A (<=10) 10/05/04 JJB MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Permit Number: SW040449 Legal Description: T15N R1W SECTION 18 LOT 72A Design Engineer: 0070 KND Engineering Owner Name: CEVIN L. GILLELAND Owner Address: 19136 BIRCHWOOD LOOP CHUGIAK , AK 99567 - Date Issued: Oct 22, 2004 Expiration Date: Oct 22, 2005 Parcel ID: 051-172-48 Site Address: 19136 BIRCHWOOD LOOP Lot Size: 41949 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be In accordance with: 1. The attached approved design. 2. All requirements specified In Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations (18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. o/ZS/oy - 13'144- SVC.LI UA/V c4c4.Eb fon, WSt .. cced,rvo,V C,-JR.vwc Alt n1 CVELc._ Loc..rrjQN wIc.- t3E o,v Soori.1 r 4sr Fitts i of LO 1- *'VO CO ✓nt o F PAI VE hNFc. ic.t 9e_ Received By: Date: /61276 h Issued By: r Date: /0/22/7 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 651 LIS Property owner(s) Cevin Gilleland Mailing address (1) 19136 Birchwood Loop. Chuolak. AK 99567 Mailing address (2) Permit Number SW Day phone 688.3688 Zip Code Legal description (Lot, Block & Sub'd.) T15N. R1W. Sec 18. Nat Lot 72A Legal description (Section, Township & Range) Lot Size y L q6 Acr THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade 1115 PROPERTY CONTAINS: Number of Bedrooms 3 ❑ Well Only ❑ Water Storage 0 Hot Tub 0 Jacuzzi Swimming Pool 0 Water Softening Unit Therapy Pool 0 ►Z0 I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Si ature of property owner or authorized agent) Permit Fees: $/7S' Waiver Fees: Date of Payment: /02//01{ Date of Payment: Receipt Number: 5Ct88lf 144 Receipt Number: (Rev. 12/00) I`C'I KN 1D ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 October 20, 2004 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Well Permit — T15N, R1W, Sec 18, Lot 72A Gentlemen: Due to the identified high nitrates, the owner has requested we proceed forward to obtain a well permit to upgrade the on-site water system on the subject lot. The results of recent water analysis are attached for your review. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111 /FAX 696-8111. Respectfully submitted, XND Engineering, Inc. Attachments: On -Site Well Application Water System Details/Site Plan Water Analysis WELL DETAILS/SITE PLAN SEWARD MERIDIAN, T15N, R1W, SEC 18, NE 1/4, LOT 72A BIRCHW❑❑D LOOP No PUBLIC VEILS WITHIN BOD' OF PROPOSED SYSTEM MO PRIVATE WELLS WITHIN 20O' OF PROPOSED SYSTEM EXCEPT AS MOTEL MO SEPTIC SYSTEMS WITHIN BOD' OF PROPOSED WELL EXCEPT AS MOOTED. NOTES: 1. DECOMMISSION EXISTING WELL. 2. DRILL NEW WELL DUE TO HIGH NITRITES IN EXISTING WELL. 3. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS. PREPARED FOR: CEVIN GILLELAND 19136 BIRCHWOOD LOOP CHUGIAK, AK. 99567 (907) 688-3688 Scale' l'= 100' PAGE 1 OF 2 FIELD BOOKS STAwNO NA AatT` NA DW0. "LE ACRD FLE: 03096WELL2.DWG COMPUTED: DRAWN: WAC CHEMED' KMD 10/20/04 NW1155 03096 DATE: CND: JOB Na: Ia HD ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 WELL DETAILS SEWARD MERIDIAN, T15N, R1W, SEC 18, NE 1/4, LOT 72A EGP�GE Chain link fence s.SIING EX15�I G O (PROPOSED) r < C L 100' WELL RADIUS Ilik 43' ,llk NG) ill It M 3 0SSE 100' WELL RADIUS EXI� • ��('� OF' , i�••••* '• 1 / GJ: •.. i * : A * / •••' PREPARED FOR' CEVIN GILLELAND 19136 BIRCHWOOD LOOP CHUGIAK, AK. 99567 (907) 688-3688 Scale' 1'= 20' PAGE 2 ❑F 2 ��. .[D;NNEI,H Y. . i-of �... _� FIELD BOOKS carom carom TEND ENGINEERING CE— °0 ND"^w NA """"° WAC ,,f STAKItlt NA p1tlf3iKMD 20441 PTARMIGAN BLVD. "8"1-11 NA DAM'10/20/04 EAGLE RIVER, AK 99577-8736 AOFE89tOSA. / owa. �.. aao: NW1155 _� \`_ 0309 WELL2.DWG "I Na: 03096 (907)896-6111/FAX (907)696-8111 �tiec-- Municipality • of Anchorage ,.••• Development Services Department )Building Safety •. . Division SA On -Site Water and Wastewater Program, 4700 S. Bragaw St.• P.O. Box 196650 'Anchorage, AK 99519-6650 Page . www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW030455 PID Number: 051-172-48 ATV of Name: Cevin Gilleland Wastewater System: ❑ New 0 Upgrade Address: 19136 Birchwood LOOD Chugiak. AK. 99567 ABSORPTION FIELD Phone: Number of Bedrooms: •::— •:: ® Deep Trench D Shallow Trench D Bed 0 Mound 0 Other. LEGAL DESCRIPTION Soil Rating: 0.6 GPD/FP Total Depth from original grade: 8 Ft. Block: Lot Subdivision: 72A Depth to pipe bottom from original grade: 2.95 - 2.97 R. Gravel depth beneath pipe: 5 FL Township: Range: Section: A Fill added above original grade: 1.35 - 1.66 Ft. Gravel Length: 82 Ft. Well: ❑ New ❑ Upgrade Gravel width: 2 Ft Number of lines: 2 Distance between lines: 10 Ft. Classification (Private, A, B, C): Private/Existing Total Depth: Ft. Cased to: Ft. Total absorption area: 820 Ft= Pipe Material: D3034 & F810 Driller. Date Drilled: Static Water Level: Ft. Installer: R.P.C. Date Installed: 12/9/2003 Yield: I GPM Pump Set at: Ft. Casing Height Above Ground: Ft. TAN K SEPARATION DISTANCES .• Septic ■ Holding ■ S.T.E.P. • Other: To From Septic Tank Absorption Field Lift Station Holding Tank Public/Private Sewer Line Manufacturer: Anchorage Tank Capacity: 1000 Gal. Well 100'+ 100'+ NA NA 2$'♦ Material: Steel Number of Compartments: 2 Surface Water 1001+ 1001+ NA NA LIFT STATION Lot Line 5'+ 10'+ NA NA Size: Gal. Manufacturer: Foundation 5'♦ 10'+ NA NA "Pump on level at: In. 'Pump off" level at: in. Hugh water alarm at: In. Curtain Drain NA *501+ NA NA Pump Make 8 Model Electrical Inspections performed by: Remarks: *none known BENCH MARK Old tank abandoned & New tank Location and Description: Bottom of siding insulated Assumed Elevation: 100 Ft: Engineer's Stamp , .41"e OF A4 4111 Inspections performed by: }CND Engineering, Inc.Dates: 1st 12/8/2003 •• , 474. •eile s1. la s0:• � ,., ..17 Ili se Or •••• �o- 2nd 12/9/03 is • • some •••• •, . Ale 0 • •_... ••...:• .• Development Services Department Approval S'' 1112/DY Reviewed and approved by: '..t Date: ytAr �••• Kenneth CE 7116uf'' oi Aro �40e04°''. (Rev. aroo) 1 ...•.•••••'`c�� tgAROFE SSIOQ�.T -' aaga s,,, AS -BUILT SYSTEM DETAILS/SITE PLAN Permit SW030455 SEWARD MERIDIAN, T15N, R1W, SEC 18, NE 1/4, LOT 72A PID#051-172-48 ]ILK Y LANE A -C= 60.9' B -C= 53.6' A -D= 66.1' B -D= 59.2' A-E= 83.6' B-E= 87.4' A -F= 88.1' B -F= 85.5' A -G= 87.2' B -G=100.0' A -H= 109.8' B -H=107.8' A -I=102.8' B -I=113.7' 99.10 I -I I ■■1.' 1 111!'. .11000 GAL 1 TANKIC 1=1 j' _ =N=N= 95.8 SCALE' NTS 95.70 II FINAL GRADErTOR TUBE B_TER FABRIC 93.7 88.70 SEWER ROC TRENCH 1 98.2 93.7 =II III II 11 II 98.23 41.0 FINAL GRADE FILTER FABRIC 88.70 .MONITOR TUBE 98.06 93.7 SEWER ROCK TRENCH 2 93.7 II II II. Ic it If 11 88.71 88.71,, I1: Ci1�11 r1 1t=lCrtill-nr-m-iir- ni-tir u=in=1 -IH'- 410' PREPARED FOR: CEVIN GILLELAND 19136 BIRCHWOOD LOOP CHUGIAK, AK. 99567 (907) 688-3688 SCALE' NTS VARIES (82.7D DCH FIELD BOOKS =MUTED: BOUNDARY: NA DRAWN: VBG STAKING: NA CHECKED: KMD ASBUILT: NA DATE: 1/15/04 DWG. FILE: GRID' NW1155 ACRD FILE: 00.DWG JOB No.: 00 END ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW030455 Legal Description: jf15N:R1W SECTION'18 Joy72A Design Engineer: 0070 KND Engineering Owner Name: CEVIN L. GILLELAND Owner Address: 19136 BIRCHWOOD LOOP CHUGIAK , AK 99567- )Zf (73- zprY, Itici/65-1D'•3Dai rvi NoOK- Date Issued: Oct 23, 2003 Expiration Date: Oct 22, 2004 Parcel ID: 051-172-48 Site Address: 19136 BIRCHWOOD LOOP Lot Size: 41969 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑✓ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Received By / Date: 00 Issued By: 1 (7r- Date: / 0/2 3/03 Parcel I.D. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING on -172 -48 Property owner(s) Cevin Gilleland Mailing address (1) 19136 Birchwood Loop, Chugiak, AK 99567 Mailing address (2) Permit Number SW 030 4.x'-s Day phone 688-3688 Zip Code Legal description .(Lot, Block & Sub'd.) TI 5N, RIW, Sec 18,464141 Lot 72A Legal description (Section, Township & Range) Lot Size 4/TO Acre THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms 3 ❑ Well Only ❑ Water Storage ❑ Jacuzzi ❑ Water Softening Unit ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: t 7Zi Waiver Fees: Date of Payment: /0%6,03 Date of Payment: Receipt Number: 4'131 fit fi Receipt Number: (Rev. 12/00) 1� KND ENGINEERING, INC. 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 October 15, 2003 Municipality of Anchorage Development Services Department On -Site Water Sr Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Upgrade Sewer Permit — T15N, R1W, Sec 18, Lot 72A Gentlemen: Due to the identified failed septic system, the owner has requested we proceed forward to obtain a septic permit to upgrade the septic system on the subject lot. On October 6, 2003 one test hole was performed for the proposed system. The results of these tests are attached. The general slope of this lot is flat at a grade of approximately 0-3%. We have designed our system utilizing the existing test hole that was excavated for the existing 3 -bedroom house. The lot is served by an individual well, located on the southeastern portion of the lot. We propose to install two 2' wide deep trenches. Water was not encountered during the excavation or during monitoring. There are no public or private wells within 200' of our proposed system location except as noted. There is no surface water within 100' of the proposed system and there are no known curtain drains within 50'. We do not expect there to be any adverse effect on adjacent lots by the development of this system. If you have any questions, please contact me at 696-6111/FAX 696-8111. Respectfully submitted, ]KLTD Engineering, Inc. Kenneth uffus, Attachments: On -Site Well and Sewer Application Wastewater Absorption System Details /Site Plan Soils Log/Percolation Test Owners/Excavators Specs WELL & WASTEWATER DISPOSAL SYSTEM DETAILS/SITE PLAN SEWARD MERIDIAN, T15N, R1W, SEC 18, NE 1/4, LOT 72A �� 0 ` tJ w w / 60A/ KND o / 0 Z / 1 kill, ELHEsrit / / BECKY LANE NOTE: BIRCHW❑❑D LOOP ROAD : wnc 7 1(1' J0 FLAG WELL RADII & PL PRI❑R TO CONST. NO PUBLIC YELLS VITHIN 200' OF PROPOSED SYSTEM. NO PRIVATE YELLS VITHIN 200. OF PROPOSED SYSTEM EXCEPT AS NOTED. NO SEPTIC SYSTEMS VITHIN 200' OF PROPOSED WELL EXCEPT AS NOTED. phbFESS10t1�' / -- --L DESIGN DETAILS 3 BDRM X 150 GPD = 450 GPD 450 GPD/0.6 GPD PER SQ. FT. (24 MIN/IN.)= 750 SQ. FT 750/(2'(W)) X 5'(D)) (5.0' GRAVEL) = 75.0 FT. TRENCH USE 2 TRENCHES - 38 (L) X 2' (W) X 5.0'(D) Total depth of system Is 8.0' from original grade. Total depth of gravel below distribution pipe is 5.0' . NOTES: 1. USE 1000 GAL SEPTIC TANK, INSULATE IF <4' OF COVER. 2. INSULATE TRENCHES WITH 2' HD BURIAL FOAM. 3. CONTRACTOR WILL ENSURE MINIMUM 2% SLOPE INTO SEPTIC TANK. 4. ADDITIONAL FILL WILL BE ADDED OVER SYSTEM TO ACHIEVE MIN. 3' COVER IF REQUIRED. 5. CONTRACTOR WILL ENSURE ALL SEPARATIONS TO ADJACENT WELLS, SEPTICS, LOT LINES, FOUNDATIONS AND ALL OTHER SETBACKS. PREPARED FOR: CEVIN GILLELAND 19136 BIRCHWOOD LOOP CHUGIAK, AK. 99567 (907) 688-3688 Scale! 1'= 100' PAGE 1 OF 2 FIELD BOOKS COMPUTED: BOUNDARY: NA DRAMN: VBG STAKING: NA CHECKED: KMD ASBUILT: NA DATE: 10/14/03 DWG. FILE: GRID: NW1155 ACRD i1LE: 00.DWG JOB No.: OQ ll n ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 ................. (907)696-6111/FAX (907)696-8111 K D WASTEWATER DISP❑SAL SYSTEM DETAILS SEWARD MERIDIAN, T15N, R1W, SEC 18, NE 1/4, LOT 72A EXISTING SYSTEM CONNECT TO EXISTING SYSTEM PROPOSED 7AEL DIIVERTER EXISTI G T - K---_. TO BE ABANDONED 6 FAL\ *49TH # * CE -7116 iv'� 44? Ai ppESSIOto' Air 1t' R POSED DIARY IARY )(STEM 54' PROPOSED 1000 GAL TANK SLOPE FLAT 0 3% PREPARED FOR: CEVIN GILLELAND 19136 BIRCHWO❑D LOOP CHUGIAK, AK. 99567 (907) 688-3688 Scale: 1'= 20' PAGE 2 OF 2 FIELD BOOKS COMPUTED: BOUNDARY: NA DRAWN: VBG STAKING: NA CHECKED: KMD ASBUILT: NA DATE' 10 /14 /03 DWG. FILE: AGAR' 00.DWG GRD: NW1155 JOB No.: 00 END ENGINEERING 20441 PTARMIGAN BLVD. EAGLE RIVER, AK 99577-8736 (907)696-6111/FAX (907)696-8111 IKND ID ENGINEERING, INC. 20441 PTARMIGAN BLVD: EAGLE RIVER, AK 99577-8736 Als 0••• 000000000 elle ••� • o Performed for: Project: 1- SOILS PERCOLATION TEST Cevin Gilleland T15N, R1W, SEC18, LOT 72A •• SSW cos. Kenneth M. �, Vii• CE711 tp JF.9 �'•. `cap. . 4,1 C.kTA ROFES� Date Performed: TEST HOLE # 03-1 Depth (Feet) 45i17:0 2- . �,. 4- �, ;• 'b1;:ti49t' 6- 7- 8- 9: • 14- '' 5- 9- 10- 11- 12- 13- 15- 16- 17- 18- 19- Org/OL — w/ topsoil SM/gm — mod. dense, gray, damp, w/ occ. cobbles to 1' B.O.H. HOLE PRESOAKED 20- PRIOR TO TEST SEE ATTACHED SITE PLAN FOR HOLE LOCATION Was Ground water encountered? NO Depth to water after monitoring? DRY What depth? NA Date? 10/13/03 Reading Date Gross Time Net Time Depth to Water Net Drop 1 10/9/03 1:00 - 6" - 2 1:30 30 min 4 8/16" 18/16" 3 1:30 - 48/16" - 4 2:00 30 min 34/16" 14/16" 5 2:00 - 34/16" - 6 2:30 30 min 2" 1 4/16" * Water Added Percolation Rate 24 (min/in) Perc Hole Diameter 6" Test Run Between 5 feet and 6 feet I, Kenneth M. Duffus, certify that this test was performed in accordance with all State and Municipal guidelines in effect on this date. GRL ! ER ANCHORAGE AREA BOIXOUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C" STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-4561 111&D 4it 1510 A,SeNIT NOL SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT FRE® F TL CE24C40 INSTALLATION LOCATION LEGAL DESCRIPTION rJJ c IJ 4,wr, MAILING ADDRESS S_ I' 1`I 867( 7t3 PHONE [_or ?I-- A AE.W C7's11t I8' Tis/I/ 12 ! w -C) len Co&t-33,4 INSTALLATION OF: SEPTIC TANK l./ S6 LettRM'T DRAIN FIELD , OTHER TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY 1,0 00 0 )11C - SOIL TEST RESULTS NOTE, THIS PERMIT IS NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED t`47 4c FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL BE SUBJECT TO PROSECUTION. SEPTIC TANK SIZE AD 06 TYPE R^ MINIMUM DISTANCES. REQUIREMENTS FOUNDATION TO SEPTICIK lwfp. se SEEPAGE AREA SIZE TYPE ��L,Q // FOUNDATION TO E PYI L/65 c DRAIN FIELD SEPTIC TANK TO Fi A9-E-PFP jWA(LLL''�_^ 2i SEPTIC TANK SC AAGE PIT ( _ DRAIN FIELD TO NEAREST LOT LINE. ,I ..,, o r WELL TO SEPTIC TANK ) 0 O BL 9 IRACE'PITt'PIT /A 10..) r DRAIN FIELD ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT DRAIN FIELD _ `p 'E'PIT S! SEPTIC TANK, ( 0 L7 iOU DRAIN FIELD TO RIVER, LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. • ryry l �I GRAVEL BACKFILL L(// 1 ^d- ` ial.AA' v /A_LvNT-�'� CONFORM TO BOROUGH REGULATIONS REGG INSTALLATION. 2c OR LICENSED DESIGNER DIAGRAM OF SYSTEM t r .... � ....�- I IT I ®.a . �.._. I 1 ._ _ 1 I I+ I j 1 t 7-._ t{ - --- I CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM I5 IN ACCORDANCE WITH SAID CODE. /��/���ppp '��.�� �/1/%�`/� DATE S'- ���2 APPLICANT'S SIGNATURE Y✓" ���r��9 ro' �' �/BV'"' _ EQ -016(3-75) Lrr/fir ll%%�(J��lf 0 Er E GEOT 'CHNI CAL Et DEVEL( 'MENT CO. Russell Ouster 694-2774 Soils Et Foundations Performed for: Name: Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 SOIL LOG Earl Ellis 688-2280 Land Development h '4t' ,ti .-1tC,t2"-w. Tel. No. f$-'3\4, 7 Mailing Address: ` `\ ri "-SSsc 71.3 ("as,we-S),‘a ceS'id7 Legal Description: \- r 7Z 4 %y., St \t t\ �3 °� '� ' $>csk\ Depth (feet) Soil Characteristics 0 1 2 3 4 5 6 7 8 9. to 11 12 13 W%,ZvVS St T403 `J�4awEN1 CZerksit✓ tiJcrN C.owast,A --'t'v t oacaA. \ evo-c m ma\a "Pest act r7 C��D.�1 �tn3fl Ga6avta,.r. 7-7Qc.ot.a-c'totJ p, 3U cgaav- -. c..5°1awe r� 9 •••""›'L7 ern W, 'a It f Ground Water Encountered: Yes `i No If yes, what depth 144 Proposed Installation: Seepage Pit Drain Field Comments: NI t U 4varsrr '4pocox 2? °/cgtr 250 y/15cL Performed by: �v,sSn `1% -re Date: 4 - 3a - %7' Time —. APPLI( NT FILLS OUT UPPER HA' ONLY Property Owner Mailing Address Derwin and Mary Ann Hamond (Call Mary Ann for directions SR1, fax 2385 to property) Cliuglak. Ak Zip Code 99567 Phone 688-3040 Buyer Address Cevin L. Gilleland and Judy Hallangen 4999 Lake Otis Blvd. Anchor agn, Alaska Zlp Code 99507 Lending Institution Address Home Savingss& Loan 535 "D" Street o Ancragp Alaska Zip Code 49501 Phone 272-1451 Realty Co. & Agent Address BRA Finis Realty & Dev. Mile 20, Old Glenn Hwy. P.O. Box 560 Chugiak, Zip Code99567 Phone ERR -1414 Legal Descrlptbn Street Location Lot 72A, NEL, Section 18, T15N, 111107, S.M. South Birchwood] Loop Type of Residence =Single Family 0 Multiple Family ❑ Other No. of Bedrooms 3 APPROVED BEDROOMS ,y, ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE Water Supply XX individual 0 Community 0 Public Utility ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. For wells drilled prlor to that date, give well depth (attach log If available). Sewer Disposal Qj{Indlvldual 0 Public Utility 0 Holding Tank Date Sewer Installed 6 Year Individual Installed: ' t� When Connected to Public Utility Septic Tank Size NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date inspector �j- Inspector Inspector Inspector /I D/rj. Field Notes: Pwlp,„(� D- lM 'p�//'�ynp''j(/� /� �1 DI 1N OF ANC MUNICIPALITY OF ANCHORAGE DEPT. OF HSALTFI 8 M /O j— ENVIRONMENTAL PROTECTION M Ivkn_Y'u.Q_'6,.'� ��/�1�e � ti $C!�'.2,, 01 �°"� RECEIVED v APPROVED BEDROOMS ,y, ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL* DATE 'CONDITIONS OF APPROVAL r1 BY: `_�/^ A, il Soils Rating Date Sewer Installed Well To Absorption Area Well to Tank Well Log Received Septic Tank Size 72023 102) Z7 _.. .-..J3L N.t..Ro.4�...EaS@m..e q.- . .'ad N. AS -BUILT • I hereby certify that I have surveyed the following described property- 1-1"..212 — Air 9,'o . • /e pc I • Anchorage Recording Precinct, Alaska, and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto. that no improvements on prop- erty lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska • _ _ this Z'"" nday of Flirt'Flirt'e i; 19 /7 • ROBERT C. JOHNSON .*;r L.`& SCALE: Registered Land Surveyor No. 3SO-LS Box 456, Eagle River, Alaska Phone 694-2543 MUNICIPALITY OF ANCHORAGE DEPARTMER' OF HEALTH AND ENVIRONMENT, PROTECTION 825 i, Street, Anchorage, Alaska -99501' 279-2511, ext. 224 or 225 Date Received: April 21, 1977 #1: Time 11:00 a.m. #2: Time #3: Time Date 4-22-77 Friday Date Date Insp Dixson Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND. WATER FACILITIES Lending Institution Request:(N/AtrsYyli 3\.a Mailing Address: Property Owner: Mailing Address: Fred B. Fitzgerald Phone: Phone: Star Route Box 713 Chugiak 99567 688-3167 3. Legal Description: T15N R1W Section 18 Lot 72A See map on back : Single Family Residence: (x) Number of Bedrooms: 2 Multiple Family Residence: ( ) Number of Bedrooms Well System: Public/Community System: ( ) s Individual Well:,' ()? Permit # Depth of Well 52' Well Log on File ( ) Construction Bacterial Analysis Sewage Disposal System: On-site System 0c) Public Utility ( ) Permit # Installed Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line � - (-Oka t -t � S u `�J.gyp,(( ( p. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner: MUNICIPALITY OF ANCHOR'+ :+" DEPT. OP HEALTH Lc ENVIRON N)- PROTECTION RECEIVED VA FHA_—.--__CONV rt tt7_.€0.rld XX Mailing Address' Day Phone:_ 1. 3. Name of Buyer: IR 4.) d % tom/ / 1 `) 0 Mailing Address: Day Phone:__&Z/-- '77°'7 4. Name of Lending Institution: A) 4 A Mailing Address: 4.14 " 3 Pc-? Phone: o2 771 - J.S"o 6 5. Name of Realtor or Agent: t t A 2 is- d Y 7Ji C C 4 aA- Mailing Address:_ - p Phone: 6 f - 9/ as - 6. .1.s'6. Legal Description: d 7.- ' Tis AI, e �J AJH%q A) /e(,te.ALao.d �.. .z. Location: 7. Type of Facility to be Inspected: 8. Water Supply Type of Supply: No Bdrms 2 - Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation 72-003(3/76) a 1:' MUNICIPALITY OF ANCHORAGL `V. 0 / ci � nL": Department of Health and Environmental ProtLO� SPY c� r 825 L Street, Anchorage, Alaska 995QP4`ll on;,ti°r,f,M.,,o'�'�-TION 2.79-2.511, ext. 224, 225 `�np r> 1. .077 r. equest foApproval of Individual Sewer. and Water Patil'.i.4L`J.es Fre0 3 MT -iv RECEIVED 1. Property Owner: RR Mailing Address: 2 f3 0 x 9 1 3 Coom-)LPhone: (p�S�S -3/4 9 2. Name of Buyer: DEFwI N HAP/M0AM Mailing Address: GP), QFL/vQr/ FA -0-t er Phone: /VU/VE 3. Lending Irstitution: -- ----------_-__---.._---- Mailing Address: / Phone: 4. Realtor./Agent: 1" (� o 4c RPA -L7 101 C , INTI M (Pe if Rd 1-714/ 69 -if n. e : 2-7Z - Mailing Address: 5. Legal Description: /1,-6 T /1214 _.)Fc%/FN 78 J .T /5 AL p ) W1 so No Street Location: 5, G/rc1iWO0D todP Rit_E 1 �� 6. Single Family Residence: ( Number of Bedrooms: Z Multiple Family Residence: ( ) Number of Bedrooms: 7. Water Supply: *Individual Well (>0. Public/Community System If ]Individual Well, well depth 5Z F If Community System, name of system 8. Sewage Disposal System: On --site System (X) Public System If Ori -site System, date of installation: v *NOTE: A well log is required on ALL wells drilled since 6/75. 3/77 Page, Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: T1SN R1W Section 18 -Lot 72A Comments: Affadavit Attached: i(`) Letter Attached: Approved: Date: S- ` / 7 Disapproved: Date: Department Worksheet: FI GLP P \/U pt,ii Cocom ,r. at.V` t,OICA . r-Q(sF or 1 IP/ I IN/ SertMCr VQ.A( D }o U) Parcell.D. Municipality of Anchorage Development Services Department ivision On -Site Water Building dSafety Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING �- Li to 1. GENERAL INFORMATION Complete legal description Lot 72A; Section 18; T15N; R1W Location (site address) 19136 S. Birchwood Loop Ch ugiak, AK 99567 COSA n /- i it Expiration Date: Current Property owners () Countrywide Homo Loans Mailing address 2.375 /✓ 1 •.H D Lending agency Mailing address Real Estate Agent Mailing Address Unless otherwise requested, COSA will be he 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System Kathy Olmstead 0 Id by DSD for pickup. 3 Day phone Day phone Day phone 696-2209 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding Tank Community On-site Public Sewer The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based onlyu paragraph engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of upon the representations given In 4 by an independent professional civil title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or 13 wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. -9315 lsogz. 4. STATEMENT OF INSPECTION BY ENGINEER application, As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined p the Certificate wastewater On -Site disposaltems syst system is (aral e) Guidelines safe, functional andor this p adequate shows that the on-site water supply ms and type of structure indicated erein. 1 further rify that based on obtained fromrthe Municipality h for the of of Ancho age files andel from my investigation and investigation on, the on- esite water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm S 8 S Engineering Address 15861 S. Birchwood Loop Chugiak, AK 99567 /0 Robert A. Shafer Date —7 Engineers Printed Name Phone 6942979 5. DSD SIGNATURE r, ___NZ Approved for bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X bedrooms, with the following stipulations: 1 NSITE • • WATER AND • • PROGRAM :•. s. • • 4.„ /Ur " Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other (RSV 11/05) Original Certificate Date: E Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 1 Legal Description: Lei —72.11. ; T IS..&J i21JJ ; Sec )23 Parcel ID: 0 57- 172 -Jig A. WELL. DATA Well type 1)C44 -ea -t_. If A, 8, or C provide PWSID # _ Well Log (Y/N) i 1 ' Date completed /%s tori Sanitary seal (Y/N) \Il Wires properly protected (Y/N) 1r Total depth 69 ft. Cased to 6$ ft. Casing height (above ground) / € '1 in. FROM WELL LOG AT INSPECTION Date of test /0740 LI /0//s%y �/ Static water level 3t/ ft. 7/ ft.. ' Well production 20 9.11111.4 . g.p:m. i WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate /J I i� ♦ mg/L Other bacteria 01 colonies/100 mL e, j Arsenic: ND ug/L date of sample: I011`1/0 1 Collected by: s S �y +^�eil.< B: SEPTIC/HOLDING TANK DATA / Date installed 12te3/U-3 Tank Type/Material Tank size WOO gal. Number of Compartments 2— Al Cleanouts (Y/N) 7 / Depression over tank (Y/N) Highwateralarm (Y/N) Pumper S�1 2 4S 1JLfl1f))\1(� Foundation cleanout (Y/N) Date of pumping 1 C. ABSORPTION FIELD DATA Date installed 12 01 Soil rating (g.p.d./f orft2/bdrm) 0.13 System type Deep "Fre cN Length Cat ft. Width ft. Gravel below pipe 5 ft. Total depth / aft. Eff. absor.tion area Oft= Monitoring tube yes Depression over field N/c7 Date of adequacy test fp /5— 0- Results (Pass/Fail) 55 ` For 3 bedrooms Fluid depth in absorption field before test ') in. Water addedS6 i gal. New depth's 1 in. Elapsed Time:lno min. Final fluid depth 211.rn.T'S' Absorption rate >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NJ/ If yes, give date y' g.p.d. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) 'Pump on level at _ in. -Pump off' level at Datum Cycles tested a er alarm level at in. Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: r Septic tank/lift station on lot f 00 i 't if On adjacent Tots /06 Absorption field on lot (0 Ort On adjacent lots 1 0 0 14 Public sewer main Al/ka Sewer /septic service line ZS t Holding tank N//3 - Animal containment areas 5Of Manure/animal excrete storage areas /0 0 4 Public sewer manhole/cleanout N!/\ -- SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line C Absorption field er, Water main /0 ri Water service line � + Surface water /00 '1 - Wells on adjacent lots /004 4 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line / 4714 Building foundation to 4 Water main / 0 it Water Service line /Orf r Surface water (O 0 "t Driveway, parking/vehicle storage /? 4 Curtain drain r0Al2 kv1ew%1 Wells on adjacent bts (0011- F. 001+F. COMMENTS IRati)ntwk-c f\:=1- 3-1arc.4k-e.e_c-436\oSelorvt}- UAe.i. AS r'^on 0C -co, G. ENGINEER'S CERTIFICATION �. , tiS,1 er I certify that I have determin=> thro gh field inspections nd •'" r,;" f iM .Q 41 review of Municipal record that - ab ve sy to s r 0 conformance with MOA CO gu'< : nes Id t o •t S te� ; Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-172-48 HAA # 01-I O&D l- .?ra,r tdamay Expiration Date. 2 - / 2-- 0,5` 1. GENERAL INFORMATION Complete legal description T15N- R1 W, SEC 18: 1 OT 72A Location (site address or directions) 19136 Birchwood Loop Chuglak, AK 99567 Current Property owner(s) Cevin 1. Gilleland Day phone 688-3688 Mailing address Lending agency Mailing address Sam' as above Day phone Real Estate Agent Roy Briley Mailing Address Day phone 529-2020 Unless otherwise requested, HM will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: _ 3_ 2. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site ❑ Individual Holding tank 0 O Community On-site ❑ Public Sewer 0 The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions In the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm KND FNGINEFRING, Inc Address 20441 Ptarmigan Blvd., Eagle River, AK 99577 Engineer's Printed Name Kenneth M. Duffus Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow and absorption rates may change due to subsurface conditions that may not be observed from the surface, changes In land use, local soil characteristics, groundwater levels that may fluctuate during the year and the water usage of the family being served by the system. The operational life of all well and septic systems are subject to these various and dynamic characteristics and are outside the control of the evaluator of the well and septic system. Therefore, KND can not give any estimate of how long a system will function satisfactory for current or future occupants or can KND guarantee that no unseen encroachments, deficiencies or discrepancies exist. 5. DSD SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for Phone (907) 696-6111 Date 11/09/04 bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other k<<t;�fOFr •.ANo `a •� oN-SITE • t��' �; WATEPANI� m= $ : WASTEWATER : i PROGRAf • /r am,� Original Certificate Date• / Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: T1 5N R1 W SEC1 8 LOT 72A Parcel ID: 051-172-48 A. WELL DATA Well type private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 10/25/04 Sanitary seal (Y/N) ¥ Wires properly protected (Y/N) Total depth 69 ft. Cased to 68 ft. Casing height (above ground) 2 4 " FROM WELL LOG AT INSPECTION Date of test 10/25/04 Static water level 3 9 ft. ft. Well production 2 0 g.p.m g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml.Nitrate 0.57 mg./I.Other bacteria 0 colonies/100 ml. Arsenic: NA mg./I. Date of sample: 10/25/04 & 1 1 /02/04 Collected by: KND Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Date installed 12/09/03 Tank size ' 1000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (YIN) Y_Depression over tank (Y/N) N High water alarm (Y/N) Jy Date of pumping NA — new tank Pumper C. ABSORPTION FIELD DATA Date installed 12/09/03 Soil rating (g.p.d./ftforft2/bdrm) System type TRENCH Length 82 (2 X 41') ft. Width 2 ft. Gravel below pipe 5.0 Total depth $ ft. Eff. absorption area 820 ft2 Monitoring tube Y Depression over field N Date of adequacy test NA — new system Results (Pass/Fail) For bedrooms ft. Fluid depth in absorption field before test in. Water added gal. New deptb_in. Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date Date installed "Pump on" level at in. "Pump off' level at in.High water alarm level at in. Datum Cycles tested E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 100 + Absorption field on lot 1 00'+ On adjacent lots 100 + Public sewer main 75'+ Public sewer manhole/cleanout 1 00'+ Sewer /septic service line 25'+ Holding tank 100' + SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Size in gallons Manhole/Access (Y/N) Meets alarm & circuit requirements? Building foundation 5'+ Property line AL± Absorption field 51+ Water main 101+ Water service line 1 0' + Surface water 1 00 + Wells on adjacent Tots 1 00'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation _1 0'+ Water main 1 0'+ Water Service line 10'+ Surface water 1 00'+ Driveway, parking/vehicle storage 1 0 + Curtain drain 50'+ Wells on adjacent lots 1 00'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Kenneth M. Duffus Date 11/09/04 rACQ`•oF •A Lal ti 0, co CV 1 I *'• 4sn t 100 • IN•NNN •• fV:Peltr ±.: fps.' ork h k f:ti sa Enst Ate ficPRorEssloter HAA Fee $430.00 Date of Payment Receipt Number (Rev. 12/01) Waiver Fee $ Date of Payment Receipt Number p1_✓ix..ef 4' tip. ala -k ct n3_oY AS -BUILT I hereby certify that Ihave surve}^et the following {described , lar 7 2-'k Y4i- Xeproperty. r 9Lr'a /t , � NDY4"A/ K t u- y SM, Anchorage Recording Precinct, ..Alaska, . and that the improvements situated thereon are,withn the property lines and do not overlap or encroach on the property lying adjacent thereto, that no hnprovements an prop- erty lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except. as indicated hereon. Dated at Eagle River, Alaska thla ZS day of lit l -A 1977 ROBERT C. JOLiNSON s ' SCALE: Registered Land S No. 1110 -La r = tt,0' Box 458 Eagle River, Ar.a Phone 494-2843