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HomeMy WebLinkAboutZONA LT 138Aac7yNQ L4 So , hn 5y,\ UDs R i �, N Municipality of Anchorage On-Site Water and Wastewater Section - (907) 343-7904 Page 2 of 4 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP221143 PID Number: 051-152-19 Dwelling: 1❑ Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New 0 Upgrade Name James and Joyce Scott SORPTION FIELD El E] Wide Trench E] Bed F-1Mound Site Site Address 19968 Birchwood Lp Chugiak Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 D/SF Ft LEGAL DESCRIPTION Depth to pipe invert from original de F . Gravel depth beneath pipe Ft. Subdivision Block Lot Zona 138A Fill added above original grade Ft. G r-av I length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding _ Sewer Total absorption area Number of trenches h Dist. between tre es From Tank Field Tank Line Ft' Well >100' NA NA NA TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer greer Capacity 1000 Gal. Surface Water >100' NA NA NA Material plastic Number of compartments 2 Lot Line I >10' NA NA NA NA Foundation > 10' NA NA NA j LI ATION Manufacturer Capacity Gal. Remarks field sized for 4 bedrooms, house is 3 BR shop has toilet. Alarm location Electric ]led by PIPE MATERIAL House to tank 3034 drainfieldTank to 3034 Installer JRs Septic Drainfield CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection 1st 7/9/2022 „tl 7/12/2022 Location and description dates:2 bottom of siding point A 3rd 4,h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp '�A �4 OF ,q� Conditional Approval: Date k g� • 9�•F�f� e *: 49 TH. *�l auris L. � ' ' • • 7 • .. L Septic System,i`�PROFEss10Na��+ Approved Date Note: this approval does not include well permit requirements. (Rev 05/02/18) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 4 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: no permit issued PID Number: 051-152-19 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ❑M- Upgrade Name James and Joyce Scott SORPTION FIELD EDTrench E] Wide Trench E] Bed E] Mound Site Address 19968 Birchwood Lp Chugiak Other Phone Number of Bedrooms Soil RatingTotal depth from original grade 4 D/SF Ft LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe F . Ft. Subdivision Block Lot Zona 138A Fill added above original grade Gra I length Ft. Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Dista lines between Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between tre es From Tank Field Lift Station Tank Line Ftz Well >100' I NA NA NA TANK N Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1000 Gal. Surface Water >100' NA I NA NA Material steel Number of compartments 2 Lot Line >10' NA I NA NA NA Foundation j >10' NA NA NA LI ATION Manufacturer Capacity Gal. Remarks field sized for 4 bedrooms, house is 3 BR shop has toilet. Alarm location Electric i i Iled by PIPE MATERIAL House to tank 3034 Tank to drainfield 3034 Installer home owner installed 2006 Drainfield CO/MT 3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection n 151 7/9/2022 ,d 7/12/2022 Location and description 2 - ---- ---- bottom of siding point A 3d 41h ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date pF A(, *:. ............. '• Septic System �,� z zoz.�/ ?F0'l� Approves'— Date 2 L2' Ho.0 11 r PROFESS\OHS.► Note: this approval does not include well permit requirements. ��\\�a�•�� (Rev 05102/18) BLM 1136 — VACANT LAND BLM 135 — VACANT LAND \SL OPE 26% NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE O Cf) m n r - O F— EX11 TING FCO DCO E�15 EGA e EFF ,�;; °• j •`� ocol / 3 BR I HOUSE 1000 GAL STEEL SEPTIC TANK INSTALLED 2006, MANUFACTURED BY ANCHORAGE TANK SHOP W/I TOILET NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE ( I I I NEW PLASTIC 1000 GAL SEPTIC TANK REPLACED WITH THIS PERMIT I i I I I ! m 100 -WAY i I E \M ! O I I uI ! a �! I J i I SCOPE OF WORK 1. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1,000 GALLON SEPTIC TANK AND TIED INTO EXISTING ABSORPTION SYSTEMS. THE TANK WAS PROVIDED WITH MINIMUM 20" G MANWAY RISER SERVING THE FIRST COMPARTMENT. TANK WAS PLACED MIN 10' AWAY FROM FOUNDATION. 3. ALL CONSTRUCTION WAS IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. Septic Tank Record Drawing Prepared for '*r'qL`%Wjj, .•''E OF JAMES AND JOYCE SCOTT 2..••••"""" �P,'••••AV : 19968 Birchwood Lp Chugiak, Alaska 99567 Y`?e ZONA LOT 138A ; dQiH * �� OSP221143 :............J.s ........................... % EKLUTNA ENGINEERING, LLC �.. ... •••���D.•f DATE: 8/23/2022 r r •OIN URTI� TO'.. r.SEr�D: �: n �� �'•. t•io. t i'GOs :•fir 19162 MOUNTAIN ROAD DRAWN: CLT 1 �S j ,i Q CHUGIAK, ALASKA 99567' SCALE: 1" = 30' �� C ��.b ••''•• yi4W (907) 406-1058 X444 :;S`���.� PID: 051-152-19 SHEET 3 OF 4 % id �9dsZ ��7�6v /P6, 06 ASSUILT SMUM & ASSOCIATES LAM SURVEYING I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCFE` �� FOLLOWING DESCRIBED PROPERTY: '`� �''� .�'*�' DATE - AND THAT NO ENCROACHMENTS MST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE TUGt1 � � �,;,• � + ��� OWNER TO DETERMINE THE MCISTENCE OF ANY I3RID= �..... ....'"' ••..... � EASEMENTS, COVENANTS., OR RESTRICTIONS '.,��:�. WHICH D© NOT APPEAR ON THE RECORDED SUSDI- . Auena Mark Seward k 6 VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD FS' 9"4,�'•.. �- ,Gl •'' �'� ANY DATA HEREON BE USED FOR CONSTRUCTION �� •��,,$. N�,5�� OF FENCE LINES, OR FOR ESTABLISHING BOUND- ARY LINES. DRAWN= ,a/V 23 Rampart Dr. chorage, Alaska 99501 one 1-907-272-3543 Fax 1-907-277-3715 �-b Site: www.anchoragetank.com Jim Scott Billed To: Any Cash Customer Terms: Ship Via: Ship To: Invoice Number: 22359 Date: 08/14/2006 19968 Birchwood Loop Contact: Purchase Order#: Due Date: 09/13/2006 Re: FOB: Qty Unit Serial # Description Price Ext Price 1 EA TANK, SEPTIC 1000 GAL $1,220.00 $1,220.00 Notes: Thank you for your prompt payment! Total Invoice Balance: $1,220.00 MM&M CONTRACTING INC. P. O. BOX 670495 PH: 688-1236 CHUGIAK, AK. 99567 FAX: 688-1238 DATE: September 12, 2006 INVOICE TO: JIM SCOTT P.O. Box 670701 Chugiak, AK 99567 WORK: REPAIR TO SEWER AND WATER LINE: .................................. S4,500 TOTAL............................................................................ $4,500 THANK YOU INVOICES ARE DUE ON RECEIPT. 1.5% INTEREST WILL BE CHARGED ON ALL. OVER DUE INVOICES. MtJN ]CIPALITY OF AN CI{ORAGE *"- On.Slte Water&-Wastewater Program *- PO Box 196650 4700 Elmore Road Anch+rage, Alaska 995'19-6650 Fhona: {S0?) 343-7904 F€x (907) 343'7SS7 http:1/www.mu ni. org/onsite On-$ite \ftfastewater Disposal System Permit Permit Number: OSP2?1143 Work Type: SsptioTank Upgrade Tax Code Number: 051 15219000 Site Lega* Addrass: ZONA LT 138A G:1256 Site Maillng Address: 19968 S BIRCHWOOD LOOP RD, Chugiek owner: SCOTT JAMHS N & JOYGE M Design Engineer: HKLUTNA ENGINEERING, LLC* This permit is for the construction of: il Disposal Field M $eptic Tank fl Holding Tank D erivy Effective Date: Expiration Date: Lot $ize in Sq Fi: TotalBedrooms: 512612022 5ft612423 55255 il Frivate Well I Water Storage All construcfion.shall he in accordance withl 1. The aftached approved design. 2. All requirements'specified in Anchorage Municipal eode Chapters 15.55 and '1 5.6$ and the $tate of Alaska Wastewater Disposal Regulations (tBAAC7Z) and Drinking Water Regulations 3. The wastewater code requires inspictions during the installation. The engineer tho Development Services Department peierilC 15.65. Provide notification by calling (907) 343-79A4 Q4l7J. 4. From Qctobir 15 to April 15, a subsuface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, soaled, and heated to prevent freezing , i.:'_- . .... .. Special Provisions: The septic tank installed in 2006 wlthout a permit shalN be docurnented to close out this ' permit. Received Byr lssued By: MUNICIPALITY OF ANCHORAGE Development Services Department�-i �f° Phone: 907-343-7904 On -Site Water & Wastewater Section `�' Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 05115219000 Property owner(s) SCOTT JAMES & JOYCE Mailing address PO BOX 670701 CHUGIAK, AK 99567 0701 Site address 19968 S BIRCHWOOD LOOP RD Chugiak Legal description (Sub'd., Block & Lot) ZONA Legal description (Township, Range & Section) LT 138A Day phone Lot Size 55,255 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field F-1 Initial❑ Single Family (SF) Q (w/wo ADU) Septic Tank 0 Upgrade 0 Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal fkodes. (Signature of property owner or authorized agent) Permit/Rush Fees: -922 S Waiver Fees: Date of Payment:Date of Payment: Receipt Number: ON 19D Receipt Number: Permit No. 05,022 I 1 y 3 Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\C lie nt FormsTermit Application.doc Eklutna Engineering, LLC curtistownsend @ gma il.com May 26,2022 Subject: Zona Lot 1384 Upgrade SePtic Tank Permit osP22tL43 This is a design narrative for a permit to install a new septic tank on this property. The existing septic tank is 35 years old. The homeowner is desiring to install a new tank. The proposed system will serve an existing three (3) bedroom house. The existing septic tank will be removed and disposed of and a new 1,250 gal septic tank will be installed. Double cleanouts will be provided downstream of the tank. ln 2006 a shop was constructed on the property containing a toilet. A new steel septic tank was installed draining this shop without the benefit of a permit. This septic tank is connected to the existing septic field. lt is proposed that a new survey will be completed this summer when the 35 year old septic tank is replaced. An inspection report will be submitted at that time. Included in this submittal is an invoice from Anchorage Tank showing that this is a steel septic tank' t. Soits. The soil in this area is composed of layers of silty poorly graded gravel. A test hole had previously been dug during the month of September to a depth of 16'. No groundwater was encountered. Soif Absorption System. The existing soilabsorption system, vintage 1987, is a79'x2.5'x7' effective depth trench. This field is sized for 4 bedrooms. The field is holding 3" of water in May 2O22.The field will not be upgraded at this time. Welts. This lot and the surrounding lots are served by private water wells. MOA has documentation for these wells. There are no wells within 100' of the septic system. Neighboring Wastewater systems. lmmediate neighboring septic systems are all +L0' distant from property lines. Surface Water: There is no surface water within 100' of the tank. The proposed tank upgrade will maintain at least 100'from all surface water and drainage ditches. Topography: The existing topography in the area downstream of the tank has a slope of 26%. The proposed installation will not affect the future development of this or the surrounding lots. Sincerely, Curtis L. Townsend, P.E. Attachments L 3. 4. 5. 6. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221143, Rebecca Carroll, 05/26/22 B LM NEIGHL 1O' FR ^omla z----r.- r^r ?m =ho-IF -a Z. LUO I EXtS'l I I I I I I I I I 4 aiIJO VACAN T LAND BLM 1 35 VACAN T Nt\\qI NDtr CAq M \vlvr L zvaa if DRIVTWAY''r:------ . IOOO GAL STEEL SEPTIC TANK INSTALLED 2006.€MANUFACTURED BY IC lJ':!,J) TING FCO \ |tNcuoRAGE TANK.\ |enowoE DIUBLE\I CLEANoUTS DIWNSTREAM \ SCOPE OF WORK1. REMOVE EXISTING2, PLACE NEW 1,250 AND TIE INTO EXIS LAN D =IGHBORING SEPTIC IS > I, FROM PROPERTY LINE SEPTIC TANK TO BE REPLACED WITH THIS PERMIT, PROVIDE DOUBLE CLEANOUTS L_l .------@ m 00 N-) -a-) --J ^!Q r->f-l F ---] = )1a,Lrl SEPTIC TANK. GALLON SEPTIC TANK TING ABSORPTION IK IS TO BE PROVIDED O MANWAY RISERI COMPARTMENT. TANK J 10' AWAY FROM I TO BE IN ACCORDANCE VENTS SPECIFIED IN ;IPAL CODE CHAPTERS SHOP W TOILET WITH MINIMUM 2O,, TO BE PLACED MII. FOUNDATION. / 3. ALL CONSTRUCTTOT' (wtTH ALL REQU|RI I ANCHORAGE MUNIC I 15.55 AND 15.65. Septic Tonk Permit Drcwing Prepored for JAMES AND JOYCE SCOTT 19968 Birchwood Lp Chugiak, Alaska 99567 ZONA LOT 138A osP221143 TKLUTNA ING/NIIRING, LLC 19162 N/OUNTAIN ROAD CHUGIAK, ALASKA 99567(e07) 406- 1 OsB DATE:512612022 DRAWN:CLT SCALE:1" = 30' PID: 051-152-19 SHEET 1 OF 1 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP221143, Rebecca Carroll, 05/26/22 ►NCHORAGE TANK & WELDING, INC. '23 Rampart Dr. ichorage, Alaska 99501 lone 1-907-272-3543 Fax 1-907-277-3715 /eb Site: www.anchoragetank.com Jim Scott Billed To: Any Cash Customer Ship To: INVOICE Invoice Number: 22359 Date: 08/14/2006 19968 Birchwood Loop Contact: Terms: Ship Via: Purchase Order#: Due Date: 09/13/2006 Re: FOB: Qty Unit Serial # Description 1 EA TANK, SEPTIC 1000 GAL Notes: Thank you for your prompt payment! Price Ext Price $1,220.00 $1,220.00 Total Invoice Balance: $1,220.00 AIM&M CONTRACTING INC. P. O. BOX 670495 PH: 688-1236 CHUGIAK, AK. 99567 FAX: 688-1238 DATE: September 12, 2006 INVOICE TO: JIM SCOTT P.O. Box 670701 Chugiak, AK 99567 WORK: REPAIR TO SEWER AND WATER LINE: ..... ............................. 54,500 TOTAL ........... .......................................... I...................... $4,500 THANK YO U INVOICES ARE DUE ON RECEIPT. 1.5% INTEREST WILL BE CHARGED ON ALL OVER DUE INVOICES. q5 a q PROPOSED CONSTRUCTION PLAN NLtjEBY CERTIFYTHAT I HAVE SURVEYED � FOLLOWING DESCRIBE[) PROPERTY - AND THAT NO ENCROACHMENTS EXIST EXCEpT AS INDICATED. IT IS THE RESPONSIBILITY OF THE )WNER TO DETERMINE THE EXISTENCE OF ANY ASEMENTSr COVENANTS, OR RESTRICTIONS VHICH DO NOT APPEAR ON THE RECORDED SUBDI_ 'ISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ,NY DATA HEREON BE USED FOR CONSTRUCTION )F FENCE LINES, OR FOR ESTABLISHING kRY LINES. BOUND_ oG A UBMITTA: APR 10, 2005 SEWARD & ASSOCIATES LAND SURVEYING SCALE: _. DATE: / GRID: . iYry /2SG FB: 1111�1 zl-ipl DRAWN: _ lalll—f OF A4 or 4 LHF,* + A �• ��Ouerte Merk Seward tF iS-a9]8 ,r OR ar�G ' -': ~",, ~.,. MUNICIPALITY OF ANCHORAGE ~ DEl TMENT OF HEALTH AND HUMAN SER~ . Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES Address ' TANK FIELD WELL Phone(s} I Permd No. No of Bedrooms WELL ~ I ~ ~ - %~ ~J ~ ~ o ~ LOT LINE [ ~ I~ LEGAL DESCRIPTION Township, Range, Section AS-BUILT DIAGRAM (Show location of well, seplic system, property hnes, foundation, ~1~ ~ [ ~ / ~TANKS) ~- ~ J ~. Or,veway, water bo0,es, etc.) ~ SEPTIC 0 HOLDING ~aterial NO. of OompaAments TYPE OF SYSTEM ~ '- ~TRENCH 0 BED 0 W. DRAIN 0 OTHER /. ~ '~;'~ tO pipe bottom fromoriginal grade ~1 Total depth ,rom original grade /~ FT ~"(,X~ FiB added above odgmai grade Gravel depth beneath pipe ~' ~ ~' GraveJ length I Gravel width '~umberolllnes Soilrahng Plpemalerial ~ -~,~ ~ ~ WELLS ~ -~,~' .~ ~ ,.'. ' ~PRIVATE ~ ~t~ S ~ '- ' OTHER Hdentifv) Classdicabon ~.B.C) ' Total Depth Cased to ~ / ~ ~ ~ ~ ~ , ~. · REMARKS: S & S ENGINEERING " I ........ =. cmily I~at this insp~li0n was pedormed according t0 all ~. .:, ...... ,. ~ ~;~. ~unici~~e~k~l~s date: ~ ~/./ ~ ~./ ~ ./ He. II" Depadment Approval' Date' ¢-~'~ 72-013 (3/85) :!:NE;'IFfi..I... F:'E!:F;: IEN[F;]:NEi:ii:I::~E; :0E:S:L[3N~; "FF;'.E:NCX"I~, '7' X '75~' TO'T'¢d... DE:F'"fI"'[ :t.;?.' ,, F~E:F:'L.F!¢::;Ii:: iE X :i: !i!i; !' :!: NE) ,."Pdqi::: ~, ¢.:~Y'~¢~FI~:t(:.iN (:::F;: :I: :i:':~ Cdxi:0 I::: ]: I...L.. :.,r. N ,, i'.IC)T :i: FY ~:;'['ff'hi!; F:I::( :[ (::!!:~ TO Ei:NB):!: NEi:E:F4:Ei!; :i E~T ¢::fix['0 ?.hi)E) :[ NSF'Ei:E;T :!: ONS I:','i' ::!:'q ::!¢'' ':J- 6iiii :L ,, 1701154 7~ }'''} i tx! ,, f?i:: I Z E, CJF: Ei;E]:-;"t 'J' (.ii 'l Fdql::: ! Ei; :}. 5:f!:J:iO SCALE / DEPARTMENT OF heALth ~ hUMAN SERVIC~ 825 L Street, Anchorage, A aska 99502-065~~'~ .... -7 SOILS LOG -- PERCOLATION ~EST~>,,,~q ~:-.~ ,,?%: / L/~A ~> Township, Range, Section: LEGAL DESCRIPTION: Sl~ I 11 s L IF YES, AT WHAT O 1 2 DEPTH? p E 13 Monilorino?-&""~'-7 DaIe:~¢~/) Gross Net Depth to Net Reading Date Time Time Water Drop 14 15 17 18 19- 20- PERCOLATION RATE ~" ~ (minutes/inch} PERC HOLE DIAMETER t~' t~' TEST RUN BETWEEN.7 FT AND '¢~ FT COMMENTS /¢'/. ~ /,o£ ;,"/~ ~:~ ~~ : PERFORMED B~ ...... ~..~. oo~ ~ / ~/~ CERTIFY THAT~HIS T~T WAS PERFORMED IN 72-008ACCORDANCE(Rev. 4/85)WITH ALL STATE AND MUNICIPAL GUIDELI~~C, ON THIS DATE. DATE: Z4/://:/ Municipality of Anchorage 825 "U' Stroot, ~nchoraoe, ~laska ¢~502-0~50 SO~LS LO~ -- ~.COL*~O. TEST PERFORMED FOR: -- ~ DATE PER~~ 2 ,~r~ &. 3 4 7 9 10 11 12 13 14 15 16 17 18 19 20- ENCOUNTERED? s L IF YES, AT WHAT O DEPTH? p E Oept? t(~ Waler A~e~~'~7'~'.~:~.....,/ Gross Net Depth to Net Reading Date Time Time Water Drop ,-, //g . PERCOLATION RATE ~-' O (minutes/inch) PERC HOLE DIAMETER __ COMMENTS S & $ ?,IGJNEJ~RING PERFORMED ~ : er ~m~ .~5~ // / ~ / ~ CERTll THAT THIS TEST ~AS PERFORMED IN EagleRiv , // ~ - A CCORDANCEWITHALLSTATEANDMUNICIPALGUiDE~EFFECTONTHIS,EFFECTONTHISDATE. DATE: 72-008 {Rev. 4/85) Municipality of Anchorage. Development Services'Department Building .Safety Division On-Site Water ahd 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 ParcelI.D. 0.~1-152-1 '1. GENERAL INFORMATION Complete legal description Zona= Lot 1 HAA# Expiration Date: ~'- //'"' ~) ~ Location (site address or directions) 19968 Birchwood Loop Rd= Chugiak= AK 99.~67 Current Property owner(s) Mailing address Zona Dahlmann Day phone -6 8 8-2 9 2 9 Lending agency Day phone Mailing -address -- Real Estate Agent Les Ballev- Prudential Vista Day phone 689-6464 Mailing Address 166R~ Centerfield Drive= Eagle River= AK 99577 Un/ess otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3.' TYPE OF WATER SUPPLY: .Individual Well Individual Water Storage Community Class · Public Water System Well TYPE OF WASTEWATER DISPOSAL: [] Individual On-site [] Individual Holding tank [] Community On-site [] Public Sewer The Municipality of Anchorage Development Services Department (DSD) Issues Cedificates 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 thee 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 ENGINEERING, Inc. Address ,;20441 Ptarmigan Blvd., Eagle · Engineer's Printed Name Kenneth M. Duffus River= AK 99577 'Phone (907) 696-Blll Date 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 "T' Disapproved. Conditional approval for bedrooms, bedrooms, with the following stipulations: ~ · · a.-; ~, WATERAND - - " ~ ~ · .e ~'~ Maintenance Agreements . Supplemental EngineeCs Repod · Other Attachments: -. HAA Checklist Septic System Advisory Well Flow Advisory X By: Original Cedificate Date: -LegaI'.D!es!ription: A. WELL DATA 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/ PPROVAL CHECKLIST Parcel ID:. (~ 5 1 - 1 5 2 - 1 9 "ZONA'LOT 138A ' Well t~/pe Private' ;If A, B, or C provide PWSID # Well Log (Y/N)'Y/N* ' . _~ '.i! . ,, Date: :' ,'C~n~pleted: .~!i"~ PRE. 1960' Sanitary seal. (YIN)fy - , WireS. Properly protected (Y/N) Y Total 'd6pth 1 60,5 ft. : Cased to 40+ ft,~ casing height (above ground) 2 4" · ,i ii~'}i [: ~:-- ' ' FRoM:wELL'LOG ' :i' '- ' ' AT INSPECTION _.___Dai~-'~iv 't~t '" ' : ' 4/23/04. ' Static water level . ,. r . ft. ~' '" . :.. 105' -- ft. Well production g.p.m :~ J' '1.69 g.p.m. wATER SAMPLE RESULTS:' " ": - ., -ColifOrrh' ~!~i0 colonies/lO0 mI.Nitrate- '0.1 ~ mg./I.~)ther'bacteria 0 .colOnies/lO0 mi. Arseni : ~ mg./I. Date of sample: 4/Z3/04 Collected by:.KND ,Engineering B.' SEPTIC/HOLDING TANK DATA , ~ Tank~,~y~e/Uaterial ,' '~ SEPTIC/STEEl.,~ Date: installed' 9 / Z 3 / 8 7 ' 'i'~h~ Size 1 z so gal. ,.Number 6f compartments2 = Clean0uts (Y/N)Y !~ ~ ; : ~,t :ti: ,.-' · , ,: , 'I, :. ; · ' ; Foundation cleanout (Y/N) Y 'Depression over· tank (Y/N) N High. Water ala[m (Y/N) Iq Date!of Pufi~ping 4/:>:>/04: Pumper SANITARY C. ABSORPTION FIELD.DATA Dateiir~talled 9/:>3/87 S0il rating (g.P.d./ft~orft~/bdr. m) 275 Syst.em'type DEEP TRENCH Length ~9''~' , ft: Wicjth .2.5 ft. Gravel below pipe 7 ' '~ '[~ *. ~ : ~ ' ' 2 ~ · · ' Totalid, ~pthl, 12 ft. Eft. absorpbon area 1106+ ft Monitoring tube Y Depression over field N . Date~Ofi~id6quacy test ' 4/23/04 : ' ~:,· :·Results (Pass/Fail) PASS ' ::'For 4 bedrooms Fluidldepthi:in absorption field before'test DRY 0 in. ! Water added 600'gal. · New depth DRY 0 in. Elapsed ,Time:,O min. Final fluid depth DRY 0 in. Absorption :rate >= 600+ g.p.d. Any rejuven, ation treatment (past 12 mo.) (YIN & type~ N Jif yes; give date D.' LIFT STATION Date installed NA ., Size in gallons "pump on" level at in. "Pump off level at__ ":Datum .-. Cycles tested E. SEPARATION DISTANCES ~ : -. Manhole/Access (Y/N). :in. High water alarm level at · Meets alarm & circuit requirements? in. SEPARATION DISTANCES 'FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ On adjacent lots 1 00'+ Absorption field on 10t 100'+ On adjacent lots 1 00'+ Public sewer main 75'+ Public sewer manhole/cleanout 1 0 O' + Sewer/septic service line ZS'+ . .~ Holding tank 1 00'+ - . SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: . Building foundation 5'+ Property line .5 '+ Absorption field 5~+ · Water main 10'+ Wells on adjacent lots 100'+ Water service line 1 0 ' + Surface water 1 0 O' +. SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 1 0'+ Building foundation 1 0'+ Water main Water Service line 10'+ :Surface water 1 0 0 ' + Driveway,~ p.a. rking/.v, ehicle storage Curtain'idrain 50'+ - Wells on adjacent lots .1 0 0'+ Well data - ~ee attached 2-Daae schematic provided bv owner . , .~_~.~.~..~ ENGINEER S CERTIFICATION ;w ,- _ ~ · · · · · e e~oe.o eeo ; ce,ify that; have determ,ned through field ,,specbons and ~'~"~'I review of Municipal records that the above systems are in" = ,, . ~ ~ ~ ~.;~. conformance with MOA H~ guidelines in effect on this date. '~ ~ Engineer's' Printed Name Kenneth M. 'DUffus "~~~?i%t Date 5/6/04 ~ ~ HAA Fee $430100, Date of Payment Receipt Number (Rev. 12/01) . Waiver Fee $ '" Date of~ payment. , Receipt Number, BLM 156 BLM 135 N 89'53'57" W 186,00' I i o ~oo ~ EXISTING ,o .- I J rm o"° :': itz.?tZ'~ Imo NOTE: U') Z Several or,he dean out pipes for ~h¢ septic system were ~oca~¢d from th~ ~987 engineers ~por~ as there was 2 ~ of snow cover a! the time of~u~v~y and ~hey ~em not ~oca~¢d. LA~D SU~lq¥]~O * ]VL,~.P.PJNO * ~I'...~]N~ SURVEY ~F. RTIFIC^¥IO~: SENI~C I.~. has ~o.d.¢tcd 2102 CLFYF. LAND ^¥F. NUB TBL. # (~07) 243-9966 ,l~hy~i¢.lsuwcyot~i~i~ro~¢~.~ ~ho~o. ~isdrawi,g ANCHORAGF. AI_,ASIz, LA 995 ! ? FAX. # (90?) 243-9967 ,.d th.t th~ impro~m~.u ASBUILT OF: L~G^L LOT ! 3~A EXCLUSION NOT£S: to dctcrmi~c thc cxistcncc of any cascmcnts, ZONA SUBD[V]$[O~ covenants, or ~$tri¢lion~ which do ~ot ~ppcar on thc WORK ORDER NUMBER: OA~: SCALE: :-.^,u rccordcd subdivision plat. NOTE: Undcr no APR. 15, 2004 1"=50' sentec©gci.net circumstances should any data hereon bc used for thc VTD I MJH _ _ constmctio~ or for thc cstablishin~ ofpropcrty ii,cs. 4--30--04; 9:38AM; ;907 5615301 SGS Ref.# 1042045001 Client Name KND Engineering Project Name//; Zona Lot 138A Client Sample ID Zona Lot 138A Matrix Drinking Water Sample Remarks: All Dates/Times are Alaska Standard Time Printed Date/Time 04/29/2004 14:29 Collected Date/Time 04/23/2004 15:00 Received Date/Time 04/23/2004 15:40 Technical Directo.~ ,~hel~ C. E de Allowable Prep Analysis Parameter Results PQI, Units Method Container ID Limits Date Date Init Waters Department Nitrate-N 0.100 U 0.100 mg/L EPA 300.0 B (<=-10) 04/23/04 JJB Microbiology Laboratory Total Coliform col/100mL SMI8 9222B A (<=1) 04/23104 DKC ~-~ " APPLI("':NT FILLS OUT UPPER HA~ · ONLY Phone Mailing Address ~'~ Buyer /~ . ~ Add~s Zip Code Lendin~ Institution Phone Address Zip Code ~ealty Go. & A~nt Phone Address Zip Oode LegalDescription L~ ~ Type of Resi~nce ~ Single Family ~ Multiple Family No. of Bedroo~ ~ Other Water Supply  Individual A~ACH WELL LOG. A w~l log is required for all wells drilled since June 1975. Community ~ ~ For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal A ~nd]v,d~ Y.~ ~.d,v~u~ ~n~t~,ed: / ~ Public ~ility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPEcTION-FE~ MUST-ACCOmPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Date Dat~ Date Ins~'ector ...~ector _ )~._ ~ DFPT. OF [':' LT" ,°' ( ~ APPROVED BEDROOMS OF APPROVAL ( ) DISAPPROVED ( ) OOND. I. TIONAL APPROVAL* / DATE Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.023 (3/82) EXCAVATION ROBERT A. SHAFER WORK January 1, 1982 CIVIL ENGINEER 694-2979 Peter Dahlmann SR 1 Box 2479 Chugiak, Alaska 99567 Dear Mr. Dahlmann, · --Reference: Lot 12~8A: Section 8~ T15N: R1W: Vona Subdivision A sewer system adequacy test was performed on.the system located on the referenced-property, as you requested. .The septic tank was pumped and verified ~to have a capacity of 1000 gallons. The absorption area was tested by a . continuous flow of water .over a period of 24 hours without any adverse effect on the system. It can be concluded from this test ~hat the waste water disposal system servin~ th~ three ~edroom residence located on this property is currently functioning adequately. However, the system cannot be guaranteed against subsequent failures. 'If we may be of further service, piease do not hesitate to call. - ~c~c~/S;unm c ~P~i 1 itY o f Anchorage " Department of Health and Environmental Protection SRB 196X EAGLE RIVER, ALASKA