Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
T12N R3W SEC 9 LT 15 W2
T12N, R3W, Section 9 Lot 15 W2 #014-172- 09 Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page of ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211248 PID Number: 014-172-09 Dwelling: ® Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New ® Upgrade Name DANIEL & ROSA CAMPOS ABSORPTION FIELD El Deep Trench El Wide Trench ® Bed E:1 Mound Site address 2716 LORE ROAD, ANCHORAGE EJ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.8 GPD/SF 8 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 7.5 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot 15 W2 Fill added above original grade VARIES 0.42 - 1 Ft. Gravel length 50 Ft. Township Range Section T12N R3W 9 Gravel width 15 Ft. Beds: Number of Lines 3 Distance between lines 5 Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 750 FtZ -- -- Ft. Well 100'+ 100'+ 25'+ TANK ® Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer GREER Capacity 1250 Gal. Surface Water 100'+ 100'+ Material HDPE Number of compartments 2 Lot Line 5'+ 10'+ NA Foundation 10'+ 10'+ LIFT STATION Manufacturer Capacity Gal. Remarks EXISTING SEPTIC TANK DECOMMISSIONED Alarm location Electrical installed by Installer QRS PIPE MATERIAL House to tank 3034. Tank to 3034 drainfield Drainfield 3034 CO/MT 3034 Inspector FWC BENCH MARK (Assumed elevation) 100 ft Inspdection 1st8/19/2021 2nd 8/20/21 Location and description 3`d 8/20/21 41h 10/4/2021 TOP OF MANHOLE ON-SITE WATER AND WASTEWATER SECTION APPROVAL �l Conditional Approval: Date t� *: 49TM ....�:*� •••• •••••••••• Septic System Approved Curtis Huffman - �F6is CE 128991 Date _/ ` 2 V `5 f •. • • •.���� % 10/4/2021. • F�pF'0 p ..... ���� AM' `t ROFESSION,` Note: this approval does not include well permit requirements. ' x'6. 1 MCV VJ/VL/ 10) PID: 014-172-09 A—C=55,2' B—C=45,0' A—D=59,0' B—D=48,8' A—E=64,0' B—E=53.9' A—F=68,1' B—F=57,9' A—G=56,5' B—G=51,6' A—H=60,3' B—H=60.5' A—I=108,9' B—I=104.1' A—J=107,2' B—J=99,5' PERMIT DECOMMISSIONED EXISTINI S.T. & INSTALLED NEW 1250 -GAL HDPE SEPTIC TA WITH NEW DCO & 50' X 15' FCO OSP211248 DCO CO p MT MT p CO II F/- /-FINAL GRADE I I H � ORIGINAL FILTER FABRIC 2' V V' 1,250 -GALLON 91.05 0.30 90.30 SW HDPE TANK SEWER ROCK SEPTIC SECTION 19, SCALEi NTS 78.80sox 1 7/3/21 DRY NO GRND. WATER SUPPORT SERVICES: T � 3W SEC9 LOT 15 W2 ® ®®®®\ 'PREPARED FOR: ®�� OF ALAS DANIEL & ROSA CAMPOS ���' 2716 LORE ROAD w ®* TH ANCHORAGE AK 99507 M s FIRST WATER CONSULTING 13030 SUES WAY ANCHORAGE, AK 99516 907-350-9566 firstwaterAK@gmail.com DATE: 10/04/2021 rtis Huffman a SURVEY: FRONTIER )1104 DRAWN: FWCS � X 10�4�2 91 yipAf SCALE: 1" = 30' n O M 00 m U L0 E w a) E O i�•I •t \ O t a I \ IN N Li D-0 N N O a) W N O E W N nM J O > c c olvoo ZSW9 3d69,L0.00S O LPA I ° a) 01 I O_ CIO 2:3 oa) yew Z Zd L'St�G 6'bb N N 0 0 m 3 0 N M a v t CONCRETE .DRIVEWAY O I N, �,��..,! '(VS!� 7 7 0 C 0 L, •,� j r• M _ co O p � 2D. =03 cc o Go Voz Y1�:i•� N O m L1 �,�� N / W� N � >�- Li O co !n C a) U Lo L + o ad �� 1 `V u V)i DIRT Lc) DRIVEWAY LL O vC M� ow moo N y co U �LLN -j a) CCm G Q) h E y co -(-01 '^ � m 0 @ m V i N Q NMN M ° v C.-) CIO 4 Q O` 00 cL Cn N o N Iw Q,.�/ m >_. OD a CL to 1� 0 Z3 n J J � = I i L A E N U L N N U =3N U98 86"9Z9 M.9ft,L0 o00N >' O m o Y . R.O.O.W. ~ � T m I a) �- a cn N L N a) N N C D E m a) IL i C > m O. 0 L o N D p C C U W m L N pQ N C O U w, m 0 O L =p — LD Y T m N N U m !!) p N u w N Q Ln C5 O 4� (D� I m \-•1 c � a' u 1d) c n o F Q� aLr, d� I - J N aa) 1 V V I li N N N i C n O � aNi 00 m U E w a) E O i�•I •t t N a aoi o E c W O N Li D-0 N N O a) NZ E 1"rT`I O > c c O i✓ st N Nm3m �� aai a) N 2,! C O_ U 2:3 oa) N N 0 0 m 3 0 N am_ o 0 a v Z�Nco 7 7 0 C 0 L, N 0 m Ln 2D. =03 o N O m (1) � >�- co m J co !n C a) U Ol vp pp N ad �� C N > L �6 o3N u �p cna Ln rn Q? ow moo N m (� N -j a) CCm G Q) h E y T .`o m E m y '^ � m 0 @ m V i N Q L Q O` a)N O N Q,.�/ m >_. OD a 1� 0 Z3 Q U J~ 7 C U T ;F C i L E N U L N N U =3N >' O J W O O o Y raci 3 ~ J d � =@J n c m O .3 `o s 9 a) �- a cn N C 4 N a) N N C D E m a) O �•, 1 > c—I i C > m O. m E E N 6 >.m v 4-Ja) o N D p C C U O m L N pQ N C O U w, m 0 O L =p — LD Y T m N N U m !!) p N u w N Ln >• 2!E Ln C5 O 4� (D� N o L',w 3 m \-•1 c o N c n o F Q� aLr, d� ^ 3 �rn 3 N aa) 1 8= a) m li N N C O. .0 O a N..• a N m O16 C a ° Q m C ui i % /// Ln C V` •p ' 'C Z I � N Z rn2 O ° � o O _� U N Q N N Q F++d m c / o (n r N O C O rn a) N v Z W ; .• O .� LL N cr 'A .•• O a Z a °N0E=o ` H W Q Q �%1w�W,�``\ (D 1-:(VMIli MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211248 Work Type: Septic Upgrade Tax Code Number: 01417209000 Site Legal Address: T1 2N R3W SEC 9 LT 15 W2 G:2234 Site Mailing Address: 2716 LORE RD, APT 000002, Anchorage Owner: CAMPOS DANIEL & ROSA Design Engineer: FIRST WATER CONSULTING This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date cnr dol .s 5:1 � r DeI)artment Lot Size in Sq Ft Total Bedrooms: 7/14/2021 7/14/2022 103332 ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The percolation results are < 1 min/in. See the Spurkland sieve in the file. 9 CQ � �ey�9rt ncct.ngej +0 a /5'x50; bed, CIe6oi&tt5 On bo�'h ends D ecuc, G�iSfrt}�n'jto✓1 ('ne- )PM I'/ S�zd/z � Received By: Issued By: Date: Date: MUNICIPALITY OF ANCHORAGE 0 Z Development Services Department `�' Phone: 907-343-7904 On -Site Water & Wastewater Section - Fax. 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 014-172-09 Property owner(s) DANIEL & ROSA CAMPOS Day phone Mailing address 2716 LORE ROAD, ANCHORAGE, AK 99507 Site address 2716 LORE ROAD, ANCHORAGE, AK 99507 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T12N R3W SEC 9 LOT 15 W2 Lot Size 103,332 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field Fx� Initial ❑ Single Family (SF) 0 (w/wo ADU) Septic Tank 0 Upgrade Z (D) El Holding Tank ❑ Renewal ElDuplex 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 Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: J`� yJ Waiver Fees: Date of Payment: oh-ot /21 Date of Payment: Receipt Number: 2 ! q 2- � 5 Receipt Number: Permit No. OS p a j j� y S Waiver No. GADevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc 13030 Sues Way, Anchorage, AK 99516 907-350-9566 / firstwaterAK@gmail.com July 8, 2021 Municipalities of Anchorage On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: SEPTIC SYSTEM UPGRADE PERMIT LEGAL: T12N R3W SEC 9 LOT 15 W2 The property owner has requested we obtain a permit to upgrade the failed septic system of the above referenced lot. We propose to install one deep trench and 1250-gallon tank to serve the existing 4-bedroom residence. The design is based on the recent test hole conducted on June 22, 2021. No groundwater was observed at test hole excavation or monitoring. The slopes are flat at the proposed upgrade location. The lot and area are served by private water. The design will not impact any of the neighboring properties. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211248, Deb Wockenfuss, 07/14/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211248, Deb Wockenfuss, 07/14/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211248, Deb Wockenfuss, 07/14/21 4661 13030 Sues Way - Anchorage, Alaska 99516 Tel. 907-350-9566 firstwaterAK@gmail.com SOILS LOG - PERCOLATION TEST LEGAL DESCRIPTION: T12N R3W SEC 9 LOT 15 W2 PERFORMED BY: FWCS / FWC - I CURTIS HUFFMAN CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE & MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 7/2/2021 DEPTH FEET OG SOILS 1 ORG/OL 2 3 4 SW 5 6 7 8 9 10 GRAB SAMPLE @10 11 12 13 14 15 16 17 18 19 20 BOH Reading Date Gross Time Net Time Depth to Water Net Drop 6/22/21 2 min 6 6 2 min 6 6 2 min 6 6 PERCOLATION RATE <1 (MIN / INCH) TEST RUN BEWTWEEN 4 & 5 FT PERC HOLE DIAMETER 6 PRE-SOAKED PRIOR TO TEST & ALL READINGS TO THE 1/16TH. GROUND WATER ENCOUNTERED: NO IF YES, AT WHAT DEPTH: NA DEPTH TO WATER AT MONITORING: DRY DATE: 7/3/21 TESTHOLE # 21-1 DATE PERFORMED: 6/22/21 SEE SITE PLAN FOR SLOPE & LOCATION COMMENTS: FAST PERCOLATING SOILS SW INSITU MATERIAL SUITABLE AS FILTER VERIFY GROUNDWATER MT AT TIME OF CONSTRUCTION PERFORMED FOR: DANIEL & ROSA CAMPOS 7/2/2021 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211248, Deb Wockenfuss, 07/14/21 N Scale 1' = 40' LOT 16-A Frontier Surreys, LLC Project No: 20.394 Date: 8/24/2020 Ordered By: Billy Hughes Plat.72-Ss3/B ----T-------- C LORE ROAD ----- ;bc Oto �c, . � EDGE OF ser plum t" Big 89.i 7 37. f 226 '1►� 2P-3, f21 _ N SHED N FlREPfr �gg `2% L Is, Wj Lot 15 r1b T 12N, R03W, Sec. 9 S.M. 103,332 Sq. Ft. +/- 2716 Lore Road 1 Story Wood Frame Nouse With Attached 2 Car Garage NerSrMrE 18182 GLQ XElectric Meter/Outside Power 0 Concrete Grid: SW 2234 218 f EZ LOT 15 "s 24 Gas Meter ® Deck m- Fence [$; SepticiUllj Water Well IL2]r Mailbox 6 20 40 80 General Notes: r l 2 Excepting for negligence, the liab1 y for tNs survey shall not exceed the cost of preparing this survey Scale in Feet 3. All rncasuranhmdalealbacha are to Ilm w=apparmhl bmlding footprint Big 89.i 7 37. f 226 '1►� 2P-3, f21 _ N SHED N FlREPfr �gg `2% L Is, Wj Lot 15 r1b T 12N, R03W, Sec. 9 S.M. 103,332 Sq. Ft. +/- 2716 Lore Road 1 Story Wood Frame Nouse With Attached 2 Car Garage NerSrMrE 18182 GLQ XElectric Meter/Outside Power 0 Concrete Grid: SW 2234 218 f EZ LOT 15 "s 24 Gas Meter ® Deck m- Fence [$; SepticiUllj Water Well IL2]r Mailbox 6 20 40 80 General Notes: 1- This document is created for the purpose of a single property transaction and is subject to Federal Copyright Laws - 2 Excepting for negligence, the liab1 y for tNs survey shall not exceed the cost of preparing this survey Scale in Feet 3. All rncasuranhmdalealbacha are to Ilm w=apparmhl bmlding footprint 4. All dimensions to property lines are Plus7rnlnus 0.1ft- This survey complies with the ASPLS Mortgage Location Standards- The survey represents visible improvements and -„»►�►1t1 S lr tet• O IF r r1 conditions at the time of the survey. This document does not constitute a boundary survey and is subject to any inaccuracies that boundary reveal tis the respmvb" of the flamer to determine the 1 ^ QS • -: 4s rrr a subsequent survey may existence of my easements, covenants, or restriction which do no appear on the record plat. Under no circumstances .r• '-.'���►� should this dommentbe used for construction orfor establishing a boundary orfnce line. +=y IL �I _ 4?lH * ; As -Built Survey of. '. W1/2 Lot 15, T12N, R431, Sec. 9, S.M. I, Pierre Sttagfer, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on August 18th, 2020. ---•.:---:-•---- rrr �Gl -• ad.l3secx rrr oe(ssl�ozo 'tit'�ut' ;ht►aa t`��• Frontier Surveys, LLC FRONTIER 550 W. 58th Ave. Suite E Anchorage, Alaska 99518 907A6P.1685-1rllc0fro h*Pl;l;4mv y&z= PROFESSK)MALSEAL weeh'ier.$ alta dvKn Municipality of Anchorage Page _, I 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: ~'~ .,=~ PIDNumber:.O/~- ~7~' ~ _ N.~: ~-~'~'~,Ti~°~5' ~ Wastewater System: ~New U Upgrade ~3/(., I~.E ~p ABSORPTION FIELD Phone: ~ ~¢~ IN°'°I~drOOms: ~DeepTrench ~ShaliowTrench ~Bed ~Mound ~Other, Tolal Depth from original grade: Lot: Block: Subdivision: )8p~h 1o pipe bolJom from original grade: Gr~vel depth beneath pipe WELL: D New ~ Upgrade Gravel~: ~'o/~ Numberoflines: ~DistSllCO~tweenllnes: OlasMflcat[on (Private, A,B,C); Total Deplh: Cased TO: Total absorption area; Pipe matedah Yield: GPM Pump Se~ at: FLI] Casing Height Above Ground:Ft. TANK SEPARATION DISTANCES ~.pt~o u Ho~di.g U S.T.~.P. TO Septic Absor¢ioa Ldt Holding >ub~ic/Prlvate Manufacturer: Oapacity In g~llo~s: Material: ~ Number el Compartments: s~,f~c. + 4. LIFT STATION Water [ ~ J ~ CurtainDrain ~ ~ 0 ~ ~ -- Pump Make & Model ~ E~ectrlcal Inspections pedormed by: Remarks: BENCH MARK I I " v ~--] Assumed Elevation: J~ ~_ ~,. E~INEER~8 SEAL 2nd ~¢ ~, Department of Health and Human Services approval Reviewed and approved by: ~ ~ ~ Date: 72-913 (1/91) MOA 25 APP~gD)C EDgE 12F,S~FAYP SEP TIC ~ole TBBBEN SPURKLAND P,E, 203 W 15TH, AVENUE ANCH, AK, 99501 S£ALE; i' -- 50 iF i/~~ LfTT 15 SEC?IDN 9 ~i~N R3~/ SEPTIC SYSTEM ASBUILT ~ATE, DE~ 2~ 1992 SHEET, 2/3 6RID, 2~24 5O Monitor Clean Standard Trench~ 1£50 9al /'c tank 50' Lon9 13' fleep 5' Sewer rock 7' Cover ND SCALE Mira£! 140 5 £t o£ Septic Rock mn TBBBEN SPURKLAND P,E, ][ 803 ~15th Ave II Anchor~§e Ak 99501 /Cleonouts Monitor LL __/ ND SCALE W/3, LD1- lS SEC, 9 ?IP_N ~93h/ TOM KEENAN £716 LOBE A)DA~ i£50 9al, s~t!C ~:a~k CIJNO~TE STOOP: ELS~ lOaO0 FE ASSUME~ SEPTIC SYSTEM DESIGN 9ATE, JA~ 3, ]994 SHEET, 3/3 GRin, ~34 .. SF"L.~-=:ZiL ~-~IZ) F~ .. E~_Z_ 205 NESE iS, TH. AVF. NUE SUITE 203 ANCHDRRGE, ,qLF~SK~ 99502-5904 (907) 279--3916 Fax (9(17) -276-8033 LIt_GAL: Wl/2 Lot 15 Seckion 9 ]I2N R3W LOCAT I ON ~ OWNER: FYPE [)F t,,,IEI__L: 27t6 LOr'F_~ Road ]homas I<eenan Private, Single Family WELL LOG AVAILABI_E: No INBTAI_LATION REQUiREMEN]S FIE] :Yes WAIVERS GRANYED: None NeF_,ded YIELD i;ROM WELl_ LOG: Gallans per Minute F'UI¥iP YIELI) FROM ] ES /: 8.5 Gallons per Minuke i)A'tE Of:' INSP'EC] ION: Jaeuary .:.6~ 1994 TEST PROCEEOUFd7: Well was pumped a'k a (:onstant rate while the dra~down was monitored with a~l acoustic_ probe. At Lbe begientng o{ the, test water level was found ak 56 -~eat below top o.F casing. At a pumping rake o-~ 8.5 gallons per frei. hula the water- level stabilized at Zo i-mat after 45 mtnutes of pumping. A total 670 gallons were pump~=,d in 70 minutes. ]he well rmcovered 'kc, 57 TEST F:EIR [:.COl_il AND ['[)TAL. NITRUGEN: WaLer- was tested .Eer E.Coli and Lotat n~trogen on JarH~ary 26~1994- E.Coli O. ]'oral Nitr--eg~.~p, U.22 mg/1. Max,. allowable Total Nitro~en lO mg/l. ESI' RESUL ES: I hi e wet 1 meets, khe r eqt.ti remenLs o-¢ the I,lunicipaliky o-E Anchorage.. THiS WELL WILL PRt]DUCE NORE THAN ~ GA LONS F'ZF,: MINUTE FOR MORE ]he Hunzcipal requir-f-~ment {or well flow is 150 gaticn~s o-f water- per bedreom per day. This well exceed thim requirement, l'he cundiizions ae o'E the day tested. 'Ibm Ytow Fake clay change dime to subsur~:=~ce conditiolas that may not be (mbserved ~r om the eur.face, and changes in the land l_t~¢m and el_her factors kbat may impact the aqui{er 4:emdi~g the well.Kd'~p PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920043 DESIGN ENGINEER:TOBBEN SPURKLAND, OWNER NAME:KEENAN THOMAS S & OWNER ADDRESS:2716 LORE RD ANCHORAGE, AK 99504 DATE ISSUED: 3/27/92 P.E. EXPIRATION DATE: 3/27/93 PARCEL ID:01417209 LEGAL DESCRIPTION: T12N R3W SEC 9 LT 15 W2 LOT SIZE: 103332 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 TNIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: THE ATTACHED APPROVED DESIGN. 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). THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISioNS' ~-/~ ~ RECEIVED BY: .~//~/Z~-~~[~ ISSUED BY: ,/-~- ;i~t--r~/~ ~ ~//~ ~ '~ .... DATE: '~7/~ ~ 203 W 15th. hvenue, Suite 206 ANCHORAGE, ALASKA 99501 (907) 279-~916 I~ Il J' 2 SEPTIC SYSTEM DESIGN LOT 15 $;EI~ 15 T12N TOH KEENAN No Gl-'(]und Water' or' Iml:)erviol.ts Layer '~o 17 -Ft. Lh;;e Standar'd ]'r'er~ch Soil Ratin(;). Fr'om test F:eb. 12~ 1992 .5m~ ri/in ]..2 ~;]a]./mi n No't:.e~ This sandmateriaI will sat:Ls~y the intent of the Idunicipal Code with r"el;la~cl to ~il~r'a~iion and tr'eatmer~t o'F 'bhe septic '~ank e~:'Fluen'b. ReqLiir¢_~d Area per Bedr'oorn." 150/1.2 125 sq ,..F'I: ,, . Finished F].oc>r Elevation LcD~est Flexor (Dr-c)t.~l]d Sur"-Fa(]e at Absorpt i tin I=':L el d 'J"E)sthc)l~2 '['c~al D6~plch :l. 7 I_ess 6 ~:eet Less Cover 5 Rock Depth 7 1 O0 103 86 92 Nt..trJlber c:)¢ Bedroorn~. 4 Length SYSTEll CDNFI611f-~I:ITI {IN OPTION 11 STANDARD TRENCH TOTAL LENBTH 56 FT. TOTAL DEPTH 10 FT. ROCK DEPTH 7 FT. COVER 5 FT. SEPTIC TANK 1250 GAL. ABANDON EXISTING SYSTEM PUMP AND CRUSH EXISTING TANK PUMP, CRUSH~ AND BACKFILL EXISTING PIT Septic System Des:i(_]n Wi/2 I_.c)t :15~ Sec. 9 -F12N R;J.",W OPTION 2 WIDE TRENCH WITH ~TEF' TANK 3-feet of rock Reduction factor .64 Length of trench: 125x4x.64/5= 58 WIDE TRENCH TOTAL LENGTH TOTAL WIDTH TOTAL DEPTH COVER 58 FT. 5 FT. 6 FTi 5 FT. 5 FT. SEPTIC TANK I500 GAL. STEP ABANDON EXISTING SYSTEM PUMP AND CRUSH EXISTINS TANK PUMP, CRUSH, AND BACKFILL EXISTING PIT The installation of this septic system will not from be installed en the adjacent lots. prevent wel] There are no developed surface / sub surface drainage courses this or the adjacent lots~ ]'he proposed septic system will not change the general slope the area. Ponding and/or concentration of surface runoff will result from this installation. The wetlands on the west half of this lot is classified as Deve] opable wetlands. Due to the heavy snowcover at this time it : not possible te determine if any surface water is within 100 fe~ o~ the proposed septic system. This determination must be do~ during or after breakup. If standing water is found within ti required 100 feet separation distance, this water can be eliml nated by localized placement of fillmaterials. Septic: System Desigl-~ t,Jil/2 I.o(~ 15, S(.:)(:::,, 9 ~ TIC APPREX, [B6[ OFi$1VAMP el~ o dO3 %/ ISTH, AVENUE ANCN, Al<, 99501 6' deep 1500 STEP TANK ~ i 1P.50 GAL SEPTIC ?ANk tiP TI[JN NLT, £ ~TP 3 tondard tr'ench 10' deep 7' sewer hock 36' Ion9 97 9 ~. o~, , c,...2~s . ~,~ / ~t, ~tTo~e'C3~~' ~ E5 50 75 I00 125 SCALD l' = 50 FT, EI'VISE'Bt MARCH 26, 199p F~ I/£ LET 15 SECTION 9 TIpN R3~/ TOM KEENAN SEPTIC SYSTEH DESIGN DATE, FEB, £4 1992 SHEET, ~o/3 GRID, 2234 L[]RE APPN£X, £7)6E DF SWAMP --~' I -T I 1617 TI']BBEN SPURKLAND P,E, '50 ~00 150 SCALE: I' = lO0 FT, Iv' 1/£ LOT 15 SECTIDN 9 H£N R3~/ T£M KEENAN £$0 $00 SEPTIC SYSTEM DESIGN I)ATEI FEB. £4, 1998 SHEETi 1/3 ORI3, ££24 m Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST (ENGIN[-' ER'S SEAL) PERFORMED FOR: LEGAL DESCRIPTION: 1 2 3- 4- 5- 6- 7- 8- 9- 10- 11 17 18 19 20 DATE PERFORMED:' Township, Range, Section: .~"' C- ~" '~"~/~2~,/~! '~ ,7 SLOPE b~O. ,9. WAS GROUND WATER ENCOUNTERED? SITE PLAN I N S L IF YES, AT WHAT DEPTH? pO E f~onitoring? I¢'t ~r-- Dale: _ ~-- Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE ~ ~) (mlnutes/*nch) PERC HOLE DIAMETER TEST RUN BETWEEN _ FT AND _FT COMMENTS PERFORMED BY: ' ~ -(~ I CERTIFY THAT THiS TEST ,WAS EERFOR ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE. /~ ~' L//, ] ,~ ~_~ 72-008 (Rev. 4185J 205 WiSTH, AVE, SUITE 206 AWCIIO~AGE, ALASKA 99501 SPECIFICATIONS FOR SEPTIC SYSTEM INSTALLATION W1/2 LOT 15 SEC 9 T12N R3W 1.0 GENERAL ]...:1. Owner is -Ina Keei-lal]~ ?.'Z].6 Lore Read~ Anchorage~ Alaska 9950'? ~ F:'herle 344'.'~S903 ].2 Engineer is 'the person of entity hired by the Owner to inspect th~s project.. The Engineer must be recognized by the Nunicipality o.F Anl:dqc:lrage,~ Department of Health and Human Sc0r'vi c. es. 1..3 Contractor is the per,_.'ion or enk. ity hired by the Owner- · [:cl install tills pr'oject. The Contractor must be recogn:i, zed by the Municipality o'f Anc:horage~ Del]artment of Health and Human Serv:i. (:~e~i~. 1.4 The I}raw:i. ngs~ sheets 1 through ~i!~, sha].l be part I.~f this speci'f i cati on. 1.5 Ali mater"ials and workmanship sha].l meet the r'equ:Lre- merits of the Munic:LpaiLity of Anc:horage~ Departmerr~ of Health and Humar~ Services, the c:onditions of t. he pereit, and a].l applicable rules ac, d regulations currer;'{:].y :i.n ],,6 Ali exc:avat:Len depths are advisery~ and are to be veri-Fied and may be modified in the .Fiel. d by the Engineer. 1.7 It is the respon!~ibility of the Owner er the Contractor 'kc) adhere to the approved design~ to ver'i'~y that the speci- f:Led separatien distances are met~ anti that the r'equired inspe(:tJ, ens L,~l"e performed. :1..8 '['he~ Contractor or the Owner sba].] r'epor'k te the Engi- neer any c)[:)~!%er'ved conclitior~ %.o["JicJl WOk~lcJ pk.lt '[][][~ septic: sysLem :Ln viei[ation o4: State or Iduni(:il~al re(~ulab, ions. 2.0 SEPTIC TANK 2.:t ]:¢ 'f:her'e :i.s an exis'L::i.n(] sept:i.c tanh:~ :i.t may be used i-F ii: mc]et:s t:he (:apac:Lty i'-(.:~(:]eiJ'-EeffJ~?nt {:C:)U th6~ ro?t~id0}nc(e. 'l"ho Lank ~ifl'ia].] I:)~.:, il"~spec:tc.td by the Engineer.~ and its wa'k:er I:.JgJ~l:n(~)5~,~5 ,:~l(] stru(::tLu"al integrity shal 1 be war-i FJ.e(:],, 2. 2 A nc.:t*o sept:i c: rani:: sha], 1 be [:il"lB fal:)r' :i cared by ei ti'let' Anchorage Tank and Welding er by Greer Tank Spec:i-f::Lcat:Lons ~:or ':~epti(:: system insta].lation WI/2 Lo'l: 15 Sec::. 9 T12N R3W The septic tank shall be a [JPC-approved twc~-compartment tar'H::~ censtructed o~ :L2 gauge~ or I:~etter'~ steel with bitu mastic coating.. Tine tank shall be set level on undisturbed so~ :1 . Fha tanl.:: shall be covered wi~:h t. he (:,qs:i. va].ent c:)-[ ~:our fee'L oF seJ 1. 2.3 Ihe sepl::i.c Larlk shall, be install, ed a minimum of five +eat ~r(:]m the house ~oundat:ien and a minimum o-F ~iw~ .feet Erom the al:)sol~pt:[c)n area. 2.4 The s~.::¥:)t:i, c: tam][:: sha]. 1 be a mi i"lJ. ml.~m o~ 100 ~ee~'. ~rc]m any well serving a single residence; 1C)0 'Feet 'From any body water'~ creel=:~) or clr'a:i, nage alit. thcs with ~:lowing water; 150 ~:eet erom Class "C" wells~ and 200 feet ~:rom Class A or Class B wells. 2.5 Ail pipe connec:LJons to the tank shall be mechanical water"tiqht c:alder" couplings. Cleanc)uts shall be install, ed as designa'Led and cal::)l:)ed with a~r-ti~ht rain caps. Clean--. C)llts shaZLl exl:end a minimum o+ 12 ir'lc:has above +ilia[ gl"Ol.lnd e)evaEion. Pr'ov:i. sic)ns shall, be made ~c)r' ]andscaping ar'uJ impc]l'"Latiol~ ~'~ tol:)soil . 2.6 [...:i~t s~:at:i, on sl'lall be as manu~:ac::tured by Anchorage Tank and Welding ~.0 ABSORPTION FIELD 3.1 Gravel L~_?~ecl :i.n the absorption +ield shall be 0.5 te 2.5 :~ncl'~ s¢:reened r*ock~ with less ~:han 3% passing the No. 2C)0 3.2 Sanc:l~ used ~c:,r' l~veling or ~c)r +Jlter:i. ng~ sha].l have an e.f~:ec:Liw~ grain size between No. 4(/ sieve and Ixl~. 1[] sieve. [lni*Fc)rmity c:oeff:i.c:::i, enL shall be less 'Lhan 4. Net mor'e than 5% by weigh'l: shall pass the No. 200 sieve. 3.3!. 4-incl'l per,orated pipe shall be AS'FId F810. Far pres-.- SLLI'"~.? dis'Lr"ibl_t'~ion~ I]ip~-' shall be Schedu].e 4() PVC or ABS. 3.q Solid 4-inch p:ipe shall be Fi]st Iron c)r AS-FM D3034. 3.5 Mol]itor standpipes si]all I:)e installed as shown. Tha'L section o*F the pipe penetrat:i.r~g the gravel shall be per+o- rated~ either I:]y drilling 0,5" holes (]1] 6-'il](:h c:eFY[er"s or []y jo:[I]Jriq a s(~ac:t:ion c).F [::'[:}1C) i]¢:2r~orated pile '1:(::) /~ solid ~L~ecL:i. or] o'F p i p e, 3..6 Geo'h~:~.xti]e sha].l be Idira~i 3.'7 Ir'isulat:J c)n shall I:)e exLl'-udf~d (::liJ-'e(::L burial polystyl"'ene. Dow Chemical SLyrofc)am HI aC). 3.~g 'Fc)psoil sba]L1 be a mixture o'f z1.0'-"60% organic: mai:tar, Spec:i.-Fications 4:or septic: system instal].ation W:[/2 I..c)'L :[5 Sec. 9 -FI~2N R3W 20-3C1% sand and mere ti'tat 20% silt. All quant:Lties are 3.9 Grass seed shall, be Kentucky bluecjras~=,. 4.0 INSTALLATION 4. :1 L_oi:::ate al ] urJderground ut:L 1 :i. ties ~ property 1 :i nes,~ · fuEure driveways~ exis'~:(ng or i]r'c~poeed water' we].ls~ water waye, sur.f a(:::e anc:l sub SL.IK'~ ace dr'ai nage ~ ac J. 1 :L t i es ,, 1 akes ~ por)c~e~ and all (-)'~her' ~ac:ilitiee requir'~ng separa'~ion dis · b. arn::es ~r'om the F)r'Dposed eeptic system. Notify Owner or Engineer c:)~ any c)bserved possible confl:i.c:'[:,, Pay specific o~: lct['.. ]:~ sur~:ac::e waters are ~our"~d w~th:[n ]00 ~eet o~ the prq:)osed septic system~ suc:h surface waters shall, be elimi- nated by pla~:::inc) ~:il] in SL.Vf~ic::i, ent amount '(:o el:)tain the requJ, recl 100 'Feet eeparation. q.2 Stake a]ignment o~ system with markers showing the i:)r'otecl:Jve diG[:anc[)s 'fr-c]m wells and water" bodi. e:)s. 4.Z", E]stab].ic.M"l an e:l. eva'l::[oc~ ber~chmarl<. "f'h:L!~ BM shall be easily ident,'.i~:lable~ stable and permanent. An arbitrary c~levation (::~ :I. 00 can be assiglned. Llse basement level. ~loc)r. 4.4 Install the tanl.c as shawn on the dr'awings. Record the inlet and out].e~ elevations o-F the tank, Tank shall be plat:ed on undisturbed nat:ive soil. 4.5 Excavate the absorption field. Bottom o.F exc:avation shall be level and scarified. I.F sidewalls smear's~ they shall also be scar'i~ied. Recorcl elevation o~ beginnin?j~ middle and end caf trench. Record e:tevati(]n (:)-f eac:h c~rner ¢:~[)d c:elqt[.~r' pc¢il]l:: o'~ [)E,d. CC3nS~'['.K't,II:tic)F} eqL.lipfllelzL', shall er.it c]p~,H'"a't]~ (][1 t:he 'f]l. oor o~ the excavati on. An,/ ms't:er:[ al cc)M-- pat:ted by /:'J'~e c:)per"a{'.:ic)n c)~ the,) C[]FIstf'L.IE:tioI'] equipment shall r'er~]clved (:]lid r"el:)].ac:ed w:i~ih L.fflc(:]mpai~c'tied ifl;tt(ar;ia].s. 4.6 Plac:e the rock te the depth !~pecified. Do not cc)ntami- r'lat:[:, rock wJ.'L:l'] rIc~t]:[ ve flla'~:c,~F'ia:L e c)r spoi].s ~["ofil the e)(cava-' · l::[on. I..evel 'f:he roc:l< s~r-Fac:e (+- 1") before installing the i:)er ¢ c)r a'~ed pipe. 4.7 ]:r~stall the distr'ibut:[on pipe. Record the mlevation each joint. F'or pressure system solvent weld the joints. 4.8 Cover J. rist,.t l a'l:: i c:)rl the dis't:ribLv~.:Lon pipe with r'oc:k~ and c::over the wi th geo'l:e~xt:L 1. e b6~'f(]l"e.) {:),~c:k't: ~, :L 3. ing and p], ac:i ng i ~: r'eql, d red. 4.9 Record the .~i.l-~i~shed (:Wourld e]evatioli at the beg:i, nrlin~;I,~ m:lddLc, and (~,nd ¢3~: 't:l*'eri¢:h. I:~c_,c:ord the .l~iI']i.~J-I grc]Ltlld eleva- t.:i. orl at ~_~a(::J'i cc:)rr~er and ,:t't:. [:he rllJ. dpc)~f'yl] C)~: I::f'l(-]. bI.Dd. Spec :L .F :i c:at :L (311!i~ F(]r sept i c system instaLL ]. at i oi] W1/2 Lot ~5 S~-~c::. 9 T12N R3W a.. :Il} F'urnish a copy o~: all ~urvey ec~tes to the Engineer. 5.0 INSPECTIONS 5,,1 A minimum o.F three J, nspections are r'equ:ired. The .f:irst inspection will be o~: the open excavatioe. At this t:ime the soil conditiene will be observed and compared to e~: bedrclc:k wi]Il be verified. The second inspec:tic~n will be a.Fter- placement o~ gravel ~ st, andp~pe!i~.,~ d:i.s'~ril:n..ttic~n p:ipir'~g,, 'b. ank(s) and other compo .... The th:ird :i. nspec:'ltJon will. b~.~ a~ter' c:omplet:~c~n o'¢ the work. Ar]y defi(::iel'lc:ies wi].l be t'lotec:l and the Contractor notified. Such de.¢icJ, encie~s sba]L1 be cmrrecl:ed withic~ ten days. 5.2 All electrical work requires either an MOA electrical J. nspect i c~n or (::er Ill f J ca b.:~ on by an ] ic:ensed elec:tr:[ clan. Subm:i.t I:)r'oe'~ o{ inspecE:i, on c)r c:erti~:ic:at:i, on to tine Engineer. 5.3 Subm:it catalog dat:a o.F all mechanical ecluil:)men~t. 5,,zl Nl:)ti~y Engineer at least 24 hours J.n advance i::)~ be(:lin- Specifications ~c)r septic system :i, nsta]L]at:i, on W1/2 Lot 15 Sec. 9 T]2N R3W MUNICIPALITY 01/. r Development Services Department r Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 014-172-09 Expiration Date: /r— ( r 2- 1. 1. GENERAL INFORMATION Complete legal description T12N R3W SEC 9 LOT 15 W2 Location (site address) 2716 LORE ROAD, ANCHORAGE, AK 99507 Current property owner(s) DANIEL & ROSA CAMPOS Day phone Mailing address Real estate agent 2716 LORE ROAD, ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone _ 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ Date of Payment Receipt Number COSA # Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/4/2021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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 ^+•,Q well and septic system. Therefore, any estimate of how long a system will function satisfactory �.%�Q: •' .. !� for current or future occupants or guarantee that no unseen encroachments, deficiencies or �•' Tl'I *��J discrepancies exist can be given by First Water Consulting & FWCS — { 6. DSD SIGNATURE • Curtis Huffman System #1 Approved for (� bedrooms�F��; •, CE t2s9s1��r'"� ---F--- � � l ..10/4/ 9 • �co� ,..''� System #2 Approved for bedrooms illl10ROFESSOW Disapproved Conditional approval for bedrooms, with the following stipulations: Ifit ii.,_ ��► STLv"ATER PROGRAM �•.— -C(/� Original Certificate Date: 10—T-21 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: T12N R3W SEC 9 LOT 15 W2 Parcel ID: 014-172-09 If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _ A. WELL DATA — PER MOA DOCS ❑ Well log is filed with Onsite (or attached) Date drilled CIRCA 1960 Total depth 79+ ft Cased to 40+ ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/10/2021 Static water level at beginning of test 51 ft. Well production at time of test 4.1+ gpm Comments B. TANK DATA Age of tank(s) *NEW TANK years Tank type/material SEPTIC / HDPE Measured operating fluid level in septic tank ® Standpipes/foundation cleanout per record drawing Date of pumping * D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ® ALL standpipes present per record drawing Total measured depth from grade 9 ft (max) Measured depth to pipe invert from grade 8_5 ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective ® Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 0.655 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) FW '. Collected by NES Date of Sample 6/11/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date Results ❑ Pass For bedrooms Fluid depth prior to test _ in Water added gal New depth in Elapsed time min Final fluid depth in Absorption rate gpd Any rejuvenation treatment (past 12 months) N If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' Water Service Line > 10' ® Yes Animal Containment > 50' ® Yes if No ® Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ®Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No Water Main > 10' ® Yes if No . ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells >' 100 _ ®Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION I certify that / have determined through field inspections and review of Municipal records that the above systems are in conformance g •• ;'p' �j with MOA COSA guidelines in effect on this date. • 11') • • • ••: .. .... ....t..�.... Curtis Huffman / �� FFG'/�.• CE 128991��+� �� ���,'•d,0/4/ZQ2t'��� FPPROFESSOO -o ft ft ft ft ft ft ft ft ondl A #0% MUWC�PAU7Y OF A"NfHORAGE&A05" Development Services Department U Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 014-172-09 1. GENERAL INFORMATION Complete legal description T12N R3W SEC 9 LOT 15 W2 Expiration Date: (C -2Z -z/ Location (site address) 2716 LORE ROAD, ANCHORAGE, AK 99507 Current property owner(s) DANIEL & ROSA CAMPOS Mailing address Real estate agent 2716 LORE ROAD, ANCHORAGE, AK 99507 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone Day phone 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ® Private Septic Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver request for: Received by: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 73 Date of Payment Receipt Number COSA # OsG21141 S Date: Waiver Fee $ Date of Payment Receipt Number Waiver # Distance: 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm FIRST WATER CONSULTING Phone 907-350-9566 Address 13030 SUES WAY, ANCHORAGE, AK 99516 Engineer's Printed Name CURTIS HUFFMAN, PE Date 711612021 Comments: This investigation was completed in compliance with MOA guidelines, regulations, and best industry practices / methods. 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, quality of construction (workmanship & materials), the water usage of the family being served by the system and maintenance. 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, any estimate of how long a system will function satisfactory for current or future occupants or guarantee that no unseen encroachments, deficiencies or discrepancies exist can be given by First Water Consulting & FWB 6. DSD SIGNATURE System #1 Approved for System #2 Approved for Disapproved Conditional approval for 41 bedrooms bedrooms OF A4 49Z_�' ..:*��% / • ' • Curtis Huffman 0 CE 128991 ,•��`��/ 0PROF SS ONP����� bedrooms. with the following stinulations: Bv:/ \ Vi '�illlllli�'' Original Certificate Date: 7_2 Z —2 The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other Legal Description: T12N R3W SEC 9 LOT 15 W2 If more than 1 septic system on lot: COSA Checklist # _of A. WELL DATA — PER MOA DOCS ❑ Well log is filed with Onsite (or attached) Date drilled CIRCA 1960 Total depth 79+ ft Cased to 40+ ft ® Sanitary seal is functioning correctly ® Wires are properly protected Casing height (above ground) 12+ in. Date of flow test for COSA 6/10/2021 Static water level at beginning of test 51 ft. Well production at time of test 4.1+ gpm Comments B. TANK DATA Age of tank(s) *NEW TANK PENDING years Tank type/material XXX Measured operating fluid level in septic tank * ® Standpipes/foundation cleanout per record drawing Date of pumping * D. ABSORPTION FIELD DATA Which system tested (date installed) NEW SYSTEM ® ALL standpipes present per record drawing Total measured depth from grade XX ft (max) Measured depth to pipe invert from grade XX ft (min) ❑ N/A — pressurized field ® Monitor tubes go to bottom of effective. If not, state depth into effective Parcel ID: 014-172-09 Structure served by this system _ Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes ® No ® Coliform bacteria is Negative Nitrate 0.655 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L ® Arsenic less than MRL (ND) Collected by FK -S Date of Sample 6/11/2021 C. LIFT STATION ❑ Required maintenance completed Age of lift station years Lift station material Comments: Adequacy test date *NEW SYSTEM PENDING Results Z Pass For bedrooms Fluid depth prior to test _ in Water added gal New depth in Elapsed time min ® Code -required soil cover over field Final fluid depth in ❑ System presoaked Absorption rate gpd (Required if vacant for greater than 30 days prior to Any rejuvenation treatment (past 12 months) N date of test) If yes, enter date Gallons introduced gallons Comments/Deficiencies: NES E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) Septic Tank/Lift Station on Lot > 100' ® Yes if No Community Sewer Manhole/Cleanout > 100' ® Yes if No ft ® Yes if No Neighboring Tank > 100' ® Yes if No ft Private Sewer/Septic Line > 25' ® Yes if No Absorption Field on Lot > 100' ® Yes if No ft Holding Tank > 100' ® Yes if No Neighboring Absorption Fields > 100' if No ft Animal Containment > 50' ® Yes if No ® Yes if No ft ft If septic tank is under driveway comment below Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ® Yes if No ft ® Yes if No From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ® Yes if No ft Surface Water > 100' ® Yes if No _ Property Line > 5' ® Yes if No ft Wells on Adjacent Lots: ® Yes Absorption Field > 5' ® Yes if No ft Private Wells > 100' ® Yes if No _ Water Main > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Water Service Line > 10' ® Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) Building Foundation > 10' ® Yes if No ft If absorption field is under driveway comment below Property Line > 10' ® Yes if No _ ft Wells on Adjacent Lots: Water Main > 10' ® Yes if No ft Private Wells > 100' ® Yes if No ft Water Service Line > 10' ® Yes if No ft Community Wells > 200' ® Yes if No Surface Water > 100' ® Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that l 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. TH ..• .... ....t...... Curtis Huffman '. CE 128991 w ;-1�'�'JF�y' • .7116/2921'���'?� OPROFESSIOO . ft ft ft ft ft ft ft ft LOT 16-A Frontier Surveys, LLC Project No: 20-394 Date: 8124/2020 Ordered Bye Billy Hughes Plat:72-1S3/BL Grid: SW 2234 G ------ lF LORE ROAD -------- EDGE 0FPAVEA,0V 38fl• b7' 36'B iae.aa AiEAS `; �, 17,11 m 1 81.9 ,...,.,, �.,�...... N 22.8 cQi i 21.8 l E z LOT 15 y Electric Meter/Outside Power Concrete 121 (S; Septic .W; Water Well f i Mailbox General Notes: 0 20 40 80 SHED 2. Fxcepling for gross negligence, the lability for this survey :hall not exceed the cost of preparing this surrey, Scale in Feet 'J. N RREPrr 1 -..- ��t�1l�tltti F A( tt 11i conditions at the 11me bthe doeument does not cons72ute a boundary survey and is subject to any inaccuades that It is the •' •'; '-: ?,j`. 'ryr a subsequent oundary cry survey may reveaL responsbdity of the Owner to detcrmim: the �p�. .•_' + i ''•;f.,9 rr existence of any easements, covenants, or restriction Yvfilch do no appear on the record plat. Under no circumstances should this dommentbe used forconshuclion orforestablishing a boundary orfmce the. WJ Lot 15 r T12N, R03W, Sec. 9 S.M. W1/2 Lot 15, T12N, R03W, Sec. 9, S.M. 103,332 Sq. Ft. Fi 0µ.vein - .. I ��i wdu smx rir °H zr1020 2716 Lore Road ss„tn1 ` Frontier Surveys, LLCR©NTj[ER. 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 unrve� I Story Wood Frame House t3D7.aEfJ.lr#+ - intoe rrogtte.rwsvrsysrram PODFFSROHAL SfAi. Wrth Attached 2 Car Garage' cs v i 21.8 l E z LOT 15 y Electric Meter/Outside Power Concrete y Gas Meter ® Deck Fence (S; Septic .W; Water Well f i Mailbox General Notes: 0 20 40 80 t. This document is created for the purpose of a single property hamsadion and is subject to Federal Copyriaht Laws. 2. Fxcepling for gross negligence, the lability for this survey :hall not exceed the cost of preparing this surrey, Scale in Feet 'J. Ali nteasurrntpttslxiback. arc to 0- vlsuagapp,.—,t building rootprinf.. 4. All dimensions to property lines aro plusknbws 0.1ft. This survey complies with the ASPLS Mortgage Location Standards. The survey represents visible improvemenls and ��t�1l�tltti F A( tt 11i conditions at the 11me bthe doeument does not cons72ute a boundary survey and is subject to any inaccuades that It is the •' •'; '-: ?,j`. 'ryr a subsequent oundary cry survey may reveaL responsbdity of the Owner to detcrmim: the �p�. .•_' + i ''•;f.,9 rr existence of any easements, covenants, or restriction Yvfilch do no appear on the record plat. Under no circumstances should this dommentbe used forconshuclion orforestablishing a boundary orfmce the. �- I� As-BuihSurvey of. W1/2 Lot 15, T12N, R03W, Sec. 9, S.M. ..• , I, Pierre Stragier, hereby certify that this Mortgage Inspection Survey was performed by me, or under my direct supervision on August 18th, 2020. Fi 0µ.vein - .. I ��i wdu smx rir °H zr1020 rut°rltott ss„tn1 ` Frontier Surveys, LLCR©NTj[ER. 650 W. 58th Ave. Suite E Anchorage, Alaska 99518 unrve� t3D7.aEfJ.lr#+ - intoe rrogtte.rwsvrsysrram PODFFSROHAL SfAi. mYim.€i a rtSfs spry} rs Flot ares CONSULTING _e- "LATER/WASTE:9AiER -- �`-� SUPPURTEPEANNING 13030 Sues Way, Anchorage, AI{ 99516 907-350-9566 / firstwaterAK@gmail.com July 16, 2021 Municipalities of Anchorage On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 RE: CONDITIONAL COSA LEGAL: T12N R3W SEC 9 LOT 15 W2 Due to unprecedented events and affects from the Covid pandemic and other factors upon the real estate market that have contributed to material and labor shortages, we are requesting a Conditional COSA for the above referenced property. The parties have loan rate locks expiring and other sales dependent on this property to close within the week. The pending permitted 4 - bedroom septic system upgrade has been impeded due these conditions and other factors. The system has been working for the occupants and granting of this Conditional COSA will not impact any of the neighboring properties or pose a public health risk. Attached are install bids and escrow letter from title for the pending installation. Please contact us if you have any questions. Sincerely, Curtis Huffman, P.E. FjrsI�`° CUNSUITINU SERVICES SUPPRAIL PE.RRIRC Cc 2 ,.':»*��•k,a- k+e rN July 22, 2021 RE: 2716 Lore Road, Anchorage AK 99507 1 T12N R03W Sec 09 Lt 15 To Whom It May Concern: RE/MAX Dynamic Properties agrees to hold in Escrow funds equal to 1.5 times the highest of two bids, a total of $30,300.00 (see attached the bids from Northern Excavation and JR Septic Pumping & Excavation) for the replacement and installation of a new septic system at the above referenced property. No funds, what -so -ever, will be released until the work is complete and the final Certificate of Onsite Systems Approval has been issued by the Municipality of Anchorage. All work to be completed by September 15, 2021. ZFr�a�nc= Broker P.O. Box 773415 Eagle River, AIC 99577 Office: (907)694-6454 Fax: (907)688-1506 Email: jrsseptic@gmail.com PROPOSAL Submitted To: Brent Western Phone: 907-440-4601 Email: Fit-stWaterAK@gmaii.com Project Location: 2716 Lore Rd. Project Description: Install new septic tank and field. PRICE INCLUDES: 1. Decommission existing tank per municipal code. 2. Install new 1250- HDPE tank per engineered design. 3. Install new septic field per engineered design. 4. Install diverter valve between existing field and new field. Estimated price for the above work: $$14,440.00 PRICE DOES NOT INCLUDE: SURVEY PROJECT LAY OUT ENGINEERING FEES ELECTRICAL (NONE EXPECTED) TOPSOIL AND SEEDING UTILITIES NOT LOCATED BY LOCATE CENTER (NONE EXPECTED) REMOVAL OF ANY MATERIALS FROM SITE UNLESS OTHERWISE STATED IN BID PURCHASE AND INSTALLATION OF INSULATION IF NEEDED. PAYMENT: 50% DOWN PAYMENT PRIOR TO WORK COMMENCING UNLESS OTHER ARRANGEMENTS ARE MADE. BALANCE DUE 30 DAY AFTER THE INVOICE DATE. Limitations Project layout will be the responsibility of the engineering firm or a licensed surveyor if needed. A. Bid amount includes installation, materials, and labor and equipment to install the septic system as designed. Unless stated otherwise, the bid amount does not include engineering services. B. Unless stated otherwise, the bid amount does not include export of overburden, trees, stumps, etc. They will be disposed of on-site unless otherwise stated. C. Final grading will consist of backfilling the construction area with onsite native soils to create a rough construction grade that meets the minimum M.O.A. soil cover requirements and provides drainage away from, or around, the septic system. Prior to landscaping, most excavation sites will require hand raking and shoveling to remove larger rocks, sticks and debris. This work is not included in the bid and unless stated otherwise landscaping is not included in the bid. D. There are limitations regarding the quality of final grading. Typically, there is settlement that may occur. JR's Septic Pumping and Excavation LLC will not be responsible for any ground settlement. E. Unless stated otherwise, the bid does not include reconstruction or restoration of decks, fences, driveways, and asphalt, trees, grass that must be removed or disturbed as part of the construction. F. If this is an engineered project, layout will be the responsibility of the engineer. All work will be in accordance with M.O.A. and State Guidelines All work will be performed as per Engineering Plans and Specifications Any alterations or deviations front the above specifications involving extra costs will be eeecuted only upon written orders or verbal and will become an extra charge over and above the estimate. All work will be (lone in a workmanlike manner in accordance with standard construction practices. This is a legally binding contract between the client and JR's Septic Pumping and Excavation. All collection fees, .attorney's fees, and late fees plus a 15% rate of interest will be applied to all accounts 30 days past (111e. Both parties acknowledge the right to lien the work site if the balance of this contract is not paid within 30 days of invoicing the work performed. This proposal will be void if not accepted within 14 clays of the proposal date. BLsigning this construction 1� osal you at(thori7e 1R'v Se tic Pumping and Excavation to Proceed in the work listed above and are agreeing to all terrns and conditions listed. Accept of Proposal/ Contract Date: Daniel or Rosa Campos JR's Septic Pumping and Excavation LLC Date: 1111ichael R Wehr Northern Excavation and Construction, LLC 15861 South Birchwood Loop Road Chugiak, AK 99567 (907)694-1373 Northern Excavation@Gmail.com ADDRESS T1 2N R1 W SEC9 LOT -15 2716 LORE RD ANCHORAGE, ALASKA 99507 ESTIMATE # DATE 1915 07/21/2021 BATE ACTIVITY AMOUNT' _ Services 20,200.00' T1 2N R1 W SEC9 LOT -15 2716 LORE RD SEPTIC SYSTEM UPGRADE Thank you for the opportunity to provide you with this estimate. Changes which increase the specific tasks of machine/labor time spent of this contract, will be submitted in writing by the owner and accepted by the contractor and the contract modified accordingly. Payment to the Contractor for modifications to this contract which increase the work will be charged. All agreements are contingent upon accidents, design changes, or delays beyond our control. Northern Excavation & Construction, (NEC) shall not be held liable for the affects that may occur to the property during and after the install. Affects such as damage and structural integrity of decks or deck supports in or close by the work zone, trees left in close proximity of where machine work takes place or having to stock displaced excavated material around trees to be retrieved, damage and structural integrity of retaining walls that may need to be partially removed or traveled close too, disturbance to driveways, disturbance to any landscaping, etc. NEC only compacts soil to ensure structural integrity of components install by NEC. Soil placed above Pipes/Tanks/Etc will not be compacted. (Additional cost for further compaction). All methods and materials shall be in accordance with MOA regulation. Payment in full is due upon completion of backfill. Payments received after 30 days of completion shall be charged a 1.5% monthly fee on unpaid balances. Description: Install new septic system in accordance with First Water "Consulting's MOA approved design. Inclusions: Machine/Labor/compaction time, 1250 gallon poly septic tank w/' 6' riser, pipe/supplies, tank bedding, drain rock, pumping, surveying, tank decommisioning, and wood platform disposal. Exclusions: Re -landscaping, re -seeding, import/export of any fill or gravel. Please note that a 48 hour notice to start digging is required by the State of Alaska for utility locates. *Northern Excavation and Construction, LLC is not liable for any utility lines not located by 811 public utility locate e.g., any lines running to detached structures. Please notify contractor of any power/gas/communications lines, prior to starting the job, so private locate services can be called. An extra charge will be incurred for private locate services. Accepted By Accepted Date Please note that a 48 hour notice to start digging is required by the State of Alaska for utility locates. Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www. ci.ancho rage.ak.us (907) 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 014-172-09 1. GENERAL INFORMATION Complete legal description W 1/2 Lot 15, Expiration Date: Section 9, T12N, R3W SM Location (site address or directions) 271_6 Lore Road Current Property owner(s) Sharon Keenan Day phone 344-8903 Mailing address PO Box 240673, Anchorage, AK 9952/* Lending agency Premier/John Anderson Mailing address 3150 C St., Ste. Real Estate Agent Day phone 563-7736 Anchorage,AK 99503 Day phone Mailing Address Unless otherwise requested, HAAwill be held by DHHSfor pickup. HAA picked up by: f/4/~, ~ ~---~ NUMBER OF BEDROOMS: '~' q 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 Department of Health and Human Services (DHHS) issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 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) on properties served by a single family on-site wastewater disposal and/or water supply system. DHHS also issues HAAs upon request to home owners. 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 less than 30 days old. 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. 72 025 (Rev 0WOO/' 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 Health Authority Approval Guidelines for tile Health Authority Approval application show that the on site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. S & S ENGIN£ERING 17034 Eagle River Loop Road No. 204 Name of Firm EaCe4;~A~er~!:~kn ggS71 Address Engineer's Printed Name Robert C, Co~an L'iL bedrooms. Phone Date DHHS SIGNATURE Approved for __ Disapproved1 Conditional approval for bedrooms, with the following stipulations. Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: /03 Original Certificate Date: Reissue Date: Municipality of Anchorage Department of Health and Human Services Division of Environmental Services On-Site Services Section 825 "L" St, reet Room 502 P.O. Box 196650 Anchorage. AK 99519-6650 www. ci.anchorage.ak.us (907) 343-4744 ( CEIVE[ JUL 1 000 MUNICIPALITY OF ANCHOP, AGE ' "n~'kiMEJx!TAL SERVICES DI~?' HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. IfA, B, or C provide PWSID Ct __ Sanitary seal ¥¢-$ WELL DATA Well type Date completed Total depth '/~1 + ft Cased to ,ye + ft FROM WELL LOG Date of test Static water level 0 [¢// ft / Well production ,/ g.p.m WATER SAMPLE RESULTS: Coliform o colonies/100 mi Date of sample: SEPTIC/HOLDING TANK DATA Tank Type/MateriaI Date installed ¢//Ii'/~f :z Tank size Cleanouts. ¥¢-~ Foundation cleanout Date of pumping 6 /t~/oO ABSORPTION FIELD DATA Nitrate ~), ~'(~ Collected by: Parcel I.D.: O~ ~--17 ;~ --0 c~ ,, Well Log Wires properly protected Casing height (above ground) __ AT INSPECTION ° 7 o ft ~', / g.p.m __ mg/I Other bacteria ~' colonies/100 mi S & S ENGINEERING 17034 Eagle River Loop Read Ne. 204 Eagle River, Alaska 9957? gal Number of Compartments __ Depression over tank /¢ o Pumper y~I ~ &'")' in. __ High water alarm Date installed ~/1~¢/qz Soilrating~orft2/bdrm)/,o~ Systemtype Length ..¢'o ft Width ~ ft Gravel below pipe Total depth I ~- ft Effective absorption area ,¢'~o fF Monitoring tube Y~J Depression over field ~'o Date of adequacy test 7/;~/¢¢ Results~ail) /~,¢.rj For ~7/ bedrooms Fluid depth in absorption field before test )~ in Water added 7 J / gal. New depth. //G" in. Elapsed Time: 3~ min Final fluid depth )/;z '~ in Absorption rate >= (~¢~ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type). ,v~,v~ k,~o,¢,~, _If yes, give date -- 72-026 (Rev. 01/00)* LIFT STATION Date installed "Pump on" level at __ Datum Size in gallons ~~Te/Access __ in ~ in High water alarm level at __ in ~ Cycles tested Meets alarm & circuit requirements E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ) o o '4- Absorption field on lot Public sewer main Sewer/septic service line On adjacent lots / oO ~-- On adjacent lots / o o ~' Public sewer manhole/cleanout Holding tank )¢J4 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation /~ O Property line /¢ o Absorption field ~' J'- Water main 10/4 Water service line ?O /-/'- Surface water / O o ~ Drainage /¢/4- Wells on adjacent lots ) o o ~/- SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water Service line Curtain drain Building foundation ~ 0 ' Water main ~J ,/4 Surface water ! 0 a ..¢- Driveway, parking/vehicle storage Wells on adjacent lots / o 0 ~- F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Date HAAFee $ '~OO.e`b Date of Payment "7/ ReeeiptNumber O lll (' Waiver Fee $ Date of Payment Receipt Number 72-026 (Rev. 01/00)* MUNICIPALITY OF ANCHORAGE DFPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HA920150 014-172-09 HAA # 1, GENERAL INFORMATION Complete legal description T12N R3W Section 9 W~ Lot 15 Location (site address or directions) 2716 Lore Road Property owner Mailing address Lending agency Mailing address_ Tom Keenan 2716 Lore Road, Anchorage~ Alaska Day phone 344-8903 99516 Day phone Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: Three(3) TYPE OF" WATER SUPPLY: Individual well xxxxxxxx Community well Public water NOTE: If comrnunity well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWA'TER DISPOSAL: Individual on-site xxxxxxxxx Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposar system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Tobben Spurkland, P. E. Phone _279-3916 Address 203 West 15th Avenue #206, Anchorage, Alaska 99501 Engineer's signature Date 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. ~ Conditional approval for _ ~" bedrooms, with the following stipulations: Sufficient funds must be place in an escrow account to cover the costs of the followings_ (1) The permitted upgrade of the septic system must be completed and approved. (2) The well casing must be extended above ground level. (3) A well flow test~ust sho,~-t~ell to produce not less than LSD ga~_ns per day per bedroom or a replacement well must be drilled, All above items must be completed by not lat~e~- than Ju~e 15, 19~2. Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their 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 engineeds work. 724)25 (Rev. 1/91) Back MOA #21 6751 W, DIMOND BLVL ANCHORAGE, ALASEA 99502-5904 (9O7) 24~-5Q95 RECEIVED MAR 9 1992 Municipality of Anchorage Dept. Flealth & Human Services 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 Parcel I.D. # CERTIFICATE OF: HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 1, GENERAL INFORMATION Complete legal description Location (site address or directions) __ Property owner _Dayphone ~g/..~- ~-~4)Z~ Mailing address Lending agency Mailing address Day phone Agent Address Day phone = Unless otherwise requested, HAA will be held for pickup, NUMBER OF: BEDROOMS: ,5 TYPE OF WATER SUPPLY: Individual well NOTE: Community well Public water If community well system, orovide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWA'rER DISPOSAL: Individual on-site 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, I/91) Front MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information 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' '~ '~'/~',,~,-1 Address ~-~.) EngineeCs signature Phone ¢4~..¢ - '~ q i ~ 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for ,-~ bedrooms, with the following stipulations: Additional Comments By: Date 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 cedain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAl. TESTING & ENGIN EI="RING CO. 5633 13 STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX:(907) 561-5301 AHALYOIS RESULTS for IHVOICE t 51681 Chemlab hoE.{ 92.0853 Sample { 1 Mat~i×: WATER Client Sample ID PWSID Collected Received Preserved with POTABLE 2716 LORE RD. Client Name :TOBBEH SPURKLAHD, P.E. UA Client Acer ~AR E 92 ~ 10:30 hrs. BPO{ : PO# :HOHE RECEIVED )~R 5 92 @ 10:50 hrs. Req# : AS REQUIRED Orde):ed By Analysis Completed : MAR 6 92 Send heports to: I)TOBBEN SPURKLAHD, P.E. Laboratory 8upe~v~TEPHEN C. EDE Paramete~ Results Umts Method Allowable Limits ~I~RA~E-H 0.16 mg/1 EPA 353.2 lO Sample ROUYINE SAgPLE COLLECTED BY: T.S. Remarks: 1 Tests Perfo~ed See Special Instructions Above UA=Unavailable ltD= Hone Detected "See Sample Remarks Above RA- Hot Analyzed LT=Less Than, GT-G~eatez Than ~ {~F~,~S Member o1 the SGS Group (Socidt4 GOnOrale de Surve[llance) 0 0 0 0 0 0 0 © 0 Z O9 r-"