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HomeMy WebLinkAboutCALKINS LT 12Calkins Lot 12 #050-211-08 Municipality of Anchorage Poge 1 of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 545-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW000299 PID Number: 050--211--08 Nome:Wastewater System: [] New · Upgrade JEFF AND CONNIE MUTCHMORE Address: 10610 HIGH BLUFF DR. ANCHORAGE, AK 99577 ENOR~./SOUm] ABSORPTION FIELD[NoRTH/SOUTh] Phone: No, of Bedrooms: (907) 922-9964 4 IDeep Trench BShellow Trench nBed DMound [3Other LEGAL DESCRIPTION 0.6 o.o/s., gb 10.25/10.25 rt. 12 -- CALKINS 4.16/4.56 r~ 6.1/5.7 n. - - - 0.5 - 2.0 r, ~ (4G'/42')rt WELL: [] New [] Upgrad~ _~"'~ Gravel wfd~:. 2.5/2.5 Ft.lumber of 2 tines:Distance12%between lines:Ft rt. GREEN EXCAVATING 8/23-24/2000 o.. .. .. TANK SEPARATION DISTANCES · Septic [] Holdltlg [] S.T.E.P. To SepUc Absorption Lift Holding ~ubllc/Pdvate Manufoctur~r:. C~pacity [n gallons: From Tank Field Station Tank S.w.r U,0, ANCHORAGE TANK 1250 Well 100'+ 100'+ - - 25'+ STEEL 2 ~oo'+ lOO'+ - - - LIFT STATION Surface Water Lot Drain NONE KNOWN I I Remarks: BENCH MARK TOP OF GAS METER PIPING. 108.8 rt. Inspections performed by: AWWC, INC. Dates: 1st 8/25/2000 ',....:...T.~.-~.'.~..¥:....!~ 2nd 8/24/2000 ~. · · · .~ N'~'4~ .]~. · · · k. · · · .~ ...... 3rd 8/28/2000 ~r,,%~_ .. Je~'re'~ iA. Department of Health and Human Services approval ~1)~.~ ~. -..."~',~¢~'~ .ev ewed approved o ~-o,~ (.~ ./.,~ ~o. ~ ~///-~ "~4.~- PERMIT NUMDER: AS BUILT D~WI~G PARCEL ID NUMBER: SW000299 - 050-211-06 I b_ NOTE: THE EXISITNG SEPTIC ) I TANK ?/AS REMOVED AND I FLOW SPLrCi'ER (FS)~ MT2 61.7 j 67.1 I P~ OF THE ALTERNATE SEE. THE PORTION OF C04 71.5 J 66.~ J ~ ~DIUS WILL NEED TO BE REMOVED COMPL~LELY,  ~EXIS~NO TRENCH AND THE ALTER~ FCO ~9,5 ~ ~ 8.5 ~ SHOWN W~LL ~ USEO AS ON~ ~ST~a. A ~OC~CL~ OR A ADVANT~ S~M WILL NEED TO BE USED. ~ ...... K.D.W. .... CONSULTANTS, INC.~ ~ 1" 30~ ........... PREPPED FOR: PHONE NUMBER: PAGE NUMBER: JEFF AND CONNIE MUTCHMORE (920) 922-9964 2 OF ~ ~'~: CALKINS SUBDIVISION; LOT 12 q~ie~ ".N ........ ~PE OF WORK: ~{~rOfess,O~ AS-BUILT OF SEPTIC SYSTEM UPGRADE PE.~ Nu** AS BUILT DRAWING P,~oEL SW000299 ' 050-211-08 fiN, q. 6P.~ ,~ 104,86 ~ ~a,u~~'W 12¢0 ~LON ,~~ SO~ T~NCH A~SI~ WATER & WASTEWATER ~.~.w. ~'x ~ v~ ".,~{ JEFF AND CONNIE MUTCHMOEE (920) 922-9964 5 OF 5 ~OAL DESCRIPTION: CALKINS SUBDIVISION; LOT 12 AS-BUILT PROFILE Of SEPTIC SYSTEM UPGRADE MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 15, 2000 Expiration Date: Aug 15, 2001 Permit Number: SW000299 Legal Description: CALKINS LT 12 Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Jeff & Connie Mutchmore Owner Address: c/o Lee Thompson 5614 E. 40th #B204 Anchorage, AK 99504- ParcellD: 050-211-08 Site Address: 010610 HIGH BLUFF DR Lot Size: 20661 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: ~ Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. ALASI A WATER & WASTEWATER August 4, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Septic System Upgrade Design for Lot 12, Calkins Subdivision To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The existing septic system consist of a 1000 gallon septic tank and a deep trench type drainfield. The existing drainfield is in a state of failure and must be upgraded prior to the sale of the house. One test hole was excavated north of the existing septic system. The proposed septic system will be designed around the 30 foot radius of this test hole. The new buyers would like a 4 bedroom system to be installed for a possible future addition or remodeling. We are proposing that a 1250 gallon septic tank and two deep trench type drainfields be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers and fill are a GM/SM material to a depth of 6 feet and then transitions to a GP/SP material with some silt to a depth of 15 feet. At 15 feet the soils transitions to a SP material to a depth of 17 feet (bottom of test hole). No groundwater was encountered during the excavation and the monitoring tubes was checked seven days later and found it to be dry. A percolation test was performed between the depth of 7.0 feet to 7.5 feet which had a percolation rate of 20 minute/inch. It is om' opinion that due to the overall appearance of the soils, a application rate of 0.6 gallons/day/ft2 should be used. 2. TRENCH DESIGN: a. Pemolation Rate: 20 minutes/inch b. Allowable Application Rate: 0.6 gallons/day/ft2 c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 1000 ft2 f. Total Depth: 10.5 feet (max.) g. Effective Depth: 6 feet 6901 Debarr Road, Suite 2B ~ Anchorage, AK 99504 ~ Pr: (907)337-6179 ~ Fax: (907)338-3246 h. Width: 2.5 feet i. Reduction Factor: N/A & Minimum Length: 84 feet total length (2 ~ 42 feet long each) · Effective absorption area = 1008 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached design, the a proposed trench is to be installed on a slope that ranges from 1 to 15 percent that runs from approximately southeast to northwest; in short, there are no slope concerns. The trench is to be installed parallel to slope contours. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems· If you have any questions, please contact us at 337-6179. Thank you for your assistance· Sincer~el: , ,~ Je~ ~,[- s, .E., M.S. Pr, NOTE.· Attached is a site plan drawing, a design drawing, a soils log, and a 7page construction specification letter which are all part of the design package for this septic system. 6901 Deban' Road, Suite 2B - Anchorage, AK 99504 ~ Ph: (907)337-6179 ~ Fax: (907)338-3246 ~ ' ~ [ ) ) LOT 2A ) ) I I ) F~NCH S/D ) ) LOT 2B ), CALRINS S/D I I CALKINS S/D i GPJ~ND ~ -~ I LOT 2D / I ) ' ) FINCH S/D I I ~ ) ~ LOT 2¢ I" Ld I I I [ FINCH S/D 6 ~ I LOT 3 LOT 11 CALKINS S/O ( CALKINS S/D E~ ] ~ w ~ I ~ ~ NO CONCERNS I h I ..... ~ I I O' I I PROPOSED SEPTIC UPG~DE~ ~ ~ ) (SEE DESIGN, PAgE 2 OF 2) ~ I ~J J d~ ~ I I // LOT ~ ' k FINCH S/D ~ ~ o ~ I X NO CONCERNS B ~ ~ I I ~ ~¢~ SEPTIC i ~ ~ BEDROOM ,, ,,' I x. ~. LOT 6/~] I LOT 14 8/4/2000 ~; ~: CONSULTANTS, INC. ..... ' 1 " (~........................ 6~om OE.~. ROLO, summE 2B* ~C.O~GE, ~ 9~50~ · PHONE (907)537-6m79 * F~ (907)55B-EZ~6 = 1 00' ,/ '~' /-~'"' JEFF AND CONNIE MUTCHMORE (920) 922-9964 1 OF 2 A , ~fl 6Y ~ess.: v~ .. ~E_7953 .." ~GAL DESCRIP~ON: ~[j~ ~ . ~ . CALKINS SUBDIVISION; LOT 12 %~ '.. ..' SITE P~N FOR SEPTIC SYSTEM UPGRADE ~' ~..~.. NOTE: THE CONTRACTOR SHALL HAVE THE WEST PROPERTY ] LINE AND THE 100 FOOT WELL RADIUS FLAGGED BY A LJJ I REOISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. I rile CONTRACTOR SHALL ALSO FIELD VERIFY ALL ADJACENT -- ~ ~/ELL LOCATIONS AND THEIR WELL RADII PRIOR TO CONSTRUCTION. I /- IPROPOSED DRAINFIELD UPGRADE. II t J EXCAVATE 1WO TRENCHES THAT ARE L lO.5 FEET DEEP BY 2,§ FEET WIDE BY 4-2 FEET LONG EAOH (84 FEET I TOTAL LENGTH). ADD 6 FEET OF CLEAN, WASHED SEWER DRAINROCK. J NSTALL pARALLEL TO CONTOURS.~ J , ~ ~). / ! / (SEE NOTE) CALKINS SUBDIVISION; LOT 12 '~ ro fessiO DESIGN OF SEPTIC SYSTEM UPGRADE ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 DEBARR ROAD, SUITE 2B * ANCHORAGE, AK. 99504 PHONE (907) 557-6179 * FAX (907) 338-324-6 [SOIL LOG - PERCOLATION TEST] LEGAL DESCRIPTION: CALKINS SUBDIVISION; LOT 12 PERFORMED FOR: JEFF AND CONNIE MUTCHMORE DATE PERFORMED: 7/28/00 FI LL ORGANICS GM/SM GP/SP W/ SOME SILT SP [TEST HOLE #1] SOIL CLASSIFICATIONS /ORG ML CL OL MH CH OH SC DEPTH TO DATE GROUNDWATER DRY 7/28/00 DrY 8/4/00 DATE READING CLOCK NET TIME WATER LEVEL NET DROP TIME (MINUTES) READING (INCHES) 8/1/00__ 1 ,3:43 - 6- - 2 4:13 30 4 1/2" 1 1/2" ;5 4:13 - 6" _ 4 4:43 30 4 1/2" 1 1/2" 5 4:43 _ 6" - 6 5:15 ..30 4 1/2" 1 1/2" PERCOLATION RATE 20 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 7.0 FT. AND 7.5 FT. COMMENTS: PERC. HOLE WAS PRESOAKED 4+ HOURS PRIOR TO TESTING. DUE TO OVER ALL APPEARANCE OF THE SOILS. RECOMMEND USING A 0.6 APPLICATION RATE. PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PERFPR~ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: ~15/b° uU�UH C PA L „ Old A H CH0 R,A`�_J77 Development Services Department r p p ment �.., Phone: 907-343-7904 On -Site Water & Wastewater Section Fax907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-211-08-000 Expiration Date: 11/30/2024 Legal description CALKINS LT 12 Site address 10610 HIGH BLUFF DR Eagle River AK 99577 Current property owner(s) HELGEN KRISTI X The On-site system(s) is/are approved for 4 bedrooms Conditional approval for bedrooms, with the following stipulations: Comments or advisories: Original Certificate Date: 1/3/2024 This Certificate of On -Site Systems Approval (COSA) is intended to demonstrate the subject system(s) is/are in substantial compliance with municipal code. The Municipality of Anchorage, Development Services Department (DSD) issues COSAs based upon representations provided by an independent professional engineer. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Well Flow Advisory Absorption Field Advisory Nitrate Advisory Tank Age Advisory X Arsenic Advisory Other COSA ApprovaLJune 2022 MUNICIPALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 Certificate of On -Site Systems Approval Application 1. GENERAL INFORMATION Parcel I.D. 050-211-08 Complete legal description Calkins Lot 12 Location (site address) 10610 High Bluff Dr. Eagle River, AK Current property owner(s) Kristi Helgen Day phone 2. ON-SITE SYSTEMS SIZED FOR 4 BEDROOMS 3. TYPE OF WATER SUPPLY: ® Private Well ❑ Private Well serving 2 dwelling units ❑ Private Well serving 3+ dwelling units ❑ Community Well or Public ❑ Water Storage 4. TYPE OF WASTEWATER DISPOSAL: ® Private Septic ❑ Private Septic serving 2 dwelling units ❑ Holding Tank ❑ Community Septic or Public Sewer 5. SEPTIC TANK: © Steel ❑ Plastic ❑ Concrete ❑ Fiberglass Age 23 - See advisory if steel older than 20 years 6. ABSORPTION FIELD: ❑ AWWTS ❑ Bed ® Deep Trench ❑ Wide Trench ❑ Seepage Pit Waiver request for: Expedited review requested: ❑ Distance: By applying for this entitlement, this property is subject to inspection by municipal On-site staff to verify the accuracy of the information provided. COSA Fee $ S50 Date of Payment COSA # _QSG231 x-17 Waiver Fee $ Date of Payment Waiver # COSA Application—June 2022 Legal Description: __ COSA Checklist Calkins Lot 12 Parcel ID: 050-211-08 If more than 1 well and/or septic system on lot, provide separate checklist. Structure served by this system A. WELL DATA ✓❑ Well log is filed with Onsite (or attached) Date drilled 3/3/76 _Total depth 400 ft Cased to 400 ft ✓❑ Sanitary seal is functioning correctly ❑✓ Wires are properly protected Casing height (above ground) 14 in. Date of flow test for COSA 11/30/23 Static water level at beginning of test 299 ft. Comments B. TANK DATA Measured operating fluid level in septic tank49" Date of pumping ❑ Required maintenance completed, if AWWTS Comments: Well production at time of test 3.0 gpm Water storage tank volume NA gallons Well disinfected for coliform test? ❑ Yes 21 No © Coliform bacteria is Negative Nitrate 0.245 mg/L ❑ Nitrate less than MRL (ND) Arsenic ug/L Arsenic less than MRL (ND) Collected by Arcterra Consulting_ Date 11/30/23 STATION ❑ Requirgainaiop Age of lift station Lift station material Comments D. ABSORPTION FIELD DATA South Trench/ North Trench nce completed Which system tested (date installed) 8/24/2000 Adequacy test date 11/30/23 Q ALL standpipes present per record drawing Results❑ Pass Total measured depth from grade 11.5111.9ft (max) Fluid depth prior to test 0/0 in Measured depth to pipe invert from grade 5/6 ft (min) Water added 600 gal ❑ N/A — pressurized field. New fluid depth 5/3 in ❑ Per record drawings, field is insulated. Elapsed time 30 min ❑✓ Monitor tubes go to bottom of effective. Final fluid depth 0/0 in If not, state depth into effective Absorption rate 600+ gpd ❑ Presoaked required if FIELD STATUS — POST RECOVERY (Required if house vacant or field not used for more Effective depth (per record drawings)68.4/73.Zn than 30 days prior to date of test) Gallons introduced gallons date Effective depth used 0/0 in Effective depth remaining68.4173.2in Any rejuvenation treatment (past 12 months) If yes, enter date Comments/Deficiencies COSA Checklist June 2022 E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well on lot) Septic Tank/Lift Station on Lot > 100' The assessment of the condition of the well and septic applies only to the conditions as of the day tested. The Community Sewer Manhole/Cleanout > 100' Yes if No ft 0 Yes if No ft Neighboring Tank > 100' 0 Yes if No ft Private Sewer/Septic Line > 25' © Yes if No ft Absorption Field on Lot > 100' [Z Yes if No ft Holding Tank > 100'✓❑ Yes if No ft Neighboring Absorption Fields > 100' Animal Containment > 50' Q Yes if No ft 0 Yes if No ft Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' ✓❑ Yes if No ft 0 Yes if No ft ❑ N/A — Served by Community Well (not on lot) or Public Water From Septic/Holding Tank and Absorption Field(s) on Lot to: (Please enter distances if less than required) Building Foundations > 10' 0 Yes if No ft Surface Water > 100' ./❑ Yes if No ft Tank to Property Line > 5' Field to Property Line > 10' Water Main > 10' Water Service Line > 10' F. ENGINEER'S COMMENTS ✓❑ Yes 0 Yes 0 Yes ✓❑ Yes if No ft if No ft if No ft if No ft Wells on Adjacent Lots: Private Wells > 100' Community Wells > 200' ✓❑ Yes if No ft © Yes if No ft If tank or field is under driveway comment below G. CERTIFICATION & 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, indicates that the on-site water supply and/or wastewater disposal system appears to comply with applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation, unless noted otherwise. Name of Firm Arcterra Consulting Phone (907)-696-6111 Engineer's Printed Name Kenneth Duffus Date _ I.ZZ/-z 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 inland 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 s systems are subject to these various and dynamic characteristics and are outside the control of the evaluator:,-., of the well and septic system. Therefore, ArcTerra can not give any estimate of how long a system will function satisfactory for current or future occupants or can ArcTerra guarantee that no unseen encroachments, deficiencies or discrepancies exist. �i COSA Checklist -June 2022 49 Di KENNE F 51 t' AN Lc i Lot 11 S 89'42'52 10' UTILITY EASEMENTS —CHAIN—LINK FENCE (NOT SURVEYED; LOCATION APPROXIMATE) 19' Lot 12 20,661 s.f. 30.0' PLOT PLAN AS BUILT X SCALE 1 " = 30' GRID SW 0055 Project No. 23-613& 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone Qo�pOO�� (907) 522-4625 Fax Professional Land Surveyors kenOlangsurvey.com 4 O F Q jonathanOlongsurvey.com ryanOlangsurvey.com ogg ••. .��� I hereby certify that I have surveyed the following described property: G' * .............. 49TH. . ........... .. LOT 12, CALKINS SUBDIVISION (PLAT No. 72-216} Anchorage Recording District. Alaska, and that the improvements situated thereon are 21 within the property lines and do not encroach onto the property adjacent thereto, that• • • • • • • • • • • • • .. G no Improvements on the property lying adjacent thereto encroach on the surveyed dA �, KENNETH LANG o G premises and that there are no roadways, transmission lines or other visible v�� `r "����� easements on said property except as indicated hereon. 0�`%i�'•.-520Z.••G� Dated this the Da of '� " V��A��SS10NAt " �� y "�-4F,� ��`.� � � ~ -� at Anchorage. Alaska 1��4��oa� It Is the responsibility of the owner to determine the existence of any easements, AECC963 covenants, or restrictions which do not appear on the recorded subdivision plat. SEPTIC PIPES V Z ' N ` 2 Q Lot 4 o o , , ria / o c°1n DECK fi 0 Q y6.3 Cirl 30.2' N � � � � � 1 STORY w. RESIDENCE 43.8 WITH DAYLIGHT ' BASEMENT 0 o W/ LOFT LA. '' ,a 317. Za 4.0' x 5.0' DECK N 89'42'52W 125.19' � Lot 5 I Lot 13 � 1 NOTE: DUE TO SNOW & ICE COVER SURFACE LEVEL FEATURES ARE APPROXIMATE. PLOT PLAN AS BUILT X SCALE 1 " = 30' GRID SW 0055 Project No. 23-613& 11500 Daryl Avenue, Anchorage, Alaska 99515-3049 Lang & Associates, inc. (907) 522-6476 Phone Qo�pOO�� (907) 522-4625 Fax Professional Land Surveyors kenOlangsurvey.com 4 O F Q jonathanOlongsurvey.com ryanOlangsurvey.com ogg ••. .��� I hereby certify that I have surveyed the following described property: G' * .............. 49TH. . ........... .. LOT 12, CALKINS SUBDIVISION (PLAT No. 72-216} Anchorage Recording District. Alaska, and that the improvements situated thereon are 21 within the property lines and do not encroach onto the property adjacent thereto, that• • • • • • • • • • • • • .. G no Improvements on the property lying adjacent thereto encroach on the surveyed dA �, KENNETH LANG o G premises and that there are no roadways, transmission lines or other visible v�� `r "����� easements on said property except as indicated hereon. 0�`%i�'•.-520Z.••G� Dated this the Da of '� " V��A��SS10NAt " �� y "�-4F,� ��`.� � � ~ -� at Anchorage. Alaska 1��4��oa� It Is the responsibility of the owner to determine the existence of any easements, AECC963 covenants, or restrictions which do not appear on the recorded subdivision plat. M UHMPA UTV OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT On -Site Water and Wastewater Section _ www.muni.org/onsite Septic Tank Advisory Certificate of On -Site Systems Approval # OSC231474 Subdivision: Calkins Block: , Lot: 12 907-343-7904 Fax: 343-7997 The septic tank for this property is 23 years old. The average life of an asphalt coated steel septic tank is 20 years. Typical replacement costs are $10,000 or more, not including engineering, surveying or MOA permitting fees. This advisory must be attached to all copies of the subject Certificate of On -Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. MUNICiPALiTY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 (907) 343~.744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILLY DWELLING o5o- 1,-OB .,,A# Parcel I.D. # 1. GENERAL INFORMATION Complete legal description CALKINS SUBDIVISION: LOT 12 Location (site address or directions) 10610 HIGH BLUFF DRIVE ANCHORAGE. AK 99577 Property owner JEFF AND CONNIE MUTCHMORE Dayphone (907) 922-9964 Mailing address 10610 HIGH BLUFF DRIVE ANCHORAGE. AK 99577 Lending agency. Day phone Mailing address Agent_JOSH MCKINNEY w/ RESIDENTIAL MORTGAGE Day phone (907) 222-8800 Address 1400 W, BENSON BLVD. ANCHORAGE. AK 99517 Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual well xxx Oommunity well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XXX Holding Tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC lng to the legality and status of system. 72~25 (Rev. 1/91) Front MOA #21 Computer Version Note: Alaska Wa~ or prior to, closir, 5. STATEMENT OF INSPE As certified by my seal a investigation of this Heal wastewater disposal sys1 structure indicated herei~ Anchorage files and frorr disposal system is in con on the date of this inspe¢ Name of Firm ALASK Address 6901 DEBARI Engineer's Signature In conducting this evaluation, system in accordance with ADEC performance of the system under measured to readily identifiable f~ on the local soils condition, grout usage of the family being served the evaluator of the system. Saris of the system, nor do they guarar AWWC, Inc. can therefore not prc system will continue to meet the The content of this report is for th reliance upon or use of this raper, nor will it confer any legal right wf 6. DHHS SIGNATURE ~ Approved for Disapproved Conditional ap Additional Comments ~~!~' .~ f;4 '. The Municipality of Anchorag, Approval Certificates based o professional engineer registe~ homes and their lending instit DHHS do not conduct inspeci Anchorage is not responsible ;r and Wastewater Consultants, Inc. shall be paid $2,320.00 at, for the engineering services provided. ~TION BY ENGINEER /xed hereto and as of the validation date shown below, I verify that my ~ Authority Approval application shows that the on-site water supply and/or ~m is safe, functional and adequate for the number of bedrooms and type of I further verify that based on the information obtained from the Municipality of I my investigation and inspection, the on-site water supply and/or wastewater phance w~th all Municipal a,r{d State codes, ordinances, and regular'ohs in effect t'on. .. W. AZ~& ¢/,~ST~'C~EI~CONSULTANTS, lNG. Phone (907)337-6179 / / Vt, *c/a~e¢¢ed to ~e a thorough, conscientious eng*eerinYanalysis of the ~nd MOA~DH~ Guidelines & Regulations. The repoRed results described the he conditions bncountered at the time of the test, and separation distances ~tures. The operational life of afl wells and septic systems depend I water levels that may fluctuate during the year, and the water y the system. These conditions are outside the control of ~cto~ test results do not guarantee future peffermance ee that there are no hidden defects or encroachments. /de any warran~ for future estimate of how long the ~erational requirements of the ADEC or MOA DHHS. sole benefit of the o~er listed above. ~y 5y any other person or pa~ is not authorized, itceever. bedrooms roval for bedrooms, with the following stipulations: Depadment of Health and Human Services (DHHS) issues Health Authority ly upon the representations given in paragraph 5 above by an independent ~d in the State of Alaska. The DHHS does this as a courtesy to purchasers of tions in order to satisfy certain federal and state requirements. Employees of )ns or analyze data before a certificate is issued. The Municipality of ~r errors or omissions in tbe professional engineer's work. 72-025 (Rev. 1/91) Sack MOA#21 Co~ )uter Version RECEIVED Municipality of Anchorage ~ DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division SEP 1 :[ Z00 825 "L" Street, Rm 502 Anchorage, Alaska 99501 (907) 343-4744 MUNICIPALITY OF ANCHORAGE Health Authority Approval Checklist ENVIRONMENTAL SEI~VICES DIVISION Legal Description: CALKINS SUBDIVISION; LOT 12 Parcel I.D.: 050-211-08 A. WELL DATA Well Type PRIVATE Date completed Cased to 400' YES Log present (Y/N) YES Total depth 400' Sanitary seal (Y/N) IfA, B, or C, attach ADEC letter. ADEC water system number 3/3/76 Casing height (above ground). Wires properly protected (Y/N) 18"+ YES Date of test FROM WELL LOG 3/3/76 AT INSPECTION *7/3/2000 Static water level 325' '315' Well production 5.6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 Nitrate Date of sample: 8/28/2000 *2.25 g.p.m. *WELL FLOW TEST PERFORMED BY S&:S ENGINEERING. SEE ATrATCHED WELL FLOW TEST DATA SHEETS. 0.5 mg/L Other bacteria 0 Collected by: A.W.W.C., iNC. B. SEPTIC/HOLDING TANK DATA Date installed 8/25/00-8/24/00 Tank size. Foundation cleanout (Y/N) YES -1250 Number of Compartments 2 Cleanouts (Y/N) Depression (Y/N). NO High water alarm (Y/N) YES Date of Pumping. NEW Pumper C. ABSORPTION FIELD DATA [NORTH/SOUTH] *BELOW FINAL GRADE Date installed 8/23/00-8/24/00 Soil rating (g.p.d,/ff2 or ft2/bdrm) 0.6 System type DEEP TRENCHES Length ~ (4-3'/42') Width 2.5' Grevel thickness below pipe 6.1'/5,7' Total depth *10.27-11.98 Effective absorption area 1003 SQ.F% Monitoring Tube present (Y/N) YES Depression over field (Y/N) NO Date of adequacy test NEW Results~(Pass/Fail). For ~ Fluid depth in absorption field before test (in.)~ added (in.): __ Fluid depth (ins~ Absorption rate = ~nt (past 12 months) (Y/N) If yes, give date 72-026 (Rev, 3/96)* Computer Version D. LIFT STATION : Date installed Manhole/Access, High water alarm level Size level at* .*Datum "Pump off' level at* E. SEPARATION DISTANCES SEPARATION DISTANCES F Septic/holding Absorption field on lot Public sewer main Sewer/septic service SEPARATION DISTANCES F 5'+ Water main/service SEPARATION DISTANCES F 10'+ Property linc Surface water Curtain drain 100'+ 100'+ 25'+ On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/eleanout N/A Lift station N/A TANK ON LOT TO: Property line 5'+ Surface water/drainage 100'+ Absorption field .Wells on adjacent lots 5'+ 100'+ ~g foundation 100'+ NONE KNOWN 10'+ Water main/service line 10'+ Driveway, parking/vehicle storage area 10% Wells on adjacent lots 100'+ F...GI....'S of Municlpal /'acoJ ~s/t~t/a[ tq~ with MOA H~ Signature .... EngineeCs Name ~ ~ JEF Date ~/7/ field inspections and review conformance ~t on this date. REY A. GARNESS HAA Fee $ Date of Payment Receipt Number 72.028 (Rev. 3/96) Computer Version Waiver Fee $ Date of Payment Receipt Number 09-01-00 08:50 FROM-CTE ENVIRONMENTAL Zt~.' CT&E Environmental Services Inc. 5615301 T-564 P.02/03 F-??6 CT&£ Ref,~ Client Name ProjeCt Client Sample LO Matrix PWS~ 1005032001 AK WaTer & WastcwaTer Consultaa~ i~c. ~nki~g W~er Client PrinTcfl Daterfimg 0g/31/2000 Collected DaTc~ime 0S/28/2000 10:45 Received Dat~ime 0g/29/2000 14:00 · Sumple R¢marks. . . % F..P300 NxtraTe; LCS 'was outsxde acccp~ce crgerm (86.8). All other QC rv.:t cRtena, Maa3x spike recovmred at 92.1 S~mplc value roay b= bias low. Allowabig prep R~ulLs PQL Um~S N]tTate-N 0500U M~hOd L~mlb Date.._. D~ Init 0.500 mg/L ~PA 300 O o8J29/00 SCL Total CohfoTm 0 col/100mI- SMI8 9222B 08129/00 ~tvlL EI,IOINEEItS WELL FLOW TEST DATA IzATE: WELL lIE P'I I h/1-'_ ~F'~ / I)AIE liRILLINO COI,4PLETEI]: 1EST L1AIA: METER pUMPING cLocl[ WA'rr-ll IFT) · -5,T:.:.-~', .w, Tz' WELL ¢,JRflEN ! LY I'I~OI)UCES ~-', I I1 FLow I'lA1 E NOT 6UARANTEED--6UBSEQUENT VARIKFION5 CAN OCt, UR. E§~'H £O/ZO'd tZ~-I NI~ IVI.LNHOISHH-I~ONH Fi¢'~':ZO O01~ZlUflV RECOVERY TEST DATA WELL WELL LOCATION (leg ~: //,~ . ~,g?_../~.,,.,/,.c ~'/ WELL D~TH: ~,,,: , WELL DRIVER, DATE DRILLED: ~ASIN; DEPTH= ~ "~' ROBEF~T G. GoWAN. P.E. ROBERTA.$HAFEFI, RE, CIVIL (907) 694,2~79 FAX [91:)7) 694-1211 ~EDURE: MISC DATA: ,, W-- I) Draw w=tel' down la pump. Casing Height: / / 2} Shut pump off t$,~0 min. S=~it;ry Se~l? ~, · ~ecerd lime Wires In conduit? ~ -reca~ meier leading Grading O.K.7 3) T~rn pump on. ~rawduwn. Pump Qepth: ~ ~ 4) Shut pump off. gamptes Taken? __ ~O - -recold time Date; -re.rd meier madl~g 5) CMeula~ gal./rain- recovery. ~ START TIME: / ~ STATIG WATER LEVEL: ~/.~ OFF OFF OFF ON OFF OFF ON OFF RESULTS: WELL CURRENTLY PRODUCES: FLOW RATE NOT GUARANTEED-SUB-~EC~'~'NT vAAiATIONS 'CAN OCCUR." 17034 ~ORTt I F_AGLE RIVER LOOP · SUITE 204 - EAGLE I~V~Ft. ALA$1~A ~57 ? TOTRL P. 04 NI~ IVliNBOIS3M~OHH ~d~:ZO O0-~Z-UH¥